Journal of the American Heart Association

Abstract Introduction: The successful outcome of endodontic retreatment heavily relies on the thorough removal of root canal filling materials. This study aimed to quantitatively and qualitatively assess the efficacy of various retreatment file systems using nano-computed tomography (nano-CT) imaging. Materials and Methods: Thirty recently extracted human mandibular molars with mesial roots having curvatures <20° were chosen and sectioned to 16 mm in length. The root canals were prepared with the ProTaper Gold system up to size F2 and they were filled with gutta percha and AH Plus sealer. After obturation, all the samples were randomly assigned to two groups (n = 15 each) for retreatment: Group 1 utilized Solite RE Black retreatment files, while Group 2 employed Coltene HyFlex Remover files. Nano-CT imaging was employed to measure pre- and postoperative volumes of remaining filling material and remaining dentin thickness and the time taken for retreatment was measured in seconds. The obtained values were analyzed statistically (P < 0.05). Results: Nano-CT analysis showed a significant difference (P < 0.05) in the volume of remaining filling material between the Solite RE Black and Coltene HyFlex Remover groups. However, no significant difference was observed in the time required for gutta-percha removal. The Solite RE Black system showed comparatively less dentin removal than the Coltene HyFlex Remover system (P < 0.05). Conclusion: The Solite RE Black retreatment file system demonstrated promising efficacy in removing filling material while preserving dentin integrity compared to the Coltene HyFlex Remover system. These findings support its potential as an effective tool for endodontic retreatment, emphasizing the need for further clinical trials to validate its performance across various clinical scenarios.

Abstract Introduction: The advancement of artificial intelligence (AI) has revolutionized digital communication, enhancing interactions between humans and computers. This study explores the application of Chat Generative Pretrained Transformer 3.5 (ChatGPT-3.5), in providing accurate information on dental trauma. Materials and Methods: Utilizing a dataset of 45 self-generated questions across three topics, general dental trauma, avulsion, and intrusion, ChatGPT-3.5 generated responses that were subsequently evaluated by five endodontic experts, each with over a decade of experience. The evaluators used a Likert scale to assess the quality of the AI-generated answers, synthesizing reliable scientific evidence and clinical expertise to ensure a thorough analysis. The data obtained from the evaluators’ scores were organized and analyzed using Microsoft Excel software and the Statistical Package for the Social Sciences version 25. For each question, descriptive statistics including the median and interquartile range were computed. Results: The study found that ChatGPT provided reliable information across the three assessed dental topics. Avulsion was rated the highest (4.40 ± 0.717), significantly outperforming general dental trauma (3.97 ± 0.885) (P = 0.005). Intrusion received a rating of 4.13 ± 0.794, showing no significant difference compared to the other topics. Most evaluator scores fell into the “Good” (44.0%) and “Very Good” (38.7%) categories. This indicates a generally positive appraisal of ChatGPT’s performance, with a fair agreement among evaluators, evidenced by a combined Fleiss’s kappa coefficient of 0.324. However, there was variability, particularly with Evaluator 4’s scores differing significantly from those of evaluators 1 and 2. Conclusions: ChatGPT’s responses on general dental trauma, avulsion, and intrusion were generally rated positively, with avulsion responses deemed the most reliable. The study underscores the need for continuous evaluation to maintain the accuracy, reliability, and safety of AI-generated content in endodontics, suggesting AI should serve as a supplementary tool rather than a primary information source.

Abstract Introduction: This study investigated the agreement between students’ self-assessment or peer assessment and faculty assessment of the quality of root canal treatment (RCT) performed during preclinical and clinical endodontic courses. Materials and Methods: This cross-sectional study enrolled 23 4th-year students and a faculty member from the University of Medical Sciences and Technology, Sudan. The radiographic technical quality of RCTs performed during preclinical and clinical endodontic courses was evaluated by the students themselves, their peers, and faculty members in terms of the obturation length, shape, and density. Paired Student’s t-test was used to compare self-peer and faculty assessments. P < 0.05 was considered indicative of statistical significance. Results: No statistically significant differences were observed among the three assessment groups in terms of the quality of RCTs performed during the preclinical course. However, statistically significant differences were observed between self- and peer assessments (P = 0.014), and between self- and faculty assessments (P = 0.005), which may be attributable to lower confidence among students when working on real patients, leading to lower self-assessment scores. Conclusion: Significant differences were observed between self- and peer assessments and faculty assessments in the quality of RCT performed during the clinical course, with students underrating their performance. Formative assessment of learning rather than summative assessment, during endodontic courses, is recommended at the end of academic year.

Abstract Persistent pain after endodontic treatment is often associated with evidence of periapical pathology. Nonetheless, this case report presents two instances of persistent pain in maxillary premolars post root canal treatment (RCT), without evident periapical radiolucency on imaging. A 35-year-old Asian female experienced dull, aching pain on biting in tooth #25, whereas a 40-year-old Caucasian female reported similar symptoms in tooth #15. Both teeth showed tenderness to percussion but not palpation. Periapical radiographs and cone-beam computed tomography (CBCT) scans revealed completed RCT with apical transportation but no detectable periapical pathology. Thus, both teeth were diagnosed as previously treated with symptomatic apical periodontitis. Non-surgical retreatment successfully addressed untreated canal spaces, resolving symptoms. This report suggested persistent pain following RCT might stem from endodontic reasons, even in the absence of visible apical pathology on CBCT scans, highlighting the importance of thorough canal debridement to resolve symptoms associated with untreated canal spaces in apical transportation. Furthermore, this case report demonstrates that clinicians should make a diagnosis through thorough dental history and other clinical investigations, without relying solely on CBCT for the diagnosis of posttreatment endodontic pain.

Abstract In the field of endodontics, the management of complex resorptive lesions demands innovative and precise interventions. This report delineates the comprehensive management of two distinct cases, each presenting unique challenges. The first case involved a 23-year-old male with hypothyroidism, presenting with pain and external cervical resorption with internal communication in his lower left front tooth. The case was diagnosed with pulp necrosis and asymptomatic apical periodontitis. The second case involved a 26-year-old female in good health, dissatisfied with the cosmetic appearance, and experiencing occasional pain from a previously treated upper front tooth with concurrent external apical and internal resorption. It was diagnosed as previously treated, with symptomatic apical periodontitis. These cases were notable for their complexity and the tailored approach to diagnosis and treatment, employing advanced techniques and materials, such as bioceramic materials, for optimal outcomes. The first case was approached through conventional endodontic disinfection, flap reflection, and the meticulous external management of the resorptive defect with bioceramic material, followed by restorative procedures. The second case required retreatment, including wide canal management, apex negotiation, and the establishment of an apical plug with bioceramic material, culminating in backfilling with thermoplasticized gutta-percha and subsequent prosthetic rehabilitation. Remarkably, both cases demonstrated successful healing and patient satisfaction at a 6-month follow-up, with radiographs and photographs evidencing the desired clinical outcomes. This report highlights the necessity of adaptability, precision, and the integration of innovative materials and techniques in endodontic practice to effectively address complex resorptive lesions. It underscores the significance of a comprehensive diagnostic and treatment framework that can guide clinical decision-making and enhance procedural outcomes in similar challenging scenarios. It contributes valuable insights and reinforces the imperative of detailed management in endodontic complexities.

Abstract Nanotechnology in modern endodontics involves manipulating materials at the nanoscale to improve dental treatments, disinfection, imaging, and tissue engineering. This narrative review aims to evaluate the impact and applications of nanotechnology in modern endodontics, focusing on advancements in materials, disinfection processes, imaging techniques, and tissue engineering while addressing associated challenges and safety concerns. A comprehensive literature search was conducted in March 2024 across PubMed, SCOPUS, EMBASE, COCHRANE Library, and Science Direct databases using MeSH terms/keywords such as “Nanotechnology,” “Endodontics,” “Disinfection,” and “Dental Tissue Engineering.” Articles published from March 2010 to March 2024 were considered, with inclusion criteria focusing on studies relevant to the objectives. From an initial pool of 774 articles, 86 were selected based on titles and abstracts, and 45 were shortlisted after full-text evaluation. The review highlights significant advancements in nanotechnology in endodontic materials, disinfection methods, imaging techniques, and tissue engineering. Nanomaterials have improved the efficiency, precision, and biocompatibility of dental treatments. However, challenges such as long-term biocompatibility, standardization of applications, and patient safety remain to be addressed. Continuous research, ethical practices, and regulatory oversight are crucial for integrating nanotechnology into endodontics. While nanotechnology offers promising advancements in endodontics, ongoing research and collaboration among researchers, clinicians, and regulatory bodies are essential to harness its full potential and ensure patient safety. Limitations of this review include potential biases in article selection and the evolving nature of nanotechnology research.

Abstract Introduction: The aim of this study is to investigate the effectiveness of cone-beam computed tomography (CBCT) reverse contrast images in the diagnosis of vertical root fractures (VRFs). Materials and Methods: In this study, 20 single-canal premolar teeth without cracks and internal resorption were selected and after root canal treatment, divided into two: experimental and control groups. In each of the teeth in the experimental group, an artificial fracture was created with the SANTAM device, then the teeth of both groups were randomly placed in the dental sockets of a dry mandible, and after preparing CBCT images of the teeth, the images were processed by reverse contrast software. Initial and reverse contrast images were examined by two radiologists and two endodontists. The data were analyzed by SPSS software version 22. Results: Observers reported higher sensitivity and positive and negative predictive value in normal contrast images than in reverse contrast images, but the specificity reported by endodontists in reverse contrast images was slightly higher than in normal contrast images. In comparing the results of radiologists and endodontists, there was a significant agreement in the review of the initial images (κ =0/59), but there was no significant agreement in the images with reverse contrast (κ = −0/1). There was not any notable distinction observed in the assessment of normal and reverse contrast images among the observers, nor in the comparison between radiologists and endodontists, except for the examination of normal contrast images by the two groups of radiologists and endodontists (P = 0.00). From this, it can be inferred that the diagnostic power of reverse contrast images in identifying VRFs is inferior to that of normal contrast images (P > 0.05). Conclusion: According to the obtained results, it was concluded that reverse contrast CBCT images are not effective in diagnosing VRFs and cause error in diagnosis.

Abstract Introduction: Silver nanoparticles (AgNPs) have garnered significant attention for their potent antibacterial properties, making them promising candidates for use as root canal irrigants in endodontics. The persistent presence of Enterococcus faecalis in treated root canals often leads to endodontic failures. This study aimed to evaluate the effectiveness of neem-synthesized AgNPs, chemically synthesized AgNPs, sodium hypochlorite (2.25%), and saline solution in reducing viable bacteria and removing smear layers in E. faecalis-infected mandibular premolar teeth. Materials and Methods: After decoronation, mandibular premolar, single-rooted, teeth (120) were instrumented until ProTaper Gold F3. In all samples, inoculation of E. faecalis was done and divided into four groups depending on the irrigating solution used into Group A: neem-synthesized AgNPs, Group B: chemically synthesized AgNPs, Group C: sodium hypochlorite (2.25%), and Group D: saline solution. After irrigation, roots were divided longitudinally and analyzed for confocal laser scanning microscopy and scanning electron microscopy. Data were statistically analyzed using Tukey’s honestly significant difference test. Results: The minimum reduction in live bacteria percentage was seen in Group C rather than Groups A and B; although there was no significant difference between them. Group D showed the maximum percentage of live bacteria and a greatest score of smear layer compared to other groups. In contrast to Group B, Group A scored higher, although the results were nonsignificant. Group C showed the least score of smear layer presence. The P value between the experimental groups was found to be <0.05, indicating statistical significance. Conclusion: Both neem-synthesized AgNp and sodium hypochlorite irrigants reduced the proportion of viable bacteria most significantly. This work demonstrates the possibility of employing nanoparticles as an irrigant that can effectively remove smear layers while also acting as an antimicrobial.

Abstract A thorough understanding of the root canal systems of various human teeth can facilitate successful root canal treatment. The mandibular canines typically have one root and one canal. Mandibular canines with two roots are uncommon. This case report describes the examination of occlusion erosion and deep caries that had reached the pulp chamber in the mandibular canine of a 56-year-old healthy Saudi female patient referred to the endodontic clinic for evaluating the left mandibular canine. Radiographic evaluation revealed a widening of the periodontal ligament and periapical radiolucency and the presence of two roots. Two roots with two root canals were observed on cone-beam computed tomography. The tooth responded to a sensitivity test and was tender upon percussion and palpation. Symptomatic irreversible pulpitis and symptomatic apical periodontitis diagnosis were established, and nonsurgical root canal treatment was performed using a dental operating microscope. At follow-up, the patient’s symptoms had completely disappeared.

Abstract Introduction: Calcium hydroxide (Ca(OH)2) is the most commonly used medicament in endodontics. This study aimed to investigate the effect of bioactive glass (BG) use with or without Ca(OH)2 on the biological and mechanical properties of dentin. Materials and Methods: Standard holes were created to simulate root canals on 84 dentin slices. Four groups were formed according to the medicament placed in the root canals: Ca(OH)2; Ca(OH)2 + 7% BG; BG and control. Scanning electron microscopy analysis to evaluate the dentin surfaces exposed to the test medicaments and energy dispersive X-ray analysis to observe apatite formation were used on the 1st, 7th, and 14th days. X-ray diffraction measurements were performed to investigate mineral phase formation. Microhardness and pH measurements were also carried out. Data were analyzed using Kruskal–Wallis and Wilcoxon signed-rank tests (P < 0.05). Results: The Ca(OH)2 and control groups showed the highest Ca and P mineral content on the 14th day, whereas the lowest Ca and P content was found in the Ca(OH)2 + BG group (P < 0.05). A gradual decrease in crystal formation was found in the Ca(OH)2 + BG group from the 1st day to the 14th day. The highest microhardness measurements were also recorded in the Ca(OH)2 + BG group (P < 0.05). The Ca(OH)2 + BG group showed the highest pH measurements (P = 0.001). Conclusions: Ca(OH)2 + BG can be an alternative intracanal medicament. Further studies should be performed to determine the clinical implications of this combination.

Abstract Introduction: The success of endodontic treatment depends on the complete removal of the smear layer from the root canal and the enhanced wettability of the irrigants employed during treatment. However, none of the irrigants efficiently accomplish this; thus, the purpose of this investigation was to evaluate the elimination of the smear layer and wettability of root dentin using the combination of 0.2% Chitosan nanoparticles(CSN) with 1% phytic acid (PA). Materials and Methods: About 100 extracted single-rooted human premolar teeth were decoronated and standardized to 13 mm root length. Fifty specimens were tested for smear layer removal and another half for wettability (n = 50) after final irrigation in five groups: Group 1 – normal saline (control), Group 2 – 17% ethylenediaminetetraacetic acid (EDTA), Group 3 – 17% EDTA with 0.2% CSN, Group 4 – 1% PA, and Group 5 – 1% PA with 0.2% CSN. After root canal instrumentation and final irrigation, the specimens were observed under scanning electron microscope for the smear layer. Wettability was determined using dentin blocks obtained (n = 50) by resecting the apical third of each specimen, treated with irrigants in aforementioned groups, and the contact angle was measured using a goniometer. Statistical analysis was done using one-way analysis of variance and post hoc Tukey tests (P < 0.05). Results: A combination of 1% PA with 0.2% CSN showed higher smear layer removal and increased wettability. Conclusions: The incorporation of 0.2% CSN to 1% PA was effective in removing the smear layer and increased the dentinal wettability.

Abstract Introduction: Dental trauma could lead to separation or crushing of the dental supporting tissues and esthetic and functional disorders. This study aims to evaluate the knowledge regarding the management of dental trauma among clinical dental students and interns in Benin City, Nigeria. Materials and Methods: This descriptive cross-sectional study utilized a self-administered questionnaire containing 15 closed and open-ended questions to garner data focused on sociodemograhic characteristics and awareness of the management of traumatic dental injury, from respondents. Data from 95 respondents were statistically analyzed and both univariate and bivariate analyses were used in this study. Results: A significant proportion; 77 (81.1%) had a poor overall knowledge of management, although most respondents had knowledge of some of the steps involved in emergency management of dental trauma. The association between respondents’ level of education and their knowledge of the management of dental trauma was found to be statistically significant (P = 0.0001). Respondents at higher level in their dental training were found to have better overall knowledge compared to those at lower levels. Conclusion: The knowledge regarding the management of dental trauma among the respondents was poor. This was associated with the level of study and clinical exposure.

Abstract Periapical radiographs (PRs) have been the most reliable modality for assessing periapical health. Later, the evolution of cone-beam computed tomography (CBCT) revolutionized three-dimensional maxillofacial skeletal imaging. CBCT imaging has emerged as a superior diagnostic tool compared to PR. The aim of this narrative review was to provide a comprehensive overview of the outcomes related to the use of CBCT in evaluating various endodontic treatments, including primary root canal treatments, secondary treatments, endodontic microsurgeries, and vital pulp therapies and the associated prognostic factors. The research selection process involved systematically searching PubMed, Scopus, and Web of Science for literature on CBCT and endodontics. Criteria included English-language; peer-reviewed articles published from January 2010 to December 2023, reporting 1-year outcomes of various endodontic treatments using CBCT. Two independent reviewers screened titles, abstracts, and full texts. A total of 18 outcome study articles utilizing CBCT to evaluate primary root canal treatment were selected, as well as 7 for secondary root canal retreatment, 3 for vital pulp therapy, and 11 articles pertaining to endodontic microsurgery. The outcomes revealed varying success rates and prognostic factors. Consistent with outcome research employing PRs, studies that utilized CBCT also exhibited substantial variability in factors affecting initial and secondary treatment outcomes. The rate of favorable outcomes was significantly lower when assessed with CBCT compared to PR. The results from utilizing CBCT for primary and secondary root canal treatments, endodontic microsurgeries, and vital pulp therapies demonstrate diverse success rates and prognostic factors in comparison to outcomes based solely on PRs.