Lasers in medical scienceAyşe Tuğba Eminsoy Avcı, İpek Eraslan Akyüz, Hüseyin Sinan Topçuoğlu
This study aimed to comparatively evaluate the effectiveness of different irrigation solutions and activation techniques in removing calcium hydroxide (CH) from standardized artificial grooves located in the apical third of root canals. Ninety extracted single-rooted human maxillary central incisors were instrumented using a standardized preparation protocol. Artificial grooves were created in the apical third of split roots and filled with CH paste. Specimens were randomly divided into two irrigation groups: 1.5% sodium hypochlorite (NaOCl) + 0.1% octenidine dihydrochloride (OCT) or 1.5% NaOCl + 17% ethylenediaminetetraacetic acid (EDTA). Each group was further subdivided according to the activation technique: conventional needle irrigation (CNI), passive ultrasonic activation (PUA), or laser-activated irrigation (LAI). Data were analyzed using Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction (α = 0.05). Significant differences were observed among the groups (p < 0.001). OCT combined with PUA showed the lowest residual CH scores and performed significantly better than OCT + CNI. OCT demonstrated superior CH removal compared with EDTA under CNI and PUA conditions. The OCT + PUA protocol was the most effective approach for CH removal.
Clinical oral investigationsDavid Han, Christopher Chun, Catherine Kim, Laurel Martinez, Jooyoung Song
OBJECTIVES: To characterize indications for endodontic microsurgery (EMS) and compare the relative proportion of these indications across two calendar periods before and after the practice's adoption of laser-activated irrigation (LAI). MATERIALS AND METHODS: A retrospective time-period comparison of consecutive EMS cases (n = 1,672) treated by six endodontists (April 2019-August 2025) was analyzed. Two periods were prespecified based exclusively on the date of surgery: Before-Laser Treatment (BLT) and After-Laser Treatment (ALT) following implementation of an Er, Cr: YSGG intracanal LAI protocol (August 2022). Each surgical tooth was assigned one or two predefined reasons. Proportions were compared between periods using Generalized Estimating Equations (GEE) adjusting for patient clustering, demographics, tooth class, and provider. RESULTS: The most frequent indications overall were large post (22.2%), uncleaned accessory canal (21.8%), and excessive calcification (14.4%). In adjusted models, the proportion of EMS cases attributed to uncleaned accessory canals decreased from 26.6% (204/767) in BLT to 17.7% (160/905) in ALT (adjusted OR = 0.49; 95% CI 0.37 to 0.65; P < .001). Conversely, the proportion of EMS cases attributed to excessive calcification increased from 10.8% (83/767) to 17.3% (157/905) (adjusted OR = 1.65; 95% CI 1.21 to 2.25; P = .002). CONCLUSIONS: In this practice-based case series, the ALT period was associated with a lower proportion of EMS cases performed for uncleaned accessory canals. By contrast, the proportion of EMS cases attributed to excessive calcification was higher in the ALT period. Causal inference regarding LAI effectiveness is limited by the time-period design and the lack of non-surgical denominator. CLINICAL RELEVANCE: Following the adoption of laser-activated irrigation (LAI) in non-surgical endodontics, uncleaned accessory anatomy constituted a smaller relative share of subsequent microsurgical cases. Conversely, clinicians should anticipate a continued substantial burden of calcification- and post-related surgical challenges.
Clinical oral investigationsAndrea Spinelli, Valentina Pergola, Carlo Prati, Maria Giovanna Gandolfi, Fausto Zamparini
OBJECTIVES: To radiographically evaluate short-term changes in NeoSealer Flo extruded beyond enlarged apical preparations under different moisture and apical-support conditions. MATERIALS AND METHODS: Thirty-two extracted single-rooted human teeth were randomly allocated to four experimental conditions (n = 8 per group). Teeth were prepared with reciprocating NiTi instruments to size 50/0.05 and filled with a matched gutta-percha cone and a premixed bioceramic sealer. The conditions combined the presence or absence of sponge support around the apex with dry or phosphate-buffered saline PBS-moistened canals. Standardized radiographs were acquired immediately after filling (T0), at 7 days (T1), and at 28 days (T2). Intracanal radiopaque area (Area of the canal, AOC) and apically extruded radiopaque area (Area of Extrusion, AE) were traced within a calibrated 6 × 10-mm region of interest. Separate random-intercept linear mixed models included group, time, and their interaction; pairwise comparisons used Sidak adjustment. RESULTS: Mean AOC changed by no more than 0.56 mm² within groups. The group-by-time interaction was not significant for AOC (Wald χ²(6) = 5.31, p = 0.505) but was significant for AE (Wald χ²(6) = 21.72, p = 0.001). From T0 to T2, mean AE changed by + 3.38 mm² (Group 1; dry/sponge), + 0.25 mm² (Group 2; moist/sponge), + 1.50 mm² (Group 3; dry/no sponge), and + 0.41 mm² (Group 4; moist/no sponge). CONCLUSIONS: Intracanal radiopaque area remained relatively stable over 28 days, whereas the extruded radiopaque area differed among experimental conditions. The largest mean increase occurred in the dry, sponge-supported group. CLINICAL RELEVANCE: Local moisture and periapical status may influence the radiopaque area of extruded NeoSealer Flo. However, the radiographic changes do not directly demonstrate material expansion, dissolution, resorption, or biological integration. Apical extrusion should be minimized in clinical practice.
Clinical and experimental dental researchAlina Paganini, Eva Magni, Wadim Leontiev, Thomas Connert, Anne Géraldine Guex, Andreas Filippi
OBJECTIVES: Endodontic treatment is mandatory after severe dental trauma such as avulsion or intrusion. Initial intracanal dressing with calcium hydroxide should be avoided according to international guidelines due to potential periodontal ligament damage by pH elevation. However, whether an intracanal dressing is able to alter the extraradicular site remains unclear. This in vitro study quantified extraradicular pH changes through dentinal diffusion of calcium hydroxide or Ledermix in a sealed-apex model in human teeth. MATERIAL AND METHODS: Thirty-five cryopreserved human premolars were prepared with or without cemental defects and received UltraCal XS, Ledermix, or saliva as an intracanal dressing. In the test groups, apices were sealed with composite resin material; the positive control remained with open apices. Teeth were stored in NaCl solution. External pH of the solution was measured on days 1, 3, 5, 7, and 14. A mixed model was applied to determine the effect of group, apical plug, cemental defect, and time on pH alterations. RESULTS: Calcium hydroxide in teeth without apical sealing caused a sustained external alkalinisation (± pH 12). In teeth with apical sealing, no significant external rise in pH occurred for any dressing over time compared to day 1; only one sealed specimen with calcium hydroxide dressing reached pH 9.1 transiently. The pH in Ledermix and saliva groups remained roughly neutral irrespective of sealing or cemental defects. Mixed-effects modeling identified the apical plug as the only significant factor (p < 0.05); presence of cemental defects or days after treatment had no significant effect on pH. CONCLUSIONS: In a sealed-apex model, intracanal dressings did not raise the external pH significantly by dentinal diffusion. Therefore, the results do not support the advantage of a certain intracanal dressing in endodontic treatment after severe dislocation injuries of teeth without open apices with respect to maintained physiological pH.
BMC research notesLoan-Chi Thi Bui, Son Hoang Le, Hien Thuc Huu Huynh, Bich-Ly Thi Nguyen
OBJECTIVE: To date, limited evidence exists regarding the clinical efficacy of MTA Flow™ Thick as a retrograde filling material in apicoectomy. This study aimed to investigate the clinical and radiographic outcomes over a 6-month follow-up period following apicoectomy with MTA Flow™ Thick as the retrograde filling material. RESULTS: A total of 24 teeth from 16 patients were included in this prospective study. All apicoectomies were performed by a single oral surgeon following a standardised surgical protocol. Clinical and radiographic outcomes were assessed at 3 and 6 months. All clinical symptoms-pain, swelling, and fistulas-showed a statistically significant reduction at both follow-up intervals (p < 0.001 for all). Periapical lesion size decreased at both time points (p < 0.001). Radiographic healing was observed in ≥ 85.5% of cases and demonstrated progressive improvement between the two follow-ups. The overall success rate increased significantly from 83.3% at 3 months to 91.7% at 6 months. Trial registration This study was registered at ClinicalTrials.gov (Identifier: NCT07254143, date 28 November 2025). This is a retrospectively registered trial.
Cell transplantationVinita Dsouza, Amrutha Hebbar, Shashi Rashmi Acharya, Raviraja N Seetharam, Kirthanashri S Vasanthan
Regeneration of dental pulp has surfaced as an exciting area of exploration in regenerative endodontics, as a result of progress in stem cell biology and their applications, along with biomaterials. Of the different cell populations studied, dental pulp stem cells (DPSCs) are recognized as possessing significant regenerative potential considering their multipotency, immunomodulatory properties and capacity to differentiate into odontoblast-like cells. Interest has also increased in alternative approaches, such as the DPSC-derived secretome, which serves as a bioactive consulting of molecules like cytokines, growth factors and extracellular vesicles, to initiate regenerative processes through paracrine signalling without the limitations of cell-based treatments. This review highlights the relative therapeutic potential of DPSCs secretome when integrated with three-dimensional scaffolds for the regeneration of the pulp-dentin complex. We discuss the biological mechanisms by which DPSCs secretome helps in regeneration assess the compatibility of scaffolds, and review advantages and limitations regarding their use based on efficacy, immunogenicity, storage and clinical use. Although DPSC scaffolds provide direct tissue reconstruction, secretome-enhanced scaffolds are clinically applicable as a cell-free, scalable and potentially safer method. A better understanding of the advantages and disadvantages of DPSC secretome-modified scaffolds will assist in the development of future and emerging translational opportunities for personalized, minimally invasive regenerative endodontic therapies.
Clinical oral investigationsÖznur Eraslan, Öznur Küçük Keleş
OBJECTIVES: This study aimed to evaluate the effects of different root canal filling strategies and coronal restoration types on the biomechanical behavior of mandibular premolars with simulated apical external root resorption using three-dimensional finite element analysis (FEA) combined with a two-parameter Weibull-based fracture probability assessment. MATERIALS AND METHODS: MTA plug + gutta-percha + composite core and ceramic crown (MTA/GP/CC), MTA full-canal obturation + composite core and ceramic crown (MTA/CC), MTA plug + gutta-percha + hybrid-ceramic endocrown (MTA/GP/ECR), MTA full-canal obturation + hybrid-ceramic endocrown (MTA/ECR), Biodentine plug + gutta-percha + composite core and ceramic crown (B/GP/CC), Biodentine full-canal obturation + composite core and ceramic crown (B/CC), Biodentine plug + gutta-percha + hybrid-ceramic endocrown (B/GP/ECR), Biodentine full-canal obturation + hybrid-ceramic endocrown (B/ECR), and an intact tooth (IT). A 300 N oblique load was simulated for all models. RESULTS: FEA showed that the highest tensile stress in coronal restorations occurred in the MTA/GP/ECR model, whereas the lowest values were found in the MTA/ECR and B/ECR models. Within root dentin, maximum tensile stress was highest in the B/GP/CC model (0.683 MPa) and lowest in the MTA/ECR configuration (0.534 MPa). At 300 N, Weibull-based system fracture probabilities ranged from 0.0180% to 0.0192% for full-coverage crown (CC) designs and from 0.0157% to 0.0167% for ECR designs. For matched root-filling strategies, ECR configurations showed approximately 13-14% lower relative system fracture probabilities than the corresponding CC configurations. CONCLUSIONS: Complete bioceramic obturation combined with a hybrid-ceramic endocrown (ECR) showed a favorable biomechanical profile and the lowest relative Weibull-based system fracture probabilities among the evaluated configurations. CLINICAL RELEVANCE: Within this idealized FEA-Weibull framework, ECR restorations combined with full-canal bioceramic obturation showed modestly lower relative system fracture probabilities than matched full-coverage crown configurations. The probabilistic response was dominated by root dentin rather than by direct fracture contributions from the restorative materials.
Acta odontologica ScandinavicaYingrui Zhou, Hongwei Ma, Yan Zhang, Haoliang Guo, Ran Ma
Root resorption is a common but unpredictable complication after delayed replantation of avulsed permanent teeth. Evidence from real-world settings regarding its long-term incidence and associated clinical factors remains limited. This study aimed to determine the incidence of root resorption and identify clinical factors associated with its occurrence following delayed replantation of permanent teeth in a real-world tertiary care setting. This retrospective cohort study analyzed patients aged 7-30 years who underwent delayed replantation (> 60 min extra-alveolar time) between 2019 and 2022 at a tertiary dental trauma center, with ≥ 12 months of follow-up. Clinical and radiographic data were reviewed, and root resorption was classified according to predefined radiographic and clinical criteria. Multivariable logistic regression was used to identify factors associated with the occurrence of root resorption, while Kaplan-Meier survival analysis and Cox proportional hazards regression were performed to evaluate the time to first root resorption event. Competing-risk analysis was conducted, considering tooth extraction as a competing event. Among 120 eligible patients (mean age 14 ± 5 years), root resorption occurred in 72 teeth (60.0%), including inflammatory (41.7%) and replacement (58.3%) types based on radiographic and clinical classification. Among all delayed replanted teeth, the estimated tooth survival and functional retention rates at 24 months were 78.3% and 68.3%, respectively. Teeth with root resorption showed longer extra-alveolar times, more frequent dry storage, and delayed or absent root canal treatment (all P < 0.01). Multivariable logistic regression identified prolonged extra-alveolar time (> 2 h), dry storage, absence of root canal treatment, and delayed endodontic intervention (> 14 days) as factors associated with a higher occurrence of root resorption. Multivariable logistic regression identified prolonged extra-alveolar time (> 2 h), dry storage, absence of root canal treatment, and delayed endodontic intervention (> 14 days) as factors independently associated with a higher occurrence of root resorption. Root resorption occurred in 60% of delayed replanted teeth in this cohort. Prolonged extra-alveolar time, dry storage, and delayed or absent endodontic treatment were independently associated with a higher occurrence of root resorption. These findings highlight the importance of timely management and appropriate endodontic intervention after delayed replantation; however, the retrospective single-center design limits causal interpretation, and further prospective studies are needed to validate these associations.
Journal of the Indian Society of Pedodontics and Preventive DentistryMousumi Goswami, Aditya Saxena, Prachi Pathak, Aayushi Sangal
BACKGROUND: Regenerative endodontic procedures (REPs) have emerged as a biologically based treatment modality for immature nonvital permanent teeth, promoting continued root maturation and periapical healing. Platelet-rich fibrin (PRF), concentrated growth factor (CGF), and collagen hydroxyapatite-based scaffolds such as SynOss Putty have been used as scaffolds during regenerative therapy; however, comparative evidence regarding their effectiveness remains limited. AIM: To evaluate and compare the clinical and radiographic outcomes of PRF, CGF, and SynOss Putty as scaffolds in regenerative endodontic treatment of immature nonvital permanent teeth. MATERIALS AND METHODS: Fifteen immature nonvital permanent teeth in children aged 7-17 years were randomly allocated into three groups ( n = 5 each): PRF, CGF, and SynOss Putty. REPs were performed according to the American Association of Endodontists guidelines. Clinical and radiographic evaluations were carried out at 1, 3, 6, and 12 months. Outcome measures included pain, swelling, tenderness to percussion, mobility, periapical healing, root elongation, dentinal wall thickening, and root apex approximation. STATISTICAL ANALYSIS: Data were analyzed using IBM SPSS Statistics software. Descriptive statistics and Chi-square/Fisher's exact tests were applied, with P < 0.05 considered statistically significant. RESULTS: All groups demonstrated resolution of signs and symptoms during the follow-up period. At 12 months, the PRF group showed significantly greater reduction in periapical pathology and superior root elongation compared with CGF and SynOss Putty ( P = 0.048). PRF also demonstrated greater dentinal wall thickening and root apex approximation. CGF exhibited moderate regenerative potential, whereas SynOss Putty showed comparatively variable radiographic outcomes. CONCLUSION: All three scaffolds were clinically successful; however, PRF demonstrated superior radiographic healing and root development.
Journal of the Indian Society of Pedodontics and Preventive DentistryVishal Vishal, Gyanendra Kumar, Mridula Goswami, Farheen Sultan, Neha Chauhan
OBJECTIVES: The success of pulpotomy depends on the medicament or technique used to preserve the vitality of the remaining radicular pulp. With the advent of bioactive materials and laser technology, newer modalities have been introduced to improve treatment outcomes. This randomized controlled trial clinically and radiographically compared pulpotomy using mineral trioxide aggregate (MTA), diode and erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er, Cr: YSGG) laser-assisted MTA in primary molars. MATERIALS AND METHODS: Thirty-six children aged 5-8 years were randomly allocated into three groups ( n = 12 each): Group I- MTA pulpotomy, Group II- diode laser-assisted MTA pulpotomy, and Group III- Er, Cr: YSGG laser-assisted MTA pulpotomy. Clinical parameters (pain, swelling, mobility, sinus tract, and tenderness on percussion) and radiographic parameters (inter-radicular radiolucency, integrity of lamina dura, and pathological root resorption) were assessed at baseline and at 3-, 6-, and 9-month follow-ups. Statistical analysis included the Shapiro-Wilk test, one-way analysis of variance (ANOVA), repeated-measures ANOVA, Kruskal-Wallis test, and Friedman test, with significance set at P < 0.05. RESULTS: All three groups demonstrated high clinical and radiographic success throughout the 9-month follow-up period. No statistically significant intergroup differences were observed. At 9 months, clinical success was 75% for MTA, 100% for Er, Cr: YSGG laser, and 91.7% for diode laser, while radiographic success was 100%, 100%, and 91.7%, respectively. The numerical differences did not reach statistical significance. CONCLUSION: MTA, diode laser, and Er, Cr: YSGG laser pulpotomy produced comparable clinical and radiographic outcomes in primary molars. Laser-assisted pulpotomy represents an effective alternative to conventional medicament-based vital pulp therapy.
Journal of the Indian Society of Pedodontics and Preventive DentistryItika Jain, Shivani Mathur, Sakshi Joshi, Diksha Bhat, Shikha Choubey, Urvashi Verma
CONTEXT: Postoperative pain and persistent microbial contamination remain significant challenges in pediatric endodontics following pulpectomy. Intracanal cryotherapy has emerged as a promising adjunct because of its anti-inflammatory, analgesic, and antimicrobial properties. However, its effectiveness requires further clinical evaluation. AIM: The aim of the study was to compare the effect of intracanal cryotherapy using cold saline (2°C-4°C) with room temperature saline (25°C-30°C) on postoperative pain and antimicrobial efficacy during the pulpectomy procedure in primary teeth. SETTINGS AND DESIGN: A randomized clinical trial was conducted involving 30 children (3-7 years) requiring pulpectomy in primary teeth. MATERIALS AND METHODS: Participants were randomly allocated into two groups: Group I (room temperature saline) and Group II (cryotherapy with cold saline). Postoperative pain was assessed using the Wong-Baker Faces Pain Rating Scale at 6, 24, 48, and 72 h posttreatment. Antimicrobial efficacy was evaluated by comparing colony-forming units (CFUs) before and after irrigation via microbiological analysis. STATISTICAL ANALYSIS: Data were analyzed using SPSS v26.0. Paired t - tests/Wilcoxon for intragroup; independent t -test/Mann-Whitney for intergroup were applied. RESULTS: Both groups showed significant intragroup pain reduction over 6, 24, 48, and 72 h ( P < 0.05), with cryotherapy exhibiting lower mean scores but no intergroup differences ( P > 0.05). Microbial counts decreased significantly within groups ( P = 0.001: Group I: 4.23-2.21 and Group II: 3.69-0.68), with cryotherapy superior postintervention ( P < 0.001). No baseline differences were existed. CONCLUSIONS: Intracanal cryotherapy with cold saline is an effective, simple, and cost-efficient method for reducing postoperative pain and enhancing antimicrobial efficacy in primary teeth pulpectomy.
Journal of applied oral science : revista FOBStephanie Isabel Diaz Zamalloa, Caroline Carvalho Dos Santos, Leticia Martins Santos, Victor Elias Arana-Chavez, Fernando Neves Nogueira, Carla Renata Sipert, …
INTRODUCTION: The unpredictability of blood clots as natural scaffolds in regenerative endodontic procedures (REPs) has driven the search for synthetic alternatives with reproducible properties. This study aimed to develop and characterize a dual-scale micro/nanofibrous poly(lactic-co-glycolic acid) (PLGA) scaffold fabricated by co-electrospinning and evaluate its physicochemical and biological suitability for REPs under lipopolysaccharide (LPS)-induced inflammatory conditions. METHODOLOGY: A 7.5% (w/v) PLGA solution was co-electrospun using distinct parameters (flow rate and needle-to-collector distance) to generate a dual-scale fiber architecture. Physicochemical characterization included water uptake, in vitro degradation, and morphological analysis by scanning electron microscopy (SEM). Biological properties were evaluated using human apical papilla cells (APCs). Metabolic activity (Alamar Blue), mineralization (Alizarin Red S), and cell adhesion/morphology (SEM) were assessed in the presence or absence of LPS to simulate an inflammatory environment. RESULTS: The co-electrospun scaffold showed a hierarchical structure with interconnected micro and nanofibers. Water uptake reached 147.4% within 24 h and increased gradually thereafter. The scaffold showed a biphasic degradation profile-slow initial degradation (21.5% over 28 days) followed by accelerated loss (63.1% at day 45). Hydration induced fiber swelling and pore remodeling. The scaffold supported APC adhesion, spreading, and metabolic activity over 72 h. Under LPS stimulation, APCs maintained metabolic activity and showed robust mineralization potential after 21 days, comparable to the positive control. CONCLUSION: The co-electrospun PLGA scaffold showed physicochemical properties compatible with tissue ingrowth and supported APCs function under inflammatory conditions. By providing a controlled microenvironment, it represents a potential scaffold design for future REPs.
AIM: This study investigated the effects of various radicular dentin conditioning agents, maleic acid, citric acid, phosphoric acid, and EDTA, on dentin-derived biomarker release and radicular dentin microhardness for regenerative endodontic applications. MATERIALS AND METHODS: Sixty single-rooted teeth were processed into dentin cylinders and discs and randomly assigned to five groups (n = 12): 7% maleic acid, 10% citric acid, 37% phosphoric acid, 17% EDTA, and phosphate-buffered saline (PBS) as a negative control. Growth factor release (TGF-β, VEGF, BMP-2) was quantified using ELISA after 24 h incubation. Microhardness changes were evaluated in corresponding dentin cylinders sectioned longitudinally. RESULTS: Maleic acid produced the highest release of TGF-β, VEGF, and BMP-2 (p < 0.001), followed by EDTA, citric acid, and phosphoric acid in a biomarker-dependent hierarchy. Microhardness was significantly affected by the conditioning agent (p = 0.004), with EDTA and maleic acid reducing dentin hardness compared with the control, while citric acid and phosphoric acid showed no significant effect. No significant differences were observed among root thirds (p = 0.169). CONCLUSION: Dentin conditioning in regenerative endodontics involves a trade-off between biological activation and preservation of structural integrity. Stronger conditioning agents enhance growth factor release but may compromise dentin hardness. Among the tested agents, citric acid demonstrated the most balanced performance, combining effective biomarker release with minimal effects on dentin microhardness. In contrast, phosphoric acid preserved dentin structure but showed limited biological activity, making it less suitable when regenerative signaling is the primary objective. CLINICAL RELEVANCE: The selection of dentin conditioning agents should not be based solely on their biological signaling potential, as it directly influences the mechanical properties of radicular dentin and may impact regenerative outcomes.
BMC oral healthRehab Ali Farag, Abd El Rahman O El Mekkawi, Khaled Beshr, Mohamed Sayed, Mohammad Rayyan
BACKGROUND: Persistent intraradicular infection remains a major cause of endodontic treatment failure because conventional syringe irrigation may not adequately reach the apical third, dentinal tubules, and canal irregularities. The aim of this in vitro study was to compare the antimicrobial efficacy and smear layer/debris removal ability of sonic activation, passive ultrasonic irrigation, and Er: YAG laser-activated irrigation using photon-induced photoacoustic streaming (PIPS), relative to conventional syringe irrigation, in prepared root canals infected with a mono-species Enterococcus faecalis biofilm. METHODS: Sixty extracted single-rooted mandibular second premolars were prepared, sterilized, inoculated with E. faecalis, and randomly allocated to conventional syringe irrigation, sonic activation, passive ultrasonic irrigation, or Er: YAG/PIPS activation (n = 15). All groups received 2.5% sodium hypochlorite. Post-irrigation bacterial load was quantified as log10 CFU/mL, and smear layer/debris removal in the apical, middle, and coronal thirds was assessed by scanning electron microscopy using a five-point score. CFU values were analysed by one-way ANOVA with Tukey's post hoc test, and SEM scores by the Kruskal-Wallis test with Dunn's multiple-comparison test. Inter-examiner agreement was assessed using Cohen's kappa. Statistical significance was set at p < 0.05. RESULTS: Bacterial load differed significantly among groups (F(3, 56) = 85.11, p < 0.001). Mean log10 CFU/mL values were 6.41 ± 0.30 for conventional irrigation, 5.37 ± 0.26 for sonic activation, 4.12 ± 0.24 for passive ultrasonic irrigation, and 4.28 ± 0.27 for Er: YAG/PIPS activation. Passive ultrasonic and Er: YAG/PIPS activation produced significantly lower bacterial loads than sonic activation and conventional irrigation, with no significant difference between the ultrasonic and laser groups (p = 0.452). SEM scores also differed significantly (H = 38.9, p < 0.001). Overall median scores were 4.5 (IQR 4-5), 3 (IQR 3-4), and 2 (IQR 2-3) for conventional, sonic, and both ultrasonic and laser activation, respectively. CONCLUSIONS: All tested activation methods improved root canal disinfection and smear layer/debris removal compared with conventional syringe irrigation. Passive ultrasonic irrigation and Er: YAG/PIPS activation were more effective than sonic activation and showed comparable performance. These methods may be useful adjuncts to sodium hypochlorite irrigation, although clinical studies are needed to confirm their clinical effectiveness.
BACKGROUND: Endodontic prognosis is based on clinical and radiographic factors that estimate the likelihood of treatment success. Because periapical healing reflects complex interactions among microbial, host, anatomical, and treatment-related factors, individual outcomes may occasionally differ from conventional prognostic expectations. This paper aimed to describe and critically analyze favorable outcomes in teeth presenting conditions traditionally associated with reduced probabilities of treatment success. CASE PRESENTATION: Three clinical cases were described in accordance with the Preferred Reporting Items for Case Reports in Endodontics (PRICE) 2020 guidelines. The cases presented adverse prognostic conditions, including substantial root resorption, inability to achieve apical patency or complete canal instrumentation, overextension of root filling material, absence of a definitive coronal restoration, and lack of recommended periodontal treatment. Despite these conditions, the teeth remained functional and asymptomatic and demonstrated favorable radiographic outcomes during longitudinal follow-up. CONCLUSIONS: These cases illustrate that unfavorable prognostic conditions do not invariably result in treatment failure. The reported outcomes neither diminish the importance of established prognostic factors nor validate the treatment limitations encountered. Rather, they emphasize that prognosis is probabilistic and that unusual favorable outcomes should be interpreted cautiously as individual observations.
Lasers in medical scienceSelen Ince Yusufoglu, Utku Can Kemeç, Neslihan Büşra Keskin, Silvana Jukic Krmek, Taha Özyürek, Mert Ocak, Mustafa Gundogar
PURPOSE: This study sought to evaluate the effectiveness of Shock Wave Enhanced Emission Photoacoustic Streaming (SWEEPS), XP-endo Finisher (XPF), Passive Ultrasonic Irrigation (PUI), and Conventional Syringe Irrigation (CSI) in the removal of calcium hydroxide (CH) from the mesial root canals of mandibular molars, utilizing micro-computed tomography (micro-CT). METHODS: Forty mesial roots of mandibular molars were pair-matched according to canal morphology based on pre-operative micro-CT analysis and randomly assigned to four groups (n = 10). Following standardized canal preparation, CH was placed and stored for two weeks before removal using the assigned irrigation protocols. Micro-CT scans were obtained before and after CH removal, and the remaining CH volumes in the apical, middle, coronal, and total canal regions were quantitatively analyzed. RESULTS: All methods significantly reduced CH volume compared with baseline at all root levels (p < 0.05). CSI demonstrated significantly lower CH removal in the coronal and middle thirds compared with the other groups and was less effective than XPF and SWEEPS in the apical region (p < 0.05). SWEEPS and XPF demonstrated markedly superior CH elimination compared to PUI in the apical third (p < 0.05). CONCLUSION: Although complete CH removal was not achieved with any technique, SWEEPS and XPF demonstrated relatively higher removal effectiveness. This in vitro study demonstrated that sophisticated irrigation activation strategies, including SWEEPS and XP-endo Finisher, improved the elimination of calcium hydroxide from intricate root canal systems.
BACKGROUND: This study evaluated the effects of obturation technique and sealer type on the fracture resistance of endodontically treated maxillary central incisors with simulated traumatic crown fractures under clinically relevant loading conditions. METHODS: Forty extracted human maxillary central incisors were randomly assigned to either the single-cone technique or warm vertical compaction technique. Each group was further divided according to the sealer used: AH Plus or TotalFill BC. After obturation, the crowns were restored with a short fiber-reinforced composite and a nanohybrid composite resin. The specimens were stored at 100% humidity for two weeks and embedded in acrylic resin. Fracture resistance was assessed using a universal testing machine with oblique loading at 45°. The data were analyzed using two-way analysis of variance (ANOVA) at a significance level of 0.05. RESULTS: Both obturation technique and sealer type significantly affected fracture resistance. TotalFill BC produced higher fracture-load values than AH Plus, while the single-cone technique (SCT)/TotalFill BC group had the highest numerical mean. However, no significant interaction was found between obturation technique and sealer type. CONCLUSIONS: Within the limitations of this in vitro study, sealer selection emerged as the primary factor influencing fracture resistance. TotalFill BC provided greater fracture resistance than AH Plus across both obturation techniques, while the absence of a significant interaction indicated that neither technique conferred a sealer-specific advantage.
BMC oral healthHalime Çetiner, Hacer Balkaya, Sezer Demirbuga, Hatice Bekci
BACKGROUND: This study aimed to characterize an experimental pulp-capping material prepared by incorporating a hydroxyapatite-binding antimicrobial peptide (HBAMP) into a resin-modified calcium silicate-based material (RMCS), and to evaluate its antibacterial, mineral deposition potential, and cytotoxicity properties. METHODS: The experimental groups were defined as Control, 1% HBAMP-RMCS, and 3% HBAMP-RMCS. Standard polymerized RMCS discs were fabricated for XRD, degree of conversion, microhardness, antibacterial, and cytotoxicity assays. For dentin surface analyses, human mandibular third molars were used. Half of the dentin surfaces were treated with the pulp-capping material, followed by application of a universal adhesive and a nanohybrid composite resin. After 72 h of storage in distilled water, and microhardness and SEM-EDX analyses were performed. Data were statistically analyzed. RESULTS: The incorporation of HBAMP at 1 wt% and 3 wt% into RMCS caused no significant changes in the degree of conversion or microhardness values (p > 0.05). Regarding mineral deposition potential, HBAMP incorporation resulted in numerical increases in dentin microhardness and Ca/P ratio, although these changes were not statistically significant among the groups (p > 0.05). While HBAMP exhibited potent antibacterial activity against S. mutans and L. casei strains, no inhibition zones were formed when it was incorporated into the RMCS. Furthermore, no statistically significant differences were detected between the mean cell viability of the experimental groups in the MTT assay at the 24-h and 48-h evaluations(p > 0.05). CONCLUSIONS: The incorporation of HBAMP enhanced the early mineral deposition on dentin surfaces of RMCS without adversely affecting its physical properties. The 1% HBAMP-RMCS group demonstrated more consistent outcomes with respect to mineral deposition and cytotoxicity. The antibacterial effect of HBAMP was attenuated when incorporated into RMCS.
Medical science monitor : international medical journal of experimental and clinical researchHazal Faiz Arslanparcasi, Mehmet Ali Arslanparcasi
BACKGROUND The aim of this study was to bibliometrically map the Web of Science Core Collection-indexed literature related to plant-derived irrigants, intracanal medicaments, and natural compounds investigated against Enterococcus faecalis in endodontics. MATERIAL AND METHODS The literature search was conducted in the Web of Science Core Collection database on March 31, 2026; it included English-language articles and reviews indexed from 2010 through March 31, 2026. Descriptive bibliometric analyses were performed using Web of Science tools. Author keyword co-occurrence and author co-citation analyses were conducted using VOSviewer. RESULTS In total, 144 publications were evaluated. Scientific output greatly increased after 2020, and the highest number of publications was recorded in 2024; data for 2026 represented partial-year coverage through the search date. The total number of citations was 1311, whereas citations excluding self-citations totaled 1179. The average number of citations per publication was 9.1, and the H-index was 22. The leading journal was Cureus Journal of Medical Science. The most prolific authors were Bottino MC and Carvalho CAT. Based on full counting, India, Brazil, and Egypt were the leading countries. The most productive institutions were Egyptian Knowledge Bank, Egypt; The Institute for Medicinal Plant Research "Dr. Josif Pančić," Serbia; and King Khalid University, Saudi Arabia. Keyword co-occurrence analysis showed thematic clustering around antibacterial efficacy, biofilm control, and comparisons with conventional endodontic agents. CONCLUSIONS This bibliometric map characterizes publication output, citation structure, leading contributors, and thematic clustering within the defined indexed literature subset.
JMIR human factorsSarang Suresh, Priya Rani, Feroze Kalhoro
SSEndoSim, a free, open access, mobile, web-based endodontic diagnostic simulation application for undergraduate dental education, demonstrated favorable usability rated on a System Usability Scale (SUS) witht a composite 100-point score (mean 75.30, SD 14.72) and high perceived educational value (PEV) on a 5-point scale (mean 4.62, SD 0.40) in a cross-sectional usability evaluation of final-year bachelor of dental surgery (BDS) students at Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Pakistan, in April 2026, establishing usability and learner acceptability.
Background and Objectives: The aim of this study was to evaluate the penetration of laser-activated irrigation solutions into dentinal tubules in root canals with different degrees of curvature and different coronal flaring. Materials and Methods: Seventy-six maxillary first molar teeth previously extracted for various reasons were included in the present study. The specimens were divided into two main groups according to distal root canal curvature, determined using the Schneider method: straight (<10°) and curved (20-40°). These groups were further classified into two subgroups according to whether a coronal flaring procedure was performed (n = 19). Following root canal preparation of all specimens, final irrigation was performed using a laser activation method and an irrigation solution prepared with the fluorescent dye Rhodamine B. Horizontal apical, middle, and coronal sections of 1 ± 0.1 mm thickness were obtained from the specimens at 2 mm, 5 mm, and 8 mm from the apical foramen, respectively. The effect of the irrigation solution on dentinal tubule penetration in the root canals was evaluated in the obtained sections using confocal laser scanning microscopy. Following evaluation, the mean and maximum penetration distances into the dentinal tubules were measured. The obtained data were statistically analyzed using Generalized Estimating Equations and Bonferroni correction for multiple comparisons, with the significance level set at p < 0.05. Results: The analysis revealed that only the region factor had a statistically significant effect on mean penetration values (p < 0.001), whereas canal curvature (p = 0.010), coronal flaring (p = 0.002), and region (p < 0.001) had statistically significant effects on maximum penetration values. However, none of the two-way or three-way interactions were significant (p > 0.05). Conclusions: Coronal flaring did not affect mean dentinal tubule penetration but increased maximum penetration depth. Maximum penetration was higher in straight canals than in curved canals, while both mean and maximum penetration were significantly affected by the root canal region.
International dental journalXiaoxing Li, Lishan Huang, Yufei Li, Siyu Li, Xin Li, Xuechao Yang
BACKGROUND: Dynamic navigation (DN) and static navigation (SN) in endodontic microsurgery (EMS) have been shown to improve the precision of osteotomy and root-end resection (RER). However, the impact of minimal incisions on DN- and SN-guided EMS remains unclear. This study assessed the accuracy of DN and SN in EMS performed via a single vertical incision at the apex (SVIA), and identified technique-specific accuracy predictors. METHODS: A retrospective analysis included 60 teeth treated with SVIA EMS, comprising 30 osteotomies and RERs each in the SN and DN groups. Preoperative variables - sex, age, tooth position, arch type, drilling depth, lesion size, and buccal bone integrity - were recorded. Postoperative cone-beam computed tomography (CBCT) scans were superimposed with preoperative plans to evaluate accuracy. Group comparisons used independent t-tests or Mann-Whitney U tests (α = 0.01); general linear model examined the interaction effects between the technique and preoperative variables on accuracy; multivariate regression (α = 0.017) identified independent predictors within each group. RESULTS: No significant differences in accuracy parameters were observed between DN and SN (P > .01). Interaction effects were nonsignificant (P > .05). Intragroup analysis indicated that for DN, a lesion diameter > 9 mm predicted increased resection angle deviation (RAD) (B = 3.13, P < .017), while for SN, posterior tooth location predicted reduced RAD (B = -5.80, P < .017). CONCLUSIONS: DN and SN exhibited comparable overall accuracy in SVIA EMS. However, DN was less accurate in cases with large lesions, whereas SN achieved higher accuracy in posterior regions. These preliminary findings support the evidence-based selection of guidance techniques according to anatomic specifics in SVIA EMS.
Medical science monitor : international medical journal of experimental and clinical researchMehmet Adıgüzel
BACKGROUND This study aimed to evaluate the accuracy, confidence, and overconfidence behavior of large language models (LLMs) in endodontics using questions derived from a national specialty entrance examination. MATERIAL AND METHODS A total of 123 text-based endodontic questions from the Turkish Dental Specialty Examination (2017-2026) were included after excluding annulled and image-based questions. Three LLMs (ChatGPT, Claude, and Gemini) were assessed. Each model answered all questions using a standardized prompt and provided a confidence score (0%-100%). Accuracy was recorded as correct/incorrect. Overconfidence was defined as incorrect responses with ≥90% confidence. Statistical analyses were performed using Cochran's Q test, Friedman test, and post hoc pairwise comparisons with Bonferroni correction. RESULTS Accuracy rates were 89.4% for ChatGPT, 76.4% for Claude, and 90.2% for Gemini, with significant differences among models (χ²(2)=21.00, P<0.001). Confidence scores differed significantly (c2(2)=213.40, P<0.001), with Gemini demonstrating highest confidence (99.51±1.49), followed by ChatGPT (90.88±9.19) and Claude (80.22±11.10). Overconfidence rates were 9.8% for Gemini and 5.7% for ChatGPT, while no overconfident responses were observed for Claude (χ²(2)=14.53, P=0.001). Despite similar accuracy between ChatGPT and Gemini, confidence patterns differed markedly, demonstrating that comparable accuracy does not necessarily reflect comparable reliability. CONCLUSIONS LLMs demonstrated high accuracy in answering text-based endodontic examination questions; however, significant differences were observed in confidence behavior and overconfidence patterns. The presence of high-confidence incorrect responses suggests that accuracy alone may be insufficient to fully evaluate model reliability. These findings highlight the importance of considering confidence-related behavior alongside accuracy when assessing LLM performance in examination-style endodontic tasks.
OBJECTIVE: The physiological occlusal force generated by mastication plays a critical role in tooth replantation after complete avulsion by promoting periodontal ligament healing. Heme oxygenase-1 (HO-1), a classical cytoprotective factor, exhibits mechanoresponsive expression in periodontal ligament cells (PDLCs). This study aims to investigate whether occlusal force can reduce replacement root resorption during the healing of periodontal ligament in replanted teeth and its potential mechanisms. METHODS: A tooth avulsion model was established in occlusal group rats and occlusal deprivation group rats. The healing of periodontal ligament was evaluated at 7 and 28 days post-replantation using micro-computed tomography, histological analysis, and immunohistochemistry. PDLCs were isolated to construct the injured periodontal ligament cells (iPDLCs) model. Following the application of cyclic tensile force, collagen synthesis level and the expression changes of HO-1 and transforming growth factor-beta 1 (TGF-β1) were assessed. RESULTS: The physiological occlusal force reduced replacement root resorption, promoted periodontal healing and the conversion of type III collagen (COL Ⅲ) to type I collagen (COL Ⅰ), and increased HO-1 expression in the periodontal ligament of replanted rat teeth. The cyclic tensile force (4% strain, 0.5 Hz) applied for 4 hours upregulated the expression of HO-1, COL Ⅰ, and COL III in iPDLCs. Enhanced HO-1 expression increased the levels of TGF-β1, COL I, and COL III, whereas inhibition of HO-1 or blockade of TGF-β1 reduced COL I and COL III expression. Simultaneous upregulation of HO-1 and inhibition of TGF-β1 resulted in decreased COL I and COL III expression. CONCLUSION: Physiological occlusal force may be associated with reduced replacement root resorption and elevated HO-1 expression, while also promoting collagen synthesis in the injured periodontal ligament. Low deformation with short-term cyclic tensile force induces HO-1 expression, thereby promoting COL I and COL III synthesis in iPDLCs. This process is closely associated with the TGF-β1 signaling pathway.
The American journal of case reportsYifan Wang, Hong Jiang, Yanhong Hao, Zhen Fang, Shige Liu, Jie Pan, Huan Jing
BACKGROUND Endo-periodontal lesions (EPL), particularly those manifesting as primary periodontal lesions with secondary endodontic involvement, pose unique clinical challenges when accompanied by odontogenic maxillary sinusitis (OMS). Furthermore, limited case reports document the nonsurgical management of such complex conditions in maxillary molars exhibiting rare multi-rooted and multi-canal variations (prevalence <0.103%). CASE REPORT A 31-year-old woman presented with pain and grade III mobility in the right maxillary first molar, with an intact crown, a deep palatal periodontal pocket, and a negative cold testing response on clinical examination. Periapical radiography indicated multi-rooted anatomy and extensive bone loss, and cone beam computed tomography (CBCT) confirmed 4 separate roots (mesiobuccal, distobuccal, mesiopalatal, distopalatal), a fifth centrally located pulp chamber canal orifice, a periapical lesion communicating with a periodontal defect, and ipsilateral maxillary sinus mucosal thickening. Nonsurgical root canal treatment for all 5 canals was performed under a dental operating microscope with ultrasonic activation (3% NaOCl) and bioceramic sealer, combined with concurrent supportive periodontal therapy. At the 8-month follow-up, the tooth was asymptomatic with reduced mobility and probing depths; CBCT revealed marked reduction in periapical lesions and significant improvement in maxillary sinus mucosal thickening (ENT consultation advised). CONCLUSIONS This case unequivocally demonstrates that meticulous nonsurgical endodontic treatment with ultrasonic activation and bioceramic sealer, in conjunction with targeted periodontal therapy and occlusal management, is a highly effective tooth-preserving strategy for maxillary molars with complex anatomic variations complicated by primary periodontal lesions with secondary endodontic involvement and secondary OMS, achieving excellent clinical and radiological outcomes.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in CancerÁlvaro Souza Wanderley, Wesley Viana de Sousa, Maria Olívia da Costa, Alícia Marcelly Souza de Mendonça Silva, Raylane Farias de Albuquerque, Igor Henrique Mor…
PURPOSE: To map and synthesize the available scientific evidence supporting the effectiveness and safety of endodontic therapy in patients who underwent head and neck radiotherapy, considering clinical and radiographic outcomes and treatment-related complications, particularly osteoradionecrosis (ORN). METHODS: This scoping review followed the Arksey and O'Malley framework, informed by the Joanna Briggs Institute Manual for Evidence Synthesis, and was reported according to PRISMA-ScR guidelines. Comprehensive searches were conducted in PubMed, Embase, Scopus, Web of Science, MEDLINE, LILACS, and gray literature sources, with no date restrictions. Clinical studies evaluating endodontic therapy in irradiated patients were included. Data were charted and narratively synthesized using a Population-Concept-Context framework. Consistent with scoping review methodology, no critical appraisal was performed. RESULTS: Of 174 identified records, five studies met the inclusion criteria. Reported success rates ranged from 18 to 100%, with lower rates observed in earlier studies employing outdated techniques. More recent investigations demonstrated high clinical success, improved radiographic stability, and no reported cases of ORN. Across all studies, endodontic therapy was not associated with ORN. However, methodological heterogeneity was noted, particularly regarding outcome definitions and follow-up duration. CONCLUSION: Endodontic therapy appears to be a safe and conservative treatment option for patients with head and neck cancer who underwent radiotherapy and may reduce the need for invasive procedures associated with ORN risk. However, the limited and heterogeneous evidence highlights the need for well-designed prospective studies to support standardized clinical decision-making within supportive oncology care.
The journal of adhesive dentistryGamze Nalci Calik, Burcu Oglakci Ozkoc, Ceren Deger, Humeyra Capkin, Kerime Akdur, Alpaslan Mayadagli
PURPOSE: The purpose of this study was to evaluate the influence of radiotherapy timing on the dentinal tubule penetration and push-out bond strength of an epoxy resin-based sealer (AH Plus) and a bioceramic sealer (BioRoot RCS). METHODS AND MATERIALS: In total, 180 single-rooted sound human mandibular premolars were used and allocated to three main groups with different radiotherapy timings: Control (no irradiation), Before RT (irradiation prior to root canal obturation), and After RT (irradiation after root canal obturation). Subsequently, each group was subdivided into different sealer types: AH Plus and BioRoot RCS. For the Before RT and After RT groups, a cumulative dose of 60 Gy (6 weeks, 2 Gy per day, 5 days per week) was delivered. The dentinal tubule penetration depth was assessed using confocal laser scanning microscopy (n = 15), and the push-out bond strength was measured using a universal testing machine (n = 15). The data were analyzed using three-way ANOVA and Bonferroni tests (p 0.05). RESULTS: In the coronal thirds, the After RT group showed significantly lower tubule penetration and bond strength compared with the Control group for both sealers. In the apical thirds, BioRoot RCS was predominantly affected. The After RT group also showed significantly lower bond strength and tubule penetration than the Before RT group. These results were confirmed by the higher frequency of adhesive failures in the After RT group compared to the others. Finally, in the coronal thirds, AH Plus exhibited significantly higher bond strength than BioRoot RCS despite having lower dentinal tubule penetration. CONCLUSION: Radiotherapy timing significantly influenced sealer-dentin adhesion, varying by root canal levels and material types. Radiotherapy applied after obturation adversely affected the sealer-dentin interaction, resulting in reduced tubule penetration and bond strength, especially for BioRoot RCS.
Scientific reportsSamah Ahmed Abdelaziz, Latifa Mohamed Abdelgawad, Iman A Fathy, Sayed Eltayab, Ali Mohamed Saafan
This study evaluated pulpal healing following direct pulp capping with polytetrafluoroethylene (PTFE) or melatonin (MEL), with or without adjunctive low-level laser therapy (LLLT), in Wistar rat molars. Fifty-two maxillary first molars from 26 male Wistar rats were included. Forty-eight molars with standardized pulp exposures were randomly allocated to four groups (n = 12): Group I, PTFE; Group II, MEL; Group III, PTFE + LLLT; and Group IV, MEL + LLLT; four unexposed molars served as negative controls. LLLT (650 nm, 100 mW; fluence 11.9 J/cm2) was applied after placement of the capping material. Irradiation was performed on alternate days, with animals receiving either three sessions (1-week group) or six sessions (2- and 4-week groups). Histological evaluation was performed after 1, 2, and 4 weeks, assessing inflammation, necrosis, vascularity, fibrosis, odontoblast-like layer organization, dentin bridge formation, and dentin bridge thickness. LLLT-treated groups showed reduced inflammation, improved odontoblast-like layer organization, enhanced vascularity, and greater dentin bridge thickness compared with non-irradiated groups. The MEL + LLLT group demonstrated the most favorable overall histological profile. Adjunctive LLLT was associated with improved pulpal healing outcomes, while melatonin showed supportive effects on the pulpal microenvironment. Their combined application produced the most favorable histological outcomes and warrants further investigation in vital pulp therapy.
Medical science monitor : international medical journal of experimental and clinical researchMehmet Adıgüzel, Alparslan Mustafa Çeler
BACKGROUND Large language models (LLMs) are increasingly used in healthcare; concerns persist regarding the accuracy of generated bibliographic references. The effect of prompt design on reference reliability has not been clearly established. This comparative experimental study evaluated the impact of prompt specificity on LLM-generated reference accuracy in endodontics and compared model performance. MATERIAL AND METHODS We used ChatGPT 5 and Claude Sonnet 4.6. Ten predefined endodontic queries were combined with 3 prompt types of increasing specificity. Each model generated 5 references per query-prompt combination (total: 300 references). References were verified using PubMed, Google Scholar, and CrossRef. Accuracy was classified as fabricated (0), partially accurate (1; existing references containing ≥1 bibliographic inaccuracy), or fully accurate (2). Digital object identifier (DOI) accuracy was assessed separately. Statistical analyses were performed using mixed-effects models and Pearson's chi-square test or Fisher's exact test. RESULTS Accuracy scores tended to increase with greater prompt specificity (P=0.249). Claude demonstrated significantly higher accuracy than ChatGPT (mean score: 1.79 vs 1.25; P<0.001). DOI accuracy did not differ among prompt groups (P=0.338); it was significantly higher for Claude than for ChatGPT (90.0% vs 35.3%; P<0.001). ChatGPT produced significantly more title, journal, and DOI errors (P<0.001); author and year errors were similar between models. CONCLUSIONS Prompt specificity had limited effects on reference accuracy; model selection played a greater role. DOI accuracy was strongly model-dependent and largely unaffected by prompt design under the test conditions, highlighting the need for external verification of LLM-generated references.
BACKGROUND: Calcium hydroxide (Ca(OH)₂), confirmed effective in studies, is frequently used as an interappointment medicament in root canal treatment. The challenges related to removing this medication from the root canals before the filling negatively influence post-treatment success. This study aimed to evaluate and compare the efficacy of different irrigant activation devices-sonic activation (EDDY), passive ultrasonic irrigation (PUI), photon-induced photoacoustic streaming (PIPS), and shockwave-enhanced emission photoacoustic streaming (SWEEPS)-in removing Ca(OH)₂ from artificial isthmuses connecting curved root canals in 3D-printed resin molar models. METHODS: Seventy resin-based upper molar models with two curved canals connected by three standardized isthmuses were 3D-printed (Hex 600, Edudent, Türkiye). After canal preparation and Ca(OH)₂ (Well-Paste, Korea) placement, samples were randomly assigned to five groups (control group n = 10, experimental group n = 15) for Ca(OH)₂ removal: conventional needle irrigation (control) (NaviTip, Ultradent, USA), EDDY sonic irrigation (VDW, Germany), PUI (Guilin Woodpecker Medical Instrument Co., LTD, China), PIPS, and SWEEPS (Fotona, Slovenia) laser-assisted irrigation. Irrigation protocols were standardized for volume and duration. The percentage of cleaned isthmus areas was quantified using pre- and post-irrigation imaging under microscopy and analyzed with ImageJ software (NIH, USA). Statistical comparisons were performed using robust ANOVA. RESULTS: Significant differences in Ca(OH)₂ removal efficacy were found between groups (p < 0.001). The SWEEPS group showed the highest median cleaning percentage (47.71%), followed by PIPS (37.96%), EDDY (29.30%), PUI (28.22%), and control (11.26%). SWEEPS showed the highest median cleaned isthmus percentage, followed by PIPS, while PUI and EDDY demonstrated comparable values. Conventional needle irrigation showed the lowest cleaning performance. Cleaning efficacy varied significantly among isthmus locations (coronal > middle > apical, p = 0.007). SWEEPS, PIPS, and EDDY showed similarly high cleaning efficacy, with PUI demonstrating comparable performance, while conventional needle irrigation showed significantly lower values. No significant differences were observed between groups in the apical isthmus. CONCLUSION: None of the irrigation activation techniques achieved complete removal of calcium hydroxide. Cleaning efficacy was significantly influenced by both irrigation method and isthmus location. Laser-activated irrigation systems showed higher efficacy in specific regions, while conventional needle irrigation consistently demonstrated the lowest performance. Overall, irrigation effectiveness in isthmus-containing root canals exhibited a clear anatomy-dependent pattern.
BMC medical educationÖzlem Sivas Yılmaz, Ayşegül Güven Kömürcü, Esma Dinger, Melis Oya Ateş
BACKGROUND: Undergraduate dental education should prepare students to understand and apply contemporary vital pulp therapy (VPT) procedures in permanent teeth. However, students' self-perceived knowledge, stated treatment preferences, and self-reported clinical approaches regarding VPT may vary according to their theoretical and clinical training. This study aimed to describe final-year dental students' self-perceived knowledge, recognition of VPT procedures, stated treatment preferences, and self-reported clinical approaches regarding VPT. METHODS: This single-institution cross-sectional survey was conducted among final-year dental students at a dental faculty in Türkiye in June 2025. Of 100 eligible students, 88 completed a 17-item questionnaire (response rate, 88.0%) addressing self-perceived knowledge, sources of information, treatment preferences, reported clinical approaches, rubber dam isolation, hemostatic agents, and material selection in VPT. Data were summarized descriptively using frequencies and percentages. RESULTS: Most students rated their self-perceived knowledge of VPT as moderate (60.2%), while theoretical courses (42.0%) and clinical practice (36.4%) were the main reported sources of VPT information. Direct pulp capping (94.3%), partial pulpotomy (Cvek; 89.8%), and indirect pulp capping (86.4%) were most frequently identified as vital pulp therapy procedures, whereas total pulpotomy was identified as a vital pulp therapy procedure by 53.4% of students. In mature teeth, direct pulp capping was reported more frequently than partial or total pulpotomy. Treatment preferences varied according to pulp exposure size, with a shift from direct pulp capping for 0-1 mm exposures to partial pulpotomy for 1-2 mm exposures and total pulpotomy or root canal treatment for exposures larger than 2 mm. Only 15.9% of students reported applying rubber dam isolation at the beginning of the treatment, and the combined response option "ferric sulfate or aluminum chloride" was selected most frequently for hemostasis (46.6%). CONCLUSIONS: Final-year dental students reported moderate self-perceived knowledge of VPT and recognized several commonly used VPT procedures, but their self-reported approaches varied, particularly regarding pulpotomy procedures, rubber dam timing, hemostatic-agent selection, and simplified pulp-exposure scenarios. These findings should be interpreted as self-reported educational indicators rather than objective evidence of clinical competence or broad curricular inadequacy. Multicenter studies using case-based and performance-based assessments are needed to guide undergraduate VPT teaching.
This retrospective study investigated the key clinical factors influencing the success of vital pulp therapy (VPT) by analyzing failed cases and evaluated the adjunctive role of a semiconductor laser in cases with different pulp exposure sizes. We included 103 VPT cases on mature permanent teeth with caries-induced pulp exposure, dividing them into four groups based on laser use and exposure size (< 0.5 mm or ≥ 0.5 mm). We graded factors including preoperative pulp vitality, intraoperative hemostasis time, and restoration quality. Treatment outcomes were assessed clinically and radiographically at 1, 3, 6, and 12 months postoperatively. The overall failure rate was 5.83% (6/103). Univariable analysis identified several factors significantly associated with failure (P < 0.05): hemostasis time ≥ 5 min (failure rate 41.67%), poor preoperative pulp vitality (failure rate 37.50%), and pulp exposure size ≥ 0.5 mm (failure rate 10.64%). Semiconductor laser use did not significantly affect the overall failure rate (P > 0.05). In the subgroup with pulp exposure ≥ 0.5 mm, however, the success rate was numerically higher in the laser group than in the control group (91.7% vs. 82.6%). The limited number of failure events in this subgroup (1 case in the laser group vs. 4 in the control group) resulted in insufficient statistical power for between-group comparison (post-hoc power ≈ 35%), so the difference was not statistically significant. This numerical trend suggests a potential advantage for laser in managing larger exposures, which requires validation in larger studies. In conclusion, our findings support a conceptualization of VPT success based on a 'three-circle intersection' model that integrates three established pillars: durable coronal sealing, accurate assessment of pulp status, and effective infection control during the procedure. Adjunctive technologies, such as lasers, may provide additional benefits but should not substitute for these fundamental principles. Clinicians should prioritize precise pulp diagnosis, high-quality coronal sealing, and strict asepsis over dependence on auxiliary tools.
BMC oral healthAmira Shafie Ibrahim Mohamed, Dalia Mohamed Mukhtar Fayyad, Dalia Abd-Allah Mohamed
BACKGROUND: This study aimed to compare the calcium hydroxide [Ca(OH)₂] removal efficiency of six irrigation‑activation techniques and conventional syringe irrigation (control) from simulated internal root‑resorptive cavities in vitro. MATERIALS AND METHODS: Seventy single-rooted human teeth were standardized to a length of 18 mm, prepared, and split longitudinally. A standardized hemispherical resorptive cavity was created in each root half; the halves were then reassembled and filled with premixed Ca(OH)₂. Specimens were incubated for 7 days and randomly allocated (n = 10) to seven groups: (1) conventional syringe irrigation (control), (2) manual dynamic agitation (MDA), (3) XP‑Endo Finisher, (4) sonic EDDY, (5) sonic EQ‑S, (6) ultrasonic Irrisafe, or (7) ultrasonic Ultra X. In each irrigation protocol, two 30 s activations with 10 mL 2.5% NaOCl were used followed by one 30 s activation with 5 mL 17% EDTA. Residual Ca(OH)₂ percentages (%) within the simulated resorptive cavity (primary outcome) and the entire root canal system, including the coronal, middle, and apical thirds (secondary outcomes) was quantified stereo-microscopically using ImageJ software. Data were analyzed using Kruskal-Wallis and Friedman tests with Dunn-Bonferroni post hoc comparisons (α = 0.05). RESULTS: Significant differences were observed among the tested groups (P ≤ 0.001). Within the simulated resorptive cavities, EDDY group demonstrated the significantly lowest percentage values of residual Ca(OH)₂ [median: 1.48%, IQR (0.65-1.59)] (P < 0.05) followed by XP-endo Finisher [median: 23.31%, IQR (16.61-24.83)] and Irrisafe [median: 36.34%, IQR (14.31-49.05)] groups. EDDY, XP-Endo Finisher and Irrisafe groups showed the significantly lowest overall (total) percentage values (P < 0.05), with no significant differences among them. Most irrigation protocols tested showed significant lower percentage values in the coronal third compared with the apical third, while no significant difference was detected between root thirds within the EDDY and Ultra X groups (P = 0.199, P = 0.182). None of the tested techniques achieved complete removal of Ca(OH)₂. CONCLUSIONS: Activated irrigation significantly enhances Ca(OH)₂ retrieval from internal resorptive defects; however, complete removal is not achieved with any of the tested techniques. EDDY demonstrates superior efficacy in removing Ca(OH)₂ specifically from simulated internal root resorption cavities. Across the entire root canal system, EDDY, XP-Endo Finisher, and Irrisafe demonstrate the highest overall efficacy for Ca(OH)₂ removal.
PloS oneZainab Shirazi, Anas Al-Jadaa, Dalya Sharaf, Abdulrahman Mohammed Saleh, Ahmed Jamleh
INTRODUCTION: This in vitro study evaluated the extent accuracy of canal shaping to apical constriction (AC) with electronic apex locator (EAL)-integrated endodontic motors using micro-computed tomography (MicroCT). MATERIALS AND METHODS: Sixty single-canalled teeth were decoronated, scanned using microCT, and distributed into three groups: Rooter Universal, Tri Auto ZX II, and control group (n = 20 each). The working length (WL) was determined simultaneously during canal shaping using the auto-reverse function set at the 0.5 mark in the RU and TA groups. In the control group, the WL was measured before the shaping using Root ZX (J. Morita, Tokyo, Japan). In the three groups, canals were shaped using ProTaper Gold files (Dentsply Sirona, Ballaigues, Switzerland) until the preset mark was reached in the two experimental groups and to the measured WL in the control group. Afterwards, post-shaping microCT scans were taken. Scan superimposition was conducted to assess the absolute distance between the final shaping endpoint and AC. Negative and positive data were recorded when the measurements were found short or beyond the AC, respectively. Analysis of variance (ANOVA) and post-hoc Tukey tests were used to analyze the distance. The chi-square test was applied to analyze the accuracy of the measurements with respect to the AC. The significance level was set at 5%. RESULTS: No over-shaping beyond the apical foramen was found in any sample, and all systems showed similar accuracy when a tolerance of 0.5 mm was set ((V = 0.263, P = 0.126). However, the shaping extent to AC was closer in the control group than the RU (P = 0.001) and TA (P < 0.001), while RU and TA were similar (P = 0.588). CONCLUSIONS: The accuracy of WL determination was not affected by the tested EAL. However, the standalone EAL was more reliable at maintaining AC integrity.
Journal of the Indian Society of Pedodontics and Preventive DentistryRaghavendra Havale, N H Praveen Kumar, Kashyap Balkattu, Santhebachalli Prakasha Shrutha, Ramesh Babu, Shiny Raj Rajan, Kanchan M Tuppadmath
BACKGROUND: Dental anxiety is a significant barrier in pediatric dentistry, particularly in children with Frankel's negative behavior ratings. Sedation through the intranasal route offers a rapid and noninvasive alternative with high bioavailability. Among various sedatives, the relative efficacy and acceptance of midazolam and dexmedetomidine in pediatric dental care remain underexplored. Hence, the purpose of the study was to compare the sedative effect, acceptance, and side effects of intranasal dexmedetomidine and intranasal midazolam in anxious children undergoing invasive dental procedures. METHODOLOGY: A triple-blind, split-mouth, crossover randomized clinical trial was conducted on 40 children aged 4-10 years who required either bilateral pulpectomy or extraction. The study was conducted from September 2024 to October 2025. Participants received intranasal midazolam (0.3 mg/kg) and dexmedetomidine (3 mcg/kg) in separate appointments, with a 2-week washout period between them. Behavior was assessed using the Houpt behavioral rating scale, whereas drug acceptance and side effects were recorded using the al-Rakaf scale. Statistical analysis included the Wilcoxon signed-rank test and Friedman test, with P < 0.05 considered statistically significant. RESULTS: Midazolam demonstrated significantly higher patient acceptance compared to dexmedetomidine. Behavior scores were significantly greater with midazolam across preoperative, intraoperative, and postoperative phases ( P < 0.002). Both agents showed minimal and nonsignificant differences in side effects, with occasional sneezing and nasal irritation observed. No serious adverse effects or carryover effects were noted. CONCLUSION: Intranasal midazolam demonstrated relatively effectiveness in comparison to dexmedetomidine regarding patient acceptance and behavioral results, with both drugs having acceptable safety profiles.
Brazilian dental journalFabienne de Freitas Rodrigues Moraes, Roberta Fonseca de Castro, Emmanuel João Nogueira Leal da Silva, Francisco Montagner, Juliana Melo da Silva Brandão
This study aims to evaluate Brazilian endodontists' perceptions of minimally invasive access cavities, characterize access-design choices, and identify the information sources informing these decisions. This cross-sectional survey randomly sampled endodontists registered with the Federal Council of Dentistry in 2021. Consenting participants completed a previously validated questionnaire. A minimum sample of 376 was calculated (assumed proportion 50%; margin of error 5%). Descriptive statistics summarized responses, and Pearson's chi-square tested associations between access type and covariates (α = 0.05). Of 378 respondents, most reported using traditional access for anterior (55.8%) and posterior teeth (66.4%). On a 0-5 scale, the modal self-rated knowledge of minimally invasive access cavities was 4 (28%). Most agreed/strongly agreed that minimally invasive access cavities: increases fracture resistance (49.5%); hinders canal location (84.4%); impairs instrument centering during preparation (73.5%); raises the risk of apical transportation (43.4%) and iatrogenic deviations (63.0%); contributes to debris accumulation (60.1%); compromises pulp-chamber cleaning (74.6%); elevates the likelihood of instrument fracture (68.3%); and increases the risk of coronal discoloration (57.6%). Scientific articles were the most frequently cited source of professional updating (44.2%). Brazilian endodontists perceived multiple procedural risks associated with minimally invasive access cavities and often believed it improves fracture resistance, a view not supported by current evidence. These findings reveal a perception-evidence gap and underscore the need to strengthen critical appraisal and evidence integration in education and clinical decision-making on access cavity design.
OBJECTIVES: To evaluate the long-term outcomes of apical surgery using intermediate restorative material (IRM) and hydraulic calcium silicate cements (HCSCs) as root-end filling materials. MATERIALS AND METHODS: Apical surgery was performed between 2012 and 2020. Of the 336 teeth initially treated, 137 met the final inclusion criteria. Periapical healing was classified as complete, incomplete, uncertain, or unsatisfactory. Root-end filling material erosion was assessed radiographically using the Erosion Index (EI), ranging from 0 to 4. RESULTS: The mean follow-up period was 6.6 ± 2.7 years. IRM was used in 72 (52.6%), while HCSCs were used in 65 (47.4%) teeth. Complete healing was observed in 84 (61.3%) teeth, incomplete healing in 13(9.5%), uncertain healing in 21(15.3%), and unsatisfactory healing in 19 (13.9%). Fifteen teeth were extracted, resulting in a tooth survival rate of 89.1%. Late failures occurred in 10 (7.3%) of the initially successful cases, with equal distribution between IRM (n = 5) and HCSC (n = 5). Erosion was detected in 20(14.6%) teeth, affecting 11.1% of IRM and 18.5% of HCSC cases, with no significant difference between materials. Complete healing was significantly associated with tooth survival and the absence of late failure (p < 0.001). Teeth exhibiting erosion (EI 1-4) were less likely to achieve complete healing compared with those without erosion (EI 0)(OR = 2.7, 95% CI: 0.8-8.1; p < 0.05). CONCLUSIONS: Apical surgery demonstrated high long-term tooth survival and favourable healing outcomes, irrespective of whether IRM or HCSCs were used. Material erosion was associated with a reduced likelihood of complete periapical healing. These findings emphasize the importance of long-term follow-up, as late failures may occur despite initially successful treatment outcomes. CLINICAL RELEVANCE: These findings suggest that clinical erosion of root-end filling materials has not been extensively investigated previously. It may represent a contributing factor to failures following apical surgery and therefore warrants further research and validation.
Brazilian oral researchPatricia de Andrade Risso, Ana Paula Portes-Zeno, Alexandre Guimarães Dos Santos, Alice Corrêa Silva-Sousa, Rodrigo Arruda-Vasconcelos, Emmanuel João Nogueira …
Regenerative endodontics has transformed the management of immature necrotic teeth by offering the potential to improve root structure rather than merely induce apical closure. Over the past two decades, considerable progress has been made in case selection, disinfection protocols, irrigation strategies, intracanal medicaments, scaffold design, and biologically based tissue engineering approaches. Despite these advances, key challenges remain, including protocol standardization, variability in clinical outcomes, limited high-quality clinical evidence, and the gap between promising laboratory findings and routine clinical implementation. This narrative review summarizes the recent literature on regenerative endodontics, focusing on contemporary clinical protocols and their limitations, prognostic factors, treatment outcomes, and emerging therapeutic strategies. Current evidence supports regenerative procedures that involve careful case selection, appropriate scaffold formation, well-sealed coronal restorations, and effective disinfection that preserves stem cell viability. While these protocols promote infection control, periapical healing, and tooth survival, continued root maturation remains variable, and existing therapies primarily result in tissue repair rather than true regeneration of a functional pulp-dentin complex. Additionally, there are several limitations to the widespread clinical adoption of advanced regenerative therapies, including outcome measures, alongside regulatory, manufacturing, and logistical challenges. Bridging the gap between innovation and clinical practice will require continued advances in tissue engineering, as well as more robust clinical evidence and standardized treatment protocols.
Clinical oral investigationsRita A Toloza-Espinoza, Pilar A Araya-Cumsille, Marcela Torrealba, Valentina Valdivia, Milenka Filipic, Lúcio S Gonçalves, José F Siqueira, Flávio R F Alves
OBJECTIVES: To investigate the association between root canal filling quality and the prevalence and volume of apical periodontitis (AP) lesions in a Chilean population using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: This retrospective cross-sectional study evaluated CBCT scans acquired between 2021 and 2024 at a private radiology clinic in Santiago, Chile, for reasons unrelated to this investigation. A total of 830 root canal-treated teeth from 520 patients were analyzed. AP prevalence was recorded and lesion volume was quantified with the CBCT Periapical Volume Index. Fillings were classified as adequate or inadequate, and the canal-to-root diameter ratio was measured 1 mm short of the filling terminus. Associations, correlations, and odds ratios (OR) were analyzed at a 5% significance level. RESULTS: Of the 830 teeth analyzed, AP was present in 37.3% (n = 310). Adequate fillings were associated with a lower lesion prevalence (OR = 0.514; CI 0.383-0.689; p< 0.001). Mean lesion volume was greater in inadequately (65.5 ± 52.3 mm³) than in adequately (50.3 ± 39.0 mm³; p < 0.05) filled teeth. Molars showed the highest prevalence (43.7%). A weak inverse correlation was found between the canal-to-root ratio and lesion volume (ρ = - 0.110; p < 0.05). CONCLUSIONS: AP affected over one-third of root canal-treated teeth in the study population. Adequate fillings and larger canal-to-root ratios were associated with a lower lesion prevalence and smaller lesion volumes. CLINICAL RELEVANCE: AP affected over one-third of root canal-treated teeth in this Chilean population. Adequate root canal fillings were significantly associated with a lower probability of AP and with smaller lesion volume. Larger canal-to-root ratios were associated with smaller lesion volumes.
BMC oral healthKhadijah Ahmed Sadek, Sybel Mokhtar Mahmoud Moussa, Ahmed Mostafa Mobarak
BACKGROUND: The aim of the study was to compare the time required for complete removal of overextended root canal filling in lower premolar teeth using two different rotary file systems; ProTaper Universal Retreatment (PTUR) system, XP-endo Retreatment (XPER) system versus manual Hedstrom (H-Files). METHODS: Thirty-six extracted permanent mandibular premolars with single canal were set to a standard length of 19 mm and prepared beyond the apical foramen by 3 mm up to F2 file of the ProTaper Gold system. Overextended obturation was performed by a size (25/08) gutta-percha and AH-Plus sealer using cold lateral condensation technique. Teeth were left for 7 days to ensure complete setting of sealer, then divided into 3 groups (n = 12) according to the gutta-percha removal method (Group Ι: H-Files, Group ΙΙ: PTUR, Group ΙΙΙ: XPER (XP-endo Shaper (XPES) + XP-endo Finisher R (XPEF-R)). Time taken was recorded and statistically analyzed. RESULTS: The XPER technique showed a statistically significant reduction in the time taken to remove the overextended gutta-percha compared to H-files and PTUR groups (P < .05), with the XPER group showing the shortest time, followed by PTUR, and then H-files. CONCLUSIONS: XPER technique was significantly faster in removing the experimentally overextended gutta-percha than H-files and PTUR files, demonstrating superior procedural time efficiency.