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Valacyclovir for Acute Apical Abscess Pain: A Randomized, Placebo-controlled, Double-blind Study 伐昔洛韦治疗急性根尖脓肿痛:一项随机、安慰剂对照、双盲研究。
IF 3.6 2区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2026-03-01 Epub Date: 2025-12-05 DOI: 10.1016/j.joen.2025.11.021
Mohammad Sabeti DDS, MA , Kyle Kitasoe DDS

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.
简介:急性根尖脓肿(AAAs)以牙髓坏死引起的快速疼痛和肿胀而闻名。虽然通常与多微生物感染有关,但最近的研究表明,活动性疱疹病毒感染也可能起作用。这项随机、双盲、安慰剂对照试验旨在评估valacyclovir与阿莫西林联合使用时是否能持续治疗疼痛,以及个体患者在更大人群中的反应如何。方法:本研究纳入38例因急性根尖脓肿引起的中度至重度疼痛的急诊患者,将其随机分为两个治疗组。瓦昔洛韦组(n=21)患者给予阿莫西林1g负荷剂量(随后500mg每日4次,连续7天)和瓦昔洛韦2g负荷剂量(随后500mg每日2次,连续3天)。安慰剂组(n=17)在服用安慰剂的同时给予相同的阿莫西林治疗。在为期6天的随访中,我们使用每日电话记录,用数字评定量表(NRS)跟踪疼痛水平,并监测止痛药的使用情况。结果数据采用Mann-Whitney和Friedman统计检验进行分析。结果:valacyclovir组在第1-3天的平均疼痛评分显著降低(p结论:valacyclovir有望作为急性根尖脓肿患者早期疼痛缓解的辅助治疗。
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引用次数: 0
Untreated Apical Periodontitis and the Risk of Medication-related Osteonecrosis of the Jaws (MRONJ): A Systematic Review with Mechanistic Insights from Preclinical Studies 未经治疗的根尖牙周炎和药物相关性颌骨骨坏死(mronj)的风险:从临床前研究的机制见解的系统综述。
IF 3.6 2区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2026-03-01 Epub Date: 2025-12-11 DOI: 10.1016/j.joen.2025.12.002
Maria Emília Mota DDS , Nelise Alexandre Silva Lascane DDS, MSc, PhD , Thais Gimenez DDS, PhD , Fábio Abreu Alves DDS, MSc, PhD , Maria Stella Moreira DDS, MSc, PhD

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.
药物相关性颌骨骨坏死(MRONJ)是一种导致进行性骨破坏并损害患者功能、美观和生活质量的疾病。目的:本研究旨在探讨未经治疗的根尖牙周炎(AP)在MRONJ发展中的作用。方法:在PubMed/MEDLINE、Web of Science、Scopus和Embase中进行综合检索。使用ProQuest数据库评估灰色文献。入选标准包括:(1)临床前研究;(2)使用抗吸收、抗血管生成或其他已知引起MRONJ的药物;(3)评估AP病变区域骨坏死发展的研究。以下研究被排除在外:(1)非动物研究。两名独立的审稿人进行了数据提取和偏倚风险评估。结果:从239条记录的初始数据集中,我们纳入了11项研究。诱导根尖周围病变最常在给予双膦酸盐后进行。唑来膦酸是使用最多的药物。72.72%的研究报告了未经治疗的AP区域存在MRONJ的组织学或临床证据。此外,有AP的区域出现MRONJ的频率更高,有或没有临床症状。结论:本临床前研究的系统综述表明,未经治疗的AP,在抗吸收治疗的背景下,可能会增加MRONJ的风险。我们的研究结果提供了阐明AP如何参与MRONJ发病机制的机制见解,为支持临床观察提供了理论背景。虽然人类研究表明潜在的致病性相互作用,但它们仍然受到异质性设计,口腔感染的可变定义以及AP与其他疾病的频繁分组的限制。这些局限性强调了我们临床前分析的转化意义。总的来说,我们的研究结果强调了接受抗吸收治疗的患者,特别是暴露于较高累积剂量的癌症患者,早期诊断和管理牙髓感染的重要性,并强调了设计良好的前瞻性临床研究的必要性,以确定AP是否构成MRONJ的独立危险因素。
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引用次数: 0
Physicochemical and Biological Properties of the “All-In-One” Endodontic Irrigant Triton “一体机”牙髓冲洗剂Triton的理化生物学特性。
IF 3.6 2区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2026-03-01 Epub Date: 2025-10-17 DOI: 10.1016/j.joen.2025.10.006
Jesus Aranda MSc , Elda Olivia Nobre de Souza DDs , Arturo Javier Aranda Garcia PhD , Renato de Toledo Leonardo PhD , Ana Paula Ramos PhD , Giampiero Rossi-Fedele PhD , Gisele Faria PhD

Introduction

Triton is a newly developed root canal irrigant that acts on both organic and inorganic tissues. This study evaluated the physicochemical properties (pH, surface tension, contact angle, available free chlorine), dentin penetration, and cytotoxicity of Triton, compared with 4% sodium hypochlorite (NaOCl) + etidronic acid (HEDP), 4% NaOCl/17% ethylenediaminetetraacetic acid, and 4% NaOCl.

Methods

pH was measured using a pH meter; surface tension and contact angle were assessed by the pendant drop and sessile drop methods, respectively. Available free chlorine was determined by titration with iodine/sodium thiosulfate. For dentin penetration, 39 extracted human premolars were instrumented, stained with crystal violet, irrigated, and analyzed under a stereomicroscope. Cytotoxicity was evaluated on L929 fibroblasts using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and neutral red (NR) assays.

Results

Triton showed a pH of 12.49, available free chlorine of 4.18%, and significantly lower surface tension and contact angle than the other irrigants (P < .05). In the cervical third, Triton showed greater dentin penetration than 4% NaOCl and 4% NaOCl + HEDP (P < .05); in the middle third, greater penetration than 4% NaOCl (P < .05). No significant differences were observed in the apical third (P > .05). Triton and 4% NaOCl + HEDP groups had significantly lower cell viability compared to other groups (P < .05).

Conclusions

Triton demonstrated an alkaline pH, lower surface tension and contact angle, and greater dentin penetration in the cervical and middle thirds compared to 4% NaOCl. However, its cytotoxicity, similar to that of 4% NaOCl + HEDP, emphasizes the need for safe irrigation dynamics to prevent periradicular tissue damage.
目的:Triton是一种新开发的根管冲洗剂,对有机和无机组织都有作用。与4%次氯酸钠(NaOCl) +地铁酸(HEDP)、4% NaOCl/17%乙二胺四乙酸(EDTA)和4% NaOCl相比,本研究评估了Triton的理化性质(pH、表面张力、接触角、有效游离氯)、牙本质渗透性和细胞毒性。方法:使用pH计测量pH值;表面张力和接触角分别用垂滴法和固滴法测定。用碘/硫代硫酸钠滴定法测定有效游离氯。为了观察牙本质的穿透,我们取出39颗人前磨牙,用结晶紫染色,冲洗,在体视显微镜下进行分析。用MTT法和中性红法评价L929成纤维细胞的细胞毒性。结果:Triton的pH值为12.49,有效游离氯为4.18%,表面张力和接触角明显低于其他冲洗液(p0.05)。与其他组相比,Triton和4% NaOCl+HEDP组的细胞活力明显降低(p结论:与4% NaOCl相比,Triton具有碱性pH,较低的表面张力和接触角,并且在颈部和中部三分之一处有较大的牙本质渗透。然而,其细胞毒性与4% NaOCl+HEDP相似,强调需要安全的灌溉动态以防止根周组织损伤。
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引用次数: 0
Preventive Endodontics: Mitigating Crack Development and Tooth Loss 预防牙髓学:减轻裂纹发展和牙齿脱落。
IF 3.6 2区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2026-03-01 Epub Date: 2025-11-14 DOI: 10.1016/j.joen.2025.11.008
Rebekah Lucier Pryles DMD , Brooke Blicher DMD , Alan H. Gluskin DDS
Cracked teeth represent a growing concern in endodontic practice, driven by biomechanical, evolutionary, and lifestyle factors. While traditionally approached as a condition requiring reactive treatment, contemporary endodontics must now shift toward prevention. This article explores the multifactorial nature of cracked teeth, including parafunctional habits, malocclusion, modern dietary patterns, and the evolutionary mismatch between human dentition and present-day lifestyles. The paper outlines key risk factors such as bruxism, malocclusion, and enamel demineralization, while also discussing effective preventive strategies. These include occlusal assessment, orthodontic or equilibration interventions, dietary counseling, and use of occlusal splints. Management of asymptomatic cracks and stabilization through full-coverage restorations or bonded restorations is emphasized to reduce the likelihood of structural failure. For teeth requiring endodontic therapy, the inclusion of bonded intraorifice barriers, timely restorations, and occlusal adjustment significantly improves long-term outcomes. Notably, recent evidence challenges outdated assumptions regarding poor prognosis for cracked teeth, highlighting the effectiveness of interdisciplinary protocols. The article calls for a paradigm shift in endodontic care from solely treating cracked teeth to actively preventing their occurrence. By integrating principles from preventive medicine and anthropology, endodontists can better preserve natural dentition. Ultimately, ensuring that the first diagnosed crack is the last one aligns with both ethical obligations and the long-term success of endodontic treatment.
受生物力学、进化和生活方式等因素的影响,牙髓治疗中牙裂的问题日益受到关注。虽然传统上作为一种需要反应性治疗的疾病,当代牙髓学现在必须转向预防。这篇文章探讨了牙齿破裂的多因素性质,包括功能习惯,错颌,现代饮食模式,以及人类牙齿与现代生活方式之间的进化不匹配。本文概述了磨牙、错牙合和牙釉质脱矿等主要危险因素,并讨论了有效的预防策略。这些包括咬合评估、正畸或平衡干预、饮食咨询和咬合夹板的使用。强调通过全覆盖修复或粘结修复来管理无症状裂缝和稳定,以减少结构破坏的可能性。对于需要根管治疗的牙齿,包括结合孔内屏障,及时修复和咬合调整显着改善了长期结果。值得注意的是,最近的证据挑战了关于牙裂预后不良的过时假设,突出了跨学科协议的有效性。这篇文章呼吁在牙髓护理的范式转变,从单纯治疗牙裂积极预防其发生。通过整合预防医学和人类学的原理,牙髓医生可以更好地保护自然牙。最后,确保第一个诊断出的裂缝是最后一个符合道德义务和牙髓治疗的长期成功。
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引用次数: 0
Study on the Geometric Location Method of the Danger Zone in the Mesial Roots of Mandibular First Molars 下颌第一磨牙近根危险区几何定位方法的研究。
IF 3.6 2区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2026-03-01 Epub Date: 2025-12-23 DOI: 10.1016/j.joen.2025.11.019
Jinjie Yan MD , Yuanling Peng MD , Jing Yang MD , Jie Liu PhD , Linxian Wang MD , Tingyuan Zhao MD , Jian Zhang PhD , Kehua Que PhD

Introduction

To investigate the geometric angle method of “danger zone” (DZ) position in the mesial roots of mandibular first molars (MFMs) using cone-beam computed tomography (CBCT) and micro-computed tomography (Micro-CT).

Methods

The CBCT images of 949 MFMs with mesial roots of single root and 2 root canals were collected and analyzed with DZ and αD (the angle between the line extending from the center of buccal/lingual root canal to DZ and the line connecting the centers of the buccal and lingual root canals) of the mesial roots in the coronal and middle thirds of roots. Thirty-four MFMs with similar root canal morphologies were analyzed using Micro-CT to validate the geometric positioning method based on CBCT. The association of αD with the root lengths, inter-orifice canal distance (DR-R), age and gender were subsequently investigated. Values with P < .05 were considered statistically significant.

Results

The DZ of MFMs was mainly located in the middle thirds of the distal wall, with an average thickness of 0.818 ± 0.143 mm. The average αD was 71.9 ± 9.0°, ranging from 42.7° to 99.9° and showed approximately 87.8% of value concentrated within the range of 60.1°–86.2°. The αD was negatively correlated with the DR-R (P < .01) and had no correlation with age or gender (P > .05). Results of the Micro-CT analyses showed that the αD was 70.4 ± 7.3°, ranging from 48.9° to 85.6°, and 92.7% of the αD were also within the range of 60.1°–86.2° established by CBCT.

Conclusions

From a geometric perspective, the distribution of DZ in the mesial roots of MFMs demonstrated a relatively consistent spatial pattern. This predictable localization may assist clinicians in accurately identifying DZ positions and improving treatment planning.
前言:利用锥形束计算机断层扫描(CBCT)和微型计算机断层扫描(Micro-CT)研究下颌第一磨牙近根“危险区”(DZ)位置的几何角度方法。方法:收集949例单根和双根管近中根的MFMs的CBCT图像,对近中根冠和中三分之一的近中根的DZ和αD(从颊/舌根管中心延伸到DZ的线与连接颊/舌根管中心的线之间的夹角)进行分析。采用Micro-CT对34例根管形态相似的MFMs进行分析,验证基于CBCT的几何定位方法。随后研究了αD与牙根长度(RLs)、孔间根管距离(DR-R)、年龄和性别的关系。p< 0.05为差异有统计学意义。结果:MFMs的DZ主要位于远端壁的中间三分之一处,平均厚度为0.818±0.143 mm。αD平均值为71.9±9.0°,范围为42.7°~ 99.9°,约87.8%的αD值集中在60.1°~ 86.2°范围内。α d与DR-R呈负相关(p< 0.01),与年龄、性别无相关性(p< 0.05)。Micro-CT分析结果显示,αD为70.4±7.3°,范围为48.9°~ 85.6°,92.7%的αD也在CBCT确定的60.1°~ 86.2°范围内。结论:从几何角度看,颞下颌嵴中根DZ的分布具有相对一致的空间格局。这种可预测的定位可以帮助临床医生准确地识别DZ位置并改进治疗计划。
{"title":"Study on the Geometric Location Method of the Danger Zone in the Mesial Roots of Mandibular First Molars","authors":"Jinjie Yan MD ,&nbsp;Yuanling Peng MD ,&nbsp;Jing Yang MD ,&nbsp;Jie Liu PhD ,&nbsp;Linxian Wang MD ,&nbsp;Tingyuan Zhao MD ,&nbsp;Jian Zhang PhD ,&nbsp;Kehua Que PhD","doi":"10.1016/j.joen.2025.11.019","DOIUrl":"10.1016/j.joen.2025.11.019","url":null,"abstract":"<div><h3>Introduction</h3><div>To investigate the geometric angle method of “danger zone” (DZ) position in the mesial roots of mandibular first molars (MFMs) using cone-beam computed tomography (CBCT) and micro-computed tomography (Micro-CT).</div></div><div><h3>Methods</h3><div>The CBCT images of 949 MFMs with mesial roots of single root and 2 root canals were collected and analyzed with DZ and α<sub>D</sub> (the angle between the line extending from the center of buccal/lingual root canal to DZ and the line connecting the centers of the buccal and lingual root canals) of the mesial roots in the coronal and middle thirds of roots. Thirty-four MFMs with similar root canal morphologies were analyzed using Micro-CT to validate the geometric positioning method based on CBCT. The association of α<sub>D</sub> with the root lengths, inter-orifice canal distance (D<sub>R-R</sub>), age and gender were subsequently investigated. Values with <em>P</em> &lt; .05 were considered statistically significant.</div></div><div><h3>Results</h3><div>The DZ of MFMs was mainly located in the middle thirds of the distal wall, with an average thickness of 0.818 ± 0.143 mm. The average α<sub>D</sub> was 71.9 ± 9.0°, ranging from 42.7° to 99.9° and showed approximately 87.8% of value concentrated within the range of 60.1°–86.2°. The α<sub>D</sub> was negatively correlated with the D<sub>R-R</sub> (<em>P</em> &lt; .01) and had no correlation with age or gender (<em>P</em> &gt; .05). Results of the Micro-CT analyses showed that the α<sub>D</sub> was 70.4 ± 7.3°, ranging from 48.9° to 85.6°, and 92.7% of the α<sub>D</sub> were also within the range of 60.1°–86.2° established by CBCT.</div></div><div><h3>Conclusions</h3><div>From a geometric perspective, the distribution of DZ in the mesial roots of MFMs demonstrated a relatively consistent spatial pattern. This predictable localization may assist clinicians in accurately identifying DZ positions and improving treatment planning.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 3","pages":"Pages 387-395.e1"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Detection Thresholds for Root Canal Visibility on High-Resolution CBCT: A Micro-CT Validation Study 高分辨率CBCT根管可见性检测阈值:微ct验证研究。
IF 3.6 2区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2026-03-01 Epub Date: 2025-11-22 DOI: 10.1016/j.joen.2025.11.016
Kheya Patel DMD, Feng-Ming Wang DDS, PhD, Mehrnaz Tahmasbi DDS, Fabricio Teixeira DDS, PhD, Madhu Nair DMD, PhD, Poorya Jalali DDS

Introduction

Cone-beam computed tomography (CBCT) is widely used to assess root canal morphology, yet practical size thresholds for canal visibility have not been established. This study determined the relationship between canal diameter and the probability of confident detection on high-resolution CBCT using micro–computed tomography (micro-CT) for reference.

Methods

Sixty-one extracted human teeth (251 canal cross-sections, including 9 with no visible lumen) were imaged with both imaging modalities. True canal diameters measured on micro-CT were spatially matched to corresponding CBCT cross-sections using anatomical landmarks. Three calibrated observers rated canal visibility on a 5-point scale; scores ≥4 indicated confident detection. Interobserver reliability was quantified using Krippendorff's α and quadratic-weighted κ. A binomial logistic regression modeled detection probability as a function of diameter. Receiver operating characteristic (ROC) analysis assessed overall discriminative accuracy.

Results

Interobserver agreement was excellent (α = 0.87; κ = 0.78–0.91). The probability of confident canal detection increased sharply with canal diameter. Model estimates indicated a 70% probability (D70) at a canal diameter of approximately 265 μm, an 80% probability (D80) at 299 μm, and a 90% probability (D90) at 350 μm. ROC analysis demonstrated excellent discriminative performance (area under the curve = 0.89), confirming strong accuracy of CBCT visibility scores for identifying canals present on micro-CT.

Conclusions

On 80-μm-voxel CBCT, consistent canal visibility emerges at approximately 300 μm. Canals measuring 200 to 300 μm are often visible, whereas those smaller than about 200 μm are frequently missed. The detection thresholds identified in this study may help clinicians anticipate when a canal is likely still patent but radiographically undetectable.
锥形束计算机断层扫描(CBCT)被广泛用于评估根管形态,但根管可见性的实际尺寸阈值尚未建立。本研究利用微ct (micro- computer tomography, micro-CT)确定了高分辨率CBCT上管径与可信检测概率之间的关系,以供参考。方法:对61颗拔除的人牙齿(251颗根管切面,其中9颗未见管腔)进行两种成像。显微ct测量的真管径在空间上与相应的CBCT横截面进行解剖标记匹配。三名经过校准的观察员以5分制对运河的能见度进行评级;得分≥4表示有信心检测。采用Krippendorff's α和二次加权κ量化观察者间信度。二项逻辑回归将检测概率建模为直径的函数。受试者工作特征(ROC)分析评估总体判别准确度。结果:观察者间一致性极好(α = 0.87; κ = 0.78-0.91)。随着根管直径的增加,根管检测的概率急剧增加。模型估计表明,在约265 μm的管径处有70%的概率(D70), 299 μm的管径处有80%的概率(D80), 350 μm的管径处有90%的概率(D90)。受试者工作特征(ROC)分析显示了出色的判别性能(AUC = 0.89),证实了CBCT可见性评分在识别微ct上存在的管道方面具有很强的准确性。结论:在80 μm体素CBCT上,在300 μm左右出现了一致的根管可见性。200-300 μm的管道通常可见,而200 μm以下的管道则经常被遗漏。在这项研究中确定的检测阈值可以帮助临床医生预测什么时候管道可能仍然是专利的,但放射检查无法检测到。
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引用次数: 0
Improved Root Canal Disinfection through Extended Sodium Hypochlorite Exposure and Renewal after Preparation Procedures 通过延长NaOCl暴露和制备程序后的更新改进根管消毒。
IF 3.6 2区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2026-03-01 Epub Date: 2025-11-29 DOI: 10.1016/j.joen.2025.11.023
Emmanuel João Nogueira Leal Silva DDS, MSc, PhD , David Victor Ferreira da Silva DDS , Graziela dos Santos Massa DDS, MSc , Bárbara de Paula Coelho BSc, MSc , Luciana Moura Sassone DDS, MSc, PhD , Marco Aurélio Versiani DDS, MSc, PhD , Ana Flávia Almeida Barbosa DDS, MSc, PhD

Introduction

This study evaluated whether extending sodium hypochlorite (NaOCl) contact time with periodic renewal after preparation enhances root canal disinfection compared with a standard continuous-irrigation protocol.

Materials and Methods

Twenty-eight bovine incisors were contaminated with Enterococcus faecalis (ATCC 29212) for 28 days. Specimens were assigned to 2 experimental groups (n = 10) and 2 controls (positive, n = 4; negative, n = 4). Experimental canals received either standard continuous irrigation (20 mL 1% NaOCl over 4 min) or an extended protocol, in which 5 mL 1% NaOCl was left in situ for 5 min and replenished over 4 cycles, with a total of 20 mL. All canals were subsequently irrigated with 6 mL 17% ethylenediaminetetraacetic acid and 6 mL 1% NaOCl under ultrasonic activation, followed by NaOCl neutralization. Microbiological samples were collected at baseline (S1), after primary irrigation (S2), and after final irrigation/activation (S3) using paper points and Hedström file scrapings. Colony-forming units (CFU) were quantified on Mitis Salivarius agar. Statistics comparison was performed with Kruskal–Wallis and Mann–Whitney U tests (α = 0.05).

Results

Negative controls confirmed asepsis, and positive controls verified bacterial viability. Both irrigation protocols significantly reduced CFU counts at S2 and S3 compared with baseline (P < .05). The extended protocol yielded lower CFU counts than standard irrigation at both postirrigation time points (P < .05). Overall bacterial reduction from baseline to final sampling (S1→S3) was significantly greater for the extended protocol (P = .027), while intermediate reduction (S1→S2) did not differ between groups (P > .05).

Conclusions

The extended protocol resulted in a significantly greater microbial reduction compared with standard continuous irrigation.
简介:本研究评估了与标准的连续灌洗方案相比,延长NaOCl接触时间并在制备后定期更新是否能增强根管消毒。材料与方法:用粪肠球菌(ATCC 29212)污染28天的牛门牙。将标本分为两个实验组(n=10)和两个对照组(阳性,n=4;阴性,n=4)。实验管道接受标准连续灌洗(20 mL 1% NaOCl超过4分钟)或扩展方案,其中5 mL 1% NaOCl原地停留5分钟,并在四个周期内补充,总共20 mL。随后在超声激活下用6 mL 17% EDTA和6 mL 1% NaOCl灌洗所有管道,然后进行NaOCl中和。在基线(S1)、初次灌溉后(S2)和最终灌溉/激活后(S3)采集微生物样本,使用纸点和Hedström文件刮刀。对唾液链球菌琼脂上菌落形成单位(CFU)进行定量。采用Kruskal-Wallis检验和Mann-Whitney U检验进行统计学比较(α=0.05)。结果:阴性对照证实无菌,阳性对照证实细菌活力。与基线相比,两种灌溉方案均显著降低了S2和S3时的CFU计数(p0.05)。结论:与标准连续灌洗相比,扩展方案的微生物减少量显著增加。
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引用次数: 0
A Novel Robot-Assisted Access in Endodontic Microsurgery Combined with Sinus Floor Elevation for Maxillary First Molar 上颌第一磨牙牙髓显微手术联合窦底提升的新型机器人辅助通道。
IF 3.6 2区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2026-03-01 Epub Date: 2025-12-01 DOI: 10.1016/j.joen.2025.11.022
Weiwei Qiao PhD , Li Qin DDS , Chen Chen DDS , Yeyu Lin MDS , Xining Zhang MDS , Yi Zhou PhD , Liuyan Meng PhD
Endodontic microsurgery (EMS) is an important treatment option for endodontic disease when the nonsurgical endodontic treatment fails. However, EMS for maxillary molars often presents a clinical challenge due to the root apex close to the maxillary sinus floor, which may increase the risk of sinus membrane perforation. Furthermore, the depth between the apex of the palatal root and the buccal cortical plate significantly impacts EMS precision for restricting visualization and instrument access. This case report is the first to use an autonomous robotic system for minimally invasive EMS on a maxillary first molar, combined with precise lateral wall sinus fenestration. A 55-year-old male patient presented with symptomatic apical periodontitis associated with previously treated left maxillary first molar. Cone-beam computed tomography revealed low-density areas surrounding the mesiobuccal and palatal (P) roots, and maxillary sinus floor descended between the palatal and buccal roots. Integrating cone-beam computed tomography and intraoral scan data, the autonomous robotic system performed guided sinus fenestration localization, autonomous osteotomy, and a 15-mm root-end resection from buccal to palatal root, with real-time monitoring of depth, angulation, and force. The clinician employed endoscopic assistance to verify the integrity of the sinus membrane and ensure the removal of debris from the surgical site. Root-end preparation and filling were carried out under a microscope. Follow-ups at 1 week, 1 month, 3 months, and 6 months indicated an absence of clinical symptoms. This approach offers a precise and minimally invasive treatment option for molars with a descended maxillary sinus floor located between the buccal and palatal root.
当非手术治疗牙髓疾病失败时,显微手术是治疗牙髓疾病的重要选择。然而,由于上颌磨牙的根尖靠近上颌窦底,可能增加窦膜穿孔的风险,EMS治疗上颌磨牙往往面临临床挑战。此外,腭根顶端与颊皮质板之间的深度显著影响EMS的精度,限制了可视化和器械的使用。本病例报告是首次使用自主机器人(ATR)系统对上颌第一磨牙进行微创EMS,并结合精确的侧壁窦开窗。一个55岁的男性病人提出了症状根尖牙周炎与先前治疗的左上颌第一磨牙。锥形束计算机断层扫描(CBCT)显示中颊根(MB)和腭根(P)周围低密度区,上颌窦底在腭根和颊根之间下降。结合CBCT和口内扫描数据,ATR系统进行了引导窦开窗定位、自主截骨和从颊根到腭根的15mm根端切除,并实时监测深度、角度和力。临床医生使用内窥镜辅助来验证窦膜的完整性,并确保手术部位的碎片被清除。在显微镜下进行根端准备和充填。随访1周、1个月、3个月和6个月均无临床症状。该入路为颊根和腭根之间上颌窦底下降的磨牙提供了一种精确和微创的治疗选择。
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引用次数: 0
Guided Auto-Transplantation of a Supernumerary Tooth Into a Surgically Created Socket Using Osseodensification and a Palatal Connective Tissue Graft: A Case Report 利用骨密度和腭结缔组织移植物引导多生牙移植到外科创造的牙槽中:一例报告。
IF 3.6 2区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2026-03-01 Epub Date: 2025-12-08 DOI: 10.1016/j.joen.2025.12.001
Javier Domínguez Bernal DDS , Nandini Suresh BDS, MDS, FDS RCS(Eng) , Venkateshbabu Nagendrababu BDS, MDS, FDS RCPS (Glasg), PhD , Naresh Yedthare Shetty BDS, MDS , Gabriel Darío Godínez Aréchiga DDS , Paul M.H. Dummer BDS, MScD, PhD, DDSc , Francesc Abella Sans DDS, PhD
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.
本病例报告描述了使用基于锥形束计算机断层扫描(CBCT)的数字规划,三维(3D)打印供体复制牙,骨密度和结缔组织移植,用多余的牙齿替换缺失的上颌右中切牙(8号牙)。36岁男性,撕脱后3个月出现一般性牙周炎和8号牙槽愈合。基于CBCT扫描,计划将单根下颌多生牙移植到8号区域手术创建的牙槽中。在拔牙前对供牙进行根管治疗。进行数字规划,并设计和打印供牙的3D复制品。手术创建的窝是用骨密度技术准备的。供牙自动拔除,植入牙槽后进行软组织移植和夹板稳定。在12个月大时植入最终冠。在30个月时,移植的牙齿功能正常,无症状,没有临床或放射学迹象的根尖病变。
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引用次数: 0
Insights into the March 2026 Issue of the JOE 洞察《JOE》2026年3月刊。
IF 3.6 2区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2026-03-01 Epub Date: 2026-03-06 DOI: 10.1016/j.joen.2026.02.007
Anita Aminoshariae DDS, MS, Amir Azarpazhooh DDS, MSc, PhD, FRCD(C), Gerald N. Glickman DDS, MS, MBA, JD, Jianing He DMD, PhD, Sahng G. Kim DDS, MS, Anil Kishen BDS, MDS, PhD, Ariadne M. Letra DDS, MS, PhD, Linda Levin DDS, PhD, Ronald Ordinola-Zapata, Frank C. Setzer DMD, PhD, MS, Franklin R. Tay BDSc(Hons), PhD, Kenneth M. Hargreaves DDS, PhD
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引用次数: 0
期刊
Journal of endodontics
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