Hossein Mohammad-Rahimi, Rishi Ramani, Frank C Setzer, Falk Schwendicke, Ruben Pauwels, Ali Nosrat
{"title":"Research That Matters: A Call for Enhancing Rigour and Relevance in Artificial Intelligence Research in Endodontics.","authors":"Hossein Mohammad-Rahimi, Rishi Ramani, Frank C Setzer, Falk Schwendicke, Ruben Pauwels, Ali Nosrat","doi":"10.1111/iej.70094","DOIUrl":"https://doi.org/10.1111/iej.70094","url":null,"abstract":"","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145932822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: This study aimed to detect the root number of maxillary premolars on panoramic radiographs using deep learning models.
Methodology: This retrospective study included 925 maxillary premolars from 350 patients with panoramic radiographs and CBCT scans, which served as the reference standard to determine root numbers. Panoramic images were cropped to isolate the premolar root region, preprocessed, resized, and used to train three convolutional neural network (CNN) models (AlexNet, DenseNet-121, EfficientNet-B0) equipped via transfer learning. Data augmentation was applied to address class imbalance. Five-fold cross-validation was performed, with each fold allocating 86% of the data (n = 797) for training, 7% (n = 64) for validation and 7% (n = 64) for testing, without patient-level overlap. An independent external validation set was also constructed to assess generalizability. An experienced endodontist evaluated the same external validation set for comparison. Accuracy, sensitivity, specificity, F1-score, and the area under the ROC curve (AUC) were calculated as mean ± standard deviation (SD) with 95% confidence intervals (CI). The ensemble model was used to improve robustness. Paired DeLong tests were performed to compare AUCs for both cross-validation predictions (n = 322) and external validation predictions (n = 148).
Results: In cross-validation, the ensemble achieved the strongest performance (accuracy 0.90, F1-score 0.90, sensitivity 0.89, specificity 0.91, AUC 0.94). Among individual models, EfficientNet-B0 and AlexNet performed similarly (accuracy 0.85), while DenseNet-121 performed lower (0.81). DeLong analyses confirmed significantly higher AUCs for the ensemble compared with all individual models (p < 0.05). On the external validation set, the ensemble again performed best (accuracy 0.87), followed by AlexNet (0.85), EfficientNet-B0 (0.84) and DenseNet-121 (0.84). The expert clinician achieved an accuracy of 0.82. DeLong comparisons on external validation predictions revealed no significant AUC differences among models (all p > 0.05), except for AlexNet vs. the ensemble. Confidence interval plots confirmed the ensemble's reduced variability and narrowest CIs.
Conclusions: Deep learning models showed reliable performance in predicting root numbers of maxillary premolars from panoramic radiographs, with the ensemble model achieving the most stable and accurate results. These findings indicate that deep learning systems may serve as a supportive tool in clinical decision-making.
{"title":"Deep Learning-Based Detection of Root Numbers in Maxillary Premolars.","authors":"Ecem Azgari, Cem Azgari, Hesna Sazak Öveçoğlu","doi":"10.1111/iej.70091","DOIUrl":"https://doi.org/10.1111/iej.70091","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to detect the root number of maxillary premolars on panoramic radiographs using deep learning models.</p><p><strong>Methodology: </strong>This retrospective study included 925 maxillary premolars from 350 patients with panoramic radiographs and CBCT scans, which served as the reference standard to determine root numbers. Panoramic images were cropped to isolate the premolar root region, preprocessed, resized, and used to train three convolutional neural network (CNN) models (AlexNet, DenseNet-121, EfficientNet-B0) equipped via transfer learning. Data augmentation was applied to address class imbalance. Five-fold cross-validation was performed, with each fold allocating 86% of the data (n = 797) for training, 7% (n = 64) for validation and 7% (n = 64) for testing, without patient-level overlap. An independent external validation set was also constructed to assess generalizability. An experienced endodontist evaluated the same external validation set for comparison. Accuracy, sensitivity, specificity, F1-score, and the area under the ROC curve (AUC) were calculated as mean ± standard deviation (SD) with 95% confidence intervals (CI). The ensemble model was used to improve robustness. Paired DeLong tests were performed to compare AUCs for both cross-validation predictions (n = 322) and external validation predictions (n = 148).</p><p><strong>Results: </strong>In cross-validation, the ensemble achieved the strongest performance (accuracy 0.90, F1-score 0.90, sensitivity 0.89, specificity 0.91, AUC 0.94). Among individual models, EfficientNet-B0 and AlexNet performed similarly (accuracy 0.85), while DenseNet-121 performed lower (0.81). DeLong analyses confirmed significantly higher AUCs for the ensemble compared with all individual models (p < 0.05). On the external validation set, the ensemble again performed best (accuracy 0.87), followed by AlexNet (0.85), EfficientNet-B0 (0.84) and DenseNet-121 (0.84). The expert clinician achieved an accuracy of 0.82. DeLong comparisons on external validation predictions revealed no significant AUC differences among models (all p > 0.05), except for AlexNet vs. the ensemble. Confidence interval plots confirmed the ensemble's reduced variability and narrowest CIs.</p><p><strong>Conclusions: </strong>Deep learning models showed reliable performance in predicting root numbers of maxillary premolars from panoramic radiographs, with the ensemble model achieving the most stable and accurate results. These findings indicate that deep learning systems may serve as a supportive tool in clinical decision-making.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Igor Bassi Ferreira Petean, Alice Corrêa Silva-Sousa, Rafael Verardino de Camargo, Yara Terezinha Corrêa Silva-Sousa, Fernanda Gonçalves Basso, André Pitondo-Silva, Francisco Wanderley Garcia de Paula-Silva, Erika Calvano Kuchler, Raquel Assed Bezerra da Silva, Lea Assed Bezerra da Silva, Jardel Francisco Mazzi-Chaves, Fabiane Carneiro Lopes-Olhê, Manoel Damião Sousa-Neto
<div> <section> <h3> Aim</h3> <p>To evaluate the impact of polymorphisms in <i>SOCS-1, TNF-α</i> and <i>RANKL</i> on gene expression of <i>RANK</i>, <i>RANKL</i>, <i>TNFRSF1, SOCS-1, IL-10</i>, <i>IL-1β</i> and <i>TNF-α</i>, and to evaluate the histopathological, immunohistochemical and microbiological aspects of persistent apical periodontitis (PAP) after root canal treatment (RCT) in Brazilian individuals.</p> </section> <section> <h3> Methodology</h3> <p>Patients with pulp necrosis and apical periodontitis at the time of the non-surgical RCT (NSRCT) were followed up for at least 1 year after NSRCT. In view of the need for surgical intervention (cases assessed with a CBCTPAI score of 4 and 5, with the presence of symptoms), 20 patients were selected for endodontic surgery, which was planned using cone beam computed tomography images. Initially, saliva was collected as a source of genomic DNA, and the individuals were genotyped for <i>SOCS-1</i>, <i>TNF-α</i> and <i>RANKL</i> polymorphisms by real-time PCR. After collecting the biological material, the periapical lesions obtained were subjected to analysis of gene expression levels for <i>RANK</i>, <i>RANKL</i>, <i>TNFRSF1, SOCS-1, IL-10</i>, <i>IL-1β</i> and <i>TNF-α</i>, and histopathological evaluation for characterisation and differentiation into periapical granulomas and cysts; immunohistochemical evaluation for SOCS-1 and IL-1β protein labeling; and microbiological analysis to identify the microorganisms involved in persistent periapical infection. The relative mRNA expression values of each gene in each group, according with genotypes in different SNPs, were analysed using one-way analysis of variance followed by Tukey's post-test or <i>T</i>-test (<i>α</i> = 5%).</p> </section> <section> <h3> Results</h3> <p>Different expression values of the genes evaluated were observed according to the genotypes of the polymorphisms evaluated in relation to PAP (<i>p</i> < 0.05). Among the cases submitted for histopathological evaluation, 66.7% were diagnosed as periapical granuloma and 33.3% as periapical cyst. Immunohistochemical analysis showed strong positivity for SOCS-1 and IL-1β in the lesions classified as periapical cyst, while the lesions diagnosed as periapical granuloma were not labelled. In the microbiological analysis, four different species of bacteria were isolated: <i>Pseudomonas aeruginosa</i>, <i>Staphylococcus epidermidis</i>, <i>Enterococcus faecalis</i> and <i>Bacillus cereus</i>.</p> </section> <section> <h3> Conclusions</h3> <p>This exploratory study indicates that genetic pol
{"title":"Exploring Persistent Apical Periodontitis in Humans: Integrative Genetic, Histological and Microbiological Perspectives for Translational Research","authors":"Igor Bassi Ferreira Petean, Alice Corrêa Silva-Sousa, Rafael Verardino de Camargo, Yara Terezinha Corrêa Silva-Sousa, Fernanda Gonçalves Basso, André Pitondo-Silva, Francisco Wanderley Garcia de Paula-Silva, Erika Calvano Kuchler, Raquel Assed Bezerra da Silva, Lea Assed Bezerra da Silva, Jardel Francisco Mazzi-Chaves, Fabiane Carneiro Lopes-Olhê, Manoel Damião Sousa-Neto","doi":"10.1111/iej.70070","DOIUrl":"10.1111/iej.70070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the impact of polymorphisms in <i>SOCS-1, TNF-α</i> and <i>RANKL</i> on gene expression of <i>RANK</i>, <i>RANKL</i>, <i>TNFRSF1, SOCS-1, IL-10</i>, <i>IL-1β</i> and <i>TNF-α</i>, and to evaluate the histopathological, immunohistochemical and microbiological aspects of persistent apical periodontitis (PAP) after root canal treatment (RCT) in Brazilian individuals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>Patients with pulp necrosis and apical periodontitis at the time of the non-surgical RCT (NSRCT) were followed up for at least 1 year after NSRCT. In view of the need for surgical intervention (cases assessed with a CBCTPAI score of 4 and 5, with the presence of symptoms), 20 patients were selected for endodontic surgery, which was planned using cone beam computed tomography images. Initially, saliva was collected as a source of genomic DNA, and the individuals were genotyped for <i>SOCS-1</i>, <i>TNF-α</i> and <i>RANKL</i> polymorphisms by real-time PCR. After collecting the biological material, the periapical lesions obtained were subjected to analysis of gene expression levels for <i>RANK</i>, <i>RANKL</i>, <i>TNFRSF1, SOCS-1, IL-10</i>, <i>IL-1β</i> and <i>TNF-α</i>, and histopathological evaluation for characterisation and differentiation into periapical granulomas and cysts; immunohistochemical evaluation for SOCS-1 and IL-1β protein labeling; and microbiological analysis to identify the microorganisms involved in persistent periapical infection. The relative mRNA expression values of each gene in each group, according with genotypes in different SNPs, were analysed using one-way analysis of variance followed by Tukey's post-test or <i>T</i>-test (<i>α</i> = 5%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Different expression values of the genes evaluated were observed according to the genotypes of the polymorphisms evaluated in relation to PAP (<i>p</i> < 0.05). Among the cases submitted for histopathological evaluation, 66.7% were diagnosed as periapical granuloma and 33.3% as periapical cyst. Immunohistochemical analysis showed strong positivity for SOCS-1 and IL-1β in the lesions classified as periapical cyst, while the lesions diagnosed as periapical granuloma were not labelled. In the microbiological analysis, four different species of bacteria were isolated: <i>Pseudomonas aeruginosa</i>, <i>Staphylococcus epidermidis</i>, <i>Enterococcus faecalis</i> and <i>Bacillus cereus</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This exploratory study indicates that genetic pol","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 3","pages":"486-501"},"PeriodicalIF":7.1,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adithya Subramanya, Sundeep Mata, Rajkumar Narkedamalli, Vijetha Shenoy Belle, Anandh Dhanushkodi, Henry F. Duncan, Vinutha Bhat, Nidambur Vasudev Ballal
Aim
The success of vital pulp treatment (VPT) has been linked to the release of growth factors (GFs) from the dentine matrix, which stimulate dental pulp stem cell (DPSC) activities. Ethylenediaminetetraacetic acid (EDTA) is a commonly used chelating agent that induces the release of GFs bound in the dentine matrix. A 7% Maleic acid (MA) solution has been shown to have better smear layer removal capability and less cytotoxicity compared with 17% EDTA. However, no study has evaluated the effect of 7% MA on the release of GFs from circumpulpal dentine and subsequent DPSC behaviour. This study aimed to evaluate the effect of 17% EDTA and 7% MA conditioning of circumpulpal dentine on the release of transforming growth factor-β1 (TGF-β1), as well as the DPSC activities.
Methodology
Dentine slices treated with phosphate-buffered saline (PBS) acted as the control, while the experimental groups comprised 17% EDTA and 7% MA. The release of TGF-β1 was quantified using ELISA following treatment with the experimental solutions. DPSC proliferation was evaluated with the MTT assay, cell migration was assessed through scratch wound and transwell migration assays. Osteogenic differentiation potential of DPSCs was verified using Alizarin Red staining and an alkaline phosphatase (AP) activity assay.
Results
7% MA induced the highest release of TGF-β1 compared with 17% EDTA and PBS (p < 0.001). 7% MA at 1/1000 dilution significantly increased DPSC proliferation compared with 17% EDTA and PBS (p < 0.001). The scratch wound healing and transwell migration assays demonstrated superior DPSC migration in the 7% MA compared with the 17% EDTA group (p < 0.001). Alizarin Red staining and quantification indicated the highest formation of mineralized nodules in the 7% MA compared with the 17% EDTA group (p < 0.0001). The AP activity assay showed similar enzyme activity in 7% MA and 17% EDTA treated samples.
Conclusions
Within the limitations of this study 7% MA performed better than 17% EDTA in promoting TGF-β1 release from dentine, as well as increased DPSC responses related to cell proliferation, migration, and mineralisation. These findings indicate that 7% MA may be a promising dentine conditioning agent during VPT procedures.
{"title":"Comparing the Bioactive Effects of Ethylenediaminetetraacetic Acid and Maleic Acid on TGF-β1 Release From Dentine and Dental Pulp Stem Cell Activity","authors":"Adithya Subramanya, Sundeep Mata, Rajkumar Narkedamalli, Vijetha Shenoy Belle, Anandh Dhanushkodi, Henry F. Duncan, Vinutha Bhat, Nidambur Vasudev Ballal","doi":"10.1111/iej.70075","DOIUrl":"10.1111/iej.70075","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The success of vital pulp treatment (VPT) has been linked to the release of growth factors (GFs) from the dentine matrix, which stimulate dental pulp stem cell (DPSC) activities. Ethylenediaminetetraacetic acid (EDTA) is a commonly used chelating agent that induces the release of GFs bound in the dentine matrix. A 7% Maleic acid (MA) solution has been shown to have better smear layer removal capability and less cytotoxicity compared with 17% EDTA. However, no study has evaluated the effect of 7% MA on the release of GFs from circumpulpal dentine and subsequent DPSC behaviour. This study aimed to evaluate the effect of 17% EDTA and 7% MA conditioning of circumpulpal dentine on the release of transforming growth factor-β1 (TGF-β1), as well as the DPSC activities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>Dentine slices treated with phosphate-buffered saline (PBS) acted as the control, while the experimental groups comprised 17% EDTA and 7% MA. The release of TGF-β1 was quantified using ELISA following treatment with the experimental solutions. DPSC proliferation was evaluated with the MTT assay, cell migration was assessed through scratch wound and transwell migration assays. Osteogenic differentiation potential of DPSCs was verified using Alizarin Red staining and an alkaline phosphatase (AP) activity assay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>7% MA induced the highest release of TGF-β1 compared with 17% EDTA and PBS (<i>p</i> < 0.001). 7% MA at 1/1000 dilution significantly increased DPSC proliferation compared with 17% EDTA and PBS (<i>p</i> < 0.001). The scratch wound healing and transwell migration assays demonstrated superior DPSC migration in the 7% MA compared with the 17% EDTA group (<i>p</i> < 0.001). Alizarin Red staining and quantification indicated the highest formation of mineralized nodules in the 7% MA compared with the 17% EDTA group (<i>p</i> < 0.0001). The AP activity assay showed similar enzyme activity in 7% MA and 17% EDTA treated samples.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Within the limitations of this study 7% MA performed better than 17% EDTA in promoting TGF-β1 release from dentine, as well as increased DPSC responses related to cell proliferation, migration, and mineralisation. These findings indicate that 7% MA may be a promising dentine conditioning agent during VPT procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 3","pages":"524-537"},"PeriodicalIF":7.1,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate the phase changes of bismuth oxide in contact with sodium hypochlorite responsible for tooth discolouration.
Methodology
Bismuth oxide (monoclinic α−phase; C) was mixed with sodium hypochlorite at 20°C, 37°C, and 60°C (B20, B37, B60) for a period of 24 weeks with weekly refreshing of solutions. The products were imaged by scanning electron and optical microscopy and characterized by thermographic analysis (TGA), phase analysis by X-ray diffraction (XRD) using Bragg Brentano geometry and Pilatus detector, infrared spectroscopy (FT-IR), and X-ray absorption fine structure (XAFS).
Results
The interaction of bismuth oxide with sodium hypochlorite resulted in a change in microstructure and colour. The thermographic assessment showed a change in mass (5%–10% weight change) and colour reversal to the yellow bismuth oxide at ~450°C. Phase changes dependent on temperature were demonstrated with δ-bismuth oxide, sodium bismuthate and bismuth oxychloride formed as by-products at the different temperatures.
Conclusions
The δ-phase bismuth oxide formation led to the material darkening which will cause tooth discolouration in a clinical setting. Due to the phase changes, the material chemistry after the interaction is different from that of the material placed in the tooth. The by-products of the reaction have not been tested for use in patients. It is recommended to ban the use of bismuth oxide from dental materials and other clinical use due to its instability. The clinical guidance for endodontic treatment needs to be changed to reflect this.
{"title":"δ-Bismuth Oxide Responsible for Tooth Discolouration—A Laboratory Investigation","authors":"J. Camilleri, P. Zaslansky, N. Ramanan","doi":"10.1111/iej.70077","DOIUrl":"10.1111/iej.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To investigate the phase changes of bismuth oxide in contact with sodium hypochlorite responsible for tooth discolouration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>Bismuth oxide (monoclinic α−phase; C) was mixed with sodium hypochlorite at 20°C, 37°C, and 60°C (B20, B37, B60) for a period of 24 weeks with weekly refreshing of solutions. The products were imaged by scanning electron and optical microscopy and characterized by thermographic analysis (TGA), phase analysis by X-ray diffraction (XRD) using Bragg Brentano geometry and Pilatus detector, infrared spectroscopy (FT-IR), and X-ray absorption fine structure (XAFS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The interaction of bismuth oxide with sodium hypochlorite resulted in a change in microstructure and colour. The thermographic assessment showed a change in mass (5%–10% weight change) and colour reversal to the yellow bismuth oxide at ~450°C. Phase changes dependent on temperature were demonstrated with δ-bismuth oxide, sodium bismuthate and bismuth oxychloride formed as by-products at the different temperatures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The δ-phase bismuth oxide formation led to the material darkening which will cause tooth discolouration in a clinical setting. Due to the phase changes, the material chemistry after the interaction is different from that of the material placed in the tooth. The by-products of the reaction have not been tested for use in patients. It is recommended to ban the use of bismuth oxide from dental materials and other clinical use due to its instability. The clinical guidance for endodontic treatment needs to be changed to reflect this.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 3","pages":"538-548"},"PeriodicalIF":7.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nidambur V. Ballal, Namith Rai, Padmaja A. Shenoy, Vibha Acharya, Vinutha R. Bhat, Matthias Zehnder
<div> <section> <h3> Aim</h3> <p>To assess whether there was an additive antimicrobial effect between calcium hydroxide (Ca(OH)<sub>2</sub>) and sodium hypochlorite (NaOCl) in an inter-visit root canal dressing.</p> </section> <section> <h3> Methodology</h3> <p>Patients presenting with a single-rooted tooth with pulpal necrosis and asymptomatic apical periodontitis were included in this randomised controlled single-center clinical superiority trial with two parallel arms. Teeth were instrumented using a rotary file system and irrigated with 3% NaOCl. Subsequently, the root canals were dressed with a Ca(OH)<sub>2</sub> slurry that was prepared from pure Ca(OH)<sub>2</sub> powder mixed with either 3% NaOCl (test group) or physiological saline solution (control group). Microbial samples were obtained after accessing the root canal, after chemo-mechanical preparation, and after the root canal dressing with the test or control slurries. A periapical fluid sample was collected after the root canal dressing removal. Samples were transferred to the microbiology lab immediately and assessed for anaerobic growth. The levels of MMP-9 were measured using a specific enzyme-linked immunosorbent assay. Negative to positive growth ratios were compared between groups using Fisher's exact test. Colony-forming units (CFUs) between and within groups and MMP-9/total protein were compared using non-parametric tests, <i>p</i> < 0.05.</p> </section> <section> <h3> Results</h3> <p>From the 110 patients recruited for this study, 48 were available for all three sampling procedures in the test (NaOCl) and 50 in the control (saline) group. All canals showed anaerobic growth initially. Chemo-mechanical instrumentation significantly reduced CFU counts (<i>p</i> < 0.001), yet all canals remained growth-positive. After dressing with Ca(OH)<sub>2</sub>/NaOCl, 19 of the 48 (40%) root canals were free of growth, compared to 3 of 50 (6%) in the Ca(OH)<sub>2</sub>/saline group (<i>p</i> < 0.001). MMP-9/TP levels in the periapical fluid were similar when root canals were dressed with Ca(OH)<sub>2</sub> slurries mixed with NaOCl or saline (<i>p</i> > 0.05).</p> </section> <section> <h3> Conclusions</h3> <p>Placing a combined NaOCl/Ca(OH)<sub>2</sub> dressing significantly reduced the microbial load in the root canals of teeth with primary apical periodontitis compared to a conventional slurry prepared with saline solution, without causing any apparent inflammatory response in the periapical tissues.</p> <p><b>Trial Registeration:</b> CTRI/2020/1
{"title":"Randomised Controlled Trial on the Additive Effect Between Calcium Hydroxide and Sodium Hypochlorite in an Inter-Visit Root Canal Dressing","authors":"Nidambur V. Ballal, Namith Rai, Padmaja A. Shenoy, Vibha Acharya, Vinutha R. Bhat, Matthias Zehnder","doi":"10.1111/iej.70078","DOIUrl":"10.1111/iej.70078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To assess whether there was an additive antimicrobial effect between calcium hydroxide (Ca(OH)<sub>2</sub>) and sodium hypochlorite (NaOCl) in an inter-visit root canal dressing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>Patients presenting with a single-rooted tooth with pulpal necrosis and asymptomatic apical periodontitis were included in this randomised controlled single-center clinical superiority trial with two parallel arms. Teeth were instrumented using a rotary file system and irrigated with 3% NaOCl. Subsequently, the root canals were dressed with a Ca(OH)<sub>2</sub> slurry that was prepared from pure Ca(OH)<sub>2</sub> powder mixed with either 3% NaOCl (test group) or physiological saline solution (control group). Microbial samples were obtained after accessing the root canal, after chemo-mechanical preparation, and after the root canal dressing with the test or control slurries. A periapical fluid sample was collected after the root canal dressing removal. Samples were transferred to the microbiology lab immediately and assessed for anaerobic growth. The levels of MMP-9 were measured using a specific enzyme-linked immunosorbent assay. Negative to positive growth ratios were compared between groups using Fisher's exact test. Colony-forming units (CFUs) between and within groups and MMP-9/total protein were compared using non-parametric tests, <i>p</i> < 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From the 110 patients recruited for this study, 48 were available for all three sampling procedures in the test (NaOCl) and 50 in the control (saline) group. All canals showed anaerobic growth initially. Chemo-mechanical instrumentation significantly reduced CFU counts (<i>p</i> < 0.001), yet all canals remained growth-positive. After dressing with Ca(OH)<sub>2</sub>/NaOCl, 19 of the 48 (40%) root canals were free of growth, compared to 3 of 50 (6%) in the Ca(OH)<sub>2</sub>/saline group (<i>p</i> < 0.001). MMP-9/TP levels in the periapical fluid were similar when root canals were dressed with Ca(OH)<sub>2</sub> slurries mixed with NaOCl or saline (<i>p</i> > 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Placing a combined NaOCl/Ca(OH)<sub>2</sub> dressing significantly reduced the microbial load in the root canals of teeth with primary apical periodontitis compared to a conventional slurry prepared with saline solution, without causing any apparent inflammatory response in the periapical tissues.</p>\u0000 \u0000 <p><b>Trial Registeration:</b> CTRI/2020/1","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 3","pages":"469-476"},"PeriodicalIF":7.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fahad BaHammam, Sultan Aldakhil, Jamal Akhil, John Whitworth
<div> <section> <h3> Background</h3> <p>Placing a pulp-capping material over the remaining dentine is integral to managing deep carious lesions in permanent teeth without pulp exposure. However, current guidelines do not favour any specific pulp-capping material, and there is no direct clinical evidence that pulp-capping materials maintain pulp vitality better than placing the restoration directly on dentine.</p> </section> <section> <h3> Objectives</h3> <p>To compare the effectiveness of various biomaterials, including pulp-capping materials and restorative materials applied directly over the remaining dentine, against one another in preserving pulp health in permanent teeth with deep carious lesions without pulp exposure.</p> </section> <section> <h3> Methods</h3> <p>On June 9, 2024, MEDLINE, Embase, Scopus, and Web of Science were searched, supplemented by a screening of clinical trial registries, grey literature, and reference lists. Randomised controlled trials (RCTs) evaluating the effectiveness of indirect pulp capping in permanent teeth affected by deep carious lesions without pulp exposure were included. Risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomised trials (RoB 2). Network meta-analyses and meta-regression were performed using a Bayesian approach and a random-effects model for the primary outcome (loss of pulp vitality), followed by an assessment of confidence in the evidence using the CINeMA framework.</p> </section> <section> <h3> Results</h3> <p>Sixteen RCTs (19 reports; 1039 participants; 1093 teeth; seven biomaterials) were included. Most comparisons involving the dentine bonding agent (DBA; control) were supported by low-confidence evidence and lacked statistical significance; however, they always resulted in RRs favouring the pulp-capping materials. Notably, moderate-confidence evidence indicated that during the second follow-up year Biodentine (RR = 0.00; 95% CI: 0.00–0.53) and glass ionomer cement (GIC) (RR = 0.30; 95% CI: 0.00–0.99) outperformed the DBA. Moderate-confidence evidence also demonstrated that during the first follow-up year mineral trioxide aggregate (MTA) (RR = 0.30; 95% CI: 0.09–0.84) outperformed calcium hydroxide cement. Meta-regression found that neither study-level demographic covariates nor clinical-technique covariates were significantly associated with pulp-vitality outcome.</p> </section> <section> <h3> Conclusions</h3> <p>While most findings in this review were of lo
{"title":"Pulp Response to Materials Used in the Management of Deep Carious Lesions Without Pulp Exposure: A Systematic Review and Network Meta-Analysis","authors":"Fahad BaHammam, Sultan Aldakhil, Jamal Akhil, John Whitworth","doi":"10.1111/iej.70076","DOIUrl":"10.1111/iej.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Placing a pulp-capping material over the remaining dentine is integral to managing deep carious lesions in permanent teeth without pulp exposure. However, current guidelines do not favour any specific pulp-capping material, and there is no direct clinical evidence that pulp-capping materials maintain pulp vitality better than placing the restoration directly on dentine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To compare the effectiveness of various biomaterials, including pulp-capping materials and restorative materials applied directly over the remaining dentine, against one another in preserving pulp health in permanent teeth with deep carious lesions without pulp exposure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>On June 9, 2024, MEDLINE, Embase, Scopus, and Web of Science were searched, supplemented by a screening of clinical trial registries, grey literature, and reference lists. Randomised controlled trials (RCTs) evaluating the effectiveness of indirect pulp capping in permanent teeth affected by deep carious lesions without pulp exposure were included. Risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomised trials (RoB 2). Network meta-analyses and meta-regression were performed using a Bayesian approach and a random-effects model for the primary outcome (loss of pulp vitality), followed by an assessment of confidence in the evidence using the CINeMA framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixteen RCTs (19 reports; 1039 participants; 1093 teeth; seven biomaterials) were included. Most comparisons involving the dentine bonding agent (DBA; control) were supported by low-confidence evidence and lacked statistical significance; however, they always resulted in RRs favouring the pulp-capping materials. Notably, moderate-confidence evidence indicated that during the second follow-up year Biodentine (RR = 0.00; 95% CI: 0.00–0.53) and glass ionomer cement (GIC) (RR = 0.30; 95% CI: 0.00–0.99) outperformed the DBA. Moderate-confidence evidence also demonstrated that during the first follow-up year mineral trioxide aggregate (MTA) (RR = 0.30; 95% CI: 0.09–0.84) outperformed calcium hydroxide cement. Meta-regression found that neither study-level demographic covariates nor clinical-technique covariates were significantly associated with pulp-vitality outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While most findings in this review were of lo","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 3","pages":"351-371"},"PeriodicalIF":7.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iej.70076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"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","authors":"Lokhasudhan Govindaraju, Rajeswari Kalaiselvam, Mathan Rajan Rajendran, Aleksandar Jakovljevic, Jelena Jacomovic, Henry F. Duncan, Venkateshbabu Nagendrababu","doi":"10.1111/iej.70073","DOIUrl":"10.1111/iej.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>PROSPERO database: CRD42024616520</p>\u0000 </section>\u0000 </div>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 3","pages":"341-350"},"PeriodicalIF":7.1,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iej.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Germán Sánchez-Herrera, Fernando José Alfaro-Ochoa, Estefanía Sayas-Balaguer, Martín Pérez-Leal, Cristina Palma-Carrió, Nicla Flacco
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.
{"title":"Impact of Haptic Virtual Reality Simulation on Dental Students' Clinical Endodontic Performance and Anxiety Management.","authors":"Germán Sánchez-Herrera, Fernando José Alfaro-Ochoa, Estefanía Sayas-Balaguer, Martín Pérez-Leal, Cristina Palma-Carrió, Nicla Flacco","doi":"10.1111/iej.70074","DOIUrl":"https://doi.org/10.1111/iej.70074","url":null,"abstract":"<p><strong>Aim: </strong>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.</p><p><strong>Methodology: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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)
{"title":"Construction of Preoperative Diagnostic Model of Periapical Cyst by Multiparameter Magnetic Resonance Imaging: A Pilot Study","authors":"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","doi":"10.1111/iej.70071","DOIUrl":"10.1111/iej.70071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>The study is registered on the Chinese Clinical Trial Registry website (ChiCTR2000035273)</p>\u0000 </section>\u0000 </div>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":"59 3","pages":"454-468"},"PeriodicalIF":7.1,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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