Odontologia

Effect of root canal filling techniques and materials on endodontic treatment outcomes: a systematic review and meta-analysis

2026-05-06T02:00:46Z

Effect of root canal filling techniques and materials on endodontic treatment outcomes: a systematic review and meta-analysis Mushtaq, Ahmed; Alsanafi, Sura; Elmsmari, Firas; Gonzalez Sanchez, Jose Antonio; Garcia Font, Marc; Abella Sans, Fransesc; Afrashtehfar, Kelvin Ian; Abbott, Paul Root canal filling is a critical determinant of endodontic treatment success, yet limited evidence exists regarding the superiority of specific techniques or materials over others. This systematic review and meta-analysis compared the clinical and radiographic outcomes of different root canal obturation techniques and materials in primary treatments and retreatments. We systematically searched PubMed, Cochrane Library, and ScienceDirect up to the last week of November 2025 following PRISMA guidelines. Studies were included if they reported primary or retreatment outcomes with at least 6 months of follow-up, < 25% loss to follow-up, and explicit documentation of obturation techniques and clinical/radiographic success. Risk of bias was assessed with ROBINS-I (cohort studies) and RoB 2.0 (randomized studies), and the overall evidence certainty was rated using GRADE. Success rates were compared across techniques using mixed-effects meta-regression, estimating differences in outcomes (beta coefficients) with 95% confidence intervals and accounting for between-study heterogeneity. Eighty-four studies (11,965 samples) met all inclusion criteria. In primary treatments, overall success rates were 87.1% at 6 months and 87.2% at 12 months, without significant differences among techniques. At 24 months, success increased to 92.0%; cold lateral condensation (CLC) (difference: 5.0%, p = 0.021) and carrier-based (CB) techniques (difference: 7.5%, p = 0.011) showed higher success than single-cone (SC). Beyond 3 years, success decreased to 84.9%, with no statistically significant differences among warm vertical compaction (WVC), warm lateral compaction (WLC), CLC, SC, and CB techniques. In retreatments, success rates were 92.9% at 6 months, 77.0% at 12 months, and 83.5% at 24 months. At 12 months, SC showed a marginally higher success than CLC (p = 0.045), while at 24 months, CB significantly outperformed WVC (p = 0.004). Beyond 3 years, success decreased to 73.7%, with no significant differences between CLC and CB techniques. Overall, primary treatments presented higher success than retreatments. At 24 months, CLC and CB techniques showed modest advantages, which were not maintained at longer follow-ups. Success appears multifactorial, with operator expertise and case selection having greater impact than obturation technique. The overall certainty of evidence remained low to very low, particularly for long-term outcomes. Bioceramic sealers used with SC techniques have not demonstrated clear clinical benefits or improved retreatment outcomes. High heterogeneity and risk of bias suggest a need for well-powered, multicenter, long-term randomized trials with standardized outcome reporting to establish clinical standards (PROSPERO registration: CRD42024524608).

Postoperative complications at the palatal donor site following autologous soft tissue grafting: a systematic review

2026-04-28T02:00:52Z

Postoperative complications at the palatal donor site following autologous soft tissue grafting: a systematic review Figueras, Oscar; Quispe-López, Norberto; MONTERO, JAVIER; LÓPEZ-VALVERDE, N.; Flores Fraile, Javier This systematic review analyzes postoperative complications at the palatal donor site following the harvesting of autologous soft tissue grafts in periodontal surgery. Although these grafts remain the clinical reference standard due to their effectiveness, their harvesting may be associated with donor-site morbidity, including pain, bleeding, partial necrosis, and sensory disturbances. A comprehensive search was conducted in PubMed, Scopus, and Web of Science, identifying 16 clinical studies published between 2019 and April 2025. The included studies comprised randomized controlled trials, prospective and retrospective clinical studies, and case series, with sample sizes ranging from 6 to 89 participants. Due to heterogeneity in study designs, outcome measures, and follow-up protocols, a qualitative synthesis was performed and a quantitative meta-analysis was not feasible. Postoperative pain was the most frequently reported complication and was commonly assessed using the Visual Analog Scale (VAS), although other instruments such as the Numeric Rating Scale (NRS) were also used. Several adjunctive strategies, including palatal stents, hyaluronic acid, platelet-rich fibrin (PRF), mucoadhesive dressings, and low-level laser therapy (LLLT), were reported to be associated with lower postoperative discomfort and favorable healing patterns. Bleeding was reported less frequently and was generally self-limiting, particularly when local hemostatic measures were applied. Sensory disturbances were typically mild and transient, resolving during routine follow-up. No serious infections or complications compromising patient health were reported. In conclusion, while morbidity at the palatal donor site is relatively common, it is generally mild and manageable. Certain adjunctive measures may help reduce postoperative discomfort and support healing; however, the overall strength of the available evidence remains moderate. These findings may help improve postoperative recovery and inform future clinical research.

Guided Cavity Preparation to Access an Invagination and Preserve Pulp Vitality of an Immature Maxillary Lateral Incisor With Type IIIa Dens Invaginatus: Technical Overview and a Case Report With 3-Year Follow-Up

2026-03-25T10:29:04Z

Guided Cavity Preparation to Access an Invagination and Preserve Pulp Vitality of an Immature Maxillary Lateral Incisor With Type IIIa Dens Invaginatus: Technical Overview and a Case Report With 3-Year Follow-Up Abella Sans, Fransesc; Nagendrababu, Venkateshbabu; Suresh, Nandini; Garcia Font, Marc; Dummer, Paul Aim: Dens invaginatus (DI) is a developmental anomaly often associated with caries and periapical pathosis. This report de-scribes guided access and filling of an infected invagination in a maxillary lateral (tooth #22) with long-term preservation of pulpvitality.Summary: A 9-year-old male presented with a palatal sinus tract associated with immature tooth 22. Based on clinical andradiographic examination, a type IIIa DI with a pseudo-foramen midway along the mesial aspect of the root was identified. Thetooth had a healthy pulp and peri-invagination periodontitis. A guided endodontic cavity was prepared to selectively access theinvagination without compromising the pulp and the invagination filled with a bioceramic calcium silicate–based material. At36 months the tooth was asymptomatic, and the pulp tested positive. Radiographically, root development was complete with bonyhealing of the lesion. This case report highlights the effectiveness of guided cavity preparation to access an invagination in animmature tooth with DI while preserving pulp vitality.

Evaluating Guideline Adherence in Gemini-Powered Dental Trauma Workflows: Standalone Gemini Chat vs. Document-Grounded NotebookLM

2026-03-25T10:51:05Z

Evaluating Guideline Adherence in Gemini-Powered Dental Trauma Workflows: Standalone Gemini Chat vs. Document-Grounded NotebookLM Dufey Portilla, Nicolás Armando; Abella Sans, Fransesc; Durán-Sindreu Terol, Fernando Salvador; Salagaray, Maite; Nagendrababu, Venkateshbabu; Abbott, Paul V.; Levin, Liran; Garcia Font, Marc Aim: The aim of this study was to compare the accuracy and inter-account consistency of two Google Gemini–powered, user-facing workflows for dental trauma decision support: standalone Gemini chat and NotebookLM, a document-grounded workflow that generates responses grounded in uploaded European Society of Endodontology and International Association of Dental Traumatology guideline documents, when answering dichotomous (yes/no) clinical questions on the management of traumatized permanent teeth. Methodology: A cross-sectional simulation was conducted using 99 dichotomous (yes/no) questions derived from the European Society of Endodontology and International Association of Dental Traumatology guidelines. Three academic endodontists submitted each question to Gemini and NotebookLM using three independent Google accounts, generating 297 responses per workflow. Accuracy was defined as exact agreement with guideline-based answers, and consistency as the proportion of identical responses across the three trials. Statistical analyses included Wald and Wilson 95% confidence intervals, Fleiss' kappa for inter-account agreement, and Pearson's chi-squared tests to compare proportions. Results: Gemini demonstrated an overall accuracy of 83.83% (95% CI: 75.08–90.47) and a consistency of 74.74% (κ = 0.84).NotebookLM showed higher accuracy (92.93%; 95% CI: 85.97–97.11) and perfect consistency (100%; κ = 1.00). While the difference in accuracy did not reach statistical significance (p = 0.076), NotebookLM exhibited significantly greater consistency(p < 0.001). Conclusions: The responses generated from the guidelines were highly consistent with both workflows. Document groundingmay enhance repeatability and alignment with guideline-derived decision points for structured dichotomous inquiries, as evidenced by NotebookLM's ability to achieve complete inter-account consistency and to quantitatively increase accuracy. Theseresults are the outcome of workflow-level benchmarking; therefore, clinical utility cannot be inferred solely from them; professional oversight and additional validation remain necessary before any clinical application. The author, N. Dufey-Portilla, thanks the National Agency for Researchand Development (ANID) for its support through the DOCTORADOBECAS CHILE/2025 - 72250040 Scholarship Program.