Search Results (27)

The term “periapical lesion” refers to a pathological change in the tissues surrounding the apex of a tooth root, defined by its anatomical location rather than a distinct disease entity. Periapical lesions may be of endodontic origin, most commonly resulting from microbial infection of the root canal system following pulp necrosis due to caries, trauma, or other insults, or of non-endodontic origin, such as developmental cysts, benign and malignant odontogenic and non-odontogenic tumors, and fibro-osseous lesions. Accurate diagnosis requires a systematic approach combining patient history, clinical examination, pulp vitality testing, and radiographic assessment; histopathological evaluation is indicated when clinical and radiographic findings are inconsistent or suspicious. The pathophysiology of these lesions involves dynamic interactions between root canal microorganisms and the host immune-inflammatory response. The primary management for endodontic periapical lesions is root canal treatment, which aims to reduce or eliminate root canal microorganisms through mechanical debridement and chemical disinfection. Persistent or extensive endodontic lesions and non-endodontic lesions may require surgical intervention. Molecular and inflammatory biomarkers have been investigated as adjunctive tools for assessing disease activity and prognosis; however, these remain largely investigational and are not yet part of routine clinical practice. Future developments in artificial intelligence, advanced imaging, molecular diagnostics, and personalized therapies may enhance the diagnosis and management of periapical lesions, although further clinical validation is required. Full article

Background: Apical periodontitis (AP) is a common inflammatory condition of the periapical tissues, most often associated with persistent endodontic infection. Conventional two-dimensional radiography may underestimate AP because of anatomical superimposition and limited sensitivity. Cone-beam computed tomography (CBCT) allows three-dimensional visualization of periapical structures and has been increasingly used in epidemiological research. Objective: This study aimed to evaluate the prevalence and distribution of apical periodontitis, with particular emphasis on apical periodontitis associated with root canal-treated teeth (AP-RCT), in a Saudi subpopulation using CBCT imaging. Methods: This retrospective cross-sectional study analyzed CBCT scans of Saudi patients obtained for routine diagnostic purposes between 2017 and 2021. Apical periodontitis was identified using standardized radiographic criteria requiring the presence of periapical radiolucency in more than one imaging plane. Demographic and clinical variables were recorded. Descriptive statistics were used to estimate prevalence. Associations between demographic factors and AP-RCT counts were evaluated using multivariable negative binomial regression. Regional tooth distribution was analyzed using generalized estimating equation models accounting for within-participant clustering. Results: A total of 320 CBCT scans were analyzed. Apical periodontitis was detected in 231 participants (72.2%) and in 667 teeth (8.3% of examined teeth). Of the affected teeth, 457 (68.5%) were associated with root canal treatment. The mean number of AP-RCT per participant was 1.36 ± 1.81 (median: 1; IQR: 0–2). Multivariable analysis identified age as the only significant predictor of AP-RCT. Compared with individuals aged 21–30 years, higher AP-RCT rates were observed in the 31–40-year and 41–50-year age groups, while participants ≤20 years showed lower rates. Tooth-level analysis demonstrated higher AP-RCT prevalence in maxillary premolars, maxillary molars, and mandibular molars, whereas mandibular anterior teeth showed the lowest prevalence. Conclusions: Apical periodontitis, particularly AP-RCT, was frequently observed in this Saudi subpopulation when assessed using CBCT. Age and tooth location were the primary determinants of disease distribution. These findings provide population-level epidemiological data on the prevalence and anatomical distribution of apical periodontitis in root canal-treated teeth. Clinical Significance: CBCT-based epidemiological assessment enables detailed evaluation of the distribution of apical periodontitis in dentate populations and may assist in characterizing disease patterns in anatomically complex regions, without implying comparative diagnostic accuracy or treatment outcome assessment. Full article

Background: This study compared the reasons for dental presentations between Indigenous and non-Indigenous Australian adults at the Nepean Centre for Oral Health, NSW, Australia. Methods: A retrospective cohort study was conducted on adult patients presenting between 1 July and 31 December 2019. Clinical notes were audited and categorized as either ‘emergency’ (pain, dental infection, dental trauma, loose teeth or dental implants, bleeding) or ‘conservative’ (dental check-ups, examinations, prosthodontic, restorative, periodontal, or non-emergency endodontic therapy). Results: A total of 4663 patients met the inclusion criteria; 61.6% were female, and 6.4% were identified as Indigenous Australians. Overall, 41.3% of presentations were for emergency dental care. Indigenous Australians were significantly more likely to present for dental emergencies compared with non-Indigenous (58.2% vs. 40.2%; χ²(1, N = 4663) = 53.4, p < 0.00001; OR = 2.07, 95% CI: 1.64–2.63), and were also more likely to undergo emergency tooth extractions (p < 0.05). Conclusions: Indigenous Australians demonstrated a higher proportion of emergency and oral surgery-related presentations and underwent tooth extractions as the primary treatment compared to their non-Indigenous counterparts. These findings suggest a higher burden of oral disease and delayed access to general dental services among Indigenous Australians, highlighting the need for targeted and culturally appropriate public health interventions. 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

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/Objectives: The aim of this narrative review is to perform an updated literature review of the root canal microbiome in secondary endodontic infections and the bacterial dynamics that govern the processes leading to the development of these persistent endodontic infections and periapical lesions. Methods: A literature search of scientific publications issued in the last 8 years, i.e., 2017–2024, was conducted in PubMed (MEDLINE) and ScienceDirect databases, using the following keywords: endodontic microbiome; endodontic pathogens; periapical lesion; primary endodontic infection; secondary/persistent endodontic infection; functional redundancy. Discussions: Secondary endodontic infections (SEIs) are a highly prevalent pathological condition affecting a minimum of one tooth in more than half of adults worldwide. The transition from primary endodontic infection (PEI) to secondary endodontic infection (SEI) is mainly governed by Enterococus faecalis (EF) that invades and dominates the previous endodontic biofilm initiated by Fusobacterium nucleatum (FN). Conclusions: The findings from different studies indicate that secondary endodontic infections are polymicrobial. In SEIs, the microbial species interactions are crucial in influencing the ecology of infected root canals. The issue of the keynote pathogen is still under debate. Both EF and FN pathogens cooperate with neighboring residents. Functional redundancy of the endodontic microbiome explains how the ecological diversity modulates its pathogenicity. Full article

Background: Pulp tissue debridement and the eradication of microorganisms from an infected root canal system before obturation is a primary focus of endodontic treatment and the best predictor for the long-term success of endodontic treatment. Objective: The purpose of this in vitro laboratory study was to evaluate pulp tissue debridement and the disinfection efficacy of two different Er;Cr:YSGG laser units, with a 2790 nm wavelength, compared to ultrasonic-activated irrigation (UAI) in root canals infected with Enterococcus faecalis. Methods: Human non-infected mandibular first molars were extracted, disinfected, and cultured with Enterococcus faecalis. Different types of Er;Cr:YSGG laser irrigation and UAI were performed according to the manufacturers’ protocols. The teeth were then processed for bacteriological and SEM analyses. Results: The different laser-activated irrigation protocols showed multiple areas of remaining bacteria, biofilm, tissue, and thermal ablation. The laser fiber tips also displayed significant tip degradation after use, which might affect efficacy. Conclusions: In this in vitro study, laser-activated irrigation using Er;Cr:YSGG technology and UAI were inefficient in eliminating pulp tissue from difficult-to-reach areas and Enterococcus faecalis from infected root canals. Full article

Background: Riboflavin (vitamin B₂) has emerged as a promising photosensitizer in photodynamic therapy (PDT) due to its strong absorption of blue light and favourable safety profile. This systematic review aims to evaluate the efficacy of riboflavin-mediated PDT in periodontology, specifically examining its antimicrobial effects and potential to improve clinical outcomes compared to conventional or other PDT-based treatments. Methods: A systematic review was conducted following PRISMA guidelines. A comprehensive literature search was performed in PubMed/Medline, Embase, Scopus, and the Cochrane Library. Studies published in English within the last 10 years were considered, where riboflavin served as the primary photosensitizer for dental treatments. Data extraction focused on study design, photosensitizer concentration, light source parameters, and clinical or microbiological outcomes. The risk of bias was assessed independently by two reviewers using a predefined scoring system. Results: Ten studies met the inclusion criteria, all demonstrating a low risk of bias. Riboflavin-mediated PDT consistently reduced microbial biofilms and pathogen viability in periodontitis, peri-implantitis, and endodontic models. Although some studies reported slightly lower efficacy compared to chlorhexidine or toluidine blue–based PDT, riboflavin-mediated PDT exhibited advantages such as minimal staining, low cytotoxicity, and enhanced collagen crosslinking. However, most studies were in vitro or small-scale clinical trials, limiting conclusions on long-term effectiveness. Conclusions: Riboflavin-mediated PDT shows promise as a safe adjunctive therapy for periodontal infections. Larger, well-designed clinical trials with standardized parameters and extended follow-up are needed to further evaluate its efficacy and optimize treatment protocols for routine clinical application. Full article

Endodontic infection is a penetration of microorganisms into the dental pulp. Bacteria are the most common entities that induce an infection. This state is associated with significant pain and discomfort. Therapeutic intervention involves removal of infected pulp from the tooth and roots, which eliminates viable tissue, thus creating a tooth less resistant to mechanical pressure. Studies suggest that there are several types of bacteria most commonly associated with endodontic infections. Furthermore, it is considered that different types of pathogens could play a major role in primary and secondary endodontic infections. The aim of this review is to summarize major bacteria involved in the process of endodontic infection. Furthermore, we discuss the bacterial properties that allow them to penetrate dental pulp and hypothesize about possible future treatment strategies. Full article

Primary root canal infection is a dynamic process. All species of oral microbiota have comparable abilities to establish in the root canals of necrotic teeth. The essential ecological factors in their biological selection are nutrient availability, anaerobic environment and bacterial interactions. In chronic apical periodontitis, all selected microflora residing in the long-term infected habitat of root canals system are synergistic, and each of them can play the role of an endodontic pathogen. Microorganisms living in the root canal system of pulpless teeth progressively reach through anatomical communications to the periodontal ligament where, sooner or later, they cause the inflammatory and immunological conflict between the infection and the host. The insight into the complexity of the root canal microbiota is improved by the current pyrosequencing and next-generation sequencing diagnostic techniques, which allow the identification of multispecies of the microbiome and their targeted treatment. The insight into the complexity of root canal microbiota is improved by present diagnostic techniques of pyrosequencing and next generation sequencing, which allow the identification of multispecies of the microbiome and their targeted treatment. Full article

Dental students are frequently exposed to percutaneous injuries (PCIs) due to the nature of their clinical work, which involves sharp instruments and close patient contact. The COVID-19 pandemic further emphasized the need for stringent biosafety measures and the use of personal protective equipment (PPE). Despite these precautions, injuries remain prevalent, highlighting the need for comprehensive education and training in biosafety and infection control. This study investigates the incidence and causes of injuries among undergraduate dental students during clinical sessions. This study was conducted at the Department of Dentistry, National and Kapodistrian University of Athens, focusing on injuries reported from 2021 to 2024. Data were collected through self-reported clinical records. The primary variables assessed included the type of injury, the instrument involved, the clinical procedure performed, and the immediate actions taken post-injury. Serological testing was conducted on students and patients to assess the risk of the transmission of bloodborne pathogens. The findings reveal a high prevalence of injuries, with needles being the most common cause (51.4%), followed by other tools such as dental probes (25.7%) and burs (8.6%). The most frequent injury type is piercing (74.2%), primarily affecting the fingers (88.6%). Periodontal treatments, restorative procedures, and endodontic treatments are the main activities leading to injuries, with 17.1% of injuries being caused by each. No statistically significant results are recorded. Despite regular medical records for most patients treated by injured students, serological testing shows significant positivity rates for HCV and HBV. Notably, most injured students demonstrate their commitment to safety by adhering to recommended post-exposure protocols, including wound cleaning, disinfecting, and serological testing. Furthermore, the impact of COVID-19 heightened the importance of personal protective equipment (PPE) and reinforced occupational health standards. Our study highlights the critical need for enhanced biosafety awareness and training among undergraduate dental students to reduce injury risks. 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

Complex microbial communities have been reported to be involved in endodontic infections. The microorganisms invade the dental pulp leading to pulpitis and initiating pulp inflammation. Fusobacterium nucleatum is a dominant bacterium implicated in both primary and secondary endodontic infections. Drugs targeting the molecular machinery of F. nucleatum will minimize pulp infection. LpxA and LpxD are early acyltransferases involved in the formation of lipid A, a major component of bacterial membranes. The identification of leads which exhibit preference towards successive enzymes in a single pathway can also prevent the development of bacterial resistance. A stringent screening strategy utilizing physicochemical and pharmacokinetic parameters along with a virtual screening approach identified two compounds, Lomefloxacin and Enoxacin, with good binding affinity towards the early acyltransferases LpxA and LpxD. Lomefloxacin and Enoxacin, members of the fluoroquinolone antibiotic class, exhibit wide-ranging activity against diverse bacterial strains. Nevertheless, their effectiveness in the context of endodontic treatment requires further investigation. This study explored the potential of Lomefloxacin and Enoxacin to manage endodontic infections via computational analysis. Moreover, the compounds identified herein serve as a foundation for devising novel combinatorial libraries with enhanced efficacy for endodontic therapeutic strategies. Full article

We sought to evaluate the effect of endodontic-causative microorganisms of primary infections on mononuclear cells such as CD14⁺, CD4⁺, CD8⁺, CD19⁺ and Tregs Foxp3⁺. Facultative anaerobic microorganisms were isolated from radicular conducts and peripheral blood samples, which were taken from patients with primary infections. Cellular cultures were performed with peripheral blood mononuclear cells (PBMC) with and without Actinomyces spp. and Streptococcus spp. during 48, 72, and 96 h of contact in culture (concentration 5 × 10⁵ cells/well) in a round plate bound with 48 wells. Later, PBMC was collected for analysis by flow cytometry, with the monoclonal antibodies αCD14, αCD4, αCD8, αCD19 and αFoxp3, and acquired using an FACSCanto II cytometer. The supernatant of cellular cultures was analyzed for the quantification of inflammatory cytokines. Data analysis was performed in FlowJo v10.8.2 and FCAPArray software, and statistical analysis was performed using GraphPad v5.0. software. We observed an increase in the percentage of CD14⁺ cells in patients at different hours of cellular culture in the presence of both Actinomyces spp. and Streptococcus spp. microorganisms, compared to healthy controls. This study demonstrates the role played by the innate immune system in the pathogeny of endodontic primary infections, explaining the effects that generate the more common microorganisms in this oral pathology. Full article