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Review Article
Influence of disinfecting solutions on the surface topography of gutta-percha cones: a systematic review of in vitro studies
Lora Mishra, Gathani Dash, Naomi Ranjan Singh, Manoj Kumar, Saurav Panda, Franck Diemer, Monika Lukomska-Szymanska, Barbara Lapinska, Abdul Samad Khan
Restor Dent Endod 2024;49(4):e42.   Published online November 1, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e42
AbstractAbstract PDFSupplementary MaterialPubReaderePub

The surface integrity of gutta-percha cones is a crucial factor in the success of endodontic procedures. Disinfecting solutions play a pivotal role in sterilizing gutta-percha cones, but their influence on gutta-percha surface topography remains a subject of concern. This systematic review aimed to present a qualitative synthesis of available laboratory studies assessing the influence of disinfecting solutions on the surface topography of gutta-percha and offers insights into the implications for clinical practice. The present review followed PRISMA 2020 guidelines. An advanced database search was performed in PubMed, Google Scholar, Embase, Scopus, LILAC, non-indexed citations and reference lists of eligible studies in May 2024. Laboratory studies, in English language, were considered for inclusion. The quality (risk of bias) of the included studies was assessed using parameters for in vitro studies. A total of 28 studies were included in the qualitative synthesis. Based on the included in vitro studies, surface deposits and alterations in the physical properties of gutta-percha cones were observed after the disinfection protocol. A comprehensive review of the available literature indicates that the choice of disinfecting solution, its concentration, and immersion time significantly affect the surface topography of gutta-percha cones.

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Research Articles
Histological evaluation of pulp response to alendronate and Biodentine as pulp capping agents: an animal study
Thangavel Boopathi, Sekar Manimaran, Joseline Charles Kerena, Mathew Sebeena, Kumaravadivel Karthick, Natesan Thangaraj Deepa
Restor Dent Endod 2024;49(4):e39.   Published online October 29, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e39
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to comparatively assess the histological response of the pulp toward alendronate and Biodentine in a direct pulp capping procedure.

Materials and Methods

Twenty-four anterior teeth from 6 New Zealand rabbits were used in this study. Firstly, all rabbits were anesthetized according to their weight. Class V cavities were prepared on the buccal surfaces of anterior teeth. A pin-point exposure of the pulp was then made using a small, sterile round carbide bur and bleeding was arrested with a saline-soaked, sterile cotton pellet. The teeth under study were divided into 2 groups (n = 12). The intentionally exposed pulp was capped with alendronate (Group 1) and Biodentine (Group 2), correspondingly. After 30 days, all rabbits were euthanized; the teeth under study were extracted and taken up for histological analysis.

Results

Biodentine showed an intact, very dense dentin bridge formation with a uniform odontoblast (OD) layer pattern and mild or absent inflammatory response whereas specimens capped with alendronate demonstrated a dense dentin bridge formation with non-uniform OD layer pattern and mild to moderate inflammatory response.

Conclusions

Biodentine showed more biocompatibility than alendronate. However, alendronate can initiate reparative dentin formation and may be used as an alternative pulp capping agent.

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Fracture resistance after root canal filling removal using ProTaper Next, ProTaper Universal Retreatment or hybrid instrumentation: an ex vivo study
Hadeel Hassan Hanafy, Marwa Mahmoud Bedier, Suzan Abdul Wanees Amin
Restor Dent Endod 2024;49(4):e38.   Published online October 11, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e38
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated the effect of ProTaper Next (PTN), ProTaper Universal Retreatment (PTR) and hybrid instrumentation (HI) for canal filling removal on the fracture resistance (FR), mode of failure (MoF), and filling removal time.

Materials and Methods

Ninety-six, mandibular premolars were decoronated and randomly divided into 6 groups (n = 16), as follows: sound (S), untreated canals; prepared teeth (P), canals only prepared to ProTaper Universal finishing instrument (F4); endodontically-treated (ET), prepared and obturated canals using the single-cone technique; and groups PTN, PTR, and HI where filling was removed using PTN, PTR, or HI respectively. FR under vertical loading; MoF and time were assessed. Data were analyzed (Significance level [α] = 0.05).

Results

There was a significant difference in FR among all groups (p < 0.001) (HI < P < PTN < S < ET < PTR). HI showed lower FR than S, ET and PTR, and P showed lower FR than PTR (p < 0.05). For experimental groups, there was a significant difference between every group pair (p < 0.05) No significant difference was found regarding MoF distribution (p > 0.05). HI required the highest filling removal time, while PTR required the least (p < 0.05 between every group pair).

Conclusions

The effect of filling removal on FR may depend on the filling removal technique/system used. PTR could be faster and protect against fracture followed by PTN; HI could adversely affect FR. FR may be associated with filling removal time.

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Case Report
Straightforward replication of digital wax-up design into direct composite resin restorations in adolescents using a custom 3-dimensionally printed index
Ra’fat Ibrahim Farah, Sanaa Najeh Al-Haj Ali, Abdullah Alharbi, Bandar Alresheedi
Restor Dent Endod 2024;49(4):e36.   Published online October 10, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e36
AbstractAbstract PDFPubReaderePub

This case report introduces a straightforward, noninvasive approach for the esthetic rehabilitation of malformed anterior teeth in adolescents using direct composite restorations. The universal composite resin restorations are applied within a transparent 3-dimensionally printed rigid-resin index, which is individually customized from a digital wax-up. Compared to other methods, this technique streamlines the restoration process, significantly reducing chairside time while enhancing the predictability, accuracy, and patient acceptance of the aesthetic outcome.

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Research Articles
Effects of different curing methods on the color stability of composite resins
Massimo Pisano, Alfredo Iandolo, Dina Abdellatif, Andrea Chiacchio, Marzio Galdi, Stefano Martina
Restor Dent Endod 2024;49(4):e33.   Published online September 5, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e33
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to compare the effects of different polymerization strategies and the effectiveness of finishing and polishing procedures of composite resins on color stability.

Materials and Methods

The samples were divided into 4 main groups according to the polymerization strategy, and all groups except the control group received surface treatment. Each group was subsequently divided into 3 subgroups respectively: Kuraray Clearfil Majesty ES-2 Classic, Premium and Universal. Approximately 24 hours after preparation of the samples, they were immersed for 7 days in a coffee solution. A first color measurement was performed after the preparation of the samples, the second measurement was performed after 7 days in the coffee solution. All measurements were carried out using a dental spectrophotometer to assess the CIE L* a* b* color parameters.

Results

There was a statistically significant difference between ΔE values for different procedures (p = 0.003); in particular, the differences were found only between the groups that received surface treatment and the control group. In addition, a statistically significant difference was observed between the values of ΔE for different composites in the different procedure groups.

Conclusions

Spectrophotometric analysis showed that the additional photopolymerization and oxygen inhibition procedures did not yield better results in relation to color stability. In addition, finishing and polishing provided better color stability compared to not performing these procedures.

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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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Alkasite restorative material for endodontically treated teeth: a randomized controlled pilot study
Davi Ariel Nobuo Bepu, Renata Siqueira Scatolin, Natalia Saud Junqueira Franco, Luiza Pejon Sanchez, Aline Evangelista Souza-Gabriel, Silmara Aparecida Milori Corona
Restor Dent Endod 2024;49(3):e24.   Published online June 11, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e24
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the clinical performance of an alkasite restorative material in molars that had undergone root canal treatment.

Materials and Methods

The research was registered in Brazilian Registry of Clinical Trials. The randomized clinical trial involved 33 patients, each with at least 1 mandibular molar requiring restoration after receiving endodontic treatment. Patients were randomly assigned to receive either bulk-fill resin composite (Tetric N Ceram Bulk Fill, Ivoclar Vivadent) or the alkasite restorative material (Cention N, Ivoclar Vivadent). Upon completion of the restorations, 3 calibrated professionals utilized the United States Public Health Service criteria to assess various factors, including retention, secondary caries, marginal adaptation, restoration color, marginal pigmentation, and anatomical form. Evaluations were conducted at intervals of 7 days, 6 months, and 17 months. Additionally, the assessment encompassed the presence of radiolucent lines adjacent to the restoration, material deficiencies or excess, contact points, and caries recurrence. The data underwent analysis using the Friedman and Mann-Whitney tests (α = 0.05).

Results

After 17 months, the results revealed that the alkasite restorative material exhibited greater wear of anatomical shape compared to the bulk-fill resin composite (p = 0.0189). Furthermore, the alkasite restorative material significantly differed from the natural tooth color in most cases (p = 0.0000). However, no other criteria displayed significant differences between the materials or over time (p > 0.05).

Conclusions

The alkasite restorative material (Cention N) emerges as a viable option for restoring endodontically treated teeth, displaying clinically acceptable alterations after a 17-month evaluation period.

Trial Registration

Brazilian Registry of Clinical Trials (ReBEC) Identifier: RBR-97kx5jv

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Can discolored dental composites be bleached in depth?
Luca Giachetti, Daniele Scaminaci Russo, Michele Nieri, Francesca Cinelli
Restor Dent Endod 2024;49(3):e23.   Published online June 11, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e23
AbstractAbstract PDFPubReaderePub
Objectives

Previous in vitro studies determined the whitening effects of bleaching products on stained resin composite surfaces. This in vitro study aimed to verify the effectiveness of a whitening system on composite resin previously subjected to pigmentation, specifically examining the depth of whitening effectiveness within the material structure.

Materials and Methods

A commercially available nano-filled composite resin was used. Specimens were stained using a coffee-based solution and a 10% carbamide peroxide-based gel was employed as the whitening agent. The pigment’s penetration and the effect of the bleaching gel were evaluated by measuring color (CieLab values) from the outer edge to the inner part of the specimens. Color measurements were taken at 14 points, starting from 0.1 mm from the external perimeter up to 3.0 mm.

Results

Analysis of variance tests showed a statistically significant difference between the Control Group (CG), Pigmentation Group, and Whitening Group. The whitening agent was effective up to 1.5 mm in depth, with Whiteness index (W) values not statistically different from those of CG up to 0.5 mm in depth.

Conclusions

Whitening agents on nano-filled resin composite previously pigmented appear effective in restoring the W to values similar to the original, particularly in the superficial layers of the sample.

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Pulp stones: any relevance with the levels of serum calcium, parathyroid hormone, vitamin D and uric acid
Ceyda Gürhan, Ercan Saruhan
Restor Dent Endod 2024;49(2):e17.   Published online March 26, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e17
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated the effect of serum calcium, parathyroid hormone (PTH), vitamin D, and uric acid levels on pulp stone formation.

Materials and Methods

Patients who were admitted to the Muğla Sıtkı Koçman University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology for dental complaints were registered. Among these patients, individuals who had routine biochemical tests at the same period in the Outpatient Clinics of Muğla Sıtkı Koçman University Training and Research Hospital were included in the study. The patients with at least 1 pulp stone on panoramic radiographs recorded as the “pulp stone group” while patients without any pulp stones were the “control group”. Demographic data and serum levels of calcium, PTH, vitamin D, and uric acid were retrospectively evaluated in both groups. Student t-test or Mann-Whitney U test was used to evaluate the differences between the groups.

Results

Among 151 patients, dental pulp stone was detected in 53.6% of patients, and 82.7% of these patients were female. Female sex and pulp stone formation were significantly associated (p = 0.001). The mean age of the pulp stone group was 43.9, while it was 39.9 in the control group, without any significant correlation between age and pulp stone (p > 0.05). Similarly, there were no significant differences in serum levels of PTH, vitamin D, uric acid and calcium between groups (p > 0.05).

Conclusions

According to the present study, the effect of dental factors rather than systemic factors should be considered primarily in pulp stone formation.

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Case Report
Garre’s osteomyelitis of the mandible managed by nonsurgical re-endodontic treatment
Heegyun Kim, Jiyoung Kwon, Hyun-Jung Kim, Soram Oh, Duck-Su Kim, Ji-Hyun Jang
Restor Dent Endod 2024;49(2):e13.   Published online March 18, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e13
AbstractAbstract PDFPubReaderePub

Chronic osteomyelitis with proliferative periostitis, known as Garre’s osteomyelitis, is a type of osteomyelitis characterized by a distinctive gross thickening of the periosteum of bones. Peripheral reactive bone formation can be caused by mild irritation or infection. Garre’s osteomyelitis is usually diagnosed in children and young adults, and the mandible is more affected than the maxilla. The following is a case report of a 12-year-old female patient with Garre’s osteomyelitis of the mandible due to an infection of a root canal-treated tooth. Without surgical intervention, the patient’s symptoms were relieved through nonsurgical root canal re-treatment with long-term calcium hydroxide placement. A cone-beam computed tomography image obtained 6 months after treatment completion displayed complete healing of the periapical lesion and resolution of the peripheral reactive buccal bone. Due to the clinical features of Garre's osteomyelitis, which is characterized by thickening of the periosteum, it can be mistaken for other diseases such as fibrous dysplasia. It is important to correctly diagnose Garre's osteomyelitis based on its distinctive clinical features to avoid unnecessary surgical intervention, and it can lead to minimally invasive treatment options.

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Research Articles
Color discrepancy of single-shade composites at different distances from the interface measured using cell phone images
Márcia Luciana Carregosa Santana, Gabriella de Jesus Santos Livi, André Luis Faria-e-Silva
Restor Dent Endod 2024;49(1):e7.   Published online January 24, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e7
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the impact of substrate color and interface distance on the color adjustment of 2 single-shade composites, Vittra APS Unique and Charisma Diamond One.

Materials and Methods

Dual disc-shaped specimens were created using Vittra APS Unique or Charisma Diamond One as the center composite, surrounded by shaded composites (A1 or A3). Color measurements were taken with a spectrophotometer against a gray background, recording the color coordinates in the CIELAB color space. Illumination with a light-correcting device and image acquisition using a polarizing filter-equipped cell phone were performed on specimens over the same background. Image processing software was used to measure the color coordinates in the center and periphery of the inner composite and in the outer composite. The color data were then converted to CIELAB coordinates and adjusted using data from the spectrophotometer. Color differences (ΔE00) between the center/periphery of single-shade and outer composites were calculated, along with color changes in single-shade composites caused by different outer composites. Color differences for the inner composites surrounded by A1 and A3 were also calculated. Data were analyzed using repeated-measures analysis of variance (α = 0.05).

Results

The results showed that color discrepancies were lowest near the interface and when the outer composite was whiter (A1). Additionally, Charisma Diamond One exhibited better color adjustment ability than Vittra APS Unique.

Conclusions

Color discrepancies between the investigated single-shade composites diminished towards the interface with the surrounding composite, particularly when the latter exhibited a lighter shade.

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The status of clinical trials regarding root canal sealers
Ahmad AL Malak, Yasmina EL Masri, Mira Al Ziab, Nancy Zrara, Tarek Baroud, Pascale Salameh
Restor Dent Endod 2024;49(1):e5.   Published online January 15, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e5
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to present the results and analyses of clinical trials, including updates on the different functions of root canal sealers.

Materials and Methods

In June 2023, we performed a comprehensive search of ClinicalTrials.gov to identify interventional clinical trials pertaining to root canal sealers. In total, 23 clinical trials conducted up to June 2023 were included in this study.

Results

Approximately half of the trials (11 out of 23) were completed, while none were terminated or withdrawn. Each included trial had a minimum of 10 participants, with 11 trials having more than 100 participants. None of the assessed trials provided outcomes, and the majority (17 out of 23) lacked associated publications. In terms of geographic distribution, the USA and Canada did not contribute to any root canal sealer trials.

Conclusions

This study highlights the lack of diversity in trial locations, the absence of reported results, and a scarcity of clinical trials examining the physicochemical properties of different sealers. Most published trials primarily focused on assessing the post-operative pain effect of these sealers, but no significant difference was found regarding post-operative pain control.

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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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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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Review Article
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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Research Articles
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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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
The clinical success of ART restorations and Hall technique in primary molars: a randomized 18-month follow-up study
Esra Oz, Zuhal Kırzıoglu, Canan Kale
Restor Dent Endod 2023;48(2):e19.   Published online May 1, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e19
AbstractAbstract PDFPubReaderePub
Objectives

The aim of the study was to evaluate the clinical and radiographic success of the Hall technique (HT) and atraumatic restorative treatment (ART) restorations using high-viscosity glass-ionomer cement for the management of occlusal carious lesions in primary molars.

Materials and Methods

This randomized clinical study observed 40 children (aged 5–6 years). For each child, one tooth was treated with HT and one with ART. The primary outcome measures for HT restorations were successful, minor, and major failure rates. Clinical evaluations of ART restorations were performed according to the modified United States Public Health Service criteria during 18-month follow-up. McNemar test was used for statistical analysis.

Results

Thirty of 40 (75%) participants returned for 18 months of follow-up. In the clinical evaluations of teeth that were treated with HT, the patients did not have complaints of pain or other symptoms, all crowns remained in the oral cavity, the gums were healthy, and the teeth were functional in all evaluations. At the end of the 18-month follow-up, the surface texture and marginal integrity criteria of ART restorations were recorded as 26.7% and 33.3%, respectively. In the radiographic evaluation of 30 patients treated with ART and HT, all restorations were considered successful.

Conclusions

The 18-month clinical and radiographic results after treatments applied to single-surface cavities in anxious children showed that both treatment methods were successful.

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Effects of surrounding and underlying shades on the color adjustment potential of a single-shade composite used in a thin layer
Mariana Silva Barros, Paula Fernanda Damasceno Silva, Márcia Luciana Carregosa Santana, Rafaella Mariana Fontes Bragança, André Luis Faria-e-Silva
Restor Dent Endod 2023;48(1):e7.   Published online December 29, 2022
DOI: https://doi.org/10.5395/rde.2023.48.e7
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the surrounding and underlying shades’ effect on the color adjustment potential (CAP) of a single-shade composite used in a thin layer.

Materials and Methods

Cylinder specimens (1.0 mm thick) were built with the Vittra APS Unique composite, surrounded (dual specimens) or not (simple specimens) by a control composite (shade A1, A2, or A3). Simple specimens were also built only with the control composites. Each specimen’s color was measured against white and black backgrounds or the simple control specimens with a spectrophotometer (CIELAB system). The whiteness index for dentistry (WID) and translucency parameters (TP00) were calculated for simple specimens. Differences (ΔE00) in color between the simple/dual specimens and the controls were calculated. The CAP was calculated based on the ratios between data from simple and dual specimens.

Results

The Vittra APS Unique composite showed higher WID and TP00 values than the controls. The highest values of ΔE00 were observed among simple specimens. The color measurements of Vittra APS Unique (simple or dual) against the control specimens presented the lowest color differences. Only surrounding the single-shade composite with a shaded composite barely impacted the ΔE00. The highest CAP values were obtained using a shaded composite under simple or dual specimens.

Conclusions

The CAP of Vittra APS Unique was strongly affected by the underlying shade, while surrounding this composite with a shaded one barely affected its color adjustment.

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Review Article
Effect of endodontic sealer on postoperative pain: a network meta-analysis
Cynthia Maria Chaves Monteiro, Ana Cristina Rodrigues Martins, Alessandra Reis, Juliana Larocca de Geus
Restor Dent Endod 2023;48(1):e5.   Published online December 29, 2022
DOI: https://doi.org/10.5395/rde.2023.48.e5
AbstractAbstract PDFPubReaderePub

This systematic review and network meta-analysis aimed to answer the following focused research question: “Does the type of endodontic sealer affect the postoperative pain in patients who received endodontic treatment?” Different databases and grey literature were surveyed. Only one randomized controlled trial were included. The risk of bias in the studies was evaluated by using the Cochrane Collaboration’s tool. A random-effects meta-analysis was conducted to compare the risk and intensity of postoperative pain. The quality of the body of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Out of 11,601 studies, 15 remained for qualitative analyses and 12 for meta-analysis. Seven studies were classified at high risk of bias, and 8 studies raised some concerns. No significant differences between the endodontic materials were observed in the direct comparisons, both in risk and in intensity of postoperative pain (pairwise comparisons with 2 studies: I2 = 0%; p > 0.05 and 8 studies: I2 = 23%; p > 0.05, respectively). The certainty of the evidence was graded as low or moderate. There was no difference in the risk and intensity of postoperative pain after filling with different endodontic sealers. Further systematic reviews should be conducted.

Trial Registration

PROSPERO Identifier: CRD42020215314

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Research Articles
Comparison of shaping ability of the Reciproc Blue and One Curve with or without glide path in simulated S-shaped root canals
Vincenzo Biasillo, Raffaella Castagnola, Mauro Colangeli, Claudia Panzetta, Irene Minciacchi, Gianluca Plotino, Simone Staffoli, Luca Marigo, Nicola Maria Grande
Restor Dent Endod 2022;47(1):e3.   Published online December 28, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e3
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to assess the impact of a glide-path on the shaping ability of 2 single-file instruments and to compare the centering ability, maintenance of original canal curvatures and area of instrumentation in simulated S-shaped root canals.

Materials and Methods

Forty simulated S-shaped root canals were used and were prepared with One Curve (group OC), One G and OC (group GOC), Reciproc Blue (group RB) and R-Pilot and RB (group PRB) and scanned before and after instrumentation. The images were analyzed using AutoCAD. After superimposing the samples, 4 levels (D1, D2, D3, and D4) and 2 angles (Δ1 and Δ2) were established to evaluate the centering ability and modification of the canal curvatures. Then, the area of instrumentation (ΔA) was measured. The data were analyzed using 2-way analysis of variance and Tukey's test for multiple comparisons (p < 0.05).

Results

Regarding the centering ability in the apical part (D3, D4), the use of the glide-path yielded better results than the single-file groups. Among the groups at D4, OC showed the worst results (p < 0.05). The OC system removed less material (ΔA) than the RB system, and for Δ1, OC yielded a worse result than RB (p < 0.05).

Conclusions

The glide-path improved the centering ability in the apical part of the simulated S-shaped canals. The RB system showed a better centering ability in the apical part and major respect of the canal curvatures compared with OC system.

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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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Case Report
Endodontic micro-resurgery and guided tissue regeneration of a periapical cyst associated to recurrent root perforation: a case report
Fernando Córdova-Malca, Hernán Coaguila-Llerena, Lucía Garré-Arnillas, Jorge Rayo-Iparraguirre, Gisele Faria
Restor Dent Endod 2022;47(4):e35.   Published online September 3, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e35
AbstractAbstract PDFPubReaderePub

Although the success rates of microsurgery and micro-resurgery are very high, the influence of a recurrent perforation combined with radicular cyst remains unclear. A 21-year-old white female patient had a history of root perforation in a previously treated right maxillary lateral incisor. Analysis using cone-beam computed tomography (CBCT) revealed an extensive and well-defined periapical radiolucency, involving the buccal and palatal bone plate. The perforation was sealed with bioceramic material (Biodentine) in the pre-surgical phase. In the surgical phase, guided tissue regeneration (GTR) was performed by combining xenograft (lyophilized bovine bone) and autologous platelet-rich fibrin applied to the bone defect. The root-end preparation was done using an ultrasonic tip. The retrograde filling was performed using a bioceramic material (Biodentine). Histopathological analysis confirmed a radicular cyst. The patient returned to her referring practitioner to continue the restorative procedures. CBCT analysis after 1-year recall revealed another perforation in the same place as the first intervention, ultimately treated by micro-resurgery using the same protocol with GTR, and a bioceramic material (MTA Angelus). The 2-year recall showed healing and bone neoformation. In conclusion, endodontic micro-resurgery with GTR showed long-term favorable results when a radicular cyst and a recurrent perforation compromised the success.

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Research Articles
Effect of intracanal cryotherapy on postoperative pain after endodontic treatment: systematic review with meta-analysis
Fernanda Garcias Hespanhol, Ludmila Silva Guimarães, Lívia Azeredo Alves Antunes, Leonardo Santos Antunes
Restor Dent Endod 2022;47(3):e30.   Published online July 4, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e30
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the effectiveness of final irrigation with cold saline solution after endodontic treatment compared with saline solution at room temperature against postoperative pain following endodontic treatment.

Materials and Methods

A broad search was performed in the PubMed, Web of Science, Scopus, Cochrane Library, Virtual Health Library (LILACS), and Grey Literature databases. Two independent reviewers performed data extraction, risk of bias using the Cochrane methodology, and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

Results

Eight studies were included in qualitative synthesis. Intracanal cryotherapy favored the reduction of postoperative pain in the systematic review. Four studies were included in meta-analyses. The meta-analysis showed that intracanal cryotherapy reduced postoperative pain in teeth with symptomatic apical periodontitis (SAP) at 24 hours. There was no association between intracanal cryotherapy and control (room temperature) groups in teeth with normal periapical tissue with respect to postoperative pain at 24 hours and 48 hours.

Conclusions

Intracanal cryotherapy was effective in reducing postoperative pain after endodontic treatment in teeth with SAP.

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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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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 Article
In-office dental bleaching with violet light emitting diode: bleaching efficacy and pulpal temperature rise
Brunna Katyuscia de Almeida Guanaes, Talyta Neves Duarte, Gisele Maria Correr, Marina da Rosa Kaizer, Carla Castiglia Gonzaga
Restor Dent Endod 2022;47(1):e7.   Published online February 3, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e7
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated the bleaching efficacy of different in-office protocols associated with violet light emitting diode (V-LED), and measured the pulpal temperature rise caused by V-LED with or without gel application.

Materials and Methods

Bovine incisors were distributed in 4 groups (n = 10): VL – V-LED; HP – 35% hydrogen peroxide (control); HYB – hybrid protocol, V-LED applied without gel for 10 irradiation cycles followed by V-LED applied with gel for another 10 irradiation cycles; and HPVL – gel and V-LED applied for 20 irradiation cycles. Three bleaching sessions were performed with 7-day intervals. Bleaching efficacy was evaluated with ΔEab*, ΔE00 and ΔWID. Data were recorded at baseline, 7, 14, 21 and 70 days. For pulpal temperature rise, thermocouples were placed inside the pulp chamber of human incisors. To determine intrapulpal temperature, the teeth were irradiated with V-LED with or without application of bleaching gel. Color difference data were analyzed by 2-way repeated measures ANOVA and Tukey’s test. Pulpal temperature was analyzed by t-test (α = 5%).

Results

VL exhibited lower color (ΔEab* and ΔE00) and whiteness changes (ΔWID) than the other groups. HPVL presented higher color change values than HYB. HYB and HPVL showed not different ΔWID values; and HP showed the highest whiteness changes at all times. There were significant differences comparing ΔT with gel (8.9°C) and without gel application (7.2°C).

Conclusions

HPLV was more efficient than HYB. The 2 protocols with VL showed similar results to control. Gel application combined with VL promoted higher pulpal temperature than to the no gel group.

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