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.

[Introduction and interpretation of The European Society of Endodontology S3-level clinical practice guideline for treatment of pulpal and apical disease].

The European Society of Endodontology published the S3-level clinical practice guideline for the treatment of pulpal and apical disease in October 2023, which provides best current therapeutic strategies supported by scientific evidences. The guideline was divided into four parts: the diagnosis and treatment of pulpitis, diagnosis and nonsurgical treatment of apical periodontitis, surgical treatment of apical periodontitis, and regenerative treatment. This article aims to introduce and interpret the guideline, and to better manage patients with pulpitis and apical periodontitis for preserving teeth over a patient's lifetime in China.

Comprehensive review of composition, properties, clinical applications, and future perspectives of calcium-enriched mixture (CEM) cement: a systematic analysis.

This review aims to comprehensively explore calcium-enriched mixture (CEM) cement as a crucial biomaterial in dentistry/endodontics. With its growing clinical relevance, there is a need to evaluate its composition, chemical/physical/biological properties, clinical applications, and future perspectives to provide clinicians/researchers with a detailed understanding of its potential in endodontic procedures. Through systematic analysis of available evidence, we assess the advantages/limitations of CEM cement, offering valuable insights for informed decision-making in dental/endodontic practice. Our findings highlight the commendable chemical/physical properties of CEM cement, including handling characteristics, alkalinity, color stability, bioactivity, biocompatibility, sealing ability, and antimicrobial properties. Importantly, CEM cement has shown the potential in promoting regenerative processes, such as dentinogenesis and cementogenesis. It has demonstrated successful outcomes in various clinical applications, including vital pulp therapy techniques, endodontic surgery, open apices management, root resorption/perforation repair, and as an orifice/root canal obturation material. The efficacy and reliability of CEM cement in diverse clinical scenarios underscore its effectiveness in endodontic practice. However, we emphasize the need for well-designed clinical trials with long-term follow-up to further substantiate the full potential of CEM cement. This review serves as a robust reference for researchers/practitioners, offering an in-depth exploration of CEM cement and its multifaceted roles in contemporary dentistry/endodontics.

Cirurgia paraendodôntica: revisão de literatura / Parendodontic surgery: a literature review

O tratamento endodôntico envolve procedimentos como abertura coronária, modelagem, limpeza, desinfecção e selamento tridimensional. Apesar de apresentar um índice de insucesso de cerca de 4%, retratamentos podem ser realizados por cirurgiões-dentistas habilitados. Quando o retratamento não é indicado, a cirurgia parendodôntica, que inclui curetagem, apicectomia e retro obturação do sistema de canais, surge como uma alternativa eficaz para manter o dente em função e estética na cavidade bucal, antes de considerar a extração. O presente trabalho busca revisar a literatura respeito da cirurgia parendodôntica. Os trabalhos foram selecionados nas plataformas Scielo, PubMed, Google Acadêmico e BVS, publicados nos últimos 5 anos em português e inglês. Pôde-se concluir que a cirurgia parendodôntica é uma alternativa efetiva em casos de insucesso do tratamento endodôntico, devendo ser considerada e indicada de maneira apropriada.

Endodontic treatment, commonly performed in dentistry, involves procedures such as coronal opening, modeling, cleaning, disinfection, and three-dimensional sealing. Despite having a failure rate of around 4%, portraits can be carried out by qualified dental surgeons. When retreatment is not indicated, endodontic surgery, including curettage, apicoectomy and retrofilling of the canal system, appears as an effective alternative to maintain dental function and oral aesthetics in the mouth, before considering extraction. The present work seeks to review the literature regarding paraendodontic surgery. The works were selected on the Scielo, PubMed, Google Scholar and VHL platforms, published in the last 5 years in Portuguese and English. It was concluded that endodontic surgery is an effective alternative in cases of unsuccessful endodontic treatment and should be considered and indicated appropriately.

Students' Perception of Remote Extended Reality Simulation Systems Using Patient-specific Three-Dimensional-printed Models in Endodontic Education: A Pilot Study.

OBJECTIVE: Extended reality (XR) technology using head-mounted devices enables the operator to visu-alise anatomical structures. We aimed to investigate student perceptions regarding applying XR simu-lation for transferring endodontic educational information between a lecturer in Japan and students in Saudi Arabia. METHODS: In this study, the students engaged with an XR simulation system and viewed teeth in virtual reality (VR). Pictures of dental anatomy were shown in the VR space, allowing participants to manipulate them. Then, the participants viewed a patient-specific three-dimensional printed model and three-dimensional root canal access guide in a second VR area. Before the sessions, the students completed a questionnaire on demograph-ic data and information concerning their VR experience. After the sessions, they completed a questionnaire evaluating the XR simulation system. The questionnaire included questions on dental anatomy, root canal access, usability, emotional impression, and data transfer. RESULTS: Eleven 5th-year dental students, comprising six male and five female students, were enrolled; three of them had previous VR experience, whereas eight did not. The highest levels of satisfaction were noted in the tooth anatomy (4.6+-0.4) and emotional impression (4.5+-0.5) domains, whereas the lowest level was noted in the data transmission domain (3.5+-0.9). Female participants and those without previous VR experience reported higher satisfaction levels across questionnaire domains compared to male participants and those with previous VR experience. CONCLUSION: XR can be successfully used in dental education and integrated into online lectures. Restrictions on education caused by health crises can be averted by using XR. Further, fifth-generation networks can offer better data transmission than wireless fidelity.

The cutting-edge roles of lasers in endodontics: A bibliometric and scientometric analysis of the 100 most-cited articles.

PURPOSE: This bibliometric and scientometric analysis aimed to delve into the forefront roles of lasers in endodontics from 1990 to 2024. METHODS: A comprehensive electronic search was conducted using "Clarivate Analytics Web of Science, All Databases" to retrieve the most-cited articles pertaining to the topic. These articles were then ranked in descending order according to their citation counts and the top 100 were selected for further analysis. Parameters including citation density, publication year, journal, journal impact factor (IF), country, institution, author, study design, study field, evidence level, laser type, and keywords were meticulously analyzed. RESULTS: The mean and standard deviations of total citation and citation density were 106.47 ± 65.76 and 7.61 ± 5.13, respectively. Positive and negative correlations were found between the number of citations and citation density and age of publication. While the mean number of citations was significantly higher in the period 2001-2010 compared to the other periods (P < 0.05), values were similar between the periods 1990-2000 and 2011-2014 (P > 0.05). Articles were mainly published in the Journal of Endodontics. The most productive country, institutions, and author were the United States, the University of Showa, and Koukichi Matsumoto. Diode and Er: YAG lasers were commonly investigated. Ex vivo studies were mainly performed followed by in vitro ones. The main study field was "antimicrobial effect". Among keywords, "photodynamic therapy" was used more frequently. CONCLUSION: Lasers are predominantly utilized to leverage their antimicrobial efficacy. Advancements in technology will lead to improvements in the properties of lasers, thereby enhancing the disinfection of the root canal system.

Historical Perspectives on the Use Plastic-Based Cements in Endodontics and Prosthodontics: Part 1 - Oxychlorides.

Oxychloride of zinc was used for years to treat teeth by different approaches and procedures. The success of material usage depended on how well the procedures were conducted and largely on the mix of the material. This article aims to review the evolutionary history of this material with a view to its clinical uses, properties, procedures, applications, and successes when used in the management of decayed tooth structure. Perspectives proffered within focus cover 110 years from 1850 to 1960."Who has not mentally asked the question, as he has taxed himself and his patient to almost complete exhaustion in some dental operation of unusual magnitude or length, Is there not some way either to prevent this destruction of tissue or to restore these organs when attacked, unattended by the severe mental and physical strain upon the operator, and the shrinking, dread, and suffering to the patient which the present general practice and teaching involve?…If the profession would avert this evil, observation must be extended and accurate; new remedies must be sought and applied; investigation by experiment made popular, and the employment of other than mere mechanical remedies encouraged."

Trichloroacetic Acid - Historical Origins and Dental Applications.

The use of trichloroacetic acid in dentistry has been advocated by several authors in the last 50 years due to its action on invasive gingival tissues that are seen in the presence of cervical resorption or proximal cavities. Publications addressing this substance and its applications are completely silent regarding its historical evolution or make general claims regarding its original source without substantiation. This perspective will attempt to provide the missing links to this substance and its contemporary use in dentistry, specifically in Endodontics.

Historical Perspectives and Comparisons on the Use Plastic-Based Cements in Endodontics and Prosthodontics: Part 2 - Oxyphosphates.

Oxyphosphate of zinc was used for years to treat teeth by different approaches and procedures. Like oxychloride of zinc, success of the material depended on how well the procedures were conducted and largely on the mix of the material. This article aims to review the evolutionary history of this material with a view to its clinical uses, properties, procedures, applications, and successes when used in the management of decayed tooth structure and rebuilding of teeth. Perspectives proffered within focus cover 110 years from 1850 to 1960.

Exploring Plant-Based Compounds as Alternatives for Targeting Enterococcus faecalis in Endodontic Therapy: A Molecular Docking Approach.

Endodontic infections pose significant challenges in dental practice due to their persistence and potential complications. Among the causative agents, Enterococcus faecalis stands out for its ability to form biofilms and develop resistance to conventional antibiotics, leading to treatment failures and recurrent infections. The urgent need for alternative treatments arises from the growing concern over antibiotic resistance and the limitations of current therapeutic options in combating E. faecalis-associated endodontic infections. Plant-based natural compounds offer a promising avenue for exploration, given their diverse bioactive properties and potential as sources of novel antimicrobial agents. In this study, molecular docking and dynamics simulations are employed to explore the interactions between SrtA, a key enzyme in E. faecalis, and plant-based natural compounds. Analysis of phytocompounds through molecular docking unveiled several candidates with binding energies surpassing that of the control drug, ampicillin, with pinocembrin emerging as the lead compound due to its strong interactions with key residues of SrtA. Comparative analysis with ampicillin underscored varying degrees of structural similarity among the study compounds. Molecular dynamics simulations provided deeper insights into the dynamic behavior and stability of protein-ligand complexes, with pinocembrin demonstrating minimal conformational changes and effective stabilization of the N-terminal region. Free energy landscape analysis supported pinocembrin's stabilizing effects, further corroborated by hydrogen bond analysis. Additionally, physicochemical properties analysis highlighted the drug-likeness of pinocembrin and glabridin. Overall, this study elucidates the potential anti-bacterial properties of selected phytocompounds against E. faecalis infections, with pinocembrin emerging as a promising lead compound for further drug development efforts, offering new avenues for combating bacterial infections and advancing therapeutic interventions in endodontic practice.

Unveiling the fatigue life of NiTi endodontic files: An integrated computational-experimental study.

Nickel-titanium (NiTi) rotary files used in root canal treatments experience fatigue and shear damage due to the complex curved geometries and operating conditions encountered within the root canal. This can lead to premature file fracture, causing severe complications. A comprehensive understanding of how different factors contribute to file damage is crucial for improving their functional life. This study investigates the combined effects of root canal curvature radius, file canal curvature, and rotational speed on the fatigue life and failure modes of NiTi endodontic files through an integrated computational and experimental approach. Advanced finite element simulations precisely replicating the dynamic motion of files inside curved canal geometries were conducted. Critical stress/strain values were extracted and incorporated into empirical fatigue models to predict the functional life of endodontic files. Extensive experiments with files rotated inside artificial curved canals at various canal curvatures and speeds provided validation. Increasing the canal curvature beyond 60∘ and shorter curvature radii below 5 mm dramatically reduced the functional life of the endodontic file, especially at rotational speeds over 360 rpm. The Coffin-Manson fatigue model based on strain amplitude showed the closest agreement with experiments. Shear stresses dominated damage at low canal curvatures, while the combined shear-fatigue loading effects were prominent at higher canal curvatures. This conclusive study elucidates how operational parameters like canal curvature radii, canal curvature, and rotational speed synergistically influence the fatigue damage processes in NiTi files. The findings offer valuable guidelines to optimize these factors, significantly extending the functional life of endodontic files and reducing the risk of intra-operative failures. The validated computational approach provides a powerful tool for virtual testing and estimation of the functional life of the new file designs before manufacturing.

The Use of Artificial Intelligence in Endodontics.

Endodontics is the dental specialty foremost concerned with diseases of the pulp and periradicular tissues. Clinicians often face patients with varying symptoms, must critically assess radiographic images in 2 and 3 dimensions, derive complex diagnoses and decision making, and deliver sophisticated treatment. Paired with low intra- and interobserver agreement for radiographic interpretation and variations in treatment outcome resulting from nonstandardized clinical techniques, there exists an unmet need for support in the form of artificial intelligence (AI), providing automated biomedical image analysis, decision support, and assistance during treatment. In the past decade, there has been a steady increase in AI studies in endodontics but limited clinical application. This review focuses on critically assessing the recent advancements in endodontic AI research for clinical applications, including the detection and diagnosis of endodontic pathologies such as periapical lesions, fractures and resorptions, as well as clinical treatment outcome predictions. It discusses the benefits of AI-assisted diagnosis, treatment planning and execution, and future directions including augmented reality and robotics. It critically reviews the limitations and challenges imposed by the nature of endodontic data sets, AI transparency and generalization, and potential ethical dilemmas. In the near future, AI will significantly affect the everyday endodontic workflow, education, and continuous learning.

GIRFT and Measuring Outcomes in MCNs: endodontics in 646 teeth treated in Tier 2 (Primary Care) and Tier 3 (Secondary Care) settings in England.

AIM: This paper aims to assess the complexity, quality and outcome of endodontic treatment provided in Managed Clinical Networks (MCNs) in England to understand if we are "getting it right first time" (GIRFT). METHODS: In a convenient sample of endodontic treatments provided between May 2011 and April 2017, the complexity of teeth treated, the quality of treatment procedure, the radiographic appearance of root fillings, as well as clinical and radiographic healing were retrospectively assessed using records taken as part of treatment. Trained, calibrated examiners independently scored radiographs using previously published scoring systems. RESULTS: 646 teeth were followed up for 24.7 months (standard deviation [SD] 17.08). The average age of those patients treated was 46.7 years (SD 15.38) with 48.3% being male. Of teeth treated, 70.4% were of complexity level 3. 88.2% of teeth were asymptomatic, and 80% demonstrated complete radiographic healing. Procedural errors inhibited achieving correct working length and taper, with more voids within root canal fillings. When patency filing was reported as being carried out, complete radiographic healing was more likely. CONCLUSIONS: It is possible to collate outcome data in the NHS system, especially if there is provision for ongoing follow up and time allocated for collection of data. Endodontic treatment provided within primary and secondary care settings are of high quality, with outcomes being better with single operators carrying out high volumes of endodontic treatment.