Journal Of Endodontics[JOURNAL]
Sun
200 papers
Effects of Instrumentation and NaOCl Concentration on Microbial DNA Load Employing a Sonic Activation Device.
Ellis M, Ordinola-Zapata R, Versiani MA … +1 more , Noblett WC
J Endod · 2026 May · PMID 41617080 · Publisher ↗
OBJECTIVE: To evaluate the bacterial DNA load reduction in mesial root canals of mandibular molars using quantitative polymerase chain reaction, examining the effects of instrumentation, irrigant type, and their interact...
OBJECTIVE: To evaluate the bacterial DNA load reduction in mesial root canals of mandibular molars using quantitative polymerase chain reaction, examining the effects of instrumentation, irrigant type, and their interaction after the use of sonic activation. METHODS: Twenty-one extracted human mandibular molars were sterilized and contaminated with human supragingival plaque under anaerobic conditions for 14 days. After sealing the apices and coating external surfaces to simulate a closed canal system, the teeth were randomly assigned to 3 irrigant groups (n = 7): 7.55% sodium hypochlorite, 1.88% sodium hypochlorite, or sterile saline. Microbiologic sampling was performed at baseline (S1), after preparation to size 25/.04 with sonic activation (S2), and after enlargement to size 30/.04 with sonic activation (S3). Bacterial DNA was quantified by quantitative polymerase chain reaction (Log molecules/μL). Data were analyzed using two-way repeated-measures ANOVA with Geisser-Greenhouse correction and Tukey's honest significant difference tests. RESULTS: The interaction between irrigant type and instrumentation was not significant (P = .852), and irrigant type alone showed no significant effect (P = .502). In contrast, instrumentation significantly reduced bacterial load (P < .0001), accounting for 68.44% of variance. Significant reductions occurred from S1 to both S2 and S3, with no difference between S2 and S3, indicating that most of the decrease in bacterial DNA load occurred during initial enlargement to size 25/.04 with sonic-activated irrigation. CONCLUSION: Root canal instrumentation combined with sonic activation was the most significant factor associated with reduction in bacterial DNA load, while irrigant type and concentration provided minimal additional effect.
Authors' Reply to the Commentary on "Comparing the Effectiveness of a Robotic and Dynamic Navigation System in Fiber Post Removal: An In Vitro Study".
Zhou D, Xu F, Dai J … +3 more , Wang X, Ping Y, Wang J
J Endod · 2026 Mar · PMID 41603846 · Publisher ↗
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Retreatment of Bioceramic Sealers Using a Novel Solvent: Dissolution, Patency, and Dentinal Effects.
Hanson J, Wu M, Shakya A … +2 more , Walsh R, Jalali P
J Endod · 2026 Feb · PMID 41591955 · Publisher ↗
INTRODUCTION: This study evaluated the effectiveness of Endo Sealer Solvent (ESS), 5.25% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA), and chloroform (CHCl) in facilitating patency in canals ob...
INTRODUCTION: This study evaluated the effectiveness of Endo Sealer Solvent (ESS), 5.25% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA), and chloroform (CHCl) in facilitating patency in canals obturated with bioceramic sealer and assessed their effects on dentin. METHODS: The study had 3 parts. First, 60 disk-shaped specimens of EndoSequence BC Sealer (BC) were immersed in one of the 4 irrigants for 3 hours and percent weight loss was calculated. Second, 60 single-canal teeth were obturated with 3 mm of BC in the apical third; after 1 week, gutta-percha was removed and the time required to regain apical patency with a 10 C-file using the respective solvent was measured. Third, 8 additional teeth were irrigated with the solutions and evaluated under scanning electron microscopy for dentinal changes. Kruskal-Wallis and Mann-Whitney tests were used for analysis. RESULTS: ESS and EDTA dissolved the greatest amount of BC, with no significant difference between them (P > .05), but both were significantly more effective than NaOCL and CHCl (P < .001). Regardless of the irrigant used, patency was achieved in all teeth with no significant difference in time (P > .05). Scanning electron microscopy showed no erosion in any group; ESS and EDTA removed the smear layer, while NaOCL and CHCl did not. CONCLUSIONS: ESS and EDTA were the most effective in dissolving BC while preserving dentin, but all irrigants allowed 100% patency with no significant time difference, indicating solvent selection does not influence clinical patency outcomes.
Insights Into the February 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 Feb · PMID 41587868 · Publisher ↗
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Fracture Resistance and Biomechanical Behavior of Retreated Teeth Obturated with Different Sealers: Combined Laboratory Testing and Finite Element Analysis.
Çapkın H, Peker FB, Güneşer MB
J Endod · 2026 May · PMID 41587601 · Publisher ↗
INTRODUCTION: This study evaluated the effect of different sealers on fracture resistance of retreated mandibular premolars and characterized their biomechanical behavior using three-dimensional finite element analysis (...
INTRODUCTION: This study evaluated the effect of different sealers on fracture resistance of retreated mandibular premolars and characterized their biomechanical behavior using three-dimensional finite element analysis (FEA). METHODS: One hundred twenty-four single-rooted premolars were instrumented and initially obturated with AH Plus. Twelve teeth with intact fillings served as positive controls, and 12 retreated but unfilled teeth served as negative controls. The remaining samples were retreated and randomly assigned to 5 sealer groups (n = 20): AH Plus, GuttaFlow Bioseal, TotalFill BC, BioRoot RCS, and NeoSealer Flo. After thermocycling, fracture resistance was tested under 45° oblique loading. Corresponding micro-computed tomography-based FEA models were generated to compare von Mises stress distributions with and without a simulated periapical lesion. RESULTS: Fracture resistance differed significantly among groups (P < .001). The negative control showed the lowest resistance, whereas the positive control exhibited the highest values (P < .05). No statistically significant differences were observed among the experimental sealer groups (P > .05). FEA demonstrated distinct stiffness-dependent patterns: NeoSealer Flo and TotalFill BC concentrated stresses within the sealer, whereas limiting dentinal stress; GuttaFlow Bioseal transmitted greater stresses to dentin; AH Plus and BioRoot RCS showed intermediate responses. CONCLUSIONS: In retreatment conditions, sealer type influences internal stress distribution even when fracture resistance values are comparable. Bioceramic sealers with higher elastic modulus may reduce dentinal stress and enhance biomechanical compatibility. Clinicians should consider not only biological performance but also mechanical compatibility when selecting sealers to support long-term structural preservation of retreated teeth.
Bioengineered Gelatin Hydrogels Functionalized with VEGF/BMP2 Mimetic Peptides for Advancing Regenerative Endodontics.
Han Y, Chopra H, Thalakiriyawa DS … +2 more , Wang H, Dissanayaka WL
J Endod · 2026 May · PMID 41580122 · Publisher ↗
INTRODUCTION: Regenerating the pulp-dentin complex is challenging due to its distinct biological, anatomical, and mechanical properties. To address this, we explored gelatin-based hydrogels modified by covalently binding...
INTRODUCTION: Regenerating the pulp-dentin complex is challenging due to its distinct biological, anatomical, and mechanical properties. To address this, we explored gelatin-based hydrogels modified by covalently binding vascular endothelial growth factor (VEGF) and bone morphogenetic protein 2 (BMP2) mimetic peptides to target pulp and dentin regeneration. METHODS: Three distinct hydrogels: GelMA (gelatin methacrylate, 5% w/v), GelNB (norbornene-modified gelatin, 5% w/v), and GelMN (5% GelMA: 5% GelNB = 1:1) were prepared and characterized by scanning electron microscopy (SEM, n = 3), Fourier transform infrared spectroscopy (FTIR, n = 3), and swelling ratio analysis (n = 3). Human dental pulp stem cells (DPSCs) were encapsulated to assess viability (live/dead staining, n = 3) and spreading (n = 3). DPSCs and human umbilical vein endothelial cells were cocultured in a VEGF mimetic peptide (200 μg/ml) functionalized GelMN hydrogel to evaluate vascular structure formation (n = 3). Conversely, DPSCs were encapsulated in a BMP2 mimetic peptide (20 μM) functionalized GelMA hydrogel to investigate the odontogenic differentiation (n = 3). RESULTS: SEM analysis showed GelMA exhibited a denser, more tightly crosslinked network and smaller pore size compared to GelNB/GelMN. FTIR confirmed the chemical composition of all 3 hydrogels, and the swelling ratio demonstrated no significant difference among them. All hydrogels exhibited excellent biocompatibility and supported cell viability after culturing with DPSCs. VEGF mimetic peptide in GelMN enhanced vascular tube formation by human umbilical vein endothelial cells supported by DPSCs. In parallel, BMP2 mimetic peptide in GelMA significantly boosted the odonto-/osteogenic differentiation of DPSCs, as indicated by the expression of dentin sialophosphoprotein, alkaline phosphatase, and mineralization levels. CONCLUSION: VEGF and BMP2 mimetic peptide-functionalized gelatin hydrogels is a promising approach to enhance pulp-dentin complex regeneration.
Autotransplantation of an Impacted Immature Third Molar Following Orthodontic Activation without Endodontic Intervention.
Ma Z, Chen G, Liu Z … +3 more , Li W, Kuang J, Zhou L
J Endod · 2026 Jun · PMID 41577029 · Publisher ↗
Autogenous tooth transplantation (ATT) using open-apex donor teeth may preserve pulp vitality, but atraumatic retrieval of impacted third molars is challenging. This case report describes an interdisciplinary workflow co...
Autogenous tooth transplantation (ATT) using open-apex donor teeth may preserve pulp vitality, but atraumatic retrieval of impacted third molars is challenging. This case report describes an interdisciplinary workflow combining orthodontic donor activation with digitally guided, vitality-preserving ATT. A 27-year-old woman with an edentulous maxillary left first molar site (tooth #14) underwent ATT using an immature mandibular right third molar (tooth #32) as the donor. After 6 weeks of orthodontic traction, cone-beam computed tomography and intraoral scans were registered for virtual planning and fabrication of a 3-dimensional-printed donor replica and trephine-compatible osteotomy and seating guides. The recipient site was prepared under trephine guidance, platelet-rich fibrin was applied, and the transplant was stabilized with splinting. Clinical and radiographic follow-up was performed for 24 months. Radiographs showed progressive trabecular fill and stable crestal bone through 18 months. At 24 months, the transplant was functional and responded to sensibility testing (electric pulp test: #14, 69; control tooth #3, 26). Cone-beam computed tomography demonstrated near-complete apical closure, stable alveolar bone, and donor-site bone regeneration (1310.53 mm), with no evidence of external root resorption or ankylosis. Orthodontic activation combined with guide-assisted preparation may facilitate vitality preserving ATT using an open-apex third molar in a posterior maxillary site.
From Evidence-based Endodontics to Generative AI: A Comparative Study of 11 Large Language Models.
de Araújo LP, Moreno LB, de Araújo BCC … +3 more , Chaves ET, Botero TM, Romero VHD
J Endod · 2026 Jun · PMID 41577028 · Publisher ↗
INTRODUCTION: Generative large language models (LLMs) are increasingly used in dentistry, yet their guideline-based diagnostic accuracy and reproducibility remain uncertain. Position statements from the American Associat...
INTRODUCTION: Generative large language models (LLMs) are increasingly used in dentistry, yet their guideline-based diagnostic accuracy and reproducibility remain uncertain. Position statements from the American Association of Endodontists and the European Society of Endodontology provide rigorous, evidence-based standards, making them an ideal benchmark to assess alignment of LLM outputs with endodontic best practices. METHODS: This study was conducted according to Transparent Reporting of a Multivariable Model for Individual Prognosis or Diagnosis-Large Language Models guidelines, evaluated 11 LLMs: ChatGPT 5, ChatGPT 4o, ChatGPT o3, Gemini 2.5 Flash, Gemini 2.5 Pro, Claude Sonnet 4, Claude Opus 4, Perplexity R1 1776, Perplexity Sonar, DeepSeek, and DeepSeek DeepThink R1. Sixty multiple-choice questions derived from American Association of Endodontists and European Society of Endodontology position statements were administered to each model in 5 rounds, generating 3300 responses. The primary outcome was all-correct accuracy and the secondary outcome was intra-model consistency. Comparisons were performed with chi-square tests and Bonferroni adjustment. RESULTS: All-correct accuracy varied significantly (χ = 50.56, df = 10, P < .001). ChatGPT 4o and Claude Opus 4 achieved 95.0% accuracy, followed by ChatGPT 5, Claude Sonnet 4, Gemini 2.5 Flash, and Gemini 2.5 Pro (93.3%), and ChatGPT o3 (90.0%). DeepSeek DeepThink R1 scored 86.7%, Perplexity R1 1776 83.3%, Perplexity Sonar 81.7%, and DeepSeek 63.3%. Consistency exceeded 90% for most models, peaking at 98.3% for top performers but falling to 75.0% for DeepSeek. CONCLUSIONS: Most LLMs demonstrated high accuracy and reproducibility when benchmarked against authoritative endodontic guidelines. Despite notable progress over earlier generations, performance variability and confidently incorrect outputs highlight the need for rigorous validation and expert oversight before clinical integration.
Metatranscriptomic Insights into Bacterial Activity, Virulence, and Antimicrobial Resistance in the Root Canal Microbiome of Acute Apical Abscesses.
Dantas LO, Candeiro GTM, Pereira ACB … +7 more , Pereira ACC, Mita D, Zajac N, Attin T, Schwendener S, Karygianni L, Pinheiro ET
J Endod · 2026 Apr · PMID 41571088 · Publisher ↗
INTRODUCTION: This study employed metatranscriptomics to investigate the endodontic microbiome and resistome in acute apical abscesses (AAA) and asymptomatic apical periodontitis (AAP). METHODS: Root canal samples were c...
INTRODUCTION: This study employed metatranscriptomics to investigate the endodontic microbiome and resistome in acute apical abscesses (AAA) and asymptomatic apical periodontitis (AAP). METHODS: Root canal samples were collected from 20 patients, including 10 cases of AAA and 10 cases of AAP. RNA sequencing was conducted using the NovaSeq 6000 system. Taxonomic analysis utilized the expanded Human Oral Microbiome Database (eHOMD) database and functional annotation was executed using the DIAMOND and EGGNOG databases. Resistome analysis was conducted with the Comprehensive Antibiotic Resistance Database (CARD) and BacMet - Antibacterial Biocide and Metal Resistance Database. Differential expression analysis was carried out using DESeq2 from the DESeq2 R package (P < .05). RESULTS: Taxonomic analysis showed more gram-negative species in AAA samples (P < .05), particularly from the Bacteroidota phylum. In functional analysis, Tannerella forsythia and Streptococcus anginosus group (SAG) showed the highest transcriptional activity in AAA. T. forsythia displayed high expression of Rag/SusD proteins, suggesting a potential virulence mechanism. The main protein family found in both conditions was the adenosine triphosphate-binding cassette (ABC) transporter. Transcripts possibly involved in resistance against various antibiotics (cephalosporins, fluoroquinolones, lincosamides, macrolides, tetracyclines), metals (silver, chromium, zinc), and disinfectants (phenolic compounds, acids, and bases) were identified. CONCLUSIONS: T. forsythia and SAG demonstrated high activity within the root canal microbiome in cases of AAA, suggesting their involvement in the pathogenicity of the community associated with acute infections. The ABC transporter may play a significant role in antimicrobial resistance through an antibiotic efflux mechanism and contribute to tolerance against disinfectants and antiseptics.
Prediction of Pulpal Sequelae in Cracked Teeth with Reversible Pulpitis using Machine Learning Models.
Wu S, Dascalu T, Seet RF … +4 more , Chan PY, Yu N, Hartanto J, Ibragimov B
J Endod · 2026 May · PMID 41571087 · Publisher ↗
INTRODUCTION: In early stages of cracked teeth, pulpal inflammation is considered reversible. Cracked teeth with retained pulp vitality demonstrate higher survival rates whereas root canal treatment (RCT) negatively infl...
INTRODUCTION: In early stages of cracked teeth, pulpal inflammation is considered reversible. Cracked teeth with retained pulp vitality demonstrate higher survival rates whereas root canal treatment (RCT) negatively influences survival outcomes. The clinical challenge lies in discerning when RCT is required. This study aimed to develop and validate machine learning models for predicting pulp survival in cracked teeth with reversible pulpitis and investigating associations between patient- and tooth-related variables and treatment outcomes. METHODS: Data from 569 patients with 593 cracked teeth were analyzed using Logistic Regression, Gaussian Processes, Random Forests, and Gradient Boosting. Input features included age, gender, tooth type, and preoperative restorative material. The binary outcome represented pulp survival. A 10-fold stratified nested cross-validation approach was used: the outer loop estimated model performance and the inner loop optimized hyperparameters. Classification thresholds were tuned for probabilistic models. Performance metrics included area under the curve, F1-score, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: Logistic Regression achieved the highest area under the curve (0.64) and F1-score (0.60), with strong PPV (0.76) and moderate NPV (0.48), indicating effective identification of patients requiring RCT. Other models showed similar but slightly lower performance (PPV: 0.74-0.77; NPV: 0.45-0.47). Significant predictors of pulp survival included age and presence of preoperative restorations. Older patients and those with existing restorations were less likely to require RCT. CONCLUSIONS: Machine learning models demonstrated a predictive accuracy of 74%-77%. They could improve diagnostic precision and support timely decision-making for endodontic intervention in the management of cracked teeth with reversible pulpitis.
Influence of Different Types of Intracanal Medicaments and Root Canal Sealers on Root Dentine Fracture Resistance at 2 Different Time Intervals.
Akkaya D, Kosar T
J Endod · 2026 May · PMID 41571086 · Publisher ↗
INTRODUCTION: To investigate the influence of different types of intracanal medicaments and root canal sealers on root dentine fracture resistance at different time intervals. METHODS: A total of 180 single-rooted human...
INTRODUCTION: To investigate the influence of different types of intracanal medicaments and root canal sealers on root dentine fracture resistance at different time intervals. METHODS: A total of 180 single-rooted human mandibular premolars were used. Samples were divided into 3 groups: negative control (unprepared and unfilled, n = 10), positive control (prepared but unfilled, n = 10), and experimental groups (10 groups, n = 15). Root canals were prepared chemomechanically. In single-visit groups, canals were filled with either AH Plus or Bio-C Sealer. In medicament-applied groups, Ultracal XS or Bio-C Temp was applied for 1 week or 1 month before obturation with AH Plus or Bio-C Sealer. Root dentine fracture resistance was measured under vertical loading using a universal testing machine. Material-dentine interface of 10 experimental samples were examined using scanning electron microscope/energy dispersive x-ray spectroscopy. Data were analyzed using the analysis of variance followed by post hoc Tukey's tests, with significance set at P < .05. RESULTS: Root dentine fracture resistance was highest in the negative control and lowest in the positive control (P < .001). Single-visit groups demonstrated significantly higher root dentine fracture resistance than the medicament-applied groups (P < .001). No significant differences were found in the single-visit AH Plus and Bio-C Sealer (P > .05). Similarly, no significant difference was observed between the groups filled with AH Plus or Bio-C Sealer after application of Ultracal XS or Bio-C Temp (P > .05). Furthermore, the time of medicament application (1 week-1 month) was found to have no significant effect on root dentine fracture resistance (P > .05). CONCLUSIONS: Different intracanal medicaments (Ultracal XS, Bio-C Temp) and root canal sealers (AH Plus, Bio-C Sealer) exhibited similar effects on root dentine fracture resistance at different time intervals. However, both Ultracal XS and Bio-C Temp may adversely affect root dentine fracture resistance due to their tendency to leave residues on the dentine surface.
Mechanical and Thermal Impact of Sequential Use-Sterilization Cycles on ProTaper Ultimate Files: An In Vitro Assessment with Practical Implications.
Khidr H, Atmeh AR, Jamal M … +4 more , Alkhatib Z, Khamis AH, Al Omari T, El Abed R
J Endod · 2026 Jun · PMID 41571085 · Publisher ↗
INTRODUCTION: Cyclic fatigue failure is an inherent feature of rotary files when used in curved canals. This study aimed to assess the effect of repeated usage and autoclave sterilization on the dynamic cyclic fatigue re...
INTRODUCTION: Cyclic fatigue failure is an inherent feature of rotary files when used in curved canals. This study aimed to assess the effect of repeated usage and autoclave sterilization on the dynamic cyclic fatigue resistance of heat-treated nickel-titanium files used to prepare J-shaped canals. METHODS: New ProTaper Ultimate nickel-titanium files (Slider, Shaper, F1, F2) (n = 180) were divided into 3 groups (n = 60): Group N, included new files, were groups US-2 and US-4 included files subjected to 2 or 4 cycles of usage and sterilization, respectively. Files were used to prepare a resin-simulated J-shaped canal (19 mm length, 30° curvature) at 37°C. After each use, files were sterilized in an autoclave at 134°C for 25 minutes. Dynamic cyclic fatigue testing was then performed at 37°C, and the mean number of cycles to failure (NCF) was recorded. Fractured fragment lengths were measured using a digital microcaliper. Statistical analysis was performed using one-way ANOVA and the Kruskal-Wallis test. A P-value <.05 was considered significant. RESULTS: The Slider file consistently showed significantly higher NCF values than Shaper, F1, and F2 files in all the groups (P < .05). Repeated cycles of usage/sterilizations had an adverse effect on the cyclic fatigue resistance of all files, with a marked reduction after 4 uses. CONCLUSIONS: Repeated usage and autoclave sterilization showed a marked adverse effect on the novel heat-treated files. A positive correlation was seen between the increased number of usage and autoclave cycles and the reduction in NCF.
Laser-activated Versus Sonic-activated Irrigation for Removing Residual Filling Materials in Mandibular Molars: A Micro-Computed Tomography Study.
Lin Y, Teixeira F, He J … +3 more , Yamaguchi M, Huynh A, Jalali P
J Endod · 2026 Jun · PMID 41571084 · Publisher ↗
INTRODUCTION: Advanced irrigation plays a crucial role in nonsurgical retreatment cases, as these procedures require the removal of existing obturation materials while preserving dentin. The aim of this study was to comp...
INTRODUCTION: Advanced irrigation plays a crucial role in nonsurgical retreatment cases, as these procedures require the removal of existing obturation materials while preserving dentin. The aim of this study was to compare the effectiveness of laser-activated versus sonic-activated irrigation in removing residual obturation material in the mesial canals of mandibular molars with isthmuses during nonsurgical root canal retreatment. METHODS: Forty mesial canals of extracted mandibular molars were instrumented and obturated with gutta-percha and a bioceramic sealer. Retretments was performed using rotary instruments, followed by a final irrigation protocol consisting of 2.5% NaOCl, 17% EDTA, and a final rinse of 2.5% NaOCl using either sonic-activated or laser-activated irrigation (LAI). Micro-computed tomography scans were obtained before and after final irrigation. The volume of obturation material was measured to calculate the median percentage of remaining material in each group. RESULTS: The LAI group showed a significantly lower median percentage of remaining filling material than the sonic group (73.9% vs. 93.8%, P = .0165). However, neither irrigation protocol completely eliminates residual obturation material from the canals. CONCLUSION: LAI was more effective at removing remaining obturation material compared to sonic-activated irrigation.
GentleWave versus Established Irrigation Techniques: Current Evidence from a Scoping Review.
Karobari MI, Adil AH, Snigdha NT … +1 more , da Silva EJNL
J Endod · 2026 May · PMID 41571083 · Publisher ↗
INTRODUCTION: The GentleWave System, based on multisonic ultra-cleaning technology, has been proposed as an irrigation approach capable of enhancing disinfection while preserving dentin structure. However, evidence regar...
INTRODUCTION: The GentleWave System, based on multisonic ultra-cleaning technology, has been proposed as an irrigation approach capable of enhancing disinfection while preserving dentin structure. However, evidence regarding its comparative efficacy and clinical relevance remains inconsistent. This scoping review aimed to comprehensively evaluate the performance of the GentleWave System in comparison with conventional syringe irrigation and other activation techniques. METHODS: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Six electronic databases (PubMed, Scopus, Web of Science, Embase, Cochrane Library, and Google Scholar) were systematically searched without language restrictions. Studies were eligible if they compared GentleWave with at least one other irrigation or activation technique and reported measurable outcomes. In vitro, ex vivo, and clinical studies were included. Study characteristics, irrigation protocols, outcomes, and key findings were extracted and synthesized descriptively across thematic domains. RESULTS: Twenty-two studies met the inclusion criteria. Laboratory evidence demonstrated that GentleWave enhanced debris removal, irrigant penetration, and calcium hydroxide removal compared to conventional syringe irrigation. However, several studies have reported no significant differences between GentleWave and ultrasonic or sonic activation in terms of smear layer removal, biofilm reduction, or removal of filling materials. Findings related to endotoxin reduction and disinfection were also heterogeneous. Clinical evidence was limited and generally indicated no differences in postoperative pain or early healing when compared with alternative techniques. CONCLUSIONS: The present scoping review indicates that the GentleWave System demonstrates promising performance across multiple laboratory outcomes, particularly in debris removal, disinfection, and irrigant penetration. However, the available evidence remains inconsistent, with several well-designed studies reporting no significant differences between GentleWave and established irrigation or activation techniques.
CBCT Slice Thickness Impacts Diagnostic Accuracy of Periapical Lesion Volume.
Boubaris M, Cameron A, Manakil J … +1 more , George R
J Endod · 2026 Jun · PMID 41548800 · Publisher ↗
INTRODUCTION: This study assesses whether variations to cone-beam computed tomography (CBCT) slice thickness (ST) effect the detection accuracy and volume assessment of periapical lesions. METHODS: Forty periapical lesio...
INTRODUCTION: This study assesses whether variations to cone-beam computed tomography (CBCT) slice thickness (ST) effect the detection accuracy and volume assessment of periapical lesions. METHODS: Forty periapical lesions were assessed on CBCT reconstructions with 0.125-mm, 0.25-mm, 0.50-mm, 1.00-mm, 1.50-mm, and 2.00-mm ST. Mimics Research was used to perform the semi-automatic segmentation technique to determine periapical lesion volume and CBCT periapical volume index (CBCTPAVI) score on each CBCT reconstruction. Diagnostic accuracy was assessed by determining the percentage of lesions detected on each reconstruction, and the Friedman test was conducted to assess for significant differences in lesion volume between the different CBCT reconstructions. Differences among CBCTPAVI scores were also assessed. RESULTS: Periapical lesion volume was significantly underestimated on CBCT reconstructions with ST above 1.00 mm. Variations in periapical lesion volume were the greatest among smaller lesions resulting in false negative diagnoses with the utilization of CBCTs with ST above 0.50 mm. CONCLUSIONS: Variations in CBCT ST can significantly influence measured periapical lesion volume, and failure to account for this may lead to misinterpretation of lesion progression or healing. A minimum ST of 0.50 mm was required for the reliable detection of all periapical lesions, and this threshold serves as a benchmark for optimizing CBCT acquisition protocols to preserve diagnostic accuracy while minimizing radiation exposure.
Antibiofilm Activity and Cytocompatibility of Novel Enzymatic Root Canal Irrigants.
Prasad N, Shenoy S, Serra M … +6 more , Kumar MFSc M, Biradara S, Kabekkodu SP, Natarajan S, Neelakantan P, Thomas MS
J Endod · 2026 Apr · PMID 41544801 · Publisher ↗
INTRODUCTION: There is a need for safe and potent antibiofilm agents for root canal irrigation. The aim of this study was to investigate the antibiofilm activity of enzymatic irrigants (Bromelain and Papain) and their cy...
INTRODUCTION: There is a need for safe and potent antibiofilm agents for root canal irrigation. The aim of this study was to investigate the antibiofilm activity of enzymatic irrigants (Bromelain and Papain) and their cytocompatibility to mammalian cells. METHODS: Biofilms of Enterococcus faecalis were developed on dentin discs and treated with 0.05% bromelain, 4% papain, 2.5% sodium hypochlorite (NaOCl) or saline for 15 min. The antibiofilm effectiveness was characterized by quantifying the colony forming units (CFU) and confocal microscopic examination of the bacterial cells (live/dead staining) and extracellular matrix polysaccharide using a selective fluorophore binding assay. Cytotoxicity of 0.05% bromelain, 4% papain and 2.5% NaOCl to human periodontal ligament fibroblasts was investigated using a metabolic activity assay. Data were analyzed using analysis of variance and nonparametric tests, with significance set at P < .05. RESULTS: Papain (4%) and Bromelain (0.05%) demonstrated 5 log CFU reduction, which was comparable to 2.5% NaOCl (P > .05). Confocal microscopy further confirmed that bromelain, sodium hypochlorite, and papain caused significantly greater bacterial cell death compared to saline (P < .05). Papain significantly reduced the extracellular matrix polysaccharide content within the biofilm compared to all other groups (P < .05). CONCLUSION: This study demonstrated that bromelain and papain showed comparable antibiofilm activity as 2.5% NaOCl and were more biocompatible than NaOCl, highlighting their potential to be developed as root canal irrigants.
Long-Term Outcomes of Nonsurgical Endodontic Retreatment Performed by a Single Clinician in Private Practice: A Retrospective Cohort Study.
Pannkuk TF, Whitmore A, Kalaichelvan A … +5 more , Wang L, Glick I, Delano EO, Sigurdsson A, Burns LE
J Endod · 2026 May · PMID 41534608 · Publisher ↗
INTRODUCTION: The purpose of this study was to evaluate long-term outcomes of nonsurgical retreatment (NS-ReTx) procedures performed by a single endodontist in private practice. METHODS: This retrospective cohort study e...
INTRODUCTION: The purpose of this study was to evaluate long-term outcomes of nonsurgical retreatment (NS-ReTx) procedures performed by a single endodontist in private practice. METHODS: This retrospective cohort study evaluated NS-ReTx procedures performed between the years 1986 and 2019, meeting the following inclusion criteria: minimum of 1-year follow-up and preoperative, postoperative, and follow-up radiographs available for analysis. Procedures were evaluated clinically and radiographically, and treatment outcomes were reported. A subset of cases included cone-beam computed tomography (CBCT) images and CBCT-assessed periapical healing was reported for these cases. The effect of clinical factors on radiographic healing was assessed using a Cox proportional hazard regression model. The Kaplan-Meier method estimated the probability of tooth survival at each year of follow-up. RESULTS: A total of 241 NS-ReTx procedures from 202 patients met the inclusion criteria. The median patient age at time of NS-ReTx was 54 years. Molars were the most frequently treated tooth type, 57.68%. Radiographic healing at the median follow-up time, 9.14 years (n = 231) was 64.07% healed (148 of 231), 7.36% healing (17 of 231), and 28.57% unhealed (66 of 231). An additional 10 teeth were extracted before any radiographic follow-up. CBCT-assessed periapical healing ("strict" criteria) was 65.63% over a median follow-up time of 9.18 years. Tooth survival following NS-ReTx was 93.3% at 5 years and 85.3% at 10 years. CONCLUSIONS: The study demonstrates that radiographic periapical healing and treatment success improve over time and that tooth survival following NS-ReTx is favorable long-term.
Guided Double Auto-transplantation of Immature Molars Replacing Multiple Posterior Teeth with Extensive Invasive External Cervical Resorption - A Case Report.
Abella Sans F, Suresh N, Garcia-Font M … +3 more , Govindaraju L, Dummer PMH, Nagendrababu V
J Endod · 2026 May · PMID 41534607 · Publisher ↗
This case report describes the extraction of 3 mandibular posterior teeth (teeth #19, 20 and 21) with extensive invasive external cervical resorption (ECR) followed by guided double auto-transplantation of immature mandi...
This case report describes the extraction of 3 mandibular posterior teeth (teeth #19, 20 and 21) with extensive invasive external cervical resorption (ECR) followed by guided double auto-transplantation of immature mandibular third molars (teeth #17 and 32). A 17-year-old male with a history of orthodontic treatment reported with intermittent pain in the mandibular left posterior region. Clinical and radiographic examination revealed extensive tooth tissue loss in teeth #19, 20 and 21 that was diagnosed as class 3 ECR (Patel 3Dp for teeth #20 and 21, 3Bp for tooth #19). Guided double auto-transplantation of the immature molar tooth #17 was performed to replace premolar teeth 20 and 21, and tooth #32 to replace tooth #19. At the 6-month follow-up the donor tooth #32 had symptoms of pulpitis and was managed with a full pulpotomy using tricalcium silicate cement. Both teeth were followed-up for 36 months when they were asymptomatic, had no associated periodontal defects, had positive pulp sensibility tests as well as radiographic evidence of substantial periapical bony healing. The roots of tooth #17 had only a limited increase in length, with apical hard tissue barrier deposition, whereas tooth #32 (after pulpotomy) had continued root development. The 36 months follow-up of this case highlights the success of an interdisciplinary approach when integrating three-dimensional guides for double auto-transplantation of immature molars to successfully replace multiple teeth with extensive invasive ECR.
Micro-CT Analysis of MTA Apical Plug Placement: Manual Condensation, Indirect Ultrasonic Activation, and Sonic-Activated Rotary Compaction Techniques.
Harndamrong N, Wichai W, Jindachot S … +1 more , Jantarat J
J Endod · 2026 Apr · PMID 41534606 · Publisher ↗
INTRODUCTION: Mineral trioxide aggregate is widely used for apexification in immature permanent teeth owing to sealing ability and biocompatibility; however, placement in teeth with open apices may result in void, potent...
INTRODUCTION: Mineral trioxide aggregate is widely used for apexification in immature permanent teeth owing to sealing ability and biocompatibility; however, placement in teeth with open apices may result in void, potentially compromising the apical seal. This study compared mineral trioxide aggregate (MTA) apical plug quality and procedural time among 3 placement techniques. METHODS: Thirty extracted human mandibular premolars with simulated open apices (apical diameter, 0.8 mm) were randomly assigned to 3 groups (n = 10). Four-millimeter MTA apical plugs were placed using manual condensation, indirect ultrasonic activation, or sonic-activated rotary compaction. Micro-computed tomography quantified closed porosity (internal voids) and open porosity (interfacial gaps) as percentages of total apical plug volume. Procedural time was recorded, and data were analyzed statistically. RESULTS: Sonic-activated rotary compaction produced the lowest open porosity (0.001% ± 0.001%) and shortest procedural time (160.00 ± 6.50 s) but resulted in the highest closed porosity (0.412% ± 0.076%). Manual condensation demonstrated the highest open porosity (0.122% ± 0.063%) and moderate closed porosity (0.108% ± 0.076%), whereas indirect ultrasonic activation showed intermediate open porosity (0.006% ± 0.002%) and lowest closed porosity (0.079% ± 0.030%). Importantly, closed porosity did not differ significantly between the manual and ultrasonic groups (P = .523). Indirect ultrasonic activation required the longest procedural time (270.30 ± 7.27 s), followed by manual condensation (229.20 ± 6.34 s), whereas sonic-activated rotary compaction was the most time-efficient. All other intergroup differences were statistically significant (P < .001). CONCLUSIONS: Sonic-activated rotary compaction demonstrated the lowest open porosity and greatest time efficiency among 3 techniques, although it produced the highest closed porosity.
Mechanical Memory and NF-κB Signaling in Dental Pulp Stem Cell Odontogenic Differentiation.
Ghaffari M, Shrestha A
J Endod · 2026 Jan · PMID 41520920 · Publisher ↗
INTRODUCTION: This study aimed to investigate how substrate stiffness and dimensionality regulate stemness, senescence, and subsequent odontogenic differentiation in dental pulp stem cells (DPSCs). It further examines th...
INTRODUCTION: This study aimed to investigate how substrate stiffness and dimensionality regulate stemness, senescence, and subsequent odontogenic differentiation in dental pulp stem cells (DPSCs). It further examines the interplay of priming period and odontogenic induction and elucidates the role of NF-κB signaling in this process. METHODS: Mechano-variant PDMS substrates with tunable stiffness (2kPa to 50kPa) were fabricated for 2D and 3D cultures. DPSCs were primed on these substrates for 7 days and subsequently induced for odontogenesis. Analyses included gene expression, immunofluorescence imaging, and matrix mineralization. RESULTS: The 2kPa substrates significantly enhanced early odontogenic differentiation, evidenced by upregulation of DMP-1 and DSPP, along with higher expression of stemness markers (NANOG, SOX-2). This condition minimized senescence and promoted mixed nuclear and cytoplasmic NF-κB localization, suggesting a priming effect for efficient differentiation. In contrast, 3D substrates exhibited delayed but robust odontogenic responses, coupled with increased epigenetic regulation (HAT-1, HDAC-1) and elevated XRCC5 expression at day 21, indicating active DNA repair and intermediate senescence levels that stabilized over time. CONCLUSIONS: Soft substrates (2kPa) preserve stemness and promote early differentiation, while 3D environments favor late-stage differentiation and balanced senescence. These findings emphasize the importance of priming period and dimensionality in optimizing MSC-based regenerative therapies.
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