International endodontic journal最新文献

Aim: Biomaterial-based strategies offer therapeutic potential for inherited disorders such as Dentinogenesis imperfecta type II (DGI-II). DGI-II, a hereditary dental disorder caused by dentine sialophosphoprotein (Dspp) gene mutations, results in fragile, discoloured teeth susceptible to wear and decay. This study investigates the structural alterations in the dentine matrix induced by mutant DSPP and the underlying molecular mechanisms. Furthermore, we evaluated a therapeutic strategy combining nanofibrous substrates with molecular activation of the Wnt5a-Cdc42 pathway, aiming to mitigate these structural defects and restore dentine integrity.

Methodology: A maxillary first premolar extracted from a patient with dentinogenesis imperfecta type II (DGI-II) carrying a known DSPP frameshift mutation was analysed using micro-computed tomography and scanning electron microscopy. MDPC-23 mouse dental pulp pre-odontoblasts were cultured in vitro on electrospun nanofibrous scaffolds with tunable fibre diameters. Dspp expression was silenced to investigate its regulatory role in cell-cell contact formation, while the Wnt5a-Cdc42 pathway was activated via recombinant Wnt5a protein and a small molecule. Data were analysed using Student's t-test or one-way ANOVA with a significance threshold of p < 0.05.

Results: Decalcified or freeze-fractured samples exhibited thick fibres, sparse dentinal tubules, and a disorganised, non-layered dentine matrix, indicating that disrupted cell-cell junctions impair directional appositional dentine formation. Silencing Dspp expression in dental pulp cells led to reduced expression of junctional proteins, Zona occludens-1 (ZO-1) and Connexin43 (Cx43), which are essential for vectorial matrix apposition. Modulating fibre thickness and activating the Wnt5a-Cdc42 signalling axis restored both the expression and cellular localisation of ZO-1 and Cx43, thereby re-establishing cell-cell junctions and paracellular permeability in Dspp-silenced dental pulp cells.

Conclusion: The results provide evidence that Dspp contributes to the structural integrity of dentine by modulating ZO-1 and Cx43 expression and suggest that biomaterial and molecular interventions may offer supportive strategies to restore dentine structure and function in DGI-affected teeth, though they do not address the underlying genetic defect.

Introduction: Accessory canals (ACs) are anatomical features that may harbour residual infected tissue and contribute to persistent periradicular inflammation. Although filling of these structures is occasionally achieved passively, their intentional mechanical negotiation remains rarely documented in clinical practice. This case series aims to describe the clinical approach, outcomes and imaging strategies used in the intentional debridement and filling of ACs.

Methods: Six teeth with identifiable ACs on cone-beam computed tomography (CBCT), in association with bone resorption, were included. All cases underwent chemomechanical preparation using rotary instrumentation with 2% chlorhexidine gel, active saline irrigation and final EDTA activation with passive ultrasonic irrigation. Intentional mechanical debridement of ACs was performed using small-diameter hand files. All fillings were performed with gutta-percha and AH Plus Jet sealer. Follow-up was performed using CBCT and periapical radiographs after a mean period of 10.16 months. Three-dimensional segmentation was used to aid localization and planning.

Results: All ACs were successfully negotiated and filled with endodontic sealer. Tomographic analysis confirmed evidence of partial or complete periradicular healing in all six cases. No patients presented with clinical symptoms at follow-up.

Conclusion: This case series presents successful intentional instrumentation and obturation of ACs, supported by CBCT-based planning and follow-up. Although limited by the lack of a control group, the findings highlight the potential role of CBCT imaging and segmentation in identifying and accessing complex anatomy. Further prospective studies are needed to determine the impact of this approach on long-term clinical outcomes.

Introduction: Cone-beam computed tomography (CBCT) has become an integral part of endodontic diagnosis and treatment, with voxel size being a critical parameter affecting spatial resolution and diagnostic outcomes. This systematic review and meta-analysis examined the effect of voxel size on the diagnostic outcome of CBCT images for root canal anatomy assessment.

Methods: A search was conducted in PubMed, Web of Science, Embase, and Scopus databases without date restrictions. Studies comparing different CBCT voxel sizes for root canal anatomy evaluation using quantitative diagnostic outcomes were included. Two reviewers independently performed study selection, data extraction, and quality assessment using QUADAS-2. Meta-analysis was conducted using random-effects models with subgroup analysis by voxel size categories (≤ 125 μm and > 125 μm).

Results: Fifteen studies met the inclusion criteria, evaluating voxel sizes from 75 to 400 μm across various anatomical structures. Seven studies were included in the meta-analysis. Individual studies consistently demonstrated improved visualisation with smaller voxel sizes, particularly for larger structures such as second mesiobuccal canals in maxillary molars. Overall pooled diagnostic accuracy was 80% (95% CI: 75%-84%) with substantial heterogeneity (I² = 86.74%). Subgroup analysis showed diagnostic accuracy of 75% (95% CI: 68%-82%) for voxel sizes > 125 μm and 85% (95% CI: 80%-90%) for voxel sizes ≤ 125 μm. The difference between the two groups was statistically significant (p = 0.002). Moreover, meta-regression showed a statistically significant association between voxel size and diagnostic accuracy (p = 0.0086).

Conclusions: The current study's findings suggest that there is an association between reducing the voxel size and enhancing the diagnostic outcome of CBCT images in assessing root canal anatomy. Although the meta-regression showed a statistically significant correlation, the results should be interpreted cautiously because of methodological heterogeneity, the complex interplay of imaging parameters beyond voxel size alone, and the lack of clinical studies. Future research should focus on standardised clinical studies to examine the impact of voxel size on the diagnostic outcome of CBCT images.

Background: In general medicine, melatonin is known to enhance wound healing and promote stem cell differentiation. Its potential relevance in endodontics, however, remains underexplored.

Objectives: This scoping review aimed to systematically assess the available evidence on the effects of melatonin (a) on dental pulp tissue and (b) on human dental pulp stem cells (hDPSCs), particularly regarding cell proliferation and differentiation with regard to endodontics.

Methodology: A comprehensive literature search was conducted in PubMed, Clarivate Analytics' Web of Science and Scopus from inception to July 1, 2025, using Medical Subject Headings (MeSH terms) and supplemented by hand searching and screening of major subject journals.

Results: The initial search yielded 252 records, with one additional record identified through citation mining and relevant journal screening. A total of 22 studies met the inclusion criteria: 11 investigated melatonin's effect on dental pulp tissue regarding anti-inflammatory properties, treatment of pulpitis, wound healing and pulp capping and 11 examined its impact on hDPSCs in terms of cell proliferation and differentiation.

Discussion: The limited evidence obtained from laboratory and animal studies suggests a dose- and time-dependent influence of melatonin, though evidence is insufficient to establish optimal concentrations.

Conclusions: (a) Melatonin demonstrates anti-inflammatory, antioxidant and anti-fibrinolytic effects on dental pulp tissue. (b) Melatonin has potential as a stem cell modulator by promoting odontogenic differentiation and may improve migration and proliferation of hDPSCs.

Background: Hypercementosis is a non-neoplastic condition characterized by excessive cementum deposition along the root surface, resulting in altered apical morphology. Although often asymptomatic and detected incidentally on radiographs, changes in apical contour may influence anatomical complexity in endodontic treatment.

Objective: To estimate the pooled prevalence of hypercementosis based on radiographic observational studies and to explore variability according to imaging modality and study characteristics while contextualizing potential implications for endodontic case complexity assessment. Furthermore, this study proposes a standardized framework for radiographic diagnosis to mitigate current methodological heterogeneity and enhance the clinical assessment of anatomical complexity in endodontic practice.

Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines and were registered in PROSPERO (CRD420251270539). PubMed/MEDLINE, Scopus, Web of Science and Embase were searched up to November 2025 without year restrictions; studies in any language were eligible, provided that an English abstract was available for screening. Cross-sectional radiographic studies reporting the prevalence of hypercementosis in humans using periapical radiographs, panoramic radiographs or cone-beam computed tomography (CBCT) were included. Pooled prevalence estimates were calculated at the patient and tooth levels using a DerSimonian-Laird random-effects model with logit transformation. Risk of bias was assessed using an adapted Newcastle-Ottawa Scale, and the certainty of evidence was appraised using the GRADE approach.

Results: Ten observational studies (14 881 participants) were included. At the patient level, the pooled prevalence of hypercementosis was 3.9% (95% CI: 2.0%-7.3%), with very high heterogeneity (I² = 98%). Tooth-level meta-analysis, based on three studies evaluating 52 666 teeth, showed a pooled prevalence of 0.25% (95% CI: 0.06%-1%), also with substantial heterogeneity (I² = 98%). Variability across studies was influenced by imaging modality, sampling strategies and diagnostic thresholds.

Conclusions: Hypercementosis is uncommon at the tooth level but present in a clinically relevant proportion of patients. However, extreme heterogeneity and very low certainty of evidence limit the precision of prevalence estimates. Standardized diagnostic criteria and harmonized imaging protocols are needed to improve reproducibility. Within contemporary CBCT-based prognostic frameworks, hypercementosis may be considered a potential modifier of anatomical complexity, warranting further outcome-oriented investigation.

Aim: An appropriate scaffold material is crucial for the success of tissue-engineered regenerative endodontic therapies. In this study, a porcine-derived decellularized dental pulp matrix hydrogel (pDDPM-G) was prepared and employed as the primary scaffold for in situ regeneration of the pulp-dentine complex in beagle dogs.

Methods: In the orthotopic pulp regeneration model, pDDPM-G was either directly injected into the root canals of canine teeth (with or without blood induction) or used as a carrier for transplantation of dental pulp stem cells (DPSCs). Collagen type I (COL I) injection (with or without blood induction) and revascularization therapy (blood induction alone) served as controls. Computed tomography images were acquired before and after surgery. Histological and immunofluorescence analyses were conducted for in vivo characterization at 14 and 90 days post-surgery, respectively.

Results: The experimental results showed that the application of pDDPM-G was critical to all three regenerative endodontic procedures, whether combined with DPSC transplantation, used with blood induction (BI), or applied alone for cell homing. Integration of pDDPM-G reduced the extent of intracanal calcification compared with conventional revascularization therapy (BI) alone. Furthermore, expression of all representative proteins, including odontoblast-like (DSPP and DMP1), angiogenic (CD31 and KDR) and neurogenic (MAP2 and TUJ1) markers, was much higher in all pDDPM-G-containing groups than in the BI+COL I, COL I and BI groups.

Conclusion: This study demonstrated the significance of pDDPM-G in functional endodontic regeneration using an orthotopic canine model. It was found that the use of pDDPM-G was not only beneficial for root development but also facilitated pulp-like tissue morphogenesis, dentinogenesis, angiogenesis and neurogenesis, thereby reconstructing hierarchically distributed functional pulp-dentine complexes.

Aim: This narrative review explores how social media is influencing the pathways of innovation within endodontics, examines the rise of influencer-led clinical authority, and investigates the ethical, educational, and regulatory challenges associated with this trend, advocating for a comprehensive framework for responsible innovation.

Summary: Social media platforms have undergone a remarkable transformation, evolving from mere channels for informal communication to formidable agents of clinical influence in the healthcare field. Dentistry, and endodontics in particular, has seen platforms such as Facebook, LinkedIn, Instagram, YouTube, and TikTok increasingly serving as conduits for innovation. These platforms facilitate the rapid dissemination of new techniques, groundbreaking devices, and streamlined workflows, often circumventing traditional academic and regulatory structures that traditionally oversee and govern the spread of dental information. This shift has broadened accessibility to a wide range of ideas, promoting global engagement among dental professionals and patients alike. However, the unregulated media has also introduced considerable risks as the growing emphasis on visual appeal, rapid content production, and trendy innovations often overshadows the essential principles of biological plausibility, evidence-based validation, and consideration of long-term patient outcomes. Such dynamics raise critical questions about the reliability and safety of the information being shared on social media and the training and competence of the authors.

Conclusions: Social media is increasingly shaping the perception and adoption of endodontic innovations beyond traditional academic governance. Influencer-driven content often lacks transparent citations, robust critical appraisal, and an adequate discussion of clinical limitations. Advanced techniques may be advocated without proper consideration of operator competence, requisite training, or necessary armamentarium. Commercial interests and patient expectations can expedite the premature adoption of innovations that are inadequately validated. Applying frameworks of responsible research and innovation can provide a balanced perspective on integrating innovation, education, and patient safety in the field of endodontics.

Clinical relevance: Social media may influence how endodontic innovations are perceived and adopted in routine practice. Clinicians must engage in critical appraisal of online content, especially when techniques surpass their training or available resources, to mitigate the risk of inappropriate implementations and safeguard patient well-being.

Aim: To investigate the ultrastructure of the mineralised tissue after direct pulp capping (DPC) treatment using focused ion beam scanning electron microscopy (FIB-SEM) and stimulated emission depletion (STED) microscopy.

Methodology: Eighteen male Wistar rats (36 maxillary first molars) were used in this study. Nine rats (18 M) were allocated for histological evaluation and immunofluorescence imaging (STED), six rats (12 M) for FIB-SEM observation, and three rats (6 M) served as untreated controls; control molars were used for both immunofluorescence imaging and FIB-SEM. For experimental allocation, two molars from each rat were randomly assigned to one of three groups: NEX MTA (NMTA), Dycal, or no-capping material (NC). After 4 weeks, teeth were collected for histological analysis, FIB-SEM observation and immunofluorescence imaging. Tubulin-b3 and nestin expression were examined by immunofluorescence staining and imaged with STED microscopy. The Kruskal-Wallis test followed by Dunn's multiple comparisons test and one-way ANOVA followed by Tukey's multiple comparisons test were performed to assess significant differences.

Results: All experimental groups exhibited complete mineralised tissue formation near the exposure site. The NMTA group showed a significantly more regular odontoblastic layer than the Dycal and NC groups (p < 0.05). FIB-SEM demonstrated that NMTA induced a well-organised and continuous tubular structure, whereas Dycal and NC produced irregular, discontinuous, and poorly organised mineralised barriers. STED imaging of the NMTA group revealed strong and organised co-localization of tubulin-β3 and nestin resembling primary dentine, whereas the Dycal and NC groups showed weak, disorganised, or absent signals and lacked co-localised processes.

Conclusions: NMTA showed superior performance compared with Dycal, consistently promoting well-organised dentine bridge formation, a continuous odontoblastic layer, and coordinated neural marker-positive processes. This indicates that NMTA more effectively supports structural formation of the pulp-dentine complex after DPC.

Aim: To develop a streamlined software workflow for converting cone-beam computed tomography (CBCT) data into augmented reality (AR) and virtual reality (VR) formats, and to evaluate dental practitioners' perceptions of these advanced visualisation modalities compared to conventional CBCT analysis for endodontic treatment planning.

Methodology: A custom add-on for Blender (an open-source 3D modelling software), named VirtualEndo, was developed to automate the processing of AI-segmented CBCT scans into AR- and VR-compatible formats. Thirty dentists evaluated two diagnostically challenging cases using four methods: conventional CBCT analysis, AI-driven 3D segmentation, AR visualisation on iPad and VR visualisation with Meta Quest 3. The presentation order was randomised, and participants completed a standardised training protocol. Perceptions regarding diagnostic confidence, usability, information extraction, and clinical relevance were assessed using 4-point Likert scales. Statistical analysis employed Friedman tests with post hoc Wilcoxon signed-rank tests and Bonferroni correction.

Results: Significant differences were found across all evaluated categories (p < 0.05). Conventional CBCT was rated significantly inferior to Segmentation, VR, and AR for information extraction (canal course: W = 0.68; canal number: W = 0.56) and usability (W = 0.40). No significant differences existed between the three advanced visualisation methods. Segmentation was most frequently selected as clinically most relevant (40%), followed by VR (20%). For canal detection, differences were small (W = 0.10) with no method demonstrating clear superiority.

Conclusions: Modern 3D visualisation technologies were perceived as significantly superior to conventional 2D CBCT slice analysis, primarily by presenting pre-integrated anatomical models that reduce the perceived cognitive burden of mental 3D reconstruction from 2D slices. Screen-based segmentation was favoured for pragmatic workflow integration, though immersive technologies showed promise if adoption barriers are addressed.