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Introduction New tricalcium silicate cements have been shown to induce less coronal discoloration. The purpose of this in vitro study was to evaluate the degree of color change induced by various silicate materials in the presence and absence of blood. Methods One hundred human extracted anterior single-canal teeth were sectioned to standardized root lengths, accessed, and instrumented. Eight random experimental groups and 2 control groups were created wherein specimens were filled with experimental materials below the buccal cementoenamel junction as follows: EndoSequence RRM putty (Brasseler USA, Savannah, GA), EndoSequence RRM fast set putty (Brasseler USA), Biodentine (Septodont, Saint-Maur-des-Fosses, France), and white mineral trioxide aggregate (Dentsply Sirona, York, PA) either with the presence or absence of blood. Blood-only and saline-only samples were used for the positive and negative controls. After incubation in 100% humidity at 37°C, color changes were evaluated with a spectrophotometer (Ocean Optics, Dunedin, FL) on days 0, 30, 60, and 180 after material placement. Data were transformed into Commission International de I'Eclairage's L∗a∗b color values, and corresponding ΔE values were calculated. The 1-way analysis of variance test was performed for statistical analysis. Results Discoloration was observed in all specimens in the presence of blood. There was no statistical significance when comparing different materials in contact with blood. Intragroup observation at various time points, Biodentine, and EndoSequence RRM fast set putty showed significant difference between the presence and absence of blood at 180 days (P Conclusions Contamination with blood of tricalcium silicate materials has the potential to cause coronal tooth discoloration.

Endodontic microsurgery is a predictable alternative to nonsurgical treatment of persistent and recurrent apical periodontitis. The modern endodontic microsurgical procedure has been evolving in pace with technological advances. The introduction of modern innovations such as cone-beam computed tomographic (CBCT) imaging, 3-dimensional (3D) printing technology, and a 3D surgical guide designed with computer-aided software has allowed for a novel approach to the surgical site. The aim of these case reports was to describe root-end surgery with the use of the implant DDS-Pro planning software (Natrodent Polska, Poland), a 3D-printed surgical guide precisely positioned according to the preoperative CBCT scan measurements (CS 8100; Carestream Dental, Atlanta, GA), and a modified soft tissue access. A hollow trephine bur was used to perform the osteotomy, resection of the root, and enucleation of the lesion. The intact cortical plate was salvaged and used as a graft along with plasma-rich fibrin acquired preoperatively from the patient's blood. The positioning guide allowed the clinicians to precisely achieve targeted tissues and shorten the procedure time. Modified soft tissue management helped achieve a small surgical wound for uneventful healing. A less than 12-month CBCT follow-up of both cases showed complete 3D healing of the surgical site.

Introduction The purpose of this randomized clinical trial was to evaluate healing after endodontic microsurgery (EMS) using mineral trioxide aggregate (MTA) versus EndoSequence root repair material (RRM; Brasseler, Savannah, GA) as root-end filling materials. Methods Two hundred forty-three teeth with persistent or recurrent apical periodontitis were randomly assigned to either the MTA or RRM group. EMS was performed, and follow-up visits with clinical and radiographic investigation were scheduled at 6, 12, and 24 months with follow-up cone-beam computed tomographic (CBCT) imaging after 12 months. Results One hundred twenty teeth with an average follow-up of 15 months were evaluated. The overall success rate was 93.3% for periapical (PA) evaluation and 85% for CBCT evaluation. The RRM group exhibited 92% and 84% success rates as assessed on PA and CBCT imaging, respectively. The MTA group exhibited 94.7% and 86% success rates as assessed on PA and CBCT imaging, respectively. No significant difference was observed between the 2 groups. Microsurgical classification, root canal filling quality, root-end filling material depth, and root fracture were found to be significant outcome predictors. Conclusions EMS is a predictable procedure with successful outcome both 2-dimensional and 3-dimensional radiographic evaluation when RRM or MTA was used as the root-end filling material.

This prospective clinical study compares postoperative pain after single-visit, non-surgical root canal treatment of teeth with irreversible pulpitis using two different root canal filling techniques.All cases were treated by endodontic residents with a standardized protocol (minimum apical size 35) and filled with one of the two techniques: warm vertical compaction technique (WVT) with gutta percha and epoxy resin-based sealer (AH Plus Jet Root Canal Sealer, Dentsply Maillefer, York, PA, USA) or sealer-based filling technique (SBT) with single cone gutta percha and calcium silicate-based sealer (EndoSequence BC Sealer, Brasseler, Savannah, GA, USA). Surveys were given to participating patients to record pain intensity on a numeric rating scale (NRS, 0-10) at 4, 24, and 48 h postoperatively. Statistical significance was set at 0.05 level.One hundred ninety-four surveys were distributed over eighteen months. Ninety-two patients returned the survey (41 WVT and 51 SBT), of which 38% were asymptomatic irreversible pulpitis cases. The NRS values reduced over time for both techniques. No statistical difference was found between the two groups at the three time points assessed (p0.05). Postoperative pain was related to age, gender, presence of preoperative pain, and sealer extrusion (p0.05), however not related to preoperative periapical symptoms (percussion/palpation), dental arch, root type, and experience of the provider (p0.05).The intensity of postoperative pain for the two obturation techniques was equivalent at evaluated time points.The obturation technique does not influence postoperative pain. After endodontic treatment of symptomatic irreversible pulpitis teeth, the pain subsides in 48 h regardless of the technique.ClinicalTrials.gov ID: NCT04462731.

Endodontic microsurgery is a predictable and successful procedure when using techniques that have been developed over the past several years. One of the steps during surgery involves curettage of the entire lesion. However, there are cases in which the lesion has advanced to invade anatomic structures like the nasal fossa, maxillary sinus, mandibular canal, neighboring vital teeth, or through and through to the palate. These lesions make endodontic microsurgery difficult for the operator to execute and have inherent risks to the patient. Selective curettage is a conservative approach to treat such cases by removing approximately 50%-70% of the granulomatous tissue while avoiding complications and damage to the neighboring structures. Three-dimensional cone-beam computed tomographic imaging, 2-dimensional periapical radiographs, and clinical follow-ups of the selective curettage lesions showed complete or incomplete (scar tissue) healing in all cases with no untoward results.

Introduction A systematic review and meta-analysis were conducted to report combined and individual weighted pooled outcome rates for crown resection (CR) and root resection (RR) procedures. Methods Three electronic databases (PubMed [MEDLINE], Scopus, and the Cochrane Library) were searched to identify human studies in 12 languages on CR (hemisection, trisection, and premolarization) and RR (amputations and RRs without removal of crown portions). Five peer-reviewed journals, references of relevant publications, and reviews were hand searched. Assessment by 3 independent reviewers was based on the following predefined Population, Intervention, Comparison, Outcome, Study Design question: “For teeth in patients undergoing surgical therapy by CR versus RR, what is the expected probability of survival according to longitudinal studies with strictly defined outcome measurements and inclusion/exclusion criteria?” Clinical investigations with at least 12 months of follow-up were included. Studies and level of evidence were appraised using the Newcastle-Ottawa Scale and Grading of Recommendations, Assessment, Development and Evaluations. Results Thirty-four articles were obtained for final analysis. Data could be extracted from 19 studies (CR and RR OVERALL: N = 2667 [19 studies], CR: n = 111 [3 studies], and RR: n = 1127 [9 studies]). A random effects model showed weighted mean survival rates of 85.6% (95% confidence interval [CI], 76.7–91.5) for CR and RR procedures OVERALL. Individual data showed weighted mean survival rates of 81.9% (95% CI, 72.0–88.8) for CR and 87.2% (95% CI, 71.7–94.8) for RR. There was no statistically significant difference between CR and RR (P = .89, odds ratio calculation) or between maxillary and mandibular molars (P = .81, Fisher exact test). Conclusions Overall, CR and RR procedures showed good outcome rates. Large-scale randomized controlled trials should be conducted to strengthen the evidence.

Introduction The aim of the present study was to investigate the influence of root-end preparation and filling material on endodontic surgery outcome. A systematic review and meta-analysis was conducted to determine the outcome of resin-based endodontic surgery (RES, the use of high-magnification preparation of a shallow and concave root-end cavity and bonded resin-based root-end filling material) versus endodontic microsurgery (EMS, the use of high-magnification ultrasonic root-end preparation and root-end filling with SuperEBA [Keystone Industries, Gibbstown, NJ], IRM [Dentsply Sirona, York, PA], mineral trioxide aggregate [MTA], or other calcium silicate cements). Methods An exhaustive literature search was conducted to identify prognostic studies on the outcome of root-end surgery. Human studies conducted from 1966 to the end of December 2016 in 5 different languages (ie, English, French, German, Italian, and Spanish) were searched in 4 electronic databases (ie, Medline, Embase, PubMed, and Cochrane Library). Relevant review articles on the subject were scrutinized for cross-references. In addition, 5 dental and medical journals (Journal of Endodontics; International Endodontic Journal; Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics; Journal of Oral and Maxillofacial Surgery; and International Journal of Oral and Maxillofacial Surgery) were hand checked dating back to 1975. All abstracts were screened by 3 independent reviewers (H.B., M.K., and F.S.). Strict inclusion-exclusion criteria were defined to identify relevant articles. Raw data were extracted from the full-text review of these selected articles independently by each of the 3 reviewers. In case of disagreement, an agreement was reached by discussion, and qualifying articles were assigned to group RES. For EMS, the same search strategy was performed for the time frame October 2009 to December 2016, whereas up to October 2009 the data were obtained from a previous systematic review with identical criteria and search strategy. Weighted pooled success rates and a relative risk assessment between RES and EMS were calculated. To make a comparison between groups, a random effects model was used. Results Sixty-eight articles were eligible for full-text review. Of these, per strict inclusion exclusion criteria, 14 studies qualified, 3 for RES (n = 862) and 11 for EMS (n = 915). Weighted pooled success rates for RES were 82.20% (95% confidence interval [CI], 0.7965–0.8476) and 94.42% for EMS (95% CI, 0.9295–0.9590). This difference was statistically significant (P Conclusions The probability for success for EMS proved to be significantly greater than the probability for success for RES, providing best available evidence on the influence of cavity preparation with ultrasonic tips and/or SuperEBA (Keystone Industries, Gibbstown, NJ), IRM (Dentsply Sirona, York, PA), MTA, or silicate cements as root-end filling material instead of a shallow cavity preparation and placement of a resin-based material. Additional large-scale randomized clinical trials are needed to assess other predictors of outcome.

Introduction The aim of this study was to compare the assessment of healing after endodontic microsurgery using 2-dimensional (2D) periapical films versus 3-dimensional (3D) cone-beam computed tomographic (CBCT) imaging. Methods The healing of 51 teeth from 44 patients was evaluated using Molven's criteria (2D) and modified PENN 3D criteria. The absolute area (2D) and volume (3D) changes of apical lesions preoperatively and at follow-up were calculated by segmentation using OsiriX software (Pixmeo, Bernex, Switzerland) and ITK-Snap (free software). Results There was a significant difference between the mean preoperative lesion volumes of 95.34 mm 3 ( n = 51, standard deviation [SD] ±196.28 mm 3 ) versus 6.48 mm 3 ( n = 51, SD ±17.70 mm 3 ) at follow-up ( P 2 ( n = 51, SD ±18.80 mm 2 ) and 1.83 mm 2 ( n = 51, SD ±.68 mm 2 ) at follow-up ( P P Conclusions CBCT analysis allowed a more precise evaluation of periapical lesions and healing of endodontic microsurgery than periapical films. Significant differences existed between the 2 methods. Over the observation period, the mean periapical lesion sizes significantly decreased in volume. Given the correct indications, the use of CBCT imaging may be a valuable tool for the evaluation of healing of endodontic surgery.

Background Endodontic treatment is one of the most widely performed procedures in a dental office. New techniques for enhancing the effectiveness of irrigants are being introduced into the dental market. It is crucial to choose a proper method to obtain the highest possible long-term success of performed endodontic treatment. Sodium hypochlorite (NaOCl) appears to be one of the most common and profitable solutions for root canal irrigation. The activation of a solution may be analyzed in 2 fields, physical - turbulence of flow, and chemical - disintegration of irrigant molecules into very active radicals that improve its activity. While the physical alternations of irrigant flow with different techniques are widely studied, there are not many attempts to approach the subject in chemical terms. Objectives The aim of the study was to compare the chemical effectiveness of 2 methods of NaOCl activation: ultrasonics vs the Self-Adjusting File system (SAF) as an adjunct to increase the efficacy of the irrigant. Material and methods The level of activation was evaluated via a reaction of the activated NaOCl samples, with 9-fluorenol as the starting organic material. The model reaction is based on the oxidation of 9-fluorenol to 9-fluorenon. The evaluation was performed using 1H nuclear magnetic resonance (NMR) spectroscopy, comparing the spectra obtained for the examined mixtures. Results Nuclear magnetic resonance studies show that the use of ultrasonics resulted in increased chemical degradation of NaOCl as compared to the SAF system and non-agitated samples. The prevalence of chemical activation in the ultrasonic group over the SAF group was almost 3 times higher, 3.11 to 1.20, respectively. The Kruskal-Wallis rank sum test revealed there is a statistically significant difference in distributions between the groups. Conclusions Both SAF and ultrasonics activate NaOCl. Ultrasonic agitation provided higher chemical activation of NaOCl solution than the SAF. The use of ultrasonic agitation of NaOCl in endodontic treatment will allow us to obtain better long-term clinical results.

Introduction The purpose of this retrospective case series was to investigate the outcome of the revascularization procedure in necrotic immature teeth. Methods The residents and faculty members at the University of Pennsylvania endodontic department were invited to submit consecutive revascularization cases treated by them, irrespective of the outcome, during the time period of 2009 to 2012. Twenty-eight of 35 submitted necrotic immature teeth met the inclusion criteria. The treatment protocol included minimal instrumentation and irrigation with 3% sodium hypochlorite and 17% EDTA. Triple antibiotic paste was placed for a minimum of 21 days. After blood clot induction, either EndoSequence Bioceramic Putty (Brasseler, Savannah, GA) or mineral trioxide aggregate was placed below the cementoenamel junction, and composite was used as a final restoration. The follow-up period ranged from 7 to 72 months. The outcome was assessed as complete healing (the absence of clinical signs and symptoms, complete resolution of periradicular radiolucency, increase in the root dentin thickness/length, and apical closure), incomplete healing (the absence of clinical signs and symptoms, the periapical lesion completely healed without any signs of root maturation or thickening, the periapical lesion either reduced in size or unchanged with/without radiographic signs of increasing root dentin thickness/length, or apical closure), and failure (persistent clinical signs and symptoms and/or increased size of the periradicular lesion). Results Twenty-one of 28 cases (75%) healed completely, 3 cases (10.7%) failed during the observation period and needed further treatment, and 4 cases (14%) presented with incomplete healing. Conclusions Within the limitation of this study, the outcome of revascularization, wherein healing of periapical periodontitis and maturation of roots occurs, is fairly high, making it a viable treatment option in comparison with apexification.

Coronal tooth discoloration induced by various endodontic materials was evaluated in vitro.Eighty extracted human maxillary anterior teeth were accessed, instrumented, and sectioned to standardized root lengths of 10 mm below the cementoenamel junction. Pulp chambers were cleaned chemomechanically to ensure complete tissue removal. Specimens were filled with experimental materials in 8 random groups: RRM, EndoSequence RRM putty (Brasseler, Savannah, GA); RRMF, EndoSequence RRM fast set paste (Brasseler); BD, Biodentine (Septodont, Saint-Maur-des-Fossés, France); WMTA, white MTA (Dentsply, York, PA), GMTA, gray MTA (Dentsply); AH+, AH Plus sealer (Dentsply); TAP, triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline); and NF, no filling (negative control group). After incubation in 100% humidity at 37°C, color changes were evaluated with a spectrophotometer (Ocean Optics, Dunedin, FL) on days 0, 7, 30, 60, and 180 after material placement (T0-T180). Data were transformed into Commission International de I'Eclairage's L*a*b color values, and corresponding ΔE values were calculated. Two-way analysis of variance and the Bonferroni method were performed.Visual discoloration was observed in all specimens in the GMTA, WMTA, and TAP groups at T7, increasing with time. The ΔE value between the initial color at T0 and at T7, T30, T60, and T180 was significantly different for GMTA, WMTA, and TAP (P.001). ΔE values for the BD, RRM, RRMF, AH+, and NF groups were not statistically significantly different between T0 and T7, T30, T60, and T180, respectively, except for 3 samples below the human perceptible threshold. Values of L* dropped significantly from T0 to T180 in the TAP, GMTA, and WMTA groups.Significant coronal tooth discoloration was caused by TAP, GMTA, and WMTA but not by BD, RRM, and RRMF.

The purpose of this retrospective study was to evaluate and compare the outcome of endodontic micro-resurgery with that of primary endodontic microsurgery and determine prognostic factors affecting the outcome of micro-resurgery.A clinical database was searched for endodontic microsurgery cases between 2001 and 2016. Nearest neighbor 2:1 propensity score matching for the following 5 variables was performed for cases of primary microsurgery and those of micro-resurgery: age, sex, tooth type, lesion type, and postoperative restoration. For the matched cases, the outcome was categorized as success or failure according to clinical and radiographic evaluations performed at least 1 year after surgery. Kaplan-Meier survival analysis and log-rank tests were performed to compare the outcome of primary microsurgery with that of micro-resurgery over time. For the micro-resurgery group, multivariate Cox proportional hazard regression analysis was performed to identify prognostic factors and estimate their effects.In total, 571 cases of endodontic microsurgery (498 primary microsurgery and 73 micro-resurgery cases) were identified, and 146 cases of primary microsurgery were matched to 73 cases of micro-resurgery through 2:1 propensity score matching. After matching, all covariates demonstrated an absolute standardized difference of0.1. The estimated 5-year success rates were 91.6% and 87.6% for primary microsurgery and micro-resurgery, respectively (P = .594). The tooth type was found to be the only contributing factor for the outcome of micro-resurgery, with molars showing a higher probability of failure than anterior teeth (hazard ratio, 8.53; P = .002).Within the limitations, the findings of this study suggest that the outcome of endodontic micro-resurgery is comparable with that of primary endodontic microsurgery.

Introduction The aim of this study was to investigate changes in treatment planning decisions among different practitioner groups over 7 years for teeth with apical periodontitis and a history of endodontic treatment. Methods A Web-based survey was sent to dentists in Pennsylvania in 2009 consisting of 14 cases with nonhealing periapical lesions and intact restorations without evidence of recurrent caries. Participants selected among 5 treatment options: wait and observe, nonsurgical retreatment (NSRTX), surgical retreatment (SRTX), extraction and fixed partial denture, or extraction and implant (EXIMP). In 2016, the identical survey was resent to the original 2009 participants. Results In 2009, 262 dentists participated in the survey. Two hundred one participants were general practitioners (GPs: 76.7%), 26 endodontists (ENDOs: 9.9%), and 35 other specialists (prosthodontics, periodontics, and oral surgery [SPECs]: 13.4%) (n = 262). EXIMP, NSRTX, and SRTX were fairly equally selected but with great variation between practitioner groups (χ2 = 173.49, P SPECs > ENDOs [χ2 = 11.2792, P Conclusions No significant differences were noted between current and past treatment planning decisions in regard to tooth preservation by endodontic retreatment versus tooth extraction and replacement. However, individual practitioners lacked consistency in their decision making over time.

Introduction Cone-beam computed tomographic (CBCT) imaging is an emerging technology for clinical endodontic practice. The aim of this study was to investigate the acceptance, accessibility, and usage of CBCT imaging among American Association of Endodontists members in the United States by means of an online survey. Methods An invitation to participate in a web-based survey was sent to 3076 members of the American Association of Endodontists. The survey consisted of 8 questions on demographics, access to CBCT machines, field of view (FOV), frequency of use for particular applications, and reasons in case CBCT was not used. Results A total of 1083 participants completed the survey, giving an overall completed response rate of 35.2%; 80.30% of the participants had access to a CBCT scan, of which 50.69% ( n = 443) were on-site and 49.31% ( n = 431) were off-site, and 19.30% of all respondents denied having access to CBCT imaging. Limited FOV was used by 55.26% participants, 22.37% used larger FOV formats, and the remaining 22.37% were not sure about the format. There was a significantly greater usage of CBCT technology in residency programs ( n = 78/84 [92.86%]) compared with practitioners who had finished an endodontic specialty program ( n = 796/999 [79.68%]) (χ 2 = 10.30, P = .02). Practitioners used CBCT imaging "frequent" or "always" for internal or external resorptions (47.28%), preoperatively for surgical retreatment or intentional replantation (45.34%), missing canals (25.39%), preoperatively for nonsurgical retreatments (24.91%), differential diagnosis (21.16%), identifying periradicular lesions (18.26%), calcified cases (13.54%), immature teeth (4.71%), and to assess healing (3.87%). There was a significant difference in on-site and off-site CBCT imaging use for any of these applications ( P Conclusions There is a widespread application of CBCT technology in endodontic practice; however, results from the survey also confirmed that the benefit versus risk ratio should always be in favor of the patient if CBCT scans are taken.

The purpose of this retrospective cohort study was to evaluate the incidence of missed canals in endodontically treated teeth in the Greater Philadelphia area patient population and to evaluate the effect of untreated canals on endodontic outcome.A total of 1397 cone-beam computed tomography (CBCT) volumes taken from January 2013 to July 2015 were investigated. Limited view CBCT images were taken with Kodak 9000 3D System field of view at voxel size, 76 μm or Morita Veraviewpocs 3D F40 field of view at voxel size, 125 μm. All root canal-treated premolars and molars were included in the study. Unfilled canals appearing from cementoenamel junction to apex including splitting from a main canal at coronal, mid, or apical third were defined as missed-untreated canal. A periapical lesion was diagnosed when disruption of the lamina dura was detected and the low density area associated with the radiographic apex was at least twice the width of the periodontal ligament space.The overall incidence of missed canals was 23.04%. The incidence of missed canals per tooth was highest in tooth #14 at 46.5% and tooth #3 at 41.3%. The incidence of missed canals was highest in the upper molars at 40.1% and lowest in the upper premolars at 9.5%. There was a significant difference in lesion prevalence when a canal was missed-untreated (P .05). Teeth with a missed canal were 4.38 times more likely to be associated with a lesion.Limited field-of-view CBCT should be examined before any endodontic retreatment to identify missed canals. This knowledge would not only help clinicians to locate missed canals clinically but would also help in deciding the surgical approach.

Introduction The purpose of this study was to compare healing after root-end surgery by using grey mineral trioxide aggregate (MTA) and EndoSequence Root Repair Material (RRM) as root-end filling material in an animal model. Methods Apical periodontitis was induced in 55 mandibular premolars of 4 healthy beagle dogs. After 6 weeks, root-end surgeries were performed by using modern microsurgical techniques. Two different root-end filling materials were used, grey MTA and RRM. Six months after surgery, healing of the periapical area was assessed by periapical radiographs, cone-beam computed tomography (CBCT), micro computed tomography (CT), and histology. Results Minimal or no inflammatory response was observed in the majority of periapical areas regardless of the material. The degree of inflammatory infiltration and cortical plate healing were not significantly different between the 2 materials. However, a significantly greater root-end surface area was covered by cementum-like, periodontal ligament–like tissue, and bone in RRM group than in MTA group. When evaluating with periapical radiographs, complete healing rate in RRM and MTA groups was 92.6% and 75%, respectively, and the difference was not statistically significant (P = .073). However, on CBCT and micro CT images, RRM group demonstrated significantly superior healing on the resected root-end surface and in the periapical area (P = .000 to .027). Conclusions Like MTA, RRM is a biocompatible material with good sealing ability. However, in this animal model RRM achieved a better tissue healing response adjacent to the resected root-end surface histologically. The superior healing tendency associated with RRM could be detected by CBCT and micro CT but not periapical radiography.

Objectives To investigate the proliferative, migratory and adhesion effect of Biodentine™, a new tricalcium silicate cement formulation, on the human dental pulp stem cells (hDPSCs). Methods The cell cultures of hDPSCs obtained from impacted third molars were treated with Biodentine™ extract at four different concentrations: Biodentine™ 0.02 mg/ml (BD 0.02), Biodentine™ 0.2 mg/ml (BD 0.2), Biodentine™ 2 mg/ml (BD 2) and Biodentine™ 20 mg/ml (BD 20). Human dental pulp stem cells proliferation was evaluated by MTT (3-(4,5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2H-tetrazolium bromide) and BrdU (5-bromo-2′-deoxyuridine) viability analysis at different times. Migration was investigated by microphotographs of wound healing and transwell migration assays. Adhesion assay was performed as well in presence of BD 0.2, BD 2 and blank control, while qRT-PCR (quantitative real-time reverse-transcriptase polymerase chain) was used for further analysis of the mRNA expression of chemokine and adhesion molecules in hDPSCs. Results Biodentine™ significantly increased proliferation of stem cells at BD 0.2 and BD 2 concentrations while decreased significantly at higher concentration of BD 20. BD 0.2 concentration had a statistically significant increased migration and adhesion abilities. In addition, qRT-PCR results showed that BD 0.2 could have effect on the mRNA expression of chemokines and adhesion molecules in human dental pulp stem cells. Conclusions The data imply that Biodentine™ is a bioactive and biocompatible material capable of enhancing hDPSCs proliferation, migration and adhesion abilities. Clinical significance Biodentine™ when placed in direct contact with the pulp during pulp exposure can positively influence healing by enhancing the proliferation, migration and adhesion of human dental pulp stem cells.

Introduction Biodentine (Septodont, Saint-Maur-des-Fosses, France), a new tricalcium silicate cement formulation, has been introduced as a bioactive dentine substitute to be used in direct contact with pulp tissue. The aim of this study was to investigate the response of human dental pulp stem cells (hDPSCs) to the material and whether mitogen-activated protein kinase (MAPK), nuclear factor-kappa B (NF-κB), and calcium-/calmodulin-dependent protein kinase II (CaMKII) signal pathways played a regulatory role in Biodentine-induced odontoblast differentiation. Methods hDPCs obtained from impacted third molars were incubated with Biodentine. Odontoblastic differentiation was evaluated by alkaline phosphatase activity, alizarin red staining, and quantitative real-time reverse-transcriptase polymerase chain reaction for the analysis of messenger RNA expression of the following differentiation gene markers: osteocalcin (OCN), dentin sialophosprotein (DSPP), dentin matrix protein 1 (DMP1), and bone sialoprotein (BSP). Cell cultures in the presence of Biodentine were exposed to specific inhibitors of MAPK (U0126, SB203580, and SP600125), NF-κB (pyrrolidine dithiocarbamate), and CaMKII (KN-93) pathways to evaluate the regulatory effect on the expression of these markers and mineralization assay. Results Biodentine significantly increased alkaline phosphatase activity and mineralized nodule formation and the expression of OCN, DSPP, DMP1, and BSP. The MAPK inhibitor for extracellular signal-regulated kinase 1/2 (U0126) and Jun N-terminal kinase (SP600125) significantly decreased the Biodentine-induced mineralized differentiation of hDPSCs and OCN, DSPP, DMP1, and BSP messenger RNA expression, whereas p38 MAPK inhibitors (SB203580) had no effect. The CaMKII inhibitor KN-93 significantly attenuated and the NF-κB inhibitor pyrrolidine dithiocarbamate further enhanced the up-regulation of Biodentine-induced gene expression and mineralization. Conclusions Biodentine is a bioactive and biocompatible material capable of inducing odontoblast differentiation of hDPSCs. Our results indicate that this induction is regulated via MAPK and CaMKII pathways.

The aim of this study was to investigate the outcome of root-end surgery. It identifies the effect of the surgical operating microscope or the endoscope on the prognosis of endodontic surgery. The specific outcomes of contemporary root-end surgery techniques with microinstruments but only loupes or no visualization aids (contemporary root-end surgery [CRS]) were compared with endodontic microsurgery using the same instruments and materials but with high-power magnification as provided by the surgical operating microscope or the endoscope (endodontic microsurgery [EMS]). The probabilities of success for a comparison of the 2 techniques were determined by means of a meta-analysis and systematic review of the literature. The influence of the tooth type on the outcome was investigated.A comprehensive literature search for longitudinal studies on the outcome of root-end surgery was conducted. Three electronic databases (ie, Medline, Embase, and PubMed) were searched to identify human studies from 1966 up to October 2009 in 5 different languages (ie, English, French, German, Italian, and Spanish). Review articles and relevant articles were searched for cross-references. In addition, 5 dental and medical journals (ie, Journal of Endodontics, International Endodontic Journal, Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics, Journal of Oral and Maxillofacial Surgery, and International Journal of Oral and Maxillofacial Surgery) dating back to 1975 were hand searched. Following predefined inclusion and exclusion criteria, all articles were screened by 3 independent reviewers (S.B.S., M.R.K., and F.C.S.). Relevant articles were obtained in full-text form, and raw data were extracted independently by each reviewer. After agreement among the reviewers, articles that qualified were assigned to group CRS. Articles belonging to group EMS had already been obtained for part 1 of this meta-analysis. Weighted pooled success rates and a relative risk assessment between CRS and EMS overall as well as for molars, premolars, and anteriors were calculated. A random-effects model was used for a comparison between the groups.One hundred one articles were identified and obtained for final analysis. In total, 14 studies qualified according to the inclusion and exclusion criteria, 2 being represented in both groups (7 for CRS [n = 610] and 9 for EMS [n = 699]). Weighted pooled success rates calculated from extracted raw data showed an 88% positive outcome for CRS (95% confidence interval, 0.8455-0.9164) and 94% for EMS (95% confidence interval, 0.8889-0.9816). This difference was statistically significant (P.0005). Relative risk ratio analysis showed that the probability of success for EMS was 1.07 times the probability of success for CRS. Seven studies provided information on the individual tooth type (4 for CRS [n = 457] and 3 for EMS [n = 222]). The difference in probability of success between the groups was statistically significant for molars (n = 193, P = .011). No significant difference was found for the premolar or anterior group (premolar [n = 169], P = .404; anterior [n = 277], P = .715).The probability for success for EMS proved to be significantly greater than the probability for success for CRS, providing best available evidence on the influence of high-power magnification rendered by the dental operating microscope or the endoscope. Large-scale randomized clinical trials for statistically valid conclusions for current endodontic questions are needed to make informed decisions for clinical practice.

The aim of this study was to investigate the outcome of root-end surgery. The specific outcome of traditional root-end surgery (TRS) versus endodontic microsurgery (EMS) and the probability of success for comparison of the 2 techniques were determined by means of meta-analysis and systematic review of the literature.An intensive search of the literature was conducted to identify longitudinal studies evaluating the outcome of root-end surgery. Three electronic databases (Medline, Embase, and PubMed) were searched to identify human studies from 1966 to October 2009 in 5 different languages (English, French, German, Italian, and Spanish). Relevant articles and review papers were searched for cross-references. Five pertinent journals (Journal of Endodontics, International Endodontic Journal, Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics, Journal of Oral and Maxillofacial Surgery, International Journal of Oral and Maxillofacial Surgery) were individually searched back to 1975. Three independent reviewers (S.S., M.K., and F.S.) assessed the abstracts of all articles that were found according to predefined inclusion and exclusion criteria. Relevant articles were acquired in full-text form, and raw data were extracted independently by each reviewer. Qualifying papers were assigned to group TRS or group EMS. Weighted pooled success rates and relative risk assessment between TRS and EMS were calculated. A comparison between the groups was made by using a random effects model.Ninety-eight articles were identified and obtained for final analysis. In total, 21 studies qualified (12 for TRS [n = 925] and 9 for EMS [n = 699]) according to the inclusion and exclusion criteria. Weighted pooled success rates calculated from extracted raw data showed 59% positive outcome for TRS (95% confidence interval, 0.55-0.6308) and 94% for EMS (95% confidence interval, 0.8889-0.9816). This difference was statistically significant (P.0005). The relative risk ratio showed that the probability of success for EMS was 1.58 times the probability of success for TRS.The use of microsurgical techniques is superior in achieving predictably high success rates for root-end surgery when compared with traditional techniques.

This study investigated the incidence of hand and rotary instrument separation (IS) in the endodontics graduate program at the University of Pennsylvania between 2000 and 2004. In 4,865 endodontic resident cases the incidence of hand and rotary IS was 0.25% and 1.68%, respectively. The odds for rotary IS were seven times more than for hand IS. The probability of separating a file in apical third was 33, and 6 times more likely when compared to coronal and middle thirds of the canals. The highest percentage of IS occurred in mandibular (55.5%) and maxillary (33.3%) molars. Furthermore, the odds of separating a file in molars were 2.9 times greater than premolars. Among the ProFile series 29 rotary instruments, the .06 taper # 5 and # 6 files separated the most. There was no significant difference in IS between the use of torque controlled versus nontorque controlled handpieces, nor between first and second year residency.