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.
Postoperative pain (POP) is a frequent occurrence after root canal treatment (RCT). There is conflicting evidence regarding the prevalence of POP after root canal filling with a bioceramic sealer in comparison with an epoxy resin-based sealer.
To ascertain whether the use of a bioceramic sealer reduces POP in comparison with an epoxy-resin-based sealer in combination with gutta percha following primary RCT and retreatment.
A literature search was carried out in electronic databases from inception to 20 January 2025. Systematic reviews (SRs) that evaluated the POP using bioceramic sealers when compared with epoxy resin-based sealers were included. The quality of the reviews was evaluated employing the AMSTAR 2 tool. The overall confidence in the findings of the review was categorised as critically low, low, moderate or high.
In total, 13 SRs were included. The POP experienced when bioceramic sealers were used in combination with gutta percha was similar to that of epoxy resin-based sealers. All the SRs adequately addressed Item 1 (‘Did the research questions and inclusion criteria for the review include the components of PICO?’). Only one SR adequately addressed Item 3 (‘Did the review authors explain their selection of the study designs for inclusion in the review?’) and Item 10 (‘Did the review authors report on the sources of funding for the studies included in the review?’). The overall confidence in the findings of ten, two and one SR(s) was classified as ‘critically low’, ‘low’ and ‘high’, respectively.
Based on current evidence, it can be concluded that root canal filling with a bioceramic sealer demonstrated POP that was comparable to that of epoxy resin-based sealers following primary RCT and retreatment. As per the recommendations in this umbrella review regarding the methodological quality of existing SRs, high-quality SRs are necessary in the future.
PROSPERO database: CRD42024616520
Due to the lack of a predictable and noninvasive method for distinguishing different types of apical periodontitis, it is difficult to estimate the actual prognosis of periapical cysts and the effectiveness of nonsurgical treatment for them. This pilot study aimed to establish a diagnostic model to differentiate periapical cysts and nonperiapical-cyst lesions based on parameters derived from magnetic resonance imaging (MRI).
Before endodontic microsurgery, MRI scans were performed for the patients with periapical lesions, including T2-weighted images (T2WI), noncontrast-enhanced T1-weighted images (T1WI), diffusion-weighted imaging (DWI) and contrast-enhanced T1-weighted images (T1WI + C). Sixteen parameters were collected, and thirteen derived parameters were calculated. The patients were divided into training and validation cohorts according to time order. The histopathological results were gold standards. Univariate, multivariate regression and multicollinearity analyses were used to filter variables and select predictors. Multivariate logistic regression was applied to develop the nomogram. Discrimination and calibration were evaluated by bootstrapping with 1000 resamples.
Eighty-four patients underwent MRI examinations followed by endodontic surgeries. Lesion length, enhanced area and enhanced-to-lesion area ratio were independent predictors for the diagnosis of periapical cysts. Area under the receiver operating characteristic (ROC) curve (AUC) of the training cohort was 0.861. Sensitivity and specificity based on ROC curves were 80.6% and 75.9%, respectively. The calibration curve of the nomogram was close to the ideal diagonal line. Decision curve analysis indicated positive net benefit in the model. The validation cohort proved the reliability of the prediction nomogram (AUC: 0.930; sensitivity: 81.8%; specificity: 76.9%).
The findings indicated that the proposed nomogram reliably identified periapical cysts through multiparameter MRI. The length of the lesion, enhanced area and enhanced-to-lesion area ratio were important variables for diagnosing periapical cysts. Multiparameter MRI was implicated as an efficient and noninvasive method to differentiate periapical lesions.
The study is registered on the Chinese Clinical Trial Registry website (ChiCTR2000035273)
There is a strong association between root canal curvatures and iatrogenic complications during root canal treatment.
This study compared the curvature of mesiobuccal (MB) and mesiolingual (ML) canals in mandibular first molars between sagittal and coronal planes using cone-beam computed tomography.
Two hundred mesial roots (400) canals from a Brazilian subpopulation were analysed. Curvature angles were measured in sagittal and coronal planes using Schneider's and Weine's methods, while curvature radii were calculated geometrically. The prevalence of S-shaped canals was also recorded. Curvature severity was classified according to the American Association of Endodontists Case Difficulty Assessment form, EndoApp, and modified versions incorporating curvature and radius. The influence of the angle measurement method and radius on case complexity was evaluated. Statistical analyses were performed using t-tests and chi-squared tests, with significance set at p ≤ 0.05.
Sagittal planes showed significantly greater angles and smaller radii than coronal planes. Weine's method yielded consistently higher angles and smaller radii than Schneider's. Severe single curvatures (≥ 30°) were more frequent in sagittal planes, whereas S-shaped canals were more prevalent in coronal planes. MB was more often classified as higher difficulty than ML canals. Incorporating radius into the classification systems generally shifted cases towards greater severity.
Sagittal planes revealed more severe single curvatures, whereas coronal planes showed a higher prevalence of S-shaped canals. Weine's method resulted in greater curvature severity than Schneider's. Inclusion of radius increased case severity grading. These findings highlight the importance of considering both measurement method and projection plane in endodontic treatment planning and research.
The ability of dental pulp stem cells (DPSCs) to undergo differentiation into odonto/osteogenic lineages is governed by complex cell signalling regulatory networks and interactions between cells and the extracellular matrix (ECM).
This article provides a comprehensive evaluation of cell signalling pathways and ECM that modulate odonto/osteogenic differentiation of DPSCs.
A comprehensive narrative review method was utilised to examine the key cell signalling mechanisms that govern odonto/osteogenic differentiation in DPSCs, aiming to clarify their significance and critically evaluate their prospective implications for future applications in dentine/pulp repair and regenerative strategies.
Current literatures demonstrate that transforming growth factor-β (TGF-β), Wnt, Notch, and fibroblast growth factor (FGF) signalling, both individually and through interactions, influence stem cell fate. TGF-β1 is essential in regulating DPSC differentiation toward odonto/osteogenic lineages. Wnt signalling crucially contributes to reparative dentine formation, evidenced by its upregulation in animal models following pulp capping. Wnt activators significantly promote dentine regeneration. Notch signalling activates in the dental pulp niches, facilitating reparative dentinogenesis post-injury. Interactions between Notch and other pathways influence DPSC odonto/osteogenic differentiation. Basic fibroblast growth factor (bFGF) regulates DPSC stemness and differentiation, with factors such as dosage and exposure time influencing its biological impact. Furthermore, ECM components play a significant role in differentiating stem cells by enhancing biological factors in the microenvironment and providing physical support, thereby promoting dentine and pulp repair.
A comprehensive understanding of these regulatory mechanisms has the potential to augment insights into the control of DPSC differentiation and facilitate their utilisation in repair and regenerative therapies for the dentine–pulp complex.
This study was conducted to evaluate the effect of maintaining optimal serum vitamin D levels through supplementation on the healing rate and quality of newly formed bone at 3, 6, 9, and 12 months in teeth with periapical lesions following endodontic treatment. Additionally, TNF-α levels were measured to investigate whether the potential healing effect was related to the anti-inflammatory properties of vitamin D.
This study was designed as a parallel, triple-blind, randomised controlled clinical trial registered at the Clinical Trials Registry. Seventy-three male patients with mature mandibular molars presenting with periapical lesions and meeting the inclusion criteria were allocated into two groups: the vitamin D group (n = 37) and the control group (n = 36). All patients received root canal treatment according to a standardised endodontic protocol. The vitamin D group received oral vitamin D supplements to raise serum 25(OH)D level to the optimal range (30–50 ng/mL), while the control group, with insufficient serum 25(OH)D levels (20–30 ng/mL), did not receive any supplementation. Periapical radiographs (pre-op, 3, 6, 9, 12 months), serum 25(OH)D (chemiluminescence), and TNF-α (ELISA) levels were assessed. The reduction in lesion area was calculated in mm2 and bone quality was assessed through fractal analysis. The data were statistically analysed using the Mann–Whitney U and Friedman tests (p < 0.05).
Lesion area reduction was significantly greater in the vitamin D group versus the control group (p < 0.05). However, no significant difference was found between the vitamin D and control groups in terms of fractal analysis values and TNF-α levels (p > 0.05).
A more rapid decrease in periapical lesion size was observed in individuals with serum vitamin D levels maintained within the optimal range (30–50 ng/mL). It is concluded that optimising vitamin D levels by supplementation, when appropriate, may be beneficial for the healing process of teeth with periapical lesions.
ClinicalTrials.gov identifier: TCTR20221020006
This study aimed to investigate the effects of copaiba oil–resin on induced apical periodontitis in rats.
A total of 24 male Wistar rats were divided equally into three groups (eight animals each): control (C), apical periodontitis (AP) and apical periodontitis with copaiba administration (AP + COP). The AP was induced by exposing the pulp chambers of the mandibular first molars to the oral environment. The openings were maintained for 28 days to allow lesion development. The AP + COP group received systemic administration of 200 mg/kg of copaiba oil–resin via intragastric gavage during the final 7 days of the AP induction period. The rats were then euthanised, and their hemimandibles were subjected to histopathological analysis to assess tissue preservation, histochemical staining with picrosirius red to evaluate collagen content, and microcomputed tomography to assess lesion volume and bone quality parameters. Statistical analyses were performed using a one-way ANOVA, followed by Tukey's post hoc test for parametric data and the Kruskal–Wallis test for nonparametric data. The results are expressed as mean and standard error of the mean for parametric tests, and median and interquartile deviation for the nonparametric test.
The findings showed that copaiba oil–resin reduced lesion volume compared to the untreated group (p = 0.0261), as well as reducing the space between the bone trabeculae found in the AP group (p = 0.0063). Additionally, copaiba oil–resin preserved the collagen fibres, which were more degraded in the untreated group (p = 0.0009). Histopathological analysis showed that copaiba oil–resin reduced tissue damage, preserving a significant area of alveolar bone surrounding the lesion.
These results indicate that copaiba oil resin has a promising adjunct therapeutic potential to reduce the bone loss caused by apical periodontitis and contribute to the maintenance of quality in the remaining bone.
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