Apicoectomy is a traditional surgical technique for treating endodontic-periodontal lesions. The use of biomaterials as fillers to improve tissue recovery at the surgical site has been gaining prominence in clinical dental practice, and leukocyte- and platelet-rich fibrin (L-PRF) membranes have demonstrated the potential to achieve effective results in resolving bone defects. This case report describes the use of an apicoectomy and L-PRF membranes on the maxillary left lateral incisor (tooth 10) to treat a persistent periapical lesion that remained after 2 unsuccessful nonsurgical endodontic treatments. When a 53-year-old woman attended a periodontics clinic for scaling and root planing, a radiograph revealed a periapical lesion at tooth 10. The lesion persisted after both nonsurgical root canal therapy and subsequent endodontic retreatment. The patient underwent apicoectomy combined with open flap scaling and root planing as well as placement of L-PRF membranes as a filling material for the bone defect to improve healing of the surgical area. Follow-up examinations were performed at 7 days, 1 month, and 6 years. Mineralization in the area of bone loss and regression of the periapical lesion were reported, favoring tissue stability. In this patient, apicoectomy combined with the use of L-PRF to fill the bone defect led to clinical and radiographic treatment success.

Fracture Resistance and Biomechanical Behavior of Retreated Teeth Obturated with Different Sealers: Combined Laboratory Testing and Finite Element Analysis.

To evaluate the impact of multiple apical periodontitis (AP) on the expression of TLR4/NF-κB pathway components, proinflammatory cytokine levels, and development of hepatic injuries in rats with and without chronic alcohol consumption. Thirty-two rats were assigned to four groups (n = 8): Control, AP, Alcohol, and Alcohol+AP. The Alcohol and Alcohol+AP groups received 25% ethanol solution. Multiple AP were induced through pulp exposure of four molars for 28 days. Following euthanasia, the jaws and livers were collected. Micro-computed tomography was used to confirm periapical lesions. Liver samples underwent histopathological analysis and ELISA assay to measure TLR4, NF-κB, IL-6, and TNF-α levels. Histopathological evaluation was performed using hepatic stereology to assess hepatocytes, sinusoids, Kupffer cells, steatosis, leukocyte infiltrate, and necrosis. Statistical analysis was carried out using one-way ANOVA followed by the Student-Newman-Keuls (p < 0.05). Hepatic levels of TLR4 and NF-κB were significantly higher in AP and Alcohol+AP groups compared to Control and Alcohol groups (p < 0.05). IL-6 and TNF-α were significantly elevated in all experimental groups compared to the Control group (p < 0.05), with higher levels observed in the Alcohol+AP group compared to the other groups (p < 0.05). Experimental groups showed a significant reduction in hepatocyte density compared to the Control group (p < 0.05), while sinusoidal volume was significantly reduced in the AP group compared to the Control group (p < 0.05). Hepatic steatosis was absent in the Control and AP groups and there was no significant difference in the percentage of steatosis between Alcohol and Alcohol+AP groups (p > 0.05). No significant differences were observed in the number of Kupffer cells among groups (p > 0.05) and leukocyte infiltrate was absent in all groups. Necrosis was significantly higher in the AP and Alcohol+AP groups compared to the Control and Alcohol groups (p < 0.05), with the Alcohol+AP group showing a higher percentage of necrosis compared to the AP group (p < 0.05). Hydropic degeneration, focal inflammatory infiltrates, and hepatocyte necrosis were observed in the AP and Alcohol+AP groups. Multiple AP led to elevated TLR4, NF-κB, IL-6, and TNF-α levels and significant hepatic alterations including hepatocyte degeneration and necrosis. When combined with alcohol consumption, multiple AP exacerbated ethanol-induced liver damage.

The accurate and timely diagnosis of dental diseases is critical for effective treatment and improved patient outcomes. However, traditional methods of analyzing panoramic X-ray images rely heavily on the expertise of oral and maxillofacial radiologists and dentists, making the process time-consuming, labor-intensive, and prone to human error. To address these challenges, this study introduces a novel web-based AI application powered by the YOLOv11-TAM model designed to automate the detection and diagnosis of dental diseases from panoramic X-ray images. The proposed system integrates a user-friendly interface, a robust PostgreSQL database, and an advanced AI engine based on the YOLOv11-TAM architecture. The AI engine was trained and validated using the publicly available DENTEX dataset, which includes 705 annotated panoramic X-ray images categorized into four disease classes: caries, deep caries, impacted teeth, and periapical lesions. The YOLOv11-TAM model incorporates architectural innovations, including the C3k2 block, Spatial Pyramid Pooling Fast (SPPF) layer, and Transformer-based attention mechanisms, to enhance feature extraction, localization accuracy, and adaptability. The customized YOLOv11-TAM model demonstrated significant improvements over YOLOv11, achieving about a 15% increase in precision, a high specificity of 0.92, and over 12% improvement in localization accuracy for periapical lesions. Class-specific evaluations revealed superior performance in detecting deep caries and periapical lesions, although challenges remain in diagnosing caries due to class imbalance. The usability study also yielded high satisfaction scores, with an average exceeding 8 across all dimensions, highlighting the application's intuitive design and seamless integration into clinical workflows. This study presents a transformative web-based AI application that leverages advanced deep learning techniques to enhance the accuracy, efficiency, and accessibility of dental diagnostics. By reducing radiologists' workload and enabling early disease detection, the proposed solution has the potential to revolutionize dental healthcare, particularly in underserved regions.

ABSTRACTIn select multirooted/vital/permanent teeth with periapical pathology in one root due to adjacent infection from neighboring teeth, cone beam computed tomography‐guided retrograde vital pulp therapy (retroVPT) with a bioactive cement can resolve the lesion and preserve pulp vitality, offering a conservative, biologically based, and cost‐effective alternative to conventional root canal treatment.

Periapical actinomycosis is an uncommon infection that may lead to osteomyelitis, especially in immunocompromised individuals like those with uncontrolled diabetes mellitus. This case involves a 22-year-old male with type 1 diabetes who presented with recurrent dental abscesses, pain, and tooth mobility. Imaging revealed extensive periapical lesions in the anterior mandible. Biopsy identified Actinomyces spp., MRSA, and Streptococcus viridans. Due to severe bone destruction, the patient underwent full-mouth extractions, marginal mandibulectomy, and mandibular reconstruction using a microvascular iliac crest flap. A postoperative mandibular fracture necessitated further resection and reconstruction with a custom titanium plate. Vestibuloplasty with a split-thickness skin graft improved soft tissue adaptation, and two implants were placed in the parasymphysis region to support an overdenture. The aggressive infection, worsened by diabetes, required a multidisciplinary approach. The iliac crest flap offered structural support and enabled early prosthetic rehabilitation. This case highlights the need for early diagnosis and integrated treatment to achieve functional and aesthetic success.

Automatic exposure compensation (AEC) in digital radiographic systems adjusts the greyscale values of the image to correct for underexposure or overexposure, ensuring consistent image brightness and contrast. High-density materials, such as metal posts, can trigger greyscale correction promoted by AEC, potentially influencing radiographic diagnosis. This study aimed to assess whether the enhancement of AEC in endodontically treated tooth restored with metal post affects the detection of simulated periapical lesions using different digital radiographic systems. The sample consisted of periapical radiographs of a tooth, with and without metal post, inserted into simulated dental sockets in 15 bovine ribs, without and with periapical lesions simulated using a mechanical-chemical method. Radiographs were obtained using a phosphor-storage plate system (KaVo eXam) and a sensor (RVG 5200). After acquisition, the images were exported, randomized, and independently evaluated by six observers, who scored the presence of periapical lesions on a 5-point scale. The area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, and specificity were calculated for each tested condition. Diagnostic values were compared using analysis of variance, setting the significance level at 5%. Regardless of the presence of the metal post and the AEC enhancement, there was no statistically significant difference in diagnostic values (AUROC, accuracy, sensitivity, and specificity; p ≥ 0.05) for both digital radiographic systems. Radiographic enhancement produced by AEC in the presence of a metal post does not impair the diagnosis of periapical lesions in the digital radiographic systems tested.

ObjectiveThis retrospective cohort study evaluated healing outcomes following endodontic microsurgery (EMS) in maxillary anterior teeth with through-and-through periapical lesions (PALs) using periapical radiographs and cone-beam computed tomography (CBCT).MethodsPermanent teeth with through-and-through PALs treated by EMS and followed for more than 24 months were included. Two calibrated endodontic specialists independently assessed two-dimensional (2D) healing according to the Molven criteria and three-dimensional (3D) healing using the PENN 3D criteria. Treatment outcomes were dichotomized as success (complete and incomplete/limited healing) or failure (uncertain and unsatisfactory healing). Preoperative and follow-up lesion volumes were calculated using Mimics software.ResultsSixteen patients (22 teeth, 16 through-and-through lesions) with a follow-up period ranging from 24 to 61 months (mean, 33 months) were included. Complete healing was observed in 62.5% of cases according to the 2D criteria and in 31.3% according to the 3D criteria. The mean lesion volume significantly decreased from 856.97 ± 566.06 mm³ preoperatively to 95.74 ± 180.45 mm³ at follow-up (P < 0.0001).ConclusionsFavorable healing outcomes were observed following EMS in maxillary anterior teeth with through-and-through lesions. CBCT-based assessment applied more stringent healing criteria than periapical radiographs and provided a more comprehensive evaluation of periapical bone regeneration.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12903-025-07614-7.

Bacteria and viruses are components of the oral microbiome and are linked to various oral diseases. Clinical observations indicate a higher prevalence of apical periodontitis (AP) during viral epidemics. However, research on this association is limited. This meta-analysis aimed to explore the relationship between viral infections and AP. This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies were identified through systematic database searches, and data were extracted for eligible studies. Three validated quality assessment tools were used to ensure rigor. The pooled odds ratio (OR) with 95% confidence interval (CI) was calculated to quantify the strength of the association. Out of 427 screened records, 31 studies comprising 1,341,636 participants met the inclusion criteria. The meta-analysis revealed that the prevalence of AP was 2.78 times higher in patients with viral infections compared to controls (95% CI = 1.88-4.12, p < 0.001). Infected individuals demonstrated more severe clinical symptoms (OR = 3.49, 95% CI = 2.07-5.90, p < 0.001) and significantly larger periapical lesions (OR = 3.84, 95% CI = 1.08-13.67, p < 0.05). The evidence suggests a significant association between viral infections and AP, particularly in cases of viral co-infections. These findings suggest that evaluating viral infections, particularly herpesviruses, could inform the clinical management of AP. However, further research is required to establish causality.

This study aims to evaluate the anatomical characteristics of periapical lesions in untreated teeth by correlating lesion diameter, volume, surface area, and sphericity with the root canal diameter measured 1mm short of the apical foramen. Additionally, the study compared lesion classifications according to the cone-beam computed tomographic periapical index (CBCTPAI) and the cone-beam computed tomographic periapical volume index (CBCTPAVI) across different anatomical regions. A total of 500 CBCT scans were assessed to identify periapical radiolucencies in teeth without previous endodontic treatment. Lesions were classified using CBCTPAI based on maximum diameter and CBCTPAVI based on volume. The apical canal diameter was measured 1mm from the apex in buccolingual and mesiodistal directions. Lesion volume and surface area were segmented semi-automatically, and sphericity was calculated. Statistical analyses were performed using the Kruskal-Wallis and Spearman's correlation tests (α = 0.05). Smaller apical diameters were associated with periapical lesions of smaller diameter and higher sphericity, particularly in mandibular anterior teeth. CBCTPAI scores of 4 were more prevalent in the anterior and posterior maxillary regions and posterior mandibular region. CBCTPAVI score 6 predominated across all regions. Lesions causing cortical bone expansion exhibited significantly larger apical diameters (p = 0.028). No significant differences in root canal diameter were observed across sphericity categories. Overall, the anatomical region influenced the correlation between root canal diameter and lesion characteristics. Periapical lesions varied in size, volume, and morphology according to anatomical region and apical canal diameter. The findings highlight the relevance of CBCT-based volumetric and morphometric assessments to support individualized diagnosis and treatment planning. However, the clinical applicability of lesion volume and sphericity measurements warrants further investigation. Accurate CBCT assessment of periapical lesion dimensions and morphology, combined with measurement of apical canal diameter, can improve treatment planning and prognostic evaluation in endodontics, particularly in cases requiring surgical intervention.

Purpose: This study evaluated the pathological effects of single posterior implant-supported fixed prostheses on adjacent and antagonistic teeth and investigated the influence of systemic diseases, occlusal conditions, implant site, and patient sex.Materials and Methods: A retrospective observational study was conducted on 100 patients who had received a single posterior implant and were followed for at least one year at Gangneung-Wonju National University Dental Hospital. Clinical and radiographic assessments compared adjacent and antagonistic teeth at the implant site (ex-perimental group) with the corresponding contralateral teeth (control group). Parameters included tooth cracks, cusp fractures, alveolar bone status, treatment history, and occlusal contact assessed using the Shimstock test. Associations with systemic diseases, occlusal contact, sex, and implant position were also analyzed. Statistical analysis was performed using the chi-square test with a significance level of 0.05.Results: The distal adjacent tooth at the implant site showed significantly higher mobility than the control group (p&lt;0.05). In patients without unilateral mastication, periapical lesions in antagonistic teeth (p&lt;0.05) and cracks in adjacent teeth (p&lt;0.05) were more frequent. Diabetic patients demonstrated a significantly higher prevalence of alveolar bone loss and treatment history in both adjacent and antagonistic teeth (p&lt;0.05). When no occlusal contact was present on the implant-antagonistic tooth, less alveolar bone loss was observed (p&lt;0.05), whereas cusp fractures in adjacent teeth were more common. Male patients showed a higher frequency of cusp fractures and cracks in adjacent teeth (p&lt;0.05).Conclusion: Single posterior implant-supported fixed prostheses can induce pathological changes in adjacent and antagonistic teeth. Implant treatment planning should consider systemic health, occlusal dynamics, sex-related differences, and long-term maintenance.

Extrusion of root canal medicaments can cause complications such as pain, swelling, and paresthesia by irritating the periapical and neural tissues. This case report aims to provide insights into both surgical and nonsurgical management strategies for dealing with this issue. It concludes that nonsurgical approaches can be effective when there is no apical infection, but surgical intervention is necessary when there are clinical symptoms or radiographic evidence of progressively worsening periapical lesions.

Cone beam CT (CBCT) has been widely used in endodontics in recent years. To promote the rational and effective application of CBCT in endodontics, this article introduces the principle of "As low as diagnostically acceptable being indication-oriented and patient-specific (ALADAIP)" for radiographic examination in endodontics. It summarizes and discusses key points of CBCT images evaluation in root canal anatomical variations, dens invaginatus, pulp calcification, odontogenic maxillary sinusitis, root fractures, periapical lesions, and post-endodontic treatment pain. Additionally, it explores how to dialectically use CBCT in evaluating root canal anatomical variations, pulp calcification and cracked tooth, and finally gives some tips about the scanning and three-dimensional reconstruction of CBCT in endodontics.

Aim: The aim of this study is to evaluate the distribution, localization and radiographic dimensions of periapical lesions of posterior teeth between jaws and teeth using CBCT. Material and Methods: In this study, CBCT images of 250 periapical lesions detected in 184 patients were evaluated. The longest diameter of the mesio-distal (MD), bucco-lingual (BL) and occluso-apical (OA) dimensions of the lesions was measured using a digital ruler. In order to determine the localization of the lesions, the region from the enamel-cementum border to the apex was divided into three equal parts as cervical, middle and apical parts. The localization of the lesions was determined by dividing the region from the cemento-enamel junction (CEJ) to the apex into three equal parts as cervical, middle, and apical parts. Results: The latero-apical region of the root surfaces was determined as the most prevalent site of lesions in both jaws. No significant correlation was observed between the mean lesion sizes of MD (p=0.331), BL (p=0.254), and OA (p=0.356) when comparing endodontically treated and untreated teeth, regardless of gender, age, and localization. In CBCT measurements, the OA distance of periapical lesions was larger than the MD and BL distances. Conclusions: The size and location of periapical lesions are two important factors affecting the success of endodontic treatment. Small periapical lesions that are difficult to identify or undetected by conventional two-dimensional (2D) radiographs can be identified by cone-beam computed tomography (CBCT).

Objective: This study aimed to compare the performance of two deep learning models, YOLOv8 and Cascade Mask R-CNN, for the artificial intelligence-assisted automatic detection of periapical lesions in dental panoramic radiographs. Material and Methods: A total of 1861 panoramic radiographs were reviewed, and 602 images containing periapical lesions were included in the study. In these radiographs, a total of 1059 lesions were identified. Observer agreement for lesion detection was evaluated using Kappa analysis. The included radiographs were divided into three datasets: training (70%), validation (20%), and testing (10%). The YOLOv8 and Cascade Mask R-CNN models were trained using the PyTorch library. The trained models were then applied to the test dataset, and true positive, false positive, true negative, and false negative outcomes were recorded for periapical lesion detection. Based on these outcomes, accuracy, sensitivity, specificity, precision, and F1 score were calculated for each model. Results: On the test dataset, the YOLOv8 model achieved 96.9% accuracy, 53.5% sensitivity, 90% precision, and an F1 score of 0.671, whereas the Cascade Mask R-CNN model achieved 97.6% accuracy, 76.2% sensitivity, 81.9% precision, and an F1 score of 0.790. Although YOLOv8 produced fewer false positives, it failed to detect a considerable number of lesions. In contrast, Cascade Mask R-CNN was able to detect more lesions but generated relatively more false positives. Conclusion: Artificial intelligence models demonstrated potential as supportive tools in clinical decision support systems based on their accuracy rates. However, the current sensitivity levels were insufficient to reliably undertake diagnostic responsibilities alone, suggesting that these models should not yet be used independently for clinical decision-making.

Root canal therapy (RCT) serves as the cornerstone treatment for irreversible pulpitis, pulp necrosis, and periapical lesions. With the integration of digital technology, biomaterials science, and artificial intelligence (AI), the paradigm of RCT has shifted from "infection elimination" to "functional reconstruction" and "tissue regeneration". This systematic review summarizes the latest advances in RCT, focusing on digital diagnostic tools, intelligent treatment systems, novel biomaterials, and regenerative endodontic strategies. We also discuss the current challenges and future directions, aiming to provide a comprehensive reference for clinical practice and scientific research. A literature search was conducted in PubMed, Embase, and Cochrane Library databases using keywords such as "root canal therapy", "digital endodontics", "regenerative endodontics", and "artificial intelligence in dentistry". Relevant studies published between 2018 and 2025 were included, and the final analysis covered 40 high-quality articles (randomized controlled trials, systematic reviews, and prospective cohort studies).

Introduction: Untreated carious lesions in primary teeth can negatively affect a child&amp;#39;s quality of life, but they can also cause long-term adverse effects on permanent teeth. Untreated carious lesions in primary teeth progress to inflammation of the dental pulp, which is followed by the development of apical periodontitis.&amp;nbsp; Aim: The aim is to review and summarize the available evidence in the specialized literature on the relationship between periapical complications in primary teeth and their association with pathological changes in the developing tooth structures of permanent teeth, such as the formation of follicular cysts or defects in the enamel structure.&amp;nbsp; Materials and methods: A systematic review of the scientific literature in PubMed, Scopus, and Web of Science was performed. An analysis was made of scientific publications that examine periapical inflammatory processes affecting mainly primary molars, as well as their potential for the development of follicular cysts.&amp;nbsp; Results: It was found that periapical infection of primary teeth is associated with defects in the enamel (hypoplasia, hypomineralization), eruption abnormalities, dilacerations, ankylosis, delayed or impaired root development, and the development of inflammatory follicular cysts.&amp;nbsp; Conclusion: Persistent inflammatory processes associated with periapical lesions have a negative effect on the follicular tissues of permanent teeth. This can lead to structural changes in these tissues, as well as to the formation of follicular cysts and eruption disorders.&amp;nbsp;

Apical surgery serves as the primary salvage treatment for persistent periapical lesions following failed root canal therapy (RCT). Over the past decade, this field has undergone a paradigm shift from "blind resection" to "precision intervention" driven by the integration of digital imaging, minimally invasive techniques, bioactive materials, and regenerative strategies. This systematic review summarizes the latest advances in apical surgery, focusing on digital navigation systems, minimally invasive resection technologies, novel retrograde filling materials, and periapical tissue regeneration approaches. We also analyze current clinical challenges and future development directions to provide evidence-based references for endodontic practice. A comprehensive literature search was conducted in PubMed, Embase, and Cochrane Library using keywords including "apical surgery", "endodontic microsurgery", "digital navigation in endodontics", and "periapical regeneration". Relevant studies published between 2018 and 2025 were included, and the final analysis covered 40 high-quality articles (randomized controlled trials, systematic reviews, and prospective cohort studies).

Periapical lesions may compromise the biomechanics of endodontically treated teeth. This study aimed to quantify, via finite element analysis (FEA), the effect of lesion size on stress distribution and deformation in a maxillary central incisor. Five 3D models (control; 2, 4, 6, 8 mm lesions) were analysed under a 300 N oblique load at 135°. Global maximum equivalent stress remained stable (89.856 MPa vs 89.673 MPa; −0.2%), whereas lesion stress increased (0.25–0.57 MPa) and deformation rose from 0.1437 to 0.1533 mm (+6.7%). Lesion enlargement minimally affects global stress but induces adverse local biomechanical changes.

This study aims to investigate the effect of Er, Cr: YSGG laser activation of NaOCl during final irrigation on the level of RANKL/OPG in the gingival crevicular fluid of mandibular molars with periapical lesions at 1 and 3 months after root canal treatment. Thirty patients with periapical lesions in mandibular molars in the study. Root canal treatment was completed in two visits. Participants were randomly allocated into two groups (n = 15). In the experimental group, NaOCl was activated using an Er, Cr: YSGG laser, while in the control group no activation was performed during final irrigation. Gingival crevicular fluid samples were collected at baseline, one month, and three months after treatment, and stored at − 80 °C until analysis. RANKL and OPG concentrations were quantified by ELISA. Statistical comparisons were made using the Mann–Whitney U and Fisher’s Exact tests. Laser activation of NaOCl did not produce a statistically significant difference in the RANKL/OPG ratio compared with the control group (p > 0.05). Within-group analysis indicated a non-significant reduction in the RANKL/OPG ratio at 3 months after treatment compared to pre-treatment levels in both groups (p > 0.05). Er, Cr: YSGG laser–activated NaOCl irrigation did not produce a statistically significant difference between groups after three months. However, the early decrease in the RANKL/OPG ratio observed in the laser group suggests that laser activation may influence early inflammatory responses associated with the healing process following root canal treatment. Er, Cr: YSGG laser activation may influence early inflammatory conditions following root canal treatment, without demonstrating a definitive advantage within the three-month follow-up period.Trial registration: This study was prospectively registered at ClinicalTrials.gov (Identifier NCT05478811, Date 08/01/2022). Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-33466-w.