International endodontic journal最新文献

Aim: Irreversible pulpitis poses a significant clinical burden due to progressive inflammatory pulp damage. While inflammatory mechanisms are central to its pathogenesis, they remain incompletely characterised. This study aims to elucidate the role of Nod-like receptor thermal domain associated protein 1 (NLRP1) in irreversible pulpitis pathogenesis.

Methodology: Transcriptomic analysis of public dataset GSE77459 identified dysregulated pyroptosis-related genes (PRGs), with machine learning prioritising hub genes for experimental validation. Key targets were experimentally verified through an integrated approach: in vitro models using lipopolysaccharide (LPS)-stimulated human dental pulp cells (hDPCs) analysed by qRT-PCR, ELISA and Western blot and specific pyroptosis assays (PI uptake, Caspase-1 cleavage); in vivo rat pulpitis models; and clinically validation with human irreversible pulpitis tissues analysed via H&E staining, immunohistochemistry (IHC) and immunofluorescence (IF). Functional roles were further assessed via NLRP1 knockdown and overexpression in hDPCs.

Results: Bioinformatics identified 11 differentially expressed PRGs, with machine learning highlighting six hub genes including unreported NLRP1. Specific pyroptosis assays confirmed that LPS induces membrane pore formation and Caspase-1 activation in hDPCs. Significant post-transcriptional regulation of NLRP1 was demonstrated by pronounced protein upregulation in LPS-stimulated hDPCs despite unaltered mRNA. Functional studies established NLRP1 as a positive regulator, where its knockdown attenuated the LPS-induced inflammatory-pyroptotic response, while its overexpression alone was sufficient to upregulate key mediators. Consistently, elevated NLRP1 expression was observed in rat models and human tissues, where IHC/IF localised prominent expression to inflammatory infiltrates.

Conclusion: NLRP1 is highlighted as a novel pyroptosis biomarker for irreversible pulpitis, with its dysregulation offering diagnostic value for inflammation. These findings suggest its potential involvement in the inflammatory mechanisms of pulpitis, providing a new molecular target for future therapeutic exploration.

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: Cell-based regenerative endodontic procedures (REPs) using dental pulp stem cells (DPSCs), stem cells from human exfoliated deciduous teeth (SHEDs) and those from apical papillae have shown great potential for authentic pulp regeneration, as evidenced by reports from preclinical studies and limited clinical trials. However, challenges, such as low cell survival rates, immune rejection during allogeneic transplantation and inconsistent protocols, hinder their widespread clinical implementation.

Objectives: This review aimed to summarise the regenerative methodologies widely used in studies involving autologous and allogenic DPSC/SHED transplantation and their clinical outcomes, analyse the discrepancies between preclinical and clinical studies, explore the potential mechanisms underlying alloimmune responses in allogeneic cell transplantation and provide possible strategies to minimise this type of immune rejection.

Methods: A comprehensive search was conducted on clinicaltrials.gov using keywords '(dental pulp stem cells) OR (dental pulp mesenchymal cells) OR (DPSCs) OR (human deciduous teeth stem cells) OR (stem cells from human exfoliated teeth) OR (SHED),' followed by inputting keywords '(NestaCell) OR (Cellavita HD).' Clinical trials not registered on the website and case reports were also included via advanced search on PubMed using keywords '(dental pulp stem cells) OR (dental pulp mesenchymal cells) OR (DPSCs) OR (human deciduous teeth stem cells) OR (stem cells from human exfoliated teeth) OR (SHED)' with filters '(Case reports) AND (Clinical trial).'

Results: Twenty-seven clinical trials and 11 case reports were included. Whereas these studies related to endodontic diseases revealed favourable outcomes for teeth treated with pulp regeneration approaches, preclinical studies observed limited cell survival in vivo, indicating that DPSCs exhibit environment-dependent immunogenicity and immunoregulatory properties under favourable conditions but become immunogenic in stressful microenvironments such as cell passage and differentiation, hypoxia and inflammation. Potential strategies have been developed to prolong DPSC survival.

Conclusions: Despite encouraging preliminary results, significant limitations remain in the establishment of standardised protocols and the development of reliable techniques for longitudinal cell tracking. In future research, optimised delivery systems, immune-evasive cell engineering and rigorous clinical trial designs should be optimised to advance REPs towards predictable, clinically viable therapies.

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.

Aim: To evaluate the clinical impact of haptic virtual reality simulation (HVRS) on undergraduate dental students' performance during endodontic access cavity preparation on real patients, and to assess its effect on situational anxiety and perceived training value.

Methodology: A controlled, parallel-group clinical study was conducted with fifth-year dental students enrolled in a clinical endodontics course. Participants were assigned to an experimental group (HVRS training followed by clinical procedure) or a control group (direct clinical procedure without HVRS). Clinical performance during access cavity preparation on real patients was evaluated using a structured rubric by two independent blinded evaluators. Situational anxiety was measured in both groups using the STAI-Y1 questionnaire before and after the clinical procedure. Satisfaction and perception were recorded post-intervention using a structured Likert-scale questionnaire. HVRS session time metrics were also collected.

Results: Thirty students completed the study (15 per group). The experimental group showed significantly higher overall clinical performance scores compared to controls (p < 0.0001), with improvements in access cavity preparation and related tasks. Both groups experienced significant reductions in STAI-Y1 scores after the intervention, with the experimental group showing a greater relative decrease that approached statistical significance (p = 0.052). Students reported high satisfaction with the simulator, particularly regarding three-dimensional visualisation and perceived preparedness. Most students (86.7%) preferred a combined training strategy using both HVRS and artificial teeth. Simulation metrics indicated consistent training time and operative engagement across participants.

Conclusion: HVRS training prior to clinical endodontic procedures would enhance student clinical performance and may contribute to a greater reduction in situational anxiety compared to standard practice, supporting its integration into undergraduate curricula as a complementary instructional tool.