To evaluate the efficacy of artificial intelligence (AI)-driven three-dimensional (3D) anatomical models as an adjunct to cone-beam computed tomography (CBCT) for root canal assessment regarding diagnostic accuracy, observer confidence, and time efficiency among undergraduate and postgraduate students. In this observational diagnostic study, 26 observers (13 undergraduates and 13 postgraduates) evaluated 22 tooth roots with complex anatomy from nine CBCT scans under two conditions: CBCT alone and CBCT supplemented with AI-generated 3D anatomical models. Observers assessed the number of roots, root canals, and apical foramina, while confidence (5-point Likert scale) and assessment time were recorded. Each observer performed 132 assessments, totaling 3,432 evaluations. A reference standard was established by consensus between two specialists. A significance level was set at 5% (α = 0.05) for all statistical analyses. Augmenting CBCT with AI-generated 3D models significantly improved diagnostic accuracy for all parameters (p < 0.001). Root detection accuracy reached 100% in both groups. Root canal detection increased from 83% to 94% among undergraduates and from 88% to 99% among postgraduates, while apical foramina detection increased to 99% in both groups. Observer confidence significantly increased (p < 0.001), reaching a median score of 5 (IQR: 5-5). Workflow efficiency also improved (p < 0.001), with median assessment time decreasing from 102s to 39s for undergraduates and from 97s to 24s for postgraduates. AI-driven 3D anatomical models used with CBCT enhance diagnostic accuracy, observer confidence, and evaluation efficiency in endodontic assessment. However, multi-centre studies with larger, more diverse samples, particularly including cases with pronounced artefacts, would further support generalisability. AI-generated 3D anatomical models derived from CBCT scans may serve as a valuable adjunct for the interpretation of complex root canal anatomy, improving diagnostic accuracy, increasing observer confidence, and reducing assessment time. These findings support their potential role not only in clinical decision-making but also as an effective educational tool for training dental students and clinicians.

Hydraulic calcium silicate-based sealers (CSBSs) are increasingly used in endodontics, but evidence on their long-term clinical effectiveness remains limited. This retrospective study evaluated the 5-year outcomes of primary root canal treatments and retreatments performed with a CSBS in teeth with symptomatic apical periodontitis. The sample consisted of 637 teeth with symptomatic apical periodontitis treated by a single experienced operator using a premixed CSBS (CeraSeal; Meta Biomed Co., Cheongju, South Korea) with the cold hydraulic condensation technique (CHC). Data were retrospectively collected from clinical charts and radiographic archives. Preoperative variables included sex, systemic health, tooth type, arch location, lesion size, pulpal diagnosis, sinus tract, and preoperative small perforation. Intraoperative factors comprised intracanal medication, apical diameter, obturation length, and sealer extrusion. Postoperative information included the type of coronal restoration. Follow-up evaluations were based on available radiographs and clinical notes at 1, 2, 3, 4, and 5 years. Outcomes were classified according to strict criteria (absence of symptoms and complete radiographic resolution) and loose criteria (absence of symptoms with complete or partial healing). Prognostic factors were investigated using bivariate associations and multivariate logistic regression models. Strict success rates increased progressively (80.2% at 1 year, 85.7% at 2 years, 86.8% at 3 years, 88.2% at 4 years, and 87.67% at 5 years). Loose success remained consistently high (99.2% at 1 year; 90.7% at 4 years, and 87.67% at 5 years). Higher baseline periapical index (PAI) scores significantly reduced odds of strict success at 2, 3, 4 years. Other factors, including age, sex, tooth type, treatment type, extrusion, and restoration, were not significant. CSBSs demonstrated favorable long-term outcomes. Preoperative lesion severity was the main prognostic factor, while demographic and procedural variables showed limited influence on long-term success. This study supports the long-term clinical reliability of CSBSs used with CHC in teeth with apical periodontitis. Preoperative lesion severity remains the primary prognostic factor influencing periapical healing over time.

The aim of this randomized clinical trial was to evaluate the 18-month clinical performance of alkasite and glass-hybrid restorations compared with resin composite in Class II restorations. A total of 50 patients requiring at least three Class II restorations in premolar and molar teeth were recruited. Each patient received three restorations, which were randomly assigned to one of the following materials: an alkasite (Cention N, Ivoclar Vivadent), a glass-hybrid (Equia Forte HT, GC Corp.), or a resin composite (Gradia Direct Posterior, GC Corp.). Alkasite and glass-hybrid served as test groups while resin composite served as the control group. During the 18-month follow-up, restorations were scored at baseline, 6, 12, and 18 months using the FDI criteria. Data were analyzed using the Chi-square and Cochran's Q tests (α = 0.05). No significant differences were detected among the groups for esthetic, functional, or biological criteria over 18 months (p > 0.05). Regarding esthetic properties, the control group showed 100% success for all esthetic criteria at all recall visits, while the alkasite group maintained a 96% success rate at all time points, and glass-hybrid showed 98% success at 6 and 12 months and 92% at 18 months. Minor score-2 changes in color match and gloss were detected in the glass-hybrid and alkasite groups but were not significant (p > 0.05). For functional and biological outcomes, all groups achieved 100% success rates for all evaluated parameters. Alkasite and glass-hybrid groups exhibited clinical performance comparable to resin composite over the 18-month follow-up in Class II cavities. All materials demonstrated excellent functional and biological stability while achieving clinically acceptable aesthetic results.

This study aimed to identify a subset of patients with pN1 oral squamous cell carcinoma (OSCC) and no adverse pathological features who derive significant benefit from adjuvant radiotherapy (RT). In this multicenter retrospective study, 232 eligible pN1 OSCC patients were analyzed. Patients were stratified by T-stage (T1-2 vs. T3-4) and lymph node yield (LNY; high: ≥20; low: <20). The impact of adjuvant RT on survival outcomes was evaluated. A significant survival benefit from adjuvant RT was observed exclusively in the subgroup with advanced T-stage (T3-4) and low LNY (< 20), with improved disease-free survival (69.2% vs. 23.1%, p = 0.003), overall survival (76.9% vs. 38.5%, p = 0.012), and disease-specific survival (80.8% vs. 46.2%, p = 0.014). In contrast, no significant survival differences were found in the other T-stage/LNY subgroups. Furthermore, LNY alone did not independently predict prognosis or RT benefit in the overall cohort. This retrospective study suggests that pN1 OSCC patients with T3-4a stage disease and a low LNY (LNY < 20, levels I-III) may represent a subgroup that derives benefit from adjuvant RT. These exploratory findings suggest a practical model that warrants prospective validation to guide personalized therapy. This study provides clinical evidence to help refine the postoperative management of pN1 OSCC patients without high-risk features. It provides a practical stratification tool to guide personalized treatment decisions, aiming to optimize survival outcomes while reducing unnecessary radiotherapy.

Plasma inflammatory biomarkers linked to cardiovascular risk have been associated with asymptomatic apical periodontitis. However, it remains unclear whether endodontic treatment can reverse these alterations. This review evaluated the effect of endodontic treatment on inflammatory markers in individuals with asymptomatic apical periodontitis. A comprehensive search was conducted in PubMed/Medline, Embase, Web of Science, Scopus, VHL, gray literature, and reference lists between October and November 2022, with an update in September 2025. Risk of bias was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence using the GRADE approach. Random-effects meta-analysis estimated pooled mean differences (MD) and 95% confidence intervals (95%CI) for serum inflammatory markers concentrations between treated individuals and controls (α = 5%). The search identified 6,295 records; sixteen studies were assessed and eight included in the quantitative synthesis. All studies showed moderate risk of bias, and evidence certainty was very low. Meta-analysis suggested possible reductions in C-reactive protein (CRP) [MD = 0.76 (95% CI: - 0.15, 1.67)] , interleukin-6 (IL-6) [MD = 0.81 (95% CI:-0.27, 1.90)], and tumor necrosis factor-alpha (TNF-α) [MD = 1.04 (95% CI:-0.38, 2.46)] after endodontic treatment, with levels similar to control groups. Evidence, although limited, suggests endodontic treatment may lower serum CRP, IL-6, and TNF-α levels in asymptomatic apical periodontitis patients. Endodontic treatment of asymptomatic apical periodontitis may help reduce systemic inflammatory biomarkers associated with cardiovascular risk, reinforcing its potential role beyond local infection control.

Pulp necrosis in immature permanent teeth arrests root development and compromises long-term prognosis. This study aimed to develop a multifunctional scaffold integrating structural biomimicry, mechanical matching, and sustained growth factor release for orderly root regeneration. A poly(ε-caprolactone) (PCL) conical scaffold was fabricated via melt electrowriting (MEW) combined with mechanical winding. Bone morphogenetic protein‑2 (BMP‑2)-loaded microspheres were prepared and physically incorporated into the scaffold. The scaffold surface was modified with collagen. Human dental pulp stem cells (hDPSCs) were cultured on the scaffold to evaluate proliferation, adhesion, and osteogenic differentiation. The scaffold exhibited a trilayer "collagen-microsphere-PCL" architecture with mechanical compatibility (elastic modulus: 22.5MPa; fracture strength: 5.29MPa; elongation: 441.59%). Microspheres (2.86 ± 0.45μm) showed a gradient distribution and sustained release (70-75% over 90 days). In vitro, the scaffold promoted hDPSC adhesion and proliferation and significantly enhanced osteogenic differentiation with elevated alkaline phosphatase activity, upregulated the expression of osteogenic-related genes, and increased protein levels. The scaffold integrates structural support, controlled growth factor delivery, and a bioactive interface, offering a promising strategy for root development in immature permanent teeth. By enabling physiological root development, the scaffold addresses a critical unmet need, offering a viable alternative to conventional root canal therapy.