Journal of endodontics最新文献_第7页

Evaluating Retrieval-Augmented Large Language Models on External Cervical Resorption: A Comparative Study of Gemini and NotebookLM 评价检索增强的大语言模型对宫颈外吸收的影响：Gemini和NotebookLM的比较研究。

IF 3.6 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2026-02-01 Epub Date: 2025-11-07 DOI: 10.1016/j.joen.2025.10.016

Marc Garcia-Font DDS, PhD , Nicolás Dufey-Portilla DDS, MSc , Fernando Durán-Sindreu DDS, PhD , José Antonio González Sánchez DDS, PhD , Gustavo Rodríguez Millán DDS, PhD , Venkateshbabu Nagendrababu BDS, MDS, FDS RCPS (Glasg) , Paul M.H. Dummer BDS, MScD, PhD, DDSc , Francesc Abella Sans DDS, PhD

Introduction

This study evaluated the accuracy and consistency of two large language models developed by Alphabet Inc., Google Gemini (GG), a base configuration, and NotebookLM (NLM), a document-grounded configuration, when answering clinical questions regarding external cervical resorption using a retrieval-augmented framework.

Methods

Forty-six dichotomous clinical questions related to external cervical resorption were developed by three academic endodontists based on established sources. Each question was submitted to GG and NLM using three independent user accounts, yielding 276 responses. The retrieval-augmented generation configuration was replicated by NLM, which was programmed to generate responses exclusively from the documents provided. Three endodontic experts independently evaluated all responses against predefined gold standard answers. Accuracy was defined as agreement with the gold standard; consistency referred to identical responses across the three trials. Statistical analyses included 95% confidence intervals (CIs) (Wald and Wilson), Fleiss' kappa, and Fisher's exact test.

Results

GG achieved an accuracy of 89% (41/46; 95% CI, 76.96–95.27) and a consistency rate of 93% (κ = 0.89; P < .001). NLM achieved an accuracy of 96% (44/46; 95% CI, 85.47–98.79) and the same consistency (κ = 0.90; P < .001). No significant differences occurred between the large language models for accuracy and consistency.

Conclusions

The NLM and GG models exhibited a high level of accuracy and consistency. Although NLM had a slightly superior performance, retrieval augmentation did not significantly enhance the responses to structured clinical tasks.

在使用检索增强框架回答有关宫颈外吸收（ECR）的临床问题时，本研究评估了由Alphabet Inc.开发的两个大型语言模型（llm）的准确性和一致性，b谷歌Gemini （GG）是一个基础配置，NotebookLM （NLM）是一个基于文档的配置。方法：由3位牙髓专家根据已建立的资料提出46个与ECR相关的临床问题。每个问题都是通过三个独立的用户账户提交给GG和NLM的，共有276个回复。检索增强生成配置由NLM复制，它被编程为只从提供的文档生成响应。三名牙髓专家根据预先确定的金标准答案独立评估所有回答。准确度被定义为与金标准的一致性；一致性指的是三个试验中相同的反应。统计分析包括95%置信区间（Wald和Wilson）、Fleiss kappa和Fisher精确检验。结果：GG的准确率为89% (41/46；95% CI为76.96 ~ 95.27)，一致性为93% （κ = 0.89; p < 0.001）。NLM的准确率为96% (44/46;95% CI, 85.47-98.79)，一致性相同（κ = 0.90; p < 0.001）。在准确性和一致性方面，llm之间没有显着差异。结论：NLM和GG模型具有较高的准确性和一致性。虽然NLM有稍好的表现，检索增强并没有显著提高对结构化临床任务的反应。

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引用次数: 0

Accuracy of Robotic Root Canal Localization Using Optimized Point Cloud Registration Strategies: An In Vitro Study 使用优化的点云配准策略的机器人根管定位精度：一项体外研究。

IF 3.6 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2026-02-01 Epub Date: 2025-10-27 DOI: 10.1016/j.joen.2025.10.013

Yang Piao DDS , Yingyan Deng MS , Xudong Bao DDS, PhD , Junchen Wang PhD , Yanmei Dong DDS, PhD

Introduction

Traditional registration process of robotic root canal localization remains cumbersome. This study aimed to determine optimal point cloud registration strategies for robotic root canal localization and evaluate its accuracy.

Methods

3D-printed mandibular dental models were divided into point cloud group (PCG) and fiducial point group (FPG) based on registration method. Fiducial points and target points were prepared in FPG, while only target points were prepared in PCG. After cone-beam computed tomography imaging and intraoral scanning, registration was performed using respective methods, with PCG acquiring point clouds from different tooth surfaces. Registration accuracy was evaluated by calculating fiducial registration error and target registration error. Then the robot system performed root canal localization in each group, measuring entry, apical and angular deviations. Statistics were analyzed using independent sample t-tests and one-way ANOVA.

Results

PCG achieved lowest registration errors when lingual surface point clouds were acquired for anterior teeth and occlusal surface point clouds for posterior teeth (P < .05). Compared with FPG, the fiducial registration error of PCG was significantly lower (P < .05), while the target registration error was comparable (P > .05). In PCG, the robotic system demonstrated entry, apical, and angular deviations of 0.25 ± 0.08 mm, 0.29 ± 0.06 mm, and 1.34 ± 0.81°, which was comparable to FPG (P > .05).

Conclusions

The registration strategy utilizing point clouds from lingual surfaces of anterior teeth and occlusal surfaces of posterior teeth achieves high accuracy, feasible for robotic root canal localization. This method may enhance registration accuracy and clinical efficiency.

传统的机器人根管定位注册过程仍然很繁琐。本研究旨在确定机器人根管定位的最佳点云配准策略并评估其准确性。方法：根据配准方法将3d打印下颌牙模型分为点云组（PCG）和基点组（FPG）。FPG中制备基准点和目标点，PCG中仅制备目标点。在CBCT成像和口内扫描后，分别使用不同的方法进行配准，PCG从不同的牙齿表面获取点云。通过计算基准配准误差（FRE）和目标配准误差（TRE）来评价配准精度。然后机器人系统对各组进行根管定位，测量入口、根尖和角度偏差。统计学分析采用独立样本t检验和单因素方差分析。结果：前牙获得舌面点云，后牙获得咬合面点云时PCG配准误差最低（P < 0.05）。与FPG相比，PCG的FRE显著降低（P < 0.05），而TRE与FPG相当（P < 0.05）。在PCG中，机器人系统的入口、根尖和角度偏差分别为0.25±0.08 mm、0.29±0.06 mm和1.34±0.81°，与FPG相当（P > 0.05）。结论：利用前牙舌面和后牙合面点云的配准策略具有较高的精度，适用于机器人根管定位。该方法可提高配准精度和临床效率。

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引用次数: 0

Managing Perforating Internal Root Resorption in Mature Incisor with Laser-assisted Regenerative Endodontic Procedures 激光辅助再生牙髓治疗成熟切牙的穿孔性内根吸收。

IF 3.6 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2026-02-01 Epub Date: 2025-08-30 DOI: 10.1016/j.joen.2025.08.019

Guoying Lu MDS , Xiuqing Wang MDS , Ruonan Chen BDS , Yu Zeng BDS , Xiaojing Huang DDS, PhD

Introduction

This report presented the successful application of laser-assisted regenerative endodontic procedures (REPs) in managing perforating internal root resorption (PIRR) in a mature incisor.

Methods

A 24-year-old female with a history of trauma was referred for treatment of her maxillary anterior tooth. Clinical examination and cone-beam computed tomography imaging revealed that tooth #9 had PIRR with a lateral inflammatory lesion and thin canal walls. Consequently, a novel laser-assisted REPs was performed to treat PIRR.

Results

Three-year follow-up showed apical healing, cessation of resorption, and hard tissue formation within the resorptive defect.

Conclusions

This outcome demonstrated the efficacy of laser-assisted REPs for managing infection in mature teeth with PIRR, where bleeding from the apical foramen could be supplemented by blood flow through the lateral wall perforations, thereby enhancing the outcome of REPs.

简介：本报告介绍了激光辅助再生根管治疗（REPs）在治疗成熟切牙穿孔性根内吸收（PIRR）中的成功应用。方法：一名24岁女性，有外伤史，对其上颌前牙进行治疗。临床检查和锥形束计算机断层成像显示9号牙有外侧炎性病变和薄管壁。因此，一种新型激光辅助REPs被用于治疗PIRR。结果：3年随访显示根尖愈合，骨吸收停止，骨吸收缺损内形成硬组织。结论：该结果证明了激光辅助REPs治疗成熟牙齿PIRR感染的有效性，其中根尖孔出血可以通过侧壁穿孔的血流来补充，从而提高了REPs的效果。

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引用次数: 0

Autogenous Transplantation of an Immature Undersized Third Molar to Rehabilitate a Cyst-associated Lateral Incisor Defect: A 3-Year Case Report 未成熟小尺寸第三磨牙自体移植修复囊肿相关侧切牙缺损：3年病例报告。

IF 3.6 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2026-02-01 Epub Date: 2025-09-02 DOI: 10.1016/j.joen.2025.08.021

Cheng Bi BM , Zirui Bian BM , Bin Peng PhD , Hui Wang BM , Jin Jiang MM , Yifan Chen BM , Jingyi Tan PhD

Severe periapical cysts frequently result in tooth loss with concomitant severe alveolar bone destruction, precluding immediate implant placement. Autogenous tooth transplantation, which involves transplanting the patient's own tooth to the recipient site, offers a biological approach to reconstruct both the dentition and supporting bone structures. This report presents a 25-year-old female with a mobile, discolored maxillary right lateral incisor (#12) exhibiting grade 3 mobility due to a large periapical cyst (extending to #14 on cone-beam computed tomography) with root developmental arrest, secondary to Oehlers type II dens invaginatus. Autogenous transplantation was performed using an immature impacted third molar (#28) with compatible root morphology. Despite pulp necrosis requiring root canal treatment at 1 month, functional stability was achieved by 3 months. Three-year follow-up demonstrated complete bone healing, intact periodontal ligament space, and absence of resorption or ankylosis on cone-beam computed tomography. This case underscores the promising role of autogenous tooth transplantation as a viable treatment option for complex dental scenarios.

严重的根尖周围囊肿经常导致牙齿脱落，并伴有严重的牙槽骨破坏，因此不能立即植入。自体牙齿移植（ATT）是将患者自己的牙齿移植到受体部位，提供了一种重建牙列和支撑骨结构的生物学方法。本报告报告了一名25岁女性，上颌右侧切牙（#12）活动，变色，由于一个大的根尖周囊肿（在CBCT上延伸到#14），牙根发育停止，继发于Oehlers II型牙槽内陷，表现为3级活动。自体移植使用根形态相容的未成熟阻生第三磨牙（#28）进行。尽管髓质坏死需要在1个月时进行根管治疗，但3个月时功能稳定。3年随访显示骨完全愈合，牙周韧带间隙完整，CBCT显示无骨吸收或强直。本病例强调了自体牙移植作为一种可行的治疗方案在复杂牙科情况下的重要作用。

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引用次数: 0

Effects of Different Root Canal Sealers and Irrigation Agitation Methods on Postoperative Pain in the Treatment of Teeth with Chronic Apical Periodontitis: A Randomized Clinical Trial 不同根管封闭器和灌洗搅拌方法对慢性根尖牙炎术后疼痛的影响：一项随机临床试验。

IF 3.6 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2026-02-01 Epub Date: 2025-10-01 DOI: 10.1016/j.joen.2025.09.015

Yakup Üstün DDS, PhD, İpek Eraslan Akyüz DDS, İlke Manolya Özdemir DDS

Introduction

This study aimed to explore how different combinations of root canal sealers and irrigation activation techniques affect postoperative pain in single-rooted teeth with chronic apical periodontitis.

Methods

Eighty teeth with single root and chronic apical periodontitis were randomly assigned into four groups according to the sealer and irrigation activation used: AH Plus sealer + manuel dynamic irrigation (MDI), AH Plus sealer + passive ultrasonic irrigation (PUI), NeoSealer Flo + MDI, NeoSealer Flo + PUI. The canals were prepared using Reciproc (R25 and R40) files. Root canals were obturated with gutta-percha cones corresponding in size and taper to the final instrument used. Ah Plus was used in the first and second groups, and NeoSealer Flo was used in the third and fourth groups as the root canal sealer. The 17% ethylenediaminetetraacetic acid used in the final irrigation was activated using two different agitation methods (MDI, PUI). Postoperative pain was assessed at multiple time points up to 7 days using the visual analog scale.

Results

Pain intensity generally peaked between 6 and 24 hours after treatment. Among the groups, the AH Plus + MDI combination resulted in the lowest pain scores, while the NeoSealer Flo + PUI group showed higher pain levels. A significant difference was noted between early pain levels and the consumption of analgesics (P < .001). There were no statistically significant differences observed in terms of demographic characteristics (P > .05).

Conclusions

The combination of MDI with the AH Plus showed lower levels of pain in the early postoperative period.

简介：本研究旨在探讨根管封闭剂和灌洗激活技术的不同组合对慢性根尖牙炎单根牙术后疼痛的影响。方法：80例单根慢性根尖牙炎患者，根据使用的封口剂和冲洗激活方式随机分为4组：AH +封口剂+曼纽动态冲洗（MDI）、AH +封口剂+被动超声冲洗（PUI）、NeoSealer Flo+MDI、NeoSealer Flo+PUI。使用Reciproc （R25和R40）文件制备管道。根管用与最终使用的器械大小和锥度相对应的杜仲胶锥体封闭。第一组和第二组使用Ah Plus，第三组和第四组使用NeoSealer Flo作为根管密封剂。用两种不同的搅拌方法（MDI、PUI）活化用于最终灌溉的17%乙二胺四乙酸。术后疼痛采用视觉模拟评分法在7天内的多个时间点进行评估。结果：疼痛强度一般在治疗后6 ~ 24小时达到高峰。其中，AH + MDI组疼痛评分最低，而NeoSealer Flo + PUI组疼痛评分较高。早期疼痛水平和镇痛药用量之间存在显著差异（p < 0.001）。人口学特征方面差异无统计学意义（p < 0.05）。结论：MDI联合AH Plus在术后早期疼痛水平较低。

{"title":"Effects of Different Root Canal Sealers and Irrigation Agitation Methods on Postoperative Pain in the Treatment of Teeth with Chronic Apical Periodontitis: A Randomized Clinical Trial","authors":"Yakup Üstün DDS, PhD, İpek Eraslan Akyüz DDS, İlke Manolya Özdemir DDS","doi":"10.1016/j.joen.2025.09.015","DOIUrl":"10.1016/j.joen.2025.09.015","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to explore how different combinations of root canal sealers and irrigation activation techniques affect postoperative pain in single-rooted teeth with chronic apical periodontitis.</div></div><div><h3>Methods</h3><div>Eighty teeth with single root and chronic apical periodontitis were randomly assigned into four groups according to the sealer and irrigation activation used: AH Plus sealer + manuel dynamic irrigation (MDI), AH Plus sealer + passive ultrasonic irrigation (PUI), NeoSealer Flo + MDI, NeoSealer Flo + PUI. The canals were prepared using Reciproc (R25 and R40) files. Root canals were obturated with gutta-percha cones corresponding in size and taper to the final instrument used. Ah Plus was used in the first and second groups, and NeoSealer Flo was used in the third and fourth groups as the root canal sealer. The 17% ethylenediaminetetraacetic acid used in the final irrigation was activated using two different agitation methods (MDI, PUI). Postoperative pain was assessed at multiple time points up to 7 days using the visual analog scale.</div></div><div><h3>Results</h3><div>Pain intensity generally peaked between 6 and 24 hours after treatment. Among the groups, the AH Plus + MDI combination resulted in the lowest pain scores, while the NeoSealer Flo + PUI group showed higher pain levels. A significant difference was noted between early pain levels and the consumption of analgesics (<em>P</em> < .001). There were no statistically significant differences observed in terms of demographic characteristics (<em>P</em> > .05).</div></div><div><h3>Conclusions</h3><div>The combination of MDI with the AH Plus showed lower levels of pain in the early postoperative period.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 2","pages":"Pages 227-238"},"PeriodicalIF":3.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225455","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

Guidelines for Authors 作者指南

IF 3.6 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2026-02-01 Epub Date: 2026-01-24 DOI: 10.1016/S0099-2399(25)00817-9

引用次数: 0

Associate Registry 将注册表

IF 3.6 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2026-02-01 Epub Date: 2026-01-24 DOI: 10.1016/S0099-2399(25)00833-7

引用次数: 0

Predoctoral Endodontic Education and Training in the United States and Canadian Dental Schools: A Web-Based Survey 美国和加拿大牙科学校博士前牙髓学教育和培训：一项基于网络的调查。

IF 3.6 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2026-02-01 Epub Date: 2025-10-08 DOI: 10.1016/j.joen.2025.09.021

Carla Y. Falcon DMD, MDS , Craig A. Dunlap DDS , Summer Youssef BDS, DDS

Objective(s)

This study aimed to evaluate endodontic education and training across United States (U.S.) and Canadian dental schools. It investigated clinical practices, curriculum structure, competency assessment methods, and program challenges in order to provide insights into improving endodontic competency among dental school graduates.

Methods

A comprehensive survey was electronically distributed to predoctoral program directors from accredited dental schools in the U.S. and Canada. The survey captured data on program characteristics, competency certification, and integration of advanced technologies. Data were evaluated and the significance level was set at P < .05.

Results

Of the 87 program directors contacted, 48 responded (response rate: 58.54%). The survey revealed variability in clinical endodontic requirements, with a mean of 4.59 root canal treatments or 4.5 canals completed per student. Nearly one-third of schools reported insufficient patient pools, with 71.43% substituting simulation exercises for clinical experience. Most programs (86.05%) used extracted teeth for training, and 42.86% permitted students to treat routine second molars. Certification methods varied, with 29.27% emphasizing live patient experiences. Notably, 54.76% of directors were uncertain about their graduates’ competence to perform molar endodontics in private practice.

Conclusion

Endodontic education in the U.S. and Canada exhibits significant variability, with patient access being a key factor influencing training quality. Simulation exercises help mitigate some challenges, but their use raises concerns about the adequacy of clinical preparedness. Standardizing clinical requirements, improving patient access, and increasing integration of advanced resources could enhance educational outcomes.

目的：本研究旨在评估美国和加拿大牙科学校的牙髓教育和培训。它调查了临床实践、课程结构、能力评估方法和项目挑战，以便为提高牙科学校毕业生的牙髓学能力提供见解。方法：通过电子方式向美国和加拿大认可的牙科学校的博士前项目主任进行全面调查。该调查收集了有关程序特征、能力认证和先进技术集成的数据。结果：在联系的87位项目主管中，48位做出了回应（回复率：58.54%）。调查显示临床根管治疗需求存在差异，平均每个学生完成4.59次根管治疗或4.5次根管治疗。近三分之一的学校报告患者资源不足，71.43%的学校用模拟练习代替临床经验。大多数项目（86.05%）使用拔牙进行训练，42.86%允许学生治疗常规第二磨牙。认证方式多种多样，29.27%强调患者现场体验。值得注意的是，54.76%的主任不确定他们的毕业生是否有能力在私人诊所进行磨牙根管治疗。结论：美国和加拿大的牙髓教育存在显著差异，患者可及性是影响培训质量的关键因素。模拟练习有助于减轻一些挑战，但它们的使用引起了对临床准备是否充分的担忧。规范临床需求、改善患者可及性和加强先进资源整合可提高教育成果。

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引用次数: 0

Evaluation of Articaine Infiltration Location on the Success Rate of Mandibular Lateral Incisor Anesthesia: A Prospective Crossover Randomized Clinical Trial Study 阿卡因浸润位置对下颌侧切牙麻醉成功率的评价：一项前瞻性交叉随机临床试验研究。

IF 3.6 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2026-02-01 Epub Date: 2025-10-09 DOI: 10.1016/j.joen.2025.09.018

Alireza Adl DDS, MSc , Fahime Alimardani DDS , Fereshte Sobhnamayan DDS, MSc

Introduction

Effective anesthesia of the mandibular lateral incisor is challenging. This study compared the efficacy of lingual infiltration alone versus combined labial and lingual infiltration using 4% articaine with 1:100,000 epinephrine.

Methods

In this prospective, randomized, crossover clinical trial, 50 healthy volunteers received 2 infiltration techniques: (1) lingual infiltration only (3.6 mL total via 2 1.8 mL injections plus a mock buccal injection), and (2) combined labial and lingual infiltration (1.8 mL each; 3.6 mL total plus a mock lingual injection). Anesthetic success was evaluated by: (1) absence of response to maximal electronic pulp tester stimulation, (2) sustained anesthesia defined as no response within 16 minutes lasting 42 minutes, and (3) anesthesia onset time (first of two consecutive no-response readings). Pain during injection was assessed via the 170-mm Heft–Parker visual analog scale. Statistical tests included McNemar's, Wilcoxon signed-rank, Friedman, and Dunn's test.

Results

The combined technique produced an equal or higher success rate (P ≤ .05), significantly greater sustained anesthesia (P < .05), and a significantly shorter onset time (P < .05) compared with lingual infiltration alone. Labial infiltration was associated with higher pain scores, especially during solution deposition (P < .05).

Conclusions

The combination of labial and lingual infiltration with 4% articaine and 1:100,000 epinephrine significantly improves the anesthetic success and duration for the mandibular lateral incisor, although it is associated with increased injection-related pain.

前言：下颌侧切牙的有效麻醉具有挑战性。本研究比较了单独舌部浸润与4%阿替卡因加1:10万肾上腺素联合唇部和舌部浸润的疗效。方法：在这项前瞻性、随机、交叉临床试验中，50名健康志愿者接受了两种浸润技术：(1)仅舌部浸润（通过两次1.8 mL注射加一次模拟颊部注射共3.6 mL），(2)唇部和舌部联合浸润（各1.8 mL，共3.6 mL加一次模拟舌部注射）。评估麻醉成功的标准是：1)对最大电髓测试仪刺激无反应，2)持续麻醉定义为在16分钟内无反应，持续42分钟，3)麻醉开始时间（连续两次无反应读数中的第一次）。通过170-mm Heft-Parker视觉模拟评分（VAS）评估注射过程中的疼痛。统计检验包括McNemar检验、Wilcoxon sign -rank检验、Friedman检验和Dunn检验。结果：与单纯舌部浸润术相比，联合手术成功率相同或更高（P≤0.05），持续麻醉时间显著延长（P < 0.05），起效时间显著缩短（P < 0.05）。唇部浸润组疼痛评分较高，尤其是溶液沉积组（P < 0.05）。结论：4%阿卡因和1:10万肾上腺素联合唇舌浸润可显著提高下颌骨侧切牙的麻醉成功率和麻醉持续时间，但与注射相关疼痛增加有关。

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引用次数: 0

Migration of a Separated Endodontic File Into the Mandibular Canal: An 8-Year Follow-up Case Report 分离的根管锉向下颌管内移动：8年随访病例报告。

IF 3.6 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of endodontics

Pub Date : 2026-02-01 Epub Date: 2025-10-13 DOI: 10.1016/j.joen.2025.10.002

Chiaki Akiba Katz , Misaki Fujimoto , Hidetaka Kuroda , Koichiro Muromachi

Separated endodontic instruments in mandibular molars may migrate into the mandibular canal, potentially causing neurological complications. The management of asymptomatic cases remains controversial. This case report presents the long-term conservative management of a separated stainless steel file that migrated into the mandibular canal. A 47-year-old male patient with chronic myeloid leukemia presented with a separated endodontic file that had migrated from the distal root of his mandibular right second molar into the mandibular canal over a 7-year period. Clinical examination, panoramic radiography, and cone-beam computed tomography were performed. Quantitative sensory testing using Semmes-Weinstein monofilament testing and psychological assessment were conducted. Conservative management with periodic observation was selected due to the patient's asymptomatic status. Cone-beam computed tomography revealed the separated file extending 1.43 mm into a mandibular canal with a diameter of 2.54 mm. Despite radiographic evidence of neural canal involvement, the patient remained asymptomatic throughout the 7-year observation period. Semmes-Weinstein monofilament testing detected minimal tactile sensitivity differences (0.1 g vs 0.55 g on the contralateral side), but no clinically significant neurological symptoms developed. Follow-up radiography at 8 years showed continued migration toward the inferior mandibular border without symptom development. Long-term migration of separated stainless steel endodontic files into the mandibular canal may remain asymptomatic. Adequate anatomical space within the mandibular canal, biocompatible properties of stainless steel, and patient-specific factors affecting sensory perception may contribute to the benign clinical course. Conservative management based on clinical symptomatology rather than radiographic findings alone appears appropriate in select asymptomatic cases, with regular monitoring recommended to detect potential delayed complications.

简介：下颌磨牙分离的根管器械可能会迁移到下颌管中，潜在地引起神经系统并发症。对无症状病例的处理仍有争议。本病例报告介绍了一个分离的不锈钢锉迁移到下颌骨管的长期保守管理。方法：一名47岁的男性慢性髓性白血病患者，在7年的时间里，他的下颌右第二磨牙的远端根向下颌管中迁移了一个分离的根管文件。进行了临床检查、全景x线摄影和锥形束计算机断层扫描（CBCT）。采用Semmes-Weinstein单丝测试（SWMT）进行定量感觉测试和心理评估。由于患者无症状，选择保守治疗并定期观察。结果：CBCT显示分离锉延伸1.43 mm进入直径2.54 mm的下颌骨管。尽管有影像学证据显示神经管受累，但在7年的观察期间，患者仍无症状。SWMT检测到最小的触觉灵敏度差异（0.1g vs 0.55g对侧），但未出现临床显著的神经系统症状。随访8年的x线片显示继续向下颌骨边界移动，无症状发展。结论：分离的不锈钢根管锉长期迁移到下颌管中可能没有症状。下颌管内足够的解剖空间、不锈钢的生物相容性以及影响感觉知觉的患者特异性因素可能有助于临床的良性发展。在一些无症状的病例中，基于临床症状而不是单纯的影像学表现的保守治疗似乎是合适的，建议定期监测以发现潜在的延迟并发症。

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引用次数: 0