European Endodontic Journal最新文献

Objectives: The final irrigation solution should have the capability of a chelation agent to remove the smear layer. The purpose of this study was to determine the effect of EDTA, novel silver citrate, and chitosan nanoparticles as a final irrigation solution on the mechanical properties of root canal dentine, namely the flexural strength and elastic modulus.

Methods: Thirty-two intact, single, and straight roots, with no caries, no cracks, and no restoration of premolars, were assigned into four groups of 8 teeth each. Group 1: irrigated with EDTA; Group 2: irrigated with novel silver citrate; Group 3: irrigated with chitosan nanoparticles; Group 4: irrigated with saline as control. Using a Universal Testing Machine, each sample was tested for flexural strength and elastic modulus with a three-point bend test. The data were analysed using one-way ANOVA and followed by the Tukey's test with a significance level of 95%.

Results: Chitosan nanoparticles generated the highest flexural strength and elastic modulus of root canal dentine (212.03 +- 1.64 and 16.40 +- 1.05, respectively) than EDTA (127.10 +- 0.90 and 7.37 +- 0.94) and novel silver citrate (177.87 +- 2.03, and 12.27 +- 1.01) (p<0.05). However, chitosan nanoparticles have similar flexural strength and elastic modulus of root canal dentine when compared to saline (213.76 +- 1.48, 17.02 +- 1.14, respectively) (p>0.05).

Conclusion: Among final irrigations used, chitosan nanoparticles produced the highest flexural strength and elastic modulus of root canal dentine compared to EDTA and novel silver citrate.

Objective: To evaluate the effect of a newly developed MTA-based material and two antibacterial-enhanced MTAs as pulp capping materials in immature permanent dental elements underwent full pulpotomy.

Methods: The present animal study included 20 Wistar albino rats that, after full pulpotomy, were randomly divided into 4 groups receiving different MTA formulations as pulp capping materials: conventional MTA, Tricalcium aluminate (TCA)- free MTA, and MTA enhanced with metronidazole or doxycycline. Histopathological assessments were carried out at 7- and 28-days post-treatment to evaluate dentinal bridge formation, inflammatory reactions, pulp tissue necrosis and internal resorption.

Results: Seven days post-treatment, all groups exhibited inflammation and pulp necrosis, that were minimal in Groups III and IV than Group I. Group II showed a statistically significant difference only in terms of pulp necrosis (p<0.001). At 28-days all Groups showed slight inflammation and pulp necrosis, mainly in Groups I. Dentinal bridge formation was appreciated in all samples belonging to Groups II, III and IV and in 7/10 specimens of Group I, resulting in a statistically significant difference (p≤0.001).

Conclusion: TCA-free MTA and antibiotic-enhanced MTAs showed superior performances in dentinal bridge formation and exhibited minimal pulpal necrosis than conventional MTA. The inclusion of antibiotics might contribute to create a more sterile environment that would improve the outcomes, favoring deposition of a mineralized matrix. However, further studies are needed to support these preliminary results. (EEJ-2024-10-157).

Objective: The present study aimed to evaluate the effect of heat-treated nickel titanium (NiTi) files TruNatomy and XP- Endo Shaper on the major apical foramen deformation and enlargement in curved root canals using area, circularity, and Feret's diameter ratio.

Methods: Sixty mesio-buccal roots of maxillary and mandibular molars with Vertucci type II root canal were selected. The teeth were decoronated using a carborundum disc. The roots with a length of 13 mm were measured using a digital caliper. The preoperative scanning electron microscope images of apical roots were taken and then divided into 4 groups. Manual (K file, Mani Tochigi, Japan), ProTaper Universal (PTU, Dentsply Maillefer, Ballaigues, Switzerland), XP-Endo Shaper (XPS;FKG Dentaire SA, La Chaux-de-134 Fonds, Switzerland), and TruNatomy (TRN;Dentsply Sirona, Ballaigues, Switzerland) group. After instrumentation, the post-operative scanning electron microscope images were taken. Surface area, circularity, and Feret's diameter ratio was calculated before and after instrumentation using Image J software. For intergroup comparison of data, student's independent t-test was employed and for intra-group comparison of data, paired t-test was applied.

Results: The area after instrumentation increased in all groups but the K file and PTU show statistically significant differences compared to TRN and XPS (p<0.001). The circularity tends towards 0 in K file and PTU and canals became ellipticals after instrumentation. However, TRN and XPS showed no difference. There is no significant difference in the Feret's diameter ratio before and after instrumentation.

Conclusion: The enlargement of the major apical foramen occurs regardless of the type of file system used. The hand K files and PTU result in significant foramen deformation when instrumented up to the major apical foramen. However, TRN and XPS promote minor alterations at the foramen which are not statistically significant. (EEJ-2024-01-20).

Objective: This study aimed to evaluate the antibacterial efficacy of different concentrations of GH12 on a simulated multispecies biofilm comprising Enterococcus faecalis, Streptococcus mutans, Fusobacterium nucleatum and Porphyromonas gingivalis.

Methods: Single rooted teeth were decoronated, cut into 1.5 mm sections to obtain dentine discs which were randomly allocated into five groups: (n=12 each), Group 1: Phosphate Buffered Solution (PBS) - negative control, Group II: 5% Sodium hypochlorite (NaOCl) - positive control, Group III: Minimum Inhibitory Concentration (MIC) of GH12, Group IV: 2x MIC of GH12, Group V: 4x MIC of GH12. Colony forming units, Crystal violet assay and scanning electron microscopy examinations were performed. One-way ANOVA and Turkey's test were applied for statistical analysis using the SPSS software version 22.0.

Results: Group II (NaOCl) showed maximum reduction in bacterial load followed by Group V (GH12 16mg/mL) with no statistically significant difference (p=1.000). On comparing the mean CFU reduction, the maximum reduction was identified for S. mutans and the least was for P. gingivalis. There was marked erosion observed in the NaOCl group whereas the GH12 group showed no erosive changes in the morphology and no bacterial colonies was identified.

Conclusion: The findings revealed that GH12 at higher concentrations inhibits and disrupts the growth of multispecies endodontic biofilm comparable to NaOCl but without erosive effects to the dentine, further highlighting its potential to be used as an antimicrobial solution. (EEJ-2023-10-147).

Objective: To evaluate the outcome of teeth filled with a single cone technique and a premixed bioceramic sealer at 3 years of follow-up.

Methods: Healthy patients were consecutively treated by a cohort of postgraduate operators. Root canal filling procedures were performed with NiTi rotary instrumentation, while non-surgical retreatments were performed using NiTi reciprocating instruments. Root canal filling procedures were performed using Ceraseal and the single cone technique. Post-endodontic restorations were performed after 15 days. Provisional and definitive crowns were positioned in case of non-sufficient coronal structure. Periapical radiographs were made before treatment, after filling, and at each follow-up visit (6, 12, 24 and 36 months). The periapical Index (PAI) was used to assess the presence of periapical lesions and their modifications over time. Success (absence of periapical radiolucency, PAI <3) and survival rates were evaluated. The presence of apical extrusion was also radiographically assessed. Linear regression analysis was used to investigate changes in mean PAI scores, and logistic regression analysis was used to investigate changes in the percentage of healed cases. All analyses were replicated using two distinct approaches: per protocol (PP) (treatments who completed the follow-up) and intention to treat (ITT) (all root canal treatments). A significance level of 5% was used for all statistical tests (α=0.05).

Results: Fifty-eight endodontic treatments in 52 patients were performed (ITT). Thirty-eight endodontic treatments in 33 patients completed the 3 years of follow-up with a survival rate of 92.7%. The success rate was 85.4% (PP).

Conclusion: The use of Ceraseal associated with the single cone technique was safe in maintaining endodontically affected teeth. (EEJ-2024-01-02).

Objective: To investigate significant differences in selected radiomic parameters when classifying periapical lesions based on volumetric size, cortical expansion, erosion, and shape using Cone Beam Computed Tomography (CBCT).

Methods: A retrospective analytical and comparative study was conducted on 100 small field of view (FOV) 50×50 mm CBCT scans collected between the years 2018 and 2023. The study involved qualitative classification of periapical lesions, followed by segmentation and extraction of radiomic parameters. The extracted parameters included first-order features such as energy, entropy, total energy, and uniformity; texture features like grey-level co-occurrence matrix contrast (GLCMC) and neighbouring grey tone difference matrix contrast (NGTDMC); and shape features including elongation, flatness, sphericity, and mesh volume, utilising 3D Slicer and Pyradiomics. The normal distribution of the variables was determined using the Shapiro-Wilk test. Various tests were used to assess significant differences, including Student's t-test, Mann-Whitney U test, ANOVA, and Tukey's post hoc analysis.

Results: Significant differences were observed in the following parameters among the classification levels when classifying periapical lesions according to their volumetric size. There were significant differences in energy with a p-value of 0.001 and total energy with a p-value of 0.02. NGTDMC also showed a significant difference with a p-value of 0.001. A larger volumetric size is associated with greater energy and lower contrast. Significant differences in periapical lesions with erosion were found in shape sphericity (mean 0.34, SD 0.10, p=0.01), energy (mean 3.73×10¹⁰, SD 4.52×10¹⁰, p=0.002), and NGTDMC (mean 0.05, SD 0.02, p=0.001) compared to lesions without erosion. GLCMC was lower in erosive lesions (mean 18.94, SD 6.81, p=0.03) than in non-erosive ones (mean 22.28, SD 8.48). Regular-shaped periapical lesions demonstrated significantly greater elongation (mean 0.794, SD 0.115, p=0.006) and flatness (mean 0.614, SD 0.107, p=0.005) than irregular-shaped lesions. These findings suggest that regular-shaped periapical lesions are more elongated and flatter than irregular ones. No significant differences were found in radiomic features depending on the presence or absence of expansion in the periapical lesion.

Conclusion: There are significant differences in texture and first-order radiomic features in periapical lesions classified based on size, erosion, and shape. This research's relevance lies in its potential to improve the quantitative characterisation of periapical lesions, leading to an objective interpretation. (EEJ-2023-11-159).

Objective: This double-blinded randomized clinical trial aimed to compare postoperative pain using 2Shape® (TS) in rotary (TSRot) and adaptive (TSAK) kinematics in the maxillary and mandibular molars in patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis following single-visit endodontic treatment.

Methods: Seventy patients were randomly assigned to two groups (TSRot /TSAK), (n=35 each). The preoperative and postoperative pain intensities at various time intervals up to 72h using a Visual-Analogue Scale was noted. Mann-Whitney U test (p<0.05*) was used to compare pain intensity, and the chi-square test was used to compare the incidence of pain. Dunns test (p<0.05*) was used for intragroup comparisons. Binary logistic regression was performed at consecutive time intervals.

Results: A total of 67 patients were included in the final analysis, and three were excluded due to medication intake. Both groups showed a gradual reduction in the mean incidence and intensity of postoperative pain from 6 to 72 hours. However, TSAK had a significantly lower intensity and incidence of pain than TSRot at 24h (p=0.02*). There was no statistically significant difference observed in the duration of instrumentation when the TS file was used in either adaptive or rotary kinematics (p=0.41).

Conclusion: Adaptive kinematics (TSAK) resulted in less pain incidence compared with rotary kinematics (TS-Rot). A statistically significant difference in incidence was observed at 24 h but may not be clinically significant. The duration of instrumentation was similar between the TSRot and TSAK groups. Thus, the 2Shape® (TS) file, which is a rotary file, can be used in adaptive kinematics to reduce the postoperative pain. (EEJ-2024-02-036).

Objectives: Determining the working length (WL) in root canal treatment facilitates the treatment prognosis. The introduction of apex locators and new CBCT devices in dentistry influenced this consideration. This comparative study evaluated the accuracy of working length measurement by cone-beam computed tomography (CBCT) in three fields of view (FOVs), conventional radiography, and the apex locator Raypex 5.

Methodology: The descriptive-analytical study was performed on 40 lower premolar teeth that met the inclusion criteria. Direct observation under the microscope was considered the gold standard and compared with measurements by the electronic apex locator, CBCT, and periapical images.

Results: The results were analyzed by paired t-tests and Wilcoxon tests. A significance level of 0.05 was considered in this study. CBCT 5×5 FOV with a p-value of 0.733 and analog radiography with a p-value of 0.001 achieved the working lengths with the highest and lowest accuracy, respectively. In addition, the difference between actual and measured working length using analog radiography was significant (p-value <0.05).

Conclusions: According to the results of this study, CBCT images at different FOVs and those taken by the apex locator Raypex 5 can be used as a reliable method for estimating the working length. (EEJ-2023-10-141).

Objective: The use of propolis-based materials within endodontics to promote pulp wound healing or disinfect the root canal system has been a recent focus of scientists and clinicians. This is mainly because of the well-documented antimicrobial, anti-inflammatory, immunomodulatory and wound healing properties of propolis. This scoping review critically appraises the literature on the clinical applications of propolis-based compounds during endodontic therapy of primary and permanent teeth.

Methods: An electronic literature search was performed in Scopus, PubMed, and Web of Science up to and including October 2023 to identify studies assessing the use of propolis during endodontic therapy of primary and permanent teeth. A combination of relevant MeSh terms and keywords was used. Only human clinical studies written in English were included. The identified manuscripts were screened and assessed for inclusion by two independent authors. Eligible manuscripts were then subjected to critical appraisal and data extraction with the information being summarised according to their clinical application.

Results: A total of 26 human clinical studies were identified and included in the analysis. Propolis was investigated for use in the primary and permanent dentitions as a direct pulp capping or pulpotomy material as well as in root canal disinfection and root filling of teeth with non-vital pulps. Overall, the studies reported that the use of propolis was associated with promising outcomes in terms of efficacy to control inflammation, enhance tissue repair, and disinfection of the root canal system. However, a critical appraisal of the studies revealed a range of methodological and reporting deficiencies, resulting in unreliable results and conclusions in terms of the clinical outcomes reported.

Conclusion: Although the studies on the use of propolis-based materials in endodontics reported promising clinical outcomes, they had a range of methodological and reporting flaws. Further well-designed and properly reported controlled clinical studies are essential to derive sound evidence-based conclusions on propolis-based materials. Furthermore, guidelines for quality assurance and safe use of propolis-based materials are necessary to enhance their production for commercial use in endodontics.