Iranian Endodontic Journal最新文献

Introduction: Achieving a three-dimensional seal in the apical, lateral, and coronal regions of the root canal is a key objective in endodontic treatment. This study aimed to compare the apical sealing ability of NeoSealer Flo, MTA-Fillapex, and AH-26 over different time intervals using the fluid filtration method.

Materials and methods: In this in vitro study, 58 single-rooted premolars (n=18 per group; 2 positive and 2 negative controls) were selected and prepared using the ProTaper system up to file F3. Canals were obturated with the single-cone technique using one of the three tested sealers. Apical microleakage was measured at 24 hours, 1 week, and 4 weeks using the fluid filtration method. Data were analyzed using one-way ANOVA, repeated measures ANOVA, ANCOVA, and Tukey's HSD post hoc test (P<0.05).

Results: The results indicated that sealer type, time, and their interaction had a statistically significant effect on apical microleakage (P<0.001). NeoSealer Flo showed the lowest and AH-26 the highest leakage values across all time intervals. In all three groups, microleakage decreased over time. This reduction was statistically significant from 24 hours to 1 week in the NeoSealer Flo and MTA-Fillapex groups (P<0.001), and from 1 week to 4 weeks in the AH-26 group (P<0.05).

Conclusion: Within the limitations of this study, NeoSealer Flo demonstrated superior apical sealing ability at all time points. Under single-cone obturation conditions, bioceramic sealers such as NeoSealer Flo may provide more predictable long-term apical sealing compared to resin-based alternatives.

Magnesium phosphate cements (MPCs) have recently gained attention as potential materials for endodontic applications due to their rapid setting, favourable mechanical properties, and bioactive potential. Laboratory and preclinical studies indicate that MPCs can form apatite-like structures, exhibit good compressive strength, and support cell viability, suggesting promising biological interactions. However, several limitations remain unresolved. The acid-base setting reaction of MPCs is strongly exothermic, which may pose a risk to pulp or periapical tissues, and ammonium-containing formulations can release cytotoxic ammonia, although partial mitigation is possible through sodium phosphate substitution. Rapid setting enhances handling in controlled conditions but may complicate placement in complex root canal anatomies. While in vitro studies suggest comparable or superior sealing ability relative to conventional calcium silicate cements, human clinical evidence is minimal or absent. Degradation and resorption profiles of MPCs may further affect their suitability as scaffolds in regenerative endodontics. Overall, MPCs represent promising investigational materials, yet claims regarding clinical readiness are premature. Careful evaluation of their physicochemical behaviour, biological safety, and practical handling is essential before consideration for routine clinical use.

Introduction: Bioceramic materials are integral to regenerative endodontics, yet comparative data on their osteogenic potential remain limited. This study compared the osteogenic potential of four bioceramics: hydroxyapatite (HA), a nano-hydroxyapatite/chitosan composite (n-HA/CSS), Angelus mineral trioxide aggregate (MTA), and calcium-enriched mixture (CEM) cement.

Materials and methods: Human osteoblast-like Saos-2 cells were exposed to materials via direct contact and extract models. Cell viability and proliferation were assessed using the MTT assay, attachment and morphology were examined by scanning electron microscopy (SEM), and osteogenic differentiation was evaluated by real-time PCR for alkaline phosphatase (ALP), bone sialoprotein (BSP), and osteocalcin (OC) at 3 and 6 days.

Results: All materials were non-cytotoxic. In direct culture, CEM significantly enhanced cell proliferation by day 3 (~3-fold, P<0.001). SEM revealed superior cell attachment and extracellular matrix secretion on n-HA/CS and CEM surfaces. Gene expression analysis demonstrated that CEM robustly upregulated ALP (~12-fold vs. control, P<0.001), a level 6-fold higher than MTA (P<0.05). Furthermore, both CEM and n-HA/CS promoted pronounced expression of the late markers BSP (~5-fold, P<0.001) and OC (10-fold and 12-fold, P<0.001 and P<0.001, respectively). MTA consistently elicited the lowest osteogenic response.

Conclusions: CEM and the n-HA/CS were identified as the strongest promoters of osteoblast proliferation and differentiation, indicating their superior bioactivity over MTA and HA and their potential for endodontic and surgical hard tissue regeneration.

Tooth avulsion represents a severe dental injury, and prognosis depends on extraoral time and storage. Its major complications include ankylosis and external inflammatory root resorption. We report a 14-year-old female who presented with pain in her upper incisors one year after avulsion of teeth 11 and 21, replanted after 60 minutes in dry cloth and splinted for four months without follow-up. Clinical and radiographic examinations were consistent with severe external inflammatory root resorption in the teeth #11, 12, 21, and 22. Given her age and unsuitability for implants, staged endodontic therapy was performed over four months. Canals were prepared under rubber dam isolation, irrigated with 17% EDTA and 5.25% sodium hypochlorite with ultrasonic activation, and dressed with non-setting calcium hydroxide. Dressing was refreshed at sequential visits until resorption stabilized. Final obturation used calcium-enriched mixture (CEM) cement at perforations and gutta-percha in remaining canal spaces, and AH-26 sealer was used as sealant. Our treatment arrested resorption and preserved function, though the long-term risk of ankylosis remains high. This case report underscores the need for immediate replantation, physiologic storage media, and timely endodontic intervention to mitigate complications. Close monitoring remains vital for maintaining aesthetics and function in growing patients.

Maxillary central incisors typically exhibit a single root and canal. The presence of two roots with separate canals, as defined by Vertucci's type V morphology, is extremely rare and presents diagnostic and technical challenges for nonsurgical endodontic treatment. This report describes the endodontic management of a maxillary right central incisor (tooth #11) exhibiting a sinus tract, negative responses to pulp sensibility tests, and radiographic evidence of apical periodontitis in a 24-year-old female patient. Cone-beam computed tomography (CBCT) revealed a two-rooted anatomy with independent canals splitting at the middle third. Under magnification, access was refined using ultrasonic tips. The palatal root canal was prepared with NiTi CM rotary files, while the wider buccal canal was instrumented with stainless steel K-files. Both canals were disinfected using passive ultrasonic irrigation with 2.5% sodium hypochlorite and 17% EDTA, followed by intracanal calcium hydroxide medication. Obturation was completed using the single-cone technique with a bioceramic sealer. Radiographic follow-up at 14 and 57 months confirmed complete periapical healing and absence of symptoms, demonstrating long-term clinical success. Atypical root canal anatomy in maxillary incisors necessitates advanced imaging/magnification. The use of CBCT, NiTi CM files, and bioceramic sealers enabled accurate diagnosis, conservative canal shaping, and a successful long-term outcome in this rare morphology case.

Taurodontism is a dental anomaly characterized by an enlarged pulp chamber and apically displaced pulpal floor. This disorder poses significant challenges in endodontic treatment, especially when perforations occur. The present case study details the endodontic retreatment of a hypertaurodont maxillary second molar in a 36-year-old female patient with a mesial canal perforation. The procedure employed a dental operating microscope for enhanced visualization and precision. Canals were prepared using a crown-down technique, with the perforation site managed using MTA and bioceramic material applied via the second mesiobuccal canal. The remaining canals were obturated using gutta-percha and bioceramic sealer. At the 1-year follow-up, the tooth was functional and asymptomatic, with radiographic evidence of a normal periodontal ligament space. This case demonstrates the efficacy of contemporary endodontic techniques, including bioceramic materials and advanced magnification, in managing the unique challenges posed by taurodontism.

Vital pulp therapy (VPT) comprises a range of conservative treatment modalities aimed at preserving the vitality of the compromised dental pulp in primary and permanent teeth. This PubMed-based review comprehensively evaluates seven distinct VPT techniques; including their historical development, broad definitions, clinical protocols and treatment outcomes as evidenced by systematic reviews and meta-analyses. The VPT modalities covered in this review include stepwise excavation, indirect pulp capping, direct pulp capping, miniature pulpotomy, partial pulpotomy, full pulpotomy and partial pulpectomy. Stepwise excavation, as a minimally-invasive option, has demonstrated effectiveness in reducing the risk of pulp exposure, particularly in permanent teeth. Clinical outcomes of indirect and direct pulp capping are promising; specifically with the application of advanced calcium silicate cements. Miniature and partial pulpotomies emphasize the importance of precise definitions and standardised protocols due to their subtle differences. Full pulpotomy has emerged as a viable alternative to root canal treatment, achieving comparable success rates in managing irreversible pulpitis. While partial pulpectomy remains the most invasive approach, it has shown potential in managing complex cases, such as root resorption, through selective tissue preservation. Despite advancements in biomaterials and technique standardisation, challenges remain, including variability in clinical protocols, limited high-quality evidence, and the need for long-term studies to better evaluate anticipated outcomes. Nevertheless, emerging biotechnologies hold promise for enhancing the precision and predictability of VPT procedures in the future.

A thorough understanding of root canal morphology is critical for achieving predictable outcomes in endodontic therapy. Anatomical variations in mandibular second premolars are uncommon compared to other teeth, and the coexistence of a C-shaped root canal configuration with four independent canals and four separate apical foramina is exceptionally rare. This case report describes the nonsurgical endodontic management of a mandibular second premolar exhibiting this unique morphology, confirmed through cone-beam computed tomography (CBCT) and magnification. A 52-year-old male was referred by a prosthodontist for elective root canal treatment before post placement. CBCT imaging revealed a C-shaped root in the coronal third that bifurcated into four separate canals at the midroot level, each terminating in an independent apical foramen. Nonsurgical treatment was performed over two visits, using meticulous chemo-mechanical preparation, intracanal calcium hydroxide dressing, and warm vertical compaction obturation. At the 9-month follow-up, the tooth was functional, asymptomatic, and radiographically stable. This case underscores the importance of preoperative assessment with advanced imaging and magnification in identifying and successfully treating rare endodontic anatomies.

The American Association of Endodontics classifies the management of pulp canal obliteration (PCO) cases as a high-risk difficulty. This classification indicates an increased likelihood of procedural errors. However, advancements in dental technology have simplified the endodontic treatment of calcified teeth. Guided endodontics uses cone-beam computed tomography (CBCT) and a three-dimensional (3D) printer to create a patient-specific guide, enhancing accuracy and predictability in complex cases. A healthy 60-year-old male was referred by a prosthodontist for root canal treatment on teeth #23, #24, and #25. Periapical radiographic examination revealed partial PCO in all teeth. After choosing guided endodontics treatment, CBCT imaging and intraoral 3D scanning were utilized to design a patient-specific endodontic guide. After verifying the stability of the endo-guide, access cavities were prepared using a Munce Discovery bur. Following the negotiation of the canals, the working length was determined. Root canal treatment was performed using rotary files up to size 25/0.04% and sodium hypochlorite irrigation. The obturation was completed using the warm condensation technique. Although PCO was present, no complications occurred during treatment. The teeth remained completely asymptomatic and functional, demonstrating the success of the treatment. Guided endodontics can be a practical and predictable approach for managing PCO in mandibular incisors. This technique provides accurate canal location, reduces procedural errors, and preserves tooth structure. Despite concerns about cost, radiation exposure, and challenges with anatomical variations, it represents a promising advancement in endodontic treatment.