Journal of endodontics最新文献

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 (NiTi) files on the biomechanical behavior of endodontically treated teeth by finite element analysis (FEA).

Methods: Six FE models were created; IT: intact tooth, SF: simulated a scenario where the apical 3 mm of a NiTi file is separated and retained, TD: simulated application of a trephine drill to expose 1 mm of the separated file, US180: simulated troughing of 180⁰ at the inner wall of root canal for an extra 1 mm of the separated file beyond the staging platform, US360: simulated circumferential ultrasonic troughing done for an extra 1 mm after the TD, and PM: simulated iatrogenic perforation sealed using MTA. Occlusal loading followed the occlusal fingerprint of the tooth before maximum von Mises stresses (vMS), maximum principal stresses (MPS), safety factor, and number of cycles (NCF) till failure were determined. Cervical region of the teeth and mid-root sections including the separated file were chosen as the areas of interest for further analysis.

Results: IT recorded the highest NCF and safety factor. Other models showed a narrow range of variation in all aspects with the PM recording the lowest NCF. The highest vMS was recorded at the mesiobuccal line angle of the PM near its cervical margin, while the lowest was found at the IT.

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 them 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.

Objectives: This study was aimed to determine the correlation between proximal caries (PC) and the extent and site of pulp canal obliteration (PCO) in CBCT scans of mandibular molar teeth.

Materials and methods: A total of 1491 CBCT scans of patients aged 18-49 years were selected from the database (2002 to 2022). From them, 328 teeth with PC and satisfying inclusion criteria were evaluated by two calibrated evaluators. PCO was observed in sagittal and coronal planes. PCO and PC were compared concerning different age groups, genders, and sites using an independent-sample t-test.

Results: The prevalence of PCO among patients with PC is 47%. In mesial PC, the extent of PCO is significantly greater in the distal root canal (73.4%); whereas in distal PC, PCO is more in the mesial canal (77.3%). The mean extent of intra-radicular calcification was found higher in the distal canal (p<0.001). Moreover, mesial PC showed a greater extent of intra-radicular obliteration (p<0.001). The probability of developing PCO was found to be significantly higher in females (p=0.003).

Conclusions: Within the limitation of this study, it can be concluded that the extent of calcification is more common on the opposite side of the location of the PC. Moreover, such intra-radicular calcification is greater in a distal canal compared to a mesial canal. Gender plays a significant role in the calcification process showing higher predilection in females compared to males.

Clinical relevance: Knowledge about the correlation between PC with PCO may help in reducing endodontic procedural errors to improve patient outcomes.

Introduction: Regenerative endodontic procedures (REPs) using cell-based approaches have emerged as novel treatment modalities. This clinical study aimed to present the outcomes and explore factors influencing REPs with minced pulp tissue (MP) grafts in a mature tooth.

Methods: Healthy patients requiring non-surgical root canal treatment were enrolled. MP obtained from the third molar was grafted into the instrumented, disinfected, and blood-filled root canal. After treatment, patients were evaluated clinically and radiographically.

Results: Follow-ups for 6 cases (male patients aged 20-27) ranged from 19 to 42 months. Radiographically, all the teeth showed favorable outcomes. Among the 6 teeth, 2 showed neither intracanal calcification nor recovery in sensibility tests, and one had no intracanal calcification with an inapplicable sensibility test evaluation. In 2 teeth, intracanal calcification was observed in the apical third; however, there was no recovery in the sensibility tests. One tooth exhibited intracanal calcification in the apical third and showed recovery in the sensibility tests. Considering these outcomes and clinical variables, the size of the apical foramen and the composition of the transplanted pulp tissue were identified as tentative influencing factors.

Conclusions: This exploratory clinical study on simplified cell-based REPs using autologous MP grafts for pulp/dentin regeneration in adult teeth not only enhances our understanding of REPs but also suggests its potential as an alternative treatment option to conventional endodontic treatment.

Introduction: Currently there is no standardization of variable taper endodontic files and corresponding gutta-percha (GP) cones. The aim of this study was to evaluate intramanufacturer and intermanufacturer variability of diameter and taper in the apical third of GP master cones and finishing files from 3 commercially available variable taper endodontic systems.

Methods: Diameter measurements were recorded using digital microscopy at 1-mm increments (D1-D4) for F2 files and corresponding GP cones (n = 20 per system) from ProTaper Gold (Dentsply Tulsa Dental Specialties, Johnson City, TN), EdgeTaper Platinum (EdgeEndo, Albuquerque, NM), and ExactTaper H (SS White, Lakewood, NJ). Taper was defined as the rate of change in diameter per 1-mm increment. Mean differences in diameter were assessed using repeated measures of analysis of variance for D1 to D4 and the Wilks test for differences in taper.

Results: In the apical third, ProTaper and EdgeEndo mean file diameters were significantly smaller than corresponding GP cone diameters (P < .01, P < .01, respectively). Contrastingly, SS White file diameters were significantly larger than their corresponding GP cones (P = .02). Files from all manufacturers had significantly smaller diameters than advertised (nominal) values (P < .01). ProTaper GP cones had similar diameters to nominal values (P = .30), while EdgeEndo and SS White GP cones were significantly smaller (P < .01). Amongst files and corresponding GP cones from all systems, taper was nonstandardized.

Conclusions: Size discrepancies between finishing files and corresponding GP cones can be expected amongst variable taper endodontic systems. Therefore, clinicians should be prepared to make intraoperative adjustments when obturating.

Introduction: Current understanding of the morphology of pulpal mineralizations is limited. Understanding the specific location and type of such mineralizations will aid clinicians in diagnosis, case complexity assessment, and treatment planning. Therefore, this study correlated the appearance of a reduced canal volume (CV) in conventional radiographs with the presence of pulp mineralizations (PMs) utilizing micro-computed tomography (CT) analysis. The morphology of PMs utilizing micro-CT technology was also analyzed.

Methods: One hundred and twenty-one extracted permanent mandibular incisors were collected. Periapical radiographs were taken of the teeth to determine if a reduced canal space was present, in which case the sample was included for micro-CT assessment. Various descriptors for PM were then determined and these labels were then applied to the entire sample to demonstrate PM. Numerical analysis was undertaken for all teeth scanned; the following data was extracted: the presence or absence of PMs, types of PM, and their morphological structures; CVs were determined. Cohen's kappa test was used to assess intraexaminer agreement.

Results: Based on radiographic appearance, forty-two teeth were included for micro-CT analysis. PMs were demonstrable in 57% and absent 43% of teeth. When PMs were absent, the CV was significantly smaller compared to when they were present (P < .05). Discrete mineralizations were more frequently located in the coronal and middle thirds compared to diffuse mineralization (P < .01). No differences in the prevalence of the individual features of discrete or diffuse mineralizations were detected (P > .05).

Conclusions: Two detectable forms of PMs were found in micro-CT analysis at all levels of the canal: discrete and diffuse mineralizations. A reduced CV on a PA was reflective of mineralized changes within the pulp but the type of PM could not be determined. PMs occurred at any level of the root canal; clinicians need to be aware of this when performing root canal treatment.

Endodontic microsurgery (EMS) is an alternative treatment option for previously treated teeth with persistent periapical disease, offering a favorable prognosis. However, it can be particularly challenging in anatomically complex cases, risking unintentional damage to adjacent critical structures. Dynamic navigation (DN), a computer-aided technique, facilitates precise presurgical planning and provides real-time guidance during operation. Integrating the DN technique into EMS procedures can enhance treatment accuracy and effectiveness. This report presents 4 cases involving a minimally invasive incision approach for DN-aided EMS in anatomically complex regions, all of which were completed without complications. After 3-12 months, patients presented asymptomatic, and radiographic examinations revealed complete healing or the periapical radiolucent area decreased in size. The DN technique contributed to reliably mitigating the risk of iatrogenic damage in complicated EMS scenarios. The minimally invasive incision approach not only provided sufficient visibility but also promoted favorable soft tissue healing, making it a valuable addition to surgical endodontics.

Introduction: Periapical lesions (PLs) are common inflammatory diseases primarily caused by microbial infections within root canals. These infections trigger complex immune responses in periapical tissues, with B lymphocytes playing dual roles: defending against pathogens while also contributing to tissue damage. This highlights the crucial role of B cells in the immunological processes of PLs.

Method: A comprehensive review of the literature on B cells in PLs was conducted using PubMed, Web of Science, Scopus, and ScienceDirect databases.

Results: The review included 123 studies that examined the distribution and subtypes of B cells, their dual functions in PLs, and the potential applications of B-cell-related therapies in treating apical periodontitis.

Conclusion: This review enhances our understanding of the complex immune mechanisms in PLs and aids in the development of new therapeutic approaches from a B-cell perspective.