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Background: Regenerative endodontics has evolved in recent years with tissue engineering concepts in particular appearing promising. Endodontic tissue engineering (ETE) describes the various approaches based on the orthograde introduction of scaffolds or biomaterials (with or without cells) into the root canal to achieve pulp tissue regeneration. There are currently no systematic reviews investigating whether ETE is a suitable method for the treatment of endodontic disease in both mature and immature permanent teeth. Objectives: The purpose of this systematic review was to determine the effectiveness of ETE in permanent teeth with pulp necrosis in comparison with conventional endodontic treatment. Methods: We searched MEDLINE, Embase and the Cochrane Library for published reports as well as Google Scholar for grey literature up to November 2021. Included were studies of patients with permanent immature or mature teeth and pulp necrosis with or without signs of apical periodontitis (P) comparing ETE (I) with calcium hydroxide apexification, apical plug and root canal treatment (C) in terms of tooth survival, pain, tenderness, swelling, need for medication (analgesics and antibiotics), radiographic evidence of reduction in apical lesion size, radiographic evidence of normal periodontal ligament space, function (fracture and restoration longevity), the need for further intervention, adverse effects (including exacerbation, restoration integrity, allergy and discolouration), oral health‐related quality of life (OHRQoL), presence of sinus tract and response to sensibility testing (O). An observation period of at least 12 months was mandatory (T) and the number of patients in human experimental studies or longitudinal observational studies had to be at least 20 (10 in each arm) at the end (S). Risk of bias was appraised using the Cochrane risk‐of‐bias (RoB 2) tool. Two authors independently screened the records, assessed full texts for eligibility and evaluated risk of bias. Heterogeneity of outcomes and limited body of evidence did not allow for meta‐analysis. Results: Two randomized clinical trials investigating cell transplantation approaches with a total of 76 participants (40 treated immature teeth and 36 treated mature teeth) were included for qualitative analysis. Both studies had moderate concerns in terms of risk of bias. Due to the lack of homogeneity a meta‐analysis was not possible. Tooth survival for ETE, root canal treatment and apexification was 100% after 12 months. Teeth treated with ETE showed a higher number of cases with positive pulpal responses to sensitivity tests and with blood perfusion compared with root canal treatment or apexification. Discussion: This systematic review highlights that there is limited evidence for ETE approaches. Even though the results of this review suggest a high survival with ETE in mature and immature teeth, there is a moderate risk of bias due to methodological limitations in the included studies, so the overall results should be interpreted with caution. Lack of a robust control group was a common problem during literature screening, and outcomes besides dental survival were reported inconsistently. Future clinical trials need to address methodical as well as assessment concerns and report long‐term results. Conclusion: The benefits and high survival rates reported for ETE techniques suggest that this procedure might be an alternative to conventional procedures for permanent teeth with pulpal necrosis. However, more appropriate studies are needed to derive clinical recommendations. Registration: PROSPERO (CRD42021266350). [ABSTRACT FROM AUTHOR]

Background: Revitalization procedures primarily aim to eliminate clinical symptoms and heal periapical lesions. Objectives: The objective of the study was to elucidate the effectiveness of revitalization in treating apical periodontitis in necrotic mature and immature permanent teeth based on the following PICO question: In patients with permanent immature or mature teeth and pulp necrosis with or without signs of apical periodontitis (P) what is the effectiveness of revitalization (I) in comparison with calcium hydroxide apexification, apical plug and root canal treatment (C) in terms of tooth survival, pain, tenderness, swelling, need for medication (analgesics and antibiotics), radiographic evidence of reduction of apical lesion size, radiographic evidence of normal periodontal ligament space, radiographic evidence of increased root thickness and length (not for mature teeth), tooth function (fracture and restoration longevity), need for further intervention, adverse effects (including exacerbation, restoration integrity, allergy and discolouration), oral health‐related quality of life (OHRQoL), presence of sinus tract and response to sensibility testing (O). (T) = Defined as a minimum of 1 year and maximum of as long as possible for all outcome measures, except 'pain, tenderness, swelling, need for medication (analgesics)', which is a minimum of 7 days and maximum of 3 months and OHRQoL which is minimum of 6 months and a maximum of as long as possible. Methods: Three databases (PubMed, Embase and Cochrane Library) were searched for human, experimental and observational studies in English, complemented with hand search, until 31/10/2021. Studies recruiting teeth with pulp necrosis (with/without apical periodontitis), with minimum 10 teeth/arm at the end of the study and with a follow‐up of at least 1 year, were included. Records without an abstract and a full text were excluded. The qualitative analysis of the included (non‐) randomized controlled clinical trials was performed with the Revised Cochrane risk‐of‐bias tools (RoB 2 and ROBINS‐I). Meta‐analysis for survival and success (including a subgroup analysis for mature/immature permanent teeth) was performed using the Mantel–Haenszel method. The certainty of evidence was assessed using GRADE (Grades of Recommendation, Assessment, Development and Evaluation). Results: From the 365 identified records, five met the inclusion criteria. The 12 months survival rate was 100% for all (im)mature permanent teeth in all groups (3 studies). The success rate at 12 months was 100% for immature permanent teeth for I and C (1 study), however, reduced to 92% and 80% for mature teeth in I and C respectively (1 study, p >.05). The risk of bias for the most critical outcome (survival) was high for two studies and low for one. For the critical outcome success, all assessed studies were highly biased. Meta‐analyses provided pooled relative risk with no statistically significant difference between I and C for both survival (RR = 1.00, 95%CI = 0.96–1.04, p = 1.00) and success (RR = 1.06; 95%CI = 0.83–1.35, p =.66). The evidence level for survival was kept 'low' and for success was downgraded to 'very low' due to inconsistency and imprecision. Discussion: The survival and success rates were favourable in all included studies and for all groups; however, these outcomes are not reliable due to the low certainty level. Clinically, the most reported adverse event was tooth discolouration, hence the application of bismuth oxide containing calcium silicate cements should be avoided in revitalization. Radiographically, caution is needed when assessing periapical bone healing and further root development with periapical radiographs, due to multifactorial inaccuracies of this imaging technique. Methodological and assessment concerns need to be addressed in future clinical trials. Long‐term results are necessary for studies reporting revitalization of mature permanent teeth, as they seem to be experimental so far. Conclusions: No robust evidence was discovered to support that revitalization is effective to treat apical periodontitis in (im)mature permanent teeth. The success and survival rates of revitalized and fully pulpectomized (im)mature permanent teeth did not differ significantly. Registration: Prospero: CRD42021262466. [ABSTRACT FROM AUTHOR]

Aim: T cells are key immunomodulatory cells in periapical lesions. This study aimed to explore the roles of T cells in chronic apical periodontitis (CAP) using single‐cell RNA sequencing and to further investigate Granzyme A (GZMA) in angiogenesis regulation. Methodology: A total of five CAP samples were collected for single‐cell RNA sequencing. We performed subcluster and lineage‐tracing analyses for T cells. According to differential gene expression, distinct biological functions enriched in T cells of CAP were presented by gene set enrichment analysis (GSEA) and compared with healthy gingiva (data obtained from the GEO database). CellChat was used to explore potential ligand–receptor interactions between T cells and endothelial cells in CAP. The coculture of primary human umbilical vein endothelial cells (HUVECs) and Jurkat T cells, as well as the addition of GZMA recombinant protein, was used to validate the predicted pair of GZMA and coagulation factor II thrombin receptor (F2R) by RT‐PCR, angiogenesis and migration assays. Results: A transcriptomic atlas of 44 746 individual cells was constructed from the periapical lesions of five patients with CAP by single‐cell RNA‐seq, and eight cell types were identified. We identified nine subsets of T cells and deciphered the cellular heterogeneity of T cells in CAP at the functional level by subclustering and GSEA. Lineage tracing revealed a distinct lineage of T cells in CAP and predicted the transition of the T cellular state upon CAP. GSEA revealed multiple biological processes and relevant angiogenesis genes upregulated in CAP T cells. GZMA‐F2R pairs were predicted by cell–cell interactions in CAP. High expression of GZMA and F2R was observed in the coculture of HUVECs and Jurkat T cells, and the proangiogenic capacity of the GZMA recombinant protein was emphasized by in vitro experiments. Conclusions: Our study provides novel insights into the heterogeneity of T cells in periapical lesions and reveals the potential role of GZMA in T cells in regulating angiogenesis in HUVECs. [ABSTRACT FROM AUTHOR]

CBCT offers many significant advantages in dentistry, while the periapical radiographs provide a cheaper technique and a lower radiation compared to CT scan. The aim of this clinical case was to compare the outcome 1 year after root canal treatment, using digital periapical radiographs versus CBCT. Tooth 46 with necrotic pulp and periapical periodontitis was rotary prepared and filled using continuous wave condensation and AH Plus. X-rays and CBCT scans were made both before and after the treatment, at 1 year recall. On x-ray the lesion appeared to be healed, while on CBCT one can still see a smaller lesion, so the tooth is healing. The increased accuracy of CBCT offers the most relevant information for the outcome of endodontic treatment. [ABSTRACT FROM AUTHOR]

Background. Root canals feature a high incidence of post-treatment flare-ups, characterized by pain, swelling, or discomfort following endodontic procedures, which remain a concern in dental practice. This study aims to evaluate the host-related factors behind the prevalence of post-endodontic flare-ups. Methodology. A retrospective study was conducted on the records of 93 patients who were treated endodontically between January 2017 and December 2021. Data extracted from records included age, medical conditions, diagnosis, and tooth type. SPSS 27.0 was used to analyze the data. Multivariate logistic regression analysis was employed to identify significant predictors while controlling for potential confounding factors. Results. The flare-up rate among patients who had received endodontic treatment was 31.2% in the study population. Multivariate logistic regression analysis demonstrated that age and the presence of a vital pulp were significant predictors of flare-ups. Older patients exhibited an increased likelihood of experiencing flare-ups (p < 0.05), suggesting age-related factors may influence post-treatment outcomes. Additionally, patients with a vital pulp had significantly higher odds of flare-ups (p <0.05), underscoring the importance of preserving pulp vitality during endodontic procedures. Medical condition, arch, and tooth type did not emerge as significant predictors (p >0.05). Conclusion. The study provided insights into the frequency of post-endodontic flare-ups and the impact of hostrelated factors on their occurrence. Age and vital pulp were found to be important predictors, highlighting the significance of individualized treatment planning. These results highlight the possibility of improved patient outcomes through a thorough understanding of post-endodontic problems and contribute to evidence-based endodontic practice. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effect of unintentional AH Plus sealer extrusion on the outcome of nonsurgical root canal treatment and retreatment in teeth with apical periodontitis (AP) compared to teeth with AP and no sealer extrusion at the 1-year follow-up. In a retrospective case-control study conducted from September 2016 to September 2021, teeth presenting clinical and radiographic signs of AP prior to treatment were included. The study comprised 2 groups: AH Plus sealer extrusion group (n = 60): initial root canal treatment or nonsurgical retreatment with unintentional apical extrusion of AH Plus sealer; and no AH Plus sealer extrusion group (n = 60): underwent the same treatment types without sealer extrusion. Additional factors, including sex, age, tooth type, tooth location, and treatment type, were recorded as potential outcome predictors. At 1-year follow-up, teeth were evaluated clinically and radiographically, and outcomes were classified as favorable (healed/healing) or unfavorable (uncertain/non-healing). Statistical analyses, such as the χ2 test, logistic regression, and Mann-Whitney U test, were employed for data analysis. A favorable outcome was observed in 88.4% and 85% of the cases of the AH Plus sealer extrusion and no AH Plus sealer extrusion groups, respectively. There was no statistically significant difference between the groups in terms of outcomes (P >.05) when analyzed categorically or ordinally. Of independent variables, nonsurgical retreatment showed lower healing of AP in both groups. Unintentional AH Plus sealer extrusion did not affect the healing of AP. However, initial root canal treatment showed better healing of AP than nonsurgical retreatment in the presence of AH Plus sealer extrusion. The analyzed outcome predictors had no effect on treatment outcome. [ABSTRACT FROM AUTHOR]

Apical periodontitis (AP) is a common consequence of root canal infection leading to periapical bone resorption. Microbial and host genetic factors and their interactions have been shown to play a role in AP development and progression. Variations in a few genes have been reported in association with AP; however, the lack of genome-wide studies has hindered progress in understanding the molecular mechanisms involved. Here, we report the first genome-wide association study of AP in a large and well-characterized population. Male and female adults (n = 932) presenting with deep caries and AP (cases), or deep caries without AP (controls) were included. Genotyping was performed using the Illumina Expanded Multi-Ethnic Genotyping Array (MEGA). Single-variant association testing was performed adjusting for sex and 5 principal components. Subphenotype association testing, analyses of genetically regulated gene expression, polygenic risk score, and phenome-wide association (PheWAS) analyses were also conducted. Eight loci reached near genome-wide significant association with AP (P < 5 × 10−6); gene-focused analyses replicated 3 previously reported associations (P < 8.9 × 10−5). Sex-specific and subphenotype-specific analyses revealed additional significant associations with variants genome-wide. Functionally oriented gene-based analyses revealed 8 genes significantly associated with AP (P < 5 × 10−5), and PheWAS analysis revealed 33 phecodes associated with AP risk score (P < 3.08 × 10−5). This study identified novel genes/loci contributing to AP and specific contributions to AP risk in men and women. Importantly, we identified additional systemic conditions significantly associated with AP risk. Our findings provide strong evidence for host-mediated effects on AP susceptibility. [ABSTRACT FROM AUTHOR]

This report describes an atypical mandibular canine with a single boomerang-shaped root and root canal system with a large periapical lesion managed by root canal treatment. The chief complaint of a 16-year-old male was acute pain and an abnormal sensation in the right mandibular canine (tooth #27). The clinical examination revealed that tooth #27 had an unusual coronal morphology. The buccal aspect of the tooth resembled that of a normal canine but was significantly broader than expected. On the lingual aspect of the crown; however, there was an unusual cusp-like structure with ridges that was slightly less prominent than the buccal incisal tip. The intraoral periapical radiographs revealed a complex root with an obvious cow horn-shaped canal mesially and distally, but with the suggestion of a root structure joining the mesial and distal extensions. A large periapical lesion was present. Computed tomography revealed the presence of a single root and canal system shaped like a boomerang. Root canal treatment was performed and the patient was followed-up for 9 years. Following root canal treatment, the patient had no symptoms, no mobility, no periodontal pockets, or root resorption. At 9 years, the cone beam computed tomography images confirmed that satisfactory healing of the periapical tissues had occurred. The mandibular right canine had a unique boomerang-shaped root and canal system. Effective shaping and cleaning of the complex canal shape plus thermoplastic root filling aided the successful healing of the periapical lesion. [ABSTRACT FROM AUTHOR]

This article discusses a study that used fractal analysis to evaluate the healing of periapical lesions after endodontic retreatment. The study found that there was a significant increase in fractal dimension values, indicating healing of the lesions. The study focused on retreatment of specific teeth to standardize the results, and the findings were consistent with other studies. The authors recommend using fractal analysis as a method for clinicians to monitor retreatment recovery. [Extracted from the article]

Pulp canal obliteration (PCO) in calcified teeth presents a challenge for endodontic treatment, especially when accompanied by discoloration. Guided endodontic access (GEA) has emerged as an advanced method for root canal therapy (RCT) in such cases. This case report describes the successful treatment of a calcified maxillary central incisor with discoloration using GEA. A 32- year-old female with a history of dental trauma presented with discoloration in the left maxillary central incisor that did not respond to external bleaching. Clinical examination revealed a pulpless infected canal with asymptomatic apical periodontitis. Cone-beam computed tomography (CBCT) and intraoral scanning were utilized to create a three dimensional (3D) template, enabling minimally invasive access preparation through the palatal aspect. The RCT was performed in a single visit, followed by tooth whitening using hydrogen peroxide. At 18 months follow-up, the tooth was asymptomatic, and the apical lesion was healed. GEA offers a predictable and conservative approach, preserving tooth structure and providing enhanced long-term prognosis for teeth with calcified canals and discoloration. [ABSTRACT FROM AUTHOR]

Introduction: The presented study aimed to characterise periapical disease in teeth with primary non-surgical root canal treatment in persistent or emergent categories and their risk association. Methods: A retrospective observational study that evaluated permanent teeth with primary non-surgical root canal treatment, was conducted clinically and radiographically for over one year. The following variables were analysed: gender, age, type and location of tooth, previous diagnosis, treatment conditions, and type of coronal restoration. The supplementary variables included the perspectives of the treatment outcome, such as Remains normal, Improvement, and Failure. Statistical analysis was performed using a univariate analysis that estimated the average and proportion for each factor according to the result of the primary non-surgical root canal treatment. The multiple correspondence analysis identified the hierarchy between active variables and their association with the results. Results: A total of 232 teeth in 155 participants were analysed. A χ² value, (P=0.023) showed that the emergent disease is associated with patients around the age of 50. The multiple correspondence analysis identified a tendency of grouping between the emergent disease and the short filling category, followed by symptomatic pulpitis as a previous diagnosis. The persistent disease was associated with errors and overfillings. An inadequate root filling and taper density adversely impacted the treatment outcome. Conclusions: The length of obturation influenced the presence of failure. Short fillings were associated with emerging periapical disease. Errors and overfillings contributed to the persistent disease in the populations studied. [ABSTRACT FROM AUTHOR]

This study aimed to investigate if apical periodontitis in different periods changes systemic levels of the antioxidant and pro-oxidant parameters in Wistar rats. Twenty-four rats were randomly allocated into healthy animals, apical periodontitis at 14 days (AP14) and apical periodontitis at 28 days (AP28). The first mandibular molars were accessed in the AP groups, and the pulp chamber was exposed to the oral environment, inducing the apical lesion. After 14 and 28 days, the animals were anesthetized, euthanized, and hemimandibles were collected formicro-computed tomography (micro-CT) analysis tomeasure lesion volume, bone volume (BV), percent of bone to total tissue volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), and trabecular space (Tb.Sp). A histological examination of the remaining bone was also performed. Finally, blood samples were collected for oxidative biochemistry analysis, investigating glutathione (GSH), Trolox equivalent antioxidant capacity (TEAC), and lipid peroxidation (TBARS). The lesion volume was greater at 28 than at 14 days, as shown by micro-CT. AP14 and AP28 had decreased BV and Tb.Th, but only AP28 showed a reduction in BV/TV. Tb.N and Tb. Sp were increased in apical periodontitis at 28 days. In the histopathological analysis, AP14 had focal regions of moderate mononuclear inflammatory infiltrate, and AP28 had an intense inflammatory infiltrate with bacterial colonies. In the biochemical evaluation, GSH, TEAC, and TBARS were increased after 14 days. However, GSH returned to control levels, TEAC was similar to AP14, and TBARS increased significantly after 28 days. Therefore, the oxidative biochemistry response was modulated according to the progression of periapical damage. After 14 days, the organism could still react to the injury. However, at 28 days, the antioxidant response decreased, associated with an increase in TBARS. [ABSTRACT FROM AUTHOR]

CBCT significantly impacts dental procedures and has brought significant reforms to our approach to diagnosis and treatment planning despite its limitations in differentiating soft tissues. It is an excellent imaging modality and quickly identifies sinus opacification and provides valuable insight into paranasal sinus pathologies, with considerably lower radiation exposure. The present study aimed to investigate the occurrence of maxillary sinus abnormalities in CBCT scans, identify the frequency, type, and location of these findings, and find the correlation between the distance of periapical lesions and radiographic changes in the maxillary sinus. Two examiners independently evaluated 117 patients to diagnose and classify the cases into different abnormality subtypes. The periapical lesions most closely related to the sinus were recorded. The diameters of the left and right maxillary sinus ostium and the distance of the ostium's lower border to the sinus's osseous floor were recorded. The findings were correlated with the age and gender of these patients. The present study reveals that sixty-one patients were diagnosed with mucosal thickening (52.1%). The sinus wall most affected by mucosal thickening was the maxillary sinus floor, followed by the medial and lateral walls. Of 19 patients with periapical lesions, 15 had maxillary sinus mucosal thickening, which is statistically significant (p = 0.004). The high occurrence of abnormalities in the maxillary sinus emphasizes the importance for the radiologist to comprehensively interpret the whole volume acquired in CBCT images, including the entire sinus. Incidental findings may be considered in the individual clinical context of signs and symptoms, reducing the risk of overestimating the real impact of radiographic findings. [ABSTRACT FROM AUTHOR]

Removing a fiber post from a root canal that requires endodontic retreatment is often very challenging. Conventional freehand techniques for removing fiber posts are time-consuming, sometimes result in iatrogenic errors, and heavily rely on the practitioner's experience. The endodontic static guide can be an alternative method. While the use of an endodontic 3D-printed static guide for fiber post removal has been reported as highly successful, it can also cause complications. Skipping any critical steps during the guide construction or its clinical application can lead to errors. This case report presents the saving of a compromised tooth with a fractured fiber post and a periapical lesion around the apex through the use of an endodontic static guide for fiber post removal. This study describes possible sources of error that may happen during construction and clinical use of the guide. [ABSTRACT FROM AUTHOR]

Objectives: To detect and evaluate early signs of apical periodontitis using MRI based on a 3D short-tau-inversion-recovery (STIR) sequence compared to conventional panoramic radiography (OPT) and periapical radiographs in patients with apical periodontitis. Materials and methods: Patients with clinical evidence of periodontal disease were enrolled prospectively and received OPT as well as MRI of the viscerocranium including a 3D-STIR sequence. The MRI sequences were assessed for the occurrence and extent of bone changes associated with apical periodontitis including bone edema, periradicular cysts, and dental granulomas. OPTs and intraoral periapical radiographs, if available, were assessed for corresponding periapical radiolucencies using the periapical index (PAI). Results: In total, 232 teeth of 37 patients (mean age 62±13.9 years, 18 women) were assessed. In 69 cases reactive bone edema was detected on MRI with corresponding radiolucency according to OPT. In 105 cases edema was detected without corresponding radiolucency on OPT. The overall extent of edema measured on MRI was significantly larger compared to the radiolucency on OPT (mean: STIR 2.4±1.4 mm, dental radiograph 1.3±1.2 mm, OPT 0.8±1.1 mm, P=0.01). The overall PAI score was significantly higher on MRI compared to OPT (mean PAI: STIR 1.9±0.7, dental radiograph 1.3±0.5, OPT 1.2±0.7, P=0.02). Conclusion: Early detection and assessment of bone changes of apical periodontitis using MRI was feasible while the extent of bone edema measured on MRI exceeded the radiolucencies measured on OPT. Clinical relevance: In clinical routine, dental MRI might be useful for early detection and assessment of apical periodontitis before irreversible bone loss is detected on conventional panoramic and intraoral periapical radiographs. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate whether single‐nucleotide polymorphisms (SNPs) in the genes encoding 5‐HTR2A (5‐Hydroxytryptamine (serotonin) receptor 2A) and MTNR1A (melatonin receptor 1A) may contribute to postoperative pain perception after root canal treatment. We hypothesised that SNPs in HTR2A and MTNR1A genes were associated with postoperative pain after root canal treatment. Methodology: This genetic cohort study enrolled patients with single‐rooted teeth diagnosed with pulp necrosis and asymptomatic apical periodontitis before root canal treatment. Root canal treatment was performed in one session using a standardized protocol. Postoperative pain and tenderness were assessed using a visual analogue scale (recorded every day for 7 days and on the 14th and 30th days after root canal treatment). Genomic DNA was extracted from saliva and used to genotype the SNPs in HTR2A (rs4941573 and rs6313) and MTNR1A (rs6553010, rs6847693 and rs13140012) using real‐time polymerase chain reaction. Genotypes were compared using univariate and multivariate Poisson regression with generalized estimating equations (p <.05). Results: In total, 108 patients were enrolled in this study. The SNPs rs6553010 (MTNR1A), rs4941573 and rs6313 (HTR2A) were associated with an increased risk of developing pain after root canal treatment (p <.05). Conclusions: This study suggests that SNPs in HTR2A and MTNR1A influence pain response after root canal treatment. [ABSTRACT FROM AUTHOR]

Aim: Prior to certain medical therapies, dental assessment and treatment of oral foci of infection are recommended. The aim of the present study was to acquire a deeper understanding of the decision‐making process regarding the pre‐medical management of root–canal–filled teeth with asymptomatic apical periodontitis (AAP). Methodology: Hospital‐affiliated dentists in Sweden were contacted for a semi‐structured, in‐depth interview. The absolute inclusion criterion was that the dentists had experienced and could recount at least two authentic cases involving root–canal–filled teeth with AAP—one case having resulted in pre‐medical treatment, and one having resulted in expectancy. Fourteen interviews, with fourteen informants, were conducted and included in the study. During the interviews, open‐ended questions and comments encouraging the informants to elaborate and clarify their experiences were offered. The interviews were digitally recorded, transcribed verbatim and analysed using Qualitative Content Analysis with an inductive approach. Results: A theme describing the latent content was identified through interpretation of the collected data: A multifaceted balancing act characterized by a sometimes‐difficult risk–benefit‐estimation, where an increased uncertainty entails an increased reliance on external opinions. Three main categories, comprising four sub‐categories, describing the manifest content were recognized: The tipping scale, The team effort and The frame of reference. Conclusions: The current interview study found pre‐medical decision‐making regarding root–canal–filled teeth with AAP to be a multifactorial and contextual process marked by uncertainty and collaborative measures. Further research, resulting in the development of evidence‐based treatment guidelines, is suggested necessary. [ABSTRACT FROM AUTHOR]

Introduction. Dens invaginatus is an infrequent developmental anomaly of teeth with an unknown etiology. The prevalence rate ranges from 0.25% to 10%. The most affected teeth are lateral maxillary incisors. Various classifications have been proposed to categorize the different types of dens in dente. However, the Oehlers classification, named after the dentist who first described it, is the most commonly used for this malformation. This classification has three primary types and was introduced in 1957. Case Report. A 17-yearold female patient appeared at the Dentistry Clinic of Vojvodina, Novi Sad with a lateral maxillary incisor exhibiting dens invaginatus (Oehlers type IIIA). The pulp was necrotic, accompanied by a large periradicular lesion. The patient had previously been prescribed penicillin antibiotics, and we initiated endodontic therapy. The patient returned for the scheduled check-up appointment with swelling in the area of the canine fossa above the upper left lateral incisor. In consultation with an oral surgeon, the tooth was extracted with purulent content. Four days after the extraction, the patient received a resin bonded bridge. Conclusion. The clinical significance and importance of dens in dente lie primarily in its potential to manifest with various symptomatic indications and its association with the occurrence and development of dental caries. It is crucial for clinicians and dental professionals to remain highly attentive, vigilant, and alert to the potential presence of dens in dente. This involves considering and acknowledging the wide array of diverse presentations and manifestations that this anomaly can exhibit. [ABSTRACT FROM AUTHOR]

The loss of periodontal tissue support and vertical buccal bone loss in apico-marginal defects can often be mistaken for features indicative of vertical root fractures and this study reports thirteen cases with persistent symptomatic apical periodontitis, apico-marginal defects, and large periapical lesions that were managed with endodontic microsurgery in conjunction with bone grafts and barrier placements with a follow-up period of up to 9 years. At the recall sessions, all cases were asymptomatic with radiographical success with only 2 cases exhibiting residual apical radiolucency, but with evident reduction in the lesion size, indicative of healing. This study highlights the potential of utilizing endodontic microsurgery combined with guided tissue regeneration that proved effective in stimulating the regeneration of periodontal tissue in cases of apico-marginal defects that can lead to favourable long-term outcomes. [ABSTRACT FROM AUTHOR]

The aim of this prospective case series was to assess the clinical and radiographic outcome of partial pulpotomy in caries-exposed symptomatic, vital, immature, permanent molars. Thirty-four immature molars with deep caries and symptoms of irreversible pulpitis were treated by partial pulpotomy and ProRoot MTA as a capping material. After complete caries removal, the inflamed part of the pulp was removed. Complete hemostasis was achieved using a sterile cotton pellet moist initially with sodium hypochlorite 1.5% and then with sterile saline. ProRoot MTA (Dentsply Sirona, Charlotte, NC) was placed as a capping material onto the remaining pulp tissue. The cavity was sealed using a light-curing resin-modified Ca(OH) 2 cavity liner, and patients were referred to a pediatric dentist for permanent restoration. Descriptive statistics and cross tabulations were performed including variables examined before, during, and after the procedure. All examined teeth presented a favorable clinical and radiographic outcome with normal periapical tissues, complete apical closure, and formation of a dentinal bridge beneath the capping material. Signs of partial pulp chamber calcification were only detected in 2 cases. Postoperatively, most patients did not report any pain (23/34, 67.7%), whereas the rest reported minor intensity pain (11/34, 32.3) and the use of analgesic or anti-inflammatory drugs only for 1 day (10/34, 29.4%). Partial pulpotomy seems to provide a universally successful outcome when managing symptomatic vital immature teeth with no signs of complications and completion of apical closure. It could be a viable treatment of choice in cases of caries-exposed vital immature teeth with symptoms of irreversible pulpitis. [ABSTRACT FROM AUTHOR]

Dental implants are a treatment option for edentulous spaces. Placing implants involves a surgical procedure requiring a high level of attention to detail. There are risks associated with implants, such as peri-implantitis, failure of osseo-integration and peri-apical implantitis. The latter condition can present after implant placement, and presents radiographically as a radiolucency around the apical part of the implant, similar in appearance to a peri-apical lesion of a non-vital tooth. The aetiology of this condition remains controversial. This article presents some of the current literature and the case report demonstrates the successful surgical management of peri-apical implantitis. [ABSTRACT FROM AUTHOR]

To investigate the efficacy of the supplementary use of a rotary agitation method [XP‐endo Finisher (XPF)] and sonically‐activated irrigation [EndoActivator (EA)], using droplet digital PCR (ddPCR) on reducing the bacterial load in previously root canal treated teeth with apical periodontitis. Twenty patients with post‐treatment apical periodontitis were allocated into two groups according to the irrigation activation method used: XPF and EA group. Total bacterial loads, as well as the amount of Enterococcus faecalis (E. faecalis) were determined before (S1) and after (S2) chemomechanical preparation, and after final irrigation activation (S3) by means of ddPCR. The bacterial copy numbers were compared between groups using the Friedman test (Nonparametric Repeated Measures ANOVA). When the groups were examined in terms of gender, age, number of root canals, periapical index score, sterility control total bacteria (SCTB), S1‐ and S2‐total bacteria copy number, it was found that there was no statistical difference between the XPF group and the EA group (p > 0.05). Subsequent activation (S3) resulted in a significant microbial reduction in both XPF and EA groups, both of which reduced significantly more bacteria than chemomechanical instrumentation (S2) (p < 0.0001). On the contrary, S3‐total bacteria copy number of the EA group was lower than the XPF group (p < 0.0147). There was no statistical difference between the XPF group and the EA group in terms of E. faecalis copy number (p > 0.05). Although both the XPF and the EA optimised the antibacterial efficiency of chemomechanical preparation in previously root canal‐treated teeth with apical periodontitis, a lower total bacterial copy number was achieved with the EA application than the XPF application. [ABSTRACT FROM AUTHOR]

This study aimed to perform an analysis of obtaining apical patency indexes during endodontic treatments considering gender, age, pulpoperiradicular diagnosis and canal/tooth (n. 639/383). Following previous clinical procedures, a thin K‐File (No. 20, 15, 10 or 08) was used to achieve apical patency. These specific data and some demographic and clinical information were submitted to the statistical analysis (p < 0.05). Significant statistical differences were not identified considering gender (p = 0.156) and age (p = 0.793). However, in 14.6% of the canals of vital teeth and 14.1% of the canals of necrotic teeth without periapical lesions, apical patency could not be achieved, which occurred in only 7% of the canals of necrotic teeth with periradicular disease (p = 0.009). Considering canal/tooth, apical patency was more challenging to obtain in canals of posterior teeth (p = 0.000). The pulpoperiapical diagnosis and canal/tooth significantly influenced the obtaining of apical patency. [ABSTRACT FROM AUTHOR]

The aim of this report is to present the results of a personalised endodontic treatment for an immature molar, using regenerative endodontic procedure (REP) combined with non‐surgical root canal treatment (NSRCT), with 7 years of follow‐up. The tooth#3 presented combined endodontic pathologies in each root, with different pulpal and periapical status. A REP in the palatal (P) canal and a NSCRT in the mesio‐buccal (MB) and disto‐buccal (DB) canals were performed. Absence of clinical signs/symptoms and continuous palatal root development with apical closure were observed over 4‐years. After 5‐years an apical lesion in the MB root was observed. Both MB canals were selectively retreated by completely filling them with TotalFill BC RRM Fast Set putty. After 7‐years, the tooth remained functional and the apical lesion was resolving. The palatal root was completely mature. This case report reveals the potential for use of combined treatment approaches for immature multirooted teeth. [ABSTRACT FROM AUTHOR]

NeoMTA is a commercially available tricalcium silicate‐based cement intended for contact with pulp and periradicular tissues. The purpose of this study was to retrospectively evaluate the outcomes of non‐surgical root canal treatments with NeoMTA obturations. Patients were treated in a private endodontic practice between 2015 and 2018. All cases, including initial treatments and retreatments, were either fully obturated with NeoMTA, or using gutta‐percha with NeoMTA as an endodontic sealer. Outcomes were assessed using follow‐up examination data with digital periapical radiographs with a minimum of a 1‐year recall. Teeth were classified based on the clinical examination as: healed/healing (success), or non‐healed (failure). 265 teeth were included with an average follow‐up time of 1.3 years. The overall success rate was 91.7%. Only the presence of a pre‐operative periapical radiolucency was found to significantly affect success. Comparison of obturation techniques demonstrated no effect on outcomes. NeoMTA is suitable for endodontic obturation. [ABSTRACT FROM AUTHOR]

This study aimed to compare the effect of a bioceramic sealer (iRoot SP) and a resin‐based sealer (AH Plus) on the outcome of root canal treatment in a 2‐year follow‐up. Seventy‐six teeth with irreversibly or necrotic pulp were recruited. After instrumentation and disinfection, the root canals were obturated using warm vertical compaction with iRoot SP (n = 43) or AH Plus (n = 33). Patients were followed up by clinical and radiographic examination at 6 12 and 24 months with recall rates of 84.2%, 65.8% and 48.7%, respectively. During each recall session, the success rates were 80%, 85.2% and 85% in the iRoot SP group and 82.8%, 91.3% and 88.2% in the AH Plus group. The success rates of the two groups did not differ significantly (p > 0.05). The bioceramic sealer resulted in a similar clinical performance and success rate to the resin‐based sealer in endodontic treatment during a 2‐year follow‐up. [ABSTRACT FROM AUTHOR]

The purpose of the present review was to examine success, survival and failure following intentional replantation of endodontically treated teeth with existing periapical pathosis and to determine the factors that might affect the outcome of replantation. Clinical trials, longitudinal studies, case series with >10 cases and at least 1‐year follow‐up were included. The average rate of success following intentional replantation was 77.23%. Meta‐analysis revealed the mean weighted survival to be 85.9% (95% CI: 79.6–91.2) Common complications include inflammatory root resorption (0%–27%) and ankylosis (0%–25%). Variables influencing successful outcome include extra alveolar dry time <15 min; root‐end resection (2–3 mm) and cavity preparation (3 mm); manipulation of the tooth using the crown only; and use of an appropriate storage media. The review concludes that intentional replantation is a viable treatment option with acceptable survival rates for endodontically treated teeth with periapical pathosis. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate radiographic periapical repair after endodontic treatment using QMix or NaOCl irrigation in single‐rooted teeth with apical periodontitis. In this randomised clinical trial, 60 patients were selected and randomised into two groups (n = 30). After instrumentation of root canals, QMix or NaOCl was used as a final irrigation and the canals obturated with gutta‐percha and AH Plus sealer. All the participants were recalled after 12 months and 15 patients were lost to the study so 45 patients were evaluated radiographically according to periapical index (PAI) scores. A significant decrease was seen in PAI scores after 1 year in all patients (p < 0.001). In the QMix and NaOCl group, absence or reduction of radiolucency was observed in 23 of 25 teeth (92%) and 20 of 20 teeth (100%), respectively. There was no significant difference between two groups according to the decrease in PAI score (p = 0.508). Root canal treatments with or without QMix irrigation contributed equally to periapical healing. [ABSTRACT FROM AUTHOR]

Florid cemento-osseous dysplasia (FCOD) is an uncommon fibro-osseous lesion that can affect the jaws. It involves the deposition of dense, acellular amorphous bone on a foundation of fibrous connective tissue, replacing normal cancellous bone. This condition often affects middle-aged women, with a mean age of 42. The lesion's epicenter is at the teeth apices and typically appears posterior to the canines. We present two cases of female patients, aged 49 and 26, who were both initially misdiagnosed with periapical infection and underwent root canal treatments while the lesions remained. Both patients visited our clinic. After careful history taking and clinical and radiographic examination, FCOD was diagnosed, and both patients were treated conservatively. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to evaluate the accuracy and effectiveness of an artificial intelligence (AI) program in identifying dental conditions using panoramic radiographs(PRs), as well as to assess the appropriateness of its treatment recommendations. Materials and Methods: PRs from 100 patients(representing 4497 teeth) with known clinical examination findings were randomly selected from a university database. Three dentomaxillofacial radiologists and the Diagnocat AI software evaluated these PRs. The evaluations were focused on various dental conditions and treatments, including canal filling, caries, cast post and core, dental calculus, fillings, furcation lesions, implants, lack of interproximal tooth contact, open margins, overhangs, periapical lesions, periodontal bone loss, short fillings, voids in root fillings, overfillings, pontics, root fragments, impacted teeth, artificial crowns, missing teeth, and healthy teeth. Results: The AI demonstrated almost perfect agreement (exceeding 0.81) in most of the assessments when compared to the ground truth. The sensitivity was very high (above 0.8) for the evaluation of healthy teeth, artificial crowns, dental calculus, missing teeth, fillings, lack of interproximal contact, periodontal bone loss, and implants. However, the sensitivity was low for the assessment of caries, periapical lesions, pontic voids in the root canal, and overhangs. Conclusion: Despite the limitations of this study, the synthesized data suggest that AI-based decision support systems can serve as a valuable tool in detecting dental conditions, when used with PR for clinical dental applications. [ABSTRACT FROM AUTHOR]

Abstract Background Hemangiomas are benign tumours, mostly seen in the soft tissues. The intraosseous appearance is rare, in particular in the jaws they represent a very seldom malformation. Aim To present a combined endodontic and surgical management report of a clinical case with a rare intraosseous hemangioma diagnosis in the mandible. Case presentation This well-documented case report describes the interdisciplinary treatment approach of an intraosseous hemangioma in the left mandible of a 70-year-old male patient. This incidental finding was detected through a routine dental examination. The panoramic radiograph revealed an asymptomatic, apical translucency approximately 15 mm diameter with contact to the mesial root of the tooth 36. The clinical examinations showed no abnormalities. The multifaceted specialized treatments started with the endodontic treatment of the tooth prior to the surgical removal of the lesion and were followed by the histological assessment. As derived from the histologically verified diagnosis, this rare case included the risk of severe bleeding complications during therapy.

Background: Endodontic microsurgery has yielded highly successful outcomes in preserving teeth with persistent or recurrent cases of periapical periodontitis that could not be successfully treated by nonsurgical endodontic approaches. To avoid complications in conditions in which periapical lesions invade anatomical structures such as the nasopalatine nerve tube and mandibular canal, selective curettage has been proposed as an alternative choice of complete curettage in surgery. Case presentation: The 8 cases reported herein had undergone root canal treatment and/or retreatment but still presented with symptoms, such as recurring sinus tracts and persistent dull pain. The radiographic examination indicated a large area of radiolucency that was associated with the tooth and had invaded adjacent critical anatomical structures. The patients opted for selective curettage via endodontic microsurgery, and the lesions were histologically confirmed as periapical cysts or granulomas. The follow-up results for one year or more indicated that the affected teeth were clinically asymptomatic and exhibited complete or incomplete healing radiographically. Conclusion: This case series provides clinical evidence for the feasibility of selective curettage in endodontic microsurgery, which can avoid complications caused by damage to the adjacent critical anatomical structures. [ABSTRACT FROM AUTHOR]

Odontogenic sinusitis is a common maxillary sinus disease. It develops due to the violation of the Schneiderian membrane due to pathological, iatrogenic, or traumatic causes from dental and dentoalveolar structures. The aim of this cohort study was to investigate local and systemic factors associated with Schneiderian mucosal thickening (MT) in patients referred for evaluation of apical periodontitis (AP) and examine their relationship with chronic sinonasal symptoms. Cone-beam computed tomography (CBCT) scans of 197 patients referred for evaluation of endodontic diseases were reviewed. Mucosal thickening in relation to the affected tooth was measured in the coronal section in millimeters at the maximum area perpendicular to the bone. Based on this measurement, the sinus floor was categorized for MT as present (>1 mm) or absent (<1 mm). The sociodemographic and clinical characteristics of the study participants were assessed and compared according to the presence or absence of MT. Furthermore, the relationship between odontogenic sinusitis and chronic sinonasal symptoms was assessed using a chronic sinusitis survey. Male patients had a higher MT than female patients. The presence of periapical lesions and inadequate endodontic treatment were significantly associated with MT. The multivariate logistic regression model showed that the presence of AP increased the odds of MT by approximately 2.5 times (p = 0.028), and nasal obstruction was significantly higher in patients diagnosed with mucosal thickness at different times of their follow-up period (p = 0.018). MT was 2.5 times more likely in the presence of apical periodontitis, and nasal obstruction was the most significant factor associated with the presence of MT. [ABSTRACT FROM AUTHOR]

Objective: The formation of blood clot, achieved through periapical bleeding or the use of peripheral venous blood, platelet-rich plasma (PRP) or platelet-rich fibrin (PRF), has been widely utilized in regenerative endodontic procedures (REPs). Except for inducing periapical bleeding, the scaffolds obtained from PRP, PRF, and venous blood are not derived from oral and maxillofacial tissues. In this case report, autologous blood clots from alveolar bone were described, which involved puncturing the maxillary terminal alveolar bone. The purpose of this case report was to assess the efficacy of the alveolar-derived blood clot in regenerative endodontic procedures in a mature permanent premolar. Methods: A mature premolar had a fractured central cusp, one of the developmental aberrations of tooth, without a proper treatment, resulting in chronic periapical lesion. To address this condition, REPs were employed, utilizing blood obtained through aspiration from the maxillary terminal alveolar bone aspiration. Result: Follow-up examinations of tooth #29 revealed the absence of clinical symptoms, a progressive resolution of a periapical lesion area and thickening of the root canal walls. Conclusion: This case demonstrated that blood clot obtained through paracentesis of the maxillary terminal alveolar bone could be successfully applied in REPs and has potential to manage periapical lesions. However, further and more clinical trials are required to verify the feasibility of the alveolar-derived blood clot in REPs and compare the outcome of alveolar-derived blood clot with currently used biological scaffolds. Clinical relevance: In comparison to PRP or PRF from peripheral venous blood, blood clots obtained via paracentesis of the maxillary terminal alveolar bone could be administrated by dentists, eliminating the need for reliance on professional nurses. The use of blood clots from alveolar bone could simplify the REPs in cases where periapical blood was insufficient to brim the root canals. [ABSTRACT FROM AUTHOR]

Aim: To investigate the changes in the biomarker levels related to inflammation and tissue destruction in the periapical exudate of mandibular pre‐molar teeth with asymptomatic apical periodontitis after receiving intracanal cryotherapy, to compare cryotherapy and control groups in terms of analgesic intake, interappointment, and post‐operative pain and evaluate the correlation between biomarker levels and interappointment pain. Methodology: Mandibular pre‐molar teeth of 44 patients aged 18–35 years, diagnosed with asymptomatic apical periodontitis, were root canal treated in two visits (registered as NCT04798144). Baseline periapical exudate samples were obtained, and the patients were assigned to either control or intracanal cryotherapy group according to the final irrigation with distilled water either at room temperature or 2.5°C. The canals were dressed with calcium hydroxide. In the second visit, the calcium hydroxide was removed with passive ultrasonic irrigation, and the periapical exudate was sampled again. IL‐1β, IL‐2, IL‐6, IL‐8, TNF‐α, PGE2 and MMP‐8 levels were determined with ELISA. Post‐operative pain levels were recorded for 6 days following both visits using a visual analogue scale. Data were analysed using t‐test, the Mann–Whitney U test and correlation tests. Results: There was a significant correlation between the pain scores reported after first visit and IL‐1β and PGE2 levels (p <.05). IL‐1β, IL‐2 and IL‐6 levels showed no significant difference in the cryotherapy group (p >.05), while they significantly increased in the control group (p <.05). There was a decrease in IL‐8, TNF‐α, PGE2 and MMP‐8 levels, however, the difference was not significant (p >.05). Pain scores were significantly lower in the cryotherapy group for the first 3 days (p <.05), except for 24th hours (p >.05). Conclusions: The positive correlation between interappointment pain and IL‐1β and PGE2 levels might indicate that these biomarker levels can be used to predict the severity of post‐operative pain. Intracanal cryotherapy was effective in reducing post‐operative pain in the short term in teeth with asymptomatic apical periodontitis. Cryotherapy prevented an increase in IL‐1β, IL‐2 and IL‐6 levels compared with the control group. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the expression of genes involved in chronic pain conditions in apical periodontitis (AP) tissues. Methodology: An electronic search was performed in Scopus and MEDLINE (via PubMed) databases to identify articles (n = 173) related to genes involved in chronic pain conditions. Full‐text reviews of the selected articles allowed the prioritization of 16 genes to be investigated with regards to their expression in AP tissues. Periapical lesions (n = 42) were collected during surgical endodontic procedures and processed for mRNA extraction and investigation of target genes via RT–qPCR. Healthy periodontal ligament tissues obtained from third molar extractions were used as controls. Relative levels of target gene expression in AP and control tissues were normalized to GAPDH expression and compared using the 2−ΔΔCt method. Data analysis was performed using the Mann–Whitney U test with a statistical significance threshold set at p <.05. Results: mRNA expression levels of MMP9, TIMP1, TNFA, CAMK4 and COMT were significantly increased in AP tissue samples compared with controls (p <.05). Positive correlations were observed between the expression of TIMP1 with COMT and CAMK4, TNFA with TIMP1 and CAMK4, COMT with CAMK4. Conclusions: This study confirms the upregulation of MMP9, TIMP1, TNFA in AP tissues and reports for the first time, the expression of CAMK4 and COMT as suggestive of their involvement in AP pathogenesis. [ABSTRACT FROM AUTHOR]

Aim: Periapical granuloma (PG) and cyst (PC) are formed as a protective response consequent to pulpal infection leaching through the apical foramen and lateral canals. Various inflammatory mediators like mast cells and cyclooxygenase (COX)‐2 are involved in this intricate process. This pilot study aimed to evaluate and compare the immunoexpression of tryptase and COX‐2 in periapical granuloma and periapical cyst, and also correlate them with intensity of inflammatory infiltrate and thickness of cystic epithelial lining. Methodology: An observational and cross‐sectional study was conducted on paraffin‐embedded tissue sections of 50 PGs and 50 PCs submitted for morphological and immunohistochemical analysis using anti‐tryptase and anti‐COX‐2 antibodies. The mean number of mast cells (total, granulated and degranulated), mean COX‐2 expression and inflammatory score was calculated. The data obtained were analysed using Mann Whitney U, Student's T, Chi‐square and Spearman correlation test (p <.05). Results: The inflammatory score, total mast cells and COX‐2 expression were similar in PGs and PCs (p =.352,.339 and.352) however, the degranulated mast cells were highly significant in PC while granulated mast cells were highly significant in PG respectively (p <.001 in both). Although a non‐significant correlation existed between COX‐2 and total mast cells in both groups but, total mast cells were significantly correlated with epithelial thickness in PC (p =.029). Conclusions: Mast cells and cyclooxygenase‐2 proved to be independent inflammatory markers in periapical lesions. Further studies should be planned on mast cell and COX‐2 inhibitors as treatment modalities of periapical lesions. [ABSTRACT FROM AUTHOR]

To assess the efficiency of AI methods in finding radiographic features in Endodontic treatment considerations. This review was based on the PRISMA guidelines and QUADAS 2 tool. A systematic search was performed of the literature on cases with endodontic treatments, comparing AI algorithms (test) versus conventional image assessments (control) for finding radiographic features. The search was conducted in PubMed, Scopus, Google Scholar and the Cochrane library. Inclusion criteria were studies on the use of AI and machine learning in endodontic treatments using dental X-rays. The initial search retrieved 1131 papers, from which 24 were included. High heterogeneity of the materials left out a meta-analysis. The reported subcategories were periapical lesion, vertical root fractures, predicting root/canal morphology, locating minor apical foramen, tooth segmentation and endodontic retreatment prediction. Radiographic features assessed were mostly periapical lesions. The studies mostly considered the decision of 1–3 experts as the reference for training their models. Almost half of the included materials campared their trained neural network model with other methods. More than 58% of studies had some level of bias. AI-based models have shown effectiveness in finding radiographic features in different endodontic treatments. While the reported accuracy measurements seem promising, the papers mostly were biased methodologically. [ABSTRACT FROM AUTHOR]

Current methods for the removal of separated endodontic instruments (RSI) are not predictable. The primary outcome of this retrospective study was to assess the clinical and radiographic success (CRS) of teeth in case of RSI after a 5-year follow-up. Secondary outcomes were to evaluate (1) the effectiveness in RSI and (2) the risk of root fracture after RSI. The study protocol was registered at ClinicalTrials.gov (ID: NCT05128266). The patients were treated by the same endodontist between January 1991 and December 2019. The RSI was performed under the operative microscope as follows: first, the dentine surrounding the coronal part of the broken instrument was selectively removed by using a small ultrasonic tip to loosen the fragment; then, a modified spinal needle was used to catch and remove the instrument. The 1-, 3-, 5-, and >5-year CRS were recorded. Logistic regression analysis was performed to determine independent predictors of failure (ie, tooth number, type of root canal, shape of the root canal, type of broken instrument, apicocoronal level of the separated instrument, presence of periapical lesions, and root perforations). A total of 158 teeth were included in this study. Finally, 131 instruments underwent RSI (82.9%). RSI was an independent predictor of CRS after 1-year of treatment (odds ratio: 58.3; 95% confidence interval: 27.42–95.73, P <.05). At the 5-year follow-up, only 10 of 131 teeth (7.6%) failed. All failures were caused by root fracture (10/10) (χ2 test, P <.05). Separated instruments located in the apical third of the root were more difficult to remove (13/49 cases, 26.5%; χ2 test, P <.05). The proposed technique can achieve excellent effectiveness in RSI, can achieve a high CRS rate when a periapical lesion is present, is not associated to a significant increase in root fracture incidence, and should be performed with the help of an operative microscope. [ABSTRACT FROM AUTHOR]

Laser ablation (LA) therapy is used as an adjunct to endodontic treatment to improve microbial reduction. However, studies evaluating the impact of LA with indocyanine green (ICG) are scarce. This study aimed to evaluate the antimicrobial efficacy of LA therapy with ICG in root canal treatment. Sixty patients with periapical lesions in teeth with a single canal and absence of pain, edema, and previous treatment were selected. Patients were randomly allocated into 3 groups according to the apical sizes used (n = 20); 25/04, 30/04, and 35/04 were the final sizes used. In half the patients of each group, 2.5% sodium hypochlorite was used as an irrigating solution, and in the other half, saline solution was used. After instrumentation, all patients received LA therapy with ICG. Root canal sampling was performed before (S1) and after (S2) root canal instrumentation and immediately after LA therapy with ICG (S3). Colony-forming units were counted, and statistical tests were applied (P <.05). There was a significant reduction in colony-forming units from S1 to S2 in all treatment protocols (P <.05); 2.5% sodium hypochlorite as an irrigating solution showed a greater microbial reduction compared with saline solution (P <.05). LA therapy with ICG further reduced the microbial counts significantly (S2 to S3 and S1 to S3) whether sodium hypochlorite or saline was used (P <.05). LA therapy with ICG significantly increased microbial reduction in root canals regardless of instrumentation sizes or the irrigation solution used. [ABSTRACT FROM AUTHOR]

To evaluate the success rate of nonsurgical root canal retreatment at the 2–3-year follow-up and identify the possible prognostic factors. Patients who underwent root canal retreatment at a university dental clinic were contacted for clinical and radiographic follow-up. The retreatment outcomes in these cases were based on clinical signs, symptoms, and radiographic criteria. Inter- and intraexaminer concordances were calculated using Cohen's kappa coefficient. The retreatment outcome was dichotomized into success or failure according to strict and loose criteria. The radiographic success criteria consisted of complete resolution or absence of a periapical lesion (strict criteria) or a reduction in the size of an existing periapical lesion at recall (loose criteria). χ2 tests were used to evaluate possible variables associated with retreatment outcomes (age, sex, tooth type, location, contact points, periapical status, quality of previous and final root canal filling, previous and final restoration, number of visits, and complications). Overall, 129 teeth (113 patients) were included in the final evaluation. The success rate was 80.6% under strict criteria and 93% under loose criteria. Molars, teeth with an initially higher periapical index score, and teeth with >5 mm periapical radiolucency had a lower success rate according to the strict criteria model (P <.05). When the loose success criteria were used, teeth with larger (>5 mm) periapical lesions and those that had been perforated during retreatment showed a lower success rate (P <.05). The present study demonstrated that nonsurgical root canal retreatment is a highly successful procedure after an observation period of 2–3 years. Treatment success is primarily affected by the presence of large periapical lesions. [ABSTRACT FROM AUTHOR]

This retrospective cohort study aimed to estimate the success rate (SR) of primary root canal treatment on teeth with a diagnosis of pulp necrosis (PN) and asymptomatic apical periodontitis (AAP) when using 2% chlorhexidine gel as an auxiliary chemical substance and foraminal enlargement instrumentation technique. This study evaluated 178 patients with 206 teeth submitted to primary root canal treatment performed by graduate residents in endodontics. The inclusion criteria were patients who underwent treatment over a period of 1–7 years on teeth with a diagnosis of PN and AAP. The SR was evaluated clinically and radiographically and categorized considering strict (complete resolution of the periradicular lesion) or loose (reduction in the size of the existing periradicular lesion) criteria. Cases of clinical and/or radiographic absence of repair were classified as a failure. Two calibrated examiners independently assessed treatment outcomes using ImageJ software (National Institutes of Health, Bethesda, MD). The SRs were 81.1% (95% confidence interval, 75.7%–86.4%) and 87.4% (95% confidence interval, 82.8%–91.9%) when considering the strict or loose criteria, respectively. Females had a higher SR when strict criteria were applied. Also, the SR was significantly reduced when there was an increase in the patient's age. Teeth with a diagnosis of PN and AAP and treated with 2% chlorhexidine gel and foraminal enlargement achieved substantial SR. Sex and age were prognostic factors that played a significant role in the SR. Future randomized controlled trials should further investigate the effects of foraminal enlargement and 2% chlorhexidine gel as an auxiliary chemical substance. [ABSTRACT FROM AUTHOR]

Previous studies have reported successful clinical outcomes after regenerative endodontic procedures (REPs) for immature permanent teeth with pulpal infection. However, it remains unclear whether the procedures promote true regeneration or repair. This case report describes the histologic and electron microscopic characteristics of a human immature permanent premolar with a chronic apical abscess that was treated with an REP. Tooth #20 of a 9-year-old girl underwent an REP. At the 6-year follow-up, the patient was asymptomatic, and closure of the apex and thickening of the dentinal walls were observed. However, 16 years after the procedure, apical periodontitis recurred, necessitating apical surgery. The resected root fragments were obtained during the surgery and analyzed using micro–computed tomography, light microscopy, and scanning electron microscopy. Distinct dentinal tubules and interglobular dentin were observed in the regenerated hard tissue. Cementum-like tissue and a root canal were also observed in the apical fragment. The regenerated root tissue in this case exhibited a structure similar to the native root structure. Therefore, we believe that cell-free REPs possess regenerative potential for teeth diagnosed with pulp necrosis and chronic apical abscess. [ABSTRACT FROM AUTHOR]

This study aimed to develop a predictive model to screen for undetected vertical root fractures (VRFs) in root canal treated teeth. We included 95 root canal treated teeth with suspected VRFs; 77 for training and 18 for validation. Following clinical and cone‐beam CT parameters were recorded: sex, tooth type, coronal restoration, time interval from completion of endodontic treatment to definitive diagnosis (TI), type of bone loss (BL), apical extent of root filling (AR) and the ratio of root filling diameter to the actual diameter in the coronal (1/3TA) and middle (2/3TA) root thirds. A predictive model p = 1/(1 – e−x) was generated, where x = −7.433 + 1.977BL + 1.479 (2/3TA) + 1.102 AR; the sensitivity and specificity were 0.852 and 0.875 for training and 0.917 and 0.833 for validation. VRF teeth were more likely to have vertical bone loss and overfilled root canals. This model had a high diagnostic efficacy for VRFs. [ABSTRACT FROM AUTHOR]

Type IIIB dens invaginatus presents with diagnostic and treatment related challenges when in need of endodontic management as a consequence of its complex anatomy, especially when presented in a vital tooth with a periapical lesion. Apical periodontitis associated with two type IIIB invaginations in a central maxillary incisor of a 10‐year‐old patient was diagnosed. A cone‐beam computed tomography (CBCT) scan provided essential diagnostic information and steered the treatment plan. The two invaginations were separate, with no communication between them and the pulp. The pulp appeared vital and non‐inflamed. Endodontic treatment of the invaginations was carried out without intervention in the pulp. A 4‐month follow‐up periapical radiograph showed significant shrinkage of the lesion and a 2‐year follow‐up CBCT scan confirmed its complete healing. The pulp remains vital, responding normally to sensitivity tests. This outcome indicates that preserving the pulp's vitality is achievable through timely diagnosis. [ABSTRACT FROM AUTHOR]

Copyright of West China Journal of Stomatology is the property of Sichuan University, West China College of Stomatology 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.)

Copyright of Necmettin Erbakan University Dental Journal (NEU Dent J) is the property of Necmettin Erbakan University Dental Journal (NEU Dent J) 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.)

This study aimed to evaluate the precision of the guided endodontic technique applied to calcified canals in anterior teeth in relation to demographic and dental variables. The present observational study was conducted during the period 2020–2021. The patients were consecutive referrals at the Department of Endodontics and Conservative Dentistry of the University Hospital of Siena. The guided endodontics protocol was applied using 0.75 mm diameter burs for the lower teeth and 0.90 mm for the upper teeth. The inclusion criteria were as follows: (i) teeth with pulp canal obliteration (PCO) associated with a periapical lesion (periapical index (PAI) ≥ 2); (ii) teeth with PCO that require the placement of a root canal post for the execution of a prosthetic treatment; (iii) teeth in which surgical treatment was not justified. Socio-demographic characteristics of the patients were recorded and related to the drill path accuracy through the guide in the calcified endodontic canal, evaluated through a radiographic analysis, and classified as optimal (in the center of the root canal) and acceptable (deviated peripherally/tangentially). A logistic regression model was built to predict the factors that influence the poor precision of the technique. Seventeen patients (mean age 48 years) with eighteen calcified single-rooted teeth were enrolled. All teeth were associated with periapical lesions with PAI scores from 2 to 5 (mean PAI: 3.055). From the model, it is evident that the presence of a calcification affecting the apical area of the root increases the probability of being off-center with the bur by about 15 times. In addition, a previous attempt at endodontic treatment and the position in the lower arch increases the probability of non-centrality of the drill, although in a non-statistically significant way. In any of the analyzed cases, the guided endodontic technique applied to PCO did not determine the presence of iatrogenic errors, such as perforations. However, the apical localization of the obliteration increases the probability of being off-center with the drill during the instrumentation phase by about 15 times. [ABSTRACT FROM AUTHOR]

Diagnosis is a key aspect in endodontic treatment, in a decade where invasive interventions are misapprehended as social tendency instead of medical necessity. All diagnostic facets should be considered before intending the operative phase. Intraoral endodontic radiology-based diagnosis has been shown to be limited. Periapical X-ray is the most used endodontic imaging, yet it does not provide high accuracy. Traditionally, dentists have been trained to diagnose a cyst by certain aspects (size, shape and appearance); hence, an assumption that teeth are affected by "periapical cyst" were subjected to unnecessary extraction or apicoectomy. The aim of this systematic review is to critically appraise the publications that relate the histological diagnosis of a periapical lesion (considered the gold standard) to intraoral X-ray investigation. Ovid Medline, PubMed, ScienceDirect, Mendeley and Scopus were searched for English-language studies comparing periapical diagnosis obtained by using two techniques (histopathology and X-ray). Sixteen articles were included for the final analysis (qualitative and quantitative evaluation) out of which only two supported the statement that periapical diagnosis can be coherently assessed through periapical imaging. Although there is not enough evidence to deliver a definitive conclusion, there are many publications that refute the diagnosis of a cyst via periapical X-ray. [ABSTRACT FROM AUTHOR]

Objectives: Maxillary sinus mucositis is frequently associated with odontogenic foci. Periapical inflammation of maxillary molars and premolars cannot be visualized directly using radiation-based imaging. The purpose of this study was to answer the following clinical question: among patients with periapical inflammatory processes in the maxilla, does the use of magnetic resonance imaging (MRI), as compared to conventional periapical (AP) and panoramic radiography (OPT), improve diagnostic accuracy? Methods: Forty-two subjects with generalized periodontitis were scanned on a 3 T MRI. Sixteen asymptomatic subjects with mucosal swelling of the maxillary sinus were enrolled in the study. Periapical edema was assessed using short tau inversion recovery (STIR) sequence. Apical osteolysis and mucosal swelling were assessed by MRI, AP, and OPT imaging using the periapical index score (PAI). Comparisons between groups were performed with chi-squared tests with Yates' correction. Significance was set at p < 0.05. Results: Periapical lesions of maxillary premolars and molars were identified in 16 subjects, 21 sinuses, and 58 teeth. Bone edema and PAI scores were significantly higher using MRI as compared to OPT and AP (p < 0.05). Using the STIR sequence, a significant association of PAI score > 1 and the presence of mucosal swelling in the maxillary sinus was detected (p = 0.03). Conclusion: Periapical inflammation and maxillary mucositis could be visualized using STIR imaging. The use of MRI may help detect early, subtle inflammatory changes in the periapical tissues surrounding maxillary dentition. Early detection could guide diagnostic criteria, as well as treatment and prevention. [ABSTRACT FROM AUTHOR]