Marie Mora, Jonathan Nguyen, Siddarth Mehta, Nader Mehra, Asgeir Sigurdsson, Min-Wen Fu, Nihan Gencerliler, Matthew Malek
Aim
Periapical Osteoperiostitis (PO) is an inflammatory reaction of the periosteum located on the maxillary sinus floor, characterised by reactionary deposition of bone caused by periradicular disease of the maxillary posterior teeth. Radiographically, PO presents as a radiopaque ‘halo’ over the involved root(s). There is a gap in the literature regarding the prevalence and predisposing factors of PO. This study aims (1) to evaluate the prevalence of PO in maxillary posterior teeth amongst patients at NYU College of Dentistry, Department of Endodontics, and (2) to identify predisposing factors associated with PO.
Methodology
A chart review and cone-beam computed tomography (CBCT) evaluation were conducted at NYU College of Dentistry from 2016 to 2021. Initially, 586 scans were screened, and 335 scans were included. The presence of PO, mucositis, sinus perforation, age, sex, pulpal and periapical diagnosis, size of the lesion, the vertical and horizontal distance between the sinus floor and roots, number of roots with apical lesions, type of tooth, and iatrogenic errors during treatment were recorded. Data were analysed using chi-square, Fisher's tests and logistic regression.
Results
Of the 335 CBCT scans included, 98 scans (29.3%) presented with PO. The presence of mucositis was associated with 3.37 times higher odds of PO than those without mucositis. Each incremental increase in the size of the lesion (CBCTPAI) was associated with a 2.51 increase in the odds of PO occurrence, and the vertical distance between the sinus and roots was statistically significant (p < 0.001).
Conclusion
The prevalence of PO in this study was higher than previously reported. Three factors were significantly associated with PO: the presence of mucositis, the size of the lesion, and the vertical distance between the sinus and roots.
{"title":"Prevalence and Predisposing Factors of Periapical Osteoperiostitis: A Retrospective Cross-Sectional Study","authors":"Marie Mora, Jonathan Nguyen, Siddarth Mehta, Nader Mehra, Asgeir Sigurdsson, Min-Wen Fu, Nihan Gencerliler, Matthew Malek","doi":"10.1111/iej.70033","DOIUrl":"10.1111/iej.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Periapical Osteoperiostitis (PO) is an inflammatory reaction of the periosteum located on the maxillary sinus floor, characterised by reactionary deposition of bone caused by periradicular disease of the maxillary posterior teeth. Radiographically, PO presents as a radiopaque ‘halo’ over the involved root(s). There is a gap in the literature regarding the prevalence and predisposing factors of PO. This study aims (1) to evaluate the prevalence of PO in maxillary posterior teeth amongst patients at NYU College of Dentistry, Department of Endodontics, and (2) to identify predisposing factors associated with PO.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>A chart review and cone-beam computed tomography (CBCT) evaluation were conducted at NYU College of Dentistry from 2016 to 2021. Initially, 586 scans were screened, and 335 scans were included. The presence of PO, mucositis, sinus perforation, age, sex, pulpal and periapical diagnosis, size of the lesion, the vertical and horizontal distance between the sinus floor and roots, number of roots with apical lesions, type of tooth, and iatrogenic errors during treatment were recorded. Data were analysed using chi-square, Fisher's tests and logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 335 CBCT scans included, 98 scans (29.3%) presented with PO. The presence of mucositis was associated with 3.37 times higher odds of PO than those without mucositis. Each incremental increase in the size of the lesion (CBCTPAI) was associated with a 2.51 increase in the odds of PO occurrence, and the vertical distance between the sinus and roots was statistically significant (<i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The prevalence of PO in this study was higher than previously reported. Three factors were significantly associated with PO: the presence of mucositis, the size of the lesion, and the vertical distance between the sinus and roots.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 1","pages":"38-46"},"PeriodicalIF":7.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040125","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}
This study aimed to quantify the effect of chitosan-hydroxyapatite precursor nanocomplexes (C-HA) on void reduction in the root canal system and isthmus regions, characterise void distribution patterns and assess sealer-dentin interface adaptation post-conditioning.
Methodology
Vertucci type II and Yin type IV mesial root canals from 24 extracted mandibular first molars were randomly divided into two groups (n = 12): (1) C-HA conditioned and (2) control (deionised water). All canals underwent standardised preparation using ProTaper Next files with 3% NaOCl irrigation (2 mL per file change) and final irrigation with 17% EDTA (5 mL, sonic activation) followed by 3% NaOCl (5 mL) and a final deionised water rinse (5 mL). Before obturation, the C-HA group received 5 min of C-HA solution (2 mg/mL) treatment with active agitation by ProTaper Next X2 gutta-percha cone, while the control group received equivalent water treatment. Canals were obturated using the single-cone technique with Ceraseal. High-resolution Micro-CT (8.6 μm voxel size) quantified void percentages in the entire canal system and isthmus regions, with analysis stratified by coronal, middle and apical thirds. Selected specimens underwent SEM evaluation of interfacial adaptation. Statistical analysis used the independent samples t-test, two-way ANOVA with Tukey's post hoc tests (α = 0.05), and Fisher's exact test.
Results
No significant differences related to the canal/isthmus pre-treatment volumes and isthmus characteristics were noted between the two groups. Micro-CT analysis revealed significantly lower void percentages in C-HA-treated canals compared to controls (9.21% vs. 19.01% in the entire canal system and 19.07% vs. 55.65% in the isthmus regions, p < 0.001). Analysis of the void distribution patterns further demonstrated statistically significant differences between the groups in the cervical and middle root thirds (p < 0.05). SEM evaluation showed continuous, gap-free interfaces with bioactive mineralization in C-HA-treated canals, contrasting with discontinuous adaptation and sparse precipitates in controls.
Conclusion
C-HA dentine conditioning significantly improved obturation quality with Ceraseal bioceramic sealer by reducing voids in isthmus regions and enhancing sealer-dentin interfacial adaptation.
{"title":"Enhancing the Quality of Single Cone Obturation Using Hydroxyapatite Precursor Grafted Nanocomplex for Dentine Conditioning: An In Vitro Study","authors":"Eissa Sameer Bunashi, Mingxin Hu, Angeline Hui Cheng Lee, Chengfei Zhang, Anil Kishen, Jeffrey Wen Wei Chang","doi":"10.1111/iej.70034","DOIUrl":"10.1111/iej.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to quantify the effect of chitosan-hydroxyapatite precursor nanocomplexes (C-HA) on void reduction in the root canal system and isthmus regions, characterise void distribution patterns and assess sealer-dentin interface adaptation post-conditioning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>Vertucci type II and Yin type IV mesial root canals from 24 extracted mandibular first molars were randomly divided into two groups (<i>n</i> = 12): (1) C-HA conditioned and (2) control (deionised water). All canals underwent standardised preparation using ProTaper Next files with 3% NaOCl irrigation (2 mL per file change) and final irrigation with 17% EDTA (5 mL, sonic activation) followed by 3% NaOCl (5 mL) and a final deionised water rinse (5 mL). Before obturation, the C-HA group received 5 min of C-HA solution (2 mg/mL) treatment with active agitation by ProTaper Next X2 gutta-percha cone, while the control group received equivalent water treatment. Canals were obturated using the single-cone technique with Ceraseal. High-resolution Micro-CT (8.6 μm voxel size) quantified void percentages in the entire canal system and isthmus regions, with analysis stratified by coronal, middle and apical thirds. Selected specimens underwent SEM evaluation of interfacial adaptation. Statistical analysis used the independent samples <i>t</i>-test, two-way ANOVA with Tukey's post hoc tests (<i>α</i> = 0.05), and Fisher's exact test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant differences related to the canal/isthmus pre-treatment volumes and isthmus characteristics were noted between the two groups. Micro-CT analysis revealed significantly lower void percentages in C-HA-treated canals compared to controls (9.21% vs. 19.01% in the entire canal system and 19.07% vs. 55.65% in the isthmus regions, <i>p</i> < 0.001). Analysis of the void distribution patterns further demonstrated statistically significant differences between the groups in the cervical and middle root thirds (<i>p</i> < 0.05). SEM evaluation showed continuous, gap-free interfaces with bioactive mineralization in C-HA-treated canals, contrasting with discontinuous adaptation and sparse precipitates in controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>C-HA dentine conditioning significantly improved obturation quality with Ceraseal bioceramic sealer by reducing voids in isthmus regions and enhancing sealer-dentin interfacial adaptation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 1","pages":"177-188"},"PeriodicalIF":7.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iej.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040132","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}
Mohammad A. Sabeti, Keyvan Nikghalb, Reza Pakzad, Ashraf F. Fouad
Introduction
Accurate diagnosis of pulpal health is crucial to identify the most effective therapeutic approach. However, differentiating pulpal conditions, which may require different treatment approaches, remains a challenge. This study aimed to address this gap by investigating the protein levels of 17 inflammatory biomarkers simultaneously in the dental pulp with different clinical diagnoses.
Methods
This study employed a cross-sectional exploratory design, enrolling 64 adult patients. After obtaining ethical approval, researchers conducted clinical and radiographic examinations to categorise teeth into four diagnostic groups: normal pulp, reversible pulpitis, symptomatic irreversible pulpitis and asymptomatic irreversible pulpitis. Pulpal blood samples were then collected and analysed using Luminex technology to measure the levels of inflammatory proteins and matrix metalloproteinases (MMPs). Statistical analyses, including the Mann–Whitney U test and Spearman's rank correlation, were used to compare the levels of these markers across the different diagnoses and to assess their correlation with patient symptoms.
Results
The study revealed significant increases in several inflammatory proteins, including IL-4, IL-8, MCP-1, MIP-1α, RANTES and MMP-9, in both types of irreversible pulpitis cases compared with other diagnostic categories p < 0.05. These elevated levels exhibited positive correlations with patient-reported pain scores, instances of spontaneous pain and bleeding times. Notably, only IL-4 and IL-7 exhibited correlations with prolonged bleeding times (over 10 min) p < 0.05, while IL-1α and MMP-2 were associated with shorter bleeding times (under 10 min) p < 0.05. Additionally, IL-8 and MCP-1 levels were significantly associated with positive palpation findings p < 0.05, whereas MIP-1α and MMP-1 were correlated with positive percussion results p < 0.05.
Conclusion
Differential specific inflammatory potential biomarker levels may differentiate pulpal disease states. Integrating molecular diagnostics into longitudinal clinical trials and eventually into routine endodontic practice, could revolutionise treatment decisions.
{"title":"The Relationship Between Pulpal Diagnostic Conditions and Potential Inflammatory Biomarkers","authors":"Mohammad A. Sabeti, Keyvan Nikghalb, Reza Pakzad, Ashraf F. Fouad","doi":"10.1111/iej.70030","DOIUrl":"10.1111/iej.70030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Accurate diagnosis of pulpal health is crucial to identify the most effective therapeutic approach. However, differentiating pulpal conditions, which may require different treatment approaches, remains a challenge. This study aimed to address this gap by investigating the protein levels of 17 inflammatory biomarkers simultaneously in the dental pulp with different clinical diagnoses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study employed a cross-sectional exploratory design, enrolling 64 adult patients. After obtaining ethical approval, researchers conducted clinical and radiographic examinations to categorise teeth into four diagnostic groups: normal pulp, reversible pulpitis, symptomatic irreversible pulpitis and asymptomatic irreversible pulpitis. Pulpal blood samples were then collected and analysed using Luminex technology to measure the levels of inflammatory proteins and matrix metalloproteinases (MMPs). Statistical analyses, including the Mann–Whitney <i>U</i> test and Spearman's rank correlation, were used to compare the levels of these markers across the different diagnoses and to assess their correlation with patient symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study revealed significant increases in several inflammatory proteins, including IL-4, IL-8, MCP-1, MIP-1α, RANTES and MMP-9, in both types of irreversible pulpitis cases compared with other diagnostic categories <i>p</i> < 0.05. These elevated levels exhibited positive correlations with patient-reported pain scores, instances of spontaneous pain and bleeding times. Notably, only IL-4 and IL-7 exhibited correlations with prolonged bleeding times (over 10 min) <i>p</i> < 0.05, while IL-1α and MMP-2 were associated with shorter bleeding times (under 10 min) <i>p</i> < 0.05. Additionally, IL-8 and MCP-1 levels were significantly associated with positive palpation findings <i>p</i> < 0.05, whereas MIP-1α and MMP-1 were correlated with positive percussion results <i>p</i> < 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Differential specific inflammatory potential biomarker levels may differentiate pulpal disease states. Integrating molecular diagnostics into longitudinal clinical trials and eventually into routine endodontic practice, could revolutionise treatment decisions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 1","pages":"23-37"},"PeriodicalIF":7.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iej.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023286","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}
Bandana Rana, Sanjiv Neupane, Yam Prasad Aryal, Elina Pokharel, Tae-Young Kim, Jae-Hee Lee, Je-Hee Jang, Hitoshi Yamamoto, Ji-Youn Kim, Seo-Young An, Chang-Hyeon An, Jae-Kwang Jung, Wern-Joo Sohn, Sung-Jin Cho, Jung-Hong Ha, Jae-Young Kim
Aim
Prickle planar cell polarity (PCP) protein 2 (Prickle2) encodes a homologue of Drosophila prickle and is involved in the non-canonical Wnt/PCP signalling pathway. However, its exact role in dentinogenesis remains unclear. Dentinogenesis, a key process in tooth morphogenesis, involves the patterned arrangement of odontoblasts and the formation of dentine matrix along the pulp cavity. This study investigates the role of PCP signalling, particularly Prickle2, in odontogenesis and dentine formation. Additionally, this study evaluates the potential application of Prickle2 modulation for dentine regeneration using an animal experimental model.
Methodology
The developmental function of Prickle2 in tooth morphogenesis was examined by analysing its precise expression pattern in the primary enamel knot. Gain and loss of function studies were performed using in vitro organ cultivation and renal capsule transplantation. At embryonic day 13 (E13), Prickle2 was knocked down using small interfering ribonucleic acid (siRNA) treatment, and histogenesis, cellular physiology (proliferation and apoptosis), and the expression of PCP pathway-related genes and tooth-related signalling molecules were examined. Furthermore, renal capsule transplantation was conducted for 3 weeks to analyse the morphological changes in tooth crown formation. To evaluate the clinical applicability of Prickle2 modulation in dentine regeneration, a pulp exposure animal model was employed, locally administering siRNA against Prickle2 into the exposed pulp cavity of the maxillary first molar at week 8 for 6 weeks.
Results
At E13.5, in situ hybridization revealed the distinctive expression of Prickle2 in the enamel knot area. Knockdown of Prickle2 at E13 led to significant alterations in histogenesis and changes in key signalling molecule expression. Renal capsule transplantation resulted in morphological changes, including a thicker pre-dentine layer and the formation of a more opaque crown. In the pulp exposure model, siRNA treatment facilitated the formation of a dentinal bridge compared to controls.
Conclusion
Our findings suggest that Prickle2 regulates dentinogenesis through Wnt/PCP signalling. Modulating Prickle2 expression presents a promising approach for dentine regeneration.
{"title":"Modulation of Prickle2 Expression to Facilitate Dentine Formation: A Laboratory Investigation","authors":"Bandana Rana, Sanjiv Neupane, Yam Prasad Aryal, Elina Pokharel, Tae-Young Kim, Jae-Hee Lee, Je-Hee Jang, Hitoshi Yamamoto, Ji-Youn Kim, Seo-Young An, Chang-Hyeon An, Jae-Kwang Jung, Wern-Joo Sohn, Sung-Jin Cho, Jung-Hong Ha, Jae-Young Kim","doi":"10.1111/iej.70024","DOIUrl":"10.1111/iej.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Prickle planar cell polarity (PCP) protein 2 (Prickle2) encodes a homologue of <i>Drosophila</i> prickle and is involved in the non-canonical Wnt/PCP signalling pathway. However, its exact role in dentinogenesis remains unclear. Dentinogenesis, a key process in tooth morphogenesis, involves the patterned arrangement of odontoblasts and the formation of dentine matrix along the pulp cavity. This study investigates the role of PCP signalling, particularly Prickle2, in odontogenesis and dentine formation. Additionally, this study evaluates the potential application of Prickle2 modulation for dentine regeneration using an animal experimental model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>The developmental function of Prickle2 in tooth morphogenesis was examined by analysing its precise expression pattern in the primary enamel knot. Gain and loss of function studies were performed using in vitro organ cultivation and renal capsule transplantation. At embryonic day 13 (E13), Prickle2 was knocked down using small interfering ribonucleic acid (siRNA) treatment, and histogenesis, cellular physiology (proliferation and apoptosis), and the expression of PCP pathway-related genes and tooth-related signalling molecules were examined. Furthermore, renal capsule transplantation was conducted for 3 weeks to analyse the morphological changes in tooth crown formation. To evaluate the clinical applicability of Prickle2 modulation in dentine regeneration, a pulp exposure animal model was employed, locally administering siRNA against Prickle2 into the exposed pulp cavity of the maxillary first molar at week 8 for 6 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At E13.5, in situ hybridization revealed the distinctive expression of Prickle2 in the enamel knot area. Knockdown of Prickle2 at E13 led to significant alterations in histogenesis and changes in key signalling molecule expression. Renal capsule transplantation resulted in morphological changes, including a thicker pre-dentine layer and the formation of a more opaque crown. In the pulp exposure model, siRNA treatment facilitated the formation of a dentinal bridge compared to controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings suggest that Prickle2 regulates dentinogenesis through Wnt/PCP signalling. Modulating Prickle2 expression presents a promising approach for dentine regeneration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"58 12","pages":"1902-1912"},"PeriodicalIF":7.1,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015145","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}
This article aims to introduce and elaborate on the innovative concept of Functional Endodontic Volume (FEV), a biologically driven approach to root canal shaping. This concept emphasizes the importance of volumetric preparation aimed at enhancing irrigation dynamics during root canal treatment, all while maintaining the tooth's structural integrity.
Summary
In recent years, contemporary endodontics has progressively shifted towards methods that prioritize irrigation-based disinfection. Traditional philosophies surrounding canal preparation have predominantly revolved around standardized apical sizes and tapers, often failing to address the true objectives of modern root canal treatment. This article advocates for the FEV concept—a sophisticated and tailored shaping strategy focused on optimizing the efficacy of irrigants used in treatment, promoting mechanical safety, and conserving the structural framework of the tooth. The FEV approach moves beyond merely considering the diameter or taper of the canal; instead, it emphasizes a comprehensive three-dimensional shaping method that is particularly beneficial in anatomically complex root canal systems. By prioritizing the effective exchange of irrigants and the delivery of energy throughout the entire canal volume, this concept not only enhances disinfection but also minimizes the risk of procedural complications. The implications of adopting the FEV concept extend to the clinical and research realms. It can guide the development and refinement of new shaping protocols, the design of endodontic instruments, and the establishment of standardized reporting metrics in endodontic studies. This holistic approach has the potential to revolutionize the way endodontic procedures are performed and assessed.
Conclusion
The FEV approach redefines the objectives of canal shaping by concentrating on achieving an effective disinfection-driven canal volume rather than adherence to fixed apical dimensions. It supports a minimally invasive technique that ensures optimal irrigant exchange and agitation, thereby enhancing overall treatment outcomes. The FEV concept could serve as a valuable clinical and research framework, enabling practitioners and researchers to evaluate and compare various shaping systems with a focus on volumetric efficacy.
{"title":"Redefining Root Canal Shaping: From Size to Volume—The Functional Endodontic Volume Concept","authors":"Mohammed Turky, Ove A. Peters","doi":"10.1111/iej.70029","DOIUrl":"10.1111/iej.70029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This article aims to introduce and elaborate on the innovative concept of <i>Functional Endodontic Volume</i> (FEV), a biologically driven approach to root canal shaping. This concept emphasizes the importance of volumetric preparation aimed at enhancing irrigation dynamics during root canal treatment, all while maintaining the tooth's structural integrity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Summary</h3>\u0000 \u0000 <p>In recent years, contemporary endodontics has progressively shifted towards methods that prioritize irrigation-based disinfection. Traditional philosophies surrounding canal preparation have predominantly revolved around standardized apical sizes and tapers, often failing to address the true objectives of modern root canal treatment. This article advocates for the FEV concept—a sophisticated and tailored shaping strategy focused on optimizing the efficacy of irrigants used in treatment, promoting mechanical safety, and conserving the structural framework of the tooth. The FEV approach moves beyond merely considering the diameter or taper of the canal; instead, it emphasizes a comprehensive three-dimensional shaping method that is particularly beneficial in anatomically complex root canal systems. By prioritizing the effective exchange of irrigants and the delivery of energy throughout the entire canal volume, this concept not only enhances disinfection but also minimizes the risk of procedural complications. The implications of adopting the FEV concept extend to the clinical and research realms. It can guide the development and refinement of new shaping protocols, the design of endodontic instruments, and the establishment of standardized reporting metrics in endodontic studies. This holistic approach has the potential to revolutionize the way endodontic procedures are performed and assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The FEV approach redefines the objectives of canal shaping by concentrating on achieving an effective disinfection-driven canal volume rather than adherence to fixed apical dimensions. It supports a minimally invasive technique that ensures optimal irrigant exchange and agitation, thereby enhancing overall treatment outcomes. The FEV concept could serve as a valuable clinical and research framework, enabling practitioners and researchers to evaluate and compare various shaping systems with a focus on volumetric efficacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"58 12","pages":"1810-1813"},"PeriodicalIF":7.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000416","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}
<div> <section> <h3> Aim</h3> <p>This study explores how lipid metabolic reprogramming contributes to the pathogenesis of pulpitis and identifies key molecular targets involved in regulating inflammation, with the goal of developing metabolic interventions to preserve dental pulp vitality.</p> </section> <section> <h3> Methodology</h3> <p>Primary human dental pulp cells (HDPCs) were stimulated with lipopolysaccharide (LPS) and subjected to integrated transcriptomic and metabolomic profiling to map inflammation-associated metabolic shifts. Functional validation included linolenic acid (LA) supplementation (alone or combined with a Fatty Acid Synthase (FASN) inhibitor, TVB-2640), Nuclear receptor subfamily 4 group A member 1 (NR4A1) knockdown, cytokine/NF-κB assessment (ELISA, Western blot), and lipid droplet/FASN visualisation (immunofluorescence). FASN expression was confirmed in vivo (rat pulpitis model). Key findings were verified in clinical pulpitis samples (histology, immunofluorescence, targeted fatty acid profiling).</p> </section> <section> <h3> Results</h3> <p>LPS stimulation significantly upregulated FASN expression and induced lipid accumulation in HDPCs and rat pulpitis models (<i>p</i> < 0.001). Transcriptomic analysis revealed marked downregulation of NR4A1, while metabolomic profiling showed depletion of key anti-inflammatory/pro-resolving PUFA precursors, including LA and γ-linolenic acid (GLA). Integrated transcriptomic–metabolomic analysis identified LA as a metabolite with high centrality in the lipid metabolic network, and NR4A1 as a significantly downregulated transcription factor linked to multiple lipid-related pathways. LA supplementation suppressed pro-inflammatory cytokines (IL-1β, TNF-α, phosphorylated NF-κB p65) and restored NR4A1 expression (<i>p</i> < 0.05). Combining LA with the FASN inhibitor TVB-2640 synergistically enhanced NR4A1 restoration and anti-inflammatory effects (<i>p</i> < 0.001). siRNA-mediated NR4A1 knockdown abolished the benefits of LA. In human pulpitis tissues, FASN upregulation, NR4A1 downregulation, and elevated palmitic acid were observed (<i>p</i> < 0.001), along with increased levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).</p> </section> <section> <h3> Conclusions</h3> <p>This study reveals a pathological FASN–LA–NR4A1 regulatory axis linking lipid metabolism to inflammatory amplification in pulpitis. Dual targeting of fatty acid synthesis and lipid depletion—through FASN inhibition and LA supplementation—attenuates inflammation via NR4A1-dependent mechanisms. These findings lay the groundwork for metabolic approaches to modulate inflammation
目的：本研究旨在探讨脂质代谢重编程在牙髓炎发病机制中的作用，并确定参与炎症调节的关键分子靶点，以开发代谢干预措施以保持牙髓活力。方法：用脂多糖（LPS）刺激原代人牙髓细胞（HDPCs），并进行综合转录组学和代谢组学分析，以绘制炎症相关的代谢变化。功能验证包括亚麻酸（LA）补充（单独或联合脂肪酸合成酶（FASN）抑制剂TVB-2640），核受体亚家族4组a成员1 （NR4A1）敲低，细胞因子/NF-κB评估（ELISA, Western blot）和脂滴/FASN可视化（免疫荧光）。体内（大鼠牙髓炎模型）证实FASN表达。在临床牙髓炎样本中验证了主要发现（组织学、免疫荧光、靶向脂肪酸谱）。结果：LPS刺激显著上调HDPCs和大鼠牙髓炎模型中FASN的表达并诱导脂质积累(p)。结论：本研究揭示了病理性FASN- la - nr4a1调节轴将牙髓炎中的脂质代谢与炎症扩增联系起来。脂肪酸合成和脂质消耗的双重靶向-通过FASN抑制和LA补充-通过nr4a1依赖机制减轻炎症。这些发现为代谢方法调节牙髓学炎症奠定了基础。
{"title":"Laboratory Investigation of Lipid Metabolic Reprogramming in Pulpitis: The Linolenic Acid–FASN–NR4A1 Axis in Modulating Dental Pulp Inflammation","authors":"Mengqi Zhou, Xin Sui, Changyi Li, Qiangqiang Zhou, Xiaoling Wei, Huaxing Xu","doi":"10.1111/iej.70026","DOIUrl":"10.1111/iej.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study explores how lipid metabolic reprogramming contributes to the pathogenesis of pulpitis and identifies key molecular targets involved in regulating inflammation, with the goal of developing metabolic interventions to preserve dental pulp vitality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>Primary human dental pulp cells (HDPCs) were stimulated with lipopolysaccharide (LPS) and subjected to integrated transcriptomic and metabolomic profiling to map inflammation-associated metabolic shifts. Functional validation included linolenic acid (LA) supplementation (alone or combined with a Fatty Acid Synthase (FASN) inhibitor, TVB-2640), Nuclear receptor subfamily 4 group A member 1 (NR4A1) knockdown, cytokine/NF-κB assessment (ELISA, Western blot), and lipid droplet/FASN visualisation (immunofluorescence). FASN expression was confirmed in vivo (rat pulpitis model). Key findings were verified in clinical pulpitis samples (histology, immunofluorescence, targeted fatty acid profiling).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>LPS stimulation significantly upregulated FASN expression and induced lipid accumulation in HDPCs and rat pulpitis models (<i>p</i> < 0.001). Transcriptomic analysis revealed marked downregulation of NR4A1, while metabolomic profiling showed depletion of key anti-inflammatory/pro-resolving PUFA precursors, including LA and γ-linolenic acid (GLA). Integrated transcriptomic–metabolomic analysis identified LA as a metabolite with high centrality in the lipid metabolic network, and NR4A1 as a significantly downregulated transcription factor linked to multiple lipid-related pathways. LA supplementation suppressed pro-inflammatory cytokines (IL-1β, TNF-α, phosphorylated NF-κB p65) and restored NR4A1 expression (<i>p</i> < 0.05). Combining LA with the FASN inhibitor TVB-2640 synergistically enhanced NR4A1 restoration and anti-inflammatory effects (<i>p</i> < 0.001). siRNA-mediated NR4A1 knockdown abolished the benefits of LA. In human pulpitis tissues, FASN upregulation, NR4A1 downregulation, and elevated palmitic acid were observed (<i>p</i> < 0.001), along with increased levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study reveals a pathological FASN–LA–NR4A1 regulatory axis linking lipid metabolism to inflammatory amplification in pulpitis. Dual targeting of fatty acid synthesis and lipid depletion—through FASN inhibition and LA supplementation—attenuates inflammation via NR4A1-dependent mechanisms. These findings lay the groundwork for metabolic approaches to modulate inflammation","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"58 12","pages":"1913-1925"},"PeriodicalIF":7.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952948","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}
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.
{"title":"The Cost of Instrument Retrieval on the Root Integrity","authors":"Marco A. Versiani, Hugo Sousa Dias, Emmanuel J. N. L. Silva, Felipe G. Belladonna, Jorge N. R. Martins, Gustavo De-Deus","doi":"10.1111/iej.70027","DOIUrl":"10.1111/iej.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate dentine loss in mesial canals of mandibular molars following instrument fragment retrieval using two techniques.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>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 (<i>n</i> = 10) or the combined ultrasonic/lasso technique (<i>n</i> = 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 <i>t</i>-test, Mann–Whitney <i>U</i> test, Chi-square and Fisher's Exact tests (<i>α</i> = 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All fragments were successfully retrieved. Ultrasonic removal was faster than the combined technique (<i>p</i> = 0.023) but resulted in greater dentine thickness reduction (<i>p</i> = 0.029). No significant differences were observed in canal area increase between groups (<i>p</i> = 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 (<i>p</i> < 0.001), with no significant differences between groups (<i>p</i> > 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"58 12","pages":"1948-1957"},"PeriodicalIF":7.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953060","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}
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).
{"title":"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","authors":"Ankita Ramani, Pankaj Sangwan","doi":"10.1111/iej.70028","DOIUrl":"10.1111/iej.70028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>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 <i>U</i> test, chi-squared test, Fisher's exact test, McNemar's test, intention-to-treat analysis and binary logistic regression, with significance set at <i>p</i> < 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 (<i>p</i> = 0.494, RR = 1.10, 95% CI = 0.88–1.40). While both groups showed comparable evidence of HTB (<i>p</i> = 0.581, RR = 1.06, 95% CI = 0.91–1.23), PCO was significantly more evident in the CP group (<i>p</i> = 0.003, RR = 0.22, 95% CI = 0.07–0.70). The PP group elicited significantly more sensibility responses to cold test (<i>p</i> = 0.015, RR = 2.35, 95% CI = 1.09–7.43). Secondary caries was a significant prognostic factor influencing overall success at 5 years (<i>p</i> < 0.05). No significant differences in success, HTB, or PCO were observed between the 1 and 5 years outcomes in either group (<i>p</i> > 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CP and PP demonstrated comparable success at 5 ","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"58 12","pages":"1835-1848"},"PeriodicalIF":7.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952998","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}
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。
{"title":"Pre-Operative Factors on Prognosis of Regenerative Endodontic Procedures: A Systematic Review and Meta-Analysis","authors":"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","doi":"10.1111/iej.70025","DOIUrl":"10.1111/iej.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although regenerative endodontics has advanced in recent years, the influence of pre-operative factors on treatment outcomes remains poorly understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 ","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"58 12","pages":"1814-1834"},"PeriodicalIF":7.1,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iej.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953039","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}
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.
{"title":"Teaching Vital Pulp Treatment for Permanent Teeth to Undergraduate/Pre-Doctoral Students: A Multinational Survey","authors":"Venkateshbabu Nagendrababu, Mohannad Nassar, Lokhasudhan Govindaraju, Anil Kishen, Paul V. Abbott, 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}
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