Luiz Alexandre Chisini, Maximiliano Sergio Cenci, Jovito Adiel Skupien, Fabiana Teixeira Marchiori, Laylla Galdino-Santos, Wietske Fokkinga, Bas Loomans, Tatiana Pereira-Cenci
Aim
This prognostic study aims to develop a machine learning (ML) survival model for estimating the longevity (success and survival rate) of restorations in endodontically treated teeth (ETT).
Methodology
Data were consolidated from four controlled clinical trials conducted in the Netherlands and Brazil, involving 424 patients and 618 restorations with up to 17 years of follow-up. The evaluated predictive models included Gradient Boosting Survival, Random Survival Forests and Survival Support Vector Machine. The dataset was split into 70% for training and 30% for testing. Hyperparameter tuning was optimised via 10-fold cross-validation with 50 iterations using hyperopt. Performance was assessed through the time-dependent area under the ROC curve (AUC), concordance index (C-index), inverse probability of censoring weights (IPCW C-index) and time-dependent Brier score.
Results
The Gradient Boosting Survival model achieved the highest AUC mean (0.83, 95% confidence interval [CI], 0.81–0.78), C-index (0.80), IPCW C-index (0.78) and Brier score (0.06) for survival rate predictions, maintaining predictive stability over time. For success rate, the Random Survival Forest model outperformed others (AUC = 0.73, 95% CI [0.70–0.75]), C-index (0.66), IPCW C-index (0.64) and Brier score (0.14). SHAP analysis identified patient age and tooth type as having the highest variable importance for survival, while the dentist's experience was critical for success outcomes. Fairness analysis revealed performance disparities across sexes and countries in the models.
Conclusions
The models demonstrated high predictive performance, mainly in survival rate prediction. ML models show promise for developing a robust, data-driven framework to evaluate success and survival outcomes in ETT.
目的：本预后研究旨在开发一种机器学习（ML）生存模型，用于估计根管治疗牙齿（ETT）修复体的寿命（成功率和存活率）。方法：数据来自荷兰和巴西进行的四项对照临床试验，涉及424名患者和618个修复体，随访长达17年。评估的预测模型包括梯度增强生存、随机生存森林和生存支持向量机。数据集被分成70%用于训练，30%用于测试。通过使用hyperopt进行50次迭代的10倍交叉验证来优化超参数调优。通过ROC曲线下随时间变化的面积（AUC）、一致性指数（C-index）、审查权逆概率（IPCW C-index）和随时间变化的Brier评分来评估绩效。结果：梯度增强生存模型在预测生存率方面获得了最高的AUC平均值（0.83,95%可信区间[CI]， 0.81-0.78）、c -指数（0.80）、IPCW c -指数（0.78）和Brier评分（0.06），并保持了长期的预测稳定性。在成功率方面，随机生存森林模型优于其他模型（AUC = 0.73, 95% CI[0.70-0.75]）、c -指数（0.66）、IPCW c -指数（0.64）和Brier评分（0.14）。SHAP分析确定患者的年龄和牙齿类型对生存具有最高的可变重要性，而牙医的经验对成功的结果至关重要。公平分析揭示了模型中不同性别和国家的表现差异。结论：该模型具有较高的预测性能，主要表现在生存率预测方面。机器学习模型有望开发一个健壮的、数据驱动的框架来评估ETT的成功和生存结果。
{"title":"Restoration's Longevity in Endodontically Treated Teeth: A Machine Learning Survival Analysis From Randomised Clinical Trials","authors":"Luiz Alexandre Chisini, Maximiliano Sergio Cenci, Jovito Adiel Skupien, Fabiana Teixeira Marchiori, Laylla Galdino-Santos, Wietske Fokkinga, Bas Loomans, Tatiana Pereira-Cenci","doi":"10.1111/iej.70048","DOIUrl":"10.1111/iej.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This prognostic study aims to develop a machine learning (ML) survival model for estimating the longevity (success and survival rate) of restorations in endodontically treated teeth (ETT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>Data were consolidated from four controlled clinical trials conducted in the Netherlands and Brazil, involving 424 patients and 618 restorations with up to 17 years of follow-up. The evaluated predictive models included Gradient Boosting Survival, Random Survival Forests and Survival Support Vector Machine. The dataset was split into 70% for training and 30% for testing. Hyperparameter tuning was optimised via 10-fold cross-validation with 50 iterations using hyperopt. Performance was assessed through the time-dependent area under the ROC curve (AUC), concordance index (C-index), inverse probability of censoring weights (IPCW C-index) and time-dependent Brier score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The Gradient Boosting Survival model achieved the highest AUC mean (0.83, 95% confidence interval [CI], 0.81–0.78), C-index (0.80), IPCW C-index (0.78) and Brier score (0.06) for survival rate predictions, maintaining predictive stability over time. For success rate, the Random Survival Forest model outperformed others (AUC = 0.73, 95% CI [0.70–0.75]), C-index (0.66), IPCW C-index (0.64) and Brier score (0.14). SHAP analysis identified patient age and tooth type as having the highest variable importance for survival, while the dentist's experience was critical for success outcomes. Fairness analysis revealed performance disparities across sexes and countries in the models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The models demonstrated high predictive performance, mainly in survival rate prediction. ML models show promise for developing a robust, data-driven framework to evaluate success and survival outcomes in ETT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 2","pages":"251-261"},"PeriodicalIF":7.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12794790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145299968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Soldado-Cañadas., C. Muñoz-Garduño, D. Sanz-Serrano, A. Sánchez-Torres, M. Mercadé
Aim
To determine whether the combined use of periapical radiography (PR) and cone beam computed tomography (CBCT) improves agreement among three endodontic experts compared with using either diagnostic tool alone.
Methodology
Sixty clinical records with CBCT scans were selected from cases performed by postgraduate and master's students in endodontics at the University of Barcelona Dental Hospital. Three endodontic experts independently evaluated each case using a standardised questionnaire. Initially, they assessed the PR images. After 4 months, they reassessed the cases using CBCT. One year later, they reviewed both PR and CBCT together. Agreement levels were analysed for pulpal and periradicular diagnoses, treatment recommendations and aetiological assessments.
Results
Inter-observer agreement improved across the study phases, peaking in phase 3—particularly for treatment recommendations. In this final phase, where both PR and CBCT were evaluated together, the agreement rate for pulpal diagnosis was 73.33%, with substantial reliability (κ = 0.67). Periradicular diagnosis showed a 40.00% agreement rate, with moderate inter-observer concordance (κ = 0.44). The lowest agreement was observed in the aetiology category (28.33%), with moderate concordance (κ = 0.50). Agreement on treatment recommendations reached 43.33% (κ = 0.51) and was the only category to show statistically significant differences between phases (p = 0.01). No significant differences were found for pulpal diagnosis (p = 0.39), periradicular diagnosis (p = 0.19) or aetiology (p = 0.36). Intra-observer agreement varied among experts, with some showing lower consistency in their responses when evaluating PR, CBCT and the combination of both, highlighting the influence of imaging modality on clinical decision-making.
Conclusions
The combination of PR and CBCT improved inter-observer agreement across all categories compared to the use of a single imaging modality. However, this improvement reached statistical significance only for treatment recommendations. These findings suggest that, whereas combining PR and CBCT may support more consistent therapeutic decision-making, its impact on diagnostic agreement may vary depending on the specific diagnostic domain.
{"title":"The Clinical Impact of the Combination of CBCT and Periapical Radiographs on Endodontic Diagnosis and Treatment Planning—A Retrospective Cohort Study","authors":"P. Soldado-Cañadas., C. Muñoz-Garduño, D. Sanz-Serrano, A. Sánchez-Torres, M. Mercadé","doi":"10.1111/iej.70050","DOIUrl":"10.1111/iej.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To determine whether the combined use of periapical radiography (PR) and cone beam computed tomography (CBCT) improves agreement among three endodontic experts compared with using either diagnostic tool alone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>Sixty clinical records with CBCT scans were selected from cases performed by postgraduate and master's students in endodontics at the University of Barcelona Dental Hospital. Three endodontic experts independently evaluated each case using a standardised questionnaire. Initially, they assessed the PR images. After 4 months, they reassessed the cases using CBCT. One year later, they reviewed both PR and CBCT together. Agreement levels were analysed for pulpal and periradicular diagnoses, treatment recommendations and aetiological assessments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Inter-observer agreement improved across the study phases, peaking in phase 3—particularly for treatment recommendations. In this final phase, where both PR and CBCT were evaluated together, the agreement rate for pulpal diagnosis was 73.33%, with substantial reliability (<i>κ</i> = 0.67). Periradicular diagnosis showed a 40.00% agreement rate, with moderate inter-observer concordance (<i>κ</i> = 0.44). The lowest agreement was observed in the aetiology category (28.33%), with moderate concordance (<i>κ</i> = 0.50). Agreement on treatment recommendations reached 43.33% (<i>κ</i> = 0.51) and was the only category to show statistically significant differences between phases (<i>p</i> = 0.01). No significant differences were found for pulpal diagnosis (<i>p</i> = 0.39), periradicular diagnosis (<i>p</i> = 0.19) or aetiology (<i>p</i> = 0.36). Intra-observer agreement varied among experts, with some showing lower consistency in their responses when evaluating PR, CBCT and the combination of both, highlighting the influence of imaging modality on clinical decision-making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The combination of PR and CBCT improved inter-observer agreement across all categories compared to the use of a single imaging modality. However, this improvement reached statistical significance only for treatment recommendations. These findings suggest that, whereas combining PR and CBCT may support more consistent therapeutic decision-making, its impact on diagnostic agreement may vary depending on the specific diagnostic domain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 2","pages":"190-202"},"PeriodicalIF":7.1,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12794742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shaqayeq Ramezanzade, Tudor Laurentiu Dascalu, Azam Bakhshandeh, Sergio E Uribe, Bulat Ibragimov, Lars Bjørndal
Aim: This study evaluated the effect of a short, personalised training session on student performance in using an artificial intelligence (AI)-based platform for pulp exposure prediction before caries excavation and determined the required sample size for a further randomised controlled trial (RCT).
Methodology: Undergraduate dental students were randomly assigned to the experimental (training) group and the control (no training) group. The training group received a 1-h training session before undertaking the experiment, focusing on the uses, applications, and drawbacks of AI and carious lesion penetration depth. The theoretical presentation was followed by practical exercises and a quiz to check learning progress. Later, participants in both groups completed an experimental task involving 292 cases. They were asked to predict pulp exposure using an AI-based website. Sample size calculations determined the required sample size, with 80% power and an alpha of 5%.
Results: 18 participants were enrolled (9 in each group). The agreement between participants' decisions and AI predictions regarding the presence or absence of pulp exposure (agreeableness with AI) was higher in the training group compared to the control group (0.83 vs. 0.76). The training group had a slightly higher mean F1-score (0.63 vs. 0.62), accuracy (0.69 vs. 0.68), and sensitivity (0.63 vs. 0.59) than the control group. Based on the sample size calculation, at least 31 participants per group are needed for the future RCT.
Conclusions: The results support further investigation of customised training sessions prior to using an AI-based platform to assess their impact on dental students' agreement with AI predictions.
目的：本研究评估了短期个性化培训课程对学生在龋挖掘前使用基于人工智能（AI）的牙髓暴露预测平台表现的影响，并确定了进一步随机对照试验（RCT）所需的样本量。方法：将牙科本科学生随机分为实验组（训练组）和对照组（未训练组）。实验组在实验前进行1小时的培训，重点了解人工智能和龋齿穿透深度的用途、应用和不足。理论陈述之后是实践练习和测试，以检查学习进度。随后，两组参与者都完成了一项涉及292个案例的实验任务。他们被要求使用一个基于人工智能的网站来预测牙髓暴露。样本量计算确定所需的样本量，功率为80%，alpha为5%。结果：共入组18例（每组9例）。与对照组相比，训练组参与者的决定与人工智能预测之间关于是否存在牙髓暴露（与人工智能的亲和性）的一致性更高（0.83对0.76）。训练组的平均f1得分（0.63 vs. 0.62）、准确率（0.69 vs. 0.68）和灵敏度（0.63 vs. 0.59）略高于对照组。根据样本量计算，未来的RCT每组至少需要31名参与者。结论：结果支持在使用基于人工智能的平台之前进一步调查定制培训课程，以评估其对牙科学生同意人工智能预测的影响。试验注册：ClinicalTrial.gov标识符：NCT05912361。
{"title":"The Impact of Training Dental Students to Use an Artificial Intelligence-Based Platform for Pulp Exposure Prediction Prior to Deep Caries Excavation: A Proof-of-Concept Randomised Controlled Trial.","authors":"Shaqayeq Ramezanzade, Tudor Laurentiu Dascalu, Azam Bakhshandeh, Sergio E Uribe, Bulat Ibragimov, Lars Bjørndal","doi":"10.1111/iej.70046","DOIUrl":"https://doi.org/10.1111/iej.70046","url":null,"abstract":"<p><strong>Aim: </strong>This study evaluated the effect of a short, personalised training session on student performance in using an artificial intelligence (AI)-based platform for pulp exposure prediction before caries excavation and determined the required sample size for a further randomised controlled trial (RCT).</p><p><strong>Methodology: </strong>Undergraduate dental students were randomly assigned to the experimental (training) group and the control (no training) group. The training group received a 1-h training session before undertaking the experiment, focusing on the uses, applications, and drawbacks of AI and carious lesion penetration depth. The theoretical presentation was followed by practical exercises and a quiz to check learning progress. Later, participants in both groups completed an experimental task involving 292 cases. They were asked to predict pulp exposure using an AI-based website. Sample size calculations determined the required sample size, with 80% power and an alpha of 5%.</p><p><strong>Results: </strong>18 participants were enrolled (9 in each group). The agreement between participants' decisions and AI predictions regarding the presence or absence of pulp exposure (agreeableness with AI) was higher in the training group compared to the control group (0.83 vs. 0.76). The training group had a slightly higher mean F1-score (0.63 vs. 0.62), accuracy (0.69 vs. 0.68), and sensitivity (0.63 vs. 0.59) than the control group. Based on the sample size calculation, at least 31 participants per group are needed for the future RCT.</p><p><strong>Conclusions: </strong>The results support further investigation of customised training sessions prior to using an AI-based platform to assess their impact on dental students' agreement with AI predictions.</p><p><strong>Trial registration: </strong>ClinicalTrial.gov identifier: NCT05912361.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate the accuracy of guided access cavity preparation in calcified canals using a robotic system, compared to static and dynamic guided methods.
Methodology
Three 3D-printed mandibular models presenting with pulp canal obliteration were allocated into three groups for robot, static and dynamic-guided access cavity preparations. The primary outcomes measured were the coronal deviation, apical deviation and angular deviation between the planned and actual paths of access cavity preparation. Additionally, all access cavities were confirmed to determine whether the canal was located. The data were analysed using the one-way analysis of variance (ANOVA), Tukey's post hoc test and multilevel linear regression models. The significance level was set at 0.05.
Results
All canals (n = 12) in the robot-guided and static-guided groups were located. In the dynamic guided group, a total of 10 out of 12 canals were found, with 2 resulting in root perforations. The accuracy of access cavity preparation using a robotic system showed no significant difference compared to the static-guided group (p > 0.05). However, the apical and angular deviation results were significantly lower in the robot-guided group than the dynamic-guided group (p < 0.05).
Conclusions
The robotic system exhibited comparable accuracy to the static guide, whereas it significantly outperformed dynamic navigation in terms of guided access cavity preparation for calcified root canals. However, further clinical studies are needed to confirm these preliminary findings.
{"title":"Accuracy of Robot-Guided Access Cavity Preparation in Managing Calcified Canals: An In Vitro Study","authors":"Yuchen Liu, Chen Liu, Shizhu Bai, Yimin Zhao","doi":"10.1111/iej.70049","DOIUrl":"10.1111/iej.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the accuracy of guided access cavity preparation in calcified canals using a robotic system, compared to static and dynamic guided methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>Three 3D-printed mandibular models presenting with pulp canal obliteration were allocated into three groups for robot, static and dynamic-guided access cavity preparations. The primary outcomes measured were the coronal deviation, apical deviation and angular deviation between the planned and actual paths of access cavity preparation. Additionally, all access cavities were confirmed to determine whether the canal was located. The data were analysed using the one-way analysis of variance (ANOVA), Tukey's post hoc test and multilevel linear regression models. The significance level was set at 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All canals (<i>n</i> = 12) in the robot-guided and static-guided groups were located. In the dynamic guided group, a total of 10 out of 12 canals were found, with 2 resulting in root perforations. The accuracy of access cavity preparation using a robotic system showed no significant difference compared to the static-guided group (<i>p</i> > 0.05). However, the apical and angular deviation results were significantly lower in the robot-guided group than the dynamic-guided group (<i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The robotic system exhibited comparable accuracy to the static guide, whereas it significantly outperformed dynamic navigation in terms of guided access cavity preparation for calcified root canals. However, further clinical studies are needed to confirm these preliminary findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 2","pages":"262-270"},"PeriodicalIF":7.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xavier Roig-Soriano, Luis María Delgado, Firas Elmsmari, Fernando Duran-Sindreu, Miriam Teulé, Marta Espina, Gerard Esteruelas, Maria Luisa García, José Antonio González Sánchez, Elena Sánchez-López
Aim
To characterise and evaluate mucoadhesive strength and antibacterial properties of a nanotechnological formulation for endodontic disinfection based on biodegradable nanoparticles dispersed in a thermosensitive gel containing calcium hydroxide (Ca(OH)2-NPs-gel).
Methodology
Morphology of Ca(OH)2-NPs-gel was studied using transmission electron microscopy. Moreover, Ca(OH)2-NPs-gel was sterilised using gamma irradiation (25 kGy), and the stability after the sterilisation process was studied by measuring Ca(OH)2-NPs-gel average size, polydispersity index, zeta potential and encapsulation efficiency. To assess the ex vivo mucoadhesive strength, extracted single-rooted human teeth were used to measure the force necessary to separate the formulation from the teeth. In addition, the short-time stability of Ca(OH)2-NPs-gel was evaluated monthly, analysing entrapment efficacy, backscattering and transmittance of Ca(OH)2-NPs-gel stored at different temperatures (4°C, 25°C and 37°C). Furthermore, the antibacterial analysis of Ca(OH)2-NPs-gel was performed against Enterococcus faecalis inoculated in extracted human single-root teeth and evaluated by confocal and scanning electron microscopy. Finally, the metabolic activity of bacteria was studied through a resazurin assay to evaluate bacterial survival after treatment.
Results
Ca(OH)2-NPs-gel owned a round shape and a smooth surface without particle aggregation. Sterilisation did not induce an alteration in Ca(OH)2-NPs-gel physicochemical properties and Ca(OH)2-NPs-gel presented a high adhesion strength. In addition, 4°C was the best temperature to store Ca(OH)2-NPs-gel. Regarding the antibacterial therapeutic efficacy, Ca(OH)2-NPs-gel possesses suitable antibacterial properties, indicating that it efficiently reduces bacterial biofilms.
Conclusion
Calcium hydroxide-loaded PLGA nanoparticles dispersed in a thermosensitive gel have been developed, optimised and characterised, obtaining excellent antibacterial properties and achieving bacterial disinfection levels similar to those of commercial formulations.
{"title":"A Thermosensitive Gel Containing Biodegradable Nanoparticles Carrying Calcium Hydroxide as Antibacterial Intracanal Therapy","authors":"Xavier Roig-Soriano, Luis María Delgado, Firas Elmsmari, Fernando Duran-Sindreu, Miriam Teulé, Marta Espina, Gerard Esteruelas, Maria Luisa García, José Antonio González Sánchez, Elena Sánchez-López","doi":"10.1111/iej.70032","DOIUrl":"10.1111/iej.70032","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To characterise and evaluate mucoadhesive strength and antibacterial properties of a nanotechnological formulation for endodontic disinfection based on biodegradable nanoparticles dispersed in a thermosensitive gel containing calcium hydroxide (Ca(OH)<sub>2</sub>-NPs-gel).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>Morphology of Ca(OH)<sub>2</sub>-NPs-gel was studied using transmission electron microscopy. Moreover, Ca(OH)<sub>2</sub>-NPs-gel was sterilised using gamma irradiation (25 kGy), and the stability after the sterilisation process was studied by measuring Ca(OH)<sub>2</sub>-NPs-gel average size, polydispersity index, zeta potential and encapsulation efficiency. To assess the ex vivo mucoadhesive strength, extracted single-rooted human teeth were used to measure the force necessary to separate the formulation from the teeth. In addition, the short-time stability of Ca(OH)<sub>2</sub>-NPs-gel was evaluated monthly, analysing entrapment efficacy, backscattering and transmittance of Ca(OH)<sub>2</sub>-NPs-gel stored at different temperatures (4°C, 25°C and 37°C). Furthermore, the antibacterial analysis of Ca(OH)<sub>2</sub>-NPs-gel was performed against <i>Enterococcus faecalis</i> inoculated in extracted human single-root teeth and evaluated by confocal and scanning electron microscopy. Finally, the metabolic activity of bacteria was studied through a resazurin assay to evaluate bacterial survival after treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ca(OH)<sub>2</sub>-NPs-gel owned a round shape and a smooth surface without particle aggregation. Sterilisation did not induce an alteration in Ca(OH)<sub>2</sub>-NPs-gel physicochemical properties and Ca(OH)<sub>2</sub>-NPs-gel presented a high adhesion strength. In addition, 4°C was the best temperature to store Ca(OH)<sub>2</sub>-NPs-gel. Regarding the antibacterial therapeutic efficacy, Ca(OH)<sub>2</sub>-NPs-gel possesses suitable antibacterial properties, indicating that it efficiently reduces bacterial biofilms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Calcium hydroxide-loaded PLGA nanoparticles dispersed in a thermosensitive gel have been developed, optimised and characterised, obtaining excellent antibacterial properties and achieving bacterial disinfection levels similar to those of commercial formulations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 1","pages":"163-176"},"PeriodicalIF":7.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iej.70032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nour Ghazi, Har-amrit Singh, Edward Longbottom, Jeremy Hayes, Damian Farnell, Arindam Dutta
<div> <section> <h3> Aim</h3> <p>To assess the complexity of root canal treatments allocated to Postgraduate Endodontology trainees at Cardiff University Dental Hospital (CUDH) using the English Clinical Standards for Restorative Dentistry (ECS) in comparison with the Dental Practicality Index (DPI), the EndoApp (EA), and the Endodontic Complexity Assessment Tool (E-CAT).</p> </section> <section> <h3> Material and Methods</h3> <p>Two-hundred-and-one case records were evaluated by two calibrated examiners using each complexity assessment system. Inter-examiner and intra-examiner variability was calculated using Cohen's kappa coefficient. Statistical analyses compared the scores obtained for the same case using the different systems.</p> </section> <section> <h3> Results</h3> <p>Most cases were assigned level 3 complexity using ECS, EA and E-CAT (82%, 92% and 74.1%, respectively), and scores of 3–5 (78.6%) using DPI. EA consistently assigned higher complexity scores compared with ECS and E-CAT. E-CAT assigned lower complexity scores compared with ECS. A statistically significant moderate–substantial level of agreement was demonstrated between E-CAT and ECS (weighted kappa = 0.647 [95% CI: 0.517 to 0.776], <i>p</i> < 0.001). A statistically significant fair level of agreement was demonstrated between EA and ECS (weighted kappa = 0.290 [95% CI: 0.113 to 0.466], <i>p</i> < 0.001) and EA and E-CAT (weighted kappa: 0.385 [95% CI: 0.226 to 0.544], <i>p</i> < 0.001). A statistically significant weak positive correlation was found between DPI and ECS [Spearman's correlation coefficient (<i>r</i><sub>s</sub>) = 0.202, <i>p</i> = 0.004], DPI and EA (<i>r</i><sub>s</sub> = 0.344, <i>p</i> < 0.001), and DPI and E-CAT (<i>r</i><sub>s</sub> = 0.364, <i>p</i> < 0.001). The most common cause of increase in complexity scores was ‘canal negotiability’ for ECS (47%) and the ‘endodontic treatment need’ for DPI (84.1%). The unknown algorithm used by EA and E-CAT prevented the identification of specific factors that contributed to the endodontic treatment complexity.</p> </section> <section> <h3> Conclusion</h3> <p>The majority of cases treated at CUDH were of high complexity. E-CAT assigned slightly lower complexity scores compared with ECS and EA, potentially due to its detailed assessment of factors. A weak positive correlation was found between the complexity grading systems. DPI's broader assessment justifies a cut-off score of 3 for specialist referral due to the increased agreement with ECS, E-CAT and EA at this threshold.</p> </sectio
目的：通过与牙科实用性指数（DPI）、牙髓应用程序（EA）和牙髓复杂性评估工具（E-CAT）比较，评估卡迪夫大学牙科医院（CUDH）牙髓学研究生使用英国临床标准（ECS）进行根管治疗的复杂性。材料和方法：由两名经过校准的审查员使用每种复杂性评估系统对221份病例记录进行评估。使用Cohen's kappa系数计算考官之间和考官内部的变异性。统计分析比较了使用不同系统对同一病例获得的分数。结果：大多数病例的ECS、EA和E-CAT评分为3级（分别为82%、92%和74.1%），DPI评分为3-5级（78.6%）。与ECS和E-CAT相比，EA始终分配更高的复杂性分数。与ECS相比，E-CAT的复杂性评分较低。E-CAT与ECS（加权kappa = 0.647 [95% CI: 0.517 ~ 0.776], p s） = 0.202, p = 0.004)、DPI与EA （rs = 0.344, p s = 0.364, p）的一致性具有统计学意义。与ECS和EA相比，E-CAT的复杂性评分略低，这可能是由于其对因素的详细评估。复杂度分级系统之间存在弱正相关关系。由于与ECS， E-CAT和EA在这一阈值上的一致性增加，DPI更广泛的评估证明了专家转诊的截止分数为3分。
{"title":"Assessment of Case Complexity of Root Canal Treatments Using Contemporary Complexity Grading Systems: A Clinical Service Evaluation","authors":"Nour Ghazi, Har-amrit Singh, Edward Longbottom, Jeremy Hayes, Damian Farnell, Arindam Dutta","doi":"10.1111/iej.70039","DOIUrl":"10.1111/iej.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To assess the complexity of root canal treatments allocated to Postgraduate Endodontology trainees at Cardiff University Dental Hospital (CUDH) using the English Clinical Standards for Restorative Dentistry (ECS) in comparison with the Dental Practicality Index (DPI), the EndoApp (EA), and the Endodontic Complexity Assessment Tool (E-CAT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Two-hundred-and-one case records were evaluated by two calibrated examiners using each complexity assessment system. Inter-examiner and intra-examiner variability was calculated using Cohen's kappa coefficient. Statistical analyses compared the scores obtained for the same case using the different systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most cases were assigned level 3 complexity using ECS, EA and E-CAT (82%, 92% and 74.1%, respectively), and scores of 3–5 (78.6%) using DPI. EA consistently assigned higher complexity scores compared with ECS and E-CAT. E-CAT assigned lower complexity scores compared with ECS. A statistically significant moderate–substantial level of agreement was demonstrated between E-CAT and ECS (weighted kappa = 0.647 [95% CI: 0.517 to 0.776], <i>p</i> < 0.001). A statistically significant fair level of agreement was demonstrated between EA and ECS (weighted kappa = 0.290 [95% CI: 0.113 to 0.466], <i>p</i> < 0.001) and EA and E-CAT (weighted kappa: 0.385 [95% CI: 0.226 to 0.544], <i>p</i> < 0.001). A statistically significant weak positive correlation was found between DPI and ECS [Spearman's correlation coefficient (<i>r</i><sub>s</sub>) = 0.202, <i>p</i> = 0.004], DPI and EA (<i>r</i><sub>s</sub> = 0.344, <i>p</i> < 0.001), and DPI and E-CAT (<i>r</i><sub>s</sub> = 0.364, <i>p</i> < 0.001). The most common cause of increase in complexity scores was ‘canal negotiability’ for ECS (47%) and the ‘endodontic treatment need’ for DPI (84.1%). The unknown algorithm used by EA and E-CAT prevented the identification of specific factors that contributed to the endodontic treatment complexity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The majority of cases treated at CUDH were of high complexity. E-CAT assigned slightly lower complexity scores compared with ECS and EA, potentially due to its detailed assessment of factors. A weak positive correlation was found between the complexity grading systems. DPI's broader assessment justifies a cut-off score of 3 for specialist referral due to the increased agreement with ECS, E-CAT and EA at this threshold.</p>\u0000 </sectio","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 1","pages":"47-56"},"PeriodicalIF":7.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iej.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peiling Hu, Yingqing Chen, Ping Long, Anni Zhang, Xiaorong Lan, Yuanpei He, Guangwen Li, Shiting Li
<div> <section> <h3> Aim</h3> <p>Under certain conditions, infection-induced inflammation may activate reparative processes to form a hard tissue barrier against microbial invasion. Autophagy participates in odontogenic differentiation during inflammation in vitro, but its role in pulp repair remains unclear. This study investigated how autophagy regulated odontogenic differentiation within the inflammatory microenvironment, emphasising the regulatory role of connexin43 (Cx43) on autophagy.</p> </section> <section> <h3> Methodology</h3> <p>Autophagy activation was detected in inflamed pulpal tissues using immunofluorescence (IF). Human dental pulp cells (hDPCs) were stimulated with 0.1/5 μg/mL lipopolysaccharide (LPS). Autophagy dynamics, including autophagic flux, were analysed through western blotting (WB), transmission electron microscopy (TEM), and mRFP-GFP-LC3 plasmid transfection. Odontogenic differentiation and mineralisation were assessed using molecular assays and Alizarin Red staining. Pharmacological inhibitors or activators were applied to determine autophagy's role. Cx43 knockdown in hDPCs and a dentine injury model in Cx43 cKO mice were used to validate their effects on autophagy. Results were analysed by two-way ANOVA.</p> </section> <section> <h3> Results</h3> <p>Autophagy-related proteins were predominantly localised in the odontoblast layer. As dental pulp infection advanced, concurrent upregulation of LC3 and p62 levels was observed, indicating that autophagy activation occurs in the pulp alongside potential impairment of autophagic flux. 0.1 μg/mL LPS promoted autophagic flux, thereby facilitating odontogenic differentiation and mineralisation, whereas autophagy inhibition attenuated these effects. Conversely, 5 μg/mL LPS induced autophagosome accumulation but blocked autophagic flux, suppressing odontogenic differentiation and mineralisation; however, restoring autophagic flux reversed this inhibition. These data suggested that maintenance of autophagic flux integrity is essential for sustaining odontogenic differentiation capacity under inflammatory stress. Cx43 knockdown under high-inflammatory conditions rescued autophagic flux and improved differentiation. Similarly, in the dentine injury model of cKO mice, Cx43 deletion attenuated p62 expression while upregulating DSPP expression, accompanied by enhanced tertiary dentine formation beneath the injury site, indicating that blockade of Cx43 promotes autophagic flux to improve pulp repair.</p> </section> <section> <h3> Conclusion</h3> <p>Autophagy regulates both inflammatory r
{"title":"From Cells to Animals: Connexin43 Suppression Enhances Autophagic Flux to Restore Odontogenesis in Inflamed Dental Pulp","authors":"Peiling Hu, Yingqing Chen, Ping Long, Anni Zhang, Xiaorong Lan, Yuanpei He, Guangwen Li, Shiting Li","doi":"10.1111/iej.70044","DOIUrl":"10.1111/iej.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Under certain conditions, infection-induced inflammation may activate reparative processes to form a hard tissue barrier against microbial invasion. Autophagy participates in odontogenic differentiation during inflammation in vitro, but its role in pulp repair remains unclear. This study investigated how autophagy regulated odontogenic differentiation within the inflammatory microenvironment, emphasising the regulatory role of connexin43 (Cx43) on autophagy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>Autophagy activation was detected in inflamed pulpal tissues using immunofluorescence (IF). Human dental pulp cells (hDPCs) were stimulated with 0.1/5 μg/mL lipopolysaccharide (LPS). Autophagy dynamics, including autophagic flux, were analysed through western blotting (WB), transmission electron microscopy (TEM), and mRFP-GFP-LC3 plasmid transfection. Odontogenic differentiation and mineralisation were assessed using molecular assays and Alizarin Red staining. Pharmacological inhibitors or activators were applied to determine autophagy's role. Cx43 knockdown in hDPCs and a dentine injury model in Cx43 cKO mice were used to validate their effects on autophagy. Results were analysed by two-way ANOVA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Autophagy-related proteins were predominantly localised in the odontoblast layer. As dental pulp infection advanced, concurrent upregulation of LC3 and p62 levels was observed, indicating that autophagy activation occurs in the pulp alongside potential impairment of autophagic flux. 0.1 μg/mL LPS promoted autophagic flux, thereby facilitating odontogenic differentiation and mineralisation, whereas autophagy inhibition attenuated these effects. Conversely, 5 μg/mL LPS induced autophagosome accumulation but blocked autophagic flux, suppressing odontogenic differentiation and mineralisation; however, restoring autophagic flux reversed this inhibition. These data suggested that maintenance of autophagic flux integrity is essential for sustaining odontogenic differentiation capacity under inflammatory stress. Cx43 knockdown under high-inflammatory conditions rescued autophagic flux and improved differentiation. Similarly, in the dentine injury model of cKO mice, Cx43 deletion attenuated p62 expression while upregulating DSPP expression, accompanied by enhanced tertiary dentine formation beneath the injury site, indicating that blockade of Cx43 promotes autophagic flux to improve pulp repair.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Autophagy regulates both inflammatory r","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 1","pages":"134-152"},"PeriodicalIF":7.1,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iej.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Background</h3> <p>Dental pulp sustains oral health through dentine formation, sensation, nutrition and defence. Beyond these classical roles, pulpal nerves have emerged as key coordinators of immune responses and tissue repair. While traditionally viewed as limited to sensory and vascular regulation, recent advances reveal that the nervous system interacts with immune mechanisms to manage inflammation and facilitate regeneration following injury or infection.</p> </section> <section> <h3> Objectives</h3> <p>To synthesise evidence on the anatomy, distribution and functional diversity of dental pulp innervation, emphasising how nerves regulate innate/adaptive immunity and orchestrate pulp tissue repair and regeneration.</p> </section> <section> <h3> Method</h3> <p>The review included studies up to the search period, utilising PubMed and Google Scholar. Search terms covered nervous-system concepts (“nerves”, “neuropeptides”, “nervefibres”, “Schwann cells”) and immune/repair concepts (“immune response”, “inflammation”, “immune cells”, “fibroblasts”, “odontoblasts”, “dental pulpstem cells”, “dentine regeneration”, “odontogenic differentiation”). Key termswere combined with Boolean operators: [nervous-system terms] AND [immune/repairterms] AND [dental], to capture studies on the role of dental nerves in pulpimmune defence and repair.</p> </section> <section> <h3> Results</h3> <p>In innate immunity, dental nerves recognise pathogens, undergo sprouting in inflamed pulp, mediate neurogenic inflammation and engage in dynamic crosstalk with immune cells. In adaptive immunity, they influence antigen presentation and regulate T-cell activation through neuropeptides, highlighting their central role in immune modulation. Furthermore, dental nerves are indispensable for tissue repair, facilitating key processes such as progenitor cell recruitment, proliferation, differentiation and reparative dentine formation. Schwann cells and sensory and sympathetic innervation play distinct yet interconnected roles throughout these stages.</p> </section> <section> <h3> Conclusion</h3> <p>The neuro-immune-endodontic axis is central to the pulp's ability to defend and repair itself, offering insights into innovative therapeutic strategies for managing dental pulp diseases. By integrating neural regulation into endodontic therapies, we can develop more effective treatments that leverage the complex interplay between the nervous and immune systems, enhancing
{"title":"Unveiling the Vital Role of Dental Nerves in Dental Pulp Immune Defence and Repair","authors":"Wenji Luo, Mingmei Yang, Chi Zhan, Zongshan Shen, Zhi Song, Zhengmei Lin, Lingling Chen","doi":"10.1111/iej.70040","DOIUrl":"10.1111/iej.70040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Dental pulp sustains oral health through dentine formation, sensation, nutrition and defence. Beyond these classical roles, pulpal nerves have emerged as key coordinators of immune responses and tissue repair. While traditionally viewed as limited to sensory and vascular regulation, recent advances reveal that the nervous system interacts with immune mechanisms to manage inflammation and facilitate regeneration following injury or infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To synthesise evidence on the anatomy, distribution and functional diversity of dental pulp innervation, emphasising how nerves regulate innate/adaptive immunity and orchestrate pulp tissue repair and regeneration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>The review included studies up to the search period, utilising PubMed and Google Scholar. Search terms covered nervous-system concepts (“nerves”, “neuropeptides”, “nervefibres”, “Schwann cells”) and immune/repair concepts (“immune response”, “inflammation”, “immune cells”, “fibroblasts”, “odontoblasts”, “dental pulpstem cells”, “dentine regeneration”, “odontogenic differentiation”). Key termswere combined with Boolean operators: [nervous-system terms] AND [immune/repairterms] AND [dental], to capture studies on the role of dental nerves in pulpimmune defence and repair.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In innate immunity, dental nerves recognise pathogens, undergo sprouting in inflamed pulp, mediate neurogenic inflammation and engage in dynamic crosstalk with immune cells. In adaptive immunity, they influence antigen presentation and regulate T-cell activation through neuropeptides, highlighting their central role in immune modulation. Furthermore, dental nerves are indispensable for tissue repair, facilitating key processes such as progenitor cell recruitment, proliferation, differentiation and reparative dentine formation. Schwann cells and sensory and sympathetic innervation play distinct yet interconnected roles throughout these stages.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The neuro-immune-endodontic axis is central to the pulp's ability to defend and repair itself, offering insights into innovative therapeutic strategies for managing dental pulp diseases. By integrating neural regulation into endodontic therapies, we can develop more effective treatments that leverage the complex interplay between the nervous and immune systems, enhancing ","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 1","pages":"2-18"},"PeriodicalIF":7.1,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iej.70040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joséphine Brodén, Maria Pigg, Niklas Vareman, Helena Fransson
Aim: In uncertain clinical situations, such as assessing the risk of exacerbation of apical periodontitis in root-filled teeth, undergraduate students can benefit from being trained to reflect. This study aimed to explore how students specifically reflected on clinical experiences in relation to uncertainty when assessing a case involving a root-filled tooth with apical periodontitis.
Methodology: Short reflections were written by 52 dental students at Malmö University in 2021. All students were asked to reflect on the risk for exacerbation of apical periodontitis in a case with a root-filled tooth with a diffuse widening of the periodontal ligament space. The reflections were written according to prompts developed to stimulate reflection. For each student, the reflections were analysed by a qualitative method, Systematic Text Condensation (STC).
Results: The analysis of the qualitative data resulted in the formulation of two themes about experience and lack of experience: Theme 1 'The meaning of clinical experience' and Theme 2 'Differences and similarities'. The themes were subdivided into nine subgroups and described the relationship between experience and certainty.
Conclusions: The students believed that certainty comes with experience even when there is a lack of scientific evidence.
{"title":"Uncertainty in Relation to Clinical Experience-A Qualitative Study on Dental Students' Reflections on Risk Assessment of Root Filled Teeth.","authors":"Joséphine Brodén, Maria Pigg, Niklas Vareman, Helena Fransson","doi":"10.1111/iej.70047","DOIUrl":"https://doi.org/10.1111/iej.70047","url":null,"abstract":"<p><strong>Aim: </strong>In uncertain clinical situations, such as assessing the risk of exacerbation of apical periodontitis in root-filled teeth, undergraduate students can benefit from being trained to reflect. This study aimed to explore how students specifically reflected on clinical experiences in relation to uncertainty when assessing a case involving a root-filled tooth with apical periodontitis.</p><p><strong>Methodology: </strong>Short reflections were written by 52 dental students at Malmö University in 2021. All students were asked to reflect on the risk for exacerbation of apical periodontitis in a case with a root-filled tooth with a diffuse widening of the periodontal ligament space. The reflections were written according to prompts developed to stimulate reflection. For each student, the reflections were analysed by a qualitative method, Systematic Text Condensation (STC).</p><p><strong>Results: </strong>The analysis of the qualitative data resulted in the formulation of two themes about experience and lack of experience: Theme 1 'The meaning of clinical experience' and Theme 2 'Differences and similarities'. The themes were subdivided into nine subgroups and described the relationship between experience and certainty.</p><p><strong>Conclusions: </strong>The students believed that certainty comes with experience even when there is a lack of scientific evidence.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To compare the accuracy and design time of artificial intelligence (AI)-generated and manually designed (MD) surgical pathways for osteotomies and root-end resections in dynamic navigation (DN)-aided endodontic microsurgery (EMS).
Methodology
Fifty-one surgical pathways were analysed, each planned using both AI and MD methodologies. Accuracy was assessed using the DCARE Navigation System (v3.2, MedNav Ltd) and AutoCAD (2023, Autodesk Inc.), evaluating five parameters: start deviation, end deviation, angular deviation, root-end resection length deviation, and root-end resection angulation deviation. Design time was measured from the point of CBCT dataset import to the finalisation of the surgical pathway design. Mann–Whitney U test was used to compare the accuracy and design time of the AI and MD groups, whereas the rank-based ANCOVA was used to assess deviations according to tooth type, jaw type, and root number. Statistical significance was set at p < 0.05.
Results
Compared with the MD group, the AI group exhibited significantly smaller root-end resection length deviations (AI: 0.01 [0.01, 0.02] mm; MD: 0.02 [0.01, 0.03] mm; p = 0.029) but significantly larger root-end resection angulation deviations (AI: 3.48 [1.01, 7.48]; MD: 0.35 [0.16, 0.73]; p < 0.001). There were no significant differences in the start deviation, end deviation, angular deviation, root-end resection length deviation, or root-end resection angulation deviation across tooth type, jaw type, or root number. The design time was significantly shorter in the AI group than in the MD group (55 [21, 74] s vs. 379 [215, 553] s; p < 0.001).
Conclusions
A clinically operational AI-based surgical path design approach is capable of minimising manual interventions and delivering time-efficient, accurate results for clinical use. The integration of AI with DN-aided EMS may contribute to the development of increasingly autonomous surgical procedures.
{"title":"Comparative Analysis of AI-Generated and Manually Designed Approaches in Accuracy and Design Time for Surgical Path Planning of Dynamic Navigation-Aided Endodontic Microsurgery: A Retrospective Study","authors":"Chen Chen, Xining Zhang, Li Qin, Liuyan Meng","doi":"10.1111/iej.70045","DOIUrl":"10.1111/iej.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To compare the accuracy and design time of artificial intelligence (AI)-generated and manually designed (MD) surgical pathways for osteotomies and root-end resections in dynamic navigation (DN)-aided endodontic microsurgery (EMS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>Fifty-one surgical pathways were analysed, each planned using both AI and MD methodologies. Accuracy was assessed using the DCARE Navigation System (v3.2, MedNav Ltd) and AutoCAD (2023, Autodesk Inc.), evaluating five parameters: start deviation, end deviation, angular deviation, root-end resection length deviation, and root-end resection angulation deviation. Design time was measured from the point of CBCT dataset import to the finalisation of the surgical pathway design. Mann–Whitney <i>U</i> test was used to compare the accuracy and design time of the AI and MD groups, whereas the rank-based ANCOVA was used to assess deviations according to tooth type, jaw type, and root number. Statistical significance was set at <i>p</i> < 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with the MD group, the AI group exhibited significantly smaller root-end resection length deviations (AI: 0.01 [0.01, 0.02] mm; MD: 0.02 [0.01, 0.03] mm; <i>p</i> = 0.029) but significantly larger root-end resection angulation deviations (AI: 3.48 [1.01, 7.48]; MD: 0.35 [0.16, 0.73]; <i>p</i> < 0.001). There were no significant differences in the start deviation, end deviation, angular deviation, root-end resection length deviation, or root-end resection angulation deviation across tooth type, jaw type, or root number. The design time was significantly shorter in the AI group than in the MD group (55 [21, 74] s vs. 379 [215, 553] s; <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A clinically operational AI-based surgical path design approach is capable of minimising manual interventions and delivering time-efficient, accurate results for clinical use. The integration of AI with DN-aided EMS may contribute to the development of increasingly autonomous surgical procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 2","pages":"288-298"},"PeriodicalIF":7.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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