E-ISSN 2548-0839
Volume : 8 Issue : 2 Year : 2024


5 year Impact Factor
2022 CiteScore
Journal Citation Reports (Clarivate, 2023)(Dentistry, Oral Surgery & Medicine (Science))
SCImago Journal & Country Rank
European Endodontic Journal - Eur Endod J: 8 (2)
Volume: 8  Issue: 2 - 2023
1.Front Matter

Pages I - VI

2.Pharmacological Management of Anxiety on Pain Occurrence During Root Canal Treatment: A Systematic Review
Isadora Ames Silva, Charles André Dall Agnol Júnior, Theodoro Weissheimer, Marcus Vinicius Reis So, Ricardo Abreu Da Rosa
PMID: 37010201  PMCID: PMC10098429  doi: 10.14744/eej.2022.83097  Pages 105 - 113
Objective: To answer the question: “Does the pharmacological management of dental anxiety influence pain occurrence during root canal treatment?”
Methods: Searches on MEDLINE/PubMed, Cochrane Library, Web of Science, Scopus, EMBASE and Open Grey were conducted until September 02, 2022. Only randomised clinical trials were included. The Cochrane risk of bias tool for randomized trials (RoB 2) was used. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.
Results: Initial screening resulted in 811 studies. Three hundred seventy-three were excluded for being duplicates. Of 438 eligible papers, ten studies met the inclusion criteria and were selected for full-text reading. Four studies were included in the final analysis. Three studies had a low risk of bias, and one was a high risk. GRADE demonstrated a low quality of evidence.
Conclusion: There is insufficient evidence to determine whether the pharmacological control of anxiety can influence intraoperative pain occurrence. (EEJ-2022-08-096)

3.Effect of Endodontic Irrigation on Mineral Content of Root Canal Dentine: A Systematic Review and Meta-Analysis
Ezatolah Kazeminejad, Milad Niazi, Ensieh Geraili, Abdolhalim Rajabi, Masoud Mohammadi
PMID: 37010204  PMCID: PMC10098431  doi: 10.14744/eej.2023.88528  Pages 114 - 124
A systematic review and meta-analysis were conducted to evaluate the effect of endodontic irrigation on the mineral content of root canal dentine. A systematic search was performed in the following databases: PubMed, Web of Science, Scopus, Cochrane, ProQuest, and Wiley. The quality assessment of the articles was performed. The meta-analysis was carried out using the random effects model in the Stata 16 software (p<0.05). The results showed that Er: YAG Laser had a significant effect on the removal of the phosphorus content of dentine (Hedges' g=-0.49; 95% CI: -0.85, -0.13; I2=0.0%). In addition, the EDTA 5Min had a lower removal effect compared to the control group on the magnesium content of dentine (Hedges' g=0.58; 95% CI: 0.00, 1.16; I2=0.0%). Other irrigations had no significant effect on other on the mineral content of root canal dentine. Evidence was found to support that most root canal irrigation protocols did not have a significantly affected in terms of the mineral content of root dentine. (EEJ-2022-11-140)

4.Efficiency of Immediate and Controlled Release of Aceclofenac on Post-instrumentation Pain in Root Canal Treatment – A Triple Blind Randomized Controlled Trial
Jothi Latha Sundaramurthy, Velmurugan Natanasabapathy, Kavitha Mahendran, Srinivasan Narasimhan, Sandhya Raghu, Anna Ravi Cherian, Murugadoss Vaanjay, Jogikalmat Krithikadatta
PMID: 37010203  PMCID: PMC10098434  doi: 10.14744/eej.2022.40469  Pages 125 - 132
Objective: Patients with moderate to severe preoperative pain have a high incidence of postoperative pain. The objective of this trial was to evaluate the efficiency of oral premedication with Aceclofenac (immediate release and controlled release) in the management of post-instrumentation pain in root canal treatment, in patients with moderate to severe preoperative pain.
Methods: Three-arm parallel, triple blinded randomized controlled trial was planned. Patients with moderate to severe endodontic pain, requiring primary endodontic treatment were enrolled. Aceclofenac 100mg- immediate release (Aceclofenac-IR), Aceclofenac 200mg- controlled release (Aceclofenac-CR), and Ibuprofen 400mg were compared. The tablets were given one hour before the root canal treatment.
Postoperatively, patients rated their pain at various time points. The duration of pain relief (primary outcome), the intensity of post-instrumentation pain, and the need for additional medicine were calculated. Statistical analysis was done using Kruskal-Wallis followed by Dunn post-hoc, Chi-square tests, and Binominal logistic regression.
Results: Aceclofenac-CR had a statistically significant longest duration of pain relief when compared to Ibuprofen (p=0.037) and Aceclofenac-IR (p=0.026). The intensity of post-instrumentation pain was lowest in Aceclofenac-CR, followed by Aceclofenac-IR and Ibuprofen. Additional medicine was required for only 8% of patients in Aceclofenac-CR group; whereas for 32% in each of Aceclofenac-IR and Ibuprofen groups. The odds of taking additional medicine were reduced to 0.16 in Aceclofenac-CR; increased to 1.05 with age.
Conclusion: Aceclofenac-CR had the longest duration of pain relief compared to Aceclofenac-IR and Ibuprofen. (EEJ-2022-03-037)

5.Analgesic Efficacy of Ibuprofen and Diclofenac Potassium on Postoperative Endodontic Pain in Maxillary and Mandibular First Molars with Irreversible Pulpitis: A Randomised Controlled Trial
Mohammadreza Vatankhah, Nazanin Zargar, Mandana Naseri, Saba Salem, Alireza Akbarzadeh Baghban, Ayeh Etemadi, Omid Dianat
PMID: 37010198  PMCID: PMC10098432  doi: 10.14744/eej.2022.45238  Pages 133 - 139
Objective: The management of postoperative endodontic pain (PEP) is essential to contemporary endodontic practice. Diclofenac and ibuprofen (IBU) are two of the most widely-used non-steroidal anti-inflammatory analgesics. However, their comparative data are neither sufficient nor conclusive. This prospective randomised clinical trial aimed to compare the analgesic efficacy of diclofenac potassium (DFK) with IBU on PEP in maxillary and mandibular first molars diagnosed with irreversible pulpitis after single-visit non-surgical root canal treatment.
Methods: Sixty-four patients were randomised into two groups of DFK (n=32) and IBU (n=32), using the stratified permuted randomisation method, and 61 participants completed the trial. After root canal treatment, patients randomly received IBU 400 mg every 6 hours (n=31) or DFK 50 mg every 8 hours (n=30) for 24 hours. Patients recorded their pain level on 0-100 mm visual analogue scales (VAS) at 2, 4, 6, 12, and 24 hours after the treatment. Recorded VAS scores and the number of pain-free patients (VAS<5) were compared between the two groups. A generalised linear estimation equation model, Chi-Square test, and Mann–Whitney U test were used to analyse the data.
Results: The mean overall PEP score was statistically significantly lower in the DFK group than the IBU group with a p value of 0.030. Pain scores at 2 (p=0.034), 4 (p=0.021), and 24 hours (p=0.042) after the treatment were also significantly lower for DFK than IBU. The number of pain-free patients was also significantly higher in the DFK group at 2-hour (p=0.015) and 4-hour (p=0.048) time points and overall (p=0.013) compared to the IBU group. There was no adverse effect observed in either group.
Conclusion: Based on the results, taking multi-dose DFK 50 mg by the clock had better analgesic outcomes than multi-dose IBU 400 mg for PEP management. (EEJ-2022-01-07)

6.The Effect of Reciprocating Instrument and Root Canal Filling Techniques on Post-operative Pain in Retreatment: A Prospective Clinical Study
Gulaya Novruzova, Nimet Gençoğlu
PMID: 37010205  PMCID: PMC10098430  doi: 10.14744/eej.2023.69772  Pages 140 - 147
Objective: The aim of this prospective clinical study was to assess the effect of different instruments and root canal filling techniques on post-operative pain in single visit of endodontic retreatment.
Methods: Forty five patients (18-65 yrs old) who needed non-surgical endodontic retreatment in mandibular premolar or molar teeth without any symptoms were included in this study. The teeth were randomly assigned into 3 groups of 15 teeth, according to the instrumentation and filling techniques: hand files with lateral compaction (group 1), Reciproc with lateral compaction (group 2), Reciproc with continuous wave
compaction technique (group 3). Retreatments were performed in a single visit and post operative pain was assesed at 4 intervals; 24, 48,72 hours and 7 days. All data were analyzed using One way Anova, Chi-square and Fisher’s Exact test and the significance level was set to (p≤0,05).
Results: No statistically significant difference was found among the groups in relation to post-operative pain (p>0.05). Although the intensity of post-operative pain was decreased over the time in all groups, significant difference was found only in Reciproc groups (p<0.05). However, no pain was found in any patient at the end of 7 day. Also, statistically significant difference was found between pain intense and periapical index in 24 and 72 hours (p<0.05).
Conclusion: In the present study, the intensity of post-operative pain was not found to be related to instrumentation or filling techniques in retreatment cases. The intensity of pain could be related to periapical index of the tooth. (EEJ-2022-09-117)

7.Observation of Inflammation, Oxidative Stress, Mitochondrial Dynamics, and Apoptosis in Dental Pulp following a Diagnosis of Irreversible Pulpitis
Savitri Vaseenon, Khunakorn Weekate, Tanida Srisuwan, Nipon Chattipakorn, Siriporn Chattipakorn
PMID: 37010199  PMCID: PMC10098433  doi: 10.14744/eej.2022.74745  Pages 148 - 155
Objective: Mitochondrial dynamics play a pivotal role in maintaining the homeostasis of the dental pulp. Inflammation and oxidative stress can trigger changes in mitochondrial dynamics, leading to cell death in the dental pulp. This study aimed to investigate inflammation, oxidative stress, mitochondrial dynamic alterations, and cell death in inflamed pulpal tissues compared to healthy pulp tissues.
Methods: Pulpal tissues were collected (n=15 per group) from: 1) healthy people as the control and 2) people with clinically diagnosed irreversible pulpitis. Proteins indicating inflammation, oxidative stress, mitochondrial dynamics, and cell death markers were investigated by western blot analysis. A Student’s t-test was used to analyse differences between the healthy and irreversible pulpitis groups. A probability of 0.05 was used to indicate statistical significance (p<0.05).
Results: The expression of the proteins, tumour necrosis factor-alpha (TNF-α) and nuclear factor kappa-lightchain-enhancer, by activated B cells (NF-κB) from inflamed pulp tissues were significantly higher than those of control. Compared to controls, 4 hydroxynonenal (4HNE) and dynamin-related protein 1 (Drp1) were significantly higher, while mitofusin 2 (MFN2) and optic atrophy type 1 (OPA1) were significantly lower in inflamed pulp tissues. Bcl-2-associated X protein (Bax), cleaved caspase-3, and cytochrome c were significantly higher in inflamed pulpal tissues compared to controls. In inflamed pulpal tissues, we found a significant increase in the expression of receptor-interacting serine or threonine-protein kinase 1 (RIPK1) but not receptor-interacting serine or threonine-protein kinase 3 (RIPK3).
Conclusion: Irreversible pulpitis is associated with inflammation, oxidative stress, alterations in mitochondrial dynamics, and apoptosis in pulpal tissues. (EEJ-2022-01-014)

8.Shaping Ability of F6 SkyTaper®, Hyflex® EDM One File, and One Curve®: A Micro-computed Tomographic Evaluation in Curved Root Canals
Taniah Ikogou, Feng Chai, Benjamin Verriest, Kadiatou Sy, Jerome Delattre, Etienne Deveaux, Lieven Robberecht
PMID: 37010202  PMCID: PMC10098428  doi: 10.14744/eej.2022.55376  Pages 156 - 161
Objective: The present study aimed to compare the shaping ability of the F6 SkyTaper® (F6S), HyFlex® EDM OneFile (HEDM), and One Curve® (OC) nickel-titanium single-file instruments using micro-computed tomography.
Methods: Fifty-two mesiobuccal roots of maxillary first molars, with a degree of curvature between 20° and 42°, were randomised into three experimental groups (n=15 per group): F6S, HEDM, and OC, and a non-instrumented control group (n=7). All specimens were scanned by micro-computed tomography before and after instrumentation. The following parameters were evaluated: preparation time, volume of dentine removed, cutting efficiency, unshaped surfaces, and canal transportation. Cutting efficiency was analysed using an ANOVA parametric test and Tukey’s multiple comparison post hoc test. Other parameters were analysed using a non-parametric Kruskall-Wallis test followed by Dunn’s multiple comparison post hoc test.
Results: No instrument separation occurred during instrumentation. No significant differences were found between the instrument groups with respect to all the parameters (p>0.05). All the instruments induced morphological changes in the root canal dentine (p<0.05) and tended to increase canal transportation toward the coronal portion of the root canals (p>0.05).
Conclusion: All instruments were able to shape curved canals and preserve their original anatomy. Single-file endodontic procedures with these instruments can be used with comparable changes in the root canal shape with minimal transportation. (EEJ-2022-01-06)

9.Effect of Continuous Chelation Irrigation Using DualRinse HEDP+3% NaOCl with or without High-power Sonic Activation on Debris and Smear Layer Removal
Christelle Aoun, Dan-Krister Rechenberg, Mia Karam, Rami Mhanna, Gianluca Plotino, Carla Zogheib
PMID: 37010200  doi: 10.14744/eej.2022.93064  Pages 162 - 169
Objective: This study aimed to assess the effect of sodium hypochlorite (NaOCl) combined with a novel chelating agent DualRinse HEDP (Medcem GmbH, Weinfelden, Switzerland), a product consisting of 0.9 g of 1-hydroxyethylidene-1,1-diphosphonic acid (HEDP) powder, with or without high-power sonic activation on debris and smear layer removal.
Methods: Seventy-five mandibular premolars were divided into 5 groups (n=15) and treated with different irrigation protocols: group 1 (D3N), DualRinse HEDP+3% NaOCl without activation; group 2 (D3NA), DualRinse HEDP+3% NaOCl with activation (EDDY, VDW, Munich, Germany) during the final irrigation; group 3 (3NE), 3% NaOCl+17% Ethylenediaminetetracetic acid (EDTA)+3% NaOCl without activation; group 4 (3NEA), 3% NaOCl+17% EDTA+3% NaOCl with activation during the final irrigation; group 5 (NC), negative control group, 0.9% saline. Samples were analysed by scanning electron microscopy (SEM) to evaluate residual debris and smear layer at 3 levels of the root canal: coronal, middle, and apical. Statistical analysis was performed with a level of significance set at p<0.05. The normality distribution of scores within each group was assessed using Kolmogorov-Smirnov and Shapiro-Wilk tests. A Kruskal-Wallis test followed by multiple comparison tests was used to compare scores among the 5 groups on the apical, middle, and coronal levels of the root canal. A Friedman test followed by multiple comparison tests was used to compare scores within the apical, middle, and coronal levels for each treatment group.
Results: Debris score was significantly the lowest for D3NA, followed by D3N, 3NEA and 3NE at all root levels (p<0.05). The smear layer score was significantly the lowest for D3NA, followed by D3N, 3NEA and 3NE only at the apical level, while no significant difference was found in the middle and coronal levels between the groups (p<0.05). DualRinse HEDP resulted in less debris and smear layer compared to the classic approach of NaOCl without activation. Implementing sonic activation further improved debris and smear layer removal.
Conclusion: DualRinse HEDP+3% NaOCl improved debris removal at all levels and smear layer elimination at the apical level of the root canal. These results were further enhanced when adding high-power sonic activation. (EEJ-2022-09-116)

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