Various inflammatory and anti-inflammatory mediators, along with diverse cell types, are implicated in the development and progression of periapical lesions. This work aimed to assess the immuno-expression of transforming growth factor-beta 1 (TGF-β1) and CD68 (a macrophage marker), elucidating their roles and potential correlations. Additionally, histological analysis was conducted to evaluate the intensity of inflammatory infiltrates in chronic periapical lesion samples.

Tissue samples from fifty individuals with chronic periapical lesions [25 radicular cysts (RCs) and 25 periapical granulomas (PGs)] were obtained, along with control samples from four healthy third molars' dental pulp. Histological examination and inflammatory infiltrate categorization were performed. Immunohistochemical analysis of TGF-β1 and CD68 markers, along with morphometric assessment, were conducted.

The control group displayed normal, inflammation-free pulp tissues, while intense inflammation was observed in PGs and RCs (Score 4 and 3, respectively) dominated by macrophages, plasma cells, and lymphocytes. Immunohistochemistry showed higher TGF-β1 and CD68 expression in PGs and RCs versus control (P < 0.001). Moreover, PGs exhibited greater TGF-β1 and CD68 expression than RCs (P < 0.001). However, a negative relationship was detected between the 2 markers (P < 0.05).

This study highlighted varying expressions of TGF-β1 and CD68 in PGs and RCs, indicating their potential roles in lesion pathology. However, a negative correlation between these markers was observed. Accordingly, their precise role in periapical lesion progression and repair requires further investigation.

The study evaluated previously-endodontically-treated premolars affected by periapical lesions and/or secondary caries requiring a multidisciplinary decision between (non-surgical) retreatment or extraction and implant replacement over an 8-year minimum follow-up.

The decision-making was performed among a pool of patients attending a University Dental School. All patients presented at least one failing previously endodontically treated premolar. Recorded parameters were: structural conditions (residual coronal-structure, caries), periodontal and endodontic status (CEJ-MBL, initial-PAI, post-presence). Two experienced operators made the decision-making and classified teeth as retreatable and restorable (Endo-group) or suitable for extraction and implant replacement (Implant-group). Logistic regression and Cox-proportional-hazard analyses with clustered-standard-errors compared baseline-characteristics and treatment-outcomes. Odds-ratios (ORs) with 95% confidence-intervals (CIs) were reported for baseline-characteristics. Hazard-ratios (HRs) expressed the association of treatment-groups with time-to-event.

Ninety-six patients (n = 124 premolars) were enrolled (49 M;47 F; mean-age 53.1 ± 11.6 years). The decision-making splitted 54.8% treatments to Endo-group (n = 68) and 45.2% to Implant-group (n = 56). The 8-year survival were 85.1% for Endo-group and 98.2% for Implant-group. The 8-year success were 80.5% and 93.9%. The HR from Cox regression favored Implant-group (HR = 0.12, P = 0.049). The Endo-group showed the highest number of critical complications (15%) due to fractures, despite the healing of lesions. Implant-group had a higher percentage of minor prosthetic complications (14%).

Endo-group demonstrated higher percentage of critical complications compared to Implant-group during the follow-up. Root fractures were accounted as main responsible, while periapical disease did not affect healing, survival and clinical longevity.

Insufficient crown structure was the major parameter associated with root fracture. In these cases, implant replacement strategy represented an adequate therapy justified by the higher success compared to root canal retreatment.

This systematic review aimed to assess the accuracy of ultrasonic (US) imaging in the differential diagnosis between inflammatory radicular cysts (IRCs) and periapical granulomas (PGs) compared with the histological examination as the reference standard. Scopus, Medline (PubMed), and Web of Science were searched from inception to April 2024. The Methodological quality was assessed using the QUADAS-2 tool. Thirteen cross-sectional studies published between 2003 and 2023 were included in this study. A total sample of 275 patients (one tooth / per patient) comparing ultrasound test vs. histopathological examination was assessed. The summary measures of the US imaging test were: sensitivity= 0.96 [95% CI, 0.93-0.99], specificity= 0.83 [95% CI, 0.76-0.88], LR+ = 3.498 [95% CI, 2.079-5.885], LR- = 0.091 [95% CI, 0.050-0.164], DOR = 65.848 (95% CI, 28.857-150.25) and AUC=0.97 (95% CI, 0.95-1.00). The methodological assessment was variable in all domains and studies. Approximately 90% and 70% of the studies revealed some form of risk of bias concern in the domains -flow and timing-, and -reference standard-, respectively. US imaging can be regarded as a highly accurate and consistent method for IRC vs. PG differential diagnosis. The echotexture features of periapical lesions in US images reflected their histopathological characteristics. (EEJ-2024-09-150).

To evaluate and correlate the expression of REDOX enzymes and NET markers during the development of periapical lesions (PLs) in mice.

PLs were experimentally induced by pulpal exposure of first molars. In all, 42 mice were involved in a negative control and five periods (after 2, 5, 7, 21 and 42 days) (n = 7 in each period). Microscopic analysis of the specimens was carried out, considering inflammatory response and the PL area (mm2). In addition, qRT-PCR (genes) and immunohistochemistry assay (proteins) were performed for REDOX enzymes (NOS2, SOD1, CAT, and GSR) and NET markers (MPO, H3CIT, and ELANE). The significance level was set at 5%.

Pulpal exposure led to the formation of PLs, especially after 21 and 42 days, when there was significantly increased bone resorption compared to previous periods (P < 0.001). There was an increased expression of all REDOX enzymes, as well as MPO and H3CIT markers after pulpal exposure in at least one time point in relation to the negative control, especially after 5 days (P = 0.002 or less). NOS2, SOD1, ELANE and H3CIT were significantly correlated with the PL area (P < 0.05). In addition, there was also a correlation between REDOX enzymes and NET markers (P < 0.05), such as all REDOX enzymes with H3CIT, CAT and GSR with MPO, and CAT and GSR with ELANE (P < 0.05).

Pulpal exposure modified the expression of REDOX enzymes and NET markers throughout the development of PLs, as well as some of these enzymes and markers were correlated, which may suggest the association of different molecular pathways.

The association between REDOX activity and NETs, including their molecular signaling, may modify the development of PLs after pulpal exposure and should be investigated as a possible therapeutic target in periapical bone repair.

Periapical inflammation on visual interpretation, especially in conditions of early inflammation, is very dependent on visual acuity. Visual ability can only detect if the inflammatory condition in the periapical area is more than 30%. This study reviewed the use of fractal dimension (FD) for quantitative assessment radiographs in periapical inflammation.

The search was performed using PubMed, Web of Science, and Scopus databases. The inclusion criteria were clinical research, the area was in the periapical inflammation, used the periapical radiograph, measured the fractal dimension in human bone, the article studies were in the English language. There was no restriction for publication date.

Five articles were found in which fractal dimension was applied for the assessment of periapical lesions visually indiscernible in radiographs, for evaluation of apical inflammation, for imaging diagnosis of the periapical lesion, for analysis of trabecular bone, and for analysis of trabecular bone structure around the bone of periapical inflammation. Various sizes and sites of the regions of interest were used to evaluate the bone structure of periapical inflammation with fractal dimension.

Fractal dimension in Dentistry has been widely applied to the study of images. Periapical radiographs were the most frequently used. The Image J software and the fractal analysis method were extensively adopted in the studies reviewed herein. Further studies are encouraged to improve the use of fractal dimension in assessing quantitative radiographs in periapical inflammation.

Odontogenic maxillary sinusitis, often triggered by dental issues like periapical periodontitis, significantly contributes to chronic sinusitis, mainly affecting adults around 50 years old, emphasizing the need for a multidisciplinary diagnostic and treatment approach.

To investigate the therapeutic effect and clinical value of root canal therapy combined with nasal endoscopic surgery compared with simple root canal therapy in the treatment of severe odontogenic maxillary sinusitis caused by periapical periodontitis.

The clinical data, diagnosis, and treatment of 200 patients with severe odontogenic maxillary sinusitis caused by periapical periodontitis from October 2020 to October 2021 were analyzed retrospectively. Among them, 63 patients were treated with simple root canal therapy as the control group, and 137 patients were treated with root canal therapy combined with nasal endoscopic surgery as the observation group. The therapeutic effect, Lund-Kennedy endoscopic score, paranasal sinus Lund-Mackay score, complication rate, recurrence rate, and patient satisfaction were compared between the two groups.

First, we compared the effective rates: 23 cases were cured, 22 were improved, and 8 were ineffective in the control group, yielding a total effective rate of 84.90%. Meanwhile, 97 cases were cured, 34 improved, and 6 were ineffective in the observation group, resulting in a total effective rate of 95.62%. The observation group had a higher total effective rate compared with the control group (P < 0.05). Second, we compared the Lund-Kennedy endoscopic score. Before treatment, no significant difference (P > 0.05) was observed in this score between the two groups. After treatment, the Lund-Kennedy endoscopic score decreased in both groups. The Lund-Kennedy endoscopic score of the observation group at 3 and 6 mo after treatment was lower compared to that of the control group (P < 0.05). Third, we compared the Lund-Mackay score of paranasal sinuses. Before treatment, there was no significant difference in this score between the two groups (P > 0.05). After treatment, the Lund-Mackay scores of paranasal sinuses decreased in both groups. The Lund-Mackay scores of paranasal sinuses in the observation group at 3 and 6 mo after treatment were lower compared to those of the control group (P < 0.05). Fourth, we compared the incidence and recurrence rate of complications. Three months after treatment, no significant difference was found in the incidence and recurrence rate of complications between the observation group (6.56%) and the control group (9.52%) (P > 0.05). However, 6 mo after treatment, the incidence and recurrence rate of complications in the observation group (2.91%) was significantly higher compared to that of the control group (12.69%) (P < 0.05). Fifth, we compared patient satisfaction. Six months after treatment, the patient satisfaction of the observation group (93.43%) was significantly better than that of the control group (84.12%) (P < 0.05).

Root canal therapy combined with nasal endoscopic surgery has a good therapeutic effect on severe odontogenic maxillary sinusitis caused by periapical periodontitis, and it can reduce the injury of maxillary sinus mucosa and bone, and significantly reduce the incidence of complications and recurrence rate. Meanwhile, it has high patient satisfaction and remarkable therapeutic effect, which is suggested to be popularized and applied in clinic.

Microorganisms have an important role in the pathogenesis of endodontic disease. Significant advances have been made to increase the sensitivity of microbial detection, identification and enumeration in endodontic samples. The aim of the present study is to compare culture and whole-genome amplification (WGA) followed by PCR assays in the detection of bacteria before and after chemical mechanical preparation (CMP) of root canals.

Ten uniradicular teeth with primary endodontic infections were analyzed. Microbiological samples were collected before and after CMP using paper points, which were separated into two groups: (i) culture assay samples were plated onto Brucella agar with 5% defibrinated sheep's blood, menadione and hemin and incubated anaerobically for 14 days at 36°C; (ii) DNA was extracted from molecular assay samples and subject to WGA by isothermal strand displacement with Phi29 DNA polymerase followed by PCR to determine the presence of bacteria.

In both assays, samples before CMP showed the presence of bacteria in all 10 teeth. After CMP, however, bacterial detection differed in the assays performed (p = 0.0198). The presence of bacteria was detected in 70% (7 of 10) of the samples by WGA followed by PCR, where only 10% (1 of 10) had demonstrated bacterial growth in the culture method.

The combination of WGA followed by PCR increased the detection of microorganisms from root canal samples after endodontic treatment using NaOCl as a CMP irrigant. So this combination of techniques can represent an important tool to improve the detection of microorganisms in endodontic research.

Surgical endodontics is the last resort to manage persistent periapical lesions, which do not respond to conventional endodontic treatment. The rationale of periapical surgery is to remove all infected tissues and provide a sealed environment that promotes the healing of periradicular tissues. In order to enhance healing, several biomaterials have been utilized, such as bone grafts, collagen membranes, and platelet concentrates. This case report presents two cases of surgical management of a periapical lesion in failed primary endodontic treatment in the maxillary first premolar and first molar by apicoectomy and the use of platelet-rich fibrin (PRF) for bone regeneration and tissue healing. Both cases were diagnosed as periapical granuloma and showed considerable radiographic bone fill at six and 12 months of follow-up, demonstrating the benefits of PRF in surgical endodontics.

The purpose of this study is to evaluate the influence of photobiomodulation therapy on the regenerative potential of non-vital mature permanent teeth of healthy Canine dogs.

54 mature roots, obtained from 27 premolars, in dogs, were selected and divided into three equal groups where Group I received regenerative endodontic procedures (REPs) using blood clot as a scaffold (positive control), Group II received similar treatment as Group I, followed by photobiomodulation therapy (study group) and Group III did not receive any intervention (negative control). Each group was further divided into three equal subgroups for the evaluation of the vascular area percentage and fibroblast count at 3 different intervals; 3, 10, and 15 weeks. Statistical analysis was performed with R statistical analysis software version 4.1.3 RESULTS: Data analysis for vascular area percentages, revealed an insignificant increase in mean values at 3 and 10 weeks for both the positive control and study group, and all values were significantly lower than the negative control (p < 0.001). At 15 weeks, there was an insignificant difference between the study group and the negative control group, with mean values was 9.76 ± 2.25, and 11.97 ± 2.37, respectively. However, both values were significantly higher than the positive control group (2.47 ± 1.0), (p < 0.001). Regarding fibroblast count, there was a gradual increase in mean values recorded at different intervals, reaching its maximum at the 15th week period; they were 41.40 ± 1.14, 56.60 ± 6.11 and 44.67 ± 17.04 for positive control, study group, and negative control respectively, with insignificant differences between the study group and negative control.

The results of this study support the revascularization of non-vital mature permanent teeth as an alternative treatment modality. Photobiomodulation could improve the construction of regenerated blood vessels and fibroblasts. However, further studies with longer flow-up periods and different animal models are recommended.

To compare and correlate bone edema volume detected by 3D-short-tau-inversion-recovery (STIR) sequence to osseous decay detected by a T1-based sequence and conventional panoramic radiography (OPT).

Patients with clinical evidence of apical periodontitis were included retrospectively and received OPT as well as MRI of the viscerocranium including a 3D-STIR and a 3D-T1 gradient echo sequence. Bone edema was visualized using the 3D-STIR sequence and periapical hard tissue changes were evaluated using the 3D-T1 sequence. Lesions were segmented and volumes were calculated for bone edema and structural decay. OPTs were assessed for corresponding periapical radiolucencies using the periapical index (PAI).

Of the 42 patients of the initial cohort 21 patients with 38 periapical lesions were included in the analysis (mean age 57.2 ± 13.8 years, 9 women). Reactive bone edema was detected on MRI in 23 periapical lesions with corresponding radiolucency on OPT. Fifteen periapical lesions were detected only in the STIR sequence. The volume of edema measured in the STIR was significantly larger in OPT-positive lesions (mean: STIR (OPT+) 207.3 ± 191.1 mm³) compared to OPT-negative lesions (mean: STIR (OPT-) 29.5 ± 34.2 mm³, p < 0.001). The ROC curve analysis demonstrated that Volume T1 (0.905, p < 0.01) and Volume STIR (0.857, p < 0.01) measurements have strong diagnostic performance for distinguishing OPT-positive from OPT-negative lesions.

Clinically symptom-free patients without pathologic changes in OPT can show signs of inflammation within the periapical bone. Bone edema volume visualized by STIR sequence exceeds bone architecture changes indicated in T1-based imaging and might precede osteolysis in dental radiography.

These results show that subtle intraosseous inflammation within the periapical tissue might remain undetected by conventional dental radiography and T1-based sequences. This emphasizes the potential of MRI in secondary prevention in dentistry.

Conventional panoramic radiography (OPT) may show only delayed findings of pathological periapical changes. MRI detected bone edema in 23 radiolucent lesions on OPT. MRI revealed 15 lesions only visible with STIR sequences. STIR sequences showed bone inflammation undetectable by conventional radiography or T1 imaging. MRI offers diagnostic advantages for early dental pathology detection.

As photobiomodulation is growing in the dental field the aim of this prospective, two-arm clinical trial was to assess the radiographic changes for chronic periapical bone lesions related to mandibular molars after primary root canal therapy with or without applying Diode laser on soft tissue. The samples were randomly divided into a Laser group and a mock laser (ML) group. Preoperative CBCT images were compared 12 months later with postoperative CBCT to gauge the changes in the volume of the bony lesion by two observers. The kappa coefficient was calculated to assess the intra-observer agreement. Data were presented as median, mean, and standard deviation (SD) values. For parametric data (age), a Student's t-test was used. Qualitative data (Gender) was presented as frequencies and percentages and then analyzed by Chi-square test. The Wilcoxon signed-rank test was used to compare CBCT measurements pre- and post-treatment. The significance level was set at P ≤ 0.05. The collected data in this study showed that there was no statistically significant difference between median volumes of the periapical lesion in the Laser and ML groups (P-value = 0.564, Effect size = 0.237) and (P-value = 0.452, Effect size = 0.310), respectively while, there was a statistically significant decrease in the volume of periapical lesion post-treatment within each group (P-value < 0.001). The size of the periapical bony lesion decreased significantly after conventional endodontic treatment whether Laser was applied or not. The study protocol was enrolled as NCT04311905 at www.clinicaltrials.gov database on (17/03/2020) after the approval of the Ethics Committee, Faculty of Dentistry, Ain Shams University (FDASURecID091703).

Background: Investigating the pattern of extension in the periapical (PA) inflammatory lesions is important in the treatment plan and prognosis of treatment. Introduction: This study evaluated the topography of PA inflammatory lesions in the first molars using cone-beam computed tomography (CBCT). Methods: In this descriptive study, 197 CBCT images about patients in the age group of 14-77 years were analyzed. The maximum extension of the PA lesion in the three orthogonal planes related to the regions of maxillary and mandibular first molars was measured and reported in millimeters. Measurements were compared based on age, gender, dental arch, and root type. Statistical analysis was performed using percentages, repeated measure ANOVA, paired t-tests, and Pearson correlation coefficient. The significant level was set at 0.05. Results: The highest total mean lesion extensions were in the vertical plane followed by the buccolingual and mesiodistal plane. There was a statistically significant difference between the extension of the PA lesion in the vertical and mesiodistal (p < 0.001), vertical and buccolingual (p =0.001), as well as the mesiodistal and buccolingual planes (p =0.027). In the maxilla and mandible, the highest mean lesion extension was in the vertical, buccolingual, and mesiodistal plane, respectively. According to the root type, there was only a statistically significant difference in lesion extension in the buccolingual plane and between the mesial and distobuccal roots (p =0.030). Conclusion: Given the limitations of the present study, regarding the extension of the PA lesion in the first molar region, the bone structure of the maxilla and mandible follows a precise and delicate pattern. In this regard, future studies in different communities and races should be designed to address this issue in different communities. In addition, CBCT is a reliable imaging method to evaluate the extension of the PA lesion both morphologically and morphometrically.

In this case study, an all-ceramic (Emax) crown and a post and core restoration are used to successfully treat external inflammatory root resorption (EIRR) in a mandibular molar. A 21-year-old male patient was diagnosed with EIRR and hypercementosis after presenting with pain and significant damage to his lower right first molar. The patient chose a post and core restoration over extraction and implant placement due to budgetary constraints. Endodontic retreatment, fiber post cementation, core buildup, and Emax crown placement were all part of the treatment. At the one-year follow-up, the patient had a healed periapical region, healthy gingiva, and sound tooth structure. In managing EIRR cases, this case study emphasizes the importance of meticulous treatment planning and execution, focusing on selecting the best course of action for the long-term stability and health of the affected tooth. Both the patient's overall dental health and the expertly crafted restoration contributed to the favorable outcome.

The intricate structure of the tooth root canals has a role in the colonization and biofilm formation in hidden areas that are hardly reached by standard endodontic treatments. This review aims at summarizing data from in vitro and ex vivo studies for a better understanding of the application of cold atmospheric plasma (CAP) for the disinfection of dental root canals.

PubMed, Scopus, and Web of Science databases were screened. Characteristics of the included studies were extracted, and a meta-analysis on ex vivo studies was carried out to evaluate the effect of CAP on colony forming unit assay of Enterococcus faecalis (E. faecalis). The study was performed following the PRISMA 2020 guidelines.

A total of 31 studies fulfilled the selection criteria. Only 2 investigations reported an indirect plasma treatment, 28 trials used direct CAP administration, while 1 study applied both methods. Most of the studies were conducted on E. faecalis using as carrier gas Helium or Argon alone or in combination with Oxygen as well air. A considerable heterogeneity among studies was found regarding treatments which varied for source type, settings, and protocols of application. Despite this, CAP showed effectiveness in reducing E. faecalis colony forming unit with a standardized mean difference of 4.51, 95% C.I. = 2.55-6.48, p-value < 0.001.

The data demonstrated the antimicrobial effect of direct CAP application against microorganisms. In-vitro studies showed an effect that depended on the time and distance of treatment, while the meta-analysis performed on ex vivo studies showed that the effect of CAP was independent of time and distance.

https://doi.org/10.17605/OSF.IO/BJ59V, identifier OSF registries.

The present study evaluated the retreatability of canals obturated using AH Plus sealer and Bioceramic (BC) sealers, employing Cone beam computed tomography (CBCT) and Scanning Electron Microscope (SEM).

A group of 90 extracted premolars was classified into two main categories based on whether they were sealed with AH Plus or BC Sealer. Each of these categories was then divided into two subcategories according to the retreatment technique applied. CBCT and SEM were used to assess the residual filling material within the canals.

The findings showed that there was no marked statistical variation in the retreatment success of canals sealed with BC and AH Plus sealers.

The diode laser was the most effective modality for eliminating root canal filling materials in the least amount of time. None of the retreatment modalities used removed the obturating material completely.

This study aimed to evaluate the effects of excessive and episodic consumption of ethanol (EtOH, a high-intensity drinking manner) on induced apical periodontitis in rats. Thirty-two animals were divided into the following four groups: control, EtOH, apical periodontitis, and EtOH + apical periodontitis. Ethanol exposure (3 g/kg 20 % w/v EtOH) was performed by orogastric gavage for 3 consecutive days, followed by 4 days of withdrawal for 4 weeks. Lesions were induced by exposing the dental pulp of the lower first molar and by the absence of any treatment/curative for 28 days. Finally, the animals were euthanized, and mandibles were collected. The mandible was divided medially, with one hemimandible being used for micro-computed tomography analysis of the volume of the periapical lesion and bone quality parameters, such as bone volume and trabecular bone assessments; the other hemimandible was used for histological analysis, with a descriptive histopathological analysis of the tissue and the pattern of bone loss presented, as well as an assessment of the collagen content present. The data were subjected to statistical analysis (one-way analysis of variance with Tukey's post-hoc test). Our results showed that the EtOH + apical periodontitis group had a larger volume of periapical lesions than animals that were not exposed to ethanol. Additionally, bone quality parameters showed a reduction in bone volume and thickening of the trabeculae, associated with increased tissue destruction and reduced collagen content in the remnant region of the alveolar bone. These results suggest that exposure to EtOH in a pattern of excessive alcohol consumption is an aggravating factor in apical periodontitis and, consequently, in its progression, the quality and quantity of the alveolar bone remaining in the region of the periapical lesion are the modulating aspects.

Apical periodontitis (AP) is one of the most common pathologies of the oral cavity. An early and accurate diagnosis of AP lesions is crucial for proper management and planning of endodontic treatments. This study investigated the diagnostic accuracy of periapical radiography (PR) and panoramic radiography (PAN) in the detection of clinically/surgically/histopathologically confirmed AP lesions.

A systematic literature review was conducted in accordance with the PRISMA guidelines. The search strategy was limited to English language articles via PubMed, Embase and Web of Science databases up to June 30, 2023. Such articles provided diagnostic accuracy values of PR and/or PAN in the detection of AP lesions or alternatively data needed to calculate them.

Twelve studies met inclusion criteria and were considered for the analysis. The average value of diagnostic accuracy in assessing AP lesions was 71% for PR and 66% for PAN. According to different accuracy for specific anatomical areas, it is recommended to use PR in the analysis of AP lesions located in the upper arch and lower incisor area, whereas lower premolar and molar areas may be investigated with the same accuracy with PR or PAN.

Two-dimensional imaging must be considered the first-level examination for the diagnosis of AP lesions. PR had an overall slightly higher diagnostic accuracy than PAN. Evidence from this review provided a useful tool to support radiologists and dentists in their decision-making when inflammatory periapical bone lesions are suspected to achieve the best clinical outcome for patients, improving the quality of clinical practice.

Root canal failure and secondary endodontic infection are frequent clinical scenarios in dentistry. The main microorganisms implicated in root canal therapy failure are persistent Enterococcus faecalis, Candida albicans, and Staphylococcus aureus. To combat the impact of disease resistance, scientists are concentrating on alternative antimicrobial root canal sealers. Nanomaterials are a recent development in endodontic materials that exhibit great antimicrobial properties, making them an ideal material choice for root canal sealers.

This systematic review aims to compare the antimicrobial properties of conventional root canal sealers to those incorporating green synthesized nanoparticles between 2010 and 2024.

A well-constructed protocol was established and registered with PROSPERO (CRD42021286373). Ethics approval was obtained from the Biomedical Research and Ethics Committee from the University of the Western Cape (UWC; BM22/1/4). PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) reporting guidelines were followed. The included criteria demonstrate the green synthesized nanoparticles studies where the nanoparticles (NPs) are incorporated in root canal sealers. MeSH (Medical Subject Headings) terms were used for the search strategy of the systematic electronic databases for articles published in English between 2010 and 2024. The selected databases included Scopus, PubMed, Web of Science, Science Direct, EBSCOhost, SpringerLink, and Wiley Online. A quality assessment tool for laboratory studies will be used to critically appraise the included studies. If applicable, statistical measures (mean, SD, etc) will be used for data analysis and presentation of the results.

The protocol is registered with PROSPERO. A preliminary search was conducted using a determined search strategy across 8 electronic databases, and the review is now complete.

It is anticipated that the results of this systematic review may reveal the increased interest and application for nanoparticle-enhanced root canal sealers. This will aid in the future development of root canal sealants and mitigate the risk of endodontic failure.

PROSPERO CRD42021286373; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286373.

DERR1-10.2196/51351.

Root canal treatment (RCT) is a common procedure practiced daily by dentists worldwide. The current systematic review aimed to evaluate and compare clinical studies on the quality of root canal fillings (RCFs) carried out by dentists with different levels of experience conducted worldwide with those conducted specifically in Saudi Arabia (SA).

A full literature search was conducted in Clarivate Analytics' Web of Science, Elsevier's Scopus, Embase, CINHAL, and PubMed, without a restriction to studies published before January 2015. Also, a manual search was carried out by checking papers that may have been missed during the electronic search. The following keywords were used: [(quality of root canal filling(s)) OR (quality of root canal obturation)) and dental practitioners as (general dental practitioners; final year students; endodontist; specialist) AND (root canal obturation) OR (endodontic treatment)]. Parameters of the quality of RCFs, such as length, density, and taper, were assessed and counted.

A total of 13 worldwide and nine SA studies were included in this review, published between 2015 and 2023. Molars were the most treated teeth, at 42.3% and 40.2% for the worldwide and SA studies, respectively. Cases treated by final year students had the highest percentage, at 60.0% for both study groups. The percentages of acceptable quality, with regard to the length, density, and taper of RCFs, were 70.9%, 77.6%, and 84.3%, and 73.2%, 64.6%, and 67.8% for the worldwide and SA studies, respectively.

The overall acceptable quality of RCFs was marginally higher in worldwide studies than in SA studies. Both prevalences can be considered as good, which indicates that the quality of RCFs is moving in the right direction.

This study aims to assess the efficacy of bioceramic (BC) sealer when applied using the single cone technique (SCT), in comparison to AH Plus sealer applied with the cold lateral condensation technique (LCT), concerning their impact on the healing of large-sized periapical lesions in both untreated and retreatment cases.

A randomized controlled trial was conducted on 41 patients who had 60 permanent teeth in the maxillary incisors that were accompanied by large-sized periapical lesions. The included teeth were radiographed with cone beam computed tomography (CBCT) images and divided equally into two groups according to the endodontic treatment statute (30 untreated previous cases and 30 retreated cases). Subsequently, teeth received uniform preparation, irrigation, and dressing procedures. Then each group was divided equally according to the used sealer (15 teeth obturated using AH plus sealer with LCT and 15 teeth obturated using BC sealer with SCT). All cases were followed up after 6 and 12 months with CBCT images. Subsequently, the change in periapical lesion diameter (PLD) was observed as an indicator to determine the treatment outcome score. One-way ANOVA and Mann-Whitney U test were used to analyze the PLD changing and scoring the treatment outcome during the follow-up periods. The significance level was set at α = 0.05.

There were no statistically significant differences between untreated and retreatment cases neither using AH plus sealer with LCT nor BC sealer with SCT regarding changes in PLD in the follow-up periods. Moreover, there were no significant differences between groups regarding treatment outcome scores in the follow-up periods. All groups showed a high success rate.

Successful treatment was achieved for untreated or retreatment maxillary incisor cases accompanied by large-sized periapical lesions using either BC sealer with the SCT or AH Plus sealer with LCT with a similar high success rate up to 12 months follow-up period.

Endo-periodontal lesions (EPLs) involve both the periodontium and pulp tissue and have complicated etiologies and pathogenic mechanisms, including unique anatomical and microbiological characteristics and multiple contributing factors. This etiological complexity leads to difficulties in determining patient prognosis, posing great challenges in clinical practice. Furthermore, EPL-affected teeth require multidisciplinary therapy, including periodontal therapy, endodontic therapy and others, but there is still much debate about the appropriate timing of periodontal therapy and root canal therapy. By compiling the most recent findings on the etiology, pathogenesis, clinical characteristics, diagnosis, therapy, and prognosis of EPL-affected teeth, this consensus sought to support clinicians in making the best possible treatment decisions based on both biological and clinical evidence.

Introduction: Apical periodontitis is one of the common dental diseases. Microorganisms are the main reasons for these lesions; irrigations are used to remove them, but because of limited penetration, the rinsing agents may not always kill the microorganisms. Laser irradiation is effective in canal disinfection. The goal of this study was to compare the effect of calcium hydroxide (Ca(OH)2 ) and diode laser on the improvement of apical periodontitis following root canal retreatment (RCR). Methods: Twenty-four teeth of 19 patients with periapical lesions which needed RCR were divided into two groups (Ca(OH)2 and Ca(OH)2+laser irradiation [LI]). In the first session, after gutta-percha removal, cleaning, and shaping, Ca(OH)2 was used for 10 days. In the second session, in the Ca(OH)2+LI group, the irradiation utilizing a diode laser (using non-initiated 200-µm fiber, continuous wave (CW), power output of 1W) was done. The periapical radiographic healing was assessed before the retreatment and after 3-month and 6-month follow-ups by periapical index (PAI) Qrstavik. The quantitative data were analyzed (P<0.05). Results: The initial periapical lesion score was 3.75 and 3.88 in the Ca(OH)2 and Ca(OH)2+LI groups, respectively. In the Ca(OH)2 and Ca(OH)2+LI groups, 3 months after the RCR, the average periapical lesion score was 2.94 and 3.05, respectively. In the Ca(OH)2 and CA(OH)2+LI groups, 6 months after the RCR, the average periapical lesion score was 1.80 and 1.75, respectively. No significant differences were found at the 3 and 6 months between the experimental groups. Conclusion: The diode laser can reduce the periapical lesion, but there was no significant difference between CA(OH)2+LI and Ca(OH)2 at 3-month and 6-month follow-ups.

A 32-year-old male patient presented with a chief complaint of ongoing endodontic treatment and swelling in the hard palate, specifically in the rugae region. On examination, a soft, non-tender, non-fluctuant swelling was observed between teeth #11 and #12, accompanied by radiographic evidence of periapical radiolucency and perforation. Cone beam computed tomography (CBCT) scans confirmed a well-defined radiolucency in the affected region, indicative of a radicular cyst. Root canal treatment was completed with mineral trioxide aggregate (MTA) obturation during the second visit. An apicoectomy was performed to remove the cystic content, followed by the placement of bone graft material, a platelet-rich fibrin (PRF) membrane, and sutures to facilitate bone regeneration. This comprehensive approach aimed to resolve the periapical pathology and promote tissue healing around the affected tooth.

Background Access cavity preparation is a crucial step in nonsurgical root canal treatment. Recent advancements in access cavity designs focus on preserving maximum tooth structure while ensuring sufficient access to canal orifices for effective cleaning and shaping, resulting in minimally invasive procedures. However, there is limited information on the impact of three-dimensional (3D)-guided access cavity preparation in molars. A literature review found no prior studies comparing the effects of various access cavity preparation techniques on apical transportation, untouched surfaces, and debris formation within the canal. Objective The objective of this study is to compare and evaluate the effects of three different access cavity techniques on apical transportation, untouched surfaces, and debris formation within the root canal. Material and methods Thirty extracted permanent mandibular first molars were selected and randomly assigned to three groups for this study: Group I received 3D-printed static guided cavity preparation, Group II underwent conservative access cavity preparation, and Group III was subjected to traditional access cavity (TAC) preparation. The mesial canals in all samples were cleaned and shaped using TruNatomy files. Preoperative and postoperative micro-CT imaging was performed on each sample to assess the effects of the different access cavity preparation techniques on apical transportation, untouched surfaces, and debris formation within the root canal. Results The study found that Group I, which used 3D-printed static guided cavity preparation, exhibited significantly less apical transportation compared to Groups II and III, with mean differences of -0.1677 and -0.2079, respectively. Debris accumulation was similar across all groups, with mean values of 0.928 ± 0.824 for Group I, 0.751 ± 0.495 for Group II, and 0.938 ± 0.681 for Group III, indicating no significant impact of cavity preparation type on debris levels. For untouched canal surfaces, Group III (TAC preparation) had the fewest untouched surfaces, with mean differences of 3.0380 and 3.9020 compared to Groups II and I, respectively. Conclusions While TAC preparation reduces substantial tooth structure, it shows higher instrumentation efficacy and better cleaning of the root canal system. However, in complex cases where tooth structure preservation is crucial, guided access cavity preparation provides an effective balance between structural conservation and adequate canal access. This approach offers a tailored solution, optimizing treatment outcomes based on the specific clinical scenario.

Rotary single-file endodontic systems are commonly used for root canal treatment. However, very few studies have evaluated the apical extrusion of debris generated by these systems during canal preparation at normal body temperature in laboratory conditions. The aim of this study was to evaluate the amount of apically extruded debris caused by seven different single-file endodontic instrumentation systems at body temperature in mandibular molar teeth with curved root canals.

One hundred forty mandibular first permanent molars were randomly divided into seven groups (n = 20) to be prepared by one of the following systems at 35°C: Reciproc Blue (REC Blue), WaveOne Gold (WOG), One Reci (OR), Neoniti, HyFlex EDM (HEDM), One Curve (OC), or XP Shaper (XPS). Debris was collected into preweighted Eppendorf tubes. The weight of the extruded debris was recorded by subtracting the weight of the tooth-free apparatus from the post-procedure weight. Data were analyzed by one-way ANOVA and Tukey's tests (p  < 5%).

REC Blue, WOG, and OR groups extruded significantly more debris from the apex than XPS, OC, and Neoniti groups (p  < 0.05). No significant difference was observed among the XPS, OC, Neoniti, and HEDM groups (p  > 0.05).

All the instruments were associated with debris extrusion. However, REC Blue, WOG, and OR extrude significantly more debris than other instruments. The amount of debris with different files was REC Blue > OR > WOG > HEDM > OC > Neoniti > XPS. XPS, Neoniti, and OC caused significantly less extrusion of debris than REC Blue, WOG, and OR.

Non-surgical endodontic treatment aims to prevent apical periodontitis, achieved with the disinfection of the root canal system. Additionally, there are pathologies where the toxic content of the canal goes to the periradicular tissues, causing osteolysis or lesions of the bone tissue that are radiographically observed as radiolucent images. When the endodontic treatment is successful, the repair of these lesions occurs over time.

To analyze the periradicular repair process of non-surgical endodontic treatment and the factors that affect it.

An electronic search was carried out using the search engines PUBMED, Scopus, Google Academic, and Scielo with the words "Non-Surgical Endodontic Treatment," "Periapical Tissues," "Biological Repair," "Apical Repair." Factors such as incomplete texts, PDF texts, and publication date of the article were considered, including data from the last five (05) years.

The information reviewed comprised 236 articles analyzed with the inclusion and exclusion criteria, and only 42 articles met these criteria.

The success of endodontic treatment lies in the absence of clinical and radiographic signs and symptoms of infection; this is achieved with a good application of clinical protocols and procedures focused on the disinfection of the root canal system, from diagnosis, biomechanical preparation, and disinfection of the root canal system with irrigating substances and filling, including coronal rehabilitation from an aesthetic and/or prosthetic point of view.

'Periodontitis' refers to periodontal destruction of connective tissue attachment and bone, in response to microorganisms forming subgingival biofilms on the root surface, while 'apical periodontitis' refers to periapical inflammatory processes occurring in response to microorganisms within the root canal system. The treatment of both diseases is based on the elimination of the bacterial challenge, though its predictability depends on the ability of disrupting these biofilms, what may need adjunctive antibacterial strategies, such as the next-generation antibacterial strategies (NGAS). From all the newly developed NGAS, the use of polymeric nanotechnology may pose a potential effective approach. Although some of these strategies have only been tested in vitro and in preclinical in vivo models, their use holds a great potential, and therefore, it is relevant to understand their mechanism of action and evaluate their scientific evidence of efficacy.

To explore NGAS based on polymeric nanotechnology used for the potential treatment of periodontitis and apical periodontitis.

A systemic search of scientific publications of adjunctive antimicrobial strategies using nanopolymers to treat periodontal and periapical diseases was conducted using The National Library of Medicine (MEDLINE by PubMed), The Cochrane Oral Health Group Trials Register, EMBASE and Web of Science.

Different polymeric nanoparticles, nanofibres and nanostructured hydrogels combined with antimicrobial substances have been identified in the periodontal literature, being the most commonly used nanopolymers of polycaprolactone, poly(lactic-co-glycolic acid) and chitosan. As antimicrobials, the most frequently used have been antibiotics, though other antimicrobial substances, such as metallic ions, peptides and naturally derived products, have also been added to the nanopolymers.

Polymeric nanomaterials containing antimicrobial compounds may be considered as a potential NGAS. Its relative efficacy, however, is not well understood since most of the existing evidence is derived from in vitro or preclinical in vivo studies.

Infection of the dental pulp involves mainly Gram-negative, anaerobic bacterial flora and due to this infection, the periapical area experiences an immunological response, which is termed a periapical lesion. This lesion may appear as a radiolucent (dark) area on X-rays, which indicates periapical inflammation and infection. Its prevalence depends on factors such as age, oral health maintenance, and dental care. Men are more likely to be affected by this infection than women. There are two modalities for the treatment of periapical lesions: surgical or non-surgical endodontic therapy. The modified triple antibiotic paste (TAP) comprising ciprofloxacin, metronidazole, and clindamycin in the ratio of 1:1:1 was first prepared expressly to treat the teeth with necrotic pulp and to support the protocol for revitalization and regrowth. The treatment was very successful in eliminating germs from the root canal system. It provides broad-spectrum antimicrobial activity against a wide range of bacteria commonly associated with endodontic infections. The modified TAP is usually inserted into the canal for a predetermined amount of time and then removed followed by the irrigation of root canal, which helps to eliminate the microorganisms from the root canal. The non-surgical treatment should always be the first choice over the surgical approach so as to avoid a more invasive procedure.

Treating the coronal dens invaginatus (CDI) with pulp infection commonly involves the removal of invagination, which increases the risk of perforation and fracture, and compromises the tooth structure. Minimally invasive endodontic management of CDI is highly recommended. This report describes two cases of type II CDI with the application of personalized templates.

Two cases of type II CDI, affecting the main root canal in a maxillary canine and a lateral incisor, were diagnosed. A guided endodontics (GE) approach was applied. Cone-beam computed tomography and intraoral scans were imported and aligned in a virtual planning software to design debridement routes and templates. The MICRO principle (which involves the aspects of Mechanical (M) debridement, Irrigation (I), Access cavities (C), Rectilinear routes (R), and Obstruction (O)) was proposed for designing optimal debridement routes for future applications. The templates were innovatively personalized and designed to preserve the tooth structure maximally while effectively debriding the root canal. Root canal treatment with supplementary disinfection was then performed. The follow-up of the two patients revealed favorable clinical and radiographic outcomes.

The GE approach could be a feasible method for preserving healthy dental structure while effectively debriding the root canal, thereby achieving successful and minimally invasive endodontic treatment for CDI.

To evaluate the effects of NLRP3 inflammasome inhibition or knockout in experimental apical periodontitis (AP) induced in mice.

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%.

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).

NLRP3 inflammasome inhibition or knockout can attenuate the inflammatory events that result in the periapical lesion (AP) formation after pulpal exposure in mice.

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.

The aim of this study was to explore the factors associated with the survival of root canal treated teeth in a practise-based study setting in a 5-year period.

This retrospective study used data from the electronic patient registration system of the public dental services of the City of Oulu, Finland. The inclusion criteria for this study were patients aged ≥ 20 years who had root canal treatment (RCT) that was initiated in 2014. One RCT per patient was included in the study. A total of 713 patients met the inclusion criteria. The outcome variable for this study was the extraction of the RCT tooth during the 5-year period. Explanatory variables included age, diagnosis, tooth type (incisive, canine, premolar, molar), RCT technique (manual, motorized), time from RCT initiation to final restoration and type of final restoration (composite, glass ionomer, fixed dental prosthesis). To evaluate the association between the outcome variable and explanatory variables, Cox regression analyses were performed.

The overall survival rate was 91%. The middle-aged (40-59-years-old) and the oldest (60 and older) patients had a two-fold risk of extraction compared to younger (20-40-years-old) patients. Similarly, a short length of time from RCT initiation to final restoration (0-14 days) resulted in a nearly three times higher risk of extraction compared to a longer period (≥ 90 days).

The 5-year survival rate of RCTs seems high. Extractions were more common among patients over 40 years of age and if the RCT was completed shortly after its initiation.

Introduction: Endodontic treatment of teeth with periapical lesions presents more clinical difficulty. Various lasers in several methods are used in endodontics, and most of them are utilized as an adjunctive protocol in order to reduce the bacterial load of the root canal system. Improved disinfection plays a crucial role in enhanced and accelerated healing of periapical lesions. This review aims to summarize studies assessing the effect of lasers on periapical lesion healing. Methods: PubMed/MEDLINE, Scopus, Embase, and Web of Science (ISI) online databases were searched, with no publication year or status restriction, for relevant articles on April 2023. Clinical studies evaluating the effect of laser application on the periapical lesion of patients using radiographic assessment were considered eligible for inclusion. Results: Eight studies were included after carefully screening the obtained articles, first by their title and abstract and then by their full texts. Diode (4), Er, Cr: YSGG (3), and Nd: YAG (1) lasers were used with output powers that varied from 0.75 to 2 watts. Photodynamic therapy was employed in two studies, and in other studies, the root canal system was directly irradiated. Irradiation of the root canal system was adjunctive to standard preparation in all studies. The healing of the teeth treated with lasers was not inferior to those conventionally treated. In all of the included studies, laser application outperformed the standard cleaning and shaping protocol; however, this improved or faster healing was not statistically significant in most studies. Conclusion: Lasers might expedite and improve the healing process of periapical lesions. Since lasers enhance the quality of cleaning of the root canal system, it is hard to point out the exact mechanism of it. Further investigations are needed to realize the effectiveness of this treatment modality and to discover the underlying biological concepts.

Endodontic therapy is performed by biomechanical preparation and intracanal medication; however, residual bacteria can be compromised due to their ability to adhere to the root canal walls. Therefore, photodynamic therapy has gained popularity because of its good ability to prevent and eradicate microbial infections by using a light-activated dye. Objective: Analyze and to update the information on the effect of curcumin in photodynamic therapy in root canal treatment.

A literature search was carried out in PubMed/MEDLINE, Scopus, Ebsco, Science Direct, and LILACS databases using the keywords "curcumin", "turmeric", "photodynamic", "photochemotherapy", "photoradiation", "photoactivated disinfection", "root canal disinfection", "root canal therapy", "endodontics" in both Spanish and English, from 2018 to 2023.

Information from the last five years was collected with the aim of updating the study topic. 749 articles were examined using inclusion and exclusion criteria, of which only 50 met these criteria and were analyzed. Current studies show the effects of therapy on the contamination of the root canal biofilm with E. faecalis, demonstrating that photoactivated curcumin promotes the disruption of the biofilm and reduction of Colony-Forming Units.

Curcumin as a photosensitizer demonstrates a potential antibacterial effect significantly decreasing the viability of microbial cells and the vitality of biofilms.

The limitations of spontaneous bone healing underscore the necessity for exploring alternative strategies to enhance bone regeneration in maxillary radicular cyst cases. This retrospective study aimed to assess the impact of a bone substitute material (i.e., Bio-Oss) on bone volume regeneration following maxillary radicular cyst enucleation using cone-beam computed tomography (CBCT).

Seventy-three patients with maxillary radicular cysts were divided into two groups: one undergoing guided bone regeneration (GBR) with Bio-Oss and absorbable collagen membrane (n = 35), and the other receiving cyst excision alone (n = 38). Volumetric measurements using Amira software on CBCT scans evaluated bone regeneration, with cystic lesion shrinkage rates calculated. Intergroup comparisons utilized independent sample t-tests (P < 0.05), and linear regression analysis assessed the influence of preoperative cyst volume and group on bone healing.

Both groups showed similar success rates in bone formation at the 12-month follow-up, with no significant differences between them (mean (SD), control: 75.16 (19.17) vs. GBR: 82 (20.22), P > 0.05). Linear regression analysis revealed a negative correlation between preoperative cyst volume and bone regeneration in both groups (P < 0.05).

Bio-Oss may not significantly enhance bone augmentation in maxillary radicular cysts. In addition, preoperative cyst volume negatively affected the shrinkage rate of cystic lesions.

Clinicians should consider patient-specific factors such as anatomy and lesion size when determining the need for bone substitute materials. Future research could focus on optimizing treatment protocols and alternative regenerative strategies to improve patient outcomes in maxillary cyst cases.

Periapical surgery has been suggested as a treatment option for teeth with periapical lesions when those lesions continue despite receiving root canal therapy. Since sealing the apical region is the operation's primary goal, the choice of the root-end filling material affects how the surgery turns out. The retrofilling materials Zinc Oxide Eugenol (ZOE) and Mineral trioxide aggregate (MTA) are both known to have antibacterial characteristics. The purpose of this study is to determine how MTA affects as a Modulator of Periapical Tissue Healing through histological examination in Rat Molar.

A dental fissure bur measuring 0.7 mm is used to remove the buccal root apex from the buccal alveolar bone's surface, creating the cavity. One of the following is placed within each cavity: Group 1: MTA, Group 2: ZOE. For each material series, six samples were used. We classified the healing outcomes for each MTA and ZOE retrograde filling material into three groups based on histological analysis: the amount of newly generated bone, the number of fibroblasts, and the infiltration of neutrophils into the surgical site.

On the 6th day of examination, fibroblasts were seen in the area around the wound. A significant inflammatory response, including neutrophil infiltration, was seen around the ZOE after retrograde filling. On the 16th day, the new alveolar bone structure showed a slight increase. After filling the MTA on the 6th day of examination, the immediate inflammatory response was insignificant. Neutrophils were observed to enter the region surrounding the retrofilled MTA, and a small number of osteoclasts were observed to be resorbing bone. Around the wound site, fibroblasts can also be detected. On the 16th day, unlike ZOE, a lot of new bone grows close to this material.

MTA has the ability to modulate periapical healing in rat molar.

Research on the connection between endodontic therapy and orthodontics is lacking. This overview of the literature synthesizes the findings from the fields of orthodontics and endodontics and explains how they are related. Beginning with the diagnosis, treating the patient at the appropriate time, moving endodontically treated teeth and traumatized teeth, resorbing roots by orthodontic mechanics, and managing traumatized teeth with orthodontic therapy. Multiple electronic databases were utilized including (PubMed, Scopus, Science Direct, and Web of Science) to perform manual literature searches. A total of 31 articles were reviewed and summarized in this paper in keywords like "Endodontically Treated Teeth and Orthodontic Treatment," "Endodontically Treated Tooth and Orthodontic Movement," "Orthodontic Treatment in RCT Teeth," "Root Canal Treatment with Orthodontic Movement," "Trauma with Orthodontic Movement," "Orthodontic and Endodontic." Orthodontic treatment of endodontically treated and traumatized teeth is a subject of controversy. The lack of research on the topic makes it a hard decision to make when to treat these teeth. Especially given that both orthodontic and endodontic treatments have multiple consequences on each other's outcomes. Thus, it is crucial for clinicians to understand how they integrate and have a guideline to refer to during decision-making. Successful orthodontic tooth movement could be carried out immediately after endodontic treatment. However, traumatized teeth need a follow-up period before initiating orthodontic movement, which ranges from three months to 12 months depending on the type of trauma and severity. Careful radiographic and clinical follow-up should be done during the healing period. Collaborative teamwork is important between orthodontists and endodontists for the success of treatment, and to achieve satisfactory outcomes.

Objectives: Antibacterial activity against endodontic pathogens is a desirable feature for root canal sealers. The objective of this study was to compare the antibacterial effect of three resin-based endodontic sealers (AH26, Adseal, and Beta RCS) against Enterococcus faecalis in vitro. Materials and Methods: The antibacterial properties of the sealers were assessed against E. faecalis using agar diffusion test (ADT) for fresh state (N=10) and direct contact test (DCT) for freshly-mixed and set states of the materials (N=10). In ADT, the diameter of the zones of inhibition was measured after 24h of contact. In DCT, the colony-forming units of the bacteria were counted after 30 minutes and 180 minutes of exposure. The results were analyzed with two-way ANOVA and independent sample t-test. P<0.05 was considered significant. Results: Regarding DCT results, all test materials indicated an antibacterial effect, both in freshly-mixed and set states. The highest antibacterial effect was related to Adseal, whereas the lowest was observed in Beta RCS. There was a significant difference between all study groups (different sealers, setting states, and contact times; P<0.001), except for freshly-mixed AH26 and Adseal at 180 minutes (P>0.05). According to ADT, AH26 and Adseal represented the widest and the smallest inhibition zones, respectively (P<0.001). Conclusion: Within the limitations of this in vitro study, AH26, Adseal, and Beta RCS showed antibacterial effects against E. faecalis in both freshly-mixed and set states. The antibacterial effect increased over time in all of the studied sealers.

This systematic review was conducted with the purpose of analyzing the effects of root-end sealers in endodontic re-treatment cases and comparing calcium-based sealers with sealers, which were resin-based.

We conducted this review based on the principles of Cochrane systematic type of studies and also based on guidelines of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). An exhaustive search was conducted across PubMed, Medline, and Embase databases for the studies, which were based on root end sealers in cases of endodontic re-treatments. The data were then analyzed statistically with the help of SPSS 25.0.

It was seen that when comparing pain levels in post-obturation cases with these sealers after 24 hours and 48 hours, not much of statistically noteworthy differences were evident. Mean difference (MD) values at 24 hours were -0.20 with confidence intervals between -0.44 and 0.07 and P value of 0.15, whereas in case of 48 hours, MD was -0.36, CI- 0.65, and P value was 0.03. However, the results were slightly better with calcium-based sealers.

Calcium silicate-based root end obturation sealers had similar performance when compared to resin-based sealers when we compared variables like pain intensity, etc.

Introduction Successful endodontic treatment relies upon the microbial debridement of the root canal system. This can be achieved to a great extent by using intracanal medicaments, which inhibit the microbes growing in the root canal. Evaluating the capacity of oxidants in the saliva is a crucial parameter for assessing the antioxidant capacity of any individual, which decreases in inflammatory conditions. An effective intracanal medicament can increase the total antioxidant capacity of saliva, which comes down because of inflammatory conditions. Aim To evaluate the effect of two intracanal medicaments on the antioxidant capacity of saliva. Materials and methods In a randomized prospective clinical trial, 42 patients with a mean age of 18-70 years were selected based on exclusion and inclusion criteria, and the baseline value of the total antioxidant capacity of saliva was recorded. The patients were categorized into two groups as per the block randomization method (Group I: calcium hydroxide (Maarc, New Delhi, India) intracanal medicament; Group II: Hekla lava (SBL Pvt. Ltd., Germany) intracanal medicament). Access opening, working length determination, and cleaning and shaping were conducted using hand K-files and ProTaper Gold rotary files. Intracanal medicaments were placed according to the groups assigned, and temporary restoration was placed. The patients were recalled after seven days. If the tooth was asymptomatic, obturation was completed, and a saliva sample was collected to assess the total antioxidant capacity. Results The total antioxidant capacity of saliva was increased after using intracanal medicaments and endodontic therapy, and there was a statistically significant difference before and after using both the medicaments (p=0.0005; i.e., calcium hydroxide and Hekla lava. When both medicaments were compared, there was no significant difference in the antioxidant capacity of saliva among medicaments (p=0.384). Conclusion The total antioxidant capacity of saliva was increased after using both the intracanal medicaments. Hence, Hekla lava can be potentially used as an alternative intracanal medicament.

Apical cysts are typically caused by dental pulp disease and are difficult to treat. In the majority of cases, surgical intervention is required. The rate of success after apical osteotomy varies between 60% and 91%. The introduction of platelet concentrates in treating chronic apical periodontitis is a promising direction for achieving quick and secure results. This article examines the healing of a sizable apical cyst after conservative surgical intervention and the application of platelet concentrate.

The aim of this study was the development of a complex multispecies endodontic biofilm using Candida albicans, Proteus mirabilis and Pseudomonas aeruginosa on a biofilm of Enterococcus faecalis in a dentinal substrate design. The endodontic pathology is a biofilm-mediated infection, and the aim of root canal therapy is to reduce, as much as possible, the bacterial population. Thus, it is important to develop a laboratory endodontic biofilm to test the effect of new irrigation and obturation techniques on reduction of bacterial count. The culture of Enterococcus faecalis from ATCC 29212 began with aerobic cultivation on blood agar, followed by transfer to Brain Heart Infusion (BHI) broth with 5% sucrose. Incubation occurred in a shaker at 37 °C for 24 h, followed by an additional 24-h static phase. After 10 d, Proteus mirabilis, Pseudomonas aeruginosa, and Candida albicans were introduced sequentially in three distinct groups. Group 1: the order of addition was Candida albicans, Proteus mirabilis, and Pseudomonas aeruginosa; Group 2: the order was Pseudomonas aeruginosa, Candida albicans, and Proteus mirabilis; and Group 3: Proteus mirabilis, Pseudomonas aeruginosa, and Candida albicans. After 16 days, the biofilm was carefully extracted, transferred to sterile BHI, and dissected using a sterile needle technique. Subsequently, an optical density test, bacterial counts, and colony enumeration were performed on various agar plates. Group 2 in which Pseudomonas aeruginosa was added directly after Enterococcus faecalis followed by Candida albicans and Proteus mirabilis showed significantly greater total bacterial count than the other two groups.

Dental pathologies of endodontic origin are varied in nature, and include infectious and non-infectious causes. Through this review, we aim to provide a deeper understanding of the role of bacterial involvement and in the pathogenesis of endodontic pathologies, by reviewing the relevant literature on the most common bacterial species involved, and their capacity to organize as biofilms. Furthermore, we focus on the most important recent updates in the management of endodontic infections, from a multidisciplinary perspective.

Introduction The utilization of endodontic sealers is of paramount importance in ensuring the sustained efficacy and resilience of endodontic treatment. The primary objective of the research was to appraise and contrast the fracture resistance (FR) of three distinct categories of endodontic sealing materials that are frequently employed in the context of endodontic therapy. Materials and methods This research used an in vitro experimental design. Sixty single-rooted human teeth indicated for extraction were utilized according to established protocols. These teeth were then arbitrarily divided into four piles, one for each of the four possible sealants. All specimens were put through a standardized thermal cycling procedure to simulate clinical conditions after the root canals were obturated. The subsequent step involved testing the FR of each group by utilizing a universal testing machine up until failure. Any statistically significant difference in FR among the three sealing materials was identified through appropriate statistical analysis. Results Group 1, which utilized a particular sealing material, exhibited the highest mean fracture resistance, measuring at an impressive 1198.33 ± 321.4 Newtons (N). A post hoc analysis was done to see the exact differences between each group and statistically significant differences between Groups 1 and 2 (p<0.05), Groups 1 and 4 (p<0.05), and Groups 3 and 4 (p<0.001) were observed. Conclusion The FR of Group 1 specimens were noticeably greater than those of Group 2 and Group 4 while the FR of Group 3 specimens was more than that of the Group 4 specimens. This study provides important insights into the fracture resistance of various endodontic sealing materials.

Statins are a category of medications widely used to reduce plasma LDL-cholesterol levels, that also possess antibacterial, anti-inflammatory, and immunomodulatory action. The aim of this systematic review was to explore the effects of systemic statins therapy on the development and treatment of apical periodontitis (AP) on humans and animals.

Three electronic databases (PubMed, Web of Science, and Scopus) and grey literature were searched from their inception until February, 20 2023 (PROSPERO CRD42021246231). For the quality assessment and risk of bias, different guidelines were used according to the typology of the studies considered (Animal Research Reporting of In Vivo Experiments, Newcastle-Ottawa Quality Assessment Form for Cohort Studies, Systematic Review Centre for Laboratory animal Experimentation Risk of Bias tool and Tool to assess risk of bias in cohort studies of CLARITY Group).

Seven hundred eleven records were screened, and six articles were included for this qualitative review. The eligible studies showed a moderate overall quality and risk of bias. Human patients in treatment with statins exhibited a higher healing rate of AP following root canal treatment. In experimental animal models, statins had a beneficial effect on the development of AP.

Despite the limited number of studies and considering that most of them are on animals, our findings suggest that systemically administered statins make a positive contribution to prevent the development and help healing of AP.

There is an increased evidence that a pharmacologic adjunct to endodontic treatment may be considered to enhance healing of AP. Among other medications, statins seem to have a positive impact on the disease.

The endodontic environment has optimal conditions for the growth of microorganisms that can release by-products into the periapical region of the tooth and cause inflammatory lesions. Chemical disinfection using irritants solutions plays an clinical important role, as they are able to remove waste from contaminated organic and inorganic tissues, generating a residual antibacterial effect. The purpose of this study was to show the effectiveness of 2.5% and 5.25% sodium hypochlorite as an irrigating agent for the clinical management of a chronic periapical abscess in a tooth with apical resorption. Initially, 2.5% sodium hypochlorite was used, however, as it did not have an optimal abscess healing response after 3 days, it was decided to use a concentration of 5.25% to achieve a better bactericidal effect. After 5 days, the fistula healed, and endodontic treatment continued. One of the perspectives of this case report is to investigate more about the use of antibiotic therapy in conjunction with a good irrigation protocol.

Introduction Resorption often takes the form of external inflammatory root resorption. Apical periodontitis or an apical cyst is the most typical cause of external inflammatory root resorption. Failure of endodontic treatment can occur if severe apical root resorption occurs.This is due to the difficulty of reaching these sites.Apical root resorption is usually discovered during routine radiographs and is usually in its later stages. If the lesion is advanced, extraction is the only viable solution. An accurate diagnosis of incipient root resorption is essential. This research is designed to analyze the effectiveness of digital intraoral periapical radiographs in assessing apical root resorption (ARR) related to periapical pathologies. Material and methods This cross-sectional radiographic observational research was conducted in a dental college and hospital in central India. Radiovisiography (RVG) images of 190 patients' teeth with inflammatory periapical pathologies were evaluated to determine the presence or absence of resorption in the apical area of the root. After the radiographic assessment of the apical root resorption, the extraction of the affected teeth was done under all aseptic conditions. The periapical tissue was sent for histological analysis and the extracted tooth sample was examined for the presence or absence of apical root resorption. Results In comparison to apical periodontitis, the proportion of severe root resorption patients was significantly higher in abscess and periapical granuloma. Using Pearson's Chi-square test, the difference in patient proportions according to the kind of resorption in the three radiological diagnosis groups was statistically significant with a p-value of 0.0058. Conclusion It was concluded that on radiographic examination, digital intraoral periapical radiographs were found to be accurate in determining periapical apical pathologies and apical root resorption.

To detect and evaluate early signs of apical periodontitis using MRI based on a 3D short-tau-inversion-recovery (STIR) sequence compared to conventional panoramic radiography (OPT) and periapical radiographs in patients with apical periodontitis.

Patients with clinical evidence of periodontal disease were enrolled prospectively and received OPT as well as MRI of the viscerocranium including a 3D-STIR sequence. The MRI sequences were assessed for the occurrence and extent of bone changes associated with apical periodontitis including bone edema, periradicular cysts, and dental granulomas. OPTs and intraoral periapical radiographs, if available, were assessed for corresponding periapical radiolucencies using the periapical index (PAI).

In total, 232 teeth of 37 patients (mean age 62±13.9 years, 18 women) were assessed. In 69 cases reactive bone edema was detected on MRI with corresponding radiolucency according to OPT. In 105 cases edema was detected without corresponding radiolucency on OPT. The overall extent of edema measured on MRI was significantly larger compared to the radiolucency on OPT (mean: STIR 2.4±1.4 mm, dental radiograph 1.3±1.2 mm, OPT 0.8±1.1 mm, P=0.01). The overall PAI score was significantly higher on MRI compared to OPT (mean PAI: STIR 1.9±0.7, dental radiograph 1.3±0.5, OPT 1.2±0.7, P=0.02).

Early detection and assessment of bone changes of apical periodontitis using MRI was feasible while the extent of bone edema measured on MRI exceeded the radiolucencies measured on OPT.

In clinical routine, dental MRI might be useful for early detection and assessment of apical periodontitis before irreversible bone loss is detected on conventional panoramic and intraoral periapical radiographs.