The State of the Art in Endodontics—Part II

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Guidelines".

Deadline for manuscript submissions: closed (21 May 2023) | Viewed by 14436

Special Issue Editors


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Guest Editor
Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, 84126 Salerno, Italy
Interests: endodontics; restorative dentistry; oral health
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, 84126 Salerno, Italy
Interests: endodontics; restorative dentistry; oral health
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The applications of minimally invasive endodontics have been continuously expanding, enabling accurate diagnostic tests, conservative access cavities, conservative shaping with the latest generation of rotating files, powerful 3D irrigation systems, and more. 

In the past few months, we published the Special Issue “The State of the Art in Endodontics"(https://www.mdpi.com/journal/jcm/special_issues/2021_Endodontics). The second installation of this Special Issue will focus on recently developed techniques and protocols in endodontics. Original articles, short communications, and review articles are all welcome.

Prof. Dr. Massimo Amato
Prof. Dr. Giuseppe Pantaleo
Prof. Dr. Alfredo Iandolo
Guest Editors

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Keywords

  • modern endodontics
  • endodontic treatment
  • endodontic surgery
  • cleaning
  • shaping
  • obturation
  • endodontic retreatment

Published Papers (8 papers)

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Editorial

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3 pages, 2731 KiB  
Editorial
Special Issue “The State of the Art in Endodontics” Part II
by Alfredo Iandolo, Giuseppe Pantaleo, Dina Abdellatif and Massimo Amato
J. Clin. Med. 2022, 11(15), 4511; https://doi.org/10.3390/jcm11154511 - 2 Aug 2022
Viewed by 1196
Abstract
The long-lasting success of root canal treatment can be achieved by applying the many advancements and technologies developed during the treatment [...] Full article
(This article belongs to the Special Issue The State of the Art in Endodontics—Part II)
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Research

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16 pages, 2977 KiB  
Article
Stronger than Ever: Multifilament Fiberglass Posts Boost Maxillary Premolar Fracture Resistance
by Naji Kharouf, Eugenio Pedullà, Gianluca Plotino, Hamdi Jmal, Mohammed-El-Habib Alloui, Philippine Simonis, Patrice Laquerriere, Valentina Macaluso, Dina Abdellatif, Raphaël Richert, Youssef Haikel and Davide Mancino
J. Clin. Med. 2023, 12(8), 2975; https://doi.org/10.3390/jcm12082975 - 19 Apr 2023
Cited by 2 | Viewed by 2427
Abstract
This paper investigates the influence of cavity configuration and post-endodontic restoration on the fracture resistance, failure mode and stress distribution of premolars by using a method of fracture failure test and finite elements analysis (FEA) coupled to Weibull analysis (WA). One hundred premolars [...] Read more.
This paper investigates the influence of cavity configuration and post-endodontic restoration on the fracture resistance, failure mode and stress distribution of premolars by using a method of fracture failure test and finite elements analysis (FEA) coupled to Weibull analysis (WA). One hundred premolars were divided into one control group (Gcontr) (n = 10) and three experimental groups, according to the post-endodontic restoration (n = 30), G1, restored using composite, G2, restored using single fiber post and G3, restored using multifilament fiberglass posts (m-FGP) without post-space preparation. Each experimental group was divided into three subgroups according to the type of coronal cavity configuration (n = 10): G1O, G2O, and G3O with occlusal (O) cavity configuration; G1MO, G2MO, and G3MO with mesio-occlusal (MO); and G1MOD, G2MOD, and G3MOD with mesio-occluso-distal (MOD). After thermomechanical aging, all the specimens were tested under compression load, and failure mode was determined. FEA and WA supplemented destructive tests. Data were statistically analyzed. Irrespective of residual tooth substance, G1 and G2 exhibited lower fracture resistance than Gcontr (p < 0.05), whereas G3 showed no difference compared to Gcontr (p > 0.05). Regarding the type of restoration, no difference was highlighted between G1O and G2O, G1MO and G2MO, or G1MOD and G2MOD (p > 0.05), whereas G3O, G3MO, and G3MOD exhibit higher fracture resistance (p < 0.05) than G1O and G2O, G1MO and G2MO, and G1MOD and G2MOD, respectively. Regarding cavity configuration: in G1 and G2, G1O and G2O exhibited higher fracture resistance than G1MOD and G2MOD, respectively (p < 0.05). In G3, there was no difference among G3O, G3MO and G3MOD (p > 0.05). No difference was found among the different groups and subgroups regarding the failure mode. After aging, premolars restored with multifilament fiberglass posts demonstrated fracture resistance values comparable to those of an intact tooth, irrespective of the different type of cavity configuration. Full article
(This article belongs to the Special Issue The State of the Art in Endodontics—Part II)
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13 pages, 2069 KiB  
Article
Severity of Post-Operative Pain after Instrumentation of Root Canals by XP-Endo and SAF Full Sequences Compared to Manual Instrumentation: A Randomized Clinical Trial
by Ajinkya M. Pawar, Anuj Bhardwaj, Alessio Zanza, Dian Agustin Wahjuningrum, Suraj Arora, Alexander Maniangat Luke, Mohmed Isaqali Karobari, Rodolfo Reda and Luca Testarelli
J. Clin. Med. 2022, 11(23), 7251; https://doi.org/10.3390/jcm11237251 - 6 Dec 2022
Cited by 6 | Viewed by 1828
Abstract
This investigation aimed to examine the post-operative pain experienced following single-visit root canal treatment using the XP-endo shaper sequence (XPS), full-sequence self-adjusting file (SAF), and manual K-files (HKF). A randomized equivalence parallel design, double-blinded clinical study was conducted on 120 patients with symptomatic [...] Read more.
This investigation aimed to examine the post-operative pain experienced following single-visit root canal treatment using the XP-endo shaper sequence (XPS), full-sequence self-adjusting file (SAF), and manual K-files (HKF). A randomized equivalence parallel design, double-blinded clinical study was conducted on 120 patients with symptomatic irreversible pulpitis, with or without clinical signs of apical periodontitis. Only teeth with fully formed roots and no periapical lesions were incorporated in the study. Patients were apportioned to one of three groups (n = 40) randomly: Group 1—XPS, Group 2—SAF, and Group 3—HKF. Pre- and post-instrumentation pain was rated utilizing Visual Analog Scale (VAS) with a spectrum of 0–100 mm. The descriptive statistics and one-way ANOVA with 95% confidence intervals were used for statistical analysis. The mean VAS scores before instrumentation were consistent in all three groups. At 6, 24, 48, and 72 h, patients with root canals instrumented by SAF had the lowest post-instrumentation mean VAS score, followed by XPS. For all time intervals, the patients in the HKF group had the highest VAS score. The full-sequence SAF instrumentation resulted in less post-operative pain than the XP-endo plus protocol, while manual instrumentation with K-files resulted in the highest post-operative pain. Full article
(This article belongs to the Special Issue The State of the Art in Endodontics—Part II)
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9 pages, 5179 KiB  
Article
How Is Endodontics Taught in Italy? A Survey of Italian Dental Schools
by Giovanni Mergoni, Irene Citterio, Andrea Toffoli, Guido Maria Macaluso and Maddalena Manfredi
J. Clin. Med. 2022, 11(23), 7190; https://doi.org/10.3390/jcm11237190 - 2 Dec 2022
Cited by 3 | Viewed by 972
Abstract
The aim of our study was to investigate how endodontics is taught in Italian universities. An online survey was conducted from August to December 2021. A comparison between courses led by full or associate professors (Group 1) versus courses led by other figures, [...] Read more.
The aim of our study was to investigate how endodontics is taught in Italian universities. An online survey was conducted from August to December 2021. A comparison between courses led by full or associate professors (Group 1) versus courses led by other figures, such as researchers or temporary lecturers (Group 2), was made. A total of 28 out of 36 schools participated (78%). In most schools, endodontics is taught in the fifth year to 15–29 students. All schools planned pre-clinical endodontic training, and in 25/28 schools (89.3%), clinical endodontic training was also provided. The course programs varied among schools, and significantly more hours were allocated to teaching nonsurgical root canal treatment in Group 1 schools than in Group 2 schools. The average numbers of hours of preclinical and clinical training were 34.3 ± 23.6 and 84.1 ± 76.7, respectively. All schools used rotary NiTi files in their clinical training, and the vertical condensation of hot gutta-percha was the most frequently taught obturation technique. As expected, the scenario of endodontic education in Italian universities was variable and needs harmonization. Courses led by full or associate professors seem to be better structured. Full article
(This article belongs to the Special Issue The State of the Art in Endodontics—Part II)
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16 pages, 5773 KiB  
Article
Buckling Susceptibility of a K-File during the Initial Negotiations of Narrow and Curved Canals Using Different Manual Techniques
by Filippo Santarcangelo, Vittorio Dibello, Laura Garcia Aguilar, Adriana Carmelita Colella, Andrea Ballini, Massimo Petruzzi, Vincenzo Solfrizzi and Francesco Panza
J. Clin. Med. 2022, 11(22), 6874; https://doi.org/10.3390/jcm11226874 - 21 Nov 2022
Viewed by 1624
Abstract
(1) Background: One possible way to investigate the potential impact or susceptibility of buckling on different manual techniques is to measure compressive loads during canal negotiation. The higher their values, the easier and quicker the critical load level to buckling is reached, leading [...] Read more.
(1) Background: One possible way to investigate the potential impact or susceptibility of buckling on different manual techniques is to measure compressive loads during canal negotiation. The higher their values, the easier and quicker the critical load level to buckling is reached, leading to possible instrument lateral deformation. The objective of the present study was to investigate the impacts of compressive loads on a small K-file manipulated with different techniques for canal negotiation in simulated narrow and curved canals. (2) Methods: The tooth model selected was a plastic double-curved premolar 23 mm long (DRSK Group AB, Kasernvagen 2, SE-281 35, Hassleholm, Sweden) with an extremely narrow canal lumen to mimic a very difficult anatomical scenario. An experienced endodontist performed the negotiation of 90 of these artificial teeth randomly assigned to 3 different groups of 30 blocks each, respectively, using 3 different techniques: Group A: watch winding/pull (WW) motion; Group B: balanced forces (BF) technique; Group C: envelope of motion (EOM). The measurement system was based on the use of a dynamometer, Instron, Ltd. (model 2525-818 2kN f.s.), linked to a data acquisition unit HBM MGC+ to test all the compression and tensile loads, including all the peaks. (3) Results: All data acquired were processed by the CATMAN AP HBM software. Multiple comparisons for the highest compressive loads estimated the mean difference between WW vs. BF techniques of 3.60 [95% confidence interval (CI): 2.85 to 4.35, p < 0.001], WW vs. EOM of −1.76 (95% CI: −2.11 to 1.40, p < 0.001), and BF vs. EOM −5.36 (95% CI: −6.04 to −4.67, p < 0.001). (4) Conclusions: In conclusion, among the tested manual motions, the BF technique (Group B) was the most susceptible to buckling with the highest compressive load. WW motion (Group A) and EOM (Group C) were less susceptible to buckling than the BF technique. Therefore, a pressure-free manipulation of manual files, such as WW motion or EOM, can help reduce the susceptibility to buckling during the negotiation of narrow-curved canals. Full article
(This article belongs to the Special Issue The State of the Art in Endodontics—Part II)
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9 pages, 3975 KiB  
Article
Two-Year Healing Success Rates after Endodontic Treatment Using 3D Cleaning Technique: A Prospective Multicenter Clinical Study
by Giuseppe Pantaleo, Alessandra Amato, Alfredo Iandolo, Dina Abdellatif, Federica Di Spirito, Mario Caggiano, Massimo Pisano, Andrea Blasi, Roberto Fornara and Massimo Amato
J. Clin. Med. 2022, 11(20), 6213; https://doi.org/10.3390/jcm11206213 - 21 Oct 2022
Cited by 9 | Viewed by 1594
Abstract
Background: Various irrigation techniques for cleansing the endodontic space have been proposed, and internal heating combined with ultrasonic activation (3D cleaning technique) is considered an effective technique. This prospective multicenter clinical study aims to evaluate healing rates for teeth after root canal treatment [...] Read more.
Background: Various irrigation techniques for cleansing the endodontic space have been proposed, and internal heating combined with ultrasonic activation (3D cleaning technique) is considered an effective technique. This prospective multicenter clinical study aims to evaluate healing rates for teeth after root canal treatment utilizing the 3D cleaning technique and to report predictive values for success. Material and Methods: Ninety patients referred for a root canal treatment were included. All enrolled patients were treated with the 3D cleaning protocol. Four endodontists performed the clinical procedures and follow-up evaluations. Preoperative, postoperative and follow-up data were gathered from the consented patients. Each patient was assessed for any clinical signs or symptoms. Afterwards, two trained, blinded, and independent evaluators scored the subject’s periapical radiographs. This score was made by checking for the presence or absence of apical periodontitis using the periapical index (PAI). Then, the teeth were classified as healing or healed and were considered a success based on a cumulative success rate of healing. Statistical analysis was performed using the Fisher’s exact test, Pearson correlation, and logistic regression analyses of the preoperative prognostic factors at a 0.05 significance level. Results: 90 patients were evaluated at two years with a follow-up rate of 97.7%. The cumulative success rate of healing was 95.4%. Eight predicting aspects were identified by employing bivariate analyses. Then, using logistic analyses, the two prognostic significant variables directly correlated to healing were the preoperative presence of periapical index (p value = 0.016). Conclusions: In this two-year clinical study, the cumulative success rate of healing was 95.4% when patients were treated with the 3D cleaning protocol. Full article
(This article belongs to the Special Issue The State of the Art in Endodontics—Part II)
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16 pages, 1447 KiB  
Article
Prevalence and Quality of Endodontic Treatment in Patients with Cardiovascular Disease and Associated Risk Factors
by Gathani Dash, Lora Mishra, Naomi Ranjan Singh, Rini Behera, Satya Ranjan Misra, Manoj Kumar, Krzysztof Sokolowski, Kunal Agarwal, Suresh Kumar Behera, Sunil Mishra and Barbara Lapinska
J. Clin. Med. 2022, 11(20), 6046; https://doi.org/10.3390/jcm11206046 - 13 Oct 2022
Cited by 1 | Viewed by 2156
Abstract
This study aimed to determine the prevalence and quality of endodontic treatment, by radiographically assessing the periapical periodontitis and endodontic treatment status in patients with cardiovascular disease (CVD) and cardiovascular risk (CVR) factors. Patients who visited the Out Patient Department of Institute of [...] Read more.
This study aimed to determine the prevalence and quality of endodontic treatment, by radiographically assessing the periapical periodontitis and endodontic treatment status in patients with cardiovascular disease (CVD) and cardiovascular risk (CVR) factors. Patients who visited the Out Patient Department of Institute of Dental Sciences and Department of Cardiology, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan University, Bhubaneswar, from August 2021 to February 2022, for a check-up or dental problem were considered as participants in this study. After obtaining informed consent, the participants were enrolled on the Oral Infections and Vascular Disease Epidemiology Study (INVEST) IDS, BHUBANESWAR. After testing negative for COVID-19, patients’ demographic details, such as age and gender were recorded, followed by a panoramic radiographic examination (OPG). A total sample of 408 patients were divided into three groups: Group 1/control (without any cardiovascular manifestation) consisting of 102 samples, group 2 of 222 CVR patients, and group 3 of 84 CVD cases. The CVR and CVD groups had a preponderance of elderly age groups between 60 to 70 years, with a significantly higher proportion of males. Co-morbidities such as diabetes mellitus, hypertension, and dyslipidemia were significantly associated with the CVR and CVD groups. From OPG interpretation, it was observed that the periapical radiolucency was greater in the CVR and CVD groups than in the control group (p = 0.009). The prevalence of endodontically treated teeth was higher in CVR and CVD than in the control group (p = 0.028). A high prevalence of dental caries, about 70%, was reported in all three groups (p = 0.356). The presence of dental restoration among all the groups was low (p = 0.079). The proportion of periodontal bone loss in the control group was significantly lower than CVR and CVD (p = 0.000). There was a strong association between periapical radiolucency, endodontically treated teeth, and periodontal bone loss in CVR and CVD patients. Notably, the associations reported herein do not reflect a cause-effect relationship; however, individuals with endodontic pathologies may accumulate additional risk factors predisposing them to hypertension or other CVDs. The results emphasize that eliminating local infections may decrease the systemic infection burden. Full article
(This article belongs to the Special Issue The State of the Art in Endodontics—Part II)
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9 pages, 1828 KiB  
Article
Micro-Computed Tomography Evaluation of Minimally Invasive Shaping Systems in Mandibular First Molars
by Elio Berutti, Edoardo Moccia, Stefano Lavino, Stefania Multari, Giorgia Carpegna, Nicola Scotti, Damiano Pasqualini and Mario Alovisi
J. Clin. Med. 2022, 11(15), 4607; https://doi.org/10.3390/jcm11154607 - 8 Aug 2022
Cited by 3 | Viewed by 1598
Abstract
The aim of this study was to compare the shaping ability of a modified ProTaper Next technique (PTNm) with that of TruNatomy (TN) in lower molars mesial curved canals using micro-computed tomography (Micro-CT). Sixty mesial canals of first mandibular molars were randomly assigned [...] Read more.
The aim of this study was to compare the shaping ability of a modified ProTaper Next technique (PTNm) with that of TruNatomy (TN) in lower molars mesial curved canals using micro-computed tomography (Micro-CT). Sixty mesial canals of first mandibular molars were randomly assigned between two groups (n = 30). After canal scouting with K-File #10, glide path and shaping were carried out with TN or PTNm systems. The PTNm sequence consists of ProGlider, followed by ProTaper Next X1 and apical finishing with NiTiFlex #25 up to working length (WL) to ensure adequate apical cleaning. Samples were scanned using micro-CT and pre- and post-shaping volumes were matched to analyse geometric parameters: the volume of removed dentin; the difference of canal surface; centroid shift, minimum and maximum root canal diameters; cross-sectional areas; the ratio of diameter ratios (RDR) and the ratio of cross-sectional areas (RA). Measurements were assessed 2 mm from the apex and in relation to the middle and coronal root canal thirds. Data were analysed using ANOVA (p < 0.05). No statistically significant differences were found between the groups for any parameter at each level of analysis, except for RA at the coronal level (p = 0.037). The PTNm system showed the tendency to enlarge more in the coronal portion with a lower centroid shift at apical level compared with TN sequence (p > 0.05). Both PTNm and TN sequences demonstrated similar maintenance of original anatomy during the shaping of lower molar mesial curved canals. Full article
(This article belongs to the Special Issue The State of the Art in Endodontics—Part II)
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