European Endodontic Journal最新文献

The objective of this article is to conduct a comprehensive review of the applications of artificial intelligence (AI) in endodontics, focusing on optimizing diagnosis, supporting clinical decision-making, and predicting treatment outcome. Additionally, its limitations and areas for improvement are analysed. Information was gathered through a search in scientific databases such as PubMed, Scopus, ScienceDirect, and Google Scholar, selecting studies published in English between 2016 and 2025. After applying exclusion criteria and removing duplicates, 51 articles were included. The main applications of AI in endodontics are grouped into three areas. In Diagnosis, AI models based on convolutional neural networks (CNNs), such as Diagnocat, have demonstrated accuracy greater than 90% in detecting periapical lesions using radiographs and cone-beam computed tomography (CBCT). Likewise, AI algorithms have successfully identified vertical root fractures with high precision in CBCT images. In the analysis of root and canal morphology, deep learning models have shown high accuracy in detecting C-shaped root canals and other anatomical variations. Regarding treatment, deep learning models can predict case complexity and improve treatment planning. Additionally, neural network-based algorithms have outperformed traditional electronic apex locators in determining root canal length. In terms of prognosis, AI models have achieved 95.6% accuracy in predicting pain after root canal treatment (RCT). AI also aids in predicting the success of non-surgical endodontic retreatments. This study demonstrates how AI is revolutionising endodontics by improving diagnostic accuracy, treatment planning, and outcome prediction. However, it faces limitations such as the need for large datasets, high costs, and lack of self-development. Future studies should address these challenges to enhance its integration into clinical practice. (EEJ-2025-05-072).

Objective: This study compared the efficacy of continuous chelation with etidronate and sequential chelation with chitosan to traditional chelation with EDTA in reducing bacterial levels in teeth with necrotic pulp.

Methods: Sixty patients with single-rooted and single-canalled teeth with pulp necrosis were randomly divided into three groups based on the irrigation protocol with passive ultrasonic activation (PUI). G1 (Control): NaOCl/EDTA+PUI, G2: NaOCl/etidronate+PUI, and G3: NaOCl/chitosan+PUI. Microbiological samples were taken before (S1) and after the root canal preparation and irrigation protocol (S2). Total bacterial counts were measured using 16S ribosomal RNA gene-based real-time quantitative polymerase chain reaction. Statistical analysis was performed using the Wilcoxon signed rank test and the Kruskal-Wallis test (P<0.05).

Results: All S1 samples tested positive for bacteria, and total bacterial counts from S1 to S2 were significantly reduced across all three groups (p<0.001), with a mean reduction of 97.7% in G1, 96.3% in G2, and 96.8% in G3. No significant differences were observed among the groups (p=0.345). Bivariate and multivariate analyses revealed that none of the patient-related or tooth-related variables had a significant effect on bacterial reduction (p>0.5).

Conclusion: All three irrigation protocols, including continuous chelation with etidronate, sequential chelation with chitosan, and traditional chelation with EDTA, significantly reduced bacterial levels in teeth with primary endodontic infections.Etidronate and chitosan may serve as alternatives to EDTA; however, further prospective clinical studies are required to validate and recommend their use in clinical practice.(EEJ-2025-07-114).

Objective: The purpose of this study was to evaluate the influence effects of different endodontic treatments ���, such as chelation ng solutions and antimicrobial photodynamic therapy (aPDT), on the rreductionng the amount of endotoxin levels in root canals.

Methods: Eighty human single-rooted teeth had their crowns sectioned, and the root canals were prepared. All samples and materials were sterilized using Cobalt-60 irradiation. Subsequently, 10 ��L of fresh lipopolysaccharide (LPS) was inoculated into the root canals and incubated for 3 days. On the fourth day, experimental treatments were applied to the root canals according to the groups (n=10): [1] pyrogen-free water, [2] 0.005% methylene blue, [3] diode LASER, and [4] 0.005% methylene blue + diode LASER (PDT), [5] 2.5% sodium hypochlorite, [6] 17% trisodium ethylenediaminetetraacetic acid (EDTA), [7] 10% tetrasodium EDTA, [8] 18% etidronate (HEBP). The exposure time for each solution and light irradiation was 5 minutes. The samples collected after treatment were analyzed using the Limulus Amebocyte Lysate test to quantify endotoxins. The data obtained were subjected to Kruskal-Wallis analysis followed by Dunn's test.

Results: All treatments demonstrated efficacy in reducing endotoxin levels in root canals compared to the use of pyrogen-free water (control). A statistically significant reduction was observed in the groups treated with 17% EDTA and 18% HEBP compared to the control group.

Conclusion: Short-term application (5 minutes) of 17% EDTA and 18% HEBP chelating solutions significantly reduced LPS in root canals and may be effective adjuncts in endodontic therapy. (EEJ-2025-03-032).

Objective: This study aimed to investigate the effectiveness of various commercial temporary restorative materials in preventing microleakage with a pre-endodontic sealing technique (PES).

Methods: Ninety-six human single-rooted premolars were prepared for endodontic access and randomly allocated to five groups according to the material to restore the cavity (n=16): CON: Control group, Tetric N-bulk, Ivoclar; COL: Coltosol, Coltene; KET: Ketac Molar, 3M; FUJ: Gold Label Fuji II, GC; CLI: Clip F; and two experimental conditions (n=8): COT: conventional technique and, PES technique. Methylene blue dye penetration was measured in mm. Two-way ANOVA and Bonferroni post-hoc were used (p<0.05) Results: For most materials, PES exhibited statistically significantly lower values of dye penetration (p < 0.001), except for KET and COL. The highest dye penetration was found in FUJ using the COT technique.

Conclusion: The PES technique was more effective in preventing microleakage when polymer-based materials were used. (EEJ-2025-02-027).

Objective: This study aimed to evaluate the wall shear stress (WSS) and smear layer (SL) removal between EndoVac, modified apical negative pressure (mANP)- a novel system, and side-vented (SV) positive pressure irrigation techniques.

Methods: (Phase 1): A simulated 3-dimensional (3D) root canal model and three types of needles (EndoVac, mANP, and SV-positive pressure) were simulated. Model parameters and computer solution were set to analyse the WSS magnitude and pattern using computational fluid dynamics (CFD). (Phase 2): 60 single-rooted extracted permanent lower premolars were decoronated (15.0mm) for standardisation. All samples were root canal prepared up to F4 Protaper size before being randomly divided into three groups according to the final irrigation protocols: Group 1 (EndoVac), Group 2 (mANP), and Group 3 (SV). The samples were vertically split into half and observed under scanning electron microscope (SEM). The SEM evaluation was compared using Fisher's exact test with the level of significance set at 0.05.

Results: CFD analysis revealed that different irrigation systems and needle designs affect the WSS pattern and magnitude. The mANP showed the highest average WSS (11.06 Pa) compared to SV (10.72 Pa) and EndoVac (10.48 Pa). For SEM evaluation, the mANP demonstrated superior SL removal compared to the other groups. There were significant differences between the three groups in SL removal using Fisher's exact test.

Conclusion: The mANP revealed the highest average WSS magnitude and the cleanest SL removal compared to the EndoVac and SV positive pressure technique. Thus, this proves, there is a direct correlation between average WSS magnitude and SL removal.(EEJ-2025-05-084).

This systematic review and meta-analysis compared the efficacy of cold lateral condensation (CLC) and warm vertical condensation (WVC) in endodontic obturation. The primary focus was to evaluate three-dimensional (3D) obturation quality, including void volume, gutta-percha adaptation, and filling completeness, using Micro-Computed Tomography (Micro-CT) and Cone-Beam Computed Tomography (CBCT). A systematic search was conducted in PubMed, Embase, Scopus, and Web of Science up to December 2024 following PRISMA guidelines. Studies were included if they had compared CLC and WVC using Micro-CT or CBCT imaging and reported quantitative outcomes on gutta-percha filling and void volume. A randomeffects meta-analysis was performed because of high heterogeneity (I��=80%), with standardized mean differences (SMD) and 95% confidence intervals (CIs) calculated. Twelve studies were included in the review, with five contributing to the meta-analysis. WVC showed superior obturation quality along the full canal length (SMD=-2.19; 95% CI: -3.78 to -0.60; p=0.02). However, in the apical third, the difference was not statistically significant (SMD=-0.79; 95% CI: -1.92 to 0.35; p=0.13). While WVC offered superior adaptation and fewer voids, it also presented a higher risk of sealer extrusion. CLC, while cost-effective and widely used, exhibited more voids and poorer adaptation, particularly in complex canals. However, substantial heterogeneity (I��=80-85%) among included studies limits confidence in these pooled estimates. WVC achieves superior obturation quality along the full length; however, the evidence remains inconclusive for the apical third, reflecting uncertainty in this anatomically complex region. High study heterogeneity underscores the need for methodological standardization. Given the high heterogeneity and methodological variation among included studies, including studies using alternative models or techniques, the findings should be interpreted with caution and serve as a basis for future standardized research. (EEJ-2025-05-077).

Endodontic therapy aims to reduce the microbial load within the root canal system to a level manageable by the host's innate defence mechanisms. Both the shaping and irrigation phases are critical determinants of treatment success. Sodium hypochlorite (NaOCl) remains the irrigant of choice owing to its potent tissue-dissolving and antimicrobial properties. To enhance the efficacy of NaOCl, various activation techniques have been proposed, including manual agitation, sonic and ultrasonic activation, as well as thermal enhancement. Notably, the internal heating of NaOCl to temperatures approaching its boiling point has been shown to increase its chemical reactivity by up to 200-fold. An electronic literature search was undertaken using three databases: PubMed, Scopus, and Web of Science. The following keywords were employed: ('irrigant' OR 'NaOCl' OR 'sodium hypochlorite') AND ('heating' OR 'pre-heating' OR 'warming' OR 'heat activation'). After the removal of duplicate records and the exclusion of irrelevant titles and abstracts, the remaining studies were screened for eligibility. A total of 226 records were identified: 110 from PubMed, 98 from Scopus, and 18 from Web of Science. Following the removal of 33 duplicate entries, 193 records remained for initial screening. Of these,153 were excluded for not meeting the inclusion criteria. The full texts of the remaining 40 articles were retrieved and assessed in detail. Twenty-one studies met the inclusion criteria. Collectively, these studies indicated that internal heating of NaOCl enhanced its antibacterial efficacy, accelerated the dissolution of organic tissues, and improved smear layer removal, all while remaining compatible with conservative root canal shaping protocols. Owing to its simplicity, cost-effectiveness, and ease of implementation within routine clinical protocols, the internal heating of sodium hypochlorite represents a promising adjunct in endodontic irrigation. This technique has the potential to improve treatment predictability and enhance patient outcomes. (EEJ-2025-04-065).

Objective: The optimal root canal preparation taper remains a subject of debate; smaller sizes putatively favoring fracture resistance and larger, better disinfection. This study evaluated the periapical healing outcome following narrow (0.04) tapered root canal preparation compared with wider tapered preparations (0.07) during non-surgical root canal treatment (NSRCT).

Methods: Clinical and radiographic records of NSRCT completed by a single operator in an endodontic specialist practice were retrospectively reviewed. Two-hundred-and-eighty-nine teeth prepared with either a 0.04 (n=157) or 0.07 (n=132) taper, as guided by pre-operative canal size, met the inclusion criteria and were reviewed for 2 years. Loose (healed and healing) criteria was used to determine the outcome of periapical healing. Logistic regression and stratified outcome analyses were used to investigate the effect of taper and other covariates on periapical healing; the covariates analysed were sex, age, tooth type, size of radiolucency, sinus tract, periodontal defects, cracks, mishaps, number of visits, patency, quality of root filling, quality of restoration, and access cavity design—traditional or non-traditional/minimally invasive. Potential confounders were addressed using a multivariable model (odds ratios [ORs] with 95% confidence intervals [CIs]; p<0.05).

Results: The periapical healing rates of teeth treated with 0.04 (95.5%) and 0.07 (93.9%) tapers were comparable (p=0.5). The presence of iatrogenic errors (n=8) had a significant negative effect on the success rate (p=0.03).

Conclusion: In this cohort study, comparable healing rates were observed between 0.04 tapered canal preparations and wider (0.07) tapers in teeth with narrow canals. (EEJ-2025-06-094).

This systematic review aimed to evaluate the comparative efficacy of gel-based versus solution-based formulations during root canal shaping in terms of smear layer and debris removal, instrument separation, file fatigue, bacterial reduction,debris extrusion, and postoperative pain. Following PRISMA 2020 guidelines, a comprehensive search of five electronic databases (PubMed, Scopus, Web of Science, Lilacs, and Google Scholar) and grey literature sources was conducted up to February 2025. The inclusion criteria encompassed randomized controlled trials, in vitro, ex vivo, and clinical studies that compared gel- (e.g., EDTA gel, NaOCl gel, CHX gel) with solution-based (e.g., NaOCl, EDTA, CHX) formulations during root canal shaping. A total of 37 studies were included. Data extraction focused on defined outcomes, and a narrative synthesis was performed due to study heterogeneity. In vitro/ex vivo: Most laboratory studies showed that gel-based formulations improved glide path lubrication and reduced apical extrusion in some models. However, they were consistently associated with increased dentinal debris retention, higher torsional/cyclic fatigue, and a greater risk of file separation due to formation of dense dentine���gel sludge. Solution-based formulations demonstrated superior smear layer removal, better cleaning efficiency, and stronger antimicrobial activity. Clinical trials showed no significant advantage of gel-based formulations in reducing bacterial load or postoperative pain. Sodium hypochlorite solutions provided better antimicrobial outcomes, while pain scores were comparable between gel and solution groups. Overall, clinical findings favoured solution-based formulations. Although gel-based formulations offer some procedural advantages, their overall clinical performance is inferior to solution-based formulations, particularly concerning cleaning efficacy, instrument safety, and antimicrobial action. Their routine use during root canal shaping should be approached with caution and ideally followed by thorough irrigation. Further well-designed clinical trials are required to establish standardized protocols and clarify the potential role of gel-based formulations in endodontic irrigation. (EEJ-2024-11-169).

Objective: This ex-vivo study aimed to evaluate the antimicrobial effects of calcium hydroxide (Ca(OH)2) nanoparticles combined with nisin against Enterococcus faecalis in infected root canals.

Methods: The Minimum Inhibitory Concentration (MIC50) and Fractional Inhibitory Concentration (FIC) index were determined to assess the potential synergistic effect of the combination. Root canal specimens infected with E. faecalis were divided into three treatment groups: Ca(OH)2 nanoparticles with nisin, Ca(OH)2 nanoparticles alone, and a control group with no treatment. Colony Forming Units (CFU) were quantified at different dentinal depths, and the relative gene expression of E. faecalis was analysed using quantitative PCR.

Results: MIC50 was not achieved by Ca(OH)2, while nisin had an MIC of 50 mg/mL. FIC analysis indicated no synergistic interaction between Ca(OH)2 and nisin. From the root canal specimen model, Ca(OH)2 nanoparticles alone and the combination of Ca(OH)2 nanoparticles and nisin disinfected dentinal tubules up to 1.3 mm. However, neither group achieved disinfection at a depth of 1.5 mm. Relative gene expression analysis showed that the combination treatment significantly reduced E. faecalis gene expression compared to Ca(OH)2 alone.

Conclusion: The combination of Ca(OH)2 nanoparticles and nisin does not improve the antimicrobial activity of Ca(OH)2 nanoparticles against E. faecalis, suggesting independent antimicrobial activity of both agents. (EEJ-2025-04-054).