Search Results (34)

Clinical root canal therapy which takes place through mechanical and chemical strategies is faced with challenges in eliminating bacteria owing to the intricate and curved nature of the root canal system. Moreover, the plaque biofilm within the root canal hinders drug penetration and limits treatment efficacy. Hence, efficient root canal therapy hinges on penetrating into the root canal and overcoming the barriers presented by the plaque biofilms. To penetrate and eradicate biofilms effectively at the root canal, we designed a novel magnetic nanoparticle (MN)-based nanoplatform which was synthesized by the self-polymerization of dopamine on the surface of Fe₃O₄ MNs, and then loaded minocycline through the electrostatic interaction. The therapeutic efficacy of minocycline-loaded magnetic nanoparticles (FDM MNs) under a magnetostatic field was observed by various antibacterial experiments. The synthesized FDM MNs exhibited favorable biocompatibility and robust anti-biofilm efficacy. The designed nanoparticles could effectively navigate biofilms to eradicate bacteria residing deep with the assistance of magnetic force. Furthermore, FDM MNs penetrated into dentin tubules under a magnetic field, effectively disrupting biofilms for deep sterilization. The significant results offered valuable experimental evidence to support the potential clinical utility of magnetic nanoparticles for managing pulpitis and periapical inflammation. Full article

Idiopathic nephrotic syndrome (NS) is associated with immune dysfunction and increased susceptibility to infections. Oral health may influence systemic inflammation and disease progression. This study aimed to evaluate the salivary levels of interleukin-6 (IL-6) and interleukin-18 (IL-18) in children with NS and their association with dental health, particularly caries prevalence and the consequences of untreated caries. A cross-sectional study was conducted on 86 children aged 5–17 years, including 40 NS patients and 46 healthy controls. Clinical dental examinations assessed caries prevalence using the dmft/DMFT index and the impact of untreated caries using the pufa/PUFA index. Unstimulated saliva samples were collected, and IL-6 and IL-18 concentrations were measured using enzyme-linked immunosorbent assay. NS patients exhibited a significantly lower prevalence of active carious lesions than controls (50% vs. 72%, p = 0.039). The DMFT index was lower in the NS group (p = 0.003). Salivary IL-6 levels were significantly reduced in NS patients compared to controls (p = 0.015), while IL-18 levels showed no significant difference. IL-6 positively correlated with decayed permanent teeth and pulp/periapical tissue diseases, whereas IL-18 correlated with white spot lesions and pulp infections. IL-6 and IL-18 could serve as potential non-invasive indicators of disease progression in NS patients. 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

Objectives: The aim of this study is to evaluate the histopathological examinations of biopsy samples obtained from patients, and to determine the prevalence, age, and gender distribution of intraoral benign lesions. The study examines the distribution of all benign intraoral pathologies, including both soft tissue and hard tissue lesions, through which the goal is to contribute to clinical diagnostic processes. Methods: The histopathological evaluation results of 235 patients who underwent biopsy between 2021 and 2024 were retrospectively analyzed. Out of 235 patients, 123 (52.34%) were female and 112 (47.66%) were male. Lesions were categorized into two groups: soft tissue lesions and intraosseous lesions. The frequency, gender distribution, and age ranges of these lesions were assessed. Lesions exhibiting dysplasia or malignancy were excluded from the study. Results: The most common benign intraoral lesion was identified as the radicular cyst, observed in 69 patients. The age range for radicular cysts varied from 8 to 80 years, with 30 cases in females and 39 in males. The most frequently encountered soft tissue lesion was traumatic fibroma, which constituted 25.33% (19 patients) of all soft tissue lesions. Traumatic fibromas were observed in patients aged between 12 and 62 years. In terms of overall prevalence among all benign intraoral pathological lesions, radicular cysts ranked first (29.36%), followed by periapical granulomas (15.31%), dentigerous cysts (11.06%), and traumatic fibromas (8.08%). The occurrence of soft tissue lesions was significantly higher in females (66.66%) compared to males (33.34%). Conclusions: There are no recent studies in the literature evaluating the prevalence and demographic distribution of intraoral benign lesions. The most common lesions diagnosed in the study are typically associated with inflammation and irritation. The most common hard tissue lesion was the radicular cyst, which was seen across a wide age range and in similar proportions in men and women. Among soft tissue lesions, traumatic fibroma was the most common, particularly in women, and was seen across a wide age range. In terms of gender distribution, soft tissue lesions were twice as common in women as in men. Full article

Background: Inflammation in the periapical area of primary teeth can affect the development and eruption of permanent teeth. In an asymptomatic course, they are detected accidentally during routine examinations. In such cases, they often reach significant dimensions and cause irreversible changes. Methods: This report presents the case of a 9-year-old boy with a radicular cyst in the mandible, resulting in the displacement of both premolar tooth buds. To address the inflammation, facilitate the proper eruption of the impacted teeth, and prevent adjacent teeth from shifting, the primary molars were extracted. Marsupialization was performed under general anesthesia, followed by the fabrication and placement of an obturator. Results: Two months after treatment, the displaced tooth buds began aligning along the natural eruption pathway. By the 8-month follow-up, the premolars had successfully erupted into their proper positions in the oral cavity. Conclusions: Marsupialization combined with the use of an obturator is an effective first-line treatment for radicular cysts in pediatric patients, offering a conservative approach that promotes natural tooth eruption while preserving the surrounding dentition. Full article

This study assessed the biocompatibility and chemical properties of two bioceramic root canal sealers, EndoSequence BC Sealer (EBC) and Nishika Canal Sealer BG (NBG), using a sealer extrusion model. Eight-week-old male Wistar rats were used. The mesial root canals of the upper first molars were pulpectomized and overfilled with EBC, NBG, or, as reference, epoxy resin-based AH Plus (AHP). After 28 days, periapical tissue reactions were assessed using microcomputed tomography and histological staining. The elemental composition and chemical composition of the extruded EBC and NBG were analyzed at Day 1 and 28 using an electron probe microanalyzer and micro-Raman spectroscopy. No periapical lesions were observed with the sealer extrusion. Additionally, inflammation around the extruded EBC and NBG was minimal to mild on Day 28, whereas moderate inflammation was found around the extruded AHP. Silicon concentration in the extruded EBC and NBG decreased significantly from Day 1 to 28, with almost no silicon present on Day 28. Furthermore, the extruded EBC and NBG became calcium- and phosphorus-rich, showing a Raman band for hydroxyapatite on Day 28. In conclusion, EBC and NBG demonstrated favorable biocompatibility and the ability to release silicon elements and produce hydroxyapatite when extruded into the periapical tissues. AHP showed moderate periapical tissue irritancy. Full article

A novel water-soluble root canal filling material based on sodium iodide (NaI) has been developed to overcome the limitations of existing iodine-based formulations. However, the biological stability of this approach in animal studies remains unverified. This study evaluated the biocompatibility of NaI compared to commercial root canal filling materials (Calcipex II and Vitapex^®) in pulpectomized canine teeth to assess its clinical applicability. Following a four-week observation period, none of the experimental groups exhibited tooth mobility or fistula formation. Radiographic and micro-CT analyses revealed no radiolucency in periapical lesions. Histopathologic evaluation demonstrated the absence of inflammatory responses in periapical regions across all material groups, with histological inflammation scoring 0. High-magnification histological examination of periapical areas showed well-preserved periodontal ligament tissue in all groups. Despite certain limitations of NaI-based fillings in the pulp cavity, including loss of radiopacity and tooth discoloration, NaI demonstrates potential as a safe and effective alternative for pulp filling material, particularly due to its minimal risk of root resorption and inflammatory response. Full article

Background: Cemento-osseous dysplasias (CODs) are rare lesions of the jawbone. Their occurrence, localization, type, size, and shape can vary between cases. This fibro-osseous lesion is typically found in the jaw near tooth-bearing areas and is often asymptomatic, discovered incidentally, and may be associated with the periapical region of the teeth. In rare cases, COD can lead to secondary bone osteomyelitis. Currently, there is limited information in the literature on the occurrence and characteristics of COD. This paper’s main aim was to focus on the authors’ COD experience in the lower Silesian area. Methods: A retrospective evaluation of radiographies (RTG-Panx, cone-beam computed tomography (CBCT)) was conducted on patients treated, diagnosed, or consulted by the authors. A statistical correlation analysis was made to establish any relationship within the gathered data. Results: COD is predominantly an incidental finding in the mandibular bone near tooth apices. It is most commonly diagnosed in females. Both CBCT and panoramic radiographies are generally sufficient for diagnosing the lesion. COD rarely requires treatment. Conclusions: COD lesions are mostly discovered incidentally during routine radiographies or cone-beam computed tomography (CBCT) scans. In most cases, clinical and radiological monitoring is sufficient, along with evaluating the teeth’s response to cold stimuli and assessing the surrounding bone structures. Biopsies or tooth extractions are seldom necessary. When oral hygiene is well-maintained and no periapical inflammation is present, COD lesions typically remain asymptomatic. Full article

Apical periodontitis is an inflammatory disease triggered by oral pathogens invading necrotic root canals. The aim of this study was to evaluate the coronal and root canal bacterial community profiles in primary endodontic infections with different periapical (PAI) indices in comparison to oral mucosa controls. A total of 31 patients with primary apical periodontitis, 14 with PAI-1 and 17 with PAI-3 were recruited. Microbial specimens from mucosa (control samples) and endodontic necrotic tissues were collected in each patient. Microbiota composition was studied through 16S ribosomal RNA gene amplicon sequencing analysis. Overall, 2953 taxa from 168 different genera of 451 various microbial species were retrieved in the controls and PAI-1 and PAI-3 groups. Firmicutes is the predominant phylum in the oral controls (34.5%) and PAI-1 (44.4%) groups, while Bacteroidetes is predominant in PAI-3 (38.6%). The Proteobacteria (21.5%) and Fusobacteria (12.5%) relative abundance is higher in oral controls while that of Synergistetes is higher in the PAI-1 (3.5%) and PAI-3 (2.5%) groups, being almost absent in controls (less than 0.1%). Most of the increased bacterial species found in the PAI groups were strict anaerobes. A diminished microbial diversity was found in apical periodontitis with higher PAI. These samples were also characterized by an increase in bacteria belonging to phyla and genera with an increased anaerobic character. Full article

Chronic odontogenic maxillary sinusitis (COMS), a prolonged inflammation of the maxillary sinus lasting over 12 weeks, is often a result of periapical lesions, marginal periodontitis, and complications like oro-antral communication (OAC) and fistula (OAF). OAC, commonly emerging post-teeth extraction in the lateral maxilla, lacks documented treatments using advanced platelet-rich fibrin (A-PRF). This study evaluates A-PRF’s efficacy in treating COMS and immediately sealing extensive OAC. A case of a 28-year-old male with COMS linked to a periapical lesion and supernumerary molars is presented. Treatment involved extracting specific teeth while preserving adjacent ones and using A-PRF for immediate OAC closure. A-PRF, enriched with growth factors, was pivotal in healing, showcasing enhanced tissue regeneration, pain reduction, and faster recovery. The findings suggest A-PRF as an effective adjunct in treating extensive OAC and COMS, proposing its inclusion in standard treatment protocols. This study underscores A-PRF’s potential in improving outcomes for patients with COMS and related complications. Full article

The aim of this validation study was to comprehensively evaluate the performance and generalization capability of a deep learning-based periapical lesion detection algorithm on a clinically representative cone-beam computed tomography (CBCT) dataset and test for non-inferiority. The evaluation involved 195 CBCT images of adult upper and lower jaws, where sensitivity and specificity metrics were calculated for all teeth, stratified by jaw, and stratified by tooth type. Furthermore, each lesion was assigned a periapical index score based on its size to enable a score-based evaluation. Non-inferiority tests were conducted with proportions of 90% for sensitivity and 82% for specificity. The algorithm achieved an overall sensitivity of 86.7% and a specificity of 84.3%. The non-inferiority test indicated the rejection of the null hypothesis for specificity but not for sensitivity. However, when excluding lesions with a periapical index score of one (i.e., very small lesions), the sensitivity improved to 90.4%. Despite the challenges posed by the dataset, the algorithm demonstrated promising results. Nevertheless, further improvements are needed to enhance the algorithm’s robustness, particularly in detecting very small lesions and the handling of artifacts and outliers commonly encountered in real-world clinical scenarios. Full article

A partial or complete pulpotomy is a type of vital pulp therapy (VPT) that aims to remove the inflamed, infected pulp, leaving behind healthy, vital pulp that is capable of healing. VPT has gained renewed popularity as a treatment option in permanent mature posterior teeth with irreversible, moderate to severe pulpitis; its high success rates matching that of root canal treatment (RCT). There is currently no consensus regarding diagnostic and prognostic predictors of success of pulpotomies for managing such cases. Therefore, we conducted a scoping review to identify and analyze how these factors affect the outcome of treatment. A literature search using the PRISMA guidelines was undertaken using PubMed and Scopus on 7 July 2023. A total of 22 studies met the inclusion criteria and were qualitatively analyzed by two reviewers. The following diagnostic and prognostic factors were recognized and discussed; presenting signs and symptoms, periapical diagnosis, bleeding time, indicators of inflammation (bleeding time, concentration of inflammatory biomarkers), patient age and medical status, the depth, activity and location of caries, and restorative factors. Based on the studies assessed, there is limited evidence to support their prognostic value. Further research is necessary to identify solid predictors of outcome. Full article

Periapical odontogenic granulomas are among the most encountered pathology that involve the alveolar bone, with severe consequences such as bone resorption, the presence of inflammatory infiltrate and the formation of abnormal vascularization. The present study aimed to quantify the existence of the microvessel density (MVD), mast cell density (MCD) and heterogeneity of the encountered blood vessels. A total of 37 patients diagnosed with odontogenic periapical granulomas were included, and the gender distribution, age and localization of the pathological lesions was assessed. After the surgical removal of the periapical odontogenic granuloma, the collected tissue was fixed in 10% buffered formalin. Primary processing, morphological analysis and immunohistochemical staining was performed in order to characterize the altered tissue. The results outlined the presence of a high number of mast cells, especially in the area of the inflamed tissue; the high heterogeneity of the blood vessels; and increased MVD with positive CD34. The conclusions of the study focus on the key role of the mast cells and their implication in the initiation and development of the angiogenesis process, triggering the inflammatory response of the host. Nevertheless, periapical odontogenic granulomas develop as an inflammatory response to the interaction between the host’s immune system and microbial invasion. Full article

The consequences of traumatic injuries are pulp necrosis, periapical inflammation, and possible external cervical resorption (ECR). The concomitant cessation of root maturation and dentinogenesis in premature teeth result in a fragile tooth. Revascularization of the pulp might be an alternative treatment option. A 12-year-old patient was referred for retreatment of chronic apical periodontitis with acute exacerbation after root canal treatment of an upper central incisor. During gutta-percha removal, an ECR was detected. First, it was closed internally with Biodentine, followed by an external composite closure after a cone beam computed tomography evaluation. In the first session, chemomechanical cleaning was aided with sodium hypochlorite and hyperpure chlorine dioxide, and the canal was dressed with Ca(OH)₂ until the next session. In the next session, only the low-toxicity, but adequate, bactericide hyperpure chlorine dioxide was applied for irrigation, before the provocation of periapical bleeding into the canal. The blood clots were covered with Biodentine, and the tooth was restored with composite filling. During the 24-month follow-up, clinical signs/symptoms had disappeared, and the periapical lesion was resolved. Increased root thickness in the apical third and decreased size of the apical foramen were detected. In conclusion, regenerative endodontic procedures could potentially be used to retreat immature teeth with persistent apical periodontitis and external cervical resorption. Full article

Periodontal disease is a broad term given when the periodontium is affected by inflammation. There are several methods to diagnose periodontitis, but no method to quantify the cancellous bone is presently used. For this purpose, a non-invasive tool that is efficient in analyzing bone quality called fractal analysis can be employed. The objective of the study was to utilize fractal dimension (FD) to evaluate cancellous patterns of interproximal alveolar bone using a digital intraoral periapical radiograph (IOPAR) in different clinical presentations of periodontitis classified according to the latest classification by the World Workshop for Periodontal and Peri-Implant Diseases and Conditions, 2017 (WWDC, 2017). The study aimed to numerically calculate the periodontitis changes in the cancellous bone around the affected tooth on an IOPAR using fractal analysis and to provide an additional criterion for the staging of periodontitis. In this cross-sectional observational study, 75 patients were selected and equally allotted to five groups based on the staging system proposed by the WWDC, 2017. The region of interest was selected on the IOPA radiograph of the tooth with the site having the most significant clinical attachment loss, and FD was calculated using Image J analysis. The association of gender and age with stages of periodontitis was studied using the chi-square test of independence. A comparison of % bone loss and fractal dimension among stages was studied by using the non-parametric Kruskal Wallis test. The relationship between % bone loss and fractal dimension within stages and gender was studied by using the Karl Pearson correlation. A receiver operating characteristic (ROC) curve analysis was performed for FD value as a marker of periodontitis patients. We demonstrated that the FD values decreased significantly with the increase in stages (p < 0.0001). The overall relationship between % bone loss and FD showed a significantly strong negative correlation of −0.739 (p < 0.0001), except for stages III and IV. FD can be utilized as a quantitative method for detecting cancellous bone changes in different stages of periodontitis, aiding in diagnosing periodontitis. Full article