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Background Objective Methods Results Discussion Conclusion Registration There is limited and conflicting data on the reduction of circulatory inflammatory mediators in patients with apical periodontitis (AP) following endodontic treatment.To answer the following research question: in adult healthy patients with AP [Population (P)], is there a difference before [Comparator (C)] and after various endodontic treatments (nonsurgical, surgical or retreatment) [Intervention (I)] on systemic levels of inflammatory biomarkers [Outcome (O)] in the follow‐up period [Time (T)]?An electronic literature search was conducted in the databases Scopus, PubMed, Clarivate Analytics' Web of Science, Cochrane Database of Systematic Reviews and Grey literature from inception to July 2024 with no language restrictions. Observational studies examining changes in serum levels of inflammatory mediators were included. Two independent reviewers selected studies, extracted data and critically appraised the included studies. Qualitative and quantitative (meta‐analysis) data synthesis methods were employed. The Newcastle–Ottawa Scale was used to assess the quality of the included studies.Sixteen studies met the inclusion criteria, of which six were included in the meta‐analysis. These studies were published between 1992 and 2024, involving a total of 596 patients (54% females) aged between 16 and 75 years. The meta‐analysis of pooled data showed a significant decrease in high‐sensitive C‐reactive protein (hs‐CRP) levels in the serum of patients with AP 6 months after treatment [2.26 ± 1.76 versus 1.28 ± 1.06 mg/L, (Z = 2.03, p = .04)] and a decrease in interleukin‐1β (IL‐1β) levels 12 months after treatment [13.01 ± 5.95 versus 10.86 ± 3.52 pg/mL, (Z = 3.72, p < .01)]. One study was assessed as poor quality, while all others were considered high quality.Despite the differences in methodologies across the included studies, it has been established that effective endodontic treatment leads to a reduction in systemic inflammatory biomarkers in the body.Following effective endodontic treatment in patients with AP, the systemic levels of hs‐CRP and IL‐1β exhibit a significant reduction at 6 and 12 months, respectively. Further clinical studies should investigate whether effective endodontic treatment and reduced levels of investigated biomarkers may change the clinical presentation of systemic diseases.PROSPERO database (CRD42024559271). [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusion Lifestyle factors significantly influence the development of inflammatory diseases, and emerging evidence suggests they may also impact oral health. However, no studies have explored their role in apical periodontitis (AP) amongst adults. This study aimed to assess the association between adherence to the Mediterranean diet (MD), physical activity, perceived stress, and sleep quality with the periapical and caries status in a university‐based cohort.A total of 149 periodontally healthy patients were included in the study. Clinical assessments and radiographic examinations [Orthopantomography (opt) and periapical radiographs] were conducted to evaluate the periapical status. Data on their periapical index (PAI) score and the decayed, missing and filled teeth (DMFT) index were recorded. Validated questionnaires were used to investigate patient's lifestyles. A final logistic regression model was performed for the multivariable analysis to evaluate the predictive ability of adherence to Mediterranean lifestyle on the presence of AP; other local, systemic and environmental factors were included as independent factors in the model.Significant associations were observed between AP and high/low adherence to the MD (p = .00), high/low‐moderate physical activity (p = .00), high/low sleep quality (p = .00) and high/low perceived stress (p = .00). The final multivariable regression model showed that low adherence to MD (OR = 3.68; 95% confidence interval [CI]: 1.24–10.83; p = . 01) and reduced sleep quality (OR = 3.04; 95% CI: 1.42–6.50; p = .00) were identified as potential risk factors for AP development. On the other hand, the DMFT index showed no significant association with lifestyle factors (OR = 1.0; CI: 1.01–1.14; p = .02) but was correlated with the development of AP (OR = 1.07; CI: 1.01–1.14; p = .02).Results from the present study suggest a potential association between low adherence to MD and reduced sleep quality with the development of AP. Individuals with low adherence to MD and inadequate sleep quality faced respectively 4‐fold and 3‐fold increased odds of developing periapical lesions. Further research is essential to elucidate the causal mechanisms underlying these associations and to determine whether lifestyle adjustments could improve endodontic success rate. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusion High‐quality, prospective clinical studies are needed to increase evidence for guided endodontics. This study aims to assess the clinical outcome of guided endodontics for treatment of teeth presenting with pulp canal obliteration (PCO) in comparison with freehand treatment.This trial was registered in the ISRCTN.com registry (ISRCTN75277265) and designed as a controlled clinical trial: Single arm trial, prospective, nonrandomized, single‐centre study (ethical approval number S64630). Inclusion criteria were; tooth presenting with PCO and symptoms and/or signs of apical periodontitis (AP). An external control group was selected from clinical records of patients presenting the same criteria but treated freehanded. Guided root canal treatments were performed by the same operator on all patients. Freehanded treatments were performed by a specialist in endodontics under microscope with pre‐operative CBCT available. Primary outcome for both groups was evaluated as: canal found, canal not found, or perforation. As secondary outcome, the qualitative accuracy of the drill path was assessed as: optimal precision, acceptable precision or technical failure. Patients were followed up yearly. Descriptive statistics on the study patient's demographics and healing outcome were performed and specific statistical analysis was performed on each outcome variable.A total of 133 teeth were included (n = 60 guided, n = 73 freehanded) from 128 patients (n = 59 guided, n = 69 freehanded). The primary outcome for the guided group was: 59 teeth canals found and 1 tooth canal not found. No perforations were recorded. In the freehanded group, the root canal was successfully found in 59 teeth, seven were not found, and seven had a perforation. An analysis of all data showed that guided endodontics presented statistically significant better outcome than freehand treatment (p < .05).Guided endodontics showed a statistically significant better outcome than freehanded treatment resulting in less technical failures. However, it is a complex procedure which should be carried out by an experienced endodontist with the aid of a dental microscope. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Epigenetic regulation of the key inflammatory genes plays a crucial role in controlling monocyte/macrophage‐mediated local and systemic responses to bacterial challenges. However, it has not been addressed in apical periodontitis (AP). We aimed to explore the methylation pattern of the TNF‐α gene promoter and its association with the inflammatory phenotype of peripheral blood monocytes from individuals with AP and controls.A cross‐sectional study was conducted, including otherwise healthy individuals with AP (n = 25) and controls (n = 29). Monocytes were isolated from the volunteer’s blood samples using a Ficoll gradient followed by negative immunoselection. RNA and DNA were extracted. The DNA methylation profiles of the TNF‐α gene promoter region were analyzed using bisulfite sequencing PCR. The mRNA expression levels of DNA methyltransferases 3a (DNMT3a) and Ten Eleven Translocation enzymes 1(TET1) were assessed by qPCR. A fraction of primary monocytes was also cultured for 24 h, and the supernatant was collected to measure cytokine levels through a Luminex assay. Generalized structural equation models (GSEM) evaluated the association between AP, DNA methylation, and TNF‐α protein expression controlled for potential covariates. Models included the effect of the methylation of TNF‐α gene promoter as a mediator of the association between AP and TNF‐α protein expression levels.Monocytes from AP individuals exhibited a heightened secretion of TNF‐α and IL‐1β and hypomethylation of the TNF gene promoter (p < .05). AP diagnosis was associated with the TNF‐α gene promoter´s hypomethylated profile and enhanced pro‐inflammatory cytokine levels, while lower methylation of the gene promoter region and ‐163 CpG single site mediated TNF‐α overexpression (p < .05).DNA hypomethylation at the TNF‐α gene mediates a proinflammatory phenotype in monocytes from AP patients, supporting a role in the systemic response. [ABSTRACT FROM AUTHOR]

Background/Objectives: To assess the cytocompatibility, antibacterial and anti-biofilm efficacy of grape seed extract (GSE) and quercetin hydrogels versus calcium hydroxide (CH) as intracanal medications (ICMs) against an endodontic ex vivo biofilm model. Methods: Single-rooted teeth (n = 50) were prepared and sterilized before being infected with E. faecalis to develop a mature biofilm. They were divided into five equal groups according to the ICM used: G1: medicated with CH paste, G2: medicated with GSE hydrogel, G3: medicated with quercetin hydrogel, G4: positive control group that was infected and not medicated, and G5: negative control group that was neither infected nor medicated. After 1 week, the ICM was removed, and the root canals were cultured to assess the antibacterial efficacy by counting the colony-forming units and the anti-biofilm efficacy by the crystal violet assay. Dead/live bacterial viability was assessed by CFLSM examination, while the cytocompatibility was assessed using the MTT assay. Results: CH had the best antibacterial efficacy, followed by GSE and quercetin hydrogels (p < 0.001). Regarding the anti-biofilm efficacy, GSE was superior, followed by quercetin and CH (p < 0.001). CFLSM examination showed CH and GSE hydrogel to be highly effective in comparison to the positive control (p < 0.0001), with no statistical difference between them (p > 0.05). CH showed significantly higher cell viability percentages using a 500 μg/mL, while quercetin and GSE started to show cell viability > 70% at concentrations of 125 μg/mL and 62.5 μg/mL. Conclusions: CH fulfilled the ideal requirements of ICM as being both antibacterial and non-cytotoxic compared to the other materials tested. [ABSTRACT FROM AUTHOR]

ABSTRACT Traumatic dental injuries of permanent teeth result in multiple immediate and long‐term consequences depending upon the severity of trauma, age of the patient, the status of root maturity, and the emergency care provided. The healing responses may get disturbed due to severe damage, loss of vascularity of the supporting structures, and infections. As a result, the prohealing mediators and pathways are overpowered by the destructive stimuli often manifested by an increased osteoclastic activity. Among the various late complications, the apical periodontitis or the periapical lesions are most worrisome for the patients and create clinical dilemma for the dentists. In the past, many such lesions were classified as cysts and subjected to surgical management. However, better understanding of lesion pathophysiology, three‐dimensional imaging, and molecular pathways have established their inflammatory nature. The advancements in materials such as calcium silicates, and regenerative techniques have propelled the research related to non‐surgical endodontic management as its clinical acceptability. The treatment largely follows the recommendations of regenerative medicine and is based on four principles: (a) establishing the drainage or an endodontic access to the area, (b) removal of most of the triggering agents such as necrosed pulp, toxins, and inflammatory mediators, (c) disinfection of the area, controlling inflammation and reversal of the acidic pH, and (d) maintenance of this infection/inflammation‐free state for a long time through adequate sealing. This review aims to highlight the rationale of the approach, case selection, pathophysiology of the causation and healing, clinical protocols, and the limitations of non‐surgical endodontic management of large periapical lesions secondary to traumatic dental injuries. [ABSTRACT FROM AUTHOR]

Objectives: To assess the existing literature on the use of machine learning (ML) and deep learning (DL) models for diagnosing apical periodontitis (AP) in humans. Materials and methods: A scoping review was conducted following the Arksey and O’Malley framework. The PubMed, SCOPUS, and Web of Science databases were searched, focusing on articles using ML/DL approaches for AP diagnosis. No restrictions were applied. Two independent reviewers screened publications and charted data in predefined Excel tables for analysis. Results: Nineteen publications focused on diagnosing AP by identifying periapical radiolucent lesions (PRLs) in dental radiographs were included. The average sensitivity and specificity for reviewed models were 83% and 90%, respectively. Only three studies explored the direct impact of artificial intelligence (AI) assistance on clinicians’ diagnostic performance. Both consistently showed improved sensitivity without compromising specificity. Significant variability in dataset sizes, labeling techniques, and algorithm configurations was noticed. Conclusions: Findings affirm AI models’ effectiveness and transformative potential in diagnosing AP by improving the accurate detection of periapical radiolucencies using dental radiographs. However, the lack of standardized reporting on crucial aspects of methodology and performance metrics prevents establishing a definitive diagnostic approach using AI. Further studies are needed to expand AI applications in AP diagnosis beyond radiographic analysis. Clinical relevance: AI can potentially improve diagnostic accuracy in AP diagnosis by enhancing the sensitivity of PRL detection in dental radiographs without compromising specificity. [ABSTRACT FROM AUTHOR]

Introduction: Radiographic diagnostic competences are a primary focus of dental education. This study assessed two feedback methods to enhance learning outcomes and explored the feasibility of artificial intelligence (AI) to support education. Materials and Methods: Fourth‐year dental students had access to 16 virtual radiological example cases for 8 weeks. They were randomly assigned to either elaborated feedback (eF) or knowledge of results feedback (KOR) based on expert consensus. Students´ diagnostic competences were tested on bitewing/periapical radiographs for detection of caries, apical periodontitis, accuracy for all radiological findings and image quality. We additionally assessed the accuracy of an AI system (dentalXrai Pro 3.0), where applicable. Data were analysed descriptively and using ROC analysis (accuracy, sensitivity, specificity, AUC). Groups were compared with Welch's t‐test. Results: Among 55 students, the eF group by large performed significantly better than the KOR group in detecting enamel caries (accuracy 0.840 ± 0.041, p =.196; sensitivity 0.638 ± 0.204, p =.037; specificity 0.859 ± 0.050, p =.410; ROC AUC 0.748 ± 0.094, p =.020), apical periodontitis (accuracy 0.813 ± 0.095, p =.011; sensitivity 0.476 ± 0.230, p =.003; specificity 0.914 ± 0.108, p =.292; ROC AUC 0.695 ± 0.123, p =.001) and in assessing the image quality of periapical images (p =.031). No significant differences were observed for the other outcomes. The AI showed almost perfect diagnostic performance (enamel caries: accuracy 0.964, sensitivity 0.857, specificity 0.074; dentin caries: accuracy 0.988, sensitivity 0.941, specificity 1.0; overall: accuracy 0.976, sensitivity 0.958, specificity 0.983). Conclusion: Elaborated feedback can improve student's radiographic diagnostic competences, particularly in detecting enamel caries and apical periodontitis. Using an AI may constitute an alternative to expert labelling of radiographs. [ABSTRACT FROM AUTHOR]