European Endodontic Journal最新文献

Inflammatory radicular cysts (IRCs) are chronic lesions that follow the development of periapical granulomas (PGs). IRCs result from multiple inflammatory reactions led initially by several pro-inflammatory interleukins and growth factors that provoke the proliferation of epithelial cells derived from epithelial cell rests of Malassez present in the granulomatous tissue, followed by cyst formation and growth processes. Multiple theories have been proposed to help explain the molecular process involved in the development of the IRC from a PG. However, although multiple studies have demonstrated the presence of epithelial cells in most PGs, it is still not fully understood why not all PGs turn into IRCs, even though both are stages of the same inflammatory phenomenon and receive the same antigenic stimulus. Histopathological examination is currently the diagnostic gold standard for differentiating IRCs from PGs. Although multiple studies have evaluated the accuracy of non-invasive or minimally invasive methods in assessing the histopathological nature of the AP before the intervention, these studies' results are still controversial. This narrative review addresses the biological insights into the complex molecular mechanisms of IRC formation and its histopathological features. In addition, the relevant inflammatory molecular mediators for IRC development and the accuracy of non-invasive or minimally invasive diagnostic approaches are summarised. (EEJ-2022-03-041).

Objective: To test the hypothesis that the (i) presence of non-carious cervical lesions (NCCLs) and (ii) type of post system have no effect on the fracture resistance and pattern in endodontically treated maxillary premolars.

Methods: Human maxillary first premolars (n=60) with two root canals were randomly allocated into four groups (n=15). Buccal wedge-shaped NCCLs were prepared in 45 teeth specimens. Following root canal treatment, the specimens were randomly divided into (i) composite resin core (CRC); (ii) NCCLs + composite resin core (NCCL+CRC); (iii) NCCLs+prefabricated fibre-reinforced composite post + composite resin core (NCCL+PFRC+CRC); (iv) NCCLs+custom fibre posts + composite resin core (NCCL+CFP+CRC). All specimens were subjected to thermocycling (5°C to 55°C/5000 cycles). The compressive load was applied non-axially to the palatal cusp with a universal testing machine at a crosshead speed of 0.5 mm/min at a 30° angle until fracture. Fracture patterns were examined using a loupe magnification (2.5×) under transillumination. Statistical analyses were performed using non-parametric tests and pairwise comparisons of the load-to-fracture among the groups. Chi-square test was used to analyse the fracture patterns (P=0.05).

Results: Fracture resistance of NCCL+PFRC+CRC was significantly higher than NCCL+CRC (P=0.011), while NCCL+CFP+CRC did not show any significant difference when compared to NCCL+CRC (P=0.089). No statistical difference was found between CRC, NCCL+PFRC+CRC and NCCL+CFP+CRC (P=1.000). The frequencies of favourable fracture patterns in descending orders were as follows: CRC (80%), NCCL+CFP+CRC (73%), NCCL+PFRC+CRC (60%), and NCCL+CRC (40%). Chi-square test did not show significant differences in fracture patterns among all groups (P=0.110).

Conclusion: Restoration of the endodontically treated maxillary premolars with NCCLs, with or without post, resulted in similar fracture resistance as their counterparts without NCCLs. Placement of a prefabricated fibre-reinforced composite post exhibited greater fracture resistance to the maxillary premolars with restored NCCLs than those without a post. (EEJ-2022-06-077).

Objective: The aim of this study was to evaluate postoperative pain after non-surgical root canal retreatment with or without GuttaClear.

Methods: Sixty participants were randomly distributed in this non-inferiority trial into two parallel singleblinded experimental groups (Group1: non-solvent, Group2: solvent). After root canal retreatment, the participants completed questionnaires using direct (numerical rating scales) and indirect (number of analgesics taken) measurements of postoperative pain at immediate, 6, 12, 24, 48, and 72 h post-retreatment. The predisposing postoperative pain factors were recorded and analysed using Generalized Estimating Equations to identify correlated factors (α=0.05).

Results: The pain incidence was not significantly different between the groups at any time point. The highest incidence of postoperative pain occurred immediately after retreatment (35%) and then decreased to 15% at 24 h (P<0.05). The number of participants requiring analgesics was 6.67% in the non-solvent group and 9.99% in the solvent group which were similar between the groups. Patients with a history of previous postoperative pain were 21.6-fold more likely to have postoperative pain than those without (P<0.05).

Conclusion: There was no difference in postoperative pain or analgesics required after root canal retreatment with or without using GuttaClear. This study is registered in ClinicalTrial.gov (NCT04326998). (EEJ-2022-05-069).

Objective: To evaluate the incidence of postoperative pain, treatment time and analgesic intake after single visit endodontic treatment of mandibular molars using XP-endo Shaper, 2Shape and ProTaper Gold rotary systems.

Methods: 150 patients with irreversible pulpitis were scheduled for single visit root canal treatment. Teeth were randomly assigned to one of the three groups: ProTaper Gold (PTG; Dentsply Tulsa Dental Specialties, Johnson City, TN), 2Shape (2S; Micro-Mega, Besancon, Cedex, France) and XP-endo Shaper (XPES; FKG Dentaire, La Chaux-de-Fonds, Switzerland). Preoperative and postoperative pain was rated by the patients at the beginning of treatment and after 24, 48, 72 hours and 7 days on Heft Parker's visual analog scale (HP-VAS).

Results: Highest mean postoperative pain score was recorded in PTG (P<0.05), followed by 2S and XPES respectively at all time intervals. XPES exhibited maximum reduction from preoperative pain at 24 (48.67%) and 48 hours (96.90 %) with no pain at 72 hours. Treatment time was significantly least in XPES (P<0.05) followed by 2S and PTG; but no significant difference in analgesic intake was noted.

Conclusion: XPES exhibited least postoperative pain at all time intervals and treatment time, followed by 2S and PTG rotary systems respectively. (EEJ-2022-04-053).

Periapical lesions of endodontic origin are fairly common in the oral cavity in association with tooth pulp infection. Most of these lesions will resolve with adequate root canal treatment and rarely cause suspicion of more insidious disease. Most clinicians tend to skip histopathological examination in cases where the lesion is excised or curetted. We present a rare case of mucinous adenocarcinoma in association an endodontically treated maxillary discoloured central incisor in a 38 year old patient with a history of root canal treatment about 15 years ago. Root canal re-treatment and wide excision was performed. Histology showed epithelial islands suggestive of a neoplasm. Immunohistochemistry was positive for CK7 and S100. Metastasis was ruled out and no evidence of recurrence has been noted in the 12-month follow up period. It is emphasized that any tissue removed from the surgical site should be analysed microscopically. (EEJ-2022-01-013).

Objective: The aim of this study was to assess penetration of AH Plus, MTA Fillapex and GuttaFlow Bioseal sealers into dentinal tubules after placement and removal of silicone oil using Confocal Laser Scanning Microscopy.

Methods: Sixty single-canaled premolars were instrumented using ProTaper Universal rotary system. Roots were divided into two main groups (n=30) where either Silicone oil was used or not. Subsequently, each main group was subdivided into 3 subgroups according to the investigated sealers. In subgroups where Silicone oil was used, it was placed in canals and then cleared. Obturation was completed utilizing lateral compaction technique using Rhodamine B labeled sealers. Penetration depth of sealer was evaluated by image J software. One way ANOVA, Duncan's test as posthoc test was performed for evaluation of statistical significances among the groups. In each sealer group, Independent -t-test was used to compare between with and without oil. P value was set at <0.05.

Results: Using silicone oil resulted in less dentinal tubule penetration depth with all sealers. Mean dentinal tubule penetration depth was the lowest in apical thirds. AH Plus showed higher penetrability in all thirds compared to MTA Fillapex and GuttaFlow Bioseal despite oil placement and removal. MTA Fillapex displayed higher penetrability in all thirds than GuttaFlow Bioseal.

Conclusion: Remnants of silicone oil has a negative impact on the penetration depth of the tested sealers.

Objective: To compare, in vitro, the bioceramic materials (MTA and BC RRM-fast set putty) capacity to prevent microleakage of Enterococcus faecalis over time.

Methods: An experimental design was made with forty extracted human teeth, coronally cut, and prepared to be placed in a leakage system under sterile conditions. They were randomly divided into two experimental groups: thirty teeth (fifteen for each of retrograde filling material MTA and BC RRM-fast set putty) and a control group: ten teeth (five positive control, five negative control). The 3 mm root-ends were submerged in a brain-heart infusion broth with a red phenol indicator. The coronal access of each sample was inoculated with E. faecalis every seven days to maintain bacterial viability. The lower chamber was evaluated daily for 30 days to observe the turbidity of the culture medium and establish the presence and day of the filtration. Calculation of the colony-forming units (CFU) was performed for each leaked sample. Fisher's Exact Test was used to verify the association between the presence or absence of leakage of the samples by type of bioceramic material used and the Mann-Whitney U test to verify the existence of a difference between the average of CFU by type of bioceramic material used. The significance level used was α=0.05 and a 95% confidence level, as a decision rule for rejecting the null hypothesis.

Results: Of the total samples prepared for each group, leakage was found in 60.0% (9/15) of the MTA group and 40.0% (6/15) of the BC RRM-fast set putty group. All positive controls filtered on the first day of evaluation, while 20% (1/5) of the negative control leaked in the second week. There was no significant difference in leakege between the two groups, nor concerning the bacterial count (P=0.101) and the type of cement used (P=1.000).

Conclusion: BC RRM-fast set putty was comparable to MTA in resisting bacterial microleakage during the observation time.

Objective: This study evaluated the effectiveness of Platelet Rich Plasma (PRP), Platelet Rich Fibrin (PRF) and Mineral Trioxide Aggregate (MTA) as direct pulp capping materials in patients with carious pulp exposure using cone beam computed tomography.

Methods: This parallel, triple blinded, randomised trial was done on 30 permanent posterior teeth chosen as candidates for direct pulp capping based on stringent inclusion and exclusion criteria. The samples were allocated based on sequentially numbered opaque sealed envelope method into three groups: MTA, PRP and PRF for direct pulp capping. The treated teeth were restored with Glass Ionomer cement liner and light-cured resin composite. Patients were followed up for a period of 12 months. Statistical analyses were performed with statistical software SPSS version 25. Data were analysed for normality using Shapiro Wilk's test. Dentine bridge volume analysis across the groups were done using Kruskal Wallis test with the significance level at P=0.05. As the test revealed a significant difference, post hoc analysis was done with Dunn test.

Results: CBCT analysis revealed that the volume of dentine bridge formed by PRP and PRF was significantly higher than the volume of dentine bridge formed by MTA (P<0.001; CI: 90%). There was no significant difference in the efficacy between the three direct pulp capping agents based on clinical assessment. A total of 27 teeth (90%) showed positive response to pulp sensibility testing and evidence of dentine bridge formation in radiograph at 12 months. No adverse events were encountered.