A fractured instrument (FI) in the root canal is a common complication during root canal therapy. Under current medical conditions, instrument separation cannot be completely avoided because of the complex morphology of root canals and the limited surgical field and operating space of the surgeon. FIs, especially those broken in the apical third of the canal, render it difficult to completely remove infection in the root canal, where the residual infection can easily develop into reinfection. The removal of FIs is therefore the preferred option for the majority of clinicians in such cases. However, root canal preparation instruments are frequently fractured during treatment because of the complex root canal morphology, such as curvature or severe calcification, which further increases the difficulty of instrument removal. In the present case, a 41-year-old female patient complained of worsening pain in the left maxillary first molar for 3 days. This patient had been treated at another hospital 2 years earlier, but the discomfort persisted after treatment. Preoperative periapical radiography revealed suspected FIs at the apical third of the mesiobuccal (MB) root and the middle third of the distal buccal (DB) root, underfilling of the palatal (P) root canal and large hypodense areas surrounding the periapical region of all roots. Next, the micro-ultrasound technique was used to remove the FI in the DB canal; a bypass through the second MB canal (MB2) was created to fill the apical stop of the MB root and the P canal was retreated. The therapeutic effect of the bypass technique was assessed by comparing bypass treatment and removal treatment for endodontic FIs. The 9-month and 27-month follow-ups revealed that the periapical inflammation surrounding the DB root treated after removal of the FI and the MB root treated by bypass was significantly controlled compared with that before the operation. In addition, the present report reviewed the research progress in bypass and removal techniques, focusing on the difficulties and key points of successful root canal therapy.

BACKGROUND: Bacteria and their byproducts are key contributors to the onset and perpetuation of pulpoperiapical pathosis. Intracanal medication is vital in achieving successful endodontic outcomes as it targets and eradicates remaining microorganisms following biomechanical preparation.
OBJECTIVE: The aim of the study was to compare and evaluate the antimicrobial efficacy of calcium hydroxide (CH) paste, triple antibiotic paste (TAP), and probiotics (PBs) as intracanal medicament in 12-17-year-old children undergoing root canal treatment for the management of infected pulpal tissues in young permanent teeth.
METHODS: A total of 30 patients aged 12-17 years indicated for endodontic therapy in maxillary incisors and with no systemic complications were selected. They were randomly divided into three groups, i.e., Group I - CH group, Group II - TAP, and Group III - PB allocating 10 teeth in each group. After access opening, the first sample (S1) was collected by inserting a paper point into the root canal, the second sample (S2) was collected immediately after biomechanical preparation, and the third sample (S3) was collected after 7 days, i.e., postintracanal medication. Samples were sent for microbiological analysis to assess the microbial count, and statistical analysis was done for the obtained data.
RESULTS: The three intracanal medicaments were successful in reducing the microbial counts of Enterococcus faecalis in the infected root canals. However, according to the results of the study, the PB group demonstrated greater effectiveness against E. faecalis compared to the CH group and displayed similar antimicrobial efficacy as the TAP group.
CONCLUSIONS: PB exhibited antimicrobial efficacy comparable to TAP but greater than Ca (OH) 2 paste. Hence, PB can be utilized as an intracanal medicament in young permanent teeth.

UNASSIGNED: This study aimed to investigate the frequency and type of endodontic procedural errors in cases indicated for retreatment through cone-beam computed tomography (CBCT) analysis.
UNASSIGNED: The sample consisted of 96 CBCT scans, encompassing 122 permanent teeth with fully formed roots. Errors included perforation, instrument fracture, canal transportation, missed canals, and inadequate apical limit of filling. Additionally, potential risk factors were analyzed and subjected to statistical modeling.
UNASSIGNED: The most frequent procedural error observed was the inadequate apical limit of filling, followed by canal transportation, perforation, missed canal, and instrument fracture. Statistically significant associations were identified between various procedural errors and specific factors. These include canal transportation and root canal wall, with the buccal wall being the most commonly affected; missed canal and tooth type, particularly the palatine and second mesiobuccal canal canals; inadequate apical limit of filling and root curvature, showing a higher deviation to the mesial direction in severely curved canals; inadequate apical limit of filling and the presence of calcifications, with underfilling being the most frequent; canal transportation and periapical lesion, notably with deviation to the buccal direction; and the direction of perforation and periapical lesion, most frequently occurring to buccal direction.
UNASSIGNED: CBCT emerges as a valuable tool in identifying procedural errors and associated factors, crucial for their prevention and management.

The successful outcome of endodontic treatment is dependent on the immune response and the reparative potential of the individual. Alteration in the host immune response is a common characteristic shared by both apical periodontitis and systemic diseases. Although infection-induced periapical lesions occur in a localized environment, numerous epidemiologic studies in the last few decades have investigated the potential association between endodontic disease pathogenesis and systemic diseases. The goal of this review is to identify common systematic factors and discuss the effect they may or may not have on the prognosis and outcome of endodontic therapy.

BACKGROUND: The dentinal debris produced during root canal preparation can be extruded through the apical foramen, which may cause undesired consequences, such as the postoperative inflammation of periapical tissues.
OBJECTIVE: The aim of the present in vitro study was to evaluate the effect of glide path preparation on apical debris extrusion for the Reciproc®, WaveOne Gold® and One Curve file systems.
METHODS: A total of 72 mandibular incisors were divided into 6 groups according to the nickel-titanium (NiTi) system used and glide path preparation: group Rp - Reciproc; group Rp-O - Reciproc after glide path preparation; group WG - WaveOne Gold; group WG-O - WaveOne Gold after glide path preparation; group OC - One Curve; and group OC-O - One Curve after glide path preparation. The preand post-instrumentation weight of Eppendorf tubes was measured. The pre-weight was subtracted from the post-weight to calculate the amount of apically extruded debris. The data was analyzed using the one-way analysis of variance (ANOVA) with the statistical program PASW Statistics for Windows, v.18.0.
RESULTS: No statistically significant differences were found between the single-NiTi file systems with different kinematics in terms of apical debris extrusion, with or without glide path preparation (p > 0.05).
CONCLUSIONS: The amount of apically extruded debris was not affected by the kinematics of different single-NiTi file systems. Moreover, creating a glide path had no effect on the apically extruded debris in straight root canals.

Extraoral sinus tracts of endodontic origin might be confused for a variety of dermatological conditions. Differential diagnosis of this clinical condition plays an essential role in providing appropriate clinical care because misdiagnosis is the most prevalent cause of prolonged therapy and healing failure. As a result, every cutaneous sinus structure affecting the face or neck should be investigated for dental issues. Its diagnosis can sometimes be difficult until the treating clinician examines the potential of a dental cause. Once an appropriate diagnosis has been established, definitive treatment, consisting of root canal therapy or tooth extraction, to remove the primary source of infection is a straightforward and successful operation.

Avulsion occurs when the tooth is completely knocked out of its alveolar socket. The maxillary central incisors are more vulnerable to avulsion due to their prominent position in the dental arch. This case report describes a successful permanent maxillary incisor replantation in an 11-year-old child. The replanted tooth was stabilized in the socket using orthodontic wire, followed by root canal treatment and composite restoration within a two-week interval. Clinical and radiographic follow-up was done at one and six months. Successful management of an avulsed tooth requires educating the patient about different storage mediums and emergency management after an avulsion. This case report concluded that the avulsed tooth result is highly dependent on the patient\'s understanding of avulsion and how to approach it.

Endo-periodontal lesions (EPLs) involve both the periodontium and pulp tissue and have complicated etiologies and pathogenic mechanisms, including unique anatomical and microbiological characteristics and multiple contributing factors. This etiological complexity leads to difficulties in determining patient prognosis, posing great challenges in clinical practice. Furthermore, EPL-affected teeth require multidisciplinary therapy, including periodontal therapy, endodontic therapy and others, but there is still much debate about the appropriate timing of periodontal therapy and root canal therapy. By compiling the most recent findings on the etiology, pathogenesis, clinical characteristics, diagnosis, therapy, and prognosis of EPL-affected teeth, this consensus sought to support clinicians in making the best possible treatment decisions based on both biological and clinical evidence.

OBJECTIVE: Nonsurgical root canal therapy (NSRCT) is indicated for management of permanent teeth diagnosed with symptomatic irreversible pulpitis. However, recent research has suggested that vital pulp therapy (VPT) may be a less invasive option in these cases. The purpose of this systematic review was to evaluate the outcomes of VPT, using hydraulic calcium silicate cements (HCSCs) including complete and partial pulpotomies in permanent posterior teeth with symptomatic irreversible pulpitis.
METHODS: The PRISMA recommendations were adhered to. The search approach used electronic databases from PubMed, EMBASE, the Cochrane Library, and grey literature. The Newcastle-Ottawa Scale, ROBINS-I, and Cochrane Collaboration Risk of Bias tools were used to evaluate the quality of the selected studies.
RESULTS: The initial database search turned up 142 papers, of which 3 prospective cohort studies and 9 randomised controlled trials were selected for analysis. For three, seven, and two articles, the risk of bias was rated as \'high\' or \'serious,\' \'fair,\' and \'low,\' respectively. The success rates for VPT using HCSCs typically ranged from 78% to 90% one to five years following VPT. The results of the VPT and NSRCT were equivalent at one and five years, according to two articles. Although the intra-operative pulp assessment is essential for VPT treatments, most studies did not provide a thorough account of this process or the time required to achieve haemostasis. Three studies reported sample sizes that were 23 teeth. The 12 studies that were analysed revealed successful VPT procedures using HCSCs in permanent posterior teeth that had symptomatic irreversible pulpitis, with radiographic success rates ranging from 81% to 90%. Two articles claimed that the results of VPT and root canal therapy were equivalent.
CONCLUSIONS: When considering VPT as an alternative to NSRCT, appropriate case selection and outcome criteria must be created. This data highlights the need for additional studies contrasting the longer-term effects of different treatment regimens.

Following endodontic (root canal) treatment, teeth loss their mechanical properties, and the teeth become fragile because of the removal of pulp and dentin. Hence, prosthetic restoration of root canal-treated teeth is a challenge. Endocrown is a single restoration, and it is considered an excellent alternative restoration for teeth with large coronal destruction and root canal treatment difficulties. Zirconia endocrowns are reliable materials for root canal-treated molars with extensive loss of crown structure. This case series presents four cases of restoration of severely damaged molars presenting various symptoms and prosthetic restorations were done by zirconia-based endocrown. The prognosis in all patients was good.