International endodontic journal最新文献

Aim: This study aimed to evaluate the effects of auditory stimuli on performance scores and anxiety levels during endodontic treatment procedures conducted on artificial molar teeth in a simulation laboratory setting.

Methodology: This single-blinded, randomised repeated-measures study was conducted with 105 third-year dental students. Participants were allocated into three groups: Mozart's music (Group M), no music (Group N), and individually selected music (Group I). Each group performed root canal treatments on artificial molars in two phases: a quiet environment for all groups in Phase 1 and under different auditory conditions in Phase 2. Anxiety levels (measured using the STAI-S) before and after each procedure, performance scores, and procedure times were recorded. Statistical analyses included paired t-tests, one-way ANOVA, chi-square tests, and Fleiss' multi-rater kappa (α = 0.05).

Results: Group I₂ demonstrated a significant reduction in anxiety levels (p = 0.006) and an improvement in performance scores (p < 0.001) between phases. Group M₂ showed a significant decrease in anxiety levels (p < 0.001) but no significant performance change. Group N showed no significant changes between phases (p > 0.05). The overall inter-rater agreement was almost perfect (Kappa = 0.824, p < 0.001).

Conclusions: Auditory stimuli, particularly individually selected music, were associated with improved performance scores and reduced anxiety during preclinical endodontic training. These findings suggest the integration of personalised auditory interventions as a feasible strategy to enhance simulation-based dental education.

Background: External cervical resorption (ECR) is a relatively rare form of tooth resorption. It is commonly classified either using two-dimensional imaging according to the Heithersay or cone-beam computed tomography using the Patel et al.

Classifications: Effective disease classification systems should provide categories that guide clinical decision-making and support the prediction of management outcomes. This principle should apply to the classification systems for ECR.

Objectives: To assess the association between Heithersay's and Patel's classification systems and the recently proposed core outcome set measures for endodontic treatment.

Method: A narrative review study type was adopted due to the anticipated heterogeneity regarding clinical management. An electronic citation search of the studies by Heithersay 1999 and Patel et al. 2018 was made on 17 September, 2025 in three electronic databases (PubMed, Web of Science, and Scopus) for cohort studies that included various categories of the classifications. No language or publication date restrictions were applied. Articles were excluded when inclusion criteria were not met. Four clinical registers were searched for emerging evidence using the same criteria. The main features of the study were extracted, tabulated, and a narrative summary was made. Two authors contributed to the process independently.

Results: Searches of the databases and clinical trials registers yielded six and nil studies, respectively. The identified studies originated from seven countries, were mostly set in postgraduate teaching clinics and were published within the past five years. The recall periods extended up to 10 years with all six studies using Heithersay's classification, with three also using Patel's classification. In total, 657 teeth were assessed against Heithersay's classification and 128 also assessed with Patel's. The three studies that included both classifications had relatively limited sample sizes and relatively short final recall periods. An association between Heithersay's classification with outcomes was evident; Classes I and II were associated with high rates of survival and 'success', and Class IV the opposite. No association was found between Patel's classification with outcomes.

Conclusion: The available literature supports an association between Heithersay's classification with management outcomes for ECR. There is insufficient evidence to assess Patel's classification regarding prognostication.

Aim: This systematic review aimed to synthesise evidence on the microbiome of deep or extremely deep caries associated with a range of different pulp conditions, by analysing studies using next-generation sequencing (NGS) approaches.

Methodology: The review reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and protocol was registered prospectively at the Open Science Framework (https://osf.io/vnwjh/). A literature search was carried out in the following databases: MEDLINE via PubMed, Scopus, Cochrane Database for Systematic Reviews (CDSR), Web of Science, the clinicaltrials.gov, and the Open Science Framework, in English language without time restriction. The last search was performed on May 1st 2025. An additional online search of the four major journals in the field of endodontics (International Endodontic Journal, Journal of Endodontics, Australian Endodontic Journal and the European Endodontic Journal) was also carried out independently starting from January 1st, 2010 to May 1st 2025. Only original research articles that used an NGS approach and investigated the microbiome of deep or extremely deep caries associated with different pulp diagnoses, assessed preoperatively, were included. The Johanna Brigg's Institute (JBI's) Critical Appraisal Instrument for Studies Reporting Prevalence Data was used to assess the risk of bias of included studies.

Results: Among 1914 articles initially identified, four were considered eligible for inclusion and further assessed for certain parameters. The overall risk of bias of the three and one included studies was characterised as 'unclear' and 'high'. Firmicutes were the most prevalent phylum in all cases. In cases of irreversible pulpitis, Firmicutes prevalence increased compared with cases of normal pulp and reversible pulpitis, while the prevalence of Actinobacteria, Proteobacteria and Bacteroidetes decreased. Lactobacillus was the most abundant genus in all cases, with its abundance in cases of symptomatic irreversible pulpitis increasing substantially.

Conclusions: The NGS studies evaluated in this review create a preliminary, but comprehensive map of the microbiome of deep caries associated with a range of pulpal diagnoses. Α shift in microbiome as the asymptomatic cases become progressively symptomatic seems to occur, which may be relevant to management of deep caries in terms of complete or selective caries removal.

Aim: Bacterial biofilms around the apex are crucial in disease progression and persistence of apical periodontitis. While intracanal biofilms initiate infection, extraradicular biofilms contribute to treatment resistance and persistence. Thus, a comprehensive understanding of these biofilms may help elucidate mechanisms underlying persistent apical periodontitis. Therefore, in this study, we aimed to compare the microbiome and predicted functional profiles in matched apical root canals with those of extraradicular biofilms associated with persistent apical periodontitis.

Methodology: Seventeen root apices from patients with persistent apical periodontitis were collected via surgery. After extraradicular biofilm was collected, intracanal biofilm was obtained by cryopulverisation. Bacterial communities were detected by amplicon sequencing of the V1-V2 region of the 16S rRNA gene. Diversity, microbial composition and predicted bacterial functions were compared between matched intracanal and extraradicular biofilms.

Results: Alpha diversity analysis of the microbiome revealed no significant differences between the two sampling sites. In contrast, the beta diversity of the microbiota of the same root (matched samples) was significantly lower than that of the microbiota of unpaired samples. There were no statistically significant differences in permutational multivariate analysis of variance for the microbiome between paired extraradicular and intracanal biofilms, regardless of the presence of the sinus tract. The abundances of the predominant genera, namely Fusobacterium, Treponema, Prevotella, Porphyromonas and Bacteroides as well as gram-positive bacteria, including Actinomyces, were similar between extraradicular and intraradicular biofilms. Linear discriminant analysis effect size analysis identified bacterial taxa significantly enriched in extraradicular biofilms, whereas no taxa were significantly enriched in intraradicular biofilms. Phylogenetic Investigation of Communities by Reconstruction of Unobserved States analysis revealed several differences in Kyoto Encyclopaedia of Genes and Genomes pathways between these biofilms.

Conclusion: While comparison of the microbiome between extraradicular and intracanal biofilms of the same root apices revealed differences in bacterial composition, certain similarities were noted, particularly in dominant bacterial species abundance, indicating a close microbial relationship between intracanal and extraradicular biofilms, with some exceptions. Additionally, some differences in predicted functional profiles were observed between the two biofilm types. Thus, the characterisation of bacterial communities around the apical foramen may guide the development of appropriate antimicrobial strategies.

Aim: Internal resorption is a rare condition that may complicate endodontic treatment and tooth retention strategies. There is a lack of information in the literature on the nature of these lesions, as well as prognosis after treatment. The aims of this study were to determine which factors may be associated with treatment outcomes, and to identify and characterise clinical and radiographic features of internal resorption lesions.

Methodology: A retrospective chart review was conducted to identify cases of internal resorption at the Tufts University School of Dental Medicine Postgraduate Endodontic Clinic between the years of 2010 and 2025. All cases of internal resorption were required to have a periapical radiograph and cone-beam computed tomography (CBCT) scan of the tooth in question. Lesion characteristics were independently judged by two calibrated board-certified endodontists. Inter-observer agreement was calculated using kappa statistics, weighted kappa statistics, and intraclass correlation coefficients. One-, five-, and seven-year outcomes were determined. Statistical analysis was performed to assess associations using Fisher's exact test. No funding was provided for this study.

Results: Fifty internal resorption cases were identified. 98% were classified as internal inflammatory resorption and 2% as internal replacement resorption. Lesions were most frequent in first molars and maxillary central incisors. Perforation was present in 36% of cases. Twenty-six teeth had ≥ 1-year of follow-up; survival and success rates were 88% and 83.3%, respectively. Teeth with a pulpal diagnosis of 'normal pulp' (p = 0.003) or periapical diagnosis of 'normal apical tissues' (p = 0.031), as well as those in female patients (p = 0.032), were significantly more likely to fail at 1 year. No significant association was found between perforation and treatment outcome. Inter-observer agreement was high across all lesion parameters.

Conclusions: Internal resorption lesions can be successfully treated with contemporary endodontic techniques. Increased risk of failure may be found in teeth with a vital pulp and absence of periapical signs or symptoms of disease due to their capacity for continued growth, or those found in female patients. Traumatised teeth are more likely to present with lesions in the middle third. Future prospective studies with larger samples will further refine treatment strategies and identify prognostic indicators.

Aim: To investigate whether moderate systemic caffeine intake modulates the progression of apical periodontitis (AP) and associated alveolar bone loss, combining in vivo rat experiments with in silico molecular docking to explore potential mechanisms.

Methodology: Male Wistar rats were randomly assigned to four groups (n = 8 per group): control, caffeine, AP, AP + caffeine. AP was induced by pulp exposure of mandibular first molars and allowed to develop for 28 days. Animals in caffeine groups received 10 mg/kg/day by orogastric gavage during the experimental period. The antioxidant capacity of caffeine was assessed by DPPH• and ABTS• + assays. Systemic oxidative status was evaluated by blood reduced glutathione (GSH) and thiobarbituric acid reactive substances (TBARS). Histology, Picro-Sirius red staining for collagen, and micro-computed tomography (micro-CT) analysis of alveolar bone (BV/TV, Tb.N, Tb.Sp, porosity, lesion volume) were performed. Molecular docking against adenosine A₁ and A_{2 A} receptors was used to probe caffeine-receptor interactions.

Results: Caffeine showed relevant radical-scavenging activity in vitro (DPPH• assay). AP induced systemic redox imbalance, marked inflammatory infiltration, collagen loss and increased lesion volume. Moderate caffeine intake restored redox markers (↑GSH, ↓TBARS), attenuated inflammatory infiltrate, preserved collagen content and reduced lesion volume (AP + caffeine vs. AP; p < 0.05). Micro-CT demonstrated improved alveolar bone microarchitecture in AP + caffeine group (increased BV/TV and Tb.N; reduced Tb.Sp and porosity). Molecular docking indicated stable hydrophobic and hydrogen-bond interactions of caffeine within A₁ and A_{2 A} receptor binding pockets, supporting an antagonistic effect on adenosine signalling consistent with reduced pro-inflammatory activation.

Conclusion: Moderate systemic caffeine (10 mg/kg/day) attenuates apical periodontitis progression and preserves alveolar bone quality in rats, associated with antioxidant activity and a probable modulation of adenosine receptor-mediated inflammatory pathways.

Aim: This study aimed to evaluate the effects of N-acetylcysteine (NAC) supplementation in apical periodontitis (AP) induced in rats.

Methodology: Eighteen male Wistar rats were randomly assigned to three groups: control, AP, and AP plus NAC. NAC was administered by oral gavage (100 mg/kg/day), beginning 1 day after lesion induction and continued daily until the day preceding euthanasia. AP induction was performed by exposing the dental pulp of the lower first molars bilaterally, maintaining this condition for 28 days. After this period, the animals were euthanized, and the following biological materials were collected: blood (for systemic oxidative stress analysis) and hemimandibles for histopathological and histochemical, and micro-computed tomography analyses, aiming to measure bone quality parameters and periapical volume. Statistical analyses were performed using one-way ANOVA and Tukey's post hoc test. In addition, correlation analyses and multivariate analyses of variance (MANOVA) were performed on the biochemical parameters.

Results: The study results showed that animals supplemented with NAC had greater preservation of bone quality parameters and a reduction in periapical volume progression when compared to the only apical periodontitis group. Additionally, in the analysis of systemic oxidative stress, supplemented animals showed higher antioxidant parameter levels and lower oxidant levels compared to non-supplemented animals, which also showed reduced preservation of bone collagen content.

Conclusions: The study findings suggest that NAC supplementation promoted greater preservation of bone quality, reduced periapical volume development, and modulation of endogenous antioxidant and oxidant aspects. This indicates that NAC can decrease local and systemic damage caused by AP, highlighting its potential as an adjunctive agent in processes involving systemic oxidative stress and the preservation of biological structures.

Aim: To assess the diagnostic performance of two language models, GPT-5 Plus and Gemini 2.5 Flash using a curated benchmark dataset of unseen endodontic and restorative dentistry related clinical case scenarios and the linguistic variations introduced around the original dataset. Additionally, a descriptive qualitative analysis was performed on a subset of cases to evaluate the quality of reasoning generated by both models.

Methodology: One hundred single best answer MCQs were generated using standardised resources, constituting a benchmark dataset. Controlled linguistic variations were introduced around the original dataset; paraphrasing (sentence/clause rewording), perturbation (token-level substitutions), and permutation (answer-order shuffle). These case scenarios were presented to both models using a standardised prompt, and the performance metrics (accuracy/recall, F-1 score) were computed. Agreement between and within models was analysed using Cohen's κ, while paired differences were evaluated using McNemar's test with a significant p-value < 0.05. Qualitative analysis was performed on a subset of the total sample, and the responses were evaluated on a 3-point Likert scale.

Results: GPT-5 Plus achieved 80% accuracy on benchmark dataset compared to 66% for Gemini 2.5 Flash (McNemar's p-value = 0.0066). When linguistic variations were introduced, the performance of GPT-5 Plus declined, with perturbation having the most significant effect (McNemar's p-value = 0.003). Gemini 2.5 Flash, on the other hand, though inferior initial performance on benchmark dataset, maintained uniform decision patterns across all transformations with no significant drop further. The descriptive qualitative analysis demonstrated an overall higher proportion of responses rated as good (8/10, 80% for original dataset; 7/10, 70% for linguistic variations) for Gemini 2.5 Flash as opposed to GPT-5 Plus.

Conclusion: GPT-5 Plus outperformed Gemini 2.5 Flash on benchmark dataset; however, it was sensitive to linguistic variations. Perturbation negatively influenced the performance of GPT-5 Plus, emphasising the need to further investigate the linguistic phenomenon that may have affected the model's degradation. Additionally, the descriptive qualitative analysis demonstrated relatively higher performance for Gemini 2.5 Flash compared to GPT-5 Plus on the original dataset and across linguistic variations. However, owing to the descriptive nature of findings and limited sample size, the results should be interpreted with caution.