European Endodontic Journal最新文献

Objective: This study aimed to assess and compare the healing outcome associated with different aqueous-based calcium hydroxide intracanal medicaments in patients with pulpal necrosis and symptomatic apical periodontitis.

Methods: Seventy five patients with pulpal necrosis and symptomatic apical periodontitis in permanent mandibular molar teeth were selected as the part of this study. The participants were randomly allocated to three groups, each comprising 25 patients, based on the type of intracanal medicament used during the treatment procedure. Group 1 consisted of calcium hydroxide (CH) mixed with 0.9% saline (NS), Group 2 contained CH combined with 2% lidocaine, and Group 3 included CH with 2% chlorhexidine (CHX). The Periapical Index Score was utilized to assess the healing of periapical lesions in preoperative and post-operative periapical radiographs at 3 month intervals for 12 months. The Kruskal-Wallis test was used to determine the significance, with Post Hoc Dunn tests for multiple comparisons.

Results: At the 12-month follow-up, the CH+CHX group demonstrated significantly improved periapical healing, with a mean PAI score of 1.57 +- 0.66, compared to CH+LA (2.27+-0.63) and CH+NS (2.48+-0.79), with Kruskal-Wallis p<0.05. The mean time to achieve a healthy periapical status (PAI ≤2) was shortest in the CH+CHX group (8.10+-3.28 months), followed by CH+NS (8.23+-3.28 months) and CH+LA (8.25+-3.31 months), with the multivariate Log-Rank test indicating a statistically significant difference among the groups (p<0.05).

Conclusion: The findings of this study indicate that CH when combined with 2% CHX as an aqueous vehicle demonstrated superior healing of periapical lesions in patients with pulpal necrosis and symptomatic apical periodontitis compared to saline or lidocaine.

Objective: This retrospective study aimed to compare the survival outcomes between crowns with repaired endodontic access cavities and intact crowns and to identify factors that influence restoration longevity.

Methods: Clinical records of patients who underwent root canal treatment through existing crowns (crowns with repaired access cavities, CRA) or received crowns after root canal treatment (intact crowns, IC) between 2012 and 2023 were analysed. A 1: 1 propensity score matching was applied based on age, sex, tooth type, and crown type. The outcomes of the matched cases were classified as survival or non-survival. Kaplan-Meier analysis and logrank tests were used to compare outcomes between the two groups over time. For CRA, multivariable Cox proportional hazards regression analysis was conducted to identify potential predisposing factors.

Results: Among 608 eligible endodontically treated teeth, 120 CRA and 488 IC met the inclusion criteria. After matching, 120 samples per group were analysed. The survival rate was significantly lower for CRA (85.8%) than for IC (91.7%) (p=0.004). Occlusal parafunctional habits or interferences were the only significant factors affecting CRA survival.

Conclusion: CRA demonstrated lower survival rates than IC, with occlusal parafunctional habits or interferences as key factors influencing their longevity.

Objectives: In root canal treatment, final root canal irrigation plays an essential role in removing smear layers, especially inorganic components, in order to achieve hermetic obturation of the root canal system. This study aimed to evaluate the root canal cleanliness, sealer penetration, and apical sealing ability of the root canal system following final irrigation using chelating agents, namely nano-chitosan, which was compared to EDTA and novel silver citrate (NSC).

Methods: This study used 135 premolars, which were divided into three evaluations: root canal cleanliness, sealer penetration, and apical sealing ability. Teeth were assigned into three groups. Group 1: EDTA, group 2: NSC, and group 3: nano-chitosan. Scanning Electron Microscope (SEM) was used to evaluate root canal cleanliness and apical sealing ability. A stereo microscope was utilized to evaluate sealer penetration. The root canal cleanliness data were analysed using the Chi-Square test, whereas sealer penetration and apical sealing ability data were analysed with a two-way ANOVA and LSD Post-Hoc test with a significance level of 95%.

Results: In the root canal cleanliness evaluation, all three final irrigation solutions showed similar cleanliness of the root canals (p>0.05). In the evaluation of sealer penetration and apical sealing ability, nano-chitosan produced the highest sealer penetration and apical sealing ability compared to EDTA and NSC (p<0.05).

Conclusion: All final irrigations produced the same root canal cleanliness; however, nano-chitosan final irrigation solution generated the longest sealer penetration and the greatest apical sealing ability than EDTA and NSC. (EEJ-2024-12-188).

Objectives: This study assessed students' perceptions of artificial teeth (AT) after completing the Endodontics I, II, and III curricular units at the Faculty of Health Sciences, Fernando Pessoa University, Porto, Portugal. Additionally, the study aims to review existing literature on students' perceptions of three-dimensional (3D) printed models used in pre-clinical training, identifying current challenges and future needs for improvement.

Methods: A questionnaire was adapted, consisting of 24 questions, using a 5-point Likert scale, from 1 (Strongly Disagree) to 5 (Strongly Agree), in which students had to compare AT with natural teeth (NT) in various aspects of anatomy and endodontic procedures. For the review of literature, a search was conducted in PubMed, MEDLINE, Scopus, and Web of Science up to March 16, 2025. The search included the keywords: endodontics; natural teeth; artificial teeth; 3D printed teeth; teaching; pre-clinical training and dental education, both individually and in combination using the Boolean operator 'AND'. Relevant original research studies and review articles, published in English were selected without time restrictions. Additionally, cross-references were examined for further relevant studies.

Results: Overall, students expressed a favorable opinion of AT in relation to external anatomy, radiopacity with files or gutta-percha, ease of acquisition, superior hygiene, and the simplicity of performing endodontic procedures. Conversely, students reported negative perceptions of AT concerning internal anatomy, pulp chamber size, canal shape and size, radiopacity, tactile sensation during access cavity preparation and pulp chamber entry, tactile feedback during endodontic procedures and debris removal, and the adequacy of AT for understanding endodontic techniques.

Conclusion: The incorporation of AT into endodontic training represents a significant advancement toward standardization and improved efficiency in dental education. However, AT cannot fully replicate the tactile feedback and anatomical characteristics of NT. Although AT offers advantages in terms of consistency and availability, their limitations in mimicking the tactile sensation and radiopacity remain critical factors influencing students' perceptions. These findings underscore the need for continued development of AT that more closely mimics the properties of NT. (EEJ-2025-03-047).

Objective: The objective of this investigation was to assess and compare the fracture resistance of roots filled with AH Plus, Total Fill and AH Plus bioceramic sealers using single cone, warm vertical compaction (WVC), and soft-core techniques.

Methods: This study utilized the palatal root canals of eighty extracted human maxillary first molars. All roots were sectioned to maintain a uniform root length of 11 mm. The samples were mechanically prepared using EdgeFile X7 rotary files to size 40/0.04. Eight teeth were left unfilled as a control group, while the remaining teeth were classified into three primary categories according to the sealer utilized for obturation; AH plus, TotallFill and AH Plus Bioceramic (BC). Each group was divided into three subgroups (n = 8) based on the obturation technique; single-cone, WVC and soft-core. Every tooth was set into blocks of acrylic resin, and a universal testing equipment (Instron Corp) with a metal-like spreader tip was used to measure the fracture force at a speed of 0.5 mm/min. The collected data were examined utilizing ANOVA, succeeded by Tukey's test.

Results: The control group's fracture resistance values were significantly less than the obturated groups in study. Overall, the fracture resistance of AH Plus and AH Plus BC were significantly higher than that of Total Fill BC sealers. The WVC and soft-core were significantly higher than single cone techniques. The obturation technique did not significantly influence the fracture resistance of AH Plus and Total Fill. While the fracture resistance of AH Plus BC was significantly impacted., WVC was significantly higher than single cone group. When roots were obturated with WVC technique, AH Plus BC exhibited statistically significant higher values of fracture resistance than AH plus and Total Fill. There was no significant difference between the three sealers when single cone and soft-core were used.

Conclusion: According to this in vitro investigation, Obturation with AH Plus and AH Plus BC sealers enhanced the fracture resistance of the roots more significantly than TotalFill BC sealer, while obturation with WVC and soft-core yielded greater fracture resistance compared to the single cone approach. (EEJ-2024-11-170).

Introduction: The flexibility and fracture resistance of nickel-titanium (NiTi) files have revolutionised root canal preparation-but file fractures caused by cyclic fatigue or torsional failure are challenging. Thermal pretreatments aim to improve fatigue resistance. This study compared the cyclic fatigue resistance (CFR) of four novel reciprocating NiTi file systems with low- versus high-temperature thermal modification under simulated clinical conditions.

Methods: Four systems (n=50) were investigated in vitro: low heat (LH; EdgeOne R-Utopia (Edge Endo, Albuquerque, New Mexico, USA); Procodile Q (Komet Dental, Lemgo, Germany)) and high heat (HH; Reciproc Blue (VDW GmbH, Munich, Germany); CC One Blue (Bondent, San Clemente, California, USA)). CFR was tested under simulated conditions (35±1°C). Two canal configurations were used: a single-curvature canal (60°, 5 mm radius, curvature centre 6 mm from the tip) and a double-curvature canal (additional 70°, 2 mm radius, curvature centre 2 mm from the tip). The files were tested in a 'pecking' motion (3 mm stroke, 0.5 Hz) until fracture occurred. The time to fracture (TTF), number of cycles to fracture (NCF) and fragment length (FL) were measured. Weibull analysis was performed to assess reliability and predict fracture behavior. Fracture fragments were analysed using scanning electron microscopy (SEM). Two-factor ANOVA was performed using instrument type and canal configuration as independent variables for each outcome measure (TTF, NCF, FL). Post hoc comparisons were conducted using Tukey-HSD (α = 0.05). Normal distribution was confirmed using Shapiro-Wilk testing.

Results: Differences in CFR were not significant between LH and HH systems (p=0.203), but were between file systems (p<0.001) and canal configurations (p<0.001). CFR was highest with Procodile Q, then Reciproc Blue, and lowest with EdgeOne R-Utopia. FL was similar between LH and HH (p=0.427) but differed between file systems and canal geometries (p<0.05). SEM analyses confirmed fatigue cracks in highly stressed areas.

Conclusion: The temperature range of thermal pretreatment did not affect cyclic fatigue resistance. Instead, file design and alloy composition were the decisive factors. Clinicians should prioritise structural features and mechanical behavior over heat treatment labels when selecting instruments for complex root canal anatomies. (EEJ-2025-02-023).

Objectives The trial was conducted to assess the impact of passive ultrasonic irrigation, XP endo finisher, AF max file, and manual dynamic agitation on postoperative pain and analgesic consumption at 6 h., 12 h., 24 h., 48 h., 72 h., and a week later on single-rooted lower premolar teeth with acute irreversible pulpitis and apical periodontitis. Methods. Seventy patients were contributed in the trial. A total of 64 eligible patients were randomized into four equal groups (n=16 per group). Considering the irrigation activation approach, participants were separated into four groups as follows: Group 1: passive ultrasonic irrigation. Group 2: XP-endo Finisher. Group 3: Fanta AF max file Group 4: Manual dynamic agitation. Following the root canal procedure, the intensity of postoperative discomfort was measured by a verbal rating scale. The frequency and quantity of analgesics used were recorded. Results. Using an analysis of variance (ANOVA), there was a statistically significant difference between the percentage of preoperative and postoperative pain at most of the follow-up period (p<0.001**) in each group. Additionally, a significant difference (p<0.05) in the postoperative pain level and analgesic consumption was found among groups and most of the time intervals. Shapiro-Wilk and Kolmogorov-Smirnov tests, the Chi-square test, Fisher's exact test, and the McNemar test were used. The excessive percentage of postoperative pain and analgesic intake was found in the MDA group, followed by the Max file and the XPF, while the lowest postoperative pain and analgesic intake were related to the PUI group. There was a significant difference (p<0.05) between the PUI and MDA groups in the degree of pain severity and increase in analgesic intake at 72 h. Regarding the percentage of swelling, there was a statistically notable difference (p<0.05) between groups after 24 h time intervals. Conclusions Minimal postoperative pain and minimal analgesic intake were significantly accompanied by passive ultrasonic irrigation, while PUI and analgesic intake were increased in MDA. (EEJ-2025-03-041).

Objective: This study investigated the intratubular decontamination promoted by high-power sonic and ultrasonic devices using either a stepwise intraoperative activation (SIA) technique or a final conventional activation (CA) approach during root canal chemomechanical preparation.

Methods: Fifty human lower premolars were contaminated with Enterococcus faecalis and assigned into five groups (n=8): conventional syringe irrigation (CSI); final ultrasonic activation (FUA) using the ultrasonic insert 25/25 IRRI S; final sonic agitation (FSA) using the high-power sonic insert 20/28 Eddy system (both CA techniques); stepwise ultrasonic activation (SUA); and stepwise sonic agitation (SSA) using the same devices during and after canal preparation (SIA techniques). Remaining specimens served as controls. Root canal preparation was performed with the Reciproc system and 5.25% NaOCl, followed by final irrigation with 17% EDTA. Bacterial viability was assessed via confocal microscopy with Live/Dead technique. Statistical analysis was employed using non-parametric tests (α=0.05).

Results: SUA showed the lowest bacterial viability, followed by FSA, both statistically similar. SSA and FUA were similar but less effective than SUA and FSA (p<0.05). The CSI group had significantly higher bacterial viability compared to all other groups (p<0.05).

Conclusion: High-power sonic agitation and ultrasonic activation enhanced intratubular decontamination against E. faecalis. The SIA technique, using IRRI S or Eddy systems, effectively reduced bacterial viability and represents a promising approach for root canal disinfection. (EEJ-2024-11-185).

This double-blinded randomised clinical trial aimed to compare the efficacy of lignocaine, diclofenac sodium and ketorolac tromethamine as supplemental intraligamentary injections for intra-appointment pain in normotensive and hypertensive patients with moderate to severe symptomatic irreversible pulpitis.

Methodology: Ethical clearance was obtained, and the trial was registered on the Clinical Trial Registry India (CTRI/2020/09/027635; Registered on 07/09/2020). A total of 198 patients were divided into two groups-hypertensive group (Group 1; n=99) and normotensive (healthy) group (Group 2; n=99). After computerised randomisation and double blinding, participants were subdivided into three subgroups-1A/2A: lignocaine (n=33), 1B/2B: diclofenac sodium (n=33) and 1C/2C: ketorolac tromethamine (n=33). The preoperative visual analogue scale (VAS) scores was recorded. For the hypertensive group, blood pressure was recorded, and inferior alveolar nerve block (IANB) comprising 1.8ml of 2% lignocaine without adrenaline was administered. For the normotensive group, IANB with 1.8ml of 2% lignocaine with adrenaline was administered. A supplemental intraligamentary injection comprising one of the experimental drugs was injected to both the groups. Endodontic access was gained, and the intraoperative VAS score was recorded. As part of the statistical analysis, paired t-tests, Tukey's post hoc test and ANOVA were performed using SPSS software version 20.

Results: Supplemental intraligamentary injections of diclofenac sodium and ketorolac tromethamine showed a statistically significant difference (p<0.05) compared to lignocaine in the reduction of intraoperative pain with no side effects in hypertensive and healthy individuals.

Conclusion: Supplemental injections of both NSAIDs performed better than lignocaine in reducing intraoperative pain among healthy and hypertensive individuals. (EEJ-2023-06-076).

Objective: This study aimed to compare the effect of blood contamination on the surface microhardness and void volume of a calcium silicate-based cement, sealer, and a combination of the two (Lid technique) when used for retrograde filling.

Methods: Thirty mesial roots of extracted human mandibular molars were divided into three groups: iRoot BP Plus (cement), iRoot SP (sealer), and a combination of the two (Lid technique). The root ends of the teeth were resected and prepared, and the roots were filled. The void volumes were evaluated using micro-computed tomography. Sixty clear resin replicas were created to assess the microhardness after exposure to phosphate-buffered saline and blood; measurements were obtained after 4 and 30 days.

Results: All groups exhibited similar void volumes. The groups retrofilled with iRoot BP Plus and the Lid technique had higher microhardness values than the iRoot SP group. The iRoot SP group displayed similar microhardness values after exposure to PBS and blood. Blood contamination reduced the microhardness values in the iRoot BP Plus and Lid technique groups; however, no significant differences were observed between the measurement times (P > 0.05).

Conclusion: In multi-canal roots, the lid approach is as effective as traditional root-end filling. Blood contamination reduced microhardness emphasizing the significance of handling materials with care during endodontic microsurgery. (EEJ-2024-10-159).