Search

Gingival fenestration is a relatively uncommon soft tissue lesion in which the root apex is exposed in the oral environment after the destruction of the overlying buccal bone plate and mucosa. At present, no clear etiology or treatment guidelines exist for gingival fenestration. This article reports three successfully treated cases of gingival fenestration associated with chronic periapical infection and can help contribute to treatment guidelines for gingival fenestration. All cases were treated with apicoectomy in conjunction with a connective tissue graft (CTG), and the first steps of each case were as follows: endodontic therapy with root-end resection and retrograde filling, then regenerative surgical therapy. However, slightly different regenerative treatment methods were used during the operation according to the different patient conditions. In Case 1, gingival fenestration in the mandibular left first premolar was treated using a xenograft and CTG. In Case 2, gingival fenestration in the maxillary left lateral incisor was treated using advanced platelet-rich fibrin (A-PRF) and CTG. In Case 3, gingival fenestration in the mandibular left second premolar was treated using CTG. Endodontic treatment was combined with periodontal surgery to achieve predictable results. After 13 to 25 months of follow-up, all cases showed well-healed gingival fenestrations and no discomfort. These three cases show the possibility of using apical excision combined with a CTG and/or bone graft/A-PRF in the treatment of gingival fenestration. Reporting these three cases may help advance the field of gingival fenestration treatment. [ABSTRACT FROM AUTHOR]

Purpose: The aims of the study were to evaluate the clinical performance and the complications of combined tooth-/implant-supported three-unit fixed partial dentures (FPDs) in the posterior mandible. Materials and Methods: A total of 78 partially edentulous patients in the posterior mandible were recruited for the study (n = 26/group). Group 1 served as the control group and received two dental implants to support a three-unit FPD. Groups 2 and 3 were the experimental groups in which one implant was placed in conjunction with support from an adjacent tooth to support a three-unit FPD. Standard implants (= 8 mm) were included in Group 2, while short implants (< 8 mm) were included in Group 3. Periapical radiographs were taken for evaluation of crestal bone loss (CBL). Modified plaque index (MPI), bleeding index (BI), and sulcus depth values of the abutment teeth were recorded at the time of FPD delivery, 6 months after FPD delivery, and annually thereafter. Recorded complications included abutment tooth intrusions, cementation failures of the restorations, porcelain chipping/delamination, framework fracture, abutment screw loosening, abutment and abutment screw fracture, and implant fracture. Results: Statistically significant differences were observed between Group 1 (0.06 ± 0.17) and Group 2 (0.18 ± 0.32) and between Group 1 and Group 3 (0.17 ± 0.30) in terms of MPI (P = .05). No difference was observed between Group 2 (0.11 ± 0.34) and Group 3 (0.14 ± 0.36) or between Group 1 (0.04 ± 0.22) and Group 2 in terms of BI. There were statistically significant differences in terms of CBL between Group 1 (0.259 ± 0.05 mm) and Group 3 (0.11 ± 0.03 mm) and between Group 2 (0.03 ± 0.03 mm) and Group 3 (P = .05). The mean abutment tooth sulcus depth was 1.11 ± 0.31 mm for Group 2 and 1.20 ± 0.46 mm for Group 3. Conclusions: Within the limitations of the current study, it was concluded that combined tooth/implant-supported prostheses (CTISPs) are a predictable treatment choice in the posterior mandible. When a CTISP is planned, it is more predictable to use a short implant than a standard-length implant. [ABSTRACT FROM AUTHOR]

This canine in vivo study assessed the effect of recombinant human platelet-derived growth factor (rhPDGF) on the healing of periapical tissues following apical surgery. From a total of 96 premolar teeth, 64 teeth from six beagle dogs (2 years old) were classified as experimental and were randomly assigned to four experimental groups (16 teeth per group). After having the pulp extirpated, leaving teeth open to the oral cavity for 1 week, and sealing with an immediate restorative material for 8 weeks, nonsurgical endodontic treatment was performed. A split-mouth design was used, and intra-animal randomization of treatment sides was applied to the groups as follows: apical curettage + 1.5-mm root-end resection (Group 1); apicoectomy + mineral trioxide aggregate (MTA) root-end filling (Group 2); apicoectomy + MTA root-end filling + rhPDGF (Group 3); and apical curettage + rhPDGF (Group 4). The animals were sacrificed 24 months after apical surgery, and histologic and µCT analyses were performed for bone volume loss (BVL). Group 1 showed partial resolution of the periapical lesions without signs of tissue regeneration (BVL: 49.09 ± 10.97 mm3). Group 2 had minimal bone regeneration and showed cementum reformation in 9 teeth, with no direct attachment to the MTA (BVL: 35.34 ± 10.97 mm3). Group 3 showed regeneration of all damaged apical tissues without direct contact between the cementum and MTA (BLV: 4.51 ± 1.55 mm3). Group 4 showed regeneration of PDL, bone, and cementum and attachment of functional cementum fibers (BVL: 2.82 ± 2.3 mm3). The difference in BVL was statistically significant only for Groups 1 and 2 (P < .05). rhPDGF may help regenerate apical tissue structures following apical surgery. [ABSTRACT FROM AUTHOR]

Bariatric dentistry is the branch of dental medicine focused on preventive and comprehensive oral health care of overweight or obese patients. Obesity is an increasing US and international health problem and is a condition characterized by abnormal or excessive fat accumulation in the adipose tissue and is categorized by body mass index (BMI) according to the World Health Organization (WHO). With the increase of morbid obesity worldwide and the unfavorable effect on the overall health and life expectancy, it is necessary that proper accommodations are made for accessible dental care of this vulnerable population of patients. The following case report details the emergency and the subsequent elective dental treatment of a patient with a morbid obesity and demonstrates the importance of necessary equipment, a multidisciplinary approach, and broad networking communication needed to treat bariatric patients. The aim of the present case report was to bring awareness and start professional discussions on the importance of dental practitioners in the community and dental academic programs working together to assure access for primary oral health for bariatric patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to comprehensively evaluate the links of genetic predisposition among 13 common circulating interleukins (ILs) and endodontic diseases by using a 2-sample Mendelian randomization method. Single nucleotide polymorphisms were chosen as instrumental variables from summary data of genome-wide association studies (GWASs), using the inverse-variance–weighted method as the primary analysis. In addition, a variety of sensitivity analyses was conducted to evaluate the resilience of the primary outcomes and identify any inherent pleiotropic effects. After multiple comparison corrections, 4 circulating ILs were genetically predicted to significantly play a role in endodontic diseases. Among these, circulating IL-17 (odds ratio [OR] IVW , 1.33; 95% confidence interval [CI], 1.15–1.54; P < 3.85 × 10−3) were significantly identified as potential risk-increasing factors toward pulp and periapical diseases, and circulating IL-16 (OR IVW , 0.89; 95% CI, 0.83 to 0.94; P < 3.85 × 10−3) may exert protective effects on the development of periapical abscess. In the reverse analyses, null significantly association was found between genetic liability to endodontics disorders and the corresponding circulating inflammatory biomarkers. Overall, sensitivity analyses were consistent with the estimates direction of primary analyses results, supporting the reliability of findings. Given the unavoidable limitations presented in this study, our findings provided significant evidence to support the identification of elevated IL-16 levels as a potential risk-mitigating factor, whereas elevated IL-17 levels exhibit potentially deleterious effects on endodontic disorders. Future validation is warranted to examine the conclusions of our study and to evaluate the potential application of these circulating ILs as lifestyle or pharmacological targets for oral health care. [ABSTRACT FROM AUTHOR]

Background: Examining stress distributions in abutment teeth with periapical lesions is essential for understanding their biomechanical impact on dental structures and tissues. This study uses finite element analysis (FEA) to evaluate these stress patterns under occlusal forces, aiming to enhance treatment strategies and prosthetic designs. Methods: Three FEA models were created: a healthy mandibular premolar (Model 1), a premolar with a single crown and a lesion repaired using a fiber-post (Model 2), and 3) a premolar with a lesion repaired using fiber-post to support a four-member bridge (Model 3). A 300 N occlusal static stress was given to each model at a 45° angle to the long axis of the tooth, namely at the lingual inclination of the buccal-cusp. Deformation behaviour and maximum equivalent stress distributions were simulated on the all components, including the bony structure for each model. Results: The study showed a reduction in equivalent stress levels in trabecular and cortical bone, crown, cementum, and PDL under occlusal force, from Model 1 to Model 3. The Von Mises yield criteria values of the tooth models differed depending on the prosthetic restorations, with the highest value seen in Model 2 (133.87 MPa). Similar locations in all models showed concentrated equivalent stresses for all components. The periapical lesion area exhibited relatively low stress values for Models 2 and 3, at 0.061 MPa and 0.039 MPa, respectively. The largest level of stress was seen in the cervicobuccal areas of the tooth in all models. Conclusion: Prosthetic restorations on teeth with periapical lesions resulted in varying stress and biomechanical responses in the tooth and surrounding bone tissue. These teeth can serve as abutments in a four-unit bridge when subjected to optimal occlusal stresses, based on the findings. [ABSTRACT FROM AUTHOR]

Background: Oral infectious diseases, such as dental caries, periodontitis and periapical periodontitis, are often complicated by causative bacterial biofilm formation and significantly impact human oral health and quality of life. Bacteriophage (phage) therapy has emerged as a potential alternative with successful applications in antimicrobial trials. While therapeutic use of phages has been considered as effective treatment of some infectious diseases, related research focusing on oral infectious diseases is few and lacks attention. Therefore, a systematic review was conducted to comprehensively evaluate the overall efficacy of phages in reducing bacterial infections associated with various oral diseases. Methods: A systematic search of PubMed, MEDLINE and Web of Science for literature published up to May 2024 was conducted according to inclusion criteria to identify studies assessing bacteriophages as potential therapy for oral infectious diseases. A total of four authors assessed study eligibility and performed data extraction. Results: A total of 487 articles published between 1975 and 2024 were retrieved. Among the 10 eligible reports, preliminary studies have been conducted on seven types of phages and reported their antibacterial effect. To be more specific, 3 contained data on dental caries (n = 32), 5 focused on periodontitis (n = 105) and 2 examined periapical diseases (n = 7). The majority of publications (9 out of 10) discussed the impact of phages on biofilm formation. Only one report (1 out of 10) mentioned the safety concern in phage application. Conclusions: This review strongly suggests that phages isolated from oral cavity with certain characteristics can be highly effective and are considered suitable candidates for phage therapy in treating oral/odontogenic infections caused by bacteria. [ABSTRACT FROM AUTHOR]

Background: The literature has reported contradictory findings regarding the association of Intra-radicular posts (IRPs) presence and periapical radiolucent lesions (PRLs) prevalence in endodontically treated teeth (ETT). Considering this, the study aimed to investigate the association between IRPs presence and PRLs prevalence. Methods: A cross-sectional study was conducted to compare PRLs prevalence in ETT with and without IRPs. CBCT images were utilized, and the teeth with at least 2 mm of remaining gutta-percha apical to the post-end were included. Two calibrated assessors assessed the PRLs presence. A stepwise backward binomial logistic regression was conducted to evaluate the effect of age, post presence, gender, tooth position (anterior/posterior), and arch location (maxillary/mandibular) on the likelihood of periapical radiolucency presence. The null hypothesis is that the presence of IRPs does not influence the prevalence of PRLs. Results: Teeth with IRPs showed significantly higher PRLs prevalence. However, there were insignificant differences in PRLs prevalence with respect to IRPs type or remaining gutta-percha length. The model, including all five predictors, demonstrated significant fit (χ²(7) = 22.528,p =.002), explaining 14.5% of the variance in the presence of radiolucency (Nagelkerke R²). The Hosmer-Lemeshow test showed no evidence of a lack of fit (χ²(8) = 11.550,p =.172), supporting the model's adequacy. The model correctly classified 67.3% of cases, with a sensitivity of 54.5%, specificity of 75.4%, positive predictive value (PPV) of 58.3%, and negative predictive value (NPV) of 72.4%. Among the predictors, post presence was the only statistically significant variable (B = 1.300,p <.001,]OR = 3.670,95%CI[1.985–6.785]). Conclusions: A higher prevalence of PRLs was noted among the ETT with IRPs. Within the limitations of this study, we recommend that clinicians should carefully weigh the risks and benefits of using IRPs during the restoration of ETT. [ABSTRACT FROM AUTHOR]

The persistence of microbial infection can lead to endodontic failure. Enterococcus faecalis (E. faecalis) is acknowledged to be a closely associated bacterium. This study investigated the antimicrobial effects of mesoporous silica nanoparticles (nMS) carrying nano-silver and chlorhexidine (nMS-nAg-Chx) on E. faecalis. Analyses were conducted to assess the antimicrobial efficacy of nMS-nAg-Chx toward planktonic E. faecalis , including the zone of inhibition, minimal inhibitory concentration, and growth curves. The measurement of lactic acid, scanning electron microscopy, live-dead bacteria staining, and quantitative real-time PCR were done to further investigate its anti-biofilm effect. Colony forming unit and scanning electron microscopy were used to assess its efficacy in infected root canals. The growth of planktonic E. faecalis was suppressed with a minimal inhibitory concentration value of 25 μg/mL (P ＜.05). nMS-nAg-Chx concentration-dependently inhibited biofilm formation of E. faecalis with the reduction of lactic acid (P <.05), sparse biofilm structure, reduced percentage of viable bacteria (P <.05), and suppressed expression of ebpR , gelE , ace , and efa genes (P <.05). The 7-day sealing of nMS-nAg-Chx resulted in a notable reduction in bacterial counts compared to the saline control group in the E. faecalis infected root canals (P <.05). nMS-nAg-Chx effectively inhibits E. faecalis and removes its biofilm from infected human root canals. It may be used for endodontic treatments in the control of E. faecalis bacteria as an intracanal medication. [ABSTRACT FROM AUTHOR]

Background: Endodontic emergencies, often presented as acute pain or swelling, constitute a substantial challenge in dental practice. While effective management emphasizes prompt intervention, antibiotics are typically indicated only when systemic signs and symptoms are present. There is limited research exists on evaluating the knowledge and clinical approach of dental practitioners in managing endodontic emergencies from our region of the world. Therefore, this study aims to evaluate dentists' knowledge, attitude, and practices regarding clinical management and the prescription of antibiotics in endodontic emergency cases. Materials and methods: A web-based questionnaire was distributed to working dentists in secondary and tertiary care hospitals and clinics. Eligible participants included dental practitioners, postgraduate trainees, and consultants. The questionnaire included demographic information and inquiries about endodontic emergency treatment approaches, antibiotic prescribing habits, and awareness of guidelines. Statistical analysis was performed Stata software version 17 (StataCorp, College Station, Texas, USA), employing a χ2 test. Results: Of the 527 dentists approached, 409 completed the survey (response rate: 77.6%). The majority of respondents were female (68%) and general dental practitioners (60.32%) with up to 5 years of experience (80.93%). Survey findings highlighted varied treatment approaches, favoring root canal treatment in multiple visits for cases of both irreversible pulpitis (73.59%) as well as with necrotic pulps/periapical lesions (79.95%). Similarly, 45.48% and 37.9% of the respondents favored pulpectomy combined with analgesics and antibiotics in managing irreversible pulpitis and acute apical periodontitis respectively. Moreover, antibiotics were frequently prescribed for acute apical abscess, with amoxicillin-clavulanate being the most common choice (83.6%). Most practitioners (69%) recommended a minimum of 5-day antibiotic course. Conclusions: This study highlights Pakistani dentists' preferences in managing endodontic emergencies and prescribing antibiotics. Despite awareness of guidelines and the consequences of overuse, there's a tendency towards antibiotic overprescription, indicating a need for educational interventions to promote rational antibiotic use and mitigate antibiotic resistance. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess and compare the performance of root canal treatment obturated either with calcium silicate-based or epoxy resin-based root canal sealers on retreatment cases with periapical lesions. Methods: Patients' radiographic data and clinical records were obtained retrospectively from the computerized patient record system. A total of 44 teeth, 28 teeth treated with calcium silicate-based sealer and 16 teeth treated with epoxy resin-based sealer, were included in the study. The mean follow-up period was 11.9 months for calcium silicate-based sealer and 23.6 months for epoxy resin based sealer groups. The outcome was evaluated based on radiographic findings and clinical records of the patients. Chi-square test and Fisher's Exact test were used to examine the differences between categorical variables. An independent samples t-test was used to compare the initial and final PAI differences based on sealer type. Results: The success rate was 100% for calcium silicate-based sealer and 93.75% for epoxy resin-based sealer. Calcium silicate-based sealer showed a faster healing capacity than epoxy resin-based sealer. Conclusions: Both sealers are viable options for retreatment cases, but calcium silicate-based sealer has a faster healing potential. [ABSTRACT FROM AUTHOR]

Aim: To evaluate M1 and M2 macrophage polarization in radicular cysts and periapical granulomas through an immunohistochemical analysis and the correlation between macrophage polarization and histopathological diagnosis, clinical characteristics and lesion volume using cone‐beam computed tomography. Methodology: Periapical biopsies diagnosed as radicular cysts (n = 52) and periapical granulomas (n = 51) were analysed by immunohistochemical method. Teeth with periapical lesion with no history of root canal treatment (primary lesion) and lesions persistent to root canal treatment (persistent lesions) were included. Pathological diagnosis, patients' age, gender and clinical characteristics were obtained from treatment records. A cone‐beam computed tomographic periapical volume index (CBCTPAVI) score was assigned to each periapical lesion based on the volume of the lesion. Immuno‐expressions of CD68 and CD163 were quantified. The CD68/CD163 ratio was adopted to represent M1 or M2 macrophage polarization. Mann–Whitney U test was used to determine the different CD68/CD163 ratio between groups of radicular cyst and periapical granuloma. Spearman's correlation test was performed to assess the correlation between the CD68/CD163 ratio and lesion volume and CBCTPAVI score. Results: Radicular cysts and periapical granulomas had CD68/CD163 median of 2.05 (IQR = 1.33) and 1.26 (IQR = 0.81), respectively. A significantly higher CD68/CD163 ratio was observed in radicular cysts (p <.001). In contrast, periapical granulomas had significantly lower median of CD68/CD163 ratio. Larger lesions had a higher median of CD68/CD163 ratio, while smaller lesions had lower median of CD68/CD163 ratio (p =.007, rs =.262). CD68/CD163 ratio was significantly correlated with the CBCTPAVI score in the overall periapical lesions (p =.002, rs =.306). The higher CD68/CD163 ratio in larger lesions indicated a higher degree of M1 polarization compared to smaller lesions. Regarding the pathological diagnosis, there was a significant positive correlation between CBCTPAVI score and CD68/CD163 ratio in periapical granulomas (p <.001, rs =.453), whereas the negative correlation was observed for radicular cysts (p <.001, rs = −.471). Conclusions: Periapical granulomas are characterized by a M2‐dominant macrophage polarization, while radicular cysts have significantly higher M1 macrophages. The higher degree of M1 macrophage polarization was significantly correlated with larger volume and higher CBCTPAVI scores of overall periapical lesion and periapical granuloma. [ABSTRACT FROM AUTHOR]

Purpose: Oral focus screening is recommended before HCT (haematopoietic cell transplantation). Acute foci are generally treated pre-HCT. However, it is unclear whether chronic foci should be treated pre-HCT. This study aimed to evaluate the association between number of foci and early post-HCT morbidity and mortality. Methods: Patients who received an oral screening pre-HCT at Radboudumc between 2013 and 2023, with a recent panoramic radiograph, were included. Foci were defined as teeth or implants with deep pockets, furcation radiolucencies, periapical radiolucencies, deep caries, partial eruption or retained roots. Dental interventions were provided pre-HCT if deemed necessary and possible. Hospital length of stay (LOS), mortality and oral exacerbations were assessed in the first hundred days post-HCT. Hospital LOS was log-transformed to normalize its skewed distribution. Multivariate regression analyses were performed. Results: Five hundred patients were included (median age 58 years, 37% female, 56% allogeneic). Four acute foci in two patients remained untreated pre-HCT. Forty-eight percent had at least one untreated chronic focus pre-HCT (mostly furcation radiolucencies and post-endodontic periapical lesions). Mean LOS was 22 days; 20 patients died, and four patients had an oral exacerbation before HCT day + 100. After adjustment for conditioning intensity, age, socioeconomic status and number of teeth, HCT recipients with ≥ 3 foci had five additional days in the hospital compared to those without foci (ratio of means 1.21; 95% CI 1.00 – 1.46). The number of foci was not associated with early post-HCT mortality. Conclusion: The presence of ≥ 3 oral foci is associated with extended hospital LOS in the first hundred days post-HCT. [ABSTRACT FROM AUTHOR]

The aim of the authors was to evaluate the periapical and endodontic conditions of patients with osteoporosis and compare them with those of age- and sex-matched controls. The association between bisphosphonate (BiP) use and periapical and endodontic status in patients with osteoporosis was also investigated. Panoramic radiographs of 711 patients with osteoporosis and 711 age- and sex-matched healthy patients were examined. The presence and number of root canal–filled teeth (RCFT), inadequate RCFT (iRCFT), and teeth with apical periodontitis (AP) were evaluated. BiP treatment history of patients with osteoporosis was also recorded. No significant difference was observed between the osteoporosis group and control group in terms of endodontic and periapical conditions. Results of bivariate logistic regression analysis showed a positive association between the number of teeth with AP and the number of iRCFT with AP and osteoporosis, and a negative association between the number of RCFT with AP and osteoporosis. Among the patients with osteoporosis, 37.5% used BiPs, specifically alendronate, ibandronate, zoledronate, and risedronate (34.3%, 24.9%, 10.6%, 7.2%, respectively). In addition, the results showed a negative association between BiP use and RCFT. As the number of teeth with AP and number of iRCFT with AP increased, patients were more likely to be in the osteoporosis group. These findings imply that periapical lesions may enlarge and become more detectable in patients with osteoporosis with lower bone density, and enhanced inflammatory response. Dentists can collaborate with health care professionals to manage the overall health of patients with osteoporosis to reduce the impact of osteoporosis on oral health and effectively treat dental problems, such as AP. [ABSTRACT FROM AUTHOR]

Endodontic microsurgery (EMS) is an alternative treatment option for previously treated teeth with persistent periapical disease, offering a favorable prognosis. However, it can be particularly challenging in anatomically complex cases, risking unintentional damage to adjacent critical structures. Dynamic navigation (DN), a computer-aided technique, facilitates precise presurgical planning and provides real-time guidance during operation. Integrating the DN technique into EMS procedures can enhance treatment accuracy and effectiveness. This report presents 4 cases involving a minimally invasive incision approach for DN-aided EMS in anatomically complex regions, all of which were completed without complications. After 3–12 months, patients presented asymptomatic, and radiographic examinations revealed complete healing or the periapical radiolucent area decreased in size. The DN technique contributed to reliably mitigating the risk of iatrogenic damage in complicated EMS scenarios. The minimally invasive incision approach not only provided sufficient visibility but also promoted favorable soft tissue healing, making it a valuable addition to surgical endodontics. [ABSTRACT FROM AUTHOR]

Endodontic therapy conserves the natural tooth by treating diseased pulp and promoting periapical healing. Curved root canals pose challenges in transportation, ledges, perforations, and instrument separation, impacting treatment results. Effective assessment and management are essential. Methodologies such as Schneider's and Weine's techniques, along with cone-beam computed tomography, refine the accuracy of curvature measurements. Proper techniques, involving anti-curvature filling and tactile controlled activation, are pivotal for successful treatment. Understanding root canal curvature and employing applicable approaches are vital for minimizing the complications and refining treatment success. An acclimatized approach grounded on curvature characteristics enhances endodontic sequels. This article reviews the cases involving patients with curved root canals, emphasizing treatment avenues and outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the fractal dimension values of trabecular bone in periapical lesions and healthy mandibular first permanent molars, based on age and gender, using panoramic radiographs. Material and Methods: The panoramic radiographs of a total of 216 patients aged 6-16 years who applied to Dicle University Faculty of Dentistry Department of Pedodontics in 2022 were retrospectively examined. The patients were equally distributed by gender into three age groups: 6-9, 10-12, and 13-16 years. Fractal analysis was applied using the ImageJ program to the regions of interest (ROI’s) of 25x25 pixels determined from two different regions on each digital panoramic radiograph, and fractal dimension calculations were performed. The data were analyzed using the Shapiro-Wilk and/or Kolmogorov-Smirnov tests, as well as the Mann-Whitney U and Kruskal-Wallis H tests. The confidence interval for all statistical tests was set at 95%, and the significance level was accepted as p<0.05. Results: According to the results of the study, the average fractal dimension value of the lesioned region was 1.106, while the average fractal dimension value of the healthy region was 1.116. No statistically significant difference was found in the fractal dimension values between both the lesioned and healthy groups, as well as between the age and gender groups (p>0.05). Conclusion: Fractal dimension (FD) calculation is a reliable method for detecting early-stage periapical lesions. However, to achieve more comprehensive evaluations, future studies should integrate histological and clinical parameters and compare 2D and 3D imaging techniques with larger sample sizes. [ABSTRACT FROM AUTHOR]

An accurate assessment of the disease extent and lesion size is needed for appropriate therapy decisions of endodontic-periodontic (endo-perio) lesions. CBCT imaging with less radiation and high spatial resolution can provide a comprehensive evaluation of endo-perio lesions. A total of 71 teeth with endo-perio lesions were assessed using CBCT. Periodontal bone defects were studied for bone loss pattern (horizontal/vertical) along with bone loss levels on mesial and distal sides in association with furcation involvement. The periapical lesions were studied for their prevalence and extent based on CBCT PAI Score. Horizontal and vertical bone loss were detected in 54 teeth (76.1%) and 17 teeth (23.95%), respectively. Mean crestal bone loss levels on mesial and distal aspects were 4.80 ± 3.21 mm and 5.74 ± 3.91 mm, respectively. The mean height, width, and depth of furcation defects were 3.19 ± 2.99 mm, 1.94 ± 0.98 mm, and 4.44 ± 1.92 mm, respectively. Periapical lesions were recorded in 55 teeth (77.5%). A CBCT PAI score of 5 was scored in 35 teeth with a mean lesion diameter of 11.3 ± 2.83 mm, while 16 teeth had healthy periapical tissues (scores of 0 and 1). CBCT is a valuable diagnostic tool that can help assess endo-perio lesions by providing morphometric measurements of periodontal bone defects and the extent of associated periapical lesions. [ABSTRACT FROM AUTHOR]

Objective: The correlation between crestal bone loss at teeth and probing pocket depth (PPD) has been established. Whether these findings can also be applied to implants is not known. The objective of this study was to determine the correlation between crestal bone loss and PPD at teeth and implants. Method and materials: Thirty-one periodontitis-susceptible patients were rehabilitated with fixed implant-supported single crowns and fixed partial dentures. Each patient was examined over a 5- to 20-year period in a 3- to 6-month strict recall program. At each session, periodontal clinical parameters were recorded at teeth and implants. In addition, standardized periapical radiographs were taken after superstructure insertion (baseline) and then at 1,3,5,10,15, and 20 years. Results: The survival rate of implants (94.0%) and teeth (97.3%) did not significantly differ in all patients after 20 years (P = .68). Almost all patients had a PPD >5 mm at implants and teeth throughout the observation period. The crestal bone loss at implants and teeth increased continuously, especially in patients with advanced periodontitis, without a correlation with PPD. A few patients (n = 5) had a PPD>5 mm and annual bone loss >0.2 mm at one implant, with a correlation between bone loss and PPD. Conclusion: In healthy implants and teeth, moderate crestal bone loss is present without correlation with PPD. A few patients showed progressive crestal bone loss at only one implant, with a correlation with PPD. [ABSTRACT FROM AUTHOR]

Background: Digital technologies have not only revolutionized workflow strategies for implant- supported fixed prostheses but also changed preferences in the choice of restoration retention. Owing to the effortlessness of developing workflows with digitalization, screw-retention has become favored for initial prostheses. However, cement retention is still indicated for cases in which abutment reuse is needed for replacing failing restorations with technical complications. Case presentation: In this case report, a modified digital workflow is described for treating an impaired occlusal relationship. A dual-scan approach for an abutment-level digital implant impression to remake a cement retained implant supported fixed restoration is defined in detail. Conclusion: Clinicians can highly benefit from the presented strategy, which offers an efficient digital workflow to simplify cement-retained abutment level impressions through the use of an intraoral scanner. Exchanging intra- and extra-orally surface scanned abutment data may become an option in complete digital model-free workflows for addressing problems related to cement-retained implant supported fixed prostheses. [ABSTRACT FROM AUTHOR]

Background: Chronic apical periodontitis (CAP) has been linked to the development of atherosclerosis, although the underlying mechanisms remain unclear. This study aimed to investigate the role of gut microbiota disruption in CAP-induced atherosclerosis development, focusing on trimethylamine N-oxide (TMAO)-related metabolites. Methods: The study utilized fecal microbiota transplantation (FMT) to transfer gut microbiota from mice with CAP to healthy mice. Atherosclerosis development was assessed by analyzing lesions in the aortic arch and aortic root. Serum lipid and inflammatory factor levels were measured. Composition and diversity of gut microbiota were analyzed using targeted metabolomics, with a focus on the ratio of Firmicutes to Bacteroidetes. The expression of hepatic flavin-containing monooxygenase 3 (FMO3) and serum TMAO levels were also evaluated. Results: Mice receiving gut microbiota from CAP mice showed increased atherosclerotic lesions compared to controls, without significant differences in serum lipid or inflammatory factor levels. Alterations in gut microbiota composition were observed, characterized by an increase in the Firmicutes to Bacteroidetes ratio. Peptostreptococcaceae abundance positively correlated with atherosclerosis severity, while Odoribacteraceae showed a negative correlation. No significant differences were found in hepatic FMO3 expression or serum TMAO levels. Conclusions: The study confirms the role of gut microbiota disruption in CAP-mediated atherosclerosis development, independent of serum lipid or TMAO levels. Alterations in gut microbiota composition, particularly increased Firmicutes to Bacteroidetes ratio and specific bacterial families, were associated with atherosclerosis severity. These findings highlight the intricate interplay between gut microbiota and cardiovascular health in the context of CAP. [ABSTRACT FROM AUTHOR]

ABSTRACT Traumatic dental injuries of permanent teeth result in multiple immediate and long‐term consequences depending upon the severity of trauma, age of the patient, the status of root maturity, and the emergency care provided. The healing responses may get disturbed due to severe damage, loss of vascularity of the supporting structures, and infections. As a result, the prohealing mediators and pathways are overpowered by the destructive stimuli often manifested by an increased osteoclastic activity. Among the various late complications, the apical periodontitis or the periapical lesions are most worrisome for the patients and create clinical dilemma for the dentists. In the past, many such lesions were classified as cysts and subjected to surgical management. However, better understanding of lesion pathophysiology, three‐dimensional imaging, and molecular pathways have established their inflammatory nature. The advancements in materials such as calcium silicates, and regenerative techniques have propelled the research related to non‐surgical endodontic management as its clinical acceptability. The treatment largely follows the recommendations of regenerative medicine and is based on four principles: (a) establishing the drainage or an endodontic access to the area, (b) removal of most of the triggering agents such as necrosed pulp, toxins, and inflammatory mediators, (c) disinfection of the area, controlling inflammation and reversal of the acidic pH, and (d) maintenance of this infection/inflammation‐free state for a long time through adequate sealing. This review aims to highlight the rationale of the approach, case selection, pathophysiology of the causation and healing, clinical protocols, and the limitations of non‐surgical endodontic management of large periapical lesions secondary to traumatic dental injuries. [ABSTRACT FROM AUTHOR]

The present case report aims to describe the successful management of pulp canal obliteration (PCO) in mandibular incisors using static‐guided endodontics. A healthy 74‐year‐old man was referred by a prosthodontist for root canal treatment on teeth #31, #32, and #41. Periapical radiographs revealed the presence of periapical lesions as well as PCOs in teeth #31 and #41. After cone‐beam computed tomography (CBCT) evaluation, guided endodontics was selected as the treatment approach. The intraoral scan of the lower jaw and CBCT datasets were aligned and processed through image processing software to design and create a 3D‐printed guide. A virtual drill was superimposed on the scans to ensure proper access to the identified root canals. Finally, the virtually designed guide was printed using a 3D printer and accurately positioned on the teeth. The access cavities were prepared using a Munce Discovery bur. After detecting the canals, the working length was determined. Root canal preparation was performed using rotary files up to F2, followed by obturation with gutta‐percha and a bioceramic sealer. After a six‐month follow‐up, the teeth remained completely asymptomatic and functional, and the periapical radiograph showed a normal periodontal ligament space, demonstrating the effectiveness of the treatment. These results indicate that static‐guided endodontics can be an effective and predictable approach for managing PCO in mandibular incisors with some consideration. Furthermore, these results highlight the clinical implications of this approach, particularly in elderly patients or teeth with severe obliterations. [ABSTRACT FROM AUTHOR]

Periapical periodontitis may manifest as a radiographic lesion radiographically. Periapical lesions are amongst the most common dental pathologies that present as periapical radiolucencies on panoramic radiographs. The objective of this research is to assess the diagnostic accuracy of an artificial intelligence (AI) model based on U²-Net architecture in the detection of periapical lesions on dental panoramic radiographs and to determine whether they can be useful in aiding clinicians with diagnosis of periapical lesions and improving their clinical workflow. 400 panoramic radiographs that included at least one periapical radiolucency were selected retrospectively. 780 periapical radiolucencies in these anonymized radiographs were manually labeled by two independent examiners. These radiographs were later used to train the AI model based on U²-Net architecture trained using a deep supervision algorithm. An AI model based on the U²-Net architecture was implemented. The model achieved a dice score of 0.8 on the validation set and precision, recall, and F1-score of 0.82, 0.77, and 0.8 respectively on the test set. This study has shown that an AI model based on U²-Net architecture can accurately diagnose periapical lesions on panoramic radiographs. The research provides evidence that AI-based models have promising applications as adjunct tools for dentists in diagnosing periapical radiolucencies and procedure planning. Further studies with larger data sets would be required to improve the diagnostic accuracy of AI-based detection models. [ABSTRACT FROM AUTHOR]

Background: This series investigates the efficacy of regenerative endodontic therapy (RET) using various platelet-rich fibrin (PRF) formulations in treating apical periodontitis and necrotic pulp in immature permanent teeth. Aim: This study aims to evaluate the effectiveness of different PRF formulations in RET. Materials and Methods: Three cases involving patients aged 15–16 with immature teeth and necrotic pulp were treated with RET using PRF, injectable PRF, and advanced PRF. The procedure included inducing bleeding with a Hedstrom file, applying PRF variants, and sealing with mineral trioxide aggregate and composite resin. Patients were followed up at 1, 3, 6, 12 and 18 months. Results: Radiographic evidence showed apical closure, root maturation, and healing of periapical tissues in all cases. However, pulp sensibility tests were negative. Conclusion: RET using PRF variants promotes root development and apical healing in immature teeth. Further research with larger sample sizes is needed to understand these therapies' potential and limitations. [ABSTRACT FROM AUTHOR]

Autophagy is an intrinsic breakdown system that recycles organelles and macromolecules, which influences metabolic pathways, differentiation, and thereby cell survival. Oral health is an essential component of integrated well-being, and it is critical for developing therapeutic interventions to understand the molecular mechanisms underlying the maintenance of oral homeostasis. However, because of the complex dynamic relationship between autophagy and oral health, associated treatment modalities have not yet been well elucidated. Determining how autophagy affects oral health at the molecular level may enhance the understanding of prevention and treatment of targeted oral diseases. At the molecular level, hard and soft oral tissues develop because of complex interactions between epithelial and mesenchymal cells. Aging contributes to the progression of various oral disorders including periodontitis, oral cancer, and periapical lesions during aging. Autophagy levels decrease with age, thus indicating a possible association between autophagy and oral disorders with aging. In this review, we critically review various aspects of autophagy and their significance in the context of various oral diseases including oral cancer, periapical lesions, periodontal conditions, and candidiasis. A better understanding of autophagy and its underlying mechanisms can guide us to develop new preventative and therapeutic strategies for the management of oral diseases. [ABSTRACT FROM AUTHOR]

Background: This clinical study aims to compare postoperative pain after single-visit root canal treatment of teeth with asymptomatic apical periodontitis using epoxy-resin-based AH Plus and calcium silicate-based Endosequence BC sealers with or without sonic activation. Methods: This study included 72 individuals with one first or second mandibular premolar tooth with asymptomatic apical periodontitis. They were randomly divided into four groups according to the root canal sealer (AH Plus or Endosequence BC) and activation protocol (sonic activation or non-activation) (n = 18). The participants were ask to rate their postoperative pain intensity on a NRS scale as none, minimal, moderate, or severe after 24 h, 48 h, 72 h, and 7 days following treatment. Patients were also asked to record the number of prescribed analgesic medication tablets (400 mg of ibuprofen) taken. Statistical analysis were performed using the Mann-Whitney U test, the Friedman test, the Spearman's correlation test, the Chi-square test. Significance level was established at 0.05. Results: There was no statistically significant difference in postoperative pain scores or analgesic intake between AH Plus and Endosequence BC sealers regardless of the activation protocol (p > 0.05). There was no statistically significant difference in postoperative pain scores between the sonic activation and non-activation groups (p > 0.05). A weak positive correlation was detected between Endoactivator sonic activation and sealer extrusion (r = 0.36). Conclusions: AH Plus and EndoSequence BC root canal sealers showed similar results in terms of prevalance and intensity of postoperative pain. Sonic activation and non-activation groups had similar postoperative pain scores. Clinical trial registration: The study was retrospectively registered with ClinicalTrials.gov (NCT06403293). Date of Registration: 07/05/24. [ABSTRACT FROM AUTHOR]

Introduction: Apical periodontitis (AP) is an inflammatory disease of the periapical tissues that is often asymptomatic and diagnosed through radiographic examination. A challenge in traditional endodontics is disinfection of the root canal system (RCS), which anatomically presents numerous variations, often leading to persistent infections. Antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) offer promising adjuncts, due to their antimicrobial and tissue-healing properties. Objective: The aim of this article was to report five cases of teeth with pulp necrosis and asymptomatic apical periodontitis (AAP) treated with aPDT and PBMT protocols. Materials and Methods: Five cases of pulp necrosis and AAP were treated with conventional endodontic therapy supplemented with aPDT and PBMT. The treatment protocol included chemomechanical preparation (CMP), aPDT using a 660 nm diode laser (DL) with methylene blue (MB) as a photosensitizer (5 min pre-irradiation time), and PBMT using a 940 nm DL. Treatment results were evaluated through cone-beam computed tomography (CBCT)-based evaluation over 1 year of clinical follow-up. Results: All cases showed significant bone regeneration and tissue healing, demonstrating the efficacy of the combination of aPDT and PBMT. Post-operative pain did not occur in any of the patients, suggesting a possible analgesic effect of PBMT. Conclusions: The combination of aPDT and PBMT in endodontic therapy promoted tissue recovery and improved the prognosis of AAP. Further research and randomized control trials are needed to optimize treatment protocols and evaluate the long-term effects. [ABSTRACT FROM AUTHOR]

Background: In clinical practice, the buccal approach is typically the primary choice for endodontic microsurgery. Owing to the thickness of the buccal bone plate, the distance between the buccal bone plate and palatal lesion location, and soft tissue traction, the palatal approach may be more suitable for microsurgery for apical periodontitis of the palatal roots of the maxillary molars. However, the length of the palatal root, location of the greater palatine artery (GPA) and foramen (GPF), and surgical field of observation make palatal surgery challenging. Case presentation: With the aid of Cone-beam computed tomography imaging, the palatal approach was successfully applied in nine cases of endodontic microsurgery of the palatal root of a maxillary molar with a periapical lesion in Hangzhou Stomatology Hospital from January to December 2022. Conclusions: Complete healing was assessed based on clinical symptoms and radiographic images at the 3- and 24-month follow-up visits in all nine cases. Several tips have been proposed including surgical positioning, incision design, palate flap modification, bone removal, and root-end resection. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the accuracy of detecting vertical root fractures in Biodentine™-filled teeth using the Promax 3Dmax cone-beam computed tomography (CBCT) unit compared to periapical radiographs. It tested hypotheses regarding CBCT's diagnostic superiority in non-root-filled and Biodentine™-root-filled maxillary central incisors and assessed the impact of smaller field of view and lower intensity settings on detection accuracy. Materials and methods: Extracted maxillary incisors were divided into groups based on fracture status and root filling material, then placed in a Thiel-embalmed skull to simulate clinical conditions. The teeth were imaged using periapical radiographs and the CBCT unit under different settings. Fracture thickness was measured with microcomputed tomography for accuracy benchmarking. Multiple observers assessed the images, and statistical analyses were conducted to evaluate diagnostic performance. Results: Intra-rater reliabilities of consensus scores ranged from good to very good. Specificities were generally higher than sensitivities across all imaging modalities, but sensitivities remained constantly low. None of the Area Under the Curve scores exceeded 0.6, indicating poor overall accuracy for all imaging modalities. Paired comparisons of the area differences under Receiver Operator Characteristic curves revealed no significant differences between the CBCT and periapical radiograph techniques for detecting vertical root fractures in either Biodentine™-filled or non-root-filled teeth. Conclusions: There was no significant accuracy improvement of the current CBCT device (Promax 3Dmax, Planmeca, Finland) over periapical radiographs in detecting small vertical root fractures in both non-root-filled and Biodentine™-root-filled maxillary central incisors. A smaller field of view with lower intensity did not enhance detection accuracy. These results highlight the challenges in accurately detecting small VRFs, emphasizing the need for further research and technological advancements in this domain. [ABSTRACT FROM AUTHOR]

Introduction: In modern times, endodontic intervention is preferred and tooth extraction is becoming increasingly rare. Root Canal Therapy (RCT) is well-established, with success rates exceeding 90%. A key contributor to post-endodontic pain is the extrusion of debris into the periapical region, which causes inflammation and nerve compression. The amount of debris extruded varies with instrumentation techniques and no current technology completely prevents it. Rotary and reciprocating Nickel-Titanium (NiTi) instruments, each with distinct designs and kinematics, play a critical role in managing this complication. Aim: To evaluate postoperative pain using rotary and reciprocating file systems in single visit endodontics. Materials and Methods: This prospective, parallel-group, singlecentre, double-blinded, equivalence, randomised clinical study was conducted at the Department of Conservative Dentistry and Endodontics, School of Dental Sciences, Krishna Vishwa Vidyapeeth (Deemed To be University), Karad, Maharashtra, India, from October 2023 to March 2024, with the aim of comparing postoperative pain following endodontic therapy using two reciprocating systems, WaveOne Gold (WOG) and E-Flex Rec, versus two rotary systems, Mtwo and XP Endo Shaper (XPES). A total of 80 patients with symptomatic irreversible pulpitis were enrolled and randomly assigned to four groups, each treated with one of the four endodontic file systems. Patients were randomised into four groups: 1A-Mtwo (Dentsply-Maillefer, Ballaigues, Switzerland); 1B-XP Endo Shaper (XPS; FKG Dentaire SA, La Chaux-de-Fonds, Switzerland); 2A-Eighteeth E-Flex Rec File; and 2B-WOG (Dentsply Sirona, York, PA). Postoperative pain scores were measured using the Visual Analogue Scale (VAS) at 24, 48 and 72 hours and seven days post-treatment. Statistical analysis was conducted using One-way Analysis of Variance (ANOVA) with Tukey's post-hoc test and Chi-square tests for categorical data using Statistical Package for Social Sciences (SPSS) software version 21.0, with p-values<0.05 considered significant. Results: According to the study's findings, postoperative pain was significantly higher in the rotary file systems compared to the reciprocating file systems at all time intervals (p-value<0.001). The mean ages were 39.00±12.70 years for Group 1A, 34.70±9.48 years for Group 1B, 42.15±12.59 years for Group 2A, and 39.10±13.65 years for Group 2B. Additionally, the consumption of analgesics was significantly higher in the rotary file systems compared to the reciprocating file systems at 24 hours (p-value=0.001) and 48 hours (p-value=0.003), highlighting the importance of file design and kinematics in managing postoperative pain. Conclusion: Compared to the rotary systems (XPES and Mtwo), the use of the reciprocating instrumentation systems (WOG and E-Flex) demonstrated noticeably less postoperative pain, both in terms of intensity and duration. [ABSTRACT FROM AUTHOR]

Background: Gremlin1 is a multifunctional protein whose expression is demonstrated to be involved in a series of physiology and pathological processes. The association between Gremlin1 and apcial periodontitis (AP) has been established. M1-polarized macrophages are crucial immune cells that exacerbate the progression of apical periodontal inflammatory response, but the function of Gremlin1 during macrophages activation in periapical lesions is still unclear. This study attempts to explore the regulatory effects of Gremlin1 on macrophage polarization on apical periodontitis microenviroment. Methods: Clinical specimens were used to determine the expression of Gremlin1 in periapical tissues by immunohistochemical (IHC) staining. Then, the disease models of periapical inflammation in rats were established, and adenovirus- associated virus (AAVs) was used to blockade Gremlin1 expression. Lentivirus carrying sh-Gremlin1 particles were used to transfect THP-1 induced M1-subtype macrophages. To assess the expression of associated molecules, Western blot, immunofluorescence staining were performed. Results: Gremlin1 was significantly up-regulated in the periapical tissues of subjects with AP as identified by IHC staining, and positively correlated with levels of M1 macrophage-associated genes. Rats AP model with inhibition of Gremlin1 in periapical lesions exhibited limited infiltration of macrophages and decreased expression of M1 macrophage-related genes in periapical lesions. Furthermore, Gremlin1 blockade substantially decreased the Notch1/Hes1 signaling pathway activation level. The in vitro experiments confirmed the above results. Conclusion: Taken together, current study illustrated that the Gremlin1 suppression in periapical lesions inhibited M1 macrophage polarization through Notch1/Hes1 axis. Moreover, Gremlin1 may act as a potential candidate in the treatment of AP. [ABSTRACT FROM AUTHOR]

Aim: Apical periodontitis (AP) is the chronic inflammation of the periradicular tissues in response to root canal infection. Whilst AP has been linked with systemic inflammation and noncommunicable diseases, its potential association with nonalcoholic fatty liver disease (NAFLD) is unknown. We aimed to evaluate the serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels as surrogate markers of hepatic injury, and the systemic inflammatory burden in otherwise healthy individuals with and without AP diagnosis. Methodology: Cross‐sectional study. Individuals with AP (n = 30) and healthy controls (n = 29) were recruited. The number, mean diameter (mm) and periapical index of the apical lesions of endodontic origin (ALEO) were assessed. ALT and AST levels (pg/mL) were measured through enzyme‐linked immunosorbent assays. The serum levels of TNF‐α, IL‐4, IL‐9, IL‐10, IL‐17A and IL‐22 were evaluated by Multiplex assay. Inferential analysis was performed using t‐test or Mann–Whitney tests according to data distribution and linear regression models. Data were analysed with StataV16 (p <.05). Results: ALT and AST levels were significantly higher in individuals with AP compared to controls (p <.05). Serum inflammatory biomarkers showed no significant differences between the study groups. Bivariate and multivariate analyses confirmed that AP diagnosis was independently associated with ALT and AST elevations (p <.05). Additionally, the number of ALEO positively influenced AST levels (p =.002). IL‐22 on the other hand, was associated with reduced ALT levels (p =.043). Conclusion: AP is associated with higher serum hepatic transaminases ALT and AST, potentially contributing to NAFLD physiopathology in young adults. [ABSTRACT FROM AUTHOR]

Apical lesions are diseases of infectious origin that can cause destruction of the surrounding periapical tissue, including bone tissue and periodontal ligaments, resulting in the loss of the affected teeth. Currently, the microorganisms present in pulp and apical disease are mostly studied as bacteria. However, in recent years, interest has been aroused in the study of viruses that could be present in apical lesions, and how these could affect the progression of disease. In the present study, we conducted a systematic review of the literature to evaluate and synthesize the scientific evidence on the presence of viruses and their possible role in pulpal and apical disease. This systematic review was performed according to the PRISMA reporting guidelines. The search for studies was performed in the PubMed and Web of Science databases. A total of seven studies published in the last 10 years were included. The types of samples used for virus analysis varied from one study to another. In all the included studies, the presence of any of the types of viruses studied was found, either in pulp or apical tissue. Herpesviridae family, Epstein–Barr virus (EBV) and Human cytomegalovirus (HCMV) stood out as the most commonly present in apical lesions. Further studies are required to clarify and understand the pathogenic role of viruses in pulpal and periapical disease. [ABSTRACT FROM AUTHOR]

This multicentered cohort study evaluated the radiographic outcomes of regenerative endodontic procedures (REPs) and apexification treatments (APEX) of immature teeth with endodontic disease. This cohort study included a retrospective record review and prospective data collection of pediatric patients with teeth treated with REPs or APEX between 2005 and 2014. Data including the presence of a periapical lesion, external root resorption, obliteration, apical hard tissue, apical closure, intracanal calcifications, and radiographic root area (RRA) change based on measurements were collected/measured from radiographic images. Univariate and multivariate analyses were conducted. The cohort included 190 subjects (204 teeth (92 REPs; 112 APEX)). The frequency of pretreatment periapical pathology was similar between cases in which the clinical treatment failed versus successful treatment cases. However, the frequency of pretreatment external root resorption was higher in failed cases than in successful cases (P =.007). The mean RRA change was greater than twenty percent in 21% of the REPs cases. In traumatized teeth, REPs resulted in less hard tissue formation than other endodontic disease etiologies measured by RRA (P =.001). Fifty-three percent of cases with ERR (16/30) showed signs of healing/arrest and were mostly treated with REPs (11/16). The presence of ERR negatively affected the treatment outcome. There was significant variability in RRA change in REPs. Signs of healing/arrest of the resorptive lesion were radiographically visible in many cases treated with REPs. [ABSTRACT FROM AUTHOR]