Root Canal Treatment (RCT): Latest Advances and Prospects

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dentistry, Oral Surgery and Oral Medicine".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 44865

Special Issue Editor

Peninsula Dental School, University of Plymouth, Plymouth, UK
Interests: endodontology; endodontics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

It is an honour to announce the upcoming Special Issue of the Journal of Clinical Medicine, edited by MDPI. My role as Guest Editor is to invite cutting edge research in endodontics. The progress in endodontic diagnosis and following the widespread usage of CBCT, together with reconsiderations of classic pulpitis’ classification, has led to smarter treatment planning that significantly differs from the planning carried out five years ago. The impact on the operator clinical decision is tremendous, with the need for high-level evidence from reputable scientific groups to support day-to-day clinical decision-making. Clinical research, in the traditional pyramid of evidence, is still positioned as high-rank evidence, just below systematic reviews; however, in vitro science has also proven to often be the key to developing novel clinical concepts. For this reason, research on world-class science about clinical endodontics is welcome, with various study designs, bearing in mind the need to bridge the knowledge gap between what is novel and what will survive the test of time. Previously, fads have come and gone: unbiased research can guide the clinician to see the wood from the trees.

Dr. Federico Foschi
Guest Editor

Manuscript Submission Information

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Keywords

  • pulp preservation
  • bioceramic
  • endodontic outcome
  • cleaning and shaping
  • minimal invasive endodontics
  • CBCT
  • NiTi shaping
  • endodontic microbiology

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Published Papers (15 papers)

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Research

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12 pages, 6445 KiB  
Article
Dentin Growth after Direct Pulp Capping with the Different Fractions of Plasma Rich in Growth Factors (PRGF) vs. MTA: Experimental Study in Animal Model
by José F. Gaviño-Orduña, Javier Caviedes-Bucheli, María C. Manzanares-Céspedes, Sophie Román-Richon, Benjamín Martin-Biedma, Juan J. Segura-Egea, Esther Berástegui-Jimeno and José López-López
J. Clin. Med. 2021, 10(15), 3432; https://doi.org/10.3390/jcm10153432 - 31 Jul 2021
Cited by 2 | Viewed by 2444
Abstract
Background: This study aimed to evaluate the area of dentin growth in rabbit incisors after pulp capping with plasma rich in growth factors (PRGF) compared with mineral trioxide aggregate (MTA) by fluorescence. Methods: twenty-seven upper and lower incisors of rabbits were divided into [...] Read more.
Background: This study aimed to evaluate the area of dentin growth in rabbit incisors after pulp capping with plasma rich in growth factors (PRGF) compared with mineral trioxide aggregate (MTA) by fluorescence. Methods: twenty-seven upper and lower incisors of rabbits were divided into 4 groups: poor PRGF (F1) (n = 9 teeth), rich PRGF (F2) (n = 8 teeth), ProRoot MTA (positive control, n = 5 teeth), and untreated (NC) (negative control, n = 5). Fluorochrome markers were injected 24 h before surgery and the day before euthanasia, 28 days after the vital pulp therapy (VPT). Two transverse cuts were performed to every tooth: the first cut (A), 1 mm incisal to the gingival margin, and the second cut (B), 5 mm apical to the first cut. The sections were assessed with histomorphometric evaluation by fluorescence microscopy, comparing the dentin area between fluorescence marks and the total mineralized area. Results: The higher percentage of dentin growth was observed in the F2 group (B = 63.25%, A = 36.52%), followed by F1 (B = 57.63%, A = 30,12%) and MTA (B = 38.64%, A = 15.74%). The group with lowest percentage of dentin growth was the NC group (B = 29.22%, A = 7.82%). Significant difference (p < 0.05) was found between F2 group and MTA, also statistically significant difference has been observed comparing dentin growth areas of NC group with F1 and F2 groups. Conclusions: The application of PRGF rich and poor fraction as a pulp capping material stimulated dentin formation more intensively than MTA and NC. Full article
(This article belongs to the Special Issue Root Canal Treatment (RCT): Latest Advances and Prospects)
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14 pages, 2046 KiB  
Article
Patterns of Oral Microbiota in Patients with Apical Periodontitis
by Izabela Korona-Glowniak, Dominika Piatek, Emilia Fornal, Anna Lukowiak, Yuriy Gerasymchuk, Anna Kedziora, Gabriela Bugla-Płoskonska, Ewelina Grywalska, Teresa Bachanek and Anna Malm
J. Clin. Med. 2021, 10(12), 2707; https://doi.org/10.3390/jcm10122707 - 19 Jun 2021
Cited by 26 | Viewed by 3699
Abstract
In this study, microbial diversity of the root canal microbiota related to different endodontic infections was investigated. In total, 45 patients with endo–perio lesions (8 patients), chronic periapical periodontitis (29 patients) and pulp necrosis (8 patients) were recruited. In 19 (42.2%) patients there [...] Read more.
In this study, microbial diversity of the root canal microbiota related to different endodontic infections was investigated. In total, 45 patients with endo–perio lesions (8 patients), chronic periapical periodontitis (29 patients) and pulp necrosis (8 patients) were recruited. In 19 (42.2%) patients there was secondary infection of root canals. Microbial specimens were collected from root canals of non-vital teeth with or without changes in periapical area visible in X-ray. Then, oral microbiota were detected and identified using the culture method and real-time PCR amplification primers and hydrolysis-probe detection with the 16S rRNA gene as the target. Overall, 1434 species/genes from 41 different genera of 90 various microbial species were retrieved. Of the major reported phyla, Firmicutes (62.9%), Actinobacteria (14.0%), Bacteroidetes (12.1%), Proteobacteria (9.1%) and Fusobacteria (4.2%) were detected. Of the bacterial species, 54.6% were strict anaerobes. Corynebacterium matruchotii (p = 0.039) was present significantly more frequently in chronic periapical periodontitis. Moreover, the higher values of Decayed, Missing and Filled Permanent Teeth index were positively correlated with relative abundance of Actinomyces spp. (p = 0.042), Lactobacillus spp. (p = 0.006), Propionibacterium spp. (p = 0.024) and Rothia spp. (p = 0.002). The multivariate analyses revealed differences in total root canal samples, where components that affected grouping of root samples into four main categories were identified. Anaerobic Gram-negative bacteria predominated in root canals of teeth with pulp necrosis and periapical lesions. Facultative anaerobic Gram-positive bacteria predominated in canals with secondary infections. All detected members of mixed population groups that might serve as keystone species contributed to the entire community in its clinical relevance. Full article
(This article belongs to the Special Issue Root Canal Treatment (RCT): Latest Advances and Prospects)
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9 pages, 1122 KiB  
Article
Porosity Distribution in Single Cone Root Canal Fillings Performed by Operators with Different Clinical Experience: A microCT Assessment
by Saulius Drukteinis, Goda Bilvinaite, Paulius Tusas, Hagay Shemesh and Vytaute Peciuliene
J. Clin. Med. 2021, 10(12), 2569; https://doi.org/10.3390/jcm10122569 - 10 Jun 2021
Cited by 5 | Viewed by 1806
Abstract
The objective of this study was to assess the porosity distribution of BioRoot RCS/single gutta-percha point root-canal fillings performed by a general dental practitioner and endodontist. Fourteen plastic models of maxillary premolars with two roots were selected and shaped with HyFlex EDM instruments [...] Read more.
The objective of this study was to assess the porosity distribution of BioRoot RCS/single gutta-percha point root-canal fillings performed by a general dental practitioner and endodontist. Fourteen plastic models of maxillary premolars with two roots were selected and shaped with HyFlex EDM instruments to a size 40/0.04 taper and randomly divided into two experimental groups. A total of 14 canals in each group were obturated by two different operators with one HyFlex EDM size 40 gutta-percha point and BioRoot RCS sealer. The specimens were scanned with a high-resolution micro-computed tomography scanner, and the porosity of the fillings at the coronal, middle, and apical thirds of the root canals was qualified and quantified. The differences between groups and root-canal thirds were compared using Mann–Whitney, Friedman, and Wilcoxon tests with the significance level set at p < 0.05. The highest number of pores was observed in the apical third of root-canal fillings in both groups; however, the porosity distribution between the two groups was not significantly different in the apical and middle thirds (p > 0.05). Statistically significant differences were determined only in the coronal third (p < 0.05). The predominance of open pores was detected in all root-canal thirds and groups, with no significant differences in the number of open pores between the coronal and middle thirds (p > 0.05). Full article
(This article belongs to the Special Issue Root Canal Treatment (RCT): Latest Advances and Prospects)
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14 pages, 2564 KiB  
Article
A Comparative Study of Biocompatibility in Rat Connective Tissue of a New Mineral Trioxide Compound (Theracal) versus MTA and a Bioactive G3 Glass
by Jesús Mena-Álvarez, Cristina Rico-Romano, Carlos Gutiérrez-Ortega, Pablo Arias-Sanz and Javier Castro-Urda
J. Clin. Med. 2021, 10(12), 2536; https://doi.org/10.3390/jcm10122536 - 08 Jun 2021
Cited by 2 | Viewed by 1954
Abstract
The aim of this paper was to assess the differences in tissue response to implantation during 15, 30 and 45 days in the subcutaneous connective tissue of Wistar rats from three biomaterials: Angelus MTA®, Theracal LC®, and Angelus MTA [...] Read more.
The aim of this paper was to assess the differences in tissue response to implantation during 15, 30 and 45 days in the subcutaneous connective tissue of Wistar rats from three biomaterials: Angelus MTA®, Theracal LC®, and Angelus MTA® to which 25% bioglass G3 was added. Twenty-four Wistar rats were used, the materials were inserted into the rat’s dorsal area in silicone tubes 5 mm long by 1.5 mm diameter. Histological reaction was assessed at 15, 30, and 45 days after implantation. They were then stained with hematoxylin eosin and evaluated by two observers. Data were analyzed using Fisher’s exact test and Mann–Whitney’s U test was used to determine the association between variables. Angelus MTA induced the formation of dystrophic calcifications twice as much as Theracal LC (p < 0.05). The addition of G3 did not affect the greater or lesser occurrence of calcifications (p > 0.05). Theracal LC and MTA plus G3 caused an inflammatory reaction, which was chronic at 15 days and decreased in intensity, almost disappearing after 45 days. Theracal LC, as well as Angelus MTA plus G3, were well tolerated when implanted in the subcutaneous connective tissue of rat. Histologically, no inconvenience was found for the use by direct contact of Theracal LC, and the mixture of MTA with 25% bioactive glass G3, in the tissue of Wistar rats. Full article
(This article belongs to the Special Issue Root Canal Treatment (RCT): Latest Advances and Prospects)
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9 pages, 4003 KiB  
Article
Root Canal Filling Quality Comparison of a Premixed Calcium Silicate Endodontic Sealer and Different Carrier-Based Obturation Systems
by Ruth Pérez-Alfayate, Montse Mercade, Juan Algar-Pinilla, Rafael Cisneros-Cabello, Federico Foschi and Stephen Cohen
J. Clin. Med. 2021, 10(6), 1271; https://doi.org/10.3390/jcm10061271 - 18 Mar 2021
Cited by 7 | Viewed by 2825
Abstract
Background: The number of voids within the root canal obturation is a relevant parameter to describe the quality of the technique, as well as to predict long-term prognosis. The aim of this study was to evaluate the quality of root canal obturation in [...] Read more.
Background: The number of voids within the root canal obturation is a relevant parameter to describe the quality of the technique, as well as to predict long-term prognosis. The aim of this study was to evaluate the quality of root canal obturation in curved root canals filled with Thermafil, GuttaCore, GuttaFusion and lateral compaction with AH Plus and EndoSequence BC sealer, by means of percentage of gutta-percha and sealer filled area. Methods: 200 curved canals of mandibular molars were divided in five groups (n = 40). Each specimen was evaluated at 3, 6 and 9 mm from the apex. A total of 600 samples were analyzed. Obturation was performed with either Thermafil (TH), GuttaCore (GC), GuttaFusion (GF) or lateral compaction (LC), using AH Plus as sealer. In another group EndoSequence BC sealer (BC) was used. Subgroups (n = 20) were made depending on the use of sonic activation during the placement of the sealer. The percentage of total obturation material was analyzed as an indirect measurement of percentage of voids. Results: GF showed a better performance at the apical level, while GC showed the higher percentage of total obturation at the coronal area. No differences were observed for the activation of sealers in any of the groups. Statistical analysis was performed by using two-way ANOVA. Statistical significance was set at CI: 95% (p < 0.05). Conclusions: Sonic activation of sealers did not show any benefit to avoid the presence of voids within obturation of curved canals. Following the manufacturer recommendations, we found that TH did not show benefits when applied to curved canals. Full article
(This article belongs to the Special Issue Root Canal Treatment (RCT): Latest Advances and Prospects)
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14 pages, 2168 KiB  
Article
Efficacy of Removing Thermafil and GuttaCore from Straight Root Canal Systems Using a Novel Non-Surgical Root Canal Re-Treatment System: A Micro-Computed Tomography Analysis
by Vicente Faus-Llácer, Rubén Linero Pérez, Ignacio Faus-Matoses, Celia Ruiz-Sánchez, Álvaro Zubizarreta-Macho, Salvatore Sauro and Vicente Faus-Matoses
J. Clin. Med. 2021, 10(6), 1266; https://doi.org/10.3390/jcm10061266 - 18 Mar 2021
Cited by 4 | Viewed by 2164
Abstract
The present study aims to evaluate the effectiveness of an XP-endo non-surgical root canal re-treatment system in removing both GuttaCore and Thermafil gutta-percha carrier-based root canal filling materials from straight root canal systems using micro-computed tomography (micro-CT) analysis. The study was performed on [...] Read more.
The present study aims to evaluate the effectiveness of an XP-endo non-surgical root canal re-treatment system in removing both GuttaCore and Thermafil gutta-percha carrier-based root canal filling materials from straight root canal systems using micro-computed tomography (micro-CT) analysis. The study was performed on 20 single-rooted upper teeth, which were randomly allocated into the following study groups: Group A, Thermafil and AH Plus sealer (n = 10); Group B, GuttaCore and AH Plus sealer (n = 10). Before and after the non-surgical root canal re-treatment procedure, the samples were submitted for a micro-CT analysis. The volume of the root canal filling material (mm3), the volume of the remaining root canal filling material (mm3) and the time (minutes) needed to remove the root canal filling material were also recorded. Student’s t-test was used to analyze the results. No statistically significant differences were found between the volume of the remaining root canal filling material in the GuttaCore and Thermafil root canal filling systems at the coronal third (p = 0.782), middle third (p = 0.838) or apical third (p = 0.882) of the straight root canal systems; however, the GuttaCore required a statistically significant (p = 0.037) shorter amount of time (4.72 ± 0.76 min) to be removed than the Thermafil carrier-based root canal filling material (5.92 ± 1.42 min). The XP-endo Finisher non-surgical endodontic re-treatment system removes both GuttaCore and Thermafil gutta-percha carrier-based root canal filling materials from straight root canal systems, although removal of the GuttaCore gutta-percha carrier-based root canal filling material required less time. Full article
(This article belongs to the Special Issue Root Canal Treatment (RCT): Latest Advances and Prospects)
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16 pages, 6761 KiB  
Article
The Influence of NiTi Alloy on the Cyclic Fatigue Resistance of Endodontic Files
by Celia Ruiz-Sánchez, Vicente Faus-Llácer, Ignacio Faus-Matoses, Álvaro Zubizarreta-Macho, Salvatore Sauro and Vicente Faus-Matoses
J. Clin. Med. 2020, 9(11), 3755; https://doi.org/10.3390/jcm9113755 - 21 Nov 2020
Cited by 10 | Viewed by 2482
Abstract
Background: The aim of this study was to analyze the influence of NiTi alloy in endodontic rotary instruments on cyclic fatigue resistance. Methods: One hundred and sixty-four (164) sterile endodontic rotary files were selected and distributed into the following study groups: A: 25.08 [...] Read more.
Background: The aim of this study was to analyze the influence of NiTi alloy in endodontic rotary instruments on cyclic fatigue resistance. Methods: One hundred and sixty-four (164) sterile endodontic rotary files were selected and distributed into the following study groups: A: 25.08 F2 ProTaper Universal (PTU) (n = 41); B: 25.06 X2 ProTaper Next (PTN) (n = 41); C: 25.08 F2 ProTaper Gold (PTG) (n = 41), and D: 25.06 ProFile Vortex Blue (PVB) (n = 41). A cyclic fatigue device was designed to conduct the static cyclic fatigue tests with stainless steel artificial root canals systems with 250 µm apical diameter, 60° curvature angle, 5 mm radius of curvature, 20 mm length, and 6% (25.06) and 8% taper (25.08). Failure of the endodontic rotary instrument was detected by a single operator through direct observation and was also filmed to allow measurement of the exact time to failure. Results were analyzed using the ANOVA test and Weibull statistical analysis. Results: All pairwise comparisons presented statistically significant differences between the time to failure for the NiTi alloy study groups (p < 0.001), except between the PTN and PVB study groups (p = 0.379). In addition, statistically significant differences between the number of cycles to failure for the NiTi alloy study groups (p < 0.001) were also observed. Conclusions: The NiTi CM-Gold wire alloy of the ProTaper Gold endodontic rotary files resulted in greater resistance to cyclic fatigue than ProFile Vortex Blue, ProTaper Next, and ProTaper Universal endodontic rotary files. Full article
(This article belongs to the Special Issue Root Canal Treatment (RCT): Latest Advances and Prospects)
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19 pages, 6700 KiB  
Article
Amoebae in Chronic, Polymicrobial Endodontic Infections Are Associated with Altered Microbial Communities of Increased Virulence
by Garrit Koller, Federico Foschi, Philip Mitchell, Elizabeth Witherden, Kenneth Bruce and Francesco Mannocci
J. Clin. Med. 2020, 9(11), 3700; https://doi.org/10.3390/jcm9113700 - 18 Nov 2020
Cited by 3 | Viewed by 1795
Abstract
Background: Infections of the root canal space involve polymicrobial biofilms and lead to chronic, low grade inflammatory responses arising from the seeding of microbes and by-products. Acute exacerbation and/or disseminating infections occur when established microbial communities undergo sudden changes in phenotypic behaviour. Methods: [...] Read more.
Background: Infections of the root canal space involve polymicrobial biofilms and lead to chronic, low grade inflammatory responses arising from the seeding of microbes and by-products. Acute exacerbation and/or disseminating infections occur when established microbial communities undergo sudden changes in phenotypic behaviour. Methods: Within clinical endodontic infections, we assessedcategorical determinants comprising, and changing microbial composition of, chronic polymicrobial infections and their association with amoebae. After standardised assessment, primary or secondary infections underwent sampling and DNA processing, targeting bacteria, fungi and amoebae, including 16S high-throughput sequencing. After taxonomic assignment, community composition was correlated with clinical signs and symptoms. Diversity and abundance analyses were carried out in relation to the presence of non-bacterial amplicons. Results: Clinical specimens revealed two distinct community clusters, where specific changes correlated with clinical signs. An association between the compositions of microbiomes was found between these groups and the presence of Entamoeba gingivalis in 44% of cases. When amoebae were present in endodontic infections, we demonstrate changes in microbial community structure that mirror those observed in treatment-resistant or recurrent infections. Conclusions: Amoeba are present in endodontic infections at a high prevalence, and may promote increased virulence by enrichment for phagocytosis-resistant bacteria. Full article
(This article belongs to the Special Issue Root Canal Treatment (RCT): Latest Advances and Prospects)
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14 pages, 4544 KiB  
Article
In Vitro Evaluation of Different Irrigation Protocols on Intracanal Smear Layer Removal in Teeth with or without Pre-Endodontic Proximal Wall Restoration
by Naji Kharouf, Eugenio Pedullà, Giusy Rita Maria La Rosa, Frédéric Bukiet, Salvatore Sauro, Youssef Haikel and Davide Mancino
J. Clin. Med. 2020, 9(10), 3325; https://doi.org/10.3390/jcm9103325 - 16 Oct 2020
Cited by 24 | Viewed by 3344
Abstract
To investigate the influence of pre-endodontic coronal wall restoration on smear layer removal during different root canal irrigation strategies, single-root premolars were prepared with a mesio-occlusal cavity. Half were left untreated (G1), while the mesial walls of the remaining half were reconstructed using [...] Read more.
To investigate the influence of pre-endodontic coronal wall restoration on smear layer removal during different root canal irrigation strategies, single-root premolars were prepared with a mesio-occlusal cavity. Half were left untreated (G1), while the mesial walls of the remaining half were reconstructed using a resin composite (G2). The specimens were divided into control (ctrl) groups, which used the conventional needle irrigation method, and four experimental subgroups according to irrigation strategy: Sonic activation using the Endoactivator, sonic activation using the EQ-S, mechanical activation using the XP-Endo finisher, and ultrasonic activation using the EndoUltra. Smear layer removal was assessed through SEM and the results were statistically analyzed. At the coronal and middle thirds, no significant difference (p > 0.05) was detected for G1 and G2, except for the control subgroups (G1ctrl vs G2 ctrl) at the middle third. At the apical third, the smear layer removal was significantly greater for G2 than G1. In G1, both at the middle and apical level, EQ-S and EndoUltra showed greater smear layer removal (p < 0.05) compared to the others G1 subgroups. In G2, at the apical level, the EQ-S and EndoUltra were the most effective in smear layer removal. Pre-endodontic coronal wall restoration may improve the smear layer removal during root canal irrigation. Full article
(This article belongs to the Special Issue Root Canal Treatment (RCT): Latest Advances and Prospects)
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17 pages, 3548 KiB  
Article
Physicochemical and Antibacterial Properties of Novel, Premixed Calcium Silicate-Based Sealer Compared to Powder–Liquid Bioceramic Sealer
by Naji Kharouf, Youri Arntz, Ammar Eid, Jihed Zghal, Salvatore Sauro, Youssef Haikel and Davide Mancino
J. Clin. Med. 2020, 9(10), 3096; https://doi.org/10.3390/jcm9103096 - 25 Sep 2020
Cited by 54 | Viewed by 5038
Abstract
The aim of this study was to compare the physicochemical properties, filling ability, and antibacterial activity of a premixed calcium silicate-based sealer to those of a powder–liquid bioceramic sealer. Ceraseal (CS) and BioRoot (BR) materials were analyzed using scanning electron microscopy and energy-dispersive [...] Read more.
The aim of this study was to compare the physicochemical properties, filling ability, and antibacterial activity of a premixed calcium silicate-based sealer to those of a powder–liquid bioceramic sealer. Ceraseal (CS) and BioRoot (BR) materials were analyzed using scanning electron microscopy and energy-dispersive X-ray spectroscopy at 7 and 14 d of immersion in distilled water. The filling ability of the two sealers as well as the water contact angle, solubility, flow, roughness, crystalline microstructure, pH, and compressive strength were also evaluated. The antibacterial activity was assessed through an agar diffusion as well as through direct tests. All the results were statistically analyzed using one-way or two-way analysis of variance tests. Statistically significant lower void percentages were observed for CS at 2 and 8 mm from the working length (WL) compared to those for the BR group, whilst no significant difference was observed at 5 mm from the WL. BR sealer showed higher alkaline pH, rougher surface, lower water contact angle values, lower flowability, and higher solubility compared to CS. BR showed globular and needle-like crystalline microstructure, whilst CS had globular and flower-like crystalline microstructure up to 72 h. No statistical difference was found for the compressive strength between the two sealers. BR and CS showed no antibacterial effect against Enterococcus faecalis after 3 h, whilst both sealers showed antibacterial capacity after 24 and 72 h. BR demonstrated higher antibacterial activity after 24 h. In conclusion, the use of bioceramic sealers may play an important role in controlling bacterial growth. Moreover, CS may have superior filling ability and lower solubility than the BioRoot sealer due to its specific chemical composition and mixing method. Full article
(This article belongs to the Special Issue Root Canal Treatment (RCT): Latest Advances and Prospects)
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10 pages, 1192 KiB  
Article
Self-Limiting versus Rotary Subjective Carious Tissue Removal: A Randomized Controlled Clinical Trial—2-Year Results
by Ahmed H. Ali, Farah Ben Thani, Federico Foschi, Avijit Banerjee and Francesco Mannocci
J. Clin. Med. 2020, 9(9), 2738; https://doi.org/10.3390/jcm9092738 - 25 Aug 2020
Cited by 5 | Viewed by 2943
Abstract
Background: the aim of this study was to assess the 2-year pulp survival of deep carious lesions in teeth excavated using a self-limiting protocol in a single-blind randomized controlled clinical trial. Methods: At baseline, 101 teeth with deep carious lesions in 86 patients [...] Read more.
Background: the aim of this study was to assess the 2-year pulp survival of deep carious lesions in teeth excavated using a self-limiting protocol in a single-blind randomized controlled clinical trial. Methods: At baseline, 101 teeth with deep carious lesions in 86 patients were excavated randomly using self-limiting or control protocols. Standardized clinical examination and periapical radiographs of teeth were performed after 1- and 2-year follow-ups (REC 14/LO/0880). Results: During the 2-year period of the study, 24 teeth failed (16 and 8 at T12 and T24, respectively). Final analysis shows that 39/63 (61.9%) of teeth were deemed successful (16/33 (48.4%) and 23/30 (76.6%) in the control and experimental groups, respectively with a statistically significant difference (z score = 2.3, p = 0.021). Of teeth with severe and mild symptoms at T0, 42.9% and 36.7% respectively failed at T24 (p > 0.05). Within the self-limiting group, there was a lower success in premolars compared to molars (p < 0.05). Conclusion: after 2 years, there was a statistically significant higher pulp survival rate of teeth with deep carious lesions excavated using self-limiting protocols in patients with reversible pulpitis. Molars showed higher success than premolars in teeth excavated using the self-limiting protocol. There was no statistically significant association between the outcome and the severity of symptoms at T0 (ClinicalTrials.gov NCT03071588). Full article
(This article belongs to the Special Issue Root Canal Treatment (RCT): Latest Advances and Prospects)
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15 pages, 2486 KiB  
Article
Antimicrobial Effectiveness of Calcium Silicate Sealers against a Nutrient-Stressed Multispecies Biofilm
by Rahul Bose, Konstantinos Ioannidis, Federico Foschi, Abdulaziz Bakhsh, Robert D. Kelly, Sanjukta Deb, Francesco Mannocci and Sadia Ambreen Niazi
J. Clin. Med. 2020, 9(9), 2722; https://doi.org/10.3390/jcm9092722 - 24 Aug 2020
Cited by 11 | Viewed by 5088
Abstract
Purpose: This study compared the antimicrobial efficacy of calcium silicate sealers (BioRoot RCS and Total Fill BC) and conventional sealers (AH Plus and Tubli-seal) against planktonic bacteria and a nutrient-stressed multispecies biofilm. Methods: Antimicrobial properties of freshly mixed sealers were investigated using the [...] Read more.
Purpose: This study compared the antimicrobial efficacy of calcium silicate sealers (BioRoot RCS and Total Fill BC) and conventional sealers (AH Plus and Tubli-seal) against planktonic bacteria and a nutrient-stressed multispecies biofilm. Methods: Antimicrobial properties of freshly mixed sealers were investigated using the direct contact test (DCT) and a nutrient-stressed multispecies biofilm comprised of five endodontic strains. Antimicrobial activity was determined using quantitative viable counts and confocal laser scanning microscopy (CLSM) analysis with live/dead staining. The pH of the sealers was analysed over a period of 28 days in Hanks Balanced Salt Solution (HBSS). Analysis of variance (ANOVA) with Tukey tests and the Kruskal–Wallis test were used for data analysis with a significance of 5%. Results: All endodontic sealers exhibited significant antimicrobial activity against planktonic bacteria (p < 0.05). BioRoot RCS caused a significant reduction in viable counts of the biofilms compared to AH Plus and the control (p < 0.05), while no significant difference could be observed compared to TotalFill BC and Tubli-seal (p > 0.05). CLSM analysis showed that BioRoot RCS and TotalFill BC exhibited significant biofilm inhibition compared to Tubli-seal, AH Plus and the control (p < 0.05). BioRoot RCS presented with the highest microbial killing, followed by TotalFill BC and Tubli-seal. Alkalizing activity was seen from the onset by BioRoot RCS, TotalFill BC and AH Plus. After 28 days, BioRoot RCS demonstrated the highest pH in HBSS (pH > 12). Conclusions: Calcium silicate sealers exhibited effective antimicrobial properties. This was demonstrated by superior biofilm inhibition capacity and microbial killing, with strong alkalizing activity compared to epoxy-based and zinc oxide-eugenol-based sealers. Full article
(This article belongs to the Special Issue Root Canal Treatment (RCT): Latest Advances and Prospects)
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Review

Jump to: Research

23 pages, 8228 KiB  
Review
The Role of Dendritic Cells during Physiological and Pathological Dentinogenesis
by Angela Quispe-Salcedo and Hayato Ohshima
J. Clin. Med. 2021, 10(15), 3348; https://doi.org/10.3390/jcm10153348 - 29 Jul 2021
Cited by 4 | Viewed by 2928
Abstract
The dental pulp is a soft connective tissue of ectomesenchymal origin that harbors distinct cell populations, capable of interacting with each other to maintain the vitality of the tooth. After tooth injuries, a sequence of complex biological events takes place in the pulpal [...] Read more.
The dental pulp is a soft connective tissue of ectomesenchymal origin that harbors distinct cell populations, capable of interacting with each other to maintain the vitality of the tooth. After tooth injuries, a sequence of complex biological events takes place in the pulpal tissue to restore its homeostasis. The pulpal response begins with establishing an inflammatory reaction that leads to the formation of a matrix of reactionary or reparative dentin, according to the nature of the exogenous stimuli. Using several in vivo designs, antigen-presenting cells, including macrophages and dendritic cells (DCs), are identified in the pulpal tissue before tertiary dentin deposition under the afflicted area. However, the precise nature of this phenomenon and its relationship to inherent pulp cells are not yet clarified. This literature review aims to discuss the role of pulpal DCs and their relationship to progenitor/stem cells, odontoblasts or odontoblast-like cells, and other immunocompetent cells during physiological and pathological dentinogenesis. The concept of “dentin-pulp immunology” is proposed for understanding the crosstalk among these cell types after tooth injuries, and the possibility of immune-based therapies is introduced to accelerate pulpal healing after exogenous stimuli. Full article
(This article belongs to the Special Issue Root Canal Treatment (RCT): Latest Advances and Prospects)
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15 pages, 27785 KiB  
Review
Influence of Coronal Preflaring on the Accuracy of Electronic Working Length Determination: Systematic Review and Meta-Analysis
by María León-López, Daniel Cabanillas-Balsera, Victoria Areal-Quecuty, Jenifer Martín-González, María C. Jiménez-Sánchez, Juan J. Saúco-Márquez, Benito Sánchez-Domínguez and Juan J. Segura-Egea
J. Clin. Med. 2021, 10(13), 2760; https://doi.org/10.3390/jcm10132760 - 23 Jun 2021
Cited by 7 | Viewed by 1957
Abstract
Aim. To conduct a systematic review and meta-analysis according to the following PICO question: in extracted human permanent teeth, does preflaring, compared with unflared canals, influence the accuracy of WL determination with EAL? Material and Methods. A systematic review was conducted according to [...] Read more.
Aim. To conduct a systematic review and meta-analysis according to the following PICO question: in extracted human permanent teeth, does preflaring, compared with unflared canals, influence the accuracy of WL determination with EAL? Material and Methods. A systematic review was conducted according to the PRISMA checklist, using the following databases: PubMed, Science Direct, Scopus, and Web of Science. Studies related to WL determination using EAL both in preflared and unflared root canals of extracted human teeth were included. The outcome of interest was the accuracy of the electronic WL determination. A quality assessment of the included studies was performed, determining the risk of bias. The meta-analyses were calculated with the 5.4 RevMan software using the inverse variance method with random effects. PROSPERO registration: CRD42021243412. Results. Ten experimental studies fulfilled the inclusion criteria, and most of them found that preflaring increases the accuracy of the EALs in WL determination. The calculated OR was 1.98 (95% CI = 1.65–2.37; p < 0.00001; I2 = 10%), indicating that the determination of WL by EALs is almost twice as accurate in preflared canals. The accuracy of Root ZX in WL determination increases more than three times (OR = 3.25; p < 0.00001). Preflaring with Protaper files significantly increases the accuracy of EALs (OR = 1.76; p < 0.00001). The total risk of bias of the included studies was low. No obvious publication bias was observed. Conclusions. The results indicate a significant increase in the accuracy of WL determination with EAL after preflaring, doubling the percentage of exact measurements. Preflaring should be recommended as an important step during mechanical enlargement of the root canal, not only because it improves the access of the files to the canal, but also because it allows one to obtain more accurate electronic determinations of WL. Full article
(This article belongs to the Special Issue Root Canal Treatment (RCT): Latest Advances and Prospects)
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14 pages, 1958 KiB  
Review
Smoking and Radiolucent Periapical Lesions in Root Filled Teeth: Systematic Review and Meta-Analysis
by Daniel Cabanillas-Balsera, Juan J. Segura-Egea, María Bermudo-Fuenmayor, Jenifer Martín-González, María Carmen Jiménez-Sánchez, Victoria Areal-Quecuty, Benito Sánchez-Domínguez, Paloma Montero-Miralles and Eugenio Velasco-Ortega
J. Clin. Med. 2020, 9(11), 3506; https://doi.org/10.3390/jcm9113506 - 29 Oct 2020
Cited by 7 | Viewed by 1976
Abstract
Aim: This systematic review and meta-analysis aimed to investigate the association between smoking habits and the prevalence of radiolucent periapical lesions (RPLs) in root-filled teeth (RFT). Methods: The Population, Intervention, Comparison, and Outcome (PICO) question was: in adult patients who have RFT, does [...] Read more.
Aim: This systematic review and meta-analysis aimed to investigate the association between smoking habits and the prevalence of radiolucent periapical lesions (RPLs) in root-filled teeth (RFT). Methods: The Population, Intervention, Comparison, and Outcome (PICO) question was: in adult patients who have RFT, does the absence or presence of a smoking habit affect the prevalence of RPLs associated with RFT? Systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, Scopus, and PRISMA protocol were used to evaluate and present the results. Studies comparing smokers with control non-smoker subjects, including RFT, and providing data on the prevalence of RFT with RPLs, were included. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. The risk of bias was assessed according to Cochrane Collaboration common scheme for bias and ROBINS-I tool. Cumulative meta-analysis was performed with a random effects model. PROSPERO registration code: CRD42020165279. Results: Four studies reported data on inclusion criteria, representing data from 9257 root-filled teeth—4465 from non-smokers and 4792 from smoker patients. The meta-analysis provided an odds ratio indicating a significant association between smoking and higher prevalence of root filled teeth with radiolucent periapical lesions (OR = 1.16; 95% CI = 1.07–1.26; p = 0.0004). The certainty of the literature assessment was moderate per GRADE. The ROBINS-I tool classified three studies as low risk of bias, and the fourth as moderate risk of bias. Conclusions: Moderate, quality scientific evidence indicates a weak but significant relationship between smoking and the prevalence of RPLs in RFT. Smoking can be considered a negative prognostic factor for the outcome of root canal treatment. Endodontic providers should be aware of the relationship between smoking and persistent apical periodontitis, assessed as RPLs, in RFT. Full article
(This article belongs to the Special Issue Root Canal Treatment (RCT): Latest Advances and Prospects)
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