Journal of endodontics最新文献

Introduction: Dental pulp stem cells have been explored as a potential source for dentin-pulp complex regeneration because of their pluripotency and differentiation capacity. However, cell-based approaches require enzymatic digestion and in vitro expansion, which may alter cell properties and hinder clinical translation. This preliminary proof-of-principle study examines a tissue-based alternative using freshly minced pulp (MP) in an ectopic mouse model as a potentially translatable approach for regenerative endodontics.

Methods: Human dental pulp tissue was either minced or enzymatically digested, seeded onto collagen type I scaffolds, inserted into root fragments, and implanted subcutaneously into immunocompromised mice.

Results: Histology revealed that MP grafting generated well-organized dentin-pulp-like tissue with high cellularity, vascularization, mineralization, and odontoblast-like cells extending processes into dentinal tubules, whereas dental pulp stem cell grafts formed less organized tissue and mineral deposits. MP-derived tissues also exhibited angiogenic potential, forming vessel-like structures containing pericytes and endothelial cells.

Conclusions: This preliminary in vivo mouse study suggests the feasibility of MP transplantation and its potential for dentin-pulp complex regeneration, though further studies are needed to assess long-term outcomes and clinical applicability.

Introduction: Medication-related osteonecrosis of the jaws (MRONJ) is a condition that causes progressive bone destruction and compromises patients' function, aesthetics, and quality of life.

Objectives: This study aims to investigate the role of untreated apical periodontitis (AP) in the development of MRONJ.

Methods: A comprehensive search was performed in PubMed/MEDLINE, Web of Science, Scopus, and Embase. Gray literature was assessed using the ProQuest database. The eligibility criteria consisted of (1) preclinical studies; (2) use of antiresorptive, antiangiogenics, or other drugs known to cause MRONJ; (3) studies evaluating the development of osteonecrosis in regions of AP lesions. The following studies were excluded: (1) non-animal studies. Two independent reviewers performed data extraction and the assessment of the risk of bias.

Results: From an initial dataset of 239 records, we included 11 studies. Induction of periapical lesions was performed most often after the administration of bisphosphonates. Zoledronic acid was the most used drug. Histologic or clinical evidence of MRONJ in areas of untreated AP was reported in 72.72% of the studies. Furthermore, areas with AP presented MRONJ more frequently, with or without clinical signs.

Conclusions: This systematic review of preclinical studies indicates that untreated AP, in the context of antiresorptive therapy, may increase the risk of MRONJ. Our findings provide mechanistic insights that clarify how AP may contribute to MRONJ pathogenesis, offering a theoretical background to support clinical observations. While human studies suggest a potential pathogenic interaction, they remain limited by heterogeneous designs, variable definitions of oral infections, and frequent grouping of AP with other conditions. These limitations underscore the translational significance of our preclinical analysis. Overall, our results reinforce the importance of early diagnosis and management of endodontic infections in patients receiving antiresorptive particularly cancer patients exposed to higher cumulative doses and highlight the need for well-designed prospective clinical studies to determine whether AP constitutes an independent risk factor for MRONJ.

Introduction: Although ultrasonic inserts are frequently used for the instrumentation of flat root canals, there is a lack of studies investigating whether instrument contact with the canal walls induces the formation of dentinal microcracks. This study aimed to evaluate the formation of apical microcracks, caused by ultrasonic instrumentation, using micro-computed tomography (microCT) and optical coherence tomography (OCT).

Method: Twenty maxillary second premolars were randomly divided into 2 groups (n = 10): ultrasonic group and brushing group. All specimens were initially prepared using Reciproc Blue files 25/.05 and 40/.06. The brushing group received additional brushing movements with Reciproc Blue 40/.06 and the ultrasonic group underwent instrumentation with a Clearsonic Black ultrasonic insert. Pre- and post-instrumentation images were obtained using both microCT and OCT and were analyzed with specialized software.

Results: Statistically significant difference was observed for the treatment variable regarding apical microcrack presence (P < .05). In the brushing group, all apical microcracks identified post-instrumentation were also present preoperatively. In contrast, new incidences were identified in the ultrasonic group via microCT. No significant differences were found for the evaluator (P > .05) or the imaging technique used (P > .05). Intra- and interexaminer agreement was nearly perfect, with kappa values ranging from 0.858 to 0.975.

Conclusion: The inclusion of an ultrasonic insert during biomechanical preparation did not significantly increase the incidence of apical microcracks when compared with a nonultrasonic protocol. OCT demonstrated high reliability for detecting apical microcracks in extracted teeth.

This case report describes the replacement of a missing maxillary right central incisor (tooth number 8) with a supernumerary tooth using cone beam computed tomography based digital planning, a three-dimensional printed donor replica tooth, osseodensification, and connective tissue grafting. A 36-year-old male presented with general periodontitis and a healed socket in the number 8 region 3 months postavulsion. Based on cone beam computed tomography scans, auto-transplantation of a single-rooted mandibular supernumerary tooth into a surgically created socket in the number 8 region was planned. Root canal treatment was performed on the donor tooth prior to its extraction. Digital planning was performed, and a three-dimensional replica of the donor tooth was designed and printed. The surgically created socket was prepared with an osseodensification technique. Extraction of the donor tooth was performed atraumatically, and soft tissue grafting and splint stabilization was performed after its placement in the socket. A definitive crown was placed at 12 months. At 30 months the transplanted tooth was functional and asymptomatic, with no clinical or radiographic signs of apical pathosis.

Introduction: Acute apical abscesses are known for rapid-onset pain and swelling from pulp necrosis. While typically associated with polymicrobial infections, recent research suggests that active herpesvirus infections may also contribute. This randomized, double-blind, placebo-controlled trial aimed to evaluate if valacyclovir, when combined with amoxicillin, can consistently manage pain and how individual patients respond within a larger population.

Methods: This study enrolled 38 emergency patients with moderate to severe pain from acute apical abscesses, randomizing them into 2 treatment groups. Patients in the valacyclovir group (n = 21) received a 1g loading dose of amoxicillin (followed by 500 mg four times daily for 7 days) and a 2g loading dose of valacyclovir (followed by 500 mg twice daily for 3 days). The placebo group (n = 17) received the same amoxicillin regimen along with a placebo. Over a 6-day follow-up, we used daily phone calls to track pain levels with a numeric rating scale and monitor analgesic use. Outcome data were analyzed using the Mann-Whitney and Friedman statistical tests.

Results: The valacyclovir group showed significantly lower mean pain scores on Days 1-3 (P < .05). They experienced a faster reduction in moderate/severe pain and a higher rate of reporting no pain (numeric rating scale= 0) throughout the study. Analgesic use dropped sharply in the valacyclovir group, with only 28.6% using analgesics on Day 1 compared to 82.4% in the placebo group. This consistently lower usage was maintained through Day 6.

Conclusion: Valacyclovir shows promise as an adjunctive therapy for early pain relief in patients with acute apical abscesses.