Primary Root Canal Treatment Research Articles

Lasers efficacy in pain management after primary and secondary endodontic treatment: a systematic review and meta-analysis of randomized clinical trials

Postoperative pain is a common concern following root canal treatments (RCT), impacting both patients and oral health practitioners. This systematic review and meta-analysis aimed to evaluate the effectiveness of laser treatment modalities in reducing postoperative pain compared to conventional methods after primary and secondary RCT in permanent mature teeth. A search of three electronic databases (PubMed, ScienceDirect, and The Cochrane Library) was conducted, using a broad range of keywords and terms. Gray literature and manual searches were conducted to complement the search. The inclusion criteria included randomized clinical trials based on the objective of the secondary study. A minimum sample size of 10 participants per group and a clearly defined criterion for postoperative pain assessment were required. The characteristics of the included studies were presented as tables. The Cochrane collaboration tool RoB 2.0 was used to assess the risk of bias within each study. Two reviewers extracted the data and assessed the studies independently, and discrepancies were resolved through consultation with a third reviewer. A random-effects model was employed for meta-analysis to estimate the overall effect measure. Heterogeneity was evaluated using Cochran’s Q test and the I2 index. Publication bias was explored via Funnel plots and Egger’s test. Subgroup analyses and meta-regression were conducted to assess variations among laser methods and examine the influence of independent factors. The significance threshold for all analyses was set at 5% (α = 0.05). Intraoral laser therapy demonstrated no significant advantage over conventional treatments but consistently outperformed placebo, particularly from 4 to 72 h post-treatment. Low-level laser therapy provided slight pain reduction in the first 8 h, though its effectiveness diminished in retreatment scenarios. Photodynamic therapy and laser disinfection showed marginal benefits, especially shortly after treatment, with reduced efficacy in longer-term or retreatment contexts. Further research is needed to explore different applications of laser modalities and assess distinct prognostic factors in more detail.

Outcomes and prognostic factors of endodontically treated teeth filled with calcium silicate- or epoxy resin-based root canal sealers: A retrospective cohort study.

The objectives of this study were to compare the clinical outcomes of root canal treatment between calcium silicate-based sealer using the cold hydraulic condensation technique and epoxy resin-based sealer using warm vertical compaction and to identify the prognostic factors affecting the outcomes of both obturation techniques. Dental records and radiographs of the teeth that received root canal treatment with calcium silicate-based sealer using the cold hydraulic condensation technique or epoxy resin-based sealer using warm vertical compaction during 2015-2021 were selected using inclusion and exclusion criteria. The cases were matched between the two groups based on four factors: primary root canal treatment or retreatment, tooth type, periapical lesion and its size and extension of root canal filling. The success rates of root canal treatment between two sealers/obturation techniques were analysed. The incidence and resorption of extruded sealer were evaluated using the McNemar's test. Generalized estimated equations were used to evaluate any prognostic factors. The median recall period of this study was 15 months. A total of 234 teeth, comprising 117 cases in each sealer/obturation group, were included. No significant difference was found in the success rates between the calcium silicate-based sealer using the cold hydraulic condensation technique group (91.5%) and the epoxy resin-based sealer using the warm vertical compaction group (94.9%). The incidence of sealer extrusion for the calcium silicate-based sealer (27.6%) did not significantly differ from that of the epoxy resin-based sealer (36.2%), with both sealers typically demonstrating no resorption at recalls. No prognostic factors related to the success rate of either technique were detected. The study findings suggest no difference in the success rate between calcium silicate-based sealer and epoxy resin-based sealer. The study did not identify any prognostic factors that significantly influenced the outcomes of the endodontic treatments.

Does selective root canal retreatment preserve the tooth’s fracture resistance? An ex-vivo study

ObjectivesTo assess the tooth’s fracture resistance when submitted to a selective root canal retreatment compared to the conventional approach.Methods33 intact permanent mandibular first molars were selected according to specific criteria. After teeth mounting, the primary root canal treatment was conducted and followed by thermo-mechanical aging procedures to mimic a few clinical conditions. The specimens were randomly divided into three groups (n = 11); a control group in which intact teeth were used and two experimental groups according to the retreatment approach: conventional non-surgical retreatment (Conventional-NSR), and selective non-surgical retreatment (Selective-NSR). Later, the teeth were submitted to a final thermo-mechanical aging procedure and tested regarding their fracture resistance (static fracture test). The maximum load to fracture was recorded as were the types of failure modes (repairable or non-repairable fracture). A proper statistical analysis was conducted, considering a significance level of 5%.ResultsThe Conventional-NSR group showed a mean failure load of 867.7 ± 108.9 N while the Selective-NSR group had 1106.8 ± 159.8 N (P = 0.012). Both retreatment groups showed significantly lower results when compared to the control group. Additionally, the Conventional-NSR group showed higher proportions of non-repairable fractures (54.5%) when compared to both the Selective-NSR (36.4%) and control (18.2%) groups.ConclusionsSelective root canal retreatment preserved the tooth’s fracture resistance compared to the conventional retreatment approach.Clinical trial numberNon-applicable. Conducting the current experiment was limited to obtaining approval from the local Research Ethics Committee at the Faculty of Dentistry, Minia University (Committee No. 105, Registration No. 902, Date: 26/3/2024).

Clinician/Patient-Reported Outcomes and Their Association Following Root Canal Treatment

IntroductionThe relationship between clinician-reported outcome measures and patient-reported outcome measures after root canal treatment is poorly understood. Oral health–related quality of life (OHRQOL) is a crucial patient-reported outcome measure. Determination of the minimal important difference (MID) is critical for determining patients’ perspective of treatment effectiveness, but the MID required to perceive any meaningful change in the OHRQOL after root canal treatment remains unclear. The aim of this prospective study was to investigate the relationship between the clinical outcome and OHRQOL after root canal treatment and to determine the corresponding MID values. MethodsPatients (N = 64) requiring primary nonsurgical root canal treatment were recruited. Clinical and radiographic (cone-beam computed tomography) assessment of treatment outcomes was performed at the 12-month follow-up. OHRQOL and pain were evaluated preoperatively and at the 12-month follow-up using the Oral Health Impact Profile-14 and visual analog scale, respectively. P < .05 was considered statistically significant. MID was assessed using distribution- and anchor-based approaches. ResultsThe final analysis included 47 patients. The clinical outcome was favorable for 92.6% of teeth. OHRQOL and pain showed significant improvement after treatment (P < .001). No significant association was found between clinical outcome and OHRQOL (P > .05). The mean Oral Health Impact Profile-14 score change (ie, 13.6) was greater than the range of MID values determined. ConclusionsRoot canal treatment significantly improves OHRQOL. Improvement in the OHRQOL score was greater than the MID values determined, implying a clinically significant change. OHRQOL does not appear to be correlated with clinician-reported outcome measures.

Navigating endodontic outcomes through cone-beam computed tomography: A narrative review

Abstract Periapical radiographs (PRs) have been the most reliable modality for assessing periapical health. Later, the evolution of cone-beam computed tomography (CBCT) revolutionized three-dimensional maxillofacial skeletal imaging. CBCT imaging has emerged as a superior diagnostic tool compared to PR. The aim of this narrative review was to provide a comprehensive overview of the outcomes related to the use of CBCT in evaluating various endodontic treatments, including primary root canal treatments, secondary treatments, endodontic microsurgeries, and vital pulp therapies and the associated prognostic factors. The research selection process involved systematically searching PubMed, Scopus, and Web of Science for literature on CBCT and endodontics. Criteria included English-language; peer-reviewed articles published from January 2010 to December 2023, reporting 1-year outcomes of various endodontic treatments using CBCT. Two independent reviewers screened titles, abstracts, and full texts. A total of 18 outcome study articles utilizing CBCT to evaluate primary root canal treatment were selected, as well as 7 for secondary root canal retreatment, 3 for vital pulp therapy, and 11 articles pertaining to endodontic microsurgery. The outcomes revealed varying success rates and prognostic factors. Consistent with outcome research employing PRs, studies that utilized CBCT also exhibited substantial variability in factors affecting initial and secondary treatment outcomes. The rate of favorable outcomes was significantly lower when assessed with CBCT compared to PR. The results from utilizing CBCT for primary and secondary root canal treatments, endodontic microsurgeries, and vital pulp therapies demonstrate diverse success rates and prognostic factors in comparison to outcomes based solely on PRs.

Effect of Application of One-Time Method and Multiple Root Canals on Cryptic Fracture with Endodontic Lesions and VAS Score

Objective: To evaluate the therapeutic efficacy of primary method root canal treatment (ORCT) and multiple root canal treatment (MRCT) for dental cryptocleidosis with endodontic lesions. Methods: 88 patients with fissured teeth with endodontic lesions who were admitted to the hospital between November 2021 and November 2023 were selected, and after randomized numerical table grouping, 44 cases in the experimental group were included in the ORCT treatment, and 44 cases in the reference group were included in the MRCT treatment, and the total effective rate, root canal filling rate, visual analog scale (VAS) score, periodontal indexes, and the complication rate were compared. Results: The total effective rate and root canal filling rate of the experimental group were higher than that of the reference group; after treatment, the VAS score of the experimental group was lower than that of the reference group, and the periodontal indexes were lower than that of the reference group; and the complication rate of the experimental group was lower than that of the reference group (P &lt; 0.05). Conclusion: ORCT can improve the overall efficacy of patients with fissured teeth with endodontic lesions, ensure the filling rate of root canals, significantly reduce pain symptoms, improve a number of periodontal indicators, have high endodontic safety, and have more therapeutic advantages than MRCT.

Comparision of interleukin-1β concentrations in posttreatment endodontic disease and other pulpal and periapical conditions - A clinical study.

To evaluate interleukin (IL)-1β concentrations in periapical tissue fluid (PTF) in persistent apical periodontitis requiring endodontic retreatment and to compare the levels of IL-1β with chronic apical periodontitis, symptomatic irreversible pulpitis (SIP), normal pulpal, and periapical tissues. The patients were selected based on inclusion and exclusion criteria and divided into 4 groups based on the pulpal and periapical status: Posttreatment endodontic diseases (PTED): Teeth with PTED due to failed primary root canal treatment having periapical radiolucency. PNAP: Teeth requiring root canal treatment due to pulpal necrosis having periapical radiolucency. SIP: Teeth with symptoms of SIP with healthy periapical tissues). Intentional root canal treatment (IRCT): Teeth requiring IRCT (healthy pulp and periapical tissues). The access cavity was redefined and the preexisting filling was removed using H-files. The root canals were minimally enlarged followed by collection of PTF using paper points, in the case of group PTED. For groups PNAP, SIP, and IRCT, conventional access cavity preparation was done followed by enlargement of canals till 20, 0.02. PTF was collected using 15, 0.02 size absorbent points 2 mm beyond the apex. Levels of IL-1β was assessed by enzyme-linked immunosorbent assay. A statistically significant difference was seen in levels of IL-1β in all the groups. The highest concentration was seen in group PTED (85.07 ± 11.57 pg/mL) followed by group PNAP (37.60 ± 10.94 pg/mL), group SIP (8.40 ± 1.99 pg/mL), and the least was seen in group IRCT (3.47 ± 1.36 pg/mL). The levels of IL-1β were highest in PETD cases followed by PNAP, SIP, and IRCT. This indicates the severity of inflammation in PETD cases as compared to other endodontic diseases.

Impact of passive ultrasonic irrigation on the outcome of non-surgical root canal treatment: a systematic review and meta-analysis of randomized clinical trials.

This systematic review aimed to assess the impact of Passive Ultrasonic Irrigation on the periapical healing rate of primary root canal treatment compared to conventional syringe irrigation. Registered a priori in the PROSPERO database, this review was conducted by two independent reviewers who performed an electronic search up to December 2023. The search included databases such as MEDLINE (PubMed), Scopus, Web of Science, Embase, LILACS, and the Cochrane Library, as well as grey literature. We included randomized clinical trials (RCTs) that focused on patients undergoing primary root canal treatments. The study compared intervention groups using PUI with control groups that did not use activation techniques. Periapical healing was assessed over follow-up periods of at least six months, utilizing either periapical radiographs or cone-beam computed tomography. To synthesize the findings, a meta-analysis and trial sequence analysis were conducted, employing the Relative Risk as the measure of effect, with a 95% confidence interval. The GRADE approach was utilized to assess the certainty of the evidence. The meta-analysis incorporated three RCTs, involving 474 patients (501 teeth). The analysis revealed that PUI led to a higher rate of periapical healing compared to CSI (Relative Risk: 1.10; 95% Confidence Interval: 1.01-1.21, I² = 0%), with moderate certainty of evidence. Despite the limited number of high-quality RCTs, the findings showed a positive impact of PUI on periapical healing rates in primary root canal treatments, in comparison to CSI. CRD42021290894.

Oral health-related quality of life and perceptions of patients following primary root canal treatment or non-surgical retreatment.

This retrospective cohort study compared the effect of primary root canal treatment (RCT) with root canal retreatment (Re-RCT) on patient-reported outcomes in Kuala Lumpur, Malaysia. Forty randomly selected adults participated (RCT n = 20; Re-RCT n = 20). The impact their dentition had on the Oral Health Impact Profile-14 (OHIP-14) was assessed by calculating the prevalence of oral health impact, and the severity score. Focus group discussions using a semi-structured guide were arranged through an online meeting platform. Qualitative content analysis identified common themes, and relevant quotes gathered. The impact on OHIP-14 was limited for both RCT and Re-RCT groups with no significant differences in the prevalence of oral health impact. Significant differences were found for functional limitation (RCT higher) and psychological discomfort (Re-RCT higher). Common themes from the discussions include the importance of retaining teeth, the significance of effective communication between clinicians and patients and that the respondents were satisfied with the treatment.

Outcomes of nonsurgical endodontic treatment under general anesthesia in special health care needs: An observational study

Background and aimThe alarming rise in the number of people with special health care needs (SHCNs) necessitates a paradigm shift in how to approach their oral health needs. General anesthesia (GA) is a valuable technique for facilitating dental procedures in patients with SHCNs who may not be able to tolerate treatment without it. The aim was to assess nonsurgical endodontic treatment and outcomes in patients with SHCNs performed under GA.MethodSeventy-eight permanent teeth in 33 patients who received nonsurgical endodontic treatment under GA were included between 2018 and 2022 in SHCNs hospital clinics. The demographic data, types of SHCNs, pulpal and periapical diagnosis, type of treatment, and material used were analyzed. All patients were recalled for clinical and radiographic examinations. Pre-treatment and recall periapical radiographs were evaluated and scored using the Periapical Index (PAI).ResultsAutism and Attention deficit hyperactivity disorder were 39.4% of patients treated. Most treatments delivered were primary nonsurgical root canal treatment (95%). Warm vertical compaction of gutta-percha for obturation accounted for 88% of cases treated. Single cone obturation technique was used in 9 cases (12%) utilizing tricalcium silicate sealer. At the recall visits, 98.7% of teeth treated had survived. Twelve teeth have pre-treatment periapical lesions, and all healed except one. Female patients were found to have higher scores of PAI compared to male patients (23.7% vs 7.5%), yet insignificant. Only 10 patients with nonsurgical root canal treatment reported recurrent caries.ConclusionThis study demonstrates a high survival rate for nonsurgical endodontic treatment performed under GA in a cohort of patients with SHCNs. Interestingly, patients with social and communication disorders received the highest proportion of treatments under GA. These findings highlight the potential of GA-facilitated endodontics for this population. However, further research is warranted to explore additional methods for optimizing oral health outcomes in SHCNs.

The trend of radiographic healing after root canal treatment in teeth with apical periodontitis based on cone-beam computed tomography: A 4-year longitudinal study

ObjectivesThe aim of this study was to observe the radiographic healing of periapical lesions after root canal treatment via volumetric measurements based on cone-beam computed tomography (CBCT) over 4 years. MethodsIn total, 162 single-root teeth from patients with chronic periapical periodontitis who underwent primary root canal treatment were included in this retrospective study. Follow-up visits were scheduled at 1, 2, and 4 years after treatment. The volume of radiolucency at pretreatment and follow-up were measured, and the radiographic outcomes were classified into 4 categories: absence, reduction, uncertain or enlargement. Reduction or enlargement was considered when the volumetric change in radiolucency was 20 % or more. ResultsDuring the 4-year follow-up period, 128 teeth were reviewed at least once, including 3 extracted teeth. Of the remaining 125 teeth, the volume of radiolucency was reduced in 116 teeth (90.6 %), uncertain in 5, and enlarged in 4 teeth during 1 to 4 years after treatment. Among the 43 teeth with reduced radiolucency at 1 year after treatment, 42 (97.7 %) had continuing reduced lesions at 4 years. In the 2 teeth with enlarged radiolucency at 1 year, the volume of radiolucency doubled at 4 years. Cox regression analysis revealed that the preoperative radiolucency size was a risk factor for persistent periapical radiolucency. ConclusionsThe efficacy of root canal treatment for apical periodontitis was predictable. When the radiolucency changed by 20 % or more in volume on CBCT scans at 1 year after treatment, reversal of the radiographic healing tendency was rare. Clinical significanceThe volumetric changes in radiolucency on CBCT could reflect trends in the healing process and may foster early clinical decision-making.

Interventions in root‐filled teeth identified in general dental practice: A 6‐year longitudinal observational study

AbstractAimTo investigate what happens to cross‐sectionally identified root‐filled teeth over a 6‐year period, regardless of the time that elapsed since primary root canal treatment, in a cohort of adult patients regularly attending a Public Dental Service. A secondary aim was to investigate how the cumulative events affecting root‐filled teeth over the same time were associated with variables obtained from a baseline examination.MethodologyAdult patients with ≥1 previously root‐filled tooth and regularly attending the Public Dental Service in Örebro County were enrolled for study participation in 2015. General dental practitioners examined all identified root‐filled teeth in this cohort at baseline using a standardized protocol and were also responsible for further decision‐making and treatments. After six years, information on events of the root‐filled teeth was collected from dental records. The highest rating (most invasive treatment) on a 5‐point ordinal scale was used in the analyses. Regression analyses with stepwise selection were performed for associations between patient‐ and tooth‐related factors and events.ResultsA total of 445 patients with 1007 root‐filled teeth were followed the entire observation time. Twenty (2.0%) of the root‐filled teeth had endodontic retreatment and 150 (14.9%) were extracted over six years. Among teeth with periapical radiolucency or pain, the majority did not undergo retreatment or extraction; however, the multivariate analysis demonstrated that retreatment or extraction was associated with baseline recordings of teeth with periapical radiolucency (p &lt; .0001), tenderness to percussion (p &lt; .0001), and poor coronal restoration (p &lt; .0001).ConclusionsThis study corroborates the notion that in general dentistry, root‐filled teeth with radiological signs of apical disease often remain untreated over time. Furthermore, it also reveals that root‐filled teeth presenting with mild pain do not necessarily receive any intervention. However, teeth with baseline signs of apical periodontitis, pain, or inadequate coronal restoration were more likely to have received intervention during the six‐year period.

Predicting early endodontic treatment failure following primary root canal treatment

BackgroundUnderstanding when and why endodontic treatments fail could help clinicians make prognoses and thus improve treatment outcomes. This study was aimed to assess potential predictors of early endodontic treatment failure. We explored factors contributing to the failure of initial root canal treatment were explored, with a specific emphasis on evaluating the influence of the time elapsed since the initial treatment.MethodsThis retrospective cohort study enrolled 1262 patients who sought endodontic treatment at our department and 175 patients were included for analysis. Potential causes of endodontic treatment failure were investigated, such as inadequate obturation quality, inadequate coronal status, the presence of additional untreated canals, anatomical complexity, instrument separation, iatrogenic perforation, cracks, and endodontic-periodontal lesions. The patients were divided into “short-term” and “long-term” groups depending on the time that had passed since the initial treatment (i.e., < 5 and > 10 years, respectively). The causes of failure in the short-term and long-term group were analyzed and compared using logistic regression analyses. Subgroup analysis was performed according to the number of years since the initial treatment in the short-term group to further investigate the association between the time and cause of failure (i.e., < 1, 2, 3, and 4 years, respectively).ResultsUntreated additional canals were present in 21.7% of all cases, and in 36.9 and 6.4% of cases in the short-term and long-term groups, respectively. Multivariable analysis showed that the presence of untreated additional canals was significantly associated with short-term compared to long-term failure. Untreated additional canals were also associated with endodontic failure within 1, 2, 3, and 4 years.ConclusionsThe presence of untreated additional canals was a predictor of endodontic failure within 5 years following initial root canal treatment. To optimize long-term prognosis, it is important to detect and treat all root canals during the initial treatment.

Factors associated with the outcome of root canal treatment-A cohort study conducted in a private practice.

To investigate the association of various pre-, intra- and post-operative factors on root canal treatment outcome. In this cohort study, primary or secondary root canal treatment of mature permanent teeth was performed by a single endodontist in a private practice over 13 years, and followed 1-4 years after treatment. Treatment details and clinical and radiographic data were collected. The proportion of successfully treated teeth and roots based on strict radiographic (periapical index (PAI) ≤2) and clinical criteria (absence of pain, swelling or sinus tract) was estimated. To evaluate joint associations of prognostic factors and treatment success probability, 44 pre, intra- and post-operative factors were investigated using bivariate associations, and a multiple logistic regression model was fitted using Generalized Estimating Equations. 1259 teeth (2445 roots, 3149 canals) were assessed with a recall rate of 91%. The proportion of successfully treated teeth was 79.9% [95% confidence interval 77.7-82.1]. Eleven prognostic factors were identified that significantly reduced the odds ratio (OR) for treatment success at tooth level. Six were preoperative: injury history (OR = 0.05[0.01-0.24]), root PAI (OR = 0.29[0.20-0.42], 0.21[0.13-0.34] and 0.22[0.12-0.42] for PAI = 3, 4 and 5, respectively, against PAI = 1), lesion diameter (OR = 0.30[0.21-0.43] and 0.24[0.16-0.37] for diameters of 1-5 mm and ≥6 mm, respectively, against no lesion), tooth type (OR = 0.51[0.27-0.97] and OR = 0.45[0.24-0.83] for premolars and molars, respectively, against incisors or canines), tenderness to periapical palpation (OR = 0.64[0.43-0.94]) and two canals per root (OR = 0.67[0.54-0.83]). Four factors were intraoperative: root filling of unsatisfactory quality (OR = 0.18[0.08-0.40]) or extending beyond or shorter than 2 mm from the apex (OR = 0.44[0.26-0.75] and 0.62[0.40-0.97] respectively), resin sealer (OR = 0.58[0.39-0.87] against bioceramic sealer) and single visit treatment (OR = 0.40[0.21-0.75] against multiple visits). One factor was post-operative: defective coronal restoration (OR = 0.35[0.21-0.56]). The following factors were associated with unsuccessful root canal treatment: (i) history of injury, apical periodontitis with increased severity (larger lesion, higher PAI, tenderness to periapical palpation), or complicated anatomic conditions (premolar or molar, two canals in a single root); (ii) technically suboptimal root filling (of unsatisfactory quality or not ending within 2 mm of radiographic apex) performed in a single-visit, or use of resin sealer instead of novel bioceramic sealer; (iii) suboptimal quality coronal restoration.

Mutational analysis of cytoplasmic domain of integrin subunit alpha-1 and its association with periapical wound healing after surgical endodontic treatment.

Numerous studies reported that the healing after surgical endodontic retreatment is influenced by multiple factors which include the genetic profile of the patient, epigenetics, and immune responses. The genes which are primarily responsible for the healing potential in different individuals are those which are involved in the regulation of the cytoskeleton and cellular adhesion which subsequently affects bone deposition and healing. Integrins are cell-surface molecules, possess a key role in the cytoskeleton and cellular adhesion. Integrin Subunit Alpha 1 (ITGA1) is one among the integrin family and helps in regulating the Epidermal Growth Factor receptor (EGFR) pathway, consequently affects proliferation and healing. The objectives of the study were to identify mutations in the cytoplasmic domain of Integrin Subunit Alpha 1 (ITGA1), to assess the expression of activated EGFR, EGFRPhospho and TC-PTP in the periapical wound and to correlate these mutations and expression patterns with periapical wound healing. Thirty-seven patients between ages 18-60 years reported chronic apical periodontitis of single-rooted anterior teeth with periapical radiolucency, equal or greater than 4 mm or periapical lesion in an open apex of single-rooted teeth due to trauma were included in the study from 01st June 2018 till 31st October 2019. Patients with persistent radiolucency after primary root canal treatment and endodontic retreatment were kept on follow-up for 3-4 months surgical endodontic treatment was performed in cases with persistent periapical lesions of 4mm or more in diameter. Periapical lesion sample was collected and used for (1) histo-pathological analysis after Hematoxylin & Eosin staining, (2) total DNA extraction for ITGA1 cytoplasmic domain mutational analysis and immunohistochemistry for EGFR and TCPTP. A positive correlation was observed between the expression levels of EGFRPhospho and the healing of periapical lesions. Moreover, a negative weak correlation was observed between the expression levels of EGFR and TCPTP and the healing of periapical lesions. Out of nine sequences of cytoplasmic domain of ITGA1 which were analyzed, none of them was detected with SNP. Higher expression levels of EGFRPhospho and lower expression levels of EGFR and TCPTP were associated with patients with good healing potential in periapical area. However, immunohistochemistry scores were statistically insignificant to draw any conclusion.

Evaluation of Mechanical Versus Manual Root Canal Preparation in Primary Molars-A Comparative In Vitro Study.

The endodontic treatment of primary teeth is to maintain the function of the tooth free of symptoms until its physiological exfoliation. A critical factor for success is how quickly and effectively the root canal preparation can be performed. Therefore, the aim of this comparative in vitro study was to analyze the efficiency of two mechanical root canal preparation systems FM (FlexMaster) and HF (HyFlex EDM) to manual KF (K-file) on extracted primary molars. A total of 45 teeth were divided into three groups (n = 15): KF (#15-35), FM (04#30) and HF (25/~ OneFile). Root canal preparation was performed, and the preparation time was measured. All root canals were non-destructively analyzed by micro-computed tomography in the cervical, middle and apical thirds before and after preparation with regard to the parameters of canal transport (in μm) and centering ratio (0-1). Statistical analysis was performed at a 5% significance level using non-parametric tests. HF caused the lowest canal transport in the apical third (p = 0.008). The centering ratio value of HF was significantly higher in the middle third of the root canals than in the other two groups (p < 0.01). The mean instrumentation time was significantly higher for KF (6.67 min) than for FM (4.69 min) and HF (4.03 min, p < 0.01). HF can be recommended for primary molar root canal treatment.

Disinfection Efficacy of Laser Activation on Different Forms and Concentrations of Sodium Hypochlorite Root Canal Irrigant against Enterococcus faecalis in Primary Teeth.

Photoactivated disinfection with sodium hypochlorite (NaOCl) has improved primary root canal treatment outcomes. This in vitro study aims to assess and compare the disinfecting efficacy of 2.5% sodium hypochlorite solution and 5.25% sodium hypochlorite gel, without laser activation and accompanied by laser activation, on Enterococcus faecalis-contaminated primary teeth root canals. After one month of incubating extracted teeth specimens with E. faecalis, 36 specimens were randomly divided into two groups: Group A (conventional method without laser-activated irrigation) and Group B (with laser-activated irrigation). Each group was further divided into three subgroups, with six samples in each subgroup. Subgroup 1 received irrigation with normal saline, Subgroup 2 with 2.5% sodium hypochlorite solution, and Subgroup 3 with 5.25% sodium hypochlorite gel. Diode laser activation at 810 nm was used in Group B. Bacterial colony counts were measured before and after the intervention. Student's t-test and one-way analysis of variance (ANOVA) with Tukey's post hoc test were used for statistical analysis. The significance level was set at p < 0.05. Microbial analysis revealed no bacterial growth in samples irrigated with 5.25% sodium hypochlorite gel activated with the laser. Activation with the laser significantly (p = 0.02) improved the disinfection ability of the irrigant compared to the non-activation group. The disinfection ability of sodium hypochlorite gel was better than that of saline (p = 0.02); however, it was comparable to that of sodium hypochlorite solution (p = 0.67). Conclusion: Root canal irrigation with 5.25% sodium hypochlorite gel activated with an 810 nm diode laser resulted in complete eradication of Enterococcus faecalis, indicating its effectiveness as an endodontic disinfection treatment modality.

The effect of various file systems on postoperative pain in primary Tooth Root Canal treatments: A randomized controlled clinical trial

Objective: All root canal preparation techniques can potentially result in debris protruding apically, leading to postoperative pain. This study aimed to assess the effects of different file systems on postoperative pain in root canal treatments performed on primary molar teeth. Material and Methods: The study included 100 patients aged 5-8 years. NiTi K-type hand files (NTK), rotary file systems ProTaper Next (PTN), AF Baby (AFB), EndoArt Niti Pedo Gold (EAN), and reciprocal file system WaveOne Gold (WOG) were employed in the canal treatment of mandibular primary molars. Postoperative pain was assessed using the Visual Analog Scale (VAS) at the 6th, 12th, 18th, 24th, 48th, 72nd hour, and 1st week following treatment, and the collected data were evaluated statistically. Results: When considering time as a factor, the postoperative pain values among the groups were compared using the Kruskal-Wallis H test, and no statistically significant differences were observed (p = 0.007). In numerical terms, the group using NTK, EAN, AFB, and PTN exhibited the highest average postoperative pain, while the group using WOG, a reciprocal system, had the lowest pain. Conclusion: In conclusion, the choice of file used impacts postoperative pain. There was no statistically significant difference in time-independent postoperative pain values between rotary files designed for primary teeth and those intended for permanent teeth. However, using files specifically designed for primary teeth is recommended, considering factors such as working comfort and suitability for working length.

Re-endodontic Treatment. Part 2: How?

Where primary root canal treatment has failed, case selection is critical. If the reason for failure can be identified and overcome, then this is the main aim of re-treatment. The second of this two-part series discusses ways in which failed cases can be predictably re-treated, using a series of cases to illustrate key points. CPD/Clinical Relevance: Root canal re-treatment can offer a predictable treatment option with awareness of common pitfalls..

Deciphering Pediatric Root Canal Practices in Turkey: A Comparative Study Bridging the Gap between Practice and Literature.

BACKGROUND Pediatric endodontics is a critical area of dental practice, involving the treatment of root canals in primary teeth. Treatment approaches can significantly vary due to a range of factors, potentially impacting the success of the procedure and patient comfort. This variability, often influenced by regional practices, individual dentist preferences, and the pace of dental technology advancements, warrants detailed examination to improve standardization and care outcomes. Accordingly, our study aims to scrutinize the endodontic practices of pedodontists in Turkey and compare them with contemporary literature. MATERIAL AND METHODS We conducted an online survey with 15 questions that 217 Turkish pedodontists answered. The questionnaire sought information about their preferences in canal length measurement, canal sealer, irrigation solution, and other procedural decisions. Chi-square test was used to analyze the responses, with a significance level of p<0.05. RESULTS The majority of respondents were associated with universities (123 out of 217). 103 preferred rotary file sets, and 114 used apex locators for canal length measurement. Iodoform pastes (160) and sodium hypochlorite (180) were the most popular choices for canal sealers and irrigation solution, respectively. 152 participants did not prefer using rubber dam, and 186 did not favor sonic-ultrasonic activators. Many reported using hand files as students (184), with 39 continuing this practice. Post-graduation, 64 participants took root canal treatment courses, while 72 were reluctant to perform the procedure under general anesthesia. CONCLUSIONS No single method stood out as superior for primary root canal treatments in deciduous teeth. Incorporating advanced technology into dental practice may potentially improve treatment success and patient comfort.