INTRODUCTION: Laser activated irrigation (LAI) has enhanced the cleaning and disinfection of root canals. However, limited evidence exists regarding its effects on dentin's structural integrity. Although proven to enhanc...INTRODUCTION: Laser activated irrigation (LAI) has enhanced the cleaning and disinfection of root canals. However, limited evidence exists regarding its effects on dentin's structural integrity. Although proven to enhance cleaning and disinfection results, it was anticipated that LAI use may alter the root dentin surface due to thermal effects. METHODS: Forty-two single-rooted human premolars were instrumented and randomly divided into 3 groups: A) control group (n = 14) no laser treatment; B) irrigant activation using diode laser (980 nm, 10 Hz, 200 μm, 21 mm) (n = 14); and C) irrigant activation using Er,Cr:YSGG laser (2940 nm, 25 mJ, 10 Hz, 60 μs 200 μm, 21 mm) (n = 14). The root canal dentin samples were subjected to scanning electron microscopy, energy dispersive X-ray spectroscopy, Fourier transform infrared spectroscopy (FTIR), and nanoindentation analysis. Sample size was calculated using G∗Power, and data were statistically analyzed using one-way ANOVA and post hoc Tukey tests through SPSS software (IBM Corp. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY). RESULTS: FTIR analysis of diode-treated dentin revealed structural degradation with new hydroxyl groups (3829.74, 3744.47 cm) and strong carbonyl peak (1741.30 cm). FTIR compositional analysis showed destruction of amide (collagen), phosphate, and carbonate contents in laser groups. Elemental analysis showed significantly increased Ca and P peaks. Structural examination revealed excessive thermal-stress-induced cracking in the diode group and moderate cracking in Er,Cr:YSGG group. Mean hardness (HIT, HVIT) and elastic modulus differed significantly between control and both laser groups. Traditional root canal disinfection produced minimal structural damage across all analyses. CONCLUSIONS: LAI significantly altered the tested properties of root dentin. Er,Cr:YSGG showed comparatively lesser structural damage than diode laser based irrigant activation.
INTRODUCTION: The aim of this study was to compare the biomechanical effects of mineral trioxide aggregate (MTA) and Biodentine for repairing root perforations in conjunction with 2 obturation strategies (complete versus...INTRODUCTION: The aim of this study was to compare the biomechanical effects of mineral trioxide aggregate (MTA) and Biodentine for repairing root perforations in conjunction with 2 obturation strategies (complete versus partial gutta-percha obturation) on the fracture resistance of maxillary first premolars. The incidence of these treatment modalities on the probability of fracture risk was evaluated quantitatively. METHODS: Seven three-dimensional finite element models were constructed from cone-beam computed tomography data. The tooth models that were used consisted of a sound tooth model (SD), a root canal-filled model, an unrepaired perforation model, and four treatment models consisting of MTA/Biodentine combined with complete (All GP) or partial gutta-percha obturation being Part GP. The stress distribution under a 300 newton (N) occlusal load was then analyzed, and the fracture probability (P) was assessed using a Weibull analysis over a load range of 0-600 N. RESULTS: Under a 300 N load, the unrepaired perforation model showed a significantly higher P (10.15%), which was 10.6 times greater than SD's. All treatment models restored dentin stress to near-SD levels (9.71-10.01 MPa). When combined with the All GP strategy, both MTA and Biodentine achieved P values comparable to root canal-filled model (2.84% at 300 N). In contrast, the Part GP strategy resulted in higher stress values in the coronal enamel and midroot dentin, and higher P values (3.24%-3.99% at 300 N). CONCLUSION: Both MTA and Biodentine are effective at restoring the biomechanical performance of perforated teeth. The obturation strategy significantly influences the long-term fracture risk. The All GP strategy combined with either repair material optimizes fracture resistance and minimizes failure risk. As a result, it is recommended as the preferred clinical technique.
INTRODUCTION: This study aimed to evaluate the impact of mineral trioxide aggregate (MTA)- and putty-based regenerative and one-step apexification protocols on the fracture strength and failure patterns of immature teeth...INTRODUCTION: This study aimed to evaluate the impact of mineral trioxide aggregate (MTA)- and putty-based regenerative and one-step apexification protocols on the fracture strength and failure patterns of immature teeth. METHODS: Seventy-two extracted human maxillary central incisors were decoronated and prepared to simulate immature root morphology. The samples were randomly divided into 8 groups (n = 10): negative control (sound teeth), positive control (simulated immature teeth with no intervention), full MTA, full putty, apical MTA barrier + warm vertical compaction (WVC), apical putty barrier + WVC, regenerative MTA, and regenerative putty groups. After material placement and restoration, all specimens were embedded in acrylic blocks and loaded at 135° to the long axis using a universal testing machine at a crosshead speed of 0.5 mm/min until fracture occurred. The maximum load at fracture (N/cm) and fracture location (above or below the cementoenamel junction) were recorded. Data were analyzed using the Kruskal-Wallis and Dunn tests, Fisher's exact test, and Weibull analysis (P < .05). RESULTS: Significant differences in fracture strength were observed among the groups (P < .05), whereas fracture location did not differ significantly (P > .05). The lowest mean fracture strength was found in the regenerative putty group, while the full MTA group exhibited the highest values. Weibull analysis revealed no significant difference in the shape parameter (P = .108), but the scale parameter differed significantly among the groups (P < .001), confirming greater reliability and characteristic strength in MTA-based protocols. CONCLUSIONS: Filling immature roots entirely with MTA or using an apical MTA plug followed by WVC provided superior and more consistent fracture resistance compared with putty-based regenerative protocols. Bioceramic putty may not be a good choice for regenerative applications when the reinforcement of immature teeth is desired.
OBJECTIVE: To compare intraorifice barrier materials for reinforcing endodontically treated teeth using a network meta-analysis of in vitro studies. METHODS: EBSCO, PubMed, Virtual Health Library, Ovid, Web of Science, S...OBJECTIVE: To compare intraorifice barrier materials for reinforcing endodontically treated teeth using a network meta-analysis of in vitro studies. METHODS: EBSCO, PubMed, Virtual Health Library, Ovid, Web of Science, Scopus, Cochrane Library, and Google Scholar were searched to December 2025. Eligible studies compared at least 2 of the following: alkasite restorative material, composite resin, fiber-reinforced composite (FRC), resin-modified glass ionomer cement (RMGIC), flowable composite, Biodentine, mineral trioxide aggregate (MTA), and control. The primary outcome was fracture resistance (Newtons). The analysis was conducted in MetaInsight v6.4.0 (Complex Reviews Synthesis Unit, NIHR (Evidence Synthesis Group, University of Glasgow), Glasgow, United Kingdom) using its Bayesian option; results are reported as 95% credible intervals (CrIs). Treatment hierarchy was summarized with SUCRA. Small-study effects were assessed with funnel plot and Egger's test. RESULTS: Twenty studies met the eligibility criteria; 14 contributed to the network meta-analysis. Versus control, fracture resistance increased with alkasite restorative material (MD 406.37; 95% CrI 133.4-679.8), FRC (MD 370.83; 95% CrI 168.82- 574.27), composite resin (MD 360.62; 95% CrI 181.92-555.15), RMGIC (MD 310.82; 95% CrI 180.93-449.62), flowable composite (MD 285.5; 95% CrI 107.79-468.35) and Biodentine (MD 230.83; 95% CrI 66.55-401.34). MTA showed no clear benefit (MD 60.41; 95% CrI -123.08- 242.82). SUCRA ranking favored alkasite restorative material, followed by FRC, composite resin, RMGIC, flowable composite resin, Biodentine, MTA, and control. Node-split analyses indicated some local inconsistency across a subset of contrasts (2 of 28 contrasts; minimum P = .003). Funnel-plot inspection and Egger's test did not suggest small-study effects (P = .664). CONCLUSIONS: Use of an intraorifice barrier generally improves the fracture resistance of endodontically treated teeth. Materials traditionally categorized as restorative materials (alkasite, resin composites, FRC, and RMGIC) tended to rank higher than calcium silicate-based barriers (Biodentine, MTA) in vitro. Standardized testing protocols are needed to optimize material selection.
The dental pulp is a highly vascularized and innervated connective tissue located at the central part of the tooth and composed of a diverse array of cell types, including fibroblasts, multipotent mesenchymal stem cell,...The dental pulp is a highly vascularized and innervated connective tissue located at the central part of the tooth and composed of a diverse array of cell types, including fibroblasts, multipotent mesenchymal stem cell, odontoblasts, and immune cells. Traumatic injuries and carious lesions can lead to dental pulp pathologies that often require replacement of damaged tissue with inert materials. Despite significant progress in recent years, cell-based dental pulp regenerative therapies remain distant from clinical applications. The lack of platforms capable of accurately modeling the human dental pulp in all its complexity hampers the development of novel therapeutic strategies. In response, numerous efforts have been focused on the development of innovative microfluidic systems designed to emulate human dental pulp physiology. These "dental pulp-on-chip" platforms enable the recreation of structural and functional complexity in an in vivo-like environment, opening new horizons for patient-specific endodontic therapies and providing valuable tools for targeted drug testing. This review focuses on state-of-the-art microfluidic devices designed to emulate the dental pulp and their specific applications in dental materials testing, drug evaluation, and pulp regeneration. By integrating multiple cell types, biomaterials, and bioactive cues within dynamic microenvironments, "dental pulp-on-chip" devices overcome the constraints of traditional in vitro cultures and animal models and enable the assessment of treatment-induced systemic effects, an aspect often overlooked in dental research. Continued advancements in "dental pulp-on-chip" technology will be pivotal for bridging preclinical research and clinical practice in dental medicine.
INTRODUCTION: Endodontic kinematics are associated with varying levels of inflammatory response and postoperative pain. The effect of apical motion algorithms in integrated endodontic motors on this relationship has not...INTRODUCTION: Endodontic kinematics are associated with varying levels of inflammatory response and postoperative pain. The effect of apical motion algorithms in integrated endodontic motors on this relationship has not been clinically evaluated. This study aimed to evaluate the effects of root canal preparation with continuous rotation (CR) and 2 different apical action algorithms on periapical inflammation mediator and patient-reported pain outcomes. METHODS: Sixty-six patients with asymptomatic pulpitis, symptomatic irreversible pulpitis, and normal pulps to be exposed for prosthetic preparation requiring endodontic treatment were randomly assigned to three groups: CR, auto apical reverse (AAR) and auto apical slow-down. Root canal instrumentation was performed and apical exudate samples were collected on postoperative Days 0 and 3 are analyzed for inflammatory mediators, including substance P (SP), tumor necrosis factor-α, interleukin-1β and interleukin-6. Preoperative and postoperative Day 3 visual analog scale pain scores were recorded. RESULTS: SP levels on Day 0 (P < .001) and Day 3 (P = .001) were significantly higher in the AAR group. No significant differences were found between the groups regarding postoperative pain scores. When cytokines were assessed in terms of percent change, only tumor necrosis factor-α showed a significant increase in the auto apical slow-down group compared to the CR group (P = .035). CONCLUSION: This study demonstrated that different apical actions influence the levels of inflammatory mediators in periapical tissues. AAR was found to be associated with higher SP release on both sampling times. However, the variations in mediator levels didn't translate into differences in pain outcomes. Further research is needed to clarify the effects of apical actions on inflammation, pain, and overall clinical outcomes.
INTRODUCTION: To investigate the geometric angle method of "danger zone" (DZ) position in the mesial roots of mandibular first molars (MFMs) using cone-beam computed tomography (CBCT) and micro-computed tomography (Micro...INTRODUCTION: To investigate the geometric angle method of "danger zone" (DZ) position in the mesial roots of mandibular first molars (MFMs) using cone-beam computed tomography (CBCT) and micro-computed tomography (Micro-CT). METHODS: The CBCT images of 949 MFMs with mesial roots of single root and 2 root canals were collected and analyzed with DZ and α (the angle between the line extending from the center of buccal/lingual root canal to DZ and the line connecting the centers of the buccal and lingual root canals) of the mesial roots in the coronal and middle thirds of roots. Thirty-four MFMs with similar root canal morphologies were analyzed using Micro-CT to validate the geometric positioning method based on CBCT. The association of α with the root lengths, inter-orifice canal distance (D), age and gender were subsequently investigated. Values with P < .05 were considered statistically significant. RESULTS: The DZ of MFMs was mainly located in the middle thirds of the distal wall, with an average thickness of 0.818 ± 0.143 mm. The average α was 71.9 ± 9.0°, ranging from 42.7° to 99.9° and showed approximately 87.8% of value concentrated within the range of 60.1°-86.2°. The α was negatively correlated with the D (P < .01) and had no correlation with age or gender (P > .05). Results of the Micro-CT analyses showed that the α was 70.4 ± 7.3°, ranging from 48.9° to 85.6°, and 92.7% of the α were also within the range of 60.1°-86.2° established by CBCT. CONCLUSIONS: From a geometric perspective, the distribution of DZ in the mesial roots of MFMs demonstrated a relatively consistent spatial pattern. This predictable localization may assist clinicians in accurately identifying DZ positions and improving treatment planning.
INTRODUCTION: This study compared the quality of placement and removal of a bioceramic intracanal medication (Bio-C Temp) and a calcium hydroxide-based medication (UltraCal XS) using micro-computed tomography (micro-CT)...INTRODUCTION: This study compared the quality of placement and removal of a bioceramic intracanal medication (Bio-C Temp) and a calcium hydroxide-based medication (UltraCal XS) using micro-computed tomography (micro-CT) analysis. METHODS: Mandibular molars with Vertucci type II mesial root configuration were selected based on micro-CT evaluation. Teeth were allocated into 2 matched groups according to root canal anatomy and volume as similar as possible. Canals were instrumented using WaveOne Gold Primary files. Medications were injected into the canal using a syringe according to the manufacturer's instructions: UltraCal XS (Ultradent, USA) or Bio-C Temp (Angelus, Brazil). After 15 days, the medication was removed by using ultrasonic activation of 2.5% NaOCl. Micro-CT scans were taken after instrumentation, and medication placement and removal to quantify the canal volume and medication volume. RESULTS: No significant differences in medication filling or removal were observed between groups at either the 4-mm or 8-mm canal levels from the apical foramen (P > .05). After placement, Bio-C Temp filled 73% of the full canal length and 30% of the apical 4-mm segment, while UltraCal XS filled 57% and 25%, respectively. The removal protocol substantially reduced medication volumes in both groups, with mean reductions of 91.9% and 88.5% for Bio-C Temp and 82.6% and 81.3% for UltraCal XS in the full canal and apical segments, respectively. Complete elimination was observed in only a few specimens from both groups. CONCLUSION: UltraCal XS and Bio-C Temp exhibited similar results in terms of placement and removal. Neither material completely filled the prepared canal, and removal with ultrasonic activation also failed to achieve complete elimination in most specimens.
INTRODUCTION: Dental pulp stem cells have been explored as a potential source for dentin-pulp complex regeneration because of their pluripotency and differentiation capacity. However, cell-based approaches require enzyma...INTRODUCTION: Dental pulp stem cells have been explored as a potential source for dentin-pulp complex regeneration because of their pluripotency and differentiation capacity. However, cell-based approaches require enzymatic digestion and in vitro expansion, which may alter cell properties and hinder clinical translation. This preliminary proof-of-principle study examines a tissue-based alternative using freshly minced pulp (MP) in an ectopic mouse model as a potentially translatable approach for regenerative endodontics. METHODS: Human dental pulp tissue was either minced or enzymatically digested, seeded onto collagen type I scaffolds, inserted into root fragments, and implanted subcutaneously into immunocompromised mice. RESULTS: Histology revealed that MP grafting generated well-organized dentin-pulp-like tissue with high cellularity, vascularization, mineralization, and odontoblast-like cells extending processes into dentinal tubules, whereas dental pulp stem cell grafts formed less organized tissue and mineral deposits. MP-derived tissues also exhibited angiogenic potential, forming vessel-like structures containing pericytes and endothelial cells. CONCLUSIONS: This preliminary in vivo mouse study suggests the feasibility of MP transplantation and its potential for dentin-pulp complex regeneration, though further studies are needed to assess long-term outcomes and clinical applicability.
The following statement was prepared by the Special Committee to Revise the Joint Position Statement on Cone-Beam Computed Tomography of the American Association of Endodontists (AAE) and the American Academy of Oral and...The following statement was prepared by the Special Committee to Revise the Joint Position Statement on Cone-Beam Computed Tomography of the American Association of Endodontists (AAE) and the American Academy of Oral and Maxillofacial Radiology (AAOMR), and was approved by the AAE Board of Directors and the AAOMR Executive Council in the spring of 2025.
INTRODUCTION: Medication-related osteonecrosis of the jaws (MRONJ) is a condition that causes progressive bone destruction and compromises patients' function, aesthetics, and quality of life. OBJECTIVES: This study aims...INTRODUCTION: Medication-related osteonecrosis of the jaws (MRONJ) is a condition that causes progressive bone destruction and compromises patients' function, aesthetics, and quality of life. OBJECTIVES: This study aims to investigate the role of untreated apical periodontitis (AP) in the development of MRONJ. METHODS: A comprehensive search was performed in PubMed/MEDLINE, Web of Science, Scopus, and Embase. Gray literature was assessed using the ProQuest database. The eligibility criteria consisted of (1) preclinical studies; (2) use of antiresorptive, antiangiogenics, or other drugs known to cause MRONJ; (3) studies evaluating the development of osteonecrosis in regions of AP lesions. The following studies were excluded: (1) non-animal studies. Two independent reviewers performed data extraction and the assessment of the risk of bias. RESULTS: From an initial dataset of 239 records, we included 11 studies. Induction of periapical lesions was performed most often after the administration of bisphosphonates. Zoledronic acid was the most used drug. Histologic or clinical evidence of MRONJ in areas of untreated AP was reported in 72.72% of the studies. Furthermore, areas with AP presented MRONJ more frequently, with or without clinical signs. CONCLUSIONS: This systematic review of preclinical studies indicates that untreated AP, in the context of antiresorptive therapy, may increase the risk of MRONJ. Our findings provide mechanistic insights that clarify how AP may contribute to MRONJ pathogenesis, offering a theoretical background to support clinical observations. While human studies suggest a potential pathogenic interaction, they remain limited by heterogeneous designs, variable definitions of oral infections, and frequent grouping of AP with other conditions. These limitations underscore the translational significance of our preclinical analysis. Overall, our results reinforce the importance of early diagnosis and management of endodontic infections in patients receiving antiresorptive particularly cancer patients exposed to higher cumulative doses and highlight the need for well-designed prospective clinical studies to determine whether AP constitutes an independent risk factor for MRONJ.
de Souza da Silva MP, da Costa Ribeiro A, Bezerra de Oliveira JR
… +5 more, Duarte DA, de Carvalho BF, Proenza YG, Velozo Dos Santos Mendonça NM, Leonidas Gomes AS
INTRODUCTION: Although ultrasonic inserts are frequently used for the instrumentation of flat root canals, there is a lack of studies investigating whether instrument contact with the canal walls induces the formation of...INTRODUCTION: Although ultrasonic inserts are frequently used for the instrumentation of flat root canals, there is a lack of studies investigating whether instrument contact with the canal walls induces the formation of dentinal microcracks. This study aimed to evaluate the formation of apical microcracks, caused by ultrasonic instrumentation, using micro-computed tomography (microCT) and optical coherence tomography (OCT). METHOD: Twenty maxillary second premolars were randomly divided into 2 groups (n = 10): ultrasonic group and brushing group. All specimens were initially prepared using Reciproc Blue files 25/.05 and 40/.06. The brushing group received additional brushing movements with Reciproc Blue 40/.06 and the ultrasonic group underwent instrumentation with a Clearsonic Black ultrasonic insert. Pre- and post-instrumentation images were obtained using both microCT and OCT and were analyzed with specialized software. RESULTS: Statistically significant difference was observed for the treatment variable regarding apical microcrack presence (P < .05). In the brushing group, all apical microcracks identified post-instrumentation were also present preoperatively. In contrast, new incidences were identified in the ultrasonic group via microCT. No significant differences were found for the evaluator (P > .05) or the imaging technique used (P > .05). Intra- and interexaminer agreement was nearly perfect, with kappa values ranging from 0.858 to 0.975. CONCLUSION: The inclusion of an ultrasonic insert during biomechanical preparation did not significantly increase the incidence of apical microcracks when compared with a nonultrasonic protocol. OCT demonstrated high reliability for detecting apical microcracks in extracted teeth.
This case report describes the replacement of a missing maxillary right central incisor (tooth number 8) with a supernumerary tooth using cone beam computed tomography based digital planning, a three-dimensional printed...This case report describes the replacement of a missing maxillary right central incisor (tooth number 8) with a supernumerary tooth using cone beam computed tomography based digital planning, a three-dimensional printed donor replica tooth, osseodensification, and connective tissue grafting. A 36-year-old male presented with general periodontitis and a healed socket in the number 8 region 3 months postavulsion. Based on cone beam computed tomography scans, auto-transplantation of a single-rooted mandibular supernumerary tooth into a surgically created socket in the number 8 region was planned. Root canal treatment was performed on the donor tooth prior to its extraction. Digital planning was performed, and a three-dimensional replica of the donor tooth was designed and printed. The surgically created socket was prepared with an osseodensification technique. Extraction of the donor tooth was performed atraumatically, and soft tissue grafting and splint stabilization was performed after its placement in the socket. A definitive crown was placed at 12 months. At 30 months the transplanted tooth was functional and asymptomatic, with no clinical or radiographic signs of apical pathosis.
INTRODUCTION: Acute apical abscesses are known for rapid-onset pain and swelling from pulp necrosis. While typically associated with polymicrobial infections, recent research suggests that active herpesvirus infections m...INTRODUCTION: Acute apical abscesses are known for rapid-onset pain and swelling from pulp necrosis. While typically associated with polymicrobial infections, recent research suggests that active herpesvirus infections may also contribute. This randomized, double-blind, placebo-controlled trial aimed to evaluate if valacyclovir, when combined with amoxicillin, can consistently manage pain and how individual patients respond within a larger population. METHODS: This study enrolled 38 emergency patients with moderate to severe pain from acute apical abscesses, randomizing them into 2 treatment groups. Patients in the valacyclovir group (n = 21) received a 1g loading dose of amoxicillin (followed by 500 mg four times daily for 7 days) and a 2g loading dose of valacyclovir (followed by 500 mg twice daily for 3 days). The placebo group (n = 17) received the same amoxicillin regimen along with a placebo. Over a 6-day follow-up, we used daily phone calls to track pain levels with a numeric rating scale and monitor analgesic use. Outcome data were analyzed using the Mann-Whitney and Friedman statistical tests. RESULTS: The valacyclovir group showed significantly lower mean pain scores on Days 1-3 (P < .05). They experienced a faster reduction in moderate/severe pain and a higher rate of reporting no pain (numeric rating scale= 0) throughout the study. Analgesic use dropped sharply in the valacyclovir group, with only 28.6% using analgesics on Day 1 compared to 82.4% in the placebo group. This consistently lower usage was maintained through Day 6. CONCLUSION: Valacyclovir shows promise as an adjunctive therapy for early pain relief in patients with acute apical abscesses.