Journal of endodontics最新文献

{"title":"The ONE File: Design Concept and Finite Element Analysis of a Novel Sixth-Generation 3-Dimensional-Printed Thermoplastic Polyurethane Hollow Lattice Endodontic Instrument with Combined Rotational-Vibrational Motion.","authors":"Albaraa Alkady","doi":"10.1016/j.joen.2026.08.010","DOIUrl":"10.1016/j.joen.2026.08.010","url":null,"abstract":"<p><strong>Introduction: </strong>Endodontic instrumentation has evolved through 5 technological generations, each addressing the shortcomings of its predecessor. This study proposes the theoretical construct of a sixth generation-the ONE File-a 3-dimensional-printed thermoplastic polyurethane (TPU) hollow diamond-lattice endodontic instrument designed for combined rotational-vibrational motion. We aimed to evaluate, through finite element analysis, the stress distribution, deformation behavior, and biomechanical safety of the ONE File compared with a ProTaper Gold F2 instrument (PTG-F2; Dentsply Sirona; D₀ 0.25 mm, taper 0.08, gold-wire heat-treated nickel-titanium [NiTi]).</p><p><strong>Methods: </strong>A parametric computer-aided design (CAD) model of the ONE File (diamond-cell hollow lattice, D₀ = 0.25 mm, ISO 25/.04 taper, 16 mm active length) was analyzed in Ansys Workbench 2023 R2. TPU was modeled with a hyperelastic Mooney-Rivlin constitutive model (C₁ = 0.822 MPa, C₂ = 0.206 MPa) and NiTi with the Auricchio superelastic model. A 35° curved canal model (5-mm radius, micro‑computed tomography derived) was used. Combined loading-rotation at 300 revolutions per minute (RPM) and axial vibration at 30 Hz (0.5-mm amplitude)-was applied to the ONE File; standard rotation at 300 RPM was applied to the NiTi control group (PTG-F2). Outcome variables included maximum von Mises stress, total deformation, predicted geometric contact coverage, and safety factor.</p><p><strong>Results: </strong>The ONE File demonstrated maximum von Mises stress of 4.2 MPa (6.8%-13.5% of TPU tensile strength; safety factor 7.4-14.8) compared with 487 MPa for the NiTi control group (PTG-F2) (87% of yield strength; safety factor 1.15-1.6). Predicted geometric contact coverage was 94.3% versus 61.8%. Total tip deformation was 0.38 mm (fully elastic) for the ONE File versus 0.12 mm with 0.02-mm residual plastic strain for NiTi. The stress concentration factor was 1.18 for the ONE File versus 3.42 for NiTi.</p><p><strong>Conclusions: </strong>Within the limitations of finite element analysis, the ONE File demonstrates superior biomechanical safety, elastic adaptability, and theoretical canal wall coverage compared with conventional NiTi. As a phase 0 translational concept, it requires in vitro fabrication and tribological validation before any clinical inference is drawn.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794011","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 Tooth Preservation Decisions among U.S. General Dentists: A Cross-sectional Vignette Study.","authors":"Lucia Wang, Eleanor Fleming, Cristina Gonzalez, Neha Patel, Morgan Celistan, Lorel E Burns","doi":"10.1016/j.joen.2026.08.009","DOIUrl":"10.1016/j.joen.2026.08.009","url":null,"abstract":"<p><strong>Introduction: </strong>The aims of this study were to evaluate the decision to extract or treat a tooth with initial root canal therapy (RCT) made by general dentists practicing in the United States; and evaluate the effect of clinical and nonclinical factors on decision-making.</p><p><strong>Methods: </strong>Authors conducted a cross-sectional survey study. Participants read a vignette presenting a questionably restorable tooth for consideration and provided their clinical recommendations. The primary treatment decision was analyzed as a binary variable: tooth extraction or RCT. Other questions about clinical decision-making used the Likert-scale for capturing responses. Clinician-related variables were evaluated as follows: age, gender, years of experience, primary practice setting, and participation with payment systems. Kruskal-Wallis tests were used to compare the treatment decision with Likert-scale responses for clinical decision-making. A logistic regression model investigated the effect of clinician factors on the treatment decision.</p><p><strong>Results: </strong>One hundred thirteen eligible dentists completed the survey. For the presented case, a maxillary first molar, 54% of general dentists recommended initial RCT, and 46% recommended extraction. 37.2% of dentists responded that the patient's tooth was somewhat or very likely restorable. None of the evaluated clinician factors were statistically significant in predicting the treatment decision. Borderline significance (P = .05) was noted for general dentists primarily practicing in academic settings; they had 3.57 times the odds of recommending tooth extraction than dentists primarily in private practice (P = .05).</p><p><strong>Conclusions: </strong>This study found that general dentists' decision to either save a tooth with initial root canal therapy or extract was primarily associated with perceived tooth restorability.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13684952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservative Endodontic Retreatment of a Structurally Compromised Maxillary Premolar Using Digitally Assisted Magnetic Orthodontic Extrusion for Ferrule Recovery.","authors":"Arturo Pineda-Lopez, Milton Villanueva Valenzuela, Consuelo Marroquín-Soto, César-Augusto Padilla-Avalos","doi":"10.1016/j.joen.2026.08.008","DOIUrl":"10.1016/j.joen.2026.08.008","url":null,"abstract":"<p><p>Endodontically treated teeth with severe coronal loss and insufficient ferrule pose major restorative and biomechanical challenges. Orthodontic extrusion can recover the ferrule while preserving periodontal support. This report describes nonsurgical endodontic retreatment combined with digitally assisted magnetic extrusion in a maxillary first premolar tooth. A 57-year-old man presented with decementation of a metal-ceramic crown on the maxillary right first premolar. The pulpal and apical diagnoses were previously treated and asymptomatic apical periodontitis, respectively. Approximately 1 mm of supragingival tooth structure remained on the mesial, buccal, and distal surfaces. After root canal filling removal, disinfection, and intracanal calcium hydroxide medication, a customized splint containing an opposing neodymium-iron-boron magnet was fabricated using intraoral scanning, computer-aided design, and additive manufacturing. Following circumferential supracrestal fiberotomy, limited coronal extrusion was achieved after 14 days of activation. The tooth was stabilized for 4 weeks, obturated, reconstructed with glass fiber posts and a composite core, and restored with a monolithic zirconia crown. After extrusion and stabilization, the ferrule height reached approximately 2-2.5 mm. At 18 months, the tooth remained functional and asymptomatic, with physiologic mobility, probing depths of 2-3 mm, stable gingival tissues, no clinically evident relapse, and favorable periapical radiographic findings. This case supports the feasibility of digitally assisted magnetic extrusion as an adjunct to endodontic retreatment for limited ferrule recovery.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793915","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":"A Histobacteriological Reappraisal of Contemporary Deep and Extremely Deep Caries Management Recommendations.","authors":"Domenico Ricucci, Irina Milovidova, Kevin B Frazier, Sajitha Kalathingal, Samuel Bush, Franklin Tay","doi":"10.1016/j.joen.2026.08.007","DOIUrl":"10.1016/j.joen.2026.08.007","url":null,"abstract":"<p><strong>Introduction: </strong>The 2026 European Federation of Conservative Dentistry-European Society of Endodontology-Organisation for Caries Research guideline recommends selective or stepwise caries removal for deep caries to reduce pulp exposure and preserve tooth structure. However, avoiding exposure does not establish the absence of pulpal infection. This histology-referenced study tested whether radiographic classification as deep or extremely deep caries was associated with bacterial penetration into the pulp. The null hypothesis was that there was no association.</p><p><strong>Methods: </strong>Thirty-two extracted permanent teeth with carious lesions approaching or involving the pulp were examined. Two blinded examiners classified preoperative periapical radiographs by consensus using the European Society of Endodontology criteria. One tooth was unclassified. Demineralized sections stained with hematoxylin and eosin and Taylor's modified Brown and Brenn stain were evaluated for bacterial penetration and pulpal inflammation. Fisher's exact test assessed the association.</p><p><strong>Results: </strong>Sixteen teeth were classified as deep caries and 15 as extremely deep caries. Bacterial penetration was identified in 13 of 16 deep lesions (81.2%) and 13 of 15 extremely deep lesions (86.7%), for an overall frequency of 26 of 31 teeth (83.9%). Most affected teeth showed moderate or extensive inflammation. No significant association was detected between the radiographic category and bacterial penetration (P = 1.000).</p><p><strong>Conclusions: </strong>The null hypothesis was not rejected. In this extraction-enriched cohort, radiographic depth and absence of exposure did not reliably identify pulps without bacterial invasion. Selective and stepwise caries removal may remain clinically useful, but their outcomes should not be interpreted as proof of pulpal health. Clinical and patient-centered outcomes should be considered with tissue-level evidence when evaluating infection and healing.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760511","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":"Magnesium-containing Calcium Silicate Sealer Modulates Bioactive Gene Expression in Immortalized Human Periodontal Ligament Stem Cells.","authors":"Soraya Viana Gadelha, Ana Carolina Bontempi, Natalia Bispo Vieira de Melo, Matheus Kury, Denise Carleto Andia, Adriano F Lima","doi":"10.1016/j.joen.2026.08.006","DOIUrl":"10.1016/j.joen.2026.08.006","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate the cytocompatibility and transcriptional bioactivity profile of a calcium silicate-based endodontic sealer containing magnesium, in comparison with 2 widely used bioactive sealers, on immortalized human periodontal ligament stem cells (iPDLCs).</p><p><strong>Methods: </strong>Disc-shaped specimens of Bio-C Sealer, Bio-C Sealer Ion+, and BioRoot RCS were prepared according to the manufacturers' instructions. Material extracts were obtained in culture medium and applied to iPDLCs. Mitochondrial metabolism was assessed by the MTT assay at 24, 48, and 72 hours. Gene expression of proliferation-associated markers (MAPK14, YAP1, and CREB1) and osteogenic markers (COL1A1, RUNX2, SP7, and ALPL) was evaluated by quantitative real-time polymerase chain reaction at 3 and 10 days. Statistical analysis was performed using two-way ANOVA followed by Tukey's post hoc test (α = 0.05).</p><p><strong>Results: </strong>Bio-C Sealer Ion + showed the lowest mitochondrial metabolism at 24 h, while BioRoot induced the highest values at 72 h (P < .05). Gene expression analysis revealed time-dependent increases in proliferation markers across all groups. At 10 days, Bio-C Sealer Ion + exhibited the highest MAPK14, YAP1, and CREB1 expression (P < .05). For osteogenic markers, Bio-C Sealer Ion + significantly increased COL1A1 and ALPL expression at both time points. RUNX2 and SP7 expression peaked in the Bio-C Sealer and Bio-C Sealer Ion + groups at 10 days, while BioRoot showed moderate expression levels.</p><p><strong>Conclusions: </strong>All tested bioceramic sealers demonstrated adequate cytocompatibility and modulated transcriptional responses in iPDLCs. Bio-C Sealer Ion+ was associated with increased expression of proliferation-associated and osteogenic markers over time, suggesting a potential stimulatory effect on periodontal cell responses related to repair.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758934","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 Endodontically Treated Teeth after Pericervical Dentin Reinforcement: An Ex Vivo Study.","authors":"Rafa Ambalathveetil, Mohannad Nassar, Hatem El-Damanhoury, Ahmed Jamleh","doi":"10.1016/j.joen.2026.08.002","DOIUrl":"10.1016/j.joen.2026.08.002","url":null,"abstract":"<p><strong>Introduction: </strong>Loss of pericervical dentin (PCD) during root canal preparation may compromise the biomechanical integrity of endodontically treated teeth (ETT). Reinforcement strategies may enhance the ETT fracture resistance. The aim of this study was to evaluate the fracture resistance and fracture patterns of ETT following restoration of prepared PCD with different materials after thermocycling and dynamic loadings.</p><p><strong>Methods: </strong>A total of 48 extracted human single-rooted premolar teeth were equally assigned to 4 groups (n = 12): control (no PDC preparation), resin composite, polyethylene fibers (Ribbond), and gutta-percha. Following standardized root canal treatment, the PCD region was restored accordingly. Samples underwent thermocycling (5-55°C) and dynamic loading (500,000 cycles). The study measured fracture resistance using a universal testing machine. Data were analyzed using Kruskal-Wallis and Mann-Whitney U tests. Fracture mode was assessed using the chi-square test. All statistical analyses were conducted at a 5% significance level.</p><p><strong>Results: </strong>Fracture resistance differed significantly among groups (P < .05). The control group showed the highest values, followed by the Ribbond and resin composite groups, while gutta-percha showed the lowest values. No significant difference was observed between the composite and Ribbond groups (P > .05). Compared with the gutta-percha group, the composite group showed a trend toward higher fracture resistance (P = .052). Fracture mode did not differ significantly (P > .05).</p><p><strong>Conclusion: </strong>Restoration of the prepared PCD region in ETT with either composite resin or Ribbond resulted in fracture resistance values comparable to those of unprepared teeth.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711945","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":"Stress Distribution after Different Apical Resection Techniques under Different Vertical Facial Pattern-Related Loading Conditions: A Finite Element Analysis.","authors":"Gülgün Atay Yılmaz, Ahmet Keleş","doi":"10.1016/j.joen.2026.08.005","DOIUrl":"10.1016/j.joen.2026.08.005","url":null,"abstract":"<p><strong>Introduction: </strong>This study evaluated stress distributions in mandibular molars following different apical resection techniques under maximum occlusal forces representing short, average, and long facial patterns.</p><p><strong>Methods: </strong>The model was generated from anonymized Visible Human Project data. Four experimental models with 4-mm mesial and distal root lesions were simulated: targeted endodontic microsurgery with 1.5-mm and 4.4-mm trephine burs, endodontic microsurgery, and the bone window technique. Control models included healthy teeth and root canal treated teeth with or without lesions. Maximum occlusal forces representing short, average, and long facial patterns (680 N, 593 N, and 454 N, respectively) were applied vertically and obliquely to the buccal cusps and central fossa.</p><p><strong>Results: </strong>Biomechanical stress was highest in short-face patterns under oblique loading. Among the experimental groups, the bone window model generally showed the highest stress values, whereas trephine models demonstrated loading direction-dependent stress patterns. Stress concentrations were mainly localized in the cervical bone and graft-bone interface.</p><p><strong>Conclusions: </strong>Within the limitations of this finite element study, apical surgical technique, loading direction, and facial pattern-related occlusal force magnitude influenced stress distribution after apical surgery.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721948","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 Intermittent Use on the Dynamic Cyclic Fatigue Resistance of Heat-treated Nickel-Titanium Endodontic Files.","authors":"Ahmed Elsayed Abdelaal, Anas Al-Jadaa, Ahmed Jamleh","doi":"10.1016/j.joen.2026.08.004","DOIUrl":"10.1016/j.joen.2026.08.004","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to investigate the effect of in vitro intermittent file use on the dynamic cyclic fatigue resistance of heat-treated nickel-titanium rotary files.</p><p><strong>Methods: </strong>iRaCe and RaCse EVO rotary files (n = 30 each) were divided into 2 groups, wherein the files operated in a dynamic motion using either continuous or intermittent use (n = 15), following the recommended speeds by the manufacturer (600 rpm for iRaCe and 800 rpm for RaCe EVO files). All files were tested inside an artificial metallic canal with a 60° angle of curvature, a 5 mm radius of curvature, and the maximum point of curvature located 5 mm from the canal terminus, under a 35 ± 1 °C water bath. In the first group (continuous use), the file executed repeated vertical strokes spanning 3 mm in amplitude, moving both apically and coronally to the full canal length until it fractured. In the second group (intermittent use), the same strokes were performed but for 10 seconds. Then, the file was completely pulled out from the canal and then reinserted to perform another 10-second cycle until the file fractured. The number of insertions was recorded. Video recording was made for the tested files to identify the time to fracture and calculate the number of cycles to fracture. Statistical analyses were performed using SPSS at a 5% significance level.</p><p><strong>Results: </strong>The number of cycles to fracture of the RaCe EVO was higher than iRaCe, especially when operated intermittently (P < .01). Within each file system, the intermittent use exhibited better cyclic fatigue resistance (P < .01). The number of insertions before fracture was greater with the RaCe EVO (P < .01).</p><p><strong>Conclusions: </strong>The intermittent use extended the lifespan of files tested under cyclic fatigue. Further nickel-titanium file failure studies should be conducted intermittently to better mimic clinical practice.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712818","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":"Management of a Separated Needle during Intraosseous Anesthesia of a Mandibular Molar: A Case Report.","authors":"Anusha Doddamani, Fiyaz Ghan As, Sidhartha Sharma, Vijay Kumar, Amrita Chawla, Ajay Logani","doi":"10.1016/j.joen.2026.08.001","DOIUrl":"10.1016/j.joen.2026.08.001","url":null,"abstract":"<p><p>Intraosseous (IO) anesthesia has emerged as an effective primary and supplemental technique for achieving profound pulpal anesthesia during root canal treatment, particularly in mandibular molars. However, needle fracture during IO administration is an exceedingly rare complication with no established management protocol. A 29-year-old female presented with symptomatic irreversible pulpitis and symptomatic apical periodontitis in tooth #30, requiring nonsurgical root canal treatment. A first-year postgraduate endodontic student administered IO anesthesia using the QuickSleeper system (Dental HiTec) with a 30-gauge, 16-mm Effitec needle and 4% articaine with 1:100,000 adrenaline. During needle retraction following an unsuccessful injection attempt, forceful manipulation resulted in separation and retention of the needle within the interdental bone between teeth #29 and #30. Needle position was confirmed with an intraoral periapical radiograph, and the patient was informed. After administration of an inferior alveolar nerve block, an envelope flap was elevated. A minimal osteotomy was performed to expose the needle head, and the intact separated needle was retrieved using the BTR pen (Broken Tool Remover; Cerkamed) via a loop/lasso technique. The surgical site was closed with interrupted 5-0 silk sutures. Root canal treatment for tooth #30 was completed in 2 visits. A minimally invasive retrieval approach using the loop/lasso technique resulted in a successful outcome without any postoperative complications.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689383","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":"Dentin-normalized Cone-beam Computed Tomography Radiomics within a Periapical Lesion Differential Diagnosis System for Differentiating Granulomas and Radicular Cysts.","authors":"Yeonju Lee, Rui Qi Chen, Hao Yan, Muralidhar Mupparapu, Fleming Lure, Jing Li, Frank C Setzer","doi":"10.1016/j.joen.2026.07.019","DOIUrl":"10.1016/j.joen.2026.07.019","url":null,"abstract":"<p><strong>Introduction: </strong>Periapical granulomas and radicular cysts cannot be reliably differentiated by clinical examination or conventional radiography. Histopathologic examination remains the gold standard for definitive diagnosis. Because biopsy is invasive, cone-beam computed tomography (CBCT)-based radiomics approaches have been explored as noninvasive alternatives. However, their performance is affected by the intensity variability inherent to CBCT imaging. The purpose of this study was to evaluate a dentin-based intensity normalization approach to improve the robustness of radiomics-based classification of periapical lesions.</p><p><strong>Methods: </strong>CBCT scans from 140 patients with histopathologically confirmed periapical lesions (100 granulomas and 40 cysts) were retrospectively analyzed. Lesion-adjacent root dentin was approximated as an internal reference region and used for affine intensity normalization. Radiomic features were extracted from segmented lesion volumes before and after normalization within the Periapical Lesion Differential Diagnosis System. Models were evaluated using morphology-only, first-order/texture-only, and full radiomics feature settings with eXtreme Gradient Boosting (XGBoost) and logistic regression classifiers. Performance was assessed using stratified 5-fold cross-validation, area under the curve (AUC), complementary classification metrics, confidence intervals, and statistical comparison of AUCs.</p><p><strong>Results: </strong>Dentin-normalized full radiomics with XGBoost achieved the highest overall performance, with an AUC of 0.78. Dentin normalization significantly improved AUC compared with raw full radiomics in the XGBoost model (0.68 vs 0.78; P < .05). AUC also improved after normalization in the first-order/texture setting for both classifiers, suggesting that normalization primarily benefited gray-value-dependent features.</p><p><strong>Conclusions: </strong>Dentin-based intensity normalization improved the performance and stability of CBCT radiomics-based models for differentiating periapical granulomas and radicular cysts. The higher AUC of dentin-normalized full radiomics compared with morphology-only features suggests that lesion-adjacent dentin may serve as a practical internal reference for stabilizing gray-value-dependent radiomic features and that first-order and texture features provided complementary information beyond lesion morphology. Further validation across different CBCT systems and acquisition protocols is required before this approach may be considered for clinical implementation.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148669626","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}