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ObjectivesThis study compared canal transportation and centering ratio produced after instrumentation with a single heat-treated reciprocating system, WaveOne Gold (WOG; Dentsply Sirona, Tulsa, OK, USA) and a single heat-treated rotary instrument, XP-endo Shaper (XPS; FKG, La Chaux-de-Fonds, Switzerland), using micro-computed tomographic (micro-CT) imaging, and evaluated the ability of double-digital radiography (DDR) to detect canal transportation.Materials and methodsMesial root canals of mandibular molars with severe curvature (25–70°) were randomly assigned to either WOG or XPS groups for preparation. Centering ratio was measured by micro-CT imaging, while canal transportation was measured by micro-CT and DDR methods at 3, 5, and 7 mm from the apex. Data were statistically compared between groups using the t test (α = 5%).ResultsThe micro-CT method showed that XPS’s shaping ability regarding the centering ability (P = 0.030) and canal transportation (P = 0.028) was significantly better than WOG only at the 7-mm level. The DDR technique detected no difference in canal transportation between groups at any level (P > 0.05); however, a significant difference between evaluation methods was detected at the 5-mm level in the WOG group (P = 0.023).ConclusionsMicro-CT technique revealed a significantly better centering ability and less canal transportation with XPS compared to WOG. The DDR technique was not capable of detecting the significant difference between the tested groups.Clinical relevanceRoot canal curvatures may lead to procedural errors during endodontic treatment. Thus, differences on the shaping ability of single heat-treated reciprocating and rotary systems should be known.

This study aimed to compare the effectiveness of an experimental root canal irrigant and 17% Ethylene-di-amine tetra acetic acid for removal of the smear layer in the coronal, middle and apical portions of the root canal. Ninety human single rooted maxillary and mandibular teeth were selected for this study. The teeth were randomly divided into two experimental groups and one control group as follows: Group A (Ethanolic extract of Sapindus Mukorossi), Group B (17% EDTA), and Group C (Distilled water). The root canals of all three groups were prepared with stainless steel K-files by means of the standard step-back technique and irrigated with 5.25% sodium hypo chloride. The teeth were decoronated, following the irrigation and divided longitudinally into two-halves and visualized using scanning electron microscope (SEM) for the amount of smear layer present utilizing the three-point score system. The observations were noted both before and after the treatment. Nonparametric tests were applied for the comparison and -value ⩽ 0.05 was considered as statistically significant. It was evident from that smear layer was completely removed in coronal portion of 27 out of 30 teeth in-group A. For middle and apical areas of group A, 24 and 19 teeth showed complete smear layer removal. In-group B it was found that there were 24, 21, and 3 teeth at coronal, middle and apical, areas respectively where smear layer were completely absent. Intra group comparison showed a significant difference (  = 0.002) in smear layer removal was found for group A at coronal, middle and apical thirds. Similarly, a significant difference (  = 0.001) was also found for group B; however heavy smear layer was found among the three parts of the canal for group C. Ethanolic extract of Sapindus Mukorossi have higher effectiveness in removing the smear layer from the root canal in comparison to 17% EDTA.

Background Optimal positioning of orthodontic mini-implants is essential for a successful treatment with skeletal anchorage. This study aims to compare the accuracy of two-dimensional radiographs with a cone beam computed tomography (CBCT) for mini-implant placement. Methods An ideal site for mini-implant placement at the buccal interradicular space between the second premolar and the first molar was determined for 40 sites (in 13 patients aged 14 to 28 years) by using CBCT data. The mini-implant placement procedure was then divided into two groups. In CBCT group, mini-implants were placed at the sites determined from CBCT data. In RVG group, mini-implants were placed with the help of two-dimensional digital radiographs and a custom made guide. Postplacement CBCT scans were obtained to determine the accuracy of the mini-implant placement. The results were statistically analyzed with a Mann-Whitney test. Results A statistically significant difference ( p value = 0.02) was observed between the two groups for deviation from an ideal height of placement of the mini-implants. Deviations in mesiodistal positioning and angular deviation showed a statistically non-significant difference. Three out of twenty mini-implants in the RVG group showed root contact in the mandibular arch that may be attributed to the narrower interradicular space and reduced accessibility in the mandibular posterior region. Conclusions Although CBCT provides an accurate three-dimensional visualization of the interradicular space, the two-dimensional intraoral radiograph of the interradicular area provides sufficient information for mini-implant placement. Considering the amount of radiation exposure and cost with the two techniques, it is recommended to use two-dimensional radiographs with a surgical guide for a routine mini-implant placement.

Aims: This triple blinded clinical trial was undertaken to check whether Platelet rich firin in its membrane form is as reliable as when it is in the gel form. Settings and Design: Triple blinded randomized clinical trial. Methods and Material: 20 patients in PRF gel group and 20 patients in PRF membrane group selected after randomization and considering inclusion and exclusion criteria were taken up for this study. The samples were clinically and radiographically evaluated for success. Results and Conclusions: Regenerative endodontics with PRF membrane is easier and less time consuming. They have similar clinical success.PRF gel gave a better radiographic success in 12 months period.

ObjectivesThe aim of this study was to evaluate the use of a convolutional neural network (CNN) system for detecting vertical root fracture (VRF) on panoramic radiography.MethodsThree hundred panoramic images containing a total of 330 VRF teeth with clearly visible fracture lines were selected from our hospital imaging database. Confirmation of VRF lines was performed by two radiologists and one endodontist. Eighty percent (240 images) of the 300 images were assigned to a training set and 20% (60 images) to a test set. A CNN-based deep learning model for the detection of VRFs was built using DetectNet with DIGITS version 5.0. To defend test data selection bias and increase reliability, fivefold cross-validation was performed. Diagnostic performance was evaluated using recall, precision, and F measure.ResultsOf the 330 VRFs, 267 were detected. Twenty teeth without fractures were falsely detected. Recall was 0.75, precision 0.93, and F measure 0.83.ConclusionsThe CNN learning model has shown promise as a tool to detect VRFs on panoramic images and to function as a CAD tool.

Background To determine the root canal morphology of human permanent maxillary and mandibular teeth in a Malaysian subpopulation using cone-beam computed tomography (CBCT). Methods A total of 208 CBCT images were examined retrospectively. Prevalence of an extra root/canal and internal morphology based on Vertucci’s classification were observed in human maxillary and mandibular permanent teeth. Variations in the external and internal morphology were compared in relation to gender and tooth side (left vs right) using Pearson Chi-square and Fisher’s exact tests with significance level set at p  < 0.05. Results In the maxillary arch, the prevalence of three canals were observed in 0.3% of first premolars and two canals in 46.5% of second premolars. Males displayed significantly higher prevalence of two canals in maxillary second premolars than females ( p  < 0.05). The prevalence of a second mesiobuccal canal in maxillary first and second molars were 36.3 and 8.5%, respectively. Males displayed significantly higher prevalence of a second mesiobuccal canal in maxillary second molars than females ( p  < 0.05). The prevalence of a second palatal canal in maxillary first and second molars were 0.9 and 0.6%, respectively. In the mandibular arch, the prevalence of two canals were observed in 5.1% of central incisors, 12.3% of lateral incisors, 6.1% of canines, 18.7% of first premolars and 0.5% of second premolars. The prevalence of a middle mesial canal, second distal canal and extra root (radix entomolaris) were detected in 1.9, 19.5 and 21.4% of mandibular first molars, respectively. The prevalence of a C-shaped canal was observed in 48.7% of mandibular second molars. Females displayed significantly higher prevalence of a C-shaped canal in the right mandibular second molars than males ( p  < 0.05). No other statistically significant differences in root anatomy and root canal morphology were observed in relation to gender and tooth side. Conclusions Wide variations in the root canal morphology exist among Malaysians. CBCT is a clinically useful tool in the identification of external and internal morphological variations in the human teeth.

Despite extensive research on maxillary impacted canines, studies specifically investigating maxillary impacted incisors remain limited. This retrospective study aimed to determine the prevalence of impacted teeth among adolescent orthodontic patients, analyze the imaging characteristics of maxillary impacted incisors, and evaluate factors influencing root development. From a cohort of 2163 underage patients who attended the children malocclusion special clinic between August 2022 and July 2024, individuals with impacted teeth were identified and their clinical data were collected. Subsequently, detailed analyses were conducted on impacted maxillary incisors using high-quality Cone-beam computed tomography (CBCT). There were 157 patients with 205 impacted teeth observed, presenting a prevalence rate of 7.26%. Maxillary canines were the most popular impacted teeth (39.51%), followed by maxillary incisors (30.24%). The tooth dilaceration demonstrated a significant relationship with the three-dimensional (3D) locations of tooth. Impacted teeth situated in low impacted depth ( P  < 0.05) and those with buccal-lingual ( P  < 0.05) or vertical ( P  < 0.01) orientations showed reduced susceptibility to root dilaceration. A positive correlation was observed between the Upper Incisor to Palatal Plane Angle (UI-PP) and both the probability ( P  < 0.05) and earlier occurrence ( P  < 0.01) of root dilaceration. The root length of impacted tooth was positively correlated with age ( P  < 0.05). Besides, the average root length of the impacted central incisors was 1.84 mm shorter than the contralateral. The prevalence of impacted teeth in our orthodontic specialist clinics was 7.26%, and 69.76% of impacted teeth were maxillary anteriors. The development of tooth roots was mainly influenced by age and 3D location. These findings enhance clinicians’ understanding of impacted maxillary incisor characteristics and factors affecting the root development. The UI-PP proves to be an effective 3D location evaluation indicator. Early intervention is recommended for impacted teeth lacking sufficient space for root development, which could facilitate root development and minimize the risk of root dilaceration.

Objectives This study was aimed to evaluate different endodontic obturation techniques (Thermafil, lateral condensation, and Tagger’s hybrid technique) regarding the homogeneity of the obturation radiopacity. Materials and methods Seventy roots of human upper central incisors were filled using the Thermafil system, lateral condensation. and Tagger’s hybrid technique. Radiopacity of the filling was evaluated based on mean of grey levels, and its homogeneity was assessed by the coefficient of variation (CV), analyzing the histograms obtained of digitized and digital radiographs. Results The increase in mean grey levels ( p  < 0.001) and reduction in the CV ( p  < 0.05) were higher for Tagger’s hybrid technique compared with other methods. Conclusions Tagger’s hybrid technique provided better homogeneity of the obturation radiopacity and better apical sealing compared with lateral condensation technique. Clinical relevance The results suggest that Tagger’s hybrid technique provided the best compaction of the root canal filling material, an important factor for the sealing of obturations and, consequently, for the effectiveness of treatment.

Background This split-mouth, double-blind randomized controlled trial evaluated radiographic changes in infrabony defects treated with open flap debridement (OFD) or OFD associated with enamel matrix derivative (EMD) after a 24–month follow-up. The radiographic distance from the CEJ to the bottom of the defect (BD) was considered the primary outcome. CEJ-BC and defect angle were secondary outcomes. Methods Ten patients presenting 2 or more defects were selected. An individualized film holder was used to take standardized radiographs of the 43 defects, at baseline and after 24 months. Images were digitized and used to measure the distances from the cemento-enamel junction (CEJ) to the alveolar crest (AC), CEJ to the bottom of the defect (BD) and infrabony defect angle. Statistical analysis was performed in SPSS for Windows (version 5.2). Paired samples t test was used to compare test and control groups and to evaluate changes within each group. The level of significance was set at α = 0.05%. Results After 24 months, a significant crestal bone loss was observed for EMD (1.01 mm; p = 0.049) but not for OFD (0.14 mm; p = 0.622). However, no differences were detected between groups (p = 0.37). Reduction of the bone defect depth was significant for OFD (0.70 mm; p = 0.005) but not for EMD (0.04 mm; p = 0.86), while no differences were detected between them (p = 0.87). Both EMD (0.69°; p = 0.82) and OFD (5.71°; p = 0.24) showed an improvement in defect angle measurements but no significant differences were observed after 24 months or between the groups (p = 0.35). Conclusion Linear radiographic analysis was not able to demonstrate superiority of EMD treated infrabony defects when compared to ODF after 24 months. Trial registration ClinicalTrials.gov: NCT02195765 . Registered 17 July 2014.