Iranian Endodontic Journal最新文献

The present study aims to provide readers with the influence of various types of dental lasers in endodontics, along with their advantages and disadvantages. A complete query was carried out on PubMed, Google Scholar, Embase, and Scopus databases, and the studies published during 2015-2024 were collected using the keywords "Laser," "Endodontics," "Disinfection," "Vital Pulp therapy," and "Regenerative Endodontic Treatment." After applying appropriate inclusion and exclusion criteria, 86 relevant articles focused on the application of dental lasers in endodontics were selected and evaluated. Based on the evaluated studies, probably the most significant advancement of dental lasers is in optimizing the treatment outcome of root canal therapy via enhanced disinfection of root canals. Moreover, various research has shown that dental lasers can also aid in diagnosing vitality of pulp, vital pulp therapy, apiectomy, regenerative treatments, pain management treatment after root canal therapy, access cavity preparation, sterilization and irrigation of root canals, treatment of periapical lesions, removing excess materials and broken instruments in canals, and prompting the healing process after root canal therapy. As evidenced by the obtained results, diode and erbium lasers have the most applications in endodontics with the lowest side effects. Nonetheless, all dental lasers face multiple limitations, including producing noticeable thermal changes and smoke and damaging surrounding structures at the emission site, which question their safe usage in clinical practice. Therefore, dental lasers' newest advancements in dental procedures require further scientific work in the future.

Introduction: The high prevalence of diabetes mellitus and related consequences in all populations of the world makes their management an important challenge in endodontic practice. This study aimed to evaluate the knowledge, attitudes, and performance of Iranian endodontists regarding the management of diabetic patients.

Materials and methods: Questionnaires with 18 items were distributed to Iranian endodontists from different geographical provinces of Iran using social media. Responses to each question used a five-point Likert scale. Data for responses were analyzed using Chi-square or Fisher's exact tests.

Results: A total of 101 valid responses were returned for analysis (50 men and 51 women). None of the respondents had aggregated scores that were rated as unfavorable on 3 domains. Knowledge was rated as favorable for 81% and acceptable for the remaining 19%. Attitude was rated as favorable for 63%, and acceptable for 37%, while performance was rated as favorable for 98% and acceptable for the remaining 2%. Also, none of the 3 variables under evaluation were influenced by demographic factors or by work experience. The most common areas of uncertainty for respondents were monitoring blood for glucose or glycated hemoglobin concentration, and decisions regarding when to prescribe antibiotics.

Conclusions: Overall, this cohort of endodontists displayed a high level of knowledge of the major issues involved in diabetic patient care and were confident in providing clinical care. Future programs for continuing professional development for endodontists should consider current methods used for monitoring blood glucose and glycated hemoglobin, both as point-of-care or personal devices. In addition, further education is needed on antibiotic stewardship.

This case report highlights the innovative application of Biodentine as an intraorifice barrier in the management of cracked teeth with radicular extension associated with endo-periodontal lesions. A 37-year-old female patient reported pain during chewing on tooth #36. Significant periodontal attachment loss was noted around the mesial root. The tooth was diagnosed with pulp necrosis. Upon endodontic access, a vertical crack extending into the mesial canal walls was observed. Root canals were identified and shaped using rotary instruments. Calcium hydroxide was placed as an intracanal dressing. After one week, the patient returned without inflammatory signs. The root canals were filled with gutta-percha and bioceramic cement. Biodentine repair cement was applied 2.0 mm beyond the orifice to seal and reinforce the area. The endodontic access cavity was restored with composite resin. Clinical and radiographic follow-ups at 12 months revealed significant periapical healing and the absence of inflammatory signs. A radiographic and computed tomography scan at 48 months confirmed substantial bone repair and continued tooth functionality. The intraorifice barrier with Biodentine demonstrated notable effectiveness, aligning with literature on its benefits. The protocol, integrating modern techniques and timely restoration, shows promise in managing cracked teeth with root extension, enhancing tooth preservation in complex cases.

Bio-obturation is an innovative approach in root canal therapy that effectively addresses complex clinical challenges using bioactive endodontic materials. This report highlights 14 diverse cases where bio-obturation was employed to manage complications such as internal and external resorption, root perforations, draining sinus tracts, mechanical obstructions, and trauma-related injuries. The outcomes demonstrate notable healing and resolution of various tooth related pathologies in failed primary root canal treatments. Root perforations and canal blockages were successfully sealed, restoring the integrity of the root canal system and ensuring continued tooth function and retention. Bio-obturation facilitated stabilization and regeneration of periradicular and supporting tissues in trauma cases, including avulsed teeth and inflammatory root resorption. Cases involving open apices, dens invaginatus, and complex root canal anatomy also showed favorable results. Overall, bio-obturation offers a transformative alternative to conventional root canal filling by promoting enhanced biological sealing and improved periradicular healing, thus increasing the probability of sustainable long-term clinical success. While calcium-enriched mixture cement served as the bioactive material in these cases, this approach may also be effectively implemented using other advanced calcium silicate-based biomaterials, broadening its applicability in challenging endodontic scenarios.

Introduction: This systematic review compared the accuracy of guided endodontics with the conventional method in non-surgical endodontic retreatment.

Methods: Two reviewers conducted a systematic search across PubMed/MEDLINE, Scopus, Embase, and Web of Science databases. Inclusion criteria consisted of all in vitro studies up to October 2024 that documented the application of cone-beam computed tomography in creating a guide for endodontic retreatment cases. The reviewers assessed the quality of the selected studies using the QUIN tool. Data regarding the first author and publication year, sample size, tooth type, retreatment application, computer-aided navigation technique, groups, image acquisition method, outcome measures, guided technique results, conventional technique results, and the main results were extracted using a predefined template.

Results: Based on our criteria, seven studies were included in this review. The studies demonstrated variability in the techniques utilized. Iatrogenic errors were less frequent in guided groups, regardless of the operator's level of experience. Most studies indicated that guided endodontics was more effective than conventional methods, particularly in fiber post-removal and access through MTA, minimizing volumetric loss of tooth structure, and preserving fracture resistance. However, when using guided techniques for removal of separated instruments, more iatrogenic errors occurred, and more time was required compared to the freehand technique.

Conclusion: Guided endodontics has shown promise in improving the outcomes of non-surgical retreatment by reducing complications. However, as all included studies were in vitro, clinical evidence is lacking, and the generalization of these results should be done cautiously. Further well-designed clinical studies are required to confirm these findings.

Taurodontism is a dental anomaly characterized by the absence of cervical constriction at the cemento-enamel junction, apical shifting of the pulpal floor, and an expanded pulp chamber. This condition presents unique challenges in endodontic diagnosis and treatment due to its variable morphology, deeply located orifices, and complex root canal system. This paper reports three cases of hypertaurodontism (Taurodont Index ≈ 50), including a maxillary first molar, mandibular third molar, and mandibular second premolar in systemically healthy patients. The identification and treatment planning were facilitated by cone-beam computed tomography (CBCT). Root canal therapy was performed under a dental operating microscope, with careful exploration, chemomechanical instrumentation using rotary files, copious irrigation with 5.25% sodium hypochlorite, and warm vertical obturation. Twelve months later, follow-up visits showed that all patients were clinically and radiographically asymptomatic, indicating successful outcomes. Taurodontism presents significant challenges due to its anatomical complexities. A multifaceted approach involving CBCT, dental operating microscopes, ultrasonic irrigation, and warm vertical obturation is recommended. This case series demonstrates that with advanced diagnostic aids and meticulous techniques, even hypertaurodontic teeth can be effectively managed.

Inferior alveolar nerve (IAN) injury is a rare but serious complication of root canal treatment (RCT), typically caused by mechanical over-instrumentation, chemical irritation from extruded sealers, or thermal damage. We report the case of a 42-year-old woman who developed persistent burning pain, numbness, and dysesthesia of the right lower lip and gingiva after RCT of the right mandibular second molar. Initial management by a general dentist involved retreatment and calcium hydroxide medicament; however, early CBCT was misinterpreted, and referral was delayed. High-quality CBCT and clinical testing later revealed obturation material within the IAN canal and a horizontal fracture of the distal root. Endodontic retreatment, followed by maxillofacial microsurgery for removal of extruded gutta-percha/sealer, combined with neuroprotective therapy (dexamethasone, vitamin B, and adjunctive low-level laser therapy). The patient achieved complete resolution of pain and sensory disturbances within one month, and remained asymptomatic with radiographic periapical healing at 12-month follow-up. Comprehensive preoperative imaging, cautious canal instrumentation, independent CBCT interpretation by the endodontist, and timely specialist referral are essential to minimize the risk of IAN injury. Even with delayed intervention, targeted microsurgical removal of extruded material can result in favorable neurological recovery.

Introduction: Endodontic cements are essential materials for achieving successful root canal treatment. Therefore, they must present adequate physicochemical properties to ensure optimal clinical performance. This study aimed to evaluate radiopacity, pH, and calcium ion release of calcium silicate- and epoxy resin-based cements/sealers.

Materials and methods: Four materials were evaluated: Vioseal, AH-Plus, AH-Plus Bioceramic Sealer, and MTA Angelus. Ten cylindrical specimens (10 mm diameter, 1 mm height) per group were prepared for each tested property, totaling 80 samples. The same specimens were used for pH and calcium ion release, while separate specimens were used for radiopacity. All samples were stored at 37^°C and 95% humidity. Radiopacity was assessed by digital radiography using an aluminum step wedge (1-10 mm). pH was measured at 1, 7, and 14 days using a calibrated digital pH meter. Calcium ion release was determined using atomic absorption spectrophotometry. Data were analyzed using Kruskal-Wallis and Dwass-Steel-Critchlow-Fligner post hoc tests (P<0.05).

Results: Vioseal and AH-Plus showed the highest radiopacity values (9.98±0.42 mm Al and 10.00±0.38 mm Al, respectively), while AH-Plus Bioceramic Sealer (9.04±0.28 mm Al) and MTA Angelus (4.72±0.40 mm Al) showed lower values. Regarding pH, AH-Plus Bioceramic presented the highest and most sustained alkaline value (up to 12.5), and AH-Plus the lowest (6.25±0.26). In calcium ion release, Vioseal showed the highest release on day 7 (29.4±3.12 ppm), while AH-Plus Bioceramic Sealer also peaked on day 7 (18.60±5.54 ppm); MTA Angelus presented its highest release on day 1 (11.80±1.00 ppm).

Conclusion: All evaluated cements/sealers met the ISO 6876 standard for radiopacity. Calcium silicate-based cements showed an alkaline pH and sustained calcium ion release, whereas Vioseal presented an initially high and transient release.

Dens invaginatus is a developmental anomaly resulting from the infolding of enamel and dentin into the dental pulp. Oehlers' Type IIIa dens invaginatus poses significant challenges due to its intricate anatomy and frequent association with immature teeth. This case report outlines the nonsurgical management of a nonvital immature maxillary central incisor with Type IIIa dens invaginatus, presenting with a chronic apical abscess and a history of trauma to the associated primary incisor. Treatment involved thorough chemomechanical debridement followed by bio-obturation using calcium-enriched mixture cement. Regular follow-ups revealed complete resolution of the periapical lesion. This case underscores the importance of precise diagnosis, individualized treatment planning, and the application of advanced biomaterials in addressing complex presentations of dens invaginatus. The successful outcome emphasizes the efficacy of nonsurgical techniques in preserving immature teeth while restoring function and aesthetics.