Percepção profissional sobre tratamento endodôntico em sessão única e múltiplas sessões / Professional perception of single and multi-session endodontic treatment

Na odontologia a decisão do tratamento é exclusiva dos cirurgiões dentistas e suas percepções, incluindo filosofia de tratamento, fazendo com que a prática de novos conceitos, tratamentos ou técnicas dependam não apenas de sua lógica ou eficácia biológica. Sendo assim, este estudo teve como objetivo avaliar os parâmetros envolvidos na tomada de decisão de cirurgiões dentistas clínicos e especialistas para a realização do tratamento endodôntico em sessão única ou múltiplas sessões. Para tanto, este estudo contou com uma coleta de dados através de um questionário online, aplicado cirurgiões dentistas clínicos gerais e especialistas em endodontia. As respostas foram tabuladas e analisadas por meio de estatística descritiva. Os resultados revelaram que a maioria dos endodontistas e dos clínicos gerais prefere realizar tratamento endodôntico em sessão única, devido ao menor desperdício de material, além do melhor domínio da anatomia e tratamento em um único momento. O motivo mais comum para os endodontistas e clínicos gerais escolherem o tratamento com múltiplas visitas é para dentes com prognóstico duvidoso e os casos em que o profissional aguarda a remissão dos sintomas antes da obturação. Em conclusão, a maioria dos endodontistas e dos clínicos gerais preferiu realizar tratamento endodôntico em sessão única.

In dentistry, treatment decisions are made exclusively by dental surgeons and their perceptions, including treatment philosophy, which means that the practice of new concepts, treatments or techniques depends not only on their logic or biological efficacy. Therefore, the aim of this study was to evaluate the parameters involved in clinical and specialist dental surgeons' decision to carry out endodontic treatment in single or multiple sessions. To this end, data was collected using an online questionnaire administered to general dental surgeons and endodontic specialists. The answers were tabulated and analyzed using descriptive statistics. The results revealed that the majority of endodontists and general practitioners prefer to carry out endodontic treatment in a single session, due to less wastage of material, as well as better mastery of the anatomy and treatment at a single time. The most common reason for endodontists and general practitioners to choose treatment with multiple visits is for teeth with a doubtful prognosis and cases in which the professional is waiting for symptoms to remit before filling. In conclusion, the majority of endodontists and general practitioners preferred to carry out endodontic treatment in a single session.

Systemic Factors Affecting Prognosis and Outcome of Endodontic Therapy.

The successful outcome of endodontic treatment is dependent on the immune response and the reparative potential of the individual. Alteration in the host immune response is a common characteristic shared by both apical periodontitis and systemic diseases. Although infection-induced periapical lesions occur in a localized environment, numerous epidemiologic studies in the last few decades have investigated the potential association between endodontic disease pathogenesis and systemic diseases. The goal of this review is to identify common systematic factors and discuss the effect they may or may not have on the prognosis and outcome of endodontic therapy.

Endodontic characteristics of mandibular premolar with dens evaginatus: a retrospective study.

Objectives: This study aimed to investigate the endodontic characteristics of mandibular premolars with dens evaginatus (DE) that require endodontic treatment. Materials and Methods: Patients who underwent endodontic treatment were enrolled. The inclusion criteria were patients who underwent root canal treatment in the lower permanent teeth with DE and were followed up for at least 1 year. Preoperative clinical and radiographic variables were obtained. The frequency distribution of the preoperative variables was compared using the χ2 or Fisher's exact tests. The significance of the change in periapical health index (PAI) and root development stages before and after treatment was examined using the Wilcoxon signed-rank test. Results: A total of 150 teeth of 134 patients with an average age of 15.3 years were included. The percentage distribution comparison of the preoperative variables and obturation techniques revealed significant differences in pulpal and periapical diagnosis, and percussion, and especially regarding age, root development stage, and PAI. Age was the only statistically significant preoperative variable associated with root growth (p < 0.05). Conclusions: Approximately, 60% of DEs requiring endodontic treatment had immature roots. Age being the most significant predisposing factor, early treatment provides the greatest opportunity for full root development.

Alkasite restorative material for endodontically treated teeth: a randomized controlled pilot study.

Objectives: This study aimed to evaluate the clinical performance of an alkasite restorative material in molars that had undergone root canal treatment. Materials and Methods: The research was registered in Brazilian Registry of Clinical Trials. The randomized clinical trial involved 33 patients, each with at least 1 mandibular molar requiring restoration after receiving endodontic treatment. Patients were randomly assigned to receive either bulk-fill resin composite (Tetric N Ceram Bulk Fill, Ivoclar Vivadent) or the alkasite restorative material (Cention N, Ivoclar Vivadent). Upon completion of the restorations, 3 calibrated professionals utilized the United States Public Health Service criteria to assess various factors, including retention, secondary caries, marginal adaptation, restoration color, marginal pigmentation, and anatomical form. Evaluations were conducted at intervals of 7 days, 6 months, and 17 months. Additionally, the assessment encompassed the presence of radiolucent lines adjacent to the restoration, material deficiencies or excess, contact points, and caries recurrence. The data underwent analysis using the Friedman and Mann-Whitney tests (α = 0.05). Results: After 17 months, the results revealed that the alkasite restorative material exhibited greater wear of anatomical shape compared to the bulk-fill resin composite (p = 0.0189). Furthermore, the alkasite restorative material significantly differed from the natural tooth color in most cases (p = 0.0000). However, no other criteria displayed significant differences between the materials or over time (p > 0.05). Conclusions: The alkasite restorative material (Cention N) emerges as a viable option for restoring endodontically treated teeth, displaying clinically acceptable alterations after a 17-month evaluation period. Trial Registration: Brazilian Registry of Clinical Trials (ReBEC) Identifier: RBR-97kx5jv.

Comparative evaluation of antimicrobial efficacy of various intracanal medicament in young permanent teeth: An in vivo study.

INTRODUCTION: Bacteria and their byproducts are key contributors to the onset and perpetuation of pulpoperiapical pathosis. Intracanal medication is vital in achieving successful endodontic outcomes as it targets and eradicates remaining microorganisms following biomechanical preparation. AIM AND OBJECTIVE: The aim of the study was to compare and evaluate the antimicrobial efficacy of calcium hydroxide (CH) paste, triple antibiotic paste (TAP), and probiotics (PBs) as intracanal medicament in 12-17-year-old children undergoing root canal treatment for the management of infected pulpal tissues in young permanent teeth. MATERIALS AND METHODS: A total of 30 patients aged 12-17 years indicated for endodontic therapy in maxillary incisors and with no systemic complications were selected. They were randomly divided into three groups, i.e., Group I - CH group, Group II - TAP, and Group III - PB allocating 10 teeth in each group. After access opening, the first sample (S1) was collected by inserting a paper point into the root canal, the second sample (S2) was collected immediately after biomechanical preparation, and the third sample (S3) was collected after 7 days, i.e., postintracanal medication. Samples were sent for microbiological analysis to assess the microbial count, and statistical analysis was done for the obtained data. RESULTS: The three intracanal medicaments were successful in reducing the microbial counts of Enterococcus faecalis in the infected root canals. However, according to the results of the study, the PB group demonstrated greater effectiveness against E. faecalis compared to the CH group and displayed similar antimicrobial efficacy as the TAP group. CONCLUSION: PB exhibited antimicrobial efficacy comparable to TAP but greater than Ca (OH) 2 paste. Hence, PB can be utilized as an intracanal medicament in young permanent teeth.

Survival evaluation of surgical extrusion for the management of complicated crown-root fractured maxillary incisors: A clinical study.

This study aimed to clinically evaluate the survivability of surgically extruded teeth, to assess the success rate and predictable factors pertaining to alterations in both hard and soft tissues adjacent to extruded teeth. A total of 46 complicated crown-root fractured maxillary central and lateral incisors with >75% tooth structure loss relatively due to trauma were included. Preoperative clinical and radiographic variables were recorded. Single operator performed endodontic treatment before surgical extrusion. Patients were recalled for review at 6, 12, 18, 24 and 36 months. Survivability was assessed using Kaplan-Meier survival analysis. With a mean follow-up of 2.8 years, survival rate was 95.7%. Mobility observed in only two cases. The crown-root ratio was favourable (1:2) in all the cases except for five teeth. Only two teeth displayed non-progressive root resorption. Survival of surgically extruded teeth relies on significant predictors like favourability of CRR and implementation of atraumatic extrusion.

Comparing the technical quality and clinical outcomes of root canal treatment on immature permanent incisors in children: a retrospective evaluation of three bioceramic plug materials.

PURPOSE: To assess the technical quality and clinical outcomes of non-surgical endodontic treatment of immature permanent incisor teeth with three different bioceramic plug materials and highlight variables which may influence treatment and quality outcomes. METHODS: This cross-sectional analysis forms part of a retrospective service evaluation of the technical quality and clinical outcome of orthograde root canal treatment carried out in the Paediatric Dentistry Department of Charles Clifford Dental Hospital (United Kingdom). Twenty-five cases were identified chronologically, using the electronic patient record system, for three bioceramic plug materials: Mineral Trioxide Aggregate (MTA), Biodentine, and TotalFill Putty. All radiographs were analysed using standard conditions. Intra- and inter-examiner agreement was calculated using Kappa and weighted Kappa tests. Data were collected using a data collection tool, entered into Microsoft Excel, and analysed using descriptive statistics, exploratory analysis with Chi-squared tests, and multivariable analyses (logistic regression). RESULTS: At 12-month review, the success rate for each apexification material was MTA (84%), Biodentine (88%), and TotalFill Putty (92%). MTA had the highest frequency of post-operative coronal discolouration, with Biodentine most associated with apical extrusion. A number of variables and trends that affect the clinical outcome were identified, including the presence of pre-operative resorption, the number of operators involved in treatment, the number of appointments to complete treatment, as well as how non-use of local anaesthetic during apical plug placement had no adverse effect on technical quality or clinical outcome. CONCLUSIONS: MTA, Biodentine, and TotalFill Putty are highly effective apexification materials which produce excellent clinical outcomes. As such, logistical and situational factors, such as continuity of care from operators with increased levels of experience, skill and ability, rather than material choice, may be more prognostic regarding the technical quality and clinical outcome of immature endodontic treatment. Further high-quality evidence is required.

Outcome of regenerative endodontic procedures in delayed replanted immature permanent teeth with apical periodontitis: A retrospective study.

BACKGROUND: Regenerative endodontic procedures (REPs) is effective for treating young permanent teeth with pulp necrosis. However, its efficacy on delayed replanted avulsed teeth is unclear. AIM: This retrospective study aimed to assess the efficacy of REPs in treating delayed replanted immature permanent teeth with apical periodontitis. DESIGN: Avulsed teeth receiving REPs were systematically screened based on predetermined criteria. This study assessed the REP outcomes, postoperative periodontal healing, and overall treatment efficacy. Samples were grouped by REP outcomes and root development stage, with Fisher's exact tests used to compare outcomes among different groups. RESULTS: Among the included 17 teeth, 47.1% exhibited successful REPs and periodontal healing. Another 47.1%, due to replacement resorption or REP failure, were categorized as tooth survival. Healing of periapical lesions was observed in 88.2% of the cases, but only 41.2% demonstrated continued root development. Although differences were not significant (p = 0.05), teeth with continued root development had a higher rate of functional healing (85.7%) compared to those without (30%). CONCLUSION: Within the limitations of this study, REPs presented reliable outcomes for treating delayed replanted immature permanent teeth with apical periodontitis mainly in periapical lesion healing. Teeth with continued root development after REPs exhibited a higher rate of functional healing. Further investigation is required to explore potential synergies between REP outcomes and periodontal healing.

Effect of fit and self-etching adhesive on fiber post retention in endodontically treated teeth.

BACKGROUND: Fiber post (FP) reinforced restoration was widespread in endodontically treated teeth, of which the retention was closely related to fit and operation process. However, the question whether the fit and self-etching adhesive (SED) affect the success of FP restoration still remained unclear. OBJECTIVE: This research aimed to assess how the fit and self-etching adhesive (SED) impact the pull-out bond strength (BS) of glass fiber-reinforced composite posts from the root canal dentin. METHODS: Eighty lower first premolars underwent simulated endodontic treatment, after which their canals were shaped to accommodate a size three RelyX fiber post (FP) (diameter 1.9 mm). They were then divided into 4 equal groups [Unfit post and no SEA (Group UN), Fit post and no SEA (Group FN), Unfit post with SEA (Group UA) and Fit post with SEA (Group FA)] using two different sized FPs and SEA. Cement thickness was acquired by histological analysis and stereomicroscopy. Each sample was tested for pull-out strength through a universal testing machine. Based on the pull-out test, the failure types were observed and scored by visualizing through a stereomicroscope. RESULTS: Group FA demonstrated significantly greater BS compared to Group UN and Group UA, with Group UN showing a statistically significant difference at p< 0.01 and Group UA at p< 0.05. Main failure types in Group FA were Type II, which illustrated that the cement detachment mainly occurred from the post-cement interface. Therefore, Group FA possessed the STRONGEST BS and was most suitable for FP-reinforced crown restorations. CONCLUSIONS: Both the fit and SEA enhanced the pull-out BS. The SEA was critical for BS promotion when the mechanical retention was inadequate.

Tooth- and implant-related prognostic factors in treatment planning.

Following a comprehensive patient examination, including the assessment of periodontal and peri-implant diseases as well as considering the patient's needs, a pretherapeutic prognosis for each tooth and implant is given. Teeth and implants with a secure pretherapeutic prognosis require simple procedures and may be regarded as secure abutments for function and with a doubtful pretherapeutic prognosis usually need a comprehensive therapy. Such teeth and implants must be brought into the category with a secure prognosis by means of additional therapy such as endodontic, restorative, and surgical procedures. Teeth and implants with a hopeless pretherapeutic prognosis should be extracted/explanted during the initial phase of cause-related therapy (i.e., infection control). For example, teeth with vertical root fracture or unrestorable caries and implants with mobility or unrestorable malposition fall into the category of hopeless units. The primary goal of periodontal and peri-implant therapy should be to arrest disease progression. The latest consensus statement highlights that periodontitis can be successfully controlled and treated teeth can be retained for life. Nevertheless, for patients with uncontrolled contributing factors, the endpoints might not always be achievable, and low disease activity may be an acceptable therapeutic goal. Similarly, the management of peri-implantitis frequently requires surgical intervention following nonsurgical therapy due to incomplete treatment outcomes. Different surgical modalities can be effective and lead to significant improvement; however, achieving complete resolution of peri-implantitis is challenging, not always predictable, and can depend on multiple baseline factors. Therefore, this review aims at summarising available evidence on the rationale for incorporating systemic, lifestyle-related, clinical, and radiographic prognostic factors into treatment planning of patients diagnosed with periodontal and peri-implant diseases.

Regenerative Surgical Management of an Endodontic Periodontic Lesion of the Mandibular Molar Combined With External Inflammation Root Resorption.

Endo-perio lesions are lesions involving pulp tissue with periodontal tissue. The bacterial infection of the pulp can spread to the furcation area through the accessory canal, causing damage to the furcation area. Regeneration therapy has good success when performed with flap surgery and is performed in cases of Grades I and II furcation involvement. Demineralized freeze-dried bone allograft (DFDBA) is a regenerating material that has osteoinductive and osteoconductive abilities. It has the advantage of successful treatment of bone defects. Biodentine is an agent used for direct pulp capping, root perforation and furcation repair, and apexification. It can bind and enter the dentinal tubules and create interlocking crystals with dentin. This case report presents the treatment of furcation involvement Grade II originating from endo-perio lesions by using DFDBA and Biodentine as regeneration materials with 6 months of follow-up.

When Maxillofacial CBCT Permits Fortuitously to Diagnose Primary Non-Hodgkin's Lymphoma: A Case Report.

A 47-year-old male with an unremarkable medical history was referred for atypical endodontic pain and treatment of his left upper molars. Clinical and radiographic examinations revealed an extensive, undefined osteolytic area around these teeth. A subsequent bone biopsy diagnosed diffuse large B-cell lymphoma, a high-grade non-Hodgkin's lymphoma. The hematology team prescribed six cycles of chemotherapy, supplemented by two cycles of methotrexate. Practitioners should be alerted by atypical tooth pain to consider 3D imaging to exclude malignant pathology as early as possible. Teaching point: An atypical tooth pain should alert the practitioner and guide them towards 3D imaging to eliminate diagnostic of malignant pathology as early as possible.

Prevalence, Characteristics and Distribution of Odontogenic Cysts amongst the Indian Subpopulation of Southern Rajasthan: A 5-year Retrospective Study of 218 Cysts.

BACKGROUND: Odontogenic cysts (OCs) arise from the odontogenic epithelium and occur in the tooth-bearing regions of the jaws. Proliferation and/or degeneration of this epithelium lead to OC development. AIM AND OBJECTIVES: The purpose of this study was to determine the prevalence, characteristics, distribution and clinicopathological features of OCs and compare with other studies. MATERIALS AND METHODS: Records of OCs were retrieved, and patient's data, aetiology, clinical features, histopathological distribution, treatment, complications and recurrence were studied. RESULTS: A total of 218 OCs were studied in 200 patients. The mean age of patients was 35.74 years. The overall sex ratio (male: female) was 1.22:1. Second, third and fourth decades of life were commonly affected. The majority of the patients (85%) reported with a complaint of pain (with or without swelling). Radicular cyst was the most prevalent type (49.55%). The most common site involved was the anterior maxilla (41.75%). Dental complications such as displacement, mobility, discoloration and root resorption were diagnosed in 91 cysts (41.75%). Bony complications such as expansion and perforation were present in 136 cysts (62.38%). Dentition was non-vital in 61.46% of cysts. The most common treatment method performed was combination surgery (enucleation with or without endodontic treatment/extraction and apicoectomy). Recurrence rate was 3.20%. CONCLUSION: The prevalence, characteristics and distribution features of OCs in India are similar to those of studies conducted in other parts of the world. There is a broad spectrum of OCs, with some cysts having a propensity for certain age, gender and site, whereas a few cysts have distinct properties to recur and have aggressive and invasive behaviour.

Evaluation of apically extruded debris during root canal filling material removal in teeth with external apical root resorption: a comparison of different obturation techniques.

BACKGROUND: Root canal retreatment is necessary when initial treatment fails. Nickel-titanium systems help remove filling materials; however, some methods can cause canal content extrusion, resulting in inflammation and delayed healing. This study aimed to examine the impact of different preparation techniques and endodontic file systems on apical debris volume to limit material dispersion to periradicular tissues. METHODS: Ninety extracted maxillary incisors were evaluated. Simulated apical root resorption was created by removing the apical 2 mm of the root. The teeth were divided into two groups: one filled with a single cone and the other with cold lateral compaction (CLC). Each group was further divided into three subgroups (n = 15 each): Subgroup 1 used Reciproc R25 for removal and R50 for final preparation; Subgroup 2 used ProTaper Universal Retreatment (PTUR) files D1, D2, and D3 for removal and ProTaper Next X5 for finalization; and Subgroup 3 used VDW.Rotate Retreatment (VDW.RotateR) for removal and VDW.Rotate 50.04 for completion. Debris from retreatment was collected in pre-weighed tubes to determine the amount. The apical extrusion data underwent a two-way analysis of variance. RESULTS: The Reciproc group had a mean extruded debris weight of 0.54 ± 0.24 mg, higher than the PTUR (0.28 ± 0.15 mg) and VDW.RotateR (0.39 ± 0.29 mg) groups (p < 0.05). The single-cone technique (SCT) resulted in a mean debris weight of 0.34 ± 0.23 mg, lower than the CLC technique, which had a mean of 0.46 ± 0.27 mg (p < 0.05). SCT had a shorter retreatment duration (111.12 ± 33.46 s) compared to CLC (176.26 ± 52.26 s) (p < 0.05). CONCLUSION: The Reciproc file system and the CLC obturation technique resulted in greater apical debris extrusion than the other methods. SCT was quicker than CLC. The Reciproc groups are more susceptible to apex extrusion during retreatment.

Comparative Evaluation of Different Methods of Activation of Chelating Solution for Smear Layer Removal in the Apical Portion of the Root Canal Using a Scanning Electron Microscopy: An In Vitro Study.

Background The smear layer has an adverse effect on the sealing of root canals during obturation, and it is the main reason for the failure of root canal treatment. Root canal irrigation using a conventional irrigation system is ineffective for smear layer removal, especially from the apical third region, where most lateral canals are present. For successful endodontic treatment, the smear layer should be removed from the apical third region using an effective irrigation activation system. Aim This study aimed to compare smear layer removal by conventional irrigation, XP Endo Finisher (XPF), endoactivator (EA), passive ultrasonic activation, and root canal brush using 17% ethylenediaminetetraacetic acid (EDTA) as a chelating solution and 5.25% sodium hypochlorite after chemomechanical preparation, using scanning electron microscopy (SEM). Method A total of 50 extracted human mandibular single canal premolars with mature roots were selected for this study. Samples were decoronated to obtain a standard working length (WL) of 15 mm. Canal patency was achieved using a 10 k file. Samples were sealed with sticky wax to obtain the vapor lock effect. Biomechanical preparation is done till F3. The samples were divided into five groups according to the final irrigation activation protocol: Group 1, control group; group 2, XPF; group 3, EA; group 4, passive ultrasonic irrigation (PUI); and group 5,, root canal brush. Samples were divided into two equal halves longitudinally. Each sample was analyzed for a smear layer under SEM at 2000x magnification. Statistical analysis was done using the one-way Anova "F" test and Tukey's post-hoc test. Results Group 3 showed the least presence of a smear layer, followed by groups 4, 2, 5, and 1. All the groups exhibited highly significant differences between each other (p < 0.001). Group B shows no significant difference with groups C, D, and E. Group C shows no significant difference with groups D and E. Group D shows no significant difference with group E. Conclusion The EA removes the smear layer effectively as compared with other groups. All the irrigation activation system shows the presence of smear layer. No activation systems were able to remove the smear layer completely.

Enriched advanced platelet-rich fibrin plus gold nanoparticles against Enterococcus faecalis for its potential use in revascularization for necrotic immature permanent teeth.

Background: Regenerative endodontic procedures allow reinforcement of root canal wall and continuation of root development, opening new therapeutic possibilities. The root canal system of infected teeth is colonized by a variety of microorganisms, which hinder the regenerative process, leading to treatment failure if not adequately addressed, thereby requiring careful attention to microbial control. Aim and Objective: The aim of the study was to assess the antimicrobial activity of advanced platelet-rich fibrin (A-PRF) and gold nanoparticles (AuNps) against Enterococcus faecalis. Materials and Methods: Intravenous blood (5-6 ml) was drawn from four healthy individuals, and A-PRF was prepared through centrifugation at 1500 revolutions per minute (rpm) for 14 min. A-PRF was doped with 3 µl of AuNps and centrifuged at 1000 rpm for 1 min. Antimicrobial activity was assessed using disk diffusion; inhibition zones were measured. For minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC), A-PRF + AuNps were added to the microbial broth at varying concentrations to determine growth inhibition and microbial death. Results: Disk diffusion assays revealed significant antibacterial effects against E. faecalis. Norfloxacin displayed the highest mean zone of inhibition (20.33 ± 1.53 mm), followed by the Test group (A-PRF + AuNPs) (19.33 ± 0.58 mm). Multiple comparisons indicated significant differences (P < 0.001). MIC of A-PRF + AuNPs against E. faecalis was 0.031 mg/ml, with MBC at 0.015 mg/ml. Conclusion: The addition of AuNPs to A-PRF offers the potential for sustained growth factor release while maintaining the sterility of the canal, leading to successful revitalization and regeneration. The combined use of A-PRF + AuNps shows promise for enhancing revascularization in necrotic immature permanent teeth.

Coping with complexity: Navigating severe curve canals in endodontic root canal treatment: A clinical case series.

Knowledge of tooth anatomy and its variations are essential for the success of endodontic treatment. Dilacerations represent developmental anomalies marked by sudden deviations in a tooth's longitudinal axis. Common causes of treatment failures in such cases are primarily related to procedural errors such as ledging, fractured instruments, canal blockages, zipping, and elbow creations. The current case series presents three such interesting cases of endodontic management of curved root canals in mandibular molars.

An in vitro comparative evaluation of cyclic fatigue resistance of two rotary and two reciprocating file systems.

Context: Root canal instrumentation is one of the important procedures for successful endodontic therapy. Unexpected fracture of files occurs during root canal instrumentation without any visible signs of deformation compromising the success of root canal treatment. Aims: The aim of the study was to evaluate and compare cyclic fatigue resistance (CFR) of rotary and reciprocating files in simulated canals with 45°, 60°, and 90° angle of curvature. Settings and Design: The study design was an In vitro study. Subjects and Methods: Sixty nickel-titanium files, 30 each of rotary and reciprocating files were selected and divided into four groups (n = 15) of Neoendo Flex, ProTaper Next, WaveOne Gold (WOG), and Reciproc Blue (RPB) files. Each group was further subdivided into three subgroups containing five samples each based on their use in simulated canals with 45°, 60°, and 90° angle of curvature. To simulate root canals with 45°, 60°, and 90° angle of curvature, three artificial canals were designed in a stainless steel metal block. Each file was autoclaved, immersed in 3% sodium hypochlorite (NaOCl), and coated with 17% ethylenediaminetetraacetic acid (EDTA). Each file was tested for CFR using a torque-controlled reduction handpiece by instrumenting in a simulated canal for 10 s until fracture. The cycle of autoclaving, exposure to NaOCl, EDTA, and testing of CFR for 10 s per canal as per groups and subgroups was repeated again and again until the respective file fracture. The time taken to file fracture was recorded using a digital chronometer. The time taken for each file fracture (in minutes) was multiplied by the number of rotations per minute to attain the number of cycles to failure (NCF). Statistical Analysis Used: The obtained results were subjected to statistical analysis using one-way analysis of variance and independent t-test. Results: One-way ANOVA test showed a statistically significant difference between the four groups, P < 0.001. Independent "t"-test between individual subgroups showed a statistically significant difference, as P < 0.05. Conclusions: WOG and RPB reciprocating file systems showed superior CFR, more especially in canals with abrupt 90° angle of curvature compared to both rotary file systems tested. Among rotary file systems tested, Neoendo Flex showed greater CFR than ProTaper Next.

Comparative evaluation of the accuracy of six different apex locators in working length determination of molars using intraoral periapical radiographs: An in vivo study.

Context: One of the crucial steps in endodontic treatment is determining the working length (WL). There are various methods for performing this procedure, one of which is an electronic apex locator (EAL) measurement. Aims: The aim of this study was to determine the accuracy of six EALs, i.e.. Root ZX, Root ZX Mini, Propex PiXi, Innvopex-1, Woodpex III, and Raypex 6 for WL estimation in the mandibular first molars. Material and Method: The study included 180 root canals with symptomatic irreversible pulpitis, divided into six groups using different apex locators. WL determination was compared with intraoral periapical radiographs. Results were categorized as accurate, short, or long. The data were statistically analyzed. Results: ROOT ZX had an accuracy of 96.7%, Root ZX Mini had an accuracy of 93.3%, PiXi had an accuracy of 90.0%, Innvopex-1 had an accuracy of 90.0%, Woodpex III had an accuracy of 86.7%, and Raypex 6 had an accuracy of 83.4%, respectively. There was a statistically nonsignificant difference between groups (P < 0.05). Conclusion: Newly developed apex locators, such as the Innvopex-1, have shown accuracy comparable to well-established EALs like the Root ZX. This highlights the importance of conducting more extensive, large-scale research to confirm and validate their effectiveness.

Efficacy and inflammatory responses of root canal therapy plus periodontal non-surgical treatment for periodontal-endodontic combined dental lesions.

OBJECTIVE: To investigate the efficacy and inflammatory responses of treating periodontal-endodontic combined lesions (PECLs) with root canal therapy (RCT) alone versus RCT combined with periodontal non-surgical treatment (PNST). METHODS: A total of 103 patients with PECLs admitted between January 2019 and January 2020 to Shenzhen Baoan Women's and Children's Hospital were divided into control (RCT alone, 50 cases) and combined (RCT + PNST, 53 cases) groups. Comparative analyses included efficacy assessment, probing depth (PD), bleeding index (BI), plaque index (PLI), gingival index (GI), serum levels of interleukin-1ß (IL-1ß), tumor necrosis factor-α (TNF-α), and high-sensitivity C-reactive protein (hs-CRP), pain severity during RCT, incidence of adverse reactions, post-treatment tooth conditions, and recurrence rates at 6 and 12 months. Univariate analysis identified factors associated with poor treatment outcome in PECL patients. RESULTS: The combined group demonstrated a higher total effective rate (90.57%) compared to the control group (74.00%) (P < 0.05). Patients receiving combined therapy showed significantly lower PD, BI, PLI, GI, IL-1ß, TNF-α, and hs-CRP levels, as well as reduced pain severity and lower recurrence rates at 6 and 12 months (all P < 0.05). The combined group also had a lower incidence of adverse (periodontal distending pain and local foreign body sensation) reactions (7.54%) compared to the control group (26.00%) (P < 0.05). After treatment, the incidence of periodontitis, percussion tenderness, and loosening of teeth in the combined group was lower than that of the control group, and the retention rate of affected teeth was significantly higher (all P < 0.05). Factors such as history of alcoholism, betel nut chewing, and treatment method (RCT) were significantly associated with poorer prognosis in PECL patients (P < 0.05). CONCLUSION: Combined RCT and PNST improves clinical efficacy, reduces pain severity and inflammation levels, decreases adverse reactions, and enhances tooth retention in PECL patients. This treatment approach should be considered the preferred option for managing PECLs.