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Abstract Objective To assess the effectiveness of a self-constructed modified apical negative pressure irrigation (ANPI) system employing commonly used clinical instruments in nonsurgical root canal therapy (NSRCT) for large cyst-like periapical lesions (LCPLs). Methods From 2017 to 2022, 35 patients diagnosed with LCPLs (5-15 mm) via preoperative clinical and radiographic evaluations of endodontic origin underwent NSRCT combined with ANPI. These patients were subjected to postoperative clinical and radiographic follow-up at 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years, with a CBCT scan specifically conducted at 6-month follow-up. Through the reconstruction of three-dimensional cone beam computed tomography (CBCT) data, an early prognosis was facilitated by monitoring changes in lesion volume. Various treatment predictors—including sex, type of treatment, lesion size, preoperative pain, jaw, type of teeth involved, sealer extrusion, and the number of root canals—were meticulously analyzed. The evaluation of post-treatment outcomes leveraged both clinical observations and radiographic data collected during the follow-up periods. The Kruskal‒Wallis test and one-way ANOVA were also conducted to determine the independent factors influencing treatment outcomes. A significance level of 5% was established. Results Thirty-five teeth from 35 patients with a median age of 28 years (range 24–34) were treated; the median follow-up duration was 19 months (range 12–26). The overall success rate was 91.4%, with a median lesion reduction of 77.0% (range 54.2–96.4%) at 6 months. Patients under 30 years of age exhibited a significantly greater success rate than older patients did (100.0% vs. 80.0%, p = 0.037). Other factors, such as sex, jaw, treatment type, preoperative pain, cyst size, tooth location, sealer extrusion, and the number of roots, did not significantly impact treatment outcomes. Conclusions Despite limitations related to the observational case-series study design and relatively small sample size, our findings suggest that utilizing the ANPI in the NSRCT for LCPLs may hold promise. The notably higher success rate in patients younger than 30 years is worth noting.

Objective: The purpose of this study was to find a reliable method to reproduce biting pain to facilitate an early diagnosis of cracked tooth and to verify the feasibility of the Tooth Slooth in diagnosing a cracked tooth. Method and materials: In this study, 46 intact teeth diagnosed as cracked teeth were selected. Patients were asked to bite wet cotton rolls and the Tooth Slooth, and clinical findings were recorded. The difference in the relevance ratio between these two bite test methods was determined. Results: The relevance ratio of biting pain by the Tooth Slooth and wet cotton rolls was 91.3% and 32.6%, respectively. There was a statistically significant difference between these two bite tests (P < .001). Conclusions: Within the limitations of this study, the relevance ratio of biting pain by the Tooth Slooth was significantly higher than that of the wet cotton rolls. The Tooth Slooth was a reliable method to reproduce biting pain and was useful for early diagnosis of cracked teeth. [ABSTRACT FROM AUTHOR]