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Background: Previous deep learning-based studies were mainly conducted on detecting periapical lesions; limited information in classification, such as the periapical index (PAI) scoring system, is available. The study aimed to apply two deep learning models, Faster R-CNN and YOLOv4, in detecting and classifying periapical lesions using the PAI score from periapical radiographs (PR) in three different regions of the dental arch: anterior teeth, premolars, and molars. Methods: Out of 2658 PR selected for the study, 2122 PR were used for training, 268 PR were used for validation and 268 PR were used for testing. The diagnosis made by experienced dentists was used as the reference diagnosis. Results: The Faster R-CNN and YOLOv4 models obtained great sensitivity, specificity, accuracy, and precision for detecting periapical lesions. No clear difference in the performance of both models among these three regions was found. The true prediction of Faster R-CNN was 89%, 83.01% and 91.84% for PAI 3, PAI 4 and PAI 5 lesions, respectively. The corresponding values of YOLOv4 were 68.06%, 50.94%, and 65.31%. Conclusions: Our study demonstrated the potential of YOLOv4 and Faster R-CNN models for detecting and classifying periapical lesions based on the PAI scoring system using periapical radiographs. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Successful management of a rare case involving both dens evaginatus and dens invaginatus in the same tooth, monitored over a 24‐month follow‐up. Dens invaginatus (DI) is a congenital dental anomaly characterized by the presence of a tooth that resembles a "tooth within a tooth." Conversely, dens evaginatus (DE) is a developmental anomaly distinguished by an additional tubercle or cusp on the tooth's crown. Both DI and DE can result in pulpal and periapical diseases in the affected tooth. This article presents a case of a healthy 14‐year‐old male with recurrent swelling under the chin and a wound with pus drainage on the right side of the submental area, associated with his left mandibular lateral incisor affected by both DI and DE. Clinical and radiographic examinations revealed that the tooth was necrotic and had a chronic apical abscess. Cone beam computed tomography (CBCT) confirmed Oehlers' type III DI and a talon cusp on the lingual surface of the same tooth. The patient underwent orthograde endodontic treatment. Passive ultrasonic activation of a 5.25% NaOCl solution and a mixture of Ca(OH)2 and a 2% chlorhexidine solution were utilized to effectively clean and eliminate the persistent pus discharge. After the resolution of the patient's symptoms, the apical third of the root canal and the invaginated space were filled with a plug of mineral trioxide aggregate (MTA), while the remaining root canal was filled using a sealer‐based obturation technique. A 24‐month follow‐up visit revealed complete bone regeneration in the previously affected periradicular tissues. [ABSTRACT FROM AUTHOR]

This systematic review was aimed to assess the prevalence of apical periodontitis (AP) in Saudi Arabia, focusing on individual-level prevalence and the frequency of AP in endodontically versus untreated teeth. This review followed the PRISMA guidelines and involved searches in several databases, including PubMed-MEDLINE, Cochrane-CENTRAL, and EMBASE, without date restrictions until August 19th, 2023. Eligibility criteria encompassed studies using CBCT, panoramic, and periapical radiographs to diagnose AP in the Saudi population. The meta -analysis employed a random-effects model due to high heterogeneity among studies. From 359 records, 13 studies were included, indicating a 40% prevalence of AP in individuals and a 6% prevalence across all teeth within the Saudi population. Root canal-treated teeth demonstrated a higher prevalence at 47%. The data revealed a substantial prevalence of AP compared to global averages, with first molars being the most affected. Studies showed moderate risk of bias and significant heterogeneity. The high occurrence of AP in Saudi Arabia, particularly in root-treated teeth, emphasizes the need for enhanced endodontic care and more accurate diagnostics. Urgent improvements in dental health policies and further research are essential to understand AP's impact and improve oral health outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Secondary endodontic infections present intricate challenges in dental practice, necessitating effective retreatment strategies. The current systematic review aimed to critically evaluate the outcomes of single-visit versus multi-visit endodontic retreatment in patients with secondary endodontic infections. Materials and Methods: The current systematic review was registered in the Open Science Framework database and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Searches were conducted in PubMed/Medline, Scopus, and Web of Science databases for articles published until April 2023. The inclusion criteria for the current systematic review were clinical trials reporting the comparison of nonsurgical single-visit versus multiple-visit endodontic retreatments with predictive outcome. The Cochrane scale was used to assess the risk of bias. Results: Six studies were included in the systematic review. Four studies reported the incidence of postoperative pain, and two studies reported the periapical lesion healing after single- and multiple-visit endodontic retreatments with an 18- and 24-month follow-up. Three studies showed a low risk of bias, one study showed unclear risk of bias, and two studies showed a high risk of bias. Conclusion: Comparative analyses indicated that single-visit endodontic retreatment yielded comparable postoperative pain levels and healing outcomes as retreatment conducted over multiple visits. Notably, the utilization of intracanal medicaments such as calcium hydroxide and triple antibiotic paste demonstrates promise in mitigating postoperative pain subsequent to retreatment procedures.

Objective: This systematic review was aimed to assess the prevalence of apical periodontitis (AP) in Saudi Arabia, focusing on individual-level prevalence and the frequency of AP in endodontically versus untreated teeth. Methods: This review followed the PRISMA guidelines and involved searches in several databases, including PubMed-MEDLINE, Cochrane-CENTRAL, and EMBASE, without date restrictions until August 19th, 2023. Eligibility criteria encompassed studies using CBCT, panoramic, and periapical radiographs to diagnose AP in the Saudi population. The meta-analysis employed a random-effects model due to high heterogeneity among studies. Results: From 359 records, 13 studies were included, indicating a 40% prevalence of AP in individuals and a 6% prevalence across all teeth within the Saudi population. Root canal-treated teeth demonstrated a higher prevalence at 47%. The data revealed a substantial prevalence of AP compared to global averages, with first molars being the most affected. Studies showed moderate risk of bias and significant heterogeneity. Conclusion: The high occurrence of AP in Saudi Arabia, particularly in root-treated teeth, emphasizes the need for enhanced endodontic care and more accurate diagnostics. Urgent improvements in dental health policies and further research are essential to understand AP’s impact and improve oral health outcomes.

Introduction: In the rapidly evolving landscape of health care, artificial intelligence (AI) has emerged as a promising tool to enhance diagnostic accuracy across various medical disciplines. Within the realm of dentistry, one critical area of focus is endodontics, which involves the diagnosis and treatment of dental pulp diseases. This systematic review investigates the diagnostic precision of AI in contrast to dental experts when predicting endodontic outcomes. Materials and Methods: The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review was registered on the Open Science Framework database. A systematic search was performed of the literature on the application of AI versus dental experts in endodontics. The search was conducted on PubMed, Scopus, Web of Science, and OVID until December 2022. The QUADAS-2 tool was used to evaluate the risk of bias. Results: The initial search retrieved 972 records, of which eight articles were included in the study. The studies reported application of AI for working length determination, periapical lesions, pulp and tooth segmentation, apical periodontitis, vertical root fracture, and C-shaped canals. QUADAS-2 tool revealed a low risk of bias in five out of the eight included studies. Conclusion: AI models demonstrated a notable increase in accuracy and effectiveness in endodontic diagnosis and treatment planning. These results suggest that the integration of AI technology in endodontic diagnosis and treatment planning has immense potential to serve as a promising aid.

Aim of study. The aim of the present study was to assess the prevalence of periapical lesions in root-filled lateral teeth as well as the distribution of periapical lesions according to various factors that can influence the therapeutic outcome. Materials and method. The study group included 163 patients (gender: 58 males, 105 females; mean age 48.13 ± 14.708 yrs.) with at least 2-yrs. follow-up of 412 endodontically treated teeth. Following the radiographic assessment of the root and its periapical area, the root canal treatments were classified as adequate and poor, while the apical lesions was diagnosed on radiographic examen. The quality of coronal marginal sealing (poor, adequate) was assessed by radiographic examen. The distribution of apical lesion was assessed on socio-demographical parameters (gender, age groups), location (maxillary, mandibular), follow-up, quality of root canal filling, status of coronal marginal sealing, occlusal contacts, recurrent caries. Results. Periapical lesions prevalence in root-filled lateral teeth was as follows: gender (males- 47,3%; females- 50,2%); age groups (20-39 yrs.- 41,9%; 40-59 yrs.- 52,4%; ≥60 yrs.- 47,4%); follow-up (2-4 yrs.- 57,7%; 5-8 yrs.- 44,5%) (p=.010*); location (maxillary teeth- 46,1%; mandibular teeth- 54,5%). 58% of teeth with poor coronal marginal sealing, and 59% of teeth with poor root canal fillings were diagnosed with AP. Conclusions. Apical lesions were detected in 49.3% of the lateral root-filled teeth. Molars, poor root canals fillings, poor coronal marginal sealing, presence of recurrent caries were significantly associated with endodontic periapical lesions.

Aim of study. The aim of the present study was to assess the prevalence of periapical lesions in root-filled lateral teeth as well as the distribution of periapical lesions according to various factors that can influence the therapeutic outcome. Materials and method. The study group included 50 patients (gender: 12 males, 38 females; mean age 51.48 ± 13.218). A total number of 150 anterior root-filled teeth were evaluated at 2-8 yrs. post-treatment. Following the radiographic assessment of the root and its periapical area, the root-canals fillings were classified as adequate and poor. The status of periapical area was assessed on periapical radiographic images. The quality of coronal marginal sealing was assessed as poor or adequate by clinical and radiographic examen. The distribution of apical periodontitis was assessed according to socio-demographical parameters (gender, age groups), location (maxillary, mandibular), follow-up, quality of root canal filling, status of coronal marginal sealing, recurrent caries. Results. The global prevalence of apical periodontitis was 50,7%. The prevalence of apical periodontitis in root-filled anterior teeth was as follows: gender (males- 37,5%; females- 54,2%); age groups (20-39 yrs.- 30%; 40-59 yrs.- 52,9%; ≥60 yrs.- 57,1%); location (maxillary teeth- 42,4%; mandibular teeth- 81,3%). The prevalence of apical periodontitis was 70% in teeth with poor coronal marginal sealing, and 61,4% in teeth with poor root canal fillings. Conclusions. Apical periodontitis was detected in half of the anterior root-filled teeth. The rate of apical periodontitis was significantly increased in maxillary anterior teeth, poor root canals fillings, poor coronal marginal sealing, and root-filled teeth with the presence of recurrent caries.

Abstract Objective The aim of the present pilot study was to assess the effectiveness of the platelet-rich fibrin (PRF) apical barrier for the placement of MTA for the treatment of teeth with periapical lesions and open apices. Methods A total of thirty teeth on twenty-eight patients with open apices and periapical periodontitis were enrolled and divided into two groups in the present pilot study. In the PRF group (fourteen teeth in thirteen patients), nonsurgical endodontic treatment was performed using PRF as an apical matrix, after which the apical plug of the MTA was created. For the non-PRF group (fourteen teeth in fourteen patients), nonsurgical endodontic therapy was performed using only the MTA for an apical plug with no further periapical intervention. Clinical findings and periapical digital radiographs were used for evaluating the healing progress after periodic follow-ups of 1, 3, 6, and 9 months. The horizontal dimension of the periapical lesion was gauged, and the changes in the dimensions were recorded each time. The Friedman test, Dunn-Bonferroni post hoc correction, and Mann-Whitney U test were used for statistical analysis, with P

Key Clinical Message: The main objective of root canal therapy is to locate all the canals, cleaning, and shaping, and obturation to obtain fluid tight seal and to heal the periapical lesion if present. The proper cleaning, shaping, and disinfection of the pulp chambers, as well as the filling of the canals, are critical to the efficacy of treatment with root canals. The success of an endodontically treated tooth is dependent on the accuracy of the diagnosis, disinfection, cleaning and shaping, obturation, and finally, the prosthetic rehabilitation management. Root canal therapy should provide a hermatic as well as fluid impenetrable seal which prevents the progression of periapical infection. There are two ways to treat such lesions: surgical and nonsurgical methods. If the root canal is cleaned, shaped, and sealed properly and adequately without the use of a surgical procedure, these lesions will recover during nonsurgical root canal therapy. This case series focuses primarily on the nonsurgical treatment of an enormous periapical lesion and provides evidence that these lesions respond well without surgery. [ABSTRACT FROM AUTHOR]

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

Background and Objectives: The present systematic review and meta-analysis were conducted to evaluate and compare the long-term clinical outcomes of immediate implants placed into fresh sockets with and without periapical pathology. Materials and Methods: After the search and review of the literature in the electronic databases, 109 publications were achieved. The titles and abstracts of 66 publications were screened. After the evaluation of the full text of 22 publications, based on the inclusion criteria, six controlled clinical studies were included in this systematic review and meta-analysis. Results: The statistical calculation showed no heterogeneity among the studies included. The implant survival was 99.6% in the test (socket with periapical pathology) and control (socket without periapical pathology) groups of all the clinical trials. The results of the meta-analysis showed no statistically significant difference between test and control groups regarding the marginal bone level and the width of keratinized mucosa in all the studies. Other parameters indicating plaque level, bleeding on probing, and gingival recession also did not differ between test and control groups at the final follow-up in nearly all studies. Conclusions: Within the limitation of this systemic review and meta-analysis, the obtained data suggest that implants immediately placed into the extraction sockets of teeth exhibiting periapical pathology can be successfully osseointegrated for an extended period. [ABSTRACT FROM AUTHOR]

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

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

Objective: To evaluate the effects of NLRP3 inflammasome inhibition or knockout in experimental apical periodontitis (AP) induced in mice. Methods: The experimental AP was induced by pulpal exposure. To evaluate NLRP3-specific inhibitor medication (MCC950), WT mice received intraperitoneal injections, while the control received PBS (n = 10). In addition, to evaluate NLRP3 knockout, 35 wild-type (WT) and 35 NLRP3−/− mice were divided into a control group (without pulpal exposure, n = 5) and three experimental groups: after 2, 14 and 42 days after pulpal exposure (n = 10). Microscopic and molecular analyzes were carried out using a significance level of 5%. Results: Exposure to MCC950 did not affect the periapical lesion size after 14 days (P = 0.584). However, exposed mice had a lower expression of IL-1β, IL-18 and caspase-1 (P = 0.010, 0.016 and 0.002, respectively). Moreover, NLRP3−/− mice showed a smaller periapical lesion after 14 and 42 days (P = 0.023 and 0.031, respectively), as well as a lower expression of IL-1β after 42 days (P < 0.001), of IL-18 and caspase-1 after 14 (P < 0.001 and 0.035, respectively) and 42 days (P = 0.002 and 0.002, respectively). NLRP3−/− mice also showed a lower mRNA for Il-1β, Il-18 and Casp1 after 2 (P = 0.002, 0.036 and 0.001, respectively) and 14 days (P = 0.002, 0.002 and 0.001, respectively). Conclusions: NLRP3 inflammasome inhibition or knockout can attenuate the inflammatory events that result in the periapical lesion (AP) formation after pulpal exposure in mice. Clinical relevance: The NLRP3 inflammasome may be a therapeutic target for AP, and new approaches may verify the impact of its inhibition (through intracanal medications or filling materials) on the bone repair process and treatment success. [ABSTRACT FROM AUTHOR]

Key Clinical Message Successful management of a rare case involving both dens evaginatus and dens invaginatus in the same tooth, monitored over a 24‐month follow‐up. Abstract Dens invaginatus (DI) is a congenital dental anomaly characterized by the presence of a tooth that resembles a “tooth within a tooth.” Conversely, dens evaginatus (DE) is a developmental anomaly distinguished by an additional tubercle or cusp on the tooth's crown. Both DI and DE can result in pulpal and periapical diseases in the affected tooth. This article presents a case of a healthy 14‐year‐old male with recurrent swelling under the chin and a wound with pus drainage on the right side of the submental area, associated with his left mandibular lateral incisor affected by both DI and DE. Clinical and radiographic examinations revealed that the tooth was necrotic and had a chronic apical abscess. Cone beam computed tomography (CBCT) confirmed Oehlers' type III DI and a talon cusp on the lingual surface of the same tooth. The patient underwent orthograde endodontic treatment. Passive ultrasonic activation of a 5.25% NaOCl solution and a mixture of Ca(OH)2 and a 2% chlorhexidine solution were utilized to effectively clean and eliminate the persistent pus discharge. After the resolution of the patient's symptoms, the apical third of the root canal and the invaginated space were filled with a plug of mineral trioxide aggregate (MTA), while the remaining root canal was filled using a sealer‐based obturation technique. A 24‐month follow‐up visit revealed complete bone regeneration in the previously affected periradicular tissues.

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

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

Aim: To evaluate the role of regulatory T lymphocytes (Tregs) in the presence or absence of the synthetic ligand Pam3Cys during the progression of periapical lesion in wild‐type (WT) and toll‐like receptor 2 knockout (TLR2KO) mice. Methodology.: A total of 130 C57BL/6 male WT and TLR2KO mice were allocated into control (n = 5) and experimental (periapical lesion induction) (n = 10) groups. In specific groups (WT+Pam3cys and TLR2KO+Pam3cys), the synthetic ligand Pam3cys was administered intraperitoneally every 7 days, according to the experimental period (14, 21 and 42 days). At the end of those periods, the animals were euthanized, and the mandible and the spleen were submitted to histotechnical processing. Mandible histological sections were analysed by haematoxylin and eosin, TRAP histoenzymology and immunohistochemistry (FOXP3, RANK, RANKL and OPG). Spleen sections were analysed by immunohistochemistry (FOXP3). Results: The inflammatory infiltrate and bone resorption were more intense in the TLR2KO group compared to the WT group. The animals that received the Pam3cys had smaller periapical lesions when compared to the animals that did not receive the ligand (p <.05). TLR2KO animals showed a significant increase in the number of osteoclasts when compared to TLR2KO+Pam3cys group (p <.05). At 21 days, the WT+Pam3cys group had a lower number of osteoclasts when compared to the WT animals (p =.02). FOXP3 expression was more intense in the WT+Pam3cys groups when compared to the WT animals in the 42 days (p =.03). In the spleen analysis, the WT+Pam3cys group also had a higher expression of FOXP3 when compared to the WT animals at 14 and 42 days (p =.02). Concerning RANKL, there was a reduction in staining in the KOTLR2+Pam3cys groups at 21 and 42 days (p =.03) and a higher binding ratio between RANK/RANKL in animals that did not receive the ligand. Conclusion: Administration of the Pam3cys increased the proliferation of Tregs, showed by FOXP3 expression and prevented the progression of the periapical lesion in WT mice. On the other hand, in the TLR2KO animals, Treg expression was lower with larger areas of periapical lesions. Finally, systemic administration of the Pam3cys in KO animals was able to limit the deleterious effects of the absence of the TLR2 receptor. [ABSTRACT FROM AUTHOR]

Training of Artificial Intelligence (AI) for biomedical image analysis depends on large annotated datasets. This study assessed the efficacy of Active Learning (AL) strategies training AI models for accurate multilabel segmentation and detection of periapical lesions in cone-beam CTs (CBCTs) using a limited dataset. Limited field-of-view CBCT volumes (n = 20) were segmented by clinicians (clinician segmentation [CS]) and Bayesian U-Net-based AL strategies. Two AL functions, Bayesian Active Learning by Disagreement [BALD] and Max_Entropy [ME], were used for multilabel segmentation ("Lesion"-"Tooth Structure"-"Bone"-"Restorative Materials"-"Background"), and compared to a non-AL benchmark Bayesian U-Net function. The training-to-testing set ratio was 4:1. Comparisons between the AL and Bayesian U-Net functions versus CS were made by evaluating the segmentation accuracy with the Dice indices and lesion detection accuracy. The Kruskal-Wallis test was used to assess statistically significant differences. The final training set contained 26 images. After 8 AL iterations, lesion detection sensitivity was 84.0% for BALD, 76.0% for ME, and 32.0% for Bayesian U-Net, which was significantly different (P <.0001; H = 16.989). The mean Dice index for all labels was 0.680 ± 0.155 for Bayesian U-Net and 0.703 ± 0.166 for ME after eight AL iterations, compared to 0.601 ± 0.267 for Bayesian U-Net over the mean of all iterations. The Dice index for "Lesion" was 0.504 for BALD and 0.501 for ME after 8 AL iterations, and at a maximum 0.288 for Bayesian U-Net. Both AL strategies based on uncertainty quantification from Bayesian U-Net BALD, and ME, provided improved segmentation and lesion detection accuracy for CBCTs. AL may contribute to reducing extensive labeling needs for training AI algorithms for biomedical image analysis in dentistry. [ABSTRACT FROM AUTHOR]

Key Clinical Message The main objective of root canal therapy is to locate all the canals, cleaning, and shaping, and obturation to obtain fluid tight seal and to heal the periapical lesion if present. Abstract The proper cleaning, shaping, and disinfection of the pulp chambers, as well as the filling of the canals, are critical to the efficacy of treatment with root canals. The success of an endodontically treated tooth is dependent on the accuracy of the diagnosis, disinfection, cleaning and shaping, obturation, and finally, the prosthetic rehabilitation management. Root canal therapy should provide a hermatic as well as fluid impenetrable seal which prevents the progression of periapical infection. There are two ways to treat such lesions: surgical and nonsurgical methods. If the root canal is cleaned, shaped, and sealed properly and adequately without the use of a surgical procedure, these lesions will recover during nonsurgical root canal therapy. This case series focuses primarily on the nonsurgical treatment of an enormous periapical lesion and provides evidence that these lesions respond well without surgery.

Resolution of a periapical periodontal lesion as determined by radiographic examination may take a year or longer. Orthodontic movement is known to have a positive effect on the bone topography and morphology. The literature presents no information about the effect of orthodontic movement on the rate of periapical endodontic healing following a root canal treatment. The aim of this report was to present the use of orthodontic root extrusion in cases with a periapical lesion, where other options are ruled out. Three case reports involving endodontically treated teeth with a periapical lesion are presented. In each case, the performed orthodontic extrusion resulted with healing of the periapical environment towards a predictable crown fabrication or replacing a hopeless tooth more safely with an implant-supported crown. In all cases presented, signs of radiographic healing were demonstrated in a relatively shorter time than is considered acceptable, following the extrusive orthodontic movement, with no clinical sensitivity to percussion or periodontal pockets. In conclusion, orthodontic extrusion of endodontically treated teeth with periapical lesions presented positive radiographic healing signs along with no clinical symptoms of pain and mobility and a positive effect on marginal bone level and soft tissues, at a faster rate than was expected. This report may assist in supporting a clinical decision to apply vertical extrusive forces on compromised endodontically treated teeth presenting with a periapical lesion. Healing signs may be observed within a shorter time period, which may allow better prediction for the prosthetic phase. [ABSTRACT FROM AUTHOR]

In this case series, radiographic images of healing lesions resulting from non-surgical root canal treatments and follow-up of periapical lesions caused by traumatic occlusion, untreated trauma injuries, inadequate root canal treatment, and pulp necrosis with deep caries and internal resorption are presented. The treatment of four cases consisting of mandibular and maxillary incisors, molars, and premolars with a lesion was completed by filling the root canals after opening the access cavity, applying biomechanical preparation, and canal medication with calcium hydroxide. The symptoms of the patients were evaluated with control examinations; lesion healing was followed by periapical radiographs taken from the patients. As a result of clinical and radiographic evaluations, it was observed that the lesions were greatly reduced, and bone formation occurred. Periapical lesions can be healed by performing conservative root canal treatment in line with correct procedures, even without surgical procedures. [ABSTRACT FROM AUTHOR]

Objectives: The biomechanical response of teeth with periapical lesions that have been restored using various substructure materials, as well as the stress mapping in the alveolar bone, has not been thoroughly described. In this context, the objective of this study is to investigate the structural stress distributions on root canal-treated maxillary right central incisors with lesions restored using different crown materials under linear static loading conditions through finite element analysis (FEA). Methods: In the study, five FEA models were utilised to represent healthy teeth and teeth restored with different substructure materials: (A) a healthy tooth, (B) a lesioned, root canal-treated, composite-filled tooth, (C) a lesioned, fiber-posted, zirconia-based crown, (D) a tooth with lesions, a fiber post, and Ni–Cr infrastructure crown, (E) a tooth with a lesion, a fiber post, and an IPS E-max infrastructure crown. A force of 100 N was applied at an angle of 45° to the long axis of the tooth from 2 mm cervical to the incisal line on the palatal surface. Deformation behaviour and maximum equivalent stress distributions on the tooth sub-components, including the bony structure for each model, were simulated. Results: Differences were observed in the stress distributions of the models. The maximum stress values of the models representing the restorations with different infrastructures varied, and the highest value was obtained in the model of the E-max crown (Model E: 136.050 MPa). The minimum stress magnitudes were obtained from Model B the composite-filled tooth (80.39 MPa); however, it was observed that the equivalent stresses in all the models showed a similar distribution for all components with varying magnitudes. In periapical lesion areas, low stresses were observed. In all models, the cervicobuccal collar region of the teeth had dense equivalent stresses. Conclusion: Different restorative treatment methods applied to root canal-treated teeth with periapical lesions can impact the stress in the alveolar bone and the biomechanical response of the tooth. Relatively high stress values in the cortical bone at the cervical line of the tooth have been observed to decrease towards the apical region. This observation may suggest a potential healing effect by reducing pressure in the periapical lesion area. Clinical significance: Composite resin restorations can be considered the first-choice treatment option for the restoration of root canal-treated teeth with lesions. In crown restorations, it would be advantageous to prefer zirconia or metal-supported prostheses in terms of biomechanics.

Background and Objectives: The present systematic review and meta-analysis were conducted to evaluate and compare the long-term clinical outcomes of immediate implants placed into fresh sockets with and without periapical pathology. Materials and Methods: After the search and review of the literature in the electronic databases, 109 publications were achieved. The titles and abstracts of 66 publications were screened. After the evaluation of the full text of 22 publications, based on the inclusion criteria, six controlled clinical studies were included in this systematic review and meta-analysis. Results: The statistical calculation showed no heterogeneity among the studies included. The implant survival was 99.6% in the test (socket with periapical pathology) and control (socket without periapical pathology) groups of all the clinical trials. The results of the meta-analysis showed no statistically significant difference between test and control groups regarding the marginal bone level and the width of keratinized mucosa in all the studies. Other parameters indicating plaque level, bleeding on probing, and gingival recession also did not differ between test and control groups at the final follow-up in nearly all studies. Conclusions: Within the limitation of this systemic review and meta-analysis, the obtained data suggest that implants immediately placed into the extraction sockets of teeth exhibiting periapical pathology can be successfully osseointegrated for an extended period.

Abstract Background The aim of this study is to examine the survival rates of immediate implants placed in extraction sockets with chronic periapical pathology. Methods 69 patients and 124 immediate implants were included in the study. The patients included in the study were examined in 3 groups. Group 1: Patients who underwent tooth extraction with periapical pathology and immediate implant placement. Group 2: patients who underwent tooth extraction with periapical pathology, immediate implant placement and guided bone regeneration. Group 3: Patients who underwent tooth extraction with periapical pathology, sinus lift procedure and immediate implant placement. In statistical analysis, t-test and Anova analysis were used in the evaluation of quantitative data, cross-tables and chi-square (χ2) test were used in the evaluation of classified qualitative data. Statistical significance was determined as p

This study aimed to investigate the reliability and accuracy of high-resolution ultrasonography (US) for diagnosing periapical lesions and differentiating radicular cysts from granulomas. This study included 109 teeth with periapical lesions of endodontic origin from 109 patients scheduled for apical microsurgery. Ultrasonic outcomes were analyzed and categorized after thorough clinical and radiographic examinations using US. B-mode US images reflected the echotexture, echogenicity, and lesion margin, while color Doppler US assessed the presence and features of blood flow of interested areas. Pathological tissue samples were obtained during apical microsurgery and subjected to histopathological examination. Fleiss' κ was used to measure interobserver reliability. Statistical analyses were performed to assess the diagnostic validity and the overall agreement between US and histological findings. The reliability of US compared to histopathological examinations was assessed based on Cohen's κ. The percent accuracy of US for diagnosing cysts, granulomas, and cysts with infection based on histopathological findings was 89.9%, 89.0%, and 97.2%, respectively. The sensitivity of US diagnoses was 95.1% for cysts, 84.1% for granulomas, and 80.0% for cysts with infection. The specificity of US diagnoses was 86.8% for cysts, 95.7% for granulomas, and 98.1% for cysts with infection. The reliability for US compared to histopathological examinations was good (κ = 0.779). The echotexture characteristics of lesions in US images correlated with their histopathological features. US can provide accurate information on the nature of periapical lesions based on the echotexture of their contents and the presence of vascularity. It can help improve clinical diagnosis and avoid overtreatment of patients with apical periodontitis. [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]

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]

The goal of modern dentistry should be to maintain patients' dentition for as long as possible. Microsurgical apicoectomy is a predictable and safe solution worth considering in the treatment of periapical diseases. The aim of our work was to present a method of dealing with a large lesion in the maxilla. The article describes surgical management in a case of a large periapical cyst with probable traumatic origin. A 45-year-old male patient reported a large radiolucent area in the region of the teeth 11-13, suggesting bone resorption with an irregular contour. The procedure consists of curettage of periapical bone, root resection, and retrograde filling. Surgery was carried out with local infiltration anesthesia. A sulcular, full-thickness flap was designed. The resection of the root apices of teeth 11 and 12 was performed, and retrograde filling was implemented. The patient was recalled after 5 days for the removal of sutures and evaluation of treatment. The patient underwent the procedure without any complications and did not report pain or swelling after surgery. During the control visit, there was a bone reconstruction visible on periapical X-rays. Minimal scarring was noticeable, and the patient was content with the esthetic result without any pain or discomfort. Endodontic microsurgery is a widely studied procedure. It is recommended to use suitable equipment, instruments, and materials that match biological concepts. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to assess the quality and state of treatment for teeth with periapical lesions (PLs) in a group of young Turkish and international residents living in Türkiye. Methods: Patients between the ages of 18 and 30 whose digital orthopantomography (OPTG) was taken between January 2018 and January 2023 were evaluated. Gender, age, nationality, the number of teeth present, the number and location of endodontically treated teeth, the number of teeth with PL, periapical status, and the standard of root canal treatment (RCT) were all employed and recorded. This study had 393 foreign patients. The same number of Turkish patients was chosen by systematic sampling from the 30405 Turkish patients. Results: The OPTGs of 786 patients including 21126 teeth were evaluated. The average age of patients was 23. The number of teeth with RCT was 1100 teeth (5.2%). In the Turkish population, 10668 teeth were examined; RCT was present in 332 teeth (3%), of which 221 (66%) had PL. In the foreigner population, 10458 teeth were examined; RCT was present in 768 teeth (7%), of which 477 (62%) had PL. In Turkish and foreign patients, molars (58%) were the most commonly treated teeth with PL. The working length of RCT was adequate for 50% of teeth in the Turkish population and 48% of teeth in the Foreigner population. 44% of teeth in Turkish population and 32% in foreigners with periapical lesions had not undergone to RCT. Conclusion: In both populations, molars were the most endodontic-treated teeth. The quality of RCT in an included young Turkish population and foreigners was in general underneath than appropriate standard. [ABSTRACT FROM AUTHOR]

This report presents a rare case of polymorphous low‐grade adenocarcinoma (PLGA) in the anterior maxilla, mimicking a periapical lesion. A 56‐year‐old male reported with a painless swelling in the maxillary right canine‐premolar region. The patient gave a history of root canal therapy for the same teeth one month ago. On intraoral examination, the involved teeth were restored with ceramic crowns. Radiographic examination revealed inadequate obturation with an ill‐defined radiolucency in the periapical region. 3D cone beam computer tomography (CBCT) revealed erosion of the buccal cortical plate near the apices of the roots. Endodontic re‐treatment was performed on both the teeth. Following this, the lesion was excised and submitted for histopathological analysis wherein it was identified as PLGA. Computerised tomographic (CT) scan and positron emission tomography scan (PET) results showed no regional or distant metastasis. Under general anaesthesia, the teeth were extracted, and wide surgical excision of the anterior maxilla was done till the healthy bone was exposed. Healing was uneventful during the follow‐up period. [ABSTRACT FROM AUTHOR]

Objective: Retrograde peri-implantitis (RPI) is defined as bone loss around an osseointegrated implant apex that usually appears within the first few months of its placement. This retrospective study aimed to evaluate the relationships between RPI and demographic factors, local bone and intraoral factors, and implant and surgery-related factors. Method and materials: A retrospective study was conducted in 116 patients with a total of 369 implants placed between January and June 2019. The associations between RPI and the following data were evaluated: location of the recipient site, bone quality, reason for previous tooth loss, condition of adjacent teeth, marginal bone loss, immediate or late placement of implants, implant brand and size, activation of lesions, and treatment modality. Results: Among the 14 (3.8%) implants that showed RPI, 10 (5.8%) were in the maxilla and four (2.0%) were in the mandible, which were detected before prosthetic loading. There was no significant difference in terms of RPI between the arches. Of the 14 RPI implants, four (28.6%) were placed into a previously periapical lesion site, three (21.4%) had endodontically treated adjacent teeth, two (14.3%) were immediately placed following extraction, three (21.4%) revealed marginal bone loss, and one (7.1%) was lost at the abutment connection. Eight RPI implants healed spontaneously, while the remaining six were subjected to treatment (P = .05). Conclusion: Local bone and intraoral factors, particularly the reason for tooth loss at the recipient site and the condition of the adjacent teeth, had stronger effects on RPI than other factors. [ABSTRACT FROM AUTHOR]

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

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

Nonsurgical endodontic management of the nonvital posterior tooth with large periapical radiolucency has been suggested as conservative approach in endodontics in existing literature. However, complete disinfection of the infected root canals has been a challenge in endodontic procedure. Recently, various types of lasers have emerged as the effective and successful way for achieving in-depth elimination of bacteria and also for healing of periapical lesions. However, there is a scarcity of published case report articles about laser-assisted endodontic therapy in combination with rotary files system for the noninvasive management of large periapical lesion associated with nonvital posterior teeth in claustrophobic child patients. Hence, the aim of this article is to present the pediatric case report about the successful nonsurgical orthograde endodontic treatment by employing diode laser of 810 nm wavelength for the disinfection of the infected root canals and resolution of periradicular radiolucency followed by functional rehabilitation of the treated tooth with preformed stainless steel crown within the shorter period. [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.

Nonsurgical endodontic management of the nonvital posterior tooth with large periapical radiolucency has been suggested as conservative approach in endodontics in existing literature. However, complete disinfection of the infected root canals has been a challenge in endodontic procedure. Recently, various types of lasers have emerged as the effective and successful way for achieving in-depth elimination of bacteria and also for healing of periapical lesions. However, there is a scarcity of published case report articles about laser-assisted endodontic therapy in combination with rotary files system for the noninvasive management of large periapical lesion associated with nonvital posterior teeth in claustrophobic child patients. Hence, the aim of this article is to present the pediatric case report about the successful nonsurgical orthograde endodontic treatment by employing diode laser of 810 nm wavelength for the disinfection of the infected root canals and resolution of periradicular radiolucency followed by functional rehabilitation of the treated tooth with preformed stainless steel crown within the shorter period.

(1) Background: Curved planar reformation (CPR) is a multiplanar reformatting technique of computed tomography (CT) commonly used during dental cone-beam CT (CBCT) to generate panorex-like images for dental evaluation. Here, we evaluated the utility of an additional CPR sequence in detecting dental pathologies in patients with chronic rhinosinusitis (CRS). (2) Methods: CRS patients who underwent paranasal sinus CT were enrolled retrospectively. The CT images featured three orthogonal sequences and a reconstructed CPR sequence. Additional dental CBCT was performed in patients with pathologies with a strongly suspected odontogenic origin. Dental pathologies detected by CT, CPR, and CBCT were analyzed. (3) Results: A total of 82 CRS patients (37 females and 45 males; mean age 47.3 ± 13.7 years) were included, of whom 23 underwent dental CBCT. In total, 1058 maxillary teeth were evaluated. Compared with paranasal sinus CT, CPR identified greater frequencies of dental pathologies, particularly caries (p < 0.001), periapical lesions (p < 0.001), and fistulae (p = 0.014). CBCT identified greater frequencies of periodontal dental pathologies (p = 0.046) and premolar caries (p = 0.002) compared with CPR. CBCT and CPR detected molar dental pathologies at similar frequencies. (4) Conclusions: CPR could increase the diagnostic rate of odontogenic pathologies compared with standard CT orthogonal views, especially when the sinusitis is caused by caries, periapical lesions, or fistulae. The addition of a CPR sequence allows for simple screening of dental pathologies in CRS patients without a need for additional radiation.

Introduction: The main cause for developing periapical lesions (PA) is the root canal infection. The mentioned causes may play a role in not controlling it but are not a “true” cause. Objective: To determine apical status and prevalence of endodontic treated tooth using radiograph assessment in relation to quality of root canal treatment and clinical factors among Saudi adults in the Eastern province. Patients and methods: This prospective case series study included 2161 patients who received root canal treatment (RCT) at Dammam Specialized Dental Center, Dammam Medical Complex, Ministry of Health, Saudi Arabia, between October 21, 2019 and April 22, 2020, after getting ethical approval from the Institutional Research Board (IRB). Saudi natives of either gender, age ≥ 18, with at least one fixed bridge or single dental crown evaluated on a clear, high-quality radiography image were recruited for the study. To determine the periapical state of root canal-filled teeth, the 'periapical index' (PAI) was used. All pertinent patient information was analyzed in SPSS verion-20 (IBM product, Chicago). Results: Out of 2161 cases, a PA lesion was present in 756 (35.0%). The prevalence of periapical lesions in endodontically treated teeth was 31.2%. PA lesion was associated with molar involvement (50.8% vs. 36.6%, p = 0.001), poor RCT quality (85.2% vs. 51.0%, p = 0.001), and smoking (13.6% vs. 10.5%, p = 0.028). According to logistic regression model, female gender, molar tooth, and poor RCT quality were more likely to expose PA lesion 1.5 times, 1.8 times, and 5 times, respectively. Conclusion: It is concluded that approximately 1/3rd of endodontically treated teeth are susceptible to the occurrence of periapical lesions in radiographic assessment, which are significantly associated with females, molars, and poor RCT quality, indicating a challenge for endodontists to improve their root canal assessment accuracy.

The untreated second mesiobuccal canal (MB2) of the maxillary first molar can be considered as one of the possible causes of treatment failure and occurrence of periapical lesions. This cross-sectional study evaluated the effect of undetected MB2 canals of maxillary first molars on periapical lesions. Cone beam computed tomography (CBCT) was used to evaluate 213 scans of the first maxillary molars from two radiology clinics. All scans were analyzed to check the quality of the root canal therapy relationship with the missed MB2 canal, and the occurrence of periapical lesions. Frequency distribution of periapical lesion showed that its presence in 51.41% of cases where MB2 canal was not found, and in 25% of cases where MB2 canal was present. The Multivariate logistic regression model of the effect of different factors on lesion formation revealed that the undetected MB2 canal increases 8.8 times the risk of lesion formation. An association between the presence of periapical lesion and undetected MB2 canal indicated that the lack of finding this canal significantly affected the prognosis maxillary first molar root treatment. Configuration of mesiobuccal canals did not affect the incidence of periapical lesions. [ABSTRACT FROM AUTHOR]

Aim: To reveal the molecular mechanisms that targets mitogen‐activated protein kinase (MAPK) signalling and the autophagic flux and to investigate the possible effects of the systemic administration of selenium (Se) on experimentally induced rat periapical lesions. Methodology: Thirty adult Sprague–Dawley rats were divided equally into negative control, positive control and Se groups. In the positive control and Se groups, the pulp chambers of their mandibular first molars were exposed to the oral environment to induce periapical lesions The Se group received daily intraperitoneal injections of Se at a dose of 0.1 mg kg−1. After 28 days, the amount of bone destruction; severity of inflammation; penetration of microorganisms along the root canal; collagen degradation in periodontal ligament; interleukin (IL)‐6, hypoxia‐inducible factor‐1 (HIF‐1), cyclooxygenase‐2 (COX‐2) and caspase‐3 expression; autophagic flux; and p38 MAPK signalling were evaluated using radiographic, histopathological, Gram staining, picrosirius red stain, immunohistochemical, quantitative real‐time polymerase chain (qRT–PCR) and Western blot methods, respectively. These data were analysed through the Kruskal–Wallis and Dunnett's tests (p <.05). Results: The area of radiographic periapical bone loss, histopathological scores, the area of periapical bone loss and the scores for the bacteria localisation, the intensity of immunohistochemical staining for IL‐6, HIF‐1, COX‐2 and caspase‐3 in the Se group was significantly less than those of the positive control group (p <.01). The mRNA expression levels of Beclin‐1, Atg3, Atg5, Atg7 and Atg16L1 were lower in the Se group than in the positive control group (p <.01). The protein expressions of Beclin‐1, Atg5 and LC3‐II, the phosphorylation ratio of the p38 MAPK and the ratios of LC3II/LC3I were significantly higher (p <.05) in the positive control and Se groups. On the contrary, the expression of the p62/SQSTM1 protein was significantly lower (p <.05) in the positive control and Se groups than in the negative control group. Conclusion: The induction of periapical lesions in rats increased autophagic flux and activated p38 MAPK signal transduction processes. Se suppressed the inflammatory process, reduced bone destruction and both the autophagic flux and p38 MAPK activation. [ABSTRACT FROM AUTHOR]

Endodontic disease with formation of periapical lesions (PALs) is one of the most common causes of chronic odontogenic sinusitis (ODS). It requires close collaboration between otolaryngologists and dentists, but the best sequence of management is still unknown. The aim of the present study is to clarify how radiological characteristics of teeth with PALs and previous root-canal treatment (RCT) influence the clinical evolution of the disease and to define the predictive value of its radiological and endoscopic features in determining the need for further surgical intervention. A total of 68 symptomatic patients with ODS with PALs were included in the study. The evaluation was performed by an otolaryngologist and a dentist based on a medical interview, nasal endoscopy, cold pulp testing and tomography images. Patients were prospectively followed for at least 12 months, during which nasal steroids, saline irrigations and RCT were administered. The criteria of disease improvement were: decrease of symptoms, healed sinonasal mucosa in endoscopy and radiological resolution of periapical radiolucency and sinus inflammation. Results showed that 9 (13%) patients improved after conservative treatment and 59 (87%) required further surgical intervention. Patients who improved after medical treatment and RCT were younger (p = 0.043) and had a greater distance from the top of the periapical lesion to the maxillary sinus' floor (p = 0.003). When expansion of PALs and bone destruction toward the maxillary sinus was observed on radiological imaging (p = 0.041), and when more than one tooth root was affected (p = 0.004), patients were more likely to require surgical intervention. In conclusion, the more roots that are affected and the closer the top of the PAL is to the maxillary sinus' floor, the greater the possibility of medical treatment and RCT failure. When the bone destruction extends into the maxillary sinus, patients eventually require both tooth extraction and FESS in order to resolve ODS completely. [ABSTRACT FROM AUTHOR]

Dentists could fail to notice periapical lesions (PLs) while examining panoramic radiographs. Accordingly, this study aimed to develop an artificial intelligence (AI) designed to address this problem. Materials and methods: a total of 18618 periapical root areas (PRA) on 713 panoramic radiographs were annotated and classified as having or not having PLs. An AI model consisting of two convolutional neural networks (CNNs), a detector and a classifier, was trained on the images. The detector localized PRAs using a bounding-box-based object detection model, while the classifier classified the extracted PRAs as PL or not-PL using a fine-tuned CNN. The classifier was trained and validated on a balanced subset of the original dataset that included 3249 PRAs, and tested on 707 PRAs. Results: the detector achieved an average precision of 74.95%, while the classifier accuracy, sensitivity and specificity were 84%, 81% and 86%, respectively. When integrating both detection and classification models, the proposed method accuracy, sensitivity, and specificity were 84.6%, 72.2%, and 85.6%, respectively. Conclusion: a two-stage CNN model consisting of a detector and a classifier can successfully detect periapical lesions on panoramic radiographs. [ABSTRACT FROM AUTHOR]

Interdisciplinarity in the diagnosis and treatment of large periapical lesions in the jaws is essential for a favorable prognosis and preservation of dental organs. This case presents apical granulomas as a consequence of chronic endo- periodontal diseases and inadequate and untimely diagnoses. This is how tools such as cone-Bean tomography, histopathology and immunohistochemistry were also applied, playing a fundamental role in their intervention for an accurate diagnosis. The objective of this case was to describe an interdisciplinary approach to a confluent periapical lesion involving the maxillary sinus, which evolved satisfactorily. [ABSTRACT FROM AUTHOR]