Periapical Lesions Research Articles

CXXC5 mitigates P. gingivalis-inhibited cementogenesis by influencing mitochondrial biogenesis

BackgroundCementoblasts on the tooth-root surface are responsible for cementum formation (cementogenesis) and sensitive to Porphyromonas gingivalis stimulation. We have previously proved transcription factor CXXC-type zinc finger protein 5 (CXXC5) participates in cementogenesis. Here, we aimed to elucidate the mechanism in which CXXC5 regulates P. gingivalis-inhibited cementogenesis from the perspective of mitochondrial biogenesis.MethodsIn vivo, periapical lesions were induced in mouse mandibular first molars by pulp exposure, and P. gingivalis was applied into the root canals. In vitro, a cementoblast cell line (OCCM-30) was induced cementogenesis and submitted for RNA sequencing. These cells were co-cultured with P. gingivalis and examined for osteogenic ability and mitochondrial biogenesis. Cells with stable CXXC5 overexpression were constructed by lentivirus transduction, and PGC-1α (central inducer of mitochondrial biogenesis) was down-regulated by siRNA transfection.ResultsPeriapical lesions were enlarged, and PGC-1α expression was reduced by P. gingivalis treatment. Upon apical inflammation, Cxxc5 expression decreased with Il-6 upregulation. RNA sequencing showed enhanced expression of osteogenic markers, Cxxc5, and mitochondrial biogenesis markers during cementogenesis. P. gingivalis suppressed osteogenic capacities, mitochondrial biogenesis markers, mitochondrial (mt)DNA copy number, and cellular ATP content of cementoblasts, whereas CXXC5 overexpression rescued these effects. PGC-1α knockdown dramatically impaired cementoblast differentiation, confirming the role of mitochondrial biogenesis on cementogenesis.ConclusionsCXXC5 is a P. gingivalis-sensitive transcription factor that positively regulates cementogenesis by influencing PGC-1α-dependent mitochondrial biogenesis.A5vAuiTS6Tkq1RfziX_nr_Video

Association between periapical odontogenic lesions and maxillary sinus mucosal thickening: A retrospective computed tomography analysis

Introduction: The maxillary sinuses are located in the middle of the nasal cavity and are thought to have the greatest air gaps. Cone-beam computed tomography (CBCT) imaging was used to characterize the radiographic connection between the apices of posterior maxillary teeth and the floor of the maxillary sinus. This study aims to evaluate the degree of apical periodontitis and the sinus mucosal thickness and find the associations between the patient’s age and gender and the degree of apical periodontitis with sinus mucosal thickness. Materials and Methods: A retrospective analysis of 364 individuals with maxillary sinuses which appears clearly within limited-field CBCT images was performed. It was also categorized and noted how the maxillary sinus floor related to the root tips and periapical lesions. In addition, the patient’s age gender, side, and level of apical periodontitis in relation to maxillary sinus mucosal (MSM) thickness were evaluated. Results: The MSM class and periapical index (PAI) were statistically significantly correlated (P 0.001). In comparison to respondents with PAI score I, respondents with PAI score V had 47.89 times the odds of having a higher MSM class (odds ratio [OR] =47.89, P = 0.05). Age and MSM thickening were not substantially correlated (P = 0.298), whereas gender and MSM thickening were strongly correlated (OR = 1.56, P = 0.05). Conclusions: The result of this study showed a clear association between the periapical lesions and MSM thickening.

Effect of EGCG-based paste as intracanal dressing, in MMPs 2 and 9 expression in dog's periapical lesions.

High expression of MMP-2 and MMP-9 in periapical lesions plays an important role in the degradation of the extracellular matrix. This study aimed to investigate the effect of epigallocatechin-3-gallate (EGCG)-based endodontic paste as an intracanal dressing on the expression of MMP-2 and MMP-9 in periapical lesions. Periapical lesions were experimentally induced in 35 mature beagle dog premolars randomly divided into healthy teeth, untreated periapical lesions, periapical lesions treated in a single session (control groups), and periapical lesions treated in two sessions with EGCG or calcium hydroxide-based pastes (experimental groups). After 120 days, specimens were obtained for histopathologic and immunofluorescence analyses to assess the expression of MMP-2 and MMP-9. The statistical analysis was performed using a p-value of 0.05. Endodontic treatment in two sessions using medication with EGCG and calcium hydroxide-based pastes provided similar repair of the apical and periapical tissues and neoformation of periodontal ligament fibers, cementum, and alveolar bone (p>0.05). The experimental groups treated in two sessions with both medications presented expression of MMP-2 and MMP-9 similar to that in healthy teeth (p>0.05), and significantly lower than teeth treated in a single session or untreated periapical lesions (p <0.001). Expression of MMP-2 and MMP-9 was observed in the cytoplasm of fibroblasts, osteoblasts, cementoblasts, cementocytes, and vascular endothelium. The use of EGCG-based endodontic paste reduced the expression of MMP-2 and MMP-9 and allowed repair of periapical lesions, similar to calcium hydroxide-based paste, and superior to treatment performed in a single session.

Mutational analysis of cytoplasmic domain of integrin subunit alpha-1 and its association with periapical wound healing after surgical endodontic treatment.

Numerous studies reported that the healing after surgical endodontic retreatment is influenced by multiple factors which include the genetic profile of the patient, epigenetics, and immune responses. The genes which are primarily responsible for the healing potential in different individuals are those which are involved in the regulation of the cytoskeleton and cellular adhesion which subsequently affects bone deposition and healing. Integrins are cell-surface molecules, possess a key role in the cytoskeleton and cellular adhesion. Integrin Subunit Alpha 1 (ITGA1) is one among the integrin family and helps in regulating the Epidermal Growth Factor receptor (EGFR) pathway, consequently affects proliferation and healing. The objectives of the study were to identify mutations in the cytoplasmic domain of Integrin Subunit Alpha 1 (ITGA1), to assess the expression of activated EGFR, EGFRPhospho and TC-PTP in the periapical wound and to correlate these mutations and expression patterns with periapical wound healing. Thirty-seven patients between ages 18-60 years reported chronic apical periodontitis of single-rooted anterior teeth with periapical radiolucency, equal or greater than 4 mm or periapical lesion in an open apex of single-rooted teeth due to trauma were included in the study from 01st June 2018 till 31st October 2019. Patients with persistent radiolucency after primary root canal treatment and endodontic retreatment were kept on follow-up for 3-4 months surgical endodontic treatment was performed in cases with persistent periapical lesions of 4mm or more in diameter. Periapical lesion sample was collected and used for (1) histo-pathological analysis after Hematoxylin & Eosin staining, (2) total DNA extraction for ITGA1 cytoplasmic domain mutational analysis and immunohistochemistry for EGFR and TCPTP. A positive correlation was observed between the expression levels of EGFRPhospho and the healing of periapical lesions. Moreover, a negative weak correlation was observed between the expression levels of EGFR and TCPTP and the healing of periapical lesions. Out of nine sequences of cytoplasmic domain of ITGA1 which were analyzed, none of them was detected with SNP. Higher expression levels of EGFRPhospho and lower expression levels of EGFR and TCPTP were associated with patients with good healing potential in periapical area. However, immunohistochemistry scores were statistically insignificant to draw any conclusion.

The Effect of Lasers on the Healing of Periapical Lesion: A Systematic Review.

Introduction: Endodontic treatment of teeth with periapical lesions presents more clinical difficulty. Various lasers in several methods are used in endodontics, and most of them are utilized as an adjunctive protocol in order to reduce the bacterial load of the root canal system. Improved disinfection plays a crucial role in enhanced and accelerated healing of periapical lesions. This review aims to summarize studies assessing the effect of lasers on periapical lesion healing. Methods: PubMed/MEDLINE, Scopus, Embase, and Web of Science (ISI) online databases were searched, with no publication year or status restriction, for relevant articles on April 2023. Clinical studies evaluating the effect of laser application on the periapical lesion of patients using radiographic assessment were considered eligible for inclusion. Results: Eight studies were included after carefully screening the obtained articles, first by their title and abstract and then by their full texts. Diode (4), Er, Cr: YSGG (3), and Nd: YAG (1) lasers were used with output powers that varied from 0.75 to 2 watts. Photodynamic therapy was employed in two studies, and in other studies, the root canal system was directly irradiated. Irradiation of the root canal system was adjunctive to standard preparation in all studies. The healing of the teeth treated with lasers was not inferior to those conventionally treated. In all of the included studies, laser application outperformed the standard cleaning and shaping protocol; however, this improved or faster healing was not statistically significant in most studies. Conclusion: Lasers might expedite and improve the healing process of periapical lesions. Since lasers enhance the quality of cleaning of the root canal system, it is hard to point out the exact mechanism of it. Further investigations are needed to realize the effectiveness of this treatment modality and to discover the underlying biological concepts.

Procedural errors detected by cone beam tomography in cases with indication for retreatment: in vivo cross-sectional study.

This study aimed to investigate the frequency and type of endodontic procedural errors in cases indicated for retreatment through cone-beam computed tomography (CBCT) analysis. The sample consisted of 96 CBCT scans, encompassing 122 permanent teeth with fully formed roots. Errors included perforation, instrument fracture, canal transportation, missed canals, and inadequate apical limit of filling. Additionally, potential risk factors were analyzed and subjected to statistical modeling. The most frequent procedural error observed was the inadequate apical limit of filling, followed by canal transportation, perforation, missed canal, and instrument fracture. Statistically significant associations were identified between various procedural errors and specific factors. These include canal transportation and root canal wall, with the buccal wall being the most commonly affected; missed canal and tooth type, particularly the palatine and second mesiobuccal canal canals; inadequate apical limit of filling and root curvature, showing a higher deviation to the mesial direction in severely curved canals; inadequate apical limit of filling and the presence of calcifications, with underfilling being the most frequent; canal transportation and periapical lesion, notably with deviation to the buccal direction; and the direction of perforation and periapical lesion, most frequently occurring to buccal direction. CBCT emerges as a valuable tool in identifying procedural errors and associated factors, crucial for their prevention and management.

Regenerative Treatment of Mature Teeth with Pulp Necrosis and Apical Periodontitis Using Biodentine Compared with MTA: Randomized Controlled Clinical Trial.

The purpose of this randomized, controlled study was to evaluate the effectiveness of Biodentine compared with MTA used as a pulp space barrier in healing periapical lesions and regaining pulp sensitivity after regenerative treatment in mature single-canal permanent teeth with pulp necrosis and apical periodontitis. The study involved 36 patients with mature teeth with necrotic pulp and apical periodontitis. The patient underwent a regenerative treatment that utilized the blood clot technique. Teeth were randomly allocated to either the intervention, Biodentine, group (n=18) or the control, MTA, group (n=18). The healing of periapical lesions and tooth sensibility were evaluated throughout follow-up visits for up to 18 months. The study analyzed 31 patients; two patients within the biodentine group and three in the MTA group were lost to follow-up. After 18 months, both groups showed effective healing of periradicular lesions; 21 out of 31 patients (67.7%) were healed, ten patients (32.3%) were healing, and no failure cases occurred. There were no significant differences between the groups (p=1.00). More than 70% (22 out of 31 patients) regained their sensibility in their teeth, and the groups had no statistically significant difference (p=0.703). Regenerative treatment using blood clots with either MTA or Biodentine effectively resolved periapical lesions and regained the sensibility of mature teeth.

Endodontic Management of Dens in Dente – A Systematic Review of Case Reports and Case Series

ABSTRACT Objective: Dens in dente is a developmental dental malformation with various anatomical traits that make treatment difficult. The importance of a timely and correct diagnosis in determining the most effective treatment approach cannot be overstated. Using three-dimensional (3D) imaging techniques has improved the diagnosis of teeth with complex anatomies, such as dens in dente. This systematic review aimed to determine the different techniques for endodontic management of teeth with Dens in dente having periapical lesions. Materials and Methods: Case reports and case series were identified in databases - PubMed-MEDLINE, Google Scholar, Research Gate, EBSCO-Host, Scopus, and Cochrane Library based on title, abstract, and full text published in the English language between January 1, 2016 and April 30, 2023. Patients who have periapical lesions and dens in dente in their permanent teeth and reporting on the results of nonsurgical or surgical intervention in terms of healing were eligible for this review, while editorial reviews, review papers, abstracts, letters to the editor, and animal studies are all excluded. Case studies on deciduous teeth, dens in dente retreatment, or dens associated with other developmental disorders are also excluded. Three authors evaluated the quality of the included studies. The quality of the included case reports and case series was evaluated using the Joanna Briggs Institute’s Critical Appraisal Checklist for Case Reports and Case Series. Results and Discussion: A total of 28 articles were suitable for inclusion, with 24 case reports and 4 case series. According to the available evidence, the condition is linked to an increased prevalence of pulp disease. Any necessary endodontic treatment may be difficult due to the aberrant anatomy. Early identification and preventive intervention rescued the teeth from further dental diseases. Conclusion: Nevertheless, thorough diagnoses and treatment planning are essential. Maintaining the vitality of the pulp or conserving the tooth using the least invasive way is the guiding principle when choosing a treatment modality. A surgical approach is only needed if the conservative approach fails. In the current systematic review, all cases showed reduction in the size of the periapical lesion or complete periapical healing.

Evaluation of artificial intelligence for detecting periapical lesions on panoramic radiographs

Background/Aim: The aim of this study is to evaluate the function of diagnostic computer software designed for the detection of periapical lesions on panoramic images with deep learning methods. Material and Methods: In our study, more than 500 adult retrospective panoramic radiography images obtained randomly were evaluated, and periapical lesions were labeled on the radiographs with the ResultLab.Ai labeling program (ResultLab.AI, Istanbul, Turkey). All images have been rechecked and verified by Oral, Dental and Maxillofacial Radiology experts. The model used is a U-Net based architecture customized for dental radiographs and optimized for fast operation. What is meant by customization is the structures called "Attention Gate" added to the architecture to draw the model's attention to the lesions. Results: Mask estimation was made separately for each image and F1 and IoU scores were calculated by comparing them with the marked masks. A list was created from the calculated F1 and IoU scores. The F1 and IoU score of the entire data set was calculated by taking the average of the values in this list. In IoU score calculation, Keras library's Mean IoU metric was used to calculate for 2 classes. In the F1 score calculation, the F1 score metric of the SKLearn library was used to calculate the unweighted average for 2 classes. As a result, the IoU-Score was obtained as 0.8578 and the F1-Score as 0.8587. Conclusions: Detection of periapical lesions on panoramic radiographs with an artificial intelligence approach will help practitioners reach definitive conclusions even in lesions that are likely to be overlooked. In addition, success rates for deep learning methods improve as data set size grows. As the number of images rises, the training models' success rates will follow.

Endodontic treatment of teeth with periapical lesions: Case series

Endodontic treatment of teeth with periapical lesions: Case series

Assessment of The Impact of Quality of Canal Obturation, Coronal and Apical Seal on The Healing Of CBCT-Diagnosed Periapical Lesions in Endodontically Treated Teeth in Sri Lanka

Background: Previous literature has investigated the association between the attribute of coronal restoration and root canal obturation with the radiographic periapical status of endodontically treated teeth. Objectives: This study intends to assess the status of periapical lesions/pathology and, the main factors influencing the healing of periapical lesions of root canal-treated teeth clinically and radiographically exploiting CBCT. The quality of coronal restoration, canal obturation, and apical seal were selected to be assessed, as they have a greater impact on healing peri apical pathology. Method: This analysis was conducted at the Department of Restorative Dentistry and the Division of Oral Medicine and Radiology, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka. All the patients who presented between January 2020 and January 2021, had root canal treatment done at least one year prior, were referred for CBCT assessment for some other conditions, and fulfilled the inclusion criteria, were selected. Root canal-treated teeth were recognized by radio-opaque filling material inside the canals in any anterior or posterior teeth. Results: A sum of 50 CBCT reports from 50 patients was encompassed in the dissertation. Median age was 26 (±4) years, with 37.5% of reports belonging to males. Statistical analysis was performed utilizing Statistical Package for Social Sciences (SPSS) version 20.0 software (IBM Corp). Out of fifty patients, 32 had been found to have adequate clinical coronal seal while 31 have been found to have adequate radiographical coronal seal. Further, 31 patients were found to have insufficient obturation and 28 were found to have adequate apical seal. A significant association was observed between periapical healing and adequate coronal restoration in root-filled teeth (p=0.048). However, the association between the healing of the periapical region, and adequate root canal obturation (p=0.09) and adequate apical seal (p=0.777) were found to be non-significant. Conclusion: The most influential factor for the healing of periapical lesions in endodontically treated teeth appears to be adequate coronal restoration, compared to root canal obturation and apical seal, in a cohort of patients in Sri Lanka

Impact of Specialized Pro-Resolving Lipid Mediators on Craniofacial and Alveolar Bone Regeneration: Scoping Review.

Craniofacial bone defects caused by tumors, trauma, long-term tooth loss, or periodontal disease are a major challenge in the field of tissue engineering. In periodontitis and peri-implantitis, reconstructive therapy is also a major challenge for the dental surgeon. Lipoxins, resolvins, protectins, and maresins, known as specialized pro-resolving lipid mediators (SPMs), have been widely studied in the field of dental, oral, and craniofacial research for bone regeneration for their actions in restoring tissue homeostasis and promoting tissue healing and regeneration. Therefore, this study focuses on a survey of the use of SPMs for craniofacial and alveolar bone regeneration. Thus, electronic searches of five databases were performed to identify pre-clinical studies that evaluated the actions of SMPs on craniofacial and alveolar bone regeneration. Of the 523 articles retrieved from the electronic databases, 19 were included in the analysis. Resolvin (Rv) E1 was the mostly assessed SPM (n=8), followed by maresins (Ma) R1 (n=3), lipoxins (Lx) A4 (n=3), RvD1 (n=3), RvD2 (n=1), LxB4 (n=1), and maresin (M)-CTR3 (n=1). Meta-analysis showed that SPMs increased the newly formed bone by 14.85% compared to the control group (p<0.00001), decreased the area of the remaining defect by 0.35 mm2 (p<0.00001), and decreased the linear distance between the defect to the bone crest by 0.53 mm (p<0.00001). RvE1 reduced inflammatory bone resorption in periodontal defects and calvarial osteolysis and enhanced bone regeneration when RvE1 was combined with a bovine bone graft. RvD2 induced active resolution of inflammation and tissue regeneration in periapical lesions, while RvD1 controlled the inflammatory microenvironment in calvarial defects in rats, promoting bone healing and angiogenesis. MaR1 induced the proliferation and migration of mesenchymal stem cells, osteogenesis, and angiogenesis in calvarial defects, and benzo (b)-LxA4 and LxA4 promoted bone regeneration calvarial and alveolar bone defects in rats, inducing regeneration under inflammatory conditions. In summary, SPMs have emerged as pivotal contributors to the resolution of inflammation and the facilitation of bone neoformation within craniofacial and alveolar bone defects. These results are based on pre-clinical studies, in vivo and in vitro, and provide an updated review regarding the impact of SPMs in tissue engineering.

Radiomic Parameters in Periapical Lesions: A CBCT Analysis Evaluating Volumetric Size, Cortical Expansion, Erosion, and Shape

Radiomic Parameters in Periapical Lesions: A CBCT Analysis Evaluating Volumetric Size, Cortical Expansion, Erosion, and Shape

Influence of the digital file format on radiographic diagnostic in dentistry: a scoping review.

Given today's higher demand for online transmission of radiographic images, clinicians and regulatory agencies should be given the evidence they need to guide them in choosing the best image file format to be adopted. To this end, the present scoping review aims to explore, map, and evaluate the literature, with the object of reporting the influence of image file formats on dental diagnostic tasks by assessing intraoral radiographic images. This scoping review complies with PRISMA-ScR. It was customized to assess the risk of bias of the included studies, and was registered on the Open Science Framework platform. The data extraction protocol was developed based on the PCC acronym. An electronic search was conducted in six databases (Pubmed, Web of Science, Scopus, Embase, Lilacs, Cochrane) in December 2023. Original articles were screened, having observational, diagnostic accuracy, and consisting of in vivo or ex vivo laboratory studies investigating the influence of file formats on different diagnostic tasks in dentistry. Eighteen studies, published between the years 1996 and 2022, were included. The following data were extracted from the selected articles: article title, authors' citation, publication date, country, diagnostic task, image file formats tested, compression level, and main conclusion. The most widely investigated diagnostic task was caries lesions (n = 10), led by root resorptions (n = 3), root fractures (n = 2), periapical lesions (n = 2), and periodontal disease (n = 1). The most commonly used radiographic techniques were periapical (n = 12) and bitewing (n = 6). The most frequently investigated image file formats were JPEG (all studies) and TIFF (n = 10 studies). BMP, PNG, and JPEG2000 were also included in 7, 3 and 3 studies, respectively. No studies included the DICOM file format. In regard to the subjective assessment of the several dental diagnostic tasks, the studies mostly showed that the influence of the file formats was not significant (n = 10/55.5%). As for the quality assessment of the included papers, more than 70% of the studies featured a low risk of bias. Current evidence on image file formats and dental radiographic diagnosis is reliable. Any image file format can be used without impairing diagnostic accuracy.

Non-endodontic periapical radiopaque jaw lesions: A mini review

Endodontic practice may be affected by periapical radiopaque/ hyperdense lesions. Oral medicine specialists and endodontists may have trouble diagnosing and treating radiopaque lesions. Inflammatory, non-inflammatory, neoplastic, dysplastic, metastatic or metabolic bone changes may occur. With the increased use of cone-beam CT, a detailed review of radiopaque lesions may help clinicians differentiate these lesions. Differentiating inflammatory, non-inflammatory and neoplastic disorders simplifies diagnosis and helps choose the best treatment. Aim: The aim of this review was to investigate the periapical radiopaque/hyperdense lesions. An extensive review of the literature was carried through. The literature search was conducted using MEDLINE (National Library of Medicine)-PubMed, Web of Science and Google scholar without restrictions concerning the date of publication. The inclusion criterion was that the article should be written in English, whereas the exclusion criterion was the opposite. This literature review covers radiopaque/hyperdense lesion differential diagnoses, clinical, radiographic, histological, and management issues. The effectiveness of root canal therapy is measured by the absence of pain, the absence or reduction of periapical lesions, and the restoration of tooth function. In endodontic practice, the diagnosis of periapical lesions is difficult because many of these lesions can mimic endodontic lesions, even when derived from different sources. For the diagnosis of periapical lesions in this scenario, a comprehensive clinical examination, in conjunction with clinical and radiographic aspects of the disease, is essential. The oral medicine specialist and endodontist must know how to diagnose radiopaque periapical lesions. Knowing how to differentiate between inflammatory, non-inflammatory, neoplastic and metabolic lesions expedites diagnosis and ensures the selection of the appropriate treatment.

Comparative Analysis of Photosensitizer Penetration Depth in Root Canal Debridement for Endodontic Disinfection.

Microbial agents play a crucial role in periapical lesions and despite mechanical preparation, presence of persistent bacteria in root canal system is a challenge. Photodynamic therapy offers a debridement method, utilizing photosensitizers such as Curcumin, Indocyanine Green (ICG), and Methylene Blue (MB). This study aimed to assess and compare the penetration depth of these photosensitizers on the lateral surface of the root canal. The crown of 30 single-rooted teeth were separated by a diamond disc. The canals were prepared using a rotary system and were rinsed with 10 mL of 2.5% NaOCl. In order to remove the smear layer debris, 17% EDTA was placed in the root canal for 1 min, then rinsed with NaOCl and saline. The teeth were sterilized by autoclave and randomly assigned to three groups that filled with curcumin, ICG, or MB. Subsequently, they were incubated for 10 min and dried up by paper. Longitudinal sections were cut, and penetration depth of the photosensitizers in coronal, middle, and apical sections were measured using a stereomicroscope. Curcumin demonstrated a higher average penetration depth (3000 µm) than MB, and MB showed higher penetration depth than ICG. Significantly different penetration depths were observed in pairwise comparisons among all three groups (P<0.005). Curcumin with its superior average penetration depth, emerges as a promising choice for effective root canal disinfection in endodontic treatments. Consideration of these findings may enhance the selection of photosensitizers in clinical applications.

Advancing dentin-pulp regeneration: clinical perspectives and insights from stem/progenitor cell transplantation (part II).

This systematic review evaluates clinical studies investigating regenerative endodontic procedures for mature/immature teeth utilizing stem cell transplantation. An electronic search of Scopus, PubMed, ISI Web Science, and Google Scholar was conducted up to January 2023. Outcome measures encompassed radiographic (periapical lesion, root length, apical foramen width, volume of the regenerated pulp) and clinical (post-operative pain, sensibility test) parameters. Among 3250 identified articles, five clinical studies were selected, comprising two randomized controlled trials (RCTs) for mature/immature teeth, and three case reports/series for mature teeth. Despite the promising potential, the included studies exhibited a notable risk of bias. The diversity in stem cells (e.g., dental pulp stem cells [DPSCs], umbilical cord mesenchymal stem cells [UC-MSCs]), scaffolds (Atecollagen, collagen membrane, platelet-poor plasma [PPP], leukocyte platelet-rich in fibrin [L-PRF]), and growth factors (granulocyte colony-stimulating factor [G-CSF]) emphasized the heterogeneity across interventions. In RCTs, DPSCs application increased root length and reduced apical foramen width in immature teeth, while UC-MSCs transplantation reduced apical lesions in mature teeth. Transplantation of DPSCs aggregates or UC-MSCs/PPP also elicited positive pulp responses and increased blood flow. In case reports/series, DPSCs application in teeth with irreversible pulpitis resulted in mineralization and increased the regenerated pulp' volume. Furthermore, transplantation of DPSCs with G-CSF/atelocollagen or L-PRF/collagen membrane led to positive pulp responses. While underscoring the potential of stem cell transplantation for regenerative endodontics in mature/immature teeth, the overall evidence quality and the limited number of available studies emphasize the need for cautious interpretation of results. Future well-designed clinical studies are essential to validate these findings further.

Healing of an Immature Permanent Tooth with Large Periapical Radiolucency, Treated with Autologous Platelet-rich Fibrin Aided Regeneration

Presenting two cases of platelet-rich fibrin (PRF) aided regenerative treatment, performed in immature permanent teeth with large periapical lesions. In contrast to conventional apexification procedures, regenerative procedures can promote root completion and achieve root reinforcement. These case reports evaluated the long-term biological outcome of PRF-aided regeneration in immature permanent teeth with periapical lesions. Three-year and 5-year recalls in these cases revealed functional teeth with complete healing of the large periapical defect. The secondary outcome of regenerative treatment varied in the two reported cases. It was concluded that enhanced repair was achieved by an autologous PRF-aided regenerative procedure, but the secondary outcomes manifest variation.

Three case reports of different clinical applications of mineral trioxide aggregate

Introduction. Calcium silicate dental cements have a wide range of applications in clinical dentistry. Many formulations were developed in the last decade and successfully employed for dental healing. In this paper, several clinical applications of mineral trioxide aggregate (MTA+, Cerkamed, Stalowa Wola, Poland) were presented. Outlines of cases. The first case report reflects the application of the MTA+ for the healing of the root perforation of the upper premolar. The second case report was the usage of MTA+ for indirect pulp capping in patient who came with pain of the tooth previously restored with composite filling. The third case report was a patient with periapical cystic lesion that was removed surgically and root canal filled retrogradely with MTA+. Conclusion. Altogether, current calcium silicate based dental cements bear a great potential for solving numerous issues in the dental practice regarding huge or problematic defects of dentine or alveolar bone.

Effect of Foraminal Enlargement on Periapical Healing in Necrotic Teeth: A Systematic Review.

Foraminal Enlargement (FE) is a cleaning performed in the apical-most region of the tooth, in order to optimize root disinfection. This systematic review evaluated the influence of FE during root canal treatment on bacterial reduction and repair of the periapical lesion. Searches in PubMed/MEDLINE, Scopus, Cochrane Library, Web of Science, Embase, Scielo, Lilacs and OpenGrey were performed until January-2024. Ex vivo and in vivo studies evaluating the effects of FE in the bacterial reduction and repair of the periapical lesion were included, respectively, followed by risk of bias assessment (modified version of Joanna Briggs Institute's for ex vivo studies and Systematic Review Centre for Laboratory animal Experimentation's risk of bias tools for in vivo studies). The meta-analysis was not feasible and a qualitative summary for each outcome was provided. Of 950 studies, 2 in vivo studies were eligible, using animal models with infected teeth. Of these two, periapical repair was evaluated with hematoxylin-eosin stain, and FE improved periapical healing. Regarding ex vivo studies, 3 were eligible, using extracted human teeth. The inoculations in ex vivo models were performed with Enterococcus (E.) faecalis, and FE reduced E. faecalis in the ex vivo models. Foraminal enlargement seems to increase bacterial reduction within the root canal, and provide major periapical tissue repair on the histological analysis in animal studies. However, caution is necessary when translating these results to the clinical environment.