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18 pages, 1501 KB

Open AccessArticle

Chitosan Molecular Weight Influences on Endodontic Biofilms and Material Enhancement Strategies

by Sumaya Abusrewil, Saeed S. Alqahtani, Mohammed Tiba, Charchit Kumar, Jerina Gjoka, Osama Ramadan, Suror Shaban, Daniel M. Mulvihill, Gordon Ramage, James Alun Scott and William McLean

Dent. J. 2026, 14(4), 192; https://doi.org/10.3390/dj14040192 - 24 Mar 2026

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Abstract

Objectives: The identification of novel antimicrobial agents for use in root canal treatment may provide opportunities to improve treatment outcomes. This study aimed to assess the antimicrobial efficacy of different molecular weights of chitosan (CS), and how modification with CS may impact on [...] Read more.

Objectives: The identification of novel antimicrobial agents for use in root canal treatment may provide opportunities to improve treatment outcomes. This study aimed to assess the antimicrobial efficacy of different molecular weights of chitosan (CS), and how modification with CS may impact on the antimicrobial, physico-mechanical and biological properties of Biodentine™, a calcium-silicate-based material used in endodontics. Methods: C. albicans biofilms were treated with either 3% sodium hypochlorite (NaOCl) or a 0.05% or 0.1% CS solution for 5 min. The growth medium was replenished, and cells were re-incubated for additional 72 h. Regrowth of biofilms was assessed using a colorimetric XTT assay. Additionally, multispecies biofilms were established and the regrowth of biofilms on Biodentine discs were quantified following the addition of 0.5 wt% and 1 wt% of CS powder using qPCR. The physico-mechanical and biological properties of the new composite of Biodentine and CS were also evaluated. Results: Viability readings revealed significant initial biofilm inhibitory effects of CS solutions, followed by significant regrowth after 72 h. Upon the addition of CS to Biodentine, significant reductions in multispecies biofilm regrowth were determined. Notably, the antibiofilm activity of CS was found to be increased as the molecular weight decreased. The addition of powdered CS of low molecular weight showed a reduction in the mechanical properties of Biodentine, whereas no detrimental effects on the other material properties were noted. Conclusions: Chitosan may not be useful as an alternative irrigant to NaOCl. Addition of CS to Biodentine represents a potential means of augmenting the antimicrobial activity of Biodentine against persistent microorganisms following endodontic therapy. Despite the reductions in mechanical properties of the material, the new composite still represents a viable material option when material strength and hardness are not critical. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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16 pages, 2355 KB

Open AccessArticle

The “Radicular Tank”: A Novel Concept in Endodontics Achieved with the MEA Inverse Taper^® Technique

by Giovanni Messina, Gaia Bonandi, Marta Marchica, Marta Longo, Luigi Stagno d’Alcontres, Lusien Distefano, Antonino Cacioppo, Pier Edoardo Maltagliati, Calogero Bugea, Eugenio Pedullà and Elena Bardellini

Dent. J. 2026, 14(3), 157; https://doi.org/10.3390/dj14030157 - 10 Mar 2026

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Abstract

Background: Successful root canal treatment depends on the synergy between mechanical instrumentation and chemical disinfection. The internal canal geometry, particularly taper configuration, critically influences irrigant flow and penetration. Conventional taper designs tend to displace irrigants coronally, creating stagnation zones and limiting cleaning efficacy. [...] Read more.

Background: Successful root canal treatment depends on the synergy between mechanical instrumentation and chemical disinfection. The internal canal geometry, particularly taper configuration, critically influences irrigant flow and penetration. Conventional taper designs tend to displace irrigants coronally, creating stagnation zones and limiting cleaning efficacy. The MEA Inverse Taper^® technique introduces a reversed taper geometry designed to retain irrigant within the canal during shaping, forming a fluid reservoir termed the Radicular Tank (RT). This proof-of-concept study aimed to experimentally demonstrate the formation of the RT generated by the MEA Inverse Taper^® design and to compare its qualitative hydrodynamic and shaping behavior with a conventional rotary system (MTWO). Methods: Standardized transparent canal models were instrumented using either the MEA Inverse Taper^® or MTWO sequence. A 1% methylene blue dye served as a visual tracer to assess potential intracanal retention at successive shaping stages. Standardized photographic documentation and digital image superimposition were used to evaluate residual dye retention, canal morphology, and taper variation. Results: The MEA Inverse Taper^® sequence maintained residual dye in the coronal and middle thirds, confirming the formation of the RT. Compared with MTWO, it produced a more conservative taper, minimized coronal and apical displacement of dye, and preserved canal curvature, removing less coronal dentin. Conclusion: The MEA Inverse Taper^® technique creates a qualitative dye-retention phenomenon (Radicular Tank) that allows continuous instrumentation within a visually persistent dye environment. This novel concept may support disinfection efficiency, alongside preserving dentin structure and reducing mechanical stress on rotary instruments, representing a potential advancement in endodontic shaping and irrigation protocols. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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19 pages, 6042 KB

Open AccessArticle

Impact of Taper Design on Cleaning Efficacy, Stress Generation, and Irrigant Performance: A Combined Experimental, Finite Element Analysis, and Computational Fluid Dynamics Assessment

by Celia Vinuesa Maqueda, Natalia Navarrete, Ana Ramírez-Muñoz, Ana Martín-Díaz, César de Gregorio, José Aranguren, Giulia Malvicini, Simone Grandini, Gaya C. S. Vieira and Alejandro R. Pérez

Dent. J. 2026, 14(2), 108; https://doi.org/10.3390/dj14020108 - 13 Feb 2026

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Abstract

Background/Objectives: This study aimed to compare the cleaning efficacy, biomechanical stress distribution under simulated occlusal loading after instrumentation, and irrigant dynamics of three NiTi rotary systems, namely ProTaper Gold, TruNatomy, and SlimShaper, using a combined experimental, finite element analysis (FEA), and computational fluid [...] Read more.

Background/Objectives: This study aimed to compare the cleaning efficacy, biomechanical stress distribution under simulated occlusal loading after instrumentation, and irrigant dynamics of three NiTi rotary systems, namely ProTaper Gold, TruNatomy, and SlimShaper, using a combined experimental, finite element analysis (FEA), and computational fluid dynamics (CFD) approach. Methods: Transparent 3D replicas of mandibular mesial roots filled with a gel-like pulp tissue were instrumented with the three systems (n = 13 per group). Standardized irrigation was performed with 4% NaOCl delivered through IrriFlex^® needles positioned 2 mm from the working length. Cleaning effectiveness was assessed through digital image analysis, FEA simulation of occlusal loading, and CFD evaluation of irrigation flow, wall shear stress, and dynamic pressure. Results: All systems left residual tissue, with no statistically significant differences in cleaning efficacy among them (p > 0.05). Descriptively, ProTaper Gold showed the lowest mean residual tissue (0.15 ± 0.25%), followed by SlimShaper (2.50 ± 3.81%) and TruNatomy (4.20 ± 5.12%). CFD revealed that ProTaper Gold generated the highest irrigant velocities and wall shear stresses, while SlimShaper showed the highest dynamic pressure. FEA indicated that ProTaper Gold produced the highest stress concentrations, especially in the pericervical dentin, whereas TruNatomy and SlimShaper preserved more dentin. Conclusions: Cleaning efficacy was comparable across systems. CFD/FEA from representative models illustrated patterns of irrigant dynamics and dentin preservation without supporting system superiority. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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16 pages, 1550 KB

Open AccessArticle

Comparative Analysis of Rotary Systems in Curved Root Canals: Evaluation of Wear, Transportation, and Centering Capacity

by Siri Paulo, Pedro Zagalo, Beatriz Louro, Ricardo Jorge Teixo, José Pedro Martinho, Tiago Nóbrega, Anabela Paula, Carlos Miguel Marto, Diogo Fonseca and Manuel Marques Ferreira

Dent. J. 2026, 14(2), 92; https://doi.org/10.3390/dj14020092 - 5 Feb 2026

Viewed by 532

Abstract

Background/Objectives: Root canal instrumentation has a crucial role in the success of endodontic treatment. However, management of curved root canals remains a challenge. This study aimed to compare the performance of four rotatory file systems, ProTaper Next, TruNatomy, ProTaper Ultimate and Race Evo, [...] Read more.

Background/Objectives: Root canal instrumentation has a crucial role in the success of endodontic treatment. However, management of curved root canals remains a challenge. This study aimed to compare the performance of four rotatory file systems, ProTaper Next, TruNatomy, ProTaper Ultimate and Race Evo, in terms of wear, transportation and centering capacity, in curved root canals. Methods: A total of 150 human tooth roots were selected, divided based on the degree of curvature, and then distributed into four experimental groups according to the rotary system used. Cone beam computed tomography images were obtained before and after instrumentation, and values were measured with ImageJ software. Results: Regarding root canal wear, the TruNatomy system displayed the lowest wear values, and the Race Evo system showed a tendency for greater wear. For transportation, TruNatomy and Race Evo had the lowest transportation, indicating a higher respect for the root canal’s original anatomy. For centering ability, Race Evo and ProTaper Ultimate displayed values closer to perfect centering compared to other systems. Conclusions: Overall, TruNatomy was confirmed as a more conservative system, Race Evo with a tendency for greater wear even though with a higher respect for root canal original anatomy. Race Evo and ProTaper Ultimate showed better centering ability. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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10 pages, 1533 KB

Open AccessArticle

Impact of Metallurgical and Geometric Features on the Cyclic Fatigue Strength of Reciprocating Endodontic Files

by Abayomi Omokeji Baruwa, Francisco M. Braz Fernandes and Jorge N. R. Martins

Dent. J. 2026, 14(2), 76; https://doi.org/10.3390/dj14020076 - 2 Feb 2026

Viewed by 391

Abstract

Background: Nickel–titanium (NiTi) endodontic instruments have undergone significant improvements in heat treatment processing and geometric design, aimed at enhancing flexibility, cutting efficiency, and fatigue strength. Reciprocating motion was introduced to increase cyclic fatigue resistance, which remains the predominant mode of failure in NiTi [...] Read more.

Background: Nickel–titanium (NiTi) endodontic instruments have undergone significant improvements in heat treatment processing and geometric design, aimed at enhancing flexibility, cutting efficiency, and fatigue strength. Reciprocating motion was introduced to increase cyclic fatigue resistance, which remains the predominant mode of failure in NiTi endodontic file systems. Although these instruments are widely used in both clinical practice and research, few comparative studies have integrated geometric, metallurgical and mechanical evaluations of the most commonly used reciprocating systems. Methods: In the present study, four single-file reciprocating NiTi systems (Reciproc Blue, WaveOne Gold, EdgeOne Fire, and Easy-File Flex) were evaluated for their geometric design, metallurgical composition, and cyclic fatigue strength. Stereomicroscopy and scanning electron microscopy were employed to assess active blade length, spiral configuration, and surface finish, while elemental composition and phase transformation temperatures were analyzed using energy-dispersive X-ray spectroscopy and differential scanning calorimetry. Ten instruments from each group were tested for cyclic fatigue using a standardized curved stainless-steel canal at room temperature, and the time to fracture was recorded. Fatigue data were statistically analyzed using Mood’s median test, with significance set at p < 0.05. Results: Reciproc Blue exhibited the longest active blade length, highest spiral density, and superior surface finish. R-phase start and finish temperatures were highest in WaveOne Gold and lowest in Easy-File Flex. Reciproc Blue demonstrated the higher cyclic fatigue strength, whereas Easy-File Flex showed the lowest. Conclusions: These findings suggest that the metallurgical and geometric characteristics of the Reciproc Blue file significantly enhance its strength to cyclic fatigue compared with the other instruments evaluated. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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18 pages, 4498 KB

Open AccessArticle

Cyclic Fatigue Resistance and Phase Transformation Behavior of SlimShaper and SlimShaper PRO NiTi Instruments: A Mechanical and Thermal Analysis

by Cristina Scolaro, Francesco Puleio, Andrea Sili and Annamaria Visco

Dent. J. 2026, 14(1), 22; https://doi.org/10.3390/dj14010022 - 4 Jan 2026

Viewed by 438

Abstract

Objectives: This study compared the cyclic fatigue resistance and the mechanical, thermal, and metallurgical characteristics of SlimShaper^® and SlimShaper PRO^® instruments. Both sequences include three instruments (ZS1–ZS3) with identical geometries, although SlimShaper PRO features an apically modified thermal treatment. Methods [...] Read more.

Objectives: This study compared the cyclic fatigue resistance and the mechanical, thermal, and metallurgical characteristics of SlimShaper^® and SlimShaper PRO^® instruments. Both sequences include three instruments (ZS1–ZS3) with identical geometries, although SlimShaper PRO features an apically modified thermal treatment. Methods: Cyclic fatigue tests were performed using a standardized metallic guide with a 45° curvature, on six instruments of each sequence type. Fractured segments were measured, and fracture surfaces were analyzed using optical microscopy and Scanning Electron Microscopy (SEM). Elemental composition was assessed by Energy-dispersive Spectroscopy (EDS), while Differential Scanning Calorimetry (DSC) was used to determine transformation temperatures and enthalpy. Results: ZS1 and ZS1 PRO exhibited comparable cyclic fatigue resistance, whereas ZS2 and ZS3 showed significantly higher resistance than their PRO counterparts. SlimShaper PRO^® instruments fractured with segments approximately 0.5–1 mm longer. EDS confirmed that both instruments were made of NiTi, with minor differences in surface composition, while DSC demonstrated similar enthalpy values but distinct transformation ranges. At room temperature (27 °C), SlimShaper^® ZS2 remained predominantly martensitic, whereas ZS2 PRO could be partially austenitic, explaining its observed reduced fatigue resistance. The results of the DSC allowed to deduce the microstructure and thus the fatigue behavior at the temperature of the oral cavity. Conclusions: SlimShaper ZS2 and ZS3 showed significantly greater cyclic fatigue resistance than their PRO counterparts, while DSC analysis revealed distinct differences in phase transformation behavior that explain their mechanical performance. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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19 pages, 1548 KB

Open AccessFeature PaperArticle

Patterns of Endodontic Practice and Technological Uptake Across Training Levels in Spain and Latin America: Results from a Multicountry Survey of 1358 Clinicians

by Rocío Piñas-Alonzo, Alejandro R. Pérez, José Aranguren, Gaya C. S. Vieira, Juan Carlos Paz, Juan Saavedra, Jenny Guerrero Ferreccio, Simone Grandini and Giulia Malvicini

Dent. J. 2025, 13(12), 558; https://doi.org/10.3390/dj13120558 - 27 Nov 2025

Viewed by 677

Abstract

Background/Objectives: The objective of this study was to investigate current endodontic practice patterns and the adoption of newer technologies among dentists, endodontic specialists, and postgraduate students in Spain and Latin America. Methods: A cross-sectional survey was conducted using a structured 30-item questionnaire [...] Read more.

Background/Objectives: The objective of this study was to investigate current endodontic practice patterns and the adoption of newer technologies among dentists, endodontic specialists, and postgraduate students in Spain and Latin America. Methods: A cross-sectional survey was conducted using a structured 30-item questionnaire covering demographics, training, technology adoption (NiTi instrumentation, magnification, CBCT, irrigation adjuncts, bioceramic sealers), obturation techniques, irrigant selection, and clinical procedures. The survey was distributed through a professional Instagram account and WhatsApp groups of dentists, specialists, and postgraduate students. Participation was voluntary, anonymous, and restricted to qualified professionals. Data were collected via Google Forms, cleaned, and grouped into Spain, Mexico, Venezuela, Colombia, Southern Cone & Andes (Argentina, Chile, Peru, Ecuador, Bolivia), and other countries. Descriptive statistics were calculated, and intergroup comparisons were performed using Chi-square or Fisher’s exact tests with Bonferroni correction (p < 0.05). Multiple regression analyses were performed. Results: A total of 1358 valid responses were analyzed, distributed as follows: Spain (219), Mexico (353), Venezuela (162), Colombia (108), Southern Cone & Andes (260), and other countries (256). Most respondents (62.8%) had ≤10 years of experience, and 61.2% reported postgraduate training. Loupes (55.4%) were the most frequent magnification system, followed by microscopes (18.6%). Sodium hypochlorite (98.3%) was the irrigant of choice, commonly used with EDTA (83.5%) and, to a lesser extent, chlorhexidine (33.4%). Sonic (83.2%) and ultrasonic (52.9%) activation were frequent. Bioceramic sealers were used by 18.9%, while calcium hydroxide medication was applied by 37.4%. Specialists and master-level clinicians showed greater use of rotary NiTi systems, CBCT, magnification, and bioceramic sealers, whereas general practitioners relied more on manual instrumentation and single-cone obturation. Success was mainly verified by combined clinical and radiographic evaluation (86.7%). Spain demonstrated higher adoption of microscopes, warm vertical compaction, and CBCT. Conclusions: Core practices such as sodium hypochlorite irrigation and rubber dam use were widespread, while advanced technologies and irrigant protocols varied with training level and region. Continuous education remains essential to promote evidence-based practice and reduce disparities in endodontic innovation. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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19 pages, 4393 KB

Open AccessArticle

Bond Strength of an Epoxy Resin Root Canal Sealer Prototype

by Matthias J. Roggendorf, Hubert C. Roggendorf, Markus Müller-Krott, Franz-Josef Faber and Roland Frankenberger

Dent. J. 2025, 13(9), 415; https://doi.org/10.3390/dj13090415 - 9 Sep 2025

Cited by 1 | Viewed by 1419

Abstract

Background/Objectives: We aimed to assess the bond strength of AH Plus Jet (AH) and an epoxy resin-based root canal sealer prototype (K-0189) adhered to three different obturation points. Methods: A total of 120 single-rooted teeth were selected after radiographic analysis, and [...] Read more.

Background/Objectives: We aimed to assess the bond strength of AH Plus Jet (AH) and an epoxy resin-based root canal sealer prototype (K-0189) adhered to three different obturation points. Methods: A total of 120 single-rooted teeth were selected after radiographic analysis, and their root canals were instrumented with ProTaper Next files (PTN) up to size X5. The teeth were randomly assigned to two sealer groups (G) (G1: AH, G2: K-0189, each n = 60) and further divided into three subgroups: (A) ConformFit X5 points (PTN) cold obturation (CO), (B) ProTaper Universal F5 points (PTU) (CO), (C) GuttaCore X5 (GC) warm obturation (WO). After final irrigation (NaOCl 3%, EDTA 17%, NaOCl 3%) and drying, root canals were obturated and stored for 30 days at 37 °C in Simulated Body Fluid (SBF). The specimens were embedded in acrylate and sectioned horizontally; then, push-out bond strength (POBS) analysis was performed. Results: The median POBS values [MPa] were G1A: 2.03; G1B: 2.12; G1C: 3.2; G2A: 1.91; G2B: 2.56; and G2C: 3.36. WO showed significantly higher POBS (p < 0.001 *) than CO. The POBS was not significantly different between the two WO groups (p = 0.508). The POBS of G2B was significantly higher compared to all other CO groups. Conclusions: The epoxy resin sealer prototype demonstrated POBS values comparable to AH Plus when used with WO and PTU points, indicating significantly higher POBS values compared to all other CO points. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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18 pages, 2867 KB

Open AccessArticle

Multimodal Evaluation of Three NiTi Rotary Systems: Clinical Simulation, Mechanical Testing, and Finite Element Analysis

by Jesus A. Aparicio, Pedro M. Mendez S, Giulia Malvicini, Simone Grandini, Carlo Gaeta, Ana Paula García Guerrero, Kristel Lidice Miranda Robles, José Aranguren and Alejandro R. Pérez

Dent. J. 2025, 13(8), 368; https://doi.org/10.3390/dj13080368 - 15 Aug 2025

Cited by 3 | Viewed by 1565

Abstract

Objectives: This study aimed to compare the clinical durability, mechanical performance, and stress behavior of three NiTi rotary systems—BlueShaper (Blue), BlueShaper Pro (Dual Wire), and BlueShaper Gold (fully gold-treated NiTi)—through a multimodal evaluation that included simulated instrumentation in 3D-printed replicas, mechanical testing, and [...] Read more.

Objectives: This study aimed to compare the clinical durability, mechanical performance, and stress behavior of three NiTi rotary systems—BlueShaper (Blue), BlueShaper Pro (Dual Wire), and BlueShaper Gold (fully gold-treated NiTi)—through a multimodal evaluation that included simulated instrumentation in 3D-printed replicas, mechanical testing, and finite element analysis (FEA). Methods: Sixty instruments (n = 20 per group) were tested. Simulated canal preparation was conducted in standardized 3D-printed mandibular molars with a 40° mesial root curvature until fracture occurred. Mechanical tests included torsional and flexural loading using a universal testing machine and stainless steel blocks with a standardized 40° curvature. FEA simulations evaluated von Mises stress, shear stress, total deformation, cyclic fatigue behavior, and contact pressure between the instrument and canal wall. Results: BlueShaper Gold prepared an average of 7.5 canals before fracture, followed by BlueShaper Pro (5.67 canals) and Blue (5.00 canals) (p < 0.001). Gold exhibited the highest torsional resistance (6.08 ± 3.08 N) and the longest fatigue life (325 ± 55.7 cycles), with the lowest von Mises stress and damage factor in FEA. BlueShaper Pro showed the longest time to fracture in mechanical testing (73.85 ± 7.10 s) and balanced mechanical behavior. Blue demonstrated the lowest performance across most parameters, including the shortest fatigue life and highest stress concentration. Conclusions: BlueShaper Gold exhibited the highest mechanical strength and fatigue resistance. BlueShaper Pro demonstrated the longest fatigue life and balanced mechanical behavior. Blue showed the lowest performance across most parameters. The strong correlation among clinical, mechanical, and FEA data reinforces the critical role of alloy composition in determining instrument durability, even when design remains constant. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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10 pages, 1917 KB

Open AccessArticle

Comparison of Two Fiber Post Removal Techniques Evaluating Dentin Removal, Efficiency, and Heat Production

by Matthew Fenigstein, Mazin Askar, Ahmad Maalhagh-Fard and Susan Paurazas

Dent. J. 2025, 13(6), 234; https://doi.org/10.3390/dj13060234 - 26 May 2025

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Abstract

Background/Objectives: The removal of a fiber post (FP) during endodontic retreatment can be the source of significant complications. This study evaluated two commonly used techniques in removing a fiber post from an endodontically treated tooth by investigating three metrics: volume of dentin [...] Read more.

Background/Objectives: The removal of a fiber post (FP) during endodontic retreatment can be the source of significant complications. This study evaluated two commonly used techniques in removing a fiber post from an endodontically treated tooth by investigating three metrics: volume of dentin removed, efficiency, and temperature increase. Methods: Thirty extracted, single-rooted teeth were decoronated at the CEJ, then underwent endodontic treatment and post-space preparation. Fiber posts were bonded within the canal space. Teeth were pair-matched and randomly assigned to undergo post removal via Munce bur (MB) or diamond-coated ultrasonic tip (US). Teeth were scanned with micro-CT prior to post placement and after post removal. Results: The volume of dentin removal was not statistically significant between groups (p > 0.05), but the Munce bur resulted in eccentric removal patterns. There was a statistically significant difference in the time required to remove the fiber post between MB and US (p < 0.05). Removal of a fiber post with a Munce bur took an average of 58 s. Removal of a fiber post with an ultrasonic tip took an average of 502 s. There was no statistically significant difference in maximum temperature generated during post removal between MB and US (p > 0.05). Conclusions: Removal of a FP with a Munce bur requires significantly less time when compared to using an ultrasonic tip, with reduced risk of generating excessive heat for either technique with adequate coolant. US can stay more centered in the canal during FP removal when compared to Munce burs, potentially reducing unfavorable outcomes. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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11 pages, 2382 KB

Open AccessArticle

Quantitative Evaluation of Debris Removal from NiTi Rotary Endodontic Instruments After Different Cleaning Procedures

by Luigi Generali, Paolo Generali, Pio Bertani, Francesco Cavani, Vittorio Checchi, Tommaso Filippini and Federica Veneri

Dent. J. 2025, 13(2), 49; https://doi.org/10.3390/dj13020049 - 23 Jan 2025

Cited by 2 | Viewed by 2188

Abstract

Objectives: Endodontic instruments require thorough decontamination and sterilization before use and reuse to ensure the safety and success of treatments. However, standardized protocols are lacking. This study aimed to quantitatively assess the effectiveness of different cleaning protocols in removing debris from NiTi rotary [...] Read more.

Objectives: Endodontic instruments require thorough decontamination and sterilization before use and reuse to ensure the safety and success of treatments. However, standardized protocols are lacking. This study aimed to quantitatively assess the effectiveness of different cleaning protocols in removing debris from NiTi rotary file surfaces. Methods: Forty-eight new Mtwo NiTi rotary instruments (sizes 10/.04, 15/.05, 20/.06, and 25/.06) were randomly assigned to four groups (n = 12). A set of new sterile instruments (Group I) served as the negative control. After usage for primary endodontic treatment, instruments underwent different cleaning protocols: steam sterilization without cleaning (Group II); ultrasonic cleaning + steam sterilization (Group III); and manual cleaning with a scouring sponge + ultrasonic cleaning + steam sterilization (Group IV). Back-scattered scanning electron microscopy (SEM) micrographs of the apical, middle, and coronal sections were processed using Fiji software (version 2.14.0) to quantify debris as a percentage of the total selected area. Results: No significant differences were found among the three sections within each group, although higher debris amounts were observed from coronal to apical in Groups I and II. Group I had the least debris, while Group II showed the most, with statistically significant differences compared to other groups (p < 0.05). There was no significant difference between Groups III and IV, though Group IV showed notably less debris. Conclusions: The combination of mechanical, chemical, and ultrasonic cleaning proved most effective at removing debris from endodontic instruments. Current cleaning methods, however, remain insufficient for complete debris removal, highlighting the need for further research to standardize and improve cleaning and sterilization protocols or preferably use single-use/single-patient instruments. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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14 pages, 819 KB

Open AccessArticle

Clinical Outcomes and Complication Rates of Endodontically Treated Teeth with Fixed Dental Prostheses: A Retrospective Study

by Sarah Aloqayli, Hanin Alsalhi and Ali Alenezi

Dent. J. 2025, 13(1), 42; https://doi.org/10.3390/dj13010042 - 20 Jan 2025

Cited by 2 | Viewed by 5355

Abstract

Background/Objectives: Endodontically treated teeth (ETT) often have significant structural damage and require multiple reinforcing methods during the reconstruction process. The aim of this study was to evaluate the complication rates of ETT with and without a post. Methods: The study investigated [...] Read more.

Background/Objectives: Endodontically treated teeth (ETT) often have significant structural damage and require multiple reinforcing methods during the reconstruction process. The aim of this study was to evaluate the complication rates of ETT with and without a post. Methods: The study investigated various clinical factors, including technical complications as well as biological complications. All patients who had previously received fixed dental prostheses (FDPs) were subjected to clinical and radiographical examinations during their follow-up visits. Clinical and radiographic assessments were performed to determine the cumulative survival rate, and life table survival analyses of FDPs in the presence of complications were performed. Results: A total of 287 ETT were evaluated in this study, in which 219 were placed in females and 68 in males, with an average follow-up time of 82.4 months. There were no significant differences between ETT with a post and ETT without a post regarding the complication rates. The complication rates of the FDPs without a post revealed a survival rate of 58% after 5 years, 44% after 10 years, and 29% after 15 years. On the other hand, the complication rates of the FDPs with a post revealed survival rates of 50%, 30%, and 21% after 5, 10, and 15 years, respectively. The Kaplan–Meier survival analysis showed no significant differences in the complication rates, regardless of the existing of the posts (p = 0.830). Conclusions: ETT restored with FDPs with or without a post can show similar complication rates in a long-term evaluation. Furthermore, the types of final restoration may not have an effect on the complication rate with ETT. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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9 pages, 425 KB

Open AccessArticle

Comparative in Vitro Study on the Antimicrobial Efficacy of Endodontic Sealers Against Common Oral Pathogens

by Csaba Dudás, Zsuzsanna Bardocz-Veres, Anita Iulia Gyulai, Silvia Izabella Pop, Melinda Székely, Bernadette Kerekes-Máthé and Mónika Kovács

Dent. J. 2025, 13(1), 17; https://doi.org/10.3390/dj13010017 - 30 Dec 2024

Cited by 2 | Viewed by 3298

Abstract

Background/Objectives: Microorganisms are the leading cause of infections in the root canal system, contributing to the failure of endodontic treatments. This in vitro study aimed to compare the antimicrobial effects of four different endodontic sealers: Endomethasone N (Septodont, Saint Maur-des-Fossés, France), Sealapex [...] Read more.

Background/Objectives: Microorganisms are the leading cause of infections in the root canal system, contributing to the failure of endodontic treatments. This in vitro study aimed to compare the antimicrobial effects of four different endodontic sealers: Endomethasone N (Septodont, Saint Maur-des-Fossés, France), Sealapex (Kerr Corporation, Orange, CA, USA), AH Plus Jet (Dentsply DeTrey GmbH, Konstanz, Germany), and MTA Fillapex (Angelus, Londrina, Brazil). Methods: The sealers were tested against common oral pathogens, including Enterococcus faecalis, Staphylococcus aureus, Escherichia coli, Candida albicans, and Streptococcus mutans, using the agar diffusion method. Inhibition zones were measured at 24, 48, and 72 h to assess antimicrobial efficacy. Results: The results showed that Endomethasone was the most effective sealer against all tested microorganisms, demonstrating consistent inhibition across all time intervals. MTA Fillapex also exhibited a significant antimicrobial effect, particularly against Streptococcus mutans, with its efficacy increasing over time. AH Plus Jet displayed limited effectiveness, showing significant results only against Staphylococcus aureus. Conclusions: Overall, this study confirms the superior antimicrobial performance of Endomethasone, while the other materials, particularly MTA Fillapex and Sealapex, also showed notable effects in experimental conditions. The antimicrobial activity of all materials, except AH Plus Jet, increased over the 72-h period. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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9 pages, 6452 KB

Open AccessArticle

Influence of Continuous Rotation and Optimal Torque Reverse Kinematics on the Cyclic Fatigue Strength of Endodontic NiTi Clockwise Cutting Rotary Instruments

by Jorge N. R. Martins, Emmanuel J. N. L. Silva, Duarte Marques and Marco A. Versiani

Dent. J. 2024, 12(10), 317; https://doi.org/10.3390/dj12100317 - 30 Sep 2024

Cited by 5 | Viewed by 2496

Abstract

Objectives: The objective of the present study was to evaluate the cyclic fatigue strength of clockwise cutting rotary endodontic instruments when subjected to two different kinematics: continuous clockwise rotation and clockwise reciprocation movement under optimum torque reverse (OTR) motion. Methods: New ProTaper Next [...] Read more.

Objectives: The objective of the present study was to evaluate the cyclic fatigue strength of clockwise cutting rotary endodontic instruments when subjected to two different kinematics: continuous clockwise rotation and clockwise reciprocation movement under optimum torque reverse (OTR) motion. Methods: New ProTaper Next X1 (n = 20) and X2 (n = 20) instruments were randomly divided into two subgroups (n = 10) based on kinematics (continuous rotation or OTR). The specimens were tested using a custom-made device with a non-tapered stainless-steel artificial canal measuring 19 mm in length, featuring a 6 mm radius and an 86-degree curvature. All instruments were tested with a lubricant at room temperature until a fracture occurred. The time to fracture and the length of the separated fragment were recorded. Subsequently, the fractured instruments were inspected under a scanning electron microscope for signs of cyclic fatigue failure, plastic deformation, and/or crack propagation. The subgroup comparisons for time to fracture and instrument length were performed using the independent samples t-test, with the level of statistical significance set at 0.05. Results: When using OTR movement, the ProTaper Next X1 increased the time to fracture from 52.9 to 125.8 s (p < 0.001), while the ProTaper Next X2 increased from 45.4 to 66.0 s (p < 0.001). No subgroup exhibited plastic deformations, but both showed dimpling marks indicative of cyclic fatigue as the primary mode of failure. Additionally, OTR movement resulted in more metal alloy microcracks. Conclusions: The use of OTR motion extended the lifespan of the tested instruments and resulted in a higher number of metal microcracks. This suggests that OTR motion helped to distribute the mechanical stress more evenly across the instrument, thereby relieving localized tension. As a result, it delayed the formation of a single catastrophic crack, enhancing the overall performance of the instruments during the experimental procedures. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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10 pages, 1440 KB

Open AccessArticle

Photothermal Effect of 970 nm Diode Laser Irradiation on Enterococcus faecalis Biofilms in Single-Rooted Teeth Ex Vivo

by Soraya Tanner, Anna Thibault, Julian Grégoire Leprince and Serge Bouillaguet

Dent. J. 2024, 12(10), 308; https://doi.org/10.3390/dj12100308 - 27 Sep 2024

Cited by 3 | Viewed by 2606

Abstract

Objective: The aim of this study was to evaluate the photothermal effect of a 970 nm diode laser on Enterococcus faecalis biofilms. Methods: 72 extracted human single-rooted teeth were prepared, sterilized, and inoculated with Enterococcus faecalis to establish a two-week-old biofilm. [...] Read more.

Objective: The aim of this study was to evaluate the photothermal effect of a 970 nm diode laser on Enterococcus faecalis biofilms. Methods: 72 extracted human single-rooted teeth were prepared, sterilized, and inoculated with Enterococcus faecalis to establish a two-week-old biofilm. The specimens were divided into six groups (n = 12): Group 1 (G1)—negative control (PBS—no laser), Group 2 (G2)—positive control (1% NaOCl rinse—no laser), Group 3 (G3)—a 970 nm laser in 1.5 W pulse mode, Group 4 (G4)—a 970 nm laser in 2 W pulse mode, Group 5 (G5)—a 970 nm laser in 1.5 W continuous mode, Group 6 (G6)—a 970 nm laser in 2 W continuous mode. Bacterial viability was evaluated using the LIVE/DEAD BacLight kit and analyzed by flow cytometry (FCM). Temperature changes on the root surface during irradiation were analyzed using a K-type thermocouple. Data were statistically analyzed using one-way ANOVA and Tukey’s multiple comparison test (α = 0.05). Results: Bacterial viability was significantly reduced after laser irradiation in continuous mode using 1.5 W (21% of live bacteria) and 2 W (14% of live bacteria). When the pulsed mode was applied, the reduction in bacterial viability was less, with a mean survival of 53% (1.5 PF, whereas 29% of bacteria survived after 2 W irradiation). Conclusions: The 970 nm diode laser at 2 W continuous mode effectively reduced the viability of E. faecalis biofilms in root canals without causing unacceptable temperature rises at the root surface. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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Review

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16 pages, 2826 KB

Open AccessReview

Micro- and Macroabrasion in the Esthetic Zone: A Narrative Review and Case Study

by Jose Villalobos-Tinoco, Carlos A. Jurado, Silvia Rojas-Rueda, Nechama S. Citrin, Staley Colvert, Jose Luis Gutierrez-Quintero and Salwa Mekled

Dent. J. 2025, 13(5), 183; https://doi.org/10.3390/dj13050183 - 23 Apr 2025

Cited by 2 | Viewed by 4602

Abstract

Background: Micro- and macroabrasion represent a minimally invasive treatment approach for stained teeth in the esthetic zone. Diagnosing the type of stain is crucial for selecting the appropriate treatment approach. These clinical procedures involve several meticulous steps that may be confusing for less [...] Read more.

Background: Micro- and macroabrasion represent a minimally invasive treatment approach for stained teeth in the esthetic zone. Diagnosing the type of stain is crucial for selecting the appropriate treatment approach. These clinical procedures involve several meticulous steps that may be confusing for less experienced clinicians. Methods: The objective of this article is to provide an updated review of the literature on the clinical procedures for micro- and macroabrasion and to present a clinical case in which a minimally invasive macroabrasion procedure was applied to treat a female patient seeking to remove stains from her anterior teeth. Preliminary reviews were conducted of existing case reports and reviews evaluating the clinical procedures and outcomes of micro- and macroabrasion. Results: A review of the literature reveals minor differences in how stains on anterior teeth are addressed. Depending on the depth of the stain, microabrasion is typically used for superficial stains, while macroabrasion is employed for deeper stains. Clinicians often combine micro- or macroabrasion with tooth whitening procedures. Literature reviews agree that micro- and macroabrasion techniques are effective minimally invasive approaches that yield high esthetic results. The case study demonstrated each clinical step of microabrasion, achieving results that fully satisfied the patient’s esthetic demands. Conclusions: Micro- and macroabrasion can be effective and minimally invasive methods for treating stained anterior teeth. Superficial stains can be treated with microabrasion, while deeper stains may require macroabrasion. In some clinical scenarios, tooth whitening can also be combined with these treatments. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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30 pages, 1344 KB

Open AccessReview

Bioceramics in Endodontics: Limitations and Future Innovations—A Review

by Peramune Arachchilage Amila Saman Prasad Kumara, Paul Roy Cooper, Peter Cathro, Maree Gould, George Dias and Jithendra Ratnayake

Dent. J. 2025, 13(4), 157; https://doi.org/10.3390/dj13040157 - 1 Apr 2025

Cited by 18 | Viewed by 12209

Abstract

Bioceramic materials for endodontic treatments have gradually transformed over the years into materials with enhanced biocompatibility and chemical and mechanical properties compared to earlier generations. In endodontics procedures, these materials are used as restorative material in applications such as root-end fillings, pulp capping, [...] Read more.

Bioceramic materials for endodontic treatments have gradually transformed over the years into materials with enhanced biocompatibility and chemical and mechanical properties compared to earlier generations. In endodontics procedures, these materials are used as restorative material in applications such as root-end fillings, pulp capping, perforations repair, and apexification repair procedures. However, they have far from ideal mechanical and handling properties, biocompatibility issues, aesthetic concerns due to tooth discolouration, limited antibacterial activity, and affordability, which are amongst several key limitations. Notably, bioceramic materials are popular due to their biocompatibility, sealing ability, and durability, consequently surpassing traditional materials such as gutta-percha and zinc oxide–eugenol sealers. A lack of recent advancements in the field, combined with nanomaterials, has improved the formulations of these materials to overcome these limitations. The existing literature emphasises the benefits of bioceramics while underreporting their poor mechanical properties, handling difficulties, cost, and various other drawbacks. The key gaps identified in the literature are the insufficient coverage of emerging materials, narrow scope, limited insights into future developments, and underreporting of failures and complications of the existing materials. Consequently, this review aims to highlight the key limitations of various endodontic materials, primarily focusing on calcium silicate, calcium phosphate, and bioactive glass-based materials, which are the most abundantly used materials in dentistry. Based on the literature, bioceramic materials in endodontics have significantly improved over recent years, with different combinations of materials and technology compared to earlier generations while preserving many of their original properties, with some having affordable costs. This review also identified key innovations that could shape the future of endodontic materials, highlighting the ongoing evolution and advancements in endodontic treatments. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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11 pages, 241 KB

Open AccessReview

How to Deal with Pulpitis: An Overview of New Approaches

by Jakub Fiegler-Rudol, Wojciech Niemczyk, Katarzyna Janik, Anna Zawilska, Małgorzata Kępa and Marta Tanasiewicz

Dent. J. 2025, 13(1), 25; https://doi.org/10.3390/dj13010025 - 8 Jan 2025

Cited by 6 | Viewed by 6313

Abstract

Background: Traditional root canal therapy (RCT) effectively removes diseased or necrotic pulp tissue and replaces it with inorganic materials. Regenerative endodontics is an alternative to conventional RCT by using biologically based approaches to restore the pulp–dentin complex. This review explores emerging techniques, including [...] Read more.

Background: Traditional root canal therapy (RCT) effectively removes diseased or necrotic pulp tissue and replaces it with inorganic materials. Regenerative endodontics is an alternative to conventional RCT by using biologically based approaches to restore the pulp–dentin complex. This review explores emerging techniques, including autogenic and allogenic pulp transplantation, platelet-rich fibrin, human amniotic membrane scaffolds, specialized pro-resolving mediators, nanofibrous and bioceramic scaffolds, injectable hydrogels, dentin matrix proteins, and cell-homing strategies. These methods utilize stem cells, growth factors, and biomaterials to regenerate vascularized, functional pulp tissue. Methods: A narrative review was conducted using PubMed, Scopus, and Embase to identify studies published between 2010 and 2023. In vitro, animal, and clinical studies focusing on innovative regenerative endodontic techniques were analyzed. Conclusions: Although regenerative endodontics demonstrates great potential, challenges remain in standardizing protocols, addressing biological variability, and achieving consistent clinical outcomes. Future research must focus on refining these techniques to ensure their safety, efficacy, and accessibility in routine practice. By addressing current limitations, regenerative endodontics could redefine the management of pulpitis, offering biologically based treatments that enhance tooth vitality, structural integrity, and long-term prognosis. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

11 pages, 234 KB

Open AccessReview

Evaluating Treatment Modalities for Reducing Recurrence in Central Giant Cell Granuloma: A Narrative Review

by Flamur Aliu, Donika Bajrami Shabani, Iliriana Aliu, Etleva Droboniku Qeli, Gerta Kaçani, Luca Fiorillo and Aida Meto

Dent. J. 2024, 12(9), 295; https://doi.org/10.3390/dj12090295 - 19 Sep 2024

Cited by 7 | Viewed by 5820

Abstract

Treating central giant cell granuloma (CGCG) is challenging due to high recurrence rates and variable therapy responses. This study examines the efficacy of various treatments in reducing CGCG recurrence. A literature review explored outcomes of surgical excision, curettage, intralesional corticosteroid injection, and adjuvant [...] Read more.

Treating central giant cell granuloma (CGCG) is challenging due to high recurrence rates and variable therapy responses. This study examines the efficacy of various treatments in reducing CGCG recurrence. A literature review explored outcomes of surgical excision, curettage, intralesional corticosteroid injection, and adjuvant therapy, considering factors like lesion location, size, and histological features. Aggressive surgical techniques such as en bloc resection were found to potentially lower recurrence rates compared to conservative approaches. However, treatment should be tailored to individual patient needs. Further research is needed to confirm these findings and improve treatment strategies. A concise literature review was conducted using PubMed, MEDLINE, and Google Scholar, focusing on papers published from 1986 to 2024. Search terms included “central giant cell granuloma”, “recurrence”, “treatment modalities”, and “surgical excision”. Studies reporting recurrence rates and treatment outcomes for CGCG were analyzed. Twenty-nine studies were reviewed, including six studies on surgical excision and curettage, eight studies on intralesional corticosteroid injections, six studies on calcitonin therapy, five studies on interferon-alpha therapy, and four studies on the therapy with denosumab. Analysis indicated that aggressive surgical treatments like en bloc resection were associated with lower recurrence rates compared to conservative methods. Predictors of recurrence included lesion size (>3 cm), location (mandible), and aggressive histopathological features. Aggressive surgical excision combined with nonsurgical methods may lower recurrence rates, while conservative techniques remain viable in some cases. Further prospective research is needed to validate these findings and enhance CGCG treatment options. Full article

(This article belongs to the Special Issue Endodontics and Restorative Sciences: 2nd Edition)

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