International endodontic journal最新文献_第5页

Does the Use of a Bioceramic Sealer Reduce Postoperative Pain Compared With an Epoxy Resin-Based Sealer After Primary Root Canal Treatment and Retreatment?—An Umbrella Review 与环氧树脂基密封剂相比，生物陶瓷密封剂在根管治疗和再治疗后是否能减少术后疼痛？——一份伞状评论。

IF 7.1 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

International endodontic journal

Pub Date : 2025-11-28 DOI: 10.1111/iej.70073

Lokhasudhan Govindaraju, Rajeswari Kalaiselvam, Mathan Rajan Rajendran, Aleksandar Jakovljevic, Jelena Jacomovic, Henry F. Duncan, Venkateshbabu Nagendrababu

Background

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.

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

Trial Registration

PROSPERO database: CRD42024616520

背景：术后疼痛（POP）是根管治疗（RCT）后常见的疼痛。与环氧树脂基封口剂相比，生物陶瓷封口剂充填根管后POP的患病率存在矛盾的证据。目的：确定在初次随机对照试验和再治疗后，与环氧树脂基密封剂联合杜仲胶密封剂相比，使用生物陶瓷密封剂是否能降低POP。方法：检索电子数据库自成立至2025年1月20日的文献。系统评价（SRs）将使用生物陶瓷密封剂的POP与环氧树脂密封剂进行比较。采用AMSTAR 2工具对评审的质量进行评估。对评价结果的总体信心分为极低、低、中等和高。结果：共纳入13例SRs。生物陶瓷封口剂与杜胶封口剂联合使用时所经历的POP与环氧树脂封口剂相似。所有SRs都充分解决了第1项（“综述的研究问题和纳入标准是否包括PICO的成分？”）。只有一个SR充分地解决了第3项（“综述作者是否解释了他们选择纳入综述的研究设计？”）)和第10项（“综述作者是否报告了综述中所包括研究的资金来源？”）。对10个、2个和1个SR(s)调查结果的总体信心分别被归类为“极低”、“低”和“高”。结论：根据目前的证据，可以得出结论，在初次随机对照试验和再治疗后，用生物陶瓷密封剂充填根管显示的POP与环氧树脂密封剂相当。根据本概括性审查中关于现有战略研究方法质量的建议，未来有必要进行高质量的战略研究。试验注册：PROSPERO数据库：CRD42024616520。

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引用次数: 0

Construction of Preoperative Diagnostic Model of Periapical Cyst by Multiparameter Magnetic Resonance Imaging: A Pilot Study 多参数磁共振成像构建根尖周囊肿术前诊断模型的初步研究。

IF 7.1 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

International endodontic journal

Pub Date : 2025-11-26 DOI: 10.1111/iej.70071

Jing Huang, Yueyi Yang, Jia Wang, Jingjing Zhu, Chunye Zhang, Shensheng Gu, Wei Zhou, Shujun Ran, Pengfei Zhang, Chenguang Niu, Meiling Jing, Zhanyi Chen, Guangyu Wu, Zhengwei Huang

Aim

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).

Methodology

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.

Results

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%).

Conclusion

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.

Trial Registration

The study is registered on the Chinese Clinical Trial Registry website (ChiCTR2000035273)

目的：由于缺乏一种可预测和无创的方法来区分不同类型的根尖牙周炎，很难估计根尖周囊肿的实际预后和非手术治疗的效果。本初步研究旨在建立一种基于磁共振成像（MRI）参数的诊断模型来区分根尖周囊肿和非根尖周囊肿病变。方法：在根管显微手术前，对根尖周病变患者进行MRI扫描，包括T2WI、非增强t1加权图像（T1WI）、弥散加权图像（DWI）和增强t1加权图像（T1WI + C）。收集了16个参数，并计算了13个导出参数。将患者按时间顺序分为训练组和验证组。组织病理学结果为金标准。采用单变量、多元回归和多重共线性分析筛选变量和选择预测因子。运用多元逻辑回归建立了正态图。用自举法对1000个样本进行判别和校准。结果：84例患者行MRI检查后行牙髓手术。病灶长度、增强面积和增强面积与病灶面积之比是诊断尖周囊肿的独立预测因子。训练队列的受试者工作特征曲线下面积（AUC）为0.861。基于ROC曲线的敏感性和特异性分别为80.6%和75.9%。标定曲线与理想对角线较为接近。决策曲线分析表明，模型的净效益为正。验证队列验证了预测nomogram的信度（AUC: 0.930，灵敏度：81.8%，特异性：76.9%）。结论：本方法可通过多参数MRI可靠地识别根尖周囊肿。病灶长度、增强面积、增强面积与病灶面积之比是诊断根尖周囊肿的重要变量。多参数MRI被认为是一种有效和无创的方法来区分根尖周围病变。试验注册：本研究已在中国临床试验注册网站（ChiCTR2000035273）注册。

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引用次数: 0

Three-Year Clinical and Economic Evaluation of Selective Caries Removal and Full Pulpotomy for Extensive Caries: An Exploratory Randomised Controlled Trial 选择性龋齿切除和全髓切开术治疗大面积龋齿的三年临床和经济评价：一项探索性随机对照试验。

IF 7.1 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

International endodontic journal

Pub Date : 2025-11-25 DOI: 10.1111/iej.70068

Jill Jing Rui Chew, Sharon Hui Xuan Tan, Sarah Kho Xian Chua, Jeen Nee Lui, Yu Fan Sim, Victoria Soo Hoon Yu

<div> <section> <h3> Aim</h3> <p>The aim of this study was to compare pulp survival following selective caries removal (SCR) and full pulpotomy treatment in teeth with extensive caries over 3 years.</p> </section> <section> <h3> Methodology</h3> <p>This two-arm, exploratory randomised controlled trial included vital mature permanent teeth with extensive primary or secondary caries diagnosed radiographically as being at least 75% or more into the thickness of dentine, without clinical signs of symptomatic irreversible pulpitis or radiographic evidence of a periapical lesion. Carious teeth were randomly allocated to receive either SCR or full pulpotomy. All teeth were reviewed clinically and radiographically at 6 months, 1 year, and 3 years post-treatment. Log-rank tests and Cox proportional hazards regressions were used to compare the outcomes of SCR and pulpotomy, adjusting for clustering using a robust variance estimator. Cost-effectiveness analysis was carried out using the healthcare system and societal perspectives. Significance level was set at 5%.</p> </section> <section> <h3> Results</h3> <p>At 3 years, 44/58 teeth (75.9%) in the SCR group and 37/55 teeth (67.3%) in the full pulpotomy group were reviewed. A total of 13 teeth in the SCR group (29.5%) and 4 teeth in the pulpotomy group (10.8%) required further intervention with root canal treatment (RCT) or extraction (<i>p</i> = 0.039). Survival rates were 74% for SCR and 89% for pulpotomy (<i>p</i> = 0.041). Overall, 79.0% of teeth treated with either SCR or pulpotomy survived without requiring further intervention over the 3-year period. In this study with more than two-thirds of the enrolled teeth classified as extremely deep lesions, pulpotomy was more cost-effective than SCR in the management of extensive caries above a willingness-to-pay threshold of $917 and $928 to avoid one tooth extraction or RCT from the healthcare system and societal perspective, respectively.</p> </section> <section> <h3> Conclusion</h3> <p>Full pulpotomy demonstrated greater effectiveness than SCR in avoiding further intervention over a 3-year period in teeth with extensive caries, of which the majority were extremely deep lesions. Further long-term studies and broader health economic evaluations are warranted to guide clinical decision-making and policy development.</p> </section> <section> <h3> Trial Registration</h3> <p>ClinicalTrials.gov identifier: NCT04672070</p> </section> </div

目的：本研究的目的是比较选择性除龋（SCR）和全髓切开术治疗大面积龋齿3年以上的牙髓存活率。方法：这项双组、探索性随机对照试验纳入了重要的成熟恒牙，这些恒牙有广泛的原发性或继发性龋齿，放射学诊断为牙本质厚度至少达到75%或更多，没有症状性不可逆牙髓炎的临床体征或根尖周病变的放射学证据。龋齿随机分为SCR组和全髓切开术组。在治疗后6个月、1年和3年对所有牙齿进行临床和影像学检查。使用Log-rank检验和Cox比例风险回归来比较SCR和髓切术的结果，并使用稳健方差估计器进行聚类调整。从医疗保健系统和社会角度进行成本效益分析。显著性水平设为5%。结果：3年时SCR组44/58(75.9%)，全髓切开术组37/55（67.3%）。SCR组13颗牙（29.5%），切髓组4颗牙（10.8%）需要进一步干预根管治疗（RCT）或拔牙（p = 0.039）。SCR的生存率为74%，髓切开术的生存率为89% （p = 0.041）。总的来说，在3年的时间里，79.0%接受SCR或切髓术治疗的牙齿存活下来，无需进一步干预。在这项研究中，超过三分之二的入组牙齿被分类为极深病变，从医疗保健系统和社会角度来看，牙髓切开术比SCR在管理大面积龋齿方面更具成本效益，其愿意支付的门槛分别为917美元和928美元，以避免一次拔牙或随机对照试验。结论：对于大面积龋齿，其中大多数是极深的龋齿，全髓切开术在避免进一步干预方面比SCR更有效。有必要进行进一步的长期研究和更广泛的卫生经济评估，以指导临床决策和政策制定。试验注册：ClinicalTrials.gov标识符：NCT04672070。

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引用次数: 0

Comparison of Curvature Severity Between Sagittal and Coronal Planes of Mesial Canals in Permanent Mandibular First Molars Using Schneider's and Weine's Methods and Multiple Complexity–Risk Criteria: A Cone-Beam Computed Tomography Cross-Sectional Study 使用Schneider’s和Weine’s方法和多重复杂性风险标准比较下颌第一恒磨牙近中牙管矢状面和冠状面曲率严重程度：一项锥形束计算机断层研究。

IF 7.1 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

International endodontic journal

Pub Date : 2025-11-25 DOI: 10.1111/iej.70072

Abhishek Isaac Mathew, Daniel Almeida Decurcio, Carlos Estrela, Lee Wu, William Nguyen Ha, Giampiero Rossi-Fedele

Background

There is a strong association between root canal curvatures and iatrogenic complications during root canal treatment.

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.

背景：在根管治疗过程中，根管曲率与医源性并发症有很强的相关性。简介：本研究采用锥束计算机断层扫描比较下颌第一磨牙矢状面和冠状面间中颊管（MB）和中舌管（ML）的曲率。方法：对来自巴西亚群的200个中根（400个）根管进行分析。曲率角采用Schneider和Weine的方法在矢状面和冠状面测量，曲率半径采用几何方法计算。s形运河的流行程度也有记录。曲率严重程度根据美国牙髓医师协会病例难度评估表、EndoApp和合并曲率和半径的修改版本进行分类。评估了角度测量方法和半径对案例复杂度的影响。采用t检验和卡方检验进行统计学分析，p≤0.05为显著性。结果：矢状面角度明显大于冠状面，半径明显小于冠状面。与施耐德的方法相比，Weine的方法产生的角度始终更高，半径更小。严重的单曲率（≥30°）在矢状面更常见，而s形管在冠状面更常见。MB通常被归类为难度高于ML管。将半径纳入分类系统通常会将病例转向更严重的程度。结论：矢状面单侧弯曲更严重，冠状面s型管更常见。Weine的方法比Schneider的方法产生了更大的曲率严重程度。纳入桡骨增加了病例严重程度分级。这些发现强调了在根管治疗计划和研究中同时考虑测量方法和投影平面的重要性。

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引用次数: 0

Regulatory Pathways Governing Odonto/Osteogenic Differentiation in Dental Pulp Stem Cells 牙髓干细胞牙髓/成骨分化的调控途径。

IF 7.1 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

International endodontic journal

Pub Date : 2025-11-24 DOI: 10.1111/iej.70069

Chatvadee Kornsuthisopon, Nunthawan Nowwarote, Tanida Srisuwan, Waruna Lakmal Dissanayaka, Thanaphum Osathanon

Background

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).

Aim

This article provides a comprehensive evaluation of cell signalling pathways and ECM that modulate odonto/osteogenic differentiation of DPSCs.

Methods

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.

Results

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.

Conclusion

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.

背景：牙髓干细胞（DPSCs）分化成牙髓/成骨谱系的能力是由复杂的细胞信号调节网络和细胞与细胞外基质（ECM）之间的相互作用决定的。目的：本文提供了一个全面的评估细胞信号通路和ECM调节牙/成骨分化的DPSCs。方法：采用一种全面的叙述性回顾方法来研究影响DPSCs成牙/成骨分化的关键细胞信号传导机制，旨在阐明其意义，并批判性地评估其在牙本质/牙髓修复和再生策略中的未来应用前景。结果：目前的文献表明，转化生长因子-β (TGF-β)、Wnt、Notch和成纤维细胞生长因子（FGF）信号，无论是单独还是通过相互作用，都影响干细胞的命运。TGF-β1在调节DPSC向牙/成骨谱系分化中至关重要。Wnt信号对修复性牙本质的形成起着至关重要的作用，这一点在牙髓盖盖后的动物模型中得到了证实。Wnt激活剂显著促进牙本质再生。Notch信号在牙髓壁龛中激活，促进牙本质损伤后的修复性形成。Notch和其他通路之间的相互作用影响DPSC牙/成骨分化。碱性成纤维细胞生长因子（bFGF）调节DPSC的干性和分化，其生物学效应受剂量和暴露时间等因素的影响。此外，ECM组分通过增强微环境中的生物因子并提供物理支持，从而促进牙本质和牙髓修复，在干细胞分化中发挥重要作用。结论：对这些调控机制的全面理解有可能增加对DPSC分化控制的认识，并促进它们在牙本质-牙髓复合体修复和再生治疗中的应用。

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引用次数: 0

Investigation of the Effect of Vitamin D Supplementation on Apical Lesion Healing Rate: Prospective, Randomised Clinical Trial 补充维生素D对根尖病变治愈率影响的研究：前瞻性、随机临床试验。

IF 7.1 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

International endodontic journal

Pub Date : 2025-11-24 DOI: 10.1111/iej.70066

Edanur Maraş, Banu Aricioğlu, Hatice Beyazal Polat, Medeni Arpa, Dilara Nil Günaçar, Taha Emre Köse

Aim

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.

Methodology

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).

Results

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).

Conclusions

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.

Trial Registration

ClinicalTrials.gov identifier: TCTR20221020006

目的：本研究旨在评估通过补充维生素D维持最佳血清水平对根管治疗后根尖周病变牙齿3、6、9和12个月新生骨愈合率和质量的影响。此外，测量TNF-α水平以研究潜在的愈合效果是否与维生素d的抗炎特性有关。方法学：本研究设计为一项平行、三盲、随机对照临床试验，已在临床试验注册中心注册。将73例符合纳入标准的男性成熟下颌磨牙患者分为两组：维生素D组（n = 37）和对照组（n = 36）。所有患者均按照标准化的根管治疗方案接受根管治疗。维生素D组口服维生素D，使血清25(OH)D水平达到最佳范围（30-50 ng/mL），对照组血清25(OH)D水平不足（20-30 ng/mL），不补充维生素D。评估根尖周x线片（术前、3、6、9、12个月）、血清25(OH)D（化学发光）和TNF-α (ELISA)水平。以mm2计算病变面积缩小，分形分析评估骨质量。使用Mann-Whitney U和Friedman检验对数据进行统计学分析(p结果：维生素D组的病变面积减少明显大于对照组（p 0.05）。结论：血清维生素D水平维持在最佳范围内（30-50 ng/mL）的个体，根尖周围病变的缩小速度更快。结论是，适当时通过补充维生素D水平来优化维生素D水平，可能有利于根尖周病变牙齿的愈合过程。试验注册：ClinicalTrials.gov标识符：TCTR20221020006。

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引用次数: 0

Copaiba Oil–Resin Reduces the Alveolar Bone Damage Triggered by Apical Periodontitis in Rats Copaiba油树脂对大鼠根尖牙周炎引起的牙槽骨损伤的影响。

IF 7.1 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

International endodontic journal

Pub Date : 2025-11-21 DOI: 10.1111/iej.70063

Rayssa Maitê Farias Nazário, Deborah Ribeiro Frazão, Leonardo Oliveira Bittencourt, Victoria Santos Chemelo, José Mário Matos-Sousa, Beatriz Rodrigues Risuenho Peinado, Roberta Souza D’almeida Couto, Osmar Alves Lameira, João Daniel Mendonça de Moura, Jorddy Neves Cruz, Fabrício Mezzomo Collares, Rafael Rodrigues Lima

Aim

This study aimed to investigate the effects of copaiba oil–resin on induced apical periodontitis in rats.

Methodology

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.

Results

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.

Conclusions

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.

目的：探讨copaiba油树脂对大鼠根尖牙周炎的治疗作用。方法：雄性Wistar大鼠24只，随机分为对照组(C)、根尖牙周炎组（AP）和根尖牙周炎加copaiba组（AP + COP），每组8只。将下颌第一磨牙的牙髓腔暴露于口腔环境中诱发AP。保持开口28天，以允许病变发展。AP + COP组在AP诱导期的最后7天，以200 mg/kg的copaiba油树脂灌胃给药。然后对大鼠实施安乐死，对其半下颌骨进行组织病理学分析以评估组织保存情况，用小天狼星红进行组织化学染色以评估胶原含量，并进行显微计算机断层扫描以评估病变体积和骨质量参数。采用单因素方差分析进行统计分析，随后对参数数据进行Tukey事后检验，对非参数数据进行Kruskal-Wallis检验。参数检验的结果表示为平均值和标准误差，非参数检验的结果表示为中位数和四分位数偏差。结果：与未治疗组相比，copaiba油树脂减少了病变体积（p = 0.0261）， AP组减少了骨小梁之间的间隙（p = 0.0063）。此外，copaiba油树脂保存了胶原纤维，未处理组胶原纤维降解程度更高（p = 0.0009）。组织病理学分析显示，copaiba油树脂减少了组织损伤，保留了病变周围的大量牙槽骨。结论：copaiba油树脂在减少根尖牙周炎引起的骨质流失和维持剩余骨质量方面具有良好的辅助治疗潜力。

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引用次数: 0

A Clinical Approach Using Scheduled-For-Extraction Teeth to Validate a Classic In Vitro Method to Assess the Performance of the EALs 临床方法使用预定拔牙验证经典体外方法评估EALs的性能。

IF 7.1 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

International endodontic journal

Pub Date : 2025-11-21 DOI: 10.1111/iej.70064

Marco Simões-Carvalho, Gustavo De-Deus, Maristela Carestiato, Viviany Cozer, Clarissa Amaral, Thâmia Adriane Rocha Matos, Erick Miranda Souza, Felipe Gonçalves Belladonna, Emmanuel João Nogueira Leal Silva, Marco Aurélio Versiani

Introduction

This study aimed to validate a commonly used in vitro methodology of testing the performance of the EALs. For that, clinical data obtained from teeth already scheduled for extraction were used to compare the accuracy and precision of an EAL in determining the position of the apical foramen in both clinical and laboratory settings using micro-CT imaging.

Methods

In a clinical setting, the working length of 11 canals was established using the Root ZX II apex locator. Subsequently, these teeth were extracted and imaged with and without the file in place using micro-CT technology. In vitro measurements of the working length were then obtained in these same teeth using an alginate model and new micro-CT scans were performed. Datasets were co-registered and the accuracy and precision of both in vivo and in vitro models were compared by measuring the distance from the file tip to a tangential line crossing the foramen margins, with a tolerance level of ±0.5 mm. Statistical comparisons were performed using Friedman post hoc Related Samples Sign and Bland–Altman tests with a significance level set at 5%.

Results

Statistical analysis revealed no significant difference between the accuracy (p = 0.368) and precision (p = 0.761) measurements obtained in both in vivo and in vitro conditions. Additionally, the Bland–Altman analysis revealed an agreement between in vivo and in vitro methods (p > 0.05).

Conclusions

The in vitro methodology using freshly mixed alginate demonstrated consistent accuracy and precision in identifying the position of the apical foramen, when compared to in vivo measurements.

本研究旨在验证一种常用的体外测试EALs性能的方法。为此，从已经计划拔牙的牙齿中获得的临床数据被用于比较临床和实验室环境下使用显微ct成像确定根尖孔位置的EAL的准确性和精度。方法：在临床环境下，使用根管ZX II根尖定位器确定11根根管的工作长度。随后，这些牙齿被拔出，并使用微ct技术对有或没有锉的牙齿进行成像。然后使用海藻酸盐模型在这些牙齿中获得工作长度的体外测量，并进行新的微ct扫描。对数据集进行联合注册，通过测量锉尖到穿过孔缘切线的距离，比较体内和体外模型的准确性和精密度，误差水平为±0.5 mm。统计学比较采用Friedman事后相关样本符号和Bland-Altman检验，显著性水平设为5%。结果：经统计学分析，在体内和体外条件下测定的准确度（p = 0.368）和精密度（p = 0.761）无显著差异。此外，Bland-Altman分析显示体内和体外方法之间的一致性（p < 0.05）。结论：与体内测量相比，使用新鲜混合海藻酸盐的体外方法在确定根尖孔位置方面表现出一致的准确性和精确性。

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引用次数: 0

Protocol for the Development of a New Comprehensive Classification for Iatrogenic Tooth Perforations 医源性牙穿孔新综合分类发展方案。

IF 7.1 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

International endodontic journal

Pub Date : 2025-11-19 DOI: 10.1111/iej.70067

Venkateshbabu Nagendrababu, Saravanan Poorni, Srividhya Srinivasan, Diana Davidson, Thomas Clauder, Bun San Chong, Paul V. Abbott, Paul M. H. Dummer

<p>In endodontics, perforation of a tooth has been defined as “the mechanical or pathologic communication between the root canal system and the external surface of the tooth” (American Association of Endodontists <span>2020</span>). Pathological perforations may occur due to tooth resorption or caries (Saed et al. <span>2016</span>), whilst perforations that occur due to mishaps during operative procedures, such as root canal treatment or post-space preparation, are referred to as iatrogenic perforations (Fuss and Trope <span>1996</span>; Tsesis and Fuss <span>2006</span>; Estrela et al. <span>2017</span>).</p><p>The occurrence of all forms of perforations has been documented to range from 0.6% to 17.6% (Eleftheriadis and Lambrianidis <span>2005</span>; Sarao et al. <span>2021</span>; Seltzer et al. <span>1967</span>; Seltzer et al. <span>1970</span>; Tsesis et al. <span>2010</span>). According to a clinical study, perforations occur in maxillary teeth (74.5%) three times more frequently than mandibular teeth (25.5%) (Kvinnsland et al. <span>1989</span>). In maxillary anterior teeth, iatrogenic perforations occur predominantly on the labial aspect of the tooth, primarily due to access preparation misalignment in relation to root inclination. In posterior teeth, perforation of pulp chamber floors may occur during access cavity preparation when locating canal orifices (Kvinnsland et al. <span>1989</span>), or along the canal following excessive tooth tissue removal during inappropriate canal instrumentation. Reports in the literature have identified that one of the significant contributing factors influencing the outcome of root canal retreatment was the existence of a perforation (Farzaneh et al. <span>2004</span>).</p><p>If located sub-gingivally, there is an intense inflammatory reaction at the site of a perforation due to microbial contamination and/or the injury caused by the instruments that had created the mishap. This chronic inflammation can result in gradual breakdown of the periodontium if not managed appropriately. Ultimately, the inflammatory cascade is likely to result in the development of a periodontal pocket, fistula and bone resorption (Clauder and Shin <span>2006</span>; Saed et al. <span>2016</span>; Tsesis and Fuss <span>2006</span>) as well as a range of symptoms.</p><p>If a perforation is not recognised or if it is treated incorrectly and an infection is established, the prognosis of the repair will be uncertain, and the possible complications can lead to tooth loss (Seltzer et al. <span>1967</span>; Tsesis and Fuss <span>2006</span>). In theory, a supragingival tooth perforation may not necessarily progress towards irreversible inflammation or treatment failure, as long as the site does not become infected and it is managed appropriately (Fuss and Trope <span>1996</span>). Even if a perforation is repaired, the inappropriate selection and/or manipulation of the repair material and a lack of effective microbial control may co

在牙髓学中，牙齿穿孔被定义为“根管系统与牙齿外表面之间的机械或病理交流”（美国牙髓医师协会2020年）。病理性穿孔可能由于牙齿吸收或龋齿而发生（Saed等人，2016），而由于手术过程中发生的事故，如根管治疗或后间隙准备而发生的穿孔被称为医源性穿孔（Fuss和Trope 1996； Tsesis和Fuss 2006； Estrela等人，2017）。文献记载，各种形式穿孔的发生率从0.6%到17.6%不等（eleftheradiis和Lambrianidis 2005； Sarao等人2021；Seltzer等人1967；Seltzer等人1970；tesis等人2010）。根据一项临床研究，上颌牙（74.5%）发生穿孔的频率是下颌骨（25.5%）的三倍（Kvinnsland et al. 1989）。在上颌前牙中，医源性穿孔主要发生在牙齿的唇侧，主要是由于通道准备与牙根倾斜有关。在后牙中，牙髓室底穿孔可能发生在预备通道腔时定位根管孔的过程中（Kvinnsland et al. 1989），或者在不适当的根管预备过程中去除过多的牙齿组织后沿根管发生。文献报道指出，影响根管再治疗结果的重要因素之一是存在穿孔（Farzaneh et al. 2004）。如果位于牙龈下，由于微生物污染和/或造成事故的器械造成的损伤，穿孔部位会有强烈的炎症反应。如果处理不当，这种慢性炎症会导致牙周组织的逐渐破坏。最终，炎症级联可能导致牙周袋、瘘管和骨吸收的发展（Clauder and Shin 2006; Saed et al. 2016; Tsesis and Fuss 2006）以及一系列症状。如果没有发现穿孔或治疗不当导致感染，修复的预后将不确定，可能的并发症可能导致牙齿脱落（Seltzer et al. 1967; tesis and Fuss 2006）。理论上，只要该部位没有感染并得到适当处理，龈上牙穿孔不一定会发展为不可逆转的炎症或治疗失败（Fuss和Trope 1996）。即使穿孔被修复，修复材料的不适当选择和/或操作以及缺乏有效的微生物控制可能会使问题复杂化，从而使愈合不太可能发生（Fuss和Trope 1996）。穿孔增加了微生物进入的风险，结构完整性差导致骨折或牙齿脱落。根据一项前瞻性研究，术前或术中有穿孔的牙齿丢失的可能性是无穿孔牙齿的3.7倍（Ng et al. 2011）。总之，医源性牙穿孔是牙髓治疗的严重并发症，如果不被识别、诊断和治疗，将不可避免地导致牙周组织的破坏和/或根尖牙周炎的持续。诸如诊断时间、微生物污染的存在/不存在和程度、穿孔与嵴骨和上皮附着的接近程度以及临床医生的治疗方法等因素对预后都至关重要（Estrela等人，2018）。Siew等人（2015）的一项系统综述得出结论，非手术修复穿孔可导致约73%的总体有利结果。正畸强制出牙是另一种非手术的替代方法，只要牙齿有足够的根长，就可以将牙冠穿孔提升到附着牙龈之上（Tsesis and Fuss 2006）。术前各种考虑可能有助于穿孔修复后愈合的可能性。上颌弓中的牙齿，穿孔部位缺乏透光性，以及使用液压硅酸钙水泥被认为是穿孔修复后牙齿存活的积极因素（Siew et al. 2015）。水力硅酸钙水泥的使用大大提高了对射孔的管理。这些材料表现出优异的密封能力、生物相容性和增强根周组织再生的能力，从而改善穿孔修复后的预后（Main et al. 2004; Gorni et al. 2016; Torabinejad et al. 2018）。鉴于其相对良好的临床结果，非手术修复现在被认为是根穿孔的首选治疗方法。然而，有许多因素可能会影响结果，所有这些都需要考虑。人们尝试根据三个主要的预后因素对医源性穿孔进行分类（Fuss和Trope 1996）：穿孔的位置（根尖-冠状或冠状）、大小（小或大）和发生时间（最近或以前）。虽然这种分类（Fuss and Trope 1996）是有帮助的，但它没有充分考虑到其他可能影响结果的重要因素；例如，穿孔的原因，穿孔前和穿孔后的牙周状况，穿孔部位病变的放射学证据，有无感染。例如，指定穿孔的尺寸或发生的时间框架更有可能指导临床决策并有助于告知预后。这篇社论的目的是阐明在医源性牙齿穿孔的新分类系统的发展中所遵循的基本原理和方法。预计一个新的、结构化的、有临床意义的、全面的分类将成为所有利益相关者（包括临床医生、教育工作者和研究人员）的宝贵工具。所有的作者都对这份手稿作出了很大的贡献。所有作者都阅读并认可了稿件的最终版本。作者声明无利益冲突。数据共享不适用于本文，因为在当前研究期间没有生成或分析数据集。

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引用次数: 0

From Quiescence to Proliferation: Molecular Mechanisms Driving Malassez Epithelial Cell Activation and Proliferation Into Inflammatory Radicular Cystic Transformation 从静止到增殖：马拉塞兹上皮细胞活化和增殖为炎性根状囊性转化的分子机制。

IF 7.1 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

International endodontic journal

Pub Date : 2025-11-18 DOI: 10.1111/iej.70062

Nestor Ríos-Osorio, Javier Caviedes-Bucheli, Juan Sosa-Gutierrez, Rafael Fernández-Grisales

<div> <section> <h3> Background</h3> <p>Inflammatory radicular cysts (IRCs) arise from periapical granulomas (PGs). IRCs originate from Malassez epithelial remnants (ERMs), which can proliferate under specific biological stimuli. Although ERMs are common within PGs, only a subset of lesions evolves into IRCs, suggesting that specific molecular and immunoregulatory mechanisms govern this selective transformation.</p> </section> <section> <h3> Objectives</h3> <p>Molecular mechanisms and cellular signalling pathways modulating the epithelial proliferation of the ERM represent an inflexion point in the progression from PG to IRC. The objective of this review is to analyse the mechanisms and pathways involved in uncontrolled ERM proliferation, intending to elucidate why only a subset of epithelium-containing PGs progress to IRCs.</p> </section> <section> <h3> Methods</h3> <p>A systematic literature search was conducted across MEDLINE (PubMed), Web of Science and Scopus from inception to July 2025. Sixty-one articles met the inclusion criteria for narrative analysis and synthesis.</p> </section> <section> <h3> Results</h3> <p>ERM proliferation emerges from a coordinated interplay between immune, stromal and epithelial compartments. Fibroblast growth factor-7 (FGF-7/KGF) activates the FGFR2-IIIb–MAPK/PI3K–AKT pathways, maintaining homeostasis of ERM proliferation. Transforming growth factor-β (TGF-β1/β2) and Smad2/3 signalling sustain epithelial quiescence. IGF-BP-6 sequesters bioavailable insulin growth factor (IGF-II), avoiding mitogenic signalling. Proteolytic cleavage of IGF-BP-6 releases bioactive IGF-II, enhancing ERM pathological proliferation. Intense AP upregulates epidermal growth factor (EGF) and its receptor (EGF-R), promoting uncontrolled ERM proliferation. IL-1β antagonises TGF-β/Smad2 suppression through NF-κB (p65) activation. IL-6 promotes pathological ERM proliferation and migration via classic and trans-signalling. Persistent M1 macrophage polarisation and Th1/Th17 dominance reinforce this microenvironment. Activated dendritic cells potentiate T-cell responses and cytokine release.</p> </section> <section> <h3> Conclusion</h3> <p>Not all PGs progress to IRCs because cystic transformation requires the convergence of epithelial, stromal and immune thresholds that override ERM quiescence. This review proposes an integrative theoretical model that redefines ERMs as dynamic, inflammation-responsive progenitors whose activation depends on imm

背景：炎性根性囊肿（IRCs）起源于根尖周围肉芽肿（pg）。IRCs起源于Malassez上皮残体（ERMs），它可以在特定的生物刺激下增殖。尽管erm在pg中很常见，但只有一小部分病变演变为IRCs，这表明特定的分子和免疫调节机制控制着这种选择性转化。目的：调节ERM上皮细胞增殖的分子机制和细胞信号通路是PG向IRC发展的一个拐点。本综述的目的是分析不受控制的ERM增殖的机制和途径，旨在阐明为什么只有一小部分含上皮的pg进展为IRCs。方法：系统检索MEDLINE （PubMed）、Web of Science和Scopus自成立至2025年7月的文献。61篇文章符合叙述分析和综合的纳入标准。结果：ERM增殖是免疫、间质和上皮细胞间协调相互作用的结果。成纤维细胞生长因子-7 （FGF-7/KGF）激活FGFR2-IIIb-MAPK/PI3K-AKT通路，维持ERM增殖的稳态。转化生长因子-β (TGF-β1/β2)和Smad2/3信号传导维持上皮静止。IGF-BP-6隔离生物可利用的胰岛素生长因子（IGF-II），避免有丝分裂信号传导。IGF-BP-6的蛋白水解裂解释放出具有生物活性的IGF-II，促进ERM病理增殖。强AP上调表皮生长因子（EGF）及其受体（EGF- r），促进不受控制的ERM增殖。IL-1β通过激活NF-κB （p65）拮抗TGF-β/Smad2抑制。IL-6通过经典和反式信号传导促进病理性ERM增殖和迁移。持续的M1巨噬细胞极化和Th1/Th17优势强化了这种微环境。活化的树突状细胞增强t细胞反应和细胞因子释放。结论：并非所有pg都进展为IRCs，因为囊性转化需要上皮、基质和免疫阈值的收敛，而这些阈值会超越ERM的静止。这篇综述提出了一个综合的理论模型，将erm重新定义为动态的，炎症反应性的祖细胞，其激活依赖于免疫上皮的串扰，而不仅仅是感染。通过描述特定的生物标志物簇——上皮、免疫/共刺激和基质/重塑——这项工作提出了一个能够预测病变行为的机制框架。它可以为分子引导诊断和合理设计靶向治疗策略奠定基础，旨在预防或逆转囊性转化，最终将分子知识与临床牙髓治疗实践联系起来。

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