Search Results (626)

Background/Objectives: This study aimed to evaluate the effect of intracanal cryotherapy on postoperative pain across obturation materials with different chemical compositions and physical properties in single-visit root canal treatment. Methods: Patients diagnosed with irreversible pulpitis (n = 73), treated in a single visit by the same operator, were categorized based on the obturation material used (AH Plus, TotalFill BC Sealer, and TotalFill BC RRM) and whether intracanal cryotherapy (20 mL of sterile saline at 4 °C for 5 min) was applied. Visual Analog Scale (VAS) scores obtained from patient follow-up forms at 24, 48, and 72 h were evaluated. Results: Cryotherapy (+) groups showed consistently lower pain scores at all time points compared with cryotherapy (−) groups (p < 0.001). Within the cryotherapy (+) groups, both TotalFill BC Sealer and TotalFill BC RRM exhibited significantly lower pain scores than AH Plus at 48 h (p < 0.05). In the cryotherapy (−) groups, TotalFill BC Sealer showed significantly lower pain scores on the third postoperative day (p < 0.05). Conclusions: Intracanal cryotherapy may serve as an effective adjunctive technique associated with lower early postoperative pain scores. Material-related differences became evident at 48 and 72 h, suggesting that obturation material selection may influence postoperative pain patterns and patient comfort during the later postoperative period. Full article

Background: The primary goal of root canal treatment is the prevention and healing of apical periodontitis through the meticulous elimination of pathogenic bacteria and infected tissues. Within this framework, apical patency remains a fundamental yet debated clinical concept. Objectives: This review aims to evaluate the clinical significance of maintaining apical patency, its influence on postoperative discomfort, and the technical strategies required for predictable negotiation. Methods: We performed a comprehensive review of existing literature, including clinical studies and recent meta-analyses, focusing on the correlation between patency maneuvers and postoperative pain, the role of preoperative CBCT imaging, and the efficacy of specialized negotiation instruments and motor kinematics. While patency facilitates thorough debridement, evidence regarding its impact on postoperative pain is conflicting, with recent meta-analyses suggesting it may actually alleviate discomfort intensity. Preoperative CBCT was identified as essential for identifying complex anatomy, such as the MB2 canal. Furthermore, the use of specialized files and reciprocating motor modes enhances the predictability of glide path establishment. Conclusions: Although failure to achieve patency does not always dictate a negative outcome, it is associated with improved long-term healing. Clinicians should prioritize “Anatomical Patency”—respecting original morphology—over forceful “Operative Patency” to ensure procedural integrity and clinical success. Full article

Panoramic radiographs are widely used in dental practice due to their ability to provide a comprehensive view of the teeth, jaws, and surrounding anatomical structures in a single examination. However, automated interpretation remains challenging because multiple conditions may co-exist within a single image, class distributions are highly imbalanced, and several findings exhibit subtle radiographic characteristics. This study presents a deep learning framework for multi-label dental findings classification using panoramic radiographs from the publicly available VZRAD2 dataset. Following a label curation process, eleven clinically relevant classes were retained, including diseases, treatments, and anatomical structures. The proposed EfficientNet-B4-CBAM model integrates an EfficientNet-B4 backbone with a Convolutional Block Attention Module (CBAM) to enhance feature representation through channel and spatial attention. EfficientNet-B4 and ResNet50 were used as baseline models for comparison under a unified training protocol. The training pipeline incorporates data augmentation, weighted sampling to address class imbalance, AdamW optimization, and Binary Cross-Entropy with Logits loss for multi-label learning. On the validation set, the proposed model achieved the highest micro-F1 score of 0.8567, compared to 0.8424 for EfficientNet-B4 and 0.8469 for ResNet50. ROC analysis showed comparable separability across models, with micro-AUC values of 0.946 (EfficientNet-B4-CBAM), 0.947 (EfficientNet-B4), and 0.960 (ResNet50). Class-wise evaluation indicated strong performance for visually distinct findings such as impacted tooth, implant, filling, and root canal treatment, while anatomically diffuse or underrepresented classes remained more challenging. Grad-CAM visualizations suggest that the model focuses on clinically relevant regions, supporting interpretability. Overall, the results indicate that attention-enhanced convolutional models can provide effective and interpretable support for multi-label dental findings classification. However, the observed performance improvements are modest, and further validation on independent datasets, along with clinical evaluation, is required to confirm generalizability and real-world applicability. Full article

Conventional: Endodontic outcome criteria established by the American Association of Endodontists (AAE) and the European Society of Endodontology (ESE) rely heavily on radiographic, clinical, and functional parameters. These criteria may not be applicable to patients with special health care needs, who often present with limited cooperation, communication impairments, and altered pain perception. Objective: This study aims to propose an adapted classification system for evaluating non-surgical root canal treatment outcomes in this underserved population. Methods: Based primarily on the criteria established by the ESE and our clinical experience, a novel classification system was developed, delineating three outcome categories grounded in both clinical and radiographic parameters. This framework deliberately excludes the “functional” criterion and introduces a “not assessable” category. It was retrospectively applied to 217 non-surgical root canal treatments performed in 137 patients with special health care needs, each with a minimum one-year follow-up. Outcomes were categorized as “favorable,” “uncertain,” or “unfavorable.” Results: Using the proposed criteria, 87 treatments (40.0%) were classified as “favorable,” 88 (40.5%) as “uncertain,” and 42 (19.3%) as “unfavorable.” By contrast, the application of AAE/ESE standards resulted in a 71.9% “favorable” classification. Most “uncertain” outcomes occurred in patients with neurodevelopmental disorders, where clinical or radiographic evaluation was not feasible. Conclusions: We propose adapted clinical and radiographic criteria for assessing non-surgical root canal treatment outcomes in patients with special health care needs, though broader validation is required. The findings suggest that this procedure remains advisable in this population, with fewer than 20% showing an “unfavorable” long-term outcome. Full article

Root canal disinfection remains challenging due to anatomical complexity and the limitations of mechanical instrumentation. Evidence on irrigation is often fragmented and focused on isolated outcomes, limiting clinically integrated protocols. This narrative review provides a clinically oriented interpretation of contemporary irrigation and activation strategies, introducing a substrate-centered perspective emphasizing dentin modification and material interaction. A structured narrative search was conducted in PubMed, Scopus, and Web of Science up to February 2026 using keywords related to irrigants, irrigation protocols, activation techniques, and dentin–material interactions. Studies were selected based on clinical relevance, including complex anatomy, mature biofilms, and realistic irrigation sequences. Irrigation effectiveness is determined by the interplay between irrigant chemistry, fluid dynamics, and activation-mediated distribution within the root canal system, as well as by irrigation-induced dentin modifications influencing the dentin–material interface. Sodium hypochlorite and chelating agents remain central, although their performance depends on delivery and activation. Activation enhances irrigant exchange, biofilm disruption, and penetration into complex regions. Irrigation also induces physicochemical changes in dentin, affecting sealer penetration and interfacial stability. It should not only be considered a disinfection step but also a substrate-conditioning phase linking cleaning to obturation, with implications for treatment predictability and long-term outcomes. Full article

Background/Objectives: Effective irrigation of the apical third remains one of the greatest challenges in root canal treatment, particularly in curved canals where anatomical complexity restricts irrigant penetration. This in vitro study evaluated the irrigation efficacy of four syringe-needle designs under standardized conditions. Methods: Ten transparent resin blocks with approximately 30° curved canals were instrumented to size 30/0.04 taper. Four irrigation needle designs were tested: flat open-ended (27G), notched open-ended (27G), double-vented closed-ended (27G), and finally a flexible polypropylene closed-ended (IrriFlex, 30G) used as a reference. Canals were filled with methylene blue and irrigated dynamically with distilled water. Residual dye was quantified spectrophotometrically at 665–668 nm. Data were analyzed using ANOVA with post hoc testing (p < 0.05). Results: Significant differences were found among the needle designs. The flexible polypropylene needle showed the lowest absorbance values and performed significantly better than both the flat open-ended and double-vented metallic needles. The notched open-ended needle demonstrated irrigation efficacy comparable to the flexible needle. The double-vented metallic needle exhibited the highest residual dye levels, indicating the poorest irrigation performance. Conclusions: Needle design significantly influences irrigation efficacy in curved root canals. Flexible and notched designs enhanced apical dye removal compared with conventional metallic open-ended and side-vented needles. Differences in performance appear to be governed by a combination of vent configuration, needle flexibility, penetration depth, and fluid-dynamic behavior rather than needle gauge alone. Full article

Objectives: This study evaluated the prevalence of periapical lesions in endodontically treated teeth restored with cast post-and-core systems after a minimum two-year follow-up, and identified restorative and clinical factors influencing periapical health. Methods: A cross-sectional study was conducted at the dental clinic of the International University of Rabat. Of 224 contacted patients, 91 met the inclusion criteria (completed endodontic treatment and post placement > 2 years), yielding 118 post-restored teeth. Radiographs were obtained using a phosphor plate system and analyzed with DBSWIN software, applying Ørstavik’s PAI index. Statistical analysis was performed with Jamovi (v2.3.24, Australia). Quantitative data were expressed as mean and standard deviation, and qualitative data as numbers and percentages. The Chi-square test was used with a significance level of p < 0.05. Results: The study found that 31.4% of the teeth presented a radiologically detectable periapical lesion (PAI ≥ 3). Maxillary incisors and premolars were the most frequently affected. Lesion prevalence was significantly associated with post/filling gaps ≥ 2 mm (p = 0.008) and low-density root fillings (p < 0.001). Although short filling length (<4 mm) was common in teeth with periapical lesions, no significant association was observed (p = 0.550). Systemic conditions, such as diabetes, showed a trend toward higher lesion prevalence (p = 0.056). Conclusions: The findings highlight the need for a rigorous approach in restoring endodontically treated teeth. Absence of gaps between the root canal filling and post and homogeneous filling density are key protective factors for maintaining periapical health. Regular radiographic follow-up and future longitudinal studies (3D imaging and clinical parameters) remain essential to refine protocols and improve outcomes. Full article

Background: This study aimed to evaluate the prevalence, morphology, and influencing factors of the second mesiobuccal (MB2) canal in maxillary molars and the middle-mesial canal in mandibular molars using cone-beam computed tomography (CBCT). Methods: A total of 146 CBCT scans acquired between 2023 and 2025 were retrospectively analyzed at the Oral Radiology Division, King Abdulaziz University Dental Hospital. Canal prevalence, morphometric dimensions, symmetry, and Vertucci configurations were recorded and correlated with age, sex, and voxel size. Results: MB2 canals were detected in 64.4% of maxillary first molars and 29.6% of second molars, while middle-mesial canals were found in 17.8% of mandibular first molars and 6.4% of second molars. Detection rates declined with increasing voxel size and patient age (p < 0.05). Bilateral symmetry was strong for MB2 (κ = 0.78) but moderate for mandibular canals (κ = 0.29). Vertucci Type I and II were most common in maxillary roots, and Type IV predominated in mandibular mesial roots. Conclusions: These findings confirm CBCT as a reliable tool for identifying complex canal systems and emphasize the importance of voxel resolution and anatomical understanding in enhancing endodontic diagnosis and treatment success. Full article

Objectives: Oral healthcare and regular dental follow-up are important during pregnancy, as maternal oral health may have important implications for both maternal and fetal well-being. However, dental attendance remains low. Therefore, this cross-sectional e-survey aimed to explore pregnant women’s dental pain management strategies, their perceptions of endodontic treatment, and avoidance of specific endodontic procedures during pregnancy. Methods: An 18-item online questionnaire was administered to 130 pregnant women. Data were collected on dental attendance, experiences of toothache, use of analgesics or antibiotics, and perceptions of the safety of dental anesthesia and radiographic procedures during pregnancy. Statistical analyses were conducted using Chi-square or Fisher’s exact tests and multivariate logistic regression (p < 0.05). Results: The mean age of participants was 32 years. Only 26.15% reported attending regular dental visits during pregnancy. Among participants who experienced toothache, 51.52% used analgesics and 1.54% used antibiotics. Although 92.31% believed dental infections should be treated during pregnancy, concerns regarding dental procedures were common; 76.92% considered dental radiography unsafe and only 50% considered local anesthesia safe. Multivariate analysis showed that the number of pregnancies was associated with dental visits during pregnancy (p = 0.048), age with analgesic use (p = 0.018), and education level with perception of dental radiography safety (p = 0.013). Conclusions: Despite awareness of the importance of treating dental infections, pregnant women may delay endodontic care during pregnancy, highlighting a need for improved patient education and clearer clinical guidance. Full article

Objective: To report a rare case of pulp space tissue growth in a mature mandibular molar with severe endo-periodontal involvement after conservative endodontic treatment and to discuss the possible biological explanations, including regeneration and granulation tissue healing. Severe endo-periodontal lesions are challenging, particularly as endodontic regeneration is usually observed in immature teeth, while revascularization in mature teeth, especially in cases of advanced periodontal disease, is rare, as demonstrated in this case. Methods: This study reports a rare case of tissue regeneration versus granulation tissue healing in the pulp space, occurring alongside periodontal healing, in a mature mandibular molar with necrotic pulp and severe periodontal involvement. A 52-year-old patient presented with a mature mandibular molar (tooth #19) exhibiting necrotic pulp with severe endo-periodontal involvement, including grade-3 mobility, tenderness to percussion, a 12 mm probing depth, and extensive periradicular radiolucency. The tooth was diagnosed with necrotic pulp and symptomatic apical periodontitis and was deemed hopeless, with extraction planned. Results: Following patient refusal, endodontic treatment was initiated, including cleaning, shaping, and placement of the intracanal medicament, Ledermix. The patient canceled the extraction due to symptom resolution and disappeared for 12 months. On return, the patient presented with spontaneous pain exacerbated by thermal stimuli, consistent with symptoms of irreversible pulpitis. Clinical examination revealed significant clinical and radiographic improvements, including reduced probing depth (3 mm), no mobility, resolution of apical translucency, radiographic findings suggestive of canal narrowing, and a positive pulp sensibility response. Re-entry elicited profuse bleeding with newly formed vital tissue beneath the medicament. Sodium hypochlorite irrigation failed to achieve hemostasis; inflamed tissue was removed; root canals were cleaned, shaped and obturated; and treatment was completed with placement of a permanent coronal resin composite restoration. A forty-month follow-up showed an asymptomatic tooth with clinical and radiographic healing. Conclusions: This case demonstrates that conservative endodontic management may result in favorable clinical and radiographic outcomes in mature teeth with severe endo-peroidontal involvement, influencing extraction decisions. It provides clinical evidence suggestive of tissue regeneration and periodontal healing in a mature tooth with necrotic pulp and severe periodontal compromise, challenging conventional prognosis. The observed pulp space tissue growth may be suggestive of regeneration; however, alternative explanations, including granulation tissue healing or repair processes, cannot be excluded. Healing by granulation tissue in the pulp space remains possible. Root canal treatment in advanced endo-perio lesions can yield favorable outcomes and may influence extraction decisions. Further clinical and histological studies are needed to clarify underlying mechanisms and optimize treatment strategies. Full article

Background and Objectives: Premature loss of primary teeth can disrupt occlusal development and oral function. Although iodoform-based materials such as Vitapex^® are widely used, concerns remain regarding their cytotoxicity and potential to accelerate root resorption. Sodium iodide (NaI) has emerged as a biocompatible, antibacterial alternative. This study evaluated the feasibility of a NaI-based root canal filling material in a canine model of Enterococcus faecalis-induced periapical inflammation. Methods: Periapical lesions were induced in a healthy male mongrel dog using E. faecalis (10⁶ CFU/mL). After six weeks, the root canals were obturated with NaI paste, Vitapex^®, or Calcipex. Untreated teeth and an E. faecalis-only group served as controls. Radiographic lesion sizes were monitored at 4, 8, 12, and 16 weeks post-obturation. Histological analysis at 16 weeks assessed inflammatory area and perimeter, stromal fibrosis, inflammatory cell infiltration, and myeloperoxidase (MPO) expression. Results: Radiographically, all treatment groups showed reduced lesion size relative to the positive control. No significant differences were observed among the NaI, Vitapex^®, and Calcipex groups at 4 and 8 weeks; however, significant differences emerged at 12 and 16 weeks (p < 0.05). The NaI group showed lesion reduction until week 8, followed by subsequent expansion thereafter, whereas the Vitapex^® and Calcipex groups showed continuous lesion reduction over time. Histologically, the periapical inflammatory area increased in the order of Vitapex^® < Calcipex < NaI < positive control (p < 0.05). MPO staining identified neutrophils as the primary inflammatory cells. Conclusions: NaI paste showed favorable early radiographic healing but limited long-term stability compared with conventional materials. With further optimization, it may have potential as an alternative root canal filling material. However, given the single-animal exploratory design, these findings should be interpreted as preliminary rather than definitive evidence. Full article

The purpose of this investigation was to establish a clinical diagnosis of the cause of instrument fracture and to evaluate its impact on fragment removal success. One hundred cases of fractured endodontic instruments were analyzed to determine the relationship between fracture cause (flexion, torsion, or combined) and removal outcomes. A diagnostic protocol was developed to classify the fracture mechanism based on radiographic findings, clinical observations, and instrument-related parameters. Fragment length, intracanal location, and removal time were recorded. Torsion was the most frequent cause (54%), followed by combined fracture (33%) and flexion (13%). Flexion-related fragments were significantly longer, located in more accessible areas, and exhibited lower mechanical retention, resulting in shorter removal times (mean: 19.62 min). In contrast, torsion-related fragments were shorter, showed greater retention, and required longer removal times (mean: 32.98 min). Statistical analysis demonstrated a significant association between fracture cause, fragment location, and removal time. The fracture mechanism may serve as a predictive clinical factor for fragment removal difficulty. Early identification of this parameter can improve treatment planning and optimize clinical resource management. Full article

Introduction: Advancements in thermo-mechanical surface treatment of endodontic nickel–titanium (NiTi) instruments introduced another aspect of variation. Particularly related to their metallurgy, which influences their behaviour in relation to temperature. This is clinically significant, considering the variation in the temperatures inside the root canal during instrumentation. This study aimed to compare the effects of different temperatures on the bending stiffness, cyclic fatigue resistance, and cutting efficiency of two reciprocating heat-treated NiTi files: R-Motion (RM) and WaveOne Gold (WOG). Methodology: Bending stiffness was examined in a temperature-controlled water bath, measuring the maximum force in Newtons during a 3 mm tip horizontal displacement. The cyclic fatigue resistance was tested in a simulated stainless-steel canal (35° curvature, 6 mm radius) in dynamic mode at 22 °C, 37 °C, and 45 °C. Time to fracture (TTF) and length of fractured fragment were recorded, and representative samples were examined using scanning electron microscopy. The cutting efficiency was assessed using bovine bone slabs measuring 1.5 mm in thickness and 15 mm in width. The files were activated in reciprocation mode for three minutes while resting on the upper surface of the slab, while submerged in a water bath maintained at 22 °C, 37 °C, or 45 °C. The maximum cutting depth was measured in millimetres under magnification. Additionally, Differential Scanning Calorimetry (DSC) analysis was performed for three specimens of each file type. Results: RM exhibited significantly higher TTF, longer fractured fragments, and smaller cutting depths than WOG across all temperatures. The RM was significantly stiffer at 37 °C and 45 °C only. For each file type, increasing the temperature was associated with a significant increase in stiffness (p < 0.01), except for WOG between 22 °C and 37 °C (p = 0.199). The TTF was significantly higher in RM at 22 °C, while the TTF in WOG increased significantly with lower temperatures. No effect was observed on the length of the fractured fragment. Lower temperatures were also associated with reduced cutting efficiency in both files. Conclusions: Temperature has a significant impact on the properties and performance of RM and WOG and should be considered during instrumentation. File design has a greater influence on their strength and cutting ability than their transformation behaviour related to heat treatment. Full article

Root canal sealers play a crucial role in the success of endodontic treatment, facilitating healing and regeneration of the periapical region. This study aimed to evaluate the biological, physicochemical and structural properties of two sealers, AH Plus and ROEKO GuttaFlow 2. Scanning electron microscopy (SEM) analysis reveals polyhedral particles uniformly distributed within the porous organic matrix of AH Plus, whereas ROEKO GuttaFlow 2 exhibits a heterogeneous structure, with particles distributed evenly. Fourier-Transform Infrared Spectroscopy (FT-IR) analysis confirmed the characteristic chemical bonds associated with both the organic and inorganic phases of each material, while X-Ray diffraction analysis identified the main crystalline phases (CaWO₄ and ZrO₂ for AH Plus and ZrSiO₄ and ZrO₂ for ROEKO GuttaFlow 2). The biocompatibility tests were performed on human osteosarcoma cells (ATCC—G 292 CRL-1423). An in vitro metabolic activity and viability test (MTT) showed a significant decrease by ~92% (* p < 0.05) and ~87% after 24 and 48 h for samples incubated with AH Plus versus the control. Regarding ROEKO GuttaFlow 2, MTT levels increased by ~8% in the first 24 h, while after 48 h they decreased by ~11% versus control. Lactate dehydrogenase levels significantly increased at 24 and 48 h for cells incubated with AH Plus (*** p < 0.001, ** p < 0.01). ROEKO GuttaFlow 2 significantly decreased the LDH level at 24 h (** p < 0.01), while at 48 h a rise was observed. The significantly increased levels of nitric oxide observed in cells incubated with the materials at 24 and 48 h (** p < 0.01, *** p < 0.001) suggest a cellular adaptation to our experimental environment. Overall, ROEKO GuttaFlow 2 exhibited a more favorable profile under our testing conditions. Full article

Objectives: To quantitatively evaluate the inhibitory effects of commercially available probiotic formulations (Probien, Enterogermina, Reflor) applied as intracanal medicaments against mature dual-species biofilms of Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans) using a qPCR-based in vitro root canal model, with calcium hydroxide included as the reference intracanal medicament for comparison. Materials and Methods: Root canal specimens containing mature dual-species biofilms were medicated with probiotic–poloxamer gel formulations (Probien, Enterogermina, or Reflor) or calcium hydroxide (reference inhibitory control); infected but untreated canals served as the non-inhibitory control, and sterile non-inoculated specimens were included to confirm procedural sterility. After a 7-day intracanal application period, microbial loads were quantified at baseline and post-treatment by qPCR, and results were expressed as delta cycle threshold (ΔCt), colony-forming equivalents (CFE/mL), and percentage reduction values. Results: A total of 78 specimens (n = 13 per group) were analyzed. No significant intergroup differences were found in E. faecalis ΔCt or reduction percentages (p > 0.05), indicating its persistence despite intracanal medication. For C. albicans, differences among groups were significant (p < 0.001). Calcium hydroxide showed the strongest antifungal effect, producing marked ΔCt and CFE reductions versus probiotic and positive control groups, whereas probiotic formulations displayed only limited antifungal activity and no measurable inhibition against E. faecalis. Conclusions: Under the conditions of this in vitro model, the tested commercially available probiotic formulations—originally developed for gastrointestinal use—did not demonstrate significant antimicrobial effects against mature E. faecalis–C. albicans biofilms. These findings should be interpreted in the context of the absence of probiotic formulations specifically designed for intracanal use and the distinct ecological characteristics of the root canal system, which represents a closed, low-oxygen environment dominated by hard-tissue surfaces. Rather than excluding the potential of probiotics in endodontics, the present results highlight the need for root canal–adapted probiotic strains and delivery strategies tailored to intracanal conditions. Clinical Relevance: This in vitro study provides experimental insight into the limitations of directly applying commercially available gastrointestinal probiotic formulations within the root canal system. The findings highlight the importance of developing root canal–specific probiotic strains and delivery strategies tailored to the unique ecological conditions of the intracanal environment, thereby informing future translational and experimental research in biological endodontics. Full article