搜索结果：Iranian endodontic journal

The American Association of Endodontics classifies the management of pulp canal obliteration (PCO) cases as a high-risk difficulty. This classification indicates an increased likelihood of procedural errors. However, advancements in dental technology have simplified the endodontic treatment of calcified teeth. Guided endodontics uses cone-beam computed tomography (CBCT) and a three-dimensional (3D) printer to create a patient-specific guide, enhancing accuracy and predictability in complex cases. A healthy 60-year-old male was referred by a prosthodontist for root canal treatment on teeth #23, #24, and #25. Periapical radiographic examination revealed partial PCO in all teeth. After choosing guided endodontics treatment, CBCT imaging and intraoral 3D scanning were utilized to design a patient-specific endodontic guide. After verifying the stability of the endo-guide, access cavities were prepared using a Munce Discovery bur. Following the negotiation of the canals, the working length was determined. Root canal treatment was performed using rotary files up to size 25/0.04% and sodium hypochlorite irrigation. The obturation was completed using the warm condensation technique. Although PCO was present, no complications occurred during treatment. The teeth remained completely asymptomatic and functional, demonstrating the success of the treatment. Guided endodontics can be a practical and predictable approach for managing PCO in mandibular incisors. This technique provides accurate canal location, reduces procedural errors, and preserves tooth structure. Despite concerns about cost, radiation exposure, and challenges with anatomical variations, it represents a promising advancement in endodontic treatment.

Geristore® (GS) is an advanced dual-cure resin-modified glass ionomer with favourable biological and physical properties, including biocompatibility, fluoride release, and excellent sealing ability. Originally developed for restorative purposes, its clinical versatility has nonetheless extended into endodontics. The current critical review primarily aims to evaluate the biological characteristics, endodontic applications, and possible clinical potential of GS as a biomaterial in modern endodontic practice. A comprehensive literature search was conducted across major databases (MEDLINE, PubMed, Scopus, Cochrane, EMBASE, Google Scholar, and grey literature) without restrictions on date and/or language. Relevant peer-reviewed studies on the composition, properties, and endodontic uses of GS were identified, screened, investigated, and critically analysed. Geristore® has demonstrated promising outcomes in endodontic procedures, e.g., root-end filling, perforation repair, vital pulp therapy, retrograde vital pulp therapy, intra-orifice barrier placement and the management of external cervical resorption, Additionally, various studies have highlighted its favourable soft tissue compatibility, sealing ability (even in moist environments) as well as its acceptable mechanical properties. However, certain limitations, including reduced flexural strength and higher cytotoxicity compared to calcium silicate-based materials, such as mineral trioxide aggregate, have been reported. Geristore® presents as a clinically useful alternative for specific endodontic indications where biocompatibility, sealability, and ease of handling seem critical. However, further high-quality clinical trials and comparative studies are essential to validate its long-term performance and establish its role relative to established endodontic biomaterials.

The present study aims to provide readers with the influence of various types of dental lasers in endodontics, along with their advantages and disadvantages. A complete query was carried out on PubMed, Google Scholar, Embase, and Scopus databases, and the studies published during 2015-2024 were collected using the keywords "Laser," "Endodontics," "Disinfection," "Vital Pulp therapy," and "Regenerative Endodontic Treatment." After applying appropriate inclusion and exclusion criteria, 86 relevant articles focused on the application of dental lasers in endodontics were selected and evaluated. Based on the evaluated studies, probably the most significant advancement of dental lasers is in optimizing the treatment outcome of root canal therapy via enhanced disinfection of root canals. Moreover, various research has shown that dental lasers can also aid in diagnosing vitality of pulp, vital pulp therapy, apiectomy, regenerative treatments, pain management treatment after root canal therapy, access cavity preparation, sterilization and irrigation of root canals, treatment of periapical lesions, removing excess materials and broken instruments in canals, and prompting the healing process after root canal therapy. As evidenced by the obtained results, diode and erbium lasers have the most applications in endodontics with the lowest side effects. Nonetheless, all dental lasers face multiple limitations, including producing noticeable thermal changes and smoke and damaging surrounding structures at the emission site, which question their safe usage in clinical practice. Therefore, dental lasers' newest advancements in dental procedures require further scientific work in the future.

This case report describes the surgical treatment of a large radicular cyst in a maxillary incisor of an adolescent, following an unsuccessful regenerative endodontic procedure (REP) and an apical plug. It highlights minimally invasive, age-appropriate decision-making. A 14-year-old boy presented with an acute abscess (pain, swelling, and fever) in the right maxilla. Tooth #11 was nonvital, with apical resorption, an open apex, and a huge radiolucent lesion involving Tooth #12, confirmed by CBCT. Initial treatment included incision/drainage, calcium hydroxide dressing, and antibiotics, which resolved symptoms. REP was performed 3 months after presentation (inducing a blood clot, placing biomaterial, and coronal sealing). Partial healing was noted at 8 months, but lesion recurrence occurred asymptomatically at 19 months. An apical plug using calcium-enriched mixture (CEM) was inserted, with slight extrusion observed. Despite patient comfort, follow-ups at 37 and 44 months showed persistent nonhealing; CBCT revealed a 12 × 18 mm lesion, CEM extrusion in Tooth #11, and resorption defects. Because of the failure of nonsurgical endodontic treatments and the patient now being 18 years old, surgical intervention was performed. This involved mucoperiosteal flap elevation, enucleation of the cystic lesion, without resecting the root-end, followed by root-end preparation and filling/sealing with CEM cement in Tooth #11 and the vital #12 (due to cystic involvement). A bone substitute was also placed. Histopathology confirmed a radicular cyst. One year after surgery, radiographic healing and bone regeneration were complete, and the tooth remained functional and asymptomatic. This case highlights that extensive cystic pathology may limit the predictability of REP in certain extensive cystic lesions and supports staged surgical intervention after conservative methods fail at skeletal maturity.

Magnesium phosphate cements (MPCs) have recently gained attention as potential materials for endodontic applications due to their rapid setting, favourable mechanical properties, and bioactive potential. Laboratory and preclinical studies indicate that MPCs can form apatite-like structures, exhibit good compressive strength, and support cell viability, suggesting promising biological interactions. However, several limitations remain unresolved. The acid-base setting reaction of MPCs is strongly exothermic, which may pose a risk to pulp or periapical tissues, and ammonium-containing formulations can release cytotoxic ammonia, although partial mitigation is possible through sodium phosphate substitution. Rapid setting enhances handling in controlled conditions but may complicate placement in complex root canal anatomies. While in vitro studies suggest comparable or superior sealing ability relative to conventional calcium silicate cements, human clinical evidence is minimal or absent. Degradation and resorption profiles of MPCs may further affect their suitability as scaffolds in regenerative endodontics. Overall, MPCs represent promising investigational materials, yet claims regarding clinical readiness are premature. Careful evaluation of their physicochemical behaviour, biological safety, and practical handling is essential before consideration for routine clinical use.

Maxillary central incisors typically exhibit a single root and canal. The presence of two roots with separate canals, as defined by Vertucci's type V morphology, is extremely rare and presents diagnostic and technical challenges for nonsurgical endodontic treatment. This report describes the endodontic management of a maxillary right central incisor (tooth #11) exhibiting a sinus tract, negative responses to pulp sensibility tests, and radiographic evidence of apical periodontitis in a 24-year-old female patient. Cone-beam computed tomography (CBCT) revealed a two-rooted anatomy with independent canals splitting at the middle third. Under magnification, access was refined using ultrasonic tips. The palatal root canal was prepared with NiTi CM rotary files, while the wider buccal canal was instrumented with stainless steel K-files. Both canals were disinfected using passive ultrasonic irrigation with 2.5% sodium hypochlorite and 17% EDTA, followed by intracanal calcium hydroxide medication. Obturation was completed using the single-cone technique with a bioceramic sealer. Radiographic follow-up at 14 and 57 months confirmed complete periapical healing and absence of symptoms, demonstrating long-term clinical success. Atypical root canal anatomy in maxillary incisors necessitates advanced imaging/magnification. The use of CBCT, NiTi CM files, and bioceramic sealers enabled accurate diagnosis, conservative canal shaping, and a successful long-term outcome in this rare morphology case.

The high prevalence of diabetes mellitus and related consequences in all populations of the world makes their management an important challenge in endodontic practice. This study aimed to evaluate the knowledge, attitudes, and performance of Iranian endodontists regarding the management of diabetic patients. Questionnaires with 18 items were distributed to Iranian endodontists from different geographical provinces of Iran using social media. Responses to each question used a five-point Likert scale. Data for responses were analyzed using Chi-square or Fisher's exact tests. A total of 101 valid responses were returned for analysis (50 men and 51 women). None of the respondents had aggregated scores that were rated as unfavorable on 3 domains. Knowledge was rated as favorable for 81% and acceptable for the remaining 19%. Attitude was rated as favorable for 63%, and acceptable for 37%, while performance was rated as favorable for 98% and acceptable for the remaining 2%. Also, none of the 3 variables under evaluation were influenced by demographic factors or by work experience. The most common areas of uncertainty for respondents were monitoring blood for glucose or glycated hemoglobin concentration, and decisions regarding when to prescribe antibiotics. Overall, this cohort of endodontists displayed a high level of knowledge of the major issues involved in diabetic patient care and were confident in providing clinical care. Future programs for continuing professional development for endodontists should consider current methods used for monitoring blood glucose and glycated hemoglobin, both as point-of-care or personal devices. In addition, further education is needed on antibiotic stewardship.

Continuous improvement and technological progress in the field of microscopic endodontics enable a gradual increase in indications for non-surgical root canal treatment. While most publications report successful surgical management of overfill or extruded foreign bodies into the periapical area, very few report that this complication can be successfully managed with non-surgical endodontic treatment. This case report presents successful management of a lower left second molar (tooth #37) diagnosed with exacerbated chronic apical periodontitis and massive overfill in a 36-year-old patient WITH non-surgical endodontic treatment AND bent H-file to remove extruded material under dental operating microscope control. It discusses technical aspects of this procedure, as well as its possible complications, including a sodium hypochlorite accident.

Persistent apical periodontitis following failed nonsurgical endodontic treatment presents significant clinical challenges. This study evaluated the long-term outcomes and prognostic factors associated with surgical treatment using calcium-enriched mixture (CEM). In this retrospective cohort study (STROBE-compliant), 197 teeth from 169 patients underwent surgical treatment at a tertiary center between 2011 and 2024. Inclusion required documented persistent apical periodontitis unresponsive to prior orthograde endodontic therapy and a minimum radiographic follow-up of 6 months. A standardized surgical protocol was followed, including root-end resection, ultrasonic root-end preparation, and root-end filling with CEM cement by a single endodontist. Treatment outcomes were assessed using composite clinical and radiographic criteria. Kaplan–Meier analysis was used to estimate survival probabilities, and Cox proportional hazards regression was applied to evaluate associations between clinical variables and treatment outcomes. The mean follow-up duration was 45.2 ± 36.5 months. The overall success rate was 94.9% (187/197 teeth). Failure-free survivals were 96.4%, 92.7%, and 87.3% at 1, 3, and 5 years, respectively. Multivariate analysis identified systemic disease as the sole significant predictor of failure (HR = 5.87; 95% CI: 1.52–22.68; p = 0.010). Tooth-related factors (lesion size, crown-root ratio, and root-end preparation depth) and demographic variables showed no significant associations. Intra-observer agreement was excellent (κ = 1.00; ICC = 0.83). CEM cement-based surgical treatment achieved 94.9% long-term success. Patients with systemic diseases exhibited a 5.87-fold higher failure risk, highlighting the critical role of medical status in prognostic assessment.

A thorough understanding of root canal morphology is critical for achieving predictable outcomes in endodontic therapy. Anatomical variations in mandibular second premolars are uncommon compared to other teeth, and the coexistence of a C-shaped root canal configuration with four independent canals and four separate apical foramina is exceptionally rare. This case report describes the nonsurgical endodontic management of a mandibular second premolar exhibiting this unique morphology, confirmed through cone-beam computed tomography (CBCT) and magnification. A 52-year-old male was referred by a prosthodontist for elective root canal treatment before post placement. CBCT imaging revealed a C-shaped root in the coronal third that bifurcated into four separate canals at the midroot level, each terminating in an independent apical foramen. Nonsurgical treatment was performed over two visits, using meticulous chemo-mechanical preparation, intracanal calcium hydroxide dressing, and warm vertical compaction obturation. At the 9-month follow-up, the tooth was functional, asymptomatic, and radiographically stable. This case underscores the importance of preoperative assessment with advanced imaging and magnification in identifying and successfully treating rare endodontic anatomies.

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This case report describes the successful guided endodontic treatment of a maxillary left canine (#23) with pulp canal obliteration (PCO) in a 30-year-old female patient. The patient had a history of orthodontic treatment and Le Fort I orthognathic surgery, both recognized as potential factors contributing to canal calcification. The patient had a history of a failed root canal treatment, contributing to incomplete canal instrumentation and iatrogenic damage (gouging) during access cavity preparation. The case was referred for completion of treatment. Upon referral, clinical and radiographic examinations revealed advanced canal obliteration, procedural gouging from the prior attempt, and a radiolucent line suggestive of a horizontal root fracture. Cone-beam computed tomography (CBCT) confirmed the extent of canal calcification, ruled out the suspected fracture, and showed a localized palatal external root resorption, likely related to previous orthodontic forces. Given the complexity of the case, a static-guided endodontic technique was selected as the preferred treatment approach. A custom 3D-printed guide, generated from merged CBCT and intraoral scan data, enabled conservative and accurate access to the calcified canal. Although a hand K-file fractured during canal negotiation, the fragment was successfully retrieved using ultrasonic devices under magnification. The tooth was treated successfully. Clinical and radiographic follow-ups at six and twelve months confirmed resolution of the periapical lesion and complete symptom relief, demonstrating that guided endodontics can serve as a safe and effective treatment option in teeth with PCO.

In select multirooted/vital/permanent teeth with periapical pathology in one root due to adjacent infection from neighboring teeth, cone beam computed tomography-guided retrograde vital pulp therapy (retroVPT) with a bioactive cement can resolve the lesion and preserve pulp vitality, offering a conservative, biologically based, and cost-effective alternative to conventional root canal treatment.

Successful management of apical periodontitis relies on effective root canal obturation to eliminate microbial activity and promote periapical healing. Bioceramic sealers have emerged as alternatives to conventional sealers due to their favorable biocompatibility and potential regenerative properties. However, their comparative clinical efficacy remains uncertain. A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Four electronic databases (PubMed, Scopus, Web of Science, and Embase) were searched for randomized controlled trials (RCTs) comparing bioceramic and conventional sealers. Three reviewers independently performed study selection, data extraction, and risk of bias assessment using the RoB 2.0 tool. The primary outcomes were apical healing and postoperative pain; secondary outcomes included adverse events and procedural complications. Meta-analysis was performed using a random-effects model. From 491 identified records, 12 RCTs met the inclusion criteria. Meta-analysis of four studies found no statistically significant difference in healing rates between bioceramic and conventional sealers (RR=1.05, 95% CI: 0.89-1.23, P=0.61; I²=0%). No major adverse events were reported. Although bioceramic sealers have theoretical advantages, the current evidence does not support their clinical superiority over conventional sealers, as the meta-analysis showed non-significant results and some methodological limitations were identified. Bioceramic sealers appear to be clinically comparable to conventional sealers regarding periapical healing and postoperative outcomes. However, due to the limited and heterogeneous data, further high-quality RCTs with standardized outcome measures are needed to determine their relative effectiveness.

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This case report presents the innovative application of ultrasonic points combined with a graphite-marked endodontic guide in a case of restricted vertical space. A 71-year-old female patient with root canal obliteration in the second left mandibular molar was referred for treatment. The patient was experiencing spontaneous pain. Using data from cone-beam computed tomography and surface scans, a virtual 3D guide was developed and positioned. As the patient presented limited interocclusal space, black graphite was inserted through the drill path to mark the pathway. The guide was withdrawn, shorter ultrasonic points were inserted 2 mm into the marked dentin, and this process was repeated until the root canals were localized. The root canals were subsequently shaped and filled. The guide drill path effectively served as a reference for ultrasonic points, enabling successful localization of the root canals. Graphite-marked guide path facilitated access to obliterated root canals in the presence of limited interocclusal space.

Endodontic cements are essential materials for achieving successful root canal treatment. Therefore, they must present adequate physicochemical properties to ensure optimal clinical performance. This study aimed to evaluate radiopacity, pH, and calcium ion release of calcium silicate- and epoxy resin-based cements/sealers. Four materials were evaluated: Vioseal, AH-Plus, AH-Plus Bioceramic Sealer, and MTA Angelus. Ten cylindrical specimens (10 mm diameter, 1 mm height) per group were prepared for each tested property, totaling 80 samples. The same specimens were used for pH and calcium ion release, while separate specimens were used for radiopacity. All samples were stored at 37&#xb0;C and 95% humidity. Radiopacity was assessed by digital radiography using an aluminum step wedge (1-10 mm). pH was measured at 1, 7, and 14 days using a calibrated digital pH meter. Calcium ion release was determined using atomic absorption spectrophotometry. Data were analyzed using Kruskal-Wallis and Dwass-Steel-Critchlow-Fligner post hoc tests (P<0.05). Vioseal and AH-Plus showed the highest radiopacity values (9.98&#xb1;0.42 mm Al and 10.00&#xb1;0.38 mm Al, respectively), while AH-Plus Bioceramic Sealer (9.04&#xb1;0.28 mm Al) and MTA Angelus (4.72&#xb1;0.40 mm Al) showed lower values. Regarding pH, AH-Plus Bioceramic presented the highest and most sustained alkaline value (up to 12.5), and AH-Plus the lowest (6.25&#xb1;0.26). In calcium ion release, Vioseal showed the highest release on day 7 (29.4&#xb1;3.12 ppm), while AH-Plus Bioceramic Sealer also peaked on day 7 (18.60&#xb1;5.54 ppm); MTA Angelus presented its highest release on day 1 (11.80&#xb1;1.00 ppm). All evaluated cements/sealers met the ISO 6876 standard for radiopacity. Calcium silicate-based cements showed an alkaline pH and sustained calcium ion release, whereas Vioseal presented an initially high and transient release.

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Root canal therapy is an essential part of dental care that has a high success rate, as reported under controlled conditions. Nevertheless, procedural errors can be present when conducted by undergraduate students and have a detrimental impact on treatment outcomes. To better endodontic education and clinical performance, the frequency and types of iatrogenic errors should be evaluated. The study aimed to determine the prevalence and the nature of iatrogenic errors during root canal treatments that are administered by undergraduate dental students in their fifth year. One hundred and twenty-five endodontically treated teeth were chosen randomly. The fifth-year dental students performed all the treatments using a standardized endodontic protocol. Preoperative, intraoperative, and postoperative radiographs were assessed to find out iatrogenic errors, such as ledge, perforation, canal obstruction, separation of instruments, overfilling, underfilling, and voids. This descriptive study reports the frequency of errors without inferential statistical analysis. Radiographic evaluation indicated that at least one of the iatrogenic errors during treatment was observed in 32.8% of the treated cases. The most common mistake was obturation voids, which were identified 11.2% of the total cases and were found mostly in the second premolars. Root canal treatments that were carried out by undergraduates had a relatively high number of iatrogenic errors, with obturation errors being the most frequent. These results lead to the necessity of more effective clinical training, better supervision, and integration of more sophisticated endodontic procedures to minimize errors in the course of the procedure and enhance the quality of the treatment.