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Surgical and Non-surgical Endodontics in 2024 and Beyond

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dentistry, Oral Surgery and Oral Medicine".

Deadline for manuscript submissions: closed (30 October 2024) | Viewed by 17094

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Special Issue Editors

Prof. Dr. Damiano Pasqualini

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Guest Editor

Department of Surgical Sciences, CIR Dental School, Universita degli Studi di Torino, Torino 10125, Italy
Interests: microsurgical endodontics; microCT scanning; dynamic navigation

Prof. Dr. Mario Alovisi

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Guest Editor

Department of Surgical Sciences, CIR Dental School, Universita degli Studi di Torino, Torino 10125, Italy
Interests: endodontic microbiology; dental pulp regeneration; confocal laser scanning
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Prof. Dr. Elio Berutti

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Guest Editor

Department of Surgical Sciences, CIR Dental School, Universita degli Studi di Torino, Torino 10125, Italy
Interests: endodontic retreatments; pulp biology; endodontic instrument technology

Special Issue Information

Dear Colleagues,

Introduction:

The Special Issue on Surgical and Non-surgical Endodontics aims to provide a comprehensive platform for researchers, practitioners, and academicians to explore and discuss the latest advancements in the field of endodontics. Endodontics, a branch of dentistry focused on the diagnosis, prevention, and treatment of dental pulp and periapical diseases, plays a crucial role in preserving natural teeth and promoting overall oral health. This Special Issue will delve into the two primary approaches employed in endodontic treatment: surgical and non-surgical techniques.

While non-surgical endodontic procedures, such as root canal therapy, have long been the primary mode of treatment for most endodontic cases, surgical interventions, such as apical surgery and periradicular surgery, present viable alternatives for complex or refractory cases. The collection of research and reviews in this Special Issue will shed light on the latest advancements, techniques, and innovations in both surgical and non-surgical endodontics, fostering a deeper understanding and promoting best practices within the dental community.

Note to Contributors:

This Special Issue on Surgical and Non-surgical Endodontics welcomes original research articles, systematic reviews, meta-analyses, and comprehensive reviews. However, please note that the Special Issue will not accept case reports or mini-reviews. We encourage submissions that provide substantial contributions to the understanding and improvement of surgical and non-surgical endodontic techniques and their clinical applications. The goal is to advance the field and promote evidence-based practices that benefit both patients and practitioners alike.

Prof. Dr. Damiano Pasqualini
Prof. Dr. Mario Alovisi
Prof. Dr. Elio Berutti
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

endodontics
surgical endodontics
non-surgical endodontics
root canal therapy
apical surgery
periradicular surgery
dental pulp diseases
periapical diseases
endodontic innovations
dental health

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Published Papers (8 papers)

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Research

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16 pages, 16653 KiB

Open AccessArticle

Periodontal Breakdown, Orthodontic Movements and Pulpal Ischemia Correlations—A Comparison Between Five Study Methods

by Radu-Andrei Moga, Cristian Doru Olteanu and Ada Gabriela Delean

J. Clin. Med. 2024, 13(23), 7062; https://doi.org/10.3390/jcm13237062 - 22 Nov 2024

Viewed by 271

Abstract

Background/Objectives: This study assessed the biomechanical behavior of dental pulp and the neuro-vascular bundle/NVB as well as the ischemic risks during orthodontic movements in a gradual horizontal periodontal breakdown, using five methods and aiming to identify the most accurate one. Methods: Seventy-two models of second lower premolar (from nine patients) were subjected to 3 N of intrusion, extrusion, rotation, tipping, and translation. Five numerical methods, Tresca, Von Mises/VM, Maximum and Minimum Principal, and hydrostatic pressure were used in a total of 1800 numerical simulations. The results were color-coded projections of the stress areas that were then correlated with maximum physiological hydrostatic pressure/MHP and known clinical biomechanical behavior. Results: During periodontal breakdown, all five methods displayed, for all movements, quantitative stresses lower than MHP, suggesting that 3 N are not inducing any local tissular ischemic risks for the healthy intact tissues. All five methods displayed rotation as the most stressful movement during periodontal breakdown, while translation was the least. The NVB was more exposed to ischemic risks than dental pulp during the periodontal breakdown due to constant tissular deformations. Only VM and Tresca methods showed translation as more prone to expose dental pulp (both coronal and radicular) to ischemic risks (than the other movements) during the periodontal breakdown simulation. However, all five methods showed intrusion and extrusion as more prone to expose the NVB to higher ischemic risks than the other movements during the periodontal breakdown simulation. Conclusions: During periodontal breakdown, Tresca and Von Mises were more accurate, with Tresca being the most accurate of all. Full article

(This article belongs to the Special Issue Surgical and Non-surgical Endodontics in 2024 and Beyond)

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9 pages, 955 KiB

Open AccessArticle

Effectiveness of Activated Sodium Hypochlorite Irrigation by Shock Wave-Enhanced Emission Photoacoustic Streaming, Sonic and Ultrasonic Devices in Removing Enterococcus faecalis Biofilm From Root Canal System

by Hadi Assadian, Sadaf Fathollahi, Maryam Pourhajibagher, Luca Solimei, Stefano Benedicenti and Nasim Chiniforush

J. Clin. Med. 2024, 13(20), 6278; https://doi.org/10.3390/jcm13206278 - 21 Oct 2024

Viewed by 605

Abstract

Aim: To compare shock wave-enhanced emission photoacoustic streaming (SWEEPS) with sonic- and ultrasonically activated irrigation systems in removing Enterococcus faecalis biofilm from the root canal system. Methodology: Fifty human single-canalled mandibular premolars were included in the study. After access cavity preparation, the root canals were prepared to a standardized size and taper. Then, the entire root surface was covered with two layers of resin, and the root apices were sealed before sterilization. All root canals were inoculated with E. faecalis biofilm, and the samples were incubated aerobically for 2 weeks at 37 °C. Biofilm formation was confirmed by scanning electron microscopy. All samples were randomly divided into five groups (n = 10 each) based on their irrigation activation method as A (no treatment or negative control), B (no irrigation or positive control), C (sonically activated irrigation (SAI)), D (ultrasonically activated irrigation (UAI)), and E (needle irrigation activated by an Er: YAG laser device using a SWEEPS quartz tip (SWEEPS)). Then, dentine chips were retrieved, vortexed, and diluted for colony-forming unit counts. Data were analysed using analysis of variance and post-hoc Tukey tests (α = 5%). Results: All methods could significantly reduce E. faecalis biofilm compared with control so that the UAI, SWEEPS, and SAI groups indicated a 23.54%, 14.89%, and 7.81% biofilm reduction, respectively. UAI demonstrated a significantly more effective reduction of E. faecalis biofilm than SAI (p = 0.004). Conclusions: All irrigation activation methods significantly reduced E. faecalis biofilm, with ultrasonic use being the most effective. Full article

(This article belongs to the Special Issue Surgical and Non-surgical Endodontics in 2024 and Beyond)

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11 pages, 1916 KiB

Open AccessArticle

Cyclic Fatigue Resistance of Four Heat-Treated Nickel-Titanium Files in Severely Curved Simulated Canals: An In Vitro Study

by Katia Greco, Gaetano Paolone, Giuseppe Cicero, Giulia Tetè, Nicola Cantile, Maria Teresa Sberna, Teresa Saladino, Enrico Felice Gherlone and Giuseppe Cantatore

J. Clin. Med. 2024, 13(19), 5739; https://doi.org/10.3390/jcm13195739 - 26 Sep 2024

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Abstract

Background: Rotary Ni-Ti files are susceptible to sudden intra-canal separation due to cyclic fatigue stress, particularly in curved canals. To increase resistance to cyclic fatigue, new heat-treated files have been introduced. This study aimed to compare the performance of four heat-treated Ni-Ti files in two simulated curved root canals by evaluating the effect of the alloy, rotation speed, and diameter of the files on their resistance to cyclic fatigue. Methods: The Ni-Ti files included in the study were the ProTaper Gold^® (Dentsply Sirona) F2, ProTaper Ultimate^® (Dentsply Sirona) F2, FQ^® (Komet) 25.06, and Blueshaper^® (Zarc4Endo) Z4 25.06. Two groups of 30 files were selected for each system and were tested in two simulated canals milled in a specific metal template. One group was tested in a 60° curved canal and the other in a 90° curved canal. Results: In the 60° simulated canal, there were no instrument fractures within the 15 min time limit. In the 90° simulated canal, the Blueshaper Z4 demonstrated a lower resistance to cyclic fatigue, while FQ 25.06 showed statistically higher fatigue resistance based on both the Kruskal–Wallis and Games–Howell tests (p < 0.05). Conclusions: No differences were found between files when tested in a 60° curved canal for up to 15 min. However, in a 90° canal, the FQ^® files showed significantly higher resistance to cyclic fatigue, especially compared to the Blueshaper^® Z4. The ProTaper Ultimate and ProTaper Gold produced intermediate results, with the ProTaper Ultimate F2 slightly outperforming the ProTaper Gold F2. Full article

(This article belongs to the Special Issue Surgical and Non-surgical Endodontics in 2024 and Beyond)

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11 pages, 1184 KiB

Open AccessArticle

Factors Influencing Non-Surgical Root Canal Treatment Outcomes in Mandibular Second Molars: A Retrospective Cone-Beam Computed Tomography Analysis

by Da-Min Park, Woo-Hyun Seok and Ji-Young Yoon

J. Clin. Med. 2024, 13(10), 2931; https://doi.org/10.3390/jcm13102931 - 16 May 2024

Cited by 2 | Viewed by 1608

Abstract

Background/Objectives: This study aimed to investigate the influence of the root canal morphology and various treatment variables on the outcomes of root canal treatments (RCTs) in mandibular second molars, assessed through cone-beam computed tomography (CBCT) imaging. Methods: A total of 150 CBCT images were examined, comprising 100 cases of persistent endodontic infections and 50 of previously treated root canals with normal apices in the mandibular second molars. CBCT was utilized to evaluate the root canal configuration, the radiographic quality of coronal restorations and treated canal systems, and the presence of periapical lesions. Statistical analyses were performed to explore the correlations between these factors. Results: The presence of a C-shaped root canal configuration did not demonstrate a significant correlation with periapical lesions (p = 0.05). Factors influencing endodontic treatment outcomes included missing canals (p = 0.018), underfilling or overfilling (p = 0.045), and inadequate coronal restoration (p = 0.006). Missing a canal was identified as the variable most significantly associated with periapical lesions (OR = 3.103). Inhomogeneous root canal obturation was more commonly observed in C-shaped root canals (p < 0.001). Conclusions: Regardless of the root canal morphology of mandibular second molars, successful RCT depends on thorough disinfection to eliminate any untreated canals, precise three-dimensional filling of the canals at the correct working length, and a securely sealed coronal restoration to prevent leakage. Full article

(This article belongs to the Special Issue Surgical and Non-surgical Endodontics in 2024 and Beyond)

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11 pages, 2688 KiB

Open AccessArticle

Effects of Etching Time and Ethanol Wet Bonding on Bond Strength and Metalloproteinase Activity in Radicular Dentin

by Allegra Comba, Andrea Baldi, Riccardo Pucci, Chiara Rolando, Mario Alovisi, Damiano Pasqualini and Nicola Scotti

J. Clin. Med. 2024, 13(9), 2474; https://doi.org/10.3390/jcm13092474 - 24 Apr 2024

Cited by 1 | Viewed by 2558

Abstract

(1) Background: The objective of this in vitro study was to evaluate the impact of different etching times and ethanol pre-treatments on the immediate bond strength of a hydrophilic multi-mode universal adhesive (Clearfil Universal Bond Quick, Kuraray, UBQ) and on the consequent gelatinolytic activity of metalloproteinases (MMPs) on radicular dentin. (2) Methods: Sixty single-root teeth were selected and divided into four groups according to the adhesive protocol applied for fiber post cementation: (G1) 15 s H₃PO₄ application + UBQ; (G2) 30 s H₃PO₄ application + UBQ; (G3) 15 s H₃PO₄ application + ethanol pre-treatment + UBQ; (G4) 30 s H₃PO₄ + ethanol pre-treatment + UBQ. After adhesive procedures, fiber posts were luted into the post space with a dual-curing cement (DC Core, Kuraray) and light-cured for 40 s. To perform the push-out test and nanoleakage analyses for both coronal end apical areas, 1 mm slices were prepared, following a 24 h storage period in artificial saliva. Additionally, an in situ zymographic assay was conducted to explore endogenous MMP activity within the radicular layer. Results were statistically analyzed with ANOVA and Tukey post hoc tests. Statistical significance was set at p < 0.05. (3) Result: ANOVA revealed a statistically significant difference in push-out bond strength related to the pre-treatment variable but did not highlight any significance of etching time. Specimens pre-treated with ethanol wet bond application showed higher bond strength (p < 0.01). In situ zymography quantification analyses revealed that all tested groups, independently of etching time end ethanol pre-treatment, activated MMP gelatinolytic activity. A significant increase in MMP activity was detected for the 30 s etching time. However, ETOH pre-treatment significantly reduced MMP activity within the adhesive interface (p < 0.01). (4) Conclusions: The tested adhesive showed similar results regardless of the etching time protocol. The gelatinolytic activity of MMPs was observed in all the groups. Further investigations and extended follow-ups are required to validate the results of the present study in vivo. Full article

(This article belongs to the Special Issue Surgical and Non-surgical Endodontics in 2024 and Beyond)

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13 pages, 1081 KiB

Open AccessFeature PaperArticle

Thermal Effects on Dental Pulp during Laser-Assisted Bleaching Procedures with Diode Lasers in a Clinical Study

by Marlene Petersen, Andreas Braun and Rene Franzen

J. Clin. Med. 2024, 13(8), 2301; https://doi.org/10.3390/jcm13082301 - 16 Apr 2024

Cited by 2 | Viewed by 1079

Abstract

Background In the current cosmetics industry, bleaching is often associated with lasers. However, such treatment also harbors risks. Tooth death is observed at pulpal temperature increases ≥5.6 °C. Therefore, it seems important to investigate the effects of using different lasers. The aim of this study was to determine pulpal temperature increases at different laser parameters during bleaching by modeling a realistic environment and to compare the temperature recording using a thermocouple and thermal camera. The authors assumed that there are laser settings for the lasers used at which the pulpal temperature increases are <5.6 °C and that the temperature recordings with thermocouples and thermal cameras differ only minimally. Methods Human teeth were used, which were extracted for dental reasons. During experiment, teeth were bleached conventionally and by laser activation at 940 nm, 445 nm, and 970 nm. The temperature in the pulp was recorded using thermocouples. In a second setup, longitudinally halved teeth were bleached, while the temperature in the pulp was recorded with a thermocouple and thermal camera. Descriptive statistics were used. The significance level is 0.05. Results In addition to conventional bleaching, temperature increases <5.6 °C were observed for bleaching at 940 nm 1.5 W, at 445 nm 0.3 W, and at 970 nm 0.5 W. For bleaching procedures using 940 nm 7 W, 940 nm 2 W, 445 nm 0.5 W, and 970 nm 1 W, the temperature increase was ≥5.6 °C. Significant differences (p < 0.05) were found in the maximum temperature increases (°C) between all groups. Temperature recordings using a thermocouple and thermal camera differed by about 2.3 °C. The working hypotheses were confirmed. Conclusion With laser bleaching, attention must be paid to the type of laser, its power, and the time in order to avoid excessive overheating of the dental pulp. Full article

(This article belongs to the Special Issue Surgical and Non-surgical Endodontics in 2024 and Beyond)

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14 pages, 1029 KiB

Open AccessArticle

Prognostic Factors Affecting the Outcome of Surgical Root Canal Treatment—A Retrospective Cone-Beam Computed Tomography Cohort Study

by Salma AlKhuwaitir, Shanon Patel, Abdulaziz Bakhsh, John Spencer Rhodes, Luis Miguel Ferrández and Francesco Mannocci

J. Clin. Med. 2024, 13(6), 1692; https://doi.org/10.3390/jcm13061692 - 15 Mar 2024

Viewed by 1378

Abstract

Aim: To assess the association between demographic and clinical variables and the outcome of root-end surgery using digital periapical radiographs (PA) and cone-beam computed tomography (CBCT). Methodology: One hundred and fifty teeth that received endodontic microsurgery were clinically and radiographically examined (PA and CBCT scans) after 1 and 2 years. Two calibrated endodontists evaluated the radiographic healing based on a six-point outcome classification. The outcome was classified using both strict (healed) and loose (healing) criteria. The success rates were calculated, and several outcome prognostic factors were assessed. Results: One hundred and fifty teeth were assessed with both radiographic systems. When “loose” success criteria were applied using PA, 90% (n = 135) of teeth were assessed as having had a favourable outcome (90%; 95% CI: 85.2–94.8%), whereas 90.7% (n = 136) of teeth showed a successful outcome when assessed with CBCT (90.7%; 95% CI: 86.0–95.3%). When “strict” success criteria were applied, there was a statistically significant difference (p = 0.018) between the success rates of mineral trioxide aggregate (MTA) (63.7%) and Biodentine (95.5%). Conclusions: Within the limitations of this study, endodontic microsurgery showed a high success rate. Among all the demographic and clinical variables assessed, in the multiregression analysis, only the use of Biodentine was associated with a higher proportion of “complete” healings compared to MTA or Intermediate Restorative Material (IRM) when assessed using CBCT. MTA and Biodentine performed similarly when “incomplete” healings were regarded as successful outcomes. Full article

(This article belongs to the Special Issue Surgical and Non-surgical Endodontics in 2024 and Beyond)

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Review

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23 pages, 11324 KiB

Open AccessReview

Negotiation of Calcified Canals

by Antonis Chaniotis, Hugo Sousa Dias and Anastasia Chanioti

J. Clin. Med. 2024, 13(9), 2703; https://doi.org/10.3390/jcm13092703 - 4 May 2024

Cited by 2 | Viewed by 7169

Abstract

The gradual formation of hard tissue along the root canal walls is a natural process associated with aging, typically progressing slowly over time. In reaction to tooth wear, operative procedures, vital pulp treatments, or regenerative endodontic procedures, hard tissue may also accumulate within the pulp canal space at a slow rate. In certain cases, such as dental trauma, autotransplantation, or orthodontic treatment, this deposition of hard tissue can accelerate unexpectedly, resulting in rapid narrowing or complete closure of the root canal space. This situation is called calcific metamorphosis (CM), root canal calcification, or pulp canal obliteration (PCO). Performing conventional endodontic therapy on severely calcified canals presents significant challenges and increases the risk of procedural accidents. Calcified canals introduce such complexity that dedicated negotiation concepts and specially designed instruments have been developed to deal with the challenge. This article seeks to review the existing methods for effectively navigating calcified canals and to introduce the buckling resistance activation test (BRAT) technique. Full article

(This article belongs to the Special Issue Surgical and Non-surgical Endodontics in 2024 and Beyond)

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