Giornale Italiano di Endodonzia

Nanoparticles: a promising tool in endodontics

Sandro Rengo — 2025-07-15

Effective disinfection of root canal system depends on different variables such as anatomy, proper shaping technique, correct penetration of irrigants and complete removal of pulp tissue and micro-organisms. The chance to obtain a correct canal disinfection strictly contributes to achieve clinical success and still remains a mayor challenging in the modern endodontics. Among different proposed strategies, use of nanoparticles has gained even more interest during the years in terms of root canal detersion. Nanoparticles are characterized by ultrasmall sizes, large surface area/mass ratio and increased chemical reactivity. Moreover, due to antibacterial features their role is promising in the removal of biofilm and microorganisms from the endodontic canal system. Different kind of nanoparticles can be incorporated within irrigant solutions, gels or even sealers to obtain and further maintain canals disinfection. The potential application of zinc oxide nanoparticles and their efficacy against bacteria are presented in the present issue of Giornale Italiano di Endodonzia, evaluating the possible enhancement of classic irrigation obtained by sodium hypochlorite. Further studies are warranted to support the use of nanoparticles in the prevention and treatment of dental infections and to establish the proper delivery systems.

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

Mahsa Moannaei — 2025-06-09

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.

Comparison Of Debris Removal Efficiency Of Different Endodontic File Systems

Yunus Emre Çakmak — 2025-06-13

Aim: This study aimed to compare four different rotary root canal shaping systems—ProTaper Next, ProTaper Ultimate, VDW.Rotate, and XP-Endo Shaper—in terms of their instrumentation time and material removal capacity using standardized resin canal models.

Methodology: Eighty transparent acrylic root canal blocks with a standardized straight canal configuration (ISO size 15, 0.02 taper) were randomly assigned to four experimental groups (n = 20 each), each prepared with one of the tested systems. All procedures were performed by a single operator following manufacturers’ protocols using a torque-controlled endodontic motor. Instrumentation time was measured using a digital stopwatch. Material removal was assessed by calculating the percentage weight loss of the blocks before and after preparation. Data were analyzed using one-way ANOVA, Kruskal-Wallis test, and Pearson correlation, with a significance level set at p < 0.05.

Results: XP-Endo Shaper showed the shortest preparation time, whereas ProTaper Ultimate exhibited the longest (p < 0.001). The XP-Endo group also demonstrated the highest material loss, significantly greater than ProTaper Next and VDW.Rotate (p < 0.001), while VDW.Rotate exhibited the most conservative dentin removal. A moderate positive correlation was found between preparation time and material loss (r = 0.579, p < 0.001).

Conclusions: Rotary file systems differ significantly in shaping efficiency and dentin preservation. The XP-Endo Shaper offered superior time efficiency but removed more material, while VDW.Rotate preserved dentin more effectively. These findings may guide clinicians in selecting instrumentation systems based on clinical priorities. Further studies in natural teeth are warranted to validate these results.

Postoperative Pain Following Endodontic Treatment in Patients With Type 2 Diabetes Mellitus: A Prospective Non-Randomized Clinical Trial

Ingrid Luiza Mendonça Cunha — 2025-06-09

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.

Next Generation Workflow for Apical Control in Endodontics: three case report

Gabriele Ragucci — 2025-07-15

Aim: The aim of this report is to propose a new step-by-step workflow to safely control the apical extent of root canal preparation with the aid of a step-forward motor-driven endodontic technology, specifically the improved Optimum Apical Stop (OAS2) function, to simplify and accelerate traditional root canal procedures.

Summary:
This case series reports on three patients undergoing endodontic therapy using a motor-driven protocol with the Morita Tri Auto ZX2+ device (J. Morita Corp., Osaka, Japan) and its OAS2 function activated. Root canal shaping was initiated with VDW.ROTATE instruments (VDW GmbH, Munich, Germany), followed by refinement using ProTaper Ultimate F2 and F3 files (Dentsply Sirona, Charlotte, NC, USA), and obturation with corresponding gutta-percha cones. Postoperative assessments included clinical evaluation, periapical radiographs, and patient-reported outcomes at 1, 3, 6, and 12 months. Outcome measures included pain, swelling, tooth function, need for reintervention, adverse effects, and radiographic signs of periapical healing.

Immediate postoperative radiographs showed high-quality apical preparation and obturation. At one-year follow-up, all three cases demonstrated complete symptom resolution and radiographic absence of periapical radiolucency.

Key learning points:

The OAS2 function allows controlled, minimal, and reproducible apical preparation.
The workflow reduces chair-time and technical variability.
Outcomes were successful regardless of operator experience.
Radiographic healing and patient satisfaction were consistently achieved.
The combined use of VDW.ROTATE and ProTaper Ultimate files supported effective and conservative canal shaping.