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A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Applied Dentistry and Oral Sciences".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 21883

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Dr. Irene Pina-Vaz

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Endodontics, Dental Faculty, University of Porto, 4200-393 Porto, Portugal
Interests: endodontics; dental materials; nanomaterials
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue of Applied Sciences Advances in Endodontics and Periodontics, aims to improve the state of the art in relation to the most relevant advances in Endodontics and Periodontics. Topics addressed in this issue include alternative treatment strategies such as “green” antimicrobials, the relationship with systemic diseases, age-related dentistry, as well as updating evidence-based knowledge pertaining to endodontics and periodontics. Recent advances in endodontics have been stressed, incorporating new devices and materials which enabled a reduction in therapy failures, though these have not been quite correlated with the expected positive outcomes in populations. On the other hand, due to increased life expectancy, geriatric dentistry has highlighted the need to be prepared to manage oral age-related diseases, such as apical periodontitis and tooth mobility, caries, and periodontal disease. Of equal importance is the implementation of preventive and conservative measures, including pulp vital and regenerative therapies, in view of the maximum possible preservation of a functional natural dentition. Dentists should be aware of the medical complexities, poor cognitive function, and lack of autonomy of some elderly patients, which can be challenging for the entire team. Thus, there is huge pressure on dental professionals worldwide, leading to prioritizing the need to update the contemporary knowledge involving medical conditions, drug prescription, or concomitant oral illnesses involving periodontics and endodontics. Reinforcing its interdependency with differential diagnosis, prevention, and treatment of dental and periradicular pathologies in an integrated systemic health of the patient is, thus, crucial. These can include epidemiological studies, narrative or systematic reviews, short notes, or other original research papers about the theme. As a recognized researcher I believe your contributions, or the contributions of your peers, will be of great value, enriching scientific communication between different fields of Dentistry.

We hope this Special Issue will provide an opportunity to discuss the state of the art of endodontics and periodontics, and look forward to addressing the best protocols to raise the quality of treatments.

Dr. Irene Pina-Vaz
Guest Editor

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Keywords

antimicrobial materials
non-antibiotic agents
tooth preservation
endodontic post-treatment disease
apical periodontitis
endodontic solvents
endodontic retreatment
periodontics
endo–periodontal disease
chlorhexidine
mouthwashes
biofilm

Published Papers (11 papers)

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Research

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25 pages, 16256 KiB

Open AccessArticle

Investigating the Ability of the Tooth and Surrounding Support Tissues to Absorb and Dissipate Orthodontic Loads during Periodontal Breakdown—Finite Elements Analysis

by Radu-Andrei Moga, Cristian Doru Olteanu and Ada Gabriela Delean

Appl. Sci. 2024, 14(3), 1041; https://0-doi-org.brum.beds.ac.uk/10.3390/app14031041 - 25 Jan 2024

Cited by 1 | Viewed by 669

Abstract

Herein, the finite elements analysis (FEA) numerical study investigated the absorption–dissipation ability of dental tissues under orthodontic forces, during orthodontic movements and the periodontal breakdown process. Additionally, we investigated the correctness of FEA boundary assumptions up to 2.4 N of loads. Eighty-one models of the second lower premolar were subjected to 810 FEA numerical simulations using Tresca failure criterion under 0.6 N, 1.2 N, and 2.4 N and five movements: intrusion, extrusion, rotation, tipping, and translation. The results showed that both coronal dentine and enamel components had comparable high absorption–dissipation abilities, allowing for only a limited fraction of stresses to reach the circulatory sensitive tissues. Isotropy, linear elasticity, and homogeneity are correct when Tresca is employed up to 2.4 N. Forces of 0.6 N, 1.2 N, and 2.4 N displayed similar qualitative results for all movements and bone levels, while quantitative results doubled for 1.2 N and quadrupled for 2.4 N when compared with 0.6 N. FEA simulations showed 0.6–1.2 N to be safe for application in intact periodontium, while for reduced periodontium more than 0.6 N are prone to resorptive and ischemic risks. For reducing these risks, after 4 mm of bone loss, 0.2–0.6 N are recommended. Rotation and translation were the most stressful followed by tipping. Full article

(This article belongs to the Special Issue Advances in Endodontics and Periodontics)

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12 pages, 6144 KiB

Open AccessArticle

Potential Synergistic Inhibition of Enterococcus faecalis by Essential Oils and Antibiotics

by Stanley John, Jeung Woon Lee, Purushottam Lamichhane, Thanhphuong Dinh, Todd Nolan and Thomas Yoon

Appl. Sci. 2023, 13(19), 11089; https://0-doi-org.brum.beds.ac.uk/10.3390/app131911089 - 9 Oct 2023

Viewed by 1092

Abstract

Recurrent infections after root canal treatments often involve Enterococcus faecalis, a microorganism closely associated with therapy failures due to its biofilm production, survival in nutrient-deprived conditions, and antibiotic tolerance. Essential oils (EOs), which display antimicrobial and antibacterial properties, exhibit inhibitory effects on the growth of many microorganisms including E. faecalis. This study assessed the in vitro efficacy of combining 5% antibiotics (kanamycin 2.5 mg/mL, streptomycin 2.5 mg/mL, gentamicin 1.5 mg/mL, and ampicillin 5 mg/mL) with cinnamon (1.25% to 5%) or clove (25% and 50%) EOs in inhibiting the growth of E. faecalis, using disk diffusion tests. Disks were treated with EOs-only, antibiotics-only, or EO–antibiotic combinations, placed on BEA agar plates, and incubated for 24 h, and the zones of inhibition were measured. Results showed that EOs (cinnamon and clove) and 5% antibiotics, by themselves, had robust growth inhibition of E. faecalis across all tested concentrations. Moreover, combining 5% aminoglycosides (kanamycin 2.5 mg/mL, streptomycin 2.5 mg/mL, and gentamicin 1.5 mg/mL) with 5% cinnamon EO produced significantly enhanced antimicrobial effect than the corresponding 10% antibiotic solution alone. These findings suggest that combining cinnamon EO with aminoglycoside antibiotics can achieve significant inhibition of E. faecalis at a lower concentration of antibiotics compared to using a higher dose of antibiotics alone. Further in vivo studies should determine the safety, efficacy, and treatment duration, with the potential to reduce antibiotic dosages and associated toxicity while preventing recurrent infections. Full article

(This article belongs to the Special Issue Advances in Endodontics and Periodontics)

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15 pages, 3112 KiB

Open AccessArticle

Effect of Traditional and Conservative Endodontic Access Cavities on Instrumentation Efficacy of Two Different Ni–Ti Systems: A Micro-CT Study

by Mehrdad Koohnavard, Berkan Celikten, Arda Buyuksungur and Kaan Orhan

Appl. Sci. 2023, 13(9), 5803; https://0-doi-org.brum.beds.ac.uk/10.3390/app13095803 - 8 May 2023

Viewed by 2301

Abstract

This study aims to compare the shaping efficiency of the nickel–titanium instrument systems, One Reci and ProTaper Ultimate, using micro-CT (micro-computed tomography) in traditional and conservative endodontic access cavities. The experimental groups were formed according to the type of access cavity and Ni–Ti file system to be used. Sixty mandibular molar teeth were randomly divided into two main groups, the conservative access cavity (CAC) group and the traditional access cavity (TAC) group, and randomly divided into two subgroups according to the file system. The groups were compared with a two-way ANOVA analysis in terms of volume change, surface area, non-instrumented area transportation, and thickness of the dentin in the danger zone area after root canal preparation. The groups showed no statistically significant differences in terms of volume change, surface area, or the thickness of the dentin in the danger zone area after root canal preparation (p > 0.05). However, in the percentage of non-instrumented areas post-instrumentation between groups, the percentage of non-instrumented areas was statistically higher in specimens with CAC compared to TAC (p < 0.05). Canal transportation was higher in CAC at all distances from the apical region (p < 0.05). Within the limitations of this study, CAC can also be used with some precautions as an alternative to TAC. Full article

(This article belongs to the Special Issue Advances in Endodontics and Periodontics)

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11 pages, 1731 KiB

Open AccessArticle

First Experience of an Undergraduate Dental Student with a Reciprocating System in Simulated Root Canals—A Pilot Study

by Ana Rita Arede, Inês Ferreira, Ana Cristina Braga and Irene Pina-Vaz

Appl. Sci. 2023, 13(8), 4848; https://0-doi-org.brum.beds.ac.uk/10.3390/app13084848 - 12 Apr 2023

Viewed by 1038

Abstract

Rotary instrumentation has been proposed in undergraduate teaching. The aim of this study was to evaluate student’s performance, through the obturation quality and treatment time, in a sequential range of L-simulated root canals. A senior undergraduate dental student sequentially prepared randomly numbered canals from 1 to 40, with the WaveOne Gold glider and primary file, according to the manufacturer instructions. A gutta-percha cone matched with the finishing instrument and epoxy resin-based sealer (AH Plus) was selected for the obturation. Three independent observers evaluated the obturation quality according to both density and length. Active, total instrumentation and obturation times were also measured. Statistical analysis was obtained by Mann–Whitney and Kruskal–Wallis tests with a significance level of p < 0.05. The quality of the obturation was independent of the number of prepared canals with adequate length and density in 87.5% of the prepared canals. Both active and total instrumentation, as well as obturation times, reduced significantly as the number of the prepared canals by the student increased (p ˂ 0.05). The use of WaveOne Gold instrumentation and matched cone obturation by an inexperienced operator provided an adequate obturation quality in most of the curved simulated canals. The working time was significantly reduced through a short learning curve. Full article

(This article belongs to the Special Issue Advances in Endodontics and Periodontics)

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9 pages, 271 KiB

Open AccessArticle

Validation of a Suggested Pre-Operative Protocol for the Prevention of Traumatic Dental Injuries during Oroendotracheal Intubation: A Pilot Study

by Daniela Silva, Rita Miranda, Inês Ferreira, Ana Braga, Joana Mourão and Irene Pina-Vaz

Appl. Sci. 2023, 13(4), 2091; https://0-doi-org.brum.beds.ac.uk/10.3390/app13042091 - 6 Feb 2023

Cited by 1 | Viewed by 986

Abstract

The aim of this study was to develop a protocol for oral pre-operative registration and dental risk assessment by the anaesthesiologist, determining its reliability through the inter-observer agreement between a senior dental student and an internal physician specializing in anaesthesiology. A convenience sample consisting of 35 patients was selected. These were observed during the anaesthesiology consultation, at Hospital de São João, Porto, Portugal. The protocol included a self-administered questionnaire and a brief clinical examination by the two observers. A descriptive analysis (qualitative and quantitative variables) was performed. The Fleiss Kappa index was used to measure the degree of agreement between the two observers. In most of the parameters defined, the agreement presented Kappa index values between 0.6 and 1, corresponding to good and excellent correlation, respectively. The general oral status was considered “poor”, with a great number of missing teeth, namely the upper central and lateral incisors. The proposed pre-anaesthetic protocol can be a reliable tool for the anaesthesiologists, which suggests the relevancy of incorporating interdisciplinary training between future health professionals. Further research is needed to assess its implementation, providing information about the pre-operative oral status, preventing intraoperative damage and potential medicolegal litigation. Full article

(This article belongs to the Special Issue Advances in Endodontics and Periodontics)

12 pages, 1176 KiB

Open AccessArticle

Levels of IL-23/IL-17 Axis in Plasma and Gingival Tissue of Periodontitis Patients According to the New Classification

by Ruth Rodríguez-Montaño, Alondra del Carmen Ruiz-Gutiérrez, Vianeth María del Carmen Martínez-Rodríguez, Juan Ramón Gómez-Sandoval, Juan Manuel Guzmán-Flores, Julieta Sarai Becerra-Ruiz, Ana Lourdes Zamora-Perez and Celia Guerrero-Velázquez

Appl. Sci. 2022, 12(16), 8051; https://0-doi-org.brum.beds.ac.uk/10.3390/app12168051 - 11 Aug 2022

Cited by 2 | Viewed by 1524

Abstract

Background: Periodontitis (P) is a chronic inflammatory disease characterized by the destruction of periodontium support tissue generated by different immuno-inflammatory mechanisms, including the RANK/RANKL/OPG and the IL-23/IL-17 axis. Methods: The study was performed with healthy subjects (HS) and patients with periodontitis. Plasma samples were obtained from peripheral blood and the gingival tissue (GT) during periodontal surgery. The ELISA technique was used to evaluate the levels of IL-23, IL-17A, IL-23R, and IL-17RA. Results: In the plasma, a significant decrease in IL-17A was observed in patients with periodontitis than HS. In the GT, IL-23, IL-17A, and IL-17RA levels were increased in periodontitis patients; on the contrary, IL-23R levels were decreased in periodontitis patients when compared with HS. Finally, several positive correlations were found: soluble IL-17RA (sIL-17RA) levels in plasma between the percentage of radiographic bone loss (RBL%), and IL-23 with IL-17A in gingival tissue. Conclusions: The detection of the IL-23/IL-17A axis in gingival tissue and plasma provides us with more information on the behavior of this axis in a localized way in the periodontal microenvironment, in contrast to the systemic levels evaluated according to the new classification of periodontitis. Full article

(This article belongs to the Special Issue Advances in Endodontics and Periodontics)

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15 pages, 477 KiB

Open AccessArticle

Chronic Obstructive Pulmonary Disease and Apical Periodontitis and Other Oral Health Variables: A Case-Control Study

by Anna Carrera-Cortés, Yuliana Pascual-González, Salud Santos, Jenifer Martín-González, Juan José Segura-Egea and José López-López

Appl. Sci. 2022, 12(14), 7141; https://0-doi-org.brum.beds.ac.uk/10.3390/app12147141 - 15 Jul 2022

Cited by 1 | Viewed by 1421

Abstract

Background: The relationship between chronic inflammatory diseases and their comorbidities and correlation with periodontal diseases has become an increasing focus of research. Objectives: The aim of this case-control study was to conclude if patients suffering from COPD (Chronic Obstructive Pulmonary Disease) tend to have more AP (Apical Periodontitis) than non-COPD patients. Materials and Methods: The study was conducted on 30 patients assigned as cases, associated with 30 control patients linked by age (+/−5 years) and sex. Results: A total of 60 patients were recorded, and a total of 12 radiographic variables were analyzed. A total of 43 (71.7%) patients were registered with PAI (Periapical Index) ≥ 3, and there was a slightly tendency in the patients from the control group 22 (73.3%) compared to those from the cases 21 (70%), respectively (p > 0.05). Conclusions: It was concluded that there was not a significant association between the levels of PAI (Periapical Index) ≥ 3 per patient in those suffering from COPD. In fact, it could be concluded that patients diagnosed with COPD tend to have more teeth with PAI ≥ 3, more endodontic treatments and their periodontitis tended to accumulate more caries. Clinical Significance: This study establishes, in a case-control study, some specific aspects of oral health in patients with COPD, as well as analyzing the importance of oral health in this disease. Full article

(This article belongs to the Special Issue Advances in Endodontics and Periodontics)

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11 pages, 2937 KiB

Open AccessArticle

Comparative Analysis of Temperature Variation with Three Continuous Wave Obturation Systems in Endodontics: An In Vitro Study

by Jesús Mena-Álvarez, Maria Ruiz-Barrio, Norberto Quispe-López, Ana de Pedro-Muñoz and Cristina Rico-Romano

Appl. Sci. 2022, 12(12), 6229; https://0-doi-org.brum.beds.ac.uk/10.3390/app12126229 - 19 Jun 2022

Cited by 1 | Viewed by 1512

Abstract

The aim of this study was to assess temperature changes with different continuous wave obturation systems when downpacking to 2 mm and 4 mm from the apical foramen in an open system not simulating the surrounding biological structures at body temperature. Sixty single-rooted teeth were divided into three groups: (A) Dia-Duo^® (DiaDent Group International, Cheongju-si, Korea), (B) Elements Free^® (Kerr Corporation, Orange, CA, USA) and (C) Calamus^® (Dentsply Sirona, Ballaigues, Switzerland). The root canals were instrumented with Protaper Gold (Dentsply Sirona, Ballaigues, Switzerland) to size F2 (25.08). The root canals were filled by a continuous wave using an AH Plus^® sealer (Dentsply Sirona). Temperatures during the obturation procedure were measured by a thermal imaging camera (Testo 875-1^®) perpendicular to a vice where the teeth were held at −2 mm and −4 mm from the apical foramen. Comparisons were made by applying Student’s t-test and ANOVA (p = 0.05). The continuous wave technique at −2 mm with the Dia-Duo system^® emitted average temperatures of 37.3 °C, Elements Free^® emitted 39.85 °C and Calamus^® emitted 40.16 °C. At −4 mm, the Dia-Duo system^® emitted average temperatures of 34.81 °C, Elements Free^® emitted 33.73 °C and Calamus^® emitted 32.91 °C. There were significant differences between continuous waves at −2 mm and at −4 mm (p < 0.05). Dia-Duo^® was the only system that did not present significant differences between the two lengths (p = 0.197). Regarding the heat emitted, the best system was Elements Free^®, since, at −2 mm, it emitted the highest temperature without going above 47 °C. The Dia-Duo^® system had lower temperatures. It could be concluded that not all systems transmit the same temperature to the apex and, therefore, to the periapical tissues. The surrounding conditions, such as temperature and humidity, have not been considered in this study. Full article

(This article belongs to the Special Issue Advances in Endodontics and Periodontics)

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Review

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13 pages, 1069 KiB

Open AccessReview

Removal of the Previous Root Canal Filling Material for Retreatment: Implications and Techniques

by Flávio R. F. Alves, Isabela N. Rôças, José C. Provenzano and José F. Siqueira, Jr.

Appl. Sci. 2022, 12(20), 10217; https://0-doi-org.brum.beds.ac.uk/10.3390/app122010217 - 11 Oct 2022

Cited by 4 | Viewed by 5687

Abstract

Adequate removal of the previous filling material may be pivotal to a favorable outcome of root canal retreatment of teeth with post-treatment periodontitis in order to permit the access of irrigants and medicaments to persistent bacteria. However, even with recent technological advances, including the introduction of specially designed instruments, no technique has been shown to predictably promote complete filling removal. Supplementary approaches used after chemomechanical preparation, including the use of finishing instruments, ultrasonics and laser, have shown promising results in enhancing root canal cleaning and disinfection. This narrative review addresses the importance and implications of maximal filling removal during retreatment and discusses the effectiveness of different techniques and supplementary approaches used for this purpose. Full article

(This article belongs to the Special Issue Advances in Endodontics and Periodontics)

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10 pages, 296 KiB

Open AccessReview

The Novel Role of Solvents in Non-Surgical Endodontic Retreatment

by Inês Ferreira and Irene Pina-Vaz

Appl. Sci. 2022, 12(11), 5492; https://0-doi-org.brum.beds.ac.uk/10.3390/app12115492 - 28 May 2022

Cited by 2 | Viewed by 2960

Abstract

Non-surgical endodontic retreatment is a reliable conservative option for managing post-treatment apical periodontitis. However, effective microbial control, based on the maximization of filling removal and disinfection protocols, is not yet predictable. Traditional gutta-percha solvents, which are indistinctively used for both the core and sealer filling materials, became obsolete due to unprecedented advances in endodontic technology. Nonetheless, microtomography, scanning electronic microscopy findings, and histobacteriological analysis tend to confirm the persistence of filling materials and the lack of association between root canal enlargement and superior disinfection. There is a controversy regarding the most suitable clinical protocols surrounding the shaping procedures and the supplementary disinfection steps. Based on the literature and the previous work of the team, the authors aimed to summarize the current knowledge regarding specific solvent formulations that target filling materials. Additionally, the advantage of an additional irrigation step to optimize disinfection was highlighted. This adjunctive procedure serves a dual role in the dissolution of filling materials, and in conferring an antibiofilm effect. Further research is needed to understand the novel contribution of these strategies upon clinical practice outcomes. Full article

(This article belongs to the Special Issue Advances in Endodontics and Periodontics)

Other

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13 pages, 1598 KiB

Open AccessSystematic Review

Prevalence of Root Canal Treatments among Diabetic Patients: Systematic Review and Meta-Analysis

by María León-López, Daniel Cabanillas-Balsera, Jenifer Martín-González, Víctor Díaz-Flores, Victoria Areal-Quecuty, Isabel Crespo-Gallardo, Paloma Montero-Miralles and Juan J. Segura-Egea

Appl. Sci. 2023, 13(10), 5957; https://0-doi-org.brum.beds.ac.uk/10.3390/app13105957 - 12 May 2023

Cited by 2 | Viewed by 1624

Abstract

(1) Apical periodontitis (AP) is the inflammatory response of the periapical tissue to bacterial antigens and toxins arriving from inside the root canal after pulp necrosis. To control AP, it is necessary to interrupt the passage of antigens from the root canal to the periapex, which is achieved via a root canal treatment (RCT), which is the indicated endodontic therapy in cases of AP. The prevalence of root-filled teeth (RFT) is an indicator of the frequency of endodontic infections and the degree of dental care. Diabetes is associated with AP and has been identified as the main prognostic factor in RCT. The aim of this study was to carry out a systematic review with meta-analysis answering the following question: What is the prevalence of RFT among diabetic patients? (2) This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines 2020. A literature search was undertaken without limits on time or language until 12 January 2023 in PubMed-MEDLINE, Embase and Scielo. All studies reporting the prevalence of RFT among diabetic patients via radiographic examination; both panoramic and periapical radiographs were included. Meta-analyses were calculated with Open Meta Analyst software. The main outcome variable was the prevalence of RFT, calculated as the total number of RFT divided by the total number of teeth, which is expressed as a percentage. As a secondary outcome variable, the prevalence of diabetic patients with at least one RFT, expressed as a percentage, was also calculated. The quality of evidence of the included studies was analyzed according to the guidelines provided by the Centre for Evidence-Based Medicine in Oxford. The risk of bias was assessed using the Newcastle–Ottawa Scale, which was adapted for cross-sectional studies. To estimate the variance and heterogeneity amongst the trials, the Higgings I2 test was employed. (3) Eight studies fulfilled the inclusion criteria. Four studies were classified as having a high risk of bias, and four were classified as having a moderate risk of bias. The prevalence of RFT was estimated for 37,922 teeth and 1532 diabetic patients. The overall calculated prevalence of RFT among diabetic patients was 5.5% (95% CI = 4.1–6.9%; p < 0.001). The percentage of diabetics who had at least one RFT was 42.7% (95% CI = 23.9–61.4%; p < 0.001). (4) This systematic review and meta-analysis concluded that the prevalence of RFT among diabetic patients is 5.5%. More than 40% of diabetics have at least one RFT. In daily clinics, dentists should suspect that patients are undiagnosed diabetics when multiple RCT failures are observed in the same patient. Full article

(This article belongs to the Special Issue Advances in Endodontics and Periodontics)

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