Journal Of Endodontics[JOURNAL]
Sun
200 papers
Sixty Years of Ethylenediaminetetraacetic Acid Use in Endodontics: A Comprehensive Bibliometric Study.
Hartmann CS, Monteiro Czornobay LF, Savaris JM … +6 more , de Oliveira Rocha A, Menezes Dos Anjos L, Pacheco de Castro Henriques BA, Cardoso M, da Fonseca Roberti Garcia L, da Silveira Teixeira C
J Endod · 2026 Apr · PMID 41232916 · Publisher ↗
INTRODUCTION: This bibliometric review aimed to analyze research trends and key characteristics of studies related to ethylenediaminetetraacetic acid (EDTA) in endodontics. METHODS: A comprehensive search was performed i...
INTRODUCTION: This bibliometric review aimed to analyze research trends and key characteristics of studies related to ethylenediaminetetraacetic acid (EDTA) in endodontics. METHODS: A comprehensive search was performed in May 2025 using the Web of Science Core Collection database. All study types were considered. Two independent reviewers extracted data on citations, publication year, journal, study design, topic, country, continent, institutions, authorship, and keywords. VOSviewer software was used to generate collaboration networks, and Spearman's correlation assessed relationships between variables. RESULTS: A total of 1947 articles were identified, of which 944 met the inclusion criteria. The most cited article received 466 citations. The Journal of Endodontics was the most prevalent journal (n = 239). Laboratory studies represented 93% of all included publications. The most common research topics involved comparisons between EDTA and other chelating agents, as well as the deleterious effects of EDTA on dentin (n = 310). Scanning electron microscopy was the most widely used imaging technique (n = 277). The most productive author was Ballal NV (n = 24). Brazil led in number of publications (n = 180), while the Asian continent accounted for the highest overall output (n = 407). Spearman's analysis showed a strong negative correlation between citation count and publication year (r = -0.792), and a weak positive correlation with journal impact factor (r = 0.235). CONCLUSIONS: This review demonstrates sustained global interest in EDTA. Brazil and Turkey are key contributors to this field. The predominance of in vitro studies highlights the need for future research to include more clinical trials and systematic reviews to enhance the strength of evidence.
Evaluating Retrieval-Augmented Large Language Models on External Cervical Resorption: A Comparative Study of Gemini and NotebookLM.
Garcia-Font M, Dufey-Portilla N, Durán-Sindreu F … +5 more , González Sánchez JA, Rodríguez Millán G, Nagendrababu V, Dummer PMH, Abella Sans F
J Endod · 2026 Feb · PMID 41207474 · Publisher ↗
INTRODUCTION: This study evaluated the accuracy and consistency of two large language models developed by Alphabet Inc., Google Gemini (GG), a base configuration, and NotebookLM (NLM), a document-grounded configuration,...
INTRODUCTION: This study evaluated the accuracy and consistency of two large language models developed by Alphabet Inc., Google Gemini (GG), a base configuration, and NotebookLM (NLM), a document-grounded configuration, when answering clinical questions regarding external cervical resorption using a retrieval-augmented framework. METHODS: Forty-six dichotomous clinical questions related to external cervical resorption were developed by three academic endodontists based on established sources. Each question was submitted to GG and NLM using three independent user accounts, yielding 276 responses. The retrieval-augmented generation configuration was replicated by NLM, which was programmed to generate responses exclusively from the documents provided. Three endodontic experts independently evaluated all responses against predefined gold standard answers. Accuracy was defined as agreement with the gold standard; consistency referred to identical responses across the three trials. Statistical analyses included 95% confidence intervals (CIs) (Wald and Wilson), Fleiss' kappa, and Fisher's exact test. RESULTS: GG achieved an accuracy of 89% (41/46; 95% CI, 76.96-95.27) and a consistency rate of 93% (κ = 0.89; P < .001). NLM achieved an accuracy of 96% (44/46; 95% CI, 85.47-98.79) and the same consistency (κ = 0.90; P < .001). No significant differences occurred between the large language models for accuracy and consistency. CONCLUSIONS: The NLM and GG models exhibited a high level of accuracy and consistency. Although NLM had a slightly superior performance, retrieval augmentation did not significantly enhance the responses to structured clinical tasks.
Research on Registration Strategy for Guided Endodontics.
Liu C, Ma L, Zhang Y … +2 more , Dong Y, Bao X
J Endod · 2026 Mar · PMID 41205993 · Publisher ↗
INTRODUCTION: The objective of this study was to evaluate which registration strategy (the number, configuration, and distribution range of fiducial markers) could obtain the optimal registration accuracy for guided root...
INTRODUCTION: The objective of this study was to evaluate which registration strategy (the number, configuration, and distribution range of fiducial markers) could obtain the optimal registration accuracy for guided root canal therapy. METHODS: One 3-dimensional-printed mandibular jaw model was created. The fiducial markers used for registration were prepared on the crowns of anterior and posterior teeth. The models were scanned using cone-beam computed tomography, and digital models were built. Different numbers (3, 4, 6, 8, and 10), configurations (quadrilateral, triangular, and linear) and distribution ranges (target tooth, adjacent teeth, and mandibular dentition) of fiducial markers were applied for registration of the dynamic navigation system. The target registration error (TRE) was measured. One-way analysis of variance was applied to assess registration error between groups. The significance level was set at .05. RESULTS: The TREs of 4 markers were significantly lower than those of three for both anterior tooth (0.32 mm vs 0.62 mm; P < .05) and posterior tooth (0.22 mm vs 1.43 mm; P < .05); increasing the number of markers to ten did not further reduce the TREs (P > .05). The TREs of markers arranged in a quadrilateral configuration were significantly lower than those in linear and triangular configurations (P < .05). The TREs of the markers selected on the target tooth and adjacent teeth were significantly lower than those in the mandibular dentition region for anterior tooth (P < .05). CONCLUSIONS: In endodontic treatment, the best registration accuracy was obtained by selecting four spatial quadrilateral fiducial markers localized around the target tooth.
Impact of Autoclaving on the Mechanical Performance and Metallurgical Behavior of ProTaper Ultimate, BlueShaper, and ZenFlex Nickel-Titanium Systems.
Bardan F, El-Kishawi M, Abou Neel EA … +3 more , Al Shehadat S, El Abed R, Jamleh A
J Endod · 2026 Feb · PMID 41167332 · Publisher ↗
INTRODUCTION: This study assessed the effect of autoclaving on the mechanical properties and metallurgy of heat-treated nickel-titanium rotary files. METHODS: Files from ProTaper Ultimate (PTU), BlueShaper (BSH), and Zen...
INTRODUCTION: This study assessed the effect of autoclaving on the mechanical properties and metallurgy of heat-treated nickel-titanium rotary files. METHODS: Files from ProTaper Ultimate (PTU), BlueShaper (BSH), and ZenFlex (ZFL) systems (n = 60) were divided into 3 groups based on autoclaving cycles (0, 3, and 7) (n = 20). In each group, the files were tested under torsional stress or dynamic cyclic fatigue (n = 10 each). The fractured fragments from both tests were examined using scanning electron microscopy. New files from each system were subjected to 0, 3, and 7 autoclaving cycles and tested using energy-dispersive spectroscopy and differential scanning calorimetry. Data were analyzed using two-way ANOVA and Wilcoxon signed-rank test at a 5% significance level. RESULTS: BSH exhibited the highest torsional strength and dynamic cyclic fatigue resistance, particularly after 3 and 7 autoclaving cycles, followed by PTU and ZFL. ZFL showed a higher distortion angle than PTU and BSH after 3 and 7 cycles. Autoclaving decreased torsional strength of BSH and increased the distortion angle of ZFL. BSH exhibited the highest austenite finish and martensite start temperatures, with minimal thermal degradation observed after autoclaving. CONCLUSIONS: BSH demonstrated the highest torsional strength, dynamic cyclic fatigue resistance, and phase transformation temperatures across all autoclaving cycles, followed by PTU and ZFL. Autoclaving reduced torsional strength of BSH and increased distortion angle of ZFL but did not affect the dynamic cyclic fatigue resistance, phase transformation, or elemental analysis of the other tested files.
Clinical and Laboratory Insights Into the GentleWave System: A Scoping Review.
de Araújo LP, Chaves de Araújo BC, Immich F … +2 more , Cavalcanti BDN, McDonald NJ
J Endod · 2026 Feb · PMID 41167331 · Publisher ↗
INTRODUCTION: The GentleWave System is an advanced endodontic irrigation technology that utilizes multisonic energy and optimized fluid dynamics to improve root canal cleaning and disinfection. While early studies report...
INTRODUCTION: The GentleWave System is an advanced endodontic irrigation technology that utilizes multisonic energy and optimized fluid dynamics to improve root canal cleaning and disinfection. While early studies report encouraging outcomes, its comparative clinical effectiveness, long-term benefits, and cost-efficiency remain under investigation. This scoping review aims to systematically assess the available clinical and laboratory evidence on the GentleWave System in endodontics. METHODS: This review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis Extension for Scoping Reviews guidelines and was prospectively registered in the Open Science Framework. A comprehensive search of 5 electronic databases (Cochrane Library, EMBASE, PubMed/MEDLINE, SciVerse Scopus, and Web of Science) was performed to identify clinical and in vitro studies evaluating the GentleWave System. RESULTS: A total of 34 studies met the inclusion criteria, including 28 laboratory-based investigations (82.4%) and 6 clinical studies (17.6%). Clinical trials reported high periapical healing rates, exceeding 97% at 6- and 12-month follow-ups, and postoperative pain levels comparable to passive ultrasonic irrigation. However, recent prospective data indicate similar healing outcomes when compared to other advanced irrigation techniques. Laboratory studies consistently demonstrated significant performance in removing biofilm, smear layer, calcium hydroxide, and filling materials, while maintaining reduced apical pressure and minimal dentin erosion. Methodological variability and limited long-term clinical data remain key limitations. CONCLUSIONS: The GentleWave System shows potential as an adjunctive irrigation technology, particularly in anatomically complex cases. Overall, the evidence mapped in this scoping review appears low to moderate, reflecting the limited number of available clinical studies and their high risk of bias.
Hospital-Based Emergency Department Visits due to Periapical Abscess in the United States: Nationwide Estimates for the Years 2021-2022.
Vogel S, Ahn G, Nalliah R … +5 more , Oubaidin M, Han MD, Elnagar MH, Allareddy V, Lee MK
J Endod · 2026 Feb · PMID 41161407 · Publisher ↗
INTRODUCTION: Periapical abscess (PA) is an odontogenic infection that primarily arises from pulpal disease and can lead to life-threatening conditions if left untreated. The objective of this study was to provide update...
INTRODUCTION: Periapical abscess (PA) is an odontogenic infection that primarily arises from pulpal disease and can lead to life-threatening conditions if left untreated. The objective of this study was to provide updated national estimates on the prevalence of PA in the United States hospital-based emergency departments (EDs) for the years 2021-2022, and to analyze predictors of related hospital charges. METHODS: The Nationwide Emergency Department Sample database was used for the years 2021-2022. All ED visits with a primary diagnosis of PA were selected for analysis of the frequency of visits, sociodemographic, and hospital-related data. A multivariable linear regression analysis model was used to identify predictor variables that influence ED and hospital charges. RESULTS: During the years 2021 and 2022 in the United States, a total of 846,629 ED visits were attributed to a primary diagnosis of PA. The populations who frequented the ED for PA the most were more likely to be insured by Medicaid (44.2%) and reside in low-income areas (42.1%). The mean ED hospital charge was $2,585 per encounter. Age, sex, ethnicity, insurance status, household income levels, geographic location, hospital teaching status, and presence of comorbid conditions all had a significant impact on influencing hospital charges (P < .05). CONCLUSIONS: The study found that the frequency of visits for PA in the ED remains high, and the hospital ED charges have increased significantly despite similar outcomes compared to data from the past decade. Demographic, socioeconomic, hospital-related, and comorbid medical conditions were associated with hospital charges.
Accuracy of Robotic Root Canal Localization Using Optimized Point Cloud Registration Strategies: An In Vitro Study.
Piao Y, Deng Y, Bao X … +2 more , Wang J, Dong Y
J Endod · 2026 Feb · PMID 41161406 · Publisher ↗
INTRODUCTION: Traditional registration process of robotic root canal localization remains cumbersome. This study aimed to determine optimal point cloud registration strategies for robotic root canal localization and eval...
INTRODUCTION: Traditional registration process of robotic root canal localization remains cumbersome. This study aimed to determine optimal point cloud registration strategies for robotic root canal localization and evaluate its accuracy. METHODS: 3D-printed mandibular dental models were divided into point cloud group (PCG) and fiducial point group (FPG) based on registration method. Fiducial points and target points were prepared in FPG, while only target points were prepared in PCG. After cone-beam computed tomography imaging and intraoral scanning, registration was performed using respective methods, with PCG acquiring point clouds from different tooth surfaces. Registration accuracy was evaluated by calculating fiducial registration error and target registration error. Then the robot system performed root canal localization in each group, measuring entry, apical and angular deviations. Statistics were analyzed using independent sample t-tests and one-way ANOVA. RESULTS: PCG achieved lowest registration errors when lingual surface point clouds were acquired for anterior teeth and occlusal surface point clouds for posterior teeth (P < .05). Compared with FPG, the fiducial registration error of PCG was significantly lower (P < .05), while the target registration error was comparable (P > .05). In PCG, the robotic system demonstrated entry, apical, and angular deviations of 0.25 ± 0.08 mm, 0.29 ± 0.06 mm, and 1.34 ± 0.81°, which was comparable to FPG (P > .05). CONCLUSIONS: The registration strategy utilizing point clouds from lingual surfaces of anterior teeth and occlusal surfaces of posterior teeth achieves high accuracy, feasible for robotic root canal localization. This method may enhance registration accuracy and clinical efficiency.
Efficacy of Post-Endodontic Access Cavity Cleaning Techniques: A Randomized Clinical Study.
Karadayi A, Irem Altintas E, Bayraktar ET … +1 more , Korkut B
J Endod · 2026 Feb · PMID 41135740 · Publisher ↗
INTRODUCTION: This randomized clinical study aimed to evaluate the efficacy of different postendodontic access cavity cleaning techniques in removing residual epoxy resin-based sealer from the pulp chamber floor followin...
INTRODUCTION: This randomized clinical study aimed to evaluate the efficacy of different postendodontic access cavity cleaning techniques in removing residual epoxy resin-based sealer from the pulp chamber floor following root canal obturation. METHODS: Seventy patients requiring root canal treatment in maxillary first molars were randomly assigned to 7 groups (n = 10) according to the cleaning protocol: dry cotton pellet, ethanol-saturated cotton pellet (5 seconds), ethanol-saturated cotton pellet (clinically acceptable cleanliness), ethanol-saturated cotton pellet + air polishing, ethanol-saturated microbrush (5 seconds), ethanol-saturated microbrush (clinically acceptable cleanliness) and air abrasion. After obturation with gutta-percha and AH Plus sealer, standardized macro photographs were taken before and after cleaning procedures. The sealer-covered area (SCA) was calculated using Adobe Photoshop based on pixel analysis. Statistical analyses included the Shapiro-Wilk, Paired samples t, Kruskal-Wallis and Mann-Whitney U tests. A P value of <.05 was considered statistically significant. RESULTS: All cleaning protocols significantly reduced SCA values compared to baseline (P < .05). The highest SCA reductions were observed in the air abrasion (96.1%), ethanol-saturated microbrush (clinically acceptable cleanliness) (93.9%), ethanol-saturated cotton pellet + air polishing (92.8%) groups, with no significant differences among them (P > .05). These groups showed significantly higher cleaning efficacy compared to the ethanol-saturated microbrush (5 seconds) (36.1%), dry cotton pellet (26.4%), and the ethanol-saturated cotton pellet (5 seconds) (17.7%) groups (P < .05). CONCLUSIONS: Among the evaluated methods, air abrasion, ethanol-saturated microbrush (clinically acceptable cleanliness), ethanol-saturated cotton pellet + air polishing and ethanol-saturated cotton pellet (clinically acceptable cleanliness) demonstrated superior effectiveness in removing residual sealer from the access cavity. Although no statistically significant differences were observed, application of microbrush and mechanically assisted cleaning techniques, including air polishing and air abrasion, emerged as the most reliable and effective cleaning strategies for clinical practice.
Intracellular Bacteria in Stem Cells of the Apical Papilla: A "Trojan Horse" for Regenerative Endodontic Failure.
Kalimuthu S, Neelakantan P
J Endod · 2026 Feb · PMID 41130500 · Publisher ↗
INTRODUCTION: Regenerative endodontic procedures show unpredictable outcomes in infected teeth due to persistent infection. While current disinfection protocols reduce but do not eliminate root canal bacteria, the fate o...
INTRODUCTION: Regenerative endodontic procedures show unpredictable outcomes in infected teeth due to persistent infection. While current disinfection protocols reduce but do not eliminate root canal bacteria, the fate of residual microorganisms during stem cell recruitment remains unclear. This study tested the hypothesis that endodontic pathogens invade and survive within stem cells of the apical papilla (SCAP), diminishing its biomineralization potential. METHODS: Internalization of SCAP by Gram-positive (Enterococcus faecalis, Actinomyces naeslundii) and Gram-negative (Porphyromonas gingivalis, Fusobacterium nucleatum) bacteria was characterized using colony-forming unit assays, confocal microscopy and flow cytometry. Intracellular survival of E. faecalis was monitored for 14 days in both planktonic and biofilm phases. The impact of intracellular E. faecalis on SCAP biomineralization and odontogenic differentiation was assessed using alkaline phosphatase activity, alizarin red staining, and quantitative real-time PCR. Statistical analyses were performed using one-way ANOVA with Dunnett's multiple comparison test or two-way ANOVA with Tukey's multiple comparison test. P < .05 was considered statistically significant. RESULTS: All tested bacteria invaded SCAP with differential efficiencies. E. faecalis and F. nucleatum demonstrated robust internalization (∼5-log colony forming unit), while P. gingivalis and A. naeslundii showed reduced invasion (∼2.5 log colony forming unit). E. faecalis persisted intracellularly for up to 14 days, with biofilm-phase bacteria showing enhanced survival in monolayer SCAP cultures. Intracellular E. faecalis abrogated SCAP mineralization while maintaining cell viability, accompanied by significant downregulation of all tested odontogenic genes (P < .05). CONCLUSIONS: Bacteria invade and establish persistent intracellular infections within SCAP, creating protected reservoirs. These intracellular bacteria severely compromise odontogenic differentiation without killing the host cells, representing a potentially unrecognized mechanism of regenerative endodontic procedure failure. This "Trojan horse" strategy may explain the unpredictable outcomes of regenerative endodontics in infected teeth.
Physicochemical and Biological Properties of the "All-In-One" Endodontic Irrigant Triton.
Aranda J, de Souza EON, Aranda Garcia AJ … +4 more , Leonardo RT, Ramos AP, Rossi-Fedele G, Faria G
J Endod · 2026 Mar · PMID 41110690 · Publisher ↗
INTRODUCTION: Triton is a newly developed root canal irrigant that acts on both organic and inorganic tissues. This study evaluated the physicochemical properties (pH, surface tension, contact angle, available free chlor...
INTRODUCTION: Triton is a newly developed root canal irrigant that acts on both organic and inorganic tissues. This study evaluated the physicochemical properties (pH, surface tension, contact angle, available free chlorine), dentin penetration, and cytotoxicity of Triton, compared with 4% sodium hypochlorite (NaOCl) + etidronic acid (HEDP), 4% NaOCl/17% ethylenediaminetetraacetic acid, and 4% NaOCl. METHODS: pH was measured using a pH meter; surface tension and contact angle were assessed by the pendant drop and sessile drop methods, respectively. Available free chlorine was determined by titration with iodine/sodium thiosulfate. For dentin penetration, 39 extracted human premolars were instrumented, stained with crystal violet, irrigated, and analyzed under a stereomicroscope. Cytotoxicity was evaluated on L929 fibroblasts using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and neutral red (NR) assays. RESULTS: Triton showed a pH of 12.49, available free chlorine of 4.18%, and significantly lower surface tension and contact angle than the other irrigants (P < .05). In the cervical third, Triton showed greater dentin penetration than 4% NaOCl and 4% NaOCl + HEDP (P < .05); in the middle third, greater penetration than 4% NaOCl (P < .05). No significant differences were observed in the apical third (P > .05). Triton and 4% NaOCl + HEDP groups had significantly lower cell viability compared to other groups (P < .05). CONCLUSIONS: Triton demonstrated an alkaline pH, lower surface tension and contact angle, and greater dentin penetration in the cervical and middle thirds compared to 4% NaOCl. However, its cytotoxicity, similar to that of 4% NaOCl + HEDP, emphasizes the need for safe irrigation dynamics to prevent periradicular tissue damage.
Corrigendum to 'Artificial Intelligence for the Computer-aided Detection of Periapical Lesions in Cone-beam Computed Tomographic Images' [Journal of Endodontics Volume 46 (2020) 987-993].
J Endod · 2026 Jan · PMID 41105085 · Publisher ↗
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Migration of a Separated Endodontic File Into the Mandibular Canal: An 8-Year Follow-up Case Report.
Katz CA, Fujimoto M, Kuroda H … +1 more , Muromachi K
J Endod · 2026 Feb · PMID 41093034 · Publisher ↗
Separated endodontic instruments in mandibular molars may migrate into the mandibular canal, potentially causing neurological complications. The management of asymptomatic cases remains controversial. This case report pr...
Separated endodontic instruments in mandibular molars may migrate into the mandibular canal, potentially causing neurological complications. The management of asymptomatic cases remains controversial. This case report presents the long-term conservative management of a separated stainless steel file that migrated into the mandibular canal. A 47-year-old male patient with chronic myeloid leukemia presented with a separated endodontic file that had migrated from the distal root of his mandibular right second molar into the mandibular canal over a 7-year period. Clinical examination, panoramic radiography, and cone-beam computed tomography were performed. Quantitative sensory testing using Semmes-Weinstein monofilament testing and psychological assessment were conducted. Conservative management with periodic observation was selected due to the patient's asymptomatic status. Cone-beam computed tomography revealed the separated file extending 1.43 mm into a mandibular canal with a diameter of 2.54 mm. Despite radiographic evidence of neural canal involvement, the patient remained asymptomatic throughout the 7-year observation period. Semmes-Weinstein monofilament testing detected minimal tactile sensitivity differences (0.1 g vs 0.55 g on the contralateral side), but no clinically significant neurological symptoms developed. Follow-up radiography at 8 years showed continued migration toward the inferior mandibular border without symptom development. Long-term migration of separated stainless steel endodontic files into the mandibular canal may remain asymptomatic. Adequate anatomical space within the mandibular canal, biocompatible properties of stainless steel, and patient-specific factors affecting sensory perception may contribute to the benign clinical course. Conservative management based on clinical symptomatology rather than radiographic findings alone appears appropriate in select asymptomatic cases, with regular monitoring recommended to detect potential delayed complications.
Cemental Tear: Systematic Review and Thematic Analysis of Clinical and Imaging Features with a Proposed Diagnostic Framework.
da Silva-Filho JE, Rodrigues-Lima AC, Silveira-Fernandes KL … +6 more , Veloso CS, Braga JPV, Ximenes SRA, Pinheiro-Júnior EC, de Albuquerque DF, Gurgel-Filho ED
J Endod · 2026 Feb · PMID 41093033 · Publisher ↗
INTRODUCTION: Cemental tear (CT) is a rare condition with poorly understood prevalence, etiology, and clinical presentation, often mimicking vertical root fractures or endodontic-periodontal lesions. This review aimed to...
INTRODUCTION: Cemental tear (CT) is a rare condition with poorly understood prevalence, etiology, and clinical presentation, often mimicking vertical root fractures or endodontic-periodontal lesions. This review aimed to synthesize current evidence on CT and propose a diagnostic framework. METHODS: A comprehensive search was conducted in Cochrane Library, Latin American and Caribbean Health Sciences Literature, PubMed, ScienceDirect, Scopus, Web of Science, and grey literature (Google Scholar, ProQuest) for case reports (2000-2024). Inclusion required full clinical and radiographic documentation. Risk of bias was assessed using the Joanna Briggs Institute checklist. Data on epidemiological, clinical, and imaging features were extracted. RESULTS: Twenty studies reported 24 patients and 39 teeth. Methodological quality was heterogeneous, mostly with moderate risk of bias. CT mainly affected single-rooted teeth, especially incisors (46.1%), in older patients (mean 56.2 years). Frequent clinical findings included deep periodontal pockets (75%), mobility (60%), and fistulas (40%). Radiographically, bone loss (33.3%), radiopaque fragments (28.2%), and lateral radiolucencies (23.1%) were noted. Cone-beam computed tomography proved crucial for detecting buccal/lingual fragments. Histopathology confirmed cementum detachment, often infection-related. Treatments ranged from fragment removal to extraction, with prognosis linked to early diagnosis. CONCLUSIONS: CT is rare and challenging, best identified with high-resolution cone-beam computed tomography and integrated clinical evaluation. Early, precise diagnosis guides prognosis, with conservative fragment removal recommended when feasible.
Effect of Restoration Strategy and Cavity Location on the Fracture Resistance of Teeth with External Cervical Resorption.
Elpe S, Sarıyılmaz Ö
J Endod · 2026 Jun · PMID 41077238 · Publisher ↗
INTRODUCTION: The restoration of external cervical resorption (ECR) defects requires materials capable of withstanding functional stresses. This study aimed to compare the fracture resistance of different restorative app...
INTRODUCTION: The restoration of external cervical resorption (ECR) defects requires materials capable of withstanding functional stresses. This study aimed to compare the fracture resistance of different restorative approaches applied to buccal versus palatal ECR defects under simulated clinical conditions. METHODS: Eighty-one extracted human maxillary central incisors were used. Nine intact teeth served as the positive control group (n = 9). The remaining 72 teeth were randomly assigned to standardized buccal or palatal ECR defect groups (n = 36 each). Each subgroup (n = 9) received one of the following treatments: negative control (no restoration), Biodentine alone, Ribbond + Biodentine, or EverX Flow + Biodentine (n = 9 per subgroup). Standardized ECR cavities were created 4 mm apical to the cementoenamel junction, with dimensions of 3 mm in width and 3 mm in depth and connected to the pulp chamber. All specimens underwent chewing simulation (240,000 cycles, 50 N load) and thermocycling (5°C-55°C) prior to fracture testing. The fracture test was performed using a universal testing machine by applying force at a 45° angle, and the maximum load was recorded in Newtons (N). Statistical analysis was performed using parametric or nonparametric tests based on data distribution, with significance set at P < .05. RESULTS: The restorative material significantly influenced fracture resistance (P < .05). In buccal defects, the Ribbond + Biodentine group demonstrated significantly higher fracture resistance compared to negative controls. For palatal defects, Biodentine alone showed significantly greater resistance than negative controls. No significant differences were observed between buccal and palatal locations (P > .05). CONCLUSIONS: While the choice of restorative material had a significant effect on the performance of restorations in ECR defects, the location of the cavity (buccal or palatal) did not significantly influence the outcomes.
Predoctoral Endodontic Education and Training in the United States and Canadian Dental Schools: A Web-Based Survey.
Falcon CY, Dunlap CA, Youssef S
J Endod · 2026 Feb · PMID 41072907 · Publisher ↗
OBJECTIVE(S): This study aimed to evaluate endodontic education and training across United States (U.S.) and Canadian dental schools. It investigated clinical practices, curriculum structure, competency assessment method...
OBJECTIVE(S): This study aimed to evaluate endodontic education and training across United States (U.S.) and Canadian dental schools. It investigated clinical practices, curriculum structure, competency assessment methods, and program challenges in order to provide insights into improving endodontic competency among dental school graduates. METHODS: A comprehensive survey was electronically distributed to predoctoral program directors from accredited dental schools in the U.S. and Canada. The survey captured data on program characteristics, competency certification, and integration of advanced technologies. Data were evaluated and the significance level was set at P < .05. RESULTS: Of the 87 program directors contacted, 48 responded (response rate: 58.54%). The survey revealed variability in clinical endodontic requirements, with a mean of 4.59 root canal treatments or 4.5 canals completed per student. Nearly one-third of schools reported insufficient patient pools, with 71.43% substituting simulation exercises for clinical experience. Most programs (86.05%) used extracted teeth for training, and 42.86% permitted students to treat routine second molars. Certification methods varied, with 29.27% emphasizing live patient experiences. Notably, 54.76% of directors were uncertain about their graduates' competence to perform molar endodontics in private practice. CONCLUSION: Endodontic education in the U.S. and Canada exhibits significant variability, with patient access being a key factor influencing training quality. Simulation exercises help mitigate some challenges, but their use raises concerns about the adequacy of clinical preparedness. Standardizing clinical requirements, improving patient access, and increasing integration of advanced resources could enhance educational outcomes.
Evaluation of Articaine Infiltration Location on the Success Rate of Mandibular Lateral Incisor Anesthesia: A Prospective Crossover Randomized Clinical Trial Study.
Adl A, Alimardani F, Sobhnamayan F
J Endod · 2026 Feb · PMID 41067376 · Publisher ↗
INTRODUCTION: Effective anesthesia of the mandibular lateral incisor is challenging. This study compared the efficacy of lingual infiltration alone versus combined labial and lingual infiltration using 4% articaine with...
INTRODUCTION: Effective anesthesia of the mandibular lateral incisor is challenging. This study compared the efficacy of lingual infiltration alone versus combined labial and lingual infiltration using 4% articaine with 1:100,000 epinephrine. METHODS: In this prospective, randomized, crossover clinical trial, 50 healthy volunteers received 2 infiltration techniques: (1) lingual infiltration only (3.6 mL total via 2 1.8 mL injections plus a mock buccal injection), and (2) combined labial and lingual infiltration (1.8 mL each; 3.6 mL total plus a mock lingual injection). Anesthetic success was evaluated by: (1) absence of response to maximal electronic pulp tester stimulation, (2) sustained anesthesia defined as no response within 16 minutes lasting 42 minutes, and (3) anesthesia onset time (first of two consecutive no-response readings). Pain during injection was assessed via the 170-mm Heft-Parker visual analog scale. Statistical tests included McNemar's, Wilcoxon signed-rank, Friedman, and Dunn's test. RESULTS: The combined technique produced an equal or higher success rate (P ≤ .05), significantly greater sustained anesthesia (P < .05), and a significantly shorter onset time (P < .05) compared with lingual infiltration alone. Labial infiltration was associated with higher pain scores, especially during solution deposition (P < .05). CONCLUSIONS: The combination of labial and lingual infiltration with 4% articaine and 1:100,000 epinephrine significantly improves the anesthetic success and duration for the mandibular lateral incisor, although it is associated with increased injection-related pain.
Cyclic Fatigue and Physical Properties Testing of Different Small Taper Heat-Treated Reciprocating Files.
Altuwalah A, Al Omari T, Alroomy R … +4 more , Mashyakhy M, Elfarraj H, Domínguez-Pérez RA, El Abed R
J Endod · 2026 Apr · PMID 41067375 · Publisher ↗
INTRODUCTION: This study aimed to evaluate the cyclic fatigue resistance of small-size reciprocating files at simulated intracanal temperature and analyze their chemical and physical properties. METHODS: Sixty new endodo...
INTRODUCTION: This study aimed to evaluate the cyclic fatigue resistance of small-size reciprocating files at simulated intracanal temperature and analyze their chemical and physical properties. METHODS: Sixty new endodontic files were subjected to cyclic fatigue resistance testing, which was performed in a CNC-milled stainless-steel artificial canal (60° curvature, 5 mm radius, 19 mm length; 1.4 mm inner diameter) submerged in a 32.0 °C water bath. Two samples were analyzed using differential scanning calorimetry and Energy Dispersive X-ray Fluorescence, while two fractured samples underwent scanning electron microscopy. RESULTS: R Motion (RM) (2542 s) and Tia Premium Blue (TPB) (2419 s) exhibited significantly higher resistance to cyclic fatigue compared to Tia Viera Gold (283 s), W Plus Gold (318 s), and Wave One Gold (292 s). RM, Tia Viera Gold, and W Plus Gold had significantly longer fractured segments than TPB and Wave One Gold. CONCLUSIONS: Blue heat-treated files showed significantly higher cyclic fatigue resistance compared to gold-treated counterparts, with RM and TPB lasting over 2400 seconds, while others failed within 300 seconds.
Tricalcium Silicate Endodontic Cements: A Bibliometric Analysis of the 100 Most Cited Articles.
Canal Vasconcellos BL, Clementino LC, da Silva Lima TC … +5 more , Andrade Maia C, Andrade-Maia G, Martins-Júnior PA, Benetti F, Tavares WLF
J Endod · 2026 Feb · PMID 41067374 · Publisher ↗
INTRODUCTION: Bibliometric analysis is an indicator of high-quality evidence for the decision-making process regarding the use of biomaterials. The aim of this study was to analyze the characteristics of the 100 most cit...
INTRODUCTION: Bibliometric analysis is an indicator of high-quality evidence for the decision-making process regarding the use of biomaterials. The aim of this study was to analyze the characteristics of the 100 most cited articles on tricalcium silicate endodontic cements. METHODS: A broad search strategy using key terms related to hydraulic endodontic cement was conducted in the Web of Science - Core Collection (WoS-CC) on May 30, 2025. Data were retrieved and organized in descending order of the number of citations in the WoS-CC, and each article was compared with the number of citations in the Scopus and Google Scholar databases. VOSviewer software (Leiden University, The Netherlands) was used to construct co-authorship networks. Spearman's correlations were performed using the Statistical Package for Social Sciences (SPSS 22.0, Armonk, NY). RESULTS: The most cited article was "Physical and chemical properties of a new root-end filling material," by Torabinejad et al. (1995), with 821 citations in WoS-CC. Of the 100 articles, the corresponding authors were predominantly from the United States (n = 37). The institution of origin of most articles was Loma Linda University (USA) (n = 15). Experimental laboratory studies were the most common study design among the included articles (58%), followed by literature reviews (14%) and observational studies (11%). The mineral trioxide aggregate (MTA), whether ProRoot MTA or MTA Angelus, was the predominant studied material (21,84%) and most studies focused on the evaluation of material properties (48%). CONCLUSIONS: This list of the most cited articles can provide a reference point to guide research and biomaterial selection.
Radial Lands and Alternating Cutting Edges Contribute to Reduced Screw-in and Torque in Curved Root Canals - An In Vitro Study.
Heimberg G, Bürklein S, Schäfer E … +2 more , Wolf TG, Donnermeyer D
J Endod · 2026 Apr · PMID 41061817 · Publisher ↗
INTRODUCTION: This study aimed to evaluate screw-in force and torsional load generated by 6 fully rotating nickel-titanium (NiTi) file systems with different geometry, cross-section, and rotational speed. METHODS: Ninety...
INTRODUCTION: This study aimed to evaluate screw-in force and torsional load generated by 6 fully rotating nickel-titanium (NiTi) file systems with different geometry, cross-section, and rotational speed. METHODS: Ninety mesial roots of human lower molars were divided into 6 groups according to the file system used for canal preparation: F360, F6, TruNatomy, RACE EVO, JIZAI I, and JIZAI II. Groups were standardized balanced to working length, chord length, and canal curvature. A custom-built test rig with an attached endodontic motor (Schlumbohm EndoPilot 2) and a 6-axis measuring device were used to measure the apically directed, screw-in and torque forces generated along the axis of the tooth as the NiTi file was moved with an amplitude of 3 mm at each peck, increasing penetration depth by 2 mm at each peck. The rotary speed was set individually for each file according to the manufacturer's instructions. Two sets of 3 pecking motions were performed with intermitting cleanings of the file and needle irrigation of the root canal. Additionally, torque forces were recorded by the endodontic motor. Maximum force values for each set of pecks were analyzed using the Kruskal-Wallis test. The correlation between z-axis tooth torque and motor-measured torque was assessed using Spearman's correlation. RESULTS: Significant differences existed between the files regarding apically directed, screw-in and torque forces (P < .05). Torque values generated on the tooth along the z-axis and torque on the file correlated significantly (P < .001). CONCLUSIONS: Radial lands or alternating cutting edges affect screw-in effect and torsional load of NiTi files.
Surgical and Nonsurgical Endodontic Treatment of a Patient with Vitamin D-resistant Rickets and Extraoral Sinus Tract: A Case Report.
Clarke BC, Noblett WC, Ordinola-Zapata R … +1 more , Chen AF
J Endod · 2026 Jan · PMID 41052719 · Publisher ↗
Vitamin D-resistant rickets is a rare genetic disorder that significantly impacts oral health, causing characteristic dental manifestations including enlarged pulp chambers, spontaneous pulp necrosis, and frequent periap...
Vitamin D-resistant rickets is a rare genetic disorder that significantly impacts oral health, causing characteristic dental manifestations including enlarged pulp chambers, spontaneous pulp necrosis, and frequent periapical infections. This case report describes the comprehensive endodontic management of a 32-year-old female with vitamin D-resistant rickets who presented with spontaneous pulp necrosis, periapical pathosis, and an extraoral sinus tract in multiple mandibular anterior teeth. Clinical examination, radiographic assessment, and vitality testing were performed. Initial nonsurgical root canal treatment was completed on teeth #22, #25, and #26, followed by aspiration. When no healing was observed at recall, surgical endodontic treatment with guided tissue regeneration was completed on teeth #24-26. Twelve-month post-treatment evaluation demonstrated complete symptom resolution, sinus tract closure, and radiographic evidence of osseous regeneration. Patients with vitamin D-resistant rickets present unique challenges for endodontic treatment due to impaired hard tissue mineralization and healing capacity. This case report demonstrates that adults with vitamin D-resistant rickets can achieve favorable endodontic outcomes, both surgically and nonsurgically.
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