Restorative Dentistry & Endodontics

Bibliometric analysis of the GentleWave system: trends, collaborations, and research gaps: Raimundo Sales de Oliveira Neto, Thais de Moraes Souza, João Vitor Oliveira de Amorim, Thaine Oliveira Lima, Guilherme Ferreira da Silva, Rodrigo Ricci Vivan, Murilo Priori Alcalde, Marco Antonio Hungaro Duarte; Restor Dent Endod 2025;50(2):e17. Published online May 12, 2025; DOI: https://doi.org/10.5395/rde.2025.50.e17; Funded: São Paulo Research Foundation

Abstract PDF Supplementary Material PubReader ePub: Objectives
The study aimed to conduct a bibliometric analysis of the GentleWave system (Sonendo, Inc.).
Methods
An electronic search was conducted in June 2024 using the Web of Science Collection database. Two reviewers independently screened publications, extracting data on authorship, publication details, study design, and citation metrics. Statistical analyses were performed in R to assess variable correlations, while the VOSviewer (Visualization of Similarities Viewer) software was used to map author and keyword networks.
Results
The search yielded 47 records, with 32 studies included. Publications spanned 2014 to 2024. The Journal of Endodontics published the highest number of studies (n = 15), and the International Endodontic Journal had the highest impact factor (5.4). The University of British Columbia and Sonendo, Inc. were the most frequent affiliations. Among the 32 articles, 28 were in vitro studies, primarily focusing on microbiology (n = 9). A total of 95 authors were identified, with Haapasalo and Shen being the most cited (n = 229). The articles accumulated 495 citations, demonstrating a strong positive correlation between the number of studies and citation counts (r = 0.98).
Conclusions
The analysis highlights a predominance of in vitro studies. Geographic concentration in the United States and Canada limits diversity, while the strong correlation between study numbers and citations suggests that increased publication volume enhances visibility.

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Cleaning protocols to enhance bond strength of fiberglass posts on root canals filled with bioceramic sealer: an in vitro comparative study: Thiago Bessa Marconato Antunes, Juliana Delatorre Bronzato, Joice Graciani, Ana Cristina Padilha Janini, Rocharles Cavalcante Fontenele, Francisco Haiter Neto, Brenda Paula Figueiredo de Almeida Gomes, Marina Angélica Marciano da Silva; Restor Dent Endod 2025;50(2):e20. Published online May 21, 2025; DOI: https://doi.org/10.5395/rde.2025.50.e20; Funded: State of São Paulo Research Foundation, State of São Paulo Research Foundation, Improvement of Higher Education Personnel

Abstract PDF PubReader ePub: Objectives
This study aimed to evaluate whether the agitation protocols using ultrasonic inserts or the XP-endo Finisher R file improved the removal of two different endodontic sealer remnants and the bond strength of fiberglass posts to dentin.
Methods
Seventy-two human teeth were selected. The canals were prepared with Reciproc 50 and Easy ProDesign 30/.10 and root filled according to the endodontic sealer groups: AH Plus or EndoSequence BC Sealer HiFlow. The samples were kept at 37ºC and 95% humidity for 28 days. During the post space preparation, the obturation was removed with Largo burs, and the groups were divided according to the irrigant agitation protocols (n = 12): no agitation, agitation with R1-Clearsonic associated with E1-Irrisonic ultrasonic inserts, or agitation with XP-endo Finisher R file. The fiberglass posts were cemented with RelyX ARC. The roots were sectioned into slices and submitted to the push-out test. Micro-computed tomography analysis was used to check the effectiveness of irrigating solution agitation in the elimination of remnants.
Results
The cleaning protocols with agitation were more effective in increasing the bond strength of posts to dentin for both sealer groups compared to non-agitation (p < 0.05). There was no difference between the same cleaning protocols for the different sealers. Among the different thirds, there was no statistical difference for the same sealer in the different cleaning protocols (p > 0.05).
Conclusions
Both agitation protocols effectively clean root-filled canals sealed with resin-based and calcium silicate-based sealers during fiberglass post space preparation. These protocols result in improved bond strength compared to non-agitation methods.

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Stress distribution of restorations in external cervical root resorption under occlusal and traumatic loads: a finite element analysis: Padmapriya Ramanujam, Paul Kevin Abishek Karthikeyan, Vignesh Srinivasan, Selvakarthikeyan Ulaganathan, Velmurugan Natanasabapathy, Nandini Suresh; Restor Dent Endod 2025;50(2):e21. Published online May 21, 2025; DOI: https://doi.org/10.5395/rde.2025.50.e21; Funded: Meenakshi Academy of Higher Education and Research

Abstract PDF PubReader ePub: Objectives
This study analyzed the stress distribution in a maxillary central incisor with external cervical resorptive defect restored with different restorative materials under normal masticatory and traumatic loading conditions using finite element analysis.
Methods
Cone-beam computed tomography of an extracted intact incisor and created resorptive models (Patel’s 3D classification-2Bd and 2Bp) in the maxillary central incisor was performed for finite element models. The 2Bd models were restored either with glass ionomer cement (GIC)/Biodentine (Septodont) or a combination of both with composite resin. 2Bp models were restored externally with a combination technique and internally with root canal treatment. The other model was external restoration with GIC and internal with fiber post. Two masticatory loads were applied at 45˚ to the palatal aspect, and two traumatic loads were applied at 90˚ to the buccal aspect. Maximum von Mises stresses were calculated, and stress distribution patterns were studied.
Results
In 2Bd models, all restorative strategies decreased stress considerably, similar to the control model under all loads. In 2Bp models, the dentin component showed maximum stress at the deepest portion of the resorptive defect, which transfers into the adjacent pulp space. In 2Bp defects, a multilayered restoration externally and root canal treatment internally provides better stress distribution compared to the placement of a fiber post.
Conclusions
Increase in load, proportionally increased von Mises stress, despite the direction or angulation of the load. Multilayered restoration is preferred for 2Bd defects, and using an internal approach of root canal treatment is suggested to restore 2Bp defects.

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Effect of quality of radiographs taken during root canal treatment on technical quality of root canal fillings and endodontic outcome: Jia Min Ng, Yan Yee Lee, Prashanti Chippagiri, Elaheh Ahanin, Abhishek Parolia; Restor Dent Endod 2025;50(1):e3. Published online January 7, 2025; DOI: https://doi.org/10.5395/rde.2025.50.e3; Funded: International Medical University, Malaysia

Abstract PDF PubReader ePub: Objectives
This study evaluated the number and quality of working length (WL) and master cone (MC) radiographs taken during root canal treatment by dental undergraduates, and their associations with the technical quality of root canal fillings (TQRCF) and endodontic outcomes (EO).
Methods
A retrospective evaluation of radiographs from 303 root canal-treated teeth in 231 patients was conducted, with 72 patients attending recall visits to assess EO. The chi-square and one-way analysis of variance tests were performed.
Results
A total of 505 WL and 557 MC radiographs were reviewed, with 72.9% and 75% deemed satisfactory, respectively. Satisfactory TQRCF was achieved in 60.4% of cases. Significant associations were found between the extension of the file in WL and gutta-percha in MC radiographs and TQRCF (p = 0.000). Misinterpretation of these radiographs resulted in poor TQRCF. Furthermore, 64.2% of teeth had satisfactory EO. A significant relationship was noted between the quality of MC radiographs and both TQRCF (p = 0.043) and EO (p = 0.003).
Conclusions
Unsatisfactory MC radiographs were linked to poor TQRCF and unfavorable EO. Regular radiographic training is recommended to enhance EO.

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Surface properties and susceptibility to staining of a resin composite after brushing with different whitening toothpastes: Aline da Silva Barros, Carolina Meneghin Barbosa, Renata Siqueira Scatolin, Waldemir Francisco Vieira Junior, Laura Nobre Ferraz; Restor Dent Endod 2025;50(1):e6. Published online February 26, 2025; DOI: https://doi.org/10.5395/rde.2025.50.e6; Funded: Research Support of the State of São Paulo

Abstract PDF PubReader ePub: Objectives
This study investigated the effects of different whitening toothpaste (WT) on the surface properties and staining susceptibility of a resin composite.
Methods
Cylindrical samples were prepared with a micro-hybrid resin composite and were randomized into groups according to the toothpaste (n = 12): distilled water (DW), regular toothpaste (RT), WT with silica + pyrophosphate (WT-S/P), WT with pentaphosphate and pyrophosphate (WT-P/P), WT with hydrogen peroxide and pyrophosphate (WT-HP/P) and WT with charcoal and pyrophosphate (WT-Ch/P). The samples were brushed for 825 cycles in an automatic brushing machine, simulating 30 days of brushing. After that, an immersion in coffee (10 mL/sample) was performed for 30 minutes for 30 days. The analyses of color, surface microhardness (SMH), and surface roughness (Ra) were performed at the initial time, after brushing with toothpaste and after immersion in coffee. The ΔL*, Δa*, Δb*, ΔEab, Δand E00 values were calculated comparing after toothpaste with initial time and after coffee with after toothpaste. Data were analyzed using a mixed linear model for repeated measures (SMH), Kruskal-Wallis, Dunn, Friedman, and Nemenyi tests, with α = 0.05.
Results
For ΔL*, the WT-Ch/P group had the lowest values and differed from the other groups comparing the after toothpaste with the initial time interval (p < 0.001). The WT-Ch/P group had the lowest SMH values in after-toothpaste time (p < 0.001). In after-toothpaste time and after coffee time, the WT-S/P group had the highest Ra values and differed from the groups except the WT-Ch/P group (p < 0.001).
Conclusions
The toothpaste composition affects the surface characteristics and susceptibility to staining of the resin composite. The charcoal-based toothpaste had the worst performance for the color analyses and SMH.

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Shaping ability and cyclic fatigue resistance between Genius ProFlex, ZenFlex, and TruNatomy rotary systems: an experimental study: Raimundo Sales de Oliveira Neto, Murilo Priori Alcalde, Pedro Cesar Gomes Titato, Pedro Henrique Souza Calefi, Carlos Alberto Spironelli Ramos, Guilherme Ferreira da Silva, Rodrigo Ricci Vivan, Marco Antonio Hungaro Duarte; Restor Dent Endod 2025;50(1):e9. Published online February 13, 2025; DOI: https://doi.org/10.5395/rde.2025.50.e9; Funded: São Paulo State Research Foundation, National Research Council

Abstract PDF PubReader ePub: Objectives
The aim of this study was to investigate the efficacy of three newly introduced rotary endodontic systems: Genius ProFlex (Medidenta), TruNatomy (Dentsply Maillefer), and ZenFlex (Kerr).
Methods
Forty-five mandibular molars with root canal curvatures <5° were utilized. Micro-computed tomography scans were performed pre- and post-preparation to assess apical transportation, centralization, percentage of dentin wear, and canal volume alterations. Eight instruments of each diameter underwent cyclic fatigue testing.
Results
The percentage of dentin wear on mesial and distal walls showed no significant differences among ZenFlex, TruNatomy, and Genius ProFlex at 1, 2, 3, and 4 mm from the apical foramen and root canal orifice (p > 0.05). Centering ability varied in the mesiolingual canal (p < 0.05). No notable differences were observed in transportation (p > 0.05). Genius ProFlex demonstrated lower volumetric changes (p < 0.05). There were significant differences in cyclic fatigue, with higher values for Genius ProFlex and lower values for TruNatomy (p < 0.05).
Conclusions
The three nickel-titanium rotary instruments are safe and efficient for root canal preparation, with Genius ProFlex exhibiting superior cyclic fatigue resistance.

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Success rates comparison of endodontic microsurgery and single implants with comprehensive and explicit criteria: a systematic review and meta-analysis: Min Jung Ko, Ju Hyun Park, Na Rae Lee, Joon-Ho Yoon, Young-Taek Kim, Sin-Yeon Cho; Restor Dent Endod 2025;50(1):e8. Published online February 19, 2025; DOI: https://doi.org/10.5395/rde.2025.50.e8; Funded: National Evidence-based Healthcare Collaborating Agency

Abstract PDF Supplementary Material PubReader ePub: Objectives
While the success criteria of endodontic microsurgery (EMS) have been consistently defined and widely accepted, the success criteria of dental implants are outdated and focus only on the implant fixture and surrounding bone. This study aimed to evaluate the outcomes of EMS and single implants (SIs) with explicit criteria.
Methods
We searched for articles published from January 2010 to February 2022 and discussed them and consulted with a clinical advisory committee composed of four dental specialists and one epidemiologist during article selection and data extraction.
Results
Twenty-two EMS studies and six SI studies were included in the meta-analysis. Teeth treated using EMS had a pooled success rate of 89% (90% at <5-year follow-up and 80% at ≥5-year follow-up) and the pooled success rate of SI was 78%.
Conclusions
The success rates of the two procedures with similar follow-up periods were comparable. Subgroup analysis found no other variable that significantly influenced study heterogeneity. Considering the treatment sequence and the similar success rates, it would be advantageous to consider EMS, rather than implants, first in a situation where both procedures are applicable.

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