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Apical periodontitis is an inflammatory condition resulting from microbial invasion in the root canal system, causing periapical tissue destruction and bone resorption. This study investigated melatonin's effects, known for its antioxidant and anti‐inflammatory properties, on experimentally induced apical periodontitis in rats. Three groups of rats were studied: control, apical periodontitis and apical periodontitis with melatonin treatment. Proinflammatory cytokines and enzyme levels in blood serum were measured, and micro‐CT analysis assessed bone resorption. Results showed significantly elevated cytokines and enzyme levels in the apical periodontitis group compared to the control. However, in the melatonin‐treated group, these levels were significantly reduced (p < 0.01–0.001). Micro‐CT analysis indicated decreased periapical resorption cavity volume and surface area with melatonin treatment. This suggests that systemic melatonin administration can mitigate inflammation and reduce bone resorption in experimentally induced apical periodontitis in rats, potentially holding promise for human endodontic disease treatment pending further research. [ABSTRACT FROM AUTHOR]

Dens invaginatus (DI) is a developmental anomaly of the teeth characterised by the in‐folding of the enamel into the dentin. Oehlers' Type III DI is the most serious form, in which the inherently invaginated channels communicate with periodontal and dental pulp tissue, increasing the risk of bacterial contamination. However, varying and complex anatomical features make diagnosis and treatment challenging. Conventional endodontic therapies promote healing by avoiding unnecessary interventions (e.g., surgical or other invasive treatments). Radiographic examination can reveal the structural details of such malformations. We obtained multiple procedural details for treating Type III DI based on radiographic analyses from our clinical experience. In addition, we introduce a new classification strategy for the management of Type III DI that is more applicable to treatment needs. This study aimed to discuss the anatomical features and current treatment considerations of Type III DI. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the effect of ibuprofen sustained release (SR) oral premedication on the efficacy of buccal infiltration (BI) with intraoperative and postoperative pain after single‐visit root canal treatment. Sixty patients diagnosed with symptomatic irreversible pulpitis and apical periodontitis in mandibular molar were divided into two groups. Group SR received ibuprofen SR 800 mg and group PL received placebo capsule 1 h before 3.6 mL articaine BI injection. Pain was recorded using a modified visual analogue scale and postoperatively at intervals 6, 24 and 48 h. Group SR showed a significantly higher anaesthetic success rate (73.3%) compared to group PL (46.7%) (p < 0.05). Intraoperative and postoperative pain was significantly higher in group PL compared to group SR (p < 0.05). Premedication of ibuprofen SR improved the efficacy of primary BI in mandibular molars with symptomatic irreversible pulpitis and decreased postoperative pain at 6 and 48 h. [ABSTRACT FROM AUTHOR]

This study assessed the influence of diverse variables on the outcome of nonsurgical root canal treatment/retreatment. In general, 304 teeth from 218 patients were treated/retreated and the outcome evaluated by the periapical index (PAI). Teeth with apical periodontitis lesions that have not completely healed were classified as success or failure based on lenient and rigid criteria, respectively. Findings were evaluated using a logistic regression analysis. The overall success rates were 74% and 82% using the PAI‐rigid and lenient success criteria, respectively. Specifically for treatment, the success rates were 73% (rigid) and 82% (lenient), while for retreatment they were 78% (rigid) and 83% (lenient). The treatment outcome was negatively affected by overextension, presence of preoperative lesion, lesion size >10 mm, and higher number of treatment visits (with no intracanal medication). Regarding retreatment, the chance of success was greater for teeth with adequate coronal restorations. [ABSTRACT FROM AUTHOR]

The apical barrier technique in permanent teeth with extensive destruction of the periapical tissue and a long infection time is much more difficult to succeed, which is a clinical challenge. This study aimed to evaluate the long‐term effects of iRoot BP Plus as an apical material in adult teeth. Fifty incisors and premolars were chosen for this study. All teeth were performed apical barrier with the same operator. After treatment, the teeth were clinically and radiographically evaluated at 1, 2 and 6 years. At the 1‐year follow‐up, 35 teeth had healed, and three patients developed an apical abscess due to root fracture at the 2‐year follow‐up. Six years postoperatively, one tooth showed root resorption, which was considered a failure. The long clinical evaluation confirmed that iRoot BP Plus is a suitable material for the apical barrier of mature teeth with open apices and periapical lesions. [ABSTRACT FROM AUTHOR]

This study's objective was to compare the cytokine expression of IL‐8 in periapical tissues of single‐rooted teeth with symptomatic apical periodontitis (SAP) before and after root canal treatments. As well as, comparing IL‐8 levels in peri‐apical tissues between vital and necrotic teeth with SAP. Methodology: Thirty‐six patients were allocated according to their pulp status into two experimental groups (n = 18) receiving the same treatment protocol; group 1: Vital pulps with SAP, and group 2: non‐vital pulps with SAP. Conventional endodontic treatment was done on two visits; isolation and disinfection of the operative field were undertaken, and two‐stage access cavity preparation was implemented. The first pre‐instrumentation peri‐apical sample (S1) was collected prior to cleaning and shaping procedures. A 2.5% NaOCl irrigation was used to thoroughly irrigate the canal after performing root canal preparation utilising the ProTaper Next (PTN) rotary system. After 1 week, the second post‐instrumentation peri‐apical sample (S2) was collected. Using an ELISA kit, the quantity of IL‐8 was evaluated following the collection of all samples. Results: In all pre‐instrumentation samples, IL‐8 was detected (100%). The level of IL‐8 expression was significantly decreased from the S1 to S2 of all samples (p < 0.001). The intra‐group comparison showed a statistically significant reduction in the level of IL‐8 expression between S1 and S2 in both vital and non‐vital groups where p < 0.001* in both groups. The inter‐group comparison of levels of IL‐8 expression (vital and non‐vital) revealed a significant difference between both groups regarding the pretreatment sample with the higher levels of IL‐8 shown in the non‐vital group (p < 0.001). While in the post‐treatment sample, both groups showed a significant reduction in the level of IL‐8 expression but the difference between them was not statistically significant (p = 0.226). Conclusion: Root canal instrumentation seems to be efficient in decreasing the levels of anti‐inflammatory cytokines, namely IL‐8. Further research should clarify how intra‐canal medicaments affect inflammatory mediator levels. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the levels of tumour necrosis factor‐alpha (TNF‐α), interleukin‐1beta (IL‐1β) and interferon‐gamma (IFN‐γ) with asymptomatic apical periodontitis (AP). A total of 60 participants were randomly divided into two groups: the conventional irrigation (control) and the Nd: YAG laser irradiation. The interstitial fluids were obtained after root canal cleaning (day 0) and 1 week later (day 7). The TNF‐α, IL‐1β and IFN‐γ levels were assayed using the enzyme‐linked immunosorbent assay. The Mann–Whitney U, continuity correction chi‐square, Pearson chi‐square and Fisher exact tests were used. An increased level of cytokines on day 7 in the control group was observed, without statistically significant differences (p > 0.05). All cytokine levels decreased over time in the laser group. Only the IL‐1β level showed a significant difference (p < 0.05). Nd: YAG irradiation has a positive effect on decreasing the proinflammatory cytokine level and may help to control infection in teeth with AP. [ABSTRACT FROM AUTHOR]

Theoretically, a necrotic root canal fulfils all requirements as a niche for methanogens to inhabit. However, their presence in it and its implication in apical periodontitis (AP) is controversial. Therefore, to contribute to ending the controversy, this study aimed to detect and compare methanogens' presence in two distinct niches with supposedly different microenvironments; both were necrotic root canals associated with AP but one from patients with type 2 diabetes mellitus (T2DM) while the other from non‐diabetic patients. A clinical examination was performed on 65 T2DM patients and 73 non‐diabetic controls. Samples from necrotic root canals were obtained, and methanogens were identified. The presence of methanogens was three times higher (27.6%) in the T2DM group than in non‐diabetic patients (8.2%). In addition, methanogens' presence was associated with a higher prevalence of periapical symptoms. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate whether there is an association between inducible in single nucleotide polymorphisms in nitric oxide synthase (rs2297518 and rs2779249) and persistent apical periodontitis. A total of 291 Brazilian subjects were included: 125 with signs/symptoms of persistent apical periodontitis and 166 with root canal‐treated teeth exhibiting healthy perirradicular tissues. Endodontically treated patients were followed up after 1 year. The two single nucleotide polymorphisms in nitric oxide synthase were analysed using real‐time polymerase chain reaction. Chi‐square test and odds ratio with 95% confidence intervals were performed to compare genotype distributions between 'healed' and 'persistent apical periodontitis' groups (p < 0.05). Logistic regression analysis was used to evaluate SNP–SNP interactions. The allele and genotype distributions for the polymorphisms between the persistent apical periodontitis and healed groups were not statistically significant (p > 0.05). In the logistic regression analysis, the polymorphisms were not associated with persistent apical periodontitis and SNP–SNP interactions. [ABSTRACT FROM AUTHOR]

This article documents cases of single‐visit pulp revascularisation for dens evaginatus and dens invaginatus, without using intracranial medicaments or antibiotics, aiming to provide a potentially applicable protocol for pulp revascularisation procedure in a single‐visit. Two patients with chief complaints of pain and swelling visited a dental hospital. Radiographs revealed that the causative teeth had an open apex and periapical radiolucency, and the teeth were diagnosed as pulp necrosis and acute apical abscess or symptomatic apical periodontitis. For both cases, single‐visit revascularisation was completed without intracanal medicaments or antibiotics. The patients were periodically recalled to evaluate periapical healing after treatment. The apical lesion healed, and the root dentin thickening was observed. The single‐visit pulp revascularisation procedure without using specific intracanal medicaments can produce clinically favourable results for these dental anomalies. [ABSTRACT FROM AUTHOR]

This study investigated variation in working length during multiple‐visit endodontic treatment. Patients (N = 106) with pulpitis or pulp necrosis, with or without apical periodontitis, were included. During the first appointment, glide path was performed with ProGlider and shaping with ProTaper Next. Working length was detected four times. Working length was then re‐recorded prior to filling during the second appointment and a 0.5 mm threshold was selected as the minimum clinically meaningful variation. A logistic regression model was used to evaluate the impact of tooth anatomy, preoperative pulp status, apical periodontitis and lesions of endodontic origin on working length variation. Working length varied between first and second appointments in 34% of patients. The presence of apical periodontitis was the only variable significantly associated with variation in working length (p = 0.011). These data suggest that working length should be re‐checked prior to root canal filling to prevent procedural errors. [ABSTRACT FROM AUTHOR]

To investigate the efficacy of the supplementary use of a rotary agitation method [XP‐endo Finisher (XPF)] and sonically‐activated irrigation [EndoActivator (EA)], using droplet digital PCR (ddPCR) on reducing the bacterial load in previously root canal treated teeth with apical periodontitis. Twenty patients with post‐treatment apical periodontitis were allocated into two groups according to the irrigation activation method used: XPF and EA group. Total bacterial loads, as well as the amount of Enterococcus faecalis (E. faecalis) were determined before (S1) and after (S2) chemomechanical preparation, and after final irrigation activation (S3) by means of ddPCR. The bacterial copy numbers were compared between groups using the Friedman test (Nonparametric Repeated Measures ANOVA). When the groups were examined in terms of gender, age, number of root canals, periapical index score, sterility control total bacteria (SCTB), S1‐ and S2‐total bacteria copy number, it was found that there was no statistical difference between the XPF group and the EA group (p > 0.05). Subsequent activation (S3) resulted in a significant microbial reduction in both XPF and EA groups, both of which reduced significantly more bacteria than chemomechanical instrumentation (S2) (p < 0.0001). On the contrary, S3‐total bacteria copy number of the EA group was lower than the XPF group (p < 0.0147). There was no statistical difference between the XPF group and the EA group in terms of E. faecalis copy number (p > 0.05). Although both the XPF and the EA optimised the antibacterial efficiency of chemomechanical preparation in previously root canal‐treated teeth with apical periodontitis, a lower total bacterial copy number was achieved with the EA application than the XPF application. [ABSTRACT FROM AUTHOR]

To synthesise the current knowledge on the effects of probiotics in apical periodontitis progression by a scoping review of animal and human studies. Reporting was based on Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) Extension for Scoping Reviews. The literature search and screening was performed on PubMed and Scopus databases by two independent reviewers selecting human and animal studies that evaluated the effectiveness of probiotics in reducing the severity of apical periodontitis. Two animal studies with 3 publications met the eligibility criteria for qualitative synthesis. The most common probiotics were Lactobacillus rhamnosus and Lactobacillus acidophilus orally administered for gavage in Wistar rats with induced apical periodontitis. Overall, probiotics significantly reduced inflammation and bone resorption with an improvement in the apical periodontitis progression. Although results in animal studies are promising, the use of probiotics in apical periodontitis progression requires caution due to the insufficient available evidence. [ABSTRACT FROM AUTHOR]

The purpose of the present review was to examine success, survival and failure following intentional replantation of endodontically treated teeth with existing periapical pathosis and to determine the factors that might affect the outcome of replantation. Clinical trials, longitudinal studies, case series with >10 cases and at least 1‐year follow‐up were included. The average rate of success following intentional replantation was 77.23%. Meta‐analysis revealed the mean weighted survival to be 85.9% (95% CI: 79.6–91.2) Common complications include inflammatory root resorption (0%–27%) and ankylosis (0%–25%). Variables influencing successful outcome include extra alveolar dry time <15 min; root‐end resection (2–3 mm) and cavity preparation (3 mm); manipulation of the tooth using the crown only; and use of an appropriate storage media. The review concludes that intentional replantation is a viable treatment option with acceptable survival rates for endodontically treated teeth with periapical pathosis. [ABSTRACT FROM AUTHOR]

The study aims to investigate and compare the success rate of concentrated growth factor (CGF) and blood clot (BC) as scaffolds in regenerative endodontic procedures (REPs). Immature permanent necrotic teeth treated by REPs with at least a 6‐month follow‐up were included. These teeth were divided into the CGF (53 teeth) and BC (68 teeth) groups. Treatment outcomes were assessed using a combined clinical and radiographic scoring system. The total success rate was 91.74% over a mean follow‐up period of 23.15 months. There was no significant difference between the CGF group (86.79%) and BC group (95.59%). The success rate of traumatic teeth (84.31%) was significantly lower than that of teeth with developmental dental anomalies (98.39%) (p < 0.05). CGF may be a suitable alternative scaffold in REPs when adequate bleeding cannot be achieved. Moreover, compared to developmental dental anomalies, traumatic teeth treated by REPs may be more vulnerable to failure. [ABSTRACT FROM AUTHOR]

Missed canals can be a common cause of persistent intraradicular infection and post‐treatment apical periodontitis. This article reports on a rare case of a maxillary lateral incisor with two roots exhibiting symptomatic post‐treatment apical periodontitis regardless of a radiographically adequate root canal treatment. The second root, which was only revealed by cone‐beam computed tomography, had passed unnoticed during the first treatment, and its missed canal was the most likely cause of symptoms and treatment failure. Reintervention including the proper management of the extra root canal and retreatment of the main canal resulted in the resolution of symptoms and periradicular tissue healing. This case report reinforces the need for three‐dimensional radiographic diagnosis to search for the cause of post‐treatment disease and guide the decision‐making process for proper management. [ABSTRACT FROM AUTHOR]

This paper presents a case report of an immature maxillary lateral incisor with type II dens invaginatus, with a periapical lesion. The tooth was treated with MTA apical barrier followed by root filling with thermoplasticised GP and restoration with resin composite. Three‐year radiographic follow‐up showed healing of the apical lesion and normal clinical parameters. [ABSTRACT FROM AUTHOR]

Type IIIB dens invaginatus presents with diagnostic and treatment related challenges when in need of endodontic management as a consequence of its complex anatomy, especially when presented in a vital tooth with a periapical lesion. Apical periodontitis associated with two type IIIB invaginations in a central maxillary incisor of a 10‐year‐old patient was diagnosed. A cone‐beam computed tomography (CBCT) scan provided essential diagnostic information and steered the treatment plan. The two invaginations were separate, with no communication between them and the pulp. The pulp appeared vital and non‐inflamed. Endodontic treatment of the invaginations was carried out without intervention in the pulp. A 4‐month follow‐up periapical radiograph showed significant shrinkage of the lesion and a 2‐year follow‐up CBCT scan confirmed its complete healing. The pulp remains vital, responding normally to sensitivity tests. This outcome indicates that preserving the pulp's vitality is achievable through timely diagnosis. [ABSTRACT FROM AUTHOR]

This retrospective cone‐beam computed tomography study aimed to investigate the possible associations of apical periodontitis (AP) with missed/unmissed second mesiobuccal (MB2) canals. MB2 canals and AP were investigated in 257 endodontically treated and 673 untreated maxillary molars, and the former were analyzed regarding missed/unmissed MB2 canals. The chi‐squared test and odds ratio (OR) were used for statistics. The prevalence of MB2 canals in maxillary first molars was higher than that in second molars (p = 0.001). MB2 canals were 1.751 times more common in males than in females (OR: 1.751; 95% CI: 1.334–2.297), with a significant difference in the 18–39 age groups (p = 0.005). The risk for AP was 5.5 times greater in endodontically treated maxillary molars with missed MB2 canals than in those with unmissed MB2 canals (p = 0.012) (OR: 5.5, 95% CI: 1.549–19.527). The findings of this study reveal that the likelihood of the MB2 canal is higher in the maxillary first molars of young adult males. [ABSTRACT FROM AUTHOR]

This study aimed to determine the intraradicular microbiota of previously root canal‐treated teeth with apical periodontitis and to investigate the antibacterial effectiveness of different intracanal medicaments. Sixteen patients with post‐treatment apical periodontitis were allocated into two groups according to the intracanal medicament used: calcium hydroxide (CH) and 2% chlorhexidine gluconate gel (CHX) group. Total bacterial loads, as well as the amount of Enterococcus faecalis (E. faecalis) were determined before (S1) and after (S2) chemomechanical preparation and finally, after intracanal medication (S3) by means of ddPCR. The unpaired t test was used to compare parametric. S3‐total bacteria copy number of the CH group was lower than the CHX group (p < 0.05). There was no statistical difference between the CHX‐ and the CH groups in terms of E.faecalis copy number (p > 0.05). But in terms of total bacteria, CH is better than CHX. Consequently, CH can be used to optimise the antibacterial efficiency of chemomechanical preparation in previously root canal‐treated teeth with apical periodontitis. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the technical treatment quality and the status of apical pathology of endodontically treated teeth, as well as apical periodontitis (AP) prevalence, in a Turkish population using cone‐beam computed tomography (CBCT). The CBCT images obtained between January 2018 and April 2020 were retrospectively examined. The quality of the endodontic treatments and the related periapical inflammatory lesions were classified according to the periapical and endodontic status scale (PESS). The data were statistically analysed using logistic regression, crosstabs and chi‐square tests. AP was detected in 41% of 429 endodontically treated teeth. The prevalence of AP was significantly higher in teeth with inadequate root canal treatment compared with those with adequate treatment, 70.8% and 29.3%, respectively. Inadequate canal length and homogeneity, and complications were significantly associated with the prognostic periapical status scores of higher risk. [ABSTRACT FROM AUTHOR]

Fractal analysis (FA) is a quantitative, objective and non‐invasive method that facilitates the characterisation of the tissue architecture. This study aims to compare the periapical healing at 1‐year follow‐up by evaluating newly generated trabecular bone with FA after Mineral trioxide aggregate (MTA) plug and regenerative endodontic treatment (RET). A total of 55 asymptomatic teeth with a single‐canal, open apex and periapical lesion, treated with MTA plug or RET, were evaluated retrospectively. After considering the inclusion/exclusion criteria, FA was conducted on 30 periapical images using the box‐counting method. In both groups, a significant decrease was observed in the periapical lesion size at 1‐year follow‐up (p < 0.01). However, there was no significant difference between the MTA plug and RET (p > 0.01). Significantly higher fractal dimension values were detected at 1‐year follow‐up in both MTA plug and RET cases (p < 0.01). However, the difference was not significant between the groups (p > 0.01). Both procedures seem to improve periapical healing with a new resistant bone of similar density and complexity. [ABSTRACT FROM AUTHOR]

The varicella zoster virus as an aetiological agent for endodontic disease is not a well‐recognised entity despite several published case reports. While advances in DNA molecular analysis techniques (PCR) have contributed to the current understanding of the potential role of the varicella zoster virus in the initiation and progression of endodontic disease, a review indicates a need for ongoing research. Case reports are presented of two female patients with a history of herpes zoster who developed pulp necrosis, with one patient progressing to apical periodontitis. Both patients received non‐surgical endodontic therapy, followed by intra‐coronal bleaching in one of the patients due to tooth discolouration which developed during the prodromal and acute phases of the herpes zoster infection. Clinical and radiographic examinations at 23 and 22 years, respectively, showed the affected teeth to be retained in an asymptomatic and aesthetically satisfactory state with no radiographic evidence of apical pathosis. [ABSTRACT FROM AUTHOR]

This pilot study assessed the glycaemic control and the serum levels of inflammatory mediators in type 2 diabetes (T2DM) patients with apical periodontitis (AP). Thirty individuals were divided into four groups: Healthy (H); with AP (AP); with T2DM (T2DM); and with T2DM and AP (T2DM‐AP). Demographic and pharmacological data were registered. The body mass index (BMI) and the levels of glycated haemoglobin (HbA1c) and IL‐1β, IL‐6, IL‐10, CCL3 and CCL4 were evaluated. AP areas were determined radiographically. Mean age was 64 ± 12 years, with 63% females. Most T2DM patients were under treatment with metformin and antihypertensives. BMI and H1bAc were significantly higher in T2DM patients in relation to H and AP groups. The AP areas were larger in the T2DM‐AP group, compared with the AP group. These preliminary findings suggest no influence of AP on glycaemic control or inflammatory levels amongst T2DM patients, although T2DM increased the AP severity. [ABSTRACT FROM AUTHOR]

Discuss the impact of new diagnostic and planning technologies on the resolution of a clinical case of an upper central incisor with lateral perforation, root canal calcification and apical periodontitis. A 44‐year‐old woman sought treatment because of a colour change in an anterior tooth. The tooth had already been endodontically accessed, and she reported that two different clinicians had failed to locate the root canal. A Cone Beam Computed Tomography scan showed excessive wear and root perforation in the middle third, as well as pulp canal obliteration in the apical third. The perforation was treated using a biomaterial, and the root canal was located using guided endodontics. This treatment protocol was used to access, prepare, medicate with calcium hydroxide for 21 days and fill the root canal. Treatment results were satisfactory at 6‐month follow‐up. [ABSTRACT FROM AUTHOR]

The knowledge of the final‐year dental students on antibiotic use in endodontics in Turkey was assessed. The study was conducted at 20 Dentistry Faculties. A questionnaire was sent to the universities including the concerning several scenarios about endodontic cases. 1113 final‐year dental students participated in the study. Respondents' significant choice was not to administrate antibiotics in endodontic treatments of symptomatic irreversible pulpitis, pulp necrosis, acute apical periodontitis, chronic apical abscess with or without sinus tract, retreatment, inadequate local anaesthesia and patient requests (P > 0.05). In acute apical abscess (AAA) with diffuse cases, choice of antibiotic administration was statistically higher (P < 0.05), while in AAA‐localised cases, the ratio of antibiotic administration versus non‐administration was similar. Amoxicillin was found to be the first‐choice antibiotic in patients without medical allergies, whereas in allergic patients the first choice was clindamycin. Final‐year dental students have fundamental knowledge on the antibiotic administration in endodontics. [ABSTRACT FROM AUTHOR]

Retrograde peri‐implantitis is a symptomatic complication, characterised by radiographic detection of bone loss at the periapex of the implant. The aim of this study was to investigate the possible endodontic aetiology, evaluating the effectiveness of surgical treatment without endodontic therapy of adjacent teeth. In the 10‐year interval, three patients reported symptoms of retrograde peri‐implantitis after a mean period of 30.6 days from implant placement. Mean follow‐up after surgical procedures was 8.66 years, with an implant survival of 100%. Retrograde peri‐implantitis was probably caused by colonisation of the apical surface of the implant by bacteria persisting in the area after endodontic failure/apical periodontitis, reactivated by drilling in the site. In all cases, the adjacent teeth remained vital during the years, showing that a direct cause‐and‐effect relationship between pulpal/periapical disease of adjacent teeth and retrograde peri‐implantitis was never present. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate in the fractal dimension (FD) time‐dependent changes of periapical bone after two different apexification treatments in teeth with immature apices and apical periodontitis. This study included 55 cases treated with apexification. Cases were divided into two groups: a calcium hydroxide group and a mineral trioxide aggregate group. In each case, the lesion area was evaluated by fractal analysis on periapical radiographs obtained before and 1‐year after treatment via Image‐J program. The FD of each region of interest on the radiographs was calculated using the fractal analysis method. The data were statistically analysed. In both groups, the FD values increased compare to initial at 1‐year follow‐up after treatment (P <.05). There was no statistically significant difference between the groups in terms of the time‐dependent increase in FD values (P = 0.118). In the present study, time‐dependent changes in FD were independent of the apexification method. [ABSTRACT FROM AUTHOR]

This study aimed to assess regenerative treatment protocols for maturogenesis of immature teeth with apical periodontitis in dogs. Apical periodontitis was induced in immature premolars of 8 mongrel dogs teeth that were divided into 5 groups; regeneration via blood clotting (REG group); chitosan loaded with demineralised bone matrix (REG‐CD group); chitosan loaded with dexamethazone corticosteroid (REG‐CC group); and positive and negative control groups. All groups showed comparable apical hard tissue formation and significantly different from the control group. Results also showed decrease in inflammatory tissue reaction, bone resorption and periodontal ligament thickness. Tissue reaction and inflammatory infiltrates were significantly less in REG‐CC group compared to others. Other parameters showed no significant difference. In conclusion, regenerative endodontic techniques using chitosan‐based formulations have the potential to be used as an alternative for root maturation in teeth with apical periodontitis. [ABSTRACT FROM AUTHOR]

This study evaluated the overall endodontic therapy success using 0.12% or 2% chlorhexidine gluconate as main irrigant. Seventy‐two teeth diagnosed as vital, necrotic or previously treated teeth with apical periodontitis that were consecutively treated by orthograde therapy. All cases were followed clinically and radiographically for at least 1‐year period. Success was established in teeth without signs or adverse clinical symptoms and complete or incomplete radiographic healing. Failure was determined in teeth with any sign or adverse clinical symptoms and a new, unchanged or enlarged radiographic periapical lesion. The data were analysed using chi‐square and Fischer's exact tests. The overall success rate for teeth undergoing vital pulp was 84.6%, 76.2% as for the necrotic teeth and 84% for the retreatment cases. No significant differences were observed between groups (P > 0.05). Cases treated with CHX as main irrigant showed a high overall endodontic therapy success rate. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review was to assess the effect of occlusal reduction on post‐operative pain following root canal treatment and was performed in accordance with the PRISMA statement being registered in the PROSPERO database (CRD42018089941). Two reviewers independently conducted a systematic literature search in the PubMed (MEDLINE), Dentistry & Oral Sciences Source and the Cochrane Library databases. Seven studies were included, of which three were used to perform meta‐analysis for 6 days post‐operative and the rest for qualitative synthesis. Three studies were assessed as low risk of bias, three as some concern, and one as high risk of bias. Occlusal reduction diminishes the post‐operative pain (SMD −1.10 (95%CI −2.06, −0.15) I2 = 96.9%) at 6 days for teeth diagnosed as irreversible pulpitis, and, overall, likely reduces post‐operative pain for patients presenting with irreversible pulpitis and/or symptomatic apical periodontitis. Future high‐quality clinical trials are needed to better understand the role of occlusal reduction. [ABSTRACT FROM AUTHOR]

The aim of this study was to systematically review the histological evidence of the neo‐formed tissues inside the root canals of human teeth having previously received regenerative endodontic treatment. An electronic research was performed in the MEDLINE, Web of Science, Scopus and Cochrane Library databases using controlled vocabulary. The retrieved studies were screened by two reviewers according to the predetermined inclusion and extrusion criteria and were full‐text‐evaluated. Research resulted in 160 studies. Among them, twelve fitted the inclusion criteria and were critically appraised. The tissues formed in the root canals of immature human teeth treated with REP indicate repair or a combination of repair and regeneration. Pulp remnants and healthy periapical tissues seem to improve regeneration. The level of available evidence was low. Further clinical studies are needed in order to establish the appropriate treatment protocol related to the pretreatment status of the dental pulp and the periapical tissues. [ABSTRACT FROM AUTHOR]

Procedural accidents are eventualities that may occur during endodontic treatment because of lack of attention to detail or even unforeseeable situations. Knowledge of the root canal anatomy and its variations is a prerequisite for successful endodontic treatment. This case report describes an endodontic treatment where there was an intercurrence, generating deviation and perforation, which was solved with the aid of guided endodontics. A 37 years old, ASA1, was referred to the clinic for localisation and treatment of a calcified canal of the second right upper premolar. The tomographic images revealed the presence of only one canal and deviation with apical perforation. With the help of CBCT and CAD/CAM, it was possible to perform the guided access technique even after deviation and root perforation. Once again, this technique proved to be safe and predictable, allowing for a favourable prognosis in the long term. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the post‐treatment apical periodontitis in endodontically treated teeth related to the technical quality of root fillings and restorations in Thai population. Full‐mouth periapical radiographs from Thai patients attending the Faculty of Dentistry, Mahidol University, Thailand were examined. The periapical status, quality of root fillings and coronal restorations, existence of intraradicular post and its relationship to the root fillings were evaluated. Among 1586 patients, 37.4% presented endodontically treated teeth. The total number of endodontically treated teeth was 1511, and 35% presented apical periodontitis. Combined data for root filling and coronal restoration qualities revealed significantly better outcome in teeth with adequate qualities of both parameters than the other combinations (P < 0.001). The prevalence of post‐treatment apical periodontitis among Thai population was relatively high and significantly associated with substandard technical quality of root fillings and restorations. [ABSTRACT FROM AUTHOR]

The aim of the study was to compare decision making for asymptomatic root‐filled teeth among dentists with differing educational backgrounds. Case scenarios based on 14 radiographs were created and 150 participants were asked to choose from five alternative treatment decisions and to state the rationale. Demographic data of the participants were recorded. Frequency distribution and cross‐tabulation were performed; chi square testing was used for comparisons and logistic regression was performed to detect significant differences. The overall response rate was 87.3%. The practitioners chose intervention predominantly with non‐surgical retreatment a common choice. Poor technical quality was a driving factor, while the existing poor coronal restoration and the need for a crown were generally not taken into account by general dentists. Speciality and experience were significant factors. Practitioners were more inclined to retain rather than extract teeth. It is concluded that clear guidelines listing factors to consider for intervention are required. [ABSTRACT FROM AUTHOR]

Abstract: Apical periodontitis, the inflammation of periapical tissue, commonly requires root canal treatment to achieve apical healing. However, if it is accompanied by pulp canal calcification, the treatment becomes complicated, and locating the root canal can be challenging. This case report describes a novel approach for treating a molar with pulp canal calcification and apical pathology. Due to the risk of perforation during treatment, a digitally printed template was used to assist in accurately locating the root canal. After six months, the patient was asymptomatic and the periradicular radiolucency was gradually reducing in size. [ABSTRACT FROM AUTHOR]

The purpose of the study was to histologically analyse transition from pulpitis to periapical periodontitis on dog's teeth. Pulps of mandibular premolars (37 roots) were exposed using a low-speed handpiece. Teeth were left open to the oral environment for 20, 35, 50 and 65 days. After the experimental period animals were sacrificed. Undemineralised teeth with surrounding bone, embedded in methylmetacrylate, were prepared for standard histological analysis. All teeth with pulpitis (five roots), regardless of the experimental period, had acute serose periapical periodontitis. All teeth (15 roots) with partial pulp necrosis had subacute periapical periodontitis. Teeth with complete pulp necrosis (19 roots) had chronic periapical periodontitis and in one case suppurative apical periodontitis. The condition of the pulp correlates with the histopathological findings of periapical tissue in the open types of pulp infection. Acute periapical periodontitis begins during pulpitis and can occur before 20 days of pulp exposure in the dog. [ABSTRACT FROM AUTHOR]

This paper describes the clinical courses of three cases with extra-oral sinus tract formation, from diagnosis and treatment to short-term follow-up and evaluation. All teeth involved had periradicular radiolucent areas noted on radiographic examination and extra-oral sinus tracts appearing on the chin with exudation and unpleasant aesthetic appearance. The adopted treatment protocol included treating the sinus tract surface simultaneously with the root canal therapy. After root canal shaping using 5.25% sodium hypochlorite solution, calcium hydroxide-based pastes associated with different vehicles were inserted into the root canal for 4 months, and were changed monthly. All the sinus tracts healed in 7 to 10 days. The apical lesions were completely repaired in a maximum period of 24 months. The treatment adopted provided a complete healing of the periapical lesions in a short follow-up period. Surgical repair of the cutaneous sinus tract was therefore unnecessary. [ABSTRACT FROM AUTHOR]