Journal of endodontics最新文献

Introduction: The present study aimed to compare the use of conventional freehand access cavity preparation with the static-guided (SG) endodontic technique in terms of its ability to locate and negotiate root canals, iatrogenic errors (perforations), and the amount of tooth structure loss while treating single-rooted traumatized teeth with pulp canal calcifications.

Methods: This randomized clinical trial was registered in the Clinical Trial Registry of India (https://ctri.nic.in, CTRI/2024/01/061580). A total of 30 patients with traumatized teeth exhibiting calcified root canals were included in the study. The patients were randomly divided into 2 groups as follows: SG endodontic technique and conventional freehand technique. Following the completion of the treatments, the cases were evaluated as either successful (canal located) or failed (perforation or canal not located). In addition, the amount of removed tissue was calculated on the postoperative radiographs using ImageJ software (National Institutes of Health, Bethesda, MD). Chi-square and Mann-Whitney U tests were performed to analyze the data (P = .05).

Results: In the SG endodontic group, the root canals were located in all teeth, while in the conventional freehand approach, 13% of cases reported failure to locate the root canals. The tooth sturucture loss was significantly lower in the SG approach compared to the conventional freehand approach (P < .05).

Conclusion: The conventional freehand technique caused three times more tooth structure loss compared to the SG endodontic approach. There were no failed cases in the SG endodontic technique group, and all root canals were successfully located.

Introduction: A retrospective analysis of a large group of cases was conducted to examine the clinical traits of teeth subjected to intentional replantation (IR) and the factors influencing the treatment effect, so as to provide guidance for indication selection and surgical operations.

Methods: A total of 445 patients, each with one affected tooth, underwent IR surgery at West China Hospital of Stomatology, Sichuan University, from 2016 to 2023, were included. Data on basic patient information, preoperative status, intraoperative procedures, and follow-up results for 107 patients with a follow-up duration exceeding 1 year were collected. Statistical analysis was performed using SPSS.

Results: The results showed that most IR patients were female (62.25%) and aged between 21 and 50 (80.45%). The predominant teeth for surgery were the mandibular second molars (44. 94%), maxillary second molars (19.33%), and maxillary lateral incisors (11.24%). The main preoperative symptoms were percussion pain (78. 65%), periodontal pockets (50.11%), sinus tract (40.45%), and tooth mobility (30.79%). The rate of completing preoperative root canal treatment was 93.71%. During surgery, 66 teeth (14.83%) had root surface cracks. Sixty-two of these teeth were not reimplanted during the operation; 47 of 62 (75.81%) had vertical root fractures. The overall success rates were 78.50%. Univariate analysis showed that the lack of periodontal pockets and the absence of bony plate defects significantly increased the success rate (P < .05). The success rate for severe coronal defects and root defects on the distal surface of the second molar was 73.68%.

Conclusion: IR can be used for complex endodontic and periapical diseases, as well as teeth with periodontitis, serving as a viable solution for salvaging challenging teeth. The periodontal status, initial etiology, and the severity of the bony plate defect are key prognostic factors.

Introduction: This study aimed to evaluate the impact of mechanical loading, induced by preparing anatomically standardized premolar and molar canal models, on the cyclic fatigue and torsional fracture resistance of heat-treated nickel-titanium (NiTi) rotary instruments.

Methods: Sixty NiTi instruments (Race Evo) were randomly assigned to 3 groups (n = 20): unused controls (N0), instruments used to prepare 2 canals in premolar models (P2), and 4 canals in molar models (M4). Cyclic fatigue testing was performed in dynamic mode with a 4 mm axial pecking motion at 37 ± 1 °C. Time to fracture and the number of cycles to fracture were recorded; the lengths of fractured fragments were measured using a digital caliper. Torsional resistance was assessed by fixing the apical 3 mm and rotating the shaft until fracture. Maximum torsional load and angle of rotation were recorded. Fractured surfaces were examined using scanning electron microscopy, and phase transformation behavior was assessed via differential scanning calorimetry. Data were analyzed using one-way analysis of variance and Tukey's post hoc test at a 95% significance level.

Results: P2 and M4 groups showed significantly higher cyclic fatigue resistance than N0 (P < .001), with no difference between P2 and M4. Torsional resistance parameters were significantly reduced in P2 and M4 compared to N0 (P < .05). Scanning electron microscopy revealed distinct fracture morphologies; differential scanning calorimetry showed consistent phase transformation behavior.

Conclusion: Within the limitations of this study, standardized simulated procedural loading paradoxically increased the cyclic fatigue resistance of heat-treated NiTi instruments, while simultaneously producing a moderate reduction in torsional strength.

Introduction: The purpose of this systematic review with meta-analysis was to analyze the hemostatic efficacy in periapical surgery and their influence on the prognosis. A secondary objective was to study the influence of clinical variables both patient- and tooth-related.

Methods: A systematic review protocol was developed following the PRISMA guidelines. A comprehensive search was carried out in PubMed, Scopus, Web of Science, and Cochrane Library up to October 2024. Inclusion criteria were randomized controlled trials and controlled clinical trials analyzing the efficacy of hemostatic agents in periapical surgery and their relationship with treatment prognosis. Studies with follow-up periods of less than 12 months for prognosis analysis were excluded. Risk of bias was assessed using RoB2 tools for randomized controlled trials and ROBINS-I-V2 for controlled clinical trials. Three types of meta-analyses were conducted: a global pooled effect meta-analysis, a meta-regression and a network meta-analysis.

Results: Ten studies with a total of 388 teeth were included. The meta-analysis estimated an average hemostatic efficacy rate of 63 ± 6.6%. The meta-analysis and the meta-regression did not identify statistically significant differences between the hemostatic agents evaluated. The network meta-analysis found that epinephrine and aluminum chloride obtained statistically significant results when compared to collagen (P < .05). Among the variables analyzed, only the smoking habit showed a trend toward statistical significance (P = .074).

Conclusions: The hemostatic agents evaluated showed good efficacy for the control of intraoperative bleeding, without finding statistically significant differences. No relationship was found between hemostatic efficacy and prognosis, nor with patient- or tooth-related variable.

Introduction: Periapical pathology, a common outcome of pulpal infection or failed endodontic therapy, remains underexplored globally. Most studies are small-scale and based on two-dimensional radiographs. This study aimed to provide a standardized worldwide estimate of its prevalence using cone-beam computed tomography (CBCT).

Methods: A cross-sectional, multicenter study was conducted across 54 countries, each represented by one calibrated examiner. Examiners consecutively assessed 3,500 roots from pre-existing CBCT scans, yielding data from 189,000 roots (138,536 teeth) of 6,688 patients. A standardized protocol was applied using the CBCT periapical index to record lesion presence, tooth type, previous root canal treatment, and demographic variables. Only scans with voxel size ≤200 μm were included. Data were analyzed through meta-analysis and logistic regression model to evaluate factors associated with periapical pathology, with meta-regression assessing voxel size and field-of-view effects.

Results: At the patient level, periapical pathology affected 58.6% of individuals worldwide. Secondary tooth-level analysis showed a prevalence of 7.3%, ranging from 2.5% in Oceania to 9.6% in Africa. Maxillary teeth (9.3%) were more frequently affected than mandibular teeth (5.3%), with maxillary first molars showing the highest prevalence (18.6%). Prevalence increased with age, from 2.9% (≤20 years) to 10.5% (≥61 years). Endodontically treated teeth showed markedly higher prevalence of post-treatment periapical radiolucencies (44.3%) than untreated teeth (2.6%) (odds ratio = 21.6; confidence interval 19.1-23.1; P < .001). Voxel size and field-of-view did not influence outcomes.

Conclusion: Periapical pathology is highly prevalent worldwide, with notable regional and age-related differences. Endodontically treated teeth showed a disproportionately high prevalence of periapical pathology.

Introduction: Comparison of the apical sealer extrusion of BioRoot RCS and BioRoot Flow and assessment of the influence of procedural and anatomical factors that contribute to extrusion.

Methods: Human mandibular premolars were divided into 2 groups based on apical gauges (<40, >40). Other variables included the presence and size of an apical lesion (2, 4, and 6 mm), canal moisture (dry and wet), pumping and no-pumping action, and sealer tip insertion depth for BioRoot Flow (coronal vs apical). The extruded material was weighed in grams using an analytical balance to the accuracy of 0.0001 g. Statistical analysis included the Kruskal-Wallis test, Mann-Whitney U test, and multivariate linear regression to identify statistically significant factors related to sealer extrusion.

Results: Sealer extrusion was observed in 86.8% of 288 variables tested. BioRoot Flow had significantly higher extrusion across all categorical variables compared to BioRoot RCS (P < .001). Key factors associated with increased extrusion included wet canals (P < .001), larger apical gauge (>40; P < .05), apical sealer placement (P < .005), and pumping action (P < .05). Among all variables, canal moisture was the most consistent contributor to sealer extrusion. The presence of a 6 mm apical lesion combined with an apical gauge of >40 in a wet canal with apically placed BioRoot Flow increased the risk of sealer extrusion.

Conclusions: Wet canals, apical sealer tip placement, larger apical diameters or gauges, and pumping actions significantly increase the risk of extrusion, particularly with sealers that are delivered in a syringe, such as BioRoot Flow. These findings underscore the significance of procedural control in minimizing sealer extrusion and enhancing clinical outcomes.

Introduction: Palatal radicular grooves (PRGs) posed diagnostic challenges due to their complex root anatomy and subtle manifestations in cone-beam computed tomography (CBCT). This study aimed to develop a deep learning framework for the automated three-dimensional visualization, diagnosis, and classification of PRG lesions.

Methods: A unified framework (PRG-Net) integrating tooth segmentation, PRG diagnosis, and lesion classification was developed. A retrospective multicenter diagnostic accuracy study was conducted using CBCT datasets with varying fields of view from one internal validation site and 3 external centers to evaluate generalizability and performance for segmentation, diagnosis, and classification tasks. The impact of PRG-Net on dentists' diagnostic accuracy, classification consistency, and workflow efficiency was also assessed.

Results: PRG-Net demonstrated strong generalizability across all datasets. For tooth segmentation, it achieved a mean Dice similarity coefficient of 97.1% [95% CI: 96.4, 97.7]. Diagnostic performance yielded area under the curve of 94.4% (internal) and 85.2%-90.0% (external). Classification area under the curve were 91.4% [95% CI: 86.8, 96.1] for Type I, 88.5% [95% CI: 81.1, 95.8] for Type II, and 96.9% [95% CI: 91.6, 100] for Type III, with consistent cross-center reproducibility. In clinical validation, PRG-Net significantly improved dentists' diagnostic accuracy and inter-rater classification agreement while substantially reducing interpretation time.

Conclusions: PRG-Net provided a robust, automated solution for PRG assessment in CBCT. It facilitated earlier and more precise diagnosis, improved inter-rater reliability, and streamlined workflow, demonstrating strong potential as a clinically valuable decision-support tool to guide treatment planning and improve patient outcomes.

Introduction: Although traditional diagnosis of pulp inflammation relies on subjective clinical and sensibility tests that lack precision, emerging objective methods such as biomarker measurement and pulse oximetry show promise in accurately assessing pulp vitality and differentiating stages of pulpitis; however, these techniques still face technical challenges and require further validation through laboratory analyses.

Materials and methods: This study investigated selected biomarkers in pulpitis by analyzing clinical and laboratory examinations from patients aged from 19 to 55 undergoing endodontic treatment. Patients were divided into test groups (reversible/irreversible pulpitis) and a control group (healthy teeth). Clinical assessments included pulse oximetry measurement and pulpal blood collection for biomarker and pH analysis. Five inflammatory mediators (interleukin (IL)-1α, IL-6, IL-8, matrix metalloproteinase-9, and tissue inhibitor of metalloproteinase-1 (TIMP-1)) were evaluated using a Luminex multiplex assay. Statistical analysis was performed using SPSS 30.0, employing both parametric and nonparametric tests with a significance level of P ≤ .05.

Results: Several investigated markers exhibited significant differences among the groups. The levels of SpO₂ and pH were highest in the control group and lowest in in cases of irreversible pulpitis. Additionally, the levels of IL-1α, IL-6, and IL-8 increased with the severity of pulpitis. Significant correlations were identified between inflammatory mediators, pH, and pulse oximetry. Notably, IL-1α, IL-8, and TIMP-1 correlated with pH (P < .01), and pulse oximetry was strongly associated with IL-1α, IL-6, and IL-8 across all groups (P < .01).

Conclusions: The values of inflammatory mediators (IL-1α, IL-6, IL-8, matrix metalloproteinase-9, TIMP-1), along with the pulp blood pH and oxygen saturation levels differed according to the pulp condition and a positive correlation was established among the parameters analyzed.