Journal of endodontics最新文献

Introduction: Palatal radicular grooves (PRGs) posed diagnostic challenges due to their complex root anatomy and subtle manifestations in cone-beam computed tomography (CBCT). This study aimed to develop a deep learning (DL) framework for the automated three-dimensional visualization, diagnosis, and classification of PRG lesions.

Methods: A unified framework (PRG-Net) integrating tooth segmentation, PRG diagnosis, and lesion classification was developed. A retrospective multicenter diagnostic accuracy study was conducted using CBCT datasets with varying fields of view from one internal validation site and three external centers to evaluate generalizability and performance for segmentation, diagnosis, and classification tasks. The impact of PRG-Net on dentists' diagnostic accuracy, classification consistency, and workflow efficiency was also assessed.

Results: PRG-Net demonstrated strong generalizability across all datasets. For tooth segmentation, it achieved a mean Dice Similarity Coefficient (DSC) of 97.1% [95% CI: 96.4, 97.7]. Diagnostic performance yielded an Area Under the Curve (AUC) of 94.4% (internal) and 85.2%-90.0% (external). Classification AUC were 91.4% [95% CI: 86.8, 96.1] for Type I, 88.5% [95% CI:81.1, 95.8] for Type II, and 96.9% [95% CI:91.6, 100] for Type III, with consistent cross-center reproducibility. In clinical validation, PRG-Net significantly improved dentists' diagnostic accuracy and inter-rater classification agreement while substantially reducing interpretation time.

Conclusions: PRG-Net provided a robust, automated solution for PRG assessment in CBCT. It facilitated earlier and more precise diagnosis, improved inter-rater reliability, and streamlined workflow, demonstrating strong potential as a clinically valuable decision-support tool to guide treatment planning and improve patient outcomes.

Aim: This study aimed to evaluate the levels of inflammatory mediators, pulpal blood pH and oxygen saturation in teeth diagnosed with pulpitis, as well as to investigate the correlations among these parameters.

Materials and methods: This study investigated selected biomarkers in pulpitis by analyzing clinical and laboratory examinations from patients aged from 19 to 55 undergoing endodontic treatment. Patients were divided into test groups (reversible/irreversible pulpitis) and a control group (healthy teeth). Clinical assessments included pulse oximetry measurement and pulpal blood collection for biomarker and pH analysis. Five inflammatory mediators (IL-1α, IL-6, IL-8, MMP-9, TIMP-1) were evaluated using a Luminex multiplex assay. Statistical analysis was performed using SPSS 30.0, employing both parametric and non-parametric tests with a significance level of p ≤ 0.05.

Results: Several investigated markers exhibited significant differences among the groups. The levels of SpO₂ and pH were highest in the control group and lowest in in cases of irreversible pulpitis. Additionally, the levels of IL-1α, IL-6, and IL-8 increased with the severity of pulpitis. Significant correlations were identified between inflammatory mediators, pH, and pulse oximetry. Notably, IL-1α, IL-8, and TIMP-1 correlated with pH (p<0.01), and pulse oximetry was strongly associated with IL-1α, IL-6, and IL-8 across all groups (p<0.01).

Conclusion: The values of inflammatory mediators (IL-1α, IL-6, IL-8, MMP-9, TIMP-1), along with the pulp blood pH and oxygen saturation levels differed according to the pulp condition and a positive correlation was established among the parameters analyzed.

Introduction: Mesenchymal stromal cells (MSCs) have been proposed for tissue regeneration based on their paracrine and immunomodulatory effects. Based on these features, MSCs may regulate inflammation and tissue repair. This case report assessed whether allogeneic bone marrow MSCs (BM-MSCs) can arrest external apical inflammatory resorption (EAIR) in a mature, nonvital traumatized tooth.

Methods: A healthy 14-year-old male with intermittent edema and a sinus tract associated with tooth #9 was referred for endodontic evaluation. Radiographically, tooth #9 showed EAIR with a vertical/diagonal mesial pattern and a 3-mm periapical lesion with widened periodontal ligament space. The root canal was cleaned and shaped, calcium hydroxide was used as interappointment medication, and cryopreserved allogeneic BM-MSCs were thawed, expanded, incorporated into preclotted platelet-rich plasma, and implanted into the pulp cavity. The cervical third was sealed with bioceramic cement and composite.

Results: Cryopreserved BM-MSCs retained fibroblast-like morphology, expressed CD73/CD90/CD105, and showed osteogenic, adipogenic, and chondrogenic differentiation. A BM-MSC/PRP clot was transplanted without complications or adverse events. At 3 months, radiographs showed reduction of the periapical radiolucency with initial bone formation and positive cold and electric pulp test (EPT) responses. Between 12 and 24 months, reappearance of lamina dura, remodeling of the resorbed surface, and complete radiographic healing with arrest of EAIR were observed. At 48 months, tooth #9 was asymptomatic, responsive to cold and EPT, and showed normal periapical architecture and mineralized tissue within the canal with an apical constriction.

Conclusions: BM-MSC transplantation may arrest EAIR and promote pulp-like and periapical tissue regeneration.

Introduction: This study compared the intracanal microbiome of teeth with apical periodontitis in oncological and healthy patients using 16S rRNA gene-based next generation sequencing.

Methods: Root canal samples were taken from 46 teeth with pulp necrosis and primary apical periodontitis (23 from oncological patients and 23 from healthy controls). DNA was extracted and sequenced using the Illumina MiSeq platform targeting the V3-V4 region of the 16S rRNA gene. Bioinformatics processing was conducted using QIIME2 and DADA2. Alpha and beta diversity analyses, genus-level abundance comparisons, and indicator species analyses were performed.

Results: After quality filtering, 3,307,822 sequence reads were retained, averaging 68,912.96 reads/sample, and resulting in 3,241 unique amplicon sequence variants. Oncological patients exhibited significantly higher bacterial richness (p = 0.01), while Shannon diversity showed no significant difference between groups. Beta diversity analysis (Bray-Curtis, MDS stress = 0.14) did not reveal significant differences between groups. Indicator species analysis identified some specific taxa more associated with oncological patients, including the candidate endodontic pathogens Prevotella, Selenomonas, Alloprevotella, Rothia, and Fretibacterium.

Conclusions: The root canal microbiome of oncologic patients with apical periodontitis was broadly similar to that of healthy controls. The oncologic group showed higher species richness, but no significant differences in the overall bacterial diversity or community structure.

Objective: To evaluate bacterial DNA load reduction in mesial root canals of mandibular molars using quantitative polymerase chain reaction (qPCR), examining the effects of instrumentation, irrigant type, and their interaction after the use of sonic activation.

Methods: Twenty-one extracted human mandibular molars were sterilized and contaminated with human supragingival plaque under anaerobic conditions for 14 days. After sealing the apices and coating external surfaces to simulate a closed canal system, the teeth were randomly assigned to three irrigant groups (n = 7): 7.55% NaOCl, 1.88% NaOCl, or sterile saline. Microbiologic sampling was performed at baseline (S1), after preparation to size 25/.04 with sonic activation (S2), and after enlargement to size 30/.04 with sonic activation (S3). Bacterial DNA was quantified by qPCR (Log₁₀ molecules/μL). Data were analyzed using two-way repeated-measures ANOVA with Geisser-Greenhouse correction and Tukey's HSD tests.

Results: The interaction between irrigant type and instrumentation was not significant (P = 0.852), and irrigant type alone showed no significant effect (P = 0.502). In contrast, instrumentation significantly reduced bacterial load (P < 0.0001), accounting for 68.44% of variance. Significant reductions occurred from S1 to both S2 and S3, with no difference between S2 and S3, indicating that most of the decrease in bacterial DNA load occurred during initial enlargement to size 25/.04 with sonic-activated irrigation.

Conclusion: Root canal instrumentation combined with sonic activation was the primary factor associated with reduction in bacterial DNA load, while irrigant type and concentration provided minimal additional effect when combined with sonic activation.

Introduction: This study evaluated the effect of different sealers on fracture resistance of retreated mandibular premolars and characterized their biomechanical behavior using three-dimensional finite element analysis (FEA).

Methods: One hundred twenty-four single-rooted premolars were instrumented and initially obturated with AH Plus. Twelve teeth with intact fillings served as positive controls, and twelve retreated but unfilled teeth served as negative controls. The remaining samples were retreated and randomly assigned to five sealer groups (n = 20): AH Plus, GuttaFlow Bioseal, TotalFill BC, BioRoot RCS, and NeoSealer Flo. After thermocycling, fracture resistance was tested under 45° oblique loading. Corresponding micro-CT-based FEA models were generated to compare von Mises stress distributions with and without a simulated periapical lesion.

Results: Fracture resistance differed significantly among groups (p < 0.001). The negative control showed the lowest resistance, whereas the positive control exhibited the highest values (p < 0.05). No statistically significant differences were observed among the experimental sealer groups (p > 0.05). FEA demonstrated distinct stiffness-dependent patterns: NeoSealer Flo and TotalFill BC concentrated stresses within the sealer, whereas limiting dentinal stress; GuttaFlow Bioseal transmitted greater stresses to dentin; AH Plus and BioRoot RCS showed intermediate responses.

Conclusions: In retreatment conditions, sealer type influences internal stress distribution even when fracture resistance values are comparable. Bioceramic sealers with higher elastic modulus may reduce dentinal stress and enhance biomechanical compatibility. Clinicians should consider not only biological performance but also mechanical compatibility when selecting sealers to support long-term structural preservation of retreated teeth.