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The Cost of Instrument Retrieval on the Root Integrity 基于根完整性的仪器检索成本。
IF 7.1 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE
International endodontic journal
Pub Date : 2025-09-02 DOI: 10.1111/iej.70027
Marco A. Versiani, Hugo Sousa Dias, Emmanuel J. N. L. Silva, Felipe G. Belladonna, Jorge N. R. Martins, Gustavo De-Deus

Aim

To evaluate dentine loss in mesial canals of mandibular molars following instrument fragment retrieval using two techniques.

Methodology

Ten mesial roots of mandibular molars with Type II configuration were selected and scanned in a micro-computed tomography (CT) device. After canal preparation, a 3-mm fragment of a size 35/0.04 rotary instrument was intentionally fractured in the middle third of each mesial canal. In each tooth, one mesial canal was randomly assigned to either ultrasonic retrieval (n = 10) or the combined ultrasonic/lasso technique (n = 10). Removal time was recorded, and pre- and post-retrieval scans were registered to assess changes in dentine thickness, dentine volume, canal volume and cross-sectional area. Data were analysed using Student's t-test, Mann–Whitney U test, Chi-square and Fisher's Exact tests (α = 0.05).

Results

All fragments were successfully retrieved. Ultrasonic removal was faster than the combined technique (p = 0.023) but resulted in greater dentine thickness reduction (p = 0.029). No significant differences were observed in canal area increase between groups (p = 0.698). After instrument retrieval, canal volume increased by 23.8%, while dentine volume decreased by 2.2%. Both techniques led to significant reductions in thick dentine regions and increases in thinner regions after preparation and retrieval (p < 0.001), with no significant differences between groups (p > 0.05).

Conclusions

Both techniques were effective in retrieving fractured instruments and resulted in similar increases in canal area and volume, as well as comparable proportions of cross-sections exhibiting minimal dentine thickness below 0.5 mm. However, while ultrasonic removal was faster, it caused a greater percentage reduction of dentine thickness compared to the combined ultrasonic/lasso technique.

目的：评价两种方法在下颌磨牙器械碎片回收术中牙本质的损失。方法：选择10颗II型型下颌磨牙近中根，用微型计算机断层扫描设备进行扫描。根管准备后，在每根近中根管的中间三分之一处故意骨折一个尺寸为35/0.04的3毫米旋转器械碎片。在每颗牙齿中，随机分配一根近中根管进行超声检索（n = 10）或超声/套索联合技术（n = 10）。记录拔牙时间，记录拔牙前后的扫描，评估牙本质厚度、牙本质体积、牙根管体积和截面积的变化。数据分析采用Student’st检验、Mann-Whitney U检验、卡方检验和Fisher’s Exact检验（α = 0.05）。结果：所有碎片均检索成功。超声去除速度比联合去除快（p = 0.023），但牙本质厚度减少更大（p = 0.029）。两组间椎管面积增加差异无统计学意义（p = 0.698）。器械取出后根管体积增加23.8%，牙本质体积减少2.2%。两种方法均能显著减少牙本质厚区，增加牙本质薄区（p < 0.05）。结论：这两种技术在修复骨折器械方面都是有效的，并且在椎管面积和体积上都有相似的增加，并且在牙质厚度小于0.5 mm的横截面上也有相似的比例。然而，虽然超声去除速度更快，但与超声/套索联合技术相比，它使牙本质厚度减少的百分比更大。
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引用次数: 0
Outcome Following Complete and Partial Pulpotomy in Managing Cariously Exposed Mature Permanent Molars With Symptomatic Irreversible Pulpitis: A 5-Year Follow-Up of a Randomised Clinical Trial 完全和部分切髓术治疗严重外露的成熟恒磨牙伴症状不可逆牙髓炎的结果：一项5年随访的随机临床试验。
IF 7.1 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE
International endodontic journal
Pub Date : 2025-09-02 DOI: 10.1111/iej.70028
Ankita Ramani, Pankaj Sangwan

Introduction

Numerous studies have reported favourable outcomes following complete pulpotomy (CP) and partial pulpotomy (PP) in cariously exposed mature permanent teeth with symptomatic irreversible pulpitis (SIP) at 1-year follow-up. However, literature on long-term outcomes is sparse. The European Society of Endodontology and the American Association of Endodontists emphasised the need for long-term evidence before establishing pulpotomy as a definitive treatment. This prospective follow-up study aimed to compare 5-year outcomes of CP and PP performed in such teeth.

Methodology

This prospective study followed participants from a previously published superiority randomised trial on CP and PP for managing cariously exposed mature permanent teeth with SIP. The original trial was registered at ClinicalTrials.gov (NCT04397315). Ninety-three participants (CP—49, PP—44) received the allocated intervention. Of these, 88 (CP—45, PP—43) participants who attended the 1-year follow-up were recalled for the 5-year follow-up. The primary outcome was combined clinical and radiographic success. Secondary outcome measures included hard tissue barrier (HTB) formation and pulp canal obliteration (PCO). Cases were analysed for restoration integrity, secondary caries, periodontal status and pulp sensibility responses. The impact of various prognostic factors on 5-year success was analysed. Outcome measures at 5-year were compared with 1-year outcomes. Statistical tests included the Mann–Whitney U test, chi-squared test, Fisher's exact test, McNemar's test, intention-to-treat analysis and binary logistic regression, with significance set at p < 0.05.

Results

At 5 years, 59 of 88 participants (CP—28, PP—31) were available for follow-up. The overall success was 83.05%, with no significant difference between groups (p = 0.494, RR = 1.10, 95% CI = 0.88–1.40). While both groups showed comparable evidence of HTB (p = 0.581, RR = 1.06, 95% CI = 0.91–1.23), PCO was significantly more evident in the CP group (p = 0.003, RR = 0.22, 95% CI = 0.07–0.70). The PP group elicited significantly more sensibility responses to cold test (p = 0.015, RR = 2.35, 95% CI = 1.09–7.43). Secondary caries was a significant prognostic factor influencing overall success at 5 years (p < 0.05). No significant differences in success, HTB, or PCO were observed between the 1 and 5 years outcomes in either group (p > 0.05).

Conclusions

CP and PP demonstrated comparable success at 5 

大量研究报道了对有症状不可逆牙髓炎（SIP）的严重外露成熟恒牙进行完全髓切术（CP）和部分髓切术（PP） 1年随访后的良好结果。然而，关于长期结果的文献很少。欧洲牙髓学学会和美国牙髓医师协会强调，在确定牙髓切开术作为一种确定的治疗方法之前，需要长期的证据。本前瞻性随访研究旨在比较这类牙行CP和PP的5年预后。方法：这项前瞻性研究追踪了先前发表的一项优越性随机试验的参与者，该试验是关于CP和PP治疗严重外露的成熟恒牙伴SIP的。最初的试验在ClinicalTrials.gov注册（NCT04397315）。93名参与者（CP-49, PP-44）接受了分配的干预。其中88名参加1年随访的参与者（CP-45, PP-43）被召回进行5年随访。主要结果是临床和放射学的综合成功。次要指标包括硬组织屏障（HTB）形成和髓管闭塞（PCO）。对病例进行修复完整性、继发龋、牙周状况和牙髓敏感性反应的分析。分析各种预后因素对5年成功的影响。将5年的结果与1年的结果进行比较。统计检验包括Mann-Whitney U检验、卡方检验、Fisher精确检验、McNemar检验、意向治疗分析和二元逻辑回归，显著性设置为p。结果：5年时，88名参与者（CP-28, PP-31）中有59人可随访。总成功率为83.05%，组间差异无统计学意义（p = 0.494, RR = 1.10, 95% CI = 0.88-1.40）。两组均有相似的HTB证据（p = 0.581, RR = 1.06, 95% CI = 0.91-1.23），而CP组的PCO更为明显（p = 0.003, RR = 0.22, 95% CI = 0.07-0.70）。PP组对冷试验的敏感性反应显著高于对照组（p = 0.015, RR = 2.35, 95% CI = 1.09-7.43）。继发龋是影响5年总体成功率的重要预后因素（p < 0.05）。结论：CP和PP在5年内表现出相当的成功。考虑到PP的保守方法，降低PCO的风险，以及更可靠的牙髓敏感性再优化反应，PP可能是首选。充分的修复密封是长期成功的关键。试验注册：ClinicalTrials.gov标识符：NCT04397315。
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引用次数: 0
Pre-Operative Factors on Prognosis of Regenerative Endodontic Procedures: A Systematic Review and Meta-Analysis 影响再生牙髓治疗预后的术前因素：一项系统综述和荟萃分析。
IF 7.1 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE
International endodontic journal
Pub Date : 2025-08-31 DOI: 10.1111/iej.70025
Filipe Colombo Vitali, Alexandre Henrique dos Reis-Prado, Pablo Silveira Santos, Ana Paula Portes Zeno, Patrícia de Andrade de Risso, Lucianne Cople Maia, Francine Benetti, Cleonice da Silveira da Teixeira
<div> <section> <h3> Background</h3> <p>Although regenerative endodontics has advanced in recent years, the influence of pre-operative factors on treatment outcomes remains poorly understood.</p> </section> <section> <h3> Objective</h3> <p>To evaluate the effect of pre-operative factors—including age, gender, tooth type, aetiology of pulp necrosis, stage of root development, clinical signs/symptoms and periradicular status—on the treatment outcomes of regenerative endodontic procedures (REPs) in immature permanent teeth.</p> </section> <section> <h3> Methods</h3> <p>A literature search was conducted on six electronic databases and grey literature to identify studies investigating the effect of pre-operative factors on REP outcomes. The risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk-of-Bias 2 tool for randomised clinical trials (RCTs). Meta-analyses of proportions were conducted to estimate pooled rates for the outcomes ‘clinical and radiographic healing’, ‘root development’ and ‘apical closure’ across different pre-operative factors. Associations between these factors and treatment outcomes were assessed through meta-analyses of effect sizes. The certainty of evidence was evaluated using the GRADE approach.</p> </section> <section> <h3> Results</h3> <p>Twenty studies were included, comprising 13 observational studies and seven RCTs. Most studies presented a moderate to high risk of bias. The pooled success rate for clinical and radiographic healing exceeded 81% across all pre-operative factors. Moreover, root development was achieved in 52%–95% of cases, whereas complete apical closure ranged from 32% to 91%. No significant association was found between pre-operative factors and clinical and radiographic healing. It was found that teeth with pulp necrosis due to trauma presented 3.59 times higher relative risk of root development failure compared to those with necrosis due to anatomic anomaly (RR = 3.59, 95% CI 1.21–10.67, <i>p</i> = 0.02). Incisors presented 1.90 times higher relative risk of root development failure (RR = 1.90, 95% CI: 1.37–2.63, <i>p</i> < 0.01) and 1.98 times higher relative risk of incomplete apical closure (RR = 1.98, 95% CI: 1.34–3.13, <i>p</i> = 0.02) compared to premolars. The presence of an apical lesion increased the relative risk of root development failure by 2.55 times (RR = 2.55, 95% CI: 1.63–4.86, <i>p</i> = 0.01). The certainty of evidence was rated as very low.</p> </section> <section>
背景：尽管再生牙髓学近年来取得了进展，但术前因素对治疗结果的影响仍然知之甚少。目的：探讨年龄、性别、牙型、牙髓坏死病因、牙根发育阶段、临床体征/症状及根周状态等术前因素对未成熟恒牙再生根管治疗效果的影响。方法：对6个电子数据库和灰色文献进行文献检索，以确定术前因素对REP预后影响的研究。观察性研究使用纽卡斯尔-渥太华量表评估偏倚风险，随机临床试验（rct）使用Cochrane偏倚风险2工具评估偏倚风险。进行了比例荟萃分析，以估计不同术前因素的“临床和影像学愈合”、“根发育”和“根尖闭合”结果的汇总率。通过效应量的荟萃分析评估这些因素与治疗结果之间的关联。使用GRADE方法评估证据的确定性。结果：纳入20项研究，包括13项观察性研究和7项随机对照试验。大多数研究显示偏倚的风险为中至高。在所有术前因素中，临床和影像学愈合的总成功率超过81%。此外，根尖发育在52%-95%的病例中得以实现，而根尖完全闭合在32% - 91%之间。术前因素与临床和影像学愈合之间无明显关联。外伤牙髓坏死相对于解剖异常牙髓坏死牙根发育失败的相对危险度为3.59倍（RR = 3.59, 95% CI 1.21 ~ 10.67, p = 0.02）。门牙牙根发育衰竭的相对危险度高出1.90倍（RR = 1.90, 95% CI: 1.37-2.63, p）结论：术前因素与rep患者的临床和影像学愈合无显著相关性，但创伤相关牙髓坏死、牙型（门牙）和根尖病变的存在与牙根发育衰竭的风险增加相关。由于研究间的异质性、中度至高度的偏倚风险和极低的证据确定性，这些发现应谨慎解释。
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引用次数: 0
Teaching Vital Pulp Treatment for Permanent Teeth to Undergraduate/Pre-Doctoral Students: A Multinational Survey 恒牙牙髓治疗教学：一项跨国调查。
IF 7.1 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE
International endodontic journal
Pub Date : 2025-08-29 DOI: 10.1111/iej.70020
Venkateshbabu Nagendrababu, Mohannad Nassar, Lokhasudhan Govindaraju, Anil Kishen, Paul V. Abbott, Henry F. Duncan

Aim

To investigate the current status of education in vital pulp treatment (VPT) for the management of permanent teeth in relation to undergraduate/pre-doctoral students at a range of dental schools worldwide.

Methodology

The web-based survey consisted of 28 questions that had been validated and piloted by a range of experienced endodontists. Faculty members who taught endodontics at one dental school in each selected country participated in the survey, which was completed in March 2025. Simple descriptive statistics were used to present the data.

Results

Forty faculty members from various countries completed the survey; the majority of which (82.5%) worked at public universities. All participating dental schools included VPT teaching in their undergraduate/predoctoral curricula. The primary method of teaching VPT in the majority of dental schools was didactic lectures. VPT preclinical exercises were included in only 32.5% of the schools. The vast majority of dental schools did not require students to pass a preclinical or clinical competency examination in relation to VPT prior to graduation. Hydraulic calcium silicate materials were the most commonly used for exposed pulps but not for pulps that were not exposed.

Conclusions

VPT has been integrated into the undergraduate/pre-doctoral curriculum of all dental schools that participated in this survey. However, the majority of dental schools that were surveyed lacked preclinical teaching and competency assessments for VPT in both preclinical and clinical scenarios.

目的：调查世界范围内牙科学校本科生/博士生在恒牙管理中的牙髓生命治疗（VPT）教育现状。方法：基于网络的调查包括28个问题，由一系列经验丰富的牙髓医生验证和试点。在每个选定国家的一所牙科学校教授牙髓学的教师参加了这项调查，该调查于2025年3月完成。使用简单的描述性统计来表示数据。结果：40位来自不同国家的教师完成了调查；其中大部分（82.5%）在公立大学工作。所有参与的牙科学校都将VPT教学纳入其本科/博士预科课程。在大多数牙科学校，VPT教学的主要方法是说教式讲座。只有32.5%的学校纳入了VPT临床前练习。绝大多数牙科学校不要求学生在毕业前通过与VPT相关的临床前或临床能力考试。水工硅酸钙材料最常用于暴露纸浆，但不用于未暴露纸浆。结论：VPT已被纳入所有参加本次调查的牙科学校的本科/博士预科课程。然而，大多数被调查的牙科学校在临床前和临床情景中缺乏临床前教学和VPT能力评估。
{"title":"Teaching Vital Pulp Treatment for Permanent Teeth to Undergraduate/Pre-Doctoral Students: A Multinational Survey","authors":"Venkateshbabu Nagendrababu,&nbsp;Mohannad Nassar,&nbsp;Lokhasudhan Govindaraju,&nbsp;Anil Kishen,&nbsp;Paul V. Abbott,&nbsp;Henry F. Duncan","doi":"10.1111/iej.70020","DOIUrl":"10.1111/iej.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To investigate the current status of education in vital pulp treatment (VPT) for the management of permanent teeth in relation to undergraduate/pre-doctoral students at a range of dental schools worldwide.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>The web-based survey consisted of 28 questions that had been validated and piloted by a range of experienced endodontists. Faculty members who taught endodontics at one dental school in each selected country participated in the survey, which was completed in March 2025. Simple descriptive statistics were used to present the data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty faculty members from various countries completed the survey; the majority of which (82.5%) worked at public universities. All participating dental schools included VPT teaching in their undergraduate/predoctoral curricula. The primary method of teaching VPT in the majority of dental schools was didactic lectures. VPT preclinical exercises were included in only 32.5% of the schools. The vast majority of dental schools did not require students to pass a preclinical or clinical competency examination in relation to VPT prior to graduation. Hydraulic calcium silicate materials were the most commonly used for exposed pulps but not for pulps that were not exposed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>VPT has been integrated into the undergraduate/pre-doctoral curriculum of all dental schools that participated in this survey. However, the majority of dental schools that were surveyed lacked preclinical teaching and competency assessments for VPT in both preclinical and clinical scenarios.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"58 12","pages":"1940-1947"},"PeriodicalIF":7.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952993","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}
引用次数: 0
Patient Satisfaction and Long-Term Outcomes: A 7- to 9-Year Prospective Cohort Study of Root Canal Treatment in the Swedish Public Dental Service 患者满意度和长期结果：瑞典公共牙科服务根管治疗的7- 9年前瞻性队列研究。
IF 7.1 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE
International endodontic journal
Pub Date : 2025-08-29 DOI: 10.1111/iej.70018
Emma Wigsten, Anita Afkhami, Hosaina Afewerki, Anna Levinsson, EndoReCo, Thomas Kvist

Aim

This prospective follow-up study aimed to assess patient satisfaction with root canal treatment (RCT) 7–9 years after initiation in a general dental practice setting.

Method

A study population of 243 patients initiated RCT at 20 public dental clinics in the Västra Götaland Region, Sweden. One to 3 years later, 159 patients (67.4%) responded to an 8-item questionnaire assessing patient satisfaction with RCT and treatment results. The questionnaire was sent out again 7–9 years after treatment initiation. Descriptive and analytical statistics were used to compare respondents and non-respondents, tooth groups and comparison over time.

Results

A total of 156 patients (72.2%) responded to the 7–9 years' questionnaire; 82 women (52.6%) and 74 men (47.4%) with a mean age of 59.3 years (SD = ±15.3). Non-respondents were significantly younger (p < 0.001). The majority of RCTs were reported as completed with a root filling (n = 102, 65.4%), although significantly fewer molars were completed (n = 43, 56.6%; p < 0.001). Sixty-six patients (63.5%) reported no current pain, while most of those reporting pain described it as mild (n = 30, 90.9%). More than half of the root filled incisors were associated with current pain (n = 15, 57.7%; p < 0.009). A total of 111 patients (76.0%) recalled the procedure as painful. Chewing ability received the highest satisfaction rating (mean = 1.3). The majority of patients reported they would choose RCT again (n = 114, 77.0%). Among the 17 who answered ‘No’, 13 had undergone extraction, and 3 reported persistent pain following RCT. Over time, the number of extracted teeth increased (p < 0.001), while current pain intensity decreased and retrospective satisfaction with RCT improved (p < 0.001).

Conclusions

Seven to nine years after the initiation of RCT in this general dental practice setting, patient satisfaction remains high despite one-third of treated teeth being reported as extracted. These findings highlight the importance of incorporating patient-reported outcomes in the evaluation of dental procedures, including endodontic treatments.

目的：本前瞻性随访研究旨在评估普通牙科治疗开始后7-9年患者对根管治疗（RCT）的满意度。方法：对瑞典Västra Götaland地区20家公立牙科诊所的243例患者进行随机对照试验。1 - 3年后，159例患者（67.4%）回答了一份8项问卷，评估患者对RCT和治疗结果的满意度。在治疗开始后7-9年再次发放问卷。描述性和分析性统计用于比较应答者和非应答者、牙齿组和时间的比较。结果：共有156例患者（72.2%）回答了7-9年的问卷调查；女性82例（52.6%），男性74例（47.4%），平均年龄59.3岁（SD =±15.3）。结论：在这个普通牙科诊所开始RCT七到九年之后，尽管有三分之一的治疗牙齿被报告拔除，但患者满意度仍然很高。这些发现强调了将患者报告的结果纳入牙科手术评估的重要性，包括牙髓治疗。
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引用次数: 0
The "Testing Effect" in Undergraduate Endodontic Education: The Impact of Regular Low Stakes Testing on Learning Outcomes and Student Engagement. 本科牙髓学教育中的“测试效应”：定期低风险测试对学习成果和学生参与的影响。
IF 7.1 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE
International endodontic journal
Pub Date : 2025-08-29 DOI: 10.1111/iej.70022
M Kalyva, K Kavvadia, L Louca, I Televantou, M P Michaelides

Aim: This study investigates the impact of regular testing on learning outcomes in undergraduate endodontic education. Specifically, it examines whether students perform better at the end of the course on previously tested material compared to non-tested material and explores the role of students' engagement and perceptions of testing in this effect.

Methodology: A within-participants experimental design was employed with 81 third-year dental students enrolled in a preclinical endodontics course. Students were tested on half of the course lectures (tested material) immediately after each lecture, while the remaining lectures served as a control (non-tested material). Testing was conducted using multiple-choice questions on the Blackboard Learn platform with immediate automated feedback. Final exam scores for tested and non-tested material were compared, and a subset of students (n = 44) completed a questionnaire assessing cognitive engagement, emotional engagement, and perceptions of testing.

Results: Students scored significantly higher on tested material (Mean = 25.284, SD = 4.202) compared to non-tested material (Mean = 21.111, SD = 3.847). The mean difference between the two scores was statistically significant with a very large effect size (F1,80 = 108.329, p < 0.001, ηp 2 = 0.575). The difference remained significant with a moderate to large effect size after accounting for the grade in the previous course and sex (F1,78 = 9.392, p = 0.003, ηp 2 = 0.107). Emotional engagement was found to moderate the effectiveness of testing, with students reporting higher emotional engagement showing greater gains from the intervention.

Conclusions: The findings demonstrate a robust testing effect in undergraduate endodontic education, supporting the hypothesis that retrieval practice enhances learning outcomes. These results suggest that integrating regular, low-stakes testing into dental curricula can enhance dental students' learning outcomes at the end of the course.

目的：探讨牙髓学教育中定期测试对学习效果的影响。具体来说，它考察了学生在课程结束时是否比未测试的材料表现得更好，并探讨了学生的参与和对测试的看法在这种影响中的作用。方法：采用参与者内实验设计，对81名参加临床前牙髓学课程的三年级牙科学生进行研究。学生们在每节课结束后立即对一半的课程（测试材料）进行测试，而其余的课程作为对照（未测试材料）。测试是在Blackboard Learn平台上使用多项选择题进行的，并有即时的自动反馈。对测试材料和未测试材料的期末考试成绩进行比较，一部分学生（n = 44）完成了一份评估认知参与、情感参与和测试感知的问卷。结果：学生在测试材料上的得分（Mean = 25.284, SD = 4.202）明显高于未测试材料（Mean = 21.111, SD = 3.847）。两种评分的平均差异有统计学意义，效应量非常大（F1,80 = 108.329, p p 2 = 0.575）。在考虑了前一课程的成绩和性别后，差异仍然显著，具有中等到较大的效应量（F1,78 = 9.392, p = 0.003, ηp 2 = 0.107）。研究发现，情绪投入可以调节测试的有效性，学生们报告的情绪投入越高，表明干预的收益越大。结论：本研究结果在牙髓学本科教育中具有显著的检验效应，支持了检索练习提高学习效果的假设。这些结果表明，将常规的、低风险的测试纳入牙科课程可以提高牙科学生在课程结束时的学习成果。
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引用次数: 0
Innovative Didactic Learning Formats: Have They Improved Dental Education? A Systematic Review and Meta-Analysis. 创新的教学模式：是否改善了牙科教育？系统回顾和荟萃分析。
IF 7.1 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE
International endodontic journal
Pub Date : 2025-08-28 DOI: 10.1111/iej.70006
Ana Arias, Min-Seock Seo, Lucia Gancedo-Caravia, Isabel Fernandez-Garcia, Juan José Pérez-Higueras

Background: New learning methods require higher professor-to-student ratios, increased faculty preparation time, continuous professional development for educators, and expanded physical spaces within university settings.

Objectives: This systematic review aimed to answer the following PICO question: In dental students (P), what is the effectiveness of innovative formats of learning (I) in comparison with traditional formats (C) in terms of educational outcomes and satisfaction (O)?

Methods: After PROSPERO protocol registration, a literature search was conducted using Web of Science (WoS), Scopus, PubMed and Cochrane Central Register of Controlled Trials. Selection of studies was performed in a three-step process: identification, screening and eligibility. Data was extracted and analysed qualitatively and quantitatively. A random-effects meta-analysis was conducted to provide an estimate of the effect of innovative teaching formats in dental education. Additionally, subgroup analyses were performed to investigate potential differences in effectiveness based on the type of innovative teaching intervention.

Results: One hundred and nineteen studies matched the inclusion criteria and were included in the systematic review. A meta-analysis of 23 studies (1074 students in the control and 1021 in the experimental group) revealed significant differences in favour of innovative teaching methods (p < 0.00001) with considerable heterogeneity (χ2 = 297.46, p < 0.00001; I2 = 93%). Subgroup analysis also revealed significantly different results depending on the innovative teaching approach (p = 0.02). Both asynchronous independent learning and synchronous learning, either in a large group with the whole class of students using blended learning or in small groups, resulted in a significantly better outcome than traditional learning (overall effect: Z = 5.85; p < 0.00001); however, synchronous blended learning showed a significantly better outcome than the rest of the subgroups (mean difference = 16.59; 95% CI = 9.03-24.15). The quality of the studies varied, with some facing methodological challenges such as inconsistent outcome measurement, which can impact the generalisability of the findings.

Conclusions: Innovative strategies lead to superior knowledge acquisition in comparison with traditional methods. Subgroup analyses favoured synchronous blended learning, but both asynchronous independent learning and synchronous learning formats, whether implemented in large-group settings via blended approaches or in small-group environments, are more effective than traditional instruction.

Trial registration: PROSPERO (CRD42024569691).

背景：新的学习方法需要更高的教授与学生的比例，增加教师的准备时间，教育工作者的持续专业发展，以及扩大大学环境中的物理空间。目的：本系统综述旨在回答以下PICO问题：在牙科学生(P)中，与传统模式(C)相比，创新学习模式(I)在教育成果和满意度(O)方面的有效性如何？方法：在PROSPERO方案注册后，使用Web of Science （WoS）、Scopus、PubMed和Cochrane Central Register of Controlled Trials进行文献检索。研究的选择分三步进行：鉴定、筛选和入选。提取数据并进行定性和定量分析。一项随机效应荟萃分析进行了提供的效果估计创新教学格式在牙科教育。此外，我们还进行了亚组分析，以探讨不同类型创新教学干预在有效性上的潜在差异。结果：有119项研究符合纳入标准并被纳入系统评价。对23项研究（对照组1074名学生，实验组1021名学生）的荟萃分析显示，支持创新教学方法的差异显著（p 2 = 297.46, p 2 = 93%）。亚组分析也显示不同创新教学方式的结果有显著差异（p = 0.02）。异步自主学习和同步学习，无论是在全班学生采用混合学习的大群体中还是在小群体中，均显著优于传统学习（总体效果：Z = 5.85; p）。结论：创新策略在知识获取方面优于传统方法。分组分析倾向于同步混合学习，但异步独立学习和同步学习形式，无论是通过混合方法在大群体环境中实施，还是在小群体环境中实施，都比传统教学更有效。试验注册：PROSPERO （CRD42024569691）。
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引用次数: 0
Impact of Haptic Simulators and 3D-Printed Teeth on Dental Students' Self-Assessment of Endodontic Access Cavities: A Comparative Pilot Study. 触觉模拟器和3d打印牙齿对牙科学生牙髓通道腔自我评估的影响：一项比较先导研究。
IF 7.1 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE
International endodontic journal
Pub Date : 2025-08-27 DOI: 10.1111/iej.70021
Sofía Folguera, Pablo Bayón, Sandra Baena, Alexandra Flesariu

Aim: This study aimed to compare the impact of two innovative training methods, haptic simulators and 3D-printed teeth, on the self-assessment accuracy of dental students when evaluating endodontic access cavities.

Methodology: A prospective, experimental, and comparative educational trial was conducted with undergraduate dental students randomly assigned to two groups: Group S (haptic simulators, n = 12) and Group 3D (3D-printed teeth, n = 10). Participants performed six access cavity preparations over two training sessions and self-assessed their work using a standardised evaluation form. A pre-test and post-test assessment of pre-prepared access cavities was conducted to measure changes in self-assessment accuracy. Evaluations were also performed by experts to establish a gold standard. The percentage of agreement and Cohen's kappa coefficient with 95% confidence intervals (CI) were calculated for both groups. Statistical analyses included McNemar's test, Wilcoxon signed-rank test, and Mann-Whitney U test (p < 0.05).

Results: Both groups improved their self-assessment scores over time. However, only Group S showed a statistically significant increase in correct responses in the post-test evaluation (p = 0.009). The overall agreement between participants and experts remained low in both groups, with Cohen's kappa values indicating fair agreement. The primary source of disagreement was overestimation, particularly in Group 3D. While Group S exhibited better alignment with expert assessments over time, differences between the two groups were not statistically significant.

Conclusions: Haptic simulators and 3D-printed teeth both contributed to students' self-assessment skills. However, haptic simulators were more effective in improving self-assessment accuracy. Despite these improvements, agreement with expert evaluations remained low; highlighting the need for additional feedback and guidance during training.

目的：本研究旨在比较触觉模拟器和3d打印牙齿两种创新训练方法对牙科学生在评估牙髓通道腔时自我评估准确性的影响。方法：采用前瞻性、实验性、对比性教育试验，将牙科本科学生随机分为两组：S组（触觉模拟器，n = 12）和3D组（3D打印牙齿，n = 10）。参与者在两个培训课程中进行了六次通道腔准备，并使用标准化评估表格对他们的工作进行了自我评估。对预制备的通道腔进行测试前和测试后的评估，以测量自评估准确性的变化。专家还进行了评价，以建立金标准。计算两组的一致性百分比和95%置信区间（CI）的Cohen's kappa系数。统计分析采用McNemar检验、Wilcoxon sign -rank检验和Mann-Whitney U检验(p)。结果：两组自我评估得分均随时间推移而提高。然而，只有S组在测试后评估中正确反应有统计学意义的增加（p = 0.009）。在两组中，参与者和专家之间的总体一致性仍然很低，科恩的kappa值表明了公平的一致性。分歧的主要来源是高估，尤其是在3D组。随着时间的推移，S组表现出与专家评估更好的一致性，但两组之间的差异没有统计学意义。结论：触觉模拟器和3d打印牙齿都有助于学生的自我评估技能。然而，触觉模拟器在提高自我评估准确性方面更为有效。尽管有这些改进，但与专家评价的一致性仍然很低；强调在培训期间需要额外的反馈和指导。
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引用次数: 0
Factors Affecting Root Canal Treatment Case Difficulty, Practitioner Rating of Difficulty and Treatment Complications Among General Dentists and Endodontists: A Prospective Cohort Study From National Dental Practice-Based Research Network PREDICT Project 影响普通牙医和牙髓医生根管治疗病例难度、从业者难度评分和治疗并发症的因素：一项来自国家牙科实践研究网络PREDICT项目的前瞻性队列研究。
IF 7.1 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE
International endodontic journal
Pub Date : 2025-08-22 DOI: 10.1111/iej.70019
Alan S. Law, Sanket Nagarkar, Ellen Funkhouser, Rahma Mungia, Donald R. Nixdorf, Ernest W. N. Lam, Ali Nosrat, Robert S. Roda, Gregg H. Gilbert, National Dental PBRN Collaborative Group (The National Dental PBRN Collaborative Group comprises practitioners, faculty and staff investigators who contributed to this network activity)

Aim

Successful root canal treatment (RCT) is necessary for managing pulpal and periapical disease. The technical quality of RCT affects its outcome. Recognising complicating factors can be important to optimising outcomes. The aims of this study were to compare the practitioner reported case difficulty before and after completion of RCT; and to determine whether any case difficulty items were associated with complications encountered while performing the RCT.

Methodology

One hundred and four general dentists (GDs) and 49 endodontists enrolled 1860 patients needing RCT, April to September 2017. Both before RCT and upon its completion, practitioners used a 10-point scale to rate the RCT's case difficulty (Difficulty Rating [DR]). Then they used a modified Case Difficulty Assessment Form (CDAF) to record the items for difficulty using the form's list of 10 provided choices. We related practitioners' pre-RCT CDAF items to their DR ratings and to the procedural complications that they subsequently experienced during this RCT. General estimating equations (GEE) were used to assess the significance of differences in proportions between GDs and endodontists. Non-parametric tests were used to analyse compositive variables.

Results

Data of 1,698 patients were available for CDAF analyses. The mean CDAF was higher for endodontists than GDs (p < 0.001). Pre- and post-RCT DRs were significantly correlated (r = 0.79, p < 0.001), as were pre-RCT DR and the number of reported CDAF difficulties (r = 0.57, p < 0.001). Overall, practitioners encountered complications in treating 16% of patients. The complications were length of obturation > 2 mm from radiographic apex or beyond apex, canals not negotiable within 2 mm of apex, instrument separation, inadvertent filing/file placement past root apex, and perforation. Several CDAF items were independently predictive of complications. Despite the higher CDAF in teeth treated by endodontists, complications were less frequent among endodontists compared to GDs (13% vs. 19%, p < 0.001).

Conclusions

Pre-RCT assessments predicted intra-operative difficulties and outcomes. Our work underscores the need for targeted assessment tools and specialised training to improve RCT, especially in complex cases treated by GDs.

目的：成功的根管治疗（RCT）是治疗牙髓和根尖周疾病的必要条件。随机对照试验的技术质量影响其结果。认识到复杂的因素对于优化结果很重要。本研究的目的是比较医生在RCT完成前和完成后报告的病例困难；并确定是否有病例难度项目与进行随机对照试验时遇到的并发症有关。方法：2017年4月至9月，104名普通牙医（GDs）和49名牙髓科医生招募了1860名需要随机对照试验的患者。在RCT之前和完成后，从业者使用10分制来评估RCT的案例难度（难度评级[DR]）。然后，他们使用修改后的案例难度评估表（CDAF），使用表格提供的10个选项列表记录难度项目。我们将从业者在RCT前的CDAF项目与他们的DR评分以及他们随后在RCT中经历的程序性并发症联系起来。一般估计方程（GEE）用于评估GDs和牙髓医生之间比例差异的意义。采用非参数检验分析综合变量。结果：1698例患者的数据可用于CDAF分析。牙髓医生的平均CDAF高于GDs（距离根尖或根尖2毫米，根尖2毫米内不能移动的管，器械分离，不小心锉/锉放置过根尖，穿孔）。几个CDAF项目独立预测并发症。尽管牙髓医生治疗的牙齿的CDAF较高，但牙髓医生的并发症发生率低于GDs （13% vs. 19%）。结论：rct前评估可预测术中困难和结果。我们的工作强调需要有针对性的评估工具和专业培训来改进随机对照试验，特别是在由GDs治疗的复杂病例中。
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引用次数: 0
Proteomic Profiling of Dentinal Fluid for the Identification of Biomarkers in Pulpal Inflammation: An Exploratory Study 牙本质液的蛋白质组学分析用于鉴别牙髓炎症的生物标志物：一项探索性研究。
IF 7.1 1区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE
International endodontic journal
Pub Date : 2025-08-15 DOI: 10.1111/iej.70017
Claudia Brizuela, Alejandra Chaparro, María Ignacia Valencia, María José Bendek, Henry F. Duncan, Juan J. Segura-Egea, Camila Alhucema, Valeria Ramírez
<div> <section> <h3> Aim</h3> <p>To identify differentially expressed proteins (DEPs) in dentinal fluid across a range of pulpal inflammatory stages—mild, moderate, severe pulpitis—using mass spectrometry.</p> </section> <section> <h3> Methodology</h3> <p>This cross-sectional study analysed dentinal fluid from 60 patients categorised into healthy pulp (control), mild, moderate and severe pulpitis groups, based on Wolters' pulp diagnostic criteria. Pulp conditions were assessed through cold sensibility tests and radiographs, with inclusion limited to patients aged 12–40, who were systemically healthy and exhibited no advanced periodontal or apical pathology. Dentinal fluid was collected under aseptic conditions, stored at −80°C and pooled into 12 representative samples for proteomic analysis. Proteins were extracted using lysis buffers and processed via LC–MS/MS with label-free quantification (LFQ) to identify DEPs. Enrichment analysis and protein–protein interaction (PPI) networks were conducted using Gene Ontology (GO), KEGG databases and STRING, with hub proteins identified using cytoscape. Statistical analysis employed Bayesian t-tests and linear models to evaluate protein expression, with a significance threshold of <i>p</i> < 0.05.</p> </section> <section> <h3> Results</h3> <p>The severe pulpitis group exhibited the highest prevalence of systemic diseases (40%) compared with other groups (6.6%). LC–MS/MS identified 577 proteins, with 62 consistently quantified across the groups. The number of DEPs increased with inflammation severity, with 13 DEPs in severe pulpitis compared with controls. Principal component analysis (PCA) revealed partial separation between control and severe inflammation groups, with significant overlap between mild and moderate stages. Functional enrichment identified key biological pathways, including immune response, energy metabolism and structural integrity. Proteins such as cofilin-1, haemoglobin subunit alpha and peroxiredoxin-1 were upregulated in severe inflammation, while hornerin and myosin light chain 6 were downregulated. These findings highlight proteomic changes associated with pulpitis progression and identify potential prognostic biomarkers and therapeutic targets.</p> </section> <section> <h3> Conclusions</h3> <p>This study identified distinct proteomic differences across pulpitis stages, with unique proteins in severe cases. These findings highlight novel biomarkers for advancing precise, cost-effective, point-of-care diagnostics and therapies, including multiplex platforms or ELISA assays. Proteomic analysis shows promise for understanding disease mechanisms and enabling personalised
目的：利用质谱法鉴定牙本质液中不同牙髓炎阶段（轻度、中度、重度牙髓炎）的差异表达蛋白（DEPs）。方法：本横断面研究根据Wolters的牙髓诊断标准，分析了60例牙髓健康（对照组）、轻度、中度和重度牙髓炎组患者的牙髓液。通过冷敏感性试验和x线片评估牙髓状况，纳入限于12-40岁的患者，他们全身健康，没有表现出晚期牙周或根尖病理。在无菌条件下收集牙本质液，-80°C保存，并汇集成12个代表性样品进行蛋白质组学分析。使用裂解缓冲液提取蛋白质，并通过LC-MS/MS进行无标记定量（LFQ）处理，以鉴定DEPs。利用基因本体（GO）、KEGG数据库和STRING进行富集分析和蛋白相互作用（PPI）网络，利用细胞景观鉴定枢纽蛋白。统计学分析采用贝叶斯t检验和线性模型评估蛋白表达，显著性阈值为p。结果：重度牙髓炎组全身性疾病患病率最高（40%），其他组最高（6.6%）。LC-MS/MS鉴定出577种蛋白质，其中62种在组间的定量一致。dep的数量随着炎症严重程度的增加而增加，与对照组相比，严重牙髓炎中dep的数量为13。主成分分析（PCA）显示对照组和重度炎症组之间存在部分分离，轻度和中度炎症组之间存在显著重叠。功能富集鉴定了关键的生物途径，包括免疫应答、能量代谢和结构完整性。在严重炎症中，cofilin-1、血红蛋白亚基α和过氧化物还蛋白-1等蛋白上调，而角蛋白和肌球蛋白轻链6下调。这些发现强调了与牙髓炎进展相关的蛋白质组学变化，并确定了潜在的预后生物标志物和治疗靶点。结论：本研究确定了不同牙髓炎阶段的蛋白质组学差异，在严重病例中具有独特的蛋白质。这些发现强调了用于推进精确、具有成本效益的即时诊断和治疗的新型生物标志物，包括多重平台或ELISA检测。蛋白质组学分析显示了理解疾病机制和实现牙髓学个性化治疗策略的希望。
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引用次数: 0
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