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Objectives: Computed tomography (CT) and cone beam computed tomography (CBCT) represent the main imaging modalities used in rhinosinusitis patients and are also important in odontogenic sinusitis (OS) diagnostics. Reports, however, often lack information on dentition. Here, we aimed to determine how maxillary dentition is initially interpreted in rhinosinusitis patients' CT/CBCT reports and which dental findings in particular are potentially missed, thus needing more attention. Study design: CT/CBCT scans and radiological reports from 300 rhinosinusitis patients were analysed focusing specifically on dental findings. An experienced oral and maxillofacial radiologist re-evaluated the scans and the assessment was compared to the original reports using the McNemar test. Results: From the 300 original reports, 233 (77.7%) mentioned the maxillary teeth. The most frequent statement (126/300, 42.0%) was 'no apical periodontitis'. Apical periodontitis and severe alveolar bone loss were significantly overlooked (p < 0.001). Amongst the 225 patients for whom the CT/CBCT report initially lacked information on dental pathology, 22 patients were diagnosed with apical periodontitis and 16 with severe alveolar bone loss upon re-evaluation. Conclusions: Dental pathology remains underreported in rhinosinusitis patients' CT/CBCT reports. Because these reports affect OS diagnostics, a routine and structured review of the maxillary teeth by a radiologist is necessary. Such examinations should encompass the maxillary teeth. [ABSTRACT FROM AUTHOR]

Objective: Unusual or unexpected effect of treatment Background: Vital pulp therapy approaches are preferred over non-surgical root canal treatment, giving the advantage of preserving the vitality of the dental pulp and thus maintaining its benefits. Such approaches can be performed in teeth having normal apical area; however, performing vital pulp therapy approaches in teeth associated with periapical pathology remains controversial. Case Report: We present a case of a mature mandibular right first permanent molar tooth in a medically fit 10-year-old female diagnosed as asymptomatic irreversible pulpitis with asymptomatic apical periodontitis with periapical radiolucency having a periapical index (PAI) score of 4. Partial pulpotomy was performed instead of non-surgical root canal treatment due to uncooperativeness of the patient. Biodentine was used as a pulp capping material. The tooth was restored with resin composite permanent restoration. Six months after the procedure, an intraoral periapical radiograph revealed normal bone features with complete periapical pathology healing and development of intact lamina dura around the mesial and distal roots. The tooth responded normal to electric pulp testing (EPT), cold, percussion, and palpation tests. Conclusions: Periapical pathology involvement having large periapical radiolucency exhibiting PAI score 4 in inflamed dental pulp tooth diagnosed as irreversible pulpitis does not necessitate non-surgical root canal treatment. Partial pulpotomy should be considered as an alternative treatment to promote the return dental pulp and periapical tissue to a healthy condition. Considering a similar approach in older patients would be interesting to gain a more comprehensive understanding of its potential as a treatment method. [ABSTRACT FROM AUTHOR]

BACKGROUND: Periodontitis is an inflammatory and destructive disease with plaque biofilm as the main pathogenic material, which occurs in the gingiva, periodontal ligament, alveolar bone and cementum. The antigen of bacterial complex and its secreted toxin and enzyme directly lead to the destruction of periodontal tissue and trigger the host’s immune response, causing indirect damage to the body tissue. Silence information regulatory factors (Sirtuins, SIRTs) play an important role in anti-aging, anti-oxidative stress, regulating inflammation, and mediating autophagy, and are closely related to the occurrence and development of periodontitis. OBJECTIVE: To review the research status of Sirtuins in periodontitis. METHODS: The first author used the computer to search the relevant research regarding the role of Sirtuins in periodontitis in PubMed, Web of Scene, CNKI and WanFang databases. The key words were “Sirtuins, Sirtuin1-7, periodontitis” in English and Chinese. After literature screening, 57 articles were included for review and analysis. RESULTS AND CONCLUSION: SIRT1, SIRT2, SIRT3, and SIRT6 participate in regulating the occurrence and development of periodontitis. Inhibition of SIRT1 expression may be the target of periodontitis treatment, while overexpression of SIRT1 can inhibit periodontitis and protect periodontal tissue. The activator of SIRT1 can reduce the inflammation of periodontal tissue and improve the systemic pathological changes caused by periodontitis. SIRT2 is involved in nicotinamide phosphoribosyltransferase-mediated periodontal inflammation and plays a role in the treatment and prognosis of periodontal diseases. SIRT3 can improve age-related periodontal disease. Gastrodin promotes the osteogenic differentiation of periodontal ligament stem cells through the up-regulation of SIRT3. The activator of SIRT3 reduces the damage of periodontitis to periodontal and renal tissues by regulating the level of autophagy in the cells. SIRT6 can inhibit the inflammatory reaction of periodontal tissue and inhibit the differentiation and mineralization of cementoblasts. SIRT6 is beneficial to the prognosis of periapical periodontitis. The relationship between SIRT4, SIRT5, SIRT7 and periodontitis is rarely reported. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to retrospectively assess the prevalence and efficacy of endodontic treatments in Turkish subpopulations, as well as the relationship between the type of coronal restorations, procedural errors, and their association with the periapical status of treated teeth. Methods: Cone beam computed tomography (CBCT) images of 500 patients were analyzed. A total of 10500 teeth were evaluated and 1185 of those had received root canal therapy. Periapical condition, coronal restoration, and root canal quality of these teeth were evaluated. Periapical status was evaluated by two observers regarding to CBCT periapical index scoring system. The chi-square test was used to evaluate all data for statistical analysis. Results: Healthy periapical status was seen in 44.9% of endodontically treated teeth. Teeth with procedural errors (broken instrument, untreated canal, perforation, ledge formation, short or overfilled canals, inadequate filling) showed more periapical pathosis than teeth with good endodontic treatment (p<0.05). Additionally, it was found that teeth with sufficient coronal restoration had lower prevalence of apical periodontitis. However, existence of post did not effect periapical status (p<0.05). Conclusion: The effectiveness of the root canal treatment and the periapical status were considerably influenced by the quality of coronal restoration. [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: Rev‐erbα has been reported to regulate the healing of inflammatory lesions through its effect on the immune system in a variety of inflammatory disease. Moreover, the balance of macrophages polarization plays a crucial role in immune response and inflammatory progression. However, in refractory periapical periodontitis (RAP), the role of Rev‐erbα in inflammatory response and bone resorption by regulating macrophage polarization remains unclarified. The aims of the present study were to investigate the expression of Rev‐erbα in experimental RAP and to explore the relationship between Rev‐erbα and macrophage polarization through the application of its pharmacological agonist SR9009 into the in vivo and in vitro experiments. Methodology: Enterococcus faecalis‐induced RAP models were established in SD rats. Histological staining and micro‐computed tomography scanning were used to evaluate osteoclastogenesis and alveolar bone resorption. The expression of Rev‐erbα and macrophage polarization were detected in the periapical tissues from rats by immunofluorescence, flow cytometry, and western blots. Furthermore, immunohistochemical staining and enzyme‐linked immunosorbent assay were performed to explore the relationship between Rev‐erbα and inflammatory cytokines related to macrophage polarization. Result: Compared to healthy periapical tissue, the expression of Rev‐erbα was significantly down‐regulated in macrophages from inflammatory periapical area, especially in Enterococcus faecalis‐induced periapical lesions, with obvious type‐1 macrophage (M1)‐like dominance and the production of pro‐inflammatory cytokines. In addition, Rev‐erbα activation by SR9009 could induce type‐2 macrophage (M2)‐like polarization in periapical tissue and THP1 cell line, followed by increased secretion of anti‐inflammatory cytokines IL‐10 and TGF‐β. Furthermore, intracanal application of SR9009 reduced the lesion size and promoted the repair of RAP by decreasing the number of osteoclasts and enhancing the formation of mineralized tissue in periapical inflammatory lesions. Conclusions: Rev‐erbα played an essential role in the pathogenesis of RAP through its effect on macrophage polarization. Targeting Rev‐erbα might be a promising and prospective therapy method for the prevention and management of RAP. [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: Endodontic microsurgery (EMS) of maxillary molars may represent a complex challenge to the clinician due to the location of the roots and the proximity of the maxillary sinus floor. This report aimed to describe the simultaneous use of a computer‐assisted dynamic navigation (C‐ADN) system and piezoelectric bony‐window osteotomy for the transantral microsurgical approach of a maxillary left first molar with adequate root canal filling and symptomatic apical periodontitis. Summary: This case report highlights the importance of C‐ADN to carry out a minimally invasive buccal surgical access to palatal roots affected by apical periodontitis and provides a practical example to help clinicians make treatment decisions based on the available evidence. Clinical and tomographic evaluations were performed before the surgical procedure and at 24‐month follow‐up. This case was treated using a C‐ADN system fitted to a piezotome for the buccal approach of the buccal roots, maxillary sinus membrane lifting, and for transantral location, root‐end resection, cavity preparation, and filling of the palatal root. The navigation system allowed to achieve an accurate apical canal terminus location and root‐end filling of the three roots with a minimally invasive piezoelectric crypt approach. At the 24‐month follow‐up examination, the patient remains asymptomatic, with normal periapical structures, and regeneration of maxillary sinus walls. It was concluded that the combination of dynamic navigation with piezoelectric bony‐window osteotomy offers enhanced accuracy, tissue preservation, diminished risk of iatrogenic complications, and could maximize success and survival rates in transantral EMS. [ABSTRACT FROM AUTHOR]

Odontoblastic differentiation of human stem cells from the apical papilla (hSCAPs) is crucial for continued root development and dentin formation in immature teeth with apical periodontitis (AP). Fat mass and obesity-associated protein (FTO) has been reported to regulate bone regeneration and osteogenic differentiation profoundly. However, the effect of FTO on hSCAPs remains unknown. This study aimed to identify the potential function of FTO in hSCAPs' odontoblastic differentiation under normal and inflammatory conditions and to investigate its underlying mechanism preliminarily. Histological staining and micro-computed tomography were used to evaluate root development and FTO expression in SD rats with induced AP. The odontoblastic differentiation ability of hSCAPs was assessed via alkaline phosphatase and alizarin red S staining, qRT-PCR, and Western blotting. Gain- and loss-of-function assays and online bioinformatics tools were conducted to explore the function of FTO and its potential mechanism in modulating hSCAPs differentiation. Significantly downregulated FTO expression and root developmental defects were observed in rats with AP. FTO expression notably increased during in vitro odontoblastic differentiation of hSCAPs, while lipopolysaccharide (LPS) inhibited FTO expression and odontoblastic differentiation. Knockdown of FTO impaired odontoblastic differentiation, whereas FTO overexpression alleviated the inhibitory effects of LPS on differentiation. Furthermore, FTO promoted the expression of secreted modular calcium-binding protein 2 (SMOC2), and the knockdown of SMOC2 in hSCAPs partially attenuated the promotion of odontoblastic differentiation mediated by FTO overexpression under LPS-induced inflammation. This study revealed that FTO positively regulates the odontoblastic differentiation ability of hSCAPs by promoting SMOC2 expression. Furthermore, LPS-induced inflammation compromises the odontoblastic differentiation of hSCAPs by downregulating FTO, highlighting the promising role of FTO in regulating hSCAPs differentiation under the inflammatory microenvironment. [ABSTRACT FROM AUTHOR]

Macrophages (Mφs) play a crucial role in the homeostasis of the periapical immune micro-environment caused by bacterial infection. Mφ efferocytosis has been demonstrated to promote the resolution of multiple infected diseases via accelerating Mφ polarization into M2 type. However, the Mφ efferocytosis–apical periodontitis (AP) relationship has not been elucidated yet. This study aimed to explore the role of Mφ efferocytosis in the pathogenesis of AP. Clinical specimens were collected to determine the involvement of Mφ efferocytosis in the periapical region via immunohistochemical and immunofluorescence staining. For a further understanding of the moderator effect of Mφ efferocytosis in the pathogenesis of AP, both an in vitro AP model and in vivo AP model were treated with ARA290, a Mφ efferocytosis agonist. Histological staining, micro-ct, flow cytometry, RT-PCR and Western blot analysis were performed to detect the inflammatory status, alveolar bone loss and related markers in AP models. The data showed that Mφ efferocytosis is observed in the periapical tissues and enhancing the Mφ efferocytosis ability could effectively promote AP resolution via facilitating M2 Mφ polarization. Collectively, our study demonstrates the functional importance of Mφ efferocytosis in AP pathology and highlights that accelerating Mφ efferocytosis via ARA290 could serve as an adjuvant therapeutic strategy for AP. [ABSTRACT FROM AUTHOR]

Manuka oil and tea tree oil are essential oils with known antibacterial properties that are believed to be caused by one main component: terpinen-4-ol. Terpinen-4-ol has potent antibacterial activity against caries-related microorganisms. However, few studies have investigated the antimicrobial effects of terpinen-4-ol on bacteria in apical periodontitis. Thus, the objective of the present study was to evaluate the antibacterial and antibiofilm potential of terpinen-4-ol against Enterococcus faecalis , Porphyromonas gingivalis , Prevotella intermedia , and Fusobacterium nucleatum , which have all been detected in apical periodontitis. The minimum inhibitory and minimum bactericidal concentrations of terpinen-4-ol were determined to assess its activity against biofilms. The minimum inhibitory concentration of terpinen-4-ol was 0.25% against E. faecalis and F. nucleatum , 0.05% against P. gingivalis , and 0.1% against P. intermedia. The minimum bactericidal concentration of terpinen-4-ol was 1.0% against E. faecalis , 0.2% against P. gingivalis and P. intermedia , and 0.5% against F. nucleatum. In the biofilm evaluations, all terpinen-4-ol-treated bacteria had significant reductions in biofilm viability compared with controls in experiments assessing attachment inhibitory activity. Furthermore, structural alterations and decreased bacterial cell clumping were observed under scanning electron microscopy, and significantly decreased cell survival was noted using fluorescence microscopy. Together, these results suggest that terpinen-4-ol is a potential antibacterial agent with bactericidal properties, and can also act on established biofilms. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This case report provides a rare case of idiopathic root resorption in maxillary first molar and suggests the importance of CBCT in the diagnosis and treatment outcome of complex endodontic diseases. Endodontic surgery is an effective method for treating teeth with persistent apical periodontitis. Idiopathic root resorption is an unexplained root resorption when the patient experiences root resorption without any local or systemic factors. Early diagnosis and appropriate treatment are crucial for long‐term outcomes. [ABSTRACT FROM AUTHOR]

Endodontic treatment failure results from treatment that is not up to a satisfactory level, which leaves a persistent microbiological infection. Teeth requiring coronal restoration replacement, inadequate obturation, and radiographic evidence of developing or persistent apical periodontitis indicate endodontic reintervention. One of the biggest obstacles in the cleaning and shaping procedure is apical calcification. Proper use of equipment and techniques will enhance effective treatment planning. This case reports a 35-year-old female complaining of pain in the permanent mandibular left first molar. Clinical examination showed 36 sensitivity on percussion with inadequate obturation, and a radiolucent appearance was revealed on radiographic examination. The diagnosis of 36 was previously treated with symptomatic apical periodontitis. Reintervention procedure was carried out with engine-driven retreatment files to remove guttapercha. Apical calcification is negotiated using an active cutting hand-use file with chelating agents. Chemomechanical preparation was performed using the crown-down technique with suitable irrigants. Canals are filled, and zirconia crown is used as the final restoration. The present case report highlights the successful endodontic reintervention by incorporating treatment planning with recognized endodontic protocols and the proper final restoration, which yields the best treatment results. [ABSTRACT FROM AUTHOR]

This report shows atypical sealer extrusion of permanent mandibular left first molar (tooth #19) after nonsurgical root canal treatment which is mimicking root perforation or root resorption. The chief complain was slight discomfort with round opening next to the tooth. Depends on the clinical and radiographical finding, tooth #19 was diagnosed as necrotic pulp with chronic apical abscess. Nonsurgical root canal treatment was provided using ProTaper gold (Dentsply Tulsa Dental, Tulsa, OK, USA) to size F3. 4 canals were located (2 mesial canals and 2 Distal canals). The tooth was obturated with single cone and Calcium Silicate-based Bioceramic Root Canal Sealer (CeraSeal). The sealer was extruded which looks like root perforation or root resorption. Finally, the tooth was crowned with single crown The patient had no symptoms, no periodontal pocket, no mobility after 3 years. The sealer can extrude not only in the apical area but also it may fill and follow the trac of sinus tract. However, it doesn’t affect the success rate of root canal treatment with proper cleaning and shaping, 3-dimentional obturation, and a good crown. [ABSTRACT FROM AUTHOR]

This study was intended to evaluate the expression of inflammatory cytokines commonly secreted by CD4+ T cells (IL-2, IL-5, IL-17, TGF-β, TNF-α, and IFN-γ) in apical granulomas and correlate with the clinical conditions and time elapsed since root canal treatment. Eighteen biopsy specimens obtained by periradicular surgery of teeth with post-treatment apical periodontitis and diagnosed as apical granuloma were available from the oral pathology laboratory. Silanized slides containing paraffin sections were used for immunohistochemical reactions. Images were analyzed by using an optical microscopy and each slide was subdivided into 5 fields at high magnification. IFN-γ and TGF-β were the cytokines with the highest expression levels. There were statistically significant differences when comparing IL-2 and IFN-γ (P <.05), and IL-2 and TGF-β (P <.05). Comparison between the detected cytokines and clinical data and time of treatment demonstrated significant correlation (P <.05) between lower expression of IL-2 and the presence of painful symptoms, absence of sinus tract, and treatments performed more than 4 years before. It was also possible to observe a significant correlation between lower expression of IL-5 and treatments performed less than 4 years before (P <.05). IFN-γ and TGF-β were highly expressed in apical granulomas. However, only IL-2 and IL-5 levels were associated with clinical data and time since previous root canal treatment. [ABSTRACT FROM AUTHOR]

No clinical studies have examined the effect of mineral trioxide aggregate (MTA) obturation levels on the outcome of endodontic retreatment. This retrospective study examined treatment outcomes in three cohorts that compared overfilling, flush filling, and underfilling after orthograde retreatment using MTA. Two hundred fifty patients with 264 teeth diagnosed with previously treated root canals and apical periodontitis retreated in a private endodontic practice were included. All teeth received MTA obturation and the extent of the final filling level was measured in relation to the major apical foramen. After 6-month follow-ups, all nonhealing cases were treated surgically. After 24- to 72-month reviews, the effect of preoperative lesion size and the degree of MTA obturation level were assessed. Multiple linear regression and time-to-event analysis using Stata 17 software (StataCorp LLC, College Station, TX) were used to evaluate the data. Within the three cohorts, 99 out of 108 overfilled teeth (91.7%), 90 out of 103 flush fills (87.4%), and 10 out of 53 underfilled teeth (18.9%) healed and were successfully retreated without surgery at 48-months. When surgical outcomes were included, the combined healed proportion was 93.2%. Preoperative lesion size was found to be an important predictor for retreatment nonhealing. A 1-mm increase in lesion size at baseline resulted in an estimated 11% (95% CI 1.04, 1.18)–38% (95% CI 1.22, 1.58) increase in the risk of surgery. Compared to overfilling and flush filling, underfilling was associated with an approximately three-fold increase in requiring surgery and characterized by delayed healing. MTA obturation is a viable retreatment option for teeth with nonhealing endodontic treatment. MTA overfills or flush fillings do not adversely affect healing outcomes. However, MTA underfilling increases the chances for nonhealing and surgical intervention. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of cigarette smoke inhalation (CSI) on apical periodontitis (AP) induced in rats by histometric, immunohistochemical, and microtomographic analysis. A total of 32 male Wistar rats were divided into 4 experimental groups (n = 8): control, CSI, AP, and CSI + AP. Rats in the CSI and CSI + AP groups inhaled cigarette smoke by remaining inside a smoking chamber for 8 minutes 3 times a day for 50 days. After 20 days of smoke inhalation, rats in the AP and CSI + AP groups had the pulp of their first right lower molar exposed to induce AP. Blood was collected on day 50 to evaluate nicotine and serum cotinine levels. The animals' mandibles were removed for histologic processing to evaluate bone resorption by histometric, immunohistochemical (receptor activator of nuclear factor kappa B ligand/osteoprotegerin), and microtomographic analysis. The Student t test was applied. Histometric analysis showed a larger area of bone resorption (P <.05) and microtomographic analysis found greater resorption volume (P <.001) for the CSI + AP group compared with the AP group. The CSI + AP group presented a high RANKL immunostaining pattern compared with the AP group (P <.001). CSI increased bone resorption caused by AP. [ABSTRACT FROM AUTHOR]

Dental pulp regeneration is challenging in endodontics. Cellular therapy is an alternative approach to induce dental pulp regeneration. Mesenchymal stromal cells (MSCs) have the capacity to induce dental pulp-like tissue formation. In this study, we evaluated the capacity of allogeneic bone marrow MSCs (BM-MSCs) to regenerate pulp following necrosis and apical periodontitis in children's permanent immature apex teeth. Patients aged 8 to 12 years with pulp necrosis and apical periodontitis were evaluated. The study included 15 teeth (13 incisors and 2 molars) from 14 patients (8 boys and 6 girls). Radiographic evaluation showed periapical radiolucency and immature apex teeth. There was no response to cold or electric pulp testing. The root canal of each tooth was cleaned, shaped, and Ca(OH) 2 used as an interappointment medication. Cryopreserved allogeneic BM-MSCs were thawed, expanded, incorporated into preclotted platelet-rich plasma, and implanted into the tooth's pulp cavity. They were sealed with bioceramic cement and composite. Sensibility, apical foramen, calcium deposits within the root canal, and resolution of periapical lesions were evaluated in each tooth over the following 12 months. Based on 9 variables established for dental pulp-like tissue regeneration, all MSC-treated teeth showed evidence of successful regeneration. Clinical and radiographic evaluation of the treated teeth showed periapical lesion healing, sensitivity to cold and electricity, decreased width of the apical foramen, and mineralization within the canal space. Transplantation of allogeneic MSCs induces the formation of dental pulp-like tissue in permanent immature apex teeth with pulp necrosis and apical periodontitis. Implant of MSCs constitutes a potential therapy in regenerative endodontics in pediatric dentistry. Future studies incorporating a larger sample size may confirm these results. [ABSTRACT FROM AUTHOR]

After pulp infection and necrosis, the passage of microbial antigens into the periapical space causes apical periodontitis (AP). Most of the clinical forms of AP can be managed without prescribing antibiotics, only with root canal treatment and abscess drainage or, where appropriate, tooth extraction. However, the scientific literature provides evidence of inappropriate antibiotic prescriptions by dentists in the management of apical disease. Objectives: The aim of this systematic review and meta-analysis was to analyze the global pattern of antibiotic prescription in the treatment of apical disease. Methods: PRISMA Guidelines were followed to carry out this systematic review. The research question was as follows: What is the pattern of antibiotic prescription by dentists in the treatment of the different clinical forms of apical periodontitis? A systematic search was conducted on MEDLINE/PubMed, Wiley Online Database, Web of Science and Scopus. All studies reporting data about the pattern of antibiotic prescription by dentists in the treatment of apical disease were included. The meta-analyses were calculated using the Open Meta Analyst version 10.10 software. Random-effects meta-analyses were performed. The risk of bias was assessed using the Newcastle–Ottawa Scale. The certainty of evidence was assessed using GRADE. Results: The search strategy identified 96 articles and thirty-nine cross-sectional studies fulfilled the inclusion criteria. The overall percentage of antibiotic prescriptions by dentists in cases of symptomatic AP was 25.8%, and 31.5% in cases of asymptomatic AP with sinus tract present. The percentage of dentists prescribing antibiotics in cases of acute apical abscess with no/mild symptoms was 47.7%, whereas, in cases of acute apical abscess with moderate/severe symptoms, 88.8% of dentists would prescribe antibiotics. Endodontists prescribe antibiotics at a lower rate than general practitioners. The total risk of bias was considered moderate, and the final rating for the certainty of the evidence was low. Conclusions: Dentists worldwide are over-prescribing antibiotics in the management of apical disease. It is necessary to improve antibiotic prescribing habits in the treatment of endodontic infections, as well as educational initiatives to encourage the rational and appropriate prescription of antibiotics in periapical diseases. [ABSTRACT FROM AUTHOR]

Apical periodontitis is an inflammatory response of the periradicular tissues to microbial infection of the root canal system (intraradicular infection) or to biofilms attached to the external surface of the root (extraradicular infection). Over the past few decades, our understanding of how microbiota initiate, progress, and sustain disease has been well characterized. In parallel, state-of-the-art approaches have attempted to demonstrate the spatiotemporal complexity of biofilm communities both within the tooth and elsewhere in the body. Despite all this research, translation of such critical knowledge into biofilm management in endodontics has been minimal, in part because of lack of directional clarity. The purpose of this commissioned review is to highlight our current understanding of root canal microbial communities as a cause of pulpal and periradicular disease. While several reviews have been written on this topic, few have delved deep into the biogeography, assembly, and functional profile, a void which this review will attempt to fill. The authors hope that this review will open out-of-the-box thinking and newer perspectives in biofilm management in endodontic treatments. [ABSTRACT FROM AUTHOR]

Objectives: To determine the characteristics of the endodontic microbiome. Material and Methods: Saliva, plaque, and infected root canal wall dentin of two teeth suffering from apical periodontitis were harvested from a 58‐year‐old man. Bacterial DNA was extracted from each sample, and 16S rRNA gene analysis targeting the V3–V4 region was conducted on the Illumina MiSeq platform using QIIME2. The functional potential of the microbiomes was inferred using PICRUSt2. Results: The four microbiomes were different in structure and membership, yet the nine most abundant metabolic pathways were common among them. The two endodontic microbiomes were more anaerobic, rich in Firmicutes, and scarce in Actinobacteriota and Proteobacteria, compared with saliva and plaque microbiomes. Their profiles were dissimilar despite their clinical and radiographic similarities. Conclusions: The endodontic microbiomes were anaerobic, rich in Firmicutes, scarce in Actinobacteriota and Proteobacteria, and considerably varied within an individual. [ABSTRACT FROM AUTHOR]

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

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

Background: The present study aimed to evaluate the effectiveness of using platelet-rich fibrin (PRF) as the apical matrix for the placement of MTA in nonsurgical endodontic therapy for teeth with periapical lesions and open apices. Methods: Twelve teeth from eleven patients with periapical periodontitis and open apices were enrolled in the study. Nonsurgical endodontic therapy was performed with the PRF used as an apical barrier and the MTA manipulated as an apical plug for further thermoplasticized gutta percha in the remaining part of the root canal. Clinical signs and periapical digital radiographs were recorded and analyzed to evaluate the curing progress after periodical follow-ups of 1, 3, and 6 months. The horizontal dimension of the periapical lesion was determined, and the changes in the dimensions were recorded each time. The Friedman test was used for statistical analysis, with P <.05 serving as the threshold for determining statistical significance. Results: All patients had no clinical symptoms after the first month of treatment, with a significant reduction in the periapical lesion after periodical appointments. Conclusions: PRF is an effective barrier when combined with MTA for the treatment of teeth with periapical periodontitis and open apices. [ABSTRACT FROM AUTHOR]

Aim: The aim of this prospective cohort study was to compare the radiographic outcome of endodontic treatment and retreatment of teeth with apical periodontitis using either 1% sodium hypochlorite (NaOCl) or 2% chlorhexidine digluconate (CHX) for root canal irrigation. Materials and Methods: In the years from 2013 to 2015 standard irrigation varied by semester between NaOCl and CHX at the Department of Endodontics at the Faculty of Dentistry. During that time, 912 teeth received treatment for apical periodontitis in 744 patients, of whom 532 responded to the request for a 1‐year follow‐up. Only one tooth per person (the most distally located) were included; 285 teeth treated with NaOCl and 247 with CHX. One hundred cases were then randomly sampled from each irrigation group and analysed for outcome by periapical index (PAI) scoring using criteria for success, uncertain and failure. Clinical and other radiographic parameters were scored or recorded and analysed for associations with radiographic outcome using chi‐square, ANOVA and regression analyses. Results: Success rates (PAI score 1 or 2 at control) were nearly identical for the two irrigation liquids. The use of irrigating solution also did not significantly influence the outcome in chi‐square analyses of subgroups of teeth or regression analyses with other variables included. Ordinal regression analysis established that preoperative lesion size or preoperative PAI score were significantly associated with outcome, and teeth in the mandible had significantly better outcomes than in the maxilla. Conclusions: No significant differences in the radiographic outcome using either 1% NaOCl or 2% CHX as irrigants were found. The outcome was better for teeth with small lesions or lower PAI scores at completion of treatment and for mandibular teeth. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association between apical periodontitis (AP) and atherosclerotic cardiovascular disease (ASCDV). Methodology: A total of 65 periodontally and systemically healthy patients (age ≥ 40 years) were included in the study. Periapical status was assessed through dental examination and periapical radiographs; 33 subjects had AP (AP+), while 32 acted as control (AP−). Moreover, data regarding their periapical index (PAI) score and the Decayed, Missing, and Filled Teeth (DMFT) index were recorded. All subjects underwent echo‐colour Doppler assessment of carotid intima‐media thickness (CIMT), carotid plaques, degree of stenosis using the North American Symptomatic Carotid Surgery Trial (NASCET) method, maximum diameter of the abdominal aorta (maximum AA) and common iliac arteries (CIA) diameters. Furthermore, peripheral blood flow was also measured using the ankle‐brachial index (ABI). Simple and multiple regression analyses were performed. Results: Among AP+ patients, 57.58% disclosed at least one sign of subclinical carotid atherosclerosis. Multiple regression analysis identified AP as a significant risk indicator for carotid plaques [OR = 4.87 (1.27, 18.98; p =.021)] and marked carotid intima‐media thickenings (OR = 14.58 [1.22, 176.15], p =.035). A significant association was established between AP and other cardiovascular (CV) variables (CIMT, NASCET, and maximum AA). On the contrary, a higher PAI score does not correlate to increased odds of carotid alterations, and the presence of AP did not prove any significant change in CIA and ABI. No significant correlation was established between DMFT and other variables. Conclusions: Results from the current study highlight that the presence of AP may be regarded as a risk indicator for ASCVD, with AP being associated with 5‐fold increased odds of having carotid plaques and 15‐fold increased odds of having marked carotid intima‐media thickenings. Further studies should be conducted in order to verify whether AP treatment could be beneficial for ASCVD signs. [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]

Objectives: Effective disinfection of the root canals is the cornerstone of successful endodontic treatment. Diminishing the microbial load within the root canal system is crucial for healing in endodontically treated teeth. The aim of this study was to evaluate the effect of 2780 nm Er,Cr:YSGG and 940 nm diode lasers on the eradication of microorganisms from single-rooted teeth with asymptomatic apical periodontitis. Materials and Methods: Thirty participants conforming to the inclusion criteria were randomly divided into 3 groups according to the disinfection protocol used; Conventional group: 2.5% Sodium Hypochlorite (NaOCl) and 17% EDTA solution NaOCl/EDTA, Dual laser group: 2780 nm Erbium, chromium: yttrium scandium-gallium-garnet (Er,Cr:YSGG) laser and 940 nm diode laser Er,CrYSGG/Diode, and Combined group: 17% EDTA and 940 nm diode laser EDTA/Diode. Bacterial samples were collected before and after intervention. The collected data were statistically analyzed using Friedman’s test and Kruskal–Wallis test (P ≤ 0.05). Results: The results of the study showed that both dual laser Er,CrYSGG/Diode and combined laser EDTA/Diode groups showed significantly less mean Log10 CFU/ml of aerobic and anaerobic bacterial counts than the conventional NaOCl/EDTA group. Conclusions: In this study we evaluated in vivo the bactericidal efficacy of three disinfection protocols for endodontic treatment of single-rooted teeth with apical periodontitis. The results indicated that both dual laser Er,CrYSGG/Diode and combined laser EDTA/Diode groups provide superior bactericidal effect compared to the conventional NaOCl/EDTA group. Clinical relevance: The integration of lasers into root canal disinfection protocols has demonstrated significant bacterial reduction which might promote healing and long-term success. [ABSTRACT FROM AUTHOR]

Objective: To observe the clinical efficacy of autologous platelet-rich fibrin (PRF) application alone in immediate dental implant placement in the molars with periapical periodontitis, and to discuss the mechanism, in order to widen its clinical application and to provide the guidance for its clinical practice. Methods: The clinical data of one patient who underwent immediate implant placement in the molars with periapical periodontitis using PRF as the sole material were collected. The changes in the tissues surrounding the implant were evaluated through the three-dimensional reconstruction of cone-beam CT (CBCT) and oral scan data, the therapeutic methods and outcomes of PRF treatment were analyzed combined with the relevant literatures. Results: A minimally invasive extraction of the patient’s 46 diseased molar was conducted followed by the immediate implant placement. Before surgery，30 mL of the patient’s own blood (3 tubes) was drawn, which was then placed in 10 mL glass-coated plastic tubes without anticoagulants. Three PRF were prepared with the blood by centrifuging at 3 000 r·min-1 for 10 min. These clots were used as the only filling material for the jumping gap. The postoperative CBCT and oral scan 3D reconstruction results showed that the peri-implant bone tissue was increased by 203. 19 mm3, the buccal bone height was increased by 5. 83 mm, and the buccal bone tissue was increased by more than 1 mm at 6 months postoperatively; after 12 months, the soft and hard tissues around the implant remained essentially stable. Conclusion: The application of autologous PRF alone in immediate implant placement in the molars with periapical periodontitis achieves favorable treatment outcomes, the peri-implant bone tissue regenerates, and the peri-implant hard and soft tissues remain stable, which providing the new insights into the immediate implant treatment. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the feasibility of immediate implantation for chronic peri-apical periodontitis in the molar region. Seventy-four molars were selected and allocated randomly to two groups. The experimental group (n = 38) received immediate implantation by flap surgery and the control group (n = 36) received delayed implantation. CBCT was performed immediately after surgery (T1) and 12 months after the permanent repair (T3). The implant survival rate at T3 was 100% in both groups. There was no significant difference in buccal or lingual vertical marginal bone loss between the groups (P = 0.515, P = 0.736). However, the buccal horizontal margin bone loss was significantly greater in the experimental group: 0.98 ± 0.34 mm vs 0.77 ± 0.27 mm in the control group (P = 0.003). In the experimental group, the highest point of buccal and lingual implant–bone contact increased at T3. The buccal and lingual jump gap widths were 3.21 ± 1.10 mm and 2.92 ± 1.01 mm at T1, and CBCT showed no jump gap around the implants at T3. The clinical outcomes showed immediate implantation to be feasible for chronic peri-apical periodontitis in the molar region. [ABSTRACT FROM AUTHOR]

Chimpanzees (Pan troglodytes) with teeth severely damaged by dental caries and/or periodontal disease are often managed with medication and/or tooth extraction. A common endodontic treatment for severely decayed teeth in a 26-year-old female chimpanzee is reported. The left maxillary central incisor tooth had lost its crown, probably due to trauma that was not recent, and it had a fistula most likely due to chronic apical periodontitis. The diagnosis was confirmed radiographically before treatment. To treat the infected root canal, endodontic treatment used in humans was adapted for a chimpanzee. After the treatment, the tooth was sealed using an adhesive resin composite. At 11-years post-treatment, there were no signs of recurrence of the lesion or of failure of the tooth seal. The results of this case report suggest that common endodontic treatments used in humans are also effective in chimpanzees. [ABSTRACT FROM AUTHOR]

This study explores the differences between the patterns of bone defects associated with vertical root fracture (VRF) and apical periodontitis (AP) in single-rooted endodontically treated premolars (SRETPs) based on cone-beam computed tomography (CBCT) data. Eighty-four SRETPs were extracted and categorized into the VRF and AP groups. On preoperative CBCT images, the location of bone defects according to the root thirds in buccolingual and mesiodistal directions across the study groups were compared. The majority of bone defects in the VRF group were longitudinal and combined, involving more than one root thirds in buccolingual and mesiodistal directions simultaneously. A uniform approach to comparing bone defects using the sites of periradicular area with bone loss as a comparison unit was developed. In the VRF group, bone loss sites in the middle and coronal thirds were detected more often and were located mainly buccolingually compared with the AP group (P <.001). Bone defects in the middle or middle and coronal root thirds in the buccolingual direction may be potential radiographic signs useful in differentiating between VRF and AP in SRETPs. The introduction of the uniform approach to assessment of bone loss patterns will give practitioners a single simple tool and improve the quality of endodontic treatment. [ABSTRACT FROM AUTHOR]

Apical lesions of endodontic origin can be classified as either granulomas or cysts. In rare cases, respiratory epithelium can proliferate and encapsulate a lesion, forming a cyst. Moreover, the innervation of apical lesions has only been previously reported in animal models of apical periodontitis. This report demonstrates an unusual case in which tooth #15 was initially treated with nonsurgical root canal therapy. Still, the patient remained in moderate to severe pain for several days following the procedure. Next, an intentional replantation was performed in which a periapical cyst was curetted from the alveolus. The patient experienced immediate pain relief following the procedure. Histological analysis revealed that the periapical cyst was lined entirely with respiratory epithelium, and immunohistochemical analysis showed it to be densely innervated. In addition, these nerve fibers expressed the LPS receptor, TLR4. This is the first demonstration of the innervation pattern of a periapical cyst. Further studies are warranted to evaluate innervation in apical lesions and its correlation with pre- and intra-operative symptoms and their participation in the pathogenesis of apical periodontitis. [ABSTRACT FROM AUTHOR]

Accurately diagnosing the state of dental pulp is crucial when addressing tooth pain to determine the best treatment approach. This study aimed to investigate the concentration of inflammatory mediators in the dental pulp of mature teeth that have been exposed via caries but show no signs of apical periodontitis. Samples of pulpal blood from adults with mature teeth responsive to pulp testing and have carious pulp exposures were obtained. These samples were analyzed for 12 inflammatory cytokines and other inflammatory proteins using the Luminex assay platform. Clinical factors were correlated with cytokine levels, and statistical analysis was performed to evaluate the impact of these factors on cytokine expression. Of the 36 patients that were included, 44.44% took pain medications, 33.33% had prolonged pulpal bleeding, 41.67% felt spontaneous pain, and 72.22% were diagnosed with symptomatic irreversible pulpitis. Significant correlations existed between presenting pain scores and levels of interleukin (IL)-1α, IL-6, and IL-8 (P <.05). Factors like analgesic medication intake, pain to percussion, pain to thermal testing, spontaneous pain, and nocturnal pain were significantly associated with higher levels of specific inflammatory proteins. No significant associations were observed with pain to palpation, bleeding time, or pulpal diagnosis. Inflammatory proteins, including cytokine levels may play a critical role in characterizing pulpal inflammation. Future studies should investigate the role of these potential biomarkers in determining the diagnosis of pulpitis and the prognosis of vital pulp therapy. [ABSTRACT FROM AUTHOR]

The aim of this study was to clinically and radiographically assess the effects of two bioceramic cements as coronal plug materials for the revascularization of non-vital, immature, permanent teeth with apical periodontitis. Twenty non-vital, immature, permanent, anterior teeth with apical periodontitis were included in this study. Samples were randomly divided into two groups based on the coronal plug materials used; group I (GI): Well Root PT (Vericom, Gangwon-do, Korea) and group II (GII): MTA Biorep (Itena Clinical, Paris, France) (n = 10). Follow-up was conducted clinically and radiographically for up to 12 months to evaluate the changes in root dimensions and resolution of the periapical disease and investigate the degree of success. Data were statistically analyzed using ANOVA tests and Mann–Whitney U tests at a 0.05 significance level. At 12 months, none of the patients in either test group had clinical signs/symptoms. There was a slight increase in root length (4.4% in GI and 3.4% in GII) and a slight increase in dentin wall thickness (10.2% in GI and 9.9% in GII) with no statistically significant (p > 0.05) differences. Whilst there was a significant decrease in lesion dimension in all patients after 12 moths of treatment (93% in GI and 91% in GII), there were no statistically significant differences between the two study groups (p > 0.05). Regarding the degree of success, all cases (100%) achieved the primary goal (the elimination of symptoms and the evidence of bony healing), while 60% in GI and 40% in GII achieved the secondary goal (increased root wall thickness and/or increased root length). No statistically significant difference was found between groups (p > 0.05). Both bioceramic cements showed satisfactory clinical and radiographic findings. Premixed calcium aluminosilicate and tricalcium silicate cements could be used as coronal plug materials in revascularization procedures. Bioceramic cements can be considered promising coronal plug materials for the revascularization of immature, permanent teeth with necrotic pulps and apical periodontitis due to their physicochemical and biological properties. [ABSTRACT FROM AUTHOR]

Aim: To assess the periapical alveolar bone pattern and the serum levels of proinflammatory cytokines, biochemical markers and metabolites in rats subjected to chronic alcohol and nicotine consumption and induced apical periodontitis. Methodology: Twenty‐eight male Wistar rats were divided into four groups: Control, Alcohol, Nicotine and Alcohol+Nicotine. The alcohol groups were exposed to self‐administration of a 25% alcohol solution, while the other groups were given only filtered water. The nicotine groups received daily intraperitoneal injections of a nicotine solution (0.19 μL of nicotine/mL), whereas the other groups received saline solution. Periapical lesions were induced by exposing the pulps of the left mandibular first molars for 28 days. After euthanasia, the mandibles were removed and the percentage bone volume, bone mineral density, trabecular thickness, trabecular separation and trabecular number of the periapical bone were measured using micro‐computed tomography images. Serum samples were collected for analysis of proinflammatory cytokines (IL‐1β, IL‐4, IL‐6 and TNF‐α), biochemical and metabolomic analysis. Statistical analysis was performed with a significance level of 5%. Nonparametric data were analysed using the Kruskal‐Wallis test followed by Dunn's test, while one‐way anova followed by Tukey's test was performed for parametric data. Results: The groups exposed to alcohol or nicotine consumption exhibited an altered bone pattern indicating lower bone density and higher levels of IL‐1β, IL‐6 and TNF‐α compared to the Control group (p <.05). Significant differences were observed among the groups in the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, cholesterol, triglycerides, urea, creatinine, albumin, uric acid, bilirubin and calcium. Metabolomic analysis revealed significant differences in glycine, phosphocholine, lysine, lactate, valine, pyruvate and lipids (CH2CH2CO), n(CH2) and n(CH3). Most of these parameters were even more altered in the simultaneous consumption of both substances compared to single consumption. Conclusion: Alcohol and nicotine chronic consumption altered several metabolic markers, impaired liver and kidney function, increased the production of systemic proinflammatory mediators and harmed the periapical bone microarchitecture in the presence of apical periodontitis. The simultaneous consumption of alcohol and nicotine intensified these detrimental effects. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the potential protective effects of N‐acetyl‐L‐cysteine (NAC) against apical periodontitis (AP) in rats with adriamycin (ADR)‐induced kidney and heart diseases. Methodology: Fourty‐eight Wistar albino rats were divided into six groups: (1) Control group, (2) ADR group (1 mg/kg/day ip for 10 days), (3) AP Group (1st mandibular molar tooth), (4) AP + ADR Group, (5) AP + NAC group (150 mg/kg/day ip), and (6) AP + ADR + NAC group. After 3 weeks, the rats were decapitated and blood and tissue samples (heart, kidney, and jaw) were collected. Tissue samples were evaluated by biochemical (inflammatory cytokines and hemodynamic parameters) and radiological analyses. One‐way anova with Tukey post hoc tests was used to compare data, considering p <.05 as statistically significant. Results: The serum levels of TNF‐α, IL‐1β, BUN, Creatinine, CK, and LDH were elevated in the test groups compared with the control group, and treatment with NAC reduced these levels (p <.05). Heart and kidney tissue analysis showed a higher heart‐to‐body weight ratio (HW/BW) and kidney‐to‐body weight ratio (KW/BW) in the test groups compared with the control group (p <.05). No significant differences in HW/BW and KW/BW were found between the control and AP + NAC groups. Volumetric apical bone resorption analysis showed an increase in periapical radiolucencies in AP‐induced groups indicating apical periodontitis. NAC treatment reduced the total area and volume of resorption cavities (p <.05). Conclusions: The results suggest that NAC's antioxidant and anti‐inflammatory effects can reduce adriamycin‐mediated heart and kidney damage and may have a positive effect on apical periodontitis in individuals with nephropathy and cardiomyopathy. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Formulating an effective root canal treatment plan necessitates clinician awareness of the complexities of the root canal system and possible anatomic challenges. The C‐shaped canal variation accompanying the radicular lingual groove makes the lingual dentinal wall so thin that cleaning and shaping of canals require accurate management. This report presents endodontic treatment of a C‐shaped mandibular second molar diagnosed with pulpal necrosis and asymptomatic apical periodontitis, that initial radiographic assessment revealed extremely thin (0.3 mm) width of the lingual wall of the canals prone to perforation. Mechanical preparation was performed through the anti‐curvature technique and basically by chemical irrigation rather than mechanical instrumentation. The C‐shaped isthmus was prepared up to 25/02 rotary system without dentinal defect while maintaining adequate dentin thickness so as to not significantly reduce the strength of the root. Follow‐up radiographs showed normal periodontal ligament and lamina dura indicating significant healing of the periapical lesion. [ABSTRACT FROM AUTHOR]

This study used a correlative multianalytical approach to investigate the bacteriologic conditions in the apical root canal system of treated teeth with or without apical periodontitis and their correlation with the technical quality of the previous root canal obturation and the presence and volume of apical periodontitis lesions. Root apexes were obtained from recently extracted root canal–treated teeth with (n = 23) and without (n = 22) apical periodontitis lesions as demonstrated by cone-beam computed tomographic examination. The root apexes were sectioned and subjected to micro–computed tomographic (micro-CT) scanning. The specimens were cryopulverized, and DNA extracted from the powder was used as a template in real-time polymerase chain reaction assays to quantify total bacteria and members of the Streptococcus genus and Actinobacteria phylum. The bacteriologic findings were compared between the 2 groups and also evaluated for associations with cone-beam computed tomographic and micro–computed tomographic data. Bacteria were detected in all apical canal samples except 1. The mean counts of total bacteria, streptococci, and actinobacteria did not differ significantly between teeth with or without apical periodontitis (P >.05). Streptococcus levels were significantly lower by 80% in the apical canals of teeth with small lesions compared with those without lesions (P <.05). The limit of filling >2 mm short was significantly associated with more total bacterial counts compared with canals filled 0–2 mm short (P <.05). An adequate coronal restoration was significantly associated with lesser counts of Streptococcus (P <.05). Comparable bacterial loads were observed in the apical canal system of treated teeth with and without apical periodontitis, suggesting that factors other than only the total bacterial levels may also influence the development and progression of apical periodontitis. Bacteria were found in the apical canal in virtually all cases with a high prevalence of streptococci and actinobacteria. Streptococci counts were significantly higher in the apical canal of teeth with inadequate restorations and teeth with no lesions. Underfilled canals showed higher bacterial counts. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate postoperative pain intensity following glide-path preparation using the ProGlider (PG) and WaveOne Gold Glider (WOGG) systems in asymptomatic teeth with necrotic pulp and periapical lesions. In this randomized clinical trial (ClinicalTrials.gov ID: NCT05955742) maxillary and mandibular molars with asymptomatic apical periodontitis of 78 patients (age, 18–65 years) were included. The patients were randomly divided into 3 groups: control (n = 26), PG (n = 26), and WOGG (n = 26). All the systems were used according to the manufacturer's instructions, and all the root canal treatments were completed by a single operator within 2 sessions. Postoperative pain was assessed using a numerical rating scale at 6, 12, 18, 24, 48, and 72 hours. Analgesics administered and abscess formation were also recorded. Statistical analyses were performed using the Mann–Whitney U, Bonferroni Dunn, Friedman, Chi-square, and Fisher exact tests. The postoperative pain at 12 and 18 hours was lower in the WOGG group than in the other groups (P <.05). The postoperative pain scores at 6 and 24 hours were higher among women than among men (P <.05). The highest postoperative pain scores were observed at 6 hours (P <.05). The WOGG glide-path file system was associated with less postoperative pain than the other systems. Abscess formation and analgesic use were higher in the PG group than in the other groups. Postoperative pain was greater in women than in men. [ABSTRACT FROM AUTHOR]

The utility and feasibility of pulp regenerative therapy with autologous dental pulp stem cells (DPSCs) in mature teeth with irreversible pulpitis were clinically demonstrated. On the other hand, there is no evidence of the utility of DPSCs in mature teeth with apical periodontitis. The aim of this case report was to describe the potential utility of regenerative cell therapy in mature teeth with apical periodontitis. A 44-year-old man was referred for pulp regeneration due to a periapical lesion in his maxillary first premolar. Root canal disinfection was performed by irrigation and intracanal medication by nanobubbles with levofloxacin and amphotericin B in addition to conventional irrigation. Autologous DPSCs isolated from an extracted third molar were transplanted into the root canal after residual bacteria and fungi were below the detection level by polymerase chain reaction assay using universal genes to amplify specific regions within bacterial 16S ribosomal DNA and fungal ribosomal DNA (ITS1), respectively. There were no adverse events or systemic toxicity assessed for clinical evaluations during the 79-week-follow-up period and laboratory evaluations after 4 weeks. The affected tooth was responsive to the electric pulp test. Cone-beam computed tomographic imaging revealed a reduced lesion size, remission of the periapical tissue, and mineralized tissue formation in the apical part of the canal after 79 weeks. The signal intensity on magnetic resonance imaging of the regenerated tissue in the affected tooth was comparable to that of the normal pulp in the adjacent teeth after 24 weeks. This case report demonstrated the potential use of DPSCs for pulp regenerative therapy in mature teeth with apical periodontitis. [ABSTRACT FROM AUTHOR]

A 65-year-old man had nonsurgical retreatment using an iodoform and calcium hydroxide paste in a maxillary left canine with persistent apical periodontitis. An apical mineralized barrier (AMB) was observed 3-months postoperatively. Unfortunately, the tooth was extracted due to a cementum tear. This provided an opportunity to analyze the AMB histologically, as there is a lack of previous reports on its microstructure. After extraction and removal of the granulation tissue from the root surface, the canine was processed, and observed using micro–computed tomography (μCT) and light microscopy. Thereafter, the specimen was resin-embedded specimen was evaluated by scanning electron microscopy, micro–X-ray fluorescence spectroscopy and Raman spectroscopy to understand the mechanism and nature of the AMB formation during apical healing. Nonsurgical retreatment was clinically successful based on the absence of clinical symptoms of apical periodontitis and the radiographic presence of an AMB. The AMB was opaque and could be readily differentiated from dentin under a light microscope. Micro–computed tomography analysis revealed that the AMB had the same mineral density as dentin. Scanning electron microscopy revealed that the AMB had two distinct layers based on the size of the calcified particles. Elemental mapping using micro–X-ray fluorescence spectroscopy showed that the localization of calcium and phosphorus differed between AMB and other areas of biomineralization. Raman spectral mapping revealed that the surface layer of the AMB consisted of collagen, calcium carbonate, and hydroxyapatite. This study explored new analytical methods for elucidating the apical wound-healing process and the nature of the mineralized repair. The findings provided detailed information on the AMB highlighting a bilaminar structure with high calcium components higher on the inside and a brightness similar to cementum not dentin and the presence of hydroxyapatite. [ABSTRACT FROM AUTHOR]