http://feed.informer.com/digests/RP4HYZUCRE/feeder WP Front Range Dental Respective post owners and feed distributors Tue, 17 May 2016 00:58:54 -0700 Feed Informer http://feed.informer.com/ https://onlinelibrary.wiley.com/doi/10.1111/iej.14071?af=R International Endodontic Journal urn:uuid:ecc2aa0b-542f-8810-d4fc-38a27ed0ff4b Thu, 18 Apr 2024 07:18:51 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Background</h2> <p>Microorganisms colonizing the apical root canal system are conceivably the ones directly involved with the causation and maintenance of apical periodontitis.</p> <h2>Objectives</h2> <p>This article systematically reviews the reports on the microbiome occurring exclusively at the apical root canal of teeth with primary and posttreatment apical periodontitis.</p> <h2>Methods</h2> <p>The electronic databases PubMed, Embase, Web of Science, Science Direct, and Proquest were searched up to August 2023. Clinical studies using culture and molecular microbiology methods to identify the microbial taxa present exclusively in the apical root canal segment of infected teeth with apical periodontitis were included. Studies were critically assessed using the Joanna Briggs Institute Critical Prevalence Assessment Checklist.</p> <h2>Results</h2> <p>From 2277 articles initially detected, 52 were selected for full reading and 21 were eventually included in this review. Of these, molecular methods were used in 19 and culture in 2 studies. Ten studies evaluated primary infections, 8 evaluated posttreatment infections, and 3 included both. Cryopulverization of the apical root specimens was conducted in 11 studies. All studies evaluated the prevalence and diversity of bacteria, and only one also reported on fungi. Overall, the most frequent/abundant bacterial taxa found in the apical canal of primary infections were <i>Pseudoramibacter alactolyticus, Olsenella uli</i>, <i>Fusobacterium</i> species, <i>Streptococcus</i> species, <i>Porphyromonas endodontalis</i>, <i>Prevotella</i> species, <i>Actinomyces</i> species, <i>Parvimonas micra, Treponema denticola</i>, Synergistetes species, and an as-yet uncharacterized taxon. In posttreatment infections, the most prevalent/abundant bacterial taxa included species of <i>Streptococcus</i>, <i>Enterococcus</i>, <i>Fusobacterium</i>, <i>Actinomyces</i>, <i>Pseudoramibacter, Pseudomonas,</i> and <i>Propionibacterium</i>. At the phylum level, <i>Firmicutes</i> was the most represented. The average apical bacterial load ranged from 10⁵ to 10⁶ in primary infections and from 10³ to 10⁴ in posttreatment infections.</p> <h2>Discussion</h2> <p>Microbial diversity in the apical part of the root canal system was examined encompassing data from both primary and posttreatment infections. Heterogeneity amongst the studies, especially in sample collection and microbial identification methods, is an important limitation that prevented a meta-analysis.</p> <h2>Conclusions</h2> <p>There is a pronounced bacterial diversity in the infected apical canal, with a high interindividual variability. Different microbiome compositions at the species/genus level are observed according to the infection type.</p> <h2>Registration</h2> <p>PROSPERO CRD42021275886.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14069?af=R International Endodontic Journal urn:uuid:1d14e8a3-8c3d-40da-a9d7-43bdbeeea4d8 Fri, 12 Apr 2024 01:29:49 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Background</h2> <p>Limited evidence is available regarding the superior clinical properties of bioceramic sealers comparted with traditional standard sealers.</p> <h2>Objectives</h2> <p>This review aimed to answer the following research questions: ‘In healthy patients requiring a root canal treatment (P), what is the efficacy of premixed bioceramic sealers (I) compared with traditional root canal epoxy resin-based sealers (C) in terms of survival, success rates (PICO1) sealer extrusion and resorption (PICO2) post-obturation pain (PICO3) (O)?’</p> <h2>Methods</h2> <p>Authors independently searched three electronic databases: PubMed (including MEDLINE), Web of Science, Embase and Scopus up to 31 October 2023. This was accompanied by both grey literature and manual search. Detailed selection criteria were applied, namely mature permanent teeth requiring root canal treatment, premixed bioceramic sealer with gutta-percha as an intervention group, a standard filling technique as control group and full-text available in English. A random-effect meta-analysis was used to synthesize the body of evidence regarding the use of bioceramic sealers in root canal treatment and their impact on post-obturation pain. Effect sizes were represented as relative risks on a logarithmic scale for binary outcomes and as mean differences for continuous outcomes.</p> <h2>Results</h2> <p>A total of 941 articles were identified. Fifteen Comparative clinical studies were finally included. Eleven were randomized clinical trials, and four were prospective clinical trials with control group. The follow-up of these studies was not greater than 2 years. No publication bias was observed in any study. No significant differences were observed between the two groups in terms of survival and success rates. A small non-significant lower risk of extrusion was observed for bioceramics. A small, non-significantly lower post-operative-pain within 24-h was observed when bioceramics were used.</p> <h2>Discussion</h2> <p>The majority of current evidence shows inconsistencies in reporting and is of short-term duration. Robust prospective long-term trials are needed in this area to better support future recommendations.</p> <h2>Conclusion</h2> <p>This systematic review is the first to analyse several clinical outcomes using premixed sealers. Included studies differed in terms of clinical protocol and operator expertise, but reported a similar outcome when comparing bioceramic versus standard sealers. Tooth survival, treatment outcome, post-operative pain and periapical extrusion were similar and presented no significant differences between the two sealer types.</p> <h2>Registration</h2> <p>PROSPERO database (CRD42023449151).</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14068?af=R International Endodontic Journal urn:uuid:bc4322c8-43e3-ae53-f809-7cb154f23618 Sat, 06 Apr 2024 00:08:35 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>This prospective cohort study was undertaken to evaluate the success rate of root canal treatment (RCT) in type 2 diabetes mellitus (T2DM) patients with targeted level and unachieved targeted level of glycaemic control as well as the impact of RCT on the glucose blood level in T2DM patients.</p> <h2>Methodology</h2> <p>Patients needing RCT were divided into three groups: these without T2DM, that is, the control group (CG), those with targeted level of glycated haemoglobin HbA1c &lt; 7% (TL A1c) and the third ones with unachieved targeted level (UTL A1c), that is, with HbA1c ≥ 7%. Before RCT, HbA1c and the periapical index (PAI) score were assessed, as well as 1 year later.</p> <h2>Results</h2> <p>Our results showed less favourable treatment results of RCT such as a reduction of radiographic lesions in T2DM patients, particularly in subjects with UTL A1c. The intergroup analysis of PAI score at the 12-month follow-up revealed a significant difference in TL A1C (<i>p</i> = .022) and CG (<i>p</i> = .001) with respect to UTL A1c. Total number of healed teeth (PAI≤2) at the 12-month after RCT in UTL A1c was significantly lower in comparison to CG (<i>p</i> = .008). Contrariwise, RCT may improve the glycaemic control in diabetic patients with UTL A1c after 12 months of posttreatment. Regression analysis showed that UTL A1c patients were more likely to have AP persistence after endodontic treatment (OR = 4.788; CI: 1.157–19.816; <i>p</i> = .031).</p> <h2>Conclusions</h2> <p>T2DM retards the AP healing and conversely AP contributes to increasing the inflammatory burden in T2DM. RCT reduces the cumulative inflammatory burden in T2DM and thus may contribute to improvement of glycaemic control particularly in patients with UTL A1c.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14030?af=R International Endodontic Journal urn:uuid:f0410bd0-528b-a3b5-8b06-fb66106b67b5 Thu, 04 Apr 2024 11:15:45 -0700 International Endodontic Journal, Volume 57, Issue 5, Page 520-532, May 2024. <h2>Abstract</h2> <h2>Aim</h2> <p>The anaesthetic success rate of an inferior alveolar nerve block (IANB) in mandibular molars with irreversible symptomatic pulpitis can be low, and postoperative pain control in teeth with this diagnosis can be challenging. This study aimed to evaluate the influence of preemptive use of dexamethasone and oral potassium diclofenac on the success of IANB. The influence of these drugs on the intensity of postoperative pain was assessed as a secondary outcome.</p> <h2>Methodology</h2> <p>Eighty-four patients with mandibular molars diagnosed with irreversible symptomatic pulpitis recorded preoperative pain intensity using a cold thermal test and a modified Numerical Rating Scale (mNRS). Sixty minutes before the anaesthetic procedure, patients were randomly assigned to one of three groups based on the medication they received: dexamethasone (4 mg), diclofenac potassium (50 mg), or placebo. All patients received IANB with 4% articaine (1:200 000 epinephrine), and 15 min later, they were evaluated for pain intensity using the cold thermal test. Anaesthetic success was analysed. The pain intensity was then recorded, and endodontic treatment and provisional restoration of the tooth were executed in a single session. Patients were monitored for 6, 12, 24, 48 and 72 h using the mNRS to assess the intensity of postoperative pain.</p> <h2>Results</h2> <p>There was a statistically significant increase in anaesthetic success when 4 mg dexamethasone (39.3%) or 50 mg diclofenac potassium (21.4%) was used compared to the placebo group (3.6%) (<i>p</i> &lt; .001), with no significant difference between the two drugs. Regarding postoperative pain, dexamethasone was superior to placebo at 6 h (<i>p</i> &lt; .001), with diclofenac having an intermediate behaviour, not differing between dexamethasone and placebo (<i>p</i> &gt; .05). There was no significant difference amongst the groups at 12 h (<i>p</i> &gt; .05). At 24, 48 and 72 h, the effectiveness of dexamethasone and diclofenac were comparable, and both were superior to placebo (<i>p</i> &lt; .001).</p> <h2>Conclusion</h2> <p>The use of dexamethasone or diclofenac potassium was favourable in terms of increasing the success rate of inferior alveolar nerve block in cases of mandibular molars with irreversible symptomatic pulpitis and decreased the occurrence of postoperative pain when compared to the use of a placebo.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14031?af=R International Endodontic Journal urn:uuid:807719c8-edeb-234d-96fd-9b89c898a3af Thu, 04 Apr 2024 11:15:45 -0700 International Endodontic Journal, Volume 57, Issue 5, Page 617-628, May 2024. <h2>Abstract</h2> <h2>Aim</h2> <p>Conventional root resection in periodontally compromised furcation-involved maxillary molars requires preceding endodontic treatment and is therefore associated with loss of tooth vitality, higher invasiveness, treatment time and costs, and the risk of endodontic complications. Vital root resection (VRR) could overcome these disadvantages while establishing stable periodontal and endodontic conditions. This case series aimed to introduce the concept of one-stage VRR with radicular retrograde partial pulpotomy (VRRretro).</p> <h2>Summary</h2> <p>Seven vital maxillary molars with residual probing pocket depths (PPD) ≥ 6 mm and furcation ≥ class 2 of five patients with stage III/IV periodontitis were treated with VRRretro using mineral trioxide aggregate. Teeth with residual through-and-through furcations were additionally tunnelled. Follow-up up to 2.5 years postoperatively during supportive periodontal care included full periodontal status, percussion and thermal sensitivity testing. Periapical radiographs were obtained to rule out possible periradicular radiolucencies. All seven treated molars were in-situ at an average of 26.84 ± 5.37 months postoperatively and were clinically and radiographically inconspicuous independent of tooth position, the resected root, the need for tunnelling and the restorative status. The mean PPD on the seven treated molars was 4.02 ± 0.85 mm (6–10 mm) preoperatively and 2.62 ± 0.42 mm (3–4 mm) at the last follow-up. Clinical attachment level and bleeding on probing could also be decreased. The teeth showed no mobility over time and furcations class 2 were reduced to class 1 while the tunnelled furcations were accessible with interdental brushes. All molars reacted negatively to percussion and positively to thermal sensitivity testing.</p> <h2>Key learning points</h2> <p>In carefully selected cases considering patient- and tooth-related factors, VRRretro could be a promising treatment option to establish stable periodontal and endodontic conditions in furcation-involved maxillary molars while preserving tooth vitality.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14048?af=R International Endodontic Journal urn:uuid:54a9b66b-1576-7263-d015-ad5770f01ebc Thu, 04 Apr 2024 11:15:45 -0700 International Endodontic Journal, Volume 57, Issue 5, Page 502-504, May 2024. https://onlinelibrary.wiley.com/doi/10.1111/iej.14070?af=R International Endodontic Journal urn:uuid:6e267027-3af6-6a56-8ad3-9a278c80ced9 Thu, 04 Apr 2024 11:15:45 -0700 International Endodontic Journal, Volume 57, Issue 5, Page 501-501, May 2024. https://onlinelibrary.wiley.com/doi/10.1111/iej.14036?af=R International Endodontic Journal urn:uuid:8c0a3a20-6f9e-195d-9d45-a5e912c9b36b Thu, 04 Apr 2024 11:15:45 -0700 International Endodontic Journal, Volume 57, Issue 5, Page 505-519, May 2024. <h2>Abstract</h2> <h2>Background</h2> <p>There is an increased tendency towards adopting minimally invasive interventions in dentistry, supported by advancement in materials and techniques. However, the decision-making process in choosing conservative or invasive treatments is influenced by several factors, particularly in permanent teeth with irreversible pulpitis.</p> <h2>Objectives</h2> <p>The objective of the study was to systematically review the literature regarding factors that influence decision-making for vital pulp therapy (VPT) as definitive treatment option in permanent mature teeth diagnosed with irreversible pulpitis.</p> <h2>Methods</h2> <p>Two independent reviewers searched five electronic databases (PubMed, Embase, Web of Science, Scopus and Cochrane Library). Grey literature was searched through Google Scholar and contact with experts. Defined search keys were applied, and all peer-reviewed literature published with no language nor publication date limits were included. The All studies investigating the factors influencing treatment decision-making in mature permanent teeth with irreversible pulpitis were included. The quality of included studies was assessed by two independent reviewers using the Joanna Briggs Institute quality assessment tool.</p> <h2>Results</h2> <p>Six articles were included in the review. All included studies used questionnaires to characterize clinician preferences and attitudes in choosing treatment options for mature permanent teeth with irreversible pulpitis. The available evidence suggests that dentist-related factors have a significant influence on the chosen treatment in teeth with irreversible pulpitis, with speciality training and years of experience influencing the choice of VPT over other treatment options. COVID-19 reportedly swayed the dentists’ decision to favour VPT. Only one article studied the influence of patient-related factors, such as age and presence of spontaneous pain on decision-making. Of note, a history of cardiovascular disease moved dentists towards prescribing VPT.</p> <h2>Discussion</h2> <p>Collectively, the included studies demonstrated an overriding influence of dentist-related factors on choosing among treatment options for painful teeth diagnosed with irreversible pulpitis. Patient-related factors were acknowledged but there are also potential factors such as socio-economic constraints that were not included in the component studies.</p> <h2>Conclusion</h2> <p>In teeth with irreversible pulpitis clinicians educational background influence the decision towards a specific treatment option. Further data, preferably derived from clinical records, is necessary in future investigations to explore the effect of other important factors related to both dentists and patients.</p> <h2>Registration</h2> <p>PROSPERO database (CRD42022339653).</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14035?af=R International Endodontic Journal urn:uuid:591bfb9f-b450-5fb8-8635-6540bb679f50 Thu, 04 Apr 2024 11:15:45 -0700 International Endodontic Journal, Volume 57, Issue 5, Page 576-585, May 2024. <h2>Abstract</h2> <h2>Aim</h2> <p>The purpose of this study was to quantify the effect of five different root canal preparation instruments on Substance P (SP), Calcitonin gene-related peptide (CGRP) and their receptors expression in healthy human periodontal ligament.</p> <h2>Methodology</h2> <p>STROBE guidelines were used to design a study using 60 periodontal ligament samples obtained from healthy lower premolars where extraction was indicated for orthodontic reasons. Prior to extraction 40 of these premolars were equally divided into four groups and root canals were prepared using different systems: Mtwo, Reciproc Blue, HyFlex EDM and Plex-V. Ten premolars were prepared with hand files and served as a positive control group. The remaining 10 premolars where extracted without treatment and served as a negative control group. All periodontal ligament samples were processed to measure the expression of SP, CGRP and their receptors by radioimmunoassay. Kruskal–Wallis and Duncan tests were performed to determine statistically significant differences between the groups for each variable.</p> <h2>Results</h2> <p>Greater expression of all the peptides measured were found in the hand-file preparation group, followed by the Reciproc Blue, Mtwo, HyFlex EDM and Plex-V groups. The lower SP, CGRP and their receptors values were for the intact teeth control group. Kruskal–Wallis test showed statistically significant differences amongst groups (<i>p</i> &lt; .001). Dunn post-hoc tests showed statistically significant differences in SP, CGRP and their receptors expression between the intact teeth and the hand-file and Reciproc Blue groups. Hand-file group showed significant differences with the other groups, except with Reciproc Blue, where no differences were observed in any of the peptides measured. Finally, no differences were observed between Plex-V and HyFlex in any of the peptides measured.</p> <h2>Conclusions</h2> <p>Root canal preparation with hand files and Reciproc Blue generates the highest expression of SP, CGRP, NK1 and CGRP1R in human periodontal ligament, whilst Plex-V and HyFlex maintain the basal expression of neuropeptides and their receptors. Mtwo showed intermediate results between Reciproc Blue and HyFlex.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14032?af=R International Endodontic Journal urn:uuid:8b6d19b0-9125-071c-f0e7-d8d877fd71df Thu, 04 Apr 2024 11:15:45 -0700 International Endodontic Journal, Volume 57, Issue 5, Page 533-548, May 2024. <h2>Abstract</h2> <h2>Aim</h2> <p>To investigate the prevalence of apical periodontitis (AP) and the technical standard of root canal treatment in a Belgian population, assess the association of different variables with periapical status, and compare the results to a similar study conducted 22 years previously.</p> <h2>Methodology</h2> <p>In this cross-sectional study, 614 panoramic radiographs of first-time adult attendees at the Dental School of the University Hospital of Ghent were examined. Recorded patient-level parameters included gender, age, number of teeth, number of root filled teeth, presence of any AP lesion, and number of implants. The following tooth-level data were collected: tooth presence, coronal status, quality of coronal restoration, post presence, type of root-filling material, length and density of root filling, root-end filling material, presence of AP, and adjacent implant. Multivariable multilevel binary logistic regression was used to explore the association between patient and tooth characteristics and AP prevalence. Risk differences and confidence intervals were calculated to compare the present with the previous study.</p> <h2>Results</h2> <p>The prevalence of AP at patient and tooth level was 46.9% and 5.6%, respectively. Fifty-one per cent of the 614 patients had at least one root filled tooth, and 5.9% of the 14 655 teeth studied were root filled. AP was found in 45% of root filled teeth. Fifty-four per cent of the root-filled teeth were rated as inadequate. Multivariable multilevel logistic regression revealed that more teeth, more implants, fewer root-filled teeth, adequate density, adequate coronal restoration, and no caries reduced the likelihood of AP. There were no statistically significant differences between the two studies regarding the prevalence of root-filled teeth or AP and the technical quality of root canal treatment.</p> <h2>Conclusions</h2> <p>The prevalence of AP and the technical quality of root canal treatment in Belgium have not substantially changed over the last 22 years, despite the technological advancements and continuing education in the field.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14033?af=R International Endodontic Journal urn:uuid:417c8d64-64ef-5075-4048-92ff3a6162d2 Thu, 04 Apr 2024 11:15:45 -0700 International Endodontic Journal, Volume 57, Issue 5, Page 586-600, May 2024. <h2>Abstract</h2> <h2>Aim</h2> <p>To evaluate the influence of an experimental solution of cobalt-doped F18 bioactive glass (F18Co) on tissue repair following regenerative endodontic procedure (REP) in rat molars.</p> <h2>Methodology</h2> <p>The F18Co solution was prepared at a ratio of 1:5 F18Co powder to distilled water. The right or left upper first molars of 12 Wistar rats were used, where the pulps were exposed, removed, and irrigated with 2.5% sodium hypochlorite (NaOCl), followed by 17% ethylenediaminetetraacetic acid (EDTA) (5 min each). Subsequently, the molars were divided into two groups (<i>n</i> = 6): REP-SS and REP-F18Co, where they received a final irrigation (5 min) with saline solution (SS) or F18Co solution, respectively. Then, intracanal bleeding was induced, and the tooth was sealed. Untreated molars were used as controls (<i>n</i> = 3). At 21 days, the rats were euthanized, and the specimens were processed for analysis of mineralized tissue and soft tissue formation inside the root canal using haematoxylin-eosin. The presence and maturation of collagen were evaluated by Masson's trichrome and picrosirius red staining. Immunolabelling analyses of proliferating cell nuclear antigen (PCNA) and osteocalcin (OCN) were performed. The data were submitted to the Mann–Whitney U-test (<i>p</i> &lt; .05).</p> <h2>Results</h2> <p>There was a similar formation of mineralized tissue in thickness and length in REP-SS and REP-F18Co groups (<i>p</i> &gt; .05). Regarding the presence of newly formed soft tissue, most specimens of the REP-F18Co had tissue formation up to the cervical third of the canal, whilst the REP-SS specimens showed formation up to the middle third (<i>p</i> &lt; .05), and there was higher maturation of collagen in REP-F18Co (<i>p</i> &lt; .05). The number of PCNA-positive cells found in the apical third of the root canal was significantly higher in the F18Co group, as well as the OCN immunolabelling, which was severe in most specimens of REP-F18Co, and low in most specimens of REP-SS.</p> <h2>Conclusion</h2> <p>The final irrigation with F18Co bioactive glass solution in REP did not influence mineralized tissue formation but induced soft tissue formation inside the root canals, with higher collagen maturation, and an increase in PCNA-positive cells and OCN immunolabelling.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14034?af=R International Endodontic Journal urn:uuid:94584d70-2442-8d47-48ff-0cdc15ef8702 Thu, 04 Apr 2024 11:15:45 -0700 International Endodontic Journal, Volume 57, Issue 5, Page 566-575, May 2024. <h2>Abstract</h2> <h2>Aim</h2> <p>This current Mendelian randomization (MR) study aims to comprehensively explore the potential bidirectional link between pulp and periapical disease (PAP) with type 2 diabetes mellitus (T2DM).</p> <h2>Methodology</h2> <p>Summary level data of European-based population genome-wide association studies (GWASs) were employed to undertake this MR study. With the selection of single nucleotide polymorphisms (SNPs) as the instrumental variable, the radial inverse-variance weighted (radial IVW) method with modified second-order weights was applied as the primary method. Additionally, a range of sensitivity analyses were conducted to investigate pleiotropy. Results from different sources of outcome were pooled by meta-analysis with the fixed model.</p> <h2>Results</h2> <p>The results of this MR analysis did not suggest a significant impact of pulp and periapical disease on type 2 diabetes (combined OR = 1.04, 95% CI: 1.00–1.07, <i>p</i> = .033) and vice versa (OR = 1.04, 95% CI: 0.96–1.14, <i>p</i> = .329). No significant pleiotropy was detected in the final model after the removal of outliers, demonstrating the reliability of the results in our primary analysis.</p> <h2>Conclusions</h2> <p>With the limitations inherent in the present MR study, there is no significant evidence in either direction to suggest a causal association between pulp and periapical disease and type 2 diabetes mellitus.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14038?af=R International Endodontic Journal urn:uuid:ceddabac-c532-65e7-767d-d37d66b42991 Thu, 04 Apr 2024 11:15:45 -0700 International Endodontic Journal, Volume 57, Issue 5, Page 549-565, May 2024. <h2>Abstract</h2> <h2>Aim</h2> <p>To explore the influence of PDGF-AA on cell communication between human dental pulp stem cells (DPSCs) by characterizing gap junction intercellular communication (GJIC) and its potential biomechanical mechanism.</p> <h2>Methodology</h2> <p>Quantitative real-time PCR was used to measure connexin family member expression in DPSCs. Cell migration and CCK-8 assays were utilized to examine the influence of PDGF-AA on DPSC migration and proliferation. A scrape loading/dye transfer assay was applied to evaluate GJIC triggered by PDGF-AA, a PI3K/Akt signalling pathway blocker (LY294002) and a PDGFR-α blocker (AG1296). Western blotting and immunofluorescence were used to test the expression and distribution of the Cx43 and p-Akt proteins in DPSCs. Scanning electron microscopy (SEM) and immunofluorescence were used to observe the morphology of GJIC in DPSCs.</p> <h2>Results</h2> <p>PDGF-AA promoted gap junction formation and intercellular communication between human dental pulp stem cells. PDGF-AA upregulates the expression of Cx43 to enhance gap junction formation and intercellular communication. PDGF-AA binds to PDGFR-α and activates PI3K/Akt signalling to regulate cell communication.</p> <h2>Conclusions</h2> <p>This research demonstrated that PDGF-AA can enhance Cx43-mediated GJIC in DPSCs via the PDGFR-α/PI3K/Akt axis, which provides new cues for dental pulp regeneration from the perspective of intercellular communication.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14047?af=R International Endodontic Journal urn:uuid:fe9a6072-913d-e324-9bac-d6b3e97c443e Thu, 04 Apr 2024 11:15:45 -0700 International Endodontic Journal, Volume 57, Issue 5, Page 601-616, May 2024. <h2>Abstract</h2> <h2>Aim</h2> <p>To compare eight large- and low-tapered heat-treated reciprocating instruments regarding their design, metallurgy, mechanical properties, and irrigation flow through an in silico model.</p> <h2>Methodology</h2> <p>A total of 472 new 25-mm E-Flex Rex (25/.04 and 25/.06), Excalibur (25/.05), Procodile (25/.06), Reciproc Blue R25 (25/.08v), WaveOne Gold Primary (25/.07v), and Univy Sense (25/.04 and 25/.06) instruments were evaluated regarding their design (stereomicroscopy, scanning electron microscopy, and 3D surface scanning), metallurgy (energy-dispersive X-ray spectroscopy and differential scanning calorimetry), and mechanical performance (cyclic fatigue, torsional resistance, cutting ability, bending and buckling resistance). Computational fluid dynamics assessment was also conducted to determine the irrigation flow pattern, apical pressure, and wall shear stress in simulated canal preparations. Kruskal–Wallis and one-way anova post hoc Tukey tests were used for statistical comparisons (<i>α</i> = 5%).</p> <h2>Results</h2> <p>Instruments presented variations in blade numbers, helical angles, and tip designs, with all featuring non-active tips, symmetrical blades, and equiatomic nickel-titanium ratios. Cross-sectional designs exhibited an S-shaped geometry, except for WaveOne Gold. Univy 25/.04 and Reciproc Blue displayed the smallest and largest core diameters at D3. Univy 25/.04 and E-Flex Rec 25/.04 demonstrated the longest time to fracture (<i>p</i> &lt; .05). Reciproc Blue and Univy 25/.04 exhibited the highest and lowest torque to fracture, respectively (<i>p</i> &lt; .05). Univy 25/.04 and Reciproc Blue had the highest rotation angles, whilst E-Flex Rec 25/.06 showed the lowest angle (<i>p</i> &lt; .05). The better cutting ability was observed with E-Flex Rec 25/.06, Procodile, Excalibur, and Reciproc Blue (<i>p</i> &gt; .05). Reciproc R25 and E-Flex Rec showed the highest buckling resistance values (<i>p</i> &lt; .05), with WaveOne Gold being the least flexible instrument. The impact of instruments' size and taper on wall shear stress and apical pressure did not follow a distinct pattern, although Univy 25/.04 and E-Flex Rec 25/.06 yielded the highest and lowest values for both parameters, respectively.</p> <h2>Conclusions</h2> <p>Low-tapered reciprocating instruments exhibit increased flexibility, higher time to fracture, and greater angles of rotation, coupled with reduced maximum bending loads and buckling strength compared to large-tapered instruments. Nevertheless, low-tapered systems also exhibit lower maximum torque to fracture and inferior cutting ability, contributing to a narrower apical canal enlargement that may compromise the penetration of irrigants in that region.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14064?af=R International Endodontic Journal urn:uuid:c43449b8-d58f-1288-ed42-e80b9b00b9fb Fri, 29 Mar 2024 08:39:14 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <p>Undergraduate education should accomplish graduates who are skilled to provide quality care for patients, who are aware of their scope of practice, competency level and limits and who are open to referring patients whose needs are beyond their own skills and experience. They should also become self-efficacious. Quality performance begins with good diagnosis and decision-making. Graduates should understand when to treat, why to treat, what to treat and how to treat. These guidelines include a list of capabilities that the graduating student will be expected to have achieved to provide a minimum level of competency in endodontics. Theoretical knowledge, practical skills, understanding and insight should be assessed, with both formative and summative assessment procedures, making use of reflection and feedback. Endodontic procedures should be undertaken within the context of comprehensive patient care and should be evidence based. Students should not perform treatments on patients until they have demonstrated in a pre-clinical setting that they possess the required skills. Only if it is not possible to simulate a specific procedure sufficiently in a pre-clinical setting should students learn this procedure by performing it clinically under close supervision. Clinical endodontics should ideally be supervised by endodontists or by staff with special knowledge, interest and self-efficacy in endodontics. It is advised to ensure that students apply their knowledge and practice their skills periodically throughout the continuum of endodontic education until graduation. A philosophy of lifelong learning and evidence-based practice should be instilled in all dental undergraduates.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14067?af=R International Endodontic Journal urn:uuid:017ce303-adb0-21d3-6369-21998a1dc4bc Sun, 24 Mar 2024 10:29:28 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Background</h2> <p>The European Society of Endodontology published in 2023, the S3-level clinical practice guidelines, which supersede the Quality Guidelines for Endodontic Treatment published in 2006.</p> <h2>Objectives</h2> <p>This review aims to summarize and compare the above guidelines to support their dissemination.</p> <h2>Method</h2> <p>A narrative synthesis of the main differences alongside tabulation according to the main themes.</p> <h2>Results</h2> <p>Three tables were prepared according to the following themes: diagnosis of pulpal and apical condition; treatment of pulpitis; and treatment of nonvital pulp and apical periodontitis.</p> <h2>Conclusions</h2> <p>A compared and simplified message regarding the most recent clinical practice guidelines has been prepared.</p> <h2>Registration</h2> <p>Not applicable as a narrative review.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14060?af=R International Endodontic Journal urn:uuid:7827c8b8-bf9e-0de3-92ab-7e24ff6997b0 Thu, 21 Mar 2024 06:38:29 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aims</h2> <p>To compare radiographic periapical healing and tooth survival outcomes of root canal (re)treatment performed within two care pathways (Routine Dental Care and Referred Treatment Pathway), in the United Kingdom Armed Forces (UKAF), and determine the effects of endodontic complexity on outcomes.</p> <h2>Methodology</h2> <p>This retrospective cohort study included 1466 teeth in 1252 personnel who received root canal (re)treatment between 2015 and 2020. General Dental Practitioners treated 661 teeth (573 patients) (Routine cohort), whilst Dentists with a Special Interest treated 805 teeth (678 patients) (Referred cohort). The latter group were graduates of an MSc programme in Endodontics with 4–8 years of postgraduation experience. Case complexity was retrospectively determined for each tooth using the endodontic component of Restorative Index of Treatment Need (RIOTN) guidelines. Periapical healing was determined using loose radiographic criteria. The data were analysed using chi-square tests, univariate logistic regression and Cox proportional hazards models.</p> <h2>Results</h2> <p>A significantly (<i>p</i> &lt; 0.0001) larger proportion of cases of low complexity had undergone root canal treatment within the Routine versus Referred cohort. The odds of periapical healing was significantly higher within the Referred versus Routine cohort, regardless of analyses using pooled (OR = 1.17; 95% CI: 1.11, 1.22) or moderate complexity (OR = 4.71; 95% CI: 2.73, 8.11) data. Within the Routine cohort, anterior teeth had higher odds of periapical healing than posterior teeth (OR = 1.13; 95% CI: 1.04, 1.22). The 60-month cumulative tooth survival was lower (<i>p</i> = 0.03) in the Routine (90.5%) than the Referred (96.0%) cohort. Within the Routine cohort, the hazard of tooth loss was higher amongst posterior teeth (HR = 4.03; 95% CI: 1.92, 8.45) but lower if posterior teeth had cast restorations (HR = 0.36; 95% CI: 0.19, 0.70). For the Referred cohort, posterior teeth restored with cast restoration (vs not) had significantly lower risk of tooth loss (HR = 0.21; 95% CI: 0.08, 0.55).</p> <h2>Conclusions</h2> <p>For UKAF patients, root canal (re)treatment provided within the Referred pathway was significantly more likely to achieve periapical healing and better tooth survival than those provided within the Routine pathway. Posterior teeth restored with an indirect restoration had a higher proportion of tooth survival. This study supported the utility of the endodontic component of RIOTN for assessing case complexity.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14066?af=R International Endodontic Journal urn:uuid:70f0a6cf-8ace-8e4f-357e-9a5066d69fb5 Sat, 16 Mar 2024 06:43:48 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Background</h2> <p>Regenerative techniques are increasingly being advocated in endodontic apical surgery (AS) to enhance the healing of periapical lesions. Various grafting and membrane materials are employed as adjuncts to modern AS.</p> <h2>Objectives</h2> <p>This systematic review aimed to answer the following PICO question: In patients with apical periodontitis (P) what is the impact of bone grafting with/without barrier membrane materials (I) compared with surgery without grafting materials (C) on the outcome of AS evaluated clinically and radiographically (O).</p> <h2>Methods</h2> <p>A systematic search was conducted in four databases (Embase, Web of Science, PubMed and Cochrane Central Register of Controlled Trials) until 1 August 2023. Google Scholar was also manually searched. Studies with a prospective randomized design were included. Cochrane risk-of-bias (RoB) tool 2.0 assessed bias. Two independent reviewers performed the study selection, data extraction and appraisal of studies. Meta-analysis was performed using R3.5.1 software.</p> <h2>Results</h2> <p>From the identified 2582 studies, eight randomized clinical trials were included for meta-analysis. Two studies had low RoB, while six had some concerns. Analysis revealed significantly better outcomes when surgery involved bone regeneration techniques than conventional surgery (OR = 2.18, 95% CI: 1.32–4.31, <i>p</i> = .004). Subgroup analyses on individual grafts (OR = 0.22, 95% CI: −0.99 to 1.44, <i>p</i> = .720) (OR = −0.09, 95% CI: −1.42 to 1.23, <i>p</i> = .885) and membranes (OR = −1.09, 95% CI: −2.94 to 0.76, <i>p</i> = .247) and their combinations (OR = 0.03, 95% CI: −1.50 to 1.55, <i>p</i> = .970) did not yield any significant results. The type of membrane used did not significantly impact the outcome (OR = −1.09, 95% CI: −2.94 to 0.76, <i>p</i> = .247) nor did altering the combination of graft/membrane.</p> <h2>Discussion</h2> <p>This systematic review examined the effects of bone grafting with/without membrane placement on the outcome of AS. It highlights the potential advantages of regenerative techniques and the need for further research in this area.</p> <h2>Conclusions</h2> <p>Based on current evidence, bone grafting with/without barrier membrane placement significantly improves healing after AS. Subgroup analysis of resorbable membranes or grafting did not significantly influence the outcome. The combination of membrane and graft was also not significant. Future well-designed, randomized controlled trials in this area are essential before these materials can be recommended for routine use to enhance healing outcomes in AS.</p> <h2>Registration</h2> <p>PROSPERO (CRD42021255171).</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14059?af=R International Endodontic Journal urn:uuid:ed193278-26ae-7cbf-43bb-9a8270d60d94 Thu, 14 Mar 2024 08:09:57 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>Previous endodontic research has provided limited understanding of the prevalence and roles of haemolytic and non-haemolytic <i>Enterococcus faecalis</i> strains in root filled teeth. This study aimed to determine the prevalence of these strains in root filled teeth with periradicular lesions and investigate their associated virulence factors.</p> <h2>Methodology</h2> <p>A total of 36 root canal samples were collected from 36 subjects. The prevalence of <i>E. faecalis</i> was determined using culture and PCR methods. Antibiotic susceptibility of haemolytic and non-haemolytic <i>E. faecalis</i> strains was assessed using the broth dilution assay. The cytokine stimulation in periodontal ligament (PDL) cells and neutrophil migration were evaluated using real-time PCR and migration assay, respectively. Cell invasion ability of the strains was assessed using a cell culture model. Additionally, the virulence gene expression of the haemolytic and non-haemolytic strains was investigated using real-time PCR. The Mann–Whitney <i>U</i> and Spearman's <i>ρ</i> tests were used to examine the significant difference between the two strains and to analyse the correlation between phenotype and gene expression, respectively.</p> <h2>Results</h2> <p><i>Enterococcus faecalis</i> was detected in 33.3% and 88.9% of samples by culture and real-time PCR, respectively. Haemolytic strains were found in 36.4% of subjects. Non-haemolytic strains exhibited susceptibility to erythromycin and varying susceptibility to tetracycline, while all haemolytic strains were resistant to both antibiotics. Haemolytic strains significantly upregulated the expression of IL-8, OPG and RANKL in PDL cells (<i>p</i> &lt; .05). Notably, the fold increases in these genes were higher: IL-8 (556.1 ± 82.9 vs. 249.6 ± 81.8), OPG (2.2 ± 0.5 vs. 1.3 ± 0.2) and RANKL (1.8 ± 0.3 vs. 1.2 ± 0.1). Furthermore, haemolytic strains had a greater effect on neutrophil migration (68.7 ± 15.2% vs. 46.9 ± 11.4%) and demonstrated a higher level of internalization into oral keratinocyte cells (68.6 ± 0.4% vs. 33.8 ± 0.5%) (<i>p</i> &lt; .05). They also showed enhanced expression of virulence genes associated with haemolysin, surface proteins, collagen-binding and aggregation substances. Gelatinase activity was only detectable in non-haemolytic strains.</p> <h2>Conclusions</h2> <p>This study revealed that haemolytic strains <i>E. faecalis</i> possessed enhanced abilities in host invasion and a higher abundance of virulence factors, suggesting their potential contribution to more severe disease manifestations.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14056?af=R International Endodontic Journal urn:uuid:98fda5fc-989b-2c7b-270c-cdd81f870d24 Wed, 13 Mar 2024 04:30:12 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>Loss-of-function mutations in <i>FAM20A</i> result in amelogenesis imperfecta IG (AI1G) or enamel-renal syndrome, characterized by hypoplastic enamel, ectopic calcification, and gingival hyperplasia, with some cases reporting spontaneous tooth infection. Despite previous reports on the consequence of FAM20A reduction in gingival fibroblasts and transcriptome analyses of AI1G pulp tissues, suggesting its involvement in mineralization and infection, its role in deciduous dental pulp cells (DDP) remains unreported. The aim of this study was to evaluate the properties of DDP obtained from an AI1G patient, providing additional insights into the effects of FAM20A on the mineralization of DDP.</p> <h2>Methodology</h2> <p>DDP were obtained from a <i>FAM20A</i>-AI1G patient (mutant cells) and three healthy individuals. Cellular behaviours were examined using flow cytometry, MTT, attachment and spreading, colony formation, and wound healing assays. Osteogenic induction was applied to DDP, followed by alizarin red S staining to assess their osteogenic differentiation. The expression of FAM20A-related genes, osteogenic genes, and inflammatory genes was analysed using real-time PCR, Western blot, and/or immunolocalization. Additionally, STRING analysis was performed to predict potential protein–protein interaction networks.</p> <h2>Results</h2> <p>The mutant cells exhibited a significant reduction in FAM20A mRNA and protein levels, as well as proliferation, migration, attachment, and colony formation. However, normal FAM20A subcellular localization was maintained. Additionally, osteogenic/odontogenic genes, <i>OSX</i>, <i>OPN</i>, <i>RUNX2</i>, <i>BSP</i>, and <i>DSPP</i>, were downregulated, along with upregulated <i>ALP</i>. STRING analysis suggested a potential correlation between FAM20A and these osteogenic genes. After osteogenic induction, the mutant cells demonstrated reduced mineral deposition and dysregulated expression of osteogenic genes. Remarkably, <i>FAM20A</i>, <i>FAM20C</i>, <i>RUNX2</i>, <i>OPN</i>, and <i>OSX</i> were significantly upregulated in the mutant cells, whilst <i>ALP,</i> and <i>OCN</i> was downregulated. Furthermore, the mutant cells exhibited a significant increase in inflammatory gene expression, that is, <i>IL-1β</i> and <i>TGF-β1</i>, whereas <i>IL-6</i> and <i>NFκB1</i> expression was significantly reduced.</p> <h2>Conclusion</h2> <p>The reduction of FAM20A in mutant DDP is associated with various cellular deficiencies, including delayed proliferation, attachment, spreading, and migration as well as altered osteogenic and inflammatory responses. These findings provide novel insights into the biology of FAM20A in dental pulp cells and shed light on the molecular mechanisms underlying AI1G pathology.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14061?af=R International Endodontic Journal urn:uuid:92bad4cf-cad8-4c89-3032-ffd9c30a6fba Tue, 12 Mar 2024 05:49:20 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Background</h2> <p>Although several studies indicate the harmful effects of bleaching on pulp tissue, the demand for this procedure using high concentrations of hydrogen peroxide (HP) is high.</p> <h2>Objectives</h2> <p>To investigate the influence of bleaching on the pulp tissue.</p> <h2>Methods</h2> <p>Electronic searches were conducted (PubMed/MEDLINE, Scopus, Cochrane Library and grey literature) until February 2021. Only in vivo studies that evaluated the effects of HP and/or carbamide peroxide (CP) bleaching gels on the inflammatory response in the pulp tissue compared with a non-bleached group were included. Risk of bias was performed according to a modified Methodological Index for Non-Randomized Studies scale for human studies and the Systematic Review Centre for Laboratory Animal Experimentation's RoB tool for animal studies. Meta-analysis was unfeasible.</p> <h2>Results</h2> <p>Of the 1311 studies, 30 were eligible. Of these, 18 studies evaluated the inflammatory response in animal models. All these studies reported a moderate-to-strong inflammatory response in the superficial regions of pulp, characterized by cell disorganization and necrotic areas, particularly during the initial periods following exposure to 35%–38% HP, for 30–40 min. In the evaluation of human teeth across 11 studies, seven investigated inflammatory responses, with five observing significant inflammation in the pulp of bleached teeth. In terms of tertiary dentine deposition, 11 out of 12 studies noted its occurrence after bleaching with 35%–38% HP in long-term assessments. Additionally, three studies reported significant levels of osteocalcin/osteopontin at 2 or 10 days post-treatment. Other studies indicated an increase in pro-inflammatory cytokines ranging from immediately up to 10 days after bleaching. Studies using humans' teeth had a low risk of bias, whereas animal studies had a high risk of bias.</p> <h2>Discussion</h2> <p>Despite the heterogeneity in bleaching protocols among studies, High-concentrations of HP shows the potential to induce significant pulp damage.</p> <h2>Conclusions</h2> <p>High-concentrations of bleaching gel increases inflammatory response and necrosis in the pulp tissue at short periods after bleaching, mainly in rat molars and in human incisors, in addition to greater hard tissue deposition over time. However, further well-described histological studies with long-term follow-up are encouraged due to the methodological limitations of these studies.</p> <h2>Registration</h2> <p>PROSPERO (CRD42021230937).</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14054?af=R International Endodontic Journal urn:uuid:1d373dca-06c7-17d2-571f-3dd3218b236a Mon, 11 Mar 2024 08:49:35 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>To evaluate the inflammatory reaction and the ability to induce mineralization activity of a new repair material, NeoPUTTY (NPutty; NuSmile, USA), in comparison with Bio-C Repair (BC; Angelus, Brazil) and MTA Repair HP (MTA HP; Angelus, Brazil).</p> <h2>Methodology</h2> <p>Polyethylene tubes were filled with materials or kept empty (control group, CG) and implanted in subcutaneous tissue of rats for 7, 15, 30, and 60 days (<i>n</i> = 6/group). Capsule thickness, number of inflammatory cells (ICs), fibroblasts, collagen content, and von Kossa analysis were performed. Unstained sections were evaluated under polarized light and by immunohistochemistry for osteocalcin (OCN). Data were submitted to two-way <span class="smallCaps">anova</span> followed by Tukey's test (<i>p ≤</i> .05), except for OCN. OCN data were submitted to Kruskal–Wallis and Dunn and Friedman <i>post hoc</i> tests followed by the Nemenyi test at a significance level of 5%.</p> <h2>Results</h2> <p>At 7, 15, and 30 days, thick capsules containing numerous ICs were seen around the materials. At 60 days, a moderate inflammatory reaction was observed for NPutty, BC while MTA HP presented thin capsules with moderate inflammatory cells. In all periods, NPutty specimens contained the highest values of ICs (<i>p &lt;</i> .05). From 7 to 60 days, the number of ICs reduced significantly while an increase in the number of fibroblasts and birefringent collagen content was observed. At 7 and 15 days, no significant difference was observed in the immunoexpression of OCN (<i>p &gt;</i> .05). At 30 and 60 days, NPutty showed the lowest values of OCN (<i>p &lt;</i> .05). At 60 days, a similar immunoexpression was observed for BC and MTA HP (<i>p &gt;</i> .05). In all time intervals, capsules around NPutty, BC, and MTA HP showed von Kossa-positive and birefringent structures.</p> <h2>Conclusions</h2> <p>Despite the greater inflammatory reaction promoted by NeoPutty than BC and MTA HP, the reduction in the thickness of capsules, the increase in the number of fibroblasts, and the reduction in the number of ICs indicate that this bioceramic material is biocompatible Furthermore, NeoPutty presents the ability to induce mineralization activity.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14062?af=R International Endodontic Journal urn:uuid:2f9acb96-3c30-1e94-fbe2-63ca556d2071 Tue, 05 Mar 2024 06:58:28 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>Apical periodontitis is an inflammatory disorder triggered by an immune response to bacterial infection, leading to the periapical tissue damage and alveolar resorption. However, the underlying mechanisms driving this process remain elusive, due to the complex and interconnected immune microenvironment within the local lesion site. In this study, the influence of Nlrp3 inflammasome-mediated immune response on the apical periodontitis was investigated.</p> <h2>Methodology</h2> <p>RNA sequencing, immunohistochemistry and ELISA assay were performed to investigate the activation of Nlrp3 inflammasome signalling pathways in the human periapical tissues, including radicular cysts, periapical granulomas and healthy oral mucosa. A mouse model of apical periodontitis was established to study the role of Nlrp3 knockout in periapical bone resorption and Treg cell stability, and the underlying mechanism was explored through in vitro experiments. In vivo Treg cell adoptive transfer was performed to investigate the effects of Treg cells on the progression of apical periodontitis.</p> <h2>Results</h2> <p>Our findings find that the hyperactivated Nlrp3 inflammasome is present in human periapical lesions and plays a vital role in the immune-related periapical bone loss. Using a mouse model of apical periodontitis, we observe that Nlrp3 deficiency is resistant to bone resorption. This protection was accompanied by elevated generation and infiltration of local Treg cells that displayed a notable ability to suppress RANKL-dependent osteoclast differentiation. In terms of the mechanism of action, Nlrp3 deficiency directly inhibits the osteoclast differentiation and bone loss through JNK/MAPK and NF-κB pathways. In addition, Nlrp3 induces pyroptosis in the stem cells from apical papilla (SCAPs), and the subsequent release of cytokines affects the stability of Treg cell in periapical lesions, leading indirectly to enhanced bone resorption. In turn, adoptive transfer of both Nlrp3-deficient and wild-type Treg cells effectively prevent the bone erosion during apical periodontitis.</p> <h2>Conclusions</h2> <p>Together, our data identify that the Nlrp3 inflammasome modulates the Treg cell stability and osteoclastogenesis in the periapical inflammatory microenvironment, thus determining the progression of bone erosion.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14043?af=R International Endodontic Journal urn:uuid:9783c7b5-e716-8aea-c03d-9dad9c5b1b01 Tue, 05 Mar 2024 05:30:31 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <p>Endodontic therapy includes various procedures such as vital pulp therapy, root canal treatment and retreatment, surgical endodontic treatment and regenerative endodontic procedures. Disinfection and tissue repair are crucial for the success of these therapies, necessitating the development of therapeutics that can effectively target microbiota, eliminate biofilms, modulate inflammation and promote tissue repair. However, no current endodontic agents can achieve these goals. Antimicrobial peptides (AMPs), which are sequences of amino acids, have gained attention due to their unique advantages, including reduced susceptibility to drug resistance, broad-spectrum antibacterial properties and the ability to modulate the immune response of the organism effectively. This review systematically discusses the structure, mechanisms of action, novel designs and limitations of AMPs. Additionally, it highlights the efforts made by researchers to overcome peptide shortcomings and emphasizes the potential applications of AMPs in endodontic treatments.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14055?af=R International Endodontic Journal urn:uuid:7b2b1f1c-c8be-dd30-a105-d234458a6c55 Mon, 04 Mar 2024 08:39:27 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aims</h2> <p>This study aimed to investigate the anti-inflammatory and odontoblastic effects of cerium-containing mesoporous bioactive glass nanoparticles (Ce-MBGNs) on dental pulp cells as novel pulp-capping agents.</p> <h2>Methodology</h2> <p>Ce-MBGNs were synthesized using a post-impregnation strategy based on the antioxidant properties of Ce ions and proposed the first use of Ce-MBGNs for pulp-capping application. The biocompatibility of Ce-MBGNs was analysed using the CCK-8 assay and apoptosis detection. Additionally, the reactive oxygen species (ROS) scavenging ability of Ce-MBGNs was measured using the 2,7-Dichlorofuorescin Diacetate (DCFH-DA) probe. The anti-inflammatory effect of Ce-MBGNs on THP-1 cells was further investigated using flow cytometry and quantitative real-time polymerase chain reaction (RT-qPCR). Moreover, the effect of Ce-MBGNs on the odontoblastic differentiation of the dental pulp cells (DPCs) was assessed by combined scratch assays, RT-qPCR, western blotting, immunocytochemistry, Alizarin Red S staining and tissue-nonspecific alkaline phosphatase staining. Analytically, the secretions of tumour necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were detected with enzyme-linked immunosorbent assay (ELISA).</p> <h2>Results</h2> <p>Ce-MBGNs were confirmed to effectively scavenge ROS in THP-1-derived macrophages and DPCs. Flow cytometry and RT-qPCR assays revealed that Ce-MBGNs significantly inhibited the M1 polarization of macrophages (Mφ). Furthermore, the protein levels of TNF-α and IL-1β were downregulated in THP-1-derived macrophages after stimulation with Ce-MBGNs. With a step-forward virtue of promoting the odontoblastic differentiation of DPCs, we further confirmed that Ce-MBGNs could regulate the formation of a conductive immune microenvironment with respect to tissue repair in DPCs, which was mediated by macrophages.</p> <h2>Conclusions</h2> <p>Ce-MBGNs protected cells from self-produced oxidative damage and exhibited excellent immunomodulatory and odontoblastic differentiation effects on DPCs. As a pulp-capping agent, this novel biomaterial can exert anti-inflammatory effects and promote restorative dentine regeneration in clinical treatment. We believe that this study will stimulate further correlative research on the development of advanced pulp-capping agents.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14058?af=R International Endodontic Journal urn:uuid:77aa62bc-a5e3-68f3-3842-d3c8979d3a58 Mon, 04 Mar 2024 05:25:06 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>Among numerous constituents of <i>Panax ginseng</i>, a constituent named Ginsenoside Rb1 (G-Rb1) has been studied to diminish inflammation associated with diseases. This study investigated the anti-inflammatory properties of G-Rb1 on human dental pulp cells (hDPCs) exposed to lipopolysaccharide (LPS) and aimed to determine the underlying molecular mechanisms.</p> <h2>Methodology</h2> <p>The KEGG pathway analysis was performed after RNA sequencing in G-Rb1- and LPS-treated hDPCs. Reverse-transcription polymerase chain reaction (RT–PCR) and western blot analysis were used for the assessment of cell adhesion molecules and inflammatory cytokines. Statistical analysis was performed with one-way <span class="smallCaps">ANOVA</span> and the Student–Newman–Keuls test.</p> <h2>Results</h2> <p>G-Rb1 did not exhibit any cytotoxicity within the range of concentrations tested. However, it affected the levels of TNF-α, IL-6 and IL-8, as these showed reduced levels with exposure to LPS. Additionally, less mRNA and protein expressions of vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) were shown. With the presence of G-Rb1, decreased levels of PI3K/Akt, phosphorylated IκBα and p65 were also observed. Furthermore, phosphorylated ERK and JNK by LPS were diminished within 15, 30 and 60 min of G-Rb1 exposure; however, the expression of non-phosphorylated ERK and JNK remained unchanged.</p> <h2>Conclusions</h2> <p>G-Rb1 suppressed the LPS-induced increase of cell adhesion molecules and inflammatory cytokines, while also inhibiting PI3K/Akt, phosphorylation of NF–κB transcription factors, ERK and JNK of MAPK signalling in hDPCs.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14063?af=R International Endodontic Journal urn:uuid:2a6b5c16-1e2c-7c4b-3908-834b895bbfc4 Mon, 04 Mar 2024 05:04:28 -0700 International Endodontic Journal, EarlyView. https://onlinelibrary.wiley.com/doi/10.1111/iej.14057?af=R International Endodontic Journal urn:uuid:2b342c1b-2a3b-bc0c-f0e7-204688b1719b Tue, 27 Feb 2024 09:14:18 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>The goal of this study was to investigate the potential effects of an immunotherapeutic drug targeting STING to suppress the overreactive innate immune response and relieve the bone defect in apical periodontitis.</p> <h2>Methodology</h2> <p>We established an apical periodontitis mouse model in <i>Sting</i> ^−/− and WT mice <i>in vivo</i>. The progression of apical periodontitis was analysed by micro-CT analysis and H&amp;E staining. The expression level and localization of STING in F4/80⁺ cells were identified by IHC and immunofluorescence staining. RANKL in periapical tissues was tested by IHC staining. TRAP staining was used to detect osteoclasts. To clarify the effect of STING inhibitor C-176 as an immunotherapeutic drug, mice with apical periodontitis were treated with C-176 and the bone loss was identified by H&amp;E, TRAP, RANKL staining and micro-CT. Bone marrow-derived macrophages (BMMs) were isolated from <i>Sting</i> ^−/− and WT mice and induced to osteoclasts in a lipopolysaccharide (LPS)-induced inflammatory environment <i>in vitro</i>. Moreover, WT BMMs were treated with C-176 to determine the effect on osteoclast differentiation by TRAP staining. The expression levels of osteoclast-related genes were tested using qRT-PCR.</p> <h2>Results</h2> <p>Compared to WT mice, the bone resorption and inflammatory cell infiltration were reduced in exposed <i>Sting</i> ^−/− mice. In the exposed WT group, STING was activated mainly in F4/80⁺ macrophages. Histological staining revealed the less osteoclasts and lower expression of osteoclast-related factor RANKL in <i>Sting</i> ^−/− mice. The treatment of the STING inhibitor C-176 in an apical periodontitis mice model alleviated inflammation progression and bone loss, similar to the effect observed in <i>Sting</i> ^−/− mice. Expression of RANKL and osteoclast number in periapical tissues were also decreased after C-176 administration. <i>In vitro</i>, TRAP staining showed fewer positive cells and qRT-PCR reflected decreased expression of osteoclastic marker, Src and Acp5 were detected during osteoclastic differentiation in <i>Sting</i> ^−/− and C-176 treated BMMs.</p> <h2>Conclusions</h2> <p>STING was activated and was proven to be a positive factor in bone loss and osteoclastogenesis in apical periodontitis. The STING inhibitor C-176 administration could alleviate the bone loss via modulating local immune response, which provided immunotherapy to the treatment of apical periodontitis.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14050?af=R International Endodontic Journal urn:uuid:f6cea411-6527-21c3-cf5c-7aefc49cfb81 Tue, 27 Feb 2024 07:34:11 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>To evaluate the indication of the endodontic treatment for vital intact teeth with the root apex involved in large radicular cystic lesions of endodontic origin.</p> <h2>Methodology</h2> <p>This prospective cohort study enrolled healthy participants with radicular cysts of endodontic origin and with the root apex of vital intact teeth involved in the bone defect, as determined by cone beam computed tomography (CBCT). Thirty-two sound vital teeth were analysed by thermal (TPT) and electric pulp tests (EPT) before surgery (T0) and 1 week (T1), 2 weeks (T2), 3 months (T3) and 6 months (T4) post-surgery. Student's <i>t</i>-test (<i>p</i> &lt; .05) was used to compare the EPT values at baseline and T4. <span class="smallCaps">anova</span> (<i>p</i> &lt; .05) was used to analyse the EPT variations for all maxillary and mandibular teeth. McNemar test (<i>p</i> &lt; .05) was used to compare the results according to variation in EPT values gathering by variation, no variation and no response.</p> <h2>Results</h2> <p>At T1, 75 and 65.7% of teeth responded positively whilst 25 and 34.3% did not respond to EPT and TPT, respectively. The variation of the EPT values between T0 and T1 was observed for 50.0% of teeth, whilst no variation was noticed in 25.0% of teeth. At T4, 90.6 and 87.5% of teeth responded positively whilst 9.4 and 12.5% did not respond to EPT and TPT, respectively. At T4, variation of the EPT values between T0 and T4 was observed for 28.1%, whilst no variation was noticed in 62.5% of teeth. There were no statistical differences in EPT results between T0 and T4 (<i>p</i> &gt; .05), but significant differences were observed for EPT values between T1 and T4 (<i>p</i> &lt; .05), and between mandibular and maxillary teeth. The pulp sensibility of maxillary teeth worsened after surgery, before reverting progressively to T0 values, whilst no statistically significant differences were observed for mandibular teeth at the different time points.</p> <h2>Conclusions</h2> <p>These data support the inconsistence of the prophylactic endodontic treatment in healthy vital teeth with apex involvement in large cystic lesions of endodontic origin. Post-surgery follow-up with TPT and EPT is recommended to assess pulp status.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14052?af=R International Endodontic Journal urn:uuid:47ff65ad-1ab4-20cc-4772-d9d4ae35fc83 Sun, 25 Feb 2024 12:44:07 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>To evaluate the influence of different preparation tapers on the reduction in planktonic bacteria and biofilms of <i>Enterococcus faecalis</i> and <i>Candida albicans</i> in the apical third (4 mm) of the mesial roots of mandibular molars, correlating decontamination with canal shape.</p> <h2>Methodology</h2> <p>After microtomography analysis for morphological standardization of the canals, 48 mandibular molar roots, each containing two canals (96 canals), were contaminated with <i>E</i>. <i>faecalis</i> and <i>C</i>. <i>albicans</i> and divided into four groups (<i>n</i> = 11) for canal instrumentation using ProDesign Logic 2 files with different tapers G (.03): # 25.03; G (.04): # 25.04; G (.05): # 25.05; and G (.06): # 25.06 and irrigation with 2.5% sodium hypochlorite. Four roots were examined under a scanning electron microscope (SEM) to qualitatively assess biofilm formation. Eight roots were used as the negative control group (samples were not contaminated). Bacteriological samples were taken exclusively from the apical third of the roots before and after chemical–mechanical preparation and bacterial counts were determined (CFU/mL). The final micro-CT scan was used to quantify the volume variation and unprepared canal area in the apical third. Statistical analysis was performed using the Kruskal–Wallis, Student–Newman–Keuls and Wilcoxon tests for analysis of microbiological data. <span class="smallCaps">anova</span> and the Tukey or Games–Howell test were used for analysis of micro-CT data and Spearman's test for correlations (<i>α</i> = 5%).</p> <h2>Results</h2> <p>All groups showed a significant reduction in bacteria (<i>p</i> &lt; .05), with no statistically significant difference between groups. There was no significant difference in per cent volume increase between groups. The unprepared area (Δ%) was affected by the file used (<i>p</i> = .026) and was significantly lower for G (.06) compared to G (.03). There was no statistically significant correlation among bacterial reduction, volume and unprepared area (<i>p</i> &gt; .05).</p> <h2>Conclusion</h2> <p>The different preparation tapers influenced root canal shaping in the apical third but did not improve decontamination in this region.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14051?af=R International Endodontic Journal urn:uuid:9b5736ba-e166-1cb7-90db-f27cec9c54e0 Sun, 25 Feb 2024 10:54:55 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>This study aimed to determine the effects of iRoot BP Plus on receptor activator of nuclear factor-κB ligand (RANKL)-induced osteoclastogenesis in vitro and inflammation-mediated bone resorption in vivo and investigated the underlying molecular mechanisms.</p> <h2>Methodology</h2> <p>CCK-8 was performed to test cell viability in RANKL-induced RAW 264.7 cells and BMDMs in response to iRoot BP Plus. The effect of iRoot BP Plus on osteoclastogenesis was determined using TRAP staining and phalloidin staining, respectively. Pit formation assay was conducted to measure osteoclast resorptive capacity. Western blot and qPCR were performed to examine osteoclast-related proteins and gene expression, respectively. Western blot was also used to investigate the signalling pathways involved. For in vivo experiments, an LPS-induced mouse calvarial bone resorption model was established to analyse the effect of iRoot BP Plus on bone resorption (<i>n</i> = 6 per group). At 7 days, mouse calvaria were collected and prepared for histological analysis.</p> <h2>Results</h2> <p>We identified that iRoot BP Plus extracts significantly attenuated RANKL-induced osteoclastogenesis, reduced sealing zone formation, restrained osteolytic capacity and decreased osteoclast-specific gene expression (<i>p</i> &lt; .01). Mechanistically, iRoot BP Plus extracts reduced TRAF6 via proteasomal degradation, then suppressed the phosphorylation of mitogen-activated protein kinases (MAPKs), blocked the nuclear translocation of c-Fos and diminished nuclear factor-κB (NF-κB) p65 and NFATc1 accumulation. Consistent with the in vitro results, iRoot BP Plus extracts attenuated osteoclast activity thus protecting against inflammatory bone resorption in vivo (<i>p</i> &lt; .05), which was accompanied by a suppression of TRAF6, c-Fos, NFATc1 and cathepsin K expression.</p> <h2>Conclusion</h2> <p>These findings provide valuable insights into the signalling mechanisms underlying nanoparticulate bioceramic putty-mediated bone homeostasis.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14053?af=R International Endodontic Journal urn:uuid:e3a686b7-667c-3ad1-f1bc-e3104db287bd Thu, 22 Feb 2024 01:00:00 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>To compare the effect of different sodium hypochlorite (NaOCl) agitation techniques on an ex vivo oral multispecies biofilm during passive disinfection of simulated immature roots.</p> <h2>Methodology</h2> <p>Extracted human teeth were prepared to simulate immature roots. They were infected with a dental plaque-derived multispecies biofilm and cultured for 14 days. The roots were randomly designated into four groups: (1) negative control (PBS), (2) 1.5% NaOCl (CNI), (3) CNI + Ultrasonic activation (UA), (4) CNI + EasyClean agitation (ECA), (5) CNI + XP-endo finisher agitation (XPF), and (6) positive control (6% NaOCl). Biofilm samples were collected from the root canals and used to determine the number of viable cells (colony-forming units), scanning electron microscopy, and 16S rRNA gene sequencing. The mean colony-forming units per mL (CFU/mL) were analysed using One-way <span class="smallCaps">anova</span>. 16S rRNA sequencing data were analysed for alpha (observed OTUs, Shannon index, and Chao1) and beta diversity (Bray-Curtis dissimilarities). The LEfSe analysis was used to determine the effect of treatment procedures on the abundance of root canal microbiota. The significance was set at .05.</p> <h2>Results</h2> <p>PBS and CNI samples had significantly higher CFU/mL counts than UA, ECA, XPF, and 6% NaOCl samples (<i>p</i> &lt; .05). The pre-treatment, PBS, and CNI groups had significantly greater alpha diversity than the UA, ECA, XPF, and 6% NaOCl groups (<i>p</i> &lt; .05). NaOCl agitation groups and the 6% NaOCl group achieved a more pronounced reduction in bacteria from the genera <i>Fusobacterium</i>, <i>Actinomyces</i>, <i>Porphyromonas</i>, and <i>Capnocytophaga</i>.</p> <h2>Conclusions</h2> <p>The effectiveness of passive disinfection protocols was enhanced by NaOCl agitation techniques, suggesting that this supplementary method can improve the outcome of revitalization procedures.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14049?af=R International Endodontic Journal urn:uuid:3d4bcfdc-147e-66c4-5b76-3b0429e8a6cf Tue, 20 Feb 2024 06:05:20 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>Regenerative Endodontic Procedures (REPs) using new materials such as hydrogels aim to replace current endodontic treatments, but numerous limitations are to overcome. Apical release was little explored in previous studies, especially regarding hydrogels that incorporate molecules, such as growth factors and antibiotics. Apical release is a key mechanism in achieving regeneration, as it could regulate disinfection or cell colonization. Few models exist for apical release, limiting the transfer of these devices from bench to bedside. This study aims to design a simple and standardized model to identify parameters that influence the early apical release kinetic of molecules from endodontic hydrogels.</p> <h2>Methodology</h2> <p>Endodontic Release Inserts (ERI) were designed to mimic the situation of an immature incisor using three different diameters (Ø 0.5 to 2 mm) and to allow the study of the early release from a hydrogel in a 96-well plate. ERI was produced with a 3D printing machine. The kinetic release was investigated using 2 fluorescent, hydrophobic (BDP-500) and hydrophilic (Fluorescein) molecules, in different hydrogels (fibrin and agarose) and in various media (PBS or serum). The release kinetics were estimated by measuring the fluorescence at different time points (1 to 24 h).</p> <h2>Results</h2> <p>ERI use made it possible to report that apical diameters increase from 500 to 1000 μm was associated with an increase in release from 4.02 ± 1.63% to 11.53 ± 2.38% over 24 h. It also allowed us to report that bottom solution composition change from PBS to human serum was associated with an increase in the release of fatty acid molecules, whilst a decrease in the hydrogel concentration was associated with a variation in release kinetics. Moreover, nano-encapsulation of a molecule was associated with a decreased release over the first 24 h from 5.25 to 0%.</p> <h2>Conclusion</h2> <p>ERI use enables investigation of the parameters influencing release kinetics from endodontic hydrogels. Further investigations are necessary to evaluate the interaction of these parameters with each other, in animal models and clinic.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14041?af=R International Endodontic Journal urn:uuid:b0b45b98-db97-1fd7-f531-fc5a71f44026 Mon, 19 Feb 2024 07:36:06 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>Design, produce and assess the viability of a novel nanotechnological antibacterial thermo-sensible intracanal medicament This involves encapsulating calcium hydroxide (Ca(OH)₂) within polylactic-co-glycolic acid (PLGA) nanoparticles (NPs) and dispersing them in a thermosensitive gel (Ca(OH)₂-NPs-gel). In addition, perform <i>in vitro</i> and ex vivo assessments to evaluate tissue irritation and penetration capacity into dentinal tubules in comparison to free Ca(OH)₂.</p> <h2>Methodology</h2> <p>Reproducibility of Ca(OH)₂-NPs was confirmed by obtaining the average size of the NPs, their polydispersity index, zeta potential and entrapment efficiency. Moreover, rheological studies of Ca(OH)₂-NPs-gel were carried out with a rheometer, studying the oscillatory stress sweep, the mean viscosity value, frequency and temperature sweeps. Tolerance was assessed using the membrane of an embryonated chicken egg. <i>In vitro</i> Ca(OH)₂ release was studied by direct dialysis in an aqueous media monitoring the amount of Ca(OH)₂ released. Six extracted human teeth were used to study the depth of penetration of fluorescently labelled Ca(OH)₂-NPs-gel into the dentinal tubules and significant differences against free Ca(OH)₂ were calculated using one-way <span class="smallCaps">anova</span>.</p> <h2>Results</h2> <p>Ca(OH)₂-NPs-gel demonstrated to be highly reproducible with an average size below 200 nm, a homogeneous NPs population, negative surface charge and high entrapment efficiency. The analysis of the thermosensitive gel allowed us to determine its rheological characteristics, showing that at 10°C gels owned a fluid-like behaviour meanwhile at 37°C they owned an elastic-like behaviour. Ca(OH)₂-NPs-gel showed a prolonged drug release and the depth of penetration inside the dentinal tubules increased in the most apical areas. In addition, it was found that this drug did not produce irritation when applied to tissues such as eggs' chorialantoidonic membrane.</p> <h2>Conclusion</h2> <p>Calcium hydroxide-loaded PLGA NPs dispersed in a thermosensitive gel may constitute a suitable alternative as an intracanal antibacterial medicament.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14044?af=R International Endodontic Journal urn:uuid:3d9d7b31-d9bc-1df0-7096-fd32ce2d1f4f Mon, 19 Feb 2024 07:29:28 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>To compare the efficacy of <i>Enterococcus faecalis</i> biofilm removal using the GentleWave System (GWS) (Sonendo Inc, CA) on non-instrumented versus minimally instrumented root canal systems.</p> <h2>Methodology</h2> <p>Thirty-four mandibular molars were autoclaved and allocated to four groups: Negative control (<i>n</i> = 5); positive control (<i>n</i> = 5); Group 1: non-instrumentation + GWS (NI + GWS) (<i>n</i> = 12); and Group 2: minimal instrumentation + GWS (MI + GWS) (<i>n</i> = 12). Of 34 samples, 24 samples with Vertucci type 2 configuration within the mesial root of each sample were allocated to Groups 1 and 2 and then matched based on the working length and root canal configuration. After inoculation of samples with <i>E. faecalis</i> for 3 weeks, the GWS was used on Group 1 without any instrumentation and Group 2 after instrumentation of mesial canals until size 20/06v. CFU and SEM analysis were used.</p> <h2>Results</h2> <p>Log₁₀ (CFU/mL) from the positive control, and Group 1 and 2 were 7.41 ± 0.53, 3.41 ± 1.54, and 3.21 ± 1.54, respectively. Both groups showed a statistically significant difference in the reduction of viable <i>E. faecalis</i> cells compared to the positive control (Group 1 [<i>p</i> = .0001] and Group 2 [<i>p</i> &lt; .0001]), whilst showing no significant difference between the two tested groups (<i>p</i> &lt; .05).</p> <h2>Conclusion</h2> <p>The use of GWS on the non-instrumented root canal system could be an effective disinfection protocol in removing the biofilm without dentin debris formation.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14046?af=R International Endodontic Journal urn:uuid:713d7dfa-9eda-3282-84a9-3aa963e37b71 Thu, 15 Feb 2024 03:04:24 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>The aim of this study was to analyse and compare the microbiome present in root canals and periapical lesions of teeth with post-treatment infections, and to identify the presence of keystone taxa in both habitats using next-generation sequencing analysis.</p> <h2>Methodology</h2> <p>Apices and periapical lesions of patients with post-treatment apical periodontitis were surgically extracted. Specimens were cryo-pulverized, bacterial DNA was extracted, and the V3–V4 hypervariable regions of the 16S rRNA gene were sequenced using the Illumina Miseq platform. Bioinformatic analysis was carried out with Mothur software, whilst diversity indices were obtained using operational taxonomic units (OTUs). The diversity indices were compared with the Kruskal–Wallis test, and community composition differences were explored with Permutational Multivariate Analysis of Variance (PERMANOVA). A bacterial functional study was performed with the Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) analysis. Co-occurrence network analyses were performed using the Sparse Correlations for Compositional data (SparCC). Eigencentrality, clr-based abundance and ubiquitousness were applied to infer keystone taxa. <i>P</i> values &lt;.05 were considered statistically significant.</p> <h2>Results</h2> <p>Thirty-two apices and thirty-nine periapical lesions were sequenced and analysed. A similar alpha-diversity (<i>p</i> &lt; .05) and community composition (<i>p</i> = .91) was observed for apices and lesion samples. The most abundant OTUs identified amongst all samples included <i>Fusobacterium nucleatum</i>, <i>Prevotella loescheii, Streptococcus intermedius, Porphyromonas gingivalis, Parvimonas micra, Synergistetes bacterium, Tannerella forsythia</i> and <i>Peptostreptococcus stomatis</i>. The metabolic pathways with &gt;0.81% abundances included membrane transport, genetic information processing and metabolic pathways. <i>F. nucleatum</i> was identified as a keystone taxon as it showed ubiquitousness, an eigenvector centrality value of 0.83 and a clr-based abundance &gt;4.</p> <h2>Conclusions</h2> <p>The microbiome in apices and periapical lesions of post-treatment endodontic infections showed a similar diversity and taxonomic composition. Co-occurrence network analyses at OTU level identified <i>F. nucleatum</i> as a keystone taxon candidate in these infections.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14042?af=R International Endodontic Journal urn:uuid:47465ab1-e6d1-3626-9795-4580762e3f7b Sat, 10 Feb 2024 05:59:10 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <p>In the last two decades, the activation of root canal irrigants with pulsed lasers as an adjunct in root canal treatment has become increasingly popular. This narrative review explains the physical basics and the working mechanism of laser-activated irrigation (LAI), explores the parameters influencing LAI efficacy, considers historical evolutions in the field and summarizes laboratory and clinical evidence with emphasis on the antimicrobial action of LAI. Cavitation is the driving force behind LAI, with growing and imploding vapour bubbles around the laser tip causing various secondary phenomena in the irrigant, leading to intense liquid dynamics throughout the underlying root canal. High-speed imaging research has shown that laser wavelength, pulse energy, pulse length and fibre tip geometry are parameters that influence this cavitation process. Nevertheless, this has not resulted in standardized settings for LAI. Consequently, there is significant variability in studies assessing LAI efficacy, complicating the synthesis of results. Laboratory studies in extracted teeth suggest that, with regard to canal disinfection, LAI is superior to conventional irrigation and there is a trend of higher antimicrobial efficacy of LAI compared to ultrasonic activation. Clinical evidence is limited to trials demonstrating similar postoperative pain levels after LAI versus no activation or ultrasonic activation. Clinical evidence concerning the effect of LAI on healing of apical periodontitis as yet is scarce.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14040?af=R International Endodontic Journal urn:uuid:6d0a2328-7997-6ebc-715b-7539443d0859 Sat, 10 Feb 2024 05:52:46 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Background</h2> <p>‘Periodontitis’ refers to periodontal destruction of connective tissue attachment and bone, in response to microorganisms forming subgingival biofilms on the root surface, while ‘apical periodontitis’ refers to periapical inflammatory processes occurring in response to microorganisms within the root canal system. The treatment of both diseases is based on the elimination of the bacterial challenge, though its predictability depends on the ability of disrupting these biofilms, what may need adjunctive antibacterial strategies, such as the next-generation antibacterial strategies (NGAS). From all the newly developed NGAS, the use of polymeric nanotechnology may pose a potential effective approach. Although some of these strategies have only been tested in vitro and in preclinical in vivo models, their use holds a great potential, and therefore, it is relevant to understand their mechanism of action and evaluate their scientific evidence of efficacy.</p> <h2>Objectives</h2> <p>To explore NGAS based on polymeric nanotechnology used for the potential treatment of periodontitis and apical periodontitis.</p> <h2>Method</h2> <p>A systemic search of scientific publications of adjunctive antimicrobial strategies using nanopolymers to treat periodontal and periapical diseases was conducted using The National Library of Medicine (MEDLINE by PubMed), The Cochrane Oral Health Group Trials Register, EMBASE and Web of Science.</p> <h2>Results</h2> <p>Different polymeric nanoparticles, nanofibres and nanostructured hydrogels combined with antimicrobial substances have been identified in the periodontal literature, being the most commonly used nanopolymers of polycaprolactone, poly(lactic-<i>co</i>-glycolic acid) and chitosan. As antimicrobials, the most frequently used have been antibiotics, though other antimicrobial substances, such as metallic ions, peptides and naturally derived products, have also been added to the nanopolymers.</p> <h2>Conclusion</h2> <p>Polymeric nanomaterials containing antimicrobial compounds may be considered as a potential NGAS. Its relative efficacy, however, is not well understood since most of the existing evidence is derived from in vitro or preclinical in vivo studies.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.13996?af=R International Endodontic Journal urn:uuid:cd6c6d65-49fe-376e-9f46-db06e3136846 Mon, 20 Nov 2023 02:08:27 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>To analyse the effect of ultrasonic irrigant activation (UIA) and the GentleWave (GW) multisonic irrigation (GW) with minimal instrumentation on the root canal microbial diversity in an ex vivo model that used extracted molars with a history of pulp necrosis.</p> <h2>Methodology</h2> <p>Twenty-three mandibular molars were prepared ex vivo for collection of superficial (surface control), pre-treatment and post-treatment samples 24 h after extraction. Samples were divided into two groups: UIA using 6% NaOCl (<i>n</i> = 11) and GW group (<i>n</i> = 12). All samples were processed using quantitative real-time polymerase chain reaction (qPCR) and 16S rRNA next-generation sequencing to measure microbial diversity before and after the antimicrobial treatment. For qPCR, a <i>t</i>-test (<i>α</i> = .05) was used to compare the log10 reduction. The Chao1 and Shannon indices evaluated alpha diversity. Differences in community composition (beta diversity) were evaluated by analysis of similarity (ANOSIM). Kruskal–Wallis test with Bonferroni corrections was performed to evaluate the differences in abundances genera in the samples.</p> <h2>Results</h2> <p>Quantitative real-time polymerase chain reaction revealed an estimated 1.6 and 2.6 log10 reduction for UIA and GW groups respectively (<i>p</i> = .048). An average of 5 ± 4 and 3 ± 5 operational taxonomic units (OTUs) were found in surface's samples in the UIA and GW group respectively. These values were significantly lower (<i>p</i> &lt; .001) compared to the number of preoperative OTUs in those groups (155 ± 79 and 187 ± 121). In assessing beta diversity, there were no significant differences found in pre-treatment samples (<i>R</i> = .090, <i>p</i> = .070 ANOSIM with Bonferroni corrections). Also, no significant differences in community composition were observed in post-treatment samples (<i>R</i> = −.05, <i>p</i> = .829). After treatment, there was a significant reduction of <i>Eubacterium</i> using conventional treatment with UIA and a significant reduction of <i>Prevotella</i> using minimal instrumentation with GW irrigation (<i>p</i> = .007 and <i>p</i> = .002 respectively).</p> <h2>Conclusion</h2> <p>Quantitative PCR analysis revealed a significant reduction in microbial load for GW group. Overall, diversity changes were similar between UIA and GW irrigation in this ex vivo model that used extracted teeth with a history of pulp necrosis. OTUs obtained from the surface sample were negligible and did not affect the statistical outcome of the study.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.13958?af=R International Endodontic Journal urn:uuid:d27cb955-c5e3-42dd-c5d8-6b5434edb5fa Mon, 31 Jul 2023 08:13:48 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Background</h2> <p>The clinical results following regenerative endodontic procedures (REPs) vary according to numerous parameters, including the presence of bacteria. This limitation reduces the indications for REPs and calls for the development of next generation antibacterial strategies (NGAS) providing alternatives to current antibacterial strategies (CAS) such as double or triple antibiotic paste (DAP/TAP) and (Ca(OH)2).</p> <h2>Objectives</h2> <p>The present scoping review aims to describe the current trends regarding the use of such strategies and highlight future perspectives.</p> <h2>Methods</h2> <p>Four databases (PUBMed, Cochrane, ClinicalTrials and Science Direct) were searched until 1st May 2023.</p> <h2>Results</h2> <p>A total of 918 records were identified, 133 were screened and assessed for eligibility, and 87 articles were included. The findings show that (1) clinical studies are only available for CAS, (2) although next generation strategies are the most studied approach since 2017, they are all at the pre-clinical stage, (3) most of the next generation strategies use galenic forms which offer cell support and colonization and which simultaneously contain antibacterial molecules as alternatives to CAS and to antibiotics in general, (4) standardization is required for future research, specifically regarding the bacterial strains studied, the use of biofilm studies and the cellular behaviour assessments.</p> <h2>Conclusion</h2> <p>Although NGAS are promising strategies to improve REPs in the context of infection, the current evidence is mostly limited to pre-clinical studies. Further methodological improvement is required to allow relevant comparisons between studies and to reduce the time from bench to bedside.</p> https://www.123dentist.com/lendcare-partners-with-123dentist/ 123Dentist urn:uuid:479e4cc3-3a93-8099-a72d-efaa118a24c6 Mon, 12 Jun 2023 11:29:36 -0700 <p>Easy financing will help the millions of Canadians who cannot afford basic dental care.</p> <p>The post <a rel="nofollow" href="https://www.123dentist.com/lendcare-partners-with-123dentist/">LendCare Partners With 123Dentist</a> appeared first on <a rel="nofollow" href="https://www.123dentist.com">123Dentist</a>.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.13934?af=R International Endodontic Journal urn:uuid:246f29fc-22a9-ce67-cf4f-f52e9701881a Fri, 02 Jun 2023 07:28:53 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2><p>To analyse and compare the root canal microbiome present in root-filled teeth of two different geographical populations, and to study their functional potential using a next-generation sequencing approach.</p><h2>Methodology</h2><p>Sequencing data obtained from surgical specimens from previously treated teeth with periapical bone loss from Spain and USA were included in the study. Taxa were classified using SILVA v.138 database. Differences in genera abundances among the 10 most abundant genera were evaluated using a Kruskal–Wallis test. Alpha diversity indices were calculated in mothur. The Shannon and Chao1 indices were used. Analyses of similarity (ANOSIM) to determine differences in community composition were done in mothur, with Bonferroni correction for multiple comparisons. <i>p</i>-Values &lt; .05 were considered statistically significant. Identification of enriched bacteria function prediction in the study groups (KEGG pathways) was carried out by linear discriminant analysis effect size (LEfSe) via Python 3.7.6.</p><h2>Results</h2><p>A greater alpha-diversity (Shannon and Chao1 indices) was observed from samples obtained in Spain (<i>p</i> = .002). Geography showed no significant effects on community composition via an ANOSIM using Bray–Curtis dissimilarities (<i>R</i> = 0.03, <i>p</i> = .21). Bacterial functional analysis prediction obtained by PICRUSt showed that 5.7% KEGG pathways differed between the Spain and US samples.</p><h2>Conclusions</h2><p>The taxonomic assessment alone does not fully capture the microbiome's differences from two different geographical locations. Carbohydrate and amino acid metabolism were enriched in samples from Spain, while samples from USA had a higher representation of pathways related to nitrogen, propanoate metabolism, and secretion systems.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.13911?af=R International Endodontic Journal urn:uuid:0f27454c-6338-2105-4496-87ea31be97d1 Wed, 29 Mar 2023 05:43:23 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>To evaluate the root canal microbiome composition and bacterial functional capability in cases of primary and secondary apical periodontitis utilizing whole-metagenome shotgun sequencing.</p> <h2>Methodology</h2> <p>Twenty-two samples from patients with primary root canal infections, and 18 samples obtained from previously treated teeth currently diagnosed with apical periodontitis were analysed with whole-metagenome shotgun sequencing at a depth of 20 M reads. Taxonomic and functional gene annotations were made using MetaPhlAn3 and HUMAnN3 software. The Shannon and Chao1 indices were utilized to measure alpha diversity. Differences in community composition were evaluated utilizing analysis of similarity (ANOSIM) using Bray-Curtis dissimilarities. The Wilcoxon rank sum test was used to compare differences in taxa and functional genes.</p> <h2>Results</h2> <p>Microbial community variations within a community were significantly lower in secondary relative to primary infections (alpha diversity <i>p</i> = .001). Community composition was significantly different in primary versus secondary infection (<i>R</i> = .11, <i>p</i> = .005). The predominant taxa observed among samples (&gt;2.5%) were <i>Pseudopropionibacterium propionicum</i>, <i>Prevotella oris</i>, <i>Eubacterium infirmum</i>, <i>Tannerella forsythia</i>, <i>Atopobium rimae</i>, <i>Peptostreptococcus stomatis</i>, <i>Bacteroidetes</i> bacterium oral taxon 272, <i>Parvimonas micra</i>, <i>Olsenella profusa</i>, <i>Streptococcus anginosus</i>, <i>Lactobacillus rhamnosus</i>, <i>Porphyromonas endodontalis</i>, <i>Pseudoramibacter alactolyticus</i>, <i>Fusobacterium nucleatum</i>, <i>Eubacterium brachy</i> and <i>Solobacterium moorei</i>. The Wilcoxon rank test revealed no significant differences in relative abundances of functional genes in both groups. Genes with greater relative abundances (top 25) were associated with genetic, signalling and cellular processes including the iron and peptide/nickel transport system. Numerous genes encoding toxins were identified: exfoliative toxin, haemolysins, thiol-activated cytolysin, phospholipase C, cAMP factor, sialidase, and hyaluronic glucosaminidase.</p> <h2>Conclusions</h2> <p>Despite taxonomic differences between primary and secondary apical periodontitis, the functional capability of the microbiomes was similar.</p> https://www.123dentist.com/123dentist-and-altima-dental-announce-a-strategic-merger-with-support-from-peloton-capital-kkr-and-heartland-dental/ 123Dentist urn:uuid:cdbbd46f-e88a-722c-8aa0-3bef9151b0d1 Tue, 12 Jul 2022 03:00:00 -0700 <p>123Dentist combines with Altima Dental and Lapointe Group, solidifying its position as one of the largest dental support organizations in Canada</p> <p>The post <a rel="nofollow" href="https://www.123dentist.com/123dentist-and-altima-dental-announce-a-strategic-merger-with-support-from-peloton-capital-kkr-and-heartland-dental/">123Dentist and Altima Dental Announce a Strategic Merger with Support from Peloton Capital, KKR, and Heartland Dental</a> appeared first on <a rel="nofollow" href="https://www.123dentist.com">123Dentist</a>.</p> https://www.123dentist.com/123dentist-named-one-of-canadas-best-managed-companies/ 123Dentist urn:uuid:fcdf2ca8-e613-56e0-5653-e78102f45969 Tue, 10 May 2022 10:40:10 -0700 <p>Now in its 29th year, Canada’s Best Managed Companies remains one of the country’s leading business awards programs recognizing Canadian-owned and managed companies for innovative, world-class business practices. </p> <p>The post <a rel="nofollow" href="https://www.123dentist.com/123dentist-named-one-of-canadas-best-managed-companies/">123Dentist Named One of Canada’s Best Managed Companies</a> appeared first on <a rel="nofollow" href="https://www.123dentist.com">123Dentist</a>.</p> https://www.123dentist.com/our-mission-vision-values-and-culture/ 123Dentist urn:uuid:84f9419d-5f14-3404-fd3b-9192c26ba26e Thu, 13 Jan 2022 10:52:59 -0700 <p>A word about our mission, vision, values and culture at 123Dentist from our CEO, Dr. Amin Shivji and Vice President of Human Resources, Sandra Morrison 123Dentist is based and founded on customer service and patient care. What began in 1993 with a single clinic in Vancouver has become Canada’s largest majority Dentist-owned network of dental [&#8230;]</p> <p>The post <a rel="nofollow" href="https://www.123dentist.com/our-mission-vision-values-and-culture/">A word about our mission, vision, values and culture from our CEO and VP of Human Resources</a> appeared first on <a rel="nofollow" href="https://www.123dentist.com">123Dentist</a>.</p> https://www.123dentist.com/working-at-123dentist-a-word-from-our-employees/ 123Dentist urn:uuid:51e87d25-138a-1e45-21ec-09b5f2f91dcd Thu, 13 Jan 2022 10:46:07 -0700 <p>123Dentist is a great place to work. But don&#8217;t take our word for it. Listen to some kind words from our team members and what it&#8217;s like working at 123Dentist. “If you want a great, fun environment to work in, a place to learn, grow and feel supported, then 123Dentist could be a great opportunity [&#8230;]</p> <p>The post <a rel="nofollow" href="https://www.123dentist.com/working-at-123dentist-a-word-from-our-employees/">Working at 123Dentist &#8211; A word from our Employees</a> appeared first on <a rel="nofollow" href="https://www.123dentist.com">123Dentist</a>.</p> https://www.123dentist.com/a-better-patient-experience-with-the-epic-hygiene-dental-laser/ 123Dentist urn:uuid:21213c5a-216c-17db-fca4-45cd35fe194a Mon, 20 Dec 2021 18:11:16 -0700 <p>Stony Plain Dental Centre, a member of 123Dentist, one of Canada’s largest majority dentist-owned network of dental practices, has been serving the Stony Plain community in Alberta, Canada, since 1999.  Over the years, Stony Plain Dental has encouraged its team to grow with continuing education, training, advances in dental technology, and communication skills to better serve [&#8230;]</p> <p>The post <a rel="nofollow" href="https://www.123dentist.com/a-better-patient-experience-with-the-epic-hygiene-dental-laser/">A Better Patient Experience With The Epic Hygiene Dental Laser</a> appeared first on <a rel="nofollow" href="https://www.123dentist.com">123Dentist</a>.</p> https://www.123dentist.com/123-dentist-presents-history-braces/ 123Dentist urn:uuid:7052a99b-b078-175a-c206-549a8017baa4 Fri, 01 Oct 2021 06:00:46 -0700 <p>It&#8217;s almost hard to remember a time when braces weren&#8217;t metal wires fastened to your teeth, but Invisalign is helping to make the past feel more distant. Now dentists and patients have a better option, one that achieves the same result without the downside. Invisalign costs about the same as regular braces, treatment takes around [&#8230;]</p> <p>The post <a rel="nofollow" href="https://www.123dentist.com/123-dentist-presents-history-braces/">123Dentist Presents: The History of Braces</a> appeared first on <a rel="nofollow" href="https://www.123dentist.com">123Dentist</a>.</p> https://www.123dentist.com/123dentist-gives-cdi-college-15000-reasons-to-smile/ 123Dentist urn:uuid:1a81b059-d13b-63df-d707-a160f2392b14 Fri, 27 Aug 2021 17:21:56 -0700 <p>123Dentist presented a number of completion scholarships to CDI College graduates from the Dental Assisting and Dental Receptionist programs during an awards luncheon on August 9, 2021. $15,000 worth of scholarships were awarded to twelve CDI College graduates from Burnaby and Surrey campuses. “We are tremendously proud to partner with and support the growth of [&#8230;]</p> <p>The post <a rel="nofollow" href="https://www.123dentist.com/123dentist-gives-cdi-college-15000-reasons-to-smile/">123Dentist Gives CDI College $15,000 Reasons to Smile</a> appeared first on <a rel="nofollow" href="https://www.123dentist.com">123Dentist</a>.</p>