European Endodontic Journal最新文献

Blood clot, platelet-rich fibrin, and plasma-rich plasma are the three most commonly used scaffolds in regenerative endodontic therapy. The current study aimed to evaluate the clinical outcomes of plasma-rich plasma (PRP) and platelet-rich fibrin (PRF) scaffolds and blood clot (BC) in regenerative endodontic therapy. For this systematic review and meta-analysis, international databases such as MEDLINE (PubMed and Ovid), Web of Science, and Scopus were searched between January 2013 and November 2023 using keywords relevant to the study objectives. Randomized controlled trials published in English that investigated the effects of BC, PRF, and PRP interventions compared to each other on permanent teeth with a six-month follow-up period were included in the study. The risk of bias was assessed using the Cochrane tool for randomized trials. Data were analyzed using STATA/MP software, employing odds ratios with fixed and random effects models in the meta-analysis. Fourteen randomized clinical trials involving 430 participants were reviewed. The present study did not reveal any statistically significant differences between BC and PRP regarding apical radiolucency healing (OR: -1.30, 95% CI; -2.68, 0.08; p=0.07, I2=0%, p=0.91) and apical closure (OR: -0.29, 95% CI; -1.07, 0.49; p=0.47, I2=32.63%, p=0.20). However, root-length increase in BC was greater compared to PRP (OR: 3.18, 95% CI; 2.78, 3.57; p<0.01) and PRF (OR: 1.75, 95% CI; 1.38, 2.13; p<0.01). The risk of bias was low for all studies, based on the Cochrane tool. BC is the preferred primary scaffold in regenerative endodontic therapy, while PRP and PRF are recommended for cases of severe canal bleeding. (EEJ-2024-05-079).

Objective: Biomechanical root canal preparation involves both mechanical instrumentation and endodontic irrigation, aiming to reduce bacterial levels to promote periradicular healing. However, complete removal of biofilm and debris, especially in complex canal morphologies, remains difficult. This study aimed to evaluate, through microcomputed tomography (micro-CT), the use of the XP-Endo Finisher and Tornado Disinfection Kit (TDK) systems during the final agitation of the irrigating solution for the final debridement of oval-shaped canals of lower incisors.

Methods: Thirty-nine extracted human mandibular incisors were instrumented up to size #25/.05 and divided into three groups (n=13) based on the final irrigation system: Conventional irrigation with syringe and needle (CI), XP-Endo Finisher (XPF), and TDK. 40 mL of 2.5% NaOCl was used for each group. Teeth were scanned ex vivo using a micro-CT before instrumentation, after instrumentation, and after irrigation. Three-dimensional root canal models were evaluated for volume, untouched surfaces, and dentin removal. Data were analyzed using repeated-measures ANOVA, t-test, and Tukey tests (p<0.05).

Results: TDK showed a significant difference in total and cervical third compared to CI and XPF regarding volume and dentin removal analysis (p<0.05), with no significant difference in the apical third compared to XPF (p>0.05). TDK had a lower percentage of untouched volume compared to the other systems in the overall analysis (p<0.05) and at all thirds compared to CI (p<0.05).

Conclusion: Supplementary instruments improve root canal debridement compared to conventional irrigation, particularly in smaller apical diameters and oval-shaped canals of lower incisors. TDK offers enhanced wall contact after root canal preparation and is a viable alternative for complementing debridement. (EEJ-2024-10-158).

Objective: X-ray microtomography (micro-CT or XMT) has previously been used to measure residual voids in root fillings. However, there is no agreement on a protocol that critically identifies and attempts to solve artefacts inherent to the micro-computed tomography technique. This article aims to describe a protocol for automated detection of voids within root-filled canals taking into account the inherent artefacts, with special interest in the partial volume effect. This is to reduce human errors and increase the accuracy and efficiency of void detection.

Methods: Human maxillary premolars (n=33) were shaped, cleaned and root-filled using the cold lateral condensation (CLC) technique. Voids were identified using either individual tomographic slices or the new proposed protocol in which: (1) pre-obturation XMT slices were used to identify the coordinates of the canal space; (2) the post-obturation data sets were aligned to the pre-obturation data sets; (3) the voids were identified as voxels with a grey level below a set threshold after subtraction of pre-obturation from post-obturation data sets. A comparison of the voids from these two methods was made.

Results: The visual inspection of slice by slice of the scanned data resulted in full agreement between the tomographic slices and the results gained from the proposed protocol. This confirmed that this protocol provided an automated, effective and accurate method for detecting voids in root-filled canals.

Conclusion: The proposed protocol provides an automated method to eliminate inaccuracies from XMT artefacts so that accurate volumetric measurements can be easily obtained. (EEJ-2024-02-031).

Objective: The aim of this study was to evaluate and compare the effect of various disinfection protocols on bacterial biofilm and subsequent release of growth factors from radicular dentin.

Methods: One hundred and ninety two extracted single rooted premolars were obtained and contaminated with E. faecalis biofilm for 21 days. The samples were then divided into three main groups - Group I: Irrigation (I) only, Group II: Calcium hydroxide (CH) placement followed by final irrigation and Group III: Triple Antibiotic paste (TAP) placement followed by final irrigation. Each group was further then divided into four sub-groups according to the final irrigating solution used - Sub group A: Saline, Sub group B: 17% EDTA, Sub group C: 1% phytic acid and Sub group D: 0.2%. chitosan nanoparticles. After treatment, the samples were subjected to colony-forming unit (CFU) analysis to determine bacterial reduction and the release of TGF-β1 and VEGF from the root canals, which was quantified using Enzyme-Linked Immunosorbent Assay (ELISA). The data were analyzed using statistical tests.

Results: The maximum reduction in E. faecalis biofilm was observed in Group III (TAP), followed by Group II (CH), and finally Group I (irrigation only). Among the subgroups, the maximum reduction in bacterial biofilm was seen with chitosan nanoparticles, followed by phytic acid, EDTA, and saline. After 24 hours, the highest release of both TGF-β1 and VEGF was observed in the chitosan nanoparticles subgroup, followed by phytic acid, EDTA, and saline. Similar results were seen in the CH and TAP groups.

Conclusion: The study concluded that newer irrigating solutions, particularly 0.2% chitosan nanoparticles, showed superior antibacterial activity and better smear layer removal, leading to greater growth factor release from the radicular dentin. The study also highlighted that TAP placement resulted in maximum bacterial reduction, regardless of the final irrigant used. Furthermore, the release of TGF-β1 was significantly higher than VEGF in all groups. (EEJ-2024-03-045).

Objective: The current study aimed to find the best cementation system for cementing the fibre post with BioCeramic putty: total-etch dual-cure hydrophobic resin cement (TC), Self-adhesive dual-cure hydrophilic resin cement (SC), with SC-modified with a bioceramic sealer (SCB), and glass ionomer cement (GIC).

Methods: An impression was captured from the immature premolar root canal, followed by scanning and the subsequent design of prefabricated root canal models for immature permanent teeth (PRCMs). A total of forty PRCM replicas were precision-printed using advanced 3D printing technology. Subsequently, etch PRCM underwent meticulous filling with BioCeramic putty and a fibre post. After two hours, the fibre posts were removed and treated with hydrofluoric acid for all groups. Subsequently, fibre posts of groups except the GIC group received silane solution application. The PRCMs were categorised into four groups based on the cementation system employed: TC Group (n=10), SC Group (n=10), SCB Group (n=10), and GIC Group (n=10). After 48 h, the specimens underwent pull-out strength testing using a universal testing machine, performed along an axis parallel to the longitudinal axis of the fibre post at a crosshead speed of 1 mm/min. Failure modes were scrutinised using a stereomicroscope. The acquired data were subjected to robust statistical analyses, employing one-way ANOVA and Tukey HSD tests with a significance level set at α=0.05.

Results: The One-way ANOVA test showed a significant difference in the pull-out bond strength of the groups (p<0.001). Accordingly, the Tukey HSD test revealed that the mean bond strength values were significantly higher in the TC group than in other groups. Adhesive failure had a higher frequency in SC and GIC groups, whereas mixed failure had a higher frequency in TC groups and 3.

Conclusion: The TC exhibited significantly superior bond strength to the other groups, particularly concerning the fibre post-cementation to BioCeramic putty. (EEJ-2024-06-094).

Objective: The design and structural properties of fiber posts play a crucial role in the long-term success of endodontically treated teeth by influencing their fracture resistance and failure patterns. This study aimed to evaluate the effect of fiber posts with different coronal designs on fracture resistance and failure mode in endodontically treated maxillary premolars restored with cusp-covering direct overlay restorations.

Methods: Forty-five extracted human maxillary premolar teeth were selected. The 2 mm cusp reducted MOD cavity preparations and root canal treatments were performed. The teeth were divided into three groups (n=15): group 1: standard conical post (SCP) (Exatec Blanco HT-glass fiber post), group 2: cylindrical core post (CCP) (Exatec Blanco HT-glass fiber post) and group 3: control group (no post applied). After the placement of posts, overlay restorations were made with resin composite. The fracture resistance test was applied with a universal testing device and maximum forces were recorded. The failure mode scores were recorded using a dental microscope. The ANOVA test was used for the statistical analysis (p<0.05).

Results: While no significant difference was observed in terms of fracture resistance between SCP and CCP groups (1033.15 N and 981.17 N, respectively), the control group had significantly lower fracture resistance (852.93 N) (p=0.004). The number of restorable failure modes was higher in all groups. The non-restorable failure mode V was higher in CCP and control groups than SCP group.

Conclusion: Different coronal designs of fiber posts showed no significant difference in fracture resistance. Restorable failures were more frequent in the SCP group. (EEJ-2025-02-018).

Objective: This study aimed to evaluate the antibacterial effectiveness of two concentrations of iodine-potassium iodide (IKI) used as the final irrigating solution during endodontic retreatment.

Methods: Thirty symptom-free root-filled anterior teeth with chronic apical periodontitis (<5*5mm) were included. They were divided into two groups consisting of 15 teeth according to the method of final irrigation. Group 1 were irrigated with 2% IKI, and Group 2 with 5% IKI. The direct bacterial viable count method was performed to determine the number of colony-forming units (CFUs) before and after disinfection. The reduction in bacterial count was assessed, and statistical analysis was performed using Mann-Whitney U tests with a 95% confidence level.

Results: Irrigation with 5% IKI resulted in significantly reduced bacterial counts than 2% IKI irrigation (p<0.05), indicating greater antibacterial effects.

Conclusion: The use of a 5% IKI solution as the final irrigating agent in endodontic retreatment cases with chronic apical periodontitis significantly reduces bacterial counts compared to a 2% IKI solution. The 5% IKI solution therefore exhibited a superior antibacterial effect. Consequently, 5% IKI solution application improves microbiological outcomes and enhances the overall disinfection of the root canal system. (EEJ-2024-08-131).

Objective: This study aimed to compare photon-induced photoacoustic streaming (PIPS) and diode laser with passive ultrasonic irrigation (PUI) in activating intracanal irrigants for bacterial elimination from the root canal and apical extrusion.

Methods: Sixty extracted single-canal human teeth were chemo-mechanically prepared and placed in 3 ml glass vials with sterile 0.9 % sodium chloride solution. The root canals were inoculated with Enterococcus faecalis and incubated for 24 hours at 37°C. The samples were divided into three experimental groups (PIPS, diode laser, and PUI) and a control group (n=15 each). The experimental groups had root canals filled with saline and activated according to the manufacturer's instructions, while the control group received saline without activation. Bacterial samples were collected from the canals and outside the apex for quantification, cultured on nutrient agar for 24 hours at 37°C, and counted as colony-forming units. Mean values were compared using one-way ANOVA and Bonferroni tests at 5 % significance.

Results: All activation protocols significantly eliminated intracanal E. faecalis compared to the negative control group (p<0.05). PUI and the diode lasers were significantly more effective than PIPS (p<0.05). Extruded bacteria were higher in PUI than in PIPS and diode lasers.

Conclusion: Within the limitations of this study, the tested techniques extruded bacteria and did not completely eliminate intracanal bacteria. The diode laser showed the best bacterial elimination and extrusion outcome. (EEJ-2024-07-112).

Objective: Root growth and apical closure continue after tooth eruption. Root growth may cease if pulp viability is lost due to caries or trauma during this period. Successful endodontic treatment is challenging in these cases due to wide root canals and lack of apical stops. New premixed bioceramic root repair putties offer superior handling and healing properties. The aim of this study is to evaluate the filling ability and volumetric changes of three bioceramic putties (BIO-C Repair, NeoMTA Putty, and EndoSequence BC RRM Fast Set Putty) using micro-CT analysis.

Methods: Thirty-six freshly extracted single-rooted teeth with straight root canals were used, divided into three groups based on the materials. Immature teeth were simulated. Pre- and post-obturated micro-CT images were taken for each root. Voids were calculated as the percentage difference between canal space volume and repair material volume. The data were then analysed statistically using one-way analysis of variance (ANOVA) with the level of significance set at α=0.05.

Results: All groups showed marginal gaps and/or internal voids after root-end filling. No significant difference between groups in canal and material volumes was detected at 3 mm (p>0.05). However, void percentage differences were significant (p=0.003); Bio-C Repair (9.28+-3.27%) and EndoSequence BC RRM (6.7+-2.72%) were significantly higher with no difference between them, while NeoMTA Putty (3.73+-1.69%) was significantly lower.

Conclusion: NeoMTA Putty exhibited the least volumetric alterations after setting, compared to EndoSequence BC RRM and BIO-C Repair. Enhanced long-term stability as a minimal dimensional change contributes to the material's durability and effectiveness over time, potentially leading to better treatment outcomes making NeoMTA Putty a reliable choice for various endodontic applications, potentially leading to improved success rates and patient outcomes. (EEJ-2024-07-114).

Objective: To assess the extruded debris apically by the ProTaper Ultimate rotary nickel-titanium files compared to the ProTaper Gold files on preparing the mesiobuccal root canals of mandibular molars.

Methods: Thirty mandibular molars with mesial canals showing Vertucci Type-IV configuration and curvatures ranging between 20° to 40° were selected and divided into two groups per the rotary files used for root canal shaping (n=15). Myers and Montgomery's methodology was adopted for the collection of debris. The average weight of the collected dried debris was recorded and statistically analyzed using the independent t-test at a significance level of (p<0.05) after log transformation.

Results: The ProTaper Ultimate showed significantly less debris extruded (2.35+-0.65 mg) than ProTaper Gold (3.25+-0.47 mg) (p=0.001).

Conclusion: ProTaper Ultimate can efficiently prepare curved root canals with the minimal amount of apical debris extruded compared to ProTaper Gold. (EEJ-2024-06-100).