Silvana Jukić Krmek

Purpose This study sought to evaluate the effectiveness of Shock Wave Enhanced Emission Photoacoustic Streaming (SWEEPS), XP-endo Finisher (XPF), Passive Ultrasonic Irrigation (PUI), and Conventional Syringe Irrigation (CSI) in the removal of calcium hydroxide (CH) from the mesial root canals of mandibular molars, utilizing micro-computed tomography (micro-CT). Methods: Forty mesial roots of mandibular molars were pair-matched according to canal morphology based on pre-operative micro-CT analysis and randomly assigned to four groups (n = 10). Following standardized canal preparation, CH was placed and stored for two weeks before removal using the assigned irrigation protocols. Micro-CT scans were obtained before and after CH removal, and the remaining CH volumes in the apical, middle, coronal, and total canal regions were quantitatively analyzed. Results: All methods significantly reduced CH volume compared with baseline at all root levels (p < 0.05). CSI demonstrated significantly lower CH removal in the coronal and middle thirds compared with the other groups and was less effective than XPF and SWEEPS in the apical region (p < 0.05). SWEEPS and XPF demonstrated markedly superior CH elimination compared to PUI in the apical third (p < 0.05). Conclusion: Although complete CH removal was not achieved with any technique, SWEEPS and XPF demonstrated relatively higher removal effectiveness. This in vitro study demonstrated that sophisticated irrigation activation strategies, including SWEEPS and XP-endo Finisher, improved the elimination of calcium hydroxide from intricate root canal systems.

This study aimed to evaluate the influence of different fluoride-containing toothpastes on fluoride uptake, surface roughness, and microhardness of six ion-releasing restorative dental materials, including glass hybrids (EQUIA Forte HT with and without coating), glass ionomer cements (Fuji IX), resin-modified GICs (Fuji II LC), alkasites (Cention Forte), and ion-releasing composites (Luminos UN and Activa). Specimens were prepared and subjected to a four-day brushing protocol using six toothpastes with varying fluoride formulations (NaF, SnF2, SMFP) and concentrations. Fluoride uptake was assessed by measuring fluoride release using an ion-selective electrode, while surface roughness and microhardness were assessed before and after brushing. Results revealed significant variations in fluoride uptake, with Fuji IX and EQUIA Forte HT showing the highest release, particularly when brushed with NaF-based toothpastes (Duraphat 5000 and 2800). Surface roughness increased post-brushing, with the greatest changes observed in Activa, while microhardness decreased across most materials, except for coated EQUIA Forte HT, which exhibited improved compactness. Resin-based composites, such as Luminos UN and Activa, demonstrated lower fluoride uptake and minimal changes in microhardness compared to GICs. The findings underscore the importance of material composition and toothpaste formulation in influencing fluoride dynamics, surface properties, and mechanical performance of restorative materials.

Objectives: This web‐based survey, conducted across multiple countries, sought to explore the factors that impact the decision‐making of clinicians when it comes to managing defective direct restorations.Methods: A survey consisting of 14 questions was sent out to dentists in 21 countries through various online platforms. The survey consisted of two sections. The first contained five questions about demographic information, while the second involved eight clinical scenarios. In the second part, participants were tasked with deciding whether to repair or replace defective composite and amalgam restorations.Results: Three thousand six hundred eighty dental practitioners completed the survey. For composite restorations, repair was preferred in scenarios like partial loss or fracture (RR:0.72; 95% CI: 0.58, 0.89; p = 0.002), whereas replacement was favored for secondary caries (RR:2.43; 95% CI: 1.87, 3.16; p < 0.001) and open/defective margins (RR:3.93; 95% CI: 2.68, 5.76;p < 0.001). Amalgam restorations were mostly replaced across all scenarios. The main factors influencing decision‐making were caries risk, restoration size, and patient oral hygiene. Substantial heterogeneity was observed across countries.Conclusion: This study underscores the complexity of the decision‐making process and the need for evidence‐based guidelines to inform clinicians' decisions regarding restoration management. Patient‐level factors predominantly influence decision‐making, emphasizing the need for individualized approaches.Clinical Significance: The study reveals that the material type in the original restoration is a critical determinant, with composite restorations being repaired in specific scenarios, while amalgam restorations are consistently replaced across different countries. Key patient and tooth‐level factors, such as high caries risk, poor oral hygiene, and restoration size, significantly impact clinicians' decisions, often favoring replacement over repair. These findings underscore the necessity for evidence‐based guidelines to assist clinicians in making informed choices, ultimately enhancing the quality of patient care.

The aim of this study was to compare the mechanical properties and ion release from a commercially available resin-modified glass ionomer cement to a formulation reinforced by the addition of short glass fibres at various percentages. Methods: Three experimental groups were prepared by adding a mass ratio of 10%, 15% and 20% of short glass fibres to the powder portion of the cement from a capsule (GC Fuji II LC), while the control group contained no fibres. Microhardness (n = 12), fracture toughness, and flexural, compressive and diametral tensile strength (n = 8) were evaluated. To study ion release, readings were obtained utilising fluoro-selective and calcium-selective electrodes after 24 h, 7 days and 30 days (n = 12). The spatial distribution of fibres within the material was evaluated through scanning electron microscopy. The data were analysed using one-way ANOVA with a Bonferroni adjustment. Results: The findings suggest that elevating fibre weight ratios to 20 wt% results in improved mechanical properties (p < 0.05) in microhardness, flexural strength, diametral tensile strength and fracture toughness. In terms of ion release, a statistically significant difference (p < 0.001) was observed between the groups at the conclusion of 24 h and 7 days, when the fluoride release was much higher in the control group. However, after 30 days, no significant distinction among the groups was identified (p > 0.05). Regarding calcium release, no statistically significant differences were observed among the groups at any of the evaluated time points (p > 0.05). SEM showed the fibres were homogeneously incorporated into the cement in all experimental groups. Conclusions: Resin-modified glass ionomer enhanced with short glass fibres at a weight loading of 20% showcased the most favourable mechanical properties while concurrently maintaining the ability to release fluoride and calcium after a 30-day period.

The aim of this study was to investigate the root canal morphology of lower second molars in the Croatian subpopulation of the Zagreb region using cone-beam computed tomography (CBCT). We analyzed 3212 CBCT scans from the two radiology centers in Zagreb. The number of roots and root canals, the occurrence of C-shaped canals and additional roots were recorded. “C”-shaped roots were classified according to Melton classification. Canals in the mesial root were classified according to Vertucci. Lower second molars were found on 608 CBCT scans from a total number of 859. Among them, 78 (9.1%) had a “C”-shaped form. In the mesial roots, the frequencies of Vertucci types were: Type I in ninety-four cases (12.0%), Type II in three hundred and twenty cases (41.0%), Type III in six cases (0.8%), Type IV in three hundred and fifty-two cases (45.1%), Type V in three cases (0.4%), Type VI was found in four cases (0.5%) and Type VIII was found in one case (0.1%). Radix entomolaris and paramolaris were found in 29 (3.4%) lower second molars. The lower second molars in the Zagreb population show significant diversity in internal anatomy with a relatively high prevalence of “C”-shaped root canals and merged root canals in the mesial root.

To compare short-term release of fluoride ions from ion-releasing dental restorative materials. Seven experimental groups were prepared using the following six different materials: alkasite (Cention Forte), resin-modified glass ionomer cement (Fuji II LC), bioactive composite (ACTIVA BioACTIVE-RESTORATIVE), fluoride-containing nano-hybrid composite (Luminos UN), coat-free glass hybrid (EQUIA Forte HT), coat-applied glass hybrid (EQUIA Forte HT), and glass ionomer cement (Fuji IX). A total of 40 samples for each group (n=40) were prepared in Teflon molds (8 mm x 2 mm) and placed in polyethylene vials with 5 ml of deionized water. Fluoride release was measured after 6, 24, 48 hours, and for 5 weeks using an ion-selective electrode. The results were expressed in mg/l and the data were statistically analyzed using ANOVA. Significant differences in fluoride release were observed within the first 6 hours (ANOVA p<0.001). EQUIA Forte HT had the highest release, while the other materials showed no significant differences. After 24 hours, EQUIA Forte HT (p<0.001) and Luminos UN (p<0.05) exhibited significantly higher releases, compared to other tested materials. EQUIA Forte HT maintained the highest release at 48 hours (p<0.001), followed by Cention Forte (p<0.05) and Luminos UN (p<0.05). All material pairs showed significant differences in fluoride release at 5 weeks (p<0.001). Coat-free EQUIA Forte HT had the overall highest fluoride release, while Cention Forte demonstrated the greatest increase over time. ACTIVA BioACTIVE-RESTORATIVE exhibited the lowest fluoride release in this study.

Background: Regenerative endodontics (RET) refers to biologically based procedures that aim to restore damaged tooth structures and reinstate the pulp–dentine complex to its normal physiological state.Aim: The purpose of this study was to examine the attitudes and practices of endodontists and paediatric dentists regarding RET.Design: A survey was conducted among endodontists and paediatric dentists from 13 countries. A number of factors were evaluated, including frequency of RET application, followed guidelines, disinfection techniques, intracanal medication type, scaffold type, preferred coronal seal material, and follow‐up period.Results: Among the 1394 respondents, 853 (61.2%) and 541 (38.8%) were endodontists and paediatric dentists, respectively. Almost half (43%) of participants have not performed RET yet. The American Association of Endodontics guideline (47.3%) was selected as the primary source for the clinical protocol. The most frequently selected irrigant solution was 1.5%–3% NaOCl at the first (26.1%) and second (13.6%) sessions. A blood clot (68.7%) and MTA (61.9%) were the most frequently selected scaffold type and coronal barrier. Most participants preferred a 6‐month follow‐up period.Conclusion: According to this survey, deviations exist from current RET guidelines regarding all aspects evaluated. Standardizing clinical protocols and adhering to available guidelines would help to ensure more predictable outcomes.

This study sought to evaluate the efficacy of SWEEPS in the removal of epoxy-resin-based and calcium-silicate-containing endodontic sealer combined with single-cone and carrier-based obturation techniques through a micro-CT analysis. Seventy-six single-rooted extracted human teeth with single root canal were instrumented with Reciproc instruments. Specimens were randomly divided into four groups (n = 19) according to the root canal filling material and obturation technique: (1) AH Plus sealer + Reciproc gutta-percha, (2) TotalFill BC sealer + TotalFill BC Points, (3) AH Plus sealer + Guttafusion obturator, and (4) MTA Fillapex + Guttafusion obturator. All specimens were re-treated one week later using Reciproc instruments. Following re-treatment, root canals were additionally irrigated using the Auto SWEEPS modality. The differences in the root canal filling remnants were analyzed by micro-CT scanning of each tooth after root canal obturation, after re-treatment, and after additional SWEEPS treatment. Statistical analysis was performed using an analysis of variance (p < 0.05). The additional treatment with SWEEPS significantly reduced the volume of the root canal filling materials in all experimental groups compared to the removal of root canal filling using only reciprocating instruments (p < 0.05). However, the root canal filling was not removed completely from any of the samples. SWEEPS can be used to enhance the removal of both epoxy-resin-based and calcium-silicate-containing sealers, in combination with single-cone and carrier-based obturation techniques.