Journal of endodontics最新文献

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 (IANBs) 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 electric pulp test (EPT) in assessing the success of local anesthesia, no standardized method has been established. This study evaluated the effectiveness of EPT and cold tests in assessing the depth of anesthesia in patients with symptomatic irreversible pulpitis in the mandibular first molar teeth.

Methods: A cross-sectional study was conducted on 50 patients with symptomatic irreversible pulpitis who met the inclusion criteria and exhibited lip numbness. Following the administration of the IANBs 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, and accuracy (AC) with 95% confidence intervals 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 positive likelihood ratio. Combining cold test and EPT evaluations improved SN, NPV, PPV, and negative likelihood ratio, 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: 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. 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, 1 in 11 (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 < .05), BoNT-A training should be offered in residency (P < .05), BoNT-A would increase profitability (P < .05), and BoNT-A will be incorporated more in the future (P < .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.

Introduction: This study aimed to determine the correlation between proximal caries and the extent and site of pulp canal obliteration (PCO) in cone-beam computed tomographic (CBCT) scans of mandibular molar teeth.

Methods: A total of 1491 CBCT scans of patients 18-49 years of age were selected from the database (2002-2022). From them, 328 teeth with proximal caries and satisfying inclusion criteria were evaluated by 2 calibrated evaluators. PCO was observed in the sagittal and coronal planes. PCO and proximal caries were compared concerning different age groups, sexes, and sites using an independent sample t test.

Results: The prevalence of PCO among patients with proximal caries is 47%. In mesial proximal caries, the extent of PCO is significantly greater in the distal root canal (73.4%), whereas in distal proximal caries, PCO is more often found in the mesial canal (77.3%). The mean extent of intraradicular calcification was higher in the distal canal (P < .001). Moreover, mesial proximal caries showed a greater extent of intraradicular obliteration (P < .001). The probability of developing PCO was significantly higher in females (P = .003).

Conclusions: Within the limitations of this study, it can be concluded that the extent of calcification is more common on the opposite side of the location of the proximal caries. Moreover, such intraradicular calcification is greater in a distal canal compared to a mesial canal. Sex plays a significant role in the calcification process, showing higher predilection in females compared to males.

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.