Journal of endodontics最新文献

Introduction: The persistence of microbial infection can lead to endodontic failure. Enterococcus faecalis (E. faecalis) is acknowledged to be a closely associated bacterium. This study investigated the antimicrobial effects of mesoporous silica nanoparticles (nMS) carrying nano-silver and chlorhexidine (nMS-nAg-Chx) on E. faecalis.

Methods: Analyses were conducted to assess the antimicrobial efficacy of nMS-nAg-Chx towards planktonic E. faecalis, including the zone of inhibition, minimal inhibitory concentration (MIC), and growth curves. The measurement of lactic acid, scanning electron microscopy (SEM), live-dead bacteria staining, and quantitative real-time PCR (qRT-PCR) were done to further investigate its anti-biofilm effect. Colony forming unit (CFU) and SEM were used to assess its efficacy in infected root canals.

Results: The growth of planktonic E. faecalis was suppressed with a MIC value of 25 μg/mL (P＜0.05). nMS-nAg-Chx concentration-dependently inhibited biofilm formation of E. faecalis with the reduction of lactic acid (P < 0.05), sparse biofilm structure, reduced percentage of viable bacteria (P < 0.05), and suppressed expression of ebpR, gelE, ace, and efa genes (P < 0.05). The seven-day sealing of nMS-nAg-Chx resulted in a notable reduction in bacterial counts compared to the saline control group in the E. faecalis infected root canals (P < 0.05).

Conclusion: NMS-nAg-Chx effectively inhibits E. faecalis and removes its biofilm from infected human root canals. It may be used for endodontic treatments in the control of E. faecalis bacteria as an intracanal medication.

Autogenous tooth transplantation (ATT) offers advantages; however, success rates depend on factors like socket formation, donor tooth manipulation, and endodontic treatment. Root canal treatment in a mature post-ATT tooth remains challenging. Cell-based regenerative endodontic therapy (RET) shows promise for regenerating the pulp-dentin complex in mature teeth. However, its application in a post-ATT tooth is unexplored. This case report demonstrates the feasibility and outcomes of cell-based RET in a post-ATT tooth. A 37-year-old male underwent ATT for a missing maxillary left first molar. The maxillary right third molar served as the donor tooth, and transplanted with surgical guides. Root canal treatment began two weeks after ATT, confirming no detectable residual bacteria and fungi after 11 weeks. Dental pulp stem cells (DPSCs) isolated from the maxillary left third molar were transplanted into the root canal 17 weeks after ATT. The ATT tooth responded positively to the electric pulp test after 1 week. Most of the periodontal ligament of the donor tooth was absent, and the ATT tooth initially showed ankylosis-like signs but regained normal mobility after 28 weeks after RET. Cone-beam computed tomography (CBCT) imaging showed successful outcomes with the presence of the periodontal ligament space and lamina dura, and without root resorption and ankylosis after 52 weeks. Magnetic resonance imaging (MRI) revealed signal intensity of the regenerated tissue comparable to normal pulp after 60 weeks. This case report suggests the effectiveness of DPSCs in regenerating dental pulp and periodontal ligament, potentially preventing root resorption and ankylosis in the post-ATT tooth.

Introduction: The traditional endodontic cavity (TEC) facilitates canal preparation, but may increase susceptibility to root fracture; conservative endodontic cavities (CEC) aim to preserve tooth structure to maintain the structural integrity of root-filled teeth. The objective of this study was to evaluate the effect of access cavity design and the degree of pulp chamber roof removal on the microstrain distribution patterns under different levels of functional loading using digital moiré interferometry (DMI).

Methods: Twelve extracted human teeth (N=12) were included, comprising of mandibular premolars (n = 6) and mandibular first molars (n = 6). Specimens were subjected to physiologic levels of compressive loading ranging from 10 to 50N for each group. DMI fringe patterns were acquired three times for each pecimen: prior to endodontic cavity preparation (control group (CG)), after conservative endodontic cavity preparation (CEC), and following traditional endodontic cavity preparation (TEC). The acquired fringe patterns were used to determine the microstrain distribution at the coronal and cervical dentin. The data was analyzed qualitatively and quantitatively using one-way ANOVA and T-tests (P< 0.05).

Results: The intact crowns of CG teeth showed significantly less microstrain, when compared to CEC and TEC with a distinct shift in coronal microstrain in both CEC and TEC groups. There were significant differences between both the coronal and cervical microstrain in the CG, CEC, and TEC groups.

Conclusions: The roof of the pulp chamber contributes to a distinct biomechanical response in posterior teeth. The microstrain at the coronal and cervical level increased significantly following de-roofing of the pulp chamber in both CEC and TEC groups, with the TEC resulting in higher coronal microstrain compared to CEC group.

Introduction: Fear of dentistry, often due to past painful experiences, is a significant barrier preventing patients from visiting dentists. Achieving effective pain control, especially during root canal treatments, is crucial. However, inferior alveolar nerve blocks (IANB) have a low success rate, influenced by factors such as anxiety, anatomical variations, and technique limitations, leading to anesthesia failure. Although numerous studies have examined the cold test and EPT in assessing the success of local anesthesia, no standardized method has been established. This study evaluated the effectiveness of electric pulp test (EPT) and cold tests in assessing the depth of anesthesia in patients with symptomatic irreversible pulpitis (SIP) in the mandibular first molar teeth.

Methods: A cross-sectional study was conducted on 50 patients with SIP who met the inclusion criteria and exhibited lip numbness. Following the administration of the IANB and confirmation of lip numbness, cold tests and EPT were performed on all patients. Subsequently, the preparation of the access cavity (gold standard test) was initiated, and patients' responses during cavity preparation were recorded as either "presence of pain or discomfort" or "absence of pain or discomfort," indicating IANB failure and success, respectively. Sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (LR-/+), and accuracy (AC) with 95% confidence intervals (CI) were calculated for each test separately as well as for sequential testing.

Results: IANB failure was determined in 56% of the patients. A comparative analysis of diagnostic tests (cold test and EPT) showed no significant difference in SN, NPV, and AC; however, the cold test had higher SP, PPV, and LR+. Combining cold test and EPT evaluations improved SN, NPV, PPV, and LR-, but SP and AC were similar to EPT alone. No correlation was found between IANB success and patient age, sex, or initial pain.

Conclusions: Despite evidence of lip numbness, a significant number of IANBs failed in cases of painful pulpitis. A positive result from the cold test strongly indicated anesthesia failure. The findings of the current study suggested that when the cold test yielded a negative result, further evaluation with EPT was necessary to confirm anesthetic success and ensure complete pain control.

Introduction: The aim of this systematic review was to evaluate the pooled estimate and relative risk of periapical lesions in natural teeth adjacent to implants.

Methods: MEDLINE (PubMed), Embase, Cochrane Library, and gray literature were searched (inception-November 2023) to identify studies. Eligible studies were selected and data extracted. Studies were critically assessed for risk of bias and quality of evidence. Quantitative analysis was performed to determine the pooled estimate of periapical radiolucent lesions (PARLs) in teeth adjacent to implants and to assess the relative risk of developing such lesions in these teeth compared to teeth adjacent to nonimplants.

Results: A total of 6 studies were included. The pooled estimate of PARL in implant adjacent teeth was 2.55%. The risk ratio for PARL in a tooth adjacent to an implant in comparison to a tooth adjacent to a nonimplant was 2.12. Analyses presented low certainty of evidence.

Conclusions: A natural tooth adjacent to an implant has 2.12 times higher probability of developing a PARL compared to a tooth adjacent to a nonimplant. The overall quality of evidence was low.

Introduction: This study investigated the implications of root canal treatment (RCT) of infected teeth with apical periodontitis (AP) in patients undergoing hematopoietic stem cell transplantation (HSCT).

Methods: One hundred patients were selected. Clinical data, oncological and endodontic diagnosis and treatment, and type of HSCT were recorded. Data on the exacerbation of AP was investigated. Leukocyte/neutrophil and C-reactive protein (CRP) levels were evaluated before and after RCT.

Results: One hundred patients underwent HSCT (55% autologous). The need for RCT was identified in 41% of the participants. AP was diagnosed in 75.6% of these patients and large lesions (> 5 mm) occurred in 45.2%. A higher prevalence of AP was observed in males (p=0.012). RCT was performed in 54.8% of the individuals and no AP exacerbation, pain, swelling, bacteremia, and need for additional medications was observed. Blood cultures were negative for bacteria and fungi. CRP levels were >1mg/dL in 54.9% of the individuals 1 month before RCT and <1mg/dL in 64.6% 6 months after treatment (p>0.05).

Conclusions: RCT was effective in controlling infection with no complications in patients undergoing HSCT. Given the potential for exacerbation of endodontic infections, RCT and patient monitoring are essential and highly recommended.

Introduction: Despite the increasing use of botulinum toxin A (BoNT-A) in dentistry, there is limited research on its use in endodontics, a specialty that often receives referrals for dental pain that can coexist with nonodontogenic pain. The purpose of this study was to assess whether endodontists believe BoNT-A can be useful in an endodontic practice as an adjunctive treatment for nonodontogenic conditions overlapping with dental pain.

Methods: A 23-question survey was emailed to 3,979 members of the American Association of Endodontists (AAE). Descriptive statistics, bivariate analysis, and logistic regression were performed with significance at α = 0.05.

Results: Among the 211 respondents confirmed to be endodontists in the United States, one in eleven (9.14%) currently administer BoNT-A treatment. The top nonodontogenic conditions indicated for BoNT-A were myofascial orofacial pain (49.22%) and temporomandibular joint disorders (41.97%). Half of the endodontists (50.26%) believe that BoNT-A could be useful for nonodontogenic conditions overlapping with dental pain. Regression analysis identified variables significantly associated with this belief: BoNT-A can improve patient satisfaction (p < 0.05), BoNT-A training should be offered in residency (p < 0.05), BoNT-A would increase profitability (p < 0.05), and BoNT-A will be incorporated more in the future (p < 0.05).

Conclusion: Endodontists have split opinions on administering BoNT-A for nonodontogenic conditions overlapping with dental pain. Including BoNT-A training in residency may be key to encouraging multidisciplinary pain management in endodontics.

Introduction: The aim of the present study was to evaluate the effectiveness of cannabidiol-rich Cannabis extract in reducing anxiety and postoperative pain in patients submitted to endodontic treatment METHODS: The study was carried out after approval by the Research Ethics Committee (Registration No. 5.075.961). The following groups were tested: cannabidiol (CBD) and placebo. Pain was measured using a Visual Analog Scale (VAS) before the start of treatment and 24, 48 and 72 h and 7 days after the session. Anxiety was assessed using the Modified Dental Anxiety Scale and a VAS, before and immediately after treatment. In addition, salivary cortisol was measured before drug administration and after anesthesia. Data were analyzed descriptively using absolute frequencies and percentages, with a 5% margin of error.

Results: The mean anxiety scores were higher in the Cannabidiol group than in the placebo group in each assessment (pre: 5.06 versus 3.07, respectively; post: 4.61 versus 2.60). However, there was no significant difference in the reduction of dental anxiety at the beginning of the consultation and throughout the procedure. We did not find statistically significant differences in postoperative pain between the Cannabidiol and placebo groups at any of the time points.

Conclusion: There was no evidence of an exposure-response relationship between the intervention and control groups. However, more studies are needed to determine clinical outcomes.

Introduction: This study evaluated the effects of retrieval strategies of separated nickel-titanium files on the biomechanical behavior of endodontically treated teeth by finite element analysis.

Methods: Six FE models were created: intact tooth; simulated a scenario where the apical 3 mm of a nickel-titanium file is separated and retained; TD, simulated application of a trephine drill to expose 1 mm of the separated file; simulated troughing of 180° at the inner wall of root canal for an extra 1 mm of the separated file beyond the staging platform; simulated circumferential ultrasonic troughing done for an extra 1 mm after the TD; and PM, simulated iatrogenic perforation sealed using mineral trioxide aggregate. Occlusal loading followed the occlusal fingerprint of the tooth before maximum von Mises stresses, maximum principal stresses, safety factor, and number of cycles till failure were determined. The cervical region of the teeth and mid-root sections including the separated file was chosen as the areas of interest for further analysis.

Results: Intact tooth recorded the highest number of cycles till failure and safety factor. Other models showed a narrow range of variation in all aspects with the PM recording the lowest number of cycles till failure. The highest von Mises stress was recorded at the mesiobuccal line angle of the PM near its cervical margin, while the lowest was found at the intact tooth.

Conclusion: Under the limitation of this study, various file retrieval strategies removing the surrounding root dentin within the amounts of general guidelines do not affect the biomechanical behavior of the tooth.

Introduction: The aim of this study was to examine the temperature changes on root canal and root surface in immature teeth with thin dentinal walls when irrigation solutions are preheated or intracanal heated, as well as the additional effects of passive ultrasonic irrigation (PUI) on these temperature changes.

Methods: Sixteen maxillary canine teeth were trimmed to a length of 20 mm and prepared to mimic immature teeth with an apical width of 1.3 mm by enlarging those using Gates Glidden burs. To measure temperatures inside the canal and on the root surface, one thermocouple was placed from the apex into the root canal, while the other thermocouple was positioned outside the root. Irrigation was performed by heating the irrigation solution with different methods (room temperature, preheated to 60°C, 5 sec intracanal heated, 20 sec intracanal heated), and PUI was applied after each method. Temperature changes occurring inside the root canal and on the root surface were recorded and subjected to statistical analysis.

Results: Using the irrigation solution preheated and intracanal heated resulted in a significant increase in both intracanal and root surface temperatures compared to using at room temperature (P < .05). The application of PUI significantly increased the temperature of the irrigation solution only at room temperature group (P < .05). None of the applications caused an increase in temperature on the root surface exceeding 10°C.

Conclusions: Applying PUI to heated solutions does not significantly increase the temperature in heating methods, but it does prolong heat retention in the canal by slowing down the cooling process. Although using preheated solution for 20 seconds results in higher intracanal temperatures, it should be noted that the solution cools rapidly within the canal. Short-term heating applications, such as 5 seconds, repeated frequently, can help maintain the high temperature during activation.