Journal of endodontics最新文献_第7页

Sabeti—Response

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

Journal of endodontics

Pub Date : 2025-12-01 DOI: 10.1016/j.joen.2025.08.009

Mike Sabeti DDS, MA, Julian Gabbay DDS, MS

引用次数: 0

An Innovative Injectable and Retrievable Drug Delivery System for Endodontic Therapy 一种创新的可注射和可回收的牙髓治疗药物输送系统。

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

Journal of endodontics

Pub Date : 2025-12-01 DOI: 10.1016/j.joen.2025.08.001

Abdel H. Mahmoud DDS, PhD , Aaron Sloutski PhD , Shi Fu PhD , Huiting Luo MS , Zoe Katevatis MS , Robert Wong MS , Yiwei Fang MS , Tatiana Zaliznyak PhD , Fernando Aguilar Perez DDS, PhD , Marcia Simon PhD , Stephen G. Walker PhD , Thomas Manders DDS , Miriam Rafailovich PhD , Jerome J. Cymerman DMD

Introduction

Endodontic treatment failures remain a significant treatment challenge. Different bacterial combinations are implicated in posttreatment disease. Enterococcus faecalis is often detected in these biofilms. Calcium hydroxide has many limitations, including low flowability, difficult retrieval, high pH, and limited efficacy against E. faecalis. Here, we show that these difficulties can be overcome using calcium salicylate (CASA) encapsulated in a photocrosslinked thermoreversible F127-dimethacrylamide (DMA) hydrogel.

Methods

CASA was prepared by mixing calcium hydroxide and salicylic acid in a 1:6 ratio, respectively and incorporated into F127-DMA at different concentrations. The mixture was photocrosslinked using lithium phenyl (2,4,6-trimethylbenzoyl) phosphinate. Chemical properties were analyzed using X-ray diffraction, Raman spectroscopy, Fourier transform infrared spectroscopy, and differential scanning calorimetry, while injectability and retrievability were assessed using plastic root canal training blocks, bovine teeth cone beam computed tomography scans, and oscillatory rheology. In Vitro antibacterial efficacy against E. faecalis biofilm was probed by injection of the compound, following inoculation on bovine extracted teeth. Cytotoxicity of the compound was measured using dental pulp stem cells.

Results

Encapsulation of CASA in F127-DMA reduced the viscosity by three orders of magnitude compared to the paste form, facilitating injection and enabling retrieval. Following retrieval, F127-DMA/CASA showed significantly lower residual medicament (∼6%) compared to Vista-Cal (26%). X-ray diffraction, Raman, and Fourier transform infrared spectroscopy analyses confirmed the formation of CASA and successful integration of CASA into photocrosslinked F127-DMA. Treatment with the F127-DMA/20% CASA following 21-day inoculation with E. faecalis resulted in a 6-log reduction in CFU and complete elimination of biofilm. No significant change in the doubling time of treated dental pulp stem cell was observed.

Conclusions

F127-DMA/CASA exhibits superior flowability, retrievability, near-neutral pH (∼6), biocompatibility, and anti-E. faecalis efficacy, which highlights its potential as a significant improvement over calcium hydroxide as an endodontic intracanal medicament.

牙髓治疗失败仍然是一个重大的治疗挑战。不同的细菌组合与治疗后疾病有关。粪化肠球菌常在这些生物膜中检出。氢氧化钙有许多局限性，包括流动性低，难以回收，pH值高，对粪肠杆菌的功效有限。在这里，我们证明了这些困难可以通过将水杨酸钙（CASA）封装在光交联、热可逆的F127-DMA水凝胶中来克服。方法：将氢氧化钙与水杨酸按1:6的比例混合制备CASA，并以不同浓度掺入F127-DMA中。用苯基（2,4,6-三甲基苯甲酰）膦酸锂（LAP）光交联混合物。化学性质采用XRD、拉曼光谱、FTIR和DSC进行分析，注射性和可回收性采用塑料根管训练块、牛牙CBCT扫描和振荡流变学进行评估。在牛拔牙上接种该化合物，观察其对粪肠球菌生物膜的体外抗菌效果。用牙髓干细胞（DPSCs）测定化合物的细胞毒性。结果：与膏状相比，CASA在F127-DMA中的包封降低了3个数量级的粘度，便于注射和检索。检索后，F127-DMA/CASA的残留药物明显低于Vista-Cal(26%)（约6%）。XRD， Raman和FTIR分析证实了水杨酸钙的形成，并成功地将CASA整合到光交联的F127-DMA中。在接种粪肠杆菌21天后，用F127-DMA/20%CASA进行处理，导致CFU降低6倍，生物膜完全消除。经处理的DPSC的倍增时间无显著变化。结论：F127-DMA/CASA具有良好的流动性、可回收性、接近中性pH值（~ 6）、生物相容性和抗e。粪粪碱的功效，突出其潜力，显著改善氢氧化钙作为根管内药物。

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引用次数: 0

Sexual Dimorphism in Apical Periodontitis Severity Detected by CBCT CBCT检测根尖牙周炎严重程度的性别二型性。

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

Journal of endodontics

Pub Date : 2025-12-01 DOI: 10.1016/j.joen.2025.08.020

Lucas R.A. Estrela DDS, MSc , Carlos Estrela DDS, MSc, PhD , Mike R. Bueno DDS, MSc, PhD , Anibal Diogenes DDS, MSc, PhD

Introduction

Although several elegant studies have reported apical periodontitis prevalence in different populations, far less is known about its associated bone loss and its correlation to sex and age. Thus, this study investigated the impact of sex and age differences on the severity of apical periodontitis (AP) using cone-beam computed tomography (CBCT) and a volumetric periapical index (CBCT-PAI).

Methods

CBCT scans of 401 patients (1,027 teeth) were analyzed by calibrated examiners in CBCT-PAI. Chi-square tests were used to assess associations between AP, sex, and age with other variables such as the presence and quality of endodontic treatment and coronal restorations. Robust Poisson regression models were used to evaluate the relationships between dependent and independent variables, with significance set at P < .05.

Results

The prevalence of AP was greater in female patients compared to males (66.9% vs 33.1%). Notably, men showed a significantly higher prevalence of larger lesions (CBCT-PAI 4 and 5) than women. Apical periodontitis was more common in root-filled teeth than primary infections, particularly posterior teeth. Lastly, AP was more commonly found in teeth with inadequate root canal fill or coronal restoration, while an intracanal post did not affect its prevalence.

Conclusions

AP was more common in women. However, the osteolytic lesions in females were smaller than those seen in males, who demonstrated a greater prevalence of severe lesions. These findings emphasize the importance of early diagnosis and treatment and highlight the significant sexual dimorphism in the pathophysiology of AP.

导读：虽然有几项研究报道了不同人群中根尖牙周炎的患病率，但对其相关的骨质流失及其与性别和年龄的关系知之甚少。因此，本研究利用锥形束计算机断层扫描（CBCT）和体积根尖周指数（CBCT- pai）研究了性别和年龄差异对根尖牙周炎（AP）严重程度的影响。材料和方法：通过CBCTPAI校准的检查员对401例患者（1027颗牙齿）的CBCT扫描进行分析。卡方检验用于评估AP、性别和年龄与其他变量（如根管治疗和冠状修复的存在和质量）之间的关系。稳健泊松回归模型用于评估因变量和自变量之间的关系，显著性设置在结果中：女性患者的AP患病率高于男性（66.9%对33.1%）。值得注意的是，男性出现较大病变（CBCTPAI 4和5）的比例明显高于女性。根尖牙周炎比原发感染更常见，尤其是后牙。最后，AP更常见于根管充填或冠状修复不充分的牙齿，而管内桩对其患病率没有影响。结论：根尖牙周炎在女性中更为常见。然而，女性的溶骨性病变比男性小，男性表现出更大的严重病变。这些发现强调了早期诊断和治疗的重要性，并强调了AP病理生理中显著的性别二态性。

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引用次数: 0

Viability of Dental Pulp Derived Stem Cells After Long-Term Cryopreservation 长期冷冻保存后牙髓干细胞的生存能力。

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

Journal of endodontics

Pub Date : 2025-12-01 DOI: 10.1016/j.joen.2025.09.014

Malika A. Malik DDS , Elizabeth Perkins BS , Alyssa Nedell DDS , Hitesh Chopra BDS, MS, PhD , James Sugai BS , Darnell Kaigler DDS, MS, PhD

Introduction

Dental pulp-derived stem cells (DPSCs) have promise for use in regenerative therapies due to their regenerative and immunomodulatory potential. Following their isolation from dental pulp tissue, DPSCs can be cryopreserved and banked for future use, however, it remains unclear to what extent long-term storage affects their properties. This study evaluated the properties of DPSCs cryopreserved for up to 13 years.

Methods

DPSCs from 12 patients cryopreserved for 5 (DPSC-5 YR), 10 (DPSC-10 YR), and 13 (DPSC-13 YR) years were analyzed for viability, immunophenotype (CD34, CD45, CD73, CD90, CD105), proliferation, and stemness. Additionally, senescence was evaluated through gene expression and senescence-associated β-galactosidase activity.

Results

All cryopreserved DPSCs showed high expression of stem cell markers CD73, CD90, and CD105 (>90%) with low expression of hematopoietic markers CD34 and CD45 (<4%). Proliferative capacity and proliferation rate demonstrated no significant differences in population doubling time among groups, with values of 1.32 ± 0.41 for DPSC-5 YR, 1.36 ± 0.44 for DPSC-10 YR, and 1.38 ± 0.53 for DPSC-13 YR, all comparable to DPSCs cryopreserved for less than 1 year (1.37 ± 0.57). Osteogenic and adipogenic differentiation of DPSCs confirmed their ability to retain multipotency. Finally, senescence-associated β-galactosidase staining revealed an absence of senescent cells up to passage 6 and while stemness and senescence gene expression profiles varied, no significant differences were found in expression of these genes between DPSCs, regardless of numbers of years of cryopreservation.

Conclusions

DPSCs can maintain viability, proliferative capacity, and stemness following long-term (up to 13 years) cryopreservation. These data support their long-term banking for clinical therapies aimed at tissue regeneration and immunomodulation.

牙髓源性干细胞（DPSCs）由于其再生和免疫调节的潜力，在再生治疗中有着广阔的应用前景。从牙髓组织中分离出来后，DPSCs可以冷冻保存并储存以备将来使用，然而，长期储存对其性能的影响程度尚不清楚。本研究评估了冷冻保存长达13年的DPSCs的特性。方法：对12例冷冻保存5年（DPSC-5YR）、10年（DPSC-10YR）和13年（DPSC-13YR）患者的DPSCs进行活力、免疫表型（CD34、CD45、CD73、CD90、CD105）、增殖和干细胞性分析。此外，通过基因表达和衰老相关β-半乳糖苷酶活性来评估衰老程度。结果：所有冷冻保存的DPSCs均高表达干细胞标志物CD73、CD90和CD105（约90%），低表达造血标志物CD34和CD45(结论：DPSCs在长期（长达13年）冷冻保存后仍能保持活力、增殖能力和干性。这些数据支持它们长期用于组织再生和免疫调节的临床治疗。

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引用次数: 0

Scientific Advisory Board 科学顾问委员会

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

Journal of endodontics

Pub Date : 2025-12-01 DOI: 10.1016/S0099-2399(25)00733-2

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 : 2025-12-01 DOI: 10.1016/S0099-2399(25)00702-2

引用次数: 0

Relationship between Craniofacial Skeletal Patterns and the Prevalence of Tooth Fractures 颅面骨骼形态与牙齿骨折发生率的关系。

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

Journal of endodontics

Pub Date : 2025-12-01 DOI: 10.1016/j.joen.2025.08.013

Julia Jeong DMD , Lucy Kim DMD , Soriul Kim PhD, MPH , Hyeran Helen Jeon DMD, MSD, DScD , Frank C. Setzer DMD, PhD, MS

Introduction

Tooth fractures are associated with various etiological factors, including occlusal stress. While science has shown associations between maximum bite force and craniofacial skeletal patterns, a direct link between skeletal morphology and the prevalence of tooth fractures has not been established. This study aimed to investigate whether sagittal and vertical skeletal patterns, as determined by cephalometric analysis, are associated with the prevalence of tooth fractures in an adult orthodontic population.

Methods

A retrospective review was conducted of 1001 adult orthodontic patients with complete records, including lateral cephalometric radiographs and demographic data. Patients were classified into vertical (high, neutral, low mandibular angle) and sagittal (Angle Class I, II, III) skeletal patterns using population-specific cephalometric norms. Tooth fractures were identified through clinical records and Current Dental Terminology codes, including whether fractured teeth were extracted or retained, and whether endodontic treatment was involved. Statistical analysis included analysis of covariance, chi-square, and Fisher exact tests.

Results

No significant differences were observed in the prevalence of tooth fractures, either extracted or retained, across vertical or sagittal skeletal classes for the overall population. Within the Caucasian subpopulation, a significantly higher prevalence of tooth fractures was noted in ANGLE-I compared to ANGLE-II (P = .02). Similarly, previously endodontically treated teeth were more frequently extracted due to fracture in ANGLE-I and ANGLE-III compared to ANGLE-II (P = .02). No significant associations were found in the African-American, Asian, or Hispanic subpopulations.

Conclusions

Craniofacial skeletal patterns may not aid in predicting tooth fracture risk in the general population. While limited associations were noted within the Caucasian subgroup, further prospective studies incorporating direct bite force measurements are warranted to clarify biomechanical contributions to tooth fractures.

牙齿骨折与多种病因有关，包括牙合应力。虽然科学已经表明最大咬合力与颅面骨骼形态之间存在关联，但骨骼形态与牙齿骨折患病率之间的直接联系尚未建立。本研究旨在调查矢状和垂直骨骼模式是否与成人正畸人群中牙齿骨折的患病率有关。材料和方法：回顾性分析1001例成人正畸患者的完整记录，包括侧位头颅x线片和人口统计资料。根据人群特异性头颅测量标准，将患者分为垂直（高、中、低下颌角）和矢状（角度I、II、III类）骨骼模式。通过临床记录和CDT （Current Dental Terminology）代码识别牙齿骨折，包括骨折的牙齿是否被拔出或保留，以及是否涉及牙髓治疗。统计分析包括ANCOVA、卡方检验和Fisher’s Exact检验。结果：在整个人群中，在垂直或矢状骨类别中，没有观察到牙齿骨折的发生率有显著差异，无论是拔出的还是保留的。在高加索人亚群中，与ANGLE-II相比，ANGLE-I的牙齿骨折发生率明显更高（p = 0.02）。同样，与ANGLE-II相比，先前进行过根管治疗的牙齿因ANGLE-I和ANGLE-III骨折而拔出的频率更高（p = 0.02）。在非裔美国人、亚洲人或西班牙裔亚人群中未发现显著关联。结论：颅面骨骼模式可能不能帮助预测一般人群的牙齿骨折风险。虽然在高加索亚组中注意到有限的关联，但进一步的前瞻性研究包括直接咬合力测量，以澄清生物力学对牙齿骨折的影响。

{"title":"Relationship between Craniofacial Skeletal Patterns and the Prevalence of Tooth Fractures","authors":"Julia Jeong DMD , Lucy Kim DMD , Soriul Kim PhD, MPH , Hyeran Helen Jeon DMD, MSD, DScD , Frank C. Setzer DMD, PhD, MS","doi":"10.1016/j.joen.2025.08.013","DOIUrl":"10.1016/j.joen.2025.08.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Tooth fractures are associated with various etiological factors, including occlusal stress. While science has shown associations between maximum bite force and craniofacial skeletal patterns, a direct link between skeletal morphology and the prevalence of tooth fractures has not been established. This study aimed to investigate whether sagittal and vertical skeletal patterns, as determined by cephalometric analysis, are associated with the prevalence of tooth fractures in an adult orthodontic population.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of 1001 adult orthodontic patients with complete records, including lateral cephalometric radiographs and demographic data. Patients were classified into vertical (high, neutral, low mandibular angle) and sagittal (Angle Class I, II, III) skeletal patterns using population-specific cephalometric norms. Tooth fractures were identified through clinical records and Current Dental Terminology codes, including whether fractured teeth were extracted or retained, and whether endodontic treatment was involved. Statistical analysis included analysis of covariance, chi-square, and Fisher exact tests.</div></div><div><h3>Results</h3><div>No significant differences were observed in the prevalence of tooth fractures, either extracted or retained, across vertical or sagittal skeletal classes for the overall population. Within the Caucasian subpopulation, a significantly higher prevalence of tooth fractures was noted in ANGLE-I compared to ANGLE-II (<em>P</em> = .02). Similarly, previously endodontically treated teeth were more frequently extracted due to fracture in ANGLE-I and ANGLE-III compared to ANGLE-II (<em>P</em> = .02). No significant associations were found in the African-American, Asian, or Hispanic subpopulations.</div></div><div><h3>Conclusions</h3><div>Craniofacial skeletal patterns may not aid in predicting tooth fracture risk in the general population. While limited associations were noted within the Caucasian subgroup, further prospective studies incorporating direct bite force measurements are warranted to clarify biomechanical contributions to tooth fractures.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"51 12","pages":"Pages 1735-1743"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956543","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

Biocompatibility of a Novel Light-Curable Hydrogel-Based Root Canal Obturation Material: In Vivo and In Vitro Analyses 一种新型光固化水凝胶根管封闭材料的生物相容性：体内和体外分析。

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

Journal of endodontics

Pub Date : 2025-12-01 DOI: 10.1016/j.joen.2025.08.017

Moe Sandar Kyaw PhD, MDSc , Yoshio Yahata DDS, PhD , Masato Nakano DDS, PhD , Fusami Toyama DDS , Chen Ke DDS , Wang Shuai DDS, MDSc , Yuya Kamano DDS, PhD , Futaba Harada DDS, PhD , Tomose Noguchi DDS , Masahiro Saito DDS, PhD

Introduction

This study aims to evaluate the biocompatibility of a new light-curable hydrogel-based root canal obturation material, OdneFill, through in vivo and in vitro analyses.

Methods

Intentional overinstrumentation and overobturation were performed on the mandibular first molars of 10-week-old male rats, divided into 4 groups: group 1 (instrumentation only), group 2 (OdneFill), group 3 (gutta-percha + AH Plus), and group 4 (sound teeth). Mandibles were dissected after 3, 28, and 90 days for micro–computed tomography, histological analysis, and immunohistochemical staining and analyzed by two-way analysis of variance and post hoc Tukey test. Cytotoxicity and proinflammatory cytokine expression were assessed using RAW 264.7 cells and analyzed by 1-way analysis of variance and Tukey test (α = 0.05).

Results

Micro–computed tomographic analysis showed no significant difference in bone resorption (P > .05). However, AH Plus exhibited a higher inflammatory score (score: 1%–90%, score: 2%–10%) with increased neutrophil and macrophage infiltration in immunostaining (P < .05) compared to the instrumentation only group at day 90. In contrast, Odnefill showed comparable results (score: 0%–50%, score: 1%–30%, score: 2%–20%) to the instrumentation-only group (P > .05). Moreover, Odnefill did not affect the viability of RAW 264.7 cells, whereas the AH Plus extract decreased cell viability and upregulated inflammatory cytokines such as interleukin-1 beta and interleukin-6.

Conclusions

OdneFill demonstrated superior biocompatibility, and a minimal inflammatory response compared to AH Plus.

本研究旨在通过体内和体外分析来评估一种新型光固化水凝胶基根管封闭材料OdneFill（瑞士Odne）的生物相容性。方法：对10周龄雄性大鼠下颌第一磨牙进行故意过内固定和过封闭，分为4组：1组（仅内固定）、2组（OdneFill）、3组（古塔百尔沙+ AH Plus）和4组（健全牙）。分别于第3、28和90天解剖下颌骨，进行显微计算机断层扫描、组织学分析和免疫组织染色（IHC），并通过双向方差分析和事后Tukey检验进行分析。采用RAW 264.7细胞评价细胞毒性和促炎细胞因子的表达，采用单因素方差分析和Tukey检验（α = 0.05）。结果：微计算机层析分析显示骨吸收差异无统计学意义（P < 0.05）。然而，与仅使用器械组相比，AH Plus在第90天表现出更高的炎症评分（评分：1-90%，2-10%），免疫组化染色中中性粒细胞和巨噬细胞浸润增加（P < 0.05）。相比之下，Odnefill显示了与仅使用器械组相当的结果（评分：0-50%，1-30%,2-20%）（P < 0.05）。此外，Odnefill不影响RAW 264.7细胞的活力，而AH Plus提取物降低细胞活力并上调炎症细胞因子如IL-1β和IL-6。结论：与AH Plus相比，OdneFill表现出优越的生物相容性和最小的炎症反应。

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引用次数: 0

Investigation of Endodontic Disinfection by Combination of Laser and Nanobubble Technology 激光与纳米气泡联合消毒牙髓的研究。

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

Journal of endodontics

Pub Date : 2025-12-01 DOI: 10.1016/j.joen.2025.08.016

Haosu Ci DDS , Bingchang Xin DDS , Andrew W. Hubbard DMD, MDS , Evan Hamilton DDS, MDS , Chaz Ainsworth DDS, MS , Brett M. Dagen DDS , Enrique R. Bursian DMD , Yuting Zhang DDS , Yanhui H. Zhang PhD , Brian R. Morrow MS , Misako Nakashima DDS, PhD , George J.-T. Huang DDS, MSD, DSc

Introduction

To investigate the combined use of laser, nanobubble water (NB-H₂O), and calcium hydroxide (Ca(OH)₂) for endodontic disinfection, particularly in regenerative endodontic cases where maximum effectiveness is needed.

Methods

The canal of human teeth were prepared, sterilized, and inoculated with Enterococcus faecalis (E. faecalis). Teeth were assigned to 4 groups for 2 rounds of disinfection with Er,Cr: YSGG laser (Biolase). Group I - control, no disinfection, Group II - 6.25% NaOCl, Group III - 1.25% NaOCl, and Group IV - 1.25% NaOCl/NB-H₂O. Ca(OH)₂ was placed in the canal for ∼10 days between the 2 disinfection rounds. Teeth were evaluated by scanning electron microscopy for biofilm removal and confocal laser scanning microscopy to detect live/dead bacteria in the dentinal tubules.

Results

Scanning electron microscopy analysis of the canal disinfection indicated that the NB-H₂O group (1.25% NaOCl/NB-H₂O) appeared to enhance the removal of biofilm/smear layer. However, it was not consistently more effective than other groups in killing the bacteria in the dentinal tubules. The combined use of low-concentration NaOCl, laser, NB-H₂O and Ca(OH)₂ largely reduced E. faecalis but did not achieve complete eradication from the canal or in the dentinal tubules.

Conclusions

Our comprehensive disinfection protocol reduced the bacteria in the dentinal tubules to a level potentially suited for regenerative endodontic therapy.

简介：研究激光、纳米泡水（NB-H2O）和氢氧化钙（Ca(OH)2）联合用于根管消毒，特别是在需要最大效果的再生根管病例中。方法：制备人牙管，消毒后接种粪肠球菌（E. faecalis）。采用Er、Cr: YSGG激光（Biolase）对牙齿进行2轮消毒。第一组为对照组，未消毒，第二组为6.25% NaOCl，第三组为1.25% NaOCl，第四组为1.25% NaOCl/NB-H2O。Ca(OH)2在两轮消毒之间放置在管中~ 10天。采用扫描电镜（SEM）检查生物膜的去除情况，用共聚焦激光扫描显微镜（CLSM）检查牙本质小管内的活/死细菌。结果：管道消毒后的扫描电镜分析表明，NB-H2O组（1.25% NaOCl/NB-H2O）对生物膜/涂抹层的去除有促进作用。然而，在杀死牙本质小管中的细菌方面，它并不总是比其他组更有效。低浓度NaOCl、激光、NB-H2O和Ca(OH)2联合使用可显著减少粪肠球菌，但不能完全根除根管或牙本质小管内的粪肠球菌。结论：我们的综合消毒方案将牙本质小管中的细菌减少到可能适合再生根管治疗的水平。

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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

Journal of endodontics

Pub Date : 2025-12-01 DOI: 10.1016/j.joen.2025.11.022

Weiwei Qiao, Li Qin, Chen Chen, Yeyu Lin, Xining Zhang, Yi Zhou, Liuyan Meng

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