European Endodontic Journal最新文献

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.

Objective: This study aimed to assess the treatment quality factors associated with the risk of radiographic detection of apical periodontitis (AP) in root-filled teeth (RFT) on CBCT images.

Methods: Two hundred eighty-five CBCT scans of patients (range 18-60, mean 35.1) years old were selected from a pool of CBCT scans which were taken from 2016-2022. Gender and age were recorded. The presence/absence of AP, unfilled canal, perforation, zipping and ledge and homogenous/nonhomogeneous root canal filling (RCF), adequate/inadequate coronal restoration and under/over filled RCF and those within 0-2 mm from the radiographic apex were recorded for RFTs. Kappa was used to assess intra-consensus reliability. Chi-square and Binary logistic regression were used to assess and predict risk factors related to the detection of AP. A significant difference was set at p<0.05.

Results: AP was present in 81.5% of RFTs. No significant difference was present in the AP prevalence in RFT between males and females, maxilla and mandible, right and left sides, RFT with adequate and inadequate coronal restoration and RFT with/without zipping and ledge and between RFT with overfilled and those with RCF end within 0-2 mm from the radiographic apex (p>0.05), respectively. Significantly higher AP prevalence was present in RFT with unfilled canal, perforations, non-homogenous and underfilled RCF (p<0.05), respectively. The odds of AP detection were 2.02, 5.5, 2 and 1.98 times higher in RFT with unfilled canal, perforations, non-homogenous and underfilled RCF, respectively. Intra-consensus reliability was (0.98, 0.95, 0.85, 0.81, 0.88, 0.85 and 0.92) for AP, unfilled canal, perforation, zipping and ledge, homogeneity of RCF, coronal restoration and length of RCF, respectively.

Conclusion: The vast majority of teeth with previous root fillings presented with AP. AP detection risk was significantly higher in root-filled teeth with perforation, non-homogeneous, and underfilled root canal filling. Other factors do not influence the radiographic detection of AP in CBCT images. (EEJ-2024-02-042).

Objective: Evaluate the bacterial reduction effect of disinfection protocols used in lower molars infected by Enterococcus faecalis.

Methods: Eighty extracted lower molars were prepared and inoculated with E. faecalis for 2 months. The teeth were then distributed into 2 control groups (n = 4) and 4 experimental groups (n = 18) in function of the disinfection protocol utilized: G1. WaveOne Gold (WOG), passive ultrasonic irrigation (PUI) and Ultracal; G2. WOG, PUI and calcium hydroxide (CH); G3. WOG, XP-Endo Finisher (XPF) and Ultracal; G4. WOG, XPF and CH. Bacteriological samples were collected previously (S1), after preparation (S2), final agitation (S3) and intracanal dressing (S4). Microbial growth was assessed according to culture turbidity and UV spectrophotometry. Statistical analyses used the Friedman test for paired samples and Kruskal-Wallis test for non-paired data (p<0.05).

Results: No protocol eliminated E. faecalis effectively. The S2, S3 and S4 samples were statistically different from the S1 samples in G1, G2, G3 and G4 (p<0.05). Statistical differences were observed in bacterial reduction between G1 and G2 and G1 and G3 after the intracanal medicament (S4) (p<0.05).

Conclusion: The WOG + PUI + CH disinfection protocol showed higher percentages of bacterial reduction.

This is a series of 7 cases in which the operator penetrated lateral canals with instruments. Two teeth presented with irreversible pulpitis, 4 with necrotic pulps, and 1 with previous treatment. Except for the teeth with pulpitis, all the others were associated with apical periodontitis. The main root canal was always relatively straight, with the lateral canals at the middle third of the root. Suggestive images of lateral canal presence were seen on periapical radiographs in five cases. The clinician introduced intentionally small hand instruments in the lateral canal in 5 cases, while the penetration was fortuitous in the others. The lateral canals were obturated in all cases. Follow-up examination was possible in five cases, all of them showed evidence of successful clinical and radiographic outcomes. Introducing files into lateral canals may permit some preparation and penetration of irrigant solution, favoring disinfection and, consequently, enhancing the treatment outcome. (EEJ-2023-05-063).

criteria were randomized to each irrigant, 65 in the NaOCl and 60 in the NSS groups. ProRoot® MTA was used as a pulp dressing material in both groups and teeth were followed for 12 months. The primary outcome was the success of VPT; requiring both clinical and radiographic success to be considered as success. The hypothesis was that the absolute difference of VPT success in the NSS group was not worse than that in the NaOCl group, by a margin of 5%. The secondary outcome was discoloration; percentages of discolorations between both groups were compared. Results: Using a per protocol analysis, the absolute difference of VPT success between the NSS and NaOCl groups was 2.08% (95% CI: -1.95, 6.1). Perceptible gray discolorations were 80% and 63% in NaOCl and NSS groups (difference -17%; 95% CI: -40.0, 6.2; p=0.15). Conclusions: For MTA-VPT procedure, irrigation with NSS was not worse than that with NaOCl. However, both irrigants caused discoloration. (EEJ-2023-05-065).