International endodontic journal最新文献

{"title":"Micro-CT Analysis of Solvent Use and Apical Enlargement in the Retreatment of S-Shaped Root Canals of Mandibular Molars.","authors":"Renata M S Leal, Maria C B P Campos, Felipe A Copelli, Lisa Y Oda, Clarissa T Rodrigues, Bruno C Cavenago, Emmanuel J N L Silva","doi":"10.1111/iej.70176","DOIUrl":"https://doi.org/10.1111/iej.70176","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the endodontic retreatment of S-shaped mesial root canals of mandibular molars using the Reciproc Blue R25 and R40 instruments, with or without the use of an orange oil solvent, and to assess the effect of additional apical enlargement with the HyFlex EDM 50/0.03 instrument on root canal cleaning after retreatment.</p><p><strong>Methodology: </strong>Eighteen mesial root canals with double curvature from mandibular molars were prepared up to size 40/0.04 using HyFlex EDM instruments and obturated. Specimens were anatomically matched and allocated into two groups (n = 9) according to the retreatment protocol: Reciproc Blue R25 and R40 without solvent and Reciproc Blue R25 and R40 with orange oil solvent. Following filling removal, all canals underwent additional apical enlargement using the HyFlex EDM 50/0.03 instrument. Micro-computed tomographic scans were performed before and after obturation, after filling removal, and after apical enlargement. The percentage of remaining filling material, canal transportation, and centering ability were quantified by root canal thirds and in all root canal. Data were analysed using Student's t-test or Mann-Whitney U test for intergroup comparisons and paired Student's t-test or Wilcoxon signed-rank test for intragroup analyses (α = 0.05).</p><p><strong>Results: </strong>No significant differences were observed between retreatment protocols, regardless of the use of orange oil solvent, for any evaluated parameter (p > 0.05). Additional apical enlargement with the HyFlex EDM 50/0.03 instrument significantly reduced the overall volume of remaining filling material in both groups (p < 0.05). However, complete removal of the filling material was not achieved in any specimen. Apical enlargement did not result in significant changes in canal transportation or centering ability (p < 0.05).</p><p><strong>Conclusion: </strong>The use of an orange oil solvent did not improve filling material removal or influence canal shaping in S-shaped mesial root canals of mandibular molars. Additional apical enlargement with the HyFlex EDM 50/0.03 instrument enhanced root canal cleanliness without compromising canal anatomy, although residual filling material persisted.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor.","authors":"Pratik Kamalkant Shah, Bun San Chong","doi":"10.1111/iej.70178","DOIUrl":"https://doi.org/10.1111/iej.70178","url":null,"abstract":"","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibre Post Removal Using Dynamic Navigation System and Autonomous Robotic System: An In Vitro Study.","authors":"Zhiming Cui, Guangdao Zhang, Bo Lv, Zhengyuan Jiang, Yuxin Liu, Liu Qu","doi":"10.1111/iej.70173","DOIUrl":"https://doi.org/10.1111/iej.70173","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate and compare the efficiency, dentine preservation and accuracy of the dynamic navigation system (DNS) and autonomous robotic system (ATR) techniques against the conventional microscope-assisted ultrasonic (MU) technique for fibre post removal.</p><p><strong>Methodology: </strong>Sixty anatomically identical 3D-printed maxillary premolars were endodontically treated, received fibre posts and were randomly assigned to three groups (n = 20) for post removal: DNS, ATR and MU. In the DNS and ATR groups, initial removal was performed using a high-speed fissure bur guided by the respective system, followed by microscopic ultrasound to eliminate residual material. The MU group employed conventional microscope-assisted ultrasound throughout. Operative time was recorded, dentine loss and path deviation were assessed through pre- and post-operative CBCT analyses. Data were analyzed using one-way ANOVA or Kruskal-Wallis H test with appropriate post hoc multiple-comparison tests. A two-tailed p < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>All posts were successfully removed without perforation. The ATR group demonstrated the shortest operative time (14 min 02 s ± 1 min 44 s), followed by DNS (21 min 26 s ± 2 min 40 s), and MU (24 min 41 s ± 2 min 46 s), with significant differences between each pair of groups (p < 0.05). Dentine loss was significantly lower in both DNS (0.24 ± 0.04 mm) and ATR (0.25 ± 0.03 mm) groups compared to the MU group (0.32 ± 0.04 mm) (p < 0.05), with no significant difference between DNS and ATR. At the apical and middle root levels, DNS and ATR caused significantly less dentine loss than MU. No significant differences in overall path deviation were observed among the groups.</p><p><strong>Conclusion: </strong>Within the limitations of this in vitro study using 3D-printed premolars, both DNS and ATR systems demonstrated superior efficiency and dentine preservation compared to the conventional MU technique for fibre post removal, with comparable accuracy-positioning them as promising alternatives. However, these findings warrant further validation using cadaveric or extracted human teeth with varied anatomies, as well as comparative assessments of thermal and cutting behaviour.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Root Canal Treatment in Patients With Autoimmune Disease: A Retrospective Case-Control Study.","authors":"Seoyeon Lee, Euiseong Kim, Hoiin Jung, Hyejin Kim, Sunil Kim","doi":"10.1111/iej.70174","DOIUrl":"https://doi.org/10.1111/iej.70174","url":null,"abstract":"<p><strong>Aim: </strong>The purpose of this study was to compare the outcome of nonsurgical root canal treatment (RCT) in patients with autoimmune diseases (AD) with the outcome in patients without AD. The null hypothesis was: there is no difference in the outcomes of RCT regardless of the patient group. Results were also compared among AD subgroups: inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and psoriasis (Ps).</p><p><strong>Methodology: </strong>Data were obtained from a database using codes corresponding to the National Health Insurance Dental Fee Schedule. Patients diagnosed with AD who received primary RCT at the Veterans Health Service Medical Center from 2010 to 2022 formed the study group. Controls were matched using propensity score matching for age, sex, arch type, and tooth type. Preoperative periapical lesions, canal filling quality, and RCT outcomes were assessed through radiographs, including panoramic, periapical, and cone-beam computed tomography images. Outcomes were evaluated at approximately 1 year and at maximum follow-up. Chi-square tests and logistic regression were used to evaluate associations between AD and RCT success.</p><p><strong>Results: </strong>The study included 203 ad patients (317 teeth) and 203 controls (312 teeth). At 1 year, success rates were 69.4% in AD patients and 73.7% in controls (p = 0.268). Within the AD group, success rates were 64.6% for IBD, 75.3% for RA, and 73.2% for Ps. Patients with IBD showed only statistical significance (p = 0.025). The mean observation duration for the maximum follow-up was approximately 50 months. Long-term success rates were 61.5% for AD and 66.0% for controls (p = 0.207). Multivariate logistic regression analysis indicated that arch type, tooth type, and the presence of preoperative apical lesions were significant factors influencing the outcome of RCT. Comparing the 1-year and long-term outcomes, IBD, RA, and Ps showed a similar trend of decreased success rates, although the differences were not statistically significant.</p><p><strong>Conclusions: </strong>RCT success rates in patients with AD were comparable to those of controls. Multivariable analysis revealed that clinical factors were the primary predictors of success, rather than the presence of AD. Therefore, high-quality clinical procedures are the critical factor for favorable outcomes in AD patients.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological Assessment of Patients With Apical Periodontitis and Caries: A Case-Control Study.","authors":"Carlo Gaeta, Ashkan Tavakkoli, Pietro Carmellini, Alessandro Cuomo, Andrea Fagiolini, Simone Grandini, Giulia Malvicini, Crystal Marruganti","doi":"10.1111/iej.70168","DOIUrl":"https://doi.org/10.1111/iej.70168","url":null,"abstract":"<p><strong>Aim: </strong>To assess the association between apical periodontitis (AP) and subclinical symptoms of anxiety, depression and disordered eating.</p><p><strong>Methodology: </strong>A total of 120 individuals were included in this case-control study. Sixty subjects were assigned to case (AP+) and 60 to control group (AP-). The periapical and dental status were assessed using radiographic images (OPT, periapical radiographs) and dental examination. The DMFT index (decayed, missing and filled teeth) and the periapical index (PAI) scores were recorded. All subjects were interviewed to compile medical history data, anxiety (Hamilton A), depression (Hamilton D) and eating disorder (EAT-26) questionnaires. Inferential and both simple and multiple logistic regression analyses were performed.</p><p><strong>Results: </strong>Significant associations were observed between AP and higher scores on HAM-A, HAM-D and EAT-26. The regression model showed that higher PAI scores were significantly associated with increased odds of anxiety, depression and disordered eating. A PAI score of 3 showed increased odds of anxiety (OR = 5.57, p = 0.004) and depression (OR = 3.65, p = 0.025). A PAI score of 4 showed even greater odds for anxiety (OR = 8.68, p = 0.001), depression (OR = 14.07, p = 0.001) and disordered eating (OR = 3.98, p = 0.032). Participants with more than one periapical lesion were 3.56 times more likely to report higher levels of anxiety (p = 0.007), 3.59 times more likely to experience elevated depression (p = 0.018) and 3.08 times more likely to exhibit disordered eating behaviours (p = 0.028). Additionally, higher DMFT scores were associated with an increased likelihood of higher HAM-A scores (OR = 1.18, p = 0.001).</p><p><strong>Conclusions: </strong>The study results show a statistically significant higher prevalence of mood disorders and mental health-related conditions including anxiety, depression and eating disorders in patients with AP. Longitudinal studies are needed to determine the nature of the observed association.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT06589076.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SSUH2 Promotes Odontogenic Differentiation of SCAPs via the FOXM1/PDK1-Mediated Regulation of Mitochondrial Function.","authors":"Wenmin Wang, Jing Wang, Shuang Wu, Jie Wang, Zehan Li, Yadong Luo, Jintao Wu, Ming Yan, Na Li, Jinhua Yu","doi":"10.1111/iej.70167","DOIUrl":"https://doi.org/10.1111/iej.70167","url":null,"abstract":"<p><strong>Aim: </strong>Regenerative endodontics focuses on the restoration of the pulp-dentine complex by promoting odontogenic differentiation of stem cells of the apical papilla (SCAPs). Although SSUH2 has been implicated in developmental processes and dentine dysplasia type I (DD-I), the specific role of SSUH2 in regulating SCAPs differentiation remains unclear. In this study, we identified SSUH2 as a novel biomarker for SCAPs odontogenic differentiation and revealed its critical regulatory mechanism.</p><p><strong>Methodology: </strong>Immunohistochemical staining of mouse mandibular first molar sections and immunofluorescence staining of human dental pulp tissues were performed to investigate the expression characteristics of SSUH2 during root development. SCAPs were treated with siRNA-mediated knockdown or lentivirus-mediated overexpression of SSUH2, followed by assessment of proliferation and odontogenic differentiation. Subcutaneous implantation of hydrogel-scaffold-root fragments loaded with SSUH2-overexpressing SCAPs in nude mice was performed to evaluate in vivo odontogenic capacity. Mechanistically, transcriptome sequencing and bioinformatic analysis identified downstream signalling pathways. Co-immunoprecipitation, nuclear-cytoplasmic fractionation, and immunofluorescence confirmed the direct interaction between SSUH2 and FOXM1, promoting FOXM1 nuclear translocation and subsequent transcriptional upregulation of PDK1. Moreover, transmission electron microscopy, mitochondrial membrane potential assays and ROS detection collectively demonstrated that SSUH2 regulates mitochondrial function in SCAPs via the FOXM1/PDK1 axis.</p><p><strong>Results: </strong>During the development of the first molar in the mouse's lower jaw, SSUH2 is enriched in the root tip papilla region and it is also enriched in the root tip papilla region of humans. SSUH2 positively regulated the odontogenic differentiation of SCAPs in vitro. In vivo transplantation models showed that SSUH2 overexpression enhanced the odontogenic differentiation capacity of SCAPs and promoted dentine-pulp-like structure formation. Transcriptomic and functional analyses indicated that SSUH2 maintained mitochondrial function. SSUH2 directly interacted with FOXM1, promoted its nuclear translocation, and upregulated PDK1 expression. FOXM1 silencing abrogated SSUH2-mediated enhancement of both mitochondrial function and odontogenic differentiation in SCAPs.</p><p><strong>Conclusions: </strong>Our study is the first to reveal that SSUH2 promotes the odontogenic differentiation of SCAPs through the FOXM1/PDK1 axis by regulating mitochondrial function. These findings suggest that SSUH2 could serve as a potential therapeutic target for enhancing the odontogenic differentiation of SCAPs and provide a novel strategic direction for pulp-dentine complex regeneration.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammation-Regeneration Axis of Dental Pulp Stem Cells: Wnt/NF-κB Crosstalk.","authors":"V Rajasekar, M Huang, M M Abdalla, P Neelakantan, C K Y Yiu","doi":"10.1111/iej.70169","DOIUrl":"https://doi.org/10.1111/iej.70169","url":null,"abstract":"<p><strong>Background: </strong>Inflammation critically determines dental pulp regenerative outcomes, with dental pulp stem cells (DPSCs) orchestrating tissue homeostasis through differentiation, self-renewal and immunomodulation processes dynamically regulated by Wnt/β-catenin and NF-κB signaling crosstalk. Given the rising therapeutic potential of Wnt-targeted interventions in dental tissue engineering, elucidating these molecular interactions under pathological conditions is essential for developing regenerative therapeutics capable of simultaneously promoting reparative dentinogenesis while resolving inflammatory insults.</p><p><strong>Objectives: </strong>This perspective review aims to: (1) critically evaluate existing literature on lipopolysaccharide (LPS)-mediated modulation of dental pulp stem cell (DPSC) fate, addressing inconsistencies in LPS concentrations, bacterial sources and inflammatory models; (2) identify methodological gaps in current standardisation and elucidate molecular mechanisms governing Wnt/NF-κB signaling crosstalk in DPSCs under acute versus chronic inflammatory conditions; and (3) assess the therapeutic potential of GSK3β inhibitors and exosome-based interventions for dentine-pulp regeneration.</p><p><strong>Methodology: </strong>A comprehensive literature search was conducted across PubMed/MEDLINE, Scopus and Web of Science Core Collection for publications through November 2025. Search strategies combined four thematic domains: (1) cell populations (\"dental pulp stem cell\" OR \"DPSC\"); (2) signaling pathways (\"Wnt\" OR \"β-catenin\" AND \"NF-κB\" OR \"crosstalk\"); (3) biological processes (\"odontogenic differentiation\" OR \"immunomodulation\" OR \"macrophage polarization\"); (4) inflammatory context (\"pulpitis\" OR \"inflammation\" OR \"LPS\"). Articles were screened for relevance to Wnt/NF-κB interactions in dental pulp regeneration under inflammatory conditions.</p><p><strong>Results and discussion: </strong>Evidence demonstrates context-dependent Wnt/NF-κB crosstalk in DPSC fate specification. Low-dose LPS (< 1 μg/mL) stimulates reparative responses through coordinated Wnt/NF-κB activation, whereas sustained high-dose exposure (> 1 μg/mL) suppresses Wnt signaling via NF-κB-driven DKK1 upregulation, attenuating differentiation capacity. While no direct evidence links Wnt/NF-κB crosstalk to DPSC self-renewal, both pathways independently maintain stemness. Critically, DPSCs and macrophages exhibit reciprocal regenerative interactions: DPSC-derived Wnt3a polarises macrophages toward the anti-inflammatory M2 phenotype, while M2-secreted Wnt7b enhances DPSC odontogenic differentiation by suppressing NF-κB expression. However, standardised inflammation models remain lacking, hindering comprehensive elucidation of context-dependent mechanisms. Developing such models would clarify how inflammation temporally and spatially influences regenerative outcomes across clinical scenarios.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Endodontic Flare-Ups: A Systematic Review and Meta-Analysis.","authors":"Jun Ohshima, Masayoshi Morita, Yuzo Kawanishi, Shotaro Abe, Nobutake Tanaka, Tsuyoshi Shimaoka, Hazuki Maezono, Yoshifumi Kinomoto, Mikako Hayashi","doi":"10.1111/iej.70164","DOIUrl":"https://doi.org/10.1111/iej.70164","url":null,"abstract":"<p><strong>Background: </strong>Endodontic flare-ups, characterized by severe postoperative pain and/or swelling requiring unscheduled intervention, remain a clinically significant concern in root canal therapy. Identifying the factors associated with flare-ups is important for anticipating and managing patient outcomes.</p><p><strong>Objectives: </strong>This systematic review and meta-analysis aimed to identify and synthesize clinical risk factors associated with endodontic flare-ups following root canal treatment.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus from database inception to September 2025. Eligible studies included observational or interventional studies evaluating the association between potential risk factors and flare-up occurrence. Risk of bias was assessed using ROBINS-I for non-randomized studies and the Cochrane RoB 2 tool for randomized controlled trials. Certainty of evidence was evaluated using the GRADE approach.</p><p><strong>Results: </strong>A total of 15 eligible studies involving 24 320 cases met the inclusion criteria. The overall incidence of severe flare-ups was 2.83%. Significant risk factors included female sex, mandibular tooth location, non-vital pulp status, preoperative spontaneous pain, periapical lesions, multiple-visit treatment, re-treatment, and preoperative percussion pain. Among these, preoperative spontaneous pain (relative risk = 5.83) and percussion pain (relative risk = 3.45) demonstrated the strongest associations. By contrast, age, tooth type, number of root canals, instrumentation technique, and preoperative analgesic use were not significantly associated with flare-up incidence.</p><p><strong>Conclusion: </strong>Several clinical factors appear to be associated with an increased risk of endodontic flare-ups. Although the overall certainty of evidence is low, these findings may assist clinicians in identifying higher-risk cases and counselling patients regarding potential postoperative outcomes. Further well-designed prospective studies are needed to strengthen the evidence base.</p><p><strong>Trail registration: </strong>PROSPERO Systematic review registration number: CRD420251025451.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Caries Management: EFCD-ESE-ORCA S3-Level Clinical Practice Guideline.","authors":"Falk Schwendicke, Esra Kosan, Avijit Banerjee, Aylin Baysan, Lars Bjørndal, Laura Ceballos, Henry F Duncan, Sascha Herbst, Klaus W Neuhaus, Anne C O'Connell, Sebastian Paris, Helena Dujic","doi":"10.1111/iej.70132","DOIUrl":"https://doi.org/10.1111/iej.70132","url":null,"abstract":"<p><strong>Objective: </strong>To develop an evidence-based S3-level clinical practice guideline for the management of deep and extremely deep caries in vital permanent teeth.</p><p><strong>Methods: </strong>An evidence-based medical guideline based on systematically searched and appraised evidence as well as a structured consensus (S3-level) was jointly developed by the European Federation of Conservative Dentistry (EFCD), the European Society of Endodontology (ESE), the Organization for Caries Research (ORCA) and the German Society of Conservative Dentistry (DGZ), following the methodological framework of the Association of Scientific Medical Societies in Germany (AWMF) and the GRADE approach. Four working groups formulated key clinical questions regarding (1) caries removal strategies, (2) cavity liners, (3) management of exposed pulps and (4) materials for direct pulp capping and pulpotomy. Systematic reviews were conducted for each question, and evidence was synthesised and graded for quality. A structured consensus process was used to formulate recommendations. In order to encourage its wide dissemination, this article is freely accessible on Clinical Oral Investigations, International Endodontic Journal and Caries Research journals' websites.</p><p><strong>Results: </strong>Evidence supports selective (SE) or stepwise caries removal (SW) over non-selective removal (NSE) to reduce the risk of pulp exposure in deep caries. Routine use of cavity liners after caries removal showed no consistent clinical benefit and is not routinely recommended. For vital pulp therapy following pulp exposure, both direct pulp capping and pulpotomy are effective options in teeth without irreversible pulpitis, while pulpotomy is an acceptable alternative to pulpectomy in cases with signs of irreversible pulpitis. Hydraulic calcium silicate cements demonstrated superior clinical outcomes compared to calcium hydroxide and should be preferred for pulp capping and pulpotomy. The certainty of evidence ranged from very low to moderate across questions and outcomes.</p><p><strong>Conclusions: </strong>For deep caries, maintaining pulp vitality by using less invasive management strategies is supported by current evidence. Implementation of this guideline requires clinician training, patient-centered decision-making and consideration of economic and practical factors. Further research is needed, particularly for extremely deep caries and towards long-term outcomes.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of SERPINE1 in Coordinating Osteogenesis and Angiogenesis of hDPSCs for Bone Regeneration.","authors":"Bang Li, Ronghua Guan, Chaoning Zhan, Qiangqiang Zhuo, Ruiqi Zhu, Kang Yan, Fan Yang, Xin Jin, Haoran Du, Xuan Yin, Rui Yu, Xiaoxuan Lu, Yifan Lin, Xiaoyan Hu, Jianguang Xu","doi":"10.1111/iej.70166","DOIUrl":"https://doi.org/10.1111/iej.70166","url":null,"abstract":"<p><strong>Aim: </strong>The repair of critical-sized bone defects remains a significant clinical challenge due to the difficulty in achieving spatio-temporal coordination between osteogenesis and angiogenesis. This study aimed to identify key molecular regulators bridging these processes in human dental pulp stem cells (hDPSCs) and to evaluate the therapeutic efficacy of a bio-inspired delivery system comprising SERPINE1-loaded hydroxyapatite/chitosan microspheres (HA/CS MS) for vascularised bone regeneration.</p><p><strong>Methodology: </strong>Temporal transcriptomic profiling of hDPSCs during osteogenic and angiogenic differentiation was employed to screen for candidate dual-regulators. Functional validation was conducted using lentiviral-mediated gain- and loss-of-function assays, as well as exogenous protein treatment. The regenerative potential was further assessed in a rat critical-sized calvarial defect model using SERPINE1-encapsulated HA/CS MS composites.</p><p><strong>Results: </strong>Transcriptomic analysis identified SERPINE1 as a pivotal gene consistently upregulated during both differentiation lineages. Mechanistically, SERPINE1 overexpression significantly enhanced osteogenic differentiation, evidenced by increased ALP activity, mineralised nodule formation, and upregulated expression of RUNX2, COL-1, and OPN. Simultaneously, it augmented angiogenic potential by elevating VEGFR2 and CD31 expression. Notably, conditioned media from SERPINE1-overexpressing hDPSCs promoted endothelial tube formation, suggesting a paracrine mechanism. Conversely, SERPINE1 knockdown suppressed these osteo-angiogenic activities. In vivo, the HA/CS MS scaffold demonstrated excellent biocompatibility and controlled release properties. At 4 weeks post-implantation, the SERPINE1-DPSCs/MS group exhibited significantly superior bone regeneration compared to controls (blank, MS, and DPSCs/MS), characterised by marked increases in bone volume fraction (BV/TV), trabecular thickness, and CD31⁺ microvessel density as revealed by micro-CT and histological analyses.</p><p><strong>Conclusions: </strong>This study establishes SERPINE1 as a crucial hub regulator that coordinates osteogenesis and angiogenesis in hDPSCs. The utilisation of the HA/CS MS delivery system effectively harnesses this dual-functionality, promoting robust vascularised bone formation. These findings provide a novel theoretical basis and a promising translational strategy for biomaterial-based bone tissue engineering.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}