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Objective: An altered sensation during endodontic treatment can occur due to the extrusion of endodontic materials. This study aims to discuss intentional replantation to address paresthesia resulting from an endodontic file penetrating the inferior alveolar nerve canal and provide a protocol for managing nerve injuries in such incidents. Case presentation: A 12-year-old girl developed paresthesia when an endodontic file separated and was inadvertently pushed through the apical foramen into the inferior alveolar nerve canal during root canal treatment of the mandibular left first molar. A CBCT scan revealed the file penetrating the canal towards the inferior border of the mandible. After considering the treatment options, intentional replantation was deemed suitable. The tooth was atraumatically extracted and preserved in sterile saline. The surgeon then carefully cleaned and irrigated the socket. The radiographic assessment confirmed successful file removal from the socket. The root ends were resected, and retrograde preparation and obturation were conducted using ultrasonic tips and mineral trioxide aggregate. The tooth was then replanted into the socket. Successful replantation was confirmed by tooth stability and an audible click. The patient was prescribed antibiotics and steroids. After completion of the endodontic treatment, a stainless steel crown was cemented. The successful intentional replantation procedure resulted in rapid improvement in the patient's condition. The normal sensation had been restored, indicating nerve recovery. At the 15-month follow-up, periapical bone healing and the eruption of the adjacent second molar were observed, affirming the treatment protocol's overall success. Conclusion: Prompt intervention and immediate intentional replantation facilitated direct inspection of the separated file within the socket. Collaboration between an oral maxillofacial surgeon and an endodontist ensures expedited and targeted treatment, leading to favorable outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Dental implants are a common treatment method after tooth loss, the accuracy of which directly affects efficacy and stability. Through a network meta-analysis, this study compared the accuracy of different modalities of implant placement: dynamic navigation (DN), fully guided static navigation (FG), partially guided static navigation (PG), and free handed (FH). Materials and Methods: This study followed the Preferred Reporting Items for Meta-Analyses (PRISMA) guidelines. An electronic literature search was conducted on October 2, 2022. The comparison of implant accuracy in all included randomized controlled trials (RCTs) conformed to at least one of the following: deviation at the implant crown, deviation at the apical portion of the implant, or angular deviation of the implant. Results: Twenty-six articles were included for the qualitative analysis (17 RCTs, 3 prospective studies, and 6 retrospective studies), and the 17 RCTs were included for network meta-analysis. The data included in this study had high consistency, and the funnel plot showed that the articles had low publication bias. Compared to FH, FG and DN had higher accuracy for coronal deviation (P < .05), and FG, DN, and PG had higher accuracy for apical and angular deviations (P < .05). According to the SUCRA (surface under the cumulative ranking curves) value, FG had the highest accuracy for coronal deviation, while DN had the highest accuracy in apical and angular deviations. Conclusions: According to the present results, the accuracies for DN, FG, and PG were higher than those for FH. DN showed the highest accuracy in terms of apical deviation and angular deviation. FG had the best control over the coronal deviation. There was no statistical difference between DN and FG in terms of accuracy. Given the limitations of the current study, further validation is required. [ABSTRACT FROM AUTHOR]

Purpose: To assess whether a recently introduced implant placement micromotor that provides site-specific, operatorindependent cancellous bone density measurements can detect the presence of a cortical bone layer and measure its thickness and density. Materials and Methods: An in vitro experiment was performed on six double-layer polyurethane foam blocks mimicking the jawbone with different cortical thickness/cancellous density combinations. The densities were measured using the micromotor after either removing the cortical layer or leaving it intact, both with and without irrigation. Results: The results were compared by means of nonparametric statistical tests. Independent of irrigation, the micromotor detected the cortical layer when it was left intact and accurately estimated its thickness. The micromotor did not discriminate between blocks when they were considered separately, but it did when they were grouped into four or three classes. Conclusions: The present study suggests that the micromotor may represent a valid device to quantitatively assess bone quality and density. If the micromotor can quantitatively distinguish different cortical/cancellous bone combinations in humans, it may be a helpful tool for performing finely tuned, patient-tailored preparations of the implant seat, making tooth rehabilitation in challenging clinical conditions more predictable. [ABSTRACT FROM AUTHOR]

This canine in vivo study assessed the effect of recombinant human platelet-derived growth factor (rhPDGF) on the healing of periapical tissues following apical surgery. From a total of 96 premolar teeth, 64 teeth from six beagle dogs (2 years old) were classified as experimental and were randomly assigned to four experimental groups (16 teeth per group). After having the pulp extirpated, leaving teeth open to the oral cavity for 1 week, and sealing with an immediate restorative material for 8 weeks, nonsurgical endodontic treatment was performed. A split-mouth design was used, and intra-animal randomization of treatment sides was applied to the groups as follows: apical curettage + 1.5-mm root-end resection (Group 1); apicoectomy + mineral trioxide aggregate (MTA) root-end filling (Group 2); apicoectomy + MTA root-end filling + rhPDGF (Group 3); and apical curettage + rhPDGF (Group 4). The animals were sacrificed 24 months after apical surgery, and histologic and µCT analyses were performed for bone volume loss (BVL). Group 1 showed partial resolution of the periapical lesions without signs of tissue regeneration (BVL: 49.09 ± 10.97 mm3). Group 2 had minimal bone regeneration and showed cementum reformation in 9 teeth, with no direct attachment to the MTA (BVL: 35.34 ± 10.97 mm3). Group 3 showed regeneration of all damaged apical tissues without direct contact between the cementum and MTA (BLV: 4.51 ± 1.55 mm3). Group 4 showed regeneration of PDL, bone, and cementum and attachment of functional cementum fibers (BVL: 2.82 ± 2.3 mm3). The difference in BVL was statistically significant only for Groups 1 and 2 (P < .05). rhPDGF may help regenerate apical tissue structures following apical surgery. [ABSTRACT FROM AUTHOR]

An accurate assessment of the disease extent and lesion size is needed for appropriate therapy decisions of endodontic-periodontic (endo-perio) lesions. CBCT imaging with less radiation and high spatial resolution can provide a comprehensive evaluation of endo-perio lesions. A total of 71 teeth with endo-perio lesions were assessed using CBCT. Periodontal bone defects were studied for bone loss pattern (horizontal/vertical) along with bone loss levels on mesial and distal sides in association with furcation involvement. The periapical lesions were studied for their prevalence and extent based on CBCT PAI Score. Horizontal and vertical bone loss were detected in 54 teeth (76.1%) and 17 teeth (23.95%), respectively. Mean crestal bone loss levels on mesial and distal aspects were 4.80 ± 3.21 mm and 5.74 ± 3.91 mm, respectively. The mean height, width, and depth of furcation defects were 3.19 ± 2.99 mm, 1.94 ± 0.98 mm, and 4.44 ± 1.92 mm, respectively. Periapical lesions were recorded in 55 teeth (77.5%). A CBCT PAI score of 5 was scored in 35 teeth with a mean lesion diameter of 11.3 ± 2.83 mm, while 16 teeth had healthy periapical tissues (scores of 0 and 1). CBCT is a valuable diagnostic tool that can help assess endo-perio lesions by providing morphometric measurements of periodontal bone defects and the extent of associated periapical lesions. [ABSTRACT FROM AUTHOR]

Background/Aim: Root resorption occurs for various reasons and can also be seen as a treatment complication in orthodontics. This study aimed to assess the reliability and quality of YouTube™ videos on root resorption and to assess whether the videos referred to orthodontic treatment and other stimulation factors. Materials and Methods: YouTube was searched using the keyword 'root resorption', which is the most searched term on Google Trends. The first 200 videos identified using the default filter 'sort by relevance' were used. Information such as the source, type, duration, and number of likes were recorded. Videos were analyzed using a 23‐point content scale related to root resorption and divided into groups (poor, moderate, and excellent) based on the Global Quality Score. Results: A total of 95 videos were included in the study. Most were uploaded by dentists or dental clinics (n = 64, 67.4%). The mean number of days since upload was 1536 ± 1254, and the mean duration was 5 ± 4 min. The videos had a mean of 80 ± 515 likes and 7043 ± 35,382 views, and a mean viewing rate of 1131.71 ± 8736.83. The most discussed topic was radiographic signs of root resorption. While the highest content score for the videos was 21, the average score was only 4. The mean GQS was 2 ± 1. Grouping videos by GQS showed that 55 (57.9%) were poor, 38 (40%) were moderate, and 2 (2.1%) were excellent. There was a significant relationship between videos that mentioned orthodontics (n = 62; 65.3%) and higher GQS (p =.036), and a significant difference was between GQS groups for total content levels (p <.001). Conclusions: YouTube videos related to root resorption lack sufficient information and clarity, and their quality needs to be improved. Oral health professionals should strive to produce higher‐quality videos. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the agreement between six currently available periapical radiography‐based methods for measuring the root canal curvatures in mesial roots of mandibular first molars, assessed by two examiners with different proficiency levels. Methodology: Non‐endodontically treated mesial roots of 41 human mandibular first molars were radiographed using the parallelling technique. Two independent observers (a specialist in endodontics and radiology and a final‐year dental student) assessed their root canal curvature using the methodologies described by Schneider (1971, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 32, 271), Weine (1982, Endodontic therapy), Berbert and Nishiyama (1994, Revista Gaúcha de Odontología, 356), Luiten et al. (1995, Journal of Endodontics, 21, 26), Hankins and ElDeeb (1996, Journal of Endodontics, 22, 123) and Pettiette et al. (1999, Journal of Endodontics, 25, 230). Intra‐ and inter‐examiner reliability was assessed using the intraclass correlation coefficient. The differences in curvature angle measured by the different methods were compared using the one‐way anova for repeated measures test, followed by Tukey's post hoc analysis. The effect was calculated using the Cohen's d method. To determine the agreement between methods, the Bland–Altman analysis was used. The significance level was set at 5%. Results: Agreement for the observers was excellent (>0.81) for the six methods considered. For the angle comparisons between methods, the maximum differences were for Schneider versus Weine (35.77°) and Luiten versus Hankins (35.14°), whilst the highest percentage of angles with a difference >10° were Weine versus Luiten and Berbert versus Pettiette (90%) and the comparison Weine versus Hankins presented with the lowest frequency (15%). Excellent agreement was found for five comparisons: Weine versus Luiten (0.940), Berbert versus Pettiette (0.917), Weine versus Pettiette (0.907), Luiten versus Pettiette (0.904) and Berbert versus Luiten (0.812). Compared to Schneider's method, the other methods showed a tendency of increasing difference as the angles became more acute. The other methods exhibited linear differences, remaining constant for smaller and larger angles. Conclusions: Reliability was excellent for all methods assessed separately. Maximum differences in curvature angles were found when comparing Schneider versus Weine and Luiten versus Hankins. Excellent agreement was found for Weine versus Luiten, Berbert versus Pettiette, Weine versus Pettiette, Luiten versus Pettiette and Berbert versus Luiten. In the presence of dilacerations, the method by Schneider was less sensitive. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the reporting quality of Scoping Reviews (ScRs) in endodontics according to the PRISMA Extension Checklist for Scoping Reviews (PRISMA‐ScR) and to analyse their association with a range of publication and methodological/reporting characteristics. Methods: Pubmed, Scopus, and Web of Science databases were searched up to 31 January 2024 to identify scoping reviews in the field of endodontics. An additional search was performed in three leading endodontic journals. Study selection and appraising the quality of the studies was carried out independently by two reviewers. Each of the 20 PRISMA‐ScR items were allocated a score of either 0, 0.5 or 1 to reflect the completeness of the reporting. An item‐specific and overall percentage reporting quality score was calculated and reported through descriptive statistics across a range of publication, as well as methodological/reporting characteristics. A univariable and multivariable quantile regression was performed to identify the effect of publication and methodological/reporting characteristics (year of publication, journal, inclusion of an appropriate reporting guideline, and study registration) on the overall percentage reporting quality score. Association of reporting quality score with publication characteristics was then investigated. Results: A total of 40 ScRs were identified and included for appraisal. Most of the studies were published from 2021 onwards. The overall median reporting quality score was 86%. The most frequent items not included in the studies were: a priori protocol registration (22/40 compliant; 55%), and reporting of funding (16/40 compliant; 40%). Other key elements that were inadequately reported were the abstract (7/40 compliant; 18%), the rationale and justification of the ScR (21/40 compliant; 52%) and the objectives of the study (18/40 compliant; 45%). Studies that adhered to appropriate reporting guidelines were associated with greater reporting quality scores (β‐coefficient: 10; 95%CI: 1.1, 18.9; p =.03). ScRs with protocols registered a priori had significantly greater reporting quality scores (β‐coefficient: 12.5; 95%CI: 6.1, 18.9; p <.001), compared with non‐registered reviews. Conclusions: The reporting quality of the ScRs in endodontics varied and was greater when the ScR protocols were registered a priori and when the authors adhered to reporting guidelines. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to investigate the expression of inflammatory biomarkers (TNF‐α, IL‐10, IL‐1β) and the pulpitis‐associated miRNA (miR‐30a‐5p and miR‐128‐3p) in pulp tissue samples from unrestored teeth with a vital normal pulp (NP), teeth with symptomatic irreversible pulpitis (IP) and in unrestored teeth with periodontal disease, unresponsive to periodontal therapy, and a vital pulp (EP). Methodology: Thirty patients were included in this observational study (10 teeth with NP, 10 teeth with IP, 10 teeth with EP). Dental pulp tissues samples were collected from patients during root canal treatment (RCT). RNA was extracted and qRT‐PCR of target genes (tumour necrosis factor [TNF]‐α, interleukin [IL]‐1β, IL‐10) and miRNAs (has‐miR‐30a‐5p, has‐miR‐128‐3p) performed to assess the expression profile. Fold‐change in expression was calculated using the formula 2−(ΔCt(Exp)−ΔCt(Ctrl)). One‐way anova with post‐hoc Tukey's was used to determine significant differences between groups. The significance level was set at 5% (p <.05). All teeth were also followed up clinically for 1 year and evaluated for a range of endodontic and periodontal‐related outcomes. Results: All investigated genes significantly increased in expression and miRNAs significantly decreased in expression in the IP and EP groups compared with the NP group (p <.05). With regards to TNF‐α and IL‐1β there were no significant differences in expression between the IP and EP groups (p >.05), whereas IL‐10 expression levels were significantly reduced in the EP compared with the IP group (p <.05). Both miR‐30a‐5p and miR‐128‐3p showed significantly reduced expression in both IP and EP lesions, compared with NP (p <.05); however, no significant differences in miRNA expression were observed between IP and EP groups (p >.05). One year after root canal treatment and periodontal maintenance, tooth mobility and probing depth were significantly reduced in the EP group (p <.05). Conclusion: Pulp tissues from teeth with IP and EP presented similar levels of altered inflammatory markers compared with NP. TNF‐α, IL‐10, IL‐1β cytokines and miRNAs (miR‐30a‐5p and miR‐128‐3p) are potential objective biomarkers to indicate pulpal inflammatory status, aiding diagnosis and directing clinical decision‐making. RCT may be beneficial to improve stage III periodontitis unresponsive to non‐surgical periodontal treatment, but further research is required. [ABSTRACT FROM AUTHOR]

Aim: The pathways to post‐operative pain are complex and encompass factors that extend beyond the treatment protocol employed. This study aimed to identify patient‐related predictors of post‐operative pain following root canal treatment. Methodology: A total of 154 patients received a single‐visit root canal treatment for asymptomatic necrotic mandibular molars. Before treatment, dental anxiety, dental fear and sense of coherence (SOC) were measured as predictors for each patient using validated questionnaires. Other measured predictors included gender, age, previous negative experiences at the dental offices and prior root canal treatment. Post‐operative pain was assessed using the Numeric Rating Scale at multiple time‐points over 30 days. Structural equation analysis was employed to evaluate the direct and indirect effects of patient‐related predictors on a theoretical model of post‐operative pain. The irrigant solution was also included in the model, as it was the only aspect that varied in the treatment protocol (sodium hypochlorite 2.5% and 8.25%). Results: Dental anxiety (coefficient 0.028; p <.01), dental fear (coefficient 0.007; p =.02) and irrigant solution (coefficient 0.004; p =.03) exerted a direct effect on post‐operative pain. SOC exerted an indirect effect on post‐operative (coefficient 0.006; p =.01) through dental anxiety and dental fear. Moreover, previous negative experiences (coefficient 0.048; p =.04) exerted an indirect effect on post‐operative pain through dental anxiety. Conclusions: Dental anxiety, dental fear, previous negative experiences and SOC are patient‐related predictors of post‐operative pain following root canal treatment. These factors should be taken into consideration in clinical practice, as patients with these characteristics may be at an increased risk of experiencing post‐operative pain. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the 6‐year outcome of root canal treatment irrigated with 0.5% or 3% sodium hypochlorite (NaOCl). Methodology: The baseline trial was designed as a quasi‐randomized clinical trial. Patients referred for root canal treatment to an endodontic specialist clinic were recruited to the study (n = 298). The concentration of NaOCl was allocated quasi‐randomized to 271 subjects (0.5% [n = 139], 3% [n = 132]). Bacterial sampling was performed immediately before root canal filling. Samples were cultured and evaluated as growth or no growth. Patients were invited to a clinical and radiological follow‐up >5 years postoperatively. The clinical outcome measurements were tooth survival, cumulative incidence of endodontic retreatments, patients' assessment of pain, clinical findings and radiological signs of apical periodontitis (AP). Results: Tooth survival was 85.6% in the 0.5% NaOCl group and 81.1% in the 3% NaOCl group (p =.45). There was no record of retreatment in 94.4% in the 0.5% NaOCl group and in 92.2% in the 3% NaOCl group (p =.76). The percentage of asymptomatic cases were 87.8% in the 0.5% group and 85.3% in the 3% NaOCl group (p =.81). Absence of clinical signs of AP was seen in 86.6% in the 0.5% NaOCl group and in 83.6% in the 3% NaOCl group (p =.80). Absence of radiological signs of AP was seen in 74.0% in the 0.5% NaOCl group and 64.1% in the 3% NaOCl group (p =.20). Subjects with positive culture before root filling reported subjective pain with a significantly higher frequency as compared to negative‐culture subjects (p =.014). Conclusions: The use of 0.5% or 3% NaOCl for irrigation during root canal treatment resulted in similar clinical outcomes 5–7 years postoperatively. Persisting bacteria immediately before root filling may predict future episodes of subjective pain. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Considering side effects of non-steroidal anti-inflammatory drugs (NSAIDs), herbal medicine including Urtica dioica might help reduce the pain. Purpose: The present study aimed to compare the effects of premedication with essential oil of Urtica dioica and ibuprofen on post-endodontic pain. Materials and Method: The present randomized clinical trial study was conducted on 60 patients with symptomatic irreversible pulpitis of mandibular first or second molars. The patients were randomly assigned to three groups (n=20) for premedication with 400 mg ibuprofen, 400 mg essential oil of Urtica dioica (Netonal; Barij, Iran), and placebo. The medications were taken 30 minutes prior to the procedure. The patients' pain score was recorded before the intervention and treatment onset (Time1 or T1), after the intervention prior the treatment onset (10 minutes after anesthetic injection) (T2), upon completion of treatment (T3), and at 8 (T4), 12 (T5), and 24 hours after endodontic treatment (T6) using a visual analog scale (VAS) and Wong-Baker FACES Pain Rating Scale (WBS), and compared. Data were analyzed by Chi-square test, one-way and repeated measures analysis of variance (ANOVA), kruskal-wallis test, and LSD post-hoc test using IBM SPSS statistics version 21 with significance value of p< 0.05. Results: The pain score was not significantly different among the three groups at T1, T2 and T3 according to both scales (p> 0.05). On the other hand, significantly lower pain scores were recorded in ibuprofen and Urtica dioica groups at 8, 12, and 24 hours after treatment compared with the placebo group (p< 0.001). The pain score was not markedly different between the ibuprofen and Urtica dioica groups (p> 0.05). Conclusion: It seems that analgesic effect of premedication with leaf extract of Urtica dioica is the same as ibuprofen. Further studies are warranted to find the optimal dosage of Urtica dioica for widespread use. [ABSTRACT FROM AUTHOR]

Background: Precise knowledge of the apical construction, which determines the end of the area for canal preparation and filling, is essential for the success of root canal treatment and the management of postoperative pain. For this purpose, devices based on various methods that determine the working length (WL) are used. However, it is still controversial which method provides the most accurate measurements. Aim: To investigate the compatibility of the electronic apex locator (EWL) and simultaneous working length determination (SWL) methods in single-root teeth in comparison with the radiographic working length determination (RWL) method and to determine which one produced more effective results in terms of postoperative pain. Materials & methods: One hundred patients scheduled for root canal treatment (RCT) were randomly assigned to one of the three groups according to the working length measurement method (EWL, SWL or RWL). After WL determination with assigned method, root canals were prepared and then obturated. Age, gender, simplified oral hygiene index (OHI-S), oral and dental examinations and Visual Analogue Scale (VAS) results of all participants were recorded. The incidence and intensity of postoperative pain were rated on a Visual Analogue Scale (VAS) by patients 6, 12, 24, 48 h and 7 days after RCT. The number of analgesic tablets (400 mg Ibuprofen) taken by patients was also recorded. Data were analyzed using the chi-square, One- way ANOVA and Kruskal-Wallis tests. Bland-Altman and Passing-Bablock regression analysis were used as method comparison techniques. Results: It was determined that the number of patients receiving analgesia and the total number of analgesia doses were higher in EWL and RWL groups compared to SWL group (p < 0.0001). When the WL values at which the treatment was applied were compared in the patient groups; WL values of EWL group were statistically lower than SWL group (p < 0.01). While there was no difference between the preoperative VAS scores of the groups (p = 0.7590), the postoperative 6th and 12th hour VAS scores of SWL group were lower than those of EWL and RWL groups (p = 0.005 and p = 0.0002, respectively). Again, the VAS scores of SWL group at the 24th and 48th postoperative hours were lower than those of RWL group (p < 0.05). According to the Bland-Altman and Passing-Bablock regression analysis results, although there was no statistically significant difference between the EWL and SWL methods (p = 0.471), the bias value of -0.1190 was well below the acceptable total error (0.1648). Additionally, a strong relationship was found between EWL and SWL methods (r = 0.9698, r2 = 0.9406, p < 0.001). Therefore, statistically these two methods were considered compatible with each other. It was determined that there was a statistically significant bias (0.340, p < 0.0001) between the RWL and SWL methods, exceeding the total error. Conclusions: As a result, it was determined that the SWL method, which is used to determine working length for the success of endodontic treatment, can be used as an alternative to the EWL method thus producing more effective results in the management of postoperative pain. However, in addition to the method used, the technology of the device developed for this method should not be ignored. Clinical relevance: Precise knowledge of the apical construction, which determines the end of the area for canal preparation and filling, is essential for the success of root canal treatment and the management of postoperative pain. For this purpose, devices based on various methods that determine the working length are used. However, it is still controversial which method provides the most accurate measurements. This study found that the simultaneous working length determination method can be used as an alternative to the electronic working length determination method and produces more effective results in the management of postoperative pain. Another important outcome of this study is that the Total Allowable Error (TEa) for the electronic apex locator method, which is accepted as the reference, has been calculated for the first time. Other methods have been evaluated according to this reference method. This is a first in literature. [ABSTRACT FROM AUTHOR]

The root canal systems of maxillary first molar (MFM) and maxillary second molar (MSM) variations represent a clinical challenge for endodontists, especially the prevalence of fused C-shaped roots. Having a thorough knowledge of root canal configuration is an extremely important point for a successful root canal treatment to avoid missing extra canals. The aim of this article was to present 2 cases of maxillary molar with an unusual C-shaped configuration diagnosed during root canal retreatment/treatment and conduct a literature review of the MFM and MSM anatomy. Case 1 reports that three separate palatal root canals fused into a C-shaped configuration in the MFM, which with an enamel pearl in the furcation, was classified as Type D and first reported in MFM. Case 2 reflects the fusion of all three buccal canals of the MSM into a C-shaped configuration that finally formed an apical foramen with a supernumerary tooth, and the configuration was Type B. Evaluation at an 18-month and a 9-month recall revealed that two patients were symptom-free after the conduct of a non-surgical retreatment/treatment, and the X-ray revealed normal periapical tissue. In addition, the thickness of the Schneiderian membrane due to odontogenic maxillary sinusitis returns to normal after an effective retreatment in case 1. These reports serve to remind endodontists of the importance and complexity of anatomical variations, which should always be considered when formulating an effective root canal treatment plan. The combined use of cone-beam computerized tomography (CBCT) and a dental operating microscope (DOM) will be profitable to locate and identify extra canals when a periapical radiograph shows signs of an unusual canal morphology. [ABSTRACT FROM AUTHOR]

Introduction Aims Methodology Results Conclusion Competency in endodontic access cavity preparation requires key motor skills, good conceptual understanding, along with an appreciation of 3‐dimensional pulp chamber anatomy. These are traditionally learned using natural or artificial teeth (AT) mounted within a phantom head (PH). Simodont® (Nissin Dental Products INC, JPN) is a haptic virtual reality simulator (HVRS) and offers an alternative to AT for training.This study aimed to (1) evaluate the evolution in the performance of learners trained to prepare access cavities incorporating Simodont (test group) against learners trained on AT mounted within PH (control group), (2) determine learner acceptability of HVRS.Forty dental students, with no prior endodontic training, were given instruction and video demonstration of access cavity preparation using a mandibular left 1st molar AT (LL6). Thereafter, they prepared an access cavity on PH mounted AT LL6. This provided a baseline record of performance. Participants were randomly assigned to the test or control groups. The test group (n = 22) trained using Simodont: preparing a virtual tooth LL6 for a period of 60 minutes with instructor feedback. The control group (n = 18) trained using AT LL6 on a PH for 60 minutes with instructor feedback. Subsequently, learners from both groups prepared an access cavity on an AT LL6 in a PH. This provided a re‐evaluation record. Two calibrated examiners graded the teeth from the baseline and re‐evaluation using rubric criteria; assigning scores with a grading range from 0 to 17. The examiners were blinded to which group the teeth belonged. Change in performance was determined by calculating the difference in assessment grade from baseline to re‐evaluation. Scores which improved by 3 or more units were labelled improvers, all other scores were described as non‐improvers.Within the test group, the numbers of improvers were 5 (23%) versus 7 (39%) in the control group The difference failed to indicate statistical significance (p = .315). The Cohen kappa values for intra and inter‐examiner agreement were 1.00 and 0.73 respectively.The evolution of skills in learners trained using Simodont is comparable to those trained using AT. It is, therefore, reasonable to use Simodont, which was acceptable to learners, as an adjunct to AT for endodontic access cavity training. [ABSTRACT FROM AUTHOR]

Intracanal medicaments are an important adjunct to the effective disinfection of the root canal system. However, conventional intracanal medicaments do not provide adequate protection against Enterococcus faecalis, which is the organism of interest in many cases of root canal failures. This study aimed to evaluate the influence of biosynthesized calcium oxide nanoparticles (CaO NPs) on the antibacterial activity, pH, microleakage and cytotoxicity of intracanal medicaments. CaO NPs were biosynthesized by the direct thermal decomposition of eggshells (EGS) and the reduction of calcium nitrate with papaya leaf extract (PLE). These nanoparticles were mixed with a proprietary calcium hydroxide powder in 10% and 25% (w/w) concentrations and blended in analytical-grade coconut oil to formulate the experimental medicaments. These were then evaluated for antibacterial activity, pH, microleakage and cytotoxicity at 1 day, 7 days and 15 days. A proprietary calcium hydroxide paste formulation (MX) was used as the control. Means and standard deviations were calculated and analyzed using repeated-measures ANOVA for pH and three-way ANOVA for the antibacterial effect, microleakage and cytotoxicity, followed by LSD post hoc analysis. Significant antibacterial activity was noted against Enterococcus faecalis at all times, with zones of inhibition (ZOI) up to 19.60 ± 2.30 mm. pH levels up to 13.13 ± 0.35 were observed for the experimental groups. Microleakage remained comparable to the control, while cytotoxicity was not observed in any of the groups at any time. Intracanal medicaments formulated with 10% and 25% (w/w) of biosynthesized CaO NPs could be promising candidates for the disinfection of the root canal system compared to conventional counterparts. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion To summarize the current knowledge of the neutrophil extracellular traps (NETs) and its critical role in various oral diseases.We reviewed the recent research on NETs through PubMed and Web of Science. An analysis of recent research results was summarized from three aspects: NETs induction and formation, functions of NETs, and NETs in oral diseases.The relationship between neutrophils and NETs is critical to the body's defense against microbial invasion. NETs can effectively combat pathogens with an anti‐inflammatory effect and meanwhile it can contribute to inflammation. Moreover, it can synergize with other immune cells to respond to stimuli, such as pathogens, host‐derived mediators, and drugs. It was revealed that NETs play different roles to influence various oral diseases like periodontitis, endodontic infection, oral mucosal diseases, maxillofacial tumors, and many other oral diseases.The balance between the protective and potentially harmful effects of NETs is a key factor in determining the outcome of infections and inflammatory responses. The role of NETs in oral diseases needs to be further studied to enable better understanding of its role in the different oral diseases. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Discussion Conclusions Artificial intelligence (AI), a field within computer science, uses algorithms to replicate human intelligence tasks such as pattern recognition, decision‐making and problem‐solving through complex datasets. In endodontics, AI is transforming diagnosis and treatment by applying deep learning algorithms, notably convolutional neural networks, which mimic human brain function to analyse two‐dimensional (2D) and three‐dimensional (3D) data.This article provides an overview of AI applications in endodontics, evaluating its use in 2D and 3D imaging and examining its role as a beneficial tool or potential challenge.Through a narrative review, the article explores AI's use in 2D and 3D imaging modalities, discusses their limitations and examines future directions in the field.AI significantly enhances endodontic practice by improving diagnostic accuracy, workflow efficiency, and treatment planning. In 2D imaging, AI excels at detecting periapical lesions on both periapical and panoramic radiographs, surpassing expert radiologists in accuracy, sensitivity and specificity. AI also accurately detects and classifies radiolucent lesions, such as radicular cysts and periapical granulomas, matching the precision of histopathology analysis. In 3D imaging, AI automates the segmentation of fine structures such as pulp chambers and root canals on cone‐beam computed tomography scans, thereby supporting personalized treatment planning. However, a significant limitation highlighted in some studies is the reliance on in vitro or ex vivo datasets for training AI models. These datasets do not replicate the complexities of clinical environments, potentially compromising the reliability of AI applications in endodontics.Despite advancements, challenges remain in dataset variability, algorithm generalization, and ethical considerations such as data security and privacy. Addressing these is essential for integrating AI effectively into clinical practice and unlocking its transformative potential in endodontic care. Integrating radiomics with AI shows promise for enhancing diagnostic accuracy and predictive analytics, potentially enabling automated decision support systems to enhance treatment outcomes and patient care.Although AI enhances endodontic capabilities through advanced imaging analyses, addressing current limitations and fostering collaboration between AI developers and dental professionals are essential. These efforts will unlock AI's potential to achieve more predictable and personalized treatment outcomes in endodontics, ultimately benefiting both clinicians and patients alike. [ABSTRACT FROM AUTHOR]

Background/Objectives: Root canal treatment (RCT) is a crucial procedure for preserving dental health. While its clinical success rates are well documented, patient-reported outcomes regarding quality of life remain less explored. This study aimed to assess the long-term impact of RCT performed in an educational hospital on patients' oral-health-related quality of life (OHRQoL) using the Oral Health Impact Profile-14 (OHIP-14). Methods: A total of 1500 patients who underwent non-surgical RCT between April 2018 and February 2023 were called and invited for a follow-up visit. During the visit, all teeth that had undergone RCT were assessed clinically and radiographically by two calibrated examiners to evaluate RCT quality and pre- and post-treatment periapical index (PAI) scores. Demographic information and OHIP-14 responses were collected, and the data were recorded. Results: Patients reported high levels of satisfaction (95%) and no negative impact on their OHRQoL. Statistical analysis revealed that post-operative periapical index (PAI) scores (p < 0.001), patient gender (p = 0.003) and nationality (p = 0.029) significantly influenced OHRQoL perceptions; Conclusion: These findings emphasize the effectiveness of RCT in enhancing patients' quality of life and highlight the impact of demographic factors—such as gender and whether the patient is a resident or a national of the country, along with post-treatment severity of the disease—on patient-reported outcomes. [ABSTRACT FROM AUTHOR]

Performing endodontic treatment on a tooth with an immature apex can be challenging due to the risk of irrigant extrusion beyond the apex. This narrative review investigates the over-apex extrusion of activated irrigants in teeth with open and immature apices and aims to provide crucial insights for practice and research. Two hundred fifty-two results were found from the electronic search. Sixteen duplicates were removed before selection, and 24 were excluded. Of the 212 remaining results, the full text was evaluated for eligibility. One hundred ninety-four results were excluded: in one hundred sixty-five, irrigant activation was not performed; twenty-nine were animal studies; in seven, irrigant activation was not performed to disinfect the canal. Finally, 13 studies were included. They cover a range of topics, from the types of irrigants used to the techniques of activation, and their findings contribute to our understanding of the risks and consequences of irrigant extrusion. All the activation techniques investigated can, to varying degrees, cause the irrigant to extrude beyond the apex. Extrusion may not always be clinically relevant; however, the consequences of excessive irrigant leakage from the apex are dangerous, so try to assess all the variables that may cause it and adopt techniques to reduce it. [ABSTRACT FROM AUTHOR]

Background: First permanent molars (FPM) are highly susceptible to decay before the age of 15. When they are severely affected, the decision between conservation and extraction arises, particularly considering the potential for the second permanent molar (SPM) to replace the FPM. This cohort study aimed to evaluate clinical practices regarding FPM pulp necrosis treatment in children aged eight to twelve in two hospital departments in the Paris region. A second objective was to evaluate the one-year outcomes of the two therapies. Methods: A retrospective analysis was conducted using computerized billing software to identify patients aged eight to twelve who underwent either extraction or root canal treatment (RCT). Data collected included sex, age, arch involved, number of decayed surfaces, presence of Molar Incisor Hypomineralization (MIH), presence of infection, and treatment type. Results: A total of 66 patients were included, representing 61 extracted teeth and 23 RCT. Three main decision criteria were identified: presence of MIH (p < 0.005), extent of decay (p < 0.05), and SPM Nolla's stage. A total of 48% of the patients were seen at one year. A total of 16 of the 32 extractions and five of the nine RCTs had favorable evolution (p = 1). Conclusions: The question of whether to perform RCT or extraction of necrotic FPM in children aged eight to twelve is difficult to assess. It appears that five criteria need to be considered before the decision: possibility of long-term sealed coronal reconstruction, SPM Nolla's stage, follow-up possibilities, arch concerned, and presence of third permanent molar. [ABSTRACT FROM AUTHOR]

Objectives: Sealers are an important component in root canal obturation to provide the seal of the root canal system. In recent years, there has been an increase in the use of hydraulic silicate sealers, commonly referred to as bioceramic sealers, due to their many advantageous properties. NeoSealer Flo (NS; Avalon Biomed USA, Houston TX) is a recently introduced premixed bioceramic sealer. There is limited evidence on its properties and clinical performance. Therefore, the purpose of this study was to evaluate the outcome of root canal treatment using NS in a sealer-based obturation technique. Materials and Methods: The records of patients in a private practice between 2017 and 2022 were analyzed to identify both initial and retreatment cases obturated with either EndoSequence BC sealer or NS using sealer-based obturation with a minimum of one-year follow-up. Treatment outcome between NS and BC was compared with chi-square test. Logistic regression was used to identify additional prognostic factors. Results: Six hundred and eighty-seven teeth met the inclusion criteria for the study. The success rate of cases obturated with BC was 94.9% and 96.5% for the cases obturated with NS. No statistically significant differences were found between the two sealer types. Presence of a periapical radiolucency or periapical radiolucency > 5.00 mm were statistically significant prognostic factors. Conclusions: Endodontic treatment using BC or NS with sealer-based obturation method is a viable treatment option. Clinical Relevance: Root canal obturation with bioceramic sealers, such as NeoSealer Flo and Endosequence BC sealer, provide favorable clinical outcomes. [ABSTRACT FROM AUTHOR]

The current advances and innovations in material technology and armamentaria help to negate the difficulties faced by clinicians in diagnosing and treating patients. Oral healthcare contributes much to the wellbeing of a person. However, the oral cavity is a small and difficult area in which to work since it is filled with vascularized mobile tissues and various shaped teeth, and connected to sinuses, nerve canals, lungs and the gastrointestinal tract via the trachea and pharynx. Moreover, each tooth has a complex root canal system that must be explored if it is infected or inflamed. Root canal treatment can be compared to entering a blind tunnel and treating something unseen. Endodontics is a field in dentistry where a clinician must use their tactile sense and correlate it with clinical knowledge, as well as skill, to treat dental infections. Digital evolution has simplified diagnosis, treatment planning, documentation and communication with patients, rendering more predictable outcomes and providing evidence for the healing or non-healing of disease. The evolution of digital radiography has offered us the best technology available. The present review discusses various helpful digital tools that are currently available, and future technologies that may guide clinicians in better diagnosis. CPD/Clinical Relevance: Advances in diagnostic tools have improved accuracy in identifying and treating dental pathologies, thereby achieving more predictable outcomes and enhancing patient care. [ABSTRACT FROM AUTHOR]

There are a number of protocols that the clinician has to consider when providing implant treatment. Immediate implant placement has its place in implant dentistry and should be considered following a strict case selection. This article discusses the factors that should be taken into account when planning and providing immediate implant placements, with an emphasis on achieving a good outcome. The evidence base is discussed with a description of the surgical stages involved and subsequent restoration. Cases to illustrate this technique and its limitations are presented. CPD/Clinical Relevance: Principles for single tooth implant replacement in the anterior maxilla, where aesthetic expectations are high are relevant to clinicians. [ABSTRACT FROM AUTHOR]

Background: The shaping of root canal space was completed using manual stainless steel files in earlier decades and with the advent of mechanical nickel–titanium (NiTi) instruments, there is potential for more efficient root canal preparation. Despite the advantages of NiTi instruments, their adoption in undergraduate dental education remains limited. The aim of this study was to evaluate three root canal instrumentation techniques, manual instrumentation using stainless steel hand files, continuous rotation employing ProTaper Gold (PTG) files, and reciprocation with WaveOne Gold (WOG) files, on endodontic resin blocks to assess the quality of preparation and the time required for instrumentation. Methods: A total of 36 third-year dental students, all lacking prior experience in root canal procedures, were divided into six groups to prepare 108 resin endodontic blocks with each student preparing 3 blocks. Images were captured at the preoperative, intraoperative, and postoperative stages to facilitate comparisons and measurements of the prepared blocks to assess the degree of resin removal, apical deviation, and mid-cervical wear. Furthermore, questionnaires were distributed to assess the students' experiences and satisfaction with the techniques. The Friedman test, Wilcoxon test with Bonferroni correction, and Kruskal–Wallis test with Mann–Whitney U test were used to analyse and compare techniques, with the level of significance set at p < 0.05. Results: Instrumentation with PTG exhibited significantly reduced apical deviation (0.073 ± 0.003) compared to both the WOG and manual instrumentations (p < 0.001). Significant differences in mid-cervical wear were observed only between PTG and the manual instrumentation. In terms of resin removal, the manual instrumentation displayed greater variability and was five times slower to complete the instrumentation. In total, 90% of students favoured mechanical instrumentation, with substantial preferences for them over manual techniques. Conclusions: Mechanical instrumentation techniques, notably with the PTG system, were significantly faster and more effective in preparation quality. This highlights the potential for the inclusion of mechanical instrumentation in undergraduate dental curricula. [ABSTRACT FROM AUTHOR]

Periapical radiography is a regular radiographic procedure performed by dentists. However, at times, it may not be possible to position the image receptor into a patient's mouth in an optimized or practical way. For these cases, some dentists advocated the use of extraoral periapical radiography (EOPA). This literature review aimed to review the dental literature on the use of EOPA. In October 2023, PubMed, Web of Science, and Scopus were searched to identify papers that reported on the use of EOPA, supplemented by manual reference tracing and Google Scholar searches. After screening, 18 papers published between 2003 and 2022 were identified, including 14 original articles and 4 reviews. From very limited and conflicting evidence, it was found that root length/working length measurements between EOPA and IOPA did not significantly differ or EOPA showed inferiority. No data were available to compare EOPA with other extraoral modalities such as panoramic radiography. The technique used in EOPA to visualize posterior teeth in the maxilla and mandible varied across studies, such as the vertical angulation of the primary beam, whether mouth should be opened or closed, and whether a holder should be used or not. At the current time, EOPA probably should not be advocated for regular use. [ABSTRACT FROM AUTHOR]

Background: This series investigates the efficacy of regenerative endodontic therapy (RET) using various platelet-rich fibrin (PRF) formulations in treating apical periodontitis and necrotic pulp in immature permanent teeth. Aim: This study aims to evaluate the effectiveness of different PRF formulations in RET. Materials and Methods: Three cases involving patients aged 15–16 with immature teeth and necrotic pulp were treated with RET using PRF, injectable PRF, and advanced PRF. The procedure included inducing bleeding with a Hedstrom file, applying PRF variants, and sealing with mineral trioxide aggregate and composite resin. Patients were followed up at 1, 3, 6, 12 and 18 months. Results: Radiographic evidence showed apical closure, root maturation, and healing of periapical tissues in all cases. However, pulp sensibility tests were negative. Conclusion: RET using PRF variants promotes root development and apical healing in immature teeth. Further research with larger sample sizes is needed to understand these therapies' potential and limitations. [ABSTRACT FROM AUTHOR]

Context: Postoperative pain occurs in 25%–60% of patients following endodontic treatment. It can significantly impact a patient's quality of life and requires timely management or, preferably, prevention. Aims: The present systematic review was conducted aiming to analyze randomized controlled trials that compared postoperative pain in patients whose canals were shaped by XPS versus other endodontic file systems. Materials and Methods: A systematic search was performed using key terms "postoperative pain" AND "XP-endo Shaper" across multiple databases to identify relevant randomized controlled trials. Details concerning the study design, endodontic preparation, XP-endo Shaper-related factors, and pain assessment were recorded. The risk of bias was calculated using the RevMan 5.3 software. Meta-analysis done using the random effects model which was represented using forest plots. Results: Six studies evaluating a total of n = 290 samples of XP-endo Shaper file and other file systems each, respectively, were included in the final review and meta-analysis. The standard mean difference ranged from 0.8 to 2.88 with a mean of 1.04 (0.80–2.88) favoring other file systems. This signifies that the postoperative pain is on average 1.04 times more by other file systems as compared to XP-endo Shapers file although the difference was statistically nonsignificant (P > 0.05). Conclusions: XP-endo Shaper has proven to be a relatively more efficient file system that effectively cleans and shapes the root canals, including those with difficult anatomy. [ABSTRACT FROM AUTHOR]

Objective: The aim of this systematic review was to evaluate the influence of maintaining apical patency (AP) in endodontic treatment outcome. Methodology: An electronic database search was performed in PubMed, Cochrane Library, LIVIVO, LILACS, and EBSCO host from inception till July 2024. The data from the included articles were extracted and the quality was assessed using the Cochrane Collaboration tool and ROBINS-I tool. Results: Five articles were included for the qualitative synthesis, and all the included articles were determined to have a low risk of bias. Maintaining the AP resulted in two-fold increase in the healing outcome with long-term follow-up. Conclusion: It can be concluded from this systematic review that maintaining AP is likely to enhance the endodontic treatment outcome. However, more long-term clinical studies are required to further evaluate the possible influence of AP. Registration: The protocol of this review was registered in the PROSPERO database with registration number: CRD42022374966. [ABSTRACT FROM AUTHOR]

The article describes interdisciplinary dentistry (ID) and how it can be applied to better care for pediatric patients. Topics discussed include the interdisciplinary dental treatment process, ID treatment plan, and University of Washington interdisciplinary dentistry example interdisciplinary problem list template.

Background: Different pulp capping materials have different origins and compositions, require different preparations, and may vary in their bioactive properties. Aim: The purpose of this study was to evaluate the antibacterial activity, biocompatibility, and mineralization‐inducing potential of calcium silicate‐based pulp capping materials. Design: Six contemporary calcium silicate‐based cements, ProRoot MTA, MTA Angelus, Biodentine, EndoSequence, NeoMTA 2, and NeoPutty, were evaluated. The antibacterial effects of these materials against Streptococcus mutans UA159 and Enterococcus faecalis ATCC 29212 were determined by the agar diffusion assay and the direct culture test. The biocompatibility and mineralization‐inducing potential of these materials in preodontoblastic 17IIA11 cells were evaluated by the MTT assay and by Alizarin Red S staining, respectively. Results and Conclusion: In agar diffusion test, only Biodentine showed distinct antibacterial effects against S. mutans. All the tested materials, however, showed antibacterial effects against S. mutans and E. faecalis in the direct culture test, with Biodentine showing the strongest growth inhibition against both S. mutans and E. faecalis. All the tested materials showed acceptable biocompatibility and mineralization‐supporting potential in our experimental conditions. In summary, ProRoot MTA, MTA Angelus, Biodentine, EndoSequence, NeoMTA 2, and NeoPutty demonstrated acceptable in vitro antimicrobial, biocompatible, and mineralization‐supporting properties. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusions To evaluate the current status of endodontic education and assessment at an undergraduate/predoctoral level in dental schools worldwide.The current survey comprised a 50‐item online questionnaire related to undergraduate endodontic education. The project leaders emailed the survey's details to faculty members responsible for endodontic teaching at one dental school in every country to seek their willingness to participate in the survey. After the faculty members accepted, the survey details were sent to participants along with the survey link. Simple descriptive statistics were used to represent the data.Amongst the 44 faculty members from different countries who agreed to participate, 36 completed the survey. Endodontic training starts in 50% of dental schools from the third year of the curriculum. Each dental school employs a diverse range of educational methods. During pre‐clinical training, 19.4% of the participating dental schools used only natural teeth. Stainless‐steel hand instruments, syringe irrigation with a needle, resin‐based sealer and the cold lateral compaction technique are the most frequently used in pre‐clinical and clinical training. A significant percentage of dental institutions necessitate that students treat a predetermined quantity of canals or teeth throughout their pre‐clinical and clinical education. Dental institutions conduct formative, summative or a combination of the formative and summative throughout the clinical and pre‐clinical phases of endodontic training.According to the data collected from this survey, there are considerable variations in the curriculum for undergraduate/predoctoral endodontic programmes amongst the surveyed dental schools. Pre‐clinical and clinical education should integrate a larger array of modern tools and procedures. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare the temperature rise, time consuming and cut quality of apicectomy using three different methods. Materials and methods: Twenty-four single-rooted teeth were collected and divided into four groups operating apicectomy with a NINJA tip of a piezoelectric device (G1), a diamond bur with 300,000 rpm (G2), and Er: YAG laser at 200 mJ/ 30 Hz (G3) as well as 250 mJ/ 30 Hz (G4). The temperature elevation and time were recorded and the cut quality was evaluated via stereomicroscope and scanning electronic microscopy (SEM). Results: The temperature increases for G1 was significantly higher than for G2. However, there was no significant difference between G1 and G2 with laser groups respectively. The median time for apicectomy was: 100.14s for G1, 22.65s for G2, 33.58s for G3, and 21.80s for G4. G1 is the most time-consuming group and there was no statistically significance in the comparisons with G2, G3 and G4. Cut quality was assessed by crack occurrence, smear layer formation and dentinal tubules exposed. The percentage of cracked teeth in G1 and G2 was 33.33% and for laser groups the percentage was 16.67% each. SEM showed that no smear layer formed and almost all dentinal tubules were exposed on resected surfaces for G3&G4, surfaces from G2 were partly covered by smear layer, and surfaces from G1 were fully covered by smear layer and with no dentinal tubules exposed. Conclusions: Er: YAG laser and conventional rotary instruments were safe and efficient for apicectomy and with a better cut quality when compared with piezoelectric equipment. Er: YAG laser could be a promising technique for apicectomy and further studies are necessary, especially larger sample in vivo investigations, to verify the feasibility of Er: YAG laser in endodontic surgery. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusions To explore the context in which general dental practitioners (GDPs) decide to refrain from further treatment, that is, ortho‐ or retrograde retreatment or extraction of a root canal filled tooth with persistent asymptomatic apical periodontitis (PAAP).Fifteen GDPs were strategically selected for in‐depth interviews. The informants were encouraged to describe in their own words and in as much detail as possible, the three most recent patient cases of PAAP of a root canal filled tooth, in which they decided to refrain from further treatment. The interviews were recorded digitally and transcribed verbatim. The collected material was analysed according to Qualitative Content Analysis with an inductive approach.A pattern of varying degrees of uncertainty associated with the decision process was identified. The motives to refrain intervention had great diversity. The result from analysis of the qualitative data was formulated in an overall theme ‘Between doubt and certainty in a complex clinical context’ covering the latent content. The first main category covering the manifest content was ‘The continuum of confidence’ with three subcategories ‘Experienced uncertainty’, ‘Reluctant approval’ and ‘At ease with refraining’ illustrating the feelings and attitudes experienced by the informants. The second category was ‘In support of acceptance’ with three subcategories ‘Patient's autonomy, risks and cost‐benefits’, ‘Emotional aspects’ and ‘Relieving measures’ representing the reasons for refraining from intervention.The decision to refrain from further treatment, that is, ortho‐ or retrograde retreatment or extraction of a root canal filled tooth with PAAP was made with some measure of confidence, combined with compensatory strategies to support the decision, taking into account not only values beneficial to the patient and awareness of limited external resources, but also factors related to the informants' personal preferences, convenience, concerns, ambition and emotions. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to evaluate the performance of polyethylene fiber reinforced resin composite fillings compared to bulk fill resin composite fillings in endodontically treated teeth over a two-year monitoring period. Method: A total of 240 individuals with endodontically treated lower molars and a moderate amount of tooth structure were divided into two equal groups of 120 each. One group received polyethylene fiber reinforced bulk fill resin composite restorations while the other group received only bulk fill resin composite restorations, both applied as per manufacturer guidelines. Two proficient experienced blinded assessors assessed the restorations using modified USPHS criteria at baseline, 6, 12, and 24 months. Statistical analysis used: Data analysis involved the utilization of Mann-Whitney U, Friedman's test, and Nemenyi post hoc test, with age data being displayed as mean and standard deviation. The significance level was established as p < 0.05, and R software was utilized for statistical analysis. Results: There were no notable distinctions in any parameters or scores between the intervention and comparator groups at various time points. Alpha scores were present for retention, gross fracture, and secondary caries at all follow up intervals. Conclusion: Both direct resin composite restorations reinforced with polyethylene fibers and direct bulk fill resin composite restorations placed in endodontically treated molars with moderate remaining tooth structure demonstrated satisfactory clinical outcomes during a 24-month follow-up period. Clinical relevance: Bulk fill resin composites directly placed in endodontically treated molars with moderate remaining tooth structure showed promise as a treatment option over a two-year period. Clinical trial registration: (06-01-2022) on https://ClinicalTrials.gov with the ID (NCT05180903). [ABSTRACT FROM AUTHOR]

Background: The use of biological scaffolds in regenerative endodontics has gained much attention in recent years. The search for a new biomimetic scaffold that contains tissue-specific cell homing factors could lead to more predictable tissue regeneration. The aim of this study was to prepare and characterize decellularized bovine dental pulp-derived extracellular matrix (P-ECM) hydrogels for regenerative endodontic applications. Methods: Freshly extracted bovine molar teeth were collected. Bovine dental pulp tissues were harvested, and stored at -40º C. For decellularization, a 5-day protocol was implemented incorporating trypsin/EDTA, deionized water and DNase treatment. Decellularization was evaluated by DNA quantification and histological examination to assess collagen and glycosaminoglycans (GAGs) content. This was followed by the preparation of P-ECM hydrogel alone or combined with hyaluronic acid gel (P-ECM + HA). The fabricated scaffolds were then characterized using protein quantification, hydrogel topology and porosity, biodegradability, and growth factor content using Enzyme-linked immunosorbent assay (ELISA): transforming growth factor beta-1(TGF-β1), basic fibroblast growth factor (bFGF), bone morphogenetic protein 2 (BMP-2) and vascular endothelial growth factor (VEGF). Results: Decellularization was histologically confirmed, and DNA content was below (50 ng/mg tissue). P-ECM hydrogel was prepared with a final ECM concentration of 3.00 mg/ml while P-ECM + HA hydrogel was prepared with a final ECM concentration of 1.5 mg/ml. Total protein content in P-ECM hydrogel was found to be (439.0 ± 123.4 µg/µl). P-ECM + HA showed sustained protein release while the P-ECM group showed gradual decreasing release. Degradation was higher in P-ECM + HA which had a significantly larger fiber diameter, while P-ECM had a larger pore area percentage. ELISA confirmed the retention and release of growth factors where P-ECM hydrogel had higher BMP-2 release, while P-ECM + HA had higher release of TGF-β1, bFGF, and VEGF. Conclusions: Both P-ECM and P-ECM + HA retained their bioactive properties demonstrating a potential role as functionalized scaffolds for regenerative endodontic procedures. [ABSTRACT FROM AUTHOR]

Root canal perforations are frequent but critical complications in endodontic treatments, which can pose a risk of irreversible damage to the affected tooth. These perforations typically occur during root canal preparation or endodontic post placement, presenting significant therapeutic challenges. The main objective in the management of such complications is to seal the perforation, thus preventing bacterial invasion and tooth loss. This report details the case of a 70‐year‐old patient with a perforation in the palatal wall of the middle root section of tooth #11. The treatment approach involved magnification techniques and the application of a bioactive material known as Biodentine. This case underscores the critical role of accurate radiographic evaluation and the use of biocompatible materials in the management of root perforations. Despite inherent challenges, proper diagnosis and planning, combined with appropriate techniques and materials, can lead to satisfactory results, effectively preserving the structure of the tooth. [ABSTRACT FROM AUTHOR]

Background: Effective endodontic treatment requires the use of a root canal sealer with optimal properties to ensure a hermetic seal, prevent reinfection, and promote healing. Despite the availability of various sealers, a standardized evaluation system still needs to be improved. Objectives: To develop a Clinical Utility Index (CUI) that systematically evaluates and ranks root canal sealers based on their sealing ability, antimicrobial efficacy, flow rate, and solubility. Methods: The CUI was developed through a structured process involving expert identification, panel discussions, and the establishment of scoring criteria. Five sealers were evaluated (Sealers A, B, C, D, and E). Mean values for the core properties were calculated, and sealers were ranked accordingly. The total CUI for each sealer was computed based on the assigned scores for each property. Results: Sealer B achieved the highest CUI at 95%, demonstrating superior performance across all core properties. Sealer C followed with a CUI of 80%, while Sealer A ranked third with 60%. Sealers D and E showed the lowest performance, with CUIs of 30% and 35%, respectively, highlighting deficiencies in multiple properties. Discussion: The CUI provides a comprehensive evaluation framework for root canal sealers, facilitating informed decision-making by practitioners. Sealer B's high CUI underscores the importance of balancing sealing ability, antimicrobial effect, flow rate, and solubility. The results align with existing literature emphasizing the critical role of these properties in endodontic success. Conclusion: The CUI offers a robust and balanced method for evaluating root canal sealers, aiding in selecting the most suitable sealer based on empirical data. Future research should refine the index and validate its applicability in diverse clinical scenarios to enhance endodontic treatment outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To assess the tooth's fracture resistance when submitted to a selective root canal retreatment compared to the conventional approach. Methods: 33 intact permanent mandibular first molars were selected according to specific criteria. After teeth mounting, the primary root canal treatment was conducted and followed by thermo-mechanical aging procedures to mimic a few clinical conditions. The specimens were randomly divided into three groups (n = 11); a control group in which intact teeth were used and two experimental groups according to the retreatment approach: conventional non-surgical retreatment (Conventional-NSR), and selective non-surgical retreatment (Selective-NSR). Later, the teeth were submitted to a final thermo-mechanical aging procedure and tested regarding their fracture resistance (static fracture test). The maximum load to fracture was recorded as were the types of failure modes (repairable or non-repairable fracture). A proper statistical analysis was conducted, considering a significance level of 5%. Results: The Conventional-NSR group showed a mean failure load of 867.7 ± 108.9 N while the Selective-NSR group had 1106.8 ± 159.8 N (P = 0.012). Both retreatment groups showed significantly lower results when compared to the control group. Additionally, the Conventional-NSR group showed higher proportions of non-repairable fractures (54.5%) when compared to both the Selective-NSR (36.4%) and control (18.2%) groups. Conclusions: Selective root canal retreatment preserved the tooth's fracture resistance compared to the conventional retreatment approach. Clinical trial number: Non-applicable. Conducting the current experiment was limited to obtaining approval from the local Research Ethics Committee at the Faculty of Dentistry, Minia University (Committee No. 105, Registration No. 902, Date: 26/3/2024). [ABSTRACT FROM AUTHOR]

Background: Different types of dental laser can be used instead of the traditional hand and rotary files in root canal treatment with highly acceptable performance. Laser devices emit an intense and focused light energy, which interacts with biologic tissues, for pulp removal, shaping and cleaning the dentinal walls to be finally sealed with gutta-percha. Various laser devices with different wavelengths such as CO2, Er:YAG, Nd: YAG and Diode present the best laser–tissue interaction. Lasers in root canal treatment show more advantages than traditional treatment. Laser is more accurate than conventional root canal treatment that allow minimal removal of healthy dentinal tissue. Lasers have anti-bacterial effect by reduction of more than 99.7% bacterial counts for root canal sterilization. Laser provides less bleeding, inflammation, pain, discomfort and infection than conventional procedures. Laser treatment of root canals results in a good sealing of gutta-percha to root canal walls to prevent infections. Conclusions: Laser application is comfortable to the patients by removing the disturbing sounds of drills and decreasing the need for local anesthesia. It decreases the need for suturing in endodontic surgery due to better hemostasis, thus getting clean and well-sealed surgical wounds. [ABSTRACT FROM AUTHOR]

This position statement on undergraduate teaching on the use of magnification in endodontics represents the consensus of the British Endodontic Society Teachers of Endodontology Group. Current clinical and scientific evidence, as well as the expertise of the committee, has been used to develop this statement. The contributors to this position statement consider, as a minimum requirement, the use of dental loupes in non‐surgical endodontics at undergraduate level. It is recommended that the use of dental loupes should be integrated into endodontic clinical skills training and the performance of endodontic treatment in the undergraduate curriculum. [ABSTRACT FROM AUTHOR]

Background: Artificial intelligence is an innovative technology that mimics human cognitive capacities and has gathered the world's attention through its vast applications in various fields. Aim: This study is aimed at assessing the effects of ChatGPT 3.5 and ChatGPT 4 on the validity, reliability, and authenticity of standard assessment techniques used in undergraduate dentistry education. Methodology: Twenty questions, each requiring a single best answer, were selected from two domains: 10 from operative dentistry and 10 from endodontics. These questions were divided equally, with half presented with multiple choice options and the other half without. Two investigators used different ChatGPT accounts to generate answers, repeating each question three times. The answers were scored between 0% and 100% based on their accuracy. The mean score of the three attempts was recorded, and statistical analysis was conducted. Results: No statistically significant differences were found between ChatGPT 3.5 and ChatGPT 4 in the accuracy of their responses. Additionally, the analysis showed high consistency between the two reviewers, with no significant difference in their assessments. Conclusion: This study evaluated the performance of ChatGPT 3.5 and ChatGPT 4 in answering questions related to endodontics and operative dentistry. The results showed no statistically significant differences between the two versions, indicating comparable response accuracy. The consistency between reviewers further validated the reliability of the assessment process. [ABSTRACT FROM AUTHOR]

Background: In clinical practice, the buccal approach is typically the primary choice for endodontic microsurgery. Owing to the thickness of the buccal bone plate, the distance between the buccal bone plate and palatal lesion location, and soft tissue traction, the palatal approach may be more suitable for microsurgery for apical periodontitis of the palatal roots of the maxillary molars. However, the length of the palatal root, location of the greater palatine artery (GPA) and foramen (GPF), and surgical field of observation make palatal surgery challenging. Case presentation: With the aid of Cone-beam computed tomography imaging, the palatal approach was successfully applied in nine cases of endodontic microsurgery of the palatal root of a maxillary molar with a periapical lesion in Hangzhou Stomatology Hospital from January to December 2022. Conclusions: Complete healing was assessed based on clinical symptoms and radiographic images at the 3- and 24-month follow-up visits in all nine cases. Several tips have been proposed including surgical positioning, incision design, palate flap modification, bone removal, and root-end resection. [ABSTRACT FROM AUTHOR]

Background: This study evaluates the fracture strength and patterns of feldspathic porcelain restorations made using CAD/CAM technology for lower first molars with extensive crown destruction. The restorations include post-core and full-contour crown, composite resin core and full-contour crown, and endocrown. This research provides insights into effective restorative options to address tooth fracture risk, supporting minimally invasive procedures and CAD/CAM integration in dental practices. Methods: This study utilized 80 permanent mandibular first molars, which were divided into four groups: Group I (Post-Core-Full-contour crown), Group II (Core- Full-contour crown), Group III (Endocrown), and Group IV (Control). Root canal treatment was performed on all samples except for the control group. Following access cavity preparation, restorations for each tooth were fabricated using the CAD/CAM system and cemented with resin cement. The specimens were embedded in acrylic blocks. After undergoing thermomechanical aging, the samples were subjected to fracture resistance testing using a universal testing machine, which applied force until fracture occurred. The fracture patterns were subsequently analyzed, and the data were statistically evaluated using the Kruskal-Wallis and Chi-Square tests (p < 0.05). Results: A significant difference in fracture values under axial forces was observed (p < 0.05). The control group had the highest fracture strength (1830 ± 277 N), while the Core- full-contour crown group showed the lowest (1532 ± 371 N). Failure types varied significantly among the groups (χ2 = 26.886, df = 9, p = 0.001). The most common failure type was Type-2 (33.75%), characterized by restorable fractures, while Type-3 fractures, unrestorable, were the least common (12.5%). Conclusions: The findings underscore the significance of technological advancements in CAD/CAM for effectively restoring endodontically treated teeth with extensive crown damage. This study contributes valuable insights, emphasizing the clinical relevance of selecting appropriate restorative options to mitigate the risk of tooth fracture associated with coronal restoration failures. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the accuracy of detecting vertical root fractures in Biodentine™-filled teeth using the Promax 3Dmax cone-beam computed tomography (CBCT) unit compared to periapical radiographs. It tested hypotheses regarding CBCT's diagnostic superiority in non-root-filled and Biodentine™-root-filled maxillary central incisors and assessed the impact of smaller field of view and lower intensity settings on detection accuracy. Materials and methods: Extracted maxillary incisors were divided into groups based on fracture status and root filling material, then placed in a Thiel-embalmed skull to simulate clinical conditions. The teeth were imaged using periapical radiographs and the CBCT unit under different settings. Fracture thickness was measured with microcomputed tomography for accuracy benchmarking. Multiple observers assessed the images, and statistical analyses were conducted to evaluate diagnostic performance. Results: Intra-rater reliabilities of consensus scores ranged from good to very good. Specificities were generally higher than sensitivities across all imaging modalities, but sensitivities remained constantly low. None of the Area Under the Curve scores exceeded 0.6, indicating poor overall accuracy for all imaging modalities. Paired comparisons of the area differences under Receiver Operator Characteristic curves revealed no significant differences between the CBCT and periapical radiograph techniques for detecting vertical root fractures in either Biodentine™-filled or non-root-filled teeth. Conclusions: There was no significant accuracy improvement of the current CBCT device (Promax 3Dmax, Planmeca, Finland) over periapical radiographs in detecting small vertical root fractures in both non-root-filled and Biodentine™-root-filled maxillary central incisors. A smaller field of view with lower intensity did not enhance detection accuracy. These results highlight the challenges in accurately detecting small VRFs, emphasizing the need for further research and technological advancements in this domain. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effect of systemic administration of propranolol on the severity of apical periodontitis (AP) in chronically stressed rats. Methodology: Twenty‐four 70‐day‐old male Wistar rats (Rattus norvegicus, albinus) were distributed into three groups (n = 8): rats with AP without stressful conditions (AP‐Control), rats with AP and submitted to a chronic unpredictable stress (CUS) protocol (AP + S) and rats with AP and submitted to a CUS protocol treated with propranolol (AP + S + PRO). Stress procedures were applied daily until the end of the experiment. After 3 weeks of CUS, AP was induced in all groups by exposing the pulpal tissue of mandibular and maxillary first molars to the oral environment. Propranolol treatment was administered orally once a day for the entire period of the experiment. Rats were sacrificed at 42 days, and the blood was collected for stress biomarkers serum dosage by multiplex assay. Mandibles were removed and submitted to microtomography and histopathological analyses. Periapical tissue surrounding the upper first molar was homogenized and subjected to RT‐PCR analysis to evaluate the mRNA expression of RANKL, TRAP and OPG. Parametric data were assessed using one‐way ANOVA followed by Tukey's test while the nonparametric data were analysed by the Kruskal–Wallis followed by Dunn's test. Significance level was set at 5% (p <.05) for all assessed parameters. Results: Micro‐CT revealed statistically significant differences in bone resorption which was greater in the AP + S group (p <.05), but no differences were observed between the Control and AP + S + PRO groups (p >.05). The AP + S + PRO group had a lower intensity and extent of inflammatory infiltrate compared to the AP + S group with smaller areas of bone loss (p < 0.05). The gene expression of RANKL and TRAP was significantly higher in the stressed group AP + S compared to the control group (p <.05), and a significantly higher OPG expression was observed in AP + S + PRO compared to the AP + S group (p <.05). Conclusions: Oral administration of propranolol had a significant effect on the AP severity in stressed rats, suggesting an anti‐inflammatory effect and a protective role on bone resorption of AP in stressed animals. Further research is necessary to fully comprehend the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Background: Bibliometric analysis is a critical indicator of the influence and relevance of scientific papers, whilst also highlighting key contributors and gaps in knowledge in a scientific field. Objectives: To update and analyse the 100 most‐cited papers in regenerative endodontics from 2019 to 2023. Methods: A search of the most‐cited recent papers focusing on regenerative endodontics using journals included in the category, 'Dentistry, Oral Surgery & Medicine', in the Clarivate Web of Science database from 2019 to 2023 was performed. Three researchers conducted the study selection and data extraction. Data extraction included publication title and year, authors, number and mean number of citations, institution, country and continent, study design, journal title, keywords and research topic. Citation counts were also collected in Google Scholar and Scopus databases. Graphical bibliometric networks were created using VOSviewer software. Results: The number of citations of the 100 most‐cited articles ranged from 6 to 85. Most were published in 2020 (n = 48), principally in the Journal of Endodontics (47%), followed by International Endodontic Journal (13%), Journal of Dental Research (6%) and Dental Materials (6%). Laboratory study was the most common study design amongst the included papers (n = 47), followed by narrative reviews (n = 17) and observational studies (n = 16). The most frequent first author on the top three most‐cited papers was Hacer Aksel, whilst Adham A. Azim (n = 6; 89 citations) contributed most to the top 100 articles. The institution from which most articles originated was the University of Hong Kong (China) (n = 5; 81 citations), whereas the corresponding authors were predominantly from the United States of America (USA) (n = 31; 560 citations). The VOSviewer map of co‐authorship demonstrated research collaborative clusters. 'Regenerative endodontics' and 'stem‐cells' were the most employed keywords (37 and 36 occurrences respectively). Discussion: The current study was designed not only to showcase the most influential papers in regenerative endodontics since 2019 but also to provide a better understanding of global research in this area over the last five years. Conclusions: This bibliometric analysis highlighted papers, authors, institutions and keywords in regenerative endodontics. The 100 most‐cited papers primarily consisted of laboratory studies published in the USA, focusing on evaluating biomaterials and scaffold design strategies in contact with stem cells. Clinical studies and systematic reviews representing higher levels of scientific evidence are currently not the most influential in the regenerative endodontic field. [ABSTRACT FROM AUTHOR]

Background: Analysis of the survival of root‐filled posterior teeth and the associated prognostic tooth‐related factors will enable clinicians to predict the outcome of root canal treatment. Objectives: To investigate (i) the survival of root‐filled posterior teeth and (ii) the tooth‐related factors that may affect their survival. Methods: Randomized controlled trials, comparative studies and observational studies assessing survival rates of root‐filled posterior teeth with a minimum 4‐year follow‐up period were identified through an electronic search of the following databases up to January 2023: The Cochrane Central Register of Controlled Trials, Medline via PubMed, the Cochrane Database of Systematic Reviews, Embase, Web of Science and NIHR centre for reviews and dissemination. Two reviewers (SP and ML) independently selected the final studies based on pre‐defined inclusion criteria. The Newcastle Ottawa Scale and the Cochrane Risk of Bias Tool for Randomized Trials were used to assess the risk of bias. Pooled weighted survival rates were analysed using a random effects meta‐analysis model using DerSimonean and Laird methods. Descriptive analysis of studies describing any prognostic tooth‐related factors was conducted. Results: Of the 72 studies identified, data from 20 studies were included in the survival meta‐analysis, and data from 13 of these studies were included in the descriptive analysis of tooth‐related factors; 12 studies were retrospective, 7 were prospective, and one was a randomized control trial. The pooled survival rates at 4–7 years and 8–20 years of root‐filled posterior teeth regardless of tooth type was 91% (95% CI, 0.85; 0.95) and 87% (95% CI, 0.77; 0.93), respectively. The prognostic tooth‐related factors mentioned in the included studies were (i) remaining coronal tooth structure, (ii) ferrule, (iii) crown‐to‐root ratio (iv) tooth type and location (v) periodontal disease (vi) proximal contacts and (vii) cracks. Conclusions: The meta‐analysis suggests that root canal treatment has a high medium to long term survival outcome. The narrative summary identified 7 factors that affect tooth survival. However, there is a paucity of evidence, and more research is needed in this area. Registration: PROSPERO Registration: CRD42021227213. [ABSTRACT FROM AUTHOR]

Introduction: In endodontics, the number of umbrella reviews has increased significantly over the last few years, but there is no evidence that they were methodologically sound. The aim of the current study was to appraise the methodological quality of umbrella reviews in endodontics, and to identify possible predictive factors associated with methodological quality. Methods: Umbrella reviews published in the discipline of endodontics until December 2023 were included. The methodological quality of the reviews was evaluated using a checklist consisting of 11 items. Each item in the checklist was evaluated by two independent assessors who assigned a score of '1' if it was fully addressed, '0.5' if it was partially ddressed, and '0' if it was not addressed. Bootstrapped multiple linear regression analysis was used to examine the association between the total scores awarded and five predictor variables (a priori protocol registration, year of publication, number of authors, journal impact factor (IF) and continent of the corresponding author). The statistical significance level was set as 5%. Results: A total of 27 reviews were included. Ninety‐six per cent of the reviews adequately reported: eligibility criteria for selecting the reviews, details of the reviews, techniques for assessing the risk of bias or methodological quality of the individual systematic reviews they included. Only 30% of the reviews adequately managed overlapping primary studies within individual systematic reviews. Among the five predictors analysed, a priori protocol registration and journals with IFs were associated with significantly greater total methodological quality scores. Discussion: Several methodological shortcomings in the umbrella reviews published within the field of endodontics were revealed. Umbrella reviews published in journals with IFs and those with protocols registered a priori had significantly superior methodological quality scores. Conclusion: In endodontics, authors intending to publish umbrella reviews should consider the limitations revealed in this study and follow the appropriate rules to ensure their reviews comply with the highest standards and provide accurate and dependable information and conclusions. [ABSTRACT FROM AUTHOR]

Aim: The European Society of Endodontology outlines best practices for the management of deep caries and the pulp. Despite evidence supporting vital pulp treatments (VPTs) as predictable alternatives to conventional endodontic treatment, studies have shown they are not widely adopted in the UK. This study aimed to explore the barriers to implementation of VPTs by primary care general dental practitioners (GDPs). Methodology: Qualitative one‐to‐one semi‐structured online interviews were conducted with purposively sampled UK GDPs. Interview transcripts were analysed using reflexive thematic analysis. Recurring themes were iteratively refined as additional transcripts were reviewed. Results: Eleven participants were interviewed. A range of barriers to the provision of VPTs were identified, which aligned with two core themes: 'Motivational barriers to service provision' and 'Educational access & opportunities'. Sub‐themes included lack of access to materials and equipment, deficiencies in knowledge of treatment (including protocols, outcomes and prognosis), lack of confidence (in treatment efficacy and clinical ability), time constraints and public dental service funding and remuneration. Conclusions: This study identifies barriers to the widespread adoption of VPTs among primary care GDPs in public and private settings. Economic constraints, practitioner confidence, time limitations and educational gaps are key challenges. Addressing these may require systemic changes such as policy interventions, education and improved resource allocation. [ABSTRACT FROM AUTHOR]