Introduction: Diagnostic procedures for pulp vitality assessment are a crucial aspect of routine dental practice. This review aims to provide a comprehensive overview of nontraditional techniques and methodologies for assessing pulp vitality, specifically exploring promising approaches that are currently not used in dental practice. Methods: The study protocol was registered a priori ( https://osf.io/3m97z/ ). An extensive electronic search was conducted across multiple databases, including MEDLINE via PubMed, Scopus, Web of Science, and Embase. Inclusion criteria were guided by the research question based on the PCC model as follows: “What are the potential nontraditional techniques (Concept) for assessing pulp vitality (Population) in the field of endodontics or clinical practice (Context)?” Studies were included that explored possible approaches to pulp vitality assessment, utilizing a range of techniques, whilst any studies using traditional pulp tests (cold, heat, and electric stimulation) or well‐known methods (pulse oximetry and laser Doppler flowmetry) were excluded. Reviewers independently screened articles and extracted data. A patent search was also performed. Results: Of 3062 studies, 65 were included that described nontraditional approaches for assessing pulp vitality. These included a range of optical diagnostic methods, ultrasound Doppler flowmetry (UDF), magnetic resonance imaging (MRI), terahertz imaging, tooth temperature measurements, as well as invasive methodologies, including ¹³³ xenon washout, radioisotope‐labelled tracers, hydrogen gas desaturation, intravital microscopy and fluorescent microspheres isotope clearance. The patent search included artificial intelligence and biomarkers methods. Conclusions: This review provides details for potential innovative tests that may directly describe pulp vitality. Importantly, these methods range from clinically impractical through to promising methods that may transform clinical practice. Several nontraditional techniques have the potential to enhance diagnostic accuracy and could provide valuable insights into the assessment of pulp vitality in challenging clinical scenarios.

Background: To evaluate the cyclic fatigue resistance of rotary endodontic nickel-titanium instruments using both experimental and finite element methods. Methodology: Four different proprietary rotary endodontic instruments (PTG, PTU, VB, and TRN) were subjected to cyclic fatigue tests through a custom-built fixture (n = 30 for each group) and tested until failure according to the manufacturer’s recommended settings, and the number of cycles to failure (NCF) was measured. Separated fragments were measured to determine the location of the fracture event. Finite element modeling replicated this experiment in silico via a two-step method, modeling the dynamic motion via an initial insertion step, then followed by rotation. Results: TRN showed the highest NCF (2027.94 ± 452.50) with the lowest values for strain (4.49% ± 0.23%) and fragment lengths (3.26 mm ± 0.47 mm), whereas PTU showed the lowest NCF (600.90 ± 80.86) and highest values for strain (6.29% ± 0.47%) and fragment lengths (5.36 mm ± 0.79 mm). All instruments showed an increase in von Mises and maximum principal stress during the insertion step but showed no changes to the maximum stress values during the rotational step. Conclusions: The finite element analysis approach used provided useful insights into the stress evolution and stress distribution of instruments during cyclic fatigue but lacked the ability with existing inputs to predict failure from cyclic fatigue.

The use of motorized nickel titanium instruments is an essential component in contemporaneous clinical endodontics. The mechanical properties of nickel titanium are optimal for the cleaning and shaping of root canal systems. However, instrumentation carries risks, particularly instrument fracture, which may become an obstacle to achieving adequate disinfection of the canal system. Although the biomechanics of instrument fracture have been extensively investigated previously, certain facets remain unexplored, specifically torsional fatigue. This review presents a comprehensive overview of the modern understanding of the biomechanics involved in nickel titanium instrument fracture. Importantly, while research has tended to describe fatigue fracture and torsional failure as distinct and separate entities, clinical conditions are likely a combination of the two. Moreover, intracanal instrument fractures may also occur following a different mechanism, torsional fatigue. This should be taken into consideration for further research and clinical guidance.

Objectives: The present study reviews the current literature regarding the utilization of the extended finite element method (XFEM) in clinical and experimental endodontic studies and the suitability of XFEM in the assessment of cyclic fatigue in rotary endodontic nickel–titanium (NiTi) instruments.Material and Methods: An electronic literature search was conducted using the appropriate search terms, and the titles and abstracts were screened for relevance. The search yielded 13 hits after duplicates were removed, and four studies met the inclusion criteria for review.Results: No studies to date have utilized XFEM to study cyclic fatigue or crack propagation in rotary endodontic NiTi instruments. Challenges such as modelling material inputs and fatigue criteria could explain the lack of utilization of XFEM in the analysis of mechanical behavior in NiTi instruments.Conclusions: The review showed that XFEM was seldom employed in endodontic literature. Recent work suggests potential promise in using XFEM for modelling NiTi structures.

This study aimed to evaluate and compare the effects of ambient temperature and post-manufacture heat-treatment on the mechanical behavior of nickel-titanium (NiTi) wires. Four types of commercial NiTi variants (Stock NiTi, heat treated “Blue”, “Gold”, “Superflex”, all Dentsply Maillefer, Ballaigues, Switzerland) were stressed in a tensile testing machine in a temperature-controlled water bath at three different temperatures. Stress and strain values were extrapolated from the raw data, and 2-way ANOVA and Tukey’s test for multiple comparisons were performed to compare the differences of the mechanical constants. Differential scanning calorimetry (DSC) tests established the martensitic transformation starting (M_s), finishing (M_f) and austenitic (reverse-martensitic) starting (A_s) and finishing (A_f) points. Austenitic modulus of elasticity and transformation stress values increased with temperature for all NiTi groups. The martensitic modulus of elasticity, maximum transformation strain and ultimate tensile stress were not significantly affected by temperature changes. Stock NiTi and Gold wire samples presented with clearly delineated austenitic and martensitic transformations in the DSC experiments. Differences in manufacturing/heat treatment conditions and ambient temperature affect the mechanical behavior of nickel-titanium and may have clinical implications. Further improvements to the experimental setup could be considered to provide more accurate measurements of strain.