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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.

The aim of this study was to evaluate the foraminal enlargement and its influence on microcrack formation and apical transportation in root canals with apical curvature. Eighteen maxillary lateral incisors with apical curvature were selected by using micro-CT images. Root canals were randomly divided in two groups (n = 9) according to root canal preparation using two working lengths: 1 mm short of the apical foramen (control group) and 1 mm beyond the apical foramen (foraminal enlargement). For both groups Reciproc Blue R40 was used for root canal instrumentation. Specimens were scanned by nano-CT (UniTOM HR) before and after root canal preparation. Percentage, length, and width of microcracks, and apical transportation were assessed. Kappa, chi‐square and McNemar tests were used for qualitative analyses while paired and unpaired t-test were used for quantitative analyses (α = 0.05). For both groups, rather similar and low percentages of microcracks were observed before root canal preparation (P > 0.05). The foraminal enlargement promoted new microcracks, not observed in the control group. An increase in microcrack length was observed when the foraminal enlargement was performed (P < 0.05). Higher apical transportation was observed when foraminal enlargement was performed (P < 0.05). Foraminal enlargement using a heat-treated reciprocating file size 40 promoted microcracks and higher apical transportation than root canal preparation up to 1 mm short of apical foramen.

Objective The aim of the present pilot study was to assess the effectiveness of the platelet-rich fibrin (PRF) apical barrier for the placement of MTA for the treatment of teeth with periapical lesions and open apices. Methods A total of thirty teeth on twenty-eight patients with open apices and periapical periodontitis were enrolled and divided into two groups in the present pilot study. In the PRF group (fourteen teeth in thirteen patients), nonsurgical endodontic treatment was performed using PRF as an apical matrix, after which the apical plug of the MTA was created. For the non-PRF group (fourteen teeth in fourteen patients), nonsurgical endodontic therapy was performed using only the MTA for an apical plug with no further periapical intervention. Clinical findings and periapical digital radiographs were used for evaluating the healing progress after periodic follow-ups of 1, 3, 6, and 9 months. The horizontal dimension of the periapical lesion was gauged, and the changes in the dimensions were recorded each time. The Friedman test, Dunn-Bonferroni post hoc correction, and Mann-Whitney U test were used for statistical analysis, with P  < 0.05 serving as the threshold for determining statistical significance. Results All patients in both groups in the present pilot study had no clinical symptoms after 1 month, with a significant reduction in the periapical lesion after periodic appointments. The lesion width of the PRF group was significantly smaller than that of the non-PRF group in the sixth and ninth month after treatment. Conclusions PRF is a promising apical barrier matrix when combined with MTA for the treatment of teeth with open apices and periapical periodontitis. Small number of study subjects and the short time of follow-up period limit the generalizability of these results. Trial registration TCTR, TCTR20221109006. Registered 09 November 2022 - Retrospectively registered, https://www.thaiclinicaltrials.org/show/TCTR20221109006 .

Background The concept of vital pulp therapy (VPT) of immature permanent teeth has evolved in recent years. There has been a great tendency towards investigating new pulp capping materials for perfect imitation for natural dentin-pulp complex formation process and restoring the normal tissue’s characteristics. Therefore, this study aimed to assess the clinical and tomographic outcomes of apexogenesis with human treated dentin matrix (hTDM) compared to mineral trioxide aggregate (MTA). Materials and methods 40 bilateral deep carious young mandibular first permanent molars (FPMs) in 20 healthy children aged between 6 and 8 years old were randomly allocated into 2 groups in which the FPMs treated with hTDM and MTA after pulpotomy procedure. The children were followed up clinically at 3, 6, 12, and 18 months. Tomographic evaluation was performed at baseline and 18-month evaluation period. Results The overall clinical success rate was 100% in both groups. Regarding tomographic evaluation, the mean differences in root length, periapical diameter and area were statistically significant in each individual group but without statistically significant differences between both groups. Conclusion Human TDM hydrogel could be considered a promising pulpotomy agent for immature permanent teeth. Trial registration The current clinical trial was recorded at clinicaltrials.gov, NCT06116695, 27/10/2023, Retrospectively registered.

Background Precise knowledge of the apical construction, which determines the end of the area for canal preparation and filling, is essential for the success of root canal treatment and the management of postoperative pain. For this purpose, devices based on various methods that determine the working length (WL) are used. However, it is still controversial which method provides the most accurate measurements. Aim To investigate the compatibility of the electronic apex locator (EWL) and simultaneous working length determination (SWL) methods in single-root teeth in comparison with the radiographic working length determination (RWL) method and to determine which one produced more effective results in terms of postoperative pain. Materials & methods One hundred patients scheduled for root canal treatment (RCT) were randomly assigned to one of the three groups according to the working length measurement method (EWL, SWL or RWL). After WL determination with assigned method, root canals were prepared and then obturated. Age, gender, simplified oral hygiene index (OHI-S), oral and dental examinations and Visual Analogue Scale (VAS) results of all participants were recorded. The incidence and intensity of postoperative pain were rated on a Visual Analogue Scale (VAS) by patients 6, 12, 24, 48 h and 7 days after RCT. The number of analgesic tablets (400 mg Ibuprofen) taken by patients was also recorded. Data were analyzed using the chi-square, One- way ANOVA and Kruskal-Wallis tests. Bland-Altman and Passing-Bablock regression analysis were used as method comparison techniques. Results It was determined that the number of patients receiving analgesia and the total number of analgesia doses were higher in EWL and RWL groups compared to SWL group ( p  < 0.0001). When the WL values at which the treatment was applied were compared in the patient groups; WL values of EWL group were statistically lower than SWL group ( p  < 0.01). While there was no difference between the preoperative VAS scores of the groups ( p  = 0.7590), the postoperative 6th and 12th hour VAS scores of SWL group were lower than those of EWL and RWL groups ( p  = 0.005 and p  = 0.0002, respectively). Again, the VAS scores of SWL group at the 24th and 48th postoperative hours were lower than those of RWL group ( p  < 0.05). According to the Bland-Altman and Passing-Bablock regression analysis results, although there was no statistically significant difference between the EWL and SWL methods ( p  = 0.471), the bias value of -0.1190 was well below the acceptable total error (0.1648). Additionally, a strong relationship was found between EWL and SWL methods ( r  = 0.9698, r 2  = 0.9406, p  < 0.001). Therefore, statistically these two methods were considered compatible with each other. It was determined that there was a statistically significant bias (0.340, p  < 0.0001) between the RWL and SWL methods, exceeding the total error. Conclusions As a result, it was determined that the SWL method, which is used to determine working length for the success of endodontic treatment, can be used as an alternative to the EWL method thus producing more effective results in the management of postoperative pain. However, in addition to the method used, the technology of the device developed for this method should not be ignored. Clinical relevance Precise knowledge of the apical construction, which determines the end of the area for canal preparation and filling, is essential for the success of root canal treatment and the management of postoperative pain. For this purpose, devices based on various methods that determine the working length are used. However, it is still controversial which method provides the most accurate measurements. This study found that the simultaneous working length determination method can be used as an alternative to the electronic working length determination method and produces more effective results in the management of postoperative pain. Another important outcome of this study is that the Total Allowable Error (TEa) for the electronic apex locator method, which is accepted as the reference, has been calculated for the first time. Other methods have been evaluated according to this reference method. This is a first in literature.

Background The aim of this prospective study was to compare root resorption after the leveling phase of treatment, performed by either super-elastic or conventional multi-stranded stainless steel arch wires. Methods From a total of 156 future orthodontic patients in a private clinic, 82 were included in the study after excluding those who earlier had orthodontic or endodontic treatment or signs of resorption. Patients were equally arbitrary allocated into two groups, where leveling was performed either with super-elastic heat-activated or conventional multi-stranded stainless steel arch wires. Root length loss was calculated using pre-treatment and post-leveling periapical radiographs. Results The use of super-elastic arch wires did not significantly increase the severity of root resorption, except for tooth 31, while it reduced leveling time compared to conventional stainless steel wires. Crossbite of maxillary lateral incisors seemed to be a risk factor for resorption. Conclusion Incisor root resorption after leveling did not differ significantly between patients treated with super-elastic and conventional stainless steel arch wires, except for a mandibular incisor.

Background Pulp necrosis is one of the main complications of dental trauma. When it happens on an immature tooth, pulp necrosis implies a lack of root maturation and apical closure. A therapy called apexification is required to induce the formation of a calcified apical barrier allowing a permanent and hermetic root filling. The aim of this prospective randomized clinical trial is to compare Mineral Trioxide Aggregate(MTA)with Calcium Hydroxide(CH)as materials used to induce root-end closure in necrotic permanent immature incisors. Methods/Design This study, promoted by AP-HP, was approved by the ethics committee(CPP Paris Ile de France IV). 34 children aged from 6 to 18 years and presenting a non-vital permanent incisor are selected. Prior to treatment, an appropriate written consent has to be obtained from both parents and from children. Patients are then randomly assigned to either the MTA(experimental)or CH(control)groups. Recalls are performed after 3, 6 and 12 months to determine the presence or absence of a calcified apical barrier through the use of clinical and radiographic exams. Additional criteria such as clinical symptoms, apical radiolucencies, periapical index(PAI)are also noted. Trial registration ClinicalTrials.gov no. NCT00472173 (First inclusion: May 10, 2007; Last inclusion: April 23, 2009; study completed: April 15, 2010)

Aim: The aim of this clinical study was to compare the effect of working length (WL) determination using electronic apex locator (EAL) or WL radiograph on the length adequacy of final WL. Materials and Methods: A total of 153 patients with 153 teeth with single canal were randomized into two groups; in Group 1, the WL was determined by WL radiograph; whereas in Group 2, it was determined by the Raypex5 EAL (VDW, Munich, Germany). Length adequacy was assessed in each group for master cone and categorized into short, acceptable, and over cases. Statistical Analysis Used: The data were statistically analyzed using the Pearson chi-square test at a significance level of P < 0.05. Results: There was no statistically significant difference between the groups in the rates of acceptable (Group 1 = 83.1% and Group 2 = 92.1%) and short cases (Group 1 = 3.9% and Group 2 = 5.2%). Over cases in master cone radiography were significantly more in Group 1 (13.1%) than Group 2 (2.6%) (P = 0.017). Conclusion: The results of our study have shown that under clinical condition, success of Raypex5 was comparable to the radiographic WL determination technique in terms of acceptable and short cases. However, there were significantly lesser over cases in EAL group, showing that EALs can avoid the overestimation of WL.

To investigate the prevalence of various morphological variations in the roots and canals of lower mandibular molar teeth in the Saudi subpopulation and measure the distance from the root apices to the inferior alveolar canal (IAC). A cross-sectional analysis was conducted on 149 CBCT scans from Taibah University the College of Dentistry (TUCD). Three evaluators independently reviewed scans for anatomical features such as the number of canals, the presence of radix molaris (RM), and root-to-IANC distances. Teeth observed from the medullary cavity to the root apical layers on the coronal, sagittal and cross-section views. Data was analyzed using SPSS 21.0 software. Statistically significant differences were defined at p < 0.05. The prevalence of RM ranged between 0.7%-3.4% in lower first and second molars. The number of the canals in the apex ranged between 2-4 canals, with most molars showing three canals. The prevalence of 2 canals in lower first molars is around 2% and in lower second molars is 9.2%. A significant age-related correlation was noted in distances from the mesial and distal roots to the IAC, with values ranging from 0 to 14.7 mm. The study reveals diverse root and canal morphologies and varying distances to the IANC within the Saudi subpopulation, emphasizing the necessity for precise preoperative radiographic assessments to optimize endodontic outcomes and reduce procedural risks. Findings suggest the need for further research into these anatomical variations to refine diagnostic and treatment strategies in endodontics, particularly in diverse populations to improve patient outcomes.

Key Points Apex locators are valid tools for use in root length determination in general dental practice. The use of apex locators may help reduce ionisation radiation exposure for patients undergoing root canal treatment. This study highlights the importance of randomised controlled trials in primary dental care settings. Objective To evaluate the ability of apex locators as a tool in determining working length in comparison to traditional working length radiographs in general dental practice. Design Randomised controlled clinical trial. Setting General dental practices in the North West of England. Subjects Adults requiring root canal treatment of at least one tooth with minimal or moderate difficulty. Intervention Root canal treatment was carried out with the working length determined by apex locator in the treatment group (AL), and periapical radiograph in the control group (PA). Outcome measure The acceptability of the master cone gutta percha measured from a radiograph before obturation was used as the primary outcome. Results Twenty-one of 23 fillings in the AL group were judged as acceptable, compared to 17 of 23 fillings in the PA group. This difference was not statistically significant. Conclusion In general dental practice, no significant difference was found in working length determined using apex locator combined with a master cone GP radiograph or using the conventional method. There is a need for larger trials to investigate these methods further.