Impact of Sequential Use of Reciprocating Files on the Shaping Load During Root Canal Treatment.

INTRODUCTION: The purpose of this in vitro study was to investigate the apical and coronal loads generated during shaping canals with 2 successive reciprocating files in comparison to a single reciprocating file from the same system. METHODS: A total of 40 narrow and straight canals were distributed into two groups: R-Motion with single file (RMS) and R-Motion with multiple files (RMM). In both groups, the R-Motion system was used in a reciprocating motion. After establishing glide path, the RMS canals were shaped down to working length with a single file (25/.06) in two insertions while the RMM canals were shaped with two files (20/.04 and 25/.06) to the working length. The shaping time and effects of tested groups on the apical and coronal peak loads were statistically analyzed using the t-test and Mann-Whitney U test, respectively, at a 95% confidence level. RESULTS: All canals were completely shaped in three insertions and no file deformation or fracture was observed. The RMS and RMM were able to shape canals in 117.3 ± 15.1 and 123.7 ± 7.3 seconds, respectively (P < .05). Within each group, the shaping load appeared to increase with the successive insertions of the file. In both groups, the ranges of apical and coronal peak loads were 0.41-1.87 N and 0.38-1.03 N, respectively. The RMM and RMS had comparable apical and coronal peak loads (P > .05) except in the last insertion where RMM showed clearly lower apical peak load than RMS (P < .01). CONCLUSIONS: Under the current laboratory conditions using the R-Motion system, preshaping the canal with a smaller reciprocating file was shown to favorably reduce the apical peak loads induced during canal shaping of extracted teeth.

Retreatment of oval-shaped root canals filled with TotalFill bioceramic or AH plus sealer.

This study investigated retreatment of oval canals filled with gutta-percha and different sealers using WaveOne Gold (WOG). Single oval canals were prepared to size 30, 0.04 and obturated with gutta percha and AH Plus (AHP) or TotalFill bioceramic (TFBC) sealer. After 6-month incubation, the canals were retreated with WOG Primary (25, 0.07) under simulated body temperature, and the developed load and torque were simultaneously measured. The time and regaining the apical patency were checked. Micro-computed tomography scanning was performed to calculate the remaining obturating materials. An independent t-test and chi-square test were performed at a 95% confidence level. A shorter retreatment time was needed in TFBC than in AHP (P = 0.003). However, a higher maximum apical load was reported with AHP (P = 0.000). Meanwhile, comparable maximum coronal load and maximum torque values were observed. Apical patency was regained in all TFBC roots and only 75% of the AHP samples (P = 0.217). The remaining obturating materials were comparable in TFBC (13.02 ± 8.12%) and AHP (10.11 ± 8.46%) (P = 0.398). WOG was able to remove 89.89% and 86.98% of obturating materials in TFBC and AHP, respectively. The TFBC presented lower apical loads and faster retreatment compared to AHP.

Research Performance of Saudi Arabia in Endodontics: A Bibliometric Analysis.

Endodontics is a subdivision of dentistry that deals with diseases and injury of the soft tissues inside the teeth. The current study aimed to investigate the bibliometric properties of endodontics publications contributed by Saudi Arabia from 2010 to 2022. The quantitative bibliometric research method was applied to the meta-data retrieved from the Web of Science on December 7, 2022. The word Endodonti* was written in the main search bar, and from the year's filter, selected starting year 2010 to the date of data collection. In the first phase, to access the global publication growth of endodontics, no country/region filter was used. After getting the summary of the global intellectual landscape, we selected Saudi Arabia from the country/region filter to analyze certain characteristics of endodontics documents. Periodical growth, accessibility modes, collaboration patterns, influential institutions, frequently used sources, international research collaboration, and most-cited documents were analyzed by using Microsoft Excel (v.16) and SPSS (v.20). The authors affiliated with Brazil contributed the highest number of documents and Saudi Arabia stood in the eighth rank in endodontics research. The growing tendency was observed in Saudi Arabia from 1.29% in 2010 to 7.60% in 2022 from a global perspective. The quality of nonopen-accessed documents was higher than open-accessed as per citation impact, similarly, the documents written on international collaboration got a higher ratio of citations compared with national collaboration. King Saud University was found the most prolific institution and the Journal of Endodontics was the most preferred source of publications. The maximum research collaboration at the international level was performed with the authors of the United States. Fifteen most-cited papers obtained 21.42% of the citations. The findings show that endodontics research in Saudi Arabia has increased significantly over the years. The research collaboration at the national level has increased, which shows that teams of national researchers in endodontics have been prepared and conducting valuable research in a national context.

Developments and Performance of Artificial Intelligence Models Designed for Application in Endodontics: A Systematic Review.

Technological advancements in health sciences have led to enormous developments in artificial intelligence (AI) models designed for application in health sectors. This article aimed at reporting on the application and performances of AI models that have been designed for application in endodontics. Renowned online databases, primarily PubMed, Scopus, Web of Science, Embase, and Cochrane and secondarily Google Scholar and the Saudi Digital Library, were accessed for articles relevant to the research question that were published from 1 January 2000 to 30 November 2022. In the last 5 years, there has been a significant increase in the number of articles reporting on AI models applied for endodontics. AI models have been developed for determining working length, vertical root fractures, root canal failures, root morphology, and thrust force and torque in canal preparation; detecting pulpal diseases; detecting and diagnosing periapical lesions; predicting postoperative pain, curative effect after treatment, and case difficulty; and segmenting pulp cavities. Most of the included studies (n = 21) were developed using convolutional neural networks. Among the included studies. datasets that were used were mostly cone-beam computed tomography images, followed by periapical radiographs and panoramic radiographs. Thirty-seven original research articles that fulfilled the eligibility criteria were critically assessed in accordance with QUADAS-2 guidelines, which revealed a low risk of bias in the patient selection domain in most of the studies (risk of bias: 90%; applicability: 70%). The certainty of the evidence was assessed using the GRADE approach. These models can be used as supplementary tools in clinical practice in order to expedite the clinical decision-making process and enhance the treatment modality and clinical operation.

Application and Performance of Artificial Intelligence Technology in Detection, Diagnosis and Prediction of Dental Caries (DC)-A Systematic Review.

Evolution in the fields of science and technology has led to the development of newer applications based on Artificial Intelligence (AI) technology that have been widely used in medical sciences. AI-technology has been employed in a wide range of applications related to the diagnosis of oral diseases that have demonstrated phenomenal precision and accuracy in their performance. The aim of this systematic review is to report on the diagnostic accuracy and performance of AI-based models designed for detection, diagnosis, and prediction of dental caries (DC). Eminent electronic databases (PubMed, Google scholar, Scopus, Web of science, Embase, Cochrane, Saudi Digital Library) were searched for relevant articles that were published from January 2000 until February 2022. A total of 34 articles that met the selection criteria were critically analyzed based on QUADAS-2 guidelines. The certainty of the evidence of the included studies was assessed using the GRADE approach. AI has been widely applied for prediction of DC, for detection and diagnosis of DC and for classification of DC. These models have demonstrated excellent performance and can be used in clinical practice for enhancing the diagnostic performance, treatment quality and patient outcome and can also be applied to identify patients with a higher risk of developing DC.

Assessment of Bioceramic Sealer Retreatability and Its Influence on Force and Torque Generation.

This study assesses the retreatability of TotalFill bioceramic (TFBC) and AH Plus (AHP) sealers and their impact on retreatment force and torque. Twenty-six premolar teeth with single oval canals were instrumented, obturated using the matched gutta-percha cone technique with one of the tested sealers, and then temporized. After a 6-month incubation at 37 °C and 100% humidity, the canals were retreated with the XP Shaper system. During retreatment, the generated force and torque were measured. Micro-CT scanning was run before and after the retreatment procedure to analyze the remaining obturating materials in the canals. The apically directed maximum force in AHP was higher than that in TFBC. The coronally directed maximum force and the maximum torque were comparable between the groups. A higher amount of remaining obturating materials was found in the AHP compared to that in the TFBC. Based on these findings, endodontic sealer had an influence on retreatability, and the TFBC showed less remaining obturating materials and lower retreatment forces in the apical direction compared to the AHP in extracted teeth with oval canals.

Evidence for reduced torsional resistance of rotary files under curved position.

OBJECTIVES: The aim of this in vitro study was to investigate the torsional fatigue resistance of different rotary files in straight and curved positions at a simulated intracanal temperature. METHODS: Forty-eight size #25 files from ProTaper Universal (PTU), ProTaper Next (PTN) and ProTaper Gold (PTG) were tested for torsional resistance in both straight and curved (90 degrees) positions (n = 8 each). The experiment was conducted at a simulated intracanal temperature of 35 ± 1 °C. The torque gauge was reset before every use, and uniform torsional stress was applied by rotating the file clockwise at a speed of 40 rpm until fracture. Torque failure values were recorded, and fractured surfaces were tested using a scanning electron microscopy (SEM). Statistical analysis of the data was completed using one-way ANOVA and post-hoc test (LSD) in order to compare between the tested systems in each file position. Student's t-test was also performed to compare between the two positions in each rotary system, and significance level was set at 5%. RESULTS: In the straight position, torsional resistance of PTN was significantly lower than that of PTU and PTG (p < 0.001), while the PTU and PTG had comparable results (p > 0.05). In the curved position, torsional resistance was found to be comparable among all systems (p > 0.05). Within each system, the curved position resulted in a significantly lower torsional resistance when compared to the straight position (p < 0.001). SEM examination revealed similar torsional failure behavior for all files tested under both positions. CONCLUSIONS: Our study identified that placing files in a curved position was associated with a significant decrease in torsional resistance of all systems, and this necessitates reconsidering the torque settings proposed by the manufacturers. Whether these effects can be translated into in vivo studies remains to be investigated, and thus future studies are essential to provide confirming evidence.

Influence of additional apical enlargement on microcrack formation in root dentine: a micro-computed tomography investigation.

OBJECTIVES: To assess the effect of additional apical enlargement using nickel titanium (NiTi) instruments on the incidence of microcracks using micro-computed tomographic analysis. MATERIALS AND METHODS: Fifty-one premolars with single canals were enlarged to ProTaper Gold (PTG) F2 (25/08) (Dentsply Sirona), ProFile Vortex Blue (VB) 25/06 (Dentsply Tulsa), or WaveOne Gold (WOG) primary (25/07) (Dentsply Sirona) NiTi rotary instruments (n = 17 each). Afterward, additional apical enlargement was performed in each group with its corresponding larger instrument (F3 (30/09), VB 30/06, or WOG Medium (35/06) instruments, respectively). All teeth were imaged with micro-computed tomography before canal enlargement and after initial and additional apical enlargements to detect new microcracks at the apical 5 mm. An Aligned Rank Transform ANOVA was conducted to examine the effects of file type and canal enlargement on the number of new microcracks resulting from enlargement. A Kruskal-Wallis test was run to compare the file types at each canal enlargement stage. RESULTS: A significant main effect (P = 0.026) of canal enlargement on the number of new microcracks was found; the number of apical microcracks found after additional enlargement was significantly greater than baseline (P = 0.021); no significant difference was found between baseline and initial enlargement (P = 0.506) and between initial enlargement and additional enlargement (P = 0.252). The Kruskal-Wallis tests found no difference between file types at baseline (P = 0.348), after initial enlargement (P = 0.369) or additional enlargement (P = 0.133). CONCLUSIONS: Regardless of the instrumentation system used, additional apical enlargement led to the formation of high number of new microcracks. CLINICAL SIGNIFICANCE: The results indicated that additional enlargement induced significant number of apical microcracks.

Shaping Ability of XP Endo Shaper File in Curved Root Canal Models.

The aim of this study was to assess the shaping ability of the XP Shaper (XPS) file in severely curved canal models under simulated body temperature and compare it with that of the WaveOne Gold (WOG) file. Ninety-six simulated root canals were equally distributed into XPS and WOG systems to be shaped by eight files each. Files were assessed under a stereomicroscope prior to canal shaping to detect deformation if any. The canals were shaped at 35 ± 1°C using the X-Smart Plus motor. Images of the canals were obtained before and after instrumentation using a stereomicroscope to measure the amount of removed resin from both the inner and outer curvature sides at apex (0 mm) and 3 mm and 6 mm from the apex. The shaping time was calculated. The data were statistically analyzed by the independent t-test at 5% significance level. The XPS and WOG systems shaped the canals in 37.0 ± 9.5 and 62.6 ± 11.3 seconds (P < 0.05), respectively. At the apex level, the amount of resin removal in both sides did not show a significant difference between the tested groups (P > 0.05). At 3 mm and 6 mm levels, the WOG removed more resin than XPS at both sides (P < 0.05). In XPS, deformation was observed in four files: one file after the first use, one file after the fourth use, and two files after the sixth use. In WOG, two files were deformed: one file after the fifth use and one file after the sixth use. One XPS file was fractured after the sixth use. In short, XPS and WOG files can be used in shaping severely curved canals as they showed the ability to maintain the original shape with minimal transportation. Both file systems showed signs of deformation after use with a lower number of deformed files observed in WOG throughout the experiment.

Regenerative Endodontic Management of an Immature Molar Using Calcium Hydroxide and Triple Antibiotic Paste: a Two-Year Follow-Up.

The regenerative endodontic procedure (REP) is considered a viable treatment option for immature teeth with necrotic pulp and periapical radiolucency which can facilitate continued root formation. In this report, an immature necrotic mandibular molar received REP in three appointments wherein chemomechanical debridement was performed with a sequential application of nonsetting calcium hydroxide (in the whole canal) and triple antibiotics paste (in the root's middle third) dressings in the first and second appointments, respectively. In the third appointment, blood clots were created in the root canals. MTA was placed over the blood clots and the tooth was restored with a composite filling and stainless-steel crown. Recall appointments were performed for two years where the tooth was deemed asymptomatic clinically and a complete root formation with significant periapical healing was evident radiographically. More cases are required to warrant the feasibility of this disinfection protocol.

Recall Practice among Dental Practitioners in Riyadh, Kingdom of Saudi Arabia.

AIM: The study aims to assess recall practice among dental practitioners in Riyadh, Saudi Arabia. MATERIALS AND METHODS: A 24-item questionnaire was used to collect information about the general practice, knowledge of dental recall, and factors affecting dental recall from general dental practitioners in Riyadh. The questionnaire elicited data on personal information (8 items), practice information (3 items), knowledge about the dental recall (3 items), recall practice (6 items), and patient factors that might influence recall (4 items). A five-point Likert scale showed the level of agreement in cases that required recall visits, reasons for patients not returning for recall, and techniques to encourage return for recall. RESULTS: A total of 315 questionnaires were analyzed (response rate = 46.3%). The mean age of participants was 32.4 years old and 52.4% of participants were male. Eighty-four percent of respondents reported that they routinely perform regular recall with their patients. Recall practice was significantly associated with practitioner experience, country of graduation, and workplace. Practitioners who graduated from Saudi universities were found to be less likely to practice regular recall visits compared to others (p <0.01). On the other hand, practitioners who are working in university hospitals are more likely to practice dental recall compared to those who are working only in dental clinics (p = 0.02). CONCLUSION: A low percentage of dentists advocated and practiced regular recall visits in their private practice. Efforts should be undertaken to educate the practitioners on the importance of regular recall visits in their healthcare settings. CLINICAL SIGNIFICANCE: Scheduling appropriate recall visits is an essential component for achieving successful treatment outcomes. This study highlights the poor recall practice among dentists and the need to raise the awareness of the importance of recall visits.

Cyclic Fatigue and Torsional Failure of EdgeTaper Platinum Endodontic Files at Simulated Body Temperature.

INTRODUCTION: The aim of this in vitro study was to compare the cyclic fatigue resistance and torsional resistance of EdgeTaper Platinum (ETP) with those of ProTaper Gold (PTG) at simulated body temperature. METHODS: ETP and PTG files with #25 tip size were selected. Cyclic fatigue tests were performed in a stainless steel artificial canal until file fracture occurred. The time to fracture was recorded. For the torsional resistance testing, the apical 5 mm of the file was firmly secured with acrylic resin, and the assembly was fixed over torque gauge device. A uniform torsional stress was applied with continuous rotation motion until fracture occurred. The torque at failure was recorded. Both experiments were conducted at 35 ± 1°C. Fractured surfaces were tested via scanning electron microscopy. Statistical analysis was performed using independent Student t test at 5% significance level. RESULTS: The ETP had superior cyclic fatigue resistance than PTG (P < .01). However, it exhibited lower torsional resistance (P < .05). The ETP and PTG showed typical features of cyclic and torsional fatigue behavior under scanning electron microscopy. CONCLUSIONS: The ETP exhibited superior resistance to cyclic fatigue but failed to show any improvement in the torsional resistance compared with PTG.

Detecting the Second Mesiobuccal Canal in Maxillary Molars in a Saudi Arabian Population: A Micro-CT Study.

The aim of this study was to determine MB2 canal detectability in maxillary first and second molars obtained from a Saudi population using micro-CT. Maxillary first (n = 35) and second (n = 30) molars were scanned with micro-CT technology. The number of canals was recorded, and in case of having more than one canal, the level of extracanal detection was analyzed. The presence of extracanal was categorized based on the level they were first detected. Among the maxillary first molars, 28 (80%) and six (17%) teeth had two and three MB canals, respectively. Among the maxillary second molars, 24 (80%) and four (13%) teeth had two and three MB canals, respectively. The MB2 canal was detected at the chamber floor in 70% and 61% of the maxillary first and second molars, respectively. At 1 mm depth, the MB2 canal was found in 15% and 18% of the maxillary first and second molars, respectively. At 2 mm depth, the MB2 canal was found in 3% and 18% of the maxillary first and second molars, respectively. The remaining teeth had the MB2 canal at levels deeper than 2 mm. The MB2 canal was detected in 97% and 93%% of maxillary first and second molars, respectively. Among them, the MB2 canal could be immediately detected in 70% and 61% of the maxillary first and second molars, respectively, once the pulp chamber is exposed. However, the rest of the MB2 were observed at deeper levels in the root and this requires troughing preparation in the chamber floor.

Vertical Force Induced with WaveOne and WaveOne Gold Systems during Canal Shaping.

INTRODUCTION: The aim of this study was to evaluate the amount of vertical force induced with WaveOne (WO; Dentsply Sirona, York, PA) and WaveOne Gold (WOG, Dentsply Sirona) systems during the canal shaping of extracted teeth. METHODS: Thirty canals in 15 maxillary premolars were divided into 2 groups: WO and WOG. The canals were gently shaped with WO/WOG Primary instruments according to the manufacturer's instructions. The vertical forces induced during canal shaping in the apical and coronal directions were recorded. The apically and coronally directed peak forces were used for analysis using the Mann-Whitney U test. The instrumentation time was analyzed using the Student t test. All statistical analyses were performed using SPSS software (Version 22.0; IBM, Armonk, NY) at a 5% significance level. RESULTS: The force increased with the successive instrument insertions within each group. The apically and coronally directed peak forces of the WO and WOG groups ranged from 2.89-11.58 N and from 1.53-2.92 N, respectively. In the 3 insertions, WO showed higher peak forces in both directions. For apically directed peak forces, WO had significantly higher peak forces in the first and third insertions than WOG (P < .01). For coronally directed peak forces, WO had significantly higher values in the first and second insertions (P < .05). CONCLUSIONS: The WOG system had significantly lower apically and coronally directed peak force values compared with the WO system.

Vertical Load Induced with Twisted File Adaptive System during Canal Shaping.

INTRODUCTION: To evaluate the vertical load induced with the Twisted File Adaptive (TFA; SybronEndo, Orange, CA) system during canal shaping of extracted teeth by comparing it with the Twisted File (TF, SybronEndo), ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), and ProTaper Universal (PTU, Dentsply Maillefer) systems. METHODS: Fifty-two root canals were shaped using the TFA, TF, PTN, or PTU systems (n = 13 for each system). They were shaped gently according to the manufacturers' instructions. During canal shaping, vertical loads were recorded and shown in 2 directions, apically and coronally directed loads. The vertical peak loads of 3 instrumentation stages were used for comparison. The effects of rotary systems on the mean positive and negative peak loads were analyzed statistically using the Kruskal-Wallis and Mann-Whitney tests at a confidence level of 95%. RESULTS: The overall pattern of the instantaneous loads appeared to increase with the use of successive instruments within the system. During canal shaping in all groups, the apically and coronally directed peak loads ranged from 0.84-7.55 N and 2.16-2.79 N, respectively. There were significant differences in both peak loads among the tested systems at each instrumentation stage. TFA had the lowest apically directed peak loads. In terms of coronally directed peak loads, the TFA and TF had a significantly lower amount of loads developed with their instruments than PTN and PTU. CONCLUSIONS: The choice of instrument system had an influence on the loads developed during canal shaping. TFA instruments were associated favorably with the lowest values of peak loads followed by TF, PTN, and PTU.

Radiographic Diagnosis of Periapical Status and Quality of Root Canal Fillings in a Saudi Arabian Subpopulation.

PURPOSE: To assess the prevalence of apical periodontitis (AP), as determined by orthopantomograms (OPGs), and its correlation with the quality of root fillings and coronal restorations. MATERIALS AND METHODS: This cross-sectional study evaluated a random sample of 193 patients--112 (58%) females and 81 (42%) males--who presented as new patients at the Division of Endodontics. Digital OPGs were independently examined by two reliability-calibrated endodontists. The total number of teeth present, the location of the root canalfilled teeth, and the presence or absence of AP were recorded for each radiograph. The results were statistically analysed using the chi-square test followed by model building using multiple logistic regression. RESULTS: A total of 324 endodontically treated teeth from the 193 selected radiographs were analysed. The mean number of teeth per patient was 25.5 ± 4.6, with an average of 1.64 root canal treatments per subject. Radiographically detected AP was associated with 190 (58.6%) root canal-treated teeth. The logistic model shows that the quality of endodontic treatment (adjusted odds ratio [ORa] = 1.82; 95% confidence interval [CI]: 1.40-3.17), status of coronal restoration (ORa = 1.77; 95% CI: 1.20-2.61) and the type of material used for coronal restorations (ORa = 1.39; 95% CI: 1.03-1.87) were significantly related to the periapical health of the teeth. CONCLUSIONS: The quality of endodontic treatment, status of coronal restoration and the type of coronal restorative material were found to be the most important factors influencing the health of periradicular tissue.