Periapical Lesions Research Articles

Lifestyle, caries, and apical periodontitis: Results from a university-based cross-sectional study.

Lifestyle factors significantly influence the development of inflammatory diseases, and emerging evidence suggests they may also impact oral health. However, no studies have explored their role in apical periodontitis (AP) amongst adults. This study aimed to assess the association between adherence to the Mediterranean diet (MD), physical activity, perceived stress, and sleep quality with the periapical and caries status in a university-based cohort. A total of 149 periodontally healthy patients were included in the study. Clinical assessments and radiographic examinations [Orthopantomography (opt) and periapical radiographs] were conducted to evaluate the periapical status. Data on their periapical index (PAI) score and the decayed, missing and filled teeth (DMFT) index were recorded. Validated questionnaires were used to investigate patient's lifestyles. A final logistic regression model was performed for the multivariable analysis to evaluate the predictive ability of adherence to Mediterranean lifestyle on the presence of AP; other local, systemic and environmental factors were included as independent factors in the model. Significant associations were observed between AP and high/low adherence to the MD (p = .00), high/low-moderate physical activity (p = .00), high/low sleep quality (p = .00) and high/low perceived stress (p = .00). The final multivariable regression model showed that low adherence to MD (OR = 3.68; 95% confidence interval [CI]: 1.24-10.83; p = . 01) and reduced sleep quality (OR = 3.04; 95% CI: 1.42-6.50; p = .00) were identified as potential risk factors for AP development. On the other hand, the DMFT index showed no significant association with lifestyle factors (OR = 1.0; CI: 1.01-1.14; p = .02) but was correlated with the development of AP (OR = 1.07; CI: 1.01-1.14; p = .02). Results from the present study suggest a potential association between low adherence to MD and reduced sleep quality with the development of AP. Individuals with low adherence to MD and inadequate sleep quality faced respectively 4-fold and 3-fold increased odds of developing periapical lesions. Further research is essential to elucidate the causal mechanisms underlying these associations and to determine whether lifestyle adjustments could improve endodontic success rate.

Metronidazole-laden silk fibroin methacrylated scaffolds for managing periapical lesions.

This study aimed to develop and characterize silk fibroin methacrylated/SilkMA electrospun scaffolds associated with metronidazole/MET to control infection in root-end resected periapical lesions while supporting bone regeneration. SilkMA-based formulations (10% w/v) incorporating MET (0-control; 5, 15, or 30% w/w) were electrospun into fibrous scaffolds and photocrosslinked. Scaffolds' morphology, chemical composition, swelling/degradation profiles, mechanical properties, cytocompatibility with alveolar bone-derived mesenchymal stem cells/aBMSCs and stem cells from apical papilla/SCAPs, anti-inflammatory potential, and antibacterial efficacy (direct contact assay against Aggregatibacter actinomycetemcomitans/Aa and Fusobacterium nucleatum/Fn; Aa biofilm model) were assessed. Statistical analysis was conducted using a significance level of 5%. Morphological analysis revealed that MET content influenced fiber diameters post-crosslinking, while the chemical composition analysis confirmed MET integration within the scaffolds. 30%MET-laden scaffolds demonstrated reduced swelling capacity compared to SilkMA/control scaffolds, while complete degradation was observed after 42days for the formulated scaffolds. Mechanical testing indicated enhanced stiffness and tensile strength in 30%MET-laden scaffolds compared to SilkMA/control (p < 0.05). Cytocompatibility evaluations showed non-cytotoxic effects across all formulations for aBMSCs and SCAPs. Anti-inflammatory assays demonstrated decreased pro-inflammatory cytokine interleukin-6 synthesis by aBMSCs treated with SilkMA + MET30% and Escherichia coli LPS, comparable to negative control (p > 0.05). Antibacterial efficacy assays revealed significant inhibition of Aa and Fn, with 30%MET-laden scaffolds demonstrating biofilm inhibition against Aa (p < 0.05). These findings underscore the potential of SilkMA scaffolds laden with MET as a promising strategy for managing periapical lesions, offering enhanced structural support, antimicrobial properties, and biocompatibility crucial for effective tissue regeneration and infection control after endodontic surgery.

Unveiling the power of artificial intelligence for image-based diagnosis and treatment in endodontics: An ally or adversary?

Artificial intelligence (AI), a field within computer science, uses algorithms to replicate human intelligence tasks such as pattern recognition, decision-making and problem-solving through complex datasets. In endodontics, AI is transforming diagnosis and treatment by applying deep learning algorithms, notably convolutional neural networks, which mimic human brain function to analyse two-dimensional (2D) and three-dimensional (3D) data. This article provides an overview of AI applications in endodontics, evaluating its use in 2D and 3D imaging and examining its role as a beneficial tool or potential challenge. Through a narrative review, the article explores AI's use in 2D and 3D imaging modalities, discusses their limitations and examines future directions in the field. AI significantly enhances endodontic practice by improving diagnostic accuracy, workflow efficiency, and treatment planning. In 2D imaging, AI excels at detecting periapical lesions on both periapical and panoramic radiographs, surpassing expert radiologists in accuracy, sensitivity and specificity. AI also accurately detects and classifies radiolucent lesions, such as radicular cysts and periapical granulomas, matching the precision of histopathology analysis. In 3D imaging, AI automates the segmentation of fine structures such as pulp chambers and root canals on cone-beam computed tomography scans, thereby supporting personalized treatment planning. However, a significant limitation highlighted in some studies is the reliance on in vitro or ex vivo datasets for training AI models. These datasets do not replicate the complexities of clinical environments, potentially compromising the reliability of AI applications in endodontics. Despite advancements, challenges remain in dataset variability, algorithm generalization, and ethical considerations such as data security and privacy. Addressing these is essential for integrating AI effectively into clinical practice and unlocking its transformative potential in endodontic care. Integrating radiomics with AI shows promise for enhancing diagnostic accuracy and predictive analytics, potentially enabling automated decision support systems to enhance treatment outcomes and patient care. Although AI enhances endodontic capabilities through advanced imaging analyses, addressing current limitations and fostering collaboration between AI developers and dental professionals are essential. These efforts will unlock AI's potential to achieve more predictable and personalized treatment outcomes in endodontics, ultimately benefiting both clinicians and patients alike.

Apical surgery for treatment of persistent sinus tract caused by infected acessory canal

Apical surgery aims to treat periapical infections that endodontic treatment or retreatment has failure. This study aims to reporting 2 years and 8 months follow-up of a surgical retreatment of tooth 23 to solve a persistent sinus tract caused by a persistent root-infection of accessory canal. A 48-years-old male patient sought an endodontist due to a persistent sinus tract in the palatal portion of tooth 23, even after 2 previous endodontic retreatment. The radiographic and tomographic examinations demonstrated satisfactory endodontic treatment, absence of periapical lesion, over filling material, presence of fiberglass post on tooth 23. Also, fistula tract in the bone 5 mm from the apex associated with accessory canal were detected by tomography. The apical surgery was performed to treat and remove the persistent infection. The apicectomy and root-end preparation were performed. The root-end cavity was filled with Sealer 26 in dense consistency and apicoplasty was performed and the flat was sutured. The 2 years and 8 months follow-up of CBCT exam demonstrated a complete healing and the absence of sinus tract trajectory in the bone. In conclusion, the accurate diagnostic and surgical planning were utmost important to success.

Periradicular Surgery Guided with Erbium Er Cr Laser:YSGG. Case Report

Purpose: The aim of the study is to observe the bone healing process of a guided periradicular surgery, performed in the endodontics postgraduate course of the University of Santo Tomas, in which an osteotomy was performed for a bone window with erbium, chromium: yttrium, scandium, gallium, garnet (Erbium,Chromium:YSGG) laser, and the healing process was evaluated by cone beam computed tomography (CBCT) during the first four months after surgery. Materials and Methods: After completing the clinical history and studying the CBCT scans, a patient was selected with a diagnosis of symptomatic apical periodontitis, periapical lesion less than 5mm with intact vestibular cortex that required periradicular surgery due to the presence of an adapted fixed prosthesis and the proximity of the mental foramen to the apex of the tooth to be treated. The treatment plan was established, the surgical guide was designed and the osteotomy was performed with Erbium,Chromium:YSGG laser. The size of the periradicular lesion and the bone density of the surgical area were measured at three points in time: pre-surgical (T0) and post-surgical at 24 hours (T1), at 4 months (T2) and at one year. Results: Bone density measured in Hounsfield units (HU) on CBCT in the axial section showed preoperative values in the vestibular apex of 1478 and 1435 HU, at 24 hours after surgery -95 and -210 HU, and in the control at 4 months of 992 and 860 HU. In the coronal slice in the mid vestibular area at the apex level, a preoperative value (T0) of 1335 HU was reported, at 24 hours (T1) -18 HU and at 4 months 1269 HU. At one year of evolution, greater bone density was evidenced comparing between month 4 and month 12. Conclusions: By performing a surgical procedure with guided technique and Erbium,Chromium:YSGG laser for the osteotomy, the adverse effects of the surgical procedures are reduced, achieving results with greater accuracy and better prognosis.

Non-Surgical Endodontic Management of Large Periapical Lesions After Traumatic Dental Injuries.

Traumatic dental injuries of permanent teeth result in multiple immediate and long-term consequences depending upon the severity of trauma, age of the patient, the status of root maturity, and the emergency care provided. The healing responses may get disturbed due to severe damage, loss of vascularity of the supporting structures, and infections. As a result, the prohealing mediators and pathways are overpowered by the destructive stimuli often manifested by an increased osteoclastic activity. Among the various late complications, the apical periodontitis or the periapical lesions are most worrisome for the patients and create clinical dilemma for the dentists. In the past, many such lesions were classified as cysts and subjected to surgical management. However, better understanding of lesion pathophysiology, three-dimensional imaging, and molecular pathways have established their inflammatory nature. The advancements in materials such as calcium silicates, and regenerative techniques have propelled the research related to non-surgical endodontic management as its clinical acceptability. The treatment largely follows the recommendations of regenerative medicine and is based on four principles: (a) establishing the drainage or an endodontic access to the area, (b) removal of most of the triggering agents such as necrosed pulp, toxins, and inflammatory mediators, (c) disinfection of the area, controlling inflammation and reversal of the acidic pH, and (d) maintenance of this infection/inflammation-free state for a long time through adequate sealing. This review aims to highlight the rationale of the approach, case selection, pathophysiology of the causation and healing, clinical protocols, and the limitations of non-surgical endodontic management of large periapical lesions secondary to traumatic dental injuries.

Clinical management of mandibular permanent premolars with periapical lesion and bilateral supernumerary teeth: A 7-years follow-up case report

Objectifs: This 7-years follow-up case report describes two diversified strategies for the management of bilateral mandibular permanent premolars associated with periapical lesion and unerupted supernumerary teeth. Case Report: A non-syndromic 9 years-old Asian female patient presented pain and swelling of the 35 in anatomical contiguity with an immature and unerupted supernumerary tooth. Clinical examination revealed an intraoral vestibular sinus tract related to the necrotic 35. Periapical radiography and CBCT showed that the 35 had an immature apex associated with a periapical lesion, and a supernumerary tooth in a lingual direction. Endodontic treatment of the 35 was performed by creating an apical plug with ProRoot MTA, while the supernumerary tooth was monitored radiographically with no intervention. Four years later, the 45 developed the same clinical condition of the left arch. Radiographic examination revealed a periapical lesion with massive periapical bone resorption, and a supernumerary tooth in normal alignment. The second premolar was herein extracted to allow for eruption of the supernumerary tooth. Outcomes: 3-years follow-up revealed continued root maturation and its spontaneous eruption in the dental arch. Proper healing of both mandibular lesions was monitored after 10 months, 3-years and 7-years revealing no recurrence on both sides.

Segmentation of periapical lesions with automatic deep learning on panoramic radiographs: an artificial intelligence study

Periapical periodontitis may manifest as a radiographic lesion radiographically. Periapical lesions are amongst the most common dental pathologies that present as periapical radiolucencies on panoramic radiographs. The objective of this research is to assess the diagnostic accuracy of an artificial intelligence (AI) model based on U²-Net architecture in the detection of periapical lesions on dental panoramic radiographs and to determine whether they can be useful in aiding clinicians with diagnosis of periapical lesions and improving their clinical workflow. 400 panoramic radiographs that included at least one periapical radiolucency were selected retrospectively. 780 periapical radiolucencies in these anonymized radiographs were manually labeled by two independent examiners. These radiographs were later used to train the AI model based on U²-Net architecture trained using a deep supervision algorithm. An AI model based on the U²-Net architecture was implemented. The model achieved a dice score of 0.8 on the validation set and precision, recall, and F1-score of 0.82, 0.77, and 0.8 respectively on the test set. This study has shown that an AI model based on U²-Net architecture can accurately diagnose periapical lesions on panoramic radiographs. The research provides evidence that AI-based models have promising applications as adjunct tools for dentists in diagnosing periapical radiolucencies and procedure planning. Further studies with larger data sets would be required to improve the diagnostic accuracy of AI-based detection models.

The immune landscape in apical periodontitis: From mechanism to therapy.

Apical periodontitis (AP) is featured by a persistent inflammatory response and alveolar bone resorption initiated by microorganisms, posing risks to both dental and systemic health. Nonsurgical endodontic treatment is the recommended treatment plan for AP with a high success rate, but in some cases, periapical lesions may persist despite standard endodontic treatment. Better comprehension of the AP inflammatory microenvironment can help develop adjunct therapies to improve the outcome of endodontic treatment. This review presents an overview of the immune landscape in AP, elucidating how microbial invasion triggers host immune activation and shapes the inflammatory microenvironment, ultimately impacting bone homeostasis. The destructive effect of excessive immune activation on periapical tissues is emphasized. This review aimed to systematically discuss the immunological basis of AP, the inflammatory bone resorption and the immune cell network in AP, thereby providing insights into potential immunotherapeutic strategies such as targeted therapy, antioxidant therapy, adoptive cell therapy and cytokine therapy to mitigate AP-associated tissue destruction.

Diagnosis and endodontic treatment of odontogenic cutaneous sinus tracts: A report of two cases

Introduction: The odontogenic cutaneous sinus tract (OCST), caused by pulp necrosis, creates connections between pathological spaces and anatomical structures. Extraoral manifestations pose diagnostic challenges leading to inappropriate treatments such as multiple surgery and antibiotic therapies. Effective management requires the treatment of dental pathology through endodontic therapy or extraction. This paper presents two cases of OCST and emphasizes the importance of accurate diagnosis and successful non-surgical endodontic treatment. Observations: Case report 1: A 23-year-old male patient referred by his dermatologist with a cutaneous sinus tract on his chin that had appeared five years ago. During this period, he reported spontaneous pain and pus discharge from the chin area. The examination revealed a periapical lesion associated with tooth number 31. Cone beam computed tomography (CBCT) revealed the existence of a localized perforation on the buccal alveolar table and a second root canal of the tooth. After six months of follow-up, the cutaneous sinus tract was significantly improved by the appropriate endodontic treatment. Case report 2: A 36-year-old female patient was referred by her dentist to examine a chin lesion that had appeared a month ago. In clinical examination and radiographic assessment, periapical lesion associated with two mandibular central incisor teeth #41 and #31 was observed. After identifying the source of infection, endodontic treatment was carried out, and a good improvement in fistula was observed after one month. Conclusions: The correct diagnosis and treatment of OCST are important for healing. CBCT aids to identify odontogenic origin of the sinus tract through the detection of apical periodontitis and bone lesion. Root canal therapy is the treatment of choice for these cases and should always be attempted first. Monitoring the patients is necessary until complete healing of the disease.

Digital Workflow for Rehabilitation of Severely Discolored Teeth Due to Red Staining from Endodontic Material.

The aim of this short communication is to present a technique to rehabilitate severely discolored teeth with computer-aided designed and computer-aided manufactured (CAD-CAM) zirconia crowns. After confirming the absence of periapical lesions and sufficient crown structure, any caries or fractured restorations can be removed and replaced by an interim composite restoration. A shoulder subgingival preparation is performed and scanned with an intraoral scanner to design a CAD-CAM zirconia crown using a monolithic zirconia material. This crown is highly polished using a specific polishing kit, but not glazed. This technique is suggested to be useful in cases of dark discolored teeth due to staining endodontic materials such as resorcinol-formaldehyde resin.

The influence of different extraction indications on the morphological changes in the maxillary sinus: A retrospective cohort study.

The comprehensive effects of maxillary posterior tooth extraction on the maxillary sinus (MS) morphology remain to be thoroughly elucidated. This retrospective cohort study aimed at evaluating the influence of different extraction indications on the morphological changes in the MS by utilizing cone-beam computed tomography (CBCT). One hundred and seventy-eight of maxillary posterior tooth extractions underwent CBCT scans before and after extraction using 3D Slicer software. Parameters such as maxillary sinus pneumatization (MSP, the primary outcome measure), buccal bone height (BBH), palatal bone height (PBH), mucosal thickness (MT), and other anatomical structures were measured for patients undergoing extraction due to periodontitis, periapical lesions, or tooth fracture. Multiple linear regression analysis was employed to assess the effect of extraction indications on the MS. While the primary outcome, MSP, did not reveal statistically significant differences across various indications for tooth extraction (p > .05), extraction itself resulted in MSP (p < .05). The rate of this pneumatization was influenced by the position of the extraction site (p < .05). Additionally, baseline values of bone height and mucosal thickness showed an inverse correlation with the rate of change in these parameters following tooth extraction (p < .001). Tooth extraction led to increased pneumatization of the maxillary sinus while simultaneously reducing bone height and mucosal thickness. However, these outcomes were not influenced by the reason for tooth extraction.

Treatment of Oroantral Communication and Fistulas with the Use of Blood-Derived Platelet-Rich Preparations Rich in Growth Factors: A Systematic Review.

The formation of an oroantral communication (OAC) or fistula (OAF) is a rare complication resulting from the presence of processes in the lateral parts of the maxilla or for iatrogenic reasons. The most common causes of OAC or OAF are tooth extraction with periapical lesions. The aims of this systematic review were to assess the use of platelet-derived preparations rich in growth factors in the treatment of OAC or OAF, to determine the success of treating the communication or fistula, as well as impact on postoperative complications and the course of healing. The study was performed following PRISMA guidelines (PROSPERO: CRD42024570758). The inclusion criteria were as follows: at least ten patients, the presence of oroantral communication or oroantral fistula, treatment with platelet-derived preparations rich in growth factors, and information regarding the response to treatment. In order to find relevant studies, international databases, including PubMed, Google Scholar, Web of Science Core Collection, MDPI, Wiley, and Cochrane Library were searched. The last search was performed on 31 August 2024. Seven articles were included in the systematic review. In total, platelet-derived preparations rich in growth factors were used in 164 patients. Only studies in which OAC was treated and with platelet-rich fibrin (PRF) met the inclusion criteria. Only PRF was used as the sole treatment method in three studies. When OAC is greater than 5 mm, platelet-derived preparations rich in growth factors should be considered adjuncts to treatment, not the sole treatment method. The success rate of OAC treatment was 90-100%. The use of blood products to close OAC may be an effective therapeutic alternative. Proper patient qualification and the use of an appropriate protocol are crucial. There is a need for future well-designed case-control or cohort studies as well as randomized controlled trials to provide the required level of evidence.

Retratamento endodôntico de dente portador de lesão periapical extensa com presença de núcleo metálico

This study aims to present a clinical case of retreatment of a tooth with an extensive periapical lesion with the presence of a metal core. A 59-year-old patient was referred for dental treatment due to the need for retreatment of tooth 22. During clinical examination, the presence of a fistula was observed and the patient reported pain on vertical and horizontal percussion, absence of a periodontal pocket, and radiographic examination showed extensive periapical bone radiolucency, presence of filling material, as well as a fused metal core. After removal of the metal core with the aid of ultrasound, retreatment was performed with rotary instrumentation (Prodesign Logic RT). Sodium hypochlorite at 2.5% was used as the irrigating solution. The root canal system was obturated using the single cone technique associated with BIO-C Sealer cement. It is concluded that endodontic retreatment after removal of a fused metal core can be performed in a single session and determine the success of endodontic therapy.

Periapical lesion detection in periapical radiographs using the latest convolutional neural network ConvNeXt and its integrated models

To overcome the limitation of a single classification model’s inability to simultaneously identify multiple lesion targets within periapical radiographs, This study proposes YoCNET (Yolov5 + ConvNeXt), a novel deep learning integrated model. YoCNET leverages the target detection capability of Yolov5 and the image classification capability of ConvNeXt to achieve automatic segmentation of individual teeth and concurrent detection of periapical lesions across multiple teeth. A dataset of 1,305 periapical radiographs was used to train and validate the ConvNeXt and ResNet34 models, with an 8:2 split for training and validation. Deciduous teeth were excluded from the dataset. Furthermore, 717 individual teeth images were extracted from 200 previously unused periapical radiographs for integrated model validation. Evaluation metrics included accuracy, precision, sensitivity, F1 score, AUC (Area Under Curve), and a confusion matrix.The YoCNET integrated model demonstrated values of 90.93%, 98.88%, 85.30%, 0.9159, and 0.9757 for accuracy, precision, sensitivity, F1 score, and AUC, respectively. These metrics were superior to those achieved by the YoRNET (Yolov5 + ResNet34) integrated model, which recorded 80.47%, 83.78%, 82.16%, 0.8296, and 0.8822. The integrated model achieved high accuracy and efficiency in automatic teeh segmentation by Yolov5 and in automatically detecting multiple periapical lesions by ConvNeXt. YoCNET exhibited superior overall data performance, making it a more suitable deep learning integrated model for clinical applications.

The impact of root end filling material type and the application of bone graft on healing of periapical tissues after endodontic microsurgery (a clinical randomized controlled trial)

To evaluate the effect of combining different bioactive root-end filling materials with composite bone graft (xenogeneic mixed with autogenous bone fragments) on the healing process of periapical tissues after endodontic micro-surgery procedure. In this triple-blinded clinical trial, 56 patients were divided into 2 main groups (28 each) according to the root-end filling material and 2 subgroups according to the presence or absence of the composite bone graft material. Group I: MTA root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Group II: TotalFill root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Healthy patients whose ages range from 20 to 50 years with small-to-medium size radiolucency in CBCT related to single-rooted maxillary teeth were included in this study. Patients were assigned a number starting from 1 to 56 and were randomly allocated to four test groups (2 main groups and 2 sub-groups) following simple randomization procedure guidelines described by IBM SPSS V23 (IBM USA) statistical analysis software. This trial was triple-blind where the patient, the outcome assessors, and the main operator were blinded to the applied intervention. Every patient was evaluated clinically and by CBCT at two main observation periods: presurgical and 12-month post-operative. They were also examined and evaluated clinically and radiographically through periapical x-rays after one week, three, and six months. Statistical analysis was performed with IBM SPSS Statistics for Windows Version 23.0. Armonk, NY: IBM Corp. Of the 56 patients enrolled in the study, 49 patients were available for the final analysis. All groups showed no statistically significant differences with regard to healing or success rates at the 12-month follow-up mark. No adverse effects were encountered. Results showed that high success rates were achieved using MTA and TotalFill in the healing of periapical lesions after endodontic surgery. The addition of bone graft in small-to-medium size lesions did not affect the success rate of endodontic surgeries.

Transient Apical Breakdown: Incidence, Pathogenesis, and Healing.

Transient apical breakdown (TAB) is a phenomenon that indicates temporary apical periodontal destruction and root resorption after tooth luxation injuries, followed by the healing process of the dental pulp. Andreasen in 1986, reported that TAB was seen in approximately 4.2% of all luxation injuries. However, there have been no reports thereafter on the types and frequency of the luxation traumatic injuries in which TAB occurs. Therefore, this retrospective study was aimed to assess the incidence and pathogenesis of dental trauma-induced TAB and to suggest a possible mechanism of subsequent healing based on a series of cases. Data analysis included mature teeth (n = 56) of 49 patients aged 9-30 years who presented in a private dental office over a period of 10 years (2012-2022) to investigate the incidence and healing sequala of TAB. TAB was observed in 43.8% of subluxation, 62.5% of extrusive luxation, and 75% of lateral luxation injuries. The average age of patients who developed TAB was 14.5 years, ranging from 9 to 28 years old. TAB can be expected in many cases of luxation injuries with minimal dislocation. Therefore, mild injuries (subluxation, extrusion, and lateral luxation), may exhibit spontaneous healing, recovery of dark discoloration of the crown, disappearance of a periapical radiolucent lesion and return to normal response to EPT as long as 12 months after the traumatic injury. Thus, a decision to perform endodontic treatment in these cases might be postponed until clear evidence for an infection exists.

Outcomes and prognostic factors of endodontically treated teeth filled with calcium silicate- or epoxy resin-based root canal sealers: A retrospective cohort study.

The objectives of this study were to compare the clinical outcomes of root canal treatment between calcium silicate-based sealer using the cold hydraulic condensation technique and epoxy resin-based sealer using warm vertical compaction and to identify the prognostic factors affecting the outcomes of both obturation techniques. Dental records and radiographs of the teeth that received root canal treatment with calcium silicate-based sealer using the cold hydraulic condensation technique or epoxy resin-based sealer using warm vertical compaction during 2015-2021 were selected using inclusion and exclusion criteria. The cases were matched between the two groups based on four factors: primary root canal treatment or retreatment, tooth type, periapical lesion and its size and extension of root canal filling. The success rates of root canal treatment between two sealers/obturation techniques were analysed. The incidence and resorption of extruded sealer were evaluated using the McNemar's test. Generalized estimated equations were used to evaluate any prognostic factors. The median recall period of this study was 15 months. A total of 234 teeth, comprising 117 cases in each sealer/obturation group, were included. No significant difference was found in the success rates between the calcium silicate-based sealer using the cold hydraulic condensation technique group (91.5%) and the epoxy resin-based sealer using the warm vertical compaction group (94.9%). The incidence of sealer extrusion for the calcium silicate-based sealer (27.6%) did not significantly differ from that of the epoxy resin-based sealer (36.2%), with both sealers typically demonstrating no resorption at recalls. No prognostic factors related to the success rate of either technique were detected. The study findings suggest no difference in the success rate between calcium silicate-based sealer and epoxy resin-based sealer. The study did not identify any prognostic factors that significantly influenced the outcomes of the endodontic treatments.

Tratamento endodôntico associado a terapia fotodinâmica em dente anterior: relato de caso

Photodynamic therapy acts on biostimulation at the cellular level, thus accelerating tissue repair and promoting analgesia. Often with conventional treatment it is not possible to achieve success and it is necessary to use alternative therapies, photodynamic therapy is used as one of these alternative therapies, demonstrating which types of photosensitizers and light can be used and how it is possible to help combat the infection. bacterial. Photosensitizers have the function of absorbing red light in the region and producing singlet oxygen. Therefore, the objective of this work was to perform endodontic treatment on element 21 with a periapical lesion, with the aid of photodynamic therapy associated with the photosensitizer Methylene Blue.

Tratamento endodôntico em sessão única em dentes com lesão apical: relato de caso

Endodontics is a branch of dentistry responsible for treating the inside of the teeth through endodontic treatment. One of the main objectives of endodontic treatment is to guide the root canal system to a clean place, consequently eliminating microorganisms, providing the cure of the infection and later restoring the function of the tooth. Endodontic treatment performed correctly is successful in the long term regardless of the number of sessions, therefore, endodontic treatment in a single session is a great alternative due to the saving of operative time, lower risk of infiltrations, shorter time to resume function of the tooth in the stomatognathic system, reduced risk of cross-infection and reduced drug administration to patients who need antibiotic prophylaxis. The success of the root canal treatment will depend on the infection control through the correct cleaning and modeling of the canals, the filling of the same through the obturation and all the care to be executed and not the medication used between sessions. Thus, the objective of this work is to report the effectiveness of endodontic treatment in a single session through a clinical case report of a patient with a large periapical lesion in elements 21 and 22.