Search Results (127)

The currently common procedures in orthognathic surgery are widely used. Different forms of skeletal malocclusion can be treated with great outcomes in terms of bite, bone harmony, function, improved mastication, esthetics, and even decreased problems with breathing. Each type and intensity of malocclusion may affect decision-making in terms of distraction, selection of osteotomy design, or even guide clinical and surgical decisions to use a less popular osteotomy protocol. CBCT (cone-beam computed tomography) is currently a milestone in the establishment of the condition of jaw bones, bone structure, temporomandibular joints, and central relation (CR), as well as the scope of maxilla–mandibular and tooth relations. When establishing all of the following in a clinical and radiological (CBCT-based) evaluation, it becomes possible to measure the occlusal plane, height, length, and three-dimensional position of each dental segment, as well as other dentoalveolar features. In the present case, CBCT helped distinguish a localized vertical anterior mandibular dentoalveolar discrepancy from generalized mandibular malposition and supported the planning of a mandibular anterior segmental subapical osteotomy (MASSO) by mapping the osteotomy corridor in relation to the dental roots, cortical bone, periapical bone height, and neurovascular structures. Significant therapeutic complexity emerges when severe skeletal Class III malocclusion (mandibular prognathism) is compounded by transverse maxillary discrepancies and a markedly elevated mandibular anterior segment. This constellation of deformities leads to profound disturbances in the anterior facial height, a disrupted maxillomandibular interincisal relationship, and the loss of a level occlusal plane. The presented case highlights how the patient’s clinical evaluation should be carefully compared with radiological data, status of both cortices in the mandible, the height of the mandibular anterior segment, presence of gum recessions and poor bone status that may affect healing, osteotomies, and occurrence of some unwanted events. Therefore, CBCT was useful not only for diagnosis and planning, but also for understanding the biological limits of movement and the risk of postoperative periodontal complications in this uncommon reversed Köle-type MASSO. Full article

Background and Objectives: Achieving optimal soft-tissue aesthetics is a paramount challenge during an apicoectomy of the maxillary central incisors. This article presents a novel modification of the Eskici Vertical Flap, designed to minimize scar formation, preserve the architectural integrity of the sub-mucosal fibers, and eliminate the risk of marginal gingival recession. Methods: The Transfrenular-Single Incision (TrSI) flap is elevated via a precise two-step process. First, a sagittal incision is carried out through the mucosa along the midline of the maxillary labial frenulum. Blunt lateral tunnel preparation is then performed toward the targeted tooth apex, and a subsequent deep periosteal incision with bony contact provides localized access to the periapical lesion. Following Paraendodontic Surgical Intervention (PSI), a two-layer suturing technique is implemented: the deep layer utilizes resorbable sutures to restore periosteal integrity and reposition the basal fibers of the frenular connective tissue, while the superficial layer promotes accurate mucosal edge adaptation. Results: The surgical access provided by the TrSI flap provides clinically sufficient exposure to perform precise osteotomy, retrograde root-end preparation, and biocompatible sealing. The evaluated clinical cases demonstrated optimal healing kinetics, the complete absence of visible scar tissue, and zero marginal gingival recession. Conclusions: The TrSI flap modification constitutes a highly predictable and effective option for PSI in the aesthetically critical anterior maxilla. Although its application spectrum is primarily limited to the central incisors, its capacity to prevent aesthetic deformities warrants its consideration in selected surgical protocols. Full article

Background/Objectives: Meta-analyses of endodontic microsurgery (EMS) report pooled success rates of 90–94%, which is now a reference point for clinical decisions. These estimates are often applied beyond the follow-up intervals and imaging conditions in which they were derived. This review defines the temporal and imaging boundaries within which such a rate can be applied with confidence. Methods: We reviewed the core meta-analyses establishing these benchmarks, together with primary studies comparing periapical radiography (PA) and cone-beam computed tomography (CBCT) within the same cohort or across follow-up intervals. Sources from MEDLINE, Embase, and the Cochrane Library were selected purposively, not by systematic screening. Results: Reported success varied with both imaging modality and follow-up time. In within-cohort comparisons, PA consistently yielded higher success than CBCT, being less sensitive to residual cancellous defects; in one cohort, CBCT found a defect in 28% of sites PA had judged healed. A long-term meta-analysis reported 91.3% success in randomized trials but 78.4% in prospective cohorts over 2 to 13 years, with 5 to 25% of early successes later reverting. Conclusions: Success after EMS is neither temporally stable nor modality-neutral. Meta-analytic estimates are valid within their stated follow-up and imaging context; applying them outside that context risks misclassification with direct consequences for clinical decision-making. Full article

Background and Objectives: Diabetes mellitus is a major systemic modifier of oral infection, periodontal inflammation, and tissue healing. Persistent hyperglycemia may intensify oxidative stress, immune dysfunction, dysbiotic biofilm activity, and advanced glycation end-product/receptor signaling, thereby reducing the predictability of periapical and periodontal healing. In patients with endo-periodontal lesions, these mechanisms may interact with pulpal infection and periodontal breakdown, complicating diagnosis, prognosis, and therapeutic sequencing. This review summarizes current evidence on diabetes, glycated hemoglobin (HbA1c), and endo-periodontal outcomes and proposes an HbA1c-guided clinical framework for risk stratification and treatment planning. Materials and Methods: A structured narrative review with an expert-informed clinical framework was conducted using the literature published between January 2016 and December 2025. Eligible sources included consensus reports, clinical practice guidelines, systematic reviews, meta-analyses, umbrella reviews, randomized and non-randomized clinical studies, observational studies, and selected mechanistic studies or contemporary narrative reviews with direct relevance to the framework. Case reports, animal studies, and in vitro investigations without direct relevance to the clinical framework were excluded from the main synthesis. Results: Diabetes is associated with increased periodontal severity, impaired periodontal treatment response, a higher prevalence of radiolucent periapical lesions in root-filled teeth, delayed periapical healing, and increased non-retention of endodontically treated teeth. Periodontal therapy is safe in diabetic patients and may be associated with modest reductions in HbA1c, especially when baseline metabolic control is poor. Conclusions: HbA1c should complement, not replace, pulpal testing, periodontal charting, and radiographic assessment. The proposed framework prioritizes endodontic infection control when pulpal necrosis or active intracanal infection is present, adapts periodontal intervention to metabolic risk, and postpones elective surgical or regenerative procedures in poorly controlled diabetes until medical stabilization is achieved. Full article

Objective: To report the conservative management of a complex failed apexification in a permanent premolar complicated by severe internal root resorption, irregular apical calcification, and exceptionally thin root canal walls and to evaluate its long-term (56-month) clinical and radiographic outcomes. Methods: A 27-year-old male presented with chronic apical periodontitis in the right mandibular first premolar. A previous apexification attempt had failed, resulting in arrested root development, an apical calcified bridge, and extensive internal root resorption. CBCT imaging revealed a critical root canal wall thickness of less than 1 mm in the middle and coronal thirds. To avoid extraction or invasive surgery, a non-surgical apical barrier technique was performed. Due to the severe structural compromise and high risk of root fracture, mechanical instrumentation was minimized; instead, chemomechanical debridement was optimized using Er:YAG laser-activated irrigation. The apical region was sealed with a bioceramic material (iRoot BP), and the weakened root structure was reinforced intraradicularly with dual-cure flowable resin, followed by progressive occlusal adjustments. Results: At the 3-month follow-up, the patient was completely asymptomatic, and radiographs indicated initial periapical bone healing. The 56-month follow-up demonstrated progressive formation of mineralized tissue, apparent thickening of the root canal walls at root apex, complete resolution of periapical radiolucency, and a stable, functional occlusion. Conclusions: This case demonstrates that teeth with severe structural compromise and internal resorption following failed apexification are not necessarily hopeless. A tailored conservative approach, integrating advanced laser-assisted disinfection, bioceramic apical barriers, internal resin reinforcement, and meticulous occlusal management, can yield highly successful long-term outcomes, ensuring the preservation of the natural dentition. Full article

Background/Objectives: Activated irrigation techniques improve intracanal disinfection, but their impact on the clinical and radiographic healing of apical periodontitis remains unclear. This systematic review and meta-analysis evaluated the efficacy of passive ultrasonic irrigation (PUI) and laser-assisted irrigation (LAI), without adjunctive systemic antibiotics, on periapical healing compared with conventional irrigation in adult patients. Methods: Following PRISMA guidelines and prospective registration in PROSPERO (CRD420261413401), PubMed, Scopus, Embase, and Web of Science were searched up to February 2026. Randomized controlled trials (RCTs) involving adults with apical periodontitis comparing PUI or LAI against conventional syringe irrigation—with a minimum of 6 months follow-up—were included. Risk of bias was assessed using RoB 2, evidence certainty via GRADE, and a random-effects meta-analysis calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs). Results: Of 1115 records identified, five randomized controlled trials involving 451 teeth fulfilled the eligibility criteria and were included in the qualitative synthesis and quantitative meta-analysis. Activated irrigation significantly increased periapical healing probability compared with conventional irrigation (OR = 2.25; 95% CI: 1.29–3.93; p = 0.004), with no statistical heterogeneity (I² = 0%). Subgroup analyses showed significant benefits for both PUI (OR = 1.95; 95% CI: 1.08–3.54) and LAI (OR = 6.77; 95% CI: 1.63–28.12). The overall certainty of evidence was moderate due to risk of bias concerns. Conclusions: Activated irrigation techniques (PUI and LAI) were significantly associated with improved clinical and radiographic healing of apical periodontitis compared with conventional irrigation alone. Enhanced intracanal disinfection contributes to a more predictable resolution of periapical lesions without adjunctive systemic antibiotics. Further high-quality RCTs with standardized protocols and long-term CBCT-based follow-up are required to confirm these findings. Full article

A 66-year-old female patient was referred to the oral surgery unit for the enucleation of a radicular cyst centered at the apex of the necrotic tooth 12. Initial panoramic and intraoral periapical radiographs suggested a persistent periapical cystic lesion despite previous root canal treatment. However, cone-beam computed tomography (CBCT) revealed the coexistence of two distinct lesions within the same anatomical region: a periapical lesion associated with tooth 12, radiographically suggestive of a radicular cyst, and a second well-defined lesion centered within the nasopalatine canal, consistent with a nasopalatine duct cyst and not detectable on conventional radiographs. This unusual association represented a significant diagnostic challenge, as the clinical and two-dimensional radiographic findings initially suggested a single persistent endodontic lesion. Surgical enucleation of both lesions was performed. Histopathological examination confirmed the diagnosis of a nasopalatine duct cyst for the lesion located within the incisive canal, whereas the periapical lesion was confirmed as a radicular cyst. Postoperative follow-up at 10 days, 3 months, 6 months, and 1 year demonstrated satisfactory healing without recurrence or complications. This case highlights the diagnostic value of CBCT in the identification of coexisting odontogenic and non-odontogenic lesions of the anterior maxilla, particularly when conventional radiography is insufficient to distinguish separate pathologies. Full article

Odontogenic cutaneous sinus tracts represent an uncommon clinical manifestation of chronic dental infection and are frequently misdiagnosed due to the absence of dental symptoms and their resemblance to dermatologic lesions. This case report describes the nonsurgical endodontic management of a cutaneous sinus tract of dental origin in a 13-year-old patient. The patient presented with a persistent extraoral lesion in the mandibular region, initially evaluated by non-dental specialists. Clinical and radiographic examination revealed a necrotic mandibular first molar associated with a periapical radiolucency and intraoral sinus tract. Nonsurgical root canal treatment was performed using chemomechanical debridement with sodium hypochlorite irrigation and calcium hydroxide as an intracanal medicament. Complete obturation was achieved following resolution of intracanal exudation. No surgical intervention of the cutaneous lesion was undertaken. Progressive healing of the periapical lesion and spontaneous resolution of the extraoral sinus tract were observed over a 6-month follow-up period. This case is noteworthy because it combines a prolonged diagnostic delay, an atypical extraoral manifestation in a child, and successful resolution by nonsurgical endodontic therapy alone without surgical excision of the cutaneous lesion. The 6-month follow-up confirms sustained clinical and radiographic healing, underscoring the importance of early recognition and conservative management in pediatric patients. Early identification and elimination of the dental source can prevent unnecessary surgical procedures and minimize the risk of permanent scarring. Full article

Background: Effective root canal disinfection is essential for successful nonsurgical root canal treatment (RCT). Although sodium hypochlorite (NaOCl) remains the standard irrigant, it carries a risk of chemical tissue injury if extruded beyond the root canal system and may have limited penetration into anatomically complex regions. Underwater discharge plasma (UDP) generates reactive oxygen and nitrogen species (RONS) through high-frequency, high-voltage electrical discharge in aqueous media, and preclinical and in vitro studies have reported broad-spectrum antimicrobial activity. This study evaluated the clinical and radiographic outcomes of nonsurgical RCT performed using physiological saline-based UDP irrigation without NaOCl in a heterogeneous real-world clinical cohort. Methods: This single-center retrospective cohort study included 186 teeth from 134 patients treated with the PLAZEN RCT^® UDP device and physiological saline irrigation, without NaOCl. The median follow-up period was 16 months. Radiographic outcomes were assessed using the Periapical Index (PAI) system, and treatment success was evaluated according to prespecified Strict and Loose criteria incorporating both radiographic and clinical findings. Stratified analysis was performed according to preoperative PAI score: Group A (PAI 1–2) and Group B (PAI 3–5). UDP-related adverse events, defined as thermal tissue injury caused by discharge heat, were ascertained through retrospective review of clinical records, operative notes, and serial periapical radiographs. Results: Among the 186 treated teeth, radiographic outcomes were classified as Healed (85.5%), Healing (3.8%), and Unhealed (10.8%). Overall Strict and Loose success rates were 79.6% and 82.3%, respectively. Initial treatment showed numerically higher success rates than retreatment. In the stratified analysis, Group A showed an 84.1% success rate with 100% tooth survival, whereas Group B demonstrated Strict and Loose success rates of 68.5% and 83.3%, respectively. Exploratory multivariable analysis showed that periodontal pocket depth > 3 mm was the most consistent factor associated with lower odds of treatment success, whereas associations involving canal obliteration and higher preoperative PAI score were less stable across sensitivity analyses and should be interpreted with caution. No UDP-related adverse events were recorded during follow-up. Attrition sensitivity analyses were performed, and the outcome estimates should be interpreted with caution, given the retrospective design and substantial loss to follow-up. Conclusions: In this preliminary observational cohort, physiological saline-based UDP irrigation without NaOCl was associated with favorable observed periapical healing outcomes and no recorded UDP-related adverse events over a median follow-up of 16 months. However, loss to follow-up was substantial; when all 116 teeth lost to follow-up were classified as treatment failures, the worst-case Strict success rate decreased to 49.0%. Therefore, these findings should be interpreted as preliminary descriptive evidence of clinical feasibility rather than as evidence of comparative efficacy or definitive clinical safety. Adequately powered randomized controlled trials with concurrent NaOCl control arms and long-term follow-up are warranted to evaluate the comparative effectiveness, safety, and reproducibility of physiological saline-based UDP irrigation protocols. Full article

Background: The objective was to synthesize and critically appraise systematic reviews with meta-analysis evaluating the association between irrigation, instrumentation, and obturation procedures and post-operative endodontic pain. Methods: An umbrella review was conducted following PRISMA guidelines. Electronic searches identified systematic reviews published between 2016 and 2025. Eligible studies are systematic reviews that include meta-analyses, published in English and correlating the presence of post-operative pain in 3 different critical stages of root canal treatments, namely irrigation, instrumentation and obturation. Methodological quality was assessed using the AMSTAR 2 tool. Outcomes included pain prevalence and intensity at different time points. Results: Out of 368 records, 25 systematic reviews with meta-analysis met the inclusion criteria: 9 on irrigation, 8 on instrumentation, and 8 on obturation. NaOCl concentrations, irrigant activation, and intracanal cryotherapy were repeatedly reported as being associated with reduced short-term post-operative pain. For instrumentation, most reviews reported lower pain with rotary systems, but two studies found no difference or favored reciprocating kinematics. Apical patency did not appear to increase pain and foraminal enlargement may increase early pain. No clinically consistent differences were observed between bioceramic/calcium silicate-based and resin-based sealers, although calcium silicate sealers seem to support periapical healing. However, the certainty of these findings was limited by heterogeneity, methodological weaknesses, and overlap among primary studies. Methodological limitations were identified across reviews, mainly related to no protocol registration (n = 4), incomplete reporting of excluded studies with justification (n = 11), limited assessment of publication bias, and poor reporting of funding sources for primary studies. Conclusions: Based on current evidence, irrigation, instrumentation, and obturation procedures may influence short-term post-operative pain. However, these findings remain tentative because of heterogeneity, methodological weaknesses, variable review quality, and overlap among primary studies. Further high-quality reviews and clinical trials are needed. Full article

Apical periodontitis is a common inflammatory oral condition and a major cause of endodontic treatment need. The present retrospective clinical study aimed to evaluate the frequency, distribution, and radiographic healing of teeth diagnosed with apical periodontitis following primary endodontic treatment or nonsurgical retreatment within a specific patient cohort. Consecutive patients presenting for endodontic treatment at the study clinic between 2020 and 2021 were screened for inclusion. Eligible cases were those in which patients provided written informed consent, presented with periapical inflammatory pathology, and underwent conservative endodontic treatment. Exclusion criteria were incomplete data, non-functional or non-restorable teeth, third molars, pregnancy, probing depth ≥ 4 mm, radiographic bone loss, pathologic tooth mobility due to attachment loss, periodontal involvement of the lesion, and primary dentition. A total of 277 teeth, all diagnosed with apical periodontitis at baseline, were included. Some patients contributed more than one tooth. All treatments were performed by a single operator according to a standardized clinical protocol, including uniform diagnostic criteria, chemo-mechanical preparation, irrigation regimen, obturation technique, and radiographic follow-up at 12 and 24 months. Periapical healing was assessed radiographically using the Periapical Index (PAI). Within this cohort, elderly patients significantly represented the largest proportion of those treated (p < 0.001). Maxillary teeth also comprised a significantly higher proportion of cases than mandibular teeth (55.2% vs. 44.8%). The mean initial PAI score was 3.37 ± 0.9 points, with a median of 3 points, and the final score was 1.31 ± 0.93 points, with a median of 1 point. Radiographic healing was observed in 56.68% of cases at 12 months and in 84.84% of cases at 24 months. Primary endodontic treatment and nonsurgical retreatment of teeth with apical periodontitis in this selected patient population were associated with substantial radiographic improvement over a 24-month follow-up period. These findings support the value of standardized endodontic management and longitudinal radiographic monitoring. Full article

Background: The biological response of the periodontal ligament (PDL) following endodontic treatment remains insufficiently investigated. This systematic review aimed to evaluate the influence of endodontic treatment modalities on PDL-related healing outcomes and periapical tissue repair. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and the Cochrane Library were searched for randomized clinical trials published between 2015 and 2025. Studies evaluating the effects of endodontic interventions on clinical, radiographic, or biological outcomes associated with PDL healing. Risk of bias was assessed using the Cochrane RoB 2 tool. Results: Ten randomized clinical trials involving approximately 710 participants were included. Endodontic treatment was generally associated with favorable healing outcomes, reflected by reductions in periapical lesion size, improvement of radiographic parameters, and resolution of clinical symptoms. Single-visit and multiple-visit treatments demonstrated comparable long-term healing outcomes, although single-visit protocols were associated with increased short-term postoperative discomfort. Activated irrigation techniques appeared to enhance healing compared with conventional irrigation methods. Most studies were judged as having some concerns regarding risk of bias. Conclusions: Current evidence suggests that endodontic treatment can promote favorable healing of the periodontal ligament–periapical complex through effective infection control and resolution of inflammation. However, the certainty of evidence remains moderate because of methodological heterogeneity and the limited availability of studies directly assessing biological PDL outcomes. Further well-designed randomized clinical trials with standardized outcome measures and longer follow-up periods are required. Full article

Background: Regenerative endodontic procedures (REPs) aim to restore pulp vitality and promote root development in immature necrotic permanent teeth. Scaffold materials provide a 3D framework to support cellular migration, proliferation, and differentiation and play a critical role in regenerative interventions. Commonly used scaffolds include PRP, PRF, and collagen; however, hyaluronic acid has also demonstrated promising treatment outcomes. Objective: To evaluate whether hyaluronic acid (HA) provides superior regenerative outcomes compared to PRP, PRF, and collagen scaffolds. Methods: A systematic electronic search was conducted across PubMed, Scopus, and EBSCOhost. A total of 952 articles were identified in the initial search, of which 19 articles were included in the final review. Due to heterogeneity, a narrative synthesis was performed. Results: PRF demonstrated the most consistent improvement in root development and dentinal wall thickening. Apical closure and periapical healing were achieved across all scaffold types. Evidence for HA was limited, with no clear superiority identified. Conclusions: Current evidence does not support the superiority of HA over established scaffolds. Further standardised clinical trials are required to make definitive comparisons on scaffold effectiveness. Full article

Background/Objectives: Implant explantation is often considered the standard treatment for severe peri-implant inflammatory lesions, including cases with apical involvement. However, this approach is relatively invasive and aggressive, which can lead to significant loss of bone and soft tissues, potentially compromising future prosthetic rehabilitation, particularly in the esthetic zone. This study aimed to present implant apicoectomy as a conservative alternative that would allow preservation of implant stability while effectively treating localized inflammation. Methods: This case report presents a female patient who was diagnosed with retrograde peri-implant inflammation, and an implant apicoectomy was performed as a conservative approach to implant explantation. The procedure was carried out using a minimally invasive microsurgical technique. Results: The treatment resulted in complete clinical and radiographic healing, maintenance of implant osseointegration and stability, and resolution of clinical symptoms, including fistula closure. No recurrence of periapical infection was observed during the twelve-month clinical and radiological follow-up visit. Conclusions: Implant apicoectomy may be considered a minimally invasive and effective alternative to explantation in selected cases of retrograde peri-implantitis, preserving hard and soft-tissue architecture while maintaining implant functionality. This approach may be particularly beneficial in esthetic regions where preservation of tissue architecture is critical for optimal clinical outcomes. Full article

Traumatised immature permanent teeth with pulp necrosis pose a clinical challenge due to incomplete root development and limited treatment options. This retrospective observational study evaluated the clinical and radiographic outcomes of regenerative endodontic treatment (RET) incorporating an additional calcium hydroxide-based step for blood clot stabilisation compared with apexification in traumatised immature teeth. A total of 49 teeth treated between 2015 and 2025 were analysed. Clinical and radiographic parameters were recorded at baseline and reassessed at 6- and 12-month follow-up, including root length, dentinal wall thickness, apical diameter, periapical status, and apical closure. RET was associated with significantly greater increases in dentinal wall thickness (p = 0.002), root length (p = 0.010), and reductions in apical diameter (p < 0.001) over time compared with apexification. Apical closure was observed significantly more frequently in the RET group (p < 0.001). Periapical healing improved in both groups, while overall clinical outcomes appeared broadly similar. Within the limitations of this retrospective observational study, RET incorporating an additional calcium hydroxide-based step for blood clot stabilisation appears to be a clinically applicable approach for promoting root development in traumatised immature teeth. Further prospective and controlled studies are required to confirm these findings and to better define the role of this adjunctive step. Full article