Assessing the Sealing Performance and Clinical Outcomes of Endodontic Treatment in Patients with Chronic Apical Periodontitis Using Epoxy Resin and Calcium Salicylate Seals.

Background and Objectives: Recognizing the significance of a hermetic apical seal for successful root canal treatment, the present investigation aimed to evaluate two sealing materials through an in vitro analysis, as well as to ascertain the clinical outcomes of patients treated with these two sealers in an in vivo setting. Materials and Methods: For the in vitro part of the study, two control groups of thirty monoradicular teeth were obturated with two sealers. Then, the sealers' performance was tested based on a predefined protocol. Group A included 30 patients treated with an epoxy oligomer resin-based sealer (Adseal, MetaBiomed), while Group S comprised 30 patients treated with a polymeric calcium salicylate-based sealer (Sealapex, Kerr). Samples were sectioned and evaluated under the microscope to determine the sealer's tightness by measuring the dye penetration into the root canal filling. For the in vivo part, a prospective study was designed to include 60 patients with chronic apical periodontitis in two endodontic treatment groups, using the same two sealers. Results: The in vitro analysis found that dye penetration in Group A was 0.82 mm (±0.428), while in Group S, the dye penetration was statistically significantly deeper, being 1.23 mm (±0.353). In the in vivo part of the study, the periapical index (PAI) significantly decreased 6 months after endodontic treatment, with 80.0% of patients in Group A having a PAI score of 2 compared to only 56.7% in Group S (p-value = 0.018). Similarly, tooth mobility scores significantly decreased after treatment, but with no difference between groups. The marginal bone loss decreased significantly more in the Adseal group compared to the Sealapex group (23.3% vs. 50.0%, p-value = 0.032). At the same time, 40.0% of patients in Group S had failed tooth healing compared to only 13.3% in Group A (p-value = 0.048). Conclusions: The in vitro study showed that Adseal had a better sealing capacity and a lower degree of dye penetration compared to Sealapex. However, on clinical evaluation in the in vivo study, both patient groups exhibited significant improvements in periapical index, tooth mobility scores, and pain reduction following endodontic treatment. Nevertheless, patients treated with Adseal showed a significantly greater improvement in PAI values, tooth mobility, and teeth healing after treatment. Overall, Adseal, as an endodontic sealer, may provide better sealing capabilities and enhanced clinical outcomes in the treatment of chronic apical periodontitis.

Comparative Assessment of the Shaping Ability of Reciproc Blue, WaveOne Gold, and ProTaper Gold in Simulated Root Canals.

Maintaining the original trajectory of the root canal is a major challenge in endodontic therapy, especially in narrow and curved root canals. The present study aims to assess the shaping capacity of three endodontic systems made of different nickel−titanium alloys on simulated curved root canals. Thirty-six endodontic resin blocks (Ref. V040245, VDW) divided into three groups, each of twelve blocks (n = 12), were shaped, photographed, and analyzed: Group 1-Protaper Gold (PTG) (Dentsply Maillefer, Ballaigues, Switzerland) F2 25/08; Group 2-Reciproc Blue (RB), RB 25/08 (VDW, Munich, Germany); Group 3-WaveOne Gold (WOG) (Dentsply Maillefer), WOG 25/07. Each block was standardized and photographed before and after shaping in the same position, with the foramen oriented to the left. Post-shaping images were superimposed onto the initial ones. Thirteen measurement points were used for evaluation, spaced with 1 mm distance from one another, from level 0, apical foramen, to level 12, coronal orifice. The amount of removed resin from inner (X1) and outer (X2) walls, the direction of transportation (X1 − X2), and the centering ability (X1 − X2)/Y were measured, calculated, and comparatively analyzed. Statistical differences (p < 0.05) were observed between the shaping capacity of the considered systems in the middle and coronal thirds. PTG had a better centering ability than WOG and RB in the coronal third, while RB was more centered in the middle third in comparison to both WOG and PTG. In the apical third, the centering capacity of WOG was higher, without being statistically significant. WOG 25/07 and PTG 25/08 tend to cut more on the inner wall of the root canals, and RB 25/08 on the external one.

Evaluation of the Shaping Ability of Three Thermally Treated Nickel-Titanium Endodontic Instruments on Standardized 3D-printed Dental Replicas Using Cone-Beam Computed Tomography.

Background and Objectives: The aim of the present study is to compare the efficacy of three root canal preparation systems in the shaping of 3D-printed root canal replicas of single rooted teeth. Materials and Methods: Sixty 3D-printed root canal replicas were produced and divided into three groups, each consisting of twenty samples. Each group was shaped with a different instrument: Reciproc Blue R25/08 (VDW GmbH, Munich, Gemany), WaveOne Gold Primary 25/07 (Dentsply Sirona, Ballaigues, Switzerland), and ProTaper Gold F2 25/08 (Denstply Sirona). To ensure the reproducibility of pre- and post-operative CBCT images of the root canals, the endodontic printed replicas were placed in a mould of silicon impression material. A cone-beam computed tomography (CBCT) software was used to compare pre- and post-instrumentation images collected at three levels of the root canal length: 3, 6, and 9 mm from the apical foramen. The amount of transportation, centring ability, and curvature angle after shaping were evaluated for each system. The results were statistically analysed and compared using one-way analysis of variance (ANOVA). Results: Regarding the transportation of the root canal after shaping, significant differences between groups at 3 mm (p = 0.010721) and 6 mm (p = 0.000046) were recorded in the mesio-distal direction, while in the bucco-lingual significant differences were only observed at 6 mm (p = 0.000554). Reciproc Blue removed more dentin from the mesial and buccal wall of the root canal. When evaluating the centring ability of the three systems, significant differences were observed between the groups at the level of 9 mm (p = 0.037258) in the mesio-distal direction, and at the level of 6 mm (p = 0.038197) in the bucco-lingual direction. Significant differences of the canal curvature angle after shaping were also observed between groups (p = 0.000001). Reciproc Blue straightened the curvature the most, while ProTaper Gold the least. Conclusions: All systems produced minor root canal transportation. No instrument was able to achieve a perfect centring preparation of the root canal. All systems produced a small degree of root canal straightening.