Endodontic Treatment Research Articles

Intracoronal whitening in teeth with root canal treatment

Intracoronal whitening in teeth with root canal treatment

Injection of clorhexidine accidentally during root canal treatment

Injection of clorhexidine accidentally during root canal treatment

The Management of Root Perforation: A Review of the Literature.

Root canal perforation is defined as an opening or communication of the root to the outer oral tissue that occurs either accidentally during root canal therapy or due to unknown pathological causes, which generally result in complications in patientsdue to the passage of microorganisms to the surrounding tissues. These complications may necessitate extraction of the affected tooth. In this literature review, 42 articles were reviewed initially; 33 of them were included in the final analysis based on exclusion and inclusion criteria. Root perforation may occur due to caries, external and internal resorption, trauma, as well as iatrogenic causes. Many studies have suggested that perforation can be identified by radiographs, unexpected bleeding and pain during instrumentation, blood on paper points, electronic apex locator, and dental operating microscope. Several materials have been used in endodontic perforation repairs, such as indium foil, super 2-ethoxybenzoic acid (super EBA), as well as bioceramic materials like mineral trioxide aggregate (MTA) and biodentine. These materials must achieve biocompatibility, bacteriostatic ability, and radio-opacity. Many studies have reported the superior properties of MTA in comparison with other materials. Based on our literature review, management of root perforation should be performed based on multiple significant factors. Clinicians must possess a comprehensive understanding of tooth anatomy to prevent perforation occurrence. Furthermore, clinical management and prognosis of root perforation have been enhanced by the availability of advanced materials and sealing techniques.

Prevalence of Decay and Tooth Condition Changes Adjacent to Restored Dental Implants: A Retrospective Radiographic Study.

This study examined the association between a dental implant and changes in adjacent teeth over time. Electronic health records of 1818 patients who received a dental implant were retrospectively evaluated over 14 years (2005-2019) in a university setting. The status of the adjacent tooth and vertical and horizontal distance from the implant platform to adjacent teeth were determined using digital intraoral radiographs taken at baseline and the last follow-up visit (1-14 years, median 4 years). In total, 1085 dental implants were evaluated. There were 234 instances of a change in the adjacent tooth. Decay was observed in 83 (7.6%) of adjacent teeth; the mean time to development was 4 years (range 1-14 years). Approximately 9% of adjacent teeth received direct restorations, 4.8% received indirect restorations, 1% received endodontic root canal treatment, and 5.6% were extracted. The mean horizontal distance between the implant platform and the adjacent teeth was 3.56 mm; the mean vertical distance from the contact point to the alveolar crest on the tooth side was 6.2 mm at the first time of the reported decay on X ray. These distances did not significantly influence the occurrence of caries. The prevalence of interproximal contact loss was higher on the mesial of the implant crown at 63% compared with 20% on the distal side. This large retrospective analysis identified that teeth adjacent to a dental implant were at risk of decay and changes in their condition. In addition, the implant-to-tooth distance and inadequate emergence profile may contribute as caries risk factors in addition to hygiene and a high sugar level diet. These findings appear essential for clinicians when making treatment decisions and discussing outcomes with patients.

Endodontic Treatment in Calcified Root Canals and Long-Term Follow-Ups

Endodontic Treatment in Calcified Root Canals and Long-Term Follow-Ups

The treatment of Enterococcus faecalis related root canal biofilms with phage therapy

As one of the global concerns, antimicrobial resistance crisis increases the clinical importance of Enterococcus species. Enterococcus faecalis (E. faecalis) specifically penetrates the dentinal tubules and remains prevalent even after endodontic treatment. It has also biofilm forming character as well as the development of resistance to antibiotics. Sodium hypochlorite (NaOCl) is considered the gold standard among antibacterial washing solutions. However, due to its toxic effects, its usage limitations have led to the search for natural, non-toxic alternatives. Phages can be considered an important alternative because of their effects on specific bacteria. The objective of this study was to compare the effect of isolated active vB_Ef1 phage on the removal of E. faecalis biofilm in dentin, together and separately with the chemical irrigation solution NaOCl. As a result of study, the optimal NaOCl solution concentration to be applied with vB_Ef1 phage is 0.5 %, and the use of solution at this value reduces the biofilm mass by 84 %, reaching the highest biofilm mass reduction value. It was found that the combination of phage and NaOCl at appropriate concentrations had the strongest biofilm disruption effect.

Sodium Hypochlorite Accidents in Endodontic Practice: Clinical Evidence and State of the Art.

Sodium hypochlorite (NaOCl) is widely utilized in endodontics for its effective antimicrobial properties and ability to dissolve necrotic tissues. However, its use is not devoid of risks, including potential severe tissue damage and chemical burns. This systematic review evaluates the documented risks of using NaOCl in endodontic treatments. It compares its safety and efficacy with other endodontic irrigants, such as EDTA and chlorhexidine. This review followed the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines and registered with PROSPERO. Comprehensive searches were performed in PubMed, Scopus, Web of Science, and CENTRAL databases, with additional hand searches in grey literature. Studies were selected reporting adverse effects related to NaOCl used in endodontic procedures, ranging from randomized controlled trials to case reports. Data extraction and risk of bias assessment were systematically performed using standardized tools. Seventeen studies were included, detailing instances from chemical burns to severe allergic reactions and tissue necrosis associated with NaOCl use. The risk of bias was predominantly low across the studies. Sodium hypochlorite demonstrated a higher efficacy in microbial eradication and tissue dissolution than other irrigants, though it also showed a higher incidence of severe complications when mishandled. Sodium hypochlorite remains a cornerstone in endodontic disinfection due to its potent antimicrobial and tissue dissolution properties. However, its application must be meticulously managed to prevent complications. Future research should focus on optimizing concentrations and application techniques to enhance safety and effectiveness, potentially integrating safer alternatives or complementary solutions like EDTA to mitigate risks while preserving irrigant benefits.

Precision in endodontic therapy by novel-guided approach

Abstract Guided endodontics has proven effective in treating pulp canal obliteration (PCO). However, challenges arise when dealing with limited vertical space, particularly in cases where long burs and guides are necessary. In this case report, we introduce a novel approach utilizing a sleeveless three-dimensional (3D)-printed guide, aimed at overcoming vertical space constraints while maintaining visibility and irrigation during drilling. A 22-year-old male patient presented with intermittent pain around tooth #21, diagnosed with pulp necrosis and symptomatic apical periodontitis. Employing the sleeveless 3D-printed guide alongside a long neck carbide bur, we achieved a minimally invasive access cavity up to the root canal. This technique presents a promising alternative to conventional guided endodontic approaches, particularly beneficial in cases of PCO.

Analysis on the relationship between Schneiderian membrane thickening in the posterior maxillary region and periapical lesions by cone beam computed tomography.

This study aimed to evaluate the thickening of sinus membrane, which is also named Schneiderian membrane (SM), in patients and its relationship with periapical lesions (PAL) in the posterior maxillary region to provide reference for the prevention and treatment of odontogenic maxillary sinusitis. A retrospective analysis was conducted on 554 cone beam computed tomography (CBCT) imaging data of maxillary sinuses from 301 patients who met the inclusion criteria to determine the correlation between PAL and SM thickening in the posterior maxillary region. Cases of pathological SM were recorded and classified on the basis of the degree and type of SM thickening. The correlation between SM thickening and the diameter of PAL, the relationship between the upper edge of PAL and the maxillary sinus floor, and its relationship with whether affected teeth with PAL undergo root canal treatment were evaluated. The detection rate of SM thickening in patients with PAL was significantly higher than in those without PAL, so PAL was correlated with SM thickening. Analysis on the correlation between PAL detection indicators and SM thickening degree showed that SM thickening degree was positively correlated with PAL diameter (cone beam computed tomography-periapical index) and not correlated with the three spread effects between the upper edge of PAL and the maxillary sinus floor, as well as whether the teeth with PAL undergo root canal treatment. The correlation analysis between PAL detection indicators and SM thickening types showed that whether the teeth with PAL undergo root canal treatment was not correlated with SM thickening types, and the diameter of PAL, the three spread effects between the upper edge of PAL, and the maxillary sinus floor were not correlated with SM thickening types. The PAL of posterior maxillary teeth is closely related to SM thickening, and the diameter of PAL is positively correlated with the degree of SM thickening. Patients with PAL who have undergone root canal treatment often exhibit SM polyp thickening. In addition, the relationship between the upper edge of PAL and the maxillary sinus floor does not affect the possibility of SM development.

Comparative evaluation of wettability of AH plus, Ceraseal and Guttaflow bioseal root canal sealers on root canal dentin: An in vitro study

Abstract Context: Effective root canal treatment relies on the ability of sealers to wet and penetrate the root canal system, ensuring a tight seal and preventing bacterial leakage. The current study investigates the wetting ability of newer root canal sealers by evaluating their contact angle. Aim: The objective of the present study was to evaluate and compare the wetting behavior of Guttaflow bioseal, Ceraseal, and AH plus root canal sealers. Materials and Methods: Decoronation and apical third resections of thirty extracted singlerooted human mandibular premolars were done. The roots were then split longitudinally into two halves buccolingually. The root dentin surfaces were treated using 10 mL 3% sodium hypochlorite for 5 min, 10 mL of 17% ethylenediaminetetraacetic acid for 5 min, and 2% chlorhexidine for 10 min. Then, these sixty dentin bars were randomly divided into three groups (n = 20): Group 1 – AH Plus, Group 2 – Ceraseal, and Group 3 – Guttaflow bioseal. The controlled volume of 0.1 mL sealer has been dispensed onto the dentin specimen using a micropipette. The contact angle of a drop of sealer was measured after 5 min using Ossila goniometer. Statistical Analysis Used: The data were analyzed using one-way analysis of variance and Tukey post hoc tests. The statistical significance was at P < 0.05. Results: The mean contact angle values for AH Plus sealer were lower when compared to the other two sealer groups which is statistically highly significant. Conclusions: AH Plus showed lesser contact angle thereby better wettability than Ceraseal and Guttaflow bioseal on the root canal dentin surface.

Comparative Evaluation Of Retrievability Of Calcium Hydroxide From Apical Third Of Root Canal With Commercially Available Root Canal Irrigants: An InVitro Study

Context: Calcium hydroxide is the most widely used intracanal medicament to aid chemomechanical preparation to thoroughly clean the root canal system. However, it is important to completely remove the medicament for predictable success of the root canal treatment. Aim: This study was aimed to compare the effectiveness of irriganting solutions and irrigation methods to remove calcium hydroxide from the root canal system. Material and Methodology: Eighty extracted single rooted teeth were selected and instrumented using ProTaper Gold rotary files, followed by application of calcium hydroxide. After incubating for a week, teeth were randomly allocated into 8 groups (n=10) based on irrigating solution (17% EDTA, 1% Phytic Acid, 3% NaOCl, 70% Ethanol) and method of irrigation used (PUI and NAI). The sample teeth were then sectioned horizontally to assess the residual calcium hydroxide on the canal walls under Confocal Laser Scanning Microscope. Statistical analysis: The difference in the mean value of the two parameters was assessed by using analysis of variance (ANOVA). Tukey’s test was used for post hoc multiple comparisons between different groups. The level of significance was fixed at p<0.05. Results: None of the irrigants were able to completely remove the calcium hydroxide from the root canal. However, irrigation with 70% Ethanol presented significantly cleaner root canal walls in NAI. Conclusion: 70% Ethanol presented with least amount of residual calcium hydroxide in comparison with phytic acid and commercially available irrigants i.e., EDTA and NaOCl in both NAI and PUI.

Regenerative Endodontic Procedures With Minced Pulp Tissue Graft in Mature Permanent Teeth: A Clinical Study

IntroductionRegenerative endodontic procedures (REPs) using cell-based approaches have emerged as novel treatment modalities. This clinical study aimed to present the outcomes and explore factors influencing REPs with minced pulp tissue (MP) grafts in a mature tooth. MethodsSix healthy male patients aged 20–27 requiring nonsurgical root canal treatment were enrolled in this study. MP tissue obtained from third molars was introduced into the instrumented, disinfected, and blood-filled root canal. The canal was sealed with bioceramic cement, and the coronal access cavity was restored. ResultsFollow-ups for 6 cases ranged from 19 to 42 months. Radiographically, all the teeth showed favorable outcomes. Among the 6 teeth, 2 showed neither intracanal calcification nor recovery in sensibility tests, and one had no intracanal calcification with an inapplicable sensibility test evaluation. In 2 teeth, intracanal calcification was observed in the apical third; however, there was no recovery in the sensibility tests. One tooth exhibited intracanal calcification in the apical third and showed recovery in the sensibility tests. Considering these outcomes and clinical variables, the size of the apical foramen and the composition of the transplanted pulp tissue were identified as tentative influencing factors. ConclusionsThis study on simplified cell-based therapy using autologous MP for pulp/dentin regeneration in adult teeth not only enhances our understanding of REPs but also suggests its potential as an alternative treatment option to conventional endodontic treatment.

Partial root canal treatment retains root fractured tooth

Partial root canal treatment retains root fractured tooth

Patterns of Pulpal Mineralization in Mandibular Anteriors: A Micro-computed Tomography Analysis

IntroductionCurrent understanding of the morphology of pulpal mineralizations is limited. Understanding the specific location and type of such mineralizations will aid clinicians in diagnosis, case complexity assessment, and treatment planning. Therefore, this study correlated the appearance of a reduced canal volume (CV) in conventional radiographs with the presence of pulp mineralizations (PMs) utilizing micro-computed tomography (CT) analysis. The morphology of PMs utilizing micro-CT technology was also analyzed. MethodsOne hundred and twenty-one extracted permanent mandibular incisors were collected. Periapical radiographs were taken of the teeth to determine if a reduced canal space was present, in which case the sample was included for micro-CT assessment. Various descriptors for PM were then determined and these labels were then applied to the entire sample to demonstrate PM. Numerical analysis was undertaken for all teeth scanned; the following data was extracted: the presence or absence of PMs, types of PM, and their morphological structures; CVs were determined. Cohen's kappa test was used to assess intraexaminer agreement. ResultsBased on radiographic appearance, forty-two teeth were included for micro-CT analysis. PMs were demonstrable in 57% and absent 42% of teeth. When PMs were absent, the CV was significantly smaller (P < .05). Discrete mineralizations were more frequently located in the coronal and middle thirds compared to diffuse mineralization (P < .01). No differences in the prevalence of the individual features of discrete or diffuse mineralizations were detected (P > .05). ConclusionsTwo detectable forms of PMs were found in micro-CT analysis at all levels of the canal: discrete and diffuse mineralizations. A reduced CV on a PA was reflective of mineralized changes within the pulp but the type of PM could not be determined. PMs can occur at any level of the root canal; clinicians need to be aware of this when performing root canal treatment.

Clinical efficacy of minimally invasive root canal treatment

Clinical efficacy of minimally invasive root canal treatment

Effect of Ascorbic Acid as A Final Flush on Post Operative Pain After Single Visit Root Canal Treatment for Patients with Symptomatic Irreversible Pulpits Related to Mandibular Molars: Randomized Controlled Trial

Effect of Ascorbic Acid as A Final Flush on Post Operative Pain After Single Visit Root Canal Treatment for Patients with Symptomatic Irreversible Pulpits Related to Mandibular Molars: Randomized Controlled Trial

Non-Surgical Endodontic Management of Teeth with Aberrant Anatomy: A Case Series

The root canal therapy aims to remove the necrotic and vital pulp tissue remnants from the root canal to treat the periradicular inflammation. The knowledge of the tooth anatomy is essential to ensure a successful treatment. However, the deviation of the tooth anatomy complicates the diagnostic and treatment processes. Effective management of such complexities requires a tailored approach, utilizing detailed imaging and precise endodontic techniques to achieve successful outcomes and restore patient function and comfort. This case series presents the endodontic management of three different anatomic variations of permanent teeth that include taurodontism in the mandibular molar, two rooted mandibular canine and dilacerated maxillary central incisor and underscores the importance of personalized treatment planning and advanced diagnostic tools in managing complex dental anomalies.

Endodontic Treatment of Fused-Maxillary Molar with Supernumerary Tooth

Endodontic Treatment of Fused-Maxillary Molar with Supernumerary Tooth

Regenerative endodontic treatment with T-PRF after delayed trauma

Regenerative endodontic treatment with T-PRF after delayed trauma

Endodontic treatment a fused molar: A case report

Endodontic treatment a fused molar: A case report