Innovative Techniques in Endodontics

A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Applied Dentistry and Oral Sciences".

Deadline for manuscript submissions: closed (31 July 2023) | Viewed by 71047

Special Issue Editor

Special Issue Information

Dear Colleagues,

It is a pleasure for me to introduce this Special Issue in the field of endodontics. Researchers are invited to submit their works.

Endodontics can be considered one of the most challenging disciplines in the field of dentistry: Experiencing difficulties during root canal treatment is common, and the breakage of an instrument, the missing of a canal, and the presence of any sort of obstacle interfering with the progression to the apex could lead to failure of the treatment.

Today, many innovations have been made in endodontics, from the intrinsic quality of the modern endodontic instruments which are more resistant to fracture, more flexible and efficient, to the production of even more safe torque-controlled motors with revolutionary kinematics that can avoid cyclical and torsional failure of the instruments.

This Special Issue is focused on innovating strategies for the diagnosis and clinical approach to the endodontic patient, including three-dimensional assessment of the pathologic conditions and the anatomical aspects of the endodontic space, and the development of new types of instrument and usage, with particular reference to thermal treatment and geometrical designs.

The definition of innovative strategies to approach the root canal system also includes computer-aided endodontics, with the development of specific software that could help clinicians to reach their goals and avoid iatrogenic damage to the important structures of the tooth.

Original articles, case reports, and reviews in the field of endodontics, which aim to enrich scientific knowledge and help not only clinicians, but also researchers involved in the development of new alloys, instruments, motors, and medicaments, are warmly welcome.

Prof. Dr. Luca Testarelli
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Applied Sciences is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Endodontics;
  • Regenerative endodontics;
  • Restorative dentistry;
  • Endodontic radiology;
  • Endodontic instrumentarium;
  • Endodontic anatomy;
  • Software-guided endodontics;
  • Cone beam computed tomography;
  • Nuclear magnetic resonance;
  • Endodontic irrigants;
  • Endodontic medicaments;
  • Root canal treatment;
  • Cyclic fatigue investigation;
  • Torque investigation;
  • Endodontic motors;
  • Apex locators;
  • Fractured instrument removal;
  • Endodontic retreatment

Published Papers (29 papers)

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Editorial

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4 pages, 184 KiB  
Editorial
Are the Current Research Methods Reliable for Evaluating the Mechanical Performance of NiTi Endodontic Rotary Instruments?
by Franco Maria Di Russo, Annamaria Gisario, Stefano Natali, Valentina Bellanova, Chiara Leone and Luca Testarelli
Appl. Sci. 2022, 12(22), 11378; https://doi.org/10.3390/app122211378 - 09 Nov 2022
Viewed by 751
Abstract
Technological innovation and the modernization of manufacturing procedures have thoroughly redefined the field of nickel–titanium (NiTi) rotary and reciprocating endodontic instruments [...] Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)

Research

Jump to: Editorial, Review, Other

16 pages, 8796 KiB  
Article
Structural Assessment of Endodontic Files via Finite Element Analysis
by Eyüp Can Kökan, Abdulkadir Yasin Atik, Şebnem Özüpek and Evgeny Podnos
Appl. Sci. 2023, 13(18), 10293; https://doi.org/10.3390/app131810293 - 14 Sep 2023
Viewed by 776
Abstract
A methodology for the structural assessment of Nickel-Titanium (Ni-Ti) endodontic files and a novel approach to predict their fatigue behavior using finite element method (FEM) were proposed. ProTaper-Universal F1 and F2 endodontic files were selected due to availability of extensive test data needed [...] Read more.
A methodology for the structural assessment of Nickel-Titanium (Ni-Ti) endodontic files and a novel approach to predict their fatigue behavior using finite element method (FEM) were proposed. ProTaper-Universal F1 and F2 endodontic files were selected due to availability of extensive test data needed for the validation of the methodology. Bending and torsional loadings were analyzed since these provide essential data for the structural integrity assessment for the endodontic files. High-definition FEM models and their computationally efficient idealized versions were developed. The results for the bending and torsional stiffness of the F1 endodontic file agreed with the literature data validating the proposed methodology. Hysteresis energy density was shown to give promising results as a predictor of low cycle fatigue failure. The predictions with the idealized models matched those of the high-definition models, justifying the proposed idealizations. The validated models demonstrated that F2 has 60% higher bending and torsion resistance and 7% higher hysteresis energy density per cycle with respect to F1, leading to the conclusion that F1 has a lower structural stiffness but a longer fatigue life as compared to F2. In summary, the developed methodology allows for the structural and durability evaluation of various design parameters for Ni-Ti endodontic files. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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13 pages, 7214 KiB  
Article
The Influence of Irrigating Solutions on the Penetration of Epoxy AH Plus Sealer in Dentinal Tubules—In Vitro Confocal Microscopy Study
by Wojciech Wilkoński, Marcin Krupiński, Lidia Jamróz-Wilkońska, Mariusz Kepczynski, Szczepan Zapotoczny, Urszula Maziarz, Janusz Opiła, Piotr Wychowański and Katarzyna Brus-Sawczuk
Appl. Sci. 2023, 13(13), 7714; https://doi.org/10.3390/app13137714 - 29 Jun 2023
Viewed by 1521
Abstract
Background: The proper sealing of the root canal seems to be critical to obtain a stable result of endodontic therapy. The sealer’s penetration into dentinal tubules during root canal treatment is probably a crucial factor to provide better clinical results. The aim of [...] Read more.
Background: The proper sealing of the root canal seems to be critical to obtain a stable result of endodontic therapy. The sealer’s penetration into dentinal tubules during root canal treatment is probably a crucial factor to provide better clinical results. The aim of this study was to compare the effect of three irrigation protocols on the penetration of the epoxy sealer into dentinal tubules and two dyes used to stain the sealer. Methods: Ninety single-canaled human teeth with straight roots were used. The root canals were instrumented with Reciproc instruments up to the size 40/04 ISO. The teeth were divided into three groups (n = 30). The root canals of each group were rinsed accordingly: the control group 1: 5.25% sodium hypochlorite (NaOCl); the experimental group 2: smear layer removal (two times alternatively: 40% citric acid and 5.25% NaOCl) and NaOCl; the experimental group 3: smear layer removal (same as in group 2) and isopropyl alcohol. In each group the roots were further divided into 2 subgroups (n = 15). The root canals were obturated using warm vertical compaction technique of gutta-percha with AH Plus sealer marked with hydrophilic fluorescein (subgroup F) or hydrophobic porphyrin (subgroup P). After 72 h, one-millimeter-thick cross-sections were cut in two, five and eight millimeters distance from the apex. The depth of the penetration of the sealer into the dentinal tubules (resin tags) was measured with the use of a confocal laser microscope. Results: In of all the root parts, the longest resin tags were observed in group 2, whereas the shortest ones were found in group 1 (in the porphyrin subgroups all differences were statistically significant). Within the fluorescein subgroups, the differences between all groups were statistically significant in the middle section of the roots. In the apical and the coronal sections, significant differences were observed between group 1 and the other two groups. Conclusions: The isopropyl alcohol at the end of the irrigating protocol did not affect the higher sealer penetration of the sealer into the dentinal tubules compared with sodium hypochlorite. With the limitation of this study, the hydrophobic porphyrin may be considered as the favorable dye choice to stain endodontic sealers in further studies with confocal laser scanning microscopy, but the methods and reagents used should still be in the research phase. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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14 pages, 2074 KiB  
Article
A Retrospective Cohort Study of Traumatic Root Fractures in Primary Dentition: Can Splinting Type Improve Therapeutic Outcomes?
by Martina Salvatorina Murgia, Nicoletta Zerman, Stefano Cubeddu, Laura Carboni and Enrico Spinas
Appl. Sci. 2023, 13(11), 6530; https://doi.org/10.3390/app13116530 - 27 May 2023
Viewed by 970
Abstract
(1) Introduction: Deciduous traumatic dental injuries pose a serious global health concern. Root fractures show an incidence rate of approximately 2%; however, the literature is limited regarding the appropriate treatment and prognosis of affected teeth. This retrospective study aims to analyze the long-term [...] Read more.
(1) Introduction: Deciduous traumatic dental injuries pose a serious global health concern. Root fractures show an incidence rate of approximately 2%; however, the literature is limited regarding the appropriate treatment and prognosis of affected teeth. This retrospective study aims to analyze the long-term outcomes of orthodontic splinting using brackets compared with composite resin-only splinting in two homogeneous samples affected by root fractures. The study also examines the onset and patterns of root resorption. (2) Methods: The first group included 25 patients with 27 deciduous upper incisors affected by root fracture; Group 2 consisted of 35 patients with 38 root fractures of maxillary deciduous teeth. The categorical data for both groups were analyzed using the chi-squared homogeneity test. Age groups were compared using the Mann–Whitney U test; p < 0.005 was considered statistically significant. (3) Results: In both groups, the male gender predominated similarly. In Group 1, early decidual loss occurred in 16% of cases, whereas in Group 2 it occurred in 51% of cases. Pulp canal obliteration was observed in 68% of deciduous teeth in Group 1, compared with 30% in Group 2. No complications affecting permanent teeth were noted in Group 1; in Group 2, 29% developed enamel dysplasia and 26% experienced delayed eruption, with statistically significant differences in these proportions. Apical fragment resorption was observed in 92% of cases in Group 1 and 30% in Group 2. (4) Conclusions: The treatment of deciduous tooth root fractures using orthodontic splints can yield significant benefits, such as reduction of early tooth loss. Furthermore, the study confirms that early resorption of the distal fragment of fractured roots is a common physiological phenomenon in primary teeth and typically occurs within a year following trauma. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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12 pages, 831 KiB  
Article
Minimizing the Vicious Circle of Pain–Anxiety–Avoidance: The Role of Positive Affect in Endodontic Therapy
by Noelia Santos-Puerta and Cecilia Peñacoba-Puente
Appl. Sci. 2023, 13(7), 4327; https://doi.org/10.3390/app13074327 - 29 Mar 2023
Cited by 1 | Viewed by 1103
Abstract
Patients with a high level of anxiety anticipate extremely intense pain during dental treatment and frequently avoid visiting dentists, showing a tendency to become caught in a vicious circle of pain–anxiety–avoidance. This research aimed to examine whether dental anxiety mediates the impact of [...] Read more.
Patients with a high level of anxiety anticipate extremely intense pain during dental treatment and frequently avoid visiting dentists, showing a tendency to become caught in a vicious circle of pain–anxiety–avoidance. This research aimed to examine whether dental anxiety mediates the impact of pain anticipation before endodontic treatment in the subjective avoidance of future treatments as a function of positive affect (moderating variable). One hundred consecutive patients that required endodontic therapy were enrolled in this study. In this prospective observational study, patients had to fill out a questionnaire twice: (a) first, prior to treatment (a baseline measurement including pain anticipation, MDAS (dental anxiety), PANAS (positive affect), ASA-PS (physical health), previous medication, an assessment form, and pulpal/periapical status); (b) second, once treatment had ended, the patients were registered for subjective avoidance and their number of canals of treated teeth. The results showed a significant correlation between pain anticipation, dental anxiety, and subjective avoidance; furthermore, the index of the association between pain anticipation and dental anxiety was diminished at higher levels of positive affect. In conclusion, there does not seem to be a direct and deterministic association between pain anticipation, dental anxiety, and subjective avoidance, but rather this relationship would depend on the possible influence of the personality variables of the patients. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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12 pages, 1313 KiB  
Article
The Impact of Apical Periodontitis and Endodontic Treatment on Salivary Inflammatory Biomarkers: A Longitudinal Study
by Abdulaziz Bakhsh, Noor Al-Abdulla, Francesco Mannocci, Marwa Allihaibi, David Moyes, Gordon Proctor and Sadia Ambreen Niazi
Appl. Sci. 2023, 13(6), 3952; https://doi.org/10.3390/app13063952 - 20 Mar 2023
Cited by 1 | Viewed by 1466
Abstract
This study aimed to assess the effect of apical periodontitis and its treatment on the profile of salivary inflammatory markers and to investigate its correlation with serum inflammatory markers. Saliva samples were collected from 115 recruited participants. Patients were reviewed after 1 and [...] Read more.
This study aimed to assess the effect of apical periodontitis and its treatment on the profile of salivary inflammatory markers and to investigate its correlation with serum inflammatory markers. Saliva samples were collected from 115 recruited participants. Patients were reviewed after 1 and 2 years following treatment. Saliva samples were analysed using Multiplex microbead immunoassay for identifying the inflammatory biomarkers’ profile. Biomarker levels were compared against healthy controls at baseline. Longitudinal comparison of those markers was further analysed for the review appointments and correlated with the size of the periapical radiolucency, treatment outcome and serum inflammatory biomarker levels. The salivary cytokines, matrix metalloproteinases (MMPs) and vascular adhesion molecules were higher at the review appointments. Pre-operative salivary levels of high-sensitivity C-reactive protein (hs-CRP) were significantly higher in the treatment group than in the control group (p < 0.001). At 1 year, hs-CRP was decreased than baseline. While, in 2 years, fibroblast growth factor (FGF)-23 was significantly lower compared to baseline levels (p = 0.005). Furthermore, the post-operative size of radiolucency was significantly correlated with the levels of several markers. When correlating the salivary levels of biomarkers with the serum levels, a significant correlation was seen in FGF-23 (p = 0.04) at baseline; in intercellular adhesion molecule (ICAM)-1 (p = 0.02) at 1 year post-treatment; and in TNF-α, ICAM-1 and E-Selectin at 2 years post-treatment (p = 0.046; p = 0.033; p = 0.019, respectively). Therefore, his study suggests that higher salivary cytokines, MMPs and vascular adhesion molecules at the post-treatment reviews are related to periapical bone healing and remodelling, whereas salivary FGF-23 and hs-CRP could be prognostic biomarkers. Correlation of some salivary with serum biomarkers suggests that saliva sampling could be a feasible non-invasive option for the measurement of inflammatory marker levels; however, further longitudinal studies are required. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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14 pages, 6414 KiB  
Communication
Experimental and 2-Step Finite Element Analysis of Cyclic Fatigue Resistance of Conventional and Heat-Treated Rotary Endodontic Nickel-Titanium Instruments
by Philip Yuan-Ho Chien, Boyang Wan, Laurence James Walsh and Ove Andreas Peters
Appl. Sci. 2023, 13(4), 2080; https://doi.org/10.3390/app13042080 - 06 Feb 2023
Cited by 2 | Viewed by 1134
Abstract
Background: To evaluate the cyclic fatigue resistance of rotary endodontic nickel-titanium instruments using both experimental and finite element methods. Methodology: Four different proprietary rotary endodontic instruments (PTG, PTU, VB, and TRN) were subjected to cyclic fatigue tests through a custom-built fixture (n = [...] Read more.
Background: To evaluate the cyclic fatigue resistance of rotary endodontic nickel-titanium instruments using both experimental and finite element methods. Methodology: Four different proprietary rotary endodontic instruments (PTG, PTU, VB, and TRN) were subjected to cyclic fatigue tests through a custom-built fixture (n = 30 for each group) and tested until failure according to the manufacturer’s recommended settings, and the number of cycles to failure (NCF) was measured. Separated fragments were measured to determine the location of the fracture event. Finite element modeling replicated this experiment in silico via a two-step method, modeling the dynamic motion via an initial insertion step, then followed by rotation. Results: TRN showed the highest NCF (2027.94 ± 452.50) with the lowest values for strain (4.49% ± 0.23%) and fragment lengths (3.26 mm ± 0.47 mm), whereas PTU showed the lowest NCF (600.90 ± 80.86) and highest values for strain (6.29% ± 0.47%) and fragment lengths (5.36 mm ± 0.79 mm). All instruments showed an increase in von Mises and maximum principal stress during the insertion step but showed no changes to the maximum stress values during the rotational step. Conclusions: The finite element analysis approach used provided useful insights into the stress evolution and stress distribution of instruments during cyclic fatigue but lacked the ability with existing inputs to predict failure from cyclic fatigue. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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9 pages, 906 KiB  
Article
Prevention of Bacterial Infiltration in Class 1 Temporary Restorations Using Zinc Oxide/Calcium Sulphate Filling Materials: An In Vitro Study
by Alessio Buonavoglia, Adriana Trotta, Francesco Pellegrini, Alfredo Iandolo and Marco Cordisco
Appl. Sci. 2023, 13(3), 1748; https://doi.org/10.3390/app13031748 - 30 Jan 2023
Viewed by 1264
Abstract
This study evaluated sealing properties of zinc oxide/calcium sulphate filling material (Plastor©) to prevent bacterial infiltration in simulated Class 1 cavities with and without the presence of a spacer apically the restoration. Twenty-eight experimental Eppendorf tubes containing Tryptic Soy Agar were prepared and [...] Read more.
This study evaluated sealing properties of zinc oxide/calcium sulphate filling material (Plastor©) to prevent bacterial infiltration in simulated Class 1 cavities with and without the presence of a spacer apically the restoration. Twenty-eight experimental Eppendorf tubes containing Tryptic Soy Agar were prepared and divided into seven groups: group A (Plastor©), group B (Plastor© + cotton pellet), group C (Plastor© + cotton pellet soaked of m-cresyl acetate), group D (Plastor© + cotton pellet soaked of eugenol), group E (Plastor© + PTFE pellet), group F (positive control), and group G (negative control). All prepared vials were individually immersed in tubes containing 5 mL of a suspension of Streptococcus mutans (105 CFU/mL) previously prepared and then incubated at 37 °C for 5 and 10 days. Subsequently, agar was collected and tested for S.mutans using real-time PCR. Aliquots of each agar samples were separately seeded on TSA for S. mutans isolation. The real-time PCR tests were negative for S. mutans on all the vials at both T5 and T10, except for positive control resulted positive at both T5 and T10. The isolation tests showed bacterial growth of S. mutans only with the agar samples collected from the vials of positive control, confirming real-time PCR tests. This in vitro study evidenced complete sealing ability of zinc oxide/calcium sulphate in temporary restorations of Class 1 cavities without mechanical loading at 10 days and complete immersion in a bacterial suspension. Moreover, sealing ability is not influenced by presence of spacers. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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9 pages, 2633 KiB  
Communication
3D-Printed Metal Surgical Guide for Endodontic Microsurgery (a Proof of Concept)
by Camille Cabezon, Davy Aubeux, Fabienne Pérez and Alexis Gaudin
Appl. Sci. 2023, 13(2), 1031; https://doi.org/10.3390/app13021031 - 12 Jan 2023
Cited by 1 | Viewed by 1304
Abstract
Thanks to recent advances, printed surgical guides are now fully integrated into digital workflows and are beneficial in terms of accuracy in endodontic microsurgery (EMS). The aim of this study was to evaluate the accuracy of new 3D-printed surgical metal guides (SMGs) with [...] Read more.
Thanks to recent advances, printed surgical guides are now fully integrated into digital workflows and are beneficial in terms of accuracy in endodontic microsurgery (EMS). The aim of this study was to evaluate the accuracy of new 3D-printed surgical metal guides (SMGs) with open-frame structures in an endodontic surgical simulation model ex vivo based on a pig jaw. Twenty-nine roots were included. SMGs were produced using 3D implant planning software and printed using cobalt-chrome and a laser sintering printer. The SMGs were designed to allow for surgical access at 3 mm from the apex of each root. Virtual planning and postoperative CBCT scans were compared by analysing the apical and angular deviations. To test for deviations equal to zero, a one-sample test was used. The differences between the virtually planned implant and the actual position of the drill path were statistically significant for five SMGs on the eight produced guides, whereas there were no differences for the three others. The mean apical deviation was 3.2 mm ± 1.7 using SMGs, and the angular deviation was measured at 3.10 degrees ± 2.37. Although deviations were observed, the results demonstrate the feasibility and the potential for such guides during EMS procedures. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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14 pages, 2669 KiB  
Article
Reciprocating System for Secondary Root Canal Treatment of Oval Canals: CBCT, X-rays for Remnant Detection and Their Identification with ESEM and EDX
by Andrea Spinelli, Fausto Zamparini, Alessio Buonavoglia, Paolo Pisi, Maria Giovanna Gandolfi and Carlo Prati
Appl. Sci. 2022, 12(22), 11671; https://doi.org/10.3390/app122211671 - 17 Nov 2022
Cited by 4 | Viewed by 1020
Abstract
Aim of the study: to evaluate root filling remnants after secondary root canal treatments (SRCTs) of oval-shaped canals with X-rays and cone beam computed tomography (CBCT). The SRCTs were performed using reciprocating NiTi instruments. Methods: Single-rooted teeth (N = 64) were randomly treated [...] Read more.
Aim of the study: to evaluate root filling remnants after secondary root canal treatments (SRCTs) of oval-shaped canals with X-rays and cone beam computed tomography (CBCT). The SRCTs were performed using reciprocating NiTi instruments. Methods: Single-rooted teeth (N = 64) were randomly treated with Reciproc Blue (RB) and filled with AH Plus/single cone (SC group) or AH Plus/Guttafusion (GF group). After seven days of storage in HBSS (Hanks balanced salt solution), Gates Glidden burs #2/3 and RB #25 and #40 were used for the SRCTs. The time to complete the procedure was measured. X-rays and CBCT were used to calculate, respectively, the area and the volume occupied by the remnants in the coronal, middle, and apical thirds of each canal. Environmental scanning electron microscopy (ESEM) and energy dispersive X-ray spectroscopy (EDX) were used for qualitative evaluation and morphology composition of the remnants in sectioned roots. A statistical analysis was performed using Sigma Plot (version 13, IBM, Armonk, NY, USA). The study was designed according to PRILE guidelines. Results: After the SRCTs, the middle thirds of the root canals showed the presence of remnants in both groups, as demonstrated by X-rays and CBCT. The GF group showed a statistically significant higher volume of remnants than the SC Group only in the middle third. The ESEM supported by the EDX revealed the remnant composition by the detection of trace elements of sealer and gutta-percha in all root canals. Conclusion: The study demonstrated that the middle third of root canals is a critical region where remnants were packed and spread in the buccal-lingual sides of canals. ESEM-EDX detected a fine layer of filling remnants in all root thirds, suggesting a larger canal contamination than the X-rays and CBCT examinations revealed. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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9 pages, 2136 KiB  
Article
Apatite-Forming Ability of Flowable vs. Putty Formulations of Newly Developed Bioactive Glass-Containing Endodontic Cement
by Naoki Edanami, Razi Saifullah Ibn Belal, Shoji Takenaka, Kunihiko Yoshiba, Nagako Yoshiba, Naoto Ohkura, Shintaro Takahara and Yuichiro Noiri
Appl. Sci. 2021, 11(19), 8969; https://doi.org/10.3390/app11198969 - 26 Sep 2021
Cited by 4 | Viewed by 1782
Abstract
This study compared the apatite-forming ability (AFA) levels of flowable and putty formulations of Nishika Canal Sealer BG Multi (F-NBG and P-NBG, respectively) and attempted to clarify the cause of differences in the AFA levels of F-NBG and P-NBG. NBG samples were aged [...] Read more.
This study compared the apatite-forming ability (AFA) levels of flowable and putty formulations of Nishika Canal Sealer BG Multi (F-NBG and P-NBG, respectively) and attempted to clarify the cause of differences in the AFA levels of F-NBG and P-NBG. NBG samples were aged in simulated body fluid (SBF) or 1-, 5-, or 10-g/L bovine serum albumin-containing SBF (BSA-SBF) and analyzed in terms of their ultrastructures, elemental compositions, and Raman spectra to identify apatite formation. The phosphate ion consumption rates of NBG samples in the media were evaluated as an indicator of apatite growth. The original elemental composition, calcium ion release, and alkalizing ability levels of F-NBG and P-NBG were also evaluated. Apparent apatite formation was detected on all NBG samples except F-NBG aged in 10-g/L BSA-SBF. P-NBG consumed phosphate ions faster than F-NBG. As-prepared P-NBG showed more silicon elements on its surface than as-prepared F-NBG. P-NBG released more calcium ions than F-NBG, although their alkalizing ability levels did not differ statistically. In conclusion, the AFA of P-NBG was greater than that of F-NBG, probably because of the greater ability of P-NBG to expose silanol groups on the surface and release calcium ions. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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14 pages, 1485 KiB  
Article
Debris Removal by Activation of Endodontic Irrigants in Complex Root Canal Systems: A Standardized In-Vitro-Study
by Matthias Widbiller, Lukas Keim, Ralf Schlichting, Birgit Striegl, Karl-Anton Hiller, Rebecca Jungbauer, Wolfgang Buchalla and Kerstin M. Galler
Appl. Sci. 2021, 11(16), 7331; https://doi.org/10.3390/app11167331 - 09 Aug 2021
Cited by 8 | Viewed by 2703
Abstract
Aim of the study was to develop a standardized model system to investigate endodontic irrigation techniques and assess the efficiency of different activation methods on the removal of hard tissue debris in complex root canal systems. Mesial roots of mandibular molars were firstly [...] Read more.
Aim of the study was to develop a standardized model system to investigate endodontic irrigation techniques and assess the efficiency of different activation methods on the removal of hard tissue debris in complex root canal systems. Mesial roots of mandibular molars were firstly scanned by micro-computed tomography (µCT) and allocated to three groups of irrigant activation: sonic activation (EDDY, VDW, Munich, Germany), laser activation (AutoSWEEPS, FOTONA, Ljubljana, Slovenia) and conventional needle irrigation (control). Roots were fixed in individual 3D-printed holders to facilitate root canal enlargement under constant irrigation with NaOCl (5%). To enable standardized quantification of remaining debris, BaSO4-enriched dentine powder was compacted into the canals, followed by another µCT-scan. The final irrigation was performed using 17% ethylenediaminetetraacetic acid (EDTA) and 5% sodium hypochlorite (NaOCl) with the respective activation method, and the volume of remaining artificial debris was quantified after a final µCT-scan. The newly developed model system allowed for reliable, reproducible and standardized assessment of irrigation methods. Activation of the irrigant proved to be significantly more effective than conventional needle irrigation regarding the removal of debris, which persisted particularly in the apical third of the root canal in the control group. The efficiency of irrigation was significantly enhanced with laser- and sonic-based activation, especially in the apical third. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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11 pages, 3674 KiB  
Article
A Comparison of Cone Beam Computed Tomography and Periapical Digital Radiography for Evaluation of Root Canal Preparation
by Khoa Van Pham
Appl. Sci. 2021, 11(14), 6599; https://doi.org/10.3390/app11146599 - 18 Jul 2021
Cited by 1 | Viewed by 1440
Abstract
The aim of the present study is to compare cone beam computed tomography and periapical digital radiography for the evaluation of root canal preparation. Nine extracted human molars were used in this study. Following access cavity preparation, mesio-buccal roots of maxillary and mesial [...] Read more.
The aim of the present study is to compare cone beam computed tomography and periapical digital radiography for the evaluation of root canal preparation. Nine extracted human molars were used in this study. Following access cavity preparation, mesio-buccal roots of maxillary and mesial roots of mandibular molars were prepared and the remaining roots were cut off. Three amalgam cavities were prepared on the coronal part of the teeth and were filled with amalgam to be used as landmarks. Specimens were scanned using cone-beam computed tomography and periapical digital radiograph images were obtained before and after root canal preparation. WaveOne Gold Primary was used for root canal preparation to full working length. Specimens were then scanned using CBCT and a periapical radiograph for the after-instrumentation images. The transportation and centering ratio were measured and calculated on the CBCT and periapical radiographic images. The Bland–Altman method was used for detecting the bias in the evaluation of agreement between the two methods’ measurements. There was agreement between the two methods’ measurements using CBCT scans and periapical digital radiographic images in the evaluation of transportation and centering ratio parameters. The two methods could be used interchangeably in measurements of transportation and calculating the centering ratio. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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8 pages, 1311 KiB  
Article
Plywood Jig—A New Technique for Root Canal Curvature Measurement
by Saleem D. Makandar, Mohammed Imran Khaiser, Sneha R. Mali, Mohmed Isaqali Karobari, Anand Marya, Pietro Messina and Giuseppe Alessandro Scardina
Appl. Sci. 2021, 11(9), 3999; https://doi.org/10.3390/app11093999 - 28 Apr 2021
Cited by 1 | Viewed by 2203
Abstract
The successful outcome of endodontic treatment is dependent on complete cleaning, shaping as well as three dimensional obturation of the root canal system. A conventional radiograph is a two-dimensional replication of a three-dimensional object and does not provide any conclusive evidence for canal [...] Read more.
The successful outcome of endodontic treatment is dependent on complete cleaning, shaping as well as three dimensional obturation of the root canal system. A conventional radiograph is a two-dimensional replication of a three-dimensional object and does not provide any conclusive evidence for canal curvatures. An accurate knowledge of the tooth anatomy and curvature is essential to avoid procedural errors. 100 freshly extracted human teeth were used in this study. Digital images were obtained using the plywood JIG and Schneider’s technique. These images were analyzed using the VixWin Pro digital image analyzing software (Gendex system). Statistical analysis was done using paired t test. The canal curvature average values measured using Jig method and Schneider method for mandibular teeth are 28.23° (±9.96) and 22.07° (±9.46) respectively. The smallest/largest curvature angles measured using Jig method and Schneider technique are 12/52° and 8/44° respectively. Canal curvature average values measured using Jig method and Schneider method for maxillary teeth were 23.40° (±11.36) and 19.23° (±11.94) respectively. The smallest/largest average curvature angles measured using Jig method, Schneider technique were 9/70° and 5/72° respectively. The values of the canal curvature angle obtained during routine radiographs in clinics have lower curvature angle and higher radius values as compared to the values obtained by this innovative JIG technique. Therefore, a clinician should always keep in mind the difference while measuring the curvature angle on radiographs during root canal treatment. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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10 pages, 3635 KiB  
Article
Pulpal Response to the Combined Use of Mineral Trioxide Aggregate and Iloprost for Direct Pulp Capping
by AlAnoud Almeshari, Rita Khounganian, Wael Mahdi, Fahd Aljarbou, Shilpa Bhandi and Sara Alsubait
Appl. Sci. 2021, 11(8), 3702; https://doi.org/10.3390/app11083702 - 20 Apr 2021
Cited by 1 | Viewed by 2369
Abstract
Purpose: The present study aims to assess the combined effects of mineral trioxide aggregate (MTA) and iloprost when used as a pulp capping material on pulpal inflammation and tertiary dentin formation compared with MTA and iloprost alone in rat molar teeth. Methods: Eighty [...] Read more.
Purpose: The present study aims to assess the combined effects of mineral trioxide aggregate (MTA) and iloprost when used as a pulp capping material on pulpal inflammation and tertiary dentin formation compared with MTA and iloprost alone in rat molar teeth. Methods: Eighty maxillary first molar rat teeth were exposed and capped with iloprost solution, MTA, or MTA mixed with iloprost (MTA-iloprost). The cavities were then filled with resin-modified glass ionomer. The cavity was restored with glass ionomer without the use of pulp capping agent in the control group. The rats were sacrificed after one and four weeks. Block sections of the molar specimens were prepared and subjected to hematoxylin and eosin staining for evaluation. Statistical analysis was done using the Kruskal–Wallis test, followed by Dunnett’s test. Results: At week one, the control group showed significantly more severe pulpal inflammatory reactions than the iloprost (p = 0.00), MTA (p = 0.04), and MTA-iloprost (p = 0.00) groups. Hard tissue formation was commonly found in the iloprost, MTA, and MTA-iloprost groups. After four weeks, pulpal tissue degeneration was observed in the control group. Complete hard tissue barriers were found in 50%, 72.7%, and 77.8% of the specimens in iloprost, MTA, and MTA-iloprost groups, respectively, with no significant differences among the experimental groups. The dentinal tubule patterns were mostly regular in the MTA-iloprost group and irregular in the iloprost and MTA groups. Conclusions: The application of iloprost, MTA, and MTA-iloprost as a pulp capping material resulted in similar pulpal responses in the mechanically exposed pulp of rat molars. Therefore, mixing MTA with iloprost might not be clinically significant. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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12 pages, 12592 KiB  
Article
Comparison of Four Dental Pulp-Capping Agents by Cone-Beam Computed Tomography and Histological Techniques—A Split-Mouth Design Ex Vivo Study
by Jayanandan Muruganandhan, Govindarajan Sujatha, Saravanan Poorni, Manali Ramakrishnan Srinivasan, Nezar Boreak, Ahmed Al-Kahtani, Mohammed Mashyakhy, Hitesh Chohan, Shilpa Bhandi, A. Thirumal Raj, Alessio Zanza, Luca Testarelli and Shankargouda Patil
Appl. Sci. 2021, 11(7), 3045; https://doi.org/10.3390/app11073045 - 29 Mar 2021
Cited by 11 | Viewed by 3002
Abstract
Dental pulp-capping is done to preserve vital teeth when the pulp is exposed due to caries, trauma or instrumentation. Various materials are used as pulp-capping agents. The introduction of newer materials requires scientific studies to assess their clinical efficacy. The study was designed [...] Read more.
Dental pulp-capping is done to preserve vital teeth when the pulp is exposed due to caries, trauma or instrumentation. Various materials are used as pulp-capping agents. The introduction of newer materials requires scientific studies to assess their clinical efficacy. The study was designed as a split-mouth randomized analysis of four pulp-capping agents (calcium hydroxide, mineral trioxide aggregate (MTA), Biodentine and EndoSequence root repair material (ERRM)). Based on selection criteria, 15 orthodontic patients requiring the extraction of four premolars (60 teeth total) were included in the study. After pulp-capping, the teeth were extracted after 8 weeks. We analyzed the extracted teeth using cone-beam computed tomography (CBCT) and histological sections to determine the quality of the dentinal bridge and the pulpal response. Ordinal scores were given based on the completeness of the dentinal bridge, the type of bridge and the degree of pulpal inflammation. Results were analyzed using a Kruskal–Wallis test (p < 0.05) with post hoc Conover values being used when applicable. All four pulp-capping materials elicited dentinal bridge formation (60/60). MTA had the highest scores (10/15) in dentinal bridge formation followed by ERRM (8/15). Both materials showed more samples with complete dentinal bridges (9/15 each) and a favorable pulpal response (15/15). Teeth capped with calcium hydroxide showed more cases of incomplete bridge formation (9/15) and pulpal inflammation. These differences in dentinal bridge formation and pulpal inflammation were statistically significant (p 0.001 and p 0.00005, respectively), with post hoc tests revealing no significant differences between MTA and ERRM (p 0.49 and p 0.71, respectively). MTA and ERRM performed better than the other pulp-capping materials but did not differ significantly from each other. The individual preference for a pulp-capping material may be based on clinical efficacy and handling characteristics. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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14 pages, 3374 KiB  
Communication
3D Finite Element Analysis of Rotary Instruments in Root Canal Dentine with Different Elastic Moduli
by Carlo Prati, João Paulo Mendes Tribst, Amanda Maria de Oliveira Dal Piva, Alexandre Luiz Souto Borges, Maurizio Ventre, Fausto Zamparini and Pietro Ausiello
Appl. Sci. 2021, 11(6), 2547; https://doi.org/10.3390/app11062547 - 12 Mar 2021
Cited by 17 | Viewed by 2647
Abstract
The aim of the present investigation was to calculate the stress distribution generated in the root dentine canal during mechanical rotation of five different NiTi endodontic instruments by means of a finite element analysis (FEA). Two conventional alloy NiTi instruments F360 25/04 and [...] Read more.
The aim of the present investigation was to calculate the stress distribution generated in the root dentine canal during mechanical rotation of five different NiTi endodontic instruments by means of a finite element analysis (FEA). Two conventional alloy NiTi instruments F360 25/04 and F6 Skytaper 25/06, in comparison to three heat treated alloys NiTI Hyflex CM 25/04, Protaper Next 25/06 and One Curve 25/06 were considered and analyzed. The instruments’ flexibility (reaction force) and geometrical features (cross section, conicity) were previously investigated. For each instrument, dentine root canals with two different elastic moduli(18 and 42 GPa) were simulated with defined apical ratios. Ten different CAD instrument models were created and their mechanical behaviors were analyzed by a 3D-FEA. Static structural analyses were performed with a non-failure condition, since a linear elastic behavior was assumed for all components. All the instruments generated a stress area concentration in correspondence to the root canal curvature at approx. 7 mm from the apex. The maximum values were found when instruments were analyzed in the highest elastic modulus dentine canal. Strain and von Mises stress patterns showed a higher concentration in the first part of curved radius of all the instruments. Conventional Ni-Ti endodontic instruments demonstrated higher stress magnitudes, regardless of the conicity of 4% and 6%, and they showed the highest von Mises stress values in sound, as well as in mineralized dentine canals. Heat-treated endodontic instruments with higher flexibility values showed a reduced stress concentration map. Hyflex CM 25/04 displayed the lowest von Mises stress values of, respectively, 35.73 and 44.30 GPa for sound and mineralized dentine. The mechanical behavior of all rotary endodontic instruments was influenced by the different elastic moduli and by the dentine canal rigidity. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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6 pages, 826 KiB  
Article
A New Device to Test the Bending Resistance of Mechanical Endodontic Instruments
by Gabriele Miccoli, Andrea Cicconetti, Gianluca Gambarini, Andrea Del Giudice, Federico Ripanti, Dario Di Nardo, Luca Testarelli and Marco Seracchiani
Appl. Sci. 2020, 10(20), 7215; https://doi.org/10.3390/app10207215 - 16 Oct 2020
Cited by 12 | Viewed by 1529
Abstract
The aims of the present study were to propose a new machine for testing the bending behavior of an instrument at multiple specific points along the cutting surface and to compare the influence of proprietary heat treatment on the bending ability of EdgeTaper [...] Read more.
The aims of the present study were to propose a new machine for testing the bending behavior of an instrument at multiple specific points along the cutting surface and to compare the influence of proprietary heat treatment on the bending ability of EdgeTaper (ET), Protaper Universal (PTU), EdgeTaper Platinum (ETP), and Protaper Gold (PTG). A total of 320 instruments were examined in the present study: 80 ET, 80 PTU, 80 ETP, and 80 PTG. The bending ability of all instruments was tested at a 45° angle and on three different portions of the instrument at 3, 6, and 9 mm from the tip using a customized device. Statistical analysis showed significant differences among each single instrument of the series and between ET and PTU as well as ETP and PTG. The bending behavior of a nickel–titanium rotary instrument is its ability to bend without any plastic deformation. This feature, according to the results of the present study, is variable along the cutting surface; therefore, it should be evaluated. Due to the present testing device, it would be possible to obtain reliable and trustworthy information about an instrument’s bending ability. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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8 pages, 1077 KiB  
Article
Assessment of Real-Time Operative Torque during Nickel–Titanium Instrumentation with Different Lubricants
by Alessandro Mazzoni, Andrea Pacifici, Alessio Zanza, Andrea Del Giudice, Rodolfo Reda, Luca Testarelli, Gianluca Gambarini and Luciano Pacifici
Appl. Sci. 2020, 10(18), 6201; https://doi.org/10.3390/app10186201 - 07 Sep 2020
Cited by 21 | Viewed by 1926
Abstract
The aim of the present study is twofold: to assess ex vivo the role of different lubricants on real-time torque generated during intracanal instrumentation and to check whether two different kinds of torque parameters, operative torque (OT) and average peak torque (APT), could [...] Read more.
The aim of the present study is twofold: to assess ex vivo the role of different lubricants on real-time torque generated during intracanal instrumentation and to check whether two different kinds of torque parameters, operative torque (OT) and average peak torque (APT), could produce similar results. Forty extracted single-rooted teeth were selected for the present study and divided into four equal groups (n = 10): Group A, NaCl 0.2%; Group B, NaOCl 5%; Group C, ethylenediaminetetraacetate (EDTA), and Group D, EDTA and hydrogen peroxide. Afterwards, Edge Taper F2 (Edge Endo, Albuquerque, New Mexico) were rotated clockwise at 300 rpm with 3 Ncm maximum torque by an endodontic torque recording motor. In each sample, mean OT and mean APT were recorded and statistically analyzed with one-way ANOVA and a post hoc Bonferroni between groups (p < 0.05). EDTA (12.11 ± 4.45 Ncm) showed statistically significant (p < 0.05) lower values compared with the other tested irrigant for both parameters. Overall, the two different parameters were both able to differentiate between the influence of lubricants on torsional loads. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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8 pages, 4358 KiB  
Article
Influence of Different Heat Treatments on Torsional and Cyclic Fatigue Resistance of Nickel–Titanium Rotary Files: A Comparative Study
by Gianluca Gambarini, Andrea Cicconetti, Dario Di Nardo, Gabriele Miccoli, Alessio Zanza, Luca Testarelli and Marco Seracchiani
Appl. Sci. 2020, 10(16), 5604; https://doi.org/10.3390/app10165604 - 13 Aug 2020
Cited by 30 | Viewed by 3358
Abstract
Protaper Universal (PTU), Protaper Gold (PTG) (Maillefer, Ballaigues, CH), EdgeTaper (ET), and EdgeTaper Platinum (ETP) (Albuquerque, NM, USA) were tested for both torsional and flexural resistance. The aim of the present study was to evaluate the influence of proprietary heat treatment on the [...] Read more.
Protaper Universal (PTU), Protaper Gold (PTG) (Maillefer, Ballaigues, CH), EdgeTaper (ET), and EdgeTaper Platinum (ETP) (Albuquerque, NM, USA) were tested for both torsional and flexural resistance. The aim of the present study was to evaluate the influence of proprietary heat treatment on the metallurgical properties of the aforementioned instruments. Four groups of 30 different instruments (size 20.07) were tested, then divided into two subgroups of 15 instruments—one for the cyclic fatigue test in a curved canal (90°—2 mm radius) at 300 rpm and 2.5 Ncm. The time to fracture (TtF) and fragment length (FL) were recorded. The other subgroup was subjected to the torsional test (300 rpm, 5.5 Ncm). The torque to fracture and TtF were recorded. All the instruments underwent a SEM analysis. The heat-treated instruments showed a significantly higher fatigue resistance than the non-heat-treated instruments (p < 0.05). No significant differences were found in the torsional resistance between the ET and PTU, and the ETP and PTG. However, when comparing all the groups, the heat-treated instruments showed less torsional resistance. The improvement from heat treatment was mainly found in the cyclic fatigue resistance. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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10 pages, 1071 KiB  
Article
Evaluation of Cross-Sectional Root Canal Shape and Presentation of New Classification of Its Changes Using Cone-Beam Computed Tomography Scanning
by Svetlana Razumova, Anzhela Brago, Ammar Howijieh, Haydar Barakat, Yuliya Kozlova and Malina Baykulova
Appl. Sci. 2020, 10(13), 4495; https://doi.org/10.3390/app10134495 - 29 Jun 2020
Cited by 11 | Viewed by 4707
Abstract
The root canal system is considering the most important factor in endodontic treatment, due to the complexity of its anatomy and morphology. The aim of this study was to evaluate the cross-sectional root canal shape in three thirds (coronal, middle, apical) in different [...] Read more.
The root canal system is considering the most important factor in endodontic treatment, due to the complexity of its anatomy and morphology. The aim of this study was to evaluate the cross-sectional root canal shape in three thirds (coronal, middle, apical) in different age groups using cone-beam computed tomography scanning (CBCT) and to present a new classification for root canal shape changes. This cross-sectional study included 300 CBCT scans for patient aged 20–70, and these scans were evaluated to study the morphology of the cross-sectional root canal shape in coronal, middle, and apical thirds among three age groups, namely the young (20–44), middle (45–59), and elderly (60–70). The root canal shape was classified as round, oval, long oval, and ribbon (with or without isthmus). The cross-sectional root canal shape was identified in two groups: canals with an unchanging (constant) shape and canals with changing shape. In turn, in canals with changing shape, the change could be identified in the region of the middle or apical thirds of the canal. The results showed that root canal shape changes in two cases: (1) the presence of one or more canals in the root (with or without isthmus between them), and (2) with age, as it was observed that the cross-sectional shape of the root canal becomes round in the apical third with age. A new classification of the changes of root canal shape in three thirds (coronal, middle, apical) was presented in this study. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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8 pages, 2057 KiB  
Article
Digital Design of Minimally Invasive Endodontic Access Cavity
by Gianluca Gambarini, Massimo Galli, Antonio Morese, Fouad Abduljabbar, Marco Seracchiani, Luigi Vito Stefanelli, Massimo Giovarruscio, Dario Di Nardo and Luca Testarelli
Appl. Sci. 2020, 10(10), 3513; https://doi.org/10.3390/app10103513 - 19 May 2020
Cited by 9 | Viewed by 5057
Abstract
New minimally invasive endodontic cavities have been described and proposed to preserve dentin (and enamel) through strategic access, including point endodontic access cavity (PEAC). There is no consensus to what extent PEAC contributes to tooth’s resistance to fracture, because there is no agreement [...] Read more.
New minimally invasive endodontic cavities have been described and proposed to preserve dentin (and enamel) through strategic access, including point endodontic access cavity (PEAC). There is no consensus to what extent PEAC contributes to tooth’s resistance to fracture, because there is no agreement on how PEAC should be performed. The purpose of the present study is to describe and classify four different types of PEACs and to examine if a dynamic navigation system /DNS) could allow planning and precisely executing these cavities in vitro. Forty TrueTooth TM Replica # 3-001 models, were randomly divided into four identical groups of ten and scanned using a cone bean computed tomography (OP-Maxio 300, Instrumentarium-Kavo, Finland). Then, four different access cavities were planned and performed by using DNS (Navident dynamic navigation system, ClaroNav, Toronto, ON, Canada). For each tooth, a different PEAC was designed to obtain endodontic access to the main mesio-buccal canal (MB1), resulting in a different location of the entry point on the occlusal surface of the tooth. Precision was evaluated by comparing deviation in the inclinations between the planned and real cavity. Data were recorded and statistically analyzed. DNS allowed preparation of minimally invasive “straight line” cavities, with some differences in the accuracy. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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8 pages, 1255 KiB  
Article
Torque Range, a New Parameter to Evaluate New and Used Instrument Safety
by Dario Di Nardo, Marco Seracchiani, Alessandro Mazzoni, Andrea Del Giudice, Gianluca Gambarini and Luca Testarelli
Appl. Sci. 2020, 10(10), 3418; https://doi.org/10.3390/app10103418 - 15 May 2020
Cited by 13 | Viewed by 1831
Abstract
The aim of the present study is to evaluate operative torque, torque at failure and the difference between these two values—the “torque range”—of two different NiTi files. We also sought to evaluate and compare these parameters for new and used files. Forty S-One [...] Read more.
The aim of the present study is to evaluate operative torque, torque at failure and the difference between these two values—the “torque range”—of two different NiTi files. We also sought to evaluate and compare these parameters for new and used files. Forty S-One 20.06 and forty M-Two 20.06 were tested, divided in four equal groups (n = 10) for each brand. Ten instruments from each brand performed three root canal treatments each on standardized extracted single-rooted teeth. Afterwards, each group was subjected to the following two tests: operative torque and torsional resistance. Mean values for all the tested groups were calculated. The results for new instruments showed that S-One developed significantly higher operative torque, but higher torsional resistance. The results for used instruments showed that the S-One 20.06 developed less operative torque and higher mean torsional resistance value compared to the M-Two. Moreover, the percentage reduction of both values was significantly higher for M-Two. The results of the present study showed a safer torsional behavior of the S-One. These results could be related to the heat treatment and the manufacturing process. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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Review

Jump to: Editorial, Research, Other

14 pages, 4980 KiB  
Review
The Incidence and Intensity of Postendodontic Pain and Flareup in Single and Multiple Visit Root Canal Treatments: A Systematic Review and Meta-Analysis
by Satish Vishwanathaiah, Prabhadevi C Maganur, Sanjeev B Khanagar, Hitesh Chohan, Luca Testarelli, Alessandro Mazzoni, Archana A Gupta, A. Thirumal Raj, Shilpa Bhandi, Deepak Mehta and Shankargouda Patil
Appl. Sci. 2021, 11(8), 3358; https://doi.org/10.3390/app11083358 - 08 Apr 2021
Cited by 8 | Viewed by 3671
Abstract
To assess the incidence and intensity of postendodontic pain and flareup in single and multiple visit root canal treatment (RCT) and determine if the difference between the two is significant, a search of PubMed, Medline, Embase, Cochrane, Scopus and Web of science was [...] Read more.
To assess the incidence and intensity of postendodontic pain and flareup in single and multiple visit root canal treatment (RCT) and determine if the difference between the two is significant, a search of PubMed, Medline, Embase, Cochrane, Scopus and Web of science was conducted. The grey literature was searched using Google Scholar and Saudi digital library. Randomised controlled trials evaluating the incidence and intensity of postendodontic pain and flareup published in English from 1 January 2000 to 15 April 2020 were searched. The PRISMA protocol was followed to select the articles. A random effects model was used for the meta-analysis of the data in the included studies. Twenty-one articles were included in the review. Three compared both the incidence and the intensity, while the rest compared either one of the parameters. Most studies used both hand-driven and rotary instruments and irrigated with sodium hypochlorite. Twelve studies used an intracanal medicament. Although individual studies showed discordant treatment outcomes, the meta-analysis did not reveal any significant difference in the incidence or the intensity of the postendodontic flareup between the single and multiple visit RCT groups. Single or a multiple visit root canal treatment is not an independent determinant for the risk of postendodontic pain or a flareup. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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16 pages, 5353 KiB  
Review
Analysis of Torque and Force Induced by Rotary Nickel-Titanium Instruments during Root Canal Preparation: A Systematic Review
by Myint Thu, Arata Ebihara, Sherif Adel and Takashi Okiji
Appl. Sci. 2021, 11(7), 3079; https://doi.org/10.3390/app11073079 - 30 Mar 2021
Cited by 10 | Viewed by 2686
Abstract
The aim of this review was to provide a detailed literature analysis of torque and force generation during nickel-titanium rotary root canal instrumentation. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search was performed using in PubMed [...] Read more.
The aim of this review was to provide a detailed literature analysis of torque and force generation during nickel-titanium rotary root canal instrumentation. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search was performed using in PubMed and in journals for articles published in English from 1987 to June 2020 on studies that investigated dynamic torque and force in vivo or in vitro. We assessed article titles and abstracts to remove duplicates, and the titles and abstracts of the remaining articles were screened for eligibility. Full texts were read to verify eligibility by considering predetermined inclusion and exclusion criteria. Fifty-two out of 4096 studies met the inclusion criteria, from which we identified 26 factors that influence torque or force generation. Factors associated with higher torque or force generation and supported by multiple studies with mostly consistent results included convex triangle cross-sectional design, regressive taper, short pitch length, large instrument size, small canal size, single-length preparation technique, long preparation time, deep insertion depth, low rate of insertion, continuous rotation (torque), reciprocating motion (force), lower rotational speed and conventional alloy. However, several factors are interrelated, which obscured the independent effect of each factor, and there was insufficient scientific evidence supporting the influence of some factors. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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11 pages, 249 KiB  
Review
A Review of Guidelines for Antibiotic Prophylaxis before Invasive Dental Treatments
by Abdulaziz A. Bakhsh, Husain Shabeeh, Francesco Mannocci and Sadia Ambreen Niazi
Appl. Sci. 2021, 11(1), 311; https://doi.org/10.3390/app11010311 - 30 Dec 2020
Cited by 5 | Viewed by 6857
Abstract
Bacteraemia associated with invasive dental treatments can propagate infective endocarditis in high-risk cardiac patients. Over the past decade, antibiotic prophylaxis before dental treatment has been questioned. This review aims to compare the variations between the UK, European and American antibiotic prophylaxis guidelines before [...] Read more.
Bacteraemia associated with invasive dental treatments can propagate infective endocarditis in high-risk cardiac patients. Over the past decade, antibiotic prophylaxis before dental treatment has been questioned. This review aims to compare the variations between the UK, European and American antibiotic prophylaxis guidelines before dental treatments. Antibiotic prophylaxis guidelines by the National Institute for Health and Care Excellence (NICE)—Clinical Guideline 64, Scottish Dental Clinical Effectiveness Programme (SDCEP), American Heart Association (AHA), European Society of Cardiology (ESC), European Society of Endodontology (ESE) and Belgian Health Care Knowledge Centre (KCE) position statements were compared regarding the indications, high-risk patients and prophylaxis regimens before dental treatments. In the United Kingdom, the NICE—Clinical Guideline 64 and SDCEP—Implementation Advice do not advise the prescription of prophylactic antibiotics for the majority of high-risk cardiac patients undergoing routine dental treatments. On the contrary, the AHA, ESC and KEC recommend the prescription of antibiotics prior to invasive dental procedures in high-risk cardiac individuals. The ESE also indicates prophylaxis before endodontic procedures for patients with other conditions, including impaired immunologic function, prosthetic joint replacement, high-dose jaw irradiation and intravenous bisphosphonates. Among these guidelines, there are variations in antibiotic prophylaxis regimens. There are variations regarding the indications and antibiotic prophylaxis regimens before invasive dental treatments among these available guidelines. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)

Other

11 pages, 1711 KiB  
Case Report
Laser Doppler for Accurate Diagnosis of Oehler’s Type III Dens Invaginatus: A Case Report
by Hui-Na Lee, Dah-You Yan, Chun-Yin Huang, Shih-Chieh Chen, Chin-Yun Pan, Jiiang-Huei Jeng, Yuk-Kwan Chen and Fu-Hsiung Chuang
Appl. Sci. 2021, 11(9), 3848; https://doi.org/10.3390/app11093848 - 24 Apr 2021
Cited by 2 | Viewed by 2122
Abstract
In vital pulp therapy, pulp testing aids in the differential diagnosis and influences the treatment plan. Different from previous doppler flowmetry studies that only recorded waves and data, we report the first time, the use of a laser doppler blood flow monitor and [...] Read more.
In vital pulp therapy, pulp testing aids in the differential diagnosis and influences the treatment plan. Different from previous doppler flowmetry studies that only recorded waves and data, we report the first time, the use of a laser doppler blood flow monitor and imager with a colored image to present pulp vitality information in the dental field. We report here a case of Oehlers type IIIa dens invaginatus of the right upper lateral incisor in a 31-year-old girl, with the opening of the invagination near CDJ and a peri-invagination lesion sized 8 × 9 mm2. Cone beam computed tomography was used to verify specific spatial and stereoscopic data. After removing the source of infection, mineral trioxide aggregate was selected to fill the invagination. Laser doppler was scheduled for further assessment. After three years of regular follow-up, the patient’s clinical condition improved, the peri-invagination lesion healed, and the laser doppler and electric pulp test both showed a positive reaction. Laser doppler has successfully improved the diagnostic accuracy Thus, unnecessary interventions can be avoided while reducing the treatment time by preserving the vitality. However, further work is needed to resolve the limitations of laser doppler. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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9 pages, 1436 KiB  
Case Report
Decision Support for Removing Fractured Endodontic Instruments: A Patient-Specific Approach
by Raphaël Richert, Jean-Christophe Farges, Cyril Villat, Sébastien Valette, Philippe Boisse and Maxime Ducret
Appl. Sci. 2021, 11(6), 2602; https://doi.org/10.3390/app11062602 - 15 Mar 2021
Cited by 2 | Viewed by 2283
Abstract
The instrumental fracture is a common endodontic complication that is treated by surgical or non-surgical removal approaches. However, no tool exists to help the clinician to choose between available strategies, and decision-making is mostly based on clinical judgment. Digital solutions, such as Finite [...] Read more.
The instrumental fracture is a common endodontic complication that is treated by surgical or non-surgical removal approaches. However, no tool exists to help the clinician to choose between available strategies, and decision-making is mostly based on clinical judgment. Digital solutions, such as Finite Element Analysis (FEA) and Virtual Treatment Planning (VTP), were recently proposed in maxillofacial surgery. The aim of the current study is to present a digital tool to help decide between non-surgical and surgical strategies in a clinical situation of a fractured instrument. Five models have been created: the initial state of the patient, two non-surgical removal strategies using a low or high root canal enlargement, and two surgical removal strategies using a 3- or 6-mm apicoectomy. Results of the VTP found a risk of perforation for the non-surgical strategies and sinus proximity for surgical ones. FEA showed the lowest mechanical risk for the apicoectomy strategy. A 3-mm apicoectomy approach was finally chosen and performed. In conclusion, this digital approach could offer a promising decision support for instrument removal by planning the treatment and predicting the mechanical impact of each strategy, but further investigations are required to confirm its relevance in endodontic practice. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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15 pages, 3575 KiB  
Case Report
Print and Try Technique: 3D-Printing of Teeth with Complex Anatomy a Novel Endodontic Approach
by Riccardo Tonini, Edit Xhajanka, Massimo Giovarruscio, Federico Foschi, Giulia Boschi, Ayfer Atav-Ates, Andrea Cicconetti, Marco Seracchiani, Gianluca Gambarini, Luca Testarelli and Luciano Pacifici
Appl. Sci. 2021, 11(4), 1511; https://doi.org/10.3390/app11041511 - 08 Feb 2021
Cited by 5 | Viewed by 4434
Abstract
The purpose of this report is to evaluate the applicability of a novel Print and Try technique in the presence of aberrant endodontic anatomies and to achieve a predictable treatment with improved outcome. According to guidelines, cone beam computed tomography (CBCT) is recommended [...] Read more.
The purpose of this report is to evaluate the applicability of a novel Print and Try technique in the presence of aberrant endodontic anatomies and to achieve a predictable treatment with improved outcome. According to guidelines, cone beam computed tomography (CBCT) is recommended in the presence of complex anatomies. The volumes were utilized to produce a stereo lithographic (STL) file, from which a 3D-plastic tooth model including a hollow root canal system was obtained. The 3D-patient-specific model facilitates the treatment planning and the trial of therapeutic approaches. Using a transparent material, all the treatment steps could be directly visualized. Subsequently, endodontic therapy could be performed in vivo with reduced operating time and with a better overview. Clinicians benefit from the Print and Try technique when facing a complicated root canal system with reduced stress and higher chances of success. In aberrant endodontic anatomies, the use of a transparent 3D plastic model, derived from the CBCT dicom, provides an exact preview of clinical challenges that will be met intra-operatively. A patient centered tailored approach to shaping, cleaning, and filling strategies can be applied. Full article
(This article belongs to the Special Issue Innovative Techniques in Endodontics)
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