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Achieving an apical seal is critical for apexification treatment of nonvital immature teeth. While this is commonly accomplished using biocompatible mineral trioxide aggregate (MTA), its limitations, such as prolonged setting time, discoloration, and challenging handling, have driven the search for alternative materials. This study aimed to compare the clinical and radiographic success of bioceramic putty Well-Root PT apical plug compared to MTA in the treatment of nonvital immature permanent incisors. Fifty immature nonvital maxillary permanent central incisors in thirty-eight children aged 8–11 years were randomly divided into two groups (25 teeth/group). Group I received MTA apical plugs, and Group II was treated with Well-Root PT apical plugs. Both groups were recalled at 6 and 12 months for clinical and radiographic evaluations. Statistical analysis was done for the gathered data. Both groups showed improved clinical signs and symptoms during all follow-up periods with no statistically significant difference. Regarding the periapical radiolucency (PAR) area, at twelve months, the mean PAR area in the Well-Root PT group was (0.14 ± 0.08) compared to (2.3 ± 0.9) in the MTA group, with highly statistically significant differences (p < 0.001). The mean periapical bone radiodensity in the Well-Root PT group was (178.2 ± 5.4) compared to (164.8 ± 9.4) in the MTA group at twelve-month follow-up, with highly statistically significant differences(p < 0.001). Well-Root PT, with its reduced technical sensitivity, demonstrates satisfactory clinical and radiographic success as an apical plug for nonvital immature permanent incisors compared to MTA.

Background Dental caries in first permanent molars (FPMs) constitutes a worldwide health concern. Managing FPMs with deep dental caries in children poses a significant struggle for dental practitioners. The objective of this research is the clinical and radiographic evaluation of composite CAD/CAM endocrowns as restoration versus stainless steel crowns (SSCs) for endodontically treated FPMs in children. Patients and methods This pilot study evaluated 24 children with deep caries in FPMs attending the dental clinic of Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Cairo University, Egypt. They were randomly assigned to receive either a composite CAD/CAM endocrown (Group I) or an SSC (Group II). Clinical evaluations (postoperative pain, crown retention, patient/parent satisfaction) were performed at one week, three, six, nine, and 12 months. Radiographic assessments (tooth fracture) were done at one week, six months, and 12 months. Results Prior to the intervention, no statistically significant differences were observed between the two groups. No significant differences in postoperative pain scores were observed between groups. Both groups showed good crown retention, with one clinical failure in each group. Patient satisfaction was higher for endocrowns compared to SSCs at three, six, nine, and 12 months. No root fractures were observed in either group. Conclusion Both composite CAD/CAM endocrowns and SSCs showed similar clinical and radiographic outcomes, except for patient satisfaction. Clinicians may consider composite CAD/CAM endocrowns if patient satisfaction is the primary concern. Trial registration Current Controlled Trial NCT05250609. Registered on 22/02/2022, retrospectively registered. https://clinicaltrials.gov/study/NCT05250609 .

Background Restoring first permanent molars after endodontic treatment in children is challenging. Improved mechanical properties and adhesion of ceramic materials have led to the emergence of endocrown as a conservative and esthetic restorative option for endodontically treated molars in adults and offer dentists a restorative treatment for endodontically treated first permanent molars in children. The purpose of this study was clinical and radiographic evaluation of both endocrowns fabricated from 2 different materials and SSCs restoring endodontically treated first permenant molars in children over one year. Methods Thirty children were selected (18 girls and 12 boys) with an age range of 10–13 years old, with an endodontically treated first molar. Children were randomly divided into 3 groups: PMC group (restored with preformed SSCs), EMX group (restored with litium disilicate endocrown), and COP group (restored with indirect reinforced composite endocrown) ( n  = 10). Evaluation was done in terms of parent satisfaction, radiograph (base line and 12 months), the restoration survival after 12 months, plaque index (PI), and gingival index (GI) at base line, 6 months, and 12 months.The data were analyzed using the Kruskal-Wallis H-test, which was used to compare an ordinal variable, and Friedman’s test was used to compare an ordinal variable ( P  ≤.050). Results Parent satisfaction showed statistically significant differences between PMC (mean rank = 7.5) and both EMX and COP (mean rank = 19.5) ( P  <.001), but not between the EMX and COP groups ( P  = 1.00). At 6 and 12 months, the PMC group’s PI values were statistically significantly higher than those of the EMX and COP groups ( P  =.001 and P  <.001, respectively). The GI values of the EMX and COP groups did not change significantly through different intervals ( P  = 1.000 and P  =.135, respectively), whereas the GI values of the PMC group did ( P  =.050). At various intervals, it was found that there was no significant difference in the GI values between the three groups. Conclusions The survival rates of endorowns and SSCs were comparable. Compared to SSCs, endocrowns demonstrated a higher parental satisfaction, less plaque buildup, and improved gingival response. Trial registration The study protocol was retrospectively registered on Clinical Trials under No. (NCT06432049-29/05/2024).

Objectives This study evaluated factors associated with vertical root fracture in endodontically treated teeth, using a cone-beam computed tomography (CBCT) image database. Materials and methods The sample for this case-control study consisted of 81 CBCT scans of teeth with vertical root fracture (VRF) and 81 CBCT scans of non-fractured teeth, matched by age, sex, and tooth position. The analyzed variables included dentin thickness, an intraradicular post, an adjacent implant, and a missing adjacent tooth. Student’s t test test was used to compare the quantitative variables. The chi-square test was used to compare the categorical variables. Logistic regression was performed to evaluate the association between the presence of VRF and the independent factors assessed. Results The mean dentin thickness of fractured teeth was 1.3 mm, whereas that of non-fractured ones was 1.5 mm ( p  < 0.001). There was no difference between the fractured and non-fractured groups, regarding implant frequency or missing adjacent tooth ( p  > 0.05). There were a significantly larger number of teeth with posts in the fractured versus non-fractured group ( p  = 0.007). However, dentin thickness ≤ 1.3 mm was the only factor associated with VRF in the multiple regression model (OR = 3.60, 95%CI = 1.76–7.37). Conclusions Dentin thickness may influence the development of VRF. Dentin thickness ≤ 1.3 mm is associated with a greater likelihood of fracture than ≥ 1.4 mm. Clinical relevance This study suggests there may be a minimum amount of safe dentin thickness that should be preserved after endodontic instrumentation.

Progress in endodontic techniques and methodological advances have altered root canal therapy over the last decades. These techniques and methods need periodical documentation. This observational study determined the current prevalence of endodontic treatments, and investigated the relationship of various factors with the periapical status in a Lower Austrian subpopulation. One thousand orthopantomograms of first-time university adult patients radiographed at an outpatient clinic were evaluated. For each tooth, the presence of periradicular pathosis and/or endodontic treatment was recorded, as was the quality of (post-)endodontic treatment (homogeneity and length of root canal fillings; preparation failures; posts/screws; apicoectomies; coronal restorations). Two evaluators, blinded to each other, scored all teeth. In cases of disagreement, they joined for a consensus score. In all, 22,586 teeth were counted. Of these, 2,907 teeth (12.9%) had periapical pathosis, while 2,504 teeth had undergone root canal treatment. Of the endodontically treated teeth, 52% showed no radiographic signs of apical periodontitis, while 44.9% had overt apical lesions, and 3,1% revealed widened periodontal ligament space. The majority of the root canal fillings was inhomogeneous (70.4%); 75.4% were rated too short, and 3.8% too long. The presence of apical pathosis was significantly correlated (odds ratio (OR) 2.556 [confidence interval (CI) 2.076-3.146]; P<0.0001) with poor root canal fillings (length and homogeneity). Posts or screws positively affected periapical status (OR 1.853 [CI 1.219-2.819]; P = 0.004), but endodontically treated posterior teeth were infrequently restored (posts, 7.5%; screws, 2.7%). Best results were found for teeth with both appropriate endodontic treatment and adequate coronal restoration. A high prevalence of periradicular radiolucencies was observed with root canal filled teeth, along with high numbers of unmet treatment needs. Periapical health was associated with adequate root canal obturation and high-grade postendodontic restorations, and quality regarding these latter aspects is considered mandatory to promote periapical health.

Aim To evaluate the influence of different levels of metal artifact reduction (MAR) tool and milliamperage (mA) on the diagnosis of fracture extension in endodontically treated teeth using cone beam CT (CBCT). Materials and methods Ten maxillary premolars were endodontically treated and positioned in the empty sockets of a human maxilla covered with wax. CBCT acquisitions were performed using the Eagle Edge device (Dabi Atlante, Brazil) adjusted to 120 kVp, FOV of 4 × 6 cm, exposure time of 24 s and voxel size of 0.2 mm in 8 different conditions with different MAR (1, 2 and 3) and mA (3.2 and 6.3) levels. Crown-root fractures were simulated in the universal testing machine, and CBCT images were acquired again. Five radiologists evaluated the presence and extension of fractures with a 5-point scale. Statistical analysis was performed by analysis of variance, Tukey and Kappa test (α = 0.05). Results Although different mA levels did not significantly ( p  > 0.05) affect the diagnosis values for fracture presence and extension, when evaluated the different levels of MAR, AUC and sensitivity showed significantly higher values ( p  < 0.05) for MAR 0 using 6.3 mA and kappa agreement showed significantly higher values ( p  < 0.05) for MAR 0 and 2 using 6.3 mA. Conclusions Although mA levels do not have a diagnostic effect when isolating the MAR level; in 6.3 mA, MAR 0 and 2 can positively influence the diagnosis of fracture extension in endodontically treated teeth using CBCT. Clinical relevance The isolate evaluation of dental fracture presence can overlook diagnostics error of its extension.

Background This investigation compared the extent of external apical root resorption (EARR) in root-filled teeth (RFT) and their contralateral vital pulp teeth (VPT) counterparts during orthodontic treatment (OT) with clear aligner (CA) treatment or fixed appliance (FA) treatment. Methods Sixty-six patients with similar baseline American Board of Orthodontics (ABO) discrepancy index scores were divided into two groups: 37 patients (21 females, 16 males; mean age 17.45 ± 2.67 years) in the FA group, and 29 patients (18 females, 11 males; mean age 18.33 ± 1.96 years) in the CA group. Digital panoramic radiographs captured pre- and post-OT were used to measure tooth lengths and root surface measurements in mandibular molars. EARR in both RFT and contralateral VPT was evaluated pre- and post-OT. Statistical analysis employed paired t-tests, independent t-tests, and analysis of covariance (ANCOVA) ( p  < .05). Results All teeth exhibited varying degrees of EARR following OT. FA treatment resulted in significantly longer treatment duration ( p  < .05) and greater EARR compared to CA treatment ( p  < .05). Moreover, statistically significant differences in EARR were observed within both groups between RFT and VPT ( p  < .05). Conclusions Comparison of pre- and post-OT radiographs revealed different degrees of EARR in all teeth. CA treatment resulted in less frequent and less severe EARR compared to FA treatment. RFT demonstrated greater resistance to EARR than VPT in both treatment groups.

ObjectivesThe aims of this study are to identify the most frequent technical errors in endodontically treated teeth and to determine which root canals were most often associated with those errors, as well as to relate endodontic technical errors and the presence of coronal restorations with periapical status by means of cone-beam computed tomography images.MethodsSix hundred eighteen endodontically treated teeth (1146 root canals) were evaluated for the quality of their endodontic treatment and for the presence of coronal restorations and periapical lesions. Each root canal was classified according to dental groups, and the endodontic technical errors were recorded. Chi-square’s test and descriptive analyses were performed.ResultsSix hundred eighty root canals (59.3%) had periapical lesions. Maxillary molars and anterior teeth showed higher prevalence of periapical lesions (p < 0.05). Endodontic treatment quality and coronal restoration were associated with periapical status (p < 0.05). Underfilling was the most frequent technical error in all root canals, except for the second mesiobuccal root canal of maxillary molars and the distobuccal root canal of mandibular molars, which were non-filled in 78.4 and 30% of the cases, respectively.ConclusionsThere is a high prevalence of apical radiolucencies, which increased in the presence of poor coronal restorations, endodontic technical errors, and when both conditions were concomitant. Underfilling was the most frequent technical error, followed by non-homogeneous and non-filled canals.Clinical relevanceEvaluation of endodontic treatment quality that considers every single root canal aims on warning dental practitioners of the prevalence of technical errors that could be avoided with careful treatment planning and execution.

Background Orthodontically induced root resorption (OIRR) is a common side effect of orthodontic treatment. This study compares the degree of OIRR between root-filled teeth (RFT) and vital pulp teeth (VPT), and analyzes relevant study variables. Methods We conducted a retrospective study on 69 patients who had undergone orthodontic treatment. Using Cone-beam computed tomography (CBCT), we measured changes of root length before and after treatment through a unique method involving three-dimensional (3D) image registration and superimposition. Factors related to the OIRR such as gender, type of treatment, tooth type, age, duration of treatment and distance of root movement were considered. Results The sample included 55 females and 14 males aged 27.19 ± 6.08 years. On the basis that there was no significant difference in the root movement distance between RFT and VPT, RFT showed significantly less OIRR than VPT ( P  < 0.05). Gender did not significantly impact on OIRR for either RFT or VPT group ( P  > 0.05). In women specifically, RFT displayed less resorption than VPT ( P  < 0.05). For treatment type, extraction cases demonstrated a lower degree of OIRR in RFT than VPT ( P  < 0.05), and notable greater OIRR in with-extraction group compared to no-extractions group was found in RFT ( P  < 0.05), but not in VPT ( P  > 0.05). Tooth type did not yield significant differences in OIRR overall; however, upper teeth and premolars experienced lower resorption in RFT than in VPT ( P  < 0.05). Cases treated with fixed appliance had higher OIRR in both RFT and VPT than those with clear aligners ( P  < 0.05). Age did not correlate significantly with OIRR for either group ( P  > 0.05). And duration of treatment positively correlated with OIRR for both types (RFT: r = 0.5506, P  < 0.0001; VPT: r = 0.4371, P  = 0.0002), so did root movement distance (RFT: r = 0.2955, P  = 0.0140; VPT: r = 0.2790, P  = 0.0206). Conclusions RFT exhibit significantly less OIRR than VPT after orthodontic treatment. Treatment type, appliance type, duration of treatment and root movement distance are significant factors influencing OIRR. Personalized orthodontic treatment plans and vigilant monitoring are crucial to mitigate OIRR risks.

Purpose This study aimed to evaluate the accuracy of detecting vertical root fractures in Biodentine™-filled teeth using the Promax 3Dmax cone-beam computed tomography (CBCT) unit compared to periapical radiographs. It tested hypotheses regarding CBCT’s diagnostic superiority in non-root-filled and Biodentine™-root-filled maxillary central incisors and assessed the impact of smaller field of view and lower intensity settings on detection accuracy. Materials and methods Extracted maxillary incisors were divided into groups based on fracture status and root filling material, then placed in a Thiel-embalmed skull to simulate clinical conditions. The teeth were imaged using periapical radiographs and the CBCT unit under different settings. Fracture thickness was measured with microcomputed tomography for accuracy benchmarking. Multiple observers assessed the images, and statistical analyses were conducted to evaluate diagnostic performance. Results Intra-rater reliabilities of consensus scores ranged from good to very good. Specificities were generally higher than sensitivities across all imaging modalities, but sensitivities remained constantly low. None of the Area Under the Curve scores exceeded 0.6, indicating poor overall accuracy for all imaging modalities. Paired comparisons of the area differences under Receiver Operator Characteristic curves revealed no significant differences between the CBCT and periapical radiograph techniques for detecting vertical root fractures in either Biodentine™-filled or non-root-filled teeth. Conclusions There was no significant accuracy improvement of the current CBCT device (Promax 3Dmax, Planmeca, Finland) over periapical radiographs in detecting small vertical root fractures in both non-root-filled and Biodentine™-root-filled maxillary central incisors. A smaller field of view with lower intensity did not enhance detection accuracy. These results highlight the challenges in accurately detecting small VRFs, emphasizing the need for further research and technological advancements in this domain.