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The term “endodontic-periodontal” (endo-perio) lesions describe lesions with the involvement of pulpal tissues and the periodontium of a tooth. These cases regarding the diagnosis, management, and prognosis of teeth are challenging for the clinician. The aim of this article was to discuss two cases of endo-perio lesions in molars with large periapical radiolucencies. Two healthy male individuals came with a chief complaint of pain during chewing. During clinical examination, a deep periodontal pocket of 10 mm and 7 mm, respectively, was noticed in both cases, and large periapical radiolucencies extended to the apical region were confirmed by the intraoral periapical radiographs. Evaluation of the symptoms together with the clinical findings determined the diagnosis endo-perio lesion of endodontic origin and accordingly the decision for the management. The successful treatment outcome with the periodontal healing in both cases was observed soon 40 days after orthograde root canal treatment. Conservative endodontic therapy was the key to the healing of the periapical tissues in endo-perio lesions of endodontic origin. The clinical approach as well as the 2-year follow-up of those compromised endo-perio lesions showed that endodontic therapy resulted in the healing, whereas no periodontal therapy was performed and the initial decision-making was confirmed.

Objective To summarize the clinical registration data of endodontic diseases registered in ClinicalTrials.gov in the United States and Chinese Clinical Trial Registry (ChiCTR), and analyze the registration characteristics at home and abroad. Methods We searched the clinical studies related to endodontic disease registered in the two databases from January 1, 2000, to August 20, 2023. We extracted and analyzed the information from clinical studies related to endodontic diseases. The extracted content included information on the registration region, registration year, trial title, research direction, sample size, trial progress, study type, trial design, blinding method, clinical trial phase, and participating institutions. Results The two databases contained a total of 536 191 registered items, of which 634 were endodontic diseases. Clinical trials in the registry of endodontic diseases involved 43 countries, of which the top three were Egypt (188 items), China (130 items), and the America (46 items). In addition, the number of registrations of clinical trials on endodontic diseases has significantly increased since 2015. The research directions were mainly pulposis (434 items), caries (106 items), and periapical diseases (77 items), which mostly involved etiology, drug intervention, surgical intervention, new technology, and new materials. Moreover, there were 430 clinical trials (67.82%) with a sample size < 100 and 185 (29.18%) with a sample size of 100-999. The progress status at the time of registration showed the largest number of completed trials, accounting for 286 items (45.11%), followed by unknown (125 items), recruiting (110 items), and not yet recruiting (81 items). The main research types were intervention studies (546 items, 86.12%), and the main design model was randomized parallel controlled trials (473 items, 74.61%). Additionally, 423 items (66.72%) were marked using the blind method, mainly double-blind trials (195 items), followed by other/unmarked (123 items, 19.40%) and open study (88 items, 13.88%). Furthermore, the largest number of items in the study phase were marked other/unlabeled (388 items), followed by phaseⅡ study (69 items) and preliminary study (62 items). Additionally, 611 items (96.37%) were clinical trials with a number of participating institutions < 3, and 23 items (3.63%) had a number of participating institutions ≥ 3. Conclusion The number of clinical trials registered for endodontic diseases is generally on the rise, but it is still relatively small. The quality of the study design needs to be enhanced, and the registration information in the study phase needs to be improved. Moreover, the number of multicenter trials is small. In the future, we should fully mobilize the talent advantages of well-known stomatology majors in China, take the lead in conducting high-quality, multi-center clinical research, and realize the transformation of results.

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Aims: To compare radiographic periapical healing and tooth survival outcomes of root canal (re)treatment performed within two care pathways (Routine Dental Care and Referred Treatment Pathway), in the United Kingdom Armed Forces (UKAF), and determine the effects of endodontic complexity on outcomes. Methodology: This retrospective cohort study included 1466 teeth in 1252 personnel who received root canal (re)treatment between 2015 and 2020. General Dental Practitioners treated 661 teeth (573 patients) (Routine cohort), whilst Dentists with a Special Interest treated 805 teeth (678 patients) (Referred cohort). The latter group were graduates of an MSc programme in Endodontics with 4–8 years of postgraduation experience. Case complexity was retrospectively determined for each tooth using the endodontic component of Restorative Index of Treatment Need (RIOTN) guidelines. Periapical healing was determined using loose radiographic criteria. The data were analysed using chi‐square tests, univariate logistic regression and Cox proportional hazards models. Results: A significantly (p < 0.0001) larger proportion of cases of low complexity had undergone root canal treatment within the Routine versus Referred cohort. The odds of periapical healing was significantly higher within the Referred versus Routine cohort, regardless of analyses using pooled (OR = 1.17; 95% CI: 1.11, 1.22) or moderate complexity (OR = 4.71; 95% CI: 2.73, 8.11) data. Within the Routine cohort, anterior teeth had higher odds of periapical healing than posterior teeth (OR = 1.13; 95% CI: 1.04, 1.22). The 60‐month cumulative tooth survival was lower (p = 0.03) in the Routine (90.5%) than the Referred (96.0%) cohort. Within the Routine cohort, the hazard of tooth loss was higher amongst posterior teeth (HR = 4.03; 95% CI: 1.92, 8.45) but lower if posterior teeth had cast restorations (HR = 0.36; 95% CI: 0.19, 0.70). For the Referred cohort, posterior teeth restored with cast restoration (vs not) had significantly lower risk of tooth loss (HR = 0.21; 95% CI: 0.08, 0.55). Conclusions: For UKAF patients, root canal (re)treatment provided within the Referred pathway was significantly more likely to achieve periapical healing and better tooth survival than those provided within the Routine pathway. Posterior teeth restored with an indirect restoration had a higher proportion of tooth survival. This study supported the utility of the endodontic component of RIOTN for assessing case complexity. [ABSTRACT FROM AUTHOR]

Introduction: Foraminal Enlargement (FE) is a cleaning performed in the apical-most region of the tooth, in order to optimize root disinfection. This systematic review evaluated the influence of FE during root canal treatment on bacterial reduction and repair of the periapical lesion. Materials and Methods: Searches in PubMed/MEDLINE, Scopus, Cochrane Library, Web of Science, Embase, Scielo, Lilacs and OpenGrey were performed until January-2024. Ex vivo and in vivo studies evaluating the effects of FE in the bacterial reduction and repair of the periapical lesion were included, respectively, followed by risk of bias assessment (modified version of Joanna Briggs Institute's for ex vivo studies and Corresponding author Gustavo Systematic Review Centre for Laboratory animal Experimentation's risk of bias tools for in vivo studies). The meta-analysis was not feasible and a qualitative summary for each outcome was provided. Results: Of 950 studies, 2 in vivo studies were eligible, using animal models with infected teeth. Of these two, periapical repair was evaluated with hematoxylin-eosin stain, and FE improved periapical healing. Regarding ex vivo studies, 3 were eligible, using extracted human teeth. The inoculations in ex vivo models were performed with Enterococcus (E.) faecalis, and FE reduced E. faecalis in the ex vivo models. Conclusions: Foraminal enlargement seems to increase bacterial reduction within the root canal, and provide major periapical tissue repair on the histological analysis in animal studies. However, caution is necessary when translating these results to the clinical environment. [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]

Components derived from an infected lesion within the bone can spread through various passages in the mandible, particularly via the mental foramen. Radiologically, the spread of infection is typically nonspecific and challenging to characterize; however, multislice computed tomography (MSCT) can effectively detect pathological changes in soft tissues and the bone marrow space. This report describes the case of a 55-year-old woman who experienced mental nerve paresthesia due to a periapical infection of the right mandibular second premolar. MSCT imaging revealed increased attenuation around the periapical lesion extending into the mandibular canal and loss of the juxtamental foraminal fat pad. Following endodontic treatment of the tooth suspected to be the source of the infection, the patient's symptoms resolved, and the previous MSCT imaging findings were no longer present. Increased bone marrow attenuation and obliteration of the fat plane in the buccal aspect of the mental foramen may serve as radiologic indicators of inflammation spreading from the bone marrow space. [ABSTRACT FROM AUTHOR]

Introduction: The presented study aimed to characterise periapical disease in teeth with primary non-surgical root canal treatment in persistent or emergent categories and their risk association. Methods: A retrospective observational study that evaluated permanent teeth with primary non-surgical root canal treatment, was conducted clinically and radiographically for over one year. The following variables were analysed: gender, age, type and location of tooth, previous diagnosis, treatment conditions, and type of coronal restoration. The supplementary variables included the perspectives of the treatment outcome, such as Remains normal, Improvement, and Failure. Statistical analysis was performed using a univariate analysis that estimated the average and proportion for each factor according to the result of the primary non-surgical root canal treatment. The multiple correspondence analysis identified the hierarchy between active variables and their association with the results. Results: A total of 232 teeth in 155 participants were analysed. A χ² value, (P=0.023) showed that the emergent disease is associated with patients around the age of 50. The multiple correspondence analysis identified a tendency of grouping between the emergent disease and the short filling category, followed by symptomatic pulpitis as a previous diagnosis. The persistent disease was associated with errors and overfillings. An inadequate root filling and taper density adversely impacted the treatment outcome. Conclusions: The length of obturation influenced the presence of failure. Short fillings were associated with emerging periapical disease. Errors and overfillings contributed to the persistent disease in the populations studied. [ABSTRACT FROM AUTHOR]

Background: Root canal treatment (RCT) is a specialized and one of the most demanded procedures in the public oral health-care sector. Multiple-visit endodontic treatment is considered a conventional method for treating the affected teeth; however, the procedure requires a considerable amount of time to complete the treatment. The recent era is showing an escalating preference of the endodontists as well as the patients toward the single-visit RCT over multiple visits due to some advantages such as the low risk of leakages usually caused by the temporary seal. To the best of our knowledge in this systematic review and meta-analysis, we aim to evaluate the effectiveness of single-visit RCT over multiple-visit RCT in terms of the rate of flare-ups and postoperative pain in both vital and nonvital teeth. Methods: We performed an electronic search through PubMed, MEDLINE Database, Cochrane Central Register of Controlled Trials, Scopus Database, Web of Science, and LILACS Database. A systematic review was performed using the Cochrane handbook and PRISMA statement. The meta-analysis presented in this study was done by applying the random effects model in RevMan 5.4. Results: A total of 106 articles were referred. Out of these, forty articles were selected for analysis in the database, and 22 were excluded because of the absence and irrelevance of required parameters. A total of ten studies were selected for meta-analysis after the complete screening and analysis. The comparison was done between the incidence of postoperative pain among vital and nonvital teeth. The difference in postoperative pain after 24 and 48 h of single-visit RCT among studied groups was found to be nonsignificant with P = 0.49 and 0.20, respectively. Moreover, the majority of studies have shown that there was no difference in the occurrence of pain whether patients were treated through the single visit or multi-visit RCT. Conclusion: Based on the evidence, single-visit RCT appeared to be a safe treatment mode when considered for flare-ups. However, within the limitation of this study, it is also concluded that the incidence of postoperative pain is seen within 24 h of treatment which was found to reduce with the passage of time. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between blood glucose control level and type 2 diabetes mellitus complicated with periapical disease. Methods: Clinical data of 300 patients with type 2 diabetes who were admitted to our hospital from September 2018 to September 2022 were retrospectively selected. According to the occurrence of periapical disease, patients were divided into periapical disease group (45 cases) and control group (255 cases). According to HbA1c, patients were divided into poor blood glucose control group (HbA1c≥6.5%, 105 cases), good blood glucose control group (HbA1c < 6.5%, 195 cases). Multivariate Logistic regression analyzed the related factors of type 2 diabetes mellitus with periapical disease, receiver operating characteristic curve (ROC) analyzed the diagnostic value of type 2 diabetes mellitus with periapical disease by HbA1c. Results: The incidence of periapical disease (28.57% vs 7.69%) and PAI score (2.66± 0.41 vs1.24± 0.26) in poor blood glucose control group were higher than those in good blood glucose control group (P<0.001). The proportion of smoking history, periodontal disease, poor blood glucose control and FPG in periapical disease group was higher than that in control group (P<0.001), the course of type 2 diabetes mellitus was longer than that in control group (P<0.001), and the proportion of taking metformin was lower than that in control group(P<0.01). Multivariate Logistic regression showed that poor blood glucose control and smoking history were risk factors for periapical disease in type 2 diabetic patients (P<0.001, P<0.01), while metformin use was protective factor (P<0.001). The area under the curve of HbA1c for the diagnosis of type 2 diabetes patients with periapical disease was0.659（95%CI: 0.650-0.756, P＜0.01）, the sensitivity was 73.33%, the specificity was 62.75%, and the Jordon index was 0.3608. Conclusions: Poor blood glucose control is related to the occurrence of periapical disease in patients with type 2 diabetes mellitus, and blood glucose level should be actively controlled to prevent periapical disease. [ABSTRACT FROM AUTHOR]

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]

Dental radiography offers significant indication for medical/clinical diagnosis, quality assessment and treatment. Huge efforts have been taken while developing the digital dental X-ray image analysis system for the enhancement of clinical quality. In this manuscript, the datasets, methodology and analysis of performance are carried out for the evaluation of qualities regarding the dental treatment with the utilization of periapical images of dental X-ray that is taken before and after the operations. With the purpose of supporting dentists to make some clinical decisions, a tool pipeline for automated clinical quality evaluation is being proposed. In this approach, a disease diagnosis from the dental image analysis is made by means of deep learning techniques. Initially, the dental input dataset is preprocessed using bias-corrected filter technique. For segmentation process, semantic contextual network segmentation (SCNS) is employed. The features were extracted using multi-scale local ternary pattern (MS-LTP). Statistical linear discriminant analysis (SLDA) approach is employed for the selection of features. At last, the extracted and selected features outcome is post-processed to improve the rate of classifier performance. The classification process is carried out by means of improved multipath residual CNN (IMRCNN) classifier. Thus, the proposed technique provides better accuracy than others in the diagnosis of dental disease to predict Periapical Disease Detection in Dental Radiographs image. Thus, the disease is predicted so as to diagnose the severity earlier and helpful for dentist in making decisions on treatment process. Thus, finally the performance estimation has been made and the results were compared with existing techniques to prove the effectiveness of proposed strategy. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare periapical status transitions in teeth after post placement compared with other post-endodontic treatments in root-filled teeth. This retrospective longitudinal radiographic study included radiographs of 284 patients with root filled and restored teeth with composite fillings (Endo-fill group, n = 100), crown or fixed prosthesis (Endo-crown group, n = 82) or post and core restorations (Endo-post group, n = 102). All post and core restorations were made of gold alloy. The radiographs taken at the end of endodontic treatment, at the end of post-endodontic treatment and at least 8 months after post-endodontic treatment were evaluated. Post-operative periapical status was assessed according to the periapical index (PAI) and all teeth included in the study had no apical periodontitis preoperatively. Multi-state Markov analysis was used to assess periapical status transitions among the treatment groups. Of 284 root-filled teeth without apical periodontitis at baseline, 7.7% developed clear apical pathology within a minimum of 8 months observational period. In the Endo-post group 11 (10.78%) teeth transited from Healthy (PAI 1) to Disease (PAI 2-4) state compared with eight (9.75%) in the Endo-crown group and four (4%) in the Endo-fill group. The transition probabilities from Healthy (PAI 1) to Mild diseased (PAI 2) were 17.5% in the Endo-post group, 13.1% in the Endo-crown group and 5.3% in the Endo-fill group. Multivariate analysis showed that teeth in the Endo-fill group had 60% lower hazard to transit from Healthy (PAI 1) to Mild diseased (PAI 2) state [HR 0.40; 95% CI 0.12, 0.94]. A period exceeding 8 months between the end of the endodontic treatment and prosthetic treatment significantly increased the hazard of disease progression by three times compared with a period of ≤8 months [HR 3.16; 95% CI 1.06, 9.42]. Teeth without radiographic lesions at baseline and restored with posts had higher hazard to transit from healthy to diseased periapical status compared with teeth restored with composite restorations. Controlled clinical trials with longer follow-up periods are needed to validate these findings. [ABSTRACT FROM AUTHOR]

Objectives: The current study aimed to investigate the influence of the periapical lesion size on healing outcome following Regenerative Endodontic Procedures (REPs) in mature teeth using cone-beam computed tomography (CBCT) and Mimics software. Methods: The study included ten mature necrotic maxillary anterior teeth with periapical lesions ≥ 3 CBCT Periapical index score (CBCTPAI). REPs via blood clots were performed for all the teeth. CBCT scans were taken pre and postoperatively after 12 months follow-up periods and transferred to Mimics for volume measurements and comparison. Statistical analysis was performed using the Wilcoxon signed-rank test. Result: All teeth were symptom-free with a statistically significant decrease in the volume of the periapical lesion (P < 0.05) after 12 months except for one case. Conclusion: The study concluded that REPs could be a successful treatment modality for mature necrotic teeth with periapical lesions however the size of the preoperative periapical lesion could affect the outcome of the periapical healing. Trial registration: The study was registered in ClinicalTrials.gov (ID: NCT04646538). [ABSTRACT FROM AUTHOR]

Odontogenic sinusitis (ODS) is more common than historically thought, representing 25% to 40% of all maxillary sinusitis. Due to a lack of widely accepted diagnostic criteria and a specific international diagnostic code, a true overall prevalence is unknown. ODS may be caused by either a multitude of infectious dental pathologies or complications after dental procedures. The most common dental etiologies causing ODS are apical periodontitis (endodontic) and oroantral communication or fistula after dental extraction. Less commonly, ODS can evolve after dental implant or maxillary sinus bone grafting surgeries, infection of odontogenic cysts, or advanced periodontitis., Competing Interests: Disclosure The author has received or receives honoraria for lecturing by the following companies. Straumann, Geistlich, Bego, BFS, Hess Dental, Nobel Biocare, and Quintessence., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Diagnosis of periapical diseases usually requires a lot of time and effort from the dentist to perform a series of examinations and evaluations, although X-rays have been available to assist in visualizing the condition of the apical region of the tooth. To achieve efficient automated detection and diagnosis of periapical diseases (periapical granuloma, periapical abscess, periapical cysts, and condensing osteitis) by dental X-rays, a deep learning-based approach is proposed, which includes an improved Mask R-CNN-based lesion area segmentation network and a neural network classifier based on six texture features extracted from the segmented lesion regions. The results demonstrate that the average pixel accuracy of lesion area segmentation is over 0.97, while the average Dice Similarity Coefficient for segmentation is over 0.95. The accuracy, precision, recall, and F1 score of this method for the diagnosis of periapical diseases are all above 0.99. Precise segmentation and accurate classification of four distinct types of periapical diseases are achieved using this method, making it possible to create automated systems that can assist in the clinical diagnosis of periapical diseases, potentially streamlining the diagnostic process, reducing the workload of dentists, and improving overall patient care. • Automated detection and diagnosis of periapical diseases using dental X-rays. • Improved Mask R-CNN network is used for lesion area segmentation. • Texture feature and neural network based periapical diseases diagnosis. • Deep learning approach for lesion segmentation and classification. • Method achieves excellent diagnostic performance for periapical diseases. [ABSTRACT FROM AUTHOR]

Objective The short-term clinical effects of two kinds of normal temperature flow root sealers (the calcium silicate-based sealer iRoot SP and the siloxane-based sealer GuttaFlow2) combined with single point filling technology and a frequently-used sealing agent (AH Plus) combined with continuous wave hot tooth filling technology were evaluated. Methods A total of 279 teeth (656 root canals) were randomly divided into three groups: the iRoot SP group, GuttaFlow2 group and AH plus group. We recorded the filling time of each root canal, collected a digital dental film to evaluate the filling effect of each root canal, and conducted a follow-up visit one week and one month after the operation to record the incidence of pain. We used SPSS 18.0 to analyze the above data. Results There was no significant difference in the root canal filling effect among the three groups (P > 0.05). There was no significant difference in the filling time between the iRoot SP group and the GuttaFlow2 group (P > 0.05), but the filling time was significantly shorter in the AH Plus group (P < 0.05). There was no significant difference in the postoperative pain between the iRoot SP group and the GuttaFlow2 group (P > 0.05), and the incidence of pain in the iRoot SP group and the GuttaFlow2 group was lower than that in the AH Plus group (P < 0.05). Conclusions GuttaFlow2 and iRoot SP combined with single point filling technology can save filling time and obtain good clinical effects compared with frequently-used hot tooth filling technology and the incidence of postoperative pain was low.

Objective: The purpose of this literature search was to highlight the utility of PET/CT scan in endodontics and compare it with CBCT and conventional radiograph. Materials and Method: PubMed, Medline, Scopus and google scholar were utilised for the analysis. The inclusion criteria was based on the studies which included PET/CT scan and CBCT scan in endodontics. The articles considered were in English lan- guage. Results: Of all the studies, 47 articles were selected which met the inclusion criteria. Results indicated that PET/CT can be utilised in the field of endodontics. Conclusion: PET/CT scan is a novel combination method which can provide valuable data for the pulpal and periapical infection combining morphological and metabolic understanding of the infected tissue and detecting the lesion at the initial stage. [ABSTRACT FROM AUTHOR]

To elucidate the presence of apical periodontitis in the root canal of teeth with secondary/persistent infection, including composition of microbiota, levels of endotoxins and lipoteichoic acid (LTA), and clinical implications of these findings. Samples were collected from root canals of 50 patients who needed endodontic retreatment and had radiographic evidence of apical periodontitis. Microorganisms were identified by using the culture technique and biochemical tests. Nested–polymerase chain reaction (nested-PCR) was used to identify 17 species of specific bacteria. Lipopolysaccharides (LPS) and LTAs were quantified by using, respectively, limulus amebocyte lysate and enzyme-linked immunosorbent assay tests. Bacteria were detected in all samples by culture and molecular methods. A total of 154 gram-positive strains, of 188 strains isolated, were found in the root canals by culture. Enterococcus faecalis and Gemella morbillorum were the most prevalent species identified by the biochemical tests, whereas molecular analyses (nested-PCR) showed a high frequency of P. gingivalis , E. faecalis , and Fusobacterium nucleatum. LPS and LTA were detected in all samples, with mean values being 3.52 EU/mL and 597.83 pg/mL, respectively. Significant statistical correlations were found between levels of LTA and clinical features. Despite the prevalence of gram-positives, the microbiota present in secondary/persistent infections showed a large variety of species. Within this diversity, associations were found between specific bacteria and clinical features. In addition, higher levels of LTA were statistically associated with larger periapical radiolucent areas, but no correlation between this feature and LPS was found. [ABSTRACT FROM AUTHOR]

Introduction: Cone beam computed tomography periapical volume index (CBCTPAVI) is a categorisation tool to assess periapical lesion size in three-dimensions and predict treatment outcomes. This index was determined using a time-consuming semi-automatic segmentation technique. This study compared artificial intelligence (AI) with semi-automated segmentation to determine AI's ability to accurately determine CBCTPAVI score., Methods: CBCTPAVI scores for 500 tooth roots were determined using both the semi-automatic segmentation technique in three-dimensional imaging analysis software (Mimics Research™) and AI (Diagnocat™). A confusion matrix was created to compare the CBCTPAVI score by the AI with the semi-automatic segmentation technique. Evaluation metrics, precision, recall, F1-score (2×precision×recallprecision+recall), and overall accuracy were determined., Results: In 84.4 % (n = 422) of cases the AI classified CBCTPAVI score the same as the semi-automated technique. AI was unable to classify any lesion as index 1 or 2, due to its limitation in small volume measurement. When lesions classified as index 1 and 2 by the semi-automatic segmentation technique were excluded, the AI demonstrated levels of precision, recall and F1-score, all above 0.85, for indices 0, 3-6; and accuracy over 90 %., Conclusions: Diagnocat™ with its ability to determine CBCTPAVI score in approximately 2 min following upload of the CBCT could be an excellent and efficient tool to facilitate better monitoring and assessment of periapical lesions in everyday clinical practice and/or radiographic reporting. However, to assess three-dimensional healing of smaller lesions (with scores 1 and 2), further advancements in AI technologies are needed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Purpose: This longitudinal cohort study aimed to evaluate the relationship between osteonecrosis of the jaw and pulp and periapical disease in patients who were administered bisphosphonates., Methods: Using data from a nationwide cohort, we examined the association among dental caries, pulp and periapical disease, and osteonecrosis of the jaw in women aged >50 years who received bisphosphonates for more than 1 year between 2002 and 2015. Because of ambiguities in the diagnosis of osteonecrosis of the jaw in population-based data, we operationally defined and categorized the condition into established and potential osteonecrosis of the jaw., Results: Pulp and periapical disease significantly increased the development of both established and potential osteonecrosis of the jaw (hazard ratio, 2.21; 95% confidence interval, 1.40-3.48; and hazard ratio, 2.22; 95% confidence interval, 1.65-2.98, respectively). Root canal treatment did not have any influence on the development of osteonecrosis of the jaw., Conclusions: Pulp and periapical disease may be a major risk factor for osteonecrosis of the jaw. The study findings suggest that patients should undergo regular dental examinations to detect pulp and periapical disease before or during the administration of bisphosphonates and that root canal treatment should be considered to decrease the risk of osteonecrosis of the jaw., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2024. Korean Academy of Periodontology.)

Pulpal and periapical diseases affect a large segment of the population. The role of microbial infections and host effector molecules in these diseases is well established. However, the interaction between host genes and environmental factors in disease susceptibility and progression is less well understood. Studies of genetic polymorphisms in disease relevant genes have suggested that individual predisposition may contribute to susceptibility to pulpal and periapical diseases. Other studies have explored the contribution of epigenetic mechanisms to these diseases. Ongoing research expands the spectrum of non-coding RNAs in pulpal disease to include viral microRNAs as well. This review summarizes recent advances in the genetic and epigenetic characterization of pulpal and periapical disease, with special emphasis on recent data that address the pathogenesis of irreversible pulpal pathosis and apical periodontitis. Specifically, proinflammatory and anti-inflammatory gene expression and gene polymorphism, as well as recent data on DNA methylation and microRNAs are reviewed. Improved understanding of these mechanisms may aid in disease prevention as well as in improved treatment outcomes.

Pulp debridement and disinfection in the pulp cavity is a critical step in achieving a successful root canal therapy. Microorganisms remaining in the root canal system after endodontic treatment are a main cause of root canal failure. The challenges faced in endodontic disinfection include the complex anatomy of the root canal system, the existence of a biofilm within the root canal, and the creation of a problematic smear layer during instrumentation of the canal. Historically, sodium hypochlorite and ethylenediaminetetraacetic acid have been utilized as irrigants and still remain as the most effective disinfectants due to their synergistic abilities to eradicate microorganisms, dissolve necrotic debris, and remove the smear layer and biofilm. This article addresses challenges in endodontic disinfection, objectives of endodontic irrigants, properties of an ideal irrigant, currently used irrigants, and irrigant delivery systems utilized in veterinary dentistry. [ABSTRACT FROM AUTHOR]

Pulpal and periapical diseases affect a large segment of the population. The role of microbial infections and host effector molecules in these diseases is well established. However, the interaction between host genes and environmental factors in disease susceptibility and progression is less well understood. Studies of genetic polymorphisms in disease relevant genes have suggested that individual predisposition may contribute to susceptibility to pulpal and periapical diseases. Other studies have explored the contribution of epigenetic mechanisms to these diseases. Ongoing research expands the spectrum of non-coding RNAs in pulpal disease to include viral microRNAs as well. This review summarizes recent advances in the genetic and epigenetic characterization of pulpal and periapical disease, with special emphasis on recent data that address the pathogenesis of irreversible pulpal pathosis and apical periodontitis. Specifically, proinflammatory and anti-inflammatory gene expression and gene polymorphism, as well as recent data on DNA methylation and microRNAs are reviewed. Improved understanding of these mechanisms may aid in disease prevention as well as in improved treatment outcomes. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the study was to evaluate the frequency and status of root canal-treated teeth in patients treated at the College of Dentistry, University of Dammam in the Eastern Province of Saudi Arabia. Materials and Methods: A total of 3701 patients visited the clinics during the study period. Through the use of radiographs, 161 patients were initially selected who had endodontically treated teeth. However, after applying the inclusion criteria, the total number of eligible cases was reduced to 155. Patients were divided into three groups according to age (children 1–12 years, adults 13–65 years and geriatrics >65 years). Results: On average, each patient had 2.28 ± 1.88 root canal-treated teeth and 24.02 ± 5.03 teeth without root canal treatment. The average number of endodontically treated teeth increased with an increase in age. The adult group showed the highest number of root-filled teeth 314 (93.4%). Of the 336 endodontically treated teeth, only 75 (22.3%) teeth exhibited periapical radiolucency. First molars (28.43–36.36%) and second premolars (20.1–27.27%) were the most frequently root-filled teeth in both jaws, followed by the first maxillary premolars (11.76%). Periapical lesions showed an almost similar pattern with the highest number of radiolucencies found in the first molars in both jaws (29.3–33.3%) followed by the second premolars in the mandible (30.6%) and first premolars in both jaws (20.8–25%). Conclusion: The first molars and second premolars were the most frequently root-filled teeth in both jaws, followed by maxillary first premolars. Periapical lesions showed an almost similar pattern among teeth with a higher number of radiolucencies found in the first molars in both jaws, followed by the second premolars in the mandible and the first premolars in both jaws.

Introduction: Health of periapical tissues has been considered as an index for the evaluation of endodontic outcomes. The present study sought to assess the pattern of periapical lesion extension in anterior teeth using cone-beam computed tomography (CBCT). Methods and Materials: In this descriptive study, 199 CBCT images belonged to patients aging from 15 to 79 were assessed according to periapical lesion extension in the regions of maxillary and mandibular anterior teeth. Maximum periapical lesion extensions in three orthogonal planes were measured and recorded in millimeters and were assessed according to age, gender, dental arch and tooth type. Statistical analysis was performed using percentages, repeated measure ANOVA and Bonferroni tests. The significant level was set at 0.05. Results: The highest average of lesion extension, in both maxilla and mandible, was in vertical dimension, followed by horizontal buccolingual and horizontal mesiodistal dimensions, respectively. There were significant differences between the vertical and mesiodistal (P=0.004) and also mesiodistal and buccolingual (P=0.010) periapical lesion extension dimensions. In addition, there were significant differences in maxilla and mandible (P=0.012). In maxilla, there were no significant differences between the three tooth types (P=0.346) but in the mandibular arch, there were significant differences between central-canine (P=0.004) and lateral-canine (P=0.026). According to independent variables, only gender had a significant effect on the lesion extension in anterior regions of maxilla and mandible (P=0.001). The periapical lesion extensions were significantly higher in men compared with women. Conclusions: The bone destruction_as a consequence of periapical inflammatory process_ was greatest in the vertical, and lowest in the horizontal mesiodistal dimensions. That way, the extension in buccolingual dimension, which could not be detected in the 2-D imaging techniques, was rather high in the present study. Thus CBCT, as a 3-D imaging technique, could be recommended for the precise evaluation of lesion extension in the periapical area. [ABSTRACT FROM AUTHOR]

Endodontic disease, 1 of the most prevalent chronic infectious diseases worldwide, occurs when the dental pulp becomes infected and inflamed, leading to bone destruction around the tooth root, severe pain, and tooth loss. Although many studies have tried to develop therapies to alleviate the bone erosion and inflammation associated with endodontic disease, there is an urgent need for an effective treatment. In this study, we used a gene-based therapy approach by administering recombinant adeno-associated virus (AAV)-mediated Atp6v1c1 knockdown to target both periapical bone resorption and inflammation in the mouse model of endodontic disease. The results showed that Atp6v1c1 knockdown is simultaneously capable of reducing bone resorption by 70% through impaired osteoclast activation, inhibiting inflammation by decreasing T-cell infiltration in the periapical lesion by 75%, and protecting the periodontal ligament from destruction caused by inflammation. Notably, AAV-mediated gene therapy of Atp6v1c1 knockdown significantly reduced proinflammatory cytokine expression, including tumor necrosis factor α , interleukin 1 α , interleukin 17, interleukin 12, and interleukin 6 levels in periapical tissues caused by bacterial infection. Quantitative real-time polymerase chain reaction revealed that Atp6v1c1 knockdown reduced osteoclast-specific functional genes (ie, Ctsk) in periapical tissues. Our results showed that AAV-mediated Atp6v1c1 knockdown in periapical tissues slowed endodontic disease progression, prevented bone erosion, and alleviated inflammation in the periapical tissues and periodontal ligament potentially through regulation of toll-like receptor signaling, indicating that targeting Atp6v1c1 may facilitate the design of novel therapeutic approaches to reduce inflammation and bone erosion in endodontic disease. • Knockdown of Atp6v1c1 expression attenuates inflammation in the periodontal ligament (PDL) and periapical lesions. • Atp6v1c1 knockdown significantly reduced proinflammatory cytokine expression, including tumor necrosis factor alpha, interleukin-1 α , interleukin-17, interleukin-12, and interleukin-6 levels in periapical tissues, indicating that Atp6v1c1 may regulate TLR signaling. • Atp6v1c1 silencing attenuates alveolar bone resorption in endodontic disease. • Atp6v1c1 knockdown prevents PDL destruction by attenuating inflammation in the periapical lesions. [ABSTRACT FROM AUTHOR]

Aim: To characterize the proteome of 20 root canals in teeth with post‐treatment endodontic disease using mass spectrometry and to correlate the identified proteins with clinical features. Methodology: Twenty patients with radiographic evidence of apical periodontitis and need for root canal re‐treatment were selected. Samples from the root canal contents were collected and processed using two‐dimensional capillary nano‐flow liquid chromatography and electrospray ionization tandem mass spectrometry. The acquired spectra were separately searched against specific protein database. The results obtained were analysed using descriptive statistics. Additionally, Pearson's chi‐square test or one‐sided Fisher's exact test, as appropriate, was chosen to examine the null hypothesis that there is no relationship between each clinical feature and the presence of specific microbial or human proteins. Significance levels were set at 5% (P < 0.05). Results: A total of 1153 human and 720 microbial UniProt accession numbers corresponding to proteins were recovered. The greater prevalence of proteins was related to biological functions, such as cellular and metabolic processes. A considerable number of microbial proteins with clinical relevance functions, such as pathogenesis/virulence, proteolysis, cell adhesion and drug resistance, were detected. Common endodontic pathogens related to post‐treatment endodontic disease such as Enterococcus spp., Propionibacterium spp. and Streptococcus spp. were associated with 23, 40 and 94 distinct proteins, respectively. As for human proteins, many factors related to the immune system process were detected. No significant correlations were found between microbial and human proteins and the clinical features investigated (P > 0.05). Conclusions: A considerable number of microbial and human proteins were identified using proteomic analyses, being mainly related to processes indicating cell viability. No significant correlation was found between proteins and clinical features. These findings suggest a network of important microbial pathogenic functions that may be responsible for the host immune system response. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the mRNA expression levels of the cytokines interferon‐γ, tumour necrosis factor‐α, interleukin (IL)‐1β, IL‐10, IL‐6, VEGF, and AGT and the chemokine CCL2/MCP‐1 in periapical interstitial fluid associated with root canal infections before and after the reduction of the bacterial load using a cleaning procedure. Methodology: The case group included 11 patients with chronic liver disease, and the control group included 11 healthy patients. Clinical samples were taken from teeth with pulp necrosis. After cleaning and drying the canal, three paper points were introduced into the root canal and passed through the root apex (2 mm) into the periapical tissues for 1 min. The samples were collected immediately after root canal cleaning and 7 days later to characterize those gene expression levels using real‐time PCR. The data were subjected to the Shapiro–Wilk and the Wilcoxon tests. Results: In the control group, significantly increased expression of the pro‐inflammatory cytokines IFN‐γ and TNF‐α was observed in teeth with restrained bacterial loads (day 7) (P < 0.05). Similarly, increased TNF‐α expression was found on day 7 in the liver group (P < 0.05). No differences were observed in the expression levels of the IL‐1β, IL‐10 and, IL‐6, MCP‐1/CCL‐2 and VEGF between the first collection (day 0) and second collection (day 7), over time in either group. Conclusion: Chronic liver disease patients exhibited sufficient immunologic ability showing relatively similar expression levels of cytokines, chemokines and angiogenic factors in periapical samples compared with the responses from no‐chronic liver disease patients. The outcomes of this study suggest that liver impairment did not compromise the periapical immune response. [ABSTRACT FROM AUTHOR]

Objectives: Early pre‐clinical inflammatory changes in periodontal and/or periapical lesions, which typically precede bone loss, are challenging to diagnose using ionizing‐radiation‐based imaging modalities. MRI provides relevant additional diagnostic information of inflammatory processes in soft and hard tissues. The aim of the present study is to undertake a systematic review of the literature on MRI in the diagnosis of periodontal and/or periapical disease. Methods and Materials: The PubMed/MEDLINE and Scopus bibliographic databases were searched (2000–2021) using the search string: ("MRI" or "magnetic resonance imaging") and ("periodontitis" or "periodontal" or "apical pathology" or "endodontic pathology" or "periapical" or "furcation" or "intrabony"). The search was limited to studies published in English. The studies were assessed independently by three reviewers, focusing on the MRI sequences, imaging modalities (radiographs, cone beam CT (CBCT), and MRI), disease definition, assessed parameters, and outcome measurements. Results: The search strategy yielded 34 studies, from which 13 were included. Overall, the findings of MRI were in agreement with CBCT. The studies showed that MRI provided diagnostic information of the hard and soft tissue components affected by periodontal and/or periapical disease with a fairly high sensitivity and specificity. However, the assessed parameters (e.g. MRI acquisition protocols, and disease definition) differed substantially. Conclusions: The included studies indicate that the use of MRI in the diagnosis of periodontal and/or periapical disease is feasible and promising. More studies are needed to define the accuracy of this non‐ionizing‐radiation‐based diagnostic modality, in the assessment of periodontal and/or periapical lesions. [ABSTRACT FROM AUTHOR]

Objectives: Early pre-clinical inflammatory changes in periodontal and/or periapical lesions, which typically precede bone loss, are challenging to diagnose using ionizing-radiation-based imaging modalities. MRI provides relevant additional diagnostic information of inflammatory processes in soft and hard tissues. The aim of the present study is to undertake a systematic review of the literature on MRI in the diagnosis of periodontal and/or periapical disease., Methods and Materials: The PubMed/MEDLINE and Scopus bibliographic databases were searched (2000-2021) using the search string: ("MRI" or "magnetic resonance imaging") and ("periodontitis" or "periodontal" or "apical pathology" or "endodontic pathology" or "periapical" or "furcation" or "intrabony"). The search was limited to studies published in English. The studies were assessed independently by three reviewers, focusing on the MRI sequences, imaging modalities (radiographs, cone beam CT (CBCT), and MRI), disease definition, assessed parameters, and outcome measurements., Results: The search strategy yielded 34 studies, from which 13 were included. Overall, the findings of MRI were in agreement with CBCT. The studies showed that MRI provided diagnostic information of the hard and soft tissue components affected by periodontal and/or periapical disease with a fairly high sensitivity and specificity. However, the assessed parameters ( e.g. MRI acquisition protocols, and disease definition) differed substantially., Conclusions: The included studies indicate that the use of MRI in the diagnosis of periodontal and/or periapical disease is feasible and promising. More studies are needed to define the accuracy of this non-ionizing-radiation-based diagnostic modality, in the assessment of periodontal and/or periapical lesions., Competing Interests: Statements and declarationsThe authors declare no conflicts of interest that could interfere with this manuscript.

Apical periodontitis is an inflammatory pathology that affects the periapical tissues of a devitalized tooth. The aim of this study was to histologically and morphometrically characterize lesions of cysts and granulomas using light microscopy. Six biopsies obtained from teeth with indication of exodontia were analyzed. The histological analysis was carried out by means of optical microscopy and microphotographs, with contrast analysis of images and cell count by ImageJ. A description of the histological characteristics was made, observing the cavities surrounded by stratified squamous non-keratinized epithelium and a fibrous capsule composed of fibrocytes, fibroblasts and chronic inflammatory infiltrate; in the granulomas, capillaries, a fibrous capsule of fibrocytes/fibroblasts and a predominantly lymphocytic inflammatory infiltrate were observed. In relation to quantification of the cellular number of inflammatory infiltrate, for cysts itwas of 9.2 cel/10000 mm2, while for granulomas it was 20.8 cel/10000 mm2, without significant statistical differences between both (p = 0.654). The quantification of the fibrocyte/fibroblast cell number was, for cysts, 15.4 cells/10000 mm2, while for granulomas it was 18.5 cells/10000 mm2, without significant statistical difference (p = 0.499). With respect to the percentage of collagen type I, for the cysts was 37.8 ± 19.2%, while for granulomas it was 33.8 ± 23.3%, without significant statistical differences (p = 0.704). A moderate negative correlation was observed for the inflammatory infiltrate (R = 0.667) and a low positive correlation for fibrocytes / fibroblasts (R = 0.121), in relation to the amount of type I collagen. Measurement of the area of the periapical lesions: the total average of lesions were 10.7 ± 5.0 mm2, the largest being a cyst of 18.1 mm2 and the smallest a granuloma of 5.2 mm2. The histological analysis allows to make a differential diagnosis of lesions with similar characteristics and thus define the most appropriate treatment. [ABSTRACT FROM AUTHOR]

Progress has been made in understanding the nature of root canal infection and periapical disease. Sterilization of root canal system is one of the prominent problems. Evidences suggested that Enterococcus faecalis(E.faecalis) caused substantial root canal infections. So, elimination of such organismis important to achieve treatment success. Advance techniques and materials increase the success in Endodontics against Enterococcus faecalis. 3 mix antibiotic therapy a new biologic approach in the treatment of carious lesions. Update Dent. Coll. j: 2016; 6 (2): 27-30

Objectives: This systematic review analyzed the relationship between periapical and periodontal pathologies in the posterior maxilla and the appearance of the Schneiderian membrane in cone-beam computed tomography (CBCT) compared with sound dentitions. Methods: Five electronic databases (Cochrane Library, Embase, OpenGrey, PubMed, Web of Science), complemented by hand searching, were screened up to May 9, 2016. Human clinical studies that used CBCT and contained information on the periapical/periodontal status in the posterior maxilla and Schneiderian membrane appearance were included. A weighted vote counting (WVC) method was applied to summarize results across studies. Results: Out of 413 records, 20 studies were included. In the WVC, the studies that observed a positive association between periapical lesions and the appearance of the Schneiderian membrane outweighed those that found no such association (WVC 51 % and WVC 33 %, respectively), with some studies yielding indeterminate results (WVC 16 %). Regarding the relation between periodontal pathologies and the appearance of the Schneiderian membrane, WVC produced a tie between studies demonstrating a positive association (WVC 46 %) and those showing no association (WVC 44 %); one study (WVC 10 %) reported indeterminate results. Conclusions: On CBCT scans, periapical lesions in the posterior maxilla are likely to be associated with Schneiderian membrane thickening. In contrast, current evidence regarding the relation between periodontal diseases and the appearance of the Schneiderian membrane in CBCT is inconclusive. Clinical relevance: Incidental maxillary sinus findings on CBCT scans warrant thorough differential diagnosis. Frequently, they may be related to dental pathologies. [ABSTRACT FROM AUTHOR]

Introduction The effectiveness of endodontic treatment regarding the number of sessions to complete the therapy is still controversial. The aim of this study was to conduct an overview of published systematic reviews (SRs) comparing endodontic treatment in single and multiple visits. Methods A systematic search was performed in the electronic databases MEDLINE/PubMed and Cochrane Central Register of Controlled Trials until August 18, 2016, without language restriction. The eligibility criteria were as follows: (1) SRs and (2) a focus on endodontic techniques in single or multiple visits. The phases of eligibility and analysis of risk of bias were conducted by 2 or 3 independent and calibrated examiners, and a fourth examiner was consulted to resolve inconsistencies. Assessment of Multiple Systematic Reviews was used to evaluate the risk of bias of the included SRs, which were assessed according to the risk to develop knowledge and the existing knowledge gap. Results The main characteristics including healing rates, success, and clinical complications during and after endodontic treatment were extracted from the SRs. From the 20 SRs initially identified, 8 were included in the analysis. Of these, 6 SRs showed low to moderate risk of bias and were suitable as strong clinical evidence on the topic. Conclusions Overall analysis indicated that single and multiple visits showed similar repair or success rates regardless of the precondition of the pulp and periapex. The apical periodontitis subgroup showed a slight positive trend toward a decreased incidence of postoperative complications and a higher effectiveness and efficiency for a single session. Based on the risk of bias, the current level of evidence for this clinical approach is high. [ABSTRACT FROM AUTHOR]

Aim Immediate implantation has gained great attention since first proposed. Immediate implants in replacement of teeth with periapical lesion is, to date, an issue of discussion. The aim of this study is to perform an illustrated literature review of immediate implants in sockets exhibiting previous periapical lesions.Materials and methods A search on medline/EMBASE database was done for the literature review which is presented together with two case reports illustrating the state of the art of immediate implants on sockets with periapical lesions. Both cases are presented in areas with great aesthetic demands and a periapical lesion of considerable size. The two cases were conducted following strict granulation tissue removal and careful rinsing and pre-operative antibiotics, followed by good primary stability of the dental implant.Results and conclusion Both cases represented successes in aesthetics and function, describing a successful protocol for immediate implant installation in areas exhibiting periapical lesions.

AbstractIntroduction: One of the branches of computer science that tries to simulate human intelligence is artificial intelligence. Correct diagnosis of pulp and periapical lesions can prevent various problems and spread of disease. The aim of this study was to use a decision support system (DSS) with a fast and accurate data processing capacity to diagnose and present treatment plan for pulp and periapical lesions in order to have an accurate and rapid access to gold standard results with minimum error.Materials and Methods: In the present study on diagnostic research, raw data was collected, revised and approved by professors as the gold standard in order to design the software. Preliminary data was standardized by writing an algorithm and then converted into a flowchart. Next, the programmer started simulation with the Visual C++ Compiler under Windows 7. α and β versions were delivered to professionals in order to fix bugs. Finally, performance evaluation of gold release (final) version was carried out by taking signs of 43 patient samples and transferring them to this version. Statistical analysis of the results was carried out with SPSS 17 at a 95% confidence interval.Results: The results showed that the overall efficacy of the software was 86.21%; software efficacy scores for periapical diagnosis, treatment plan and periapical diagnosis were 89.66%, 86.21% and 82.76%, respectively.Conclusion: This software with high data storage and recall details can assist the dental practitioner as a reliable tool in the diagnosis and appropriate endodontic treatment planning.Key words: Computer-assisted, Dental pulp disease, Diagnosis, Periapical disease, Software, Therapy.

Introduction. There is still no agreement as to which materials are best for final root canal fillings. Endodontal research remains focused on finding a synthetic material that lacks antigenic properties when implanted in vital tissue. This report describes how two different types of silers affect periapical tissue. One contained epoxy resins (AH Plus), and the other contained calcium hydroxide (Apexit). We assessed the effect of these materials by observing clinical signs, sensitivity, and by analysis of radiological (RTG) scans done just before therapy, immediately after and at 12 months after. Methods. Our study included 53 patients of both genders with ages ranging between 15 and 50 years. All patients were diagnosed with acute or chronical periodontitis following endodontic therapy. One group of patients had a total of 26 teeth filled with AH Plus siler, while the second group had 27 teeth filled with Apexit siler. Patients were classfied according to their gender, morphological characteristics of their teeth, presence of spontaneous pain, oedema, sensitivity to vertical and horizontal percussion, and the presence or absence of fistulas. Results. Immediately after treatment and 12 months later, patients from both groups (teeth filled with either AH Plus or Apexit) experienced neither pain nor oedema. However, existing fistulas persisted in the majority of patients whose teeth are filled with Apexit. Percutory sensitivity persisted immediately after the treatment as well as 12 months later in half or more of the patients whose teeth are filled with Apexit. Pathological changes identified by RTG were 30% more common in the Apexit patient group than in the AH Plus group immediately after treatment, and 50% more common at the 12 month follow up visit. Conclusion. From the results presented, we conclude that AH Plus siler is preferable to Apexit for endodontic treatment in periapical disease.

INTRODUCTION: Bacterial infection of tooth pulp can progress into periapical diseases. Root canal treatment has been established as the best treatment. In cases of failure, nonsurgical retreatment of teeth is preferred to surgical procedure and extraction. MATERIALS & METHODS: In this historical cohort study, 104 permanent teeth with apical lesion were treated during 2002-2008. All teeth showed radiographic evidence of periapical lesion varying in size from 1 to >10mm. A total of 55 teeth were treated with initial root canal treatment and 49 teeth required retreatment. Patients were recalled up to ≈7 years. All radiographs were taken by RSV MAC digital imaging set and long cone technique. The presence/absence of signs and symptoms and periapical index scores (PAI) were used for measuring outcome. Teeth were classified as healed (clinical/radiographic absence of signs and symptoms) or diseased (clinical/radiographic presence of signs and symptoms). The data were statistically analyzed using student t-test and Pearson chi-square or fisher’s exact test. RESULTS: The rate of complete healing for teeth with initial treatment was 89.7%, and for retreatment group was 85.7%; there was no significant difference. Size of lesions did not significantly affect the treatment outcomes. Success of tooth treatment did not reveal significant correlation with gender and number of roots. CONCLUSION: Orthograde endodontic treatment/retreatment demonstrates favorable outcomes. Thus, nonsurgical endodontic treatment/retreatment should be considered as the first choice in teeth with large periapical lesion.