فهرست مطالب
Iranian Endodontic Journal
Volume:19 Issue: 2, Spring 2024
- تاریخ انتشار: 1403/01/25
- تعداد عناوین: 10
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Pages 61-74Introduction
The current study aimed to compare the quality of root canal obturation performed with cold lateral condensation with other obturation techniques.
Materials and MethodsDiverse Search was conducted using six electronic/academic databases following PICOS (i.e. population, intervention, control, outcomes, and study design) strategy: (P) Extracted mature permanent teeth; (I) Obturation techniques except for cold lateral condensation; (C) Cold lateral condensation tyechnique; (O) Quality of root canal obturation; and (S) In vitro studies assessing parameters using micro-computed tomography. The statistical method used for the meta-analyses was the “inverse variance DerSimonian-Laird test”. The heterogeneity data was calculated using the T2, Cochran Q test, and I2 statistics.
ResultsFifteen studies were included for the final analysis; one had a low risk of bias, eight a moderate risk, and six a high risk of bias. Ten studies were selected for meta-analyses; three studies comparing cold lateral condensation with carrier-based gutta-percha techniques [P=0.96; mean difference (MD)=-0.02; confidence interval (CI): (-0.77, 0.73); I2=21%]; three comparing cold lateral condensation with single-cone techniques [P=0.75; MD=-0.39; CI: (-2.77, 1.99); I2=92%]; two comparing cold lateral condensation and thermo-plasticized injectable techniques [P=0.37; MD=5.91; CI: (-7.13,18.94); I2=99%]; and five comparing cold lateral condensation with warm vertical condensation techniques [P<0.0001; MD=5.29; CI=(2.84, 7.74); I2=92%]. The overall effect reported significant results [P=0.0003; MD=2.69; CI=(1.23, 4.16); I2=96%]; favoring fewer voids and gaps for the other used obturation techniques.
ConclusionsCold lateral condensation and single-cone techniques presented no statistical differences. Nonetheless, Warm vertical condensation technique had better results compared to cold lateral condensation.
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Pages 75-84Introduction
Foraminal Enlargement (FE) is a cleaning performed in the apical-most region of the tooth, in order to optimize root disinfection. This systematic review evaluated the influence of FE during root canal treatment on bacterial reduction and repair of the periapical lesion.
Materials and MethodsSearches in PubMed/MEDLINE, Scopus, Cochrane Library, Web of Science, Embase, Scielo, Lilacs and OpenGrey were performed until January-2024. Ex vivoand in vivostudies evaluating the effects of FE in the bacterial reduction and repair of the periapical lesion were included, respectively, followed by risk of bias assessment (modified version of Joanna Briggs Institute’s for ex vivostudies and Systematic Review Centre for Laboratory animal Experimentation’s risk of bias tools for in vivostudies). The meta-analysis was not feasible and a qualitative summary for each outcome was provided.
ResultsOf 950 studies, 2 in vivostudies were eligible, using animal models with infected teeth. Of these two, periapical repair was evaluated with hematoxylin-eosin stain, and FE improved periapical healing. Regarding ex vivo studies, 3 were eligible, using extracted human teeth. The inoculations in ex vivomodels were performed with Enterococcus (E.) faecalis, and FE reduced E. faecalis in the ex vivomodels.
ConclusionsForaminal enlargementseems to increase bacterial reduction within the root canal, and provide major periapical tissue repair on the histological analysisin animal studies. However, caution is necessary when translating these results to the clinical environment.
Keywords: Endodontics, Periapical Disease, Periapical Repair, Root Canal Instrumentation, Tissue Healin -
Pages 85-98
Artificial intelligence (AI) is transforming the diagnostic methods and treatment approachesinthe constantly evolving field of endodontics. The currentreview discusses the recent advancements in AI; with a specific focus on convolutional and artificial neural networks. Apparently, AI models have proved to be highly beneficial in the analy sis of root canal anatomy,detecting periapical lesions in early stages as well as providing accurate working-length determination. Moreover, they seem to be effective in predicting the treatment success next toidentifying various conditions e.g., dental caries, pulpal inflammation, vertical root fractures, and expression of second opinions for non-surgical root canal treatments. Furthermore, AI has demonstrated an exceptional ability to recognize landmarks and lesions in cone-beam computed tomography scans with consistently high precision rates. While AI has significantly promoted the accuracy and efficiency of endodontic procedures, it is of high importance to continue validating the reliability and practicality of AI for possible widespread integration into daily clinical practice. Additionally, ethical considerations related to patient privacy, data security, and potential bias should be carefully examined to ensure the ethical and responsible implementation of AI in endodontics.
Keywords: Artificial Intelligence, Artificial Neural Networks, Deep Learning, Diagnostic Precision, Endodontics, Convolutional Neural Networks -
Pages 99-104Introduction
This study explored the effects of propolis extract calcium hydroxide (Ca(OH)2) combination on malondialdehyde and superoxide dismutase expression in dental pulp, aiming to assess its potential as a direct pulp capping material.
Materials and MethodsThirty male Wistar rats were randomly assigned to three groups. Mandibular molar teeth were prepared using a low-speed round bur. In Group I, no material was applied; in Group II, teeth were treated with Ca(OH)2; and in Group III, teeth were treated with Propolis extract-Ca(OH)2, followed by Cention N filling. Immunohistochemistry was conducted on pulp tissue samples obtained on the third and seventh days post-treatment to assess malondialdehyde and superoxide dismutase expression. Statistical analyses included the Shapiro-Wilk test, Levene test, ANOVA, and Tukey’s HSD.
ResultsThe samples treated with propolis extract-Ca(OH)2combination exhibited significantly lower malondialdehyde expression on both days compared to samples treated with Ca(OH)2 (P<0.05), indicating reduced oxidative stress. Superoxide dismutase expression in the propolis extract-Ca(OH)2 group was higher (P<0.05), suggesting an enhanced antioxidant activity. The control group showed intermediate results. Statistical analyses confirmed significant differences between groups for both malondialdehyde and superoxide dismutase expressions (P<0.05).
ConclusionThe study suggests that the propolis extract-Ca(OH)2combination holds promise for direct pulp capping applications by minimizing oxidative stress and promoting antioxidant defense mechanisms in dental pulp.
Keywords: Calcium Hydroxide, Direct Pulp Capping, Malondialdehyde, Propolis, Superoxide Dismutase -
Pages 105-111Introduction
The success of endodontic treatment is based on microbial reduction promoted by the interaction of chemical and mechanical procedures. Photodynamic therapy (PDT) is used as an adjunct to conventional treatment, with significant microbial reduction. This study aimed to evaluate the influence of passive ultrasonic irrigation (PUI) of the photosensitizer (PS) used in PDT on microbial reduction in the root canal system.
Materials and MethodsForty-five mesiobuccal root canals from extracted human mandibular molars that were inoculated with standard strains of Enterococcus faecalis, Candida albicans, and Streptococcus mutansfor 21 days were selected. The root canals were prepared using the ProTaper Next system and randomly divided into 3 groups (n=15): 1) PDT : PDT alone; 2) PUI+PDT: PUI followed by PDT; and 3) PUI/PS+PDT: PUI of the PS followed by PDT. Microbiological samples were collected from the canals before and after using the protocols described above. The data were analyzed by analysis of variance (Tukey’s test) at a significance level of 5%.
ResultsMicrobial counts before PDT, PUI+PDT, and PUI/PS+PDT did not differ significantly (P>0.05), showing methodological standardization in the microbial contamination of the root canal system. There was a significant reduction in microbial counts after PDT (61.05%), PUI+PDT (65.04%), and PUI/PS+PDT (68.58%) (P<0.01), but with no statistically significant difference between the three groups (P>0.05).
ConclusionBased on the present findings, it was concluded that the combination of PUI with PDT or PS activation did not influence microbial reduction achieved by PDT alone
Keywords: Endodontics, Methylene Blue, Photochemotherapy, Photosensitizing Agents, Root Canal Irrigant -
Pages 112-119Introduction
Thefinalstepofirrigationhasbeenconsideredtoofincreasethebondingstrengthoffillingmaterial to dentin. This study investigated the impact of three final -step irrigation methods on the endodonticsealer bond strength to dentin by using a micro push-out test.
Materials and MethodsPalatal roots of humanmaxillary molars were cleaned and shaped and randomly divided in six groups (n=15) according to the final-step irrigation method and the type of root canal sealer used. The solutions used for the final -step irrigationwere 17% ethylenediaminetetraacetic acid and 2.5% sodium hypochlorite, which underwent thre e
methods1)syringe-needle irrigation/conventional, 2) passive ultrasonic irrigation, and 3) XP-e ndo Finisher agitation. Theroot canal sealers used were: EndoSequence BC Sealer, and AH-Plus sealer. Roots were obturated with thesingle cone technique and then, cross -sectioned in 2- mm-thick slices (3 slices from each root). Push -out testwas performed on the sliced specimens (cervical, middle, and apical thirds) with a universal testing machine.Bond strength values were recorded in megapascal (MPa). Subsequently, each specimen was longitudinallysplit to verify the type of failur e. Data analysis was performed using Johnson transformation, three -way analysisof variance, Tukey’s post -hoc tests, and the partial Eta squared test.
ResultsThere were significant differencesin bond strength between the sealers [AH: 4.46±2.24 and BC: 3.47±2.19 MPa (P<0.001)]; between final -stepirrigation methods [ passive ultrasonic irrigation: 4.52±2.25, XP-e ndo Finisher: 3.93±3.93 and syringe-needleirrigation/conventional: 3.37±2.51 MPa (P<0.001)], and between the root canal thirds represented by the slicedspecimens [cervical: 5.45±2.39, middle: 4.14±1.99 and apical: 2.30±1.30 MPa (P<0.001)]. The interactionbetween the variables had no significance (P>0.05).
ConclusionAgitation of the final irrigating solution mayimprove the bonding of the sealer to canal walls. AH-Plus sealer had the highest bond strength. The bondstrength reduced significantly towards the apical thir
Keywords: Bond Strength, Final Flush, Final -Step Irrigation Methods, Outshout Test, Passive Ultrasonic Irrigation, Root Canal Treatment, XP-endo Finisher -
Pages 120-123
In this case report, the regeneration method was used to treat the previously treated first molar, which presented with symptoms of pain during chewing and secondary acute apical periodontitis.Due to the importance of preserving the patient's permanent teeth in order to maintain optimal space and function, the regeneration treatment was performed in two visits and according to the American Association of Endodontists (AAE) guidelines. The continuation of tooth root development, healing of periapical radiolucency and positive response to sensibility test (cold test) were observed during follow-up radiographs at intervals of 6 months, 1 year & 2 year.
Keywords: Immature Permanent Tooth, Open Apex, Previously Treated Tooth, Regenerative Endodontics, Revascularization -
Pages 124-129
The current case report aims to document a rare presentation of a distant odontogenic lesion of a 35-year -old male patient with mild clinical discomfort in the mandibular right first molar; exploring the diagnostic and therapeutic intricacies of an uncommon distant endodontic pathosisultimately resolved through meticulous nonsurgical retreatment. Desp ite a normal oral examination, diagnostic radiography revealed a suboptimal root canal treatment and apical lesions surrounding mesial- and distal-root apices; including a distinct radiolucency beneath the apex of the second mandibular molar discovered through panoramic radiography, and confirmed via cone-beam computed tomography. In addition, the computed tomography disclosed a previously unreported and unusually large endodontic lesion that extended toward the mandibular canal; highlighting a necessity for the continued exploration of a unique endodontic presentation. A nonsurgical endodontic retreatment led to a remarkable reduction in the radiolucent lesions within one year; emphasizing the significance of comprehensive diagnostic approaches and individualized treatments
Keywords: Cone -beam Computed Tomography, Distant Endodontic Lesion, Endodontic Pathology, Nonsurgical Retreatment -
Pages 130-133
Endodontic treatment in dens invaginatus anomaly is associated with challenges in all stages.This case report outlines the therapy provided for tooth #10 with occasional pain. In examinations, tenderness to percussion and touch and non-response to sensibility tests were observed, and pulp necrosis and symptomatic periapical periodontitis were diagnosed.Radiographic evaluation showed a structural anomaly related to the dens invaginatus and the associated periapical lesion. Cone-beam computed tomography confirmed the presence of DI type II. Endodontic treatment combined with photodynamic therapy and active irrigation using a dental operating microscope was successful and radiographic examinations showed periapical healing along with bone formation in 6-month and 1-year follow-up.
Keywords: Dens Invaginatus, Disinfection, Photodynamic Therapy, Root Canal Therapy -
Pages 134-138
Endodontic management of teeth afflicted with pulp canal obliteration faces a challenge due to the heightened risk of complications including excessive wear, perforation, and suboptimal chemomechanical preparation. This report aims to elucidate the clinical endodontic strategy employed in addressing pulp canal obliteration after a history of dental trauma and an associated periradicular lesion in an upper lateral incisor. A patient visited the dental emergency department with symptoms of apical swelling, acute persistent pain, and discoloration of tooth 22. Following comprehensive clinical evaluation and cone-beam computed tomography, the diagnosis of pulp canal obliteration involving the cervical and middle thirds of the tooth, alongside an acute periradicular abscess was established. Root canal was accessed using tomographic image planning, augmented by loupe magnification and ultrasonic instrumentation. Precise identification of the access cavity was radiographically confirmed,preceded by thorough irrigation with 2.5% sodium hypochlorite and subsequent cervical and middle third preparation. Verification of the working length by an electronic apex locator ensured precise apical preparation, followed by passive ultrasonic irrigation to optimize disinfection and to enhance penetrability of intracanal calcium hydroxide medication, administered for 15 days to eliminate microbial invasion. Upon resolution of symptoms, root canal obturation employing thermo-mechanical compaction and coronal sealing with composite resin was accomplished. Radiographic assessment after a one-year interval presented evidence of lesion regression and bone repair. Subsequent cone-beam computed tomography imaging at the three-year follow-up confirmed complete healing of the periradicular tissues, attesting to the efficacy of the endodontic intervention.
Keywords: Dentistry, Endodontics, Pulp Canal Obliteration, Traumatic Dental Injury