What is new in the 2023 European Society of Endodontology S3-level clinical practice guidelines?

BACKGROUND: The European Society of Endodontology published in 2023, the S3-level clinical practice guidelines, which supersede the Quality Guidelines for Endodontic Treatment published in 2006. OBJECTIVES: This review aims to summarize and compare the above guidelines to support their dissemination. METHOD: A narrative synthesis of the main differences alongside tabulation according to the main themes. RESULTS: Three tables were prepared according to the following themes: diagnosis of pulpal and apical condition; treatment of pulpitis; and treatment of nonvital pulp and apical periodontitis. CONCLUSIONS: A compared and simplified message regarding the most recent clinical practice guidelines has been prepared. REGISTRATION: Not applicable as a narrative review.

Fifteen years of engine-driven nickel-titanium reciprocating instruments, what do we know so far? An umbrella review.

Numerous systematic reviews (SRs) have produced conflicting findings on engine-driven nickel-titanium reciprocating instruments (reciprocating instruments) since Yared's seminal study 15 years ago. This umbrella review analysed SRs examining the clinical and laboratory evidence regarding reciprocating instruments for root canal treatment. SRs that evaluated qualitatively and/or quantitatively the outcomes postoperative pain, oral health-related quality of life (OHRQoL), shaping ability, debris extrusion, microbial load, endotoxins reduction, cyclic fatigue, file fracture, dentinal cracks and root canal filling removal were included. The AMSTAR 2 tool was used to evaluate SRs quality, while the ROBIS tool to assess risk of bias (RoB). Forty SRs were included. The SRs revealed predominantly 'high' RoB and 'critically low' quality. Most focused on technical outcomes, exhibiting significant methodological and statistical heterogeneity. Findings suggest comparable efficacy between reciprocating and rotary instruments. However, due to the scarcity of high-quality evidence, future well-designed studies and reviews considering core outcome measures are needed.

Evaluation of Antimicrobial Properties, Cell Viability, and Metalloproteinase Activity of Bioceramic Endodontic Materials Used in Vital Pulp Therapy.

This study aimed to evaluate the antimicrobial properties, cell viability, and matrix metalloproteinase (MMP) inhibition capacity of several endodontic materials aimed at vital pulp therapy: Pro Root MTA®, EndoSequence®, Biodentine®, MTA Angelus®, TheraCal LC®, and BioC Repair®. The materials were prepared according to the manufacturer's instructions. Antimicrobial tests were conducted using a microcosm biofilm model, cell viability was assessed using murine fibroblasts (L929), and MMP activity was analyzed through electrophoresis. The results showed that BioC Repair®, Biodentine®, and EndoSequence® exhibited similar antimicrobial properties, while MTA Angelus® and ProRoot MTA® had inferior results but were comparable to each other. In terms of cell viability, no significant differences were observed among the materials. EndoSequence® demonstrated the highest MMP inhibition capacity. In conclusion, BioC Repair®, Biodentine®, EndoSequence®, and TheraCal® showed better antimicrobial properties among the tested materials. The materials did not exhibit significant differences in terms of cytotoxicity. However, EndoSequence® displayed superior MMP inhibition capacity.

Effect of an Intraorifice Barrier on Endodontically Treated Teeth: A Systematic Review and Meta-Analysis of In Vitro Studies.

The main cause of unsuccess in endodontically treated teeth (ETT) is due to bacterial recontamination. The placement of an intraorifice barrier (IOB) has been proposed for preventing this event in cases that the restoration is in an inadequate condition, enhancing the possibilities for predictable long-term success in endodontic therapy. Objectives. To evaluate through a systematic review and meta-analysis if it would be necessary to place an IOB in ETT. Materials and Methods. The present review is in accordance with the PRISMA 2020 Statement and is registered in the Open Science Framework. Two blinded reviewers carried out a comprehensive search in four databases up to July 10th, 2021: MEDLINE, Scopus, Embase, and Web of Science. Eligible studies were the ones which evaluated the use of an IOB in ETT in reducing microleakage with any material of choice and with any methods employed. Only in vitro studies published in English were included. Results. A total of thirty in vitro studies were included in the qualitative synthesis, and seven of those were included in the quantitative analyses evaluating the following materials: bioceramic cement, glass-ionomer cement (GIC), and resin-based composite (RBC). Most of the included studies placed an IOB at a 3 mm depth. Reduction in microleakage was observed when an IOB was placed, regardless of the material employed (p ≤ 0.01). Among the materials, GIC and RBC performed similarly (p > 0.05), with the bioceramic subgroup being statistically superior to the GIC subgroup (p ≤ 0.05). Conclusions. Although well-designed randomized clinical trials are required, the placement of an intraorifice barrier can significantly reduce microleakage in endodontically treated teeth, and the use of bioceramics as IOB seems to be the best available material for this purpose.

Bioactivity Potential of Bioceramic-Based Root Canal Sealers: A Scoping Review.

INTRODUCTION: Bioceramic-based root canal sealers are novel materials with a bioactivity potential that stands out compared with conventional root canal sealers. However, the term bioactivity may be overused and is often misunderstood. Hence, the objective of this study was to synthesize and map key concepts related to the bioactivity analysis of bioceramic-based root canal sealers. METHODS: The present scoping review is reported in accordance with the PRISMA-ScR Statement and is registered in the Open Science Framework. Two blinded reviewers carried out a comprehensive search in six databases up to January 10th, 2022: MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, and Lilacs/BBO. Eligibility was considered for in vitro and in vivo studies that evaluated the bioactivity potential of bioceramic-based root canal sealers. RESULTS: A total of 53 studies were included in the qualitative synthesis. In vitro bioactivity was evaluated through the mineralization potential, formation of carbonated apatite on the surface, and the gene expression related to proteins involved in the mineralization process. Meanwhile, for in vivo studies, staining techniques associated with immunohistochemical tests were mainly used to detect mineralization on the material-host tissue interface. CONCLUSIONS: According to the methodology used, the most prevalent methods to assess bioactivity in acellular form were the immersion of the material in Hank's balanced salt solution, followed by surface observation with scanning electron microscopy and energy dispersive X-ray. In cell cultures, the chosen method was usually Alizarin Red staining, followed by the evaluation of alkaline phosphatase enzymatic activity and the use of molecular biology tests.

Evaluation of physical and biological properties of conventional glass ionomer cements / Avaliação das propriedades físicas e biológicas de cimentos de ionômero de vidro convencionais

Objetivo: avaliar as propriedades físicas e biológicas dos cimentos de ionômero de vidro convencionais (CIVs). Metodologia: foram avaliados os seguintes CIVs: Fuji IX (GC Europe, Bélgica), Ketac Molar (3M ESPE, Estados Unidos), Maxxion R (FGM, Brasil) e Vitro Molar (Nova DFL, Brasil). O tempo de presa, a alteração dimensional, a radiopacidade, a sorção e a solubilidade em água foram avaliados para todos os materiais. A resistência à compressão foi analisada em intervalos de 1h, 24h, 7 dias e 28 dias; e liberação de íons fluoreto em 3h, 24h e 72h. A viabilidade celular foi avaliada após 24 e 48 horas com células de fibroblastos. A análise estatística foi realizada por meio do software SigmaPlot 12 (Systat Inc, San Jose, CA, EUA), com nível de significância estabelecido em α = 0,05. Resultado: apenas o Fuji IX teve um tempo de presa dentro da faixa recomendada pela Especificação Padrão da ADA 96 (2012), não superior a 6 minutos. Vitro Molar e Maxxion R apresentaram radiopacidade que não estava de acordo com a especificação ADA 96 (2012). Maxxion R e Vitro Molar mostraram uma alteração dimensional estatisticamente semelhante. Quanto às propriedades mecânicas, o Fuji IX foi o único CIV que apresentou aumento da resistência à compressão durante o período de avaliação de 28 dias. O Ketac Molar apresentou a maior viabilidade celular, enquanto o Maxxion R apresentou citotoxicidade severa e o maior valor cumulativo de liberação de flúor. Conclusão: Fuji IX e Ketac Molar apresentaram as propriedades físicas e biológicas mais adequadas entre os CIVs avaliados.(AU)

Objective: to evaluate the physical and biological properties of conventional glass ionomer cements (GICs). Methodology: the following GICs were evaluated: Fuji IX (GC Europe, Belgium), Ketac Molar (3M ESPE, United States), Maxxion R (FGM, Brazil) and Vitro Molar (Nova DFL, Brazil). Setting time, dimensional change, radiopacity, water solubility and water absorption were evaluated for all materials. Compressive strength was analyzed after intervals of 1h, 24h, 7 days and 28 days; and release of fluoride ions at 3 am, 24 am and 72 am. Cell viability was assessed after 24 and 48 hours with fibroblast cells. Statistical analysis was performed using SigmaPlot 12 software (Systat Inc, San Jose, CA, USA), with a significance level set at α = 0.05. Result: only the Fuji IX had an adjustment time within the range recommended by the Standard Specification of ADA 96 (2012) of not exceeding 6 minutes. Vitro Molar and Maxxion R had radiopacity that was not in accordance with the ADA 96 (2012) specification. Maxxion R and Vitro Molar showed a statistically similar dimensional change. As for mechanical properties, Fuji IX was the only GIC that showed an increase in compressive strength during the evaluation period of 28 days. Ketac Molar showed the highest cell viability, while Maxxion R showed severe cytotoxicity and the highest cumulative fluoride release value. Conclusion: Fuji IX and Ketac Molar showed the most appropriate physical and biological properties among the evaluated GICs.(AU)