Journal Of Endodontics[JOURNAL]
Sun
200 papers
Evaluation of Organic Debris Removal by 2 Irrigant Activation Systems using a Novel Chairside Quantitative Assay.
Kennelly S, Lin D, Aksel H … +2 more , Ratakonda M, Vera J
J Endod · 2026 Jun · PMID 41765174 · Publisher ↗
INTRODUCTION: This study aimed to investigate a novel quantitative adenosine triphosphate assay, to evaluate organic debris/bacterial reduction after irrigation activation with passive ultrasonic irrigation and the XP-en...
INTRODUCTION: This study aimed to investigate a novel quantitative adenosine triphosphate assay, to evaluate organic debris/bacterial reduction after irrigation activation with passive ultrasonic irrigation and the XP-endo Finisher (XPF), and to compare its efficacy with traditional colony-forming unit (CFU) detection in vitro. METHODS: The root canals of 40 extracted single-canal teeth were shaped to a 30.04 using NiTi files. Following inoculation of the root canals with Enterococcus faecalis for 3 weeks, the teeth were randomly allocated into 2 experimental groups (n = 20): (1) activation of 5.25% NaOCl using passive ultrasonic irrigation, or (2) activation using the XPF. The quantitative adenosine triphosphate assay (Endocator) was used before and after the irrigant activation protocols to determine the amount of bacteria/organic debris present. Data were analyzed using the Student t test and the Mann-Whitney U test (P = .05). RESULTS: The Endocator raw score exhibited a strong correlation with the number of bacteria present, as determined by CFU counts (R = 0.99). In contrast, Endoscore values showed a high correlation with the logarithmically transformed CFU counts (R = 0.95). The amount of intracanal organic debris/bacteria remaining after the passive ultrasonic irrigation and XPF protocols was approximately 1.7% and 1.2%, respectively. No statistically significant differences were observed between the groups regarding the amount of residual bacteria remaining in the canals after the irrigation protocols (P > .05). CONCLUSION: Both irrigation activation systems were similarly effective in removing organic debris/bacteria from the root canal system following final irrigation. None of the tooth samples was completely free of bacterial or organic debris residues after treatment with either of the tested systems.
Regenerative Endodontic Procedures: Mapping and Critical Appraisal of Clinical Trial Evidence.
Nunes FO, Sollim EB, Dos Santos CF … +6 more , Ferreira MKM, Moura JDM, Brandão JM, Sousa-Neto MD, Palma PJ, Lima RR
J Endod · 2026 Jul · PMID 41765173 · Publisher ↗
INTRODUCTION: Regenerative endodontic procedures (REPs) are biologically based approaches aimed at restoring the vitality of immature teeth with pulp necrosis. Over the past decades, these procedures have gained increasi...
INTRODUCTION: Regenerative endodontic procedures (REPs) are biologically based approaches aimed at restoring the vitality of immature teeth with pulp necrosis. Over the past decades, these procedures have gained increasing attention. This study mapped and critically appraised the clinical trial evidence on REPs, providing an overview of research trends and methodological characteristics. METHODOLOGY: A comprehensive bibliometric analysis was conducted following Bibliometric Reviews of the Biomedical Literature guidelines using the Web of Science Core Collection database. Randomized and nonrandomized clinical trials available in the database up to 2025 were included, covering the full period of indexed clinical evidence on REPs. Quantitative variables (citations, countries, journals, and keywords) and qualitative aspects (techniques, materials, irrigants, intracanal medications, and barriers) were analyzed. RESULTS: Among the 6,287 retrieved records, 58 clinical studies met the inclusion criteria. The most productive authors were De-Jesus-Soares A, Gomes BPFA, Kang J, Nazzal H, and Elheeny AAH. The most cited author was Xuan K, with 346 citations. Asia was the most productive continent, and the Journal of Endodontics published the highest number of studies. The most frequent keywords were regenerative endodontics, revascularization, and immature teeth. Blood clot induction was the predominant regenerative technique, while sodium hypochlorite, triple antibiotic paste, and mineral trioxide aggregate were the most commonly used irrigant, intracanal medication, and barrier material, respectively. CONCLUSIONS: Clinical evidence on REPs suggests a consolidation of biologically based strategies, particularly blood clot induction with mineral trioxide aggregate barriers. However, methodological heterogeneity limits the strength and comparability of findings, highlighting the need for standardized protocols and long-term randomized studies.
Artificial Intelligence Chatbots Taking American Board of Endodontics Simulated Oral Board Examination.
Jalali P, Wang FM, Ourang SA … +3 more , Zahedrozegar S, Mohammad-Rahimi H, Nosrat A
J Endod · 2026 Jul · PMID 41759779 · Publisher ↗
INTRODUCTION: The aim of this study was to assess the overall performance of artificial intelligence (AI) chatbots in taking the American Board of Endodontics simulated Oral Board Examination. METHODS: Three oral board c...
INTRODUCTION: The aim of this study was to assess the overall performance of artificial intelligence (AI) chatbots in taking the American Board of Endodontics simulated Oral Board Examination. METHODS: Three oral board cases were constructed by 2 academic board-certified endodontists. Each case included a comprehensive patient profile consisting of medical history, dental history, and results of clinical testing, followed by 20 consecutive open-ended oral board-style questions. Two publicly accessible AI chatbots were selected to take the exam: GPT-4o and Gemini-2.5 Pro. Responses were scored based on a comprehensive rubric on a 4-point ordinal scale (0-3) by the same 2 examiners independently: response validity, citation validity, and overall performance score. A Cumulative Link Mixed Model (proportional odds) was used with fixed effects for chatbot and case, and random intercepts for reviewer and question to analyze and compare the performance of models, that is, inter- and intra-chatbot comparisons. RESULTS: Gemini-2.5 Pro and GPT-4o achieved high mean overall performance scores of 2.83 (±0.42) and 2.73 (±0.51), respectively. Cumulative Link Mixed Model showed no significant difference between the 2 chatbots in probability of receiving an excellent score (ie, 3) in response validity (odds ratio = 2.44, 95% confidence interval [0.98-6.06], P = .054) or in overall performance (odds ratio = 2.04, 95% confidence interval 0.97-4.30, P = .061). There was a positive correlation between response validity and citation validity for GPT-4o (ρ = 0.21, P = .019). CONCLUSIONS: Both chatbots scored considerably high in the simulated American Board of Endodontics Oral Board Examination. Results of this study support the concept of using AI chatbots as aid in endodontic education.
Online Postoperative Instructions After Nonsurgical Root Canal Treatment: Readability, Usability, and Transparency.
Boroumand T, Sabeti MA
J Endod · 2026 Jun · PMID 41759778 · Publisher ↗
INTRODUCTION: Postoperative recovery after root canal treatment (RCT) relies on patients' ability to interpret instructions. However, the readability, usability, and transparency of online postoperative instructions for...
INTRODUCTION: Postoperative recovery after root canal treatment (RCT) relies on patients' ability to interpret instructions. However, the readability, usability, and transparency of online postoperative instructions for nonsurgical RCT are unclear. This study evaluated their readability, understandability, actionability, and transparency using a standardized Google search. METHODS: We performed a cross-sectional analysis of online postoperative instructions for nonsurgical RCT from the first 100 Google search results. Readability was assessed using four grade-level formulas and summarized as an Average Grade Level (AGL). Understandability and actionability were evaluated using the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P), and transparency was assessed against Journal of the American Medical Association benchmarks. Outcomes were compared with recommended thresholds and between practice types. RESULTS: Sixty-three webpages met inclusion criteria. Mean AGL was 11.49; no webpage met the recommended sixth-grade reading level. Endodontic practice webpages were less readable than general practice webpages (AGL 11.82 vs 11.16; P = .022). Mean PEMAT-P understandability and actionability were 74.34% and 60.16%; 47/63 webpages (75%) met the understandability benchmark, but 7 (11%) met the actionability benchmark. Readability was not correlated with PEMAT-P scores. Journal of the American Medical Association transparency scores were low; most webpages met only one criterion, and none met all four. CONCLUSIONS: Online postoperative instructions for nonsurgical RCT require reading levels above recommended targets, offer limited actionable information, and lack transparency. Endodontic practice webpages are less readable than general practice webpages, yet they do not provide better understandability, actionability, or transparency. These findings highlight the need for guideline-based, low-literacy, actionable postoperative instructions.
Long-term Survival and Outcomes of Direct Pulp Capping with Bioceramic iRoot BP Plus in Symptomatic Irreversible Pulpitis.
Lv H, Li Y, Cui H
J Endod · 2026 Jun · PMID 41748067 · Publisher ↗
OBJECTIVE: To evaluate the long-term efficacy and safety of the bioceramic material iRoot BP Plus compared with mineral trioxide aggregate (MTA) in direct pulp capping for symptomatic irreversible pulpitis (SIP). METHODS...
OBJECTIVE: To evaluate the long-term efficacy and safety of the bioceramic material iRoot BP Plus compared with mineral trioxide aggregate (MTA) in direct pulp capping for symptomatic irreversible pulpitis (SIP). METHODS: A single-center retrospective cohort study was conducted, including SIP patients who underwent direct pulp capping between January 2016 and December 2020, with a minimum follow-up of 36 months. Propensity score matching (PSM) with replacement was used to balance baseline characteristics, resulting in 92 teeth each in the iRoot BP Plus group and the MTA group The primary outcome was pulp survival, assessed by combined clinical and radiographic criteria. Statistical analyses for group comparisons incorporated weights from the PSM. Secondary outcomes included pain intensity changes, reparative dentin bridge formation, and complications. An exploratory multivariable Cox regression analysis with a reduced set of covariates was employed to identify prognostic factors, and sensitivity analyses were performed according to tooth position and preoperative pain level. RESULTS: At 36 months post-treatment, the pulp survival rate was 88.0% (95% confidence interval [CI]: 79.6-93.4%) in the iRoot BP Plus group and 86.9% (95% CI: 78.3-92.6%) in the MTA group, with no statistically significant difference (P = .730). The absolute difference was 1.1% (95% CI: -8.4% to 10.7%). No significant differences were observed between groups in reparative dentin bridge formation (78.3% vs. 75.0%), vitality response, or complication rates. Exploratory multivariate analysis identified higher preoperative pain level (visual analog scale ≥7) as an independent risk factor for treatment failure (hazard ratio = 2.35, 95% CI: 1.22-4.52, P = .010), whereas the type of capping material did not influence outcomes (hazard ratio = 0.98, 95% CI: 0.46-2.11, P = .962). Subgroup analyses further confirmed comparable performance of both materials across different tooth positions and pain strata. CONCLUSION: iRoot BP Plus demonstrates comparable long-term efficacy to MTA in direct pulp capping for SIP, with favorable clinical applicability and safety. Preoperative pain intensity, rather than the choice of capping material, appears to be a critical determinant of prognosis.
Effectiveness of Artificial Intelligence Models for Detection of Vertical Root Fractures: A Systematic Review.
Patil S, Licari FW, Bennion C … +3 more , Deshpande A, Nasseh AA, Bhandi S
J Endod · 2026 Jun · PMID 41740650 · Publisher ↗
INTRODUCTION: Vertical root fractures (VRFs) are diagnostically challenging lesions with significant clinical implications. Artificial intelligence (AI) models have emerged as a potential diagnostic aid. This systematic...
INTRODUCTION: Vertical root fractures (VRFs) are diagnostically challenging lesions with significant clinical implications. Artificial intelligence (AI) models have emerged as a potential diagnostic aid. This systematic review assessed the diagnostic performance of AI-based models for VRF detection across various imaging techniques. METHODS: Databases including PubMed, Scopus, and Web of Science were thoroughly searched until Jan 2025. Studies that reported on diagnostic accuracy, sensitivity, and specificity were included. Articles in languages other than English were excluded. Study quality was evaluated using QUADAS-2, and the certainty of evidence was rated following the GRADE approach. RESULTS: Of the initial 1,544 studies, 7 met the inclusion criteria. Across these studies, convolutional neural network-based models showed a 75%-97.8% accuracy, 75%-98% sensitivity, and 60%-99% specificity. Applying ResNet-50 to manually curated cone-beam computed tomography (CBCT) slices achieved the highest accuracy at 97.8%. Probabilistic neural networks and ensemble-based architectures also performed well, especially when trained on large, balanced datasets. Performance declined when lower-resolution modalities such as panoramic or periapical radiographs were used, or when automatic region-of-interest selection was applied. Models trained on CBCT consistently outperformed those using 2D radiography. CONCLUSIONS: There is low-level evidence that indicates convolutional neural network-based AI models, especially when trained on high-resolution CBCT and enhanced images, can achieve high diagnostic accuracy for VRF detection. The overall certainty of this evidence remains low due to methodological limitations, small sample sizes, and limited external validation. Prospective, multicenter studies using clinically acquired datasets are necessary to confirm generalizability and support clinical implementation.
Clinical-imaging Model for Predicting Prognosis in Contemporary Endodontic Microsurgery: A Retrospective Machine Learning-based Study.
Tobón-Arroyave SI, Restrepo-Restrepo FA, Marín-Cardona N … +4 more , Muñoz-Vélez JA, Tangarife-Villa CA, Fasoulas A, Villa-Machado PA
J Endod · 2026 Jun · PMID 41724212 · Publisher ↗
INTRODUCTION: Predictive tools for endodontic microsurgery outcomes remain limited. This study evaluated the performance of various machine learning algorithms in forecasting endodontic microsurgery prognosis using patie...
INTRODUCTION: Predictive tools for endodontic microsurgery outcomes remain limited. This study evaluated the performance of various machine learning algorithms in forecasting endodontic microsurgery prognosis using patient-, tooth-, and procedure-related variables. METHODS: A retrospective analysis was conducted on 213 teeth from 180 patients. Clinical and tomographic data were dichotomized and processed using synthetic minority oversampling technique to address class imbalance. Feature selection used SelectKbest, chi-square, mutual information, and ensemble classifiers. Several classifiers including logistic regression, random forest, support vector machine, k-nearest neighbors, simple decision tree, and naïve Bayes were trained and validated on an 80:20 split, with performance assessed via accuracy, sensitivity, specificity, precision, F1-score, and area under the receiver operating characteristic curve. To interpret the model and assess feature importance, the SHapley Additive exPlanations technique was applied. RESULTS: The random forest classifier achieved the highest predictive performance (accuracy: 91%, sensitivity: 91%, specificity: 85%, area under the receiver operating characteristic curve: 0.97). Eight key predictors of poor prognosis were identified: lack of guided tissue regeneration techniques, poor root-end filling quality, use of rotary osteotomy, lesion size ≤6.29 mm, patient age >52.50 years, poor root-end resection quality, steep root-end resection bevel, and suboptimal coronal restoration. CONCLUSION: This study demonstrates that the random forest model showed strong internal performance, but results may be optimistic given the small, synthetic minority oversampling technique-augmented dataset and single train-test split. SHapley Additive exPlanations-derived predictors are clinically plausible yet represent model associations, underscoring the need for external validation before drawing firm clinical conclusions.
Comparative Efficacy and Extrusion Risk of Polypropylene Needle versus Various Supplemental Irrigations in Cleaning Simulated Curved Root Canals.
Eungnapatanin S, Jearanaiphaisarn T, Chivatxaranukul P
J Endod · 2026 May · PMID 41722812 · Publisher ↗
INTRODUCTION: This in vitro study compared the cleaning efficacy and irrigant extrusion of polypropylene needles and various supplemental irrigation techniques in curved root canals. METHODS: Simulated canals with 20° (m...
INTRODUCTION: This in vitro study compared the cleaning efficacy and irrigant extrusion of polypropylene needles and various supplemental irrigation techniques in curved root canals. METHODS: Simulated canals with 20° (moderate) and 40° (severe) curvatures were prepared to size 25/0.07 and filled with biofilm-mimicking hydrogel. Six irrigation techniques were tested (n = 9 per group): conventional irrigation with stainless steel needles, conventional irrigation with polypropylene needles (PN), and stainless-steel needles supplemented with manual dynamic agitation using a 0.04 taper standardized cone (MDA-S), manual dynamic agitation with a matched cone (MDA-M), sonic activation with EDDY, or mechanical activation with XP-endo Finisher (XP). Residual hydrogel in the main canal, hydrogel clearance in accessory canals, and irrigant extrusion through the apical vent were assessed. Data were analyzed using two-way analysis of variance with Bonferroni post hoc test (P < .05). RESULTS: In the severe curvature, PN resulted in significantly less residual hydrogel in the main canal than steel needles (P < .05). However, in both curvatures, all supplemental techniques showed superior performance compared with PN (P < .05). MDA-M provided the greatest hydrogel clearance in main and accessory canals (P < .05), but with the highest extrusion (P < .05). CONCLUSION: Polypropylene needles improved apical cleaning in severely curved canals compared with stainless steel needles. However, supplemental activation provided superior overall debridement in both curvatures, although with an increased risk of extrusion.
Comparative Evaluation of Static-guided versus Freehand Endodontic Access in Single-rooted Permanent Teeth with Pulp Canal Calcification: A Randomized Clinical Trial.
Ali A, Ikhar A, Doğanay Yıldız E … +6 more , Ahmed HMA, Grisales RF, Bakhsh A, Patel AS, Sharma S, Arslan H
J Endod · 2026 May · PMID 41692296 · Publisher ↗
INTRODUCTION: The present study aimed to compare the use of conventional freehand access cavity preparation with the static-guided (SG) endodontic technique in terms of its ability to locate and negotiate root canals, ia...
INTRODUCTION: The present study aimed to compare the use of conventional freehand access cavity preparation with the static-guided (SG) endodontic technique in terms of its ability to locate and negotiate root canals, iatrogenic errors (perforations), and the amount of tooth structure loss while treating single-rooted traumatized teeth with pulp canal calcifications. METHODS: This randomized clinical trial was registered in the Clinical Trial Registry of India (https://ctri.nic.in, CTRI/2024/01/061580). A total of 30 patients with traumatized teeth exhibiting calcified root canals were included in the study. The patients were randomly divided into 2 groups as follows: SG endodontic technique and conventional freehand technique. Following the completion of the treatments, the cases were evaluated as either successful (canal located) or failed (perforation or canal not located). In addition, the amount of removed tissue was calculated on the postoperative radiographs using ImageJ software (National Institutes of Health, Bethesda, MD). Chi-square and Mann-Whitney U tests were performed to analyze the data (P = .05). RESULTS: In the SG endodontic group, the root canals were located in all teeth, while in the conventional freehand approach, 13% of cases reported failure to locate the root canals. The tooth sturucture loss was significantly lower in the SG approach compared to the conventional freehand approach (P < .05). CONCLUSION: The conventional freehand technique caused three times more tooth structure loss compared to the SG endodontic approach. There were no failed cases in the SG endodontic technique group, and all root canals were successfully located.
Retrospective Analysis of Clinical Characteristics and Therapeutic Effect of Intentional Replantation.
Zhu J, Li X, Su Q
J Endod · 2026 Jul · PMID 41687916 · Publisher ↗
INTRODUCTION: A retrospective analysis of a large group of cases was conducted to examine the clinical traits of teeth subjected to intentional replantation (IR) and the factors influencing the treatment effect, so as to...
INTRODUCTION: A retrospective analysis of a large group of cases was conducted to examine the clinical traits of teeth subjected to intentional replantation (IR) and the factors influencing the treatment effect, so as to provide guidance for indication selection and surgical operations. METHODS: A total of 445 patients, each with one affected tooth, underwent IR surgery at West China Hospital of Stomatology, Sichuan University, from 2016 to 2023, were included. Data on basic patient information, preoperative status, intraoperative procedures, and follow-up results for 107 patients with a follow-up duration exceeding 1 year were collected. Statistical analysis was performed using SPSS. RESULTS: The results showed that most IR patients were female (62.25%) and aged between 21 and 50 (80.45%). The predominant teeth for surgery were the mandibular second molars (44. 94%), maxillary second molars (19.33%), and maxillary lateral incisors (11.24%). The main preoperative symptoms were percussion pain (78. 65%), periodontal pockets (50.11%), sinus tract (40.45%), and tooth mobility (30.79%). The rate of completing preoperative root canal treatment was 93.71%. During surgery, 66 teeth (14.83%) had root surface cracks. Sixty-two of these teeth were not reimplanted during the operation; 47 of 62 (75.81%) had vertical root fractures. The overall success rates were 78.50%. Univariate analysis showed that the lack of periodontal pockets and the absence of bony plate defects significantly increased the success rate (P < .05). The success rate for severe coronal defects and root defects on the distal surface of the second molar was 73.68%. CONCLUSION: IR can be used for complex endodontic and periapical diseases, as well as teeth with periodontitis, serving as a viable solution for salvaging challenging teeth. The periodontal status, initial etiology, and the severity of the bony plate defect are key prognostic factors.
Hemostatic Agents in Periapical Surgery: Systematic Review and Meta-analysis.
Genchi F, Blaya Tárraga JA, Palma Carrió C … +2 more , Estévez Llorens R, Menéndez Nieto I
J Endod · 2026 Jun · PMID 41679429 · Publisher ↗
INTRODUCTION: The purpose of this systematic review with meta-analysis was to analyze the hemostatic efficacy in periapical surgery and their influence on the prognosis. A secondary objective was to study the influence o...
INTRODUCTION: The purpose of this systematic review with meta-analysis was to analyze the hemostatic efficacy in periapical surgery and their influence on the prognosis. A secondary objective was to study the influence of clinical variables both patient- and tooth-related. METHODS: A systematic review protocol was developed following the PRISMA guidelines. A comprehensive search was carried out in PubMed, Scopus, Web of Science, and Cochrane Library up to October 2024. Inclusion criteria were randomized controlled trials and controlled clinical trials analyzing the efficacy of hemostatic agents in periapical surgery and their relationship with treatment prognosis. Studies with follow-up periods of less than 12 months for prognosis analysis were excluded. Risk of bias was assessed using RoB2 tools for randomized controlled trials and ROBINS-I-V2 for controlled clinical trials. Three types of meta-analyses were conducted: a global pooled effect meta-analysis, a meta-regression and a network meta-analysis. RESULTS: Ten studies with a total of 388 teeth were included. The meta-analysis estimated an average hemostatic efficacy rate of 63 ± 6.6%. The meta-analysis and the meta-regression did not identify statistically significant differences between the hemostatic agents evaluated. The network meta-analysis found that epinephrine and aluminum chloride obtained statistically significant results when compared to collagen (P < .05). Among the variables analyzed, only the smoking habit showed a trend toward statistical significance (P = .074). CONCLUSIONS: The hemostatic agents evaluated showed good efficacy for the control of intraoperative bleeding, without finding statistically significant differences. No relationship was found between hemostatic efficacy and prognosis, nor with patient- or tooth-related variable.
The Global Periapical Health Study: A Big Data CBCT Analysis of Periapical Pathology across 54 Countries.
Martins JNR, “GPHS Research Group” (including all authors participating in the “GPHS Research Group”), Versiani MA
J Endod · 2026 May · PMID 41679428 · Publisher ↗
INTRODUCTION: Periapical pathology, a common outcome of pulpal infection or failed endodontic therapy, remains underexplored globally. Most studies are small-scale and based on two-dimensional radiographs. This study aim...
INTRODUCTION: Periapical pathology, a common outcome of pulpal infection or failed endodontic therapy, remains underexplored globally. Most studies are small-scale and based on two-dimensional radiographs. This study aimed to provide a standardized worldwide estimate of its prevalence using cone-beam computed tomography (CBCT). METHODS: A cross-sectional, multicenter study was conducted across 54 countries, each represented by one calibrated examiner. Examiners consecutively assessed 3,500 roots from pre-existing CBCT scans, yielding data from 189,000 roots (138,536 teeth) of 6,688 patients. A standardized protocol was applied using the CBCT periapical index to record lesion presence, tooth type, previous root canal treatment, and demographic variables. Only scans with voxel size ≤200 μm were included. Data were analyzed through meta-analysis and logistic regression model to evaluate factors associated with periapical pathology, with meta-regression assessing voxel size and field-of-view effects. RESULTS: At the patient level, periapical pathology affected 58.6% of individuals worldwide. Secondary tooth-level analysis showed a prevalence of 7.3%, ranging from 2.5% in Oceania to 9.6% in Africa. Maxillary teeth (9.3%) were more frequently affected than mandibular teeth (5.3%), with maxillary first molars showing the highest prevalence (18.6%). Prevalence increased with age, from 2.9% (≤20 years) to 10.5% (≥61 years). Endodontically treated teeth showed markedly higher prevalence of post-treatment periapical radiolucencies (44.3%) than untreated teeth (2.6%) (odds ratio = 21.6; confidence interval 19.1-23.1; P < .001). Voxel size and field-of-view did not influence outcomes. CONCLUSION: Periapical pathology is highly prevalent worldwide, with notable regional and age-related differences. Endodontically treated teeth showed a disproportionately high prevalence of periapical pathology.
Fracture Resistance of Heat-treated NiTi Instruments by the Load of Mechanical Preparation According to Tooth Type and Canal Number.
AlAli B, Atmeh A, Jamal M … +4 more , Ahmad F, Khamis AH, Kim HC, El Abed R
J Endod · 2026 May · PMID 41679427 · Publisher ↗
INTRODUCTION: This study aimed to evaluate the impact of mechanical loading, induced by preparing anatomically standardized premolar and molar canal models, on the cyclic fatigue and torsional fracture resistance of heat...
INTRODUCTION: This study aimed to evaluate the impact of mechanical loading, induced by preparing anatomically standardized premolar and molar canal models, on the cyclic fatigue and torsional fracture resistance of heat-treated nickel-titanium (NiTi) rotary instruments. METHODS: Sixty NiTi instruments (Race Evo) were randomly assigned to 3 groups (n = 20): unused controls (N0), instruments used to prepare 2 canals in premolar models (P2), and 4 canals in molar models (M4). Cyclic fatigue testing was performed in dynamic mode with a 4 mm axial pecking motion at 37 ± 1 °C. Time to fracture and the number of cycles to fracture were recorded; the lengths of fractured fragments were measured using a digital caliper. Torsional resistance was assessed by fixing the apical 3 mm and rotating the shaft until fracture. Maximum torsional load and angle of rotation were recorded. Fractured surfaces were examined using scanning electron microscopy, and phase transformation behavior was assessed via differential scanning calorimetry. Data were analyzed using one-way analysis of variance and Tukey's post hoc test at a 95% significance level. RESULTS: P2 and M4 groups showed significantly higher cyclic fatigue resistance than N0 (P < .001), with no difference between P2 and M4. Torsional resistance parameters were significantly reduced in P2 and M4 compared to N0 (P < .05). Scanning electron microscopy revealed distinct fracture morphologies; differential scanning calorimetry showed consistent phase transformation behavior. CONCLUSION: Within the limitations of this study, standardized simulated procedural loading paradoxically increased the cyclic fatigue resistance of heat-treated NiTi instruments, while simultaneously producing a moderate reduction in torsional strength.
Factors Influencing Apical Extrusion of 2 Types of Endodontic Sealers with Different Delivery Systems.
Iqbal S, Adams NS, Camilleri J
J Endod · 2026 May · PMID 41672243 · Publisher ↗
INTRODUCTION: Comparison of the apical sealer extrusion of BioRoot RCS and BioRoot Flow and assessment of the influence of procedural and anatomical factors that contribute to extrusion. METHODS: Human mandibular premola...
INTRODUCTION: Comparison of the apical sealer extrusion of BioRoot RCS and BioRoot Flow and assessment of the influence of procedural and anatomical factors that contribute to extrusion. METHODS: Human mandibular premolars were divided into 2 groups based on apical gauges (<40, >40). Other variables included the presence and size of an apical lesion (2, 4, and 6 mm), canal moisture (dry and wet), pumping and no-pumping action, and sealer tip insertion depth for BioRoot Flow (coronal vs apical). The extruded material was weighed in grams using an analytical balance to the accuracy of 0.0001 g. Statistical analysis included the Kruskal-Wallis test, Mann-Whitney U test, and multivariate linear regression to identify statistically significant factors related to sealer extrusion. RESULTS: Sealer extrusion was observed in 86.8% of 288 variables tested. BioRoot Flow had significantly higher extrusion across all categorical variables compared to BioRoot RCS (P < .001). Key factors associated with increased extrusion included wet canals (P < .001), larger apical gauge (>40; P < .05), apical sealer placement (P < .005), and pumping action (P < .05). Among all variables, canal moisture was the most consistent contributor to sealer extrusion. The presence of a 6 mm apical lesion combined with an apical gauge of >40 in a wet canal with apically placed BioRoot Flow increased the risk of sealer extrusion. CONCLUSIONS: Wet canals, apical sealer tip placement, larger apical diameters or gauges, and pumping actions significantly increase the risk of extrusion, particularly with sealers that are delivered in a syringe, such as BioRoot Flow. These findings underscore the significance of procedural control in minimizing sealer extrusion and enhancing clinical outcomes.
Letter to the Editor Regarding, "Diabetes Increases Residual Stress and Microcrack Length in Dentin: An XRD-SEM Study with AI-assisted Quantification".
De Souza HS, Fernandes M, de Ataide IN
J Endod · 2026 Feb · PMID 41655630 · Publisher ↗
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A Unified Deep Learning Framework for Visual Diagnosis of Palatal Radicular Grooves in CBCT Scans: A Multicenter Validation Study.
Zhu Q, Fu W, Lin Y … +9 more , Li J, Tang W, Zhang Y, Zhang R, Lu G, Lin Y, Shen J, Bian Z, Meng L
J Endod · 2026 Jul · PMID 41655629 · Publisher ↗
INTRODUCTION: Palatal radicular grooves (PRGs) posed diagnostic challenges due to their complex root anatomy and subtle manifestations in cone-beam computed tomography (CBCT). This study aimed to develop a deep learning...
INTRODUCTION: Palatal radicular grooves (PRGs) posed diagnostic challenges due to their complex root anatomy and subtle manifestations in cone-beam computed tomography (CBCT). This study aimed to develop a deep learning framework for the automated three-dimensional visualization, diagnosis, and classification of PRG lesions. METHODS: A unified framework (PRG-Net) integrating tooth segmentation, PRG diagnosis, and lesion classification was developed. A retrospective multicenter diagnostic accuracy study was conducted using CBCT datasets with varying fields of view from one internal validation site and 3 external centers to evaluate generalizability and performance for segmentation, diagnosis, and classification tasks. The impact of PRG-Net on dentists' diagnostic accuracy, classification consistency, and workflow efficiency was also assessed. RESULTS: PRG-Net demonstrated strong generalizability across all datasets. For tooth segmentation, it achieved a mean Dice similarity coefficient of 97.1% [95% CI: 96.4, 97.7]. Diagnostic performance yielded area under the curve of 94.4% (internal) and 85.2%-90.0% (external). Classification area under the curve were 91.4% [95% CI: 86.8, 96.1] for Type I, 88.5% [95% CI: 81.1, 95.8] for Type II, and 96.9% [95% CI: 91.6, 100] for Type III, with consistent cross-center reproducibility. In clinical validation, PRG-Net significantly improved dentists' diagnostic accuracy and inter-rater classification agreement while substantially reducing interpretation time. CONCLUSIONS: PRG-Net provided a robust, automated solution for PRG assessment in CBCT. It facilitated earlier and more precise diagnosis, improved inter-rater reliability, and streamlined workflow, demonstrating strong potential as a clinically valuable decision-support tool to guide treatment planning and improve patient outcomes.
Reply to the Letter to the Editor: "Diabetes Increases Residual Stress and Microcrack Length in Dentin: An XRD-SEM Study with AI-assisted Quantification".
Saghiri MA, Momeni K, Chien CH … +3 more , Conte M, Pinnaka P, Morgano SM
J Endod · 2026 Feb · PMID 41655628 · Publisher ↗
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Evaluation of Inflammatory Mediators, Pulpal Blood pH, and Oxygen Saturation in Teeth with Pulpitis.
Hosseinzadehfard P, Kostenkova A, Lodienė G … +5 more , Grabliauskienė Ž, Skučaitė N, Kulkovienė G, Nedzelskienė I, Mačiulskienė-Visockienė V
J Endod · 2026 Jun · PMID 41654292 · Publisher ↗
INTRODUCTION: Although traditional diagnosis of pulp inflammation relies on subjective clinical and sensibility tests that lack precision, emerging objective methods such as biomarker measurement and pulse oximetry show...
INTRODUCTION: Although traditional diagnosis of pulp inflammation relies on subjective clinical and sensibility tests that lack precision, emerging objective methods such as biomarker measurement and pulse oximetry show promise in accurately assessing pulp vitality and differentiating stages of pulpitis; however, these techniques still face technical challenges and require further validation through laboratory analyses. MATERIALS AND METHODS: This study investigated selected biomarkers in pulpitis by analyzing clinical and laboratory examinations from patients aged from 19 to 55 undergoing endodontic treatment. Patients were divided into test groups (reversible/irreversible pulpitis) and a control group (healthy teeth). Clinical assessments included pulse oximetry measurement and pulpal blood collection for biomarker and pH analysis. Five inflammatory mediators (interleukin (IL)-1α, IL-6, IL-8, matrix metalloproteinase-9, and tissue inhibitor of metalloproteinase-1 (TIMP-1)) were evaluated using a Luminex multiplex assay. Statistical analysis was performed using SPSS 30.0, employing both parametric and nonparametric tests with a significance level of P ≤ .05. RESULTS: Several investigated markers exhibited significant differences among the groups. The levels of SpO and pH were highest in the control group and lowest in in cases of irreversible pulpitis. Additionally, the levels of IL-1α, IL-6, and IL-8 increased with the severity of pulpitis. Significant correlations were identified between inflammatory mediators, pH, and pulse oximetry. Notably, IL-1α, IL-8, and TIMP-1 correlated with pH (P < .01), and pulse oximetry was strongly associated with IL-1α, IL-6, and IL-8 across all groups (P < .01). CONCLUSIONS: The values of inflammatory mediators (IL-1α, IL-6, IL-8, matrix metalloproteinase-9, TIMP-1), along with the pulp blood pH and oxygen saturation levels differed according to the pulp condition and a positive correlation was established among the parameters analyzed.
Allogeneic Mesenchymal Stromal Cells Transplantation Induces Arrest of External Apical Inflammatory Resorption in a Mature Nonvital Traumatized Tooth.
Gomez-Sosa JF, Wittig O, Diaz-Solano D … +1 more , Cardier JE
J Endod · 2026 May · PMID 41638480 · Publisher ↗
INTRODUCTION: Mesenchymal stromal cells (MSCs) have been proposed for tissue regeneration based on their paracrine and immunomodulatory effects. Based on these features, MSCs may regulate inflammation and tissue repair....
INTRODUCTION: Mesenchymal stromal cells (MSCs) have been proposed for tissue regeneration based on their paracrine and immunomodulatory effects. Based on these features, MSCs may regulate inflammation and tissue repair. This case report assessed whether allogeneic bone marrow MSCs (BM-MSCs) can arrest external apical inflammatory resorption (EAIR) in a mature, nonvital traumatized tooth. METHODS: A healthy 14-year-old male with intermittent edema and a sinus tract associated with tooth #9 was referred for endodontic evaluation. Radiographically, tooth #9 showed EAIR with a vertical/diagonal mesial pattern and a 3-mm periapical lesion with widened periodontal ligament space. The root canal was cleaned and shaped; calcium hydroxide was used as interappointment medication, and cryopreserved allogeneic BM-MSCs were thawed, expanded, incorporated into preclotted platelet-rich plasma, and implanted into the pulp cavity. The cervical third was sealed with bioceramic cement and composite. RESULTS: Cryopreserved BM-MSCs retained fibroblast-like morphology, expressed CD73/CD90/CD105, and showed osteogenic, adipogenic, and chondrogenic differentiation. A BM-MSC/PRP clot was transplanted without complications or adverse events. At 3 months, radiographs showed reduction of the periapical radiolucency with initial bone formation and positive cold and electric pulp test responses. Between 12 and 24 months, reappearance of lamina dura, remodeling of the resorbed surface, and complete radiographic healing with arrest of EAIR were observed. At 48 months, tooth #9 was asymptomatic, responsive to cold and electric pulp test, and showed normal periapical architecture and mineralized tissue within the canal with an apical constriction. CONCLUSIONS: BM-MSC transplantation may arrest EAIR and promote pulp-like and periapical tissue regeneration.
Root Canal Microbiome in Patients Undergoing Antineoplastic Therapy: A Next-generation Sequencing Study.
Romeiro K, Siqueira JF, Rôças IN … +4 more , Gominho LF, Villela LB, Brisson-Suárez K, Carmo FL
J Endod · 2026 Jun · PMID 41628729 · Publisher ↗
INTRODUCTION: This study compared the intracanal microbiome of teeth with apical periodontitis in oncologic and healthy patients using 16S rRNA gene-based next generation sequencing. METHODS: Root canal samples were take...
INTRODUCTION: This study compared the intracanal microbiome of teeth with apical periodontitis in oncologic and healthy patients using 16S rRNA gene-based next generation sequencing. METHODS: Root canal samples were taken from 46 teeth with pulp necrosis and primary apical periodontitis (23 from oncologic patients and 23 from healthy controls). DNA was extracted and sequenced using the Illumina MiSeq platform targeting the V3-V4 region of the 16S rRNA gene. Bioinformatics processing was conducted using QIIME2 and DADA2. Alpha and beta diversity analyses, genus-level abundance comparisons, and indicator species analyses were performed. RESULTS: After quality filtering, 3,307,822 sequence reads were retained, averaging 68,912.96 reads/sample, and resulting in 3,241 unique amplicon sequence variants. Oncologic patients exhibited significantly higher bacterial richness (P = .01), while Shannon diversity showed no significant difference between groups. Beta diversity analysis (Bray-Curtis, MDS stress = 0.14) did not reveal significant differences between groups. Indicator species analysis identified some specific taxa more associated with oncologic patients, including the candidate endodontic pathogens Prevotella, Selenomonas, Alloprevotella, Rothia, and Fretibacterium. CONCLUSIONS: The root canal microbiome of oncologic patients with apical periodontitis was broadly similar to that of healthy controls. The oncologic group showed higher species richness, but no significant differences in the overall bacterial diversity or community structure.
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