Journal Of Endodontics[JOURNAL]
Sun
200 papers
Trends and Outcomes of Vital Pulp Therapy in Korea: A Nationwide Retrospective Cohort Study.
Song J, Kim E, Lee JK … +2 more , Kim S, Song M
J Endod · 2026 May · PMID 42140419 · Publisher ↗
INTRODUCTION: Vital pulp therapy (VPT) has gained increasing attention as a pulp-preserving treatment, particularly with advances in bioceramic materials and policy-driven reimbursement changes in Korea. However, real-wo...
INTRODUCTION: Vital pulp therapy (VPT) has gained increasing attention as a pulp-preserving treatment, particularly with advances in bioceramic materials and policy-driven reimbursement changes in Korea. However, real-world evidence regarding long-term utilization and outcomes is limited. This study investigated temporal trends in VPT utilization and evaluated 5-year survival outcomes in Korea using a nationwide insurance database. METHODS: A retrospective cohort study was conducted using Korean National Health Insurance Service claims data from 2003 to 2018. Teeth treated with pulp capping or pulpotomy were identified. Utilization trends before and after 2015 were analyzed. Five-year survival was assessed using Kaplan-Meier analysis, and prognostic factors were evaluated using log-rank tests and multivariable Cox proportional hazards regression models. RESULTS: A total of 1,638,422 teeth underwent VPT, including 1,090,501 pulp capping and 547,921 pulpotomy. Utilization increased markedly after 2015. Contrary to expectations, 5-year survival declined post-2015 for both pulp capping (from 87.58% to 82.73%) and pulpotomy (from 72.62% to 60.93%). Older age was associated with a higher failure risk for both procedures. Failure predominantly occurred early in follow-up, with a more pronounced long-term decline for pulpotomy. CONCLUSIONS: Despite increased VPT utilization following material advancements and reimbursement changes, long-term survival outcomes in Korea did not improve. These findings emphasize that accurate diagnosis and appropriate case selection remain more critical to VPT survival than material or procedural innovations, while also highlighting the key areas that endodontists should prioritize when educating general practitioners.
Cerebellar Abscess Caused by Rare Bacteria: A Case Report.
Kapsetaki ME, Susanto C, Theofanopoulos A … +6 more , Lazarioti S, Moustakis N, Trikkos A, Ntotsikas K, Giannopapas G, Tsitsipanis C
J Endod · 2026 May · PMID 42134536 · Publisher ↗
Rothia dentocariosa and Streptococcus intermedius are bacteria of the normal upper respiratory tract flora. To our knowledge, only 3 cases of a brain abscess due to R. dentocariosa have been reported. We present a 66-yea...
Rothia dentocariosa and Streptococcus intermedius are bacteria of the normal upper respiratory tract flora. To our knowledge, only 3 cases of a brain abscess due to R. dentocariosa have been reported. We present a 66-year-old man with a cerebellar abscess due to R. dentocariosa and S. intermedius. The patient had a gradual worsening of dizziness with imbalance and binocular diplopia during the 3 days before admission. Abnormal findings from the neurological examination were horizontal and circular positional nystagmus on right and left gaze, torsional vertical nystagmus on downward gaze, skew deviation with a slightly hypertropic right eye with cover-uncover correction, a slightly smaller right palpebral fissure, mild right limb ataxia in the upper (more than the lower) limbs, dysdiadochokinesia in the left upper limb, and dysmetria in the right lower limb. Magnetic resonance imaging showed a spherical lesion in the right cerebellar lobe with large surrounding edema. On the third day after admission, his temperature increased, and he had nausea and a delusional episode. A repeat computed tomography of the brain scan showed an increase in the surrounding edema. The patient underwent unilateral suboccipital craniectomy with drainage of the lesion. Based on culture results, the diagnosis was an abscess due to R. dentocariosa and S. intermedius. No source of infection was found. After surgery and a course of intravenous antibiotics, the patient's symptoms gradually improved. In conclusion, this is a rare case of a cerebellar abscess due to R. dentocariosa and S. intermedius.
Micro-CT Assessment of Hydraulic Calcium Silicate Cements for Perforating Internal Resorption in 3D-printed Tooth Replicas at Different Root Thirds: An In Vitro Study.
Torres-Carrillo AJS, Mazzi-Chaves JF, Creazzo G … +5 more , Salazar-Gamarra RE, Assis HC, Ordinola-Zapata R, Sousa-Neto MD, Lopes-Olhê FC
J Endod · 2026 May · PMID 42128278 · Publisher ↗
INTRODUCTION: Effective repair of perforating internal resorption (PIR) requires adequate defect filling; however, the influence of defect location on the filling ability of hydraulic calcium silicate cements (HCSCs) rem...
INTRODUCTION: Effective repair of perforating internal resorption (PIR) requires adequate defect filling; however, the influence of defect location on the filling ability of hydraulic calcium silicate cements (HCSCs) remains unclear. This micro-computed tomography (micro-CT) study evaluated Bio-C Repair (BCR), Biodentine (BD), and white MTA-Angelus (WMTA) in three dimensional-printed tooth replicas with PIR defects in different root thirds. The null hypothesis was that material performance would not differ according to defect location. METHODS: A maxillary central incisor was instrumented to size R50 and scanned by micro-CT. PIR defects were digitally created in the apical, middle, and cervical thirds. Ninety replicas were printed and distributed by defect location (n = 30) and HCSC type (n = 10). After obturation, scans quantified cement-filling and extrusion. Surface characteristics were assessed by confocal laser scanning microscopy. Data were analyzed with Welch's analysis of variance (ANOVA) with Games-Howell post hoc and Kruskal-Wallis tests (P < .05). RESULTS: In apical PIRs, WMTA achieved greater filling and sealing than BCR and BD (P < .05), including superior filling of the adjacent apical canal (P < .001). No differences were observed in the middle third (P > .05). In cervical PIRs, all materials showed high filling, although BD exhibited greater extrusion than WMTA (P < .01). BCR presented higher surface roughness in apical PIRs (P < .05). CONCLUSIONS: HCSC performance in PIR repair was influenced by defect location. WMTA demonstrated more predictable apical adaptation, whereas BD showed greater cervical extrusion under simulated periodontal conditions.
Delayed Apical Pathology during Trigeminal Postherpetic Neuralgia Managed with Antiviral-Antibiotic Therapy: A Case Report.
Ja WW
J Endod · 2026 May · PMID 42119845 · Publisher ↗
Postherpetic neuralgia (PHN) is a possible chronic sequela of trigeminal herpes zoster characterized by persistent neuropathic pain that can complicate odontogenic pain assessment. Little is known about potential associa...
Postherpetic neuralgia (PHN) is a possible chronic sequela of trigeminal herpes zoster characterized by persistent neuropathic pain that can complicate odontogenic pain assessment. Little is known about potential associations between zoster/PHN and periapical complications years after the acute episode, or whether such pathology might respond to conservative antiviral-antibiotic therapy. This case report describes a 40-year-old man with a childhood varicella history who developed trigeminal herpes zoster in the right mandibular division-preceded by prodromal odontalgia, followed by a vesicular rash, and mild PHN persisting thereafter. At age 46, despite no clinical symptoms in the affected region beyond stable PHN and no prior radiographic evidence of periapical abnormality, a new periapical radiolucency appeared at tooth #29 (Universal), while tooth #30 showed an area of altered opacity. Tooth #29 was nonresponsive to cold testing and was diagnosed with pulp necrosis with asymptomatic apical periodontitis, requiring endodontic treatment. In contrast, tooth #30 remained responsive to cold testing, indicating a vital pulp, but developed acute localized pain and gingival inflammation several weeks later; this resolved with valacyclovir-amoxicillin, and the tooth has remained radiographically stable for over 2 years without further intervention. This case illustrates successful conservative management of delayed apical pathology in chronic trigeminal PHN and the diagnostic challenge of distinguishing neuropathic from odontogenic pain. Future research should explore links between varicella-zoster virus reactivation/PHN and periapical disease, including PHN as a potential risk factor or marker.
Dens Invaginatus with Apical Periodontitis: A Case Series Illustrating Oehlers Classification-based Management and Genetic Insights.
Liu X, Ding M, Wang Y … +8 more , Wang K, Zhang J, Jin C, Xie Y, Zhang Y, Ding C, Liu L, Chen X
J Endod · 2026 May · PMID 42107637 · Publisher ↗
Dens invaginatus (DI), a developmental anomaly characterized by enamel organ invagination into the dental papilla, presents significant therapeutic challenges due to its complex anatomy. The treatment of DI necessitates...
Dens invaginatus (DI), a developmental anomaly characterized by enamel organ invagination into the dental papilla, presents significant therapeutic challenges due to its complex anatomy. The treatment of DI necessitates a comprehensive assessment of multiple factors, including invagination depth, periodontal status, and the severity of pulp-periapical disease. This case series integrates clinical management with genetic analysis to explore personalized strategies for DI with apical periodontitis. Three cases were managed according to Oehlers' classification. Case 1, a tooth with type IIIa DI with peri-invagination periodontitis received endodontic treatment of the invagination and successfully preserved pulp vitality of the true canal, resulting in sustained periapical bone healing improvement over 24 months. Case 2 and 3, two teeth with type II DI were treated with conventional nonsurgical root canal treatment, one of which subsequently required apical surgery. Both achieved complete periapical lesion healing at 12-month follow-up. Concurrently, whole-genome shotgun sequencing of a familial cohort presenting with concomitant DI and microdontia identified putatively relevant variants in several genes, with a notable variant in BCL11B, a gene associated with isolated microdontia. Additional variants in ANKRD26, NOTCH3, and PAX3 suggest a potential oligogenic contribution to this developmental anomaly. This case series provides a pragmatic clinical perspective for conservative, vital pulp therapy in select DI cases and offers preliminary genetic insights.
Cuproptosis in Endodontics: Potential Mechanisms and Therapeutic Applications.
Li YY, Tay F
J Endod · 2026 May · PMID 42106094 · Publisher ↗
INTRODUCTION: Cuproptosis is a recently identified copper-dependent form of regulated cell death that is distinct from apoptosis, pyroptosis, and ferroptosis. Its relevance to endodontic disease remains poorly understood...
INTRODUCTION: Cuproptosis is a recently identified copper-dependent form of regulated cell death that is distinct from apoptosis, pyroptosis, and ferroptosis. Its relevance to endodontic disease remains poorly understood despite increasing evidence that copper dyshomeostasis influences oxidative stress, mitochondrial dysfunction, and inflammatory tissue destruction. METHODS: A structured PubMed search was conducted up to April 27, 2026, using terms related to cuproptosis, copper, endodontics, pulpitis, and apical periodontitis. Original studies, reviews, and mechanistic reports relevant to the topic were included. Evidence from oncology, microbiology, and materials science was considered only when it had clear relevance to pulpal inflammation, apical periodontitis, endodontic infection, or copper-based therapeutic strategies. RESULTS: Cuproptosis occurs when excess copper binds lipoylated mitochondrial proteins and destabilizes iron-sulfur cluster proteins, causing proteotoxic stress and cell death. In pulpitis, oxidative stress, altered glutathione metabolism, and bacterial virulence factors may promote copper accumulation and cuproptosis in odontoblast lineage cells. Recent human pulpitis evidence confirms copper overload and cuproptosis activation. In periapical lesions, excess copper may intensify osteoclastogenesis and bone resorption through altered glycogen metabolism and pentose phosphate pathway activity. Copper-based materials may also induce cuproptosis-like bacterial death, suggesting potential antimicrobial value in endodontics. Therapeutic approaches include copper-regulating nanomaterials, ionophores, and microenvironment-responsive delivery systems, although toxicity, resistance, and biomarker validation remain concerns. CONCLUSIONS: Given the limited direct endodontic evidence, this conceptual framework suggests that cuproptosis may link copper dyshomeostasis with pulpal inflammation, periapical bone destruction, and bacterial killing. The biological role of cuproptosis warrants further investigation in endodontics.
Analysis of CD4+ and CD8+ T Lymphocytes and Expression of Immune Checkpoint Proteins (PD-1 and PD-L1) in Primary and Persistent Periapical Lesions.
Macêdo Filho RA, de Lima WP, Dos Santos CMB … +4 more , Goulart Filho JAV, Alves PM, Nonaka CFW, Gordón-Núñez MA
J Endod · 2026 May · PMID 42103079 · Publisher ↗
INTRODUCTION: Persistent periapical lesions (PePL) represent a clinical challenge because of their inadequate response to conventional endodontic therapies. Studies indicate differences in immunoinflammatory mechanisms b...
INTRODUCTION: Persistent periapical lesions (PePL) represent a clinical challenge because of their inadequate response to conventional endodontic therapies. Studies indicate differences in immunoinflammatory mechanisms between primary periapical lesions (PrPL) and PePL but the findings remain conflicting. This study aimed to evaluate CD4+ and CD8+ T lymphocytes and the expression of immune checkpoint proteins (programmed cell death protein 1 [PD-1] and its ligand [PD-L1]) in PrPL and PePL, correlating the findings with the intensity of the inflammatory infiltrate and pattern of the cystic epithelial lining. METHODS: Ten primary radicular cysts, 10 persistent radicular cysts (PeRC), 10 primary periapical granulomas (PrPG), and 10 persistent periapical granulomas were submitted to immunohistochemical analysis using anti-CD8, anti-CD4, anti-PD-1, and anti-PD-L1 antibodies. RESULTS: Higher median T lymphocyte counts were observed in PeRC when compared to the other groups, with a statistically significant difference in CD8+ T cells compared to PrPG (P < .05). Regarding PD-L1, PeRC exhibited higher median percentages of positivity in connective tissue and epithelial lining, which differed significantly from the other groups (P < .005). There were no statistically significant differences in the numbers of CD4+ or CD8+ T lymphocytes nor in the expression of PD-1 or PD-L1 according to morphologic parameters (P > .05). Immunoexpression of PD-L1 and CD4+ T lymphocyte count showed a positive correlation in PrPL (r = .592; P < .005) and PePL (r = .532; P < .05). In the latter, PD-L1 and CD8+ T lymphocyte count were also positively correlated (r = .690; P < .001). CONCLUSIONS: The results suggest the involvement of PD-1 and PD-L1 in the regulation of immunoinflammatory responses in PrPL and PePL. These immune checkpoint proteins may be particularly important for the suppression of CD4+ and CD8+ T lymphocyte activities in the periapical lesions studied, contributing to their chronicity.
Characterization and Evaluation of Biological Properties of Calcium Silicate Cement-based Sealers after Thermal Pretreatment.
Jang YE, Kim Y, Kim HI … +1 more , Oh HS
J Endod · 2026 May · PMID 42103078 · Publisher ↗
INTRODUCTION: Hydraulic calcium silicate cement-based sealers (CSC sealers) are now frequently used with warm vertical compaction in root canal treatment. However, the impact of heat on the biological properties of CSC s...
INTRODUCTION: Hydraulic calcium silicate cement-based sealers (CSC sealers) are now frequently used with warm vertical compaction in root canal treatment. However, the impact of heat on the biological properties of CSC sealers remains unclear. Therefore, this study investigated the effects of thermal pretreatment on the material characteristics, antimicrobial activity, and cytocompatibility of CSC sealers, assessed immediately after setting and after a 28-day post-setting maturation period. METHODS: An epoxy resin-based sealer (AH Plus) and 2 CSC sealers (AH Plus Bioceramic and BioRoot Flow) were evaluated. The sealers were heated to 100°C for 30 seconds and subsequently cooled to 37°C. Materials were characterized by field emission scanning electron microscopy, energy-dispersive spectroscopy, and X-ray diffraction analysis. The leaching profile, pH, surface roughness, and contact angles were also assessed. All tests were performed immediately after setting and after 28 days of post-setting maturation. The antimicrobial activity of freshly mixed and set sealers was assessed against 3-day Enterococcus faecalis biofilms by quantifying colony-forming units. The osteogenic cell line MC3T3-E1 was assessed with regard to cell viability and cell migration/proliferation following exposure to sealer leachates. Statistical analyses included one-way analysis of variance with Tukey's post hoc test for group comparisons and paired t-tests for temperature and post-setting maturation period, alongside nonparametric tests where appropriate (P < .05). RESULTS: Microstructural changes in the CSC sealers were observed after thermal pretreatment at 100°C. Calcium ion release significantly decreased in BioRoot Flow after thermal pretreatment (P < .05). Thermal pretreatment significantly increased antimicrobial activity in AH Plus Bioceramic after a 72-hour setting period (P < .05), whereas no significant change was observed in BioRoot Flow (P > .05). Regardless of thermal pretreatment, BioRoot Flow maintained its antimicrobial activity after 28 days of post-setting maturation. Both CSC sealers maintained alkalinity for up to 28 days. No significant differences were observed between the 100°C pretreated and 37°C control groups in cell viability or proliferation (P > .05). CONCLUSIONS: Thermally pretreated AH Plus Bioceramic and BioRoot Flow exhibited changes in microstructure and calcium ion release, which may affect early antimicrobial activity in a material-dependent manner, but did not influence cytocompatibility or alkalinity.
Insights Into the May 2026 Issue of the JOE.
Aminoshariae A, Azarpazhooh A, Glickman GN … +9 more , He J, Kim SG, Kishen A, Letra AM, Levin L, Ordinola-Zapata R, Setzer FC, Tay FR, Hargreaves KM
J Endod · 2026 May · PMID 42067233 · Publisher ↗
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Referral Patterns and Professional Perceptions of Referring Dentists and Endodontists.
Karia P, Hong HY, Kim JR
J Endod · 2026 Apr · PMID 42067055 · Publisher ↗
INTRODUCTION: The professional relationship between general practitioners and endodontists is essential for high-quality patient care. The purpose of this study was to provide a dual-perspective evaluation of the referra...
INTRODUCTION: The professional relationship between general practitioners and endodontists is essential for high-quality patient care. The purpose of this study was to provide a dual-perspective evaluation of the referral patterns and professional perceptions held by both referring dentists (RDs) and endodontists (EDs) to identify modern barriers to effective collaboration. METHODS: An anonymous 22-item online survey was distributed to EDs and RDs through professional networks and social media. The questionnaire addressed demographics, clinical workflows, and professional perceptions. Data were analyzed using Pearson chi-squared tests and binary logistic regression (P < .05). RESULTS: A total of 1,352 responses were analyzed (793 EDs, 559 RDs). Clinical procedural problems were the primary driver for referral for both RDs (47.2%) and EDs (50.7%). However, significant perceptual gaps were identified: 30% of RDs believed restorability assessment was primarily the endodontist's responsibility, compared to 20.6% of EDs (P < .05). Although RDs reported high satisfaction with specialist reports, 44.2% of EDs found referral letters inadequate more than 30% of the time. While both groups prioritized phone communication for relationship maintenance (RD: 51.4%; ED: 25.7%), EDs placed a significantly higher value on personal office visits (18.2%) than RDs (7.4%). Relationship termination also differed, with RDs most commonly citing patient dissatisfaction (30.7%) and EDs citing divergent treatment philosophy (40.0%) as the primary reasons for discontinuing referral. CONCLUSIONS: The RD-ED referral pathway is characterized by shared clinical goals but significant discrepancies in documentation expectations and responsibility for restorability. Implementing standardized referral templates and improving bidirectional communication of restorative intent are essential for reducing professional friction and enhancing the continuity of patient care.
Assessment of Inflammatory Cytokines in Molar Incisor Hypomineralization-affected First Permanent Molars: A Clinical Study.
Sahin S, Oktay NS, Caliskan S … +2 more , Kargul B, Sen Yavuz B
J Endod · 2026 Apr · PMID 42067054 · Publisher ↗
INTRODUCTION: Molar incisor hypomineralization is a developmental enamel defect that weakens tooth structure, increasing susceptibility to caries, hypersensitivity, and treatment challenges. This study aimed to evaluate...
INTRODUCTION: Molar incisor hypomineralization is a developmental enamel defect that weakens tooth structure, increasing susceptibility to caries, hypersensitivity, and treatment challenges. This study aimed to evaluate pro- and anti-inflammatory cytokine levels in the pulp of molar incisor hypomineralization-affected and nonmolar incisor hypomineralization (MIH) first permanent molars. METHODS: This study analyzed pulpal inflammatory mediator levels in blood samples collected from 85 first permanent molars (38 (44.7%) with MIH and 47 (55.3%) without) requiring pulp treatment in systemically healthy children aged 8-13 years. During routine treatment, sterile cotton pellets were placed on the pulp exposure site for approximately 1 minute to obtain samples. Based on clinical findings and bleeding time, teeth were classified as reversible pulpitis, symptomatic or asymptomatic irreversible pulpitis. Clinical assessment included the Schiff cold air sensitivity score, periapical index and cold test. The collected samples were stored in lithium heparin-coated tubes at -70 °C, and the levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-4, IL-6, IL-8, IL-10, IL-13, matrix metalloproteinase (MMP)-3, MMP-8, and MMP-9 were analyzed using the enzyme-linked immunosorbent assay method. RESULTS: In the molar incisor hypomineralization group, 18 (47.4%) teeth had reversible pulpitis, 8 (21%) symptomatic, and 12 (31.6%) asymptomatic irreversible pulpitis; corresponding numbers in the non-MIH group were 20 (42.6%), 11 (23.4%), and 16 (34%), respectively. Molar incisor hypomineralization-affected molars showed higher TNF-α, IL-4, IL-13, MMP-3, and MMP-8 levels than non-MIHs (P< .05). Subgroup analyses demonstrated that inflammatory marker levels were higher, particularly in MIH-related pulpitis subgroups (P< .05). These differences were mainly observed in biomarkers such as IL-4, IL-13, and MMP-8. Tooth maturity showed no overall differences, though IL-4 was higher in immature MIH teeth (P< .05). CONCLUSION: Elevated cytokine levels in molar incisor hypomineralization-affected teeth suggest severe pulp inflammation (TNF-α), a strong anti-inflammatory response (IL-4, IL-13), and inflammation-related tissue destruction (MMP-3, MMP-8), potentially leading to subclinical inflammation and increased pulpal damage.
Effect of Root Canal Irrigants on the Microbial Viability and Matrix Composition of Young and Mature Polymicrobial Biofilms.
Vishwanath V, Pudipeddi A, Neelakantan P
J Endod · 2026 Apr · PMID 42061703 · Publisher ↗
INTRODUCTION: Disinfection is critical for regenerative endodontic procedures, yet the antibiofilm activity of root canal irrigants remains poorly characterized. This study investigated the effects of sodium hypochlorite...
INTRODUCTION: Disinfection is critical for regenerative endodontic procedures, yet the antibiofilm activity of root canal irrigants remains poorly characterized. This study investigated the effects of sodium hypochlorite (NaOCl) (1, 3, and 6%) and chlorhexidine (CHX) (2%) on biofilm viability and extracellular matrix composition. METHODS: Multispecies biofilms were developed for 7 or 21 days and treated with CHX or NaOCl. Untreated biofilms served as controls. Biofilms were subject to multimodal assessment including (1) quantification of bacterial viability, (2) characterization of three-dimensional architecture, and (3) quantification of extracellular matrix composition using a selective fluorescence-binding assay and confocal microscopy. Data were statistically analyzed by 2-way analysis of variance (ANOVA) and Tukey multiple comparisons test, with significance set at P< .05. RESULTS: Both NaOCl and CHX significantly reduced biofilm bacterial viability compared to the untreated control in 7-day old biofilms (P< .05), with no significant difference between any NaOCl concentration and CHX (P> .05). However, against 21-day biofilms, all NaOCl concentrations killed significantly more bacteria than CHX (P< .05). All NaOCl concentrations significantly reduced biovolume compared to 2% CHX in young biofilms (P< .05), whereas only 3% and 6% NaOCl achieved greater reductions than CHX in mature biofilms (P< .05). All NaOCl concentrations significantly outperformed CHX in reducing eDNA and exopolysaccharide levels at both timepoints (P< .05). CONCLUSION: CHX exhibited limited antibiofilm activity against mature biofilms, while 3 and 6% NaOCl achieved superior bacterial killing and matrix disruption compared to 1% NaOCl and CHX both in mature biofilms.
Effect of Intracanal Medications on Cell Adhesion, Viability, and Differentiation During Regenerative Endodontic Procedures: A Systematic Review of In Vitro Studies.
Braido A, Cardim LC, Matta ACG … +5 more , Silvério KG, Gabriel PH, Martins EA, de Jesus Soares A, Vieira WA
J Endod · 2026 Apr · PMID 42061702 · Publisher ↗
INTRODUCTION: Intracanal medications used during regenerative endodontic procedures may influence the biological behavior of stem cells through changes in the dentin microenvironment. Understanding these effects is essen...
INTRODUCTION: Intracanal medications used during regenerative endodontic procedures may influence the biological behavior of stem cells through changes in the dentin microenvironment. Understanding these effects is essential for optimizing regenerative outcomes. OBJECTIVE: This systematic review aimed to answer the following PICO (Population, Intervention, Comparison, Outcome, and Study design) question: Does dentin conditioning with different intracanal medications alter the adhesion, migration, and differentiation of undifferentiated cells during regenerative endodontic therapy? METHODS: A comprehensive search was performed in PubMed, Embase, Scopus, LILACS, and Web of Science up to May 2025. Gray literature was screened through Google Scholar and ProQuest. In vitro studies evaluating the effects of dentin conditioning with intracanal medications on cell behavior (proliferation, adhesion, migration, and differentiation) were included. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment using the RoBDEMAT tool. Data were qualitatively synthesized. RESULTS: From 2620 retrieved records, 12 studies fulfilled the eligibility criteria. Most studies used human root dentin as a substrate and tested calcium hydroxide-based formulations, triple antibiotic paste, or double antibiotic paste; others evaluated silver nanoparticles, calcium hypochlorite, Bio-C Temp, or antibiotic-containing fibers. Dental pulp stem cells were most frequently used, followed by apical papilla, deciduous tooth, and periodontal ligament stem cells. Conditioning times ranged from 7 to 28 days. Calcium hydroxide showed the most favorable outcomes for cell adhesion, morphology, and proliferation. Lower antibiotic concentrations (1 mg/mL) demonstrated acceptable biocompatibility. Only one study assessed cell differentiation, showing increased dentin matrix protein-1 and DSPP expression after calcium hydroxide conditioning; none evaluated cell migration. CONCLUSIONS: Calcium hydroxide exhibited the most consistent and favorable biological responses. Triple antibiotic paste and double antibiotic paste showed concentration-dependent cytotoxicity; however, more robust evidence is needed to clarify how intracanal medications influence cell behavior on conditioned dentin.
Long-term Outcomes of Predoctoral Root Canal Therapy: Retreatment and Tooth Loss in a 17-year Institutional Cohort.
Baghaie F, Kashani N, Baghaie FK
J Endod · 2026 Jul · PMID 42019677 · Publisher ↗
INTRODUCTION: Nonsurgical root canal therapy (RCT) is predictable; however, some teeth develop post-treatment disease requiring retreatment or extraction. This study evaluated the durability of predoctoral RCT by quantif...
INTRODUCTION: Nonsurgical root canal therapy (RCT) is predictable; however, some teeth develop post-treatment disease requiring retreatment or extraction. This study evaluated the durability of predoctoral RCT by quantifying retreatment and tooth loss within a single institutional cohort. METHODS: This retrospective chart review used Axium records from January 1, 2008, through October 31, 2025. All nonsurgical RCTs in the predoctoral clinic (n = 7,340) were identified. Phase I quantified retreatment frequency. Phase II characterized retreated teeth by diagnosis, radiographic quality, intracoronal core placement, restoration status, and timing. Phase III linked RCTs to extraction codes to assess tooth loss and time-to-event patterns. Descriptive statistics, Kaplan-Meier analyses, and an exploratory two-by-two analysis of retreatments attributed to suspected coronal leakage and restoration status were performed. RESULTS: Of 7,340 RCTs, 131 teeth underwent retreatment (1.78%) and 531 were extracted (7.23%), yielding a 9.02% combined adverse outcome rate. Retreatment occurred at a median of 1.21 years and was most commonly attributed to suspected coronal leakage, obturation deficiencies, and missed canals. Teeth without documented intracoronal core placement demonstrated earlier retreatment and higher odds of retreatment attributed to suspected coronal leakage without definitive restoration (odds ratio 1.98; 95% confidence interval 0.99-3.97). Extractions occurred at a median of 2.10 years, with no survival differences among tooth types. CONCLUSION: Retreatment after predoctoral RCT was uncommon, whereas extraction occurred more frequently. Early retreatments and later extractions represent distinct endpoints, emphasizing durable coronal sealing and timely definitive restoration for long-term tooth retention.
Artificial Intelligence-assisted Periapical Radiographic Assessment: Lesion Detection, Endodontic Complication Analysis, and Review of Clinical Treatment Recommendations.
Akyüz İE, Kıvırcık BE, Aslan T
J Endod · 2026 Jul · PMID 42019676 · Publisher ↗
INTRODUCTION: Artificial intelligence (AI) systems are increasingly used in dental radiology to support endodontic diagnosis. However, their diagnostic reliability across different clinical categories remains unclear. Th...
INTRODUCTION: Artificial intelligence (AI) systems are increasingly used in dental radiology to support endodontic diagnosis. However, their diagnostic reliability across different clinical categories remains unclear. This study compared 3 vision-language AI models (ChatGPT-5 Plus, Gemini 2.5 Pro, and Copilot Pro) with expert endodontists by assessing sensitivity, specificity, overall diagnostic agreement, and Youden's Index across multiple endodontic conditions. METHODS: This retrospective diagnostic accuracy study evaluated the relationship between periapical radiographs and treatment decisions, procedural complications, and lesion detection. Expert endodontists served as the gold standard of reference. Diagnostic categories included primary treatment selection, nonsurgical retreatment, final treatment decisions, perforation, underfilling, overfilling, broken file, calcification, and periapical lesion detection. RESULTS: There was an almost perfect agreement between the endodontists (κ = 0.95). Gemini 2.5 Pro demonstrated the highest diagnostic accuracy, particularly in periapical lesion detection (sensitivity 100%, specificity 88%), while ChatGPT-5 Plus showed similarly strong performance in treatment selection. Copilot Pro exhibited markedly low sensitivity for complications such as perforation and instrument fracture. Kappa values for preoperative and postoperative treatment decisions were high for Gemini and ChatGPT-5 Plus, but low for Copilot Pro. The Friedman test confirmed significant differences among the groups (P < .001). CONCLUSIONS: AI systems demonstrated promising diagnostic accuracy in treatment selection tasks and lesion detection, but performed less reliably in identifying complex procedural complications. Gemini 2.5 Pro showed the most balanced performance, whereas Copilot Pro displayed the highest variability across diagnostic categories.
Comparative Evaluation of Postoperative Pain and Clinical Success Following Rotary and Reciprocating Instrumentation in Teeth with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial.
Deniz İ, Kaval ME, Hülsmann M … +1 more , Kandemir Demirci G
J Endod · 2026 Jul · PMID 41997302 · Publisher ↗
INTRODUCTION: The aim of this study was to evaluate the clinical success rate and the effects of different root canal shaping systems (hand files, reciprocating, and rotary) on postoperative pain in patients with symptom...
INTRODUCTION: The aim of this study was to evaluate the clinical success rate and the effects of different root canal shaping systems (hand files, reciprocating, and rotary) on postoperative pain in patients with symptomatic irreversible pulpitis (SIP) in vital mandibular molars. METHODS: A total of 63 patients with a Numerical Rating Scale pain score ≥7 and SIP in mandibular first or second molars were included. Patients were randomly divided into 3 groups (n = 21) and root canal shaping was performed using reciprocating or rotary files; preparation using hand files served as the control. Irrigation was performed using sodium hypochlorite and EDTA, calcium hydroxide was used for temporary medication. In all cases, obturation was completed using AH Plus Bioceramic sealer in a second appointment one week later. Postoperative pain was assessed using the Numerical Rating Scale at 6, 12, and 24 hours after the emergency appointment, and on days 2 through 7 and day 30, postoperatively. Clinical success was evaluated clinically and radiographically after 6 and 12 months. RESULTS: Although the postoperative pain decreased over time in all groups (P < .05), it did not differ significantly between the groups (P > .05). Despite the lack of significance, the hand file group reported higher pain levels at most follow-up intervals. Clinical success was 96.8% at 6 months and 85.7% at 12 months, respectively, with a significant correlation observed between the level of root canal filling and treatment success at 12 months (P < .05). No significant difference between the instrument systems in terms of success was observed. CONCLUSIONS: In symptomatic and severely painful vital teeth, the hand files, reciprocating and rotary systems showed comparable levels of postoperative pain.
Association of Occlusal Morphology with Cracked Teeth: A 3D Morphometric Comparative Clinical Study.
Deng J, Wang H, Pan Z … +7 more , Lin W, Huang Y, Gao M, Yue L, Wang X, Lin F, Ordinola-Zapata R
J Endod · 2026 Jul · PMID 41997301 · Publisher ↗
INTRODUCTION: Tooth morphology may predispose tooth cracking, yet evidence linking occlusal morphology to cracked molars remains limited. This study aimed to investigate the association between them, to establish referen...
INTRODUCTION: Tooth morphology may predispose tooth cracking, yet evidence linking occlusal morphology to cracked molars remains limited. This study aimed to investigate the association between them, to establish reference intervals for early risk detection and management of cracked teeth. METHODS: Eighty-three cracked molars (68 patients) and 83 matched controls (69 volunteers) were analyzed. Occlusal morphologies (functional/nonfunctional cuspal inclination/height/slope) were measured using intraoral scans (Trios, 3Shape, Denmark) and analyzed using 3D digital design software. The crack initiation side (CIS) and propagation side (CPS) of crack lines were identified. Paired t-tests were used to compare the differences between groups. Multivariate logistic regression was used to assess correlations between occlusal morphology and cracked molars. RESULTS: Maxillary cracked molars exhibited steeper functional cuspal inclinations (CIS: [31.87 ± 7.72]°, CPS: [29.03 ± 7.50]°) than controls ([26.01 ± 7.01]°, [25.61 ± 7.47]°, P < .05), with 4°-6° differences. Mandibular cracked molars showed steeper inclinations only in functional cusps on CIS ([30.79 ± 7.89]° vs [24.53 ± 6.97]°, P < .05). Functional cuspal heights were 0.2-0.4 mm higher in cracked teeth than in controls for both arches (P < .05). Cracked molars exhibited flatter functional cusp slopes. Multivariate analysis identified CIS inclination (OR 1.098) and CPS height (OR 3.407) of functional cusps as maxillary risk factors; CIS functional cuspal height (OR 8.177) showed the highest risk for mandibular cracked molars. CONCLUSIONS: Within the limitations of this study, specific occlusal morphologies were correlated with cracked teeth. The identification of an excessively steep or high functional cusp in a molar warrants a thorough examination for crack lines. Morphology-guided occlusal adjustments should be considered in the treatment of cracked molars.
Endodontic Implications of Medication-Related Osteonecrosis of the Jaw.
AAE Committee on Practice Affairs
J Endod · 2026 Apr · PMID 41985837 · Publisher ↗
Abstract loading — click title to view on PubMed.
National Trends in Child and Adult Medicaid Coverage and Reimbursement for Endodontic Procedures.
Burns LE, Wang L
J Endod · 2026 Apr · PMID 41967636 · Publisher ↗
INTRODUCTION: Medicaid is the largest source of health coverage in the United States and provides dental benefits to eligible low-income families. Federal policies establish minimum dental service requirements for childr...
INTRODUCTION: Medicaid is the largest source of health coverage in the United States and provides dental benefits to eligible low-income families. Federal policies establish minimum dental service requirements for children, while states have flexibility regarding the coverage of dental services for adults in any capacity. The objective of this study was to evaluate endodontic procedure coverage, reimbursement, and dentist participation for Medicaid beneficiaries. METHODS: This retrospective, cross-sectional study evaluated child and adult dental Medicaid benefits in 2021. For children, 18 endodontic procedure codes were evaluated; 16 were evaluated for adults. Mapping was used to depict state-level coverage of procedures. Logistic regression analyses were conducted to evaluate the odds of procedural coverage. RESULTS: For children and adults, initial root canal therapy was the most routinely covered endodontic procedure category; and molar teeth were the least likely tooth type to be covered. States were more likely to have established payment policies for vital pulp therapy procedures for children than for adults. For children and adults, geographic region was significantly associated with Medicaid coverage of endodontic procedures. Endodontic procedure reimbursement rates ranged from $7.00 to $1113.87 (median, $251.00). Overall, adult procedures tended to have lower reimbursement rates than child procedures at the category level but had a higher overall median reimbursement rate. Median endodontist participation for child dental services was 24%. CONCLUSIONS: Gaps in endodontic coverage exist for Medicaid beneficiaries. Endodontic treatments for molar teeth, vital pulp therapy, and regenerative endodontic procedures are the least consistently covered.
External Cervical Resorption Treatment: Case Report and Outcome-based Strategies.
Pannkuk TF
J Endod · 2026 Jul · PMID 41967635 · Publisher ↗
External cervical resorption (ECR) is a complex dental condition that is traditionally treated with external surgical repair and nonsurgical root canal therapy as needed. This case report describes a patient with 8 teeth...
External cervical resorption (ECR) is a complex dental condition that is traditionally treated with external surgical repair and nonsurgical root canal therapy as needed. This case report describes a patient with 8 teeth treated for ECR. Follow-up examination and management strategies are described, using microscopic techniques, three-dimensional imaging, and bioactive root filling materials. The chosen techniques were based on the severity of ECR, root location, defect geometry, and management of the portals of entry. Access to the external resorption defect was achieved through the root canal system, while considering the potential need for later external surgical repair. Materials were chosen for root filling and defect repair based on viscosity, bioactivity, physical strength, and handling properties. The treatment protocol included multiple visits to ensure definitive lesion debridement, root sealing, and material setting. The case highlights stable healing in different types of ECR defects. From a restorative perspective, posts were considered undesirable, because they could interfere with bioactive material placement, particularly in cases where later revision is required. This case supports a systematic treatment approach for saving teeth with ECR that were previously considered candidates for extraction.
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