Search Results (213)

This study aims to evaluate the feasibility and accuracy of 3D printing-guided endodontics in the maxillary teeth of dogs. CT data from a Beagle dog were processed to create a 3D model of the maxilla, and virtual root canal pathways were established using SOLIDWORKS software (version 29.0.0.5028). Guided endodontic templates were 3D printed and tested in vitro on 20 maxillary teeth (excluding the third molars), with 36 root canals treated using both guided and conventional methods. Results indicated that 3D printing-guided endodontics provided accurate root canal pathways, with minimal deviations in length (average 3.08 ± 1.75%) and angular alignment (average 2.06° ± 0.5°) compared to conventional methods. This research represents a significant step forward in the application of 3D printing technology in veterinary endodontics, offering a promising alternative to traditional methods for treating complex dental conditions in dogs. Full article

Objectives: This study aimed to evaluate the success rates of NSRCT performed by AEGD residents and to identify predictive factors associated with clinical outcomes and patient satisfaction. Methods: A retrospective chart review was conducted on cases treated between 2012 and 2021. Eligible cases included fully developed permanent teeth that underwent NSRCT and received a final restoration by general dentistry residents, with a minimum of 12 months of follow-up. Data collected included demographic information, medical history, clinical symptoms, radiographic findings, instrumentation, type and timing of final restorations, and patient satisfaction scores. Treatment success was defined as the absence of symptoms and either the resolution or stability of periapical radiolucency. Patient satisfaction and pain levels were also analyzed. Results: AEGD residents achieved radiographic and clinical RCT success rates of 93.3% and 91.5%, respectively. Multivariate logistic regression showed that the presence of an intact restoration was significantly associated with increased odds of tooth retention (odds ratio [OR] = 3.4, p < 0.001), while post placement in a straight root was also a significant predictor of survival (OR = 4.2, p = 0.02). Conversely, pre-existing radiolucency (OR = 0.37, p = 0.018) and the use of a metal post (OR = 0.23, p = 0.012) were significantly associated with lower odds of tooth retention. Worse periodontal health was significantly associated with increased odds of pain on percussion, with a 74.19% increase in odds per worsening category (OR = 1.74, p = 0.002). Patient satisfaction was significantly higher when restorations remained intact, with esthetic satisfaction increasing by a factor of 3.08 (OR = 3.08, p < 0.001) and functional satisfaction increasing by a factor of 3.9 (OR = 3.9, p < 0.001). Conclusions: Endodontic treatments performed by AEGD residents demonstrated high success rates and favorable patient-reported outcomes. Restoration integrity, periodontal health, and post and final restoration selection play critical roles in treatment success and patient satisfaction. Full article

This study evaluated the effects of mechanical agitation of Aloe vera Barbadensis Miller solution at different concentrations using passive ultrasonic irrigation (PUI), XP Endo Finisher (XPF), XP Clean (XPC), and Easy Clean (ECL), compared to conventional endodontic irrigation (CIE), on bond strength and adhesive failure patterns in the cervical, middle, and apical thirds of the root canal. Aloe vera solutions at 1%, 3%, and 5% were tested to reverse collagen fiber collapse induced by hypochlorous acid, a free radical released by 2.5% sodium hypochlorite, which impairs dentin hybridization and the light curing of resin cement. Fiberglass posts were cemented using an etch-and-rinse adhesive system (Ambar; FGM) and conventional dual resin cement (Allcem Core) in root dentin across all thirds. Human teeth underwent chemical–mechanical preparation, and the Aloe vera solution was agitated using the CIE, PUI, XPF, XPC, or ECL protocols. Slices from each root third were evaluated under a stereomicroscope at 10× magnification and subjected to the push-out test. Cytotoxicity was assessed by applying various Aloe vera concentrations to stem cells from the apical papilla (SCAPs) for 24 h, followed by analysis of cell metabolism (Alamar Blue), viability (Live/Dead), and proliferation (F-actin). Aloe vera demonstrated significant biological activity and enhanced bond strength, particularly at 3% and 5%, irrespective of the agitation method or root third. Thus, it can be concluded that using Aloe vera solution is an alternative for pre-treatment before the cementation of fiberglass posts with conventional dual-cure resin cement in endodontically treated dentin. Full article

Objective: This study aims to evaluate the stress distribution on endodontically treated anterior teeth restored using different restorative materials and different post lengths versus endocrowns employing finite element analysis (FEA). Methods: An extracted human central incisor tooth with a fully formed apex was scanned using high-resolution cone beam computed tomography (CBCT) to generate 3D finite element models. Six models of restorations of badly destructed central incisor were grouped according to the type of ceramic material and post length versus endocrown restorations. Group V-L: Vita Enamic, long post (10 mm intra-radicular), Group C-L: Celtra Duo, long post (10 mm intra-radicular), Group V-Sh: Vita Enamic, short post (3 mm intra-radicular), Group C-Sh: Celtra Duo, short post (3 mm intra-radicular), Group V-E: Vita Enamic endocrown (3 mm intra-radicular), and Group C-E: Celtra Duo endocrown (3 mm intra-radicular). A static load of 200 N was applied to the palatal surface at a 45 degree angle to the tooth’s long axis. The maximum equivalent von Mises stress and maximum principal stress were analyzed at four locations: the finish line, coronal third of the root (12 mm from the apex), middle third of the root (8 mm from the apex), and apical third of the root (4 mm from the apex). Results: Group C-L exhibited the highest maximum VM stress and PS at the finish line, in addition to the highest maximum VM stress and PS at the root apical third, while group C-Sh reported the least maximum VM stress at the root apical third among the groups. All Celtra Duo groups reported higher maximum VM stress than the corresponding groups of Vita Enamic at the finish line and root coronal thirds. However, at the root middle and apical thirds, both materials recorded similar stresses. Conclusions: Short posts and Vita Enamic endocrowns showed minimal stress, especially at the finish line, while long posts increased stress and fracture risk. The findings support conservative restorations without posts, although clinical validation is needed to confirm their long-term effectiveness and safety. Full article

The aim of this study was to explore diabetes mellitus type 2 as a risk factor in the prevalence of chronic apical periodontitis (CAP) in untreated and endodontically treated teeth. The second objective was to describe the correlation between the presence of periapical lesions and blood glucose/glycated hemoglobin levels among diabetic (DM) and non-diabetic patients with endodontically treated or untreated teeth with CAP. Materials and methods: This cross-sectional study was conducted on 90 patients (55 with DM, 35 without DM), admitted to the Oral and Maxillofacial Surgery Department of “St. Spiridon” Hospital in Iași, Romania. Endodontic and perapical status was evaluated using the Periapical Index (PAI) based on clinical and radiological evaluations with blood glucose levels and HbA1c analysis. Statistical analysis included data, correlations and regression analysis, and group comparisons using appropriate parametric or non-parametric tests. DM subjects had a higher mean value of untreated teeth with CAP (2.53 vs. 2.00) compared to the control group (p = 0.010) and a lower mean number of endodontically treated teeth without CAP (1.53 vs. 2.74) compared to the control group (p < 0.001). Diabetic patients also had a higher mean number of root-filled teeth with CAP (3.33 vs. 1.94; p < 0.001). Conclusions: There was a clear association between diabetes and oral pathology, with diabetic patients having fewer teeth, more untreated teeth, and a higher prevalence of periapical lesions. Elevated blood glucose and HbA1c levels indicated that poor metabolic control negatively impacts periapical healing and overall endodontic health. Full article

The aim of this study is to evaluate the apical sealing ability of novel bioceramic-based (BCB) and widely used resin-based (RB) root canal sealers in combination with traditional or bioceramic-coated gutta-percha points. A total of 92 human single-root extracted teeth were endodontically treated and divided into three groups (A, B, and C) of 30 samples based on the endodontic sealer/type of gutta-percha points/obturation method used. One tooth sample was used for the negative and positive controls (each). Group A: BCB sealer BioRoot RCS (Septodont, Saint-Maur-des-Fossés, France)/bioceramic-impregnated gutta-percha TotalFill BC points (FKG Dentaire, La Chaux-de-Fonds, Switzerland)/cold hydraulic single-cone. Group B: BioRoot RCS (Septodont, France)/traditional Protaper Gold Gutta-Percha Points (Dentsply Sirona, Charlotte, NC, USA)/cold hydraulic single-cone. Group C: RB sealer AdSeal (Meta Biomed, Cheongju, Republic of Korea)/traditional Protaper Gold Gutta-Percha Points (Dentsply Sirona, USA)/warm vertical condensation. A dye penetration method was applied, and the length of apicocoronal penetration was measured using a surgical microscope. The data were statistically analyzed to evaluate differences at the 0.05 significance level. A significant difference was found between groups A and C, p = 0.0003, and groups B and C, p = 0.003. The data analysis proved that the BCB sealer using the cold hydraulic single-cone method ensured a substantially better seal than the RB sealer using the warm vertical condensation method. The choice of the type of gutta-percha points (bioceramic-coated or regular) appeared to be unimportant. No statistical significance was found between groups A and B, which indicates that using bioceramic-coated gutta-percha points does not bring any considerable benefit in view of a no-gap root canal obturation. Full article

Background: Regenerative endodontic therapy (RET) allows for continued root development in necrotic immature permanent teeth. Autologous platelet concentrates (APC) such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are proposed alternatives to conventional blood clot scaffolds (BCS). Objectives: This systematic review compared the use of APC and BCS in RET of human necrotic immature permanent teeth. Methods: The electronic databases MEDLINE, CENTRAL and EMBASE were searched for randomized controlled trials (RCTs) which investigated the efficacy of APC and BCS in RET. We conducted this review following PRISMA 2020 guidelines. Quantitative radiographic outcomes of root length and root thickness were considered. The included RCTs were assessed for risk of bias using the Cochrane Risk-of-Bias tool. A meta-analysis was performed using RevMan 5.4. The protocol was registered on PROSPERO (CRD42023391536). Results: Of the 89 records screened, 10 RCTs were included in this review, in which 373 necrotic immature permanent teeth were treated. Both APC and BCS enable continued root development and would therefore be preferred over conventional root canal therapy with or without apexification. The meta-analysis revealed a statistically significant improvement in clinical success for PRP compared to BCS (Risk Ratio [RR] = 1.14, 95% Confidence Interval [CI]: 1.03–1.27, p = 0.02), whereas no significant difference was observed between PRP and PRF (RR = 1.04, 95% CI: 0.95–1.13, p = 0.37). Conclusions: PRP and PRF scaffolds enhance root length and thickness development in REPs compared to BCS. While PRP provides a modest but significant improvement in clinical success over BCS, PRF and PRP exhibit similar clinical outcomes. These findings support the use of platelet concentrates as viable alternatives to conventional blood clot scaffolds in regenerative endodontics. Full article

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

Purpose: The aim of this in vitro study was to investigate the adhesive bond strength of glass fiber posts when cemented with universal resin cement in two different adhesion modes: adhesive and self-adhesive. Methods: A total of 20 extracted single-root teeth were endodontically treated, decoronated and prepared to receive glass fiber posts (GFPs) with a diameter of 1.6 mm (RelyX fiber post 3D). Specimens were randomly divided into two groups: (G1) GFPs were cemented using RelyX Universal cement in self-adhesive mode, and (G2) GFPs were cemented using Scotch Bond Universal Plus and RelyX Universal cement (adhesive mode). Afterwards, the specimens were sliced at three root levels: coronal, middle and apical. Bond strength was measured using a push-out test. Data were analyzed with a two-way analysis of variance (ANOVA) test and independent sample T-test. Results: Bond strength was significantly influenced by the adhesive strategy (p < 0.025) and the position of the root third (p < 0.007). Microscopic analysis of failure mode revealed a higher prevalence of adhesive failures (cement–dentine). Conclusions: Glass fiber posts cemented with universal resin cement applied in adhesive mode showed significantly higher push-out bond strength than when applied in self-adhesive mode. In both study groups, the apical root regions exhibited the highest retention values, followed by the middle and coronal regions. Full article

Objectives: A retrospective clinical audit was carried out to evaluate and compare the quality of record-keeping (QRK) and quality of root canal therapy (QRCT) performed by 4th-year and 5th-year predoctoral students. Methods: Electronic records and periapical radiographs of 702 root canal treated teeth performed by 4th-year and 5th-year predoctoral students from July 2018 to December 2021 were evaluated in compliance with standard European Society of Endodontology (ESE) and American Association of Endodontists (AAE) guidelines. Associations between the QRK and the QRCT were statistically analysed using the chi-square test (p < 0.05). Results: Overall acceptability of the QRK and the QRCT was 72.08% and 50.57%, respectively. The reference point of working length was the most common criterion not recorded (33.91%). No significant difference was observed in the QRK between 4th-year (76.05%) and 5th-year (69.70%) students (p = 0.226), as well as the QRCT between 4th-year (51.33%) and 5th-year (50.11%) students (p = 0.755). Acceptable root canal fillings were significantly higher in anterior teeth (57.48%) than in posterior teeth (47.54%) (p = 0.015). Satisfactory QRK was significantly associated with satisfactory QRCT (p = 0.046). Conclusions: Both predoctoral cohorts showed no difference in QRK and QRCT. However, QRK was better than QRCT. Comprehensive and accurate record-keeping positively impacted the QRCT. Full article

Background/Objectives: Contemporary dentistry aims to preserve healthy tissues and perform minimally invasive procedures. The availability of ever-improving equipment allows practitioners to follow this conceptual innovation. This approach is also used in endodontics, as new types of access cavities seem to be gaining popularity, allegedly reducing tissue destruction and loss of mechanical resistance of the treated teeth. Methods: We performed a comprehensive review of the available literature on the subject, focusing on in vitro studies accessible through major search engines and limiting the search to English-language articles published between 2010 and 2024. Results: Our analysis showed that the realization of reduced access cavities seems to preserve the mechanical resistance of the treated teeth, may compromise disinfection, and respects the original root canal path and the quality of obturation. In addition, these procedures appear to increase instrument deformation, fracture susceptibility, and treatment time: Mini-invasive cavities have many limitations and should only be used in situations where there is a high likelihood of success, where there are few difficulties and where sufficient material is available. However, with appropriate case selection, these new approaches can be used and should improve the prognosis of endodontically treated teeth. Full article

Background and Clinical Significance: Dental implants are widely used; however, tooth extraction often results in alveolar bone loss and gingival recession, necessitating bone and connective tissue reconstruction, especially in the esthetic anterior regions. To address these issues, implants are occasionally connected to adjacent teeth, but this remains controversial, as complications (e.g., intrusion of natural teeth) have been observed. This report demonstrates the long-term success of implants replaced after removing maxillary bilateral central incisors and connecting them to lateral incisors with reduced supportive bone due to periodontitis. Case Presentation: A 57-year-old woman with root fractures in maxillary bilateral central incisors, periodontitis, and malocclusion was treated with connecting implants and natural teeth. Bone levels surrounding maxillary bilateral lateral incisors were diminished due to root fractures in adjacent central incisors and periodontitis. After initial periodontal therapy, hopeless maxillary central incisors were extracted, replaced with implants using a digitally simulated surgical guide, and guided bone regeneration and connective tissue grafting were performed. Implants were connected to lateral incisors with provisional restorations, and orthodontic treatment was initiated following digital set-ups incorporating implants into the overall strategy. Final porcelain-fused-to-zirconia restorations were placed after orthodontic treatment. At the 5-year follow-up, gingival morphology, coloration, and position of lateral incisors remained stable. Conclusions: This case demonstrates that connecting implants to natural teeth in the anterior region can effectively maintain periodontal tissues around natural teeth and allow for minimally invasive, short-term, and esthetic treatment. However, careful long-term observation through maintenance is necessary due to limited evidence for this approach in the anterior region. Full article

Enterococcus faecalis is strongly associated with secondary/persistent root canal infections, being the most prevalent bacterium in cases of apical periodontitis in previously treated teeth. This study was elaborated to evaluate the anti-planktonic, antibiofilm, and synergistic effects of Nasturtium officinale and Psidium guajava hydroethanolic extracts against standard and clinical strains of E. faecalis. Firstly, the N. officinale extract was prepared from watercress leaves, and P. guajava extract was prepared from guava tree leaf shoots. Then, the content of soluble solids was quantified in both. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values of the isolated N. officinale and P. guajava extracts for each bacterial strain were determined using the broth microdilution method, following the Clinical and Laboratory Standards Institute (CLSI) guideline M7-A9. The MTT assay was used to evaluate the antibiofilm activity, and the fractional bactericidal concentration index (FBCI) was utilized to evaluate the synergistic effect of the N. officinale and P. guajava extracts using the checkerboard technique. Again, the MTT assay was used to evaluate the antibiofilm activity of the combined extracts this time. The data were subjected to statistical analysis using ANOVA and Tukey’s test, with a significance level of p ≤ 0.05. It was found that the soluble solid content of N. officinale was 50 mg/mL, and of P. guajava was 33.5 mg/mL. The MBC value of N. officinale was 12.5 mg/mL, and of P. guajava was 0.52 mg/mL against all the tested strains of E. faecalis. The combined 0.1 mg/mL N. officinale + 0.1 mg/mL P. guajava, and 0.1 mg/mL N. officinale + 0.5 mg/mL P. guajava hydroethanolic extracts effectively reduced the biofilm formation of the standard and clinical strain 4 of E. faecalis. Therefore, these combined extracts may be considered as endodontic irrigants in future studies. Full article

Background/Objectives: Dentoalveolar ankylosis in adolescents involves a series of difficulties related to bone growth and development, especially in a vertical manner. A systematic review of studies on ankylosis in young permanent teeth treated by decoronation which considered the preservation/vertical growth of the alveolar bone as their main objective was carried out. Methods: The PRISMA 2020 guidelines were followed. Our research question was formulated using the PICO structure. Clinical cases or a series of cases of ankylosis in which a tooth had been treated with decoronation, with a minimum follow-up of one year, were included. The search was carried out in five databases. The selection of search terms was based on previous works within this framework and their most cited descriptors. The article selection and data extraction were carried out by two investigators. The JBI critical checklist of clinical cases was used for quality assessment. Results: Twelve articles were selected with a total of 23 cases that met the inclusion criteria. The mean age at the time of trauma was 9 years and the mean age at decoronation was 12.5 years. The traumatic event was avulsion in 10 out of the 14 cases. The upper right central incisor represented 62.5% of the sample compared to 25% for the contralateral tooth. The follow-up period ranged from 1 to 10 years. Vertical bone augmentation was found in all cases except in three cases where it remained stable. Conclusions: Based on the results of the present review, it can be concluded that decoronation is an effective technique for maintaining/stimulating vertical bone growth in young ankylosed permanent teeth and that complete root resorption is an important factor associated with vertical bone growth. Full article

Background/Objectives: Vital pulpotomy involves the partial removal of the coronal pulp tissue in cases of vital pulp exposure, aiming to maintain the health and function of the remaining radicular pulp. The first aim of this study was to compare the effects of two different methodological approaches towards vital pulpotomy of the primary teeth—conventional and laser pulpotomy; thereafter, the aim was to perform a comparison of the effects of the application of calcium hydroxide (Ca(OH)₂) versus mineral trioxide aggregate (MTA); then, we analyzed and compared clinical and radiographic changes in pulpotomized teeth over a defined time period; finally, we determined the degree of efficiency of different methods of vital pulpotomy of the primary teeth. Methods: This study analyzed 40 primary molars, 20 teeth treated with conventional pulpotomy and 20 teeth submitted to laser pulpotomy. Additionally, two pulpotomy agents—Ca(OH)₂ and MTA—were used. The following clinical parameters were examined: pain, percussion sensitivity, swelling, sinus tract presence and pathological mobility. Absence of apical radiolucency, external and internal root resorption, and periodontal ligament widening were key radiographic parameters of the success of the endodontic therapy. Results: The results showed that there was no statistically significant difference between the two pulpotomy agents—Ca(OH)₂ and MTA—and therefore both can be used as alternative pulpotomy agents in the primary teeth. Conclusions: The success rate of pulpotomy with Ca(OH)₂ is similar to that of pulpotomy with MTA. The combination of laser pulpotomy and the use of MTA gave the best results according to all clinical and radiographic criteria examined and in all analyzed periods. Full article