Journal of endodontics最新文献

{"title":"Immunohistological Characterization of Minced Dental Pulp Transplant in an Ectopic Mouse Model","authors":"Chaehwan Lee DDS, MS ,&nbsp;Yuka Miyamoto DDS, PhD ,&nbsp;Wei Chen PhD ,&nbsp;Euiseong Kim DDS, MSD, PhD ,&nbsp;Insoon Chang DDS, MS, PhD ,&nbsp;Mo K. Kang DDS, PhD","doi":"10.1016/j.joen.2025.11.017","DOIUrl":"10.1016/j.joen.2025.11.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Dental pulp stem cells have been explored as a potential source for dentin–pulp complex regeneration because of their pluripotency and differentiation capacity. However, cell-based approaches require enzymatic digestion and <em>in vitro</em> expansion, which may alter cell properties and hinder clinical translation. This preliminary proof-of-principle study examines a tissue-based alternative using freshly minced pulp (MP) in an ectopic mouse model as a potentially translatable approach for regenerative endodontics.</div></div><div><h3>Methods</h3><div>Human dental pulp tissue was either minced or enzymatically digested, seeded onto collagen type I scaffolds, inserted into root fragments, and implanted subcutaneously into immunocompromised mice.</div></div><div><h3>Results</h3><div>Histology revealed that MP grafting generated well-organized dentin–pulp–like tissue with high cellularity, vascularization, mineralization, and odontoblast-like cells extending processes into dentinal tubules, whereas dental pulp stem cell grafts formed less organized tissue and mineral deposits. MP-derived tissues also exhibited angiogenic potential, forming vessel-like structures containing pericytes and endothelial cells.</div></div><div><h3>Conclusions</h3><div>This preliminary <em>in vivo</em> mouse study suggests the feasibility of MP transplantation and its potential for dentin–pulp complex regeneration, though further studies are needed to assess long-term outcomes and clinical applicability.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 3","pages":"Pages 405-413"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145794150","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":"Survival of Endodontically Treated Cracked Teeth: A 10- to 15-Year Retrospective Study","authors":"Pei Yuan Chan BDS, MDS, M Endo RCS, FAMS ,&nbsp;Rachel Fangying Seet BDS, MDS ,&nbsp;Seyed Ehsan Saffari PhD ,&nbsp;Stella Jinran Zhan PhD ,&nbsp;Nah Nah Chen BDS, MDS, MS, FAMS","doi":"10.1016/j.joen.2025.11.010","DOIUrl":"10.1016/j.joen.2025.11.010","url":null,"abstract":"<div><h3>Introduction</h3><div>To investigate long-term (10- to 15-year) survival and success rates of endodontically treated cracked teeth and to identify possible prognostic factors related to their survival and success.</div></div><div><h3>Methods</h3><div>Patients who had endodontically treated cracked teeth were seen for a 10- to 15-year review. Preoperative and intraoperative treatment records were retrieved. Clinical and radiographic evaluations were performed. Two outcomes were investigated: survival (tooth present) and success (asymptomatic with complete radiographic healing). The 10- and 15-year tooth survival and success rate were estimated. Cox proportional hazards regression assessed the impact of various factors on the time to tooth extraction and time to complete healing.</div></div><div><h3>Results</h3><div>Data from 196 patients with 204 endodontically treated cracked teeth were analyzed. The 10- and 15-year survival rates were 66% (95% confidence interval [CI]: 60%-73%) and 55% (95% CI: 48%-63%), respectively. Success rates declined from 64% at 10 years to 37% at 15 years. Preoperative probing depth (PD) was the primary statistically significant factor for survival. Teeth with no preoperative PD (&lt;4 mm) had higher survival rates of 76% at 10 years and 64% at 15 years. Multivariable analysis revealed significantly increased risk for teeth with PD of 4–5 mm (adjusted hazard ratio [aHR] = 2.48, 95% CI: 1.41-4.38, <em>P</em> = .002) and ≥6 mm (aHR = 3.19, 95% CI: 1.56-6.54, <em>P</em> = .002) for survival analysis. Older age was a modest independent risk factor (aHR = 1.03 per year, 95% CI: 1.00–1.05, <em>P</em> = .026) for survival.</div></div><div><h3>Conclusions</h3><div>Endodontic treatment of cracked teeth with favorable preoperative PDs demonstrates long-term survival comparable to noncracked teeth and is a viable long-term treatment option which should be recommended.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 3","pages":"Pages 376-386.e2"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145587720","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":"In Vitro and Ex Vivo Evaluation of a Novel Solvent for Tricalcium Silicate-based Sealers","authors":"David Colmenar DMD, MSD ,&nbsp;Saaya Sakoda DDS ,&nbsp;Tanguy Terlier PhD ,&nbsp;Takashi Komabayashi DDS, MDS, PhD ,&nbsp;Timothy Kirkpatrick DDS ,&nbsp;Ji Wook Jeong DMD, MSD","doi":"10.1016/j.joen.2025.11.009","DOIUrl":"10.1016/j.joen.2025.11.009","url":null,"abstract":"<div><h3>Introduction</h3><div>The need for removal of tricalcium silicate-based sealers in endodontic retreatment is increasing, but it is challenging due to their limited solubility. Therefore, new solvents are needed.</div></div><div><h3>Methods</h3><div><em>In vitro</em> solubility assays of EndoSequence BC sealer (BC) were prepared and evaluated in 7 groups (<em>n</em> = 10): pH 4 buffer (B4), pH 6 buffer (B6), pH 7 deionized water (H₂O), pH 8.16 buffer B8, pH 10 buffer (B10), 17% ethylenediaminetetraacetic acid (EDTA), and pH 10 buffered 17% EDTA (E10). <em>Ex vivo</em> dentin disks were immersed in either B4 or E10, then the time-of-flight secondary ion mass spectrometry was used to quantify dentin decalcification. Extracted teeth were instrumented and obturated using a single cone technique with BC short of working length and the apical 2 mm filled only with sealer. Three groups (<em>n</em> = 11) of teeth were retreated by a single blinded operator with either H₂O, EDTA, or E10 until patency was obtained. Results were analyzed using two-way ANOVA with post hoc tests.</div></div><div><h3>Results</h3><div>Solubility values for each group were: B4, 48.6% ± 2.8; B6, 41.4% ± 4.6; H₂O, 13.5% ± 1.9; B8, 13.2% ± 3.2; B10, 11.4% ± 3.4; EDTA, 32.6% ± 6.4; and E10, 51.1% ± 4.7. BC was significantly more soluble in both B4 and E10 than in the other groups. There was no significant difference in solubility or dentin decalcification between B4 and E10. Patency rates and time to achieve patency did not differ significantly among all groups.</div></div><div><h3>Conclusions</h3><div>E10 is an effective solvent for BC during endodontic retreatment procedures but does not affect the ability to regain patency.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 3","pages":"Pages 436-441"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563984","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":"Valacyclovir for Acute Apical Abscess Pain: A Randomized, Placebo-controlled, Double-blind Study","authors":"Mohammad Sabeti DDS, MA ,&nbsp;Kyle Kitasoe DDS","doi":"10.1016/j.joen.2025.11.021","DOIUrl":"10.1016/j.joen.2025.11.021","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute apical abscesses are known for rapid-onset pain and swelling from pulp necrosis. While typically associated with polymicrobial infections, recent research suggests that active herpesvirus infections may also contribute. This randomized, double-blind, placebo-controlled trial aimed to evaluate if valacyclovir, when combined with amoxicillin, can consistently manage pain and how individual patients respond within a larger population.</div></div><div><h3>Methods</h3><div>This study enrolled 38 emergency patients with moderate to severe pain from acute apical abscesses, randomizing them into 2 treatment groups. Patients in the valacyclovir group (<em>n</em> = 21) received a 1g loading dose of amoxicillin (followed by 500 mg four times daily for 7 days) and a 2g loading dose of valacyclovir (followed by 500 mg twice daily for 3 days). The placebo group (<em>n</em> = 17) received the same amoxicillin regimen along with a placebo. Over a 6-day follow-up, we used daily phone calls to track pain levels with a numeric rating scale and monitor analgesic use. Outcome data were analyzed using the Mann–Whitney and Friedman statistical tests.</div></div><div><h3>Results</h3><div>The valacyclovir group showed significantly lower mean pain scores on Days 1–3 (<em>P</em> &lt; .05). They experienced a faster reduction in moderate/severe pain and a higher rate of reporting no pain (numeric rating scale= 0) throughout the study. Analgesic use dropped sharply in the valacyclovir group, with only 28.6% using analgesics on Day 1 compared to 82.4% in the placebo group. This consistently lower usage was maintained through Day 6.</div></div><div><h3>Conclusion</h3><div>Valacyclovir shows promise as an adjunctive therapy for early pain relief in patients with acute apical abscesses.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 3","pages":"Pages 396-404"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145701088","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":"Untreated Apical Periodontitis and the Risk of Medication-related Osteonecrosis of the Jaws (MRONJ): A Systematic Review with Mechanistic Insights from Preclinical Studies","authors":"Maria Emília Mota DDS ,&nbsp;Nelise Alexandre Silva Lascane DDS, MSc, PhD ,&nbsp;Thais Gimenez DDS, PhD ,&nbsp;Fábio Abreu Alves DDS, MSc, PhD ,&nbsp;Maria Stella Moreira DDS, MSc, PhD","doi":"10.1016/j.joen.2025.12.002","DOIUrl":"10.1016/j.joen.2025.12.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Medication-related osteonecrosis of the jaws (MRONJ) is a condition that causes progressive bone destruction and compromises patients' function, aesthetics, and quality of life.</div></div><div><h3>Objectives</h3><div>This study aims to investigate the role of untreated apical periodontitis (AP) in the development of MRONJ.</div></div><div><h3>Methods</h3><div>A comprehensive search was performed in PubMed/MEDLINE, Web of Science, Scopus, and Embase. Gray literature was assessed using the ProQuest database. The eligibility criteria consisted of (1) preclinical studies; (2) use of antiresorptive, antiangiogenics, or other drugs known to cause MRONJ; (3) studies evaluating the development of osteonecrosis in regions of AP lesions. The following studies were excluded: (1) non-animal studies. Two independent reviewers performed data extraction and the assessment of the risk of bias.</div></div><div><h3>Results</h3><div>From an initial dataset of 239 records, we included 11 studies. Induction of periapical lesions was performed most often after the administration of bisphosphonates. Zoledronic acid was the most used drug. Histologic or clinical evidence of MRONJ in areas of untreated AP was reported in 72.72% of the studies. Furthermore, areas with AP presented MRONJ more frequently, with or without clinical signs.</div></div><div><h3>Conclusions</h3><div>This systematic review of preclinical studies indicates that untreated AP, in the context of antiresorptive therapy, may increase the risk of MRONJ. Our findings provide mechanistic insights that clarify how AP may contribute to MRONJ pathogenesis, offering a theoretical background to support clinical observations. While human studies suggest a potential pathogenic interaction, they remain limited by heterogeneous designs, variable definitions of oral infections, and frequent grouping of AP with other conditions. These limitations underscore the translational significance of our preclinical analysis. Overall, our results reinforce the importance of early diagnosis and management of endodontic infections in patients receiving antiresorptive particularly cancer patients exposed to higher cumulative doses and highlight the need for well-designed prospective clinical studies to determine whether AP constitutes an independent risk factor for MRONJ.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 3","pages":"Pages 359-375"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145751974","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":"Physicochemical and Biological Properties of the “All-In-One” Endodontic Irrigant Triton","authors":"Jesus Aranda MSc ,&nbsp;Elda Olivia Nobre de Souza DDs ,&nbsp;Arturo Javier Aranda Garcia PhD ,&nbsp;Renato de Toledo Leonardo PhD ,&nbsp;Ana Paula Ramos PhD ,&nbsp;Giampiero Rossi-Fedele PhD ,&nbsp;Gisele Faria PhD","doi":"10.1016/j.joen.2025.10.006","DOIUrl":"10.1016/j.joen.2025.10.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Triton is a newly developed root canal irrigant that acts on both organic and inorganic tissues. This study evaluated the physicochemical properties (pH, surface tension, contact angle, available free chlorine), dentin penetration, and cytotoxicity of Triton, compared with 4% sodium hypochlorite (NaOCl) + etidronic acid (HEDP), 4% NaOCl/17% ethylenediaminetetraacetic acid, and 4% NaOCl.</div></div><div><h3>Methods</h3><div>pH was measured using a pH meter; surface tension and contact angle were assessed by the pendant drop and sessile drop methods, respectively. Available free chlorine was determined by titration with iodine/sodium thiosulfate. For dentin penetration, 39 extracted human premolars were instrumented, stained with crystal violet, irrigated, and analyzed under a stereomicroscope. Cytotoxicity was evaluated on L929 fibroblasts using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and neutral red (NR) assays.</div></div><div><h3>Results</h3><div>Triton showed a pH of 12.49, available free chlorine of 4.18%, and significantly lower surface tension and contact angle than the other irrigants (<em>P</em> &lt; .05). In the cervical third, Triton showed greater dentin penetration than 4% NaOCl and 4% NaOCl + HEDP (<em>P</em> &lt; .05); in the middle third, greater penetration than 4% NaOCl (<em>P</em> &lt; .05). No significant differences were observed in the apical third (<em>P</em> &gt; .05). Triton and 4% NaOCl + HEDP groups had significantly lower cell viability compared to other groups (<em>P</em> &lt; .05).</div></div><div><h3>Conclusions</h3><div>Triton demonstrated an alkaline pH, lower surface tension and contact angle, and greater dentin penetration in the cervical and middle thirds compared to 4% NaOCl. However, its cytotoxicity, similar to that of 4% NaOCl + HEDP, emphasizes the need for safe irrigation dynamics to prevent periradicular tissue damage.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 3","pages":"Pages 421-428"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329305","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":"Preventive Endodontics: Mitigating Crack Development and Tooth Loss","authors":"Rebekah Lucier Pryles DMD ,&nbsp;Brooke Blicher DMD ,&nbsp;Alan H. Gluskin DDS","doi":"10.1016/j.joen.2025.11.008","DOIUrl":"10.1016/j.joen.2025.11.008","url":null,"abstract":"<div><div>Cracked teeth represent a growing concern in endodontic practice, driven by biomechanical, evolutionary, and lifestyle factors. While traditionally approached as a condition requiring reactive treatment, contemporary endodontics must now shift toward prevention. This article explores the multifactorial nature of cracked teeth, including parafunctional habits, malocclusion, modern dietary patterns, and the evolutionary mismatch between human dentition and present-day lifestyles. The paper outlines key risk factors such as bruxism, malocclusion, and enamel demineralization, while also discussing effective preventive strategies. These include occlusal assessment, orthodontic or equilibration interventions, dietary counseling, and use of occlusal splints. Management of asymptomatic cracks and stabilization through full-coverage restorations or bonded restorations is emphasized to reduce the likelihood of structural failure. For teeth requiring endodontic therapy, the inclusion of bonded intraorifice barriers, timely restorations, and occlusal adjustment significantly improves long-term outcomes. Notably, recent evidence challenges outdated assumptions regarding poor prognosis for cracked teeth, highlighting the effectiveness of interdisciplinary protocols. The article calls for a paradigm shift in endodontic care from solely treating cracked teeth to actively preventing their occurrence. By integrating principles from preventive medicine and anthropology, endodontists can better preserve natural dentition. Ultimately, ensuring that the first diagnosed crack is the last one aligns with both ethical obligations and the long-term success of endodontic treatment.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 3","pages":"Pages 353-358"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145533834","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":"Study on the Geometric Location Method of the Danger Zone in the Mesial Roots of Mandibular First Molars","authors":"Jinjie Yan MD ,&nbsp;Yuanling Peng MD ,&nbsp;Jing Yang MD ,&nbsp;Jie Liu PhD ,&nbsp;Linxian Wang MD ,&nbsp;Tingyuan Zhao MD ,&nbsp;Jian Zhang PhD ,&nbsp;Kehua Que PhD","doi":"10.1016/j.joen.2025.11.019","DOIUrl":"10.1016/j.joen.2025.11.019","url":null,"abstract":"<div><h3>Introduction</h3><div>To investigate the geometric angle method of “danger zone” (DZ) position in the mesial roots of mandibular first molars (MFMs) using cone-beam computed tomography (CBCT) and micro-computed tomography (Micro-CT).</div></div><div><h3>Methods</h3><div>The CBCT images of 949 MFMs with mesial roots of single root and 2 root canals were collected and analyzed with DZ and α_D (the angle between the line extending from the center of buccal/lingual root canal to DZ and the line connecting the centers of the buccal and lingual root canals) of the mesial roots in the coronal and middle thirds of roots. Thirty-four MFMs with similar root canal morphologies were analyzed using Micro-CT to validate the geometric positioning method based on CBCT. The association of α_D with the root lengths, inter-orifice canal distance (D_R-R), age and gender were subsequently investigated. Values with <em>P</em> &lt; .05 were considered statistically significant.</div></div><div><h3>Results</h3><div>The DZ of MFMs was mainly located in the middle thirds of the distal wall, with an average thickness of 0.818 ± 0.143 mm. The average α_D was 71.9 ± 9.0°, ranging from 42.7° to 99.9° and showed approximately 87.8% of value concentrated within the range of 60.1°–86.2°. The α_D was negatively correlated with the D_R-R (<em>P</em> &lt; .01) and had no correlation with age or gender (<em>P</em> &gt; .05). Results of the Micro-CT analyses showed that the α_D was 70.4 ± 7.3°, ranging from 48.9° to 85.6°, and 92.7% of the α_D were also within the range of 60.1°–86.2° established by CBCT.</div></div><div><h3>Conclusions</h3><div>From a geometric perspective, the distribution of DZ in the mesial roots of MFMs demonstrated a relatively consistent spatial pattern. This predictable localization may assist clinicians in accurately identifying DZ positions and improving treatment planning.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 3","pages":"Pages 387-395.e1"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834215","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":"Detection Thresholds for Root Canal Visibility on High-Resolution CBCT: A Micro-CT Validation Study","authors":"Kheya Patel DMD,&nbsp;Feng-Ming Wang DDS, PhD,&nbsp;Mehrnaz Tahmasbi DDS,&nbsp;Fabricio Teixeira DDS, PhD,&nbsp;Madhu Nair DMD, PhD,&nbsp;Poorya Jalali DDS","doi":"10.1016/j.joen.2025.11.016","DOIUrl":"10.1016/j.joen.2025.11.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Cone-beam computed tomography (CBCT) is widely used to assess root canal morphology, yet practical size thresholds for canal visibility have not been established. This study determined the relationship between canal diameter and the probability of confident detection on high-resolution CBCT using micro–computed tomography (micro-CT) for reference.</div></div><div><h3>Methods</h3><div>Sixty-one extracted human teeth (251 canal cross-sections, including 9 with no visible lumen) were imaged with both imaging modalities. True canal diameters measured on micro-CT were spatially matched to corresponding CBCT cross-sections using anatomical landmarks. Three calibrated observers rated canal visibility on a 5-point scale; scores ≥4 indicated confident detection. Interobserver reliability was quantified using Krippendorff's α and quadratic-weighted κ. A binomial logistic regression modeled detection probability as a function of diameter. Receiver operating characteristic (ROC) analysis assessed overall discriminative accuracy.</div></div><div><h3>Results</h3><div>Interobserver agreement was excellent (α = 0.87; κ = 0.78–0.91). The probability of confident canal detection increased sharply with canal diameter. Model estimates indicated a 70% probability (D₇₀) at a canal diameter of approximately 265 μm, an 80% probability (D₈₀) at 299 μm, and a 90% probability (D₉₀) at 350 μm. ROC analysis demonstrated excellent discriminative performance (area under the curve = 0.89), confirming strong accuracy of CBCT visibility scores for identifying canals present on micro-CT.</div></div><div><h3>Conclusions</h3><div>On 80-μm-voxel CBCT, consistent canal visibility emerges at approximately 300 μm. Canals measuring 200 to 300 μm are often visible, whereas those smaller than about 200 μm are frequently missed. The detection thresholds identified in this study may help clinicians anticipate when a canal is likely still patent but radiographically undetectable.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 3","pages":"Pages 442-450"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145596501","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":"Improved Root Canal Disinfection through Extended Sodium Hypochlorite Exposure and Renewal after Preparation Procedures","authors":"Emmanuel João Nogueira Leal Silva DDS, MSc, PhD ,&nbsp;David Victor Ferreira da Silva DDS ,&nbsp;Graziela dos Santos Massa DDS, MSc ,&nbsp;Bárbara de Paula Coelho BSc, MSc ,&nbsp;Luciana Moura Sassone DDS, MSc, PhD ,&nbsp;Marco Aurélio Versiani DDS, MSc, PhD ,&nbsp;Ana Flávia Almeida Barbosa DDS, MSc, PhD","doi":"10.1016/j.joen.2025.11.023","DOIUrl":"10.1016/j.joen.2025.11.023","url":null,"abstract":"<div><h3>Introduction</h3><div>This study evaluated whether extending sodium hypochlorite (NaOCl) contact time with periodic renewal after preparation enhances root canal disinfection compared with a standard continuous-irrigation protocol.</div></div><div><h3>Materials and Methods</h3><div>Twenty-eight bovine incisors were contaminated with <em>Enterococcus faecalis</em> (ATCC 29212) for 28 days. Specimens were assigned to 2 experimental groups (<em>n</em> = 10) and 2 controls (positive, <em>n</em> = 4; negative, <em>n</em> = 4). Experimental canals received either standard continuous irrigation (20 mL 1% NaOCl over 4 min) or an extended protocol, in which 5 mL 1% NaOCl was left <em>in situ</em> for 5 min and replenished over 4 cycles, with a total of 20 mL. All canals were subsequently irrigated with 6 mL 17% ethylenediaminetetraacetic acid and 6 mL 1% NaOCl under ultrasonic activation, followed by NaOCl neutralization. Microbiological samples were collected at baseline (S1), after primary irrigation (S2), and after final irrigation/activation (S3) using paper points and Hedström file scrapings. Colony-forming units (CFU) were quantified on Mitis Salivarius agar. Statistics comparison was performed with Kruskal–Wallis and Mann–Whitney U tests (α = 0.05).</div></div><div><h3>Results</h3><div>Negative controls confirmed asepsis, and positive controls verified bacterial viability. Both irrigation protocols significantly reduced CFU counts at S2 and S3 compared with baseline (<em>P</em> &lt; .05). The extended protocol yielded lower CFU counts than standard irrigation at both postirrigation time points (<em>P</em> &lt; .05). Overall bacterial reduction from baseline to final sampling (S1→S3) was significantly greater for the extended protocol (<em>P</em> = .027), while intermediate reduction (S1→S2) did not differ between groups (<em>P</em> &gt; .05).</div></div><div><h3>Conclusions</h3><div>The extended protocol resulted in a significantly greater microbial reduction compared with standard continuous irrigation.</div></div>","PeriodicalId":15703,"journal":{"name":"Journal of endodontics","volume":"52 3","pages":"Pages 451-457"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648712","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}