Search Results (89)

Background and Objectives: The anatomically demanding structure of curved root canals increases the technical difficulty of retreatment procedures. This study aimed to evaluate the retreatment efficacy of various rotary and reciprocating instruments in curved root canals obturated with cold and warm techniques regarding root canal filling material removal, apical transportation, and retreatment time. Materials and Methods: Sixty-four curved mesial root canals of mandibular molars with Vertucci type IV morphology were prepared using the ProTaper Gold system and obturated with AH Plus sealer using either the single-cone (SC) (n = 32) or continuous wave vertical compaction (CWC) (n = 32) technique. Each group was divided into four subgroups (n = 8) and retreated using MicroMega Remover (MM Remover), ProTaper Universal Retreatment (PTUR), Reciproc (Rec), and Hedstrom file systems. Micro-computed tomography was used to assess residual filling material volume and apical transportation. The time required for retreatment was recorded. The level of statistical significance was set at p < 0.05. Results: Across both obturation techniques, the MM Remover and PTUR groups demonstrated shorter retreatment times compared with the CWC–Hedstrom group (p < 0.05). No statistically significant differences were observed among the file systems in terms of filling material removal and apical transportation (p > 0.05). Conclusions: All tested instruments effectively preserved root canal anatomy within clinically acceptable apical transportation limits. The MM Remover and PTUR systems achieved significantly shorter retreatment times, indicating clinical advantages in efficiency. None of the evaluated systems achieved complete removal of the filling materials in either obturation technique. This study provides one of the first comparative evaluations of the MM Remover system, supporting its applicability in complex canal configurations. 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

Background/Objectives: Diode lasers are used as adjuncts for endodontic disinfection, but their depth-resolved effects on root dentin are insufficiently described. This ex vivo study used optical coherence tomography (OCT) to qualitatively document laser-related morphological signatures on canal walls. Methods: Palatal roots from extracted maxillary first molars were standardized and hemisectioned to create specimens allocated to a conventional diode-laser protocol, a higher-power protocol, or control. A 940-nm diode laser with endodontic tips was applied per group. Swept-source OCT acquired serial B-scans along the root length. Two endodontists reviewed images for thermally induced morphological alterations (TIMAs). Reporting is descriptive. Results: OCT revealed laser-related hyper-reflective linear/radial signatures extending from the canal lumen toward the external root surface in laser-treated specimens. Qualitatively, signatures appeared more conspicuous and extended deeper with the higher-power protocol than with the conventional protocol. Findings were most evident in the coronal/middle thirds. Control specimens served to contextualize background appearances from preparation and sectioning. Representative B-scans illustrate typical patterns. The novelty of the present study results from the identification of areas of morphological alteration through the OCT examination of the walls of the root canals. Conclusions: Depth-resolved OCT can visualize dentinal alterations associated with diode-laser irradiation in an ex vivo model. These observations support careful parameter selection and motivate in situ studies with concurrent temperature monitoring and histologic correlation. Full article

Background/Objectives: Root canal treatment (RCT) is a common dental procedure performed to preserve teeth by removing infected or at-risk pulp tissue caused by caries, trauma, or other pulpal conditions. A successful outcome, among others, depends on accurate identification of the root canal anatomy, planning a suitable therapeutic strategy, and ensuring a bacteria-tight root canal filling. Despite advances in dental techniques, there remains limited integration of computational methods to support key stages of treatment. This review aims to provide a comprehensive overview of computational methods applied throughout the full workflow of RCT, examining their potential to support clinical decision-making, improve treatment planning and outcome assessment, and help bridge the interdisciplinary gap between dentistry and computational research. Methods: A comprehensive literature review was conducted to identify and analyze computational methods applied to different stages of RCT, including root canal segmentation, morphological analysis, treatment planning, quality evaluation, follow-up, and prognosis prediction. In addition, a taxonomy based on application was developed to categorize these methods based on their function within the treatment process. Insights from the authors’ own research experience were also incorporated to highlight implementation challenges and practical considerations. Results: The review identified a wide range of computational methods aimed at enhancing the consistency and efficiency of RCT. Key findings include the use of advanced image processing for segmentation, image analysis for diagnosis and treatment planning, machine learning for morphological classification, and predictive modeling for outcome estimation. While some methods demonstrate high sensitivity and specificity in diagnostic and planning tasks, many remain in experimental stages and lack clinical integration. There is also a noticeable absence of advanced computational techniques for micro-computed tomography and morphological analysis. Conclusions: Computational methods offer significant potential to improve decision-making and outcomes in RCT. However, greater focus on clinical translation and development of cross-modality methodology is needed. The proposed taxonomy provides a structured framework for organizing existing methods and identifying future research directions tailored to specific phases of treatment. This review serves as a resource for both dental professionals, computer scientists and researchers seeking to bridge the gap between clinical practice and computational innovation. Full article

Introduction: Apicectomy is an endodontic surgical procedure prescribed for persistent periapical pathologies when conventional root canal therapy or retreatment have failed. Accurate intraoperative visualization of the root apex and surrounding structures remains challenging and subject to possible errors. Augmented reality (AR) allows for the addition of real-time digital overlays of the anatomical region, thus potentially improving surgical precision and reducing invasiveness. The purpose of this pilot study is to describe the application of an AR method in cases requiring apicectomy. Materials and Methods: Patients presenting with chronic persistent apical radio-translucency associated with pain underwent AR-assisted apicectomy. Cone-beam computed tomography (CBCT) scans were obtained preoperatively for segmentation of the target root apex and adjacent anatomical structures. A custom visual–inertial odometry (VIO) algorithm was used to map and stabilize the segmented digital 3D models on a portable device in real time, enabling an overlay of digital guides onto the operative field. The duration of preoperative procedures, was recorded. Postoperative pain measured by a Visual Analogue Scale (VAS), and periapical healing assessed with radiographic evaluations, were recorded at baseline (T0) and at 6 weeks and 6 months (T1–T2) after surgery. Results: AR-assisted apicectomies were successfully performed in all three patients without intraoperative complications. The digital overlap procedure required an average of [1.49 ± 0.34] minutes. VAS scores decreased significantly from T0 to T2, and patients showed radiographic evidence of progressive periapical healing. No patient reported persistent discomfort at follow-up. Conclusion: This preliminary pilot study indicates that AR-assisted apicectomy is feasible and may improve intraoperative visualization with low additional surgical time. Future larger-scale studies with control groups are needed to validate the method proposed and to quantify the outcomes. Clinical Significance: By integrating real-time digital images of bony structures and root morphology, AR guidance during apicectomy may offer enhanced precision for apical resection and may decrease the risk of iatrogenic damage. The use of a visual–inertial odometry-based AR method is a novel technique that demonstrated promising results in terms of VAS and final outcomes, especially in anatomically challenging cases in this preliminary pilot study. Full article

Background/Objectives: Successful endodontic treatment relies on a precise understanding of root canal morphology and effective disinfection of the entire canal system. Anatomical variations, such as additional canals, canal merging, and intercanal communications, may affect clinical outcomes. This retrospective CBCT study evaluated the root and canal morphology of mandibular first molars in a Saudi population, with specific focus on the prevalence and configuration patterns of middle mesial canals (MMCs) and isthmuses in the mesial root. Methods: A total of 552 CBCT scans taken between 2017 and 2021 were screened. After applying strict eligibility criteria, 167 scans from Saudi patients containing fully erupted mandibular first molars with completely formed apices were included, yielding 322 teeth. Teeth with prior root canal treatment or distorted scans were excluded. Root canal configurations were classified according to Weine’s system. The presence of MMCs, isthmuses, intercanal distance, and bilateral symmetry was recorded. Descriptive and comparative analyses were performed using Fisher’s exact test, chi-square test, Kruskal–Wallis test, and McNemar’s test. Results: Most mandibular first molars (75.5%) had two roots, whereas 24.5% exhibited two distinct distal roots. Mesial roots predominantly demonstrated Weine type II (50.9%) and type III (48.1%) configurations, while distal roots were mainly type I (69.3%). MMCs were rare (0.98%). Isthmuses were highly prevalent (82%) and occurred significantly more often in type III mesial roots (72.3%) compared with type II (1.2%) (p < 0.0001). Bilateral symmetry was substantial in both mesial and distal roots (86.8% and 88.4%, respectively). Conclusions: Middle mesial canals were uncommon, whereas isthmuses were frequently observed in the mesial roots of mandibular first molars among Saudi individuals. The high prevalence of isthmuses underscores the need to anticipate intercanal communications during endodontic treatment. CBCT evaluation enhances detection of such complex anatomical features and supports improved diagnostic accuracy and treatment planning. Full article

Objectives: This systematic review analyzed the root canal morphology and configuration (RCC) of maxillary first premolars (Mx1Ps) and sex-specific differences based on existing literature. Methods: Registered in PROSPERO (CRD42023394460) and following PRISMA guidelines, systematic searches were conducted in five databases (Cochrane, Embase, LILACS, Scopus, MEDLINE via PubMed) using predefined MeSH terms. Additional studies were identified through cross-referencing. Studies on Mx1P RCCs were included, assessed using the AQUA tool. Data extraction focused on RCC prevalence, sex differences, root variations, and examination methods. Results: Of 865 studies, 86 were included, analyzing 31,325 teeth. The most common RCCs were 2-2-2/2 (IV, frequencies between 0.6–80.5%) and 1-1-1/1 (I, 1.1–72.0%). Mx1Ps primarily had two roots (7.1–96.2%) or one root (3.8–93.2%), with three-rooted variants being rare (0.4–6.5%). Males more frequently exhibited two- or three-rooted Mx1Ps with RCCs like 2-2-2/2 (IV; OR = 1.39 [1.22, 1.58]), and 1-1-3/3 (VIII; OR = 2.22 [1.59, 3.11]). Females showed higher frequencies of RCCs like 1-1-1/1 (I; OR = 0.71 [0.53, 0.96]), 2-2-1/1 (II; OR = 0.66 [0.57, 0.77]), 1-2-1/1 (III; OR = 0.70 [0.59, 0.83]), and 1-1-2/2 (V; OR = 0.81 [0.70, 0.95]). Conclusions: Mx1Ps predominantly have two roots and a 2-2-2/2 (IV) RCC. CBCT was the most used method, followed by staining and clearing. Clinicians should consider sex-specific and morphological variations. Full article

To evaluate the impact of different surface treatment regimens, Neodymium-doped yttrium orthovanadate (Nd: YVO4) laser, Toluidine blue (TB) activated Low-level laser therapy (LLLT), and Bioactive glass particles (BAGPs) on the surface roughness (Ra), surface morphology, and bond strength (BS) of Glass fiber posts (GFP) bonded to canal dentin. Forty single human rooted incisors with a closed apex were included. The endodontic treatment was performed, followed by post space preparation. Fifty-six GFP were sorted into four categories based on the conditioning method used (n = 14). Group 1: H₂O₂, Group 2: Nd: YVO4 laser, Group 3: TB-LLLT, and Group 4: BAGPs. Surface Ra and topographic changes were identified using a profilometer and Scanning Electron Microscopy (SEM). Post cementation was executed by utilizing self-adhesive resin cement. Analysis of BS and fracture pattern was performed using a universal testing machine and a stereomicroscope, respectively. Variance analysis with Tukey’s test was used to compare Ra and BS between the study groups at different root sections (p < 0.05). Group 2 (Nd: YVO4 laser) displayed the highest Ra scores (1051.54 ± 0.087 µm) and BS at all thirds. Whereas Group 3 TB-activated LLLT exhibited the lowest outcomes of Ra (539.39 ± 0.091) and BS at all three sections. Comparison among the investigated groups displayed that Group 1 (H₂O₂) and Group 2 Nd: YVO₄ exhibited comparable outcomes of Ra and BS (p ˃ 0.05). Nd: YVO₄ laser has the potential to roughen the surface of GFP, thereby enhancing its BS to resin cement Full article

The success of root canal treatment depends on the proper execution of each phase. However, the instrumentation and irrigation phase is especially important. During this phase, the interior of the root canal system must be removed to facilitate the next phase, obturation, achieving the most airtight seal possible, resulting in the success of the endodontic treatment. This study aimed to compare the chelating capacity and smear layer removal effectiveness of two irrigants—17% ethylenediaminetetraacetic acid (EDTA) and 9% hydroxyethylidene bisphosphonate (HEBP)—when activated using two different irrigant activation systems: sonic and ultrasonic. Additionally, the study assessed the relationship between these variables and the average diameter of dentinal tubules in the coronal, middle, and apical thirds of the root canal. A total of 105 single-rooted human teeth were decoronated and instrumented using a rotary system. Teeth were randomly assigned to four experimental groups based on the irrigant (EDTA or HEBP) and the activation method (sonic or ultrasonic). Final irrigation was performed with the corresponding protocol. Samples were analyzed using scanning electron microscopy (SEM). Smear layer removal was quantified using the Carvalho method, and dentinal tubule diameter was measured with image analysis software. Data were statistically analyzed using Kolmogorov–Smirnov and non-parametric tests, with a significance level set at α = 0.05. EDTA showed superior smear layer removal in the coronal and middle thirds, particularly when activated ultrasonically. In contrast, HEBP was more effective in the apical third, especially when used with sonic activation. There were no statistically significant differences in the overall tubule diameter between the two chelating agents; however, HEBP resulted in significantly larger tubule openings in the apical third. Activation systems played a critical role, with ultrasonic irrigation being more effective for EDTA and sonic irrigation favoring HEBP in specific canal regions. The combination of chelating agent and activation system influences both smear layer removal and dentinal tubule morphology. HEBP demonstrated promising results in the apical third with minimal structural damage, supporting its use as a viable alternative to EDTA in continuous chelation protocols. Full article

Dens invaginatus is a developmental dental anomaly characterized by the infolding of the enamel organ into the dental papilla during early odontogenesis. This process leads to a broad spectrum of anatomical variations, ranging from minor enamel-lined pits confined to the crown to deep invaginations extending through the root, occasionally communicating with periodontal or periapical tissues. The internal complexity of affected teeth presents diagnostic and therapeutic challenges, particularly in severe forms that mimic root canal systems or are associated with pulpal or periapical pathology. Maxillary lateral incisors are most frequently affected, likely due to their unique developmental timeline and morphological susceptibility. Although various classification systems have been proposed, Oehlers’ classification remains the most clinically relevant due to its simplicity and correlation with treatment complexity. Recent advances in diagnostic imaging, especially cone beam computed tomography (CBCT), have revolutionized the identification and classification of these anomalies. CBCT-based adaptations of Oehlers’ classification allow for the precise assessment of invagination extent and pulpal involvement, facilitating improved treatment planning. Contemporary therapeutic strategies now include calcium-silicate-based cement sealing materials, endodontic microsurgery for inaccessible anatomy, and regenerative endodontic procedures for immature teeth with necrotic pulps. Emerging developments in artificial intelligence, genetic research, and tissue engineering promise to further refine diagnostic capabilities and treatment options. Early detection remains critical to prevent complications such as pulpal necrosis or apical disease. A multidisciplinary, image-guided, and patient-centered approach is essential for optimizing clinical outcomes in cases of dens invaginatus. Full article

Background/Objectives: A thorough understanding of tooth anatomy is essential for effective root canal treatment. This study aims to investigate the root canal morphology of mandibular incisors (MIs) and the presence of distolingual roots in mandibular first molars (MFMs) and to explore the potential correlation between these anatomical variations. Methods: A total of 562 CBCT scans were retrospectively analyzed, corresponding to 1124 mandibular central incisors (MCIs), mandibular lateral incisors (MLIs), and MFMs each. The DLR in MFMs was correlated with the complex anatomy in MIs and analyzed using a chi-square test, with the odds ratio obtained through binary regression analysis. Differences related to gender, site, and age were analyzed using the chi-square test. Results: Most MI scans revealed Vertucci Type I canal morphology, with a higher percentage in MCIs (71.1%) than MLIs (64.9%). Additionally, 5.25% of MFM scans indicated a DLR, with a higher prevalence in males (3.5%) and younger individuals (3.4%); however, a statistically significant difference was observed only in MCIs (p = 0.035) across different age groups. The study also identified a highly significant difference in complex canal anatomy, comparing both MIs on either side and the presence of DLR in MFMs (p < 0.001). Furthermore, the relationship between complex canal systems in MIs and MFMs with DLR was confirmed. Conclusions: In conclusion, the Vertucci Type I canal configuration was predominant in both MIs, followed by Type III. The DLR was present in 5.25% of the total scans, and its presence strongly correlated with complex morphology in both MIs. Full article

This study evaluated the chemical composition and subcutaneous tissue biocompatibility of C-Point, a root canal filling material, compared to ProTaper gutta-percha cones (control). Material characterization was conducted using scanning electron microscopy with energy-dispersive spectroscopy (SEM-EDS). For biocompatibility assessment, both materials were implanted subcutaneously in the dorsal connective tissue of sixteen albino rats (n = 8 per group). Histological evaluation of inflammatory infiltrate intensity was performed at 30 and 60 days post-implantation, with statistical analysis (significance set at p < 0.05). SEM-EDS analysis revealed distinct elemental compositions: C-Point primarily contained zirconium and cobalt ions, while gutta-percha cones demonstrated a strong zinc signature with trace amounts of barium, aluminum, and sulfur. Both materials exhibited similar particulate morphology with radiopaque inclusions. Histologically, no significant difference in inflammatory response was observed between C-Point and gutta-percha at any time point (p > 0.05). All specimens developed a fibrous encapsulation. The inflammatory profile showed temporal dynamics, with lymphocyte predominance during early stages that progressively diminished by the study endpoint. These findings demonstrate that while C-Point possesses a unique elemental profile dominated by zirconium, its tissue biocompatibility parallels that of conventional gutta-percha obturation materials. However, due to the absence of mechanical testing and the limited in vivo follow-up period, the long-term stability of the material remains uncertain. 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: This study evaluates the root canal anatomy (main and accessory canals) of mandibular first molars in Black South Africans using micro-computed tomography. The effect of sex, arch side, and age are also investigated. Methods: The number of root canals in each tooth and individual roots (including an observation of the middle-mesial and middle-distal canals), the number of accessory canals, accessory canal type, root canal thirds, and the prevalence of apical deltas were recorded. A chi-squared test of association (p < 0.05) was used to report on variables (sex, arch sides, and age). Results: In most teeth, either three (55.81%) or four canalled (24.42%) configurations were present. The middle-mesial canal was found in 18.6% of teeth (males and females), with a higher prevalence among females (23.68%). The middle-distal canal was found in 3.49% of teeth. Chamber canals were identified in 4.7% of teeth. Accessory canals most likely located in the apical third were found in approximately 84.9% and 86.1% of mesial roots and distal roots, respectively. Apical deltas were identified in 15.12% of mesial and 20.93% of distal roots. Conclusion: Root canal anatomy in this population is diverse and includes differences in arch sides between the sexes. Full article

Background and Objectives: Endodontic success depends on eliminating infection and creating a durable seal to prevent recontamination. The goal of this study was to assess the impact of different ISO sizes on the obturation quality using two reciprocating single-file systems, WaveOne^® Gold and Procodile^®, in two different canal morphologies. Material and Methods: Overall, 140 root canals from human permanent teeth were randomly assigned to 14 groups based on selected ISO sizes and straight and curved canal curvatures, and the two file systems, WaveOne^® Gold files in ISO sizes 20, 25, and 45, and Procodile^® files in ISO sizes 20, 25, 40, and 45, were employed for canal preparation. These 140 canals were obturated using corresponding gutta-percha points and AH-Plus sealer and the quality of the obturation was assessed after sectioning the roots (apical, middle, coronal third) by evaluating the resulting 420 sections under a digital fluorescence microscope with regard to the proportion of gutta-percha, sealer, and unfilled areas. The results were analyzed using nonparametric tests. Results: For both systems, there was a significant difference in the percentage of gutta-percha-filled areas (PGFA, p < 0.001) and sealer-filled areas (PSFA, p < 0.001 among the different ISO sizes). However, no significant difference was observed in the percentage of unfilled areas (PUA, p = 0.354). ISO 40 demonstrated the best results, with the highest percentage of gutta-percha-filled areas (87%) and the lowest percentages of sealer-filled areas (13%) and voids (0.5%). In contrast, the lowest percentages of gutta-percha filled areas were observed in root canal fillings with ISO 20 (81%) and ISO 25 (81%). Regarding both reciprocating file system sizes, ISO 45 in WaveOne^® Gold and ISO 40 in Procodile^® demonstrated significantly improved (p < 0.05) filling quality, with PGFA of 85% and 87%, respectively. The differences between both systems were not significant. Conclusions: The results presented suggest that larger sizes provide better filling results, especially in the apical region. These results underline the importance of selecting appropriate preparation sizes adjusted to the initial anatomical specifications to optimize root canal obturation and ensure a high quality and durable seal. Full article