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.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.14268?af=R International Endodontic Journal urn:uuid:63087956-2446-46e6-4d77-04915b0035fc Sun, 15 Jun 2025 00:00:00 -0700 International Endodontic Journal, EarlyView. <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.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.14091?af=R International Endodontic Journal urn:uuid:3f782a86-b187-a468-2e2e-cdeedbdbf469 Thu, 12 Jun 2025 06:30:12 -0700 International Endodontic Journal, Volume 58, Issue 7, Page 929-929, July 2025. https://onlinelibrary.wiley.com/doi/10.1111/iej.14238?af=R International Endodontic Journal urn:uuid:f321c72b-6022-1bb2-86ac-97f5c96684ee Thu, 12 Jun 2025 06:30:12 -0700 International Endodontic Journal, Volume 58, Issue 7, Page 930-951, July 2025. <h2>Abstract</h2> <p>Cell polarity refers to the asymmetry of cellular morphology and function along the polar axis. Odontoblast polarization is essential for the formation of tubular dentine. However, our understanding of odontoblast polarization remains limited compared to the extensively studied process of epithelial cell polarization. This gap in knowledge hinders the advancement of regenerative endodontics, where the regeneration of tubular dentine is both a central focus and a significant challenge. In this review, we begin by outlining the process of odontoblast differentiation, emphasizing that odontoblast polarization represents an early stage of this differentiation. We then summarize the key features of odontoblast polarization, including changes in cell morphology, alterations in cellular structure, and modifications in intercellular junctions. Additionally, we compare the key characteristics of odontoblast polarization with those of ameloblast polarization. Next, we summarize the intracellular and extracellular molecules involved in odontoblast polarization, while underscoring the significance of epithelial–mesenchymal interactions in this context. Furthermore, we discuss the evolution of research platforms for studying odontoblast polarization, with a particular focus on the application of advanced nanofibrous platforms in this field. Finally, we identify existing knowledge gaps in odontoblast polarization and offer suggestions and perspectives for future research, aiming to inspire further investigations in dentine regeneration.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14228?af=R International Endodontic Journal urn:uuid:a9918aa6-db8c-24ac-8389-30ed6e0d0046 Thu, 12 Jun 2025 06:30:12 -0700 International Endodontic Journal, Volume 58, Issue 7, Page 952-964, July 2025. <h2>Abstract</h2> <h2>Aim</h2> <p>The COVID-19 pandemic affected practice in endodontic offices. Same-day endodontic emergencies are cases with moderate or severe self-reported pain who request an unscheduled visit on the day they contact the office. The aims of this observational study were to: (A) analyse the rate of same-day endodontic emergencies in two endodontists' private offices, with respect to their demographic, aetiologic, diagnostic and procedural data; and (B) investigate the changes in characteristics of same-day emergencies between March 16 and May 31 annually over five years: 2019–2023.</p> <h2>Methodology</h2> <p>Records of 5795 patients were reviewed and 892 same-day emergencies were identified. Overall and year-to-year comparisons of proportions of same-day emergencies, as well as demographic, aetiologic, diagnostic and procedural data were performed using chi-square test of independence followed by adjustments for multiple testing using the Benjamini-Hochberg method.</p> <h2>Results</h2> <p>The rate of same-day endodontic emergencies significantly increased during the initial outbreak of COVID-19 in 2020 and remained high in 2021 (<i>p</i> &lt; .05; <i>Q</i> &lt; .05). The rate of same-day emergencies in 2022 subsided to levels comparable to 2019 (<i>p</i> &gt; .05). Year-to-year comparisons of aetiologic factors (caries, restorative, persistent infection and cracks) showed a significant increase only in the rate of cracks in 2020, 2021and 2022 compared with 2019 (<i>p</i> &lt; .05), but this increase did not reach the significance level after adjusting for multiple comparisons throughout the 5 years (<i>Q</i> &gt; .05).</p> <h2>Conclusions</h2> <p>The COVID-19 pandemic was associated with a significant increase in the rate of same-day endodontic emergencies for 2 years. The spike in endodontic emergencies associated with the COVID-19 pandemic lasted well beyond the initial period of the outbreak. Further national and international studies are recommended to better understand the long-term impacts of pandemics of respiratory diseases on the public's oral health.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14233?af=R International Endodontic Journal urn:uuid:73af1fb4-d546-0429-9484-bd8ad0004301 Thu, 12 Jun 2025 06:30:12 -0700 International Endodontic Journal, Volume 58, Issue 7, Page 965-990, July 2025. <h2>Abstract</h2> <h2>Background</h2> <p>Solubilized endogenous dentine extracellular matrix components (dECMs) are potent mediators in pulp regeneration and could potentially promote similar healing effects in diseased periradicular tissues by upregulating local mesenchymal stem cell-derived regenerative events.</p> <h2>Aims</h2> <p>(1) Determine if endodontic treatment outcomes with irrigation regimes promoting dECM release (17% ethylenediaminetetraacetic acid [EDTA]) are equivalent to conventional regimes (5.25% sodium hypochlorite [NaOCl]) in mature permanent teeth with asymptomatic apical periodontitis. (2) Explore changes in pain scores, expressions of periradicular tissue fluid (PTF)-derived inflammatory mediators, and volumtric changes in lesion size between the different irrigant regimes.</p> <h2>Methods</h2> <p>Forty single-rooted teeth, from 37 healthy adults, were block randomized into parallel groups of irrigation with either 17% EDTA, optimized for dECM solubilization, or 5.25% NaOCl (<i>n</i> = 20). All other aspects of the endodontic protocol were standardized over two visits with 14 days of calcium hydroxide intracanal medicament. Patient-reported pain scores were recorded at six hours and then daily for one week post-instrumentation and post-obturation. PTF samples were collected pre-instrumentation and pre-obturation, where analyte profiles (pg/TPC) were determined using an O-link Target-48 cytokine array. Treatment outcomes were clinically and radiographically assessed with cone beam computed tomography at 1 year using dichotomous criteria (favourable/unfavourable) based on volumetric change in lesion size. Participants, operators and assessors were blinded, and per-protocol analyses were conducted using binary logistic regression models with initial alpha values for statistical comparisons set at <i>p</i> &lt; .05.</p> <h2>Results</h2> <p>A 90% recall rate was achieved at one year (NaOCl: 19; EDTA: 17). Favourable outcomes were observed in 89.5% of treatments using NaOCl and 94.1% of treatments using EDTA irrigation, with median lesion volume reductions of 92.5% (IQR: 67.33–99.13) and 95.84% (IQR: 78.81–100), respectively, (<i>p</i> &gt; .05). Odds of unfavourable periradicular healing with EDTA irrigation were 0.53 [95% CI: 0.04–6.44; <i>p</i> &gt; .05]. No serious adverse effects or atypical pain patterns were reported, although two acute exacerbations occurred post-instrumentation with NaOCl irrigation (<i>p</i> &gt; .05). Target-48 panels consistently detected 15 inflammatory analytes in both groups (CCL-2, -3, -4; CSF-1; CXCL-8; HGF; IL-1β, -6, -18; MMP-1, -12; OLR-1; OSM; TNFSF-10; VEGF-A), all of which reduced pre-obturation. At this stage, IL-6 and -18 were significantly more abundant in the intervention group (<i>p</i> &lt; .05).</p> <h2>Conclusions</h2> <p>Therapeutic irrigant regimes promoting dECM solubilization resulted in one-year treatment outcomes equivalent to conventional irrigant protocols with no serious adverse effects reported.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14234?af=R International Endodontic Journal urn:uuid:1f74f163-0ff4-9f65-edfb-3191ad46ccfc Thu, 12 Jun 2025 06:30:12 -0700 International Endodontic Journal, Volume 58, Issue 7, Page 1042-1059, July 2025. <h2>Abstract</h2> <h2>Aim</h2> <p>Osteoporosis is a disease that is related to a higher prevalence and greater volumes of apical periodontitis. The purpose of this study was to evaluate the effect of ovariectomy-induced osteoporosis and high- or low-level laser photobiomodulation (PBM) on the repair of apical periodontitis (AP) in adult female Wistar rats.</p> <h2>Methodology</h2> <p>Sixty female Wistar rats (<i>n</i> = 120) were randomly allocated into four control (<i>n</i> = 6 teeth) and 8 experimental (<i>n</i> = 12 teeth) groups, according to procedure and time of evaluation: healthy control (GCS14/GCS28), osteoporotic control (GCO14/GCO28), sham (SHAM14/SHAM28), osteoporotic (OVX14/OVX28), low-level laser (OVX-LLL14/OVX-LLL28) and high-level laser (OVX-GEM14/OVX-GEM28). All groups were submitted to bilateral ovariectomy, except for the healthy control and sham. Eight weeks later, AP was induced bilaterally in mandibular first molars' mesial roots in experimental groups, and after 21 days, their endodontic treatment (RCT) was conducted. For 14 or 28 days, PBM was applied three times/week, as follows: sham application (SHAM and OVX groups); low-level laser (OVX/LLL groups); defocused high-power laser (OVX/GEM groups). After the respective experimental periods, the animals were euthanized. Tibias and hemi-mandibula were obtained and submitted to computed microtomography. Bone volume fraction (BV/TV), trabeculae number (Tb.N), spacing (Tb.Sp) and thickness (Tb.Th) were obtained for tibias, while RCT apical limit, periodontal ligament and AP volumes (APvol) were recorded for hemi-mandibula. Data were subjected to statistical analysis through generalized estimating equations (GEE), ANOVA and chi-square tests (5% significance level).</p> <h2>Results</h2> <p>Ovariectomy tibias showed lower BV/TV and Tb.N (<i>p</i> &lt; .0001) and higher Tb.Th (<i>p</i> = .020) and Tb.Sp (<i>p</i> &lt; .0001) when compared to sham groups. For hemi-mandibula, lower APvol values were found in SHAM14 when compared to OVX/LLL14 and OVX/GEM14 groups (<i>p</i> &lt; .05), which were not different from each other. Over the 28-day period, the OVX/LLL28 group showed higher AP volumes when compared to OVX28 and OVX/GEM28 (<i>p</i> &lt; .05). Analysing variables effects on APvol, time, PBM and RCT apical limit showed no effect (<i>p</i> &gt; .05), while ovariectomy showed a significant increase (<i>p</i> = .004).</p> <h2>Conclusions</h2> <p>Ovariectomy-induced osteoporosis in Wistar rats led to a reduction in AP repair, and PBM was unable to counteract this effect.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14232?af=R International Endodontic Journal urn:uuid:c346f697-5de8-f2d2-266b-e0d324b10036 Thu, 12 Jun 2025 06:30:12 -0700 International Endodontic Journal, Volume 58, Issue 7, Page 1025-1041, July 2025. <h2>Abstract</h2> <h2>Aim</h2> <p>Recent findings suggest that mitigating ferroptosis could serve as an effective strategy for treating inflammation. This study aimed to investigate the role that the enhancer of zeste homologue 2 (EZH2) mediated the signal transducer and activator of transcription 3 (stat3) methylation plays in the modulation of ferroptosis in pulpitis. The study results offer potential advancements in the therapeutic approaches for pulpitis and provide new insights and strategies for managing this condition.</p> <h2>Methodology</h2> <p>Bioinformatics analysis combined with methylation capture sequencing of EZH2^fl/flCre^+/− pulp tissue was used to explore the association between pulpitis and ferroptosis. In this study, we used an EZH2 knockout model prepared through lentiviral transduction and an LPS-induced inflammatory model of endometrial mesenchymal stromal cells to confirm the role that the EZH2/STAT3 axis plays in ferroptosis.</p> <h2>Results</h2> <p>Bioinformatics analysis identified a link between pulpitis and DNA methylation. Methylation sequencing further revealed the association of methylation with ferroptosis and the regulation of STAT3 methylation by EZH2. In vitro, lipopolysaccharide (LPS) stimulation induced ferroptosis, whereas EZH2 disruption suppressed STAT3 expression but increased Glutathione Peroxidase 4 (GPX4) expression, leading to the escalation of oxidative stress and exacerbation of ferroptosis. This illustrates the complex interactions between methylation, ferroptosis and oral inflammation, highlighting potential therapeutic targets.</p> <h2>Conclusions</h2> <p>Overall, pulpitis plays a crucial role in EZH2-mediated STAT3 methylation and activates ferroptosis by regulating GPX4 expression. This study provides new insights and strategies for treatment and advances our understanding of the pathogenesis of pulpitis.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14226?af=R International Endodontic Journal urn:uuid:7899cfcd-bd88-533f-38f9-20dc500ab3f9 Thu, 12 Jun 2025 06:30:12 -0700 International Endodontic Journal, Volume 58, Issue 7, Page 991-1005, July 2025. <h2>Abstract</h2> <h2>Aim</h2> <p>Establishing functional circulation on time is crucial to dental pulp tissue regeneration. Mesenchymal stem cells (MSCs) could act as mural cells to stabilize newly formed blood vessels, accelerating anastomosis. Our preliminary study found that direct coculture of dental pulp stem cells (DPSCs) and human umbilical vein endothelial cells (HUVECs) significantly enhanced Activin A secretion. This study aimed to disclose the dynamic patterns of Activin A expression and its regulation on vascular formation and stabilization.</p> <h2>Methodology</h2> <p>DPSCs and HUVECs were cocultured directly at a ratio of 1:1 for 3 and 6 days. Activin A and Follistatin expression were evaluated by qRT-PCR and ELISA. HUVECs were exposed to 100 ng/mL Activin A or the conditioned medium (CM) generated from DPSC monoculture and DPSC-HUVEC coculture, respectively. HUVEC proliferation, migration, tube formation and angiogenic sprouting were assessed. In parallel, membrane-bound vascular endothelial growth factor receptors (mVEGFR1 and mVEGFR2) and soluble VEGFR1 (sVEGFR1) were analysed at days 3 and 6.</p> <h2>Results</h2> <p>Activin A expression and secretion were elevated time-dependently during DPSC-HUVEC coculture. Follistatin expression decreased in DPSC-HUVEC coculture while the ratio of Activin A/Follinstain increased significantly. Activin A treatment did not promote DPSC towards smooth muscle cell (SMC)-specific differentiation, while Activin A and DPSC+HUVEC-CM suppressed HUVEC proliferation, migration, tube formation and sprouting. Activin A and DPSC+HUVEC-CM treatment markedly increased mVEGFR1 expression and sVEGFR1 secretion, suppressing HUVEC vascular formation. Activin A IgG partially reversed the effects of DPSC+HUVEC-CM on HUVECs by decreasing VEGFR1 expression and increasing vessel formation. Activin A pretreatment downregulated VEGF-triggered VEGFR2 phosphorylation of HUVECs. INHBA knockdown DPSCs disrupted the stabilization of the preformed HUVEC vascular tube network.</p> <h2>Conclusion</h2> <p>DPSC-HUVEC direct coculture upregulates Activin A secretion, interrupting VEGF receptors' balance in HUVECs to suppress HUVEC angiogenic sprouting and enhance vascular stabilization. These findings provide novel insights into the paracrine interactions on vascular stabilization of DPSC-HUVEC direct coculture.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14227?af=R International Endodontic Journal urn:uuid:7dee91b8-e517-8a16-bc1f-a8b09b3e8848 Thu, 12 Jun 2025 06:30:12 -0700 International Endodontic Journal, Volume 58, Issue 7, Page 1091-1108, July 2025. <h2>Abstract</h2> <h2>Aim</h2> <p>The microbiota of endodontic infections in patients from the Arabian Gulf region (AGR) is largely unexplored. While research in different global regions has investigated the microbial composition of such infections, studies using shotgun metagenomic sequencing (SMS) alongside culture-dependent techniques (CDT) are limited. There are also few <i>in vitro</i> biofilm models that reflect the microbial profiles of endodontic infections. Therefore, by employing SMS and CDT, this research aimed to explore compositional and functional microbial profiles of endodontic infections from the AGR. The research also sought to develop <i>ex vivo</i> biofilms directly from endodontic infection samples.</p> <h2>Methodology</h2> <p>SMS and CDT were used to analyze 32 root canal samples from necrotic pulp. Patients' samples were categorized into two cohorts: symptomatic (<i>n</i> = 19) and asymptomatic (<i>n</i> = 13). Samples underwent sequencing followed by bioinformatic analysis to investigate microbial composition, resistome, virulome, and functional differences. Two representative samples (8R, 15R) were selected to develop <i>ex vivo</i> biofilms on hydroxyapatite coupons. Similarity between inoculum and developed biofilms was assessed using SMS and CDT. The reproducibility of developed biofilms was assessed based on microbial composition and relative abundance at the species level using correlation coefficient analysis.</p> <h2>Results</h2> <p>Endodontic samples had high bacterial diversity, with a total of 366 bacterial species detected across the two cohorts. Several antibiotic resistance (<i>n</i> = 59) and virulence (<i>n</i> = 82) genes were identified, with no significant differences between the cohorts. CDT identified 28 bacterial species, with 71.4% of the isolated bacteria having phenotypic resistance to clinically relevant antibiotics. SMS showed that the <i>ex vivo</i> biofilms were polymicrobial. Biofilm derived from sample 15R had 9 species and was dominated by <i>Enterococcus faecalis</i>, while sample 8R had 12 species and was dominated by <i>Streptococcus mutans</i>. Pearson correlation analysis demonstrated a significant positive correlation between biological biofilm replicates, confirming the reproducibility of biofilm formation.</p> <h2>Conclusions</h2> <p>There was high bacterial diversity in root canal samples from necrotic pulp. Samples were shown to contain antibiotic resistance and virulence genes, with no differences evident between symptomatic and asymptomatic infections. A high number of isolated bacteria were resistant to clinically used antibiotics. <i>Ex vivo</i> biofilm models from clinical samples were successfully developed and reproducibly reflected a polymicrobial composition.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14229?af=R International Endodontic Journal urn:uuid:bd752da6-88b0-bf0e-3290-b94ec9b8199c Thu, 12 Jun 2025 06:30:12 -0700 International Endodontic Journal, Volume 58, Issue 7, Page 1006-1024, July 2025. <img src="https://onlinelibrary.wiley.com/cms/asset/c2ded565-916b-49df-abb7-4a7351cebd62/iej14229-toc-0001-m.png" alt="An HRL-SC/HIF-1α positive feedback loop enhances cell proliferation, migration and angiogenesis in dental pulp stem cells via PI3K/AKT signalling pathway"/> <p>Diagram showing that HRL-SC forms a positive feedback loop with HIF-1α and activates the PI3K/AKT signalling pathway through the integrin αvβ3/FAK and HIF-1α/PDK1 axes, thereby regulating the function of dental pulp stem cells.</p> <br/> <h2>Abstract</h2> <h2>Aim</h2> <p>Dental pulp stem cells (DPSCs) are essential for pulp regeneration but face low survival rates after transplantation. Genetic modification before transplantation is a promising solution to this issue. We aim to elucidate the biological function and regulatory mechanism of hypoxic lncRNA HRL-SC in DPSCs.</p> <h2>Methodology</h2> <p>The biological functions of HRL-SC and hypoxia inducible factor-1α (HIF-1α) in DPSCs were evaluated in vitro by cell proliferation, migration and tube formation assays. Subcutaneous transplantation in nude mice was used to evaluate the effect of HRL-SC on DPSC viability in vivo. RNA sequencing and bioinformatics analysis, RNA immunoprecipitation, dual luciferase reporter gene assay, co-immunoprecipitation, RNA fluorescence in situ hybridization, immunofluorescence and RNA and protein stability assays were used to explore the potential mechanism of HRL-SC in DPSCs. Data were analysed by one-way analysis of variance (<span class="smallCaps">anova</span>) or Student's <i>t</i>-test, with a <i>p</i> &lt;.05 indicating statistical significance.</p> <h2>Results</h2> <p>HRL-SC, a hypoxia-responsive lncRNA, enhanced the proliferation, migration and tube formation abilities of DPSCs. Subcutaneous transplantation of dental blocks revealed that HRL-SC-mediated DPSCs exhibited improved cell viability and elevated expression of Ki-67 and CD31, along with the capacity to form vascular-like structures. HIF-1α was observed to induce transcription of HRL-SC. Reciprocally, HRL-SC bound to VHL, thereby inhibiting VHL-mediated HIF-1α ubiquitination, which resulted in a positive feed-forward loop of HRL-SC/HIF-1α. RNA-sequencing and functional analyses revealed that HRL-SC was closely associated with hypoxia, angiogenesis, regeneration, integrin and PI3K/AKT signalling pathways. Furthermore, HRL-SC was shown to stabilize ITGAV and ITGB3 through PTBP1. Finally, it was confirmed that HRL-SC activated the PI3K/AKT signalling pathway via the integrin αvβ3/FAK and HIF-1α/PDK1 axes.</p> <h2>Conclusions</h2> <p>DPSCs modified with HRL-SC demonstrated enhanced cell viability via the PI3K/AKT signaling pathway and exhibited functional characteristics of endothelial cells, which may provide a novel strategy for the application of DPSCs in pulp regeneration.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14242?af=R International Endodontic Journal urn:uuid:e47813cd-1c96-e5a9-b6b7-cbfadc5a096c Thu, 12 Jun 2025 06:30:12 -0700 International Endodontic Journal, Volume 58, Issue 7, Page 1060-1072, July 2025. <h2>Abstract</h2> <h2>Aim</h2> <p>Gold standard as material in vital pulp therapy (VPT) is hydraulic calcium silicate cements (HCSC). To circumvent their prolonged setting time, light-cured pulp capping materials containing calcium silicate or calcium hydroxide powder are available. Although their positive biological properties are advertised, the data regarding the biocompatibility of light-cured pulp capping materials (LCPCM) is inconclusive. This in vitro study compared the biocompatibility of five LCPCM containing calcium silicate (TheraCal LC, ReviCal, MTA PulpCap, Pulprotec MTA) or calcium hydroxide (Calcimol LC) with that of the HCSC Biodentine.</p> <h2>Methods</h2> <p>Of each material, 226 cylindrical specimens (51.472 mm³) were prepared and incubated in a sterile cell culture medium (alpha Modified Eagle Medium) for 24 h to obtain an extract. Human dental pulp cells (hDPC) were added to the specimens and/or extracts. Cell viability and changes in cell morphology were examined (MTT, LDH, live-dead staining, light microscope). Calcium release from the materials (Ca²⁺ colorimetric assay) and the mineralisation capacity of the cells (Alizarin Red S Staining, Alkaline Phosphatase Assay) were determined. Statistical analysis was performed by <span class="smallCaps">anova</span> and the post-hoc Tukey test (<i>p</i> &lt; 0.05).</p> <h2>Results</h2> <p>Compared to Biodentine, hDPC showed significantly lower cell viability when in contact with LCPCM (<i>p</i> &lt; 0.05). Further, an inhibition zone around the test bodies or an altered cell morphology was observed. Biodentine showed almost no negative effects on cell viability or cell morphology. In contact with Biodentine, hDPC mineralise with and without mineralisation induction conditions. Among the LCPCM, mineralisation was only detectable under induction conditions with ReViCal and MTA PulpCap. In addition, Biodentine released significantly more calcium ions than the LCPCM (<i>p</i> &lt; 0.05).</p> <h2>Conclusion</h2> <p>In this in vitro study, LCPCM showed cytotoxic effects on hDPC and were hardly able to induce cell mineralisation. Biodentine showed little negative effects on cell viability, induced cell mineralisation and released more calcium than LCPCM. Biodentine is significantly superior to LCPCM in terms of biocompatibility and mineralisation induction capacity.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14243?af=R International Endodontic Journal urn:uuid:b233b793-7ac8-df05-2439-84056cc43f04 Thu, 12 Jun 2025 06:30:12 -0700 International Endodontic Journal, Volume 58, Issue 7, Page 1073-1090, July 2025. <h2>Abstract</h2> <h2>Aim</h2> <p>Tissue engineering can be applied to dentine regeneration, stimulating tissue repair by promoting mesenchymal cell migration and differentiation into odontoblast-like cells while modulating inflammation. This study aimed to investigate the effect of quercetin (QU) and calcium hydroxide (CH) incorporated into polycaprolactone (PCL)/polyethylene oxide (PEO) scaffolds on the differentiation of dental pulp stem cells (DPSCs) in a simulated inflammatory environment in vitro.</p> <h2>Methodology</h2> <p>Dental pulp stem cells (DPSCs) were cultured and treated with different concentrations of quercetin (QU) to assess cell viability, mineralized matrix production and responses under inflammatory stimuli. Reactive oxygen and nitrogen species, as well as TNF-α synthesis, were quantified using fluorescence and ELISA methods. Scaffolds of PCL/PEO with calcium hydroxide and QU were fabricated via electrospinning, characterized and analysed for cell adhesion, viability, inflammatory and mineralisation-related genes in an artificial pulp chamber model. Statistical analysis was performed using <span class="smallCaps">anova</span>, Kruskal–Wallis and confidence intervals with a significance level of 5%.</p> <h2>Results</h2> <p>Polycaprolactone/polyethylene oxide scaffolds incorporated with CH and QU showed cytocompatibility and support for DPSC differentiation at concentrations of up to 5 M diluted in the culture medium. After 14 days of treatment, the scaffolds upregulated <i>ALPL</i> gene expression under the inflammatory stimulus, with no differences between the control group and the nonincorporated scaffold. The expression of osteocalcin (<i>OCN</i>) and dentine sialophosphoprotein (<i>DSPP</i>) genes was significantly upregulated for the scaffold-treated group when stimulated with LPS.</p> <h2>Conclusions</h2> <p>Incorporating QU and CH into PCL/PEO scaffolds modulated the inflammatory-related response and upregulated mineralisation-related genes of LPS-challenged dental pulp stem cells.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14269?af=R International Endodontic Journal urn:uuid:abc21f20-827f-51c5-2267-2488c6ea6d1d Wed, 11 Jun 2025 03:29:01 -0700 International Endodontic Journal, EarlyView. <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.14265?af=R International Endodontic Journal urn:uuid:16ccd6ee-315b-c087-3e0f-20791a2b628e Tue, 10 Jun 2025 00:43:41 -0700 International Endodontic Journal, EarlyView. <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.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.14261?af=R International Endodontic Journal urn:uuid:c9036703-9007-d51b-ee14-4d5b0c552eb9 Mon, 09 Jun 2025 11:05:32 -0700 International Endodontic Journal, EarlyView. <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.14266?af=R International Endodontic Journal urn:uuid:ae42e00d-97c3-3353-4a3c-1ae38555cf32 Mon, 09 Jun 2025 11:05:18 -0700 International Endodontic Journal, EarlyView. <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.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.14262?af=R International Endodontic Journal urn:uuid:f41df1bd-9f62-0b52-ef5e-74f2c9a5aa4f Tue, 03 Jun 2025 00:29:16 -0700 International Endodontic Journal, EarlyView. <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:85aadbb3-6309-9a8e-bbc5-95eae0aa5b0c Mon, 02 Jun 2025 00:00:00 -0700 International Endodontic Journal, EarlyView. <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.14264?af=R International Endodontic Journal urn:uuid:71783e53-a936-cef3-ea63-0c2e52b50462 Fri, 30 May 2025 06:44:43 -0700 International Endodontic Journal, EarlyView. <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.14254?af=R International Endodontic Journal urn:uuid:c14d6737-0870-9b97-07ce-cff3da0a5d89 Tue, 27 May 2025 07:25:44 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>Determine the reliability and clinical validity of the Wolters classification of pulpitis.</p> <h2>Methodology</h2> <p>Prospective diagnostic accuracy study in which patients with pulpitis were included. Based on history, clinical and radiographic examination, participants were categorized into initial, mild, moderate or severe pulpitis based on Wolters classification and received treatment as suggested in the classification. The American Association of Endodontists (AAE) classification was used for comparison. Treatment outcome was evaluated at 12 months. Classification reliability was assessed by measuring the interrater agreement using Fleiss' Kappa. Construct validity was assessed by cluster analysis using an unsupervised machine learning approach. Predictive validity was determined by the association of treatment outcome with the diagnostic category. All statistical analyses were conducted using R v4.3.1; a <i>p</i>-value of &lt;.05 was considered statistically significant.</p> <h2>Results</h2> <p>Ninety-two patients were included in the study. The interrater reliability showed fair agreement for Wolters classification (Kappa (<i>κ</i>) = 0.593, 95% confidence interval (CI): 0.592–0.595), compared with substantial agreement (<i>κ</i> = 0.888, 95% CI: 0.887–0.889) for the AAE classification. Association of Wolters classification with output of unsupervised K-mode cluster analysis showed that the use of a three-category model may improve discrimination of pulpitis subdivided into mild, moderate, and severe categories. The revised classification model demonstrated 100% sensitivity and specificity for accurate discrimination between mild and severe pulpitis and 83% sensitivity and 85.7% specificity for classifying moderate pulpitis. There was no significant difference between these revised diagnostic categories considering treatment outcome, suggesting good predictive validity (<i>p</i> &gt; .05). Compared with the AAE classification, the new classification in conjunction with proposed treatments resulted in preserving 87% of the pulps compared with historical treatment.</p> <h2>Conclusions</h2> <p>We propose that a revised Wolters classification model is suitable for determining mild, moderate, and severe pulpitis to aid in clinical management of pulpitis.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14257?af=R International Endodontic Journal urn:uuid:64a092a2-1a56-7585-dcdd-9f2f81c40d5b Fri, 23 May 2025 07:09:47 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>This study aims to demonstrate that phase transformation analysis, assessed via differential scanning calorimetry (DSC), offers a more comprehensive understanding of NiTi instruments' mechanical behaviour than traditional fixed-temperature fatigue testing by evaluating phase transformation temperatures and their impact on cyclic fatigue strength of ProTaper Universal and ProTaper Gold at 20 and 35°C.</p> <h2>Methodology</h2> <p>Fifty ProTaper Universal F2 (<i>n</i> = 25) and ProTaper Gold F2 (<i>n</i> = 25) NiTi instruments were compared for geometric design (blade length, helical spirals, spiral density, spiral geometry, tip design and surface quality) and metallurgical properties including elemental analysis (energy-dispersive X-ray spectroscopy) and phase transformation temperatures. Then, cyclic fatigue strength was tested at room (20 ± 1°C) and body (35 ± 1°C) temperatures using a standardized artificial canal and cyclic fatigue resistance test. Time to fracture (in seconds) was recorded, and data were statistically analysed using the independent Student's <i>t</i>-test for intergroup analysis and the paired Student's <i>t</i>-test for intragroup analysis (<i>α</i> = 5%).</p> <h2>Results</h2> <p>Both instruments had a 17 mm blade with 10 spirals (0.59 spirals/mm), similar geometry and NiTi wires with near-equiatomic nickel-titanium ratios, differing only in metal alloy colour. DSC analysis showed distinct phase transformation temperatures, with ProTaper Universal exhibiting an R-phase start (Rs) at 16.2°C and finish (Rf) at −12.7°C, while ProTaper Gold had an Rs at 44.0°C and Rf at 28.6°C, though both transitions occurred gradually. Fracture time was significantly longer at 20°C than at 35°C for both instruments (<i>p</i> &lt; 0.05), with ProTaper Gold showing a greater reduction (58%) but maintaining superior cyclic fatigue strength at both temperatures (<i>p</i> &lt; 0.05).</p> <h2>Conclusion</h2> <p>The cyclic fatigue strength of NiTi instruments depends on temperature, highlighting the limits of assessing performance at a single predefined temperature. DSC offers key insights into phase transformation, enabling a better interpretation of mechanical properties beyond mechanical testing alone. Integrating metallurgical characterization with cyclic fatigue analysis improves the evaluation of NiTi instruments, ensuring a more accurate understanding of their mechanical performance.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14255?af=R International Endodontic Journal urn:uuid:e62f97ea-71bf-00ae-c59a-e53d9c96d0e4 Fri, 23 May 2025 05:25:54 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>Apical periodontitis (AP) is a chronic inflammatory disease arising from the contamination of the root canal system. Epigenetic regulation plays a pivotal role in controlling monocyte/macrophage-mediated local and systemic responses to bacterial challenges via <i>toll</i>-like receptors (TLRs). We aimed to explore the relationship between the methylation and expression patterns of TLR-2 in peripheral blood monocytes of individuals with AP and controls.</p> <h2>Methodology</h2> <p>Cross-sectional study. Otherwise healthy individuals with AP (<i>n</i> = 25) and controls (<i>n</i> = 29) were recruited. Peripheral blood monocytes were isolated from blood samples by Ficoll gradient and negative immunoselection. DNA and RNA were extracted from monocytes. DNA was bisulfite-treated, amplified and sequenced to evaluate the global and cytosine-phosphate-guanine (CpG) single-site methylation pattern of the TLR-2 gene promoter. mRNA relative levels of TLR-2 were assessed by qPCR. The potential associations between AP, TLR-2 DNA methylation and TLR-2 gene expression were explored using generalized structural equation models (GSEM).</p> <h2>Results</h2> <p>TLR-2 expression was significantly upregulated in peripheral blood monocytes from individuals with AP compared to controls (<i>p</i> = 0.005). Though no differences were found in the global methylation pattern, CpG single sites from the TLR-2 gene were differentially methylated at positions −40 and +24 (<i>p</i> &lt; 0.05). The methylated positions at −40 and −20 in TLR-2 were associated with TLR-2 transcriptional upregulation (<i>p</i> &lt; 0.05). Further evaluation with GSEM analysis showed that AP promoted the methylation of the −40 CpG single site on the TLR-2 gene, which, in turn, upregulated TLR-2. Conversely, the methylation of the −20 CpG single site did not act as a mediator of TLR-2 transcription in AP.</p> <h2>Conclusions</h2> <p>AP diagnosis activates peripheral blood monocytes via −40 CpG single-site methylation, independently promoting TLR-2 expression.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14260?af=R International Endodontic Journal urn:uuid:a875d5c9-24a4-0c61-09e7-156e64ee0028 Fri, 23 May 2025 05:25:19 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>To determine the effect of two contrast-enhancement strategies in nano-computed tomography (nano-CT) imaging on the contrast-to-noise ratio (CNR) of various dental tissues, including pulp, dentine and cementum, with the goal of enhancing the visibility of dental soft tissues to a level not yet reported in laboratory nano-CT imaging.</p> <h2>Methodology</h2> <p>Ten sound human third molars underwent decalcification and subsequent treatment with Lugol's iodine (<i>n</i> = 5, Group 1) or phosphotungstic acid (PTA) treatment without prior decalcification (<i>n</i> = 5, Group 2) for contrast enhancement. Imaging was performed using the laboratory nano-CT system Skyscan 2211 and the synchrotron radiation for medical physics (SYRMEP) beamline. CNRs were measured for pulpal tissue, dentine and cementum and nano-CT images were compared with classical histology, scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDXS).</p> <h2>Results</h2> <p>Group 1 significantly enhanced the contrast of pulp tissue, resulting in a 168.2% increase due to decalcification and an additional 148.7% increase after Lugol's iodine treatment. Dentine exhibited higher contrast in Group 2, whereas cementum showed similar contrast across both groups. Laboratory nano-CT enabled the visualization of detailed soft tissue structures, including nerves, blood vessels and odontoblasts within the pulp, but cementocytes remained invisible.</p> <h2>Conclusions</h2> <p>Decalcification followed by Lugol's iodine treatment was superior for enhancing soft tissue contrast, especially for pulp visualization. PTA without decalcification yielded better contrast for dentine and facilitated the visualization of attached soft tissues, such as periodontal ligament and predentine. These findings provide insights into selecting the most appropriate protocol to optimize nano-CT imaging for specific dental tissue analyses, including the pulp.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14256?af=R International Endodontic Journal urn:uuid:e527bca0-2140-6bca-ab9a-7e7b6141aee6 Tue, 20 May 2025 10:24:13 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Background</h2> <p>Direct pulp capping (DPC) is the least minimal approach for maintaining pulp vitality after pulp exposure. Besides calcium hydroxide (CaOH), hydraulic calcium silicate cements (HCSC) have increasingly been used for DPC.</p> <h2>Objectives</h2> <p>During the S3 level guideline development for material choice in DPC, we conducted a systematic review and meta-analysis of existing literature comparing CaOH and HCSC for DPC on permanent teeth. We aimed (1) to assess clinical and radiographic outcomes and (2) patient-reported outcomes of DPC.</p> <h2>Method</h2> <p>Three databases from 1 January 1990 to 19 February 2025 (MEDLINE via PubMed, EMBASE and Cochrane Database of Systematic Reviews). Prospective comparative clinical studies comparing CaOH to HCSC for DPC in permanent teeth with healthy or reversibly inflamed pulps were included. Studies on primary teeth or teeth indicative of irreversible pulpitis, teeth with unclear diagnoses or pulp exposure of non-cariogenic origin were excluded. The risk of bias and certainty of evidence were evaluated using the GRADE approach. Using the effect sizes and standard errors for every study, pairwise meta-analysis was performed comparing CaOH and different subgroups of HCSC. Success was defined as the absence of any clinical symptoms (e.g. pain, swelling) and any radiographical signs of an apical lesion. Patient-reported outcomes were additionally sought after.</p> <h2>Results</h2> <p>Five randomized-controlled trials including 552 teeth with an overall moderate certainty of evidence were included. HCSC showed a significantly higher probability of success compared to CaOH (Odds Ratio (OR): 2.68, 95% confidence interval [1.7, 4.22], <i>I</i> ² = 0%). The differences between various HCSC materials were minimal. Meta-regression indicated that neither follow-up nor risk of bias significantly influenced treatment outcomes, and the funnel plot did not reveal evidence of publication bias.</p> <h2>Conclusion</h2> <p>HCSC showed significantly higher probability for clinical and radiographic success than CaOH. This finding comes with moderate certainty. The impact of material choice on postoperative pain remains unclear. Future clinical studies should include patient-reported outcomes.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14258?af=R International Endodontic Journal urn:uuid:2e820c95-6837-a257-5551-2a021225aa82 Mon, 19 May 2025 05:20:25 -0700 International Endodontic Journal, EarlyView. https://onlinelibrary.wiley.com/doi/10.1111/iej.14253?af=R International Endodontic Journal urn:uuid:f27d0803-15c2-b112-99df-c6b3eceb45bc Wed, 14 May 2025 06:09:23 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>This study aimed to evaluate the impact of diamond-like carbon (DLC) surface treatment on the mechanical properties of nickel–titanium (NiTi) rotary instruments.</p> <h2>Methodology</h2> <p>One hundred and ten nickel–titanium instruments with a size of 25/.06 and a length of 25 mm, both with (<i>n</i> = 55) and without (<i>n</i> = 55) a DLC coating were selected and compared regarding their design (stereomicroscopy, scanning electron microscopy), metallurgy (energy-dispersive X-ray spectroscopy, differential scanning calorimetry), and mechanical performance (time to fracture, bending strength, buckling strength, cutting efficiency, and microhardness). Data were analysed using Mann–Whitney and independent Student's <i>t</i>-test (α = 5%).</p> <h2>Results</h2> <p>The design analysis confirmed that both instruments had identical geometric features, similar spiral and tip designs, with DLC-coated instruments showing fewer surface irregularities and a multi-coloured appearance. Metallurgical analysis revealed identical transformation temperatures for both groups, with the R-phase starting at ~32°C, finishing at ~25°C during cooling, and the austenitic finish occurring at ~35°C. DLC-coated instruments demonstrated significantly superior cyclic fatigue resistance (<i>p</i> = 0.0028), lower bending load (<i>p</i> = 0.0294), lower cutting efficiency (<i>p</i> &lt; 0.0001), and higher microhardness (<i>p</i> = 0.0019), whilst no difference was observed in terms of buckling strength (<i>p</i> = 0.3569).</p> <h2>Conclusions</h2> <p>Diamond-like carbon surface treatment significantly enhanced cyclic fatigue resistance, flexibility, and microhardness of NiTi rotary instruments without compromising their structural integrity.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14251?af=R International Endodontic Journal urn:uuid:dedcc6ab-a8b4-aa7e-07b9-b7251311c26e Wed, 14 May 2025 00:00:00 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Background</h2> <p>Orthodontic forces may lead to neurogenic inflammation in the dental pulp by triggering the release of somatosensory neuropeptides such as Substance P (SP), Calcitonin gene-related peptide (CGRP) and Neurokinin A (NKA). In the vast majority of patients, acute symptoms are not triggered, probably due to the control of the neurogenic inflammatory process exerted by endogenous opioid systems.</p> <h2>Objective</h2> <p>This review aimed to assess the cellular and molecular mechanisms through which the endogenous opioid system modulates the orthodontic-induced neurogenic inflammation of the dental pulp and to identify potential mechanisms for endogenous control of pulp pain.</p> <h2>Methods</h2> <p>A literature search was conducted in the databases Pubmed, ISI Web of Science and Scopus to find relevant studies using the keywords: “orthodontic movement,” “opioids” and “neurogenic inflammation.” Following the PRISMA and Amstar recommendations, studies were selected for the literature review.</p> <h2>Results</h2> <p>After removing duplicated and irrelevant articles, and those that does not meet the inclusion criteria, 38 articles were selected and classified according to the opioid peptides analysed in relation to orthodontic movement and dental pulp.</p> <h2>Discussion</h2> <p>Both peripheral and central pathways, via endogenous opioid systems such as somatostatin (SST), dynorphin, β-endorphin, methionine enkephalin, endocannabinoids and anti-inflammatory cytokines, modulate the neurogenic inflammation elicited by orthodontic movements. The bradykinin and monoaminergic systems also appear to display regulatory effects on pain response. These control mechanisms, however, may be insufficient in cases where severe orthodontic forces are applied, thus leading to asymptomatic irreversible pulpitis or necrosis.</p> <h2>Conclusion</h2> <p>The opioid system regulates neurogenic pulpal inflammation and pain at the level of the central and peripheral nervous systems by releasing endogenous substances, including SST, opioid peptides, endocannabinoids and anti-inflammatory cytokines.</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.14247?af=R International Endodontic Journal urn:uuid:4bdc282c-f7e1-74f8-d8ac-3ae938199f0b Thu, 08 May 2025 07:33:52 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>This study aimed to investigate the effects of açai on bone and systemic damage caused by apical periodontitis (AP) in an animal model.</p> <h2>Methodology</h2> <p>In this experimental study, 32 male Wistar rats were randomly allocated into six groups—Control 14 days (<i>n</i> = 4), Control 28 days (<i>n</i> = 4), AP 14 days (<i>n</i> = 4), AP 28 days (<i>n</i> = 4), AP plus açai treatment for 14 days (<i>n</i> = 8) and AP plus açai treatment for 28 days (<i>n</i> = 8). Apical periodontitis was induced under general anaesthesia by exposing the pulp of the first molars to the oral environment. Daily treatments were administered by gavage at a dose of 0.01 mL/g, using either saline solution or clarified açai. At the end of each experimental period, periapical lesions were quantitatively evaluated by micro-computed tomography (micro-CT) and histopathological analyses, whilst systemic oxidative stress was assessed through biochemical assays. Data normality was verified using the Shapiro–Wilk test, followed by one-way <span class="smallCaps">anova</span> and Tukey's post hoc test (<i>p</i> &lt; .05).</p> <h2>Results</h2> <p>Micro-CT analysis revealed that açai reduced apical periodontitis lesion volume and improved bone quality (<i>p</i> &lt; .05). Histopathological evaluation corroborated these findings, revealing moderate inflammation at 14 days and more pronounced, heterogeneous inflammatory responses at 28 days, with no significant differences between groups. Additionally, açai modulated systemic oxidative biochemistry, enhanced antioxidant defences and reduced pro-oxidant damage after 28 days.</p> <h2>Conclusions</h2> <p>Oral açai administration was associated with reduced progression of apical periodontitis and improved bone quality, suggesting its potential as a protective antioxidant in endodontic treatment, minimizing both local and systemic damage.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14248?af=R International Endodontic Journal urn:uuid:9056b541-7cbf-3631-9133-6e79b8e9ce43 Thu, 08 May 2025 07:29:26 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>Dental pulp stem cells (DPSCs) regulate immune responses; however, their heterogeneity in deep caries remains unclear. This study aimed at investigating the role of intercellular adhesion molecule 1-positive DPSCs (ICAM1⁺ DPSCs) within the immune microenvironment of deep carious pulp tissue to develop therapeutic strategies.</p> <h2>Methodology</h2> <p>Single-cell sequencing was used to compare cellular profiles between deep caries and healthy pulp tissues. ICAM1⁺ DPSCs were quantified using immunofluorescence/flow cytometry in human/mouse models and sorted for functional analyses. Odontogenic differentiation was assessed using alkaline phosphatase/Alizarin Red staining, while inflammatory mediator production was assessed using RT-qPCR, Western Blot, ELISA, SCENIC and RNA-seq. THP-1 was cultured in conditioned media from ICAM1⁺ DPSCs and ICAM1⁻ DPSCs. RT-qPCR, Western Blot and flow cytometry were used to assess the proportion of proinflammatory to reparative THP-1. Macrophage-derived cytokines (IL-1β/4/6/10 and TNF-α) were tested for DPSCs to ICAM1⁺ differentiation induction.</p> <h2>Results</h2> <p>Cellular profiling showed a significant increase in ICAM1⁺ DPSCs and proinflammatory monocytes in deep carious dental pulp tissue, with ICAM1⁺ DPSCs closely interacting with mononuclear macrophages. Immunofluorescence and flow cytometry confirmed the increase in ICAM1⁺ DPSCs in deep caries in the affected human and mouse pulp tissue. Alkaline phosphatase and Alizarin Red staining, SCENIC, RT-qPCR, Western Blot and ELISA revealed decreased odontogenic differentiation in ICAM1⁺ DPSCs and increased expression of CEBPD, IL-6, CCL2 and CXCL10 in ICAM1⁺ DPSC cells. RT-qPCR, Western Blot and flow cytometry indicated an elevated proinflammatory to reparative THP-1 ratio for THP-1 that was cultured in ICAM1⁺ DPSC-conditioned media for 1–3 days.</p> <h2>Conclusions</h2> <p>During deep caries progression, TNF-α drives the transformation of DPSCs into inflammatory ICAM1⁺ DPSCs. This subcluster exhibits impaired odontogenic differentiation capacity, secretes proinflammatory cytokines and chemokines, and enhances macrophage inflammatory activity, contributing to the advancement of deep caries lesions.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14249?af=R International Endodontic Journal urn:uuid:ea69be5d-038b-afb0-7d63-3decb23673c9 Sat, 03 May 2025 02:28:26 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>To evaluate the influence of blade design (conventional, flat and hybrid) and metallurgical properties on the mechanical performance of nickel-titanium endodontic instruments.</p> <h2>Methodology</h2> <p>Two hundred and seven NiTi instruments (25 mm in length) with three different blade designs were selected for analysis: conventional (<i>n</i> = 69, CC One Blue, size 25/0.08v), flat (<i>n</i> = 69, Platinum V.EU, size 25/0.06) and hybrid (<i>n</i> = 69, Flash Endo Power, size 25/0.06v). The instruments were evaluated regarding geometric design (scanning electron microscopy), alloy elements composition (energy-dispersive X-ray spectroscopy) and phase transformation temperatures (differential scanning calorimetry). Additionally, their mechanical behaviour was investigated by testing cyclic fatigue resistance, torsional resistance, bending resistance, buckling resistance, cutting efficiency and microhardness. Statistical significance was determined using One-Way <span class="smallCaps">anova</span> and Kruskal–Wallis tests (<i>α</i> = 5%).</p> <h2>Results</h2> <p>Platinum V.EU and Flash instruments exhibited design inconsistencies within the same lot, including nonstandard positioning and variations in the length of the flat side. All instruments were composed of a nickel-titanium alloy with equiatomic ratios of nickel and titanium. At 20°C, Flash instruments exhibited a mixed R-phase and austenitic arrangement, transitioning fully to austenitic at 36°C, while CC One Blue and Platinum V.EU displayed a complete R-phase at 20°C and retained a mixed R-phase and austenitic arrangement at 36°C. The CC One Blue exhibited superior performance in time to fracture (156 ± 34 s), maximum torque (1.5 N·cm) and buckling strength (372 ± 31 gf) (<i>p</i> &lt; .0001), while no differences were found in maximum rotation angle (<i>p</i> = .602). In terms of flexibility, the Flash (328 gf) and CC One Blue (341 gf) outperformed the Platinum V.EU (376 gf) (<i>p</i> = .006). Flash (121 gf) and CC One Blue (137 gf) also outperformed Platinum V.EU (253 gf) in terms of cutting efficiency (<i>p</i> &lt; .0001). Conversely, the Platinum V.EU demonstrated significantly higher microhardness (386 ± 45 HVN) compared to CC One Blue and Flash (<i>p</i> = .0340).</p> <h2>Conclusions</h2> <p>Overall, instruments featuring either flat-side (Platinum V.EU) or hybrid (Flash) active blades demonstrated inferior mechanical performance compared to the conventional nonflat instrument (CC One Blue).</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14250?af=R International Endodontic Journal urn:uuid:fb8635e2-2469-6d90-96a6-024d4cf30548 Sat, 03 May 2025 00:00:00 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>Accurate detection of periapical radiolucent lesions (PARLs) is crucial for endodontic diagnosis. While cone beam computed tomography (CBCT) is considered the radiographic gold standard for detecting PARLs in non-root filled teeth, its use is often limited by cost and radiation exposure. Artificial Intelligence (AI)-based radiographic analysis has shown the potential to enhance the diagnostic capability of periapical (PA) radiographs, but its accuracy, compared with CBCT, needs further evaluation.</p> <p>The aim of this paper is to assess the diagnostic accuracy of Diagnocat, a commercial AI-driven platform in detecting PARLs on PA radiographs of teeth diagnosed with irreversible pulpitis or pulp necrosis and scheduled for primary root canal treatment, using CBCT as the reference standard, and to compare Diagnocat's performance with that of experienced clinicians.</p> <h2>Methodology</h2> <p>This retrospective diagnostic accuracy study analysed 339 teeth (796 roots). PA radiographs were independently assessed by two experienced, calibrated endodontists and by Diagnocat. CBCT scans, serving as the reference standard, were evaluated by two different endodontists, blinded to the PA radiograph results. Sensitivity, specificity, accuracy and area under the receiver-operating characteristic curve (AUC-ROC) were calculated for Diagnocat and clinicians at both tooth and root levels.</p> <h2>Results</h2> <p>CBCT identified PARLs in 121 (35.7%) teeth and 240 (30.2%) roots. Diagnocat displayed a high level of correlation with clinicians in determining lesion status, with an agreement of 89%. Clinicians demonstrated significantly higher accuracy at the tooth level (86.1% vs. 78.5%, <i>p</i> &lt; .001) and greater sensitivity (65.3% vs. 47.9%, <i>p</i> &lt; .001) than Diagnocat, while specificity was comparable (97.7% vs. 95.4%, <i>p</i> = .3). Similar trends were observed at the root level. AUC-ROC values were higher for clinicians than Diagnocat at both tooth (0.81 vs. 0.72) and root (0.77 vs. 0.68) levels, although these differences were not statistically significant.</p> <h2>Conclusion</h2> <p>While Diagnocat exhibited high agreement with clinicians in detecting PARLs on PA radiographs, clinicians demonstrated superior accuracy and sensitivity overall. Notably, Diagnocat performed comparably to experienced clinicians in cases without PARLs, highlighting its potential utility for reliably ruling out disease. However, further refinement is required before it can reliably complement clinical judgment in endodontic practice.</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.14244?af=R International Endodontic Journal urn:uuid:b4448a61-1fa8-6b06-8da1-8d1f70ce5274 Fri, 25 Apr 2025 04:32:15 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>The anatomy and functions of lymphatic vessels (LV) in mammals remain poorly understood compared to the blood vascular system. In particular, whether or not LV exist in the dental pulp is still controversial. This study aims to identify the existence of LV in the mouse dental pulp using a Prox1 (Prospero homeobox 1)-eGFP transgenic mouse model combined with a tissue-clearing technique.</p> <h2>Methodology</h2> <p>Mandible or mandibular first molars of Prox1-eGFP mice were extracted, cleared for whole-mount observation and imaged using confocal microscopy. Dylight 594-lectin was injected intracardially to differentiate Prox1-eGFP+ LV from the blood vascular network. To further determine if pulpal LV act as an interstitial fluid drainage system, we examined ink absorption in surgically exposed dental pulp of mandibular first molars.</p> <h2>Results</h2> <p>At the early stage of tooth development, abundant Prox1-eGFP+ LV distinct from lectin-labelled blood vessels were present in a dental pulp. However, after the initiation of root development, the expression of Prox1-eGFP in dental pulp decreased. In mature dental pulp, Prox1-eGFP+ LV was scattered with a discontinuous lumen. In response to a non-infectious transient pulp stimulation (TPS), the Prox1-eGFP+ LV increased in number and diameter with continuous lumen reaching the apical foramen. Ink particles applied to exposed dental pulp are distributed throughout the dental pulp via interstitial spaces and vessel-like structures. Histological evaluation revealed that ink particles were mainly present in the cell-free zone. However, due to TPS, ink particles were taken up into Prox1-eGFP+ LV.</p> <h2>Conclusion</h2> <p>Our findings suggest the presence of LV in the mature dental pulp that contributes to fluid drainage in this tissue together with the extravascular pathway.</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> https://onlinelibrary.wiley.com/doi/10.1111/iej.14240?af=R International Endodontic Journal urn:uuid:6e9c1838-c9fa-ffb4-4810-94151b1746e8 Sat, 19 Apr 2025 09:29:20 -0700 International Endodontic Journal, EarlyView. <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.14239?af=R International Endodontic Journal urn:uuid:7a59fa5d-8f7f-25c2-3574-6e47370dc6d3 Sat, 19 Apr 2025 00:00:00 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>To highlight the development and application of a novel virtual reality (VR) haptic simulation program in endodontic microsurgery (EMS) to prepare for a clinical case performed by a resident student.</p> <h2>Summary</h2> <p>Modern EMS requires adequate training and a learning curve for mastering surgical techniques and refining individual skills. VR haptic simulation is gaining attention in dentistry. Pre-clinical virtual training may enhance skills and minimize the risk of unintentional iatrogenic damage during surgery. VR simulation offers an innovative approach, allowing for the saving, reviewing and repetition of exercises without constraints.</p> <p>In this case report, a female patient presented with persistent apical periodontitis related to an endodontically treated maxillary right second premolar. Utilizing a validated digital workflow, cone beam-computed tomography images were converted into STL file format and optimized for VR simulation. The Virteasy Editor interface was used to generate graphics and touchable haptic solids representing different tissues (enamel, dentine, root canal filling and bone). Following the creation of the virtual patient and the simulation of the endodontic lesion, a postgraduate student in endodontics executed 10 sessions of ostectomy, root-end resection and ultrasonic retro preparation in the evaluation stage until reaching ideal standards of practice in the virtual scenario. The student then proceeded to perform supervised root-end surgery on the actual patient. A 1-year postoperative CBCT evaluated the healing outcomes.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14237?af=R International Endodontic Journal urn:uuid:38c91d0c-8a12-ad69-cb20-4af61747306c Fri, 18 Apr 2025 00:00:00 -0700 International Endodontic Journal, EarlyView. <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.14236?af=R International Endodontic Journal urn:uuid:2066a93c-f912-8b9d-d952-8317ec09fc3f Thu, 10 Apr 2025 06:25:56 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>This study aimed to evaluate the influence of virtual reality (VR) haptic simulators on manual dexterity, self-confidence and stress levels of 3rd-semester dental students during preclinical endodontic training, as well as to determine the optimal timing for their introduction into the curriculum—before or after training with artificial teeth.</p> <h2>Methodology</h2> <p>Forty volunteered dental students enrolled in preclinical endodontic training were randomly divided into two groups. Group 1 (VR Haptic Simulator group, <i>n</i> = 20) completed four sessions with VR haptic simulators, including three training sessions followed by an evaluation session, before practicing on artificial teeth, whilst Group 2 (Control group, <i>n</i> = 20) performed a single attempt on artificial teeth first followed by the identical VR haptic simulator training period as Group 1. Prior to the training sessions, both groups received standardized lectures and demonstrations on access cavity preparation. Pre- and post-training evaluations included stress levels measured via a visual analog scale (VAS) at different phases, assessment of manual dexterity through preclinical training with artificial teeth performance scores, and self-confidence surveys. Statistical analyses were conducted with significance set at <i>p</i> &lt; .05.</p> <h2>Results</h2> <p>Group 1 demonstrated significantly higher manual dexterity scores and self-assessed proficiency compared to Group 2 (<i>p</i> &lt; .05). Stress levels, measured via VAS, were notably reduced following simulator practice in both groups, with Group 1 reporting lower anxiety levels during preclinical training with artificial teeth sessions (<i>p</i> &lt; .05). Simulator-based performance metrics were comparable between the groups (<i>p</i> &gt; .05). Self-confidence surveys indicated that Group 1 felt better prepared and more confident in performing access cavity preparations and managing procedural challenges.</p> <h2>Conclusion</h2> <p>The integration of VR haptic simulators before preclinical training with artificial teeth has a positive effect on students' manual dexterity along with reduced stress and increased self-confidence in clinical skills. Further research is needed to explore long-term effects and optimal integration strategies for VR simulators in dental curricula.</p> https://onlinelibrary.wiley.com/doi/10.1111/iej.14235?af=R International Endodontic Journal urn:uuid:868cc851-b230-4264-45c8-47ab8095f966 Thu, 10 Apr 2025 00:29:08 -0700 International Endodontic Journal, EarlyView. <h2>Abstract</h2> <h2>Aim</h2> <p>To develop a 3D-printed model enabling treatment simulation of trauma-related endodontic and restorative procedures like revitalization or placement of an apical plug on teeth with incomplete root formation.</p> <h2>Methodology</h2> <p>To generate a realistic training model suitable for trauma-related simulations, CT-Data sets were segmented, combined, adjusted and optimized using computer-aided design features. Specific focus was on optimally reflecting characteristics of immature teeth like open apical foramina and thin root walls. For reflection of the revitalization process, a set-up including a tube filled with red liquid under pressure was developed to be perforated during the procedure by the trainee, simulating bleeding from the apical papilla into the root canal system. Design was based on a combination of cost-effective simple parts combined with 3D-printed components to achieve maximal accessibility, exchangeability and re-usability. Model assembly and preparation were described in step-by-step instructions.</p> <h2>Results</h2> <p>As a result of the developmental process, the presented model qualifies for the training of the endodontic management of complications on immature teeth after dental trauma. Step-by-step descriptions aligned with the clinical procedures are performable for a revitalization procedure, for pulpotomy followed by fragment re-attachment and splint application and for placement of an apical plug using hydraulic calcium silicate cements.</p> <h2>Conclusions</h2> <p>The model successfully achieved its intended objectives, so that it may be used in the future in various dental trauma treatment simulations for undergraduate and postgraduate education on the endodontic management of trauma-related therapies in immature teeth. Its common manufacturing process, affordability and re-usability support accessibility and sustainability.</p>