Journal Of Endodontics[JOURNAL]
Sun
200 papers
Clinical Outcome of Replanted Avulsed Anterior Teeth: A Retrospective Cohort Study.
Koo H, Kim U, Kim E … +1 more , Kim D
J Endod · 2026 Jul · PMID 42392504 · Publisher ↗
INTRODUCTION: Long-term outcomes after replantation of avulsed anterior teeth remain difficult to predict. This retrospective study evaluated post-replantation tooth survival and assessed the tooth- and patient-level fac...
INTRODUCTION: Long-term outcomes after replantation of avulsed anterior teeth remain difficult to predict. This retrospective study evaluated post-replantation tooth survival and assessed the tooth- and patient-level factors associated with tooth loss and ankylosis. METHODS: Patients with replanted avulsed anterior teeth treated between 2008 and 2021 were identified from a clinical database. Observation time extended from replantation to tooth failure or last follow-up. Kaplan-Meier analysis was used to estimate the survival probabilities using patient-cluster bootstrap confidence intervals (CIs). Cox and logistic regression models with patient-cluster robust standard errors evaluated the factors associated with tooth loss and ankylosis, respectively. RESULTS: The cohort included 248 replanted anterior teeth from 180 patients; 19 teeth (7.7%) were lost and 103 teeth (41.5%) had ankylosis. The estimated 1- and 5-year survival probabilities were 96.8% (95% CI, 94.1%-98.8%) and 92.9% (95% CI, 87.7%-97.2%), respectively. In Cox regression analysis, no clinical variables were significantly associated with tooth loss after patient-cluster robust inference. Mandibular location (odds ratio [OR], 0.41; 95% CI, 0.17-0.97) and alveolar bone fracture (OR, 0.45; 95% CI, 0.22-0.89) were associated with lower univariable odds of ankylosis, but neither remained significant in the multivariable model. CONCLUSIONS: Tooth retention and ankylosis should be interpreted as distinct outcomes after replantation of avulsed anterior teeth. Tooth loss was uncommon, but ankylosis was frequent, and independent prognostic factors for failure were not confirmed after accounting for sparse events and patient-level clustering.
Mahidol study 3: Post-operative Effect and Adverse Events of Regenerative Endodontic Procedures in Immature Permanent Teeth.
Osiri S, Theekakul C, Banomyong D … +1 more , Jantarat J
J Endod · 2026 Jun · PMID 42373073 · Publisher ↗
INTRODUCTION: Regenerative endodontic procedures (REPs) have demonstrated high success rates; however, adverse effects and complications remain inadequately characterized. This study investigated the incidence and associ...
INTRODUCTION: Regenerative endodontic procedures (REPs) have demonstrated high success rates; however, adverse effects and complications remain inadequately characterized. This study investigated the incidence and associated factors of tooth discoloration, intracanal calcification, and treatment failure, including fatal tooth fracture, following REPs in immature permanent teeth. METHODS: A retrospective cohort study was conducted on 120 immature permanent teeth treated with REPs at Mahidol University between January 2006 and May 2023. Clinical and radiographic outcomes were evaluated at a median follow-up of 30.5 months (12-148 months). Tooth discoloration and intracanal calcification were assessed, and multivariable modified Poisson regression was used to identify associated factors. RESULTS: Among 61 teeth with available discoloration data, 37 (60.7%) exhibited postoperative discoloration, with MTA identified as a significant risk factor compared to Biodentine (P = 0.001). Partial intracanal calcification was observed in 60 teeth (50.0%), while complete canal obliteration was not detected. EDTA use during the bleeding induction visit was significantly associated with calcification (P = 0.031). Thirteen teeth (10.8%) were classified as disease, with causes comprising persistent infection (4 teeth), coronal and/or root fracture (3 teeth), coronal leakage (2 teeth), postoperative trauma (2 teeth), parafunctional force (1 tooth), and unidentified cause (1 tooth). CONCLUSIONS: Conclusions: Tooth discoloration and partial intracanal calcification are common adverse effects following REPs. MTA was significantly associated with discoloration, and EDTA irrigation during the bleeding induction visit was significantly associated with intracanal calcification. As a case-series observation, three fatal crown-root fractures occurred, in which coronal barrier positioning appeared to leave inadequate depth for bonded composite restoration; this descriptive observation is hypothesis-generating and warrants confirmation.
Non-Surgical Management of Horizontal Root Fracture with Necrotic Apical Segment and Coronal Cervical Abfraction Using Mineral Trioxide Aggregate: Case Report.
Al Farhah A, Shaikh M
J Endod · 2026 Jun · PMID 42373072 · Publisher ↗
Horizontal root fractures are relatively rare dental findings and often pose diagnostic and treatment challenges. In addition to a horizontal root fracture, this case report also demonstrates a finding of a non-carious c...
Horizontal root fractures are relatively rare dental findings and often pose diagnostic and treatment challenges. In addition to a horizontal root fracture, this case report also demonstrates a finding of a non-carious cervical abfraction lesion, which involves the loss of dental hard tissue from the cervical areas of teeth through processes unrelated to caries. A 22 -year-old healthy female patient was complaining of the maxillary left first premolar area with a history of dental trauma. Clinically, the tooth presented with a non-carious cervical abfraction lesion. Endodontic testing showed a negative response to cold and tenderness to percussion and palpation. Horizontal mid-root fracture with a periapical radiolucency surrounding the apical segment of the buccal root, along with periapical radiolucency of both buccal and palatal roots, and a furcal radiolucency related to the fracture line with fenestration of the buccal cortical bone were identified from radiographic examination. Root canal therapy was performed, and the necrotic apical segment beyond the fracture line was treated. Obturation was carried out using MTA as an alternative to gutta-percha, followed by a fiber post in the palatal root, and a full coverage ceramic crown. The follow-up has revealed significant healing and significant pain relief. Root canal therapy using mineral trioxide aggregate as an obturation material, combined with restorative treatment with a fiber-reinforced post and a full-coverage ceramic crown was an effective treatment for managing teeth with horizontal mid-root fracture and non-carious cervical abfraction lesions.
Identification of pain-related biomarkers and the associated potential molecular regulation mechanism in pulpitis by bioinformatics method.
He Y, Zhu Y, Yao M … +5 more , Qiu X, Jiang Y, Wu L, Chen X, Yang X
J Endod · 2026 Jun · PMID 42373071 · Publisher ↗
INTRODUCTION: This study aims to screen pain-related genes through bioinformatics analysis and to explore their potential molecular regulatory mechanisms in pulpitis. METHODS: Differentially expressed miRNAs were identif...
INTRODUCTION: This study aims to screen pain-related genes through bioinformatics analysis and to explore their potential molecular regulatory mechanisms in pulpitis. METHODS: Differentially expressed miRNAs were identified using datasets GSE77459 and HRA007469. Pain-related genes were obtained from the GeneCards database. Cytoscape was used for the ceRNA network visualization and analysis. MCODE was used to extract the subnetwork from the ceRNA network. A miRNA-mRNA-TF structure was constructed, and GO and KEGG analyses were performed. The LASSO regression model was constructed to predict pulpitis and CytoHubba analysis with the maximal clique centrality method was used to identify the hub RNAs. Finally, immunofluorescence was used to validate the expression of the screened biomarkers. Statistical analysis was conducted using the unpaired Student's t-test. p < 0.05 was considered statistically significant. RESULTS: A total of 36 miRNAs exhibited consistent and statistically significant differential expression across GSE77459 and HRA007469. Meanwhile, 16,470 pain-related genes and 189 pulpitis pain-related genes were retrieved from GeneCards. A pain-associated ceRNA network was constructed, which integrated 26 miRNAs, 479 mRNAs, and 1 lncRNA. A subsequent MCODE-based module was identified, containing 11 miRNAs, 106 mRNAs, and 14 transcription factors. Among these, miR-223, miR-155, and miR-21 emerged as top candidate regulatory miRNAs, with NAMPT and ERBB4 as their common target genes. LASSO regression analysis identified SCD, FGL2, TET1, and PCDH10 as diagnostic biomarkers for pulpitis, with SCD exhibiting the highest interaction centrality score. Immunofluorescence analysis revealed that the expression levels of SCD, NAMPT and FGL2 were significantly higher in pulpitis. CONCLUSIONS: MiR-21/155/223 and their target genes SCD, FGL2, TET1, PCDH10, NAMPT, ERBB4 may serve as key molecules which regulate the inflammatory response and pain sensitization in pulpitis.
AI Prognostic Models in Endodontics: Scoping Review and Clinical Gap Analysis for Retreatment vs Microsurgery Decision Support.
Sabeti MA, Torabi G
J Endod · 2026 Jun · PMID 42362144 · Publisher ↗
INTRODUCTION: Artificial intelligence (AI) prognostic models in endodontics may estimate treatment outcomes, but single-pathway prediction does not provide comparative decision support for failed cases in which nonsurgic...
INTRODUCTION: Artificial intelligence (AI) prognostic models in endodontics may estimate treatment outcomes, but single-pathway prediction does not provide comparative decision support for failed cases in which nonsurgical retreatment (NS-ReTx) and endodontic microsurgery (EMS) may both be considered. This scoping review mapped AI prognostic models in endodontics and evaluated their alignment with prespecified clinical decision domains relevant to NS-ReTx-versus-EMS selection. METHODS: A dual-track scoping review was conducted according to PRISMA-ScR. PubMed, Embase, Web of Science, Cochrane CENTRAL, IEEE Xplore, ACM Digital Library, and arXiv were searched from inception through February 23, 2026. Track 1 identified AI models developed to estimate future endodontic outcomes. Track 2 synthesized clinical decision domains relevant to NS-ReTx-versus-EMS selection. Risk of bias and applicability were assessed with PROBAST+AI; reporting was evaluated using TRIPOD+AI and CLAIM where applicable. Because of heterogeneity and limited evidence across outcomes, predictors, and performance metrics, findings were synthesized narratively. RESULTS: Six AI prognostic studies met Track 1 eligibility, and 11 clinical studies informed Track 2 decision domains. Included models used radiographic, structured-variable, or hybrid approaches. All models used internal validation only; calibration, external validation, and clinical utility analyses were absent. No model generated treatment-conditional predictions comparing NS-ReTx and EMS within the same clinical scenario. Restorability, technical retrievability, and surgical-access variables were inconsistently represented. CONCLUSIONS: Current AI prognostic models in endodontics remain early-stage single-pathway prediction tools and are not yet structured for comparative NS-ReTx-versus-EMS decision support.
AI-based 3D measurement of root canal curvature from CBCT: Validation of an automated Schneider angle analysis.
Çakmak YE, Erkal D, Er K … +1 more , Wolf TG
J Endod · 2026 Jun · PMID 42362143 · Publisher ↗
INTRODUCTION: Conventional 2D curvature assessment methods are insufficient to capture the complex 3D geometry of root canals. This study aimed to develop and validate a deep learning-based pipeline for automated 3D Schn...
INTRODUCTION: Conventional 2D curvature assessment methods are insufficient to capture the complex 3D geometry of root canals. This study aimed to develop and validate a deep learning-based pipeline for automated 3D Schneider angle measurement from cone-beam computed tomography (CBCT) images of mandibular molar mesial roots and to evaluate its agreement with expert manual measurements. METHODS: A 3D nnU-Net segmentation model was developed using 331 training/validation CBCT volumes and evaluated on an independent held-out test set of 50 cases comprising 127 canal segments. Automated Schneider angles were compared with reference measurements obtained by 2 experienced endodontists performing blinded, repeated measurements across 2 sessions. Agreement was assessed using intraclass correlation coefficients (ICC), Bland-Altman analysis, and quadratic weighted kappa. The equivalence margin was set at ±5°. RESULTS: Overall, AI-manual agreement was good (ICC = 0.890; 95% CI: 0.840-0.920), with a mean bias of +0.88° (limits of agreement: -6.51° to +8.27°). Agreement was highest for common segments in Vertucci Type II configurations (ICC = 0.947). Mesiobuccal canals showed a small but statistically significant positive bias (+1.45°; p < 0.05). Schneider category agreement was substantial (quadratic weighted κ = 0.717). Mean-difference equivalence was demonstrated within the prespecified ±5° margin for all canal types (all p < 0.05), although the 95% limits of agreement extended beyond the ±5° margin at the individual-measurement level. CONCLUSIONS: This internal validation study suggests that the AI-assisted workflow can approximate expert 3D Schneider angle measurements at the mean-difference level; however, external validation and stronger individual-level agreement are required before clinical implementation.
Insights into the July 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 Jul · PMID 42331504 · Publisher ↗
Abstract loading — click title to view on PubMed.
The frontiers of orthodontically induced inflammatory root resorption: mechanism, treatment, and future prospects.
Lin X, Chen S, Cai J … +8 more , Cai J, Chen L, Chen Z, Huang P, Chen Z, Cai S, Xu L, Wang H
J Endod · 2026 Jun · PMID 42331141 · Publisher ↗
Orthodontically induced inflammatory root resorption (OIIRR) is a common complication of orthodontic therapy, characterized by sterile inflammatory degradation of dental hard tissues on the root surface. Its pathogenesis...
Orthodontically induced inflammatory root resorption (OIIRR) is a common complication of orthodontic therapy, characterized by sterile inflammatory degradation of dental hard tissues on the root surface. Its pathogenesis involves complex interplay of biomechanical forces and molecular pathways within the periodontal microenvironment. Key mechanisms include inflammatory signaling via IL-6, IL-1β, and IL-18, mechanotransduction through Piezo1 and sphingosine-1-phosphate (S1P), cell-to-cell communication via exosomes and ligand-receptor interactions, and disruptions in osteogenic pathways including Wnt/β-catenin and EphB4/ephrinB2. Programmed cell death (pyroptosis, ferroptosis), mitochondrial dysfunction, autophagy, and post-transcriptional regulation by non-coding RNAs further contribute to osteoclast differentiation. Current predictive strategies focus on biomarkers in gingival crevicular fluid (GCF). Therapeutic interventions under investigation include anti-inflammatory agents, low-intensity pulsed ultrasound, laser and photobiomodulation (PBM) therapy, and bioactive substances such as lithium chloride (LiCl), exosomes, and intermittent parathyroid hormone (iPTH). Prognostically, mild to moderate OIIRR rarely compromises long-term tooth survival, whereas severe resorption requires individualized risk assessment. Notably, endodontically treated teeth exhibit significantly less OIIRR than vital pulp teeth, as root canal therapy eliminates pulp-derived pro-resorptive signaling (CH25H/25-HC, NF-κB, MMPs), offering a clinically relevant strategy for high-risk cases. This review synthesizes current knowledge on OIIRR mechanisms and emerging treatments, providing a framework for prevention and targeted therapy.
Corrigendum to 'Reinforcing Effect of Intraradicular Filling Materials in Simulated Immature Mandibular Premolars with Mineral Trioxide Aggregate Apical Barrier: A Weibull Analysis [Journal of Endodontics, Volume 51, Issue 10, October 2025, Pages 1438-1445].
Opacharoensuk P, Banomyong D, Chotvorrarak K … +2 more , Suphanarongpun P, Osiri S
J Endod · 2026 Jun · PMID 42329201 · Publisher ↗
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Class 2, Stage A cemental tear mimicking apical periodontitis: A case report.
Takeda K, Furutama D, Arita T … +5 more , Naruse T, Takahashi Y, Kawai R, Yuhi K, Shiba H
J Endod · 2026 Jun · PMID 42323014 · Publisher ↗
A cemental tear is a rare condition that can closely mimic endodontic and periodontal diseases, making accurate diagnosis challenging. Early identification is essential to ensure appropriate treatment and to avoid unnece...
A cemental tear is a rare condition that can closely mimic endodontic and periodontal diseases, making accurate diagnosis challenging. Early identification is essential to ensure appropriate treatment and to avoid unnecessary or ineffective interventions. A 75-year-old woman presented with discomfort and a sinus tract associated with the mandibular right lateral incisor (tooth 42 (Universal #26)). Clinical examination showed no periodontal pocket, and conventional periapical radiographs showed a periapical radiolucency. Based on these findings, the initial diagnosis was symptomatic apical periodontitis, and root canal therapy was performed. However, the lesion did not improve. Cone-beam computed tomography (CBCT) then showed a cemental tear on the labial aspect of the root, classified as Class 2, Stage A, and the treatment plan was revised to include surgical intervention. Root-end surgery and removal of the cemental fragment resulted in good healing. Histopathological examination demonstrated granulation tissue consistent with a periapical granuloma and bacterial colonies on the detached cemental fragments. This case highlights the diagnostic difficulty of differentiating apical periodontitis from Class 2, Stage A cemental tears located on the buccolingual aspect without a periodontal pocket, particularly in elderly patients and in cases involving incisors. Clinicians should maintain a high index of suspicion for a cemental tear when clinical signs and symptoms fail to improve after root canal treatment and consider the use of CBCT to improve diagnostic accuracy. In addition, in elderly patients with incisors and suspected occlusal trauma, CBCT imaging before starting root canal treatment should also be considered in selected cases to facilitate early and accurate diagnosis.
The Regulatory Role of Vitamin D on Dental Pulp Stem Cells in Inflammatory Conditions: An In Vitro Study.
Bahador Zirh E, Zirh S, Zeybek ND … +1 more , Kucukkaya Eren S
J Endod · 2026 Jun · PMID 42309443 · Publisher ↗
INTRODUCTION: This study evaluated the effects of vitamin D on the immune response and regenerative properties of dental pulp stem cells (DPSCs) under lipopolysaccharide (LPS)-induced inflammatory conditions. METHODS: DP...
INTRODUCTION: This study evaluated the effects of vitamin D on the immune response and regenerative properties of dental pulp stem cells (DPSCs) under lipopolysaccharide (LPS)-induced inflammatory conditions. METHODS: DPSCs were exposed to predetermined concentrations of vitamin D and LPS, administered individually, concomitantly, or sequentially. DPSCs cultured in the growth medium without further treatment were used as the control group. Cell proliferation and migration assays were performed, and inflammatory mediator expression was assessed to determine the immunomodulatory impact of vitamin D. Odontogenic/osteogenic differentiation was assessed using Alizarin Red staining, alkaline phosphatase (ALP) assay and immunocytochemical analysis of dentin matrix protein 1, dentin sialophosphoprotein and nestin expression. Data were analyzed statistically. RESULTS: LPS stimulation significantly reduced cell proliferation, migration, ALP activity, and mineral deposition while increasing inflammatory mediator expression (P < .05). In contrast, vitamin D treatment attenuated mediator levels and preserved cellular functional capacity (P < .05). Concomitant exposure to vitamin D and LPS resulted in improved proliferation and migration compared with LPS exposure alone (P < .05). Both concomitant exposure and the sequential protocol in which vitamin D was administered after LPS exposure demonstrated significantly higher ALP activity, enhanced mineralization, increased dentin matrix protein 1 and dentin sialophosphoprotein expression and decreased nestin expression compared with LPS exposure alone (P < .05). However, the sequential protocol in which LPS was administered after vitamin D exposure showed no significant differences compared with LPS exposure alone (P > .05). CONCLUSIONS: Continuous vitamin D exposure was associated with attenuation of the inflammatory response and better preservation of the regenerative capacity of DPSCs compared with prior vitamin D exposure alone.
Application of High-Performance Liquid Chromatography to Quantify Formaldehyde Release From the Chemical Interaction of Sodium Hypochlorite and EDTA.
Ioannidis K, Katmerou I, Nikolaidis A … +2 more , Kolokouris I, Koulaouzidou E
J Endod · 2026 Jun · PMID 42285459 · Publisher ↗
INTRODUCTION: The aim of this study was to examine, in vitro, the formation of formaldehyde with the aid of high performance liquid chromatography (HPLC), following the interaction of sodium hypochlorite (NaOCl) 2% w/v a...
INTRODUCTION: The aim of this study was to examine, in vitro, the formation of formaldehyde with the aid of high performance liquid chromatography (HPLC), following the interaction of sodium hypochlorite (NaOCl) 2% w/v and ethylenediaminetetraacetic acid (EDTA) 17% w/v, NaOCl 2% w/v + etidronic acid (Dual Rinse), and a premixed solution containing NaOCl and EDTA (Labarak). METHODS: NaOCl and EDTA solutions were mixed at different irrigant volume ratios (1:1, 1:2, 1:4, 2:1v/v). Dual Rinse was prepared according to the manufacturer's instructions. Labarak did not require any further handling preparations. The aliquots (n = 5 per group) were ultrasonically agitated and mixed with dinitrophenylhydrazine, phosphoric acid (H3PO4), and dichloromethane (CH2Cl2). The reaction product was extracted, dried, and dissolved in methanol (CH3OH). The final product was filtered and transferred for HPLC analysis. Formaldehyde concentration (ppm) was measured according to the developed calibration curve. Statistical analysis was performed with Kruskal-Wallis test for independent samples (SPSS; IBM, USA). The level of statistical significance was set at P < .05. RESULTS: The interaction of NaOCl and EDTA resulted in abundant formaldehyde release (>20ppm). Different irrigant volume ratios did not result in significant differences in the measurable concentrations of formaldehyde (P > .05). Labarak contained formaldehyde, which was not detected in Dual Rinse. CONCLUSIONS: HPLC is an appropriate analytical method for detecting formaldehyde after the chemical interaction of NaOCl and EDTA. The interaction between NaOCl and HEDP did not result in the release of formaldehyde. Further research is required to justify patient exposure rates and potential occupational health hazards in clinical settings.
Machine Learning-Based Prediction of Treatment Success, Postoperative Pain, and Analgesic Use after Full Pulpotomy in Permanent Molars with Symptomatic Irreversible Pulpitis.
Karakoyunlu E, Mıdoglu G, Gürler K … +1 more , Yilmaz K
J Endod · 2026 May · PMID 42217616 · Publisher ↗
INTRODUCTION: This study aimed to develop and evaluate machine learning (ML) models for predicting treatment success, postoperative pain, and analgesic use following full pulpotomy in permanent molars with symptomatic ir...
INTRODUCTION: This study aimed to develop and evaluate machine learning (ML) models for predicting treatment success, postoperative pain, and analgesic use following full pulpotomy in permanent molars with symptomatic irreversible pulpitis. METHODS: This retrospective multicohort study included 214 molars with a minimum 2-year follow-up. ML models, including logistic regression, support vector machines, and random forest, were developed for classification tasks, whereas ridge regression was used for postoperative pain prediction. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), accuracy, F1 score, and calibration analysis with Brier scores. Internal validation was performed using a training-test split and cross-validation. RESULTS: Predictive performance was highest for treatment success, for which classification models showed modest discriminative ability (AUC, 0.68-0.75), with logistic regression achieving the best performance (AUC = 0.75). Bleeding time emerged as the most influential predictor of treatment success. Prediction of analgesic use was limited (F1 score = 0.19), likely owing to class imbalance, and prediction of postoperative pain was weak (R = 0.21), indicating low explanatory capacity. Calibration analysis using the Brier score showed moderate agreement between predicted and observed outcomes. CONCLUSIONS: When based on routinely available clinical variables, ML models showed the greatest predictive value for treatment success, whereas prediction of analgesic use and postoperative pain remained limited. Bleeding time may represent a clinically accessible variable with potential prognostic relevance. Although these models are not suitable for standalone clinical decision-making, they may support risk stratification, particularly for treatment success.
Artificial Intelligence Chatbots' Performance on Dental Trauma Case-based Queries: Examining the Effect of Prompt and Content Engineering.
Ourang SA, Kahler B, Ha WN … +3 more , Jafari B, Zahedrozegar S, Nosrat A
J Endod · 2026 May · PMID 42217615 · Publisher ↗
INTRODUCTION: Traumatic dental injuries (TDIs) require prompt and accurate guidance, yet little is known about how the prompting influences the quality of artificial intelligence (AI) chatbot responses in these situation...
INTRODUCTION: Traumatic dental injuries (TDIs) require prompt and accurate guidance, yet little is known about how the prompting influences the quality of artificial intelligence (AI) chatbot responses in these situations. METHODS: Four dental trauma scenarios were developed by expert endodontists. For each scenario, a series of questions was posed to 4 AI chatbots (Claude Sonnet 3.5, Microsoft Copilot, GPT-4, Gemini Pro 2.5) using 2 approaches: unprompted layperson phrasing (n = 10) and endodontist's prompts referencing International Association of Dental Traumatology guidelines (n = 10). Responses were independently evaluated by 2 raters for validity, completeness, and relevance using a 5-point ordinal scale. RESULTS: Scores (n = 1920) of responses to endodontist questions were associated with significantly higher odds of receiving superior ratings across all 3 domains: validity (odds ratio [OR] = 1.82; 95% confidence interval [CI]: 1.35-2.38; P < .001); completeness (OR = 2.50; 95% CI: 1.85-3.33; P < .001) and relevance (OR = 2.94; 95% CI: 2.04-4.17; P < .001). When a threshold-based acceptability (score ≥4) was applied, responses to endodontist queries were more often acceptable in criterion-based as well as overall analyses (P < .05). CONCLUSIONS: The quality of AI chatbot guidance in TDIs is significantly associated with how questions are asked. While clinically structured prompts yield more reliable responses, most patients facing dental trauma are unlikely to formulate questions in this way. This gap highlights an important limitation of current AI chatbot applications in TDIs and underscores the need for caution when relying on these tools without professional input.
United States Endodontists' Preferences and Perceptions of Single-Visit versus Multiple-Visit Root Canal Treatment: A Cross-Sectional Survey.
Tsai S, Kim JR
J Endod · 2026 May · PMID 42214667 · Publisher ↗
INTRODUCTION: The optimal number of visits for root canal treatment remains debated. This study examined United States endodontists' single-visit versus multiple-visit preferences and identified demographic, regional, an...
INTRODUCTION: The optimal number of visits for root canal treatment remains debated. This study examined United States endodontists' single-visit versus multiple-visit preferences and identified demographic, regional, and technological correlates. METHODS: A cross-sectional, anonymous, 30-item online survey was administered from April to June 2024 to practicing United States endodontists. Associations between demographic variables and responses were assessed using chi-square tests. Binary logistic regression evaluated independent predictors of single-visit treatment across eight clinical scenarios. RESULTS: Of 511 submissions, 462 met eligibility criteria (response rate 14.5%). Routine single-visit completion was reported for necrotic teeth by 74.9% and for irreversible pulpitis by 92.4%. Most respondents perceived no difference between protocols in postoperative complications (65.6%) or success rate (81.0%). Single-visit completion was least common when canals could not be dried (92.6% multiple-visit) and with diffuse swelling (79.9% multiple-visit). Single-visit completion at lesion sizes of ≥5 mm was reported by 60.4% and declined to 37.9% at ≥15 mm. Male sex was the most consistent independent predictor of single-visit preference (7/8 scenarios; odds ratios 2.01-2.74). GentleWave use independently predicted single-visit completion for infection-related scenarios. Preferences varied significantly by age, practice region, and technology use. CONCLUSIONS: Single-visit treatment is widely practiced among United States endodontists, with most perceiving comparable outcomes. Visit number remains case-dependent, particularly when canal dryness is unachievable or acute infection is present. Preferences varied by sex, age, region, and technology adoption.
Vegetarian Diet and the Mechanics of Root Canal Dentin: Surface Hardness, SEM-Quantified Tubule Irregularity, and Diametral Tensile Strength.
Saghiri MA, Chien CH, Kamyabi H … +6 more , Shekarian M, Youssef H, Ramasubbu N, Napoli S, Govindaraj M, Morgano SM
J Endod · 2026 May · PMID 42214666 · Publisher ↗
INTRODUCTION: Root dentin is essential in shaping, bonding, and long-term stability. Since mineralized tissues depend on adequate calcium, phosphate, and vitamin intake, this study investigated whether long-term vegetari...
INTRODUCTION: Root dentin is essential in shaping, bonding, and long-term stability. Since mineralized tissues depend on adequate calcium, phosphate, and vitamin intake, this study investigated whether long-term vegetarian dietary patterns are associated with changes in root dentin microstructure and mechanical properties compared to omnivores. MATERIALS AND METHODS: Twenty-four extracted human teeth were assigned to vegetarian (VEG) or omnivore (OMNI) groups based on ≥3-year dietary history. Mid-root dentin discs were prepared for scanning electron microscopy (SEM) to quantify tubule circularity and aspect ratio, Vickers microhardness testing at 100, 300, and 500 μm from the canal surface, and diametral tensile strength (DTS) testing. Microhardness was analyzed with linear mixed-effects models, and DTS and morphology were compared using independent-samples t-tests. Pearson correlations evaluated relationships between tubule morphology and mechanical properties. RESULTS: VEG dentin exhibited significantly greater tubule irregularity, with lower circularity and higher aspect ratio than OMNI (p < 0.001). Microhardness increased with depth in both groups. However, VEG values were significantly lower at 100 and 300 μm (p < 0.01), converging with OMNI only at 500 μm. DTS was also significantly lower in VEG (14.46 ± 1.89 MPa) compared with OMNI (18.39 ± 1.32 MPa) (p < 0.001). Associations between tubule morphology and mechanical properties were moderate, with significant correlations observed for circularity and microhardness, circularity and DTS, and aspect ratio and microhardness. CONCLUSION: Within the limitations of this ex vivo study, long-term vegetarian status was associated with lower canal-adjacent dentin microhardness, reduced diametral tensile strength, and greater dentin tubule irregularity compared to omnivores. These differences suggest that dietary patterns may contribute to natural variation in dentin structure and mechanics. However, the clinical significance of these associations remains uncertain.
Inflammatory Modulation and Odontogenic Responses of Riboflavin-loaded Hydrogel Applied for Regenerative Endodontics.
Juman O, Leite ML
J Endod · 2026 May · PMID 42208760 · Publisher ↗
INTRODUCTION: This study investigated riboflavin as a bioactive signaling molecule with anti-inflammatory and odontogenic effects under inflammatory (+lipopolysaccharide [LPS]) and noninflammatory conditions (-LPS), and...
INTRODUCTION: This study investigated riboflavin as a bioactive signaling molecule with anti-inflammatory and odontogenic effects under inflammatory (+lipopolysaccharide [LPS]) and noninflammatory conditions (-LPS), and its incorporation into a novel hydrogel system for regenerative endodontics. METHODS: Human dental pulp stem cells were stimulated with E. coli lipopolysaccharide (LPS; 10 μg/mL, 7 days) to model chronic inflammation and treated with riboflavin (0, 3, 30, or 300 μM). Intracellular reactive oxygen species, nitric oxide production, migration, proliferation, collagen synthesis, and mineralized matrix deposition were evaluated. Based on these outcomes, a thermo-crosslinked Pluronic F127 hydrogel was developed with or without riboflavin. Release kinetics were assessed and the same biological assays were performed under ±LPS conditions using a transwell system. RESULTS: Riboflavin reduced reactive oxygen species at all concentrations and decreased nitric oxide in a dose-dependent manner, with significant effects at 30 and 300 μM under +LPS. Riboflavin at 300 μM enhanced cell migration under both ±LPS and restored proliferation, particularly under +LPS. Collagen synthesis and mineralized matrix deposition were improved at all concentrations under +LPS. Riboflavin-loaded hydrogel showed initial burst release followed by sustained delivery. Under +LPS, riboflavin-loaded hydrogel significantly reduced oxidative stress, enhanced migration, proliferation, collagen synthesis, and mineralized matrix deposition, whereas unloaded hydrogel did not improve these deficits. CONCLUSIONS: Riboflavin exerted potent anti-inflammatory and regenerative effects on inflamed human dental pulp stem cells. When incorporated into a controlled-release hydrogel system, it reduced inflammatory response and restored odontogenic properties to levels comparable with noninflammatory conditions, underscoring its potential as a cell-free tissue engineering strategy for vital pulp therapy.
Insights into the June 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 Jun · PMID 42203383 · Publisher ↗
Abstract loading — click title to view on PubMed.
Effect of a Novel Bioceramic Solvent on Apical Patency during Nonsurgical Endodontic Retreatment: An Ex Vivo Study.
Stopar D, Deeb JG, Carrico CK … +1 more , Andrada AC
J Endod · 2026 May · PMID 42203145 · Publisher ↗
INTRODUCTION: Calcium silicate-based sealers (CSC) are widely used due to their favorable biological and physical properties; however, their removal during nonsurgical root canal retreatment (NSReTx) remains challenging....
INTRODUCTION: Calcium silicate-based sealers (CSC) are widely used due to their favorable biological and physical properties; however, their removal during nonsurgical root canal retreatment (NSReTx) remains challenging. This study evaluated the efficacy of a novel bioceramic solvent in re-establishing apical patency during NSReTx of canals obturated with CSC, comparing its performance to sodium hypochlorite (NaOCl), with and without adjunctive Er:YAG laser activation. METHODS: Forty-eight extracted single-rooted teeth were instrumented and obturated 2 mm short of the working length using gutta-percha and CSC. After 14 days, the gutta-percha was removed, and BC Sealer Solvent (Brasseler USA, Savannah, GA) or NaOCl was used, with or without Er:YAG laser activation, to re-establish apical patency. The time to achieve patency using a size 10 C-file was recorded. Differences among the 4 groups were analyzed using the Kruskal-Wallis test. RESULTS: Apical patency was achieved in all canals except one with transportation. The median overall time was 186 seconds, ranging from 57 seconds observed with solvent to 582 seconds with NaOCl. Significant differences were found among the groups (P < .05). Post hoc analysis showed a significant difference between the solvent and NaOCl with the Laser groups (adjusted P < .05). CONCLUSIONS: BC Sealer solvent demonstrated greater effectiveness and efficiency than NaOCl, with or without laser activation, in re-establishing apical patency. These findings suggest its potential to enhance the efficiency of this step during NSReTx involving CSC.
Volumetric Stability and Interfacial Adaptation of Tricalcium Silicate-Based Cements Used in the Lid Technique: A Micro-Computed Tomography and Scanning Electron Microscopy Analysis.
Nomura LH, de Lima Dias-Júnior LC, Paz Dotto ME … +6 more , Barros Steffens F, Cavalini Cavenago B, da Silveira Teixeira C, Tanomaru-Filho M, Bortoluzzi EA, da Fonseca Roberti Garcia L
J Endod · 2026 May · PMID 42203144 · Publisher ↗
INTRODUCTION: This in vitro study evaluated the volumetric stability and interfacial adaptation of tricalcium silicate-based cements with different consistencies (sealer and putty) applied using the Lid technique for ret...
INTRODUCTION: This in vitro study evaluated the volumetric stability and interfacial adaptation of tricalcium silicate-based cements with different consistencies (sealer and putty) applied using the Lid technique for retrograde filling in apical surgery. METHODS: Thirty bovine incisors were prepared, obturated, and apically resected to create standardized 3 mm retrograde cavities. Specimens were randomly allocated to three groups (n = 10): BioRoot Flow + BioRoot RCS, EndoSequence BC Sealer + EndoSequence RRM, and Bio-C Sealer + Bio-C Repair. Flowable sealers were injected into the retrocavities, followed by placement of a putty layer. Micro-computed tomography scans were obtained at baseline (D0) and after 30 days of immersion in phosphate-buffered saline (pH 7.4, 37 °C). Volumetric changes over time were analyzed using one-way and repeated measures ANOVA with Tukey post hoc tests for intergroup and intragroup comparisons (α = 0.05). Selected specimens underwent scanning electron microscopy for qualitative evaluation of interfacial adaptation. RESULTS: All materials exhibited minimal volumetric change after 30 days (<1.1%), with no significant differences among groups (P > .05). Scanning electron microscopy analysis demonstrated close adaptation to dentinal walls, continuous interfaces between sealer and putty layers, and penetration of sealers into dentinal tubules. Occasional microgaps were observed but did not compromise overall interfacial continuity. CONCLUSIONS: The Lid technique using tricalcium silicate-based sealers and putties maintained volumetric stability and demonstrated favorable interfacial adaptation under simulated physiological conditions. These findings support the structural compatibility of combining materials with different consistencies and suggest that this approach represents a feasible option for retrograde filling in apical surgery.
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