Search Results (202)

Background: Pulpitis requires operative dental treatment, and antibiotics are not indicated. Nevertheless, inappropriate antibiotic prescribing persists worldwide. This systematic review and meta-analysis evaluated the prevalence of antibiotic prescription for pulpitis among dentists. Methods: A systematic search of MEDLINE/PubMed, Web of Science, Scopus, Embase, and ProQuest (2015–2025) was performed according to PRISMA guidelines. Observational studies reporting the proportion of dentists prescribing systemic antibiotics for pulpitis were included. Random-effects meta-analyses estimated pooled prevalence for all clinicians, general dental practitioners (GDPs), and endodontists (ENs). Risk of bias was assessed using a modified Newcastle–Ottawa Scale, and certainty of evidence was rated with GRADE. Results: Twelve cross-sectional studies met the inclusion criteria, including 3189 dentists. The overall pooled prevalence of antibiotic prescribing for pulpitis was 19.2% (95% CI: 10.4–32.6%), with very high heterogeneity (I² = 98%). GDPs exhibited significantly higher prescribing rates (26.9%, 95% CI: 14.9–43.5%; I² = 98%) compared with ENs (5.1%, 95% CI: 1.2–19.2%; I² = 92%). Sensitivity analysis excluding two high-prevalence studies reduced the pooled estimate to 13.3% (95% CI: 8.0–21.3%) but heterogeneity remained substantial (I² = 95%). Most studies showed moderate-to-high risk of bias, and the certainty of evidence was graded as very low due to inconsistency, indirectness, imprecision, and potential publication bias. Conclusions: Approximately one in five dentists prescribe antibiotics for pulpitis, despite strong guideline recommendations against their use. However, certainty of evidence was very low. Marked variability across regions and clinical profiles highlights persistent gaps in diagnostic accuracy, access to emergency dental care, and antibiotic stewardship. Targeted education, improved urgent care pathways, and strengthened antimicrobial stewardship programs are needed to reduce unnecessary antibiotic use in pulpitis. Full article

Background/Objectives: Apical periodontitis is a prevalent dental condition associated with systemic inflammation. C-reactive protein (CRP) is a sensitive biomarker of inflammatory status. While previous studies have examined CRP changes after endodontic treatment, limited evidence exists on short-term systemic effects following clinically indicated endodontic therapy in healthy individuals. This prospective observational cohort study aimed to evaluate the impact of endodontic treatment or retreatment on serum CRP levels in patients with symptomatic and asymptomatic apical periodontitis and assess demographic influences. No control group was included. Methods: A prospective observational cohort study was conducted in a private endodontic clinic in Jeddah, Saudi Arabia (2021–2023). Three hundred ASA I patients were enrolled and categorized into symptomatic apical periodontitis (SAP) and asymptomatic apical periodontitis (AAP) groups. Blood samples were collected before treatment and two weeks post-treatment. CRP levels were measured using a high-sensitivity assay. Statistical analyses included paired t-tests, Mann–Whitney U tests, and multiple regression. Laboratory personnel were blinded to patient grouping. Results: CRP levels significantly decreased after treatment in both groups (SAP: 6.99 to 2.01 mg/L; AAP: 5.40 to 1.64 mg/L; p < 0.001). Reduction was greater in SAP (mean difference = 4.98 mg/L) than AAP (3.76 mg/L; p < 0.001). Paired t-test showed a very large effect size (Cohen’s d = 3.51). Age and sex were not significant predictors of CRP changes (R² < 0.02). Conclusions: Endodontic treatment or retreatment significantly reduces systemic inflammation in patients with apical periodontitis. These findings reinforce the oral–systemic health link and highlight the clinical relevance of managing apical infections. Longer-term studies and inclusion of additional biomarkers are recommended. Full article

Background: Porphyromonas gingivalis is one of the most prevalent periodontal pathogens, involved in the development of periodontitis, deep caries, pulpitis, endodontic infections, and peri-implantitis. Antiseptics are commonly used in the treatment of oral diseases, but their effectiveness against P. gingivalis remains only partially understood. This preliminary study investigated antimicrobial and antibiofilm activity of eight pure antiseptics: boric acid (BA), chlorhexidine (CHX), ethacridine lactate (ET), hydrogen peroxide (H₂O₂), octenidine (OCT), polyhexanide (PHMB), potassium permanganate (KMnO₄), and sodium hypochlorite (NaOCl), as well as five commercial rinses containing these agents, against periopathogen P. gingivalis ATCC 33277. Methods: Minimal inhibitory concentrations (MICs) were determined using the broth microdilution method. The Clinical Efficiency of MIC (CEMIC) was subsequently calculated. Antibiofilm activity was evaluated using the crystal violet method, LIVE/DEAD fluorescence assay and by measuring biofilm thickness with digital microscopy in combination with the author’s Python-based application Biofilm Thickness Analyzer. Results: OCT, CHX, PHMB and ET showed the strongest activity against P. gingivalis, in both its planktonic and biofilm forms. H₂O₂ and BA had variable MIC efficacy and moderate antibiofilm activity. In contrast, NaOCl and KMnO₄ demonstrated the weakest activity or no significant effect against P. gingivalis. Conclusions: The results have a translational dimension, supporting the potential clinical relevance of the selected compounds. However, this study was conducted strictly in vitro on a single strain under monomicrobial biofilm conditions. Therefore, while the findings suggest that mouthwashes containing OCT, CHX, and PHMB may be effective against P. gingivalis, their actual clinical efficacy in the treatment and prevention of oral diseases remains to be confirmed in in vivo studies. Full article

Failure of the endodontic treatment is often associated with persistent polymicrobial biofilms, particularly those involving Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans), which display synergistic pathogenicity and resistance to standard disinfection methods. This in vitro study compared the antimicrobial activity and oxidative damage induced by indocyanine green (ICG)–mediated laser ablation (LA) with that produced by antimicrobial photodynamic therapy (aPDT) using methylene blue (MB) or curcumin (CUR) in root canals infected with dual-species biofilms. The samples were divided into five experimental groups (n = 20): Group A—Methylene Blue + Red Laser (RL), Group B—Curcumin + Blue LED (BL), Group C—Indocyanine Green + Infrared Diode Laser (DL), Group D—saline solution (Negative Control—NC), Group E—2.5% sodium hypochlorite (Positive Control—PC). One hundred treated bovine incisors (20 per group) were analyzed for microbial viability (colony-forming unit (CFU/mL)), the metabolic functionality of biofilms was assessed through the 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino)carbonyl]-2H-tetrazolium hydroxide (XTT) based reduction method, and oxidative stress markers, including Thiobarbituric Acid Reactive Substances (TBARS), protein carbonyl content, total oxidant capacity (TOC), and total protein levels. All experimental treatments significantly reduced microbial load compared to the negative control (p < 0.05), with ICG achieving the greatest reduction. ICG also induced the highest levels of oxidative stress across all parameters (p < 0.05). These findings suggest that LA with ICG is more effective than aPDT with MB or CUR, achieving disinfection outcomes comparable to those of 2.5% sodium hypochlorite, and warrant further investigation in complex clinical models. Full article

Cannabinoids have been shown to have effective antibacterial applications. With the limitations of current intracanal endodontic medicaments and the rise of bacterial resistance, it is important to investigate novel treatment strategies for endodontic infections. The aim of this study was to test the antibacterial efficacy of cannabinoids on bacteria in persistent endodontic infections: Enterococcus faecalis, Streptococcus mutans, and Fusobacterium nucleatum. Planktonic bacteria were exposed to a negative control (no exposure), a positive control (3% NaOCl), and the experimental groups Cannabidiol (CBD), Cannabinol (CBN), and Tetrahydrocannabinol (THC). The Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) were also investigated. Biofilms were cultured and treated with cannabinoids. A crystal violet assay (CVA) and live/dead analysis assessed the biofilm degradation and inhibition, respectively. A statistical analysis was performed using an ANOVA. CBD, CBN, and THC reached a MIC for both E. faecalis and S. mutans in planktonic forms. The MBC was found for the tested cannabinoids on planktonic E. faecalis. No MBC was found for S. mutans. The live/dead analysis of E. faecalis and S. mutans biofilms showed a decrease in the viability of the biofilm with an increased cannabinoid concentration. The CVA revealed that cannabinoids only degrade the E. faecalis biofilm. Planktonic F. nucleatum had no MIC for tested cannabinoids. Cannabinoids have inhibitory effects on E. faecalis and S. mutans in the planktonic and biofilm states. No inhibitory effects of F. nucleatum were found at tested concentrations of all three cannabinoids. The findings suggest that cannabinoids have distinct antibacterial effects on certain pathogens associated with persistent endodontic infections. 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/Objectives: Endodontic treatment quality can be graded from A to D according to international standards. This study aimed to evaluate radiographic treatment success of high-standard endodontic treatments (Grade A). A secondary aim was to assess the students’ self-perceived assessment of case difficulty. Methods: A retrospective analysis was conducted on root canal treatments (RCTs) performed by undergraduate students at the University of Bergen between January 2012 and December 2014. Data related to endodontic treatments graded as A, along with a postoperative self-perceived assessment of case difficulty, were extracted from patient records. Statistical analysis was performed with a significance level set at p ≤ 0.05. Results: Out of 1149 RCTs, 462 (40.2%) were classified as Grade A. Among these, 350 teeth had at least one recall after one year. Out of the 350 teeth, 312 were successful (89.2%), 6 (1.7%) were failures and 32 (9.1%) were extracted due to factors unrelated to endodontic infection. After exclusion or inclusion of extracted teeth, the success rate was 98.1% and tooth survival 90.9%. Patients under 56 years of age, and teeth with indirect coronal restorations, had significantly better tooth survival. Students significantly underestimated case difficulty (p < 0.01). Conclusions: High-standard endodontic treatments can achieve a high success rate. Self-assessment of endodontic treatment and accurate assessment of case difficulty using relevant tools serves as an important educational aid, potentially contributing to enhanced knowledge and improved clinical decision-making. Full article

The development of endodontics leads to increasingly innovative techniques, which improve mechanical root canal preparation. Endostar E3 Azure (Poldent Co., Warsaw, Poland) is a nickel–titanium file, which can be used in rotary, reciprocal, and optimum torque reverse (OTR) movements. The aim of this study was to assess canal transportation (CT), canal-centering ability (CCA), and wall thickness reduction (WTR) after the use of Endostar E3 Azure files in these three movements. In total, 24 two-canal artificial teeth were used, which were divided into three groups, depending on the applied movement (n = 16 canals). Each canal was initially prepared manually and then instrumented with Endostar E3 Azure files using rotary, reciprocal, or OTR movements. Cone-beam computed tomography was performed before and after canal preparation. The root wall thickness was measured at 3 mm, 6 mm, and 9 mm from the radiological apex and CT, CCA, and WTR were calculated. Reciprocal movement resulted in significantly better outcomes in canal-centering ability (CCA = 0.57) compared with rotary movement (CCA = 0.27) in the middle part of the canal. The wall thickness was significantly reduced in the rotary group: 0.21, 0.19, and 0.13; in the reciprocal group: 0.09, 0.08, and 0.1; and in the OTR group: 0.11, 0.15, and 0.17 at 3, 6, and 9 mm from the apex, respectively. Moreover, rotary movement caused a statistically greater reduction in wall thickness in the apical and middle area compared to other groups. Endostar E3 Azure files significantly reduce the thickness of the root wall along its entire length, which may indicate the effective removal of infected tissue. The use of OTR movement did not affect the analyzed parameters negatively, and it is a safe option which combines the advantageous features of rotary and reciprocal movements. Full article

This study investigates the bactericidal efficacy and penetration ability inside dentinal tubules of calcium hydroxide (CH) and a modified tri-antibiotic paste (ciprofloxacin, metronidazole, clarithromycin) (TAP) during regenerative endodontic procedures (REPs). The blood clot serving as a biological scaffold was introduced into the root canal to assess its influence on bacterial regrowth. Forty-four human extracted teeth were infected with E. faecalis and divided in four experimental groups (N = 10) with positive and negative controls (N = 4). Samples were treated with either CH or TAP as intracanal dressing. Bacterial viability and depth of penetration were evaluated using confocal laser scanning microscopy (CLSM) after fluorescent vital staining. The same analysis was performed with or without blood clot exposure and the data were analyzed by one-way ANOVA and a post hoc Bonferroni test (p < 0.05). TAP demonstrated significantly stronger bactericidal activity than CH (p = 0.008). However, its efficacy significantly decreased in the presence of blood clot (p = 0.032). CH showed a moderate antibacterial effect, with its efficacy reduced in the presence of blood. Blood clot exposure consistently reduced the bactericidal efficacy in both groups (p = 0.01) and the dye penetration in CH group (p = 0.041). In conclusion, TAP demonstrated superior antibacterial performance compared to CH and blood clot exposure seemed to decrease antimicrobial efficacy and depth of disinfection during REPs. Full article

The dental pulp is a dynamic connective tissue essential for tooth vitality, sensory function, immune defense, and reparative dentinogenesis. Conventional endodontic procedures, while effective in eradicating infection, often result in a non-functional, devitalized tooth, highlighting the need for biologically based regenerative approaches. The emergence of three-dimensional (3D) culture systems has transformed pulp biology and endodontic research by providing physiologically relevant microenvironments that better reproduce the dentino-pulp interface, vascular and neural networks, and immune interactions. This review synthesizes current advances in 3D dental pulp modeling, from scaffold-based and hydrogel systems to spheroids, organoids, bioprinted constructs, and microfluidic “tooth-on-a-chip” platforms. Each system’s composition, biological relevance, and translational potential are critically examined with respect to odontogenic differentiation, angiogenesis, neurogenesis, and inflammatory response. Applications in disease modeling, biomaterial screening, and regenerative endodontics are highlighted, showing how these models bridge fundamental biology and therapeutic innovation. Finally, we discuss key challenges including vascularization, innervation, standardization, and clinical translation, and propose integrative strategies combining bioprinting, stem-cell engineering, and organ-on-chip technologies to achieve functional pulp regeneration. Overall, 3D pulp models represent a paradigm shift from reductionist cultures to bioinstructive, patient-relevant platforms that accelerate the development of next-generation endodontic therapies. Full article

Persistent Enterococcus faecalis infections represent a major cause of endodontic treatment failure, highlighting the need for innovative disinfection strategies beyond conventional irrigation. This in vitro study evaluated the antimicrobial potential of pulsed electric fields (PEF) as a non-thermal and non-chemical adjunctive method for root canal disinfection. Fifty-two extracted mandibular premolars with single canals were standardized to 16 ± 0.1 mm, inoculated with E. faecalis, and incubated for 28 days to establish mature biofilms. The teeth were subsequently exposed to PEF under varying electrical parameters using sterile water as the irrigant, and bacterial viability and metabolic activity were assessed post-treatment. Confocal laser scanning microscopy (CLSM) was performed to visualize bacterial distribution within dentinal tubules, with particular attention to the apical region, which is most resistant to disinfection. PEF application significantly reduced bacterial viability and metabolic activity compared with baseline (p < 0.05), although complete elimination was not achieved. CLSM images revealed both red-stained non-viable cells, reflecting irreversible electroporation, and green-stained viable cells, indicating reversible electroporation and residual bacterial survival. These findings demonstrate that PEF can inactivate microorganisms through electroporation while maintaining tissue compatibility, and its antimicrobial effect may be enhanced when combined with sodium hypochlorite. Optimization of electrical parameters and evaluation in polymicrobial biofilm models are warranted to establish clinical relevance and support translation into practice. Full article

Background: Endo-periodontal lesions (EPLs) are defined by a pathological connection between the pulp and the periodontium in a specific tooth. Although the identification of EPL etiology is of paramount importance for a correct treatment plan, it may be impossible at times to pinpoint the primary cause prospectively. A critical aspect of treatment planning involves assessing the necessity of root canal treatment in periodontal patients presenting with EPLs, evaluating the indication for periodontal intervention in cases of endodontic origin and determining whether splinting of the affected tooth is required. The aim of this article is to provide a concise perspective on the management of EPLs without root damage. Methods: A clinical decision-making flowchart was created based on current classification systems to guide treatment strategies for EPLs. Results: A flowchart of the treatment of EPLs based on possible decision pathways with a starting point in the diagnosis of the periodontitis or non-periodontitis patient that can prove particularly useful in cases where the initial etiology remains uncertain. Conclusions: EPLs are infections that represent a significant clinical challenge. This article summarizes key diagnostic considerations and therapeutic steps, offering practical guidance for clinicians managing these lesions. Full article

Objectives: The aim of this study is to assess the influence of diabetes mellitus on the microbial flora involved in root canal infections through a comparative analysis with that of systemically healthy individuals. Methods: A total of 39 participants, including 21 patients with diabetes mellitus and 18 systemically healthy individuals (controls), were enrolled in the study. In the diabetic group, 12 teeth were diagnosed with secondary/persistent endodontic infections (SEIs) and 9 with primary endodontic infections (PEIs). In the healthy group, 12 teeth presented with SEIs and 6 with PEIs. Root canal samples were obtained using sterile paper points. The V3–V4 hypervariable regions of 16S rDNA from both sample types were amplified and sequenced using the Illumina MiSeq platform. Microbial richness and diversity were assessed using alpha diversity indices and beta diversity metrics. Results: Faith’s Phylogenetic Diversity showed a significant difference between diabetic patients with SEIs and healthy individuals with PEIs (p = 0.02). Both weighted and unweighted UniFrac beta diversity analyses indicated significant differences in microbial composition and phylogenetic structure between diabetic patients with SEIs and healthy individuals with PEIs (p = 0.01 and p = 0.02, respectively). Within the diabetic patient group, significant differences were observed between SEI and PEI groups based on alpha (Fisher’s alpha, p = 0.04) and beta diversity analyses (Bray–Curtis and Weighted UniFrac p = 0.02 and p = 0.01, respectively). Conclusions: Diabetic patients showed different microbial profiles compared to healthy individuals. Full article

Palatal abscesses of endodontic origin are rarer than buccal ones due to maxillary anatomy. Their clinical appearance may resemble that of other palatal illnesses, complicating diagnosis and treatment. Prevention of problems requires early detection and endodontic treatment. A 26-year-old female patient presented with a 2 cm diameter palatal abscess, significant pulsatile discomfort, fever, and enlargement of the anterior hard palate. Clinical examination showed grade 1 mobility of the central and lateral incisors, percussion discomfort, and negative pulp vitality in the case of the lateral incisor. Cone-beam computed tomography (CBCT) showed two radiolucent lesions: a posterior cystic lesion near the first molar and an anterior lesion near the upper left lateral incisor. Palatal cortical bone puncture and soft tissue extension indicated the abscess origin. According to the clinical and imaging evaluation, the upper left lateral incisor had a persistent periapical lesion of endodontic origin that a palatal abscess with cortical bone perforation had exacerbated. Full article

X-linked hypophosphatemic rickets (XLH) is a rare genetic disorder with a frequency of 1:20,000, caused by mutations in the PHEX gene, resulting in impaired phosphate metabolism and bone mineralization. There is an association between hypophosphatemia and dental issues, though this link is not definitively established. This study aims to evaluate the dental status, including oral hygiene, caries prevalence, and malocclusions, as well as parental awareness of dental complications, in children with XLH in Bulgaria, particularly those receiving or about to begin burosumab treatment, and to compare their oral health status with that of healthy children. Eleven children with XLH (seven girls, four boys, aged 2.5–17 years), nine receiving burosumab, were assessed and compared with eleven age- and gender-matched healthy children (seven girls, four boys, aged 2.5–17 years) without XLH or systemic conditions affecting dental health. Parental awareness of dental implications was assessed via a questionnaire, revealing no awareness of potential complications. Oral hygiene, measured using the Oral Hygiene Index-Simplified (OHI-s), was poor in 66.67% of children, with an average of 6.45 ± 5.80 carious lesions per child, and was highest in the 11–16 age group. Malocclusions were observed in 63.64% of children, and spontaneous endodontic infections occurred in 18.18%. Compared with healthy children, patients with XLH had significantly worse oral hygiene (p = 0.013) and a higher caries prevalence (p = 0.001). Children with XLH exhibit poor oral hygiene, a high caries burden, and frequent malocclusions, compounded by a lack of parental awareness of dental risks. These findings underscore the need for targeted dental interventions and education in XLH management, including the integration of routine dental assessments and structured parental education programs into existing clinical protocols to improve oral health outcomes. Full article