Journal of endodontics最新文献

{"title":"Analysis of CD4+ and CD8+ T lymphocytes and expression of immune checkpoint proteins (PD-1 and PD-L1) in primary and persistent periapical lesions.","authors":"Robeci Alves Macêdo Filho, Wliana Pontes de Lima, Camila Maria Belarmino Dos Santos, João Augusto Vianna Goulart Filho, Pollianna Muniz Alves, Cassiano Francisco Weege Nonaka, Manuel Antonio Gordón-Núñez","doi":"10.1016/j.joen.2026.04.015","DOIUrl":"https://doi.org/10.1016/j.joen.2026.04.015","url":null,"abstract":"<p><strong>Introduction: </strong>Persistent periapical lesions (PePL) represent a clinical challenge because of their inadequate response to conventional endodontic therapies. Studies indicate differences in immunoinflammatory mechanisms between primary periapical lesions (PrPL) and PePL but the findings remain conflicting. This study aimed to evaluate CD4+ and CD8+ T lymphocytes and the expression of immune checkpoint proteins (PD-1 and PD-L1) in PrPL and PePL, correlating the findings with the intensity of the inflammatory infiltrate and pattern of the cystic epithelial lining.</p><p><strong>Methods: </strong>Ten primary radicular cysts (PrRC), 10 persistent radicular cysts (PeRC), 10 primary periapical granulomas (PrPG), and 10 persistent periapical granulomas (PePG) were submitted to immunohistochemical analysis using anti-CD8, anti-CD4, anti-PD-1, and anti-PD-L1 antibodies.</p><p><strong>Results: </strong>Higher median T lymphocyte counts were observed in PeRC when compared to the other groups, with a statistically significant difference in CD8+ T cells compared to PrPG (P < .05). Regarding PD-L1, PeRC exhibited higher median percentages of positivity in connective tissue and epithelial lining, which differed significantly from the other groups (P < .005). There were no statistically significant differences in the numbers of CD4+ or CD8+ T lymphocytes nor in the expression of PD-1 or PD-L1 according to morphological parameters (P > .05). Immunoexpression of PD-L1 and CD4+ T lymphocyte count showed a positive correlation in PrPL (r = .592; P < .005) and PePL (r = .532; P < .05). In the latter, PD-L1 and CD8+ T lymphocyte count were also positively correlated (r = .690; P < .001).</p><p><strong>Conclusions: </strong>The results suggest the involvement of PD-1 and PD-L1 in the regulation of immunoinflammatory responses in PrPL and PePL. These immune checkpoint proteins may be particularly important for the suppression of CD4+ and CD8+ T lymphocyte activities in the periapical lesions studied, contributing to their chronicity.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856342","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":"Characterization and evaluation of biological properties of calcium silicate cement-based sealers after thermal pretreatment.","authors":"Young-Eun Jang, Yemi Kim, Hye-In Kim, Hyeon-Sae Oh","doi":"10.1016/j.joen.2026.04.017","DOIUrl":"https://doi.org/10.1016/j.joen.2026.04.017","url":null,"abstract":"<p><strong>Introduction: </strong>Hydraulic calcium silicate cement-based sealers (CSC sealers) are now frequently used with warm vertical compaction in root canal treatment. However, the impact of heat on the biological properties of CSC sealers remains unclear. Therefore, this study investigated the effects of thermal pretreatment on the material characteristics, antimicrobial activity, and cytocompatibility of CSC sealers, assessed immediately after setting and after a 28-day post-setting maturation period.</p><p><strong>Methods: </strong>An epoxy resin-based sealer (AH Plus) and two CSC sealers (AH Plus Bioceramic and BioRoot Flow) were evaluated. The sealers were heated to 100°C for 30 s and subsequently cooled to 37°C. Materials were characterized by field emission scanning electron microscopy, energy-dispersive spectroscopy, and X-ray diffraction analysis. The leaching profile, pH, surface roughness, and contact angles were also assessed. All tests were performed immediately after setting and after 28 days of post-setting maturation. The antimicrobial activity of freshly mixed and set sealers was assessed against 3-day Enterococcus faecalis biofilms by quantifying colony-forming units. The osteogenic cell line MC3T3-E1 was assessed with regard to cell viability and cell migration/proliferation following exposure to sealer leachates. Statistical analyses included one-way ANOVA with Tukey's post hoc test for group comparisons and paired t-tests for temperature and post-setting maturation period, alongside non-parametric tests where appropriate (P < .05).</p><p><strong>Results: </strong>Microstructural changes in the CSC sealers were observed after thermal pretreatment at 100°C. Calcium ion release significantly decreased in BioRoot Flow after thermal pretreatment (P < .05). Thermal pretreatment significantly increased antimicrobial activity in AH Plus Bioceramic after a 72-hour setting period (P < .05), whereas no significant change was observed in BioRoot Flow (P > .05). Regardless of thermal pretreatment, BioRoot Flow maintained its antimicrobial activity after 28 days of post-setting maturation. Both CSC sealers maintained alkalinity for up to 28 days. No significant differences were observed between the 100°C-pretreated and 37°C control groups in cell viability or proliferation (P > .05).</p><p><strong>Conclusions: </strong>Thermally pretreated AH Plus Bioceramic and BioRoot Flow exhibited changes in microstructure and calcium ion release, which may affect early antimicrobial activity in a material-dependent manner, but did not influence cytocompatibility or alkalinity.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856316","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":"Guidelines for Authors","authors":"","doi":"10.1016/S0099-2399(26)00166-4","DOIUrl":"10.1016/S0099-2399(26)00166-4","url":null,"abstract":"","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 5","pages":"Pages A11-A18"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755595","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":"Bioengineered Gelatin Hydrogels Functionalized with VEGF/BMP2 Mimetic Peptides for Advancing Regenerative Endodontics","authors":"Yuanyuan Han BDS, MSc, PhD ,&nbsp;Hitesh Chopra BDS, MDS, PhD ,&nbsp;Dineshi Sewvandi Thalakiriyawa BDS ,&nbsp;Hong Wang BDS, MDS, PhD ,&nbsp;Waruna Lakmal Dissanayaka BDS, PhD","doi":"10.1016/j.joen.2026.01.015","DOIUrl":"10.1016/j.joen.2026.01.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Regenerating the pulp-dentin complex is challenging due to its distinct biological, anatomical, and mechanical properties. To address this, we explored gelatin-based hydrogels modified by covalently binding vascular endothelial growth factor (VEGF) and bone morphogenetic protein 2 (BMP2) mimetic peptides to target pulp and dentin regeneration.</div></div><div><h3>Methods</h3><div>Three distinct hydrogels: GelMA (gelatin methacrylate, 5% w/v), GelNB (norbornene-modified gelatin, 5% w/v), and GelMN (5% GelMA: 5% GelNB = 1:1) were prepared and characterized by scanning electron microscopy (SEM, <em>n</em> = 3), Fourier transform infrared spectroscopy (FTIR, <em>n</em> = 3), and swelling ratio analysis (<em>n</em> = 3). Human dental pulp stem cells (DPSCs) were encapsulated to assess viability (live/dead staining, <em>n</em> = 3) and spreading (<em>n</em> = 3). DPSCs and human umbilical vein endothelial cells were cocultured in a VEGF mimetic peptide (200 μg/ml) functionalized GelMN hydrogel to evaluate vascular structure formation (<em>n</em> = 3). Conversely, DPSCs were encapsulated in a BMP2 mimetic peptide (20 μM) functionalized GelMA hydrogel to investigate the odontogenic differentiation (<em>n</em> = 3).</div></div><div><h3>Results</h3><div>SEM analysis showed GelMA exhibited a denser, more tightly crosslinked network and smaller pore size compared to GelNB/GelMN. FTIR confirmed the chemical composition of all 3 hydrogels, and the swelling ratio demonstrated no significant difference among them. All hydrogels exhibited excellent biocompatibility and supported cell viability after culturing with DPSCs. VEGF mimetic peptide in GelMN enhanced vascular tube formation by human umbilical vein endothelial cells supported by DPSCs. In parallel, BMP2 mimetic peptide in GelMA significantly boosted the odonto-/osteogenic differentiation of DPSCs, as indicated by the expression of dentin sialophosphoprotein, alkaline phosphatase, and mineralization levels.</div></div><div><h3>Conclusion</h3><div>VEGF and BMP2 mimetic peptide-functionalized gelatin hydrogels is a promising approach to enhance pulp-dentin complex regeneration.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 5","pages":"Pages 767-776"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146043957","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":"Fracture Resistance of Heat-treated NiTi Instruments by the Load of Mechanical Preparation According to Tooth Type and Canal Number","authors":"Badria AlAli BDS, MSc ,&nbsp;Amre Atmeh BDS, MSc, PhD ,&nbsp;Mohamed Jamal DDS, MSD, DScD, FRCD(C) ,&nbsp;Fatemeh Ahmad BDS, MSc ,&nbsp;Amar H. Khamis BSc, MSc, DEA, PhD ,&nbsp;Hyeon-Cheol Kim DDS, MS, PhD ,&nbsp;Rashid El Abed BDS, JBE","doi":"10.1016/j.joen.2026.02.005","DOIUrl":"10.1016/j.joen.2026.02.005","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to evaluate the impact of mechanical loading, induced by preparing anatomically standardized premolar and molar canal models, on the cyclic fatigue and torsional fracture resistance of heat-treated nickel–titanium (NiTi) rotary instruments.</div></div><div><h3>Methods</h3><div>Sixty NiTi instruments (Race Evo) were randomly assigned to 3 groups (<em>n</em> = 20): unused controls (N0), instruments used to prepare 2 canals in premolar models (P2), and 4 canals in molar models (M4). Cyclic fatigue testing was performed in dynamic mode with a 4 mm axial pecking motion at 37 ± 1 °C. Time to fracture and the number of cycles to fracture were recorded; the lengths of fractured fragments were measured using a digital caliper. Torsional resistance was assessed by fixing the apical 3 mm and rotating the shaft until fracture. Maximum torsional load and angle of rotation were recorded. Fractured surfaces were examined using scanning electron microscopy, and phase transformation behavior was assessed via differential scanning calorimetry. Data were analyzed using one-way analysis of variance and Tukey's post hoc test at a 95% significance level.</div></div><div><h3>Results</h3><div>P2 and M4 groups showed significantly higher cyclic fatigue resistance than N0 (<em>P</em> &lt; .001), with no difference between P2 and M4. Torsional resistance parameters were significantly reduced in P2 and M4 compared to N0 (<em>P</em> &lt; .05). Scanning electron microscopy revealed distinct fracture morphologies; differential scanning calorimetry showed consistent phase transformation behavior.</div></div><div><h3>Conclusion</h3><div>Within the limitations of this study, standardized simulated procedural loading paradoxically increased the cyclic fatigue resistance of heat-treated NiTi instruments, while simultaneously producing a moderate reduction in torsional strength.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 5","pages":"Pages 812-819"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180536","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":"Influence of Different Types of Intracanal Medicaments and Root Canal Sealers on Root Dentine Fracture Resistance at 2 Different Time Intervals","authors":"Damla Akkaya DDS, MSc,&nbsp;Tugba Kosar DDS, MSc","doi":"10.1016/j.joen.2026.01.013","DOIUrl":"10.1016/j.joen.2026.01.013","url":null,"abstract":"<div><h3>Introduction</h3><div>To investigate the influence of different types of intracanal medicaments and root canal sealers on root dentine fracture resistance at different time intervals.</div></div><div><h3>Methods</h3><div>A total of 180 single-rooted human mandibular premolars were used. Samples were divided into 3 groups: negative control (unprepared and unfilled, <em>n</em> = 10), positive control (prepared but unfilled, <em>n</em> = 10), and experimental groups (10 groups, <em>n</em> = 15). Root canals were prepared chemomechanically. In single-visit groups, canals were filled with either AH Plus or Bio-C Sealer. In medicament-applied groups, Ultracal XS or Bio-C Temp was applied for 1 week or 1 month before obturation with AH Plus or Bio-C Sealer. Root dentine fracture resistance was measured under vertical loading using a universal testing machine. Material–dentine interface of 10 experimental samples were examined using scanning electron microscope/energy dispersive x-ray spectroscopy. Data were analyzed using the analysis of variance followed by post hoc Tukey's tests, with significance set at <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>Root dentine fracture resistance was highest in the negative control and lowest in the positive control (<em>P</em> &lt; .001). Single-visit groups demonstrated significantly higher root dentine fracture resistance than the medicament-applied groups (<em>P</em> &lt; .001). No significant differences were found in the single-visit AH Plus and Bio-C Sealer (<em>P</em> &gt; .05). Similarly, no significant difference was observed between the groups filled with AH Plus or Bio-C Sealer after application of Ultracal XS or Bio-C Temp (<em>P</em> &gt; .05). Furthermore, the time of medicament application (1 week–1 month) was found to have no significant effect on root dentine fracture resistance (<em>P</em> &gt; .05).</div></div><div><h3>Conclusions</h3><div>Different intracanal medicaments (Ultracal XS, Bio-C Temp) and root canal sealers (AH Plus, Bio-C Sealer) exhibited similar effects on root dentine fracture resistance at different time intervals. However, both Ultracal XS and Bio-C Temp may adversely affect root dentine fracture resistance due to their tendency to leave residues on the dentine surface.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 5","pages":"Pages 783-796"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029659","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":"Fracture Resistance and Biomechanical Behavior of Retreated Teeth Obturated with Different Sealers: Combined Laboratory Testing and Finite Element Analysis","authors":"Hümeyra Çapkın DDS,&nbsp;Fatma Begüm Peker DDS,&nbsp;Mehmet Burak Güneşer DDS","doi":"10.1016/j.joen.2026.01.016","DOIUrl":"10.1016/j.joen.2026.01.016","url":null,"abstract":"<div><h3>Introduction</h3><div>This study evaluated the effect of different sealers on fracture resistance of retreated mandibular premolars and characterized their biomechanical behavior using three-dimensional finite element analysis (FEA).</div></div><div><h3>Methods</h3><div>One hundred twenty-four single-rooted premolars were instrumented and initially obturated with AH Plus. Twelve teeth with intact fillings served as positive controls, and 12 retreated but unfilled teeth served as negative controls. The remaining samples were retreated and randomly assigned to 5 sealer groups (<em>n</em> = 20): AH Plus, GuttaFlow Bioseal, TotalFill BC, BioRoot RCS, and NeoSealer Flo. After thermocycling, fracture resistance was tested under 45° oblique loading. Corresponding micro-computed tomography–based FEA models were generated to compare von Mises stress distributions with and without a simulated periapical lesion.</div></div><div><h3>Results</h3><div>Fracture resistance differed significantly among groups (<em>P</em> &lt; .001). The negative control showed the lowest resistance, whereas the positive control exhibited the highest values (<em>P</em> &lt; .05). No statistically significant differences were observed among the experimental sealer groups (<em>P</em> &gt; .05). FEA demonstrated distinct stiffness-dependent patterns: NeoSealer Flo and TotalFill BC concentrated stresses within the sealer, whereas limiting dentinal stress; GuttaFlow Bioseal transmitted greater stresses to dentin; AH Plus and BioRoot RCS showed intermediate responses.</div></div><div><h3>Conclusions</h3><div>In retreatment conditions, sealer type influences internal stress distribution even when fracture resistance values are comparable. Bioceramic sealers with higher elastic modulus may reduce dentinal stress and enhance biomechanical compatibility. Clinicians should consider not only biological performance but also mechanical compatibility when selecting sealers to support long-term structural preservation of retreated teeth.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 5","pages":"Pages 797-805"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052354","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":"Guided Double Auto-transplantation of Immature Molars Replacing Multiple Posterior Teeth with Extensive Invasive External Cervical Resorption – A Case Report","authors":"Francesc Abella Sans DDS, PhD ,&nbsp;Nandini Suresh BDS, MDS, FDS RCS(Eng) ,&nbsp;Marc Garcia-Font DDS, PhD ,&nbsp;Lokhasudhan Govindaraju BDS, MDS ,&nbsp;Paul M.H. Dummer BDS, MScD, PhD, DDSc ,&nbsp;Venkateshbabu Nagendrababu BDS, MDS, FDS RCPS (Glasg), PhD","doi":"10.1016/j.joen.2026.01.003","DOIUrl":"10.1016/j.joen.2026.01.003","url":null,"abstract":"<div><div>This case report describes the extraction of 3 mandibular posterior teeth (teeth #19, 20 and 21) with extensive invasive external cervical resorption (ECR) followed by guided double auto-transplantation of immature mandibular third molars (teeth #17 and 32). A 17-year-old male with a history of orthodontic treatment reported with intermittent pain in the mandibular left posterior region. Clinical and radiographic examination revealed extensive tooth tissue loss in teeth #19, 20 and 21 that was diagnosed as class 3 ECR (Patel 3Dp for teeth #20 and 21, 3Bp for tooth #19). Guided double auto-transplantation of the immature molar tooth #17 was performed to replace premolar teeth 20 and 21, and tooth #32 to replace tooth #19. At the 6-month follow-up the donor tooth #32 had symptoms of pulpitis and was managed with a full pulpotomy using tricalcium silicate cement. Both teeth were followed-up for 36 months when they were asymptomatic, had no associated periodontal defects, had positive pulp sensibility tests as well as radiographic evidence of substantial periapical bony healing. The roots of tooth #17 had only a limited increase in length, with apical hard tissue barrier deposition, whereas tooth #32 (after pulpotomy) had continued root development. The 36 months follow-up of this case highlights the success of an interdisciplinary approach when integrating three-dimensional guides for double auto-transplantation of immature molars to successfully replace multiple teeth with extensive invasive ECR.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 5","pages":"Pages 827-833"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984704","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":"Allogeneic Mesenchymal Stromal Cells Transplantation Induces Arrest of External Apical Inflammatory Resorption in a Mature Nonvital Traumatized Tooth","authors":"Jose Francisco Gomez-Sosa DDS, PhD ,&nbsp;Olga Wittig MSc ,&nbsp;Dylana Diaz-Solano PhD ,&nbsp;Jose E. Cardier MD, PhD","doi":"10.1016/j.joen.2026.01.019","DOIUrl":"10.1016/j.joen.2026.01.019","url":null,"abstract":"<div><h3>Introduction</h3><div>Mesenchymal stromal cells (MSCs) have been proposed for tissue regeneration based on their paracrine and immunomodulatory effects. Based on these features, MSCs may regulate inflammation and tissue repair. This case report assessed whether allogeneic bone marrow MSCs (BM-MSCs) can arrest external apical inflammatory resorption (EAIR) in a mature, nonvital traumatized tooth.</div></div><div><h3>Methods</h3><div>A healthy 14-year-old male with intermittent edema and a sinus tract associated with tooth #9 was referred for endodontic evaluation. Radiographically, tooth #9 showed EAIR with a vertical/diagonal mesial pattern and a 3-mm periapical lesion with widened periodontal ligament space. The root canal was cleaned and shaped; calcium hydroxide was used as interappointment medication, and cryopreserved allogeneic BM-MSCs were thawed, expanded, incorporated into preclotted platelet-rich plasma, and implanted into the pulp cavity. The cervical third was sealed with bioceramic cement and composite.</div></div><div><h3>Results</h3><div>Cryopreserved BM-MSCs retained fibroblast-like morphology, expressed CD73/CD90/CD105, and showed osteogenic, adipogenic, and chondrogenic differentiation. A BM-MSC/PRP clot was transplanted without complications or adverse events. At 3 months, radiographs showed reduction of the periapical radiolucency with initial bone formation and positive cold and electric pulp test responses. Between 12 and 24 months, reappearance of lamina dura, remodeling of the resorbed surface, and complete radiographic healing with arrest of EAIR were observed. At 48 months, tooth #9 was asymptomatic, responsive to cold and electric pulp test, and showed normal periapical architecture and mineralized tissue within the canal with an apical constriction.</div></div><div><h3>Conclusions</h3><div>BM-MSC transplantation may arrest EAIR and promote pulp-like and periapical tissue regeneration.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 5","pages":"Pages 761-766"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119172","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":"GentleWave versus Established Irrigation Techniques: Current Evidence from a Scoping Review","authors":"Mohmed Isaqali Karobari PhD, MDSc, BDS ,&nbsp;Abdul Habeeb Adil MDSc, BDS ,&nbsp;Niher Tabassum Snigdha MDSc, BDS ,&nbsp;Emmanuel João Nogueira Leal da Silva PhD, MSc, DDS","doi":"10.1016/j.joen.2026.01.012","DOIUrl":"10.1016/j.joen.2026.01.012","url":null,"abstract":"<div><h3>Introduction</h3><div>The GentleWave System, based on multisonic ultra-cleaning technology, has been proposed as an irrigation approach capable of enhancing disinfection while preserving dentin structure. However, evidence regarding its comparative efficacy and clinical relevance remains inconsistent. This scoping review aimed to comprehensively evaluate the performance of the GentleWave System in comparison with conventional syringe irrigation and other activation techniques.</div></div><div><h3>Methods</h3><div>This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Six electronic databases (PubMed, Scopus, Web of Science, Embase, Cochrane Library, and Google Scholar) were systematically searched without language restrictions. Studies were eligible if they compared GentleWave with at least one other irrigation or activation technique and reported measurable outcomes. <em>In vitro</em>, <em>ex vivo</em>, and clinical studies were included. Study characteristics, irrigation protocols, outcomes, and key findings were extracted and synthesized descriptively across thematic domains.</div></div><div><h3>Results</h3><div>Twenty-two studies met the inclusion criteria. Laboratory evidence demonstrated that GentleWave enhanced debris removal, irrigant penetration, and calcium hydroxide removal compared to conventional syringe irrigation. However, several studies have reported no significant differences between GentleWave and ultrasonic or sonic activation in terms of smear layer removal, biofilm reduction, or removal of filling materials. Findings related to endotoxin reduction and disinfection were also heterogeneous. Clinical evidence was limited and generally indicated no differences in postoperative pain or early healing when compared with alternative techniques.</div></div><div><h3>Conclusions</h3><div>The present scoping review indicates that the GentleWave System demonstrates promising performance across multiple laboratory outcomes, particularly in debris removal, disinfection, and irrigant penetration. However, the available evidence remains inconsistent, with several well-designed studies reporting no significant differences between GentleWave and established irrigation or activation techniques.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 5","pages":"Pages 713-723"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029619","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}