Journal of endodontics最新文献

{"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}

{"title":"The Effect of Intraorifice Barrier Materials on the Fracture Resistance of Endodontically Treated Teeth: A Systematic Review and Network Meta-Analysis","authors":"Sevilay Karahan PhD ,&nbsp;Zeynep Buket Dağ DDS ,&nbsp;Emel Uzunoğlu Özyürek DDS, PhD","doi":"10.1016/j.joen.2025.12.010","DOIUrl":"10.1016/j.joen.2025.12.010","url":null,"abstract":"<div><h3>Objective</h3><div>To compare intraorifice barrier materials for reinforcing endodontically treated teeth using a network meta-analysis of <em>in vitro</em> studies.</div></div><div><h3>Methods</h3><div>EBSCO, PubMed, Virtual Health Library, Ovid, Web of Science, Scopus, Cochrane Library, and Google Scholar were searched to December 2025. Eligible studies compared at least 2 of the following: alkasite restorative material, composite resin, fiber-reinforced composite (FRC), resin-modified glass ionomer cement (RMGIC), flowable composite, Biodentine, mineral trioxide aggregate (MTA), and control. The primary outcome was fracture resistance (Newtons). The analysis was conducted in MetaInsight v6.4.0 (Complex Reviews Synthesis Unit, NIHR (Evidence Synthesis Group, University of Glasgow), Glasgow, United Kingdom) using its Bayesian option; results are reported as 95% credible intervals (CrIs). Treatment hierarchy was summarized with SUCRA. Small-study effects were assessed with funnel plot and Egger's test.</div></div><div><h3>Results</h3><div>Twenty studies met the eligibility criteria; 14 contributed to the network meta-analysis. Versus control, fracture resistance increased with alkasite restorative material (MD 406.37; 95% CrI 133.4-679.8), FRC (MD 370.83; 95% CrI 168.82- 574.27), composite resin (MD 360.62; 95% CrI 181.92-555.15), RMGIC (MD 310.82; 95% CrI 180.93–449.62), flowable composite (MD 285.5; 95% CrI 107.79-468.35) and Biodentine (MD 230.83; 95% CrI 66.55–401.34). MTA showed no clear benefit (MD 60.41; 95% CrI −123.08- 242.82). SUCRA ranking favored alkasite restorative material, followed by FRC, composite resin, RMGIC, flowable composite resin, Biodentine, MTA, and control. Node-split analyses indicated some local inconsistency across a subset of contrasts (2 of 28 contrasts; minimum <em>P</em> = .003). Funnel-plot inspection and Egger's test did not suggest small-study effects (<em>P</em> = .664).</div></div><div><h3>Conclusions</h3><div>Use of an intraorifice barrier generally improves the fracture resistance of endodontically treated teeth. Materials traditionally categorized as restorative materials (alkasite, resin composites, FRC, and RMGIC) tended to rank higher than calcium silicate–based barriers (Biodentine, MTA) <em>in vitro</em>. Standardized testing protocols are needed to optimize material selection.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 5","pages":"Pages 696-712.e1"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145900584","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":"Comparative Evaluation of Static-guided versus Freehand Endodontic Access in Single-rooted Permanent Teeth with Pulp Canal Calcification: A Randomized Clinical Trial","authors":"Afzal Ali BDS, MDS, PhD (Scholar and Supervisor) ,&nbsp;Anuja Ikhar MDS, PhD (Scholar and Supervisor) ,&nbsp;Ezgi Doğanay Yıldız DDS ,&nbsp;Hany Mohamed Aly Ahmed BDS, HDD (Endo), MFDS RCPS (Glasgow), MDTFEd RCS (Edinburgh), PhD, FDS RCS (England), FICD, FPFA, FADI ,&nbsp;Rafael Fernandez Grisales DDS, MSC ,&nbsp;Abdulaziz Bakhsh BDS, MClinDent (Endo), MEndo (RCSed), PhD ,&nbsp;Aditya Singh Patel MDS, PhD ,&nbsp;Sidhartha Sharma MDS ,&nbsp;Hakan Arslan DDS, PhD","doi":"10.1016/j.joen.2026.02.008","DOIUrl":"10.1016/j.joen.2026.02.008","url":null,"abstract":"<div><h3>Introduction</h3><div>The present study aimed to compare the use of conventional freehand access cavity preparation with the static-guided (SG) endodontic technique in terms of its ability to locate and negotiate root canals, iatrogenic errors (perforations), and the amount of tooth structure loss while treating single-rooted traumatized teeth with pulp canal calcifications.</div></div><div><h3>Methods</h3><div>This randomized clinical trial was registered in the Clinical Trial Registry of India (<span><span>https://ctri.nic.in</span><svg><path></path></svg></span>, CTRI/2024/01/061580). A total of 30 patients with traumatized teeth exhibiting calcified root canals were included in the study. The patients were randomly divided into 2 groups as follows: SG endodontic technique and conventional freehand technique. Following the completion of the treatments, the cases were evaluated as either successful (canal located) or failed (perforation or canal not located). In addition, the amount of removed tissue was calculated on the postoperative radiographs using ImageJ software (National Institutes of Health, Bethesda, MD). Chi-square and Mann–Whitney U tests were performed to analyze the data (<em>P</em> = .05).</div></div><div><h3>Results</h3><div>In the SG endodontic group, the root canals were located in all teeth, while in the conventional freehand approach, 13% of cases reported failure to locate the root canals. The tooth sturucture loss was significantly lower in the SG approach compared to the conventional freehand approach (<em>P</em> &lt; .05).</div></div><div><h3>Conclusion</h3><div>The conventional freehand technique caused three times more tooth structure loss compared to the SG endodontic approach. There were no failed cases in the SG endodontic technique group, and all root canals were successfully located.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 5","pages":"Pages 688-695"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146201993","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":"Associate Registry","authors":"","doi":"10.1016/S0099-2399(26)00186-X","DOIUrl":"10.1016/S0099-2399(26)00186-X","url":null,"abstract":"","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 5","pages":"Pages 834-846"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755799","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 Outcomes of Nonsurgical Endodontic Retreatment Performed by a Single Clinician in Private Practice: A Retrospective Cohort Study","authors":"Terrell F. Pannkuk DDS, MScD ,&nbsp;Austin Whitmore DDS ,&nbsp;Anusha Kalaichelvan DDS ,&nbsp;Lucia Wang MPH ,&nbsp;Isabel Glick DDS, MS ,&nbsp;E. Olutayo Delano BDS, MS ,&nbsp;Asgeir Sigurdsson DDS, MS ,&nbsp;Lorel E. Burns DDS, MS","doi":"10.1016/j.joen.2026.01.005","DOIUrl":"10.1016/j.joen.2026.01.005","url":null,"abstract":"<div><h3>Introduction</h3><div>The purpose of this study was to evaluate long-term outcomes of nonsurgical retreatment (NS-ReTx) procedures performed by a single endodontist in private practice.</div></div><div><h3>Methods</h3><div>This retrospective cohort study evaluated NS-ReTx procedures performed between the years 1986 and 2019, meeting the following inclusion criteria: minimum of 1-year follow-up and preoperative, postoperative, and follow-up radiographs available for analysis. Procedures were evaluated clinically and radiographically, and treatment outcomes were reported. A subset of cases included cone-beam computed tomography (CBCT) images and CBCT-assessed periapical healing was reported for these cases. The effect of clinical factors on radiographic healing was assessed using a Cox proportional hazard regression model. The Kaplan-Meier method estimated the probability of tooth survival at each year of follow-up.</div></div><div><h3>Results</h3><div>A total of 241 NS-ReTx procedures from 202 patients met the inclusion criteria. The median patient age at time of NS-ReTx was 54 years. Molars were the most frequently treated tooth type, 57.68%. Radiographic healing at the median follow-up time, 9.14 years (<em>n</em> = 231) was 64.07% healed (148 of 231), 7.36% healing (17 of 231), and 28.57% unhealed (66 of 231). An additional 10 teeth were extracted before any radiographic follow-up. CBCT-assessed periapical healing (“strict” criteria) was 65.63% over a median follow-up time of 9.18 years. Tooth survival following NS-ReTx was 93.3% at 5 years and 85.3% at 10 years.</div></div><div><h3>Conclusions</h3><div>The study demonstrates that radiographic periapical healing and treatment success improve over time and that tooth survival following NS-ReTx is favorable long-term.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 5","pages":"Pages 724-732"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984655","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":"Factors Influencing Apical Extrusion of 2 Types of Endodontic Sealers with Different Delivery Systems","authors":"Shumaila Iqbal BDS, MPH, LDS RCS (Eng), MFDS, MSc,&nbsp;Nicholas S. Adams BDS, MSc, MRD RCS (Eng),&nbsp;Josette Camilleri BChD, FDS RCPS (Glasg), MPhil, PhD, FICD, FADM, FIMMM, FHEA","doi":"10.1016/j.joen.2026.02.001","DOIUrl":"10.1016/j.joen.2026.02.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Comparison of the apical sealer extrusion of BioRoot RCS and BioRoot Flow and assessment of the influence of procedural and anatomical factors that contribute to extrusion.</div></div><div><h3>Methods</h3><div>Human mandibular premolars were divided into 2 groups based on apical gauges (&lt;40, &gt;40). Other variables included the presence and size of an apical lesion (2, 4, and 6 mm), canal moisture (dry and wet), pumping and no-pumping action, and sealer tip insertion depth for BioRoot Flow (coronal vs apical). The extruded material was weighed in grams using an analytical balance to the accuracy of 0.0001 g. Statistical analysis included the Kruskal–Wallis test, Mann–Whitney U test, and multivariate linear regression to identify statistically significant factors related to sealer extrusion.</div></div><div><h3>Results</h3><div>Sealer extrusion was observed in 86.8% of 288 variables tested. BioRoot Flow had significantly higher extrusion across all categorical variables compared to BioRoot RCS (<em>P</em> &lt; .001). Key factors associated with increased extrusion included wet canals (<em>P</em> &lt; .001), larger apical gauge (&gt;40; <em>P</em> &lt; .05), apical sealer placement (<em>P</em> &lt; .005), and pumping action (<em>P</em> &lt; .05). Among all variables, canal moisture was the most consistent contributor to sealer extrusion. The presence of a 6 mm apical lesion combined with an apical gauge of &gt;40 in a wet canal with apically placed BioRoot Flow increased the risk of sealer extrusion.</div></div><div><h3>Conclusions</h3><div>Wet canals, apical sealer tip placement, larger apical diameters or gauges, and pumping actions significantly increase the risk of extrusion, particularly with sealers that are delivered in a syringe, such as BioRoot Flow. These findings underscore the significance of procedural control in minimizing sealer extrusion and enhancing clinical outcomes.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 5","pages":"Pages 806-811"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165503","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":"Effects of Instrumentation and NaOCl Concentration on Microbial DNA Load Employing a Sonic Activation Device","authors":"Matthew Ellis DDS, MS ,&nbsp;Ronald Ordinola-Zapata DDS, MS, PhD ,&nbsp;Marco A. Versiani DDS, MS, PhD ,&nbsp;W. Craig Noblett DDS, MS","doi":"10.1016/j.joen.2026.01.017","DOIUrl":"10.1016/j.joen.2026.01.017","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the bacterial DNA load reduction in mesial root canals of mandibular molars using quantitative polymerase chain reaction, examining the effects of instrumentation, irrigant type, and their interaction after the use of sonic activation.</div></div><div><h3>Methods</h3><div>Twenty-one extracted human mandibular molars were sterilized and contaminated with human supragingival plaque under anaerobic conditions for 14 days. After sealing the apices and coating external surfaces to simulate a closed canal system, the teeth were randomly assigned to 3 irrigant groups (<em>n</em> = 7): 7.55% sodium hypochlorite, 1.88% sodium hypochlorite, or sterile saline. Microbiologic sampling was performed at baseline (S1), after preparation to size 25/.04 with sonic activation (S2), and after enlargement to size 30/.04 with sonic activation (S3). Bacterial DNA was quantified by quantitative polymerase chain reaction (Log₁₀ molecules/μL). Data were analyzed using two-way repeated-measures ANOVA with Geisser–Greenhouse correction and Tukey's honest significant difference tests.</div></div><div><h3>Results</h3><div>The interaction between irrigant type and instrumentation was not significant (<em>P</em> = .852), and irrigant type alone showed no significant effect (<em>P</em> = .502). In contrast, instrumentation significantly reduced bacterial load (<em>P</em> &lt; .0001), accounting for 68.44% of variance. Significant reductions occurred from S1 to both S2 and S3, with no difference between S2 and S3, indicating that most of the decrease in bacterial DNA load occurred during initial enlargement to size 25/.04 with sonic-activated irrigation.</div></div><div><h3>Conclusion</h3><div>Root canal instrumentation combined with sonic activation was the most significant factor associated with reduction in bacterial DNA load, while irrigant type and concentration provided minimal additional effect.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 5","pages":"Pages 777-782"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093274","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":"Comparative Efficacy and Extrusion Risk of Polypropylene Needle versus Various Supplemental Irrigations in Cleaning Simulated Curved Root Canals","authors":"Sasin Eungnapatanin DDS ,&nbsp;Thanomsuk Jearanaiphaisarn DDS, MSc ,&nbsp;Pavena Chivatxaranukul DDS, PhD","doi":"10.1016/j.joen.2026.02.010","DOIUrl":"10.1016/j.joen.2026.02.010","url":null,"abstract":"<div><h3>Introduction</h3><div>This <em>in vitro</em> study compared the cleaning efficacy and irrigant extrusion of polypropylene needles and various supplemental irrigation techniques in curved root canals.</div></div><div><h3>Methods</h3><div>Simulated canals with 20° (moderate) and 40° (severe) curvatures were prepared to size 25/0.07 and filled with biofilm-mimicking hydrogel. Six irrigation techniques were tested (<em>n</em> = 9 per group): conventional irrigation with stainless steel needles, conventional irrigation with polypropylene needles (PN), and stainless-steel needles supplemented with manual dynamic agitation using a 0.04 taper standardized cone (MDA-S), manual dynamic agitation with a matched cone (MDA-M), sonic activation with EDDY, or mechanical activation with XP-endo Finisher (XP). Residual hydrogel in the main canal, hydrogel clearance in accessory canals, and irrigant extrusion through the apical vent were assessed. Data were analyzed using two-way analysis of variance with Bonferroni post hoc test (<em>P</em> &lt; .05).</div></div><div><h3>Results</h3><div>In the severe curvature, PN resulted in significantly less residual hydrogel in the main canal than steel needles (<em>P</em> &lt; .05). However, in both curvatures, all supplemental techniques showed superior performance compared with PN (<em>P</em> &lt; .05). MDA-M provided the greatest hydrogel clearance in main and accessory canals (<em>P</em> &lt; .05), but with the highest extrusion (<em>P</em> &lt; .05).</div></div><div><h3>Conclusion</h3><div>Polypropylene needles improved apical cleaning in severely curved canals compared with stainless steel needles. However, supplemental activation provided superior overall debridement in both curvatures, although with an increased risk of extrusion.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 5","pages":"Pages 820-826"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776340","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":"Insights Into the May 2026 Issue of the JOE","authors":"Anita Aminoshariae DDS, MS,&nbsp;Amir Azarpazhooh DDS, MSc, PhD, FRCD(C),&nbsp;Gerald N. Glickman DDS, MS, MBA, JD,&nbsp;Jianing He DMD, PhD,&nbsp;Sahng G. Kim DDS, MS,&nbsp;Anil Kishen BDS, MDS, PhD,&nbsp;Ariadne M. Letra DDS, MS, PhD,&nbsp;Linda Levin DDS, PhD,&nbsp;Ronald Ordinola-Zapata,&nbsp;Frank C. Setzer DMD, PhD, MS,&nbsp;Franklin R. Tay BDSc(Hons), PhD,&nbsp;Kenneth M. Hargreaves DDS, PhD","doi":"10.1016/j.joen.2026.03.015","DOIUrl":"10.1016/j.joen.2026.03.015","url":null,"abstract":"","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 5","pages":"Pages 685-687"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755596","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":"The Global Periapical Health Study: A Big Data CBCT Analysis of Periapical Pathology across 54 Countries","authors":"Jorge N.R. Martins DDS, MSc, PhD","doi":"10.1016/j.joen.2026.01.021","DOIUrl":"10.1016/j.joen.2026.01.021","url":null,"abstract":"<div><h3>Introduction</h3><div>Periapical pathology, a common outcome of pulpal infection or failed endodontic therapy, remains underexplored globally. Most studies are small-scale and based on two-dimensional radiographs. This study aimed to provide a standardized worldwide estimate of its prevalence using cone-beam computed tomography (CBCT).</div></div><div><h3>Methods</h3><div>A cross-sectional, multicenter study was conducted across 54 countries, each represented by one calibrated examiner. Examiners consecutively assessed 3,500 roots from pre-existing CBCT scans, yielding data from 189,000 roots (138,536 teeth) of 6,688 patients. A standardized protocol was applied using the CBCT periapical index to record lesion presence, tooth type, previous root canal treatment, and demographic variables. Only scans with voxel size ≤200 μm were included. Data were analyzed through meta-analysis and logistic regression model to evaluate factors associated with periapical pathology, with meta-regression assessing voxel size and field-of-view effects.</div></div><div><h3>Results</h3><div>At the patient level, periapical pathology affected 58.6% of individuals worldwide. Secondary tooth-level analysis showed a prevalence of 7.3%, ranging from 2.5% in Oceania to 9.6% in Africa. Maxillary teeth (9.3%) were more frequently affected than mandibular teeth (5.3%), with maxillary first molars showing the highest prevalence (18.6%). Prevalence increased with age, from 2.9% (≤20 years) to 10.5% (≥61 years). Endodontically treated teeth showed markedly higher prevalence of post-treatment periapical radiolucencies (44.3%) than untreated teeth (2.6%) (odds ratio = 21.6; confidence interval 19.1-23.1; <em>P</em> &lt; .001). Voxel size and field-of-view did not influence outcomes.</div></div><div><h3>Conclusion</h3><div>Periapical pathology is highly prevalent worldwide, with notable regional and age-related differences. Endodontically treated teeth showed a disproportionately high prevalence of periapical pathology.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 5","pages":"Pages 740-760"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180612","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}