Iranian Endodontic Journal

This case report describes the successful nonsurgical endodontic management of a mandibular second molar with a confirmed C-shaped canal configuration complicated by chronic apical periodontitis and active external inflammatory root resorption in a 16-year-old female patient. The patient presented with pain on biting, deep localized periodontal probing, and radiographic evidence of a large periapical radiolucency and resorptive changes in the distal root. Diagnostic tests confirmed pulpal necrosis and an endodontic–periodontal communication. Following access under magnification, the complex C-shaped canal system was negotiated and disinfected using 5.25% sodium hypochlorite, activated irrigation, and calcium hydroxide dressing. Because of apical resorption and an open apex, a 4–5 mm mineral trioxide aggregate apical plug was placed, followed by warm vertical obturation of the remaining canal system. The tooth was restored and monitored clinically/radiographically. At the 8-month follow-up, the patient was asymptomatic, probing depths had normalized, and radiographs demonstrated complete resolution of the periapical lesion with arrest of external root resorption. This case highlights that conservative endodontic therapy, supported by modern materials and careful disinfection, can achieve predictable healing even in teeth with complex morphology and resorptive defects. Early diagnosis and meticulous management are essential for a favorable outcome.

The present study aims to provide readers with the influence of various types of dental lasers in endodontics, along with their advantages and disadvantages. A complete query was carried out on PubMed, Google Scholar, Embase, and Scopus databases, and the studies published during 2015-2024 were collected using the keywords "Laser," "Endodontics," "Disinfection," "Vital Pulp therapy," and "Regenerative Endodontic Treatment." After applying appropriate inclusion and exclusion criteria, 86 relevant articles focused on the application of dental lasers in endodontics were selected and evaluated. Based on the evaluated studies, probably the most significant advancement of dental lasers is in optimizing the treatment outcome of root canal therapy via enhanced disinfection of root canals. Moreover, various research has shown that dental lasers can also aid in diagnosing vitality of pulp, vital pulp therapy, apiectomy, regenerative treatments, pain management treatment after root canal therapy, access cavity preparation, sterilization and irrigation of root canals, treatment of periapical lesions, removing excess materials and broken instruments in canals, and prompting the healing process after root canal therapy. As evidenced by the obtained results, diode and erbium lasers have the most applications in endodontics with the lowest side effects. Nonetheless, all dental lasers face multiple limitations, including producing noticeable thermal changes and smoke and damaging surrounding structures at the emission site, which question their safe usage in clinical practice. Therefore, dental lasers' newest advancements in dental procedures require further scientific work in the future.

Introduction: Tooth discoloration remains a significant concern in endodontic treatment, particularly with the use of intracanal medicaments. This study investigated the discoloration potential of niosomal doxycycline and triamcinolone, a novel nanotechnology-based drug delivery system, in comparison to conventional medications. Materials and Methods: Fifty extracted single-rooted human teeth were assigned to five groups: (1) calcium hydroxide, (2) calcium hydroxide+triamcinolone, (3) niosomal doxycycline+triamcinolone, (4) doxycycline+triamcinolone, and control groups (positive: blood; negative: saline). All samples were prepared using standardized endodontic procedures, filled with medicaments, and incubated for one month. Discoloration values (∆E) were measured at baseline, 1 week, and 1 month using the CIE Lab system and a spectrophotometer. A ∆E>3.3 was considered clinically unacceptable. Results: All groups exhibited discoloration values within clinically acceptable limits (∆E<3.3). At one month, significant differences were observed among groups (ANOVA, P<0.05). The niosomal doxycycline+triamcinolone group showed the lowest ∆E values, similar to the calcium hydroxide group, while the doxycycline+triamcinolone and calcium hydroxide+triamcinolone groups exhibited higher discoloration values. Conclusion: Emphasize that at 4 weeks, all medicaments induced clinically acceptable ∆E, with niosomal performing similarly to calcium hydroxide alone and significantly better than the conventional doxycycline+triamcinolone combination.

This case report describes the successful guided endodontic treatment of a maxillary left canine (#23) with pulp canal obliteration (PCO) in a 30-year-old female patient. The patient had a history of orthodontic treatment and Le Fort I orthognathic surgery, both recognized as potential factors contributing to canal calcification. The patient had a history of a failed root canal treatment, contributing to incomplete canal instrumentation and iatrogenic damage (gouging) during access cavity preparation. The case was referred for completion of treatment. Upon referral, clinical and radiographic examinations revealed advanced canal obliteration, procedural gouging from the prior attempt, and a radiolucent line suggestive of a horizontal root fracture. Cone-beam computed tomography (CBCT) confirmed the extent of canal calcification, ruled out the suspected fracture, and showed a localized palatal external root resorption, likely related to previous orthodontic forces. Given the complexity of the case, a static-guided endodontic technique was selected as the preferred treatment approach. A custom 3D-printed guide, generated from merged CBCT and intraoral scan data, enabled conservative and accurate access to the calcified canal. Although a hand K-file fractured during canal negotiation, the fragment was successfully retrieved using ultrasonic devices under magnification. The tooth was treated successfully. Clinical and radiographic follow-ups at six and twelve months confirmed resolution of the periapical lesion and complete symptom relief, demonstrating that guided endodontics can serve as a safe and effective treatment option in teeth with PCO.

Introduction: The dental pulp is a specialized connective tissue responsible for maintaining tooth vitality through a complex interplay of cellular, vascular, and immunological components. Despite the clinical use of conventional capping materials, their limited regenerative potential often results in pulp devitalization and compromised structural integrity. Recent advances in tissue engineering, particularly the application of three-dimensional scaffolds, have demonstrated promising outcomes in promoting dentin-pulp complex regeneration and biomimetic tissue repair. This systematic review and meta-analysis evaluated the efficacy of three-dimensional matrices, with or without bioactive materials, as direct pulp capping agents in animal models. Outcomes included cellularity, dentin thickness, dentin bridge formation, dystrophic calcification, inflammation control, and pulp organization compared to commercial materials. Materials and Methods: A comprehensive search was conducted in indexed databases and gray literature. A random-effects meta-analysis used standardized mean differences and the inverse variance method. Heterogeneity (I²), publication bias (Egger’s and Begg’s tests), and risk of bias (SYRCLE’s RoB tool) were assessed. Statistical analyses were conducted using RevMan (P<0.05). Results: Seventeen studies met the inclusion criteria, with 13 included in the meta-analysis. The risk of bias was predominantly low, yet the certainty of evidence was very low. Scaffolds significantly enhanced cellularity (P=0.02; I²=91%), dentin thickness (P<0.00001; I²=87%), and inflammation control (P=0.03; I²=20%) compared to controls. No significant differences were observed for dentin bridge formation (P=0.30; I²=63%), dystrophic calcification (P=0.14; I²=32%), or pulp organization (P=0.10; I²=0%). Conclusion: Three-dimensional scaffolds demonstrated potential in promoting cellular activity, dentin formation, and inflammation control. However, their impact on dentin bridge formation, pulp organization, and dystrophic calcification remains inconclusive. Further high-quality studies are required to validate their clinical applicability.

Introduction: Endodontic cements are essential materials for achieving successful root canal treatment. Therefore, they must present adequate physicochemical properties to ensure optimal clinical performance. This study aimed to evaluate radiopacity, pH, and calcium ion release of calcium silicate- and epoxy resin-based cements/sealers. Materials and Methods: Four materials were evaluated: Vioseal, AH-Plus, AH-Plus Bioceramic Sealer, and MTA Angelus. Ten cylindrical specimens (10 mm diameter, 1 mm height) per group were prepared for each tested property, totaling 80 samples. The same specimens were used for pH and calcium ion release, while separate specimens were used for radiopacity. All samples were stored at 37^°C and 95% humidity. Radiopacity was assessed by digital radiography using an aluminum step wedge (1-10 mm). pH was measured at 1, 7, and 14 days using a calibrated digital pH meter. Calcium ion release was determined using atomic absorption spectrophotometry. Data were analyzed using Kruskal-Wallis and Dwass-Steel-Critchlow-Fligner post hoc tests (P<0.05). Results: Vioseal and AH-Plus showed the highest radiopacity values (9.98±0.42 mm Al and 10.00±0.38 mm Al, respectively), while AH-Plus Bioceramic Sealer (9.04±0.28 mm Al) and MTA Angelus (4.72±0.40 mm Al) showed lower values. Regarding pH, AH-Plus Bioceramic presented the highest and most sustained alkaline value (up to 12.5), and AH-Plus the lowest (6.25±0.26). In calcium ion release, Vioseal showed the highest release on day 7 (29.4±3.12 ppm), while AH-Plus Bioceramic Sealer also peaked on day 7 (18.60±5.54 ppm); MTA Angelus presented its highest release on day 1 (11.80±1.00 ppm). Conclusion: All evaluated cements/sealers met the ISO 6876 standard for radiopacity. Calcium silicate-based cements showed an alkaline pH and sustained calcium ion release, whereas Vioseal presented an initially high and transient release.

Introduction: The present study aimed to evaluate the instrumentation time and transportation ability of three file sequences sharing the same physical properties (diameter, tip design, cross-sectional shape, and taper), each manufactured entirely of one single alloy type (Pink, Blue, or Gold). Materials and Methods: One hundred and eighty simulated curved resin canals were instrumented using the BlueShaper system, with full Z1-Z4 sequences, each made entirely of a single alloy type (Pink, Blue, or Gold). Images before and after instrumentation of each specimen were overlaid with Photoshop software to evaluate centering ability in the coronal, middle, and apical thirds. Data were analyzed using one-way analysis of variance (ANOVA) with post hoc multiple comparisons or the non-parametric Kruskal-Wallis test for intergroup analysis. Results: No significant differences were found between the different alloys in the centering ability of the simulated canals in the coronal third (P>0.05). The Blue alloy of the BlueShaper system showed significantly less transport ability in the middle third than Pink and Gold alloys (P<0.05). A significantly lower centering ability (P<0.001) was observed in the apical third between the Blue and Pink alloys than the Gold alloy. Conclusions: It was concluded that the Blue alloy performed better than the Pink and Gold alloys in the middle and apical thirds. The pink alloy performed better than the Gold alloy in the apical third.

Treating coronal dens invaginatus (CDI) with pulp infection typically involves the removal of the invaginatus, which increases the risk of fracture and perforation, compromising tooth structure. Minimally invasive endodontic management of coronal dens invaginatus is highly recommended. This case report presents the management of a 19-year-old female patient with a permanent maxillary lateral incisor exhibiting two distinct dens invaginatus anomalies. Cone-beam computed tomography (CBCT) was used to assist in the diagnosis of tooth morphology and canal location. CBCT confirmed that the buccally positioned orifice was classified as Oehlers Type II, while the one with a palatally positioned orifice corresponded to Oehlers Type l. The pulp and periapical diagnosis of this tooth was pulpless and an infected root canal system with chronic apical periodontitis according to Abbott classification. The pulp chamber was carefully accessed with minimal intervention, and the root canals were explored under magnification. All root canals were prepared using EDMax rotary files, followed by irrigation with sodium hypochlorite (NaOCl). Calcium hydroxide medication was also applied. Root canal obturation was performed using the warm vertical compaction, employing AH-Plus sealer in combination with thermosplasticized gutta-percha. After 6 and 12 months, the patient showed healing of the periapical region, with the absence of symptoms and normal dental function. Favorable radiographic and clinical findings were observed during both follow-up sessions. At the 18-month follow-up, the lesion was completely healed.

Introduction: Knowledge of the internal anatomy of mandibular third molars is essential for successful endodontic treatment, yet their complex morphology often complicates management. This study evaluated the root canal morphology of mandibular third molars using cone-beam computed tomography (CBCT) according to Vertucci’s classification. Materials and Methods: A total of 653 CBCT scans were screened, and 274 mandibular third molars meeting the inclusion criteria were analyzed. Root canal configurations were classified according to Vertucci, with atypical cases recorded as “type 0” for statistical purposes. Data were analyzed with Fisher’s exact test (α=0.05). Results: Vertucci type I was the most prevalent configuration (62.8%), followed by type V (17.4%). Sex and dental arch side significantly influenced the distribution of configurations (P=0.044 and P=0.013, respectively), while age did not (P=0.569). Distal and distolingual roots were predominantly type I, whereas mesial roots showed greater variability, particularly between sexes. Conclusion: Mandibular third molars exhibit considerable anatomical variation, with types I and V being most frequent. Patient sex and arch side significantly affect root canal morphology, underscoring the importance of detailed preoperative assessment with CBCT for accurate endodontic planning.

Inferior alveolar nerve (IAN) injury is a rare but serious complication of root canal treatment (RCT), typically caused by mechanical over-instrumentation, chemical irritation from extruded sealers, or thermal damage. We report the case of a 42-year-old woman who developed persistent burning pain, numbness, and dysesthesia of the right lower lip and gingiva after RCT of the right mandibular second molar. Initial management by a general dentist involved retreatment and calcium hydroxide medicament; however, early CBCT was misinterpreted, and referral was delayed. High-quality CBCT and clinical testing later revealed obturation material within the IAN canal and a horizontal fracture of the distal root. Endodontic retreatment, followed by maxillofacial microsurgery for removal of extruded gutta-percha/sealer, combined with neuroprotective therapy (dexamethasone, vitamin B, and adjunctive low-level laser therapy). The patient achieved complete resolution of pain and sensory disturbances within one month, and remained asymptomatic with radiographic periapical healing at 12-month follow-up. Comprehensive preoperative imaging, cautious canal instrumentation, independent CBCT interpretation by the endodontist, and timely specialist referral are essential to minimize the risk of IAN injury. Even with delayed intervention, targeted microsurgical removal of extruded material can result in favorable neurological recovery.

The management of extensive periapical lesions poses a significant challenge in endodontic therapy due to their potential cystic nature, anatomical proximity to critical structures, risk of cortical perforation, and complex infection dynamics. This report presents a successful case of a large through-and-through periapical lesion managed conservatively via decompression. Initial periapical radiographs revealed poor-quality root canal therapy and a large radiolucent lesion associated with a maxillary lateral incisor. Cone-beam computed tomography (CBCT) imaging confirmed a through-and-through lesion approximately 12 × 9.5 × 10.5 mm in size. Based on the clinical and radiographic features, pulpal diagnosis was previous endodontic treatment with an infected root canal system and the periapical diagnosis was a radicular cyst; however, a definitive diagnosis would have required a serial sectioning biopsy, which was not feasible under the present circumstances. Initial non-surgical retreatment as the first treatment choice, with multiple intracanal medicament replacements, proved ineffective due to persistent discharge of the canal. Furthermore, surgical intervention was deemed high-risk due to the lesion's proximity to the incisive foramen, palatal mucosa, sinus floor, and nasal cavity. Decompression, a minimally invasive technique with low morbidity, was selected. Following drainage, a drain was inserted via the thinnest cortical plate, and daily irrigation was initiated. The lesion was monitored every two weeks, with progressive reduction in size documented radiographically. After 5 months, the root canal was obturated and the tooth was restored by composite resin due to the cessation of drainage. The drain was removed at 6 months, and by the 9-month follow-up, significant bone regeneration was evident radiographically. The tooth was asymptomatic, exhibited no mobility or sensitivity to percussion or palpation, and periodontal probing revealed no pathologic pockets.

Internal root resorption (IRR) is an uncommon but clinically significant condition traditionally managed with complete pulpectomy and root canal therapy. Advances in vital pulp therapy and bioactive calcium silicate–based cements have enabled conservative strategies aimed at preserving residual pulp vitality. A 33-year-old woman presented with an asymptomatic, unperforated IRR in the maxillary left lateral incisor, confirmed by periapical radiography and cone-beam computed tomography. The tooth responded positively to sensibility testing and showed healthy periapical tissues. A partial pulpectomy was performed: diseased coronal and mid-root pulp was removed, while approximately 5 mm of vital apical pulp was preserved. The resorptive cavity and root canal were bio-obturated with calcium-enriched mixture cement, which also served as a capping biomaterial for the apical pulp stump. Postoperative imaging confirmed complete filling/sealing of the resorptive defect and root canal while maintaining the apical pulp segment. At 2-year follow-up, the tooth remained functional, symptom-free, and radiographically stable, with intact lamina dura and no evidence of progressive resorption. This case demonstrates that partial pulpectomy combined with bio-obturation using an endodontic biomaterial may successfully arrest IRR and preserve apical pulp vitality in carefully selected cases. While the outcome supports the biological feasibility of this approach, further studies with larger samples and longer follow-up are required before it can be considered a routine alternative to conventional treatment.

A thorough understanding of root canal morphology is critical for achieving predictable outcomes in endodontic therapy. Anatomical variations in mandibular second premolars are uncommon compared to other teeth, and the coexistence of a C-shaped root canal configuration with four independent canals and four separate apical foramina is exceptionally rare. This case report describes the nonsurgical endodontic management of a mandibular second premolar exhibiting this unique morphology, confirmed through cone-beam computed tomography (CBCT) and magnification. A 52-year-old male was referred by a prosthodontist for elective root canal treatment before post placement. CBCT imaging revealed a C-shaped root in the coronal third that bifurcated into four separate canals at the midroot level, each terminating in an independent apical foramen. Nonsurgical treatment was performed over two visits, using meticulous chemo-mechanical preparation, intracanal calcium hydroxide dressing, and warm vertical compaction obturation. At the 9-month follow-up, the tooth was functional, asymptomatic, and radiographically stable. This case underscores the importance of preoperative assessment with advanced imaging and magnification in identifying and successfully treating rare endodontic anatomies.

This case report presents the innovative application of ultrasonic points combined with a graphite-marked endodontic guide in a case of restricted vertical space. A 71-year-old female patient with root canal obliteration in the second left mandibular molar was referred for treatment. The patient was experiencing spontaneous pain. Using data from cone-beam computed tomography and surface scans, a virtual 3D guide was developed and positioned. As the patient presented limited interocclusal space, black graphite was inserted through the drill path to mark the pathway. The guide was withdrawn, shorter ultrasonic points were inserted 2 mm into the marked dentin, and this process was repeated until the root canals were localized. The root canals were subsequently shaped and filled. The guide drill path effectively served as a reference for ultrasonic points, enabling successful localization of the root canals. Graphite-marked guide path facilitated access to obliterated root canals in the presence of limited interocclusal space.

Root canal mishaps such as perforations, separated instruments, and canal ledges remain significant challenges in endodontic retreatment. This case report describes the successful non-surgical management of a mandibular first molar presenting with a strip perforation in the mesiobuccal canal, a separated file in the mesiolingual canal, and a ledge in the distal canal. The tooth was generally asymptomatic with only mild sensitivity to percussion, without any pockets of endodontic origin. Radiographic examination revealed periapical and furcation radiolucencies. The tooth had a previous endodontic treatment with an infected root canal system and chronic apical periodontitis. Notably, the tooth was left undressed for approximately three months following the initial mishap, negatively influencing prognosis. Nonetheless, considering the patient’s preference and the favorable periodontal and restorative conditions, non-surgical retreatment was initiated. Treatment included thorough chemomechanical preparation, bypassing the separated file and ledge, and sealing the perforation with calcium-enriched mixture cement. The tooth was subsequently restored with bonded composite resin. At 12-month follow-up, radiographic signs of healing were evident, and at 18 months, the tooth remained asymptomatic with no clinical or radiographic signs of apical or furcation pathology.

Root canal mishaps such as perforations, separated instruments, and canal ledges remain significant challenges in endodontic retreatment. This case report describes the successful non-surgical management of a mandibular first molar presenting with a strip perforation in the mesiobuccal canal, a separated file in the mesiolingual canal, and a ledge in the distal canal. The tooth was generally asymptomatic with only mild sensitivity to percussion, without any pockets of endodontic origin. Radiographic examination revealed periapical and furcation radiolucencies. The tooth had a previous endodontic treatment with an infected root canal system and chronic apical periodontitis. Notably, the tooth was left undressed for approximately three months following the initial mishap, negatively influencing prognosis. Nonetheless, considering the patient’s preference and the favorable periodontal and restorative conditions, non-surgical retreatment was initiated. Treatment included thorough chemomechanical preparation, bypassing the separated file and ledge, and sealing the perforation with calcium-enriched mixture cement. The tooth was subsequently restored with bonded composite resin. At 12-month follow-up, radiographic signs of healing were evident, and at 18 months, the tooth remained asymptomatic with no clinical or radiographic signs of apical or furcation pathology.

Root canal mishaps such as perforations, separated instruments, and canal ledges remain significant challenges in endodontic retreatment. This case report describes the successful non-surgical management of a mandibular first molar presenting with a strip perforation in the mesiobuccal canal, a separated file in the mesiolingual canal, and a ledge in the distal canal. The tooth was generally asymptomatic with only mild sensitivity to percussion, without any pockets of endodontic origin. Radiographic examination revealed periapical and furcation radiolucencies. The tooth had a previous endodontic treatment with an infected root canal system and chronic apical periodontitis. Notably, the tooth was left undressed for approximately three months following the initial mishap, negatively influencing prognosis. Nonetheless, considering the patient’s preference and the favorable periodontal and restorative conditions, non-surgical retreatment was initiated. Treatment included thorough chemomechanical preparation, bypassing the separated file and ledge, and sealing the perforation with calcium-enriched mixture cement. The tooth was subsequently restored with bonded composite resin. At 12-month follow-up, radiographic signs of healing were evident, and at 18 months, the tooth remained asymptomatic with no clinical or radiographic signs of apical or furcation pathology.

Continuous improvement and technological progress in the field of microscopic endodontics enable a gradual increase in indications for non-surgical root canal treatment. While most publications report successful surgical management of overfill or extruded foreign bodies into the periapical area, very few report that this complication can be successfully managed with non-surgical endodontic treatment. This case report presents successful management of a lower left second molar (tooth #37) diagnosed with exacerbated chronic apical periodontitis and massive overfill in a 36-year-old patient WITH non-surgical endodontic treatment AND bent H-file to remove extruded material under dental operating microscope control. It discusses technical aspects of this procedure, as well as its possible complications, including a sodium hypochlorite accident.

Introduction: This study compared apical transportation and centering ability of TruNatomy, EDMax, and Reciproc Blue in curved mesiobuccal canals of mandibular molars. Materials and Methods: This ex vivo study was conducted on curved (20-40 degrees) mesiobuccal canals of 60 mandibular molars. The teeth were randomly assigned to 4 groups (n=15) for instrumentation of the mesiobuccal canals with (I) TruNatomy, (II) EDMax, (III) Reciproc Blue, and (IV) Reciproc Blue+R-Pilot. Cone-beam computed tomography (CBCT) scans were obtained before and after instrumentation. Changes in canal wall thickness in mesiodistal (MD) and buccolingual (BL) directions were assessed at 1, 2, 3, and 4 mm from the apex using OnDemand software. Data were analyzed by the Kruskal-Wallis, Bonferroni, Friedman, and Fisher’s exact tests (alpha=0.05). Results: TruNatomy showed significantly lower transportation than Reciproc Blue and EDMax in the apical, middle, and coronal thirds (P<0.05). Reciproc Blue and EDMax had no significant difference in transportation (P>0.05). Using the R-Pilot glider had no significant effect on transportation (P>0.05). Canal transportation was not significantly different within each group at four distances from the apex (P>0.05). TruNatomy showed significantly higher centering ability than Reciproc Blue+R-Pilot in the BL dimension at 3 mm from the apex (P<0.05). Conclusion: TruNatomy showed significantly lower canal transportation than Reciproc Blue and EDMax at all distances from the apex. The files had no significant difference in centering ability except at 3 mm in BL dimension, where TruNatomy had significantly higher centering ability than Reciproc Blue+R-Pilot.

Introduction: Geristore® (GS) is an advanced dual-cure resin-modified glass ionomer with favourable biological and physical properties, including biocompatibility, fluoride release, and excellent sealing ability. Originally developed for restorative purposes, its clinical versatility has nonetheless extended into endodontics. The current critical review primarily aims to evaluate the biological characteristics, endodontic applications, and possible clinical potential of GS as a biomaterial in modern endodontic practice. Methods: A comprehensive literature search was conducted across major databases (MEDLINE, PubMed, Scopus, Cochrane, EMBASE, Google Scholar, and grey literature) without restrictions on date and/or language. Relevant peer-reviewed studies on the composition, properties, and endodontic uses of GS were identified, screened, investigated, and critically analysed. Results: Geristore® has demonstrated promising outcomes in endodontic procedures, e.g., root-end filling, perforation repair, vital pulp therapy, retrograde vital pulp therapy, intra-orifice barrier placement and the management of external cervical resorption, Additionally, various studies have highlighted its favourable soft tissue compatibility, sealing ability (even in moist environments) as well as its acceptable mechanical properties. However, certain limitations, including reduced flexural strength and higher cytotoxicity compared to calcium silicate-based materials, such as mineral trioxide aggregate, have been reported. Conclusion: Geristore® presents as a clinically useful alternative for specific endodontic indications where biocompatibility, sealability, and ease of handling seem critical. However, further high-quality clinical trials and comparative studies are essential to validate its long-term performance and establish its role relative to established endodontic biomaterials.

This case report highlights the innovative application of Biodentine as an intraorifice barrier in the management of cracked teeth with radicular extension associated with endo-periodontal lesions. A 37-year-old female patient reported pain during chewing on tooth #36. Significant periodontal attachment loss was noted around the mesial root. The tooth was diagnosed with pulp necrosis. Upon endodontic access, a vertical crack extending into the mesial canal walls was observed. Root canals were identified and shaped using rotary instruments. Calcium hydroxide was placed as an intracanal dressing. After one week, the patient returned without inflammatory signs. The root canals were filled with gutta-percha and bioceramic cement. Biodentine repair cement was applied 2.0 mm beyond the orifice to seal and reinforce the area. The endodontic access cavity was restored with composite resin. Clinical and radiographic follow-ups at 12 months revealed significant periapical healing and the absence of inflammatory signs. A radiographic and computed tomography scan at 48 months confirmed substantial bone repair and continued tooth functionality. The intraorifice barrier with Biodentine demonstrated notable effectiveness, aligning with literature on its benefits. The protocol, integrating modern techniques and timely restoration, shows promise in managing cracked teeth with root extension, enhancing tooth preservation in complex cases.

Noonan syndrome is a genetic condition characterized by various systemic issues, including cardiac defects, short stature, bleeding problems, and intellectual disabilities. This disorder also shows several manifestations in the oral and maxillofacial region, highlighting the dentist’s role in diagnosing and addressing related complications. This report represents the effective dental management of a 15-year-old boy with Noonan syndrome who suffered from several oral and dental problems and was clinically and radiographically asymptomatic in a nine-month follow-up session. Awareness of the medical conditions and orofacial manifestations of patients with Noonan syndrome can be effective in determining a better treatment plan, providing more effective and safer treatment, and subsequently enhancing the long-term prognosis.

Introduction: The high prevalence of diabetes mellitus and related consequences in all populations of the world makes their management an important challenge in endodontic practice. This study aimed to evaluate the knowledge, attitudes, and performance of Iranian endodontists regarding the management of diabetic patients. Materials and Methods: Questionnaires with 18 items were distributed to Iranian endodontists from different geographical provinces of Iran using social media. Responses to each question used a five-point Likert scale. Data for responses were analyzed using Chi-square or Fisher’s exact tests. Results: A total of 101 valid responses were returned for analysis (50 men and 51 women). None of the respondents had aggregated scores that were rated as unfavorable on 3 domains. Knowledge was rated as favorable for 81% and acceptable for the remaining 19%. Attitude was rated as favorable for 63%, and acceptable for 37%, while performance was rated as favorable for 98% and acceptable for the remaining 2%. Also, none of the 3 variables under evaluation were influenced by demographic factors or by work experience. The most common areas of uncertainty for respondents were monitoring blood for glucose or glycated hemoglobin concentration, and decisions regarding when to prescribe antibiotics. Conclusions: Overall, this cohort of endodontists displayed a high level of knowledge of the major issues involved in diabetic patient care and were confident in providing clinical care. Future programs for continuing professional development for endodontists should consider current methods used for monitoring blood glucose and glycated hemoglobin, both as point-of-care or personal devices. In addition, further education is needed on antibiotic stewardship.

Vital pulp therapy is one of the least invasive and simplest and most economically acceptable treatment alternatives for immature teeth with pulpitis. The success rate of this treatment, with calcium silicate-based cements, ranges from 85% to 100%. Vital pulp therapy prevents the development of apical periodontitis and promotes normal root development, allowing the tooth to remain in the dentition and perform its functions. The patient was a nine-year-old boy with pain on chewing and a positive response to cold. The panoramic radiograph showed an immature permanent lower molar with deep caries. Partial pulpectomy and root pulp sealing with pre-mixed calcium silicate-based cement were performed under aseptic conditions. The absence of symptoms and the formation of roots with apical sealing were successfully achieved and observed by follow-up and radiographic control, making this treatment a viable option for immature teeth with pulpitis.

Introduction: Calcium-enriched mixture (CEM) cement is a water-based biomaterial with properties similar to calcium silicate-based cements (CSCs). Zinc oxide (ZnO), a bioactive material widely used for its antimicrobial properties and beneficial biological effects on body tissues, was incorporated into CEM cement in this study. The objective was to evaluate the impact of ZnO nanoparticles (ZON) on the physical, chemical, and mechanical properties of CEM cement. Materials and Methods: ZON powder was blended with CEM cement powder at a 10% weight ratio. The mixture was combined with liquid (1 g powder: 0.33 mL liquid) and cast into test-specific molds. Samples of original CEM cement without ZON served as the control group. The samples were evaluated for changes in setting time (n=6), compressive strength (n=6), solubility (n=10), and pH (n=10). Results: The initial setting time was identical in both groups. ZON incorporation reduced the secondary setting time, though not significantly. Compressive strength remained unchanged. After 7 days, solubility increased significantly in ZON-containing samples. While ZON reduced the pH of CEM cement in deionized water after 5 hours, no significant difference was observed at 24 hours. Conclusion: Incorporating ZON into CEM cement caused minor changes, including a reduced secondary setting time, increased solubility, and transient pH changes, without significantly affecting overall performance.

Strip perforation is a severe procedural complication during root canal therapy, often associated with poor prognosis, especially when combined with overextended gutta-percha. While surgical or nonsurgical retreatment is commonly indicated, patient-centered decision-making and long-term follow-up may influence the management strategy. This case report describes the conservative follow-up and eventual successful treatment of a mandibular second molar with an extensive midroot strip perforation and extruded gutta-percha, ultimately managed with intentional replantation and root-end filling using calcium-enriched mixture (CEM) cement. In 2015, a 40-year-old female patient presented for routine examination. A previously treated mandibular second molar (#37), which had a severe strip perforation in the mesial root and overextended gutta-percha one year prior, remained asymptomatic and functional. The patient declined retreatment and opted for annual monitoring. Over five years, the tooth remained functional and symptom-free, and the extruded gutta-percha showed gradual radiographic resorption. In 2023, the patient returned with a symptomatic apical periodontitis and a large periapical lesion associated with the same tooth. Intentional replantation was performed with midroot resection of the mesial root, root-end filling using CEM cement, and immediate replantation. At the 1-year follow-up, the tooth remained functional, asymptomatic, and radiographically healed. The case highlights the long-term clinical risks of untreated strip perforations, the unpredictable resorption of overextended materials, and the efficacy of minimally invasive surgical interventions in preserving tooth function.

The American Association of Endodontics classifies the management of pulp canal obliteration (PCO) cases as a high-risk difficulty. This classification indicates an increased likelihood of procedural errors. However, advancements in dental technology have simplified the endodontic treatment of calcified teeth. Guided endodontics uses cone-beam computed tomography (CBCT) and a three-dimensional (3D) printer to create a patient-specific guide, enhancing accuracy and predictability in complex cases. A healthy 60-year-old male was referred by a prosthodontist for root canal treatment on teeth #23, #24, and #25. Periapical radiographic examination revealed partial PCO in all teeth. After choosing guided endodontics treatment, CBCT imaging and intraoral 3D scanning were utilized to design a patient-specific endodontic guide. After verifying the stability of the endo-guide, access cavities were prepared using a Munce Discovery bur. Following the negotiation of the canals, the working length was determined. Root canal treatment was performed using rotary files up to size 25/0.04% and sodium hypochlorite irrigation. The obturation was completed using the warm condensation technique. Although PCO was present, no complications occurred during treatment. The teeth remained completely asymptomatic and functional, demonstrating the success of the treatment. Guided endodontics can be a practical and predictable approach for managing PCO in mandibular incisors. This technique provides accurate canal location, reduces procedural errors, and preserves tooth structure. Despite concerns about cost, radiation exposure, and challenges with anatomical variations, it represents a promising advancement in endodontic treatment.

Introduction: This in vitro study assessed the effects of bonding application time (immediate vs. 24-hour delay) and strategy [self-etch (SE) vs. etch-and-rinse (ER)] on cytotoxicity of three calcium silicate-based cements [calcium-enriched mixture (CEM) cement, ProRoot mineral trioxide aggregate (MTA) and Biodentine] at 1mm and 2mm thicknesses. Materials and methods: Specimens (n=20 per group) were fabricated using CEM, MTA, and Biodentine. Scotchbond Universal was applied immediately or after 24 hours via SE or ER strategies. Cytotoxicity of cement extracts (100%, 50%, and 25% concentrations) on human gingival fibroblasts was evaluated using methyl thiazolyl tetrazolium (MTT) assay. Data were analyzed with four-way ANOVA and Tukey’s test (P≤0.05). Results: The biomaterials showed comparable cytotoxicity (P>0.05), with toxicity decreasing progressively at lower concentrations (25% <50%<100%). At 100% concentration, ER bonding significantly improved cell viability for CEM (P<0.05), while immediate bonding of 1-mm specimens increased cytotoxicity (P<0.05). Immediate SE bonding of 1-mm MTA and Biodentine specimens also resulted in higher cytotoxicity (P<0.05). At 50% concentration, SE strategy and 1-mm thickness increased cytotoxicity, with bonding time effects significant only in ER mode. No significant differences were observed at 25% concentration (P>0.05). Conclusion: Delayed bonding (24 hours), ER strategy, and ≥2-mm thickness minimize cytotoxicity of calcium silicate-based cements. Clinically, immediate permanent restoration after vital pulp therapy is viable when considering these parameters, eliminating the need for interim protective layers (e.g., glass ionomer bases).

Dens invagination (DI) is a developmental dental anomaly characterized by the infolding of the enamel organ into the dental papilla. Type IIIb DI, involving deep invagination that extends apically along the root, poses significant challenges in endodontic treatment due to its complex anatomy. We describe a case of type IIIb DI in a 13-year-old female referred with the chief complaint of spontaneous pain on the left maxillary lateral incisor. Clinical examinations showed tenderness to percussion and palpation as well as a positive response to cold test with lingering pain. Cone-beam computed tomography (CBCT) confirmed the presence of type IIIb DI associated with a periapical lesion. The final diagnosis was irreversible pulpitis with apical periodontitis for main canal (distal) and pulpless and infected root canal system with secondary acute apical periodontitis according to Abbott classification for the other canal. Two separate access cavities were prepared with the guidance of CBCT. Root canal therapy was performed on both root canals, using photodynamic therapy (PDT) and ultrasonic-activated sodium hypochlorite for enhanced disinfection. Calcium-enriched mixture cement was used to obturate the apical third, followed by thermoplastic gutta-percha in the middle and coronal thirds. The patient was asymptomatic at 6- and 12-month follow-ups, with radiographic evidence of complete healing. This case highlights the effectiveness of conservative endodontic treatment using PTD in managing complex DI cases, with a focus on maintaining tooth structure and achieving long-term success.

Internal inflammatory root resorption (IRR) poses significant challenges in endodontic treatment due to its potential to compromise tooth integrity. This case report describes the conservative management of IRR in a 40-year-old woman with a radiolucent lesion in the midroot of a maxillary central incisor. Early diagnosis using cone-beam computed tomography prevented perforation and guided treatment planning. Non-surgical endodontic treatment was performed using a dental operating microscope, ultrasonic irrigation, and a hybrid obturation technique. The apical portion of the canal was sealed with a bioceramic sealer and single-cone gutta-percha, while the resorptive defect was filled with calcium-enriched mixture cement due to its biocompatibility and sealing properties. At one-year follow-up, the patient was asymptomatic, with radiographic evidence of healing. This case highlights the efficacy of combining advanced diagnostic tools, bioactive materials, and minimally invasive techniques for successful IRR management.

Dentin Dysplasia Type II (DD-II) is a rare genetic disorder that affects the coronal dentin, often leading to pulp stones and complicated endodontic treatment. This case report presents the endodontic management of DD-II in an 11-year-old female patient. The patient, referred for root canal treatment, exhibited symptoms of moderate pain and was diagnosed with pulp necrosis in tooth #19; radiographic findings revealed multiple pulp stones, pulp canal calcification, and apical radiolucency. Endodontic treatment was performed, involving the removal of pulp stones with ultrasonic tips, careful cleaning and shaping of the root canals, and obturation using gutta-percha and AH-26 sealer. Twelve months post-treatment, the patient showed complete healing of the apical lesion, with no related complications. This case underscores the importance of early diagnosis and timely endodontic intervention for favorable outcomes in patients with DD-II.

Introduction: This study aimed to assess the thermal behavior of five different commercial gutta-percha brands using optical thermography. We focused on temperature differences and heat transfer characteristics at different apical distances. Materials and Methods: Gutta-percha cones from the following brands were tested: Autofit Greater Taper, Protaper Gold F2, TruNatomy Prime, ZARC Gutta-percha points # 25/0.06, and Reciproc Blue R25. A specific heating system was used to subject the cones to thermal imaging. Measurements were taken at 1-, 2-, 3-, and 4-mm apical distances for 5 mm and 10 mm cone lengths. Statistical analyses included Student’s t-tests and Analysis of Variance with the significance level set at 0.05. Results: Upon intragroup comparison, we found subtle distinctions in thermal behavior when examining gutta-percha cone lengths (5 mm versus 10 mm). TruNatomy exhibited statistically significant variations (P<0.05) at 2- and 3-mm distances. Conversely, ZARC and Reciproc Blue R25 displayed notable differences (P<0.05) at 2-, 3-, and 4-mm distances. In contrast, Autofit Greater Taper and Protaper Gold F2 consistently diverged across all distances (P<0.05). In intergroup comparisons of 5 mm length, significant variances (P<0.05) emerged among brands at 1- and 2-mm distances. At 10 mm length, TruNatomy differed significantly (P<0.05) from other brands across all distances. The heat tip maintained an average maximum temperature of 154.54^°C. Conclusion: Thermal behavior of gutta-percha brands varied significantly, with implications for endodontic treatments. While differences were observed in heat transfer and maximum temperatures, all brands remained within safe temperature ranges for clinical use. Understanding these variations can aid clinicians in selecting appropriate gutta-percha for specific clinical scenarios, ultimately optimizing root canal obturation quality.

Bio-obturation is an innovative approach in root canal therapy that effectively addresses complex clinical challenges using bioactive endodontic materials. This report highlights 14 diverse cases where bio-obturation was employed to manage complications such as internal and external resorption, root perforations, draining sinus tracts, mechanical obstructions, and trauma-related injuries. The outcomes demonstrate notable healing and resolution of various tooth related pathologies in failed primary root canal treatments. Root perforations and canal blockages were successfully sealed, restoring the integrity of the root canal system and ensuring continued tooth function and retention. Bio-obturation facilitated stabilization and regeneration of periradicular and supporting tissues in trauma cases, including avulsed teeth and inflammatory root resorption. Cases involving open apices, dens invaginatus, and complex root canal anatomy also showed favorable results. Overall, bio-obturation offers a transformative alternative to conventional root canal filling by promoting enhanced biological sealing and improved periradicular healing, thus increasing the probability of sustainable long-term clinical success. While calcium-enriched mixture cement served as the bioactive material in these cases, this approach may also be effectively implemented using other advanced calcium silicate-based biomaterials, broadening its applicability in challenging endodontic scenarios.

Taurodontism is a dental anomaly characterized by an enlarged pulp chamber and apically displaced pulpal floor. This disorder poses significant challenges in endodontic treatment, especially when perforations occur. The present case study details the endodontic retreatment of a hypertaurodont maxillary second molar in a 36-year-old female patient with a mesial canal perforation. The procedure employed a dental operating microscope for enhanced visualization and precision. Canals were prepared using a crown-down technique, with the perforation site managed using MTA and bioceramic material applied via the second mesiobuccal canal. The remaining canals were obturated using gutta-percha and bioceramic sealer. At the 1-year follow-up, the tooth was functional and asymptomatic, with radiographic evidence of a normal periodontal ligament space. This case demonstrates the efficacy of contemporary endodontic techniques, including bioceramic materials and advanced magnification, in managing the unique challenges posed by taurodontism.

Restoring endodontically treated teeth (ETT) that exhibit cracks, enlarged roots, or weakened root walls is a frequent challenge in dental practice. The present study describes three cases in which contemporary restorative techniques were employed and suggests that applying Ribbond tape (RT) to ETT can improve fracture resistance and better prevent the propagation of cracks compared with traditional methods. Although extensive in vitro research has been conducted on fiber-reinforced composites, studies evaluating the clinical use and durability of fiber-reinforced composites to restore ETT are limited. This report strictly adhered to the case report (CARE) guidelines, and the treatments were initiated only after signed informed consents were obtained from the patients. Therefore, the old restorations were removed from the teeth that required intervention and composite resin core build-up was created, followed by endodontic treatments or retreatment. Subsequently, the endodontic accesses were reinforced with RT. The protective restorations were performed and bonded. The two-year follow-ups showed that the patients had complete remission of signs and symptoms, and they remain under monitoring. The study emphasizes the importance of internal reinforcement of ETT and strengthening weakened walls with a resin core build-up reinforced with fibers like RT. This approach enhances mechanical retention, inhibit fracture propagation, and establish a strong chemical bond between RT and resin. It is suggested to be a promising strategy for increasing the longevity and strength of the teeth, providing a conservative and effective alternative to traditional methods.

Taurodontism is a dental anomaly characterized by the absence of cervical constriction at the cemento-enamel junction, apical shifting of the pulpal floor, and an expanded pulp chamber. This condition presents unique challenges in endodontic diagnosis and treatment due to its variable morphology, deeply located orifices, and complex root canal system. This paper reports three cases of hypertaurodontism (Taurodont Index ≈ 50), including a maxillary first molar, mandibular third molar, and mandibular second premolar in systemically healthy patients. The identification and treatment planning were facilitated by cone-beam computed tomography (CBCT). Root canal therapy was performed under a dental operating microscope, with careful exploration, chemomechanical instrumentation using rotary files, copious irrigation with 5.25% sodium hypochlorite, and warm vertical obturation. Twelve months later, follow-up visits showed that all patients were clinically and radiographically asymptomatic, indicating successful outcomes. Taurodontism presents significant challenges due to its anatomical complexities. A multifaceted approach involving CBCT, dental operating microscopes, ultrasonic irrigation, and warm vertical obturation is recommended. This case series demonstrates that with advanced diagnostic aids and meticulous techniques, even hypertaurodontic teeth can be effectively managed.

Regenerative endodontic procedures (REPs) have emerged as a biologically driven approach for managing immature teeth with necrotic pulp and open apices, providing an alternative to traditional apexification techniques. This case report describes the successful treatment of a three-rooted immature mandibular first molar with necrotic pulp and chronic apical periodontitis in a 9-year-old patient using REPs. The treatment followed the guidelines set by the American Association of Endodontists and utilized a two-visit protocol. Concentrated growth factor (CGF) was employed as a biological scaffold in the root canals, while calcium-enriched mixture (CEM) cement was used for the coronal seal. Radiographic evaluations conducted at 6, 12, and 15 months revealed progressive periapical healing, significant root elongation, increased thickness of the root walls, and partial apical closure. Clinically, the patient remained asymptomatic during all follow-ups. This case highlights the potential of CGF and CEM cement-enhanced REPs to promote continued root development and achieve predictable outcomes in immature teeth with necrotic pulps, offering a biologically based alternative to conventional apexification.

In the article titled Revascularization of a Previously Treated Mandibular First Molar with Open Apices: A Case Report by Mojgan Feli, Anita Taheri and Mahgol Mehrabani, published in the Iranian Endodontic Journal [2024;19(2):120-123; doi: 10.22037/iej.v19i2.43321], the authors regret an omission in the acknowledgment section of the original publication.

Dens invaginatus is a developmental anomaly resulting from the infolding of enamel and dentin into the dental pulp. Oehlers’ Type IIIa dens invaginatus poses significant challenges due to its intricate anatomy and frequent association with immature teeth. This case report outlines the nonsurgical management of a nonvital immature maxillary central incisor with Type IIIa dens invaginatus, presenting with a chronic apical abscess and a history of trauma to the associated primary incisor. Treatment involved thorough chemomechanical debridement followed by bio-obturation using calcium-enriched mixture cement. Regular follow-ups revealed complete resolution of the periapical lesion. This case underscores the importance of precise diagnosis, individualized treatment planning, and the application of advanced biomaterials in addressing complex presentations of dens invaginatus. The successful outcome emphasizes the efficacy of nonsurgical techniques in preserving immature teeth while restoring function and aesthetics.

An acute apical abscess (AAA) is a rapid-onset inflammatory condition characterized by spontaneous pain, pus formation, and swelling, often resulting from pulp necrosis. Complications may include systemic manifestations and severe outcomes, such as tooth extrusion. This case report describes a rare instance of AAA causing rapid extrusion of a maxillary central incisor in a 17-year-old female. The patient presented with spontaneous pain and mobility of the extruded tooth, accompanied by localized swelling. Clinical and radiographic evaluations revealed pulp necrosis, an AAA, and apical bone rarefaction. Emergency treatment was initiated, including intracanal medication with calcium hydroxide and temporary splinting of the tooth. Subsequent treatment involved obturation with gutta-percha and sealer, followed by permanent restoration. Radiographic and clinical recalls up to 5 years demonstrated complete periapical healing, normal tooth mobility, and no recurrence of symptoms. Effective management, including timely root canal therapy and splinting, led to successful long-term outcomes. This case underscores the importance of prompt diagnosis and immediate, tailored treatment to manage AAA and prevent severe complications.

Dens invaginatus is a developmental malformation that is caused by the invagination of the enamel organ into the internal region of the dental papilla before tissue calcification. The aim of the present report is to discuss a clinical case of endodontic treatment of tooth #12, using bioceramic sealer. The extraoral examination revealed atypical anatomy, while vitality and percussion tests were negative, palpation test was positive. Edema was observed in the adjacent gingival mucosa. Based on clinical and tomographic findings, the diagnosis was pulp necrosis with chronic periapical abscess and Oehlers’ type II dens invaginatus. In the first session, access surgery was performed with spherical drills with the aid of an operating microscope (OM) and an ultrasonic diamond tip. Four canals were located, and they were partially debrided and medicated. In the second session, odontometry and chemical-mechanical preparation with nickel-titanium instruments were performed. The irrigation solution was 2.5% sodium hypochlorite. The root canals were filled with calcium hydroxide paste and the chamber was temporarily sealed. During the third session, ultrasonic irrigation was applied for final washing and the root canals were filled with Bio-C sealer using the classic single-cone technique. At 6-month follow-up, the tooth was asymptomatic and the radiography revealed significant bone repair. It was concluded that tomography, operating microscope, ultrasonic irrigation, and materials with greater flow, such as bioceramic sealers, enhanced the clinical success of the clinical case.

Permanent maxillary second molars’ root canal treatment due to their root configurations complexity and high root canal systems variations, are one of the most problematic teeth. Accordingly, clinicians should consider unusual canal morphology to reduce the rate of missed canals.  A thirty-year-old female was referred for root canal treatment of her maxillary right second molar tooth with obvious recurrent caries under restoration and necrotic pulp. Pre-operative radiographs showed the unusual morphology and cone-beam computed tomography was ordered for precise evaluation of the root canal anatomy. The principal aim of this paper is to report a five-root canals maxillary second molar, with two palatal root canals and a palatal root-like enamel pearl canal.

Paresthesia is described as a burning or prickling sensation or partial numbness caused by neurologic injury. The sensory loss may be the result of a reversible and/or irreversible nerve damage, and it can be caused by local or systemic factors. Local factors include traumatic injuries caused by impacted teeth, local injection, endodontic therapy, implant placement and exposure to toxic materials. This article reports a paresthesia by anesthetic injection. A 44-year-old man reported moderate pain during chewing and exposure to cold. Upon clinical examination, extension of the tooth fracture line was in the mesiodistal region of the mandibular left second premolar crown and was detected with 16× magnification of microscope. The diagnosis was cracked tooth syndrome, and root canal treatment was indicated. After the first appointment the patient reported altered sensation on left side of mandible, numbness and electric shock sensation, and therefore was diagnosed with mental nerve paresthesia. Diclofenac sodium, thiamine, cyanocobalamin, and pyridoxine were prescribed for 7 days as part of the treatment, and then root canal and restorative treatments were completed. Patient was scheduled for follow-up appointments after 1, 3, 6, and 8 months. After the first month, the feeling of paresthesia was still present and the patient was experiencing a painful “electric shock”. At the 8-month follow-up visit, the paresthesia had been resolved with return of normal sensation.

Introduction: The middle mesial canal (MMC) of mandibular molars is of particular interest in endodontics due to its complexity. This study investigated the association between MMC presence in first and second mandibular molars and the radiolucency in the furcation area using cone-beam computed tomography (CBCT) scans. Materials and Methods: CBCT scans of 400 patients referred to the largest radiology center in Kerman City from January 1, 2022, to January 1, 2023, were examined. All CBCT scans were assessed for radiolucency in the furcation area and the presence of MMC. Variables, including age, gender, tooth number, and MMC presence were recorded. Chi-squared tests and logistic regression analyses were employed to compare MMC frequency and its impact on furcation radiolucency. Results: Of 201 examined teeth, 37 (18.4%) had MMC, and 23 (11.4%) exhibited furcation radiolucency. However, teeth with a mesial canal showed a higher prevalence of furcation lesions compared to those without (38% vs. 5.2%) (P<0.001). A significant association was observed between a mesial canal and furcation radiolucency, with odds of furcation radiolucency at 12.7 after controlling for age and gender (P<0.001). Conclusion: A strong association exists between MMC presence in first and second mandibular molars and furcation radiolucency, unaffected by age and gender.

Introduction: This systematic review compared the accuracy of guided endodontics with the conventional method in non-surgical endodontic retreatment. Methods: Two reviewers conducted a systematic search across PubMed/MEDLINE, Scopus, Embase, and Web of Science databases. Inclusion criteria consisted of all in vitro studies up to October 2024 that documented the application of cone-beam computed tomography in creating a guide for endodontic retreatment cases. The reviewers assessed the quality of the selected studies using the QUIN tool. Data regarding the first author and publication year, sample size, tooth type, retreatment application, computer-aided navigation technique, groups, image acquisition method, outcome measures, guided technique results, conventional technique results, and the main results were extracted using a predefined template. Results: Based on our criteria, seven studies were included in this review. The studies demonstrated variability in the techniques utilized. Iatrogenic errors were less frequent in guided groups, regardless of the operator’s level of experience. Most studies indicated that guided endodontics was more effective than conventional methods, particularly in fiber post-removal and access through MTA, minimizing volumetric loss of tooth structure, and preserving fracture resistance. However, when using guided techniques for removal of separated instruments, more iatrogenic errors occurred, and more time was required compared to the freehand technique. Conclusion: Guided endodontics has shown promise in improving the outcomes of non-surgical retreatment by reducing complications. However, as all included studies were in vitro, clinical evidence is lacking, and the generalization of these results should be done cautiously. Further well-designed clinical studies are required to confirm these findings.

Vital pulp therapy (VPT) comprises a range of conservative treatment modalities aimed at preserving the vitality of the compromised dental pulp in primary and permanent teeth. This PubMed-based review comprehensively evaluates seven distinct VPT techniques; including their historical development, broad definitions, clinical protocols and treatment outcomes as evidenced by systematic reviews and meta-analyses. The VPT modalities covered in this review include stepwise excavation, indirect pulp capping, direct pulp capping, miniature pulpotomy, partial pulpotomy, full pulpotomy and partial pulpectomy. Stepwise excavation, as a minimally-invasive option, has demonstrated effectiveness in reducing the risk of pulp exposure, particularly in permanent teeth. Clinical outcomes of indirect and direct pulp capping are promising; specifically with the application of advanced calcium silicate cements. Miniature and partial pulpotomies emphasize the importance of precise definitions and standardised protocols due to their subtle differences. Full pulpotomy has emerged as a viable alternative to root canal treatment, achieving comparable success rates in managing irreversible pulpitis. While partial pulpectomy remains the most invasive approach, it has shown potential in managing complex cases, such as root resorption, through selective tissue preservation. Despite advancements in biomaterials and technique standardisation, challenges remain, including variability in clinical protocols, limited high-quality evidence, and the need for long-term studies to better evaluate anticipated outcomes. Nevertheless, emerging biotechnologies hold promise for enhancing the precision and predictability of VPT procedures in the future.