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Introduction. Endodontic iatrogenia, such as iatrogenic perforation, formation of ledges, blockage of canals, instrument breakage, unaddressed anatomical complexities, can have a substantial impact on the long-term outcome of endodontic treatment. The most frequent complications during endodontic treatments are root canal perforations, ledges, and instrument fractures. Prevention and management. Endodontic iatrogenia can be prevented by the use of AAE’s assessment tool (low, moderate, high difficulty cases), operator microscope, static/dynamic guided endodontics systems. Steps in management of endodontic iatrogenia consists of: assessment and diagnosis, communication with patient, immediate management, referral to specialist for non-surgical or surgical approach if necessary, monitorisation of healing process. Conclusions. Clinicians must possess a comprehensive understanding of the causes, prevention strategies, and reliable corrective measures for specific endodontic iatrogenia. Endodontic iatrogenia must be managed by individualised therapeutic approach using effective instrumentarium and biomaterials for positive long-term outcomes. Interdisciplinary collaboration of general dentist with specialists (endodontic specialist, oral surgeon) can be required in complex cases.

The aim of the study was to collect data about the prevalence and risk factors of apical periodontitis in a population of endodontically treated patients. The study group included 151 patients (52 males, 99 females; mean age 48.36 ± 15.708 yrs.) with 391 endodontically treated teeth (mean follow-up of 5.25 ± 1.759 yrs.). According to the initial tooth diagnosis, root-filled teeth were divided into Group A, root-filled teeth treated for pulpitis or for the purpose of prosthetic pulpectomies (vital pulp group), and Group B, root-filled teeth with non-vital pulp (necrotic pulp). Clinical and radiographic evaluation of the root and its periapical area were performed to establish the success/failure of endodontic therapy, the quality of the root canal fillings (length, density, taper), and coronal restoration. The presence of recurrent caries, periodontal pathology, or endo-periodontal lesions were also recorded. Univariate and multivariate analyses were used to determine the risk factors for apical periodontitis and calculate their odds ratios (ORs). For the root-filled vital pulp tooth group, the highest risks for apical periodontitis are associated with inadequate homogeneity (OR 30.938), periodontitis (OR 9.226), and over-filling (OR 8.800). For the root-filled non-vital pulp tooth group, the highest risks are associated with periodontitis (OR 4.235) and age over 60 yrs. (OR 4.875). For the necrotic pulp tooth group, multivariate analysis identified an age > 60 yrs., filled molars, intracanal posts, poor coronal restoration quality, under-filling, and periodontitis as significant combined risk factors. Inadequate root canal filling and periodontitis in both groups were risk factors associated with most cases of apical periodontitis. Other risk factors include age > 60 yrs., poor coronal restoration quality, and the presence of intracanal posts in root-filled teeth with necrotic pulp. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the variation in the size of periapical lesions in patients with ENT cancer before and after radiotherapy by using the imaging examination represented by CT. Materials and methods: our study included 35 cancer patients-34 men and one female, with ENT cancer, under treatment at the Regional Institute of Oncology, Iasi. They were examinated by four endodontist, two radiologists and an ENT doctor. We measured the size of the periapical lesions before and after radiotherapy. Results: We found the change in the dimensions of periapical lesions: their maximum overall size was initially 5.4591 ± 3.88509 mm; after radiotherapy the global maximum size reached 7.0000 ± 3.37510, reaching 14.00 mm. The observed difference was statistically significant, so it could be stated that radiotherapy accentuates the severity of periapical lesions systematically. Before radiotherapy, the most extensive periapical lesions were observed in the case of laryngeal neoplasm ( with an average of 6.6778 ± 4.17246 mm) and nasopharyngeal neoplasm ( with an average of 6.000 ± 2.82843 mm) and the lowest ones were found in the case of the neoplasm of the oropharynx (with an average of 4.0000 ± 3.74166 mm). After radiotherapy, we found an increase in the size of the periapical lesions in the case of all five types of neoplasm investigated. The most extensive lesions were observed in the case of the neoplasm of the oropharynx, with an average of 7.6000 ± 3.84708 mm, followed by the neoplasm of the larynx, with an average of 7.4000 ± 3.33999 and the neoplasm of the oral cavity, with an average of 7.4000 ± 4.33590 mm. Disscusions: In terms of expectancy and quality of life of patients can only be achieved through a multidisciplinary approach. As soon as the dentist diagnoses a pontetially malignant disorder in the ENT sphere, patients should undergo an ENT screening complete for detecting lesions in any area of the upper aerodigestive tract. After radiotherapy an increase in the size of the periapical lesions is observed. The ENT doctor must encourage the patients with ENT cancer to extract their teeth with periapical lesions before the implementation of radiotherapy to avoid the risk of postradiotherapy osteoradionecrosis. Conclusions: By using CT, the increase in the size of periapical lesions after radiotherapy is observed in patients with cancer in the ENT sphere. [ABSTRACT FROM AUTHOR]

Temporo-mandibular disorders (TMDs) represent a major cause of non-dental pain in the orofacial region, the effects of which may be presumed to form at the site where the greatest forces are exerted, and host resistance is least. The signs and symptoms of TMDs which are observed in patients with psychiatric easy disease observed and measured by anthropometrical methods and correct with specific treatment. The literature reviewed in the present work revealed that suggests a complex relationship between psychological status and treatment outcome and TMDs signs and symptoms in different groups of individuals persists and the specificity and morphological dates also. Timely identification and the management of this condition may improve the comfort and psychic status of the patients, underlined also in our research. [ABSTRACT FROM AUTHOR]

Aim. The aim of study was to assess the root-filled teeth with periapical lesions by using Periapical and Endodontic Status Scale (PEES) index. Materials and method. The study group included 166 filled root canals (70 molars and premolars) in 42 patients (gender: 12 males, 32 females; mean age 35.90 ± 10.571 yrs.) treated in Clinical Base of Faculty of Dental Medicine, U.M.F. "Grigore T.Popa" Iasi. The evaluation of root canals and periapical areas was performed by using the two components of Periapical and Endodontic Status Scale (PEES) index, COPI and ETTI. Results. Distribution of COPI components in the study group was as follows: COPI D: 30,7% D1, 69,3% D3; COPI R: 27,1% R1, 70,5% R2, 2,4% R3; COPI S: S1 16,3%, S2 21,7%, S3 62%. Distribution of ETTI components in the study group was as follows: ETTI L: 42,2% L1, 43,4% L2, 5,4% L3, 5,4% L4, 3,6% L5; ETTI H: 36,7% H1, 63,3% H2; ETTI CS: 10,8% CS1, 89,2% CS2; ETTI CF: 3,6% CF1, 9% CF2, 5,4% CF3, 81,9% CF5. Conclusions. In endodontically treated teeth with apical periodontitis, PEES indices allowed to detect 62% of root canals with periapical lesions with diameter over 5 mm, while more than two thirds of teeth roots had periapical lesions extended in cortical bone (69,3%) affecting more than one root (70,2%). All teeth roots with apical radiolucency and non-treated root canals as well as roots with perforations or resorptions had apical lesions with diameter over 5 mm extended in cortical bone. The presence of apical radiolucency more than one root was associated to overfilling or root resorption. [ABSTRACT FROM AUTHOR]

Dysfunctional syndromes of the stomatognathic system are interconnected with various pathologies, including complex psychiatric conditions. In these intricate cases, an interdisciplinary approach that integrates both dentistry and psychiatry is crucial. Effective oral rehabilitation demands strategic treatment plans designed to enhance quality of life and achieve optimal results for patients with schizophrenia. [ABSTRACT FROM AUTHOR]

This article presents the findings of a study on the prevalence of apical periodontitis in root-filled teeth. The study found that 46.3% of the teeth had periapical lesions, and the prevalence varied based on demographic and clinical factors. The article highlights the advantages of using cone-beam computed tomography (CBCT) in diagnosing and monitoring the outcomes of root canal treatment. The study concludes that CBCT examination and the CBCT-PAI index are reliable tools for evaluating the healing process of chronic periapical lesions. The research also suggests that inadequate root canal filling and poor coronal marginal sealing contribute to treatment failure. [Extracted from the article]

This article discusses the relationship between dysfunctional syndrome of the stomatognathic system and schizophrenia, emphasizing the need for an interdisciplinary approach in treating complex oral rehabilitation cases in patients with schizophrenia. It provides a detailed clinical case of a patient with schizophrenia and their specific oral rehabilitation needs. The article also discusses therapeutic solutions and objectives for the rehabilitation process. Additionally, the document is a clinical examination report that assesses the oral health status of a schizophrenic patient, including their medical history, physical condition, dental examination findings, and periodontal risk factors. The report aims to develop a treatment plan that addresses both the patient's dental needs and psychological well-being. [Extracted from the article]

This article discusses the use of cone beam computed tomography (CBCT) in assessing the success or failure of endodontic treatment in root-filled teeth. The study found that 49.2% of the root-filled teeth showed signs of chronic apical periodontitis, indicating failure of the treatment. The distribution of CBCT-PAI indices was significantly influenced by factors such as age, follow-up period, dental group, quality of coronal restoration, and quality of endodontic treatment. The study confirms previous research that identified these factors as risk factors for endodontic failure. CBCT was found to be a valuable tool in detecting periapical lesions and assessing treatment outcomes. The article emphasizes the importance of CBCT in improving the assessment and management of endodontic treatment outcomes. [Extracted from the article]

This article from the Romanian Journal of Oral Rehabilitation examines the use of interdisciplinary approaches in treating young patients with social anxiety who require complex intraoral rehabilitation. The authors stress the significance of a well-developed protocol to instill confidence and ensure effective and efficient therapeutic treatment. The study focuses on twenty cases of social anxiety and explores the relationship between psychiatric and dental anxiety. The article also presents a diagnosis and treatment plan for a specific patient, discussing the management and treatment of patients with dental and social anxiety in the context of oral cavity treatments. It emphasizes the importance of behavioral therapy and personalized treatment plans to address the mild to moderate effects of anxiety. The study also highlights the importance of multidisciplinary approaches and specialized protocols for patients with special needs. The text references various studies and scales used to measure anxiety levels and examines the connection between anxiety and oral health. [Extracted from the article]

This article from the Romanian Journal of Oral Rehabilitation examines the relationship between hearing loss and mental health issues, as well as the treatment options for patients with hearing loss. The study focuses on the therapeutic implications of diagnosing and treating comorbid conditions such as hearing loss, mental disorders, and temporomandibular joint (TMJ) disorders. The research sample consisted of 28 patients with hearing loss who sought treatment for TMJ disorders. The article outlines the stages of the treatment plan and suggests that further testing is needed to determine the long-term effects of the treatment. It also discusses the potential role of orthognathic therapy in improving ear function and dental malocclusion. Temporomandibular disorders (TMDs) are a common condition associated with orofacial pain and can be linked to comorbid conditions such as headaches, tinnitus, and hearing loss. Physiotherapy treatments have been shown to be effective in treating TMDs and improving symptoms. Complex oral rehabilitation can lead to recovery and homeostasis in patients with TMDs. [Extracted from the article]

Aim of the study This study aimed to explore the possibility that digitized conventional periapical radiographs to be used for an accurate assessment and measurement of the results of the endodontic treatment for patients with chronic apical periodontitis (CAP). Material and methods The study included 20 patients (12 males, 8 females) with ages between 18-38 years, presenting severe CAP with non-surgical endodontic treatment recommendation. For each patient, conventional intraalveolar periapical radiographs were taken initially (before and after treatment completion) and at interval of 24 months. The endodontic therapy used intracanalar medications (calcium hydroxide paste for 14 days) and endodontic sealer (Endoflas, Sanlor) with high antibacterial and remineralisation properties. The group of digitized radiographs was submitted to the radiodensitometric measurement. Results The results regarding the success rate of CAP healing were as follows: 1 case had no periapical healing (5%), 11 cases presented (55%) partial bone periapical healing and 8 cases (40%) presented complete periapical healing with total absence of periapical radiotransparence. The degree of bone remineralisation for the cases with partial bone healing varied between 52% and 80%, with a mean value of 66%. Conclusions The radiodensitometric measurements of periapical and CAP area provides a tool of quantitative assessment of the healing of CAP after completion of endodontic treatment.

Aim study. The personal study aimed to determine pH and solubility of some root canal sealers used frequently in the treatment of chronic apical periodontitis. Materials and method The sealers were prepared accordingly to producer instructions. The analysis of pH was performed after a mixture between 0.5 g sealer and 20 ml sol. KCl 0,1N was shaked for 5 minutes. The pH values were recorded at diverse time intervals (baseline, 24 h, 7 days, 14 days) using pH-meter SEIBOLD WIEN. The analysis of solubility was focused on two hydroxid calcium based endodontic sealers (Sealapex- Septodont, Endoflas- Sanlor) immersed in two artificial solutions with pH 6 and pH 7,5. The solubility was assessed, at diverse time intervals (24 h, 48 h, 72 h) measuring the solid substance dissolved in 100 ml specific solvent. Results The pH values at baseline were 8.65 (Sealapex), 8.55 (Endomethasone), 8.26 (Endospad), 6.68 (AH26) and 5.80 (Pulpispad). The pH values after 2 weeks were 9.13 (Sealapex), 8.90 (Endomethasone), 8.72 (Endoflas), 8.50 (Endospad), 6.66 (Pulpispad) and 6.59 (AH26). Sealapex presents lowest solubility at pH 6 after 48 hours. After 72 h, solubility of Endoflas is higher comparing with Sealapex at pH 7.5. Conclusions The endodontic sealers with highest pH values present significant antibacterial and periapical remineralisation effects (Sealapex 8.65, Endospad 8.26, Endoflas 7.2). The degree of coronal filling sealing is an important factor to avoid the solubility of endodontic cements and to ensure the success of endodontic therapy.

Introduction MMP8 are secreted as inactive proproteins, stored in secondary granules within neutrophils and are activated by autolytic cleavage. The function of MMP8 is degradation of type I, II and III collagens. In this context, the concentration of MMP8 can be related to the intensity of inflammatory processes associated with chronic periapical lesions. Objectives The aim of our study was to measure changing of MMP8 within the periapical secretion of teeth affected by periapical lesions and treated with antibacterial medication, using immunological tests. Methods Study group included 22 patients with age 22-64 years. A number of 30 teeth with periapical lesions (periapical granuloma and diffuse periapical osteitis) were submitted to endodontic treatment and filled with Ca(OH)2 paste. The periapical secretion was collected with paper points at baseline, after 14 days and after 28 days. The concentration of MMP8 was assessed using ELISA test Quantikinine (Human MMP-8 Immunoassay, R&D System, USA) based on quantitative sandwich enzyme immunoassay. Results and discussions At baseline the mean concentration of MMP8 was 31.3 ng/mL. The concentrations of MMP8 were closely related to the type of periapical lesion: 12.5 ng/mL for incipient periapical lesions, 18.1 ng/mL for small periapical granuloma and 91.6 ng/mL for extended periapical granuloma. The levels of MMP8 decreased gradually after 2 weeks and 4 weeks comparing with baseline. Conclusion Metaloproteinases (MMP8) could be used as biochemical markers of the periapical status of inflammatory processes in course of initial stage of endodontic therapy.