E-ISSN 2548-0839
Volume : 8 Issue : 3 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 (3)
Volume: 8  Issue: 3 - 2023
1.Front Matter

Pages I - VI

2.Regenerative Endodontic Procedures in Teeth with Root Resorption: A Systematic Review
Ashwini Manish Dadpe, Dipali Yogesh Shah, Velmurugan Natanasabapathy, Nivedhitha Malli Sureshbabu, Ajit Narayan Hindlekar, Kajal Modi
PMID: 37257034  PMCID: PMC10244915  doi: 10.14744/eej.2023.77486  Pages 170 - 186
The purpose of this systematic review was to critically evaluate the available clinical literature on the use of regenerative endodontic therapy (RET) for the treatment of root resorption. All case reports, case series and clinical studies documenting the management of root resorption in mature or immature permanent teeth using RET were included. Review articles, animal studies, and RET in teeth showing developmental anomalies were excluded. A literature search was conducted in electronic databases MEDLINE, Scopus, Cochrane, and Google Scholar from 2001 to January 2022. The JBI Critical Appraisal Checklist Quality was used to appraise the included case reports and case series. The Methodological item for non-randomised studies (MINORS) tool was used to appraise the clinical study critically. After applying the inclusion and exclusion criteria, the search resulted in 14 studies (12 case reports, 1 case series, and 1 clinical study) accounting for root resorption in 34 teeth from 29 patients treated with RET. Despite the wide variation in RET protocols, the arrest of root resorption and resolution of symptoms was seen in all teeth except one (failure after 27 months). The clinical study’s cone beam computed tomography (CBCT) imaging evalu- ation documented a significant volumetric decrease in resorptive and periapical lesions after RET. The clinical study was deemed as good quality using the MINORS scale. The JBI critical appraisal tool showed that the case series was of poor quality; 11 of the case reports were of good quality, while 1 case report was of fair quality. This systematic review revealed a low-to-moderate level of evidence for the use of RET in resorption cases. However, further well-designed, long-term clinical studies are required to recommend it as an alternative treatment option for root resorption management. Funding: None. The systematic review was registered in PROSPERO (CRD42021274569). (EEJ-2022-11-136)

3.The Effect of Final Irrigation Agitation Techniques on Postoperative Pain after Single Visit Root Canal Treatment of Symptomatic Irreversible Pulpitis: A Randomised Clinical Trial
Ahmed Ali, Ahmed Abdel Rahman Hashem, Nehal Nabil Roshdy, Adel Abdelwahed
PMID: 37257031  PMCID: PMC10244918  doi: 10.14744/eej.2022.39200  Pages 187 - 193
Objective: To evaluate the degree of postoperative pain and rate of analgesic intake in patients with symptomatic irreversible pulpitis in mandibular first molar teeth at 6 h, 12 h, 24 h, 48 h, and 72 h after using different irrigation activation techniques in single-visit endodontic treatment.
Methods: A total of 78 patients with symptomatic irreversible pulpitis with no signs of periapical pathology were randomly divided into 3 groups according to the final irrigation activation technique; Group XP-endo Finisher, Group Ultra X ultrasonic device, and Group side-vented needle. The teeth underwent standardised single-visit root canal treatment procedures using 2.5% sodium hypochlorite for irrigation. Each patient was
given a chart to record postoperative pain at 6, 12, 24, 48 and 72 hours intervals. Ibuprofen, 400 mg tablets, was prescribed to be taken when the pain was unbearable. The incidence and number of analgesic tablets taken were recorded. Data were analysed using a Kruskal-Wallis test followed by a pairwise Mann-Whitney U test with Bonferroni correction for intergroup comparisons and Freidman’s test followed by Dunn’s post hoc test for intragroup comparisons.
Results: No statistically significant difference was found between all groups regarding the incidence and intensity of pain at different time intervals (p>0.05). There was no significant difference in analgesic intake between different groups, with most cases in all groups not taking analgesics (p>0.05).
Conclusion: Adding XP-endo Finisher or passive ultrasonic irrigation to the final irrigation protocol in singlevisit endodontic treatment had no significant effect on postoperative pain or analgesic intake. (EEJ-2021-11-185)

4.The Outcome of Prescribing Antibiotics for the Management of Patients with Endodontic Infections
Masoud Parirokh, Anahita Saffarzadeh, Nouzar Nakhaei, Paul Abbott
PMID: 37257032  PMCID: PMC10244919  doi: 10.14744/eej.2023.39306  Pages 194 - 200
Objective: This study aimed to evaluate the efficacy and duration of antibiotic therapy with different regi- mens of antibiotics for patients presenting with primary and secondary endodontic infections.
Methods: In a case series outcome study, all patients needing antibiotics due to endodontic infection were included. In patients with no history of hypersensitivity to penicillin, amoxicillin was used as the first-line antibiotic, followed by adding metronidazole if the symptoms did not show signs of recovery during the first 24 hours after prescribing the medication. If a patient did not respond to the combination of amoxicillin and metronidazole, amoxicillin was substituted with a parental penicillin G procaine. Patients who had sensitivity to penicillin received clindamycin. In cases where drainage was possible, the effect of the procedure on the success rate of antibiotic therapy was evaluated. All patients were asked to continue taking the antibiotic for up to two days following the relief of symptoms. Data were analysed by Chi-square, Fisher exact test, Indepen- dent t-test, and One-way ANOVA.
Results: Over a period of 6 years, 97 patients were eligible to be included in this study. In patients with no history of sensitivity to penicillin (95.9% of the patients), 52.7% of patients on amoxicillin and 43% of patients on amoxicillin plus metronidazole overcame the endodontic infections. In addition, drainage significantly increased the success rate of antibiotic therapy when amoxicillin was prescribed (p=0.046). There were no significant differences between the gender, age, type of tooth, need for primary or secondary endodontic treatment, previous history of infection, need for drainage or duration of antibiotic consumption (p>0.05), and the success of antibiotic prescription. However, patients who received a single antibiotic (either amoxi- cillin or clindamycin) had significantly shorter average times for the recovery of symptoms (p<0.05).
Conclusion: Amoxicillin helped patients recover from endodontic infection symptoms in more than half of the cases. However, it is necessary to monitor the patients to understand if they should be needed further treatment, such as another antibiotic or drainage. (EEJ-2022-11-138)

5.Dynamic Cyclic Fatigue Resistance of Heat-treated Nickel Titanium Instruments in Reciprocating Motion
Thaís Kauana Magalhães Sobral, Lucila Piasecki, Flávia Sens Fagundes Tomazinho, Alison Luís Kirchhoff, Marilisa Carneiro Leão Gabardo, Natanael Henrique Ribeiro Mattos, Flares Baratto Filho, Luiz Fernando Fariniuk
PMID: 37257036  PMCID: PMC10244920  doi: 10.14744/eej.2023.73792  Pages 201 - 206
Objective: To compare the fatigue resistance of different heat-treated reciprocating instruments tested in a dynamic cyclic fatigue model.
Methods: Forty-eight new instruments were inspected under magnification and selected for this study, and then divided as follows (n=12): X1 Blue (MK Life, Porto Alegre, RS, Brazil), Pro-R (MK Life), Reciproc (VDW, Munich, Germany), and Reciproc Blue (VDW). Artificial canals presenting a curvature of 60° angle and 5 mm radius were milled in zirconia. The block containing the artificial canals was mounted in a container filled with water kept at 37°C. A specially designed device was used to perform controlled axial movements while the instruments were activated inside the canals. Time to failure was recorded in seconds, and fragment lengths were measured (mm). Data were analyzed statistically with the significance level set at 5% (One-Way ANOVA and Tukey test).
Results: Pro-R and Reciproc Blue instruments presented the highest fatigue resistance, being significantly different from the other tested files (p<0.05). Reciproc presented intermediate results, significantly different X1 Blue (p<0.05). The fractographic analysis showed typical features of cyclic fatigue for all instruments.
Conclusion: Pro-R and Reciproc Blue instruments are more resistant to dynamic cyclic fatigue than the Reciproc and X1 Blue. (EEJ-2022-10-124)

6.Effect of Polydopamine on Bonding Characteristics of Mineral Trioxide Aggregate to Resin Composite
Arumugam Keerthivasan, Kothandaraman Rajkumar, Sampath Vidhya, Sekar Mahalaxmi
PMID: 37257035  PMCID: PMC10244921  doi: 10.14744/eej.2023.73745  Pages 207 - 214
Objective: The success of vital pulp therapy is crucial to preserve the integrity of the teeth and to enable an uninterrupted root formation in a young permanent tooth. This warrants placement of an intact permanent seal immediately in contact with the pulp capping material. Mineral trioxide aggregate (MTA) sets by hydration and deters placement of an immediate permanent resin composite restoration over it. The aim of this in vitro study is to evaluate the wettability, surface morphology and shear bond strength (SBS) of polydopamine (PDA)-pretreated MTA to resin composite (RC).
Methods: The contact angle (CA) and morphological changes caused by self-etch (SE) adhesive on untreated and PDA-pretreated MTA was analyzed using contact angle meter and scanning electron microscope (SEM) respectively. To evaluate SBS, 144 MTA samples were prepared using a custom-made mold of 5 mm diameter and 3 mm height. The samples were randomly divided into two groups of 72 samples each based on whether their surface was pretreated with PDA or not. Under each group, nano-hybrid RC restoration was done either immediately or after a delay of 3 h, 24 h and 96 h. SBS of the MTA/resin composite assembly was tested in a universal testing machine. CA values were analyzed using One-way analysis of variance and Games-Howell Post Hoc test. Mann-Whitney test and Friedman post-hoc Dunn test were used to analyze SBS values.
Results: SE adhesive made a significantly lesser mean CA with PDA-pretreated MTA (27.20°±2.28) compared to untreated MTA (34.22°±1.45, p<0.05). SEM micrographs showed that while etching with SE primer eroded the surface characteristics, PDA coating minimized the erosive effect of the acidic primer and preserved the original crystalline plate-like structure of MTA. At all tested time intervals, PDA pretreatment significantly increased the SBS of MTA to RC, compared to untreated control. Immediate bond strength of PDA pretreated MTA (26.30±7.60 MPa) was equivalent to the SBS value achieved at 96 h with untreated MTA (27.82±2.96 MPa).
Conclusion: Within the limitations of this in vitro study, it can be concluded that PDA pretreatment of MTA surface improved its wettability, prevented loss of surface integrity following etching and increased the SBS of RC to MTA. (EEJ-2022-11-144)

7.The Effect of a Setting Accelerator on the Physical and Mechanical Properties of a Fast-set White Portland Cement Mixed with Nano-zirconium Oxide
Yik Zhen Chen, Ming Jun Yong, Vi Yuan Tan, Stephen Lik Soon Kong, Hoda Mohamed Abdelrazek Elnawawy, Noor Azlin Yahya, Muralithran Govindan Kutty, Hany Mohamed Aly Ahmed
PMID: 37257037  PMCID: PMC10244917  doi: 10.14744/eej.2023.36449  Pages 215 - 224
Objective: This study compared the effects of calcium chloride dihydrate (CaCl2.2H2O) on the physical properties and push-out bond strength of white Mineral Trioxide Aggregate (WMTA) and an experimental Malaysian Portland cement mixed with nano-zirconium oxide (nano-ZrO) [(radiopaque Malaysian Portland cement (RMPC). Mineral Trioxide Aggregate (MTA) was the first calcium silicate cement (CSC) introduced in dentistry, but up to date, it is an expensive cement with long setting time and causes tooth discolouration. Although Portland cement has been introduced as a potential substitute to MTA, it still faces some challenges such as long setting time and lack of sufficient radiopacity.
Methods: Four groups [WMTA, RMPC, fast-set WMTA (FS-WMTA) and fast-set RMPC (FS-RMPC)] were prepared. Initial setting time was evaluated using Vicat apparatus. The pH was measured at seven-day intervals. For discolouration potential, cements were packed in the pulp chamber of 46 extracted maxillary incisors. Spectrophotometric readings were obtained at seven-day intervals, and the rate of colour change (ΔE) was recorded. For the push-out bond strength testing, cements were applied in 48 sectioned root samples, and the test was performed using universal testing machine at crosshead speed of 0.5 mm/min until bond failure. Statistical analysis was done according to the nature of each group of data using SPSS 26.
Results: Addition of CaCl2.2H2O decreased the initial setting times of both RMPC and WMTA significantly (p<0.05). The pH values of FS-WMTA and FS-RMPC were comparable to their non-accelerated counterparts ranging from 10 to 12. Discolouration effect was more obviously observed with WMTA and FS-WMTA with time compared to RMPC formulations. Push-out bond strength of the two materials also showed an increase with the addition of the accelerator, however, only FS-WMTA showed statistically significant difference compared to WMTA (p<0.05).
Conclusion: The addition of CaCl2.2H2O improves the physical and mechanical properties of the newly formulated RMPC and WMTA. The RMPC formulation overcomes the discolouration potential of WMTA. (EEJ-2022-12-155)

8.Evaluation of Dentine Structure Loss after Separated File Retrieval by Three Different Techniques: An Ex-vivo Study
Mohamed Ashraf Abdeen, Gianluca Plotino, Ehab El-sayed Hassanien, Mohammed Turky
PMID: 37257038  PMCID: PMC10244914  doi: 10.14744/eej.2023.37929  Pages 225 - 230
Objective: To evaluate the success rate of retrieving separated instrument, the root canal volume changes using cone-beam computed tomography and the retrieval time using Ruddle's technique, Terauchi file retrieval kit (TFRK) and Endo Rescue kit.
Methods: Sixty human mandibular first molars were selected, and a 4-mm portion of #25/.04 rotary files were separated in the middle third of moderately curved mesio-buccal canals. Teeth were randomly assigned into three groups (n=20): R group, in which separated files were retrieved according to Ruddle's technique; T group, in which separated files were retrieved using TFRK and E group, in which separated files were retrieved using Endo Rescue kit. Values were analyzed using IBM SPSS. Results presented as mean±standard deviation and 95% confidence interval for the root canal volume and time and frequency (%) for success rate. Comparisons of differences in time, canal volume and success rate between groups were assessed.
Results: Retrieval was successful in R and T groups (70% and 80% respectively) without any significant difference between them (p=0.715), while E group hadn’t any successful samples (0.0%) with significant difference compared to R and T groups (p<0.001, p<0.001). E group showed the highest increase in canal volume followed by R group, while T group exhibited the lowest increase in canal volume. There was no significant difference in the mean retrieval time between R and T groups (p=0.815).
Conclusion: TFRK provides a more conservative way for retrieval of separated instrument from the middle third of moderately curved canals. (EEJ-2023-01-01)

9.The Biomechanical Behaviour and life span of a Three-Rooted Maxillary First Premolar with Different Access Cavity Designs: A Finite Element Analysis
Nehal Alshazly, Nawar Naguib Nawar, Gianluca Plotino, Shehabeldin Saber
PMID: 37257033  PMCID: PMC10244916  doi: 10.14744/eej.2023.07078  Pages 231 - 236
Objective: The present study aimed to evaluate the influence of different access cavity designs on the biomechanical behaviour of a three-rooted maxillary first premolar using finite element analysis (FEA).
Methods: Three experimental FEA models were generated: the intact tooth (IT) model, the traditional access cavity (TAC) model, and the conservative access cavity (CAC) model. In both TAC and CAC models, root canals preparation was simulated as follows: the mesiobuccal and distobuccal canals with a final tip size of 30 and taper of 0.04 and the palatal canal with a final tip size of 35 and taper of 0.04. Cyclic loading of 50 N was simulated on the occlusal surface of the three models. The number of cycles until failure (NCF), the location of failure, stress distribution patterns, maximum von Mises (VM), and maximum principal stress (MPS) were all evaluated and compared.
Results: Both types of access cavity preparation caused a reduction in the lifelog of the tooth; when compared to the IT model the TAC model had a lifelog of 94.82% while the CAC model had a lifelog of 95.80%. The maximum VM stresses value was registered on the occlusal surface of the TAC model (7 MPa), while the minimum was on the occlusal surface of the IT (6.2 MPa). MPS analysis showed that the highest stress value was recorded on the occlusal surface of the CAC model (7.71 MPa), while the least was recorded on the occlusal surface of the TAC model (3.77 MPa). Radicular stresses were always of minimal value regardless the model.
Conclusion: The relation between the access cavity margins and the functional load points is a deciding factor that influences the biomechanical behaviour and fatigue life of endodontically treated teeth. (EEJ-2023-01-03)

10.Endodontic Advances and Evidence-based Clinical Guidelines
Edgar Schäfer
PMCID: PMC10244913  Pages 237 - 238
Abstract |Full Text PDF

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