INTRODUCTION:Root lateral perforation repair may restore structural continuity, but the biomechanical behavior of perforated teeth restored with post-and-core systems under different perforation sizes, anatomical locations, and functional loading conditions remains unclear. METHODS:Three-dimensional finite element models of a maxillary central incisor and a mandibular first premolar with MTA-repaired lateral perforations and subsequent post-and-core restorations were constructed. Perforations with different sizes and anatomical locations were repaired with MTA, followed by post-and-core restoration under functional loading. Maximum principal stress and von Mises stress were evaluated in the remaining radicular dentin and perforation region. RESULTS:Perforation size, anatomical location, and loading direction all markedly influenced stress distribution in the repaired roots. Tensile stress increased with perforation size and remained concentrated at the perforation margin and lingual cervical region. Middle-third perforations exhibited the least favorable biomechanical behavior in the maxillary central incisor, whereas lateral loading markedly increased stress in the mandibular first premolar. Most repaired models remained within the dentin tensile strength reference range; however, large perforations approaching 1.7 mm exceeded the reported threshold under unfavorable anatomical or loading conditions. CONCLUSIONS:The biomechanical behavior of roots after lateral perforation repair was jointly influenced by perforation size, anatomical location, and loading direction. Small perforations generally maintained favorable stress conditions following post-and-core restoration, whereas large perforations, particularly those located in unfavorable anatomical regions or subjected to nonaxial loading, remained mechanically vulnerable. These findings highlight the importance of post-and-core restorative design and occlusal management in improving the long-term prognosis of perforated teeth.
BACKGROUND:Direct pulp capping preserves pulp vitality after pulp exposure. Mineral trioxide aggregate (MTA) is widely used but relies mainly on host-mediated repair. Concentrated platelet-rich fibrin (C-PRF), an autologous plasma-derived biomaterial, may actively modulate the local healing microenvironment through sustained delivery of bioactive factors, but its biological performance in direct pulp capping has not been fully characterized. METHODS:Human dental pulp cells (hDPCs) were treated with PBS, MTA, or C-PRF to assess viability, proliferation, migration, and mineralization via live/dead staining, CCK-8, scratch and transwell assays, ALP and Alizarin Red S staining, as well as qPCR for genes encoding ALP, RUNX2, and COL1A1. Furthermore, an in vivo rabbit direct pulp capping model was utilized and treated with MTA or C-PRF. Pulp regenerative potential was evaluated using H&E, Masson's trichrome, and CD31 immunohistochemistry, with quantitative analysis of vascularization. RESULTS:C-PRF demonstrated good biocompatibility and enhanced hDPCs migration, proliferation, and mineralization compared with MTA. In vivo, the C-PRF group exhibited increased CD31-positive staining, suggesting enhanced early vascular responses. CONCLUSION:Within the limitations of this study, C-PRF enhanced cellular responses, including migration and mineralization, and showed potential to promote early vascularization. These findings suggest that C-PRF may serve as a biologically active adjunct for direct pulp capping.
BACKGROUND:Large language models (LLMs) are increasingly used by clinicians and learners for endodontic information, yet their reliability for irrigation-related knowledge remains unclear. This study evaluated the accuracy, readability, hallucination profile, clinical risk, and temporal stability of 4 general-purpose LLMs on endodontic irrigation questions, including false-premise prompts. METHODS:A literature-based reference set was developed for sodium hypochlorite, calcium hypochlorite, ethylenediaminetetraacetic acid, and chlorhexidine. ChatGPT-5.2, Claude Sonnet 4.5, Gemini 3 Pro, and DeepSeek 3.2 were each asked 100 questions comprising 80 factual items and 20 contradiction-seeking items. Responses were independently scored by 2 blinded endodontists for accuracy, hallucination subtype, and clinical risk. Five readability indices were calculated, and model stability was reassessed 10 days later. RESULTS:Inter-rater agreement was almost perfect (weighted κ = 0.92 for accuracy; κ = 0.97 for hallucination). Claude Sonnet 4.5 and Gemini 3 Pro showed the highest accuracy (1.75 and 1.74) and the lowest hallucination rates (7% and 9%). DeepSeek 3.2 showed the lowest accuracy (1.08), the highest hallucination rate (29%), and critical-risk outputs in 16% of responses. Gemini showed the highest test-retest stability (weighted κ = 0.95). Hallucination strongly correlated with clinical risk (ρ = 0.93; P < 0.001). Readability analysis showed a 2-tier pattern: Gemini and DeepSeek produced more accessible text, whereas ChatGPT and Claude generated denser outputs. CONCLUSIONS:LLM performance in endodontic irrigation is model- and irrigant-dependent. Hallucination profiling is clinically relevant, and high initial accuracy does not guarantee temporal stability. LLM outputs should be used only as clinician-verified adjuncts.
INTRODUCTION:The placement level of hydraulic calcium silicate (HCS) materials during regenerative endodontic procedures (REPs) may affect biomechanical performance of immature permanent teeth. This study aimed to evaluate effect of different Biodentine placement levels on biomechanical performance of immature permanent teeth treated with REPs using three-dimensional finite element analysis (FEA) validated by fracture resistance testing. METHODS:Standardized immature maxillary premolars (n = 10/group) were assigned to five groups: intact teeth (negative control), access preparation without restoration (positive control), and Biodentine placed above, at, or below the cementoenamel junction (CEJ), followed by adhesive restoration. The FEA was performed to evaluate stress distribution under occlusal loading. Fracture resistance and fracture patterns were assessed by compressive loading to failure. Data were analyzed groups using one-way ANOVA. RESULTS:Buccal cervical region exhibited highest stress concentration in all FEA models and corresponded to predominant fracture site during mechanical testing. Fracture resistance was the highest in intact teeth (1893.23 ± 63.30 N), followed by Biodentine placed below CEJ (1785.06 ± 69.11 N), at CEJ (1426.87 ± 96.09 N), above CEJ (946.61 ± 131.20 N), and positive control (724.48 ± 89.29 N). Biodentine placement below CEJ showed fracture resistance comparable to intact teeth and fewer non-restorable fractures (50%) than placement above the CEJ (70%) and positive control (80%). CONCLUSIONS:Biodentine placement level significantly influenced biomechanical performance of immature teeth treated with REPs. Placement below CEJ provided most favorable biomechanical performance by reducing cervical stress concentration, maintaining fracture resistance comparable to intact teeth, and decreasing non-restorable fractures.
INTRODUCTION:Emergency dental pain remains a significant clinical challenge, with many patients experiencing moderate-to-severe pain that is inadequately controlled by NSAIDs and acetaminophen. This is compounded by high rates of anesthetic failure in dental practices for cases with symptomatic irreversible pulpitis. Inflammation-driven upregulation of Naᵥ1.8 sodium channels contributes to persistent nociceptive signaling and local anesthetic failure. Suzetrigine (Journavx), a first-in-class selective Naᵥ1.8 inhibitor approved for acute moderate to severe pain, offers a mechanism-based approach by targeting the peripheral sodium channel driving inflammatory dental pain. METHODS:This case series describes four patients treated at endodontic specialty practices who received suzetrigine for distinct acute pain scenarios: (1) augmentation of local anesthesia in a patient with symptomatic irreversible pulpitis and prior anesthetic failure, (2) management of pre-operative emergency dental pain in a patient with symptomatic irreversible pulpitis refractory to conventional analgesics, (3) control of post-treatment inflammatory flare-up pain inadequately managed by NSAIDs and corticosteroids, and (4) management of post-surgical pain in a medically complex patient with Ehlers-Danlos syndrome for whom non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids were contraindicated. Suzetrigine was prescribed as a 100 mg oral loading dose followed by 50 mg every 12 hours as needed. RESULTS:Across all four cases, suzetrigine provided clinically meaningful reductions in pain intensity. In Case 1, a single pre-operative loading dose facilitated profound pulpal anesthesia and successful completion of nonsurgical root canal treatment on two teeth that had previously been refractory to multi-agent local anesthetic protocols. In Case 2, suzetrigine consistently reduced pain from 6-8/10 to ≤2/10, effectively bridging the patient to definitive treatment over six days without opioid use. In Case 3, suzetrigine in combination with ibuprofen and acetaminophen achieved complete symptom resolution of flare-up pain that had been inadequately controlled by high-dose ibuprofen, a corticosteroid dose pack, and antibiotics. In Case 4, a single loading dose provided significant pain relief in a patient with contraindications to NSAIDs and corticosteroids. No adverse effects attributable to suzetrigine were reported in any case. CONCLUSIONS:This case series provides the first clinical evidence for the use of suzetrigine in the management of acute dental pain thereby highlighting the role of Naᵥ1.8 in both pre-operative and post-operative dental pain. Further investigation through randomized controlled trials to establish optimal dosing, combination strategies, and efficacy relative to conventional analgesic regimens are warranted.
Introduction To compare the clinical and radiographic outcomes of the bone lid technique and conventional osteotomy in endodontic microsurgery (EMS) for teeth with an intact labial or buccal plate of bone (≥1 mm). Methods This retrospective study included 64 teeth from 64 patients who underwent EMS between January 2021 and July 2025. Cases were assigned to the bone lid (BL) group or conventional osteotomy (CO) group according to the surgical approach. Cone-beam computed tomography data were evaluated at baseline and at 3, 6, and 12-24 months after surgery. The primary outcome was comprehensive success, defined as both clinical and radiographic success at 6 and 12-24 months. Secondary outcomes included clinical success, radiographic success, lesion volume reduction, grayscale value changes, buccal plate of bone thickness, and alveolar arch contour. Regression models were used to identify outcome-associated factors. Results The BL group achieved greater lesion volume reduction and better preservation of buccal plate of bone thickness at both intervals (P< 0.05). Alveolar arch collapse was less frequent in the BL group at 6 months (6.3% vs. 73.1%, P< 0.05) and 12-24 months (0.0% vs. 26.3%, P< 0.05). Clinical success (asymptomatic healing) was comparable between groups at all time points (e.g., T3: 100.0% in BL vs. 77.3% in CO, P> 0.05). However, the BL group showed significantly higher radiographic complete healing rates at T2 (80.0% vs. 30.3%, P< 0.05) and T3 (100.0% vs. 59.1%, P< 0.05), as well as higher comprehensive success at T2 (90.0% vs. 54.5%, P< 0.05) and T3 (100.0% vs. 68.2%, P< 0.05). Conclusions For teeth with a preoperative buccal plate of bone ≥1 mm, the bone lid technique provided more favorable radiographic healing and better preserved alveolar arch contour than conventional osteotomy.
INTRODUCTION:Stem cell-based regenerative endodontics has evolved into a biologically driven strategy for pulp-dentin complex regeneration. Despite substantial research output, the extent to which high-impact evidence has translated into clinical practice remains poorly defined. Accordingly, this study aimed to systematically analyze the 100 most cited articles in this field to delineate research trends, characterize the knowledge structure, and identify key barriers to clinical translation. METHODS:A systematic search was conducted in the Web of Science Core Collection (WoS-CC) on July 11, 2026. Articles were ranked by citation count to identify the 100 most cited publications on stem cell-based regenerative endodontics. Data on publication and citation characteristics were extracted, including total citations, year of publication, authorship, institutional affiliations, and keywords. Descriptive statistics and Spearman's rank correlation were applied to assess consistency in citation counts. RESULTS:A total of 1,433 records were identified in the Web of Science Core Collection (WoS-CC). After removing 62 records before screening (60 ineligible document types and 2 non-English records), 1,371 articles were screened. Following title/abstract screening, 317 full-text articles were assessed for eligibility, and the top 100 most-cited publications were included in the bibliometric analysis. These articles accumulated 11,823 citations in the WoS-CC, 13,862 in Scopus, and 21,179 in Google Scholar. Scientific output increased markedly after 2008, whereas peak citation impact was observed between 2007 and 2012. The United States, China, and Japan were the leading contributors. Dental pulp stem cells (DPSCs) were the most extensively studied cell population. Reviews constituted the largest study category (42%), followed by animal studies (38%), in vitro investigations (14%), and clinical studies (6%), highlighting the limited availability of high-level clinical evidence. CONCLUSIONS:The most influential literature in stem cell-based regenerative endodontics remains largely confined to preclinical research, underscoring a persistent translational gap between experimental advances and clinical implementation. These findings highlight the need for rigorously designed clinical studies to enable the effective integration of these therapies into routine endodontic practice.
Pulp tissue resides within rigid dentinal walls and depends on terminal circulation, making its healing capacity highly contingent on the degree of inflammation and suggesting the presence of intrinsic protective mechanisms to prevent necrosis. Multiple cell types including odontoblasts, fibroblasts, endothelial cells, and inflammatory cells, contribute to these mechanisms through the synthesis of bioactive molecules. Odontoblasts and pulp fibroblasts detect pathogen-associated molecular patterns via Toll-like receptors and release pro-inflammatory cytokines such as IL-6, IL-8, and TNF-α. These mediators, also produced during sterile inflammation, recruit phagocytic cells that clear pathogens and tissue debris.Pulp fibroblasts further contribute to innate defense by constitutively generating Complement components, including C3b, which opsonizes cariogenic bacteria, and the membrane attack complex, which lyses microbes. Physical injury or exposure to bacterial components enhances fibroblast production of these molecules, demonstrating potent local modulation during carious or traumatic insult.Beyond antimicrobial roles, fibroblasts influence repair by regulating stem cell recruitment and differentiation via Complement activation. They also participate in macrophage recruitment and polarization into M1 and M2 subsets. While M1 macrophages primarily mediate pathogen clearance, both phenotypes contribute to the early stages of pulp healing.This review examines key mechanisms governing local control of pulpal inflammation and repair, emphasizing emerging evidence that fibroblast-macrophage interactions and macrophage polarization are central regulators of both inflammatory resolution and initiation of tissue regeneration.
Introduction Extracellular adenosine triphosphate (ATP) is a key alarmin in inflammatory responses and amplifies pain signalling through the activation of P2X3 receptors. This study aimed to validate a peripheral neuronal model, differentiated from human pulp stem cells, for the study of neuronal immunomodulation with relevance to ATP-P2X3 signalling. Methods Human dental pulp stem cells (DPSCs) were enriched from dental pulp cells obtained by explant culture from the pulp tissue of extracted third molar teeth. DPSCs were differentiated to peripheral neuronal equivalents (PNEs) in neurogenic media for 14 days. Characterisation of the neuronal transcriptome of PNEs was carried out by single-cell sequencing (ScRNA-seq). Transcriptomic and secretome changes in PNEs treated with the synthetic ATP analogue αβ-methylene ATP (αβmeATP) were analysed using ScRNA-seq and antibody microarray respectively. ATP release was measured using the ATPlite luciferase assay (Perkin Elmer) following mechanical stimulation by stretch or lipopolysaccharide (LPS) treatment of PNEs. The functional expression of P2X3 receptors was assessed by calcium mobilisation assays. Results PNEs were shown to express a neuronal gene signature, without the expression of genes typical of odontogenic cells. Transcriptomic analysis of PNEs following αβmeATP treatment demonstrated an enriched expression of pain and neuropathy pathways (P<0.05). Antibody microarray results indicated that the increased expression of 9 cytokines with αβmeATP treatment was attenuated by a P2X3 antagonist. Mechanical stretch or LPS treatment of PNEs resulted in increased ATP release (P<0.05). Responses to ATP were inhibited by a specific P2X3 antagonist indicating functional expression of P2X3 receptors in PNEs (P<0.001). Conclusions ScRNA-seq of the PNE model confirms a neuronal gene signature following differentiation, supporting its use as a relevant human model for studying neuronal immunomodulation and evaluating potential P2X3 receptor-targeted therapies for dental pain.
Introduction To develop new regenerative endodontic procedures (REPs) we require an understanding of the basic biology of the dentin-pulp complex and its behavior in health, disease and healing. Clinicians and scientific research partnerships are essential for this field to advance. Translational-targeted tissue regenerative approaches can then be identified, developed in tandem with the development of novel next-generation diagnostics. Combined, these advancements will improve clinical outcomes. Methods This narrative review aims to summarize developments over recent decades in the field of dentin-pulp complex biology focusing on our understanding of the intersection between inflammation and regeneration. Results Our knowledge of inflammation and regeneration in the pulp has rapidly expanded. As carious disease progresses the microflora changes, pulpal cells detect this infection and mount a defensive immune response. The cytokines released orchestrate immune cell infiltration and activation, with cells such as neutrophils utilizing their antimicrobial armamentarium, including the release of Neutrophil Extracellular Traps (NETs). This response although defensive, can be double-edged, leading to detrimental effects on the host tissue. Damaged tissue signals, combined with bacterial components, then activate molecular pathways, such as the inflammasome, which further exacerbate immune activity. In individuals with systemic diseases, such as type-2-diabetes (T2D), the chronic inflammation can accelerate tissue aging and potentially increase pulpal mineralization events. Epigenetic and immunotherapeutic compounds have been shown to modulate inflammation and enable innate regenerative responses. The use of high-quality preclinical laboratory-based in vitro, ex vivo and animal models is however essential to underpin the next stages of evidence-based clinical translation. Enhanced knowledge of the molecular response during pulpitis has the potential to facilitate accurate objective diagnosis and guide the most appropriate treatments. Conclusion Sustained collaboration between scientist and clinicians with a translational-focus will continue to increase our understanding of the association between inflammation and regeneration within the dentin-pulp complex. Further research in this area will lead to clinical benefit in the form of new point-of-care diagnostics and therapeutics.
Introduction The development of endodontic biomaterials requires balancing scientific performance, clinical practicality, patient expectations and regulatory requirements. This review synthesizes these perspectives to map current strengths, limitations and translational pathways for materials used in vital pulp therapy, root repair and root canal filling, as well as regenerative endodontics. Methods Narrative literature synthesis integrating recent primary studies, systematic reviews, regulatory standards and normative documents, alongside clinical and market observations, to derive a holistic framework for endodontic biomaterials. Results Scientific priorities favor biocompatibility and bioactivity and regenerative potential, whereas clinicians prioritize ease of handling, predictable performance and cost-effectiveness. Patients primarily value symptom relief, function and aesthetics. Regulatory frameworks impose safety and quality requirements through biological validation and mechanical testing. Developments over the past decades demonstrate that hydraulic calcium silicate cements have achieved successful clinical translation by reconciling, in particular, biocompatibility with clinical performance. Biomaterials used in regenerative endodontic procedures likewise show promising clinical outcomes, however, histological evidence frequently indicates reparative tissue formation rather than true pulp-dentin complex regeneration. Emerging directions in both fields, including premixed and fast-setting formulations, smart or drug-device combinations, and customized scaffolds for endodontic tissue engineering, hold considerable promise but require clinically relevant testing and demonstration of superiority over current state-of-the-art applications. Conclusions Future innovation in endodontic biomaterials will depend on integrating scientific rigor, clinical feasibility, patient demand and regulatory strategy from early development to ensure safe, adoptable and clinically meaningful advances in care.
Regenerative endodontic therapies aim to restore the biological vitality and function of dental pulp tissues, including the vascularized and innervated pulp and the mineralized dentin. While approaches such as cell homing, stem cell transplantation, and scaffold-based regeneration have shown promise in immature teeth, outcomes in previously infected mature, fully formed adult teeth remain inconsistent. These limitations highlight the need to better define the interactions among vascular, immune, and microbiological factors within the pulp microenvironment. This narrative review examines the dentin-pulp complex from a microengineering perspective, focusing on strategies to engineer vascular, immune, and mineralized niches using bioactive and immune-informed materials. It also outlines current challenges and future directions, emphasizing the integration of LPS neutralization, immune modulation, and fabrication of pre-vascularized and pre-calcified scaffolds with scalable stem cell and dentin matrix sources to enable predictable and functional regeneration of the dentin-pulp complex.
Introduction Biomaterials that both seal the pulp during direct pulp capping (DPC) and actively control inflammation are unusual. Here, we engineered injectable gelatin methacryloyl (GelMA) hydrogels carrying omega-3 polyunsaturated fatty acids. Our null hypothesis states that GelMA and GelMA-omega-3 hydrogels do not differ in their physicochemical, mechanical, cytocompatibility, immunomodulatory, or in vivo effects. Methods Distinct omega-3 concentrations were added to GelMA, and the resulting hydrogel was photocrosslinked. Scanning electron microscopy (SEM) and Fourier-transform infrared spectroscopy (FTIR) were used to examine the hydrogels’ microstructure and composition. Swelling, degradation, compression, and rheological tests were also performed. Dental pulp stem cell (DPSC) viability and mineralization capacity were assessed with or without lipopolysaccharide (LPS). LPS-challenged RAW 264.7 macrophages were exposed to hydrogel-conditioned media to measure TNF-α and IL-6 levels. In vivo implantation of the hydrogels was conducted to determine biocompatibility, macrophage polarization (iNOS/CD163), and TGF-β expression. Statistics used one-way ANOVA with Tukey’s post-hoc test or two-way ANOVA with the Holm-Šídák test (p<0.05). Results SEM revealed a more fibrous, heterogeneous network in the omega-3 hydrogels. Incorporating omega-3 reduced swelling and slowed mass loss compared to GelMA. Although a high omega-3 load decreased Young’s modulus, the ultimate strength remained similar. FTIR confirmed omega-3 incorporation. Crosslinked hydrogels were solid-like, shear-thinning, thermally stable, and recovered post-shear. All formulations were cytocompatible. Without LPS, mineralization levels were similar across groups. With LPS, high omega-3 concentration decreased mineralization, while low concentration matched the control. All hydrogels suppressed LPS-induced TNF-α and IL-6; omega-3 further reduced IL-6 compared to GelMA. In vivo, omega-3 hydrogels increased early cell influx that resolved by day 28, enhanced M2 macrophage marker expression at 7 and 28 days, lowered the M1/M2 ratio over time, and elevated TGF-β expression early on with sustained levels. Conclusions Omega-3 hydrogels are biocompatible and actively modulate inflammation, supporting their potential as an immunomodulatory strategy for DPC.
INTRODUCTION: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]). METHODS: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. RESULTS: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. CONCLUSIONS: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.
Introduction 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 non-clinical factors on decision-making. Methods Authors conducted a cross-sectional survey study. Participants read a clinical vignette presenting a questionably restorable tooth for consideration and provided their clinical recommendations. The primary treatment decision was analyzed as a binary variable: extraction or RCT. Other questions about clinical decision-making used the Likert-scale for capturing responses. Clinician related variables were evaluated: 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. Results 113 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=0.05) 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=0.05). Conclusions 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.
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.
INTRODUCTION: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. METHODS: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. RESULTS: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). CONCLUSIONS: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.
INTRODUCTION: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). METHODS: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). RESULTS: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. CONCLUSIONS: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.
