Root Canal Research Articles

Quality of Life in Patients with Endodontically Treated Teeth: A Retrospective Study at an Educational Hospital

Background/Objectives: Root canal treatment (RCT) is a crucial procedure for preserving dental health. While its clinical success rates are well documented, patient-reported outcomes regarding quality of life remain less explored. This study aimed to assess the long-term impact of RCT performed in an educational hospital on patients’ oral-health-related quality of life (OHRQoL) using the Oral Health Impact Profile-14 (OHIP-14). Methods: A total of 1500 patients who underwent non-surgical RCT between April 2018 and February 2023 were called and invited for a follow-up visit. During the visit, all teeth that had undergone RCT were assessed clinically and radiographically by two calibrated examiners to evaluate RCT quality and pre- and post-treatment periapical index (PAI) scores. Demographic information and OHIP-14 responses were collected, and the data were recorded. Results: Patients reported high levels of satisfaction (95%) and no negative impact on their OHRQoL. Statistical analysis revealed that post-operative periapical index (PAI) scores (p < 0.001), patient gender (p = 0.003) and nationality (p = 0.029) significantly influenced OHRQoL perceptions; Conclusion: These findings emphasize the effectiveness of RCT in enhancing patients’ quality of life and highlight the impact of demographic factors—such as gender and whether the patient is a resident or a national of the country, along with post-treatment severity of the disease—on patient-reported outcomes.

Postobturation Pain of three Novel Calcium Silicate-based sealers with asymptomatic irreversible pulpitis or necrotic pulp with chronic apical periodontitis: prospective clinical trial

BackgroundBioceramic-based root canal sealers are increasingly important in root canal treatment because of their biocompatible properties. This study aimed to evaluate postobturation pain incidence and intensity after root canal obturation with NeoSealer Flo, MTA-Bioseal, and GuttaFlow bioseal calcium silicate-based sealers and AH Plus epoxy resin-based sealer in patients with asymptomatic irreversible pulpitis or necrotic pulp with chronic apical periodontitis.MethodsA total of 120 participants with single-rooted teeth were included and randomly divided into four groups according to the root canal sealer used (n = 30). The patients were subsequently categorised based on the pulp vitality (vital or nonvital) in each group (n = 15) and all teeth were obturated in a single-visit. The postobturation pain scores were recorded on a visual analogue scale (VAS) at 6 h, 24 h, 48 h, 72 h, 7 d and 30 d. Moreover, analgesic intake was also noted at 24 h and 48 h. The Mann–Whitney U test, Kruskal‒Wallis H test, Friedman test, and Spearman’s correlation test were used, and a p value < 0.05 was considered significant.ResultsVAS scores were highest for the 6 h > 24 h > 48 h ≈ 72 h ≈ 7 d ≈ 30 d time intervals for both pulp status in each root canal sealer. A significant decrease in the VAS score was observed for all sealers from 6 h to 48 h (p 0.05). Nonvital cases had lower VAS scores at all time intervals. Analgesic intake was greater in the first 24 h (p < 0.05) in vital cases (p < 0.05) and also in females than males.ConclusionThe level of pain experienced after obturation was similar in patients with different pulp status for all the root canal sealers. Analgesic intake was greater in vital cases and females within 24 h.Trial registrationClinicalTrial.gov, NCT06515756, record date: 2024-07-17, retrospectively registered.

Nonsurgical Endodontic Retreatment of a Cystic Apical Lesion Associated with Root Resorption: A Promising Approach

This case report highlights the successful management of a cystic apical lesion associated with root resorption through nonsurgical endodontic retreatment, utilizing calcium-enriched mixture (CEM) cement as an obturating biomaterial. A 35-year-old woman presented with mild discomfort in the mandibular right first molar (#46), with radiographic evidence of a well-defined radiolucent lesion at the apex of the mesial root. The tooth had a history of previous failed endodontic treatment with poor root canal obturation, indicating internal root resorption. Nonsurgical endodontic retreatment was performed, and the canals were filled/sealed with CEM cement. Follow-up radiographs showed a gradual reduction in the size of the cystic lesion. At 54 months, complete bone healing of the cystic apical lesion was evident. This case report provides clinical evidence supporting the potential efficacy of nonsurgical endodontic retreatment using CEM cement in managing certain cystic apical lesions, offering a promising alternative to traditional surgical enucleation, even in cases with inflammatory root resorption. Further research is needed to validate the long-term efficacy of this approach in larger patient populations.

Retreatment and aesthetic restoration of maxillary incisor with calcified root canal using a dynamic navigation system: a case report

BackgroundPulp canal occlusion (PCO) increases the difficulty of root canal treatment as well as tooth preservation and restoration. This is the first case report of successful localization of a calcified root canal under the guidance of a dynamic navigation system (DNS) for complete root canal retreatment and aesthetic restoration after a failed attempt to locate the calcified root canal with a traditional dental operating microscope (DOM).Case presentationThe patient was scheduled for root canal treatment for a labially inclined maxillary central incisor and post-core crown restoration with resin veneers in another hospital, but the calcified root canal could not be located with a microscope, so the patient was referred to our department. Root canal retreatment was planned for tooth #8, and the calcified root canal of tooth #9 was planned to be located and dredged under the guidance of a DNS. We used a DNS for successful positioning and to complete the root canal retreatment operation in the following 4 steps: preoperative CBCT imaging, preoperative plan design, calibration and registration, and real-time dynamic navigation. Three months later, teeth #8 and #9 presented no clinical symptoms, after which the fiber post-cores and zirconia all-ceramic crown restorations were completed. At the 12-month follow-up visit, the patient continued to be symptom­free, and satisfied with the final aesthetic restoration.ConclusionsThis case report suggests that DNS may be a promising technique with high accuracy and effectiveness to reduce the risk of iatrogenic errors and provide maximal preservation of dentin, when the traditional treatment of calcified root canals approaches failure (lateral perforation).

In Vitro Evaluation of the Influence of Biosynthesized Calcium Oxide Nanoparticles on the Antibacterial Activity, pH, Microleakage and Cytotoxicity of Conventional Intracanal Medicaments

Intracanal medicaments are an important adjunct to the effective disinfection of the root canal system. However, conventional intracanal medicaments do not provide adequate protection against Enterococcus faecalis, which is the organism of interest in many cases of root canal failures. This study aimed to evaluate the influence of biosynthesized calcium oxide nanoparticles (CaO NPs) on the antibacterial activity, pH, microleakage and cytotoxicity of intracanal medicaments. CaO NPs were biosynthesized by the direct thermal decomposition of eggshells (EGS) and the reduction of calcium nitrate with papaya leaf extract (PLE). These nanoparticles were mixed with a proprietary calcium hydroxide powder in 10% and 25% (w/w) concentrations and blended in analytical-grade coconut oil to formulate the experimental medicaments. These were then evaluated for antibacterial activity, pH, microleakage and cytotoxicity at 1 day, 7 days and 15 days. A proprietary calcium hydroxide paste formulation (MX) was used as the control. Means and standard deviations were calculated and analyzed using repeated-measures ANOVA for pH and three-way ANOVA for the antibacterial effect, microleakage and cytotoxicity, followed by LSD post hoc analysis. Significant antibacterial activity was noted against Enterococcus faecalis at all times, with zones of inhibition (ZOI) up to 19.60 ± 2.30 mm. pH levels up to 13.13 ± 0.35 were observed for the experimental groups. Microleakage remained comparable to the control, while cytotoxicity was not observed in any of the groups at any time. Intracanal medicaments formulated with 10% and 25% (w/w) of biosynthesized CaO NPs could be promising candidates for the disinfection of the root canal system compared to conventional counterparts.

Effect of Cross-sectional Designs on Torsional Resistance of Endodontic Nickel-Titanium Files: A Finite Element Study.

This study aimed to assess the influence of two key design parameters on the torsional resistance of endodontic rotary files: the ratio of the equivalent radius (re ) to the polar moment of inertia (J), or re /J ratio, and the percentage of the inner core area. Understanding these factors can guide the development of files with improved performance during root canal procedures. Finite element analysis was employed to simulate the behavior of rotary files under torsional loading conditions. This method allowed for the investigation of maximum shear stress across various cross-sections (D4-D16) of the files. The relationship between the re /J ratio and the maximum shear stress was also evaluated. To assess the impact of cross-sectional design modifications on stress distribution, the study analyzed files with progressively changing configurations. Regions situated outside the inner core circle experienced lower shear stress compared with a circular shaft. Furthermore, a strong linear correlation was observed between the maximum shear stress experienced by the file, the applied torque during operation, and the re /J ratio. Significantly, the study established a connection between the percentage of the inner core area and the torsional resistance of the file. Files with a larger inner core area exhibited a lower coefficient (C) within a newly derived torsional formula. This lower C value directly translated to a reduction in the maximum shear stress experienced by the file. In essence, files with a higher percentage of inner core area demonstrated enhanced torsional resistance, allowing them to withstand higher torsional loads encountered during root canal procedures. This study identified the re /J ratio and the percentage of inner core area as the most critical design factors influencing the torsional resistance of rotary files. Files with a lower re /J ratio and a larger inner core area experienced lower shear stress, resulting in enhanced torsional resistance and potentially reducing the risk of torsional fracture during use. These findings offer valuable insights for both clinicians selecting rotary files and manufacturers designing future iterations, ultimately contributing to improved safety and efficacy during root canal treatments.

Effect of Cryotherapy and Occlusal Reduction on Postoperative Endodontic Pain in Mandibular First Molars with Symptomatic Apical Periodontitis: A Prospective, Parallel, Double-Blinded Randomized Controlled Trial.

This study aimed to compare the intensity of postoperative pain following the final rinse using cold saline compared with room temperature saline and occlusal reduction. A prospective, parallel, double-blinded randomized controlled trial was conducted on 69 first mandibular molars diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis. Single-visit root canal treatment was performed; access cavity preparations and chemomechanical preparations were carried out using the ProTaper Gold rotary system under copious irrigation using 3% sodium hypochlorite and 17% EDTA. The patients were divided into three groups (n = 23): control group: room temperature saline (25°C) final rinse without occlusal reduction; cryotherapy group: cold saline (2.5-4°C) final rinse without occlusal reduction; and occlusal reduction group: room temperature saline with occlusal reduction. Pain scores were recorded using the visual analog scale preoperatively and postoperatively via telephone at 6, 24, 48, 72 hours, and 7 days intervals. Age data were analyzed using one-way analysis of variance followed by Tukey's post hoc test. Pain score data were analyzed using Kruskal-Wallis' test followed by Dunn's post hoc test for intergroup comparisons and Friedman's test followed by Nemenyi's post hoc test for intragroup comparisons. Correlations were analyzed using Spearman's rank-order correlation coefficient. The significance level was set at p < 0.05 within all tests. Cryotherapy reduced postoperative pain compared with the control group with a statistically significant difference at 24 hours only (p = 0.016). At other intervals, no statistically significant difference in pain score was measured between all three groups (p > 0.05). After 7 days, all patients recorded a zero pain score. Cryotherapy was as effective as the occlusal reduction in reducing postoperative pain in cases of symptomatic irreversible pulpitis with symptomatic apical periodontitis, significantly more than the control group.

Oxygen as obturation biomaterial in endodontic treatment: development of novel membranous dental restoration system

Complexities in obturation and difficulties in disinfection are the major problems that make endodontic treatment very time-consuming. A new perspective is needed to reduce the working time as well as to answer these two problems. Until now, none of the established obturation techniques for root canal filling can guarantee a perfect seal. Solid substances cannot be manipulated easily to fill the tiny branches of the root canal system hermetically. At the same time, anaerobes and facultative anaerobes, especially Enterococcus faecalis, are very dominant in endodontic infections discussion. As shown in many studies, it is extremely difficult to perfectly disinfect Enterococcus faecalis even by using some irrigating solutions with strong antibacterial properties. Under anaerobic conditions, the invasion efficiency of facultative anaerobes is increased. In case irrigation and disinfection cannot totally eliminate anaerobes and facultative anaerobes, a new strategy is also needed to deal with the bacteria that still survive in the root canal. Oxygen can fill the root canal system with ease, eliminate anaerobes, and prevent facultative anaerobes from being pathogenic. Therefore, using oxygen as obturation biomaterial after proper cleaning and shaping procedures is expected to solve the two major endodontic problems. The aim of this article was to discuss a new possible concept of dental restoration system that uses an oxygen-permeable membrane to decrease the time required in endodontic treatment. The membrane is placed at the orifice of a duct created to connect the entire root canal system with free air outside the restoration. The function of the membrane is more or less similar to the mask used during the COVID-19 pandemic, as it enables the oxygen to circulate while preventing any fluid, debris, and microorganisms from passing. We hypothesize that the oxygen circulating in the root canal system will also act as an antimicrobial agent that is constantly renewed.

Clinical outcome of guided endodontics versus freehand drilling: A controlled clinical trial, single arm with external control group.

High-quality, prospective clinical studies are needed to increase evidence for guided endodontics. This study aims to assess the clinical outcome of guided endodontics for treatment of teeth presenting with pulp canal obliteration (PCO) in comparison with freehand treatment. This trial was registered in the ISRCTN.com registry (ISRCTN75277265) and designed as a controlled clinical trial: Single arm trial, prospective, nonrandomized, single-centre study (ethical approval number S64630). Inclusion criteria were; tooth presenting with PCO and symptoms and/or signs of apical periodontitis (AP). An external control group was selected from clinical records of patients presenting the same criteria but treated freehanded. Guided root canal treatments were performed by the same operator on all patients. Freehanded treatments were performed by a specialist in endodontics under microscope with pre-operative CBCT available. Primary outcome for both groups was evaluated as: canal found, canal not found, or perforation. As secondary outcome, the qualitative accuracy of the drill path was assessed as: optimal precision, acceptable precision or technical failure. Patients were followed up yearly. Descriptive statistics on the study patient's demographics and healing outcome were performed and specific statistical analysis was performed on each outcome variable. A total of 133 teeth were included (n = 60 guided, n = 73 freehanded) from 128 patients (n = 59 guided, n = 69 freehanded). The primary outcome for the guided group was: 59 teeth canals found and 1 tooth canal not found. No perforations were recorded. In the freehanded group, the root canal was successfully found in 59 teeth, seven were not found, and seven had a perforation. An analysis of all data showed that guided endodontics presented statistically significant better outcome than freehand treatment (p < .05). Guided endodontics showed a statistically significant better outcome than freehanded treatment resulting in less technical failures. However, it is a complex procedure which should be carried out by an experienced endodontist with the aid of a dental microscope.

The Effectiveness of Triton Used With XP-3D Adaptive Files and Active Irrigation on Smear Layer Removal During Root Canal Preparation: A Qualitative Scanning Electron Microscopy (SEM) Study.

Standard irrigating protocols during root canal treatment call for the use of sodium hypochlorite during chemo-mechanical preparation, followed by final irrigation with ethylenediaminetetraacetic acid (EDTA). This study determined the effectiveness of a new irrigant, Triton (Brasseler, USA), on smear layer removal during root canal treatment compared to that of 5.25% sodium hypochlorite and CanalPro EDTA 17% (Coltene). Twenty-one extracted anterior teeth were prepared for root canal treatment. The teeth were divided into three groups: five teeth were used as control with saline as the irrigant, eight teeth with sodium hypochlorite and 17% EDTA as irrigants, and eight teeth with Triton as the irrigant. Root canal preparation was done using the XP-3D shaper and finisher files (Brasseler, USA) for all teeth with respective irrigants. A single operator performed all root canal treatment procedures. The teeth were prepared for scanning electron microscopy (SEM), and analysis was performed by a second investigator. The smear layer removal was qualitatively assessed to determine the effectiveness of irrigants. Smear layer removal was most effective for teeth irrigated with 5.25% sodium hypochlorite, followed by 17% EDTA (Group B). Teeth irrigated with Triton (Group A) showed a similar appearance to the hypochlorite/EDTA group but with isolated instances of inter-tubular debris. Sodium hypochlorite use followed by a final rinse with EDTA remains the gold standard for the removal of the smear layer created during canal instrumentation.

Activation of Irrigants in Root Canals with Open Apices: A Narrative Review.

Performing endodontic treatment on a tooth with an immature apex can be challenging due to the risk of irrigant extrusion beyond the apex. This narrative review investigates the over-apex extrusion of activated irrigants in teeth with open and immature apices and aims to provide crucial insights for practice and research. Two hundred fifty-two results were found from the electronic search. Sixteen duplicates were removed before selection, and 24 were excluded. Of the 212 remaining results, the full text was evaluated for eligibility. One hundred ninety-four results were excluded: in one hundred sixty-five, irrigant activation was not performed; twenty-nine were animal studies; in seven, irrigant activation was not performed to disinfect the canal. Finally, 13 studies were included. They cover a range of topics, from the types of irrigants used to the techniques of activation, and their findings contribute to our understanding of the risks and consequences of irrigant extrusion. All the activation techniques investigated can, to varying degrees, cause the irrigant to extrude beyond the apex. Extrusion may not always be clinically relevant; however, the consequences of excessive irrigant leakage from the apex are dangerous, so try to assess all the variables that may cause it and adopt techniques to reduce it.

Dentinogenesis imperfecta in a 6-year-old male neutered Labrador retriever: Case report with atypical clinical presentation and treatment review

This case report details the diagnosis and treatment of dentinogenesis imperfecta in a 6-year-old neutered male Labrador, presenting without concurrent osteogenesis imperfecta. Diagnostic modalities, including radiographs, CT imaging, and histopathological examination, are reviewed in conjunction with the latest literature on canine dentinogenesis imperfecta. This patient presented at a more advanced age than typically reported cases. The clinical history, as provided by referring veterinarians, documented fractured deciduous teeth with delayed exfoliation. By 10 months of age, the patient’s permanent dentition exhibited a translucent appearance and structural anomalies. Upon presentation to Eastcott Referrals the patient was experiencing significant oral pain and exhibited generalised coronal wear with yellow/brown intrinsic discolouration. CT imaging revealed that all teeth had endodontic disease and associated apical periodontitis, with varied root canal widths indicating that teeth succumbed to endodontic disease at different time points. The treatment protocol involved staged full-mouth extractions, resulting in the complete resolution of clinical symptoms. This case underscores the importance of early diagnosis and intervention in managing dentinogenesis imperfecta in dogs.

Is Apical Enlargement with Single Reciprocating Instruments the Key to Success in Endodontic Retreatment?

Modern endodontics has provided significant advancements, particularly in the treatment and retreatment of root canals. However, the complete removal of obturation material during retreatment remains a challenge, especially in the apical third of root canals, where complex anatomy imposes limitations. This study aimed to evaluate the effectiveness of using WaveOne Gold reciprocating instruments of different diameters and kinematics (brushing motion and pecking motion) for removing obturation material from root canals during retreatment, with a particular focus on the apical third. Thirty human maxillary molars with separate roots were selected and divided into four groups. Root canals were prepared and obturated using different WaveOne Gold instruments (Primary and Medium) and then retreated with larger diameter instruments using different kinematics. The removal of obturation material was evaluated through cone beam computed tomography (CBCT). The results were statistically analyzed using ANOVA and logistic regression. Statistical analysis revealed no significant differences between the groups regarding the type of instrument or kinematics applied. Residual obturation material was observed in approximately 60% of the samples, regardless of instrument diameter or kinematics used, indicating that complete removal of obturation material from the apical portion of root canals remains a substantial challenge. The use of larger diameter instruments, such as the WaveOne Gold Medium, and the application of brushing motion kinematics did not prove significantly more effective in removing obturation material compared to smaller diameter instruments. These findings highlight the need to explore new approaches and technologies to optimize obturation material removal, especially in complex anatomical regions like the apical third of root canals.

Navigating the digital frontier: transforming endodontic diagnosis through digitization. part 1

The current advances and innovations in material technology and armamentaria help to negate the difficulties faced by clinicians in diagnosing and treating patients. Oral healthcare contributes much to the wellbeing of a person. However, the oral cavity is a small and difficult area in which to work since it is filled with vascularized mobile tissues and various shaped teeth, and connected to sinuses, nerve canals, lungs and the gastrointestinal tract via the trachea and pharynx. Moreover, each tooth has a complex root canal system that must be explored if it is infected or inflamed. Root canal treatment can be compared to entering a blind tunnel and treating something unseen. Endodontics is a field in dentistry where a clinician must use their tactile sense and correlate it with clinical knowledge, as well as skill, to treat dental infections. Digital evolution has simplified diagnosis, treatment planning, documentation and communication with patients, rendering more predictable outcomes and providing evidence for the healing or non-healing of disease. The evolution of digital radiography has offered us the best technology available. The present review discusses various helpful digital tools that are currently available, and future technologies that may guide clinicians in better diagnosis. CPD/Clinical Relevance: Advances in diagnostic tools have improved accuracy in identifying and treating dental pathologies, thereby achieving more predictable outcomes and enhancing patient care.

In-vitro and In-silico evaluation of antimicrobial and antibiofilm effect of Neem oil and Calcium hydroxide nanoparticles against Mutans Streptococci and Enterococcus faecalis isolated from endodontic infections

Different Streptococcal species including Streptococcus mutans, Streptococcus sobrinus and Enterococcus faecalis are commonly isolated in root canal infections including refractory, recurrent, and persistent cases. Calcium hydroxide (Ca (OH)2) has been widely used in endodontics as an intracanal medicament. However, using new antimicrobial herbal alternatives offers promising potentials which can be additionally enhanced by using nanoparticles (NPs). In this study, we evaluate the antimicrobial efficacy and antibiofilm effect of Neem oil including its NPs preparations and we compare the effect of conventional Ca (OH)2 to Ca (OH)2 NPs using standard disc diffusion method and quantitative microtitre dish biofilm formation assay against common pathogens isolated from root canal samples. Molecular docking was used to test the binding of 10 Streptococcal macromolecules to 5 candidate neem active constituents. Neem NPs 0.125 mg/ml showed better antibacterial effect than both Neem 15 mg/ml and Neem 0.15 mg/ml. Ca (OH)2 NPs 0.125 mg/ml also showed better antibacterial effect than each of Ca (OH)2 10 mg/ml and Ca (OH)2 0.1 mg/ml. Best biofilm mass inhibition was achieved by Neem oil 0.15 mg/ml at 74.55% ( IQ: 67.36–87.65) and Neem NPs 0.0125 mg/ml at 59.33% (IQ: 51-–75.27). For Ca (OH)2, the best biofilm mass inhibition was observed with Ca (OH)2 NPs 0.125 mg/ml at 54.7% (IQ: 42.37– 77.25). Both neem oil and neem NPs show promising antibacterial and antibiofilm potential against Mutans Streptococci group at low concentrations and hence are good candidates for use as endodontic medications. In silico analysis shows that both Sitosterol and Gedunin appear to be important active constituents of neem and possible drug candidates. Additionally, Ca (OH)2 NPs showed significantly higher antimicrobial effect against Mutans streptococci group than conventional Ca (OH)2 preparations.

Impact of strontium added fluorophosphate glass on the physico-chemical properties of mineral trioxide aggregate

Mineral trioxide aggregate (MTA) is widely employed in the field of endodontics, extensively for root canal therapy. Despite being successful, MTA has certain limitations regarding its physico-chemical properties. The present investigation aims to enhance the physicochemical and mechanical behavior of MTA by formulating a cement paste by addition of strontium containing fluorophosphate glass (SrFP). The addition of strontium on to the fluorophosphate glass improves the mechanical strength of the glass network and also accelerates the mineralization process during implantation. In this regard, fluorophosphate glasses with 6 mol% of strontium content were synthesized by standard melt quenching technique and the glasses were ball milled to obtain fine powder. Cement paste was prepared by adding optimized 5 wt% of 6 mol% SrFP glass powder on to 95 wt% of MTA cement. Comparative analysis of conventional MTA with SrFP added MTA were evaluated for various properties such as pH variation, contact angle, radiopacity, compressive strength, push-out bond strength, setting expansion, sealing ability, tooth color change, surface morphology and ALP activity. The obtained results from the investigation exposed that the addition of strontium added fluorophosphate on to MTA impacts the physical properties which includes wettability, sealing ability, push out bond strength and ALP. These findings suggest that SrFP to be a promising additive to MTA with wide scope of applications in dentistry.

To Treat or to Extract Necrotic First Permanent Molars Between 8 and 12 Years of Age: A Retrospective Cohort Study.

Background: First permanent molars (FPM) are highly susceptible to decay before the age of 15. When they are severely affected, the decision between conservation and extraction arises, particularly considering the potential for the second permanent molar (SPM) to replace the FPM. This cohort study aimed to evaluate clinical practices regarding FPM pulp necrosis treatment in children aged eight to twelve in two hospital departments in the Paris region. A second objective was to evaluate the one-year outcomes of the two therapies. Methods: A retrospective analysis was conducted using computerized billing software to identify patients aged eight to twelve who underwent either extraction or root canal treatment (RCT). Data collected included sex, age, arch involved, number of decayed surfaces, presence of Molar Incisor Hypomineralization (MIH), presence of infection, and treatment type. Results: A total of 66 patients were included, representing 61 extracted teeth and 23 RCT. Three main decision criteria were identified: presence of MIH (p < 0.005), extent of decay (p < 0.05), and SPM Nolla's stage. A total of 48% of the patients were seen at one year. A total of 16 of the 32 extractions and five of the nine RCTs had favorable evolution (p = 1). Conclusions: The question of whether to perform RCT or extraction of necrotic FPM in children aged eight to twelve is difficult to assess. It appears that five criteria need to be considered before the decision: possibility of long-term sealed coronal reconstruction, SPM Nolla's stage, follow-up possibilities, arch concerned, and presence of third permanent molar.

Features of endodontic treatment of teeth with curved root canals according to a survey of dentists

Purpose: to identify difficulties of endodontic treatment of teeth with curved root canals according to a survey of dentists. Materials and methods: 90 dentists (26 men, 64 women) participated in the survey. 68 people had a therapeutic certificate, 19 people had an orthopedic certificate, 10 people had a surgical certificate, 6 people had a certificate in pediatric dentistry, and 43 people had a certificate in general dentistry (some respondents indicated that they had several certificates). The average age of respondents is 32 years (23–60). The interviewed dentists conduct practical work in public medical institutions, private dental clinics, and rented offices. The questionnaire included 20 questions (6 questions were aimed at collecting demographic data, 14 questions were aimed at obtaining information about the treatment of teeth with curved root canals). The questionnaire was submitted electronically to Google Forms. Statistical analysis of conjugacy tables using the Pearson chi-square test was performed using the program StatTech (Russia). Results: this survey reliably showed that dentists often experience difficulties in treating teeth with curved root canals. Dentists working in state institutions are significantly more likely to note that the rubberdam latex interferes (p= 0.049) and the clamp bow (p= 0.029) compared to doctors working in other institutions. Dentists working in a rented office are significantly more likely to report that a rubberdam latex interferes (p= 0.024) compared to doctors working in other institutions. Dentists who report difficult access when working with the mesial buccal canal of the lower molars are significantly more likely to note that a rubberdam latex interferes (p= 0.036). Dentists who use the approach «first negotiation to the working length – then coronal flaring» significantly more often experience difficulties when working with the mesial buccal first canal of the upper molars. Conclusions: the results of the survey demonstrated a number of differences in the performance of endodontic treatment of teeth with curved root canals. Based on the survey, statistically significant relationships were identified between some work features and difficulties encountered by doctors at the stages of treatment.

A Novel pH-Responsive Nano-Sized Lanthanum-Doped Polyvinyl Alcohol-Carbon Quantum Dot Composite for Root Canal Irrigation.

The primary goals of endodontic therapy are to eliminate microbes and prevent reinfection. Persistent root canal infections and failure of root canal therapy are primarily attributed to the presence of bacteria, particularly E. faecalis. Chemical irrigants play a crucial role in complementing mechanical instrumentation in ensuring adequate disinfection. However, current techniques and available irrigants are limited in their ability to achieve optimal sterilization of the root canal system. In this study, we developed a novel material called La@PCDs by combining CQD-PVA and lanthanum for root canal irrigation. A one-pot hydrothermal method was used to prepare composites of lanthanum and CQD-PVA (La@PCDs). Scanning electron microscopy (SEM), Fourier-transform infrared (FTIR) spectroscopy and the particle size were employed to characterize La@PCDs. ROS generation was evaluated by measuring the fluorescence intensity emitted at 525 nm from 2',7'-dichlorodihydrofluorescein diacetate (DCFH-DA). In vitro experiments were conducted to assess the effectiveness of the nanoparticles in combating Enterococcus faecalis and eradicating in situ biofilm eradication in root canal. Furthermore, cytotoxicity assessments were carried out to demonstrate the safety of La@PCDs. SEM and FTIR results showed that La@PCDs were successfully prepared and exhibiting a homogeneous size distribution and irregular morphology. ROS assessment demonstrated that La@PCDs have a synergistic effect, promoting the production of a large number of ROS. This effect only occurred under acidic PH conditions. The inherent acidity in the biofilm microenvironment can act as internal stimulus. In vitro experiments revealed superior antibacterial efficiency under acidic conditions without causing significant cytotoxicity compared to the commonly used NaClO irrigant. The biosafety of La@PCDs was confirmed. Compared to existing materials, these nanoparticles exhibit favorable antibacterial and anti-biofilm properties, along with improved biocompatibility. These findings emphasize the potential of the integrated La@PCDs as a promising option for enhancing root canal irrigation and disinfection.

Clinical experience of tooth replantation

Relevance. Modern dental practice strives, above all, to preserve teeth. A variety of operations aimed at this include dental replantation. Replantation is used in cases where there are difficulties with the root canals, such as their pathological bending or previous treatment with the resorcinol-formalin method, and also when root resection is impossible due to the risk of damage to surrounding structures, for example, the maxillary sinus or the inferior alveolar nerve.The purpose of this study was to study the osseointegration of a replanted tooth subjected to coronoradicular separation. Materials and methods. Thirty-one-year-old patient K. came to the dental clinic with the problem of pain in the projection of tooth 4.6, which occurs during chewing. A detailed examination revealed that the crown of tooth 4.6 had previously undergone restoration using a filling material that had defects. It was decided that tooth 4.6 should be removed and subsequently replanted. The tooth was extracted according to established procedures, while maximally preserving the surrounding periodontal and periosteal tissues. To preserve periodontal tissues, alveolar curettage was carefully performed. During the extraction of the tooth, it was longitudinally divided into two parts – the medial and distal roots. After this, the root canals were treated using extraoral therapy. The roots of tooth 4.6, treated with an antiseptic, were returned to their anatomical positions in the alveolus. The final stage was the creation of a control x-ray to verify the correctness of the replantation. Conclusions. After two years of observation of tooth 4.6, which was subjected to replantation, no pathological changes in root stability were detected. It was reported that the soft tissue surrounding the roots of the tooth formed a structure similar to the periodontal sulcus, which facilitated the use of retraction cord during tooth preparation.