Giornale Italiano di Endodonzia

Investigating the Efficacy of the Metal Artifact Reduction Algorithm in Cone-Beam Computed Tomography Images for Endodontic and Restorative Materials

2025-06-04T08:41:57+00:00

Aim: This study aimed to assess the effectiveness of metal artifact reduction (MAR) algorithms in cone-beam computed tomography (CBCT) images, specifically for various common dental materials. Metal restorations, posts, and gutta-percha frequently cause artifacts due to their high density, impacting image quality.

Methodology: Researchers used 11 extracted human mandibular teeth with different dental materials (amalgam, metal posts, porcelain-fused-to-metal (PFM) crowns, gutta-percha) and three intact teeth. CBCT scans were performed using a Galileos scanner on a mandible in water to simulate soft tissue. Images were acquired both with and without MAR activation across various tooth positions. Contrast-to-noise ratio (CNR) was calculated at multiple distances and angles. Statistical analysis was conducted using the Wilcoxon test.

Results: The study found that activating the MAR algorithm had no significant impact on reducing metal artifacts across any of the evaluated dental materials, regardless of tooth type, position, or angle.

Conclusion: The MAR algorithm, as tested, does not significantly reduce metal artifacts caused by dental materials like amalgam, metal posts, PFM crowns, or gutta-percha in CBCT images. In this context, clinical application of these algorithm does not provide justifiable added benefits.

Postoperative Pain Following Endodontic Treatment in Patients

2025-05-04T14:38:47+00:00

Aim: Diabetic patients may exhibit altered responses to nerve stimulation due to diabetes-related neurological damage. This prospective, non-randomized, parallel, blinded clinical trial evaluated postoperative pain following endodontic treatment by comparing two groups of patients—with and without type 2 diabetes mellitus (T2DM).

Methodology: Eighty adult patients were included: 40 with T2DM and 40 without T2DM. At baseline, glycated hemoglobin (HbA1c) levels were recorded. Endodontic treatment was performed and root canals were irrigated with 2.5% sodium hypochlorite solution. Postoperative pain was assessed by a blinded researcher at 6, 12, 24, and 72 hours using a Numerical Rating Scale (NRS, 0–10).

Results: Within the first 6 hours, 19 patients in the T2DM group and 24 in the control group reported pain (p = 0.429). After 12 hours, 11 T2DM patients and 19 control patients experienced pain (p = 0.165). At 24 hours, 9 patients with T2DM and 11 in the control group reported pain (p = 0.930). After 72 hours, 5 patients from each group reported pain (p = 0.186). No significant differences in pain intensity were observed between the groups at 6 hours (p = 0.139), 12 hours (p = 0.169), 24 hours (p = 0.387), or 72 hours (p = 0.687). However, regression analysis revealed that patients with T2DM had lower odds of experiencing postoperative pain (OR = 0.19; 95% CI = 0.04–0.77), regardless of sex, age, preoperative pain, tooth type, treatment modality, or sealer extrusion.

Conclusions: Patients with T2DM may experience less postoperative pain following endodontic treatment.

Endodontics towards the future

2025-03-03T08:17:54+00:00

echnological progress is making great strides among different area, as well as medical and dental fields. In the last years, dentistry is living a radical change thanks to development of advanced operative procedures, use of latest generation materials, modern imaging techniques up to 3D technology. In addition, the recent introduction in several fields of artificial intelligence (AI) would seem to be of a great interest even in dentistry. AI aid should provide solutions able to manage every event or variable, complex cases diagnosis and immediate and successful treatment plans. However, the real feasibility in dentistry is currently under debate. Main limitations might be not only related to ethical issue, but also to the consideration of patient as a person with several variables, risk factors and co-morbidities that have a certain impact on disease occurrence, its progress and prognosis. Specifically, endodontics could benefit from AI use for the morphological characterization of root-canal anatomy, as well as correct analysis of radiographic images and planning of a workflow able to optimize working time. On the other hand, the fundamental principles of “traditional” endodontics cannot be ignored as base of correct therapy and long-term success. In this light, in the present issue of Giornale Italiano di Endodonzia, are presented classic aspects such as irrigants, debridement and post-endodontic restoration, but is also published a very interesting review on AI in endodontics. Since the central role played by clinicians in the therapeutic choice, it’ll be increasingly important to be updated and to develop the appropriate knowledge regarding the biological issue and the precious help provided by technological progress.

Zinc oxide nanoparticles and blue light enhance sodium hypochlorite disinfection against Enterococcus faecalis: an in vitro study

2025-03-04T08:51:53+00:00

Aim: This study aimed to evaluate the antimicrobial efficacy of zinc oxide nanoparticles (ZnO NPs) and blue light, both individually and in combination, against Enterococcus faecalis (E. faecalis) in vitro. Their performance was compared to 1% sodium hypochlorite (NaOCl) to determine whether these adjuncts could enhance root canal disinfection.

Materials and Methods: A laboratory investigation was conducted using eight experimental groups: E. faecalis with phosphate-buffered saline (control), 1% NaOCl, ZnO NPs, blue light, 1% NaOCl/ZnO NPs, 1% NaOCl/blue light, ZnO NPs/blue light, and 1% NaOCl/ZnO NPs/blue light. Standardized E. faecalis inocula were exposed to each treatment under controlled conditions. Bacterial cells were then recovered, serially diluted, and plated on agar to determine colony-forming units (CFU). Reductions in CFU, compared to the control, were analyzed using Mann-Whitney tests. Statistical significance was set at p<0.05.

Results: Most experimental groups exhibited significantly lower bacterial counts than the control (p=0.000), except for the blue light–only group, which was not statistically different. Among the single-agent treatments that reached significance, 1% NaOCl produced the greatest bacterial reduction, followed by ZnO NPs. When combined, dual treatments reduced bacterial counts more than single agents. The triple combination achieved the highest reduction overall.

Conclusions: This study highlights the potential of ZnO NPs and blue light as adjuncts to 1% NaOCl for more effective elimination of E. faecalis in planktonic cultures. The enhanced antimicrobial activity observed with combined treatments suggests that incorporating nanoparticles and photodisinfection could reduce the need for higher NaOCl concentrations while maintaining robust antibacterial efficacy.

Histological evaluation of root canal cleaning by different final irrigation protocols

2025-02-06T08:29:04+00:00

Aim: This study aimed to evaluate in vitro the ability to remove pulp tissue from the mesial root canals of mandibular molars using three different protocols for the final activation time of irrigation with the Easy Clean (EC) rotary instrument.

Materials and Methods: Thirty mandibular molars with vital pulp were instrumented with the ProDesign Logic rotary system and divided into three experimental groups according to the protocol for the final activation time of the irrigants (n=10). Group EC1: the final rinse was performed with 5 mL of 2.5% sodium hypochlorite (NaOCl), followed by 5 mL of 17% ethylenediaminetetraacetic acid (EDTA) and another 5 mL of 2.5% NaOCl solution, with each rinsing agent activated in 3 cycles of 20 seconds. Group EC2 used the same sequence of solutions as group EC1, with each irrigant activated in 6 cycles of 20 seconds. In group EC3, the operation technique and the sequence of solutions were the same as in groups EC1 and EC2, with each rinsing agent being activated in 9 cycles of 20 seconds. At the end, samples from all groups were washed with 20 mL of distilled water using a NavigTip 30-G syringe and needle. The samples were fixed in 10% formaldehyde, cut into micrometers, fixed on histology slides and stained with hematoxylin-eosin (HE). The total area of the canal and remaining tissue was determined using the Image J program to determine the percentage of remaining pulp.

Results: In the cervical third, all groups had similar results. In the middle and apical thirds, EC1 and EC2 had similar percentages of pulp remnants and differed from EC3 (p<0.05).

Conclusions: It can be concluded that the removal of pulp tissue increases with longer contact time of the NaOCl.