Atypical healing of an endodontic lesion following emergency treatment: a case report.

This case report examines the atypical healing of an endodontic lesion without standard endodontic treatment, influenced by the patient's failure to attend treatment appointments. A 50-year-old woman with no notable medical history presented with a deep carious lesion on her mandibular right first molar, accompanied by localized pain. Citing forgetfulness as a reason, the patient missed her initially scheduled root canal treatment, necessitating an emergency intervention. The emergency treatment included access cavity preparation, irrigation with 5.25% sodium hypochlorite solution, application of a modified triple antibiotic paste (equal parts penicillin G, metronidazole, and ciprofloxacin), and temporary restoration with amalgam. A large apical lesion was detected in immediate postoperative radiographs. However, the patient failed to return for definitive endodontic treatment, due to a lack of symptoms and time for treatment. Follow-up examinations 1 and 5 years after emergency treatment disclosed gradual healing of the lesion, culminating in the establishment of a normal periodontal ligament. This case underscores the potential efficacy of a modified triple antibiotic paste and highlights the importance of a well-sealed coronal restoration in promoting the healing of endodontic lesions, even in the absence of pulpectomy and conventional root canal therapy. Additional research is needed to understand the mechanisms behind such healing events.

Evaluation of Postoperative Pain after Using Dexamethasone Intracanal Rinse in Irreversible Pulpitis.

OBJECTIVE: To evaluate the efficacy of dexamethasone as a final intracanal rinse in relieving postoperative pain of teeth with symptomatic irreversible pulpitis. STUDY DESIGN: Randomised controlled trial. Place and Duration of the Study: Department of Operative Dentistry, PIMS, Islamabad, Pakistan, from June 2019 to December 2020. METHODOLOGY: Sixty patients aged 18- 50 years diagnosed with symptomatic irreversible pulpitis were selected according to the inclusion criterion. After obtaining informed consent, root canal therapy (RCT) was initiated under rubber dam. Pulpectomy was done followed by canal preparation. The lottery method was utilised for the division of patients. Group A (experimental) received dexamethasone (4mg/ml in 5ml syringe) as a final rinse, while Group B (control group) recalled after 1 week and asked whether their pain had relieved or not as a yes/no question. After data collection teeth were obturated and permanent restoration was placed. Data were analysed using Chi-square test. RESULTS: The efficacy of dexamethasone as a final intracanal rinse was greater than saline 86.67% and 20.0%, respectively (p < 0.05) in relieving postoperative pain in teeth with symptomatic irreversible pulpitis. CONCLUSION: Dexamethasone was proved to be more efficacious than saline in alleviating postoperative pain when used as a final intracanal rinse after canal instrumentation. KEY WORDS: Irreversible pulpitis, Dexamethasone, Postoperative pain, Pulpectomy.

A novel surgical treatment approach for the vertical root fracture of posterior teeth: a case report with 24-month review.

BACKGROUND: Up to 25% of the tooth extraction after root canal treatment could be attributed to the vertical root fracture (VRF). The treatment choice for teeth with VRF would mostly be the extraction despite some repairing methods were also reported. The repairing treatment result of VRF would mostly depend on the fixation strength and the bioactivity of the repairing materials, especially for the posterior teeth with high masticating stresses. This case report designed a novel surgical treatment approach for the VRF of posterior teeth. METHODS: a maxillary premolar with buccal-palatal complete VRF was treated with a new dual-layered repairing approach using adhesive resin + iRoot BP Plus bioceramic cement to fill the modified fracture line with retention forms through the intentional replantation. RESULTS: At the 24-month review, the tooth showed desirable periodontal healing and normal function. CONCLUSIONS: This case report indicated that the dual-layered repairing approach might be effective for saving the posterior teeth with VRF. Nevertheless, further clinical trials are needed for its long-term result.

Survival of endodontically treated teeth in public dental service in Northern Finland: a practise-based register study.

OBJECTIVE: The aim of this study was to explore the factors associated with the survival of root canal treated teeth in a practise-based study setting in a 5-year period. MATERIAL AND METHODS: This retrospective study used data from the electronic patient registration system of the public dental services of the City of Oulu, Finland. The inclusion criteria for this study were patients aged ≥ 20 years who had root canal treatment (RCT) that was initiated in 2014. One RCT per patient was included in the study. A total of 713 patients met the inclusion criteria. The outcome variable for this study was the extraction of the RCT tooth during the 5-year period. Explanatory variables included age, diagnosis, tooth type (incisive, canine, premolar, molar), RCT technique (manual, motorized), time from RCT initiation to final restoration and type of final restoration (composite, glass ionomer, fixed dental prosthesis). To evaluate the association between the outcome variable and explanatory variables, Cox regression analyses were performed. RESULTS: The overall survival rate was 91%. The middle-aged (40-59-years-old) and the oldest (60 and older) patients had a two-fold risk of extraction compared to younger (20-40-years-old) patients. Similarly, a short length of time from RCT initiation to final restoration (0-14 days) resulted in a nearly three times higher risk of extraction compared to a longer period (≥ 90 days). CONCLUSIONS: The 5-year survival rate of RCTs seems high. Extractions were more common among patients over 40 years of age and if the RCT was completed shortly after its initiation.

Molar root canal treatment performed by undergraduate dental students; an observational study of procedural errors and student perception.

BACKGROUND: Molar root canal treatment (RCT) is challenging and requires training and specific skills. Rotary instrumentation (RI) reduces the time needed for instrumentation but may increase the risk of certain procedural errors. The aims of this study were to evaluate the quality of molar RCTs provided by undergraduate students, to compare the prevalence of procedural errors following manual and RI, and to assess the students' self-perceived confidence to perform molar RCT without supervision and their preference for either manual or RI. METHODS: Molar RCTs performed by the final year students were evaluated radiographically according to predefined criteria (Appendix 1). The procedural errors, treatment details, and the students' self-perceived confidence to perform molar RCT and their preference for either manual or RI were recorded. Descriptive statistics were performed, and the Chi-squared test was used to detect any statistically significant differences. RESULTS: 60.4% of RCTs were insufficient. RI resulted in more sufficient treatments compared with MI (49% vs. 30.3% respectively. X2: 7.39, p = 0.007), required fewer visits to complete (2.9 vs. 4.6 respectively. X2: 67.23, p < 0.001) and was the preferred technique by 93.1% of students. The most common procedural errors were underextension of the root canal obturation (48.4%), insufficient obturation (45.5%), and improper coronal seal (35.2%) without a significant difference between the two techniques. 26.4% of the participating students reported that they did not feel confident to perform molar RCT without supervision. CONCLUSION: The quality of molar RCT provided by UG students was generally insufficient. RI partially improved the technical quality of RCT compared with MI. UG students need further endodontic training and experience before they can safely and confidently practise molar RCT.

Postendodontic Pain Using Single File System with Different Irrigation Protocols in Single-visit Root Canal Treatment: A Randomized Control Trial.

AIM: To evaluate the intensity of postendodontic pain (PEP) using final irrigation with side-vented needle (SV), EndoActivator (EA), and Ultra X (UX) in single-visit endodontics (SVE) with F-One rotary files. MATERIALS AND METHODS: A total 150 patients indicated for endodontic treatment were selected. Single-visit endodontics treatment was performed under local anesthesia. For the final irrigation protocol, they were divided into three groups: group I (SV), group II (EA), and group III (UX). The severity of PEP was assessed using visual analogue scale (VAS) score after 6, 12, 24, and 48 hours. Analgesics taken by patients, for pain, were also recorded. Finally, the data were tabulated and statistically analyzed using SPSS 20.0 software at a level of significance being 0.05. RESULTS: Postendodontic pain was less in group III (UX) and group II (EA) compared with group I (SV) at 6 and 12 hours, which is statistically significant (p < 0.05). There was no statistically significant difference found after 24 hours and 48 hours. CONCLUSION: The intensity of PEP was minimum in patients treated with EndoActivator and ultrasonic along with single rotary file systems. The incidence of analgesic intake was similar in all three groups. How to cite this article: Kathiria NV, Attur K, Bagda KM, et al. Postendodontic Pain Using Single File System with Different Irrigation Protocols in Single-visit Root Canal Treatment: A Randomized Control Trial. J Contemp Dent Pract 2024;25(2):180-185.

The evaluation of effective rate and pain intensity of root canal treatment in primary teeth-a retrospective study.

Two-visit root canal treatment for children reduce the time of visits and the by-chair time in comparison with the three-visit root canal treatment. However, it is not clear whether two-visit root canal treatment increase the risk of complications. This study aimed to evaluate the clinical effects and post-operative pain intensity after the root canal treatment between two-visit and three-visit groups in primary molars from children.106 patients were screened for eligibility, of which 74 went back to the preservation visit. Therefore, 74 primary molars from 74 children that diagnosed with chronic pulp and periodontal tissue diseases in the clinics of pediatric dentistry were retrospectively analyzed, in which 37 in the two-visit group and 37 in the three-visit group. The total effective rate and postoperative pain intensity were assessed after treatment and all statistical data were carried out with SPSS software.The average age of children in the two-visit and three-visit groups was 6.4 and 7.0, respectively, with no significant difference (p = 0.056). The two-visit group consisted of 59.5% male and 40.5% female children, while the three-visit group consisted of 56.8% male children and 43.2% female children (p = 0.813). Two months after treatment, the total effective rate in the three-visit group was 97.30%, a little higher than that in the two-visit group (94.59%), but with no significant difference (p = 0.201). Besides, there was also no significant difference in pain intensity between the two-visit and three-visit groups (p = 0.692). Therefore, there were no significant difference of total effective rate and pain intensity in root canal treatment between the two-visit and three-visit groups in primary molars from children.

Predictors of apical periodontitis in root canal treated teeth from an adult Nepalese subpopulation: a cross-sectional study.

BACKGROUND: Endodontic literature search revealed that no study has been conducted to evaluate the prevalence of apical periodontitis (AP) in root canal treated teeth from an adult Nepalese population of Madhesh Province. Consequently, little is known about the extent and risk factors associated with it. This study aimed to determine AP prevalence in root canal treated teeth from an adult Nepalese subpopulation and to analyze the related risk factors including age, sex, tooth type, type of coronal restoration and quality of root canal treatment and coronal restoration as predictors of AP. METHODS: Digital panoramic radiographs were evaluated. Periapical status of 300 root canal-treated teeth was scored by using the periapical index. The quality of root canal treatment and coronal restorations were categorized as adequate or inadequate through radiographic and clinical evaluation. The data were analyzed using univariate and multivariate logistic regression models. RESULTS: Prevalence of AP in the present study was 31.7%. In 45.7% of the treated teeth, quality of root canal treatment was adequate whereas 46% of the cases had adequate coronal restorations. Multivariate logistic regression analysis revealed statistically significant associations and remarkably increased risk for AP in teeth with inadequate root canal treatment (odds ratio [OR] = 7.92; 95% CI: 3.96-15.82; p < 0.001) whereas lower risk for AP was found in females (OR = 0.51; 95% CI: 0.28-0.90; p = 0.021) and in teeth restored with crown (OR = 0.22; 95% CI: 0.09-0.51; p < 0.001) and filling (OR = 0.18; 95% CI: 0.08-0.42; p < 0.001). Quality of coronal restoration, tooth type and age of the patient were not found to be the predictors of AP. CONCLUSIONS: Within the limits of this study, a high prevalence of AP and poor overall quality of root canal treatment and coronal restoration was found in the subpopulation studied. Quality of root canal treatment, type of coronal restoration and sex of the patient are significant predictors of possible AP development in root canal treated teeth. Substantial efforts are needed to improve the endodontic treatment standards.

Influence of the severity of periodontal disease on the outcome of non-surgical endodontic therapy: A prospective cohort study.

OBJECTIVE: To investigate the influence of severity of periodontal disease on periapical healing after non-surgical endodontic therapy (NSET). MATERIAL AND METHODS: In this prospective study, subjects (n = 45) requiring NSET in a mandibular molar tooth with the diagnosis of pulp necrosis and asymptomatic apical periodontitis exhibiting radiographic periapical index (PAI) score ≥ 3 and concomitant endodontic periodontal lesion (CEPL) without communication were enrolled. After dividing as per the classification of Periodontal and Peri-Implant Diseases and Conditions, subjects were equally allocated into three groups. Group I- only endodontic lesion {control: healthy periodontium (n = 15)}, Group II- CEPL having stage I and II periodontitis (n = 15) and Group III- CEPL having stage III periodontitis (n = 15). Standardized two-visit NSET was performed with 2% chlorhexidine gel as an intracanal medicament. Periodontal therapy was instituted wherever required. Subjects were recalled at 6-and 12-months for clinical and radiographic assessment. Chi-square test was performed to evaluate the difference between the groups. RESULTS: At 12-month follow-up, all teeth in the three study groups were asymptomatic. On radiographic evaluation of the periapical region, healing was observed in 80%, 47% and 50% of teeth in Groups I, Group II and Group III, respectively. However, the difference was not statistically significant between the groups (p = 0.150). CONCLUSION: The severity of periodontal disease had no influence on periapical healing after NSET in teeth with concomitant endodontic periodontal lesions without communication. CLINICAL RELEVANCE: Periodontal disease has significant impact on apical periodontitis however severity of the periodontitis does not negatively impact the apical periodontitis.

A system for automatic classification of endodontic treatment quality in CBCT.

OBJECTIVES: An evaluation of the effectiveness of a new computational system proposed for automatic classification, developed based on a Siamese network combined with Convolutional Neural Networks (CNNs), is presented. It aims to identify endodontic technical errors using Cone Beam Computed Tomography (CBCT). The study also aims to compare the performance of the automatic classification system with that of dentists. METHODS: One thousand endodontically treated maxillary molars sagittal and coronal reconstructions were evaluated for the quality of the endodontic treatment and the presence of periapical hypodensities by three board-certified dentists and by an oral and maxillofacial radiologist. The proposed classification system was based on a Siamese network combined with EfficientNet B1 or EfficientNet B7 networks. Accuracy, sensivity, precision, specificity, and F1-score values were calculated for automated artificial systems and dentists. Chi-square tests were performed. RESULTS: The performances were obtained for EfficienteNet B1, EfficientNet B7 and dentists. Regarding accuracy, sensivity and specificity, the best results were obtained with EfficientNet B1. Concerning precision and F1-score, the best results were obtained with EfficientNet B7. The presence of periapical hypodensity lesions was associated with endodontic technical errors. In contrast, the absence of endodontic technical errors was associated with the absence of hypodensity. CONCLUSIONS: Quality evaluation of the endodontic treatment performed by dentists and by Siamese Network combined with EfficientNet B7 or EfficientNet B1 networks was comparable with a slight superiority for the Siamese Network. CLINICAL RELEVANCE: CNNs have the potential to be used as a support and standardization tool in assessing endodontic treatment quality in clinical practice.

Opinions of UK General Dental Practitioners on the Restoration of Posterior Root Filled Teeth: a Vignette Survey.

OBJECTIVE: To investigate factors which influence UK general dental practitioners (GDPs) when restoring posterior root filled teeth. METHOD: An electronic survey was designed to explore current strategies of treatment of posterior root filled teeth by UK-based GDPs working in primary care. Three vignette cases included in the questionnaire explored a variety of tooth, patient, and financial factors. The survey was distributed by email and social media platforms between December 2018 and February 2019. RESULTS: A total of 528 valid responses were collected. The majority of participants (84.1%) regularly restored posterior root filled teeth with an indirect restoration. Presence of persistent symptoms post root canal treatment (RCT) completion would impact the management of 85% of the surveyed respondents. Referral to a specialist, deferral of provision of the definitive restoration, and fear of litigation were reported by the GDPs as influencing factors. CONCLUSION: This survey highlights that decision making regarding restoration of root filled teeth is a multifactorial process. Tooth, patient, and financial factors were all shown to influence the restorative management of the posterior root filled teeth.

Correlation between pulp sensibility and magnetic resonance signal intensity following regenerative endodontic procedures in mature necrotic teeth- a retrospective cohort study.

BACKGROUND: With increasing studies being published on regenerative endodontic procedures (REPs) as a treatment modality for mature necrotic teeth, the assessment of outcomes following regenerative endodontic procedures has become more challenging and the demand for a better understanding of the regenerated tissues following this treatment is rising. The study aimed to correlate cold, electric pulp testing (EPT), and magnetic resonance imaging (MRI) signal intensity (SI) in mature necrotic teeth treated with regenerative endodontic procedures. METHODOLOGY: This retrospective cohort study included eighteen adult patients who experienced tooth necrosis in mature maxillary anterior teeth recruited from the outpatient clinic, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt from July 2017 until December 2018 with 12 months of follow-up. regenerative endodontic procedures via blood clot were performed. The canals were instrumented by ProTaper Next (PTN) files until final sizes X3 or X5. Biodentine was used as cervical plug material. Pre and post-operative clinical follow-up was done where the patients' responses to cold and electric pulp testing were given a scoring system and were compared to the normal contralateral tooth. Pre and post-operative magnetic resonance imaging signal intensity of both the involved tooth and its contralateral at the middle and the apical thirds of the root canals were assessed after 3, 6, and 12 months. Data was analyzed using the ANOVA, Friedman and Bonferroni tests. Significance was set at a p-value < 0.05. RESULTS: All 18 teeth scored a baseline score of "2" for cold and electric pulp testing. There was a significant difference between scores of the cold test at baseline and 12-month follow-up (p < 0.001). There was a significant difference between scores of the electric pulp testing of baseline and 12-month follow-up (p < 0.001). There was a moderately significant indirect (inverse) correlation between magnetic resonance imaging signal intensity and cold test in both the middle and apical thirds at 12 months. No significant correlations were detected between magnetic resonance imaging signal intensity and electric pulp testingat any of the time intervals (p > 0.05). CONCLUSION: Magnetic resonance imaging is a successful non-invasive method to assess outcomes of regenerative endodontic procedures and correlating it with another reliable method of assessing pulpal responses, cold test, could validate these outcomes. CLINICAL TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov (ID: NCT03804450).

Removal of fiber posts using conventional versus guided endodontics: a comparative study of dentin loss and complications.

OBJECTIVES: To compare the efficacy of fiber post removal using conventional (CONV) versus guided endodontics (GE) in terms of dentin loss, residual resin material, procedural errors, and working time in vitro. MATERIAL AND METHODS: Ninety human central incisors were root-filled and scanned by micro-computed tomography (CT), then restored with fiber posts and composite. Twenty-four sets of teeth with up to four human maxillary central incisors were fabricated and divided into three groups: conventional post removal by a general dentist (CG) or endodontology specialist (CS) and guided endodontics (GE) by a general dentist, yielding 30 teeth per operator and group. After treatment, the prepared access cavities were volumetrically assessed by micro-CT. Statistical significance was evaluated by one-way analysis of variance followed by post hoc comparisons with Tukey's HSD test and Pearson's chi-squared test for independence. RESULTS: Both CONV and GE resulted in dentin loss and residual resin material. CS resulted in more dentin loss and less residual resin material than CG and GE (p < .05). All groups had some deviations from the original root canal but no perforations. The shortest working time was observed in the GE group. CONCLUSIONS: Compared to the conventional freehand technique, GE resulted in significantly less radicular dentin loss, a few deviations but no perforations. CLINICAL RELEVANCE: Guided endodontics can improve the speed and safety of fiber post removal without root perforation.

Efficacy of pulpotomy in managing irreversible pulpitis in mature permanent teeth: A systematic review and meta-analysis.

OBJECTIVES: This paper evaluated the success rates of pulpotomy, compared its efficacy with non-surgical root canal treatment (NSRCT), evaluated different pulpotomy techniques, and analyzed the effectiveness of contemporary bioactive materials in managing irreversible pulpitis in mature permanent teeth. DATA SOURCES: A comprehensive literature search was conducted across multiple databases including PubMed, Web of Science, Scopus, and the Cochrane Library. Search was conducted from the inception of each database to the present, adhering to PRISMA 2020 guidelines. STUDY SELECTION: Studies were selected through a multi-step screening process, focusing on adult populations, randomized controlled trials, and single-arm trials. DATA: Fifteen randomized controlled trials and eight single-arm trials were included. For a follow-up period of more than 24 months, pooled clinical success rate of pulpotomy was 92.9 % (95 %CI;82.1-99.0 %), whereas pooled radiographic success rate was 78.5 % (95 %CI;66.7-88.4 %). Meta-analyses showed that there was no significant difference in success rates between pulpotomy and NSRCT, between full and partial pulpotomy techniques, or between Mineral Trioxide Aggregate pulpotomy and Calcium Enriched Mixture pulpotomy. The results indicated comparable efficacy across these variables. CONCLUSIONS: The study highlights the potential of less invasive treatments. Pulpotomy may be a viable alternative to NSRCT for managing irreversible pulpitis in mature permanent teeth. Limitations such as the low quality of some single-arm trials and the high risk of bias in some randomized controlled trials highlight the need for further research to standardize methodologies and broaden literature inclusion for a more comprehensive understanding of the efficacy of pulpotomy, considering the high success rates reported. Clinical Significance This quantitative systematic review recognizes the potential of full or partial pulpotomy as a viable treatment alternative to root canal therapy for managing irreversible pulpitis in mature permanent teeth. Future studies should aim for standardized protocols to validate these findings and improve patient treatment outcomes.

The influence of laser-activated irrigation on post-operative pain following root canal treatment: A systematic review.

OBJECTIVES: Synthesise evidence on post-endodontic pain (PEP) in adult teeth undergoing primary root canal treatment with the adjunctive use of laser-activated irrigation (LAI) as compared with conventional needle irrigation (CNI) during the first post-operative week. DATA: An electronic search was performed; no language constraints or restriction on the year of publication were applied. SOURCES: Medline, Scopus, Cochrane and PubMed on 04 June 2023 STUDY SELECTION: Randomised clinical trials (RaCTs) that evaluated PEP after LAI of endodontic irrgants were included. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. PEP was analysed at various time intervals until 1 week after treatment, related to the type of LAI used and the need for analgesia. REULTS: Of the 793 articles identified through the electronic database search, 6 RaCTs were included. Qualitative review was favoured over meta-analysis due to substantial methodological heterogeneity between studies. Five studies were at high risk for bias determined by the Cochrane Risk-of-Bias 2 tool. Diode LAI demonstrated superior efficacy to needle irrigation in reducing pain 6-48 h post-treatment. The impact of LAI by photon-induced photoacoustic streaming (PIPS) was unclear and no difference was observed between PIPS and needle irrigation. However, PIPS mitigated PEP better than manual dynamic activation, sonic and ultrasonic activation. There was no difference in analgesia intake between LAI and needle irrigation groups. CONCLUSIONS: LAI may help reduce PEP in the first 48 h. Methodological standardisation of future RaCTs on LAI would be beneficial in allowing a more accurate review with the possibility of quantitative synthesis. CLINICAL SIGNIFICANCE: This unique synthesis used stringent criteria to reduce confounding factors and provided valuable evidence regarding PEP with different types of LAI. It helps clinicians choose an appropriate LAI technique as compared with CNI and predicts a time frame for reducing PEP.

Outcome of nonsurgical management of large cyst-like periapical lesions using a modified apical negative pressure irrigation system: a case series study.

OBJECTIVE: To assess the effectiveness of a self-constructed modified apical negative pressure irrigation (ANPI) system employing commonly used clinical instruments in nonsurgical root canal therapy (NSRCT) for large cyst-like periapical lesions (LCPLs). METHODS: From 2017 to 2022, 35 patients diagnosed with LCPLs (5-15 mm) via preoperative clinical and radiographic evaluations of endodontic origin underwent NSRCT combined with ANPI. These patients were subjected to postoperative clinical and radiographic follow-up at 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years, with a CBCT scan specifically conducted at 6-month follow-up. Through the reconstruction of three-dimensional cone beam computed tomography (CBCT) data, an early prognosis was facilitated by monitoring changes in lesion volume. Various treatment predictors-including sex, type of treatment, lesion size, preoperative pain, jaw, type of teeth involved, sealer extrusion, and the number of root canals-were meticulously analyzed. The evaluation of post-treatment outcomes leveraged both clinical observations and radiographic data collected during the follow-up periods. The Kruskal‒Wallis test and one-way ANOVA were also conducted to determine the independent factors influencing treatment outcomes. A significance level of 5% was established. RESULTS: Thirty-five teeth from 35 patients with a median age of 28 years (range 24-34) were treated; the median follow-up duration was 19 months (range 12-26). The overall success rate was 91.4%, with a median lesion reduction of 77.0% (range 54.2-96.4%) at 6 months. Patients under 30 years of age exhibited a significantly greater success rate than older patients did (100.0% vs. 80.0%, p = 0.037). Other factors, such as sex, jaw, treatment type, preoperative pain, cyst size, tooth location, sealer extrusion, and the number of roots, did not significantly impact treatment outcomes. CONCLUSIONS: Despite limitations related to the observational case-series study design and relatively small sample size, our findings suggest that utilizing the ANPI in the NSRCT for LCPLs may hold promise. The notably higher success rate in patients younger than 30 years is worth noting.

Removal Efficiency and Effectiveness of Four Different Fiber Posts Using Five Different Drill Systems in Multirooted Teeth.

AIM: In comparing the effectiveness and efficiency of different types of post removal systems in removing different types of fiber posts (FPs), this study aims to shed light on the success of removal by currently available drill systems. MATERIALS AND METHODS: A total of 200 maxillary first molars, were root canal treated and prepared to receive posts. The molars were divided into four groups corresponding to four different FPs: Group RX, Radix FP; Group RF, Reforpost Glass Fiber; Group HI; Hi-Rem Endodontic Post; and Group DT, D.T. Light-Post Illusion X-RO. Fiber posts were done with luting by Gradia Core (GC America, Inc.). Groups were again divided into five subgroups corresponding to the technique by which the FP was removed into as follows: Subgroup P, PD-25-1.1 Drill; subgroup G, GC FP Drill; subgroup E, EasyPost Precision Drill; subgroup R, Reaccess Carbide Double Taper Kit; and subgroup H; H-Endodontic Drill. After posts were removed, effectiveness and efficiency were documented. Data were tabulated and statistically analyzed. RESULTS: Strong significant differences regarding efficiency among groups (FP type) and subgroups (drills used) (p = 0.00) were shown by the one-way analysis of variance (ANOVA) test. Subgroup DT-G scored the longest mean removal time (20.9 minutes) while Subgroup RX-R scored the shortest mean removal time (1.4 minutes) Regarding effectiveness, strong significant differences among groups (p = 0.00) and subgroups (p = 0.00) were shown by one-way ANOVA. Subgroup RF-G scored the highest scale (5.2) whereas subgroup HI-R scored the lowest mean scale (1.2). CONCLUSION: The difference was strongly significant between tested post-removal kits and between tested FPs. Re-access Carbide Double Taper Kit performed superiorly in both effectiveness and efficiency, followed by PD-25-1.1 Drill. Hi-Rem post showed the best retrieving results among other FPs. CLINICAL SIGNIFICANCE: Knowing the best technique and tools for post removal could spare the practitioner any unwanted complications during post removal. How to cite this article: Sayed M, Alahmad AM, Alhajji KS, et al. Removal Efficiency and Effectiveness of Four Different Fiber Posts Using Five Different Drill Systems in Multirooted Teeth. J Contemp Dent Pract 2024;25(1):72-78.

Does the use of different scaffolds have an impact on the therapeutic efficacy of regenerative endodontic procedures? A systematic evaluation and meta-analysis.

BACKGROUND: In the regenerative endodontic procedures, scaffolds could influence the prognosis of affected teeth. Currently, there is controversy regarding the postoperative evaluation of various scaffolds for pulp regeneration. The objective of this study was to access whether other scaffolds, used alone or in combination with blood clot (BC), are more effective than BC in regenerative endodontic procedures. METHODS: We systematically search the PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Google Scholar databases. Randomized controlled trials examining the use of BC and other scaffold materials in the regenerative endodontic procedures were included. A random effects model was used for the meta-analysis. The GRADE method was used to determine the quality of the evidence. RESULTS: We screened 168 RCTs related to young permanent tooth pulp necrosis through electronic and manual retrieval. A total of 28 RCTs were related to regenerative endodontic procedures. Ultimately, 12 articles met the inclusion criteria and were included in the relevant meta-analysis. Only 2 studies were assessed to have a low risk of bias. High quality evidence indicated that there was no statistically significant difference in the success rate between the two groups (RR=0.99, 95% CI=0.96 to 1.03; 434 participants, 12 studies); low-quality evidence indicated that there was no statistically significant difference in the increase in root length or root canal wall thickness between the two groups. Medium quality evidence indicated that there was no statistically significant difference in pulp vitality testing between the two groups. CONCLUSIONS: For clinical regenerative endodontic procedures, the most commonly used scaffolds include BC, PRP, and PRF. All the different scaffolds had fairly high clinical success rates, and the difference was not significant. For regenerative endodontic procedures involving young permanent teeth with pulp necrosis, clinical practitioners could choose a reasonable scaffold considering the conditions of the equipment and patients.

Characterization of cells in blood evoked from periapical tissues in immature teeth with pulp necrosis and their potential for autologous cell therapy in Regenerative Endodontics.

OBJECTIVE: The objectives of this study were to isolate, characterize progenitor cells from blood in the root canals of necrotic immature permanent teeth evoked from periapical tissues and evaluate the applicable potential of these isolated cells in Regenerative Endodontics. DESIGN: Ten necrotic immature permanent teeth from seven patients were included. Evoked bleeding from periapical tissues was induced after chemical instrumentation of the root canals. Cells were isolated from the canal blood and evaluated for cell surface marker expression, multilineage differentiation potential, proliferation ability, and target protein expression. Cell sheets formed from these cells were transferred into human root segments, and then transplanted into nude mice. Histological examination was performed after eight weeks. Data analysis was conducted using one-way ANOVA followed by Tukey's post-hoc comparison, considering p < 0.05 as statistically significant. RESULTS: The isolated cells exhibited characteristics typical of fibroblastic cells with colony-forming efficiency, and displayed Ki67 positivity and robust proliferation. Flow cytometry data demonstrated that at passage 3, these cells were positive for CD73, CD90, CD105, CD146, and negative for CD34 and CD45. Vimentin expression indicated a mesenchymal origin. Under differentiation media specific differentiation media, the cells demonstrated osteogenic, adipogenic, and chondrogenic differentiation potential. Subcutaneous root canals with cell sheets of isolated cells in nude mice showed the formation of pulp-like tissues. CONCLUSIONS: This study confirmed the presence of progenitor cells in root canals following evoked bleeding from periapical tissues of necrotic immature teeth. Isolated cells exhibited similar immunophenotype and regenerative potential with dental mesenchymal stromal cells in regenerative endodontic therapy.

Expert consensus on difficulty assessment of endodontic therapy.

Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy (RCT). Recent research, encompassing bacterial etiology and advanced imaging techniques, contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT. Success in RCT hinges on factors like patients, infection severity, root canal anatomy, and treatment techniques. Therefore, improving disease management is a key issue to combat endodontic diseases and cure periapical lesions. The clinical difficulty assessment system of RCT is established based on patient conditions, tooth conditions, root canal configuration, and root canal needing retreatment, and emphasizes pre-treatment risk assessment for optimal outcomes. The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT. These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.