Effect of preemptive use of a nonsteroidal anti-inflammatory drug and a corticosteroid on the efficacy of inferior alveolar nerve blockade and postoperative pain control in endodontic treatment of molars with symptomatic pulpitis: A randomized double-blind placebo-controlled clinical trial.

AIM: The anaesthetic success rate of an inferior alveolar nerve block (IANB) in mandibular molars with irreversible symptomatic pulpitis can be low, and postoperative pain control in teeth with this diagnosis can be challenging. This study aimed to evaluate the influence of preemptive use of dexamethasone and oral potassium diclofenac on the success of IANB. The influence of these drugs on the intensity of postoperative pain was assessed as a secondary outcome. METHODOLOGY: Eighty-four patients with mandibular molars diagnosed with irreversible symptomatic pulpitis recorded preoperative pain intensity using a cold thermal test and a modified Numerical Rating Scale (mNRS). Sixty minutes before the anaesthetic procedure, patients were randomly assigned to one of three groups based on the medication they received: dexamethasone (4 mg), diclofenac potassium (50 mg), or placebo. All patients received IANB with 4% articaine (1:200 000 epinephrine), and 15 min later, they were evaluated for pain intensity using the cold thermal test. Anaesthetic success was analysed. The pain intensity was then recorded, and endodontic treatment and provisional restoration of the tooth were executed in a single session. Patients were monitored for 6, 12, 24, 48 and 72 h using the mNRS to assess the intensity of postoperative pain. RESULTS: There was a statistically significant increase in anaesthetic success when 4 mg dexamethasone (39.3%) or 50 mg diclofenac potassium (21.4%) was used compared to the placebo group (3.6%) (p < .001), with no significant difference between the two drugs. Regarding postoperative pain, dexamethasone was superior to placebo at 6 h (p < .001), with diclofenac having an intermediate behaviour, not differing between dexamethasone and placebo (p > .05). There was no significant difference amongst the groups at 12 h (p > .05). At 24, 48 and 72 h, the effectiveness of dexamethasone and diclofenac were comparable, and both were superior to placebo (p < .001). CONCLUSION: The use of dexamethasone or diclofenac potassium was favourable in terms of increasing the success rate of inferior alveolar nerve block in cases of mandibular molars with irreversible symptomatic pulpitis and decreased the occurrence of postoperative pain when compared to the use of a placebo.

The effect of root canal preparation tapers on planktonic bacteria and biofilm reduction in the apical third: A correlative microtomography and microbiological laboratory study.

AIM: To evaluate the influence of different preparation tapers on the reduction in planktonic bacteria and biofilms of Enterococcus faecalis and Candida albicans in the apical third (4 mm) of the mesial roots of mandibular molars, correlating decontamination with canal shape. METHODOLOGY: After microtomography analysis for morphological standardization of the canals, 48 mandibular molar roots, each containing two canals (96 canals), were contaminated with E. faecalis and C. albicans and divided into four groups (n = 11) for canal instrumentation using ProDesign Logic 2 files with different tapers G (.03): # 25.03; G (.04): # 25.04; G (.05): # 25.05; and G (.06): # 25.06 and irrigation with 2.5% sodium hypochlorite. Four roots were examined under a scanning electron microscope (SEM) to qualitatively assess biofilm formation. Eight roots were used as the negative control group (samples were not contaminated). Bacteriological samples were taken exclusively from the apical third of the roots before and after chemical-mechanical preparation and bacterial counts were determined (CFU/mL). The final micro-CT scan was used to quantify the volume variation and unprepared canal area in the apical third. Statistical analysis was performed using the Kruskal-Wallis, Student-Newman-Keuls and Wilcoxon tests for analysis of microbiological data. anova and the Tukey or Games-Howell test were used for analysis of micro-CT data and Spearman's test for correlations (α = 5%). RESULTS: All groups showed a significant reduction in bacteria (p < .05), with no statistically significant difference between groups. There was no significant difference in per cent volume increase between groups. The unprepared area (Δ%) was affected by the file used (p = .026) and was significantly lower for G (.06) compared to G (.03). There was no statistically significant correlation among bacterial reduction, volume and unprepared area (p > .05). CONCLUSION: The different preparation tapers influenced root canal shaping in the apical third but did not improve decontamination in this region.

The antimicrobial effect of different ozone protocols applied in severe curved canals contaminated with Enterococcus faecalis: ex vivo study.

The aim of this study was to evaluate 3 different irrigation protocols using ozone on monoculture biofilm of Enterococcus faecalis. Fifty disto-buccal roots of maxillary first molars were instrumented up to the size 25.08, sterilized and then incubated with Enterococcus faecalis for 21 days for biofilm maturation in the root canal walls. After contamination, the initial collection (S1) was performed and the 50 samples were divided in 3 experimental groups (n = 15) and 1 positive control group (n = 5) as follows: Group1: Ozonated water (40 µg/ml); Group2: gaseous ozone (40 µg/ml); Group3: Ozonated water (40 µg/ml) under continuous ultrasonic irrigation (CUI) and, Group 4: 2.5% sodium hypochlorite (positive control). The final collection (S2) was performed using hedstroem files # 25 by scraping the root canal wall and absorbed paper cone. The collected samples were analyzed by CFU/ml count and qPCR. To compare the effect of irrigation methods and to investigate E. faecalis count data, Kruskal-Wallis and Wilcoxon nonparametric tests were used at p < 05. The values of the differences between the S1 values and the S2 values revealed that the groups did not differ significantly for either E. faecalis CFU count data (p = 0.713) or q-PCR (p = 0.185), however, it is observed that for all groups, the CFU count of E. faecalis decreased over 99%. For the q-PCR assay, the reduction was on the order of 74-95%. Only the NaOCl positive control group presented total elimination of CFU/mL bacterial counting. The ozone protocols assessed were similar in regard to Enterococcus faecalis reduction.

The impact of a dental operating microscope on the identification of mesiolingual canals in maxillary first molars.

The aim of this study was to clinically assess the impact of a dental operating microscope (DOM) on the clinician's ability to locate a second canal in the mesiobuccal root (MB2), also known as the mesiolingual canal. An endodontic specialist treated 180 maxillary first molars using the same protocol for all teeth except for the use of the DOM (n = 90 per group). In the teeth treated without the use of a DOM, a mesiolingual canal was located in 26.67% of the cases; when a DOM was used, a mesiolingual canal was located in 77.78% of the cases. Analysis with the Fisher exact test revealed that the magnification provided by a DOM significantly (P < 0.05) improved the identification of MB2 canals in maxillary first molars.

Analysis of Cutting Capacity, Surface Finishing, and Mechanical Properties of NiTi Instruments 25/.04: ROTATE and LOGIC 2.

INTRODUCTION: In an effort to enhance the quality of mechanized endodontic instruments, various thermal treatment methods, and design modifications have been suggested. However, upon evaluation, these endodontic instruments may exhibit microscopic irregularities. The objective of this in vitro study was to analyze the cutting capacity, surface finish, and mechanical properties of Nickel-Titanium 25/.04 Rotate (VDW GmbH, Munich, Germany) and LOGIC 2 (Easy Equipamentos Odontológicos, Belo Horizonte, MG, Brazil) rotary instruments. METHODOLOGY: Twenty rotary instruments were divided into 2 groups: GR, the group with ROTATE instruments (n = 10); and GL2, the group with LOGIC 2 instruments (n = 10). They were evaluated for roughness, using a profilometer, for bending resistance, buckling resistance, and cutting capacity using a universal testing machine, as well as for torsional strength (torque and angular deflection) using a torquemeter. The instruments were visualized before and after the mechanical tests through scanning electron microscopy. RESULTS: GR showed better surface finish in terms of roughness, greater cutting capacity, and greater angular deflection than GL2 (P < .05). However, GL2 showed better flexibility than GR (P < .05). GL2 and GR did not show statistically significant differences in terms of buckling and torque (P > .05). CONCLUSION: The ROTATE and LOGIC 2 rotary instruments differed in their surface finish, cutting capacity, and mechanical properties, except for their buckling resistance and required fracture torque.

In Vitro Evaluation of the Dynamic Cyclic Fatigue Resistance of a New TruNatomy Glider File after Different Cycles of Use.

INTRODUCTION: Determination of the glide path is recommended before using rotary instruments. This study aimed to evaluate the dynamic cyclic fatigue resistance of new and used glider rotary instruments in up to 6 root canals. METHODS: Seventy-two TruNatomy Glider files were used for the preparation of root canals of extracted lower molars, which were then submitted to the dynamic cyclic fatigue test carried out in a curved metallic artificial canal. The instruments were divided into 4 groups (n = 18): Control group, new instruments without any use in the root canal; Group 2U, instruments used in 2 mesial canals; Group 4U, instruments used in 4 mesial canals; Group 6U, instruments used in 6 mesial canals. The time to failure (TF) of the instrument was recorded, and the number of cycles to failure (NCF) was calculated. The data were submitted to 1-way analysis of variance and to the Games-Howell test for multiple comparisons, adopting a significance level of 5%. RESULTS: TF and NCF were significantly affected by the number of file uses. The Games-Howell test revealed that TF and NCF were significantly greater in the control group than in Group 4U. In Group 2U, TF and NCF were intermediate and not significantly different from the control group. Group 6U had significantly lower TF and NCF than all other groups. CONCLUSION: The TruNatomy Glider can be used as a glide path for up to 2 mesial canals of mandibular molars, whereas its use on 4 or 6 root canals is not suggested.

Influence of the brushing motions on the dynamic cyclic fatigue resistance of the Reciproc Blue instrument: In vitro study.

INTRODUCTION: This study aimed to evaluate the dynamic cyclic fatigue resistance of Reciproc® Blue files subjected to brushing motion. METHODS: Twenty Reciproc® Blue files (R25, VDW, Munich, Germany) were employed for chemical-mechanical preparation in root canals of 3D printed replicas of mandibular molars. The instruments were divided into two groups (n=10): Group BM, instrumentation with brushing motions; Group WBM, instrumentation without brushing motions. Subsequently, the same instruments underwent cyclic fatigue testing using artificial canals consisting of a stainless-steel plate and an apical segment with a 45° curvature. Data regarding the time to fracture, number of cycles to fracture (NCF), and length of the fractured fragment were collected and subjected to statistical analysis using the t-test or Mann-Whitney test, with a significance level of 5%. Additionally, the fractured fragments were examined under a scanning electron microscope. RESULTS: No statistical differences were observed between the groups in terms of time to fracture (p<0.05), NCF (p<0.05), and length of the fractured fragment (p<0.05). CONCLUSION: The brushing motion did not affect the dynamic cyclic fatigue resistance of Reciproc Blue files.

Efficacy of WaveOne Gold and ProDesign RT systems in removing filling material: a micro-CT analysis.

The remaining filling material after retreatment can harbor bacteria and organic tissues that can influence the outcome of the therapy. AIM: The aim of this study was to evalúate, by micro-CT, the amount of filling material remaining in the root canal after its removal using WaveOne Gold or ProDesign RT. MATERIAL AND METHOD: Forty human mandibular canines were instrumented with the ProTaper Next system up to the X2 instrument (25.06) and filled with gutta-percha cones and AHPlus. Teeth were divided into 2 groups (n=20): WaveOne Gold 25.07 (WOG) and ProDesign RT 25.08 (PRT) for filling removal, after which they were scanned in a micro-CT device to quantify the volume of remaining filling material. The data were subjected to log 10 transformation, Student 's t-test was performed to account for multiple observationsper sample, significance was set at 5%. RESULTS: Student 's t-test showed that there was no difference between the two systems regarding the volume of remaining filling material in the thirds: apical (p = 0.392), middle (p = 0.065), or cervical (p = 0.918). CONCLUSIÓN: Remaining filling material was present in all groups and both systems were similar in removing root filling material in mandibular canines.

A permanencia de material obturador após o retratamento pode abrigar bactérias e tecidos orgánicos que podem influenciar o resultado da terapia. OBJETIVO: O objetivo deste estudo foi avaliar, por micro-CT, a quantidade de material obturador remanescente no canal radicular após a desobturagdo com WaveOne Gold e ProDesign RT. MATERIAL E MÉTODO: Quarenta caninos inferiores humanos foram instrumentados com o sistema ProTaper Next até o instrumento X2 (25.06) e obturados com cones de guta-percha e AHPlus. Os dentes foram divididos em dois grupos (n=20): WaveOne Gold 25.07 (WOG) e ProDesign RT 25.08 (PRT) e escaneados em micro-CT para quantificagdo do volume de material obturador remanescente. Os dados foram submetidos á transformando log 10, o teste t de Student foi realizado para contabilizar múltiplas observagoes por amostra, a significáncia foi fixada em 5%. RESULTADOS: O teste t de Student mostrou que ndo houve diferenga no volume de material obturador remanescente entre os dois sistemas nos tergos: apical (p = 0,392), médio (p = 0,065) ou cervical (p = 0,918). CONCLUSÃO: O material obturador remanescente estavapresente em todos os grupos e ambos os sistemas foram semelhantes na remogdo do material obturador radicular nos caninos inferiores.

Analysis of the penetration of NaOCl 5.25% into dentinal tubules using different irrigation protocols: An ex vivo study.

The objective of the study was to investigate the 5.25% sodium hypochlorite (NaOCl) penetration into the dentinal tubules after different irrigation methods. Seventy canines were stained with 1% crystal violet and divided into groups (n = 20): GEC-EasyClean; GPUI-E1 Irrisonic ultrasonic insert; GXP-XP-Endo finisher; GPC-conventional irrigation and GNC-stained tooth without irrigation. Axial sections (16×) were assessed and irrigant penetration was quantified as a bleaching halo on the surface of the apical, middle and coronal third. In the apical third, GPUI promoted greater NaOCl penetration (p < 0.05). GXP was better than GEC (p < 0.05), as was GPC (p > 0.05). The GPUI and GXP groups were similar in the middle and coronal third (p > 0.05). GPUI and GXP showed better results than GEC (p < 0.05). GPUI was more effective in the apical third and like GXP in the cervical and middle third.

Evaluation of Bone Growth around Autotransplanted Teeth Using Cone-Beam Computed Tomographic Images.

INTRODUCTION: The aim of this observational study was to evaluate bone growth at the recipient site of autotransplanted teeth using cone-beam computed tomography (CBCT) images and to compare it to the control tooth. METHODS: Bone growth was measured on CBCT images obtained from the anterior region of the maxilla, which received a single transplant of immature premolars due to early loss of the central incisor. The results were compared to the bone growth of contralateral central incisor that served as control. The sample consisted of 13 autotransplanted teeth and 13 control teeth. It was determined the thickness of the buccal bone of the marginal ridge, the thickness of the palatal bone of the marginal ridge, the height of the maxillary bone, and the thickness of the maxillary bone at its mid-height. The measurements were analyzed statistically, adopting a significance level of 5%. RESULTS: The mean interval between the dental autotransplantation surgery and the CBCT scan was 16.2 years. The mean thickness of the buccal bone of the marginal ridge, thickness of the palatal bone of the marginal ridge, height of the maxillary bone, and thickness of the maxillary bone at its mid-height were, respectively, 0.85, 0.94, 19.6, and 8.85 mm for autotransplanted teeth and 0.79, 1.09, 18.88, and 8.5 mm for control teeth. There were no significant differences in the bone measurements between autotransplanted and control teeth (P > .05). CONCLUSIONS: The growth of maxillary bone in the region that received the autotransplanted tooth was proportional to that of maxillary bone that supports the contralateral tooth. Thus, autogenous transplantation is efficient in maintaining the bone architecture at the recipient site.

Evaluation of the rotary kinematics between actual and set speeds of X-Smart Plus, VDW.Silver and iRoot motors.

The present study evaluated the actual rotational speed of three different endodontic motors compared to the values provided by the manufacturers. A total of three endodontic motors (X-Smart Plus, VDW.Silver, and iRoot) were tested at 400 rpm and 800 rpm and 2 N/cm2 torque. The kinematics of the devices was recorded by using a custom angle-measuring disc with a 50-mm diameter attached to the handpiece provided by the manufacturer, whereas their movement was captured by a high-speed camera at 2,400 frames per second, 800 x 800 pixel-resolution and distance of 0.3 m from the target object. Statistical analysis was performed at a significance level of 5%. At 400 rpm, the iRoot motor had a value of 17.94 rpm above that indicated by the manufacturer, which was significantly different from those of X-Smart Plus (5.20 rpm below that indicated by the manufacturer) and VDW.Silver (0.62 rpm above that indicated by the manufacturer) motors (P < 0.05). At 800 rpm, the iRoot motor had a value of 51.34 rpm below that indicated by the manufacturer, whereas the X-Smart Plus motor had a value of 13.00 rpm below that indicated by the manufacturer (P > 0.05). The VDW.Silver motor statistically differed from the iRoot and X-Smart Plus ones, showing a value of 1.68 rpm above that indicated by the manufacturer. In conclusion, the X-Smart Plus, VDW.Silver, and iRoot motors showed lower variations in the rotational speed values compared to those reported by their manufacturers. The endodontic motors presented different behaviors between them, with the VDW.Silver motor presents the most accurate values and the iRoot presents the most divergent values.

Assessment of the root surface temperature during the use of intracanal agitation systems: In vitro study.

This study aimed to evaluate the temperature changes that the different methods of agitation of irrigants promote on the external dental root surface. Nine extracted human lower premolars were standardized by cone-beam computed tomography and used. The root canal was instrumented with a Reciproc 40.06 file. Temperature measurement was performed using K-type thermocouple sensors attached to the middle, cervical, and apical thirds of the teeth. The teeth had their roots immersed in distilled water at 37ºC, which were distributed into 3 experimental groups according to the mechanical agitation methods to be studied. US Group (n=3), Irrisonic Ultrasonic Tip activated through ultrasound; EC Group (n=3), Easyclean Tip coupled to a contra-angle low-speed handpiece; XP Group (n=3), XP-endo Finisher file coupled to an endodontic electrical motor. Temperature measurements were performed simultaneously with agitation and irrigation of intracanal irrigants. Statistical analysis was performed using SPSS software with a significance level of 5%. For multiple comparisons, the Tukey test was used. The association between mechanical agitation methods and root third was statistically significant. Regarding the temperatures recorded on the external surface of the roots, the ultrasonic tip was significantly higher than the XP-endo Finisher file and the Easyclean tip, which did not differ from each other. Regarding the ultrasonic tip, the external temperature in the middle third (39.46ºC) of the root was significantly lower than in the cervical (40.41ºC) and apical third (40.53ºC). None of the agitation methods of irrigants studied presented heating above 47ºC, and their use is safe for periodontal tissues.

Reciprocating Kinematics of X-Smart Plus, VDW Silver and, iRoot Endodontic Motors: A Comparison Between Real and Set Values.

This study assessed 3 endodontic motors, X-Smart Plus (Dentsply Sirona, Ballaigues, Switzerland), VDW.Silver Reciproc (VDW GmbH, München, Germany) and, iRoot (Bassi Endodontics, Belo Horizonte, Brazil) in 2 different reciprocating settings. The movements evaluated were 170° in counter-clockwise (CCW) and 50° in clockwise (CW) at 350 RPM, and 150° CCW and 30° CW at 300 RPM. For the X-Smart Plus and VDW Silver the settings used were the ones in the motor library. For the iRoot, the motor was adjusted to the angles of the study. A customized optic target was attached to the contra-angle of the motor and the movements were recorded with a high-resolution camera (K2 DistaMaxTM Long-Distance Microscope System, Infinity Photo-Optical Company, Colorado, EUA) at 2,400 frames per second (FPS). The images were analyzed with the Vision Research software (Inc. Headquarters, Wayne, New Jersey, EUA). The following kinematic parameters were assessed: CCW angle, CW angle, speed (RPM) at both directions, and, standstill time at each change of directions. The Intraclass Correlation Coefficient (ICC) and Kruskal-Wallis (method of Dunn) were used at a significant level of 5%. There was no statistically significant difference among the motors at the 150°/30° setting (P > .05); the iRoot was the least reliable at the 170°/50° setting for CCW angle, speed, and net angle parameters (P < 0.05). The standstill time of all motors in both directions was identical. None of the motors were able to reproduce faithfully the set movements. The iRoot motor presented a higher discrepancy when compared to X-Smart and VDW Silver.

Apical periodontitis in mesiobuccal roots of maxillary molars: influence of anatomy and quality of root canal treatment, a CBCT study.

Objectives: This study aimed to evaluate the prevalence of apical periodontitis (AP) in the mesiobuccal roots of root canal-treated maxillary molars. Materials and Methods: One thousand cone-beam computed tomography images of the teeth were examined by 2 dental specialists in oral radiology and endodontics. The internal anatomy of the roots, Vertucci's classification, quality of root canal treatment, and presence of missed canals were evaluated; additionally, the correlation between these variables and AP was ascertained. Results: A total of 1,000 roots (692 first molars and 308 second molars) encompassing 1,549 canals were assessed, and the quality of the root canal filling in the majority (56.9%) of the canals was satisfactory. AP was observed in 54.4% of the teeth. A mesiolingual canal in the mesiobuccal root (MB2 canal) was observed in 54.9% of the images, and the majority (83.5%) of these canals were not filled. Significant associations were observed between the presence of an MB2 canal and the quality of the root canal filling and the presence of AP. Conclusions: AP was detected in more than half of the images. The MB2 canals were frequently missed or poorly filled.

Influence of Sodium Hypochlorite and Chlorhexidine on the Dynamic Cyclic Fatigue Resistance of XP Endo Shaper Instruments.

OBJECTIVE: This study evaluated the dynamic cyclic fatigue resistance of the XP-Endo Shaper (XPS), associated with chlorhexidine digluconate (CHX) or sodium hypochlorite (NaOCl) in two different formulations: gel (G) or liquid (L). MATERIALS AND METHODS: Sixty XPS were used in an artificial stainless-steel canal, and the files were fully immersed in the irrigating solution throughout the experiment until the fracture. The files were divided into six groups (n = 10) based on the irrigation solution used: NaOCl(L), NaOCl(G), CHX(L), CHX(G), natrosol gel (NAT) (control), and lubricating oil (LO) (control). The artificial canal was manufactured 1.5 mm wide, 20 mm long, and, 3.5 mm deep with a straight cervical segment measuring 14.29 mm; an apical segment of 4.71 mm with 3 mm radius; and 90 degrees of curvature apical 1 mm long straight segment. Resistance to cyclic fatigue was determined by recording the number of cycles to fracture (NCF). RESULTS: The CHX(G), CHX(L), and OIL (LO) groups showed no significant difference between them and presented longer time to fracture (p > 0.05). NaOCl(L) shows the lowest NCF without significant differences between NaOCl(G) and NAT. The NCF of the NaOCl(G) was statistically similar to the CHX(L) and statistically lower than the CHX(G) and OIL groups. NAT did not present a statistical difference of the NaOCl(L), NaOCl(G), and presented a significantly lower NCF than the CHX(G) (p < 0.01). CONCLUSION: The use of CHX(G) resulted in increased cyclic fatigue resistance of the XPS instruments compared to NaOCl or LO.

Fluoride effect on the secretory-stage enamel organic extracellular matrix of mice.

The formation of an ordered enamel organic extracellular matrix (EOECM) seems to be a crucial step for the proper formation of the enamel mineral phase. The ordered supramolecular structure of the EOECM in the secretory stage can be analyzed using polarizing microscopy, as it is strongly birefringent. Excessive fluoride (F) ingestion during tooth development can cause enamel fluorosis, leading to increased porosity in mature enamel. We analyzed the effects of F on the birefringence of the EOECM in the A/J, CBA, and DBA/2 strains of mice given 0, 11.25, and 45 ppm of fluoride in drinking water. In the CBA and DBA/2 strains, the 11.25 and 45 ppmF groups presented a significant decrease in optical retardation (OR) when compared with the respective 0 (CBA 11.25 ppmF p = 0.0056 and 45 ppmF p < 0.0001; DBA/2 11.25 and 45 ppmF p < 0.05). ORs in A/J 0 ppmF were significantly higher than in 45 (p < 0.0001). The enamel of the A/J strain was more severely affected by fluoride than it was in the other strains of mice and exhibited the lowest levels of fluoride in plasma, whereas its normal secretory enamel presented a significantly higher protein absorbance than it did in CBA and DBA mice (p = 0.0099 and p = 0.0025, respectively). The results showed that experimental fluorosis can alter the supramolecular organization of EOECM in the secretory stage of amelogenesis and that the susceptibility to dental fluorosis seems to be influenced by the inherent characteristics of the developing enamel.

CONSORT Compliance in Randomized Clinical Trials of Regenerative Endodontic Treatments of Necrotic Immature Teeth: A Scoping Review.

INTRODUCTION: This study aimed to investigate methodological quality of clinical trials in regenerative endodontics and its compliance with the CONSORT statement. METHODS: An electronic search was performed in 8 electronic databases. Only clinical trials whose participants underwent regenerative endodontic treatment on necrotic permanent immature teeth were included. Quality assessment was performed using the Cochrane Collaboration's Risk of Bias Tool (RoB, version 2.0). Compliance of articles with the CONSORT guidelines was assessed by a tool with scales: 0 = no description, 1 = deficient, and 2 = adequate description, totaling a maximum score of 32 points. The Mann-Whitney and Kruskal-Wallis tests were used to compare the scores among journals, studies, country, income levels, and publication periods. Spearman correlation analyses were performed between CONSORT compliance scores and 2019 journal CiteScore values, publication year, and quality assessment. RESULTS: Twenty studies were included. The average CONSORT compliance score was 20.95 (±6.19). The better reported items were the description of the interventions performed in the trials (100%), followed by the description of the number of patients analyzed, losses and exclusions (90%), and the hypothesis tested (85%). Within the 20 studies, 3 articles were classified as "low risk of bias," 8 studies were classified as "some concerns," and 9 studies were considered "high risk of bias." Studies carried out in countries with higher income levels presented higher CONSORT scores. Significant moderate correlations were found between the CONSORT score and the percentage of risk of bias in low-risk domains (rs = 0.63; 95% CI, 0.31-0.94; P = .003) and the overall risk of bias categories (rs = 0.76; 95% CI, 0.54-0.98; P = .001). CONCLUSIONS: The adequacy of reporting based on the CONSORT checklist items of regenerative endodontic trials was low with a moderate to high risk of bias.

Comparison of Postobturation Pain Experience after Apical Extrusion of Calcium Silicate- and Resin-Based Root Canal Sealers.

INTRODUCTION: This study compared the intensity of postobturation pain after unintentional apical extrusion of calcium silicate-based root canal sealers (EndoSequence BC Sealer [Brasseler USA, Savannah, GA] and Bio-C Sealer [Angelus, Londrina, PR, Brazil]) with a resin-based sealer (AH Plus; Dentsply Sirona, York, PA). METHODS: A total of 330 patients referred for root canal treatment on molar teeth with asymptomatic irreversible pulpitis were recruited. Root canals were prepared using WaveOne Gold instruments (Dentsply Sirona) in a crown-down technique and irrigated with 2% chlorhexidine gel and saline solution. Next, patients were randomly distributed into 3 groups according to the root canal sealer used (n = 110): AH Plus, BC Sealer, and Bio-C Sealer. Root canal filling was then accomplished with a vertical compaction technique. Patients presenting with an unintentional extrusion of sealers (n = 13/group) were assessed for postobturation pain experience using a visual descriptor scale ranging from 0-10 at 6-, 12-, 24-, and 48-hour and 1-week intervals after treatment. Mixed analysis of variance repeated measures were used to assess the results (α = 0.05). RESULTS: The extrusion rate was similar for all sealers (~12%). There was no significant difference in the postobturation pain results between the root canal sealers evaluated (P > .05). However, after the time interval of 12 hours, AH Plus (P = .04073) and Bio-C Sealer (P = .04327) demonstrated a significant reduction in pain, whereas BC Sealer did not show differences in pain intensity, even in the maximum period evaluated of 1 week (P > .05). CONCLUSIONS: The occurrence of unintentional apical extrusion of calcium silicate-based root canal sealers presents similar postoperative pain results compared with resin-based sealers with low-intensity pain.

Success, Survival Rate, and Soft Tissue Esthetic of Tooth Autotransplantation.

INTRODUCTION: The aim of this retrospective study was to assess the success, survival rate, and soft tissue esthetic of autotransplanted teeth. METHODS: This study included patients with at least 1 tooth autotransplanted to the maxilla during childhood or adolescence. The autotransplantation technique included the removal of an immature tooth from a donor site and its placement in the maxilla as a replacement for a missing or extremely compromised tooth. The cases were properly restored to ensure function and esthetic. To be considered successful, the tooth should be asymptomatic at the time of assessment, no pain to palpation and percussion, have no signs of apical periodontitis or a sinus tract, have a periodontal probe ≤3, and have an absence of root resorption and development of at least 70% of the normal root. The esthetic evaluation of the soft tissue was based on the pink esthetic score and graded as very unsatisfactory, unsatisfactory, poor, fair, good, or excellent. Data were statistically analyzed at a significance level of 5%. RESULTS: Thirty-five patients (23 males and 12 females) had 43 anterior teeth replaced, including 42 central incisors and 1 lateral incisor. The follow-up period ranged from 1-25 years. In regard to success and the survival rate, 43 teeth were assessed; 34 cases (79.07%) were considered successful and 9 (20.93%) unsuccessful. Only 1 tooth was lost, and 42 teeth remained functional (survival rate = 97.67%). In regard to the esthetic, 40 teeth could be assessed and were considered as excellent (30%), good (35%), fair (27.5%), and poor (7.5%); there were no reports of unsatisfactory or very unsatisfactory cases. CONCLUSIONS: Tooth autotransplantation can be considered a valid procedure to replace lost teeth in the maxilla, presenting high survival and success rates. The overall esthetic of the patients was considered as satisfactory.

Birefringence of the secretory-stage enamel organic extracellular matrix from rats submitted to successive injections of bisphosphonates.

The aim of the present study was to assess birefringence of the secretory-stage enamel organic extracellular matrix (ECM) and mechanical properties of mature enamel from rats treated with bisphosphonates. Longitudinal sections were obtained from upper incisors of rats that had been submitted to injections of bisodic etidronate (8 mg/Kg/day), sodium alendronate (30 microg/Kg/day), or sodium chloride as control (8 mg/Kg/day) for 42 days. Sections were immersed in 80% glycerin for 30 min and optical retardation of birefringence brightness in the secretory-stage enamel organic ECM was determined in nanometers. Etidronate-treated rats exhibited extensive morphological changes in the secretory-stage enamel organic ECM inclusive nonbirefringent conspicuous incremental lines, but presented optical retardation values similar to those showed by control rats (p > 0.05). Birefringence of secretory enamel organic ECM from etidronate rats presented an irregular aspect. Alendronate-treated rats did not show morphological alterations in the secretory-stage enamel organic ECM, however, they presented significant reduction in optical retardation of birefringence brightness when compared with control and etidronate rats (p < 0.01). Alendronate and etidronate groups exhibited reductions of approximately 6-10% in mature enamel cross-sectional microhardness when compared with control group (p < 0.01). Scanning electron microscopy analysis showed extensive alterations in mature enamel only from etidronate group with absence of enamel rods. The present work shows that bisphosphonates can affect the birefringence of the secretory-stage enamel organic ECM. The results presented here suggest that alterations in the supramolecular organization of the secretory-stage enamel organic ECM are a plausible mechanism by which environmental factors may cause enamel defects.