European Endodontic Journal最新文献

Objective: This study aims to compare the pain perception associated with the needle-free system (Comfort-In™) and the standard needle injection method during root canal treatments in adults.

Methods: Forty-four maxillary premolar teeth of the patients that applied to university for treatment and needed endodontic treatment were included in the study. Patients were anesthetized with two different injection methods; needle-free injection and conventional dental injection. In both groups, oxygen saturation and pulse measurements of the patients were recorded at 30-second intervals for 2 minutes before anesthesia and 4 minutes after anesthesia. Pain during the injection and opening of the access cavity preparation was recorded according to Visual Analog Scale (VAS). The data were analyzed according to a statistical program.

Results: In this study, a significant difference was found between the groups in terms of pain during anesthesia administration and the access cavity preparation (p<0.001). There were no significant differences in terms of gender and age (p>0.05). There was no significant difference between the groups in terms of oxygen saturation and pulse values before and after treatment (p>0.05).

Conclusion: Needle-free injection makes the treatment more comfortable for patients with injection fear and anxiety, making the procedure easier for the physician and the patient. (EEJ-2024-12-197).

Objective: To compare the cyclic fatigue resistance of conventional and heat-treated "replica-like" reciprocating instruments with their original counterparts under single and double curvatures and assess tip size discrepancies against manufacturer-reported values.

Methods: Eighteen instruments were used per group for the study. Two measurements at the instrument's tip were made with a digital calliper. Cyclic fatigue resistance was evaluated under single (60°, 5 mm radius) and double curvatures (60°, 5 mm radius each) in a 37°C water bath. Time to fracture (seconds) was recorded and analysed with appropriate statistical tests (p=0.05).

Results: The tip sizes of all instruments were smaller than the value purported by the manufacturers (0.25 mm) and outside the range of values obtained, with significant differences for all groups (p<0.001). Time to fracture were as follows: Reciproc R25: single curvature: 171.5+-38.9, double curvature: 133.4+-47.4; Reverso Silver: single curvature: 169.0+-104.8, double curvature: 57.8+-20.0; Reciproc Blue R25 single curvature: 355.4+-86.4, double curvature: 140.5+-67.7; Reverso Blue: single curvature: 359.5+-102.8, double curvature: 142.9+-69.0. Reverso Silver presented with a significantly lower time to fracture overall when compared with the Blue instruments (p=0.002) and with all instruments in double curvatures (p<0.05). In single curvatures, blue files had longer times to fracture (p<0.05). When comparing single versus double curvatures, only Reciproc R25 had no significant differences regarding time to fracture (p=0.54).

Conclusion: The tip sizes of the instrument tested were smaller than what is reported by the manufacturers. The cyclic fatigue resistance of the conventional 'replica-like' instrument (Reverso Silver) was significantly lower than the blue "heat-treated" comparators. Double curvature hastened fracture. (EEJ-2024-11-174).

Objective: To evaluate the effectiveness of three rotary file systems on the elimination of Enterococcus faecalis (E. faecalis) biofilms in single-rooted teeth.

Methods: A total of 70 mandibular premolars were included in this study in which 60 root canals were inoculated with E. faecalis. The positive control group (n=5) received bacterial inoculation without mechanical preparation. The negative control group (n=5) was neither infected nor mechanically prepared. The teeth were randomly assigned to 3 experimental groups (n=20 per-group) according to application of the rotary files: Group 1: XP-endo Rise Shaper (FKG, Le Crêt-du-Locle, Switzerland); Group 2: XP-endo Shaper (FKG, Le Crêt-du-Locle, Switzerland); Group 3: ProTaper Gold (Dentsply Sirona, Erlangen, Germany). Samples were collected using paper points before (S1) and after (S2) mechanical preparation. Colony-forming units (CFUs) were used to quantify bacterial loads.

Results: Significant differences in bacterial counts were observed from S1 to S2 in all tested groups (p<0.001). Intergroup comparisons revealed no significant differences between the XP-endo Rise Shaper and XP-endo Shaper groups (p>0.05) and between XP-endo Shaper and ProTaper Gold groups (p>0.05). Significant differences were observed between the XP-endo Rise Shaper and ProTaper Gold groups (p<0.05). The XP-endo Rise shaper group showed the largest reduction in bacterial loads (98.2%), followed by the XP-endo Shaper (96.0%) and ProTaper Gold (93.8%) groups.

Conclusion: All tested rotary files were able to reduce bacteria but the novel single-file system (XP-endo Rise shaper) was superior in reducing bacterial load compared to XP-endo Shaper and the multiple file system (ProTaper Gold). (EEJ-2024-08-133).

Objective: This study investigated the morphology of accessory canals in the mandibular first molar of a Malaysian subpopulation.

Methods: A total of 140 mandibular first molars were scanned using micro-computed tomography. The accessory canals for each of the mesial and distal roots were classified according to Ahmed et al. system based on location (coronal, middle and apical thirds) and type (patent, blind, loop and delta). A total of thirty mandibular first molar teeth were used for calibration. The Chi-square and Chi-square goodness-fit tests were used to assess the association between the categorical variables. The significance was set at 0.05 (p<0.05).

Results: Results showed that the prevalence of accessory canal is 80.71%. The apical third was the most common location for accessory canals in the mesial (79.3%) and distal (75.9%) roots (p<0.001). Amongst accessory canal types, the patent type was the most common (76.43% and 71.43%, respectively) with the codes of M(A1), D(A1). No significant association was found between root type and the presence of the accessory canals (p=0.071). A significant difference was found in the type of accessory canals and the location within the root (p<0.001).

Conclusion: In this population, the mandibular first molars showed a high prevalence of accessory canals in the mesial and distal roots. Patent accessory canals in the apical third are the most common in both roots followed by apical delta. (EEJ-2024-10-163).

This research assessed the interobserver agreement and precision of the tactile method (TM) during orthograde exploration of the apical terminal portion of permanent teeth with necrotic pulps and open apices. Nine non-vital teeth with incomplete root development from nine patients were included. Two observers analyzed preoperative cone beam computed tomography (CBCT) images to determine the distance between the incisal reference point and the apical terminal portion at four apical measurement points: buccal, lingual, distal, and mesial. The shortest of these points was considered the tomographic working length (TWL) and was used as control group. Subsequently, endodontic access and light chemo-mechanical brushing of the main canals were performed, followed by radiographic working length (RWL) establishment. Two different operators applied the TM using a #25 manual K-file (Dentsply Maillefer, Ballaigues, Switzerland) pre-curved in the tip at a 90° angle. The same four apical measurement points were explored, and the tactile method working length (TMWL) was determined. Interobserver agreement was assessed using Bland-Altman method. Wilcoxon signed-rank test and Student's t-test were used to analyze the correlation between methods (p≤0.05). The measurements conducted for TM and TWL showed a high level of agreement (0.486 and -0.144 mm, respectively). Compared with the control group (TWL) and TMWL, the RWL showed no significant correlation (<0.001 and 0.0068, respectively). TM demonstrated a reliable level of inter-observer agreement and could prove valuable when treating permanent teeth exhibiting non-vital pulps and open apices, especially in cases with radiographic evidence of external inflammatory apical resorption. (EEJ-2024-11-187).

Objective: This study compared the dentinal tubule penetration of NeoSEALER Flo bioceramic sealer using single cone and cold lateral compaction obturation techniques.

Methods: Eighteen extracted single-rooted mandibular premolars were randomly divided into two groups (n=9) according to the obturation technique used. The maximum penetration depth in microns, percentage of penetration depth, and percentage of penetration area of the NeoSEALER Flo bioceramic sealer were assessed using confocal laser scanning microscopy at different root levels; coronal, middle, and apical. Data was statistically analyzed using Kruskal-Wallis's test followed by Dunn's post hoc test with Bonferroni correction and Friedman's test followed by Nemenyi post hoc test with the significance level set at p<0.05.

Results: The single cone obturation technique has shown a statistically significantly higher percentage area of NeoSEALER Flo penetration than the lateral compaction technique at the coronal root level only. Otherwise, both obturation techniques have shown no statistically significant differences in NeoSEALER Flo penetration distance, percentage of penetration distance, and percentage of area penetration at the middle and apical root levels.

Conclusion: The single cone obturation technique can be used with bioceramic sealers yielding comparable results to the cold lateral compaction technique. (EEJ-2024-12-192).

Objective: This case-control study aimed to explore the expression of different osteogenic-related genes in inflamed dental pulp and to correlate these expressions amongst each other and with the extent of pain.

Methods: Dental pulp tissues were collected from patients who were diagnosed with irreversible pulpitis. All samples were processed for RNA extraction and analysis of bone morphogenic protein 2 (BMP2), RUNX family transcription factor 2 (RUNX2), dentine sialophosphoprotein (DSPP), dentine matrix acidic phosphoprotein 1 (DMP1), bone gamma-carboxyglutamate protein (BGLAP), and alkaline phosphatase, biomineralization associated (ALPL) gene expression using real-time PCR. Pearson's correlation analysis was used to assess the linear relationships between different genes and the extent of pain, where p<0.05 was considered significant.

Results: The demographic and clinical characteristics of the patients varied according to age, sex, tooth type, clinical diagnosis, pain level, percussion pain response, and palpation pain sensitivity. The expression levels of the RUNX2 and BGLAP genes in the inflamed dental pulp were significantly greater than those in the control samples. Pearson's correlation analysis demonstrated significant positive correlations between the expression of the BMP2 and BGLAP genes and between the RUNX2 and DMP1 genes within inflamed pulp tissues.

Conclusion: Irreversible pulpitis was associated with positive coordination among odontoblastic activities, metabolism, and dentine formation as a compensatory mechanism. Our findings provide information on the molecular pathogenesis of pulpitis, suggesting future treatment approaches. (EEJ-2024-11-182).

Assessing scientific literature about prevalence of periapical lesions in individuals with osteoporosis in comparison to those without osteoporosis. Systematic searches were conducted up to November 24th, 2023 in Cochrane Library, EMBASE, MEDLINE/PubMed, SCOPUS, Web of Science and Grey Literature Reports databases. Only observational studies were included. The ROBINS-E tool, a revised Cochrane instrument for assessing bias in nonrandomized exposure studies, was employed. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was utilized to evaluate the certainty of the evidence. From 484 studies, three were included. One of them was categorized as having an exceptionally high risk of bias, while two were deemed to have certain concerns. Two studies reported that osteoporotic patients may have more chances to present a periapical lesion compared to non-osteoporotic patients. One study reported no differences between groups. The GRADE analysis indicated a markedly low level of certainty in the evidence. The present review indicates that osteoporotic patients may present more periapical lesions compared to non-osteoporotic patients. This statement should be cautiously interpreted and further well-designed studies are needed. (EEJ-2023-09-123).

This systematic review aimed to assess the accuracy of ultrasonic (US) imaging in the differential diagnosis between inflammatory radicular cysts (IRCs) and periapical granulomas (PGs) compared with the histological examination as the reference standard. Scopus, Medline (PubMed), and Web of Science were searched from inception to April 2024. The Methodological quality was assessed using the QUADAS-2 tool. Thirteen cross-sectional studies published between 2003 and 2023 were included in this study. A total sample of 275 patients (one tooth / per patient) comparing ultrasound test vs. histopathological examination was assessed. The summary measures of the US imaging test were: sensitivity= 0.96 [95% CI, 0.93-0.99], specificity= 0.83 [95% CI, 0.76-0.88], LR+ = 3.498 [95% CI, 2.079-5.885], LR- = 0.091 [95% CI, 0.050-0.164], DOR = 65.848 (95% CI, 28.857-150.25) and AUC=0.97 (95% CI, 0.95-1.00). The methodological assessment was variable in all domains and studies. Approximately 90% and 70% of the studies revealed some form of risk of bias concern in the domains -flow and timing-, and -reference standard-, respectively. US imaging can be regarded as a highly accurate and consistent method for IRC vs. PG differential diagnosis. The echotexture features of periapical lesions in US images reflected their histopathological characteristics. (EEJ-2024-09-150).

Objective: To evaluate the cyclic fatigue fracture resistance, torsional fatigue, and angular deflection of Reciproc Blue (RB), WaveOne Gold (WOG), One Reci (OR), and Plex RC-One (RC-One) instruments for managing root curvatures in simulated canals.

Methods: A sample size calculation determined 10 samples per group (5 instruments for the cyclic fatigue test and 5 for the torsional fatigue test) for detecting significant differences. The study included 40 NiTi instruments (25 mm) from four reciprocating systems groups: RB R25, WOG 25, OR 25, and RC-One 25. Instruments were inspected for defects. Bending tests assessed memory control. Static cyclic fatigue tests used an artificial 60° curved canal with motorized activation. Torsional fatigue followed ISO 3630-1, measuring torque and angular deflection until failure. Fractured surfaces were analyzed using automated image analysis and measured with Rhinoceros 8.0 software. Statistical analysis included central tendency and dispersion measures, followed by ANOVA to identify statistically significant differences between groups.

Results: The bending test showed RC-One retained shape after pressure, while RB exhibited moderate resistance. WOG and OR did not demonstrate satisfactory bending resistance. Analysis of cyclic fatigue revealed RC-One had the highest resistance, followed by RB, OR, and WOG (p<0.001). RB required the highest torque for fracture, followed by RC-One, WOG, and OR (p<0.001). WOG had the lowest deflection angle at fracture, followed by OR, RB, and RC-One (p=0.0399). SEM and intelligent automated image processing analysis showed RC-One and RB had wear zones indicative of slow fracture, while WOG and OR displayed 100% rapid fracture dimples. RC-One had 41.86% slow fracture and 54.14% rapid fracture, while RB had 17.83% slow and 82.17% rapid fracture. Torsion tests revealed similar features in RC-One and RB, supporting their high and similar torsional resistance and deflection, unlike WOG's lower resistance and OR's lowest resistance with the highest deflection.

Conclusion: The best performance in the bending test was obtained by RC-One, followed by RB, while most failures were observed in WOG and OR. RC-One showed significantly higher cyclic fatigue resistance in severe curvatures than RB, WOG, and OR. RB and RC-One exhibited very similar torsional resistance values, significantly higher than OR and WOG. RC-One displayed superior angular deflection results compared to the other instruments. (EEJ-2024-08-135).