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This document provides a comprehensive overview of therapeutic solutions for the discoloration of calcified teeth based on CBCT diagnosis. It emphasizes the importance of compiling a correct case history and conducting a CBCT study to establish a diagnosis and determine the best treatment plan. The document discusses different types of tooth discoloration and their corresponding treatment options, such as dental bleaching and the use of ceramic veneers. It also highlights the importance of minimally invasive treatments and informed consent for patients. Additionally, the document provides a step-by-step clinical management guide for treating tooth discoloration caused by pulp canal obliteration (PCO). [Extracted from the article]

A healthy 47-year-old woman consulted the Oral Surgery and Implantology Unit of the University Hospitals of Geneva with a request to treat her painful tooth 11 and replace the missing tooth 21. The dental history revealed that the patient had lost teeth 21 and 22 due to advanced caries. On clinical examination, tooth 11 showed an ill-fitting prosthetic crown with overhanging margins, an increased localized probing depth of 8 mm in the disto-vestibular area, and sensitivity to percussion. The edentulous site 21 showed horizontal bone atrophy. Radiological examination revealed a well-defined unilocular radiotransparent lesion surrounded by a thin radiolucent border, located at the apex of tooth 11 and measuring 10 × 8 mm. The treatment consisted of extraction of 11, enucleation of the apical lesion, and insertion of implants at sites 11 and 21 with simultaneous bone augmentation in a single surgical procedure, with aesthetic and functional results at 3-year follow-up without any complications. Our case highlights that immediate implant placement in cases of cystic periapical lesions represents a good valid alternative to standard treatment. [ABSTRACT FROM AUTHOR]

Enterococcus faecalis is an important contributor to the persistence of chronic apical periodontitis. However, the mechanism by which E. faecalis infection in the root canals and dentinal tubules affects periapical tissue remains unclear. Bacterial extracellular vesicles (EVs) act as natural carriers of microbe-associated molecular patterns (MAMPs) and have recently attracted considerable attention. In this study, we investigated the role of EVs derived from E. faecalis in the pathogenesis of apical periodontitis. We observed that E. faecalis EVs can induce inflammatory bone destruction in the periapical areas of mice. Double-labeling immunofluorescence indicated that M1 macrophage infiltration was increased by E. faecalis EVs in apical lesions. Moreover, in vitro experiments demonstrated the internalization of E. faecalis EVs into macrophages. Macrophages tended to polarize toward the M1 profile after treatment with E. faecalis EVs. Pattern recognition receptors (PRRs) can recognize MAMPs of bacterial EVs and, in turn, trigger inflammatory responses. Thus, we performed further mechanistic exploration, which showed that E. faecalis EVs considerably increased the expression of NOD2, a cytoplasmic PRR, and that inhibition of NOD2 markedly reduced macrophage M1 polarization induced by E. faecalis EVs. RIPK2 ubiquitination is a major downstream of NOD2. We also observed increased RIPK2 ubiquitination in macrophages treated with E. faecalis EVs, and E. faecalis EV-induced macrophage M1 polarization was notably alleviated by the RIPK2 ubiquitination inhibitor. Our study revealed the potential for EVs to be considered a virulence factor of E. faecalis and found that E. faecalis EVs can promote macrophage M1 polarization via NOD2/RIPK2 signaling. To our knowledge, this is the first report to investigate apical periodontitis development from the perspective of bacterial vesicles and demonstrate the role and mechanism of E. faecalis EVs in macrophage polarization. This study expands our understanding of the pathogenic mechanism of E. faecalis and provides novel insights into the pathogenesis of apical periodontitis. [ABSTRACT FROM AUTHOR]

Aim: This study assesses if the size of periapical lesions has an effect on the bone immediately peripheral to an apical lesion. Methods: Cone-beam computed tomography (CBCT) images of 271 periapical lesions were analyzed using Mimics Research™ to determine the CBCT periapical lesion volume index (CBCTPAVI) score, along with the radiodensity of the lesion, lesion border, and surrounding bone in 0.5 mm increments up to 2.0 mm peripheral to the apical lesion. The one-way analysis of variance was used to assess for significant differences in the radiodensity of the lesion, border, and peripheral bone, as well as differences among CBCTPAVI scores. Results: The radiodensity of bone peripheral to the apical lesion increased significantly up to 1.0 mm around the lesion’s perimeter. In addition, lesions with higher CBCTPAVI scores showed a significantly greater difference in the radiodensity from the lesion to the lesion border and the peripheral bone, compared to lesions with smaller CBCTPAVI scores. Conclusions: This study for the first time shows the influence of periapical lesion size on the radiodensity of bone peripheral to an apical lesion. Variations in radiodensity at the perimeter of a periapical lesion can be influenced by the size of the lesion, possibly indicating differences in defense response. Knowledge of these phenomena may provide information on bone healing and enhance our understanding of bone peripheral to a periapical lesion. [ABSTRACT FROM AUTHOR]

Copyright of Acta Odontologica Latinoamericana: AOL is the property of Acta Odontologica Latinoamericana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Implant bone loss and implant failure are growing concerns. In some cases, a possible factor leading to bone loss may be an allergy to titanium (Ti). In this report, the existing literature on Ti allergy as a factor in implant loss is reviewed, and the current views on its potential role in implant bone loss are discussed. A case report of implant loss and retreatment in a patient with a potential Ti allergy or intolerance is presented and clinically analyzed. The subsequent success of a ceramic implant may support the finding of a Ti allergy or intolerance. Unfortunately, the lack of prospective clinical trials and lack of a reliable test for Ti allergy makes it impossible to clinically verify whether Ti allergy plays a part in implant bone loss. [ABSTRACT FROM AUTHOR]

Purpose: To observe the effect of different prosthetic materials (polymethyl methacrylate [PMMA] and flowable composite [FC]) on marginal bone loss, pink esthetic score (PES), and cytokine levels (receptor activator of nuclear factor kappa-B ligand [RANKL] and osteoprotegerin [OPG]). Materials and Methods: A total of 46 patients (31 women, 15 men) were treated with immediate implant therapy after tooth extraction. For standardization, only the maxillary premolar tooth of each patient was restored, and also, both of the adjacent teeth were present in the dental arch. Provisional crowns were prepared before the surgery on patient models with two different materials (24 PMMA, 22 FC). Following the surgical procedure, provisional crowns were adjusted on polyetheretherketone (PEEK) abutments as nonfunctional in centric and eccentric movements. After the surgery, patients were evaluated monthly for 3 months. At each follow-up, periapical radiography was obtained by the parallel technique, and peri-implant crevicular fluid (PICF) was collected. Pink esthetic scoring was done. MBL was calculated for the mesial and distal sides separately. Cytokine levels were analyzed from PICF. Statistical analyses (Shapiro-Wilk, Mann-Whitney U, independent-samples t test, Wilcoxon t test, paired-samples t test, and Friedman two-way analysis of variance with Bonferroni correction) were completed (α = .05). Results: PES was increased significantly within groups (P < .01). However, there was no statistically significant difference between groups. According to the Mann-Whitney U test, no significant difference was found for the MBL (P > .05). When the RANKL/OPG values were evaluated within the group by using the Friedmann two-way analysis of variance test, no significant difference was found (P > .05). Conclusion: Similar pink esthetics, cytokine levels, and bone loss can be achieved using a protocol including immediate implants, particle grafts, soft tissue graft, PEEK abutments, and provisional restorations fabricated using PMMA and FC. [ABSTRACT FROM AUTHOR]

Apical fenestration is a defect in the alveolar cortical plate, exposing the root without involving the alveolar bone margin, often linked to trauma, periodontal disease, and orthodontic treatment, leading to symptoms such as pain and abscesses from endodontic infections. This case report describes managing a mucosal fenestration in an endodontically treated tooth with nonsurgical root canal therapy and periodontal surgery. A 44-year-old male presented with mucosal fenestration and pain in the upper front jaw due to trauma and an inadequately treated root canal. Examination revealed an ill-fitting crown and an open apex with periapical radiolucency. Treatment included scaling, root planing, nonsurgical root canal therapy, apexification using Biodentine, and obturation with bioceramic sealer. Persistent fenestration necessitated periodontal surgery to remove extruded material and place an alloplastic graft. Apical fenestrations, although uncommon, require coordinated endodontic and periodontal treatment for successful outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Common dental diseases may develop into severe odontogenic infections (OIs). This study aimed to characterize the occurrence and nature of dental diseases in OIs requiring hospitalization. Method and materials: Data of a total of 168 adult patients requiring hospital care for severe OI were retrospectively investigated. Study participants were grouped according to OI etiology: apical periodontitis, marginal periodontitis, combined infection (apical and marginal periodontitis) or vertical root fracture, pericoronitis, and root remnant. The categorization of the dental diseases was achieved by radiologic evaluation and supplemented with clinical findings from patient records. Differences in background variables and infection severity were statistically analyzed. Results: Apical periodontitis was the most common dental infection disease leading to OI (n = 113; 67%). In 83 cases, no root canal treatment (RCT) was administered prior to hospital admission; in 30 cases, RCT had been commenced or completed. Between study groups, significant differences were observed in age (P < .001), immunocompromised status (P = .024), and pulse (P = .012). Patients with marginal periodontitis were older and more often immunocompromised; patients with pericoronitis were younger. Pulse was higher in patients with a severe OI originating from apical periodontitis than in patients with OI originating from other dental diseases. Conclusion: Apical periodontitis, specifically with no prior endodontic treatment, was observed in the majority of severe OIs. Additionally, when compared with other types of dental diseases, apical periodontitis was associated with features of more severe infections. This highlights the importance of periapical health. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to evaluate healing in apicomarginal defects with amniotic membrane (AM) using 2D periapical radiography and 3D cone beam computed tomography imaging. Method and materials: Thirty-four patients with symptomatic apical periodontitis and apicomarginal communication were allocated to either the AM or control group. Clinical and radiographic assessment was performed at baseline and at 12 months using Molven criteria, modified Penn 3D criteria, and RAC and B indices at resected plane, apical area, cortical plate, and combined apicocortical area, respectively. Results: There was no significant difference in the healing outcome in 2D imaging (93.3% control and 86.7% AM) and 3D imaging (80.0% control and 53.3% AM) between the groups. With RAC scoring, a greater percentage of unhealed cases was observed in cortical plate. Radiographic buccal bone formation in the 3D imaging was evident only in six cases. However, both the groups depicted significantly greater percentage reduction in the size of the lesion in 2D than the 3D analysis (AM group 91.69 ± 15.99 2D, 76.06 ± 47.62 3D, P = .020) and (control group 92.06 ± 14.36 2D, 85.12 ± 18.55 3D, P = .005). Conclusion: No significant difference in healing was observed between the AM and the control groups with the use of both periapical radiography and CBCT imaging. Despite good clinical healing and radiographic apical bone fill, buccal bone formation was not evident in 3D imaging in most of the cases. [ABSTRACT FROM AUTHOR]

This case report describes the diagnosis and multidisciplinary treatment of a clinically indiscoverable cementodentinal tear associated with a periodontalendodontic combined lesion. The tear site was located at the palatal root surface of the maxillary left canine. Due to its position and concomitant periapical periodontitis, it was not noticed at the initial visit until a 3D CBCT examination was conducted. Through combined endodontic-periodontal therapy (which included root canal therapy, root debridement, and periodontal flap surgery), the tear fragment was removed, and the periapical lesion healed gradually. A histologic examination confirmed the definitive diagnosis of a cementodentinal tear. After 14 months, the periodontal and endodontic status of the maxillary left canine were stable. According to these results, CBCT examination and multidisciplinary cooperation seem to be effective and necessary for the diagnosis and treatment of such clinically indiscoverable cementodentinal/cemental tears. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present pilot study was to assess the effectiveness of the platelet-rich fibrin (PRF) apical barrier for the placement of MTA for the treatment of teeth with periapical lesions and open apices. Methods: A total of thirty teeth on twenty-eight patients with open apices and periapical periodontitis were enrolled and divided into two groups in the present pilot study. In the PRF group (fourteen teeth in thirteen patients), nonsurgical endodontic treatment was performed using PRF as an apical matrix, after which the apical plug of the MTA was created. For the non-PRF group (fourteen teeth in fourteen patients), nonsurgical endodontic therapy was performed using only the MTA for an apical plug with no further periapical intervention. Clinical findings and periapical digital radiographs were used for evaluating the healing progress after periodic follow-ups of 1, 3, 6, and 9 months. The horizontal dimension of the periapical lesion was gauged, and the changes in the dimensions were recorded each time. The Friedman test, Dunn-Bonferroni post hoc correction, and Mann-Whitney U test were used for statistical analysis, with P < 0.05 serving as the threshold for determining statistical significance. Results: All patients in both groups in the present pilot study had no clinical symptoms after 1 month, with a significant reduction in the periapical lesion after periodic appointments. The lesion width of the PRF group was significantly smaller than that of the non-PRF group in the sixth and ninth month after treatment. Conclusions: PRF is a promising apical barrier matrix when combined with MTA for the treatment of teeth with open apices and periapical periodontitis. Small number of study subjects and the short time of follow-up period limit the generalizability of these results. Trial registration: TCTR, TCTR20221109006. Registered 09 November 2022 - Retrospectively registered, https://www.thaiclinicaltrials.org/show/TCTR20221109006. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study aimed to investigate the influence of the root canal morphology and various treatment variables on the outcomes of root canal treatments (RCTs) in mandibular second molars, assessed through cone-beam computed tomography (CBCT) imaging. Methods: A total of 150 CBCT images were examined, comprising 100 cases of persistent endodontic infections and 50 of previously treated root canals with normal apices in the mandibular second molars. CBCT was utilized to evaluate the root canal configuration, the radiographic quality of coronal restorations and treated canal systems, and the presence of periapical lesions. Statistical analyses were performed to explore the correlations between these factors. Results: The presence of a C-shaped root canal configuration did not demonstrate a significant correlation with periapical lesions (p = 0.05). Factors influencing endodontic treatment outcomes included missing canals (p = 0.018), underfilling or overfilling (p = 0.045), and inadequate coronal restoration (p = 0.006). Missing a canal was identified as the variable most significantly associated with periapical lesions (OR = 3.103). Inhomogeneous root canal obturation was more commonly observed in C-shaped root canals (p < 0.001). Conclusions: Regardless of the root canal morphology of mandibular second molars, successful RCT depends on thorough disinfection to eliminate any untreated canals, precise three-dimensional filling of the canals at the correct working length, and a securely sealed coronal restoration to prevent leakage. [ABSTRACT FROM AUTHOR]

Purpose. The authors of this study proposed an innovative approach involving the use of Biodentine™ material as an intraorifice barrier in cracked teeth with root extension to promote internal crack sealing, preventing the possibility of microinfiltration and apical crack propagation. Materials and Methods. The dental records of 11 patients with 12 posterior cracked teeth with root extension were included with a precise protocol performed by a senior endodontist. The treatment protocol included pulp diagnosis, crack identification using a dental operating microscope (DOM), endodontic treatment, placing a Biodentine™ as an intraorifice barrier, and immediate full-coverage restoration. The effectiveness of the treatment was assessed at two intervals, 6 months, and 1−3 years posttreatment, evaluating clinical, radiographic, and tomographic aspects. The treatment was deemed successful if there were no indications of radiolucency, sinus tracts, edema, or periodontal pockets associated with the crack line. Results. The study observed remarkably positive outcomes during the follow-up period, which spanned from 1 to 3 years. All the cracked teeth (100%) remained asymptomatic, meaning they were free of pain or discomfort. Furthermore, these teeth were in occlusal function. Both radiographic and tomographic assessments revealed the absence of bone loss along the crack line. This outcome signifies that the treatment effectively prevented further deterioration of the surrounding bone. Conclusions. Integrating advanced biomaterials and conservative restorative techniques has paved the way for innovative approaches in dental care. This protocol suggests a proactive step for managing cracked teeth with root extension. It addresses both biological aspects by sealing internal cracks and mechanical aspects by preventing crack progression, thereby improving these teeth' prognosis and long-term survival. [ABSTRACT FROM AUTHOR]

Background/Objectives: Periapical lesions (PLs) are frequently detected in dental radiology. Accurate diagnosis of these lesions is essential for proper treatment planning. Imaging techniques such as orthopantomogram (OPG) and cone-beam CT (CBCT) imaging are used to identify PLs. The aim of this study was to assess the diagnostic accuracy of artificial intelligence (AI) software Diagnocat for PL detection in OPG and CBCT images. Methods: The study included 49 patients, totaling 1223 teeth. Both OPG and CBCT images were analyzed by AI software and by three experienced clinicians. All the images were obtained in one patient cohort, and findings were compared to the consensus of human readers using CBCT. The AI's diagnostic accuracy was compared to a reference method, calculating sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and F1 score. Results: The AI's sensitivity for OPG images was 33.33% with an F1 score of 32.73%. For CBCT images, the AI's sensitivity was 77.78% with an F1 score of 84.00%. The AI's specificity was over 98% for both OPG and CBCT images. Conclusions: The AI demonstrated high sensitivity and high specificity in detecting PLs in CBCT images but lower sensitivity in OPG images. [ABSTRACT FROM AUTHOR]

Diagnosis of dysthyroid optic neuropathy (DON) typically relies on a set of diagnostic clinical features, including decreased visual acuity, impaired color vision, presence of relative afferent pupillary defect, optic disc swelling and ancillary tests including visual field (VF), pattern visual evoked potential (pVEP), and apical crowding or optic nerve stretching on neuroimaging. We summarize various diagnostic methods to establish or rule out DON. A total of 95 studies (involving 4619 DON eyes) met the inclusion criteria. All of the studies considered clinical features as evidence of DON, while most of the studies confirmed DON diagnosis by combining clinical features with ancillary tests. Forty studies (42.1%) used at least 2 out of the 3 tests (VF, pVEP and neuroimaging) and 13 studies (13.7%) used all 3 tests to diagnose DON. In 64 % of the published studies regarding DON, the diagnostic methods of DON were not specified. It is important to note the limitations of relying solely on clinical features for diagnosing DON. On the other hand, since some eyes with optic neuropathy can be normal in one ancillary test, but abnormal in another, using more than one ancillary test to aid diagnosis is crucial and should be interpreted in correlation with clinical features. We found that the diagnostic methods of DON in most studies involved using a combination of specific clinical features and at least 2 ancillary tests. [ABSTRACT FROM AUTHOR]

Semaphorin 3A (SEMA3A), also referred to as H‐Sema III, is a molecule with significant biological importance in regulating physiological and pathological processes. However, its role in oral diseases, particularly its association with inflammatory immunity and alveolar bone remodeling defects, remains poorly understood. This comprehensive review article aims to elucidate the recent advances in understanding SEMA3A in the oral system, encompassing nerve formation, periodontitis, pulpitis, apical periodontitis, and oral squamous cell carcinoma. Notably, we explore its novel function in inflammatory immunomodulation and alveolar bone formation during oral infectious diseases. By doing so, this review enhances our comprehension of SEMA3A's role in oral biology and opens up possibilities for modulatory approaches and potential treatments in oral diseases. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this investigation was to analyze the prevalence of apical periodontitis (AP) and periodontal disease (periodontitis) (PD) in Chronic kidney disease (CKD) patients in relation to their treatment phase. Subjects and Methods: In this cross‐sectional study, 188 patients with CKD were divided into two groups: patients without dialysis (WD group, n = 53) and patients on dialysis (DP group, n = 135). Panoramic radiographs were used to diagnose AP. The presence of periodontal disease was evaluated radiographically assessing alveolar bone loss. Student's t‐test, chi‐squared test, and logistic regression analysis were used to determine the significance of differences between groups. Results: In the WD group, 55% of patients had at least one tooth with AP, whereas in the DP group 67% had at least one tooth with AP (OR = 2.11; 95% CI = 1.09–4.08; p < 0.05). PD was more prevalent in the DP group (78%) than in the WD group (36%) (OR = 6.26; CI 95% = 3.13–12.52; p < 0.01). Conclusions: Oral infections are more prevalent in the advanced stages of CKD. The treatment of PD and AP should be incorporated in the treatment planning of patients with CKD. [ABSTRACT FROM AUTHOR]

Aim: This current Mendelian randomization (MR) study aims to comprehensively explore the potential bidirectional link between pulp and periapical disease (PAP) with type 2 diabetes mellitus (T2DM). Methodology: Summary level data of European‐based population genome‐wide association studies (GWASs) were employed to undertake this MR study. With the selection of single nucleotide polymorphisms (SNPs) as the instrumental variable, the radial inverse‐variance weighted (radial IVW) method with modified second‐order weights was applied as the primary method. Additionally, a range of sensitivity analyses were conducted to investigate pleiotropy. Results from different sources of outcome were pooled by meta‐analysis with the fixed model. Results: The results of this MR analysis did not suggest a significant impact of pulp and periapical disease on type 2 diabetes (combined OR = 1.04, 95% CI: 1.00–1.07, p =.033) and vice versa (OR = 1.04, 95% CI: 0.96–1.14, p =.329). No significant pleiotropy was detected in the final model after the removal of outliers, demonstrating the reliability of the results in our primary analysis. Conclusions: With the limitations inherent in the present MR study, there is no significant evidence in either direction to suggest a causal association between pulp and periapical disease and type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Summary: This case report describes septic suturitis as a likely cause of periapical dental disease in a 3‐year‐old Thoroughbred colt. The horse was presented for a unilateral sinusitis initially managed by a frontal osteotomy and sinus lavage and subsequently developed a septic suturitis. Subsequently, a computed tomography (CT) examination identified a periapical infection of cheek tooth 109 with associated sinusitis of the rostral sinus compartments and an extensive suturitis, with the most severe changes located at the right nasomaxillary suture line. There was an associated local fistulous tract rostral to the mesial periapical region of cheek tooth 107 but unassociated with typical periapical or endodontic dental disease changes on CT. The sinusitis did not respond to oral extraction of cheek tooth 109 and sinus lavage. A repeat head CT 2 weeks later, now revealed buccal alveolar bone loss surrounding cheek tooth 107 with obvious periodontal and endodontic dental disease changes. Oral extraction of cheek tooth 107 was performed and local curettage of the fistulous tract was conducted. We conclude that septic suturitis can become extensive and slow to resolve and its rostral extension can cause periapical infection of the closely associated rostral cheek teeth in young horses. [ABSTRACT FROM AUTHOR]

Squamous cell carcinoma (SCC) is the type of cancer that most frequently affects the oral cavity, mainly in men older than 50 years of age. Treatment for oral SCC often involves surgical excision of the affected margins, resulting in mutilation that affects the patient's quality of life. The objective of this case report is to describe the prosthetic treatment of a 56-year-old man who underwent total glossectomy, resulting in speech and swallowing difficulties. The proposed treatment was a tongue prosthesis retained by orthodontic clasps on the mandibular first molars. After maxillary and mandibular complete-arch impressions were performed and casts were prepared for prosthetic planning, an acrylic resin plate and 3 tongue prototypes were fabricated. Esthetic chemoand functional tests were carried out, and 2 tongue models (1 for speech and 1 for eating) were selected for acrylization, finishing, and polishing. After placement of the prostheses, the patient was referred for follow-up with a speech therapist to improve his adaptation with the prostheses. The patient was satisfied with the prostheses and able to perform the functions of chewing, swallowing, and speech production, which helped in his social reintegration and improved his quality of life. [ABSTRACT FROM AUTHOR]

This study investigated the natural course of cemento-osseous dysplasia (COD) on cone-beam computed tomography (CBCT). Retrospectively, 104 CBCT scans from 36 patients (mean age, 44.5 years; 33 female and three male) with mandibular COD (10 florid, seven focal, 19 periapical) were included, based upon clinico-radiological features, without complications such as infection and related surgery. Changes in maximum diameter and morphology (lytic, mixed lytic-sclerotic, sclerotic) were evaluated in 83 lesions, with a mean follow-up of 28.3 months. The occurrence of a diameter increase was assessed by time-to-event analysis; interreader agreement for diameter and morphological evaluation by intraclass correlation coefficient and weighted κ statistics, respectively. Fifteen of 83 (18.1%) lesions (eight florid, one focal, six periapical) in 10 patients increased in diameter; 12 of 83 (14.5%) lesions (five florid, seven periapical) in 11 patients changed morphologically. The median period until a diameter increase was longest (120 months) for periapical COD, and shortest (66 months) for florid COD (p = 0.023). There was high reader agreement (ICC = 0.891; weighted κ = 0.901). In conclusion, CBCT is an effective tool with which to follow-up COD. If any, the natural progress in uncomplicated COD is prolonged, which underlines its non-surgical character and aids in its long-term management. [ABSTRACT FROM AUTHOR]

Modern tissue engineering strategies have elucidated the potential of regenerative endodontic treatment (RET) as an alternative for treating mature teeth. Here, we report two cases in which cell-based RET (CB-RET) using encapsulated allogeneic umbilical cord mesenchymal stem cells (UC-MSCs) in a platelet-poor plasma (PPP)-based scaffold was used in two mature teeth with pulp necrosis and apical periodontitis. After 5 years of follow-up, the healing response was satisfactory in both cases, with evidence of pulp revitalization. This is the first study to report the success of an extended, 5-year follow-up for allogeneic CB-RET. This report presents an innovative and sustainable solution to challenging endodontic scenarios. [ABSTRACT FROM AUTHOR]

Objective: To compare the expression of IL‐17 in periapical lesions (cysts and granulomas) among elderly individuals and adults. We selected 20 periapical lesions of the elderly (12 granulomas and eight cysts) and 20 periapical lesions of adults (12 granulomas and eight cysts). Materials and Methods: Immunohistochemistry was performed using a specific antibody for IL‐17. The slides were subdivided into five high magnification fields and then the images were observed through an optical microscope. According to the number of positive markings for the antibody, grades were given, ranging from 0 to 2. Results: The results demonstrate that there was no statistical difference when comparing the expression of IL‐17 between cysts and granulomas of both groups (study group: cysts 0.7 ± 0.21 × granulomas 0.96 ± 0.58, p =.61; control group: cysts 0.37 ± 0.16 × granulomas 0.31 ± 0.23, p =.27). The comparison between adult (control group) and elderly patients (study group) showed a statistical difference both in cysts (study group: 0.7 ± 0.21 × control group: 0.37 ± 0.16, p =.007) and in granulomas (study group: 0.96 ± 0.58 × control group: 0.31 ± 0.23, p =.0009), in which elderly patients had a higher expression of interleukin 17, in relation to adult patients. Conclusion: We concluded that elderly patients have a higher expression of IL‐17 in both cysts and granulomas, when compared to adult patients. [ABSTRACT FROM AUTHOR]

Copyright of Revista de la Asociación Odontológica Argentina is the property of Asociacion Odontologica Argentina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Autophagy is a cellular process that is evolutionarily conserved, involving the sequestration of damaged organelles and proteins into autophagic vesicles, which subsequently fuse with lysosomes for degradation. Autophagy controls the development of many diseases by influencing apoptosis, inflammation, the immune response and different cellular processes. Autophagy plays a significant role in the aetiology of disorders associated with dentistry. Autophagy controls odontogenesis. Furthermore, it is implicated in the pathophysiology of pulpitis and periapical disorders. It enhances the survival, penetration and colonization of periodontal pathogenic bacteria into the host periodontal tissues and facilitates their escape from host defences. Autophagy plays a crucial role in mitigating exaggerated inflammatory reactions within the host's system during instances of infection and inflammation. Autophagy also plays a role in the relationship between periodontal disease and systemic diseases. Autophagy promotes wound healing and may enhance implant osseointegration. This study reviews autophagy's dento‐alveolar effects, focusing on its role in odontogenesis, periapical diseases, periodontal diseases and dental implant surgery, providing valuable insights for dentists on tooth development and dental applications. A thorough examination of autophagy has the potential to discover novel and efficacious treatment targets within the field of dentistry. [ABSTRACT FROM AUTHOR]

Background: Radiolucencies found at the root apex in patients with cemento-osseous dysplasia (COD) may be mistaken for periapical cysts (PC) of endodontic origin. The purpose of this study was to examine the utility of quantitative texture analysis using cone-beam computed tomography (CBCT) to differentiate between COD and PC. Methods: Patients who underwent CBCT at Wonkwang University Daejeon Dental Hospital between January 2019 and December 2022 and were diagnosed with COD and PC by clinical, radiologic, and, if necessary, histopathologic examination were included. Twenty-five patients each were retrospectively enrolled in the COD and PC group. All lesions observed on axial CBCT images were manually segmented using the open-access software MaZda version 4.6 to establish the regions of interest, which were then subjected to texture analysis. Among the 279 texture features obtained, 10 texture features with the highest Fisher coefficients were selected. Statistical analysis was performed using the Mann-Whitney U-test, Welch's t-test, or Student's t-test. Texture features that showed significant differences were subjected to receiver operating characteristics (ROC) curve analysis to evaluate the differential diagnostic ability of COD and PC. Results: The COD group consisted of 22 men and 3 women, while the PC group consisted of 14 men and 11 women, showing a significant difference between the two groups in terms of sex (p=0.003). The 10 selected texture features belonged to the gray level co-occurrence matrix and included the sum of average, sum of entropy, entropy, and difference of entropy. All 10 selected texture features showed statistically significant differences (p<0.05) when comparing patients with COD (n=25) versus those with PC (n=25), osteolytic-stage COD (n=11) versus PC (n=25), and osteolytic-stage COD (n=11) versus cementoblastic-stage COD (n=14). ROC curve analysis to determine the ability to differentiate between COD and PC showed a high area under the curve ranging from 0.96 to 0.98. Conclusion: Texture analysis of CBCT images has shown good diagnostic value in the differential diagnosis of COD and PC, which can help prevent unnecessary endodontic treatment, invasive biopsy, or surgical intervention associated with increased risk of infection. [ABSTRACT FROM AUTHOR]

Background: Reconstruction of the entire dentition with odontogenic keratocyst is a very challenging quandary. Most cases of odontogenic keratocyst are often reported to be benign, resulting in severe occlusal discrepancies with the maxillary and mandibular dentition. Dental radiographs occasionally reveal an uncommon, locally aggressive developing cyst termed as odontogenic keratocyst, which is typically located in the posterior jaw. When this cyst occurs in the anterior region, it is often misdiagnosed with other periapical lesions due to its lack of response to pulp vitality tests. Case presentation: This clinical case scenario demarcates the endodontic management of a patient diagnosed with odontogenic keratocyst. A 37-year-old Indian male patient reported to the department with throbbing pain in the lower left posterior tooth requiring endodontic therapy. This patient also presented with odontogenic keratocyst in the anterior region of the jaw, for which he had undergone surgical rehabilitation. This case report highlights the clinical protocol for the endodontic therapy in patient diagnosed with ododntogenic keratocyst. Masticatory impairment was not visible after the follow-up period and the treatment outcome was successful. Conclusion: This case report details the presentation, characteristic radiographic findings, and endodontic management of a patient with an extremely rare condition of odontogenic keratocyst. The management involves multidisciplinary approach for the rehabilitation. [ABSTRACT FROM AUTHOR]

Introduction Odontogenic infections are one of the common causes of maxillary sinusitis. With the close proximity of the roots of maxillary posterior teeth to the sinus floor, the infection may spread into the sinus causing sinus mucosal thickening. This study aims to evaluate the association between maxillary posterior teeth periapical pathologies and maxillary sinus mucosal changes using cone-beam computed tomography (CBCT) images. Methods One-hundred six maxillary posterior teeth with periapical lesions were included in this study and were assessed using CBCT images by two maxillofacial radiologists. The proximity of the roots to the sinus floor, the proximity of the top edge of the periapical lesion to the sinus floor, and the sinus mucosal changes associated with the periapical lesions were studied. The size of the periapical lesion was measured and scored using CBCT periapical index. Mucosal thickening more than 2 mm was considered pathological and the type, pattern, and severity of mucosal thickening were assessed. Data were analyzed using chi-squared tests at a level of significance set at p -value less than 0.05. Results Among the 106 teeth with periapical lesions, 99 teeth (93.4%) revealed the presence of maxillary sinus mucosal thickening. The prevalence of mucosal thickening increased significantly with the presence of cortical bone destruction, the close proximity of the root, and the periapical lesion to the sinus floor. The generalized type of mucosal thickening was more prevalent with larger periapical lesions and a significant increase in the severity of the thickening was observed closer spatial relationship of the root to the sinus floor. Conclusion Periapical pathologies of maxillary posterior teeth often cause sinus mucosal thickening. The early diagnosis and management of these pathologies will be helpful in preventing the spread of infection into the maxillary sinus. [ABSTRACT FROM AUTHOR]

Objectives: An evaluation of the effectiveness of a new computational system proposed for automatic classification, developed based on a Siamese network combined with Convolutional Neural Networks (CNNs), is presented. It aims to identify endodontic technical errors using Cone Beam Computed Tomography (CBCT). The study also aims to compare the performance of the automatic classification system with that of dentists. Methods: One thousand endodontically treated maxillary molars sagittal and coronal reconstructions were evaluated for the quality of the endodontic treatment and the presence of periapical hypodensities by three board-certified dentists and by an oral and maxillofacial radiologist. The proposed classification system was based on a Siamese network combined with EfficientNet B1 or EfficientNet B7 networks. Accuracy, sensivity, precision, specificity, and F1-score values were calculated for automated artificial systems and dentists. Chi-square tests were performed. Results: The performances were obtained for EfficienteNet B1, EfficientNet B7 and dentists. Regarding accuracy, sensivity and specificity, the best results were obtained with EfficientNet B1. Concerning precision and F1-score, the best results were obtained with EfficientNet B7. The presence of periapical hypodensity lesions was associated with endodontic technical errors. In contrast, the absence of endodontic technical errors was associated with the absence of hypodensity. Conclusions: Quality evaluation of the endodontic treatment performed by dentists and by Siamese Network combined with EfficientNet B7 or EfficientNet B1 networks was comparable with a slight superiority for the Siamese Network. Clinical relevance: CNNs have the potential to be used as a support and standardization tool in assessing endodontic treatment quality in clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this systematic review and meta‐analysis of observational studies was to assess whether herpes simplex virus type 1 (HSV‐1) can infect endodontic periapical lesions. Materials and Methods: Studies with cross‐sectional design investigating HSV‐1 in periapical tissues of patients with symptomatic and asymptomatic acute and chronic apical periodontitis were searched through MEDLINE, Scopus, Embase, Web of Science, and Google Scholar. Pooled HSV‐1 prevalence proportion with 95% confidence interval (95CI) in periapical lesions was assessed with both fixed‐effect and random‐effects models, with/without adjustment for study quality and publication bias. Result robustness was investigated through sensitivity and subgroup analyses. Results: Literature search, performed twice, provided 84 items, and eight remained for the meta‐analysis; globally, there were 194 patients mostly adults. The pooled HSV‐1 prevalence proportions, assessed with various methods, were 6.9% (95CI, 3.8–11.3%, fixed‐effect); 6.8% (95CI, 3.6–11.0%, random‐effects); 8.1% (95CI, 4.4–14.5%, quality‐adjusted); and 4.8% (95CI, 2.0–11.4%; adjusted for small‐study effect). Conclusions: The results indicated that HSV‐1 can colonize the periapical tissues of 3%–11% patients with periapical diseases. Such data do not imply a causative role of HSV‐1 in disease development and advancement. Well‐designed and large‐sized prospective cohort studies should be added in the literature panorama. [ABSTRACT FROM AUTHOR]

Aim: Rev‐erbα has been reported to regulate the healing of inflammatory lesions through its effect on the immune system in a variety of inflammatory disease. Moreover, the balance of macrophages polarization plays a crucial role in immune response and inflammatory progression. However, in refractory periapical periodontitis (RAP), the role of Rev‐erbα in inflammatory response and bone resorption by regulating macrophage polarization remains unclarified. The aims of the present study were to investigate the expression of Rev‐erbα in experimental RAP and to explore the relationship between Rev‐erbα and macrophage polarization through the application of its pharmacological agonist SR9009 into the in vivo and in vitro experiments. Methodology: Enterococcus faecalis‐induced RAP models were established in SD rats. Histological staining and micro‐computed tomography scanning were used to evaluate osteoclastogenesis and alveolar bone resorption. The expression of Rev‐erbα and macrophage polarization were detected in the periapical tissues from rats by immunofluorescence, flow cytometry, and western blots. Furthermore, immunohistochemical staining and enzyme‐linked immunosorbent assay were performed to explore the relationship between Rev‐erbα and inflammatory cytokines related to macrophage polarization. Result: Compared to healthy periapical tissue, the expression of Rev‐erbα was significantly down‐regulated in macrophages from inflammatory periapical area, especially in Enterococcus faecalis‐induced periapical lesions, with obvious type‐1 macrophage (M1)‐like dominance and the production of pro‐inflammatory cytokines. In addition, Rev‐erbα activation by SR9009 could induce type‐2 macrophage (M2)‐like polarization in periapical tissue and THP1 cell line, followed by increased secretion of anti‐inflammatory cytokines IL‐10 and TGF‐β. Furthermore, intracanal application of SR9009 reduced the lesion size and promoted the repair of RAP by decreasing the number of osteoclasts and enhancing the formation of mineralized tissue in periapical inflammatory lesions. Conclusions: Rev‐erbα played an essential role in the pathogenesis of RAP through its effect on macrophage polarization. Targeting Rev‐erbα might be a promising and prospective therapy method for the prevention and management of RAP. [ABSTRACT FROM AUTHOR]

Aim: To investigate the association of various pre‐, intra‐ and post‐operative factors on root canal treatment outcome. Methodology: In this cohort study, primary or secondary root canal treatment of mature permanent teeth was performed by a single endodontist in a private practice over 13 years, and followed 1–4 years after treatment. Treatment details and clinical and radiographic data were collected. The proportion of successfully treated teeth and roots based on strict radiographic (periapical index (PAI) ≤2) and clinical criteria (absence of pain, swelling or sinus tract) was estimated. To evaluate joint associations of prognostic factors and treatment success probability, 44 pre, intra‐ and post‐operative factors were investigated using bivariate associations, and a multiple logistic regression model was fitted using Generalized Estimating Equations. Results: 1259 teeth (2445 roots, 3149 canals) were assessed with a recall rate of 91%. The proportion of successfully treated teeth was 79.9% [95% confidence interval 77.7–82.1]. Eleven prognostic factors were identified that significantly reduced the odds ratio (OR) for treatment success at tooth level. Six were preoperative: injury history (OR = 0.05[0.01–0.24]), root PAI (OR = 0.29[0.20–0.42], 0.21[0.13–0.34] and 0.22[0.12–0.42] for PAI = 3, 4 and 5, respectively, against PAI = 1), lesion diameter (OR = 0.30[0.21–0.43] and 0.24[0.16–0.37] for diameters of 1‐5 mm and ≥6 mm, respectively, against no lesion), tooth type (OR = 0.51[0.27–0.97] and OR = 0.45[0.24–0.83] for premolars and molars, respectively, against incisors or canines), tenderness to periapical palpation (OR = 0.64[0.43–0.94]) and two canals per root (OR = 0.67[0.54–0.83]). Four factors were intraoperative: root filling of unsatisfactory quality (OR = 0.18[0.08–0.40]) or extending beyond or shorter than 2 mm from the apex (OR = 0.44[0.26–0.75] and 0.62[0.40–0.97] respectively), resin sealer (OR = 0.58[0.39–0.87] against bioceramic sealer) and single visit treatment (OR = 0.40[0.21–0.75] against multiple visits). One factor was post‐operative: defective coronal restoration (OR = 0.35[0.21–0.56]). Conclusion: The following factors were associated with unsuccessful root canal treatment: (i) history of injury, apical periodontitis with increased severity (larger lesion, higher PAI, tenderness to periapical palpation), or complicated anatomic conditions (premolar or molar, two canals in a single root); (ii) technically suboptimal root filling (of unsatisfactory quality or not ending within 2 mm of radiographic apex) performed in a single‐visit, or use of resin sealer instead of novel bioceramic sealer; (iii) suboptimal quality coronal restoration. [ABSTRACT FROM AUTHOR]

This case report presents the use of haptic robotic technology in one patient with six implants placed in the maxilla and five implants in the lower mandible with the goal of individual single implant supported crowns to be placed over each implant after 6 months. All implants were placed using a flapless technique, with one immediate implant placement after extraction. All implants were placed with a high degree of accuracy relative to the pre‐operative plan as determined by post‐op CBCT analysis with an average angular deviation of 2.58° and positional deviations at the coronal and apical aspects of the implant around 1 mm (0.93 and 1.06 mm, respectively). Total surgical time of less than 2 h. Haptic robotics physically guides the location, orientation, and depth of the tools during both drilling and implantation and thus allows for accurate placement as well as the intra‐operative flexibility to change the plan as necessary while providing excellent visualization and irrigation. This robotic technology provides a treatment that focuses on accuracy and safety providing the best chance at excellent surgical outcomes for the patient. [ABSTRACT FROM AUTHOR]

Periapical cyst is considered one of the most common non-odontogenic cysts affecting oral and maxillofacial tissues. It is characterized by having a pathological cavity lined with epithelium, and is most often asymptomatic, originating from a tooth without vitality, derived from a long-term inflammatory process, and for this reason, it ends up being considered an imaging finding when diagnosed through imaging exams. The aim of this study is to report a clinical case of a root cyst in the mandibular body region, emphasizing the large volume and extent of the lesion presented, relating endodontic treatment with the use of biomaterial to fill the tooth, and the association of the surgical technique of cystic enucleation. A 63-year-old male patient presented with a periapical cyst located at the apex of tooth 34, a radiographic finding discovered through a complementary examination (panoramic radiography) requested during a routine consultation. Endodontic treatment was chosen for tooth 34, associated with surgical treatment of the cystic lesion in the mandible, using the enucleation technique. The surgical intervention associated with the endodontic treatment proved to be effective based on the imaging exams, where it was possible to see the beginning of bone neoformation and maintenance of the tooth without altering its masticatory function. [ABSTRACT FROM AUTHOR]

Introduction: Periapical lesions of teeth are typically evaluated using periapical X-rays (PA) or cone-beam computer tomography (CBCT); however, ultrasound imaging (US) can also be used to detect bone defects. A comparative analysis is necessary to establish the diagnostic accuracy of US for the detection of periapical lesions in comparison with PA and CBCT. Objectives: This study aimed to evaluate and compare the measurement precision of US against PA and CBCT in detecting periapical lesions. Methods: This study included 43 maxillary and mandibular teeth with periapical lesions. All teeth were examined clinically, radiographically, and ultrasonographically. Observers evaluated and measured the periapical lesions on CBCT, PA, and US images. Results: The comparison of lesion size showed that it differs significantly between the different methods of examination. A statistically significant difference was found between CBCT and US (mean difference = 0.99 mm, 95% CI [0.43–1.55]), as well as between CBCT and PA (mean difference = 0.61 mm, 95% CI [0.17–1.05]). No difference was found between the US and PA methods (p = 0.193). Conclusion: US cannot replace PA radiography in detecting pathologies but it can accurately measure and characterize periapical lesions with minimal radiation exposure. CBCT is the most precise and radiation-intensive method so it should only be used for complex cases. [ABSTRACT FROM AUTHOR]

This study was intended to evaluate the expression of inflammatory cytokines commonly secreted by CD4+ T cells (IL-2, IL-5, IL-17, TGF-β, TNF-α, and IFN-γ) in apical granulomas and correlate with the clinical conditions and time elapsed since root canal treatment. Eighteen biopsy specimens obtained by periradicular surgery of teeth with post-treatment apical periodontitis and diagnosed as apical granuloma were available from the oral pathology laboratory. Silanized slides containing paraffin sections were used for immunohistochemical reactions. Images were analyzed by using an optical microscopy and each slide was subdivided into 5 fields at high magnification. IFN-γ and TGF-β were the cytokines with the highest expression levels. There were statistically significant differences when comparing IL-2 and IFN-γ (P <.05), and IL-2 and TGF-β (P <.05). Comparison between the detected cytokines and clinical data and time of treatment demonstrated significant correlation (P <.05) between lower expression of IL-2 and the presence of painful symptoms, absence of sinus tract, and treatments performed more than 4 years before. It was also possible to observe a significant correlation between lower expression of IL-5 and treatments performed less than 4 years before (P <.05). IFN-γ and TGF-β were highly expressed in apical granulomas. However, only IL-2 and IL-5 levels were associated with clinical data and time since previous root canal treatment. [ABSTRACT FROM AUTHOR]

The development of dedicated coils and new magnetic resonance imaging (MRI) sequences has led to an increase in image resolution and a reduction in artifacts. Consequently, numerous studies have demonstrated the utility of MRI as a nonionizing alternative to cone-beam computed tomographic imaging. The aim of this systematic review was to evaluate the accuracy of MRI in clinical applications in endodontics. A literature search was conducted using PubMed, Embase, Scopus, and Web of Science. The inclusion criteria encompassed studies evaluating MRI applications in endodontics, covering tooth and root canal anatomy, root canal working length, pulp vitality and regeneration, the effect of caries on dental pulp, guided endodontics, periapical lesions, and root cracks/fractures. The selected studies examined both ex vivo and in vivo human teeth using clinical MRI units. Two researchers independently screened the studies, applied the eligibility criteria, and assessed the potential risk of bias using the revised QUADAS-2 tool (Bristol Medical School, University of Bristol, UK). A total of 18 studies were included in this systematic review, demonstrating that the use of MRI has a high diagnostic value in endodontics. In the evaluation of tooth and root canal anatomy, pulp vitality and regeneration, the effect of caries on dental pulp, periapical lesions, and root cracks/fractures, MRI's accuracy is comparable to or even higher than reference standards such as cone-beam computed tomographic imaging, micro–computed tomographic imaging, and histology. MRI has high potential accuracy for diagnosing various clinical endodontic tasks, except for root canal length, size of caries, and periapical lesion dimensions, which are overestimated in MRI. [ABSTRACT FROM AUTHOR]

No clinical studies have examined the effect of mineral trioxide aggregate (MTA) obturation levels on the outcome of endodontic retreatment. This retrospective study examined treatment outcomes in three cohorts that compared overfilling, flush filling, and underfilling after orthograde retreatment using MTA. Two hundred fifty patients with 264 teeth diagnosed with previously treated root canals and apical periodontitis retreated in a private endodontic practice were included. All teeth received MTA obturation and the extent of the final filling level was measured in relation to the major apical foramen. After 6-month follow-ups, all nonhealing cases were treated surgically. After 24- to 72-month reviews, the effect of preoperative lesion size and the degree of MTA obturation level were assessed. Multiple linear regression and time-to-event analysis using Stata 17 software (StataCorp LLC, College Station, TX) were used to evaluate the data. Within the three cohorts, 99 out of 108 overfilled teeth (91.7%), 90 out of 103 flush fills (87.4%), and 10 out of 53 underfilled teeth (18.9%) healed and were successfully retreated without surgery at 48-months. When surgical outcomes were included, the combined healed proportion was 93.2%. Preoperative lesion size was found to be an important predictor for retreatment nonhealing. A 1-mm increase in lesion size at baseline resulted in an estimated 11% (95% CI 1.04, 1.18)–38% (95% CI 1.22, 1.58) increase in the risk of surgery. Compared to overfilling and flush filling, underfilling was associated with an approximately three-fold increase in requiring surgery and characterized by delayed healing. MTA obturation is a viable retreatment option for teeth with nonhealing endodontic treatment. MTA overfills or flush fillings do not adversely affect healing outcomes. However, MTA underfilling increases the chances for nonhealing and surgical intervention. [ABSTRACT FROM AUTHOR]

This study's objective was to compare the cytokine expression of IL‐8 in periapical tissues of single‐rooted teeth with symptomatic apical periodontitis (SAP) before and after root canal treatments. As well as, comparing IL‐8 levels in peri‐apical tissues between vital and necrotic teeth with SAP. Methodology: Thirty‐six patients were allocated according to their pulp status into two experimental groups (n = 18) receiving the same treatment protocol; group 1: Vital pulps with SAP, and group 2: non‐vital pulps with SAP. Conventional endodontic treatment was done on two visits; isolation and disinfection of the operative field were undertaken, and two‐stage access cavity preparation was implemented. The first pre‐instrumentation peri‐apical sample (S1) was collected prior to cleaning and shaping procedures. A 2.5% NaOCl irrigation was used to thoroughly irrigate the canal after performing root canal preparation utilising the ProTaper Next (PTN) rotary system. After 1 week, the second post‐instrumentation peri‐apical sample (S2) was collected. Using an ELISA kit, the quantity of IL‐8 was evaluated following the collection of all samples. Results: In all pre‐instrumentation samples, IL‐8 was detected (100%). The level of IL‐8 expression was significantly decreased from the S1 to S2 of all samples (p < 0.001). The intra‐group comparison showed a statistically significant reduction in the level of IL‐8 expression between S1 and S2 in both vital and non‐vital groups where p < 0.001* in both groups. The inter‐group comparison of levels of IL‐8 expression (vital and non‐vital) revealed a significant difference between both groups regarding the pretreatment sample with the higher levels of IL‐8 shown in the non‐vital group (p < 0.001). While in the post‐treatment sample, both groups showed a significant reduction in the level of IL‐8 expression but the difference between them was not statistically significant (p = 0.226). Conclusion: Root canal instrumentation seems to be efficient in decreasing the levels of anti‐inflammatory cytokines, namely IL‐8. Further research should clarify how intra‐canal medicaments affect inflammatory mediator levels. [ABSTRACT FROM AUTHOR]

Nonsurgical endodontic therapy is usually advised as primary approach to treat the nonvital teeth with pulpal or periapical infection. However, in certain clinical scenarios and also owing to various factors, surgical modality of endodontics is eventually adopted to manage the recurrent or persistent pulpal or periapical infection and also to treat the failed cases of previously endodontically-treated teeth with conventional approach. In existing literature, there is deficiency of published case report articles regarding successful surgical endodontic management of recurrent pulpal/priapical signs and symptoms and also of failed cases of nonsurgical modality of endodontic therapy in growing pediatric patients. Hence, the present article describes the case report of the effective and successful clinical management of recurrent and failed case of conventional nonsurgical orthograde endodontic therapy by employing the surgical endodontic modality in an adolescent pediatric patient aged 13 years. The whole clinical procedure in step-wise manner has been described, and furthermore, the relevant contemporary endodontic techniques have been elucidated in context of the present case. [ABSTRACT FROM AUTHOR]

Aim: This clinical trial aimed to compare the clinical success of coronal pulpotomy and indirect pulp capping (IPC) in managing symptomatic deep proximal caries in molars with moderate pulpitis over a 12-month period. Materials and Methods: A total of 108 vital mature permanent molars with moderate pulpitis were randomly allocated to the IPC (n = 54) or coronal pulpotomy group (n = 54). Dycal and Biodentine were used as pulp-capping materials, followed by composite restoration. The absence of periapical infection and asymptomatic teeth that positively responded to the cold pulp sensitivity test (only in IPC) was considered posttreatment success at 12 months. Data from the study were analyzed using the Chi-square test and Kaplan-Meier survival analysis. Results: There was a statistically significant difference between preoperative symptoms and the cold pulp sensibility test response (P = 0.000), indicating an association between symptoms and pulp sensibility. The average remaining dentine thickness (RDT) value was 0.48 ± 0.5 mm, with no statistically significant difference found between the location of caries and RDT (P = 0.084, P > 0.05). Compared to the IPC group, the pulpotomy group had a greater number of patients at 12 months after treatment that required no intervention. The Kaplan-Meier survival analysis revealed that the mean survival duration for pulpotomy was 48 weeks, and for IPC, it was 42.3 ± 2.35 weeks. Conclusion: Coronal pulpotomy with Biodentine proved more effective in reducing symptoms, achieving radiographic success, and ensuring tooth survival compared to IPC with calcium hydroxide. [ABSTRACT FROM AUTHOR]

Objectives: To determine the characteristics of the endodontic microbiome. Material and Methods: Saliva, plaque, and infected root canal wall dentin of two teeth suffering from apical periodontitis were harvested from a 58‐year‐old man. Bacterial DNA was extracted from each sample, and 16S rRNA gene analysis targeting the V3–V4 region was conducted on the Illumina MiSeq platform using QIIME2. The functional potential of the microbiomes was inferred using PICRUSt2. Results: The four microbiomes were different in structure and membership, yet the nine most abundant metabolic pathways were common among them. The two endodontic microbiomes were more anaerobic, rich in Firmicutes, and scarce in Actinobacteriota and Proteobacteria, compared with saliva and plaque microbiomes. Their profiles were dissimilar despite their clinical and radiographic similarities. Conclusions: The endodontic microbiomes were anaerobic, rich in Firmicutes, scarce in Actinobacteriota and Proteobacteria, and considerably varied within an individual. [ABSTRACT FROM AUTHOR]

After pulp infection and necrosis, the passage of microbial antigens into the periapical space causes apical periodontitis (AP). Most of the clinical forms of AP can be managed without prescribing antibiotics, only with root canal treatment and abscess drainage or, where appropriate, tooth extraction. However, the scientific literature provides evidence of inappropriate antibiotic prescriptions by dentists in the management of apical disease. Objectives: The aim of this systematic review and meta-analysis was to analyze the global pattern of antibiotic prescription in the treatment of apical disease. Methods: PRISMA Guidelines were followed to carry out this systematic review. The research question was as follows: What is the pattern of antibiotic prescription by dentists in the treatment of the different clinical forms of apical periodontitis? A systematic search was conducted on MEDLINE/PubMed, Wiley Online Database, Web of Science and Scopus. All studies reporting data about the pattern of antibiotic prescription by dentists in the treatment of apical disease were included. The meta-analyses were calculated using the Open Meta Analyst version 10.10 software. Random-effects meta-analyses were performed. The risk of bias was assessed using the Newcastle–Ottawa Scale. The certainty of evidence was assessed using GRADE. Results: The search strategy identified 96 articles and thirty-nine cross-sectional studies fulfilled the inclusion criteria. The overall percentage of antibiotic prescriptions by dentists in cases of symptomatic AP was 25.8%, and 31.5% in cases of asymptomatic AP with sinus tract present. The percentage of dentists prescribing antibiotics in cases of acute apical abscess with no/mild symptoms was 47.7%, whereas, in cases of acute apical abscess with moderate/severe symptoms, 88.8% of dentists would prescribe antibiotics. Endodontists prescribe antibiotics at a lower rate than general practitioners. The total risk of bias was considered moderate, and the final rating for the certainty of the evidence was low. Conclusions: Dentists worldwide are over-prescribing antibiotics in the management of apical disease. It is necessary to improve antibiotic prescribing habits in the treatment of endodontic infections, as well as educational initiatives to encourage the rational and appropriate prescription of antibiotics in periapical diseases. [ABSTRACT FROM AUTHOR]

This report explores a unique manifestation of myospherulosis in the periapical region of lower anterior teeth following root canal treatment with calcium hydroxide Ca(OH)2. A 38-year-old woman complained of enduring pain in her lower front teeth for the past 15 days. During the clinical examination, it was observed that the labial vestibule in the lower anterior region was obliterated. The teeth exhibited tenderness upon percussion. Radiographic examination indicated an ill-defined radiolucency in the periapical region, prompting further investigation into the delayed healing. Histopathological examination of the periapical tissue unveiled cyst-like spaces containing brownish-black-stained spherules, indicative of myospherulosis. Curettage with apicectomy was performed to address the delayed healing. A 6-month follow-up revealed complete healing of the lesion, emphasizing the successful management of myospherulosis-induced delayed healing. The unintended consequence of myospherulosis development emphasizes the importance of preventing medicament overflow into the periapical region during root canal therapy to minimize the delayed healing process. [ABSTRACT FROM AUTHOR]

Apical periodontitis is an inflammatory response of the periradicular tissues to microbial infection of the root canal system (intraradicular infection) or to biofilms attached to the external surface of the root (extraradicular infection). Over the past few decades, our understanding of how microbiota initiate, progress, and sustain disease has been well characterized. In parallel, state-of-the-art approaches have attempted to demonstrate the spatiotemporal complexity of biofilm communities both within the tooth and elsewhere in the body. Despite all this research, translation of such critical knowledge into biofilm management in endodontics has been minimal, in part because of lack of directional clarity. The purpose of this commissioned review is to highlight our current understanding of root canal microbial communities as a cause of pulpal and periradicular disease. While several reviews have been written on this topic, few have delved deep into the biogeography, assembly, and functional profile, a void which this review will attempt to fill. The authors hope that this review will open out-of-the-box thinking and newer perspectives in biofilm management in endodontic treatments. [ABSTRACT FROM AUTHOR]