International endodontic journal最新文献

{"title":"Outcome of High-Fidelity 3D Jaw Model Simulations in Enhancing Endodontic Microsurgical Training.","authors":"Pei Yuan Chan, Lean Heong Foo, Jeen Nee Lui","doi":"10.1111/iej.70041","DOIUrl":"https://doi.org/10.1111/iej.70041","url":null,"abstract":"<p><strong>Background: </strong>Endodontic microsurgery (EMS), indicated to manage teeth unresponsive to conventional root canal treatment, requires advanced technical expertise and clinical judgement. Traditional pre-clinical training methods lack fidelity and fail to replicate diseased states, leading to a steep learning curve clinically. High-fidelity 3D jaw model simulations offer a realistic and repeatable training solution, bridging the gap between theory and clinical practice.</p><p><strong>Aim: </strong>To evaluate the effectiveness of high-fidelity 3D jaw model simulations in enhancing residents' confidence and preparedness for endodontic microsurgery.</p><p><strong>Methodology: </strong>A descriptive cross-sectional study was conducted involving second-year Endodontic residents enrolled in a postgraduate programme at the National University of Singapore. The intervention group (n = 11; 2021-2023 cohorts) participated in a structured four-session simulation training using high-fidelity 3D jaw models replicating anatomical details and periapical pathology. The curriculum incorporated diverse clinical scenarios, deliberate practice, and structured feedback. The control group (n = 4; 2020 cohort) attended a single-session workshop using pig mandibles. Pre- and post-workshop questionnaires were administered to assess self-reported confidence and preparedness using questions adapted from the Simulation Design Scale (SDS) and the Student Satisfaction and Self-Confidence in Learning (SSSCL) scale. Residents also completed a post-surgical evaluation after their first EMS procedure.</p><p><strong>Results: </strong>Residents trained with 3D models demonstrated greater improvements across all domains. Confidence in treatment planning improved from 2.45 ± 0.93 to 3.68 ± 0.69, compared to 3.75 ± 0.50 to 4.00 ± 0.00 in controls. Preparedness for EMS increased from 1.54 ± 0.82 to 3.20 ± 0.91 in the 3D group, and from 2.00 ± 0.82 to 2.75 ± 0.96 in the control group. Confidence in independently performing EMS rose from 1.27 ± 0.47 to 3.03 ± 0.95 in the 3D group, compared to 2.25 ± 0.82 to 3.00 ± 0.82 in the control group. The 3D group reported higher ratings for simulation realism, reduced stress, and greater perceived preparedness for clinical EMS.</p><p><strong>Conclusion: </strong>High-fidelity 3D jaw model simulations were effective in improving residents' confidence and preparedness for EMS. These findings support the integration of 3D simulation into Endodontic training to enhance clinical readiness and surgical competence.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149010","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":"Biological Advantages of Calcium Hypochlorite Solution Over Sodium Hypochlorite for Regenerative Endodontic Procedures: An Ex Vivo and In Vitro Study on Human Apical Papilla.","authors":"Hernán Coaguila-Llerena, Ellen Rabelo Ferraz, Bárbara Roma Mendes, Luana Raphael da Silva, Carlos Rossa Júnior, Paulo Sérgio Cerri, Gisele Faria","doi":"10.1111/iej.70038","DOIUrl":"https://doi.org/10.1111/iej.70038","url":null,"abstract":"<p><strong>Aim: </strong>Calcium hypochlorite [Ca(OCl)₂] has been proposed as an alternative to sodium hypochlorite (NaOCl) for use as an irrigant. This study aimed to assess morphological changes in human apical papilla (AP) ex vivo, and to evaluate viability, proliferation, chemotaxis and osteogenic differentiation of human apical papilla cells (hAPCs) in vitro following exposure to Ca(OCl)₂, in comparison to NaOCl.</p><p><strong>Methodology: </strong>Ex vivo, three AP samples per group were exposed to 1.5% Ca(OCl)₂, 1.5% NaOCl or control solutions [17% ethylenediaminetetraacetic acid (EDTA) and saline] for 3 min. The AP sections were stained with haematoxylin and eosin (H&E), Masson's trichrome and Alcian Blue for morphological analysis. In vitro, hAPCs were exposed to Ca(OCl)₂, NaOCl, EDTA or culture medium. Cell viability was assessed with the methyl-thiazole-tetrazolium (MTT) assay; proliferation by bromodeoxyuridine incorporation; chemotaxis by transwell assay; and mineralised nodule formation by alizarin red staining. Data were analysed by two-way ANOVA followed by Tukey's test or by the Kruskal-Wallis and Dunn tests (α = 0.05).</p><p><strong>Results: </strong>Ex vivo, marked loss of both cells and extracellular matrix components was observed in the outer layer of AP samples, particularly in the NaOCl and Ca(OCl)₂ groups, with more severe damage found in the NaOCl samples. Samples treated with EDTA exhibited structural organisation similar to those treated with saline. In vitro, Ca(OCl)₂ induced less cytotoxicity, resulted in the highest proliferation (p < 0.05), but promoted lower chemotaxis than the other irrigants (p < 0.05). EDTA and Ca(OCl)₂ led to greater mineralised nodule formation than the other solutions (p < 0.05).</p><p><strong>Conclusions: </strong>Ca(OCl)₂ at 1.5% caused less structural damage to AP than NaOCl at the same concentration and had a more favourable influence on the viability, proliferation and osteogenic differentiation of hAPCs. Moreover, it did not impair cell chemotaxis. These findings suggest that Ca(OCl)₂ may offer biological advantages in regenerative endodontic procedures.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148939","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":"Fibroblast Dysregulation in Multiple Idiopathic External Cervical Resorption: Laboratory Investigation From a Rare Case of 13 Affected Teeth.","authors":"Houwang Lai, Mingmei Yang, Shuheng Huang, Fan Wu, Xinfang Zhang, Chi Zhan, Yang Ning, Zhengmei Lin, Lingling Chen","doi":"10.1111/iej.70037","DOIUrl":"https://doi.org/10.1111/iej.70037","url":null,"abstract":"<p><strong>Introduction: </strong>Multiple idiopathic external cervical resorption (MIECR) is a rare and aggressive form of external resorption with an unclear aetiology. This study reports and investigates a unique case of extensive MIECR, potentially associated with chemotherapy exposure. The patient, a pharmacist responsible for preparing chemotherapy drugs, developed external cervical resorption affecting 13 teeth, with rapid progression occurring within just one year after starting her occupation. Notably, following local surgical treatment and cessation of high-risk work, the progression of MIECR was temporarily controlled.</p><p><strong>Methods: </strong>Whole-exome sequencing was conducted to identify potential genetic contributors. Granulation tissue removed from the tooth cavity, along with extracted teeth obtained during surgery, was collected for histopathological analysis to characterise the pathological features of MIECR. Single-cell RNA sequencing was performed on granulation tissue and healthy gingival tissue to explore the molecular basis of MIECR. Fibroblast-like cells were isolated from granulation tissue and subjected to in vitro experiments to validate their role in MIECR pathogenesis. Statistical analyses were conducted using Student's t-test or one-way analysis of variance (ANOVA), with a p-value of less than 0.05 considered statistically significant.</p><p><strong>Results: </strong>Whole-exome sequencing suggested a pivotal role for a GNAS missense mutation in disease pathogenesis. Histopathological analysis revealed extensive fibroblast proliferation and invasiveness within the lesion tissue. Moreover, single-cell RNA sequencing and in vitro experiments demonstrated abnormal fibroblast activity characterised by excessive proliferation and osteoclastic traits, implicating fibroblasts in MIECR progression. Importantly, the inhibition of the PI3K/Akt signalling pathway significantly reduced fibroblast invasion and osteoclastogenesis.</p><p><strong>Conclusions: </strong>This study offers novel insights into the pathogenesis of MIECR, paving the way for more effective diagnostic and therapeutic strategies.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130703","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":"Long-Term Biobanked Dental Pulp Stem Cells Retain Angiogenic Potential for Vascularised Tissue Engineering-Laboratory Investigation.","authors":"Shuntaro Yamada, Katerina Holomkova, Åshild Johansen, Masoumeh Jahani Kadousaraei, Niyaz Al-Sharabi, Francesco Torelli, Pierfrancesco Pagella, Ana Angelova Volponi, Hiroshi Egusa, Inge Fristad, Kamal Mustafa","doi":"10.1111/iej.70036","DOIUrl":"https://doi.org/10.1111/iej.70036","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to evaluate whether human dental pulp stem cells (DPSCs), after long-term biobanking (7-8 years), retain their pro-angiogenic properties and can be used to engineer vascularised tissues, addressing their potential for clinical translation in regenerative dentistry.</p><p><strong>Methodology: </strong>Cryopreserved DPSCs from adolescent donors were recovered from biobanking and characterised for chromosomal integrity, MSC immunophenotype and multipotency. After conditioning in pro-angiogenic conditions in vitro, gene and protein expression were analysed by RT-qPCR array, flow cytometry and high-throughput immunophenotyping. Functional angiogenic capacity was assessed via in vitro tube formation, ex ovo CAM implantation assay, organ-on-chip perfusion model and long-term culture (45 days) in clinical-grade GelMA hydrogels, with and without HUVECs.</p><p><strong>Results: </strong>Biobanked DPSCs retained MSC identity and multi-lineage differentiation potential. Pro-angiogenic/endothelial conditioning enhanced the expression of angiogenic/endothelial genes (PECAM1, VEGFR2, NRP1, ACE), yet most cells maintained a pericyte-like phenotype. Both naive and endothelial-conditioned DPSCs (i.e., naiveDPSCs and endoDPSCs, respectively) significantly enhanced vascular ingrowth in the CAM model. In the organ-on-chip system, naiveDPSCs formed perfusable vasculature with HUVECs and differentiated into perivascular cell types. Most notably, endoDPSCs alone successfully generated vascularised tissue with both CD31(+) and αSMA(+) cells present in GelMA hydrogels after prolonged stimulation.</p><p><strong>Conclusion: </strong>Long-term biobanked DPSCs preserve their angiogenic potential and, following extended endothelial induction, can independently generate vascularised tissue in 3D in vitro culture models. This is the first report demonstrating the comprehensive pro-angiogenic characterisation and the feasibility of using biobanked DPSCs for vascularised tissue engineering, highlighting their strong clinical applicability for future regenerative therapies.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130683","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":"A Protocol for the Development of a New Three-Dimensional Classification of Dens Invaginatus Using Cone Beam Computed Tomography Imaging.","authors":"Venkateshbabu Nagendrababu, Asiya Sameer Mujawar, Nandini Suresh, Francesc Abella Sans, Michael Hülsmann, Frank C Setzer, Paul M H Dummer","doi":"10.1111/iej.70035","DOIUrl":"https://doi.org/10.1111/iej.70035","url":null,"abstract":"","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085978","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":"Modelling of the Systemic Inflammatory Host Response in Relation to the Microbiome of the Endodontic Infection.","authors":"A C Georgiou, G R van der Ploeg, J A Westerhuis, S V van der Waal, A Heintz-Buschart, A K Smilde, B W Brandt","doi":"10.1111/iej.70023","DOIUrl":"https://doi.org/10.1111/iej.70023","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to investigate systemic inflammatory responses in individuals with apical periodontitis (AP) compared to age-matched healthy controls, using advanced multiway modelling techniques. We examined associations between inflammatory mediators, age, gender, symptomatic status, and the microbial composition and function to better understand host-microbe interactions in AP.</p><p><strong>Methods: </strong>We conducted a longitudinal study with 53 participants (27 with AP, 26 controls) aged 18 to 80. Blood inflammatory mediators were measured at multiple time points. Root canal microbiome and potential functions were analysed using 16S rRNA gene sequencing. Data were analysed using Parallel Factor Analysis (PARAFAC) and Advanced Coupled Matrix and Tensor Factorization (ACMTF) to capture time-resolved variation.</p><p><strong>Results: </strong>PARAFAC revealed that IL-4 levels were significantly elevated in AP cases, suggesting a role for adaptive immune activation. Age strongly influenced markers such as CRP, TNF-α, and VEGF. Symptomatic AP cases showed higher CRP and lower OPG levels, indicating more active inflammation and altered bone metabolism. ACMTF identified associations between specific taxa (e.g., Parvimonas micra, Streptococcus mutans) and inflammatory mediators, with functional analysis highlighting enriched pathways like sphingolipid signalling in asymptomatic cases.</p><p><strong>Conclusion: </strong>This study provides novel insights into the systemic immune profile of individuals with AP. IL-4 and bone metabolism markers may serve as potential biomarkers for distinguishing AP status. Our findings support the relevance of systemic inflammation in endodontic infections and underscore the value of multi-marker, multivariate approaches to better characterise disease progression and host-microbiome interactions. Such insights could contribute to improved risk stratification and personalised management in dental and systemic health contexts.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086093","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":"Yerba Mate (Ilex paraguariensis A. St.-Hil.) Reduces Oxidative Stress and Bone Resorption in Apical Periodontitis.","authors":"Carolina Sayuri Wajima, Carolina de Barros Morais Cardoso, Caroline Anselmi, Renan Dal-Fabbro, Murilo Catelani Ferraz, Cristiane Cantiga da Silva, Paulo César Ciarlini, Edilson Ervolino, Marco Cícero Bottino, Luciano Tavares Angelo Cintra","doi":"10.1111/iej.70031","DOIUrl":"https://doi.org/10.1111/iej.70031","url":null,"abstract":"<p><strong>Aim: </strong>Apical periodontitis (AP) is a highly prevalent chronic inflammatory disease that can exert systemic effects by releasing biochemical mediators that initiate and regulate the immune response. Yerba Mate (Ilex paraguariensis, YM), a popular plant broadly consumed in South America, is rich in biologically active compounds known for their therapeutic potential. This study assessed Y's in vitro cytocompatibility, anti-osteoclastogenic and immunomodulatory effects on oral stem cells and macrophages, as well as its in vivo potential to reduce AP severity and systemic side effects.</p><p><strong>Methodology: </strong>In vitro, instant powdered YM was dissolved in distilled water, filtered and diluted in culture media to final concentrations ranging from 1 to 200 μg/mL. Cell viability and pro-inflammatory cytokine release (IL-1α, IL-6, TNF-α) were assessed in human exfoliated deciduous teeth stem cells. The NF-κB pathway and anti-osteoclastogenic activity were evaluated using a luciferase reporter assay and TRAP staining in RAW 264.7. Forty male Wistar rats were divided into control (C), YM-treated(YM), AP-induced (AP) and AP with YM treatment (AP + YM). YM treatment (20 Mg/Kg/Day) was administered via gavage for 58 days. AP was induced after 28 days of YM intake, and the animals were euthanised 30 days later. In serum, systemic redox state was assessed via total antioxidant capacity (TAC) and thiobarbituric acid reactive substances (TBARS). Histological and immunohistochemical analyses evaluated inflammation, cytokine expression (TNF-α, IL-6, IL-10 and IL-17) and bone resorption markers. Micro-CT quantified alveolar bone loss. Data were analysed at p < 0.05.</p><p><strong>Results: </strong>YM treatment demonstrated significant anti-inflammatory, antioxidant and bone-protective effects. In vitro, YM-supported cell viability, reduced TNF-α and IL-1α, inhibited NF-κB activation and suppressed osteoclastogenesis. In vivo, YM treatment restored systemic antioxidant capacity and reduced lipid peroxidation, mitigating AP-induced oxidative stress. Furthermore, YM intake attenuated the local inflammatory response and reduced the bone resorptive activity associated with AP.</p><p><strong>Conclusion: </strong>In vitro, YM suppressed pro-inflammatory cytokines and NF-κB, inhibited osteoclastogenesis and was cytocompatible. In vivo, it reversed AP-induced redox state and reduced inflammation and bone resorption, suggesting therapeutic promise.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069414","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":"Prevalence and Predisposing Factors of Periapical Osteoperiostitis: A Retrospective Cross-Sectional Study.","authors":"Marie Mora, Jonathan Nguyen, Siddarth Mehta, Nader Mehra, Asgeir Sigurdsson, Min-Wen Fu, Nihan Gencerliler, Matthew Malek","doi":"10.1111/iej.70033","DOIUrl":"https://doi.org/10.1111/iej.70033","url":null,"abstract":"<p><strong>Aim: </strong>Periapical Osteoperiostitis (PO) is an inflammatory reaction of the periosteum located on the maxillary sinus floor, characterised by reactionary deposition of bone caused by periradicular disease of the maxillary posterior teeth. Radiographically, PO presents as a radiopaque 'halo' over the involved root(s). There is a gap in the literature regarding the prevalence and predisposing factors of PO. This study aims (1) to evaluate the prevalence of PO in maxillary posterior teeth amongst patients at NYU College of Dentistry, Department of Endodontics, and (2) to identify predisposing factors associated with PO.</p><p><strong>Methodology: </strong>A chart review and cone-beam computed tomography (CBCT) evaluation were conducted at NYU College of Dentistry from 2016 to 2021. Initially, 586 scans were screened, and 335 scans were included. The presence of PO, mucositis, sinus perforation, age, sex, pulpal and periapical diagnosis, size of the lesion, the vertical and horizontal distance between the sinus floor and roots, number of roots with apical lesions, type of tooth, and iatrogenic errors during treatment were recorded. Data were analysed using chi-square, Fisher's tests and logistic regression.</p><p><strong>Results: </strong>Of the 335 CBCT scans included, 98 scans (29.3%) presented with PO. The presence of mucositis was associated with 3.37 times higher odds of PO than those without mucositis. Each incremental increase in the size of the lesion (CBCTPAI) was associated with a 2.51 increase in the odds of PO occurrence, and the vertical distance between the sinus and roots was statistically significant (p < 0.001).</p><p><strong>Conclusion: </strong>The prevalence of PO in this study was higher than previously reported. Three factors were significantly associated with PO: the presence of mucositis, the size of the lesion, and the vertical distance between the sinus and roots.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040125","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":"Enhancing the Quality of Single Cone Obturation Using Hydroxyapatite Precursor Grafted Nanocomplex for Dentine Conditioning: An In Vitro Study.","authors":"Eissa Sameer Bunashi, Mingxin Hu, Angeline Hui Cheng Lee, Chengfei Zhang, Anil Kishen, Jeffrey Wen Wei Chang","doi":"10.1111/iej.70034","DOIUrl":"https://doi.org/10.1111/iej.70034","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to quantify the effect of chitosan-hydroxyapatite precursor nanocomplexes (C-HA) on void reduction in the root canal system and isthmus regions, characterise void distribution patterns and assess sealer-dentin interface adaptation post-conditioning.</p><p><strong>Methodology: </strong>Vertucci type II and Yin type IV mesial root canals from 24 extracted mandibular first molars were randomly divided into two groups (n = 12): (1) C-HA conditioned and (2) control (deionised water). All canals underwent standardised preparation using ProTaper Next files with 3% NaOCl irrigation (2 mL per file change) and final irrigation with 17% EDTA (5 mL, sonic activation) followed by 3% NaOCl (5 mL) and a final deionised water rinse (5 mL). Before obturation, the C-HA group received 5 min of C-HA solution (2 mg/mL) treatment with active agitation by ProTaper Next X2 gutta-percha cone, while the control group received equivalent water treatment. Canals were obturated using the single-cone technique with Ceraseal. High-resolution Micro-CT (8.6 μm voxel size) quantified void percentages in the entire canal system and isthmus regions, with analysis stratified by coronal, middle and apical thirds. Selected specimens underwent SEM evaluation of interfacial adaptation. Statistical analysis used the independent samples t-test, two-way ANOVA with Tukey's post hoc tests (α = 0.05), and Fisher's exact test.</p><p><strong>Results: </strong>No significant differences related to the canal/isthmus pre-treatment volumes and isthmus characteristics were noted between the two groups. Micro-CT analysis revealed significantly lower void percentages in C-HA-treated canals compared to controls (9.21% vs. 19.01% in the entire canal system and 19.07% vs. 55.65% in the isthmus regions, p < 0.001). Analysis of the void distribution patterns further demonstrated statistically significant differences between the groups in the cervical and middle root thirds (p < 0.05). SEM evaluation showed continuous, gap-free interfaces with bioactive mineralization in C-HA-treated canals, contrasting with discontinuous adaptation and sparse precipitates in controls.</p><p><strong>Conclusion: </strong>C-HA dentine conditioning significantly improved obturation quality with Ceraseal bioceramic sealer by reducing voids in isthmus regions and enhancing sealer-dentin interfacial adaptation.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040132","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 Relationship Between Pulpal Diagnostic Conditions and Potential Inflammatory Biomarkers.","authors":"Mohammad A Sabeti, Keyvan Nikghalb, Reza Pakzad, Ashraf F Fouad","doi":"10.1111/iej.70030","DOIUrl":"https://doi.org/10.1111/iej.70030","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate diagnosis of pulpal health is crucial to identify the most effective therapeutic approach. However, differentiating pulpal conditions, which may require different treatment approaches, remains a challenge. This study aimed to address this gap by investigating the protein levels of 17 inflammatory biomarkers simultaneously in the dental pulp with different clinical diagnoses.</p><p><strong>Methods: </strong>This study employed a cross-sectional exploratory design, enrolling 64 adult patients. After obtaining ethical approval, researchers conducted clinical and radiographic examinations to categorise teeth into four diagnostic groups: normal pulp, reversible pulpitis, symptomatic irreversible pulpitis and asymptomatic irreversible pulpitis. Pulpal blood samples were then collected and analysed using Luminex technology to measure the levels of inflammatory proteins and matrix metalloproteinases (MMPs). Statistical analyses, including the Mann-Whitney U test and Spearman's rank correlation, were used to compare the levels of these markers across the different diagnoses and to assess their correlation with patient symptoms.</p><p><strong>Results: </strong>The study revealed significant increases in several inflammatory proteins, including IL-4, IL-8, MCP-1, MIP-1α, RANTES and MMP-9, in both types of irreversible pulpitis cases compared with other diagnostic categories p < 0.05. These elevated levels exhibited positive correlations with patient-reported pain scores, instances of spontaneous pain and bleeding times. Notably, only IL-4 and IL-7 exhibited correlations with prolonged bleeding times (over 10 min) p < 0.05, while IL-1α and MMP-2 were associated with shorter bleeding times (under 10 min) p < 0.05. Additionally, IL-8 and MCP-1 levels were significantly associated with positive palpation findings p < 0.05, whereas MIP-1α and MMP-1 were correlated with positive percussion results p < 0.05.</p><p><strong>Conclusion: </strong>Differential specific inflammatory potential biomarker levels may differentiate pulpal disease states. Integrating molecular diagnostics into longitudinal clinical trials and eventually into routine endodontic practice, could revolutionise treatment decisions.</p>","PeriodicalId":13724,"journal":{"name":"International endodontic journal","volume":" ","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023286","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}