Journal of endodontics最新文献

{"title":"Biocompatibility of a Novel Light-Curable Hydrogel-Based Root Canal Obturation Material: In Vivo and In Vitro Analyses.","authors":"Moe Sandar Kyaw, Yoshio Yahata, Masato Nakano, Fusami Toyama, Chen Ke, Wang Shuai, Yuya Kamano, Futaba Harada, Tomose Noguchi, Masahiro Saito","doi":"10.1016/j.joen.2025.08.017","DOIUrl":"10.1016/j.joen.2025.08.017","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to evaluate the biocompatibility of a new light-curable hydrogel-based root canal obturation material, OdneFill, through in vivo and in vitro analyses.</p><p><strong>Methods: </strong>Intentional overinstrumentation and overobturation were performed on the mandibular first molars of 10-week-old male rats, divided into 4 groups: group 1 (instrumentation only), group 2 (OdneFill), group 3 (gutta-percha + AH Plus), and group 4 (sound teeth). Mandibles were dissected after 3, 28, and 90 days for micro-computed tomography, histological analysis, and immunohistochemical staining and analyzed by two-way analysis of variance and post hoc Tukey test. Cytotoxicity and proinflammatory cytokine expression were assessed using RAW 264.7 cells and analyzed by 1-way analysis of variance and Tukey test (α = 0.05).</p><p><strong>Results: </strong>Micro-computed tomographic analysis showed no significant difference in bone resorption (P > .05). However, AH Plus exhibited a higher inflammatory score (score: 1%-90%, score: 2%-10%) with increased neutrophil and macrophage infiltration in immunostaining (P < .05) compared to the instrumentation only group at day 90. In contrast, Odnefill showed comparable results (score: 0%-50%, score: 1%-30%, score: 2%-20%) to the instrumentation-only group (P > .05). Moreover, Odnefill did not affect the viability of RAW 264.7 cells, whereas the AH Plus extract decreased cell viability and upregulated inflammatory cytokines such as interleukin-1 beta and interleukin-6.</p><p><strong>Conclusions: </strong>OdneFill demonstrated superior biocompatibility, and a minimal inflammatory response compared to AH Plus.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956545","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":"Relationship between Craniofacial Skeletal Patterns and the Prevalence of Tooth Fractures.","authors":"Julia Jeong, Lucy Kim, Soriul Kim, Hyeran Helen Jeon, Frank C Setzer","doi":"10.1016/j.joen.2025.08.013","DOIUrl":"10.1016/j.joen.2025.08.013","url":null,"abstract":"<p><strong>Introduction: </strong>Tooth fractures are associated with various etiological factors, including occlusal stress. While science has shown associations between maximum bite force and craniofacial skeletal patterns, a direct link between skeletal morphology and the prevalence of tooth fractures has not been established. This study aimed to investigate whether sagittal and vertical skeletal patterns, as determined by cephalometric analysis, are associated with the prevalence of tooth fractures in an adult orthodontic population.</p><p><strong>Methods: </strong>A retrospective review was conducted of 1001 adult orthodontic patients with complete records, including lateral cephalometric radiographs and demographic data. Patients were classified into vertical (high, neutral, low mandibular angle) and sagittal (Angle Class I, II, III) skeletal patterns using population-specific cephalometric norms. Tooth fractures were identified through clinical records and Current Dental Terminology codes, including whether fractured teeth were extracted or retained, and whether endodontic treatment was involved. Statistical analysis included analysis of covariance, chi-square, and Fisher exact tests.</p><p><strong>Results: </strong>No significant differences were observed in the prevalence of tooth fractures, either extracted or retained, across vertical or sagittal skeletal classes for the overall population. Within the Caucasian subpopulation, a significantly higher prevalence of tooth fractures was noted in ANGLE-I compared to ANGLE-II (P = .02). Similarly, previously endodontically treated teeth were more frequently extracted due to fracture in ANGLE-I and ANGLE-III compared to ANGLE-II (P = .02). No significant associations were found in the African-American, Asian, or Hispanic subpopulations.</p><p><strong>Conclusions: </strong>Craniofacial skeletal patterns may not aid in predicting tooth fracture risk in the general population. While limited associations were noted within the Caucasian subgroup, further prospective studies incorporating direct bite force measurements are warranted to clarify biomechanical contributions to tooth fractures.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956543","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 and Prognostic Analysis of Root Canal-treated Posterior Cracked Teeth: The Modified Iowa Index.","authors":"Norachai Wongkornchaowalit, Taratorn Soontornkiat, Tadkamol Krongbaramee, Attawood Lertpimonchai, Keith V Krell","doi":"10.1016/j.joen.2025.08.012","DOIUrl":"10.1016/j.joen.2025.08.012","url":null,"abstract":"<p><strong>Introduction: </strong>Cracked teeth requiring root canal treatment present with variable prognoses. This study aimed to evaluate the treatment outcomes of root canal-treated posterior cracked teeth and to identify prognostic factors influencing endodontic outcomes.</p><p><strong>Methods: </strong>A retrospective cohort of 263 cracked posterior teeth with 1- to 5-year follow-up was analyzed. The Iowa index was modified by subcategorizing each stage according to crack extension. Outcomes were assessed using strict clinical and radiographic criteria. Cox regression analysis was performed to identify significant predictors of failure.</p><p><strong>Results: </strong>The overall success and survival rates were 82.9% and 89.7%, respectively, with a mean follow-up period of 40.3 months. The estimated 2-year and 5-year survival rates were 99.2% and 78.6%, respectively. Multivariable analysis identified 7 independent predictors of failure: increasing age, pocket depth ≥5 mm along the crack line, radicular extension ≥3 mm, preoperative periapical lesion, multiple crack lines, absence of occlusal splint in patients with parafunctional habits, and restoration with onlay or composite. Cracked teeth with probing depths <5 mm (Stages I-III) showed favorable outcomes (success rate: 78.9%-98.3%, survival rate: 86.5%-100%), whereas those exhibiting both radicular extension and periodontal pocket ≥5 mm (Stage IV-R) had poor prognosis (success rate: 33.3%, survival rate: 63.0%).</p><p><strong>Conclusions: </strong>The modified Iowa index, incorporating the classification of crack extension, demonstrated prognostic value. The combination of radicular crack and periodontal pocket ≥5 mm should be considered a high-risk profile when evaluating the treatment potential of cracked teeth.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955889","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":"Association between Apical Periodontitis and the Severity of Marginal Periodontitis in Root Canal-treated Teeth: A Retrospective Cohort Study.","authors":"Xavier-Fructuós Ruiz, Fernando Duran-Sindreu, Milous Snijders, Leslie Elenbass, Hagay Shemesh, Juan Gonzalo Olivieri","doi":"10.1016/j.joen.2025.08.014","DOIUrl":"10.1016/j.joen.2025.08.014","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate whether the severity of marginal periodontitis is correlated with the development of apical periodontitis (AP) in root canal-treated teeth. The secondary aim was to investigate the variables associated with the development of AP in patients with different levels of bone loss.</p><p><strong>Methods: </strong>This longitudinal, observational, retrospective cohort study entailed radiographic evaluation of root-canal-filled teeth in patients with and without periodontal involvement after a minimum period of 2 years. Independent, calibrated specialists evaluated the baseline periapical radiographs for the presence or absence of AP and periodontal bone loss (PBL). PBL was categorized as normal, mild, moderate, and severe. Logistic regression analysis was conducted to examine differences between groups and potential relationships among variables.</p><p><strong>Results: </strong>A total of 1365 patients (2235 root canal-treated teeth) were initially screened, including 663 patients in the control group and 702 with periodontal involvement. 1011 root canal-filled teeth were included for analysis (normal PBL: 401 teeth; mild PBL: 304 teeth; moderate PBL: 228 teeth; and severe PBL: 78 teeth). 10.1% of teeth developed AP: 4.2% with normal PBL, 1.6% with mild PBL, 19.73% with moderate PBL, and 44.9% with severe PBL. Multivariable regression analysis showed no significant difference between teeth with normal and mild PBL (P > .05). Moderate PBL was associated with an 8.4-fold increase in the odds of developing AP (odds ratio [OR]: 8.38; 95% confidence interval [CI]: 3.06-22.98), whereas severe PBL was linked to a 41.3-fold increase (OR: 41.26; 95% CI: 8.15-208.95), both compared to normal PBL (P < .05). Furthermore, patients who smoke also showed a higher odd of developing AP (OR: 2.22; 95% CI: 1.11-4.46) (P < .05).</p><p><strong>Conclusions: </strong>A clear association was found between the severity of marginal periodontitis and the development of AP in root canal-treated teeth. Additionally, smoking habit showed a significant association with the development of AP acting as a confounding factor.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956486","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 Dentine Thickness and Intraradicular Reinforcement on Fracture Resistance of MTA-apexified Immature Anterior Teeth.","authors":"Thanyaphurt Utamavatin, Danuchit Banomyong, Pairoj Linsuwanont","doi":"10.1016/j.joen.2025.08.015","DOIUrl":"10.1016/j.joen.2025.08.015","url":null,"abstract":"<p><strong>Introduction: </strong>The most common cause of failure of mineral trioxide aggregate (MTA)-apexified teeth is root fracture. This study aimed to identify the appropriate reinforcement materials following MTA apexification in immature teeth under simulated oral conditions.</p><p><strong>Methods: </strong>Part 1: To investigate the effect of dentine thickness: twenty-four teeth (n = 8) were assigned to 3 groups; intact, simulated immature teeth with 2.0 mm, and 1.5 mm dentin thicknesses. Roots were prepared using Peeso reamers until the predetermined thickness was achieved. Part 2: To evaluate the effect of reinforcement materials: forty teeth were prepared as simulated immature roots with 1.5 mm dentin thickness and received MTA apexification. They were randomly assigned into 5 groups (n = 8): gutta-percha, MTA, DUAL-cure composite resin, fiber post, and anatomic post. All teeth underwent thermocycling and cyclic loading before compression testing. Fracture patterns and maximum load to fracture were recorded. Data were analyzed using one-way analysis of variance with Tukey's test and Weibull regression for survival probability.</p><p><strong>Results: </strong>Teeth with 1.5 mm dentin thickness showed significantly lower fracture resistance than intact and 2.0 mm groups. An oblique horizontal root fracture was observed in all samples. In fiber postgroup, the most observed fracture was at the interface between MTA and post. The DUAL-cure composite resin group showed fracture resistance and survival probability comparable to intact group.</p><p><strong>Conclusions: </strong>Within the limit of this study, MTA-apexified teeth could be reinforced with DUAL-cure composite resin.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956522","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":"Performance of Advanced Artificial Intelligence Models in Pulp Therapy for Immature Permanent Teeth: A Comparison of ChatGPT-4 Omni, DeepSeek, and Gemini Advanced in Accuracy, Completeness, Response Time, and Readability.","authors":"Berkant Sezer, Tuğba Aydoğdu","doi":"10.1016/j.joen.2025.08.011","DOIUrl":"10.1016/j.joen.2025.08.011","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to evaluate and compare the performance of three advanced chatbots-ChatGPT-4 Omni (ChatGPT-4o), DeepSeek, and Gemini Advanced-on answering questions related to pulp therapies for immature permanent teeth. The primary outcomes assessed were accuracy, completeness, and readability, while secondary outcomes focused on response time and potential correlations between these parameters.</p><p><strong>Methods: </strong>A total of 21 questions were developed based on clinical resources provided by the American Association of Endodontists, including position statements, clinical considerations, and treatment options guides, and assessed by three experienced pediatric dentists and three endodontists. Accuracy and completeness scores, as well as response times, were recorded, and readability was evaluated using Flesch Kincaid Reading Ease Score, Flesch Kincaid Grade Level, Gunning Fog Score, SMOG Index, and Coleman Liau Index.</p><p><strong>Results: </strong>Results revealed significant differences in accuracy (P < .05) and completeness (P < .05) scores among the chatbots, with ChatGPT-4o and DeepSeek outperforming Gemini Advanced in both categories. Significant differences in response times were also observed, with Gemini Advanced providing the quickest responses (P < .001). Additionally, correlations were found between accuracy and completeness scores (ρ: .719, P < .001), while response time showed a positive correlation with completeness (ρ: .144, P < .05). No significant correlation was found between accuracy and readability (P > .05).</p><p><strong>Conclusions: </strong>ChatGPT-4o and DeepSeek demonstrated superior performance in terms of accuracy and completeness when compared to Gemini Advanced. Regarding readability, DeepSeek scored the highest, while ChatGPT-4o showed the lowest. These findings highlight the importance of considering both the quality and readability of artificial intelligence-driven responses, in addition to response time, in clinical applications.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956513","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":"Digital-guided Autotransplantation of Teeth with Autogenous Bone Augmentation: A Case Report.","authors":"Huilin Wu, Zuwen Ma, Yongqi Li, Guangwei Chen, Weifa Li, Jinglin Kuang, Libin Zhou","doi":"10.1016/j.joen.2025.08.006","DOIUrl":"https://doi.org/10.1016/j.joen.2025.08.006","url":null,"abstract":"<p><p>Long-term dental defects are often accompanied by severe alveolar bone resorption, which compromises the maintenance of alveolar bone height and thickness, thereby increasing the complexity of restoration. This case report presents a 24-year-old female patient with a 6-month dental defect and alveolar bone resorption. The treatment consisted of autotransplanting the left mandibular third molar to the defect site, with the use of a three-dimensional printed donor tooth replica and the surgical guide for precise alveolar socket preparation. Simultaneously, autogenous bone harvested intraoperatively was transplanted to the buccal bone defect area. Root canal treatment was performed 2 weeks postoperatively. A 21-month follow-up demonstrated a stable transplanted tooth, satisfactory buccal bone regeneration, and notable esthetic improvement. This case highlights the potential benefits of integrating digital technology with autogenous bone grafting in autotransplantation of teeth for complex dentition defects.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956559","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 grading system for pulp canal calcification based upon 3-D imaging to aid in assessment of case difficulty in orthograde endodontic treatment.","authors":"Paul Cruci, Allen Gaon, Mitul Patel, Angelo Zavattini, Samira K Al Salehi","doi":"10.1016/j.joen.2025.08.005","DOIUrl":"https://doi.org/10.1016/j.joen.2025.08.005","url":null,"abstract":"<p><p>This article describes a novel grading system for quantifying potential difficulty in locating and instrumenting root canals where there is evidence of calcification. The system is based upon limited field of view cone beam computed tomography (CBCT) which is an essential tool in the diagnosis and treatment of the calcified canal. The new grading system considers the vertical level at which the canal becomes radiographically evident (coronal, middle or apical), the length of patent canal, and whether the canal is patent at the terminus. At present there is no classification for canal calcification and no means of categorizing a canal in terms of the potential difficulty/feasibility involved in treating it.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956529","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":"Endotoxin Levels after Calcium Hydroxide Placement in Root Canals Irrigated with Continuous or Sequential Chelation in Previously Treated Teeth with Symptomatic Apical Periodontitis: A Randomized Controlled Clinical Trial.","authors":"Dhvani Sunil Pandya, Selvakumar Kritika, Kavitha Sanjeev, Sekar Mahalaxmi, Prasanna Neelakantan","doi":"10.1016/j.joen.2025.08.004","DOIUrl":"https://doi.org/10.1016/j.joen.2025.08.004","url":null,"abstract":"<p><strong>Introduction: </strong>Endotoxins are proinflammatory components of Gram-negative bacteria. The aim of this randomized clinical trial was to test the null hypotheses that (i) there is no significant difference between continuous chelation irrigation (5.25% sodium hypochlorite + 9% etidronic acid) and sequential chelation (5.25% sodium hypochlorite - 17% ethylene diaminetetra-acetic acid) in endotoxin reduction, and (ii) placement of calcium hydroxide (CH) does not further improve endotoxin reduction in previously treated teeth with symptomatic apical periodontitis.</p><p><strong>Methods: </strong>Previously treated teeth with symptomatic apical periodontitis (n = 48) were randomly allocated to (n = 24) Group 1, sequential chelation (SC) or Group 2, continuous chelation (CC). Root canal sampling was performed with sterile paper points at three time intervals: immediately after gutta-percha removal (T₀), following chemomechanical preparation (T₁), and following 7 days of CH placement (T₂). A turbidimetric kinetic limulus amebocyte lysate assay was used for endotoxin quantification. Repeated measures ANOVA was used to compare SC and CC at different time points and between different time points for each protocol. P < .05 was considered to be statistically significant.</p><p><strong>Results: </strong>Both SC and CC showed significant endotoxin reduction from T₀ to T₁ (P < .05), while only SC group exhibited further significant reduction from T₁ to T₂ (P < .05). CC group demonstrated significantly lower endotoxin levels than the SC group at T₁ (P < .01) and T₂ (P < .001).</p><p><strong>Conclusion: </strong>This study shows for the first time that CC irrigation resulted in significantly lower quantity of endotoxins than SC followed by calcium hydroxide.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Ultrasonically Activated Irrigation and Laser-Activated Irrigation for Postoperative Pain Reduction in Endodontics: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Mohammad Sabeti, Aaron Harouni, Julian Gabbay","doi":"10.1016/j.joen.2025.08.002","DOIUrl":"10.1016/j.joen.2025.08.002","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review and meta-analysis evaluate the effects of ultrasonically activated irrigation (UAI) and laser-activated irrigation (LAI) on postoperative pain following root canal treatment (RCT).</p><p><strong>Methods: </strong>An extensive search of the literature was performed using MEDLINE, Web of Science, Embase, and the Cochrane Library from January 2000 to March 2025. Eligible randomized controlled trials (RCTs) comparing UAI with LAI and reporting postoperative pain outcomes at multiple postoperative time on the visual analog scale were included. The included RCTs were thoroughly evaluated for potential risk of bias and overall quality of evidence, and their data were pooled and analyzed using a random-effects model.</p><p><strong>Results: </strong>Seven RCTs (n = 490 teeth, 30 comparisons) were meta-analyzed, showing that LAI significantly reduced postoperative pain compared to UAI (standard mean difference [SMD] = -0.58; 95% CI: -0.94 to -0.22; P = .0016). Subgroup analysis highlighted the greatest pain reduction at 24-48 hours (SMD = -1.00), especially with pulsed Er: YAG lasers (PIPS: SMD = -1.10; SWEEPS: SMD = -1.57), while diode lasers showed no significant effect (SMD = 0.03). Sensitivity analyses supported the reliability of these findings.</p><p><strong>Conclusions: </strong>LAI provides a statistically and clinically meaningful reduction in postoperative endodontic pain compared to ultrasonic activation, with the most pronounced effects observed between 24- and 48-hours post-treatment. Among laser types, pulsed Er: YAG modalities-especially SWEEPS-demonstrated the strongest analgesic benefit.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862242","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}