Iranian Endodontic Journal最新文献

This case report presents the innovative application of ultrasonic points combined with a graphite-marked endodontic guide in a case of restricted vertical space. A 71-year-old female patient with root canal obliteration in the second left mandibular molar was referred for treatment. The patient was experiencing spontaneous pain. Using data from cone-beam computed tomography and surface scans, a virtual 3D guide was developed and positioned. As the patient presented limited interocclusal space, black graphite was inserted through the drill path to mark the pathway. The guide was withdrawn, shorter ultrasonic points were inserted 2 mm into the marked dentin, and this process was repeated until the root canals were localized. The root canals were subsequently shaped and filled. The guide drill path effectively served as a reference for ultrasonic points, enabling successful localization of the root canals. Graphite-marked guide path facilitated access to obliterated root canals in the presence of limited interocclusal space.

Restoring endodontically treated teeth (ETT) that exhibit cracks, enlarged roots, or weakened root walls is a frequent challenge in dental practice. The present study describes three cases in which contemporary restorative techniques were employed and suggests that applying Ribbond tape (RT) to ETT can improve fracture resistance and better prevent the propagation of cracks compared with traditional methods. Although extensive in vitro research has been conducted on fiber-reinforced composites, studies evaluating the clinical use and durability of fiber-reinforced composites to restore ETT are limited. This report strictly adhered to the case report (CARE) guidelines, and the treatments were initiated only after signed informed consents were obtained from the patients. Therefore, the old restorations were removed from the teeth that required intervention and composite resin core build-up was created, followed by endodontic treatments or retreatment. Subsequently, the endodontic accesses were reinforced with RT. The protective restorations were performed and bonded. The two-year follow-ups showed that the patients had complete remission of signs and symptoms, and they remain under monitoring. The study emphasizes the importance of internal reinforcement of ETT and strengthening weakened walls with a resin core build-up reinforced with fibers like RT. This approach enhances mechanical retention, inhibit fracture propagation, and establish a strong chemical bond between RT and resin. It is suggested to be a promising strategy for increasing the longevity and strength of the teeth, providing a conservative and effective alternative to traditional methods.

Internal root resorption (IRR) is an uncommon but clinically significant condition traditionally managed with complete pulpectomy and root canal therapy. Advances in vital pulp therapy and bioactive calcium silicate-based cements have enabled conservative strategies aimed at preserving residual pulp vitality. A 33-year-old woman presented with an asymptomatic, unperforated IRR in the maxillary left lateral incisor, confirmed by periapical radiography and cone-beam computed tomography. The tooth responded positively to sensibility testing and showed healthy periapical tissues. A partial pulpectomy was performed: diseased coronal and mid-root pulp was removed, while approximately 5 mm of vital apical pulp was preserved. The resorptive cavity and root canal were bio-obturated with calcium-enriched mixture cement, which also served as a capping biomaterial for the apical pulp stump. Postoperative imaging confirmed complete filling/sealing of the resorptive defect and root canal while maintaining the apical pulp segment. At 2-year follow-up, the tooth remained functional, symptom-free, and radiographically stable, with intact lamina dura and no evidence of progressive resorption. This case demonstrates that partial pulpectomy combined with bio-obturation using an endodontic biomaterial may successfully arrest IRR and preserve apical pulp vitality in carefully selected cases. While the outcome supports the biological feasibility of this approach, further studies with larger samples and longer follow-up are required before it can be considered a routine alternative to conventional treatment.

This case report describes the successful guided endodontic treatment of a maxillary left canine (#23) with pulp canal obliteration (PCO) in a 30-year-old female patient. The patient had a history of orthodontic treatment and Le Fort I orthognathic surgery, both recognized as potential factors contributing to canal calcification. The patient had a history of a failed root canal treatment, contributing to incomplete canal instrumentation and iatrogenic damage (gouging) during access cavity preparation. The case was referred for completion of treatment. Upon referral, clinical and radiographic examinations revealed advanced canal obliteration, procedural gouging from the prior attempt, and a radiolucent line suggestive of a horizontal root fracture. Cone-beam computed tomography (CBCT) confirmed the extent of canal calcification, ruled out the suspected fracture, and showed a localized palatal external root resorption, likely related to previous orthodontic forces. Given the complexity of the case, a static-guided endodontic technique was selected as the preferred treatment approach. A custom 3D-printed guide, generated from merged CBCT and intraoral scan data, enabled conservative and accurate access to the calcified canal. Although a hand K-file fractured during canal negotiation, the fragment was successfully retrieved using ultrasonic devices under magnification. The tooth was treated successfully. Clinical and radiographic follow-ups at six and twelve months confirmed resolution of the periapical lesion and complete symptom relief, demonstrating that guided endodontics can serve as a safe and effective treatment option in teeth with PCO.

This case report describes the successful nonsurgical endodontic management of a mandibular second molar with a confirmed C-shaped canal configuration complicated by chronic apical periodontitis and active external inflammatory root resorption in a 16-year-old female patient. The patient presented with pain on biting, deep localized periodontal probing, and radiographic evidence of a large periapical radiolucency and resorptive changes in the distal root. Diagnostic tests confirmed pulpal necrosis and an endodontic-periodontal communication. Following access under magnification, the complex C-shaped canal system was negotiated and disinfected using 5.25% sodium hypochlorite, activated irrigation, and calcium hydroxide dressing. Because of apical resorption and an open apex, a 4-5 mm mineral trioxide aggregate apical plug was placed, followed by warm vertical obturation of the remaining canal system. The tooth was restored and monitored clinically/radiographically. At the 8-month follow-up, the patient was asymptomatic, probing depths had normalized, and radiographs demonstrated complete resolution of the periapical lesion with arrest of external root resorption. This case highlights that conservative endodontic therapy, supported by modern materials and careful disinfection, can achieve predictable healing even in teeth with complex morphology and resorptive defects. Early diagnosis and meticulous management are essential for a favorable outcome.

Permanent maxillary second molars' root canal treatment due to their root configurations complexity and high root canal systems variations, are one of the most problematic teeth. Accordingly, clinicians should consider unusual canal morphology to reduce the rate of missed canals. A thirty-year-old female was referred for root canal treatment of her maxillary right second molar tooth with obvious recurrent caries under restoration and necrotic pulp. Pre-operative radiographs showed the unusual morphology and cone-beam computed tomography was ordered for precise evaluation of the root canal anatomy. The principal aim of this paper is to report a five-root canals maxillary second molar, with two palatal root canals and a palatal root-like enamel pearl canal.

Introduction: Tooth discoloration remains a significant concern in endodontic treatment, particularly with the use of intracanal medicaments. This study investigated the discoloration potential of niosomal doxycycline and triamcinolone, a novel nanotechnology-based drug delivery system, in comparison to conventional medications.

Materials and methods: Fifty extracted single-rooted human teeth were assigned to five groups: (1) calcium hydroxide, (2) calcium hydroxide+triamcinolone, (3) niosomal doxycycline+triamcinolone, (4) doxycycline+triamcinolone, and control groups (positive: blood; negative: saline). All samples were prepared using standardized endodontic procedures, filled with medicaments, and incubated for one month. Discoloration values (∆E) were measured at baseline, 1 week, and 1 month using the CIE Lab system and a spectrophotometer. A ∆E>3.3 was considered clinically unacceptable.

Results: All groups exhibited discoloration values within clinically acceptable limits (∆E<3.3). At one month, significant differences were observed among groups (ANOVA, P<0.05). The niosomal doxycycline+triamcinolone group showed the lowest ∆E values, similar to the calcium hydroxide group, while the doxycycline+triamcinolone and calcium hydroxide+triamcinolone groups exhibited higher discoloration values.

Conclusion: Emphasize that at 4 weeks, all medicaments induced clinically acceptable ∆E, with niosomal performing similarly to calcium hydroxide alone and significantly better than the conventional doxycycline+triamcinolone combination.

Introduction: Geristore® (GS) is an advanced dual-cure resin-modified glass ionomer with favourable biological and physical properties, including biocompatibility, fluoride release, and excellent sealing ability. Originally developed for restorative purposes, its clinical versatility has nonetheless extended into endodontics. The current critical review primarily aims to evaluate the biological characteristics, endodontic applications, and possible clinical potential of GS as a biomaterial in modern endodontic practice.

Methods: A comprehensive literature search was conducted across major databases (MEDLINE, PubMed, Scopus, Cochrane, EMBASE, Google Scholar, and grey literature) without restrictions on date and/or language. Relevant peer-reviewed studies on the composition, properties, and endodontic uses of GS were identified, screened, investigated, and critically analysed.

Results: Geristore® has demonstrated promising outcomes in endodontic procedures, e.g., root-end filling, perforation repair, vital pulp therapy, retrograde vital pulp therapy, intra-orifice barrier placement and the management of external cervical resorption, Additionally, various studies have highlighted its favourable soft tissue compatibility, sealing ability (even in moist environments) as well as its acceptable mechanical properties. However, certain limitations, including reduced flexural strength and higher cytotoxicity compared to calcium silicate-based materials, such as mineral trioxide aggregate, have been reported.

Conclusion: Geristore® presents as a clinically useful alternative for specific endodontic indications where biocompatibility, sealability, and ease of handling seem critical. However, further high-quality clinical trials and comparative studies are essential to validate its long-term performance and establish its role relative to established endodontic biomaterials.

Introduction: Calcium-enriched mixture (CEM) cement is a water-based biomaterial with properties similar to calcium silicate-based cements (CSCs). Zinc oxide (ZnO), a bioactive material widely used for its antimicrobial properties and beneficial biological effects on body tissues, was incorporated into CEM cement in this study. The objective was to evaluate the impact of ZnO nanoparticles (ZON) on the physical, chemical, and mechanical properties of CEM cement.

Materials and methods: ZON powder was blended with CEM cement powder at a 10% weight ratio. The mixture was combined with liquid (1 g powder: 0.33 mL liquid) and cast into test-specific molds. Samples of original CEM cement without ZON served as the control group. The samples were evaluated for changes in setting time (n=6), compressive strength (n=6), solubility (n=10), and pH (n=10).

Results: The initial setting time was identical in both groups. ZON incorporation reduced the secondary setting time, though not significantly. Compressive strength remained unchanged. After 7 days, solubility increased significantly in ZON-containing samples. While ZON reduced the pH of CEM cement in deionized water after 5 hours, no significant difference was observed at 24 hours.

Conclusion: Incorporating ZON into CEM cement caused minor changes, including a reduced secondary setting time, increased solubility, and transient pH changes, without significantly affecting overall performance.

Strip perforation is a severe procedural complication during root canal therapy, often associated with poor prognosis, especially when combined with overextended gutta-percha. While surgical or nonsurgical retreatment is commonly indicated, patient-centered decision-making and long-term follow-up may influence the management strategy. This case report describes the conservative follow-up and eventual successful treatment of a mandibular second molar with an extensive midroot strip perforation and extruded gutta-percha, ultimately managed with intentional replantation and root-end filling using calcium-enriched mixture (CEM) cement. In 2015, a 40-year-old female patient presented for routine examination. A previously treated mandibular second molar (#37), which had a severe strip perforation in the mesial root and overextended gutta-percha one year prior, remained asymptomatic and functional. The patient declined retreatment and opted for annual monitoring. Over five years, the tooth remained functional and symptom-free, and the extruded gutta-percha showed gradual radiographic resorption. In 2023, the patient returned with a symptomatic apical periodontitis and a large periapical lesion associated with the same tooth. Intentional replantation was performed with midroot resection of the mesial root, root-end filling using CEM cement, and immediate replantation. At the 1-year follow-up, the tooth remained functional, asymptomatic, and radiographically healed. The case highlights the long-term clinical risks of untreated strip perforations, the unpredictable resorption of overextended materials, and the efficacy of minimally invasive surgical interventions in preserving tooth function.