Journal Of Endodontics[JOURNAL]
Sun
200 papers
A Novel Robot-Assisted Access in Endodontic Microsurgery Combined with Sinus Floor Elevation for Maxillary First Molar.
Qiao W, Qin L, Chen C … +4 more , Lin Y, Zhang X, Zhou Y, Meng L
J Endod · 2026 Mar · PMID 41338471 · Publisher ↗
Endodontic microsurgery (EMS) is an important treatment option for endodontic disease when the nonsurgical endodontic treatment fails. However, EMS for maxillary molars often presents a clinical challenge due to the root...
Endodontic microsurgery (EMS) is an important treatment option for endodontic disease when the nonsurgical endodontic treatment fails. However, EMS for maxillary molars often presents a clinical challenge due to the root apex close to the maxillary sinus floor, which may increase the risk of sinus membrane perforation. Furthermore, the depth between the apex of the palatal root and the buccal cortical plate significantly impacts EMS precision for restricting visualization and instrument access. This case report is the first to use an autonomous robotic system for minimally invasive EMS on a maxillary first molar, combined with precise lateral wall sinus fenestration. A 55-year-old male patient presented with symptomatic apical periodontitis associated with previously treated left maxillary first molar. Cone-beam computed tomography revealed low-density areas surrounding the mesiobuccal and palatal (P) roots, and maxillary sinus floor descended between the palatal and buccal roots. Integrating cone-beam computed tomography and intraoral scan data, the autonomous robotic system performed guided sinus fenestration localization, autonomous osteotomy, and a 15-mm root-end resection from buccal to palatal root, with real-time monitoring of depth, angulation, and force. The clinician employed endoscopic assistance to verify the integrity of the sinus membrane and ensure the removal of debris from the surgical site. Root-end preparation and filling were carried out under a microscope. Follow-ups at 1 week, 1 month, 3 months, and 6 months indicated an absence of clinical symptoms. This approach offers a precise and minimally invasive treatment option for molars with a descended maxillary sinus floor located between the buccal and palatal root.
Conservative Management of Internal Root Resorptions and a Large Periapical Lesion with Combined Nonsurgical Treatment and Decompression: A Case Report with 3 years Follow-up.
Brochado Martins JF, Georgiou AC, Dommering F … +1 more , Shemesh H
J Endod · 2026 Apr · PMID 41338470 · Publisher ↗
Occlusal trauma is increasingly recognized as a significant contributor to pulpal inflammation, potentially leading to internal root resorption. Internal root resorption is a rare, chronic inflammatory process characteri...
Occlusal trauma is increasingly recognized as a significant contributor to pulpal inflammation, potentially leading to internal root resorption. Internal root resorption is a rare, chronic inflammatory process characterized by dentin loss within the pulp space. Typically asymptomatic, it is often discovered incidentally during radiographic examination. Managing large cyst-like periapical lesions associated with internal resorption presents challenges, particularly when nonsurgical treatments are unsuccessful. Decompression, a minimally invasive technique, has shown promising outcomes but remains underutilized. This report describes the management of a 51-year-old male presenting with multiple internal root resorption defects and a large periapical lesion in a mandibular incisor, likely caused by occlusal trauma. Nonsurgical root canal treatment combined with decompression led to complete clinical and radiographic healing at the three-year follow-up. This case highlights decompression as a conservative strategy for treating large periapical lesions and emphasizes the potential contribution of occlusal trauma to the development of internal root resorption.
Improved Root Canal Disinfection through Extended Sodium Hypochlorite Exposure and Renewal after Preparation Procedures.
Silva EJNL, da Silva DVF, Massa GDS … +4 more , Coelho BP, Sassone LM, Versiani MA, Barbosa AFA
J Endod · 2026 Mar · PMID 41319936 · Publisher ↗
INTRODUCTION: This study evaluated whether extending sodium hypochlorite (NaOCl) contact time with periodic renewal after preparation enhances root canal disinfection compared with a standard continuous-irrigation protoc...
INTRODUCTION: This study evaluated whether extending sodium hypochlorite (NaOCl) contact time with periodic renewal after preparation enhances root canal disinfection compared with a standard continuous-irrigation protocol. MATERIALS AND METHODS: Twenty-eight bovine incisors were contaminated with Enterococcus faecalis (ATCC 29212) for 28 days. Specimens were assigned to 2 experimental groups (n = 10) and 2 controls (positive, n = 4; negative, n = 4). Experimental canals received either standard continuous irrigation (20 mL 1% NaOCl over 4 min) or an extended protocol, in which 5 mL 1% NaOCl was left in situ for 5 min and replenished over 4 cycles, with a total of 20 mL. All canals were subsequently irrigated with 6 mL 17% ethylenediaminetetraacetic acid and 6 mL 1% NaOCl under ultrasonic activation, followed by NaOCl neutralization. Microbiological samples were collected at baseline (S1), after primary irrigation (S2), and after final irrigation/activation (S3) using paper points and Hedström file scrapings. Colony-forming units (CFU) were quantified on Mitis Salivarius agar. Statistics comparison was performed with Kruskal-Wallis and Mann-Whitney U tests (α = 0.05). RESULTS: Negative controls confirmed asepsis, and positive controls verified bacterial viability. Both irrigation protocols significantly reduced CFU counts at S2 and S3 compared with baseline (P < .05). The extended protocol yielded lower CFU counts than standard irrigation at both postirrigation time points (P < .05). Overall bacterial reduction from baseline to final sampling (S1→S3) was significantly greater for the extended protocol (P = .027), while intermediate reduction (S1→S2) did not differ between groups (P > .05). CONCLUSIONS: The extended protocol resulted in a significantly greater microbial reduction compared with standard continuous irrigation.
Impact of Maxillary Sinus Mucosal Thickening on Endodontic Outcomes: A Retrospective Cone-beam Computed Tomographic Cohort Study.
Buizastrow J, Roque-Torres GD, Handysides R … +5 more , Gray R, Noorvash S, Oyoyo U, Silvestrin T, Rice DD
J Endod · 2026 Apr · PMID 41297838 · Publisher ↗
INTRODUCTION: To evaluate whether maxillary sinus mucosal thickening (MT) observed on cone-beam computed tomography (CBCT) influences endodontic outcomes, and to identify other radiographic predictors of healing. METHODS...
INTRODUCTION: To evaluate whether maxillary sinus mucosal thickening (MT) observed on cone-beam computed tomography (CBCT) influences endodontic outcomes, and to identify other radiographic predictors of healing. METHODS: This retrospective cohort study included cases treated at a graduate endodontic clinic with pretreatment or intraoperative limited field-of-view CBCT scans and a minimum 5.5 months recall. MT was measured in coronal and sagittal planes and classified by severity, morphology, and presumed origin. Additional variables included CBCT-periapical index (CBCT-PAI) scores, lesion proximity, and treatment type and quality. Outcomes were assessed with clinical testing and periapical radiographs. Associations were analyzed with bivariate tests and multivariable logistic regression. RESULTS: MT ≥ 2 mm was present in 70% of cases, most commonly with polypoidal morphology and presumed odontogenic origin. However, MT presence, severity, and origin showed no association with treatment outcome. In contrast, changes in periapical index (ΔPAI) strongly correlated with favorable healing, while higher baseline CBCT-PAI scores and retreatment cases were linked with less favorable outcomes. CONCLUSIONS: MT was a frequent radiographic finding but was not prognostic of endodontic healing. Prognosis was best indicated by ΔPAI, with baseline lesion severity and treatment type contributing additional value. ΔPAI should be interpreted in conjunction with clinical findings and patient-reported symptoms to provide a comprehensive assessment of treatment outcome.
Detection Thresholds for Root Canal Visibility on High-Resolution CBCT: A Micro-CT Validation Study.
Patel K, Wang FM, Tahmasbi M … +3 more , Teixeira F, Nair M, Jalali P
J Endod · 2026 Mar · PMID 41285308 · Publisher ↗
INTRODUCTION: Cone-beam computed tomography (CBCT) is widely used to assess root canal morphology, yet practical size thresholds for canal visibility have not been established. This study determined the relationship betw...
INTRODUCTION: Cone-beam computed tomography (CBCT) is widely used to assess root canal morphology, yet practical size thresholds for canal visibility have not been established. This study determined the relationship between canal diameter and the probability of confident detection on high-resolution CBCT using micro-computed tomography (micro-CT) for reference. METHODS: Sixty-one extracted human teeth (251 canal cross-sections, including 9 with no visible lumen) were imaged with both imaging modalities. True canal diameters measured on micro-CT were spatially matched to corresponding CBCT cross-sections using anatomical landmarks. Three calibrated observers rated canal visibility on a 5-point scale; scores ≥4 indicated confident detection. Interobserver reliability was quantified using Krippendorff's α and quadratic-weighted κ. A binomial logistic regression modeled detection probability as a function of diameter. Receiver operating characteristic (ROC) analysis assessed overall discriminative accuracy. RESULTS: Interobserver agreement was excellent (α = 0.87; κ = 0.78-0.91). The probability of confident canal detection increased sharply with canal diameter. Model estimates indicated a 70% probability (D) at a canal diameter of approximately 265 μm, an 80% probability (D) at 299 μm, and a 90% probability (D) at 350 μm. ROC analysis demonstrated excellent discriminative performance (area under the curve = 0.89), confirming strong accuracy of CBCT visibility scores for identifying canals present on micro-CT. CONCLUSIONS: On 80-μm-voxel CBCT, consistent canal visibility emerges at approximately 300 μm. Canals measuring 200 to 300 μm are often visible, whereas those smaller than about 200 μm are frequently missed. The detection thresholds identified in this study may help clinicians anticipate when a canal is likely still patent but radiographically undetectable.
Top 100 Most Cited Articles on Antibiotics in Endodontics: A Bibliometric Analysis.
Albanyan H, Asseery M, Alahmari H … +2 more , Haq IU, Alaqla A
J Endod · 2026 Mar · PMID 41276250 · Publisher ↗
INTRODUCTION: This bibliometric study aimed to evaluate the 100 most cited articles on antibiotics in endodontics using the Web of Science database. METHODS: Articles were identified using the keywords "Endodontics" AND...
INTRODUCTION: This bibliometric study aimed to evaluate the 100 most cited articles on antibiotics in endodontics using the Web of Science database. METHODS: Articles were identified using the keywords "Endodontics" AND "Antibiotics" and ranked by citation count. Key bibliometric indicators including publication and citation trends, study designs, levels of evidence, top sources, authors, countries, institutions, and most frequently occurring keywords were analyzed using Microsoft Excel version-16 and Visualization of Similarities Viewer. RESULT: The top 100 most cited articles were published between 1954 and 2022, across 40 different sources, and were authored by 397 researchers from 30 countries. Most publications (76%) were from 2006 to 2019. The United States, Brazil, and England were the leading contributors. Cross-sectional studies and reviews were the most common designs with level of evidence V dominating the database and showing the highest citation impact. The Journal of Endodontics and International Endodontic Journal were the top sources. CONCLUSION: This upward trend over the past 2 decades reflects advancements in oral health education and growing research interest. This analysis highlights the influential publications and research trends, offering valuable insights for future studies, clinical practice, and academic collaboration in antibiotic used for endodontic therapy.
Survival of Endodontically Treated Cracked Teeth: A 10- to 15-Year Retrospective Study.
Chan PY, Seet RF, Saffari SE … +2 more , Zhan SJ, Chen NN
J Endod · 2026 Mar · PMID 41276249 · Publisher ↗
INTRODUCTION: To investigate long-term (10- to 15-year) survival and success rates of endodontically treated cracked teeth and to identify possible prognostic factors related to their survival and success. METHODS: Patie...
INTRODUCTION: To investigate long-term (10- to 15-year) survival and success rates of endodontically treated cracked teeth and to identify possible prognostic factors related to their survival and success. METHODS: Patients who had endodontically treated cracked teeth were seen for a 10- to 15-year review. Preoperative and intraoperative treatment records were retrieved. Clinical and radiographic evaluations were performed. Two outcomes were investigated: survival (tooth present) and success (asymptomatic with complete radiographic healing). The 10- and 15-year tooth survival and success rate were estimated. Cox proportional hazards regression assessed the impact of various factors on the time to tooth extraction and time to complete healing. RESULTS: Data from 196 patients with 204 endodontically treated cracked teeth were analyzed. The 10- and 15-year survival rates were 66% (95% confidence interval [CI]: 60%-73%) and 55% (95% CI: 48%-63%), respectively. Success rates declined from 64% at 10 years to 37% at 15 years. Preoperative probing depth (PD) was the primary statistically significant factor for survival. Teeth with no preoperative PD (<4 mm) had higher survival rates of 76% at 10 years and 64% at 15 years. Multivariable analysis revealed significantly increased risk for teeth with PD of 4-5 mm (adjusted hazard ratio [aHR] = 2.48, 95% CI: 1.41-4.38, P = .002) and ≥6 mm (aHR = 3.19, 95% CI: 1.56-6.54, P = .002) for survival analysis. Older age was a modest independent risk factor (aHR = 1.03 per year, 95% CI: 1.00-1.05, P = .026) for survival. CONCLUSIONS: Endodontic treatment of cracked teeth with favorable preoperative PDs demonstrates long-term survival comparable to noncracked teeth and is a viable long-term treatment option which should be recommended.
Comparative Outcome Analysis of Endodontic Microsurgery for Through-and-Through Lesions Using Propensity Score Matching: A Retrospective Cohort Study.
Kim U, Park H, Kim S … +1 more , Kim E
J Endod · 2026 Apr · PMID 41276248 · Publisher ↗
INTRODUCTION: Through-and-through (T-T) lesions present unique anatomical challenges in endodontic microsurgery (EMS), often resulting in delayed or incomplete healing. This study aimed to evaluate the clinical outcomes...
INTRODUCTION: Through-and-through (T-T) lesions present unique anatomical challenges in endodontic microsurgery (EMS), often resulting in delayed or incomplete healing. This study aimed to evaluate the clinical outcomes of EMS in T-T lesions, compare them with non-T-T lesions using propensity score matching. METHODS: This retrospective case-control study reviewed 89 T-T teeth and 294 non-T-T teeth that underwent EMS in anterior regions, excluding those treated with bone grafts. Propensity score matching was performed at a 1:2 ratio (T-T: non-T-T), resulting in 89 T-T and 178 non-T-T matched teeth for cumulative outcome assessment with Kaplan-Meier analysis, and 75 T-T with 150 non-T-T, and 34 T-T with 68 non-T-T matched teeth for the 1- and 3-year evaluations of clinical and radiographic outcomes, respectively. RESULTS: The 1-year success rate was 88.0% in the non-T-T group and 77.3% in the T-T group (P < .05). For 3-year outcomes, the success rates were 97.1% (non-T-T) and 88.2% (T-T), respectively. Lesion type significantly influenced the 1-year outcome, with T-T lesions associated with higher failure rates. No statistically significant difference was identified for 3-year outcomes. The cumulative survival analysis showed no significant differences between the groups. CONCLUSIONS: EMS appears to be a reliable treatment option for T-T lesions. Although short-term outcomes at 1 year were less favorable than those of the non-T-T lesions, these differences were no longer evident at 3 years. A follow-up period longer than 1 year may be necessary to accurately assess the healing dynamics of T-T lesions.
Biomechanical Evaluation of Maxillary Central Incisors After Regenerative Endodontic Treatment: An Extended Finite Element Analysis.
Wan B, Swain MV, Kahler B
J Endod · 2026 Apr · PMID 41276247 · Publisher ↗
INTRODUCTION: To undertake an in-silico analysis of two maxillary central incisors treated with regenerative endodontic treatment (RET) where the right incisor did not undergo further root maturation and compare it to th...
INTRODUCTION: To undertake an in-silico analysis of two maxillary central incisors treated with regenerative endodontic treatment (RET) where the right incisor did not undergo further root maturation and compare it to the left central incisor where further root maturation occurred. METHODS: This study employed eXtended Finite Element Analysis to evaluate the fracture resistance of maxillary central incisors treated with RET. Post-treatment cone beam computed tomography data were used to reconstruct two 3D tooth models. Both models were subjected to two physiologically relevant loading conditions: biting (300 N at a 60° angle to the tooth's long axis) and trauma (300 N perpendicular to the labial surface). The mechanical behaviour was assessed by extracting stress distributions, force-displacement curves, and crack propagation behaviour. RESULTS: Biting generated lower peak tensile stress (∼30 MPa) than trauma (∼45 MPa, ∼50% higher), with trauma causing stronger cervical stress concentrations. The mature root showed greater stiffness (4.5 kN/mm vs 3.9 kN/mm, ∼15% higher). Crack initiation occurred at 100 N under biting and 60 N under trauma (∼40% lower threshold). Biting produced more stable crack growth, whereas trauma caused earlier initiation and faster propagation. Overall, root maturation improved stiffness and fracture resistance, particularly under lateral trauma. CONCLUSIONS: The mature root exhibited higher stiffness and more stable crack progression, likely due to thicker dentine walls and enhanced structural support. These findings suggest that RET-treated teeth with less mature roots may not experience higher stress under load, but their reduced resistance to crack growth poses a higher fracture risk.
Clinical Outcomes of Nonmetallic Customized Post-and-Core Systems: A Systematic Review.
Yuen JJX, Beh YH, Saw ZK … +1 more , Chua HS
J Endod · 2026 Apr · PMID 41276246 · Publisher ↗
INTRODUCTION: This systematic review evaluates the types and clinical outcomes of nonmetallic customized post-and-core systems in endodontically treated teeth. Customized systems refer to those individually fabricated to...
INTRODUCTION: This systematic review evaluates the types and clinical outcomes of nonmetallic customized post-and-core systems in endodontically treated teeth. Customized systems refer to those individually fabricated to replicate the specific morphology of the prepared root canal. METHODS: A comprehensive search for clinical studies evaluating nonmetallic customized post-and-cores was conducted across five electronic databases (PubMed, Scopus, Web of Science, Cochrane, Elton B. Stephens Company (EBSCO)) and Google Scholar. Two independent reviewers screened studies, extracted data, and assessed risk of bias using Cochrane Risk-of-Bias Tool for randomized controlled trials and Newcastle-Ottawa Scale for cohort studies. Data from all included studies were presented descriptively using tables. RESULTS: Twelve studies with 829 teeth were included in the review. Indirect fabrication materials included computer-aided design/computer-aided manufacturing milled zirconia, polyetheretherketone, and polyetherketoneketone. Direct chairside methods evaluated individually formed (EverStick Post and Ribbond) and rigid (bundle fiber posts and prefabricated fiber posts relined with composite resin) fiber-reinforced composite systems and corono-radicular direct composite. Computer-aided design/computer-aided manufacturing milled zirconia posts exhibited comparable clinical outcomes to conventional cast posts, while polyetheretherketone and polyetherketoneketone posts showed lower survival, with a high incidence of debonding. Individually formed fiber-reinforced composite systems demonstrated favorable failure patterns. CONCLUSIONS: Although these post-and-core systems appear promising, the available data were limited and show considerable variability in terms of materials used and fabrication techniques, resulting in significant heterogeneity that precludes meaningful comparative analysis. Each evaluated system has its own advantages and limitations that shall be considered individually when planning for the final restoration for an endodontically treated tooth.
Three-year Outcomes of Conventional Versus Minimally Invasive Endodontic Treatment Protocols: A Retrospective Study.
Hossini K, Liu H, Shen Y … +3 more , Aleksejuniene J, Algahtani F, Hieawy A
J Endod · 2026 Apr · PMID 41276245 · Publisher ↗
INTRODUCTION: This study compared the 3-year outcomes of a conventional endodontic treatment protocol (CEP) and a minimally invasive endodontic protocol (MIEP) incorporating GentleWave (GW) technology. METHODS: A total o...
INTRODUCTION: This study compared the 3-year outcomes of a conventional endodontic treatment protocol (CEP) and a minimally invasive endodontic protocol (MIEP) incorporating GentleWave (GW) technology. METHODS: A total of 114 patients from 2 endodontic specialty clinics were included in this retrospective study. Patients received either the MIEP/GW protocol, obturated using the warm vertical compaction technique and a bioceramic sealer, or the CEP protocol, obturated using the single-cone technique and a bioceramic sealer. Clinical and radiographic evaluations were performed at the 36-month follow-up. Treatment outcomes were categorized as success or failure according to both strict and loose criteria. Data were analyzed using the Chi-square test or Fisher's exact test. RESULTS: Of the 114 patients, 110 completed the 36-month follow-up, yielding a 96.5% recall rate. No moderate or severe postoperative pain was reported in the MIEP/GW group, which was significantly lower than in the CEP group (P < .05). The MIEP/GW group showed comparable success rates to the CEP group-88.7% and 69.4% versus 81.3% and 54.2% under the loose and strict criteria, respectively (P > .05). CONCLUSIONS: The MIEP/GW protocol achieved comparable success rates and demonstrated a lower incidence of moderate or severe postoperative pain compared with the conventional approach. These findings suggest that MIEP incorporating GW technology may serve as a reliable and effective alternative to conventional endodontic treatment.
In Vitro and Ex Vivo Evaluation of a Novel Solvent for Tricalcium Silicate-based Sealers.
Colmenar D, Sakoda S, Terlier T … +3 more , Komabayashi T, Kirkpatrick T, Jeong JW
J Endod · 2026 Mar · PMID 41265747 · Publisher ↗
INTRODUCTION: The need for removal of tricalcium silicate-based sealers in endodontic retreatment is increasing, but it is challenging due to their limited solubility. Therefore, new solvents are needed. METHODS: In vitr...
INTRODUCTION: The need for removal of tricalcium silicate-based sealers in endodontic retreatment is increasing, but it is challenging due to their limited solubility. Therefore, new solvents are needed. METHODS: In vitro solubility assays of EndoSequence BC sealer (BC) were prepared and evaluated in 7 groups (n = 10): pH 4 buffer (B4), pH 6 buffer (B6), pH 7 deionized water (HO), pH 8.16 buffer B8, pH 10 buffer (B10), 17% ethylenediaminetetraacetic acid (EDTA), and pH 10 buffered 17% EDTA (E10). Ex vivo dentin disks were immersed in either B4 or E10, then the time-of-flight secondary ion mass spectrometry was used to quantify dentin decalcification. Extracted teeth were instrumented and obturated using a single cone technique with BC short of working length and the apical 2 mm filled only with sealer. Three groups (n = 11) of teeth were retreated by a single blinded operator with either HO, EDTA, or E10 until patency was obtained. Results were analyzed using two-way ANOVA with post hoc tests. RESULTS: Solubility values for each group were: B4, 48.6% ± 2.8; B6, 41.4% ± 4.6; HO, 13.5% ± 1.9; B8, 13.2% ± 3.2; B10, 11.4% ± 3.4; EDTA, 32.6% ± 6.4; and E10, 51.1% ± 4.7. BC was significantly more soluble in both B4 and E10 than in the other groups. There was no significant difference in solubility or dentin decalcification between B4 and E10. Patency rates and time to achieve patency did not differ significantly among all groups. CONCLUSIONS: E10 is an effective solvent for BC during endodontic retreatment procedures but does not affect the ability to regain patency.
Preventive Endodontics: Mitigating Crack Development and Tooth Loss.
Pryles RL, Blicher B, Gluskin AH
J Endod · 2026 Mar · PMID 41242658 · Publisher ↗
Cracked teeth represent a growing concern in endodontic practice, driven by biomechanical, evolutionary, and lifestyle factors. While traditionally approached as a condition requiring reactive treatment, contemporary end...
Cracked teeth represent a growing concern in endodontic practice, driven by biomechanical, evolutionary, and lifestyle factors. While traditionally approached as a condition requiring reactive treatment, contemporary endodontics must now shift toward prevention. This article explores the multifactorial nature of cracked teeth, including parafunctional habits, malocclusion, modern dietary patterns, and the evolutionary mismatch between human dentition and present-day lifestyles. The paper outlines key risk factors such as bruxism, malocclusion, and enamel demineralization, while also discussing effective preventive strategies. These include occlusal assessment, orthodontic or equilibration interventions, dietary counseling, and use of occlusal splints. Management of asymptomatic cracks and stabilization through full-coverage restorations or bonded restorations is emphasized to reduce the likelihood of structural failure. For teeth requiring endodontic therapy, the inclusion of bonded intraorifice barriers, timely restorations, and occlusal adjustment significantly improves long-term outcomes. Notably, recent evidence challenges outdated assumptions regarding poor prognosis for cracked teeth, highlighting the effectiveness of interdisciplinary protocols. The article calls for a paradigm shift in endodontic care from solely treating cracked teeth to actively preventing their occurrence. By integrating principles from preventive medicine and anthropology, endodontists can better preserve natural dentition. Ultimately, ensuring that the first diagnosed crack is the last one aligns with both ethical obligations and the long-term success of endodontic treatment.
Effect of Pre- and Post-thermocycling Strontium Infiltration on Cracks and Tubular Structure in Human Root Dentin.
Saghiri MA, Shekarian M, Chien CH … +3 more , Napoli S, Yousef H, Morgano SM
J Endod · 2026 Apr · PMID 41242657 · Publisher ↗
INTRODUCTION: This study aimed to evaluate the effect of topical application of strontium under thermocycling conditions on average crack length, crack density, tubular density, and tubular diameter in both healthy and d...
INTRODUCTION: This study aimed to evaluate the effect of topical application of strontium under thermocycling conditions on average crack length, crack density, tubular density, and tubular diameter in both healthy and diabetic root dentin. METHODS: Sixty mid-root dentin discs from extracted premolars (n = 30 healthy, n = 30 diabetic) were allocated to 6 groups: no Sr treatment (CTL), Sr treatment before thermocycling (Sr-PRE), or Sr after thermocycling (Sr-POST) for both metabolic conditions. Sr treatment involved a 5-minute application of 1.8 μM L-ascorbic acid-2-phosphate strontium solution. All specimens underwent 2000 thermal cycles (5°C-55°C). Scanning electron microscopy was used to assessed average crack length, crack density, tubule density, and tubule diameter. Data were analyzed using two-way ANOVA (metabolic status × Sr regimen; α = 0.05) using GraphPad Prism software (10.5.0.774 version; GraphPad Software, San Diego, CA). RESULTS: Diabetic dentin exhibited significantly greater crack growth (P < .05) and tubule density (P < .05) after thermocycling compared to healthy controls. Sr-PRE reduced crack growth by approximately 70% in diabetic dentin and 56% in healthy dentin (P < .05), significantly lowering tubule density and diameter. Sr-POST provided intermediate protection. Sr's protective effects were most pronounced in diabetic dentin. CONCLUSIONS: A brief chairside Sr rinse applied before thermal stress markedly reduced crack metrics and tubule density/diameter relative to controls after thermocycling.
Investigating Adhesion Molecules in Stem Cell - Immune Cell Interactions Using Organoids.
Rotondi L, Li FC, Magalhaes M … +1 more , Kishen A
J Endod · 2026 Mar · PMID 41242656 · Publisher ↗
INTRODUCTION: Immune cell-mesenchymal stem cell interactions modulate repair and regeneration, with cell-to-cell interactions being a necessary component facilitating this crosstalk. This study used a collagen-based orga...
INTRODUCTION: Immune cell-mesenchymal stem cell interactions modulate repair and regeneration, with cell-to-cell interactions being a necessary component facilitating this crosstalk. This study used a collagen-based organoid model to examine direct cell-to-cell interactions between stem cells from apical papilla (SCAP) and macrophages (MQ). The aim was to better understand how adhesion molecules contribute to apical periodontitis dynamics in the immature permanent tooth. METHODS: Two-dimensional SCAP-MQ co-cultures were compared to three-dimensional (3D) SCAP-MQ self-assembled tissue constructs under 3 conditions: non-stimulated, lipopolysaccharide (LPS), and interleukin (IL)-4 for up to 7 days. Expression of 5 candidate adhesion molecules (CD200, CD200 R, intercellular adhesion molecule (ICAM)-1, N-cadherin, and lymphocyte function-associated antigen (LFA)-1) were assessed by quantitative real time polymerase chain reaction and confocal microscopy. RESULTS: LPS decreases CD200 and CD200 R immunofluorescence in an organoid model (P < .05). N-CADHERIN gene expression increased on day 5 in the 3D model in response to LPS (P < .05). LFA-1 showed a trend toward increased immunofluorescence in the juxtacrine zone of the organoid model under LPS stimulation, though this difference was not significant. ICAM-1 gene expression in the 2D model increased in response to LPS (P < .05) but no change was observed with IL-4. CONCLUSION: Extracellular collagen and inflammatory conditions modulate adhesion molecule expression in SCAP-MQ co-cultures. LPS promoted N-cadherin, ICAM-1, and LFA-1 expression, while IL-4 increased CD200, CD200 R, and ICAM-1. These findings highlight the molecular mechanisms underlying SCAP-MQ interactions and validate the use of 3D models to potentially inform future therapeutic strategies for enhancing pulpal regeneration.
Virtual Reality Haptic Simulators and Mobile Applications-Potential AI-enhanced Tools for Improving Clinical Endodontic Training: A Randomized Controlled Trial.
Usta SN, Silva EJNL, Tekkanat H … +1 more , Keskin C
J Endod · 2026 Mar · PMID 41242655 · Publisher ↗
INTRODUCTION: This study aimed to evaluate the effects of a virtual reality haptic simulator (VRHS, VirTeaSy Dental) and a mobile application (Dental EndoMaster) on the manual competency, stress, and self-confidence leve...
INTRODUCTION: This study aimed to evaluate the effects of a virtual reality haptic simulator (VRHS, VirTeaSy Dental) and a mobile application (Dental EndoMaster) on the manual competency, stress, and self-confidence levels of 4th-year dental students in endodontic clinical practice. METHODS: Thirty dental students were randomly assigned to 3 groups as follows (n = 10): Group 1 (VRHS), Group 2 (mobile application), and Group 3 (control). Before clinical training, Groups 1 and 2 completed 3 standardized practice sessions and one final assessment session using VRHS and a mobile application. In contrast, Group 3 directly started with the clinical procedure without prior exposure to VRHS or the mobile application. All students performed access cavity preparations on maxillary incisors diagnosed with chronic apical periodontitis. Clinical performance was evaluated by an endodontist. Self-clinical scores and drilling time were recorded. Upon the termination of clinical practice, students completed a self-confidence survey. Stress levels were measured using a visual analog scale at different time points. Statistical analyses were conducted with significance set at P < .05. RESULTS: Students in Group 1 showed significantly higher clinical and self-clinical scores and reduced drilling time compared to Group 3 (P < .05). Students in Groups 1 and 2 exhibited lower stress levels before the clinical procedures (P < .05). Groups 1 and 2 reported greater self-confidence and perceived preparedness for clinical endodontic procedures compared to Group 3. CONCLUSIONS: The integration of artificial inteligence-enhanced VRHS and a mobile application into endodontic training significantly enhanced students' clinical performance, reduced stress levels, and increased self-confidence during their first clinical procedures.
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 Feb · PMID 41236008 · Publisher ↗
INTRODUCTION: This in vitro study evaluated the effectiveness of a robotic system (RS) and dynamic navigation system (DNS) compared with the freehand technique (FH) in fiber post removal. METHODS: Thirty-six 3D-printed t...
INTRODUCTION: This in vitro study evaluated the effectiveness of a robotic system (RS) and dynamic navigation system (DNS) compared with the freehand technique (FH) in fiber post removal. METHODS: Thirty-six 3D-printed teeth were fabricated from a human extracted maxillary incisor that had undergone root canal treatment and postspace preparation. After fiber post cementation, the 3D-printed replicas were mounted in plaster models and randomly assigned to RS, DNS, and FH groups (n = 12 each). Cone-beam computed tomography and model scans were performed on all models. The drilling trajectory was planned virtually using DentalNavi software. Fiber postremoval was performed by a single experienced endodontist using DNS, RS, or FH under a dental operating microscope, with operation time recorded. Pre- and post instrumentation data were obtained using micro-computed tomography. Coronal deviation, apical deviation, angular deflection, and operation time were compared among groups using One-way ANOVA and least significant difference tests. RESULTS: There were no significant differences in coronal deviation (P > .05). The RS group showed the lowest apical deviation (0.23 ± 0.04 mm), angular deflection (0.94° ± 0.33°), and shortest operation time (0.81 ± 0.07 min), followed by the DNS group (0.50 ± 0.13 mm, 2.43° ± 0.82°, 2.17 ± 0.70 min). FH had the greatest deviations and longest time (0.92 ± 0.27 mm, 4.84° ± 1.67°, 3.64 ± 1.25 min) (P < .05). CONCLUSIONS: In this benchtop in vitro study using 3D-printed teeth, the RS demonstrated superior accuracy and efficiency in fiber post removal compared with DNS and FH technique.
Analysis of Factors Affecting the Accuracy of Static-guided Endodontics.
Chen C, Leng D, Wu T … +7 more , Chen L, Zhu T, Dai M, Wu Y, Zhao T, Tang Y, Wu D
J Endod · 2026 Feb · PMID 41235965 · Publisher ↗
INTRODUCTION: To evaluate how template type, sleeve height, revolutions per minute (RPM), tooth type, drilling distance, and drill diameter affect the accuracy of static-guided endodontics. METHODS: In this in vitro stud...
INTRODUCTION: To evaluate how template type, sleeve height, revolutions per minute (RPM), tooth type, drilling distance, and drill diameter affect the accuracy of static-guided endodontics. METHODS: In this in vitro study, 113 isolated premolars and molars collected from the oral surgery clinic and 10 three-dimensional printed resin teeth were mounted in a standard dental mold in their corresponding tooth positions. Cone-beam computed tomography and optical scans were obtained and co-registered. Templates were designed, and deviations were measured using Implant Studio (3Shape Unite, 3shape, Copenhagen, Denmark). RESULTS: The angular deviation of the resin template (without metal sleeve) was higher than that of the metal template (P < .05). The apical linear deviation of the resin template (without metal sleeve) was significantly higher than that of the resin template (with metal sleeve) (P < .05). The coronal linear deviation of the metal template was higher than that of the resin template (with metal sleeve) (P < .05).The apical linear deviation of the resin template with 4-mm height sleeve was higher than that of the 6-mm and 8-mm height sleeves (P < .05), and there was no significant difference between the 6-mm and 8-mm height sleeves. Drill diameter, RPM, and tooth type (resin or isolated teeth) did not affect the accuracy of static guided endodontics. CONCLUSIONS: The apical linear deviation increased with drilling distance. Resin templates (without metal sleeves) are not recommended. The accuracy of static-guided endodontics was not affected by drill diameter, RPM, or tooth type (resin or isolated teeth).
Investigating the Odontogenic Potential of Human Induced Pluripotent Stem Cells-derived Mesenchymal Progenitor Cells in Comparison to Stem Cells of the Apical Papilla.
Khalil MM, Giddey A, Mahanwah F … +5 more , Zehra F, Shah M, Al Yazeedi T, Rawat SS, Jamal M
J Endod · 2026 Apr · PMID 41232918 · Publisher ↗
INTRODUCTION: Over the past 2 decades, numerous researchers have focused on identifying cell populations capable of regenerating the pulp-dentin complex. Most research focused on dental tissue-derived mesenchymal stromal...
INTRODUCTION: Over the past 2 decades, numerous researchers have focused on identifying cell populations capable of regenerating the pulp-dentin complex. Most research focused on dental tissue-derived mesenchymal stromal cells (dMSCs), which possess multipotent differentiation potential and can be isolated from various dental tissues. However, these dMSCs have limitations, prompting researchers to explore alternative cell sources that offer greater scalability and sustained regenerative potential while preserving the unique expression and functional profile of dMSCs. This study aimed to test the odontogenic properties of mesenchymal progenitor cells derived from human induced pluripotent stem cells (i-MPCs) as a promising alternative to dMSCs. METHODS: Patient-specific human-induced pluripotent stem cells were differentiated to generate mesenchymal progenitors via a cranial neural crest intermediate, replicating embryonic tooth development. The expression profile of the i-MPCs was assessed and compared to stem cells of the apical papilla (SCAPs) through a panel of cell surface markers: CD90, CD73, CD105, CD13, CD14, CD271, CD57, and CD146, using flow cytometry, differentiation potential through trilineage differentiation assays, and average gene expression through bulk RNA sequencing. The odontogenic differentiation (OD) potential of the cell types was determined and compared after odontogenic induction using RNA sequencing and proteomics analysis, Alizarin red staining, and alkaline phosphatase quantification. RESULTS: The i-MPCs demonstrated CD90, CD73, CD105, CD13, CD14, CD271, CD57, and CD146 and their trilineage differentiation capabilities were comparable to SCAPs. The average gene expression revealed a clear distinction, with the highest expression of neural and embryonic markers in i-MPCs and odontogenic markers in SCAPs. The proteomics analysis revealed a higher baseline expression of proteins involved in OD and mineralization in SCAPs. In contrast, the differentiated cells revealed enrichment in more common pathways responsible for OD in i-MPCs. The Alizarin red staining and quantification confirmed the OD of both cell types through mineralization and calcification at 7 and 14 days. Alkaline phosphatase activity of the OD cells significantly increased on days 7 and 14 in the i-MPCs, compared to SCAPs. CONCLUSIONS: i-MPCs and SCAPs demonstrated comparable phenotypic characteristics, with distinct transcriptomic profiles and expressions associated with their origin. Proteomics analysis of the odontogenically induced cells revealed more significant enrichment of OD pathways in i-MPCs compared to SCAPs, indicating a stronger response to differentiation cues.
Cytotoxicity and Genotoxicity of Triton All-In-One Irrigation Solution: An InVitro Study.
Hwang J, Askar M, Smoczer C … +3 more , Young L, Ferracciolo J, Paurazas S
J Endod · 2026 Apr · PMID 41232917 · Publisher ↗
INTRODUCTION: Successful endodontic therapy depends on effective microbial control and the biocompatibility of irrigants. While sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) are widely used, conc...
INTRODUCTION: Successful endodontic therapy depends on effective microbial control and the biocompatibility of irrigants. While sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) are widely used, concerns regarding their cytotoxic and genotoxic potential remain. Triton, a novel all-in-one irrigant, combines NaOCl with chelators and surfactants, potentially simplifying irrigation. This study aimed to evaluate the cytotoxicity and genotoxicity of Triton compared with NaOCl and EDTA in human periodontal ligament fibroblasts. METHODS: Human periodontal ligament fibroblasts were exposed to 4% NaOCl, 6% NaOCl, 17% EDTA, and Triton for 1 and 10 minutes. Cytotoxicity was assessed using the Cell Counting Kit-8 assay. Genotoxicity was evaluated via immunofluorescence staining for γH2AX and 53BP1, markers of DNA double-strand breaks. A total of 0.9% sodium chloride and phosphate-buffered saline served as the negative controls, while lysis buffer and hydrogen peroxide served as positive controls in respective studies. RESULTS: Triton exhibited cytotoxicity comparable to 4% and 6% NaOCl but significantly lower than 17% EDTA. Immunofluorescence analysis showed no genotoxicity with Triton or NaOCl at either concentration or time point. In contrast, 17% EDTA induced a time-dependent increase in γH2AX/53BP1 colocalized foci, indicating DNA damage. CONCLUSIONS: Triton has shown cytotoxicity and genotoxicity levels comparable to those of NaOCl while demonstrating significantly lower toxicity than 17% EDTA in both assays. These findings suggest that Triton may serve as a beneficial addition to the current endodontic irrigation armamentarium, offering a simplified protocol.
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