Endodontic Treatment Research Articles

Generative Adversarial Networks (GANs) 2D imaging optimization in image–J for estimation of endodontic filling material measurement: A review

Background: Root canal treatment (RCT) remains the most common clinical intervention in dentistry, treating a wide range of pulp-related conditions and structural tooth injuries. RCT begins by partially removing the crown to access and remove the infected pulp through a meticulous process of cleaning, reshaping, and irrigating the canal. This prepared canal is filled with gutta-percha as the endodontic filling material (EFM), and adhesive cement is used to seal the canal before final restoration with a crown. The success of RCT, however, hinges on accurately measuring and applying the EFM volume within the canal. Current measurement practices using 2D radiographic imaging fall short in accuracy due to operator limitations and the inherent lack of depth and clarity in 2D images, which contribute to high variability in EFM application. CBCT has emerged as a viable alternative, offering comprehensive 3D imaging for a more accurate EFM volume assessment, yet its high radiation levels, cost, and accessibility issues pose challenges. Thus, with increasing demand for safer and cost-effective alternatives, AI-driven enhancements in 2D imaging are being explored to achieve CBCT-level accuracy without its drawbacks, marking a significant step forward in RCT reliability and success rates. Purpose: To explore the potential of GANs and Image–J integration on 2D images for estimation of EFM measurement. Method: A literature review of studies published within the past five years from sources like ResearchGate, ScienceDirect, PubMed, and Google Scholar. Result: This study explores the integration of artificial intelligence, specifically convolutional neural networks (CNN) and generative adversarial networks (GANs), to enhance the accuracy of endodontic filling material (EFM) measurements in root canal treatments (RCT). CNN's structure, comprising multilayered networks with pooling layers, has shown potential in medical imaging by segmenting anatomical details for EFM measurement. However, challenges remain due to CNN's reliance on extensive datasets and its susceptibility to misinterpretation when faced with complex anatomical variations. GANs, combining a generator and discriminator, address these limitations by enabling unsupervised learning, allowing the generation of photorealistic data samples for more precise EFM measurement. This bidirectional learning system refines measurement accuracy through continuous feedback between the generator and discriminator, achieving superior outcomes across parameters like radiopacity, dimensional consistency, classification performance, and sealing ability. Furthermore, the AI model is enhanced by integrating Image-J, a Java-based image analysis software with precise 2D measurement capabilities. Despite its effectiveness in analyzing length and volume, Image-J has limitations due to its dependence on the operator’s interpretation, especially with low-quality 2D images. The combined use of GANs with Image-J allows for automated, detailed border detection of the pulp anatomy, improving measurement accuracy even with complex root canal forms. The results suggest that this integrated AI approach can advance clinical practices by providing precise, rapid, and consistent EFM measurements, potentially overcoming the limitations of traditional 2D radiographic methods and addressing CBCT’s drawbacks in radiation exposure and accessibility. Conclusion: The integration of generative adversarial networks (GANs) with Image-J offers a promising advancement in the measurement of endodontic filling materials (EFM) for root canal treatments based on 2D imaging. GANs enhance Image-J’s measurement precision and accuracy by utilizing bidirectional deep learning, which enables continuous learning and refinement without requiring extensive external inputs. This approach not only improves EFM estimation but also presents a viable alternative to cone-beam computed tomography (CBCT), reducing potential health risks and economic burdens associated with CBCT. The combined GANs and Image-J system thus supports a more accessible, efficient, and precise methodology for EFM assessment in clinical dentistry.

Patient-related perceptions and experience measures of non-surgical endodontic treatment – A cross-sectional study

Objectives: This study assessed the outpatients’ perceptions of non-surgical root canal treatment (RCT) and compared them with their post-treatment experiences. Material and Methods: Eighty participants were selected for this cross-sectional study based on inclusion and exclusion criteria. Two surveys were conducted from October 01, 2023, to November 30, 2023 (Pretreatment survey) – one conducted before the RCT includes a survey about the patient’s past RCT experiences and demographics such as age, sex, and level of educational status. Multiple-choice questions were employed to determine patient concerns related to RCT, while modified visual analog scales (0–100) were used to assess pain and anxiety (Post-treatment survey) – done after the endodontic procedure with a root canal filling material. It outlines the patient’s experience, any discomfort experienced during treatment, the significance of tooth retention, and Re-RCT. Results: No difference was found in the demographic analysis. Out of the 80 participants, 33 participants (41.25%) presented with pretreatment anxiety, and 12 participants (15%) reported post-treatment. In the pretreatment survey, the primary concerns were pain and cost, which were reported at 27.55% and 10%, respectively. The post-treatment survey detailed that the time and the need for Re-RCT were the concerns, with reported rates of 11.25% and 10%, respectively. An absolute difference was found between anticipated and pre-operative pain and between experienced and pre-operative pain. However, no difference was found between anticipated and experienced pain 89% of the patients were willing to go for RCT again if needed. Conclusion: Treatment success is the goal for any dental procedure performed, which might be perceived differently by the patient and dentist. Consideration of patient perceptions and experiences, along with the dentist’s opinions, will help enhance endodontic treatment success.

Naproxen Sodium: The Superior Choice Over Dexketoprofen for Dental Pain and Inflammation Management

The management of postoperative pain and inflammation following dental procedures, such as dental implants and root canal therapies, is essential to ensure patient comfort and optimal recovery. Nonsteroidal anti-inflammatory drugs (NSAIDs) like Naproxen Sodium and Dexketoprofen are widely utilized due to their effectiveness in controlling pain and inflammation by inhibiting cyclooxygenase (COX) enzymes. This review compares the pharmacological characteristics, onset of action, duration of analgesic effects, and safety profiles of Naproxen Sodium and Dexketoprofen in managing pain associated with dental treatments. Naproxen Sodium’s rapid onset of action (within 15 minutes) and prolonged duration (up to 13 hours) make it a superior choice for postoperative pain control, minimizing the need for frequent dosing. Dexketoprofen, while providing pain relief within 30 minutes, has a shorter duration of effect, requiring more frequent administration. Naproxen Sodium also demonstrates superior anti-inflammatory properties and safety profile make it the preferred first-line option over Dexketoprofen for managing pain and inflammation following dental procedures as evidenced by FDA recommendations. The review concludes that Naproxen Sodium offers a more balanced efficacy, safety, and sustained analgesia, making it a preferred NSAID for managing postoperative dental pain and inflammation over Dexketoprofen. Keywords: Naproxen Sodium, Dexketoprofen, Dental Pain, cyclooxygenase (COX) enzymes

Endodontic management of distinctive anatomic aberration with maxillary 1 molar -a case report of three mesiobuccal canal on one side and taurodontism on contralateral arch

The present case describes root canal treatment in a maxillary first molar with unusual anatomy of MB3 canal in one arch and Taurodontism on the contralateral arch. Understanding the differences in root canal morphology is crucial to the success of endodontic treatment. Taurodontism in the contralateral maxillary molar is an uncommon condition. A male patient was referred for the treatment of maxillary right and left first molar tooth. Clinical examination of the pulpal floor revealed 3 orifices in the mesio-buccal root in #16 while Taurodontism in #26. The tooth was treated successfully. Anatomic variations must be taken into consideration in clinical and radiographic evaluation during endodontic treatment.

A Comparative Evaluation of the Antimicrobial Properties of 50% Grape Seed Extract, N-acetyl Cysteine and 5.25% Sodium Hypochlorite against Enterococcus faecalis (ATCC 19433) – An In vitro Study

Abstract Introduction: Endodontic infections are complex and polymicrobial, presenting significant challenges in dental treatment. Eliminating bacteria is the main objective of endodontic preparation, ensuring a tight seal to prevent reinfection. A commonly isolated bacterium, Enterococcus faecalis, is Gram positive and facultative anaerobic. It thrives in low-nutrient environments, forming resilient biofilms. Due to its tissue dissolving properties and broad-spectrum antimicrobial, sodium hypochlorite (NaOCl) is the most sought after irrigant, but its cytotoxicity is a concern. Alternatives such as grape seed extract (GSE) and N-acetyl cysteine (NAC) are being explored for their potential antimicrobial effects and biocompatibility. Materials and Methods: Forty single-rooted, non-carious premolars extracted for orthodontic reasons were selected. Teeth were cleaned, sectioned and prepared, ensuring apical patency. Specimens were autoclaved and contaminated with E. faecalis (ATCC 19433) for 30 days. Four groups (n = 10) were formed: Group I – GSE 50%, Group II – NAC 200 mg/ml, Group III – NaOCl 5.25% and Group IV – sodium chloride (0.9%). Manufacturer’s instructions were followed precisely to prep the solutions, and root canals were treated using the Reciproc R25 instrument. Samples were collected before (F1) and after (F2) instrumentation and irrigation. Colony-forming units (CFUs) were quantified and analysis was done using two-way analysis of variance and Tukey’s honestly significant difference post hoc tests, with significance set at P < 0.05. Results: NaOCl significantly reduced CFU counts, demonstrating superior antimicrobial efficacy compared to NAC and GSE (P < 0.01). In comparison to negative control and GSE (P < 0.01), NAC showed significant antimicrobial activity, but not significantly different from GSE (P > 0.05). GSE displayed potential antimicrobial properties but was less effective than NaOCl and NAC. Conclusion: NaOCl remains the most effective irrigant; however, NAC and GSE also demonstrated significant antimicrobial properties and could serve as adjuncts in endodontic therapy. Further research is needed to optimise their formulations and validate clinical applications.

Endodontic treatment modifies circulatory inflammatory mediator levels: A systematic review with meta-analysis.

There is limited and conflicting data on the reduction of circulatory inflammatory mediators in patients with apical periodontitis (AP) following endodontic treatment. To answer the following research question: in adult healthy patients with AP [Population (P)], is there a difference before [Comparator (C)] and after various endodontic treatments (nonsurgical, surgical or retreatment) [Intervention (I)] on systemic levels of inflammatory biomarkers [Outcome (O)] in the follow-up period[Time (T)]? An electronic literature search was conducted in the databases Scopus, PubMed, Clarivate Analytics' Web of Science, Cochrane Database of Systematic Reviews and Grey literature from inception to July 2024 with no language restrictions. Observational studies examining changes in serum levels of inflammatory mediators were included. Two independent reviewers selected studies, extracted data and critically appraised the included studies. Qualitative and quantitative (meta-analysis) data synthesis methods were employed. The Newcastle-Ottawa Scale was used to assess the quality of the included studies. Sixteen studies met the inclusion criteria, of which six were included in the meta-analysis. These studies were published between 1992 and 2024, involving a total of 596 patients (54% females) aged between 16 and 75 years. The meta-analysis of pooled data showed a significant decrease in high-sensitive C-reactive protein (hs-CRP) levels in the serum of patients with AP 6 months after treatment [2.26 ± 1.76 versus 1.28 ± 1.06 mg/L, (Z = 2.03, p = .04)] and a decrease in interleukin-1β (IL-1β) levels 12 months after treatment [13.01 ± 5.95 versus 10.86 ± 3.52 pg/mL, (Z = 3.72, p < .01)]. One study was assessed as poor quality, while all others were considered high quality. Despite the differences in methodologies across the included studies, it has been established that effective endodontic treatment leads to a reduction in systemic inflammatory biomarkers in the body. Following effective endodontic treatment in patients with AP, the systemic levels of hs-CRP and IL-1β exhibit a significant reduction at 6 and 12 months, respectively. Further clinical studies should investigate whether effective endodontic treatment and reduced levels of investigated biomarkers may change the clinical presentation of systemic diseases. PROSPERO database (CRD42024559271).

Retrospective analysis and clinical features of periapical tissue regeneration

Background: Chronic periodontitis is associated with changes in periapical tissues. Untimely diagnosis and lack of appropriate mechanical treatment increase the incidence of chronic periodontitis. Periodontitis that causes destructive changes due to long-term inflammation of periapical tissues is of particular concern. Thus, the treatment of destructive periodontal diseases is a pressing issue in modern dentistry. Aim: To assess periapical tissue regeneration following treatment in chronic periodontitis patients. Materials and Methods: A retrospective analysis of the destruction and regeneration of periapical tissues before and after treatment during 3–6 months was performed in 20 patients. Results: A retrospective analysis of X-ray findings in 20 patients revealed bone destruction of varying degrees. Low-quality root canal preparation was due to various factors, primarily the anatomy and topography of root canals. Of the 20 patients who required treatment for chronic periodontitis with varying degrees of destruction, 16 came back for follow-up appointments and received endodontic treatment. Following treatment, X-ray findings were used to identify taper root canal preparation and assess the quality of obturation up to the root apex. X-ray examination was performed after 3 months in patients with clinical signs of periodontitis and after 6 months in patients without clinical signs of periodontitis. After 3 months, X-ray findings showed a reduction in bone destruction in the causative tooth area, indicating an improvement. Conclusion: The study of periapical tissue regeneration following treatment in chronic periodontitis patients revealed that effective apical preparation, as well as appropriate irrigation and root canal filling, promote regeneration in periodontitis. Healing of periapical tissues is essential for effective root canal treatment.

The Flexural Strength and the Effect of the Autoclave Sterilization of Polypropylene/Natural Rubber Blended Materials

Background: Rubber dam clamps are used extensively in dentistry, especially during root canal treatment. However, existing rubber dam clamps have several drawbacks, including discomfort and potential damage to vital tissue in the oral cavity. To address these existing issues, a new rubber dam clamp should be developed. The aim of this study was to identify the optimum ratios of polypropylene and natural rubber (PP/NR) for a customized rubber dam clamp in dentistry. This study was focused on the flexural strength of PP/NR in various ratios. Moreover, the impact of autoclave sterilization was also considered. Methods: Six proportions of PP/NR blends (100/0, 90/10, 80/20, 70/30, 60/40 and 50/50) were prepared and assessed for flexural strength using a three-point bending test. After this test, the PP/NR blends with 100/0, 90/10 and 80/20 ratios were selected and underwent autoclave sterilization for 1, 5 and 10 cycles. Eventually, the flexural strength testing was repeated and investigated. An analysis of variance and Tukey’s test were used to evaluate the flexural strength of various PP/NR blends before autoclave sterilization at p &lt; 0.05. An analysis of variance and Dunnett’s T3 test were used to evaluate the flexural strength of selected PP/NR blends before and after autoclave sterilization at p &lt; 0.05. Results: The results revealed that the flexural strength of PP/NR blended materials showed a statistically significant difference in every group of this study. The autoclave sterilization test revealed that the flexural strength of the PP/NR 90/10 and 80/20 ratios was significantly increased after sterilization for 1, 5 and 10 cycles. In addition, the PP/NR 90/10 ratio was also comparable to the 100/0 ratio. The lower NR content in PP/NR blends resulted in significantly higher flexural strength, and autoclave sterilization had an effect on this property. Conclusions: This study suggested that the PP/NR blend with a 90/10 ratio might be considered as an alternative material for developing rubber dam clamps.

Literature review and case study: unveiling the complexities of mandibular second molar with three distal canals.

The occurrence of morphological deviations in root canal anatomy is challenging and can influence treatment outcomes. While mandibular second molars typically have 2 roots and 3 canals, a unique case emerged in a 23-year-old Indian male with a symptomatic permanent left mandibular second molar showing three distal, two mesial canals, and two roots. The tooth presented as non-mobile but tender on percussion. The patient was diagnosed with symptomatic irreversible pulpitis with symptomatic apical periodontitis. The presence of mid distal canal was radiographically and visually confirmed with the aid of limited FOV cone-beam computed tomography and the dental operating microscope. Successful nonsurgical root canal treatment with 6-month follow-up has been documented in this case report.

The Endodontic Treatment of Three-Rooted Maxillary Premolar Resembling a Small Molar: A Case Report

The Endodontic Treatment of Three-Rooted Maxillary Premolar Resembling a Small Molar: A Case Report

Antibacterial Effects of Silica Nanoparticles Loading Nano-silver and Chlorhexidine in Root Canals Infected by Enterococcus faecalis.

The persistence of microbial infection can lead to endodontic failure. Enterococcus faecalis (E. faecalis) is acknowledged to be a closely associated bacterium. This study investigated the antimicrobial effects of mesoporous silica nanoparticles (nMS) carrying nano-silver and chlorhexidine (nMS-nAg-Chx) on E. faecalis. Analyses were conducted to assess the antimicrobial efficacy of nMS-nAg-Chx towards planktonic E. faecalis, including the zone of inhibition, minimal inhibitory concentration (MIC), and growth curves. The measurement of lactic acid, scanning electron microscopy (SEM), live-dead bacteria staining, and quantitative real-time PCR (qRT-PCR) were done to further investigate its anti-biofilm effect. Colony forming unit (CFU) and SEM were used to assess its efficacy in infected root canals. The growth of planktonic E. faecalis was suppressed with a MIC value of 25 μg/mL (P＜0.05). nMS-nAg-Chx concentration-dependently inhibited biofilm formation of E. faecalis with the reduction of lactic acid (P < 0.05), sparse biofilm structure, reduced percentage of viable bacteria (P < 0.05), and suppressed expression of ebpR, gelE, ace, and efa genes (P < 0.05). The seven-day sealing of nMS-nAg-Chx resulted in a notable reduction in bacterial counts compared to the saline control group in the E. faecalis infected root canals (P < 0.05). NMS-nAg-Chx effectively inhibits E. faecalis and removes its biofilm from infected human root canals. It may be used for endodontic treatments in the control of E. faecalis bacteria as an intracanal medication.

Comparative Efficacy of Intracanal Medicaments in Healing Apical Periodontitis: Insights from a Comprehensive Clinical Study

ABSTRACT Background: Apical periodontitis is a prevalent condition that necessitates effective intracanal medicaments for successful endodontic therapy. Materials and Methods: A randomized controlled clinical trial was conducted on 120 patients diagnosed with apical periodontitis. The patients were randomly assigned to three groups, Group A (calcium hydroxide), Group B (triple antibiotic paste), and Group C (chlorhexidine gel), with 40 patients in each group. Each medicament was placed in the root canal after standard endodontic procedures, and the patients were evaluated at 1, 3, and 6 months using radiographic assessment and clinical examination. The primary outcome measure was the reduction in lesion size, and secondary outcomes included pain relief and healing time. Results: After 6 months, Group B (triple antibiotic paste) showed the highest reduction in lesion size, with an average decrease of 75%, followed by Group C (chlorhexidine gel), with a 60% reduction, and Group A (calcium hydroxide), with a 50% reduction. Pain relief was observed in 85% of patients in Group B, 75% in Group C, and 65% in Group A. The average healing time was the shortest in Group B (4 months), compared to Group C (5 months) and Group A (6 months). Conclusion: Triple antibiotic paste demonstrated superior efficacy in healing apical periodontitis compared to calcium hydroxide and chlorhexidine gel.

Mechanistic Insight into the Anti-Bacterial/Anti-Biofilm Effects of Low Chlorhexidine Concentrations on Enterococcus faecalis—In Vitro Study

Background: Endodontic treatment failures are often linked to the persistence of Enterococcus faecalis in the root canal system. This study aimed to investigate the antibacterial/antibiofilm mechanism of chlorhexidine (CHX), particularly at low concentrations, against E. faecalis, to improve endodontic treatment protocols. Methods: The antibacterial activity of CHX (0.125–20 μg/mL) was evaluated against E. faecalis ATCC 29212 using various assays, including planktonic growth inhibition, colony-forming units (CFUs), membrane permeability and potential assays, high-resolution scanning electron microscopy (HR-SEM), confocal laser scanning microscopy of biofilms, biomass and metabolic activity assays on matured biofilm, and quantitative real-time PCR for gene expression. Statistical analysis was performed using Student’s t-test and ANOVA. Results: CHX demonstrated concentration-dependent inhibition of E. faecalis, significantly reducing planktonic growth and CFUs. Membrane assays showed increased permeability and depolarization, indicating damage. HR-SEM revealed morphological changes, such as pore formation, while confocal microscopy showed a reduction in biofilm mass and extracellular substances. Gene expression analysis indicated the downregulation of virulence genes and upregulation of stress response genes. Conclusions: CHX at low concentrations disrupts E. faecalis at multiple levels, from membrane disruption to gene expression modulation, affecting mature biofilm. These findings support the refinement of endodontic disinfection protocols to reduce microbial persistence.

Internal septa of the maxillary sinus and their significance in the planning of endodontic interventions, sinus lifting and dental implantation using a collagen matrix scaffold

INTRODUCTION. The study of the structure of the septa in the area of the maxillary sinus floor is important when planning implantation and sinus lifting operations. The height, number and location of the septa can affect the course of the sinus lifting operation. The aim is to study the structure of the maxillary sinus septa, their height, size, localization in order to prevent complications during surgical interventions.MATERIAL AND METHODS. The article analyzes CBCT data from 444 patients for the presence of septa in the area of the lower wall of the maxillary sinus. The subjects were divided into two groups: with the presence of premolars and molars (288 CBCT) and with the absence of at least one chewing tooth (156 CBCT). A study of 48 passportized skulls was conducted, the anterior wall of the maxillary sinus was sawed out, the structure of the sinus floor and septa was studied in detail. The ratio of the volume of compact and spongy bone substance in the premolar and molar areas was also measured.RESULTS. The obtained research data allowed us to obtain new information about the number of septa in the case of a complete dentition and partial tooth loss. Due to changes in the processes of sinus pneumatization, the number of septa increases with partial tooth loss. Their presence increases the risk of perforation of the Schneiderian membrane during sinus lift surgery, including the use of scaffolds based on a collagen matrix. However, when installing an implant in the base of the septum, its stability can be ensured, since the septa are some kind of buttresses of the maxillary bone. The ratio of the volume of spongy and compact bone substance in the premolar and molar area changes with age.CONCLUSION. The study found that the presence of coronal septa can cause complications of sinus lift surgery in the form of perforation of the Schneiderian membrane. At the same time, septa, being buttresses of the maxillary bone, can serve as a basis for installing an implant. With partial loss of teeth, the number of coronal septa increases. With age, the ratio of spongy and compact bone substance changes, towards a decrease in the volume of trabecular and an increase in the volume of compact bone.

Quality of Life in Patients with Endodontically Treated Teeth: A Retrospective Study at an Educational Hospital

Background/Objectives: Root canal treatment (RCT) is a crucial procedure for preserving dental health. While its clinical success rates are well documented, patient-reported outcomes regarding quality of life remain less explored. This study aimed to assess the long-term impact of RCT performed in an educational hospital on patients’ oral-health-related quality of life (OHRQoL) using the Oral Health Impact Profile-14 (OHIP-14). Methods: A total of 1500 patients who underwent non-surgical RCT between April 2018 and February 2023 were called and invited for a follow-up visit. During the visit, all teeth that had undergone RCT were assessed clinically and radiographically by two calibrated examiners to evaluate RCT quality and pre- and post-treatment periapical index (PAI) scores. Demographic information and OHIP-14 responses were collected, and the data were recorded. Results: Patients reported high levels of satisfaction (95%) and no negative impact on their OHRQoL. Statistical analysis revealed that post-operative periapical index (PAI) scores (p &lt; 0.001), patient gender (p = 0.003) and nationality (p = 0.029) significantly influenced OHRQoL perceptions; Conclusion: These findings emphasize the effectiveness of RCT in enhancing patients’ quality of life and highlight the impact of demographic factors—such as gender and whether the patient is a resident or a national of the country, along with post-treatment severity of the disease—on patient-reported outcomes.

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.

Endodontic and Surgical Management of Trauma-Induced Combined Internal and External Root Resorption with Periapical Cyst: A Case Report

Root resorption, involving the breakdown of hard tissues like dentin and cementum, can result from trauma and subsequent infection, potentially leading to tooth loss. This case report details the management of combined internal and external root resorption with a periapical cyst in a 32-year-old male. After trauma, the maxillary left central incisor (#21) presented with root resorption and a displaced apex. Endodontic treatment using MTA and surgical enucleation of the cyst were performed. A 12-month follow-up showed successful resolution and tissue regeneration. This case emphasizes the effectiveness of combining advanced endodontic and surgical techniques for complex resorption cases.

Clinical Performance of 3D Printed Resin Composite Posterior Fixed Dental Prosthesis: A Permanent Solution?

This clinical trial aimed to evaluate the clinical outcomes of 3D-printed resin composite posterior fixed dental prosthesis (FDP) restorations. Between October 2020 and August 2022, 49 patients (33 females, 16 males, aged 19-60) received 68 3-unit 3D-printed resin composite posterior FDPs (ELS Even Stronger, Saremco, Switzerland). Follow-ups were conducted at baseline (2 weeks) by independent observers using modified FDI criteria, assessing anatomical form, marginal adaptation, surface roughness, color match, fracture, retention, and patient feedback. Fifty FDPs completed a 1-year follow-up, and 18 reached 2 years. The mean observation period was 14.15 months. Failures were categorized as mechanical or biological, with 19 FDPs failing: 14 mechanical (12 cohesive fractures) and 5 biological (3 needing endodontic treatment, 2 periodontal issues). Two FDPs were recemented. Three FDPs showed surface luster loss, color mismatches, and staining. The survival rate based on mechanical failures was 69.5%, dropping to 61.0% when including biological complications. After 2 years, 3D-printed resin composite FDPs demonstrated acceptable performance, with most failures due to fractures in the connector region, suggesting the need for design revisions.

Endodontic Management of Failed Root Canal Treatment in Teeth With Previously Missed Canals: A Report of Two Cases With Rare Root Canal Morphology

Endodontic Management of Failed Root Canal Treatment in Teeth With Previously Missed Canals: A Report of Two Cases With Rare Root Canal Morphology

Postobturation Pain of three Novel Calcium Silicate-based sealers with asymptomatic irreversible pulpitis or necrotic pulp with chronic apical periodontitis: prospective clinical trial

BackgroundBioceramic-based root canal sealers are increasingly important in root canal treatment because of their biocompatible properties. This study aimed to evaluate postobturation pain incidence and intensity after root canal obturation with NeoSealer Flo, MTA-Bioseal, and GuttaFlow bioseal calcium silicate-based sealers and AH Plus epoxy resin-based sealer in patients with asymptomatic irreversible pulpitis or necrotic pulp with chronic apical periodontitis.MethodsA total of 120 participants with single-rooted teeth were included and randomly divided into four groups according to the root canal sealer used (n = 30). The patients were subsequently categorised based on the pulp vitality (vital or nonvital) in each group (n = 15) and all teeth were obturated in a single-visit. The postobturation pain scores were recorded on a visual analogue scale (VAS) at 6 h, 24 h, 48 h, 72 h, 7 d and 30 d. Moreover, analgesic intake was also noted at 24 h and 48 h. The Mann–Whitney U test, Kruskal‒Wallis H test, Friedman test, and Spearman’s correlation test were used, and a p value < 0.05 was considered significant.ResultsVAS scores were highest for the 6 h > 24 h > 48 h ≈ 72 h ≈ 7 d ≈ 30 d time intervals for both pulp status in each root canal sealer. A significant decrease in the VAS score was observed for all sealers from 6 h to 48 h (p 0.05). Nonvital cases had lower VAS scores at all time intervals. Analgesic intake was greater in the first 24 h (p < 0.05) in vital cases (p < 0.05) and also in females than males.ConclusionThe level of pain experienced after obturation was similar in patients with different pulp status for all the root canal sealers. Analgesic intake was greater in vital cases and females within 24 h.Trial registrationClinicalTrial.gov, NCT06515756, record date: 2024-07-17, retrospectively registered.