Complications, Volume 2, Issue 3 (September 2025) – 2 articles

Endodontic perforations are serious complications encountered in the dental setting. Early detection, diagnosis, and proper management of perforations are crucial for a favorable prognosis. However, there are a limited number of studies that provide an overview of perforations, emphasizing these three strategies: prevention, diagnostic challenges, and management. The objective of this narrative review is to highlight the multifaceted components of endodontic perforations while also identifying the most effective methods used in their detection, diagnosis, and management. An electronic literature search was conducted using various databases and applying keywords for articles published in English. Eligible papers were reviewed further to gather relevant information. The results of the literature search found that, although perforations are relatively uncommon occurrences in the clinical setting, they still need to be understood for the prevention and treatment of these iatrogenic complications. The combination of case complexity and limited operator experience often determines the likelihood of endodontic perforation occurrence. Accurate diagnosis and identification of perforations rely heavily on the combination of clinical examination and advanced imaging technologies. In recent times, new technologies have emerged and hope to contribute to a decreased occurrence of endodontic perforations and increased prognosis in cases that do arise. Full article

Background/Objectives: This study aimed to evaluate the prognostic significance of preoperative inflammatory biomarkers—C-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR)—in predicting early postoperative complications (within 30 days) in patients undergoing percutaneous endoscopic gastrostomy (PEG). Methods: Data from 184 patients who underwent PEG placement at our institution between January 2021 and May 2022 were retrospectively analyzed. Demographic characteristics, PEG indications, and preoperative laboratory parameters (CRP, albumin, neutrophils, lymphocytes, and platelets) were recorded. CAR was calculated as the ratio of CRP (mg/L) to albumin (g/dL). Complications occurring within 30 days post-procedure were defined as early postoperative complications. Patients with and without complications were compared, and logistic regression analysis was used to identify potential risk factors. Results: The mean age of the patients was 71.5 ± 5.9 years, and 58.7% were male. PEG indications included neurological dysphagia (54.3%), head and neck malignancies (21.7%), and other causes (23.9%). At least one early complication occurred in 26 patients (14.1%). There were no significant differences in age, sex, body mass index, or Charlson Comorbidity Index between patients with and without complications (p > 0.05). Logistic regression revealed that elevated CAR was an independent predictor of postoperative complications (OR = 2.88; 95% CI: 1.62–5.13; p < 0.001). Although NLR (OR = 1.34) and PLR (OR = 1.02) were also associated with increased risk, they were less predictive than CAR in multivariate analysis. Conclusions: Preoperative CAR, NLR, and PLR levels are valuable biomarkers for predicting early complications following PEG. Notably, higher CAR levels are significantly associated with increased complication risk. Incorporating these indicators into clinical decision-making could facilitate early identification of high-risk patients and implementation of preventive strategies. Full article