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Reciprocating motion expands the lifetime of endodontic instruments during the preparation of severely curved root canals. This study aimed to investigate the time to fracture (TTF) and number of cycles to failure (NCF) of different reciprocating instruments (n = 20 in each group) at body temperature using a dynamic testing model (amplitude = 3 mm). Reciproc Blue (RPB), size 25/.08, WaveOne Gold (WOG) 25/.07, Procodile (Proc) 25/.06, R-Motion (RM_06) 25/.06 and R-Motion (RM_04) 30/.04 instruments were tested in their specific reciprocating motion in artificial matching root canals (size of the instrument ± 0.02 mm; angle of curvature 60°, radius 5.0 mm, and centre of curvature 5.0 mm from apical endpoint). The number of fractured instruments, TTF, NCF, the and lengths of the fractured instruments were recorded and statistically analysed using the Chi-Square or Kruskal–Wallis test. Both TTF (median 720, 643, 562, 406, 254 s) and the NCF (3600, 3215, 2810, 2032, 1482 cycles) decreased in the following order RM_06 > RPB > RM_04 > Proc > WOG with partially significant differences. During testing, only six RM_06 instruments fractured, whereas 16/20 (RPB), 18/20 (Proc), and 20/20 (RM_04, WOG) fractures were recorded (p < 0.05). Within the limitations of the present study, blue-coloured RPB and RM instruments exhibited a significantly superior cyclic fatigue resistance compared to SE-NiTi and Gold-wire instruments. Heat treatment, cross-sectional design and core mass significantly influenced the longevity of reciprocating instruments in cyclic dynamic testing. [ABSTRACT FROM AUTHOR]

Aim: To investigate the influence of pulse energy, tip geometry and tip position in simulated 3D‐printed root canals with multiple side canals at different levels in all directions on the cleaning performance of laser‐activated irrigation (LAI) compared to sonic activation (EDDY) and conventional needle irrigation (NI). Methodology: 3D‐printed root canal models (25/.06, length 20 mm, curvature 60°, radius 5 mm) with side canals (diameter 0.2 mm) at 2, 5 and 8 mm from the apex were filled with coloured biofilm‐mimicking hydrogel. LAI (Morita AdvErL Evo, Kyoto, Japan) was performed with six settings (n = 20; pulse‐energy, pulses per second [PPS], tip position): LAI1 (50 mJ, 25 PPS, P400FL, canal entrance [CE]), LAI2 (same as LAI1, but insertion depth 9 mm before the apical endpoint [AE] [corresponding to 1 mm above the first lateral canals]), LAI3 (80 mJ, 25 PPS, P400FL, 9 mm before AE), LAI4 (same as LAI 3, but at CE) for 3 × 20 s each, LAI5 (50 mJ, 25 PPS, P400FL 2 × 20 s, CE & R200T (30 mJ, 25 PPS, 1 × 20 s, 9 mm before AE), LAI6 (30 mJ, 25 PPS, R200T, 9 mm before AE, 3 × 20 s). A continuous irrigation (3 mL/20 s) using distilled water accompanied the irrigation cycles. NI and EDDY (3 × 20 s each; 3 mL/20 s irrigation, insertion AE minus 1 mm, amplitude 4 mm) served as control groups. Biofilm‐mimicking hydrogel removal (ImageJ, NIH) was assessed for the entire system, the central canal and the lateral canals using standardized photographs with a microscope (Expert DN, Müller‐Optronic) and statistically analysed was performed using Kruskal–Wallis and Dunn tests (p =.05). Irrigant extrusion beyond the foramina was also recorded. Results: LAI2 (99.08%; interquartile range [IQR]: 96.85–100.00) and LAI3 (97.50%; 96.24–100.00) achieved the significantly best and LAI6 (80.08%; 73.41–84.69) the significantly worst removal of hydrogel from the entire root canal system amongst all LAI configurations (p <.05). There were no significant differences between LAI6, EDDY (72.89%; 67.49–76.22) and manual irrigation (54.39%; 51.01–56.94) (p >.05). R200T laser tip caused significantly more often irrigant extrusion than all other techniques (p <.05). Conclusion: Tip design, energy settings, and the positioning of the laser tip below the canal entrance caused an improvement in cleaning performance of the LAI. However, the small R200T tip created significantly more procedural errors (irrigant extrusion) due to higher concentrated energy. [ABSTRACT FROM AUTHOR]

There is insufficient research to evaluate social media's influence on endodontic education. Therefore, this study assessed the percentage of students utilising Facebook in their education and the factors influencing their engagement. A survey was conducted on dental students, interns and dentists undertaking specialist programmes. Categorical data were analysed using Fisher's Exact test and multiple pairwise comparisons. The significance level was set at p < 0.05. Responses were received from 801 participants, with 98.4% using Facebook for endodontic knowledge. Although most students knew that scientific evidence is not always provided, they still deemed such information valuable as it was a practical demonstration of clinical cases. Most students turn to Facebook for endodontic education to compensate for the gap between their academic education and clinical practice. The utilisation of social media for education can be a concerning phenomenon and should not be ignored by academic institutes. [ABSTRACT FROM AUTHOR]

Background: The development of endodontic instruments has rapidly advanced, but their impact on endodontic outcome parameters remains unclear. Objectives: This systematic review aimed to answer the following PICOT questions: In patients with apical periodontitis (P) what is the effectiveness of root canal instrumentation ([Q1] performed with contemporary techniques [I] in comparison with 'traditional' techniques [C]] and ([Q2] performed with contemporary engine‐driven NiTi instruments [I] compared with other types of contemporary engine‐driven NiTi instruments [with different design and/or technology] [C]) in terms of clinical and patient‐related outcomes (O)? Methods: After PROSPERO protocol registration, a literature search was conducted using Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials. Grey literature and major journal contents were examined. Two independent reviewers performed the study selection, data extraction and appraisal of included studies. A quantitative meta‐analysis was considered, and statistical heterogeneity and overall quality of evidence were assessed. Results: Nine studies were identified showing substantial methodological differences. Five studies addressed PICOT 1 and three PICOT 2, whereas one study aimed both. A random‐effects meta‐analysis model was considered for the outcome 'radiographic evidence of normal periodontal ligament space or reduction of apical lesion size' (PICOT 1) based on three studies with 332 evaluable participants and showed that contemporary instrumentation was associated with a more favourable outcome (p =.005) compared with root canal preparation with stainless steel instruments (odds ratio = 2.07 [95%‐confidence interval = 1.25–3.44]) with no evidence of statistical heterogeneity (I2 = 0%) but low quality of evidence. Discussion: Albeit a few studies fulfilled eligible criteria, no study had a low risk of bias. Compelling evidence indicating significantly different outcome rates using different endodontic instruments when treating teeth with apical periodontitis is lacking. Conclusions: In terms of healing, the results of the meta‐analysis determined the higher effectiveness of root canal instrumentation performed with contemporary techniques in comparison with conventional stainless steel instruments in patients with apical periodontitis followed for a minimum of 1 year with low quality of evidence. No differences could be demonstrated between preparations with traditional stainless steel and contemporary NiTi instruments for other clinical and patient‐related outcomes. Registration: PROSPERO (CRD42021274642). [ABSTRACT FROM AUTHOR]

Background: The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3‐level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence‐based recommendations for the management of patients presenting with pulpal and apical disease. Aim: To develop an S3‐level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss. Methods: This S3‐level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert‐based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders. Results: The S3‐level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re‐evaluations during and after treatment is stressed. Conclusion: The first S3‐level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient's lifetime, according to the best comparative evidence currently available. [ABSTRACT FROM AUTHOR]

Objectives: The prevalence of "dental anxiety" (DA) is often underestimated and numerous diagnostic methods are available for dental practitioners. It is difficult to differentiate between a dental phobia requiring an interdisciplinary approach and DA, which can be managed by dental practitioners alone. The appropriate use of diagnostic tools is key for the successful management of highly anxious and/or phobic patients. The aim was to provide a guideline to recognize dental fear and to differentiate DA from patients who are highly anxious or even have a phobia.Data sources: In total, 8,929 articles that were selected for the development of the German guidelines for "Dental anxiety in adults" in PubMed, Web of Science, Embase, and Med-Pilot were filtered for diagnosis of DA disorder. The focus for this review was on the use of scales to measure DA levels. The methods and tools used in the 51 reviewed articles to assess DA levels were evaluated in terms of their practicability and suitability in daily practice to differentiate between phobia (ie, DA disorder) and nonpathologic anxiety. In addition, the internal consistency (Cronbach alpha) of the questionnaires/tools was determined. Conclusion: All identified DA questionnaires validated in the German language had an acceptable to excellent internal consistency (0.7 to 0.986). The only validated questionnaire-free method was galvanic skin reaction measurement. For the assessment of DA and diagnosis of a DA disorder in adults, the survey by means of any suitable questionnaire or even several questionnaires in combination with a behavioral observation of the patient is currently the method of choice. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the impact of glide path preparation on the incidence of dentinal defects after preparation of severely curved canals using ProTaper Next, F6 SkyTaper, and One Shape instruments. Method and Materials: One hundred and forty human mandibular molars with mesiobuccal canals with angles of curvatures ranging between 25 and 35 degrees and radii ranging between 4 and 9 mm were assigned to seven homogenous groups (n = 20 teeth per group). In half of the teeth of each of the seven groups a manual glide path (size 15) was created prior to instrumentation. The root canals were instrumented using the three different types of instruments to an apical size 25. One group served as control as no canal preparation was performed. Roots were sectioned horizontally at 3, 6, and 9 mm from the apex and evaluated under a microscope using 25-fold magnification. The presence of dentinal defects (complete/ incomplete cracks) was noted and analyzed using Fisher's exact test. Results: No defects were observed in the controls. All canal preparations created dentinal defects. More incomplete and complete cracks were found in the apical (n = 4) and the middle (n = 3) canal third than in the coronal (n = 1), without any significant differences between the three instruments (P > .05). Prior glide path preparation had no significant impact on the incidence of dentinal defects (P > .05). Conclusion: A glide path preparation seems not to be mandatory to reduce the risk of dentinal defects formation when using the tested instruments in severely curved canals. [ABSTRACT FROM AUTHOR]

The aim of this review is to provide a critical overview of the physical properties (surface hardness, cutting efficiency, bending properties, flexibility and cyclic fatigue resistance) of NiTi instruments. Frequently used experimental models regarding these aspects will be presented and discussed with regard to their strengths and weaknesses. For all these aspects, a plethora of experimental models have been described. Based on a critical appraisal and especially taking the appropriate translation of experimental findings to clinical endodontics into account, suggestions for future research based on clearly defined and valid experimental methodologies will be provided. Up to now, very few attempts have been made to assess which particular physical properties of NiTi instruments exert an impact on the clinical outcome of root canal treatment. Departure from merely focusing on physical properties and fracture characteristics towards more biological aspects in terms of treatment outcome is essential. [ABSTRACT FROM AUTHOR]