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The Preferred Reporting Items for Diagnostic Accuracy Studies in Endodontics (PRIDASE) 2024 guidelines are based on the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 guidelines and the Clinical and Laboratory Images in Publications (CLIP) principles, with the addition of items specifically related to endodontics. The use of the PRIDASE 2024 guidelines by authors and their application by journals during the peer review process will reduce the possibility of bias and enhance the quality of future diagnostic accuracy studies. The PRIDASE 2024 guidelines consist of a checklist containing 11 domains and 66 individual items. The purpose of the current document is to provide an explanation for each item on the PRIDASE 2024 checklist, along with examples from the literature to help readers understand their importance and offer advice to those developing manuscripts. A link to the PRIDASE 2024 explanation and elaboration document is available on the Preferred Reporting Items for study Designs in Endodontology (PRIDE) website (https://pride‐endodonticguidelines.org/pridase/) and on the International Endodontic Journal website (https://onlinelibrary.wiley.com/page/journal/13652591/homepage/pride‐guidelines.htm). [ABSTRACT FROM AUTHOR]

BackgroundObjectiveMethodsResultsDiscussionConclusionPulpitis may be pain free or alternatively characterized by mild to severe pain and associated symptoms. Evidence has recently emerged that patients presenting with carious pulp exposure range of symptoms can be treated effectively with pulpotomy.The current systematic review aimed to answer the following research question: “In patients with deep caries lesions in permanent teeth associated with no symptoms, reversible pulpitis or signs and symptoms indicative of irreversible pulpitis (P), is partial pulpotomy (I) as effective as full pulpotomy (C), in terms of a combination of patient and clinical reported outcomes (O), with “tooth survival” as the most critical outcome?The systematic literature search was conducted in the following electronic databases: OVID, Scopus, PubMed (Including MEDLINE), and Cochrane Central Register of Controlled Trials (CENTRAL) supplemented with Grey literature and hand searching of relevant journals. The English language clinical trials comparing the patient and clinical reported outcomes between partial and full/complete were included. After a structured literature search, two authors independently performed study selection, extracted data and performed a risk of bias assessment; a third reviewer resolved disagreements. As there were only two studies with different exclusion criteria, no meta‐analysis was performed and the quality of evidence was assessed by the GRADE approach.After study selection a total of two randomised clinical trials with a total of 156 teeth were included both for the management of teeth with irreversible pulpitis. There were no studies for asymptomatic teeth or teeth with reversible pulpitis. A “Low” risk of bias was noted for both studies with a high level of overall evidence. A meta‐analysis was not carried out due to differences in inclusion criteria between the studies related principally to caries depth. Both studies reported a high rate of clinical success for pulpotomy with a pooled unadjusted success rate for full pulpotomy of 90% and 83% partial pulpotomy of at 1‐year; however, no significant difference between the treatments was noted in either study. There was significantly reduced postoperative pain reported in the full pulpotomy group over 1‐week compared with the partial pulpotomy in one but not in the other study.Pulpotomy as a definitive treatment modality is as effective in managing teeth exhibiting signs and symptoms indicative of irreversible pulpitis and challenges the established protocols to manage this condition. Although based on only two RCTs with a limited number of patients, no difference was shown in terms of clinical or radiographic outcome or postoperative pain between groups. Further well designed randomised clinical trials of longer duration are required in this area to improve the evidence available.There is no consistent difference in patient‐reported pain between partial and full pulpotomy at day 7 postoperatively and the clinical success rate was similar after 1 year for both treatment modalities. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusions To evaluate M1 and M2 macrophage polarization in radicular cysts and periapical granulomas through an immunohistochemical analysis and the correlation between macrophage polarization and histopathological diagnosis, clinical characteristics and lesion volume using cone‐beam computed tomography.Periapical biopsies diagnosed as radicular cysts (n = 52) and periapical granulomas (n = 51) were analysed by immunohistochemical method. Teeth with periapical lesion with no history of root canal treatment (primary lesion) and lesions persistent to root canal treatment (persistent lesions) were included. Pathological diagnosis, patients' age, gender and clinical characteristics were obtained from treatment records. A cone‐beam computed tomographic periapical volume index (CBCTPAVI) score was assigned to each periapical lesion based on the volume of the lesion. Immuno‐expressions of CD68 and CD163 were quantified. The CD68/CD163 ratio was adopted to represent M1 or M2 macrophage polarization. Mann–Whitney U test was used to determine the different CD68/CD163 ratio between groups of radicular cyst and periapical granuloma. Spearman's correlation test was performed to assess the correlation between the CD68/CD163 ratio and lesion volume and CBCTPAVI score.Radicular cysts and periapical granulomas had CD68/CD163 median of 2.05 (IQR = 1.33) and 1.26 (IQR = 0.81), respectively. A significantly higher CD68/CD163 ratio was observed in radicular cysts (p < .001). In contrast, periapical granulomas had significantly lower median of CD68/CD163 ratio. Larger lesions had a higher median of CD68/CD163 ratio, while smaller lesions had lower median of CD68/CD163 ratio (p = .007, rs = .262). CD68/CD163 ratio was significantly correlated with the CBCTPAVI score in the overall periapical lesions (p = .002, rs = .306). The higher CD68/CD163 ratio in larger lesions indicated a higher degree of M1 polarization compared to smaller lesions. Regarding the pathological diagnosis, there was a significant positive correlation between CBCTPAVI score and CD68/CD163 ratio in periapical granulomas (p < .001, rs = .453), whereas the negative correlation was observed for radicular cysts (p < .001, rs = −.471).Periapical granulomas are characterized by a M2‐dominant macrophage polarization, while radicular cysts have significantly higher M1 macrophages. The higher degree of M1 macrophage polarization was significantly correlated with larger volume and higher CBCTPAVI scores of overall periapical lesion and periapical granuloma. [ABSTRACT FROM AUTHOR]

Aim: Post‐operative pain may occur after non‐surgical root canal treatment (NSRCT). The root filling technique and choice of sealer may be contributing factors. This randomized controlled clinical trial compared post‐operative pain and analgesics intake after NSRCT using a sealer‐based obturation technique (SBO) with single‐cone gutta‐percha and calcium silicate sealer (CSS) versus a warm‐vertical compaction (WVC) technique with gutta‐percha and a resin‐based sealer (RBS). Methodology: This study was designed as a parallel‐two arm, double‐blind, randomized superiority clinical trial registered at www.clinicaltrials.gov (NCT04753138). Patients referred for NSRCT fulfilling the inclusion criteria participated in this study. Pre‐operative periapical radiographs and CBCT scans were taken and numerical rating scale (NRS) pain scores were recorded. Upon completion of canal instrumentation, participants were randomly allocated to either Group SBO: SBO with CSS or Group WVC: Warm‐vertical compaction with RBS. Post‐operative pain and analgesics intake were recorded at 1, 3 and 7 days after endodontic treatment completion. Non‐parametric Mann–Whitney U and Friedman tests and a generalized estimating equation were used to assess differences in pain scores between the groups, within each treatment group at different time points and for correlations, respectively. Results: The study included 195 participants (212 teeth). One participant declined to submit the NRS form. Therefore, 194 participants (211 teeth) were included in the final analysis (99.5% response rate). No statistically significant differences in post‐operative pain or analgesic intake existed between the two groups at any time point (p >.05). Age, pre‐operative pain, apical diagnosis and post‐operative analgesic intake were significantly related to post‐operative pain (p <.05). Conclusions: Sealer‐based obturation technique with CSS was associated with similar post‐operative pain levels and analgesics intake as WVC with RBS. Regarding post‐operative pain, SBO with CSSs may be a suitable clinical alternative. [ABSTRACT FROM AUTHOR]

Aim: To describe the management of the palato‐mesiobuccal (PMB) canal in maxillary second molars with fused roots using conventional techniques. Summary: Root canal treatment success hinges upon effectively addressing the intricate and variable anatomy of molar teeth. Failure to do so can lead to persistent infections and treatment failure. Recent advancements in imaging technologies have provided unparalleled insights into dental anatomy, especially in molars. Among these discoveries is the PMB canal, a unique anatomical variant recently reported for the first time in Endodontic literature. This canal, found in maxillary second molars with fused roots and originating from the coronal third of the palatal canal while traversing towards the mesiobuccal root presents challenges in clinical management due to its location. This article is the first to showcase the management of the PMB canal using conventional techniques. In the first case, a 38‐year‐old male patient presented with asymptomatic irreversible pulpitis in the maxillary second right molar. Following thorough instrumentation and irrigation, the presence of the PMB canal was discovered during root canal preparation. The canal was managed using rotary instruments and obturated successfully, resulting in a symptom‐free tooth at an 8‐year follow‐up. The second case illustrates a similar scenario in a 23‐year‐old female patient presenting with symptomatic irreversible pulpitis in tooth 17. The PMB canal was identified during treatment and managed using rotary nickel‐titanium instruments, leading to a favourable outcome at a 9‐year follow‐up. Key learning points: In fused roots of maxillary second molars, a PMB canal might be expected.Exploration of the buccal wall of the palatal canal under magnification after shaping procedures can reveal the PMB canal orifice in fused roots.Small tapers are suggested for the enlargement of the PMB canal.Continuous bleeding spots in the palatal canal might indicate a possible PMB canal orifice in vital cases.The use of an apex locator is suggested for the differential diagnosis of the PMB canal orifice from a perforation site. [ABSTRACT FROM AUTHOR]

Aim: To investigate what happens to cross‐sectionally identified root‐filled teeth over a 6‐year period, regardless of the time that elapsed since primary root canal treatment, in a cohort of adult patients regularly attending a Public Dental Service. A secondary aim was to investigate how the cumulative events affecting root‐filled teeth over the same time were associated with variables obtained from a baseline examination. Methodology: Adult patients with ≥1 previously root‐filled tooth and regularly attending the Public Dental Service in Örebro County were enrolled for study participation in 2015. General dental practitioners examined all identified root‐filled teeth in this cohort at baseline using a standardized protocol and were also responsible for further decision‐making and treatments. After six years, information on events of the root‐filled teeth was collected from dental records. The highest rating (most invasive treatment) on a 5‐point ordinal scale was used in the analyses. Regression analyses with stepwise selection were performed for associations between patient‐ and tooth‐related factors and events. Results: A total of 445 patients with 1007 root‐filled teeth were followed the entire observation time. Twenty (2.0%) of the root‐filled teeth had endodontic retreatment and 150 (14.9%) were extracted over six years. Among teeth with periapical radiolucency or pain, the majority did not undergo retreatment or extraction; however, the multivariate analysis demonstrated that retreatment or extraction was associated with baseline recordings of teeth with periapical radiolucency (p <.0001), tenderness to percussion (p <.0001), and poor coronal restoration (p <.0001). Conclusions: This study corroborates the notion that in general dentistry, root‐filled teeth with radiological signs of apical disease often remain untreated over time. Furthermore, it also reveals that root‐filled teeth presenting with mild pain do not necessarily receive any intervention. However, teeth with baseline signs of apical periodontitis, pain, or inadequate coronal restoration were more likely to have received intervention during the six‐year period. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusion The aim of this study is to investigate the expression of inflammatory biomarkers (TNF‐α, IL‐10, IL‐1β) and the pulpitis‐associated miRNA (miR‐30a‐5p and miR‐128‐3p) in pulp tissue samples from unrestored teeth with a vital normal pulp (NP), teeth with symptomatic irreversible pulpitis (IP) and in unrestored teeth with periodontal disease, unresponsive to periodontal therapy, and a vital pulp (EP).Thirty patients were included in this observational study (10 teeth with NP, 10 teeth with IP, 10 teeth with EP). Dental pulp tissues samples were collected from patients during root canal treatment (RCT). RNA was extracted and qRT‐PCR of target genes (tumour necrosis factor [TNF]‐α, interleukin [IL]‐1β, IL‐10) and miRNAs (has‐miR‐30a‐5p, has‐miR‐128‐3p) performed to assess the expression profile. Fold‐change in expression was calculated using the formula 2−(ΔCt(Exp)−ΔCt(Ctrl)). One‐way anova with post‐hoc Tukey's was used to determine significant differences between groups. The significance level was set at 5% (p < .05). All teeth were also followed up clinically for 1 year and evaluated for a range of endodontic and periodontal‐related outcomes.All investigated genes significantly increased in expression and miRNAs significantly decreased in expression in the IP and EP groups compared with the NP group (p < .05). With regards to TNF‐α and IL‐1β there were no significant differences in expression between the IP and EP groups (p > .05), whereas IL‐10 expression levels were significantly reduced in the EP compared with the IP group (p < .05). Both miR‐30a‐5p and miR‐128‐3p showed significantly reduced expression in both IP and EP lesions, compared with NP (p < .05); however, no significant differences in miRNA expression were observed between IP and EP groups (p > .05). One year after root canal treatment and periodontal maintenance, tooth mobility and probing depth were significantly reduced in the EP group (p < .05).Pulp tissues from teeth with IP and EP presented similar levels of altered inflammatory markers compared with NP. TNF‐α, IL‐10, IL‐1β cytokines and miRNAs (miR‐30a‐5p and miR‐128‐3p) are potential objective biomarkers to indicate pulpal inflammatory status, aiding diagnosis and directing clinical decision‐making. RCT may be beneficial to improve stage III periodontitis unresponsive to non‐surgical periodontal treatment, but further research is required. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusions The pathways to post‐operative pain are complex and encompass factors that extend beyond the treatment protocol employed. This study aimed to identify patient‐related predictors of post‐operative pain following root canal treatment.A total of 154 patients received a single‐visit root canal treatment for asymptomatic necrotic mandibular molars. Before treatment, dental anxiety, dental fear and sense of coherence (SOC) were measured as predictors for each patient using validated questionnaires. Other measured predictors included gender, age, previous negative experiences at the dental offices and prior root canal treatment. Post‐operative pain was assessed using the Numeric Rating Scale at multiple time‐points over 30 days. Structural equation analysis was employed to evaluate the direct and indirect effects of patient‐related predictors on a theoretical model of post‐operative pain. The irrigant solution was also included in the model, as it was the only aspect that varied in the treatment protocol (sodium hypochlorite 2.5% and 8.25%).Dental anxiety (coefficient 0.028; p < .01), dental fear (coefficient 0.007; p = .02) and irrigant solution (coefficient 0.004; p = .03) exerted a direct effect on post‐operative pain. SOC exerted an indirect effect on post‐operative (coefficient 0.006; p = .01) through dental anxiety and dental fear. Moreover, previous negative experiences (coefficient 0.048; p = .04) exerted an indirect effect on post‐operative pain through dental anxiety.Dental anxiety, dental fear, previous negative experiences and SOC are patient‐related predictors of post‐operative pain following root canal treatment. These factors should be taken into consideration in clinical practice, as patients with these characteristics may be at an increased risk of experiencing post‐operative pain. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusions To evaluate the 6‐year outcome of root canal treatment irrigated with 0.5% or 3% sodium hypochlorite (NaOCl).The baseline trial was designed as a quasi‐randomized clinical trial. Patients referred for root canal treatment to an endodontic specialist clinic were recruited to the study (n = 298). The concentration of NaOCl was allocated quasi‐randomized to 271 subjects (0.5% [n = 139], 3% [n = 132]). Bacterial sampling was performed immediately before root canal filling. Samples were cultured and evaluated as growth or no growth. Patients were invited to a clinical and radiological follow‐up >5 years postoperatively. The clinical outcome measurements were tooth survival, cumulative incidence of endodontic retreatments, patients' assessment of pain, clinical findings and radiological signs of apical periodontitis (AP).Tooth survival was 85.6% in the 0.5% NaOCl group and 81.1% in the 3% NaOCl group (p = .45). There was no record of retreatment in 94.4% in the 0.5% NaOCl group and in 92.2% in the 3% NaOCl group (p = .76). The percentage of asymptomatic cases were 87.8% in the 0.5% group and 85.3% in the 3% NaOCl group (p = .81). Absence of clinical signs of AP was seen in 86.6% in the 0.5% NaOCl group and in 83.6% in the 3% NaOCl group (p = .80). Absence of radiological signs of AP was seen in 74.0% in the 0.5% NaOCl group and 64.1% in the 3% NaOCl group (p = .20). Subjects with positive culture before root filling reported subjective pain with a significantly higher frequency as compared to negative‐culture subjects (p = .014).The use of 0.5% or 3% NaOCl for irrigation during root canal treatment resulted in similar clinical outcomes 5–7 years postoperatively. Persisting bacteria immediately before root filling may predict future episodes of subjective pain. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusions Natural bioactive products have been tested as alternative antimicrobial agents. This study evaluated the effect of Punica granatum extract (PGE) on oral multispecies biofilms.Lyophilized extracts from pomegranate peel were prepared, and the punicalagin content was assessed by ultra‐performance liquid chromatography (UPLC). Oral multispecies biofilms from 2 donors were grown on four collagen‐coated hydroxyapatite discs. After incubation for 7 days or 3 weeks, the biofilms were exposed to water (control), 2% CHX, 10% PGE, 20% PGE or 30% PGE for 3 min. The proportions of dead bacteria were assessed by the live/dead staining and confocal microscopy. After the analysis, the best PGE concentration (30%) was combined with CHX. The experimental phases were repeated using water, 2% CHX, 30% PGE and 30% PGE + 2% CHX. Five random areas of the biofilm on each disc were scanned, resulting in 20 scanned areas for each group.Regarding the biofilm volume, no differences were found amongst solutions (p = .111). The PGE solution killed bacteria effectively in 1‐week, 2‐week and 3‐week‐old‐plaque biofilms, ranging from 37 to 55.3%, depending on the PGE concentration. The 30% PGE (a) (p = .0009) had greater antibiofilm effectiveness than 2% CHX (b), which killed bacteria in the 25.2 to 48.7% range. The 10% and 20% PGE had intermediate values (ab), without significant differences from 30% PGE (p = 1.002). Water (c) had the lowest proportion of dead bacteria (p < .00001) in a range of 5 to 6.7% and lower effectiveness in killing bacteria (p < .05). The PGE alone or mixed with 2% CHX had greater anti‐biofilm effectiveness than CHX (p < .05). The old plaque biofilms were more resistant than the 7‐day‐old plaque (p < .05).The 30% PGE (alone or combined with CHX) exhibited a greater antibiofilm effect on oral multispecies biofilms grown on hydroxyapatite discs than 2% CHX. [ABSTRACT FROM AUTHOR]

Studies investigating the accuracy of diagnostic tests should provide data on how effectively they identify or exclude disease in order to inform clinicians responsible for managing patients. This consensus‐based project was undertaken to develop reporting guidelines for authors submitting manuscripts, which describe studies that have evaluated the accuracy of diagnostic tests in endodontics. These guidelines are known as the Preferred Reporting Items for Diagnostic Accuracy Studies in Endodontics (PRIDASE) 2024 guidelines. A nine‐member steering committee created an initial checklist by integrating and modifying items from the Standards for Reporting of Diagnostic Accuracy (STARD) 2015 checklist and the Clinical and Laboratory Images in Publications (CLIP) principles, as well as adding a number of new items specific to the specialty of endodontics. Thereafter, the steering committee formed the PRIDASE Delphi Group (PDG) and the PRIDASE Online Meeting Group (POMG) in order to collect expert feedback on the preliminary draft checklist. Members of the Delphi group engaged in an online Delphi process to reach consensus on the clarity and suitability of the items in the checklist. The online meeting group then held an in‐depth discussion on the online Delphi‐generated items via the Zoom platform on 20 October 2023. According to the feedback obtained, the steering committee revised the PRIDASE checklist, which was then piloted by several authors when preparing manuscripts describing diagnostic accuracy studies in endodontics. Feedback from this process resulted in the final version of the PRIDASE 2024 checklist, which has 11 sections and 66 items. Authors are encouraged to use the PRIDASE 2024 guidelines when developing manuscripts on diagnostic accuracy in endodontics in order to improve the quality of reporting in this area. Editors of relevant journals will be invited to include these guidelines in their instructions to authors. [ABSTRACT FROM AUTHOR]

Background: Limited evidence is available regarding the superior clinical properties of bioceramic sealers comparted with traditional standard sealers. Objectives: This review aimed to answer the following research questions: 'In healthy patients requiring a root canal treatment (P), what is the efficacy of premixed bioceramic sealers (I) compared with traditional root canal epoxy resin‐based sealers (C) in terms of survival, success rates (PICO1) sealer extrusion and resorption (PICO2) post‐obturation pain (PICO3) (O)?' Methods: Authors independently searched three electronic databases: PubMed (including MEDLINE), Web of Science, Embase and Scopus up to 31 October 2023. This was accompanied by both grey literature and manual search. Detailed selection criteria were applied, namely mature permanent teeth requiring root canal treatment, premixed bioceramic sealer with gutta‐percha as an intervention group, a standard filling technique as control group and full‐text available in English. A random‐effect meta‐analysis was used to synthesize the body of evidence regarding the use of bioceramic sealers in root canal treatment and their impact on post‐obturation pain. Effect sizes were represented as relative risks on a logarithmic scale for binary outcomes and as mean differences for continuous outcomes. Results: A total of 941 articles were identified. Fifteen Comparative clinical studies were finally included. Eleven were randomized clinical trials, and four were prospective clinical trials with control group. The follow‐up of these studies was not greater than 2 years. No publication bias was observed in any study. No significant differences were observed between the two groups in terms of survival and success rates. A small non‐significant lower risk of extrusion was observed for bioceramics. A small, non‐significantly lower post‐operative‐pain within 24‐h was observed when bioceramics were used. Discussion: The majority of current evidence shows inconsistencies in reporting and is of short‐term duration. Robust prospective long‐term trials are needed in this area to better support future recommendations. Conclusion: This systematic review is the first to analyse several clinical outcomes using premixed sealers. Included studies differed in terms of clinical protocol and operator expertise, but reported a similar outcome when comparing bioceramic versus standard sealers. Tooth survival, treatment outcome, post‐operative pain and periapical extrusion were similar and presented no significant differences between the two sealer types. Registration: PROSPERO database (CRD42023449151). [ABSTRACT FROM AUTHOR]

Aim: To compare the effect of different sodium hypochlorite (NaOCl) agitation techniques on an ex vivo oral multispecies biofilm during passive disinfection of simulated immature roots. Methodology: Extracted human teeth were prepared to simulate immature roots. They were infected with a dental plaque‐derived multispecies biofilm and cultured for 14 days. The roots were randomly designated into four groups: (1) negative control (PBS), (2) 1.5% NaOCl (CNI), (3) CNI + Ultrasonic activation (UA), (4) CNI + EasyClean agitation (ECA), (5) CNI + XP‐endo finisher agitation (XPF), and (6) positive control (6% NaOCl). Biofilm samples were collected from the root canals and used to determine the number of viable cells (colony‐forming units), scanning electron microscopy, and 16S rRNA gene sequencing. The mean colony‐forming units per mL (CFU/mL) were analysed using One‐way anova. 16S rRNA sequencing data were analysed for alpha (observed OTUs, Shannon index, and Chao1) and beta diversity (Bray‐Curtis dissimilarities). The LEfSe analysis was used to determine the effect of treatment procedures on the abundance of root canal microbiota. The significance was set at.05. Results: PBS and CNI samples had significantly higher CFU/mL counts than UA, ECA, XPF, and 6% NaOCl samples (p <.05). The pre‐treatment, PBS, and CNI groups had significantly greater alpha diversity than the UA, ECA, XPF, and 6% NaOCl groups (p <.05). NaOCl agitation groups and the 6% NaOCl group achieved a more pronounced reduction in bacteria from the genera Fusobacterium, Actinomyces, Porphyromonas, and Capnocytophaga. Conclusions: The effectiveness of passive disinfection protocols was enhanced by NaOCl agitation techniques, suggesting that this supplementary method can improve the outcome of revitalization procedures. [ABSTRACT FROM AUTHOR]

Endodontic therapy includes various procedures such as vital pulp therapy, root canal treatment and retreatment, surgical endodontic treatment and regenerative endodontic procedures. Disinfection and tissue repair are crucial for the success of these therapies, necessitating the development of therapeutics that can effectively target microbiota, eliminate biofilms, modulate inflammation and promote tissue repair. However, no current endodontic agents can achieve these goals. Antimicrobial peptides (AMPs), which are sequences of amino acids, have gained attention due to their unique advantages, including reduced susceptibility to drug resistance, broad‐spectrum antibacterial properties and the ability to modulate the immune response of the organism effectively. This review systematically discusses the structure, mechanisms of action, novel designs and limitations of AMPs. Additionally, it highlights the efforts made by researchers to overcome peptide shortcomings and emphasizes the potential applications of AMPs in endodontic treatments. [ABSTRACT FROM AUTHOR]

In the last two decades, the activation of root canal irrigants with pulsed lasers as an adjunct in root canal treatment has become increasingly popular. This narrative review explains the physical basics and the working mechanism of laser‐activated irrigation (LAI), explores the parameters influencing LAI efficacy, considers historical evolutions in the field and summarizes laboratory and clinical evidence with emphasis on the antimicrobial action of LAI. Cavitation is the driving force behind LAI, with growing and imploding vapour bubbles around the laser tip causing various secondary phenomena in the irrigant, leading to intense liquid dynamics throughout the underlying root canal. High‐speed imaging research has shown that laser wavelength, pulse energy, pulse length and fibre tip geometry are parameters that influence this cavitation process. Nevertheless, this has not resulted in standardized settings for LAI. Consequently, there is significant variability in studies assessing LAI efficacy, complicating the synthesis of results. Laboratory studies in extracted teeth suggest that, with regard to canal disinfection, LAI is superior to conventional irrigation and there is a trend of higher antimicrobial efficacy of LAI compared to ultrasonic activation. Clinical evidence is limited to trials demonstrating similar postoperative pain levels after LAI versus no activation or ultrasonic activation. Clinical evidence concerning the effect of LAI on healing of apical periodontitis as yet is scarce. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusions Registration Analysis of the survival of root‐filled posterior teeth and the associated prognostic tooth‐related factors will enable clinicians to predict the outcome of root canal treatment.To investigate (i) the survival of root‐filled posterior teeth and (ii) the tooth‐related factors that may affect their survival.Randomized controlled trials, comparative studies and observational studies assessing survival rates of root‐filled posterior teeth with a minimum 4‐year follow‐up period were identified through an electronic search of the following databases up to January 2023: The Cochrane Central Register of Controlled Trials, Medline via PubMed, the Cochrane Database of Systematic Reviews, Embase, Web of Science and NIHR centre for reviews and dissemination. Two reviewers (SP and ML) independently selected the final studies based on pre‐defined inclusion criteria. The Newcastle Ottawa Scale and the Cochrane Risk of Bias Tool for Randomized Trials were used to assess the risk of bias. Pooled weighted survival rates were analysed using a random effects meta‐analysis model using DerSimonean and Laird methods. Descriptive analysis of studies describing any prognostic tooth‐related factors was conducted.Of the 72 studies identified, data from 20 studies were included in the survival meta‐analysis, and data from 13 of these studies were included in the descriptive analysis of tooth‐related factors; 12 studies were retrospective, 7 were prospective, and one was a randomized control trial. The pooled survival rates at 4–7 years and 8–20 years of root‐filled posterior teeth regardless of tooth type was 91% (95% CI, 0.85; 0.95) and 87% (95% CI, 0.77; 0.93), respectively. The prognostic tooth‐related factors mentioned in the included studies were (i) remaining coronal tooth structure, (ii) ferrule, (iii) crown‐to‐root ratio (iv) tooth type and location (v) periodontal disease (vi) proximal contacts and (vii) cracks.The meta‐analysis suggests that root canal treatment has a high medium to long term survival outcome. The narrative summary identified 7 factors that affect tooth survival. However, there is a paucity of evidence, and more research is needed in this area.PROSPERO Registration: CRD42021227213. [ABSTRACT FROM AUTHOR]

Aim: To investigate the prevalence of apical periodontitis (AP) and the technical standard of root canal treatment in a Belgian population, assess the association of different variables with periapical status, and compare the results to a similar study conducted 22 years previously. Methodology: In this cross‐sectional study, 614 panoramic radiographs of first‐time adult attendees at the Dental School of the University Hospital of Ghent were examined. Recorded patient‐level parameters included gender, age, number of teeth, number of root filled teeth, presence of any AP lesion, and number of implants. The following tooth‐level data were collected: tooth presence, coronal status, quality of coronal restoration, post presence, type of root‐filling material, length and density of root filling, root‐end filling material, presence of AP, and adjacent implant. Multivariable multilevel binary logistic regression was used to explore the association between patient and tooth characteristics and AP prevalence. Risk differences and confidence intervals were calculated to compare the present with the previous study. Results: The prevalence of AP at patient and tooth level was 46.9% and 5.6%, respectively. Fifty‐one per cent of the 614 patients had at least one root filled tooth, and 5.9% of the 14 655 teeth studied were root filled. AP was found in 45% of root filled teeth. Fifty‐four per cent of the root‐filled teeth were rated as inadequate. Multivariable multilevel logistic regression revealed that more teeth, more implants, fewer root‐filled teeth, adequate density, adequate coronal restoration, and no caries reduced the likelihood of AP. There were no statistically significant differences between the two studies regarding the prevalence of root‐filled teeth or AP and the technical quality of root canal treatment. Conclusions: The prevalence of AP and the technical quality of root canal treatment in Belgium have not substantially changed over the last 22 years, despite the technological advancements and continuing education in the field. [ABSTRACT FROM AUTHOR]

Background: There is an increased tendency towards adopting minimally invasive interventions in dentistry, supported by advancement in materials and techniques. However, the decision‐making process in choosing conservative or invasive treatments is influenced by several factors, particularly in permanent teeth with irreversible pulpitis. Objectives: The objective of the study was to systematically review the literature regarding factors that influence decision‐making for vital pulp therapy (VPT) as definitive treatment option in permanent mature teeth diagnosed with irreversible pulpitis. Methods: Two independent reviewers searched five electronic databases (PubMed, Embase, Web of Science, Scopus and Cochrane Library). Grey literature was searched through Google Scholar and contact with experts. Defined search keys were applied, and all peer‐reviewed literature published with no language nor publication date limits were included. The All studies investigating the factors influencing treatment decision‐making in mature permanent teeth with irreversible pulpitis were included. The quality of included studies was assessed by two independent reviewers using the Joanna Briggs Institute quality assessment tool. Results: Six articles were included in the review. All included studies used questionnaires to characterize clinician preferences and attitudes in choosing treatment options for mature permanent teeth with irreversible pulpitis. The available evidence suggests that dentist‐related factors have a significant influence on the chosen treatment in teeth with irreversible pulpitis, with speciality training and years of experience influencing the choice of VPT over other treatment options. COVID‐19 reportedly swayed the dentists' decision to favour VPT. Only one article studied the influence of patient‐related factors, such as age and presence of spontaneous pain on decision‐making. Of note, a history of cardiovascular disease moved dentists towards prescribing VPT. Discussion: Collectively, the included studies demonstrated an overriding influence of dentist‐related factors on choosing among treatment options for painful teeth diagnosed with irreversible pulpitis. Patient‐related factors were acknowledged but there are also potential factors such as socio‐economic constraints that were not included in the component studies. Conclusion: In teeth with irreversible pulpitis clinicians educational background influence the decision towards a specific treatment option. Further data, preferably derived from clinical records, is necessary in future investigations to explore the effect of other important factors related to both dentists and patients. Registration: PROSPERO database (CRD42022339653). [ABSTRACT FROM AUTHOR]

Aim: To determine the systemic inflammatory burden, including hsCRP and its monomeric forms, in patients with apical lesions of endodontic origin treated with root canal treatment (RCT). Methodology: Prospective pre‐/post‐study. Apical periodontitis (AP) individuals aged 16–40 were included (N = 29). Individuals received RCT and were followed at 1 and 6 months. Fasting blood samples were obtained. Apical lesions of endodontic origin (ALEO) diameter (mm), and periapical index (PAI), were recorded. The serum concentrations of total hsCRP were determined by turbidimetry. Tumour necrosis factor (TNF)‐α, interleukin (IL)‐6, IL‐10, IL‐1β, and soluble (s) E‐selectin were assessed by Multiplex assay. Additionally, mCRP forms were determined in the serum of AP patients with a baseline moderate to high cardiovascular risk based on hsCRP stratification (hsCRP ≥1 mg/L) by immunowestern blot (n = 15). Also, CRP isoforms were explored in ALEOs from AP individuals (n = 4). Data were analysed with StataV16. Results: Periapical index and ALEO sizes were reduced at both follow‐up visits after RCT (p <.05). Serum levels of TNF‐α, IL‐6, IL‐10, IL‐1β, and sE‐selectin did not show significant differences. CRP was borderline reduced at 1 month (p =.04); however, in AP individuals at cardiovascular risk (hsCRP ≥ 1 mg/L), hsCRP and its monomeric isoform significantly decreased at 1 and 6 months (p <.05). Conclusions: High‐sensitivity CRP and mCRP are reduced after RCT in AP individuals at cardiovascular risk. [ABSTRACT FROM AUTHOR]

Aim: To investigate the association of various pre‐, intra‐ and post‐operative factors on root canal treatment outcome. Methodology: In this cohort study, primary or secondary root canal treatment of mature permanent teeth was performed by a single endodontist in a private practice over 13 years, and followed 1–4 years after treatment. Treatment details and clinical and radiographic data were collected. The proportion of successfully treated teeth and roots based on strict radiographic (periapical index (PAI) ≤2) and clinical criteria (absence of pain, swelling or sinus tract) was estimated. To evaluate joint associations of prognostic factors and treatment success probability, 44 pre, intra‐ and post‐operative factors were investigated using bivariate associations, and a multiple logistic regression model was fitted using Generalized Estimating Equations. Results: 1259 teeth (2445 roots, 3149 canals) were assessed with a recall rate of 91%. The proportion of successfully treated teeth was 79.9% [95% confidence interval 77.7–82.1]. Eleven prognostic factors were identified that significantly reduced the odds ratio (OR) for treatment success at tooth level. Six were preoperative: injury history (OR = 0.05[0.01–0.24]), root PAI (OR = 0.29[0.20–0.42], 0.21[0.13–0.34] and 0.22[0.12–0.42] for PAI = 3, 4 and 5, respectively, against PAI = 1), lesion diameter (OR = 0.30[0.21–0.43] and 0.24[0.16–0.37] for diameters of 1‐5 mm and ≥6 mm, respectively, against no lesion), tooth type (OR = 0.51[0.27–0.97] and OR = 0.45[0.24–0.83] for premolars and molars, respectively, against incisors or canines), tenderness to periapical palpation (OR = 0.64[0.43–0.94]) and two canals per root (OR = 0.67[0.54–0.83]). Four factors were intraoperative: root filling of unsatisfactory quality (OR = 0.18[0.08–0.40]) or extending beyond or shorter than 2 mm from the apex (OR = 0.44[0.26–0.75] and 0.62[0.40–0.97] respectively), resin sealer (OR = 0.58[0.39–0.87] against bioceramic sealer) and single visit treatment (OR = 0.40[0.21–0.75] against multiple visits). One factor was post‐operative: defective coronal restoration (OR = 0.35[0.21–0.56]). Conclusion: The following factors were associated with unsuccessful root canal treatment: (i) history of injury, apical periodontitis with increased severity (larger lesion, higher PAI, tenderness to periapical palpation), or complicated anatomic conditions (premolar or molar, two canals in a single root); (ii) technically suboptimal root filling (of unsatisfactory quality or not ending within 2 mm of radiographic apex) performed in a single‐visit, or use of resin sealer instead of novel bioceramic sealer; (iii) suboptimal quality coronal restoration. [ABSTRACT FROM AUTHOR]

Aim: To investigate patient outcomes from either pulpotomy or pulpectomy for the management of symptomatic irreversible pulpitis, with and without application of antibiotic/corticosteroid pastes in urgent primary dental care settings in the United Kingdom. Methodology: All patients receiving intervention for symptomatic irreversible pulpitis in three different primary care settings were invited to participate. Pre‐operatively, data regarding patients' numerical ratings scale (NRS), pain score (0–10), analgesic use, oral‐health impact profile‐14 (OHIP‐14) and need for time away from work were collected. For 7 days post‐operatively, participants recorded their NRS pain score, global rating of change score, medication use and their ability to work. Analysis used a mixed‐effects model with post hoc Tukey's multiple comparisons test for continuous data and chi‐squared or Fisher's exact test for categorical data. To test the effect of the corticosteroid/antibiotic paste, pulpectomy and pulpotomy groups were combined following Mantel–Haenszel stratified analysis or a weighted average of the difference between pulpotomy and pulpectomy with and without the use of corticosteroid/antibiotic paste. A binary composite score was constructed using pre‐ and post‐operative data, whereby overall treatment success was defined as: (i) patients did not return for treatment due to pain by day seven; (ii) at day three, there was a 33% (or 2‐points) reduction in NRS pain score; (iii) there was a change score of +3 in global rating; (iv) the patient was no longer using analgesia and able to return to work. Results: Eighty‐five participants were recruited, with 83 completing follow up. Overall treatment success was 57%, with 25% of participants returning for more treatment due to inadequate pain relief. Overall treatment success did not differ between the two groups (p =.645), although patients self‐reported greater improvement with an antibiotic/corticosteroid dressing for global rating of change (p =.015). Conclusions: This study identified limited evidence of improved outcomes using antibiotic/corticosteroid dressings in the management of symptomatic irreversible pulpitis in the emergency setting. Further clinical research is needed to understand if these medications are beneficial in affording pain relief, above that of simple excision of irreversibly inflamed pulp tissue. [ABSTRACT FROM AUTHOR]

Aim: There are currently no high‐quality studies comparing the static navigation technique with conventional methods of fibre post removal. The aim of this ex vivo study was to compare the effectiveness of fibre post removal between a static navigation technique and a conventional freehand technique using ultrasonics by experienced and inexperienced operators. Methodology: Forty‐eight extracted single‐rooted human premolars were root‐filled. A fibre post was cemented in all 48 teeth, which were then divided randomly into the following groups: static navigation group using burs; static navigation‐ultrasonic group; and non‐guided group using ultrasonic tips. The following parameters were evaluated for both experienced operators and inexperienced operators: reaching the gutta‐percha root filling successfully, the time required to remove the entire post, the occurrence of lateral root perforations, and the amount of root dentine removed. The Kolmogorov–Smirnov test was used to examine the normality of the data; the anova test was used to compare the significant differences among groups; and Tukey tests were used for all two‐by‐two comparisons. The significance level was set at 0.05. Results: In the static navigation group, the gutta‐percha was reached significantly more frequently than in the non‐guided group (p <.05). The static navigation approach required significantly less time than the non‐guided approach to reach the gutta‐percha (p <.05). The total removal of posts was significantly different between groups (p <.05), but there was no significant difference between experienced and inexperienced operators in the static navigation group (p >.05). More perforations were associated with the non‐guided group than with the other two groups. The total mean loss of dentine in the non‐guided group in all directions was 0.39 (±0.17) mm, with 0.25 (±0.09) mm for experienced, and 0.42 (±0.16) mm for inexperienced operators. Conclusion: When compared to a conventional ultrasonic technique for the removal of fibre posts, the static navigation method using burs resulted in less dentine removal, more rapid access to the gutta‐percha root filling, less overall time to remove the posts, and fewer complications. When using static navigation, there was no difference in performance between experienced and inexperienced operators. [ABSTRACT FROM AUTHOR]

Background: Development of a standardized set of topic‐specific outcomes known as a Core Outcome Set (COS) is important to address issues of heterogeneity in reporting research findings in order to streamline evidence synthesis and clinical decision making. Aim: The aim of the current international consensus study is to identify "what" outcomes to include in the Core Outcome Set for Endodontic Treatments (COSET). Outcomes of various endodontic treatments (non‐surgical root canal treatment, surgical endodontics, vital pulp treatment and revitalization procedures) performed on permanent teeth were considered. Methods: A standard validated methodology for COS development and reporting was adopted. The process involved identification of existing outcomes through four published scoping reviews. This enabled creation of a list of outcomes to be prioritized via semi‐structured patient interviews, e‐Delphi process and a consensus meeting with a range of relevant global stakeholders. Outcomes were prioritized using a 1–9 Likert scale, with outcomes rated 7–9 considered critical, 4–6 are important and 1–3 are less important. Outcomes rated 7–9 by ≥70% and 1–3 by <15% of participants were considered to achieve consensus for inclusion in the COS. The outcomes that did not achieve consensus in the first round were considered for further prioritization in the second Delphi round and consensus meeting. Final decisions about the outcomes to include in COSET were made by voting during the consensus panel meeting using the Zoom Poll function. Results: A total of 95 participants including patients contributed to the COS development process. The consensus panel recommended, with strong consensus, eight outcomes shared across all treatment modalities for inclusion in COSET: pain; signs of infection (swelling, sinus tract); further intervention/exacerbation; tenderness to percussion/palpation; radiographic evidence of disease progression/healing; function; tooth survival; and patient satisfaction. Additional treatment specific outcomes were also recommended. Discussion: Many of the outcomes included in COSET are patient reported. All should be included in future outcomes studies. Conclusion: COSET identified outcomes that are important for patients and clinicians and validated these using a rigorous methodology. Further work is ongoing to determine "how" and "when" these outcomes should be measured. [ABSTRACT FROM AUTHOR]

Background: Several studies have suggested a relationship between AP, as well as the loss of root‐filled teeth (RFT), and hypertension (HTN). Objectives: The aims of this systematic review and meta‐analysis were to investigate the prevalence of AP, and non‐retention of RFT, in hypertensive patients. Methods: A search was performed in PubMed/MEDLINE, Web of Science, Scopus and EMBASE. The inclusion criteria established were studies published until February 2023, comparing hypertensive subjects with controls, assessing the prevalence of AP and/or providing data on the prevalence of non‐retained RFT. Meta‐analysis was performed using the RevMan (analyst) tool to determine the pooled prevalence of AP and loss of RFT. Risk of bias was assessed using the Cochrane Risk‐of‐Bias tool. The quality of evidence was assessed by GRADE. Results: The search strategy identified 454 articles, and only eight met the inclusion criteria. Six studies had analysed the association between AP and HTN and two studies had analysed the association between non‐retention of RFT and HTN. Meta‐analysis showed and overall OR = 1.71 (95% CI = 0.92–3.16; p =.09) for the prevalence of AP among patients with HTN. The prevalence of non‐retention of RFT among patients with HTN has an overall OR = 1.78 (95% CI = 1.60–1.98; p =.000001). The risk of bias in the individual studies was low or moderate, and the quality of the overall evidence has shown a level of certainty very low. Discussion: There is no association between the prevalence of AP and HTN. In addition, hypertensive patients have significantly increased odds of losing RFT. Given the high prevalence of hypertension, it is very common to perform root canal treatments on hypertensive patients. It is imperative to communicate this heightened risk to patients and recommend periodic monitoring of oral health and hypertension, paying special attention to this subset of patients. Registration: PROSPERO CRD42022302385. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate 2‐year changes in periapical trabecular patterns in single‐rooted teeth with apical periodontitis using fractal analysis and periapical index (PAI) after root canal treatment performed with or without BioPure MTAD solution. Methodology: In this randomized clinical trial, 100 patients were selected and randomized to either the BioPure MTAD or the control groups. Initial periapical radiographs were obtained for each participant before and 2 years after root canal treatment. The region of interest in the periapical lesion around the root apex was selected from the paired periapical radiographs, and then, the fractal dimension (FD) was calculated. With regards to the classification of periapical status, PAI was labelled as "healed" (PAI ≤ 2) or "unhealed" (PAI ≥ 3). Results: After 24 months, 28 patients did not comply with the follow‐up and the data of 72 patients were compared. When the initial and the follow‐up PAI scores were compared, the decrease was statistically significant in 33 of 37 teeth (89.2%) and 32 of 35 teeth (91.4%) in the BioPure MTAD and control group, respectively. In both groups, statistically significant increases were observed in FD values after 2 years in all patients (p <.001). No significant difference was found between the two groups amongst decreased PAI scores and increased FD values. Conclusions: Root canal treatments with or without BioPure MTAD irrigation contributed to periapical healing in single‐visit root canal treatment. Two years after root canal treatment, the extent of the periapical trabecular bone radiographically increased, as the FD and PAI data revealed. [ABSTRACT FROM AUTHOR]

Aim: Several factors influence the condition of the periapical tissues associated with root filled teeth. The primary objective of this study was to retrospectively evaluate the extent and speed of bone healing of large periapical lesions associated with nonsurgical root canal treatment or retreatment. The secondary objective was to analyse the relationship between the time to complete healing when analysed using cone beam computed tomography (CBCT) and other possible predictors that affect healing. Methodology: Seventy‐nine patients were treated during the years 2013–2020 with large periapical lesions of endodontic origin (10–15 mm) as observed on intraoral periapical radiographs (IOPAR) were included. IOPAR and CBCT were available before treatment and during the follow‐up (IOPAR every 6 months and CBCT every 12 months). The volume of periapical lesions was calculated by OsiriX Lite software. Variables such as initial volume of the lesion, age, gender, type of treatment or type of root canal filling were compared to identify the differences between healed and unhealed lesions. Pearson's Chi‐square test was used for categorical variables, the t‐test for age and the Wilcoxon test for initial volume of the lesion. The association between time to healing and the variables was assessed using univariate analysis and multivariate analysis. The Wilcoxon test was used to observe the association of healing time with categorical variables and the correlation index was measured with the quantitative variables. Results: Of the 79 cases analysed, 60 lesions (76%) were completely healed as verified by CBCT in a mean healing time of 19 months, of which 60% healed fully between 12 and 18 months. Increase in age of patient and larger initial volume of the lesion were associated with a significantly longer healing time (p <.001). Gender, filling material and type of treatment did not have a significant effect on the healing process (p >.05). Conclusions: Clinicians should be aware that periapical lesions in older patients and larger areas of bone loss take longer to heal. CBCT monitoring of large periapical lesions is critical and it can help clinicians in the decision‐making process. [ABSTRACT FROM AUTHOR]

Aim: To determine the cytotoxicity mechanism of 2.5% calcium hypochlorite [Ca(OCl)2] in L929 fibroblasts and the effect of this solution on human osteoblast‐like cells (Saos‐2) mineralization, compared to that of 2.5% sodium hypochlorite (NaOCl). Methodology: L929 fibroblasts were exposed to Ca(OCl)2 and NaOCl at different dilutions for 10 min. Cell metabolism was assessed by methyl‐thiazole‐tetrazolium (MTT); lysosome integrity, by neutral red (NR) assay; type of cell death, by flow cytometry (apoptosis/necrosis); cytoskeleton, by actin and α‐tubulin fluorescence and cell ultrastructure, by transmission electron microscopy (TEM). The alkaline phosphatase (ALP) activity and mineralized nodule formation were determined in Saos‐2 by thymolphthalein release and alizarin red staining (ARS), respectively. The data were analysed by two‐way anova and Bonferroni's post‐test (α =.05). Results: Ca(OCl)2 promoted higher cell viability and a lower percentage of apoptosis and necrosis than NaOCl (p <.05). Ca(OCl)2 and NaOCl decreased cell metabolism and lysosome integrity, induced the breakdown of microtubules and actin filaments, promoted alterations of rough endoplasmic reticulum and disruption of mitochondrial cristae. Additionally, Ca(OCl)2 did not induce ALP activity and had no effect on mineralized nodules formation. Conclusions: Although Ca(OCl)2 and NaOCl promoted the same cytotoxicity mechanism, Ca(OCl)2 was less cytotoxic than NaOCl. As for ALP activity, no differences were observed between NaOCl and Ca(OCl)2. The production of mineralized nodules induced by Ca(OCl)2 was lower than those induced by NaOCl, but was not different from those induced by the control group. [ABSTRACT FROM AUTHOR]

The article discusses the prevalence and evaluation of postoperative pain following root canal treatment. It highlights the increase in clinical trials focusing on postoperative pain as a primary outcome, but questions the relevance of short-term pain studies in determining the efficacy of different irrigation protocols. The article emphasizes the subjective nature of pain and the presence of confounding factors that make it challenging to attribute pain solely to irrigation. It suggests that longer-term follow-up or the control of various variables is necessary for more meaningful results. The article concludes by suggesting the consideration of objective surrogate outcomes, such as inflammatory markers, in future studies. [Extracted from the article]

Aim: This study aimed to compare the outcome of SCR and Pulpotomy in teeth with deep caries extending at least 75% into dentine. Methodology: This two‐armed, parallel‐group, randomized, superiority trial included vital mature permanent teeth with deep primary or secondary caries diagnosed radiographically as being at least 75% into the thickness of dentine, without clinical signs of symptomatic irreversible pulpitis or radiographic evidence of a periapical lesion. Carious teeth were blindly allocated to receive either SCR or Pulpotomy using computer‐generated randomized patient codes concealed in opaque envelopes. All teeth were reviewed clinically and radiographically at 6 months and 1 year post‐treatment. Using a significance level of p <.05, the log rank test and Cox proportional hazards regression were used to compare the outcome of SCR and Pulpotomy and to identify potential prognostic factors, respectively. Results: In all, 58 teeth in the SCR group and 55 teeth in the pulpotomy group completed treatment, after excluding 6 teeth because they did not complete the allocated treatment and another due to severe periodontal disease. At one year, 57/58 (98.3%) teeth from the SCR group and 48/55 (87.3%) teeth from the Pulpotomy group were available for analysis. One tooth in the Pulpotomy group (2.1%) and eight teeth in the SCR group (14.0%) required the further intervention of root canal treatment (p <.05). There were no other significant prognostic factors for survival. Overall, 91.4% of teeth treated with either SCR or Pulpotomy survived without requiring further intervention over a period of one year. No other adverse events occurred over the review period. Conclusion: Within the limitations of this study, Pulpotomy fares better than SCR in preserving the remaining pulp and periapical health. As a treatment modality, Pulpotomy carries greater cost outlay to patient and takes a longer time to complete treatment than SCR. Long‐term follow‐up is needed to study the pulpal and restorative outcomes of Pulpotomy and SCR. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to assess the tolerance to the new root canal irrigation fluid RISA after root canal treatment (RCT) by evaluating the subject's postoperative well‐being, postoperative pain (PP) and treatment outcome. Methodology: A single‐arm prospective study with 16 subjects (17 teeth) diagnosed with asymptomatic apical periodontitis. Endodontic treatment in one session performed using RISA for root canal irrigation. Well‐being was assessed on the same day and after 24 h by telephone. For pain intensity, a visual analogue scale was used at 0–5 days. Clinical and radiographic evaluations were performed at ≥12 months. Well‐being, occurrence of PP and outcome were qualitatively reported. Friedman test for paired samples and Spearman correlation coefficient were used. Significance was set at p <.05. Results: At the same day and after 24 h, 14/16 subjects felt 'good'. 9/16 presented intra‐ or extra‐oral swelling. The frequency of PP ≥36 (weak) was 82.4%. On the same day, 1 and 2 days postoperatively, there was more pain compared with preoperative pain p <.05. At Day 3, PP equalled preoperative pain (p >.05). 62.5% of subjects needed analgesics Day 0–2. The recall rate was 94.1%, and resolution of apical periodontitis was observed in 87.5%. Conclusions: The well‐being of subjects was good, and the overall PP intensity was low. However, postoperative intra‐ and extra‐oral swelling occurred often. At the recall visit, the effectiveness of the RCT with RISA appeared high (87.5%). The encouraging outcome results plus the fact that RISA has a broader action range than NaOCl in vitro, justify further work on the RISA solution. To reduce postoperative swelling, it is advised to further investigate the optimal way of application of RISA in the laboratory before clinical application is recommended. [ABSTRACT FROM AUTHOR]

Aims: Chitosan‐based biomaterials exhibit several properties of biological interest for endodontic treatment. Herein, a low molecular weight chitosan (CH) solution was tested for its antimicrobial activity against Enterococcus faecalis (E. faecalis) and effects on dentine structure. Methodology: The root canal of 27 extracted uniradicular teeth were biomechanically prepared, inoculated with a suspension of E. faecalis and randomly assigned to be irrigated with either 5.25% sodium hypochlorite (NaClO), 0.2% CH or sterile ultrapure water (W). Bacteriologic samples were collected from root canals and quantified for of E. faecalis colony‐forming units (CFUs). The effectiveness of CH over E. faecalis biofilms was further measured using the MBEC Assay®. Additionally, dentine beams and dentine powder were obtained, respectively, from crowns and roots of 20 extracted third molars. Dentine samples were treated or not with 17% EDTA and immersed in either CH or W for 1 min. The effects of CH on dentine structure were evaluated by assessment of the modulus of elasticity, endogenous proteolytic activity and biochemical modifications. Results: The number of E. faecalis CFUs was significantly lower for samples irrigated with CH and NaClO. No significant differences were found between CH and NaClO treatments. Higher modulus of elasticity and lower proteolytic activity were reported for dentine CH‐treated specimens. Chemical interaction between CH and dentine was observed for samples treated or not with EDTA. Conclusions: Present findings suggest that CH could be used as an irrigant during root canal treatment with the triple benefit of reducing bacterial activity, mechanically reinforcing dentine and inhibiting dentine proteolytic activity. [ABSTRACT FROM AUTHOR]

Background: Pulpitis characterized by spontaneous pain can result in debilitating pain. Dogma has existed to offer only have two treatment options, namely root canal treatment (RCT) or extraction, although pulpotomy has always remained a potential treatment modality. Objective: This review aimed to answer the following research question: 'Does pulpotomy (partial or full) (I) result in better patient and clinical reported outcomes (O), compared with RCT (C) in permanent teeth with pulpitis characterized by spontaneous pain (P) evaluated at various time intervals?' (T). Methods: Two authors independently performed study selection, data extraction and risk of bias assessment. The literature search was conducted in the following electronic databases: Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials. English language clinical trials comparing the patient and clinical reported outcomes between RCT and pulpotomy were included. The meta‐analysis was performed on a fixed‐effect model and the quality of evidence assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results: Two randomized clinical trials were included. Amongst two trials, one has published four reports at different time points involving the same cohorts. The meta‐analysis revealed no difference in postoperative pain (Day 7) between RCT and pulpotomy (OR = 0.99, 95% CI 0.63–1.55, I2 = 0%) and quality of evidence was graded as 'High'. Clinical success was high at year 1, 98% for both interventions, however, decreased over time to 78.1% (pulpotomy) and 75.3% (RCT) at 5 years. Discussion: Pulpotomy is a definitive treatment modality that is as effective as RCT. This could have a significant impact on treatment of such patients affording the advantages of retaining a vital pulp and preventing the need for RCT. Conclusion: This review could only include two trials, hence there is insufficient evidence to draw robust conclusions. The clinical data accumulated so far suggests no difference in pain between RCT and pulpotomy at Day 7 postoperatively and a single randomized control trial suggests that the clinical success rate for both treatment modalities is similar long term. There is a need for more well‐designed trials by different research groups to develop a stronger evidence base in this area. Registration: PROSPERO database (CRD42021259744). [ABSTRACT FROM AUTHOR]

Background: Adjunct therapy refers to any intracanal procedure going beyond chemomechanical preparation with instruments and traditionally delivered irrigants (excluding interim dressings). It is not clear whether and which of these adjunct therapies have a significant impact on the outcome of root canal treatment [healing of apical periodontitis (AP) and other patient‐related outcomes]. Objectives: This systematic review aimed to analyse available evidence on the effectiveness of adjunct therapy for the treatment of AP in permanent teeth, according to a population, intervention, comparison, outcome, time and study design framework formulated a priori by the European Society of Endodontology. Methods: Five electronic databases (PubMed, Embase, Scopus, Cochrane and Web of Science) were searched up to October 2021 to identify clinical studies comparing adjunct therapy to no adjunct therapy in adult patients with AP. Animal studies, reviews, studies with less than 10 patients per arm and studies with a follow‐up time of less than 1 year, or less than 7 days for postoperative pain, were excluded. The quality of the included studies was appraised by the appropriate tools [Risk of Bias 2 (RoB2) for randomized clinical trials (RCTs) and Newcastle–Ottawa Scale for observational studies]. Meta‐analysis was performed using a random‐effects model. The certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results: Fourteen studies (13 RCTs and one retrospective cohort) fulfilled the inclusion criteria for this review. They evaluated different types of adjunct therapy: antimicrobial photodynamic therapy (aPDT; three studies), diode laser canal irradiation (3), Nd:YAG laser canal irradiation (2), Er;Cr:YSGG laser canal irradiation (1), ozone therapy (2) and ultrasonically activated irrigation (UAI) (4). Radiographical healing was reported in seven studies, but meta‐analysis was only possible for UAI (two studies), showing no statistically significant difference in healing after 12 months. Pain after 7 days was reported in seven studies. Meta‐analysis on three studies that used aPDT and on two studies using diode laser irradiation showed no significant difference in the prevalence of pain after 7 days between the control and adjunct therapy. According to RoB2 tool, six studies had a high risk of bias, five studies had some concerns, and two studies low risk of bias. The GRADE assessment revealed a very low strength of evidence for diode laser, and low strength of evidence for PDT, ozone and UAI studies. Discussion: The included studies displayed significant heterogeneity in terms of type of adjunct therapy, technical details per adjunct therapy, outcome reporting and several combinations of these, limiting the potential for meta‐analysis. Conclusions: There is insufficient evidence to recommend any adjunctive therapy for the treatment of apical periodontitis. Registration: Prospero CRD42021261869. [ABSTRACT FROM AUTHOR]

Background: In addition to non‐surgical root canal treatment or retreatment, apical surgery may be carried out to manage teeth with apical periodontitis. However, it is unclear which treatment option is more effective. Objective: To systematically review the effectiveness of apical surgery compared with non‐surgical treatment or retreatment in terms of clinical and patient‐related outcomes in teeth with apical periodontitis. Methods: A literature search of electronic databases, the grey literature, the reference lists of included articles and previous reviews, and a hand search of leading endodontic journals, was conducted. Randomised and non‐randomised control trials, and longitudinal observational studies on patients undergoing surgical (treatment group) and non‐surgical root canal treatment or retreatment (control group) of teeth with apical periodontitis were included. The risk of bias was appraised using the Cochrane risk‐of‐bias tool; ROBINS‐I and the Newcastle‐Ottawa Scale. Results: Five studies, consisting of two randomised clinical trials, two non‐randomised clinical trials, and a retrospective cohort study, were included. The interobserver agreement was high and kappa correlation coefficient was good. In total 529 teeth were available for follow‐up that varied from 6 months to 8.7 years. The overall risk of bias was high for four studies and raised some concerns in one study. Apical surgery showed seemly better results regarding periapical healing and less need for more and further intervention, although tooth survival was higher in the control group. Given the heterogeneity of the studies, meta‐analysis was not possible. Discussion: Previous systematic reviews have conducted an indirect comparison by separately pooling the outcomes of studies analysing either non‐surgical, or surgical, treatment. In this systematic review, only studies that compared both treatments were included. Most results of this and previous reviews were similar. Conclusion: No treatment option showed clear superiority. However, to arrive at statistically supported conclusions there is a need for additional high‐quality comparative trials. Registration: PROSPERO database (Registration number CRD42021260300). [ABSTRACT FROM AUTHOR]

Background: Preoperative pulpal status may influence the outcomes of root canal treatment (RCTx) according to various measures used. Objectives: To compare the effectiveness of RCTx of teeth with a vital pulp versus a necrotic pulp, using a range of clinical and patient‐related outcomes proposed for the development of S3‐level clinical practice guidelines. Methods: A search was conducted in the PubMed‐MEDLINE, Scopus, EMBASE, Google scholar databases and available repositories, followed by hand searches, until 29 March 2022. Clinical studies published in the English language comparing the stipulated outcomes of RCTx of teeth with vital versus necrotic pulp were included. The Newcastle–Ottawa Scale was adapted to assess study quality. Effects of pulpal status were estimated and expressed as risk ratio (RR) using fixed‐ and random‐effect meta‐analyses. The quality of evidence was assessed through the Grading of Recommendations Assessment, Development and Evaluation tool. Results: Twenty‐eight studies published between 1961 and 2021 were included. Five studies have investigated the "tooth survival" outcome, four reported pulpal status was not a significant predictor, consistent with meta‐analysis findings (RR: 1.00; 95% CI: 1.00, 1.00; n = 3). Seven studies reported pulpal status had no significant influence on postoperative pain, regardless of duration after treatment. Sixteen studies have analysed "periapical health," and 11 revealed pulpal status had no significant influence. Meta‐analyses revealed the influence was not significant if preoperative periapical radiolucency was absent (RR: 0.95; 95% CI: 0.90, 1.00; n = 9) but significant if it was present (RR: 1.12; 95% CI: 1.05, 1.19; n = 11). Most studies were classified as "some concerns" (n = 17) to "low" (n = 9) risk of bias RoB. Discussion: Evidence is limited and only available for three outcomes when comparing the effectiveness of RCTx in permanent teeth with vital pulp versus pulp necrosis. Nevertheless, the quality of available evidence was moderate to high. The "periapical health" data heterogeneity could be explained by preoperative radiolucency, thus RCTx was found more effective for prevention than the resolution of apical periodontitis. Conclusions: There was no significant difference in the "tooth survival," "postoperative pain" and "evidence of apical radiolucency" outcomes of RCTx in teeth with vital or necrotic pulps. Registration: PROSPERO database (CRD42021260280). [ABSTRACT FROM AUTHOR]

Background: Regenerative endodontics has evolved in recent years with tissue engineering concepts in particular appearing promising. Endodontic tissue engineering (ETE) describes the various approaches based on the orthograde introduction of scaffolds or biomaterials (with or without cells) into the root canal to achieve pulp tissue regeneration. There are currently no systematic reviews investigating whether ETE is a suitable method for the treatment of endodontic disease in both mature and immature permanent teeth. Objectives: The purpose of this systematic review was to determine the effectiveness of ETE in permanent teeth with pulp necrosis in comparison with conventional endodontic treatment. Methods: We searched MEDLINE, Embase and the Cochrane Library for published reports as well as Google Scholar for grey literature up to November 2021. Included were studies of patients with permanent immature or mature teeth and pulp necrosis with or without signs of apical periodontitis (P) comparing ETE (I) with calcium hydroxide apexification, apical plug and root canal treatment (C) in terms of tooth survival, pain, tenderness, swelling, need for medication (analgesics and antibiotics), radiographic evidence of reduction in apical lesion size, radiographic evidence of normal periodontal ligament space, function (fracture and restoration longevity), the need for further intervention, adverse effects (including exacerbation, restoration integrity, allergy and discolouration), oral health‐related quality of life (OHRQoL), presence of sinus tract and response to sensibility testing (O). An observation period of at least 12 months was mandatory (T) and the number of patients in human experimental studies or longitudinal observational studies had to be at least 20 (10 in each arm) at the end (S). Risk of bias was appraised using the Cochrane risk‐of‐bias (RoB 2) tool. Two authors independently screened the records, assessed full texts for eligibility and evaluated risk of bias. Heterogeneity of outcomes and limited body of evidence did not allow for meta‐analysis. Results: Two randomized clinical trials investigating cell transplantation approaches with a total of 76 participants (40 treated immature teeth and 36 treated mature teeth) were included for qualitative analysis. Both studies had moderate concerns in terms of risk of bias. Due to the lack of homogeneity a meta‐analysis was not possible. Tooth survival for ETE, root canal treatment and apexification was 100% after 12 months. Teeth treated with ETE showed a higher number of cases with positive pulpal responses to sensitivity tests and with blood perfusion compared with root canal treatment or apexification. Discussion: This systematic review highlights that there is limited evidence for ETE approaches. Even though the results of this review suggest a high survival with ETE in mature and immature teeth, there is a moderate risk of bias due to methodological limitations in the included studies, so the overall results should be interpreted with caution. Lack of a robust control group was a common problem during literature screening, and outcomes besides dental survival were reported inconsistently. Future clinical trials need to address methodical as well as assessment concerns and report long‐term results. Conclusion: The benefits and high survival rates reported for ETE techniques suggest that this procedure might be an alternative to conventional procedures for permanent teeth with pulpal necrosis. However, more appropriate studies are needed to derive clinical recommendations. Registration: PROSPERO (CRD42021266350). [ABSTRACT FROM AUTHOR]

Background: The development of endodontic instruments has rapidly advanced, but their impact on endodontic outcome parameters remains unclear. Objectives: This systematic review aimed to answer the following PICOT questions: In patients with apical periodontitis (P) what is the effectiveness of root canal instrumentation ([Q1] performed with contemporary techniques [I] in comparison with 'traditional' techniques [C]] and ([Q2] performed with contemporary engine‐driven NiTi instruments [I] compared with other types of contemporary engine‐driven NiTi instruments [with different design and/or technology] [C]) in terms of clinical and patient‐related outcomes (O)? Methods: After PROSPERO protocol registration, a literature search was conducted using Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials. Grey literature and major journal contents were examined. Two independent reviewers performed the study selection, data extraction and appraisal of included studies. A quantitative meta‐analysis was considered, and statistical heterogeneity and overall quality of evidence were assessed. Results: Nine studies were identified showing substantial methodological differences. Five studies addressed PICOT 1 and three PICOT 2, whereas one study aimed both. A random‐effects meta‐analysis model was considered for the outcome 'radiographic evidence of normal periodontal ligament space or reduction of apical lesion size' (PICOT 1) based on three studies with 332 evaluable participants and showed that contemporary instrumentation was associated with a more favourable outcome (p =.005) compared with root canal preparation with stainless steel instruments (odds ratio = 2.07 [95%‐confidence interval = 1.25–3.44]) with no evidence of statistical heterogeneity (I2 = 0%) but low quality of evidence. Discussion: Albeit a few studies fulfilled eligible criteria, no study had a low risk of bias. Compelling evidence indicating significantly different outcome rates using different endodontic instruments when treating teeth with apical periodontitis is lacking. Conclusions: In terms of healing, the results of the meta‐analysis determined the higher effectiveness of root canal instrumentation performed with contemporary techniques in comparison with conventional stainless steel instruments in patients with apical periodontitis followed for a minimum of 1 year with low quality of evidence. No differences could be demonstrated between preparations with traditional stainless steel and contemporary NiTi instruments for other clinical and patient‐related outcomes. Registration: PROSPERO (CRD42021274642). [ABSTRACT FROM AUTHOR]

Background: Revitalization procedures primarily aim to eliminate clinical symptoms and heal periapical lesions. Objectives: The objective of the study was to elucidate the effectiveness of revitalization in treating apical periodontitis in necrotic mature and immature permanent teeth based on the following PICO question: In patients with permanent immature or mature teeth and pulp necrosis with or without signs of apical periodontitis (P) what is the effectiveness of revitalization (I) in comparison with calcium hydroxide apexification, apical plug and root canal treatment (C) in terms of tooth survival, pain, tenderness, swelling, need for medication (analgesics and antibiotics), radiographic evidence of reduction of apical lesion size, radiographic evidence of normal periodontal ligament space, radiographic evidence of increased root thickness and length (not for mature teeth), tooth function (fracture and restoration longevity), need for further intervention, adverse effects (including exacerbation, restoration integrity, allergy and discolouration), oral health‐related quality of life (OHRQoL), presence of sinus tract and response to sensibility testing (O). (T) = Defined as a minimum of 1 year and maximum of as long as possible for all outcome measures, except 'pain, tenderness, swelling, need for medication (analgesics)', which is a minimum of 7 days and maximum of 3 months and OHRQoL which is minimum of 6 months and a maximum of as long as possible. Methods: Three databases (PubMed, Embase and Cochrane Library) were searched for human, experimental and observational studies in English, complemented with hand search, until 31/10/2021. Studies recruiting teeth with pulp necrosis (with/without apical periodontitis), with minimum 10 teeth/arm at the end of the study and with a follow‐up of at least 1 year, were included. Records without an abstract and a full text were excluded. The qualitative analysis of the included (non‐) randomized controlled clinical trials was performed with the Revised Cochrane risk‐of‐bias tools (RoB 2 and ROBINS‐I). Meta‐analysis for survival and success (including a subgroup analysis for mature/immature permanent teeth) was performed using the Mantel–Haenszel method. The certainty of evidence was assessed using GRADE (Grades of Recommendation, Assessment, Development and Evaluation). Results: From the 365 identified records, five met the inclusion criteria. The 12 months survival rate was 100% for all (im)mature permanent teeth in all groups (3 studies). The success rate at 12 months was 100% for immature permanent teeth for I and C (1 study), however, reduced to 92% and 80% for mature teeth in I and C respectively (1 study, p >.05). The risk of bias for the most critical outcome (survival) was high for two studies and low for one. For the critical outcome success, all assessed studies were highly biased. Meta‐analyses provided pooled relative risk with no statistically significant difference between I and C for both survival (RR = 1.00, 95%CI = 0.96–1.04, p = 1.00) and success (RR = 1.06; 95%CI = 0.83–1.35, p =.66). The evidence level for survival was kept 'low' and for success was downgraded to 'very low' due to inconsistency and imprecision. Discussion: The survival and success rates were favourable in all included studies and for all groups; however, these outcomes are not reliable due to the low certainty level. Clinically, the most reported adverse event was tooth discolouration, hence the application of bismuth oxide containing calcium silicate cements should be avoided in revitalization. Radiographically, caution is needed when assessing periapical bone healing and further root development with periapical radiographs, due to multifactorial inaccuracies of this imaging technique. Methodological and assessment concerns need to be addressed in future clinical trials. Long‐term results are necessary for studies reporting revitalization of mature permanent teeth, as they seem to be experimental so far. Conclusions: No robust evidence was discovered to support that revitalization is effective to treat apical periodontitis in (im)mature permanent teeth. The success and survival rates of revitalized and fully pulpectomized (im)mature permanent teeth did not differ significantly. Registration: Prospero: CRD42021262466. [ABSTRACT FROM AUTHOR]

Background: Sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) and/or calcium hydroxide (Ca(OH)2) are commonly used during root canal treatment. Evaluation of their effectiveness regarding clinical and patient‐related outcomes requires further understanding. Objectives: To assess the effectiveness of root canal irrigation and dressing for the treatment of teeth with apical periodontitis (AP). Methods: A search was conducted in the PubMed‐MEDLINE, Scopus, EMBASE, Google scholar databases and available repositories, followed by hand searches, until July 2021. Eligibility criteria followed the a priori formulated Population, Intervention, Comparator, Outcomes, Timing, and Study design (PICOTS) framework. Clinical studies restricted to English language were included. The revised Cochrane risk‐of‐bias tool for randomised trials (RoB 2) was used to assess the quality of included studies. Meta‐analyses were performed using the fixed‐effect model to obtain Risk Ratio (RR) and 95% Confidence Interval (CI), with sensitivity analysis. Overall quality of evidence of meta‐analyses was assessed through the Grading of Recommendations Assessment, Development, and Evaluation tool. Results: The search identified 1357 records of which six fulfilled the inclusion criteria, providing data for 'irrigation' from 212 teeth and for 'dressings' from 438 teeth. Two studies reported no significant difference regarding the outcome 'pain at 7 days' using 2% chlorhexidine vs. 5.25% NaOCl and EDTA or after using different concentrations of NaOCl (1% vs. 5%). No significant difference was detected between different NaOCl concentrations regarding the reduction of AP. A meta‐analysis was possible for the comparison of single‐visit (SV) versus multiple‐visits including the use of Ca(OH)2 demonstrating a significant effect in favour of SV (RR: 1.10; 95% CI: 1.03–1.19; p =.007; I2 = 0). RoB of included studies was moderate to low. Discussion: The use of Ca(OH)2 for the treatment of AP may not be beneficial. There is scarce or no evidence fulfilling the proposed PICOTS regarding irrigants and dressings. Conclusions: There is moderate certainty that SV treatment is associated with better radiographic evidence of normal periodontal ligament space (strict criteria) compared with the use of Ca(OH)2. Reduction of AP is comparable after irrigation with 1% and 5% NaOCl, whereas postoperative pain at 7 days for the irrigants assessed is similar. Registration: PROSPERO database CRD42021260271. [ABSTRACT FROM AUTHOR]

Background: Intentional replantation (IR) to treat disease of endodontic origin remains controversial. While IR has been advocated by some clinicians as another valid treatment option, others consider it as a treatment procedure of last resort. Objective: To systematically review and critically evaluate the effectiveness of IR compared with nonsurgical root canal treatment/retreatment or apical surgery in terms of clinical and patient‐related outcomes in managing permanent teeth with apical periodontitis (AP). Methods: A literature search of five databases (PubMed, Embase, Scopus, Web of Science and Cochrane Central register of Controlled Trials), and the grey literature (Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, DART‐Europe E‐theses Portal, British Library E‐Theses Online Service), from inception to November 2021, was conducted. Randomised clinical trials, comparative clinical trials (CCTs), nonrandomised, retrospective, and prospective comparative cohort and case–control two arm studies which evaluated clinical and/or patient‐related outcomes of permanent teeth with AP treated with IR compared with nonsurgical root canal treatment/retreatment or apical surgery were identified. The quality of the studies was appraised using the Cochrane risk of bias tool for randomized trials (RoB 2.0), the Robins‐I for nonrandomized controlled clinical trials and the Newcastle‐Ottawa scale for observational studies. Two independent reviewers were involved in the literature selection, performed the data extraction and the appraisal of the studies identified; disagreements were resolved in conjunction with a third reviewer. Results: No comparative study was identified from the literature search. Four longitudinal studies (one prospective and three retrospective) were identified during the screening of titles and abstracts but were excluded after reading the full text, because only IR was evaluated (single arm studies). Discussion: The available evidence on IR is mainly based on observational studies, which reported high overall mid‐ to long‐term survival, and low complication rates. The results suggest that IR may represent an alternative treatment procedure to solve problems of endodontic origin. However, in the absence of high‐quality evidence from CCTs, clinical decision‐making should be on a case‐by‐case basis and in accordance with the clinician's experience and the patient's preference. Conclusion: Clinical studies showed that IR may be a treatment modality to manage problems of endodontic origin. However, clinical trials comparing the effectiveness of IR with nonsurgical root canal treatment/retreatment or apical surgery are still required given the paucity of evidence. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate whether single‐nucleotide polymorphisms (SNPs) in the genes encoding 5‐HTR2A (5‐Hydroxytryptamine (serotonin) receptor 2A) and MTNR1A (melatonin receptor 1A) may contribute to postoperative pain perception after root canal treatment. We hypothesised that SNPs in HTR2A and MTNR1A genes were associated with postoperative pain after root canal treatment. Methodology: This genetic cohort study enrolled patients with single‐rooted teeth diagnosed with pulp necrosis and asymptomatic apical periodontitis before root canal treatment. Root canal treatment was performed in one session using a standardized protocol. Postoperative pain and tenderness were assessed using a visual analogue scale (recorded every day for 7 days and on the 14th and 30th days after root canal treatment). Genomic DNA was extracted from saliva and used to genotype the SNPs in HTR2A (rs4941573 and rs6313) and MTNR1A (rs6553010, rs6847693 and rs13140012) using real‐time polymerase chain reaction. Genotypes were compared using univariate and multivariate Poisson regression with generalized estimating equations (p <.05). Results: In total, 108 patients were enrolled in this study. The SNPs rs6553010 (MTNR1A), rs4941573 and rs6313 (HTR2A) were associated with an increased risk of developing pain after root canal treatment (p <.05). Conclusions: This study suggests that SNPs in HTR2A and MTNR1A influence pain response after root canal treatment. [ABSTRACT FROM AUTHOR]

Aim: To compare two flat‐side single‐file rotary instruments with three single‐file reciprocating systems through a multimethod assessment. Methodology: A total of 290 new NiTi single‐file rotary (AF F One Blue 25/0.06 and Platinum V.EU 25/0.06) and reciprocating (One Files Blue R25, Reciproc Blue R25, Reciproc R25) instruments were selected, carefully examined for any major deformations, and evaluated regarding their macroscopic and microscopic design, nickel and titanium elements ratio, phase transformation temperatures, and mechanical performance (time/rotation to fracture, maximum torque, angle of rotation, microhardness, maximum bending, and buckling strengths). One‐way anovapost hoc Tukey, T‐test, and nonparametric Mood's median tests were used for statistical comparisons (α = 5%). Results: Tested instruments had identical blade counts and near‐identical helical angles of approximately 24° (rotary instruments) and 151° (reciprocating instruments). The flat‐side analysis revealed a few inconsistencies, such as discontinuity segments, different orientations, and gaps in the homogeneity of the bluish colour. Microscopically, flat‐side instruments exhibited blade discontinuity and an incomplete S‐shaped cross‐section. The surface finish was smoother for One Files Blue and more irregular for both rotary instruments. There were distinct phase transformation temperatures amongst all instruments. All heat‐treated instruments were in R‐phase arrangement, and Reciproc was in R‐phase plus austenite at test temperature (20°C). Compared with the reciprocating instruments, both flat‐side instruments exhibited lower results in the cyclic fatigue tests using two different clockwise kinematics, maximum torque, angle of rotation, and maximum buckling strength (p <.05). The rotary systems also exhibited low flexibility (p <.05). AF F One Blue had the lowest microhardness, whilst Reciproc had the highest value. Conclusion: This multimethod investigation revealed that the flat‐side rotary instruments underperformed the reciprocating instruments regarding cyclic fatigue (with two different clockwise kinematics), maximum torque, angle of rotation, maximum buckling strength, and flexibility. Manufacturing inconsistencies were also observed in some of the flat‐side instruments, including discontinuity segments, different orientations, and in the homogeneity of their bluish colour given by the heat treatment. [ABSTRACT FROM AUTHOR]

These may be related to a "structure" (such as anatomy), a "disease" (such as pulp and periapical diseases), a "material" (such as bioceramic materials) or a "procedure" (such as diagnostic and root canal treatment procedures). Consensus, controversial terms, endodontics, root canal treatment, glossary 5 Ahmed, H.M.A., Versiani, M.A., De-Deus, G. & Dummer, P.M.H. (2017) A new system for classifying root and root canal morphology. Keywords: consensus; controversial terms; endodontics; glossary; root canal treatment EN consensus controversial terms endodontics glossary root canal treatment 788 791 4 06/13/23 20230701 NES 230701 INTRODUCTION Scientific terminology is an essential tool of communication as it plays a critical role in the understanding of scientific and technical terms and their associated definitions (Sageder, [34]). [Extracted from the article]

The article explores the concept of the Metaverse and its potential applications in the field of endodontics. The Metaverse is a virtual reality universe that combines elements of the physical and digital worlds, allowing for real-time communication and dynamic interactions with digital objects. In the context of endodontics, the Metaverse could be used for patient-clinician consultations, digital education, diagnostics, and therapeutics. It offers the possibility of remote dental consultations, reducing the need for travel and wait times, while also reducing anxiety and fear in patients. The integration of the Internet of Dental Things (IoDT) with the Metaverse presents opportunities for advancements in dentistry, such as the use of wearable oral sensors for early detection of dental caries. The Metaverse also enables collaboration among specialists and provides virtual educational models for dental students. Additionally, advanced metaverse headsets can enhance precision in root canal treatments and provide pain relief for patients. However, challenges such as data privacy and technological limitations need to be addressed. Overall, further exploration and evaluation are needed to determine the effectiveness and safety of Metaverse technology in endodontics. [Extracted from the article]

Aims: To evaluate and compare the treatment outcome of root filled teeth with apical periodontitis treated either non‐surgically or by endodontic microsurgery, and to assess the influence of an intra‐radicular post, clinical and demographic factors. Methodology: Clinical and radiological data from 1157 patients with apical periodontitis in previously root filled teeth treated by postgraduate students at the Department of Endodontics, University of Oslo, between September 2010 and January 2020 with recall data at least 11 months from completion were studied. Surgical cases were scored using the Rud/Molven criteria and grouped into success, uncertain or failure at control. Non‐surgical cases were scored with the periapical index (PAI) and similarly grouped into success, uncertain or failure at control. Chi‐square analyses were used for comparison of subgroups of teeth treated and logistic regression analyses for assessment of the influence of clinical variables. Results: Non‐surgical retreatment was performed on 351 teeth and 107 teeth were treated with endodontic microsurgery, with overall success rates of 65.5% and 77.6%, respectively. The difference was statistically significant. Teeth with an intra‐radicular post treated non‐surgically (n = 30) were successful in 73.3% of cases, whereas teeth with intra‐radicular post treated with endodontic microsurgery (n = 30) had a lower, 66.7% success rate. The distribution of tooth groups (anterior, premolar and molar) differed significantly between surgical and non‐surgical cases, with maxillary anterior and premolar teeth more often treated surgically. Non‐surgical retreatment cases were significantly influenced by patients' age (older patients had poorer outcome) and pre‐operative PAI score (negatively correlated with outcome). Surgical cases were not significantly influenced by the factors studied here. Conclusions: The tooth type differed significantly for teeth treated by surgical versus non‐surgical methods. Microsurgical treatment with apicectomy and retrograde filling showed significantly better treatment results than non‐surgical retreatment of teeth with apical periodontitis, whereas treatment outcome in teeth with posts after non‐surgical treatment tended to be better than after surgical treatment. Outcome of non‐surgical retreatment was negatively influenced by older age and higher pre‐operative PAI score. [ABSTRACT FROM AUTHOR]

Observational studies play a critical role in evaluating the prevalence and incidence of conditions or diseases in populations as well as in defining the benefits and potential hazards of health‐related interventions. There are currently no reporting guidelines for observational studies in the field of Endodontics. The Preferred Reporting Items for study Designs in Endodontology (PRIDE) team has developed and published new reporting guidelines for observational‐based studies called the 'Preferred Reporting items for OBservational studies in Endodontics (PROBE) 2023' guidelines. The PROBE 2023 guidelines were developed exclusively for the speciality of Endodontics by integrating and adapting the 'STrengthening the Reporting of OBservational studies in Epidemiology (STROBE)' checklist and the 'Clinical and Laboratory Images in Publications (CLIP)' principles. The recommendations of the Guidance for Developers of Health Research Reporting Guidelines were adhered to throughout the process of developing the guidelines. The purpose of this document is to serve as a guide for authors by providing an explanation for each of the items in the PROBE 2023 checklist along with relevant examples from the literature. The document also offers advice to authors on how they can address each item in their manuscript before submission to a journal. The PROBE 2023 checklist is freely accessible and downloadable from the PRIDE website (http://pride‐endodonticguidelines.org/probe/). [ABSTRACT FROM AUTHOR]

Aim: There are currently no prospective studies evaluating the long‐term outcomes of non‐surgical root canal treatments beyond 5 years, both in terms of treatment success and tooth preservation, and identifying factors predictive of treatment outcome. The aim of the present work was therefore to fill this gap by assessing these outcomes over time and identifying predictive variables based on systematic data collection over a 25‐year period. Methodology: Data concerning the treatments (N = 2500) were systematically collected since 1990. Information was recorded among clinical, technical, radiographic and patient‐related characteristics, i.e., approximately 150 variables for each treatment. The data were analysed regarding both treatment success and tooth preservation by multivariable Cox proportional hazards model, and survival curves were generated. The statistical significance level was set at 0.0125. Results: In total, 56.4% of the treatments could be followed over time (0–25 years, mean = 6.5 years, median = 5 years). Survival probability decreased almost linearly for treatment success, with about 85% after 5 years and 60% after 20 years, and for tooth preservation, with about 90% at 5 years and 50% at 20 years. The variables significantly associated with treatment failure were: pre‐operative pain (Hazard Ratio—HR = 1.56 [95% CI 1.23–1.97]), persistent pain (HR = 2.63 [95% CI 1.44–4.80]), good operator rating of treatment prognosis (HR = 0.46 [95% CI 0.36–0.58]), size of periapical bone radiolucency (HR = 1.88 [95% CI 1.67–2.11]), and tooth type (p =.0006). For tooth extraction, they were: combined endodontic‐periodontal lesion (HR = 3.37 [95% CI 1.88–6.05]), pre‐existing complication before treatment (HR = 1.67 [95% CI 1.26–2.21]), good operator rating of treatment prognosis (HR = 0.45 [95% CI 0.33–0.60]), clinical failure of root canal treatment (HR = 2.78 [95% CI 1.98–3.89]) and tooth type (p =.0012). Conclusion: Root canal treatment success and tooth preservation on the arch are not static outcomes, but evolve with time. Among a substantial set of potential predictors, only a small proportion was significantly predictive of treatment success and tooth preservation, most of them being disease and patient characteristics, and not technical aspects, except pre‐existing complications. These observations challenge the importance frequently given to byzantine considerations related to the numerous technical details of endodontic procedures, as opposed to general concepts of good clinical practice. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to compare the frequency of root filled teeth and quality of root fillings (RFs) in two parallel, Danish cohorts each examined over 10 years and to evaluate factors associated with apical periodontitis (AP) and extraction of root filled teeth. Methodology: Two randomly selected cohorts (C1, C2) from Aarhus (age: 20–64 years) were followed for approximately 10 years, with full‐mouth radiographic surveys performed at 5‐year intervals (C1: 1997–2003–2008; C2: 2009–2014–2019). Frequency of root filled teeth, quality of RFs and coronal restorations, periapical status and tooth extraction were registered. Logistic regression analyses compared C1 with C2 for baseline and follow‐up periods and assessed variables associated with AP (PAI‐based) and extraction of root filled teeth. Results: C1 included 330 and C2, 170 individuals, mean age 42.9 and 47.3 years, respectively, who attended all three radiographic examinations. The relative frequency of root filled teeth was lower in C2 than C1 at baseline (C1: 4.7%, C2: 3.6%; p <.001) and after 10 years (C1: 5.7%, C2: 4.2%; p <.001). The relative frequency of new RFs was lower in C2 than in C1 (p =.02). C2 had fewer short/long RFs at baseline than C1; quality of new RFs or coronal restorations was similar in C1 and C2. The risk of tooth extraction (p =.93) and risk of AP (p =.37) at 10‐year follow‐up was similar between the two cohorts. For both C1 and C2, root filled teeth with AP at baseline had increased risk of having AP (p <.001) or having been extracted (p <.001) at follow‐up. Risk of extraction was higher for root filled premolars (p =.01) and molars (p =.01) than anteriors. Risk of AP at follow‐up was higher for root filled molars (p <.001). Furthermore, inadequate quality of RFs (p =.02) and coronal restorations (p =.04) increased the risk of AP at follow‐up in C1 and C2. Conclusions: The frequency of root filled teeth and new RFs decreased and little to no change in new RFs' quality, AP, or tooth extraction was seen over time (1997–2019). Root filled molars and teeth with AP at baseline had increased risk of AP and extraction. [ABSTRACT FROM AUTHOR]

Healthcare is an expensive endeavour, and it is likely that costs for endodontic treatment will grow over the next decade. The assessment of costs and, in most cases, health outcomes, and the comparison of the cost‐health ratio of interventions, is at the heart of health economics. The present review aims to introduce the main concepts of health economic analysis, to systematically review the existing economic endodontic literature, and to deduce further action for the community. Overall, the identified body of evidence on the health economics of endodontic therapies is heterogenous and has several limitations: Not all studies identified robust data to inform their analyses and many relied on a wide range of assumptions, which were only explored for their impact in a limited way. However, a number of themes were identified from the review: (1) Maintaining pulpal vitality is preferable over root canal treatment if possible when it comes to cost‐effectiveness. (2) Retaining teeth is usually more cost‐effective than removing and replacing them. (3) Endodontic retreatment may be clinically indicated, but not always cost‐effective, and should hence be considered carefully. In conclusion, the general sparsity of economic analyses is a concern, as decision makers such as commissioners or those funding dental care increasingly rely on them. The endodontic community is called to action to improve the competency of both researchers to conduct such analyses and consider them when planning research, but also clinicians who should factor in health economics when assigning interventions. Health economics should become an accepted pillar of endodontic research. [ABSTRACT FROM AUTHOR]

This paper undertakes a broad and comprehensive synthesis of relevant clinical, biological, biomechanical, technical and healthcare services data to understand the factors affecting outcomes of periapical healing after root canal (re)treatment. The medical and dental evidence‐based era (1980–present) is contextualized with the earlier evidence drive in endodontics (1911–1940) triggered by the focal infection era. The current evidence‐based approach has a sharper focus on evidence quality and derivation of practice guidelines. Contrary views question whether guideline‐driven, or expertise‐development‐driven endeavours would best serve outcome improvement in society. The endodontic discipline functions in a broad healthcare framework and sustains industrial, economic and trend pressures that may be deemed to influence outcomes. The nature of root canal treatment and the challenges in determining the factors that affect its outcomes is discussed. The factors potentially affecting periapical healing after root canal treatment are classified into pre‐operative, intra‐operative and postoperative groups. These categories subsume multiple elements with interactive influences, creating a complex picture, further confounded by some apparently surprising, counter‐intuitive and contradictory findings. The technical versus biological conundrum in root canal treatment continues to cause cognitive dissonance. However, due reflection and cross‐discipline‐synthesis resolve the apparent data conflicts into a very simple, consistent and plausible picture of how root canal treatment works and the key factors that affect periapical healing. Root canal retreatment is considered mainly in the context of its differences from primary treatment as the majority of factors influencing outcomes are common to both. The exceptional difference is that retreatments have a proportionately reduced probability of healing by virtue of compromised apical root canal ramification access or modified host/infection interactions. Root canal (re)treatment outcomes are dominantly influenced by the nature of prior dynamic host/infection interaction (pre‐operative patient factors) and how the direction of this dynamic is influenced by two factors: (1) the active efficacy of the operators' root canal treatment protocol to sustain a microbial ecological shift (intra‐operative treatment factors) and dampen periapical inflammation; and (2) the passive ability of the functional tooth (and its restoration margin) to maintain its integrity to resist infection reversal (postoperative restorative factors). [ABSTRACT FROM AUTHOR]