Search Results (283)

This study aimed to examine how downward load applied during instrumentation affects the stress generation and shaping properties in thermally treated and non-treated NiTi rotary instruments. ProTaper Universal (PTU; non-thermally treated) and ProTaper Gold (PTG; thermally treated) were used to prepare J-shaped canals in resin blocks. Load-controlled automated instrumentation and torque/force sensing devices were employed with preset downward loads of 1, 2, or 3 N (n = 10 each). The torque/force, instrumentation time, and canal-centering ratio were measured and analyzed using two-way or one-way analysis of variance with Tukey’s test (α = 0.05). In the PTU-1N group, instrumentation was not completed because a ledge was formed in all canals. The PTU-3N group showed significantly greater upward force (screw-in force) and clockwise torque, along with a significantly smaller canal-centering ratio (less deviation) at the apical 0 mm level, than the PTU-2N group (p < 0.05). The downward load did not influence the instrumentation time (p > 0.05). In the PTG groups, these effects of downward load on the force generation and canal-centering ratio were not significant (p > 0.05). In the non-thermally treated PTU instruments, greater downward loads enhanced screw-in force while decreasing apical canal deviation; however, these effects were abolished in the thermally treated PTG instruments. This study highlights the importance of adapting the instrumentation technique with instrument characteristics: thermally treated flexible instruments facilitate smoother use, while stiffer, non-thermally treated ones may require precise control of downward loads. Full article

Chemical endodontic irritants can lead to the demineralization of the inorganic tooth structure, its loss of integrity, microhardness changes, erosion, and an increased risk of fractures. We investigated the action of iron oxide nanomagnet particles (IONPs) as an irrigant solution for improving hardness and identifying the concentration of element ions in the root canal. There were six groups in total: a control group (no treatment) and experimental groups (UN: ultrasound agitation normal saline, UI: ultrasound agitation IONPs, MSI: magnetic field and endodontic needle with syringe agitation IONPs, MUI: magnetic field and ultrasound agitation IONPs, and EDTA: ethylenediaminetetraacetic acid). We hypothesized that IONPs with magnetic agitation would preserve microhardness better than EDTA. Vickers hardness testing was used to evaluate microhardness, which was then analyzed using energy-dispersive X-ray spectroscopy (EDS) to investigate the calcium/phosphorus ratio and the presence of iron. The IONP groups exhibit a higher VHN value than the EDTA group (p < 0.05). These results support our hypothesis, indicating that utilizing an IONP irrigant solution with an external magnetic field does not change microhardness but enhances it compared to the EDTA group, suggesting that employing an external magnetic field to deliver nanoparticles to the root canal wall does not affect the properties of the tooth structure compared to conventional instrumentation techniques, which lead to unnecessary loss of root structure. Full article

Background: Separated endodontic instruments are a significant complication in root canal treatment, affecting disinfection and long-term prognosis. Their detection on panoramic radiographs is challenging, particularly in complex anatomy or for less experienced clinicians. Objectives: This study aimed to develop and evaluate a deep learning model using the U²-Net architecture for automated detection and segmentation of separated instruments in panoramic radiographs from multiple imaging systems. Methods: A total of 36,800 panoramic radiographs were retrospectively reviewed, and 191 met strict inclusion criteria. Separated instruments were manually segmented using the Computer Vision Annotation Tool. The U²-Net model was trained and evaluated using standard performance metrics: Dice coefficient, IoU, precision, recall, and F1 score. Results: The model achieved a Dice coefficient of 0.849 (95% CI: 0.840–0.857) and IoU of 0.790 (95% CI: 0.781–0.799). Precision was 0.877 (95% CI: 0.869–0.884), recall was 0.847 (95% CI: 0.839–0.855), and the F1-score was 0.861 (95% CI: 0.853–0.869). Conclusions: These results demonstrate a strong overlap between predictions and ground truth, indicating high segmentation accuracy. The U²-Net model showed robust performance across radiographs from various systems, suggesting its clinical utility in aiding detection and treatment planning. Further multicenter studies are recommended to confirm generalizability. Full article

Background and objectives: Post-operative pain (POP) is a common complication after root canal treatment and is influenced by various clinical and patient-related factors. The present study evaluated the incidence and intensity of POP following root canal treatment using a bioceramic sealer performed by operators with different levels of experience. Methods: A total of 115 patients were included in this prospective observational study. Patients were treated by operators with different levels of experience: postgraduate students (PGSs) and endodontic specialists (ESs). Standardized protocols were used in two distinct appointments: an instrumentation visit and an obturation visit. Obturation was performed using the continuous wave condensation technique and Total Fill Hi-Flow BC Sealer (TFHF). POP, mastication discomfort, and sleep disturbance were assessed at 24, 48, and 72 h after the instrumentation and obturation phases using a numeric rating scale (NRS). Results: The results indicate significantly higher POP after the instrumentation phase, compared to the obturation phase (p < 0.001). The pain intensity progressively decreased over time for both phases. No significant differences were observed between the PGS and ES groups regarding POP, mastication discomfort, or sleep disturbance at any time. Sealer extrusion did not significantly impact POP (p > 0.05). Conclusions: This study found that operator experience does not significantly influence POP when a standardized protocol is followed. The use of TFHF with the continuous wave condensation technique was associated with minimal POP. Full article

This study investigates the impact of pipe installation height on the hydraulic performance of a combined canal–pipe water conveyance system (CCPS) and provides practical recommendations. A combined experimental and numerical simulation approach was conducted to systematically analyze and evaluate the impact of different pipe installation heights (0, 1, 3, and 5 cm) and flow rates (18.40, 21.21, 24.74, 28.27, 33.58, and 38.88 L/s) on the system’s behavior. The results indicated that the canal water depths obtained from the numerical simulations were in close agreement with the measurements from the experiments. The water depth in the upstream canal remained nearly parallel to the canal bottom. At the junction, the trend of water depth varies under different flow rates. When the flow rate is low, the water depth sharply decreases. Conversely, when the flow rate is higher, the water depth rises significantly. Cross sections farther from the junction exhibit a higher uniformity in flow velocity distribution. As the height of the pipe installation increases, the range of influence of the junction on the flow velocity distribution in the upstream canal decreases. The elevation of the pipe installation height has been instrumental in enhancing the uniformity of flow velocity distribution across the section. However, the local head loss gradually increases as the installation height increases. Turbulent kinetic energy (TKE) and turbulent eddy dissipation rate (TED) are negatively correlated with the distance between the section and the junction point, and the maximum value decreases gradually with increasing values of the pipe installation height. Considering the hydraulic performance and engineering construction investment, the recommended pipe installation height under the conditions of this study is 1 cm. Full article

The effect of root canal irrigants on the mechanical properties of dentin is crucial in endodontic treatment planning. While antiseptics such as sodium hypochlorite and EDTA are widely used, their potential to weaken dentin structure remains a concern. Polyhexanide-based formulations may offer a safer alternative. To assess the impact of a polyhexanide-based antiseptic composition, compared to standard irrigants, on the microhardness, Young’s modulus, and elastic deformation energy of dentin. Sixty extracted human teeth were sectioned and polished to prepare dentin samples. Baseline measurements of Vickers microhardness, Young’s modulus, and elastic deformation work were performed using a Microhardness Tester (CSM Instruments, Switzerland) with a Berkovich indenter. Samples were then divided into six groups (n = 10 per group) and exposed to different irrigants (NaCl 0.9%, NaOCl 3%, chlorhexidine 2%, EDTA 17%, and polyhexanide-based solutions—0.1% and 0.2% Lavasept). Post-treatment measurements were performed. Statistical analysis was conducted using non-parametric tests with Bonferroni correction. Sodium hypochlorite (3%) caused the most pronounced reduction in dentin microhardness and mechanical strength, though not always statistically significant. Polyhexanide-based solutions (0.1% and 0.2% Lavasept) showed a milder effect, with statistically significant changes observed only in elastic deformation energy for 0.2% polyhexanide. EDTA treatment led to severe surface destruction, precluding reliable post-treatment measurements. Polyhexanide-based irrigants demonstrated a more favorable impact on dentin mechanical properties compared to traditional irrigants, supporting their potential use in endodontic protocols aimed at preserving dentin integrity. Full article

Background: This study aimed at delivering first clinical results after the use of a screw-and-PEEK rod system. Emphasis was placed on the ability of the construct to prevent adjacent segment disease at an average of 5 years follow up. Methods: The cohort was made up of 33 patients who received decompressive surgery in one segment and instrumentation with a screw-and-PEEK rod-based construct for stenosis of the lumbar spinal canal and a control group of 20 who received fusion surgery. Results: At an average of 68 months follow up there were 19 patients where the symptoms had markedly improved or completely subsided. There were also nine patients where the symptoms initially subsided only to reoccur years later and five who had a subjective non-satisfactory result. Conclusions: The system showed no major disadvantage when compared to similar non-fusion pedicle-based techniques, nor was it able to consequently prevent ASD. Under a clinical point of view, there was, in our opinion, no marked benefit when compared against decompressive surgery and fusion as the accepted standard. Full article

The provision of food in pre-Inca/Inca cultures (1000 BC–≈1532 AD) in environments near Lake Titikaka (approximately 4000 m above sea level) was possible through an agricultural technique called “Waru-Waru”, which consists of filling the space (volume) between rows of land containing plants that are cultivated (a series of earth platforms surrounded by water canals) with water, using water as thermal energy storage to store energy during the day and to regulate the temperature of the soil and crop atmosphere at night. The problem is that these cultures left no evidence in written documents that have been preserved to this day indicating the mathematical models, the physics involved, and the experimental part they performed for the research, development, and innovation of the “Waru-Waru” technique. From a review of the existing literature, there is (1) bibliography that is devoted to descriptive research (about the geometry, dimensions, and shapes of the crop fields (and more based on archaeological remains that have survived to the present day) and (2) studies presenting complex mathematical models with many physical parameters measured only with recently developed instrumentation. The research objectives of this paper are as follows: (1) develop a mathematical model that uses finite differences in fluid mechanics, thermodynamics, and heat transfer to explain the experimental and theory principles of this pre-Inca/Inca technique; (2) the proposed mathematical model must be in accordance with the mathematical calculation tools available in pre-Inca/Inca cultures (yupana and quipu), which are mainly based on arithmetic operations such as addition, subtraction, and multiplication; (3) develop a mathematical model in a sequence of steps aimed at determining the best geometric form for thermal energy storage and plant cultivation and that has a simple design (easy to transmit between farmers); (4) consider the assumptions necessary for the development of the mathematical model from the point of view of research on the geometry of earth platforms and water channels and their implantation in each cultivation area; (5) transmit knowledge of the construction and maintenance of “Waru-Waru” agricultural technology to farmers who have cultivated these fields since pre-Hispanic times. The main conclusion is that, in the mathematical model developed, algebraic mathematical expressions based on addition and multiplication are obtained to predict and explain the evolution of soil and water temperatures in a specific crop field using crop field characterization parameters for which their values are experimentally determined in the crop area where a “Waru-Waru” is to be built. Therefore, the storage of thermal energy in water allows crops to survive nights with low temperatures, and indirectly, it allows the interpretation that the Inca culture possessed knowledge of mathematics (addition, subtraction, multiplication, finite differences, approximation methods, and the like), physics (fluids, thermodynamics, and heat transfer), and experimentation, with priority given to agricultural techniques (and in general, as observed in all archaeological evidence) that are in-depth, exact, practical, lasting, and easy to transmit. Understanding this sustainable energy storage technique can be useful in the current circumstances of global warming and climate change within the same growing areas and/or in similar climatic and environmental scenarios. This technique can help in reducing the use of fossil or traditional fuels and infrastructure (greenhouses) that generate heat, expanding the agricultural frontier. Full article

Objectives: The aim of this study is to investigate how Adaptive Torque Control motion influences the shaping efficiency of Neolix EDMax (Neolix SAS, Évron, France) and its ability to reach working length with or without a pre-existing glide path. Methods: A total of 90 endo training blocks with an S-shape curvature were divided into three groups based on the kinematics and preparation phase: the control group, where the Neolix EDMax (Neolix SAS, Évron, France) was used for shaping after a glide path was established; the no glide path group, where the Neolix EDMax (Neolix SAS, Évron, France) was used for shaping without a glide path; and the Adaptive Torque Control group, where the Neolix EDMax (Neolix SAS, Évron, France) was used for shaping without a glide path but in an Adaptive Torque Control motion. The time for shaping, the instrument passes, and the ability to reach working length were recorded and analyzed using a one-way Anova and Tukey’s HSD post hoc test. Results: Establishing a glide path helped the shaping file to reach working length faster and in fewer passes when compared with the no glide path group, but the Adaptive Torque Control group was able to perform even better than the control group despite not having a pre-established glide path. Conclusions: The Adaptive Torque Control motion on continuous rotation instruments does impact their performance. Combining the efficiency of continuous rotation and the safety of reciprocation, this type of motion had a significant effect on the ability to shape the simulated root canal even in the presence of a double curvature and without a pre-established glide path. Full article

Background: A 19-year-old female patient reported to the Department of Conservative Dentistry, Medical University of Gdańsk, with pain in the left lateral incisor. During the attempt to perform root canal treatment on tooth 22, we encountered difficulties in locating the canal opening, which resulted in treatment failure. Radiographic examinations revealed Pulp Canal Obliteration and a root fracture with a double fracture line, resulting in two root fragments. The prognosis for this tooth was poor, with extraction being the most likely outcome. Methods: To provide effective therapy, a 3D-printed endodontic guide was utilized, allowing for more precise localization of the canal in a tooth with a calcified root canal and complex fracture morphology. An intraoral scan and cone-beam computed tomography (CBCT) were performed, followed by the design of the guide. This facilitated accurate planning of the entry path for endodontic instruments, promoting minimally invasive treatment and reducing the loss of tooth structure. Results: Through navigated endodontics, the treatment became more predictable, and the risk of iatrogenic complications was minimized, significantly improving the prognosis of the therapy. Clinical and radiological examinations conducted after 12 months demonstrated successful treatment and preservation of the tooth in the oral cavity. Conclusions: The obtained results suggest that the use of guided endodontics can improve outcomes in cases with pulp canal obliteration and complex fractures, offering a minimally invasive and predictable approach. Full article

Background/Objectives: This study aimed to assess and compare the elimination of the smear layer and microhardness of dentin in root canals after sequential versus continuous chelation using different agitation techniques. Methods: Sixty-four palatal roots of upper first molars were instrumented to size X3 (Protaper Next files). According to the irrigant solution, samples were assigned to two groups (N = 32/group), 3% NaOCl irrigation followed by 17% EDTA (sequential chelation (SC)), or dual-rinse (3% NaOCl/9% HEDP) irrigation (continuous chelation (CC)). Each group has been divided into four subgroups (n = 8/subgroup), based on agitation techniques used: conventional needle (CN) (control group), EndoActivator (EA), ultrasonic agitation (UAI), and Er.Cr.YSGG 2780 nm (laser). SEM images assessed the smear layer, and Vicker microhardness (VHN) was performed at 50 and 100 µm depths. Data were analyzed using: Kruskal–Wallis, Wilcoxon, and the Mann–Whitney U test. Statistical significance was set at p < 0.05. Results: In the UAI and laser agitation, CC significantly reduced the smear layer presence compared to SC in the apical and coronal thirds, respectively (p < 0.05), and no significant differences were observed in the CN and EA groups between SC and CC (p > 0.05). There were significantly higher VHNs of dentine in CC groups than in SC groups in all sections and depths, except in the apical of the CN group at 50 µm and the coronal section of EA and UAI groups at 100 µm. Conclusions: CC was comparable to SC in smear layer removal. CC had a less detrimental effect on dentin compared with SC. Full article

Background and Objectives: Nickel–titanium (Niti) instruments have enhanced root canal cleaning in primary teeth, but file fractures are still common. Materials and Methods: This study evaluated the cyclic fatigue resistance of 120 Niti files from four different systems, A: Kedo SG (n = 30); B: Neoendo Pedoflex (n = 30); C: Pedoflex Waldent files (n = 30); and D: Vortex Blue files (n = 30). All the files had similar tip diameters (0.25 mm) and tapers (0.4%) and underwent heat treatment during manufacturing. Cyclic fatigue tests showed notable variations in cycles to fracture (NCF) across groups. All fracture surfaces of the files were assessed through scanning electron microscopy. Results: The mean values achieved in the experimental groups (A, B, C) were less than those in the control Group D (976.90 ± 1085.19). Files in Group A demonstrated the highest NCF (697.01 ± 420.09), while Pedoflex files in Group C showed the lowest values (203.88 ± 155.46). Statistical analysis using the Mann–Whitney test revealed significant differences between Group C and Groups A, B, and D and no differences among Groups A, B, and D. Conclusions: These findings suggest that Kedo SG and Neoendo Pedoflex files offer comparable cyclic fatigue resistance to Vortex Blue files. In contrast, Pedoflex Waldent files exhibit lower resistance to fracture. Full article

Objectives: This study aimed to evaluate the efficacy of cleaning in minimally shaped mesial and oval distal canals of 3D models of mandibular molars, focusing on positive pressure irrigation, wireless and conventional passive ultrasonic irrigation (PUI), and diode laser (DL) at 980 nm. Methods: Forty-four 3D-printed resin models, based on eleven natural mandibular molars (each with mesial and distal canals), were divided into four groups (n = 11 per group) to evaluate different irrigation methods. A total of 22 mesial canals (size 20/.04) and 11 oval distal canals (size 25/.04) were analyzed per group. Each root canal was uniformly filled with an artificial hydrogel to simulate a biofilm mixture. Following this preparation, the specified irrigation techniques were applied to the respective groups. Quantitative evaluations of pre- and post-irrigation images were performed to assess the efficiency of tissue removal along the entire length of the canal and in the apical, middle, and coronal thirds. Results: The findings revealed no significant differences in the initial amount of tissue between the samples, indicating uniform filling. In the apical region of mesial canals, conventional PUI showed the highest cleaning efficiency (14.1% residual tissue), significantly outperforming the other methods (p < 0.05). Cordless PUI and DL also surpassed positive pressure irrigation, leaving 30.4% and 29.3% residual tissue, respectively, compared to 42.2% with positive pressure. In the middle third, all methods tested performed better than needle irrigation (p < 0.05), but there were no significant differences in the coronal third or over the full canal length. Distal oval canals showed no significant differences in cleaning effectiveness among methods. Conclusions: Although no single method was superior regarding the full canal length, supplementary techniques such as PUI and DL offer potential benefits over conventional irrigation methods, particularly in the apical third of the canal. Complementary approaches such as conventional PUI and diode laser at 980 nm showed superior cleaning efficiency, particularly in the apical third. These results suggest their integration could improve the effectiveness of cleaning in minimally instrumented mesial canals. Full article

Objective: This study investigated the shaping efficiency of four reciprocating systems—WaveOne Gold, Reciproc Blue, Excalibur, and One Reci—in three dimensional (3D) resin models of natural mandibular premolar teeth with two canals. Methods: Forty 3D-printed mandibular premolars (Vertucci configuration type V) were divided into four groups, each of which was assigned one of the reciprocating systems. According to the manufacturer’s protocols, each canal was prepared, with pre- and post-instrumentation micro computed tomography (micro-CT) scans evaluating canal volume, surface area, percentage of unprepared canal walls, and resin reduction in the pericervical area. Instrumentation time and screw-in sensation were recorded as qualitative performance indicators. Statistical analysis was performed using one-way ANOVA and chi-square tests with a significance of (p < 0.05). Results: All systems increased canal volume and surface area, primarily in the apical third, with Reciproc Blue and One Reci achieving the largest volume. WaveOne Gold had the highest percentage of unprepared walls (27.03%) and Reciproc Blue the lowest (19.65%), though these differences were not statistically significant (p > 0.05). Reciproc Blue caused the highest pericervical resin loss (22.24%), significantly higher than Excalibur (15.09%) and One Reci (15.17%) (p = 0.035). Reciproc Blue exhibited the highest incidence of screw-in sensation (70%), while WaveOne Gold achieved the shortest instrumentation time (86.7 s), although neither variable showed statistical significance. Conclusions: All systems effectively shaped complex canal anatomies, with Reciproc Blue demonstrating the highest dentin removal and WaveOne Gold proving the most time efficient. Clinically, these findings suggest that instrument selection should balance shaping efficiency with dentin preservation. Minimizing unprepared areas and preserving pericervical dentin are essential for enhancing disinfection and reducing the risk of root fractures, ultimately contributing to the long-term success of endodontic treatment. Full article

Objectives: This study aims to evaluate the effectiveness of current conventional and advanced irrigation techniques after minimally invasive instrumentation in necrotic oval root canals by histological analysis. Methods: Seventy extracted necrotic lower premolars with single oval canals classified utilizing bidirectional radiographs (mesiodistal diameter 2.5 times larger than buccolingual) were prepared up to 20.04 v. The samples were assigned to five experimental groups (n = 14) using the complementary irrigation technique: needle (control), passive ultrasonic, and shockwave-enhanced emission photo-acoustic streaming activation using Er:YAG laser (SWEEPS), Er,Cr:YSGG laser (Waterlase iPlus), and multisonic ultracleaning technology (GentleWave). After irrigation protocols, the roots were demineralized and the apical 5 mm was multi-sliced and processed for histologic examination. The residual necrotic tissue and debris percentage was calculated via image analysis software. One-way ANOVA and Tukey’s test were used to verify the variables influencing debridement (p < 0.05). Results: The mean value of the GentleWave group was the record low at 1.54 ± 1.46, and the utmost was needle irrigation with 15.64 ± 7.23. The main effect of techniques on the debridement was statistically significant (p < 0.001). The course of debridement effectiveness, according to the levels of significance between the groups, was as follows: Multisonic ultracleaning > Er:YAG > Er,Cr:YSGG > Passive ultrasonic irrigation > Needle irrigation (p <0.05). Conclusions: In necrotic oval-shaped canals after minimally invasive instrumentation, multisonic ultracleaning with updated software was considerably more effective in removing remnants in the apical level. Er:YAG and Er,Cr:YSGG lasers were highly promising, with results close to multisonic ultracleaning. It should be considered that needle irrigation and passive ultrasonic activation may not be able to provide competent debridement in treating such types of root canals. Full article