Iranian Endodontic Journal最新文献

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.

Root canal mishaps such as perforations, separated instruments, and canal ledges remain significant challenges in endodontic retreatment. This case report describes the successful non-surgical management of a mandibular first molar presenting with a strip perforation in the mesiobuccal canal, a separated file in the mesiolingual canal, and a ledge in the distal canal. The tooth was generally asymptomatic with only mild sensitivity to percussion, without any pockets of endodontic origin. Radiographic examination revealed periapical and furcation radiolucencies. The tooth had a previous endodontic treatment with an infected root canal system and chronic apical periodontitis. Notably, the tooth was left undressed for approximately three months following the initial mishap, negatively influencing prognosis. Nonetheless, considering the patient's preference and the favorable periodontal and restorative conditions, non-surgical retreatment was initiated. Treatment included thorough chemomechanical preparation, bypassing the separated file and ledge, and sealing the perforation with calcium-enriched mixture cement. The tooth was subsequently restored with bonded composite resin. At 12-month follow-up, radiographic signs of healing were evident, and at 18 months, the tooth remained asymptomatic with no clinical or radiographic signs of apical or furcation pathology.

Dens invaginatus is a developmental malformation that is caused by the invagination of the enamel organ into the internal region of the dental papilla before tissue calcification. The aim of the present report is to discuss a clinical case of endodontic treatment of tooth #12, using bioceramic sealer. The extraoral examination revealed atypical anatomy, while vitality and percussion tests were negative, palpation test was positive. Edema was observed in the adjacent gingival mucosa. Based on clinical and tomographic findings, the diagnosis was pulp necrosis with chronic periapical abscess and Oehlers' type II dens invaginatus. In the first session, access surgery was performed with spherical drills with the aid of an operating microscope (OM) and an ultrasonic diamond tip. Four canals were located, and they were partially debrided and medicated. In the second session, odontometry and chemical-mechanical preparation with nickel-titanium instruments were performed. The irrigation solution was 2.5% sodium hypochlorite. The root canals were filled with calcium hydroxide paste and the chamber was temporarily sealed. During the third session, ultrasonic irrigation was applied for final washing and the root canals were filled with Bio-C sealer using the classic single-cone technique. At 6-month follow-up, the tooth was asymptomatic and the radiography revealed significant bone repair. It was concluded that tomography, operating microscope, ultrasonic irrigation, and materials with greater flow, such as bioceramic sealers, enhanced the clinical success of the clinical case.

Introduction: The present study aimed to evaluate the instrumentation time and transportation ability of three file sequences sharing the same physical properties (diameter, tip design, cross-sectional shape, and taper), each manufactured entirely of one single alloy type (Pink, Blue, or Gold).

Materials and methods: One hundred and eighty simulated curved resin canals were instrumented using the BlueShaper system, with full Z1-Z4 sequences, each made entirely of a single alloy type (Pink, Blue, or Gold). Images before and after instrumentation of each specimen were overlaid with Photoshop software to evaluate centering ability in the coronal, middle, and apical thirds. Data were analyzed using one-way analysis of variance (ANOVA) with post hoc multiple comparisons or the non-parametric Kruskal-Wallis test for intergroup analysis.

Results: No significant differences were found between the different alloys in the centering ability of the simulated canals in the coronal third (P>0.05). The Blue alloy of the BlueShaper system showed significantly less transport ability in the middle third than Pink and Gold alloys (P<0.05). A significantly lower centering ability (P<0.001) was observed in the apical third between the Blue and Pink alloys than the Gold alloy.

Conclusions: It was concluded that the Blue alloy performed better than the Pink and Gold alloys in the middle and apical thirds. The pink alloy performed better than the Gold alloy in the apical third.