Background: Scaffold systems have been widely investigated in regenerative endodontic therapy (RET) because they may facilitate cell proliferation, growth factor delivery and tissue regeneration in immature teeth with pulp necrosis. Platelet-rich scaffolds contain high concentrations of growth factors, promoting cell proliferation and tissue regeneration. However, variations in preparation protocols make it difficult to identify key trends. This study aimed to evaluate bibliometric data from the 100 most-cited articles on platelet-rich concentrates in RET. Methods: Articles were retrieved from the Web of Science Core Collection and ranked by citation count. Data regarding publication year, study design, citation counts, journals, authorship, institutional and geographic distribution, keywords and type of platelet concentrate were extracted. Data were visualised using descriptive outputs, and a negative binomial regression model was applied to evaluate the association between citation counts, publication year and platelet concentrate type. Results: Most publications were from 2017 to 2019, with narrative reviews having the highest cumulative citation impact. The Journal of Endodontics was the leading publication source. China and the United States were the most influential countries. Regression modelling showed that studies combining platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) had higher predicted citation rates than those with PRP or PRF alone (rateratios of 1.30 and 1.95, respectively). Conclusion: The upward trend over 2 decades shows progress in PRF-based scaffolds for RET. However, inconsistent reporting of platelet subtypes and protocols hinders clinical use. This study highlights key publications and trends, offering insights for future research in platelet-rich scaffolds for RET.
Objective: This study developed a computer vision–based framework for quantitative morphometric analysis of mandibular incisors with single root canals using axial video data obtained from micro-computed tomography (micro-CT). Methods: Fifty extracted micro-CT scanned single-rooted mandibular incisors with single root canals (coded 1TN1 according to Ahmed et al. coding system) were included. After segmentation of the pulp space, video recordings were constructed using Mimics. The video frames were preprocessed through Gaussian filtering and segmented in the hue, saturation and value/brightness colour space domain. The contours were fitted with ellipses to compute morphometric descriptors, including aspect ratio (AR), roundness (R) and form factor. Aspect ratio–based classification was used to categorise canal cross-sections into 4 types (Round, Oval, Long Oval and Flattened). Automated AR measurements were validated against manual reference measurements of the same parameter at the cemento-enamel junction in 30 specimens, using Passing–Bablok and Deming regression, Bland–Altman analysis and the intraclass correlation coefficient; R and FF were not subjected to formal method comparison. Longitudinal trends along all thirds were visualised, and similarity measurement–based grouping comparisons were performed using dynamic time warping (DTW) clustering algorithm. Results: The automated framework successfully processed 8334 axial frames. Within each root third, DTW clustering of AR trajectories resolved 3 morphological strata. Cluster 1 represented canals with the highest R (mean = 0.82) and lowest AR (mean = 1.39). Cluster 2 showed moderate ovality, while Cluster 3 exhibited the most complex morphology with the highest AR (mean = 2.84) and lowest R (mean = 0.40). Only 17 of the 50 specimens (34%) retained the same stratum in all 3 root thirds (mean adjusted Rand index 0.176), indicating that a canal’s morphological class frequently changes along the root. Morphometric analysis revealed that canal complexity and flattening reached their peak in the middle third of the root. Conclusion: This study introduces a robust and fully automated framework for quantitative assessment of canal morphology using axial videos. The findings highlight that mandibular incisors often harbour significant morphological complexity in the middle third, which may challenge standard instrumentation.
Objective: The impact of contracted access cavities on organic tissue dissolution by irrigant solutions supplemented with ultrasonic agitation has not been determined. This laboratory study compared the organic tissue dissolution ability of 5.25% sodium hypochlorite (NaOCl) with ultrasonication and 17% ethylenediaminetetraacetic acid (EDTA), in artificial molars having traditional (TradAC), conservative (ConsAC), or ultraconservative (UltraAC) endodontic access cavities. Methods: Resin mandibular molar replicas (n = 135) with canals prepared, derived from micro-computed tomography scan datasets, were randomly allocated to the 3 experimental groups: TradAC, ConsAC or UltraAC (n = 45 per group). Porcine palatal mucosa samples (0.4-0.6 mg) were placed in the mesial root isthmuses, the teeth were reassembled and sealed. Both mesial canals were irrigated with 1.5 mL NaOCl ultrasonicated, followed by 1 mL EDTA and a final 1.5 mL NaOCl rinse. The total contact time was 90 seconds for NaOCl and 10 seconds for EDTA. Tissue was re-weighed, and mass loss was expressed as the percentage of weight reduction. The Kruskal–Wallis test (χ2) was used to assess differences between groups. Significance was set at P = .05. Results: Percentage dissolution means (SD) were TradAC, 32.2 (20.3); ConsAC, 25.0 (13.8); and UltraAC, 23.4 (15.0). The analysis showed no significant variation in porcine palatal mucosa tissue dissolution percentages across the experimental groups (χ2 = 4.37, df = 2, P = .117). Conclusion: No statistically significant differences in porcine palatal mucosa dissolution were detected among the tested access cavity designs under the laboratory conditions investigated.
Objective: To investigate the long-term maintenance of periapical health in healthy teeth after root canal treatment for restorative indications (RCT-FRIs) and to identify factors associated with loss of periapical health over time. Methods: In this prospective cohort study, 206 teeth (406 roots) with normal pulp and periapical status at baseline underwent standardised RCT-FRI. Follow-up included annual clinical and periapical radiographic (PR) assessment; cone-beam computed tomography (CBCT) was performed at baseline and at the corresponding follow-up assessment using standardised limited-field protocols, with follow-up duration varying according to recall attendance and endpoint status. Periapical radiolucency (PARL) was defined as PAI ≥2 on PR and CBCTPAI ≥1 on CBCT. Maintenance of periapical health was analysed using Kaplan–Meier estimates, and study variables were assessed using multivariable Cox proportional hazards models with robust variance estimation to account for clustering. Results: All teeth remained in situ throughout follow-up. Periapical radiolucencies developed in a subset of cases and were consistently associated with clinical symptoms. CBCT identified significantly more PARLs than PR (40/406 roots, 9.8% vs 18/406 roots, 4.4%; exact McNemar test, P < .001). Inter-examiner agreement was excellent for both imaging modalities (Fleiss’ κ = 0.90 for PR; Fleiss’ κ = 0.96 for CBCT). Increasing age, missed canals, inadequate definitive coronal restoration and the presence of an intraradicular post were independently associated with reduced maintenance of periapical health. Kaplan–Meier estimates at 10 years showed that maintenance of periapical health was 95.5% and 92.5% by PR, and 90.1% and 89.0% by CBCT, at the root and tooth levels, respectively. Conclusion: Root canal treatment for restorative indications in healthy teeth was associated with high longterm maintenance of periapical health. Standardized limited-field CBCT provided a more stringent characterisation of periapical status than PR. Long-term outcomes were associated with restorative and anatomical factors
Pulpitis is a progressive inflammatory disease of the dental pulp, traditionally classified using histopathological or symptom-based schemes such as ‘reversible’ vs. ‘irreversible’. While these frameworks have aided understanding, they often fail to reflect the dynamic biological state of the pulp that can aid in precise, minimally invasive treatment decisions. The aim of this article is to introduce a clinically meaningful classification of pulpitis that combines preoperative and intraoperative diagnostic assessment criteria to enable objective therapeutic choices. Drawing on the medical staging model used in other progressive diseases, the proposed classification is defined by (i) preoperative clinical and radiographic characteristics, (ii) intraoperative clinical observation of time‑to‑haemostasis and (iii) evidence‑based therapeutic recommendations from conservative vital pulp therapy to pulpectomy. The proposed staging system comprises Stage 0: normal healthy pulp, Stage 1: mild pulpitis, Stage 2: severe pulpitis, Stage 2.1: partial coronal pulpitis, Stage 2.2: complete coronal pulpitis, Stage 2.3: total pulpitis and Stage 3: pulp necrosis. This staging system provides a structured, objective framework for communication with patients, prognostic assessment, research comparability, and health system integration (coding, record‑keeping and reimbursement). It also represents a shift from theoretical disease labels towards actionable, biologically driven treatment pathways. The current staging classification provides a structured clinical framework to guide evidence-based treatment selection and aids the clinician to choose the most appropriate therapeutic approach for each case.
