Introduction: Modern endodontics aims to decrease the bacterial load from the complex endodontic space. Over the years, improvements in the operative phases have led to a considerable increase in the success rate of endodontic treatments. The shaping phase has seen the development of new techniques supported by technological innovations that have led to higher treatment predictability. Endodontic instruments have experienced a series of changes that have led to modifications in their design, surface treatments, and heat treatments. The clinical use of rotating nickel–titanium instruments has become widespread and consolidated, a success due primarily to the alloy’s mechanical characteristics, which are superior to steel ones, but also to innovations in instrument design. The advent of the Ni-Ti alloy has kept the concepts and requirements of shaping the same but has modified its implementation in endodontics. Aim: The following review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) protocol. The research question focused on Ni-Ti endodontic instruments whose cyclic fatigue was evaluated by analyzing cyclic fatigue strength and the incidence of fracture. Results: At the end of the research, 10 systematic reviews and 1 randomized controlled trial were included in this comprehensive review. The most frequently analysed alloys were M-wire, conventional Ni-Ti, and CM-wire. In seven articles, instruments made of M-wire alloy were used; in eight articles, instruments made of conventional Ni-Ti; and in seven articles, instruments made of CM-wire alloy. Conclusions: The technological evolution of Ni-Ti alloys has led to the development of increasingly high-performance endodontic files that are resistant to cyclic fatigue during clinical practice and have greater resistance to sterilisation practices, making treatment easier and more predictable over time. In particular, heat-treated nickel-titanium root canal instruments present greater resistance to cyclic fatigue than untreated ones and those used with reciprocating kinematics concerning continuous rotation.

Background and Objectives: To achieve success in endodontic treatment, it is essential to properly perform the steps of shaping, cleansing and obturation. Determining the working length of the canal is, therefore, a process that must be precise and accurate. Electronic apex locators are a useful tool for the clinician to best perform this step of endodontic treatment. Materials and Methods: The purpose of the following umbrella review is to evaluate, through data in the literature, the degree of accuracy of apex locators. Results: Seven systematic reviews were included in the following umbrella review. Five compare the accuracy of apex locators versus radiographic techniques, two compare different types of electronic apex locators, and two analyze the determination of working length in primary teeth. Conclusions: From the results obtained from the following umbrella review, albeit at low levels of evidence, the methods for determining working length using electronic apex locators and other methods, particularly using radiographic evaluation, are equally valid.

Background/Objectives: Molar incisor hypomineralization (MIH) is a qualitative enamel defect affecting pediatric populations, predisposing to hypersensitivity, caries, and post-eruptive breakdown, and potentially impacting oral health-related quality of life (OHRQoL). Therefore, the primary aim of the present umbrella review was to evaluate the overall OHRQoL among pediatric subjects with MIH, as well as individual domains from both children and parents. Secondary aims were to evaluate the influence of MIH severity, extent/distribution pattern, age, and dentition status on overall- and domain-specific OHRQoL outcomes, and to assess the impact of different dental treatments on OHRQoL. Methods: Following PRISMA guidelines and PROSPERO registration, six systematic reviews were included. To address metric heterogeneity, mean scores were normalized into a 0–100% descriptive percentage impact index. Treatment-related changes were calculated as percentage improvements. Results: A total of 4028 respondents (3193 children and 835 parents/caregivers) were evaluated for OHRQoL. The overall impact on children and parents was highest in the oral domain (26.43%), followed by the psychological (20.25%), functional (19.50%), and social (11.75%) domains. Parental underestimation of MIH was consistently observed across all domains. Children in early mixed dentition reported a higher perceived impact than those in late mixed/permanent dentition (26.77% vs. 14.43%). In an exploratory subsample (n = 494), MIH severity appeared to impact OHRQoL, particularly in oral and functional domains. Overall, post-treatment OHRQoL improved across all domains, although evaluated in a limited sample (n = 491). Conclusions: MIH showed a relevant impact on pediatric OHRQoL. Notably, children consistently report a greater perceived impact than parents, suggesting potential parental underestimation. However, findings regarding dentition stage, MIH severity, and post-treatment improvements should be interpreted with caution, as heterogeneity in assessment tools, limited subsamples, and variable follow-up intervals precludes definitive conclusions.

There is no clear consensus on the optimal retrograde filling material for endodontic surgery, with uncertainty regarding long-term comparative performance among contemporary options. This systematic review aimed to determine which retrograde filling material provides the best long-term clinical and radiographic outcomes in endodontic microsurgery. Following PRISMA guidelines, a systematic search of PubMed/MEDLINE, Scopus, Cochrane Library, and BioMed Central was conducted up to 30 January 2026. Randomized controlled trials (RCTs) with a minimum 12-month follow-up comparing retrograde materials in endodontic surgery were included. Study selection, data extraction, and risk-of-bias assessment (Cochrane RoB 2 tool) were performed by different reviewers. It was not possible to perform a meta-analysis due to the heterogeneity of the data but only a narrative synthesis. Eleven RCTs (2002–2024), reporting on approximately 1600 teeth, were included. The overall risk of bias was moderate. Mineral trioxide aggregate (MTA) demonstrated high long-term success (typically >90%). However, in a head-to-head comparison, MTA was not statistically superior to alternatives like super-ethoxybenzoic acid (Super-EBA) or zinc oxide and eugenol-based cement reinforced with resin (IRM). A significant difference favoring MTA was consistently observed only against traditional gutta-percha techniques. No study evaluated the newest premixed bioceramic sealers beyond 12 months, while they show the best properties. Within the limitations of the current evidence, MTA, Super-EBA, and IRM are all highly effective for retrograde obturation in endodontic microsurgery, with no single material demonstrating clear superiority in long-term success. This equivalence supports clinical decision-making based on handling characteristics, cost, and surgeon preference. A critical evidence gap exists regarding the long-term (>1 year) efficacy of newer bioceramic sealers.