Journal of endodontics最新文献

Introduction: This study evaluated whether extending sodium hypochlorite (NaOCl) contact time with periodic renewal after preparation enhances root canal disinfection compared with a standard continuous-irrigation protocol.

Materials and methods: Twenty-eight bovine incisors were contaminated with Enterococcus faecalis (ATCC 29212) for 28 days. Specimens were assigned to 2 experimental groups (n = 10) and 2 controls (positive, n = 4; negative, n = 4). Experimental canals received either standard continuous irrigation (20 mL 1% NaOCl over 4 min) or an extended protocol, in which 5 mL 1% NaOCl was left in situ for 5 min and replenished over 4 cycles, with a total of 20 mL. All canals were subsequently irrigated with 6 mL 17% ethylenediaminetetraacetic acid and 6 mL 1% NaOCl under ultrasonic activation, followed by NaOCl neutralization. Microbiological samples were collected at baseline (S1), after primary irrigation (S2), and after final irrigation/activation (S3) using paper points and Hedström file scrapings. Colony-forming units (CFU) were quantified on Mitis Salivarius agar. Statistics comparison was performed with Kruskal-Wallis and Mann-Whitney U tests (α = 0.05).

Results: Negative controls confirmed asepsis, and positive controls verified bacterial viability. Both irrigation protocols significantly reduced CFU counts at S2 and S3 compared with baseline (P < .05). The extended protocol yielded lower CFU counts than standard irrigation at both postirrigation time points (P < .05). Overall bacterial reduction from baseline to final sampling (S1→S3) was significantly greater for the extended protocol (P = .027), while intermediate reduction (S1→S2) did not differ between groups (P > .05).

Conclusions: The extended protocol resulted in a significantly greater microbial reduction compared with standard continuous irrigation.

Introduction: To evaluate whether maxillary sinus mucosal thickening (MT) observed on cone-beam computed tomography (CBCT) influences endodontic outcomes, and to identify other radiographic predictors of healing.

Methods: This retrospective cohort study included cases treated at a graduate endodontic clinic with pretreatment or intraoperative limited field-of-view CBCT scans and a minimum 5.5 months recall. MT was measured in coronal and sagittal planes and classified by severity, morphology, and presumed origin. Additional variables included CBCT-periapical index (CBCT-PAI) scores, lesion proximity, and treatment type and quality. Outcomes were assessed with clinical testing and periapical radiographs. Associations were analyzed with bivariate tests and multivariable logistic regression.

Results: MT ≥ 2 mm was present in 70% of cases, most commonly with polypoidal morphology and presumed odontogenic origin. However, MT presence, severity, and origin showed no association with treatment outcome. In contrast, changes in periapical index (ΔPAI) strongly correlated with favorable healing, while higher baseline CBCT-PAI scores and retreatment cases were linked with less favorable outcomes.

Conclusions: MT was a frequent radiographic finding but was not prognostic of endodontic healing. Prognosis was best indicated by ΔPAI, with baseline lesion severity and treatment type contributing additional value. ΔPAI should be interpreted in conjunction with clinical findings and patient-reported symptoms to provide a comprehensive assessment of treatment outcome.

Introduction: Cone-beam computed tomography (CBCT) is widely used to assess root canal morphology, yet practical size thresholds for canal visibility have not been established. This study determined the relationship between canal diameter and the probability of confident detection on high-resolution CBCT using micro-computed tomography (micro-CT) for reference.

Methods: Sixty-one extracted human teeth (251 canal cross-sections, including 9 with no visible lumen) were imaged with both imaging modalities. True canal diameters measured on micro-CT were spatially matched to corresponding CBCT cross-sections using anatomical landmarks. Three calibrated observers rated canal visibility on a 5-point scale; scores ≥4 indicated confident detection. Interobserver reliability was quantified using Krippendorff's α and quadratic-weighted κ. A binomial logistic regression modeled detection probability as a function of diameter. Receiver operating characteristic (ROC) analysis assessed overall discriminative accuracy.

Results: Interobserver agreement was excellent (α = 0.87; κ = 0.78-0.91). The probability of confident canal detection increased sharply with canal diameter. Model estimates indicated a 70% probability (D₇₀) at a canal diameter of approximately 265 μm, an 80% probability (D₈₀) at 299 μm, and a 90% probability (D₉₀) at 350 μm. ROC analysis demonstrated excellent discriminative performance (area under the curve = 0.89), confirming strong accuracy of CBCT visibility scores for identifying canals present on micro-CT.

Conclusions: On 80-μm-voxel CBCT, consistent canal visibility emerges at approximately 300 μm. Canals measuring 200 to 300 μm are often visible, whereas those smaller than about 200 μm are frequently missed. The detection thresholds identified in this study may help clinicians anticipate when a canal is likely still patent but radiographically undetectable.

Introduction: Through-and-through (T-T) lesions present unique anatomical challenges in endodontic microsurgery (EMS), often resulting in delayed or incomplete healing. This study aimed to evaluate the clinical outcomes of EMS in T-T lesions, compare them with non-T-T lesions using propensity score matching.

Methods: This retrospective case-control study reviewed 89 T-T teeth and 294 non-T-T teeth that underwent EMS in anterior regions, excluding those treated with bone grafts. Propensity score matching was performed at a 1:2 ratio (T-T: non-T-T), resulting in 89 T-T and 178 non-T-T matched teeth for cumulative outcome assessment with Kaplan-Meier analysis, and 75 T-T with 150 non-T-T, and 34 T-T with 68 non-T-T matched teeth for the 1- and 3-year evaluations of clinical and radiographic outcomes, respectively.

Results: The 1-year success rate was 88.0% in the non-T-T group and 77.3% in the T-T group (P < .05). For 3-year outcomes, the success rates were 97.1% (non-T-T) and 88.2% (T-T), respectively. Lesion type significantly influenced the 1-year outcome, with T-T lesions associated with higher failure rates. No statistically significant difference was identified for 3-year outcomes. The cumulative survival analysis showed no significant differences between the groups.

Conclusions: EMS appears to be a reliable treatment option for T-T lesions. Although short-term outcomes at 1 year were less favorable than those of the non-T-T lesions, these differences were no longer evident at 3 years. A follow-up period longer than 1 year may be necessary to accurately assess the healing dynamics of T-T lesions.

Introduction: To undertake an in-silico analysis of two maxillary central incisors treated with regenerative endodontic treatment (RET) where the right incisor did not undergo further root maturation and compare it to the left central incisor where further root maturation occurred.

Methods: This study employed eXtended Finite Element Analysis to evaluate the fracture resistance of maxillary central incisors treated with RET. Post-treatment cone beam computed tomography data were used to reconstruct two 3D tooth models. Both models were subjected to two physiologically relevant loading conditions: biting (300 N at a 60° angle to the tooth's long axis) and trauma (300 N perpendicular to the labial surface). The mechanical behaviour was assessed by extracting stress distributions, force-displacement curves, and crack propagation behaviour.

Results: Biting generated lower peak tensile stress (∼30 MPa) than trauma (∼45 MPa, ∼50% higher), with trauma causing stronger cervical stress concentrations. The mature root showed greater stiffness (4.5 kN/mm vs 3.9 kN/mm, ∼15% higher). Crack initiation occurred at 100 N under biting and 60 N under trauma (∼40% lower threshold). Biting produced more stable crack growth, whereas trauma caused earlier initiation and faster propagation. Overall, root maturation improved stiffness and fracture resistance, particularly under lateral trauma.

Conclusions: The mature root exhibited higher stiffness and more stable crack progression, likely due to thicker dentine walls and enhanced structural support. These findings suggest that RET-treated teeth with less mature roots may not experience higher stress under load, but their reduced resistance to crack growth poses a higher fracture risk.

Introduction: This bibliometric study aimed to evaluate the 100 most cited articles on antibiotics in endodontics using the Web of Science database.

Methods: Articles were identified using the keywords "Endodontics" AND "Antibiotics" and ranked by citation count. Key bibliometric indicators including publication and citation trends, study designs, levels of evidence, top sources, authors, countries, institutions, and most frequently occurring keywords were analyzed using Microsoft Excel version-16 and Visualization of Similarities Viewer.

Result: The top 100 most cited articles were published between 1954 and 2022, across 40 different sources, and were authored by 397 researchers from 30 countries. Most publications (76%) were from 2006 to 2019. The United States, Brazil, and England were the leading contributors. Cross-sectional studies and reviews were the most common designs with level of evidence V dominating the database and showing the highest citation impact. The Journal of Endodontics and International Endodontic Journal were the top sources.

Conclusion: This upward trend over the past 2 decades reflects advancements in oral health education and growing research interest. This analysis highlights the influential publications and research trends, offering valuable insights for future studies, clinical practice, and academic collaboration in antibiotic used for endodontic therapy.

Introduction: This systematic review evaluates the types and clinical outcomes of nonmetallic customized post-and-core systems in endodontically treated teeth. Customized systems refer to those individually fabricated to replicate the specific morphology of the prepared root canal.

Methods: A comprehensive search for clinical studies evaluating nonmetallic customized post-and-cores was conducted across five electronic databases (PubMed, Scopus, Web of Science, Cochrane, Elton B. Stephens Company (EBSCO)) and Google Scholar. Two independent reviewers screened studies, extracted data, and assessed risk of bias using Cochrane Risk-of-Bias Tool for randomized controlled trials and Newcastle-Ottawa Scale for cohort studies. Data from all included studies were presented descriptively using tables.

Results: Twelve studies with 829 teeth were included in the review. Indirect fabrication materials included computer-aided design/computer-aided manufacturing milled zirconia, polyetheretherketone, and polyetherketoneketone. Direct chairside methods evaluated individually formed (EverStick Post and Ribbond) and rigid (bundle fiber posts and prefabricated fiber posts relined with composite resin) fiber-reinforced composite systems and corono-radicular direct composite. Computer-aided design/computer-aided manufacturing milled zirconia posts exhibited comparable clinical outcomes to conventional cast posts, while polyetheretherketone and polyetherketoneketone posts showed lower survival, with a high incidence of debonding. Individually formed fiber-reinforced composite systems demonstrated favorable failure patterns.

Conclusions: Although these post-and-core systems appear promising, the available data were limited and show considerable variability in terms of materials used and fabrication techniques, resulting in significant heterogeneity that precludes meaningful comparative analysis. Each evaluated system has its own advantages and limitations that shall be considered individually when planning for the final restoration for an endodontically treated tooth.

Introduction: To investigate long-term (10- to 15-year) survival and success rates of endodontically treated cracked teeth and to identify possible prognostic factors related to their survival and success.

Methods: Patients who had endodontically treated cracked teeth were seen for a 10- to 15-year review. Preoperative and intraoperative treatment records were retrieved. Clinical and radiographic evaluations were performed. Two outcomes were investigated: survival (tooth present) and success (asymptomatic with complete radiographic healing). The 10- and 15-year tooth survival and success rate were estimated. Cox proportional hazards regression assessed the impact of various factors on the time to tooth extraction and time to complete healing.

Results: Data from 196 patients with 204 endodontically treated cracked teeth were analyzed. The 10- and 15-year survival rates were 66% (95% confidence interval [CI]: 60%-73%) and 55% (95% CI: 48%-63%), respectively. Success rates declined from 64% at 10 years to 37% at 15 years. Preoperative probing depth (PD) was the primary statistically significant factor for survival. Teeth with no preoperative PD (<4 mm) had higher survival rates of 76% at 10 years and 64% at 15 years. Multivariable analysis revealed significantly increased risk for teeth with PD of 4-5 mm (adjusted hazard ratio [aHR] = 2.48, 95% CI: 1.41-4.38, P = .002) and ≥6 mm (aHR = 3.19, 95% CI: 1.56-6.54, P = .002) for survival analysis. Older age was a modest independent risk factor (aHR = 1.03 per year, 95% CI: 1.00-1.05, P = .026) for survival.

Conclusions: Endodontic treatment of cracked teeth with favorable preoperative PDs demonstrates long-term survival comparable to noncracked teeth and is a viable long-term treatment option which should be recommended.

Introduction: This study compared the 3-year outcomes of a conventional endodontic treatment protocol (CEP) and a minimally invasive endodontic protocol (MIEP) incorporating GentleWave (GW) technology.

Methods: A total of 114 patients from 2 endodontic specialty clinics were included in this retrospective study. Patients received either the MIEP/GW protocol, obturated using the warm vertical compaction technique and a bioceramic sealer, or the CEP protocol, obturated using the single-cone technique and a bioceramic sealer. Clinical and radiographic evaluations were performed at the 36-month follow-up. Treatment outcomes were categorized as success or failure according to both strict and loose criteria. Data were analyzed using the Chi-square test or Fisher's exact test.

Results: Of the 114 patients, 110 completed the 36-month follow-up, yielding a 96.5% recall rate. No moderate or severe postoperative pain was reported in the MIEP/GW group, which was significantly lower than in the CEP group (P < .05). The MIEP/GW group showed comparable success rates to the CEP group-88.7% and 69.4% versus 81.3% and 54.2% under the loose and strict criteria, respectively (P > .05).

Conclusions: The MIEP/GW protocol achieved comparable success rates and demonstrated a lower incidence of moderate or severe postoperative pain compared with the conventional approach. These findings suggest that MIEP incorporating GW technology may serve as a reliable and effective alternative to conventional endodontic treatment.

Introduction: The need for removal of tricalcium silicate-based sealers in endodontic retreatment is increasing, but it is challenging due to their limited solubility. Therefore, new solvents are needed.

Methods: In vitro solubility assays of EndoSequence BC sealer (BC) were prepared and evaluated in 7 groups (n = 10): pH 4 buffer (B4), pH 6 buffer (B6), pH 7 deionized water (H₂O), pH 8.16 buffer B8, pH 10 buffer (B10), 17% ethylenediaminetetraacetic acid (EDTA), and pH 10 buffered 17% EDTA (E10). Ex vivo dentin disks were immersed in either B4 or E10, then the time-of-flight secondary ion mass spectrometry was used to quantify dentin decalcification. Extracted teeth were instrumented and obturated using a single cone technique with BC short of working length and the apical 2 mm filled only with sealer. Three groups (n = 11) of teeth were retreated by a single blinded operator with either H₂O, EDTA, or E10 until patency was obtained. Results were analyzed using two-way ANOVA with post hoc tests.

Results: Solubility values for each group were: B4, 48.6% ± 2.8; B6, 41.4% ± 4.6; H₂O, 13.5% ± 1.9; B8, 13.2% ± 3.2; B10, 11.4% ± 3.4; EDTA, 32.6% ± 6.4; and E10, 51.1% ± 4.7. BC was significantly more soluble in both B4 and E10 than in the other groups. There was no significant difference in solubility or dentin decalcification between B4 and E10. Patency rates and time to achieve patency did not differ significantly among all groups.

Conclusions: E10 is an effective solvent for BC during endodontic retreatment procedures but does not affect the ability to regain patency.