Journal of endodontics最新文献

{"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, Angelo Zavattini, Allen Gaon, Mitul Patel, Samira K Al Salehi","doi":"10.1016/j.joen.2025.08.005","DOIUrl":"10.1016/j.joen.2025.08.005","url":null,"abstract":"<p><strong>Introduction: </strong>This article describes a novel grading system for quantifying potential difficulty in locating and instrumenting root canals where there is evidence of calcification.</p><p><strong>Methods: </strong>The system is based upon limited field of view cone beam computed tomography which is an essential tool in the diagnosis and treatment of the calcified canal.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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. It is hoped that this novel grading system will be useful in treatment decision making.</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}

{"title":"Endodontic Microsurgery of Mandibular Molars with an Autonomous Robotic System.","authors":"Haiying Zhang, Zi Yang, Mangnan Liu, Yaoxin Wang, Mei Fu, Benxiang Hou, Chen Zhang","doi":"10.1016/j.joen.2025.08.003","DOIUrl":"10.1016/j.joen.2025.08.003","url":null,"abstract":"<p><p>Minimally invasive osteotomy and precise root-end resection are key factors in endodontic microsurgery (EMS), particularly in the mandibular molars. Autonomous robotic (ATR) systems facilitate accurate presurgical planning and real-time robot-guided osteotomy and root resection. Integrating the ATR technique with EMS can enhance the accuracy and effectiveness of the treatment. This report presents 2 cases diagnosed with symptomatic apical periodontitis in the mandibular left and right first molar. Cone-beam computed tomography and intraoral scanning data were used to design the surgical plan via planning software. The ATR system guided the robotic arm to autonomously perform precise osteotomy and root resection based on the presurgical plan. At 3-12 months of follow-up, both patients were asymptomatic and radiographic examination revealed complete healing. The ATR technique enabled precise root-end resection despite thick and intact cortical plates, contributing to successful EMS outcomes during the 3- to 12-month follow-up period. This feasibility demonstration warrants further validation in clinical trials with extended follow-ups to assess its potential role in surgical endodontics.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862243","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":"An Innovative Injectable and Retrievable Drug Delivery System for Endodontic Therapy.","authors":"Abdel H Mahmoud, Aaron Sloutski, Shi Fu, Huiting Luo, Zoe Katevatis, Robert Wong, Yiwei Fang, Tatiana Zaliznyak, Fernando Aguilar Perez, Marcia Simon, Stephen G Walker, Thomas Manders, Miriam Rafailovich, Jerome J Cymerman","doi":"10.1016/j.joen.2025.08.001","DOIUrl":"10.1016/j.joen.2025.08.001","url":null,"abstract":"<p><strong>Introduction: </strong>Endodontic treatment failures remain a significant treatment challenge. Different bacterial combinations are implicated in posttreatment disease. Enterococcus faecalis is often detected in these biofilms. Calcium hydroxide has many limitations, including low flowability, difficult retrieval, high pH, and limited efficacy against E. faecalis. Here, we show that these difficulties can be overcome using calcium salicylate (CASA) encapsulated in a photocrosslinked thermoreversible F127-dimethacrylamide (DMA) hydrogel.</p><p><strong>Methods: </strong>CASA was prepared by mixing calcium hydroxide and salicylic acid in a 1:6 ratio, respectively and incorporated into F127-DMA at different concentrations. The mixture was photocrosslinked using lithium phenyl (2,4,6-trimethylbenzoyl) phosphinate. Chemical properties were analyzed using X-ray diffraction, Raman spectroscopy, Fourier transform infrared spectroscopy, and differential scanning calorimetry, while injectability and retrievability were assessed using plastic root canal training blocks, bovine teeth cone beam computed tomography scans, and oscillatory rheology. In Vitro antibacterial efficacy against E. faecalis biofilm was probed by injection of the compound, following inoculation on bovine extracted teeth. Cytotoxicity of the compound was measured using dental pulp stem cells.</p><p><strong>Results: </strong>Encapsulation of CASA in F127-DMA reduced the viscosity by three orders of magnitude compared to the paste form, facilitating injection and enabling retrieval. Following retrieval, F127-DMA/CASA showed significantly lower residual medicament (∼6%) compared to Vista-Cal (26%). X-ray diffraction, Raman, and Fourier transform infrared spectroscopy analyses confirmed the formation of CASA and successful integration of CASA into photocrosslinked F127-DMA. Treatment with the F127-DMA/20% CASA following 21-day inoculation with E. faecalis resulted in a 6-log reduction in CFU and complete elimination of biofilm. No significant change in the doubling time of treated dental pulp stem cell was observed.</p><p><strong>Conclusions: </strong>F127-DMA/CASA exhibits superior flowability, retrievability, near-neutral pH (∼6), biocompatibility, and anti-E. faecalis efficacy, which highlights its potential as a significant improvement over calcium hydroxide as an endodontic intracanal medicament.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859188","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 Behavior of Maxillary Premolars with Non-carious Cervical Lesions: Influence of Minimally Invasive Endodontic Access and Restoration Protocols.","authors":"Fabiane Carneiro Lopes-Olhê, Helena Cristina de Assis, Gustavo Creazzo, Ana Paula Macedo, Marco Aurélio Carvalho, Angelo José Sócrates Torres-Carrillo, Lautaro Gallardo Altube, Gabrielle Jacob, Guilherme Nilson Alves Dos Santos, Jardel Francisco Mazzi-Chaves, Manoel D Sousa-Neto","doi":"10.1016/j.joen.2025.07.019","DOIUrl":"10.1016/j.joen.2025.07.019","url":null,"abstract":"<p><strong>Introduction: </strong>Non-carious cervical lesions (NCCLs) compromise tooth structure and may cause inflammation requiring endodontic treatment. This study evaluated the influence of endodontic access design on fracture resistance, failure patterns, and stress distribution in maxillary premolars with wedge-shaped NCCLs restored using different restorative strategies.</p><p><strong>Methods: </strong>One hundred maxillary premolars were divided into ten groups based on access type (sound and NCCL with traditional, minimally invasive, and no access) and restorative material (provisional, conventional composite, high-viscosity bulk-fill resin, or low-viscosity bulk-fill resin combined with conventional resin composite). NCCLs were standardized, endodontic treatments performed, and restorations applied. After thermocycling, specimens underwent fracture resistance testing and failure mode analysis. One tooth was scanned for finite element analysis (FEA).</p><p><strong>Results: </strong>The sound group and the minimally invasive access group restored with high-viscosity bulk-fill resin had numerically higher fracture resistance. No significant difference was found between traditional and minimally invasive access. Adhesive protocols performed significantly better than temporary restorations (P < .05). Type III (nonrestorable) fractures predominated (50%-90%). FEA revealed stress concentrations in the buccal cusp, central groove, marginal ridges, and cervical region, with similar patterns across groups and slightly lower stress in minimally invasive access.</p><p><strong>Conclusions: </strong>Endodontic access preparation reduced the fracture resistance of maxillary premolars with noncarious cervical lesions; however, the access design itself did not significantly influence this outcome. FEA revealed similar stress distribution patterns across all groups, regardless of access type. Adhesive restorative protocols, especially those employing bulk-fill composites, enhanced biomechanical performance compared to provisional restorations. These findings underscore the importance of minimally invasive access in preserving structural integrity and highlight the critical role of adhesive strategies in restoring biomechanical function.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812078","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":"Cellular Crosstalk Between Periodontal Ligament Fibroblasts and Macrophages: Insights from 2D and 3D Culture Systems in External Inflammatory Root Resorption.","authors":"Rajeshwari Hadagalu Revana Siddappa, Anil Kishen","doi":"10.1016/j.joen.2025.07.021","DOIUrl":"10.1016/j.joen.2025.07.021","url":null,"abstract":"<p><strong>Introduction: </strong>Root resorption following traumatic dental injuries is a complex process involving the breakdown of root dentin and cementum by odontoclasts, which differentiate from precursor macrophages. This differentiation is regulated by periodontal ligament fibroblasts (PDLF). Macrophages can polarize into two types: proinflammatory (M1) and anti-inflammatory (M2), which can influence either disease progression or healing.</p><p><strong>Methods: </strong>This review considers experimental models that have been utilized to study the interactions between PDLF and macrophages under normal and inflammatory conditions, including bacterial exposure and hypoxia.</p><p><strong>Results: </strong>Under normal circumstances, PDLFmaintain the balance of periodontal tissues and the surrounding immune environment. However, during inflammatory conditions such as exposure to bacteria or hypoxia, injured PDLF interact with macrophages through signaling mechanisms that promote the differentiation of macrophages into odontoclasts. Various experimental models have been utilized to study the interactions between PDLF and macrophages. These interactions alter the balance of macrophage polarization, with M1 macrophages contributing to disease progression.</p><p><strong>Conclusion: </strong>This review highlights recent insights into the dynamic relationship between PDLF and macrophages in the context of external inflammatory root resorption, emphasizing the importance of their crosstalk in determining disease outcome.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812079","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":"Innervation Changes in Apical Periodontitis and its Correlation with Preoperative Symptoms.","authors":"Austah Obadah, Johnathan Fu, David Wong, Anibal Diogenes","doi":"10.1016/j.joen.2025.07.018","DOIUrl":"10.1016/j.joen.2025.07.018","url":null,"abstract":"<p><strong>Introduction: </strong>Previous anatomical studies have demonstrated the cellular composition of apical periodontitis (AP) lesions, primarily focusing on immune cells. Only recently has the innervation of an apical lesion been reported, but evidence regarding the quantity and quality of neural innervation in AP lesions remains largely unknown. Importantly, periapical innervation has been shown to modulate cellular response in AP, and the voltage-gated sodium channels Nav1.8, a marker of nociceptors, and Nav1.9 have been associated with various pain-related conditions. This study aimed to quantify sensory innervation and evaluate the expression of Nav1.8 and Nav1.9 in symptomatic vs asymptomatic AP.</p><p><strong>Methods: </strong>Soft tissue biopsy samples (n = 20) were collected during endodontic microsurgery. Samples underwent protein extraction and immunohistochemistry. Enzyme-linked immunosorbent assay was used to quantify β-tubulin III Nav1.8 and Nav1.9. Immunoreactivity for calcitonin gene-related peptide, neurofilament heavy, PGP9.5, and Nav1.8 was analyzed using confocal microscopy. Data were analyzed using the Mann-Whitney U test with significance set at P < .05.</p><p><strong>Results: </strong>Symptomatic lesions exhibited an approximately 6-fold increase in innervation density (410.6 ± 359.2 vs 63.4 ± 75.7 pg/μg) and significantly higher Nav1.8 (10.3 ± 10.3 vs 2.97 ± 2.5 pg/μg) and Nav1.9 (9.5 ± 8.5 vs 42.5 ± 39.6 pg/μg) expression compared to asymptomatic lesions (P < .05). Neuronal fibers were identified by the co-localization of neurofilament heavy and PGP9.5 immunoreactivity, revealing a higher density of innervation in apical lesions from symptomatic cases. Notably, the majority of these fibers exhibited strong Nav1.8 expression, indicating a predominance of nociceptive innervation within these lesions.</p><p><strong>Conclusions: </strong>This study provides novel evidence of increased sensory innervation and upregulation of Nav1.8 and Nav1.9 in symptomatic AP. These neural changes may contribute to pain mechanisms in AP and challenges in achieving local anesthesia.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799277","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":"Evaluation of Aluminum Chloride-based Hemostatic Agents in Endodontic Microsurgery: An In Vitro and In Vivo Preclinical Study.","authors":"Yae Lim Kim, Ukseong Kim, Sukjoon Lee, Sunmi Jang, Euiseong Kim, Sunil Kim","doi":"10.1016/j.joen.2025.07.017","DOIUrl":"10.1016/j.joen.2025.07.017","url":null,"abstract":"<p><strong>Introduction: </strong>While the aluminum chloride-based hemostatic agent Expasyl is proposed for efficient hemostasis in endodontic microsurgery, its high viscosity may hinder removal and lead to adverse tissue reactions. Traxodent, with lower viscosity, is less studied. This study preclinically compared Expasyl and Traxodent to evaluate (1) cellular responses in human osteoblasts (HOBs) and (2) hemostatic efficacy and tissue response in a rabbit calvarial model.</p><p><strong>Methods: </strong>HOBs were cultured in media containing high and low concentrations of each agent to assess short- and long-term effects. Cell viability was assessed using the Cell Counting Kit-8 assay, and osteogenic (ALPL, BGLAP, RUNX2) and inflammatory (interleukin 6, C-X-C motif chemokine ligand 8, transforming growth factor beta 1) gene expression were analyzed via reverse transcription-quantitative polymerase chain reaction. In vivo, six calvarial bone defects were surgically created in each of six rabbits. Defects were randomly assigned to six groups: control, epinephrine, Expasyl, or Traxodent with or without curettage. Hemostasis was evaluated using photographic bleeding scores. Histological analysis assessed tissue response and bone healing.</p><p><strong>Results: </strong>Short-term exposure (2 min - 1 h) to Expasyl or Traxodent reduced HOB viability. Expasyl significantly decreased transforming growth factor beta 1 and increased C-X-C motif chemokine ligand 8 expression. Both agents reduced osteogenic markers. Expasyl showed the highest hemostatic efficacy but also induced more inflammation and delayed bone healing based on histological findings. Traxodent was easier to remove, left minimal residue, and did not impair healing but demonstrated no significant improvement in bleeding control.</p><p><strong>Conclusions: </strong>Expasyl provided effective hemostasis but was associated with delayed healing and inflammation. Both agents showed cytotoxicity and reduced osteogenic gene expression. Residual Expasyl may hinder healing in endodontic microsurgery.</p>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784401","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}