The use of propolis-based materials within endodontics to promote pulp wound healing or disinfect the root canal system has been a recent focus of scientists and clinicians. This is mainly because of the well-documented antimicrobial, anti-inflammatory, immunomodulatory and wound healing properties of propolis. This scoping re-view critically appraises the literature on the clinical applications of propolis-based compounds during endodon-tic therapy of primary and permanent teeth. An electronic literature search was performed in Scopus, PubMed, and Web of Science up to and including October 2023 to identify studies assessing the use of propolis during en-dodontic therapy of primary and permanent teeth. A combination of relevant Medical Subject Headings (MeSH) terms and keywords was used. Only human clinical studies written in English were included. The identified manuscripts were screened and assessed for inclusion by two independent authors. Eligible manuscripts were then subjected to critical appraisal and data extraction with the information being summarised according to their clinical application. A total of 26 human clinical studies were identified and included in the analysis. Propolis was investigated for use in the primary and permanent dentitions as a direct pulp capping or pulpotomy material as well as in root canal disinfection and root canal filling material of teeth with non-vital pulps. Overall, the included studies reported that the use of propolis was associated with promising outcomes in terms of efficacy to control inflammation, enhance tissue repair, and disinfection of the root canal system. However, a critical appraisal of the studies revealed a range of methodological and reporting deficiencies, resulting in unreliable results and con-clusions in terms of the clinical outcomes reported. Although the studies on the use of propolis-based materials in endodontics reported promising clinical outcomes, they had a range of methodological and reporting flaws. Therefore, further well-designed and properly reported controlled clinical studies are essential to derive sound evidence-based conclusions on propolis-based materials. Furthermore, guidelines for quality assurance and safe use of propolis-based materials are necessary to enhance their production for commercial use in endodontics.

Objective: To compare treatment success and discolouration of the permanent posterior teeth treated with vital pulp therapy (VPT) using mineral trioxide aggregate (MTA), irrigated with sodium hypochlorite (NaOCl) or normal saline solution.
Methods: A randomised non-inferiority trial was conducted. One hundred and twenty-five teeth that met the inclusion criteria were randomised to each irrigant, 65 in the NaOCl and 60 in the NSS groups. ProRoot® MTA was used as a pulp dressing material in both groups and teeth were followed for 12 months. The pri-mary outcome was the success of VPT; requiring both clinical and radiographic success to be considered as success. The hypothesis of the primary outcome of this study was that the absolute difference of VPT success in the NSS group was not worse than that in the NaOCl group, by a margin of 5%. The hypothesis of the secondary outcome was that the NSS group would have a lower percentage of discolouration com-pared to the NaOCl group.
Results: Using a per protocol analysis, the absolute difference of VPT success between the NSS and NaOCl groups was 2.08% (95% CI: -1.95, 6.1). Perceptible grey discolourations were 80% and 63% in NaOCl and NSS groups (difference -17%; 95% CI: -40.0, 6.2; p=0.15).
Conclusion: For MTA-VPT procedure, irrigation with NSS was not worse than that with NaOCl. However, NSS did not lower the percentage of discolouration as discolouration was found in both irrigant groups.

Objective: Childhood experiences of pain associated with dental treatment can induce dental anxiety. Infe-rior alveolar nerve blocks are eight times more likely to fail in patients with irreversible pulpitis. The objective was to compare the effectiveness of lignocaine with and without pre-operative oral ibuprofen for controlling pain in primary mandibular molars scheduled for pulpectomy procedures in 5 to 9-year-old children.
Methods: One hundred and twenty-two children diagnosed with irreversible pulpitis in mandibular posterior teeth and scheduled for pulpectomy procedures were included. The children were assigned to one of the two groups, Treatment group A: Pre-operative with oral ibuprofen and local anaesthesia with 2% lignocaine (with adrenaline 1: 80000); Treatment group B: Pre-operative with oral placebo and local anaesthesia with 2% ligno-caine (with 1: 80000 adrenaline). Pain and pulse rate were recorded at baseline, one hour after administration of oral medication, fifteen minutes following administration of Inferior Alveolar Nerve Block (IANB), and also during the course pulpectomy. The results were statistically analysed using chi square test and repeated mea-sures analysis of variance (ANOVA).
Results: In treatment group A, 90.16% children had IANB success compared to 9.83% in group B.. The differ-ence in the success rate between two groups was statistically significant (p<0.001) with an odds ratio of 84.
Conclusion: Oral medication with ibuprofen is effective in increasing the success rate of IANB with lignocaine for the treatment of irreversible pulpitis of 5 to 9-year-old children.

Objective: This study aimed to compare the effectiveness of lidocaine with magnesium sulphate in patients undergoing root canal treatment following irreversible pulpitis.
Methods: A total of 86 patients were randomised to receive 1.8 ml of 2% lidocaine replaced with 0.2 ml of 10% magnesium sulphate with 1: 80,000 epinephrine (n=43) as MGS group and 1.8 ml of 2% lidocaine with 1: 80,000 epinephrine (n=43) as LDC group. Preoperative visual analogue scale (VAS) pain scores were record-ed. Patients were instructed to report any perioperative pain felt during the access cavity preparation and when introducing the first patency file (#10 k) in the root canal and perioperative VAS recorded.
Results: The success rate of the inferior alveolar nerve block (IANB) was higher in the MSG group. The mean±SD of perioperative pain was 0.16±0.37 in the MSG group and 3.13±0.77 in the LDC group. The MGS group produced better anaesthetic efficacy with a p-value of 0.01.
Conclusion: Based on the results, adding 10% magnesium sulphate to 2% lidocaine increased the effective-ness of IANB in patients with symptomatic irreversible pulpitis of mandibular molar teeth.

Objective: To compare the effect of pre-treatment transdermal and oral diclofenac on post-endodontic pain level and oral health-related quality of life (OHRQOL) in patients with symptomatic irreversible pulpitis with apical periodontitis in mandibular molars following single visit root canal treatment.
Methods: This parallel-arm, randomised, double-blinded clinical trial is reported according to the Consoli-dated Standards of Reporting Trials (CONSORT) 2020 guidelines. The protocol was approved by the Institu-tional Ethical Committee on 30th March 2021 (MADC/IEC-I/029/2021) and registered at the clinical trial reg-istry of India (CTRI/2021/12/038696). Adult patients fulfilling the eligibility criteria were randomised into two groups. Group DTP received a diclofenac transdermal patch 100 mg, and Group DOT received a diclofenac oral tablet 100 mg one hour before root canal treatment. Pain scores were checked at baseline, 2, 4, 6, 8, 24, 48, and 72 hours after the treatment. OHRQOL was assessed at baseline and one week after the treatment.
Results: Both groups were associated with a significantly lower incidence of post-operative pain and im-proved OHRQOL. At 2 hours, the pain level was significantly lower with an oral diclofenac tablet, and at 24 hours, the pain level was significantly lower with a diclofenac transdermal patch. Regarding OHRQOL, there was no significant difference between the two groups.
Conclusion: Within the limitations of this study, the diclofenac transdermal patch had lesser post-operative pain at 24 hours, whereas the oral diclofenac tablet had lesser pain at 2 hours.

Objective: This study aimed to address the lack of comparative analyses of newly developed bioceramic materials by examining the chemical composition, thermodynamic profile, and microscopic surface features of three bioceramic putties: EndoSequence BC Root Repair Material Fast Set Putty (ESRRM-FS), BIO-C Repair (BCR), and Cera Putty (CP).
Methods: Samples of each of the three bioceramic putty obtained directly from manufacturers were prepared for analysis of physicochemical composition and microscopic features by differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), scanning electron microscopy (SEM) imagery, and energy-disper-sive X-ray spectroscopy (EDS). The data obtained was qualitatively and statistically analysed. Statistical signif-icance was determined at p≤0.05.
Results: DSC analysis indicated a standard polymeric vehicle for BCR and CP, coinciding with the polyethene glycol (PEG) thermal profile; the polymeric vehicle in ESRRM-FS remains to be identified. The material with the highest heat capacity was CP (p<0.05), followed by ESRRM-FS and BCR. TGA revealed an inflexion point at 394.12 ºC for ESRRM-FS, which may correspond to the mass loss of dihydroxylation of calcium hydroxide. A more homogenous structure was observed in scanning electron microscopy (SEM) images for ESRRM-FS. EDS analysis indicated BCR had minimal amounts of aluminium (2.06±0.44%) and a lower percentage of cal-cium than ESRRM-FS (9.11±1.38% vs. 11.3±0.87%). CP was composed of aluminium (49.35±7.01%), carbon (30.65±5.62%), and oxygen (16.75±2.44%); no silicon was identified. ESRRM-FS had no aluminium present and the highest calcium percentage (11.3±0.87%) (p<0.05).
Conclusion: BCR is a Portland cement-derived material with a lower percentage of calcium than ESRRM-FS and minimal amounts of aluminium. CP is a monocalcium aluminate cement, mainly composed of aluminium, carbon, and oxygen. ESRRM-FS is a biphasic material with the highest calcium percentage among all materials studied and no aluminium.

Objective: Post-endodontic pain (PEP) after endodontic treatment (ET) might be reduced by adding cortisone to the composition of root canal sealer (RCS). This study aimed to test this hypothesis using grade A methodology.
Methods: A multicentric prospective randomised controlled clinical trial was performed in general practice. Adult patients with an indication of ET in a molar or premolar performed in one session were included be-tween 2021 and 2022 in 15 centres. The main objective was to demonstrate the superiority of Endomethasone N RCS (EndoN), compared to its hydrocortisone-free equivalent Endomethasone SP RCS (EndoSP), regarding the reduction of the maximum spontaneous PEP pain during the 7 days following the ET, self-estimated on a 0–100 mm Visual Analogic Scale (VAS). The secondary objectives were to assess 1) spontaneous PEP, 2) pro-voked (masticatory) PEP, 3) intake of analgesics, 4) quality of life and anxiety before and after ET, and 5) safety.
Results: The final sample consisted of 286 patients with a mean age of 47.7 years, including 51% men and 49% women. Before ET, 49.7% of the teeth were asymptomatic; provoked pain occurred in 29.4% and sponta-neous pain in 21.0%. The study evidenced a lower maximum spontaneous PEP intensity during the 7 days fol-lowing ET in EndoN compared to the EndoSP group (13.5±17.9 vs 23.9±26.6, IC 95% 10.5 [5.2–15.8], p=0.0001 Wilcoxon test). Maximal masticatory PEP was also lower in the EndoN group (12.3±19.1 vs 24.0±27.8, IC 95% 11.7 [5.8–17.6], p<0.0001 Wilcoxon test). At every evaluation time, the masticatory PEP in the EndoSP group was higher than in the EndoN group. In addition, no serious adverse events occurred during the study.
Conclusion: This RCT demonstrated EndoN’s superiority over EndoSP in reducing spontaneous and mastica-tory PEP during the 7 days following ET. This study was funded by the Septodont company (Saint Maur des Fossés, France) and registered at ClinicalTrials.gov # NCT04885686.

Objective: This study investigated the effect of static and dynamic conditions on the solubility of three en-dodontic sealers: AH Plus (an epoxy-resin-based sealer), Bio-C Sealer (a bioceramic sealer), and EndoSequence BC (a bioceramic sealer).
Methods: Plastic moulds were used to create 150 specimens, which were divided into three groups, with each group being filled with one of the three sealers. After the setting time, the specimens were removed from the moulds, dried, and weighed. Thirty specimens from each group were subdivided into three subgroups and stored in distilled water for 30, 60, or 90 days, while the remaining 20 specimens in each group were subdivid-ed into four subgroups and subjected to 0, 20, 50, or 100 thermocycling cycles. After storage time and thermo-cycling, the specimens were reweighed, and the weight loss and solubility percentage were calculated. The data were analysed using one-way ANOVA, Post Hoc Tukey, and Pearson correlation tests (p<0.05).
Results: The results showed that AH Plus had the lowest solubility, followed by EndoSequence BC and then Bio-C Sealer (p<0.0001). Both static and dynamic conditions had a negative effect on the solubility of all tested sealers, with the effect being more pronounced in bioceramic sealers. The increase in storage days and the number of thermocycling cycles were significantly correlated with the increasing solubility levels of all tested sealers (p<0.0001).
Conclusion: The increased solubility of endodontic sealers may have a negative impact on long-term treat-ment outcomes. Both static and dynamic conditions can affect the solubility of endodontic sealers.

Objective: This study aimed to evaluate the bacterial reduction effect of disinfection protocols used in mandibular molars infected by Enterococcus faecalis.
Methods: Eighty extracted mandibular molars were prepared and inoculated with E. faecalis for 2 months. The teeth were then divided into 2 control groups (n=4) and 4 experimental groups (n=18) according to the disin-fection protocol utilized: G1. WaveOne Gold (WOG), passive ultrasonic irrigation (PUI) and Ultracal; G2. WOG, PUI and calcium hydroxide (CH); G3. WOG, XP-Endo Finisher (XPF) and Ultracal; G4. WOG, XPF and CH. Bac-teriological samples were collected previously (S1), after preparation (S2), final agitation (S3) and intracanal dressing (S4). Microbial growth was assessed according to culture turbidity and UV spectrophotometry. Statis-tical analyses used the Friedman test for paired samples and Kruskal-Wallis test for non-paired data (p<0.05).
Results: No protocol eliminated E. faecalis effectively. The S2, S3 and S4 samples were statistically different from the S1 samples in G1, G2, G3 and G4 (p<0.05). Statistical differences were observed in bacterial reduction between G1 and G2 and G1 and G3 after the intracanal medicament (S4) (p<0.05).
Conclusion: The combination of WOG with PUI and CH disinfection protocol showed higher percentages of bacterial reduction.

Objective: The aim of this in vitro study was to assess the stress distribution of novel endodontic rotary files of different cross sections and metallurgy against the root canal wall at three different levels by using finite element analysis.
Methods: A total of 60 novel NiTi rotary files were included in this study after being scanned for any sur-face deformities using a scanning electron microscope. The scanned files were assigned into 4 groups of 15 samples each based on their metallurgy and design: Group A-TruNatomy, Group B-XP-endo Shaper, Group C-F360, and Group D-2shape files. ANSYS® 15 Workbench finite element software (Canonsburg, Pennsyl-vania, United States) was used to numerically analyse the stress created by computer-aided models of these instruments on the dentinal wall of a simulated root canal to test the mechanical behaviour of these files. All data were analysed using one-way ANOVA with post hoc Tukey analysis, the Shapiro Wilk test, and Levene's test. The significance level was set at 5%.
Results: XP-endo Shaper files employed minimal stress on the surface of dentine during instrumentation, and F360 files exerted maximum stress on the dentinal wall. However, no statistically significant difference was found among the groups in relation to the amount of stress produced at the distinct levels of the root canal wall (p>0.05).
Conclusion: There was no discernible difference in stress generation among the four groups in the current investigation. Therefore, it can be inferred that the upgrade in design and metallurgy of rotary files has the potential to downgrade the stress during the shaping of the canal and the menace of instrument breakage during their clinical usage.

Objective: This study aimed to assess the treatment quality factors associated with the risk of radiographic detection of apical periodontitis (AP) in root-filled teeth (RFT) on CBCT images.
Methods: Two hundred eighty-five CBCT scans of patients (range 18-60, mean 35.1) years old were selected from a pool of CBCT scans which were taken from 2016-2022. Gender and age were recorded. The presence/absence of AP, unfilled canal, perforation, zipping and ledge and homogenous/nonhomogeneous root canal filling (RCF), adequate/inadequate coronal restoration and under/over filled RCF and those within 0-2 mm from the radiographic apex were recorded for RFTs. Kappa was used to assess intra-consensus reliability. Chi-square and Binary logistic regression were used to assess and predict risk factors related to the detection of AP. A significant difference was set at p<0.05.
Results: AP was present in 81.5% of RFTs. No significant difference was present in the AP prevalence in RFT between males and females, maxilla and mandible, right and left sides, RFT with adequate and inadequate coronal restoration and RFT with/without zipping and ledge and between RFT with overfilled and those with RCF end within 0-2 mm from the radiographic apex (p>0.05), respectively. Significantly higher AP prevalence was present in RFT with unfilled canal, perforations, non-homogenous and underfilled RCF (p<0.05), respec-tively. The odds of AP detection were 2.02, 5.5, 2 and 1.98 times higher in RFT with unfilled canal, perforations, non-homogenous and underfilled RCF, respectively. Intra-consensus reliability was (0.98, 0.95, 0.85, 0.81, 0.88, 0.85 and 0.92) for AP, unfilled canal, perforation, zipping and ledge, homogeneity of RCF, coronal restoration and length of RCF, respectively.
Conclusion: The vast majority of teeth with previous root fillings presented with AP. AP detection risk was significantly higher in root-filled teeth with perforation, non-homogeneous, and underfilled root canal filling. Other factors do not influence the radiographic detection of AP in CBCT images.

Objective: L-arginine is a semi-essential amino acid produced by the body which has an important role in the process of stem cell regeneration. However, under inflammatory conditions, denaturation of pulp amino acids and proteins occurr resulting in a decrease in the ability of stem cells to self-renew. Therefore, in this study, L-arginine was added in vitro to the culture media Dulbecco’s Modified Eagle Medium – (DMEM) of human dental pulp stem cells (hDPSCs) to analyse the potential of L-arginine on migration and proliferation by comparing between 3 concentrations, namely 300, 400, 500 μmol/L and control group (DMEM), to obtain the most optimal concentration for proliferation and migration.
Methods: Serum-starved hDPSCs were divided into four groups: control: hDPSCs in DMEM; hDPSCs in 300 μmol/L of the L-Arginine based culture media group; hDPSCs in 400 μmol/L of the L-Arginine based culture media group; and hDPSCs in 500 μmol/L of the L-Arginine based culture media group, which were added in two separate 24-well-plates (5×104 cell/well) for proliferation and migration evaluation. The proliferation of all groups was measured by using a cell count test (haemacytometer and manual checker) after 24 h. The migratory speed rate of all groups was measured by using cell migration assay (scratch wound assay) after 24 h. Cell characteristics were evaluated under microscope that was then evaluated using image-J® interpretation. This image J represented the measurement of migratory speed rate (nm/h) data. Statistical analysis was conducted using one-way ANOVA and post hoc Bonferroni (p<0.05) for proliferation and post hoc LSD (p<0.05) for migration.
Results: There was a statistically significant difference in hDPSCs proliferation among various concentration groups of the L-Arginine based solution (300, 400 and 500 μmol/L) compared to the control group (p<0.05). There was a statistically significant difference in the migratory speed rate of hDPSCs at 500 μmol/L of the L-Arginine based solution group compared to lower concentrations and control group (p<0.05).
Conclusion: All three concentrations of L-arginine can induce proliferation of hDPSCs. L-arginine at 500 μmol/L can induce higher hDPSCs proliferation and faster migration at 24 hours compared to lower concen-trations and control.

Objective: Determining the working length (WL) in root canal treatment facilitates the treatment prognosis. The introduction of apex locators and new devices in dentistry influenced this consideration. This compar-ative study evaluated the accuracy of working length measurement by cone beam computed tomography (CBCT) in three fields of view (FOVs), conventional radiography, and the apex locator Raypex 5.
Methods: The descriptive-analytical study was performed on 40 mandibular premolar teeth that met the inclusion criteria. Direct observation under the microscope was considered the gold standard and compared with measurements by the electronic apex locator, CBCT at three field of view settings and periapical images. The results were analyzed by paired t-tests and Wilcoxon tests. The level of significance was set at 0.05 (p=0.05).
Results: Results showed that the CBCT at 5×5 FOV (p=0.733) and Conventional radiography(p=0.001) achieved the working lengths with the highest and lowest accuracy, respectively. In addition, the difference between actual and measured working length using conventional radiography was significant (p<0.05).
Conclusion: According to the results of this study, CBCT images at different FOVs and those taken by the apex locator Raypex 5 can be used as a reliable method for estimating the working length.

Objective: Extended reality (XR) technology using head-mounted devices enables the operator to visu-alise anatomical structures. We aimed to investigate student perceptions regarding applying XR simu-lation for transferring endodontic educational information between a lecturer in Japan and students in Saudi Arabia.
Methods: In this study, the students engaged with an XR simulation system and viewed teeth in virtual reality (VR). Pictures of dental anatomy were shown in the VR space, allowing participants to manipulate them. Then, the participants viewed a patient-specific three-dimensional printed model and three-dimensional root canal access guide in a second VR area. Before the sessions, the students completed a questionnaire on demograph-ic data and information concerning their VR experience. After the sessions, they completed a questionnaire evaluating the XR simulation system. The questionnaire included questions on dental anatomy, root canal access, usability, emotional impression, and data transfer.
Results: Eleven 5th-year dental students, comprising six male and five female students, were enrolled; three of them had previous VR experience, whereas eight did not. The highest levels of satisfaction were noted in the tooth anatomy (4.6±0.4) and emotional impression (4.5±0.5) domains, whereas the lowest level was noted in the data transmission domain (3.5±0.9). Female participants and those without previous VR experience reported higher satisfaction levels across questionnaire domains compared to male participants and those with previous VR experience.
Conclusion: XR can be successfully used in dental education and integrated into online lectures. Restrictions on education caused by health crises can be averted by using XR. Further, fifth-generation networks can offer better data transmission than wireless fidelity.

Objective: Syringe irrigation, commonly used for delivering sodium hypochlorite (NaOCl) during root canal treatment, requires careful handling to prevent NaOCl extrusion into periapical tissues. This randomised con-trolled in vitro study aimed to quantify syringe plunger forces exerted by dental undergraduates and to assess the impact of an educational intervention on adherence to safe irrigant delivery parameters.
Methods: Fifty-two undergraduates performed syringe irrigation at three intervals: baseline (T1), af-ter two weeks (T2), and after 12 weeks (T3). At T1, irrigation was conducted without prior educational intervention, while at T2, it was preceded by an intervention. The educational intervention involved a short video highlighting safe irrigation practices, including plunger force and time recommendations for syringe irrigation. At T3, the undergraduates were randomly allocated to two groups: One received a repeated intervention, while the other did not. Syringe irrigation was performed on a 3D-printed tooth using two side-vented cannulas: one of 25 Gauge (G) and another of 30 G. A syringe equipped with a force sensor recorded the plunger forces. Based on earlier research, plunger forces exceeding 10 Newtons (N) for the 25 G cannula and 40 N for the 30 G cannula were deemed critical. The data were subjected to descriptive statistical analyses.
Results: Overall, the mean of maximum values of plunger forces remained under 10 N for the 25 G and below 20 N for the 30 G cannulas, with only a few measurements exceeding 40 N. Instances of surpassing the critical plunger force threshold were more common with the 25 G side-vented cannula than with the 30 G variant. At T3, the group that received the repeated educational intervention exhibited lower average maximum plunger forces for both cannulas than the group that did not receive the intervention.
Conclusion: Integrating plunger force measurements with targeted educational interventions presents an effective approach for instructing undergraduates in the proper techniques of syringe irrigation. The findings suggest that, generally, undergraduates do not apply excessive plunger forces that could risk apical irrigant extrusion. Implementing repeated educational interventions decreased the plunger forces exerted by under-graduates, underscoring its effectiveness in fostering safe endodontic irrigation.

This is a series of 7 cases in which the operator penetrated lateral canals with instruments. Two teeth present-ed with irreversible pulpitis, 4 with necrotic pulps, and 1 with previous treatment. Except for the teeth with pulpitis, all the others were associated with apical periodontitis. The main root canal was always relatively straight, with the lateral canals at the middle third of the root. Suggestive images of lateral canal presence were seen on periapical radiographs in five cases. The clinician introduced intentionally small hand instru-ments in the lateral canal in 5 cases, while the penetration was fortuitous in the others. The lateral canals were filled in all cases. Follow-up examination was possible in five cases, all of them showed evidence of successful clinical and radiographic outcomes. Introducing files into lateral canals may permit some preparation and penetration of irrigant solution, favoring disinfection and, consequently, enhancing the treatment outcome.