ABSTRACT
Microorganisms are the primary aetiological factor of apical periodontitis. The goal of endodontic treatment is to prevent and eliminate the infection by removing the microorganisms. However, microbial biofilms and the complex root canal anatomy impair the disinfection process. Effective and precise endodontic therapy could potentially be achieved using advanced multifunctional technologies that have the ability to access hard-to-reach surfaces and perform simultaneous biofilm killing, removal, and detection of microorganisms. Advances in microrobotics are providing novel therapeutic and diagnostic opportunities with high precision and efficacy to address current biofilm-related challenges in biomedicine. Concurrently, multifunctional magnetic microrobots have been developed to overcome the disinfection challenges of current approaches to disrupt, kill, and retrieve biofilms with the goal of enhancing the efficacy and precision of endodontic therapy. This article reviews the recent advances of microrobotics in healthcare and particularly advances to overcome disinfection challenges in endodontics, and provides perspectives for future research in the field.
Subject(s)
Biofilms , Disinfection , Humans , Disinfection/methods , Robotics , Endodontics/methods , Endodontics/instrumentation , Periapical Periodontitis/therapy , Periapical Periodontitis/microbiology , Root Canal Therapy/methods , Root Canal Therapy/instrumentation , Dental Pulp Cavity/microbiologyABSTRACT
INTRODUCTION: This study aimed to systematically search and review all available literature regarding systemic (oral or locally injected) corticosteroids in endodontics to assess their effect on postoperative pain. METHODS: A search was conducted using PubMed, Cochrane Library, Embase, Scopus, Dentistry & Oral Science, and ProQuest. Randomized controlled trials enrolling participants undergoing endodontic treatment and assessing the presence of pain and pain scores at 6, 12, and 24 hours postoperatively were included. We synthesize the effect measures using risk ratios (RRs), standardized mean differences (SMDs), and their corresponding 95% confidence intervals (CIs). Meta-analysis was performed using the random-effects inverse variance method. The level of significance was set at P < .05. The certainty of the evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS: A total of 2303 participants from 29 trials were included. Patients who received corticosteroids were significantly less likely to report pain at 6 hours (RR = 2.5; 95% CI, 1.74-3.61; P < .00001), 12 hours (RR = 2.10; 95% CI, 1.53-2.90; P < .00001), and 24 hours (RR = 1.77; 95% CI, 1.38-2.28; P < .00001) postoperatively. Furthermore, they reported lower pain intensity at 6 hours (SMD = - 0.82; 95% CI, -1.17 to -0.48; P < .00001), 12 hours (SMD = - 0.63; 95% CI, -0.75 to -0.51; P < .00001), and 24 hours (SMD = - 0.68; 95% CI, -0.90 to -0.46; P < .00001) postoperatively. CONCLUSIONS: Moderate certainty evidence indicates that the use of systemic corticosteroids likely results in a moderate to large reduction in postoperative endodontic pain.
Subject(s)
Adrenal Cortex Hormones , Pain, Postoperative , Humans , Pain, Postoperative/drug therapy , Adrenal Cortex Hormones/therapeutic use , Adrenal Cortex Hormones/administration & dosage , Endodontics , Randomized Controlled Trials as Topic , Root Canal Therapy/methods , Pain MeasurementABSTRACT
INTRODUCTION: Chronic inflammation in irreversible pulpitis leads to heightened sensitivity of nociceptive receptors, resulting in persistent hyperalgesia. This poses significant challenges in achieving effective anesthesia for patients with irreversible pulpitis. Various anesthetic techniques and pharmacological approaches have been employed to enhance the success of local anesthesia. Recently, the preemptive use of anti-inflammatory agents, specifically corticosteroids, has gained attention and shown promising results in randomized controlled trials. This systemic review and meta-analysis aimed to evaluate the impact of systemically administered corticosteroids on enhancing anesthetic success in patients undergoing endodontic treatment. METHODS: A comprehensive search was conducted across multiple databases including PubMed, Cochrane Library, Embase, Scopus, Dentistry & Oral Science, and ProQuest. Additionally, the references of primary studies and related systematic reviews were manually searched for additional relevant publications. The primary outcome assessed was the success of anesthesia, and the effect measure was risk ratio using the random-effects inverse variance method. Statistical significance was set at P < .05. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: Twelve studies involving 917 participants were analyzed to determine the frequency of successful anesthesia. The corticosteroid group demonstrated a significantly higher number of patients achieving successful anesthesia (risk ratio = 1.66; 95% confidence interval, 1.34-2.06;P < .00001). However, heterogeneity within the pooled data analysis was observed (I2 = 57%, P = .007). CONCLUSIONS: Moderate certainty evidence indicates that preemptive use of systemic corticosteroids enhances the success of local anesthesia, specifically inferior alveolar nerve block, in cases of irreversible pulpitis.
Subject(s)
Adrenal Cortex Hormones , Anesthesia, Dental , Anesthesia, Local , Pulpitis , Humans , Adrenal Cortex Hormones/therapeutic use , Adrenal Cortex Hormones/administration & dosage , Anesthesia, Local/methods , Anesthesia, Dental/methods , Root Canal Therapy/methods , Anesthetics, Local/administration & dosage , Endodontics/methodsABSTRACT
An enhanced understanding of neurotransmitter systems contributing to pain transmission aids in drug development, while the identification of biological variables like age and sex helps in the development of personalized pain management and effective clinical trial design. This study identified enhanced expression of purinergic signaling components specifically in painful inflammation, with levels increased more in women as compared to men. Inflammatory dental pain is common and potentially debilitating; as inflammation of the dental pulp can occur with or without pain, it provides a powerful model to examine distinct pain pathways in humans. In control tissues, P2X3 and P2X2 receptors colocalized with PGP9.5-positive nerves. Expression of the ecto-nucleotidase NTPDase1 (CD39) increased with exposure to extracellular adenosine triphosphate (ATP), implying CD39 acted as a marker for sustained elevation of extracellular ATP. Both immunohistochemistry and immunoblots showed P2X2, P2X3, and CD39 increased in symptomatic pulpitis, suggesting receptors and the ATP agonist were elevated in patients with increased pain. The increased expression of P2X3 and CD39 was more frequently observed in women than men. In summary, this study identifies CD39 as a marker for chronic elevation of extracellular ATP in fixed human tissue. It supports a role for increased purinergic signaling in humans with inflammatory dental pain and suggests the contribution of purines shows sexual dimorphism. This highlights the potential for P2X antagonists to treat pain in humans and stresses the need to consider sex in clinical trials that target pain and purinergic pathways. PERSPECTIVE: This article demonstrates an elevation of ATP-marker CD39 and of ATP receptors P2X2 and P2X3 with inflammatory pain and suggests the rise is greater in women. This highlights the potential for P2X antagonists to treat pain and stresses the consideration of sexual dimorphism in studies of purines and pain.
Subject(s)
Dental Pulp , Pain , Male , Humans , Female , Dental Pulp/metabolism , Inflammation/metabolism , Adenosine Triphosphate/metabolism , PurinesABSTRACT
AIM: To evaluate two- and three-dimensionally the effect of resorbable collagen-based bone-filling material on periapical healing of endodontic lesions with four-wall defects following endodontic microsurgery (EMS). METHODOLOGY: This parallel, randomized controlled superiority clinical trial involved 86 lesions with the strictly endodontic origin and four-wall defect morphology. EMS procedures were performed by calibrated postgraduate residents. Before flap closure, osteotomies were randomized to the control or treatment group. In the control group, the flap was repositioned with no material added. In the treatment group, a collagen-based bone-filling augmentation material was placed into the osteotomy. Clinical and radiographic examinations were completed after 12 months. Periapical healing was evaluated by blinded evaluators using periapical (PA) radiographs according to Molven's criteria and cone beam computed tomography (CBCT) scans according to PENN's 3D criteria. Cortical plate healing was scored according to the RAC/B index. The data were analysed using Fisher's exact test, Logistic regression models and Chi-squared test. The significance level was predetermined at p < .05. RESULTS: Sixty-six cases were evaluated at the 12-month follow-up, with 30 and 36 cases in the control and treatment groups, respectively. Only the asymptomatic cases (control = 26, treatment = 32) were included in the radiographic evaluation. Twenty-three cases (88.5%) in the control and 28 (87.5%) cases in the treatment group demonstrated complete healing on PA radiographs (p = 1.000). On CBCT, 10 (38.4%) and 21 (65.6%) cases had completely healed in the control and treatment groups, respectively (p = .095). The re-establishment of the buccal cortical plate was detected in 12 (46.2%) and 22 (68.8%) cases in the control and treatment groups, respectively (p = .243). CONCLUSION: Within the limitations of the present study, the use of collagen-based bone-filling material had no statistically significant effect on the periapical healing of endodontic lesions with four-wall defect following EMS at the 12-month follow-up when evaluated by PA radiographs or CBCT scans. However, the observed higher percentage of a re-established cortical plate in the treatment group could suggest a clinical benefit that is of interest after surgical endodontic treatment.
Subject(s)
Microsurgery , Wound Healing , Humans , Microsurgery/methods , Collagen/therapeutic use , Cone-Beam Computed Tomography/methods , Dental MaterialsABSTRACT
Backgroud/purpose: The prevalence of carious lesions and traumatic injury in individuals between ages 6 and 12 is high. This study aimed to characterize pediatric patients aged 6-12 treated in the endodontic clinic and investigate the prevalence and patterns of their provided endodontic treatments. Materials and methods: Clinical and radiographic records of patients (ages 6-12) referred to the postgraduate Endodontics clinic from June 2017 to June 2020 were reviewed. Demographics, pre-and post-operative conditions, type of endodontic treatment, and behavioral management were collected. Results: A total of 6350 teeth from 6089 patients were treated in this period, and 425 teeth (6.7%) from 405 patients were included. Ages 9-11 were the most commonly treated age group. Significantly more lower molars (41.9%) and upper anterior teeth (36.7%) were treated (P < 0.05). The majority of teeth were diagnosed with pulp necrosis (39.5%), and the most common periapical diagnosis was normal apical tissues (39.8%), then symptomatic apical periodontitis (38.8%). The most common etiological factor was caries (63.5%). Two hundred six teeth (48.5%) were treated with root canal therapy, 161 teeth (37.9%) with vital pulp therapy, 46 teeth (10.8%) with apexification or regenerative endodontic procedure, 12 teeth (2.8%) with non-surgical retreatment. A statistically high number of patients (87.8%) tolerated the endodontic procedures without any sedation (P < 0.0001). Conclusion: Pediatric patients aged 6-12 compose around 7% of the population treated at the postgraduate Endodontics clinic, reflecting the high demand for endodontic treatment in a pediatric mixed dentition population.
ABSTRACT
INTRODUCTION: Currently, there are no studies evaluating the impact of 3-dimensional (3D) printed models on endodontic surgical treatment planning. The aims of this study were: 1) to determine if 3D models could influence treatment planning; and 2) to assess the effect of 3D supported planning on operator confidence. MATERIALS: Endodontic practitioners (n = 25) were asked to analyze a preselected cone beam computed tomography (CBCT) scan of an endodontic surgical case and answer a questionnaire that elucidated their surgical approach. After 30 days, the same participants were asked to analyze the same CBCT scan. Additionally, participants were asked to study and to perform a mock osteotomy on a 3D printed model. The participants responded to the same questionnaire along with a new set of questions. Responses were statistically analyzed using chi square test followed by either logistic or ordered regression analysis. Adjustment for multiple comparison analysis was done using a Bonferroni correction. Statistical significance was set at ≤0.005. RESULTS: The availability of both the 3D printed model and the CBCT scan resulted in statistically significant differences in the participants' responses to their ability to detect bone landmarks, predict the location of osteotomy, and to determine the following: size of osteotomy, angle of instrumentation, involvement of critical structures in flap reflection and involvement of vital structures during curettage. In addition, the participants' confidence in performing surgery was found to be significantly higher. CONCLUSIONS: The availability of 3D printed models did not alter the participants' surgical approach but it significantly improved their confidence for endodontic microsurgery.
Subject(s)
Dental Care , Osteotomy , Humans , Osteotomy/methods , Cone-Beam Computed Tomography , Microsurgery/methods , Printing, Three-DimensionalABSTRACT
This study compared the accumulated hard-tissue debris (AHTD) after preparation with WaveOne Gold (WOG) to XP-endo Shaper (XPS), without and with a supplementary step using XP-endo Finisher (XPF) using clinically applicable irrigation. Twenty-four mesial roots with two canals and single foramen were micro-CT-scanned and matched. Scans were also taken after preparation with WOG or XPS, and after XPF. Irrigation with 2.5% NaOCl (total: 17 ml per canal) and 17% EDTA (2.5 ml per canal) was performed using a 30ga Max-I-Probe needle placed up to the working length. Morphological parameters were calculated and compared within and among groups. XPF significantly reduced unprepared area within XPS and WOG groups, and AHTD within WOG (p < 0.05). There were no significant differences between WOG and XPS after preparation and after XPF (p > 0.05). In conclusion, WOG and XPS produced a similar volume of AHTD, but the supplementary step with XPF decreased the AHTD in the WOG group.
Subject(s)
Dental Pulp Cavity , Root Canal Preparation , Dental Pulp Cavity/diagnostic imaging , Dental Pulp Cavity/anatomy & histology , Molar , X-Ray Microtomography , Tooth Root/diagnostic imagingABSTRACT
BACKGROUND: The authors' aim was to describe 2 endodontically treated mandibular first premolars with apical and mesiolingual radiolucencies on radiographs with different approaches that were resolved with intentional replantation. CASE DESCRIPTION: In case 1, a 58-year-old man reported biting sensitivity on endodontically treated mandibular first premolar with good quality restorations. A periapical radiograph (PAX) and cone-beam computed tomography (CBCT) image revealed 2 low-density areas located at the apical and mesiolingual aspects of the root. A radicular groove accessory canal was noted on the mesial root surface during intentional replantation. The patient has been asymptomatic. At a 3-year follow-up, complete healing was observed on PAX and CBCT images. In case 2, a 40-year-old woman reported pinching pain of her mandibular right quadrant that returned a few months after initial root canal treatment. Radiographs revealed periapical radiolucency at the apexes of the mandibular first premolar with a missed lingual canal. Nonsurgical retreatment was performed in 2 visits with calcium hydroxide dressing. Two months later, endodontic microsurgery was performed owing to ongoing symptoms. In addition, CBCT images showed extensive bone loss on the mesiolingual aspect of the root. Intentional replantation was performed 2 weeks later because she had intolerable pain. A radicular groove accessory canal was observed on the mesial root surface during the procedure. The patient reported substantial relief of pain. The radiolucencies healed by the 25-month follow-up as observed on PAX and CBCT images. PRACTICAL IMPLICATIONS: Intentional replantation is recommended in mandibular first premolars with a mesiolingual lesion that cannot be accessed easily with endodontic microsurgery and after conservative retreatment has been performed.
Subject(s)
Root Canal Therapy , Tooth Replantation , Adult , Bicuspid/surgery , Cone-Beam Computed Tomography/methods , Dental Pulp Cavity , Female , Humans , Male , Middle Aged , Pain , Root Canal Therapy/methods , Tooth RootABSTRACT
OBJECTIVE: To compare the shaping ability of the XP-endo Shaper (XPS) system to the ProTaper Next (PTN) system in oval-shaped distal root canals. METHODS: From 12 mandibular molars, distal roots with moderately curved single oval canals were randomly assorted to be instrumented with XPS (experimental group) or PTN (control group) and then scanned using micro-computed tomography [Scan 1]. The root canals of the XPS samples were prepared following the manufacturer's instructions using 15 insertions (XPS15) and rescanned [Scan 2]. An additional 10 insertions to the working length were applied, totalling 25 insertions (XPS25), and the roots were rescanned again [Scan 3]. PTN samples were prepared up to the X3 instrument (PTNX3) and rescanned [Scan 2]. The dentine removed and the unprepared areas were assessed. Data were analysed using a t-test with significance at α=0.05. RESULTS: XPS25 was associated with a significantly greater dentine removal than XPS15 over the entire root canal length and in all three-thirds of the root canal (P<0.05). XPS25 significantly removed more dentine than PTNX3 in only the coronal third (P<0.05). XPS25 was also associated with a significantly smaller percentage of unprepared areas than XPS15 overall and in the coronal third (P<0.05). PTNX3 was associated with a significantly larger percentage of unprepared areas than XPS15 and XPS25 overall and in the coronal and middle thirds (P<0.05). CONCLUSION: Ten additional movements with XPS significantly improved instrumentation capacity, reducing the percentage of untouched surface areas but also removing more dentine.
Subject(s)
Dental Pulp Cavity , Root Canal Preparation , Dental Pulp Cavity/diagnostic imaging , Dental Pulp Cavity/surgery , Molar/diagnostic imaging , Root Canal Therapy , X-Ray MicrotomographyABSTRACT
OBJECTIVE: This study aimed to evaluate unsuccessful endodontic surgery cases for possible causes for treatment failure and evaluate if a nonsurgical retreatment (NSRTX) approach could have been a better alternative to resurgery. METHODS: Analyses of clinical and cone-beam computed tomography (CBCT) images, periapical radiographs, and chart documentation determined study parameters. Preoperative factors were age, sex, tooth type, signs and/or symptoms, presence of periapical radiolucency, previous root canal treatment, timeline since previous endodontic surgery, presence of posts, cores, and restorations. The intra-operative factors were microsurgical classification, previous techniques, and current techniques utilized. Postoperative factors were signs and/or symptoms, time to follow-up, and healing status. The accessibility of the root canal system and the quality of the existing root filling were used to evaluate NSRTX as an alternative to resurgery. RESULTS: A total of 1073 surgical cases from 2011-2019 were reviewed. In 14 patients, 20 cases matched the inclusion criteria and allowed for data extraction. The mean time since the previous surgery was 2.9+-2.1 years, with a mean follow-up of 9.1+-5.8 months after the resurgery. Possible reasons for failure identified were: insufficient root-end filling (leaking, off-axis preparation, lack of depth, overfill) n=12/20, 60.0%; missed anatomy (main and lateral canals, isthmus) n=9/20, 45.0%; incomplete resection n=6/20, 30.0%. In 18/20 cases (90.0%), resurgery appeared to be indicated for 2/20 cases (10.0%). Therefore, NSRTX may have been a potential alternative. CONCLUSION: Further evidence for possible causes of failure of endodontic surgery was provided, which were primarily iatrogenic. The evaluation of CBCT and high magnification intra-operative images proved beneficial for identifying critical issues for all investigated cases.
Subject(s)
Dental Pulp Cavity , Root Canal Therapy , Cone-Beam Computed Tomography/methods , Humans , Retrospective Studies , Root Canal Obturation , Root Canal Therapy/methodsABSTRACT
AIM: To compare the shaping ability of a heat-treated centric reciprocating file system (WaveOne Gold), a heat-treated eccentric rotary multifile system (TRUShape 3D Conforming Files), and a heat-treated expandable one-file rotary system (XP-endo Shaper) extending its activation time, in preparing oval-shaped root canals in extracted mandibular molars by means of microcomputed tomography (micro-CT) analysis. METHODOLOGY: Thirty moderately curved oval-shaped distal roots of mandibular molars were selected. The normality of canal length, curvature angle, volume, surface area, structure model index, and aspect ratio were confirmed. The samples were randomly divided into three groups (n = 10). Micro-CT scans were taken before and after canals were instrumented using WaveOne Gold (size 35, .06 taper), or TRUShape (size 30, .06v taper), both following the manufacturer's instructions, or XP-endo Shaper following a new protocol with extended activation time. The mechanical preparation time for each sample was recorded. Pre- and postoperative images were analysed for the percentage of unprepared canal areas and the percentage of removed dentine. Data were compared between groups using the statistical analyses one-way ANOVA and Tukey tests (p < .05). RESULTS: The percentage of unprepared canal areas was significantly higher with WaveOne Gold (% 11.5 ± 4.0) and TRUShape (% 12.4 ± 5.8) compared with XP-endo Shaper (% 5.2 ± 2.6) (p < .05). XP-endo Shaper removed significantly more dentine (3.3 ± 1.5 mm3 ) than WaveOne Gold (1.8 ± 0.8 mm3 ) and TRUShape (1.9 ± 0.8 mm3 ) (p < .05). No significant differences were seen for mechanical preparation time between WaveOne Gold (79 ± 31 s), TRUShape (104 ± 41 s) and XP-endo Shaper (71 ± 23 s) (p > .05). CONCLUSIONS: The comparison of three recognized root canal filing systems has shown that with similar preparation times, the XP-endo Shaper removed more dentine (mm3 ) leaving less unprepared canal wall area (%) than WaveOne Gold and TRUShape when preparing oval-shaped root canals of extracted mandibular molars.
Subject(s)
Dental Pulp Cavity , Root Canal Preparation , Dental Pulp Cavity/diagnostic imaging , Gold , Molar/diagnostic imaging , Molar/surgery , X-Ray MicrotomographyABSTRACT
BACKGROUND/PURPOSE: Sodium hypochlorite (NaOCl) is a highly alkaline solution which exhibits antimicrobial properties. However, it causes corrosion to endodontic rotary files. This study investigated the effect of NaOCl on the metal surface of five different unused endodontic rotary files in vitro. MATERIALS AND METHODS: Two non-heat-treated nickel-titanium (NiTi) files, ProTaper, BioRace, and three heat-treated NiTi files, VortexBlue, TRUShape, and EdgeFile X7 files, were immersed in 4% NaOCl for 5, 10, and 20â¯min, and 1, 6 and 24â¯h. The corrosion susceptibility was evaluated by visual inspection and scanning electron microscopy (SEM). RESULTS: In the TRUShape group, the black particulate matter was mostly formed at the file's curvature and shaft. A large amount of precipitate accumulated in the EdgeFile group. The extent and prevalence of surface defects were found to be consistently higher in EdgeFile X7 instruments than in any other instruments. EdgeFile X7 and TRUShape files exhibited a greater corrosive tendency to NaOCl than BioRace, ProTaper, and VortexBlue not only under visual inspection, but also under SEM analysis after prolonged immersion (1, 6, 24â¯h) in 4% NaOCl. However, shorter immersion periods (5, 10, 20â¯min) showed little surface corrosion across all experimental groups. CONCLUSION: Within the limitations of this study, EdgeFile X7 and TRUShape files exhibit greater corrosive tendencies to NaOCl in vitro than BioRace, ProTaper, and VortexBlue files after prolonged immersion in 4% NaOCl. However, shorter immersion periods, which more closely approximate clinical conditions during single root canal therapy, may not show surface corrosion across all experimental groups.
ABSTRACT
We have characterized a recently rediscovered chemosensory structure at the rear of the mandibular mucosa in the mouse oral cavity originally reported in the 1980s. This consists of unorganized taste buds, not contained within troughs, associated with the ducts of an underlying minor salivary gland. Using whole-mount preparations of transgenic mice expressing green fluorescent protein under the promoter of taste-signaling-specific genes, we determined that the structure contains taste bud clusters and salivary gland orifices at the rear of each mandible, distal to the last molar and anterior to the ascending ramus. Immunohistochemical analysis shows in the retromolar taste buds expression of the taste receptors Tas2R131 and T1R3 and taste cascade molecules TrpM5, PLCß2, and GNAT3, consistent with type II taste cells, and expression of GAD1, consistent with type III taste cells. Furthermore, the neuronal marker, calcitonin gene-related peptide, in retromolar mucosa tissue wrapping around TrpM5+ taste buds was observed. RT-PCR showed that retromolar taste buds express all 3 mouse tas1r genes, 28 of the 35 tas2r genes, and taste transduction signaling genes gnat3, plcb2, and trpm5, making the retromolar taste buds similar to other lingual and palate taste buds. Finally, histochemistry demonstrated that the mandibular retromolar secretory gland is a minor salivary gland of mucous type. The mandibular retromolar taste structure may thus play a role in taste sensation and represent a potential novel pharmacological target for taste disorders.
Subject(s)
Mandible/metabolism , Mucus/metabolism , Salivary Glands/metabolism , Taste Buds/metabolism , Animals , Mice , Mice, Inbred C57BLABSTRACT
OBJECTIVE: This prospective clinical study compares postoperative pain after single-visit, non-surgical root canal treatment of teeth with irreversible pulpitis using two different root canal filling techniques. MATERIAL AND METHODS: All cases were treated by endodontic residents with a standardized protocol (minimum apical size 35) and filled with one of the two techniques: warm vertical compaction technique (WVT) with gutta percha and epoxy resin-based sealer (AH Plus Jet Root Canal Sealer, Dentsply Maillefer, York, PA, USA) or sealer-based filling technique (SBT) with single cone gutta percha and calcium silicate-based sealer (EndoSequence BC Sealer, Brasseler, Savannah, GA, USA). Surveys were given to participating patients to record pain intensity on a numeric rating scale (NRS, 0-10) at 4, 24, and 48 h postoperatively. Statistical significance was set at 0.05 level. RESULTS: One hundred ninety-four surveys were distributed over eighteen months. Ninety-two patients returned the survey (41 WVT and 51 SBT), of which 38% were asymptomatic irreversible pulpitis cases. The NRS values reduced over time for both techniques. No statistical difference was found between the two groups at the three time points assessed (p > 0.05). Postoperative pain was related to age, gender, presence of preoperative pain, and sealer extrusion (p < 0.05), however not related to preoperative periapical symptoms (percussion/palpation), dental arch, root type, and experience of the provider (p > 0.05). CONCLUSIONS: The intensity of postoperative pain for the two obturation techniques was equivalent at evaluated time points. CLINICAL RELEVANCE: The obturation technique does not influence postoperative pain. After endodontic treatment of symptomatic irreversible pulpitis teeth, the pain subsides in 48 h regardless of the technique. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT04462731.
Subject(s)
Dental Pulp Cavity , Root Canal Filling Materials , Calcium Compounds , Epoxy Resins/therapeutic use , Gutta-Percha , Humans , Incidence , Pain, Postoperative/prevention & control , Prospective Studies , Root Canal Filling Materials/therapeutic use , Root Canal Obturation , Root Canal Preparation , Silicates/therapeutic useABSTRACT
BACKGROUND: Optimum Glide Path (OGP) is a new reciprocating motion aiming to perform efficient glide path preparation in constricted canals. The aim of this study was to investigate and compare manual and OGP movement in terms of canal transportation and centering ability in glide path preparation of constricted canals. METHODS: Thirty constricted mesial root canals of mandibular molars, with initial apical size no larger than ISO#8, were selected and negotiated with #6-#8 K-files under the microscope. Canals were randomly divided into two experimental groups: Group 1 (MAN, n = 15): Glide path was established by using #10-#15 stainless steel K-files manually; Group 2 (OGP, n = 15): #10-#15 Mechanical Glide Path super-files were used with OGP motion (OGP 90°, 300 rpm). Each instrument was used to prepare only 2 canals (as in one mesial root). Canals were scanned before and after glide path preparation with micro-computed tomography (micro-CT) to evaluate root canal transportation and centering ratio at 1, 3 and 5 mm levels from the root apex. File distortions and separations were recorded. Paired t-test was used to statistically evaluate the data (P < .05). RESULTS: Group 2 showed a significantly lower transportation value than group 1 at 1-mm and 3-mm levels (P < .05), however the difference at 5-mm level was not significant. There was no significant difference regarding the centering ratio between the groups. Six #10 K-files were severely distorted in group 1, while no file separation or distortion was found in group 2. CONCLUSIONS: OGP motion performed significantly less canal transportation (apical 3 mm) and file distortion during glide path establishment in constricted canals comparing to manual motion, while the centering ability between the two was similar. CLINICAL RELEVANCE: OGP reciprocating motion provides a safer and efficient clinical approach compared to traditional manual motion in glide path establishment with small files in constricted canals.
Subject(s)
Dental Pulp Cavity , Root Canal Preparation , Dental Pulp Cavity/diagnostic imaging , Equipment Design , Humans , Molar/diagnostic imaging , Molar/surgery , Tooth Root , X-Ray MicrotomographyABSTRACT
INTRODUCTION: New tricalcium silicate cements have been shown to induce less coronal discoloration. The purpose of this in vitro study was to evaluate the degree of color change induced by various silicate materials in the presence and absence of blood. METHODS: One hundred human extracted anterior single-canal teeth were sectioned to standardized root lengths, accessed, and instrumented. Eight random experimental groups and 2 control groups were created wherein specimens were filled with experimental materials below the buccal cementoenamel junction as follows: EndoSequence RRM putty (Brasseler USA, Savannah, GA), EndoSequence RRM fast set putty (Brasseler USA), Biodentine (Septodont, Saint-Maur-des-Fossés, France), and white mineral trioxide aggregate (Dentsply Sirona, York, PA) either with the presence or absence of blood. Blood-only and saline-only samples were used for the positive and negative controls. After incubation in 100% humidity at 37°C, color changes were evaluated with a spectrophotometer (Ocean Optics, Dunedin, FL) on days 0, 30, 60, and 180 after material placement. Data were transformed into Commission International de I'Eclairage's L∗a∗b color values, and corresponding ΔE values were calculated. The 1-way analysis of variance test was performed for statistical analysis. RESULTS: Discoloration was observed in all specimens in the presence of blood. There was no statistical significance when comparing different materials in contact with blood. Intragroup observation at various time points, Biodentine, and EndoSequence RRM fast set putty showed significant difference between the presence and absence of blood at 180 days (P < .05). CONCLUSIONS: Contamination with blood of tricalcium silicate materials has the potential to cause coronal tooth discoloration.
Subject(s)
Root Canal Filling Materials , Tooth Discoloration , Tooth , Aluminum Compounds , Calcium Compounds/adverse effects , Drug Combinations , France , Humans , Oxides , Root Canal Filling Materials/adverse effects , Silicates/adverse effects , Tooth Discoloration/chemically inducedABSTRACT
OBJECTIVES: This paper is aimed at addressing the urgent need to develop a protocol that will address the operatory and clinical aspects of dental care during the Coronavirus disease 2019 (COVID-19) outbreak. DATA SOURCES: The epidemiology, clinical signs and symptoms, and modes of transmission of COVID-19 are presented. This protocol was established as an international collaboration of three dental universities: Hadassah School of Dental Medicine, Israel; University of Rochester Medical Center, USA; and the University of Pennsylvania, USA. This protocol is based on a detailed review of the existing English language literature as well on the logistic and clinical experience of each facility and the opinion of the authors. The protocol is designed for a hospital setting and includes considerations related to dental treatment in both healthy subjects and those suspected or diagnosed with COVID-19. The first part of this review discusses operatory considerations; the second part discusses general dental clinical aspects; the third part discusses endodontic considerations; and the fourth part discusses surgical aspects. This protocol may be applicable to other future similar pandemics. CONCLUSION: Logistic and clinical steps are required to provide dental care during the COVID-19 outbreak while preventing cross-contamination and protecting the dental team during the provision of care.
Subject(s)
Coronavirus Infections , Coronavirus , Dental Care/trends , Endodontics/trends , Infectious Disease Transmission, Patient-to-Professional , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Disease Outbreaks , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Israel , Pandemics , Pneumonia, Viral , SARS-CoV-2ABSTRACT
The purpose of this study was to evaluate the incidence and microscopic anatomy of the isthmus to provide more precise anatomical information about the mesiobuccal (MB) roots of the maxillary first molars and the mesial (M) roots of the mandibular first molars. Twenty-eight maxillary and 31 mandibular first molars were embedded, sectioned, stained, and observed at 30× magnification to evaluate the incidence and microscopic anatomy of the isthmus. The incidence of an isthmus 3 mm from the apex was 89.3% and 100% in the MB roots of the maxillary first molars and in the M roots of the mandibular first molars, respectively. The mean dentin thickness between the isthmus and the distal root surface was <1 mm at a distance of 3 mm from the apex in both types of roots. In this study, whenever two main canals were located in the MB roots of the maxillary first molars and in the M roots of the mandibular first molars, the likelihood of the presence of an isthmus increased. Therefore, clinicians should be aware of the thinnest dimensions in the distal surface of the MB roots of the maxillary first molars and the M roots of the mandibular first molars during nonsurgical and surgical root canal treatment.