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Volume 48 (4); November 2023
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Review Articles
Does minimally invasive canal preparation provide higher fracture resistance of endodontically treated teeth? A systematic review of in vitro studies
Sıla Nur Usta, Emmanuel João Nogueira Leal Silva, Seda Falakaloğlu, Mustafa Gündoğar
Restor Dent Endod 2023;48(4):e34.   Published online October 17, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e34
AbstractAbstract PDFPubReaderePub

This systematic review aimed to investigate whether minimally invasive root canal preparation ensures higher fracture resistance compared to conventional root canal preparation in endodontically treated teeth (ETT). A comprehensive search strategy was conducted on the “PubMed, Web of Science, and Scopus” databases, alongside reference and hand searches, with language restrictions applied. Two independent reviews selected pertinent laboratory studies that explored the effect of minimally invasive root canal preparation on fracture resistance, in comparison to larger preparation counterparts. The quality of the studies was assessed, and the risk of bias was categorized as low, moderate, or high. The electronic search yielded a total of 1,767 articles. After applying eligibility criteria, 8 studies were included. Given the low methodological quality of these studies and the large variability of fracture resistance values, the impact of reduced apical size and/or taper on the fracture resistance of the ETT can be considered uncertain. This systematic review could not reveal sufficient evidence regarding the effect of minimally invasive preparation on increasing fracture resistance of ETT, primarily due to the inherent limitations of the studies and the moderate risk of bias.

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Disinfectant effectiveness of chlorhexidine gel compared to sodium hypochlorite: a systematic review with meta-analysis
Theodoro Weissheimer, Karem Paula Pinto, Emmanuel João Nogueira Leal da Silva, Lina Naomi Hashizume, Ricardo Abreu da Rosa, Marcus Vinicius Reis Só
Restor Dent Endod 2023;48(4):e37.   Published online October 26, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e37
AbstractAbstract PDFSupplementary MaterialPubReaderePub

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.

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Research Articles
Evaluation of at-home bleaching protocol with application on different surfaces: bleaching efficacy and hydrogen peroxide permeability
Heloisa Forville, Michael Willian Favoreto, Michel Wendlinger, Roberta Micheten Dias, Christiane Philippini Ferreira Borges, Alessandra Reis, Alessandro D. Loguercio
Restor Dent Endod 2023;48(4):e33.   Published online October 6, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e33
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the bleaching efficacy and hydrogen peroxide permeability in the pulp chamber by the at-home bleaching gel in protocols applied on different dental surfaces.

Materials and Methods

Forty premolars were randomly into 4 groups: control group no bleaching, only application on the buccal surface (OB), only application on the lingual surface (OL) and application in buccal and lingual surfaces, simultaneously (BL). At-home bleaching gel (White Class 7.5%) was used for the procedure. The bleaching efficacy was evaluated with a digital spectrophotometer (color change in CIELAB [ΔE ab] and CIEDE 2000 [ΔE 00] systems and Whitening Index for Dentistry [ΔWID]). The hydrogen peroxide permeability in the pulp chamber (µg/mL) was assessed using UV-Vis spectrophotometry and data were analyzed for a 1-way analysis of variance and Tukey’s test (α = 0.05).

Results

All groups submitted to bleaching procedure showed bleaching efficacy when measured with ΔE ab and ΔE 00 (p > 0.05). Therefore, when analyzed by ΔWID, a higher bleaching efficacy were observed for the application on the groups OB and BL (p = 0.00003). Similar hydrogen peroxide permeability was found in the pulp chambers of the teeth undergoing different protocols (p > 0.05).

Conclusions

The application of bleaching gel exclusively on the OB is sufficient to achieve bleaching efficacy, when compared to BL. Although the OL protocol demonstrated lower bleaching efficacy based on the ΔWID values, it may still be of interest and relevant in certain clinical scenarios based on individual needs, requiring clinical trials to better understand its specificities.

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Effect of dentin roughening and type of composite material on the restoration of non-carious cervical lesions: an in vivo study with 18 months of follow-up
Sanjana Verma, Rakesh Singla, Gurdeep Singh Gill, Namita Jain
Restor Dent Endod 2023;48(4):e35.   Published online October 17, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e35
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to evaluate the impact of dentin roughening and the type of composite resin used (either bulk-fill flowable or nanohybrid) on the restoration of non-carious cervical lesions (NCCLs) with an 18-month follow-up period.

Materials and Methods

This prospective split-mouth study included 36 patients, each with a minimum of 4 NCCLs. For each patient, 4 types of restorations were performed: unroughened dentin with nanohybrid composite, unroughened dentin with bulk-fill flowable composite, roughened dentin with nanohybrid composite, and roughened dentin with bulk-fill flowable composite. A universal bonding agent (Tetric N Bond Universal) was applied in self-etch mode for all groups. The restorations were subsequently evaluated at 6, 12, and 18 months in accordance with the criteria set by the FDI World Dental Federation. Inferential statistics were computed using the Friedman test, with the level of statistical significance established at 0.05.

Results

The 4 groups exhibited no significant differences in relation to fracture and retention, marginal staining, marginal adaptation, postoperative hypersensitivity, or the recurrence of caries at any follow-up point.

Conclusions

Within the limitations of the present study, over an 18-month follow-up period, no significant difference was present in the clinical performance of bulk-fill flowable and nanohybrid composite restorations of non-carious cervical lesions. This held true regardless of whether dentin roughening was performed.

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Micro-CT evaluation of the removal of root fillings using rotary and reciprocating systems supplemented by XP-Endo Finisher, the Self-Adjusting File, or Er,Cr:YSGG laser
Gülsen Kiraz, Bulem Üreyen Kaya, Mert Ocak, Muhammet Bora Uzuner, Hakan Hamdi Çelik
Restor Dent Endod 2023;48(4):e36.   Published online October 23, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e36
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to compare the effectiveness of a single-file reciprocating system (WaveOne Gold, WOG) and a multi-file rotary system (ProTaper Universal Retreatment, PTUR) in removing canal filling from severely curved canals and to evaluate the possible adjunctive effects of XP-Endo Finisher (XPF), the Self-Adjusting File (SAF), and an erbium, chromium: yttrium, scandium, gallium garnet (Er,Cr:YSGG) laser using micro-computed tomography (μCT).

Materials and Methods

Sixty-six curved mandibular molars were divided into 2 groups based on the retreatment technique and then into 3 based on the supplementary method. The residual filling volumes and root canals were evaluated with μCT before and after retreatment, and after the supplementary steps. The data were statistically analyzed with the t-test, Mann-Whitney U test, analysis of covariance, and factorial analysis of variance (p < 0.05).

Results

PTUR and WOG showed no significant difference in removing filling materials (p > 0.05). The supplementary techniques were significantly more effective than reciprocating or rotary systems only (p < 0.01). The supplementary steps showed no significant differences in canal filling removal effectiveness (p > 0.05), but XPF showed less dentin reduction than the SAF and Er,Cr:YSGG laser (p < 0.01).

Conclusions

The supplementary methods significantly decreased the volume of residual filling materials. XPF caused minimal changes in root canal volume and might be preferred for retreatment in curved root canals. Supplementary approaches after retreatment procedures may improve root canal cleanliness.

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Investigation of fracture prevalence of instruments used in root canal treatments at a faculty of dentistry: a prospective study
Mehmet Eskibağlar, Merve Yeniçeri Özata, Mevlüt Sinan Ocak, Faruk Öztekin
Restor Dent Endod 2023;48(4):e38.   Published online November 1, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e38
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to examine the use of hand or rotary files by pre-graduation (fourth- and fifth-year) and postgraduate students in endodontic treatments and to determine the incidence of file fracture and the management of cases with broken instruments.

Materials and Methods

A total of 2,168 teeth undergoing primary endodontic treatment were included in this study. It was determined that 79 of these teeth resulted in broken tools. In the case of broken tools, the education level of the treating clinician, the tooth that was being treated, the canal and fracture level, the curvature of the tooth and the management of the broken instrument were recorded. Periapical radiographs of the patients were used to calculate curvature following the Schneider method.

Results

There was no significant difference in the incidence of broken tools according to education level (p > 0.05). The incidence of file fracture in molar teeth (73.4%) was higher than in other teeth (p < 0.05). More files were broken in the mandibular molar MB canal (20.25%) and in the apical third of the canals (72.1%). The risk of instrument fracture was high in teeth with moderate (44.3%) and severe (38%) curvature canals. The management of apically broken (80%) files mostly involved lefting (p < 0.05).

Conclusions

There was no statistically significant difference between fourth-year students, fifth-year students and postgraduate students in terms of instrument fracture.

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Can different agents reduce the damage caused by bleaching gel to pulp tissue? A systematic review of basic research
Letícia Aparecida Silva Batista, Alexandre Henrique dos Reis-Prado, Hebertt Gonzaga dos Santos Chaves, Lara Cancella de Arantes, Luís Fernando Santos Alves Morgan, Carolina Bosso André, Thaís Yumi Suzuki, Francine Benetti
Restor Dent Endod 2023;48(4):e39.   Published online November 6, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e39
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Objectives

This study aimed to investigate the effectiveness of different topical/systemic agents in reducing the damage caused by bleaching gel to pulp tissue or cells.

Materials and Methods

Electronic searches were performed in July 2023. In vivo and in vitro studies evaluating the effects of different topical or systemic agents on pulp inflammation or cytotoxicity after exposure to bleaching agents were included. The risk of bias was assessed.

Results

Out of 1,112 articles, 27 were included. Nine animal studies evaluated remineralizing/anti-inflammatories agents in rat molars subjected to bleaching with 35%–38% hydrogen peroxide (HP). Five of these studies demonstrated a significant reduction in inflammation caused by HP when combined with bioglass or MI Paste Plus (GC America), or following KF-desensitizing or Otosporin treatment (n = 3). However, orally administered drugs did not reduce pulp inflammation (n = 4). Cytotoxicity (n = 17) was primarily assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay on human dental pulp cells and mouse dental papilla Cell-23 cells. Certain substances, including sodium ascorbate, butein, manganese chloride, and peroxidase, were found to reduce cytotoxicity, particularly when applied prior to bleaching. The risk of bias was high in animal studies and low in laboratory studies.

Conclusions

Few in vivo studies have evaluated agents to reduce the damage caused by bleaching gel to pulp tissue. Within the limitations of these studies, it was found that topical agents were effective in reducing pulp inflammation in animals and cytotoxicity. Further analyses with human pulp are required to substantiate these findings.

Trial Registration

PROSPERO Identifier: CRD42022337192

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Effects of eye dominance on shade matching and color perception among the dentist population
Pattnaik Kalyani, Kannan Subiksha, Amit Jena, Govind Shashirekha, Saumyakanta Mohanty, Gaurav Sharma
Restor Dent Endod 2023;48(4):e40.   Published online November 9, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e40
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to evaluate the influence of eye dominance on color perception, and shade matching.

Materials and Methods

A total of 104 participants were selected for the study. There were 3 groups: Group I: 3rd and 4th year dental students and interns (n = 40); Group II: postgraduates (n = 34); Group III: senior residents and faculty members (≥ 6 years of clinical experience) (n = 30). All participants were evaluated for congenital color blindness with Ishihara plates, their dominant eye with Mile's test, and their color perception with the Farnsworth-Munsell 100 hue test. The shade guide test was used for shade matching with a second corresponding set of Vitapan classical shade guides.

Results

The results of Mile’s test revealed that 60.6% were right-eye dominant and 39.4% were left-eye dominant. There was a statistically significant difference among all participants between the dominant eye and the non-dominant eye in shade matching.

Conclusions

The dominant eye has a positive effect on shade matching and the ability to match shades becomes better with an increase in clinical experience.

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A scientometric, bibliometric, and thematic map analysis of hydraulic calcium silicate root canal sealers
Anastasios Katakidis, Konstantinos Kodonas, Anastasia Fardi, Christos Gogos
Restor Dent Endod 2023;48(4):e41.   Published online November 13, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e41
AbstractAbstract PDFPubReaderePub
Objectives

This scientometric and bibliometric analysis explored scientific publications related to hydraulic calcium silicate-based (HCSB) sealers used in endodontology, aiming to describe basic bibliometric indicators and analyze current research trends.

Materials and Methods

A comprehensive search was conducted in Web of Science and Scopus using specific HCSB sealer and general endodontic-related terms. Basic research parameters were collected, including publication year, authorship, countries, institutions, journals, level of evidence, study design and topic of interest, title terms, author keywords, citation counts, and density.

Results

In total, 498 articles published in 136 journals were retrieved for the period 2008–2023. Brazil was the leading country, and the universities of Bologna in Italy and Sao Paolo in Brazil were represented equally as leading institutions. The most frequently occurring keywords were “calcium silicate,” “root canal sealer MTA-Fillapex,” and “biocompatibility,” while title terms such as “calcium,” “sealers,” “root,” “canal,” “silicate based,” and “endodontic” occurred most often. According to the thematic map analysis, “solubility” appeared as a basic theme of concentrated research interest, and “single-cone technique” was identified as an emerging, inadequately developed theme. The co-occurrence analysis revealed 4 major clusters centered on sealers’ biological and physicochemical properties, obturation techniques, retreatability, and adhesion.

Conclusions

This analysis presents bibliographic features and outlines changing trends in HCSB sealer research. The research output is dominated by basic science articles scrutinizing the biological and specific physicochemical properties of commonly used HCSB sealers. Future research needs to be guided by studies with a high level of evidence that utilize innovative, sophisticated technologies.

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Case Report
Ingestion and surgical retrieval of an endodontic file: a case report
Devon Marta Ptak, Elinor Alon, Robert Bruce Amato, Julia Tassinari, Adrian Velasquez
Restor Dent Endod 2023;48(4):e32.   Published online September 2, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e32
AbstractAbstract PDFPubReaderePub

Ingestions and aspirations of foreign bodies are rare, but do occasionally occur during dental treatment. Although reports exist, few include photos demonstrating the extensive surgical intervention that may be necessary to manage such events. Perhaps this lack of visualization, and associated lack of awareness, is one of the reasons some clinicians still provide non-surgical root canal therapy (NSRCT) without a rubber dam. This case report outlines the medical treatment of a 30-year-old male who initially presented to a general dentist’s office (not associated with the authors) for NSRCT of their mandibular right first molar. A rubber dam was not used for this procedure, during which the accidental ingestion of an endodontic K-file occurred. The patient was subsequently hospitalized for evaluation and treatment, consisting of numerous imaging studies, endoscopic evaluation, and surgical removal of the file from his small intestine. The ingestion of foreign bodies, and the associated complications, can be reduced through the routine use of a rubber dam, which is considered the standard of care for NSRCT. This case graphically illustrates the potential consequences associated with deviating from the standard of care and should remind clinicians that a rubber dam is necessary for all cases of NSRCT.

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