Biological response to endodontic treatment in one versus two-visit: a systematic review and meta-analysis of animal studies.

OBJECTIVES: To perform a systematic review of animal studies that compared the histopathological characteristics between teeth with apical periodontitis after endodontic treatment in one or two visits. MATERIALS AND METHODS: This systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) - CRD42022340849. Studies were collected from PubMed/MEDLINE, LILACS, EMBASE, Livivo, SciELO, Web of Science, Scopus, and Cochrane Library and manual and gray literature searches. Animal studies that evaluated histological characteristics after endodontic treatment of teeth with apical periodontitis in one or two visits were included. Risk of bias analysis of the included studies was performed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) tool. Data synthesis of the included studies with quantitative data was performed, and meta-analysis was conducted with the Comprehensive Meta-Analysis software, using the random effects model and odds ratio (OR). RESULTS: Eighteen studies met the inclusion criteria (Kappa = 0.891). Meta-analyses indicated values in inflammatory infiltrate intensity with effect size of 5.5% (95% CI: 0.020-0.148; p < 0.001), periodontal ligament thickness: 25.6% (95% CI: 0.134-0.487; p < 0.001), dentin resorption: 13% (95% CI: 0.015-1.141; p = 0.066), cementum resorption: 7.1% (95% CI: 0.015-0.325; p = 0.001), bone resorption: 1.4% (95% CI: 0.002-0.130; p < 0.001), mineralized tissue resorption: 42.8% (95% CI: 0.110-1.671; p = 0.222), biological apical sealing: 13.1% (95% CI: 0.055-0.314; p < 0.001), and presence of microorganisms: 10.3% (95% CI: 0.014-0.747; p = 0.025). CONCLUSIONS: When considering animal studies, the two-visit endodontic treatment, using calcium hydroxide-based intracanal medication, resulted in better biological repair characteristics. CLINICAL RELEVANCE: A two-visit endodontic treatment with calcium hydroxide-based intracanal medication yields superior histopathological outcomes.

Referred pain is associated with greater odontogenic spontaneous pain and a heightened pain sensitivity in patients with symptomatic irreversible pulpitis.

BACKGROUND: Symptomatic irreversible pulpitis often results in heightened reactions to thermal stimuli such as pain evoked by a cold stimulus, and spontaneous odontogenic pain (unprovoked pain). OBJECTIVE: This study primarily compared the clinical manifestations of odontogenic spontaneous pain and pain provoked by cold stimulus specifically focusing on their sensory discriminative characteristics (intensity, duration and quality) between symptomatic irreversible pulpitis patients with and without referred pain. METHODS: Twenty-three patients with symptomatic irreversible pulpitis with referred pain and 12 patients without referred pain were included in this cross-sectional study. The following outcomes were assessed: odontogenic spontaneous pain and its descriptors; pain evoked by cold stimulus and qualitative sensory testing before and after local anaesthesia; referred pain location; use of analgesic medication; complementary anaesthesia efficacy. T-test, chi-squared and McNemar tests were applied to the data (p < .50). RESULTS: Patients with referred pain presented a greater odontogenic pain intensity (p < .05) when considered the average of the last 24 h. These patients also showed higher pain rating and pain descriptors (p < .05). Intensity and duration of the pain evoked by cold stimulus in the non-affected contralateral tooth at baseline were higher for patients with referred pain (p < .05). CONCLUSION: Symptomatic irreversible pulpitis patients with referred pain present greater odontogenic spontaneous pain and a heightened pain sensitivity. Therefore, patients with referred pain seem more complex from a pain severity perspective, supporting the clinical utility of discriminating symptomatic irreversible pulpitis with and without referred pain.

Enhancing debris removal in curved canals: a comparative evaluation of XP-endo Finisher and Passive Ultrasonic Irrigation.

OBJECTIVES: The study aimed to compare the efficacy of XP-endo Finisher and Passive Ultrasonic Irrigation (PUI) in removing hard tissue debris from curved canals. MATERIALS AND METHODS: Thirty-four mandibular molars with Vertucci's type II mesial canals were scanned in microcomputed tomography before and after preparation with HyFlex EDM, and accumulated hard tissue debris was quantified. Subsequently, the teeth were randomly divided into two groups according to the supplementary procedure: PUI with the Ultra-X insert or XP-endo Finisher. After the intervention, the specimens underwent another scanning. Two separate analyses were conducted, one for the total canal and another for the isthmus area. Unpaired and paired T-tests were used for inter- and intergroup comparisons, with a significance level set at 5%. RESULTS: Both supplementary methods reduced the amount of debris compared to the initial volume. Remarkably, the XP-endo Finisher achieved a significantly higher percentage of debris removal (71% for the total canal and 74% for the isthmus areas) compared to PUI (41% for the total canal and 52% for the isthmus area) (P < 0.05). CONCLUSIONS: Both supplementary approaches reduced the amount of hard tissue debris from canal preparation, still XP-endo Finisher showed a higher reduction compared to PUI (p < 0.05). CLINICAL RELEVANCE: None of the supplementary methods rendered canals completely free of hard tissue debris. However, the supplementary approach with XP-endo Finisher resulted in lower levels of hard tissue debris than PUI in curved canals with isthmuses.

Effectiveness of a new endodontic irrigation system for removing smear layer and dissolving simulated organic matter.

OBJECTIVES: The study aimed to evaluate the potential for the dissolution of organic tissue in areas of simulated complexity and cleaning of root canal walls of the new iVac® endodontic irrigation system. MATERIAL AND METHODS: Thirty mandibular premolars were evaluated by scanning electron microscopy before and after biomechanical preparation. Then, they were distributed according to the final irrigation protocol into groups with conventional irrigation, ultrasonic agitation with metallic insert (UA), and iVac® system, and new photomicrographs were obtained. For tissue dissolution analysis, glass capillaries filled with catgut were attached to the cervical and apical thirds of twenty-one prototyped upper incisors. They were weighed before and after the previously mentioned irrigation protocols. The data were statistically compared with a significance level of 5%. RESULTS: The final irrigation provided greater cleaning of the root canal walls in the cervical, middle, and apical thirds of the root canals (P < 0.05), with no statistically significant difference between UA and iVac®, regardless of the analyzed thirds. Both ultrasonic irrigation protocols dissolved a significantly greater volume than the conventional irrigation protocol (P < 0.05), with no difference between the two protocols (P < 0.05). CONCLUSIONS: The iVac® system showed root canal wall cleaning and tissue dissolution similar to UA with a metallic insert, and both were superior to conventional irrigation. CLINICAL RELEVANCE: The new irrigation system iVac is more effective than conventional irrigation and has similar root canal wall cleaning and tissue dissolution to UA.

In Vivo Biological Behavior of Polymer Scaffolds of Natural Origin in the Bone Repair Process.

Autologous bone grafts, used mainly in extensive bone loss, are considered the gold standard treatment in regenerative medicine, but still have limitations mainly in relation to the amount of bone available, donor area, morbidity and creation of additional surgical area. This fact encourages tissue engineering in relation to the need to develop new biomaterials, from sources other than the individual himself. Therefore, the present study aimed to investigate the effects of an elastin and collagen matrix on the bone repair process in critical size defects in rat calvaria. The animals (Wistar rats, n = 30) were submitted to a surgical procedure to create the bone defect and were divided into three groups: Control Group (CG, n = 10), defects filled with blood clot; E24/37 Group (E24/37, n = 10), defects filled with bovine elastin matrix hydrolyzed for 24 h at 37 °C and C24/25 Group (C24/25, n = 10), defects filled with porcine collagen matrix hydrolyzed for 24 h at 25 °C. Macroscopic and radiographic analyses demonstrated the absence of inflammatory signs and infection. Microtomographical 2D and 3D images showed centripetal bone growth and restricted margins of the bone defect. Histologically, the images confirmed the pattern of bone deposition at the margins of the remaining bone and without complete closure by bone tissue. In the morphometric analysis, the groups E24/37 and C24/25 (13.68 ± 1.44; 53.20 ± 4.47, respectively) showed statistically significant differences in relation to the CG (5.86 ± 2.87). It was concluded that the matrices used as scaffolds are biocompatible and increase the formation of new bone in a critical size defect, with greater formation in the polymer derived from the intestinal serous layer of porcine origin (C24/25).

Influence of cervical preflaring and root canal preparation on the fracture resistance of endodontically treated teeth.

BACKGROUND: Evaluate the fracture resistance of endodontically treated teeth after cervical preflaring and root canal preparation and to assess the volume of the root canal and the amount of remaining root dentin before and after cervical preflaring. METHODS: Forty-four mandibular incisors were selected using micro-CT scanning and distributed into 4 groups (n = 11) according to the instrument used for cervical preflaring: control group - no cervical preflaring; Gates Glidden - burs size #2 and #3; WXN - 25.07 Navigator instrument; and Easy - 25.08 ProDesign S instrument. Coronal opening was performed, and the canals were prepared with Wave One Gold Primary and filled with an epoxy-resin based sealer and gutta-percha cones. Micro-CT scans were performed before and after root canal instrumentation. All images were reconstructed and assessed for the thickness of mesial and distal root dentin at 3 mm and 5 mm from the cement -enamel junction and for the volume of cervical portion of the canal after preparation. Fracture resistance test was performed applying compressive loads at a crosshead speed of 0.5 mm/min, applied on the palatal aspect of specimens at 135° along the long axis of the tooth. The data were analyzed using ANOVA and Tukey's test (P = .05). RESULTS: Cervical preflaring and canal preparation reduced the dentin thickness (P < .05) and increased the canal volume (P < .05) in all groups at 3 mm an 5 mm. Cervical preflaring with Gates Gliden burs reduced the fracture resistance of endodontically treated teeth (P < .05). CONCLUSIONS: All instruments reduced the dentin thickness and increased the canal volume in the cervical at 3 mm and 5 mm. Gates Glidden reduced fracture resistance of mandibular incisors submitted to cervical preflaring, whereas NiTi instruments did not. CLINICAL RELEVANCE: Cervical preflaring assumes particular importance previously to the root canal preparation because it minimizes the occurrence of operative accidents, and permits more accurate determination of working length and the apical diameter.

Effect of temperature on the cyclic fatigue resistance of thermally treated reciprocating instruments.

OBJECTIVES: The aim of this study was to evaluate the impact of body temperature on the cyclic fatigue resistance of different NiTi alloys used for the manufacturing of Reciproc Blue R25 (RB 25.08; VDW, Munich, Germany), X1 Blue File 25 (X1 25.06; MK Life Medical and Dental Products, Porto Alegre, Brazil) and WaveOne Gold Primary (WOG 25.07; Dentsply Maillefer, Ballaigues, Switzerland). MATERIALS AND METHODS: Sixty instruments of the RB 25.08, X1 25.06 and WOG 25.07 systems were used (n = 20). Cyclic fatigue tests were performed at room temperature (20° ± 1 °C) and at body temperature (37° ± 1 °C). The instruments were reciprocated until fracture occurred in an artificial stainless steel canal with a 60° angle and a 5-mm radius of curvature. The time to fracture (TTF) was recorded. Also, the number of cycles to fracture (NCF) was calculated. Data were analysed using one-way ANOVA and Tukey's tests for inter-group comparison at both temperatures and for the reduction of cyclic fatigue at body temperature. For intra-group comparison at the different temperatures, the unpaired t test was used. RESULTS: The cyclic fatigue test at 20 °C showed that RB 25.08 and X1 25.06 presented significantly higher TTF and NCF than WOG 25.07 (P < 0.05). At 37 °C, all groups presented significant reduction of TTF and NCF (P < 0.05). RB 25.08 presented significant higher TTF than WOG 25.07 (P < 0.05). Regarding the NCF, there was no significant difference among the groups (P > 0.05). The WOG 25.07 presented the lowest percentage reduction of cyclic fatigue (P < 0.05). CONCLUSION: The body temperature treatment caused a marked reduction of the cyclic fatigue resistance for all reciprocating instruments tested. The RB 25.08 and X1 25.06 systems presented similar results at both temperatures tested. However, WOG 25.07 presented the lowest percentage reduction in fatigue resistance at body temperature. CLINICAL RELEVANCE: The cyclic fatigue resistance of NiTi reciprocating instruments has been evaluated at room temperature. However, the fatigue resistance significantly decreases upon exposure to body temperature, which could affect the mechanical behaviour of the NiTi instruments during root canal preparation.

Cyclic fatigue and torsional strength of three different thermally treated reciprocating nickel-titanium instruments.

OBJECTIVES: The aim of this study was to evaluate the cyclic and torsional fatigue resistance of the reciprocating single-file systems Reciproc Blue 25.08 (VDW GmbH, Munich, Germany), Prodesign R 25.06 (Easy Dental Equipment, Belo Horizonte, Brazil), and WaveOne Gold 25.07 (Dentsply/Tulsa Dental Specialties, Tulsa, OK, USA). MATERIALS AND METHODS: Sixty reciprocating instruments of the systems Reciproc Blue R25 (RB #25 .08 taper), Prodesign R (PDR #25 .06 taper), and WaveOne Gold (WOG #25 .07 taper) (n = 20) were used. Cyclic fatigue resistance testing was performed by measuring the time to failure in an artificial stainless steel canal with a 60° angle of curvature and a 5-mm radius located 5 mm from the tip (n = 10). The torsional test (ISO 3630-1) evaluated the torque and angle of rotation at failure of new instruments (n = 10) in the portion 3 mm from the tip. The fractured surface of each fragment was also observed using scanning electron microscopy (SEM). In addition, a supplementary examination was performed to measure the cross-sectional area of each instrument 3 and 5 mm from the tip. The data were analyzed using one-way ANOVA and Tukey's test, and the level of significance was set at 5%. RESULTS: The cyclic fatigue resistance values of PDR 25.06 were significantly higher (P < 0.05). RB 25.08 showed higher fatigue resistance than WOG 25.07 (P < 0.05). The torsional test showed that PDR 25.06 had lower torsional strength (P < 0.05). No differences were observed between RB 25.08 and WOG 25.07 (P > 0.05). PDR 25.06 showed higher angular rotation values than RB 25.08 and WOG 25.07 (P < 0.05). RB 25.08 presented higher angular rotation than WOG 25.07 (P < 0.05). The cross-sectional area analysis showed that PDR 25.06 presented the smallest cross-sectional areas at 3 and 5 mm from the tip (P < 0.05). CONCLUSION: PDR 25.06 presented the highest cyclic fatigue resistance and angular rotation until fracture compared to RB 25.08 and WOG 25.07. In addition, RB 25.08 and WOG 25.07 had higher torsional strength than PDR 25.06. CLINICAL RELEVANCE: In endodontic practice, thermally treated reciprocating instruments have been used for the root canal preparation of curved and constricted canals; therefore, these instruments should present high flexibility and suitable torsional strength to minimize the risk of instrument fracture.

Conservative management of external root resorption after tooth reimplantation: a 3-year follow-up.

The aim of this case report is to describe the treatment of a 9-year-old patient who suffered external root resorption of the permanent maxillary left lateral incisor following reimplantation of the avulsed left central and lateral incisors. Sixteen days after reimplantation and splinting of the incisors in a hospital emergency department, the patient was brought to the pediatric department of a dental school for further treatment. Root canal access was created in the maxillary left lateral and central incisors, and calcium hydroxide paste was used as intracanal dressing. At the 5-month follow-up, a radiograph revealed extensive external root resorption, a communicating root canal, and a periodontal lesion affecting the left lateral incisor. Management of the root resorption included obturation of the apical third of the canal with gutta percha and the middle third with mineral trioxide aggregate (MTA). At the 3-year recall examination, the patient was asymptomatic, and no mobility or soft tissue alterations were observed clinically. There was no radiographic sign that resorption had progressed. Despite the success of treatment, observation is still required. The use of MTA may be considered an alternative treatment for external root resorption after tooth reimplantation. The technique may allow tooth preservation in children until skeletal growth and development are completed and implant treatment may be considered.

How Does Intentional Apical Foraminal Enlargement Affect the Foramen and Root Canal Morphology?

INTRODUCTION: This study assessed the effect of intentional foraminal enlargement on the foramen and the apical root canal morphology. METHOD: Sixty mesial roots of mandibular molars were scanned by micro-computed tomography. Their apical foramina were photographed with a stereomicroscope before and after preparation. Three groups were formed (n = 20) according to the working length (WL). G-1: foramen - 1 mm; G0: foramen; and G+1: foramen + 1 mm. Each group originated 2 subgroups (n = 10): G-1: Buchanan's patency (size 10 K-type file) and foraminal debridement (sizes 20, 25 and 30 K-type files); G0 and G+1: rotary foraminal enlargement (ProDesign S size 25/.08) or reciprocating foraminal enlargement (R25). The area, perimeter, transportation, and noninstrumented walls of the foramen were evaluated. The root canal transportation and the centering index of preparation at 1, 3 and 5 mm from the foramen were also assessed. Data were compared statistically (α = 5%). RESULTS: The instruments used at the foramen and 1 mm beyond promoted foraminal enlargement and transportation. Regarding NIW, there was no difference between mechanized foraminal enlargements performed at the foramen or 1 mm beyond, similar to the manual foraminal debridement group (P > .05). There was no difference in transportation and centralization at 1-, 3-, and 5-mm apical levels, regardless of the instrumentation systems. CONCLUSION: Mechanical preparation at the foramen, or 1 mm beyond, resulted in foraminal enlargement, transportation and were not able to touch all root canal walls that delimit the foramen.

Impact of different agitation methods on smear layer cleaning of mesial canals with accentuated curvature.

Objectives: This study evaluated the impact of different methods of irrigant agitation on smear layer removal in the apical third of curved mesial canals of 3 dimensionally (D) printed mandibular molars. Materials and Methods: Sixty 3D-printed mandibular second molars were used, presenting a 70° curvature and a Vertucci type II configuration in the mesial root. A round cavity was cut 2 mm from the apex using a trephine of 2 mm in diameter, 60 bovine dentin disks were made, and a smear layer was formed. The dentin disks had the adaptation checked in the apical third of the teeth with wax. The dentin disks were evaluated in environmental scanning electron microscope before and after the following irrigant agitation methods: G1(PIK Ultrasonic Tip), G2 (Passive Ultrasonic Irrigation with Irrisonic- PUI), G3 (Easy Clean), G4 (HBW Ultrasonic Tip), G5 (Ultramint X Ultrasonic tip), and G6 (conventional irrigation-CI) (n = 10). All groups were irrigated with 2.5% sodium hypochlorite and 17% ethylenediaminetetraacetic acid. Results: All dentin disks were 100% covered by the smear layer before treatment, and all groups significantly reduced the percentage of the smear layer after treatment. After the irrigation protocols, the Ultra-X group showed the lowest coverage percentage, statistically differing from the conventional, PIK, and HBW groups (p < 0.05). There was no significant difference among Ultramint X, PUI-Irrisonic, and Easy Clean (p > 0.05). None of the agitation methods could remove the smear layer altogether. Conclusions: Ultramint X resulted in the most significant number of completely clean specimens.

Micro-CT Assessment of Filling Removal Effectiveness in the Apical Third of Curved Canals with Different Types of Anatomy.

Introduction: The aim of this study was to assess the effectiveness of filling removal material from the apical third of curved mesial root canals of mandibular molars. Reciprocating instrumentation followed by additional rotary instrumentation with instruments made of alloys with different heat treatments was evaluated. Materials and Methods: Thirty-six mesial roots of mandibular molars were divided into two groups: Group Class IV consisted of 16 roots with two independent canals, and Group Class II consisted of 20 roots with two canals that merged into one at their apical level. Each of these two groups were further divided into two subgroups, according to the additional rotary instrument used after the reciprocating instrumentation: Group RH and Group RM for Hyflex and Mtwo, respectively. After each procedural step, the roots were scanned by micro-tomography. After each step of filling removal, the Wilcoxon matched pair test and the Mann-Whitney test were used for the evaluation between groups. The significance level adopted was 5%. Results: Significant differences were observed between groups with different Class II and Class IV anatomies, regarding filling removal after Reciproc (P<0.05). After the use of an additional rotary instrumentation, no differences were observed between the two groups (P>0.05). Conclusions: In the apical third of mesial roots of mandibular molars with Class II anatomy, an additional rotary instrumentation was shown to be necessary for improving the removal of filling material after using the single-file reciprocating instrumentation technique.

Does the Mixing Method of AH Plus Jet Affect its Physicochemical and Mechanical Properties?

INTRODUCTION: The purpose of this study was to evaluate whether the mixing method of AH Plus Jet sealer affects its physicochemical and mechanical properties. METHODS: The properties of AH Plus Jet sealer were analyzed when mixed using either the Auto Mix Tip or manual mixing. The evaluated properties included radiopacity (n = 5), initial and final setting times (n = 5), flow (n = 5), and solubility (n = 3), following specifications outlined in ISO 6876/2012 and ADA Nº 57/2000. pH levels were measured at intervals of 3, 24, 72, and 168 hours (n = 10). The push-out bond strength test was conducted using a universal testing machine and using bovine teeth (n = 30). Failure modes were analyzed with stereomicroscopy. Porosity was evaluated under micro-CT (n = 5), and scanning electron microscopy was also performed (n = 5). One-way analysis of variance and Tukey, unpaired t-tests, or Mann-Whitney tests were used with a significance level of 5%. RESULTS: The Auto Mix exhibited a radiopacity value of 12.11 mmAl, whereas manual mixing resulted in 12.55 mmAl (P > .05). For initial and final setting times, Auto Mix showed 901 minutes and 1779 minutes, respectively, while manual mixing recorded values of 631 minutes and 1504 minutes (P < .05). In terms of flow, Auto Mix demonstrated higher values (25.26 mm) than manual mixing (21.71 mm) (P < .05). No statistical differences were observed between the two methods for solubility and pH (P > .05). Manual mixing presented a higher bond strength value (14.52 MPa) than Auto Mix (9.81 MPa) (P < .05). The mixed failure mode was the most frequent outcome for both methods. The highest porosity was observed for Auto Mix (P < .05). Scanning electron microscopy analysis revealed that manual mixing resulted in a smoother surface with fewer pores and smaller, more evenly distributed agglomerates compared to automatic mixing. CONCLUSION: The mixing method employed for AH Plus Jet sealer influences some physicochemical and mechanical properties of the material.

Biaxial flexural strength of hydrothermally aged resin-based materials.

PURPOSE: The strength of temporary restorations plays a vital role in full-mouth reconstruction, and it can be impacted by the aging process. The aim of this in vitro study was to evaluate the biaxial flexural strength and fractographic features of different resin-based materials submitted to thermal aging. MATERIAL AND METHODS: One hundred and ninety-two resin disc-shaped specimens (6.5 mm in diameter and 0.5 mm in thickness) were fabricated and divided into six experimental groups according to the resin-based materials (Filtek Bulk-Fill flowable resin; J-Temp temporary resin; and Fuji Lining glass ionomer cement) and aging process (before and after thermal cycling). Biaxial flexural strength test was performed using a universal testing machine at a crosshead speed of 0.5 mm/min before and after thermal cycling (5 °C and 55 °C, 5760 cycles, 30 s). The mechanical properties were assessed using Weibull parameters (characteristic strength and Weibull modulus) (n = 30). Fractured specimens were examined under a polarized light stereomicroscope to identify crack origin and propagation direction. The surface microstructure of the resin-based materials was assessed by scanning electron microscopy (n = 2). The Weibull modulus (m), characteristic strength, and reliability properties were calculated, and a contour plot was used to detect differences among groups (95% confidence interval). RESULTS: The Weibull modulus (m), characteristic strength, and reliability of the resin-based compounds were influenced by material type and thermal aging (p < 0.05). Weibull modulus (m) revealed no differences when comparing the materials and aging process (p > 0.05), except for the preceding aging period where Filtek Bulk-Fill exhibited higher values compared to J-Temp (p < 0.05). Filtek Bulk-Fill demonstrated superior characteristic strength and reliability compared to J-Temp and Fuji Lining before and after thermal cycling (p < 0.05). Fractography of the resin-based materials showed fractures originating from surface defects exposed to tensile side and their propagation toward the compressive side. Generally, no differences in surface microstructure were observed on micrographs before and after thermal aging for Filtek Bulk-Fill and Fuji Lining. However, the aging process developed flaws in J-Temp. CONCLUSION: Resin-based material composition resulted in different flexural strength performance, impacting the Weibull modulus (m), characteristic strength, and reliability of the resin-based restorations.

A Global Overview of Guided Endodontics: A Bibliometric Analysis.

INTRODUCTION: This review aimed to analyze the trend and main characteristics of articles related to guided endodontics (GE). METHODS: The search was conducted in May 2023 on Web of Science. GE-related articles were included, and conferences were excluded. Three researchers selected the articles and extracted: the number of citations; year and journal; design and study theme; authorship and institutions; country and continent. Collaborative networks were generated in the Visualization of Similarities Viewer software. The relationship between data was determined by Spearman's correlation. Google Trends was used to investigate the global popularity of GE research. RESULTS: The search resulted in 135 articles, of which 85 were included. The most cited article totaled 116 citations. The studies were published between 2016 and 2023, most frequently in 2022 (n = 22). The most prevalent journal was the Journal of Endodontics (n = 28). Case report (n = 38) was the most frequent study design. The most studied theme was the use of static GE for calcified canals (n = 27). Connert T was the author with the highest number of articles (n = 13). The University of Basel (n = 9) stood out. The most prevalent country was Brazil (n = 13). Europe was the most frequent continent (n = 38). Visualization of Similarities Viewer demonstrated an interaction between authors. There was a moderate positive correlation between citations and the impact factor (rho = .483). According to Google Trends, the United States was the country that most researched GE. CONCLUSIONS: Based on this review, a more significant research interest in GE was observed in Europe, addressing the application of GE in locating severely calcified root canals.

Evaluation of cyclic and torsional fatigue resistance of several heat-treated reciprocating nickel-titanium instruments.

This study investigated the cyclic fatigue and torsional resistance of Unicone Plus (UCP 25.06), Unicone (UC 25.06), Reciproc Blue (RB 25.08) and Wave One Gold (WOG 25.07) performed at body temperature (35° ± 1°C). Time and number of cycles to fracture (NCF), as well as torque and angular deflection were recorded. Fractured surfaces were evaluated by scanning electron microscopy (SEM). Data were analysed using one-way ANOVA and Holm-Sidak's tests for multiple comparison. The RB had a significantly higher time to fracture, followed by the WOG and UCP (p < 0.05). Regarding the NCF, there was no significantly difference between RB and WOG (p > 0.05). UC presented highest torque values and the lowest angular deflection (p < 0.05). SEM analysis demonstrated typical failures features in both cyclic and torsional fatigue tests. Overall, UC had the lowest time, NCF and angular deflection at fracture. RB presented the highest time to fracture and angular deflection values.

Influence of temperature on the torsional properties of two thermally treated NiTi rotary instruments.

This study aimed to evaluate the influence of temperature on torsional strength and angular deflection of two experimental NiTi rotary instruments manufactured from Blue and Gold thermal treatments and with identical cross-sections. A total of 40 experimental NiTi instruments 25.06 and with a triangular cross-section and manufactured from Blue and Gold thermal treatments were used (n=20). The torsional test was performed in the 3 mm from the tip of the instrument according to ISO 3630-1. The torsional test evaluated the torsional strength and angular deflection to failure at room temperature (21°C ± 1° C) and body temperature (36°C ±1°C). The fractured surface of each fragment was observed by using scanning electron microscopy (SEM). Data were analyzed using an unpaired t test for inter and intra-group comparison and the level of significance was set at 5%. The results showed that the body temperature did not affect the torsional strength and angular deflection of the instruments when compared with room temperature (P>0.05). However, at body temperature, the Blue NiTi instruments presented significantly lower angular deflection in comparison with Gold NiTi instruments (P<0.05). There was no significant difference regarding the torsional strength of the instruments at body temperature (P>0.05). The temperature did not affect the torsional strength of the instruments manufactured from Blue and Gold technology. However, the Blue NiTi instruments presented significantly lower angular deflection than Gold instruments at 36°C temperature.

Postoperative Pain After Using Passive Ultrasonic Irrigation and EasyClean Device, Irrigation Activation Techniques: A Randomized Clinical Trial.

INTRODUCTION: This randomized clinical trial aimed to compare postoperative pain after the use of 2different irrigation activation techniques: passive ultrasonic irrigation and the EasyClean device. METHODS: Sixty-six single-rooted teeth diagnosed with asymptomatic pulp necrosis and apical periodontitis were randomly assigned to 2experimental groups (n = 33), which differed in the irrigation activation technique. Postoperative pain levels were assessed after 24, 48, and 72 hours using a verbal rating scale; the ibuprofen intake amount was recorded at the same time intervals. Data were analyzed using Student's t-test, Mann-Whitney U and Fisher's exact tests, with a significance level of 5%. RESULTS: Postoperative pain levels and analgesic intake frequency were not significantly different across the 2irrigation activation techniques (P > .05). The frequencies obtained in relation to the prevalence of postoperative pain were 3.1-25.8% for all participants of the 2studied groups. CONCLUSION: The irrigation activation techniques of passive ultrasonic irrigation and the EasyClean device were found to be equivalent in terms of postoperative pain and analgesic intake.

Shaping ability of a pediatric motor-driven instrumentation system in primary molar root canal prototypes.

Evaluate the shaping ability and preparation time using a pediatric motor-driven rotary instrumentation compared to other systems in resin prototypes of primary molars. METHODS: Thirty specimens were scanned in micro-CT and divided into three groups according to the instrumentation type: pediatric motor-driven Sequence baby File (SBF); conventional motor-driven (Sequence Rotary File - SRF); manual K file. Instrumentation time was timed. After preparation, the specimens were scanned again. The pre- and post-instrumentation images were superimposed to measure the amount of root canal deviation and the resin remnant thickness. ANOVA followed by the Tukey test analyzed the comparisons between groups (p<0.05). RESULTS: No statistically significant differences occurred in root canal deviation among groups (p>0.05). There were statistically significant differences in the comparison among root thirds (p<0.001) but without significant differences in the interaction group vs. root third (p>0.05). Both motor-driven instrumentations showed statistically greater weariness than manual instrumentation (p<0.001), without significant significant differences between SBF and SRF. Motor-driven instrumentation had a shorter working time than manual instrumentation (p<0.001). CONCLUSION: Pediatric motor-driven instrumentation demonstrated good outcomes in relation to root canal deviation and amount of remnant structure, with shorter instrumentation time. SBF can be a suitable alternative for endodontic instrumentation in primary molars.

Divergence between confidence and knowledge of endodontists regarding non-odontogenic pain.

INTRODUCTION: This study aimed to assess the self-reported levels of confidence and knowledge related to non-odontogenic pain among a group of Brazilian endodontists. METHODOLOGY: A total of one hundred and forty-six endodontists affiliated with the Brazilian Society of Endodontics participated in the survey. The questionnaire, distributed via email or WhatsApp, contained inquiries designed to gauge self-perceived confidence and knowledge concerning non-odontogenic pain. The practitioners were categorized into four groups based on their self-reported familiarity with various orofacial pain types, classified as either sufficient or insufficient, and on their engagement in ongoing educational programs related to orofacial pain. Data were analyzed by Chi-Square Test and Fischer's exact test (p<0.05). RESULTS: Overall, self-reported confidence about non-odontogenic pain was high, especially for endodontists who considered their knowledge about orofacial pain sufficient, regardless of whether they had (71.1% - 97.8%) or not (35.7% - 96.4%) been continuously involved in education courses on orofacial pain. In general, self-reported knowledge about non-odontogenic pain was insufficient (0% - 42%), except in the question about how they would act in cases of pain that persists beyond the normal healing time after an endodontic procedure (70.6% - 81.9%). In general, endodontists are confident in their diagnosis and treatment of non-odontogenic pain. Nonetheless, this confidence did not correlate with a commensurate knowledge depth of. Thus, specialization courses in endodontics should highly consider training and qualifying these professionals in the diagnosis of non-odontogenic pain.