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.70019?af=R International Endodontic Journal urn:uuid:3827d693-d3a9-e35d-a9f4-c516c93fc49d Fri, 22 Aug 2025 11:34:57 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Aim</h2> <p>Successful root canal treatment (RCT) is necessary for managing pulpal and periapical disease. The technical quality of RCT affects its outcome. Recognising complicating factors can be important to optimising outcomes. The aims of this study were to compare the practitioner reported case difficulty before and after completion of RCT; and to determine whether any case difficulty items were associated with complications encountered while performing the RCT.</p> <h2>Methodology</h2> <p>One hundred and four general dentists (GDs) and 49 endodontists enrolled 1860 patients needing RCT, April to September 2017. Both before RCT and upon its completion, practitioners used a 10-point scale to rate the RCT's case difficulty (Difficulty Rating [DR]). Then they used a modified Case Difficulty Assessment Form (CDAF) to record the items for difficulty using the form's list of 10 provided choices. We related practitioners' pre-RCT CDAF items to their DR ratings and to the procedural complications that they subsequently experienced during this RCT. General estimating equations (GEE) were used to assess the significance of differences in proportions between GDs and endodontists. Non-parametric tests were used to analyse compositive variables.</p> <h2>Results</h2> <p>Data of 1,698 patients were available for CDAF analyses. The mean CDAF was higher for endodontists than GDs (<i>p</i> &lt; 0.001). Pre- and post-RCT DRs were significantly correlated (<i>r</i> = 0.79, <i>p</i> &lt; 0.001), as were pre-RCT DR and the number of reported CDAF difficulties (<i>r</i> = 0.57, <i>p</i> &lt; 0.001). Overall, practitioners encountered complications in treating 16% of patients. The complications were length of obturation &gt; 2 mm from radiographic apex or beyond apex, canals not negotiable within 2 mm of apex, instrument separation, inadvertent filing/file placement past root apex, and perforation. Several CDAF items were independently predictive of complications. Despite the higher CDAF in teeth treated by endodontists, complications were less frequent among endodontists compared to GDs (13% vs. 19%, <i>p</i> &lt; 0.001).</p> <h2>Conclusions</h2> <p>Pre-RCT assessments predicted intra-operative difficulties and outcomes. Our work underscores the need for targeted assessment tools and specialised training to improve RCT, especially in complex cases treated by GDs.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.70017?af=R International Endodontic Journal urn:uuid:90835e08-b720-22ca-d686-952695522779 Fri, 15 Aug 2025 05:25:53 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Aim</h2> <p>To identify differentially expressed proteins (DEPs) in dentinal fluid across a range of pulpal inflammatory stages—mild, moderate, severe pulpitis—using mass spectrometry.</p> <h2>Methodology</h2> <p>This cross-sectional study analysed dentinal fluid from 60 patients categorised into healthy pulp (control), mild, moderate and severe pulpitis groups, based on Wolters' pulp diagnostic criteria. Pulp conditions were assessed through cold sensibility tests and radiographs, with inclusion limited to patients aged 12–40, who were systemically healthy and exhibited no advanced periodontal or apical pathology. Dentinal fluid was collected under aseptic conditions, stored at −80°C and pooled into 12 representative samples for proteomic analysis. Proteins were extracted using lysis buffers and processed via LC–MS/MS with label-free quantification (LFQ) to identify DEPs. Enrichment analysis and protein–protein interaction (PPI) networks were conducted using Gene Ontology (GO), KEGG databases and STRING, with hub proteins identified using cytoscape. Statistical analysis employed Bayesian t-tests and linear models to evaluate protein expression, with a significance threshold of <i>p</i> &lt; 0.05.</p> <h2>Results</h2> <p>The severe pulpitis group exhibited the highest prevalence of systemic diseases (40%) compared with other groups (6.6%). LC–MS/MS identified 577 proteins, with 62 consistently quantified across the groups. The number of DEPs increased with inflammation severity, with 13 DEPs in severe pulpitis compared with controls. Principal component analysis (PCA) revealed partial separation between control and severe inflammation groups, with significant overlap between mild and moderate stages. Functional enrichment identified key biological pathways, including immune response, energy metabolism and structural integrity. Proteins such as cofilin-1, haemoglobin subunit alpha and peroxiredoxin-1 were upregulated in severe inflammation, while hornerin and myosin light chain 6 were downregulated. These findings highlight proteomic changes associated with pulpitis progression and identify potential prognostic biomarkers and therapeutic targets.</p> <h2>Conclusions</h2> <p>This study identified distinct proteomic differences across pulpitis stages, with unique proteins in severe cases. These findings highlight novel biomarkers for advancing precise, cost-effective, point-of-care diagnostics and therapies, including multiplex platforms or ELISA assays. Proteomic analysis shows promise for understanding disease mechanisms and enabling personalised treatment strategies in endodontics.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.70015?af=R International Endodontic Journal urn:uuid:e000d4f9-1359-aaf0-c764-a0933d4460e9 Wed, 13 Aug 2025 10:30:52 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Introduction</h2> <p>To evaluate the antimicrobial activity and changes in community composition in biofilms treated with two root canal sealers or calcium hydroxide.</p> <h2>Material and Methods</h2> <p>Forty-nine extracted bovine dentine cylinders were inoculated with subgingival dental plaque for 2 weeks in a CDC biofilm reactor. Three treatment groups were assigned: AH Plus, BC Sealer, and calcium hydroxide. Propylene glycol inert vehicle (PG) and untreated contaminated samples were used as controls. The infected root canal space was in direct contact with the materials for 7 days under anaerobic incubation. Anaerobic culture (colony forming units, CFU), quantification PCR (qPCR), and next generation sequencing were used to assess the effect of each material. Differences in the number of molecules (qPCR), CFU, and abundances of genera were evaluated using the Kruskal–Wallis test. The Shannon and Chao1 indices were used to measure alpha diversity. Differences in community composition were evaluated using non-parametric analysis of similarity (ANOSIM).</p> <h2>Results</h2> <p>The CFU, Shannon, and Chao1 indices revealed significant differences between BC Sealer, AH Plus, and calcium hydroxide groups versus the untreated control group and PG (<i>p</i> &lt; 0.003). Calcium hydroxide and BC Sealer significantly reduced the qPCR values compared to the control group and PG. The biofilm composition (98.5%) was primarily composed of <i>Peptostreptococcus</i>, <i>Streptococcus</i>, <i>Parvimonas</i>, <i>Fusobacterium</i>, <i>Veillonela</i>, <i>Mogibacterium</i>, <i>Lancefieldella</i>, <i>Eubacterium</i>, <i>Slackia</i>, and <i>Prevotella</i>. Significant differences in overall community composition and beta diversity between untreated controls and AH Plus were observed (ANOSIM <i>R</i> = 0.674, <i>p</i> &lt; 0.001). <i>Parvimonas</i>, <i>Streptococcus</i>, <i>Eubacterium</i>, and <i>Lancefieldella</i> were not affected by any of the materials tested.</p> <h2>Conclusion</h2> <p>Calcium hydroxide and BC Sealer significantly reduced the viability and the total number of DNA copies. AH Plus sealer reduced the bacterial viability but did not affect the DNA concentration. AH Plus significantly alters overall biofilm community composition compared to other groups. None of the materials tested eliminated the multispecies biofilm completely.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.70013?af=R International Endodontic Journal urn:uuid:d4043062-dc89-a2cd-9239-ee26f8af541b Wed, 13 Aug 2025 09:09:24 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Aim</h2> <p>The primary objective of this clinical study was to analyse, through physiological and psychological parameters, undergraduate dental student stress during the management of deep compared with moderate carious lesions. Additional objectives aimed to compare student confidence, anxiety and satisfaction during deep and moderate caries management and their perception of the quality of teaching they received regarding these treatments.</p> <h2>Methodology</h2> <p>In this crossover study, 35 clinical students treated deep and moderate caries on permanent vital teeth in adult patients with no history of spontaneous pain. The STAI-State (STAI-S) anxiety questionnaire was completed preoperatively. Stress-VAS (visual analogic scale) and confidence-VAS scores were collected during the preoperative (before anaesthesia), perioperative (end of caries excavation) and postoperative (after patient left) phases of both caries management. Cardiovascular parameters (blood pressure and heart rate) were collected during the same stages. A satisfaction-VAS was completed postoperatively. The effects of the depth of the caries, time and student demographics on preoperative anxiety (STAI-S), pre-, peri- and postoperative stress, confidence, blood pressure and heart rate, as well as postoperative satisfaction, were assessed using Mixed ANOVA with multiple pairwise comparisons. The statistical analysis was performed with IBM SPSS. A questionnaire assessing teaching adequacy was completed after each treatment.</p> <h2>Results</h2> <p>The treatment of deep caries led to a significantly higher level of stress and a significantly lower level of confidence among students than the treatment of moderate caries, pre-, per- and post-operatively (<i>p</i> ≤ 0.05). Student preoperative anxiety was significantly higher in cases of deep caries, and their post-operative satisfaction was significantly lower. However, there was no significant difference between the two groups in terms of cardiovascular parameters at any stage. There was no influence of the student year of study on the parameters examined; however, gender influenced confidence at all times combined, as well as preoperative stress, with females less confident and more stressed than males. The median level of perceived teaching ‘adequacy’ was higher for moderate caries than for deep caries.</p> <h2>Conclusions</h2> <p>Within the limits of this study, the management of deep carious lesions is associated with a higher level of stress among students compared with moderate caries.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14268?af=R International Endodontic Journal urn:uuid:ce6f7a3f-fe50-a5e2-b5da-4db2a2f7a3d7 Mon, 11 Aug 2025 08:54:51 -0700 International Endodontic Journal, Volume 58, Issue 9, Page 1474-1487, September 2025. <h2>Abstract</h2> <h2>Aim</h2> <p>This case report explored the application of next-generation sequencing (NGS) and fluorescence in situ hybridization (FISH) to visualize and characterize microbial populations in a refractory endodontic infection with apical calculus-like deposits, a rarely reported phenomenon.</p> <h2>Summary</h2> <p>Histopathologic analysis revealed bacterial biofilms and calcifications on the root surface, with Gram-positive bacteria predominant in both hard and soft tissues. Microbial sequencing showed <i>Pseudomonadota</i> dominated hard tissues, whereas <i>Bacillota</i> were prevalent in soft tissues, with distinct genera like <i>Lactibacterium</i> and <i>Streptococcus</i> identified. FISH imaging confirmed spatially distributed bacterial taxa, including <i>Actinomycetota</i> and <i>Chloroflexota</i>, within the biofilm, aligning with NGS findings. Notably, <i>Bacteroidota</i> was exclusive to soft tissues, whereas <i>Chloroflexota</i> was detected only in hard tissues. The presence of extensive calculus-like deposits on the root surface provided new insights into the microbial complexity of persistent endodontic infections and their management.</p> <h2>Key learning points</h2> <p> The combination of NGS and FISH provided unprecedented insights into the microbial composition of refractory endodontic infections, revealing a diverse and spatially organized ecosystem. Distinct microbial compositions in hard and soft tissues emphasize the importance of targeted therapeutic strategies for endodontic infections. The presence of unique bacterial taxa and biofilms in calculus-like deposits offers new avenues for research into the pathogenesis and persistence of endodontic infections. </p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14093?af=R International Endodontic Journal urn:uuid:b30fb492-5426-d16e-0c03-fe0df2df6f25 Mon, 11 Aug 2025 08:54:51 -0700 International Endodontic Journal, Volume 58, Issue 9, Page 1281-1281, September 2025. https://onlinelibrary.wiley.com/doi/10.1111/iej.14225?af=R International Endodontic Journal urn:uuid:a23a6906-1c04-f205-afcb-29be2b5843d6 Mon, 11 Aug 2025 08:54:51 -0700 International Endodontic Journal, Volume 58, Issue 9, Page 1289-1300, September 2025. <h2>Abstract</h2> <p>The influence of gender is underexplored in endodontic educational research. This review examines the effect of gender on learning within the domains of skill acquisition, performance and difficulties encountered. It also analyses the stress and confidence experienced by male and female students during clinical endodontics, as well as their preparedness at the end of their undergraduate studies. Finally, this review analyses the influence of gender on student career choices in dentistry with a focus on endodontics. The review highlights that gender is invariably studied as a secondary outcome in endodontic education. Based on current evidence, it appears that female students tend to underestimate their skills and knowledge more than male counterparts in endodontics. They are also often more stressed than males, feeling less confident and not as prepared. A recognition of gender differences in learning and stress management is important. Student aspirations regarding their choice of endodontic postgraduate speciality appear to be relatively well balanced in terms of gender. Finally, there is a need for further research to elucidate more clearly the impact of gender in endodontic education and endodontic career choice.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14261?af=R International Endodontic Journal urn:uuid:f2273a59-dd11-7a50-dd2e-1a713ae800ed Mon, 11 Aug 2025 08:54:51 -0700 International Endodontic Journal, Volume 58, Issue 9, Page 1354-1383, September 2025. <h2>Abstract</h2> <h2>Background</h2> <p>Bioactive molecules have gained significant attention in regenerative medicine due to their ability to boost the reparative properties of stem cells, including those in the dental pulp. This narrative review aims to deepen our understanding of the dynamics of bioactive molecules in the dental pulp and their role in enhancing hard tissue reparative processes.</p> <h2>Objectives</h2> <p>(i) To discuss the role of different cells and the critical pathways involved in dentine formation through direct (reparative) or indirect (infection control and immunomodulatory) mechanisms. (ii) To highlight how innovative therapeutic strategies could be employed to target key molecules for successful dentine repair and regeneration.</p> <h2>Methods</h2> <p>The review encompassed all years up to the search period. Databases such as PubMed, Scopus and Medline were utilized to gather relevant studies. The search strategy involved specific signalling molecules such as Transforming growth factor-β1 (TGF-β), Bone Morphogenetic Proteins (BMP), Small Integrin Binding Ligand N-linked Glycoproteins (SIBLING) and growth factors. Cell types including odontoblasts, fibroblasts, immune cells and dental pulp stem cells (DPSCs) were of interest. Additionally, signalling pathways like Wnt, Notch, Shh, amongst others, were investigated for their roles in repair mechanisms. Key terms were combined using Boolean operators [Cell type] AND [signalling molecules] AND/OR [dentine], [Cell type] AND/OR [signalling pathways] AND/OR [dentine] to include studies addressing the interaction of these components in enhancing repair processes.</p> <h2>Discussion</h2> <p>Key molecules such as TGF-β1, BMP and SIBLING proteins effectively enhance the dentine reparative response, whilst other molecules such as complement proteins and antimicrobial peptides primarily activate immune cells and facilitate pathogen clearance to promote the regenerative capabilities of DPSCs. This well-orchestrated interaction emphasizes the need to investigate the effects of these molecules on all cells within the dental pulp. Morphogenic signalling molecules such as BMP-2, -4 and -7, and Wnt show temporal, yet significant regenerative properties, whilst Shh and Notch present inconsistent effects on dentine regeneration, and a consensus on their roles and properties in dentine repair has yet to be reached.</p> <h2>Conclusions</h2> <p>This review highlights the critical role of bioactive molecules in dentine repair to guide the development of next-generation bioinspired therapeutics for vital pulp therapy.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14269?af=R International Endodontic Journal urn:uuid:dfef932c-39e5-64dd-b9d7-af0af063e6bf Mon, 11 Aug 2025 08:54:51 -0700 International Endodontic Journal, Volume 58, Issue 9, Page 1384-1407, September 2025. <h2>Abstract</h2> <h2>Background</h2> <p>Dental pulp is a richly vascularised and innervated tissue vital for tooth vitality, sensory function, and structural integrity. While conventional root canal therapy effectively treats necrotic permanent teeth, it irreversibly eliminates pulp vitality, potentially increasing the risk of secondary infections and long-term structural compromise. In response, regenerative endodontics has emerged as a biologically favourable alternative that seeks to restore the pulp–dentine complex using principles of tissue engineering.</p> <h2>Objectives</h2> <p>This review aims to explore the therapeutic potential and mechanisms of action of exosomes derived from dental stem cells (DSC-Exos), a subclass of mesenchymal stem cells (MSCs), in promoting regeneration of the pulp–dentine complex, while also addressing translational challenges and proposing an integrated regenerative framework.</p> <h2>Methods</h2> <p>A comprehensive literature search was conducted across Web of Science, PubMed, and Scopus databases using keywords associated with “stem cells,” “exosomes,” “extracellular vesicles,” and “dental pulp regeneration.” Titles and abstracts were screened, and eligible studies were selected based on predefined inclusion criteria: (a) original research or case reports focusing on DSC-Exos in regenerative endodontics, (b) in vitro and in vivo studies, and (c) clinical trials or animal studies showing pulp-like tissue development. Studies not fulfilling these criteria were excluded. A total of 67 articles were included for narrative synthesis.</p> <h2>Results</h2> <p>DSC-Exos were found to facilitate multiple regenerative functions: promoting odontoblastic differentiation and dentine mineralisation, enhancing angiogenesis, regulating inflammation, modulating immune responses, promoting cell proliferation and migration, reducing apoptosis and senescence, and supporting neuroprotection. In-vivo studies demonstrated pulp-like tissue formation, revascularisation, and functional restoration. However, heterogeneity in exosome isolation, culture conditions, donor variability, and unclear molecular pathways remain unresolved issues.</p> <h2>Discussion</h2> <p>DSC-Exos present a promising acellular, immunologically safer approach to regenerative endodontics compared to direct stem cell transplantation. Despite their potential, the lack of standardised methodologies and incomplete understanding of their molecular interaction with odontoblasts hinders clinical translation. Integration of exosomes with scaffolds, growth factors, and endogenous cues may enhance regenerative efficacy.</p> <h2>Conclusions</h2> <p>DSC-Exos represent a novel frontier in regenerative endodontics. This review proposes a triangular framework encompassing DSCs, exosomes, signalling molecules, scaffolds, and the dentine microenvironment to support a holistic and clinically translatable model for pulp–dentine complex regeneration.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14266?af=R International Endodontic Journal urn:uuid:2d9c1e10-1a8d-6ae4-b660-83e3b53502f8 Mon, 11 Aug 2025 08:54:51 -0700 International Endodontic Journal, Volume 58, Issue 9, Page 1331-1353, September 2025. <h2>Abstract</h2> <h2>Background</h2> <p>Studies based on next-generation sequencing (NGS) have reported conflicting evidence regarding the presence of <i>Enterococcus</i> in root canal infections.</p> <h2>Objective</h2> <p>To determine whether <i>Enterococcus</i> prevalence differs among secondary root canal infection (SRCI), persistent root canal infection (PRCI) and primary root canal infection (PrRCI).</p> <h2>Methods</h2> <p>Literature search was carried out across databases (PubMed, Web of Science, Scopus and Excerpta Medica Database) and other online resources from 1 September 2005, to 24 October 2024. Studies were selected according to inclusion and exclusion criteria. Risk of bias was evaluated according to the JBI Prevalence Critical Appraisal Checklist. The selection of 28 studies focused on the main and secondary outcomes. Pooled estimates of Odds Ratio (OR), prevalence and 95% Confidence Interval (CI) were determined with a common effect or random effects model. Multivariate meta-regression models were fitted. Subgroup analyses were conducted based on sample collection method, region and NGS platform. Sensitivity analysis was conducted to further investigate the robustness of results and to explore plausible causes for heterogeneity.</p> <h2>Results</h2> <p>Among 28 included studies, 16 studies reporting the detection rate of <i>Enterococcus</i> were incorporated in the meta-analysis. The detection rate of <i>Enterococcus</i> was significantly higher in SRCI than in PrRCI (OR = 2.691; 95% CI: 1.234–5.868; <i>p</i> = .013). The pooled prevalences were 0.400 (95% CI: 0.235–0.565) for SRCI, 0.444 (95% CI: 0.000–0.976) for PRCI and 0.278 (95% CI: 0.087–0.470) for PrRCI, respectively. Within the PrRCI group, the cryogenic pulverization (CP) method yielded a significantly higher detection rate (0.768; 95% CI: 0.642–0.894) than the paper points/hand or rotary instruments (PP) method (0.113; 95% CI: 0.045–0.180). The relative abundance of <i>Enterococcus</i> ranged from 0.01% to 18.88% in SRCI, 2% to 10.5% in PRCI and 0.0008% to 2.03% in PrRCI.</p> <h2>Discussion</h2> <p>Although a quantitative synthesis of <i>Enterococcus</i> prevalence has been conducted, the data of abundance remain insufficient in literatures.</p> <h2>Conclusion</h2> <p>A higher prevalence of <i>Enterococcus</i> was correlated with SRCI and PRCI compared to PrRCI. Sample collection method had a significant impact on the prevalence of <i>Enterococcus</i> in the PrRCI context. <i>Enterococcus</i> seems not to be a predominant genus in most studies based on its relatively low abundance.</p> <h2>Registration</h2> <p>PROSPERO database CRD42024609984.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14212?af=R International Endodontic Journal urn:uuid:daa199c3-b1f1-581b-0fe4-dc7156742db3 Mon, 11 Aug 2025 08:54:51 -0700 International Endodontic Journal, Volume 58, Issue 9, Page 1313-1320, September 2025. <h2>Abstract</h2> <h2>Aim</h2> <p>Leadership opportunities within professional fields often include invitations to speak at major organizational meetings. However, the representation of speakers from underrepresented groups at annual scientific meetings of endodontic organizations has yet to be documented. This observational study aimed to evaluate the percentage of women invited to speak at selected endodontic organization meetings.</p> <h2>Methodology</h2> <p>The number of male and female keynote or invited speakers at the European Society of Endodontology (ESE), Asian Pacific Endodontic Confederation (APEC), and International Federation of Endodontic Associations (IFEA) conferences from 2013 to 2023 were recorded. A chi-square test was conducted to assess differences in the percentage of women speakers over time and among the three organizations.</p> <h2>Results</h2> <p>A total of 714 keynote and invited speakers from the scientific meetings of the three endodontic organizations between 2013 and 2023 met the inclusion criteria. Of these, 601 (84.17%) were men, and 113 (15.83%) were women, reflecting a significant gender disparity (<i>p</i> &lt; 0.001). No significant differences were observed between the organizations, nor was there a significant change in the number of women speakers over time.</p> <h2>Conclusions</h2> <p>Regardless of the organization or the timeframe, the number of women speakers at scientific meetings remains consistently lower than that of men, with no significant change observed over the past decade.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14237?af=R International Endodontic Journal urn:uuid:d7b1d51c-5ffc-c155-22b0-53b0db2b2e4a Mon, 11 Aug 2025 08:54:51 -0700 International Endodontic Journal, Volume 58, Issue 9, Page 1301-1312, September 2025. <h2>Abstract</h2> <h2>Aim</h2> <p>To explore gender distribution within the field of Endodontology in Europe and to evaluate the representation of women in executive and academic roles within scientific societies as well as national and international conferences.</p> <h2>Methodology</h2> <p>After ethical approval, an online questionnaire was developed and shared with the European Society of Endodontology and the 36 national Endodontic societies officially affiliated. The survey inquired about gender composition amongst members, executive committee roles, participation in major congresses and representation in leadership and authorship positions within scientific journals affiliated with these societies over the last 5 years. Information was also retrieved from publicly available websites. Genders of the first, last and corresponding authors from scientific journals were identified. The relative ratio of women amongst society members, executive committee roles, participation in major congresses and representation in leadership and authorship positions within scientific journals was calculated. The ratio of women in leadership positions was statistically compared with the mean relative ratio of women amongst society members using a one-sample t-test. The current proportion of women in individual roles was compared with the general proportion of women members using the Binomial test.</p> <h2>Results</h2> <p>Women account for 44% of members in endodontic societies. No significant discrepancy was observed in the overall representation of women as members in executive or editorial committees or in authorship positions within scientific journals in relation to the mean relative ratio of female society members but are significantly underrepresented in key positions such as society presidents, treasurers and scientific event organizers (<i>p</i> &lt; .05). Additionally, women were significantly underrepresented at scientific events, both as lecturers and workshop leaders, at major congresses of national/international societies (<i>p</i> &lt; .05). Few initiatives have been implemented to address these inequities; only three societies reported programmes aimed at promoting women in leadership or scientific roles.</p> <h2>Conclusions</h2> <p>Within the limitations of this study, women appear to be fairly represented as members of executive and editorial committees in national endodontic societies and the ESE, as well as in authorship positions within scientific journals, but underrepresentation of women in positions of power and scientific forums persists. Some countries have begun implementing strategic measures to promote gender equity.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14264?af=R International Endodontic Journal urn:uuid:3aadec1b-7232-385b-bf9a-8825b77ee185 Mon, 11 Aug 2025 08:54:51 -0700 International Endodontic Journal, Volume 58, Issue 9, Page 1408-1419, September 2025. <h2>Abstract</h2> <h2>Aim</h2> <p>Information regarding differences between general dentists (GDs) and endodontists in their daily practices is limited. The aim of this prospective cohort clinical study was to compare the details of clinical approaches of GDs and endodontists when performing non-surgical root canal treatments (NSRCT).</p> <h2>Methodology</h2> <p>The study was conducted among 153 practitioners (104 GDs and 49 endodontists) in the National Dental Practice-Based Research Network in the United States who performed NSRCT on at least one of 1705 patients. Practitioners completed postoperative forms to document procedural data. Bivariate and multivariable analyses were performed to adjust for the potential effect of confounders. Two different multivariable models were tested to eliminate the impact of unstable variables.</p> <h2>Results</h2> <p>Overall, after adjusting for the tooth type, multivariable models showed that endodontists were significantly more likely than GDs to use magnifications &gt;5×, rubber dam isolation, NaOCl irrigation, EDTA or H₂O₂ or chlorhexidine irrigations, ultrasonic/sonic irrigant activation, electronic apex locator and radiographs for working length determination, warm vertical condensation and lateral condensation techniques for obturation, report adequately dense obturation without voids, and to complete NSRCT in a single visit (<i>p</i> ≤ .01). Endodontists were significantly less likely to use lubricants and to report unacceptable obturation length (≥2 mm short or extended beyond the radiographic apex) (<i>p</i> ≤ .01).</p> <h2>Conclusions</h2> <p>Based on actual clinical data, this study observed major differences between GDs and endodontists in their clinical approaches when performing NSRCTs. Further studies are needed to assess the effect of these differences on the outcome of NSRCTs.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14187?af=R International Endodontic Journal urn:uuid:e154f1c7-6966-6f12-2127-7da8b83023c3 Mon, 11 Aug 2025 08:54:51 -0700 International Endodontic Journal, Volume 58, Issue 9, Page 1321-1330, September 2025. <h2>Abstract</h2> <h2>Aim</h2> <p>To evaluate the presence of women on editorial boards and as authors in leading global endodontics journals from 2018 to 2023.</p> <h2>Methodology</h2> <p>The selection of journals was based on the impact factor from Journal Citation Reports (JCR) and CiteScore 2022, with criteria of JCR above 1 and CiteScore above 1.5. Editorial board members were categorized as editor-in-chief and associate editor. Authorship was categorized into first, last, and corresponding author roles. The names of editorial board members and authors were extracted into an Excel spreadsheet, and gender analysis was conducted using the platforms Genderize, PubMed, Scopus, ResearchGate, and author's affiliated institutions' websites, categorized in a binary way. Descriptive statistics were used to analyse the data on the editorial board. A Poisson regression analysis was performed to investigate the prevalence ratio (PR) of female authorship compared with male authorship in the roles of first, last, and corresponding author. The Chi-square test was performed to evaluate the associations between female authors in prominent positions and the presence of other female authors.</p> <h2>Results</h2> <p>A total of four journals were analysed, identifying 24 editors-in-chief and 233 associate editors. None of the editor-in-chief were women, and 23 (9.8%) of the associate editors were female. Amongst the 8965 authors identified, 2983 (33.2%) were female: 1288 (41.1%) were first authors, 827 (27.7%) were last authors and 928 (31.1%) were correspondence authors. The PR for female corresponding authors was higher in AEJ than in JOE (1.07 [CI 1.03–1.11]), whilst the PR for female first authors was lower in IEJ than in JOE (0.96 [CI 0.93–0.99]). There was a lower PR for women as first authors in 2018 (0.94 [CI 0.90–0.99]) and as first (0.94 [CI 0.90–0.98]) and last (0.94 [CI 0.90–0.98)] authors in 2019 compared with 2023. The presence of women in prominent authorship positions was associated with increased female authorship in other positions (<i>p</i> &lt; .01).</p> <h2>Conclusion</h2> <p>Female participation on editorial boards and as prominent authors in leading journals is low, indicating significant challenges. Increasing female presence in prominent authorship roles may lead to greater female participation in other authorship positions.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14262?af=R International Endodontic Journal urn:uuid:b564ba36-217c-9ff7-d99b-b9eb903a6820 Mon, 11 Aug 2025 08:54:51 -0700 International Endodontic Journal, Volume 58, Issue 9, Page 1433-1455, September 2025. <h2>Abstract</h2> <h2>Aim</h2> <p>Elucidating the mechanism of osteo/odontogenic differentiation of human dental pulp stem cells (hDPSCs) is crucial for advancing regenerative endodontic procedures (REPs). Circular RNAs (circRNAs) play significant regulatory roles in stem cell differentiation, and exosomes are crucial for intercellular communication. This study investigated the role of exosomal circRNAs in hDPSCs during osteo/odontogenic differentiation using in vitro and in vivo evidence.</p> <h2>Materials and Methods</h2> <p>We isolated hDPSCs from dental pulp tissues of healthy immature permanent teeth. CircRNA microarray analysis was used to identify differentially expressed circRNAs. Exosomes were extracted from hDPSCs using ultracentrifugation, and circRNA content was detected. Functional validation of exosomal circRNAs was performed using siRNA/overexpression plasmids and subcutaneous transplantation in to nude mice. The biological effects of circ_0003057, EIF4A3 and ANKH were determined using real-time quantitative polymerase chain reaction (qRT-PCR), western blotting (WB), alkaline phosphatase (ALP) staining and activity, alizarin red staining (ARS), quantification and immunofluorescence staining. EIF4A3 was identified as a potential binding protein (RBP) for circ_0003057 in the database, and this binding relationship was confirmed using RNA pull-down and RIP assays. qRT-PCR and WB were performed to determine whether the host gene ANKH of circ_0003057 was activated.</p> <h2>Results</h2> <p>circ_0003057 expression was increased during osteo/odontogenic differentiation of hDPSCs, whereas circ_0003057 downregulation suppressed this process. EIF4A3 was confirmed to be a binding protein of circ_0003057 and was upregulated during osteo/odontogenic differentiation of hDPSCs. Further investigation revealed that circ_0003057 upregulation during osteo/odontogenic differentiation led to the upregulation of its parental gene, ANKH. Co-transfection experiments confirmed that circ_0003057 upregulated ANKH, promoting osteo/odontogenic differentiation of hDPSCs.</p> <h2>Conclusions</h2> <p>This study demonstrates that exosomal circ_0003057 promotes osteo/odontogenic differentiation of hDPSCs by interacting with EIF4A3 and upregulating ANKH, providing new insights into the molecular mechanisms underlying this process and its potential applications in regenerative endodontics.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14263?af=R International Endodontic Journal urn:uuid:d4dfb293-d593-9e8c-07e2-2d82867fbe7f Mon, 11 Aug 2025 08:54:51 -0700 International Endodontic Journal, Volume 58, Issue 9, Page 1456-1473, September 2025. <h2>Abstract</h2> <h2>Aim</h2> <p>Microtubule-associated protein 1B (MAP1B), an important regulator of the cytoskeleton, has been shown to be associated with osteoblast migration; however, its role in human dental pulp cells (hDPCs) has not been reported. In this study, the effects of MAP1B on hDPCs and their molecular mechanisms were investigated.</p> <h2>Methodology</h2> <p>Histological staining was performed to investigate the expression of MAP1B in human dental pulp and mouse dentine injury models. MAP1B expression was knocked down in hDPCs to explore its effect on the biological behaviour of hDPCs. RNA-seq was used to explore the specific mechanism of MAP1B regulation in the cells. Then, exogenous C-X-C motif chemokine ligand 12 (CXCL12) supplementation was performed to determine whether MAP1B regulated hDPCs through CXCL12. Finally, co-immunoprecipitation, immunofluorescence staining, and p53 knockdown experiments were conducted to determine whether MAP1B regulates CXCL12 expression through direct interaction with p53. A <i>t</i>-test or a one-way ANOVA test of variance followed by post hoc Dunnett's tests were performed to compare the treatment group means. Values of <i>p</i> &lt; .05 were considered indicative of statistical significance.</p> <h2>Results</h2> <p>MAP1B was primarily localized in the odontoblast cell layer under physiological conditions but was also expressed in the pulp central area during injury repair. In odontoblast-cultured hDPCs, MAP1B expression was upregulated, whereas MAP1B downregulation inhibited the differentiation, proliferation and migration of hDPCs. Subsequent experiments confirmed that MAP1B regulates the differentiation and migration, but not the proliferation ability, of hDPCs through CXCL12. Further experiments showed that MAP1B influences CXCL12 expression by interacting with p53.</p> <h2>Conclusions</h2> <p>MAP1B exhibited a positive regulatory role in the odontogenic potential of hDPCs through the p53/CXCL12 axis.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14265?af=R International Endodontic Journal urn:uuid:641f41d4-3d4f-86fb-5308-f6843f544573 Mon, 11 Aug 2025 08:54:51 -0700 International Endodontic Journal, Volume 58, Issue 9, Page 1420-1432, September 2025. <h2>Abstract</h2> <h2>Aim</h2> <p>Calcium silicate-based sealers (CSSs) have gained popularity in endodontic applications primarily due to their biological properties and ease of use. This study aimed to assess the 24-month efficacy and safety of root canal treatment using a new injectable CSS, BioRoot<i>™</i> Flow, and to demonstrate the non-inferiority compared to the established hand-mixed BioRoot<i>™</i> RCS.</p> <h2>Methodology</h2> <p>This was a multicentric, prospective, randomised, assessor-blinded, controlled, non-inferiority trial (<a target="_blank" title="Link to external resource" href="http://clinicaltrials.gov">ClinicalTrials.gov</a>: NCT04757753). Patients requiring a primary or a secondary root canal treatment on a single or multi-rooted tooth were block randomly assigned to BioRoot Flow or BioRoot RCS groups. The primary outcome was the 24-month success rate based on clinical and radiological criteria. Secondary outcomes included the 6- and 12-month success rates based on similar radiological and clinical criteria, quality of obturation, resorption of extruded material in case of overfilling assessed at 6, 12 and 24 months, post-operative pain measured using the Visual Analog Scale (VAS) at baseline, 12 h, 24 h, 48 h, 72 h and 7 days, and occurrence of adverse events. A subgroup analysis was also performed based on the type of treatment and on the presence or absence of apical periodontitis (AP) at baseline. Non-inferiority between materials was assessed using Dunnett and Gent's Chi-squared (χ²) test, based on an initial hypothesis with a non-inferiority margin set at 13%, an 80% power and a 5% one-sided alpha risk. Investigators and patients were not blinded to the assigned medical device. Two qualified evaluators performed a blinded independent central review of the retro-alveolar radiographs.</p> <h2>Results</h2> <p>A total of 160 patients with a mean age of 48 years were treated (77 in BioRoot Flow and 83 in BioRoot RCS). The 24-month follow-up rate was 85.6%. The overall 24-month success rates were 86.6% and 87.7% (<i>p</i> = .0195), respectively. No significant differences were observed between the groups regarding any of the considered secondary outcomes. No adverse events were reported.</p> <h2>Conclusion</h2> <p>This study demonstrated the non-inferiority of the new injectable CSS (BioRoot Flow) compared to the previous hand-mixed version (BioRoot RCS) in terms of efficacy and safety, supporting the implementation of the new material in clinical practice.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14240?af=R International Endodontic Journal urn:uuid:fb555ee9-fe7c-62af-51d1-48639ff1f258 Mon, 11 Aug 2025 08:54:51 -0700 International Endodontic Journal, Volume 58, Issue 9, Page 1282-1288, September 2025. <h2>Abstract</h2> <p>Gender differences are not often emphasized in endodontic literature, and any impact on endodontic understanding and practice is therefore unknown. In this narrative review, we will examine the broader concept of gender and sex-role stereotypes in relation to uncertainty and seek to identify gaps in endodontic shared decision-making. Gender differences in oral health status and patient and clinician choices are highlighted. The importance of effective communication between men and women in shared decision-making as a future research direction is described. We also propose a systematic approach to identify sources of uncertainty in endodontic treatment, formulate probabilities of favourable and unfavourable outcomes based on available best evidence and take steps to minimize gender bias towards equitable and timely care for patients.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.70011?af=R International Endodontic Journal urn:uuid:77ee4495-bd99-ef66-3402-1014af8fa2db Mon, 11 Aug 2025 08:19:54 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Aim</h2> <p>To identify relationships among bacterial species in endodontic infections, to determine their core microbiome, and associated clinical characteristics.</p> <h2>Methodology</h2> <p>206 patients with endodontic infections and apical periodontitis were assessed for clinical parameters (periapical lesion, symptomatology, sinus tract). Samples from the apical third of roots were obtained before cleaning and shaping root canals, and microbial composition was analysed using 16S rRNA sequencing and HOMINGS. Correlation Network Analysis (CNA) was performed using the R package igraph, and networks were visualised in Cytoscape with centralities determined by CytoHubba. The core microbiome was identified using the R package Microbiome, listing species comprising at least 1% of samples in over 50% of cases.</p> <h2>Results</h2> <p>The endodontic core microbiome included <i>Parvimonas micra</i>, <i>Streptococcus sanguinis</i>, <i>Enterococcus faecalis</i>, <i>Porphyromonas endodontalis</i>, <i>Prevotella nigrescens</i> and <i>Fusobacterium nucleatum</i>. Symptomatic cases had a core microbiome of <i>Bacteroidaceae.G.1. sp oral taxon 272</i> and <i>Haemophilus parainfluenzae</i>. Sinus cases had a core microbiome of <i>Bacteroidaceae.G.1. sp oral taxon 272</i>, <i>Mogibacterium timidum</i>, <i>Peptostreptococcus stomatis</i>, <i>Pseudoramibacter alactolyticus</i> and <i>Rothia dentocariosa</i>. Lesion cases had a core microbiome of <i>Atopobium rimae</i>, <i>Eubacterium.11.G.1. infirmum</i>, <i>Mogibacterium timidum</i> and <i>Pseudoramibacter alactolyticus</i>. Certain taxa like <i>Bacillus clausii</i> and <i>Eubacterium limosum</i> were never detected.</p> <h2>Conclusions</h2> <p>Despite critical gaps in root canal treatment clinical effectiveness, standardisation and understanding of pathogen complexity, our study, utilising next-generation 16S rRNA Sequencing and HOMINGS, provides valuable insights into core microbiome members involved in endodontic infections and their associations with distinct clinical signs and symptoms, offering insights that may guide more precise diagnosis and targeted treatment.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.70016?af=R International Endodontic Journal urn:uuid:57e87edb-ada3-12a8-69aa-201cede719cd Mon, 11 Aug 2025 00:00:00 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Aim</h2> <p>This study explores the role of PFKFB3 in pulpitis and its potential as a therapeutic target by modulating glycolytic reprogramming in dental pulp stem cells (DPSCs). Pulpitis, a common inflammatory disease, causes long-term damage to dental structures. Recent evidence suggests that metabolic reprogramming can modulate inflammatory responses and promote tissue repair. This study aims to investigate the anti-inflammatory and reparative effects of glycolysis inhibitors on inflamed dental pulp through in vivo and in vitro experiments.</p> <h2>Methodology</h2> <p>In vitro, hDPSCs were stimulated with lipopolysaccharide (LPS) (1 μg/mL, 3 h) to mimic pulpitis. The effects of the PFKFB3 inhibitor 3PO (10 μM) and siRNA targeting PFKFB3 (50 nM) on glycolysis were assessed using Seahorse analysis, while their impacts on inflammation were evaluated via ELISA and qRT-PCR. A co-culture of DPSCs and macrophages was used to study 3PO's effects on inflammation interactions and glycolytic reprogramming of the inflammatory microenvironment. The influences of 3PO on odontogenic differentiation were examined through qRT-PCR, Western blotting, ALP staining and ARS staining. The related signalling pathways were validated through Western blot (WB) experiments. An SD rat model was employed to validate the in vivo efficacy of 3PO@GelMA pulp capping, and HE staining and immunohistochemistry were used to evaluate the degree of pulp inflammation and reparative dentine formation.</p> <h2>Results</h2> <p>In vitro, LPS elevated glycolytic activity and inflammatory factors (IL-6, IL-1β, TNF-α) in DPSCs. 3PO and si-PFKFB3 mitigated these factors and promoted odontogenic differentiation, evidenced by increased DSPP and ALP expression. Metabolic reprogramming mediated by 3PO and si-PFKFB3, as assessed by Seahorse XF analysis, indicated a shift from glycolysis to oxidative phosphorylation. Additionally, 3PO induced metabolic reprogramming of the co-culture system, reduced the levels of pro-inflammatory cytokines, and promoted the polarisation of macrophages towards the M2 phenotype. PFKFB3 inhibition activated the AMPK/SIRT1/PGC-1α/NF-κB and AMPK/mTOR/NF-κB signalling pathways. In vivo, in the rat pulpitis model, 3PO@GelMA hydrogel application resulted in significantly decreased IL-6 and increased DSPP expression compared to the LPS group (<i>p</i> &lt; 0.001), accompanied by reduced inflammation and enhanced reparative dentine formation.</p> <h2>Conclusion</h2> <p>The PFKFB3 inhibitor 3PO reduces inflammation and promotes reparative dentine formation in pulpitis via metabolic reprogramming and specific signalling pathways, offering a new therapeutic strategy.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.70012?af=R International Endodontic Journal urn:uuid:7e29b0b6-bbc9-b789-0086-94714ad684cb Fri, 08 Aug 2025 04:44:55 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Background</h2> <p>Endodontics is considered a challenging and stressful area by dental practitioners and particularly by dental undergraduate students. Stress or anxiety is prevalent among dental undergraduates, with academic and clinical factors considered the principal sources. In addition, the lowest level of student confidence is generally observed when undertaking complex procedures such as root canal treatment.</p> <h2>Objectives</h2> <p>The aim of this review was to investigate the factors responsible for stress, anxiety and confidence in endodontic education and to identify factors which could potentially moderate undergraduate student stress and enhance confidence, improve well-being before concluding by suggesting potential educational improvements.</p> <h2>Method</h2> <p>A narrative review was performed by searching 3 databases (Pubmed, Web of Science and Scopus). Inclusion criteria were original research reports related to undergraduate dental students' stress, anxiety or confidence in endodontics education. Quantitative, qualitative or mixed-method studies were considered.</p> <h2>Results</h2> <p>This narrative review included 51 studies, which were subdivided into six categories describing factors that have an influence on student stress, anxiety and confidence in endodontics: the patient, the clinical procedure, the academic staff, the teaching methods, the clinical organisation and the student. The management of the endodontic patient's expectations, personality and sometimes acute pain can be stressful for the student. The clinical endodontic procedure, with its complexity and multiple steps, visualisation difficulties and possible complications can also be challenging. Academic staff experienced in endodontics, who are supportive and provide consistent advice, are crucial in managing student stress and anxiety. Educational methods also play an important role in increasing confidence, with a reflective approach, a special focus on hands-on sessions and clinical support with systematic feedback. The clinic should be well-organised and ideally multi-disciplinary, with adequate endodontic equipment and should ensure that the student has sufficient time to practise. Finally, the student's individual stress level is an important factor. The year of training as well as gender should be considered as having an influence on the student stress level.</p> <h2>Conclusions</h2> <p>Undergraduate students find endodontics stressful. Educational improvements in endodontics can contribute to moderating the stress and increasing confidence, while improving endodontic learning and promoting student well-being.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.70014?af=R International Endodontic Journal urn:uuid:383db976-6bb6-7228-a955-c4f869eca238 Thu, 07 Aug 2025 09:34:44 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Aim</h2> <p>This technical review and case report describes the Minimally Invasive Vertical Incision Subperiosteal Technique (MIVIST) for use in specific targeted endodontic surgical cases.</p> <h2>Summary</h2> <p>The proposed MIVIST technique includes a vertical incision along with auxiliary vertical release incisions to enhance soft tissue healing during targeted endodontic surgery for teeth with small periapical lesions. The technique is described in a case report where a patient presented with persistent periapical periodontitis associated with a previously root canal treated tooth (#15). Based on the preoperative intraoral scan and cone beam computed tomography (CBCT) three-dimensional surgical guides were printed. A vertical main incision and additional release incisions were placed in the buccal mucosa of tooth 15 over healthy bone, with subperiosteal tunnelling then being performed to provide adequate access to the lesion and root apex. A guided osteotomy was carried out using the surgical template, followed by root-end cavity preparation and filling. The patient was followed up over 24 months, when excellent soft tissue healing as well as radiographic healing was apparent.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.70010?af=R International Endodontic Journal urn:uuid:34851a86-d148-f3dc-83ac-52e0c6040224 Tue, 05 Aug 2025 10:04:54 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Aim</h2> <p>To comprehensively compare 12 nickel–titanium (NiTi) reciprocating single-file systems from eight manufacturers by integrating geometric, mechanical, metallurgical and <i>in silico</i> analyses.</p> <h2>Methodology</h2> <p>A total of 276 NiTi reciprocating instruments, representing 12 types across 8 brands, were selected, including Easy-File Flex Regular 25, EdgeOne Fire Primary, Flash 25.06vt, One Files R25 and Blue R25, One RECI N25, Perfect RC R25 (Blue, Gold and Silver), Reciproc R25 (Blue and M-Wire) and WaveOne Gold Primary. They were evaluated using stereomicroscopy, scanning electron microscopy, 3D optical scanning, energy-dispersive X-ray spectroscopy and differential scanning calorimetry to assess design and metallurgical properties. Mechanical performance was tested via buckling resistance and microhardness. A micro-CT-based premolar model was virtually prepared for each instrument to simulate canal shaping. Computational fluid dynamics (CFD) assessed irrigant penetration, wall shear stress and apical pressure. Finite element analysis (FEA) evaluated stress distribution in prepared roots. Data were analysed using the Shapiro–Wilk test for normality and the Kruskal–Wallis test for group comparisons (<i>p</i> &lt; 0.05).</p> <h2>Results</h2> <p>The systems differed considerably in spiral density, cross-sectional design, size, volume and phase transformation temperatures. Instruments with larger apical cores (One Files and Reciproc M-Wire) and austenitic-phase dominance (Perfect RC Silver and One Files) showed greater buckling strength. Files with martensitic phases (Perfect RC Gold, WaveOne Gold and One Files Blue) or hybrid cross-sections (One RECI and Flash) were more flexible. CFD revealed that conservative shaping (Easy-File Flex, EdgeOne Fire, One RECI, WaveOne Gold) increased wall shear stress but reduced apical irrigant exchange. FEA showed similar stress patterns across all groups, with lower stress in restored roots.</p> <h2>Conclusions</h2> <p>Substantial variation exists among current NiTi reciprocating systems in terms of design, mechanics, fluid dynamics and metallurgy. Instruments with large cores and austenitic-phase structure provide superior buckling resistance. Conservative shaping improves shear stress but limits apical cleaning. Root stress remained consistent across systems. These findings highlight the importance of optimising instrument design and clinical protocols to balance shaping efficacy and irrigant delivery.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.70008?af=R International Endodontic Journal urn:uuid:fba6c6fe-9ae4-1f89-7035-44cfd123580b Mon, 04 Aug 2025 08:49:36 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Aim</h2> <p>The silver tsunami poses a global healthcare challenge, and this study aimed to assess the impact of endodontic disease on oral health-related quality of life (OHRQOL) in an elderly population who received non-surgical root canal treatment (NSRCT). The appropriateness of the Oral Health Impact Profile (OHIP-17) and General Oral Health Assessment Index (GOHAI) as OHRQOL assessment tools for this population was also assessed.</p> <h2>Methodology</h2> <p>Patients aged ≥ 65 years who received NSRCT were recruited. OHRQOL assessments were conducted using OHIP-17, GOHAI and an oral health perception questionnaire. The severity of impact was assessed by summing the numeric response codes for all questions, producing a total score for each participant potentially ranging from 0 to 68 for OHIP-17 and 0 to 48 for GOHAI, with higher scores indicating poorer OHRQOL. Potential influencing factors for OHRQOL scores were investigated. Internal consistency, concurrent validity and discriminant validity of both tools were evaluated.</p> <h2>Results</h2> <p>One hundred and twenty-two patients were recruited. The mean total OHIP-17 and GOHAI scores were 16.35 ± 11.81 (maximum possible score = 68) and 16.85 ± 7.04 (maximum possible score = 48) respectively. The percentage of patients reporting no impact was lower with GOHAI (0.8%) than OHIP-17 (9.8%). Multivariate analyses showed that higher OHRQOL scores were significantly associated with higher levels of education, full/part-time employment and more teeth that received NSRCT. Internal consistency was high for both tools. Concurrent validity assessment demonstrated a significant association of satisfaction with oral health for GOHAI, and perceived importance of keeping one's own teeth and perceived oral health for both OHIP-17 and GOHAI. Neither tool significantly correlated patient-reported impact with clinicians' assessment of oral health.</p> <h2>Conclusions</h2> <p>In elderly patients who received NSRCT, OHRQOL is negatively associated with higher education level, being employed, and more teeth that received NSRCT. GOHAI appears more successful than OHIP-17 in detecting the impact of endodontic disease on OHRQOL.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.70009?af=R International Endodontic Journal urn:uuid:20b830f6-1ba2-1198-ee8b-32c4e9577516 Mon, 04 Aug 2025 08:34:57 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Aim</h2> <p>To evaluate the effect of electropolishing on the mechanical properties of One RECI and One Curve mini nickel-titanium (NiTi) instruments by comparing electropolished and non-electropolished versions of each instrument type.</p> <h2>Methodology</h2> <p>Electropolished and non-electropolished One RECI (reciprocating) and One Curve mini (rotary) NiTi instruments, all manufactured with identical geometry and heat treatment, were evaluated. Instrument design was analysed by light microscopy and scanning electron microscopy, while metallurgical characterisation was performed using energy-dispersive X-ray spectroscopy (EDS) and differential scanning calorimetry (DSC). Mechanical performance was assessed through torsional resistance, bending and buckling load, surface microhardness, and cutting efficiency. Statistical comparisons were performed using the independent samples t-test or the Mann–Whitney <i>U</i>-test, with significance set at <i>p</i> &lt; 0.05.</p> <h2>Results</h2> <p>Design and metallurgical analyses confirmed that electropolished and non-electropolished instruments within each group were equivalent in terms of geometry, cross-sectional design, tip configuration, elemental composition, and phase transformation temperatures. Electropolishing significantly enhanced flexibility in both instrument types, as indicated by reduced bending loads and lower buckling resistance (<i>p</i> &lt; 0.05). However, torsional strength was significantly reduced in the electropolished One RECI instruments, reflected by lower maximum torque and angle of rotation prior to fracture (<i>p</i> &lt; 0.05). No significant torsional differences were observed in the One Curve mini group (<i>p</i> &gt; 0.05). Surface microhardness and cutting efficiency remained unaffected by electropolishing in both systems (<i>p</i> &gt; 0.05).</p> <h2>Conclusions</h2> <p>Electropolishing improved the flexibility of both One RECI and One Curve mini NiTi instruments without compromising their surface microhardness or cutting efficiency. However, its impact on torsional resistance was system-dependent, resulting in reduced strength only in the reciprocating One RECI instruments.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.70003?af=R International Endodontic Journal urn:uuid:fbcf5ed7-c462-d576-0687-47b31b4fe95c Wed, 30 Jul 2025 10:00:26 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Aim</h2> <p>Stem cells from apical papillae (SCAPs) are promising seed cells for angiogenesis, neurogenesis and dental pulp regeneration, which are contingent upon endoplasmic reticulum (ER) homeostasis. Due to the narrow anatomical structure of the root canal system and slow ingrowth of vasculatures, the presence of hypoxia and nutrient-deficient microenvironment within the sterilised root canal space may induce ER stress in the transplanted cells and affect their differentiation into neural lineages. This study aimed to investigate the role of ER stress in the neuronal differentiation of human SCAPs and its underlying mechanisms.</p> <h2>Methodology</h2> <p>Thapsigargin (TG) was employed to induce ER stress in SCAPs. ER Ca²⁺ level was quantified by Mag-Fluo 4 AM. Quantitative real-time PCR (qRT-PCR) and western blot were conducted to detect ER stress markers. SCAPs, with or without ER stress, were guided towards neuronal differentiation. We measured the expression of neuronal markers and the activation of the extracellular signal-regulated kinase (ERK1/2) and the unfolded protein response (UPR) signalling. Immunofluorescence staining was applied to observe SCAP-derived neuron-like cells. The kinetic Ca²⁺ influx of SCAP-derived neuron-like cells was monitored using a fluorescence microscope. SCH772984 and MKC8866 were used to selectively inhibit ERK1/2 and inositol-requiring enzyme 1α (IRE1α) activation, respectively. Statistical analyses were conducted using the GraphPad Prism 10 software.</p> <h2>Results</h2> <p>After TG stimulation, ER Ca²⁺ levels in all TG-treated SCAP groups were markedly reduced, the ER stress markers were significantly upregulated and UPR activation was found. Following neuronal induction, ER stress induced by 20 nM TG did not inhibit SCAP neuronal differentiation. However, ER stress induced by 40 or 80 nM TG significantly inhibited neuronal marker expression, neurite outgrowth and Ca²⁺ influx in SCAP-derived neuron-like cells. The phosphorylated ERK1/2 decreased during neuronal differentiation, along with the reduction of phosphorylated-IRE1α (p-IRE1α). Inhibition of ERK1/2 activation led to neuronal marker protein reduction, neurite outgrowth restraint and p-IRE1α decrease. Selective inhibition of IRE1α activity suppressed NeuN expression and neurite outgrowth.</p> <h2>Conclusion</h2> <p>Severe ER stress inhibits the neuronal differentiation of SCAPs via decreasing ERK1/2 and IRE1α activity, whereas ER stress at an appropriate level is essential for the neuronal differentiation of SCAPs.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14267?af=R International Endodontic Journal urn:uuid:ab863ee6-fabe-de86-678b-047c6ef62ebf Tue, 29 Jul 2025 11:09:18 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>Orofacial pain, characterized by discomfort originating from areas such as the tooth pulp, trigeminal nerve and temporomandibular joint, poses substantial challenges in dentistry. Notably, pulpal and periapical pain profoundly impact the quality of life for affected individuals. Recent studies have highlighted a concerning association between pulpal pain and cognitive dysfunction, highlighting the intricate interplay between sensory distress and cognitive processes. Naringenin, a natural flavonoid, has garnered attention for its diverse physiological effects, including pain modulation. This investigation aims to elucidate the therapeutic potential of naringenin in mitigating capsaicin-induced pulpal pain and concomitant cognitive impairments. Additionally, we endeavour to unravel the underlying molecular mechanisms responsible for these observed effects, thereby contributing to a deeper understanding of naringenin's therapeutic utility in the management of orofacial pain syndromes.</p> <h2>Methodology</h2> <p>Pulpal pain induction was achieved through intrapulpal injection of capsaicin (100 μg) in rat subjects. Central administration of naringenin was carried out at doses of 5, 10 and 15 μg per rat. Assessment of learning and memory performance was conducted using the Morris water maze task. Evaluation of inflammatory cytokine expression levels, including TNF-α, IL-1α, IL-1β, COX-2 and IL-6, as well as BDNF and TrkB expression, was performed using real-time PCR analysis.</p> <h2>Results</h2> <p>Capsaicin administration resulted in a notable escalation of nociceptive responses alongside a concurrent decrement in cognitive function within the experimental rat model. Molecular analysis unveiled an upregulation of inflammatory cytokines coupled with a downregulation of BDNF and TrkB expression levels within the hippocampal region following pulpal pain induction. Remarkably, naringenin administration demonstrated a palliative effect against capsaicin-induced pain sensitivity and cognitive impairments, while also attenuating alterations in the aforementioned gene expressions induced by pain stimuli.</p> <h2>Conclusions</h2> <p>Naringenin appears to exert decreasing effects on both dental pain and pain-induced cognitive deficits, likely mediated through its ability to attenuate neuroinflammation and enhance growth factor signalling pathways. Consequently, it emerges as a promising natural therapeutic agent for the management of pain and associated cognitive impairments. Moreover, the intertwined neural pathways governing cognition and pain processing further underscore the complexity of orofacial pain syndromes.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.70007?af=R International Endodontic Journal urn:uuid:6220cb9f-4bf9-84bf-1ab3-fe14f72e0b59 Tue, 29 Jul 2025 00:00:00 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Background</h2> <p>Achieving effective anaesthesia in mandibular molars with symptomatic irreversible pulpitis is challenging. Various strategies involving the inferior alveolar nerve block (IANB) have been investigated, such as supplementing with additional injections after IANB failure (SUPP) or combining injections with IANB as primary injections (COMB). However, studies directly comparing SUPP and COMB are still lacking.</p> <h2>Objectives</h2> <p>This study aims to assess and compare the anaesthetic effectiveness of different IANB strategies—SUPP and COMB—in mandibular posterior teeth with symptomatic irreversible pulpitis using a systematic review and network meta-analysis.</p> <h2>Method</h2> <p>A comprehensive search was conducted in the PubMed, Embase, Cochrane Library, CINAHL and Scopus databases to identify relevant studies up to October 2024. Eligible randomised clinical trials (RCTs) were analysed using pairwise meta-analysis and network meta-analysis with a random-effects model to estimate treatment effects. Results were reported as risk ratios (RRs) with 95% confidence intervals (CIs) and surface under the cumulative ranking curve (SUCRA) values. The quality of the evidence was assessed using the CINeMA (Confidence in network meta-analysis) software (University of Bern, Bern, Switzerland).</p> <h2>Results</h2> <p>A total of 28 studies involving five interventions were identified. Compared with IANB alone, both SUPP (RR = 2.02; 95% CI: 1.55–2.30; SUCRA: 85.1%) and COMB (RR = 1.86; 95% CI: 1.50–2.30; SUCRA: 64.9%) significantly improved anaesthetic success. However, there was no significant difference in effectiveness between SUPP and COMB.</p> <h2>Conclusion</h2> <p>The quality of evidence ranging from low to high suggests that both SUPP and COMB are comparable in anaesthetic efficacy during endodontic treatment of mandibular molars with symptomatic irreversible pulpitis. However, both SUPP and COMB strategies showed significantly superior effectiveness compared to IANB alone.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.70000?af=R International Endodontic Journal urn:uuid:71d6a7bd-d1d8-697f-83be-d32a63ed208a Mon, 28 Jul 2025 01:30:20 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Aim</h2> <p>To investigate the role and mechanism of progranulin (PGRN) in reparative dentinogenesis and inflammation control for rat pulpitis and inflammatory human dental pulp stem cells (hDPSCs).</p> <h2>Methodology</h2> <p>Eight-week-old male Wistar rats with irreversible pulpitis were treated with pulpotomy and divided into five groups: No treatment; Control; iRoot BP plus (BP); GelMA and recombinant human PGRN (rhPGRN) + GelMA (rhPGRN). Micro-computed tomography (Micro-CT) scans and histological and immunohistochemical staining were conducted to evaluate rhPGRN' anti-inflammation and pro-healing properties. The effects of rhPGRN on hDPSC inflammatory response, proliferation and dentinogenic differentiation and potential signalling pathways were assessed through CCK-8, alkaline phosphatase (ALP) staining, alizarin red staining, quantitative reverse transcription polymerase chain reaction (qRT-PCR), enzyme-linked immunosorbent assay (ELISA), immunofluorescence staining and western blotting.</p> <h2>Results</h2> <p>In vivo, PGRN expression obviously increased in both the Control and GelMA groups compared to healthy pulp (<i>p</i> &lt; 0.05). The BP and rhPGRN groups showed a significant decrease in inflammatory scores and expression of M1 macrophage markers CD86 and tumour necrosis factor alpha (TNF-α) while increasing M2 markers CD206 and interleukin 10 (IL-10) compared with the controls (<i>p</i> &lt; 0.05). Enhanced dentine bridge formation and dentine sialophosphoprotein (DSPP) expression were observed in the BP and rhPGRN groups versus the controls (<i>p</i> &lt; 0.05). Moreover, the rhPGRN group presented higher expressions of CD206, IL-10 and DSPP than the BP group (<i>p</i> &lt; 0.05). In vitro, PGRN expression significantly increased in lipopolysaccharide (LPS)-stimulated hDPSCs (<i>p</i> &lt; 0.05). rhPGRN significantly reduced the release of TNF-α, interleukin 1 beta (IL-1β) and IL-6 in LPS-stimulated hDPSCs and enhanced ALP activity, mineralized nodule formation and expression of ALP, Runt-related transcription factor 2 (RUNX2) and DSPP in LPS-stimulated or unstimulated hDPSCs (<i>p</i> &lt; 0.05). Mechanistically, co-immunoprecipitation showed that PGRN bound to tumour necrosis factor receptor-2 (TNFR2), interacting with 14-3-3 epsilon (14-3-3ε) in hDPSCs. PGRN significantly inhibited LPS-activated phosphorylation of NF-κB/p65 and its nuclear translocation, and the use of a TNFR2 neutralising antibody or the 14-3-3 protein inhibitor R18 reversed these effects (<i>p</i> &lt; 0.05).</p> <h2>Conclusion</h2> <p>These findings suggest that PGRN plays a crucial role in anti-inflammation, immunomodulation and reparative dentinogenesis in rat pulpitis via the TNFR2/14-3-3ε-NF-κB pathway, highlighting its potential as a strategy for vital pulp therapy.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.70004?af=R International Endodontic Journal urn:uuid:43f8f205-1bb0-ee8c-1f04-25d00f4c9e9c Fri, 25 Jul 2025 05:03:41 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Background</h2> <p>The pulp responds to disease and trauma through inflammation which modulates the tooth's ability to instigate healing mechanisms. In vitro human dental pulp cell (HDPC) culture models are widely used to study the tooth's response to pro-inflammatory stimuli.</p> <h2>Objectives</h2> <p>The purpose of this review is to generate a structured appraisal of in vitro research methodologies to study HDPC cultures in a state of inflammation.</p> <h2>Method</h2> <p>In this narrative review the Scopus, PubMed and Google Scholar databases were searched to identify studies reporting the use of HDPC cultures in vitro in inflammation-associated research until December 2024. The dataset initially identified 642 publications, which were manually screened to identify 246 relevant studies for inclusion and methodologically mined for information on: (i) study purpose, (ii) source and characterisation of cells, (iii) pro-inflammatory stimuli used and (iv) assays and markers used to characterise the inflammatory response. The collected data underpinned this review.</p> <h2>Results</h2> <p>Most published studies aimed to characterise HDPC responses to a range of pro-inflammatory stimulants which included bacterial components (lipopolysaccharides [LPS] and lipoteichoic acids [LTA]), cytokines and biomaterials. These stimulations were studied: to characterise their effect in the development of new scaffolds and dental (bio)materials and to mimic the in vivo environment. Various tooth sources were used to establish HDPC cultures, and predominantly, cells were isolated using the pulp tissue explant technique. The most frequently used stimulant and concentrations were LPS at 1 and 10 μg/mL. The time for cell stimulation prior to inflammatory response assay varied from 15 min to 10 days. Inflammatory assessments were performed using quantitative polymerase chain reaction (qPCR), Western Blotting, enzyme-linked immunosorbent assay (ELISA) and high-throughput assays targeting archetypical cytokines and dentinogenic and mineralisation-associated molecules.</p> <h2>Discussion</h2> <p>This review highlights the broad range of experimental conditions used to study HDPC inflammatory responses in vitro and combines these data to identify a framework for a consensus and a more uniform experimental approach.</p> <h2>Conclusion</h2> <p>Standardisation of in vitro experimental conditions to evaluate the pulps response to inflammatory stimuli would enhance research rigour and improve clinical translation to ultimately inform patient treatment and outcomes.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.70005?af=R International Endodontic Journal urn:uuid:97ce6a0b-26d7-6e20-4dd3-0fb1c36d5ba6 Tue, 22 Jul 2025 02:20:29 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Aim</h2> <p>To assess the effectiveness of the benzyl benzoate and benzyl alcohol (BABB) solution in transparent teeth preparation compared to methyl salicylate using comprehensive digital and radiographic quantitative values analysis.</p> <h2>Methodology</h2> <p>Freshly extracted 32 single-rooted teeth were immersed in 10% formalin for 24 h. They were then processed following a standard demineralization and dehydration protocol. The teeth were then divided into two groups: the first group, consisting of 12 teeth, was immersed in the BABB solution for 24 h; the second group of 20 teeth underwent the traditional protocol, which involved soaking the teeth in 99% methyl salicylate for the same duration. The optical properties of the processed teeth's translucency were evaluated by transluminant light imaging using a collimated light source and digital camera. Radiographic images of each tooth included in the study, along with a control group consisting of a freshly extracted natural tooth, were acquired under standardised computer settings, exposure conditions and X-ray tube positioning. The segmentation of the radiographic images into superpixels and the selection of areas of interest were conducted in the same manner as with visible light images. Image processing algorithms within the MatLab computational environment were utilised to assess the colour and intensity of the translucent light at the apical region of the root for each tooth.</p> <h2>Results</h2> <p>The optical properties of selected anatomical locations were consistent across both groups of teeth when evaluating hue, saturation and value of pixels. The X-ray absorption in the translucent teeth was significantly lower than that in the non-translucent teeth, with notable differences observed between the groups; specifically, teeth affected by BABB material exhibited greater permeability to X-rays than those affected by methyl salicylate.</p> <h2>Conclusions</h2> <p>The BABB solution demonstrates comparable efficacy to methyl salicylate regarding the optical properties of translucent teeth. When examining X-ray absorption, teeth treated with the BABB solution exhibited greater permeability to X-ray absorption than those treated with methyl salicylate.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14277?af=R International Endodontic Journal urn:uuid:a52a216c-f13e-a95e-6f0a-714da9746c69 Tue, 22 Jul 2025 00:45:34 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>To develop and evaluate an e-learning tool utilizing a generative pre-trained transformer (GPT), a form of artificial intelligence (AI), to allow for realistic conversation on virtual patients when undergoing training on how to diagnose diseases of endodontic origin, and to evaluate improvements in self-perceived skills.</p> <h2>Methodology</h2> <p>A web app consisting of three components [website for user access, database server with patient case information, GPT-4-turbo model (OpenAI)] was designed to serve as the e-learning platform. Undergraduate students from 4th and 5th year at the dental school of the University of Münster, Germany, were asked to solve eight cases of virtual patients presenting with pain from endodontic or periodontal origin. Before, a questionnaire applying a 5-point Likert scale served to evaluate the current self-perceived state regarding the education, experience and skills in endodontic diagnostics and emergency treatment. After a 3-month timeframe of working with the programme individually, the students were asked to answer a second questionnaire which focused on their experience and self-perceived skills improvement after using the training software.</p> <h2>Results</h2> <p>Ninety-two students participated in the first questionnaire and 72 students finished the second questionnaire, resulting in a drop-out rate of 21.7%. Students in the 5th-year reported more experience in dealing with emergency patients. Initially, both cohorts mainly did not feel confident to perform endodontic diagnostics independently. The evaluation of confidence to perform endodontic diagnostics independently, both by 4th- and 5th-year students, seemed improved after the training on the e-learning tool. The tool was recommended to be available for endodontic education by 72.2% of the students, who strongly agreed to such a statement. 76.4% of the participants strongly agreed to recommend the use of the tool to other students.</p> <h2>Conclusions</h2> <p>AI-based interactive e-learning programmes allowing for complex conversational patient encounters present a possibility to improve diagnostic and interactive skills of undergraduate students.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.70001?af=R International Endodontic Journal urn:uuid:91f63fe2-8c1d-c2a8-3a4a-fed2b1f9faf2 Fri, 18 Jul 2025 08:28:42 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Aim</h2> <p>Exploring the effectiveness of a game-based pilot educational strategy for learning endodontic terminology and assessing satisfaction among postgraduate students.</p> <h2>Methodology</h2> <p>The study was conducted on the first- and second-year students of the postgraduate program in Endodontology (<i>n</i> = 12). A game-based activity, modelled on a television quiz show, was designed to facilitate the learning of endodontic terminology. Students were randomly allocated into four teams based on their course year. Each team answered 26 questions corresponding to definitions of endodontic terms, with correct answers beginning with or containing consecutive letters of the alphabet. Teams within the same cohort competed, and the team with the most correct answers was declared the winner. Students completed three tests at different time points (2 weeks, 1 month and 1 year) after the game-based educational session. A trained rater blindly scored the tests. Additionally, participants completed an anonymous satisfaction web-based survey. The survey included multiple-choice questions to be answered with a 5-point Likert scale to address satisfaction with the content and instructional methods and four questions assessing overall satisfaction on a scale from 0 to 10, along with open-ended questions for additional feedback. Scores of students and numerical responses in the satisfaction survey were compared between first- and second-year students with the Mann–Whitney <i>U</i> test. Scores obtained 2 weeks and 1 month/1 year after the instructional activity were compared with the Wilcoxon paired test. Responses to the multiple-choice questions, based on a 5-point Likert scale, regarding the impact of content and instructional methods were compared between first- and second-year students with the ordinal chi-squared test.</p> <h2>Results</h2> <p>Students demonstrated high test scores and reported high satisfaction with the game-based learning strategy. No statistically significant differences in test scores or satisfaction levels were observed between cohorts. Additionally, test scores remained consistent regardless of the time elapsed between the activity and testing (<i>p</i> &gt; 0.05).</p> <h2>Conclusions</h2> <p>The high scores and satisfaction reported by both cohorts suggest that game-based educational strategies are an innovative practical approach that may serve as an additional method to memorise endodontic terminology.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.70002?af=R International Endodontic Journal urn:uuid:dc2c1a44-120d-b4e5-06e7-a885beabe3b3 Thu, 17 Jul 2025 04:04:41 -0700 International Endodontic Journal, EarlyView. <h2>ABSTRACT</h2> <h2>Aim</h2> <p>Patient-specific 3D-printed dental models present innovative opportunities in endodontic education, offering a bridge between theoretical learning and clinical practice. This study aimed to compare the effectiveness of such models versus extracted natural teeth for training postgraduate residents in the MTA apexification technique, focusing on procedural accuracy and perception.</p> <h2>Methodology</h2> <p>This mixed in vitro study (QUAL-quant) involved 21 postgraduate endodontic residents who were randomly assigned to two groups: The control group (CG), using 63 extracted natural teeth, and the experimental group (EG), using 63 patient-specific 3D-printed open-apex models derived from in vivo CBCT scans. After proper calibration, the participants performed the training sessions including identical procedural steps. Subsequently, the residents completed two Likert scale surveys: Academic Satisfaction Scale and Open-Apex Model Questionnaire. Additionally, an observer reviewed the radiographs of all practices and rated the executed procedures. Statistical analyses included descriptive statistics, Spearman's correlation, confirmatory factor analysis (CFA), chi-square and Fisher's exact tests (<i>p</i> ≤ 0.05).</p> <h2>Results</h2> <p>Patient-specific 3D-printed teeth achieved high acceptance rates among residents, with approval scores of 96.6% on the Academic Satisfaction Scale and 70.79% on the Open-Apex Model Questionnaire. Procedural accuracy was comparable across groups, with 86.14% of treatments free of errors in both. Significant correlations were identified among key procedural variables, such as dental radiographic aspect, access and negotiation of the root canal, determination of working length, and creation of the apical barrier with MTA, highlighting the internal consistency of performance patterns of the 3D model. Inferential analyses revealed significant differences in specific procedural steps: the CG outperformed the EG in determining working length (<i>p</i> = 0.043) and achieving a homogeneous apical barrier (<i>p</i> = 0.004). Minor concerns regarding the tactile sensation and radiographic properties of the artificial prototypes were noted but considered addressable.</p> <h2>Conclusion</h2> <p>Patient-specific 3D-printed open-apex teeth demonstrated high acceptance and supported technically proficient treatments during MTA apexification training. Although overall performance was comparable to that with natural teeth, specific procedural differences suggest that further refinement of the artificial models may enhance their effectiveness as alternative training tools in postgraduate endodontic education.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14281?af=R International Endodontic Journal urn:uuid:8123a0a3-9253-135c-88ea-0133254699cb Mon, 14 Jul 2025 09:44:40 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>The dental pulp is extensively innervated. Our previous study showed that the α1B-adrenergic receptor ADRA1B is the primary sympathetic neurotransmitter receptor in human dental pulp stem cells (hDPSCs) and its expression was enhanced in inflamed pulp tissues. The sympathetic nerve system (SNS) negatively impacts the proliferation and migration capacities of hDPSCs via ADRA1B. In this study, we aimed to explore the role of the SNS in odontoblast differentiation of hDPSCs and tertiary dentine formation during dentine-pulp injury repair.</p> <h2>Methodology</h2> <p>We investigated in vitro function of ADRA1B activity in regulating odontoblast differentiation of hDPSCs by evaluating protein and RNA expression levels of DSPP and DMP1, alkaline phosphatase (ALP) activity and alizarin red S (ARS) staining in control, ADRA1B-overexpression and ADRA1B-knockdown groups. The underlying mechanisms were further examined by assessing the oxygen consumption rate (OCR), glucose consumption and mitochondrial morphology. In vivo, a rat model with superior cervical ganglionectomy (SCGx) followed by direct pulp capping was established to assess the effects of the SNS on tertiary dentinogenesis. Additionally, <i>Adra1b</i> ^{<i>flox/flox</i>}, <i>Prx1-cre</i> mice, combined with a severe dentine exposure model, were used to explore the effects of the SNS on mesenchymal cells via ADRA1B during tertiary dentine formation. Tertiary dentine was determined by histological staining.</p> <h2>Results</h2> <p>Adrenergic signalling through ADRA1B was a crucial signal that inhibits the odontoblast differentiation ability of hDPSCs in vitro by suppressing mitochondrial metabolism via PGC-1α. Sympathectomy enhanced dentine formation in the direct pulp capping rat model. Furthermore, the ablation of <i>Adra1b</i> in mesenchymal cells led to increased odontoblast differentiation and tertiary dentine formation in a mouse model with severe dentine exposure.</p> <h2>Conclusion</h2> <p>Here, we show a new link between the SNS and the odontoblast differentiation capacity of hDPSCs through the adrenergic receptor ADRA1B. Our findings indicate that the SNS impedes the odontoblast differentiation capacity of hDPSCs by suppressing mitochondrial metabolism, which further hampers tertiary dentine formation via ADRA1B.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14280?af=R International Endodontic Journal urn:uuid:bcffb05a-f00a-a96a-40bc-bb04b10a0961 Fri, 11 Jul 2025 09:55:43 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>Parathyroid hormone (PTH) and its Gα_s-coupled receptors, PTH receptor, mediate odontoblast differentiation; however, the detailed intracellular adenylyl cyclase-mediated signalling pathway mediated by the PTH–PTH receptor axis remains to be elucidated. Therefore, we measured the intracellular levels of cyclic adenosine monophosphate (cAMP) in living single odontoblasts.</p> <h2>Methodology</h2> <p>We obtained acutely isolated odontoblasts from newborn Wistar rats and analysed the mineralization ability by Alizarin red staining. Intracellular-free Ca²⁺ concentration was measured using a fluorescent Ca²⁺ indicator, whereas intracellular cAMP levels were examined by a mNeon Green–based cAMP sensor.</p> <h2>Results</h2> <p>Granulated PTH was detected in the vascular area of the dental pulp periphery. Application of the non-selective PTH receptor agonist DPC AJ1951 increased cAMP levels in odontoblasts. This increase was significantly inhibited by the non-selective PTH receptor antagonist 4185-v and the adenylyl cyclase inhibitor SQ 22536. However, applying the non-selective PTH receptor agonist DPC AJ1951 did not increase the intracellular Ca²⁺ concentration without extracellular Ca²⁺. In mineralization assays, PTH promoted mineralization by odontoblasts. The mineralization was inhibited by SQ 22536 and 4185-v but not by the phospholipase C inhibitor U73122.</p> <h2>Conclusion</h2> <p>Thus, the present study suggests that PTH from the bloodstream functionally activates the Gα_s-coupled PTH receptor in odontoblasts, which plays an essential role in dentinogenesis.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14279?af=R International Endodontic Journal urn:uuid:fe12f22a-926e-0433-dfdb-6c5559c4179d Fri, 11 Jul 2025 00:00:00 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Background</h2> <p>Injectable hydrogels are widely used in biomedicine and tissue engineering. Recently, they have been introduced as promising capping materials for vital pulp therapy (VPT) owing to their biocompatibility, in situ adaptability, minimal immunogenicity, and ability to modify the cellular activities of dental pulp exposed to caries or accidental injuries. Although injectable hydrogel-based biomaterials facilitate pulp healing and reparative dentine formation, their clinical utility has not been fully explored.</p> <h2>Objectives</h2> <p>This review highlights the gaps in current research, including the lack of studies on the long-term in vivo effects of injectable hydrogels and comprehensive interactions between injectable hydrogel and the dentine–pulp complex, which impede clinical translation, especially for VPT.</p> <h2>Methods</h2> <p>A comprehensive literature search was conducted in PubMed and Scopus in April 2024 using relevant keywords related to injectable hydrogels and VPT. Eligible articles published between 2014 and 2024 included laboratory, animal and clinical studies, addressing the biological function, design, or clinical applicability of injectable hydrogels for VPT.</p> <h2>Results</h2> <p>This review covers various biomaterial-based injectable hydrogels developed using hyaluronic acid, gelatine methacryloyl, chitosan, collagen, decellularized extracellular matrix, self-assembling peptides, and nanoparticles for VPT, highlighting possibilities for future clinical translation and innovation. Laboratory studies on injectable hydrogels provide promising results, including enhanced pulp healing, reduced inflammation, homogeneous reparative dentine formation, and also key innovations to enhance the functionality, adaptability, and characteristics of novel injectable hydrogels developed for VPT.</p> <h2>Conclusion</h2> <p>Hydrogels functionalized with advanced biomaterials and bioengineering approaches can overcome the existing shortcomings, enabling their smooth transition into clinical practice. Nevertheless, further research is required to elucidate their long-term effects and optimal application methods.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14276?af=R International Endodontic Journal urn:uuid:2aa67c7c-0d68-1381-872f-e7d89dd4cf0e Fri, 04 Jul 2025 08:33:17 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>This study evaluated the effectiveness of three-dimensional prototyped macro-models (3DPMM) as an educational aid for teaching endodontic access to dental students.</p> <h2>Methodology</h2> <p>A total of 72 students were randomly assigned to three groups (<i>n</i> = 24) and participated in study sessions with 3DPMM at different stages: before, during (intermediate) or after performing laboratory projects. The timing of the 3DPMM study sessions rotated across groups for different tooth types (anterior, premolar and molar). Each student performed endodontic access on nine teeth (four anterior, three premolars and two molars). Students completed a questionnaire evaluating their learning experience and confidence. Endodontic access projects were graded by masked instructors, and the data were statistically analysed (<i>α</i> = 0.05).</p> <h2>Results</h2> <p>Students rated their learning experience with the 3DPMM positively, regardless of their differences based on group assignment, tooth type or timing of the study session (<i>p</i> &gt; .05). Procedural errors were observed in 47% of the teeth, with 35.6% exhibiting one error and 11.4% exhibiting two errors. The most common errors included gouging (26.6%) and oversized access cavities (23.5%). Students who completed endodontic access before using the 3DPMM had a significantly higher frequency of multiple errors, oversized access cavities and retained pulp chamber roof (<i>p</i> &lt; .05). Approximately 60% of participants reported increased confidence after using the models, regardless of group assignment, tooth type or study session timing (<i>p</i> &gt; .05).</p> <h2>Conclusion</h2> <p>The findings suggest that integrating 3DPMM enhanced students' understanding of internal tooth anatomy, increased their confidence and reduced procedural errors. Students appreciated the hands-on, interactive learning experience offered by the models, reinforcing the value of innovative educational tools in endodontic training.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14274?af=R International Endodontic Journal urn:uuid:c23482d6-c2f9-e215-8cfa-fcf0e761b3a8 Tue, 01 Jul 2025 11:04:08 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>Metals are essential for metabolism and play a crucial role in various biological processes. Therefore, the aim of this study was to characterize and compare the metallomic profiles of periapical lesions and healthy alveolar bone in rats using complementary analytical techniques.</p> <h2>Methodology</h2> <p>This study included 76 lower first molars (from 38 Wistar rats) where induced periapical lesions and controls (sham) were compared. Periapical lesion induction was performed by pulp exposure of these teeth, allowing infection development. After 40 days, the animals were reweighed, euthanised and their hemimandibles analysed by periapical radiography, histological analysis, micro-computed tomography (μ-CT), X-ray fluorescence microscopy (μ-XRF), scanning electron microscopy with energy dispersive spectroscopy (SEM/EDS), inductively coupled plasma optical emission spectrometry (ICP-OES) and inductively coupled plasma mass spectrometry (ICP-MS). Ten essential metals for metabolism were analysed (sodium, potassium, magnesium, calcium, iron, manganese, cobalt, copper, zinc and molybdenum). The analyses observed a significance level of 5%.</p> <h2>Results</h2> <p>Radiographic analysis confirmed the induction of periapical lesions, without difference in animal weight between the conditions (<i>p</i> &gt; .05). Histologically, the periapical lesions showed intense inflammatory infiltrate, cells with bluish cytoplasmic granules, alveolar resorption and scores ranging from moderate to intense. The μ-CT analysis of the induced lesion revealed a significant difference in the periapical region volume (12.74 mm³, <i>p</i> = .0017). SEM/EDS showed limited sensitivity for the investigated chemical elements; however, μ-XRF identified diminished intensities for calcium and zinc and increased intensities for iron. ICP-MS and ICP-OES identified increased concentrations of sodium (<i>p</i> = .0137), potassium (<i>p</i> = .0005), calcium (0.0059), magnesium (<i>p</i> = .0004), iron (<i>p</i> &lt; .001), ⁵⁶iron (<i>p</i> = .0078), ⁵⁷iron (<i>p</i> = .0315) and manganese (<i>p</i> &lt; .001) within the induced periapical lesion, suggesting a direct impact on mineral homeostasis following this pathology.</p> <h2>Conclusions</h2> <p>This study demonstrated differences in the levels of various essential elements between conditions with periapical lesions and healthy controls.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14278?af=R International Endodontic Journal urn:uuid:316dd25f-c3e9-2a9e-0d09-49ff785ac6d9 Tue, 01 Jul 2025 09:53:02 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>Endodontic periapical lesions are prevalent in routine dental practice, yet a substantial proportion of these lesions may not be directly attributable to pulpal infection. This study aimed to assess the diagnostic accuracy of periapical lesions and the prevalence and demographic profiles of nonendodontic lesions misdiagnosed as endodontic in origin.</p> <h2>Methodology</h2> <p>The clinical and pathologic diagnoses of periapical lesions associated with the apex of nonvital or endodontically treated teeth over a 20-year period were systematically collected. These diagnoses were categorized into endodontic and nonendodontic lesions. Endodontic diagnoses included radicular cyst, periapical granuloma, periapical abscess and periapical scar. The diagnostic accuracy, receiver operating characteristics curves and the differences in clinical characteristics of these lesions were subsequently analysed. Additionally, the frequency and clinical data of nonendodontic periapical lesions were tabulated.</p> <h2>Results</h2> <p>Of the 1611 periapical lesions included, 1521 cases (94.4%) were endodontic lesions, whilst 90 cases (5.6%) were nonendodontic in origin. The overall diagnostic accuracy was 91.4%, with areas under curve (AUCs) for diagnosing endodontic and nonendodontic periapical lesions being 0.955 and 0.767, respectively. Clinicians correctly diagnosed endodontic lesions with 95.5% sensitivity, whilst the specificity of diagnosing nonendodontic lesions was 23.3%. Endodontic lesions exhibited a significantly higher prevalence of cases presenting with a size less than 2 cm, exhibiting no swelling and presenting with a rounded radiographic appearance. The frequency of nonendodontic periapical lesions clinically misdiagnosed as endodontic in origin was 69 out of a total sample of 1521 (4.5%). Most lesions (47.8%) affected the anterior maxilla. Odontogenic keratocyst (27.5%) and ameloblastoma (24.6%) were the most common pathoses mimicking endodontic lesions clinically. Malignant neoplasms constitute 5.8% of all nonendodontic periapical lesions, the most common of which were intraosseous squamous cell carcinoma.</p> <h2>Conclusions</h2> <p>Despite the high overall diagnostic accuracy, the specificity of recognizing nonendodontic periapical lesions is relatively low. Clinicians often overdiagnose endodontic lesions clinically. In the presence of periapical lesions with a diameter of 2 cm or more, clinical swelling or a nonrounded radiographic appearance, clinicians should consider the possibility of nonendodontic lesions. Diverse benign and malignant conditions can mimic endodontic pathoses. Tissue biopsy is indispensable for accurate and timely management.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14275?af=R International Endodontic Journal urn:uuid:03ee651b-6008-5f17-8cbc-8973304f92fd Thu, 26 Jun 2025 00:00:00 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>To evaluate the association of inflammatory mediators with clinical signs and symptoms and their spatial distribution in teeth with pulpitis.</p> <h2>Methodology</h2> <p>Fifty permanent teeth from adults with clinical diagnoses of normal pulp (<i>n</i> = 17), reversible pulpitis (<i>n</i> = 13) and symptomatic/asymptomatic irreversible pulpitis (<i>n</i> = 20), were recruited. Two pulp blood samples from each tooth, one at the pulp exposure site (coronal blood) and one at the orifice level (radicular blood), were collected and analysed using multiplex immunoassay. The expression of 52 inflammatory mediators was analysed to compare regional variations within teeth, between groups and amongst teeth with pulpitis regrouped by symptom severity. Statistical comparisons were made using paired comparison tests at <i>p</i> &lt; 0.05.</p> <h2>Results</h2> <p>TGFα and FGF-2 were significantly downregulated in teeth with reversible and irreversible pulpitis compared with healthy controls (<i>p</i> &lt; 0.05). IL-1β was significantly upregulated in the radicular blood of teeth with irreversible pulpitis compared with reversible pulpitis (<i>p</i> &lt; 0.05). Higher concentrations of inflammatory markers were found in the coronal blood of reversibly inflamed teeth, whilst irreversibly inflamed teeth exhibited elevated fractalkine and IL-2 in radicular regions (<i>p</i> &lt; 0.05). The spatial distribution of biomarkers in teeth with pulpitis after regrouping by symptom severity demonstrated increased IL-22 in coronal blood and IL-13 in radicular blood in symptomatic teeth (<i>p</i> &lt; 0.001, <i>p</i> &lt; 0.05). Radicular blood of teeth with mild symptomatic pulpitis showed significantly increased levels of IL-17A but decreased concentrations of TGFα and MMP-2 compared to asymptomatic teeth (<i>p</i> &lt; 0.05). Teeth with severe symptomatic pulpitis exhibited significantly higher levels of IL-1α and TGFα in coronal blood compared with asymptomatic irreversible pulpitis (<i>p</i> &lt; 0.05). Symptomatic teeth generally exhibited more pronounced coronal inflammatory mediator expression.</p> <h2>Conclusion</h2> <p>IL-1β is a promising biomarker for distinguishing between reversible and irreversible pulpitis. TGFα and FGF-2 demonstrate significant potential as diagnostic biomarkers in discriminating between states of pulpitis and health. IL-1α, IL-13, IL-17A, IL-22, TGFα and MMP2 also showed potential to differentiate between teeth with symptomatic and asymptomatic irreversible pulpitis. Both classification systems used revealed distinct inflammatory mediator patterns, which were found to be correlated with symptom severity, particularly in the coronal region.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14273?af=R International Endodontic Journal urn:uuid:c601a93e-0b07-4b5c-116c-5eda0dcf6913 Thu, 19 Jun 2025 05:14:28 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>Academic integrity is crucial in dental education, especially during practical exams assessing competencies. Traditional oversight may not detect sophisticated academic dishonesty methods like radiograph substitution or tampering. This study aimed to develop and evaluate a novel artificial intelligence (AI) model utilizing a Siamese neural network to detect inconsistencies in radiographic images taken for root canal treatment (RCT) procedures in preclinical endodontic courses, thereby enhancing educational integrity.</p> <h2>Methododology</h2> <p>A Siamese neural network was designed to compare radiographs from different RCT procedures. The model was trained on 3390 radiographs, with data augmentation applied to improve generalizability. The dataset was split into training, validation, and testing subsets. Performance metrics included accuracy, precision, sensitivity (recall), and F1-score. Cross-validation and hyperparameter tuning optimized the model.</p> <h2>Results</h2> <p>Our AI model achieved an accuracy of 89.31%, a precision of 76.82%, a sensitivity of 84.82%, and an F1-score of 80.50%. The optimal similarity threshold was 0.48, where maximum accuracy was observed. The confusion matrix indicated a high rate of correct classifications, and cross-validation confirmed the model's robustness with a standard deviation of 1.95% across folds.</p> <h2>Conclusions</h2> <p>The AI-driven Siamese neural network effectively detects radiographic inconsistencies in RCT preclinical procedures. Implementing this novel model will serve as an objective tool to uphold academic integrity in dental education, enhance the fairness and reliability of assessments, promote a culture of honesty amongst students, and reduce the administrative burden on educators.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14271?af=R International Endodontic Journal urn:uuid:d1d392a5-2447-ddbb-2dd4-94e1b4bbbca2 Fri, 13 Jun 2025 01:20:44 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>This study aimed to assess how three different treatment protocols affect the survival of teeth and the survival of teeth without further interventions after root canal treatment (RCT), while also considering additional factors that could potentially influence the treatment outcome.</p> <h2>Methodology</h2> <p>Data were collected from an outpatient clinic database from July 1999 to January 2024 and 14 233 treated teeth could be included in a retrospective cohort study. Treatment protocols incorporated hand files (Protocol 1), multiple-file rotary NiTi systems added with passive ultrasonic irrigation (PUI), citric acid and occasionally chlorhexidine (Protocol 2) and reciprocating instruments added with PUI, EDTA, warm vertical compaction and calcium silicate-based sealer (Protocol 3). Survival analysis coupled with Cox proportional hazard regression and Kaplan–Meier curves took into account several variables including treatment, patient demographics and experience of the treatment provider. Confounding was addressed by entropy balancing and gradient boosted logistic regression. Multistate analysis was conducted to evaluate the influence of treatment protocols on the transition between various intervention states.</p> <h2>Results</h2> <p>Survival analysis revealed that Protocol 3 significantly enhanced survival rates and survival rates without further interventions by 30%–40% compared to both other protocols. Additionally, higher patient age was identified as a negative predictor of treatment outcomes. Supportive periodontal treatments were a positive predictor. Factors such as tooth type, vitality, number of visits, experienced treatment provider, calcium silicate-based sealer and patient gender did not significantly affect outcomes in the adjusted models. Multistate analysis confirmed that Protocol 3 was associated with significantly reduced incidences of retreatment and extraction.</p> <h2>Conclusion</h2> <p>Protocol 3 significantly enhanced survival and survival without further interventions compared to both other protocols. Patient age and supportive periodontal treatments were significant predictors of outcomes throughout all calculated models.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14272?af=R International Endodontic Journal urn:uuid:2b598190-d6c5-28d4-95b0-6e6e8117874d Fri, 13 Jun 2025 00:00:00 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>This prospective cohort study aimed to study lesion size, proximity to anatomical structures and detection of missed canals using 2D digital periapical (PA) radiographs and 3D cone beam computed tomography (CBCT) radiographic imaging, amongst a cohort of asymptomatic persistent endodontic lesions (APEL), and to develop a radiographic protocol for these asymptomatic lesions.</p> <h2>Methodology</h2> <p>APEL persisting ≥4 years after endodontic treatment were recruited with informed consent. PA radiographs taken at different angles (KaVo Kerr, Brea, CA) and a limited field-of-view CBCT scan (KaVo Kerr, Brea, CA) of 0.125mm³ voxel size were evaluated. Two calibrated independent endodontic practitioners examined all radiographic images in a random and blinded sequence, under similar viewing conditions. Agreement above chance (kappa) was calculated for parameters of interest (Graphpad by Dotmatics, <a target="_blank" title="Link to external resource" href="https://www.graphpad.com/">https://www.graphpad.com/</a>).</p> <h2>Results</h2> <p>Eighty-two APEL (15 incisors, 25 premolars, 42 molars; 59.8% treated 4–10 years prior) in 77 patients (34 male, 43 female, median age 51–60) were examined. Root filling quality was acceptable with 14/82 (17.0%) lacking density and homogeneity. Weighted kappa on <i>lesion size</i> (0.5–1.9, 2–4.9 and 5–9.9 mm) between PA radiographs and CBCT was 0.466 – in 24 APEL, lesion size was &gt;2 mm larger on CBCT whilst in 4 APEL, lesions were &gt;2 mm smaller on CBCT. On <i>proximity</i> to maxillary sinus and neurovascular structures (‘yes’, ‘no’, ‘unable to tell’), kappa was 0.237, with 9 APEL scored ‘unable to tell’ on PA radiographs and 0 uncertainty on CBCT. Agreement between PA radiographs and CBCT on <i>missed canals</i> (‘not likely’, ‘somewhat likely’, ‘very likely’, ‘unable to tell’) was 0.349, with 13 teeth scored ‘somewhat likely’ and ‘very likely’ on CBCT and only 6 teeth similarly scored on PA.</p> <h2>Conclusion</h2> <p>Overall, CBCT provided a more comprehensive examination of teeth with APEL than PA radiographs. Larger lesion sizes were generally observed, especially in posterior teeth. Sinus involvement was more readily identified, and the assessment of the presence of missed canals could be performed with more certainty. Where lesion monitoring is chosen, CBCT imaging should be considered for a more thorough assessment of posterior teeth, and where there is uncertainty in PA radiograph interpretation of anterior teeth.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14270?af=R International Endodontic Journal urn:uuid:32ce4d82-191a-16ec-d07c-920aaa2eab6d Tue, 10 Jun 2025 00:39:43 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>To describe the application and management of robotic navigation system in access cavity preparation of a maxillary central incisor with severe pulp canal obliteration.</p> <h2>Summary</h2> <p>The identification and preparation of root canal(s) in teeth with pulp canal obliteration (PCO) may be challenging, resulting in excessive removal of sound dentine and/or perforation. A static or dynamic navigation system has been demonstrated to be a useful aid to locate obliterated canals with minimal removal of sound dentine. However, navigation systems are not completely infallible, with potentially poorer outcomes when used by an inexperienced operator. This novel case adds to the emerging clinical literature on the robotic navigation system (RNS) in endodontics to increase the accuracy of access cavity preparation and to preserve tooth substance in a tooth with PCO and diagnosed with chronic periapical periodontitis. A 34-year-old male was referred for the management of an endodontic problem. His chief complaint was intermittent, mild discomfort which lingered for over 30 s localized to the upper left central incisor tooth #9 (21) to cold drinks for 1 week. Clinical examination revealed that tooth #9 (21) was tender to percussion and cold thermal testing reproduced the patient's presenting symptoms. A radiograph, including a cone beam computed tomography scan, revealed pulp canal obliteration and widening of the periodontal ligament of the apical third of tooth #9 (21). A diagnosis of symptomatic irreversible pulpitis was reached. The Digital Information and Communication in Medicine (DICOM) dataset was exported into an RNS. The RNS successfully accessed the canal without any human intervention, after which endodontic treatment was completed by an endodontist. At a 12-month review, the tooth was asymptomatic and a radiograph confirmed healthy periapical tissues. This case highlights the potential use of RNS for minimal access and time-saving access cavity preparation of teeth with PCO.</p> <h2>Key learning points</h2> <p> Multiple factors can lead to pulp canal obliteration, making it difficult to locate and negotiate the root canal. Robotic navigation system is a minimally invasive, efficient, and predictable solution for managing calcified root canals. </p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14259?af=R International Endodontic Journal urn:uuid:fdc60113-c2b1-00dc-cb10-13664473c574 Tue, 03 Jun 2025 00:34:58 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <p>The concept of innovation in dental education often invites scepticism—is it merely a buzzword, or a true driver of progress? In Endodontics, the answer is clear: innovation is essential. As the field grapples with persistent challenges—including difficulty in recruiting and retaining qualified educators, rising student demand, and the lack of standardized global training—traditional pedagogical models must be reimagined. A transformative educational framework is urgently needed, one that aligns with three foundational pillars of Endodontics: delivering high-quality, patient-centred care; building sustainable educational systems; and promoting research-driven advancement. This article examines the major obstacles confronting endodontic education and proposes a strategic, multi-dimensional approach rooted in disruption and innovation. Key strategies include the integration of digital platforms, incorporation of advanced technologies into the curriculum, use of artificial intelligence in education and assessment, and the development of global standards for endodontic training and evaluation. These solutions aim to address disparities in resources through decentralized learning and mentorship models, ultimately enhancing patient care and supporting lifelong learning. Innovation in Endodontics is not a matter of convenience—or inconvenience—but a professional obligation. It is the pathway to preparing future specialists to thrive in a rapidly evolving, technology-driven landscape. By embracing this imperative, the field can move beyond outdated conventions and current limitations, driving sustainable progress for educators, learners and patients alike.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14252?af=R International Endodontic Journal urn:uuid:368c10ae-a9eb-bad9-6feb-eaa9918de748 Mon, 12 May 2025 00:00:00 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Introduction</h2> <p>The use of haptic virtual reality simulators in preclinical dental education is evolving rapidly. However, the application of immersive haptic simulations for specific dental procedures, such as access cavity preparation, has not been extensively explored.</p> <h2>Aims</h2> <p>This study aimed to (i) evaluate the impact of using the VirTeaSy Dental® simulator in conjunction with a virtual reality (VR) headset on student performance during access cavity preparation, with a focus on haptic parameters; (ii) assess students' perceptions of the experience; and (iii) examine the side effects associated with VR headset use.</p> <h2>Methodology</h2> <p>The study included 90 third-year dental students from the Dental Faculty of Nantes University, enrolled in January 2023. Participants were divided into two parallel groups. In Phase 1, Group 1 (<i>n</i> = 45) completed two endodontic access cavity exercises on the VirTeaSy Dental® without the VR headset, whilst Group 2 performed the same exercises using the VR headset. In Phase 2, the groups switched conditions and followed the same protocol. Performance was assessed using haptic parameters, and comparisons between groups for each phase were made using parametric and non-parametric tests (<i>p</i> &lt; .05). Students also completed questionnaires to assess their experience and report any side effects from using the VR headset.</p> <h2>Results</h2> <p>Across both groups and phases, participants performed better in access cavity preparation without the VR headset. They showed greater accuracy, made fewer errors, and completed the exercises more quickly. Notably, more students failed to complete the exercises within the 10-minute time limit when using the VR headset (27 vs. 12 in Group 1, 23 vs. 13 in Group 2). Most participants expressed a preference for using VirTeaSy Dental® without the VR headset. Approximately, 20% of students reported side effects, including dizziness, nausea, migraines, and neck muscle fatigue.</p> <h2>Conclusion</h2> <p>The results suggest that full immersion in haptic simulation, when paired with a VR headset, negatively impacts student performance in complex tasks such as access cavity preparation. These findings underscore the current limitations of immersive virtual reality in dental education and highlight the need for technical refinements before its widespread adoption in preclinical training.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14246?af=R International Endodontic Journal urn:uuid:a3f2a720-ca25-7d97-abbb-629ac6276d74 Wed, 30 Apr 2025 03:24:55 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Background</h2> <p>The outcomes of root canal treatment performed by students has not been well researched. Treatment outcomes of student clinicians directly correspond to the education they receive and therefore paves the way for future directions in endodontic education.</p> <h2>Objectives</h2> <p>This systematic review aimed to evaluate endodontic outcomes and success rates of contemporary root canal treatment delivered by undergraduate dental students. Factors with a positive or negative effect on endodontic education and clinical treatment quality were evaluated.</p> <h2>Methods</h2> <p>The investigation followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies from 2000 to 2024 were selected from PubMed, Scopus, Cochrane Library and Embase databases after applying inclusion and exclusion criteria. Each study was independently assessed, and bias was categorized systematically as low, moderate or high using the risk of bias (RoB) assessment tool. Unweighted and weighted pooled success rates for each factor were calculated, and statistical heterogeneity among study subgroups was evaluated.</p> <h2>Results</h2> <p>Eleven studies were eligible for data extraction and qualitative synthesis. Three studies were eligible for meta-analysis and showed that teeth diagnosed with a vital pulp had a success rate of 87.8%, while teeth diagnosed with pulp necrosis had a success rate of 65.6%. Weighted success rates for teeth with and without preoperative radiolucencies were 56.3% and 86.8%, respectively. The RoB assessment showed that 4 out of 11 studies (36.4%) had a low risk of bias.</p> <h2>Conclusions</h2> <p>The outcomes of root canal treatment performed by undergraduate students using contemporary techniques are not well understood. This analysis demonstrated that while student clinic outcomes were comparable to those reported in contemporary literature for general and specialist practice, variations in success rates may be influenced by factors such as clinical experience, exposure to diverse cases and teaching methodologies. Further research is needed to explore how educational innovations and clinical training impact endodontic outcomes in undergraduate settings.</p> <h2>Registration</h2> <p>The systematic review search protocol was registered in the PROSPERO database (CRD42024604079).</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14245?af=R International Endodontic Journal urn:uuid:cc6a8836-124b-4819-388d-df900875b7f0 Wed, 23 Apr 2025 06:29:50 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>To assess the postural risk adopted by postgraduate endodontic students during endodontic procedures using different magnification tools and, secondarily, to evaluate the presence of musculoskeletal symptoms (MSDs) in these students.</p> <h2>Methodology</h2> <p>The present study has a repeated measures design that included 10 endodontic postgraduate students. Data on musculoskeletal symptoms were collected using a modified Standardized Musculoskeletal Symptom Perception Questionnaire. Working postures adopted during endodontic access until canal localization were recorded from three angles. Each student used no magnification, ergonomic loupes and the microscope in three different patients in random order. Selected still frames were assessed using rapid upper limb assessment (RULA). Survey data were presented with descriptive statistics, and the RULA scores were analysed using the Friedman test.</p> <h2>Results</h2> <p>All participants experienced pain in at least one body region within the past 12 months, with upper back pain being the most frequently reported, followed by pain in the neck and lower back. A statistically significant decrease (<i>p</i> &lt; .001) in postural risk was observed when using magnification compared to no magnification. No difference was observed between the loupes and microscope groups (<i>p</i> = .786). However, no magnification was statistically different from loupes (<i>p</i> &lt; .001) and microscopes (<i>p</i> &lt; .001).</p> <h2>Conclusion</h2> <p>The risk of MSDs was higher when no magnification was used than when using ergonomic loupes and the microscope. All the postgraduate endodontic students assessed reported MSD symptoms in the back and other body regions.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14241?af=R International Endodontic Journal urn:uuid:8d74e45e-fb05-1dc0-9f96-487c011d23f4 Sat, 19 Apr 2025 09:35:33 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <p>The positive effects of coaching on enhancing performance and development within sport have been well recognized over the past 40 years. More recently, the beneficial effects of utilizing a coaching approach upon learning have been recognized in the commercial world and, increasingly, in education. The potential of using a coaching approach within medical education has been investigated, with observed improvements in performance, academic success, resilience, professional identity and self-efficacy – all of which are important in the development of clinicians. Endodontic education and training, whether undergraduate or postgraduate, aim to prepare clinicians to undertake high-quality endodontic care for patients. To achieve this, the student needs to have the capability to perform the appropriate level of endodontic treatments, but also the confidence and self-efficacy to execute those treatments, where self-efficacy contributes to how successful their performances will be. This paper outlines the sources and development of self-efficacy and describes how a coaching approach can be used to enhance students' skills acquisition and performance, both during clinical teaching sessions and in their periodic development reviews.</p>