E-ISSN 2548-0839
: 3 (1)

Volume: 3  Issue: 1 - 2018

EDITORIALS
1.Editorial – European Endodontic Journal: From a Dream to an Indexed Journal
Ismail Davut Çapar, Hany Mohamed Aly Ahmed
doi: 10.14744/eej.2018.1  Page 1 (250 accesses)
Abstract | Full Text PDF

REVIEW ARTICLES
2.Does Conventional Endodontic Treatment Impact Oral Health-related Quality of Life? A Systematic Review
Leonardo S. Antunes, Claudia R. Souza, Alessandro G. Salles, Cinthya C. Gomes, Livia A. Antunes
doi: 10.5152/eej.2017.17017  Pages 2 - 8 (296 accesses)
Could conventional endodontic treatment have an impact on oral health-related quality of life? There are still unresolved questions regarding this theme. In order to answer them, a systematic review on the available literature was undertaken to identify the methodological quality of and the risk of bias in all relevant studies. A broad search for articles was conducted, and only articles published before May 2016 were considered for review. The following portals were used: Pubmed, VHL (Medline, SciELO, Lilacs and BBO), Cochrane Library, and Web of Science. The keywords used for the search were ‘quality of life’ and ‘root canal treatment.’ Furthermore, we included MeSH synonyms, related terms and free terms. Articles written in any language were included according to the PICOS approach (population, intervention, comparison, outcome and study design). After application of these eligibility criteria, selected articles were qualified by assessing their methodological quality and potential risk of bias. The initial search identified 302 references. After excluding duplicated abstracts and analysing the titles and abstracts, 6 were selected. One study was added via manual search of the reference lists. From these, 2 were eligible for quality assessment and were classified as being of high methodological quality and as having low risk of bias. Based on these studies, it can be concluded that conventional endodontic treatment improves oral health-related quality of life. However, these results should be interpreted with caution, due to the lack of important methodological details in the included studies. Additional investigations are warranted to provide more evidence on this subject.

ORIGINAL ARTICLES
3.Advantages and Applications of a New System for Classifying Roots and Canal Systems in Research and Clinical Practice
Hany Mohamed Aly Ahmed, Paul Michael Howell Dummer
doi: 10.5152/eej.2017.17064  Pages 9 - 17 (412 accesses)
Objective: A new coding system for classifying the roots, main and accessory canals as well as developmental anomalies has been introduced recently. This paper discusses the advantages and potential application of the new system in research and clinical practice.
Methods: A comprehensive analysis was undertaken on the most common, existing classification for root canal morphology. The advantages and potential applications of a new system for classifying roots and canal systems in research and clinical practice are discussed.
Results: The analysis demonstrates deficiencies of the existing classification including lack of information on the number of roots, pulp chamber outline, lack of clarity in multi-rooted teeth, inability to define complex root canal configurations. The new coding system addresses the root and canal morphology in an accurate and systematic manner to provide detailed information of the tooth, root and canal anatomical features.
Conclusion: With current advances in endodontic research and practice and the increasing body of knowledge on root and canal morphology, the deficiencies of the existing system used for classifying root canal morphology have become more apparent. The new system for classifying root, main and accessory canal morphology as well as teeth with anomalies has the potential to be used in research, clinical practice and education to accurately reflect the real anatomy of a tooth.

4.Endoscopic Evaluation of Cut Root Faces and Histologic Analysis of Removed Apices Following Root Resection: a Clinical Study
Thomas Von Arx, Dieter Bosshardt, Andreas C. Bingisser, Michael M. Bornstein
doi: 10.5152/eej.2017.17046  Pages 18 - 23 (273 accesses)
Objective: To evaluate the resection plane after root-end resection during apical surgery using endoscopy.
Methods: Following apicectomy of 69 roots, the cut root faces were inspected with a rigid endoscope for the presence of unfilled areas of the root canal space, gaps between the obturated root canal and dentinal wall, isthmi, ‘opaque’ dentine and cracks. Endoscopic pictures were captured and assessed using a 12-sector transparent grid for determination of location of the studied elements. Furthermore, the removed apices
were examined histologically (n=47). The surfaces of the removed apices opposite the cut root faces were histologically analysed for the same outcome measures.
Results: Endoscopy revealed the following findings: opaque dentine in 84.1%, unfilled parts of the root canal system in 59.4%, gaps between the existing root canal filling and dentinal walls in 49.3%, and cracks in 10.1% of cases. With regard to isthmi, histology of the removed apices demonstrated an isthmus in two-thirds of those seen with endoscopy at the root end. Ramifications were histologically observed only in 6 root apices.
Conclusion: The studied elements may cause failure of the root canal treatment, and conventional root canal retreatment or apical surgery may be indicated. The clinical significance of opaque dentine with regard to tooth prognosis after apical surgery remains unclear and warrants further research.

5.Periapical Healing of Endodontically Treated Teeth Filled Only in the Apical Third: A Randomized Controlled Trial
Roberto Gustavo Sánchez- Lara Y Tajonar, Karla Pamela Sánchez- Mendieta, Rita Elizabeth Martínez- Martínez, Rubén Abraham Domínguez- Pérez
doi: 10.5152/eej.2017.17037  Pages 24 - 30 (362 accesses)
Objective: To provide evidence from a clinical viewpoint that the bacteria that persist within the root canal system do not have a significant impact on the treatment outcome as long as an adequate apical sealing is performed. Design: A randomized, controlled trial.
Methods: Population: A total of 42 patients with pulp necrosis and a periapical index (PAI) score of 5. Root canal treatments obturated only in the apical third. In control group, root canal treatments were completely obturated. Hypothesis: Same apical healing. Data were analysed using the Mann-Whitney test and the χ2 or the Fisher exact test (when appropriate).
Results: All cases presented clinical success, absence of pain, swelling, sinus tract, tenderness to palpation or percussion and presented normal tooth mobility. Fifteen months were enough for all cases of both groups to be classified with a PAI score of ≤2. There was no statistical difference between the cases that ended the study with a PAI-1 or PAI-2 score.
Conclusion: Within the limitations of this study, no significant differences in healing rates after complete obturation or only apical third obturation were observed. An adequate apical sealing can improve periapical healing, thus intracanal remnant bacteria apparently have no significant impact, at least for the first 15 months of follow-up.

6.Influence of Method of Teaching Endodontics on the Self-Efficacy and Self-Perceived Competence of Undergraduate Dental Students
Annemarie Baaij, Ahmet Rýfat Özok
doi: 10.5152/eej.2017.17048  Pages 31 - 37 (240 accesses)
Objective: This study assessed whether self-efficacy and the self-perceived competence of undergraduate dental students had been influenced by the method of teaching endodontics.
Methods: Certain modules of the undergraduate endodontic programme at the Academic Centre for Dentistry Amsterdam (ACTA) including the tutorials, the clinical training and the assessment were revised. The self-efficacy and self-perceived competence close to graduation of an intermediate cohort of 24 students who attended all or some of the former modules or the revised modules were assessed. Additionally, the performance of students in performing root canal treatments was assessed according to predetermined criteria. Data were analysed using Cohen’s Kappa, Cronbach’s Alpha, Mann-Whitney and T-tests.
Results: Self-efficacy and the self-perceived competence of students who followed the former modules of clinical training and assessment were similar to those of students who followed the revised modules. The revised module with higher number of tutorials increased students’ self-perceived competence, but did not influence their self-efficacy statistically significantly. Not the entire number, but the number of root canal treatments performed under supervision of endodontists was related with an increase in students’ self-efficacy and self-perceived competence. The performance of students in performing root canal tretaments was not statistically significantly related to their self-efficacy and self-perceived competence.
Conclusion: Among the modules and their components assessed in the present study, only the number of tutorials and the number of root canal treatments performed under supervision of endodontists influenced the self-efficacy and the self-perceived competence of students.

7.Physico-chemical and Biological Properties of a New Portland Cement-based Root Repair Material
Letícia Chaves De Souza, Mamatha Yadlapati, Hélio Pereira Lopes, Renato Silva, Ariadne Letra, Carlos Nelson Elias
doi: 10.5152/eej.2017.17018  Pages 38 - 47 (281 accesses)
Objective: To propose bismuth carbonate, a radiopacifying agent, as a new endodontic root repair material that was added to Portland cement (PC) at 2 wt%, 5 wt%, 10 wt% and 15 wt%, and physicochemical and biological properties of each formulation were evaluated in comparison to MTA-Angelus.
Methods: Mixed and powder samples were analysed by scanning electron microscopy (SEM) and X-ray power diffraction (XRD), and the semiquantitative constitution of the powder was determined by energy-dispersive spectrometer (EDS). Setting time was evaluated by Vicat needle and radiopacity analysed with digital X-ray. The pH of all tested materials was observed after immersion in water for 3, 24, 48, 72 and 168 h (or 7 days). Solubility and calcium release were measured after immersion in water for 24 h. A multiparametric assay XTT-NR-CVDE was used to evaluate the cytotoxicity of the materials in human periodontal ligament (HPDL) fibroblasts. HPDL fibroblasts were exposed to PC 15% and mineral trioxide aggregate (MTA), and the expression of proinflammatory cytokines (IL1A, IL6, IL8, TNF) and bone formation genes (ALP, COL1, RUNX2) was evaluated by real-time PCR. Mineralisation of HPDL fibroblasts cocultured with PC, PC 15% and MTA was evaluated with Von Kossa staining.
Results: PC-based groups presented more irregular and larger particles than MTA. PC and MTA showed similarities as observed by XRD and EDS. Setting time of PC-based groups was increased with the addition of bismuth carbonate. All tested materials were alkaline, and pH tended to reduce over time. All cements had solubility lower than recommended, with no difference between them (P>0.05) and showed calcium release. PC 15% had similar radiopacity when compared with MTA (P>0.05). Cell viability was higher for the tested materials than the positive control (P<0.001), but there was no difference when they were compared with negative control (P>0.05). Gene expression levels were similar for all tested groups (P>0.05). Analysed cements had positive Von Kossa staining.
Conclusion: Overall, the addition of 15% of bismuth carbonate did not result in significant changes to its physicochemical and biological properties when compared with MTA, except for the setting time, and may be considered a potential substitute for MTA.

8.The Influence of Humidity on Intra-tubular Penetration and Bond Strength of AH Plus and MTA Fillapex: An in Vitro Study
Bruno Piazza, Melissa Esther Rivera- Peña, Murilo Priori Alcalde, Bruno Carvalho De Vasconcelos, Marco Antonio Húngaro Duarte, Ivaldo Gomes De Moraes, Rodrigo Ricci Vivan
doi: 10.5152/eej.2017.17036  Pages 48 - 54 (283 accesses)
Objective: The aim of this study was to evaluate the influence of humidity on the intra-tubular penetration, bond strength and failure mode associated with AH Plus (AH) and MTA Fillapex (MTAF) sealers.
Methods: For this analysis, an apparatus was created to maintain the humidity of the specimens. Sixty bovine single-rooted teeth with similar anatomy were used. The teeth were randomly divided into 4 groups (N=15): G1 - AH/moist, G2 - AH/dry, G3 - MTAF/moist and G4 - MTAF/dry. A laser scanning confocal microscope was used to analyse the penetrability of the sealers into the dentinal tubules. A push-out test was performed to examine the diameter and height of the root canal fillings. The failure mode was analysed under a stereomicroscope at 40× magnification. The data were submitted to non-parametric Kruskal-Wallis and Dunn’s tests. The significance level was P<0.05.
Results: The MTAF sealer exhibited higher intra-tubular penetration values compared to AH Plus (P<0.05)
sealer. AH Plus showed the highest bond strength values. Regarding the type of failure mode, a majority of
cohesive failures was identified, irrespective of the moisture conditions, which were not statistically significant among the sealers (P<0.05).
Conclusion: Humidity conditions did not influence the intra-tubular penetration, bond strength and failure mode of AH Plus and MTAF sealers.

9.Influence of an Innovative Anti-Corrosive Solution on Resistance of Endodontic NiTi Rotary Instruments: A Preliminary Study
Mohammed Ali Saghiri, Armen Asatourian, Franklin Garcia Godoy, Nader Sheibani
doi: 10.5152/eej.2017.17043  Pages 55 - 60 (202 accesses)
Objective: To evaluate the effects of deionised water, blood, phosphate-buffered saline (PBS) and a new anti-corrosive solution based on methoxy propyl amine (MOPA) on the cyclic fatigue resistance of endodontic NiTi rotary instruments under in vitro conditions.
Methods: Forty ProTaper F1 files were provided and divided to four groups (n=10). Samples were first autoclaved and then stored in deionised water, blood, PBS or MOPA for 24 hours. Cyclic fatigue was tested with a custom-made stainless-steel block including artificial canals (curvature angle=30 degree, radius of curvature=5 mm). After immersion in test solutions, samples were rotated 300 rpm until fracture occurred. The number of cycles to failure (NCF) was calculated using recorded fracture time.
Results: Data were analysed by the Kolmogorov–Smirnov, Levene, ANOVA and Scheffe statistical tests. Samples in blood group showed the lowest and samples in MOPA group showed the highest NCF values. Significant difference was observed between groups (p=0.001). NCF value of PBS group was significantly more than the NCF values of samples in blood and deionised water groups (p<0.05).
Conclusion: The tested novel anti-corrosive solution significantly increased the fracture resistance of the endodontic NiTi rotary instruments by reducing the cyclic fatigue. In contrast, blood and deionised water caused more corrosion and resulted in earlier file fracture.

10.Comparison of PathFile and ProFinder systems to create a glide path in curved root canals
Ruth Pérez Alfayate, Montse Mercade, Jorge Vera Rojas, Roberto Estévez Luaña, Ana Antoranz Pereda, Juan Algar, Rafael Cisneros Cabello
doi: 10.14744/eej.2018.75047  Pages 61 - 65 (208 accesses)
Objective: Root canal shaping is as important as irrigation and filling when attempting to obtain a high success rate in endodontic treatment. The creation of a glide path before the use of rotary instruments reduces the risk of posterior iatrogenic errors. The objective of the present study was to evaluate instrumentation time and root canal transport after using 2 different glide path rotary systems.
Methods: In total, 60 mesiobuccal root canals of mandibular molars, with curvature angles between 11° and 82°, were standardized to measure 15 mm. The specimens were divided into 2 groups, depending on their angles of curvature (11º–38º and 39º–82º), and further divided into 4 groups (n=15). Two groups were instrumented using the PathFile system and the other 2 using the ProFinder system. The angle and radius of curvature were measured at the most abrupt angle of curvature before and after instrumentation. Both measurements were analyzed and compared using AutoCAD software to determine canal transportation. Curvature angles were compared using Student’s t test and the radii of curvature using the Wilcoxon test. The time for instrumentation was also evaluated using Student’s t tests.
Results: There were no statistically significant differences between the two systems with respect to root canal transport (P>0.05); however, the ProFinder system took a longer time to create a glide path (P=0.004)
Conclusion: Both systems were equally effective in creating a glide path; however, the PathFile system proved to be faster than the ProFinder system.

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