Search Results (304)

Introduction: Odontogenic infections may influence distant structures, including the eye. Their extension into the paranasal sinuses and orbital region can contribute to inflammatory and glaucomatous conditions. Case Report: A 46-year-old man was examined for a possible odontogenic source of chronic eye disease. The patient had an 18-year history of progressive vision loss in his left eye associated with Posner–Schlossmann syndrome, chronic uveitis, and episodic elevation of intraocular pressure (IOP). Imaging studies revealed the presence of a foreign body in the alveolar recess of the left maxillary sinus, as detected on panoramic radiography, cone-beam computed tomography (CBCT), and infrared thermography (IRT). Preliminary IRT examination showed marked thermal asymmetry (ΔT = 1.1 °C) between the left and right sides of the maxilla. Worsening of ocular symptoms and increased IOP despite steroid treatment prompted surgical treatment. The foreign body, identified as a root canal filling, was removed, and the chronically inflamed sinus mucosa was excised. During a follow-up visit two weeks later, the IRT examination showed a reduction in temperature difference (ΔT = 0.2 °C) and routine postoperative healing. After two months, no thermal asymmetry was found (ΔT = 0 °C), and an ophthalmological examination showed no active inflammation. Six months after the procedure, the patient remained asymptomatic, and the IRT examination revealed only minimal residual variability within the measurement tolerance (ΔT = 0.1 °C), consistent with the resolution of the sinus inflammation. Conclusions: This case highlights the value of interdisciplinary diagnostics in identifying odontogenic contributors to chronic ocular disease. Infrared thermography proved to be a helpful non-invasive adjunct for detecting and monitoring subclinical maxillary sinus inflammation. Full article

Background/Objectives: Patients undergoing antiresorptive therapy were evaluated, focusing on clinical and radiological features and their relationship with medication-related osteonecrosis of the jaw (MRONJ). Methods: Patients were allocated to two groups: MRONJ (n = 27) and non-MRONJ (n = 139). Clinical evaluation included decayed, missing, and filled teeth (DMFT), number of teeth, periodontal status, prosthesis use, and preventive/therapeutic measures. Imaging analysis included panoramic radiography (PAN) and cone beam computerized tomography (CBCT) to assess MRONJ-related signs. Results: The sample showed high levels of DMFT and prosthesis use. There was a tendency of higher prevalence of deeper periodontal pockets in the MRONJ group, with greater need for oral hygiene reinforcement and chlorhexidine prescription. PAN showed higher frequency of osteolysis, persistent alveolar socket, bone sequestration, mandibular canal involvement, periosteal reaction, and sinus involvement in the MRONJ group. Still on PAN, all cases in both groups exhibited a sclerotic trabecular bone pattern. CBCT showed higher frequency of a sclerotic trabecular bone pattern, mandibular canal involvement, and bone sequestration in the MRONJ group. Composite radiographic index modified (CRIm) was higher in the MRONJ group for PAN and CBCT, with low-grade cases in the non-MRONJ and medium-/high-grade cases in the MRONJ group. A positive correlation was found between CRIm and MRONJ staging. Conclusions: This study underscores the role of preventive oral care in patients undergoing antiresorptive therapy, highlighting the need for regular periodontal monitoring. Also emphasized is the importance of integrating clinical and radiographic examinations of these patients. Accordingly, CRIm seems to be a reliable tool for MRONJ staging and monitoring. Full article

Background and Objectives: This prospective case series evaluated a treatment strategy in endodontic-periodontal lesions resulting from concurrent pulpal and periodontal infections. These present significant management challenges, particularly when they exhibit resistance to standard treatment modalities. Persistent microbial biofilms in regions like dentinal tubules and lateral canals can make it hard for healing to happen, even with good endodontic and periodontal care. Diode lasers have antibacterial and photobiomodulatory effects, but they are most often used as single-stage disinfection techniques. This pilot study evaluated a multi-stage diode laser protocol designed to enhance healing outcomes in refractory endo-perio lesions that had not responded to conventional treatment. Materials and Methods: Twelve patients (aged 20–60 years) with chronic endo-perio lesions, referred after unsuccessful earlier treatment, were treated utilizing a sequential diode laser regimen: Phase 1—Endodontic disinfection: Following canal instrumentation (0.75 W, pulsed mode, frequency 15 Hz, 200 μm fiber, 15 J dosage/20 s) using a 976 nm diode laser. Phase 2—Periodontal disinfection: Following SRP, intra-pocket (0.75 W, pulsed mode, frequency 15 Hz, 300 μm fiber, 3.75 J dosage/5 s) using a 976 nm diode laser; Phase 3—Post treatment photobiomodulation: After periodontal and endodontic therapy, photobiomodulation was applied using a 650 nm diode laser intra-pocket and in the periapical region (25 mW, continuous mode, 1.5 J dosage) to reduce postoperative inflammation and stimulate healing. Clinical parameters—probing depth (PD), bleeding on probing (BOP), and mobility—along with radiographic bone fill were recorded at baseline and after 6 months. Results: All twelve cases showed measurable within-patient improvements over the six-month follow-up. Median probing depth decreased from 7.6 mm to 6.0 mm, and median bleeding on probing declined from 0.9 to 0.3. Radiographically, partial bone fill was observed in all cases, with a median value of 58.3 percent. Postoperative pain decreased progressively over the first 24 h, with patients reporting mild discomfort by 24 h. No adverse events were recorded. Conclusions: Within the limitations of this small, uncontrolled pilot study, the multi-stage diode laser protocol was associated with clinical and radiographic improvements and low postoperative discomfort in refractory endo-perio lesions. These preliminary findings suggest that such a protocol may serve as a useful adjunct to conventional therapy. Larger, controlled studies are required to confirm these outcomes and determine long-term efficacy. Full article

Background and Clinical Significance: Advanced periodontitis with severe vertical bone loss and grade III mobility is usually managed by extraction and implant placement. Digital workflows and modern regenerative techniques have opened the possibility of preserving teeth that would traditionally be considered for extraction. This report describes a digitally guided modified intentional replantation (MIR) protocol applied to a maxillary tooth with severe periodontal involvement and unfavourable prognosis. Case Presentation: A 68-year-old male, non-smoker, with a history of heart transplantation under stable medical control, presented with generalized Stage IV, Grade C periodontitis. Tooth 21 showed >75% vertical bone loss, probing depths ≥ 9 mm, bleeding on probing, and grade III mobility. After non-surgical therapy and periodontal stabilization, a CAD/CAM-assisted MIR procedure was planned. Cone-beam computed tomography (CBCT) and a 3D-printed tooth replica were used to design a surgical guide for a new recipient socket. The tooth was atraumatically extracted, stored in chilled sterile saline, and managed extraorally for approximately 10 min. Apicoectomy and retrograde sealing with Biodentine^® were performed, followed by immediate replantation into the digitally prepared socket, semi-rigid splinting, and guided tissue regeneration using autologous bone chips, xenograft (Bio-Oss^®), enamel matrix derivative (Emdogain^®), and a collagen membrane (Bio-Gide^®). A conventional orthograde root canal treatment was completed within the first month. At 12 months, tooth 21 exhibited grade 0 mobility, probing depths of 3–4 mm without bleeding on probing, and stable soft tissues. Standardized periapical radiographs and CBCT showed radiographic bone fill within the previous defect and a continuous periodontal ligament-like space, with no signs of ankylosis or root resorption. The tooth was fully functional and asymptomatic. Conclusions: In this medically complex patient, digitally guided MIR allowed preservation of a tooth with severe periodontal involvement and poor prognosis, achieving favourable short-term clinical and radiographic outcomes. While long-term data and larger series are needed, MIR may be considered a tooth-preserving option in carefully selected cases as an alternative to immediate extraction and implant placement. Full article

Background/Objectives: Root canal treatment (RCT) is a common dental procedure performed to preserve teeth by removing infected or at-risk pulp tissue caused by caries, trauma, or other pulpal conditions. A successful outcome, among others, depends on accurate identification of the root canal anatomy, planning a suitable therapeutic strategy, and ensuring a bacteria-tight root canal filling. Despite advances in dental techniques, there remains limited integration of computational methods to support key stages of treatment. This review aims to provide a comprehensive overview of computational methods applied throughout the full workflow of RCT, examining their potential to support clinical decision-making, improve treatment planning and outcome assessment, and help bridge the interdisciplinary gap between dentistry and computational research. Methods: A comprehensive literature review was conducted to identify and analyze computational methods applied to different stages of RCT, including root canal segmentation, morphological analysis, treatment planning, quality evaluation, follow-up, and prognosis prediction. In addition, a taxonomy based on application was developed to categorize these methods based on their function within the treatment process. Insights from the authors’ own research experience were also incorporated to highlight implementation challenges and practical considerations. Results: The review identified a wide range of computational methods aimed at enhancing the consistency and efficiency of RCT. Key findings include the use of advanced image processing for segmentation, image analysis for diagnosis and treatment planning, machine learning for morphological classification, and predictive modeling for outcome estimation. While some methods demonstrate high sensitivity and specificity in diagnostic and planning tasks, many remain in experimental stages and lack clinical integration. There is also a noticeable absence of advanced computational techniques for micro-computed tomography and morphological analysis. Conclusions: Computational methods offer significant potential to improve decision-making and outcomes in RCT. However, greater focus on clinical translation and development of cross-modality methodology is needed. The proposed taxonomy provides a structured framework for organizing existing methods and identifying future research directions tailored to specific phases of treatment. This review serves as a resource for both dental professionals, computer scientists and researchers seeking to bridge the gap between clinical practice and computational innovation. Full article

Background/Objectives: The clinical outcome of root canal treatments using calcium silicate-based sealer (CSBS) remains unclear. This study aimed to evaluate the 1-year effect of CSBS in combination with a single-cone obturation technique on periapical lesion (PL) healing evaluated on cone beam computed tomography scans (CBCT) after single-visit root canal retreatment. Methods: This randomized clinical study involved 50 patients with chronic apical periodontitis and previous root canal treatment (ClinicalTrials.gov ID: NCT04072926). The inclusion criteria were previous endodontic treatment, asymptomatic inadequate endodontic treatment, PLs measuring > 5 mm, and percussion and palpation sensitivity. The exclusion criteria were immunocompromised status, pregnancy, periodontally compromised teeth, vertical root fracture, and antibiotic usage in the last month. Single-visit root canal retreatment was performed by the same endodontist. The patients were randomly divided into two groups based on the root canal sealer used: CSBS (BioRoot RCS) and epoxy resin-based sealer (ERBS) (AH Plus). Periapical healing, as the primary outcome measure, was determined according to the reduction in PL volume on CBCT from the preoperative period to the 1-year postoperative period. Results: Pre- and postoperative PL volumes (p > 0.05) were not significantly different between the CSBS and ERBS groups. The success rate (loose criteria) was 82.9% in the ERBS group and 94.7% in CSBS group. Conclusions: Root canal retreatment outcomes of CSBS, including periapical healing, are comparable to those of ERBS at 1 year after the retreatment. Full article

Background/Objectives: Non-surgical retreatment aims to remove infected filling material, prepare the canal for disinfection, and re-obturate. This ex vivo study evaluated the residual filling material and dentin volume removed after retreatment using a rotary or reciprocating system. Methods: Twenty mesial roots of mandibular molars with two independent, straight canals were decoronated to a 16 mm working length and obturated. Pre-operative nano-CT scans measured the initial dentin and filling material volumes. Specimens were randomly assigned to two groups: Solite RE Black system (RE1-30/0.08; RE2-20/0.06) and WaveOne Gold—small file (20/0.07). Post-operative nano-CT scans were superimposed to calculate the remaining filling material and dentin volume removed. Data are presented as the mean ± SD, and groups were compared using independent t-tests. Results: Neither system completely removed the intracanal filling material. The mean residual filling material volume was 1.42 ± 0.21 mm³ (Solite RE Black) vs. 1.56 ± 0.27 mm³ (WaveOne Gold), representing approximately 14% vs. 16% of the initial filling material, respectively (p < 0.05). Mean dentin volume removed was 0.95 ± 0.18 mm³ vs. 1.12 ± 0.22 mm³, with no significant difference (p > 0.05). Conclusions: In single-rooted, straight canals, Solite RE Black removed more filling material than WaveOne Gold, while dentin loss was similar. These findings are specific to straight canals, and further studies are required for curved or multi-rooted teeth. Full article

Background/Objectives: Artificial intelligence (AI) has been increasingly used to support radiological assessment in dentistry. We benchmarked machine learning (ML), deep learning (DL), and a hybrid optimization-assisted approach for the automatic five-class image-level classification of dental restorations (filling, implant, root canal treatment, fixed partial denture/bridge, crown) on panoramic radiographs. Methods: We analyzed 353 anonymized panoramic images comprising 2137 labeled restorations, acquired on the same device. Images were cropped and enhanced (histogram equalization and CLAHE), and texture features were extracted with GLCM. A three-stage pipeline was evaluated: (i) GLCM-based features classified by conventional ML and a baseline DL model; (ii) Hybrid Grey Wolf–Particle Swarm Optimization (HGWO-PSO) for feature selection followed by SVM; and (iii) a CNN trained end-to-end on raw images. Performance was assessed with an 80/20 per-patient split and 5-fold cross-validation on the training set. While each panoramic radiograph may contain multiple restorations, in this study we modeled the task as single-label, image-level classification (dominant restoration type) due to pipeline constraints; this choice is discussed as a limitation and motivates multi-label, localization-based approaches in future work. The CNN baseline was implemented in TensorFlow 2.12 (CUDA 11.8/cuDNN 8.9) and trained with Adam (learning rate 1 × 10⁻⁴), with a batch size 32 and up to 50 epochs with early stopping (patience 5); data augmentation included horizontal flips, ±10° rotations, and ±15% brightness variation. A post hoc power analysis (G*Power 3.1; α = 0.05, β = 0.2) confirmed sufficient sample size (n = 353, power > 0.84). Results: The HGWO-PSO + SVM configuration achieved the highest accuracy (73.15%), with macro-precision/recall/F1 = 0.728, outperforming the CNN (68.52% accuracy) and traditional ML models (SVM 67.89%; DT 59.09%; RF 58.33%; K-NN 53.70%). Conclusions: On this single-center dataset, the hybrid optimization-assisted classifier moderately improved detection performance over the baseline CNN and conventional ML. Given the dataset size and class imbalance, the proposed system should be interpreted as a decision-supportive tool to assist dentists rather than a stand-alone diagnostic system. Future work will target larger, multi-center datasets and stronger DL baselines to enhance generalizability and clinical utility. Full article

Background/Objectives: Reverse shoulder arthroplasty (RSA) using a 135-degree inlay-type humeral stem has recently gained popularity due to its bone-preserving design. However, stem subsidence (hereafter, subsidence) and its contributing factors are poorly understood. We aimed to investigate the incidence of subsidence and its associated factors in patients undergoing RSA using a 135-degree inlay-type stem. Methods: A total of 44 shoulders treated with uncemented Tornier Perform^® Reversed Stems were retrospectively analyzed. Radiographic evaluations included stem alignment and canal filling ratio at three levels. The outcome, subsidence, was defined as >5 mm inferior migration of the stem. Results: Subsidence was observed in 6 shoulders (13.6%), which showed significantly greater stem alignment and lower proximal filling ratio. Logistic regression analysis identified proximal filling ratio <80% as an independent risk factor (odds ratio: 70.0, 95% confidence interval: 3.6–1342.6). Conclusions: Although the findings remain exploratory due to the small sample size and short follow-up period, they suggest that inadequate proximal fit may contribute to subsidence in 135-degree inlay RSA. Ensuring proper stem sizing and alignment during implantation may be essential to improving initial stability and clinical outcomes. Larger, long-term studies are required to generalize these conclusions. Full article

Navigating ships through one-way channels introduces significant uncertainties due to their unique navigational constraints, yet a comprehensive and tailored risk evaluation system for such channels remains notably underdeveloped. Recognizing its critical role as a global maritime artery, this study selects the Suez Canal as the case study to address this gap. The study begins by analyzing the navigational characteristics of one-way channels, systematically identifying key risk factors such as channel width, traffic density, and environmental conditions. Building on this, a novel risk evaluation model is developed, integrating the entropy weight method to assign objective weights, fuzzy logic to handle uncertainty, and Evidential Reasoning (ER) to aggregate multi-criteria assessments. The Suez Canal is then utilized as a case study to demonstrate the model’s effectiveness and practical applicability. The results reveal that Channel C exhibits the highest risk utility value, consistent with its history of the most grounding incidents, including the notable “Ever Given” event during 2021–2023. These findings not only provide valuable insights for enhancing Suez Canal management strategies but also contribute to filling the existing void in risk evaluation frameworks for one-way channels, paving the way for future research into dynamic risk assessment methodologies. Full article

Artificial Intelligence, especially Convolutional Neural Networks (CNN), is gaining importance in health sciences, including forensic odontology. This study aimed to systematically analyze elements for automated dental status registration on OPGs using CNNs, on different image segments and resolutions. A dataset of 1400 manually annotated digital OPGs was divided into train, test, and validation sets (75%–12.5%–12.5%). Pre-trained and from-scratch models were developed and evaluated on images from full OPGs to individual and segmented teeth and sizes from 256 px to 1820 px. Performance was measured by Sørensen–Dice coefficient for segmentation and mean average precision (mAP) for detection. For segmentation, the UNet Big model was the most successful, using segmented or individual images, achieving 89.14% for crown and 84.90% for fillings, and UNet with 79.09% for root canal fillings. Caries presented a significant challenge, with the UNet model achieving the highest score of 64.68%. In detection, YOLOv5x6, trained from scratch, achieved the highest mAP of 98.02% on 1820 px images. Larger image resolutions and individual tooth inputs significantly improved performance. This study confirms the success of CNN models in specific tasks on OPGs. Image quality and input (individual tooth, resolutions above 640 px) critically influenced model competence. Further research with from-scratch models, higher resolutions, and smaller image segments is recommended. Full article

Background and Objectives: Cone Beam Computed Tomography (CBCT) offers high-resolution, three-dimensional imaging for detecting apical periodontitis (AP) and evaluating the technical quality of endodontic treatments. This study aimed to investigate the diagnostic value of CBCT in identifying endodontic failures and periapical lesions and to explore the clinical patterns associated with these findings in a Romanian patient cohort. Materials and Methods: A retrospective study was conducted on 258 patients (with 876 root canal-treated teeth), all of whom underwent CBCT imaging between October 2024 and April 2025 at a private radiology center in Craiova, Romania. Of the 876 treated teeth, 409 were diagnosed with apical periodontitis. Patients were present for endodontic treatment at the Endodontics Clinic of the Faculty of Dentistry, University of Medicine and Pharmacy of Craiova. With the patients’ consent, 3D radiological examinations were recommended for better case planning and accurate diagnosis. The periapical status and technical parameters of root canal fillings were assessed using the CBCT-PAI index and evaluated by three calibrated observers. Associations with demographic, clinical, and behavioral factors were statistically analyzed. Results: Apical periodontitis was detected in 46.69% of the teeth examined during the study period, with CBCT-PAI score 3 being the most prevalent. Poor root canal obturation quality (underfilling, overfilling, and voids) was significantly associated with periapical pathology. Chronic lesions were more common than acute ones, especially in older patients. The number of teeth with endodontic treatments and no AP, as well as the number of teeth with AP, was significantly lower for patients with acute AP, indicating the more severe impact of chronic AP on the patients’ oral health status. CBCT allowed the precise localization of missed canals and assessment of lesion severity. Conclusions: Within the limits of a retrospective, referral-based cohort, CBCT aided the detection of periapical pathology in root canal-treated teeth (46.69%). These findings do not represent population-based rates but support the selective use of CBCT, in line with current ESE guidance, for complex cases or when conventional imaging is inconclusive. Full article

The adhesion of endodontic sealers to dentin may be influenced both by the chemical composition of the sealer and the final irrigation protocol. The aim of this study was to examine the push-out bond strength of three differently formulated bioceramic sealers to root canal dentin, after different irrigation protocols. Four cavities were prepared in dentine discs obtained from middle thirds of third molars with fused roots. Discs were randomly divided into three groups (n = 8). Group 1: specimens were immersed in 2.5% NaOCl; group 2: in 2.5% NaOCl followed by 17% EDTA; and group 3: in a solution of 2.5% NaOCl with 9% etidronic acid (HEDP). The cavities on each disk were filled with four tested sealers: AH Plus Bioceramic, Bio C Angelus, BioRoot RCS, and AH Plus (n = 8 per sealer). The push-out bond strength test was performed after 7 days. The data were statistically analyzed using two-way analysis of variance with the Bonferroni post hoc test (α = 0.05). Irrigation with NaOCl resulted in significantly lower bond strength values of the sealers in comparison to NaOCl/EDTA and NaOCl/HEDP groups. In the NaOCl and NaOCl/HEDP groups, BioRoot RCS showed similar push-out bond strength compared to AH Plus and significantly higher compared to Bio-C and AH Plus Bioceramic. In the NaOCl/EDTA group, bioceramic sealers achieved a significantly weaker bond strength compared to AH Plus. The bond strength of BioRoot RCS was significantly higher compared to Bio-C and AH Plus Bioceramic. The irrigation protocols and the chemical composition of the sealers significantly influenced their bond strength to dentin. Epoxy resin-based sealer achieved the strongest bond strength, while within bioceramic sealers, the highest values were obtained for BioRoot RCS and the lowest for AH Plus Bioceramic. Full article

Background. Post-treatment apical periodontitis (PAP) is a frequent consequence of root canal treatment (RCT) failure, often caused by untreated missed canals in root-filled teeth (RFT). While cone-beam computed tomography (CBCT) has been used to find these missed canals, the results are controversial. This systematic review and meta-analysis investigates the association between PAP in RFT and missed canals detected via CBCT. Methods. Two independent reviewers searched PubMed, Scopus, Dialnet, and SciELO for relevant articles published up until 17 February 2025. The main outcome was the prevalence of PAP in RFT with and without missed canals detected via CBCT. The overall odds ratio (OR) was calculated using a binary random effects model meta-analysis (OpenMeta Analyst). Risk of bias was assessed using the Newcastle–Ottawa Scale, and certainty was evaluated using GRADE. Results. Eight cross-sectional studies (9983 RFT) were included in the review. The pooled prevalence of PAP was significantly higher in RFT with missed canals (85.1%) than those without (56.3%). The meta-analysis showed a strong association between missed canals and PAP (OR = 7.17, 95% CI = 4.55–11.29), indicating a sevenfold increased likelihood. Maxillary molars, especially first molars, most commonly had missed canals. Heterogeneity was high (I² = 86%), and evidence certainty was low, due to methodological limitations. Conclusions. Untreated missed canals significantly increase the likelihood of PAP in RFT, highlighting the need for thorough canal detection and treatment. Clinicians should prioritize anatomical knowledge and advanced imaging to minimize treatment failure. Full article

The success rate of root canal treatment is high, but it can fail. In these cases, orthograde root canal retreatment is often the treatment of choice, for which numerous biomaterials are available on the market, including endodontic files. This systematic review aimed to study the endodontic files available on the market and establish their efficacy in root canal retreatment. An electronic search of six different databases was performed, and in vitro experimental studies that studied root canal cleaning, debris extrusion, retreatment time, or dentinal damage produced with any of the comparison methods were selected. The quality of the studies was assessed with the QUIN scale. In total, 78 studies were included for the analysis, of which 9 had a high risk of bias, 53 had a moderate risk, and 16 had a low risk. The methods used to evaluate the efficacy of endodontic files in root canal retreatment are heterogeneous. Manual files produce more apical extrusion than rotary files. PTUR files are the most studied endodontic files. It is the file system that leaves the least residual filling material in the canal, takes the least time during retreatment, and removes the greatest amount of dentine. However, no file system achieved the complete removal of the root canal filling material. No consistent pattern emerged across studies when comparing rotary files with continuous and reciprocating rotation in terms of the removal of the filling material, the time required for de-obturation, dentine damage produced, or apical extrusion. Full article