e-ISSN 2459-1726
Turkish Endodontic Journal (TEJ) - Turk Endod J: 8 (3)
Volume: 8  Issue: 3 - 2023
1.Investigation of the effect of boric acid in different concentrations on dentin microhardness
Gözde Kotan, Melike Özbek, Betül Aycan Alim Uysal, Gamze Nalcı
doi: 10.14744/TEJ.2023.20982  Pages 97 - 101
Purpose: This study compared the effects of different irrigation solutions on the microhardness of root dentin.
Methods: Fifty single-rooted human teeth were chosen, and the roots were randomly divided into five groups (n = 10) according to the irrigant used for 5 min: 17% ethylenediaminetetraacetic acid (EDTA), 2% boric acid (BA), 5% BA, 10% BA, and distilled water (DW). After the irrigation procedure, dentin surface microhardness was calculated using a Vickers indenter 100 μm from the root canal lumen. Comparisons between the groups were performed with a two-way ANOVA test and and Tukey’s multiple comparison test (p = 0.05).
Results: All irrigation solutions decreased the microhardness of root canal dentin. The DW and 2% BA had a minimum effect on the microhardness of root canal dentin, whereas a significant decrease in surface microhardness was found in 10% BA group (p < 0.05). The coronal third of the 10% BA group showed the lowest percentage decrease, with a significant difference between the apical and middle thirds (p < 0.05).
Conclusion: In this study, 5% BA and 17% EDTA showed similar effects on the microhardness of root canal dentin. Further clinical research is required to evaluate the biocompatibility and safety of BA solutions.

2.Alterations in isolation, infection control, and personal protective equipment during the transition from pandemic to endemic in endodontic practice: A cross-sectional study
Sena Kaşıkçı, Sena Kolunsağ Özbek
doi: 10.14744/TEJ.2023.86658  Pages 102 - 109
Purpose: This study aimed to evaluate the alterations in isolation, infection control, and personal protective equipment (PPE) by endodontists and pregraduate endodontic students in Türkiye before and after pandemic.
Methods: The survey consisted of 25 questions with three parts. The first part consisted of demographic questions, and second part was about coronavirus disease 2019 (COVID-19) knowledge. Participants were asked using third part, rubber dam (RD) use and which PPE before and after the pandemic.
Results: There was no significant relationship between the participants’ general knowledge of COVID-19 (p > 0.05). While the use of N95/FFP2 masks by participants was 8.7% before the pandemic, this rate of use increased significantly to 92% after the pandemic (p < 0.05). It was concluded that if the pandemic becomes endemic, participants will continue to use N95/FFP2 masks to a large extent (71%). When the frequency of use of RD was compared before and after the pandemic, a significant difference was found (p < 0.05). In addition, the majority of participants (89.1%) stated that they are considering adding RD to their routine endodontic treatment procedures even when the pandemic becomes endemic.
Conclusion: Endodontic treatments with RD and PPE increased with pandemic. When the pandemic becomes endemic, these usage habits are likely to persist to a large extent.

3.Topographic analysis of HyFlex EDM Glide Path, ProGlider, TruNatomy Glider, and WaveOne Gold Glider after micro-glide path preparation in simulated root canals with single curvature
Olcay Özdemir, Sibel Koçak, Ecehan Hazar, Baran Can Sağlam, Mustafa Murat Koçak
doi: 10.14744/TEJ.2023.62534  Pages 110 - 115
Purpose: This study aimed to compare HyFlex electrical discharge machining Glide Path, ProGlider, TruNatomy Glider, and WaveOne Gold Glider in terms of topographic changes after instrumentation.
Methods: Simulated canals with 40° curvature were used to analyze the surface behavior of four brands of micro-glide path files (n = 36 in total, n = 3/subgroup). The files were used in single or three simulated canals for micro- glide path preparation. Surface topographies were evaluated using atomic force microscopy. The data were analyzed with Shapiro–Wilk and two-way robust analysis of variance tests.
Results: RMS median values did not differ according to the file groups (p = 0.448) and use (p = 0.055). There was a significant difference between the intact WaveOne Gold Glider group and the use of 3 times (p = 0.002).
Conclusion: The tested files exhibited acceptable surface behavior considering single use but in multi-rooted teeth. However, it should be considered that more surface distortion occurs on the surface of heat-treated files when used for multiple roots, especially curved ones.

4.Apical foramen position in relation to proximal root surfaces of the premolar teeth in Kurdistan region of Iraq: A retrospective CBCT assessment
Maysaloon Shaman Saeed
doi: 10.14744/TEJ.2023.63825  Pages 116 - 122
Purpose: The purpose of the study is to determine the location of the apical foramen (AF) in relation to the root surfaces of human permanent premolar teeth in the population of Iraqi Kurdistan using cone beam computed tomography (CBCT) imaging.
Methods: CBCT images from 103 patients from the Iraqi Kurdistan region were evaluated. Multiplanar images were captured to check the position of the AF in relation to the root canal surfaces of premolars. The data were analyzed using Fisher’s, Chi-square, and t-tests.
Results: The most common AF location of all premolars was central, followed by distal and then mesial, except for the mandibular right second premolar where central and mesial were the most prevalent. The mean distance between the AF and anatomic apex on the right side of all the first premolars was 0.6205 mm. That of the second premolars was 0.6205 mm in males and 0.5854 mm in females. There was no significant difference between both sides and genders.
Conclusion: In the Kurdistan region of Iraq, the most common location for the apical foramina of all premolar teeth is central AF, followed by the distal location. A minimum 1 mm of distance from the anatomic apex in mandibular premolars could be appropriate for root canal therapy.

5.Do age and sex factors affect dentin thickness of mandibular incisors?
Öznur Sarıyılmaz, Rüya Sessiz
doi: 10.14744/TEJ.2023.25349  Pages 123 - 128
Purpose: The purpose of this study was to evaluate the root dentinal thickness of the mandibular incisor teeth in relation with the age and sex using cone-beam computed tomography (CBCT).
Methods: CBCT images of 320 mandibular incisors of 40 male and 40 female patients were analyzed retrospectively. The mesial and distal dentinal thickness was measured at three points as coronal, middle, and apical root canal thirds. The images were analyzed using a software and analyzed to investigate the differences in the dentinal thickness association between age and sex.
Results: Dentinal thickness decreased significantly from coronal to the apical root canal level. The middle and apical dentinal thickness of mesial side the roots were found significantly higher than the distal side of the root.
Conclusion: The coronal and apical dentinal thickness of the roots was found to be higher in males than females while the middle root dentinal thickness was found to be higher in females than males. It was found that dentinal thickness increased with age only in the coronal root region.

6.Evaluation of the use of cone-beam computed tomography by endodontic practitioners in Türkiye
Cemre Koç, Mete Üngör, Ayşe Taş
doi: 10.14744/TEJ.2023.39358  Pages 129 - 136
Purpose: The present study aimed to investigate the perspectives of endodontists and doctoral/residency students in Türkiye regarding the acceptance, accessibility, and usage of cone-beam computed tomography (CBCT) imaging.
Methods: An online survey was conducted, and members of the Turkish Endodontic Society were invited to participate. The survey comprised 15 questions, with the first six focusing on CBCT use and accessibility, as well as participants’ demographics.
Results: Out of 178 respondents, 79.2% reported using CBCT in their clinical practice, with 69.1% having on-site access and 22.5% using off-site facilities. Faculty members showed the highest frequency of CBCT usage. CBCT was most commonly prescribed for cases involving internal/external root resorption and dental anomalies.
Conclusion: Based on the survey’s results, it is suggested that CBCT scans should be used with a patient-centric approach, weighing the benefits against risks, and should be limited based on individual case requirements.

7.A cross-sectional study of the periapical status of teeth and quality of root canal treatment in a selected population of young Turkish and foreigners living in Türkiye
Simay Koç, Dide Tekinarslan, Kürşat Er
doi: 10.14744/TEJ.2023.87609  Pages 137 - 142
Purpose: The objective of this study was to assess the quality and state of treatment for teeth with periapical lesions (PLs) in a group of young Turkish and international residents living in Türkiye.
Methods: Patients between the ages of 18 and 30 whose digital orthopantomography (OPTG) was taken between January 2018 and January 2023 were evaluated. Gender, age, nationality, the number of teeth present, the number and location of endodontically treated teeth, the number of teeth with PL, periapical status, and the standard of root canal treatment (RCT) were all employed and recorded. This study had 393 foreign patients. The same number of Turkish patients was chosen by systematic sampling from the 30405 Turkish patients.
Results: The OPTGs of 786 patients including 21126 teeth were evaluated. The average age of patients was 23. The number of teeth with RCT was 1100 teeth (5.2%). In the Turkish population, 10668 teeth were examined; RCT was present in 332 teeth (3%), of which 221 (66%) had PL. In the foreigner population, 10458 teeth were examined; RCT was present in 768 teeth (7%), of which 477 (62%) had PL. In Turkish and foreign patients, molars (58%) were the most commonly treated teeth with PL. The working length of RCT was adequate for 50% of teeth in the Turkish population and 48% of teeth in the Foreigner population. 44% of teeth in Turkish population and 32% in foreigners with periapical lesions had not undergone to RCT.
Conclusion: In both populations, molars were the most endodontic-treated teeth. The quality of RCT in an included young Turkish population and foreigners was in general underneath than appropriate standard.

8.Canal transportation and instrumentation time efficacy of pediatric rotary files with or without glide path
Hakan Özdoğru, Gül Keskin
doi: 10.14744/TEJ.2023.15238  Pages 143 - 150
Purpose: This study aimed to investigate the canal transportation and instrumentation time of pediatric rotary files with or without a glide path.
Methods: Fifty simulated resin blocks were randomly assigned to one of five experimental groups (n = 10): Group K is a K-type hand file (control), group P is a Kiddy files rotary system, group OP is a One G glide path file and a Kiddy files rotary system, group F is an AF baby tooth file (AFB) rotary system, and group OF is a One G glide path file and an AFB rotary system. The instrumentation time was recorded after preparing simulated canals. Image J software was used to calculate canal transportation at various canal levels.
Results: The group K had the longest preparation period (p < 0.05) and the greatest apical transportation scores (0.35 ± 0.23). It was followed by groups F (0.18 ± 0.26), OF (0.03 ± 0.09), OP (0.03 ± 0.03), and P (0.02 ± 0.01). The difference between the K and P groups, the K and OP groups, and the F and P groups was statistically significant (p < 0.05).
Conclusion: Using a glide path during canal preparation by rotary systems could reduce procedural errors. For root canal preparation, Kiddy files with or without a glide path may be advised.

9.Assessment of apical patency maintenance and its influence on post-endodontic pain of root canal treated teeth: A systematic review and meta-analysis
Nidhi Shah, Abhinav Singh, Abhishek Purohit, Prateek Shakti
doi: 10.14744/TEJ.2023.18291  Pages 151 - 158
Purpose: The purpose of this study was to determine the effect of apical patency versus non-apical patency filing on post-endodontic pain in root canal treated teeth in permanent dentition.
Methods: A search was conducted in Medline, Google Scholar, Scopus, Web of science, and Cochrane databases for randomized controlled trials and clinical trials comparing post-endodontic pain with apical patency and without apical patency maintenance with a follow-up period of 12 h, 24 h, 2 days, and 7 days. Certainty of evidence was determined using the grading of recommendations, assessment, development, and evaluations assessment tool. A random-effect model was used to assess the mean differences between the two used techniques.
Results: Five studies met the inclusion criteria. A total of 372 patients with apical filling versus 372 with no apical filling were available for analysis at end of 24 and 48 h. Apical patency maintenance was associated with lesser post-endodontic pain with a statistically significant difference at 12 h (MD = −1.49; p = 0.003) and 2 days (MD = −0.85; p = 0.04). Certainty of evidence for this association was moderate.
Conclusion: This meta-analysis presents evidence for reduced post-endodontic pain in permanent dentition when the apical patency technique is used for recapitulation. Clinical trials are further recommended so that research evidence may again be substantiated in the future.

10.Pelargonium sidoides: A possible preventive role in the development of endodontic flare-up
Meltem Küçük, Umut Aksoy, Ahmet Özer Şehirli
doi: 10.14744/TEJ.2023.59389  Pages 159 - 166
Purpose: In the presence of acute or chronic inflammation in the periapical tissues caused by various anaerobic and facultative bacteria, it is aimed to create suitable healing conditions by performing successful root canal treatment. However, endodontic flare-ups may occur between appointments, and this may cause discomfort for the patient and damage the patient-clinician relationship. Therefore, in this brief review, it is aimed to describe the possible preventive effects of the natural medicine Pelargonium sidoides extract (EPs® 7630), which has broad anti-infective and anti-inflammatory properties.
Methods: PubMed and Google Scholar databases were searched and reviewed related to P. sidoides. The anti-inflammatory and antimicrobial effects of P. sidoides extract and its chemical constituents in periodontitis and other systemic infections are discussed.
Results: Clinical and in vitro studies have confirmed that P. sidoides extract and some of its fractions may be involved in inflammatory tissue responses by showing immunomodulatory effects in mild infections of periapical tissues. This implies that the natural remedy, EPs® 7630, could be a potential therapeutic and prophylactic medicine for root canal treatments.
Conclusion: This review provides basic information about the immunomodulatory, anti-infective, and anti-inflammatory effects of EPs® 7630 and outlines its possible functions in periradicular tissues as a promising therapeutic medicine.

11.Multiple pulp necroses in a patient with heterozygous sickle cell disease: A case report
Wendpoulomdé Aimé Désiré Kaboré, Stéphane Xavier Djolé, Kouadio Florent Kouakou, Anta Seck, Marie Chantal Avoaka-Boni, Yolande Gnagne-Koffi
doi: 10.14744/TEJ.2023.14632  Pages 167 - 171
This study reports several pulp necroses in a patient with sickle cell disease (SCD), a pathology with a high risk of infection which can lead to life-threatening patients. An African male patient with SCD, 31 years old, was received at the municipal oral health center on June 4, 2002, for a pericoronitis of 48 which quickly evolved into cellulitis. The treatment consisted of removing 48. He was seen in 2006 for pain while chewing. Intraoral examination showed dyschromia of 44, 45, 46, and 47. Teeth 46 and 47 presented acute apical periodontitis which were endodontically treated. In 2019, tooth 47 which is painful is removed. X-ray panoramic showed apical translucent images on several teeth. On December 13, 2021, he was received with a depressible palatal swelling due to 12. Endodontic treatment is performed under curative antibiotic therapy. Conclusion: Regular oral monitoring of patients with SCD must be implemented to prevent severe complications with life-threatening.

12.Microsurgical apicoectomy with retro filling in a patient with extensive periapical lesion in maxilla - A case report
Justyna Klepacz- Szewczyk, Katarzyna Fabjanska
doi: 10.14744/TEJ.2023.74745  Pages 172 - 179
The goal of modern dentistry should be to maintain patients’ dentition for as long as possible. Microsurgical apicoectomy is a predictable and safe solution worth considering in the treatment of periapical diseases. The aim of our work was to present a method of dealing with a large lesion in the maxilla. The article describes surgical management in a case of a large periapical cyst with probable traumatic origin. A 45-year-old male patient reported a large radiolucent area in the region of the teeth 11–13, suggesting bone resorption with an irregular contour. The procedure consists of curettage of periapical bone, root resection, and retrograde filling. Surgery was carried out with local infiltration anesthesia. A sulcular, full-thickness flap was designed. The resection of the root apices of teeth 11 and 12 was performed, and retrograde filling was implemented. The patient was recalled after 5 days for the removal of sutures and evaluation of treatment. The patient underwent the procedure without any complications and did not report pain or swelling after surgery. During the control visit, there was a bone reconstruction visible on periapical X-rays. Minimal scarring was noticeable, and the patient was content with the esthetic result without any pain or discomfort. Endodontic microsurgery is a widely studied procedure. It is recommended to use suitable equipment, instruments, and materials that match biological concepts.

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