Aim: In uncertain clinical situations, such as assessing the risk of exacerbation of apical periodontitis in root-filled teeth, undergraduate students can benefit from being trained to reflect. This study aimed to explore how students specifically reflected on clinical experiences in relation to uncertainty when assessing a case involving a root-filled tooth with apical periodontitis.
Methodology: Short reflections were written by 52 dental students at Malmö University in 2021. All students were asked to reflect on the risk for exacerbation of apical periodontitis in a case with a root-filled tooth with a diffuse widening of the periodontal ligament space. The reflections were written according to prompts developed to stimulate reflection. For each student, the reflections were analysed by a qualitative method, Systematic Text Condensation (STC).
Results: The analysis of the qualitative data resulted in the formulation of two themes about experience and lack of experience: Theme 1 'The meaning of clinical experience' and Theme 2 'Differences and similarities'. The themes were subdivided into nine subgroups and described the relationship between experience and certainty.
Conclusions: The students believed that certainty comes with experience even when there is a lack of scientific evidence.
To compare the accuracy and design time of artificial intelligence (AI)-generated and manually designed (MD) surgical pathways for osteotomies and root-end resections in dynamic navigation (DN)-aided endodontic microsurgery (EMS).
Fifty-one surgical pathways were analysed, each planned using both AI and MD methodologies. Accuracy was assessed using the DCARE Navigation System (v3.2, MedNav Ltd) and AutoCAD (2023, Autodesk Inc.), evaluating five parameters: start deviation, end deviation, angular deviation, root-end resection length deviation, and root-end resection angulation deviation. Design time was measured from the point of CBCT dataset import to the finalisation of the surgical pathway design. Mann–Whitney U test was used to compare the accuracy and design time of the AI and MD groups, whereas the rank-based ANCOVA was used to assess deviations according to tooth type, jaw type, and root number. Statistical significance was set at p < 0.05.
Compared with the MD group, the AI group exhibited significantly smaller root-end resection length deviations (AI: 0.01 [0.01, 0.02] mm; MD: 0.02 [0.01, 0.03] mm; p = 0.029) but significantly larger root-end resection angulation deviations (AI: 3.48 [1.01, 7.48]; MD: 0.35 [0.16, 0.73]; p < 0.001). There were no significant differences in the start deviation, end deviation, angular deviation, root-end resection length deviation, or root-end resection angulation deviation across tooth type, jaw type, or root number. The design time was significantly shorter in the AI group than in the MD group (55 [21, 74] s vs. 379 [215, 553] s; p < 0.001).
A clinically operational AI-based surgical path design approach is capable of minimising manual interventions and delivering time-efficient, accurate results for clinical use. The integration of AI with DN-aided EMS may contribute to the development of increasingly autonomous surgical procedures.
This randomised clinical trial compared the effect of wound lavage using chlorhexidine (CHX) versus sodium hypochlorite (NaOCl) on the outcome of partial pulpotomy (PP) in mature permanent molars with carious pulpal exposure and symptomatic irreversible pulpitis (SIP).
In this double-arm parallel-group randomised clinical trial, 104 mandibular molars undergoing PP were randomised equally to either NaOCl lavage group (NL) (n = 52) or CHX lavage group (CL) (n = 52). The pulpal wound after pulp amputation during PP was irrigated with 3% NaOCl in the NL and 2% CHX in the CL group. After haemostasis, ProRoot Mineral Trioxide Aggregate (ProRoot MTA) was used as a pulpotomy agent. Patients were evaluated for pain experience at every 24 h for 7 days, clinical success at 3, 6 and 12 months, and radiographic success at 6 and 12 months. Data were analysed using Mann–Whitney U test to compare age, duration of haemostasis, pain score and analgesic consumption between groups and Chi-square test/Fisher's exact test to compare gender, the number of tooth surfaces involved by caries, hard tissue barrier, clinical and radiographic success, pain incidence and pulp sensibility responses.
Ninety-nine patients were assessed for clinical and radiographic success at 12 months follow-up. The NL group showed a higher success (91.8%) than the CL group (84%), albeit with no significant difference (p > 0.05). No significant difference was observed between the groups in postoperative pain experience (p > 0.05). Significantly less time was required to achieve haemostasis in NL (p < 0.001), and evidence of hard tissue barrier formation was significantly higher in the CL group (p = 0.024).
Comparable success was observed following the use of the two lavage agents during PP in managing cariously exposed adult teeth with SIP. CHX can serve as a suitable alternative to NaOCl as a pulpal wound lavage agent.
clinicaltrials.gov identifier: NCT06240130
Background: Endodontic microsurgery (EMS), indicated to manage teeth unresponsive to conventional root canal treatment, requires advanced technical expertise and clinical judgement. Traditional pre-clinical training methods lack fidelity and fail to replicate diseased states, leading to a steep learning curve clinically. High-fidelity 3D jaw model simulations offer a realistic and repeatable training solution, bridging the gap between theory and clinical practice.
Aim: To evaluate the effectiveness of high-fidelity 3D jaw model simulations in enhancing residents' confidence and preparedness for endodontic microsurgery.
Methodology: A descriptive cross-sectional study was conducted involving second-year Endodontic residents enrolled in a postgraduate programme at the National University of Singapore. The intervention group (n = 11; 2021-2023 cohorts) participated in a structured four-session simulation training using high-fidelity 3D jaw models replicating anatomical details and periapical pathology. The curriculum incorporated diverse clinical scenarios, deliberate practice, and structured feedback. The control group (n = 4; 2020 cohort) attended a single-session workshop using pig mandibles. Pre- and post-workshop questionnaires were administered to assess self-reported confidence and preparedness using questions adapted from the Simulation Design Scale (SDS) and the Student Satisfaction and Self-Confidence in Learning (SSSCL) scale. Residents also completed a post-surgical evaluation after their first EMS procedure.
Results: Residents trained with 3D models demonstrated greater improvements across all domains. Confidence in treatment planning improved from 2.45 ± 0.93 to 3.68 ± 0.69, compared to 3.75 ± 0.50 to 4.00 ± 0.00 in controls. Preparedness for EMS increased from 1.54 ± 0.82 to 3.20 ± 0.91 in the 3D group, and from 2.00 ± 0.82 to 2.75 ± 0.96 in the control group. Confidence in independently performing EMS rose from 1.27 ± 0.47 to 3.03 ± 0.95 in the 3D group, compared to 2.25 ± 0.82 to 3.00 ± 0.82 in the control group. The 3D group reported higher ratings for simulation realism, reduced stress, and greater perceived preparedness for clinical EMS.
Conclusion: High-fidelity 3D jaw model simulations were effective in improving residents' confidence and preparedness for EMS. These findings support the integration of 3D simulation into Endodontic training to enhance clinical readiness and surgical competence.
Calcium hypochlorite [Ca(OCl)2] has been proposed as an alternative to sodium hypochlorite (NaOCl) for use as an irrigant. This study aimed to assess morphological changes in human apical papilla (AP) ex vivo, and to evaluate viability, proliferation, chemotaxis and osteogenic differentiation of human apical papilla cells (hAPCs) in vitro following exposure to Ca(OCl)2, in comparison to NaOCl.
Ex vivo, three AP samples per group were exposed to 1.5% Ca(OCl)2, 1.5% NaOCl or control solutions [17% ethylenediaminetetraacetic acid (EDTA) and saline] for 3 min. The AP sections were stained with haematoxylin and eosin (H&E), Masson's trichrome and Alcian Blue for morphological analysis. In vitro, hAPCs were exposed to Ca(OCl)2, NaOCl, EDTA or culture medium. Cell viability was assessed with the methyl-thiazole-tetrazolium (MTT) assay; proliferation by bromodeoxyuridine incorporation; chemotaxis by transwell assay; and mineralised nodule formation by alizarin red staining. Data were analysed by two-way ANOVA followed by Tukey's test or by the Kruskal–Wallis and Dunn tests (α = 0.05).
Ex vivo, marked loss of both cells and extracellular matrix components was observed in the outer layer of AP samples, particularly in the NaOCl and Ca(OCl)2 groups, with more severe damage found in the NaOCl samples. Samples treated with EDTA exhibited structural organisation similar to those treated with saline. In vitro, Ca(OCl)2 induced less cytotoxicity, resulted in the highest proliferation (p < 0.05), but promoted lower chemotaxis than the other irrigants (p < 0.05). EDTA and Ca(OCl)2 led to greater mineralised nodule formation than the other solutions (p < 0.05).
Ca(OCl)2 at 1.5% caused less structural damage to AP than NaOCl at the same concentration and had a more favourable influence on the viability, proliferation and osteogenic differentiation of hAPCs. Moreover, it did not impair cell chemotaxis. These findings suggest that Ca(OCl)2 may offer biological advantages in regenerative endodontic procedures.
Multiple idiopathic external cervical resorption (MIECR) is a rare and aggressive form of external resorption with an unclear aetiology. This study reports and investigates a unique case of extensive MIECR, potentially associated with chemotherapy exposure. The patient, a pharmacist responsible for preparing chemotherapy drugs, developed external cervical resorption affecting 13 teeth, with rapid progression occurring within just one year after starting her occupation. Notably, following local surgical treatment and cessation of high-risk work, the progression of MIECR was temporarily controlled.
Whole-exome sequencing was conducted to identify potential genetic contributors. Granulation tissue removed from the tooth cavity, along with extracted teeth obtained during surgery, was collected for histopathological analysis to characterise the pathological features of MIECR. Single-cell RNA sequencing was performed on granulation tissue and healthy gingival tissue to explore the molecular basis of MIECR. Fibroblast-like cells were isolated from granulation tissue and subjected to in vitro experiments to validate their role in MIECR pathogenesis. Statistical analyses were conducted using Student's t-test or one-way analysis of variance (ANOVA), with a p-value of less than 0.05 considered statistically significant.
Whole-exome sequencing suggested a pivotal role for a GNAS missense mutation in disease pathogenesis. Histopathological analysis revealed extensive fibroblast proliferation and invasiveness within the lesion tissue. Moreover, single-cell RNA sequencing and in vitro experiments demonstrated abnormal fibroblast activity characterised by excessive proliferation and osteoclastic traits, implicating fibroblasts in MIECR progression. Importantly, the inhibition of the PI3K/Akt signalling pathway significantly reduced fibroblast invasion and osteoclastogenesis.
This study offers novel insights into the pathogenesis of MIECR, paving the way for more effective diagnostic and therapeutic strategies.
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