Iranian Endodontic Journal最新文献

Introduction: The dental pulp is a specialized connective tissue responsible for maintaining tooth vitality through a complex interplay of cellular, vascular, and immunological components. Despite the clinical use of conventional capping materials, their limited regenerative potential often results in pulp devitalization and compromised structural integrity. Recent advances in tissue engineering, particularly the application of three-dimensional scaffolds, have demonstrated promising outcomes in promoting dentin-pulp complex regeneration and biomimetic tissue repair. This systematic review and meta-analysis evaluated the efficacy of three-dimensional matrices, with or without bioactive materials, as direct pulp capping agents in animal models. Outcomes included cellularity, dentin thickness, dentin bridge formation, dystrophic calcification, inflammation control, and pulp organization compared to commercial materials.

Materials and methods: A comprehensive search was conducted in indexed databases and gray literature. A random-effects meta-analysis used standardized mean differences and the inverse variance method. Heterogeneity (I²), publication bias (Egger's and Begg's tests), and risk of bias (SYRCLE's RoB tool) were assessed. Statistical analyses were conducted using RevMan (P<0.05).

Results: Seventeen studies met the inclusion criteria, with 13 included in the meta-analysis. The risk of bias was predominantly low, yet the certainty of evidence was very low. Scaffolds significantly enhanced cellularity (P=0.02; I²=91%), dentin thickness (P<0.00001; I²=87%), and inflammation control (P=0.03; I²=20%) compared to controls. No significant differences were observed for dentin bridge formation (P=0.30; I²=63%), dystrophic calcification (P=0.14; I²=32%), or pulp organization (P=0.10; I²=0%).

Conclusion: Three-dimensional scaffolds demonstrated potential in promoting cellular activity, dentin formation, and inflammation control. However, their impact on dentin bridge formation, pulp organization, and dystrophic calcification remains inconclusive. Further high-quality studies are required to validate their clinical applicability.

An acute apical abscess (AAA) is a rapid-onset inflammatory condition characterized by spontaneous pain, pus formation, and swelling, often resulting from pulp necrosis. Complications may include systemic manifestations and severe outcomes, such as tooth extrusion. This case report describes a rare instance of AAA causing rapid extrusion of a maxillary central incisor in a 17-year-old female. The patient presented with spontaneous pain and mobility of the extruded tooth, accompanied by localized swelling. Clinical and radiographic evaluations revealed pulp necrosis, an AAA, and apical bone rarefaction. Emergency treatment was initiated, including intracanal medication with calcium hydroxide and temporary splinting of the tooth. Subsequent treatment involved obturation with gutta-percha and sealer, followed by permanent restoration. Radiographic and clinical recalls up to 5 years demonstrated complete periapical healing, normal tooth mobility, and no recurrence of symptoms. Effective management, including timely root canal therapy and splinting, led to successful long-term outcomes. This case underscores the importance of prompt diagnosis and immediate, tailored treatment to manage AAA and prevent severe complications.

Introduction: The middle mesial canal (MMC) of mandibular molars is of particular interest in endodontics due to its complexity. This study investigated the association between MMC presence in first and second mandibular molars and the radiolucency in the furcation area using cone-beam computed tomography (CBCT) scans.

Materials and methods: CBCT scans of 400 patients referred to the largest radiology center in Kerman City from January 1, 2022, to January 1, 2023, were examined. All CBCT scans were assessed for radiolucency in the furcation area and the presence of MMC. Variables, including age, gender, tooth number, and MMC presence were recorded. Chi-squared tests and logistic regression analyses were employed to compare MMC frequency and its impact on furcation radiolucency.

Results: Of 201 examined teeth, 37 (18.4%) had MMC, and 23 (11.4%) exhibited furcation radiolucency. However, teeth with a mesial canal showed a higher prevalence of furcation lesions compared to those without (38% vs. 5.2%) (P<0.001). A significant association was observed between a mesial canal and furcation radiolucency, with odds of furcation radiolucency at 12.7 after controlling for age and gender (P<0.001).

Conclusion: A strong association exists between MMC presence in first and second mandibular molars and furcation radiolucency, unaffected by age and gender.

Introduction: This study compared apical transportation and centering ability of TruNatomy, EDMax, and Reciproc Blue in curved mesiobuccal canals of mandibular molars.

Materials and methods: This ex vivo study was conducted on curved (20-40 degrees) mesiobuccal canals of 60 mandibular molars. The teeth were randomly assigned to 4 groups (n=15) for instrumentation of the mesiobuccal canals with (I) TruNatomy, (II) EDMax, (III) Reciproc Blue, and (IV) Reciproc Blue+R-Pilot. Cone-beam computed tomography (CBCT) scans were obtained before and after instrumentation. Changes in canal wall thickness in mesiodistal (MD) and buccolingual (BL) directions were assessed at 1, 2, 3, and 4 mm from the apex using OnDemand software. Data were analyzed by the Kruskal-Wallis, Bonferroni, Friedman, and Fisher's exact tests (alpha=0.05).

Results: TruNatomy showed significantly lower transportation than Reciproc Blue and EDMax in the apical, middle, and coronal thirds (P<0.05). Reciproc Blue and EDMax had no significant difference in transportation (P>0.05). Using the R-Pilot glider had no significant effect on transportation (P>0.05). Canal transportation was not significantly different within each group at four distances from the apex (P>0.05). TruNatomy showed significantly higher centering ability than Reciproc Blue+R-Pilot in the BL dimension at 3 mm from the apex (P<0.05).

Conclusion: TruNatomy showed significantly lower canal transportation than Reciproc Blue and EDMax at all distances from the apex. The files had no significant difference in centering ability except at 3 mm in BL dimension, where TruNatomy had significantly higher centering ability than Reciproc Blue+R-Pilot.

Vital pulp therapy is one of the least invasive and simplest and most economically acceptable treatment alternatives for immature teeth with pulpitis. The success rate of this treatment, with calcium silicate-based cements, ranges from 85% to 100%. Vital pulp therapy prevents the development of apical periodontitis and promotes normal root development, allowing the tooth to remain in the dentition and perform its functions. The patient was a nine-year-old boy with pain on chewing and a positive response to cold. The panoramic radiograph showed an immature permanent lower molar with deep caries. Partial pulpectomy and root pulp sealing with pre-mixed calcium silicate-based cement were performed under aseptic conditions. The absence of symptoms and the formation of roots with apical sealing were successfully achieved and observed by follow-up and radiographic control, making this treatment a viable option for immature teeth with pulpitis.

Pulp canal calcification (PCC) is common in patients with dentinogenesis imperfecta (DGI). We present endodontic management of multiple anterior and posterior teeth with PCCs in a patient with DGI type II using guided endodontics. A 26-year-old female patient was diagnosed with DGI type II. Clinical examination revealed palatal cusp fracture in tooth #13, microcracks in tooth #14, and a sinus tract in the maxillary right buccal vestibule related to tooth #13. Periapical radiographs revealed PCCs in all teeth, and periapical radiolucencies in several teeth. Due to difficult negotiation of canal orifices, guided endodontic approach was planned. Cone-beam computed tomography (CBCT) was requested and obtained. Intraoral scanning was performed, and CBCT and intraoral scanning data were superimposed. A template was designed and 3D printed. The root canal orifices were successfully negotiated and endodontic treatments were successfully accomplished. At the 1-year follow-up, the endodontically treated teeth were asymptomatic, and periapical lesions were healing.

Introduction: Microbial agents play a crucial role in periapical lesions and despite mechanical preparation, presence of persistent bacteria in root canal system is a challenge. Photodynamic therapy offers a debridement method, utilizing photosensitizers such as Curcumin, Indocyanine Green (ICG), and Methylene Blue (MB). This study aimed to assess and compare the penetration depth of these photosensitizers on the lateral surface of the root canal.

Materials and methods: The crown of 30 single-rooted teeth were separated by a diamond disc. The canals were prepared using a rotary system and were rinsed with 10 mL of 2.5% NaOCl. In order to remove the smear layer debris, 17% EDTA was placed in the root canal for 1 min, then rinsed with NaOCl and saline. The teeth were sterilized by autoclave and randomly assigned to three groups that filled with curcumin, ICG, or MB. Subsequently, they were incubated for 10 min and dried up by paper. Longitudinal sections were cut, and penetration depth of the photosensitizers in coronal, middle, and apical sections were measured using a stereomicroscope.

Results: Curcumin demonstrated a higher average penetration depth (3000 µm) than MB, and MB showed higher penetration depth than ICG. Significantly different penetration depths were observed in pairwise comparisons among all three groups (P<0.005).

Conclusion: Curcumin with its superior average penetration depth, emerges as a promising choice for effective root canal disinfection in endodontic treatments. Consideration of these findings may enhance the selection of photosensitizers in clinical applications.

Immediate care and accurate diagnosis are essential for treating dental trauma. This report presents a 7-year-old boy suffered a bicycle accident with direct trauma to the mouth and extrusive luxation of teeth #11 and #21. The emergency treatment was performed within the first hour. Clinical examinations showed that both teeth exhibited 3 mm extrusion from comparing their incisal edges to their neighboring teeth, had edematous gingiva, showed grade 3 mobility and were painful to percussion. Radiographic exams showed incomplete root formation, widened periodontal spaces along their entire lengths and absence of bone or root fractures. The treatment consisted of immediate repositioning and semi-rigid splinting. After 15 days, tooth #11 exhibited no clinical signor symptom and tooth #21 was diagnosed with pulp necrosis, with an acute dentoalveolar abscess and intraoral edema. Immediate endodontic treatment was initiated (intracanal dressing with calcium hydroxide paste). At 30 days, another pulp sensibility test was performed on tooth #11, which had a negative response. In the same visit, the intracanal dressing of tooth #21 was replaced. The Ca(OH)₂ medication was replaced every 6 months until the formation of an apical barrier. The final dressing consisted of gutta-percha and Grossman's sealer and was placed two and a half years after the first dressing appointment. The extrusive luxation resulted in two different sequelae: complete root obliteration in tooth #11 and anomalous root development after the formation of an apical barrier in tooth #21. The patient received orthodontic treatment after 6 years from the initial treatment with no negative outcome. After 18 years follow-up, both teeth were stabilized with no symptom or sign. It's important to follow the evolution of every trauma case continuously because the sequelae can be unpredictable.

Introduction: Endodontic therapy has been regarded as a safe treatment option with highly promising results in preserving natural teeth. Numerous factors may influence the longevity of endodontically treated teeth (ETT), thus altering their success/survival rate. This study aimed to determine the survival and success rates of endodontically treated premolars and molars with different complex restorative/prosthodontic treatments.

Materials and methods: A total of 190 patients with an ETT were included, who had received final coronal restoration up to 14 days after the temporary one and at least one year prior to the enrollment. The investigator evaluated the quality of endodontic filling, coronal restoration, mobility, and proximal contacts. Data were analyzed with multiple binary logistic regression and the Chi-Square test.

Results: The average duration of follow-up was 28.6±11.9 months. Overall, 89.4% (170/190) of the teeth survived. The overall success rate for the investigated teeth was 70.5% (134/190). Success rates of 100% for crown, 95.7% for post and core crown (PCC), and 94.7% for amalgam build-up with post were achieved. However, the success rates were 75%, 52.5%, and 50% for amalgam build-up, composite build-up, and PCC with crown lengthening, respectively. The Chi-square test revealed that there was a significant difference between the different restorations in terms of success (P<0.001). Multiple binary logistic regression models revealed that coronal leakage (P=0.048), obturation void (P=0.037), obturation length (P=0.020), mobility (P=0.002), type of the restoration (P<0.001), and proximal contact (P<0.001) were significant predictors for success. However, apical lucency, root length, marginal caries, tooth type, and post did not appear to be significant indicators of success (P>0.05).

Conclusions: ETT with minimal mobility, exhibiting underfilled obturations without visible voids, and having received crown/PCC/amalgam build-up with a post, along with the presence of both proximal contacts, tend to exhibit a significantly high success rate.

Introduction: This study aimed to compare the effectiveness of two endodontic cleaning techniques, passive ultrasonic irrigation (PUI) and the XP-endo Finisher R (XPR) system, in removing residual filling material during endodontic retreatment procedures.

Materials and methods: Forty mandibular premolars with oval canals were divided into four groups based on the sealer used (AH-Plus or Bio-C Sealer) and the cleaning technique employed (PUI or XPR). To ensure uniformity of canal volume among groups, initial micro-CT scans were conducted. The canals were instrumented, filled, and then re-instrumented before undergoing either PUI or XPR cleaning techniques. Residual filling material volumes were assessed through micro-CT scans, and statistical analysis was performed using the Kruskal-Wallis and Mann-Whitney U tests.

Results: Following instrumentation, there was no significant difference in residual filling material volumes between AH-Plus and Bio-C Sealer groups (1.35 mm³and 1.02 mm³, respectively; P>0.05). However, after supplementary cleaning techniques, XPR-cleaned specimens exhibited significantly less residual material compared to PUI-cleaned specimens (0.01 mm³ and 0.29 mm³ for Bio-C Sealer, and 0.07 mm³ and. 0.30 mm³ for AH-Plus, P<0.05).

Conclusion: The XPR system was found to be more effective than PUI in removing residual filling material from Bio-C Sealer-filled root canals. This highlights its potential as a useful supplementary cleaning technique in endodontic retreatment procedures.