Search Results (642)

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/Objectives: Temporomandibular disorders may influence the perception of odontogenic pain through shared trigeminal pathways and referred pain mechanisms. This study compared postoperative pain following root canal treatment (RCT) between patients with anterior disc displacement with reduction (ADDwR) and individuals without temporomandibular disorders. Methods: The study was registered at ClinicalTrials.gov (NCT07329413; 8 January 2026). Individuals with irreversible pulpitis and symptomatic apical periodontitis in a vital mandibular molar, with or without ADDwR according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), were included. After exclusions and losses to follow-up, 70 patients (35 per group) were analyzed. All RCTs were performed by one clinician using a standardized protocol. Postoperative pain was assessed using the Numeric Rating Scale at 6 and 12 h and on postoperative days 1, 2, 3, 5, and 7. Joint pain and maximum mouth opening were recorded preoperatively and on postoperative day 7, and their associations with postoperative pain were analyzed. Results: Patients with ADDwR reported significantly higher pain scores at 6 and 12 h compared with the comparison group (p < 0.05). Multivariable analyses showed that ADDwR, female gender, and age were independently associated with postoperative pain at specific time points (p < 0.05). Additionally, procedure duration was significantly longer in the ADDwR group than in the comparison group (p < 0.05). Conclusions: Patients with ADDwR reported higher levels of early postoperative pain following RCT than individuals without temporomandibular disorders. These findings suggest that temporomandibular conditions may influence postoperative pain perception and should be considered when evaluating postoperative pain complaints. Full article

The oral pathogen Filifactor alocis encodes a repeats-in-toxin (RTX) protein, FtxA, that is encoded by the ftxA gene; it is present in approximately 50% of known isolated strains from various infected oral sites, including periodontitis, peri-implantitis, and root canal infections. It has been determined from PCR assessment of periodontally diseased cohorts in Ghana and Australia. Based on current knowledge, ftxA appears to be associated with both the progress and severity of periodontitis. This finding could potentially be linked to enhanced levels of ftxA-positive F. alocis, relative to ftxA-negative strain, and/or, in addition, a synergy between ftxA-positive strains and other periodontal pathogens. The exact mechanism remains unclear but may depend on an FtxA-mediated shifting of the host cell response toward immunosuppression. The main objective of the present work was to evaluate the prevalence and loads of F. alocis and the presence of ftxA in subgingival plaque in patients recruited for periodontal treatment in Sweden. This observational study included all samples that were received from external clinics over one full year (n = 71 patients). Our findings revealed that F. alocis was carried by 49 (69%) of the individuals, with the prevalence of ftxA amounting to 42.9% (n = 21). In 32 of the 71 samples, F. alocis could be quantitatively assessed. In this sub-population of F. alocis-positive patients, high loads of the bacterium were not related to age, and high loads were more frequently observed upon carriage of ftxA. The presence of, and co-colonization with, F. alocis with four additional periodontal pathogens was also evaluated. F. alocis was notable in that it co-colonized with all of the other species. Moreover, it was detected alongside two and even three of the other species within the same sample. Full article

Background/Objectives: The aim of the present investigation was to validate the diagnostic performance of the AI-based dental cloud software Diagnocat^® AIS (Version 1.0 (UDI: 860010268018), DGNCT LLC, Miami, FL, USA) regarding the detection possibilities of seven different endodontic findings on cone-beam computed tomography (CBCT) against a multi-rater consensus reference standard, and to characterize its calibration, threshold-optimized performance and clinical utility. Methods: 358 root-canal-treated teeth from 167 CBCT scans (167 patients) were retrospectively evaluated at a single private dental practice. From initially included 383 root-canal-treated teeth from 177 patients, 358 (93.5%) were recognized by the AI tool and entered the primary analysis. Two experienced dentists with a clinical focus on endodontics independently graded each tooth and disagreements were adjudicated by a senior expert. Seven different endodontic findings were evaluated: (i) apical (periapical) lesion; (ii) short root-canal filling (apical filling end >2 mm short of the radiographic apex); (iii) voids/lacunae in the root-canal filling; (iv) missed (un-instrumented/un-filled) canal; (v) overfilled root-canal filling (apical extrusion); (vi) apicoectomy (resected root apex with or without retrograde filling); and (vii) coronal restoration with a full-coverage crown. Diagnocat^® output was binarized at the manufacturer-fixed 0.50 probability threshold; sensitivity, specificity, predictive values, accuracy, area under the curve AUC (ROC), Cohen κ and Gwet AC1 were computed with 95% cluster-bootstrap confidence intervals (cluster = scan). Threshold optimization, probability calibration, GEE-based subgroup analyses, and decision-curve analysis were pre-specified. Results: Diagnostic performance varied by finding. AUCs were 0.984 for missed canal, 0.917 for overfilled root canal, 0.902 for short root filling, 0.893 for crown, 0.864 for apical lesion, 0.857 for apicoectomy and 0.761 for voids in the root filling. Apical-lesion sensitivity rose from 33.6% for sub-millimeter lesions to ≥80% for lesion measuring 1–5 mm. Re-tuning the decision threshold raised missed-canal sensitivity from 69.6% to 97.5%. Decision-curve analysis confirmed positive benefits for missed canal and root-filling-quality findings. Conclusions: The AI tool Diagnocat^® can be recommended as a focused screening adjunct in CBCT-based endodontic interpretation for missed canals, crowns, and gross root-filling-quality flaws. Sub-millimeter apical lesions and several less common findings (resorption, instrument fragment, retrograde filling) remain outside the reliable performance envelope of the current platform. 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

Dental diseases have long been taught and treated as separate entities: cariology, operative dentistry, endodontics, and periodontology, each working within its own boundaries. However, increasing biological and clinical evidence suggests that this classified view does not fully reflect how disease progresses in the mouth. Instead, dental disease should be understood as a continuum within the interconnected tooth–pulp–periodontium complex. This review provides current evidence showing how dental caries can serve as the starting point of a process that can progress through pulpitis and apical periodontitis and eventually affect surrounding periodontal tissues. Caries is now widely known as a biofilm-driven and host-influenced condition shaped by ecological imbalance rather than specific pathogens alone. As lesions penetrate deeper into dentin, the structure becomes more permeable, permitting diffusion of microbial metabolites and signaling molecules toward the pulp. This initiates a multifaceted inflammatory reaction within the pulp tissue. At this stage, pulpitis becomes a critical turning point, where the outcome depends on microbial load, lesion activity, host response, and quality of clinical intervention. If the disease is not well controlled, it may lead to pulp necrosis, allowing infection to spread beyond the root canal and initiate periapical inflammation. Through anatomical pathways such as apical foramina and lateral canals, these processes can extend further, sometimes resembling or overlapping with periodontal disease. This overlap creates diagnostic challenges, as conventional tests may not always distinguish between conditions. A structured, pathway-based diagnostic approach is therefore essential. From a treatment perspective, this continuum model highlights early intervention, minimally invasive care, preservation of pulp vitality when possible, and maintenance of a strong coronal seal. Ultimately, stronger integration across dental disciplines can improve diagnosis, guide treatment decisions, support long-term tooth preservation, and promote unified dental education. This article presents a narrative review supported by a structured literature search and proposes a clinically actionable framework that extends established endodontic–periodontal concepts upstream to include caries initiation and restorative modulation. Full article

Occupational stress in dentistry, particularly during endodontic procedures, impacts practitioners’ health and performance. This study introduces a novel approach using real-time Heart Rate (HR) data from Apple Watch technology to assess physiological responses potentially indicative of occupational stress among endodontists. Materials and Methods: Twelve endodontists participated in this study, treating 119 patients. In a controlled clinical environment, HR was continuously monitored with the Apple Watch, and data were recorded via the Cardiogram app, capturing HR variations across treatment stages. Results: Significant HR fluctuations were observed during procedurally demanding stages such as local anesthesia and rubber dam placement. The endodontist’s HR, as a physiological proxy for stress, was significantly influenced by the treatment difficulty level, stage, and the patient’s age. Conclusions: Using Apple Watch technology, our study revealed significant HR variations during different endodontic treatment stages, suggesting fluctuating physiological responses that may reflect occupational stress. Elevated HR was noted during patient examination and rubber dam placement, particularly in complex cases. These preliminary findings suggest that HR monitoring via wearable technology may serve as a useful, albeit indirect, indicator of occupational stress during endodontic procedures. Future studies with larger samples and additional validated stress biomarkers are needed to confirm these observations. Full article

Introduction: Bite force is a key indicator of masticatory system function and is influenced by various biological and dental factors. Alterations in pulpal innervation and periodontal sensory feedback following root canal treatment (RCT) may affect force regulation during mastication. The aim of this study was to compare pain/discomfort-limited bite force threshold values between root canal-treated and untreated teeth using a digital bite force transducer (GM10). Methods: A total of 131 patients (48 males and 83 females) participated in the study. Bite force measurements were obtained from 447 teeth (248 with RCT and 199 without RCT). Participants were instructed to bite on a digital bite fork until discomfort or pain was experienced. Therefore, the recorded values represent a pain/discomfort-limited bite force threshold rather than true maximal voluntary bite force. Peak force was recorded in Newtons (N). The device was modified with a rubber tip and a protective cover to improve safety and patient comfort. Results: Teeth without RCT demonstrated significantly higher bite force values than root canal-treated teeth (245.39 N vs. 197.06 N, adjusted p = 0.0347). Male participants exhibited significantly higher bite force values than female participants (277.62 N vs. 186.96 N, adjusted p = 0.0016). In addition, molars demonstrated significantly higher bite force values than premolars (227.83 N vs. 202.75 N, adjusted p = 0.0347). Conclusions: Root canal-treated teeth demonstrated lower bite force values than untreated teeth. However, these findings should be interpreted cautiously because of potential confounding factors. Full article

The maxillary second premolar, while frequently single rooted, exhibits a high degree of morphological diversity in its internal canal system. This unpredictability can lead to clinical oversights if a simple anatomy is assumed. The aim of this study was to review current knowledge regarding the number of roots and root canal configurations in permanent maxillary second premolars across different populations. A comprehensive literature search was conducted using the PubMed database for studies published between 2015 and December 2025, with the keyword “maxillary second premolar anatomy.” Out of 358 identified articles, 27 studies met the inclusion criteria and were analyzed. Only human-based studies on maxillary second premolars that used CBCT imaging and were written in English were included. The reviewed studies revealed that single-rooted maxillary second premolars are the most prevalent morphology, occurring in over 70% of cases, although significant variations exist among different ethnic groups. The presence of two roots was the second most common configuration, while three-rooted teeth were rare (<2%). Gender-related differences were also observed, with a higher prevalence of two-rooted teeth in males. Analysis of root canal configurations based on Vertucci’s classification demonstrated that all eight types can occur, with Type I being the most frequent in most populations with a result of more than 50% of all teeth. However, substantial variability was noted, with certain studies reporting a higher prevalence of more complex configurations such as Types IV and V. The findings emphasize the importance of thorough knowledge of root canal anatomy and its variations to ensure successful endodontic outcomes. Advanced imaging techniques, particularly cone beam computed tomography (CBCT), play a crucial role in improving diagnostic accuracy and proper endodontic treatment. Further research is needed to better understand anatomical differences across populations and enhance clinical decision-making in endodontics. Full article

This study aimed to use intact mineral trioxide aggregate (MTA) as a root canal sealer by hydrophilizing the gutta-percha (GP) surface. The GP specimens were treated with atmospheric air plasma, cetylpyridinium chloride (CPC), or a combination of both. The wettability and surface chemical properties were evaluated using contact angle measurements and X-ray photoelectron spectroscopy (XPS). The physicochemical properties of MTA mixed with water or 100 mM of CPC solution were evaluated using setting time, flowability, compressive strength, and X-ray diffraction (XRD) analyses. Sealing ability was assessed by evaluating the dye penetration in obturated single-rooted teeth. Combined plasma and CPC treatment significantly decreased the contact angle of GP compared to that of the untreated group (p < 0.05) and showed the least hydrophobic recovery after 8 weeks. The XPS analysis confirmed the adsorption of CPC onto the GP surface. The XRD and compressive strength results indicated that the CPC did not interfere with the setting reaction of intact MTA, although the setting time was prolonged (p < 0.05). Dye penetration was significantly reduced in the plasma- and CPC-treated GP groups compared to the untreated GP group (p < 0.05), with a sealing ability comparable to that of the zinc oxide-based sealer. 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

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

Objectives: Commercial artificial teeth (AT) and three-dimensional printed teeth (3DPT) have been increasingly used in preclinical endodontic education; however, limitations regarding anatomical realism, tactile sensation, and procedural simulation continued to be reported. This study assessed students’ and evaluators’ perceptions regarding AT and PolyJet™ 3DPT fabricated with RGD525™, compared with natural teeth (NT), together with the quality of endodontic procedures performed using both artificial models. Methods: Undergraduate dental students with no previous experience using AT or 3DPT performed standardized endodontic procedures on both artificial models. Students and evaluators completed questionnaires regarding anatomical realism, tactile sensation, radiographic characteristics, educational applicability, and model preference. Procedural quality and errors were independently assessed radiographically by evaluators. Results: AT received more favorable perceptions regarding external anatomy, whereas 3DPT were more positively evaluated for internal anatomy, radiopacity, resistance of root canal walls and tactile sensation during instrumentation (p ≤ 0.002). NT remained the preferred training model, followed by 3DPT, while AT received the lowest preference ratings (p < 0.001). Evaluators consistently perceived 3DPT as more similar to NT than AT. Regarding treatment outcomes, 3DPT showed significantly higher scores for endodontic preparation, verifier fitting, and root canal filling (p < 0.05), while presenting significantly fewer procedural errors than AT (p < 0.001). Conclusions: PolyJet™ 3DPT fabricated with RGD525™ demonstrated promising applicability for preclinical endodontic training, combining favorable perceptions, fewer procedural errors, and potential for low-cost large-scale in-house production. Nevertheless, improvements in material realism and tactile simulation are still required. Full article

Apical perforation is a possible complication during root canal treatment, often caused by instrumentation beyond the working length, and requires prompt, precise sealing. In immature teeth needing endodontic therapy, the same principles used for managing apical perforations apply. Despite the widespread use of calcium silicate cement (CSC)-based materials, there is limited evidence comparing the sealing performance of putty-type CSCs and injectable bioceramic sealers in apical perforations under standardized laboratory conditions. This study aimed to compare the sealing ability of Retro-MTA cement and Endoseal MTA sealer in standardized apical perforations using the fluid-filtration method. In this in vitro study, 34 extracted human maxillary central incisors were used and divided into two groups. In Group 1, apical perforations were sealed with Retro-MTA and obturated using warm vertical compaction. In Group 2, perforations were sealed with Endoseal MTA and obturated using the single-cone technique. Micro-leakage was assessed using the fluid-filtration method. Data were analyzed with an independent t-test (α = 0.05). All samples exhibited leakage after two weeks. However, Retro-MTA demonstrated significantly lower micro-leakage than Endoseal MTA (0.265 vs. 0.473 μL/min/cmH₂O; p < 0.001), corresponding to approximately a 44% difference in leakage values between the two materials. The findings indicate that Retro-MTA provides a superior apical seal and lower leakage rates than Endoseal MTA. Therefore, Retro-MTA appears to be the more effective material for sealing apical perforations and managing open apices, potentially providing more stable apical seal under controlled laboratory conditions. Full article