Search Results (790)

Traumatised immature permanent teeth with pulp necrosis pose a clinical challenge due to incomplete root development and limited treatment options. This retrospective observational study evaluated the clinical and radiographic outcomes of regenerative endodontic treatment (RET) incorporating an additional calcium hydroxide-based step for blood clot stabilisation compared with apexification in traumatised immature teeth. A total of 49 teeth treated between 2015 and 2025 were analysed. Clinical and radiographic parameters were recorded at baseline and reassessed at 6- and 12-month follow-up, including root length, dentinal wall thickness, apical diameter, periapical status, and apical closure. RET was associated with significantly greater increases in dentinal wall thickness (p = 0.002), root length (p = 0.010), and reductions in apical diameter (p < 0.001) over time compared with apexification. Apical closure was observed significantly more frequently in the RET group (p < 0.001). Periapical healing improved in both groups, while overall clinical outcomes appeared broadly similar. Within the limitations of this retrospective observational study, RET incorporating an additional calcium hydroxide-based step for blood clot stabilisation appears to be a clinically applicable approach for promoting root development in traumatised immature teeth. Further prospective and controlled studies are required to confirm these findings and to better define the role of this adjunctive step. Full article

Background/Objectives: This study aimed to evaluate the effect of intracanal cryotherapy on postoperative pain across obturation materials with different chemical compositions and physical properties in single-visit root canal treatment. Methods: Patients diagnosed with irreversible pulpitis (n = 73), treated in a single visit by the same operator, were categorized based on the obturation material used (AH Plus, TotalFill BC Sealer, and TotalFill BC RRM) and whether intracanal cryotherapy (20 mL of sterile saline at 4 °C for 5 min) was applied. Visual Analog Scale (VAS) scores obtained from patient follow-up forms at 24, 48, and 72 h were evaluated. Results: Cryotherapy (+) groups showed consistently lower pain scores at all time points compared with cryotherapy (−) groups (p < 0.001). Within the cryotherapy (+) groups, both TotalFill BC Sealer and TotalFill BC RRM exhibited significantly lower pain scores than AH Plus at 48 h (p < 0.05). In the cryotherapy (−) groups, TotalFill BC Sealer showed significantly lower pain scores on the third postoperative day (p < 0.05). Conclusions: Intracanal cryotherapy may serve as an effective adjunctive technique associated with lower early postoperative pain scores. Material-related differences became evident at 48 and 72 h, suggesting that obturation material selection may influence postoperative pain patterns and patient comfort during the later postoperative period. Full article

Introduction: Odontogenic sinusitis (ODS) is an underrecognized cause of maxillary sinus inflammation and is frequently associated with dental, periodontal, endodontic, and iatrogenic factors. Accurate identification of the odontogenic source is essential for appropriate treatment planning. Cone-beam computed tomography (CBCT) allows detailed evaluation of the maxillary sinus, adjacent teeth, alveolar bone, and periodontal structures, and may improve the radiologic differentiation of ODS. Materials and Methods: This retrospective observational study analyzed radiologic data from patients evaluated and treated by the authors for suspected odontogenic sinusitis between 2019 and 2026. The final study group included 85 patients with CBCT-based evidence of odontogenic pathology affecting the maxillary sinus. CBCT scans were reviewed to identify tooth-related and treatment-related etiologic factors associated with ODS. Based on the radiologic findings, the authors developed a CBCT-based classification of odontogenic etiologies and proposed an imaging-guided management algorithm. Results: CBCT identified a broad spectrum of odontogenic factors associated with maxillary sinus disease. The most relevant radiologic patterns included endodontic and periapical pathology, periodontal or combined endo-periodontal disease, post-extraction inflammatory changes, odontogenic cysts, oro-antral communication or fistula, retained roots or teeth, displaced endodontic materials, and grafting or implant-related complications. These findings were organized into 16 radiologic categories reflecting the principal etiologic pathways of ODS. The proposed classification facilitated correlation between radiologic presentation and the recommended dental, surgical, and otolaryngologic treatment approach. Conclusions: CBCT is a valuable imaging modality for identifying odontogenic causes of maxillary sinus inflammation and provides more precise diagnostic information than conventional radiography alone. A structured CBCT-based evaluation may improve etiologic diagnosis, support multidisciplinary decision-making, and help guide individualized management of patients with ODS. Full article

Background and Clinical Significance: Dental trauma presents a considerable challenge for clinicians due to the diverse and complex effects on teeth. Effective management often requires the collaboration of multiple specialists, including endodontists and orthodontists. Case Presentation: This case report presents the interdisciplinary management of a complex dental trauma case involving three permanent maxillary anterior teeth. Unlike most reports of dental trauma, this case includes complete pre-trauma diagnostic records, providing valuable baseline information for treatment planning and outcome assessment. A 15-year-old female patient was examined in the orthodontic clinic, with comprehensive diagnostic records being obtained at the initial visit. Before the commencement of active orthodontic therapy, the patient experienced an extraoral traumatic incident. Clinical and radiographic assessment revealed concussion and traumatic mobility of the upper right canine, intrusive luxation of the upper right lateral incisor and extrusive luxation with increased mobility of the upper right central incisor. Taking into consideration treatment alternatives, an orthodontic–endodontic approach was preferred. Conclusions: The successful management of complex dental trauma affecting multiple permanent teeth requires interdisciplinary collaboration. The clinical significance lies in the potential long-term consequences on both tooth function and aesthetics, which can impact patient well-being. Full article

Background: Metallic and metal oxide nanoparticles are increasingly explored as antimicrobial biomaterials in endodontics due to their multi-target mechanisms of action, largely mediated by metal ion release (e.g., Ag⁺, Cu⁺). However, bacterial metal resistance systems, particularly efflux-related proteins, may influence their antimicrobial performance. This study aimed to analyze the prevalence and distribution of metal resistance-associated proteins in bacteria involved in endodontic infections using a bioinformatic approach. Methods: An in silico, cross-sectional bioinformatic analysis was conducted using publicly available genomes from the Bacterial and Viral Bioinformatics Resource Center (BV-BRC). Bacterial species associated with acute apical abscess (AAA), symptomatic apical periodontitis (SAP), asymptomatic apical periodontitis (AAP), and post-treatment apical periodontitis (PTAP) were included. The presence of selected metal resistance-related proteins (CutC, CopA, CzcA, CusA, SilA, P-type ATPase, and PA3920) was assessed using a binary presence/absence framework. Prevalence, group comparisons (Fisher’s exact test), and co-occurrence patterns (Phi coefficient) were analyzed. Results: Metal resistance-associated proteins were widely distributed across all infection types, with prevalence ranging from 70.0% to 82.9% and no significant differences between groups (p > 0.05). CutC was the most prevalent protein, followed by CopA and CzcA, whereas SilA and PA3920 were not detected. Correlation analysis revealed consistent co-occurrence patterns among key taxa, including Porphyromonas gingivalis, Fusobacterium nucleatum, and Prevotella spp. Conclusions: Metal resistance-related proteins are broadly distributed in endodontic microbiota, indicating a conserved genetic capacity for metal tolerance. These findings suggest that microbial resistance determinants may influence, but do not directly determine, the antimicrobial performance of nanoparticle-based biomaterials. This study provides a hypothesis-generating, bioinformatic framework to support the design and optimization of antimicrobial biomaterials, highlighting the need for experimental validation and integration of phenotypic and biofilm-based analyses. Full article

Conventional: Endodontic outcome criteria established by the American Association of Endodontists (AAE) and the European Society of Endodontology (ESE) rely heavily on radiographic, clinical, and functional parameters. These criteria may not be applicable to patients with special health care needs, who often present with limited cooperation, communication impairments, and altered pain perception. Objective: This study aims to propose an adapted classification system for evaluating non-surgical root canal treatment outcomes in this underserved population. Methods: Based primarily on the criteria established by the ESE and our clinical experience, a novel classification system was developed, delineating three outcome categories grounded in both clinical and radiographic parameters. This framework deliberately excludes the “functional” criterion and introduces a “not assessable” category. It was retrospectively applied to 217 non-surgical root canal treatments performed in 137 patients with special health care needs, each with a minimum one-year follow-up. Outcomes were categorized as “favorable,” “uncertain,” or “unfavorable.” Results: Using the proposed criteria, 87 treatments (40.0%) were classified as “favorable,” 88 (40.5%) as “uncertain,” and 42 (19.3%) as “unfavorable.” By contrast, the application of AAE/ESE standards resulted in a 71.9% “favorable” classification. Most “uncertain” outcomes occurred in patients with neurodevelopmental disorders, where clinical or radiographic evaluation was not feasible. Conclusions: We propose adapted clinical and radiographic criteria for assessing non-surgical root canal treatment outcomes in patients with special health care needs, though broader validation is required. The findings suggest that this procedure remains advisable in this population, with fewer than 20% showing an “unfavorable” long-term outcome. Full article

Background/Objective: The present case demonstrates the successful preservation of a severely inflamed dental pulp despite uncontrolled bleeding occurring during pulpotomy. This novel therapeutic approach was developed when a 7-year-old boy presented for endodontic treatment one week after sustaining a crown-root fracture in an immature incisor. The tooth exhibited slight hypersensitivity to cold testing, with no tenderness to percussion or palpation. An exposed pulp was present; however, when he could avoid contact with the exposed pulp tissue, the patient reported no symptoms. Methods: The critical determinant of success when uncontrolled pulpal bleeding occurred following pulpotomy was the stepwise treatment in two visits and the bacteria-tight seal of the access cavity. The seal was achieved through the incremental application of the temporary filling material. A calcium hydroxide preparation was applied as interappointment topical pulp dressing. Four weeks after the initial visit the pulpotomy could be accomplished. Results: During 3.5 years of follow-up, the patient remained without symptoms and the tooth showed ongoing root growth in length and width combined with positive reaction to electric pulp testing. Conclusions: In summary, this case demonstrates that, despite persistent bleeding following pulpotomy, pulpal vitality can be preserved, thereby promoting continued root development. Full article

Objectives: This study evaluated the prevalence of periapical lesions in endodontically treated teeth restored with cast post-and-core systems after a minimum two-year follow-up, and identified restorative and clinical factors influencing periapical health. Methods: A cross-sectional study was conducted at the dental clinic of the International University of Rabat. Of 224 contacted patients, 91 met the inclusion criteria (completed endodontic treatment and post placement > 2 years), yielding 118 post-restored teeth. Radiographs were obtained using a phosphor plate system and analyzed with DBSWIN software, applying Ørstavik’s PAI index. Statistical analysis was performed with Jamovi (v2.3.24, Australia). Quantitative data were expressed as mean and standard deviation, and qualitative data as numbers and percentages. The Chi-square test was used with a significance level of p < 0.05. Results: The study found that 31.4% of the teeth presented a radiologically detectable periapical lesion (PAI ≥ 3). Maxillary incisors and premolars were the most frequently affected. Lesion prevalence was significantly associated with post/filling gaps ≥ 2 mm (p = 0.008) and low-density root fillings (p < 0.001). Although short filling length (<4 mm) was common in teeth with periapical lesions, no significant association was observed (p = 0.550). Systemic conditions, such as diabetes, showed a trend toward higher lesion prevalence (p = 0.056). Conclusions: The findings highlight the need for a rigorous approach in restoring endodontically treated teeth. Absence of gaps between the root canal filling and post and homogeneous filling density are key protective factors for maintaining periapical health. Regular radiographic follow-up and future longitudinal studies (3D imaging and clinical parameters) remain essential to refine protocols and improve outcomes. Full article

Background/Objectives: Birooted mandibular canines are a rare but clinically significant variation that is often underdiagnosed and may complicate dental treatment. The aim of this review was to conduct a comprehensive meta-analysis to estimate the prevalence of birooted and multirooted mandibular canines, and to address the research question of whether geographical region, sex, or side predilections significantly influence these anatomical variations. Methods: A systematic search was performed on 4 September 2025 across five databases: BASE, Scopus, PubMed, DOAJ, and Scielo. Studies on permanent mandibular canines with at least 10 cases, assessed radiologically or in vitro, were included. Reports without detailed root number data or based only on two-dimensional imaging were excluded. Meta-analysis estimated prevalence and odds ratios by sex and geographic region, with results shown in tables and graphs. Risk of bias was assessed using the Joanna Briggs Institute appraisal tools. Results: Eighteen studies met the inclusion criteria, of which seventeen were classified as population studies and one case as a series. The pooled prevalence of birooted mandibular canines was 2.71%. A female predilection was statistically significant in four modern cohorts. Only one case of a three-rooted mandibular canine was documented. No clinical outcome data were available regarding endodontic success or extraction complications. Conclusions: Birooted mandibular canines represent a relatively common anatomical variant, especially in females and on the right side of the jaw. However, clinical implications related to treatment outcomes remain underreported, emphasizing the need for future clinical and radiological investigations. Full article

Background: Primary teeth play a crucial role in guiding permanent dentition; however, data regarding root apex closure in primary molars remain limited. The aim of this study was to evaluate the age-related root apex closure status of primary second molars in children aged 2–7 years using panoramic radiographs and to obtain clinically guiding data for pediatric dental treatment planning. Materials and Methods: This cross-sectional, descriptive, and retrospective study evaluated panoramic radiographs. A total of 1628 panoramic radiographs obtained from 1628 patients were evaluated, each representing one individual with primary second molars. The relationships between age groups, gender, and root apex closure status were analyzed statistically with a significance level set at p < 0.05. Results: No root apex closure was observed in either maxillary or mandibular primary second molars in the 2–2.99-year age group. In the 3–3.99-year group, a limited number of closed apices were detected only in mandibular primary second molars. A marked increase in the proportion of closed apices was observed in both jaws in the 4–4.99-year group. In the 5–5.99- and 6–6.99-year groups, root apex closure was completed in the majority of maxillary and mandibular primary second molars. Although statistically significant gender-related differences were detected in certain age groups, these differences were not consistent across all age categories. Conclusions: Root apex closure in primary second molars demonstrates a clear age-dependent pattern between 2 and 7 years of age. The findings are expected to provide clinically relevant guidance for pediatric endodontic treatment planning and contribute to the limited literature regarding root development in primary teeth. Full article

Background: This study aimed to evaluate the prevalence, morphology, and influencing factors of the second mesiobuccal (MB2) canal in maxillary molars and the middle-mesial canal in mandibular molars using cone-beam computed tomography (CBCT). Methods: A total of 146 CBCT scans acquired between 2023 and 2025 were retrospectively analyzed at the Oral Radiology Division, King Abdulaziz University Dental Hospital. Canal prevalence, morphometric dimensions, symmetry, and Vertucci configurations were recorded and correlated with age, sex, and voxel size. Results: MB2 canals were detected in 64.4% of maxillary first molars and 29.6% of second molars, while middle-mesial canals were found in 17.8% of mandibular first molars and 6.4% of second molars. Detection rates declined with increasing voxel size and patient age (p < 0.05). Bilateral symmetry was strong for MB2 (κ = 0.78) but moderate for mandibular canals (κ = 0.29). Vertucci Type I and II were most common in maxillary roots, and Type IV predominated in mandibular mesial roots. Conclusions: These findings confirm CBCT as a reliable tool for identifying complex canal systems and emphasize the importance of voxel resolution and anatomical understanding in enhancing endodontic diagnosis and treatment success. Full article

Objectives: Oral healthcare and regular dental follow-up are important during pregnancy, as maternal oral health may have important implications for both maternal and fetal well-being. However, dental attendance remains low. Therefore, this cross-sectional e-survey aimed to explore pregnant women’s dental pain management strategies, their perceptions of endodontic treatment, and avoidance of specific endodontic procedures during pregnancy. Methods: An 18-item online questionnaire was administered to 130 pregnant women. Data were collected on dental attendance, experiences of toothache, use of analgesics or antibiotics, and perceptions of the safety of dental anesthesia and radiographic procedures during pregnancy. Statistical analyses were conducted using Chi-square or Fisher’s exact tests and multivariate logistic regression (p < 0.05). Results: The mean age of participants was 32 years. Only 26.15% reported attending regular dental visits during pregnancy. Among participants who experienced toothache, 51.52% used analgesics and 1.54% used antibiotics. Although 92.31% believed dental infections should be treated during pregnancy, concerns regarding dental procedures were common; 76.92% considered dental radiography unsafe and only 50% considered local anesthesia safe. Multivariate analysis showed that the number of pregnancies was associated with dental visits during pregnancy (p = 0.048), age with analgesic use (p = 0.018), and education level with perception of dental radiography safety (p = 0.013). Conclusions: Despite awareness of the importance of treating dental infections, pregnant women may delay endodontic care during pregnancy, highlighting a need for improved patient education and clearer clinical guidance. Full article

Objective: To report a rare case of pulp space tissue growth in a mature mandibular molar with severe endo-periodontal involvement after conservative endodontic treatment and to discuss the possible biological explanations, including regeneration and granulation tissue healing. Severe endo-periodontal lesions are challenging, particularly as endodontic regeneration is usually observed in immature teeth, while revascularization in mature teeth, especially in cases of advanced periodontal disease, is rare, as demonstrated in this case. Methods: This study reports a rare case of tissue regeneration versus granulation tissue healing in the pulp space, occurring alongside periodontal healing, in a mature mandibular molar with necrotic pulp and severe periodontal involvement. A 52-year-old patient presented with a mature mandibular molar (tooth #19) exhibiting necrotic pulp with severe endo-periodontal involvement, including grade-3 mobility, tenderness to percussion, a 12 mm probing depth, and extensive periradicular radiolucency. The tooth was diagnosed with necrotic pulp and symptomatic apical periodontitis and was deemed hopeless, with extraction planned. Results: Following patient refusal, endodontic treatment was initiated, including cleaning, shaping, and placement of the intracanal medicament, Ledermix. The patient canceled the extraction due to symptom resolution and disappeared for 12 months. On return, the patient presented with spontaneous pain exacerbated by thermal stimuli, consistent with symptoms of irreversible pulpitis. Clinical examination revealed significant clinical and radiographic improvements, including reduced probing depth (3 mm), no mobility, resolution of apical translucency, radiographic findings suggestive of canal narrowing, and a positive pulp sensibility response. Re-entry elicited profuse bleeding with newly formed vital tissue beneath the medicament. Sodium hypochlorite irrigation failed to achieve hemostasis; inflamed tissue was removed; root canals were cleaned, shaped and obturated; and treatment was completed with placement of a permanent coronal resin composite restoration. A forty-month follow-up showed an asymptomatic tooth with clinical and radiographic healing. Conclusions: This case demonstrates that conservative endodontic management may result in favorable clinical and radiographic outcomes in mature teeth with severe endo-peroidontal involvement, influencing extraction decisions. It provides clinical evidence suggestive of tissue regeneration and periodontal healing in a mature tooth with necrotic pulp and severe periodontal compromise, challenging conventional prognosis. The observed pulp space tissue growth may be suggestive of regeneration; however, alternative explanations, including granulation tissue healing or repair processes, cannot be excluded. Healing by granulation tissue in the pulp space remains possible. Root canal treatment in advanced endo-perio lesions can yield favorable outcomes and may influence extraction decisions. Further clinical and histological studies are needed to clarify underlying mechanisms and optimize treatment strategies. Full article

Background: Oral biofilms are a major etiological factor in dental caries, periodontal disease, peri-implantitis, and endodontic infections. Increasing antimicrobial resistance and the limitations of conventional therapies have intensified interest in antimicrobial photodynamic therapy (aPDT). Hypericin, a natural photosensitizer derived from Hypericum perforatum, demonstrates potent reactive oxygen species generation and broad antimicrobial activity; however, its dental applications remain insufficiently synthesized. Objective: To systematically evaluate the antimicrobial efficacy, treatment parameters, safety, and clinical potential of hypericin-mediated aPDT against oral biofilms and infections in dentistry. Methods: This systematic review was conducted according to PRISMA 2020 and registered in PROSPERO CRD42024617727. Electronic searches of PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library (January 2010 to December 2025) were performed. Studies assessing hypericin-mediated aPDT in oral or dental contexts were included. Methodological quality was evaluated using a predefined nine-domain risk-of-bias tool. Results: Eleven studies met the inclusion criteria. Hypericin-mediated aPDT demonstrated strong antimicrobial effects, achieving up to 99% planktonic inactivation and significant biofilm reduction across bacterial and fungal species. Activity was particularly pronounced against Gram-positive organisms, including Staphylococcus aureus and Enterococcus faecalis. However, efficacy against mature biofilms was variable and often dependent on formulation and irradiation parameters. Most studies showed moderate methodological quality, with frequent deficiencies in reporting light calibration and dosimetry. Advanced delivery systems, including liposomal and nanoparticle formulations, improved photodynamic performance. Conclusions: Hypericin-mediated aPDT shows promising antimicrobial activity against oral pathogens and biofilms, with favorable selectivity and safety profiles. Nevertheless, the evidence remains predominantly preclinical and heterogeneous. Standardized protocols and well-designed clinical trials are required before routine dental implementation can be recommended. Full article

The purpose of this investigation was to establish a clinical diagnosis of the cause of instrument fracture and to evaluate its impact on fragment removal success. One hundred cases of fractured endodontic instruments were analyzed to determine the relationship between fracture cause (flexion, torsion, or combined) and removal outcomes. A diagnostic protocol was developed to classify the fracture mechanism based on radiographic findings, clinical observations, and instrument-related parameters. Fragment length, intracanal location, and removal time were recorded. Torsion was the most frequent cause (54%), followed by combined fracture (33%) and flexion (13%). Flexion-related fragments were significantly longer, located in more accessible areas, and exhibited lower mechanical retention, resulting in shorter removal times (mean: 19.62 min). In contrast, torsion-related fragments were shorter, showed greater retention, and required longer removal times (mean: 32.98 min). Statistical analysis demonstrated a significant association between fracture cause, fragment location, and removal time. The fracture mechanism may serve as a predictive clinical factor for fragment removal difficulty. Early identification of this parameter can improve treatment planning and optimize clinical resource management. Full article