OBJECTIVE: The pathways to post-operative pain are complex and encompass factors that extend beyond the treatment protocol employed. This study aimed to identify patient-related predictors of post-operative pain following root canal treatment.
METHODS: A total of 154 patients received a single-visit root canal treatment for asymptomatic necrotic mandibular molars. Before treatment, dental anxiety, dental fear and sense of coherence (SOC) were measured as predictors for each patient using validated questionnaires. Other measured predictors included gender, age, previous negative experiences at the dental offices and prior root canal treatment. Post-operative pain was assessed using the Numeric Rating Scale at multiple time-points over 30 days. Structural equation analysis was employed to evaluate the direct and indirect effects of patient-related predictors on a theoretical model of post-operative pain. The irrigant solution was also included in the model, as it was the only aspect that varied in the treatment protocol (sodium hypochlorite 2.5% and 8.25%).
RESULTS: Dental anxiety (coefficient 0.028; p < .01), dental fear (coefficient 0.007; p = .02) and irrigant solution (coefficient 0.004; p = .03) exerted a direct effect on post-operative pain. SOC exerted an indirect effect on post-operative (coefficient 0.006; p = .01) through dental anxiety and dental fear. Moreover, previous negative experiences (coefficient 0.048; p = .04) exerted an indirect effect on post-operative pain through dental anxiety.
CONCLUSIONS: Dental anxiety, dental fear, previous negative experiences and SOC are patient-related predictors of post-operative pain following root canal treatment. These factors should be taken into consideration in clinical practice, as patients with these characteristics may be at an increased risk of experiencing post-operative pain.

Purpose: To report a case of a suspected open-globe injury and globe penetration complicated by a rhegmatogenous retinal detachment (RRD) after administration of intraoral anesthetic injections during an endodontic procedure. Methods: A retrospective chart review was performed. Results: A 34-year-old woman presented with acute onset of flashes, floaters, and a curtain-like shadow across her field of vision. Four days previously, she had multiple left-sided anesthetic injections during an endodontic procedure. The visual acuity (VA) in the left eye was 20/25. Ophthalmoscopy showed a suspected globe-penetration site inferiorly, associated multilayered hemorrhages, and adjacent subretinal fluid. Laser demarcation of the inferior RRD was performed at sequential clinical visits. Through 8 months, the multilayered hemorrhages improved while proliferative vitreoretinopathy-associated tissue formation over the posterior pole caused macular distortion and mild visual deterioration. The VA in the left eye was 20/40 at the last follow-up. Conclusions: Iatrogenic globe penetration during intraoral anesthesia delivery associated with an endodontic procedure may result in globe injury.

OBJECTIVE: This bibliometric and scientometric analysis aimed to delve into the forefront roles of lasers in endodontics from 1990 to 2024.
METHODS: A comprehensive electronic search was conducted using \"Clarivate Analytics Web of Science, All Databases\" to retrieve the most-cited articles pertaining to the topic. These articles were then ranked in descending order according to their citation counts and the top 100 were selected for further analysis. Parameters including citation density, publication year, journal, journal impact factor (IF), country, institution, author, study design, study field, evidence level, laser type, and keywords were meticulously analyzed.
RESULTS: The mean and standard deviations of total citation and citation density were 106.47 ± 65.76 and 7.61 ± 5.13, respectively. Positive and negative correlations were found between the number of citations and citation density and age of publication. While the mean number of citations was significantly higher in the period 2001-2010 compared to the other periods (P < 0.05), values were similar between the periods 1990-2000 and 2011-2014 (P > 0.05). Articles were mainly published in the Journal of Endodontics. The most productive country, institutions, and author were the United States, the University of Showa, and Koukichi Matsumoto. Diode and Er: YAG lasers were commonly investigated. Ex vivo studies were mainly performed followed by in vitro ones. The main study field was \"antimicrobial effect\". Among keywords, \"photodynamic therapy\" was used more frequently.
CONCLUSIONS: Lasers are predominantly utilized to leverage their antimicrobial efficacy. Advancements in technology will lead to improvements in the properties of lasers, thereby enhancing the disinfection of the root canal system.

BACKGROUND: This study characterized the bacteriome in primary endodontic infection (PEI) with apical periodontitis (AP), identified core and rare bacteriome species and community diversity metrics, and analyzed the relationship between the bacteriome composition, diversity and features, and patient variables.
METHODS: Twenty-seven patients with PEI and AP were sampled. The DNA was extracted and quantified using qPCR. Raw V3-V4 amplicon sequencing data were processed with the DADA2 pipeline to generate amplicon sequence variants (ASVs), and taxonomic assignment of the ASVs up to the species level was done against the HOMD. Core bacteriome and differential abundance analyses were performed using ANCOM. Alpha diversity was determined using Chao1, Shannon, and Simpson indexes. LeFse analysis was used to identify abundant taxa. SECOM analysis estimated linear and nonlinear relationships among bacteria.
RESULTS: 24/27 root canal samples were analyzed, and 3 RCS were filtered out with a low read count. The bacterial phyla with top mean relative abundance were Bacteroidetes, Firmicutes, Synergistetes, Fusobacteria, and Actinobacteria. A total of 113 genera and 215 species were identified. The samples were gathered into three clusters. LeFse analysis identified differences in abundant taxa between distinct age, gender, symptomatology, and lesion size groups. SECOM distance analysis indicatedSlackia exiguaas the node with the highest degree.
CONCLUSIONS: The bacteriome in PEI with AP among the patients in this study was complex and displayed high microbial heterogeneity. Moreover, age, gender, symptomatology, and lesion size were associated with differences in bacteriome features in PEI with AP.

The distinct physicochemical and biological characteristics of metal and metal oxide nanoparticles have attracted considerable interest in various branches of dentistry as potential solutions to the problems associated with conventional dental treatments and to promote human health. Many scientists have been interested in nanoparticles for endodontic applications in the last several decades. Endodontic treatment is more likely to be successful when metal and metal oxide nanoparticles are used. Endodontic therapies often make use of nanoparticles made of metals and metal oxides. The effect of nano metals and metal oxide in endodontic treatments has not been published or is not widely available in the literature. Therefore, this paper aims to review recent studies on the development and application of some important metal and metal oxide nanoparticles such as silver and silver oxide, zinc oxide, zirconium oxide, magnesium oxide, titanium dioxide and other metal oxide nanoparticles in endodontic therapeutic procedures.

BACKGROUND: This study aimed to investigate the perspectives, preferences, and clinical experiences regarding using electronic apex locator and apex locator integrated instrumentation of dentists and endodontists.
METHODS: A web-based questionnaire consisting of 3 parts and 23 closed-ended questions to achieve the objective of the study was carried out in ethical conditions between August and October 2023. The first part of survey included demographic information, while the second part was about evaluating electronic apex locator usage. In the last part, only participants\' use of apex locator-integrated instrumentation was evaluated. Data were analyzed at a significance level of p < 0.05.
RESULTS: A total of 297 clinicians, including 59 endodontists and 34 endodontic residents/Ph.D. students participated in the questionnaire. Endodontists and endodontic residents/Ph.D. students perform statistically significantly more root canal treatments per week on average (p = 0.001). For the working length determination method (multiple option question), 78.5% of participants use an electronic apex locator and 39.7% apex locator-integrated engines. However, the preference rate for electronic apex determination technique was generally 95.6%, with the full rate confirmation of endodontists and endodontic residents/Ph.D. students (100%). A total of 21 endodontists out of 59 prefer apex locator integrated engine-driven instrumentation. Although many of these specialized clinicians use this technique, they stated that they measure electronic working length passively for confirmation of the working length before (90.5%) and after the preparation (66.7%).
CONCLUSIONS: Dentists, as well as endodontists, are skeptical about apex locator-integrated engine-driven instrumentation. Using this technique as a supporter rather than a primary way for preparation within safe limits may give safer results in terms of treatment outcomes.

A 65-year-old Caucasian male was referred to an endodontic specialist practice in a private clinic in December 2019 for the management of an asymptomatic, radiolucent lesion located at the cervical level of the distal root of his right lower first molar, noticed during a routine periapical radiograph. After an accurate evaluation with cone-beam computed tomography (CBCT), the subgingival lesion was diagnosed as a supracrestal external cervical resorption (ECR), with a circumferential spread ⩽90°, confined to dentine without pulp involvement. The lesion was treated with the following sequence: (1) a full flap accessed the ECR, (2) the granulomatous tissue was removed from the root area, (3) the cavity was refreshed and filled with a well-refined and polished resin composite, (4) the flap was sutured at the cemento-enamel junction. A mandibular CBCT scan was performed before treatment, right after treatment, and 3 years postoperatively. Compared to the 3-year posttreatment CBCT scan, the immediate posttreatment one, revealed the absence of bone loss and an unexpected coronal bone remodeling with new bone formation over the treated lesion.

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OBJECTIVE: To evaluate the impact of acquisition protocols and artifact reduction filters in cone beam computed tomography on diagnosing vertical root fractures in endodontically treated teeth with and without intraradicular posts.
METHODS: We analyzed 480 tomographic images acquired from two J. Morita scanners (0.125- and 0.08-mm voxel sizes protocols), with application of a blooming artifact reduction filter. Three evaluators assessed these images for root fractures using a 5-point Likert scale. Diagnostic accuracy between filters and protocols was determined using generalized linear models with binomial distribution for the outcome, considering protocol, filter, and dental status. Sensitivity, specificity, positive predictive value, and negative predictive value were also estimated for the filters and protocols.
RESULTS: The 0.08-mm voxel size protocol demonstrated a significantly higher percentage of accurate diagnosis compared to the 0.125-mm protocol (p = .001). No statistically significant differences (p ≥ .087) were observed for filter application, interaction between protocol and filter, or dental status. Accuracy, sensitivity, and specificity values were respectively: .93, .87, 1.00 (protocol 1); .99, .99, .99 (protocol 2); .98, .96, .99 (no filter); .95, .90, 1.00 (with filter).
CONCLUSIONS: The new findings found for the two J Morita scanners used in our study were that images acquired using the voxel size of 0.08 mm showed an improvement in the diagnosis of root fractures and the filters in these devices have no relevance significant for the diagnosis.

OBJECTIVE: To evaluate the 6-year outcome of root canal treatment irrigated with 0.5% or 3% sodium hypochlorite (NaOCl).
METHODS: The baseline trial was designed as a quasi-randomized clinical trial. Patients referred for root canal treatment to an endodontic specialist clinic were recruited to the study (n = 298). The concentration of NaOCl was allocated quasi-randomized to 271 subjects (0.5% [n = 139], 3% [n = 132]). Bacterial sampling was performed immediately before root canal filling. Samples were cultured and evaluated as growth or no growth. Patients were invited to a clinical and radiological follow-up >5 years postoperatively. The clinical outcome measurements were tooth survival, cumulative incidence of endodontic retreatments, patients\' assessment of pain, clinical findings and radiological signs of apical periodontitis (AP).
RESULTS: Tooth survival was 85.6% in the 0.5% NaOCl group and 81.1% in the 3% NaOCl group (p = .45). There was no record of retreatment in 94.4% in the 0.5% NaOCl group and in 92.2% in the 3% NaOCl group (p = .76). The percentage of asymptomatic cases were 87.8% in the 0.5% group and 85.3% in the 3% NaOCl group (p = .81). Absence of clinical signs of AP was seen in 86.6% in the 0.5% NaOCl group and in 83.6% in the 3% NaOCl group (p = .80). Absence of radiological signs of AP was seen in 74.0% in the 0.5% NaOCl group and 64.1% in the 3% NaOCl group (p = .20). Subjects with positive culture before root filling reported subjective pain with a significantly higher frequency as compared to negative-culture subjects (p = .014).
CONCLUSIONS: The use of 0.5% or 3% NaOCl for irrigation during root canal treatment resulted in similar clinical outcomes 5-7 years postoperatively. Persisting bacteria immediately before root filling may predict future episodes of subjective pain.