Journal of endodontics最新文献

Introduction: The purpose of this study was to evaluate long-term outcomes of nonsurgical retreatment (NS-ReTx) procedures performed by a single endodontist in private practice.

Methods: This retrospective cohort study evaluated NS-ReTx procedures performed between the years 1986 and 2019, meeting the following inclusion criteria: minimum of 1-year follow-up and preoperative, postoperative, and follow-up radiographs available for analysis. Procedures were evaluated clinically and radiographically, and treatment outcomes were reported. A subset of cases included cone-beam computed tomography (CBCT) images and CBCT-assessed periapical healing was reported for these cases. The effect of clinical factors on radiographic healing was assessed using a Cox proportional hazard regression model. The Kaplan-Meier method estimated the probability of tooth survival at each year of follow-up.

Results: A total of 241 NS-ReTx procedures from 202 patients met the inclusion criteria. The median patient age at time of NS-ReTx was 54 years. Molars were the most frequently treated tooth type, 57.68%. Radiographic healing at the median follow-up time, 9.14 years (n = 231) was 64.07% healed (148 of 231), 7.36% healing (17 of 231), and 28.57% unhealed (66 of 231). An additional 10 teeth were extracted before any radiographic follow-up. CBCT-assessed periapical healing ("strict" criteria) was 65.63% over a median follow-up time of 9.18 years. Tooth survival following NS-ReTx was 93.3% at 5 years and 85.3% at 10 years.

Conclusions: The study demonstrates that radiographic periapical healing and treatment success improve over time and that tooth survival following NS-ReTx is favorable long-term.

Introduction: Mineral trioxide aggregate is widely used for apexification in immature permanent teeth owing to sealing ability and biocompatibility; however, placement in teeth with open apices may result in void, potentially compromising the apical seal. This study compared mineral trioxide aggregate (MTA) apical plug quality and procedural time among 3 placement techniques.

Methods: Thirty extracted human mandibular premolars with simulated open apices (apical diameter, 0.8 mm) were randomly assigned to 3 groups (n = 10). Four-millimeter MTA apical plugs were placed using manual condensation, indirect ultrasonic activation, or sonic-activated rotary compaction. Micro-computed tomography quantified closed porosity (internal voids) and open porosity (interfacial gaps) as percentages of total apical plug volume. Procedural time was recorded, and data were analyzed statistically.

Results: Sonic-activated rotary compaction produced the lowest open porosity (0.001% ± 0.001%) and shortest procedural time (160.00 ± 6.50 s) but resulted in the highest closed porosity (0.412% ± 0.076%). Manual condensation demonstrated the highest open porosity (0.122% ± 0.063%) and moderate closed porosity (0.108% ± 0.076%), whereas indirect ultrasonic activation showed intermediate open porosity (0.006% ± 0.002%) and lowest closed porosity (0.079% ± 0.030%). Importantly, closed porosity did not differ significantly between the manual and ultrasonic groups (P = .523). Indirect ultrasonic activation required the longest procedural time (270.30 ± 7.27 s), followed by manual condensation (229.20 ± 6.34 s), whereas sonic-activated rotary compaction was the most time-efficient. All other intergroup differences were statistically significant (P < .001).

Conclusions: Sonic-activated rotary compaction demonstrated the lowest open porosity and greatest time efficiency among 3 techniques, although it produced the highest closed porosity.

Introduction: This study aimed to investigate how substrate stiffness and dimensionality regulate stemness, senescence, and subsequent odontogenic differentiation in dental pulp stem cells (DPSCs). It further examines the interplay of priming period and odontogenic induction and elucidates the role of NF-κB signaling in this process.

Methods: Mechano-variant PDMS substrates with tunable stiffness (2kPa to 50kPa) were fabricated for 2D and 3D cultures. DPSCs were primed on these substrates for 7 days and subsequently induced for odontogenesis. Analyses included gene expression, immunofluorescence imaging, and matrix mineralization.

Results: The 2kPa substrates significantly enhanced early odontogenic differentiation, evidenced by upregulation of DMP-1 and DSPP, along with higher expression of stemness markers (NANOG, SOX-2). This condition minimized senescence and promoted mixed nuclear and cytoplasmic NF-κB localization, suggesting a priming effect for efficient differentiation. In contrast, 3D substrates exhibited delayed but robust odontogenic responses, coupled with increased epigenetic regulation (HAT-1, HDAC-1) and elevated XRCC5 expression at day 21, indicating active DNA repair and intermediate senescence levels that stabilized over time.

Conclusions: Soft substrates (2kPa) preserve stemness and promote early differentiation, while 3D environments favor late-stage differentiation and balanced senescence. These findings emphasize the importance of priming period and dimensionality in optimizing MSC-based regenerative therapies.

Introduction: Laser activated irrigation (LAI) has enhanced the cleaning and disinfection of root canals. However, limited evidence exists regarding its effects on dentin's structural integrity. Although proven to enhance cleaning and disinfection results, it was anticipated that LAI use may alter the root dentin surface due to thermal effects.

Methods: Forty-two single-rooted human premolars were instrumented and randomly divided into 3 groups: A) control group (n = 14) no laser treatment; B) irrigant activation using diode laser (980 nm, 10 Hz, 200 μm, 21 mm) (n = 14); and C) irrigant activation using Er,Cr:YSGG laser (2940 nm, 25 mJ, 10 Hz, 60 μs 200 μm, 21 mm) (n = 14). The root canal dentin samples were subjected to scanning electron microscopy, energy dispersive X-ray spectroscopy, Fourier transform infrared spectroscopy (FTIR), and nanoindentation analysis. Sample size was calculated using G∗Power, and data were statistically analyzed using one-way ANOVA and post hoc Tukey tests through SPSS software (IBM Corp. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY).

Results: FTIR analysis of diode-treated dentin revealed structural degradation with new hydroxyl groups (3829.74, 3744.47 cm^-1) and strong carbonyl peak (1741.30 cm^-1). FTIR compositional analysis showed destruction of amide (collagen), phosphate, and carbonate contents in laser groups. Elemental analysis showed significantly increased Ca and P peaks. Structural examination revealed excessive thermal-stress-induced cracking in the diode group and moderate cracking in Er,Cr:YSGG group. Mean hardness (HIT, HVIT) and elastic modulus differed significantly between control and both laser groups. Traditional root canal disinfection produced minimal structural damage across all analyses.

Conclusions: LAI significantly altered the tested properties of root dentin. Er,Cr:YSGG showed comparatively lesser structural damage than diode laser based irrigant activation.

Introduction: The aim of this study was to compare the biomechanical effects of mineral trioxide aggregate (MTA) and Biodentine for repairing root perforations in conjunction with 2 obturation strategies (complete versus partial gutta-percha obturation) on the fracture resistance of maxillary first premolars. The incidence of these treatment modalities on the probability of fracture risk was evaluated quantitatively.

Methods: Seven three-dimensional finite element models were constructed from cone-beam computed tomography data. The tooth models that were used consisted of a sound tooth model (SD), a root canal-filled model, an unrepaired perforation model, and four treatment models consisting of MTA/Biodentine combined with complete (All GP) or partial gutta-percha obturation being Part GP. The stress distribution under a 300 newton (N) occlusal load was then analyzed, and the fracture probability (P_f) was assessed using a Weibull analysis over a load range of 0-600 N.

Results: Under a 300 N load, the unrepaired perforation model showed a significantly higher P_f (10.15%), which was 10.6 times greater than SD's. All treatment models restored dentin stress to near-SD levels (9.71-10.01 MPa). When combined with the All GP strategy, both MTA and Biodentine achieved P_f values comparable to root canal-filled model (2.84% at 300 N). In contrast, the Part GP strategy resulted in higher stress values in the coronal enamel and midroot dentin, and higher P_f values (3.24%-3.99% at 300 N).

Conclusion: Both MTA and Biodentine are effective at restoring the biomechanical performance of perforated teeth. The obturation strategy significantly influences the long-term fracture risk. The All GP strategy combined with either repair material optimizes fracture resistance and minimizes failure risk. As a result, it is recommended as the preferred clinical technique.

Introduction: This study aimed to evaluate the impact of mineral trioxide aggregate (MTA)- and putty-based regenerative and one-step apexification protocols on the fracture strength and failure patterns of immature teeth.

Methods: Seventy-two extracted human maxillary central incisors were decoronated and prepared to simulate immature root morphology. The samples were randomly divided into 8 groups (n = 10): negative control (sound teeth), positive control (simulated immature teeth with no intervention), full MTA, full putty, apical MTA barrier + warm vertical compaction (WVC), apical putty barrier + WVC, regenerative MTA, and regenerative putty groups. After material placement and restoration, all specimens were embedded in acrylic blocks and loaded at 135° to the long axis using a universal testing machine at a crosshead speed of 0.5 mm/min until fracture occurred. The maximum load at fracture (N/cm) and fracture location (above or below the cementoenamel junction) were recorded. Data were analyzed using the Kruskal-Wallis and Dunn tests, Fisher's exact test, and Weibull analysis (P < .05).

Results: Significant differences in fracture strength were observed among the groups (P < .05), whereas fracture location did not differ significantly (P > .05). The lowest mean fracture strength was found in the regenerative putty group, while the full MTA group exhibited the highest values. Weibull analysis revealed no significant difference in the shape parameter (P = .108), but the scale parameter differed significantly among the groups (P < .001), confirming greater reliability and characteristic strength in MTA-based protocols.

Conclusions: Filling immature roots entirely with MTA or using an apical MTA plug followed by WVC provided superior and more consistent fracture resistance compared with putty-based regenerative protocols. Bioceramic putty may not be a good choice for regenerative applications when the reinforcement of immature teeth is desired.

Objective: To compare intraorifice barrier materials for reinforcing endodontically treated teeth using a network meta-analysis of in vitro studies.

Methods: EBSCO, PubMed, Virtual Health Library, Ovid, Web of Science, Scopus, Cochrane Library, and Google Scholar were searched to December 2025. Eligible studies compared at least 2 of the following: alkasite restorative material, composite resin, fiber-reinforced composite (FRC), resin-modified glass ionomer cement (RMGIC), flowable composite, Biodentine, mineral trioxide aggregate (MTA), and control. The primary outcome was fracture resistance (Newtons). The analysis was conducted in MetaInsight v6.4.0 (Complex Reviews Synthesis Unit, NIHR (Evidence Synthesis Group, University of Glasgow), Glasgow, United Kingdom) using its Bayesian option; results are reported as 95% credible intervals (CrIs). Treatment hierarchy was summarized with SUCRA. Small-study effects were assessed with funnel plot and Egger's test.

Results: Twenty studies met the eligibility criteria; 14 contributed to the network meta-analysis. Versus control, fracture resistance increased with alkasite restorative material (MD 406.37; 95% CrI 133.4-679.8), FRC (MD 370.83; 95% CrI 168.82- 574.27), composite resin (MD 360.62; 95% CrI 181.92-555.15), RMGIC (MD 310.82; 95% CrI 180.93-449.62), flowable composite (MD 285.5; 95% CrI 107.79-468.35) and Biodentine (MD 230.83; 95% CrI 66.55-401.34). MTA showed no clear benefit (MD 60.41; 95% CrI -123.08- 242.82). SUCRA ranking favored alkasite restorative material, followed by FRC, composite resin, RMGIC, flowable composite resin, Biodentine, MTA, and control. Node-split analyses indicated some local inconsistency across a subset of contrasts (2 of 28 contrasts; minimum P = .003). Funnel-plot inspection and Egger's test did not suggest small-study effects (P = .664).

Conclusions: Use of an intraorifice barrier generally improves the fracture resistance of endodontically treated teeth. Materials traditionally categorized as restorative materials (alkasite, resin composites, FRC, and RMGIC) tended to rank higher than calcium silicate-based barriers (Biodentine, MTA) in vitro. Standardized testing protocols are needed to optimize material selection.

The dental pulp is a highly vascularized and innervated connective tissue located at the central part of the tooth and composed of a diverse array of cell types, including fibroblasts, multipotent mesenchymal stem cell, odontoblasts, and immune cells. Traumatic injuries and carious lesions can lead to dental pulp pathologies that often require replacement of damaged tissue with inert materials. Despite significant progress in recent years, cell-based dental pulp regenerative therapies remain distant from clinical applications. The lack of platforms capable of accurately modeling the human dental pulp in all its complexity hampers the development of novel therapeutic strategies. In response, numerous efforts have been focused on the development of innovative microfluidic systems designed to emulate human dental pulp physiology. These "dental pulp-on-chip" platforms enable the recreation of structural and functional complexity in an in vivo-like environment, opening new horizons for patient-specific endodontic therapies and providing valuable tools for targeted drug testing. This review focuses on state-of-the-art microfluidic devices designed to emulate the dental pulp and their specific applications in dental materials testing, drug evaluation, and pulp regeneration. By integrating multiple cell types, biomaterials, and bioactive cues within dynamic microenvironments, "dental pulp-on-chip" devices overcome the constraints of traditional in vitro cultures and animal models and enable the assessment of treatment-induced systemic effects, an aspect often overlooked in dental research. Continued advancements in "dental pulp-on-chip" technology will be pivotal for bridging preclinical research and clinical practice in dental medicine.

Introduction: Endodontic kinematics are associated with varying levels of inflammatory response and postoperative pain. The effect of apical motion algorithms in integrated endodontic motors on this relationship has not been clinically evaluated. This study aimed to evaluate the effects of root canal preparation with continuous rotation (CR) and 2 different apical action algorithms on periapical inflammation mediator and patient-reported pain outcomes.

Methods: Sixty-six patients with asymptomatic pulpitis, symptomatic irreversible pulpitis, and normal pulps to be exposed for prosthetic preparation requiring endodontic treatment were randomly assigned to three groups: CR, auto apical reverse (AAR) and auto apical slow-down. Root canal instrumentation was performed and apical exudate samples were collected on postoperative Days 0 and 3 are analyzed for inflammatory mediators, including substance P (SP), tumor necrosis factor-α, interleukin-1β and interleukin-6. Preoperative and postoperative Day 3 visual analog scale pain scores were recorded.

Results: SP levels on Day 0 (P < .001) and Day 3 (P = .001) were significantly higher in the AAR group. No significant differences were found between the groups regarding postoperative pain scores. When cytokines were assessed in terms of percent change, only tumor necrosis factor-α showed a significant increase in the auto apical slow-down group compared to the CR group (P = .035).

Conclusion: This study demonstrated that different apical actions influence the levels of inflammatory mediators in periapical tissues. AAR was found to be associated with higher SP release on both sampling times. However, the variations in mediator levels didn't translate into differences in pain outcomes. Further research is needed to clarify the effects of apical actions on inflammation, pain, and overall clinical outcomes.