The aim of this study was to evaluate the effect of different irrigation solutions used during root canal irrigation in root canal treatment on the microhardness of nickel-titanium (NiTi) files subjected to different heat treated. The pre-preparation microhardness levels of EndoArt Smart Blue and EndoArt Smart Gold (İnci Dental Productions Co, Istanbul, Turkey) file systems were measured at five different points using a microhardness testing device (HMV-2000; Shimadzu, Tokyo, Japan). Microhardness evaluation was performed on thirty-two 30.04 files from each file system. A total of 64 single-rooted and single-canaled mandibular incisor teeth were prepared up to size 30.04 using file systems. The preparation was completed with the irrigation solutions (5.25% NaOCl, 17% EDTA, ozonated water, and distilled water) for an average of 3 min with a 30.04 file. After preparation, the microhardness levels of the 30.04 files were again measured. The differences between the microhardness values were statistically compared. According to the obtained data, the pre-preparation measurement values were higher than the post-preparation values (p < 0.05). No statistically significant differences were found between the microhardness measurement values (p > 0.05). The highest and lowest microhardness changes were observed in the EndoArt Smart Blue file system, in the ozonated water (195.63 ± 71.04 VHN (Vickers Hardness Number)) and distilled water (152.88 ± 51.10 VHN) groups, respectively. In this study, different irrigation solutions did not have a statistically significant effect on the microhardness of heat-treated NiTi files.

INTRODUCTION. Evaluation of endodontic treatment outcomes through radiographic assessment is subject to interobserver variability and depends heavily on clinician experience. Artificial intelligence (AI) platforms offer potential for standardized, objective assessment of periapical healing. MATERIALS AND METHODS. This retrospective study analyzed 400 panoramic radiographs from patients who underwent root canal treatment between January 2023 and December 2024. An AI platform developed using TensorFlow and Keras, with model training in PyTorch and validation in MATLAB Deep Learning Toolbox, was employed. Three blinded expert endodontists independently assessed all radiographs, with consensus serving as the gold standard. Outcomes were classified as healed, healing, or diseased based on periapical index criteria. Diagnostic performance metrics including sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS. The AI platform demonstrated overall accuracy of 89.8% in classifying treatment outcomes. For detecting healed cases, sensitivity was 92.3%, specificity 87.6%, PPV 88.9%, and NPV 91.5%. For diseased / persistent pathology detection, sensitivity was 88.7%, specificity 93.2%, PPV 84.3%, and NPV 95.1%. Agreement between AI and expert consensus was substantial (Cohen’s κ = 0.834, p &lt; 0.001). AI performance was superior in anterior teeth (93.2% accuracy) compared to molars (86.4% accuracy, p = 0.008). Processing time per radiograph averaged 2.3 ± 0.4 seconds. CONCLUSIONS. The AI-driven platform demonstrated high diagnostic accuracy comparable to expert assessment, with potential for standardized, rapid evaluation of endodontic treatment outcomes. Further prospective validation and clinical integration studies are warranted.

Objective: To determine the anesthetic effectiveness of inferior alveolar nerve block with 2% lidocaine and inferior alveolar nerve block with 2% lidocaine supplemented with 4% articaine buccal infiltration for the mandibular molars in non-surgical root canal treatment with symptomatic irreversible pulpitis.Methods: This prospective interventional comparative single-blind study was conducted at PNS Shifa Hospital, Karachi. Based on the non-probability convenience sampling, 88 adults aged 18-52 years old, with irreversible pulpitis of vital mandibular molars diagnosed as spontaneous lingering pain with positive cold pulp test, were randomly allocated to either Group A, who received IANB with 2% lidocaine alone or Group B received IANB with 2% lidocaine supplemented with 4% articaine buccalinfiltration. Heft Parker VAS Scale was used to report pain levels during the endodontic treatment. SPSS 27.00 software version was used to analyze the data.Results: Mean age in Group A was 35.6 ± 9.16 years, while in Group B it was 32.9 ± 10.54 years. Mean VAS pain score in Group A was 3.3 ± 2.68 compared to 3.0 ± 2.39 in Group B. There were 20 (45.5%) males and 24 (54.5%) females in Group A, and 30 (68.2%) males and 14 (31.8%) females in Group B. Pain severity in Group-A was no Pain 6 (13.6%), Mild Pain 21 (47.7%), Moderate Pain 11 (25.0%), and Severe Pain 6 (13.6%); in Group-B, No Pain 5 (11.4%), Mild Pain 28 (63.6%), ModeratePain 6 (13.6%), and Severe Pain 5 (11.4%). Treatment effectiveness was achieved in 28 (63.6%) patients in Group A and 33 (75.0%) in Group B.Conclusion: The combined approach of IANB with 2% lidocaine supplemented with 4% articaine buccal infiltration had significantly improved the anesthetic success outcome as compared to the 2% lidocaine alone for IANB.

Root canal treatment is crucial for preventing oral diseases, and its success hinges on the effective removal of biofilm and debris from the canal wall by the irrigant. However, the intricate and narrow anatomy of root canals limits the efficacy of irrigant jet in the critical apical region, hindering fluid mixing and the removal of wall-adherent material. To address this, a passive self-exciting jet technique using a novel slot jet needle is proposed. This design aims to reorganize the flow and induce secondary jet self-excitation within the narrow cavity, thereby enhancing root canal irrigation effect. The influence of the slot angle and aperture diameter is first investigated, and the results show that the efficacy of jet coupling depends not only on the slot jet direction but also on the relative strength of the jets. The irrigation performance is optimal when the slot angle is 90 deg and the aperture diameter is 0.1 mm. Furthermore, the influence of the tapering angle is investigated using the principle of a tapering nozzle. Compared to the clinically common prototype 30 G needle, the optimized design increases the effective cleaning area by up to 20.82% and the extending depth by up to 50.79%, while reducing the mean apical pressure by up to 23.39%. These improvements demonstrate that the cleaning performance, mass exchange capability, and safety are improved simultaneously.

Abstract Aim: This ex vivo study aimed to assess the effect of preendodontic build-up (PEB) on irrigant penetration into dentinal tubules using confocal laser scanning microscopy (CLSM) and to compare two different PEB materials. Materials and Methods: Sixty-four extracted mandibular first premolars with single canals were standardized and randomly allocated into four groups ( n = 16): Group I – no PEB with syringe irrigation, Group II – no PEB with sonic activation, Group III – liquid rubber dam PEB with sonic activation, and Group IV – composite resin PEB with sonic activation. Root canals were prepared up to size 30/0.06 using rotary instruments. 5.25% NaOCl labeled with rhodamine B was used as the irrigant. Specimens were sectioned at coronal, middle, and apical levels and evaluated under CLSM to measure maximum irrigant penetration depth. Data were analyzed using Kruskal–Wallis and Friedman tests ( P ≤ 0.05). Results: Irrigant penetration was significantly greater in groups with PEB compared with those without PEB at all canal levels ( P &lt; 0.0001). Group IV demonstrated the highest penetration, particularly in the apical third. Conclusion: PEB significantly enhances irrigant penetration, especially in the apical third. Establishing an effective coronal reservoir, regardless of the build-up material used, improves irrigation efficacy.

Abstract Background: Missed root canals are a common cause of endodontic failure and are often related to complex root canal anatomy that cannot be adequately visualized using conventional radiography. Cone-beam computed tomography (CBCT) allows three-dimensional assessment and improves the detection of untreated canals. Aim: The aim of this study was to determine the prevalence of missed canals in endodontically treated mandibular first molars in a Central Indian population and to evaluate their association with extra roots. Materials and Methods: This retrospective cross-sectional study evaluated 400 CBCT scans of endodontically treated mandibular first molars obtained from government and private imaging centers in Central India. Canals appearing unfilled from the cementoenamel junction to the apex were recorded as missed canals. The presence of extra roots was also assessed. Data were analyzed using the Chi-square and Fisher’s exact tests, with statistical significance set at P &lt; 0.05. Results: Missed canals were detected in 88 teeth, representing a prevalence of 22.0%. Extra roots were identified in 15 (3.75%) teeth, of which 11 (73.3%) exhibited missed canals. Teeth with extra roots showed a significantly higher prevalence of missed canals compared to those without extra roots (73.3% vs. 20.0%; χ 2 = 20.92, P &lt; 0.001), with an 11-fold increased odds (odds ratio = 11.0). No significant association was observed between gender and missed canals ( P = 1.00). Conclusion: CBCT revealed a high prevalence of missed canals in mandibular first molars, with extra roots significantly increasing the risk. These findings emphasize the clinical value of CBCT in detecting anatomical complexities and preventing endodontic treatment failure.

Comparative analysis between resin-based root canal sealer and recent bioceramic-based root canal sealers using MicroCT, film thickness, and solubility.

The endodontic management of immature permanent teeth with open apices that subsequently become necrotic presents a significant clinical and research challenge. Such cases are problematic due to the difficulty in achieving effective disinfection, proper apical closure, and long-term sealing of the root canal system. Over the years, various treatment approaches have been introduced to address this issue and promote apical closure and repair. These include apexification with calcium hydroxide, the use of Mineral Trioxide Aggregate (MTA), and, more recently, the application of advanced bioceramic materials, which have shown promising outcomes in root-end modification. These modern bioceramics include MTA, Biodentine®, which is used in successful root-end procedures due to the benefits of biocompatibility, sealing ability, and bioactivity. Issues include the long setting times, sensitivity towards handling, and high costs. This paper also reviews the more traditional apexification techniques and newer approaches like pulp revascularisation and regeneration against modern bioceramic materials. While these materials have had encouraging results, more clinical trials are needed to evaluate their long-term effectiveness.

Abstract Aim: The aim of this study was to perform a two-dimensional (2D) and three-dimensional (3D) comparative evaluation of bone regeneration using autologous platelet-rich fibrin (PRF) versus calcium phosphosilicate-based bone putty in large periapical lesions before and after endodontic surgery. Materials and Methods: Fifty patients with a history of dental trauma and periapical pathology involving the maxillary and mandibular anterior and premolar tooth regions were randomly allocated into two groups, with 25 patients in each group. All patients underwent endodontic surgery following root canal treatment. Bony defects were managed with autologous PRF in Group I and bone putty in Group II. After a 1-year follow-up period, 2D healing was assessed using intraoral periapical radiographs (IOPARs), and area calculation was performed using ImageJ software. 3D healing was evaluated using cone-beam computed tomography (CBCT), and volumetric analysis was conducted using ITK-SNAP software. Results: Patients in Group II exhibited a significantly greater reduction in lesion volume (95.017% ±5.809%) and area (98.376% ± 2.916%) compared to those in Group I (volume reduction: 72.449% ± 14.264% and area reduction: 87.868% ± 11.048%). Bone healing assessed through CBCT and volumetric analysis using ITK-SNAP (83.733 ± 15.668%) was found to be more accurate than 2D area evaluation (93.122 ± 9.598) using IOPAR. Conclusion: Calcium phosphosilicate-based bone putty demonstrated significantly faster bone regeneration than PRF. CBCT-based volumetric assessment (3D) provides a more objective and accurate evaluation of bone healing than conventional IOPAR-based area assessment (2D) and may serve as a valuable tool for assessing treatment outcomes in complex endodontic surgeries.

Abstract Background: Complete disinfection of the root canal while preserving dentinal integrity remains a major challenge. Diode laser activation improves irrigant penetration yet its combined effect with novel irrigants Triton and Twin Kleen on dentin composition remains unclear. Aims: To compare the effect of Triton, Twin Kleen, and sodium hypochlorite (5.25% NaOCl) +ethylenediaminetetraacetic acid (17% EDTA) with and without diode laser activation on the radicular dentin composition. Materials and Methods: Eighty extracted human mandibular premolars were prepared and divided into four groups ( n = 20): Normal saline, Triton, Twin Kleen, and NaOCl + EDTA. Each group was further subdivided into diode laser-activated and nonactivated subgroups. Longitudinal dentin sections were analyzed using attenuated total reflectance Fourier-transform infrared spectroscopy to assess the root dentin inorganic and organic alterations. Statistical Analysis: Kruskal–Wallis and Mann–Whitney U tests ( P &lt; 0.05). Results: Among both laser and nonlaser activated groups, normal saline preserved the highest carbonate and amide peaks, followed by Triton and Twin Kleen and least in NaOCl + EDTA. Diode laser activation slightly decreased all FTIR ratios. Conclusion: Triton activated with and without diode laser, maintained dentin composition effectively, supporting its use as a single step irrigant in endodontic therapy.

Abstract Aim: To evaluate periapical healing following nonsurgical root canal treatment of large periapical lesions using three bioactive materials, assessed using cone-beam computed tomography (CBCT) at 6 months and 1 year. Materials and Methods: A total of 40 teeth were taken for this retrospective study with single or multirooted teeth and periapical pathology of 4–8 mm in diameter, present with preoperative and follow-up CBCT scans available. All the cases considered underwent endodontic treatment using one of three bioactive materials (mineral trioxide aggregate, Biodentine, and bioceramics). Assessment of healing was done based on radiographic CBCT scans and CBCT–periapical index (PAI) criteria. The teeth were divided into healing, healed, or diseased based on the changes in the CBCT-PAI score after 6 months and 1 year. All the data were recorded in a tabular form and sent for statistical analysis using Chi-square test, t-test, and Friedman’s test. Results: While there was a statistically significant difference in individual teeth after 6 months ( P = 0.01) and 1 year ( P = 0.004), with maxillary incisors showing the highest percentage of healing after 1 year (29.6%), no significant difference was seen between the use of the three bioactive materials after 6 months ( P = 0.97) or 1 year ( P = 0.78), respectively. There was no statistically significant difference in age-wise ( P = 0.27; 0.82) or gender-wise ( P = 0.82; 0.39) distribution. Conclusion: Among all the teeth assessed, single-rooted maxillary teeth showed the highest amount of healing. All three bioactive materials showed a favorable outcome for the treatment regardless of the material used. In addition, healing outcomes were not significantly influenced by patient age or gender.

Strip perforation repair is one of the most challenging treatments in endodontics. Marginal adaptation is a crucial factor in evaluating the sealing ability of materials. This study aimed to microscopically examine the marginal adaptation of bioceramic-based sealers, MTA-Angelus, and Cold Ceramic in repairing strip perforation areas. The mesiobuccal canals of 80 human mandibular first molars were prepared using rotary files and then divided into two groups (A and B, n = 40). All samples in group A were obturated using the lateral compaction technique with gutta-percha and AH-26 sealer. Then, strip perforation was created using Gates Glidden and piezo reamer drills. The samples were divided into subgroups (A1 and A2, n = 20). The strip perforations in groups A1 and A2 were repaired with MTA-Angelus and Cold Ceramic. Strip perforation in group B was formed in the mesiobuccal canals after root canal preparation and before obturation. Then, the samples were divided into B1 and B2 subgroups (n = 20) and filled with Sure-Seal Root and Endoseal MTA sealers, respectively. Afterward, obturation was completed using the single-cone technique with gutta-percha 0.04 taper. The marginal adaptation in the perforation area was measured in all the samples using a stereomicroscope with Dino-Lite Capture software. SPSS software was used to analyze the data using one-way analysis of variance (ANOVA) and the Kruskal-Wallis test. The greatest mean gap length was observed in the Endoseal MTA group (0.116 ± 0.203), followed by the Sure-Seal Root (0.097 ± 0.215), MTA-Angelus (0.083 ± 0.225), and Cold Ceramic (0.016 ± 0.052) groups. The mean gap length between the groups was not significantly different (p = 0.375). This study's results indicate a comparable marginal adaptation for Endoseal MTA, Sure-Seal Root, and Cold Ceramic to MTA-Angelus.

Abstract Context: The role of Root canal sealers is a very crucial role in endodontic therapy by forming a hermetic seal within the canal, filling minor voids between the dentinal wall and gutta-percha to prevent microleakage from bacterial infiltration from the oral cavity and tissues of periapical areas. Aim: This study aims to compare and evaluate the depth of penetration and microleakage of AH Plus, Bio-C, Sealapex, and MTA Fillapex using a confocal laser scanning microscope (CLSM). Subjects and Methods: This study evaluated sealer penetration and microleakage in 170 single-rooted teeth divided into two groups ( n = 85 each). Group A assessed sealer penetration of Group I: MTA Fillapex, Group II: Selapex, Group III: Bio-C, Group IV: AH Plus, and Group V: Control group (obturated without sealer) using 0.1% Rhodamine B-labeled sealers, and CLSM was done at 3 mm and 5 mm from the apex. Group B measured microleakage in the above-mentioned 5 groups, after 7-day immersion of samples in 0.1% Rhodamine B and evaluating dye penetration longitudinally from the cemento-dentinal junction. Statistical Analysis: Data were analyzed using paired t-tests, Tukey Honestly Significant Difference, ANOVA, and Pearson’s correlation as statistical tools. Results: Group III has demonstrated the highest sealer penetration at both 3 mm and 5 mm levels, and exhibits the best microleakage resistance. However, minimum penetration has been shown by Group I and Group II at 3 mm and 5 mm, respectively. Group II has shown the highest microleakage among the sealers. Conclusion: Bio-C sealer performed best, whereas Sealapex has shown the worst both in sealer penetration and microleakage.

Abstract Aim: The study aimed to evaluate and compare the apical sealing ability of three different sealers, i.e., NT Biocera Flo, AH Plus, and Calapex modified with chitosan nanoparticles using spectrophotometric evaluation. Methodology: Thirty-six extracted single-rooted mandibular premolars were selected. Access opening and biomechanical preparation were done using the step-back technique, and samples were randomly divided into three groups with three different sealers ( n = 12): Group 1 – NT Biocera Flo with chitosan nanoparticles, Group 2 – AH Plus with chitosan nanoparticles, and Group 3 – Calapex with chitosan nanoparticles. Following obturation, samples were immersed in 2% methylene blue for 72 h. Teeth were then dissolved in 35% nitric acid, and dye penetration was quantified using a spectrophotometer at 670 nm. Data were statistically analyzed using Kruskal–Wallis and Mann–Whitney U tests. Results: Group 1 (NT Biocera Flo + chitosan nanoparticles) demonstrated the lowest mean dye penetration (1.56 ± 0.48), followed by Group 2 (AH Plus + chitosan nanoparticles) (2.02 ± 0.57), whereas Group 3 (Calapex + chitosan nanoparticles) showed the highest leakage (2.53 ± 0.34). Conclusions: NT Biocera Flo with chitosan nanoparticles demonstrated superior apical sealing ability, followed by AH Plus and Calapex. Context: Achieving an effective apical seal is critical to prevent microleakage and ensure the long-term success of root canal therapy. This study assesses the effect of chitosan nanoparticle incorporation on the apical sealing ability of commonly used endodontic sealers. Settings and Design: This in vitro experimental study was conducted in the Department of Conservative Dentistry and Endodontics, using extracted human mandibular premolar teeth to evaluate the apical sealing ability of different chitosan-modified endodontic sealers. A randomized laboratory design was employed, with samples allocated into three groups based on the sealer used, followed by standardized preparation, obturation, dye penetration, and spectrophotometric analysis.

Long-term clinical outcomes for single dental crowns versus extensive direct restorations: A register-based cohort study with up to 10 years of follow-up in a Swedish population.

Optimal file system selection remains critical in endodontic practice for effective root canal preparation in teeth with apical periodontitis. Therefore, it is of interest to compare rotary NiTi (ProTaper Gold) versus reciprocating (WaveOne Gold) systems in 224 teeth over 18 months. Both achieved comparable success rates (87.5% rotary vs. 89.3% reciprocating, p=0.672), with similar periapical healing and symptom resolution. Reciprocating files demonstrated shorter treatment times and fewer separations, improving procedural efficiency and safety. This advances endodontics by validating reciprocating systems as equally effective yet more efficient alternatives to rotary NiTi in primary treatments

Evaluation of Organic Debris Removal by Two Irrigant Activation Systems Using a Novel Chairside Quantitative Assay.

Background: Biofilm removal plays a key role in the long-term success of root canal therapy. This ex-vivo study aimed to compare the antibacterial efficacy of two rotary instrumentation systems (ProTaper Ultimate and Pro AF Baby Gold) and an irrigation-based non-instrumentation endodontic treatment (NIET) in eliminating Enterococcus faecalis (E. faecalis) biofilms from extracted mandibular second primary molars. Methods: A total of 45 extracted mandibular second primary molars were used. Only teeth with at least two-thirds of the root length intact and without structural anomalies were included. Five teeth served as a negative control group, while the remaining 40 were contaminated with E. faecalis and randomly assigned to four groups (n = 10) based on the preparation technique. Group 1: irrigation-only NIET; Group 2: ProTaper Ultimate; Group 3: Pro AF Baby Gold; and a positive control group (no instrumentation or irrigation) comprised the study groups. After treatment, biofilm samples were collected, and bacterial load was quantified by colony-forming unit (CFU) counting. Data were analyzed with the Kruskal-Wallis H test with Dunn’s multiple comparisons for post hoc pairwise testing and the Mann-Whitney U test. Statistical significance level was set at 0.05. Results: The median bacterial counts were 7.99 in the control group, 6.81 in Group 1, 4.73 in Group 2, and 0.00 in Group 3. Group 1 showed no significant difference from the control group (p = 0.3985), but differed significantly from Group 2 (p = 0.0031) and Group 3 (p &lt; 0.0001). Both rotary systems effectively reduced E. faecalis biofilms, with the highest efficacy observed in Group 3. In contrast, NIET provided limited bacterial reduction. Conclusions: While NIET may be useful in pediatric patients, its limited antibacterial efficacy highlights the need for further improvement before it can be considered a reliable clinical alternative.

This in vitro study aimed to evaluate the fatigue behaviour of root canal treated teeth, filled with either AH Plus Jet (AHP) or AH Plus Bioceramic Sealer (AHPB) and rehabilitated with either mesio-occlusal-distal (MOD) restorations (direct resin composite) or endocrowns (indirect resin composite). Seventy human upper premolars were prepared and randomly divided into five experimental groups according to the endodontic sealer and type of coronal restoration: AHP-MOD: AHP sealer + MOD restoration; AHP-EC: AHP sealer + endocrown; AHPB-MOD: AHPB sealer + MOD restoration; AHPB-EC: AHPB sealer + endocrown; control group (intact teeth). Monotonic testing was performed to define the fatigue parameters, then a cyclic fatigue test was conducted. Fracture analysis was performed using a stereomicroscope. Fatigue failure loads and the number of cycles to failure were analysed using the Kaplan-Meier and Mantel-Cox (Log Rank) test. Survival rates were calculated for each 'step' of the fatigue test. Fracture types were analysed descriptively. Teeth treated with AHP and restored with endocrowns achieved better results in both load resistance and number of cycles, compared to the AHP-MOD group and teeth filled with AHPB regardless of the restoration used (p<0.05). However, there was no significant difference when these groups were compared to the control (p>0.05). Most failures (≥50%) were catastrophic (longitudinal fractures). Endodontically treated upper premolars filled with an epoxy resin-based sealer and restored with endocrowns presented a superior fatigue behaviour, suggesting this combination may offer better long-term outcomes compared to MOD restorations or calcium silicate-based sealers.

The close anatomical relationship between root apices and the mandibular canal (MC) may be of clinical importance in preventing inferior alveolar nerve (IAN) injury during the root canal treatment (RCT) of mandibular molars. The aim of the present study was to evaluate the impact of the mean distance between MC and the root apices of mandibular first and second molars on the risk of IAN injury during RCT in a Turkish subpopulation. Cone-beam computed tomography (CBCT) images of 934 patients were evaluated. Mandibular molars were examined, and parasagittal sections were used to measure the shortest linear distance between the root apex and the superior cortical border of MC. The mesial and distal roots were closer to MC in the 18-25-year age group and in females (p < 0.05). Overall, 284 (10.5%) mesial roots were in intimate contact with or invading MC, and 80 (3.0%) were located very close to MC (<1.00 mm). Among distal roots, 328 (12.2%) were in intimate contact with or invading MC, 76 (2.8%) were very close to MC, and 2,288 (85.0%) were distant from MC. The risk of IAN injury during RCT was higher for the distal roots of second molar teeth, especially in the age group of 18-25 years and in female patients.