Influence of the timing of periodontal intervention on periapical/periodontal repair in endodontic-periodontal lesions: a systematic review.

INTRODUCTION: This study is aimed at answering the following question: "Does the timing of periodontal intervention influence the periapical/periodontal repair in endodontic-periodontal lesions?". MATERIAL AND METHODS: Six electronic databases were systematically searched for studies published up to April 2022, without restriction of language or year of publication, following the PIOS strategy: (P) adult patients with a diagnosis of endodontic-periodontal lesions, (I) endodontic and periodontal treatment, (O) periapical and periodontal healing, and (S) clinical studies. Risk of bias assessment was performed with the revised Cochrane risk of bias tools for randomized trials (RoB 2) and non-randomized interventions (ROBINS-I). The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. RESULTS: Three studies (one prospective, one retrospective, and one randomized clinical trial) were included in the present review. Non-randomized studies had a critical and serious risk of bias. The randomized clinical trial had some concerns risk of bias. Non-randomized studies reported that the endodontic intervention should be performed previous to the periodontal intervention. Randomized clinical trial reported improvements when endodontic and periodontal interventions were performed simultaneously. GRADE analysis showed a very low quality of evidence for both randomized and nonrandomized studies. CONCLUSIONS: Based on the evidence from the included studies, although it is suggested that the endodontic treatment should be performed prior to periodontal treatment, it is not possible to assure the best treatment sequence for endodontic-periodontal lesions. CLINICAL RELEVANCE: Evidences suggests that although the endodontic intervention should be the first therapy of choice, it was not possible to specify the best time to perform the periodontal intervention.

Do NSAIDs used prior to standard inferior alveolar nerve blocks improve the analgesia of mandibular molars with irreversible pulpitis? An umbrella review.

INTRODUCTION: The aim of the present umbrella review was to answer the following question: "Does the use of NSAIDs as premedication increase the efficacy of the standard inferior alveolar nerve block on teeth with symptomatic irreversible pulpitis?" MATERIAL AND METHODS: Systematic reviews with and without meta-analyses that evaluated the influence of premedication on anesthetic efficacy of the inferior alveolar nerve in symptomatic irreversible pulpitis of mandibular molars were searched in six electronic databases (MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library, EMBASE, and Grey Literature Reports), without the restriction of language or year of publication. A Measurement Tool to Assess systematic Reviews (AMSTAR 2) was used to evaluate the quality of the included studies. RESULTS: Twelve systematic reviews were included. Only one did not perform a meta-analysis. The AMSTAR 2 overall confidence ranged from very low to high. In general, the main findings of the systematic reviews were that non-steroidal anti-inflammatory drugs (e.g., ibuprofen, oxicam, diclofenac, association of ibuprofen with acetaminophen, and ketorolac) increased the success rate of the inferior alveolar nerve block. CONCLUSIONS: From the "very low" to "high"-quality evidence available, this umbrella review concluded that NSAIDs as premedication acts through cyclooxygenase pathways and block the synthesis of specific prostaglandins that complicate the mechanism of action of the anesthesia, improving its success rate. CLINICAL RELEVANCE: Non-steroidal anti-inflammatory drugs can increase the success rate of the anesthetic technique of inferior alveolar nerve block efficacy in situations of mandibular molars with symptomatic irreversible pulpitis.

Do orthodontic movements of traumatized teeth induce dental pulp necrosis? A systematic review.

INTRODUCTION: Usually, orthodontic movements encompass children and young adult patients, which are more susceptible to the occurrence of traumatic dental injuries. It is necessary to understand whether the effects of orthodontic movements on traumatized teeth could induce pulp necrosis. The aim of this study was to answer the following question: "Do orthodontic movements of traumatized teeth induce dental pulp necrosis?". MATERIAL AND METHODS: Searches were performed for studies published up to May 11, 2023, in the MEDLINE/PubMed, Cochrane Library, Scopus, SciELO Citation Index, Web of Science, EMBASE, and Grey Literature Report databases, without restriction for language or year of publication. The revised Cochrane risk of bias tools for nonrandomized interventions (ROBINS-I) was used to assess the quality of the included studies. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. RESULTS: Of 2671 potentially relevant studies, five were included. Four were classified as having a moderate risk of bias and one as a serious risk of bias. It was reported a higher susceptibility to pulp necrosis in teeth subjected to orthodontic movements with history of trauma involving periodontal tissues. Additionally, orthodontic movements of traumatized teeth with total pulp obliteration had an increased risk of pulp necrosis. GRADE analysis presented a moderate certainty of evidence. CONCLUSIONS: An increased risk for pulp necrosis when traumatized teeth are subjected to orthodontic movements was verified. However, this is based on evaluations performed with subjective tests. Further well-designed studies are necessary to confirm this trend. CLINICAL RELEVANCE: Clinicians must be aware of the possibility of pulp necrosis. However, endodontic treatment is recommended when verified signs and symptoms of pulp necrosis.

Effect of music during endodontic treatment on patients' anxiety: a systematic review of randomized clinical trials.

OBJECTIVES: Endodontic treatment is one of the most fearful procedures among dentistry, and the use of music during the procedure has been evaluated to control patients' anxiety. This systematic review has been conducted to provide a synthesis of the state of knowledge in this field and aimed to answer the following question: "Can music therapy reduce patient's state anxiety during endodontic treatment?". METHODS: A search was performed in six electronic databases (PubMed, Cochrane Library, Scopus, Web of Science, EMBASE, and Open Gray) for articles published until April 2022. The eligibility criteria, based on the PICOS strategy, were as follows: (P) patients undergoing endodontic treatment; (I) exposure to music; (C) no music; (O) patients' anxiety; (S) only randomized clinical trials. The risk of bias was analyzed according to the Cochrane Risk of Bias tool for randomized controlled trials (RoB 2). The strength of evidence from the included studies was assessed using the Grading of Assessment, Development, and Assessment Recommendations (GRADE) tool. RESULTS: Five eligible studies were retrieved. A low to high risk of bias was verified. Descriptive analysis showed an effect in favor of music intervention, with differences among state anxiety, heart rate and blood pressure. CONCLUSIONS: With a very low quality of evidence, dental care professionals may consider playing background music during endodontic treatment since it is a cost-effective and easy alternative to trying to reduce dental anxiety. CLINICAL RELEVANCE: Five studies were included in this systematic review and showed, with a very low quality of evidence, that music may reduce state anxiety levels on patients during root canal treatment.

Comparison between isolated and associated with codeine acetaminophen in pain control of acute apical abscess: a randomized clinical trial.

OBJECTIVES: The study aimed to compare the acetaminophen administration efficacy or its combination with codeine for pain control in acute apical abscesses cases. MATERIALS AND METHODS: Thirty-nine patients who sought emergency treatment in the Faculty of Dentistry of the Federal University of Rio Grande do Sul were included, all of them with acute apical abscess diagnosis. These patients were divided into two groups: acetaminophen group-prescription of acetaminophen (1000 mg) and acetaminophen-codeine group-prescription of acetaminophen (1000 mg) + codeine (30 mg), both with oral intake every 6 h for 3 days. The pain scores were recorded by the patients on their own at 6, 12, 24, 48, and 72 h after finishing clinical assistance, by filling a pain evolution journal, containing a visual analogue scale (VAS). Student t test was conducted to investigate different mean ages between groups 1 and 2. A comparison of weight and means of initial pain scores between groups was carried out using the Mann-Whitney U test. Chi-square test was performed to compare gender, affected tooth, education, initial swelling, and frequency of adverse effect between test and control groups. Mann-Whitney U test was applied to compare groups in the same period. Friedman's test was used to compare results from the same group over time. RESULTS: Both groups showed score reduction over time (P < 0.05). Paracetamol-codeine group showed significant pain score reduction at 48 h registers when compared to baseline and at 6 h scores (P < 0.05). Further, pain scores at 72 h were significantly lower, when compared to the baseline, at 6 h, and at 12 h scores (P < 0.05). Acetaminophen group showed significant pain score reduction observed at 72 h, when compared to the baseline and at 6 h scores (P < 0.05). There were no significant differences in pain score reduction over time between groups (P > 0.05). There was no difference between the groups regarding the frequency of adverse reactions (P > 0.05). CONCLUSION: Both medications were effective for pain control in acute apical abscess cases. The findings might have inferred in pain control of acute apical abscess associated pain in patients who used an antibiotic drug. External validity of the findings for acute apical abscess cases with no need for an antibiotic prescription is uncertain. CLINICAL RELEVANCE: This paper suggests acetaminophen 1000 mg can be used for pain control in the treatment of acute apical abscess associated with systemic manifestation.

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.

Final irrigation protocols may affect intraradicular dentin ultrastructure.

OBJECTIVES: The aim of this study was to evaluate the effect of different irrigation protocols on the root dentin structure using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). MATERIALS AND METHODS: Thirty-nine lower bovine incisors were hemisected longitudinally and randomly divided into 13 groups (n = 3). After the root halves were reassembled, it was applied a specific irrigation protocol for each group, as following: G1, distilled water (control); G2, 0.9% saline; G3, saline + 17% EDTA; G4, saline + PUI; G5, saline + PUI + EDTA; G6 to G9 received the same protocol as above replacing 0.9% saline by 2.5% NaOCl; and G10 to G13 by 2% CHX. One-half of each sample was prepared and evaluated using SEM and the other one by TEM observations. RESULTS: TEM descriptive analysis showed modifications in dentin organic ultrastructure, characterized by the thinning of dentin collagen fibrils, caused by NaOCl, enhanced by EDTA and/or PUI. SEM analysis showed that NaOCl with PUI caused significantly larger erosion of the peritubular dentin than in all the other groups (P < 0.05), followed by NaOCl + EDTA and NaOCl + EDTA + PUI. CONCLUSIONS: NaOCl caused ultrastructural alterations in the dentin collagen, and enhanced by EDTA and/or PUI, promoted peritubular and intertubular erosion. CLINICAL RELEVANCE: The effect of irrigating solutions on dentin ultrastructure was still unclear. The acknowledgment about the kind of solution, concentrations, application time, and sequence of use was important to achieve the right sanitization without jeopardizing the dentin ultrastructure quality.

The influence of different cements on the pull-out bond strength of fiber posts.

STATEMENT OF PROBLEM: Glass fiber posts are commonly used to provide adequate support and retention for the restoration of endodontically treated teeth, but their resistance to dislodgement depends on their adhesion to root dentin. PURPOSE: The purpose of this study was to assess the effect of cement type on the pull-out bond strength of fiber posts. MATERIAL AND METHODS: Seventy maxillary canines were endodontically treated and then divided into 7 groups according to the cement used for fiber post cementation as follows (n = 10): RelyX Unicem, BisCem, RelyX Luting 2, RelyX ARC, Panavia F, Enforce, and Allcem. The specimens were subjected to a pull-out bond strength test in a universal testing machine at a crosshead speed of 0.5 mm/min. The results, in newtons, were analyzed with 1-way ANOVA and the Tukey post hoc test (α = .05). RESULTS: RelyX Unicem (472.3 ± 8.9 N), BisCem (506.6 ± 9.2 N), RelyX ARC (498.0 ± 8.2 N), Panavia F (502.3 ± 7.0 N), and Allcem (470.0 ± 11.3 N) presented significantly higher bond strength than RelyX Luting 2 (241.8 ± 9.70 N) and Enforce (309.5 ± 6.3 N) cements (mean ± SD; P < .05). CONCLUSIONS: Except for Enforce, all resin cements produced pull-out bond strength values twice that of resin modified glass ionomer cement. However, all cements promoted adequate retention to fiber posts to withstand functional loads.

Effect of Obturation Techniques on the Quality of Root Canal Fillings: A Systematic Review and Meta-analysis of in Vitro Studies.

Introduction: The current study aimed to compare the quality of root canal obturation performed with cold lateral condensation with other obturation techniques. Materials and Methods: Diverse Search was conducted using six electronic/academic databases following PICOS (i.e. population, intervention, control, outcomes, and study design) strategy: (P) Extracted mature permanent teeth; (I) Obturation techniques except for cold lateral condensation; (C) Cold lateral condensation tyechnique; (O) Quality of root canal obturation; and (S) In vitro studies assessing parameters using micro-computed tomography. The statistical method used for the meta-analyses was the "inverse variance DerSimonian-Laird test". The heterogeneity data was calculated using the T2, Cochran Q test, and I2 statistics. Results: Fifteen studies were included for the final analysis; one had a low risk of bias, eight a moderate risk, and six a high risk of bias. Ten studies were selected for meta-analyses; three studies comparing cold lateral condensation with carrier-based gutta-percha techniques [P=0.96; mean difference (MD)=-0.02; confidence interval (CI): (-0.77, 0.73); I2=21%]; three comparing cold lateral condensation with single-cone techniques [P=0.75; MD=-0.39; CI: (-2.77, 1.99); I2=92%]; two comparing cold lateral condensation and thermo-plasticized injectable techniques [P=0.37; MD=5.91; CI: (-7.13,18.94); I2=99%]; and five comparing cold lateral condensation with warm vertical condensation techniques [P<0.0001; MD=5.29; CI=(2.84, 7.74); I2=92%]. The overall effect reported significant results [P=0.0003; MD=2.69; CI=(1.23, 4.16); I2=96%]; favoring fewer voids and gaps for the other used obturation techniques. Conclusions: Cold lateral condensation and single-cone techniques presented no statistical differences. Nonetheless, Warm vertical condensation technique had better results compared to cold lateral condensation.

Interfacial adaptation of NeoMTA Plus, BioRoot RCS and MTA in root-end cavities: A micro-CT study.

AIM: This study aimed to use the micro-computed tomography to evaluate the interfacial adaptation and the presence of gaps of NeoMTA Plus, BioRoot RCS, and MTA in the root-end cavities. METHODOLOGY: Thirty standardized bovine roots measuring 15 mm in length were selected. Chemical-mechanical preparation was performed up to instrument #80 and obturation with the cold lateral compaction technique with cement based on zinc oxide and eugenol. The roots were kept at 37°C for 7 days. Afterward, apicectomy of the apical 3 mm and a root-end filling cavity was performed at 3 mm depth. Micro-computed tomography (micro-CT) was performed to measure the volume of the retroactivity. The roots were divided by stratified randomization into three groups according to the retro-end filling material: NeoMTA Plus, BioRoot RCS, and MTA. A new micro-CT was performed to assess the presence of voids in the root-end filling material and between it and the canal wall. One-way ANOVA and Tukey tests were performed using the BioEstat 4.0 program. RESULTS: There was no difference in the initial volume values of the root-end cavities (p > .05). After the insertion of root-end filling materials, the most significant volumes of voids were observed in the NeoMTA Plus group (p < .05), with no difference for the BioRoot RCS and MTA Angelus groups (p > .05). CONCLUSION: Micro-computed tomography showed that MTA and BioRoot RCS have better interfacial adaptation and presented fewer number of gaps than NeoMTA Plus when used as root-end filling materials. RESEARCH HIGHLIGHTS: Micro-computed tomography evaluation of different root-end fillings materials.

Fracture resistance of weakened teeth restored using accessory glass fiber posts.

This study used differential root weakening to evaluate the fracture resistance of bovine teeth restored using glass fiber posts (with or without accessory glass fiber posts). Fifty bovine mandibular incisors were sectioned 14 mm from the apex, fixed in acrylic resin blocks, and divided into 5 groups: healthy roots with a glass fiber post (Group 1), partially weakened teeth with a glass fiber post (Group 2), partially weakened teeth with a glass fiber post and 2 accessory glass fiber posts (Group 3), extensively weakened teeth with a glass fiber post (Group 4), and extensively weakened teeth with a glass fiber post and 5 accessory glass fiber posts (Group 5). Posts were luted with resin cement, cores were prepared using composite resin, and metallic crowns were cemented. The specimens were stored in distilled water at 37°C for more than 72 hours until the fracture resistance test. Specimens were loaded at 135 degrees relative to the long axis of the tooth at a crosshead speed of 0.5 mm/minute in a universal testing machine. All groups predominantly exhibited favorable failure patterns and there were no statistically significant differences between groups (two-way ANOVA, α = 0.05).

Dentinal tubule penetration of sodium hypochlorite in root canals with and without mechanical preparation and different irrigant activation methods.

Objectives: This study evaluated the dentinal penetration depth of 2.5% sodium hypochlorite (NaOCl) in root canals with and without preparation and different irrigant activation protocols. Materials and Methods: Sixty-three bovine mandibular incisors were randomly allocated to 6 groups (n = 10): G1, preparation + conventional needle irrigation (CNI); G2, preparation + passive ultrasonic irrigation (PUI); G3, preparation + Odous Clean (OC); G4, no preparation + CNI; G5, no preparation + PUI; G6, no preparation + OC; and CG (negative control; n = 3). Samples were filled with crystal violet for 72 hours. Irrigant activation was performed. Samples were sectioned perpendicularly along the long axis, 3 mm and 7 mm from the apex. Images of the root thirds of each block were captured with a stereomicroscope and analyzed with an image analysis software. One-way analysis of variance, followed by the Tukey post hoc test, and the Student's t-test were used for data analysis, with a significance level of 5%. Results: The NaOCl penetration depth was similar when preparation was performed, regardless of the method of irrigation activation (p > 0.05). In the groups without preparation, G6 showed greater NaOCl penetration depth (p < 0.05). The groups without preparation had a greater NaOCl penetration depth than those with preparation (p = 0.0019). Conclusions: The NaOCl penetration depth was similar in groups with root canal preparation. Without root canal preparation, OC allowed deeper NaOCl penetration. The groups without preparation had greater NaOCl penetration than those undergoing root canal preparation.

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.

Cyclic and torsional fatigue resistance of a new rotary file on a rotary and reciprocating motion.

This study evaluated the cyclic and torsional fatigue resistance of a new nickel-titanium (Flat File 25.04) instrument on the continuous and reciprocating motion. Sixty instruments of the ProDesign Logic2 25.03 and 25.05 (Easy Equipamentos Odontológicos, Belo Horizonte, Brazil), and MK Flat File 25.04 (n = 20) (MK Life, Porto Alegre, Brazil) were used. For the cyclic fatigue test, an artificial stainless steel simulated canal with an angle of 60° and a radius of curvature of 5 mm located 5 mm from its tip was used. The torque and rotation angle at the instruments' failure on the torsional fatigue test was based on the ISO 3630-1 protocol, in which the 3 mm tip of each instrument was fixed and connected to an electric motor and a load cell. The fractured surface of each fragment was examined by scanning electron microscopy. Data were analyzed using a 1-way analysis of variance and Tukey's test with a significance level of 5%. Flat File 25.04 had lower cyclic fatigue in both kinematics than the Logic instruments (p < .05). Reciprocating motion improved the cyclic fatigue of the tested instruments (p < .05). Flat File 25.04 had similar torque to Logic2 25.05 (p > .05), and both were superior to Logic2 25.03 (p < .05). The angular deflection values were different for the three tested instruments (p < .05), in the decreasing order: Logic2 25.03, 25.05, and Flat File 25.04. Flat File presented good resistance to cyclic and torsional fatigue resistance. Reciprocating motion improved the cyclic fatigue resistance of the instruments and can be considered when using programmable motors. RESEARCH HIGHLIGHTS: Scanning electron microscopy evaluation of different endodontic rotary file and fatigue resistance tests.

Disinfectant effectiveness of chlorhexidine gel compared to sodium hypochlorite: a systematic review with meta-analysis.

This study aimed to compare the disinfectant ability of chlorhexidine (CHX) gel and sodium hypochlorite (NaOCl). Systematic searches were conducted from inception until December 8th, 2022 (MEDLINE/PubMed, Cochrane Library, Web of Science, Scopus, Embase, and Grey Literature databases). Only randomized clinical trials were included. The revised Cochrane risk of bias tools for randomized trials were used to assess the quality of studies. Meta-analyses were performed. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation tool. Six studies were included. Five had a low risk of bias and 1 had some concerns. Three studies assessed bacterial reduction. Two were included in the meta-analysis for bacterial reduction (mean difference, 75.03 [confidence interval, CI, -271.15, 421.22], p = 0.67; I2 = 74%); and 3 in the meta-analysis for cultivable bacteria after chemomechanical preparation (odds ratio, 1.03 [CI, 0.20, 5.31], P = 0.98; I2 = 49%). Five studies assessed endotoxin reduction. Three were included in a meta-analysis (mean difference, 20.59 [CI, -36.41, 77.59], p = 0.48; I2 = 74%). There seems to be no difference in the disinfectant ability of CHX gel and NaOCl, but further research is necessary.

Does photobiomodulation on the root surface decrease the occurrence of root resorption in reimplanted teeth? A systematic review of animal studies.

This review aimed to answer the following question "Does photobiomodulation treatment of the root surface decrease the occurrence of root resorption in reimplanted teeth?" Electronic searches were performed in the MEDLINE/PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Grey Literature Report databases. Risk of bias was evaluated using SYRCLE Risk of Bias tool. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool was used to assess the certainty of evidence. In total, 6 studies were included. Five studies reported a reduced occurrence of root resorption in teeth that received photobiomodulation treatment of the root surface prior to replantation. Only 1 study reported contradictory results. The photobiomodulation parameters varied widely among studies. GRADE assessment showed a low certainty of evidence. It can be inferred that photobiomodulation treatment of the root surface prior to replantation of teeth can reduce the occurrence of root resorption. Nonetheless, further clinical studies are needed. Trial Registration: PROSPERO Identifier: CRD42022349891.

Impact of Nonsurgical Treatment of Asymptomatic Apical Periodontitis on the Oral Health-related Quality of Life: A Prospective Study.

Introduction: The aim of this study was to evaluate the impact of nonsurgical root canal treatment (nRCT) and the healing of asymptomatic apical periodontitis (AAP) on the oral health-related quality of life (OHRQoL) in a Brazilian population. Materials and Methods: This prospective longitudinal observational study included 56 adults, in which 84 teeth with asymptomatic apical periodontitis underwent nonsurgical root canal treatment. Socio-demographic and medical data were collected; the primary outcome oral health-related quality of life was measured by the short form of the Oral Health Impact Profile (OHIP-14). Statistical analysis was carried out by Mann-Whitney U-test, and changes in the oral health-related quality of life scores post-treatment were estimated by Student t-test. Results: The mean age was 51.0±15.2 years, with 53.5% of females. Overall, nRCT significantly improved the OHRQoL (P<0.001, effect size=0.76). Gender (female) was associated with a higher OHRQoL after nRCT (P<0.05). OHIP-14 showed a significant reduction six months after root canal treatment compared to baseline scores. Conclusion: Present findings revealed that nonsurgical root canal treatment improved the oral health-related quality of life in patients with asymptomatic apical periodontitis.

Efficacy of reciprocating instruments and final irrigant activation protocols on retreatment of mesiobuccal roots of maxillary molars: a micro-CT analysis.

Objectives: This study evaluated the efficacy of 3 reciprocating systems and the effects of 2 instruments for irrigant activation on filling material removal. Materials and Methods: Forty mesiobuccal roots of maxillary molars were prepared up to size 25.06 and obturated. Micro-computed tomography (micro-CT) examination #1 was performed. Teeth were then divided into 4 groups (n = 10), according to the retreatment protocol: (1) manual, (2) Reciproc Blue, (3) WaveOne Gold, and (4) X1 Blue. Micro-CT examinations #2 and #3 were performed after filling removal and repreparation, respectively. Next, all teeth were divided into 2 new groups (n = 20) according to the irrigant activation protocol: XP Clean (XP Clean size 25.02) and Flatsonic (Flatsonic ultrasonic tip). Micro-CT examination #4 was performed after irrigant activation. Statistical analysis was performed with a significance level set at 5%. Results: WaveOne Gold removed a significantly greater amount of filling material than the manual group (p < 0.05). The time to reach the WL was similar for all reciprocating systems (p > 0.05). X1 Blue was faster than the manual group (p < 0.05). Only manual group improved the filling material removal after the repreparation stage (p < 0.05). Both activation protocols significantly improved the filling material removal (p < 0.05), without differences between them (p > 0.05). Conclusions: None of the tested instruments completely removed the filling material. X1 Blue size 25.06 reached the working length in the shortest time. XP Clean and Flatsonic improved the filling material removal.

Influence of the root canal filling technique on the success rate of primary endodontic treatments: a systematic review.

Objectives: This study aimed to investigate the influence of different obturation techniques compared to cold lateral compaction on the success rate of primary non-surgical endodontic treatments. Materials and Methods: Systematic searches were performed for studies published up to May 17th, 2022 in MEDLINE/PubMed, Cochrane Library, Web of Science, Scopus, EMBASE, and Grey Literature Reports. Randomized clinical trials and nonrandomized (nonrandomized clinical trials, prospective or retrospective) studies that evaluated the success rate of primary non-surgical endodontic treatments obturated with the cold lateral compaction (control) and other obturation techniques were included. The revised Cochrane risk of bias tools for randomized trials (RoB 2) and nonrandomized studies of interventions (ROBINS-I) were used to evaluate the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was used to evaluate the certainty of evidence. Results: Eleven studies (4 randomized clinical trials (RCTs), 4 prospective, and 3 retrospectives) were included. Two RCTs were classified as having some concerns risk of bias and 2 as a low risk of bias. Two nonrandomized studies were classified as having a critical risk of bias and 5 as having a moderate risk of bias. The GRADE analysis demonstrated a very low to moderate certainty of evidence. Conclusions: This systematic review generally evidenced no differences in the success rate of primary non-surgical endodontic treatments when the cold lateral compaction technique and other obturation techniques are performed. Further well-designed studies are still necessary.

Comparative study of Vertucci and Ahmed classifications to evaluate the main root canal configuration of mandibular incisors in a Brazilian population.

This study aimed to compare the main root canal configurations of mandibular incisors (MI) in a Brazilian population using Vertucci and Ahmed et al. classifications. One hundred and sixty-five human permanent MI were scanned using a micro-CT. Two examiners classified the samples according to Vertucci and Ahmed et al. classification. Kappa coefficient was employed. The majority of MI had a single root canal (52.1%). Type III Vertucci and 1 MI1-2-1 Ahmed et al. was the most common 2-canal MI (20%). In the apical third, the presence of one, two and three canals was found in 81.8%, 15.2% and 3% respectively. In the cervical and middle thirds, one, two and three canals were found in 86%, 12.2% and 1.8% respectively. Ahmed et al. classification was able to classify the entire sample studied, whereas 11 teeth (6.66%) did not fit Vertucci's classification.