Search Results (84)

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

Background: Odontogenic cysts can damage the surrounding bone tissue as they grow, making it essential to implement effective regenerative strategies tailored to each patient. Personalised approaches in oral surgery, such as selecting the most suitable bone graft materials, can lead to improved treatment outcomes. Filling the bone defect created after cyst removal, root resection, or extraction with a bone graft material can stabilise the weakened tooth and promote faster bone regeneration. This article shares our experiences with the therapeutic effects of albumin-coated bone allograft (BoneAlbumin^®) placed in the bone defect following cyst removal in the oral cavity, compared to cases where the defect was left untreated (controls). Methods: The study involved thirty patients who underwent the removal of maxillary odontogenic cysts. In 15 of these patients, the bone defect was filled with albumin-coated bone allograft (BoneAlbumin^®, OrthoSera, Budapest, Hungary). In the control group, which consisted of 15 patients, the defect was left untreated. A consistent surgical protocol was adhered to throughout the study. Follow-up periapical X-rays were taken immediately after surgery as well as at 6 and 12 weeks post-surgery, using a standardised template. These images were used to assess the shrinkage and healing of the defect caused by the cyst. Measurements were adjusted to reference points to account for potential distortions in the X-rays. Results: The control and study groups exhibited no statistically significant differences in their basic parameters. Additionally, there was no notable difference in the sizes of postoperative defects between the two groups. However, statistical analysis revealed a significant difference in the changes in defect size (∆defect size) between the groups at both 6 weeks (p < 0.000001) and 12 weeks (p = 0.000296). This suggests that the BoneAlbumin^®-graft group experienced significantly greater changes in defect size over time. Conclusions: The use of BoneAlbumin^® graft leads to a markedly better reduction in defect size as time progresses, although these changes have only been compared to graft-free healing. Full article

The fundamental goal of endodontic surgery is to remove the infection cause and create an ideal environment for periapical tissue and bone recovery. This systematic review aims to present evidence-based findings regarding the healing ability of endodontic materials in retrograde treatment. The study evaluates the advantages and drawbacks of commonly utilized materials, empowering clinicians with valuable insights for preoperative planning in endodontic surgery. A comprehensive search was conducted across multiple databases, including MEDLINE, Scielo, Web of Science, Scopus, Embase, and Google Scholar, using the PIOT framework. A total of 3124 papers were identified, of which 2534 remained after removing duplicates. Following a stringent selection process, 35 clinical studies were included for qualitative assessment. The risk of bias was assessed using the Risk of Bias in Non-randomized Studies—of Interventions (ROBINS-I) tool for non-randomized trials, the Newcastle–Ottawa Scale for cohort studies, and the Joanna Briggs Institute (JBI) critical appraisal checklist for cross-sectional studies. Due to high heterogeneity in study designs and outcomes, a meta-analysis could not be performed. The review identified Super Ethoxybenzoic Acid (Super EBA), Mineral Trioxide Aggregate (MTA), and Intermediate Restorative Material (IRM^®), Retroplast, Endosequence^®, and gutta-percha as the primary retrograde root filling materials. Follow-up periods ranged from 6 months to 17.5 years. Although the materials showed varying degrees of success, the overall findings highlighted that no single material demonstrated universally superior healing ability. The review also emphasized the need for standardization in future clinical trials to facilitate better comparisons. The selection of retrograde filling materials plays a pivotal role in the success of endodontic surgery. New bioceramic materials like MTA and Biodentine offer improved sealing, biocompatibility, and tissue regeneration compared to traditional materials, leading to better clinical outcomes. Full article

Background and Objectives: Periapical healing and bone regeneration are key indicators of endodontic success. This study evaluated the effectiveness of laser-assisted disinfection compared to conventional chemical irrigation in promoting periapical healing across various bone densities (D1–D5), using cone-beam computed tomography (CBCT) over multiple follow-up intervals. Materials and Methods: A total of 120 patients with radiographically confirmed periapical lesions were enrolled and allocated into two groups: an experimental group (n = 60, chemical irrigation + Er,Cr:YSGG laser disinfection) and a control group (n = 60, chemical irrigation only). CBCT scans were obtained at 6 months, 1 year, 2 years, and 2.5 years post-treatment to assess lesion size and CBCT-PAI scores. Lesions were classified radiographically as either well-defined radiolucent lesions or undefined periapical radiolucencies. Paired t-tests and ANOVA were used for statistical comparisons. Results: The experimental group demonstrated significantly greater reductions in lesion size and improvements in CBCT-PAI scores at all time points. Healing was especially enhanced in low-density bone (D4–D5). Complete healing rates were higher in the laser group for well-defined radiolucent (89.5% vs. 68.4%) and undefined lesions (81.8% vs. 59.1%). Post hoc power analysis confirmed statistical reliability (Cohen’s d = 3.48; power > 0.99). Conclusions: Laser-assisted endodontic disinfection significantly accelerates periapical healing and promotes bone regeneration, particularly in low-density bone. CBCT imaging supports its clinical superiority over conventional irrigation methods. Full article

The aim of this study was to explore diabetes mellitus type 2 as a risk factor in the prevalence of chronic apical periodontitis (CAP) in untreated and endodontically treated teeth. The second objective was to describe the correlation between the presence of periapical lesions and blood glucose/glycated hemoglobin levels among diabetic (DM) and non-diabetic patients with endodontically treated or untreated teeth with CAP. Materials and methods: This cross-sectional study was conducted on 90 patients (55 with DM, 35 without DM), admitted to the Oral and Maxillofacial Surgery Department of “St. Spiridon” Hospital in Iași, Romania. Endodontic and perapical status was evaluated using the Periapical Index (PAI) based on clinical and radiological evaluations with blood glucose levels and HbA1c analysis. Statistical analysis included data, correlations and regression analysis, and group comparisons using appropriate parametric or non-parametric tests. DM subjects had a higher mean value of untreated teeth with CAP (2.53 vs. 2.00) compared to the control group (p = 0.010) and a lower mean number of endodontically treated teeth without CAP (1.53 vs. 2.74) compared to the control group (p < 0.001). Diabetic patients also had a higher mean number of root-filled teeth with CAP (3.33 vs. 1.94; p < 0.001). Conclusions: There was a clear association between diabetes and oral pathology, with diabetic patients having fewer teeth, more untreated teeth, and a higher prevalence of periapical lesions. Elevated blood glucose and HbA1c levels indicated that poor metabolic control negatively impacts periapical healing and overall endodontic health. Full article

Interdisciplinary decision-making significantly influences both the therapeutic potential and clinical outcomes, shaping clinical attitudes and management strategies. As the integration between endodontic and restorative-prosthetic considerations becomes increasingly prevalent, it is essential to understand how different dental specialists, particularly general dental practitioners, prosthodontists and endodontists, approach clinical decision-making and collaborate to optimize patient care. Objectives: This study aims to identify practice disparities in post-endodontic crown placement to inform national policy reforms, including standardised timing protocols and interdisciplinary referral criteria. Methods: A structured questionnaire was distributed to dentists practicing in Romania, yielding 238 collected responses. Results: Substantial variability was found in clinical approaches: diagnostic imaging preferences indicated frequent use of periapical radiography (83.49%) and CBCT (53.67%). Over 70% expressed high confidence in CBCT’s diagnostic precision, significantly higher than periapical radiography (Wilcoxon Signed-Rank test, p < 0.00001). A statistically significant majority (69.3%, binomial test, p < 0.001) preferred delaying definitive crown placement until radiographic healing of periapical lesions. Logistic regression analysis showed endodontists were significantly less likely to choose invasive treatments compared to other specialists (p = 0.027). Although clinicians widely recognize the significance of prosthetic planning, its early integration into the overall treatment strategy has been inconsistent. Conclusions: This study points out the necessity for standardised guidelines that clearly integrate prosthetic planning into endodontic decision-making, enhancing predictability and tooth preservation. Full article

Background: Periapical cysts are the most common odontogenic cysts, often resulting in large bone defects. Guided tissue regeneration techniques support tissue healing by means of membranes and bone grafts. The present case report evaluates for the first time clinical application of a resorbable magnesium membrane in guided bone regeneration (GBR) following cystectomy. Case report: A 35-year-old male patient presented with a large periapical cystic lesion in the maxillary anterior region. Treatment involved marsupialization followed by cyst enucleation and GBR using a resorbable magnesium membrane and bovine xenograft. The magnesium membrane served as a structural support to bridge the bony discontinuity in the palatal bone. Cone-beam computed tomography (CBCT) was used for diagnosis, treatment planning, and follow-up assessments. At 16 months post-treatment, CBCT imaging revealed significant bone regeneration, with restoration of the palatal contour and cortication of the palatal wall. Clinical examination showed asymptomatic teeth with normal mobility and optimal soft tissue healing. Conclusions: This case demonstrates the potential of resorbable magnesium membranes in managing large periapical defects, offering a promising alternative to traditional GBR materials by combining mechanical strength with complete resorption, therefore eliminating the need for membrane removal surgery. However, future studies on larger patient samples should focus on confirming the long-term outcomes of this approach and investigating patient-specific factors that are important in choosing effective treatment options. Full article

Biodentine, a tricalcium silicate cement, has emerged as a retrograde root-end filling material to promote periapical lesion (PL) healing after apicoectomy. However, its underlying mechanisms remain unclear. This study tested the hypothesis that Biodentine stimulates the osteogenic differentiation of mesenchymal stromal cells (MSCs) derived from PLs. The Biodentine extract (B-Ex) was prepared by incubating polymerized Biodentine in RPMI medium (0.2 g/mL) for three days at 37 °C. B-Ex, containing both released microparticles and soluble components, was incubated with PL-MSCs cultured in either a basal MSC medium or suboptimal osteogenic medium. Osteogenic differentiation was assessed by Alizarin Red staining and the expression of 20 osteoblastogenesis-related genes. Non-cytotoxic concentrations of B-Ex stimulated the proliferation of PL-MSCs and induced their osteogenic differentiation in a dose-dependent manner, with a significantly enhanced effect in suboptimal osteogenic medium. B-Ex upregulated most early and late osteoblastic genes. However, the differentiation process was prolonged, as indicated by the delayed expression of wingless-type MMTV integration site family member 2 (WNT2), bone gamma-carboxyglutamate protein (BGLAP), bone morphogenic protein-2 (BMP-2), growth hormone receptor (GHR), and FOS-like 2, AP-1 transcription factor subunit (FOSL2), compared with their expression under optimal osteogenic conditions. The stimulatory effect of B-Ex was primarily calcium dependent, as it was reduced by 85% when B-Ex was treated with the calcium-chelating agent EGTA. In conclusion, Biodentine promotes the osteogenic differentiation of PL-MSCs in a calcium-dependent manner, supporting its stimulatory role in periapical healing. Full article

Background/Objectives: In a previous study, we utilized categorical variables and machine learning (ML) algorithms to predict the success of non-surgical root canal treatments (NSRCTs) in apical periodontitis (AP), classifying the outcome as either success (healed) or failure (not healed). Given the importance of radiographic imaging in diagnosis, the present study evaluates the efficacy of deep learning (DL) in predicting NSRCT outcomes using two-dimensional (2D) periapical radiographs, comparing its performance with ML models. Methods: The DL model was trained and validated using leave-one-out cross-validation (LOOCV). Its output was incorporated into the set of categorical variables, and the ML study was reproduced using backward stepwise selection (BSS). The chi-square test was applied to assess the association between this new variable and NSRCT outcomes. Finally, after identifying the best-performing method from the ML study reproduction, statistical comparisons were conducted between this method, clinical professionals, and the image-based model using Fisher’s exact test. Results: The association study yielded a p-value of 0.000000127, highlighting the predictive capability of 2D radiographs. After incorporating the DL-based predictive variable, the ML algorithm that demonstrated the best performance was logistic regression (LR), differing from the previous study, where random forest (RF) was the top performer. When comparing the deep learning–logistic regression (DL-LR) model with the clinician’s prognosis (DP), DL-LR showed superior performance with a statistically significant difference (p-value < 0.05) in sensitivity, NPV, and accuracy. The same trend was observed in the DL vs. DP comparison. However, no statistically significant differences were found in the comparisons of RF vs. DL-LR, RF vs. DL, or DL vs. DL-LR. Conclusions: The findings of this study suggest that image-based artificial intelligence models exhibit superior predictive capability compared with those relying exclusively on categorical data. Moreover, they outperform clinician prognosis. Full article

Apical periodontitis is a common inflammatory condition associated with root canal treatment (RCT) failure. The quality of the three-dimensional root canal seal is critical to the success of the treatment. Bioceramic sealants, such as Neosealer Flo, offer biological advantages such as osteoconduction, biocompatibility and sustained calcium ion release, which may improve apical healing. The aim of this study was to compare AH Plus and Neosealer Flo in terms of postoperative pain, extrusion and periapical healing. A single-blind, randomised clinical trial was conducted with 60 patients divided into AH Plus and Neosealer Flo groups. Post-operative pain was assessed using a visual analogue scale (VAS) at 24 and 48 h and at 7 days. Seal quality and periapical healing were assessed at 6 months using the AAE success criteria by clinical and radiographic evaluation. Neosealer Flo resulted in less postoperative pain at 24 h and 7 days compared to AH Plus. Extrusion did not significantly affect pain or correlate with the type of sealer used. Both materials achieved similar periapical healing rates. Neosealer Flo demonstrated advantages in pain reduction, while both sealants showed comparable efficacy. Full article

Background: Apical surgery can address periapical pathologies when conventional endodontic treatments fail. Advanced platelet-rich fibrin (A-PRF) has emerged as a regenerative material with the potential to enhance healing in periapical surgery. In this study, we evaluated the effect of A-PRF on periapical lesion healing using cone beam computed tomography (CBCT). Methods: A randomized controlled trial at Rīga Stradiņš University Institute of Stomatology included 43 participants (15 males, 28 females; mean age: 44 years) with periradicular lesions. Participants were divided into experimental and control groups. Baseline and follow-up CBCT imaging assessed lesion volumes at 6 and 12 months post-surgery. Results: Mean lesion volumes significantly decreased from 431.4 mm³ at baseline to 102.8 mm³ at 6 months and 49.2 mm³ at 12 months (p < 0.001). A-PRF did not significantly reduce the lesion sizes compared to the controls (p = 0.043), but was associated with reduced inflammation and enhanced soft tissue healing. Key confounders included gender and baseline lesion volume, with males exhibiting smaller lesion sizes postoperatively. Conclusions: The results suggest that A-PRF may not offer a significant advantage in terms of reducing defect size or improving radiographic resolution. Full article

Background/Objectives: Guided tissue regeneration (GTR) and the use of various grafting materials and platelet concentrates have emerged as promising adjunctive techniques in endodontic surgery to enhance bone regeneration and improve healing outcomes, although evidence regarding their consistent effectiveness remains inconclusive. The aim of this systematic review is to evaluate existing randomized controlled trials (RCTs) and prospective clinical trials to determine the efficacy of bone grafts, membranes, or platelet concentrates on outcomes in endodontic periapical surgery, employing a robust evidence-based approach. Methods: Searches were conducted in MEDLINE (PubMed), Embase, Cochrane Library, and gray literature databases from their inception until March 2024. Study selection and data extraction were conducted independently by two reviewers. Eligible randomized controlled trials (RCTs) and prospective clinical trials underwent critical appraisal for risk of bias and quality of evidence and were subjected to meta-analysis to determine treatment effects. Results: Twelve studies were included. The pool success rate for periapical surgery using any regenerative material (bone graft, membrane, or platelet concentrate) was 2.48 (OR: 2.48, 95% CI: 1.42–4.34). Multiple subgroup analyses based on the type of regenerative material used during treatment were performed, presenting high certainty of evidence. The subgroup analysis, which examined bone graft only, bone graft with membrane, membrane only, concentrated growth factor only, and concentrated growth factor with bone graft, yielded significant results only for concentrated growth factor with bone graft (OR: 15.01, 95% CI: 1.12–271.70). While the success rate of periapical surgery with other regenerative materials did not reach statistical significance, the effect size was substantial. Conclusions: Overall, the findings indicate that utilizing a concentrated growth factor with a bone graft significantly improves the success of bone regeneration procedures over a 12-month follow-up period compared to interventions without these components. However, more research will be needed with larger sample sizes and longer follow-up times. Full article

This study aimed to evaluate the effectiveness of two intracanal medications in promoting periapical bone healing following endodontic treatment using radiomics-enabled texture analysis of cone-beam computed tomography (CBCT) images as a novel biosensing technique. By quantifying tissue changes through advanced image analysis, this approach seeks to enhance the monitoring and assessment of endodontic treatment outcomes. Thirty-four single-rooted teeth with pulp necrosis and periapical lesions were allocated to two groups (17 each): calcium hydroxide +2% chlorhexidine gel (CHX) and Ultracal XS^®. CBCT scans were obtained immediately after treatment and three months later. Texture analysis performed using MaZda software extracted 11 parameters based on the gray level co-occurrence matrix (GLCM) across two inter-pixel distances and four directions. Statistical analysis revealed significant differences between medications for S [0,1] inverse difference moment (p = 0.043), S [0,2] difference of variance (p = 0.014), and S [0,2] difference of entropy (p = 0.004). CHX treatment resulted in a more organized bone tissue structure post-treatment, evidenced by reduced entropy and variance parameters, while Ultracal exhibited less homogeneity, indicative of fibrous or immature tissue formation. These findings demonstrate the superior efficacy of CHX in promoting bone healing and underscore the potential of texture analysis as a powerful tool for assessing CBCT images in endodontic research. Full article

Odontogenic sinusitis is a maxillary sinus infection arising from dental pathology, primarily involving posterior maxillary teeth due to their anatomical proximity to the sinus floor. Endodontic infections are a significant etiological factor, yet the condition is frequently underdiagnosed due to its overlapping presentation with sinonasal sinusitis. The present cases illustrate the diagnosis, management, and outcomes of maxillary sinusitis of endodontic origin through endodontic interventions. Two patients with histories of recurrent maxillary sinusitis underwent dental evaluations after conventional medical therapies failed. Cone-beam computed tomography confirmed the dental etiology in all cases, identifying inadequately treated second mesiobuccal (MB2) canals or significant periapical pathology. Endodontic retreatments were employed to address the underlying dental causes, followed by resolution of sinus symptoms within days. Follow-up imaging demonstrated ongoing bone healing and resolution of sinus involvement. These cases underscore the importance of addressing the dental etiology in maxillary sinusitis of endodontic origin to achieve complete symptom resolution and minimize recurrence. Cone-beam computed tomography proved instrumental in diagnosing and planning treatment, enabling precise management of periapical and sinus conditions. The cases highlight the necessity of a multidisciplinary approach, involving dental and medical professionals, to optimize outcomes. Full article

The formation of an oroantral communication (OAC) or fistula (OAF) is a rare complication resulting from the presence of processes in the lateral parts of the maxilla or for iatrogenic reasons. The most common causes of OAC or OAF are tooth extraction with periapical lesions. The aims of this systematic review were to assess the use of platelet-derived preparations rich in growth factors in the treatment of OAC or OAF, to determine the success of treating the communication or fistula, as well as impact on postoperative complications and the course of healing. The study was performed following PRISMA guidelines (PROSPERO: CRD42024570758). The inclusion criteria were as follows: at least ten patients, the presence of oroantral communication or oroantral fistula, treatment with platelet-derived preparations rich in growth factors, and information regarding the response to treatment. In order to find relevant studies, international databases, including PubMed, Google Scholar, Web of Science Core Collection, MDPI, Wiley, and Cochrane Library were searched. The last search was performed on 31 August 2024. Seven articles were included in the systematic review. In total, platelet-derived preparations rich in growth factors were used in 164 patients. Only studies in which OAC was treated and with platelet-rich fibrin (PRF) met the inclusion criteria. Only PRF was used as the sole treatment method in three studies. When OAC is greater than 5 mm, platelet-derived preparations rich in growth factors should be considered adjuncts to treatment, not the sole treatment method. The success rate of OAC treatment was 90–100%. The use of blood products to close OAC may be an effective therapeutic alternative. Proper patient qualification and the use of an appropriate protocol are crucial. There is a need for future well-designed case-control or cohort studies as well as randomized controlled trials to provide the required level of evidence. Full article