BACKGROUND:Calcium silicate sealers (CSS) have become the dominant approach to root canal obturation in many specialist practices, yet evidence on their performance in nonsurgical retreatment is sparse and CBCT-based assessment remains uncommon. The behaviour of a CSS-based retreatment protocol under three-dimensional assessment is therefore poorly characterised. AIM:To evaluate the clinical and radiographic outcomes of nonsurgical retreatment with a calcium silicate sealer using both periapical (PAI) and CBCT (CBCT-PAI) indices, and to identify factors associated with CBCT-assessed success. METHODOLOGY:One hundred and thirty-six previously root canal treated teeth in 97 patients were enrolled at Jaber Al-Ahmed Dental Center, Kuwait, between March 2023 and December 2024. A single endodontist performed retreatment using a standardised sealer-based obturation protocol with a calcium silicate sealer (CeraSeal). Teeth were re-examined clinically at 12-24 months. Two calibrated specialists independently scored periapical radiographs (PAI) and small-field-of-view CBCT (CBCT-PAI), classifying each tooth as Healed, Healing or Diseased under both systems to yield four endpoints (PAI-loose, PAI-strict, CBCT-loose, CBCT-strict). The CBCT endpoints were primary and PAI endpoints descriptive. Multivariable analysis used Hosmer-Lemeshow purposeful selection with generalised estimating equations (CBCT-strict) and Firth's penalised logistic regression (CBCT-loose). RESULTS:Of 136 enrolled teeth, 118 in 80 patients were re-examined (tooth-level recall 86.8%, patient-level recall 82.5%, mean follow-up 13.9 months). Success rates were 93.2% (PAI-loose), 89.0% (CBCT-loose), 83.1% (PAI-strict) and 64.4% (CBCT-strict). Each one-point increase in pre-operative CBCT-PAI reduced the adjusted odds of CBCT-strict success (adjusted OR 0.57, 95% CI 0.41-0.81, p = 0.001). Non-molar teeth had higher odds of CBCT-loose success than molars (OR 4.69, 95% CI 1.30-25.01, p = 0.017). A pre-specified sensitivity analysis recoding pre-operative CBCT-PAI as absence (≤ 1) versus presence (≥ 2) of periapical radiolucency confirmed the CBCT-strict finding. CONCLUSIONS:In a cohort weighted toward large pre-operative lesions (65% at CBCT-PAI ≥ 4), nonsurgical retreatment with a calcium silicate sealer produced outcomes at the upper end of the pooled retreatment literature under both PAI- and CBCT-based assessment at 12 to 24 months. Pre-operative lesion size was the dominant predictor of complete healing (CBCT-strict), while tooth type was the only independent predictor of CBCT-loose success. TRIAL REGISTRATION:This study was registered on ClinicalTrials.gov (identifier NCT05714384).

INTRODUCTION:Artificial intelligence (AI) has shown promise in dental diagnostics; however, its accuracy in assessing endodontic treatment outcomes compared to experienced clinicians remains unclear. This study evaluated the performance of an AI-driven platform (Diagnocat) against experienced clinicians in assessing endodontic treatment outcomes on periapical radiographs, using cone-beam computed tomography as the reference standard. METHODS:This retrospective diagnostic accuracy study analyzed 376 teeth (860 roots) from 4 prospective clinical trials. Treatment outcomes were assessed using periapical radiographs, independently evaluated by 2 calibrated endodontists and the AI-driven platform. Cone-beam computed tomography scans served as the reference standard. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve were calculated. RESULTS:The AI-driven platform demonstrated higher sensitivity but lower specificity than clinicians at both tooth (sensitivity: 67.3% vs 49.3%, P < .001; specificity: 82.3% vs 92.5%, P < .001) and root levels (sensitivity: 54.3% vs 43.8%, P = .003; specificity: 86.7% vs 94.5%, P < .001). Overall accuracy was comparable at the tooth level (AI: 76.3%, clinicians: 75.3%, P = .716) but slightly lower for the AI-driven platform at the root level (78.5% vs 81.6%, P = .021). Receiver operating characteristic curve analysis showed comparable area under the curve values between the AI-driven platform and clinicians at both tooth (0.75 vs 0.71) and root levels (0.71 vs 0.69). CONCLUSIONS:While the AI-driven platform demonstrated potential as an adjunctive tool for assessing endodontic treatment outcomes, particularly in detecting lesions that might be missed by human assessment, its lower specificity highlights the need for clinical oversight to prevent overdiagnosis.

AIM:Accurate detection of periapical radiolucent lesions (PARLs) is crucial for endodontic diagnosis. While cone beam computed tomography (CBCT) is considered the radiographic gold standard for detecting PARLs in non-root filled teeth, its use is often limited by cost and radiation exposure. Artificial Intelligence (AI)-based radiographic analysis has shown the potential to enhance the diagnostic capability of periapical (PA) radiographs, but its accuracy, compared with CBCT, needs further evaluation. The aim of this paper is to assess the diagnostic accuracy of Diagnocat, a commercial AI-driven platform in detecting PARLs on PA radiographs of teeth diagnosed with irreversible pulpitis or pulp necrosis and scheduled for primary root canal treatment, using CBCT as the reference standard, and to compare Diagnocat's performance with that of experienced clinicians. METHODOLOGY:This retrospective diagnostic accuracy study analysed 339 teeth (796 roots). PA radiographs were independently assessed by two experienced, calibrated endodontists and by Diagnocat. CBCT scans, serving as the reference standard, were evaluated by two different endodontists, blinded to the PA radiograph results. Sensitivity, specificity, accuracy and area under the receiver-operating characteristic curve (AUC-ROC) were calculated for Diagnocat and clinicians at both tooth and root levels. RESULTS:CBCT identified PARLs in 121 (35.7%) teeth and 240 (30.2%) roots. Diagnocat displayed a high level of correlation with clinicians in determining lesion status, with an agreement of 89%. Clinicians demonstrated significantly higher accuracy at the tooth level (86.1% vs. 78.5%, p < .001) and greater sensitivity (65.3% vs. 47.9%, p < .001) than Diagnocat, while specificity was comparable (97.7% vs. 95.4%, p = .3). Similar trends were observed at the root level. AUC-ROC values were higher for clinicians than Diagnocat at both tooth (0.81 vs. 0.72) and root (0.77 vs. 0.68) levels, although these differences were not statistically significant. CONCLUSION:While Diagnocat exhibited high agreement with clinicians in detecting PARLs on PA radiographs, clinicians demonstrated superior accuracy and sensitivity overall. Notably, Diagnocat performed comparably to experienced clinicians in cases without PARLs, highlighting its potential utility for reliably ruling out disease. However, further refinement is required before it can reliably complement clinical judgment in endodontic practice.

There remains huge variability in decision-making when it comes to whether a compromised tooth requiring endodontic treatment should be saved, or extracted and replaced with an implant. Both internal and external biases, as well as inconsistent data from clinical studies, further complicate this frequent clinical conundrum. This paper presents tangible outcomes for both root-filled teeth and dental implants, together with comparative research to help clinicians better understand the available data. It is hoped that we can also highlight the key considerations when treatment planning for both root-filled teeth and dental implants. Both treatment modalities have excellent survival rates, but at the same time, neither is a panacea. Holistic and thoughtful consideration is required to help guide patients to make well-informed choices regarding their treatment.

INTRODUCTION:This retrospective cohort study compared the radiographic healing of apical periodontitis following root canal treatments and retreatments in patients regularly taking statins versus those who had never taken statins. METHODS:Patients who underwent root canal treatment or retreatment performed by undergraduate and postgraduate students were included. The patients were divided into 2 age-matched groups: those who reported regularly taking statins and those who had never taken statins. The outcome was assessed using periapical radiographs taken at least at 1-year post-treatment. Teeth with short root canal fillings were excluded. Single and multiple binary logistic regression tested the association between statin use and radiographic treatment outcome while adjusting for root-canal and restoration quality, diabetes mellitus, cardiovascular diseases, patient age, tooth type, and follow-up period. RESULTS:A total of 122 teeth were analyzed: 62 from patients taking statins and 60 from patients not taking statins. Using lenient criteria, logistic regression showed no significant difference in healing rates between the statin and control groups (90.3% vs. 90%; OR = 1.04; P = .952). However, under strict criteria, patients taking statins had a significantly lower probability of success compared to controls (62.9% vs 85%; OR = 0.30; P = .008). CONCLUSIONS:Patients taking statins had a lower number of radiographic complete healings than those not taking statins. The results of this study challenge the presumed benefits of systemic statins intake on AP healing.

Deep carious lesions often lead to pulp exposure, highlighting the need for effective pulp preservation strategies. While root canal treatment was the conventional approach, alternatives like partial pulpotomy (PP) showed high success rates in maintaining pulp vitality. This review aimed to assess the success rates of PP in vital, mature teeth with carious pulp exposure, particularly focusing on adults aged 18 and older, as recent research is limited. This systematic review (PROSPERO ID: CRD42024494545) examines the success rate of partial pulpotomy in adult mature permanent teeth with carious pulp exposure after at least one year of follow-up. The PICO framework outlines the population (adults with mature teeth), intervention (partial pulpotomy), comparators (various capping materials and pulp therapies), and outcome (success rates). Databases used for research included PubMed, ScienceDirect, Cochrane Library, and Embase. Inclusion criteria focused on RCTs and observational studies from 2000 to 2025 involving adults with deep carious pulp exposure, while exclusion criteria eliminated animal studies, case reports, and studies on primary teeth. Quality assessment tools included the Cochrane RoB 2 tool for RCTs and the Newcastle-Ottawa Scale for observational studies. Mesh terms used included (“pulpotomy” OR “pulp therapy”) AND ( “mature” OR “adults”) OR (“carious” OR “Pulp exposure”). The search yielded six randomized controlled trials reported in eight records and three observational studies from 42,320 records, highlighting significant success rate differences among capping materials. PP using Calcium hydroxide (CH) had a mean success rate of 34.3

Apical periodontitis (AP) is a common and clinically significant oral health condition, associated with an inflammatory response to infections within the root canal system. As patients retain natural teeth for longer, managing AP becomes more complex. Whilst generally effective, endodontic treatment outcomes can vary considerably in individuals with systemic health conditions, such as autoimmune diseases. The intersection of systemic inflammation, immune dysfunction and pharmacological treatments of the different diseases raises important questions about how autoimmune diseases influence AP prevalence and healing. This article examines current evidence on this interplay, its clinical implications and the need for tailored endodontic approaches in patients with autoimmune diseases.

AIMS:Apical Periodontitis (AP) involves complex interactions between the root canal microbiome and the host immune response, with potential risk of local and systemic inflammatory burden, however there is no evidence available regarding correlation between microbiome and inflammatory marker levels. This study aims to identify the microbiome of saliva, intracanal and blood samples in AP subjects and investigate the correlation between intracanal and blood microbiomes with serum inflammatory biomarker levels, and salivary microbiomes with salivary inflammatory biomarker levels. METHODOLOGY:Saliva, Intracanal and blood samples were collected from AP patients undergoing root canal retreatment. Following DNA extraction, 16SrRNA gene-sequence analysis (V1-V2) was performed using Illumina MiSeq 300 platform. Serum and salivary inflammatory marker levels were measured using the magnetic multiplex-microbead assay. The alpha and beta diversities were tested using the phyloseq package in R (version 4.1). The abundance of the identified phyla and genera were analysed using non-parametric tests. Spearman´s correlation coefficient was used for correlation between microbial abundance and biomarker levels. RESULTS:Streptococcus and Prevotella were prevalent in saliva; Enterococcus, Streptococcus and Bacteroidaceae_(G-1) in intracanal; and Cutibacterium and Staphylococcus in blood samples. Streptococcus, Prevotella, Actinomyces and Rothia were the most abundant common genera among all three sample sources. In saliva, Haemophilus, Gemella, Prevotella, and Alloprevotella were positively correlated with salivary levels of IL-8, MMP-2, TNF-α, and IL-6, respectively. Intracanal genera, Enterobacter, and Parvinomonas, were positively correlated serum FGF-23. Finally, the abundance of Novosphingobium, Streptococcus, Bosea, and Corynebacterium genus in blood were positively correlated with FGF-23, MMP-9, CRP, IL-8, and ICAM-1. CONCLUSION:Microbiome in saliva, blood and intracanal samples were correlated with some of the inflammatory biomarker levels of saliva and serum, suggesting that the effect of AP goes beyond a periapical infection and may pose a potential systemic inflammatory burden risk if left untreated.

Background: Nickel-titanium (Ni-Ti) endodontic files are revolutionizing root canal therapy because of their remarkable flexibility, shape memory, and corrosion resistance. Nonetheless, cyclic fatigue, corrosion-related fractures, and biofilm development have restricted their clinical efficacy. Recent developments in nanotechnology provide solutions using surface coatings with nanoparticles to enhance the mechanical, chemical, and biological properties of Ni-Ti alloys. Materials and Methods: Current developments in nanoparticle coatings for Ni-Ti alloy are investigated in this narrative study. Of the 57 papers generated from a preliminary literature assessment, only 10 fit the inclusion criteria for relevance, approach, and scientific interest. Results: The selected studies highlight a spectrum of nanoparticles: Titanium dioxide (TiO₂), Zirconia (ZrO₂), Silver (Ag), Silicon carbide (SiC), Graphene oxide (GO), Hydroxyapatite (HA), Carbon nanotubes (CNTs), and Fullerene-like tungsten disulfide (IF-WS₂). Fatigue resistance, wear resistance, corrosion resistance, and antibacterial properties of Ni-Ti alloy coated with these nanoparticles have shown significant development. These coatings not only extend the lifetime of Ni-Ti alloy but also reduce bacterial colonization, therefore improving the possible rates of root canal treatment success. Physical vapor deposition, sol-gel dip coating, electrodeposition, chemical deposition technique and direct current magnetron reactive sputtering have been evaluated among several coating techniques. These coatings have therapeutic value depending on homogeneity, adhesive strength, and biocompatibility. Excellent coating performance is thought to depend critically on the eradication of the natural titanium oxide layer from Ni-Ti alloys. Conclusion: Despite these positive advancements, numerous challenges still exist, including regulatory approval, coating durability, and the need for long-term clinical validation. Self-healing coatings, bioactive layers for regenerative endodontics, and intelligent coatings with antimicrobial release driven by environmental changes should be the main focus of further studies. Bringing these discoveries into practical application depends on cooperation among materials scientists, nanotechnologists, and endodontists, thereby improving the performance and durability of Ni-Ti endodontic files.

OBJECTIVE:This study aimed to evaluate the diagnostic performance of an artificial intelligence (AI)-based platform (Diagnocat) in detecting periapical radiolucencies (PARLs) in cone-beam computed tomography (CBCT) scans of molars. Specifically, we assessed Diagnocat's performance in detecting PARLs in non-root-filled molars and compared its diagnostic performance between preoperative and postoperative scans. METHODS:This retrospective study analyzed preoperative and postoperative CBCT scans of 134 molars (327 roots). PARLs detected by Diagnocat were compared with assessments independently performed by two experienced endodontists, serving as the reference standard. Diagnostic performance was assessed at both tooth and root levels using sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), F1 score, and the area under the receiver operating characteristic curve (AUC-ROC). RESULTS:In preoperative scans of non-root-filled molars, Diagnocat demonstrated high sensitivity (teeth: 93.9 %, roots: 86.2 %), moderate specificity (teeth: 65.2 %, roots: 79.9 %), accuracy (teeth: 79.1 %, roots: 82.6 %), PPV (teeth: 71.8 %, roots: 75.8 %), NPV (teeth: 91.8 %, roots: 88.8 %), and F1 score (teeth: 81.3 %, roots: 80.7 %) for PARL detection. The AUC was 0.76 at the tooth level and 0.79 at the root level. Postoperative scans showed significantly lower PPV (teeth: 54.2 %; roots: 46.9 %) and F1 scores (teeth: 67.2 %; roots: 59.2 %). CONCLUSION:Diagnocat shows promise in detecting PARLs in CBCT scans of non-root-filled molars, demonstrating high sensitivity but moderate specificity, highlighting the need for human oversight to prevent overdiagnosis. However, diagnostic performance declined significantly in postoperative scans of root-filled molars. Further research is needed to optimize the platform's performance and support its integration into clinical practice. CLINICAL SIGNIFICANCE:AI-based platforms such as Diagnocat can assist clinicians in detecting PARLs in CBCT scans, enhancing diagnostic efficiency and supporting decision-making. However, human expertise remains essential to minimize the risk of overdiagnosis and avoid unnecessary treatment.

Aim To compare the prevalence of apical periodontitis (AP), endodontic treatments, quality of endodontic treatments and their association with apical radiolucencies, and decayed, missing and filled teeth (DMFT) scores in patients attending a British NHS hospital in 2008-2009 (Cohort 1/C1) and 2018-2019 (Cohort 2/C2). Methodology Randomly selected panoramic radiographs of 980 patients, evenly distributed into two cohorts: C1 (2008-2009) and C2 (2018-2019) were retrospectively analysed. Patient demographics, number of teeth, presence and quality of endodontic treatments, apical radiolucencies in treated and untreated teeth, endodontic treatment quality, AP prevalence by tooth type, and DMFT scores were compared. Results C1 had significantly higher DMFT scores (p <0.001). Patients with AP had higher DMFT scores and lower number of molars (p <0.001). Similar percentages of untreated teeth had AP in C1 (3.4%) and C2 (2.9%) but at a patient level, C2 had significantly fewer endodontic treatments (48.2% versus 41.2%; p = 0.015), less apical disease (51%, versus 44%; p = 0.04) and fewer endodontically treated teeth (5.5% versus 4.2%; p = 0.007). The percentage of endodontically treated teeth with AP was similar (29.3% versus 27.9%). C2 patients had less unsatisfactorily obturated teeth (63.7% versus 57.6%) though this was not statically significant (p = 0.072). Conclusion A reduction of caries and endodontic disease burden and a slight improvement in the quality of endodontic treatments in the 2018/2019 cohort was observed. This was not accompanied by increased tooth retention suggesting that more extractions of salvageable teeth were undertaken in the latter cohort

Background/Objectives: This study aimed to assess and compare the elimination of the smear layer and microhardness of dentin in root canals after sequential versus continuous chelation using different agitation techniques. Methods: Sixty-four palatal roots of upper first molars were instrumented to size X3 (Protaper Next files). According to the irrigant solution, samples were assigned to two groups (N = 32/group), 3% NaOCl irrigation followed by 17% EDTA (sequential chelation (SC)), or dual-rinse (3% NaOCl/9% HEDP) irrigation (continuous chelation (CC)). Each group has been divided into four subgroups (n = 8/subgroup), based on agitation techniques used: conventional needle (CN) (control group), EndoActivator (EA), ultrasonic agitation (UAI), and Er.Cr.YSGG 2780 nm (laser). SEM images assessed the smear layer, and Vicker microhardness (VHN) was performed at 50 and 100 µm depths. Data were analyzed using: Kruskal–Wallis, Wilcoxon, and the Mann–Whitney U test. Statistical significance was set at p < 0.05. Results: In the UAI and laser agitation, CC significantly reduced the smear layer presence compared to SC in the apical and coronal thirds, respectively (p < 0.05), and no significant differences were observed in the CN and EA groups between SC and CC (p > 0.05). There were significantly higher VHNs of dentine in CC groups than in SC groups in all sections and depths, except in the apical of the CN group at 50 µm and the coronal section of EA and UAI groups at 100 µm. Conclusions: CC was comparable to SC in smear layer removal. CC had a less detrimental effect on dentin compared with SC.

AIM:This study aimed to develop a modified gutta-percha (GP) multifunctional endodontic material by incorporating mesoporous calcium silicate nanoparticles (MCSNs) or silver-incorporated mesoporous calcium silicate nanoparticles (Ag-MCSNs) as bioactive nanoparticle fillers to enhance bioactivity, biomineralization, and radiopacity while achieving low cytotoxicity and improved antibacterial activity. METHODOLOGY:MCSNs and Ag-MCSNs were synthesized and incorporated into GP at concentrations of 1%, 5%, and 10% by weight. The chemical and structural characterization of the new GP materials was performed using Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), energy-dispersive spectrometry (EDS), and field emission-scanning electron microscopy (FE-SEM) to assess filler distribution. Biomineralization was evaluated using XRD, EDS, and scanning electron microscopy (SEM). Ion release, pH changes, MTT assays, and culture-based techniques were employed to assess bioactivity, biocompatibility, and antibacterial properties. Finally, radiopacity testing was conducted. RESULTS:All samples of the newly developed GP exhibited uniform particle distribution within the GP matrix. Bioactivity and biomineralization tests revealed hydroxyapatite (HA) layer precipitation at 3, 7, 14, and 28 days, with maximum HA formation observed with prolonged immersion. Samples containing MCSNs or Ag-MCSNs created a weakly alkaline microenvironment initially, maintaining a suitable pH over time. All groups demonstrated non-cytotoxicity, with cell viability exceeding 70%. Antibacterial tests showed larger inhibition zones in all experimental groups compared to the control, with GP containing 10% MCSNs or Ag-MCSNs exhibiting the highest antibacterial activity, particularly Ag-MCSNs. Radiopacity tests indicated no significant difference between the experimental and control groups. CONCLUSION:Gutta-percha materials incorporated with 10% MCSNs or Ag-MCSNs demonstrated enhanced bioactivity, biomineralization, and antibacterial properties compared to the control GP, while maintaining suitable levels of biocompatibility in accordance with ISO 10993/2009 standards. The incorporation of Ag-MCSNs significantly improved antibacterial effects, particularly against Enterococcus faecalis, and increased radiopacity, making it a promising material for root canal therapy.

Aim: To compare the prevalence of apical periodontitis (AP), endodontic treatments, quality of endodontic treatments and their association with apical radiolucencies and DMFT scores, in patients attending a British National Health Service (NHS) Hospital in 2008-2009 (Cohort 1/C1) and 2018-2019 (Cohort 2/C2). Methodology Randomly selected panoramic radiographs of 980 patients, evenly distributed into two cohorts: C1 (2008-2009) and C2 (2018-2019), were retrospectively analysed. Patient demographics, number of teeth, presence and quality of endodontic treatments, apical radiolucencies in treated and untreated teeth, endodontic treatment quality, apical periodontitis prevalence by tooth type and DMFT scores were compared. Results: C1 had significantly higher DMFT scores (p<0.001), but similar numbers of teeth to C2. Patients with apical periodontitis had higher DMFT scores and lower number of molars (p<0.001). Similar percentages of untreated teeth had apical periodontitis in C1 (3.4%) and C2 (2.9%) but at a patient level, C2 had significantly fewer endodontic treatments (48.2% vs 41.2%; p=0.015), less apical disease (51%, vs 44%; p=0.04) and fewer endodontically treated teeth (5.5% vs 4.2%; p=0.007). The percentage of endodontically treated teeth with apical periodontitis was similar (29.3%, vs 27.9%). C2 patients had less unsatisfactorily obturated teeth (63.7% vs 57.6%) which was short of significance (p=0.072). C2 had fewer endodontically treated anterior teeth (p<0.001) but a higher proportion of endodontically treated molars (20.2%, vs 28.7%; p=0.003). A close to significant improvement in the quality of molars’ root canal treatments in C2 was noted (well-obturated teeth C1: 23.48%, c2: 35.11%; p=0.061). Conclusion A reduction of caries and endodontic disease burden and a slight improvement in the quality of endodontic treatments in the 2018/2019 cohort was observed. This was not accompanied by increased tooth retention.

INTRODUCTION:This study evaluated and compared the amount of apically extruded debris, unprepared wall surface areas, and dentinal crack formation resulting from root canal preparation using ProTaper Next (PTN), ProTaper Ultimate (PTU), and R-Motion (RM) file systems. METHODS:Forty-five palatal roots of maxillary first molars were shortened to a uniform length of 12 mm. The samples were divided randomly into 3 groups (n = 15/group) to be prepared using either PTN, PTU, and RM file systems. The investigator adopted modified Myers and Montgomery's approach to replicate the temperature of the human body. Debris was collected in vials and weighed before and after instrumentation with a sensitive balance. Every specimen was irrigated using distilled water during preparation, utilizing a side-vented needle. Weight before instrumentation was subtracted from weight after instrumentation to identify the weight of the collected debris. Cone-beam computed tomography (CBCT) scans were taken before and after canal preparation using a Planmeca ProMax CBCT machine. The unprepared canal surface area was calculated by superimposing preoperative and postoperative CBCT images using the Mimics Medical program. After preparation, a low-speed diamond disc horizontally sectioned the roots at 3, 6, and 9 millimeters from the apex. The specimens were examined under a digital microscope to detect crack formation. Statistical analysis was carried out using one-way (ANOVA) and Tukey (HSD) tests, with a significance level of P < .05. RESULTS:There was no statistically significant difference in the quantity of debris extruded apically and dentinal crack numbers among the 3 shaping files (P > .05). Only the apical third of root canals prepared by PTU displayed a significantly lower unprepared surface area compared to PTN and RM. CONCLUSIONS:Instrumentation with PTN, PTU, and RM yielded similar amounts of apically extruded debris and dentinal cracks. The PTU files demonstrated higher effectiveness in preparing the apical third by reducing the unprepared surface area in the prepared root canal.

Aim: To assess the association between demographic and clinical variables and the outcome of root-end surgery using digital periapical radiographs (PA) and cone-beam computed tomography (CBCT). Methodology: One hundred and fifty teeth that received endodontic microsurgery were clinically and radiographically examined (PA and CBCT scans) after 1 and 2 years. Two calibrated endodontists evaluated the radiographic healing based on a six-point outcome classification. The outcome was classified using both strict (healed) and loose (healing) criteria. The success rates were calculated, and several outcome prognostic factors were assessed. Results: One hundred and fifty teeth were assessed with both radiographic systems. When “loose” success criteria were applied using PA, 90% (n = 135) of teeth were assessed as having had a favourable outcome (90%; 95% CI: 85.2–94.8%), whereas 90.7% (n = 136) of teeth showed a successful outcome when assessed with CBCT (90.7%; 95% CI: 86.0–95.3%). When “strict” success criteria were applied, there was a statistically significant difference (p = 0.018) between the success rates of mineral trioxide aggregate (MTA) (63.7%) and Biodentine (95.5%). Conclusions: Within the limitations of this study, endodontic microsurgery showed a high success rate. Among all the demographic and clinical variables assessed, in the multiregression analysis, only the use of Biodentine was associated with a higher proportion of “complete” healings compared to MTA or Intermediate Restorative Material (IRM) when assessed using CBCT. MTA and Biodentine performed similarly when “incomplete” healings were regarded as successful outcomes.

Introduction: With the importance of restricted access cavities, this study aimed to compare the cyclic fatigue and the centering ability of TruNatomy rotary file versus R-motion reciprocating file systems in premolars accessed by traditional versus ultraconservative access cavity preparations. Materials and Methods: Forty extracted intact maxillary first premolars were divided into two groups (n = 20/group) according to the access cavity design (traditional or ultraconservative). Each group was then subdivided according to the type of file used for instrumentation (TruNatomy [26/0.04] or R-motion [30/0.04] [n = 10 teeth/subgroup]). Cone-beam computed tomography (CBCT) scans were obtained for all the teeth before and after instrumentation. The teeth were accessed and instrumented by three in-and-out pecking motions repeated two times until the instrument reached the working length. Every instrument was only used to prepare one canal. For cyclic fatigue assessment, the used files, in addition to 10 brand-new TruNatomy and R-motion files that were used as control groups, were tested in stainless-steel artificial canals, and the time to fracture was used to determine the number of cycles to fracture (NCF). After obtaining and analyzing the before and after instrumentation CBCT images, the centering ability of the buccal roots was calculated at 3, 5, and 7 mm from the apex. Data were statistically analyzed. Results: There were no differences in NCF and centering ability of each file in both access cavities (P > 0.05). There were higher NCF values of the R-motion file compared to the TruNatomy file (P < 0.05). The R-motion file showed significantly higher centering than the TruNatomy file in the traditional access cavity at the 3 and 5 mm levels and the 3 mm level in the ultraconservative access cavity (P < 0.05). Conclusion: The R-motion file had significantly higher cyclic fatigue resistance and centering ability than the TruNatomy file. The ultraconservative access cavity had no unfavorable influence on the cyclic fatigue resistance and the centering ability of R-motion and TruNatomy files.

Background: Few studies focus upon patient-reported outcomes in endodontics. AimTo determine whether full pulpotomy offers a less painful, improved health-related quality of life (HRQoL) compared with root canal treatment (RCT) in cases of irreversible pulpitis (IP) in the 7 days after the treatment. Methodology: One hundred sixty-eight participants presenting with symptoms of IP were randomized to either pulpotomy (n = 86) or RCT (n = 82). Two participants were excluded, 61 participants underwent full pulpotomy with Biodentine (35.7%), 80 had RCT (46.8%), and 25 were randomized to have pulpotomy which progressed to RCT (PRCT) due to uncontrollable bleeding (14.6%). Clinical and radiographic assessments, using CBCT and periapical radiographs, were carried out preoperatively, for the evaluation of the results only CBCT images were used. Pain (VAS) and HRQoL (EQ 5D) assessments were carried out at baseline and Days 1, 3, 5 and 7 post-baseline. Analysis included descriptive and continuous variables, chi-squared, Fisher's exact, and two-sample t-tests. Results: In pulpotomy and RCT groups, VAS pain decreased significantly over the first week (p < .001). The magnitude of reduction was similar in RCT and pulpotomy (p = .804), RCT and PRCT (p = .179), pulpotomy vs. PRCT (p = .144) and in the comparison of combined RCT /PRCT groups (ORCT) with Pulpotomy (0.729). However, the overall level of VAS pain was significantly higher in the PRCT group than in the Pulpotomy (p = .045) and RCT group (p = .049). Using CBCT, significantly more radiolucencies were found in the PRCT group than in the pulpotomy group and overall teeth presenting with CBCT radiolucencies had significantly higher pain scores (p = .015), particularly at Days 1, 3 and 5. There were significant differences in many OHRQoL domains (Questions 1, 6, 11 and 12) between RCT and PRCT groups with higher frequencies of the impact of oral health problems at Day 0 and Day 7 in the PRCT group. Conclusion: In the treatment of IP, pulpotomy is as effective as RCT in reducing post-operative pain, and improving QoL and HRQoL, teeth displaying uncontrollable bleeding and periapical radiolucencies detected using CBCT are associated with more intense postoperative pain and lower QoL.