(1) The objective of the study is to conduct a comprehensive systematic review of in vitro studies in order to assess the depth to which E. faecalis bacteria penetrate human dentinal tubules after the use of various irrigation solutions. (2) Methods: A literature search of the MEDLINE, Scopus, Cochrane CENTRAL, and Embase databases was conducted, as well as a backward and forward citation search. Two independent reviewers then selected suitable studies based on inclusion and exclusion criteria. Data were extracted and the risk of bias and methodology of the studies were evaluated. (3) Results: Out of a total of 504 papers evaluated following the removal of duplicates, 7 studies met the inclusion criteria and were included in the systematic review. The heterogeneity of the studies made it impossible to perform a meta-analysis. The majority of the studies reported that sodium hypochlorite (NaOCl) and chlorhexidine digluconate (CHX) can affect the penetration depth of E. faecalis suspensions. The studies included in this review possess a moderate to high risk of bias and thus represent moderate evidence that the antimicrobial activity of NaOCl and CHX affects the intra-tubular penetration of bacteria. (4) Conclusions: The evidence indicates that irrigants may affect the bacteria inside human dentinal tubules. Standardized high-quality methods are needed to evaluate bacterial penetration in in vitro studies.

Introduction: The integration of clinical inspection and diagnostic imaging forms the basis for endodontic diagnosis, decision making, treatment planning, and outcome assessments. In recent years, CBCT imaging has become a common diagnostic tool in endodontics. CBCT should only be used to ensure that the benefits to the patient exceed the risks. As such, our aim in this study was to evaluate the high level diagnostic efficacy studies and their risk of bias. Methods: A systematic search of the literature was conducted to identify studies evaluating the use of CBCT imaging in endodontics. The following databases were searched: Medline (PubMed), Scopus, and Cochrane Central. The identified studies were subjected to rigorous inclusion criteria. Studies considered as having a high efficacy level were then subjected to a risk of bias assessment using the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Results: Initially, 1568 articles were identified for possible inclusion in the review. Following title and abstract assessment, duplicate removal, and a full-text evaluation, 22 studies were included. Of those studies, 2 had a low risk of bias and 20 had a high risk of bias. Six studies investigated non-surgical treatment, eight investigated surgical treatment, two investigated both non-surgical and surgical treatment, and six studies investigated diagnostic thinking or decision making. Conclusion: The evidence for the influence of CBCT on decision making and treatment outcomes in endodontics is predominantly based on studies with a high risk of bias.

Introduction: Vertical root fracture (VRF) is a root-canal treatment complication and is a major reason for extraction of the root-canal-treated teeth. The diagnosis of VRF can be complicated because of absence of specific signs, symptoms, and radiographic features. A combination that includes the presence of deep pocket and a sinus tract in root-canal-treated tooth was proposed as a pathognomonic for VRF. The purpose of this study was to systematically search and evaluate the literature regarding the correlation between the clinical signs considered pathognomonic for the diagnosis of VRF, with the actual reference standard by means of systematic review of the literature. Methods: A systematic search of the literature was performed to identify studies evaluating the clinical signs considered pathognomonic for the diagnosis of VRF. The following databases were searched: Medline (PubMed), Scopus, and Cochrane Central. The identified studies were subjected to strict inclusion and exclusion criteria. Results: Initially, 1141 possible relevant articles were identified. After title and abstract screening, 40 articles were subjected to a full-text evaluation, 3 articles met the inclusion criteria and contained data regarding the prevalence of the pathognomonic combination in VRF’s-confirmed teeth. The presence of deep pocket and a sinus tract in endodontically treated teeth was found in 28% of the cases. Conclusion: To date, the current scientific knowledge regarding the correlation between the clinical symptoms considered pathognomonic for VRF diagnosis in the root-canal-treated tooth and the actual reference standard is quite low.

An endo-perio lesion is one of the more common tooth-related problems. An association between the presence of apical and marginal periodontitis is known in the literature and has been observed in 5.7% of individuals aged 40–45 years old. The purpose of the present article is to present three case reports describing the successful retreatment of endo-perio lesions. In each of these cases, we used a biologically active bioceramic root canal sealer, GuttaFlow Bioseal, which is a bioactive root canal filling material composed of gutta percha, polydimethylsiloxane, platinum catalyzer, zirconium dioxide, and bioglass. All cases were followed up clinically and radiographically for a period of at least 11 months.

Introduction: Nasal septum surgery has been associated with postoperative numbness or paresthesia of the anterior maxillary teeth, primarily involving the incisors and canines, with an incidence reported between 3% and 30%. This sensory alteration may result from trauma to the nasopalatine nerve or anterior superior alveolar nerve, which innervate the anterior maxilla. Current literature on this topic is limited, outdated, and primarily based on retrospective studies that lack long term follow-up. This study aims to investigate the impact of nasal septal surgery on anterior maxillary teeth sensation, focusing on the incidence, predisposing factors, and the timeline for sensory recovery. Methods: This prospective study included 21 patients who underwent nasal septum surgery from September 2023 to September 2024. Patients with pre-existing conditions affecting dental sensation or those who recently underwent dental procedures were excluded. Sensory assessments were conducted preoperatively, post-topical anesthesia application, and at 10 days, one month, and three months post-surgery. Demographic data, surgical approach, and medical history were recorded. Results: The cohort had an average age of 32.6 years (range 20-62), with 52% male participants. Significant temporary sensory loss was observed following the application of topical anesthesia (p=0.007). Postoperatively, sensory reduction occurred in two patients, resulting in a 9.5% incidence of sensory disturbances (p=0.4): one patient experienced numbness in all four incisors, while another reported numbness in the two central incisors. Both patients regained full sensation within one month after surgery. Multivariate analysis did not identify any significant predictive factors for sensory impairment, including surgical approach, presence of nasal fracture, or history of prior nasal surgeries. Conclusion: Nasal septal surgery is associated with a low incidence of transient sensory disturbances in the anterior maxillary teeth, with full recovery typically occurring within one to three months. These findings suggest that careful surgical technique can minimize nerve injury and that the risk of permanent sensory loss is low. Additional research with larger patient cohorts is needed to validate these findings and identify possible risk factors, thus improving patient counseling and surgical techniques.

Introduction: Bite force is a key indicator of masticatory system function and is influenced by various biological and dental factors. Alterations in pulpal innervation and periodontal sensory feedback following root canal treatment (RCT) may affect force regulation during mastication. The aim of this study was to compare pain/discomfort-limited bite force threshold values between root canal-treated and untreated teeth using a digital bite force transducer (GM10). Methods: A total of 131 patients (48 males and 83 females) participated in the study. Bite force measurements were obtained from 447 teeth (248 with RCT and 199 without RCT). Participants were instructed to bite on a digital bite fork until discomfort or pain was experienced. Therefore, the recorded values represent a pain/discomfort-limited bite force threshold rather than true maximal voluntary bite force. Peak force was recorded in Newtons (N). The device was modified with a rubber tip and a protective cover to improve safety and patient comfort. Results: Teeth without RCT demonstrated significantly higher bite force values than root canal-treated teeth (245.39 N vs. 197.06 N, adjusted p = 0.0347). Male participants exhibited significantly higher bite force values than female participants (277.62 N vs. 186.96 N, adjusted p = 0.0016). In addition, molars demonstrated significantly higher bite force values than premolars (227.83 N vs. 202.75 N, adjusted p = 0.0347). Conclusions: Root canal-treated teeth demonstrated lower bite force values than untreated teeth. However, these findings should be interpreted cautiously because of potential confounding factors.