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Aim: This prospective clinical study analyzed the 24-month outcome of conventional apical surgery retro-filled with calcium-silicate cement versus apical surgery with simultaneous orthograde retreatment by means of clinical and radiographic criteria. Materials and methods: This study included 83 teeth affected by persistent periapical lesions in 68 patients. Mean age was 52 years (median = 51 years; range 19–81 years). Twenty-eight cases were treated with apical surgery, 16 cases with apical surgery with simultaneous orthograde retreatment and 39 cases with orthograde retreatment in previously treated teeth established as control group. Periapical index score (PAI) was used as radiographic criteria. Teeth were examined at 6 months, 1 and 2 years and classified as healed (without any symptoms and PAI ≤ 2), healing (without any symptoms and PAI = 3) or diseased (with symptoms or PAI ≥ 4 and not functional) on the basis of radiographic and clinical criteria. At 24 months evaluation, healed and healing were considered as success and diseased and fracture as failure. Multilevel GLM model and an ordered logistic regression as statistical analysis was made with level of significance set at p

Aim To evaluate the two-year success rate of primary root canal treatment performed with two integrated shaping and filling systems on upper central incisors with chronic periapical pathosis. Methodology The trial enrolled 60 patients with an untreated maxillary central incisor presenting a chronic periapical lesion smaller than 5 mm in diameter, who were randomly assigned to two treatment groups: G1 ( n = 30), Revo-S/One Step Obturator; G2 ( n = 30) GTX/GTX Obturator. The patients underwent single-session root canal treatments by an experienced endodontist and were followed up for two years. The clinical evaluation entailed percussion and palpation tests. Two independent examiners rated the radiographic healing on the basis of a previously described scale. Comparability between groups in terms of baseline clinical parameters was tested with a Mann-Whitney test (age, apical gauging) and χ 2 test (tenderness to percussion and palpation). The comparison of clinical data and radiographic healing scores between the groups and among time points was carried out with non-parametric statistical methods ( p Results The two groups were comparable in terms of baseline clinical parameters. All patients were available for the re-evaluation after two years. Only one patient per group was positive to the clinical tests at the final recall. An improvement of radiographic healing scores along the follow-up period was observed. After two years, the lesions were scored as totally healed, partially healed and not healed in 93.3%, 3.3% and 3.3% of cases in G1 and in 93.3%, 0% and 6.7% of cases in G2, without pointing out statistically significant differences between groups. Conclusions Both the two tested integrated shaping and filling systems proved to be effective for the treatment of upper central incisors with periapical pathosis. When monitoring the healing of periapical lesions, follow-up times longer than one year may be required to observe complete healing.

Aim To assess the 18-month success rate of root canal treatment with two integrated shaping and filling systems on upper central incisors with chronic periapical pathosis. Methodology Sixty patients with an upper central incisors with a chronic periapical lesion smaller than 5 mm in diameter were randomly allocated to two treatment groups, which only differed in terms of canal shaping and filling protocol: G1 (n = 30), Revo-S/One Step Obturator; G2 (n = 30) GTX/GTX Obturator. The patients underwent clinical assessment at baseline and after 6, 12 and 18 months. Radiographic healing was scored according to a previously described scale by two independent examiners, who analysed the periapical radiographs taken at the recall visits. Intra- and inter-observer reliability was tested with Kappa statistics. The significance of the differences between the two groups and among time points with regard to clinical and radiographic data was evaluated with non-parametric tests (p Results All enrolled patients were available for re-evaluation. At the final recall, the cases were scored as total healing, partial healing and failure with the following frequencies: 93.3%, 3.3% and 3.3% of cases in G1 and in 93.3%, 0% and 6.7% of cases in G2. Radiographic healing scores were similar in the two groups irrespective of the experimental time point. The prevalence of symptoms was scarce (0–10%), stable over time and similar in the two groups. Conclusions The clinical performance of two considered integrated systems for the endodontic treatment of upper central incisors with periapical lesion was comparable and allowed for high success rates after 18 months.

Aim In Endodontics, a complete chemo-mechanical cleansing of the root canal system is essential to achieving success, which is gained through adequate tridimensional obturation of the endodontic space. Materials and methods Today, thanks to modern technologies as Operative Microscope, ultrasonic tips, M-Wire Files, devices to activate irrigation and tridimensional obturation performed with thermo plasticized gutta-percha, satisfactory results can be obtained. Results This study shows all the technologies that are available today to increase the chemo-mechanical cleansing and obturation of the entire and complicated endodontic system. Conclusions The positive results highlighted by these clinical cases demonstrate how the use of modern technologies are essential to avoid iatrogenic injury, and guarantee, on the other hand, safe and reproducible results.

Aim To assess preliminarily the success rate of the root canal treatment with two integrated shaping and filling systems of upper central incisors with chronic periapical pathosis. Methodology Sixty adult subjects with an untreated maxillary central incisor presenting a chronic periapical lesion smaller than 5 mm in diameter were recruited for the present study. The patients were randomly divided into two treatment groups: G1 ( n = 30), Revo-S/One Step Obturator; G2 ( n = 30) GTX/GTX Obturator. All root canal treatments were performed in a single session by the same operator. Sensitivity to palpation and percussion was registered at baseline and at the six-month recall. Radiographic healing was scored by two blind examiners according to a previously described scale. The absence of statistically significant differences in terms of baseline clinical parameters between the two groups was assessed by means of a Mann–Whitney test (age, apical gauging) and χ 2 test (sensitivity to percussion and palpation). The radiographic scores attributed to the two groups were compared with a Mann–Whitney test, while a χ 2 test served to compare the clinical data gathered after six months ( p Results Baseline clinical parameters registered in the two groups were found to be comparable. All patients attended the six-month recall and all the teeth were referred to be negative to sensitivity, with the exemption of two subjects per group. The periapical lesions were scored as totally healed, partially healed and not healed in 43.4%, 53.3% and 3.3% of cases in G1 and in 43.3%, 50.0% and 6.7% of cases in G2. The differences between the groups were not significant. Conclusions Tough cases scored as incomplete healing should be further followed up, the present study attests that the two tested integrated shaping and filling systems are capable of high and comparable six-month success rate in upper central incisors with periapical pathosis.

Aim: Evaluate the antibacterial efficacy and depth of action into dentinal tubules of different antibiotic mixtures used for dental pulp regeneration (1-9). Methodology: Cylindrical specimens of radicular dentine (n = 72), sterilized with ethylene oxide, have been infected with Enterococcus Faecalis (3 × 107 CFU/mL) for 3 weeks (10). Specimens were randomly assigned to 3 experimental groups (n = 20) plus positive (n = 6) and negative (n = 6) controls. • TRIMIX group (ciprofloxacin, metronidazole and minocycline) • BIMIX group (ciprofloxacin and metronidazole) • TRICLARITRO group (ciprofloxacin, metronidazole and clarithromycin) Each experimental group was divided in two subgroups exposed to antibiotic paste formulations added to macrogol (MG) or ialuronic acid (HA). After 3 weeks o exposition to antibiotic formulations, all specimens were vertically fractured and analyzed with confocal laser scanning microscopy (CLSM) and viability staining (Live/Dead BacLight Viability Stain) to quantitatively evaluate the ratio of dead/live bacteria into dentine tubules (11-12). Volume ratio of red fluorescence (Dead bacteria) was calculated in three-dimensional reconstructions. Differences among groups were analyzed with Kruskall-Wallis and post-hoc Dunn's test (P 0,05). All antibiotic mixtures conveyed by HA showed a better efficacy compared with MG (P 0,05). Conclusions: TRICLARITRO antibiotic mixture showed an effective antibacterial action deep into dentinal tubules, without the risk of tooth crown staining (10).

Aim The targets of the endodontic therapy are damaged tissue and bacteria removal from the canals and dentinal tubules and the prevention of recontamination after the treatment. Introduction Correct endodontic treatment has to follow several parameters: proper diagnosis, isolation of operating field, full chemo-mechanical preparation of the complex endodontic system, three-dimensional obturation of the root canals, post endodontic restoration. Respecting all these parameters short and long term success can be achieved. Materials and methods In this article an orthograde retreatment of maxillary first molar has been described, which showed at pre-operative X-ray, an incongruous endodontic therapy, the failed finding of the fourth canal and the presence of periapical lesions. Discussion A high percentage of failures is due to missed root canals and therefore not cleansed, shaped and it is essential to use modern technologies to achieve safe and reproducible results. Conclusions The endodontic retreatment of this right maxillary first molar was performed with the proper protocols and sophisticated tools, with which we can achieve success in the short- and long-term treatments.

Aim In endodontics a complete chemo mechanical cleansing of the complex root canal system is essential in order to achieve a theraupetic success. Methodology Sodium hypoclorite due to its antimicrobial and proteolytic characteristic, is an efficient endodontic irrigant and it is the most commonly used. The following article introduces a refined technique in order to increase the degree of cleansing during endodontic treatment. The technique involves intracanal heating of the irrigants through a heat source. Results The described technique is able to enhance simply and considerably the use of sodium hypochlorite, making it easily accessible even to generic operators. Conclusions To confirm the validity of this improved technique, further research and scientific studies are needed, although at the clinical level, the results by using it are very satisfactory.

Aim Aim of this study was to compare the removal of smear layer and organic debris within the tooth canal among conventional needle irrigation, EndoVac and Endoactivator. Methodology Eighty single-rooted extracted human teeth were prepared with rotary NiTi instrumentation and randomly separated into 4 groups. Twenty teeth were used as positive control (Group 1), irrigated with only saline. Teeth assigned to Group 2 ( n = 20) received irrigation with a conventional syringe and a 30-gauge needle (NaviTip, Ultradent, South Jordan, UT); samples in Group 3 ( n = 20) were rinsed with an irrigation device based on apical negative pressure (EndoVac, Discus Dental, Culver City, CA) and teeth in Group 4 ( n = 20) were treated with a sonic irrigation system (EndoActivator, Dentsply Tulsa Dental, Tulsa, OK, USA). The amount of residual smear layer and debris was evaluated under a scanning electron microscope, and a semi-quantitative score was assigned to each root at the coronal, middle and apical thirds; the chi-square test was used to compare the results of the S.E.M. analysis. Results EndoActivator performed the best cleansing for both smear layer and organic debris in all root canal thirds, followed by EndoVac and conventional irrigation ( p > 0.001). EndoVac and conventional irrigation showed better cleaning in the coronal area, whereas EndoActivator performed an homogeneous cleansing at all levels. Conclusions The EndoVac system and the EndoActivator system demonstrated significantly more efficacy in cleansing root canal walls than conventional needle irrigation.

Aim To evaluate the wear of new rotary instruments produced via electro discharge machining and to test their fatigue resistance. Methodology Twenty-one HyFlex EDM (Coltene/Whaledent, Switzerland) files were used for laboratory instrumentation of curved root canals of extracted teeth. Superficial characteristics were analyzed pre- and postoperatively by scanning electron microscopy (SEM) (JSM-5200, JEOL, Tokyo, Japan) at same points and with same angulations to identify the wear features. Number of fractures, microcracks blunt/disruption of cutting edge and tip deformations were reported. Twenty HyFlex EDM and 20 HyFlex CM (Coltene/Whaledent, Switzerland) were subjected to cyclic fatigue test in a 70° artificial metal canal. Results were statistically analyzed using Mann–Whitney tests. Results No fractures were registered during laboratory canal instrumentation. No wear and no degradation of the 25.12 and 25.08 files were reported. Slight plastic deformations were only observed in three 10.05 files. The cyclic fatigue test revealed a significant increase of fatigue resistance of EDM files compared to CM (p = 0.0001). Conclusions The typical irregular surface of HyFlex EDM remained unaffected after multiple uses, confirming a high wear resistance. The new manufacturing process of electrical discharge machining had a substantial impact on fatigue lifetime of EDM files when compared with HyFlex CM. Within limitations of the present in vitro results, EDM files appeared suitable in shaping severely curved canals.