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The immune system is an extremely complex biological network that plays a crucial role in the hemostasis of periapical tissue, pathogenesis of apical periodontitis (AP), and periapical tissue healing. The successful elimination of microbial infections remains a significant challenge, mostly because of the ever-growing development of antimicrobial-resistant pathogens. The bacterial endurance in the root canal system contributes to features ranging from altered posttreatment healing to exacerbation of chronic periradicular immune response, which compromise the outcome of endodontic treatment. A highly effective strategy for combating infectious diseases and the associated inflammation-mediated tissue damage is to modulate the host immune response in conjunction with antimicrobial therapy. There are several medications currently used in endodontic treatment; however, they suffer various levels of microbial resistance and do not deliver all the required characteristics to simultaneously address both intracanal bacteria and periapical inflammation. The interaction of antimicrobial agents with the immune system can impact its function, leading to immune-suppressive or immune-stimulatory effects. The group of nonconventional antimicrobial medications, such as antimicrobial peptides, propolis, and nanomaterials, are agents that provide strong antimicrobial effectiveness and concomitant immunomodulatory and/or reparative effect without any host tissue damages. In this review, we provide an overview of local immune modulation in AP and a comprehensive review of the immunomodulatory effect of antimicrobial intracanal medications applied in endodontics with specific emphasis on the antimicrobial nanomaterial-based approaches that provide immunomodulatory potential for successful clinical deployment in endodontics.

Background/Aim. Chronic microbial infections of the root canal are a common issue. This process very often causes an immune reaction in the root canal system that results in forming of chronic periapical lesions (PLs). The aim of this study was to determine the quantitative expression of the bacterial heat shock protein (HSP), chaperonin 60 (cpn60), and the pro-inflammatory and anti-inflammatory cytokines in periapical tissue obtained from individuals with chronic PLs and to determine if there is a correlation between the expression of the bacterial HSP and the expression of these cytokines. Methods. The study was performed on 18 PLs and 6 control samples of healthy periapical tissue, taken at the Department of Dentistry, Faculty of Medicine, University of Pristina/Kosovska Mitrovica. The levels of messenger ribonucleic acid (mRNA) expression of pro- and anti-inflammatory cytokines and bacterial HSP were determined by quantitative real-time polymerase chain reaction (RT-PCR) and quantified by comparing to the internal control gene for glyceraldehyde 3-phosphate dehydrogenase (GAPDH). Results. Analysis revealed significantly higher mRNA levels of tumor necrosis factor-alpha (TNF-a) and cpn60 in the tissue of PLs compared with normal periapical tissue (p < 0.05). Contrary to these results, the mRNA expression of anti-inflammatory interleukin-10 (IL-10) was significantly higher in the samples of normal periapical tissue compared with the mRNA levels of this cytokine in the tissue of PLs (p < 0.001). Expression of cpn60 is in strong correlation with TNF-a expression in PLs. Conclusion. cpn60 released from bacteria in periapical tissue could be a strong stimulator of inflammatory response and one of the important players in the pathogenesis of PLs.

Although epigallocatechin-3-gallate (EGCG) from green tea has been successfully used in the prevention and treatment of several infectious and immunoinflammatory diseases because of its proven anti-inflammatory, antioxidant, antimicrobial, and antiresorptive role, its use as an intracanal dressing has not been proposed. The aim of this study was to develop a formulation based on EGCG for endodontic use by assessing its physicochemical and biological properties.Initially, physicochemical characterization of EGCG was performed by ultraviolet-visible and fluorescence spectroscopy to evaluate if the properties were maintained in acidic pH and time (1-6, 24, and 27 hours). After that, biological studies evaluated the developed formulation of EGCG at different concentrations (1.25, 5, 10, and 20 mg/mL). The tissue compatibility with subcutaneous tissue of mice was evaluated by plasma leakage after 24 hours and the examination of macroscopic and microscopic features at 7, 21, and 63 days after the insertion of polyethylene tubes containing the formulations. The repair of experimentally induced periapical lesions in dog's teeth by radiographic and histopathologic analysis was also evaluated. The scores were statistically analyzed by the chi-square and Fisher exact test. Analysis of variance followed by the Tukey posttest were used for the quantitative analysis. The significance level was 5%.The physicochemical characterization performed under ultraviolet-visible spectrophotometry showed that the EGCG properties remained unaltered in acid pH and function of time, keeping its wavelength to 274 nm. Macroscopic parameters evaluated at 7, 21, and 63 days showed that all concentrations presented no epithelial ulceration or presence of mild superficial tissue necrosis, edema, or vascularization with no significant difference in the control group. During all periods of microscopic examination, all groups presented the absence of abscess foci and edema and the presence of fibrous capsule and neovascularization. The presence of reparative tissue with a gentle presence of neutrophilic inflammatory cells was also observed for all groups, except for the calcium hydroxide paste group, which presented a more pronounced inflammation and tissue necrosis at days 7 and 21 (P .001). At day 63, all groups presented an absence of inflammatory infiltrate and necrosis. The evaluation of dog teeth showed that treatment with the EGCG formulation provided a reduction of the periapical radiolucent area and allowed the repair of apical and periapical tissues (P .05).The developed formulation based on EGCG from green tea presented physicochemical stability and tissue compatibility and provided the repair of periapical lesions when used as an intracanal dressing.

The epidemiological aspects of endodontics in comparison with the epidemiology of caries have been insufficiently studied, especially in our country. Aim. The purpose of this work is to assess the endodontic status of patients depending on the level of dental caries resistance. Material and methods. We, based on clinical observations, put forward an assumption about the relationship between the frequency and nature of complications of caries and the level of their resistance to disease according to Nedosenko V.B. The subject of our study was to test this assumption on factual material. The materials of the study were medical documents of 292 patients treated for diseases of the periapical tissues. Orthopantomograms of these patients were analyzed. Methods of statistical analysis were used for assessments and conclusions: Kullback's information statistics and the difference method. Results. When considering the relationship between complications of caries and levels of resistance, an inverse relationship was found, that is, among persons with an average level of dental resistance to caries, the frequency of complicated forms is much lower than among persons with low and very low (p < 0.001). Most often, diseases of the periapical tissues with a destructive process in the periodontium occurred in persons with a low level of resistance. The frequency of diagnostics of destructive periodontitis arising without endodontic treatment and periodontitis arising after endodontic treatment in patients with an average level of resistance is lower than in patients with a low level of resistance. Discussions. The lower the level of resistance of teeth to caries, the more often untreated periodontitis is detected, more often destructive periodontitis occurs as an outcome of endodontic treatment for pulpitis. Conclusions. The data we have obtained allow us to increase the effectiveness of caries treatment, taking into account the level of tooth resistance.

The regenerative endodontic procedure (REP) represents a treatment option for immature necrotic teeth with a periapical lesion. Currently, this therapy has a wide field of pre-clinical and clinical applications, but no standardization exists regarding successful criteria. Thus, by analysis of animal and human studies, the aim of this systematic review was to highlight the main characteristics of the tissue generated by REP. A customized search of PubMed, EMBASE, Scopus, and Web of Science databases from January 2000 to January 2022 was conducted. Seventy-five human and forty-nine animal studies were selected. In humans, the evaluation criteria were clinical 2D and 3D radiographic examinations. Most of the studies identified a successful REP with an asymptomatic tooth, apical lesion healing, and increased root thickness and length. In animals, histological and radiological criteria were considered. Newly formed tissues in the canals were fibrous, cementum, or bone-like tissues along the dentine walls depending on the area of the root. REP assured tooth development and viability. However, further studies are needed to identify procedures to successfully reproduce the physiological structure and function of the dentin–pulp complex.

Semaphorin 4D (SEMA4D) is an important immunoregulator in the development of inflammatory diseases. Currently, the role of SEMA4D in human apical periodontitis remains unclear. This study aims to investigate the expression of SEMA4D and its potential immunomodulatory roles in apical periodontitis.A total of 31 periapical tissues and 6 healthy gingival tissues were used in this experiment. Hematoxylin-eosin staining, immunohistochemical staining, and multiplex immunofluorescence staining were performed for histologic examination and immunochemical analysis. For data processing, the number of SEMA4DRadicular cysts (RCs) (n = 18) and periapical granulomas (PGs) (n = 13) were identified by histologic evaluation. The number of SEMA4DThe expression of SEMA4D and related immune cells showed different characteristics between RCs and PGs. The disparate expression patterns indicated the possible different pathologic states of the 2 types of periapical lesions. This study provides a new perspective on the description of the comprehensive microenvironment of periapical lesions.

Objective: To investigate the implication of quality of obturation and coronal restoration on periapical tissue in failed endodontically treated teeth. Study Design and Setting: This cross-sectional research was performed in the Operative Department of BUMDC on 187 patients reporting with root canal failure from March 2019 to August 2019. Methodology: Patients of both genders aged between 20-60 years were considered for this study. Single and multirooted teeth indicated for repeated endodontic treatment due to under filled, overfilled obturation, voids in obturation, absence and presence of coronal restoration were included. One operator carried out clinical examination of the teeth and periapical radiograph was taken for each patient by using E-Speed film and evaluated by the same operator using an illuminated viewer box. SPSS 17 for windows software was used for data entering and chi- square test was applied for statistical calculation of the outcomes. Results: Total n=187 endodontic treated failed teeth were evaluated, out of which 52.9% were of females and 47.1% to males. The number of obturations with acceptable length were 81(43.3%), with adequate density were 107 (57.2%) and with consistent taper were 116(62%). Periapical lesion was observed in 118(63.1%) cases. Quality of obturation significantly affects the periapical health. Cross tabulation showed a significant association (p-value

The purpose of this paper is to detect the leading diseases diagnosed in dental care, for the population 0-6 years and 07-18 years of age for the Herzegovina-Neretva Canton in 2008 and 2013, to compare the results for those two years, to determine trends, individual diseases, and comparing the obtained results with the results for the territory of the Federation of B&H. During the preparation of this paper, the data collected and published in its reports by the Institute of Public Health of the Federation of Bosnia and Herzegovina were used. Dental caries / K02 / takes the first place on the list of diseases in the field of dental activity, in all age groups. Diseases of the pulp and periapical tissue / K04 /, which most often occur as a result of caries, take second place on the list of diseases in all age groups. It is necessary to work on increasing the number of public healthcare of specialist teams of preventive and pediatric dentistry in the area of HNK, as well as increasing the number of dental care points, where children and youth would receive the service. Further work is needed to improve the state of oral health and the population through.

Radicular cysts are the most common inflammatory cysts of the jaws. Surgical intervention aims to eliminate periapical pathology in order to allow bone regeneration and healing of periapical tissues. Autologous platelet-rich fibrin is a healing biomaterial in oral surgical defects with the new perspective of accelerated healing. Titanium-prepared platelet rich fibrin (T-PRF) is a third-generation platelet concentrate developed to overcome the harmful effects of silica in glass tubes and also has a longer resorption rate. The purpose of this case report is to present the effects of T-PRF applied to the bone defect that occurs after the enucleation of the radicular cyst. A significant increase in bone density was observed after eight months of follow-up. T-PRF has been shown to be effective in the treatment of bone defects. Therefore, it is thought that it can be used as the only regenerative material in the treatment of bone defects.

Background: The objective of this narrative review was to analyze the available scientific evidence regarding the application of biomaterials in endodontic microsurgery and its influence in post-surgical tissue repair. Material and Methods: The review question was Do biomaterials used in endodontic microsurgery influence post-surgical tissue repair and regeneration? Systematic MEDLINE/PubMed review was used to evaluate and present the results. Results: The search yielded 131 references, 82 of which were selected for full text review after reading the abstracts. After a manual search in the references of the articles selected, 52 references were eliminated. Finally, 30 articles were selected. Conclusions: Bone grafts, membranes and bioceramics, especially MTA, are biomaterials with the ability to stimulate periapical tissue regeneration. This is one of many reason why bioceramics are the best choice as retrograde sealing materials. However, microsurgically treated periapical lesions can heal completely without the need to use bone grafts or membranes. Those techniques are indicated in endodontic microsurgery when additional stimulation of tissue regeneration is required, or when bone collapse needs to be prevented.

Two fundamental goals of endodontic treatment are to prevent or treat apical periodontitis. From a predictive perspective, several variables can affect the outcome of root canal treatment. Some of these variables depend on intraoperative factors, which include irrigation technique, size of the apical preparation, use of intracanal medicaments or the number of appointments necessary to complete the treatment. However, the outcome may also be affected by host and microbial factors. The intensity of periradicular bone loss or tissue damage, the presence of preoperative pain and associated conditions such as mechanical allodynia and central sensitization, the anatomical complexity of the apical portion of the canal, and the virulence and longevity of the bacterial infection can all have a profound influence on the outcome. Furthermore, numerous medical conditions have been reported to decrease the capability of the immune system to heal the periapical tissues. It is the clinician's responsibility to analyse these variables and incorporate them into the disinfection strategy to maximize the chances of healing. This narrative review will focus on the present status of intracanal medicaments, the clinical indications for their use and future directions for research.

Background The study aims to investigate the pulp and periapical reaction and healing after capping with EndoSequence Root Repair Material (ERRM) combined with low-level laser application. Methods In 6 rabbits, pulps were exposed via class V, half of the samples received a low-level diode laser at 980 nm. Thereafter, cavities were capped with regular-set ERRM. The specimens were processed for histomorphological examination after 2 weeks and two months. Results After 2 weeks, images show mild inflammation and organized odontoblasts in lased group. The non-lased group shows more severe inflammation. The predentin thickness was thicker in the lased group with statistical significance (p Conclusions Using low-level laser therapy in combination with ERRM for pulp capping shortens the inflammatory phase and enhances healing.

Background/Aims: Nuclear factor kappa beta (NF-κB) is a member of the transcription factor family, and it plays a key role in coordinating the expression of genes in many chronic inflammatory diseases. The main etiology of endodontic treatment failure is caused by bacteria in root canal, including Enterococcus faecalis. The aim of this study to determine NF-κβ and osteocalcin expressions during the periapical tissue damage due to induction of E. faecalis. Materials and Methods: Fifty-four male rats were randomly divided into two main groups, each of which had three subgroups. In Group C (control), every tooth was induced only by sterile brain–heart infusion broth (BHIb). Group C had three subgroups, namely Group C3 with 3 days inductionprocess, Group C10 with 10 days induction process, and Group C21 with 21 days induction process. In Group T, every tooth was induced by 10 μl of BHI-b E. faecalis ATCC212 (106 CFU). Similarly, Group T also had three subgroups, namely Group T3 with 3 days induction process, Group T10 with 10 days induction process, and Group T21 with 21 days induction process. The animals were sacrificed based on their group schedule and then prepared for histological and immunohistochemical examinations of periapical tissue. Afterward, the expressions of NF-κβ and osteocalcin were calculated on the light microscope. Results: The results revealed that the number of cells expressed of NF-κβ and osteocalcin increased significantly in all sub-groups of Group B induced by E. faecalis compared to the control group. Conclusion: It can be concluded that the number of cells expressed NF-κβ and osteocalcin increase during the periapical tissue damage induced by E. faecalis.

Establishing an accurate diagnosis is the first and prime requisite, in initiating the correct treatment, but unfortunately due to the limitations of the diagnostic procedure, this step can be highly confounding. Biological marker serves as a parameter, that is indicative of underlying physiology and health of the tissue. Healthy and diseased pulp and periapical tissue, tend to reflect physiologic and pathologic agents, which on isolation and estimation, can help diagnose, the condition more conclusively. Use of these agents, along with signs, symptoms, result of various tests, can aid in establishing the condition, more precisely. This review article focuses upon, identification of biomarkers, that play important role in pathogenesis of dental caries, pulpal and periapical pathosis and help to diagnose the pathological and healthy condition accurately, thus guide decisions, regarding clinical treatment. Key words: biological products, biomarkers, dental Caries, dental Pulp, diagnostic Tests

Successful management of endodontic problems is reliant on diagnostic imaging techniques to provide critical information about the teeth under investigation. CBCT is of great help in diagnosing conditions and diseases related to pulp and periapical tissue. It is also useful in detecting missed canal, extra canals, bizarre root form, extra roots, and diverse other anatomical variations. This review article emphasizes on the working of CBCT and its applications in endodontics. Keywords: CBCT in endodontics, 3D imaging, TACT, Magnetic resonance imaging (MRI).

Objective Periapical extrusion is frequently observed during endodontic therapy. It can lead to acute injury of periapical tissues, resulting in interappointment pain or swelling. The effect is pronounced in teeth with immature teeth which are more susceptible to the extrusion of irrigant. The aim of this study was to evaluate the effect of gravity on apical extrusion of irrigating solution with different irrigation protocols in immature anterior teeth. Methods An extracted maxillary central incisor was modified to simulate an open apex with an apical diameter of 1.3 mm and parallel canal walls. The tooth was subjected to a cone-beam computed tomographic scan, and the image data set was utilized to prepare 30 resin tooth models with a 3D printer. These resin teeth were used to form an open-ended Myers and Montgomery extrusion models. These were then randomly divided into two groups to simulate their orientation in the jaw during endodontic therapy, i.e., group I (maxillary arch, n=15) models fixed at 45° inclined plane and group II (mandibular arch, n=15) models placed at a plane parallel to the floor. Five models from each group (n=5) were tested by three different irrigation protocols: positive pressure (PP) Irrigation, passive ultrasonic irrigation (PUI), and negative pressure (NP) irrigation. The extruded irrigating solution was collected in glass vials, and the volume was measured. Results The volume of extruded irrigating solution in groups I and II was compared using Mann-Whitney U-test. The median values for PP, PUI, and NP irrigation protocols were 0.6, 1, and 0 ml and 10, 10, and 0.5 ml for groups I and II, respectively. PP and PUI protocols were associated with significantly less extrusion in group I when compared to group II (P=0.004). There was no statistically significant difference in the volume of irrigating solution extruded in groups I and II (P=0.007) for NP irrigation protocol. Conclusion Gravitation force has an influence on periapical extrusion of irrigant in immature permanent teeth irrespective of the irrigant system used. NP performed better when compared to PP or PUI irrigation protocol irrespective of the tooth orientation.

Pulpal/periapical responses of human teeth that are treated successfully with tricalcium silicate-based materials are extremely difficult to obtain because of the typical unavailability of these teeth for histologic examination. The present case series reports histologic and histobacteriologic findings of 3 human teeth that had undergone pulpotomy, orthograde retreatment, and apicoectomy/root-end filling using tricalcium silicate-based endodontic materials. The teeth were extracted after 34 days, 7 weeks, and 20 months, respectively, because of unusual circumstances. The extracted teeth were processed, paraffin embedded, sectioned, stained with hematoxylin-eosin or the modified Brown and Brenn technique, and examined with light microscopy. The recurrent observation for the 3 cases presented was the absence of inflammatory or foreign body reactions of the host tissues in contact with tricalcium silicate-based materials after different observation periods despite the identification of bacteria in dentinal tubules close to the site of operation. Wound healing was rapid with repair/regeneration of lost tissues with cementum and new bone trabeculae. Although the level of evidence for a case series is low because of the anecdotal nature of the reported episodes, the histologic results reported in the present case series illustrate the highly biocompatible and bioactive nature of the tricalcium silicate-based materials used in treating these cases.

This article reports an unusual case of foreign body lesion on the oral mucosa. A 61-year-old man, with no previous traumatic episode, presented with a small swelling resembling a sinus tract on the mucosa in the anterior mandible, adjacent to the left central and lateral incisors. Because of a discrete drainage of serous/purulent exudate, the clinician initially suspected endodontic involvement; however, the adjacent teeth were caries-free, responded positively to pulp tests, and the periapical tissues were radiographically normal. Exploration of the lesion opening under an operating microscope revealed a small seed associated with a dark filamentous structure; both were removed and processed for histologic examination. The seed was from a fig, and was germinating under the mucosa conditions. Bacterial colonization of the vegetable structures and polymorphonuclear leukocyte accumulations were histologically observed. The mucosa healed completely and uneventfully over the following weeks.

During root canal treatment, intra-canal content as well as irrigants and root filling materials may be extruded into the periapical tissues, leading to undesirable consequences such as delay of healing and flare-ups. Although apical extrusion of debris is an inherent occurrence of root canal treatment and no instrument or technique has totally solved this problem, attempts are underway to minimize the harm exerted to periapical tissues with the development of new techniques. This has led researchers to continuously evaluate new instruments and methodologies in terms of apical extrusion. New research on extrusion is frequently published some of which utilize traditional experimental designs and others assessing extrusion using modified or innovative methodologies. This review focuses on the research methods and experimental models to study apical extrusion of debris and irrigants by making a critical analysis of each technique. A PubMed and Scopus search was conducted and 144 articles relevant to apical extrusion were retrieved from 1968 until 2021. The methodologies used in every research article were evaluated and a classification was created. Each methodology is described with the general outlines and advantages and drawbacks of each technique summarized with a critical approach. It appears that the collection of debris in a vial still serves as a method chosen by authors even in most recent studies. On the other hand, development of experimental models that include multiple factors considering the drawbacks of the existing study designs is essential to draw more reliable conclusions on the apical extrusion phenomenon.

The aim of the study was to determine the expression of cell proliferating marker, anti-proliferating cell nuclear antigen (anti-PCNA) and mesenchymal stem cell (MSC) markers (anti-STRO-1 and anti-CD44) in periapical periodontitis and their role in the healing of periapical lesion in periapical periodontitis.Ninety Sprague-Dawley male rats (100 g) were divided into 3 groups: Experimental group I (EG I: n = 30), experimental group II (EG II: n=30) and control group (CG: n = 30). Periapical lesions were experimentally developed by leaving the dental pulp of maxillary first molars mesial root open to oral environment for 4 weeks. Conventional root canal treatment was performed in EG II. Maxillary first molars along with alveolar bone were resected and fixed. The processed samples were stained with routine hematoxylin and eosin (HE), and evaluated immunohistochemically using antibodies against anti-PCNA, anti-STRO-1, and anti-CD44 polyclonal antibodies. Data were analyzed using Chi-square test and a p-value of0.05 was considered significant.Immunostaining of anti-PCNA showed 30%, 70% and 53.3% positive staining in CG, EG I, and EG II, respectively (p0.001). Moreover, the CD44 staining was 20% in CG in contrast to 63.6% in EG I and 43.3 in EG II. STRO-1 staining in CG was 10%, 50% in the EG I and 36.6% in the EG II (p0.001).Periapical inflammatory tissues expressed significant proliferative cell marker PCNA and mesenchymal stem cell markers STRO-1, and CD44. These findings further reaffirm the promising role of mesenchymal stem cells in the healing of periapical periodontitis.

Circulating blood is a readily available scaffold when enough bleeding cannot be induced from periapical tissues during regenerative endodontic treatments (RETs). The aim of this investigation was to compare the radiographic outcome (ie, linear and 3-dimensional volumetric) of RET using periapical blood or circulating blood as scaffolds in sheep immature mandibular incisors.Thirty-two immature sheep mandibular central incisors were randomly assigned to the following groups (n = 8): the positive control groups, the pulps were removed without any treatment; the periapical blood group, RET was performed using periapical blood as the scaffold; the circulating blood group, RET was performed using circulating blood as the scaffold; and the negative control group, intact teeth without any treatment. After 8 months, micro-computed tomographic images of mandibular blocks were taken to assess the following: root length, root thickness at the midroot and cementoenamel junction levels, and the incidence of apical closure. Root structures were segmented, and root volumes were calculated and analyzed statistically.RET using periapical blood and circulating blood resulted in increases in root length and root wall thickness at the midroot and cementoenamel junction levels, the incidence of apical closure, and root volume (P.05). There were no significant differences between the RET groups and the negative control group regarding linear measurements (ie, root length, root thickness, and apical closure) (P.05). The root volumes of the 2 RET groups were similar (P.05) and were less than those observed in the negative control group (P.05).There were no significant radiographic differences between the RET groups using periapical blood and circulating blood as scaffolds. RET resulted in less root volume compared with normal root development.

The consequence of the material used during obturation being overextended out of the root canal may cause a reaction of an inflammatory process with a rarefaction area in periapical tissue. The process of healing is not affected by filling materials because the periapical tissues could tolerate it well, but a greater failure frequency is identified in teeth with an overfilled. Case report: This case report depicts an overextended guttapercha material and a different nonsurgical approach to remove this material. Conclusion: This conservative approach is a secure and plausible choice to remove extruded guttapercha in the periapical area. Clinical significance: The failure of endodontic treatment could increase with overextended guttapercha materials. One of the most common approaches to remove this overextended guttapercha cone is a surgical technique. Nonetheless, this nonsurgical technique could be a better alternative treatment technique and could increase success.

The aim: To establish the dynamics of reparation processes in periapical tissues in chronic granulomatous periodontitis under the influence of the developed composition based on calcium hydroxyapatite in comparison with the generally accepted drug MTA.Materials and methods: The main group included 52 individuals, and the comparison group - 19 patients with chronic granulomatous periodontitis. In the first experimental subgroup, patients were obturated of the tooth root apical area with the proposed composition, and in the second experimental subgroup patients were performed obturation of the root canal apical area with additional transcanal withdrawal of the composition into the periapical area. In the comparison group, the tooth root apex was obturated with MTA material.Results: Clinical studies have shown that the composition based on calcium hydroxyapatite, having osteoconductive, antioxidant and anti-inflammatory properties, activates the synthesis of organic and mineral components, that promotes the bioreparation and regeneration processes of periapical tissues in chronic granulomatous periodontitis, which occurred most intensively during the first 6 months after treatment. At the same time, with additional transcanal removal of the filling composition based on calcium hydroxyapatite into the periapical area in patients with chronic granulomatous periodontitis with acquired wide tooth root apex was observed in 1.6 time better results than the method of creating an apical root canal obturation (p0,05), indicating a high therapeutic effect.Conclusions: Composition based on calcium hydroxyapatite, having osteoconductive, antioxidant and anti-inflammatory properties, activates the synthesis of organic and mineral components, which promotes the processes of bioreparation and regeneration of periapical tissues, especially in the early stages. And additional transcanal removal of the filling composition into the periapical space causes the acceleration of the period of periodontal tissues revitalization, bioreparation and regeneration compared to the creation of the apical obturation within the physiological tooth root apex.

Irrigation is considered an indispensable part of root canal treatment as it fortifies the cleaning and disinfection of areas of the root canal system that have been inadequately influenced by instruments. The aim of this systematic review was to collate published data on the two modes of irrigation i.e., conventional irrigation and apical negative pressure irrigation (ANP) for cleaning and shaping of the canals and to compare their efficacy in debridement and periapical tissue repair. The electronic databases PubMed and Google Scholar were searched in this review using specific inclusion and exclusion criteria. The search was performed in June 2018 and updated in March 2019. Among 1481 studies, five studies satisfied the eligibility criteria and were included in the review to be analysed. These studies compared the effectiveness of ANP method against syringe irrigation in removing debris within the root canal system and their effect in periapical tissue repair, including: different types of irrigation methods, debris removal during cleaning and shaping, and updating studies of their effect in periodontal and periapical repair. The compiled data observed that ANP was more efficient in removing the debris and offered a greater advantage that should lead to wider acceptance among dentists for effective results compared to different irrigation systems. However, more clinical trials with standardized protocol and defined clinical, radiographic, and histopathological outcomes with longer follow-up periods are warranted.

Introduction: in Colombia, persisting post-endodontic disease has been reported by up to 45%, validating the use of secondary alternative therapies, like endodontic microsurgery (EM). The aim of this study was to systematically-and with reliable scientific evidence-develop de Novo Clinical Practice Guidelines for the surgical endodontic management of post-treatment periapical disease (PPD), with more accurate recommendations for therapeutic decisions and preferences consulted with both practitioners and patients. Method: the guidelines developers team identified EM as a topic in the literature and established the scope, objective, questions, and outcomes, which were analyzed using the scientific evidence reported in secondary or primary clinical studies. A first screening identified titles and abstracts for each question asked. The validity of the selected studies was quantified with tools like AMSTAR or SIGN. Finally, the strength of recommendations and the quality of evidence were confirmed with GRADE. Results: concepts like PPD, EM indication, use of local anesthetics, antibiotics and presurgical anti-inflammatory drugs, effect of magnification, implementation of cone beam computed tomography, hemostasis, retrograde filling, and control time were integrated, supporting each topic with relevant evidence, experts’ recommendations, and even good practice points. Conclusions: this document is considered a tool with sufficient evidence for clinical decision-making in EM. RESUMEN Introducción: en Colombia, la persistencia de enfermedad posendodoncia ha sido reportada hasta en un 45%, lo cual justifica propuestas terapéuticas secundarias, como la microcirugía endodóntica (ME). El objetivo del presente estudio consistió en desarrollar sistemáticamente, y con evidencia científica confiable, una Guía de Práctica Clínica de Novo para el manejo quirúrgico en endodoncia de la enfermedad periapical postratamiento (EPP), con las recomendaciones más acertadas frente a decisiones y preferencias terapéuticas consultadas a profesionales y pacientes. Método: el grupo desarrollador de la guía identificó el tópico ME y estableció el alcance, el objetivo, las preguntas y los desenlaces, analizados mediante la evidencia científica registrada a partir de estudios clínicos secundarios o primarios. Un primer tamizaje identificó títulos y resúmenes para cada pregunta formulada. La validez de los estudios seleccionados se cuantificó con las herramientas AMSTAR o SIGN. Finalmente, la fuerza de las recomendaciones y la calidad de la evidencia se constataron con la herramienta GRADE. Resultados: se integraron los conceptos de EPP, indicación de la ME, uso de anestésicos locales, antibióticos y antinflamatorios prequirúrgicos, efecto de la magnificación, implementación de la tomografía computarizada de haz cónico, hemostasia, materiales de retroobturación y el tiempo de control, sustentando cada tópico con la evidencia, la recomendación de los expertos y en ocasiones con las premisas de las buenas prácticas. Conclusiones: el presente documento se considera una herramienta con suficiente evidencia para la toma de decisiones clínicas en ME.

Over 2500 articles and 200 reviews have been published on the bioactive tri/dicalcium silicate dental materials. The indications have expanded since their introduction in the 1990s from endodontic restorative and pulpal treatments to endodontic sealing and obturation. Bioactive ceramics, based on tri/dicalcium silicate cements, are now an indispensable part of the contemporary dental armamentarium for specialists including endodontists, pediatric dentists, oral surgeons andfor general dentists. This review emphasizes research on how these materials have conformed to international standards for dental materials ranging from biocompatibility (ISO 7405) to conformance as root canal sealers (ISO 6876). Potential future developments of alternative hydraulic materials were included. This review provides accurate materials science information on these important materials. STATEMENT OF SIGNIFICANCE: The broadening indications and the proliferation of tri/dicalcium silicate-based products make this relatively new dental material important for all dentists and biomaterials scientists. Presenting the variations in compositions, properties, indications and clinical performance enable clinicians to choose the material most suitable for their cases. Researchers may expand their bioactive investigations to further validate and improve materials and outcomes.

Objectives To investigate the periapical bone thicknesses of maxillary posterior teeth at the preferred level for root resection (3 mm apical to the root end) and to determine vertical distances from apex to maxillary sinus floor (MSF) using cone beam computed tomography (CBCT) scans. Methods CBCT scans were collected from 341 subjects (2389 teeth). Associations of bone thicknesses and vertical distances with age and sex were determined by one-way analysis of variance. Results At the level of root-end resection, buccal bone was the thickest over the mesiobuccal roots of second molars (mean, 2.99 mm) and thinnest over the double-root first premolars (mean, 0.29 mm). In maxillary posterior teeth, thicker buccal bone was found in men than in women. The mesiobuccal roots of second molars were nearest to the MSF (mean, 1.33 mm), and were also most frequently extended into the sinus cavity (15.81%). Subjects more than 40 years of age had larger vertical distances from root apices to MSF in the molar region, compared with younger subjects. Conclusions Generally, periapical bone was thicker in men, and root apices were located nearer to the MSF in younger subjects. Age and sex should be considered before endodontic microsurgery.

INTRODUCTION The aim was to assess the association of inducible costimulator (ICOS) and ICOS ligand with bone destruction in apical periodontitis (AP). METHODS Specimens from patients presenting with AP were obtained during apicoectomy and subjected to histopathologic analysis and molecular assessment of ICOS/ICOS ligand. In addition, the experimental AP was induced by exposing the pulp of first mandibular molars of rats. Histologic and radiographic examinations were performed to validate the periapical lesions. The immunolocalization and messenger RNA expression of ICOS/ICOS ligand were evaluated by immunofluorescence staining and quantitative real-time polymerase chain reaction. The osteoclastic activities in periapical lesions, including the lesion size and the expression of tartrate-resistant acid phosphatase and the receptor activator of nuclear factor kappa B ligand, were recorded and followed by correlation analysis with ICOS/ICOS ligand expression. RESULTS In excisional specimens from AP patients, a significantly increased expression of ICOS/ICOS ligand was found compared with the healthy control. In the experimental AP samples, the expression of ICOS/ICOS ligand, tartrate-resistant acid phosphatase, and receptor activator of nuclear factor kappa B ligand was significantly elevated in inflamed periapical tissues (AP group) when compared with the healthy control. The number of ICOS+/ICOS ligand+ cells was highly correlated with the periapical lesion size (r = 0.892, P < .01 and r = 0.930, P < .01, respectively). CONCLUSIONS The increased expression of ICOS/ICOS ligand in periapical lesions was associated with the inflammatory infiltration and alveolar bone destruction of AP.

To develop and assess a set of criteria to grade inflammation including relative area of inflammation in periapical lesions in endodontically treated teeth.A set of criteria was developed, encompassing data on: Lymphocytes, denoting chronic inflammation, were graded 0 (occasional) to 4 (heavy/dense inflammation). Polymorphonuclear cells, denoting acute inflammation, were graded 0 (none) to 2 (many). The third parameter, area of inflammation, that is, the relative area of the specimen that was inflamed, was graded 0 (none) to 4 (76-100%). The criteria were tested on 199 consecutive biopsies from 180 patients (aged 31-75 years). Information about symptoms was retrieved from the referrals. Mann-Whitney's U-test was used to calculate possible differences in average values for the histopathological variables in the two groups of patients: symptomatic or asymptomatic.Using the criteria, varying grades of inflammation were seen in the biopsies. The majority showed few or no PMN cells. There was a correlation between symptoms and the extent of infiltration of lymphocytes and plasma cells (p = .001), PMN cells (p .001) and the area of inflammation (p = .002): biopsies from the asymptomatic patients exhibited less pronounced and relatively smaller areas of inflammation.Using the criteria on a specific selection of root-filled teeth with persisting apical periodontitis, periapical inflammation was common, but varied in extent and severity. The inflammation was less pronounced and affected a relatively smaller area in asymptomatic teeth, although outliers in both directions were identified.

This article describes a successful management of permanent mandibular second molar presented with extruded foreign particles. Root canal foreign bodies in or beyond the root canal system may affect the treatment outcome. Attempts for removal of such materials are challenging and can jeopardize the tooth structure. Therefore, a proper diagnosis and treatment planning for such cases is critical to achieving adequate outcomes.

Objectives The aim of this study was to evaluate the shaping ability of the TruShape and Reciproc Blue systems and the apical extrusion of debris after root canal instrumentation. The ProTaper Universal system was used as a reference for comparison. Materials and Methods Thirty-three mandibular premolars with a single canal were scanned using micro-computed tomography and were matched into 3 groups (n = 11) according to the instrumentation system: TruShape, Reciproc Blue and ProTaper Universal. The teeth were accessed and mounted in an apparatus with agarose gel, which simulated apical resistance provided by the periapical tissue and enabled the collection of apically extruded debris. During root canal preparation, 2.5% sodium hypochlorite was used as an irrigant. The samples were scanned again after instrumentation. The percentage of unprepared area, removed dentin, and volume of apically extruded debris were analyzed. The data were analyzed using 1-way analysis of variance and the Tukey test for multiple comparisons at a 5% significance level. Results No significant differences in the percentage of unprepared area were observed among the systems (p > 0.05). ProTaper Universal presented a higher percentage of dentin removal than the TruShape and Reciproc Blue systems (p < 0.05). The systems produced similar volumes of apically extruded debris (p > 0.05). Conclusions All systems caused apically extruded debris, without any significant differences among them. TruShape, Reciproc Blue, and ProTaper Universal presented similar percentages of unprepared area after root canal instrumentation; however, ProTaper Universal was associated with higher dentin removal than the other systems.

Aim To assess and correlate three distinct states of severely painful endodontically derived inflammation with their depiction on periapical radiographs using periapical index (PAI) scores. Methodology During a period of 15 months, 368 consecutively enrolled patients with suspected endodontic emergency conditions were examined at the University of Zurich, Center of Dental Medicine. Cases with a severely painful (numeric rating scale, NRS‐11 > 6) endodontically involved tooth and a clear pulpal and apical diagnosis (n = 162) were selected (one tooth per patient). Teeth were divided into three groups according to the clinically diagnosed main location of the inflammatory process: level 1: pulp (positive response to cold test), level 2: periodontium (no response to cold without swelling) and level 3: periapical tissues (no response to cold with swelling). Periapical radiographs were obtained using a digital unit and analysed by two calibrated observers. For level 2, which had the highest PAI variance (n = 76), the PAI scores were further scrutinized regarding their dependence on tooth location and the duration of pain. Data were analysed using chi‐squared and non‐parametric tests, alpha = 0.05. Results Overall, the PAI scores correlated well with the clinically diagnosed main location of periapical inflammation (Spearman’s rho = 0.5131, P

Background/Aim. Amalgam has been used for years in dentistry, but controversy on its adverse effects both on local oral/dental tissues and systemic health still exists. When used for retrograde filling in apical surgery, amalgam comes in close contact with periapical tissue and sometimes is responsible for induction of periapical lesion (PL) or its exacerbation. Therefore, our aim was to examine the effect of amalgam on cytotoxicity and production of pro-inflammatory cytokine by cells isolated from PL. Methods. Conditioned medium from freshly prepared amalgam (ACM) was performed according to ISO 10993-12, by incubating the alloy in RPMI medium (0.2g/ml) for 3 days at 37°C. Cells were isolated from 20 human PLs after apicotomy by collagenase/DNA-ase digestion and cultured with different dilutions of ACM. Cytotoxicity was determined by MTT (n=7 cultures) and apoptosis/necrosis assays (n=8 cultures), whereas cytokine production was measured by a Flow Cytomix Microbeads Assay (n= 8 cultures). Results. Undiluted (100%) and 75% ACM was cytotoxic due to induction of apoptosis of PL cells. Non-cytotoxic concentrations of ACM (50% and 25%) inhibited the production of pro-inflammatory cytokines (TNF-α, IL-1β, IL-6 and IL-8), concentration dependently. Conclusion. Our results showed for the first time an unexpected anti-inflammatory property of amalgam on PL cells, which could be beneficial for PL healing after apicotomy.

Objective: To evaluate the efficacy of periapical infiltration injection of dexamethasone and morphine in reducing postoperative endodontic pain. Method: Ninety patients participated in this double-blind randomised controlled clinical trial. They were referred to the dental school of Shahid Beheshti Medical University, Tehran, Iran for conventional endodontic treatment of molar teeth. The canals of each tooth were completely prepared with cleansing and shaping. The patients were randomly divided into three experimental groups to receive dexamethasone, morphine or normal saline (1 mL). Patients were then instructed to complete a pain diary 4, 8, 24 and 48 h after the appointment. Statistical analysis consisted of chi-squared test, analysis of variance and Kruskal–Wallis test. Results: There was a statistically significant correlation between dexamethasone or morphine treatment and decreased levels and incidence of endodontic pain at 4, 8 and 24 h, but not at 48 h (P

Aim: The aim of the present study was to retrospectively assess the healing of periapical lesions in permanent central incisors with open apices after unintentional extrusion of mineral trioxide aggregate (MTA). Materials and Methods: The clinical and radiographic records of 75 maxillary permanent central teeth treated by MTA apexification were evaluated. Teeth with unintentionally extruded MTA formed the study group (Group 1, n = 28), whereas the teeth with no MTA extrusion formed the control group (Group 2, n = 47). For both the groups, the records were analyzed for a follow-up period of 3 years. Results: Complete healing (CH) was observed in 25 teeth in the study group, whereas all the teeth in the control group showed CH (P > 0.05). Within the study group, 6 teeth (21%) showed CH in the 6th month in Group 1, whereas in the control group, 34 teeth (72.3%) showed CH (P < 0.001). At the 1-year follow-up appointment, 19 teeth (67.8%) showed CH in Group 1, whereas 9 teeth (19.1%) showed the same result in Group 2 (P < 0.001). At the end of the 3-year follow-up period, it was noticed that in 21 (84%) teeth, extruded MTA remained unchanged, whereas it was reduced in 4 (16%) of them (P < 0.001). Conclusion: Extrusion of MTA does not have a significant effect on the healing of the periapical lesion. However, it may lead to a delay in the healing of periapical healing. Patients should be informed about the complication and consequences of extruded MTA and should be kept on follow-up to observe periapical healing.

Introduction: There is high occurrence of apical periodontitis in diabetes mellitus patients. The healing process of periapical tissue in diabetes is affected by the altered immunity. The aim of the study is to determine the periapical healing followed by endodontic therapy in type 2 diabetes mellitus and compare with non-diabetes Methodology: This review was directed as per the PRISMA and JBI guidelines. A total of six articles published over a period of past 15 years were included in qualitative synthesis. Results: Total of 1424 articles were searched out of which 26 articles were selected after reading title and abstract. As a next step, full text papers were obtained. However studies in which periapical healing in type II diabetes and non- diabetes were selected. Finally a total of 26 articles were included out of which 20 articles were excluded on basis of insufficient data and 6 articles were selected for final synthesis. Conclusion: Patients with type II diabetes mellitus had slower healing rate compared to non-diabetes patients. Keywords: Type II diabetes mellitus, Non- Diabetes, Root Canal Therapy, Periapical Healing

Aim of the study: In vitro evaluation of the effects of plasminogen activator inhibitor-1 (PAI-1) transfected-conditioned media (P-CM) on the differentiation of human periodontal ligament stem cells (hPDLSCs) and human periapical follicular stem cells (hPAFSCs). Materials and Methods: The hPDLSCs and hPAFSCs received from impacted third molars were treated with P-CM and viability, as well as differentiation of the cells were evaluated. Plasmids were constructed according to standard techniques, and all sequences were validated by proper enzyme digestion and sequencing. Chinese hamster ovarian (CHO) cells were transfected with pcDNA3.1-hPAI-1 plasmid to obtain P-CM, followed by western blotting and PAI-1-specific ELISA kit to evaluate the proteins of P-CM. The cell viability of hPDLSCs and hPAFSCs were analyzed using MTT assay after 48 h of incubation. Alizarin red S staining was performed to evaluate the differentiation of hPDLSCs and hPAFSCs. The reverse transcription-polymerase chain reaction was used to observe the expression levels of osteogenic/cementogenic marker genes. The human cytokine antibody array was applied for further analysis of cytokine expression in P-CM. Results: P-CM significantly promoted the differentiation of hPDLSCs and hPAFSCs and upregulated the expression of osteogenic/cementogenic marker genes in vitro . Furthermore, rhPAI-1 promoted mineralized nodules formation of hPDLSCs and hPAFSCs, and we identified that other proteins, RANTES and IL-6, were highly expressed in P-CM. Conclusions: P-CM promoted the differentiation of hPDLSCs and hPAFSCs by upregulating the expression of RANTES and IL-6, and interaction between PAI-1 and RANTES/IL-6 signaling may be involved in P-CM-induced osteogenic/cementogenic differentiation.

The Bayesian approach is being a fundamental tool in forensic and legal field where inferences and decisions are made. In this study, a full Bayesian calibration model was developed to make probabilistic inferences about age estimation in a reference sample of 891 periapical X-rays of upper and lower canines. These teeth belonged to both deceased and living adult subjects, aged between 20 and 86 years, coming from five different countries (Turkey, Italy, Portugal, Japan and Mexico). For this purpose, the narrowing of pulp chamber due to the apposition of secondary dentine was analysed by means of the pulp/tooth area ratio. To determine the agreement of the method, intra- and inter-observer differences for measuring process were calculated by means of the intraclass correlation coefficient (ICC) analysis. Observer error tests showed excellent agreement between observers and between repeated assessments. According to the results of the ANCOVA, neither nationality nor sex was associated to the secondary dentine apposition while it is associated with individual's age. The results of the present study indicated that the concept of probability is intrinsically linked to the assessment of age in a forensic context, and the Bayesian approach could be considered a robust tool to overtake the bias generated by traditional regression models, thus helping the decision-making process in a legal framework.

A progressão das lesões de cárie em dentes molares permanentes de pacientes jovens, frequentemente resulta em tratamento endodôntico. Este estudo prospectivo de coorte teve como objetivo avaliar a incidência de dor e reparo apical após tratamento endodôntico de dentes molares jovens e identificar fatores associados aos resultados do tratamento. O tratamento endodôntico foi realizado por estudantes de graduação em dentes molares permanentes (n=75) de pacientes jovens de 9 a 17 anos de idade (n=60) na Clínica de Extensão Endodôntica e Restauradora da Universidade Federal de Uberlândia, Brasil. Foi utilizada instrumentação oscilatória com o sistema Protaper Next (Dentsply) e obturação empregando dois cimentos endodônticos (Sealer 26, Dentsply e AH Plus, Dentsply) definidas de forma aleatória nos dentes tratados. Após o tratamento endodôntico realizou-se restauração direta em resina composta. Dois desfechos primários foram considerados: 1- reparo apical e 2- dor pós-operatória, avaliados após 12 e 24 meses. Os dados longitudinais foram analisados por taxas de incidência e regressão do modelo misto usando as Equações de Estimativa Generalizadas (GEE). Ao final dos 2 anos foram avaliados 69 dentes de 54 pacientes. As incidências de reparo apical e dentes assintomáticos foram respectivamente: 90,5% e 89,3%, 96,8% e 90,0% após 1 e 2 anos. A falha do reparo apical foi associada ao tratamento endodôntico insatisfatório (P = 0,003) e condições periapicais (P = 0,007), bem como a interação delas (P = 0,016). Nenhuma dessas variáveis independentes foi capaz de prever a ocorrência de dor nos períodos de acompanhamento. O tratamento endodôntico mostrou resultados satisfatórios no período de 2 anos de avaliação. Nenhum efeito significativo do tipo de cimento endodôntico foi observado nos parâmetros analisados. O tratamento endodôntico de dentes molares jovens associados a restaurações de resina composta, realizado por estudantes de graduação tem papel relevante na redução do risco de perda dos dentes permanentes, tendo, portanto, significativo impacto social. The faster progression of caries lesions in permanent molar teeth of young patients, frequently result in endodontic treatment. This prospective cohort study aimed to evaluate the incidence of pain and apical repair after endodontic treatment of young molar teeth and identify factors associated with treatment outcomes. Endodontic treatment was performed by undergraduate students in permanent molar teeth (n=75) of young patients (n=60) at the Endodontic and Restorative Extension Clinic of the Federal University of Uberlandia, Brazil. Protaper Next was used and two sealers (Sealer 26 and AH Plus) were randomly assigned in the samples, which were restored with direct composite resin. Two primary clinical outcomes – apical repair and postoperative pain, were assessed after 12 and 24 months. Analysis of longitudinal data included the description of incidence rates and mixed-model regression using Generalized Estimation Equations (GEE). After 2 years 69 molar teeth of 54 patients were evaluated. The incidences (%) of apical repair and asymptomatic teeth were respectively 90.5 and 89.3, 96.8 and 90.0 for 1- and 2-years follow-up. Failed apical repair was associated with unsatisfactory endodontic treatment (P=0.003) and periapical conditions (P=0.007) as well as their interaction (P=0.016). None of these independent variables was able to predict the occurrence of pain in follow-up periods. Endodontic treatment showed satisfactory results after 2 years. Prognosis of apical repair is dependent on the initial conditions. No effect of the endodontic sealer was observed. Endodontic treatment of young molars associated with composite restorations performed by undergraduate students, have a relevant role in reducing the risk of permanent teeth loss. Tese (Doutorado)

To evaluate the mRNA expression levels of cytokines interferon-γ, tumour necrosis factor-α, interleukin IL-1β, IL-10, and the chemokine CCL2/MCP-1, CCL4, and CXCR4 in the periapical interstitial fluid from root canal infections before and after bacterial load reduction in patients undergoing haematopoietic stem cell transplantation (HSCT). The case group was composed of 10 patients undergoing HSCT, and our control group included 10 healthy patients. Clinical samples were taken from teeth with pulp necrosis. Three paper points were placed in the RCS and maintained for 2 min for microbial evaluation before cleaning and shaping procedures. After cleaning and drying the canal, three paper points were introduced into the root canal, passing passively through the root apex (2 mm) into the periapical tissues for 1 min. Samples were collected immediately after root canal cleaning and 7 days later (restrained root canal bacterial load) to characterize gene expression using real-time PCR. The results showed significantly reduction in the microbial load on day 7. An increased expression level of TNF-α and IFN-γ on day 7 in control and case groups was observed (p

To evaluate the selenium (Se) behavior when used as an endodontic dressing in teeth with pulp necrosis. Additionally, its effects was also compared with the calcium hydroxide (C.H.), which is used globally as a root canal dressing, and the combination of the C.H. with Se (C.H. + Se). The sample consisted of 60 patients requiring endodontic treatment who were divided into groups, i.e., without intracanal medication (empty) and with medications as follows: selenium (Se), calcium hydroxide (C.H.), and calcium hydroxide + selenium (C.H. + Se) (n = 15). After the coronary opening, three absorbent paper points were placed in the RCS and maintained for 2 min for microbial evaluation. Following the cleaning and shaping procedures, new paper points were introduced into the root canal system, passing passively through the root apex (2 mm) into the periapical tissues for 2 min, for immune evaluation. The collections were performed again 15 days later. Real-time PCR quantified the expression of the prokaryotic 16S ribosomal RNA. The 16S mRNA was evaluated before the cleaning and shaping procedures and 15 days later in the groups treated with or without medication. A significant reduction in the microbial load was observed only in the groups that received endodontic dressing (p

Background: Surgical root canal retreatment is required when peri-radicular pathosis associated with endodontically treated teeth cannot be treated by non-surgical root canal therapy (retreatment), or when retreatment was ineffective, not feasible or contraindicated. Endodontic failures maybe happen when irritants remain within the confines of the root canal, or when an extra-radicular infection cannot be eradicated by orthograde root canal treatment. Following enhanced microsurgical techniques in the last years, the success rates of surgical root canal retreatment have improved considerably. Objective: The aim of this systematic review is to gather updated data in regard to the surgical root canal (retrograde) retreatment to heal the periapical lesions. Materials and methods: The electronic databases PubMed and Google Scholar were searched in this review using specific inclusion and exclusion criteria. The search was performed in June 2019 and updated in November 2019. Among 3900 studies, 10 studies satisfied the eligibility criteria and were included in the review to be analyzed. Results: The 10 studies showed the importance of surgical root canal retreatment as a treatment option in removing infections within the root canal system and its efficiency in periapical tissue healing. These studies investigated different aspects of healing of periapical lesion after surgical (retrograde) retreatment including success rates, follow-up duration, and updated studies in surgical (retrograde) retreatment. Conclusions: Surgical root canal (retrograde) retreatment demonstrates its efficiency in reducing the period needed for healing of the periapical lesions in short-term follow-up compared to conventional orthograde retreatment.

The progression of caries in permanent molar teeth of young patients, frequently result in endodontic treatment. This randomized blinded clinical trial assessed the effect of two endodontic sealers (Sealer 26 and AH Plus) on the incidence of pain and apical repair after endodontic treatment of young molar teeth, and secondly identify factors associated with the outcomes. Endodontic treatment was performed by undergraduate students in molar teeth (n=69) of young patients (n=54) at the Endodontic and Restorative Public Extension Clinic Service. Protaper Next was used and the endodontic sealers were allocated which were restored with direct composite resin. Two primary clinical outcomes - apical repair and postoperative pain, were assessed after 12 and 24 months for blinded operators. Description of incidence rates and mixed-model regression using Generalized Estimation Equations (GEE). After 2 years 69 molar teeth of 54 patients were evaluated. No effect of the endodontic sealer was observed irrespective of period of evaluation. Apical repair incidences and asymptomatic teeth were, respectively, 90.5 and 89.3, 96.8 and 90.0% during 1 and 2 years of follow-up. Failed apical repair was associated with unsatisfactory pulpectomy (p=0.003) and periapical conditions (p=0.007) as well as their interaction (p=0.016). None of these independent variables was able to predict the occurrence of pain in both periods. Prognosis of apical repair is dependent on the initial conditions. Endodontic treatment of young molars associated with composite resin restorations performed by undergraduate students have satisfactory results after 2 years and was effective to prevent the risk of permanent teeth loss. Resumo A rápida progressão das lesões de cárie nos dentes molares permanentes de pacientes jovens, frequentemente resulta no tratamento endodôntico. Este ensaio clinico randomizado cego avaliou o efeito de dois cimentos endodônticos (Sealer 26 e AH Plus) na incidência de dor e reparo apical após tratamento endodôntico de dentes molares jovens e identificar fatores associados aos desfechos do tratamento. O tratamento endodôntico foi realizado por estudantes de graduação em dentes molares permanentes (n=69) de pacientes jovens (n=54) na Clínica de Extensão Endodôntica e Restauradora da Universidade Federal de Uberlândia, Brasil. Protaper Next foi usado e os dois cimentos foram distribuídos aleatoriamente nas amostras, as quais foram restauradas com resina composta direta. Dois desfechos clínicos primários - reparo apical e dor pós-operatória foram avaliados após 12 e 24 meses por operadores de forma cega. Análise longitudinal dos dados incluiu a descrição das taxas de incidência e modelo de regressão misto usando Equações de Estimativa Generalizadas (GEE). As incidências (%) do reparo apical e dos dentes assintomáticos foram respectivamente 90,5/89,3 e 96,8/90,0 nos períodos de 1 e 2 anos de acompanhamento. Ausência de reparo apical foi associada com pulpectomia insatisfatória (p=0,003) e condições periapicais (p=0,007), bem como sua interação (p=0,016). Nenhuma dessas variáveis independentes foi capaz de prever a ocorrência de dor nos períodos de acompanhamento. O tratamento endodôntico mostrou resultados satisfatórios após 2 anos. O prognóstico do reparo apical depende das condições iniciais. Nenhum efeito do cimento endodôntico foi observado. O tratamento endodôntico de molares jovens associado com restaurações em resina composta realizado por estudantes de graduação tem um papel relevante na redução do risco de perda do dente permanente.

The aim of this case report was to evaluate the efficacy of a new platelet-rich plasma preparation and its regenerative capacity of bone periapical tissue for the treatment of a very compromised endodontic treated tooth, with a periapical lesion of 1.5 cm in diameter, using a pure platelet concentrate. This is made without the use of anticoagulant or any type of activator, e.g., bovine thrombin, calcium chloride. For this reason, it has been called “Pure”; it is the B.P.F.C.® Bio-Plasma® with Pure Growth Factors (BioPlasma®) designed and developed by Dr. Raffaello Viganò. The patient has read and signed a written consent form. The study protocol was approved by the Ethics Committee for Human Studies, University of Varese. X-ray at 2 and 6 months and 4 years after endodontic surgery demonstrated the success of the treatment.

Objective The clinical benefits of simultaneous implant placement and soft tissue augmentation using different treatment modalities are unclear. The current meta-analysis aimed to compare the effect of simultaneous soft tissue augmentation using subepithelial connective tissue graft (SCTG) around immediate or delayed dental implant placement with other treatment modalities on the peri-implant tissue health and esthetic. Methods Up to May 2021, four databases (PubMed, EMBASE, Cochrane Central, and Google Scholar) were searched. Randomized control trials with follow-up >3 months, evaluating simultaneous implant placement (immediate or delayed) and soft tissue augmentation using SCTG compared with other treatment modalities were included. The predictor variables were SCTG versus no augmentation with/without guided bone regeneration (GBR) or other augmentation techniques (Acellular dermal matrix (ADM), Xenogeneic collagen matrix (XCM). The outcome variables were buccal tissue thickness (BTT), mid-buccal gingival level (MGL), marginal bone loss (MBL), and pink esthetic scores (PES). Cumulative mean differences (MD) and 95% confidence interval (CI) were estimated. Results Twelve studies were included. SCTG along with immediate implant placement (IIP) or delayed implant placement (DIP) showed a statistically significant improvement in BTT (Fixed; MD, 0.74; 95% CI, 0.51; 0.97), MGL (Fixed; MD, 0.5; 95% CI, 0.21; 0.80), PES (Fixed; MD, 0.79; 95% CI, 0.29; 1.29), and less MBL (Fixed; MD, -0.11; 95% CI, -0.14; -0.08) compared to no graft (P Conclusion There is a very low quality of evidence to provide recommendations on whether simultaneous dental implant placement (IIP or DIP) and soft tissue augmentation using SCTG is superior to no augmentation or is comparable to the other tissue augmentation materials in improving the quality and quantity of peri-implant tissues. Therefore, further, well-designed RCTs with larger sample sizes and long follow-up times are still needed.

Introduction NeoMTA Plus (Avalon Biomed Inc, Bradenton, FL) is a tricalcium silicate material similar to the first mineral trioxide aggregate product, ProRoot MTA (Dentsply Sirona, York, PA), but with improvements such as decreased setting time, increased ion release, increased water sorption, and nonstaining radiopacifiers. Quick-Set2 (Avalon Biomed Inc) is a newly formulated calcium aluminosilicate material that has a faster setting time and increased acid resistance and is nonstaining. The purpose of this study was to compare the healing of pulpal and periapical tissues in dogs after exposure to NeoMTA Plus and Quick-Set2 after pulpotomy and root-end surgery procedures. Methods Seventy-two teeth (36 for each procedure) in 6 beagle dogs received pulpotomy or root-end surgery using either NeoMTA Plus or Quick-Set2. The dogs were sacrificed at 90 days, and the teeth and surrounding tissues were prepared for histologic evaluation. Sixty teeth were evaluated and scored histologically (29 with pulpotomies and 31 with root-end resections). Specimens were scored for inflammation, quality and thickness of dentin bridging, pulp tissue response, cementum and periodontal ligament formation, and apical bone healing. Results Both materials displayed favorable healing at 90 days. The only significant difference was the quality of dentin bridge formation in pulpotomies using NeoMTA Plus compared with Quick-Set2. Conclusions Quick-Set2 and NeoMTA Plus had similar effects on inflammation, pulp response, periodontal ligament and cementum formation, and apical tissue healing in dogs. NeoMTA Plus had superior dentin bridge quality compared with Quick-Set2.

Background: Extrusion of infected debris into the periapical tissue has been cited as the major cause of postoperative pain, regardless of instrumentation technique. Aim: Comprehensively review two different kinematics of instrumentation (reciprocating and rotary) and association to the postoperative pain after endodontic treatment. Methods: Two investigators performed a systematic review with meta-analysis. MEDLINE/PubMed, Cochrane Library, and Scopus supplied relevant data from studies published until February 2018 to answer the PICO question. Primary outcome was overall postoperative pain, and the secondary outcomes were nature of the pain (mild, moderate, and severe) at 12, 24, and 48 h. Results: Ten randomized clinical trials fulfilled eligibility criteria, and five of them were submitted in the meta-analysis. Primary outcome indicated that reciprocating system results in less postoperative pain compared to rotary system (P < 0.05). As a secondary outcome, there was no statistical difference for mild, moderate, and severe pain after 12 and 24 h using reciprocating or rotary systems (P > 0.05). However, the reciprocation system showed less severe pain after 48 h (P < 0.05). Conclusion: Rotary motion had a negative impact on postoperative pain after endodontic treatment. Furthermore, after 48 h, more patients presented severe pain under rotary motion. More randomized clinical studies would be helpful.