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Background: Treating tooth root canal systems with Er:YAG laser together with irrigants has been shown to be effective in reducing biofilms formed by Enterococcus faecalis. This study investigated whether laser-activated irrigation (LAI) with side-firing Endo tip (LiteTouch™; Light Instruments, Yokneam, Israel) affects dentin mineral composition when used with common endodontic irrigants. Methods: Root canals of extracted human teeth were treated with Er:YAG laser using a side-firing Endo tip combined with 17% ethylenediaminetetraacetic acid (EDTA) and/or 2.5% NaOCl in continuous or intermittent mode for 60 s. Dentin mineral composition (Ca, P, O) in coronal, middle, and apical regions of root canals was examined by energy dispersive X-ray spectroscopy. Results: The use of LAI with continuous EDTA resulted in the largest reduction in Ca and P levels. A final NaOCl rinse mitigated the EDTA-mediated mineral loss in all root canal regions and increased the O content. Likewise, the reduced Ca/O and Ca/P ratios caused by continuous EDTA irrigation were reversed when combined with a final NaOCl rinse. Conclusions: LAI with Er:YAG Endo tip using continuous EDTA irrigation followed by NaOCl caused minimal dentin mineral loss and can therefore be considered to be a safe treatment module for cleaning root canals. [ABSTRACT FROM AUTHOR]

Aim. The aim of study was to assess the root-filled teeth with periapical lesions by using Periapical and Endodontic Status Scale (PEES) index. Materials and method. The study group included 166 filled root canals (70 molars and premolars) in 42 patients (gender: 12 males, 32 females; mean age 35.90 ± 10.571 yrs.) treated in Clinical Base of Faculty of Dental Medicine, U.M.F. “Grigore T.Popa” Iasi. The evaluation of root canals and periapical areas was performed by using the two components of Periapical and Endodontic Status Scale (PEES) index, COPI and ETTI. Results. Distribution of COPI components in the study group was as follows: COPI D: 30,7% D1, 69,3% D3; COPI R: 27,1% R1, 70,5% R2, 2,4% R3; COPI S: S1 16,3%, S2 21,7%, S3 62%. Distribution of ETTI components in the study group was as follows: ETTI L: 42,2% L1, 43,4% L2, 5,4% L3, 5,4% L4, 3,6% L5; ETTI H: 36,7% H1, 63,3% H2; ETTI CS: 10,8% CS1, 89,2% CS2; ETTI CF: 3,6% CF1, 9% CF2, 5,4% CF3, 81,9% CF5. Conclusions. In endodontically treated teeth with apical periodontitis, PEES indices allowed to detect 62% of root canals with periapical lesions with diameter over 5 mm, while more than two thirds of teeth roots had periapical lesions extended in cortical bone (69,3%) affecting more than one root (70,2%). All teeth roots with apical radiolucency and non-treated root canals as well as roots with perforations or resorptions had apical lesions with diameter over 5 mm extended in cortical bone. The presence of apical radiolucency more than one root was associated to overfilling or root resorption.

Aim. The aim of study was to assess the root-filled teeth with periapical lesions by using Periapical and Endodontic Status Scale (PEES) index. Materials and method. The study group included 166 filled root canals (70 molars and premolars) in 42 patients (gender: 12 males, 32 females; mean age 35.90 ± 10.571 yrs.) treated in Clinical Base of Faculty of Dental Medicine, U.M.F. "Grigore T.Popa" Iasi. The evaluation of root canals and periapical areas was performed by using the two components of Periapical and Endodontic Status Scale (PEES) index, COPI and ETTI. Results. Distribution of COPI components in the study group was as follows: COPI D: 30,7% D1, 69,3% D3; COPI R: 27,1% R1, 70,5% R2, 2,4% R3; COPI S: S1 16,3%, S2 21,7%, S3 62%. Distribution of ETTI components in the study group was as follows: ETTI L: 42,2% L1, 43,4% L2, 5,4% L3, 5,4% L4, 3,6% L5; ETTI H: 36,7% H1, 63,3% H2; ETTI CS: 10,8% CS1, 89,2% CS2; ETTI CF: 3,6% CF1, 9% CF2, 5,4% CF3, 81,9% CF5. Conclusions. In endodontically treated teeth with apical periodontitis, PEES indices allowed to detect 62% of root canals with periapical lesions with diameter over 5 mm, while more than two thirds of teeth roots had periapical lesions extended in cortical bone (69,3%) affecting more than one root (70,2%). All teeth roots with apical radiolucency and non-treated root canals as well as roots with perforations or resorptions had apical lesions with diameter over 5 mm extended in cortical bone. The presence of apical radiolucency more than one root was associated to overfilling or root resorption. [ABSTRACT FROM AUTHOR]

This study aimed to assess better effectiveness between regenerative endodontic procedures (REP) and apexification procedures (AP) with mineral trioxide aggregate (MTA) and calcium hydroxide for inducing root end apex closure. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed and registered in PROSPERO-CRD42023398997. Electronic databases were searched for studies evaluating effectiveness of REP and AP in terms of survival rate, success rate, increase in root length, root width and decrease in apical diameter. Cochrane risk of bias (RoB) -2 tool was used for quality assesssment using RevMan 5.3. The risk ratio (RR) and standardized mean difference (SMD) was used as summary statistic measure with random effect model (P < 0.05). Nine studies were included in qualitative synthesis and eight studies for meta-analysis. Quality assessment revealed moderate to low risk of bias. The pooled estimate through RR and SMD favoured REP being superior to AP for better survival rate (RR = 1.01 (0.96 – 1.06)), success rate (RR = 1.09 (0.96 – 1.24)), increase in root length (SMD = 0.25 (-0.14 – 0.63)), root width (0.66 (0.22 – 1.10)) and decrease in apical diameter (SMD =0.66 (-0.51 – 1.83)). Funnel plot did not show any heterogeneity indicating absence of publication bias. REP significantly improved apical root end closure. AP are equally effective in forming calcific barrier, however it was concluded that regeneration procedures are comparably superior to apexification procedures with greater outcomes. Clinicians should consider employing the REP in cases when root development is severely deficient and where tooth’s prognosis is hopeless even with an apexification procedure.

Aim: The present study aimed to evaluate the knowledge, attitude, and practice (KAP) of endodontists in India for working length measurements using Apex locators. Methods: This study is an online questionnaire-based survey consisting of 24 questions in total, divided into five parts. The first part consisted of questions related to demographic details, the second part inquires about the tools and technology used for working length determination, and the remaining questions evaluate the KAP regarding the use of apex locators to determine working length (five questions each). Participants in the study were either pursuing or completed postgraduation in endodontics. A total of 257 responses were recorded; however, six participants were excluded due to incomplete submission. Thus, 251 responses were analyzed as descriptive analyses. Correlation analysis and Chi-square tests were performed to find any association between demographic variables and years of experience in practice with KAP of using apex locators by endodontists. Results: In this study, it was observed that the knowledge of the majority of endodontic practitioners was fair, with a positive attitude and practice of using apex locators. Knowledge of the study participants was significantly (P ≤ 0.05) associated with the good attitude and practice of the study participants. Furthermore, years of experience in practice have a positive association with the KAP of endodontists. Conclusion: It can be concluded that endodontists have better clinical acceptance, as they show positive attitudes and practices for using apex locators for working length determination.

Key Clinical Message: Due to the complexities and variations of the root canal system's anatomy, mandibular premolars are among the most difficult teeth for endodontic treatment. The lack of clinician knowledge ultimately leads to treatment failure. Mandibular premolars are the most complicated teeth for endodontic treatment because of the variations in root canal anatomy. On the other hand, missing root canals can subsequently lead to failure of endodontic treatment, which causes the patient to become symptomatic. Therefore, the clinician's knowledge of the different types of root canal anatomy and the skill of using new equipment for proper root canal treatment improve the outcome. This study reported the successful endodontic treatment of a mandibular second premolar with four root canals by using an operative microscope. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to evaluate the knowledge, attitude, and practice (KAP) of endodontists in India for working length measurements using Apex locators. Methods: This study is an online questionnaire-based survey consisting of 24 questions in total, divided into five parts. The first part consisted of questions related to demographic details, the second part inquires about the tools and technology used for working length determination, and the remaining questions evaluate the KAP regarding the use of apex locators to determine working length (five questions each). Participants in the study were either pursuing or completed postgraduation in endodontics. A total of 257 responses were recorded; however, six participants were excluded due to incomplete submission. Thus, 251 responses were analyzed as descriptive analyses. Correlation analysis and Chi-square tests were performed to find any association between demographic variables and years of experience in practice with KAP of using apex locators by endodontists. Results: In this study, it was observed that the knowledge of the majority of endodontic practitioners was fair, with a positive attitude and practice of using apex locators. Knowledge of the study participants was significantly (P ≤ 0.05) associated with the good attitude and practice of the study participants. Furthermore, years of experience in practice have a positive association with the KAP of endodontists. Conclusion: It can be concluded that endodontists have better clinical acceptance, as they show positive attitudes and practices for using apex locators for working length determination. [ABSTRACT FROM AUTHOR]

Aim. The aim of study was to assess the quality of root canal fillings and occurrence of various categories of technical errors in patients with endodontically treated teeth. Materials and method. The study group included 158 patients (gender: 56 males, 102 females; mean age 50.44 ± 13.469 yrs.) with 400 endodontically treated teeth. The endodontic treatments were considered poor when one or more of the next technical errors were noted on the orthopantomography and/or periapical radiography: length (short filling; overfilling); poor density; inadequate preparation; inadequate conicity; untreated root canals. Results. Only 21,5% of the endodontically treated teeth had root canal fillings without any technical error. 78,5% of the endodontically treated teeth had at least 1 root canal with poor endodontic treatments. AP prevalence in teeth with adequate root canal fillings was 16,3%, while teeth with at least one poor root canal filling had AP prevalence of 56,4%. According to sociodemographic parameters the distribution of poor root canal fillings was as follows: gender (males- 69,1%; females- 82,7%; age groups: 20-39 yrs.- 76,2%; 40-59 yrs.- 76,9%; ≥ 60 yrs.- 86,5%). According to location, the distribution of poor root canal fillings was as follows: Mx/Md: Mx- 75%; Md- 84,2%); dental groups: frontal- 76,3%; premolars- 73,1%; molars- 83,2%). Most technical errors were non-homogenous root canal fillings (64,8%), poor conicity (64,5%), short filling (56%). Conclusions. Considering all categories of technical errors in root canal filling, 78,5% of endodontically treated teeth had inadequate endodontic filling in at least one root canal. Apical periodontitis was found in 56,4% of teeth with poor root canal filling. The most frequent technical errors in endodontically treated teeth were inadequate conicity, non-homogenous root canal fillings and underfilled root canals.

Background: Treating tooth root canal systems with Er:YAG laser together with irrigants has been shown to be effective in reducing biofilms formed by Enterococcus faecalis. This study investigated whether laser-activated irrigation (LAI) with side-firing Endo tip (LiteTouch™; Light Instruments, Yokneam, Israel) affects dentin mineral composition when used with common endodontic irrigants. Methods: Root canals of extracted human teeth were treated with Er:YAG laser using a side-firing Endo tip combined with 17% ethylenediaminetetraacetic acid (EDTA) and/or 2.5% NaOCl in continuous or intermittent mode for 60 s. Dentin mineral composition (Ca, P, O) in coronal, middle, and apical regions of root canals was examined by energy dispersive X-ray spectroscopy. Results: The use of LAI with continuous EDTA resulted in the largest reduction in Ca and P levels. A final NaOCl rinse mitigated the EDTA-mediated mineral loss in all root canal regions and increased the O content. Likewise, the reduced Ca/O and Ca/P ratios caused by continuous EDTA irrigation were reversed when combined with a final NaOCl rinse. Conclusions: LAI with Er:YAG Endo tip using continuous EDTA irrigation followed by NaOCl caused minimal dentin mineral loss and can therefore be considered to be a safe treatment module for cleaning root canals.

This review aimed to analyze the trend and main characteristics of articles related to guided endodontics (GE). The search was conducted in May 2023 on Web of Science. GE-related articles were included, and conferences were excluded. Three researchers selected the articles and extracted: the number of citations; year and journal; design and study theme; authorship and institutions; country and continent. Collaborative networks were generated in the Visualization of Similarities Viewer software. The relationship between data was determined by Spearman's correlation. Google Trends was used to investigate the global popularity of GE research. The search resulted in 135 articles, of which 85 were included. The most cited article totaled 116 citations. The studies were published between 2016 and 2023, most frequently in 2022 (n = 22). The most prevalent journal was the Journal of Endodontics (n = 28). Case report (n = 38) was the most frequent study design. The most studied theme was the use of static GE for calcified canals (n = 27). Connert T was the author with the highest number of articles (n = 13). The University of Basel (n = 9) stood out. The most prevalent country was Brazil (n = 13). Europe was the most frequent continent (n = 38). Visualization of Similarities Viewer demonstrated an interaction between authors. There was a moderate positive correlation between citations and the impact factor (rho =.483). According to Google Trends, the United States was the country that most researched GE. Based on this review, a more significant research interest in GE was observed in Europe, addressing the application of GE in locating severely calcified root canals. [ABSTRACT FROM AUTHOR]

This study aimed to assess better effectiveness between regenerative endodontic procedures (REP) and apexification procedures (AP) with mineral trioxide aggregate (MTA) and calcium hydroxide for inducing root end apex closure. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed and registered in PROSPERO-CRD42023398997. Electronic databases were searched for studies evaluating effectiveness of REP and AP in terms of survival rate, success rate, increase in root length, root width and decrease in apical diameter. Cochrane risk of bias (RoB) -2 tool was used for quality assesssment using RevMan 5.3. The risk ratio (RR) and standardized mean difference (SMD) was used as summary statistic measure with random effect model (P < 0.05). Nine studies were included in qualitative synthesis and eight studies for meta-analysis. Quality assessment revealed moderate to low risk of bias. The pooled estimate through RR and SMD favoured REP being superior to AP for better survival rate (RR = 1.01 (0.96 - 1.06)), success rate (RR = 1.09 (0.96 - 1.24)), increase in root length (SMD = 0.25 (-0.14 - 0.63)), root width (0.66 (0.22 - 1.10)) and decrease in apical diameter (SMD =0.66 (-0.51 - 1.83)). Funnel plot did not show any heterogeneity indicating absence of publication bias. REP significantly improved apical root end closure. AP are equally effective in forming calcific barrier, however it was concluded that regeneration procedures are comparably superior to apexification procedures with greater outcomes. Clinicians should consider employing the REP in cases when root development is severely deficient and where tooth's prognosis is hopeless even with an apexification procedure. [ABSTRACT FROM AUTHOR]

Key Clinical Message Due to the complexities and variations of the root canal system's anatomy, mandibular premolars are among the most difficult teeth for endodontic treatment. The lack of clinician knowledge ultimately leads to treatment failure. Abstract Mandibular premolars are the most complicated teeth for endodontic treatment because of the variations in root canal anatomy. On the other hand, missing root canals can subsequently lead to failure of endodontic treatment, which causes the patient to become symptomatic. Therefore, the clinician's knowledge of the different types of root canal anatomy and the skill of using new equipment for proper root canal treatment improve the outcome. This study reported the successful endodontic treatment of a mandibular second premolar with four root canals by using an operative microscope.

Background: The objective of this report was to highlight the importance of using a dental operating microscope (DOM) to locate supernumerary canals and diagnose variations in root canals using cone-beam computed tomographic (CBCT) images. Case Presentation: A 23-year-old male patient had reported with a pain for 1 months and was referred to evaluate symptomatic apical periodontitis for lower right first permanent molar. Root canal therapy was proposed and conducted with the use of DOM and CBCT. Conclusions: Proper diagnosis and careful clinico-radiological examination are necessary, and it is essential to reinforce the knowledge of the rare morphology of root canals for clinicians.

Non-thermal plasmas (NTPs), known as cold atmospheric plasmas (CAPs), hold great potential for diverse medical applications, including dentistry. However, traditional linear and rigid dielectric barrier discharge reactors used for NTP generation encounter limitations in accessing oral cavities and root canals. To address this issue, we have developed an innovative NTP reactor featuring an angled end for improved accessibility. The central copper electrode, with a 0.59 mm diameter and adjustable length for desired angulation, is coated with zircon powder (ZrSiO4) to ensure stable NTP generation. This central electrode is housed within a stainless steel tube (3 mm internal diameter, 8 mm external diameter, and 100 mm length) with a 27° angle at one end, making it ergonomically suitable for oral applications. NTP generation involves polarizing the reactor electrodes with 13.56 MHz radio frequency signals, using helium gas as a working medium. We introduce plasma-treated water (PTW) as an adjunctive therapy to enhance biofilm eradication within root canals. A synergistic approach combining NTP and PTW is employed and compared to the gold standard (sodium hypochlorite, NaOCl), effectively neutralizing Enterococcus faecalis bacteria, even in scenarios involving biofilms. Moreover, applying NTP in both gaseous and liquid environments successfully achieves bacterial inactivation at varying treatment durations, demonstrating the device's suitability for medical use in treating root canal biofilms. The proposed NTP reactor, characterized by its innovative design, offers a practical and specific approach to plasma treatment in dental applications. It holds promise in combatting bacterial infections in root canals and oral cavities. [ABSTRACT FROM AUTHOR]

Background: The objective of this report was to highlight the importance of using a dental operating microscope (DOM) to locate supernumerary canals and diagnose variations in root canals using cone-beam computed tomographic (CBCT) images. Case Presentation: A 23-year-old male patient had reported with a pain for 1 months and was referred to evaluate symptomatic apical periodontitis for lower right first permanent molar. Root canal therapy was proposed and conducted with the use of DOM and CBCT. Conclusions: Proper diagnosis and careful clinico-radiological examination are necessary, and it is essential to reinforce the knowledge of the rare morphology of root canals for clinicians. [ABSTRACT FROM AUTHOR]

As indicated by standards of modern dentistry, the essence of endodontic treatment is chemo-mechanical disinfection of the root canal system. The vital element of this process is the irrigation of canals with designated solutions as well as activating them. This review article summarizes various techniques of activation of irrigants for endodontic treatment such as manual activation, thermal, pressure, sonic, ultrasonic, and laser techniques in order to compare them. Results were gathered using PubMed, Scopus, Web of Science, and Google Scholar databases by searching keywords: activation, irrigation, irrigation protocols, and sodium hypochlorite. [ABSTRACT FROM AUTHOR]

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Microbial flora in the oral cavity gain entry into root canals after pulpal exposure, either due to trauma or dental caries. Once inside the root canal, bacteria of different species organize into a network and communicate with each other to withstand the chemical and physical disturbances during the treatment. They cause extraradicular infections that do not respond to conventional endodontic therapies. Bacteria present on the surface of root canals organize into a framework consisting of the matrix, bacteria, and water. The matrix consists of extracellular polysaccharide, which varies with the species that secrete them. It also contains proteins, fatty acids, and extracellular DNA, which help in the growth of the matrix, survival, and pathogenesis of organisms. Microorganisms entering the root canals should survive the nitric oxide rich, oxygen stressed, and nutrient-deprived environment. They should also resist the chemical and mechanical disturbances created during endodontic treatment to enable their persistence in the root canals. This review aims to discuss biofilm formation and the mechanisms by which it helps in bacterial survival in root canals. [ABSTRACT FROM AUTHOR]

Background: Knowledge about the anatomic variations of the root canal system and their prevalence is necessary for clinicians to ideally clean the root canal system. The anatomic complexity of the root canal system is one of the reasons for its inadequate debridement, resulting in residual microorganisms and root canal treatment failure. The present study aimed to evaluate the prevalence of middle mesial root canals in mandibular molars in an Iranian population. Materials and Methods: The samples in the present descriptive/cross-sectional study consisted of mandibular first and second molars (n = 100, with 50 first and 50 s molars). A convenient sampling method was used to collect samples. The teeth were mounted in gypsum and scanned using a micro-computed tomography unit. The images were reconstructed with software, and the relevant checklist was completed by the observers. The data were analyzed with SPSS v26 using the Chi-squared test at a significance level of P < 0.05. Results: The prevalence of the middle mesial root canal in the present study was 36% for mandibular first molars and 22% for mandibular second molars, with an overall prevalence of 29%. The prevalence of the middle mesial root canal was not significantly different between the first and second mandibular molars (P = 0.12). The mean distance between the mesiobuccal and mesiolingual root canal orifices in the teeth with a middle mesial root canal was significantly higher than in those without the middle mesial root canal (P < 0.001). In addition, there was no significant difference in the prevalence of the middle mesial root canal between the teeth with and without the second distal root canal (P = 0.89). Conclusion: The prevalence of the middle mesial root canal in the studied population was 29%, which is significant clinically. In addition, the mean distance between the mesiobuccal and mesiolingual root canal orifices in teeth with a middle mesial root canal was higher than that in teeth without this root canal.

The objective of this paper is to assess the prevalence of a second canal in maxillary and mandibular premolars based on two classification systems of root canal morphology using Cone beam computed tomography (CBCT) images. A total of 286 CBCT scans from the archive of the Radiology department of a hospital were assessed for the presence of a second canal in maxillary and mandibular premolars. The canal configuration and its assessment was undertaken using Vertucci and Ahmed's classification. A Chi-square test was used to test the significance of the difference between gender and age. A total of 286 premolars were examined (217 mandibular premolars and 69 maxillary premolars); of these, 173 teeth (60.5%) were from males and 113 were from females (39.5%). Some 62% of maxillary left first premolars had two roots, followed by maxillary right first premolars (47%), and then maxillary left second premolars (30%) and maxillary right ones (27%), respectively. Type IV Vertucci were seen in maxillary premolars, while type I were ordinarily seen in the included mandibular premolars. Surprisingly, Vertucci type III was only found in mandibular left first premolars at a frequency of 2%. One orifice with two separate canals and two orifices of two distinct canals with two portals of exit were predominantly noticed with maxillary first premolars (2 FP B1 P1) in 73% and 81%, respectively, followed by (1 FP 2) 19%. The prevalence of a second canal in maxillary and mandibular premolars was low in the investigated premolars in comparison to the premolars that had just one root and canal, as assessed based on Vertucci and Ahmed's root canal system classification. [ABSTRACT FROM AUTHOR]

Apical periodontitis (AP) represents an inflammatory condition of peri-radicular tissues due to invasion and colonization of bacteria in the root canals. Primary apical periodontitis (PAP) is associated with untreated necrotic root canal and can be efficiently treated with endodontic treatment to remove bacteria. Persistent/secondary apical periodontitis (SAP) is a perpetual periapical lesion due to unsuccessfully treated root canals after an initial apparent healing of the tooth. The aim of the study was evaluating the microbial communities associated with root canals using Nanopore sequencing. Seventeen samples from the root canals of 15 patients with AP were Polymerase Chain Reaction-amplified for 16s ribosomal DNA gene and sequenced. Information regarding the presence or absence of AP symptoms, PAP and SAP, and periapical index of patients were recorded. Firmicutes, Bacteroidetes, and Actinobacteria were the most abundant phyla detected and Phocaeicola , Pseudomonas , Rothia , and Prevotella were the most prominent genera. In samples of patients with AP symptoms, the most frequent detected genera were Cutibacterium , Lactobacillus , Pseudomonas , Dialister , Prevotella , and Staphylococcus. In PAP samples, the most represented genera were Cutibacterium , Lactobacillus , Pseudomonas , and Prevotella , whilst in SAP cases were Cutibacterium , Prevotella , Atopobium , Capnocytophaga , Fusobacterium , Pseudomonas , Solobacterium , and Streptococcus. The results provide additional information on the microbiota of root-canals. These data evidence the complexity of the microbiota and the relationship with many clinical and endodontic conditions. Future studies must evaluate these conditions and identify their role in inducing bone damage and local and systemic disease, aiming to better elucidate the relationship between microbes and endodontic pathologies. [ABSTRACT FROM AUTHOR]

Treatment of deep caries can result in exposure of the dental pulp, even in teeth with sensitive but asymptomatic pulps. Direct pulp capping (DPU) is used to preserve pulp health, although it may sometimes require additional follow-up treatments, such as root canal treatment (RTC), which could have been performed immediately after exposure, possibly with better results. The purpose of this case report is to highlight the advantages of RPD compared to TCR, which, while having a high success rate, is not a predominantly conservative approach. The follow-up evaluations were carried out in a time range that varied from 2 to 30 days. It is important to highlight that the present case contributes to the existing clinical evidence and provides a perspective on the effectiveness and clinical implications of RPD as an ultra-conservative alternative in the management of deep neck injuries. [ABSTRACT FROM AUTHOR]

Descriptive morphology of tooth roots traditionally focuses on number of canals and roots. However, how or if canal and root number are related is poorly understood. While it is often assumed that canal number is concomitant with root number and morphology, in practice canal number and morphology do not always covary with external root features. To investigate the relationship between canal and root number, fully developed, adult post‐canine teeth were examined and quantified from computerized tomography scans from a global sample of 945 modern humans. We tested the hypotheses that root and canal number do not follow a 1:1 ratio, that canal to root ratios differ between teeth, and that canal to root ratios differ across major human geographical groups. Results indicate that not only is root number dependent on canal number, but that this relationship becomes more variable as canal number increases, varies between individual teeth and by major geographical group, and changes as these groups increase in geographical distance from Sub‐Saharan Africa. These results show that the ratio of canal number to root number is an important indicator of variation in dental phenotypes. [ABSTRACT FROM AUTHOR]

Abstract Background The objective of this report was to highlight the importance of using a dental operating microscope (DOM) to locate supernumerary canals and diagnose variations in root canals using cone-beam computed tomographic (CBCT) images. Case presentation A 35-year-old Chinese female had repeated swelling in the upper right posterior maxilla for 3 months and was referred to evaluate symptomatic apical periodontitis and mesotaurodonts for upper right first permanent molar and upper right second permanent molar. Root canal therapy was proposed and conducted with the use of DOM and CBCT. Conclusions Proper diagnosis and careful clinicoradiological examination are necessary, and it is essential to reinforce the knowledge of the rare morphology of root canals for clinicians.

As indicated by standards of modern dentistry, the essence of endodontic treatment is chemo-mechanical disinfection of the root canal system. The vital element of this process is the irrigation of canals with designated solutions as well as activating them. This review article summarizes various techniques of activation of irrigants for endodontic treatment such as manual activation, thermal, pressure, sonic, ultrasonic, and laser techniques in order to compare them. Results were gathered using PubMed, Scopus, Web of Science, and Google Scholar databases by searching keywords: activation, irrigation, irrigation protocols, and sodium hypochlorite.

Aim of the research: To explore the morphology of the root canal systems of permanent maxillary second premolars among the Iraqi Kurdistan population. Material and methods: Cone-beam computed tomography (CBCT) scan images were accessed from a documented database of 300 patients (165 male, 135 female) from Iraqi Kurdistan regions, who had had oral and maxillofacial examinations. The age of the patients ranged from 18 to 50 years, and scanned images were evaluated by 2 independent dental radiologists who assessed the axial, sagittal, and coronal sections to check the number of orifices, roots, root canals, and foramina. Canal configuration was classified using the Vertucci classification to evaluate and analyse the root canal morphology. Results: One orifice was the most prevalent number of orifices in 3 governorates in Iraqi Kurdistan (86.33%). The teeth with one canal (67.0%) and one root (89.33%) were the most prevalent. One foramen was the most prevalent number of a foramen in 3 governorates and Iraqi Kurdistan (86.7%) followed by 2 foramina (13.3%). The first canal type was the most prevalent in the Kurdish population with permanent maximally second premolars (69.0%) followed by class V (12.3%) and class II (11%). Classes VI (0.7%) and III (2%) were rare canal types in this region. Class VII canal type was not found in the population in the Iraqi Kurdistan region. Conclusions: One orifice, one foramen, one canal, and one root with type I were the most prevalent morphology of the maxillary second premolar in Iraqi Kurdish populations. [ABSTRACT FROM AUTHOR]

Important role in solving the problem of the clinical efficacy and biocompatibility widespread today in dental practice takes endogermetikov choice of material. Scientifically proven that there is a direct connection between the choice of filling sealer and a favorable prognosis after endodontic treatment. In this study we examined the relationship common to date of filling materials for obturation of root canals and their impact on periodontal tissue . The experiment was conducted on 60 white rats - males , who were divided into four groups depending on the material that obturated root canals . The data obtained show the objective picture of the impact on the efficiency properties sealers endodontic treatment

This article deals with the conservative treatment of chronic periodontitis in the acute stage without the «open period of the tooth» and mandatory appointment of antibiotics and anti-inflammatory drugs. 17 clinical cases are presented with a detailed description of the methods of treatment and the results. 16 patients aged 28-65 years with a diagnosis К04.7 were treated. Positive results confirmed clinically and radio graphically after 6-12 months. The treatment takes place without complications and complete recovery of bone structures in the former foci of destruction is faster in teeth with one root canal, do not expose previously endodontic treatment.

The article is devoted to the development and clinical experimental testing of new pastes for filling root canals of teeth with chronic periodontitis. The experiment put on 80 outbred rats in the clinical part of the study involved 93 patients (42 men and 51 women), all treated teeth 114. It is established that the most beneficial effect in the treatment of destructive forms of chronic periodontitis observed when using 2 simultaneously active substances (choline salicylate and chondroitin sulfate) in the paste introduced into the periapical lesion.

The aim of this study was to conduct clinical and laboratory studies in the process of complex treatment of patients with chronic apical periodontitis and assessing the effectiveness of endodontic technologies of root channels with the use of self-adapting the SAF files, ultrasonic treatment, 3% solution of sodium hypochlorite and 2% chlorhexidine solution. In the process, were selected 77 patients with a diagnosis of chronic apical periodontitis. Then there were formed 3 groups and 6 subgroups. In the control subgroups, we conducted instrumental and medicamental processing of root canals with manual instruments using a 3% solution of sodium hypochlorite and 2% chlorhexidine solution. In the comparison group were given the combined treatment with ultrasonic activation of irrigants (3% sodium hypochlorite, 2% chlorhexidine solution.) and the SAF system with the same irrigation solutions, respectively. Clinical impact evaluation method dresses: women's treatment on the outcome of endodontic treatment was performed according to the frequency of the diagnosed complications a year after treatment of apical periodontitis. The structure of the biofilm root canals was studied using scanning electron microscopy (SEM) using a microscope Quantum 3D (USA).According to the results of clinical and microbiological studies have observed a positive trend to reduce the number of the designated pathogens when irrigation SAF, as in the application solution of 3% sodium hypochlorite and 2% chlorhexidine solution.

The results of studying the effectiveness of endodontic treatment of complicated forms of caries (pulpitis, periodontitis) in 224 people, including 169 men and 55 women, aged from 18 to 55 years in early and late periods after treatment, as well as analysis software quality standard endodontic treatment. Satisfactory root canal filling finishing endodontic treatment of pulpitis single rooted, two or three tooth root defined respectively in 77.78%, 83.33% and 65.28% of cases; upon completion of the endodontic treatment of periodontitis, respectively, 73.33%, 69.23 and 66.67% of cases. The effectiveness in the long term treatment of complicated caries single rooted, two or three teeth of the root, respectively, 60%, 61.54% and 59.68% of cases with pulpitis and respectively 66.67%, 72.72% and 68 42% of cases of periodontitis.

Poor quality treatment of periodontal inflammation is the cause of tooth extraction. Most of the teeth treated endodontically in the future are subject to retreatment. The success of conservative treatment of apical periodontitis appreciably depends from compliance with the standards of classical endodontics. This article summarizes three clinical cases of endodontic retreatment of destructive forms of apical periodontitis, where noted positive dynamics

The use of high-tech in endodontics has changed our understanding of the root canal treatment. 3D microscope and diagnostics, ultrasonic, machine tools for processing channels, high-quality irrigation and, finally, a three-dimensional obturation of hot gutta percha. This is the components of a successful endodontic treatment. In the article the clinical case illustrates the possibility of comprehensive application of these technologies. All of the above significantly expands the capabilities of a dentist, which certainly affects the quality of treatment

The new method, which is in the process of orthodontic dental treatment allows you to use the guide template to determine the location position of the mouths of root canals, which is a visual search for one reason or another is diffi cult. Application of the method in clinical practice will allow successfully to search for additional and calcifi ed root canals without the use of the optical zoom.

The aim of this research was the study of registered in the root canal and periapical tissues of permanent teeth with children’s incomplete root development, chronic periodontal disease and its exacerbation in children residing in a major industrial center of Western Siberia (omsk). We observed 33 patients aged 6 to 13 years, 16 patients were diagnosed with chronic periodontitis in the acute stage, the remaining children - chronic apical periodontitis. Microbiocenosis periodontal complex in the state of complicated caries in primary school children showed the diversity of the microbiota of both the prokaryotes (aerobic, anaerobic, microaerophilic, facultative anaerobic bacteria), and to eukaryotes (yeast-like fungi of the genus Candida).

The article considers the technical aspects of the use of different spreaders during root canal obturation by the cold lateral condensation technique. It was identified the influence of spreader penetration depth on the quality of apical and coronal obturation depending on a material and a diameter of a tool. The differentiated approach to the choice of a spreader was suggested for a high-quality obturation of curved canals by the cold lateral condensation technique.

Clinical and laboratory study and evaluation of the effectiveness of ultrasonic treatment of the root canal system in combination with photodynamic therapy, in relation to the microflora of root canals in vitro and in the process of complex treatment of patients with inflammatory diseases of dental pulp. In the control subgroups, we conducted instrumental and medicamental processing of root canals. In the comparison group were given the combined treatment with ultrasonic activation of irrigant and further photodynamic treatment. Evaluate the influence of ultrasonic treatment in combination with photoactivatable system disinfection was performed according to the frequency of the diagnosed complications in the treatment of various forms of chronic pulpitis. The structure of the biofilm root canals was studied using scanning electron microscopy (SEM) using a microscope Quantum 3D (USA). Statistical processing of data in 5 replicates and were processed by parametric statistics for small samples by Manna-Whitney test (p < 0,05). When performing scanning electron microscopy revealed the existence of high level of microbial contamination of areas of the root canal and dentinal tubules. In subgroups, where it was used the standard method of treatment, the percentage of re-treatment and surgical intervention prevails compared to the study group. According to the results of clinical and microbiological studies have observed a positive trend to reduce the number of the designated pathogens and the use of complex interaction of ULTRASOUND and PDT was the most successful method compared to traditional method of treatment

The objective of this paper is to assess the prevalence of a second canal in maxillary and mandibular premolars based on two classification systems of root canal morphology using Cone beam computed tomography (CBCT) images. A total of 286 CBCT scans from the archive of the Radiology department of a hospital were assessed for the presence of a second canal in maxillary and mandibular premolars. The canal configuration and its assessment was undertaken using Vertucci and Ahmed’s classification. A Chi-square test was used to test the significance of the difference between gender and age. A total of 286 premolars were examined (217 mandibular premolars and 69 maxillary premolars); of these, 173 teeth (60.5%) were from males and 113 were from females (39.5%). Some 62% of maxillary left first premolars had two roots, followed by maxillary right first premolars (47%), and then maxillary left second premolars (30%) and maxillary right ones (27%), respectively. Type IV Vertucci were seen in maxillary premolars, while type I were ordinarily seen in the included mandibular premolars. Surprisingly, Vertucci type III was only found in mandibular left first premolars at a frequency of 2%. One orifice with two separate canals and two orifices of two distinct canals with two portals of exit were predominantly noticed with maxillary first premolars (2 FP B1 P1) in 73% and 81%, respectively, followed by (1 FP 2) 19%. The prevalence of a second canal in maxillary and mandibular premolars was low in the investigated premolars in comparison to the premolars that had just one root and canal, as assessed based on Vertucci and Ahmed’s root canal system classification.

The mandibular second premolar can be considered one of the most challenging teeth to treat endodontically; due to the complexity of its root canal morphology and increased incidence of multiple canals. The knowledge of internal anatomy of root canals and their possible variations as well as use of magnification, e.g. operating microscope, radiographic examination and illumination, can increase the chances of finding additional canals and contribute to the success of endodontic treatment. The purpose of the current investigation is to report the successful endodontic treatment of a mandibular second premolar with 4 canals; all of them in one single root. [ABSTRACT FROM AUTHOR]

Cone Beam Computerized Tomography (CBCT) imaging technique can be used for identifying the root canal anatomy and its use in determining sexual dimorphism. The aim of current study was to identify the commonly found root canal morphology and gender dimorphism for mandibular pre-molars in Western Asia population according to Vertucci's classification using CBCT 3D imaging technique. On ethical approval 470 patients from Western Asia population with intact healthy mandibular first and second premolars were included in the study. The selected patients were sent to radiology department of Riyadh Elm University, Saudi Arabia for CBCT images. The observations recorded included: i) number of roots; and ii) type of root canal morphology based on Vertucci's classification. All the mandibular first and second pre-molars had single root both in males and females. The type of Vertucci's classification commonly observed was Type I both in males (88.94 %) and females (100 %) in mandibular first pre-molars. Similarly Type I was identified as a common root canal configuration in mandibular second pre-molars for males (82.77 %) and females (100 %). The two canal configurations Type IV and V were only observed in the males. It can be concluded from the results mandibular first and second pre-molars in the Western Asia population are single rooted with common Vertucci's Type I canal configuration in the females with rare evidence of two canals in males. Additionally CBCT is an effective technique and should be used for detection of root canals in the mandibular pre-molars which can aid dentists in providing a successful endodontic therapy. [ABSTRACT FROM AUTHOR]

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Background: The objective of this report was to highlight the importance of using a dental operating microscope (DOM) to locate supernumerary canals and diagnose variations in root canals using cone-beam computed tomographic (CBCT) images. Case presentation: A 35-year-old Chinese female had repeated swelling in the upper right posterior maxilla for 3 months and was referred to evaluate symptomatic apical periodontitis and mesotaurodonts for upper right first permanent molar and upper right second permanent molar. Root canal therapy was proposed and conducted with the use of DOM and CBCT. Conclusions: Proper diagnosis and careful clinicoradiological examination are necessary, and it is essential to reinforce the knowledge of the rare morphology of root canals for clinicians. [ABSTRACT FROM AUTHOR]

The results of the study of primary medical documentation (PMD) 167 (132 (79.04%) men and 35 (20.96%) women) man held endodontic treatment for various forms of pulpitis and 83 people (73 (87.95%) men and 10 (12.05%) women) held endodontic treatment for various forms of periodontitis. Patients ranged in age from 18 to 55 years of age (young and middle age). The analysis used by physicians diagnostic methods and their frequency in the treatment of pulpitis and periodontitis, as well as their comparison with the departmental standard endodontic treatment. The paper noted the presence of a large number of defects in mine action, as identified in the departmental medical institution metropolis.

The choice of material for permanent obturation of the root canals in the treatment of complicated caries is a top priority for the dentist. The article presents clinical cases of treatment of periodontitis, odontogenic sinusitis using the material for filling the root canals with «Granulotec» (PD, Switzerland). The results of the treatment were evaluated clinically and radiologically at the time of treatment and after 3-6 months. Currently, the use of «Granulotec» in the treatment of pulpitis, periodontitis and their complications leads to the successful treatment of these diseases.

The success of nonsurgical endodontic management depends on the complete elimination of infection that compromises the tooth function. Thorough knowledge about the root canal anatomy is one of the principal factors in achieving a successful outcome. The morphology of root canals is not always typical. Maxillary molars, known for varied morphology, require advanced imaging modalities such as cone-beam computed tomography (CBCT). This case report describes a series of four maxillary molars with different forms, numbers, and configurations of root canals and with unusual morphology, including a case of a third mesiobuccal (MB3) canal, a case of a second mesiobuccal (MB2) canal with two palatal canals [mesiopalatal (MP) and distopalatal (DP)], a case of three mesiobuccal canals (MB1, MB2, MB3), three distobuccal (DB1, DB2, DB3) canals, and two palatal canals [mesiopalatal (MP) and distopalatal (DP)], and a case of taurodontism, where different access cavity modifications, diagnostic methods, and magnifications were considered.

Introduction: The aim of this systematic review was to systematically evaluate and summarize the outcomes of in vitro studies comparing Endoactivator irrigation and Endovac irrigation techniques for removing calcium hydroxide (Ca[OH]2) medicament from the root canals. Materials and Methods: The research question was developed according to the population, intervention, comparison, and outcome strategy. A computerized literature search was conducted in Medline, PubMed, Google Scholar, and Embase. A hand search of the reference lists of identified articles was performed to separate relevant articles. Two reviewers critically assessed the studies that fulfilled the inclusion criteria and processed. Evaluation of the risk of bias of the studies was performed independently by the two reviewers. Results: After study selection, 61 were assessed for eligibility. Of these, 13 met the inclusion criteria and were included in the systematic review. Since significant heterogeneity was found in the methodologies, it was not possible to conduct a meta-analysis. Conclusions: On the basis of available evidence, we determined that Endoactivator irrigation technique showed better performance in removing Ca(OH)2intracanal medicaments from middle third and coronal third area of the root canals and Endovac irrigation technique showed better performance from the apical third area of the root canals. Due to the limitations, small sample sizes, and low number of included studies, further research is needed to confirm our results.

BACKGROUND & OBJECTIVE: Missed root/canal is one of the main causes of endodontic failure. Permanent mandibular canine is considered to be a single rooted tooth. The complex pattern of root canal system poses difficulty in the root canal treatment and the prognosis becomes uncertain if the debridement and obturation of the root canals is not satisfactory therefore our objective of the study is to assess frequency of two roots in permanent mandibular canine of Pakistani population using CBCT scan. METHODOLOGY: A descriptive; retrospective study was planned by using Cone Beam Computerized Tomography (CBCT) images of the past 02 year, i.e. December 2017 till November 2018. Images were assessed for the number of roots in permanent mandibular canines using software NNTVIEWER NewTOM. Data was entered and analyzed using SPSS 21. RESULTS: 134 permanent mandibular canines of 67 patients were studied. 64.2% of the images were of male patients while 35.8% were of females. Mean age of the patients was 48.12 ± 15.92 years. 7 (5.22%) out of 134 canines had two roots. 4 patients (5.97%) had canines with 2 roots of which 3 patients (4.48%) had bilateral two-rooted canines and 1 patient (1.49%) had unilateral two-rooted canines. Frequency of two roots in mandibular canines had no association with gender (p= 0.127). CONCLUSION: All mandibular permanent canines were single rooted but 5.2% of the permanent mandibular canines had two roots.

Bacterial infections of root canals and the surrounding dental hard tissue are still a challenge due to biofilm formation as well as the complex root canal anatomy. However, current methods for analyzing biofilm formation, bacterial colonization of root canals and dental hard tissue [e.g., scanning electron microscopy, confocal laser scanning microscopy (CLSM) or determination of colony forming units (CFU)] are time-consuming and only offer a selective qualitative or semi-quantitative analysis. The aim of the present study is the establishment of optimized molecular biological methods for DNA-isolation and quantification of bacterial colonization via quantitative PCR (qPCR) from dental hard tissue. Root canals of human premolars were colonized with Enterococcus faecalis. For isolation of DNA, teeth were then grinded with a cryo mill. Since the hard tissues dentin and especially enamel belong to the hardest materials in the human organism, the isolation of bacterial DNA from root dentin is very challenging. Therefore, treatment steps for the isolation of DNA from grinded teeth were systematically analyzed to allow improved recovery of bacterial DNA from dental hard tissues. Starting with the disintegration of the peptidoglycan-layer of bacterial cells, different lysozyme solutions were tested for efficacy. Furthermore, incubation times and concentrations of chelating agents such as EDTA were optimized. These solutions are crucial for the disintegration of teeth and hence improve the accessibility of bacterial DNA. The final step was the determination of prior bacterial colonization of each root canal as determined by qPCR and comparing the results to alternative methods such as CFU. As a result of this study, optimized procedures for bacterial DNA-isolation from teeth were established, which result in an increased recovery rate of bacterial DNA. This method allows a non-selective and straightforward procedure to quantify bacterial colonization from dental hard tissue. It can be easily adapted for other study types such as microbiome studies and for comparable tissues like bones.