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12 pages, 1599 KB

Open AccessArticle

Efficiency of Four Irrigation Needles in Curved Simulated Root Canals

by Benedicte Elisabeth Strand, Marianne Lægreid and Inge Fristad

Dent. J. 2026, 14(5), 278; https://doi.org/10.3390/dj14050278 - 7 May 2026

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Abstract

Background/Objectives: Effective irrigation of the apical third remains one of the greatest challenges in root canal treatment, particularly in curved canals where anatomical complexity restricts irrigant penetration. This in vitro study evaluated the irrigation efficacy of four syringe-needle designs under standardized conditions. Methods: [...] Read more.

Background/Objectives: Effective irrigation of the apical third remains one of the greatest challenges in root canal treatment, particularly in curved canals where anatomical complexity restricts irrigant penetration. This in vitro study evaluated the irrigation efficacy of four syringe-needle designs under standardized conditions. Methods: Ten transparent resin blocks with approximately 30° curved canals were instrumented to size 30/0.04 taper. Four irrigation needle designs were tested: flat open-ended (27G), notched open-ended (27G), double-vented closed-ended (27G), and finally a flexible polypropylene closed-ended (IrriFlex, 30G) used as a reference. Canals were filled with methylene blue and irrigated dynamically with distilled water. Residual dye was quantified spectrophotometrically at 665–668 nm. Data were analyzed using ANOVA with post hoc testing (p < 0.05). Results: Significant differences were found among the needle designs. The flexible polypropylene needle showed the lowest absorbance values and performed significantly better than both the flat open-ended and double-vented metallic needles. The notched open-ended needle demonstrated irrigation efficacy comparable to the flexible needle. The double-vented metallic needle exhibited the highest residual dye levels, indicating the poorest irrigation performance. Conclusions: Needle design significantly influences irrigation efficacy in curved root canals. Flexible and notched designs enhanced apical dye removal compared with conventional metallic open-ended and side-vented needles. Differences in performance appear to be governed by a combination of vent configuration, needle flexibility, penetration depth, and fluid-dynamic behavior rather than needle gauge alone. Full article

(This article belongs to the Special Issue Present Status and Future Directions in Endodontics)

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13 pages, 2522 KB

Open AccessArticle

Prevalence of Pre-Eruptive Intracoronal Resorption (PEIR) and Proposal of a Novel Classification: Retrospective Study with the Aid of Cone Beam Computed Tomography (CBCT)

by Emmanuel Mazinis, Konstantinos Ioannidis, Shanon Patel, Vassilis Karagiannis and Christos Gogos

Dent. J. 2026, 14(2), 118; https://doi.org/10.3390/dj14020118 - 17 Feb 2026

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Abstract

Background/Objectives: Pre-eruptive intracoronal resorption (PEIR) in impacted or unerupted teeth often remains undiagnosed. The aim of this study was to investigate the prevalence of PEIR with the aid of cone beam computed tomography (CBCT) and propose a new three-dimensional (3D) classification for [...] Read more.

Background/Objectives: Pre-eruptive intracoronal resorption (PEIR) in impacted or unerupted teeth often remains undiagnosed. The aim of this study was to investigate the prevalence of PEIR with the aid of cone beam computed tomography (CBCT) and propose a new three-dimensional (3D) classification for the analysis of the lesions. Methods: A total of 164 unerupted teeth diagnosed in CBCT scans, derived from an equivalent number of patients, were examined for the presence of PEIR, tooth type, angulation and position. A novel 3D classification system was proposed and all PEIR lesions were further classified. The classification system was used to stage PEIR lesions according to their extend from the enamel level apically, the circumferential spread and their proximity to the pulp chamber. Descriptive statistics were used to assess the prevalence and type of resorption. The association between PEIR, demographics, tooth type, position and angulation were studied. The estimation of the multivariate relationship between PEIR, patient’s demographics and tooth characteristics was conducted with the multiple binary logistic regression model. Results: The prevalence of PEIR was 33.5%, affecting mostly maxillary canines, and maxillary and mandibular molars. The prevalence of PEIR in ages over 45 years was significantly higher (p < 0.001). The presence of PEIR was significantly associated with buccal position (p = 0.002) and buccal angulation (p = 0.016) of the tooth. Conclusions: Due to the high prevalence of PEIR, CBCT may improve detection and 3D characterization when imaging is already clinically indicated, and influence treatment planning in selected cases. Full article

(This article belongs to the Special Issue Present Status and Future Directions in Endodontics)

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14 pages, 4639 KB

Open AccessArticle

The Intersection of Non-Communicable Chronic Disease and Endodontic Care: A Pilot Retrospective Cross-Sectional Study

by Fausto Zamparini, Mohamed Mowafy, Andrea Spinelli, Stefano Chersoni, Igor Diemberger, Antonella Polimeni, Maria Giovanna Gandolfi and Carlo Prati

Dent. J. 2026, 14(2), 74; https://doi.org/10.3390/dj14020074 - 2 Feb 2026

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Abstract

Objective: To evaluate the prevalence of systemic chronic diseases among patients undergoing endodontic therapy in a University Department of Endodontology and to assess their potential implications for treatment planning and prognosis. Methods: A retrospective cross-sectional study analysis was performed on clinical records of [...] Read more.

Objective: To evaluate the prevalence of systemic chronic diseases among patients undergoing endodontic therapy in a University Department of Endodontology and to assess their potential implications for treatment planning and prognosis. Methods: A retrospective cross-sectional study analysis was performed on clinical records of patients aged > 18 years treated at the Department of Endodontics, University of Bologna. Data collected included demographic information, presence of chronic systemic diseases, endodontic disease and medication history. Descriptive statistics were used to estimate prevalence rates. Results: More than one third of patients (35%) presented with at least one systemic chronic disease or multiple comorbidities. Cardiovascular diseases (19.8%) were the most prevalent. Polypharmacy was observed in 32% of patients. Patients aged 40 years and older showed a significantly higher prevalence of systemic conditions compared to younger individuals. Conclusions: The study supports the finding that a high percentage of patients undergoing endodontic therapies present systemic chronic diseases, multiple comorbid conditions and polypharmacy. It is important to assess these factors and to customize endodontic treatment and decision-making. These realities are likely to become even more pronounced in the coming years, as global population aging continues apace. Full article

(This article belongs to the Special Issue Present Status and Future Directions in Endodontics)

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9 pages, 2002 KB

Open AccessArticle

Fracture Resistance of Endodontically Treated Teeth with Different Perforation Diameters: An In Vitro Analysis

by Flora Kakoura, Kleoniki Lyroudia, Nikolaos Economides, Dimitrios Dimitriadis and Georgios Mikrogeorgis

Dent. J. 2026, 14(1), 12; https://doi.org/10.3390/dj14010012 - 1 Jan 2026

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Abstract

Objectives: The aim of this study was to investigate the relationship between the diameter of iatrogenic root perforations and the fracture resistance (FR) of endodontically treated teeth. Methods: Sixty-five single-rooted teeth were sectioned at 13 mm from the anatomic apex. Their [...] Read more.

Objectives: The aim of this study was to investigate the relationship between the diameter of iatrogenic root perforations and the fracture resistance (FR) of endodontically treated teeth. Methods: Sixty-five single-rooted teeth were sectioned at 13 mm from the anatomic apex. Their weight and the mesiodistal (MD) and buccolingual (BL) dimensions were recorded in order to ensure their allocation into five homogeneous groups (N = 13); Group 1 (control group): teeth remained intact, Group 2: teeth were instrumented but not perforated, Group 3: teeth were instrumented and perforated with a 2.1 mm bur, Group 4: teeth were instrumented and perforated with a 1 mm bur, and Group 5: teeth were instrumented and perforated with a 0.5 mm bur. All perforations were created at the same spot in the buccal surface of the roots. To further standardize the defects, an apparatus ensured that the cutting bur was positioned with a steady angle of 105° to the external root surface. A universal testing machine was used for fracture testing by applying a compressive vertical load at a speed of 1 mm/min until root fracture. The recorded forces were statistically analyzed with one-way analysis of variance (ANOVA) and post hoc Tukey test. Results: The mean fracture load was 342.68 ± 146.45 N for Group 1, 322.96 ± 98.62 N for Group 2, 214.65 ± 71.32 N for Group 3, 212.66 ± 77.89 N for Group 4, and 307.14 ± 109.16 N for Group 5. However, only the differences between groups 1–3 and 1–4 were statistically significant (p < 0.05). Conclusions: The teeth with 2.1 mm and 1 mm perforations were found to have significantly decreased FR. Full article

(This article belongs to the Special Issue Present Status and Future Directions in Endodontics)

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17 pages, 8204 KB

Open AccessArticle

Advanced Microstructural Investigation of the Endodontic Sealing Ability of Three Different Obturation Techniques

by Mihaela Păstrav, Radu Marcel Chisnoiu, Marioara Moldovan, Lucian Barbu Tudoran, Ioan Petean, Andrea Maria Chisnoiu and Ovidiu Păstrav

Dent. J. 2026, 14(1), 9; https://doi.org/10.3390/dj14010009 - 23 Dec 2025

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Abstract

Objectives: This study evaluated and compared the sealing ability and elemental composition of a resin-based endodontic sealer (AH Plus) used with three root canal obturation techniques: single cone (SC), lateral compaction (LC), and warm vertical condensation (WVC). The investigation focused on microstructural characteristics, [...] Read more.

Objectives: This study evaluated and compared the sealing ability and elemental composition of a resin-based endodontic sealer (AH Plus) used with three root canal obturation techniques: single cone (SC), lateral compaction (LC), and warm vertical condensation (WVC). The investigation focused on microstructural characteristics, interfacial integrity, and elemental distribution within filled root canals. Material and Methods: Sixty extracted single-root teeth were instrumented using the ProTaper Gold system and randomly assigned to three groups (n = 20) according to the obturation technique. The AH Plus Jet sealer was applied in all cases. Following obturation, samples were subjected to radiographic investigation and analyzed using optical microscopy and scanning electron microscopy (SEM) coupled with energy-dispersive X-ray spectroscopy (EDX) to assess the sealing performance and chemical composition. Results: Radiographic and microscopic assessments indicated that the SC method showed strong gutta-percha adhesion to dentin with a thin cement layer, whereas WVC provided excellent adaptation and penetration of gutta-percha. The LC technique demonstrated good adhesion but displayed occasional structural irregularities. SC has the thicker adhesion layer with uneven distribution regarding coronal, median, and apical, regions ranging from 45 to 80 μm, while WVC ensures a thin and uniform sealing layer of about 35 μm in all regions. SEM and EDX analyses detailed the interfacial microstructure and confirmed the presence of carbon (C), oxygen (O), calcium (Ca), zinc (Zn), barium (Ba), and sulfur (S) across all groups. Conclusions: All three obturation techniques (SC, WVC, LC) achieved effective sealing when combined with the AH Plus sealer. The main difference between the methods consists of the sealer layer thickness and its even distribution regarding gutta-percha cones. Full article

(This article belongs to the Special Issue Present Status and Future Directions in Endodontics)

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12 pages, 1788 KB

Open AccessArticle

Comparative Evaluation of the Intratubular Penetration Ability of Two Retrograde Obturation Techniques in Micro-Endodontic Surgical Procedure: An In Vitro Study with Confocal Laser Scanning Microscopy

by Alberto Casino Alegre, Michell Ramírez López, Manuel Monterde Hernández, Susana Aranda Verdú, Jorge Rubio Climent and Antonio Pallarés Sabater

Dent. J. 2025, 13(11), 509; https://doi.org/10.3390/dj13110509 - 3 Nov 2025

Cited by 1 | Viewed by 2772

Abstract

Background: The development of calcium silicate materials and new techniques have resulted in significant clinical benefits in endodontics and microapical surgery. The objective of this investigation was to analyze the percentage of dentinal tubule penetration of two retrograde obturation techniques in microapical surgery, [...] Read more.

Background: The development of calcium silicate materials and new techniques have resulted in significant clinical benefits in endodontics and microapical surgery. The objective of this investigation was to analyze the percentage of dentinal tubule penetration of two retrograde obturation techniques in microapical surgery, namely the conventional technique and the lid technique. Methods: 60 single-root human teeth were selected, which were divided into two groups (n = 30). These teeth were subjected to an endodontic procedure using the single-cone technique. They were prepared with apicoectomy and 3 mm apical retrocavity and then obturated using two retrograde obturation techniques with bioceramic materials: TotalFill RRM fast set Putty^® (RRM) using the conventional technique and TotalFill BC Sealer HiFlow^® (HiFlow) and RRM using the lid technique. The teeth were selected and evaluated using 1 mm portions in the apical third. In each case, the images were obtained using a Leica TCS SP8 Confocal Microscope (CLSM). The extent of penetration into the dentinal tubule regions was measured using AutoCad^®. Results: Statistical analyses were performed using the Levene test (p ≤ 0.05) and Student’s t-test (p ≤ 0.05). Analysis of the penetration area of calcium silicate materials into the dentinal tubules revealed that the relative penetration percentages were higher when using the conventional technique with the RRM than the lid technique with RRM + HiFlow in the apical third evaluated. Conclusion: The conventional technique yields significantly better outcomes, showing statistically significant differences in the percentage of penetration into the intratubular area compared to the lid technique. Full article

(This article belongs to the Special Issue Present Status and Future Directions in Endodontics)

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Review

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18 pages, 792 KB

Open AccessReview

CBCT in Evaluation of Root Canal Preparation—A Scoping Review

by Andreia Vidal, Ana Moura Teles, Miguel Cardoso, Maria Bartolomeu and Rita Noites

Dent. J. 2026, 14(2), 114; https://doi.org/10.3390/dj14020114 - 14 Feb 2026

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Abstract

Cone-beam computed tomography (CBCT) is widely utilized in endodontics for evaluating root canal shaping outcomes, offering critical three-dimensional imaging capabilities. This study aims to assess the differences in apical and root canal preparation across various instrumentation techniques using CBCT. A systematic search of [...] Read more.

Cone-beam computed tomography (CBCT) is widely utilized in endodontics for evaluating root canal shaping outcomes, offering critical three-dimensional imaging capabilities. This study aims to assess the differences in apical and root canal preparation across various instrumentation techniques using CBCT. A systematic search of the Medline database (via PubMed) and Web of Science was performed up to 12 April 2025, yielding a total of 70 studies, with 45 full-text articles assessed for eligibility; 28 were included in the review. Studies showed great heterogeneity in experimental design, anatomical variables, and outcome measurements. The results indicate that rotary instruments, such as ProTaper Next^® and XP-Endo Shaper^®, were reported more frequently or showed favorable shaping trends in individual studies. Although rotary systems often appeared advantageous, conclusions were limited by study design variability and a lack of correlation with clinical outcomes. The evidence highlights the need for standardized methodologies and further research, especially on manual techniques. CBCT remains a valuable research tool despite inherent spatial resolution limitations. Full article

(This article belongs to the Special Issue Present Status and Future Directions in Endodontics)

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Other

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21 pages, 5262 KB

Open AccessCase Report

Root Resective Procedures: A Case Series of Tooth Hemisection and Bicuspidization with Prosthetic Rehabilitation in Contemporary Dental Practice

by Sofia Sokratous, Andreas Krokidis and Nikolaos P. Kerezoudis

Dent. J. 2026, 14(2), 122; https://doi.org/10.3390/dj14020122 - 20 Feb 2026

Viewed by 749

Abstract

Background/Objective: Root resective procedures are well established tooth-preserving techniques used when pathology is confined to one root of a multirooted tooth or in the furcation area. Although in recent years implant therapy has become a standard approach in many cases, the rising [...] Read more.

Background/Objective: Root resective procedures are well established tooth-preserving techniques used when pathology is confined to one root of a multirooted tooth or in the furcation area. Although in recent years implant therapy has become a standard approach in many cases, the rising incidence of peri-implantitis has renewed interest in classical conservative treatment alternatives, such as hemisection, root resection and bicuspidization. The aim of this study is to present clinical cases in which hemisection and bicuspidization were performed to maintain compromised molars in function and achieve long-term outcomes. Methods: This retrospective case series study was conducted in a private dental practice and included three patients treated between 2009 and 2017. The presented cases involved molar teeth exhibiting a vertical fracture or extensive subgingival carries in one root while the remaining root(s) demonstrated favourable periodontal, endodontic and restorative prognosis. An interdisciplinary approach was followed in each case, involving comprehensive clinical and radiographic evaluation including cone beam computed tomography when indicated. The clinical treatment included an endodontic approach (primary treatment or retreatment if required) followed by hemisection or bicuspidization and placement of a permanent prosthetic rehabilitation with full-coverage restoration designed to optimize proper load distribution. Clinical and radiographic follow-up examination was done up to six years in case one, after six months in case two and up to six years in case three. Results: The teeth remained in function through their respective follow-up periods. Clinical and radiographic assessments, according to predefined success criteria, demonstrated periodontal stability (probing depth ≤ 4 mm), no evidence of secondary caries or root fracture, absence of clinical symptoms, normal tooth mobility and masticatory function, absence or reduction in periradicular radiolucency, and stable bone levels. Conclusions: Resective techniques require an interdisciplinary approach, namely, careful case selection, lege artis endodontic treatment, precise surgical technique, and appropriate prosthetic rehabilitation, in order to provide predictable and long-term outcomes. Within the limitations of this case series, resective techniques appeared to be a reliable and predictable alternative to extraction and implant placement in carefully selected clinical cases. Full article

(This article belongs to the Special Issue Present Status and Future Directions in Endodontics)

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