Journal of endodontics最新文献_第5页

Guidelines for Authors 作者指南

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2024-10-01 DOI: 10.1016/S0099-2399(24)00501-6

引用次数: 0

Effects of the Irrigation Needle Design on Root Canal Disinfection and Cleaning 灌洗针设计对根管消毒和清洁的影响

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2024-10-01 DOI: 10.1016/j.joen.2024.07.006

Alessandra Baasch MSc , Andrea F. Campello PhD , Renata C.V. Rodrigues PhD , Flávio R.F. Alves PhD , Danielle D. Voigt PhD , Ibrahimu Mdala PhD , Renata Perez PhD , Sabrina C. Brasil PhD , Isabela N. Rôças PhD , José F. Siqueira Jr PhD

Introduction

This ex vivo study evaluated the disinfecting and cleaning effects of root canal preparation using sodium hypochlorite irrigation with 3 different needle designs.

Methods

Mesial roots from extracted mandibular molars with Vertucci class II configuration were anatomically matched based on micro-computed tomography (micro-CT) analyses and distributed into 3 groups (n = 18/group). The canals were contaminated with a mixed bacterial culture for 30 days and then subjected to preparation using 2.5% sodium hypochlorite irrigation with open-ended flat needle (3 mm short of the working length - WL), closed-ended side-vented irrigation needle (1 mm short of the WL), or a closed-ended plastic needle with 2 lateral outlets (TruNatomy) (1 mm short of the WL). Bacteriological samples were taken from the canals before (S1) and after preparation (S2). After another micro-CT scan, the roots were sectioned and samples were also taken from the apical canal segment (S3). Bacterial reduction was assessed by quantitative real-time polymerase chain reaction. The amount of accumulated hard tissue debris was evaluated by micro-CT.

Results

A substantial reduction in bacterial counts was observed in all 3 groups when comparing S1 with S2 (99.95%, 98.93%, and 98.90% in the open-ended, closed-ended, and TruNatomy needle groups, respectively) (P < .01). No significant differences were observed between groups for bacterial reduction in the full and apical canal (P > .05). There were no intergroup differences in the amount of accumulated hard tissue debris either (P > .05). The open-ended needle group showed significantly more specimens with quantitative real-time polymerase chain reaction negative results for bacteria in S3 than TruNatomy (P < .05).

Conclusion

When used up to an appropriate insertion depth, the 3 needle types result in similar antibacterial and cleaning performance, provided variables such as needle size and irrigant type, volume and flow rate are controlled. Exclusive analysis of the apical segment, including the isthmus, revealed that the open-ended needle yielded more cases negative for bacteria.

简介：这项体内外研究评估了使用三种不同设计的针头进行 NaOCl 冲洗根管预备的消毒和清洁效果：根据显微计算机断层扫描（micro-CT）分析，对拔出的下颌臼齿 Vertucci II 类构造的中根进行解剖匹配，并将其分为三组（n=18/组）。用混合细菌培养液污染牙管 30 天，然后用开口扁平针（距工作长度 - WL 短 3 毫米）、闭口侧排灌洗针（距工作长度短 1 毫米）或闭口双侧出口塑料针（TruNatomy）（距工作长度短 1 毫米）进行 2.5% NaOCl 冲洗。在制备前（S1）和制备后（S2），分别从牙槽骨中提取细菌样本。在进行另一次微型 CT 扫描后，对牙根进行切片，并从根尖管段取样（S3）。细菌减少情况通过实时定量聚合酶链反应（qPCR）进行评估。显微 CT 评估了硬组织碎屑的累积量：结果：与 S1 和 S2 相比，所有三组的细菌数量均有大幅减少（开口针组、闭口针组和 TruNatomy 针组分别为 99.95%、98.93% 和 98.90%）（P < 0.01）。在全管和根尖管细菌减少方面，各组间无明显差异（P > 0.05）。在硬组织碎屑累积量方面，组间也没有差异（P > 0.05）。开口针组在 S3 中显示 qPCR 阴性结果的细菌标本明显多于 TruNatomy 组（P < 0.05）：结论：只要控制好针头大小、冲洗液类型、容量和流速等变量，在达到适当的插入深度时，三种类型的针头具有相似的抗菌和清洁性能。对包括峡部在内的根尖部分进行的专门分析表明，开口针产生的阴性细菌更多。

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引用次数: 0

Tooth Loss is a Risk Factor for Cardiovascular Disease Mortality: A Systematic Review with Meta-analyses 牙齿脱落是心血管疾病死亡的风险因素：系统回顾与元分析》。

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2024-10-01 DOI: 10.1016/j.joen.2024.06.012

Introduction

The current evidence linking tooth loss and cardiovascular disease mortality is inconclusive. Thus, the aim of this systematic review was to explore the association between tooth loss and cardiovascular disease (CVD) mortality.

Methods

A comprehensive literature search of databases and gray literature included: Web of Science, Scopus, PubMed, Cochrane Central Register of Controlled Trials, Google Scholar, various digital repositories. The included studies reported on CVD mortality and tooth loss. The Newcastle-Ottawa scale was used to assess the quality of included studies. Random-effects meta-analysis method, sub-group analysis (based on the tooth loss categories (edentulous and fewer than 10 teeth present), meta-regression (based on the number. of confounders), publication bias, and sensitivity analysis were performed.

Results

Twelve articles met the eligibility criteria with an overall “Good” quality. A significant association between tooth loss (edentulous or less than 10 teeth present) and CVD mortality was found in the primary meta-analysis, which compiled data from 12 studies. The estimated hazard ratio was 1.66 (95% CI: 1.32–2.09), and there was high heterogeneity (I² = 82.42). Subgroup analysis revealed that the edentulous subgroup showed a higher risk with no significant heterogeneity, while the subgroup with fewer than 10 teeth showed a higher risk with substantial heterogeneity. Meta-regression analysis did not reveal any significant impact (P = .626) on whether variations in the number of confounders across studies would substantially affect the overall findings. No publication bias was detected and the sensitivity analysis based on the critical confounders also confirmed that tooth loss as a risk factor for CVD mortality (hazard ratio = 1.52, 95% CI: 1.28–1.80), (I² 51.82%).

Conclusion

The present systematic review reported that being edentulous or having lesser than 10 teeth is a predictive indicator of CVD mortality.

介绍：目前有关牙齿脱落与心血管疾病死亡率之间关系的证据尚无定论。因此，本系统综述旨在探讨牙齿脱落与心血管疾病（CVD）死亡率之间的关系：方法：对数据库和灰色文献进行了全面的文献检索：方法：对数据库和灰色文献进行了全面的文献检索，包括：Web of Science、Scopus、PubMed、CENTRAL、Google Scholar 和各种数字资料库。纳入的研究报告了心血管疾病死亡率和牙齿脱落情况。采用纽卡斯尔-渥太华量表评估纳入研究的质量。进行了随机效应荟萃分析法、亚组分析（基于缺牙类别（无牙和少于 10 颗牙齿））、元回归（基于混杂因素的数量）、发表偏倚和敏感性分析：结果：12 篇文章符合资格标准，总体质量为 "良好"。在对 12 项研究数据进行的主要荟萃分析中发现，牙齿缺失（无牙齿或牙齿少于 10 颗）与心血管疾病死亡率之间存在明显联系。估计危险比 (HR) 为 1.66（95% CI：1.32-2.09），异质性较高（I2 = 82.42）。亚组分析显示，无牙齿亚组的风险较高，但无明显异质性，而牙齿少于 10 颗的亚组的风险较高，但有很大异质性。元回归分析表明，不同研究中混杂因素数量的变化是否会对总体研究结果产生重大影响（p = 0.626）。没有发现发表偏倚，基于关键混杂因素的敏感性分析也证实，牙齿缺失是心血管疾病死亡的一个风险因素（HR = 1.52，95% CI：1.28- 1.80），（I2 51.82%）：本系统综述报告指出，无牙或牙齿少于 10 颗是心血管疾病死亡率的预测指标。

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引用次数: 0

Leveraging Pretrained Transformers for Efficient Segmentation and Lesion Detection in Cone-Beam Computed Tomography Scans 利用预训练变压器在锥形束 CT 扫描中进行高效分割和病变检测

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2024-10-01 DOI: 10.1016/j.joen.2024.07.012

Rui Qi Chen PhD , Yeonju Lee PhD , Hao Yan MS, PhD , Muralidhar Mupparapu DMD, MDS, DipABOMR , Fleming Lure PhD , Jing Li PhD , Frank C. Setzer DMD, PhD, MS

Introduction

Cone-beam computed tomography (CBCT) is widely used to detect jaw lesions, although CBCT interpretation is time-consuming and challenging. Artificial intelligence for CBCT segmentation may improve lesion detection accuracy. However, consistent automated lesion detection remains difficult, especially with limited training data. This study aimed to assess the applicability of pretrained transformer-based architectures for semantic segmentation of CBCT volumes when applied to periapical lesion detection.

Methods

CBCT volumes (n = 138) were collected and annotated by expert clinicians using 5 labels – "lesion," "restorative material," "bone," "tooth structure," and "background." U-Net (convolutional neural network-based) and Swin-UNETR (transformer-based) models, pretrained (Swin-UNETR-PRETRAIN), and from scratch (Swin-UNETR-SCRATCH), were trained with subsets of the annotated CBCTs. These models were then evaluated for semantic segmentation performance using the Sørensen–Dice coefficient (DICE), lesion detection performance using sensitivity and specificity, and training sample size requirements by comparing models trained with 20, 40, 60, or 103 samples.

Results

Trained with 103 samples, Swin-UNETR-PRETRAIN achieved a DICE of 0.8512 for "lesion," 0.8282 for "restorative materials," 0.9178 for "bone," 0.9029 for "tooth structure," and 0.9901 for "background." “Lesion” DICE was statistically similar between Swin-UNETR-PRETRAIN trained with 103 and 60 images (P > .05), with the latter achieving 1.00 sensitivity and 0.94 specificity in lesion detection. With small training sets, Swin-UNETR-PRETRAIN outperformed Swin-UNETR-SCRATCH in DICE over all labels (P < .001 [n = 20], P < .001 [n = 40]), and U-Net in lesion detection specificity (P = .006 [n = 20], P = .031 [n = 40]).

Conclusions

Transformer-based Swin-UNETR architectures allowed for excellent semantic segmentation and periapical lesion detection. Pretrained, it may provide an alternative with smaller training datasets compared to classic U-Net architectures.

简介锥形束计算机断层扫描（CBCT）被广泛用于检测颌骨病变，但 CBCT 的判读耗时且具有挑战性。用于 CBCT 分段的人工智能（AI）可提高病变检测的准确性。然而，一致的自动病变检测仍然很困难，尤其是在训练数据有限的情况下。本研究旨在评估基于变压器的预训练架构在应用于根尖周病变检测时对 CBCT 图像进行语义分割的适用性：方法：收集 CBCT 图像（n=138），由临床专家使用 "病变"、"修复材料"、"骨"、"牙齿结构 "和 "背景 "五个标签进行标注。使用注释 CBCT 的子集对 U-Net（基于卷积神经网络 (CNN)）和 Swin-UNETR（基于转换器）模型进行了预训练（Swin-UNETR-PRETRAIN）和从头开始训练（Swin-UNETR-SCRATCH）。然后使用索伦森-戴斯系数（DICE）对这些模型的语义分割性能进行评估，使用灵敏度和特异性对病变检测性能进行评估，并通过比较使用 20、40、60 或 103 个样本训练的模型，对训练样本的大小进行评估：使用 103 个样本进行训练后，Swin-UNETR-PRETRAIN 的 "病变 "DICE 为 0.8512，"修复材料 "DICE 为 0.8282，"骨骼 "DICE 为 0.9178，"牙齿结构 "DICE 为 0.9029，"背景 "DICE 为 0.9901。用 103 张图像和 60 张图像训练的 Swin-UNETR-PRETRAIN 的 "病变 "DICE 在统计学上相似（P>.05），后者在病变检测方面的灵敏度为 1.00，特异度为 0.94。在使用小型训练集的情况下，Swin-UNETR-PRETRAIN 在所有标签的 DICE 中的表现优于 Swin-UNETR-SCRATCH（PConclusions：基于变换器的 Swin-UNETR 架构可实现出色的语义分割和根尖周病变检测。与传统的 U-Net 架构相比，经过预先训练的 Swin-UNETR-SCRATCH 可为较小的训练数据集提供替代方案。

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引用次数: 0

Clinician/Patient-Reported Outcomes and Their Association After Root Canal Treatment. 根管治疗后临床医师/患者报告的结果及其关联性。

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2024-09-28 DOI: 10.1016/j.joen.2024.09.009

Jasmine Wong, Angeline Hui Cheng Lee, Gary Shun Pan Cheung, Colman McGrath, Prasanna Neelakantan

Introduction: The relationship between clinician-reported outcome measures (CROM) and patient-reported outcome measures (PROM) after root canal treatment is poorly understood. Oral health-related quality of life (OHRQOL) is a crucial PROM. Determination of the minimal important difference (MID) is critical for determining patients' perspective of treatment effectiveness, but the MID required to perceive any meaningful change in the OHRQOL after root canal treatment remains unclear. The aim of this prospective study was to investigate the relationship between the clinical outcome and OHRQOL after root canal treatment and to determine the corresponding MID values.

Methods: Patients (N = 64) requiring primary nonsurgical root canal treatment were recruited. Clinical and radiographic (cone-beam computed tomography) assessment of treatment outcomes was performed at the 12-month follow-up. OHRQOL and pain were evaluated preoperatively and at the 12-month follow-up using the Oral Health Impact Profile-14 and visual analog scale, respectively. P < .05 was considered statistically significant. MID was assessed using distribution- and anchor-based approaches.

Results: The final analysis included 47 patients. The clinical outcome was favorable for 92.6% of teeth. OHRQOL and pain showed significant improvement after treatment (P < .001). No significant association was found between clinical outcome and OHRQOL (P > .05). The mean Oral Health Impact Profile-14 score change (ie, 13.6) was greater than the range of MID values determined.

Conclusions: Root canal treatment significantly improves OHRQOL. Improvement in the OHRQOL score was greater than the MID values determined, implying a clinically significant change. However, PROM (OHRQOL) does not appear to be correlated with CROM.

简介：人们对根管治疗后临床医生报告的结果（CROMs）和患者报告的结果测量（PROMs）之间的关系知之甚少。口腔健康相关生活质量（OHRQoL）是一个重要的 PROM。最小重要差异（MID）的确定对于确定患者对治疗效果的看法至关重要，但根管治疗后患者口腔健康相关生活质量（OHRQoL）发生有意义变化所需的最小重要差异仍不清楚。这项前瞻性研究旨在调查根管治疗后临床结果与 OHRQoL 之间的关系，并确定相应的 MID 值：方法：招募需要进行初级非手术根管治疗的患者（n = 64）。在 12 个月的随访中对治疗效果进行临床和放射学（锥束计算机断层扫描）评估。分别使用口腔健康影响档案-14（OHIP-14）和视觉模拟量表（VAS）对术前和术后 12 个月的 OHRQoL 和疼痛进行评估。结果：最终分析包括 47 名患者。92.6%的牙齿临床结果良好。OHRQoL和疼痛在治疗后有明显改善（P.05）。OHIP-14评分的平均变化（即13.6分）大于所确定的中值范围：结论：根管治疗能明显改善患者的 OHRQoL。结论：根管治疗可明显改善患者的 OHRQoL，OHRQoL 得分的改善幅度大于所确定的中位值，这意味着存在具有临床意义的变化。OHRQoL 似乎与 CROMs 无关。

{"title":"Clinician/Patient-Reported Outcomes and Their Association After Root Canal Treatment.","authors":"Jasmine Wong, Angeline Hui Cheng Lee, Gary Shun Pan Cheung, Colman McGrath, Prasanna Neelakantan","doi":"10.1016/j.joen.2024.09.009","DOIUrl":"10.1016/j.joen.2024.09.009","url":null,"abstract":"<p><strong>Introduction: </strong>The relationship between clinician-reported outcome measures (CROM) and patient-reported outcome measures (PROM) after root canal treatment is poorly understood. Oral health-related quality of life (OHRQOL) is a crucial PROM. Determination of the minimal important difference (MID) is critical for determining patients' perspective of treatment effectiveness, but the MID required to perceive any meaningful change in the OHRQOL after root canal treatment remains unclear. The aim of this prospective study was to investigate the relationship between the clinical outcome and OHRQOL after root canal treatment and to determine the corresponding MID values.</p><p><strong>Methods: </strong>Patients (N = 64) requiring primary nonsurgical root canal treatment were recruited. Clinical and radiographic (cone-beam computed tomography) assessment of treatment outcomes was performed at the 12-month follow-up. OHRQOL and pain were evaluated preoperatively and at the 12-month follow-up using the Oral Health Impact Profile-14 and visual analog scale, respectively. P < .05 was considered statistically significant. MID was assessed using distribution- and anchor-based approaches.</p><p><strong>Results: </strong>The final analysis included 47 patients. The clinical outcome was favorable for 92.6% of teeth. OHRQOL and pain showed significant improvement after treatment (P < .001). No significant association was found between clinical outcome and OHRQOL (P > .05). The mean Oral Health Impact Profile-14 score change (ie, 13.6) was greater than the range of MID values determined.</p><p><strong>Conclusions: </strong>Root canal treatment significantly improves OHRQOL. Improvement in the OHRQOL score was greater than the MID values determined, implying a clinically significant change. However, PROM (OHRQOL) does not appear to be correlated with CROM.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142347939","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

Ectopic Dental Canal: A Case Report Highlighting a Unique Bifid Mandibular Canal Variant. 异位牙槽骨：突显独特下颌双歧管变异的病例报告

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2024-09-28 DOI: 10.1016/j.joen.2024.09.007

Kevin W Yu, Manal H Hamdan, Stephanie J Sidow

Bifid mandibular canals are common anatomical findings with variations based on direction and location of branching, which carry significant clinical implications for endodontic and surgical dental procedures. This case report describes a previously unreported ectopic dental canal that branches off the superior border of the mandibular canal, enters the apex of a mandibular second molar, traverses through the root, anastomoses with the root canal system, and subsequently exits through the lingual aspect of the root. The anastomosis of this ectopic dental canal with the mesial lingual canal led to significant bleeding during rotary instrumentation. This unique anatomical variation demonstrates the importance of a thorough cone-beam computed tomography analysis to identify critical structures prior to undertaking dental procedures involving the root apices of mandibular posterior teeth and adjacent areas.

下颌双叉管是一种常见的解剖发现，其分支方向和位置各不相同，对牙髓治疗和牙科手术具有重要的临床意义。本病例研究描述了一个以前未报道过的异位牙管，它从下颌管的上缘分支，进入下颌第二磨牙的顶点，穿过牙根，与根管系统吻合，随后从牙根的舌侧流出。该异位牙管与舌中管的吻合导致旋转器械操作时大量出血。这种独特的解剖变异表明，在进行涉及下颌后牙根尖和邻近区域的牙科手术之前，必须进行全面的锥形束计算机断层扫描分析，以确定关键结构。

引用次数: 0

PAINe: An Artificial Intelligence-based Virtual Assistant to Aid in the Differentiation of Pain of Odontogenic versus Temporomandibular Origin. PAINe - 一种基于人工智能的虚拟助手，用于区分牙源性疼痛和颞下颌源性疼痛。

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2024-09-27 DOI: 10.1016/j.joen.2024.09.008

Bianca Marques de Mattos de Araujo, Pedro Felipe de Jesus Freitas, Angela Graciela Deliga Schroder, Erika Calvano Küchler, Flares Baratto-Filho, Vania Portela Ditzel Westphalen, Everdan Carneiro, Ulisses Xavier da Silva-Neto, Cristiano Miranda de Araujo

Introduction: Pain associated with temporomandibular dysfunction (TMD) is often confused with odontogenic pain, which is a challenge in endodontic diagnosis. Validated screening questionnaires can aid in the identification and differentiation of the source of pain. Therefore, this study aimed to develop a virtual assistant based on artificial intelligence using natural language processing techniques to automate the initial screening of patients with tooth pain.

Methods: The PAINe chatbot was developed in Python (Python Software Foundation, Beaverton, OR) language using the PyCharm (JetBrains, Prague, Czech Republic) environment and the openai library to integrate the ChatGPT 4 API (OpenAI, San Francisco, CA) and the Streamlit library (Snowflake Inc, San Francisco, CA) for interface construction. The validated TMD Pain Screener questionnaire and 1 question regarding the current pain intensity were integrated into the chatbot to perform the differential diagnosis of TMD in patients with tooth pain. The accuracy of the responses was evaluated in 50 random scenarios to compare the chatbot with the validated questionnaire. The kappa coefficient was calculated to assess the agreement level between the chatbot responses and the validated questionnaire.

Results: The chatbot achieved an accuracy rate of 86% and a substantial level of agreement (κ = 0.70). Most responses were clear and provided adequate information about the diagnosis.

Conclusions: The implementation of a virtual assistant using natural language processing based on large language models for initial differential diagnosis screening of patients with tooth pain demonstrated substantial agreement between validated questionnaires and the chatbot. This approach emerges as a practical and efficient option for screening these patients.

导言：与颞下颌功能障碍（TMD）相关的疼痛常常与牙源性疼痛相混淆，这是牙髓诊断中的一个难题。经过验证的筛查问卷可以帮助识别和区分疼痛的来源。因此，本研究旨在开发一种基于人工智能的虚拟助手，利用自然语言处理技术自动对牙痛患者进行初步筛查：PAINe 聊天机器人使用 Python 语言开发，使用 PyCharm 环境和 "openai "库集成了 ChatGPT 4 API，并使用 "streamlit "库构建了界面。聊天机器人集成了经过验证的 TMD 疼痛筛查问卷和一个关于当前疼痛强度的问题，用于对牙痛患者进行 TMD 鉴别诊断。在 50 个随机场景中对回答的准确性进行了评估，以比较聊天机器人与有效问卷。计算了卡帕系数，以评估聊天机器人的回答与有效问卷之间的一致程度：结果：聊天机器人的准确率达到了 86%，并且具有相当高的一致性（Kappa = 0.70）。大多数回复都很清晰，并提供了足够的诊断信息：利用基于大型语言模型的自然语言处理技术实施虚拟助手，对牙痛患者进行初步鉴别诊断筛查，结果表明有效问卷与聊天机器人之间存在很大的一致性。这种方法是筛查这些患者的一种实用、高效的选择。

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引用次数: 0

Micro-Computed Tomographic Analysis of Radicular Dentin Thickness in Mandibular Second Molars Across Diverse Anatomic Root Variations: Identifying Potential Danger Zones. 下颌第二磨牙根部牙本质厚度的显微 CT 分析，跨越不同的牙根解剖变异：识别潜在危险区。

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2024-09-21 DOI: 10.1016/j.joen.2024.09.005

Min Chen, Chialing Tsauo, Shenghao Qiu, Weiwei Wu, Jingzhi Ma, Ove A Peters, Yuan Gao

Introduction: This study aimed to investigate radicular dentin thicknesses in mandibular second molars (MSMs), considering variations in root configuration and the morphology of the pulp chamber floor (PCF). The types of radicular grooves and potential danger zones were also identified.

Methods: A total of 149 MSMs were scanned with micro-computed tomographic imaging and classified into 4 groups according to root fusion and PCF morphology as follows: (1) 45 with fused roots and C-shaped PCFs, (2) 45 with fused roots and non-C-shaped PCFs, (3) 14 with a single canal, and (4) 45 with separated roots. The first 2 groups were subdivided into Ω-shaped, U-shaped, and V-shaped radicular groove subgroups. Measurements included minimum and mean dentin thickness from the start of the radicular groove or root bifurcation extending 5 mm apically, the ratio of outer to inner dentin thickness, and the distribution of dentin thickness.

Results: Ω-shaped and U-shaped subgroups showed significant thinner minimum inner wall thickness than V-shaped subgroups at 2-5 mm from the starting point of the radicular groove in both C-shaped and non-C-shaped pulp floor categories (P < .05). The mesial roots of separated rooted MSMs showed significant thinner dentin than a non-C-shaped floor regarding minimum and mean inner thickness and mean outer thickness (P < .05). Teeth with a single canal had significantly thicker walls compared with the other 3 groups.

Conclusions: In MSMs, caution must be exercised, especially in the presence of Ω-shaped and U-shaped grooves in C-shaped roots and around the root furcation of separated roots.

简介本研究旨在调查下颌第二磨牙（MSM）的放射状牙本质厚度，同时考虑牙根构造和髓室底层（PCF）形态的变化。此外，还确定了放射沟的类型和潜在危险区：使用显微 CT 扫描了 149 颗 MSM，并根据牙根融合和 PCF 形态将其分为四组：(1) 45 颗牙根融合，PCF 呈 C 形；(2) 45 颗牙根融合，PCF 呈非 C 形；(3) 14 颗牙根为单管；(4) 45 颗牙根分离。前两组又分为Ω形、U形和V形根状沟亚组。测量包括从根状沟或根分叉开始向根尖延伸 5 毫米的最小和平均牙本质厚度、外侧牙本质厚度与内侧牙本质厚度之比以及牙本质厚度的分布：结果：在C形和非C形牙髓底层类别中，Ω形和U形亚组在距放射槽起点2-5毫米处的最小内壁厚度明显薄于V形亚组（P < 0.05）。在最小内壁厚度、平均内壁厚度和平均外壁厚度方面，分根MSM的中侧根比非C形牙髓底层的牙本质明显薄（p < 0.05）。与其他三组相比，单根牙管的牙本质壁明显较厚：对于 MSM，尤其是在 C 形牙根中存在 Ω 形和 U 形凹槽时，以及在分离牙根的根嵴周围，必须小心谨慎。

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引用次数: 0

Outcome of Nonsurgical Root Canal Retreatment of Teeth with Persistent Apical Periodontitis Treated with Foraminal Enlargement and 2% Chlorhexidine Gel: A Retrospective Cohort Study. 对根尖周炎久治不愈的牙齿进行根管扩大和 2% 洗必泰凝胶治疗的非手术根管再治疗效果：一项回顾性队列研究。

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2024-09-21 DOI: 10.1016/j.joen.2024.09.006

Patrick Wilson Quelis Baltieri, Lucas Peixoto de Araújo, Brenda P F A Gomes, José Flávio Affonso de Almeida, Caio Cezar Randi Ferraz, Adriana de-Jesus-Soares

Introduction: Nonsurgical root canal retreatment (NS-RCRT) becomes necessary when primary endodontic procedures fail. This study evaluates the efficacy of NS-RCRT using 2% chlorhexidine gel and foraminal enlargement techniques, aiming to assess whether these approaches enhance periapical healing outcomes and success rates compared to traditional NS-RCRT techniques reported in the literature.

Methods: This retrospective cohort study analyzed 120 teeth diagnosed with persistent apical periodontitis, from 80 patients who underwent NS-RCRT between January 2014 and December 2018 at a specialist's private practice. Data were collected following the Preferred Reporting Items for Observational Studies in Endodontics 2023 guidelines. Periapical healing was evaluated using digital periapical radiographs by three calibrated examiners. The outcome of the treatment was analyzed through descriptive statistics and bivariate analyses, including the Chi-Square and Fisher's Exact tests. Treatment outcomes were deemed successful if they showed complete or incomplete repair and unsuccessful if no repair was observed.

Results: The average follow-up period was 30 months. Under loose criteria, 92.50% (n = 111) of the teeth were categorized as successful, and 7.5% (n = 9) as unsuccessful. Bivariate analysis indicated that the radiographic restoration of apical transportation was the only factor that significantly influenced the outcome.

Conclusions: NS-RCRT performed in a single visit using the foraminal enlargement technique and 2% chlorhexidine gel demonstrated high success rates and may be an effective alternative to tooth extraction. This method promoted periapical healing and could significantly improve NS-RCRT protocols. Further prospective studies are recommended to corroborate these findings.

引言当初级根管治疗失败时，就需要进行非手术根管再治疗（NS-RCRT）。本研究评估了使用 2% 洗必泰凝胶和根管扩大技术进行非手术根管再治疗的疗效，旨在评估与文献报道的传统非手术根管再治疗技术相比，这些方法是否能提高根尖周愈合效果和成功率：这项回顾性队列研究分析了2014年1月至2018年12月期间在一家专科私人诊所接受NS-RCT治疗的80名患者的120颗诊断为顽固性根尖牙周炎的牙齿。数据收集遵循牙髓病学观察性研究首选报告项目（PROBE）2023 指南。由三名经过校准的检查人员使用数字根尖周X光片对根尖周愈合情况进行评估。治疗结果通过描述性统计和双变量分析（包括 Chi-Square 检验和费雪精确检验）进行分析。如果治疗结果显示完全或不完全修复，则认为治疗成功；如果未观察到修复，则认为治疗不成功：平均随访时间为 30 个月。根据松散标准，92.50%（n = 111）的牙齿被归类为成功，7.5%（n = 9）的牙齿被归类为不成功。双变量分析表明，根尖运输的放射学修复是唯一对结果有显著影响的因素：使用穹窿扩大技术和 2% 洗必泰凝胶在一次就诊中完成 NS-RCRT 的成功率很高，可以有效替代拔牙。这种方法能促进根尖周愈合，并能显著改善 NS-RCT 方案。建议进一步开展前瞻性研究以证实这些发现。

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引用次数: 0

Teaching a New Obturation Technique in Preclinical Endodontic Training: Assessment of Student Learning Experience, Performance, and Self-Evaluation. 在牙髓病临床前培训中教授一种新的封固技术：对学生学习经历、表现和自我评价的评估。

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2024-09-17 DOI: 10.1016/j.joen.2024.09.004

Meltem Kucuk, Mohini Ratakonda, Lucila Piasecki

Introduction: This study investigated the impact of implementing hydraulic condensation (HC) as a second obturation technique in the Endodontic Preclinical course for dental students trained in warm vertical compaction (WVC).

Methods: A total of 70 students performed root canal treatment of 2 extracted molars; they performed the HC technique for the first time after a demonstration. The combination of the obturation technique (WVC or HC) and the type of molar (maxillary or mandibular) was randomly assigned, resulting in 4 groups (n = 35). The students answered a questionnaire appraising their learning experience and completed a self-evaluation rubric. Masked instructors graded projects. Data were statistically analyzed (significance set at 5%).

Results: Most of the students (91%) considered learning 2 obturation techniques relevant and considered it difficult to perform the downpack in molars (P < .05). About half of the students (45.7%) responded that HC resulted in fewer errors and disagreed that WVC derives in a more homogeneous obturation; accordingly, 52.9% of the students selected the highest self-grading for HC obturations, while only 38.6% for WVC. No significant difference was found in the distribution of grades attributed by students and instructors (P > .05). Students reported significantly higher levels of confidence for HC and difficulty for WVC (P < .05). No difference was found between the techniques regarding the presence of voids. The presence of multiple errors was more frequent for WVC (P < .05).

Conclusion: The findings indicate a positive learning experience and comparable performance among preclinical dental students in implementing HC as an alternative obturation technique.

简介：本研究调查了在牙髓病学临床前课程中将液压冷凝（HC）作为第二种封闭技术对接受温垂直压合（WVC）培训的牙科学生的影响：本研究调查了在牙髓病学临床前课程中将液压冷凝（HC）作为第二种封闭技术对接受过温热垂直压合（WVC）培训的牙科学生的影响：共有 70 名学生对两颗拔出的臼齿进行了根管治疗；他们在示范后首次使用了液压冷凝技术。封固技术（WVC 或 HC）和臼齿类型（上颌或下颌）的组合是随机分配的，结果分为四组（n=35）。学生们回答了一份评估其学习经历的问卷，并填写了一份自我评估表。蒙面教师对项目进行评分。对数据进行了统计分析（显著性设定为 5%）：大多数学生（91%）认为学习两种封髓技术是有意义的，并认为在磨牙中进行下包扎是困难的（P0.05）。学生们对 HC 的信心和对 WVC 的难度都明显较高（p 结论：研究结果表明，临床前牙科学生在将 HC 作为一种替代性充填技术时有积极的学习体验和可比的表现。

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