Restorative Dentistry & Endodontics

The influence of bioactive glass (BGS-7) on enamel remineralization: an in vitro study: Chaeyoung Lee, Eunseon Jeong, Kun-Hwa Sung, Su-Jung Park, Yoorina Choi; Restor Dent Endod 2025;50(4):e33. Published online October 15, 2025; DOI: https://doi.org/10.5395/rde.2025.50.e33; Funded: National Research Foundation of Korea

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The aim of this study was to compare the remineralizing capacity of bioactive glass (BGS-7, CGBIO) with other agents.
Methods
Twenty caries-free third molars were sectioned and demineralized. Specimens were divided into four groups: (1) control, (2) Clinpro XT varnish (Solventum), (3) 1.23% acidulated phosphate fluoride gel, and (4) a new type of CaO-SiO2-P2O5-B2O3 system of bioactive glass ceramics (BGS-7). Agents were applied and stored in simulated body fluid at 37℃ for 2 weeks. Microhardness was measured using the Vickers hardness testing method. Five specimens per group were analyzed using quantitative light-induced fluorescence (QLF) to assess mineral loss. Field-emission scanning electron microscopy (FE-SEM) and energy-dispersive X-ray spectroscopy (EDS) were used to examine the surface morphology and elemental composition. Data were analyzed using paired t-test and one-way analysis of variance (p < 0.05).
Results
BGS-7 showed the highest microhardness values and the greatest recovery in QLF analysis (p < 0.05). FE-SEM revealed granular precipitates on demineralized enamel in the BGS-7 group. EDS confirmed the presence of newly formed silicon and fluoride layers.
Conclusions
BGS-7 demonstrated superior remineralization capacity compared to other agents, suggesting its potential as an effective remineralizing material.

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Comparison of remineralization in caries-affected dentin using calcium silicate, glass ionomer cement, and resin-modified glass ionomer cement: an in vitro study: Kwanchanok Youcharoen, Onwara Akkaratham, Papichaya Intajak, Pipop Saikaew, Sirichan Chiaraputt; Restor Dent Endod 2025;50(4):e37. Published online November 14, 2025; DOI: https://doi.org/10.5395/rde.2025.50.e37; Funded: Srinakharinwirot University

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This study evaluated the ability of calcium silicate cement (CSC) as a remineralizing agent compared with conventional glass ionomer cement (GIC) and resin-modified GIC (RMGIC) to remineralize artificial caries-affected dentin.
Methods
Twenty-five class V cavities were prepared on extracted human third molars. Twenty teeth underwent artificial caries induction. The remaining five teeth with sound dentin serve as the positive control. The twenty demineralized teeth were subdivided into four groups (n = 5): carious dentin without restoration (negative control [NC]), carious dentin restored with CSC (Biodentine, Septodont), carious dentin restored with GI (Fuji IX, GC Corporation), and carious dentin restored with RMGIC (Fuji II LC, GC Corporation). Following restoration, the specimens were stored in artificial saliva for 7 days. The elastic modulus was evaluated by a nanoindentation test. The mineral composition was analyzed by scanning electron microscopy-energy-dispersive X-ray spectroscopy (SEM-EDX), and the mineral composition at the dentin-material interface.
Results
CSC had a higher modulus of elasticity compared to GI, RMGI, and NC groups (p < 0.05). Higher calcium and phosphorus content was observed under CSC restorations, as indicated by SEM-EDX examination, which may lead to better remineralization.
Conclusions
Compared to GI and RMGI, CSC showed the best remineralization and mechanical reinforcement in caries-affected dentin, indicating CSC for use in minimally invasive restorative dentistry.

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How protocol, posts, and experience affect fracture detection in multi-rooted teeth using cone-beam computed tomography: an ex vivo experimental study: Gleica Dal’ Ongaro Savegnago, Gabriela Marzullo de Abreu, Carolina Baumgratz Spiger, Lucas Machado Maracci, Wislem Miranda de Mello, Gabriela Salatino Liedke; Restor Dent Endod 2025;50(3):e23. Published online July 24, 2025; DOI: https://doi.org/10.5395/rde.2025.50.e23; Funded: Coordination for Funding and Support of Tertiary Education

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This study aimed to evaluate the influence of cone-beam computed tomography (CBCT) acquisition protocol, the presence of intraradicular metal post, and examiner experience on the detection of complete root fractures in multi-rooted teeth.
Methods
Twenty human molar teeth filled with gutta-percha were placed into artificial alveoli created in bovine ribs. The sample was divided into two groups based on the presence or absence of intraradicular posts in the distal roots. CBCT scans were obtained using four acquisition protocols with varying voxel sizes (0.28, 0.2, 0.125, and 0.80 mm). Following the creation of controlled fractures using a chisel and hammer, CBCT imaging was repeated, resulting in 160 images. Five examiners assessed the images using OnDemand software (KaVo Dental GmbH). Sensitivity, specificity, and accuracy were calculated for each examiner, CBCT protocol, and post-condition. Statistical comparisons were performed using Cochran’s Q test and McNemar test, and a significance level of 5%.
Results
In teeth without metallic posts, sensitivity, specificity, and accuracy values exceeded 0.70, 0.70, and 0.80, respectively. However, the presence of metallic posts significantly reduced diagnostic performance, particularly in low-resolution protocols evaluated by less-experienced examiners.
Conclusions
CBCT acquisition protocols should be selected based on the presence of metallic posts to optimize root fracture detection in multi-rooted teeth. Examiner experience also plays a critical role in diagnostic accuracy.

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Calcium silicate-based sealers remnants in isthmuses of mesial roots of mandibular molars: an in vitro evaluation: David Saldanha de Brito Alencar, Ana Cristina Padilha Janini, Lauter Eston Pelepenko, Brenda Fornazaro Moraes, Francisco Haiter Neto, Marco Antonio Hungaro Duarte, Marina Angélica Marciano; Restor Dent Endod 2025;50(3):e25. Published online July 15, 2025; DOI: https://doi.org/10.5395/rde.2025.50.e25; Funded: Coordination for the Improvement of Higher Education Personnel, São Paulo Research Foundation

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Endodontic retreatment aims to address treatment failure through the removal of root canal filling materials. This in vitro study evaluated the presence of filling material remnants in the mesial root canals, specifically focusing on the isthmuses, of mandibular molars after retreatment.
Methods
One hundred extracted mandibular molar mesial roots with isthmuses were prepared with an R25 file, obturated with one of five calcium silicate-based sealers (BioRoot RCS [Septodont], MTApex [Ultradent Products Inc.], EndoSequence BC Sealer HiFlow [Brasseler USA], Bio-C Sealer [Angelus]) or an epoxy resin-based sealer (AH Plus Jet [Dentsply Maillefer]), all stained with rhodamine B, and stored at 37ºC for 30 days to allow for setting. Retreatment was subsequently performed using R40 and XP-endo Finisher R instruments (FKG Dentaire) with 2.5% sodium hypochlorite irrigation. The presence of remaining filling material was then assessed using confocal microscopy, and setting times were tested per ISO 6876:2012.
Results
AH Plus Jet showed the most remnants at 2 mm and the longest retreatment time. Calcium silicate-based sealers exhibited prolonged setting times under dry conditions, with EndoSequence BC Sealer HiFlow showing a particularly extended setting period.
Conclusions
Despite retreatment, residues remained in all canals and isthmus regions, particularly Bio-C Sealer and AH Plus Jet in apical areas, emphasizing the difficulty of complete removal and the persistence of filling material.

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Does the use of different root canal sealers and adhesive resin cements impact the bond strength of glass fiber posts?: Ália Regina Neves de Paula Porto, Rudá França Moreira, Felipe Gonçalves Belladonna, Victor Talarico Leal Vieira, Emmanuel João Nogueira Leal da Silva; Restor Dent Endod 2025;50(3):e29. Published online August 29, 2025; DOI: https://doi.org/10.5395/rde.2025.50.e29; Funded: CAPES (n.001), CNPq and FAPERJ

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This study aimed to assess the influence of two endodontic sealers on the bond strength of glass fiber posts using conventional and self-adhesive resin cement through a push-out test. Methods: Forty central human incisors were randomly divided into four groups (n = 10) based on sealer (epoxy resin- based or calcium silicate-based) and cement (conventional and self-adhesive resin) types: AH Plus (Dentsply De- Trey)/RelyX ARC (3M ESPE), AH Plus/RelyX U200 (3M ESPE), Bio-C Sealer (Angelus)/RelyX ARC, and Bio-C Sealer/RelyX U200. After canal filling and post cementation, roots were sectioned to obtain one specimen per root third. A pushout test and failure pattern assessment were conducted, with bond strength analyzed using the one-way analysis of variance and Tukey test. Results: AH Plus/RelyX ARC showed the highest bond strength values, with a significant difference in the middle third. The most common failure was mixed (55%), while adhesive failures made up 45%, with 23.5% at the cement/post interface and 21.5% at the cement/dentin interface. Conclusions: AH Plus/RelyX ARC provided the highest bond strength values for glass fiber posts to dentin.

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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

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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

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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

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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.

Citations

Citations to this article as recorded by

Assessment of radiographic errors and repetition rates in undergraduate endodontic education: a retrospective clinical study
Marwa Ameen, Abdul Rahman Saleh, Dunia Alhadi, Manal Almaslamani
The Saudi Dental Journal.2025;[Epub] CrossRef
Application of Periapical Radiography in Root Canal Treatment: A Literature Review
Jennifer Lois Violita Malau, Keizha Allysia Nabila, Widiani Harrista, Regina Amara Ginting, Tassa Kusuma Arya Putri, Jatu Rachel Keshena
Acta Odontologica Indonesia.2025; 1(2): 49. CrossRef

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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

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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

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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.

Citations

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Surgical Management of a Separated Instrument and Radicular Cyst: A Nine-Month Cone Beam Computed Tomography (CBCT) Follow-up
Dipti Chauhan, Hemant Yadav, Anshu Minocha, Vishal Sharma
Cureus.2025;[Epub] CrossRef

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