Dentistry Journal

Research

Jump to: Review

13 pages, 656 KiB

Open AccessArticle

Impact of Clinician Experience on Intraosseous Anesthesia Outcomes in Endodontic Treatment: Retrospective Cohort Study

by Ahmed I. Alali, Jacqueline Lopez Gross, Mustafa Ayad Al-Sumaidaee, Michelle Wong, Sean Xinyang Feng, Pavel S. Cherkas and Bettina R. Basrani

Dent. J. 2025, 13(6), 238; https://doi.org/10.3390/dj13060238 - 27 May 2025

Viewed by 263

Abstract

Objectives: Although many studies have demonstrated the effectiveness of intraosseous anesthesia (IOA), the experience of clinicians administering IOA has rarely been reported. Some endodontists may never have received formal training in IOA, raising questions about whether inexperienced clinicians can achieve similar results. [...] Read more.

Objectives: Although many studies have demonstrated the effectiveness of intraosseous anesthesia (IOA), the experience of clinicians administering IOA has rarely been reported. Some endodontists may never have received formal training in IOA, raising questions about whether inexperienced clinicians can achieve similar results. Although the previous studies suggest that limited experience may increase the risk of complications, the extent to which clinician experience influences IOA outcomes remains uncertain. This study sought to assess whether clinician experience affects the effectiveness, patient comfort, and safety of IOA in endodontic treatment. Methods: This retrospective cohort study included 72 patients who had previously undergone endodontic treatment or retreatment for mandibular molars. Of these, 37 were treated by an endodontic resident with limited IOA experience, and 35 by an endodontist with extensive IOA experience. IOA was administered using the QuickSleeper 5 system (Dental Hi Tec, Cholet Cedex, France) as the sole anesthetic technique before the start of the endodontic treatment or retreatment. Pain assessments were recorded preoperatively (baseline), during IOA administration, and during the treatment. Statistical analyses included binomial and chi-square tests to compare the success rates and associations between the clinician experience and the IOA outcomes. Statistical significance was set at p < 0.05. Results: Pain during IOA administration was reported as none or mild in 98.6% of the patients, with no significant difference between the endodontist (97.2%) and resident (100%) groups (p = 0.378). Profound anesthesia was achieved in 94.1% of the cases, with no significant difference between the endodontist (96.8%) and resident (91.9%) groups (p = 0.738). Complications were rare, with two cases of perforator separation (5.4%) in the resident group; nevertheless, clinician experience was not significantly associated with complications (p = 0.553). Conclusions: Within the limitations of this study, clinician experience did not significantly affect the IOA outcomes, including effectiveness, patient comfort, and safety. These findings suggest that IOA can be used effectively by clinicians with different levels of experience, thus supporting its broader implementation in endodontic practice. Full article

(This article belongs to the Special Issue Endodontics: From Technique to Regeneration)

► Show Figures

Figure 1

14 pages, 10329 KiB

Open AccessArticle

SEM and Bacteriological Evidence of Laser-Activated Irrigation Compared to Ultrasonic-Activated Irrigation: A Pilot Study

by David E. Jaramillo, Ji W. Jeong, Zhen Shen and Enrico Divito

Dent. J. 2025, 13(5), 195; https://doi.org/10.3390/dj13050195 - 29 Apr 2025

Viewed by 385

Abstract

Background: Pulp tissue debridement and the eradication of microorganisms from an infected root canal system before obturation is a primary focus of endodontic treatment and the best predictor for the long-term success of endodontic treatment. Objective: The purpose of this in vitro laboratory [...] Read more.

Background: Pulp tissue debridement and the eradication of microorganisms from an infected root canal system before obturation is a primary focus of endodontic treatment and the best predictor for the long-term success of endodontic treatment. Objective: The purpose of this in vitro laboratory study was to evaluate pulp tissue debridement and the disinfection efficacy of two different Er;Cr:YSGG laser units, with a 2790 nm wavelength, compared to ultrasonic-activated irrigation (UAI) in root canals infected with Enterococcus faecalis. Methods: Human non-infected mandibular first molars were extracted, disinfected, and cultured with Enterococcus faecalis. Different types of Er;Cr:YSGG laser irrigation and UAI were performed according to the manufacturers’ protocols. The teeth were then processed for bacteriological and SEM analyses. Results: The different laser-activated irrigation protocols showed multiple areas of remaining bacteria, biofilm, tissue, and thermal ablation. The laser fiber tips also displayed significant tip degradation after use, which might affect efficacy. Conclusions: In this in vitro study, laser-activated irrigation using Er;Cr:YSGG technology and UAI were inefficient in eliminating pulp tissue from difficult-to-reach areas and Enterococcus faecalis from infected root canals. Full article

(This article belongs to the Special Issue Endodontics: From Technique to Regeneration)

► Show Figures

Graphical abstract

8 pages, 327 KiB

Open AccessArticle

Dissolution of Bovine Palatal Tissue with Degassed Sodium Hypochlorite

by Justin Fang, Zhen Shen, Ransome van der Hoeven and David E. Jaramillo

Dent. J. 2025, 13(3), 110; https://doi.org/10.3390/dj13030110 - 28 Feb 2025

Viewed by 621

Abstract

Objective: To investigate the tissue dissolution efficacy of different concentrations of sodium hypochlorite (NaOCl) using the GentleWave^® technology (GW) and compare it with that of passive ultrasonic irrigation. This study will provide a novel in vitro model used to evaluate the tissue [...] Read more.

Objective: To investigate the tissue dissolution efficacy of different concentrations of sodium hypochlorite (NaOCl) using the GentleWave^® technology (GW) and compare it with that of passive ultrasonic irrigation. This study will provide a novel in vitro model used to evaluate the tissue dissolution efficacy of different concentrations of NaOCl using the GentleWave^® procedure. Materials and Methods: Palatal bovine tissue was standardized by weight at 70–75 mg (average of 74.4 mg). The samples were divided into three groups of n = 10, Group 1: GW + 0.5% NaOCl, Group 2: GW + 3% NaOCl, and Group 3: ultrasonic group (US) + 6% NaOCl, and a control group of n = 2 with GW + H₂O. A specialized CleanFlow instrument was manufactured for the GW groups. For the US group, an apparatus was developed to allow the tissue to be in close contact with a freely operating ultrasonic tip. Each group was operated with its specific irrigants and dissolution times were obtained unless the samples were not visually dissolved within 5 min, and the dissolution rates were calculated. Dissolution times and rates were analyzed using univariate analysis of variance followed by a t-test. Results: The GW groups with 0.5% and 3% NaOCl dissolved entire tissue samples within 5 min and had average dissolution times of 227.5 s (Group 1) and 81.5 s (Group 2). GW with water had a higher tissue dissolution rate than ultrasonics with 6% NaOCl. Conclusions: The GentleWave^® using a lower concentration of NaOCl showed a similar clinical efficacy of dissolving tissues but displayed a significantly faster rate when compared with passive ultrasonic agitation. Full article

(This article belongs to the Special Issue Endodontics: From Technique to Regeneration)

► Show Figures

Figure 1

12 pages, 1282 KiB

Open AccessArticle

Quantitative Assessment of Apically Extruded Debris During Retreatment Procedures Using Three Nickel-Titanium Rotary Systems: An In Vitro Comparative Study

by Luigi Generali, Federica Veneri, Francesco Cavani, Vittorio Checchi, Carlo Bertoldi, Angela Lucia Ingrosso, Giusy Rita Maria La Rosa and Eugenio Pedullà

Dent. J. 2024, 12(12), 384; https://doi.org/10.3390/dj12120384 - 26 Nov 2024

Cited by 1 | Viewed by 1025

Abstract

Objectives: Apical extrusion of debris can affect the success of endodontic treatments, and the specific performance of certain retreatment systems has not been studied yet. Therefore, the aim of this in vitro study was to quantitatively assess the amount of apically extruded [...] Read more.

Objectives: Apical extrusion of debris can affect the success of endodontic treatments, and the specific performance of certain retreatment systems has not been studied yet. Therefore, the aim of this in vitro study was to quantitatively assess the amount of apically extruded debris produced during retreatment procedures using three rotary NiTi retreatment systems in mature non-resorbed straight roots. Methods: Thirty extracted permanent human teeth with single straight roots were selected. The root canals were prepared with the ProTaper Next system up to size 30 and obturated with gutta-percha and AH Plus sealer using the continuous wave of condensation technique. The samples were stored for 30 days and randomized by computer sequence into three retreatment groups (n = 10): (1) ProTaper Universal Retreatment; (2) HyFlex Remover; and (3) VDW.Rotate Retreatment. Apically extruded debris was collected in Eppendorf tubes and weighed with a microbalance (10⁻⁵ g) before and after retreatment procedure. As the data were not normally distributed, the Kruskal–Wallis test was applied for comparing data among groups, with an alpha level set at α = 0.05. Dunn’s test was considered for post-hoc analyses, if appropriate. Results: Hyflex Remover was associated with the highest amount of extruded debris (0.85 ± 0.82 mg), followed by VDW.Rotate Retreatment (0.78 ± 0.41 mg) and ProTaper Universal Retreatment (0.62 ± 0.28 mg). However, the differences were not statistically significant (p > 0.05). Conclusions: All the retreatment systems tested were associated with apical extrusion of debris in vitro, with no significant quantitative differences between them, suggesting that clinicians can choose a retreatment system with features appropriate to the specific clinical situation without risk of increasing the amount of apically extruded debris. Full article

(This article belongs to the Special Issue Endodontics: From Technique to Regeneration)

► Show Figures

Graphical abstract

11 pages, 1853 KiB

Open AccessArticle

Accuracy and Efficiency of the Surgical-Guide-Assisted Fiber Post Removal Technique for Anterior Teeth: An Ex Vivo Study

by Ryota Ito, Satoshi Watanabe, Kazuhisa Satake, Ryuma Saito and Takashi Okiji

Dent. J. 2024, 12(10), 333; https://doi.org/10.3390/dj12100333 - 18 Oct 2024

Cited by 1 | Viewed by 1391

Abstract

Background/Objectives: This study compared the accuracy and efficiency of different surgical-guide (SG)-assisted and freehand drilling techniques for removing fiber posts from maxillary anterior teeth performed by differently experienced operators. Methods: A fiber post was bonded to the root canal of 54 extracted maxillary [...] Read more.

Background/Objectives: This study compared the accuracy and efficiency of different surgical-guide (SG)-assisted and freehand drilling techniques for removing fiber posts from maxillary anterior teeth performed by differently experienced operators. Methods: A fiber post was bonded to the root canal of 54 extracted maxillary anterior teeth. After mounting the teeth in the jaw models, SGs were designed by integrating cone-beam computed tomography (CBCT) and intraoral scanner data. Each SG included a custom sleeve. An experienced or inexperienced operator drilled the post using three different techniques: (i) SG-assisted incremental drilling at 2–3 mm (SG1), (ii) SG-assisted one-time drilling to a predetermined depth (SG2), and (iii) freehand incremental drilling without SG (FH; n = 9 in each group). Deviations in coronal, sagittal, and horizontal planes and the angle of deviation were measured. Results: The SG1 and SG2 groups showed significantly smaller sagittal and horizontal deviations than the FH group, regardless of the operator’s experience. The SG2 group had a significantly shorter working time than the SG1 and FH groups. In the FH group, the experienced operator required a significantly shorter working time than the inexperienced operator. Conclusions: SG-assisted drilling techniques enhanced the accuracy and efficiency of removing fiber posts from the anterior teeth, irrespective of the operator’s experience. Full article

(This article belongs to the Special Issue Endodontics: From Technique to Regeneration)

► Show Figures

Figure 1

11 pages, 1223 KiB

Open AccessArticle

Prevalence and Classification of C-Shaped Canal and Radix in Mandibular Molars Using Cone-Beam Computed Tomography on Mexican Population

by Hugo Bojorquez Armenta, Angel Gustavo Romo Mireles, Javier Solis Martinez, Jesus Pescador Alvarez, Yarely Ramos Herrera, Omar Tremillo Maldonado, Oscar Almeda Ojeda, Jose Salas Pacheco, Gamaliel Ortiz Sarabia, Francisco Xavier Castellanos-Juarez and Sergio Salas Pacheco

Dent. J. 2024, 12(7), 212; https://doi.org/10.3390/dj12070212 - 10 Jul 2024

Cited by 4 | Viewed by 2394

Abstract

The diverse morphological configurations in teeth present clinical challenges in root canal treatment, complicating instrumentation and irrigation processes, which can lead to treatment failure. Understanding anatomical variations, such as C-shaped canals and radix entomolaris, enhances clinical skills and improves long-term endodontic treatment success [...] Read more.

The diverse morphological configurations in teeth present clinical challenges in root canal treatment, complicating instrumentation and irrigation processes, which can lead to treatment failure. Understanding anatomical variations, such as C-shaped canals and radix entomolaris, enhances clinical skills and improves long-term endodontic treatment success rates. Cone-beam computed tomography (CBCT) offers superior diagnostic capabilities over conventional radiography, enabling the pre-operative detection of root configurations and canal numbers, facilitating personalized endodontic treatments. A total of 2173 teeth of a Mexican population, including 1057 first mandibular molars and 1116 s mandibular molars, were studied using only CBCT to identify C-shaped canals and radix configurations of patients who were treated from 2018 to 2023 at the Department of Radiology at the Faculty of Dentistry, Juarez University of the State of Durango, Mexico. C-shaped canals were identified in 160 teeth, with a prevalence of 0.2% in first mandibular molars and 14.1% in second mandibular molars. The highest frequency was in the left second mandibular molar (3.7) at 14.8%. Gender differences were significant, with higher prevalence in females (27.3%) compared to males (13.3%). The most common C-shaped canal configuration was type C2 (39.3%). Radix entomolaris was found in 52 teeth, with a prevalence of 3.4% in first mandibular molars and 1.4% in second mandibular molars. This research on a Mexican population using cone-beam computed tomography (CBCT) highlights significant findings in the prevalence and types of C-shaped canals and radix entomolaris in mandibular molars for this population. The left second mandibular molar (3.7) showed the highest prevalence at 14.8%, followed closely by the right second mandibular molar (4.7) at 13.5%, with a significant difference (p < 0.001). We found a significant difference in the prevalence of C-shaped canals between genders (p = 0.004, OR 1.78). Additionally, radix entomolaris (p < 0.001) was more frequently identified in first mandibular molars to a significant degree. These insights underscore the importance of CBCT in diagnosing complex root anatomies, which can greatly enhance the success rates of endodontic procedures by allowing for more tailored and precise treatments for this population. Full article

(This article belongs to the Special Issue Endodontics: From Technique to Regeneration)

► Show Figures

Graphical abstract

15 pages, 8522 KiB

Open AccessArticle

40-Year Outcome of Old-School, Non-Surgical Endodontic Treatment: Practice-Based Retrospective Evaluation

by Roland Frankenberger, Stephan Becker, Benedicta Beck-Broichsitter, Susanne Albrecht-Hass, Charlotte J. Behrens, Matthias J. Roggendorf and Andreas Koch

Dent. J. 2024, 12(4), 90; https://doi.org/10.3390/dj12040090 - 1 Apr 2024

Cited by 4 | Viewed by 2149

Abstract

(1) Background: Non-surgical endodontic treatment has been shown to be clinically successful; however, clinical long-term data are scarce. This practice-based retrospective clinical investigation evaluated endodontic outcomes over 40 years and identified relevant clinical co-factors. (2) Methods: Two experienced dental practitioners in two different [...] Read more.

(1) Background: Non-surgical endodontic treatment has been shown to be clinically successful; however, clinical long-term data are scarce. This practice-based retrospective clinical investigation evaluated endodontic outcomes over 40 years and identified relevant clinical co-factors. (2) Methods: Two experienced dental practitioners in two different private dental practices treated 174 patients with 245 teeth from 1969 to 1993. After root canal obturation, either a new direct restoration (amalgam, resin composite, or glass-ionomer cement) or the re-cementation of a pre-existing prosthetic restoration or renewal of prosthetic restoration followed. Metal posts (operator A) or metal screws (operator B) were inserted when coronal substance loss was significant. The primary outcome (i.e., tooth survival) was achieved when the endodontically treated tooth was, in situ, painless and had full function at the end of the observation period. A secondary outcome, the impact of different prognostic factors on survival rate, was evaluated. (3) Results: The overall mean survival was 56.1% of all treated teeth after 40 years of clinical service, resulting in an annual failure rate of 1.1%. Most investigated clinical co-factors (jaw, tooth position, intracanal dressings, post/screw placement, and gender) showed no significant influence on survival. (4) Conclusions: Even with materials and techniques from the 1970s and 1980s, successful root canal treatment was achievable. Except for post-endodontic restorations, most of the evaluated factors had no significant influence on the clinical long-term survival of root canal-treated teeth. Full article

(This article belongs to the Special Issue Endodontics: From Technique to Regeneration)

► Show Figures

Figure 1

11 pages, 1387 KiB

Open AccessArticle

Comparative Analysis of Endodontic 0.15 Stainless-Steel K-Files: Exploring Design, Composition, and Mechanical Performance

by Abayomi Omokeji Baruwa, Filipa Chasqueira, Sofia Arantes-Oliveira, João Caramês, Duarte Marques, Jaime Portugal and Jorge N. R. Martins

Dent. J. 2024, 12(2), 29; https://doi.org/10.3390/dj12020029 - 31 Jan 2024

Cited by 2 | Viewed by 2652

Abstract

To establish a glide path, smaller files (up to size 0.15) with tapers of 2% are commonly used as pathfinding files. They pre-shape the root canal space before transitioning to larger taper endodontic instruments, aiming to prevent procedural errors. This study aimed to [...] Read more.

To establish a glide path, smaller files (up to size 0.15) with tapers of 2% are commonly used as pathfinding files. They pre-shape the root canal space before transitioning to larger taper endodontic instruments, aiming to prevent procedural errors. This study aimed to compare the design, metal wire composition, and mechanical characteristics of seven different ISO size 15 stainless-steel hand files (K-File and C-File+). Ninety-one new stainless-steel ISO 15 K-files were mechanically tested. All files were inspected for deformations before the assessment. Dental operating microscope, scanning electron microscope (SEM), and optical microscope analyses were conducted on four randomly selected instruments from each group, and two instruments per group underwent an energy-dispersive X-ray spectroscopy (EDS) analysis. Buckling mechanical tests were performed using an Instron universal testing machine, and microhardness was assessed using a Vickers hardness tester. The statistical analysis employed the nonparametric Mood’s median test, with a significance level set at 0.05. The instrument design analysis unveiled variations in the active blade area length and the number of spirals, while maintaining consistent cross-sections and symmetrical blades. Distinct tip geometries and surface irregularities were observed. While the energy-dispersive X-ray spectroscopy confirmed similar compositions, the buckling strength and microhardness values exhibited variability across for all tested files. Notably, the Dentsply ReadySteel C-File+ recorded the highest buckling value (2.10 N), and the Dentsply ReadySteel K-File exhibited the lowest (1.00 N) (p < 0.05). Moreover, the Dentsply ReadySteel K-File recorded the highest microhardness value (703 HVN), while the SybronEndo Triple-Flex had the lowest (549 HVN) (p < 0.05). While similarities in cross-section design and metal wire composition were noted among the files, variations in the number of spirals and mechanical performance were also observed. Thus, all of these factors should be considered when selecting suitable files for an efficient root canal treatment. Full article

(This article belongs to the Special Issue Endodontics: From Technique to Regeneration)

► Show Figures

Figure 1

10 pages, 1630 KiB

Open AccessArticle

Effect of Dentin Conditioning with EDTA and Diode Lasers on Expression of Odontoblast-like Cell Markers of Dental Pulp Stem Cells

by Gabriela Martín, Valentín Preve, Kenneth Hargreaves, Anibal Diogenes, Carolina Inostroza, Nicole Saint-Jean and Claudia Brizuela

Dent. J. 2023, 11(9), 210; https://doi.org/10.3390/dj11090210 - 4 Sep 2023

Cited by 3 | Viewed by 3326

Abstract

Regenerative endodontic procedures rely on the delivery of mesenchymal stem cells into the root canal and on the effect of local growth factors from the dentin and blood clot. The aim of this study was to assess the effect of dentin conditioning with [...] Read more.

Regenerative endodontic procedures rely on the delivery of mesenchymal stem cells into the root canal and on the effect of local growth factors from the dentin and blood clot. The aim of this study was to assess the effect of dentin conditioning with ethylenediamine tetraacetic acid (EDTA) and diode lasers with different wavelengths (808 nm and 980 nm) on the expression of odontoblast-like cell markers. Forty dentin cylinders were divided into four groups according to the irrigation protocol: EDTA, EDTA + 808 nm diode laser, EDTA + 980 nm diode laser, and phosphate-buffered saline as the control group. Dental pulp stem cells were seeded into the previously conditioned cylinders and incubated for 14 days. The quantitative real-time polymerase chain reaction was used to evaluate the expression of dentin sialophosphoprotein (DSPP), dentin morphoprotein-1 (DMP-1), and transforming growth factor-beta 1 (TGF-β1). Data analysis was performed using the Kruskal–Wallis test. The activation of EDTA with 980 nm and 808 nm diode lasers resulted in lower DSPP and DMP-1 expression than that for EDTA alone (p < 0.05 and p < 0.01, respectively). The expression of TGF was similar among all groups. The highest level of expression of odontoblast-like differentiation markers was observed with EDTA alone. However, the use of an 808 nm diode laser during EDTA irrigation reduced the expression of odontoblastic differentiation markers. Full article

(This article belongs to the Special Issue Endodontics: From Technique to Regeneration)

► Show Figures

Graphical abstract

Review

Jump to: Research

12 pages, 457 KiB

Open AccessReview

Retreatment Strategies for Cases Containing Calcium Silicate-Based Root Canal Sealers: A Comprehensive Review

by Hussain Al akam, Hyeon-Cheol Kim and Ji Wook Jeong

Dent. J. 2024, 12(2), 41; https://doi.org/10.3390/dj12020041 - 18 Feb 2024

Cited by 4 | Viewed by 3636

Abstract

This review explores the field of retreatment strategies for cases filled with calcium silicate-based root canal sealers. Since the introduction of calcium silicate-based materials in dentistry, calcium silicate-based root canal sealers have become popular among dentists because of their biocompatibility, bioactivity, and sealing [...] Read more.

This review explores the field of retreatment strategies for cases filled with calcium silicate-based root canal sealers. Since the introduction of calcium silicate-based materials in dentistry, calcium silicate-based root canal sealers have become popular among dentists because of their biocompatibility, bioactivity, and sealing ability. Therefore, effective retreatment strategies are indispensable. This article aims to identify the challenges associated with the removal of calcium silicate-based sealers themselves and removal of gutta-percha with the sealers during retreatment, evaluate current techniques and materials, and provide future directions for research in this field. Regarding the strategies of removal of root canal sealers, calcium silicate-based sealers are still relatively new materials for clinicians compared with traditional sealers such as epoxy- or eugenol-based sealers. First, no clinically established solvents have been reported. Second, calcium silicate-based sealers are currently utilized by clinicians in either the cold sealer-based technique or the warm vertical condensation technique. Third, the setting process of calcium silicate-based sealers generates byproducts, primarily calcium hydroxide and secondarily hydroxyapatite, that could interact with dentine. Lastly, there is a lack of clinical studies evaluating the efficacy of retreatment protocols for teeth filled with calcium silicate-based sealers. Therefore, it is important to investigate the chemo-mechanical properties of calcium silicate-based sealers themselves and their reactions to solvents and/or mechanical instruments and identify the interfacial properties of calcium silicate-based sealers with respect to dentine and gutta-percha. In addition, researchers in the clinical field need to actively gather and report data on retreatments of teeth filled with calcium silicate-based sealers. Full article

(This article belongs to the Special Issue Endodontics: From Technique to Regeneration)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Endodontics: From Technique to Regeneration

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (10 papers)

Research

Review

Further Information

Guidelines

MDPI Initiatives

Follow MDPI