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Advances in the Diagnosis and Treatment of Endodontic Diseases

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dentistry, Oral Surgery and Oral Medicine".

Deadline for manuscript submissions: closed (26 November 2023) | Viewed by 11891

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Special Issue Editors

Prof. Dr. Falk Schwendicke

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Guest Editor

Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
Interests: dental; diagnostics; oral; artificialintelligence; deeplearning; endodontics
Special Issues, Collections and Topics in MDPI journals

Dr. Sascha Herbst

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Guest Editor

Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
Interests: dentistry; endodontics; artificialintelligence; traumatology

Special Issue Information

Dear Colleagues,

Endodontics is a rapidly evolving field in dentistry with an impact on patients’ general health and quality of life. In recent decades, translational research has led to many advances which have shaped the way of diagnosing, understanding and treating endodontic diseases.

Histological studies facilitated the understanding of biological pathways of pulpal diseases and the development of strategies for classifying and treating them. Additionally, three-dimensional radiographs (dental cone-beam computed tomography) made it possible to gain more insights into complex root canal anatomies and periapical structures for more targeted treatment planning and conduct. A new promising approach for improving quality in diagnosis and treatment planning is the application of artificial intelligence for detecting patterns on radiographs or for assisting endodontic treatment planning.

Additionally, new materials and technologies were also implemented for endodontic treatments. The introduction of biocompatible hydraulic calcium silicate cements in the late 1990s has significantly improved the prognosis of certain endodontic therapies, and has dramatically broadened the possibility of retaining teeth via endodontic treatment. Simultaneously, newly developed nickel–titanium alloys have enabled the development of machine-driven endodontic files for more effective and less-invasive root canal preparation compared to traditional hand preparations. Further improvements were also made in root canal disinfection protocols and methods, and first attempts towards regenerating the pulp have been clinically validated, concluding the journey from better understanding the biological foundation of endodontic diseases towards achieving improved outcomes for patients.

Last, the impacts and benefits, but also costs, of endodontic therapies have been increasingly in focus. Understanding why patients value certain therapies, evaluating their long-term costs and benefits, and assessing how healthcare systems may be best equipped to provide high-quality, affordable endodontic therapy is another important focus of more recent research in the domain.

As the Guest Editors, we are looking forward for original studies and systematic reviews concerning recent advances in the field of endodontics.

Prof. Dr. Falk Schwendicke
Dr. Sascha Herbst
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

endodontics
vital pulp therapy
cone-beam computed tomography
artificial intelligence
root canal preparation
hydraulic calcium silicate cement

Published Papers (7 papers)

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Research

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10 pages, 1018 KiB

Open AccessArticle

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

by Nelly Schulz-Weidner, Jiameng Wang, Jessica Steinbart, Anton G. Windfelder, Gabriele A. Krombach, Norbert Krämer, Maximiliane A. Schlenz and Jan Scherberich

J. Clin. Med. 2023, 12(24), 7718; https://doi.org/10.3390/jcm12247718 - 15 Dec 2023

Cited by 2 | Viewed by 1000

Abstract

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. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Endodontic Diseases)

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10 pages, 546 KiB

Open AccessFeature PaperArticle

Machine Learning to Predict Apical Lesions: A Cross-Sectional and Model Development Study

by Sascha Rudolf Herbst, Vinay Pitchika, Joachim Krois, Aleksander Krasowski and Falk Schwendicke

J. Clin. Med. 2023, 12(17), 5464; https://doi.org/10.3390/jcm12175464 - 23 Aug 2023

Viewed by 805

Abstract

(1) Background: We aimed to identify factors associated with the presence of apical lesions (AL) in panoramic radiographs and to evaluate the predictive value of the identified factors. (2) Methodology: Panoramic radiographs from 1071 patients (age: 11–93 a, mean: 50.6 a ± 19.7 a) with 27,532 teeth were included. Each radiograph was independently assessed by five experienced dentists for AL. A range of shallow machine learning algorithms (logistic regression, k-nearest neighbor, decision tree, random forest, support vector machine, adaptive and gradient boosting) were employed to identify factors at both the patient and tooth level associated with AL and to predict AL. (3) Results: AL were detected in 522 patients (48.7%) and 1133 teeth (4.1%), whereas males showed a significantly higher prevalence than females (52.5%/44.8%; p < 0.05). Logistic regression found that an existing root canal treatment was the most important risk factor (adjusted Odds Ratio 16.89; 95% CI: 13.98–20.41), followed by the tooth type ‘molar’ (2.54; 2.1–3.08) and the restoration with a crown (2.1; 1.67–2.63). Associations between factors and AL were stronger and accuracy higher when using fewer complex models like decision tree (F1 score: 0.9 (0.89–0.9)). (4) Conclusions: The presence of AL was higher in root-canal treated teeth, those with crowns and molars. More complex machine learning models did not outperform less-complex ones. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Endodontic Diseases)

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19 pages, 4938 KiB

Open AccessArticle

Roots and Root Canals Characterization of Permanent Mandibular Premolars Analyzed Using the Cone Beam and Micro Computed Tomography—A Systematic Review and Metanalysis

by Mohmed Isaqali Karobari, Ali A. Assiry, Galvin Sim Siang Lin, Hussain Almubarak, Saleh Ali Alqahtani, Robina Tasleem, Mohammed Mustafa, Alexander Maniangat Luke, Krishna Prasad Shetty, Tahir Yusuf Noorani and Giuseppe A. Scardina

J. Clin. Med. 2023, 12(6), 2183; https://doi.org/10.3390/jcm12062183 - 11 Mar 2023

Cited by 8 | Viewed by 1741

Abstract

This current paper aims to review the literature on the root canal configuration (RCC) and root structure of permanent mandibular premolars. To find the published scientific literature on the RCC of mandibular premolars up to July 2022, a systematic search of four electronic databases was performed. The studies were selected, rendering to a predetermined point of reference: “mandibular 2nd premolar”, “root and canal system”, “morphology of root and canal”, “root and canal configuration”, and “morphology”, along with “anatomy” and “mandibular premolars”. Cross-referencing along with screening through the bibliographies of the chosen articles resulted in the identification of further studies. In the current study, we examined 30 different articles, and we chose them based on the quality of research investigations. From 3471 retrieved studies, a total of 15981 mandibular 2nd premolars were observed in 30 studies. The mean JBI score for studies assessing the structure of the root, as well as the root canal of the mandibular 2nd premolar, was 7.78 ± 0.81. We have found a pooled prevalence of 91.82% for Vertucci class I root canal morphology and 78.63% pooled prevalence of single-rooted mandibular second premolar. A total of 8677 mandibular 1st premolars were observed in 22 studies. The mean JBI score for studies assessing the structure and anatomy of the root, as well as root canal of mandibular 1st premolar, was 7. 95 ± 0.85. We have found a pooled prevalence of 74.34% for Vertucci class I root canal morphology and 85.20% pooled prevalence of single-rooted mandibular 1st premolar. Mandibular first and second premolars were mostly single-rooted teeth (89.5–100%). The most frequently seen RCC is a 1-1-2-/2 (type V–Vertucci’s), followed by 1-1-2-/1 (type IV– Vertucci’s; type III–Weine’s), and finally RCC 2-2-2-1 (type IV–Vertucci’s; type III–Weine’s). Presently, the imaging of CBCT is the most used research approach for studying Mn2Ps’ structural characteristics. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Endodontic Diseases)

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9 pages, 1852 KiB

Open AccessArticle

Influence of Ascorbic Acid as a Growth and Differentiation Factor on Dental Stem Cells Used in Regenerative Endodontic Therapies

by Antje Diederich, Hanna Juliane Fründ, Bogusz Trojanowicz, Alexander Navarrete Santos, Anh Duc Nguyen, Cuong Hoang-Vu and Christian Ralf Gernhardt

J. Clin. Med. 2023, 12(3), 1196; https://doi.org/10.3390/jcm12031196 - 2 Feb 2023

Cited by 5 | Viewed by 2103

Abstract

Background: Vitamin C is one of the major extracellular nonenzymatic antioxidants involved in the biosynthesis of collagen. It promotes the growth of fibroblasts, wound healing processes, and enhances the survival and differentiation of osteoblasts. The potential effects of ascorbic acid on human dental pulp cells (DPC) and the cells of the apical papilla (CAP) used in actual regenerative endodontic procedures remain largely unknown. In this study, we investigated the possible employment of ascorbic acid in the differentiation and regenerative therapies of DPC and CAP. Methods: Nine extracted human wisdom teeth were selected for this study. Subpopulations of stem cells within DPC and CAP were sorted with the mesenchymal stem cell marker STRO-1, followed by treatments with different concentrations (0 mM, 0.1 mM, 0.5 mM, and 1.0 mM) of ascorbic acid (AA), RT-PCR, and Western blot analysis. Results: FACS analysis revealed the presence of cell subpopulations characterized by a strong expression of mesenchymal stem cell marker STRO-1 and dental stem cell markers CD105, CD44, CD146, CD90, and CD29. Treatment of the cells with defined amounts of AA revealed a markedly increased expression of proliferation marker Ki-67, especially in the concentration range between 0.1 mM and 0.5 mM. Further investigations demonstrated that treatment with AA led to significantly increased expression of common stem cell markers OCT4, Nanog, and Sox2. The most potent proliferative and expressional effects of AA were observed in the concentration of 0.1 mM. Conclusions: AA might be a novel and potent growth promoter of human dental cells. Increasing the properties of human dental pulp cells and the cells of the apical papilla using AA could be a useful factor for further clinical developments of regenerative endodontic procedures. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Endodontic Diseases)

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20 pages, 4660 KiB

Open AccessArticle

Effectiveness of Teeth Whitening after Regenerative Endodontics Procedures: An In Vitro Study

by Irini Fagogeni, Joanna Metlerska, Tomasz Falgowski, Maciej Górski, Mariusz Lipski and Alicja Nowicka

J. Clin. Med. 2022, 11(23), 7016; https://doi.org/10.3390/jcm11237016 - 28 Nov 2022

Cited by 1 | Viewed by 1879

Abstract

Discolouration resulting from regenerative endodontic procedures may have a negative impact on the quality of life of treated patients; therefore, it is recommended to minimize this risk by selecting appropriate scaffolds and barrier materials, and if discolouration occurs, the use of a simple, cost-effective and minimally invasive technique, such as whitening, should be considered. This in vitro study aimed to evaluate tooth discolouration after two- and single-visit regenerative endodontic procedures and the effectiveness of subsequent whitening procedures with carbamide peroxide. Two hundred bovine incisors were included in this study and divided into twenty groups based on the tested material combinations. Two groups were control groups, one with saline and the other group with blood. In the 12 groups, the experiment was designed to be consistent with the two-visit regenerative endodontic procedures. Triple antibiotic paste or calcium hydroxide were placed in the root canal, and then scaffolds (e.g., blood or platelet-rich fibrin) and barrier materials (Biodentine, OrthoMTA or MTA Repair HP) were applied after rinsing the disinfectant pastes. In the six groups that corresponded to the single-visit regenerative endodontic procedure, the use of a disinfectant paste was omitted. Subsequently, the specimens were bleached twice with carbamide peroxide at a 7-day interval. Colour change measurements were performed using a spectrophotometer (VITA Easyshade Compact 5.0, VITA Zahnfabrik, Bad Säckingen, Germany). Statistical analysis was performed with the Kruskal–Wallis H test, the independent t-test and t-test for related samples. Tooth discolouration was noticed after two- and single-visit regenerative endodontic procedures, except for the platelet-rich fibrin+MTA Repair HP group. After the first and second whitening procedures, all of the tested two- and single-visit regenerative endodontic procedures groups showed a change in the colour of the crown, which was noticeable to the naked eye (∆E > 3.3). When analysing the ∆E value between the first and second bleaching procedures, no changes in the colour of teeth were visually noticed in the calcium hydroxide and platelet-rich fibrin +MTA Repair HP groups (∆E < 3.3). Single-visit regenerative endodontic procedures are suggested if possible; however, if two-visit regenerative endodontic procedures are performed, it is recommended to use calcium hydroxide as the disinfectant paste because of the lower staining potential. In the context of discolouration, platelet-rich fibrin is advisable for use as a scaffold. The whitening procedure is worth considering, but does not guarantee a return to the original tooth colour, especially when triple antibiotic paste is used. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Endodontic Diseases)

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15 pages, 4303 KiB

Open AccessArticle

Plasma Rich in Growth Factors in the Treatment of Endodontic Periapical Lesions in Adult Patients: 3-Dimensional Analysis Using Cone-Beam Computed Tomography on the Outcomes of Non-Surgical Endodontic Treatment Using A-PRF+ and Calcium Hydroxide: A Retrospective Cohort Study

by Katarzyna Machut and Agata Żółtowska

J. Clin. Med. 2022, 11(20), 6092; https://doi.org/10.3390/jcm11206092 - 16 Oct 2022

Cited by 3 | Viewed by 1610

Abstract

The study presents results of periapical lesion healing after one-visit root canal treatment (RCT) with Advanced Platelet Rich Fibrin plus (A-PRF+) application compared to a two-visit RCT with an inter-appointment calcium hydroxide filling. The comparison was made based on CBCT-Periapical Index (PAI) lesion volume changes and the occurrence of post endodontic pain. The results of 3D radiographic healing assessments based on volume reduction criteria were different from the CBCT-PAI. Based on volume changes, the healing assessment criteria-9 cases from the Study Group and six cases in the Control Group were defined as healed. Based on the CBCT-PAI healing assessment criteria, 8 cases from the Study Group and 9 cases from the Control Group were categorized as healed. The volumes of apical radiolucency were, on average, reduced by 85.93% in the Study Group and by 72.31% in the Control Group. Post-endodontic pain occurred more frequently in the Control than in the Study Group. The highest score of pain in the Study Group was five (moderate pain, n = 1), while in the Control Group, the highest score was eight (severe pain, n = 2). In the 6-month follow-up, CBCT scans showed a better healing tendency for patients in the Study Group. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Endodontic Diseases)

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Review

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11 pages, 1094 KiB

Open AccessReview

Application of the Extracts of Uncaria tomentosa in Endodontics and Oral Medicine: Scoping Review

by Mario Dioguardi, Francesca Spirito, Diego Sovereto, Andrea Ballini, Mario Alovisi and Lorenzo Lo Muzio

J. Clin. Med. 2022, 11(17), 5024; https://doi.org/10.3390/jcm11175024 - 26 Aug 2022

Cited by 3 | Viewed by 1799

Abstract

Background: The main purpose of endodontic treatment is to eliminate the bacteria that are responsible for the contamination and infection of the internal surfaces in order to resolve any pulp or periapical pathology. In fact, some bacteria, such as Enterococcus faecalis, can escape the action of root canal irrigants by aggregating into a biofilm and penetrating deeply into the dentinal tubules. Uncaria tomentosa is a plant belonging to the Rubiaceae family and also commonly known as cat’s claw due to the shape and position of the spines; it is a traditional Peruvian medicinal plant of Amazonian origin. Applications in the dental field have been described both in the prevention and treatment of stomatitis and as an antibacterial and anti-inflammatory agent; it has also been investigated as an additive in irrigants and specifically as gels in endodontic cements. The aim of this scoping review is to summarize all the scientific evidence on the possible applications of Uncaria tomentosa extracts in endodontics and, more generally, in oral medicine, in order to understand whether the active ingredients extracted from Uncaria tomentosa can bring a real advantage in endodontics, in the reduction of endodontic failures and in the onset of recurrent endodontic lesions. Methods: The scoping review was carried out strictly following the PRISMA-ScR checklist; the search was carried out on five databases (PubMed, Scopus, Science Direct, EBSCO and Web of Science) and a register (Cochrane library). Results: The research produced a number of bibliographic sources totaling 2104. With the removal of duplicates, 670 were obtained; potentially eligible articles amounted to 23, of which only seven in vitro studies (four microbiological studies), five clinical studies (three randomized trials) and a case report were included. Conclusions: From the data in the literature, it can be stated that the active ingredients present in Uncaria tomentosa could represent an interesting product to be used in the endodontic field, both in endocanalary cements and as a gel. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Endodontic Diseases)

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