E-ISSN 2548-0839
European Endodontic Journal - Eur Endod J: 7 (1)
Volume: 7  Issue: 1 - 2022

Pages I - III

2.A Literature Review of Minimally Invasive Endodontic Access Cavities - Past, Present and Future
Maggie Yuk Ching Chan, Venetia Cheung, Angeline Hui Cheng Lee, Chengfei Zhang
PMID: 35353062  doi: 10.14744/eej.2022.62681  Pages 1 - 10
Minimally invasive endodontic access cavities have gained popularity in academic discussions for their clinical applications in recent years. Although some studies showed an improved fracture resistance of endodontically-treated teeth accessed with a minimally invasive access cavity design, the resulting effectiveness and efficiency of subsequent root canal treatment procedures may be impaired. Aspects that may be impaired are canal detection and negotiation, chemomechanical debridement of the root canal system, quality of the obturation. These are potentially complicated by the increased incidence of procedural mishaps and compromised aesthetic outcomes. In addition, the inherent flaws presented in the methodology of some in vitro studies and the lack of a universal classification system are also of concern. This literature review aims to present a comprehensive overview of the development of the minimally invasive endodontic access cavity and summarise the currently available from a clinical context. (EEJ-2021-05-091)

3.Do Calcium Chelators Play a Role in the Removal of Calcium Hydroxide From Root Canals? A Systematic Review of Laboratory Studies
Nandini Suresh, Aswathi Varghese, Sathish Sundar, Venkateshbabu Nagendrababu, Natanasabapathy Velmurugan
PMID: 35353065  doi: 10.14744/eej.2021.73644  Pages 11 - 19
Objective: To identify whether root canal irrigants with calcium chelation ability play a role in the removal of calcium hydroxide (CH) from the root canals when compared to non-chelators.
Methods: The protocol is registered in the Open Science Framework registry (doi 10.17605/OSF.IO/CHG2Q). PubMed, Scopus, Embase, Cochrane Library, ProQuest, Google Scholar, Science direct and open grey databases were searched until March 2021. Laboratory studies comparing the effectiveness of calcium chelators in the removal of CH with non-chelators delivered using needle irrigation, irrigation agitation or instrumentation techniques were included. The quality of included studies was appraised using a modified Joanna Briggs Institute critical appraisal checklist for a randomised clinical trial. Two independent reviewers were involved in study selection, data extraction, appraising the quality of studies. Any disagreements were resolved by a third reviewer.
Results: The current review included 17 studies, with 16 being of "moderate" quality and one of "low" quality. Due to methodological differences within the included studies, quantitative analysis was not performed. Laboratory studies were only included in the current review because no clinical study exists on this topic. Evidence from the review indicates that calcium chelators are superior to non-chelators in the removal of CH when used with needle irrigation, passive ultrasonic irrigation and instrumentation techniques.
Conclusion: Calcium chelators are superior in the removal of CH from the root canal system over non-chelators. (EEJ-2021-01-06)

4.Tooth Survival Following Non-Surgical Root Canal Treatment in South Korean Adult Population: A 11-Year Follow-Up Study of a Historical Cohort
Sun-mi Kim, Eunsuk Ahn
PMID: 35353067  doi: 10.14744/eej.2021.86648  Pages 20 - 26
Objective: This study examined the survival rate of root canal treatment (RCT) and identified the factors affecting the survival/failure of RCT with respect to the patient’s demographic, socioeconomic and dental healthcare factors.
Methods: The data of patients with RCT were analyzed using the 2002 patient data of the Korean National Health Insurance Service (KNHIS). The analysis included 1,193,666 patients, with 1,414,715 targeted teeth. Survival analysis was performed using the Kaplan-Meier method based on the occurrence of the untoward event. The proportional hazard of failure of RCT was measured using the Cox proportional hazard model and considering variables were gender, age, income, type of dental healthcare, number of visits for RCT, and type of teeth.
Results: The 11-year cumulative survival rate for non-surgical RCT teeth was 88.37%. The Cox proportional hazard model showed significantly lower females (HR 0.704; CI 1.022-1.079) than males. The hazard ratio (HR) of over 65 years (HR 2.959; CI 2.864-3.058) was higher than that of other groups. In addition, the HR varied according to the income level (medical beneficiary was the highest) and the type of dental healthcare (tertiary hospital was the lowest).
Conclusion: Performing RCT survival analysis using representative data revealed that the demographic and socioeconomic factors of the patients affect the failure of RCT. This study can serve as the basis for improving the survival trend in RCT and provide important implications in clinical decision-making in endodontics. (EEJ-2021-08-138)

5.Comparison of the Survival Rate Against Fracture of Endodontically Treated Premolars with Exposed Cervical Lesions Restored with Crowns and Resin Composites: A Retrospective Study
Kantaporn Kaewchomphoo, Danuchit Banomyong, Yaowaluk Ngoenwiwatkul, Piyapanna Pumpaluk
PMID: 35353058  doi: 10.14744/eej.2021.21939  Pages 27 - 32
Objective: The purpose of this study was to evaluate the effect of coronal restorations on the survival rates against fracture of endodontically treated premolars with exposed cervical lesions and to identify the prognostic factors for fracture.
Methods: Data of the endodontically treated premolars with exposed cervical lesions restored with resin composites or crowns between 2011 and 2020 were collected. The presence of a fracture was recorded, and the possible prognostic factors were recorded. Statistical analyses were performed, with a significance level of P<0.05, using a Kaplan-Meier survival analysis, log-rank tests, and Cox proportional hazard models were used to identify the prognostic factors.
Results: The survival rates against fracture were not significantly different between the teeth restored with crowns (93.3%) or resin composites (86%) (P≥0.05). A high frequency of non-restorable fractures was observed in both groups. Crestal bone reduction to the middle-third of the root was identified as the significant prognostic factor (P<0.05).
Conclusion: For endodontically treated premolars with exposed cervical lesions, resin composite restorations provided a high comparable survival rate that was comparable to that of crowns. A higher risk of fracture was found in endodontically treated premolars with crestal bone loss to the middle-third of the root. (EEJ-2021-05-088)

6.Postoperative Pain After Using Reciprocating Motion with Reciproc Files Versus Adaptive Motion with Twisted File Adaptive in Instrumentation of Necrotic Mandibular Molars: A Randomized Clinical Trial
Ahmed Yaser, Hebatallah Mohamed Maged Elfar, Ghada El Hilaly Mohamed Eid
PMID: 35353061  doi: 10.14744/eej.2021.53215  Pages 33 - 39
Objective: The objective of the present study was to assess the effect of using Reciproc (RC), (VDW GmbH, Munich, Germany) files with reciprocating motion versus Twisted File Adaptive (TFA, Kerr, Orange, California, USA) system with adaptive motion on post-instrumentation and post-obturation pain of necrotic mandibular molars.
Methods: Fifty-eight patients with mandibular molar assessed at 3 intervals; 6, 12 and, 24 hrs. Mann Whitney U and Friedman test was used for data analysis, and the significance level was set to (P≤0.05).
Results: There was no statistically significant difference in the mean values of post-instrumentation pain at each time interval for the RC and TFA groups (P>0.05). Pain decreased in each group with a statistically significant difference from preoperative condition to all six post-instrumentation time intervals (P<0.001). In each group, post-instrumentation mean pain values at 6, 12, and 24 hrs were higher than post-obturation pain values at 6, 12, and 24 hrs with a statistically significant difference (P<0.001).
Conclusion: TFA and RC had a similar impact on post-instrumentation and post-obturation pain. The post-instrumentation pain was higher than post-obturation pain in both groups. (EEJ-2021-01-05)

7.Cleaning Efficacy and Debris Extrusion using XP-Endo Finisher and XP-Endo Finisher R as Supplementary Files during Retreatment: An in Vitro Study
Ekramy Hassan, Marwa Sharaan, Mai Ragab
PMID: 35353059  doi: 10.14744/eej.2021.44366  Pages 40 - 46
Objective: The aim of the study was to examine the efficacy and debris extrusion of XP -Endo Finisher and XP-Endo Finisher R when used in the removal of root canal filling as supplementary files.
Methods: Sixty single-rooted mandibular premolars with single canals were selected. After root canal preparation and obturation, roots were distributed across four groups according to the method of retreatment (n=15): H files, D Race files, D Race +XP-Endo Finisher and D Race+ XP -Endo Finisher R. After retreatment completion, the debris was dried in a hot air oven and weighed. Later, the coronal, middle and apical thirds were assessed using the stereomicroscope. One-way ANOVA followed by Tukey’s post hoc test was used to compare across all tested groups. The significance level was set at 0.05 (P<0.05).
Results: XP- Endo Finisher R exhibited significantly cleaner root canals than XP- Endo Finisher (41.58±10.56 and 52.68±9.94 respectively) and extruded more debris apically (16.56%±4.07 and 12.82%±3.41 respectively) (P<0.001).
Conclusion: Although none of the tested approaches rendered root canals free of filling remnants, the XP-Endo Finisher R cleaned canals significantly more than the XP-Endo Finisher and extruded more debris apically. (EEJ-2021-07-124)

8.An in Vitro Comparison of Coronal Discolouration Caused by White Mineral Trioxide Aggregate, Theracal, Calcium-Enriched Mixture and Biodentine
Zohreh Khalilak, Ehsan Esnaashari, Keivan Saati, Delaram Bineshmarvasti, Hazhir Yousefshahi, Mahsima Nobakht
PMID: 35353066  doi: 10.14744/eej.2020.83584  Pages 47 - 51
Objective: The use of calcium silicate-based cements has greatly increased in the past decade. This study compared coronal discolouration caused by white mineral trioxide aggregate (MTA), TheraCal (TC), calcium enriched mixture (CEM), and Biodentine (BD) on bovine enamel-dentin block.
Methods: In this in vitro, experimental study, enamel-dentin blocks (7x7x3.5 mm) were cut out of 60 extracted sound bovine central incisors. A cavity (2.5 mm diameter and 1 mm depth) was created at the center of each block with 1 mm distance from the labial surface. The blocks were randomly divided into four experimental groups (n=12) of MTA, CEM, BD, and TC and two groups of positive (blood) and negative (empty) controls. After filling cavities with experimental materials, the surfaces of the materials were covered with composite resin. The colour parameters were measured using a spectrophotometer, before (T0) and 1 week (T1), 1 month (T2), and 6 months (T3) after the application of the materials. The data was analysed using repeated measures ANOVA and the Kruskal-Wallis test.
Results: At 1 week and 1 month, a significant difference in ∆E was noted in the control groups compared to the experimental groups (P<0.001). The difference among the four cements was not significant (P=0.06) at 1 week but it was significant at 1 month. TC showed greater ∆E whereas BD showed lower ∆E in the six-month period (P<0.001). Colour change was significant over time in the MTA and TC groups (P<0.05).
Conclusion: TheraCal caused greater discolouration in the bovine tooth blocks after 6 months, which may make it inappropriate for application in the aesthetic zone. (EEJ-2020-07-169)

9.Radiopacity of Portland Cement and Calcium Silicate-Based Cement with Different Mixed Ratios of Radiopacifiers
Cholkamol Sarunket, Danuchit Banomyong, Piyawat Vibulcharoenkitja, Supachai Sutimuntanakul
PMID: 35353064  doi: 10.14744/eej.2021.72691  Pages 52 - 57
Objective: The present study aimed to compare the radiopacity of Portland cement (PC) or calcium silicate-based cement (CSC) with different mixed radiopacifiers [bismuth oxide (BO)/ tantalum oxide (TO) and zirconium oxide (ZO)/barium sulfate (BS)] in a ratio of 1: 1 or 1: 2, with the 3 mm aluminium thickness (mmAl) acceptable value of ISO 6876: 2012.
Methods: PC and CSC mixed with different ratios of radiopacifiers were evaluated. One of high radiopacity radiopacifiers, BO or TO, was mixed with one of low radiopacity radiopacifiers, ZO or BS, in ratio of 1: 1 and 1: 2. PC or CSC powder, 1.6 g, was added into 0.4 g mixed radiopacifiers. Disc-shaped specimens of 1-mm thickness were prepared by mixing PC or CSC powder containing radiopacifiers with distilled water; the radiopacity was measured according to ISO 6876: 2012. One-way ANOVA/Tukey's test and Welch ANOVA/Games-Howell test were used to compare the radiopacity among the groups. The significance level was set at 0.05.
Results: PC groups had a higher radiopacity than CSC groups with the same radiopacifiers and ratio. BO groups showed higher radiopacity than TO groups. The groups with 1: 1 ratio provided a higher radiopacity than 1: 2 ratio groups (P>0.05).
Conclusion: All tested radiopacifiers revealed adequate radiopacity ranging from 3.05-4.25 mmAl, except CSC with TO/BS in ratio of 1: 2. (EEJ-2021-07-125)

10.Comparative Evaluation of the Antimicrobial Effect of Mangosteen, Triphala, Chitosan, and 2% Chlorhexidine on Mono- and Dual-Species Biofilms of – and Candida albicans: An in Vitro Study
Vinoo Subramanaiam Ramachandran, Mensudar Rathakrishnan, Malathy Balaraman Ravindrran, Venkatesh Alagarsamy
PMID: 35353063  doi: 10.14744/eej.2021.70783  Pages 58 - 66
Objective: The purpose of this in vitro study was to compare the antimicrobial effectiveness of 2% chlorhexidine gel, 0.5% chitosan, ethanol extract of mangosteen pericarp, and Triphala used as intracanal medicaments against Enterococcus faecalis and Candida albicans in mono- and dual-species biofilms.
Methods: Bioactive components in the ethanol extract of mangosteen pericarp and Triphala were evaluated by gas chromatography-mass spectrometry (GCMS). Quantitative assessment of the biofilm formations of E. faecalis and C. albicans and as a dual-species in the presence of test medicaments was carried out using a crystal violet (CV) assay in a microtiter plate. Following this, 246 single-rooted premolar teeth were collected, and root specimens were prepared. C. albicans and E. faecalis mono- and dual-species biofilms were grown in the root specimens. At the end of 21 days, the samples were divided into five groups and subjected to different types of medicaments: Control group- distilled water; Chlorhexidine group- 2% chlorhexidine gel; Chitosan group- 0.5% chitosan; Mangosteen group- ethanol extract of mangosteen pericarp; and Triphala group- ethanol extract of Triphala. Colony-forming units (CFUs) were assessed on the first and fifth day after medicament placement.
Results: Microbial population reduction was measured by one-way analysis of variance, followed by post-hoc Tukey’s multiple comparison test (P<0.05). Chlorhexidine showed maximum log reduction in CFUs of microorganisms, followed by chitosan, which showed a similar log reduction (P>0.05) for both mono- and dual-species biofilms. However, in the mangosteen and Triphala extract groups, the CFU/mL for dual-species on both days did not have a significant reduction in count (P<0.05) when compared to chlorhexidine and chitosan.
Conclusion: Chlorhexidine showed maximum antimicrobial activity, followed by chitosan, on both mono- and dual-species biofilms. Mangosteen and Triphala had good antimicrobial action on the mono-species biofilm. (EEJ-2021-07-128)

11.A Comparison of Antibacterial Properties of Tachyplesin, Thanatin, and Enterocin P on Enterococcus faecalis
Armita Rouhani, Afshin Javadzadeh, Abbas Tanhaeian, Sara Navabi
PMID: 35353057  doi: 10.14744/eej.2021.04696  Pages 67 - 72
Objective: Enterococcus faecalis (E. faecalis) is one of the persistent microorganisms responsible for the failure of root canal treatments. This study investigated the antibacterial property, the time-killing of 3 peptides, namely Tachyplesin, Thanatin, and Enterocin P, on E. faecalis.
Methods: In this study, recombinant peptides were synthesized via secretory synthesis. The peptides were then purified and isolated using affinity chromatography after which their purification was evaluated through SDS-PAGE. The antimicrobial activity of peptides against E. faecalis was tested using the minimum inhibitory concentration test (MIC), the minimum bactericidal concentration test (MBC), and the time-killing assay.
Results: Based on antimicrobial tests, a similar value was observed for the MIC and MBC in the recombinant peptide of Enterocin P. The concentration of MBC was twice as much as that of MIC for Tanatin and Tachyplesin. The time-killing-assay antimicrobial test showed that Enterocin P has a better pattern and antimicrobial activity than the other two peptides; all three peptides have weaker antimicrobial activities than sodium hypochlorite.
Conclusion: Considering the equivalence of MIC and MBC in the recombinant peptide of Enterocin P, it can be a viable replacement for traditional disinfectants and medicaments used in root canal treatment procedures. (EEJ-2021-01-01)

12.Demystifying Dens Invaginatus: Suggested Modification of the Classification based on a Comprehensive Case Series
Selvakumar Kritika, Sweta Surana Bhandari, Gergely Benyöcs, Paula Andrea Villa Machado, Nirmala Bishnoi, Felipe Augusto Restrepo Restrepo, Kittappa Karthikeyan, Ida Ataide, Sekar Mahalaxmi
PMID: 35353060  doi: 10.14744/eej.2021.48303  Pages 73 - 80
Dens invaginatus (DI) is one of the most common developmental anomalies observed in maxillary lateral incisors. An early diagnosis requires thorough clinical knowledge, advanced radiographic evaluation as well as the use of cone beam computed tomography (CBCT) and dental operating microscope (DOM), dictates the successful endodontic management of such teeth. A total of 7 cases with (DI) in maxillary lateral incisors were collected from dental practitioners worldwide, analysed and reported in the present case series. Our aim was to analyse and understand the various morphological patterns of DI in maxillary lateral incisors with their varied treatment protocols employed worldwide. This article illustrates the aberrant morphological patterns and the diverse treatment protocols followed by the clinicians worldwide. The use of biomaterials enhances post-operative healing. Further, a modification in the existing classification has been proposed in this report which would enable the clinicians to easily diagnose, categorise and effectively manage DI. The different treatment protocols employed for the management of DI has been discussed and the use of CBCT and DOM in identifying and managing the anatomical variation of DI were emphasised. (EEJ-2021-03-054)

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