Giampiero Rossi-Fedele

Objective: The impact of contracted access cavities on organic tissue dissolution by irrigant solutions supplemented with ultrasonic agitation has not been determined. This laboratory study compared the organic tissue dissolution ability of 5.25% sodium hypochlorite (NaOCl) with ultrasonication and 17% ethylenediaminetetraacetic acid (EDTA), in artificial molars having traditional (TradAC), conservative (ConsAC), or ultraconservative (UltraAC) endodontic access cavities. Methods: Resin mandibular molar replicas (n = 135) with canals prepared, derived from micro-computed tomography scan datasets, were randomly allocated to the 3 experimental groups: TradAC, ConsAC or UltraAC (n = 45 per group). Porcine palatal mucosa samples (0.4-0.6 mg) were placed in the mesial root isthmuses, the teeth were reassembled and sealed. Both mesial canals were irrigated with 1.5 mL NaOCl ultrasonicated, followed by 1 mL EDTA and a final 1.5 mL NaOCl rinse. The total contact time was 90 seconds for NaOCl and 10 seconds for EDTA. Tissue was re-weighed, and mass loss was expressed as the percentage of weight reduction. The Kruskal–Wallis test (χ2) was used to assess differences between groups. Significance was set at P = .05. Results: Percentage dissolution means (SD) were TradAC, 32.2 (20.3); ConsAC, 25.0 (13.8); and UltraAC, 23.4 (15.0). The analysis showed no significant variation in porcine palatal mucosa tissue dissolution percentages across the experimental groups (χ2 = 4.37, df = 2, P = .117). Conclusion: No statistically significant differences in porcine palatal mucosa dissolution were detected among the tested access cavity designs under the laboratory conditions investigated.

Objective: The effect of intracanal heating (IH) combined with ultrasonic agitation on the organic tissue–dissolving ability of sodium hypochlorite (NaOCl) in the peripheral areas of the root canal system remains unexplored. This in vitro study evaluated the ability of 2.5% NaOCl, with IH and/or ultrasonication (US), to dissolve porcine palatal tissue within standardized simulated grooves in roots of human maxillary central incisors. Methods: The root canals of 105 decoronated human maxillary central incisors were chemo–mechanically prepared and the teeth split. A standardized longitudinal intracanal groove was created in 1 of the root halves; porcine palatal mucosa samples were collected, adapted to fit into the grooves, and weighed. The reassembled samples were randomly divided into 3 experimental groups and positive/negative controls (PC/NC) n = 21 each. Sodium hypochlorite was delivered using a syringe and needle positioned 2 mm short of the working length. The intervention protocols were as follows: IH: 2 cycles at 150ÅãC for 10 seconds each; US: 2 cycles at high frequency for 10 seconds each; and combined IH+US: 1 cycle of each adjunct. Specimens were submerged in 37ÅãC water bath. Percentage tissue dissolution was compared among groups using one‑way analysis of variance (ANOVA), and pairwise comparisons were performed with the Tukey post-hoc test. The level of significance was set at P = .05. Results: The mean (SD) percentages of tissue dissolution were as follows: PC: 95.2 (4.3); IH: 38.7 (10.1); IH+US: 32.2 (11.4); US: 26.5 (10.9); NC: 1.8 (0.9). A significant difference was observed between IH and US (mean difference = 12.2%; P = .008). No further significant differences were detected among the experimental groups. Conclusions: Within the limitations of this laboratory study, IH resulted in greater tissue dissolution in simulated grooves than ultrasonic agitation alone, whereas the combined IH+US protocol showed intermediate values and did not differ significantly from either technique.

Non‐odontogenic orofacial pain (OFP) is a common presentation in oral medicine and frequently co‐occurs with sleep disturbances. Health‐related and oral health‐related quality of life (HRQoL/OHRQoL) are clinically meaningful outcomes; however, the relationship between sleep disturbances and quality of life (QoL) across non‐odontogenic OFP conditions has not been comprehensively synthesised. This systematic review investigated the relationship between sleep disturbances and non‐odontogenic OFP in adults and assessed their impact on HRQoL and OHRQoL. The review was conducted in accordance with PRISMA 2020 guidelines. PubMed, MEDLINE, EMBASE and CINAHL Ultimate were searched from inception to November 2025. Eligible studies included adults with non‐odontogenic OFP, assessed sleep disturbance using validated or self‐reported measures, and reported QoL outcomes. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools. Due to heterogeneity, results were synthesised narratively. Nine studies were included, encompassing temporomandibular disorders, burning mouth syndrome, painful post‐traumatic trigeminal neuropathy, and other chronic non‐odontogenic OFP conditions. Across studies, poorer sleep was consistently associated with reduced QoL, including lower vitality, impaired daily functioning, greater emotional distress and increased pain‐related interference. Sleep disturbances were consistently associated with reduced HRQoL/OHRQoL in adults with non‐odontogenic OFP. Sleep disturbances are frequently reported in adults with non‐odontogenic orofacial pain and are associated with meaningful reductions in both health‐related and oral health‐related quality of life. This review highlights the importance of considering sleep as a clinically relevant component of the assessment of chronic orofacial pain conditions, including temporomandibular disorders, burning mouth syndrome and painful post‐traumatic trigeminal neuropathy. Incorporating routine enquiry regarding sleep may facilitate identification of patients with greater functional, psychological, and pain‐related burden, supporting a more comprehensive biopsychosocial approach to patient management. Recognition of sleep‐related impairment may also assist clinical decision‐making, improve communication with patients, and support timely interdisciplinary referral where indicated. Trial Registration: PROSPERO Registration: CRD420251071445

Objective: To compare the efficacy of sodium hypochlorite (NaOCl) combined with ethylenediaminetetraacetic acid (EDTA), etidronic acid (HEDP), or Keratobacter (KB; a glycocholic acid–based solution with surfactants), for smear-layer removal, using subsonic agitation during the final rinse. Methods: Following decoronation, 40 human central mandibular incisors (single-canal) were randomly assigned into one of 3 experimental groups (n=12 each) based on the irrigant solution used (NaOCl + EDTAfinal, NaOCl + HEDP, and NaOCl + KB) or used as control specimens: positive controls (irrigation omitted) or negative controls (no chemo-mechanical preparation) (n=2 per group). Experimental groups were prepared using reciprocating instruments and irrigated with the respective solutions, with the chelator omitted for the NaOCl + EDTAfinal group at this stage. The teeth were then split, scanned with an electron microscope, and the smear layer was scored (0-3) at 3 levels by 2 blinded examiners. The reassembled specimens underwent a final rinse with the relevant solutions incorporating subsonic agitation, after which they were disassembled, and the remaining smear layer was scored as before. A non-parametric Brunner–Langer model of longitudinal data was estimated for the cleaning results for each of the levels. Then, an ATS-type ANOVA statistical test was used to analyze the effect of the irrigant, the treatment stage, and the interaction between them. The Mann–Whitney test with Bonferroni correction was used for multiple comparisons between irrigants in each phase. The significance level for all analyses was 5%. Results: Following instrumentation, negative controls were scored 0, and positive controls were scored 3. NaOCl + KB was associated with significantly lower scores compared to NaOCl + EDTAfinal and NaOCl + HEDP (coronal and apical levels) (P < .001). After the final rinse, NaOCl + KB showed significantly lower scores compared to NaOCl + HEDP coronally (P=.015), with the final rinse being associated with significantly lower scores solely for NaOCl + KB at the middle and apical levels (P=.002). Conclusions: NaOCl + KB had the lower scores for smear layer compared to the other experimental groups, with the final rinse enhancing smear layer removal for NaOCl + KB.

Background: External cervical resorption (ECR) is a relatively rare form of tooth resorption. It is commonly classified either using two‐dimensional imaging according to the Heithersay or cone‐beam computed tomography using the Patel et al. classifications. Effective disease classification systems should provide categories that guide clinical decision‐making and support the prediction of management outcomes. This principle should apply to the classification systems for ECR. Objectives: To assess the association between Heithersay's and Patel's classification systems and the recently proposed core outcome set measures for endodontic treatment. Method: A narrative review study type was adopted due to the anticipated heterogeneity regarding clinical management. An electronic citation search of the studies by Heithersay 1999 and Patel et al. 2018 was made on 17 September, 2025 in three electronic databases (PubMed, Web of Science, and Scopus) for cohort studies that included various categories of the classifications. No language or publication date restrictions were applied. Articles were excluded when inclusion criteria were not met. Four clinical registers were searched for emerging evidence using the same criteria. The main features of the study were extracted, tabulated, and a narrative summary was made. Two authors contributed to the process independently. Results: Searches of the databases and clinical trials registers yielded six and nil studies, respectively. The identified studies originated from seven countries, were mostly set in postgraduate teaching clinics and were published within the past five years. The recall periods extended up to 10 years with all six studies using Heithersay's classification, with three also using Patel's classification. In total, 657 teeth were assessed against Heithersay's classification and 128 also assessed with Patel's. The three studies that included both classifications had relatively limited sample sizes and relatively short final recall periods. An association between Heithersay's classification with outcomes was evident; Classes I and II were associated with high rates of survival and ‘success’, and Class IV the opposite. No association was found between Patel's classification with outcomes. Conclusion: The available literature supports an association between Heithersay's classification with management outcomes for ECR. There is insufficient evidence to assess Patel's classification regarding prognostication.

This scoping review mapped and critically appraised laboratory evidence on counterfeit and replica‐like nickel–titanium endodontic files, evaluating design, metallurgical composition, surface finishing, and mechanical performance to clarify clinical and regulatory implications. Comprehensive searches of major databases and key endodontic journals identified 17 in vitro studies; no clinical studies were found. Counterfeit instruments consistently exhibited design irregularities, surface defects, and altered metallurgical properties that reduced cyclic fatigue resistance and produced unpredictable mechanical behaviour, posing significant patient‐safety concerns. Replica‐like instruments showed heterogeneous performance, with some matching or rarely exceeding original files in specific tests but others demonstrating inferior flexibility or torsional resistance. Quality‐control standards were inconsistent or lacking. These findings demonstrate that deviations in alloy processing, phase transformation, and surface finishing compromise mechanical reliability and highlight the urgent need for stronger regulatory oversight and clinical validation to safeguard practitioners and patients.

Background: There is a strong association between root canal curvatures and iatrogenic complications during root canal treatment. Introduction: This study compared the curvature of mesiobuccal (MB) and mesiolingual (ML) canals in mandibular first molars between sagittal and coronal planes using cone‐beam computed tomography. Methods: Two hundred mesial roots (400) canals from a Brazilian subpopulation were analysed. Curvature angles were measured in sagittal and coronal planes using Schneider's and Weine's methods, while curvature radii were calculated geometrically. The prevalence of S‐shaped canals was also recorded. Curvature severity was classified according to the American Association of Endodontists Case Difficulty Assessment form, EndoApp, and modified versions incorporating curvature and radius. The influence of the angle measurement method and radius on case complexity was evaluated. Statistical analyses were performed using t ‐tests and chi‐squared tests, with significance set at p ≤ 0.05. Results: Sagittal planes showed significantly greater angles and smaller radii than coronal planes. Weine's method yielded consistently higher angles and smaller radii than Schneider's. Severe single curvatures (≥ 30°) were more frequent in sagittal planes, whereas S‐shaped canals were more prevalent in coronal planes. MB was more often classified as higher difficulty than ML canals. Incorporating radius into the classification systems generally shifted cases towards greater severity. Conclusions: Sagittal planes revealed more severe single curvatures, whereas coronal planes showed a higher prevalence of S‐shaped canals. Weine's method resulted in greater curvature severity than Schneider's. Inclusion of radius increased case severity grading. These findings highlight the importance of considering both measurement method and projection plane in endodontic treatment planning and research.