10.5577/intdentres.468
Vol. 16 (2026) Continuous Publication
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Review
6 Items
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Endocrown restorations: A review
With advances in adhesive dentistry, endocrowns have emerged as a minimally invasive alternative to traditional methods for restoring endodontically treated teeth with severe tooth structure loss. Unlike traditional post applications, endocrowns are monoblock restorations anchored in the pulp chamber and the remaining coronal tooth tissue. The aim of this review is to evaluate the biomechanical properties, clinical performance, and key factors affecting the success of endocrown restorations in light of the current literature. While traditional post-core applications can weaken the tooth structure and increase the risk of root fractures, endocrowns offer advantages such as lower cost, shorter preparation time, and maximum preservation of tooth tissue. The literature reports that endocrowns exhibit excellent survival rates and adequate clinical performance in molar teeth. However, the higher non-axial (horizontal/lateral) forces and narrower bonding surfaces encountered in premolar and anterior teeth can increase the risk of restoration failure. One of the most important factors affecting clinical success is the preparation design. For optimal retention, the central retention cavity should have a minimum depth of 3 mm and a cervical margin width of at least 2 mm. Adding a ferrule, short axial walls, and a shoulder/chamfer finish line to the restoration design significantly increases fracture resistance. Furthermore, the application of immediate dentin sealing (IDS) protocols improves dentin bond strength and minimizes the risk of debonding. During fabrication, direct methods using composite resins can be used, or indirect methods using CAD/CAM technology with materials such as lithium disilicate, zirconia-reinforced ceramics, polymer-infiltrated ceramic networks (PICN), or PEEK can be preferred. Provided that appropriate cavity design, bonding surface, and material selection are ensured, endocrowns can perform similarly to, or better than, conventional treatments such as inlays/onlays, post-core restorations, or direct composite restorations. As a promising alternative for restoring heavily damaged, endodontically treated teeth, further long-term clinical studies are needed to confirm their overall suitability.Endocrown, endodontically treated teeth, Computer-Aided Design/Manufacturing, CAD/CAM, lithium disilicate, PEEK, dental materialsDersim Gökce, Emrah Ayna195-202 -
Irrigation activation methods in endodontics: A comprehensive review
In contemporary endodontics, the core objective is to thoroughly cleanse and disinfect the root canal system. While shaping the canals is an important step, it alone is not sufficient. Successful treatment relies on a combined chemo-mechanical approach, which ensures the removal of organic tissue remnants, microbial contaminants, and their by-products from within the canal space. In this context, flushing the root canals with appropriate irrigation solutions is of great importance. The irrigation solutions used play a critical role in dissolving both organic and inorganic tissues and reducing the microbial load. However, the effect of irrigation can be further enhanced by actively circulating and agitating the solution within the canals. For this reason, activation methods such as ultrasonic or sonic activation systems, negative pressure irrigation techniques, and laser-assisted methods have become widely used in treatment protocols in recent years. In short, successful endodontic treatment is not only achieved by shaping the canal; it is also possible through the correct selection of irrigation solutions, sufficient duration of use, and effective activation. Once these procedures are properly carried out, the root canal system becomes more effectively disinfected, which in turn enhances the likelihood of achieving a successful long-term treatment outcome. This article comprehensively evaluates the activation devices used in today's endodontic practices and the new systems recently introduced to the market in terms of their advantages and limitations. Furthermore, current activation techniques are discussed comparatively, and their contributions to clinical practice and differences in use are debated.Endodontic, irrigation activation, sonic irrigation, passive ultrasonic irrigation, EndoActivator, EasyClean, Ultra XMakbule Taşyürek, Özkan Adıgüzel92-115 -
Laser systems and current applications in endodontics: A review
Laser technology has gained increasing attention in endodontics due to its potential to enhance disinfection, improve treatment outcomes, and support minimally invasive clinical approaches. The aim of this review was to provide a comprehensive overview of commonly used laser systems in endodontics and to summarize their current clinical applications. Various laser types, including carbon dioxide (CO₂), diode, neodymium-doped yttrium aluminum garnet (Nd:YAG), neodymium-doped yttrium aluminum perovskite (Nd:YAP), erbium-doped yttrium aluminum garnet (Er:YAG), and erbium chromium-doped yttrium scandium gallium garnet (Er,Cr:YSGG), have been evaluated in terms of their mechanisms of action and clinical effectiveness. Lasers are used in multiple endodontic procedures, such as root canal disinfection, smear layer removal, pulp capping, pulpotomy, dentin hypersensitivity management, and treatment of pulp and periapical pathologies. In particular, laser-activated irrigation techniques, including photon-induced photoacoustic streaming (PIPS) and shock wave–enhanced emission photoacoustic streaming (SWEEPS), have shown promising results in improving irrigation efficacy and bacterial elimination, especially in complex root canal anatomies. Compared with conventional irrigation methods, these advanced laser techniques enhance the penetration of irrigants into dentinal tubules while minimizing thermal damage to surrounding tissues. Erbium lasers, owing to their high water absorption and photoacoustic effects, appear to be especially effective for smear layer removal and biofilm disruption. Other laser systems, such as diode and Nd:YAG lasers, also contribute to antimicrobial activity and postoperative pain reduction when used appropriately. However, laser parameters, irradiation time, and safety considerations remain critical for successful clinical outcomes. In conclusion, laser systems offer significant advantages in endodontic therapy by improving disinfection, supporting tissue preservation, and enabling minimally invasive techniques. Further well-designed clinical studies are needed to strengthen the evidence regarding their long-term efficacy, safety, and optimal clinical protocols.Laser, endodontics, CO₂, Nd:YAG, Nd:YAP, Er:YAG, Er,Cr:YSGG, PIPS, SWEEPSMakbule Taşyürek, Özkan ADIGÜZEL116-122 -
Ozone applications in dentistry: A review
Ozone (O 3 ) therapy has been applied in medicine and dentistry for many years and has become increasingly widespread. Ozone, composed of three oxygen atoms (O 3 ), is a strong antioxidant and a highly effective antimicrobial agent. Ozone gas has high oxidizing properties and exhibits a 1.5-fold higher antimicrobial effect than chloride. Its use has become popular in many fields of dentistry in recent years, owing to its various properties. It is categorized as one of the non-invasive, atraumatic, protective, and preventive treatment modalities that have been improved by modern dentistry, and its acceptability among patients has increased as a result. Ozone is an antimicrobial, analgesic, and biosynthetic agent that stimulates the immune system, enhances blood circulation capacity, and positively affects oxygen transport mechanisms. It influences both cellular and humoral immunity. All three forms of ozone (gaseous, oil, and solution) can be used in dentistry. It is indicated for the treatment of approximately 300 different pathological conditions. Ozone is used in endodontics (irrigation solution, intracanal medicament, abscess cases, disinfection), periodontology (gingivitis, periodontitis, periimplantitis, surgical injuries, prophylaxis), oral pathology (stomatitis, aphthous ulceration, candidiasis, herpes lesions), oral, dental, and jaw surgery (implantation, reimplantation, simple-to-complicated tooth extraction, homeostasis, wound healing, temporomandibular joint (TMJ) surgery, osteonecrosis cases), prosthetic dental treatment (disinfection of fixed and removable prostheses), restorative dental treatment (caries lesions, dentine hypersensitivity, cracked tooth, bleaching), orthodontics (remineralization and prophylaxis of white spot lesions), pedodontics (caries lesions, root canal treatment, positive psychological impact, short treatment duration), and sterilization of dental instruments and units. This review aimed to describe the usage fields and effects of ozone in dental applications, provide insights into clinical practices in other fields of dentistry, and introduce newly conducted in vitro and in vivo studies.Ozone, ozone therapy, dentistry, disinfectionMerve Doğan İlik, Özkan Adıgüzel, Myroslav Goncharuk-Khomyn222-236 -
Regenerative endodontics: A review
Oral health and function are critical components of a patient's overall quality of life. Pulp necrosis in immature permanent teeth, resulting from trauma, caries, or developmental anomalies, presents a significant clinical challenge. Traditionally, apexification has been the routine treatment; however, it fails to promote continued root development, often leaving teeth brittle and susceptible to fractures. This review examines regenerative endodontic procedures (REPs), which represent a paradigm shift toward biologically based treatments designed to replace damaged structures and cells of the pulp-dentin complex. The success of REPs relies on the interaction of three key components: stem cells, bioactive molecules (growth factors), and scaffolds. During these procedures, a blood clot is typically induced to act as a scaffold, facilitating the influx of undifferentiated stem cells, such as stem cells of the apical papilla (SCAPs). The review details current clinical protocols recommended by the American Association of Endodontists (AAE) and the European Society of Endodontology (ESE). Key technical aspects include the use of low-concentration sodium hypochlorite (1.5%) to maintain cell viability and EDTA to promote the release of growth factors from the dentin matrix. Intracanal medicaments, specifically triple antibiotic paste (TAP) and calcium hydroxide, are evaluated for their disinfection efficacy and impact on stem cell survival. While REPs demonstrate high success rates in terms of symptom resolution and apical healing, histological evidence suggests the resulting tissue is often a repair (bone or cementum-like) rather than true pulpal regeneration. Despite these challenges, REPs offer a promising therapeutic pathway for increasing root length and wall thickness, ultimately enhancing the long-term retention of immature permanent teeth.Regenerative endodontics, pulp revitalization, immature permanent teeth, Stem Cells of the Apical Papilla, SCAP, tissue engineering, triple antibiotic paste, root development, scaffoldsTolga Han Edebal, Gülşen Edebal203-221 -
Use of novel polyetheretherketone (PEEK) polymer in pediatric dentistry
The purpose of this study is to discuss the applications of PEEK in pediatric dentistry and the advantages of PEEK material in terms of periodontal health. In pediatric dentistry, there is a continuous search for biocompatible, esthetic, and durable materials to overcome the limitations of conventional options such as stainless steel and zirconia. Polyetheretherketone (PEEK), a high-performance semicrystalline polymer, has emerged as a novel alternative due to its superior mechanical properties, resistance to heat and chemicals, and an elastic modulus comparable to human bone. This review aims to evaluate the material characteristics of PEEK, its impact on periodontal health, and its clinical applications within pediatric dentistry. PEEK is amenable to digitalization and can be fabricated using CAD/CAM milling and 3D printing, ensuring precise fit and patient comfort. In pediatric orthodontics and space maintenance, PEEK serves as an esthetic, metal-free alternative, eliminating risks of nickel allergy while providing high strength and significantly reduced weight compared to traditional appliances. For restorative procedures, PEEK is utilized in crowns, endocrowns, and post-core systems. Its shock-absorbing capability allows for favorable stress distribution in dentin, reducing the risk of root fractures often associated with rigid materials like metal or glass fibers. Additionally, its low specific gravity and biocompatibility make it an effective material for obturators in treating cleft lip and palate defects. Regarding periodontal health, polished PEEK surfaces demonstrate low plaque affinity and acceptable surface roughness, supporting gingival health. PEEK offers distinct advantages in pediatric dentistry, particularly for patients requiring metal-free, lightweight, and shock-absorbing restorations. While it presents a promising alternative to traditional materials, achieving durable adhesion requires specific surface treatments, and further prospective clinical studies are warranted to validate its long-term performance.PEEK, pediatric dentistry, space maintainers, biocompatibility, CAD/CAM, periodontal health, dental applicationSemih Ercan Akgün, Şemsettin Yıldız, Samet Tekin85-91
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