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Review Article
Success rate of direct pulp capping on permanent teeth using bioactive materials: a systematic review and meta-analysis of randomized clinical trials
Karem Paula Pinto, Gabriela Ribeiro da Silva, Cláudio Malizia Alves Ferreira, Luciana Moura Sassone, Emmanuel João Nogueira Leal da Silva
Restor Dent Endod 2024;49(4):e34.   Published online September 6, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e34
AbstractAbstract PDFSupplementary MaterialPubReaderePub

This systematic review and meta-analysis aimed to evaluate the success rate of direct pulp capping (DPC) on permanent teeth, comparing the use of MTA with calcium hydroxide and calcium silicate-based cements. A systematic search was carried out in 4 databases until July 2023. The selection was based on PICOS criteria and only randomized clinical trials were included. The risk of bias was assessed using RoB-2 tool, and meta-analyses were performed using RevMan 5.3 software. The overall quality of evidence was determined using the GRADE tool. Thirteen studies were included. Meta-analyses indicated significantly higher success rate for DPC using MTA compared to calcium hydroxide, while no significant difference was observed between MTA and Biodentine, showing a success rate from 80% to 100% even after 3 years of follow-up. Five studies were classified as having high risk of bias and the GRADE assessment revealed low certainty of evidence. DPC is highly effective for permanent teeth when using MTA or Biodentine. There is a need for future well-designed randomized clinical trials to evaluate the efficacy of DPC using newer bioceramic materials.

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Research Articles
Endodontic characteristics of mandibular premolar with dens evaginatus: a retrospective study
Minjin Kim, Sujin Jeon, Min-Seock Seo
Restor Dent Endod 2024;49(3):e28.   Published online July 11, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e28
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to investigate the endodontic characteristics of mandibular premolars with dens evaginatus (DE) that require endodontic treatment.

Materials and Methods

Patients who underwent endodontic treatment were enrolled. The inclusion criteria were patients who underwent root canal treatment in the lower permanent teeth with DE and were followed up for at least 1 year. Preoperative clinical and radiographic variables were obtained. The frequency distribution of the preoperative variables was compared using the χ2 or Fisher’s exact tests. The significance of the change in periapical health index (PAI) and root development stages before and after treatment was examined using the Wilcoxon signed-rank test.

Results

A total of 150 teeth of 134 patients with an average age of 15.3 years were included. The percentage distribution comparison of the preoperative variables and obturation techniques revealed significant differences in pulpal and periapical diagnosis, and percussion, and especially regarding age, root development stage, and PAI. Age was the only statistically significant preoperative variable associated with root growth (p < 0.05).

Conclusions

Approximately, 60% of DEs requiring endodontic treatment had immature roots. Age being the most significant predisposing factor, early treatment provides the greatest opportunity for full root development.

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Procedural errors detected by cone beam tomography in cases with indication for retreatment: in vivo cross-sectional study
Henry Paul Valverde Haro, Carmen Rosa Garcia Rupaya, Flávio R. F. Alves
Restor Dent Endod 2024;49(3):e26.   Published online June 24, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e26
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to investigate the frequency and type of endodontic procedural errors in cases indicated for retreatment through cone-beam computed tomography (CBCT) analysis.

Materials and Methods

The sample consisted of 96 CBCT scans, encompassing 122 permanent teeth with fully formed roots. Errors included perforation, instrument fracture, canal transportation, missed canals, and inadequate apical limit of filling. Additionally, potential risk factors were analyzed and subjected to statistical modeling.

Results

The most frequent procedural error observed was the inadequate apical limit of filling, followed by canal transportation, perforation, missed canal, and instrument fracture. Statistically significant associations were identified between various procedural errors and specific factors. These include canal transportation and root canal wall, with the buccal wall being the most commonly affected; missed canal and tooth type, particularly the palatine and second mesiobuccal canal canals; inadequate apical limit of filling and root curvature, showing a higher deviation to the mesial direction in severely curved canals; inadequate apical limit of filling and the presence of calcifications, with underfilling being the most frequent; canal transportation and periapical lesion, notably with deviation to the buccal direction; and the direction of perforation and periapical lesion, most frequently occurring to buccal direction.

Conclusions

CBCT emerges as a valuable tool in identifying procedural errors and associated factors, crucial for their prevention and management.

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Color stability and solubility of Biodentine and NeoPutty in contact with different irrigation solutions
Sıla Nur Usta, Cangül Keskin
Restor Dent Endod 2024;49(3):e25.   Published online June 19, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e25
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the color stability and solubility of Biodentine and NeoPutty in contact with different irrigation solutions.

Materials and Methods

Biodentine and NeoPutty were set in cylindrical molds with 7 mm diameter and 1.5 mm high and immersed in distilled water, 17% ethylenediaminetetraacetic acid (EDTA), 2% chlorhexidine (CHX), 9% 1-hydroxyethylidene 1,1-diphosphonate (HEDP), and 5% sodium hypochlorite (NaOCl) solutions for 24 hours. The color change was measured with a spectrophotometer. The solubility values were calculated as the mass loss was expressed as a percentage of the original mass using an analytical balance with 10−4 g accuracy. Data were analyzed with Kruskal-Wallis followed by Mann-Whitney U tests, and 2-way analysis of variance test followed by Bonferroni corrections for pairwise comparisons for solubility and color stability with a 5% significance threshold, respectively.

Results

Biodentine exhibited higher color changes compared to the NeoPutty contact with all solutions except distilled water (p < 0.05). Both hydraulic cements (HCs) showed higher discoloration values immersion in CHX followed by NaOCl. No statistically significant difference was found between Biodentine and NeoPutty regardless of irrigation solution in terms of solubility (p > 0.05). Solubility values were lower in the distilled water group compared to EDTA and CHX (p < 0.05).

Conclusions

Tested HCs showed solubility and color changes at various rates. NeoPutty could be an appropriate material in aesthetic areas. The usage of HEDP as an irrigant solution can be considered suitable for various endodontic treatments due to its relatively lower solubility and discoloration values.

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Review Article
The prevalence of apical periodontitis in patients prior to hematopoietic cell transplantation: a systematic review
Letícia Tainá de Oliveira Lemes, Carolina Horn Troian-Michel, Theodoro Weissheimer, Marcus Vinicius Reis Só
Restor Dent Endod 2024;49(2):e22.   Published online May 9, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e22
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Objectives

This systematic review addressed the question: “What is the prevalence of apical periodontitis in patients prior to hematopoietic cell transplantation?”

Materials and Methods

A systematic search was conducted in MEDLINE/PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Grey Literature Report. Eligibility criteria were based on the condition, content, and population strategy: the condition was the radiographic prevalence of apical periodontitis, the content comprised patients scheduled for hematopoietic stem cell transplantation, and the population consisted of adult and pediatric patients. The revised Risk of Bias in Nonrandomized Studies of Exposure tool was used to assess the quality of studies. The Grading Recommendations Assessments, Development, and Evaluation (GRADE) tool was used to assess the quality of evidence.

Results

Eight studies were included in this review. The average number of patients with apical periodontitis was 15.65% (range, 2.1%–43.34%). One study was classified as having a very high risk of bias, 1 with a high risk of bias, and 6 with some concern for bias. GRADE analysis showed a very low certainty of evidence. Significant limitations concerning the absence of control over confounding variables were identified.

Conclusions

With the caveat of the very low quality of evidence in the studies reviewed, there was a low to moderate prevalence of apical periodontitis in patients prior to undergoing hematopoietic cell transplantation.

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Research Article
Prevalence of apical periodontitis and quality of root canal treatment in an adult Kuwaiti sub-population: a cross-sectional study
Abdulrahman A. Alhailaa, Saad A Al-Nazhan, Mazen A Aldosimani
Restor Dent Endod 2024;49(2):e16.   Published online March 22, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e16
AbstractAbstract PDFPubReaderePub
Objectives

This cross-sectional study evaluated the prevalence of apical periodontitis (AP) and the technical quality of root canal fillings in an adult Kuwaiti subpopulation using cone-beam computed tomography (CBCT) images.

Materials and Methods

Two experienced examiners analyzed 250 CBCT images obtained from Kuwaiti patients aged 15–65 years who attended government dental specialist clinics between January 2019 and September 2020. The assessment followed the radiographic scoring criteria proposed by De Moor for periapical status and the technical quality of root canal filling. Chi-square and Fisher’s exact tests were used for statistical analysis, with significance level set at p < 0.05.

Results

Among the 2,762 examined teeth, 191 (6.91%) exhibited radiographic signs of AP, and 176 (6.37%) had undergone root canal filling. AP prevalence in root canal-treated teeth was 32.38%, with a significant difference between males and females. Most of the endodontically treated teeth exhibited adequate root canal filling (71.5%).

Conclusions

The study demonstrated a comparable prevalence of AP and satisfactory execution of root canal treatment compared to similar studies in different countries.

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Review Article
Cone-beam computed tomography in endodontics: from the specific technical considerations of acquisition parameters and interpretation to advanced clinical applications
Néstor Ríos-Osorio, Sara Quijano-Guauque, Sandra Briñez-Rodríguez, Gustavo Velasco-Flechas, Antonieta Muñoz-Solís, Carlos Chávez, Rafael Fernandez-Grisales
Restor Dent Endod 2024;49(1):e1.   Published online December 11, 2023
DOI: https://doi.org/10.5395/rde.2024.49.e1
AbstractAbstract PDFPubReaderePub

The implementation of imaging methods that enable sensitive and specific observation of anatomical structures has been a constant in the evolution of endodontic therapy. Cone-beam computed tomography (CBCT) enables 3-dimensional (3D) spatial anatomical navigation in the 3 volumetric planes (sagittal, coronal and axial) which translates into great accuracy for the identification of endodontic pathologies/conditions. CBCT interpretation consists of 2 main components: (i) the generation of specific tasks of the image and (ii) the subsequent interpretation report. A systematic and reproducible method to review CBCT scans can improve the accuracy of the interpretation process, translating into greater precision in terms of diagnosis and planning of endodontic clinical procedures. MEDLINE (PubMed), Web of Science, Google Scholar, Embase and Scopus were searched from inception to March 2023. This narrative review addresses the theoretical concepts, elements of interpretation and applications of the CBCT scan in endodontics. In addition, the contents and rationale for reporting 3D endodontic imaging are discussed.

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Research Articles
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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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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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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Incidence of interappointment emergencies in multiple-visit root canal treatments performed with or without intracanal medicament by undergraduate students
Annemarie Baaij, Corine Mirjam Visscher, Manon Jansen, Ahmet Rifat Özok
Restor Dent Endod 2023;48(3):e31.   Published online August 14, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e31
AbstractAbstract PDFPubReaderePub
Objectives

This retrospective cohort study examined the incidence of interappointment emergencies during multiple-visit molar root canal treatments conducted by undergraduate students. Treatments performed without the use of intracanal medicament were compared to treatments that incorporated calcium hydroxide as an intracanal medicament.

Materials and Methods

Interappointment emergencies, defined as instances of pain or swelling that required the patient to make an unscheduled follow-up visit, were recorded for up to 2 months after the intervention. To avoid the influence of obturation on the observed incidence of emergency visits, only unscheduled visits occurring between the start and end of the root canal treatment were included.

Results

Of the 719 patients included in this study, 77 (10.7%) were recorded as experiencing interappointment emergencies. Of these emergencies, 62% occurred within 2 weeks following the most recent intervention. In the group of patients who did not receive intracanal medicament, the incidence of interappointment emergencies was 11.9% (46 of 385 patients). In comparison, this rate was 9.3% (31 of 334 patients) among those who received calcium hydroxide as an intracanal medicament (odds ratio, 1.33; 95% confidence interval, 0.82–2.15; p = 0.249).

Conclusions

Interappointment emergencies may arise at any point during root canal treatment, but they most commonly occur within the first 2 weeks following intervention. The omission of intracanal medicament in multiple-visit molar root canal treatments, performed by undergraduate students, did not significantly increase the incidence of these emergencies.

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Effect of cryotherapy duration on experimentally induced connective tissue inflammation in vivo
Jorge Vera, Mayra Alejandra Castro-Nuñez, María Fernanda Troncoso-Cibrian, Ana Gabriela Carrillo-Varguez, Edgar Ramiro Méndez Sánchez, Viviana Sarmiento, Lourdes Lanzagorta-Rebollo, Prasanna Neelakantan, Monica Romero, Ana Arias
Restor Dent Endod 2023;48(3):e29.   Published online August 2, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e29
AbstractAbstract PDFPubReaderePub
Objectives

This study tested the hypothesis that cryotherapy duration influences lipopolysaccharide (LPS)-induced inflammation in a rat model.

Materials and Methods

Six Wistar rats (Rattus norvegicus albinus) were used. Five sites were selected per animal and divided into 5 groups: a negative control group (NC), 2 positive control groups (PC1 and PC2), and 2 experimental groups (E1 and E2). Cryotherapy was applied for 1 minute (E1) or 5 minutes (E2). An acute inflammatory response was induced in the PC and E groups via subcutaneous administration of 0.5 mL/kg. In the PC2 group, a catheter was inserted without additional treatment. For the E1 and E2 groups, 2.5°C saline solution was administered through the implanted catheters for 1 and 5 minutes, respectively. The rats were sacrificed, and samples were obtained and processed for histological analysis, specifically examining the presence of polymorphonuclear neutrophils and hemorrhage. The χ2 test was used to compare the presence of acute inflammation across groups. Dependent variables were compared using the linear-by-linear association test.

Results

Inflammation and hemorrhage varied significantly among the groups (p = 0.001). A significantly higher degree of acute inflammation was detected (p = 0.0002) in the PC and E1 samples than in the E2 group, in which cryotherapy was administered for 5 minutes. The PC and E1 groups also exhibited significantly greater numbers of neutrophils (p = 0.007), which were essentially absent in both the NC and E2 groups.

Conclusions

Cryotherapy administration for 5 minutes reduced the acute inflammation associated with LPS and catheter implantation.

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Effect of irrigation protocols on smear layer removal, bond strength and nanoleakage of fiber posts using a self-adhesive resin cement
Rodrigo Stadler Alessi, Renata Terumi Jitumori, Bruna Fortes Bittencourt, Giovana Mongruel Gomes, João Carlos Gomes
Restor Dent Endod 2023;48(3):e28.   Published online July 27, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e28
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to investigate the effect of the application method of 2% chlorhexidine (CHX) and its influence on the adhesion of fiberglass posts cemented with a self-adhesive resin cement.

Materials and Methods

Sixty human mandibular premolars were endodontically treated and divided into 5 groups (n = 12), according to the canal irrigant and its application method: 2 groups with conventional syringe irrigation (CSI)—2.5% sodium hypochlorite (NaOCl) (control) and 2% CHX— and 3 groups with 2% CHX irrigation/activation—by passive ultrasonic irrigation (PUI), Easy Clean file, and XP-Endo Finisher file. Two roots per group were evaluated for smear layer (SL) removal by scanning electron microscopy. For other roots, fiber posts were luted using a self-adhesive resin cement. The roots were sectioned into 6 slices for push-out bond strength (BS) (7/group) and nanoleakage (NL) (3/group). Data from SL removal were submitted to Kruskal-Wallis and Student-Newman-Keuls tests (α = 0.05). Data from BS and NL were evaluated by 2-way analysis of variance and Tukey’s test (α = 0.05).

Results

For SL removal and BS, the CHX irrigation/activation promoted better values than CSI with CHX (p < 0.05), but it was not significantly different from CSI with NaOCl (p > 0.05). For NL, the lowest values were obtained by the chlorhexidine irrigation/activation groups (p < 0.05).

Conclusions

Active 2% CHX irrigation can be used to improve the post space cleaning and adhesion before fiber post cementation with self-adhesive resin cements.

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Contemporary research trends on nanoparticles in endodontics: a bibliometric and scientometric analysis of the top 100 most-cited articles
Sıla Nur Usta, Zeliha Uğur-Aydın, Kadriye Demirkaya, Cumhur Aydın
Restor Dent Endod 2023;48(3):e27.   Published online July 26, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e27
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Objectives

Advancements in nanotechnology have led to the widespread usage of nanoparticles in the endodontic field. This bibliometric study aimed to determine and analyze the top 100 most-cited articles about nanoparticles in endodontics from 2000 to 2022.

Materials and Methods

A detailed electronic search was conducted on the “Clarivate Analytics Web of Science, All Databases” to receive the most-cited articles related to the topic. Articles were ranked in descending order based on their citation counts, and the first 100 were selected for bibliometric analysis. Parameters such as citation density, publication year, journal, country, institution, author, study design, study field, evidence level, and keywords were analyzed.

Results

The top 100 most-cited articles received 4,698 citations (16–271) with 970.21 (1.91–181) citation density in total. Among decades, citations were significantly higher in 2011–2022 (p < 0.001). Journal of Endodontics had the largest number of publications. Canada and the University of Toronto made the highest contribution as country and institution, respectively. Anil Kishen was the 1 who participated in the largest number of articles. The majority of the articles were designed in vitro. The main study field was “antibacterial effect.” Among keywords, “nanoparticles” followed by “Enterococcus faecalis” were used more frequently.

Conclusions

Developments in nanotechnology had an impact on the increasing number of studies in recent years. This bibliometric study provides a comprehensive view of nanoparticle advances and trends using citation analysis.

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Tip and taper compatibility of accessory gutta-percha points with rotary and reciprocating instruments
Júlia Niero Zanatta Streck, Sabrina Arcaro, Renan Antônio Ceretta, Eduardo Antunes Bortoluzzi, Lucas da Fonseca Roberti Garcia, Josiane de Almeida, Patrícia Maria Poli Kopper, Anarela Vassen Bernardi
Restor Dent Endod 2023;48(3):e22.   Published online June 8, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e22
AbstractAbstract PDFPubReaderePub
Objectives

This study was conducted to evaluate and compare the tip and taper compatibility of accessory gutta-percha points (AGPs) with various rotary and reciprocating instruments.

Materials and Methods

Using a profile analyzer, tip and taper measurements were taken of 10 AGPs of each of the 14 models available from Odous de Deus and the 4 models available from Dentsply-Maillefer. Diameter measurements were taken at 1-mm intervals, from 3 mm from the tip (D3) to 16 mm.

Results

Based on the mean values obtained, 3-dimensional (3D) models of the AGPs were drawn in Autodesk Fusion 360 and superimposed on 3D models of each instrument selected (Mtwo, Reciproc, RaCe, K3, and ProDesign Logic) to determine the compatibility between the instrument and the AGP. Data corresponding to the tips and tapers of the various AGPs, as well as the tip and taper differences between the AGPs and the instruments, were analyzed using descriptive statistics. The tapers of the AGPs were subject to the American National Standards Institute/American Dental Association No. 57 standard. The Odous de Deus extra-long medium and extra-long extra-medium AGPs were shown to be compatible with Mtwo, K3, and ProDesign Logic instruments with taper 0.06 and tip sizes 25 and 30, while the Dentsply fine and fine medium cones were compatible with Mtwo, RaCe, and K3 instruments with conicity of 0.04 and tip sizes 35 and 40.

Conclusions

Both the Odous de Deus and Dentsply commercial brands included 2 AGP models with tip (D3) and taper compatibility with Mtwo, RaCe, K3, and/or Prodesign Logic instruments.

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Review Article
Stem cell-derived exosomes for dentin-pulp complex regeneration: a mini-review
Dina A. Hammouda, Alaa M Mansour, Mahmoud A. Saeed, Ahmed R. Zaher, Mohammed E. Grawish
Restor Dent Endod 2023;48(2):e20.   Published online May 3, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e20
AbstractAbstract PDFPubReaderePub

This mini-review was conducted to present an overview of the use of exosomes in regenerating the dentin-pulp complex (DPC). The PubMed and Scopus databases were searched for relevant articles published between January 1, 2013 and January 1, 2023. The findings of basic in vitro studies indicated that exosomes enhance the proliferation and migration of mesenchymal cells, as human dental pulp stem cells, via mitogen-activated protein kinases and Wingless-Int signaling pathways. In addition, they possess proangiogenic potential and contribute to neovascularization and capillary tube formation by promoting endothelial cell proliferation and migration of human umbilical vein endothelial cells. Likewise, they regulate the migration and differentiation of Schwann cells, facilitate the conversion of M1 pro-inflammatory macrophages to M2 anti-inflammatory phenotypes, and mediate immune suppression as they promote regulatory T cell conversion. Basic in vivo studies have indicated that exosomes triggered the regeneration of dentin-pulp–like tissue, and exosomes isolated under odontogenic circumstances are particularly strong inducers of tissue regeneration and stem cell differentiation. Exosomes are a promising regenerative tool for DPC in cases of small pulp exposure or for whole-pulp tissue regeneration.

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Research Articles
Effectiveness of endodontic retreatment using WaveOne Primary files in reciprocating and rotary motions
Patricia Marton Costa, Renata Maíra de Souza Leal, Guilherme Hiroshi Yamanari, Bruno Cavalini Cavenago, Marco Antônio Húngaro Duarte
Restor Dent Endod 2023;48(2):e15.   Published online April 25, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e15
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated the efficiency of WaveOne Primary files (Dentsply Sirona) for removing root canal fillings with 2 types of movement: reciprocating (RCP) and continuous counterclockwise rotation (CCR).

Materials and Methods

Twenty mandibular incisors were prepared with a RCP instrument (25.08) and filled using the Tagger hybrid obturation technique. The teeth were retreated with a WaveOne Primary file and randomly allocated to 2 experimental retreatment groups (n = 10) according to movement type: RCP and CCR. The root canals were emptied of filling material in the first 3 steps of insertion, until reaching the working length. The timing of retreatment and procedure errors were recorded for all samples. The specimens were scanned before and after the retreatment procedure with micro-computed tomography to calculate the percentage and volume (mm3) of the residual filling material. The results were statistically evaluated using paired and independent t-tests, with a significance level set at 5%.

Results

No significant difference was found in the timing of filling removal between the groups, with a mean of 322 seconds (RCP) and 327 seconds (CCR) (p < 0.05). There were 6 instrument fractures: 1 in a RCP motion file and 5 in continuous rotation files. The volumes of residual filling material were similar (9.94% for RCP and 15.94% for CCR; p > 0.05).

Conclusions

The WaveOne Primary files used in retreatment performed similarly in both RCP and CCR movements. Neither movement type completely removed the obturation material, but the RCP movement provided greater safety.

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Comparative analysis of torsional and cyclic fatigue resistance of ProGlider, WaveOne Gold Glider, and TruNatomy Glider in simulated curved canal
Pedro de Souza Dias, Augusto Shoji Kato, Carlos Eduardo da Silveira Bueno, Rodrigo Ricci Vivan, Marco Antonio Hungaro Duarte, Pedro Henrique Souza Calefi, Rina Andréa Pelegrine
Restor Dent Endod 2023;48(1):e4.   Published online December 8, 2022
DOI: https://doi.org/10.5395/rde.2023.48.e4
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to compare the torsional and cyclic fatigue resistance of ProGlider (PG), WaveOne Gold Glider (WGG), and TruNatomy Glider (TNG).

Materials and Methods

A total of 15 instruments of each glide path system (n = 15) were used for each test. A custom-made device simulating an angle of 90° and a radius of 5 millimeters was used to assess cyclic fatigue resistance, with calculation of number of cycles to failure. Torsional fatigue resistance was assessed by maximum torque and angle of rotation. Fractured instruments were examined by scanning electron microscopy (SEM). Data were analyzed with Shapiro-Wilk and Kruskal-Wallis tests, and the significance level was set at 5%.

Results

The WGG group showed greater cyclic fatigue resistance than the PG and TNG groups (p < 0.05). In the torsional fatigue test, the TNG group showed a higher angle of rotation, followed by the PG and WGG groups (p < 0.05). The TNG group was superior to the PG group in torsional resistance (p < 0.05). SEM analysis revealed ductile morphology, typical of the 2 fracture modes: cyclic fatigue and torsional fatigue.

Conclusions

Reciprocating WGG instruments showed greater cyclic fatigue resistance, while TNG instruments were better in torsional fatigue resistance. The significance of these findings lies in the identification of the instruments’ clinical applicability to guide the choice of the most appropriate instrument and enable the clinician to provide a more predictable glide path preparation.

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Dentinal tubule penetration of sodium hypochlorite in root canals with and without mechanical preparation and different irrigant activation methods
Renata Aqel de Oliveira, Theodoro Weissheimer, Gabriel Barcelos Só, Ricardo Abreu da Rosa, Matheus Albino Souza, Rodrigo Gonçalves Ribeiro, Marcus Vinicius Reis Só
Restor Dent Endod 2023;48(1):e1.   Published online December 1, 2022
DOI: https://doi.org/10.5395/rde.2023.48.e1
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated the dentinal penetration depth of 2.5% sodium hypochlorite (NaOCl) in root canals with and without preparation and different irrigant activation protocols.

Materials and Methods

Sixty-three bovine mandibular incisors were randomly allocated to 6 groups (n = 10): G1, preparation + conventional needle irrigation (CNI); G2, preparation + passive ultrasonic irrigation (PUI); G3, preparation + Odous Clean (OC); G4, no preparation + CNI; G5, no preparation + PUI; G6, no preparation + OC; and CG (negative control; n = 3). Samples were filled with crystal violet for 72 hours. Irrigant activation was performed. Samples were sectioned perpendicularly along the long axis, 3 mm and 7 mm from the apex. Images of the root thirds of each block were captured with a stereomicroscope and analyzed with an image analysis software. One-way analysis of variance, followed by the Tukey post hoc test, and the Student’s t-test were used for data analysis, with a significance level of 5%.

Results

The NaOCl penetration depth was similar when preparation was performed, regardless of the method of irrigation activation (p > 0.05). In the groups without preparation, G6 showed greater NaOCl penetration depth (p < 0.05). The groups without preparation had a greater NaOCl penetration depth than those with preparation (p = 0.0019).

Conclusions

The NaOCl penetration depth was similar in groups with root canal preparation. Without root canal preparation, OC allowed deeper NaOCl penetration. The groups without preparation had greater NaOCl penetration than those undergoing root canal preparation.

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Evaluation of blood clot, platelet-rich plasma, and platelet-rich fibrin–mediated regenerative endodontic procedures in teeth with periapical pathology: a CBCT study
Swati Markandey, Haridas Das Adhikari
Restor Dent Endod 2022;47(4):e41.   Published online October 21, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e41
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Objectives

This study compared the clinical and radiological outcomes of regenerative endodontic procedures (REPs) using blood clots (BCs), platelet-rich plasma (PRP), and platelet-rich fibrin (PRF) through intraoral periapical radiography (IOPAR) and cone-beam computed tomography (CBCT).

Materials and Methods

Forty-five single-rooted necrotic teeth with periapical pathology were randomly allocated to receive BC, PRP, or PRF as an individual scaffold. Outcomes were evaluated in 35 teeth in 23 patients with a follow-up period of 12–24 months through qualitative IOPAR scoring and quantitative CBCT measurements. Healing of periapical lesions and in immature teeth, changes in the apical foramen diameter (AFD), root wall thickness (RWT), and root length (RL) were assessed. A p value less than 0.05 was considered to indicate statistical significance.

Results

All teeth were asymptomatic except 1 in the PRP group. Periapical lesion healing was seen in all except 2 teeth in the BC group and 3 in the PRP group. Both IOPAR and CBCT revealed no significant differences in bone healing or changes in AFD, RWT, and RL among the 3 groups. A positive pulp sensibility response to the cold test was seen in 2 teeth in the BC group, but none to the electric pulp test. Intracanal calcification (ICC) was evident in more teeth in the BC group than in the PRP and PRF groups, and was also significantly higher in immature teeth.

Conclusions

Our results revealed that BC, PRP, and PRF have similar potential as scaffolds in REPs, and ICC may be a concern for long-term outcomes.

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Review Article
Influence of the root canal filling technique on the success rate of primary endodontic treatments: a systematic review
Daniel Feijolo Marconi, Giovana Siocheta da Silva, Theodoro Weissheimer, Isadora Ames Silva, Gabriel Barcelos Só, Leonardo Thomasi Jahnke, Jovito Adiel Skupien, Marcus Vinicius Reis Só, Ricardo Abreu da Rosa
Restor Dent Endod 2022;47(4):e40.   Published online October 11, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e40
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Objectives

This study aimed to investigate the influence of different obturation techniques compared to cold lateral compaction on the success rate of primary non-surgical endodontic treatments.

Materials and Methods

Systematic searches were performed for studies published up to May 17th, 2022 in MEDLINE/PubMed, Cochrane Library, Web of Science, Scopus, EMBASE, and Grey Literature Reports. Randomized clinical trials and nonrandomized (nonrandomized clinical trials, prospective or retrospective) studies that evaluated the success rate of primary non-surgical endodontic treatments obturated with the cold lateral compaction (control) and other obturation techniques were included. The revised Cochrane risk of bias tools for randomized trials (RoB 2) and nonrandomized studies of interventions (ROBINS-I) were used to evaluate the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was used to evaluate the certainty of evidence.

Results

Eleven studies (4 randomized clinical trials (RCTs), 4 prospective, and 3 retrospectives) were included. Two RCTs were classified as having some concerns risk of bias and 2 as a low risk of bias. Two nonrandomized studies were classified as having a critical risk of bias and 5 as having a moderate risk of bias. The GRADE analysis demonstrated a very low to moderate certainty of evidence.

Conclusions

This systematic review generally evidenced no differences in the success rate of primary non-surgical endodontic treatments when the cold lateral compaction technique and other obturation techniques are performed. Further well-designed studies are still necessary.

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Research Articles
Outcome of endodontic treatments performed by Brazilian undergraduate students: 3- to 8-year follow up
Jéssica Gabriele da Rocha, Isabella Marian Lena, Jéssica Lopes Trindade, Gabriela Salatino Liedke, Renata Dornelles Morgental, Carlos Alexandre Souza Bier
Restor Dent Endod 2022;47(3):e34.   Published online August 18, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e34
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the success rate of endodontic treatments performed by undergraduate students and the factors associated with the outcome.

Materials and Methods

A follow-up of 3 to 8 years after root canal filling was carried out in 91 patients. At the follow-up visits, medical and dental history questionnaires were applied along with clinical and radiographic examinations. Data collected in the clinical exam included: the presence of pain, swelling, sinus tract, mobility, tenderness to palpation and percussion, periodontal probing profile, and type/quality of coronal restoration. Postoperative and follow-up radiographs were digitalized and analyzed by 2 trained and calibrated examiners to assess periapical healing. The treatment outcome was based on strict clinical and radiographic criteria and classified as success (absence of any clinical and radiographic sign of apical periodontitis) or failure (other combination). Logistic regression was used to investigate the impact of clinical and radiographic variables on endodontic treatment outcomes at a 5% significance level.

Results

The success rate of endodontic treatments was 60.7%. The only risk factor significantly associated with failure was the presence of a periapical lesion on the postoperative radiograph (odds ratio, 3.35; 95% confidence interval, 1.17–9.54).

Conclusions

The success rate of endodontic treatments performed by undergraduate students was low and was jeopardized by the presence of a periapical lesion on the postoperative radiograph.

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Proximity of maxillary molar apexes to the cortical bone surface and the maxillary sinus
Han Shin Lee, Dokyung Kim, Sung Kyo Kim
Restor Dent Endod 2022;47(3):e33.   Published online August 8, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e33
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to analyze the proximity of maxillary molar roots to their overlying cortical bone surfaces and the maxillary sinus.

Materials and Methods

Cone-beam computed tomographic images of 151 patients with completely erupted upper molars that had 3 separate roots were studied. The following distances were measured: from the root apex to the cortical plate and maxillary sinus floor, and from the apical 3-mm level of the root to the cortical plate. Differences between groups were analyzed with 1-way analysis of variance and the Scheffé post hoc test, the significance of differences between cone-beam computed tomography views with the paired t-test, and the significance of differences among age groups with linear regression analysis. The significance level was set at p < 0.05.

Results

The mesiobuccal and distobuccal root apexes of maxillary second molars were more distant from the buccal cortical plate than the maxillary first molars (p < 0.05). The apical 3-mm level of the mesiobuccal root of the first molar was closer to the buccal cortical bone than the second molar (p < 0.05). In the maxillary first molars, the thickness of the buccal cortical bone decreased in all roots with age (p < 0.05). In all root apexes of both molars, the difference in the vertical level between the maxillary sinus floor and the root apex increased with age (p < 0.05).

Conclusions

Awareness of the anatomical profile of maxillary molar apices in relation to the cortical bones and maxillary sinus will be beneficial for apical surgery.

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Clinical and radiographic outcomes of regenerative endodontic treatment performed by endodontic postgraduate students: a retrospective study
Hadi Rajeh Alfahadi, Saad Al-Nazhan, Fawaz Hamad Alkazman, Nassr Al-Maflehi, Nada Al-Nazhan
Restor Dent Endod 2022;47(2):e24.   Published online May 9, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e24
AbstractAbstract PDFPubReaderePub
Objectives

Regenerative endodontic treatment is a clinical procedure aimed at biologically regenerating damaged root canal tissue of immature permanent teeth. This study aimed to report the outcomes of regenerative endodontic treatment performed by endodontic postgraduate students.

Materials and Methods

Clinical and radiographic data of 27 patients, aged 10–22 years, who underwent regenerative treatment of immature permanent teeth from 2015 to 2019 were followed up, wherein clinical and radiographic examinations were performed for each patient. Postoperative success rate and tooth survival were analyzed, and the postoperative radiographic root area changes were quantified.

Results

A total of 23 patients attended the dental appointments, showing that all teeth survived and were asymptomatic. Specifically, 7 periapical pathosis cases were completely healed, 12 were incompletely healed, and 4 cases failed. Moreover, significant differences were found between discolored and non-discolored teeth, and between the presence or absence of periapical radiolucency. Additionally, 3 anterior teeth showed complete closure of the apical foramen, while the apical foramen width was reduced in 17 teeth and failed in 3 teeth. Root length was also found to have been increased in 7 anterior and 4 posterior teeth, and the average length ranged from 4.00–0.63 mm in the anterior teeth, 2.85–1.48 mm of the mesial root, and 2.73–2.16 mm of the molar teeth distal root. Furthermore, calcified tissue deposition was observed in 7 teeth.

Conclusions

A favorable outcome of regenerative endodontic treatment of immature permanent teeth with necrotic pulp was achieved with a high survival rate.

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Difficulties experienced by endodontics researchers in conducting studies and writing papers
Betul Aycan Alim-Uysal, Selin Goker-Kamali, Ricardo Machado
Restor Dent Endod 2022;47(2):e20.   Published online March 15, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e20
AbstractAbstract PDFPubReaderePub
Objectives

The study investigated the difficulties experienced by endodontics researchers around the world in conducting studies and writing papers.

Materials and Methods

A survey consisting of 18 questions on the difficulties experienced by endodontics researchers in performing studies and writing papers was e-mailed to academics in the field of endodontics working at 202 universities. The independent risk factors were analyzed using binary logistic regression at a significance level of 0.05.

Results

A total of 581 individuals (10.7%) agreed to participate in the study. Almost half the participants (48.2%) reported that they had received some type of training in conducting studies and writing papers. In response to the question, “Do you get help from a statistician to perform the statistical analyses of your studies?,” 77.1% answered “yes.” Around 40% of the participants stated that the need to obtain ethical approval negatively affected their desire to conduct studies. The participants’ regions had no effect on the reported difficulties associated with writing papers in English or conducting statistical analyses (p > 0.05). Most participants (81.8%) reported difficulties in writing the Discussion section, regardless of their region, academic degrees, or years of experience.

Conclusions

The participants stated they experienced difficulties in many areas, such as conducting statistical analyses, finding new ideas, and writing in English. Engaging in a detailed examination of ethics committee rules, expanding biostatistics education, increasing the number of institutions providing research funding, and increasing the number of endodontics journals can increase the enthusiasm of endodontics researchers to publish papers.

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Case Report
Leukocyte platelet-rich fibrin in endodontic microsurgery: a report of 2 cases
Mariana Domingos Pires, Jorge N. R. Martins, Abayomi Omokeji Baruwa, Beatriz Pereira, António Ginjeira
Restor Dent Endod 2022;47(2):e17.   Published online March 4, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e17
AbstractAbstract PDFPubReaderePub

Endodontic microsurgery is a predictable treatment option when orthograde treatment or retreatment is unsuccessful or unfeasible. However, when there is a gross compromise of periapical bone, achievement of bone regeneration after the surgical procedure may be hampered. In such cases, the application of guided tissue regeneration principles, with adjunctive use of leukocyte platelet-rich fibrin to fill the bone defect as a bone substitute and as a membrane to cover the site, provides a cost-effective solution with the benefits of accelerated physiological healing and reduced post-surgical pain and discomfort. This case report presents 2 cases of endodontic microsurgery of the upper lateral incisors with loss of buccal cortical plate, where platelet-rich fibrin was successfully applied.

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Research Articles
Comparison of the cyclic fatigue resistance of One Curve, F6 Skytaper, Protaper Next, and Hyflex CM endodontic files
Charlotte Gouédard, Laurent Pino, Reza Arbab-Chirani, Shabnam Arbab-Chirani, Valérie Chevalier
Restor Dent Endod 2022;47(2):e16.   Published online March 4, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e16
AbstractAbstract PDFPubReaderePub
Objectives

This study compared the cyclic fatigue resistance of One Curve (C wire) and F6 Skytaper (conventional austenite nickel-titanium [NiTi]), and 2 instruments with thermo-mechanically treated NiTi: Protaper Next X2 (M wire) and Hyflex CM (CM wire).

Materials and Methods

Ten new instruments of each group (size: 0.25 mm, 6% taper in the 3 mm tip region) were tested using a rotary bending machine with a 60° curvature angle and a 5 mm curvature radius, at room temperature. The number of cycles until fracture was recorded. The length of the fractured instruments was measured. The fracture surface of each fragment was examined with a scanning electron microscope (SEM). The data were analyzed using one-way analysis of variance and the post hoc Tukey test. The significance level was set at 0.05.

Results

At 60°, One Curve, F6 Skytaper and Hyflex CM had significantly longer fatigue lives than Protaper Next X2 (p < 0.05). No statistically significant differences were found in the cyclic fatigue lives of One Curve, F6 Skytaper, and Hyflex CM (p > 0.05). SEM images of the fracture surfaces of the different instruments showed typical features of fatigue failure.

Conclusions

Within the conditions of this study, at 60° and with a 5 mm curvature radius, the cyclic fatigue life of One Curve was not significantly different from those of F6 Skytaper and Hyflex CM. The cyclic fatigue lives of these 3 instruments were statistically significantly longer than that of Protaper Next.

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Efficacy of reciprocating instruments and final irrigant activation protocols on retreatment of mesiobuccal roots of maxillary molars: a micro-CT analysis
Lilian Tietz, Renan Diego Furlan, Ricardo Abreu da Rosa, Marco Antonio Hungaro Duarte, Murilo Priori Alcalde, Rodrigo Ricci Vivan, Theodoro Weissheimer, Marcus Vinicius Reis Só
Restor Dent Endod 2022;47(1):e13.   Published online February 15, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e13
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated the efficacy of 3 reciprocating systems and the effects of 2 instruments for irrigant activation on filling material removal.

Materials and Methods

Forty mesiobuccal roots of maxillary molars were prepared up to size 25.06 and obturated. Micro-computed tomography (micro-CT) examination #1 was performed. Teeth were then divided into 4 groups (n = 10), according to the retreatment protocol: (1) manual, (2) Reciproc Blue, (3) WaveOne Gold, and (4) X1 Blue. Micro-CT examinations #2 and #3 were performed after filling removal and repreparation, respectively. Next, all teeth were divided into 2 new groups (n = 20) according to the irrigant activation protocol: XP Clean (XP Clean size 25.02) and Flatsonic (Flatsonic ultrasonic tip). Micro-CT examination #4 was performed after irrigant activation. Statistical analysis was performed with a significance level set at 5%.

Results

WaveOne Gold removed a significantly greater amount of filling material than the manual group (p < 0.05). The time to reach the WL was similar for all reciprocating systems (p > 0.05). X1 Blue was faster than the manual group (p < 0.05). Only manual group improved the filling material removal after the repreparation stage (p < 0.05). Both activation protocols significantly improved the filling material removal (p < 0.05), without differences between them (p > 0.05).

Conclusions

None of the tested instruments completely removed the filling material. X1 Blue size 25.06 reached the working length in the shortest time. XP Clean and Flatsonic improved the filling material removal.

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Review Article
Outcomes of the GentleWave system on root canal treatment: a narrative review
Hernán Coaguila-Llerena, Eduarda Gaeta, Gisele Faria
Restor Dent Endod 2022;47(1):e11.   Published online February 14, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e11
AbstractAbstract PDFPubReaderePub

This study aimed to describe the outcomes of the GentleWave system (GW) (Sonendo) on root canal treatment. Published articles were collected from scientific databases (MEDLINE/PubMed platform, Web of Science, Scopus, Science Direct and Embase). A total of 24 studies were collected from August/2014 to July/2021, 20 in vitro and 4 clinical. GW System was not associated with extrusion of the irrigant, promoted faster organic dissolution than conventional syringe irrigation (CSI), passive ultrasonic irrigation (PUI) continuous ultrasonic irrigation (CUI) and EndoVac, reduced more bacterial DNA and biofilm than PUI and CUI, promoted higher penetration of sodium hypochlorite into dentinal tubules than PUI and CUI in vitro, and removed more intracanal medication than CSI and PUI. GW was able to remove pulp tissue and calcifications. Moreover, its ability to remove hard-tissue debris and smear layer was better than that of CSI, and its ability to remove root canal obturation residues was lower or similar to that of PUI, and similar to that of CSI and EndoVac. Regarding root canal obturation of minimally instrumented molar canals, GW was associated with high-quality obturation. Clinically, the success rate of endodontic treatment using GW was 97.3%, and the short-term postoperative pain in the GW group was not different from CSI. Further research, mainly clinical, is needed to establish whether GW has any advantages over other available irrigation methods.

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Research Article
How do imaging protocols affect the assessment of root-end fillings?
Fernanda Ferrari Esteves Torres, Reinhilde Jacobs, Mostafa EzEldeen, Karla de Faria-Vasconcelos, Juliane Maria Guerreiro-Tanomaru, Bernardo Camargo dos Santos, Mário Tanomaru-Filho
Restor Dent Endod 2022;47(1):e2.   Published online December 15, 2021
DOI: https://doi.org/10.5395/rde.2022.47.e2
AbstractAbstract PDFPubReaderePub
Objectives

This study investigated the impact of micro-computed tomography (micro-CT)-based voxel size on the analysis of material/dentin interface voids and thickness of different endodontic cements.

Materials and Methods

Following root-end resection and apical preparation, maxillary premolars were filled with mineral trioxide aggregate (MTA), Biodentine, and intermediate restorative material (IRM) (n = 24). The samples were scanned using micro-CT (SkyScan 1272; Bruker) and the cement/dentin interface and thickness of materials were evaluated at voxel sizes of 5, 10, and 20 µm. Analysis of variance and the Tukey test were conducted, and the degree of agreement between different voxel sizes was evaluated using the Bland and Altman method (p < 0.05).

Results

All materials showed an increase in thickness from 5 to 10 and 20 µm (p < 0.05). When evaluating the interface voids, materials were similar at 5 µm (p > 0.05), while at 10 and 20 µm Biodentine showed the lowest percentage of voids (p < 0.05). A decrease in the interface voids was observed for MTA and IRM at 20 µm, while Biodentine showed differences among all voxel sizes (p < 0.05). The Bland-Altman plots for comparisons among voxel sizes showed the largest deviations when comparing images between 5 and 20 µm.

Conclusions

Voxel size had an impact on the micro-CT evaluation of thickness and interface voids of endodontic materials. All cements exhibited an increase in thickness and a decrease in the void percentage as the voxel size increased, especially when evaluating images at 20 µm.

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