Search Results (397)

The evidence for photobiomodulation in reducing postoperative pain after endodontic instrumentation is classified as low or very low certainty, indicating a need for further research. Longitudinal pain assessments over 24 h are crucial, and studies should explore these pain periods. Background/Objectives: This double-blind, randomized controlled clinical trial evaluated the effect of PBM on pain following single-visit endodontic treatment of maxillary molars at 4, 8, 12, and 24 h. Primary outcomes included pain at 24 h; secondary outcomes included pain at 4, 8, and 12 h, pain during palpation/percussion, OHIP-14 analysis, and frequencies of pain. Methods: Approved by the Research Ethics Committee (5.598.290) and registered in Clinical Trials (NCT06253767), the study recruited adults (21–70 years) requiring endodontic treatment in maxillary molars. Fifty-eight molars were randomly assigned to two groups: the PBM Group (n = 29), receiving conventional endodontic treatment with PBM (100 mW, 333 mW/cm², 9 J distributed at 3 points near root apices), and the control group (n = 29), receiving conventional treatment with PBM simulation. Pain was assessed using the Visual Analog Scale. Results: Statistical analyses used chi-square and Mann–Whitney tests, with explained variance (η²). Ten participants were excluded, leaving 48 patients for analysis. No significant differences were observed in postoperative pain at 24, 4, 8, or 12 h, or in palpation/percussion or OHIP-14 scores. Pain frequencies ranged from 12.5% to 25%. Conclusions: PBM does not influence post-treatment pain in maxillary molars under these conditions. These results emphasize the importance of relying on well-designed clinical trials to guide treatment decisions, and future research should focus on personalized dosimetry adapted to the anatomical characteristics of the treated dental region to enhance the accuracy and efficacy of therapeutic protocols. Full article

Background: Mesenchymal stem cells (MSCs), multipotent and immune-regulatory cells derived from tissues such as bone marrow, dental pulp, and periodontal ligament, emerged as promising agents in regenerative dentistry. Their clinical applications include endodontic tissue regeneration, periodontal healing, and alveolar bone repair, addressing critical challenges in dental tissue restoration. Methods: A systematic review was conducted following PRISMA guidelines and registered in PROSPERO. We searched PubMed, Scopus, and Web of Science databases for open-access, English-language clinical trials and observational studies published from 2015 to 2025. Studies focusing on the application of MSCs in dental tissue regeneration were included based on predefined eligibility criteria. Results: Out of 2400 initial records, 13 studies met the inclusion criteria after screening and eligibility assessment. Most studies investigated MSCs derived from dental pulp and periodontal ligament for regenerating periodontal tissues and alveolar bone defects. The majority reported improved clinical outcomes; however, variations in MSC sources, delivery methods, sample sizes, and follow-up periods introduced methodological heterogeneity. Conclusions: MSCs show significant potential in enhancing bone and periodontal regeneration in dental practice. Nonetheless, the current evidence is limited by small sample sizes, short follow-up, and inconsistent methodologies. Future large-scale, standardized clinical trials are required to validate MSC-based regenerative therapies and optimize treatment protocols. Full article

This study aims to evaluate the effect of endodontic irrigation solutions on the bond strength of composites subjected to different aging procedures. Using a shear bond strength test, the effects of sodium hypochlorite (NaOCl), ethylenediaminetetraacetic acid (EDTA), and chlorhexidine (CHX) solutions on composite–composite bond strength were examined. The findings revealed that NaOCl alone significantly reduced bond strength, while its adverse effect was completely reversed by the subsequent application of EDTA. CHX, when applied after NaOCl or in combination with EDTA, provided only partial improvement. An aging procedure (5000 thermal cycles) did not have a statistically significant impact on the bond strength. This study provides valuable insights into the roles of endodontic irrigation solutions in composite repair and their implications for restorative dentistry. These findings underline the clinical relevance of selecting appropriate irrigation protocols to preserve or improve bonding during the repair of composite restorations after endodontic treatment. Full article

This critical narrative review presents the concepts and methods that have been or are currently applied in the treatment of periapical tissue changes in mature and immature permanent teeth. Treatment success is defined as the healing of the inflammatory lesion in permanent teeth and, additionally, the completion of root development in immature teeth. Background/Objectives: Endodontics focuses on the prevention and treatment of diseases affecting the dental pulp and periapical tissues. Periapical changes have been managed using various methods depending on factors such as the extent of the lesion and the stage of root and apical development. Conventional root canal treatment, revitalization, and apexification have all been employed. Methods: Three databases (PubMed, Scopus, and Web of Science) were searched for studies discussing different treatment approaches, materials, and the efficacy of techniques used over time in mature and immature permanent teeth. Results: This review includes seven case reports, seven case series, and three cohort studies, each detailing the treatment method, case characteristics, follow-up period, and treatment outcomes. Conclusions: Modern materials have significantly improved the outcomes of revitalization and apexification procedures. These methods can now compete with or even surpass the clinical effectiveness of conventional root canal therapy. Full article

Dens invaginatus is a developmental dental anomaly characterized by the infolding of the enamel organ into the dental papilla during early odontogenesis. This process leads to a broad spectrum of anatomical variations, ranging from minor enamel-lined pits confined to the crown to deep invaginations extending through the root, occasionally communicating with periodontal or periapical tissues. The internal complexity of affected teeth presents diagnostic and therapeutic challenges, particularly in severe forms that mimic root canal systems or are associated with pulpal or periapical pathology. Maxillary lateral incisors are most frequently affected, likely due to their unique developmental timeline and morphological susceptibility. Although various classification systems have been proposed, Oehlers’ classification remains the most clinically relevant due to its simplicity and correlation with treatment complexity. Recent advances in diagnostic imaging, especially cone beam computed tomography (CBCT), have revolutionized the identification and classification of these anomalies. CBCT-based adaptations of Oehlers’ classification allow for the precise assessment of invagination extent and pulpal involvement, facilitating improved treatment planning. Contemporary therapeutic strategies now include calcium-silicate-based cement sealing materials, endodontic microsurgery for inaccessible anatomy, and regenerative endodontic procedures for immature teeth with necrotic pulps. Emerging developments in artificial intelligence, genetic research, and tissue engineering promise to further refine diagnostic capabilities and treatment options. Early detection remains critical to prevent complications such as pulpal necrosis or apical disease. A multidisciplinary, image-guided, and patient-centered approach is essential for optimizing clinical outcomes in cases of dens invaginatus. Full article

Three-dimensional (3D) printing has emerged as a transformative technology in dental splint fabrication, offering significant advancements in customization, production speed, material efficiency, and patient comfort. This comprehensive review synthesizes the current literature on the clinical use, benefits, limitations, and future directions of 3D-printed dental splints across various disciplines, including prosthodontics, orthodontics, oral surgery, and restorative dentistry. Key 3D printing technologies such as stereolithography (SLA), digital light processing (DLP), and material jetting are discussed, along with the properties of contemporary photopolymer resins used in splint fabrication. Evidence indicates that while 3D-printed splints generally meet ISO standards for flexural strength and wear resistance, their mechanical properties are often 15–30% lower than those of heat-cured PMMA in head-to-head tests (flexural strength range 50–100 MPa vs. PMMA 100–130 MPa), and study-to-study variability is high. Some reports even show significantly reduced hardness and fatigue resistance in certain resins, underscoring material-specific heterogeneity. Clinical applications reviewed include occlusal stabilization for bruxism and temporomandibular disorders, surgical wafers for orthognathic procedures, orthodontic retainers, and endodontic guides. While current limitations include material aging, post-processing complexity, and variability in long-term outcomes, ongoing innovations—such as flexible resins, multi-material printing, and AI-driven design—hold promise for broader adoption. The review concludes with evidence-based clinical recommendations and identifies critical research gaps, particularly regarding long-term durability, pediatric applications, and quality control standards. This review supports the growing role of 3D printing as an efficient and versatile tool for delivering high-quality splint therapy in modern dental practice. Full article

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: Separated endodontic instruments are a significant complication in root canal treatment, affecting disinfection and long-term prognosis. Their detection on panoramic radiographs is challenging, particularly in complex anatomy or for less experienced clinicians. Objectives: This study aimed to develop and evaluate a deep learning model using the U²-Net architecture for automated detection and segmentation of separated instruments in panoramic radiographs from multiple imaging systems. Methods: A total of 36,800 panoramic radiographs were retrospectively reviewed, and 191 met strict inclusion criteria. Separated instruments were manually segmented using the Computer Vision Annotation Tool. The U²-Net model was trained and evaluated using standard performance metrics: Dice coefficient, IoU, precision, recall, and F1 score. Results: The model achieved a Dice coefficient of 0.849 (95% CI: 0.840–0.857) and IoU of 0.790 (95% CI: 0.781–0.799). Precision was 0.877 (95% CI: 0.869–0.884), recall was 0.847 (95% CI: 0.839–0.855), and the F1-score was 0.861 (95% CI: 0.853–0.869). Conclusions: These results demonstrate a strong overlap between predictions and ground truth, indicating high segmentation accuracy. The U²-Net model showed robust performance across radiographs from various systems, suggesting its clinical utility in aiding detection and treatment planning. Further multicenter studies are recommended to confirm generalizability. Full article

Objectives: This study aimed to evaluate the success rates of NSRCT performed by AEGD residents and to identify predictive factors associated with clinical outcomes and patient satisfaction. Methods: A retrospective chart review was conducted on cases treated between 2012 and 2021. Eligible cases included fully developed permanent teeth that underwent NSRCT and received a final restoration by general dentistry residents, with a minimum of 12 months of follow-up. Data collected included demographic information, medical history, clinical symptoms, radiographic findings, instrumentation, type and timing of final restorations, and patient satisfaction scores. Treatment success was defined as the absence of symptoms and either the resolution or stability of periapical radiolucency. Patient satisfaction and pain levels were also analyzed. Results: AEGD residents achieved radiographic and clinical RCT success rates of 93.3% and 91.5%, respectively. Multivariate logistic regression showed that the presence of an intact restoration was significantly associated with increased odds of tooth retention (odds ratio [OR] = 3.4, p < 0.001), while post placement in a straight root was also a significant predictor of survival (OR = 4.2, p = 0.02). Conversely, pre-existing radiolucency (OR = 0.37, p = 0.018) and the use of a metal post (OR = 0.23, p = 0.012) were significantly associated with lower odds of tooth retention. Worse periodontal health was significantly associated with increased odds of pain on percussion, with a 74.19% increase in odds per worsening category (OR = 1.74, p = 0.002). Patient satisfaction was significantly higher when restorations remained intact, with esthetic satisfaction increasing by a factor of 3.08 (OR = 3.08, p < 0.001) and functional satisfaction increasing by a factor of 3.9 (OR = 3.9, p < 0.001). Conclusions: Endodontic treatments performed by AEGD residents demonstrated high success rates and favorable patient-reported outcomes. Restoration integrity, periodontal health, and post and final restoration selection play critical roles in treatment success and patient satisfaction. Full article

Background and Clinical Significance: Prosthetic rehabilitation in the aesthetic zone of periodontally compromised patients presents a complex clinical challenge, requiring a careful coordination of aesthetic, functional, and biological demands. This case highlights the benefits of digital dentistry, interdisciplinary collaboration, and regular maintenance in achieving long-term success in complex rehabilitations of periodontally compromised patients. Case Presentation: This case report describes the digital minimally invasive rehabilitation of a 39-year-old male patient with Stage III periodontitis, occlusal discrepancies, tooth mobility, and an interincisal diastema. A fully digital workflow—including intraoral scanning, aesthetic previewing, and mandibular motion analysis—was employed to guide diagnosis, treatment planning, and prosthetic execution. Conservative tooth preparations using a biologically oriented approach (BOPT) were combined with customised provisional restorations to support soft tissue conditioning and functional control throughout the provisional phases. Mandibular motion tracking facilitated the design of a personalised anterior guidance to improve occlusion and correct the deep bite. The interincisal diastema was initially maintained then closed during the advanced phase of treatment based on aesthetic simulations and patient preference. One unplanned endodontic treatment was required during the provisional phase, but no other complications occurred. Conclusions: At the four-year follow-up, the patient demonstrated stable periodontal and occlusal conditions, improved clinical indices, and high satisfaction with the aesthetic outcome. Full article

Aim: hydraulic calcium silicate-based cements (HCSCs) are widely used in endodontics for vital pulp therapy and other clinical procedures due to their favorable physicochemical and biological properties. This study evaluates the biological properties of two HCSCs—MTA Flow™ and MTA Flow™ White (in a 3:2 liquid-to-powder ratio, thick consistency)—on human dental pulp stem cells (hDPSCs). Methodology: hDPSCs were exposed to leachates from MTA Flow™, MTA Flow™ White, and ProRoot^® MTA. pH changes, cytotoxicity, cell proliferation, cell morphology, and cell death (apoptosis/necrosis) were assessed in vitro. Results: MTA Flow™ White and ProRoot^® MTA leachates produced a strongly alkaline pH (~10–12) compared to the negative control, whereas MTA Flow™ leachate caused a smaller pH increase (~9.4). Freshly mixed cements showed moderate cytotoxicity (around 40–60% cell viability at 100% concentration), while hardened cement leachates did not significantly affect cell viability. At 100% concentration, MTA Flow™ and MTA Flow™ White leachates significantly inhibited hDPSC proliferation and caused cell death, but at lower concentrations (≤50%) they supported cell viability and proliferation comparable to ProRoot^® MTA. hDPSCs exposed to MTA Flow™ and MTA Flow™ White leachates appeared more elongated morphologically than those exposed to ProRoot^® MTA. Notably, cells treated with MTA Flow™ White leachates were significantly smaller than those treated with MTA Flow™. Conclusions: MTA Flow™ and MTA Flow™ White, used in 3:2 thick consistency, demonstrated biocompatibility comparable to ProRoot^® MTA in vitro. While 100% leachates showed moderate cytotoxicity, lower concentration dilutions (≤50%) supported hDPSC viability, proliferation, and morphology. These findings support their potential as safe alternatives for vital pulp therapy. Further in vivo studies and dynamic models are needed to confirm long-term biological performance. Full article

Objectives: The aim of this study was to assess the taxonomic diversity of the microbiota associated with periapical lesions of endodontic origin and to determine whether microbial profiles vary across different populations and clinical characteristics using a unified in silico analysis of next-generation sequencing (NGS) data. Methods: Raw 16S rRNA sequencing data from three published studies were retrieved from the NCBI Sequence Read Archive and reprocessed using a standardized bioinformatics pipeline. Amplicon sequence variants were inferred using DADA2, and taxonomic assignments were performed using BLASTN against a curated 16S rRNA reference database. Alpha and beta diversity analyses were conducted using QIIME 2 and R, and differential abundance was assessed with ANCOM-BC2. Statistical comparisons were made based on population, sex, symptomatology, and other clinical metadata. Results: A total of 38 periapical lesion samples yielded 566,223 high-confidence reads assigned to 347 bacterial species. Significant differences in microbial composition were observed between geographic regions (China vs. Spain), sexes, and symptoms. Core species such as Fretibacterium sp. HMT 360 and Porphyromonas endodontalis were prevalent across datasets. Porphyromonas gingivalis and Fusobacterium nucleatum were found in abundance across all three studies. Beta diversity metrics revealed distinct clustering by study and country. Symptomatic lesions were associated with higher abundance of Alloprevotella tannerae and Prevotella oris. Conclusions: The periapical lesion microbiota is taxonomically diverse and varies significantly by geographic and clinical features. Full article

Background/Objectives: The aim of this study was to identify and assess the independent risk factors and potential predictors for endo-periodontal lesions (EPLs) in endodontically treated teeth with periapical pathology. Methods: The study group included 90 patients (35 men, 55 women; mean age 47.96 ± 13.495 years) with 126 endodontically treated teeth. Following clinical examinations and radiologic evaluation, 50 patients were diagnosed with endo-periodontal lesions (EPLs) in 64 molars (test group); the control group included 62 endodontically treated teeth without EPLs diagnosed in 40 patients. The independent variables were assessed as risk factors for EPLs. The relationship between patients’ demographic and clinical features and endo-periodontal status was assessed using Chi-squared tests for categorical variables and Student’s t- or Mann–Whitney tests for continuous variables, depending on data distribution. The potential risk factors were characterized by calculating Odds Ratios (ORs) with 95% confidence intervals. The variables included in the multivariate logistic regression model were selected based on their clinical relevance and statistical significance in the univariate analysis. To evaluate the combined effect of the identified risk factors, a binary logistic regression model was constructed using the Enter method. Results: Out of the 126 endodontically treated molars with periapical pathology, 64 teeth (50.8%) were diagnosed with endo-periodontal lesions (EPLs). Patients aged ≥60 years were significantly more represented in the EPL group (32.8%) compared to the control group (12.9%) (p = 0.024). Probing pocket depth ≥ 4 mm was present in 85.9% of teeth with EPLs versus only 30.6% in teeth without EPLs (p < 0.001). Probing pocket depth (PPD) ≥ 4 mm was the strongest predictor (OR = 13.830) and remained significant after adjustment in multivariate analysis (OR = 6.585). PPD ≥ 3.625 mm showed a strong association in univariate analysis (OR = 12.587) and preserved significance in the multivariate model (OR = 6.163). Conclusions: This study highlights age ≥ 60 years and PPD ≥ 4 mm as the most significant independent risk factors for EPLs, emphasizing the need for early periodontal assessment in endodontically treated teeth with periapical pathology. While PPD greater than 3.625 mm is a strong indicator of the presence of EPLs, other factors such as MBL (marginal bone loss) and occlusal considerations appear to have indirect roles in EPL development in endodontically treated teeth with periapical lesions. Full article

Background and objectives: Post-operative pain (POP) is a common complication after root canal treatment and is influenced by various clinical and patient-related factors. The present study evaluated the incidence and intensity of POP following root canal treatment using a bioceramic sealer performed by operators with different levels of experience. Methods: A total of 115 patients were included in this prospective observational study. Patients were treated by operators with different levels of experience: postgraduate students (PGSs) and endodontic specialists (ESs). Standardized protocols were used in two distinct appointments: an instrumentation visit and an obturation visit. Obturation was performed using the continuous wave condensation technique and Total Fill Hi-Flow BC Sealer (TFHF). POP, mastication discomfort, and sleep disturbance were assessed at 24, 48, and 72 h after the instrumentation and obturation phases using a numeric rating scale (NRS). Results: The results indicate significantly higher POP after the instrumentation phase, compared to the obturation phase (p < 0.001). The pain intensity progressively decreased over time for both phases. No significant differences were observed between the PGS and ES groups regarding POP, mastication discomfort, or sleep disturbance at any time. Sealer extrusion did not significantly impact POP (p > 0.05). Conclusions: This study found that operator experience does not significantly influence POP when a standardized protocol is followed. The use of TFHF with the continuous wave condensation technique was associated with minimal POP. Full article

Background/Objectives: Root canal infections represent a serious challenge to the success of endodontic treatment. The most commonly used antimicrobial irrigants, such as sodium hypochlorite (NaOCl), have certain limitations, while endodontic biofilms pose a significant microbiological complexity in the endodontic field. Silver nanoparticles (AgNPs) have emerged as a promising irrigant option in root canal treatments; however, few studies are focusing on endodontic biofilms. This work aimed to evaluate the antimicrobial and anti-adherence properties of AgNPs against clinically isolated bacteria taken directly from patients with various pulp and periapical diseases. Methods: AgNPs of two sizes were synthesized and characterized. The bactericidal and anti-adherence activities of AgNPs were evaluated through microbiological assays using experimental in vitro and ex vivo tests on oral biofilms taken from patients with symptomatic apical periodontitis (AAP) and pulp necrosis (PN). NaOCl solution was used as the gold standard. Results: The size of AgNPs was uniformly distributed (13.2 ± 0.4 and 62.6 ± 14.9 nm, respectively) with a spherical shape. Both types of nanoparticles exhibited good antimicrobial and anti-adherence activities in all microbiological assays, with a significant difference from NaOCl for in vitro and ex vivo models (p < 0.05). The inhibitory activity of AgNPs is mainly related to the type of microbiological sample and the exposure time. The antibacterial substantivity of both nanoparticle sizes was time-dependent. Conclusions: AgNPs may represent a promising antimicrobial option as an endodontic irrigant during conventional root canal treatments to prevent and control endodontic infections. Full article