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Challenges and Opportunities in Endodontics

Challenges and Opportunities in Endodontics

Garapati, H., Rajasekhar, V., Naidu, S. S., Bhavana, K. S., Balaraju, K., & Darla, S. (2023)


Endodontic therapy is only successful in the long run if the tooth is suitably rehabilitated. Although countless studies on various types of post and core have been conducted, there is a paucity of studies on customizing post and core with digitalization to eliminate the hassle of impression-making emphasizing the need for the development of strategic techniques. 

This article aims to present a novel technique that combines the advantages of pre-fabricated post, in terms of saving clinical time, yet achieving the custom fit of post and core utilizing a digital approach. Further, this study emphasizes two case reports employing the same technique of customizing post and core utilizing Cone Beam Computed Tomography.

A compact run-through for the fabrication of a Digi Post prologues with the preparation of the post space, Standard Tessellation Language (STL) file is attained by converting the Digital Imaging and Communications in Medicine (DICOM) file of a Cone Beam Computed Tomography scan, in which the post can be designed digitally. This innovative technique allows practitioners to perform post-endodontic rehabilitation with greater confidence, simplicity and precision.

Gaeta, C., Malvicini, G., Mignosa, E., Cecot, G., Grandini, S., & Marruganti, C. (2023)


The present ex vivo study evaluated the influence of periodontal ligament simulation, load inclination, and tip morphology on fracture strength test results on intact premolars. Forty maxillary premolars were divided into four groups, Group 1, with a 90° load inclination, spherical tip with a diameter of 3mm and periodontal ligament simulation (PDL+); Group 2, with a 90° load inclination, flat tip with a diameter of 2mm, PDL+; Group 3, with a 45° load inclination, flat tip with 2mm of diameter, PDL+; Group 4, 90° load inclination, spherical tip with 3mm diameter, without periodontal ligament reproduction. Interactions among variables and intergroup significance were tested with Wilcoxon rank-sum and Kruskal Wallis’s tests (p≤0.05). Statistically significant differences were found between groups B and C, but they were not found for the others. A 90° load inclination significantly increases fracture strength, while periodontal ligament simulation and tip morphology did not significantly influence the results.

Jakkamsetty, C., Garapati, H., Seera, S., Balaraju, K., & Kalla, B. (2023)


Introduction: Teeth with a final post-endodontic restoration cannot support significant structural loss brought on by fracture, caries, big pre-existing restorations, or aggressive cavity preparation. Post and core restoration allows for the restoration of such teeth. Reduced dentine size, moisture, and compromise on supporting structures such the oblique bridge, marginal ridges, and pulp chamber roof result in a reduction in their resistance because of structural loss. Under such circumstances, choosing a good post-endodontic restorative material can be difficult.

Materials and Methods:

In terms of post-treatment procedures, 40 single-rooted decoronated mandibular premolar teeth were endodontically treated and randomly divided into four groups. As a control, the first group had a composite core but no post; groups two and three had prefabricated metal threaded posts; group four had prefabricated hybrid posts. The posts were affixed using dual-cure resin cement, and the core build-up material was nano composite. Each group’s core structure was standardised, and metal crowns of the same size were used to reinforce it. A universal testing machine was used to test every specimen, and the fracture load was tabulated.

Statistical analysis used: one way ANOVA analysis

Results: The highest failure load was found with prefabricated hybrid post. This group had significantly higher load compared to other post groups. Followed by prefabricated fibre post and prefabricated metal threaded post.

Conclusions: Fracture resistance of endodontically treated teeth reinforced with hybrid post showed significant values when compared to that of prefabricated glass fiber posts, prefabricated threaded post and control teeth.

Susila, A. V. (2023)


Matrix metalloproteinase inhibition and antimicrobial properties are important in many applications in the field of Conservative Dentistry and Endodontics to preserve the quality of dentin in a bond or to prevent reinfection and failure in root canal treated teeth. Many natural products are being explored for the above properties as they are safer compared to synthetic ones.

Aim: Present study aims to check for the antibacterial action of small onion and large onion peel extracts against Enterococcus faecalis (E. faecalis), Streptococcus mutans (S. mutans), and their Matrix metalloproteinase inhibitory action.

Materials and methods: Ethanolic extracts of small onion and large onion peels were prepared and their Minimum inhibitory concentration, Minimum bactericidal concentration, and zone of inhibition determined. Computational Drug Designing and Characterization of Phytocompounds present in the extract was done by Gas Chromatography-Mass Spectrometry Profiling. Ultraviolet-visible spectrophotometric analysis and Fourier transform infrared spectroscopy were performed for the characterization. Molecular docking (in-silico) was performed using AutoDock open source free software by using editing options and other default parameters for enzymatic interactions and affinities.

Results: Both onion peel extracts had good antibacterial properties against both S mutans and  E faecalis as determined by their Minimum inhibitory concentration, Minimum bactericidal concentration, and zone of inhibition. They were found to have many phytochemicals notably, β-sitosterol and quercetin. Small onion peel extract had greater quantities of β-sitosterol and quercetin than large onion peel extract in Gas Chromatography-Mass Spectrometric analysis. Ultraviolet-visible spectrophotometry revealed that the extracts were transparent in the wavelength range studied and had the characteristic peaks. Fourier transform infrared Spectroscopy  confirmed the presence of benzene derivative and anhydride. Molecular docking for enzymatic inhibition using in-silico docking study found that both the extracts have Matrix metalloproteinase 2 & 9 inhibition equivalent to control Galardin.

Varghese, M. J. A., BDS; Rajendran, J. F., BDS; Anand, V. S., MDS, PhD; Aruna Kumari, V., MDS; & Shamini, S., MDS. (2024)


Aim: Intentional Root canal treatment of abutments is preferred by many prosthodontists to satisfy the principles of parallelism and line of draw before construction of fixed partial dentures. However, intact non-supra-erupted and non-tilted teeth need not be devitalized as this weakens the abutment. Hence this systematic review was undertaken to understand if the success of fixed partial denture improves with devitalized abutments.

Materials and Methods: The systematic review was done according to the PRISMA guidelines 2020. The databases searched were PubMed, Cochrane and Google Scholar. New castle Ottava scale of risk of bias tool was used for assessing the bias. Certainty of evidence was assessed using GRADEpro. Studies eligible for Meta-analysis was evaluated using Forest plot.

Results: Eleven studies were selected for the systematic review. None of the studies found non vital abutments to be superior to vital abutments in the survival or longevity of FPDs. All the studies included in the review either concluded that vital abutments improved the longevity/survival of FPDs and decrease the risk of complications or that there was no significant difference between vital and non-vital abutments for the success of FPDs. Meta-analysis was done for 8 eligible studies using Forest plot.

Conclusion: Endodontically treated abutments are not favorable for the longevity/survival of FPDs and they present with more risk of hazards/complications. Therefore, vitality of the abutment should not be sacrificed unless there is a questionable pulpal and/or periapical diagnosis preoperatively.

Patil, P., Banga, K. S., Metkari, S., Sheth, K., Sachdev, S. S., & Latke, S. (2023)


Introduction: The canal-centering ability of an endodontic file is the ability of a file to maintain its path centered through the root canal without causing transportation. Various researchers have attempted to compare the canal-centering ability of the different file systems used routinely in endodontic practice. The present systematic review aimed to comparatively analyze the canal-centering ability of the various endodontic file systems.

Methods: A systematic search was performed using the keywords ‘Canal centering ability’ and ‘Endodontics’ across the databases Medline, PubMed, PubMed Central, Web of Science Citation Index Expanded, and Google Scholar to identify studies related to canal-centering ability of various file systems in endodontic treatment or re-treatment in English language without any restriction for the date of publication.

Results: A total of 22 studies were identified, most of which utilized human extracted teeth for analyzing the canal-centering ability. The mesial root of the mandibular first molars was most commonly used, with the mesiobuccal canal being commonly chosen to compare the canal centering ability. No significant difference was found between the canal-centering ability of reciprocating and continuous rotary file systems. The individual conclusions regarding comparisons made between respective file systems in each study have been summarized in the text.

Conclusion: The canal-centering ability of various endodontic file systems does not depend on the speed or motion of the file but is a derivative of multiple factors including geometry, composition, size, and shape of the files. Findings from the present systematic review would serve as a guide for an appropriate selection of the files to be used in cases with challenging canal morphology requiring endodontic treatment.

Shetty, V., Chudasma, K., Barik, S., Patil, S., Shetty, H., & Sachdev, S. S. (2023)


Aim: The present study aims to assess the color stability of nano-filled composite resin polished using three different polishing systems (Sof-lex, Enhance, and mylar strip) and stained with commonly consumed discoloring agents (tea, dal, and Coca-Cola) in India.

Materials and Methods: 120 Disc-shaped samples were prepared and divided into polishing groups, with each group subjected to specific polishing procedures. After baseline measurements, samples were immersed in staining solutions, and color differences were measured by a spectrophotometer to assess discoloration.

Results: Statistical analysis revealed significant staining differences among the polishing groups (P<0.001 by ANOVA). Group 3 (Enhance) exhibited higher staining compared to Group 2 (Sof-Lex). Dal caused significantly greater staining compared to other agents in all groups. The staining potential of beverages ranked as Dal > Tea > Distilled water ≥ Coca-Cola.

Conclusion: This study highlights the impact of polishing systems on the color stability of nano-filled composite resin restorations when exposed to common discoloring agents. The findings underscore the importance of selecting appropriate finishing and polishing techniques to mitigate discoloration risks, particularly in the context of varied staining potentials of different agents. This knowledge contributes to improving clinical practices for enhancing the long-term aesthetic outcomes of composite resin restorations in dental applications.

Susila, A. V., & Balasubramanian, V. (2023)


Objectives: Assess the thermal and hydrolytic stability of patented macromer- based dental polymer matrices and composites

Methods: Polymer matrices and composites based on a patented material (IP:343192) containing hybrid amorphous macromers co-polymerized with one of the 4 different dimethacrylates was prepared and the thermal and photo-thermal behavior were assessed. Diffusivity resistance and cross-link density of polymers were assessed. Sorption (𝑆(𝑡), 𝑀𝑔%(𝑡) 𝖠 𝑆%(𝑡)and solubility (𝑆𝐿(𝑡) 𝖠 𝑆𝐿%(𝑡) of composites in chloroform (CHCl3), tetrahydrofuran (THF), carbon tetrachloride (CCL) and acetone (Ace) for varying durations (1h, 24h 1mo), and deionized water for 120h were determined.

Results: Dual Tg were noticed for both the matrices and composites; matrices containing BisGMA (G) and UDMA (U) as the dimethacrylate co-polymer showed significantly lower𝑆𝐿(𝑡). Matrix containing TEGDMA (T) as the dimethacrylate co-polymer showed the least 𝑆(𝑡). Matrix containing BisEMA (E) had the highest cross-link density. photo-DSC of composites showed a Degree of Conversion of 97% at lower enthalpies (15-28J/g). None of the composites showed water solubility. All materials showed solubility in acetone with U being the least. Sorption and solubility in other organic solvents was lower and occurred only at longer immersion time.

Conclusions: Amorphous hybrid macromer-based polymer matrices and composites show promising thermal and hydrolytic behavior.

Alharbi, M. A. (2023)


Introduction: Intentional replantation is a clinical procedure in which a tooth is extracted and then replanted back into its original socket after root end endodontic treatment. This procedure is typically performed as a last resort when other treatment options, such as root canal therapy or apical surgery are not feasible or have failed. The success of intentional replantation depends on several factors including the length of time the tooth was out of the socket, the condition of the root surfaces and the skills of the clinician.

This retrospective case series aimed to assess the success rate of the intentional replantation procedures done in the Endodontic Department at the University of Pennsylvania and a faculty endodontic practice.

Methods: Thirty teeth met the inclusion criteria. Teeth were a-traumatically extracted. All the procedures were done under high-power magnification with the use of the surgical operating microscope. Teeth were kept hydrated with Hank’s Balanced Salt Solution. Contemporary root end surgery was performed on the teeth outside the socket. Retrograde preparation and filling were performed with the use of Mineral Trioxide Aggregate or Endosequence Bioceramic Putty. The outcome of IR was determined by clinical and radiographic evaluation. The cases were categorized as completely healed, healing, or failed.

Results: Teeth with a minimum of 6 months follow up were included in the study. The mean follow-up period was 18 months.  Twenty-two out of the thirty teeth showed complete healing, four were healing and four were considered failures. The overall success rate of the cases was 86.7%

Conclusion: Despite the small sample size, our results showed that intentional replantation is a reliable and predictable procedure; when indicated, with a very high success rate if it was done correctly in a timely manner and the periodontal ligament integrity was preserved as much as possible.

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