Abstract Introduction: In endodontics, antibiotics and analgesics are frequently prescribed, yet many prescriptions remain inappropriate, contributing to antimicrobial resistance, adverse drug events, and increased healthcare burden. Despite clear recommendations from the American Association of Endodontists (AAE), European Society of Endodontology, and American Dental Association (ADA), a knowledge–practice gap persists. Clinical decision-support systems (CDSS) may help standardize prescribing, but their role in endodontics remains underexplored. This study aimed to assess antibiotic and analgesic prescribing patterns among endodontic clinicians, evaluate adherence to stewardship guidelines, identify predictors of inappropriate prescribing, and explore the potential role of CDSS. Materials and Methods: A cross-sectional survey was conducted among 385 participants (postgraduate students, academic faculty, and private practitioners) across India. A validated questionnaire collected demographic data, prescribing behavior in five structured clinical vignettes and perceptions of CDSS. Appropriateness was evaluated against AAE/ADA recommendations. Data were analyzed using descriptive statistics, Chi-square tests, and logistic regression. Results: Overall, 33.8% of prescriptions were inappropriate. Inappropriate prescribing was highest among postgraduate students (36.5%), followed by faculty (34.1%). Guideline awareness showed no significant association with appropriateness ( χ ² =0.27, P = 0.60). Logistic regression revealed no significant predictors, though postgraduate and faculty status showed nonsignificant higher odds of inappropriate prescribing. Nonsteroidal anti-inflammatory drugs were most commonly prescribed (54.5%), whereas 11.7% reported opioid use. Notably, 68.8% of respondents expressed support for CDSS integration. Conclusion: Inappropriate prescribing remains prevalent in endodontics, unaffected by guideline awareness or practice type. Persistent suboptimal analgesic patterns highlight the need for multifaceted stewardship interventions. Integration of CDSS, alongside education and system-level measures, may improve alignment with evidence-based practice.
Abstract Introduction: Preserving the original canal anatomy while achieving efficient shaping is a major challenge in curved root canals. This study aimed to compare the shaping performance of three rotary file systems: Neoendo Neotaper, ProTaper Next, and HERO Shaper Gold, using cone-beam computed tomography (CBCT). Materials and Methods: Forty-five extracted mandibular first molars with 25°–30° curved mesiobuccal canals were randomly divided into three groups ( n = 15). Each group was instrumented with one of the rotary systems following the manufacturers’ protocols. Pre- and postinstrumentation CBCT scans were obtained at 3 mm and 7 mm from the apex to evaluate dentin removal, canal transportation, and centering ratio. Statistical analysis was performed using one-way analysis of variance and Tukey’s post hoc test ( P < 0.05). Results: Neoendo Neotaper exhibited the least dentin removal and canal transportation at both levels, while ProTaper Next demonstrated the best centering ability. HERO Shaper Gold showed the highest dentin removal and transportation, particularly at the 7-mm level. The intergroup differences were statistically significant ( P < 0.05). Conclusion: Neoendo Neotaper preserved canal anatomy most effectively, ProTaper Next achieved optimal centering, and HERO Shaper Gold produced the greatest dentin loss. CBCT proved to be a reliable tool for three-dimensional evaluation of canal shaping.
Abstract External root resorption is a progressive and destructive condition often triggered by trauma, which may compromise the long-term prognosis of affected teeth. This case report describes the management of a 27-year-old female who presented with pain and mobility in the maxillary anterior region, 6 months after trauma. A provisional diagnosis of symptomatic apical periodontitis secondary to chronic irreversible pulpitis was made. Clinical and radiographic assessment, supplemented with cone-beam computed tomography (CBCT), confirmed external inflammatory root resorption involving the left maxillary central and lateral incisors with associated symptomatic apical periodontitis secondary to pulp necrosis. Conventional endodontic treatment was initiated using intracanal medicaments, including calcium hydroxide and triple antibiotic paste, followed by obturation with a bioceramic sealer. Owing to the extent of resorptive defects, intentional replantation was performed. Both teeth were atraumatically extracted, extraoral defects were repaired with bioceramic putty, and the teeth were reimplanted and stabilized with a flexible splint. At the 18-month follow-up, the patient remained asymptomatic with normal probing depths, absence of mobility, and radiographs demonstrating satisfactory periapical healing without signs of progressive resorption. The patient expressed satisfaction with the treatment as it allowed preservation of her natural teeth. This case emphasizes the importance of early diagnosis with CBCT and highlights intentional replantation, combined with bioactive materials, as a viable option for advanced resorption cases that might otherwise require extraction.
Abstract Introduction: Dynamic navigation technology is revolutionizing endodontic microsurgery by enabling real-time surgical guidance and improved procedural accuracy. The incorporation of trephine burs and multiple drill techniques has further enhanced the precision and predictability of root-end resections. Within this context, the present study aimed to compare the accuracy and efficiency of two dynamic navigation-assisted root-end resection techniques. Materials and Methods: Thirty standardized three-dimensionally printed maxillary central incisors were fabricated and randomly allocated into three groups ( n = 10 each): freehand with trephine (FH-T), dynamic navigation system (DNS)-assisted trephine, and DNS -assisted sequential drills. Preoperative cone-beam computed tomography (CBCT) scans were obtained, and root-end resection was performed following the respective group protocols. Postoperative CBCT scans were then acquired to evaluate accuracy parameters, including entry, apex, and angular deviations, using EvaluNav ® software. The operation time for each procedure was recorded to assess efficiency. Data were analyzed using one-way analysis of variance with Tukey’s post hoc test ( P ≤ 0.05). Results: The DNS-assisted trephine approach demonstrated a significantly lower mean entry deviation, apex deviation, and angular deviation, in addition to the shortest operation time compared to the FH-T approach. Conclusion: The DNS-assisted trephine approach demonstrated superior accuracy in entry, apex, and angular deviations, along with the shortest operation time, indicating enhanced efficiency compared to the freehand trephine approach.
Abstract Introduction: The detection of vertical root fractures (VRFs) in root canal-treated teeth with metallic posts is challenging because of beam hardening artifacts in cone-beam computed tomography (CBCT) images. This in vitro study aimed to evaluate whether placing a cotton spacer could reduce artifacts and improve diagnostic accuracy in CBCT detection of VRFs. Materials and Methods: Twenty single-rooted human teeth were selected and endodontically treated, and metallic posts were placed. VRFs were artificially induced in a subset. Teeth were mounted in dry human mandibles with simulated soft tissue and scanned via CBCT, both with and without a cotton spacer placed between the mandible and phantom head. Two observers independently evaluated the scans in the axial, coronal, and sagittal planes. Artifact reduction was quantified via ImageJ software. Diagnostic performance was assessed via sensitivity, specificity, predictive values, and Cohen’s kappa for inter- and intraobserver reliability. Statistical significance was tested via one-sample t -tests and Shapiro–Wilk tests. Results: Interobserver and intraobserver agreement improved with spacer use. The diagnostic accuracy for detecting VRFs improved from 65% (without spacers) to 80% (with spacers). The sensitivity increased from 40% to 60%, and the specificity increased from 90% to 100%. The use of a cotton spacer significantly reduced artifacts by an average of 25.19% ( P < 0.001). Conclusion: Incorporating a cotton spacer during CBCT imaging significantly reduces artifacts and improves both diagnostic accuracy and observer reliability in detecting VRFs in teeth with metallic posts.
Abstract Contextual clues are used to reach the proper diagnosis of a primary periodontal lesion secondary to endodontic involvement, which is an absence of any cause of endodontic infection, such as caries or deep restoration. Therefore, treatment should involve a sequential approach of periodontal and endodontic treatment to address disease entities. A 45-year-old diabetic patient was complaining of maxillary left first molar area, showed a negative response to cold testing, and was not sensitive to percussion or palpation. The tooth has no caries or previous restorations. Deep palatal and interproximal pockets, Grade II furcation involvement, and Grade I mobility were identified. After performing root canal therapy, the palatal root was resected, and retrograde filling was performed with bioceramic putty, followed by freeze-dried bone allograft mixed with recombinant human platelet-derived growth factor-BB (rhPDGF BB) to graft the socket. Follow-up assessments were scheduled for 2 weeks, 3 months, 6 months, and 1 year, revealed significant healing in periodontal health. The patient experienced significant pain relief, along with improved tooth stability and the infection resolving. Root resection combined with rhPDGF-BB and bone grafting has proven to be an effective treatment modality for managing endodontic-periodontal lesions. However, further clinical research is necessary to validate the long-term efficacy and broader applicability of this technique.
Abstract Introduction: Artificial intelligence (AI) chatbots are increasingly used by the public to obtain medical and dental information, including inquiries related to endodontic surgery. Evaluating the accuracy of these platforms is essential to ensure reliable patient education. This study aimed to assess and compare the reliability of three advanced AI chatbot platforms – ChatGPT-5, DeepSeek, and Grok in responding to patient-style questions related to surgical endodontic treatment. Materials and Methods: A set of 16 patient-centered questions covering four domains (indications, procedure, postoperative care, and complications) was presented to each AI platform. Responses were independently evaluated by two board-certified specialists using a 5-point Likert-type scale (1 = strongly disagree to 5 = strongly agree) reflecting alignment with evidence-based surgical endodontic standards. Descriptive statistics were used to summarize the distribution of ratings, and a Chi-square test was prespecified for potential comparative analysis. Results: All platforms demonstrated consistently high reliability. ChatGPT-5 and DeepSeek each received 15 ratings of 5 and 1 rating of 4, while Grok received 14 ratings of 5 and 2 ratings of 4. No responses from any platform were rated as neutral or negative. Because all responses were rated “agree” or “strongly agree,” no inferential statistical testing was performed. Conclusions: All tested AI chatbot platforms performed comparably in delivering clinically relevant and accurate responses to patient-style endodontic questions. These findings suggest that modern AI chatbots may serve as valuable adjuncts in dental communication and education, particularly in enhancing patient understanding and engagement.
Abstract Introduction: System B is a widely used endodontic heat source for warm vertical condensation (WVC) during root canal obturation. As gutta-percha (GP) remains the most commonly used obturation material, this study evaluated the thermal conduction characteristics of three rotary GP cones with different tapers using both experimental measurements and thermal modeling. Materials and Methods: Root canal treatment was performed on eight extracted, single-rooted maxillary central incisors. The thermal conductivity and diffusivity of ProTaper NEXT, WaveOne Gold (W1G), and ProTaper Universal (PTU) GP cones were measured using a modified transient plane source technique. Temperature changes were recorded at 0.5 mm, 2.5 mm, and 10.5 mm along the cone using K-type thermocouples and the System B heat source. A two-dimensional axisymmetric transient heat conduction simulation was performed to validate experimental results. The output temperature of the System B tip was also evaluated for consistency and accuracy. Data were statistically analyzed. Results: PTU exhibited the highest thermal conductivity (1.07 W/m·K) and diffusivity (6.0 × 10 -7 m²/s), while W1G showed the greatest mean maximum temperature and temperature rise at 0.5 mm and 2.5 mm ( P < 0.05). Thermal simulation showed that up to 0.9 mm of the GP cone reached the softening temperature (≥65 °C). Taper size significantly influenced both the extent and direction of heat conduction. Conclusions: GP cone composition and taper significantly influence thermal conduction during WVC. Cones with low zinc oxide content showed superior heat transmission, and greater taper enhanced apical heat flow.
Abstract Introduction: Endodontics is a core component of general dental practice, yet many general dentists perceive root canal treatment as complex and prefer referral to specialists. Confidence in endodontic knowledge and skills influences whether practitioners treat independently or refer. This study assessed confidence levels and referral patterns among general dentists in Al-Madinah Al-Munawwarah, Saudi Arabia. Materials and Methods: A cross-sectional, paper-based questionnaire survey was conducted among practicing general dentists at 11 governmental hospitals/health centers and 25 private clinics. A total of 266 dentists participated. The validated questionnaire assessed confidence in endodontic care and referral practices. Data were analyzed with SPSS using Chi-square tests to determine associations between confidence and influencing factors. Results: While 83% of respondents reported confidence in their endodontic knowledge, only 42% felt confident in their diagnosis competence. Confidence was positively associated with years of experience and participation in professional development ( P < 0.05). Among those with diagnostic confidence, 66.7% performed full root canal treatments ( P < 0.05). Higher confidence was also linked to undertaking complex procedures such as orthograde retreatment. Risk of litigation was a concern for most general dental practitioners (88%), and 84% expressed a need for more training opportunities. Conclusions: The majority of general dentists in Al-Madinah Al-Munawwarah demonstrated confidence in their endodontic knowledge, particularly with greater experience and training. Diagnostic confidence was limited among the majority, with those reporting lower confidence tending to restrict care to emergency pulp extirpation. Referrals to specialists were mainly for complex retreatment cases, although more confident dentists referred less.
Abstract Introduction: Periapical lesions (PALs) are common sequelae of pulpal infection, and accurate detection of these lesions is essential for diagnosis, treatment planning, and long-term prognosis. Although cone-beam computed tomography (CBCT) has improved the identification of periapical pathology, its interpretation remains operator-dependent and subject to interobserver variability. Recent advances in artificial intelligence (AI) have shown promise in automating image analysis and supporting diagnostic decision-making. This study was performed to assess the diagnostic performance of AI-based algorithms in detecting PALs on CBCT images. Materials and Methods: This review follows Preferred Reporting Items for Systematic Reviews and Meta-Analysis – Diagnostic Test Accuracy guidelines. A comprehensive search was conducted in PubMed, SCOPUS, EBSCOhost, and Google Scholar until September 2025. Eligible studies compared AI algorithms with expert examiners or reference standards for PALs detection in CBCT imaging. Methodological quality was assessed using the quality assessment of diagnostic accuracy studies (QUADAS)-2 tool, and meta-analysis was performed for calculating pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratios, and overall accuracy in terms of area under the curve (AUC) through summary receiver-operating characteristics (SROC). Results: Eight studies ( n = 2820 CBCT images) met the inclusion criteria. AI algorithms assessed were artificial neural networks, convolutional neural networks, deep learning, Diagnocat, VGG-16, and DenseNet-121. The pooled sensitivity and specificity were 0.76 (95% confidence interval [CI]: 0.37–0.97) and 0.88 (95% CI: 0.48–1.00), respectively, with an AUC of 0.89, indicating excellent diagnostic performance. Most studies demonstrated low-to-moderate risk of bias (ROB). Conclusion: AI algorithms demonstrated good to excellent diagnostic performance for detecting radiographic signs of periapical disease and may serve as adjunctive tools in endodontic diagnosis. However, their current application is limited to image-based interpretation and should be complemented by clinical assessment.
Abstract Introduction: This study aims to investigate the apical morphology of mandibular premolars using microcomputed tomography (micro-CT) analysis. The research quantified the distance from the apical foramen to the anatomical apex (AFA) and apical constriction to the anatomical apex (ACA) concerning the periapical (PA) findings. Materials and Methods: Three-dimensional scanning images of 80 extracted mandibular premolar teeth were reconstructed using the free software. The apical morphology, including the location of apical foramen (AF) and apical constriction (AC), and the mean distance from AFA, ACA, and mid-AF to AC (AFC) in relation to PA radiographic findings, was evaluated. All the parameters were evaluated by two researchers. The independent t -test was utilized to assess the mean differences of AFA and ACA between the two groups regarding PA findings. Results: Eighteen subjects (22.5%) exhibited radiographic evidence of PA lesions or root resorption. Conversely, 62 subjects (77.5%) indicated no signs of PA lesions. Consequently, the average AFA distances were 0.46 mm and 0.54 mm with and without accounting for PA findings, respectively. The average ACA and the height between AFC regarding PA findings were also 0.62 and 0.48 mm, respectively. In contrast, these values in the absence of PA findings were 0.78 and 0.53 mm, respectively. Conclusion: Despite certain constraints, this micro-CT study did not demonstrate significant correlations among AFA, ACA, AFC distances, and PA evidence. Therefore, subsequent research should augment the total quantity of tooth samples pertaining to PA findings. This augmented dataset will facilitate more rigorous statistical analysis and accurately represent the actual alterations in apical morphology.
Abstract Introduction: Calcium silicate-based cements are widely used in endodontic procedures due to their bioactivity and biocompatibility. NeoMTA 2 is a newer formulation designed to improve radiopacity, setting performance, and manipulation compared with earlier materials. This study aimed to compare the setting time and surface microhardness of NeoMTA 2 and Biodentine cements. Materials and Methods: Seven specimens of cement, two groups (NeoMTA 2 and Biodentine), were prepared in type II gypsum molds for setting time evaluation and tested with Gillmore needles at 37°C under controlled humidity. For microhardness, 48 disk-shaped specimens were prepared (24 per material), with half stored for 4 days and the other half for 7 days ( n = 12 per group). Three indentations were averaged for each specimen. Data were analyzed using two-way analysis of variance and Tukey’s post hoc tests (α =0.05). Results: Biodentine showed significantly shorter initial and final setting times than NeoMTA 2 ( P < 0.001). Biodentine also demonstrated higher microhardness values at both 4 and 7 days ( P < 0.001). Both materials exhibited significant increases in hardness over time, while the interaction between cement and storage period was not significant. Conclusion: NeoMTA 2 and Biodentine exhibited clinically acceptable setting and microhardness behavior. Biodentine set faster and reached higher hardness, which may be advantageous when early mechanical performance is required. NeoMTA 2 still showed improved behavior compared with earlier MTA formulations, supporting its suitability for clinical use.
Abstract Introduction: Zirconia endocrowns (ECs) combine high fracture resistance with low bacterial adhesion potential, yet the optimal axial height for clinical success remains unclear. This in vitro study assessed and measured the effect of different axial height-length designs on the bacterial colony-forming unit (CFU), fracture resistance, and fracture patterns in one-piece molars’ ECs. Materials and Methods: Forty fresh extracted maxillary and mandibular molar teeth were categorized according to the remaining axial height (extending from 2 to 4 mm on all surfaces), with an additional 2 mm intrapulpal extension. Specimens underwent thermocycling for 10,000 cycles during aging, and then the bacterial CFU of Streptococcus mutans bacteria was counted. A universal testing device was utilized for testing the fracture resistance and failure types, which were classified under magnification. Data were analyzed using the SPSS to assess significance between and within groups, where a P ≤ 0.05 indicated statistical significance. Results: The count of adhered S. mutans bacteria was high in all groups, 498 ± 5.027 and 516 ± 7.967 (CFU/mm²), without significant differences, P > 0.05. Fracture force analysis in Newton indicated the highest values for 2 mm mandibular one-piece ECs for molars (2658.15 ± 118.41), with significant differences compared to maxillary one-piece ECs molars at 2 mm ( P < 0.05) but with no significant differences at 4 mm ( P = 0.72). Failure patterns showed that Type V fractures (irreparable) were most common in mandibular one-piece ECs, whereas Type III failures (reparable) were least frequent. Conclusion: One-piece ECs with a 2 mm axial height in both arches showed the highest bacterial CFU and fracture resistance. Irreparable fractures were more common in mandibular one-piece ECs, whereas most of the maxillary molars show an irreparable fracture type.
Abstract Introduction: Endodontic files separation is the common complication in endodontics. This study aimed to determine the prevalence and management techniques for separated endodontic files among endodontic postgraduate students in the Qassim region. Materials and Methods: This retrospective cross-sectional study evaluated nonsurgical endodontic treatments performed by postgraduate students in the Qassim region, Saudi Arabia, including 1879 permanent teeth with complete records. Data were collected using a structured pro forma on patient demographics, file separation during treatment (type, location, and management), and follow-up. Associations between file separation, training center, and year of training were assessed using the Chi-squared or Fisher’s exact tests. Risk factors for file separation were identified using binary logistic regression. Results: File separation occurred in 48 cases (2.6%) and did not differ between centers but was significantly associated with year of training, being highest among 2 nd -year residents (14.4%). Most separations involved rotary files (79.2%), particularly ProTaper Next (31.3%) and EdgeFile X7 (25.0%) and were most frequent in molars (72.9%), especially the mesio-buccal canal, typically in the apical third, with fragment lengths ≤3 mm. Multivariate analysis showed 2 nd -year trainees (odds ratios [OR] 17.3, 95% confidence intervals [CI] 7.06-50.2), rotary file use (OR 3.89, 95% CI 1.93–7.85), and molar teeth (OR 4.88, 95% CI 1.55–15.39) as the significant predictors of file separation. Most of cases with instrument separation were managed by bypassing the fragment (39.6%). When an active removal method was applied, ultrasonics was the most commonly used. Conclusions: Although separation of endodontic files was low (2.6%) among postgraduates, it occurred more often with rotary files in molars and among 2 nd -year trainees. Most of the separated files were handled by either bypassing the fragment or leaving it in place highlighting the importance of careful technique and supervised training.
Abstract Introduction: Despite the widespread use of warm vertical compaction, the effects of transient high temperatures on the setting kinetics and chemical stability of the majority of sealers remain uncharacterized. This study aimed to evaluate the effect of heat application on the setting time and chemical properties of AH Plus (epoxy resin-based) and nanozinc oxide (NZO) sealers. Materials and Methods: AH Plus and NZO sealers were assigned to five temperature groups (37°C control, 65°C, 97°C, 150°C, 250°C for 1 min), yielding 10 groups with 9 discs per group (90 discs total). Sealers were placed in 10 mm diameter, 2 mm height stainless-steel molds. Control samples were kept at 37°C, and intervention groups were heated as specified, then all were incubated at 37°C. The setting time was checked periodically using a standard probe. Then, samples were ground for Fourier transform infrared (FTIR) spectroscopy, and differential thermal analysis (DTA). Procedures followed the ISO 6876 specifications. Data were analyzed using ANOVA with Tukey post hoc tests ( P = 0.05). Results: Heat exposure significantly reduced AH Plus setting time ( P < 0.001). NZO was largely unaffected ( P > 0.05), except at 65°C, where setting time was significantly reduced ( P < 0.001). FTIR showed minor, temporary changes in both sealers. DTA revealed that heat decreased the reaction rate between NZO and eugenol but enhanced the reaction between calcium tungstate and zirconium oxide in AH Plus. Conclusions: Both sealers exhibit minimal chemical changes at 250°C, making them suitable for vertical compaction techniques with stable chemical properties.
Abstract Introduction: Despite high reported success rates for endodontic treatment, failures remain a common clinical challenge. Identifying the contributing factors to such failures is critical to improving long-term treatment outcomes. This study aimed to determine the clinical and radiographic causes of failure in endodontically treated teeth and analyze their association with tooth type, quality of obturation, coronal restoration status, and other procedural factors. Materials and Methods: This cross-sectional study included 117 patients presenting with 145 failed endodontically treated teeth. After obtaining ethical clearance and informed consent, each case was assessed using clinical examination and standardized periapical radiographs. Data regarding tooth type, gender, quality of root canal obturation, coronal restoration, and reasons for failure were recorded. Descriptive statistics were used to analyze the distribution and frequency of failure-related variables. Results: Endodontic factors alone accounted for 40.68% of failures, followed by combined endodontic and restorative factors (31.03%) and restorative factors alone (28.27%). Maxillary molars were the most frequently affected teeth (47.58%). The most common radiographic defect was underfilled canals (41.37%), followed by poorly filled (24.82%) and missed canals (22.06%). Regarding coronal restorations, 22.06% of failed teeth had no restoration, while 24.82% had full-coverage crowns. Among extracted teeth, 48.27% failed due to restorative reasons. Overall, 80% of teeth were referred for retreatment, and 20% were extracted. Conclusion: The majority of failures were associated with technical deficiencies, primarily related to inadequate obturation (endodontic factors) and coronal restoration quality, highlighting the importance of strict adherence to clinical protocols.
Abstract Introduction: The long-term success of endodontic treatment depends on strong adhesion between pulp capping materials and restorative composites. Limited data exist on the bond strength of NeoPUTTY, a recently introduced pulp capping material, with bulk-fill flowable composites. This pilot study evaluates the interfacial adhesion of NeoPUTTY with three commercial composites to guide clinical selection. Materials and Methods: Thirty cylindrical resin blocks, each with a central cavity of 2 mm in depth and 4 mm in diameter, were fabricated using a three-dimensional printer for the shear bond strength test. The cavity was filled with NeoPUTTY and then divided into three groups of ten based on the type of composite material used (Beautifil Bulk Fill Flowable Composite, EverX Flow, and Filtek Bulk Fill Flowable Composite). Three supplementary samples, one for each group, were prepared for the study of the bonding interface through scanning electron microscopy. Data were statistically analyzed using ANOVA and the Games–Howell post hoc test. Results: The mean values were significantly higher in the EverX group (11.76 ± 1.4) than in the other two groups. There was no significant difference between Beautifil Bulk Fill Flowable Composite (9.1 ± 1.19) and Filtek Bulk Fill Flowable Composite (9.0 ± 2.0). The scanning electron microscope images demonstrated notable variations in surface morphology at the bonded interfaces between groups. Conclusions: Covering NeoPUTTY with EverX Flow enhances interfacial adhesion and shear bond strength, potentially improving sealing ability in pulp capping procedures.
Abstract Introduction: Tooth avulsion is a severe traumatic dental injury in which prognosis depends on prompt and appropriate emergency management. Dental professionals play a critical role in its management; however, variability in knowledge and preparedness has been reported. This systematic review aims to evaluate the knowledge and awareness of tooth avulsion management among dental professionals in Saudi Arabia. Materials and Methods: Comprehensive searches were performed across PubMed, Scopus, Web of Science, and EBSCO databases up to September 2025. Cross-sectional studies assessing knowledge, attitudes, or practices of dental professionals in Saudi Arabia regarding tooth avulsion management were eligible for inclusion. Two reviewers independently screened studies, extracted data, and assessed quality using the AXIS tool. Results: The initial search retrieved 57 articles. After removal of duplicates and screening, seven studies conducted between 2015 and 2025 were included, representing 2150 dental professionals from Riyadh, Jazan, Qassim, Al-Kharj, and Jeddah. All studies were cross-sectional and questionnaire-based. Overall, dental professionals demonstrated moderate to inadequate knowledge of avulsion management. Deficiencies were most evident in identifying appropriate storage media, recognizing the critical time for replantation, determining correct splinting duration, and awareness of long-term follow-up protocols. Specialists and dentists with postgraduate training scored significantly higher than undergraduates and general practitioners. Female dentists, those employed in public institutions, and those with prior exposure to workshops or training consistently achieved better knowledge scores. Four studies were rated high quality, one moderate–high, and two moderate on the AXIS appraisal. Conclusion: This review highlights persistent knowledge gaps among Saudi dental professionals in managing tooth avulsion, despite the recognized importance of prompt and correct intervention. Educational exposure, clinical experience, and professional environment strongly influenced knowledge levels. Findings underscore the need for curricular reforms, structured continuing professional development, and adoption of national evidence-based guidelines to enhance clinical preparedness and improve patient outcomes in dental trauma care.
Abstract Introduction: Inferior alveolar nerve block has a limited success during endodontic management of teeth with symptomatic irreversible pulpitis (SIP). Hence, various therapies, such as aromatherapy, acupuncture are advised due to their high safety level. This trial aimed to evaluate the effect of low-level laser therapy-activated Hegu acupoint on pain during anesthetic solution deposition and access opening in teeth with SIP. Materials and Methods: 68 healthy adults, aged between 18-40 years, with SIP in mandibular molars and satisfying inclusion criteria, were categorized into Group I (laser acupuncture [Lac]) and Group II (Control, sham LAc [SLAc] – use of similar low-level laser therapy setting without activation). In the LAc group, the ipsilateral Hegu acupoint of the participant was laser irradiated in a contact mode, and the Deqi sensation (in the form of 12 descriptors like soreness, aching, deep pressure etc.) was assessed using a Massachusetts General Hospital Acupuncture Sensation Scale. In the SLAc group, the same procedure was repeated except that the laser was kept in “off mode” to avoid any bias in the perception of participants. Root canal treatment was initiated under inferior alveolar nerve block, and the patient’s anesthetic solution deposition and access opening pain scores were marked on Visual Analog Scale. The Mann–Whitney U - and Chi-square tests were applied. Results: Participants in the LAc group had significantly lower pain scores compared to those in the SLAc group during anesthetic solution deposition and access opening ( P < 0.001). Conclusion: Needless acupuncture can be considered a safe, noninvasive, and efficient complementary treatment modality to improve inferior alveolar nerve block success.
