International endodontic journal最新文献

Background: Artificial intelligence (AI) is transforming medical imaging, yet its economic impact in dentistry remains largely unexplored.

Aim: This study evaluated the cost-effectiveness of AI-assisted detection of apical periodontitis on panoramic radiographs, including downstream clinical decision-making.

Material and methods: Using data from a randomised study on AI-assisted detection of apical lesions, a decision-analytic model was established to analyse costs and effectiveness from a German mixed-payer perspective.

Results: AI support reduced average costs per case and increased treatment effectiveness, outperforming unaided examiner performance. These gains were primarily driven by improved specificity, reducing false-positive detection. However, effects varied by examiner experience; junior clinicians achieved the greatest cost savings and effectiveness gains, whereas senior examiners showed reduced sensitivity and slightly lower effectiveness at similar costs.

Conclusion: AI-assisted diagnostics offer significant potential to improve cost-effectiveness by reducing overtreatment, with benefits being most pronounced among less experienced practitioners. Adapting AI systems to individual examiners or experience levels might further enhance clinical and economic impact.

Aim: This cross-sectional study aimed to compare the endodontic microbiome assessed from root canals of teeth associated with either symptomatic or asymptomatic apical periodontitis and analysed by 16S rDNA gene sequencing.

Methodology: 60 teeth presenting clinical and radiographic signs of symptomatic or asymptomatic apical periodontitis (n = 30) were included in this cross-sectional study after participants had given their written informed consent. After isolation with rubber dam, disinfection and access cavity preparation, glide paths were prepared using C-Pilot Files and K-Files under electronic root canal length control. Microbial samples were collected from a total of 120 root canals (symptomatic apical periodontitis, SAP: n = 62, asymptomatic apical periodontitis, AAP: n = 58) each with a sterile file (size 20/0.06) in a single length technique. Only one specimen per tooth was included in the analysis; in multi-rooted teeth, the specimen with highest sequencing depth. After DNA extraction, the hypervariable region V4 of the bacterial 16 S rRNA gene was amplified and sequenced (Illumina MiSeq). Taxonomy was assigned based on the expanded Human Oral Microbiome Database (eHOMD). Statistical analysis of diversity parameters comprised Mann-Whitney U tests and PERMANOVA. Compositional differences were evaluated by differential abundance analyses using DESeq2, LinDA, and ANCOM-BC2 methods.

Results: No differences were observed in richness and diversity (Shannon diversity index) on the genus or ASV level (p > 0.05). According to PERMANOVA, SAP and AAP microbiomes did not differ significantly both on genus and ASV levels (p > 0.05). Among highly abundant genera, Fusobacterium was indicated to be more abundant in SAP samples whereas Actinomyces was more abundant in AAP samples.

Conclusions: The expression of clinical symptoms in apical periodontitis does not appear to be determined by specific microorganisms but may instead reflect shifts of the relative abundance of the microbial community.

Objectives: The objectives of this study were to estimate and compare the 1-year clinical success rates of triple antibiotic paste (TAP), double antibiotic paste (DAP), calcium hydroxide (CH) within regenerative endodontic procedures (REPs) on permanent necrotic immature teeth.

Materials and methods: Trials investigating REP success were searched through MEDLINE, Scopus, Embase, Web of Science, GOOGLE Scholar (last update December 2025). Primary study quality was evaluated through the revised Cochrane Risk of Bias tool for Randomised Trials (RoB2). Pooled success rates with 95% confidence intervals (95% CIs) were assessed. Heterogeneity was investigated with the Cochran's Q and quantified with I²: The random-effects model was preferred to the fixed-effect model for I² > 50%. Sensitivity (study quality, publication bias, study inclusion) and subgroup (scaffold type, world Region) analyses were made. The differences in pooled success rates between protocols were assessed and were evaluated using an equivalence range of -2.5%/+2.5%. The GRADE system was employed to evaluate the Quality of Evidence of the pooled success rates.

Results: Twenty-four studies of average quality were included involving 544, 64, 183 patients, for TAP, DAP, CH, respectively. The pooled success rates (tooth survival after 1 year with periapical healing, absence of signs and symptoms of pathology) were TAP 96.7% (95% CI, 94.8%-98.0%), DAP 84.2% (95% CI, 73.2%-92.0%), CH 97.4% (95% CI, 93.9%-99.1%). The pooled differences in success rates were TAP-DAP 12.5% (95% CI, 2.8%-22.1%, TAP superiority demonstrated), TAP-CH -0.7% (95% CI, -0.9%-2.5%, TAP/CH equivalence demonstrated), CH-DAP 13.2% (95% CI, 3.3%-23.0%, CH superiority demonstrated). Secondary analyses corroborated these results, although the overall statistical test power was low due to small sample sizes. The GRADE quality of evidence was high for TAP and CH, and low for DAP, due to substantial imprecision attributed to the small number of studies with small sample sizes.

Conclusions: The lack of direct comparisons between protocols and of a common comparator did not allow for more robust analyses. Nevertheless, the use of TAP and CH as intracanal medicament within REPs resulted equivalent in eradicating the infection and promoting periapical healing in permanent necrotic immature teeth at 1-year follow up, and these protocols resulted superior over DAP.

Registration: PROSPERO registration number: CRD42023484189.

True regeneration of the pulp-dentine complex is the ultimate goal of regenerative endodontic procedures (REPs). Despite favourable clinical outcomes, such as resolution of apical periodontitis, continued root elongation and apical closure, histological evidence suggests that most clinical cases result in tissue repair rather than true regeneration. This discrepancy arises from the intricate requirements for optimising the microenvironment, which encompasses two essential stages: disinfection and regeneration. These two stages are not necessarily sequential; they can overlap and be highly interconnected, influencing each other. Current REPs protocols have limitations in both disinfection and regeneration. Endodontic biofilms exhibit a notable tolerance to disinfectants and have the capability of recovery, which negatively affects the odontogenic potential of stem cells. Additionally, immune cells, particularly M1 and M2 macrophages, interact with stem cells and affect their regenerative capacity. Standard irrigants and intracanal medicaments often fail to eliminate biofilms, compromising stem cell viability and differentiation potential. On the regeneration side, age-related decline in stem cell function reduces cell survival and differentiation capacity, while insufficient delivery and lack of control over signalling molecules limit odontogenesis, angiogenesis, and neurogenesis. Commonly used scaffolds for REPs lack the structural, biochemical and biological precision required to guide regeneration of well-organised tissue. Furthermore, a microenvironment characterised by hypoxia, restricted nutrients and limited neurovascular ingrowth further constrains regenerative outcomes. This review will focus on the limitations of the current regenerative microenvironment in REPs and discuss emerging strategies aimed at integrating infection control with tissue engineering design. It also highlights the need for novel antimicrobial approaches and advanced tissue engineering strategies in REPs. Multifunctional biomaterials, such as chitosan nanoparticles, antimicrobial peptides and hierarchically structured scaffolds, may ultimately facilitate true biological regeneration of the pulp-dentine complex.

Background: Systematic reviews are essential for evidence-based decision-making in endodontics, and their number has grown substantially in recent years. However, little is known about the publication patterns, methodological features and citation impact of these studies.

Objectives: To perform a bibliometric analysis of evidence synthesis reviews (including systematic, scoping, bibliometric and umbrella reviews) in endodontics published between 2018 and 2023, and to evaluate the associations between citation impact and demographic, article-related, author-related and journal-related variables.

Methods: This bibliometric analysis was reported in accordance with the PRISMA 2020 guidelines and was registered in the Open Science Framework (https://osf.io/jf9et/). A comprehensive search was conducted in five databases (PubMed, Embase, Web of Science, Scopus and Cochrane Library). Inclusion criteria encompassed systematic, scoping, umbrella and bibliometric reviews in endodontics. Citation data were extracted from Scopus and Google Scholar. Data analysis included descriptive statistics and negative binomial regression to assess associations with citation counts.

Results: Of 9683 records identified, 511 endodontic reviews met the inclusion criteria. Most were published in 2022-2023, predominantly by authors from Asia, Europe and the Americas. Brazil had the highest publication volume, while the USA led in citations. PRISMA adherence was high (90%), but funding and conflict of interest disclosures were infrequent. Citation impact was positively associated with earlier publication year, the last author's h-index, the number of included studies and journal CiteScore. Methodological factors such as protocol registration and article-related variables like open access were not significantly associated with citations after adjustment.

Conclusion: The citation impact of endodontic evidence synthesis reviews is primarily influenced by temporal factors, author academic standing and journal prestige rather than methodological rigour alone. These findings reveal a disconnect between indicators of research quality and citation performance and highlight the necessity of promoting transparency as a scientific value rather than as a surrogate for visibility.

Trial registration: This study was registered in the Open Science Framework (https://osf.io/jf9et/).

Aim: The stem/progenitor cell is crucial for organogenesis. Sensory nerves, as key components of the stem cell niche, secrete various factors to modulate stem/progenitor cell fate decision. Here, we utilised tooth root development as a model to explore the role of sensory nerves in this regulatory process and to elucidate the underlying mechanism.

Methodology: Spatiotemporal dynamics of nerve innervation were characterised during tooth root development. We treated mouse dental papilla cells (mDPCs) with trigeminal ganglion-conditioned medium (TG-CM) and employed a subrenal co-culture of TG-tooth germ to evaluate sensory nerve function in odontoblastic differentiation and tooth root formation. A subrenal co-culture of TG-tooth germ was employed to detect sensory nerve function in tooth root formation. Integrated analysis of scRNA-seq from the TG and molar at post-natal day 3.5 (PN3.5) and PN30 identified potential nerve-derived factors, which were further assessed through subrenal transplantation with recombinant protein-loaded or neutralising antibody-loaded beads. CellChat was used to analyse cell-cell communication between TGs and molars. Co-immunoprecipitation (Co-IP) and proximity ligation assays (PLA) were used to confirm the interaction between secreted phosphoprotein 1 (SPP1) and integrin alpha 4 (ITGA4). The siRNA-mediated Itga4 knockdown assessed its role in odontoblastic differentiation.

Results: Sensory nerve fibres localized to the apical papilla and follicle at PN3.5 and extended toward the crown. TG-CM and subrenal co-culture of TG-tooth germ enhanced odontoblast differentiation and root elongation, demonstrating the indispensable role of sensory nerves for proper root development. Integrated scRNA-seq analysis of TG and molar at PN3.5 and PN30 uncovered various sensory nerve-derived factors, including SPP1, calcitonin gene-related polypeptide (CGRP) and kit ligand (KITL), whose function in tooth root development was validated in vivo. Furthermore, CellChat analysis revealed SPP1-ITGA4 as a critical ligand-receptor interaction, which was confirmed by Co-IP and PLA. Itga4 was specifically expressed in the apical papilla and upregulated during odontoblastic differentiation. Itga4 knockdown impaired odontoblastic differentiation and abolished SPP1-promoted odontogenesis.

Conclusions: Collectively, our findings elucidate a novel mechanism whereby sensory nerves orchestrate tooth root development by regulating progenitor cell fate through the SPP1/ITGA4 axis. This neuro-mesenchymal crosstalk provides insights for stem cell therapies and tooth root regeneration.

Background: Dental caries demineralises the enamel and dentine of the teeth, and as infection progresses it can lead to pulpal inflammation, infection and severe pain.

Aim: To determine and compare the level of mRNA expression of Toll-like receptors ((TLR)-2, TLR-4 and TLR-9), tumour necrosis factor (TNF)-α, interleukins ((IL)-1α, IL-1β, IL-4, IL-6, IL-8, IL-17 and IL-23) as well as markers of dentinogenic (dentine matrix protein (DMP)-1, dentine sialophosphoprotein (DSPP)), regulatory (nuclear factor-kappa B (NF-κB1), mitogen activated protein kinase (MAPK1)), proliferative (mitogen activated protein kinase (MKi)) and stemness (sex determining region Y-box 2 (SOX2)) between non-carious and carious dental pulp tissues.

Methodology: This study undertook a comprehensive analysis of inflammatory markers including TLR-2, TLR-4, TLR-9, TNF-α, IL-1α, IL-1β, IL-4, IL-6, IL-8, IL-17 and IL-23, as well as markers of dentinogenic DMP-1, DSPP, NF-κB1, MAPK1, proliferative MKi and stemness SOX2 processes in healthy and carious pulp tissues using quantitative real-time reverse-transcription polymerase chain reaction.

Results: We found higher levels of TLR-2, TLR-4, IL-6, IL-8, IL-17A, IL-23A, along with NF-κB1 and MKi67 in the carious pulps (p < 0.05). The concurrent upregulation of IL-17A and IL-23A may suggest the activation of the IL-23/IL-17 signalling axis in the carious pulps, a point underreported in the literature.

Conclusion: These findings highlight the crucial role of the immune system in pulpal inflammation and potential implications in developing targeted molecular treatments, supporting the need for further translational research.

The rapid emergence of novel concepts in endodontics-ranging from minimally invasive approaches to digital workflows and artificial intelligence-assisted decision-making-has significantly reshaped contemporary discourse within the specialty. While innovation is essential for progress, it is crucial to recognize that not all conceptual advances are inherently clinically responsible. The premature translation of inadequately validated concepts can expose patients to unforeseen risks and compromise long-term treatment outcomes. This article proposes a structured framework for defining clinical responsibility in the development of endodontic concepts. Grounded in key pillars-biological plausibility, proportional evidence, ethical accountability, and clinical applicability-this framework aims to strike a balance between fostering innovation and ensuring patient-centered care. By establishing clear criteria for responsible conceptual advancement, this paper seeks to guide authors, reviewers, and editors in critically evaluating emerging ideas before their integration into routine clinical practice.

Aims: To assess the relationship between endodontic and subgingival bacterial communities in individuals with apical periodontitis (AP), and to identify disease-associated subgingival microbial signatures. We propose that subgingival microbial communities exhibit a dysbiotic profile, defined by distinct bacterial signatures, which may provide complementary biological insights into AP.

Methods: In this cross-sectional study, DNA was extracted from paired endodontic and subgingival samples from mesiobuccal sites of first molars in patients with AP (n = 25 sample pairs), and from subgingival samples from the same sites in healthy individuals (n = 34). Microbiota was explored using 16S rRNA sequencing. Alpha and beta diversity metrics were calculated. Differentially abundant taxa were identified using LEfSe. Random forest models based on the bacterial counts observed in the subgingival samples were trained to classify the individuals with AP from the controls.

Results: Within AP individuals, the subgingival communities differed from those present in root canals. Subgingival communities exhibited higher alpha diversity than root canal communities, irrespective of the clinical diagnosis (p < 0.001). Subgingival microbial communities in AP individuals exhibited a dysbiotic profile associated with enrichment of anaerobic and inflammophilic species (p < 0.05). Beta diversity analyses showed compositional differences between AP and control individuals, with Jaccard distance reaching statistical significance (p < 0.05), and Bray-Curtis indicating a borderline effect (p = 0.07). The best predictive model (Streptococcus sanguinis and Prevotella maculosa) achieved an accuracy of 89.8%, sensitivity of 80%, specificity of 97%, precision of 95.2%, and an AUC of 0.98.

Conclusions: Subgingival profiles from AP individuals are distinct from those in healthy controls, showing AP-associated dysbiosis. Specific subgingival bacterial signatures achieved high diagnostic accuracy, supporting the potential broader impact of AP on the subgingival microbiota.