Journal of endodontics最新文献

{"title":"Deformation and Fracture of NiTi Instruments Using Adaptive Reciprocation Intelligent or Fixed-Angle Reciprocation Settings.","authors":"Felipe G Belladonna, Victor T L Vieira, Marco Simões-Carvalho, Carlos Garcia Puentes, Alejandro Jaime, Emmanuel J N L Silva","doi":"10.1016/j.joen.2026.10.004","DOIUrl":"https://doi.org/10.1016/j.joen.2026.10.004","url":null,"abstract":"<p><strong>Introduction: </strong>To compare the canal number at first visible deformation, the number of simulated canals completely prepared before fracture, and fractured-fragment length of One RECI instruments operated using fixed-angle conventional reciprocation or the Adaptive Reciprocation Intelligent (ARI) setting.</p><p><strong>Methods: </strong>Twenty-six One RECI instruments were allocated to conventional reciprocation or ARI groups (n = 13). Fixed-angle reciprocation used parameters of 170° counterclockwise/60° clockwise, 4.0 Ncm, and 400 rpm. ARI initially used the same parameters but automatically changed to 90° counterclockwise/30° clockwise, 0.4 Ncm and 500 rpm when resistance to instrument advancement was detected. A single experienced operator repeatedly prepared simulated canals in transparent resin blocks until instrument fracture. Each canal was prepared using successive sequences of three gentle in-and-out pecking movements, with instrument cleaning and inspection, canal irrigation with 5 mL of distilled water, and recapitulation with a size 15 K-file between sequences, until the working length was reached. The canal number at first visible deformation and the number of canals completely prepared before fracture were recorded. Fractured-fragment length was measured digitally from the instrument tip to the fracture line. Groups were compared using two-sided Mann-Whitney U tests (α = 0.05).</p><p><strong>Results: </strong>First visible deformation was detected at a significantly higher simulated canal number with ARI than with conventional reciprocation (median [interquartile range], 3 [1-5] versus 1 [1-2]; P = 0.037). ARI also increased the number of canals completely prepared before fracture (20 [18-30] versus 6 [5-11]; P < 0.001). Fractured-fragment length did not differ significantly between ARI and conventional reciprocation (14.15 [11.65-14.43] mm versus 13.77 [13.61-14.51] mm; P = 0.644).</p><p><strong>Conclusions: </strong>The ARI setting delayed visible deformation and markedly increased the number of simulated canals prepared before fracture of One RECI instruments, without significantly affecting fractured-fragment length.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ferroptosis in endodontic pathobiology: Emerging evidence, mechanistic rationale, and translational uncertainties.","authors":"Anna Parviainen, Franklin Tay, Yuan-Yuan Li","doi":"10.1016/j.joen.2026.06.013","DOIUrl":"https://doi.org/10.1016/j.joen.2026.06.013","url":null,"abstract":"<p><strong>Introduction: </strong>Ferroptosis is an iron-dependent form of regulated cell death characterized by lipid peroxidation and impaired antioxidant defense. Its defining biochemical features, including iron-redox imbalance and lipid peroxide accumulation, overlap with biological conditions present in infected, hypoxic, and cytokine-rich endodontic tissues. This narrative review examined the potential role of ferroptosis in endodontic pathobiology, with emphasis on separating direct endodontic evidence from indirect or extrapolated oral evidence.</p><p><strong>Methods: </strong>Electronic searches were performed in PubMed, Scopus, and Web of Science using terms related to ferroptosis, endodontics, pulpitis, apical periodontitis, dental pulp, root canal infection, Enterococcus faecalis, periodontal ligament, ferritinophagy, iron metabolism, lipid peroxidation, and major ferroptosis-related regulators. Ferroptosis-associated papers were classified according to proximity to endodontic disease and strength of evidence.</p><p><strong>Results: </strong>Current evidence suggests that ferroptosis-associated pathways may participate in pulpitis and apical periodontitis. Direct evidence is strongest for active pulpitis and apical periodontitis, where ferroptosis-related changes have been reported in human tissues, animal models, and endodontic-relevant cell systems, including dental pulp fibroblasts, dental pulp cells, dental pulp stem cells, endothelial cells, and macrophages. Extrapolated evidence from periodontitis, periodontal ligament cells, oral bone models, and dental stem-cell studies provides biological context but does not establish causation in endodontic disease. Evidence for complete pulp necrosis, inflammatory root resorption, post-treatment healing, and regenerative endodontics is indirect, limited, or absent.</p><p><strong>Conclusions: </strong>Ferroptosis-associated pathways represent a credible but still emerging area of endodontic pathobiology. Current evidence suggests a possible contributory role in pulpal and periapical inflammation, but causal relevance, disease-stage specificity, and clinical significance remain unresolved. Future studies should use polymicrobial or infected-dentin models, human tissue validation, standardized ferroptosis criteria, and longitudinal intervention designs before ferroptosis-related mechanisms can be translated into endodontic diagnosis, treatment, or regenerative strategies.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Diagnostic Ability of Two Off-the-Shelf Large Language Models with That of Endodontists for Teeth Requiring Initial Root Canal Treatment: A Multicenter Retrospective Investigation.","authors":"Mahmoud Torabinejad, Patricia A Tordik, Mona Alenezi, Massoud Parirokh, Omid Dianat, Max Foroughi, Zegar Zegar, Udochukwu E Oyoyo","doi":"10.1016/j.joen.2026.10.003","DOIUrl":"https://doi.org/10.1016/j.joen.2026.10.003","url":null,"abstract":"<p><strong>Introduction: </strong>Despite growing interest in large language models (LLMs) for endodontic diagnosis, prior studies have used simulated cases, examination formats, or small selected series. This multicenter retrospective study compared the diagnostic accuracy of ChatGPT-5.2 and Gemini 3.0 with that of calibrated endodontists across 645 teeth requiring initial root canal treatment.</p><p><strong>Methods: </strong>Cases were evaluated across four endpoints: pulpal diagnosis, periapical diagnosis, treatment planning, and case difficulty. Standardized clinical summaries and radiographs were submitted to endodontists and both LLMs using a fixed single-pass protocol. Exact-match accuracy, Cohen's κ, Gwet's AC1, macro-averaged F1 score, McNemar tests, and generalized estimating equations were used for statistical comparison.</p><p><strong>Results: </strong>Endpoint accuracies ranged from 74% to 88%. Macro F1 was highest for periapical diagnosis (ChatGPT-5.2, 0.724; Gemini 3.0, 0.719) and lowest for treatment planning (0.385; 0.550), where both models showed lower observed performance in minority categories, interpreted as suggestive given small subgroup sizes. Composite accuracy across the three clinical endpoints was 61.1% (95% CI, 57.4%-64.8%) and 59.4% (95% CI, 55.3%-63.3%), and four-endpoint accuracy was 47.3% (95% CI, 43.3%-51.2%) and 46.2% (95% CI, 42.3%-49.8%), indicating at least one clinically relevant error in about half of cases. Treatment planning was the only endpoint differing between models after Holm-Bonferroni correction, favoring Gemini 3.0 (OR, 1.457; adjusted p = .003).</p><p><strong>Conclusions: </strong>Both models performed acceptably on individual endpoints and common presentations, but performance was endpoint-specific and substantially reduced on integrated assessment and low-prevalence categories. These findings support use of LLMs in endodontic diagnosis and treatment planning as adjunctive tools, but not without expert supervision.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive C-Shaped incision as a novel approach for Endodontic Microsurgery: A case report.","authors":"A Torres, N Van Caeneghem, M S Pedano","doi":"10.1016/j.joen.2026.09.017","DOIUrl":"https://doi.org/10.1016/j.joen.2026.09.017","url":null,"abstract":"<p><strong>Introduction: </strong>Endodontic microsurgery (EMS) is a well-established treatment for persistent periapical pathology when orthograde retreatment is not feasible or has failed. Surgical access is traditionally achieved using a sulcular or submarginal flap. However, these flap designs may be associated with aesthetic limitations and postoperative discomfort.</p><p><strong>Methods: </strong>This case report describes the use of a vertical Minimally Invasive C-shaped (MICS) incision as a simple and minimally invasive alternative to the conventional flap designs.</p><p><strong>Results: </strong>Its curved configuration facilitates atraumatic flap retraction, maintaining vascular integrity, and enables tension-free primary closure. At 1 year, both cases showed complete periapical healing and healthy soft tissues without scarring or gingival recession.</p><p><strong>Conclusion: </strong>The MICS incision represents a promising minimally invasive alternative for conventional flap designs in EMS. Its potential effect on postoperative pain and swelling remains to be investigated.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Survival of Endodontically Treated Cracked Teeth: A Systematic Review and Meta-analysis.","authors":"Chenglu Ruan, Lin Wang","doi":"10.1016/j.joen.2026.10.002","DOIUrl":"https://doi.org/10.1016/j.joen.2026.10.002","url":null,"abstract":"<p><strong>Introduction: </strong>Previous meta-analyses of endodontically treated cracked teeth emphasized 1- to 5-year cohorts. New long-term data permit a time-anchored reassessment.</p><p><strong>Methods: </strong>PubMed/Europe PMC, Embase, and Web of Science were searched from inception through October 3, 2026. Longitudinal cohorts of endodontically treated permanent cracked teeth with at least 1 year of follow-up were eligible. Tooth survival was the primary outcome. Two authors independently screened records, assessed full texts, and verified study-level data. Published 4- to 5-year proportions were synthesized on the logit scale using restricted maximum likelihood random effects and modified Knapp-Hartung inference. Longer horizons and prognostic factors were synthesized narratively. Risk of bias was assessed with ROBINS-E-informed domains.</p><p><strong>Results: </strong>Fifteen studies were included; 9 contributed to time-anchored quantitative synthesis. The pooled 4- to 5-year survival estimate was 82.2% (95% confidence interval [CI], 67.7%-91.1%; I²=89.5%; 7 cohorts). Two independent cohorts reported 10-year survival of 54% and 66%; the latter Singapore cohort reported 55% at 15 years. Deep crack-associated probing was an established adverse marker across multiple cohorts. In the longest cohort, adjusted extraction hazards were 2.48 for 4- to 5-mm probing and 3.19 for probing of at least 6 mm. Radicular extension, periapical disease, multiple cracks, older age, and lack of definitive cuspal coverage were additional risk indicators. All studies were at serious risk of bias; certainty was very low.</p><p><strong>Conclusions: </strong>Selected endodontically treated cracked teeth frequently remain functional for 4 to 5 years, but survival declines thereafter and varies by setting. Prognosis should be time-dependent and individualized. Deep crack-associated probing is not a newly identified factor; this review quantifies its persistent long-term association with extraction and integrates it with radicular extension and restorative status.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Preceding Enlargement Steps on Real-Time Torque Generation and Post-Instrumentation Mechanical Properties of Rotary Nickel-Titanium Finishing Instruments.","authors":"Hyeonu Jo, Sang Won Kwak, Jae-Hoon Kim, Jung-Hong Ha, Sunil Kim, Hyeon-Cheol Kim","doi":"10.1016/j.joen.2026.10.001","DOIUrl":"https://doi.org/10.1016/j.joen.2026.10.001","url":null,"abstract":"<p><strong>Introduction: </strong>This study evaluated the influence of instrumentation sequence on real-time torque generation and post-instrumentation mechanical properties of finishing instruments in two nickel-titanium (NiTi) rotary systems.</p><p><strong>Methods: </strong>Standardized simulated canals in resin blocks were prepared using HyFlex EDM OGSF (HEDM) and RACE EVO (RAVO) with three sequences: direct finishing, initial enlargement-finishing, and initial enlargement-intermediate shaping-finishing. Real-time torque was recorded using a torque acquisition module coupled to an endodontic motor. Maximum torque, mean peak torque, integrated torque, and total sequence-integrated torque were calculated. The finishing instruments were then subjected to cyclic fatigue testing in an artificial canal with a 35° curvature and torsional resistance testing.</p><p><strong>Results: </strong>Preceding enlargement instruments significantly reduced the maximum torque, mean peak torque, and integrated torque of the finishing instrument in both systems (P < .05). In HEDM, total sequence-integrated torque was lower in both sequential groups than in the direct finishing group (P < .05), whereas no significant difference was found among RAVO sequences. Cyclic fatigue resistance of the HEDM Finisher increased significantly with sequence expansion (P < .05), whereas that of the RAVO 30/.04 file did not differ among sequences. The HEDM Finisher showed reduced maximum torsional strength and increased distortion angle with sequence expansion, whereas the RAVO 30/.04 file differed only in toughness.</p><p><strong>Conclusion: </strong>The use of preceding enlargement instruments reduced the peak and integrated torque generated by the finishing instrument in both NiTi rotary systems, whereas its effects on total sequence-integrated torque and post-instrumentation fracture resistance were system-dependent.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting Stromal Cell Markers in Dental Pulp and Apical Papilla Cells.","authors":"Ding Yuan, Mieke Gouwy, Naiera Zayed, Chen Zong, Paula Pincela Lins, Annelies Bronckaers, Sofie Struyf, Kirsten Van Landuyt, Pedro Elias Marques, Bart Van Meerbeek, Zhi Chen, Mostafa EzEldeen, Mariano Simón Pedano de Piero","doi":"10.1016/j.joen.2026.09.016","DOIUrl":"https://doi.org/10.1016/j.joen.2026.09.016","url":null,"abstract":"<p><strong>Introduction: </strong>STRO-1 remains a widely used odontogenic mesenchymal stromal cell (MSC) marker, yet its ambiguous expression, non-specific tissue distribution, and unsolved structural features continue to raise questions. This study aimed to systematically characterize STRO-1 expression in human dental pulp stromal cells (hDPSCs), stromal cells from the apical papilla (SCAPs), and their native tissues, alongside CXCR4 as a biologically relevant reference marker associated with dental pulp injury and repair.</p><p><strong>Method: </strong>STRO-1 and CXCR4 expression were characterized in hDPSCs and SCAPs by flow cytometry and immunofluorescence, including assessment of surface and intracellular localization and changes during in-vitro expansion. STRO-1 expression was further evaluated under osteogenic differentiation and lipopolysaccharide stimulation. Tissue distribution of both markers was examined in healthy dental pulp and apical papilla, ex-vivo pulp healing model, and a clinical specimen following regenerative endodontic treatment (RET). CXCR4-enriched and CXCR4-depleted populations were assessed for colony formation, migration, and adipogenic differentiation.</p><p><strong>Results: </strong>In-vitro, STRO-1 showed negligible surface expression and predominantly intracellular localization, whereas CXCR4 demonstrated more accessible and quantifiable expression in expanded cells. In healthy tissues, both markers were mainly detected in perivascular regions. Following ex-vivo pulp healing, their distribution extended beyond these regions. In the RET specimen, STRO-1 and CXCR4 were expressed in vascularized pulp-like tissue and odontoblast-like cells adjacent to reparative dentin.</p><p><strong>Conclusion: </strong>STRO-1 has important limitations for identifying and isolating expanded dental stromal cells because of its restricted surface availability and predominantly intracellular localization. CXCR4 may serve as a complementary marker for investigating stromal cell heterogeneity and injury-responsive populations.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analytical methods for biomarker-based diagnosis of pulpitis in minimally invasive biological fluids: a systematic review.","authors":"Sarah Sahloul, Loïc Englebert, Sam Aryanpour, Tchilalo Boukpessi","doi":"10.1016/j.joen.2026.09.014","DOIUrl":"https://doi.org/10.1016/j.joen.2026.09.014","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory biomarkers measured in minimally invasive biological fluids are promising objective tools for diagnosing pulpitis. However, the analytical methods used to detect and quantify these biomarkers, and their diagnostic performance, have not been critically evaluated. This review aimed to identify and assess the analytical methods for detecting and quantifying inflammatory biomarkers in gingival crevicular fluid, dentinal fluid and pulpal blood to distinguish healthy pulp from different stages of pulpitis.</p><p><strong>Methods: </strong>This systematic review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420261289672). PubMed/MEDLINE, Embase, Scopus and the Cochrane Library were searched, alongside grey literature. Risk of bias was assessed using QUADAS-3. All included studies informed the synthesis, whereas GRADE assessment was limited to diagnostic questions from studies reporting individual-level discrimination.</p><p><strong>Results: </strong>Nineteen of 6,508 records were included. Six analytical strategy categories were identified. ELISA was the most frequently used (9 studies), followed by Luminex-based multiplex immunoassays, fluorometric assays, cytometric bead array, other multiplex immunoassays, and label-free LC-MS/MS proteomics. Only 3 of the 19 studies formally evaluated diagnostic discrimination; in these three studies, some individual biomarkers and multimarker models showed high discriminatory performance (AUC 0.90-0.997), but all estimates derived from single, internally validated datasets and no direct comparisons between analytical strategies were performed. Certainty of evidence was low.</p><p><strong>Conclusions: </strong>No biomarker-based analytical approach currently has sufficient evidence tosupportroutine clinical use. Although some biomarkers appear promising, comparative evidence remains insufficient.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Planning protocol for apical preparation maximizing root canal wall instrumentation and preserving root dentin structural integrity.","authors":"Bruno Carvalho de Sousa, Fabio Luiz Cunha D'Assunção, Celso Luiz Caldeira, Hugo Victor Dantas, Frederico Barbosa de Sousa","doi":"10.1016/j.joen.2026.09.013","DOIUrl":"https://doi.org/10.1016/j.joen.2026.09.013","url":null,"abstract":"<p><strong>Introduction: </strong>This study developed a personalized root canal instrumentation planning protocol designed to minimize uninstrumented canal walls while preserving a remaining dentin thickness (RDT) of at least 0.5 mm and compared it with the best available planning protocol.</p><p><strong>Methods: </strong>One hundred maxillary lateral incisors were scanned by micro-CT, and 400 cross-sections were analyzed at 1, 2, 3, and 4 mm from the apical foramen. Canal diameters, aspect ratio, and minimum RDT were measured. Virtual preparation was planned using 5 NiTi systems (ProTaper Ultimate, Reciproc Blue, SRF Sequence MKLife, HyFlex EDM, and WaveOne Gold) individually and a new hybrid protocol allowing instruments from multiple systems and hand K-files when necessary. The primary outcomes were uninstrumented canal surfaces and RDT <0.5 mm. Paired risk ratios (RRs), exact McNemar tests, and Bayes factors (BF10) were calculated.</p><p><strong>Results: </strong>The mean canal taper was 0.08 mm/mm, and the mean aspect ratio was 1.40 ± 0.59. Among single-system protocols, ProTaper Ultimate produced the lowest frequency of uninstrumented surfaces (215/400; 53.8%). The new protocol reduced this frequency to 52/400 (13.0%), corresponding to a 76% reduction versus ProTaper Ultimate (RR of 4.13; 95% CI, 3.20-5.34; p <.001). The hybrid protocol was also the only strategy with no sections presenting RDT <0.5 mm (0/400), whereas single-system protocols ranged from 1.8% to 4.5%. The protocol significantly outperformed every tested single-system strategy for both primary outcomes.</p><p><strong>Conclusions: </strong>The new personalized hybrid instrumentation planning substantially reduced uninstrumented canal surfaces while preventing critical dentin thinning compared with existing customized single-system protocols.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of a Calcium Silicate-Specific Solvent on Filling Material Removal during Retreatment and Subsequent Multisonic Irrigation: A Micro-CT Study.","authors":"Gavin Raddall, Bettina Basrani, Gustavo De-Deus, Emmanuel J N L Silva, Felipe G Belladonna, Erick M Souza, Jorge N R Martins, Marco A Versiani","doi":"10.1016/j.joen.2026.09.015","DOIUrl":"https://doi.org/10.1016/j.joen.2026.09.015","url":null,"abstract":"<p><strong>Introduction: </strong>Complete removal of calcium silicate-based sealers (CSS) during retreatment remains challenging. This study evaluated the effect of a calcium silicate-specific solvent on filling-material removal during retreatment and during subsequent multisonic irrigation.</p><p><strong>Methods: </strong>Twenty-four mesial roots of mandibular molars were pair-matched by root canal configuration and allocated to CSS-solvent or No CSS-solvent groups according to solvent use during retreatment (n = 12/group). Filling-material volume and percentage reduction were quantified by micro-CT after obturation, retreatment, and supplementary irrigation with the GentleWave system, including the additional percentage reduction relative to the post-retreatment volume. Between-group effects were expressed as mean differences or Hodges-Lehmann shifts (95% CIs). Longitudinal changes were analyzed using generalized estimating equations (α = 0.05).</p><p><strong>Results: </strong>Filling-material volume did not differ between groups at any stage, nor did the percentage reduction during retreatment (P > 0.05 and P = 0.312, respectively). The additional reduction during supplementary irrigation, relative to the post-retreatment volume, was greater in the CSS-solvent group (43.64% vs. 13.86%; Hodges-Lehmann difference, 22.51 percentage points; 95% CI, 9.59-33.72; P = 0.003), with no significant group-by-stage interaction (P = 0.063). In the apical third, no significant between-group differences were detected at any stage, including this additional reduction (Hodges-Lehmann difference, -5.35 percentage points; 95% CI, -39.51 to 18.79; P = 0.486).</p><p><strong>Conclusions: </strong>The calcium silicate-specific solvent did not significantly improve filling-material removal during retreatment alone. Its use was associated with a significantly greater percentage-based reduction during subsequent multisonic irrigation in the entire root canal, although absolute volumes did not differ significantly between groups.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}