Apical periodontitis in endodontically-treated teeth: association between missed canals and quality of endodontic treatment in a Colombian sub-population. A cross-sectional study.

A high prevalence of post-treatment apical periodontitis associated to variables such as endodontic treatment quality and missed canals has been reported. AIM: The aim of this study was to evalúate the quality of endodontic treatment and the frequency of missed canals associated with teeth with apicalperiodontitis (AP) through CBCTin a Colombian sub-population. MATERIAL AND METHOD: This was a cross-sectional study assessing 318 cone beam computed tomography (CBCT) scans of endodontically treated teeth from Colombian individuals. The scans were taken using J Morita X550 (J Morita Corporation, Osaka, Japan), with voxel size 0.125 to 0.20 mm. All endodontically treated teeth were assessed for quality of treatment, presence of missed canals and AP. Allsamples were analyzed bytwo endodontics specialists and an radiology specialist. Chi-square or Fisher 's test and odds ratio were calculated to identify the association and risk relationship between the presence of AP and the study variables. RESULTS: Missed canals were found in 18.61% (86/462), and 95.3% were associated with AP. The frequency of AP was 62.34% (288/462) for all the evaluated teeth. AP was found in 27.43 % (79/288) of the teeth with adequate endodontic treatment, in contrast to 72.57% (209/288) of the teeth with inadequate treatment (P<0.01). The frequency of missed canals was highest in maxillary molars, with 55.23% (58/105), with 96.55% presenting AP. The second mesiobuccal canal wasthe most frequently missed canal, 88.52%o(54/61), with AP in 90.74% (49/54) of the cases. CONCLUSIÓN: There was a high frequency of teeth with missed canals and PA. More than half of the teeth with missed canals were maxillary molars, with MB2 being the most common canal, commonly presenting apical periodontitis.

Uma alta prevalência de periodontite apical pós-tratamento associada a variáveis como qualidade do tratamento endodôntico e fracasso do tratamento é relatada na literatura. O objetivo deste estudo foi avaliar a qualidade do tratamento endodôntico e a frequência e fracasso do tratamento associados a dentes com periodontite apical (PA) por meio de tomografia computadorizada de feixe cônico (TCFC) em uma subpopulação colombiana. MATERIAL E MÉTODO: Este foi um estudo transversal que avaliou 318 tomografias computadorizadas de dentes tratados endodonticamente de indivíduos colombianos. Os exames foram realizados utilizando o tomógrafo J Morita X550, com tamanho de voxel de 0,125 a 0,20 mm. Todos os dentes tratados endodonticamente foram avaliados quanto à qualidade do tratamento, presença de canais não localizados e AP. Todas as amostras foram avaliadas por dois especialistas em endodontia e um especialista em radiologia. Foram calculados o teste qui-quadrado ou de Fisher e a razão de chances para identificar associação e relação de risco entre a presença de PA e as variáveis do estudo. RESULTADOS: Foram encontrados canais não localizados em 18,61% (86/462) e 95,3% estavam associados à PA. A frequência de AP foi de 62,34% (288/462) para todos os dentes avaliados. AP foi encontrada em 27,43% (79/288) dos dentes com tratamento endodôntico adequado, em contraste com 72,57% (209/288) dos dentes com tratamento inadequado (P<0,01). A frequência de canais não localizados foi maior nos molares superiores, com 55,23% (58/105), sendo que 96,55% apresentavam PA. O canal mésio-palatino (MB2) apresentou maior frequência de canal não localizado (88,52% - 54/61), com PA em 90,74% (49/54) dos casos. CONCLUSÃO: Houve alta frequência de dentes com canais não localizados e com PA. Mais da metade dos dentes com canais não localizados eram molares superiores, sendo o MB2 é o canal com a maior frequência, comumente apresentando periodontite apical.

The incidence and intensity of postoperative pain and Flare-up following the use of three different intracanal medicaments in teeth with posttreatment apical periodontitis: a randomized clinical trial.

OBJECTIVES: This randomized clinical trial aimed to compare the effect of intracanal medicaments on the incidence of postoperative pain and flare-up with posttreatment apical periodontitis (PTAP) of retreatment cases. MATERIALS AND METHODS: One hundred twenty patients diagnosed with PTAP with single-rooted teeth with single-canal without spontaneous pain or swellings were included and randomly divided into three groups according to the intracanal medicament used. Intracanal medicaments were placed into the root canals following the removal of previous root canal fillings and re-instrumentation. Calcium hydroxide (Ca (OH)2), chlorhexidine gel (CHX), calcium hydroxide and chlorhexidine gel combinations were used as intracanal medicaments. Postoperative pain scores were recorded at 6 and 12 h and 1, 2, 3, 4, 5, 6, and 7 days using a visual analog scale (VAS). Sensitivity on percussion, spontaneous pain, swelling, antibiotic and analgesic requirements of the patients were evaluated during clinical examinations performed postoperatively after 2 and 7 days. RESULTS: There were no statistically significant differences between groups in terms of VAS scores following the intracanal medicament application (p > 0.05). However, compared to the patients of 20-34 and 50-65 age groups, greater VAS scores were observed in patients of 35-49 age groups at 12 h, and 3, 4, 7 days (p < 0.05). Flare-up was observed in only one patient in the CHX gel group, and no flare-up was observed in other groups. CONCLUSIONS: Similar postoperative pain incidence in all experimental groups indicates that all three medicaments are clinically acceptable in inter-appointment management of retreatment cases in terms of post-endodontic pain and flare-up. CLINICAL RELEVANCE: In this randomized clinical trial, three different intracanal medicaments were utilized in nonsurgical endodontic retreatment and their effect on postoperative pain and flare-up incidence was examined. Thus, this study will be a significant contribution in the decision-making during clinical practice; since there are a limited number of prospective clinical trials in the literature about the severity of pain following retreatment procedures including intracanal medicament use.

Regenerative Endodontic Procedure on an Immature Necrotic Molar: A Case Report with a 5-Year Review.

BACKGROUND The regenerative endodontic procedure (REP) for managing necrotic immature permanent teeth has the advantage of promoting root growth over the traditionally used apexification techniques. However, there is limited evidence on the long-term outcome of standardized REPs performed on immature molars. This case report presents the 5-year clinical and radiographic outcomes of REP performed on an immature mandibular first molar. CASE REPORT A healthy 7-year-old girl with a carious right mandibular first molar was referred to the endodontic clinic for evaluation and treatment. Clinical examination showed large occlusal caries, no tenderness to palpation and percussion tests, and no response to cold and electric pulp tests. Radiographic examination showed deep caries, apical radiolucency related to the open apices, and wide root canal space. Accordingly, the tooth was diagnosed with necrotic pulp and asymptomatic apical periodontitis. The REP was performed following the American Association of Endodontics guidelines, which comprise minimal instrumentation, disinfection with sodium hypochlorite irrigant, use of triple antibiotic paste, induced intracanal bleeding, and application of a coronal mineral trioxide aggregate plug. The patient missed the scheduled follow-up appointments but presented at the clinic 5 years later with an asymptomatic tooth. Clinical and radiographic examination revealed no tenderness to percussion and palpation test, no response to cold test, positive response to electric pulp test, apical healing, apical closure, root lengthening, and canal wall thickening and calcification. CONCLUSIONS While true pulp regeneration is unachievable, the REP, following the current protocol, is clinically successful in achieving root maturation and tooth retention.

The influence of intraoral cryotherapy on postoperative pain and substance P in symptomatic apical periodontitis: randomized clinical study.

Cryotherapy is widely utilized in medicine, particularly for pain management. This randomized clinical trial aimed to assess the effect of intraoral cold pack application (cryotherapy) on postoperative pain (POP) and the level of Substance P (SP) in patients with symptomatic apical periodontitis (SAP). Enrolled patients were randomly assigned to either cryotherapy or control group. After adequate anesthesia, access cavity, and biomechanical preparation of the root canal system were completed, the first apical fluid (AF) sample (S1) was obtained. A custom-made intraoral ice-gel pack was applied for 30 min in the cryotherapy group, while no intervention was performed in the control group. The second AF sample (S2) was collected 30 min later in both groups. Patients were asked to complete the Visual Analogue Scale (VAS) questionnaire to assess their POP. Quantification of SP in AF samples was performed using the enzyme-linked immunosorbent assay (ELISA) test. Data were analyzed statistically, revealing a significant reduction in POP and SP levels in the cryotherapy group compared to the control group (P ≤ 0.05). Furthermore, a moderate positive correlation was observed between SP levels and POP (P ≤ 0.05). In conclusion, intraoral cryotherapy represents a simple and cost-effective option for controlling POP and reducing inflammation levels in patients with SAP.

The trend of radiographic healing after root canal treatment in teeth with apical periodontitis based on cone-beam computed tomography: A 4-year longitudinal study.

OBJECTIVES: The aim of this study was to observe the radiographic healing of periapical lesions after root canal treatment via volumetric measurements based on cone-beam computed tomography (CBCT) over 4 years. METHODS: In total, 162 single-root teeth from patients with chronic periapical periodontitis who underwent primary root canal treatment were included in this retrospective study. Follow-up visits were scheduled at 1, 2, and 4 years after treatment. The volume of radiolucency at pretreatment and follow-up were measured, and the radiographic outcomes were classified into 4 categories: absence, reduction, uncertain or enlargement. Reduction or enlargement was considered when the volumetric change in radiolucency was 20 % or more. RESULTS: During the 4-year follow-up period, 128 teeth were reviewed at least once, including 3 extracted teeth. Of the remaining 125 teeth, the volume of radiolucency was reduced in 116 teeth (90.6 %), uncertain in 5, and enlarged in 4 teeth during 1 to 4 years after treatment. Among the 43 teeth with reduced radiolucency at 1 year after treatment, 42 (97.7 %) had continuing reduced lesions at 4 years. In the 2 teeth with enlarged radiolucency at 1 year, the volume of radiolucency doubled at 4 years. Cox regression analysis revealed that the preoperative radiolucency size was a risk factor for persistent periapical radiolucency. CONCLUSIONS: The efficacy of root canal treatment for apical periodontitis was predictable. When the radiolucency changed by 20 % or more in volume on CBCT scans at 1 year after treatment, reversal of the radiographic healing tendency was rare. CLINICAL SIGNIFICANCE: The volumetric changes in radiolucency on CBCT could reflect trends in the healing process and may foster early clinical decision-making.

Microrobotics in endodontics: A perspective.

Microorganisms are the primary aetiological factor of apical periodontitis. The goal of endodontic treatment is to prevent and eliminate the infection by removing the microorganisms. However, microbial biofilms and the complex root canal anatomy impair the disinfection process. Effective and precise endodontic therapy could potentially be achieved using advanced multifunctional technologies that have the ability to access hard-to-reach surfaces and perform simultaneous biofilm killing, removal, and detection of microorganisms. Advances in microrobotics are providing novel therapeutic and diagnostic opportunities with high precision and efficacy to address current biofilm-related challenges in biomedicine. Concurrently, multifunctional magnetic microrobots have been developed to overcome the disinfection challenges of current approaches to disrupt, kill, and retrieve biofilms with the goal of enhancing the efficacy and precision of endodontic therapy. This article reviews the recent advances of microrobotics in healthcare and particularly advances to overcome disinfection challenges in endodontics, and provides perspectives for future research in the field.

Platelet-rich fibrin as an apical barrier for MTA placement in the treatment of teeth with open apices: a pilot study.

OBJECTIVE: The aim of the present pilot study was to assess the effectiveness of the platelet-rich fibrin (PRF) apical barrier for the placement of MTA for the treatment of teeth with periapical lesions and open apices. METHODS: A total of thirty teeth on twenty-eight patients with open apices and periapical periodontitis were enrolled and divided into two groups in the present pilot study. In the PRF group (fourteen teeth in thirteen patients), nonsurgical endodontic treatment was performed using PRF as an apical matrix, after which the apical plug of the MTA was created. For the non-PRF group (fourteen teeth in fourteen patients), nonsurgical endodontic therapy was performed using only the MTA for an apical plug with no further periapical intervention. Clinical findings and periapical digital radiographs were used for evaluating the healing progress after periodic follow-ups of 1, 3, 6, and 9 months. The horizontal dimension of the periapical lesion was gauged, and the changes in the dimensions were recorded each time. The Friedman test, Dunn-Bonferroni post hoc correction, and Mann-Whitney U test were used for statistical analysis, with P < 0.05 serving as the threshold for determining statistical significance. RESULTS: All patients in both groups in the present pilot study had no clinical symptoms after 1 month, with a significant reduction in the periapical lesion after periodic appointments. The lesion width of the PRF group was significantly smaller than that of the non-PRF group in the sixth and ninth month after treatment. CONCLUSIONS: PRF is a promising apical barrier matrix when combined with MTA for the treatment of teeth with open apices and periapical periodontitis. Small number of study subjects and the short time of follow-up period limit the generalizability of these results. TRIAL REGISTRATION: TCTR, TCTR20221109006. Registered 09 November 2022 - Retrospectively registered, https://www.thaiclinicaltrials.org/show/TCTR20221109006 .

Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults.

BACKGROUND: Dental pain can have a detrimental effect on quality of life. Symptomatic apical periodontitis and acute apical abscess are common causes of dental pain and arise from an inflamed or necrotic dental pulp, or infection of the pulpless root canal system. Clinical guidelines recommend that the first-line treatment for these conditions should be removal of the source of inflammation or infection by local operative measures, and that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection (cellulitis, lymph node involvement, diffuse swelling) or systemic involvement (fever, malaise). Despite this, there is evidence that dentists frequently prescribe antibiotics in the absence of these signs. There is concern that this could contribute to the development of antibiotic-resistant bacteria. This review is the second update of the original version first published in 2014. OBJECTIVES: To evaluate the effects of systemic antibiotics provided with or without surgical intervention (such as extraction, incision and drainage of a swelling, or endodontic treatment), with or without analgesics, for symptomatic apical periodontitis and acute apical abscess in adults. SEARCH METHODS: We searched Cochrane Oral Health's Trials Register (26 February 2018 (discontinued)), CENTRAL (2022, Issue 10), MEDLINE Ovid (23 November 2022), Embase Ovid (23 November 2022), CINAHL EBSCO (25 November 2022) and two trials registries, and performed a grey literature search. There were no restrictions on language or date of publication. SELECTION CRITERIA: Randomised controlled trials of systemic antibiotics in adults with a clinical diagnosis of symptomatic apical periodontitis or acute apical abscess, with or without surgical intervention (considered in this situation to be extraction, incision and drainage, or endodontic treatment) and with or without analgesics. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias. We used a fixed-effect model in the meta-analysis as there were fewer than four studies. We contacted study authors to request missing information. We used GRADE criteria to assess the certainty of the evidence. MAIN RESULTS: There was one new completed trial on this topic since the last update in 2018. In total, we included three trials with 134 participants. Systemic antibiotics versus placebo with surgical intervention and analgesics for symptomatic apical periodontitis or acute apical abscess One trial (72 participants) compared the effects of a single preoperative dose of clindamycin versus a matched placebo when provided with a surgical intervention (endodontic chemo-mechanical debridement and filling) and analgesics to adults with symptomatic apical periodontitis. We assessed this study at low risk of bias. There were no differences in participant-reported pain or swelling across trial arms at any time point assessed. The median values for pain (numerical rating scale 0 to 10) were 3.0 in both groups at 24 hours (P = 0.219); 1.0 in the antibiotic group versus 2.0 in the control group at 48 hours (P = 0.242); and 0 in both groups at 72 hours and seven days (P = 0.116 and 0.673, respectively). The risk ratio of swelling when comparing preoperative antibiotic to placebo was 0.50 (95% confidence interval (CI) 0.10 to 2.56; P = 0.41). The certainty of evidence for all outcomes in this comparison was low. Two trials (62 participants) compared the effects of a seven-day course of oral phenoxymethylpenicillin (penicillin VK) versus a matched placebo when provided with a surgical intervention (total or partial endodontic chemo-mechanical debridement) and analgesics to adults with acute apical abscess or symptomatic necrotic tooth. Participants in both trials also received oral analgesics. We assessed one study at high risk of bias and the other at unclear risk of bias. There were no differences in participant-reported pain or swelling at any time point assessed. The mean difference for pain (short ordinal numerical scale 0 to 3, where 0 was no pain) was -0.03 (95% CI -0.53 to 0.47) at 24 hours; 0.32 (95% CI -0.22 to 0.86) at 48 hours; and 0.08 (95% CI -0.38 to 0.54) at 72 hours. The standardised mean difference for swelling was 0.27 (95% CI -0.23 to 0.78) at 24 hours; 0.04 (95% CI -0.47 to 0.55) at 48 hours; and 0.02 (95% CI -0.49 to 0.52) at 72 hours. The certainty of evidence for all the outcomes in this comparison was very low. Adverse effects, as reported in two studies, were diarrhoea (one participant in the placebo group), fatigue and reduced energy postoperatively (one participant in the antibiotic group) and dizziness preoperatively (one participant in the antibiotic group). Systemic antibiotics without surgical intervention for adults with symptomatic apical periodontitis or acute apical abscess We found no studies that compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults. AUTHORS' CONCLUSIONS: The evidence suggests that preoperative clindamycin for adults with symptomatic apical periodontitis results in little to no difference in participant-reported pain or swelling at any of the time points included in this review when provided with chemo-mechanical endodontic debridement and filling under local anaesthesia. The evidence is very uncertain about the effect of postoperative phenoxymethylpenicillin for adults with localised apical abscess or a symptomatic necrotic tooth when provided with chemo-mechanical debridement and oral analgesics. We found no studies which compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults.

Frequency of apical periodontitis in root-filled teeth restored with post and core: A 5-year retrospective study.

BACKGROUND: In conjunction with post placement in root-filled teeth with periapical healthy conditions, root canal retreatment may be performed to improve the seal of the root canal. Whether root canal retreatment for technical reasons (retreatments in teeth without apical periodontitis (AP)) results in lower frequency of AP is unknown. OBJECTIVE: To examine whether there is a difference in frequency of AP between roots with root canals retreated for technical reasons, and roots with root canals not retreated before post placement, with a minimum follow-up of 5 years. Also, to examine changes in root filling quality following root canal retreatment for technical reasons. METHODS: This retrospective study included radiographs of 441 root-filled roots without periapical radiolucencies at baseline, scheduled for post and core treatment. Follow-up data for a minimum of 5 years were available for 305 roots (loss to follow-up 30.8%), 46 of which were retreated for technical reasons. Two calibrated observers assessed root filling sealing quality and length, respectively, and periapical status according to the Periapical Index. The main outcome of the study, AP, was used as the dependent variable and all analyses were performed at root level. RESULTS: The overall frequency of AP at follow-up was 13.8%. The difference in frequency of AP between retreated (4.3%) and nonretreated (15.4%) root canals was not statistically significant, p = .061. Analyses including only roots with preoperatively inadequate root filling quality showed a statistically significant difference (p = .017) between the two treatment groups (2.4% vs. 22.9%). CONCLUSIONS: Root canal retreatment for technical reasons before post and core placement significantly reduces the frequency of AP in roots with inadequate root filling quality.

Deciduous pulp tissue implantation into the root canal of mandibular incisor resulted in pulp revascularization: a case report with a 5-year follow-up.

To explore a new method to implant deciduous tooth pulp into the canal of young permanent teeth with necrotic pulps and apical periodontitis for the regenerative endodontic treatment of tooth no: 41 in a 7-year-old male. Briefly, 1.5% Sodium Hypochlorite (NaOCl) irrigation and calcium hydroxide-iodoform paste were used as root canal disinfectant at the first visit. After 2 weeks, the intracanal medication was removed, and the root canal was slowly rinsed with 17% Ethylene Diamine Tetraacetic Acid (EDTA), followed by flushing with 20 mL saline and then drying with paper points. Tooth no: 72 was extracted, and its pulp was extracted and subsequently implanted into the disinfected root canal along with induced apical bleeding. Calcium hydroxide iodoform paste was gently placed over the bleeding clot, and after forming a mineral trioxide aggregate (MTA) coronal barrier, the accessed cavities were restored using Z350 resin composite. The root developments were evaluated via radiographic imaging at 6 months, 1 year and 5 years after treatment. Imaging and clinical analysis showed closure of the apical foramen, thickening of the root canal wall, and satisfactory root length growth. Autologous transplantation might be useful to regenerate dental pulp in necrotic young permanent teeth.

Photodynamic and nitric oxide therapy-based synergistic antimicrobial nanoplatform: an advanced root canal irrigation system for endodontic bacterial infections.

BACKGROUND: The main issues faced during the treatment of apical periodontitis are the management of bacterial infection and the facilitation of the repair of alveolar bone defects to shorten disease duration. Conventional root canal irrigants are limited in their efficacy and are associated with several side effects. This study introduces a synergistic therapy based on nitric oxide (NO) and antimicrobial photodynamic therapy (aPDT) for the treatment of apical periodontitis. RESULTS: This research developed a multifunctional nanoparticle, CGP, utilizing guanidinylated poly (ethylene glycol)-poly (ε-Caprolactone) polymer as a carrier, internally loaded with the photosensitizer chlorin e6. During root canal irrigation, the guanidino groups on the surface of CGP enabled effective biofilm penetration. These groups undergo oxidation by hydrogen peroxide in the aPDT process, triggering the release of NO without hindering the production of singlet oxygen. The generated NO significantly enhanced the antimicrobial capability and biofilm eradication efficacy of aPDT. Furthermore, CGP not only outperforms conventional aPDT in eradicating biofilms but also effectively promotes the repair of alveolar bone defects post-eradication. Importantly, our findings reveal that CGP exhibits significantly higher biosafety compared to sodium hypochlorite, alongside superior therapeutic efficacy in a rat model of apical periodontitis. CONCLUSIONS: This study demonstrates that CGP, an effective root irrigation system based on aPDT and NO, has a promising application in root canal therapy.

Physical training attenuates systemic cytokine response and tissue damage triggered by apical periodontitis.

Apical periodontitis (AP) is a condition characterized by inflammatory and infectious components in the tooth canal. AP affects periradicular tissues and has systemic repercussions. Physical exercise is a structured activity that requires cardiorespiratory function, and can modulate the inflammatory profile in pathological conditions. As a result, this study aimed to determine the effects of aerobic physical training (PT) on the alveolar bone with and without AP, and its systemic inflammatory repercussions. AP was induced in the mandibular first molars, and PT was performed on a treadmill for five consecutive days over four weeks, with progressive increases in speed and activity time. Blood samples were collected to determine serum cytokine levels using immunoassays, and alveolar bone samples were collected for histopathological evaluation, lesion volume and microarchitecture assessment using computed microtomography. Animals with AP had increased pro-inflammatory cytokines levels compared to those without AP; however, these levels were attenuated or restored by PT. Compared to the AP group, the AP + PT group had a smaller lesion volume and greater preservation of the bone trabeculae in the remaining alveolar bone surrounding the lesion. In overall, PT minimized the severity of AP proving to be a valid strategy for individuals undergoing endodontic treatment.

Clinical and Radiographic Failure of Nonsurgical Endodontic Treatment and Retreatment Using Single-cone Technique With Calcium Silicate-based Sealers: A Systematic Review and Meta-analysis.

INTRODUCTION: This systematic review and meta-analysis aimed to evaluate the clinical and radiographic failure of nonsurgical endodontic treatment and retreatment for mature permanent teeth with or without apical periodontitis using the single-cone (SC) obturation technique with calcium silicate-based bio-ceramic (CSBC) sealers and to compare these failure rates to other sealer materials and obturation techniques. METHODS: A comprehensive search was conducted using MEDLINE (PubMed), Embase, Cochrane Library, Scopus, Web of Science, and gray literature up to March 2023. Two reviewers assessed the eligibility of the included studies. Eligible studies were critically appraised for risk of bias and quality of evidence. Subsequently, a meta-analysis of pooled data was conducted utilizing the RevMan software (P < .05) to evaluate the failure rate of non-surgical root canal therapy using CSBC sealers and SC obturation procedures. Separately, another analysis was conducted to compare those results with the outcome of nonsurgical root canal therapy using alternative obturation materials and methods. RESULTS: Five studies were included. The pooled failure rate for nonsurgical endodontic treatment and retreatment combined using CSBC sealers and SC obturation technique was 6.8% [95% confidence interval (CI) = (3%-12%), I2 = 46%]. A second analysis was conducted on the 3 included clinical trials to compare the outcomes of the intervention (CSBC sealers and SC obturation technique) and control groups (other sealers and other obturation techniques). This analysis found no significant difference between the 2 groups regarding clinical and radiographic failure of endodontic treatment and retreatment [Risk ratio = 0.71, 95% CI = (0.33, 1.51), I2 = 0]. This difference was also not statistically significant when the failure rate of primary root canal treatment and retreatment were separately analyzed [Combined Risk ratio of primary root canal treatment = 0.94, 95% CI = (0.46, 1.93), I2 = 0%; Combined Risk ratio of retreatment = 0.21, 95% CI = (0.001, 75.46), I2 = 0%]. CONCLUSIONS: The overall results of this systematic review and meta-analysis demonstrate that the SC obturation technique with CSBC sealer provides similar results compared to other obturation materials and techniques in facilitating the healing of apical periodontitis.

Comparation of the effectiveness of conventional needle irrigation and photon-induced photoacoustic streaming with sodium hypochorite in the treatment of teeth with apical periodontitis: a randomized clinical trial.

Photon-initiated photoacoustic streaming (PIPS) with an Er: YAG laser has been introduced in root canal treatment to improve irrigation and facilitate the removal of bacteria in the root canal system. This study aimed to compare the antibacterial effectiveness of two different root canal irrigation techniques, conventional needle irrigation (CNI) and PIPS, using 1% sodium hypochlorite (NaOCl), in the treatment of teeth with apical periodontitis. Sixty patients with a total of sixty teeth affected by apical periodontitis were included in this study. The teeth underwent root canal therapy, and after mechanical instrumentation, they were randomly assigned to two groups (n = 30) based on the final irrigation protocol: CNI or PIPS with 1% NaOCl. Bacterial suspensions in the root canals were evaluated using Adenosine 5'-triphosphate (ATP) assay kit after mechanical instrumentation and after final irrigation. Then, a follow-up was conducted after 7 days. The results revealed that final irrigation significantly reduced ATP values in both the CNI and PIPS groups (P < 0.001). The ATP values after final irrigation was greater in the CNI group compared to the PIPS group (P < 0.001). After a 7-day follow-up, percussion tenderness and fistula were significantly resolved in both groups (P < 0.05). A multivariate linear regression model was used to identify the factors that influence post irrigation ATP values. The analysis demonstrated that pre-operative percussion tenderness (P = 0.006), the presence of a fistula (P < 0.001) and the method used in the final irrigation (P < 0.001) had a significant impact on the ATP value after final irrigation. These results indicate that employing PIPS with 1% NaOCl as the final irrigation protocol exhibited superior antibacterial effectiveness and has the potential to enhance clinical outcomes in the treatment of teeth afflicted with apical periodontitis.

Outcome of nonsurgical management of large cyst-like periapical lesions using a modified apical negative pressure irrigation system: a case series study.

OBJECTIVE: To assess the effectiveness of a self-constructed modified apical negative pressure irrigation (ANPI) system employing commonly used clinical instruments in nonsurgical root canal therapy (NSRCT) for large cyst-like periapical lesions (LCPLs). METHODS: From 2017 to 2022, 35 patients diagnosed with LCPLs (5-15 mm) via preoperative clinical and radiographic evaluations of endodontic origin underwent NSRCT combined with ANPI. These patients were subjected to postoperative clinical and radiographic follow-up at 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years, with a CBCT scan specifically conducted at 6-month follow-up. Through the reconstruction of three-dimensional cone beam computed tomography (CBCT) data, an early prognosis was facilitated by monitoring changes in lesion volume. Various treatment predictors-including sex, type of treatment, lesion size, preoperative pain, jaw, type of teeth involved, sealer extrusion, and the number of root canals-were meticulously analyzed. The evaluation of post-treatment outcomes leveraged both clinical observations and radiographic data collected during the follow-up periods. The Kruskal‒Wallis test and one-way ANOVA were also conducted to determine the independent factors influencing treatment outcomes. A significance level of 5% was established. RESULTS: Thirty-five teeth from 35 patients with a median age of 28 years (range 24-34) were treated; the median follow-up duration was 19 months (range 12-26). The overall success rate was 91.4%, with a median lesion reduction of 77.0% (range 54.2-96.4%) at 6 months. Patients under 30 years of age exhibited a significantly greater success rate than older patients did (100.0% vs. 80.0%, p = 0.037). Other factors, such as sex, jaw, treatment type, preoperative pain, cyst size, tooth location, sealer extrusion, and the number of roots, did not significantly impact treatment outcomes. CONCLUSIONS: Despite limitations related to the observational case-series study design and relatively small sample size, our findings suggest that utilizing the ANPI in the NSRCT for LCPLs may hold promise. The notably higher success rate in patients younger than 30 years is worth noting.

Correlation between pulp sensibility and magnetic resonance signal intensity following regenerative endodontic procedures in mature necrotic teeth- a retrospective cohort study.

BACKGROUND: With increasing studies being published on regenerative endodontic procedures (REPs) as a treatment modality for mature necrotic teeth, the assessment of outcomes following regenerative endodontic procedures has become more challenging and the demand for a better understanding of the regenerated tissues following this treatment is rising. The study aimed to correlate cold, electric pulp testing (EPT), and magnetic resonance imaging (MRI) signal intensity (SI) in mature necrotic teeth treated with regenerative endodontic procedures. METHODOLOGY: This retrospective cohort study included eighteen adult patients who experienced tooth necrosis in mature maxillary anterior teeth recruited from the outpatient clinic, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt from July 2017 until December 2018 with 12 months of follow-up. regenerative endodontic procedures via blood clot were performed. The canals were instrumented by ProTaper Next (PTN) files until final sizes X3 or X5. Biodentine was used as cervical plug material. Pre and post-operative clinical follow-up was done where the patients' responses to cold and electric pulp testing were given a scoring system and were compared to the normal contralateral tooth. Pre and post-operative magnetic resonance imaging signal intensity of both the involved tooth and its contralateral at the middle and the apical thirds of the root canals were assessed after 3, 6, and 12 months. Data was analyzed using the ANOVA, Friedman and Bonferroni tests. Significance was set at a p-value < 0.05. RESULTS: All 18 teeth scored a baseline score of "2" for cold and electric pulp testing. There was a significant difference between scores of the cold test at baseline and 12-month follow-up (p < 0.001). There was a significant difference between scores of the electric pulp testing of baseline and 12-month follow-up (p < 0.001). There was a moderately significant indirect (inverse) correlation between magnetic resonance imaging signal intensity and cold test in both the middle and apical thirds at 12 months. No significant correlations were detected between magnetic resonance imaging signal intensity and electric pulp testingat any of the time intervals (p > 0.05). CONCLUSION: Magnetic resonance imaging is a successful non-invasive method to assess outcomes of regenerative endodontic procedures and correlating it with another reliable method of assessing pulpal responses, cold test, could validate these outcomes. CLINICAL TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov (ID: NCT03804450).

Influence of the severity of periodontal disease on the outcome of non-surgical endodontic therapy: A prospective cohort study.

OBJECTIVE: To investigate the influence of severity of periodontal disease on periapical healing after non-surgical endodontic therapy (NSET). MATERIAL AND METHODS: In this prospective study, subjects (n = 45) requiring NSET in a mandibular molar tooth with the diagnosis of pulp necrosis and asymptomatic apical periodontitis exhibiting radiographic periapical index (PAI) score ≥ 3 and concomitant endodontic periodontal lesion (CEPL) without communication were enrolled. After dividing as per the classification of Periodontal and Peri-Implant Diseases and Conditions, subjects were equally allocated into three groups. Group I- only endodontic lesion {control: healthy periodontium (n = 15)}, Group II- CEPL having stage I and II periodontitis (n = 15) and Group III- CEPL having stage III periodontitis (n = 15). Standardized two-visit NSET was performed with 2% chlorhexidine gel as an intracanal medicament. Periodontal therapy was instituted wherever required. Subjects were recalled at 6-and 12-months for clinical and radiographic assessment. Chi-square test was performed to evaluate the difference between the groups. RESULTS: At 12-month follow-up, all teeth in the three study groups were asymptomatic. On radiographic evaluation of the periapical region, healing was observed in 80%, 47% and 50% of teeth in Groups I, Group II and Group III, respectively. However, the difference was not statistically significant between the groups (p = 0.150). CONCLUSION: The severity of periodontal disease had no influence on periapical healing after NSET in teeth with concomitant endodontic periodontal lesions without communication. CLINICAL RELEVANCE: Periodontal disease has significant impact on apical periodontitis however severity of the periodontitis does not negatively impact the apical periodontitis.

Revolutionizing Endodontics: Innovative Approaches for Treating Mature Teeth With Closed Apices and Apical Lesions: A Report of Two Cases.

INTRODUCTION: Modern tissue engineering strategies have elucidated the potential of regenerative endodontic treatment (RET) as an alternative for treating mature teeth. METHODS: Here, we report two cases in which cell-based RET (CB-RET) using encapsulated allogeneic umbilical cord mesenchymal stem cells (UC-MSCs) in a platelet-poor plasma (PPP)-based scaffold was used in two mature teeth with pulp necrosis and apical periodontitis. RESULTS: After 5 years of follow-up, the healing response was satisfactory in both cases, with evidence of pulp revitalization. CONCLUSIONS: This is the first study to report the success of an extended, 5-year follow-up for allogeneic CB-RET. This report presents an innovative and sustainable solution to challenging endodontic scenarios.

Next-generation antibacterial nanopolymers for treating oral chronic inflammatory diseases of bacterial origin.

BACKGROUND: 'Periodontitis' refers to periodontal destruction of connective tissue attachment and bone, in response to microorganisms forming subgingival biofilms on the root surface, while 'apical periodontitis' refers to periapical inflammatory processes occurring in response to microorganisms within the root canal system. The treatment of both diseases is based on the elimination of the bacterial challenge, though its predictability depends on the ability of disrupting these biofilms, what may need adjunctive antibacterial strategies, such as the next-generation antibacterial strategies (NGAS). From all the newly developed NGAS, the use of polymeric nanotechnology may pose a potential effective approach. Although some of these strategies have only been tested in vitro and in preclinical in vivo models, their use holds a great potential, and therefore, it is relevant to understand their mechanism of action and evaluate their scientific evidence of efficacy. OBJECTIVES: To explore NGAS based on polymeric nanotechnology used for the potential treatment of periodontitis and apical periodontitis. METHOD: A systemic search of scientific publications of adjunctive antimicrobial strategies using nanopolymers to treat periodontal and periapical diseases was conducted using The National Library of Medicine (MEDLINE by PubMed), The Cochrane Oral Health Group Trials Register, EMBASE and Web of Science. RESULTS: Different polymeric nanoparticles, nanofibres and nanostructured hydrogels combined with antimicrobial substances have been identified in the periodontal literature, being the most commonly used nanopolymers of polycaprolactone, poly(lactic-co-glycolic acid) and chitosan. As antimicrobials, the most frequently used have been antibiotics, though other antimicrobial substances, such as metallic ions, peptides and naturally derived products, have also been added to the nanopolymers. CONCLUSION: Polymeric nanomaterials containing antimicrobial compounds may be considered as a potential NGAS. Its relative efficacy, however, is not well understood since most of the existing evidence is derived from in vitro or preclinical in vivo studies.

Platelet rich fibrin and MTA in the treatment of teeth with open apices.

BACKGROUND: The present study aimed to evaluate the effectiveness of using platelet-rich fibrin (PRF) as the apical matrix for the placement of MTA in nonsurgical endodontic therapy for teeth with periapical lesions and open apices. METHODS: Twelve teeth from eleven patients with periapical periodontitis and open apices were enrolled in the study. Nonsurgical endodontic therapy was performed with the PRF used as an apical barrier and the MTA manipulated as an apical plug for further thermoplasticized gutta percha in the remaining part of the root canal. Clinical signs and periapical digital radiographs were recorded and analyzed to evaluate the curing progress after periodical follow-ups of 1, 3, and 6 months. The horizontal dimension of the periapical lesion was determined, and the changes in the dimensions were recorded each time. The Friedman test was used for statistical analysis, with P < .05 serving as the threshold for determining statistical significance. RESULTS: All patients had no clinical symptoms after the first month of treatment, with a significant reduction in the periapical lesion after periodical appointments. CONCLUSIONS: PRF is an effective barrier when combined with MTA for the treatment of teeth with periapical periodontitis and open apices.