European Endodontic Journal最新文献

Objective: The present study aimed to compare the shaping ability of the F6 SkyTaper® (F6S), HyFlex® EDM OneFile (HEDM), and One Curve® (OC) nickel-titanium single-file instruments using micro-computed tomography.

Methods: Fifty-two mesiobuccal roots of maxillary first molars, with a degree of curvature between 20° and 42°, were randomised into three experimental groups (n=15 per group): F6S, HEDM, and OC, and a non-instrumented control group (n=7). All specimens were scanned by micro-computed tomography before and after instrumentation. The following parameters were evaluated: preparation time, volume of dentine removed, cutting efficiency, unshaped surfaces, and canal transportation. Cutting efficiency was analysed using an ANOVA parametric test and Tukey's multiple comparison post hoc test. Other parameters were analysed using a non-parametric Kruskall-Wallis test followed by Dunn's multiple comparison post hoc test.

Results: No instrument separation occurred during instrumentation. No significant differences were found between the instrument groups with respect to all the parameters (p>0.05). All the instruments induced morphological changes in the root canal dentine (p<0.05) and tended to increase canal transportation toward the coronal portion of the root canals (p>0.05).

Conclusion: All instruments were able to shape curved canals and preserve their original anatomy. Single-file endodontic procedures with these instruments can be used with comparable changes in the root canal shape with minimal transportation. (EEJ-2022-01-06).

A systematic review and meta-analysis were conducted to evaluate the effect of endodontic irrigation on the mineral content of root canal dentine. A systematic search was performed in the following databases: PubMed, Web of Science, Scopus, Cochrane, ProQuest, and Wiley. The quality assessment of the articles was performed. The meta-analysis was carried out using the random effects model in the Stata 16 software (p<0.05). The results showed that Er: YAG Laser had a significant effect on the removal of the phosphorus content of dentine (Hedges' g=-0.49; 95% CI: -0.85, -0.13; I2=0.0%). In addition, the EDTA 5Min had a lower removal effect compared to the control group on the magnesium content of dentine (Hedges' g=0.58; 95% CI: 0.00, 1.16; I2=0.0%). Other irrigations had no significant effect on other on the mineral content of root canal dentine. Evidence was found to support that most root canal irrigation protocols did not have a significantly affected in terms of the mineral content of root dentine. (EEJ-2022-11-140).

Objective: The aim of this prospective clinical study was to assess the effect of different instruments and root canal filling techniques on post-operative pain in single visit of endodontic retreatment.

Methods: Forty five patients (18-65 yrs old) who needed non-surgical endodontic retreatment in mandibular premolar or molar teeth without any symptoms were included in this study. The teeth were randomly assigned into 3 groups of 15 teeth, according to the instrumentation and filling techniques: hand files with lateral compaction (group 1), Reciproc with lateral compaction (group 2), Reciproc with continuous wave compaction technique (group 3). Retreatments were performed in a single visit and post operative pain was assesed at 4 intervals; 24, 48,72 hours and 7 days. All data were analyzed using One way Anova, Chi-square and Fisher's Exact test and the significance level was set to (p≤0,05).

Results: No statistically significant difference was found among the groups in relation to post-operative pain (p>0.05). Although the intensity of post-operative pain was decreased over the time in all groups, significant difference was found only in Reciproc groups (p<0.05). However, no pain was found in any patient at the end of 7 day. Also, statistically significant difference was found between pain intense and periapical index in 24 and 72 hours (p<0.05).

Conclusion: In the present study, the intensity of post-operative pain was not found to be related to instrumentation or filling techniques in retreatment cases. The intensity of pain could be related to periapical index of the tooth. (EEJ-2022-09-117).

Objective: The management of postoperative endodontic pain (PEP) is essential to contemporary endodontic practice. Diclofenac and ibuprofen (IBU) are two of the most widely-used non-steroidal anti-inflammatory analgesics. However, their comparative data are neither sufficient nor conclusive. This prospective randomised clinical trial aimed to compare the analgesic efficacy of diclofenac potassium (DFK) with IBU on PEP in maxillary and mandibular first molars diagnosed with irreversible pulpitis after single-visit non-surgical root canal treatment.

Methods: Sixty-four patients were randomised into two groups of DFK (n=32) and IBU (n=32), using the stratified permuted randomisation method, and 61 participants completed the trial. After root canal treatment, patients randomly received IBU 400 mg every 6 hours (n=31) or DFK 50 mg every 8 hours (n=30) for 24 hours. Patients recorded their pain level on 0-100 mm visual analogue scales (VAS) at 2, 4, 6, 12, and 24 hours after the treatment. Recorded VAS scores and the number of pain-free patients (VAS<5) were compared between the two groups. A generalised linear estimation equation model, Chi-Square test, and Mann-Whitney U test were used to analyse the data.

Results: The mean overall PEP score was statistically significantly lower in the DFK group than the IBU group with a p value of 0.030. Pain scores at 2 (p=0.034), 4 (p=0.021), and 24 hours (p=0.042) after the treatment were also significantly lower for DFK than IBU. The number of pain-free patients was also significantly higher in the DFK group at 2-hour (p=0.015) and 4-hour (p=0.048) time points and overall (p=0.013) compared to the IBU group. There was no adverse effect observed in either group.

Conclusion: Based on the results, taking multi-dose DFK 50 mg by the clock had better analgesic outcomes than multi-dose IBU 400 mg for PEP management. (EEJ-2022-01-07).

Objective: The high prevalence of chronic kidney disease in the community, especially in older patients, makes their management an important aspect of clinical practice. The aim of this study was to evaluate the knowledge attitudes and performance of Iranian endodontists regarding patients with chronic kidney disease (CKD).

Methods: This cross-sectional, descriptive-analytical study involved 100 Iranian endodontists (41 M, 59 F), who completed questionnaires with 21 items on CKD. Responses were analyzed by SPSS, using Chi-square or Fisher's exact tests.

Results: Overall levels of knowledge were rated as optimal in 55% of subjects, while attitudes to care were favourable in 83%. This cohort of specialist clinicians had strong scores for optimal attitude and performance. Awareness of issues around prescribed analgesics, antibiotic cover, bleeding risk and hypertension was high. Proximity to specialist training (younger specialists, and less years in practice) and female gender were associated with significantly higher scores across the three domains measured.

Conclusion: Most specialists were aware of requirements for safe care of dental patients with CKD. Continuing professional education should target older clinicians who may have had less exposure to formal training in this topic during their clinical training. (EEJ-2022-04-059).

Objective: This study aimed to evaluate the survival from fractures and risk factors of VPT-treated permanent molars restored with direct resin composites in young patients.

Methods: The dental records of patients aged 6 to 18 years with VPT-treated permanent molars restored with resin composites were retrospectively evaluated for the presence of fractures on these teeth. Kaplan-Meier methods were used to estimate the survival probabilities. The potential risk factors were assessed using the multivariable Cox proportional hazard model.

Results: A total of 234 treated molars from 189 patients were included. An overall average follow-up time was 33.34+-20.54 months (ranging from 6 to 83 months). At the end of the study, 21.8% of molars had fractures with the majority of them (92.2%) were restorable. Radiographically, only 3.9% of the fractured molars had periapical lesions and considered VPT failures. The percentages of the fracture types are as follows: 54.9% natural tooth structure fracture, 27.5% restoration fracture, and 17.6% combination fracture. The most common fracture location among the 37 molars with natural tooth fracture (either alone or in combination with restoration fracture) was at the marginal ridge (59.5%), followed by the marginal ridge extending to cusp (21.6%), and the cusp itself (18.9%). The cumulative survival probabilities of these teeth decreased over time, reaching 66.02% (95% CI: 55.89-74.36) after 5 years. VPT-treated molars in the mandible had a 2.1 times higher risk of fracture than those in the maxilla. Furthermore, the molars treated with partial and coronal pulpotomy had 2.4 times and 4.6 times higher risks of fracture when compared to those with indirect pulp capping, respectively.

Conclusion: In VPT-treated permanent molars in young patients, more fractures were seen in mandibular teeth and in teeth with pulp roof removal (partial and coronal pulpotomy). Clinicians should plan for proper restoration on these teeth. (EEJ-2022-08-097).

Objective: This study was performed to assess smear layer formation and erosion after final irrigation protocols with metal and non-metal tips in the apical third of root canals.

Methods: Forty mandibular premolars were instrumented with ProTaper Gold files up to F3 and embedded in a closed silicone flask system. The teeth were subsequently cleaved and 4 sequential indentations (1 to 4 mm from the apical foramen) were prepared on the buccal root canal walls to standardize sites for environmental scanning electron microscopy (ESEM) imaging. The samples were cleaned in an ultrasonic bath and observed under ESEM (controls), reassembled and divided into four groups (n=10 each) and subjected to different final irrigation protocols; XPF Group (XP-endo Finisher) and PUI Group (passive ultrasonic irrigation) with metal tips; EA Group (EndoActivator) and MDA Group (Manual dynamic agitation) with non-metal tips. The smear layer formation and dentine erosion were evaluated using ESEM. The data were analyzed with Kruskal-Wallis test with Bonferroni correction.

Results: In comparison to the control groups, XPF group had significantly increased smear layer formation at 1 and 2 mm (P<0.05). PUI group had significantly higher smear layer (P<0.05) formation at 3mm while EA and MDA groups did not present with significantly higher smear layer at all levels. Erosion was significantly higher (P<0.05) in MDA, XPF and PUI groups at all levels when compared to controls while EA group presented with significantly more erosion only at 2 and 3 mm.

Conclusion: Final irrigation protocol using EA and MDA with non-metal tips did not result in significant smear layer formation. Dentine erosion was observed after all experimental irrigation protocols. (EEJ-2021-12-194).

Objective: According to the American Association of Endodontists (AAE), 22 million endodontic procedures have been performed annually. Root canal treatment is needed to prevent infection and restore function when a tooth is severely infected or decayed. This procedure is the only way to preserve the natural tooth and avoid artificial replacement (implant, denture, etc.). The current study aims to develop an electrochemical reamer (EC-Reamer or EC-R) that can help to disinfect the canal system and thus improve the success rate of root canal treatment.

Methods: The COMSOL Multiphysics software was utilized to simulate the experimental setup and confirm the current flow in the electrolyte. The benchtop experimental approach follows a specific electrochemical protocol, (i) open circuit potential to monitor the electrochemical stabilization and (ii) potentiostatic scan at -9.0 V as the treatment stage. Identification of feasible reference electrode (RE) and insulation material for the exploratory benchtop studies considered platinum (Pt) and gold (Au) wire as the REs and hot melt adhesive (HMA) and liquid tape as the insulation materials. The antimicrobial effects of EC-R were analysed using Enterococcus faecalis (E. faecalis). One-way ANOVA with the Tukey post hoc test and a significance level of P<0.05 is used to compare the groups with an experimental duration of 60 seconds.

Results: The findings showed that magnitude and current fluctuations created by Pt wire are promising when compared to Au wire, while Pt-HMA pair is chosen considering Pt's good electrochemical inertness and HMA's easy handling, availability, and non-hazardous features. The use of potentiostatic duration of 1 s and 3 s resulted in >99.99% E. faecalis reduction. Duration at 5 s and above resulted in a total bacterial kill. Statistical analysis confirmed a significant difference among the groups tested with commercial and custom-built potentiostats.

Conclusion: The outcome provided preliminary data for developing an EC-R prototype to enhance the antimicrobial effect during root canal treatment potentially. (EEJ-2022-01-04).

This systematic review aims to establish whether various irrigant activation techniques (IATs) result in greater penetration of irrigant up to the working length. The MEDLINE, Scopus and Cochrane Library electronic databases were searched to determine the difference in irrigant penetration depth in the main canal following the use of manual dynamic activation (MDA), sonic irrigation (SI), passive ultrasonic irrigation (PUI), and apical negative pressure irrigation technique (ANP) in comparison with conventional needle irrigation technique (CNI) in mature permanent teeth. Meta-analysis was performed for straight canals as well as curved canals in addition to subgroup analyses for a) Individual IATs in comparison with CNI, b) Comparison of PUI v ANP and SI v ANP in the straight canals, c) comparison of different IATs performed in straight and curved canals. The outcome was presented as effect size: standardized mean difference (SMD) and percentage difference (% diff) of irrigant penetration up to the working length (WL) alongside 95% confidence intervals using chi-square analysis. Of the 840 records screened, 20 studies were included in the systematic review and 17 studies were included in the meta-analysis. It revealed IATs had significant improvement in irrigant delivery up to the WL in straight (% diff: 51.94%, 95% CI: 39.20-64.67%) and curved canals (SMD: 1.08, 95% CI: 0.64-1.52) over CNI. The subgroup analysis revealed ANP was the most effective and significant technique followed by PUI, SI and MDA techniques in straight canals (% diff: 91.70%, 95% CI: 75.63-107.77%) and curved canals (SMD: 1.45, 95% CI: 0.77-2.13). IATs improve irrigant penetration when compared to CNI technique. In both straight and curved canals, ANP is the most effective in delivering the irrigant up to the WL followed by PUI, SI and MDA techniques. Hence adaptation of recent IATs in routine endodontic practice is recommended. (EEJ-2022-03-036).

In addition to pathogenic teeth associated with cysts, the roots of adjacent teeth are often included in the cystic cavity. Whether these teeth require elective endodontic treatment followed by cystic enucleation remains unclear. In the case presented herein, we aimed to preserve the pulp of the teeth included in the cystic lesion. Unfortunately, the sensibility of the included teeth was negative after endodontic surgery, including cystic enucleation. However, the sensibility recovered after 1 year and was maintained throughout a 4.5-year follow-up. Therefore, we suggest that elective endodontic treatment of the included teeth should be avoided, and further research should be conducted regarding this issue. (EEJ-2022-05-063).