Journal of endodontics最新文献

Introduction: Regenerating the pulp-dentin complex is challenging due to its distinct biological, anatomical, and mechanical properties. To address this, we explored gelatin-based hydrogels modified by covalently binding vascular endothelial growth factor (VEGF) and bone morphogenetic protein 2 (BMP2) mimetic peptides to target pulp and dentin regeneration.

Methods: Three distinct hydrogels: GelMA (gelatin methacrylate, 5% w/v), GelNB (norbornene-modified gelatin, 5% w/v), and GelMN (5% GelMA: 5% GelNB = 1:1) were prepared and characterized by scanning electron microscopy (SEM, n = 3), Fourier transform infrared spectroscopy (FTIR, n = 3), and swelling ratio analysis (n = 3). Human dental pulp stem cells (DPSCs) were encapsulated to assess viability (live/dead staining, n = 3) and spreading (n = 3). DPSCs and human umbilical vein endothelial cells were cocultured in a VEGF mimetic peptide (200 μg/ml) functionalized GelMN hydrogel to evaluate vascular structure formation (n = 3). Conversely, DPSCs were encapsulated in a BMP2 mimetic peptide (20 μM) functionalized GelMA hydrogel to investigate the odontogenic differentiation (n = 3).

Results: SEM analysis showed GelMA exhibited a denser, more tightly crosslinked network and smaller pore size compared to GelNB/GelMN. FTIR confirmed the chemical composition of all 3 hydrogels, and the swelling ratio demonstrated no significant difference among them. All hydrogels exhibited excellent biocompatibility and supported cell viability after culturing with DPSCs. VEGF mimetic peptide in GelMN enhanced vascular tube formation by human umbilical vein endothelial cells supported by DPSCs. In parallel, BMP2 mimetic peptide in GelMA significantly boosted the odonto-/osteogenic differentiation of DPSCs, as indicated by the expression of dentin sialophosphoprotein, alkaline phosphatase, and mineralization levels.

Conclusion: VEGF and BMP2 mimetic peptide-functionalized gelatin hydrogels is a promising approach to enhance pulp-dentin complex regeneration.

Introduction: Generative large language models (LLMs) are increasingly used in dentistry, yet their guideline-based diagnostic accuracy and reproducibility remain uncertain. Position statements from the American Association of Endodontists and the European Society of Endodontology provide rigorous, evidence-based standards, making them an ideal benchmark to assess alignment of LLM outputs with endodontic best practices.

Methods: This study was conducted according to Transparent Reporting of a Multivariable Model for Individual Prognosis or Diagnosis-Large Language Models guidelines, evaluated 11 LLMs: ChatGPT 5, ChatGPT 4o, ChatGPT o3, Gemini 2.5 Flash, Gemini 2.5 Pro, Claude Sonnet 4, Claude Opus 4, Perplexity R1 1776, Perplexity Sonar, DeepSeek, and DeepSeek DeepThink R1. Sixty multiple-choice questions derived from American Association of Endodontists and European Society of Endodontology position statements were administered to each model in 5 rounds, generating 3300 responses. The primary outcome was all-correct accuracy and the secondary outcome was intra-model consistency. Comparisons were performed with chi-square tests and Bonferroni adjustment.

Results: All-correct accuracy varied significantly (χ² = 50.56, df = 10, P < .001). ChatGPT 4o and Claude Opus 4 achieved 95.0% accuracy, followed by ChatGPT 5, Claude Sonnet 4, Gemini 2.5 Flash, and Gemini 2.5 Pro (93.3%), and ChatGPT o3 (90.0%). DeepSeek DeepThink R1 scored 86.7%, Perplexity R1 1776 83.3%, Perplexity Sonar 81.7%, and DeepSeek 63.3%. Consistency exceeded 90% for most models, peaking at 98.3% for top performers but falling to 75.0% for DeepSeek.

Conclusions: Most LLMs demonstrated high accuracy and reproducibility when benchmarked against authoritative endodontic guidelines. Despite notable progress over earlier generations, performance variability and confidently incorrect outputs highlight the need for rigorous validation and expert oversight before clinical integration.

Autogenous tooth transplantation (ATT) using open-apex donor teeth may preserve pulp vitality, but atraumatic retrieval of impacted third molars is challenging. This case report describes an interdisciplinary workflow combining orthodontic donor activation with digitally guided, vitality-preserving ATT. A 27-year-old woman with an edentulous maxillary left first molar site (tooth #14) underwent ATT using an immature mandibular right third molar (tooth #32) as the donor. After 6 weeks of orthodontic traction, cone-beam computed tomography and intraoral scans were registered for virtual planning and fabrication of a 3-dimensional-printed donor replica and trephine-compatible osteotomy and seating guides. The recipient site was prepared under trephine guidance, platelet-rich fibrin was applied, and the transplant was stabilized with splinting. Clinical and radiographic follow-up was performed for 24 months. Radiographs showed progressive trabecular fill and stable crestal bone through 18 months. At 24 months, the transplant was functional and responded to sensibility testing (electric pulp test: #14, 69; control tooth #3, 26). Cone-beam computed tomography demonstrated near-complete apical closure, stable alveolar bone, and donor-site bone regeneration (1310.53 mm³), with no evidence of external root resorption or ankylosis. Orthodontic activation combined with guide-assisted preparation may facilitate vitality preserving ATT using an open-apex third molar in a posterior maxillary site.

Introduction: To investigate the influence of different types of intracanal medicaments and root canal sealers on root dentine fracture resistance at different time intervals.

Methods: A total of 180 single-rooted human mandibular premolars were used. Samples were divided into 3 groups: negative control (unprepared and unfilled, n = 10), positive control (prepared but unfilled, n = 10), and experimental groups (10 groups, n = 15). Root canals were prepared chemomechanically. In single-visit groups, canals were filled with either AH Plus or Bio-C Sealer. In medicament-applied groups, Ultracal XS or Bio-C Temp was applied for 1 week or 1 month before obturation with AH Plus or Bio-C Sealer. Root dentine fracture resistance was measured under vertical loading using a universal testing machine. Material-dentine interface of 10 experimental samples were examined using scanning electron microscope/energy dispersive x-ray spectroscopy. Data were analyzed using the analysis of variance followed by post hoc Tukey's tests, with significance set at P < .05.

Results: Root dentine fracture resistance was highest in the negative control and lowest in the positive control (P < .001). Single-visit groups demonstrated significantly higher root dentine fracture resistance than the medicament-applied groups (P < .001). No significant differences were found in the single-visit AH Plus and Bio-C Sealer (P > .05). Similarly, no significant difference was observed between the groups filled with AH Plus or Bio-C Sealer after application of Ultracal XS or Bio-C Temp (P > .05). Furthermore, the time of medicament application (1 week-1 month) was found to have no significant effect on root dentine fracture resistance (P > .05).

Conclusions: Different intracanal medicaments (Ultracal XS, Bio-C Temp) and root canal sealers (AH Plus, Bio-C Sealer) exhibited similar effects on root dentine fracture resistance at different time intervals. However, both Ultracal XS and Bio-C Temp may adversely affect root dentine fracture resistance due to their tendency to leave residues on the dentine surface.

Introduction: This study employed metatranscriptomics to investigate the endodontic microbiome and resistome in acute apical abscesses (AAA) and asymptomatic apical periodontitis (AAP).

Methods: Root canal samples were collected from 20 patients, including 10 cases of AAA and 10 cases of AAP. RNA sequencing was conducted using the NovaSeq 6000 system. Taxonomic analysis utilized the expanded Human Oral Microbiome Database (eHOMD) database and functional annotation was executed using the DIAMOND and EGGNOG databases. Resistome analysis was conducted with the Comprehensive Antibiotic Resistance Database (CARD) and BacMet - Antibacterial Biocide and Metal Resistance Database. Differential expression analysis was carried out using DESeq2 from the DESeq2 R package (P < .05).

Results: Taxonomic analysis showed more gram-negative species in AAA samples (P < .05), particularly from the Bacteroidota phylum. In functional analysis, Tannerella forsythia and Streptococcus anginosus group (SAG) showed the highest transcriptional activity in AAA. T. forsythia displayed high expression of Rag/SusD proteins, suggesting a potential virulence mechanism. The main protein family found in both conditions was the adenosine triphosphate-binding cassette (ABC) transporter. Transcripts possibly involved in resistance against various antibiotics (cephalosporins, fluoroquinolones, lincosamides, macrolides, tetracyclines), metals (silver, chromium, zinc), and disinfectants (phenolic compounds, acids, and bases) were identified.

Conclusions: T. forsythia and SAG demonstrated high activity within the root canal microbiome in cases of AAA, suggesting their involvement in the pathogenicity of the community associated with acute infections. The ABC transporter may play a significant role in antimicrobial resistance through an antibiotic efflux mechanism and contribute to tolerance against disinfectants and antiseptics.

Introduction: The GentleWave System, based on multisonic ultra-cleaning technology, has been proposed as an irrigation approach capable of enhancing disinfection while preserving dentin structure. However, evidence regarding its comparative efficacy and clinical relevance remains inconsistent. This scoping review aimed to comprehensively evaluate the performance of the GentleWave System in comparison with conventional syringe irrigation and other activation techniques.

Methods: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Six electronic databases (PubMed, Scopus, Web of Science, Embase, Cochrane Library, and Google Scholar) were systematically searched without language restrictions. Studies were eligible if they compared GentleWave with at least one other irrigation or activation technique and reported measurable outcomes. In vitro, ex vivo, and clinical studies were included. Study characteristics, irrigation protocols, outcomes, and key findings were extracted and synthesized descriptively across thematic domains.

Results: Twenty-two studies met the inclusion criteria. Laboratory evidence demonstrated that GentleWave enhanced debris removal, irrigant penetration, and calcium hydroxide removal compared to conventional syringe irrigation. However, several studies have reported no significant differences between GentleWave and ultrasonic or sonic activation in terms of smear layer removal, biofilm reduction, or removal of filling materials. Findings related to endotoxin reduction and disinfection were also heterogeneous. Clinical evidence was limited and generally indicated no differences in postoperative pain or early healing when compared with alternative techniques.

Conclusions: The present scoping review indicates that the GentleWave System demonstrates promising performance across multiple laboratory outcomes, particularly in debris removal, disinfection, and irrigant penetration. However, the available evidence remains inconsistent, with several well-designed studies reporting no significant differences between GentleWave and established irrigation or activation techniques.

Introduction: Cyclic fatigue failure is an inherent feature of rotary files when used in curved canals. This study aimed to assess the effect of repeated usage and autoclave sterilization on the dynamic cyclic fatigue resistance of heat-treated nickel-titanium files used to prepare J-shaped canals.

Methods: New ProTaper Ultimate nickel-titanium files (Slider, Shaper, F1, F2) (n = 180) were divided into 3 groups (n = 60): Group N, included new files, were groups US-2 and US-4 included files subjected to 2 or 4 cycles of usage and sterilization, respectively. Files were used to prepare a resin-simulated J-shaped canal (19 mm length, 30° curvature) at 37°C. After each use, files were sterilized in an autoclave at 134°C for 25 minutes. Dynamic cyclic fatigue testing was then performed at 37°C, and the mean number of cycles to failure (NCF) was recorded. Fractured fragment lengths were measured using a digital microcaliper. Statistical analysis was performed using one-way ANOVA and the Kruskal-Wallis test. A P-value <.05 was considered significant.

Results: The Slider file consistently showed significantly higher NCF values than Shaper, F1, and F2 files in all the groups (P < .05). Repeated cycles of usage/sterilizations had an adverse effect on the cyclic fatigue resistance of all files, with a marked reduction after 4 uses.

Conclusions: Repeated usage and autoclave sterilization showed a marked adverse effect on the novel heat-treated files. A positive correlation was seen between the increased number of usage and autoclave cycles and the reduction in NCF.

Introduction: Advanced irrigation plays a crucial role in nonsurgical retreatment cases, as these procedures require the removal of existing obturation materials while preserving dentin. The aim of this study was to compare the effectiveness of laser-activated versus sonic-activated irrigation in removing residual obturation material in the mesial canals of mandibular molars with isthmuses during nonsurgical root canal retreatment.

Methods: Forty mesial canals of extracted mandibular molars were instrumented and obturated with gutta-percha and a bioceramic sealer. Retretments was performed using rotary instruments, followed by a final irrigation protocol consisting of 2.5% NaOCl, 17% EDTA, and a final rinse of 2.5% NaOCl using either sonic-activated or laser-activated irrigation (LAI). Micro-computed tomography scans were obtained before and after final irrigation. The volume of obturation material was measured to calculate the median percentage of remaining material in each group.

Results: The LAI group showed a significantly lower median percentage of remaining filling material than the sonic group (73.9% vs. 93.8%, P = .0165). However, neither irrigation protocol completely eliminates residual obturation material from the canals.

Conclusion: LAI was more effective at removing remaining obturation material compared to sonic-activated irrigation.