This study aimed to evaluate the effect of silicone oils with varying viscosities (100, 350 and 1000 cSt) and 17% Ethylenediaminetetraacetic acid (EDTA) (1.8 cSt) on the efficiency of removing separated instruments using an ultrasonic device from the curved regions of mesio-buccal canals in mandibular first and second molars. Forty-eight mesio-buccal canals of mandibular first and second molars with curvatures ranging from 15 to 30 degrees were prepared and simulated with separated instruments. Nickel-titanium (Ni-Ti) 25-4% rotary files, measuring 3-4 mm in length, were intentionally fractured within the curvature region of the canals. The samples were randomly divided into four groups (n = 12) based on the lubricant used: EDTA and silicone oils with viscosities of 100, 350 and 1000 cSt at 25°C. Primary outcomes were retrieval time and dentine loss from the canal's inner wall, measured via Cone Beam Computed Tomography (CBCT). Secondary outcomes included the coronal exposure of separated instruments to initiate bodily movement and the accuracy of CBCT versus periapical radiography in measuring fractured file length. Data were analysed using the Shapiro-Wilk test for normality, one-way ANOVA and the Kruskal-Wallis test at a significance level of 0.05. The experimental conditions were homogeneous between groups, with no significant differences in canal curvature (p = 0.907), ultrasonic preparation time (p = 0.632), or actual SI length (p = 0.082). The results showed no significant differences among the groups regarding SI retrieval time (p = 0.797), dentine loss (p = 0.653), or coronal SI exposure (p = 0.653). CBCT measurements demonstrated significantly greater accuracy in determining fractured file length compared to periapical radiography (p < 0.001). Within the limitations of this in vitro study, the findings suggest that silicone oils, regardless of their viscosity, did not provide additional benefits over EDTA in reducing retrieval time or preserving dentine in the mesio-buccal canals of mandibular molars. However, CBCT proved more accurate than periapical radiography in measuring SI length. Despite the lack of significant effects of silicone oils with higher viscosity, EDTA remains clinically preferred due to its inherent chelating properties. Further research is needed to confirm or refute these findings.
The management of iatrogenic perforations in the permanent dentition is challenging. Early detection and timely repair of iatrogenic tooth perforations are crucial for achieving a favourable prognosis. This article brings together information on the factors that affect the success of perforation repair and categorises them into three domains: Perforation-related, patient-related, and clinician-related. By analysing the existing literature, the review offers a holistic perspective on how these factors impact the prognosis of perforation repair, providing useful guidance for clinical decision-making and risk evaluation. In highlighting the current limitations within the evidence base, the review also suggests avenues for future research aimed at enhancing the predictability and success rates of iatrogenic perforation repair in contemporary endodontic treatment.
This study compared the accuracy and repeatability of responses generated by three advanced language models (ChatGPT-4, Gemini, and DeepSeek) in determining the necessity and appropriate regimen of antibiotic prophylaxis in endodontic treatment. 15 questions on the basis of guidance published by the European Society of Endodontics in 2018 were developed and presented to each model by three different users, three times per day over 10 consecutive days. Accuracy was evaluated for individual questions and overall performance, and repeatability across days and times was statistically analysed. All models consistently provided correct responses for patients with penicillin allergy and those with a history of infective endocarditis. Significant differences were observed in responses regarding joint prosthesis, high-dose radiation to the jaws, bypass surgery history, and controlled diabetes, although overall accuracy did not differ significantly among models. These findings highlight the potential clinical value of the models, but their responses must be verified before clinical use.
This systematic review evaluated the influence of resin-based, eugenol-based and bioceramic endodontic sealers on the bond strength of glass fibre posts cemented with resin cements. Searches were conducted in PubMed, Scopus, Web of Science, Cochrane Library, Google Scholar and Embase, including in vitro studies using human or bovine teeth restored with fibre posts. Risk of bias was assessed using the QUIN Tool. Thirty three studies met the eligibility criteria. Most evidence indicates that resin-based sealers promote higher bond strength values than eugenol-based sealers, whereas findings for bioceramic sealers were inconsistent. Only a minority of studies showed a low risk of bias, while most presented moderate methodological limitations. Substantial heterogeneity was also observed, including differences in irrigation protocols, sealer types, adhesive strategies and post-cementation intervals. Within the limitations of the available evidence, resin-based sealers appear to be the most favourable choice for clinical fibre post cementation. PROSPERO Registration Number: CRD42023467018.
The aim was to assess the quality and accuracy of Vital Pulp Therapy videos on YouTube. First, sixty videos were surfed using five (pulp capping, pulpotomy, vital pulp therapy, and two layman terms) keywords. Quality was assessed using the following validated indices: Modified DISCERN, Global Quality Score (GQS), and Video Information and Quality index (VIQI). Accuracy was evaluated using scoring criteria based on European Society of Endodontology (ESE) and American Association of Endodontists (AAE) position statements. The correlation between the derived metrics was established using Spearman's rank order. The average quality scores were 3.03 (modified DISCERN), 3.1 (GQS), and 11.08 (VIQI). As per the ESE statement, the average accuracy was 44.64%, 25.87%, and 32.8%, respectively, for 'pulpotomy', 'pulp capping', and 'vital pulp therapy' videos. Mean accuracy as per the AAE statement was 24.63%. A positive correlation of accuracy was established with all the metrics derived. The overall quality and accuracy were subpar.
This in vitro study investigated the antibiofilm efficacy of calcium silicate-based, Simvastatin, Levofloxacin and calcium hydroxide intracanal medicaments against mature Enterococcus faecalis biofilm. Ninety dentine specimens were inoculated with Enterococcus faecalis biofilm for three weeks and divided into five groups (n = 18): (1) calcium silicate-based; (2) Simvastatin; (3) Levofloxacin; (4) calcium hydroxide (CH); (5) positive control, no medicament. After two weeks of intracanal medicament application, live/dead bacterial cells were assessed using confocal laser scanning microscopy. The results revealed a statistically significant difference in the percentage of dead bacteria of the four tested groups compared to the positive control group (H = 30.45, p < 0.001). The calcium silicate-based group recorded the highest median (IQR) percentage of dead bacteria at 56.33 (10.03), followed by Simvastatin 44.88 (7.30), CH 41.70 (12.53), Levofloxacin 35.99 (3.78), and the positive control group 3.61 (1.01). These findings suggest that these intracanal medicaments demonstrate promising antibiofilm activity, with further investigations needed.
This study aimed to systematically evaluate the risk factors associated with the failure of separated instrument removal. A comprehensive search of PubMed, Embase and the Cochrane Library was performed to identify studies reporting on the success rates of separated instrument removal, covering the period from 1988 to 2025. The meta-analysis was performed using Stata 17.0. Seven studies encompassing 922 patients with separated instruments were included. The pooled success rate of separated instrument removal was 66%. Meta-analysis identified several significant risk factors for removal failure: instrument location in posterior teeth, mandibular teeth, the apical third of the canal, the apical side of a curved canal, and root curvature exceeding 30°. Current evidence indicates that unfavourable anatomical factors significantly increase the likelihood of failed instrument retrieval. These findings underscore the importance of preoperative assessment and careful case selection when planning separated instrument removal procedures.
Achieving profound local anaesthesia during mandibular molar root canal treatment can be challenging. This study evaluated procedural pain and supplemental anaesthesia used, considering endodontic diagnosis and buccal bone morphology. Seventy-seven patients undergoing primary root canal treatment completed a post-treatment survey questionnaire asking appointment associated questions relating to pain and fear. Providers used a standardized anaesthetic protocol with supplemental injections as needed. Data were compared with demographic, diagnostic, and radiographic variables. Supplemental anaesthesia was required in 14% of cases. Patients reported no procedural pain in the majority of cases (73%), and felt adequately numb during the procedure in nearly all cases (95%). Sixty-five percent of patients rated the experience better than expected. Buccal bone thickness showed no significant association with pain or need for supplemental anaesthesia. Overall, an inferior alveolar nerve block with lidocaine and supplemental buccal articaine infiltration achieved a high success of profound local anaesthesia.
This systematic review analysed the analgesic efficacy of low-level laser therapy (LLLT) compared to conventional drug therapy and placebo for postoperative pain in endodontics. PubMed, PubMed Central, Scopus, LILACS, SciELO, Virtual Health Library, Embase and Open Gray were searched. Clinical trials assessing pain intensity were included. Risk of bias was assessed using the RoB 2.0 tool. Nine studies were included, five classified as having low risk of bias. Eight studies demonstrated that LLLT was more effective in modulating postoperative pain compared to control interventions. Meta-analysis of five studies (I2 = 31%) showed statistically significant pain reduction with LLLT in comparison with placebo after 1 day (VAS mean difference = -0.56; 95% CI = [-0.74 to -0.38]; p < 0.001). LLLT may improve postoperative pain control after endodontic treatment. Additional high-quality studies are necessary to strengthen the evidence base for LLLT's analgesic efficacy in endodontic applications.
This study measured the accuracy of an intraoral scanner (Primescan, Dentsply Sirona, Charlotte, NC, USA) in examining endodontic access openings. The method was compared to the clinical microscope and CBCT. Primescan scanned the pulp chambers of 24 extracted molars shortly after access, and the computer-3D models were inspected to document the orifices (number; location) and chamber features (calcifications; defects originated during access; anatomical variations). Scanner agreement to identify the orifices' number and location was non-significant in relation to both the microscope and CBCT; considered, therefore, accurate. It was also accurate to show defects (bur abrasion) and/or anatomical features (isthmus) in the chamber floor, with diagnostic accuracy estimated in 87.5% (95% CI: 67.6-97.3) in relation to the microscope. Scanner diagnostic accuracy to show calcified orifices was estimated in 79.2% (95% CI: 57.8-92.9) in relation to the microscope, and 70.8% (95% CI: 48.9-87.4) in relation to the CBCT, considered, then, of moderate accuracy.
The objective of the study was to compare the role of Cryopreserved human amniotic membrane (cHAM) for early pulp biomineralisation in comparison to Biodentine using the tooth culture model. This study was conducted in two stages. The first stage aimed to establish the tooth culture model and assess the viability of pulp cells at 28 and 50 days. In the second stage, pulp capping was performed in the tooth culture model using cHAM and Biodentine. A total of 20 freshly extracted teeth (for orthodontic reasons) were used for pulp capping with either cHAM or Biodentine. The samples were evaluated for biomineralisation at 14 and 28 days using micro-computed tomography (micro-CT) and histological analysis. Morphometric data from micro-CT scans were analysed using the Chi-square test. The viability of pulp cells in the tooth culture model was 66.1% at 28 days and 38.4% at 50 days. Pulp capping with cHAM resulted in a thicker and larger volume of mineralisation at 28 days (720 μm, 0.7 mm3) compared to Biodentine (630 μm, 0.46 mm3). Histological analysis revealed that the dentine formed in the HAM group was homogeneous and continuous, while the Biodentine group showed discontinuous foci of mineralisation in the newly formed hard tissue. Within the study's limitations, it is observed that cHAM induces enhanced early pulpal mineralisation compared to Biodentine.
This study evaluated the thermal effect of TheraCal LC on pulpal temperature during light curing in Class I and II cavities. A mandibular first molar model was developed using COMSOL Multiphysics, with enamel, dentine, pulp and restorative material. Simulations were performed under physiological conditions at 37°C for cavities with 0.5 and 1 mm remaining dentine thickness, and temperature changes were analysed at 2 and 5 mm curing distances. The model was validated against two experimental studies. Results showed that without TheraCal LC, temperature rises were minimal and below the damage threshold. However, TheraCal LC significantly increased intrapulpal temperature, particularly at 0.5 mm dentine thickness, with rises exceeding 12°C. Shorter curing distances (2 mm) also increased temperatures, and in all cases with TheraCal LC, ΔT surpassed the critical 5.5°C threshold. These findings indicate that TheraCal LC poses a thermal risk to pulpal tissue, especially in deep cavities with minimal dentine thickness.
This study aimed to establish a standardised protocol for isolating dental pulp stem cells (DPSCs) from fully impacted third molar teeth and to assess the effect of long-term cryopreservation on their viability for future clinical applications in regenerative endodontics. DPSCs were isolated from 21 impacted third molars. The clinical relevance of these cells was characterised via flow cytometry, confirming that 96% expressed mesenchymal stem cell markers. Seventeen samples were cryopreserved at -86°C for up to 12 months to evaluate biological stability for autologous transplantation. The standardised surgical extraction and isolation protocol yielded a high concentration of therapeutic-grade cells (3.43 × 106 cells/mL). Post-thaw viability remained stable (74% to 99%) over 12 months. Importantly, the cells maintained consistent morphology, suggesting they retained the biological potential necessary for dentine-pulp complex regeneration. The results validate a reliable long-term DPSC preservation protocol, supporting feasible dental stem cell banking and a source of viable cells for regenerative endodontic procedures.
There is a scarcity of data regarding knowledge, attitudes and practices (KAP) of endodontists about cone-beam computed tomography (CBCT), which may be related to the lack of valid and reliable measures. The present study aimed to develop and validate a KAP measure about CBCT. The developed measure showed good content validity and was administered to 506 endodontists. Exploratory and confirmatory factor analysis revealed a factorial structure composed of three factors (KAP) with 13 items. The measure showed evidence of good internal consistency and discriminant validity, being able to accurately discriminate KAP according to the length of experience and level of education. Taken together, results provided evidence of good psychometric properties of a new KAP measure regarding CBCT, allowing future research in the field.
This study examined population-specific morphological variations in human premolar roots and canals and their clinical implications. Cone-beam computed tomography (CBCT) was used with the Ahmed classification system. A retrospective descriptive cross-sectional study analysed 388 maxillary premolars from CBCT scans of 97 participants obtained from participating private dental practices in Swakopmund and Windhoek and from the University of Namibia dental clinic. The root number and canal configuration were classified by the Ahmed system. Associations were assessed by comparing identical tooth types in the right and left maxilla. First premolars were mostly two-rooted (56.2%), and second premolars were mostly single-rooted (88.1%), with key configurations of 1MP1, 1MP1-2 and 2MP B1P1. Age-related changes showed increased 2MP B1P1 in first premolars and 1MP1-2-1 in second premolars. The dominant configurations in this Namibian sample align with other populations, emphasising the importance of population-specific data for endodontic treatment and supporting the relevance of the Ahmed classification.
This study evaluated the effect of glycolic acid (GA) as a final irrigant on the long-term bond strength of AH Plus and Bio-C Sealer. Forty-eight single-rooted teeth were assigned to four groups (n = 12): ethylenediaminetetraacetic acid (EDTA) + AH Plus, glycolic acid + AH Plus, EDTA + Bio-C Sealer, and glycolic acid + Bio-C Sealer. The bond strength and failure pattern were evaluated immediately and after 6 months, while the interface adaptation and sealer penetrability were also assessed. Immediate bond strength did not differ between groups, but after 6 months AH Plus showed higher values than Bio-C Sealer. The failure pattern was similar among all groups at both evaluation time points. EDTA + AH Plus exhibited superior interface adaptation compared with EDTA + Bio-C Sealer, particularly in the cervical third. Sealer penetrability was comparable among groups. Glycolic acid produced similar outcomes to EDTA, and AH Plus maintained greater bond strength over time.
Root canal irrigants are essential for biofilm elimination, with sodium hypochlorite (NaOCl) as the current gold standard, though limited by cytotoxicity and poor dentine penetration. This study assessed the antibacterial efficacy of a reduced graphene oxide-cuprous oxide (rGO-Cu2O) nanocomposite against Enterococcus faecalis and Streptococcus mutans biofilms. Thirty decoronated premolars were prepared with Protaper Next X5, and biofilms were cultured for 21 days. The rGO-Cu2O nanocomposite, synthesised using an 808 nm laser-assisted method and characterised by FE-SEM, XRD and XPS, was compared with 2.5% NaOCl and saline. Antibacterial activity was evaluated through CFU counts and confocal laser scanning microscopy. rGO-Cu2O showed significantly greater bacterial reduction than saline, with superior efficacy to NaOCl against E. faecalis and comparable effects against S. mutans. CLSM confirmed disruption of mature biofilms, indicating its promise as a novel endodontic irrigant.
The aim of this study was to assess the effectiveness of simvastatin (SMV) in combination with alpha tricalcium phosphate (αTCP) as pulpotomy agents in cariously exposed permanent mandibular molars with symptomatic irreversible pulpitis. Sixty patients were randomly assigned equally to either the SMV-αTCP or MTA group. The overall success of the treatments was evaluated after 12 months. Pain levels were recorded by patients preoperatively and postoperatively at intervals of 6, 12, 18 h and days 1 through 7. No significant difference in success rates was found between the SMV-αTCP (92.5%) and MTA (96.2%) groups (p > 0.05). Although a significant difference in pain intensity was noted between the groups on the first and second days (p < 0.05), no significant differences in pain levels were observed at any other time points. The outcomes of this study suggest that SMV can be effectively utilised as a pulpotomy agent in carious permanent teeth. Trial Registration: ClinicalTrials.gov identifier: NCT04374214.
This systematic review following PRISMA guidelines evaluated the effects of endodontic chelators on free available chlorine (FAC) in sodium hypochlorite (NaOCl), with emphasis on the influence of concentration, contact time, temperature, and pH. Risk of bias was assessed using the Quality Assessment Tool for In Vitro Studies (QUIN). Twelve in vitro studies met the inclusion criteria, all using iodometric titration to measure FAC. Seven studies had low risk of bias and five had moderate risk. Seventeen chelators were evaluated, with Na2EDTA, malic acid, citric acid, ATMA, and SmearOFF causing rapid FAC loss (> 70% within 1 min), whereas Na2EDTA, HEDP-based chelators, and several aminopolycarboxylates showed minimal FAC reduction (0%-25%). FAC degradation was influenced by chelator type, pH reduction, temperature, and exposure time. Chelator interactions can markedly reduce FAC, potentially limiting antimicrobial and tissue-dissolving efficacy. Clinicians should tailor irrigation protocols, considering chelator choice, contact time, and irrigant replenishment to optimise clinical outcomes.
This ex vivo study characterised the mesial root morphology of mandibular first molars with a middle mesial canal (MMC) using micro-CT. Among 469 scanned molars, 42 (8.96%) presented an MMC. Morphological parameters analysed included canal configuration, chamber orifice features, dentine thickness, isthmus type, and aspect ratio. Twenty-four configurations were found, with the confluent type most prevalent (90.48%). Three separate orifices occurred in 64.29% of teeth, and MMCs were mainly in the coronal and middle thirds. Fully independent MMCs were rare (2.38%). Mean dentine thickness 2 mm below the furcation was 1.31 mm (MB), 1.03 mm (MMC) and 1.28 mm (ML). The mean aspect ratio was 2.90. Accessory canals appeared in 28.58%, and an independent MMC foramen in 38.09%, mainly on the mesial wall. Type III isthmus predominated (52.38%). Mesial roots with MMCs exhibit marked anatomical variability, with thin dentine around the MMC requiring careful endodontic management.