E-ISSN 2548-0839
European Endodontic Journal - : 5 (1)
Volume: 5  Issue: 1 - 2020
EDITORIALS
1.Editorial: A New Achievement to the European Endodontic Journal and Appreciation to Editors and Reviewers
Ismail Davut Capar, Hany Mohamed Aly Ahmed
PMID: 32342029  PMCID: PMC7183801  doi: 10.14744/eej.2020.1  Page 1
Abstract | Full Text PDF

ORIGINAL ARTICLES
2.Fear and Anxiety Pathways Associated with Root Canal Treatments Amongst a Population of East Asian Origin
Wei-Ju Chen, Ava Elizabeth Carter, Mark Boschen, Robert Love, Roy George
PMID: 32342030  PMCID: PMC7183800  doi: 10.14744/eej.2019.46338  Pages 2 - 5
Objective: This study aimed to identify and compare the pathways of endodontic fear and anxiety amongst East Asian origin patients attending Griffith University’s Dental Clinic, Gold Coast, Australia.
Methods: East Asian patients who attended the Griffith University dental clinics were included in this study. The “My Endodontic Fear” survey was used. The pathways involved in self-perception of dental fear and anxiety were assessed through 5 different questions. Chi-square test was for statistical analysis and the level of significance was set at P<0.05.
Results: One hundred and forty six participants (n=146) (ages 18-62 years) of East Asian descent met criteria to participate. 58.2% were females, and 41.8% males. The ethnicities were split into Chinese origin and non-Chinese origin (Korean, Phillipino, Japanese, Vietnamese). Results indicate multiple pathways affect met the criteria the origin of fear, regardless of ethnicity. The Cognitive Conditioning pathway was the primary pathway selected by the Chinese and non-Chinese sub groups (51.4%, 43.6%) followed by the Informative (38.3%, 38.5%), then Vicarious (27.1%, 33.3%) and Parental (18.7%, 33.3%) pathways respectively.The Verbal Threat pathway was the least selected pathway for both groups, however the non- Chinese groups selected this pathway significantly more often than the Chinese group (P<0.001).
Conclusion: This study demonstrates that the Cognitive Conditioning pathway was the primary fear and anxiety pathway utilized by both East Asian sub-groups. Understanding how patients develop fear and anxiety can help treating dentists discuss triggering factors for patients and alleviate undue anxiety prior to treatment.

3.Comparative Evaluation of Accuracy of Ipex, Root Zx Mini, and Epex Pro Apex Locators in Teeth with Artificially Created Root Perforations in Presence of Various Intracanal Irrigants
Sakshi Bilaiya, Pallav Patni, Pradeep Jain, Sanket Hans Pandey, Swadhin Raghuwanshi, Bhupesh Bagulkar
PMID: 32342031  PMCID: PMC7183797  doi: 10.14744/eej.2019.07279  Pages 6 - 9
Objective: The study aimed to compare and evaluate the accuracy of iPex, Root ZX mini, and Epex Pro Electronic apex locators (EALs) in diagnosing root perforations in both dry and in different wet conditions: 5% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), and 17% Ethylenediaminetetraacetic acid (EDTA).
Methods: Thirty extracted, human single rooted mandibular premolars were artificially perforated with a diameter of 1.5 mm in middle third of root. Actual canal lengths (ALs) in millimetre (mm) were evaluated for all teeth up to perforation location, and alginate mould were used to embed the teeth. After this, the electronic measurements were calculated by all EALs up to perforation site using a 20 K-file in both dry and wet canal conditions. Up to the perforation sites, the ALs were subtracted from the electronic length. Statistical analyses were done using One-way ANOVA with post hoc tukey’s test for pairwise comparison and the level of significance was set at 0.05.
Results: All three EAL’s detected canal perforations which were clinically acceptable. There was significant difference for dry and wet conditions. Most accurate measurement were seen in dry canals for all three EALs. Root ZX mini in dry condition showed most accurate reading and there was a significant difference when compared with other groups. No significance difference was observed in iPex and Epex Pro Apex locator, and between NaOCl and CHX, CHX and EDTA.
Conclusion: Perforations were determined within a clinical acceptable range of 0.03–0.05 mm by all three EALs. Root ZX mini in dry canals gave most accurate measurement. The presence of irrigating solution influenced the accuracy of all the apex locators.

4.Root and Canal Configuration of Mandibular First Molars in a Yemeni Population: A Cone-beam Computed Tomography
Elham Senan, Ahmed A. Madfa, Hatem Alhadainy
PMID: 32342032  PMCID: PMC7183802  doi: 10.14744/eej.2020.99609  Pages 10 - 17
Objective: To describe root and canal morphology of mandibular first molars (MFMs) in a Yemeni population using cone-beam computed tomography (CBCT).
Methods: CBCT images of 500 right and left untreated MFMs with fully developed roots from 250 Yemenis (125 male and 125 female) comprised the sample size of this study. The following characteristics were recorded: (1) number of roots and their type and morphology, (2) number of canals orifices per root, (3) type of canal configuration and (4) primary variations in the morphology of the root and canal systems.
Results: 96.8% of MFMs are double-rooted. A third root was found in 3.2%, more in females than males. Mesial root was mainly ribbon-shaped (92.2%) and distal root was kidney-shaped in 56.2%. Two canals orifices were found in mesial root of 95.8% and one canal orifice was found in distal root of 96.4%. Vertucci type II canal configuration was the most frequent (57%), followed by type IV (35.6%) in mesial root. Type III canal
configuration was the most prevalent (48.8%), followed by type I (41%) in distal root. Variant 3 represented the most common root and canal morphology (89.8%).
Conclusion: MFMs in Yemeni population are mainly two-rooted with 3.2% having a supernumerary distolingual root. Cross section of mesial root was mainly ribbon-shaped and distal root was kidney-shaped. Vertucci type II and III configurations were the higher incidence in mesial and distal roots, respectively. The presence of two canals in mesial root and one canal in distal root of MFMs with two separate roots (variant 3) was the most common morphology.

5.Influence of Final Apical Width on Smear Layer Removal Efficacy of Xp Endo Finisher and Endodontic Needle: An Ex Vivo Study
Divya Nangia, Ruchika Roongta Nawal, Seema Yadav, Sangeeta Talwar
PMID: 32342033  PMCID: PMC7183796  doi: 10.14744/eej.2019.58076  Pages 18 - 22
Objective: Chemical disinfection along with mechanical instrumentation, is required to achieve debridement, especially in apical third of root canal. Thus, this study aimed to compare the influence of final apical width on the smear layer removal efficacy of XP Endo Finisher and Endodontic Needle, in mandibular premolars.
Methods: 40 single-rooted mandibular premolars were included in the study, prepared using K3 XF rotary files (SybronEndo, Orange, CA). The samples were equally divided into 4 groups: Group 1: Master apical file 30/0.06 taper, final irrigation with endodontic needle (30G Max I probe, Dentsply International, York PA); Group 2: Master apical file 40/0.06 taper, final irrigation with endodontic needle; Group 3: Master apical file 30/0.06 taper, final irrigation with XP-Endo Finisher (FKG Dentaire, La Chaux-de-Fonds, Switzerland); Group 4: Master apical file 40/0.06 taper, final irrigation with XP-Endo Finisher. Smear layer and debris scores were given using SEM.
Results: Group 3 and 4 performed significantly better than group 1 & 2 (P<0.05). No significant difference was observed in Group 1&2 (P>0.05); and Group 3&4 (P>0.05). Significantly higher scores were observed in the apical third, as compared to other sections of the root canal, in all the 4 groups.
Conclusion: Increase in the final apical width did not significantly improve root canal cleanliness for both XP Endo Finisher and endodontic needle. However, XP endo finisher proved to be significantly better than the endodontic needle.

6.Comparative Evaluation of Physicochemical Properties and Apical Sealing Ability of a Resin Sealer Modified with Pachymic Acid
Ottilingam Kamalakannan Preethi, Vidhya Sampath, Nesamani Ravikumar, Sekar Mahalaxmi
PMID: 32342034  PMCID: PMC7183805  doi: 10.14744/eej.2019.68442  Pages 23 - 27
Objective: The addition of pachymic acid (PA) to AH Plus (an epoxy resin sealer) offsets the cytotoxicity of the latter. Prior to the clinical implementation of this formulation, a thorough knowledge of its physicochemical properties and sealing ability becomes mandatory. Hence, this in vitro study aimed to characterize and evaluate the physicochemical properties and apical sealing ability of AH Plus (AHP) with and without the addition of PA.
Methods: Flow, setting time, film thickness, solubility and radiopacity of AHP (group 1) and AHP modified with PA (AHP/PA, group 2) were evaluated in accordance with the guidelines put forth by ISO 6876: 2012. The percentage was determined under each parameter. Apical sealing ability was assessed using fluid filtration device. An independent samples t-test was used for inter- and intra-group comparisons of mean fluid flow (MFF).
Results: Incorporating PA to AHP decreased its flow, setting time and film thickness by 24.34%, 2.14% and 31.71% respectively. The solubility of group 2 increased on day 1 by 85.71% and decreased on days 3, 7 and 14 by 46.67%, 34.79% and 13.8% respectively. The radiopacity of AHP was not altered by the addition of PA. MFF rates of group 2 was significantly higher than group 1 on day 1, but not significantly different on day 7.
Conclusion: AHP/PA exhibited physicochemical properties that were within the requirements of ISO and with time, and showed fluid flow similar to AHP.

7.Erosive Potential of 1% Phytic Acid on Radicular Dentine at Different Time Intervals
Zareen Afshan, Shahbaz Ahmed Jat, Javeria Ali Khan, Arshad Hasan, Fazal Qazi
PMID: 32342035  PMCID: PMC7183798  doi: 10.14744/eej.2019.02411  Pages 28 - 34
Objective: The objective of this in-vitro study was to compare the erosive potential and smear layer removal ability of 1% Phytic acid (IP6) and 17% Ethylenediaminetetaacetic acid (EDTA).
Methods: Canal preparation of 225 single rooted extracted human teeth was performed with Protaper NiTi rotary instruments. Teeth were divided into three groups according to the final irrigation protocol. Group 1: Saline irrigation (n=75), Group 2: 17% EDTA (n=75), Group 3: 1% Phytic Acid (n=75). Roots were splitted and observed under Scanning Electron Microscope (SEM) for erosion and smear layer removal. Mean differences between the groups for smear layer removal and erosion were assessed using the Kruskal Wallis and Mann Whitney U test. (P≤0.05) Friedman and Willcoxon Signed Rank tests were used to make comparisons within the groups.
Results: Group 3 was significantly less erosive than Group 2 at all root portions (P<0.001). With regards to smear layer removal, group 2 (EDTA) removed more smear layer compared to group 3 (Phytic acid) at all root portions (P<0.001). Both 17% EDTA and 1% IP6 removed significantly less smear layer in the apical root portion. Intra group comparisons revealed no significant differences at any root level. There was a time dependent increase in erosion and smear layer removal in Group 2, with severe erosion at 5 minutes time interval. In Group 3, however, there was moderate erosion and smear removal at 3 and 5 minutes interval.
Conclusion: IP6 at the concentration of 1% and pH 3 was less erosive than 17% EDTA. It exhibited moderate smear layer removal ability.

8.Antibacterial Efficacy of the Grape Seed Extract as an Irrigant for Root Canal Preparation
Fernando Soveral Daviz, Ediléia Lodi, Matheus Alves Albino, Ana Paula Farina, Doglas Cecchin
PMID: 32342036  PMCID: PMC7183804  doi: 10.14744/eej.2019.85057  Pages 35 - 39
Objective: The purpose of this research was to compare relative effectiveness of sodium hypochlorite 5.25% (NaOCl), 2% chlorhexidine gel (CHX) and 6.5 % grape seed extract (GSE) against Enterococcus faecalis using instrument Reciproc R25 in root canal preparation.
Methods: Forty-five mesiobuccal root canals from extracted human maxillary molars were collected and infected with Enterococcus faecalis. The samples were divided into five groups according to the different types of irrigants: saline (positive control) (n=5); in the other groups were used 10 root canals for each group: NaOCl+EDTA; CHX gel+EDTA; GSE solution+EDTA; GSE gel+EDTA. All the groups were prepared with reciprocating instruments Reciproc R25. Bacterial reduction was measured by two-way ANOVA (P<0.001) followed by Tukey HSD post-hoc tests, from the counting of colony forming units (CFUs) from samples collected before instrumentation and after. The significance level established at 5% (P<0.05).
Results: The group prepared with the NaOCl resulted in highest antimicrobial capacity among of all (P>0.05), followed by CHX and GSE gel (P<0.05). Control and GSE solution showed similar results (P<0.05) and resulted in the lowest percentage of the reduction of the microorganism into the root canals.
Conclusion: NaOCl had the higher elimination capacity of Enterococcus faecalis than GSE and CHX.

9.Antibacterial Effect of Cupral® on Oral Biofilms - An In-Vitro Study
Nadine Freifrau Von Maltzahn, Nico Sascha Stumpp
PMID: 32342037  PMCID: PMC7183803  doi: 10.14744/eej.2019.83997  Pages 40 - 45
Objective: This study aimed to assess the efficacy of Cupral®, a Ca(OH)2 and Cu2+ based materials used in endodontics, against biofilms of the oral species Streptococcus oralis, Streptococcus gordonii and Aggregatibacter actinomycetemcomitans at different maturation stages.
Methods: Biofilms of the bacterial target species were grown in brain heart infusion (BHI) medium for 1 and 5 days on titanium disks (titanium, grade 4) to collect microbial communities at different stages of biofilm maturation. Biofilms were subjected to different Cupral® concentrations (4-, 15- and 50-fold dilution) to assess the antimicrobial- and biofilm dissolving effect. 0.2% chlorhexidine gluconate (CHX) solution was used as a positive control. Biovolume and antibacterial efficacy were analyzed by live/dead staining in combination with confocal laser scanning microscopy (CLSM) to quantify biofilm detachment and antibacterial efficacy.
Results: All tested Cupral® concentration showed a strong antibacterial effect on tested bacterial species at all biofilm maturation stages. Efficacy of biofilms detachment was concentration dependent, i.e. higher Cupral® concentrations generally led to increased biofilm detachment. The antibacterial efficacy of tested Cupral® concentration was at least equal to CHX treatment (P=0.03).
Conclusion: Cupral® shows a strong anti-biofilm efficacy and may be applied for oral biofilm treatment and control in dental disciplines other than endodontics.

REVIEW ARTICLES
10.Vital Pulp Therapy an Insight Over the Available Literature and Future Expectations
Samer Ibrahim, Ruth Perez Alfayate, James Prichard
PMID: 32342038  PMCID: PMC7183799  doi: 10.14744/eej.2019.44154  Pages 46 - 53
Vital pulp therapy (VPT) defined as “treatment which aims at preserving and maintaining the pulp tissue that has been compromised but not destroyed by extensive dental caries, dental trauma, and restorative procedures or for iatrogenic reasons”, offers some beneficial advantages over the conventional root canal treatment such as protective resistance for mastication forces or to prevent the loss of environmental changes sensation ability, which can lead to unnoticeable progression of caries and later fracture. A wide range of materials are suggested in the literature to be used as pulp capping protective dressing materials that varies from ready-made synthetic materials to biological based scaffolds and composites. The aim of the present review is to provide a full understanding of currently used materials to clinicians in order to help in their decision-making process delivering the best available evidence-based treatments to their patients. An extensive search for recent available data regarding direct pulp capping materials and potential suggestions for future use have been made. Newly developed biological based scaffolds showed promising results in dentine regeneration therefore strengthening the tooth structure and overcoming potential drawbacks of use of currently available recommended materials.

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