Search Results (20)

Background/Objectives: The aim of this study was to compare the effectiveness of the Reciproc Blue (RB) and MicroMega Remover (MR) systems in removing root canal filling material and to evaluate the effect of passive ultrasonic irrigation (PUI) on remaining filling material (RFM) using micro-computed tomography (micro-CT)-based three-dimensional (3D) analysis. Methods: Forty single-rooted mandibular premolar teeth were included in the study. The root canals were prepared up to size F2 using the ProTaper Gold rotary file system and obturated with the lateral compaction technique. After the initial micro-CT scan, the teeth were randomly divided into four groups: Group RB, Group MR, Group RB + PUI, and Group MR + PUI (n = 10). Following retreatment, a second micro-CT scan was performed. The percentage of RFM was calculated, and statistical analyses were performed using Kruskal–Wallis and Mann–Whitney U tests with Bonferroni correction. A rank-based factorial analysis was additionally performed (p < 0.05). Results: RFM was observed in all groups. No significant difference was found between the RB (7.37%) and MR (7.31%) systems (p > 0.05). However, the groups treated with PUI (RB + PUI and MR + PUI) showed significantly lower RFM values than the groups without PUI (p = 0.001). Factorial analysis revealed no significant effect of file system or file system × PUI interaction, whereas PUI significantly reduced RFM (p < 0.001). Conclusions: The RB and MR systems demonstrated similar effectiveness in removing root canal filling material. Although complete canal cleanliness could not be achieved, under the in vitro conditions of the present study, PUI significantly reduced the amount of micro-CT-measured RFM. Full article

Calcium silicate-based sealers are widely used in contemporary endodontics, but their strong interaction with dentinal substrates may complicate their removal during nonsurgical retreatment and potentially hinder canal disinfection. This ex vivo study evaluated the effectiveness of different irrigation activation techniques in removing a calcium silicate-based sealer from oval-shaped root canals. Sixty extracted single-rooted teeth were instrumented and obturated using the single-cone technique with NeoSealer Flo, followed by retreatment using a reciprocating system. Specimens were randomly assigned to four final irrigation protocols: conventional needle irrigation (CNI) with NaOCl/EDTA, ultrasonic activation (US), diode laser activation (LI), and Er:YAG laser activation using the SWEEPS mode (SW) (n = 15). Residual filling material was quantified before and after final irrigation using stereomicroscopic imaging and ImageJ (version 1.54) analysis. Dentinal surface morphology and residual sealer were further evaluated using SEM–EDS. Statistical analysis included one-way ANOVA and chi-square tests (p < 0.05). All protocols significantly reduced residual filling material compared with mechanical retreatment alone (US 15.08%, CNI 7.89%, LI 8.01%, SW 7.20%) (p < 0.01). US resulted in significantly greater sealer removal compared with CNI, LI, and SW, with mean differences ranging from 7.08% to 7.88% (p < 0.05). These findings indicate that irrigation activation enhances the removal of NeoSealer Flo calcium silicate-based sealer, with ultrasonic activation demonstrating greater effectiveness among the evaluated techniques, under the conditions of this experimental setup. Full article

Background: The maxillary canine is considered a cornerstone tooth that plays an important role in aesthetics and function. This study compared the morphometric measurements and morphology of maxillary canines between Saudi and Spanish populations using cone-beam computed tomography (CBCT). Methods: A total of 100 CBCT scans (50 patients from King Khalid University, Saudi Arabia, and 50 patients from University of Barcelona Dental Hospital, Spain) were analyzed in this retrospective cross-sectional study conducted between May and September 2025. The study examined root length, mesiodistal and buccopalatal dimensions, root canal curvatures, apical foramen position, and canal morphology. Results: Canines from the Spanish population were significantly longer than those from the Saudi population (16.9 ± 2.2 mm vs. 13.2 ± 2.5 mm, p < 0.0001). No significant differences were observed in mesiodistal and buccopalatal dimensions. Both groups primarily exhibited mild root canal curvatures and buccally placed foramina. However, the prevalence of palatal foramina (20% vs. 8%, p = 0.04) and oval/ribbon morphologies (52%/12% vs. 22%/6%, p = 0.01) was higher in the Spanish population. The Saudi population showed a greater prevalence of round or irregular canals. The Spanish group was identified as an independent predictor of root length (β = +3.7 mm, p < 0.001), oval canal morphology (odds ratio = 3.8, p = 0.005), and palatal foramina (relative risk ratio = 2.5, p = 0.04). Conclusion: The Spanish population exhibited longer canine roots, associated with oval or ribbon-shaped canal morphologies. In contrast, the Saudi canines displayed shorter length, with more rounded or irregular morphologies. 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

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

Objectives: To evaluate the retreatment efficacy of premixed bioceramic sealer using a reciprocating system, comparing single-cone and carrier-based obturation techniques. Materials and Methods: Twenty-three monoradicular teeth with oval canals were divided into two groups: NeoSealer Flo with single cone (SC) and NeoSealer Flo with Guttafusion (GF). Retreatment was performed using Reciproc Blue (RB) with a crown-down technique. X-ray and CBCT images were taken to measure the remnant areas and volumes. Results: Apical patency was achieved in all the samples. The remnants were mostly distributed in the middle third in the GF group, while an equal distribution in both the middle and apical thirds was observed in the SC group. The GF group had a lower remnant area and volume after RB 50.05, respectively (0.18 ± 0.33 mm² vs. 0.39 ± 0.80 mm² and 0.36 ± 0.59 mm³ vs. 0.51 ± 1.16 mm³). The use of RB 50.05 led to an additional reduction in the remnant areas in the SC (14.89%) and GF (69.49%) groups, while in terms of the volume, the reductions were 20.63% and 36.36%. Conclusions: Reciprocating instruments are effective in removing remnants from root canals filled with both single-cone and carrier-based techniques. The blooming effect in CBCT imaging suggests further in vivo studies for validation. Full article

The purpose of the present study was to perform a preliminary analysis of the fitting of different fiber-reinforced composite (GFRC) posts to tooth root canals and determine the resin cement layer thickness. The following GFRC posts were assessed: bundle posts (Rebilda GT^TM, VOCO, Germany), sleeve system (SAP^TM, Angelus Ind, Brazil), and accessory posts (Reforpin^TM, Angelus, Brazil). Twenty-four freshly extracted mandibular single-rooted pre-molars were endodontically treated and divided into six groups, according to the type of GFRC post and resin cement (self-adhesive or conventional dual-cured). Then, specimens were cross-sectioned and inspected by optical microscopy regarding the cement layer thickness and presence of defects such as pores, voids, or fissures were assessed. Bundle and accessory posts revealed a regular distribution of resin cement with a lower number of voids than found with sleeve systems. The sleeve system posts showed poor fitting at the apical portion of the root canals. The type of resin cement did not affect the thickness of the interface, although both bundle and accessory posts allow a better distribution of resin cement and fibers. The present preliminary study reveals interesting insights on the fitting of bundle and accessory posts to root dentin and resin cement layer thickness in oval-shape root canals. The sleeve system posts showed adequate fitting only at the coronal portion of the canals. Full article

Background: The aim of this investigation was to assess the apical extrusion potential of sodium hypochlorite (NaOCl) in agarose-embedded mandibular first premolars employing four final agitation procedures. Methods: Based on CBCT confirmation of single oval-shaped canals, one hundred extracted mandibular first premolars were chosen. Using 5.25% NaOCl, the teeth were prepared using the XP Endo Shaper and divided into experimental and control groups. The following were the experimental groups: Group 1 comprised the XP-Endo Finisher, Group 2 the Ultrasonic Activation, Group 3 the Gentle File Finisher Brush, and Group 4 the 27-gauge side-vented needle. To test extrusion, the teeth were placed in a 0.2% agarose gel that contained the pH-sensitive dye m-cresol purple, allowing pixel quantification via ImageJ software (version 1.54i). Results: The XP Endo Finisher featured the most pixels, depicting higher apical extrusion (p < 0.01), followed by the side-vented needle, Gentle File Finisher Brush, and PUI, while the Control Group endured no extrusion. Conclusions: The effective irrigation method for root canal therapy is critical, especially in situations of open apices, resorption, or perforation. According to in vitro experiments, the XP-Endo Finisher has the maximum sodium hypochlorite extrusion, which is determined by parameters such as apical preparation size and irrigation system. Full article

The objective of this in vitro study was to compare the efficacy of three different rotary systems, namely D-RaCe, R-Endo, and Edgefile XR, in the removal of root canal obturation materials during non-surgical retreatment procedures. Lower first premolars with straight oval canals were utilized, and microcomputed tomography (micro-CT) was employed as an evaluation method. The study also aimed to investigate the influence of two different initial obturation methods, the single cone and the continuous wave compaction techniques, on the amount of residual material after retreatment. The findings revealed that none of the retreatment systems could completely eliminate the obturation material, corroborating existing studies. However, Edgefile XR outperformed the other systems in terms of reduced residual material. The continuous wave compaction method for initial obturation resulted in fewer remnants compared to the single cone technique. This contradicts prior research suggesting that the two methods offer comparable sealing abilities. The study underscores the advantages of using micro-CT for evaluation, as it provides a more accurate three-dimensional assessment of the residual materials in the canals. Despite its limitations, such as the focus on straight canals and the in vitro setting, the study provides crucial insights for clinicians. It suggests that the choice of rotary system and initial obturation method can significantly impact the success of root canal retreatment procedures. Full article

Background: Calcium silicate-based sealers have gained in popularity over time due to their physicochemical/biological properties and their possible use with single-cone obturation. The single cone technique is a sealer-based obturation and there is still a knowledge gap regarding the potential impact of the sealer insertion method on the root canal-filling quality. Therefore, the aim of this micro-CT study was to assess the impact of the calcium silicate-based sealer insertion technique on void occurrence and on the sealer extrusion following single-cone obturation. Methods: Thirty-six single-rooted mandibular premolars with one canal were shaped with Reciproc^® R25 (VDW, Munich, Germany) then divided randomly into four groups of nine canals, each depending on the TotalFill^® BC Sealer insertion technique used with single cone obturation: injection in the coronal two-thirds (group A); injection in the coronal two-thirds followed by direct sonic activation (group B); injection in the coronal two-thirds followed by indirect ultrasonic activation on tweezers (group C); sealer applied only on the master-cone (control group D). Samples were then scanned using micro-CT for voids and sealer extrusion calculation. Data were statistically analyzed using v.26 IBM; Results: No statistically significant differences were noted between the four groups in terms of voids; nevertheless, sonic activation (group B) followed by ultrasonic activation on the tweezers (group C) showed the best results (p = 0.066). Group D showed significantly less sealer extrusion when compared with group C (p = 0.044), with no statistically significant differences between groups D, A and B (p > 0.05). Conclusions: Despite no significant differences observed between the different sealer placement techniques, the use of sonic and ultrasonic activation might be promising to reduce void occurrence. Further investigations are needed to demonstrate the potential benefit of calcium silicate-based sealer activation especially in wide and oval root canals in order to improve the quality of the single-cone obturation. Full article

Full endoscopic techniques are becoming more popular for degenerative lumbar pathologies. Percutaneous endoscopic lumbar interbody fusion (PETLIF) is a minimally invasive surgical technique for spondylolisthesis and lumbar spinal canal stenosis with instability. Nagahama first introduced PETLIF in 2019. This study investigated the clinical outcomes and complications of 24 patients who underwent PETLIF in our facility and compared them with previous studies. Literature searches were conducted on PubMed and Web of Science. The PETLIF surgical technique involves three steps to acquire disc height under general anesthesia. The procedure includes bone harvesting, spondylolisthesis reduction, endoscopic foraminoplasty, disc height expansion using an oval dilator, and intervertebral disc curettage. A cage filled with autologous bone is inserted into the disc space and secured with posterior fixation. Patients underwent PETLIF with an average operation time of 130.8 min and a blood loss of 24.0 mL. Postoperative hospital stays were 9.5 days. Improvement in VAS, disc height, spinal canal area, and % slip was observed, while lumbar lordosis remained unchanged. Complications included end plate injury, subsidence, and exiting nerve root injury. The differences between PETLIF and the extracted literature were found in patients’ age, direct decompression, epidural or local anesthesia, approach, order of PPS, and cage insertion. In conclusion, PETLIF surgery is a practical, minimally invasive surgical technique for patients with lumbar degenerative diseases suffering from back and leg pain, demonstrating significant improvements in pain scores. However, it is essential to carefully consider the potential complications and continue to refine the surgical technique further to enhance the safety and efficacy of this procedure. Full article

Background and Objectives: Successful root canal treatment depends on the thorough removal of biofilms through chemomechanical preparation. This study aimed to investigate and compare the cleaning and disinfecting efficiency of oval-shaped root canals using XP-endo Shaper (XPS), ProTaper Next (PTN), and HyFlex CM (HCM) in combination with passive ultrasonic irrigation (PUI). Materials and Methods: Ninety extracted teeth were contaminated and randomly divided into three groups: XPS, PTN, and HCM. Each group was assigned to three subgroups: subgroup A (sterile saline), subgroup B (3% sodium hypochlorite and 17% ethylenediaminetetraacetic acid), and subgroup C (3% sodium hypochlorite, 17% ethylenediaminetetraacetic acid, and PUI). Bacterial sampling was conducted both from baseline samples and samples after chemomechanical preparation. Scanning electron microscopy (SEM) was used to evaluate the residue bacterial biofilms, hard tissue debris, and smear layers on the buccolingual walls of oval-shaped root canals. Results: When combined with sterile saline, XPS demonstrated a higher reduction of bacterial counts and was more effective in eradicating Enterococcus faecalis in the middle third of the canals compared to the other instruments (p < 0.05). Additionally, when used with antimicrobial irrigants, XPS was more effective in disinfecting the coronal third of the canals than the other instruments (p < 0.05). Furthermore, XPS reduced hard tissue debris more effectively in the middle third of canals than in the apical third (p < 0.05). Conclusions: XPS outperforms PTN and HCM in disinfecting oval-shaped root canals. Despite the fact that combining XPS and PUI improves cleaning and disinfecting, removing hard tissue debris from the critical apical area remains challenging. Full article

Anatomical characteristics play a pivotal role in understanding the evolutionary relationship among various plant taxa and identifying species of pharmacological importance. Though the anatomical features of the family Apocynaceae have been widely recognized, there is limited research on the stem wood anatomy of Kopsia fruticosa, whereas nothing was previously known about its root wood anatomy. The present work describes and analyses its anatomy and correlates the anatomical features with the habitat and ecology of this plant. The oval shape of the young stem and the presence of unicellular trichomes, stone cells in the pith region, laticiferous canals, calcium oxalate crystals, and vascular bundles of two different sizes, viz., smaller in the broad, flattened region and more prominent on the two narrow sides, are remarkable features of the plant, which collectively may often be helpful in distinguishing K. fruticosa from other species of this genus. Apart from the previously known qualitative characteristics of the family Apocynaceae, the coalescence of pit aperture and storied pattern of vessels of K. fruticosa are newly observed features of the subfamily Rauvofiòideae. On the other hand, in the root wood, vessels are wider (33–64 μm), less frequent (about 53% more in the stem), and shorter, and the rays are larger (21–46 cells in height) and more frequent than those of stem wood; these are the valuable findings which strongly support the non-climbing nature of the studied plant. The vulnerability and mesomorphy indices for stem wood are 0.914 and 349, respectively, indicating plants’ adaptation toward a mesic habitat. The correlation of the anatomical traits of plants with the habitat and ecology represents their survivability in different situations. Consequently, anatomical features such as intraxylary phloem, vessel grouping, the storied pattern of vessels, the simple perforation plate, and intervascular vestured pits suggest that plants can tolerate drought. We firmly believe that the present study’s outcome can fulfil the research gaps of this hardy plant. Full article

The removal of filling material is important for successful root canal retreatment. The aim of the study was to compare the efficiency of two activated irrigation techniques, the shock wave-enhanced emission photoacoustic streaming (SWEEPS) mode of the Er:YAG laser and ultrasonically activated irrigation (UAI) and a conventional syringe-needle technique (SNI), in the removal of bioceramic sealer/gutta-percha during conventional retreatment in oval root canals. The study sample consisted of distal root canals of 42 extracted human mandibular molars, which were prepared using a ProTaper Next system up to size 40/0.06 and filled with bioceramic sealer using a single-cone obturation technique. The teeth were then re-treated with a Reciproc Blue RB40 file and 3% sodium hypochlorite solution. The prepared teeth were randomly divided into three groups (n = 14 per group) and subjected to one of the three irrigation methods. Micro-CT scans were performed at different stages to assess the amount of filling material after each retreatment phase. The results of the study showed that all the tested irrigation techniques reduced a statistically significant amount of the remnant filling material at retreatment (p < 0.05), and there were no statistically significant differences in efficacy between the three methods. All tested techniques had similar efficacy in the removal of the remaining filling remnants. Full article

Aim of the study: to evaluate root filling remnants after secondary root canal treatments (SRCTs) of oval-shaped canals with X-rays and cone beam computed tomography (CBCT). The SRCTs were performed using reciprocating NiTi instruments. Methods: Single-rooted teeth (N = 64) were randomly treated with Reciproc Blue (RB) and filled with AH Plus/single cone (SC group) or AH Plus/Guttafusion (GF group). After seven days of storage in HBSS (Hanks balanced salt solution), Gates Glidden burs #2/3 and RB #25 and #40 were used for the SRCTs. The time to complete the procedure was measured. X-rays and CBCT were used to calculate, respectively, the area and the volume occupied by the remnants in the coronal, middle, and apical thirds of each canal. Environmental scanning electron microscopy (ESEM) and energy dispersive X-ray spectroscopy (EDX) were used for qualitative evaluation and morphology composition of the remnants in sectioned roots. A statistical analysis was performed using Sigma Plot (version 13, IBM, Armonk, NY, USA). The study was designed according to PRILE guidelines. Results: After the SRCTs, the middle thirds of the root canals showed the presence of remnants in both groups, as demonstrated by X-rays and CBCT. The GF group showed a statistically significant higher volume of remnants than the SC Group only in the middle third. The ESEM supported by the EDX revealed the remnant composition by the detection of trace elements of sealer and gutta-percha in all root canals. Conclusion: The study demonstrated that the middle third of root canals is a critical region where remnants were packed and spread in the buccal-lingual sides of canals. ESEM-EDX detected a fine layer of filling remnants in all root thirds, suggesting a larger canal contamination than the X-rays and CBCT examinations revealed. Full article