Critical analysis of a new system to classify root and canal morphology — A systematic review

A novel system to classify root and canal morphology was recently introduced (Ahmed et al. 2017). This systematic review aimed to answer the following research question: Does the Ahmed et al. system provide a more accurate and practical classification of root and canal anatomy compared to other classifications? A literature search was conducted in Google Scholar, Scopus and Wiley Online Library to identify the citation counts for the article entitled ‘A new system for classifying root and root canal morphology; doi.org/10.1111/iej.12685’. After removal of duplicates and unrelated articles, 15 studies were included and analysed. All studies compared the Ahmed et al. system with the Vertucci classification. Results revealed that both systems were able to classify simple canal configurations in single‐rooted anterior and premolar teeth, disto‐buccal and palatal roots of maxillary molars. However, the Ahmed et al. system provided more accurate and comprehensive categorisations of single‐rooted teeth with complex canal anatomy, multi‐rooted maxillary and mandibular premolars and the mesio‐buccal root of maxillary molars. Further evidence on the utility of the Ahmed et al. system is required using other diagnostic devices especially in molars

A bibliometric analysis of the top 100 most-cited case reports and case series in Endodontic journals

Aim To identify the top 100 most-cited case reports and case series published in Endodontic journals and to analyse their bibliometric characteristics. Methodology The Clarivate Analytics’ Web of Science (WoS), Scopus and PubMed databases were used to identify the top 100 most-cited case reports and case series in Endodontic journals. Complete bibliographic records of the selected case reports and case series were exported in plain text or BibTeX format and imported into the R environment for statistical computing and graphics. The following parameters were then analysed: names and affiliations of the authors, title, year of publication, journal of publication, first author, corresponding author, literature cited within reports, language, citation counts, impact factor of the journal, keywords, Keywords Plus and research topic. Results In total, 88 case reports and 12 case series published in English between 1977 and 2016 were identified as the most-cited reports in the field of Endodontics. The terms “case report(s)” or “case series” were not included in the title of 57 articles. The number of authors per report ranged from one to seven, with the average number of co-authors per report being 3.14. The most-cited author was M Trope (University of Pennsylvania, USA). The University of Washington and Private Practice, Cetraro, Italy, were the most productive institutions. The country whose case reports received the largest total number of citations was the United States. The largest number of the most-cited reports appeared in 2002, 2004 and 2007 (n = 7, respectively). According to the WoS database, the total number of citations ranged from 42 to 453, with the average number of citations per report being 79.97. The majority of the top 100 most-cited articles were published in the Journal of Endodontics and the International Endodontic Journal. The most frequently used author keywords were revascularization and mineral trioxide aggregate. The majority of the case reports and case series dealt with topics related to pulp regeneration. Conclusion This bibliometric study provides a comprehensive overview on the progress, trends and current directions in clinical practice within the field of Endodontics

The study and relevance of pulp chamber anatomy in endodontics – A comprehensive review

With the ever-increasing understanding of tooth anatomy, there is a renewed focus on the pulp chamber as an important component of the root canal system. For example, the pulp chamber is of critical relevance during diagnostic procedures such as pulp sensibility tests, deep caries removal, vital pulp treatments, access cavity preparation, tooth whitening, tooth restoration as well as methods for examining the floor of the pulp chamber to aid the detection of root canal orifices or the presence of perforations and cracks. The more recent concept of minimal invasive endodontics has also created a need to understand better the anatomy of the pulp chamber. The purpose of this article is to discuss the research methods used to study pulp chamber anatomy and the significance of the pulp chamber in endodontic research and clinical practice. In addition, directions for future research are emphasised

Validation of self-reported history of root canal treatment in a southern Brazilian subpopulation

The aim of this study was to assess self-reported history of root canal treatment (SRHRCT) as a method for detecting the presence of root canal treatment (RCT) and apical periodontitis (AP) in a southern Brazilian subpopulation. In this cross-sectional study, 136 military police officers from the city of Porto Alegre, Brazil, were included. The participants were interviewed and full-mouth periapical radiographs were taken. A calibrated examiner determined the presence of RCT and AP by applying standardized criteria. The diagnostic accuracy of SRHRCT was calculated separately for RCT and AP. Accuracy, sensitivity, specificity, positive and negative predictive values (+PV and -PV), efficiency, and positive and negative likelihood ratios (+LR and -LR) were estimated. The mean age of the participants was 34.1 ± 10.4 years and 88.2% were males. Overall, SRHRCT demonstrated high sensitivity and specificity for RCT, but not for AP: sensitivity (RCT = 0.960, AP = 0.757) and specificity (RCT = 0.835, AP = 0.631). The estimated values for PV and LR were: +PV (RCT=0.777, AP=0.396), -PV (RCT = 0.972, AP = 0.890), +LR (RCT = 5.853, AP = 2.057), and -LR (RCT = 0.046, AP = 0.383). SRHRCT proved to be a good predictor of the presence of RCT, but a weak predictor of AP in this subpopulation

PRILE 2021 guidelines for reporting laboratory studies in Endodontology: A consensus-based development

Reproducible, skilfully conducted and unbiased laboratory studies provide new knowledge, which can inform clinical research and eventually translate into better patient care. To help researchers improve the quality and reproducibility of their research prior to a publication peer-review, this paper describes the process that was followed during the development of the Preferred Reporting Items for Laboratory studies in Endodontology (PRILE) 2021 guidelines and which used a well-documented consensus-based methodology. A steering committee was created with eight individuals (PM, RO, OP, IR, JS, EP, JJ and SP), plus the project leaders (PD, VN). The steering committee prepared an initial checklist by combining and adapting items from the modified Consolidated Statement of Reporting Trials checklist for reporting in vitro studies of dental materials and the Clinical and Laboratory Images in Publications principles as well as adding several new items. The steering committee then formed a PRILE Delphi Group (PDG) and PRILE Online Meeting Group (POMG) to provide expert advice and feedback on the initial draft checklist and flowchart. The members of the PDG participated in an online Delphi process to achieve consensus on the items within the PRILE 2021 checklist and the accompanying flowchart for clarity and suitability. The PRILE checklist and flowchart developed by the online Delphi process were discussed further by the POMG. This online meeting was conducted on 12 February 2021 via the Zoom platform. Following this meeting, the steering committee developed a final version of the PRILE 2021 guidelines and flowchart, which was piloted by several authors when writing up a laboratory study for publication. Authors are encouraged to use the PRILE 2021 guidelines and flowchart to improve the clarity, completeness and quality of reports describing laboratory studies in Endodontology. The PRILE 2021 checklist and flowchart are freely available and downloadable from the Preferred Reporting Items for study Designs in Endodontology website (http://pride-endodonticguidelines.org/prile/)

Influence of some chemical characteristics on the use of chlorine-containing solutions as root canal irrigants

Objetivo : este estudo buscou avaliar as interações e características químicas, além da concentração de cloro, que afetam o desempenho das soluções irrigadoras contendo cloro na desinfecção dos canais radiculares. Metodologia : Sete estudos foram realizados, sendo três de revisão de literature e quarto trabalhos experimentais. (1) revisou a influência das modificações de pH na eficácia das soluções irrigadoras contend cloro. (2) estudou as interações químicas indesejáveis entre hipoclorito de sódio e clorexidina, EDTA e ácido cítrico. (3) comparou o hipoclorito de sódio usado isoladamente e adicionado com agente surfactante. Uma busca manual foi realizada dos artigos disponíveis online, quando necessário, utilizando o mesmo critério da busca eletrônica. (4) avaliou a atividade antimicrobiana do Sterilox e do hipoclorito de sódio em dentes bovinos infectados por Enterococcus faecalis. (5) avaliou a capacidade de dissolução de tecido pulpar bovino do Sterilox, do HealOzone e do hipoclorito de sódio a 0,5%, tanto em uso isolado como em combinação. (6) Buscou compreender o efeito da luz solar na estabilidade do Sterilox comparado ao hipoclorito de sódio. (7) avaliou o efeito da imersão, em hipoclorito de sódio a 0,5% e a 5,25%, de cones de guta-percha impregnados com clorexidina na modificação de cor e na formação de precipitado em tubos de Eppendorf transparentes. As metodologias específicas de cada estudo encontram-se nas publicações. Resultados : Os estudos de revisão mostraram que o pH pode interferir positivamente na ação antimicrobiana e negativamente na capacidade de dissolução tecidual das soluções contendo cloro (1). Além disso, interações com as substâncias contendo cloro podem afetar positiva ou negativamente nas propriedades dessas substâncias (2). O uso de surfactante ainda necessita maiores estudos para avaliar o potencial no favorecimento da ação dessas substâncias no sistema de canais radiculares (3). Em relação aos estudos experimentais, foram encontradas os seguintes achados: o Sterilox tem atividade antimicrobiana, mas estatisticamente inferior ao hipoclorito de sódio (4); o Sterilox não tem capacidade de dissolver tecido pulpar, mas a velocidade de dissolução do hipoclorito de sódio pode ser aumentada com o uso do ozônio (5); a luz solar interfere no tempo de estabilidade do Sterilox (6); precipitados são formados depois da imersão em hipoclorito de sódio por 14 dias, tanto em cones sem como com clorexidina, embora a clorexidina propiciasse precipitados bastante expressivos (7). Conclusões : Do ponto de vista de ação antimicrobiana, o hipoclorito de sódio parece ser a melhor solução irrigadora. Sua ação pode ser aumentada com a diminuição do seu pH. As interações com outras substâncias podem reduzir a ação do hipoclorito de sódio, e o efeito de um surfactante necessita maiores estudos para avaliar seu efeito. O hipoclorito de sódio é a única substância contendo cloro que tem ação relevante na dissolução de tecido pulpar, mas sua atividade pode ser potencializada por ozônio. A mistura de hipoclorito de sódio com clorexidina forma precipitados e a liberação de substância potencialmente cancerogênica. Este precipitado pode ocorrer inclusive em cones de guta-percha impregnados com clorexidina quando em contato com o hipoclorito de sódio. A concentração de cloro no Sterilox permanence estável por 14 dias se estiver protegida da luz solar.Aim : the goal of the present investigation was to look into chemical interactions and characteristics, other than chlorine concentration, and their effect on the overall performance of chlorine-containing root canal irrigants. Methodology : Three different searches were performed in the Medline electronic database, with the purpose of identifying publications that: (a) reviewed the influence of pH changes on the efficacy of chlorine-containing endodontic irrigating solutions; (b) studied unwanted chemical interactions between sodium hypochlorite (NaOCl), chlorhexidine (CHX), EDTA and Citric acid; (c) compared NaOCl alone and NaOCl modified with the addition of a surface-active agent in endodontics. A hand search of articles published online, and appearing in the reference list of the articles included (for search c only), was further performed, using the same search criteria as the electronic search. Four investigations were carried out: (a) to evaluate the antimicrobial effect of Sterilox and sodium hypochlorite against Enterococcus faecalis in a bovine root canal model; (b) to evaluate the bovine pulp tissue dissolution ability of Sterilox, HealOzone, and 0.5% sodium hypochlorite, used alone or in combination; (c) to understand the effect of storage conditions on Sterilox’s stability. Eight bottles (four completely full, four half-full) of freshly prepared solution were divided into four groups and subsequently stored by being either exposed to or protected from sunlight; (d) to evaluate whether the immersion of CHX impregnated guttapercha points in chlorine-containing endodontic irrigants causes colour changes and precipitate formation, eighty-one CHX medicated points were immersed in microtubes, containing the following solutions: 0.5 and 5.25% NaOCl or Aquatine (Sterilox). The samples were visually assessed by two independent observers at regular intervals over three weeks to detect colour changes and precipitate formation. Results : The searches identified: for topic a: 1304 publications, 20 fulfilled the inclusion/exclusion criteria; for topic b: 1285 publications, 19 fulfilled the inclusion/exclusion criteria; for topic c: 302 publications 11 fulfilled the inclusion/exclusion criteria. For investigation a: statistically significant differences between the groups exposed to sunlight and non-exposed groups (p <0.001) were found, whilst the presence of air did not affect the chlorine decomposition in the bottles. For investigation b: the groups containing 5.25% NaOCl started to produce a visible precipitate after fourteen days (16.48 ± 0.98) for the impregnated points; no other test group presented with changes. Conclusions : Regarding investigation (a), on antimicrobial efficacy, NaOCl appears to be the best preparation amongst chlorine-containing irrigants; this can be enhanced by reducing its pH. Interactions with chelating agents can reduce this action, and there is no clear evidence regarding the effect of surface-tension modification. Investigation (b) on tissue dissolution ability showed that NaOCl is the only chlorine-containing solution with a clinically relevant action. Sodium hypochlorite dissolution ability may be speeded up with the adjunct use of ozone. The literature reviews also pointed out that interaction with chelators reduce this ability, whilst the surface tension of the preparations has no influence. By mixing NaOCl and CHX in liquid or gel forms, a precipitate is formed; this is likely to contain a cancerogenic substance. Investigation (c) showed that Sterilox chlorine concentration is stable for a twoweek period if protected from direct sunlight; if exposed to sunlight the degradation process started after 4 days. Investigation (d) allowed stating that the placement of impregnated guttapercha points in 5.25% NaOCl for a two-week period caused the formation of a precipitate in the experimental conditions of this study