Periapical Tissues Research Articles

Sensory innervation of rat molar root pulp and dentin, apex, foramen, cellular cementum, vasculature and periodontium.

Sensory innervation of rat molar root pulp and dentin, apex, foramen, cellular cementum, vasculature and periodontium.

EFEITOS DA LASERTERAPIA DE BAIXA INTENSIDADE NO CONTROLE DA DOR E NA REPARAÇÃO PERIAPICAL EM TRATAMENTOS ENDODÔNTICOS: UMA REVISÃO DE LITERATURA

Low-intensity laser therapy (LLLT), also known as photobiomodulation, has been extensively studied as adjuvant therapy in pain control and the promotion of periapical repair in endodontic treatments. This article aims to review the scientific literature on the effects of LLLT in these clinical contexts. Postoperative pain is a common complication after root canal treatment, usually associated with inflammatory processes in periapical tissues. Traditionally, management involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs). However, the search for non-pharmacological alternatives has grown. Reviewed studies show that LLLT can reduce pain intensity in the first 24 to 72 hours after treatment, and promote bone regeneration and tissue healing. Although the results are promising, the heterogeneity of the protocols and the methodological limitation of some studies indicate the need for additional research to standardize their clinical application. For this research, we used the electronic databases: U.S National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO), ScienceDirect, Cochrane Library and Lilacs. In addition, two descriptors were used for the composition of the search key, being the following (MeSH/DeCS). After research, it is concluded that LLLT is an effective complementary approach in the endodontic context, with potential to improve patient comfort and therapeutic outcomes. Although more standardized studies are needed to consolidate their therapeutic protocols.

Puerarin relives inflammation, bone destruction and facilitates osteogenic differentiation in periodontitis by enhancing mitochondrial autophagy via activating mitochondrial Mitofusin 2

PurposePuerarin (Pue) has recently been reported to have therapeutic effects on periodontitis (PD). However, there is insufficient evidence, and the mechanism involved has not yet been revealed. This work delved to explore the exact therapeutic effects and molecular mechanism of Pue in treating PD.MethodsPD mouse (C57BL/6 N mouse) model constructed by Porphyromonas gingivalis-lipopolysaccharide (Pg-LPS) induction was treated with Pue. Therapeutic efficacy of Pue for PD was examined by a series of experiments. PD cell model was induced by treating human periodontal ligament cells with Pg-LPS. Therapeutic effects of Pue on PD cell model, along with the potential molecular mechanism, were explored by logical experiments. Rescue experiments based on in vitro and in vivo studies were implemented to validate the molecular mechanism of Pue in treating PD.ResultsIn PD mice, Pue treatment relieved inflammation and bone destruction, facilitated osteogenic differentiation and autophagy in periapical tissues. In PD cell model, Pue treatment facilitated osteogenic differentiation and mitochondrial autophagy; suppressed inflammation and mitochondrial reactive oxygen species; maintained mitochondrial membrane potential and mitochondrial kinetic homeostasis; and activated mitochondrial Mitofusin 2 (Mfn2). However, these influences of Pue on PD cell model were eliminated by CsA (mitochondrial autophagy inhibitor). The enhanced mitochondrial autophagy induced by Pue was reversed by Mfn2 silencing. Through in vivo data, Mfn2 knockdown counteracted the therapeutic effects of Pue on PD mice.ConclusionPue exerted therapeutic effects on PD, possibly by enhancing mitochondrial autophagy via activating mitochondrial Mfn2. This might be a cure for PD.Graphical

The interaction between third molars and surrounding periapical tissues in mandibular stress distribution during high-impact trauma: a finite element study.

The presence of mandibular third molars has been associated with the risk of mandibular fractures, highlighting the need for comprehensive studies considering the interaction with other mandibular structures. This study investigates how mandibular third molars and neighboring tissues can influence the structural fragility of the mandible using finite element analysis. A finite element analysis study following the guidelines proposed by RIFEM 1.0 was performed using three previously created mandible models: Model A, without right and left third molars; Model B, without one third molar; Model C, with bilateral presence of third molars. A 2452N force was applied to the right mandibular body in a virtual environment, allowing for a structural analysis of each mandible. Models without third molars and with only one third molar showed similar energy dissipation patterns, contrasting with the model with both third molars. The presence of third molars influenced the magnitude and distribution of stress, highlighting fragility points in specific areas such as the lingual surface, the condyles bilaterally (models without and with one contralateral third molar to trauma), and the distal cervical region of the second molar (third molar absent), as well as significantly showed the path of energy towards the contralateral side of the trauma with a concentration of energy at the contact points of virtually all teeth present immediately after impact. The presence of mandibular third molars influenced the distribution and magnitude of stress within the mandible during a simulated high-impact trauma. Models with third molars exhibit distinct stress patterns, with fragility points appearing in critical areas such as the lingual surface, condyles, and second molar regions. These findings suggest that the presence of third molars increases the structural fragility of the mandible, potentially elevating the risk of mandibular fractures, especially in the context of traumatic impacts.

Extrusion degree of a new low-viscosity, injectable, light-cured endodontic filling material: an in-situ study in a cadaveric close-to-mouth experimental model.

To evaluate the ability of the liquid-injectable OdneFill sealer to stay within the boundaries of prepared root canals of posterior teeth using a cadaveric model. Eight maxillary bone blocks containing 3 to 5 posterior teeth were collected. Pre-operative radiographs were taken, and only maxillary premolars (n = 10) and molars (n = 16) were included. The canals were prepared with WaveOne Gold Primary and Large instruments, then randomly assigned to two groups (n = 33 canals). Group 1 used Warm Vertical Compaction with gutta-percha and AH Plus sealer, while Group 2 used only the OdneFill sealer to fill the canals. Post-operative radiographs were taken to assess sealer extrusion into the periapical tissues using a 4-point scale. Data analysis was conducted with a 5% significance level. Out of 26 teeth examined (5 teeth were excluded), 47.6% (8 molars and 2 premolars) showed filling extrusion, with 77.8% of teeth in Group 1 (12 root canals) and 25.0% in Group 2 (3 root canals). A significant difference was found in the frequency of sealer extrusion between the two groups (P = 0.001), but no significant difference was observed between premolars and molars in terms of sealer extrusion frequency (P = 0.144). The OdneFill filling protocol showed better control over extrusion compared to the Warm Vertical Compaction technique in posterior teeth of a cadaveric model. This study highlights the potential of a new liquid-injectable root canal sealer designed to remain confined within the boundaries ofthe root canal anatomy.

Symptomatic irreversible pulpitis and other orofacial pain: overcoming challenges in diagnosis and management

Due to the unique sensory innervation of the teeth and face, orofacial pain can be challenging to diagnose and manage. Odontogenic pain, or ‘toothache', is the most common orofacial pain condition and encompasses the vast majority of pain which is presented to dental practitioners. While diagnosis is often straightforward, the clinical picture is occasionally unclear or contradictory, and in these situations, the clinician should be able to consider reasons other than the teeth for the patient's presenting complaint. The primary aim of managing odontogenic pain is to treat the underlying cause, often arising from the dental pulp or periapical tissues; however, several factors can make pre-, intra- and post-operative management of odontogenic pain challenging. This paper will consider key similarities and differences in the clinical presentation of odontogenic pain and other non-odontogenic causes of orofacial pain in order to help practitioners arrive at the correct diagnosis. We discuss evidence-based recommendations for intra- and post-operative management of acute odontogenic pain, and consider the underlying neurophysiological features which make orofacial pain challenging to manage.

Selective removal of carious dentin in hidden caries: a case report using an occlusal matrix-guided restorative approach

This study aims to describe the treatment of a hidden carious lesion using the occlusal replica technique combined with selective removal of carious dentin (SRCD). A combination of radiographic and visual examinations was utilized for diagnosis. The restorative procedure was performed using the occlusal matrix technique, which facilitated precise molding of the tooth. The matrix was fabricated with low-viscosity flowable resin. After isolating the teeth, the matrix was positioned over the occlusal surface using polytetrafluoroethylene tape. A microbrush and an exploratory probe were employed to capture the anatomical features of the occlusal surface, creating an accurate occlusal stamp. After six months, the patient reported no pain, and the restoration was deemed satisfactory. Furthermore, periodontal and periapical tissues appeared healthy. The occlusal replication technique for hidden carious lesions proved to be an effective approach for reconstructing occlusal morphology, eliminating the need for clinical adjustments. This method is cost-effective, easy to perform, and, when combined with SRCD, has been shown to preserve pulp vitality and enhance the restoration process.

The interleukin gene landscape: understanding its influence on inflammatory mechanisms in apical periodontitis.

Apical periodontitis is a common inflammatory illness caused by microbial infections in the root canal system, which destroys the periapical tissue. This disease's course and severity are highly regulated by a complex interaction of host immunological responses and genetic variables, particularly interleukin (IL) gene polymorphisms. These genetic variants influence cytokine production, the inflammatory cascade, and the ability to resolve infections. Polymorphisms in important cytokines (e.g., IL-1β, IL-6, IL-10, TNF-α, and IL-17) have been linked to worsening or reducing inflammation, affecting the clinical presentation and chronicity of apical periodontitis. A thorough examination of the molecular and clinical consequences of interleukin polymorphisms in apical periodontitis is given in this article. It emphasizes their function in regulating bone resorption, tissue degradation, and immune cell signaling. Their value in enhancing diagnostic precision, forecasting disease susceptibility, and directing treatment approaches is demonstrated by the incorporation of genetic insights into clinical practice. Targeted therapies, like immunomodulatory drugs and cytokine inhibitors, have great potential to reduce inflammation and encourage periapical healing. Future studies should focus on population-based research to examine genetic variability across ethnic groups, functional investigations to clarify the mechanisms behind polymorphism-driven cytokine regulation, and longitudinal studies to evaluate illness trajectories. Furthermore, developments in precision medicine and bioinformatics could completely transform patient-specific strategies by providing customized treatments and diagnostics. This review highlights the necessity of a multidisciplinary strategy that integrates immunology, genetics, and clinical practice to maximize apical periodontitis therapy and enhance dental health outcomes worldwide.

Exploring the Links Between Rheumatoid Arthritis and Pulpal-Periapical Diseases: Insights from Meta-Analysis and Two-Sample Mendelian Randomization.

Exploring the Links Between Rheumatoid Arthritis and Pulpal-Periapical Diseases: Insights from Meta-Analysis and Two-Sample Mendelian Randomization.

Three-dimensional matrix stiffness-based stem cell soil: Tri-phase biomechanical structure promoted human dental pulp stem cells to achieve pulpodentin regeneration.

Three-dimensional matrix stiffness-based stem cell soil: Tri-phase biomechanical structure promoted human dental pulp stem cells to achieve pulpodentin regeneration.

A Two-Way Communication Between Apical Periodontitis and Various Systemic Disorders: A Narrative Review.

One prevalent inflammatory disorder that affects the mouth is apical periodontitis. It starts with an infection in the tooth's pulp chamber. The periapical bone may eventually deteriorate as a result of this infection spreading there. Systemic immune responses are triggered when inflammatory cytokines generated in periapical lesions and pathogens and their metabolites in the periapical tissues enter the bloodstream. Numerous systemic disorders may emerge as a result of this procedure. Although endodontic infections can be influenced by systemic disorders, there is ample evidence that these infections can also result in bodily changes that impair general health. Therefore, rather than being a limited oral problem, apical periodontitis may be associated with systemic illnesses. Furthermore, individuals with chronic inflammation-related diseases may experience hyperinflammatory states, which could influence the progression or outcome of apical periodontitis. The underlying mechanisms and the relationship between apical periodontitis and systemic diseases are still unknown. Even though this topic has been explored previously, new information has just come to light. This review's objective is to evaluate the body of knowledge regarding the evolving relationships between endodontic therapy, apical periodontitis, and systemic health. Gaining a better understanding of this relationship will help medical professionals identify risk factors and enhance the recovery of apical periodontitis and systemic illnesses.

Comparative analysis of the inflammatory response of human gingival fibroblasts to NeoSEALER Flo and CeraSeal bioceramic sealers: an in vitro study

BackgroundTherapeutic quality of endodontic sealers plays a critical role in promoting the success of root canal therapy by blocking entrance of microbes as well as facilitating tissue reparative process. The bioceramic sealers NeoSEALER Flo and CeraSeal have been on the rise owing to their biocompatibility and bioactivity. However, their relations with periapical tissues especially human gingival fibroblasts (HGFs) are still significant determinants of treatment outcomes. This in vitro case intends to analyze the inflammatory reaction of HGFs towards NeoSEALER Flo and CeraSeal bioceramic sealers and AH plus resin sealer as control.Materials and methodsHGFs were cultured and treated with eluates of tested sealers at different dilutions; 25%, 50%, 75% and 100%. The extracts were left in incubator for 1, 3, and 7 days. Cell death was determined by the MTT assay, and the secretion levels of pro-inflammatory cytokines such as IL-6, IL-8, and TNF-α, were measured using q RT-PCR. Furthermore, mRNA and protein levels of some inflammatory markers were also estimated by q RT-PCR.ResultsAnalysis of the data showed that NeoSEALER Flo was cytotoxic in a concentration-dependent manner to HGFs, though it appeared marginally more toxic than CeraSeal when tested at the same ratios and same time. The high levels of all the measured pro-inflammatory cytokines in HGFs treated with both sealers at a higher concentration with NeoSEALER Flo showing a more intense effect. Having said so, gene expression profiles endorsed these results by showing that both sealers increase the level of IL-6, IL-8, and TNF-α at the higher concentrations.ConclusionsThe study indicates that both NeoSEALER Flo and CeraSeal bioceramic sealers activate HGFs inflammatory response with a slight preference for CeraSeal biocompatibility. Therefore, it becomes important and relevant to assess the cytotoxic and inflammatory propensity of various endodontic materials in order to guide enrolment of these endodontic products in clinical practice and improve the quality of endodontic treatment. Subsequent in vivo works should be done to confirm these in vitro findings as well as to examine the chronic effects of sealer-tissue interaction.

Comparative Evaluation of the Antimicrobial Efficacy of Endodontic Sealers Against Staphylococcus aureus and Streptococcus mutans: An In Vitro Study.

Endodontic therapy aims to eliminate microbial infections from the root canal system and prevent reinfection, thus ensuring periapical tissue healing. Persistent bacterial contamination, particularly from Staphylococcus aureus and Streptococcus mutans, is a major cause of endodontic treatment failure. Owing to the complexity of the root canal anatomy, conventional mechanical and chemical disinfection methods may be insufficient to eliminate bacteria. Endodontic sealers with antimicrobial properties play a crucial role in enhancing disinfection and preventing bacterial re-colonization. This study aimed to evaluate and compare the antimicrobial efficacy of three commonly used endodontic sealers, AH Plus (Dentsply Maillefer, Ballaigues, Switzerland), Zinc Oxide Eugenol (ZOE; Pyrax Cavibond, Roorkee, India), and Tubli Seal (SybronEndo, Glendora, CA, USA), against Staphylococcus aureus and Streptococcus mutans using the agar diffusion method. This in vitro study was conducted at the Department of Conservative Dentistry and Endodontics between May 2024 and October 2024. The antimicrobial properties of three endodontic sealers - AH Plus, ZOE sealer, and Tubli Seal - were tested against Staphylococcus aureus ATCC 25923 and Streptococcus mutans ATCC 700610. The bacterial suspensions were standardized to 1.5 × 10⁸ colony-forming units (CFU)/ml. Agar wells (6 mm diameter, 5 mm depth) were filled with freshly mixed sealers and inhibition zones were measured using a digital caliper at 24 hours and seven days. Statistical analysis was performed to compare the antibacterial efficacy of sealers over time. At 24 hours, AH Plus exhibited the highest antimicrobial activity against both bacterial species (p < 0.05), followed by the Tubli Seal and ZOE. By seven days, the ZOE sealer demonstrated the most potent antibacterial effect, surpassing AH Plus and Tubli Seal (p < 0.05). Both AH Plus and Tubli Seal exhibited a decline in the antibacterial activity over time. All the sealers were more effective against Streptococcus mutans. Endodontic sealers exhibit time-dependent antibacterial properties. AH Plus is the most effective sealer in the early stages of treatment, providing strong initial bacterial suppression, whereas ZOE sealer demonstrated sustained antimicrobial activity over time. The Tubli Seal showed moderate efficacy. These findings emphasize the importance of sealer selection based on clinical scenarios.

Predictable outcomes with vital pulp therapy in deep caries management of mature teeth

Preserving pulp vitality is paramount in endodontics, necessitating a conservative and systematic approach. In the first case, a 48-year-old woman complained of pain on cold stimuli and food lodgement in the upper left posterior tooth region. Following thorough clinical and radiographic examination, the UL7 was diagnosed with reversible pulpitis and normal peri-apical tissues. Upon caries removal, pulp exposure occurred and was treated with direct pulp capping with Biodentine. A successful outcome was observed at 12-month follow-up. In the second case, a 26-year-old woman complained of food lodgement in a upper left posterior tooth region for 2 months. Subsequent clinical and radiographic examination confirmed deep caries in the UL4 with normal peri-apical tissues. Indirect pulp capping was performed, followed by 12-month follow-up. CPD/Clinical Relevance: This case report underscores the management of deep caries, emphasizing the importance of following correct protocols, including isolation, use of bioceramic materials and adhering to proper bonding protocols to ensure maximum success.

Comparative evaluation of postoperative pain and healing following root canal obturation with calcium silicate and bioactive glass-based sealers to epoxy resin-based sealers: A systematic review and meta-analysis.

To compare the postoperative pain and healing following obturation with calcium silicate and bioactive glass-based sealers to epoxy resin sealers. A systematic search (2018-2024) was conducted using PubMed, Cochrane, and Google Scholar, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (PRISMA). Risk of bias (RoB) was assessed using Cochrane RoB 2 tool and quality was evaluated using GRADE. Twenty-three studies were included for qualitative analysis and 11 for quantitative analysis, including meta-analysis for bioactive glass and epoxy resin-based sealers. Meta-analysis revealed no significant difference in pain occurrence between groups at 24 h, 48 h, and 7 days. Similarly, for bioactive glass sealer, no significant difference in pain occurrence was observed at 24 h, 48 h, and 7 days. Calcium-silicate-based sealers showed comparable and satisfactory results to epoxy resin sealers regarding postoperative pain incidence and intensity. In addition, they facilitated improved healing of periapical tissues. Notably, bioactive glass-based sealer also demonstrated exceptional properties, offering enhanced benefits.

ZEB1 expression in Th17 cells correlated with p-STAT3 in human apical periodontitis

BackgroundZEB1, a zinc-finger E homeobox-binding transcription factor most frequently associated with developmental programs linked to epithelial-mesenchymal transition, has been demonstrated to regulate immune cell function. The study aimed to investigate the expression pattern of ZEB1 in Th17 cells and its colocalization with p-STAT3 in human apical periodontitis lesions.MethodsThirty-nine human periapical tissues were collected for ex vivo study, including periapical granulomas (PGs, n = 14), radicular cysts (RCs, n = 12), and healthy control tissues (control group, n = 13). Inflammatory infiltration of the lesions was assessed using hematoxylin-eosin staining. The expression of ZEB1 was detected and analyzed by immunohistochemistry. The localization of ZEB1 in Th17 cells and its colocalization with p-STAT3 were assessed using fluorescence colocalization.ResultsZEB1 expression was significantly higher in PGs and RCs than in the healthy control group; however no significant difference between the two groups was observed. Immunofluorescence analysis revealed that ZEB1 expression was correlated with IL17 and CD4 double-positive cells in human periapical lesions. ZEB1/ p-STAT3 double-positive cells were predominant in RCs and PGs than in the healthy control group.ConclusionsThe expression of ZEB1 was significantly elevated in PGs and RCs, and correlated with Th17 cells and p-STAT3 expression. This study revealed that ZEB1 is a potential player correlated with STAT3 activation and Th17 cells in apical periodontitis pathogenesis.

Postoperative pain and quality of life assessment after endodontic preparation with rotary and reciprocating endodontic instruments: randomized clinical trial

BackgroundPostoperative pain is a common complication following endodontic treatment, often caused by acute inflammatory responses in the periapical tissues. Several factors contribute to this, including inadequate instrumentation, apical extrusion of debris during canal preparation, and other aspects of the procedure. Advances in technology have led to the development of nickel-titanium (NiTi) instruments that have shown potential to reduce postoperative discomfort. The purpose of this study was to evaluate postoperative pain in patients undergoing endodontic treatment with different NiTi systems.MethodsThis randomized clinical trial will include 128 patients between the ages of 18 and 50 years with a diagnosis of pulp changes in molars without pain or radiographic lesions requiring endodontic treatment. Patients will be randomized to receive root canal preparation with the rotary ProTaper Ultimate rotary system or the Reciproc Blue reciprocating single-file system. The primary outcome will be the intensity of postoperative pain measured by a numerical rating scale (NRS-10 cm) in 24 h postoperatively. Secondary outcomes will include the intensity of postoperative pain measured by a visual analog scale (VAS-0–10 cm) at 6 and 12 h and spontaneous pain, occlusion sensitivity, and quality of life, assessed by the OHIP-14 questionnaire.DiscussionOur null hypothesis is that there will be no significant difference in postoperative pain between the two systems. The results of this study will provide information on the incidence and intensity of postoperative pain after instrumentation of root canal instrumentation with different NiTi systems and may help improve patient outcomes and quality of life.Trial registrationBrazilian Clinical Trials Registry (REBEC): RBR-10kbw6nx. Registered on April 6, 2024.

Injectable Hydrogel as Intracanal Medication for Root Canal Disinfection

Due to the complex anatomical structures of the root canal, thorough intracanal disinfection has always been challenging in endodontic treatment. Existing intracanal medicaments exhibit limitations such as low permeability and suboptimal antibacterial performance. Thus, an intracanal medicament that combines excellent operating performance with potent antibacterial properties is required. Therefore, we designed an injectable hydrogel loaded with modified triple antibiotic drugs (mTAD) through a Schiff base reaction of carboxymethyl chitosan (CMCS) and polyethylene glycol aldehyde (OHC-PEG-CHO), mTAD/CMCS/OHC-PEG-CHO (mTCP). We subsequently evaluated the characteristics of mTCP. Moreover, the antibacterial capacity of the hydrogels was assessed in vitro. The effects of mTCP on the cell biocompatibility and odonto-/osteogenic differentiation of stem cells from the apical papilla (SCAPs) were also examined. Furthermore, we established a periapical inflammation model in the young permanent teeth of a Beagle dog and explored the effects of mTCP on root canal disinfection and root development. Our findings revealed that mTCP exhibited excellent operability, fluidity, and ease of removal from the root canal. mTCP presented outstanding antibacterial efficacy both in vitro and in vivo, attributed to its exceptional permeability and sustained release of mTAD. The odonto-/osteogenic differentiation of SCAPs was augmented by adding mTCP. Moreover, mTCP facilitated root elongation, dentinal wall thickening, and apical closure in the Beagle dog model. mTCP exhibited a pronounced effect on promoting periapical tissue healing and root development. In conclusion, mTCP hydrogel has promising potential for root canal disinfection in endodontic therapy.

Incidence and Clinicopathological Correlation of Periapical Granulomas Associated with Extracted Teeth in Jeddah, Saudi Arabia

Objectives: study the incidence and clinicopathological correlation, focusing on the histologic diagnosis of periapical granulomas associated with extracted teeth. Methods: Over the course of one year, a prospective study was conducted involving the routine biopsy of retrievable periapical tissues from patients undergoing tooth extraction. Additionally, routine histopathologic examinations were performed on recoverable Periapical tissues from the extracted teeth. The study involved the participation of 120 patients, of whom 52 (43.33%) were diagnosed with histopathological peri-radicular lesions. Findings: The male-to-female incidence ratio was 2:1, and most of the patients with lesions identified by histopathology were in their first, second, or third decades of life, comprising 41 (34%) cases. Among the 52 (43.33%) cases with histopathologically diagnosed periradicular lesions, the most common types were periapical abscess 8 (15.38%) and inflammatory (periapical) granuloma 27 (92%). Remarkably, clinically confirmed acute apical periodontitis was shown to be associated with periapical granuloma, which is primarily characterized by foamy cells and macrophages. Several clinical and radiologic features exhibited significant associations with the histopathologic diagnosis of specific periradicular lesions (P&lt;0.05). Furthermore, a significant correlation was observed between clinical diagnosis and histopathologic diagnosis, specifically for inflammatory (periapical) granuloma and periapical abscess. Novelty: The study strengthens the link between clinical presentation and histopathological characteristics of periapical granulomas. The study uncovers several clinical signs that could help predict the histopathological diagnosis of periapical granulomas. This is an important finding, as it could improve the accuracy of diagnosis and help dental professionals identify these lesions earlier, which may lead to more effective and timely interventions. Keywords: Periapical lesion, Extracted tooth, Periapical granuloma, Histopathology, Clinical diagnosis, Biopsy

Do fiber tips with different geometric designs affect organic tissue loss in laser-activated irrigation of teeth with immature apex? An in vitro study

The aim of this study is to quantitatively evaluate the effect of irrigation activation performed with standard needle irrigation (SNI) and laser activated irrigation (LAI) tips of different geometric designs on organic tissue loss in the periapical area of teeth with immature apex. Fifteen single-rooted and canal teeth and seventy-five bovine mucosae were used in this study. An experimental model was constructed, and bovine mucosae were placed in the periapical area. Samples were randomly divided into five groups according to the irrigation activation method (n = 15): SNI, PIPS-flat (F), PIPS-radial (R), SWEEPS-flat (F) and SWEEPS-radial (R). Root canals were irrigated with totally 15 mL of 2% NaOCl for three irrigation cycles. Bovine mucosae were weighed before and after the irrigation activation protocols. The difference between the initial and final weights measured organic tissue loss. One-way analysis of variance was performed, followed by post-hoc Tukey significant difference test (p < 0.05). The amount of organic tissue loss in PIPS-R was found to be significantly higher compared to PIPS-F (p < 0.05). However, there was no significant difference in the amount of periapical organic tissue loss among all other tested irrigation activation methods (p > 0.05). All irrigation activation methods caused organic tissue loss. PIPS-R caused more organic tissue loss than PIPS-F, while no difference was found between SWEEPS-F and SWEEPS-R used at the same power setting.