European Endodontic Journal最新文献

Objective: To evaluate the degree of postoperative pain and rate of analgesic intake in patients with symptomatic irreversible pulpitis in mandibular first molar teeth at 6 h, 12 h, 24 h, 48 h, and 72 h after using different irrigation activation techniques in single-visit endodontic treatment.

Methods: A total of 78 patients with symptomatic irreversible pulpitis with no signs of periapical pathology were randomly divided into 3 groups according to the final irrigation activation technique; Group XP-endo Finisher, Group Ultra X ultrasonic device, and Group side-vented needle. The teeth underwent standardised single-visit root canal treatment procedures using 2.5% sodium hypochlorite for irrigation. Each patient was given a chart to record postoperative pain at 6, 12, 24, 48 and 72 hours intervals. Ibuprofen, 400 mg tablets, was prescribed to be taken when the pain was unbearable. The incidence and number of analgesic tablets taken were recorded. Data were analysed using a Kruskal-Wallis test followed by a pairwise Mann-Whitney U test with Bonferroni correction for intergroup comparisons and Freidman's test followed by Dunn's post hoc test for intragroup comparisons.

Results: No statistically significant difference was found between all groups regarding the incidence and intensity of pain at different time intervals (p>0.05). There was no significant difference in analgesic intake between different groups, with most cases in all groups not taking analgesics (p>0.05).

Conclusion: Adding XP-endo Finisher or passive ultrasonic irrigation to the final irrigation protocol in singlevisit endodontic treatment had no significant effect on postoperative pain or analgesic intake. (EEJ-2021-11-185).

Objective: To compare the fatigue resistance of different heat-treated reciprocating instruments tested in a dynamic cyclic fatigue model.

Methods: Forty-eight new instruments were inspected under magnification and selected for this study, and then divided as follows (n=12): X1 Blue (MK Life, Porto Alegre, RS, Brazil), Pro-R (MK Life), Reciproc (VDW, Munich, Germany), and Reciproc Blue (VDW). Artificial canals presenting a curvature of 60° angle and 5 mm radius were milled in zirconia. The block containing the artificial canals was mounted in a container filled with water kept at 37°C. A specially designed device was used to perform controlled axial movements while the instruments were activated inside the canals. Time to failure was recorded in seconds, and fragment lengths were measured (mm). Data were analyzed statistically with the significance level set at 5% (One-Way ANOVA and Tukey test).

Results: Pro-R and Reciproc Blue instruments presented the highest fatigue resistance, being significantly different from the other tested files (p<0.05). Reciproc presented intermediate results, significantly different X1 Blue (p<0.05). The fractographic analysis showed typical features of cyclic fatigue for all instruments.

Conclusion: Pro-R and Reciproc Blue instruments are more resistant to dynamic cyclic fatigue than the Reciproc and X1 Blue. (EEJ-2022-10-124).

Objective: The success of vital pulp therapy is crucial to preserve the integrity of the teeth and to enable an uninterrupted root formation in a young permanent tooth. This warrants placement of an intact permanent seal immediately in contact with the pulp capping material. Mineral trioxide aggregate (MTA) sets by hydration and deters placement of an immediate permanent resin composite restoration over it. The aim of this in vitro study is to evaluate the wettability, surface morphology and shear bond strength (SBS) of polydopamine (PDA)-pretreated MTA to resin composite (RC).

Methods: The contact angle (CA) and morphological changes caused by self-etch (SE) adhesive on untreated and PDA-pretreated MTA was analyzed using contact angle meter and scanning electron microscope (SEM) respectively. To evaluate SBS, 144 MTA samples were prepared using a custom-made mold of 5 mm diameter and 3 mm height. The samples were randomly divided into two groups of 72 samples each based on whether their surface was pretreated with PDA or not. Under each group, nano-hybrid RC restoration was done either immediately or after a delay of 3 h, 24 h and 96 h. SBS of the MTA/resin composite assembly was tested in a universal testing machine. CA values were analyzed using One-way analysis of variance and Games-Howell Post Hoc test. Mann-Whitney test and Friedman post-hoc Dunn test were used to analyze SBS values.

Results: SE adhesive made a significantly lesser mean CA with PDA-pretreated MTA (27.20°+-2.28) compared to untreated MTA (34.22°+-1.45, p<0.05). SEM micrographs showed that while etching with SE primer eroded the surface characteristics, PDA coating minimized the erosive effect of the acidic primer and preserved the original crystalline plate-like structure of MTA. At all tested time intervals, PDA pretreatment significantly increased the SBS of MTA to RC, compared to untreated control. Immediate bond strength of PDA pretreated MTA (26.30+-7.60 MPa) was equivalent to the SBS value achieved at 96 h with untreated MTA (27.82+-2.96 MPa).

Conclusion: Within the limitations of this in vitro study, it can be concluded that PDA pretreatment of MTA surface improved its wettability, prevented loss of surface integrity following etching and increased the SBS of RC to MTA. (EEJ-2022-11-144).

The purpose of this systematic review was to critically evaluate the available clinical literature on the use of regenerative endodontic therapy (RET) for the treatment of root resorption. All case reports, case series and clinical studies documenting the management of root resorption in mature or immature permanent teeth using RET were included. Review articles, animal studies, and RET in teeth showing developmental anomalies were excluded. A literature search was conducted in electronic databases MEDLINE, Scopus, Cochrane, and Google Scholar from 2001 to January 2022. The JBI Critical Appraisal Checklist Quality was used to appraise the included case reports and case series. The Methodological item for non-randomised studies (MINORS) tool was used to appraise the clinical study critically. After applying the inclusion and exclusion criteria, the search resulted in 14 studies (12 case reports, 1 case series, and 1 clinical study) accounting for root resorption in 34 teeth from 29 patients treated with RET. Despite the wide variation in RET protocols, the arrest of root resorption and resolution of symptoms was seen in all teeth except one (failure after 27 months). The clinical study's cone beam computed tomography (CBCT) imaging evalu- ation documented a significant volumetric decrease in resorptive and periapical lesions after RET. The clinical study was deemed as good quality using the MINORS scale. The JBI critical appraisal tool showed that the case series was of poor quality; 11 of the case reports were of good quality, while 1 case report was of fair quality. This systematic review revealed a low-to-moderate level of evidence for the use of RET in resorption cases. However, further well-designed, long-term clinical studies are required to recommend it as an alternative treatment option for root resorption management. Funding: None. The systematic review was registered in PROSPERO (CRD42021274569). (EEJ-2022-11-136).

Objective: This study compared the effects of calcium chloride dihydrate (CaCl2.2H2O) on the physical properties and push-out bond strength of white Mineral Trioxide Aggregate (WMTA) and an experimental Malaysian Portland cement mixed with nano-zirconium oxide (nano-ZrO) [(radiopaque Malaysian Portland cement (RMPC). Mineral Trioxide Aggregate (MTA) was the first calcium silicate cement (CSC) introduced in dentistry, but up to date, it is an expensive cement with long setting time and causes tooth discolouration. Although Portland cement has been introduced as a potential substitute to MTA, it still faces some challenges such as long setting time and lack of sufficient radiopacity.

Methods: Four groups [WMTA, RMPC, fast-set WMTA (FS-WMTA) and fast-set RMPC (FS-RMPC)] were prepared. Initial setting time was evaluated using Vicat apparatus. The pH was measured at seven-day intervals. For discolouration potential, cements were packed in the pulp chamber of 46 extracted maxillary incisors. Spectrophotometric readings were obtained at seven-day intervals, and the rate of colour change (ΔE) was recorded. For the push-out bond strength testing, cements were applied in 48 sectioned root samples, and the test was performed using universal testing machine at crosshead speed of 0.5 mm/min until bond failure. Statistical analysis was done according to the nature of each group of data using SPSS 26.

Results: Addition of CaCl2.2H2O decreased the initial setting times of both RMPC and WMTA significantly (p<0.05). The pH values of FS-WMTA and FS-RMPC were comparable to their non-accelerated counterparts ranging from 10 to 12. Discolouration effect was more obviously observed with WMTA and FS-WMTA with time compared to RMPC formulations. Push-out bond strength of the two materials also showed an increase with the addition of the accelerator, however, only FS-WMTA showed statistically significant difference compared to WMTA (p<0.05).

Conclusion: The addition of CaCl2.2H2O improves the physical and mechanical properties of the newly formulated RMPC and WMTA. The RMPC formulation overcomes the discolouration potential of WMTA. (EEJ-2022-12-155).

Objective: This study aimed to assess the effect of sodium hypochlorite (NaOCl) combined with a novel chelating agent DualRinse HEDP (Medcem GmbH, Weinfelden, Switzerland), a product consisting of 0.9 g of 1-hydroxyethylidene-1,1-diphosphonic acid (HEDP) powder, with or without high-power sonic activation on debris and smear layer removal.

Methods: Seventy-five mandibular premolars were divided into 5 groups (n=15) and treated with different irrigation protocols: group 1 (D3N), DualRinse HEDP+3% NaOCl without activation; group 2 (D3NA), DualRinse HEDP+3% NaOCl with activation (EDDY, VDW, Munich, Germany) during the final irrigation; group 3 (3NE), 3% NaOCl+17% Ethylenediaminetetracetic acid (EDTA)+3% NaOCl without activation; group 4 (3NEA), 3% NaOCl+17% EDTA+3% NaOCl with activation during the final irrigation; group 5 (NC), negative control group, 0.9% saline. Samples were analysed by scanning electron microscopy (SEM) to evaluate residual debris and smear layer at 3 levels of the root canal: coronal, middle, and apical. Statistical analysis was performed with a level of significance set at p<0.05. The normality distribution of scores within each group was assessed using Kolmogorov-Smirnov and Shapiro-Wilk tests. A Kruskal-Wallis test followed by multiple comparison tests was used to compare scores among the 5 groups on the apical, middle, and coronal levels of the root canal. A Friedman test followed by multiple comparison tests was used to compare scores within the apical, middle, and coronal levels for each treatment group.

Results: Debris score was significantly the lowest for D3NA, followed by D3N, 3NEA and 3NE at all root levels (p<0.05). The smear layer score was significantly the lowest for D3NA, followed by D3N, 3NEA and 3NE only at the apical level, while no significant difference was found in the middle and coronal levels between the groups (p<0.05). DualRinse HEDP resulted in less debris and smear layer compared to the classic approach of NaOCl without activation. Implementing sonic activation further improved debris and smear layer removal.

Conclusion: DualRinse HEDP+3% NaOCl improved debris removal at all levels and smear layer elimination at the apical level of the root canal. These results were further enhanced when adding high-power sonic activation. (EEJ-2022-09-116).

Objective: To answer the question: 'Does the pharmacological management of dental anxiety influence pain occurrence during root canal treatment?'

Methods: Searches on MEDLINE/PubMed, Cochrane Library, Web of Science, Scopus, EMBASE and Open Grey were conducted until September 02, 2022. Only randomised clinical trials were included. The Cochrane risk of bias tool for randomized trials (RoB 2) was used. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.

Results: Initial screening resulted in 811 studies. Three hundred seventy-three were excluded for being duplicates. Of 438 eligible papers, ten studies met the inclusion criteria and were selected for full-text reading. Four studies were included in the final analysis. Three studies had a low risk of bias, and one was a high risk. GRADE demonstrated a low quality of evidence.

Conclusion: There is insufficient evidence to determine whether the pharmacological control of anxiety can influence intraoperative pain occurrence. (EEJ-2022-08-096).

Objective: Patients with moderate to severe preoperative pain have a high incidence of postoperative pain. The objective of this trial was to evaluate the efficiency of oral premedication with Aceclofenac (immediate release and controlled release) in the management of post-instrumentation pain in root canal treatment, in patients with moderate to severe preoperative pain.

Methods: Three-arm parallel, triple blinded randomized controlled trial was planned. Patients with moderate to severe endodontic pain, requiring primary endodontic treatment were enrolled. Aceclofenac 100mg- immediate release (Aceclofenac-IR), Aceclofenac 200mg- controlled release (Aceclofenac-CR), and Ibuprofen 400mg were compared. The tablets were given one hour before the root canal treatment. Postoperatively, patients rated their pain at various time points. The duration of pain relief (primary outcome), the intensity of post-instrumentation pain, and the need for additional medicine were calculated. Statistical analysis was done using Kruskal-Wallis followed by Dunn post-hoc, Chi-square tests, and Binominal logistic regression.

Results: Aceclofenac-CR had a statistically significant longest duration of pain relief when compared to Ibuprofen (p=0.037) and Aceclofenac-IR (p=0.026). The intensity of post-instrumentation pain was lowest in Aceclofenac-CR, followed by Aceclofenac-IR and Ibuprofen. Additional medicine was required for only 8% of patients in Aceclofenac-CR group; whereas for 32% in each of Aceclofenac-IR and Ibuprofen groups. The odds of taking additional medicine were reduced to 0.16 in Aceclofenac-CR; increased to 1.05 with age.

Conclusion: Aceclofenac-CR had the longest duration of pain relief compared to Aceclofenac-IR and Ibuprofen. (EEJ-2022-03-037).

Objective: Mitochondrial dynamics play a pivotal role in maintaining the homeostasis of the dental pulp. Inflammation and oxidative stress can trigger changes in mitochondrial dynamics, leading to cell death in the dental pulp. This study aimed to investigate inflammation, oxidative stress, mitochondrial dynamic alterations, and cell death in inflamed pulpal tissues compared to healthy pulp tissues.

Methods: Pulpal tissues were collected (n=15 per group) from: 1) healthy people as the control and 2) people with clinically diagnosed irreversible pulpitis. Proteins indicating inflammation, oxidative stress, mitochondrial dynamics, and cell death markers were investigated by western blot analysis. A Student's t-test was used to analyse differences between the healthy and irreversible pulpitis groups. A probability of 0.05 was used to indicate statistical significance (p<0.05).

Results: The expression of the proteins, tumour necrosis factor-alpha (TNF-α) and nuclear factor kappa-lightchain-enhancer, by activated B cells (NF-κB) from inflamed pulp tissues were significantly higher than those of control. Compared to controls, 4 hydroxynonenal (4HNE) and dynamin-related protein 1 (Drp1) were significantly higher, while mitofusin 2 (MFN2) and optic atrophy type 1 (OPA1) were significantly lower in inflamed pulp tissues. Bcl-2-associated X protein (Bax), cleaved caspase-3, and cytochrome c were significantly higher in inflamed pulpal tissues compared to controls. In inflamed pulpal tissues, we found a significant increase in the expression of receptor-interacting serine or threonine-protein kinase 1 (RIPK1) but not receptor-interacting serine or threonine-protein kinase 3 (RIPK3).

Conclusion: Irreversible pulpitis is associated with inflammation, oxidative stress, alterations in mitochondrial dynamics, and apoptosis in pulpal tissues. (EEJ-2022-01-014).