Thai Endodontic Journal

Retreatment Challenges and Removal Strategies for Hydraulic Calcium Silicate–Based Root Canal Sealers: A Review

Kitichai Singharat — 2025-12-19

Hydraulic calcium silicate sealers (HCSs) are increasingly used in endodontics for their bioactivity, alkaline pH, calcium release, dentin bonding, and biocompatibility. While beneficial in primary treatment, these properties complicate nonsurgical retreatment, where effective removal of filling materials is required for disinfection and healing. HCSs become progressively harder and strongly bonded to dentin, and no reliable solvents exist for their dissolution. Nickel–titanium (NiTi) rotary and reciprocating instruments remain the primary tools. Heat-treated rotary files and reciprocating systems, such as Reciproc Blue and WaveOne Gold, improve efficiency but cannot fully eliminate remnants, especially in the apical third. Solvents such as chloroform, formic acid, hydrochloric acid, and citric acid have demonstrated variable efficacy, accompanied by concerns regarding dentin erosion and inconsistent clinical outcomes. Adjunctive methods enhance removal. Passive ultrasonic irrigation, sonic devices, and advanced ultrasonics improve irrigant dynamics. Shape-memory instruments (XP Finisher) and laser-assisted photoacoustic streaming (PIPS, SWEEPS) achieve superior cleaning in complex morphologies but still leave residual material. Complete removal of HCSs remains unachievable, with apical remnants the main limitation. Integration of mechanical, chemical, and supplemental techniques maximizes removal and supports periapical healing.

Cemental Tear: A Comprehensive Literature Review of Etiology, Diagnosis and Management

Apichada Jayema — 2025-12-19

Cemental tear is a pathological condition characterized by the separation of cementum from the dentin at the cemento-dentinal junction (CDJ). This condition is often overlooked and misdiagnosed due to its non-specific symptoms, such as rapid periodontal attachment loss, localized deep periodontal pockets, and persistent sinus tracts despite appropriate periodontal and/or endodontic treatment. Diagnosis with conventional 2D radiography can be difficult and may lead to confusion with other conditions. However, the detection rate of this condition has increased, possibly due to the growing use of Cone Beam Computed Tomography (CBCT). Therefore, the objective of this literature review is to review the relevant literature on the etiology, diagnosis, and management of cemental tear to provide a better understanding and enable clinicians to apply this knowledge in their clinical practice.

Retreatment of Root Canals Obturated with Bioceramic Sealer: Concept and Techniques

Kittayanan Kasa — 2025-12-19

The success rate of conventional root canal treatment is high; however, some cases fail and require root canal retreatment.
Currently, the clinical use of bioceramic sealers has increased due to their favorable physicochemical properties, particularly their
sealing ability. However, they present greater challenges when retreatment is required.
This review article summarizes current strategies and techniques for retreatment of canals previously obturated with
bioceramic sealers, including the use of solvents and supplementary equipment. The combined use of different methods
enhances debridement, minimizes residual obturation material, and may improve the likelihood of successful retreatment.
Keywords: endodontic retreatment, bioceramic sealer, solvents, nickel–titanium rotary files, ultrasonics, supplementary irrigation

Cold hydraulic condensation (sealer-based) root canal obturation: what are the differences in clinical techniques from the traditional obturation?

Danuchit Banomyong — 2025-12-19

Recently, a calcium silicate-based root canal (CSRC) sealer has been introduced. CSRC sealer is designed for a special obturation technique by using it as a main obturation material in root canals, namely cold hydraulic condensation (CHC) or sealer-based root canal obturation. The obturation techniques of CHC using CSRC sealer are different from that of traditional obturation. In particular, more conservative root canal preparation, single matched main cone, final rinse with normal saline solution or distilled water, moist canals before obturation, creating gutta-percha plug at the orifice, cleaning the sealer using sponge or micro-brush followed by irrigation, and delaying post-space preparation are described.

Statistics in Endodontics Part 4: Comparing Means—Basic Statistical Tests in Endodontics

Sittichoke Osiri — 2025-12-19

Appropriate statistical test selection is essential for valid conclusions in endodontic research and evidence-based clinical practice. This article provides a comprehensive guide to parametric and non-parametric tests for comparing means, emphasizing the critical importance of verifying statistical assumptions before analysis. The review covers fundamental assumptions—continuous dependent variables, independence of observations, normal distribution, homogeneity of variances, and absence of outliers—with practical methods for assessment
using visual inspection and numerical tests. Parametric tests discussed include One-Sample t-test, Independent Samples t-test, Paired Samples t-test, One-Way ANOVA, and One-Way Repeated Measures ANOVA, with detailed guidance on post-hoc testing procedures for
multiple comparisons. When parametric assumptions are violated, non-parametric alternatives are presented with corresponding post-hoc procedures. A decision framework guides test selection based on research design, data characteristics, and assumption verification. Each test includes specific assumptions, hypotheses, and practical examples from endodontic research. Understanding and correctly applying these principles enhances research reliability, reduces statistical errors, and promotes evidence-based clinical decision-making in endodontics.

Evaluating Sixth-Year Dental Students’ Performance and Preference Using NiTi Rotary Systems: A Comparative Analysis of ProTaper Gold and WaveOne Gold in Educational Settings

Pornpirat Chanchalermchai — 2025-12-19

Objective: Nickel-titanium (NiTi) rotary systems, such as ProTaper Gold (PTG) and WaveOne Gold (WOG), are widely used for root canal shaping due to their flexibility and efficiency. PTG operates in continuous rotation, while WOG uses reciprocation, potentially influencing their suitability for inexperienced operators like dental students. This study compared the performance and user preferences of PTG and WOG systems on molars among sixth-year dental students during their first experience with rotary endodontics.

Materials and Methods: A total of 98 sixth-year dental students were randomly divided into four groups using stratified randomisation based on hand instrument preparation scores. Each student prepared one maxillary and one mandibular molar using either PTG or WOG, with a randomised working sequence. Root canal preparation quality was evaluated using requirement books and radiographic analysis, focusing on procedural errors such as inadequate master apical file (MAF) size, inadequate MAF length, loss of apical stop, ledging, canal deviation, zipping, perforation, and instrument separation. Students also completed a questionnaire to evaluate their perceptions of the systems.

Results: No significant differences were observed in procedural error rates between PTG (82.7%) and WOG (88.8%). The most common error for both systems was inadequate MAF length. Students rated PTG significantly higher in controllability, with 61.2% preferring it over WOG. This preference was attributed to its ease of use, superior tactile control, and continuous rotation motion.

Conclusion: Both PTG and WOG systems demonstrated similar performance in procedural error rates during root canal preparation by novice operators in a preclinical setting. However, PTG was preferred by students due to its superior controllability, obturation ease, and higher screwing effect.