Search Results (176)

Background/Objectives: The clinical outcome of root canal treatments using calcium silicate-based sealer (CSBS) remains unclear. This study aimed to evaluate the 1-year effect of CSBS in combination with a single-cone obturation technique on periapical lesion (PL) healing evaluated on cone beam computed tomography scans (CBCT) after single-visit root canal retreatment. Methods: This randomized clinical study involved 50 patients with chronic apical periodontitis and previous root canal treatment (ClinicalTrials.gov ID: NCT04072926). The inclusion criteria were previous endodontic treatment, asymptomatic inadequate endodontic treatment, PLs measuring > 5 mm, and percussion and palpation sensitivity. The exclusion criteria were immunocompromised status, pregnancy, periodontally compromised teeth, vertical root fracture, and antibiotic usage in the last month. Single-visit root canal retreatment was performed by the same endodontist. The patients were randomly divided into two groups based on the root canal sealer used: CSBS (BioRoot RCS) and epoxy resin-based sealer (ERBS) (AH Plus). Periapical healing, as the primary outcome measure, was determined according to the reduction in PL volume on CBCT from the preoperative period to the 1-year postoperative period. Results: Pre- and postoperative PL volumes (p > 0.05) were not significantly different between the CSBS and ERBS groups. The reduction in PL volume at the 1-year follow-up was also not significantly different (median: 77.53% vs. 82.12%, p = 0.781). Conclusions: Root canal retreatment outcomes of CSBS, including periapical healing, are comparable to those of ERBS at 1 year after the retreatment. Full article

Background: Cone-beam computed tomography (CBCT) was used for a 1-year follow-up of a randomized clinical trial to compare a stainless-steel Tornado file system with OneShape and WaveOne rotary systems for biomechanical canal preparation, as indicated by radiolucency sizes of periapical lesions. Methods: Lower molars with necrotic pulps and periapical lesions were randomly divided into three groups (n = 20) according to three rotary file systems. After root canal treatment, clinical and assessment of the CBCT periapical index scores were blindly evaluated at one year using pre- and post-instrumentation CBCT images. Statistical analysis was performed to compare the three systems at a p-value of 0.05. Results: The results revealed a significant decrease in the size of apical radiolucency in each group after one-year follow-up, with no statistically significant difference among the three systems (p > 0.05). Conclusions: CBCT is a valuable biomedical imaging modality for assessing periapical lesion healing. Tornado, WaveOne, and OneShape systems can be used with similar efficacy for root canal preparation in teeth with periapical lesions. Clinical Trial Registration: The study was retrospectively registered with ClinicalTrials.gov (NCT06752837). Date of Registration: 30 December 2024. The CONSORT group has identified it as essential. Full article

Background/Objectives: Tooth numbering is essential because it allows dental clinicians to identify lesion locations during diagnosis, typically using the Fédération Dentaire Internationale system. However, accurate tooth numbering is challenging due to variations in periapical radiograph (PA) angles. In this study, we aimed to develop a deep learning-based tool to assist dentists in accurately identifying teeth via tooth numbering and improve diagnostic efficiency and accuracy. Methods: We developed a Hybrid Faster Region-based Convolutional Neural Network (R-CNN) technique and a custom loss function tailored for PA tooth numbering to accelerate training. Additionally, we developed a tooth-numbering position auxiliary localization algorithm to address challenges associated with missing teeth and extensive crown loss in existing datasets. Results: We achieved a maximum precision of 95.16% utilizing the transformer-based NextViT-Faster R-CNN hybrid model, along with an accuracy increase of at least 8.5% and a 19.8% reduction in training time compared to models without the proposed tooth-numbering position auxiliary localization algorithm and conventional methods. Conclusions: The results demonstrate the effectiveness of the proposed method in overcoming challenges in PA tooth numbering within AI-assisted dental diagnostics, enhancing clinical efficiency, and reducing the risk of misdiagnosis in dental practices. Full article

Odontogenic cutaneous fistulas (OCFs) are relatively uncommon in veterinary patients. They are typically caused by chronic periapical infections of the maxillary teeth. Mandibular OCFs that extend through the cortical bone into submandibular soft tissues are extremely rare. This report describes the case of a 14-year-old male mixed-breed dog that presented with a submandibular cutaneous lesion initially misdiagnosed as a salivary mucocele. OCFs are frequently misdiagnosed because atypical presentations may lack obvious intraoral abnormalities and mimic salivary gland disease, lymphadenopathy, or cutaneous neoplasia. Computed tomography (CT) revealed a periapical lesion associated with the right mandibular first molar, cortical bone lysis, and extension into the adjacent submandibular tissues, which formed an external fistulous tract. Surgical management included extraction of the affected tooth, resection of the fistulous tract, and excision of the associated lymph nodes, which resulted in a complete and uneventful resolution of the fistula. At the 3-month follow-up, the patient remained clinically stable without evidence of recurrence. This case underscores the clinical pearl that odontogenic origins should always be considered in the differential diagnosis of submandibular or cervical cutaneous lesions and that cross-sectional imaging modalities, such as CT, are indispensable for confirming anatomical continuity and guiding surgical planning. Full article

Objective: This randomized controlled trial evaluated postoperative pain (PP), bioceramic extrusion, and procedure duration in necrotic immature incisors treated with three apical barrier methods (ABMs): Bioceramic Putty Apical Plug (BPAP), Single Cone with Bioceramic Sealer (SBS), and Bioceramic Putty–Sealer Mixture (BPSM). Case-related factors influencing these outcomes were also examined. Methods: Ninety-nine children (8–11 years) with necrotic maxillary incisors and moderate periapical lesions were randomly assigned (1:1:1) to BPAP, SBS, or BPSM groups. Standardized protocols included calcium hydroxide dressing and XP-Endo Finisher irrigation. Pain (VAS) was recorded at 1-, 3-, 7-, and 14-day post-treatment. Extrusion (yes/no) and procedure duration were documented. Regression analyses identified predictors of outcomes. Results: At day 1, pain was highest in the BPAP group (mean 3.5) and lowest in the SBS group (mean 1.05; p < 0.001). Pain decreased substantially by day 3 and resolved in all groups by day 14. Extrusion was most frequent in SBS (60.6%) and least frequent in BPAP (21.2%; p = 0.002). Treatment duration was longest in BPAP (25.8 min) and shortest in SBS (12.6 min; p < 0.001). Regression showed that preoperative pain and pulpal diagnosis were the strongest predictors of postoperative pain. Apical size and ABM predicted extrusion, while apical size and child behavior significantly influenced duration. Conclusions: The apical barrier method had a significant impact on short-term outcomes. SBS offered reduced pain and shorter chair time but carried a higher risk of extrusion, while BPAP minimized extrusion but caused more pain and required more extended visits. Clinical selection should balance patient comfort, apical anatomy, behavior, and operator expertise. Longer-term outcomes on periapical healing remain to be evaluated. Full article

This study aimed to elucidate the role of peroxisome proliferator-activated receptor-γ (PPAR-γ) in regulating macrophage efferocytosis during the pathogenesis of chronic apical periodontitis (CAP). Clinical specimens, rat periapical lesion models, and an in vitro model simulating the CAP inflammatory milieu were employed to examine the contribution of PPAR-γ to efferocytosis throughout disease progression. The expression of PPAR-γ in vivo was assessed by single-cell RNA sequencing and immunohistochemical (IHC) staining. Pearson’s correlation and linear trend tests were conducted to investigate the association between PPAR-γ and macrophage efferocytosis during CAP progression. Pharmacological modulation of PPAR-γ was further conducted using rosiglitazone (RSG) as an agonist and GW9662 as an antagonist, followed by an assessment of efferocytosis-related parameters and inflammatory responses. Both clinical specimens and animal models demonstrated a progressive reduction in PPAR-γ expression and macrophage efferocytosis during CAP. Notably, PPAR-γ attenuated efferocytosis impairment and significantly reduced pathogen-induced inflammatory responses in macrophages. These findings indicate that defective macrophage efferocytosis contributes to the exacerbation of CAP severity, whereas targeting PPAR-γ may represent a promising therapeutic strategy to alleviate inflammation in periapical lesions by restoring efferocytic capacity. Collectively, this study highlights PPAR-γ as a potential therapeutic target warranting further investigation in CAP treatment. Full article

Background: The relationship between orthodontics and endodontics during the treatment planning phase is scarcely investigated, especially when orthodontic treatment is considered for endodontically treated teeth with apical periodontitis. This systematic review aimed to investigate the effect of orthodontic movement on the periapical healing of teeth that have undergone endodontic root canal treatment/retreatment. Materials and methods: On 15 March 2025, a systematic search was conducted in PubMed, Web of Science Core Collection, EBSCO host and complemented with a manual search of Google Scholar and the gray literature. The quality and the risk of bias of the included studies were assessed using the Joanna Briggs Critical Appraisal tools for human studies and the Systematic Review Centre for Laboratory Animal Experimentation for animal studies. The data about the influence of orthodontic movement on the periapical healing of endodontically treated teeth were extracted and pooled. Results: Out of 4614 identified titles, 6 studies were finally included (two animal and four clinical studies). The risk of bias was high in one study, moderate in three, and low in two. The included animal studies demonstrated a significant delay in the healing process of periapical lesions when orthodontic forces were applied shortly after root canal treatment. However, clinical studies showed no significant impact of orthodontic movement on periapical radiolucency except when the quality of obturation was compromised. Conclusions: Current clinical studies indicate that orthodontic tooth movement does not impair the periapical healing of endodontically treated teeth when the root canal obturation is of adequate quality. Full article

This study aimed to evaluate cytokine profiling in a periapical lesion to provide a rationale for future treatment strategies for periapical lesions. Thirteen samples of exudative fluid were collected from such a lesion directly through the root canal. Cytokine profiling was performed using the Bio-Plex system. CXCL10 (C-X-C motif chemokine ligand 10, IP10) was found to be elevated in apical exudates of patients exhibiting favorable healing. To evaluate the role of CXCL10 in cell migration, a Transwell assay was conducted using bone marrow-derived mononuclear cells (BMMCs). Different types of cytokines were detected from the samples of periapical lesion at the initial visit. However, cytokine production varied across patient samples. Release of interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-13, IL-17, granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon gamma (IFN-γ), monocyte chemoattractant protein (MCP)-1, macrophage inflammatory protein (MIP)-1α, MIP-1β, and tumor necrosis factor (TNF)-α showed differential expression. Comparison of cytokine profiles indicated that cytokine production was variable before and after root canal treatment. In vitro, CXCL10 significantly improved BMMC migration in a dose-dependent manner, supporting clinical findings that elevated CXCL10 levels are associated with favorable healing in apical lesions. Although this study was limited by the small sample size and exploratory design, the cytokine profile of periapical lesions may be useful for assessing the condition of periapical lesions and modulating the immune response to bacterial infection. Full article

Artificial Intelligence (AI) applications in sports dentistry have the potential to improve early detection and diagnosis. We aimed to validate the diagnostic performance of AI-assisted software in detecting dental caries, periodontitis, and tooth wear using panoramic radiographs in elite athletes. This cross-sectional validation study included secondary data from 114 elite athletes from the Sports Dentistry department at Egas Moniz Dental Clinic. The AI software’s performance was compared to clinically validated assessments. Dental caries and tooth wear were inspected clinically and confirmed radiographically. Periodontitis was registered through self-reports. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), as well as the area under the curve and respective 95% confidence intervals. Inter-rater agreement was assessed using Cohen’s kappa statistic. The AI software showed high reproducibility, with kappa values of 0.82 for caries, 0.91 for periodontitis, 0.96 for periapical lesions, and 0.76 for tooth wear. Sensitivity was highest for periodontitis (1.00; AUC = 0.84), moderate for caries (0.74; AUC = 0.69), and lower for tooth wear (0.53; AUC = 0.68). Full agreement between AI and clinical reference was achieved in 86.0% of cases. The software generated a median of 3 AI-specific suggestions per case (range: 0–16). In 21.9% of cases, AI’s interpretation of periodontal level was deemed inadequate; among these, only 2 cases were clinically confirmed as periodontitis. Of the 34 false positives for periodontitis, 32.4% were misidentified by the AI. The AI-assisted software demonstrated substantial agreement with clinical diagnosis, particularly for periodontitis and caries. The relatively high false-positive rate for periodontitis and limited sensitivity for tooth wear underscore the need for cautious clinical integration, supervision, and further model refinements. However, this software did show overall adequate performance for application in Sports Dentistry. Full article

Background and Objectives: This study retrospectively investigated the impact of regenerative endodontic treatments (RET) on the healing of periapical lesions in young permanent molars with open apices. Our objective was to evaluate the relationship between treatment outcomes and changes in the fractal dimension (FD) of the periapical bone before and after RET. The study was conducted at the Department of Pediatric Dentistry, Necmettin Erbakan University between January 2020 and December 2024. Materials and Methods: We examined panoramic radiographs from systematically healthy patients aged 6–16 years who underwent RET in the posterior mandible between January 2020 and December 2024. Changes in periapical bone were assessed using fractal analysis before treatment and after a 6-month follow-up. Additionally, mental index (MI), mandibular cortical width (MCW), mental length (ML), and periapical index (PAI) values were evaluated. Radiographs were taken with a Planmeca ProOne^® device and analyzed using ImageJ v1.54 software. Results: Comparison of FD values between treated and contralateral tooth areas, as well as before and after RET, revealed an average FD value of 1.27 ± 0.05 after regeneration, increasing to 1.29 ± 0.27 at the 6-month follow-up. Significant increases were observed in MCW (p = 0.005/p = 0.049) and ML (p = 0.022/p = 0.001) in the 35–36 and 45–46 regions post-RET, though MI values showed no significant change. Importantly, PAI scores demonstrated significant improvement after RET. Conclusions: The findings suggest that RET is effective in promoting the healing of periapical lesions in young permanent molars. The observed increases in cortical width and improvements in PAI scores support the positive impact of this treatment on bone healing. Furthermore, FD analysis, when combined with radiomorphometric indices, could provide a valuable and objective tool for evaluating RET outcomes. Full article

Objectives: The aim of this study was to evaluate the performance of GPT-4o in identifying nine common dental conditions on panoramic radiographs, both overall and at specific tooth sites, and to assess whether the use of different tooth numbering systems (FDI and Universal) in prompts would affect its diagnostic accuracy. Methods: Fifty panoramic radiographs exhibiting various common dental conditions including missing teeth, impacted teeth, caries, endodontically treated teeth, teeth with restorations, periapical lesions, periodontal bone loss, tooth fractures, cracks, retained roots, dental implants, osteolytic lesions, and osteosclerosis were included. Each image was evaluated twice by GPT-4o in May 2025, using structured prompts based on either the FDI or Universal tooth numbering system, to identify the presence of these conditions at specific tooth sites or regions. GPT-4o responses were compared to a consensus reference standard established by an oral-maxillofacial radiology team. GPT-4o’s performance was evaluated using balanced accuracy, sensitivity, specificity, and F1 score both at the patient and tooth levels. Results: A total of 100 GPT-4o responses were generated. At the patient level, balanced accuracy ranged from 46.25% to 98.83% (FDI) and 49.75% to 92.86% (Universal), with the highest accuracies for dental implants (92.86–98.83%). F1-scores and sensitivities were highest for implants, missing, and impacted teeth, but zero for caries, periapical lesions, and fractures. Specificity was generally high across conditions. Notable discrepancies were observed between patient- and tooth-level performance, especially for implants and restorations. GPT-4o’s performance was similar between using the two numbering systems. Conclusions: GPT-4o demonstrated superior performance in detecting dental implants and treated or restored teeth but inferior performance for caries, periapical lesions, and fractures. Diagnostic accuracy was higher at the patient level than at the tooth level, with similar performances for both numbering systems. Future studies with larger, more diverse datasets and multiple models are needed. Full article

Objectives: The presence of gingival buccal recession is a frequent problem especially in the canine area. The cortical buccal bone may be absent in presence of health normal lingual/palatal bone and of other periodontal pockets. The present case report describes a minimally invasive approach in a 76-year-old patient with previously endodontically treated lower canine affected by root fracture and by a serious chronic buccal recession. Methods: The tooth was characterized by a deep vestibular bone defect, lack of buccal bone and acute periapical lesion. After extraction, Maryland bridge was positioned on the edentulous area. A two-piece convergent neck transmucosal implant was inserted with a flapless approach after 6 months. Maryland bridge was left in place for additional 3 months. After this time, digital impressions were taken, and a customized abutment was positioned. A provisional crown was designed according to Biologically Oriented Preparation Technique (BOPT) concept and maintained for 6 months. A zirconia definitive crown was digitally designed and cemented with a polycarboxylate-based cement. The Pink Esthetic Score (PES) was used as an index to assess peri-implant soft tissue stability over time (preoperatively, at 9 months, at 12 months and 72 months). Results: The patient was followed for 6 years under a conventional hygienic recall program. No complications occurred, and the PES improved from 4 preoperatively to 8 at 9 months, 10 at 12 months and 13 at 72 months. Conclusions: The use of Maryland bridge prevented occlusal trauma on healing tissues and appeared to support bone and soft tissue healing for transmucosal implant placement. A stable aesthetic rehabilitation was achieved up to 6 years. Full article

Background and Objectives: Cone Beam Computed Tomography (CBCT) offers high-resolution, three-dimensional imaging for detecting apical periodontitis (AP) and evaluating the technical quality of endodontic treatments. This study aimed to investigate the diagnostic value of CBCT in identifying endodontic failures and periapical lesions and to explore the clinical patterns associated with these findings in a Romanian patient cohort. Materials and Methods: A retrospective study was conducted on 258 patients (with 876 root canal-treated teeth), all of whom underwent CBCT imaging between October 2024 and April 2025 at a private radiology center in Craiova, Romania. Of the 876 treated teeth, 409 were diagnosed with apical periodontitis. Patients were present for endodontic treatment at the Endodontics Clinic of the Faculty of Dentistry, University of Medicine and Pharmacy of Craiova. With the patients’ consent, 3D radiological examinations were recommended for better case planning and accurate diagnosis. The periapical status and technical parameters of root canal fillings were assessed using the CBCT-PAI index and evaluated by three calibrated observers. Associations with demographic, clinical, and behavioral factors were statistically analyzed. Results: Apical periodontitis was detected in 46.69% of the teeth examined during the study period, with CBCT-PAI score 3 being the most prevalent. Poor root canal obturation quality (underfilling, overfilling, and voids) was significantly associated with periapical pathology. Chronic lesions were more common than acute ones, especially in older patients. The number of teeth with endodontic treatments and no AP, as well as the number of teeth with AP, was significantly lower for patients with acute AP, indicating the more severe impact of chronic AP on the patients’ oral health status. CBCT allowed the precise localization of missed canals and assessment of lesion severity. Conclusions: Within the limits of a retrospective, referral-based cohort, CBCT aided the detection of periapical pathology in root canal-treated teeth (46.69%). These findings do not represent population-based rates but support the selective use of CBCT, in line with current ESE guidance, for complex cases or when conventional imaging is inconclusive. Full article

Artificial intelligence is an emerging tool that is being used in multiple fields, including dentistry. An example of this is the diagnosis of periodontal bone loss by analyzing two-dimensional (2D) radiographs (periapical, bitewing, and panoramic). Objectives: The objectives of this systematic review are to bring together the existing evidence and evaluate the effectiveness of the different artificial intelligence architectures that have been used in recent studies. Materials and Methods: This work has been carried out following the PRISMA criteria and has been recorded in PROSPERO (ID = CRD 42025640049). We searched six different databases, and the results were filtered according to previously established inclusion and exclusion criteria. We extracted data independently by three review authors and analyzed the risk of bias of the studies using the QUADAS-2 test, calculating Cohen’s kappa index (κ) to measure the agreement between assessors. Results: We included 20 diagnostic accuracy studies according to the inclusion and exclusion criteria, published between 2019 and 2024. All included studies described the detection of periodontal bone loss on radiographs. Limitations: One of the main limitations identified was heterogeneity in the indices used to assess the accuracy of models, which made it difficult to compare results between studies. In addition, many works use different imaging protocols and X-ray equipment, introducing variability into the data and limiting reproducibility. Conclusions: Artificial intelligence is a promising technique for the automated detection of periodontal bone loss, allowing the accurate measurement of bone loss, identifying lesions such as apical periodontitis and stage periodontitis, in addition to reducing diagnostic errors associated with fatigue or inexperience. However, improvements are still required to optimize its accuracy and clinical applicability. Full article

Background: Large periapical cyst-like lesions pose challenges for nonsurgical management. This study evaluated the clinical and radiological outcomes of conventional endodontic therapy alone versus endodontic therapy with decompression in treating such lesions. Methods: Ten patients with CBCT-confirmed periapical lesions >5 mm were randomly assigned to two groups. Group 1 received standard root canal treatment with calcium hydroxide; Group 2 received the same protocol plus decompression. Lesion dimensions were measured in three planes using CBCT at baseline, 12 months, and 24 months. Results: Both groups showed significant lesion size reduction over time. At 12 months, Group 2 had a significantly greater mean reduction (8.49 ± 5.09 mm) compared to Group 1 (4.36 ± 1.46 mm) (p = 0.008). At 24 months, both groups had comparable outcomes (Group 1: 1.12 ± 0.98 mm; Group 2: 2.41 ± 5.15 mm; p = 0.356), with most lesions nearly or fully resolved. Histopathology confirmed radicular cysts in decompressed cases. Conclusions: Conservative endodontic therapy is effective for large periapical lesions. Adjunctive decompression accelerates early healing, particularly in extensive cases, potentially reducing the need for surgical intervention. CBCT is valuable for monitoring healing. Full article