Giornale Italiano di Endodonzia

Influence of different torque control and apex locator settings on apical debris extrusion

Arzu Kaya Mumcu — 2025-01-28

Aim: This study evaluated the effects of torque control settings and automatic stop functions on apical debris extrusion during root canal preparation using a continuous rotation file system.

Methodology: Forty-eight extracted human lower premolars were randomly divided into four groups based on two torque control settings and two auto-stop functions. The extruded debris was collected in pre-weighed Eppendorf tubes and subsequently quantified.

Results: Statistical analyses were conducted using SPSS, and the Kruskal–Wallis test and the Mann–Whitney U test revealed that the auto-stop mode significantly reduced debris extrusion, while the torque control settings did not.

Conclusion: These findings suggest that clinicians can potentially minimise debris extrusion by utilising the auto-stop mode during root canal procedures.

Endodontic micro-surgery by means of two different surgical templates performed with selective Piezosurgery^® root resection: a report of two cases

Martina Amendolea — 2025-01-23

Aim. The aim of this case series is to introduce a new surgical template designed for static endodontic microsurgery using Piezosurgery^®. The template, created with computer-aided design/computer-aided manufacturing (CAD-CAM) technologies, aims to enhance the precision of root-end resections by providing individualized guidance for the surgical procedure. This approach seeks to reduce invasiveness, minimize bone loss, and improve surgical outcomes in cases of persistent apical periodontitis or other post-treatment endodontic complications.

Summary. Conventional endodontic treatments can fail in 14-16% of cases due to persistent infections within the root canal system or extraradicular factors. In such cases, endodontic microsurgery, especially when guided by advanced technologies, offers a high success rate of up to 89%. Recent innovations in piezoelectric devices and CAD-CAM-based surgical templates enable more precise, less invasive procedures. The new surgical template presented in this study allows for accurate root-end resections, ensuring optimal root sealing while minimizing damage to surrounding tissues. The template’s design aims to improve accuracy and reduce the risk of surgical errors compared to freehand procedures, promoting better healing and fewer complications.

Key Learning Point

Persistent apical periodontitis after root canal treatment can often be resolved with microsurgical techniques.

The integration of CAD-CAM technology with Piezosurgery® enhances surgical precision, reducing bone loss and tissue trauma.

Surgical templates designed for static endodontic microsurgery provide individualized, accurate guidance, leading to improved surgical outcomes.

The use of piezoelectric devices offers precise cutting with minimal damage to soft tissues, crucial for surgeries near sensitive structures.

-Advances in guided endodontic surgery are improving success rates and minimizing post-operative complications.

Endodontics: the central core within a multidisciplinary approach

Sandro Rengo — 2024-11-07

Successful treatment of a damaged upper molar using 3D Technology: a case report with 4 years follow-up

Bodgan Oprea — 2024-10-17

Aim: The aim of this case report is to describe, in a stepwise manner, the diagnosis, treatment planning, execution, and rehabilitation of a damaged upper molar using Sicat Endo software and a computer-aided design/computer-aided manufacturing (CAD/CAM) system.

Summary: A patient with no painful symptoms presented to our clinic to complete a treatment that had been initiated a year ago (left unfinished for personal reasons) to save the tooth. Clinical tests indicated a previously initiated therapy and normal apical tissues. Cone beam computed tomography (CBCT) was used for the diagnosis and treatment planning of the root canal procedure. The planning of the previously designed access cavity and identification of all the root canals was performed with Sicat Endo software (Sicat, Bonn, Germany). Additionally, the quality of the final root canal obturation was evaluated using Sicat Endo software. The final crown restoration was fabricated using a CAD/CAM system and pressed lithium disilicate material. Our case report revealed a successful four-year follow-up of a one-session endodontic treatment of a maxillary molar and CAD/CAM final restoration using digital technologies and 3D software.

Key learning points

• In the present case report, Sicat Endo Software was used for root canal treatment planning and for assessing the quality of final obturation.

• The present case report utilized CAD/CAM technology for one-session treatment.

• This case report presents a middle-term follow-up of four years on the use of digital technologies for one-session endodontic therapy and prosthetic rehabilitation.

Influence of the direct composite restauration on the fracture strength and failure modes of endodontically treated premolars restored with posts

Vincenzo Spinelli — 2025-02-11

Aim: The long-term success of endodontically treated teeth requires maintaining structural integrity, functionality, and aesthetics. The combined use of endodontic fiber posts with resin-based micro- and nano-composites seems to be an intriguing solution for the reinforcement of the damaged tooth structures. This in vitro study aimed to evaluate the mechanical behavior and fracture patterns of premolars restored with different combinations of endodontic fiber posts and composite resins, subjected to thermomechanical aging and masticatory force simulation.

Methods: Fifty extracted maxillary premolars were divided into five groups, including a control group of healthy teeth and four experimental groups with two types of fiber posts (hollow and compact) and two composite resins with different elasticity (traditional and bulk-fill). After cyclic fatigue testing, fracture strength and failure modes were analyzed using statistical methods.

Results: The control group exhibited significantly higher fracture resistance (1909±177) than the experimental groups, with no significant differences among experimental groups (p. value >0.05). However, teeth restored with bulk-fill composites demonstrated slightly higher fracture resistance and a higher percentage of favorable fractures than other samples. The combination of bulk-fill composite and hollow fiber posts was associated with more favorable fracture outcomes (n=8 favorable fractures).