Iranian Endodontic Journal最新文献

Pulp canal obliteration (PCO) in calcified teeth presents a challenge for endodontic treatment, especially when accompanied by discoloration. Guided endodontic access (GEA) has emerged as an advanced method for root canal therapy (RCT) in such cases. This case report describes the successful treatment of a calcified maxillary central incisor with discoloration using GEA. A 32-year-old female with a history of dental trauma presented with discoloration in the left maxillary central incisor that did not respond to external bleaching. Clinical examination revealed a pulpless infected canal with asymptomatic apical periodontitis. Cone-beam computed tomography (CBCT) and intraoral scanning were utilized to create a three dimensional (3D) template, enabling minimally invasive access preparation through the palatal aspect. The RCT was performed in a single visit, followed by tooth whitening using hydrogen peroxide. At 18 months follow-up, the tooth was asymptomatic, and the apical lesion was healed. GEA offers a predictable and conservative approach, preserving tooth structure and providing enhanced long-term prognosis for teeth with calcified canals and discoloration.

Introduction: The presented study aimed to characterise periapical disease in teeth with primary non-surgical root canal treatment in persistent or emergent categories and their risk association.

Methods: A retrospective observational study that evaluated permanent teeth with primary non-surgical root canal treatment, was conducted clinically and radiographically for over one year. The following variables were analysed: gender, age, type and location of tooth, previous diagnosis, treatment conditions, and type of coronal restoration. The supplementary variables included the perspectives of the treatment outcome, such as Remains normal, Improvement, and Failure. Statistical analysis was performed using a univariate analysis that estimated the average and proportion for each factor according to the result of the primary non-surgical root canal treatment. The multiple correspondence analysis identified the hierarchy between active variables and their association with the results.

Results: A total of 232 teeth in 155 participants were analysed. A χ2 value, (P=0.023) showed that the emergent disease is associated with patients around the age of 50. The multiple correspondence analysis identified a tendency of grouping between the emergent disease and the short filling category, followed by symptomatic pulpitis as a previous diagnosis. The persistent disease was associated with errors and overfillings. An inadequate root filling and taper density adversely impacted the treatment outcome.

Conclusions: The length of obturation influenced the presence of failure. Short fillings were associated with emerging periapical disease. Errors and overfillings contributed to the persistent disease in the populations studied.

The anatomy of the root canal system always affects endodontic treatment outcomes. Mandibular premolar teeth demonstrate extreme variations in root canal morphology. Mandibular first premolars typically exhibit basic single-root and single-canal anatomy. The occurrence of three roots in the mandibular first premolar has not been commonly reported in the literature. This article reported a case of a 26-year-old male with spontaneous pain of the mandibular first premolar representing the presence of an extra canal on the periapical radiograph. Cone-beam computed tomography (CBCT) was used to assess the root canal details which led to the finding of three canals. Further, a periapical bone defect was detected, and finally, the nonsurgical endodontic management of the mandibular first premolar with three canals and three different apical foramina was performed in one session.

Endodontic therapy of dens invaginatus (DI) anomalies is challenging due to difficult access, inadequate cleaning and shaping, and incomplete disinfection of its complicated root canal system. The present case report describes the treatment of tooth #10 with tooth discomfort, intermittent pus discharge, and localized swelling. Sinus tract, mobility, and probing grade 1 were observed. The tooth was tender on palpation and percussion with negative responses to pulp sensibility tests. Radiographic assessments revealed an atypical structure of pulpal anatomy, probably dens invaginatus, associated with a large periapical lesion and severe root curvature. Cone-beam computed tomography confirmed the presence of DI type II. Finally, the diagnosis of pulp necrosis with chronic apical abscess of tooth #10 was made. Combining antimicrobial photodynamic therapy as an adjunctive treatment with different irrigation techniques were effective in nonsurgical endodontic management of the complicated DI type II in a maxillary lateral incisor with a large periradicular lesion and severe root curvature. Six-month and one-year recall radiographic images revealed asymptomatic tooth and progressive osseous healing.

Introduction: Disinfection of the root canal system is crucial for a successful endodontic treatment. Several factors influence the performance of effective irrigation. Diverse irrigating substances have been used but none has proved to completely penetrate the root canal system. HybenX dries biofilm due to its hygroscopic properties; therefore, it is effective in the treatment of biofilm-related diseases. This investigation aimed to estimate HybenX's degree of penetration into the dentinal tubules of upper first premolars.

Materials and methods: Experimental in vitro intervention where 30 extracted maxillary premolars were evaluated to determine HybenX's degree of penetration and 5% sodium hypochlorite in the dentinal tubules using three different irrigation techniques (passive ultrasonic irrigation, dynamic manual irrigation and conventional single jet irrigation technique). After preparation, the root canals were irrigated with fluorescent rhodamine 6G; then 500-micrometer sections were made to be analyzed under a fluorescence microscope. Measurements were made in micrometer in ZEN software to determine the penetration degree of each substance in the different root thirds.

Results: In the apical third, significant differences between the 3 irrigation techniques were found (P<0.05), similarly, for the middle and cervical thirds. Significant statistical differences between the HybenX and sodium hypochlorite were found at the cervical and middle levels when using the conventional Monoject irrigation and passive ultrasonic irrigation techniques. As for the apical level, differences were found between the passive ultrasonic irrigation techniques and the dynamic manual irrigation technique.

Conclusions: Based on this in vitro study, HybenX proved to highly penetrate into the dentinal tubules, especially when using the passive ultrasonic irrigation technique. HybenX may be a useful option for root canal irrigation in endodontics.

Bioceramic cements used for filling root canals in cases of endo-perio lesion of endodontic origin seem to be promising due to having the potential of promoting faster and more predictable healing of the periapical lesion as they stimulate osteogenesis. An effective treatment plan depends on the precise diagnosis of endo-perio lesions. The origin of an infection, being exclusive to the root canal, from the periodontium, or both, is extremely important for devising the treatment plan. In both cases, no clinical evidence of periodontal disease (bleeding, calculus, etc.) was found; however, primary endodontic lesions with the possibility of drainage through the gingival crevice were present. In addition to the disinfection strategies used during the root canal treatments, the bioceramics Bio C Sealer, Bio C Repair and Bio Root RCS were used to fill in the root canals. Both cases presented an impressive bone gain within 8 months for case 1 and 5 months for case 2. Regarding case 1, in the palatal root canal an apical plug with a bioceramic repair cement was used. Based on the literature studied, it can be concluded that after adequate disinfection of the root canals, using bioceramic cements in filling the root canals shows the potential of supporting capabilities in remineralization of osteolytic lesions in endo-perio diseases.

Introduction: The study aimed to investigate the influence of various factors on the localization of the second mesiobuccal (MB2) canal in maxillary molars, a commonly missed canal during endodontic treatment.

Materials and methods: A comprehensive assessment of maxillary molars treated over three years with a dental operative microscope was conducted. Factors such as patient gender, age, tooth type, pulp status, pre-operative cone-beam computed tomography (CBCT), and treatment modality were examined. Statistical analyses included chi-square and multiple logistic regression.

Results: Among 333 treated maxillary molars, the MB2 canal was identified in 60.1%. The prevalence of MB2 canals was significantly higher in the first molars (72.3%) compared to the second molars (40.2%; P=0.001). Multiple logistic regression models showed that gender, tooth type, and treatment modality emerged as significant determinants of MB2 canal localization: males [odds ratio 3.01(CI 95%:1.71-5.32), P<0.001], first molar tooth [odds ratio 4.26 (CI 95%:2.53-7.18), P<0.001] and secondary endodontic treatment [odds ratio 0.06 (CI 95%: 0.004-0.890), P<0.04].

Conclusions: Patient gender, tooth type, and treatment modality play pivotal roles in the identification of the MB2 canal. Additionally, the availability of pre-operative CBCT imaging was associated with a heightened ability to locate the MB2 canal.

The current case study evaluated the effect of vital pulp therapy on a human dental pulp after a long-term period using micro-computed tomography (MCT) for the first time. In the presented report, the successful outcomes of full pulpotomy using calcium-enriched mixture (CEM) cement on an irreversible pulpitis case were documented clinically/radiographically over 5 years. Due to an unrestorable crown fracture at the 5-year recall, the tooth was extracted and evaluated by MCT; the images showed that CEM pulpotomy allowed the dental pulp to create complete dentinal bridges without pulp canal obliteration (PCO). These MCT results showed that CEM pulpotomy, as a bio-regenerative treatment, caused no negative consequence of PCO or calcific metamorphosis on dental pulp over the long term.

Introduction: This ex vivo study aimed to compare the adaptation of single gutta-percha cone in teeth prepared with the Wave One Gold and Reciproc Blue reciprocating systems through cone-beam computed tomography.

Materials and methods: A total of 40 recently extracted mono radicular premolars were randomly assigned into two groups (n=20) corresponding to Reciproc Blue and Wave One Gold reciprocating systems and adapted to a single cone system. Each group was evaluated by cone-beam computed tomography at 1 mm, 2 mm and 4 mm from the apical foramen. We evaluated the number of walls adapted by the cone, quality of filling and the number of spaces between the filling and the walls of the root canal. The Mann-Whitney U and T-tests were employed to associate and compare both groups (P<0.05).

Results: At 1 mm in the lingual wall the Wave One Gold system did not adapt by 45% compared to 15% with Reciproc Blue (P<0.05). Likewise, the single-cone filling technique of the Reciproc Blue system showed better sealing quality obtaining an ideal category (75%) compared to Wave One Gold (40%) (P<0.05). The amount of space (mm) found between the cone and the filling walls was greater with Wave One Gold. However, these values were not statistically significant.

Conclusions: Based on this ex vivo study the better adaptation of root canals and ideal filling condition was more frequent with Reciproc Blue than Wave One Gold system, mainly at 1 mm from the radicular apex.

Introduction: The goal of this paper was to determine the impact of calcium hydroxide (CH) and nano-calcium hydroxide (NCH) on the push-out bond strength of an epoxy resin-based sealer.

Materials and methods: A total of 48 mandibular premolars were decoronated in vitro and instrumented by a ProTaper rotary system up to F4. The specimens then were randomly allocated into 3 groups (n=16). The two intervention groups were treated with either CH or NCH and one control group which did not receive any intracanal medicament. After one week of medicament placement, the specimens were irrigated by 10 mL 17% EDTA, followed by 10 mL 2.5% NaOCl and an ultimate flushing by 5 mL sterile saline. The samples were obturated using AH-Plus Jet sealer and gutta-percha by lateral condensation technique. Push-out test was done by a universal test machine to evaluate the bond strength among the sealer and the root canal dentin. Repeated measurement analysis followed by Tukey's HSD and Bonferroni post-hoc tests were used for data analysis.

Results: The control group showed a higher push-out bond strength in comparison to the specimens in the CH and NCH groups (P<0.05). In spite of the greater push-out bond strength of the samples treated with NCH in comparison to those in CH group, no statistically notable difference was found among them (P>0.05). Additionally, irrespective of the kind of medicament, the bonding at the apical level of the root canal was stronger compared to the coronal third (P<0.001).

Conclusion: According to the present in vitro study, application of CH and NCH resulted in a significant reduction of the bond strength between the epoxy resin-based sealer and dentinal walls. Although, application of these medicaments resulted in reduction of bonding of epoxy resin-based sealers root canal dentin significantly.