European Endodontic Journal最新文献

Objective: To compare the effectiveness of lateral canal irrigation penetration by conventional needle, passive ultrasonic, sonic endo activator, and Erbium laser (2780nm).

Methods: A total of 40 palatal roots of human maxillary first molars were collected and instrumented at a working length of 12 mm by an X1-X4 rotary Protaper Next system (Dentsply, Maillefer, Ballaigues, Switzerland) using the crown-down technique. Artificial lateral canals were made at 2, 4, and 6 mm from the apex on mesial and distal sides using an ISO rotary reamer (Dentsply, Maillefer, Ballaigues, Switzerland; #10 for mesial, #08 for distal). The samples were then cleared using methyl salicylate. A solution of black ink and normal saline was used as an irrigant for the root canal. The percentages of the penetration of the ink into the lateral canals were measured using a stereomicroscope (Q-Scope, Arnhem, The Netherlands) with the aid of program Image J. The Tukey test is used to assess the significant difference between intragroup and intergroup comparisons of different thirds, and the T-test is used to assess the significant difference between every two groups and for the mesial and distal sides of each group. The level of significance was set at 0.05.

Results: Results showed that none of the activation techniques used resulted in complete lateral canal penetrations; however, on both sides at all thirds, the Erbium laser (2780 nm) achieved the highest results with a highly significant statistical difference (p=0.05) with all other groups, and the least penetration was in the conventional needle group.

Conclusion: The size of the lateral canal is a restricting factor for all activation methods; the best results can be achieved by laser. Conventional needles cannot be used alone to disinfect complex canal anatomy; however, passive ultrasonic and sonic endo activator activations can produce comparable results.

Objective: Tramadol hydrochloride has shown local anesthetic properties similar to lidocaine, apart from a central analgesic effect. The present study evaluated the effect of the administration of tramadol alone or in addition to 2% lidocaine, as supplementary intraligamentary injections.

Methods: One hundred and five patients, with a failed primary inferior alveolar nerve block (IANB), were randomly allocated to one of the three supplementary intraligamentary groups: 2% lidocaine with 1: 80,000 epinephrine; tramadol hydrochloride (50 mg/mL); and 2% lidocaine with 1: 80,000 epinephrine plus tramadol hydrochloride. Patients received 1.2 mL doses (0.6 mL of each root). Patients reporting pain ≤54 on Heft Parker visual analogue scale (Heft-Parker VAS), were categorized as successful anesthesia. A finger pulse oximeter was used to measure the heart rates. The anesthetic success rates, gender, and type of tooth were compared using the Pearson chi-square test. The heart rates and age were statistically evaluated using the one-way analysis of variance test. The level of significance was set at 0.05 (p=0.05).

Results: The initial IANB was successful in 31% of cases. There were significant differences in the anesthetic success rates of different supplementary intraligamentary injections (χ2= 33.6, p<0.001, df=2). The 2% lidocaine-plus-tramadol resulted in significantly higher success rates than the two groups. There were no significant changes in the baseline heart rates of all groups (p>0.05).

Conclusion: The addition of tramadol to 2% lidocaine with 1: 80,000 epinephrine, given as supplementary intraligamentary injection, can help in achieving successful anesthesia during the endodontic management of mandibular molars with irreversible pulpitis resistant to IANB injections.

Objective: This study aimed to examine the shaping ability of six rotary and reciprocating file systems, as well as hybrid techniques in simulated S-shaped root canals.

Methods: A hundred and twenty S-shaped radiopaque thermosetting epoxy resin blocks were grouped according to the system used for biomechanical preparation. Six groups of 15 canals each were prepared using TruNatomy, Procodile, VDW Rotate, Hyflex CM, OneCurve, and WaveOne Gold, respectively. Two additional hybrid (Procodile/Hyflex CM and Procodile/TruNatomy) groups (n=15 each) were added after evaluating the results of individual systems. All canals were enlarged to 0.25 mm apically. Canal transportation, centering ability, diameter increase, and iatrogenic errors were assessed by superimposed pre-operative and post-operative images. AutoCAD was used for data analysis. All groups were statistically compared with analysis of variance and Tukey honest significant difference test (p<0.05).

Results: Hyflex CM resulted in the most conservative diameter increase in all thirds (coronal, middle, and apical; p<0.001). Procodile showed the best (p<0.001) centering ability in the coronal and middle thirds, while TruNatomy resulted in the least canal transportation and most centering preparation in the apical third (p<0.001). Hybridisation of Procodile and Hyflex CM produced the least canal transportation and best centering ability in the middle third (p<0.001). No instrument breakage occurred, and no ledge, elbow, or apical zip formation was observed during canal preparation.

Conclusion: Hybridisation of Procodile and Hyflex CM showed remarkable results in preserving the canal diameter in all thirds and resulted in the least canal transportation and best centering ability in the middle third of the canal. However, when treatment cost and duration limit the clinical applicability of the hybrid technique, clinicians can use a single file system (Hyflex CM or TruNatomy) since it shows satisfactory results in all parameters when compared with a hybrid system.

Objective: To evaluate the impact of different file access angles and root canal curvature's location on the fatigue failure of One Curve (OC) and E3 Azure (EZ) NiTi files using a dynamic model at simulated body temperature.

Methods: Eighty new instruments with similar tip sizes and taper (#25/0.06) from two NiTi rotary systems, One Curve and E3 Azure, were tested at simulated body temperatures (37°C) using a custom-made dynamic cyclic fatigue device. Instruments were divided into four subgroups according to the location of root canal curvature (a coronal curve 5 mm from the root canal orifice and an apical curve 10 mm from the root canal orifice) and the angle of file access (0° or 30°). Instruments were operated in simulated stainless-steel canals having a 60° curve and a 3 mm radius. A custom-made device produced controlled vertical pecks during file rotation. Time to failure (sec) was registered, and the length of the fragment segments was measured (mm). Data were analysed statistically with One-Way ANOVA and Tukey post hoc tests. The significance level was set at 5%. All separated instruments were examined by scanning electron microscope.

Results: One-way ANOVA (p<0.05) found a significant difference among the tested instruments. Post Hoc analysis revealed lower cyclic fatigue resistance when the angle of file access was 30º, and the root canal curvature was located coronally for both files (p<0.0001). Three-way ANOVA showed that the angle of file access was the most influential contributor to cyclic fatigue, followed by the location of file curvature and, finally, the file type (p<0.0001). The fractographic examination revealed a predominantly ductile fracture mode for all tested instruments. The lengths of all fractured segments showed no significant difference (p>0.05), indicating an accurate trajectory during testing.

Conclusion: OC files had superior cyclic fatigue resistance than EZ files; coronal curvatures negatively impacted cyclic fatigue resistance compared to apical curvatures, while the angle of file access presented the highest impact on dynamic cyclic fatigue.

Objective: Triple antibiotic paste (TAP) is known to have an essential role in the success of endodontic treatment by eliminating pathogens from the root canal system. Unfortunately, it causes discolouration and cytotoxicity at high concentrations. The objective of this research was to assess and compare the antimicrobial effectiveness of various concentrations (1 mg, 5 mg, 10 mg) of TAP, TAP hydrogel (TAPH), M-TAP, and M-TAP hydrogel (MTAPH) against Enterococcus faecalis.

Methods: The agar well diffusion method was used to assess the antibiotic sensitivity of the following intracanal medicaments: TAP (ciprofloxacin, metronidazole, and minocycline) mixed in a ratio of 1: 1: 1; TAPH, M-TAP (ciprofloxacin, metronidazole, and amoxicillin), M-TAPH and plain hydrogel. Each tested medicament was individually evaluated for its antimicrobial activity against Enterococcus faecalis. Structural and topographical characterisation were analysed using a Scanning Electron Microscope (SEM) and interpreted using ImageJ software. A microdilution broth test was performed to examine the minimum inhibitory concentration and minimum bactericidal concentration (MBC) of M-TAP and TAP.

Results: Except for the plain hydrogel, M-TAP and hydrogel and TAP and hydrogel showed significantly varied inhibitory zones at different concentrations. M-TAPH showed the highest mean zone of inhibition of 21.6, 33.33 and 38.0 mm at a concentration of 1, 5, and 10 mg/mL when compared to TAPH, which showed a mean zone of inhibition of 3.3 mm,12.3 mm, 21.3 mm at the respective concentrations. The MIC study shows that more than 75% of Enterococcus faecalis growth was inhibited by M-TAP at a concentration of 5 μg/mL, whereas TAP showed inhibition at a concentration of 35 μg/mL. MBC results indicate that almost 99.9% of the bacterial population was killed at a concentration of 100 μg/mL (10-1) for TAP and 10 μg/mL (10-2) for M-TAP.

Conclusion: The antibacterial efficacy of M-TAP was significantly higher than TAP. Application of M-TAP at lower doses is advised to overcome the disadvantages seen with TAP.

Objective: The aim of this study was to investigate the bactericidal effect of various concentrations of triple antibiotic paste (TAP) against Enterococcus faecalis (E. faecalis) in dentinal tubules using a bacterial culture assay and confocal laser scanning microscope (CLSM).

Methods: Ninety human teeth were contaminated with E. faecalis (ATCC 29212) and randomly allocated into 5 groups; the negative control (without TAP), 1 mg/ml, 5 mg/ml, 7.5 mg/ml and 10 mg/ml TAP (n=18). After a 3-week TAP treatment, samples were collected from the root canal space, root dentin at 100-μm and 200-μm depth. The collected samples were subjected to a bacterial culture assay (n=10). Eight roots from each group underwent CLSM analysis to determine the live/dead bacterial cells.

Results: The bacterial culture assay results indicated that the negative control samples were all culturable. The number of culture-positive samples decreased after TAP treatment at 1, 5, 7.5 and 10 mg/ml, with 2, 2, 1 and 0 culturable samples, respectively. However, there was no significant difference among the TAP treatments. Surprisingly, the CLSM analysis demonstrated live bacteria in the dentinal tubules in all samples. The negative control had 52.36%+-3.24 live bacteria. TAP treatment at 10 mg/ml had the lowest percentage of live bacterial cells (40.58%+-5.40), followed by 7.5 mg/ml (44.14%+-6.03), 5 mg/ml (46.31%+-5.32) and 1 mg/ml (52.55%+-8.82). The percentage of live cells in the 10 mg/ml, 7.5 mg/ml and 5 mg/ml TAP groups were significantly lower than the 1 mg/ml TAP and negative control groups.

Conclusion: TAP treatment significantly decreased the percentage of viable E. faecalis cells in the dentinal tubules and its bactericidal effect was dose-dependent.

Objective: This study aimed to evaluate the effect of WaveOne Glider (WOGG) with Waveone Gold (WOG) primary reciprocation systems on root dentine microcrack formation and to know the effect of TruNatomy Glider (TRNG) with TruNatomy (TRN) prime rotary systems on root dentine microcrack formation.

Methods: In this study, 40 extracted mandibular first molar roots were selected and divided randomly into four groups (n=10). Group MWOG: a manual glide path was performed + WOG primary. Group MTRN: manual glide path performed+TRN prime. Additionally, group WOGG: glide path preparation with WOGG+WOG primary. Finally, for group TRNG, the glide path preparation was performed with TRNG+TRN prime. Micro-CT was used for pre and post-instrumentation image analysis. Statistical analysis was performed using the Kruskal- Wallis test (p<0.05) with Two-way ANOVA.

Results: The Kruskal-Wallis test showed no significant differences among all groups in all thirds for pre and post-instrumentation regarding the crack formation. The Two-way ANOVA showed no significant difference or interaction between the ways of glide path preparation, whether manual or reciprocal WOGG, or between the rotary TRNG and the motion used in root canal preparation (rotary TRN or reciprocal WOG) regarding the crack formation and propagation.

Conclusion: Microcrack formation and propagation occurred independently of using different glide path techniques (manual, rotary, or reciprocal).

Objective: The aim was to compare the 'reverse sandwich restoration' to resin composite restorations re- garding marginal adaptation, fracture resistance, favourable/unfavourable fractures in the management of external cervical resorption.

Methods: Forty-eight extracted maxillary central incisors were selected and endodontically treated. Cervical regions of the labial root surfaces received simulated resorptive defects and were restored as three randomly allocated groups: Reverse Sandwich Restoration (resin composite + resin-modified glass ionomer) (RSR); resin composite restoration (COMP), and no restoration (NR). Each group was further divided into two subgroups (n=8 each): Thermomechanical Aging (TA) (equivalent to one year) and No Aging (NA). Marginal adaptation was scored by scanning electron microscopy. Fracture resistance was tested using a universal testing machine. Favourable versus unfavourable fractures were classified based on fracture extent.

Results: TA decreased the marginal adaptation for both RSR and COMP. Mean fracture resistance per groups were: RSR-NA 1522.4+-94.9N, RSR-TA 939.6+-72.9N, COMP-NA 1197.6+-95.7N, COMP-TA 870.4+-86.3N, NR-NA 1057.1+-88.1N, and NR-TA 836.6+-81.9N, respectively. Fracture resistance was the highest for RSR- NA compared to all other groups (p<0.05). TA decreased the fracture resistance in all groups (p<0.05), there was no significant difference between RSR and COMP regarding fracture resistance and favourable/ unfavourable fractures (p>0.05).

Conclusion: RSR provided comparable results to resin composite fillings to restore artificial cervical defects pertaining to marginal adaptation, fracture resistance, and favourable versus unfavourable fractures. RSR is preferable due to its inherent biocompatibility to the periodontium. (EEJ-2023-04-050).

Objective: The aim of this in vitro study was to compare the smear layer and debris removal and antimicrobial activity of two dual-action irrigating solutions for continuous chelation (Triton; Brasseler, Savannah, USA and Dual Rinse HEDP; Medcem GmbH, Weinfelden, Switzerland) with a dual step irrigation protocol with sodium hypochlorite (NaOCl) followed by ethylenediaminetetraacetic acid (EDTA).

Methods: Thirty single-rooted single-canal teeth were divided into three groups (n=10) and irrigated with Triton, Dual Rinse HEDP mixed with 6% NaOCl and 6% NaOCl/17% EDTA. The teeth were observed under a scanning electron microscope (SEM) to assess the canal wall cleanliness. In addition, 80 dentine discs were contaminated with Candida albicans and 80 discs with Enterococcus faecalis and irrigated with Triton, Dual Rinse HEDP mixed with 6% NaOCl and 6% NaOCl/17% EDTA or not treated (n=20). Fifteen discs were used to evaluate colony-forming units, while 5 discs were analysed by SEM. Data were analysed using the Shapiro- Wilk, Kruskal-Wallis and One-Way ANOVA tests.

Results: Triton was statistically more effective than Dual Rinse HEDP and NaOCl/EDTA in removing debris (p<0.05), except with NaOCl/EDTA in the coronal third. Triton was more effective than Dual Rinse HEDP in removing the smear layer from the apical and middle thirds (p<0.05). All the irrigation protocols significantly re- duced the number of E. faecalis. The Triton group showed the lowest number of remaining C. albicans (p<0.05).

Conclusion: Triton was the most effective irrigation solution in removing debris and as effective as NaOCl/ EDTA in removing the smear layer. Triton showed the highest efficacy against C. albicans. New irrigating solutions that provide continuous chelation may provide an alternative to current irrigation protocols.

Objective: To evaluate the effect of diode laser (GaAlAs-980 nm) for full coronal pulpotomy (FCP) compared to conventional crown pulpotomy (CCP) in mature teeth with symptomatic irreversible pulpitis (SIP) and assess dentine bridge formation after FCP using CBCT.

Methods: A total of 86 patients (43 per group) with SIP in permanent mandibular molars were included. Access opening and FCP were done, after which haemostasis was achieved with 2.5% NaOCl in the CCP group and a diode laser (GaAlAs-980 nm) in the laser crown pulpotomy group (LCP). Biodentine (Septodont, Saint-Maur-des-Fossés, France) was placed, and the cavity was sealed. Clinical and radiographic follow-ups were done at 6, 12, and 18 months, with additional CBCT evaluation at 18 months. Statistical analysis was performed using the Mann-Whitney U test, and survival rates were assessed using Kaplan-Meier analysis. The Cox proportional model was used to determine the effect of possible covariates on pulpotomy outcomes. P<0.05 was considered to be statistically significant.

Results: The overall success rate for CCP and LCP at 18 months was 88.4% and 93% respectively. At the end of 18 months, 8 cases (5 in CCP, 3 in LCP) failed. The postoperative pain score at 48 hours was significantly higher for CCP (mean +- standard deviation: 1.7+-1.4; p<0.001). CBCT analysis at 18 months revealed thicker dentine bridge formation for LCP (Median & IQR: 0.89, 1.06) compared to CCP (p=0.0479). The Kaplan-Meier curve showed a more rapid decline in the survival rate of CCP (0.89) compared to that of LCP (0.93). Postoperative pain at 48 hours, PAI scores at 6, 12, 18 months, and age were found to affect the hazard ratio based on the Cox regression model.

Conclusion: Within the limitations of this trial, there was no significant difference in the outcome between diode laser and conventional pulpotomy. However, LCP resulted in lesser postoperative pain at 48 hours and thicker dentine bridge formation at 18 months, with a longer estimated survival rate. (EEJ-2023-01-011).