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Introduction: Root canal treatment (RCT) is often considered a difficult procedure for both the patient and treatment provider. The American Association of Endodontists case difficulty assessment form categorizes cases as minimal, moderate, and high difficulty level. We recently showed that endodontic mishaps occur frequently during treatment of teeth in high difficulty category. The aims were to investigate the clinical and radiographic outcome at least 4 years after RCT and to evaluate patients’ perceived oral health-related quality of life (OHRQoL). Methods: Two hundred thirty-four patients (257 endodontically treated teeth) who were previously included in a quality assurance study were offered a recall appointment at the Department of Clinical Dentistry, University of Bergen, Norway. Patients were given a thorough clinical, radiographic examination and asked to fill out the Oral Health Impact Profile-14 questionnaire. Results: A total of 149 patients (160 teeth) attended the 4-year (range, 4–6 years) recall appointment. An unchanged or lower Periapical Index (PAI) score at recall visit was registered on 153 teeth (95.6%) (P < .001). Radiographic success rate (PAI score ≤ 2) was 87.5%, and clinical success (absence of clinical signs and symptoms) was 88.8%. Both radiographic and clinical success was observed in 78.8% of teeth. Teeth in high difficulty category, instrumented with engine-driven files, and molars presented with significantly more clinical signs and symptoms but not high PAI score (PAI score ≥ 3) (P < .05). Endodontic mishaps such as overinstrumentation and overfill with gutta-percha resulted in significantly high PAI score (P < .05). Patients with no clinical signs and symptoms after RCT and elderly had a significantly better OHRQoL (P < .05). Conclusions: Presence of clinical signs and symptoms rather than PAI score affected patients’ OHRQoL. publishedVersion

This study aimed to compare the effects of static navigation (SN), a dynamic navigation system (DNS), and the freehand (FH) technique in root end resection and the differences between these effects according to the level of experience of the operator.Maxillary models reconstructed with Mimics software (Materialise, Leuven, Belgium) were 3-dimensionally printed and divided according to the experimental technique (FH, SN, or DNS) and the operator (experienced or inexperienced). SN was designed using 3-matic Medical software (Materialise) and printed, and a surgical approach plan for DNS was established and performed using DCARER (Suzhou, China) software. The accuracy, efficiency, and safety of the resections were assayed.The length, angle, volume, and depth deviations of the root end resections were significantly lower in the SN and DNS group compared with the FH group. SN significantly improved the efficiency of both operators, whereas DNS only improved the efficiency of the inexperienced operator. No difference between the SN and DNS groups was found, except for the time required for the surgery. No mishaps occurred during surgery in the SN or DNS group. The number of mishaps with the FH technique when used by the inexperienced operator was significantly higher than that registered for the rest of the groups. No interaction effect between technique and operator experience level was detected.Regardless of operator experience, both SN and DNS could improve the accuracy and safety of root end resection. SN significantly improved the chairside efficiency of both operators, whereas DNS was more helpful for the inexperienced operator.

The efficacy of trypsin-chymotrypsin in postoperative pain management following single-visit root canal treatment of teeth with symptomatic irreversible pulpitis (SIP) was evaluated. Additionally, synergistic effects with nonsteroidal anti-inflammatory drugs (NSAIDs) and reported side effects were also investigated.This prospective, parallel, triple-blinded phase IV randomized controlled trial (RCT) included 60 patients with mandibular first molars exhibiting SIP. The patients were randomly allocated using computer software to one of four treatment groups (n=15 each), and either ibuprofen (600mg), ambezim-G (trypsin 5mg-chymotrypsin 5mg), a combination of both, or a placebo drug were administered postoperatively. The participants scored pain intensity at different time-intervals using a numerical scale, and passive surveillance of harm was used to detect clinical safety. Age was compared between groups using a one-way ANOVA test. Pain scores were analyzed using the Kruskal-Wallis and Friedman's tests and, if significant, Dunn's test was used for pair-wise comparisons. The Chi-square test was used to compare qualitative data, and the significance level was set at p-value≤ 0.05.All interventions were found to be effective in reducing postoperative pain, and no statistically significant differences were observed between the ibuprofen, trypsin-chymotrypsin, and combination groups. However, all three groups differed significantly from the placebo group. The safety profile of the interventions didn't differ significantly.Trypsin-chymotrypsin exhibits comparable efficacy to NSAIDs. No synergistic effects occur when the two are used in combination. This is the first RCT to assess the effects of proteolytic enzymes on post-endodontic pain.

Introduction: The purpose of this study was to evaluate pulp tissue dissolution ability of sodium hypochlorite (NaOCl) when mixed with tetrasodic etidronate (Na4HEBP) and disodic ethylenediaminetetraacetate (Na2EDTA) under controlled flow. Methods: Bovine pulp tissue was extracted from the lower incisors of 10 bovine jaws. Pulp specimens were standardized in size (1 × 3 × 10 mm), blotted dry, and weighed (initial weight [T0]: mean (SD) = 31.98 (1.18) mg). Specimens from the same jaw were randomly assigned to 2 control (n = 3 each) and 4 experimental groups (n = 10 each): NC (negative control/distilled water), PC (positive control/6%NaOCl), G1 (3%NaOCl), G2 (3%NaOCl-17% Na2EDTA), G3 (3%NaOCl-18% Na4HEBP), and G4 (3%NaOCl-9% Na4HEBP). Distilled water and NaOCl were provided using a delivery pump under a continuous controlled rate (1 mL/min). A second pump alternately delivered either Na2EDTA or Na4HEBP at the same rate with a 30-second programmed interval. Percentage of tissue weight loss was calculated at 2, 5, and 10 minutes (T2, T5, and T10) and compared among groups with analysis of variance. Free available chlorine and pH were controlled at T0 and T10. Results: No tissue remained in PC at T5. No dissolution occurred in NC. There were no significant differences in the percentage of weight loss among experimental groups at any point of time. Some remnant tissue was found in G3 (1.4% ± 2.4) and G4 (1.6% ± 2.3) at T10, whereas nothing was left in G1 and G2. Conclusions: The controlled delivery of Na2EDTA and Na4HEBP did not alter tissue dissolution ability of NaOCl when fresh solutions were mixed in the root canal. Sin financiación 4.422 Q1 JCR 2021 1.399 Q1 SJR 2022 No data IDR 2021 UEM

Root resorption is a destructive process that compromises tooth structure and can result in tooth loss. Often it remains asymptomatic and is an incidental finding on radiographic examinations. The purpose of this study was to determine prevalence and characteristics of root resorption in patients referred for cone beam computed tomography (CBCT) imaging for a variety of indications.The study included CBCT scans of 1,086 consecutive patients referred for CBCT imaging over an 18-month period. A total of 1,148 scans were acquired. Data were abstracted from radiology reports, and prevalence estimates of resorption were computed for the aggregate sample and also across specific indications.Resorption was identified in 171 patients (15.7%, 95% CI: 13.6% - 17.9%) and in 249 teeth with a prevalence range of 2.6% - 92.3% across specific indications. An 18.7% of the patients had two resorption sites whereas 8.8% had three or more resorption sites. The majority of affected teeth were anteriors (43.8%), followed by molars (40.6%) and premolars (14.5%). The most prevalent resorption types were external (29.3%), cervical (22.5%), infection-induced apical resorption (13.7%), internal (9.6%) and impacted tooth induced (8.8%). The majority of teeth with resorption did not have prior endodontic treatment (73.9%) and had radiographically normal periapex (69.5%). Of 249 teeth with resorption, 31% presented as incidental finding. The prevalence of incidental findings of resorption (IFR) increased with age, p0.05, and was significantly lower for anterior teeth (20.2%) as compared to premolars (41.7%) and molars (36.6%), (p0.05).The high proportion of IFR detected by CBCT suggests that resorption is not recognized/detected by conventional radiography and therefore remains underdiagnosed.

Pre-Eruptive Intracoronal Root Resorption (PEIR) is a rare yet significant phenomenon in which an abnormal, well-circumscribed, radiolucent area develops in the tooth prior to eruption. This case report outlines the treatment of a 12 year old Hispanic female who was referred for endodontic evaluation of tooth #31 and subsequently diagnosed with PEIR. The patient's chief complaint was recorded as "spontaneous pain" in the lower right quadrant of her jaw. Clinical examination revealed a partially erupted tooth #31 with no visible decay. Radiographic examination, including a CBCT scan, led to the detection of a radiolucent area surrounding the pulp chamber on the mesial aspect of tooth #31. Radiographically, the enamel appeared intact with no signs of perforation. Based on the clinical and radiographic evaluation, tooth #31 was determined to have PEIR, with the pulpal and periapical diagnosis of "Symptomatic Irreversible Pulpitis" and "Normal Apical Tissue," respectively. The Orthodontic consultation obtained for this patient recommended that tooth #31 be maintained at least until tooth #32 appeared in the oral cavity and could be used as a replacement. Therefore, a treatment plan involving vital pulp therapy (VPT) and gingivectomy was selected. During the procedure, granulation tissue was excavated and sent for histological evaluation, which concluded the presence of "granulation tissue with acute and chronic inflammation". No caries were detected. Following the procedure, the tooth was found to be asymptomatic with continued root development. A positive response to EPT was achieved after 3.5 years of follow up.

Candida spp has recently been introduced to interact with conventional carious bacteria, leading to dental caries progression and virulence ability. Evidence regarding the influence of Candida spp on human dental pulp cell response remains unknown. This study aimed to investigate the effects of Candida albicans mannans on cytotoxicity, cell proliferation, osteogenic differentiation, and inflammatory-related gene expression in human dental pulp cells (hDPs).hDPs were treated with cell wall mannans isolated from C. albicans, C. krusei, C. glabrata, C. tropocalis, C. parapsilosis, and C. dubliniensis. Cell viability was performed using an MTT assay. Osteogenic differentiation- and inflammatory-related gene expression were determined using a real-time polymerase chain reaction. Mineralization was examined using Alizarin Red S staining.The treatment of mannans isolated from C. albicans, C. krusei, C. glabrata, C. tropocalis, C. parapsilosis, and C. dubliniensis at concentrations ranging from 10 to 100 ug/mL did not affect cytotoxicity or cell proliferation. Mannans isolated from C. albicans, C. glabrata, and C. tropocalis significantly attenuated mineralization. However, cell wall mannans isolated from C. krusei, C. parapsilosis, and C. dubliniensis did not significantly influence mineral deposition in hDPs. C. albicans cell wall mannans significantly attenuated osteogenic differentiation-related gene expression (RUNX2, ALP, and ENPP1). Interestingly, IL-12 mRNA expression was significantly upregulated when treated with C. albicans cell wall mannans. The addition of IL-12 significantly decreased mineralization in hDPs.C. albicans cell wall mannans attenuated osteogenic differentiation in hDPs and upregulated inflammatory-related gene, IL12, expression.

The purpose of this study was to evaluate the antimicrobial efficacy of a novel irrigation strategy using synchronized microbubble-photodynamic activation (SYMPA) in a minimally prepared single canal.Single canal mandibular incisors were inoculated with Enterococcus faecalis for 3 weeks, and randomly allocated to 4 groups based on the irrigation protocols: (1) control (saline), (2) conventional needle irrigation (CI), (3) ultrasonic-assisted irrigation (UI), (4) irrigation with SYMPA. The first three groups were instrumented to size 25.07v (WaveOne Gold Primary) and SYMPA group was minimally prepared to size 20.07v (WaveOne Gold Small, Dentsply Sirona, Tulsa, OK). The apical 5mm was resected for microbiological assessment using culture technique (colony-forming-unit (CFU)), ATP-based viability assay (relative luminescence units (RLU)), and percentage of live bacteria using confocal-laser-scanning-microscopy (CLSM).Log CFU from UI (2.37 ± 0.66) and SYMPA (2.21 ± 0.86) showed reduction compared to control (5.16 ± 0.75) and CI (4.08 ± 1.19). RLU reduction was significant for UI (619.08 ± 352.78) and SYMPA (415.25 ± 329.51) compared to control (1213.2 ± 880.03) (p.05). The percentage of live bacteria was significantly lower in UI, SYMPA, compared to control and CI. Although higher microbial reduction was observed in SYMPA when compared to UI, there was no statistical significance (p.05).SYMPA in minimally prepared canals showed significant antimicrobial efficacy. The novel irrigation strategy using SYMPA could be an effective disinfection strategy for minimally prepared root canals.

Apical periodontitis (AP) represents an inflammatory condition of peri-radicular tissues due to invasion and colonization of bacteria in the root canals. Primary AP (PAP) is associated with untreated necrotic root canal and can be efficiently treated with endodontic treatment to remove bacteria. Persistent/secondary AP (SAP) is a perpetual periapical lesion due to unsuccessfully treated root canals after an initial apparent healing of the tooth. The aim of the study was evaluating the microbial communities associated with root canals using Nanopore sequencing.Seventeen samples from the root canals of 15 patients with AP were PCR-amplified for 16srDNA gene and sequenced. Information regarding the presence or absence of AP symptoms, PAP and SAP and periapical index (PAI) of patients were recorded.Firmicutes, Bacteroidetes and Actinobacteria were the most abundant phyla detected and Phocaeicola, Pseudomonas, Rothia and Prevotella were the most prominent genera. In samples of patients with AP symptoms, the most frequent detected genera were Cutibacterium, Lactobacillus, Pseudomonas, Dialister, Prevotella and Staphylococcus. In PAP samples, the most represented genera were Cutibacterium, Lactobacillus, Pseudomonas and Prevotella, whilst in SAP cases were Cutibacterium, Prevotella, Atopobium, Capnocytophaga, Fusobacterium, Pseudomonas, Solobacterium and Streptococcus.The results provide additional information on the microbiota of root-canals. These data evidence the complexity of the microbiota and the relationship with many clinical and endodontic conditions. Future studies must evaluate these conditions and identify their role in inducing bone damage and local and systemic disease, aiming to better elucidate the relationship between microbes and endodontic pathologies.

The scaffolds used in regenerative endodontic therapy (RET) provide structural support for cells so that they can adhere to the scaffolds and also are crucial for cellular proliferation and differentiation. The objective of this network meta-analysis was to compare effects of different intracanal scaffolds on success outcomes of RET.PubMed/Medline, EMBASE, Cochrane, CINAHL, Scopus, and Web of Science databases were searched. Studies evaluating and/or comparing clinical and/or radiographic success of RET using different scaffolds with a minimum of 12 months follow-up were included. The Cochrane Collaboration risk of bias (ROB) tool and appropriate tools from Joanna Brigg's Institute were used for the assessment of ROB. A network meta-analysis was performed to compare the primary outcome (clinical success) and other success outcomes (root maturation, and pulpal sensibility) using different scaffolds.Twenty-seven studies fulfilled the desired inclusion criteria of which 25 had a low ROB whereas two had a moderate ROB. Clinical success of RET using platelet-rich plasma (PRP), blood clot (BC), and platelet-rich fibrin (PRF) scaffolds ranged between 91.66%-100%, 84.61-100%, and 77-100% respectively. The different scaffolds did not show any statistically significant difference in clinical success (PRF versus BC [p=1.000], PRP versus BC [p=1.000], and PRF versus PRP [p=0.999]), apical root closure (PRF versus BC [p=1.000], PRP versus BC [p=0.835], PRF versus PRP[p=0.956]), and pulp sensibility (PRF versus BC[p=0.980], PRP versus BC [p=0.520], and PRF versus PRP, p=0.990]).The intracanal scaffolds used during RET did not result in significant differences in regard to clinical success, root maturation, and pulpal sensibility.

The retreatment of teeth obturated with bioceramic sealers has shown to be challenging. The purpose of this study was to compare the efficacy of 10% Formic acid (FA), 20% Hydrochloric acid (HCL), and chloroform for achieving patency in teeth obturated with a bioceramic sealer.45 extracted single-canaled teeth were instrumented and obturated 1.5 mm short of the working length using gutta-percha and EndoSequence BC sealer (Brasseler USA, Savannah, GA). 2 weeks later gutta-percha was removed, and apical patency was attempted with a 10 C file and a solvent (FA, HCL, or chloroform). The time to gain patency through the BC sealer was recorded. Five additional teeth were irrigated with the solvents, and SEM was used to evaluate the effect of solvents on the dentin. Kruskal Wallis and Mann Whitney were used for statistical analysis.Patency was achieved in all canals except for 1 in the chloroform group. Regarding the time to achieve patency, no significant difference was noted between chloroform and FA (P0.05). However, there was a significant difference between chloroform and HCl (P0.05) and between FA and HCl (P0.05) Erosion of dentinal tubules was more evident when HCL was used compared to the other irrigants.20% HCl was superior to 10% FA and chloroform in achieving patency in teeth obturated with BC sealer. Regardless of the solvent used, patency may be achieved for most of the cases obturated with gutta-percha and BC sealer.

The aim of this study was to assess the temporal evolution of external cervical resorption (ECR) defects using a volumetric quantification method.Cone-beam computed tomographic (CBCT) images of patients diagnosed with ECR who chose not to receive treatment and attended recalls were collected. ECR defects were segmented in CBCT images at baseline and recall, and their volumes were quantified. The volumetric ratio of resorption defects/teeth was calculated. Three-dimensional classification of defects at baseline and recall and the prevalence of root surface perforations ≥1 mm were determined. The Wilcoxon matched pairs signed rank test, chi-square test, and linear regression models were used to analyze the data.Fifteen patients with 20 teeth diagnosed with ECR and an average recall time of 21 months were included. Nine (45%) teeth showed a change in 3-dimensional classification at recall. The volume of resorption defects (P = .0001) and the volumetric ratio of resorption defects/teeth (P = .0001) increased over time. The prevalence of root surface perforations ≥1 mm was higher at recall (n = 17, 85%) compared with baseline (n = 9, 45%) (P = .008). Linear regression models showed significant associations between the resorption defect volume at recall compared with baseline (P .0001; 95% confidence interval, 0.053-0.081) and the volumetric ratio of resorption defects/teeth at recall compared with baseline (P .0001; 95% confidence interval, 0.205-0.356). There was no association between the volume of resorption defects at recall with the length of the recall period, sex, or age (P .05).When left untreated, ECR defects can increase in size and develop more root surface perforations. ECR has a dynamic nature, and its volumetric increase over time does not result from uniform/linear expansion of the defects.

The conventional treatment for irreversibly inflamed or necrotic teeth is root canal treatment or apexification. Regenerative endodontics aims to regenerate the damaged "pulp-like" tissue, which can preserve the teeth' vitality and sensitivity while avoiding necrosis. The main clinical benefit is root maturation. The "pulp-like" tissue does not refer to regenerated pulp tissue with an odontoblastic layer or the formation of pulp-dentin complexes. The cell homing technique is built on endogenous stem cells and their capacity to regenerate tissue. Cell homing refers to endogenous cells' migration or infiltration into the cite when stimulated by physiochemical or biological stimuli or by passive flow with a blood clot from the apical tissue. Its Regenerative Endodontic Procedures success criteria are defined by the American Association of Endodontists. The purpose of this article is to provide an overview of vital pulp tissue and various strategies to promote regeneration of damaged pulp tissue. The cell homing technique will be reviewed through clinical trials.We performed a comprehensive literature review on a total of nine clinical trials of regenerative endodontics using the cell-homing technique based on three databases and duplicate manuscripts were removed.Regenerative endodontics using the cell-homing technique shows promising results that can be translated into clinical practice. However, a favorable result was observed in immature teeth, and the results are contradictory in mature teeth.Regeneration therapy is an attractive new alternative to conventional endodontic treatments. Preservation of vitality and continuation of root development in damaged teeth would be a clear advantage.

The purpose of this study was to evaluate the physicochemical and biological properties of AH Plus Bioceramic (AHPB; Dentsply Sirona, Charlotte, NC) in comparison to AH Plus (AHP, Dentsply Sirona) and EndoSequence BC Sealer (BC; Brasseler, Savannah, GA).The setting time, radiopacity, flow, solubility, calcium ion release, and pH were evaluated following ISO guidelines. Surface characterization and chemical constitution were evaluated by scanning electron microscopy/energy-dispersive X-ray spectroscopy. The antibacterial effect was tested against Enterococcus faecalis. Sealer cytotoxicity was tested using the XTT cell viability assay. Analysis of variance, Tukey, and unpaired t tests were used with a significance level of 5%.The initial setting time of AHPB was shorter than AHP and BC (P ≤ .0001), whereas AHP showed a shorter final setting time (P ≤ .0001). AHPB was more radiopaque than BC (P = .0012) but less radiopaque than AHP (P = .0001). AHPB was more soluble than AHP (P ≤ .0001), whereas no difference was observed between AHPB and BC (P .05). Immersion in phosphate-buffered saline decreased the solubility of AHPB and BC (P ≤ .005). AHPB calcium ion release was higher than AHP (P ≤ .05) but less than BC (P ≤ .0001). AHPB had the highest flow followed by AHP and BC (P .05). All sealers were alkaline and able to eradicate E. faecalis. Surface morphology and chemical composition of all sealers changed after immersion in water and phosphate-buffered saline. Cell viability for AHPB and BC was higher than AHP (P ≤ .0001).AHPB presented adequate properties to be considered a good sealer, however, the high solubility may negatively impact the quality of the obturation.

The purpose of this study was to evaluate and compare 2 different access cavity designs in combination with 2 popular single-file preparation systems to see which combination preserves dentin, more specifically pericervical dentin, best. The minimum remaining dentin thickness and dentin volumes were evaluated pre- and postinstrumentation.Sixty extracted human mandibular molars were selected and randomly divided into 2 different access cavity design preparation groups: traditional access cavities (n = 30) and conservative access cavities (n = 30). Within each cavity preparation design group, the 30 teeth were divided into 2 instrumentation groups (WaveOne Gold Primary; Dentsply Sirona, Ballaigues, Switzerland [n = 15] and TruNatomy Prime, Dentsply Sirona [n = 15]). Samples were scanned using micro-computed tomographic imaging before and after access cavity preparation as well as after final endodontic instrumentation. The pericervical remaining dentin thickness and dentin volume changes were evaluated and compared.Conservative access cavity designs resulted in more favorable remaining dentin thickness. The least amount of mean dentin volume loss was also recorded in the conservative access cavity preparation groups regardless of the preparation instrumentation.In terms of the remaining pericervical dentin thickness and dentin volume reductions, the authors conclude that conservative access cavity designs preserve dentin best.

Inflammation of the dental pulp due to caries is a highly prevalent pathology which causes intense pain. Here, we sought to correlate the clinical picture with the histopathology of the affected tissue. The interaction between nociceptive neurons and immune cells is fundamental to regulate the inflammatory response, but little is known about the glial network involved in this process, and its impact on caries pathogenesis.This study characterized Schwann cells and other neuroimmune components in human dental pulps with reversible and symptomatic irreversible pulpitis (IP). Twenty eight human teeth were extracted for reasons beyond the scope of this study. Twelve were diagnosed as reversible and symptomatic IP respectively, and 4 as controls. The teeth were decalcified, processed for immunolabeling and analyzed with confocal microscopy.Symptomatic IP was characterized by a significantly higher density of neutrophils, and the release of neutrophil extracellular traps. Between IP and healthy controls, there were significant differences in the density of Schwann cells, macrophages, and neutrophils, in addition to morphological alterations. In IP, Schwann cell arborization extended toward the pulpodentinal interface along with more spindle-shaped cell bodies, while some macrophages displayed a distinct fusiform phenotype.The dental pulp has a complex multicellular organization and its pulpodentinal interface acts as a barrier in which Schwann and immune cells are distributed strategically to stop the progress of pathogens. A synergistic interaction of Schwann cells with immune cells creates a novel perspective to better understand the role of these glial cells and their active participation in pulpal inflammation.

This clinical study evaluated the antibacterial effects of calcium hydroxide associated with different vehicles during the treatment of infected teeth with apical periodontitis.Bacteriologic samples were taken from 90 necrotic root canals of teeth with apical periodontitis before (S1) and after preparation with a rotary nickel-titanium instrument system and 2.5% sodium hypochlorite irrigation (S2). The teeth were distributed in 3 groups according to the intracanal medication used, which consisted of a calcium hydroxide paste in glycerin, camphorated paramonochlorophenol/glycerin (CHPG), or 2% chlorhexidine for 1 week, and then another sample was taken (S3). The frequency of bacteria-positive cases and the reduction of bacterial counts were evaluated by quantitative real-time polymerase chain reaction.Substantial intracanal bacterial reduction was observed after preparation in the 3 groups (P .001). After calcium hydroxide paste in glycerin medication, the number of bacteria-positive cases decreased from 20/29 (69%) to 17/29 (59%); however, the mean bacterial counts increased 8.4% from S2 to S3. Medication with CHPG reduced the number of bacteria-positive cases from 17/29 (59%) to 15/29 (52%), with a significant mean S2-S3 reduction of 71% (P .05). In the chlorhexidine group, the number of bacteria-positive cases decreased from 21/30 (70%) to 17/30 (57%) after medication, with a mean S2-S3 reduction of 55%, which, however, was not statistically significant (P .05). Intergroup comparisons showed no significant differences (P .05).Comparison between the 3 calcium hydroxide pastes showed no significant differences in antibacterial effectiveness in the main root canal. However, only the CHPG paste showed a significant reduction in bacterial counts when postpreparation and postmedication samples were compared.

A rare case of extensive multiple idiopathic cervical root resorption with potential genetic predisposition was presented. A heathy 19-year-old Chinese male with no contributory medical or family/social history complained of pain during mastication that lasted for several months. Oral examination identified 7 missing teeth and external cervical root resorption involving 9 teeth. Comparison of orthopantomograms taken in May 2021 and February 2022 identified that cervical root resorption occurred in 22 teeth. Resorption commenced at the cementoenamel junction and progressed rapidly over the 9-month period. Laboratory test results were within normal limits. Trio-based whole-exome sequencing showed a missense mutation c.5630 C T in the filamin A (FLNA) gene at chromosome X of the subject. This is suggestive of the possibility of sex-linked recessive inheritance. This is the first study to report FLNA mutation in human subjects with cervical root resorption involving multiple teeth.

Endodontic microsurgery is important for preservation of natural teeth with symptomatic apical periodontitis when conventional endodontic treatment is neither feasible nor effective. The thick buccal cortex, poor visibility, and potential neurovascular complications can make microsurgical procedures of mandibular second molars infeasible. With the aid of cone-beam computed tomography, the bony lid approach was applied in 10 cases of endodontic microsurgery of mandibular second molars at the VIP Center, Hangzhou Stomatology Hospital between 2019 and 2020. In all cases, the clinical and radiographic findings at the 24- or 36-month follow-up revealed complete healing of the periapical lesions. The bony lid technique contributed to precise root-end localization and helped avoid excessive postoperative pain or unfavorable healing that occurred in cases of excessive alveolar bone resection. Some clinical tips on preserving the cortical bone, obtaining precise access, and improving surgical efficiency have been proposed in this report.

In this study, we generated a 3-dimensional (3D) collagen fibrous scaffold for potential pulp regeneration and investigated the influence of various pore sizes of these scaffolds on proliferation, odontoblastic differentiation of human dental pulp cells (hDPCs), and subsequent tissue formation during pulp regeneration.Electrospinning followed by freeze-drying was used to fabricate 3D fibrous collagen scaffolds. hDPCs were cultured on these scaffolds. Cell growth was detected by a Cell Counting Kit-8 assay and observed via scanning electron microscopy. Odontogenic genes and protein expression were analyzed by real-time reverse transcription polymerase chain reaction and immunofluorescence staining. The formation of mineralized nodules was tested by von Kossa staining, scanning electron microscopy, and energy-dispersive X-ray microanalysis. Subcutaneous transplantation of the seeded scaffold/tooth fragments into nude mice was performed to observe tissue formation for pulp regeneration.Collagen 3D fibrous scaffolds with 3 distinct mean pore sizes (approximately 20 μm, 65 μm, and 145 μm) were fabricated, which showed good biocompatibility and bioactivity. Scaffolds with larger mean pore sizes of 65 and 145 μm improved hDPC ingrowth and proliferation, with the 65-μm scaffold group presenting the highest level of odontogenic gene expression (DSPP and DMP-1), protein expression (DMP-1), mineralized area ratio, and vascular pulplike tissue formation after 6 weeks of subcutaneous implantation.The pore size of collagen 3D fibrous scaffolds significantly affected cell adhesion, proliferation, odontoblastic differentiation, and tissue rehabilitation. Scaffolds with a mean pore size of 65 μm presented superior results and could be an alternative for pulp regeneration.