Journal of endodontics最新文献

{"title":"Congenital Morphology and Occlusion in Cracked Teeth: A Combined T-Scan and Finite Element Analysis.","authors":"Aidi Zhang, Zhuping Sang, Chenxu Gong, Minjuan Tan, Yu Tian, Wei Wang","doi":"10.1016/j.joen.2026.08.036","DOIUrl":"10.1016/j.joen.2026.08.036","url":null,"abstract":"<p><strong>Introduction: </strong>To investigate the biomechanical characteristics of innate occlusal contact patterns in cracked teeth (CT) using T-Scan analysis combined with finite element analysis, and to establish a theoretical foundation for clinical prevention and restorative strategies.</p><p><strong>Methods: </strong>Twelve patients with cracked maxillary first molars exhibiting mesial marginal ridge cracks and twelve controls were enrolled. Occlusal contacts were recorded using T-Scan, with categorical variables analyzed via Fisher's exact test (P < .05). Patient-specific finite element models were constructed from the cone beam computed tomography data of 3 cracked and 3 intact maxillary first molars. Stress distribution under different loadings was compared using two-way analysis of variance (P < .05).</p><p><strong>Results: </strong>T-Scan analysis demonstrated a significantly higher incidence of abnormal occlusal contact points in the CT group compared with controls (P < .05), along with bilateral occlusal imbalance. Finite element analysis revealed that maximum von Mises stress values on the mesial surfaces were consistently higher than those on the distal surfaces in the CT group under vertical loading (P < .05). Abnormal contact sites contributed to increased stress on the mesial surfaces in both CT and controls. A significant intergroup difference in maximum von Mises stress was observed on the mesial surfaces (P < .05), whereas no significant difference was detected on the distal surfaces.</p><p><strong>Conclusions: </strong>Patients with CT exhibited bilateral occlusal imbalance, characterized by abnormal occlusal contact points on the affected teeth. Congenital morphological discrepancies represent the primary etiologic factor for CT, whereas aberrant contact points further exacerbate crack progression. Early occlusal adjustment and crown-supported protection are recommended to compensate for underlying morphological abnormalities.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850553","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":"Radiographic Assessment of Apical Periodontitis and Periodontal Bone Loss in Oral Squamous Cell Carcinoma: A Cross-Sectional Study.","authors":"Rachelle Li, Melika Pahlevan Sabbagh, Tina Mahjoubi, Sonica Singhal, Amir Azarpazhooh, Anil Kishen, Marco Magalhaes","doi":"10.1016/j.joen.2026.08.012","DOIUrl":"10.1016/j.joen.2026.08.012","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic oral inflammation has been implicated in oral squamous cell carcinoma (OSCC), but the role of apical periodontitis (AP) remains unclear. This study compared radiographic AP and periodontal radiographic bone loss (RBL), used as a surrogate for periodontal disease, between patients with OSCC and controls with benign oral lesions.</p><p><strong>Methods: </strong>This retrospective cross-sectional study included 113 patients with biopsy-confirmed OSCC and 130 controls with benign oral lesions. Two calibrated examiners assessed panoramic radiographs for decayed, missing, and filled teeth, AP, AP lesion size, endodontically treated teeth, and RBL. Multivariable logistic regression evaluated AP after adjustment for age, sex, cancer risk factors, periodontal RBL, and decayed, missing, and filled teeth. Secondary analyses evaluated the AP × RBL interaction and differences by OSCC stage. Exploratory analyses assessed OSCC and AP distributions across neighborhood-level marginalization strata.</p><p><strong>Results: </strong>After adjustment, AP was not statistically significantly associated with OSCC (adjusted odds ratio, 1.35; 95% confidence interval [CI], 0.74‑2.46; P = .324). After accounting for AP, severe RBL (>33%) was more prevalent in OSCC than in controls (38.9% vs 20.8%, P = .004) and was associated with OSCC (odds ratio, 2.99; 95% CI, 1.38‑6.51; P = .006). No statistically significant AP × RBL interaction was detected. Among patients with OSCC, neither AP nor RBL was significantly associated with the stage.</p><p><strong>Conclusions: </strong>Severe periodontal RBL was associated with OSCC after accounting for AP. AP was not statistically significantly associated with OSCC status or stage; however, CIs do not exclude smaller AP-related associations. These findings highlight the importance of periodontal and endodontic assessments as components of preoncologic dental care.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794000","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":"Combined Cannabidiol and Δ⁹-Tetrahydrocannabinol Modulate Inflammation and Nociceptive Signaling in Human Dental Pulp Cells.","authors":"Zar Chi Soe, Daneeya Na Nan, Rahman Wahyudi, Kanokwan Sriwattanapong, Thantrira Porntaveetus, Soranun Chantarangsu, Paksinee Kamolratanakul, Vincent Everts, Chatvadee Kornsuthisopon, Thanaphum Osathanon, Sornkanok Vimolmangkang, Nuttapol Limjeerajarus, Chalida Nakalekha Limjeerajarus","doi":"10.1016/j.joen.2026.09.003","DOIUrl":"10.1016/j.joen.2026.09.003","url":null,"abstract":"<p><strong>Introduction: </strong>Dental pulp inflammation, caused by caries, trauma, or restorative operations, produces pain and slows regeneration. Cannabidiol (CBD) and Δ⁹-tetrahydrocannabinol (THC), cannabinoids of Cannabis sativa, have effects on inflammation and pain relief. However, the impact of these factors on dental pulp healing is not yet understood. This study investigated the combined effects of CBD and THC in controlling inflammation and nociception during dental pulp repair.</p><p><strong>Methods: </strong>Human dental pulp cells were stimulated with lipopolysaccharide and treated with CBD (2.5 μg/mL), THC (0.6 μg/mL), and their combination. Pro-inflammatory cytokines (interleukin [IL]-6, IL-12, and IL-1β) and anti-inflammatory cytokine IL-10 were analyzed using qPCR and enzyme-linked immunosorbent assay, while anti-nociceptive markers (cannabinoid receptor type 1, cannabinoid receptor type 2, and transient receptor potential vanilloid 1) were evaluated by qPCR and Western blot. Cell viability, proliferation, and migration assays were performed to evaluate treatment effects on cellular behaviors associated with pulpal repair and regenerative potential.</p><p><strong>Results: </strong>Compared with either treatment alone, the CBD/THC combination more effectively attenuated pro-inflammatory cytokines IL-6, IL-12, and IL-1β, enhanced cannabinoid receptor type 1 and cannabinoid receptor type 2 expression, modulated transient receptor potential vanilloid 1, and increased IL-10 expression. Viability assays determined optimal non-cytotoxic concentrations for treatment. The combination enhanced cell proliferation and migration, promoted mineralized nodule formation, and significantly upregulated markers associated with tissue repair, odontogenic differentiation (dentin matrix protein 1), and angiogenesis (vascular endothelial growth factor and basic fibroblast growth factor).</p><p><strong>Conclusion: </strong>Combined CBD and THC show promise for promoting dental pulp healing by modulating inflammation and nociceptive signaling, while supporting odontogenic differentiation, angiogenesis, and cell migration in human dental pulp cells. These findings provide in vitro evidence supporting combined cannabinoid treatment as a therapeutic strategy for vital pulp therapies.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930007","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":"Biomechanical Effect of Different Biodentine Placement Levels in Regenerative Endodontic Procedures: A Finite Element Analysis and Fracture Resistance Study.","authors":"Nithinun Sutam, Wassana Wichai, Mongkol Thianwiboon, Jeeraphat Jantarat","doi":"10.1016/j.joen.2026.08.032","DOIUrl":"10.1016/j.joen.2026.08.032","url":null,"abstract":"<p><strong>Introduction: </strong>The placement level of hydraulic calcium silicate materials during regenerative endodontic procedures (REPs) may affect biomechanical performance of immature permanent teeth. This study aimed to evaluate the effect of different Biodentine placement levels on biomechanical performance of immature permanent teeth treated with REPs using three-dimensional finite element analysis (FEA) validated by fracture resistance testing.</p><p><strong>Methods: </strong>Standardized immature maxillary premolars (n = 10/group) were assigned to 5 groups: intact teeth (negative control), access preparation without restoration (positive control), and Biodentine placed above, at, or below the cementoenamel junction (CEJ), followed by adhesive restoration. FEA was performed to evaluate stress distribution under occlusal loading. Fracture resistance and fracture patterns were assessed by compressive loading to failure. Data were analyzed in groups using one-way analysis of variance.</p><p><strong>Results: </strong>Buccal cervical region exhibited highest stress concentration in all FEA models and corresponded to predominant fracture site during mechanical testing. Fracture resistance was the highest in intact teeth (1893.23 ± 63.30 N), followed by Biodentine placed below CEJ (1785.06 ± 69.11 N), at CEJ (1426.87 ± 96.09 N), above CEJ (946.61 ± 131.20 N), and positive control (724.48 ± 89.29 N). Biodentine placement below CEJ showed fracture resistance comparable to intact teeth and fewer nonrestorable fractures (50%) than placement above the CEJ (70%) and positive control (80%).</p><p><strong>Conclusions: </strong>Biodentine placement level significantly influenced biomechanical performance of immature teeth treated with REPs. Placement below CEJ provided the most favorable biomechanical performance by reducing cervical stress concentration, maintaining fracture resistance comparable to intact teeth, and decreasing nonrestorable fractures.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849933","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 the Outcome of Root Canal Treatment of Teeth With Apical Periodontitis as Related to Molecular Microbiological Findings.","authors":"José F Siqueira, Monica S Neves, José C Provenzano, Andrea F Campello, Ibrahimu Mdala, Flávio R F Alves, Isabela N Rôças","doi":"10.1016/j.joen.2026.09.002","DOIUrl":"10.1016/j.joen.2026.09.002","url":null,"abstract":"<p><strong>Introduction: </strong>This study evaluated the influence of microbiological, clinical, and therapeutic factors on the outcome of root canal treatment/retreatment of teeth with apical periodontitis using a sensitive molecular microbiology approach for bacterial quantification in canal samples.</p><p><strong>Methods: </strong>Root canals of infected single-rooted teeth with apical periodontitis were treated or retreated using different instrument systems, irrigants, and intracanal medications. Root canal samples were taken before (S1) and after chemomechanical preparation (S2) and immediately before obturation (S3). Bacterial levels were quantified by using a quantitative real-time polymerase chain reaction assay. Patients were followed up for 1 to 2 years, and the treatment/retreatment outcome was evaluated by clinical and radiographic criteria and categorized as healed, healing, or diseased. Lesions that were decreasing in size (healing) were classified as failure under a strict criterion and as success under a lenient one.</p><p><strong>Results: </strong>One hundred sixteen patients returned for follow-up evaluation. Diseased cases exhibited significantly higher bacterial counts both at baseline and at the time of filling compared to healing and healed cases (P < .01). The canals of teeth with large lesions had 15 times higher bacterial counts at S1 than those with small lesions. Overall, 56/116 (48%) cases were classified as healed, whereas 14/116 (12%) were diseased. Treatment was successful in 51% (strict criterion) and 94% (lenient criterion) of the cases, while retreatment succeeded in 42% and 75%, respectively. Patients with large/very large lesions were 91% less likely to exhibit healing or complete healing compared to those with small lesions. Cases with baseline periapical index (PAI) scores of 4 or 5 showed lower healing/healed rates than those with a PAI score of 3. The use of 1% NaOCl was associated with lower odds of healing or complete healing compared with 2% chlorhexidine. The probability of success increased as a direct function of the magnitude of bacterial reduction from S1 to S2/S3.</p><p><strong>Conclusion: </strong>Treatment outcome was influenced by multiple factors, including initial bacterial load, lesion size, PAI score, irrigant type, and retreatment. Higher bacterial counts at the time of filling were directly associated with persistent apical periodontitis. Bacterial reduction had a significant impact on the outcome: for each 1% decrease in bacterial counts from baseline, the odds of a favorable outcome significantly increased by 10%.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905922","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":"Finite Element Analysis of Mineral Trioxide Aggregate-Repaired Root Perforations in Post-and-core Restored Teeth: Effects of Perforation Size, Location, and Loading Direction on Stress Distribution.","authors":"Lelan Li, Kun Huang, Lei Jiang, Run Chen","doi":"10.1016/j.joen.2026.08.037","DOIUrl":"10.1016/j.joen.2026.08.037","url":null,"abstract":"<p><strong>Introduction: </strong>Root lateral perforation repair may restore structural continuity, but the biomechanical behavior of perforated teeth restored with post-and-core systems under different perforation sizes, anatomical locations, and functional loading conditions remains unclear.</p><p><strong>Methods: </strong>Three-dimensional finite element models of a maxillary central incisor and a mandibular first premolar with mineral trioxide aggregate-repaired lateral perforations and subsequent post-and-core restorations were constructed. Perforations with different sizes and anatomical locations were repaired with mineral trioxide aggregate, followed by post- and core restoration under functional loading. Maximum principal stress and von Mises stress were evaluated in the remaining radicular dentin and perforation region.</p><p><strong>Results: </strong>Perforation size, anatomical location, and loading direction all markedly influenced stress distribution in the repaired roots. Tensile stress increased with the perforation size and remained concentrated at the perforation margin and lingual cervical region. Middle-third perforations exhibited the least favorable biomechanical behavior in the maxillary central incisor, whereas lateral loading markedly increased stress in the mandibular first premolar. Most repaired models remained within the dentin tensile strength reference range; however, large perforations approaching 1.7 mm exceeded the reported threshold under unfavorable anatomical or loading conditions.</p><p><strong>Conclusions: </strong>The biomechanical behavior of roots after lateral perforation repair was jointly influenced by perforation size, anatomical location, and loading direction. Small perforations generally maintained favorable stress conditions following post-and-core restoration, whereas large perforations, particularly those located in unfavorable anatomical regions or subjected to nonaxial loading, remained mechanically vulnerable. These findings highlight the importance of post-and-core restorative design and occlusal management in improving the long-term prognosis of perforated teeth.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891753","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":"Treatment Outcomes Following Root Perforation Repair in Permanent Teeth: A Systematic Review and Meta-analysis.","authors":"Yee Ang, Lay Ann Teh, Jonathan Jun Xian Yuen, Galvin Sim Siang Lin","doi":"10.1016/j.joen.2026.08.003","DOIUrl":"10.1016/j.joen.2026.08.003","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review and meta-analysis aimed to evaluate the treatment outcomes of root perforation repair in permanent teeth and identify relevant prognostic factors.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, Embase, Scopus, Cochrane Library, Web of Science, and Google Scholar identified studies published between January 2000 and February 2026. Studies reporting treatment outcomes of repaired root perforations in permanent teeth with ≥12 months of follow-up were included. Two investigators independently performed study selection, data extraction, and risk of bias assessment using the Joanna Briggs Institute Critical Appraisal Checklist. Level and certainty of evidence were assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and the Grading of Recommendations Assessment, Development, and Evaluation approach. Random effects meta-analyses estimated the proportion of favorable outcomes and associations with preoperative prognostic factors.</p><p><strong>Results: </strong>Nine observational studies evaluating nonsurgical root perforation repair were included, of which 7 contributed to the meta-analysis. The pooled favorable outcome was 89.7% (95% confidence interval [CI]: 83.0%-94.9%). Smaller perforations (≤3 mm) were associated with higher odds of a favorable outcome than larger defects (odds ratio = 2.69; 95% CI: 1.29-5.59; P = .008), while maxillary teeth demonstrated higher odds than mandibular teeth (odds ratio = 2.31; 95% CI: 1.12-4.75; P = .023). Tooth type, perforation location, gender, preoperative radiolucency, and preoperative signs and symptoms were not significantly associated with favorable outcomes.</p><p><strong>Conclusions: </strong>Nonsurgical root perforation repair appears to be associated with generally favorable treatment outcomes, particularly in smaller perforations (≤3 mm) and maxillary teeth. These findings should be interpreted cautiously, given the substantial clinical heterogeneity and low-certainty evidence.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697522","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":"Early Pulp Healing After Direct Pulp Capping with Concentrated Platelet-Rich Fibrin: A Preliminary Study.","authors":"Xingyu Zhang, Jihua Chai, Richard J Miron, Yulan Wang, Shimin Yu, Shan Shi, Sensen Li, Guoyong Tong, Zaibo Yang, Meiling Chen","doi":"10.1016/j.joen.2026.08.034","DOIUrl":"10.1016/j.joen.2026.08.034","url":null,"abstract":"<p><strong>Background: </strong>Direct pulp capping preserves pulp vitality after pulp exposure. Mineral trioxide aggregate (MTA) is widely used but relies mainly on host-mediated repair. Concentrated platelet-rich fibrin (C-PRF), an autologous plasma-derived biomaterial, may actively modulate the local healing microenvironment through sustained delivery of bioactive factors, but its biological performance in direct pulp capping has not been fully characterized.</p><p><strong>Methods: </strong>Human dental pulp cells were treated with phosphate-buffered saline, MTA, or C-PRF to assess viability, proliferation, migration, and mineralization via live/dead staining, CCK-8, scratch and transwell assays, alkaline phosphatase and Alizarin Red S staining, as well as qPCR for genes encoding alkaline phosphatase, RUNX2, and COL1A1. Furthermore, an in vivo rabbit direct pulp capping model was utilized and treated with MTA or C-PRF. Pulp regenerative potential was evaluated using hematoxylin and eosin, Masson's trichrome, and CD31 immunohistochemistry, with quantitative analysis of vascularization.</p><p><strong>Results: </strong>C-PRF demonstrated good biocompatibility and enhanced human dental pulp cells migration, proliferation, and mineralization compared with MTA. In vivo, the C-PRF group exhibited increased CD31-positive staining, suggesting enhanced early vascular responses.</p><p><strong>Conclusion: </strong>Within the limitations of this study, C-PRF enhanced cellular responses, including migration and mineralization, and showed potential to promote early vascularization. These findings suggest that C-PRF may serve as a biologically active adjunct for direct pulp capping.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865242","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":"Evaluating Large Language Models in Endodontic Irrigants: A Structured Assessment of Accuracy, Readability, Hallucination Subtypes, and Clinical Risk.","authors":"Damla Erkal, Yunus Emre Çakmak, Kürşat Er","doi":"10.1016/j.joen.2026.08.033","DOIUrl":"10.1016/j.joen.2026.08.033","url":null,"abstract":"<p><strong>Introduction: </strong>Large language models (LLMs) are increasingly used by clinicians and learners for endodontic information, yet their reliability for irrigation-related knowledge remains unclear. This study evaluated the accuracy, readability, hallucination profile, clinical risk, and temporal stability of 4 general-purpose LLMs on endodontic irrigation questions, including false-premise prompts.</p><p><strong>Methods: </strong>A literature-based reference set was developed for sodium hypochlorite, calcium hypochlorite, ethylenediaminetetraacetic acid, and chlorhexidine. ChatGPT-5.2, Claude Sonnet 4.5, Gemini 3 Pro, and DeepSeek 3.2 were each asked 100 questions comprising 80 factual items and 20 contradiction-seeking items. Responses were independently scored by 2 blinded endodontists for accuracy, hallucination subtype, and clinical risk. Five readability indices were calculated, and model stability was reassessed 10 days later.</p><p><strong>Results: </strong>Inter-rater agreement was almost perfect (weighted κ = 0.92 for accuracy; κ = 0.97 for hallucination). Claude Sonnet 4.5 and Gemini 3 Pro showed the highest accuracy (1.75 and 1.74) and the lowest hallucination rates (7% and 9%). DeepSeek 3.2 showed the lowest accuracy (1.08), the highest hallucination rate (29%), and critical-risk outputs in 16% of responses. Gemini showed the highest test-retest stability (weighted κ = 0.95). Hallucination strongly correlated with clinical risk (ρ = 0.93; P < .001). Readability analysis showed a 2-tier pattern: Gemini and DeepSeek produced more accessible text, whereas ChatGPT and Claude generated denser outputs.</p><p><strong>Conclusions: </strong>LLM performance in endodontic irrigation is model- and irrigant-dependent. Hallucination profiling is clinically relevant, and high initial accuracy does not guarantee temporal stability. LLM outputs should be used only as clinician-verified adjuncts.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850533","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":"Refining Pulpal Diagnostics for Predictable Vital Pulp Treatment.","authors":"Ikhlas El Karim, Henry F Duncan, Imad About, Orla M Dunne, Fionnuala T Lundy","doi":"10.1016/j.joen.2026.08.022","DOIUrl":"10.1016/j.joen.2026.08.022","url":null,"abstract":"<p><strong>Introduction: </strong>Vital pulp treatment (VPT) comprises a range of biologically based procedures aimed at preserving pulp vitality, reducing the need for invasive interventions, and improving long-term tooth survival. Despite growing evidence supporting these approaches, their implementation in clinical practice remains limited by the lack of reliable methods for accurately assessing the inflammatory status of the dental pulp and by the continued use of diagnostic terminology that does not adequately support pulp-preserving treatment strategies.</p><p><strong>Methods: </strong>This narrative review examines the limitations of current pulp diagnostic methods and traditional classifications of pulp disease. It also explores emerging research and innovative approaches aimed at improving diagnostic accuracy and facilitating more effective application of VPT.</p><p><strong>Results: </strong>Contemporary evidence suggests that pulp disease is more appropriately viewed as a continuum rather than through the traditional dichotomous classification of reversible and irreversible pulpitis. Advances in the understanding of pulpitis pathophysiology at the molecular level have identified potential biomarkers that may enable the development of objective chairside diagnostic tests. These emerging technologies offer the potential to provide more precise assessment of pulpal inflammation and improve treatment decision-making.</p><p><strong>Conclusions: </strong>Refinement of the terminology used to describe pulp disease, together with the integration of objective, biomarker-based diagnostic technologies, is essential for improving diagnostic accuracy. Such advances are expected to support wider adoption of VPT, enhance the predictability of clinical outcomes, and promote successful long-term preservation of natural teeth.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840562","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}