Purpose. To evaluate the effects of pulse duration and repetition rate on Er: YAG laser ablation efficiency and sound dentin preservation in artificial and natural carious models. Methods. Fifty-six artificially decalcified dentin specimens were allocated to six Er: YAG laser groups (L1–L6; pulse durations 50–300 µs, repetition rates 20–40 Hz, energies 60–70 mJ) and one rotary bur control (n = 8 each). Twenty-four natural carious molars were assigned to medium-short pulse (MSP: 100 µs, 40 Hz) versus bur or super-short pulse (SSP: 50 µs, 40 Hz) versus bur comparisons (n = 12 pairs each). Sound dentin loss (mm²) and treatment duration (s/mm²) were quantified using standardized radiography or three-dimensional surface scanning, and ablation threshold changes (ΔE = E₁ − E₂) were assessed in natural carious model. Results. In the artificial model, L1 (70 mJ, 300 µs, 20 Hz) yielded the lowest sound dentin loss (median 0.040 mm², IQR 0.037–0.043), significantly less than bur (p < 0.001) and short-pulse groups L4 and L6 (p < 0.05 to p < 0.0001). L4 (70 mJ, 50 µs, 40 Hz) achieved the shortest laser treatment duration (mean 190.64 s/mm², SD 36.90; p < 0.05 vs. L1–L3). In natural caries, both MSP and SSP protocols preserved sound dentin comparably to bur (p > 0.05) but required 3.3- and 2.6-fold longer treatment times, respectively (p < 0.0001). Overall, 70

Background Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most prevalent chronic liver disease but lacks effective therapies. Oral microbial dysbiosis is closely associated with metabolic dysfunction.Objective This study aimed to delineate MAFLD-specific oral microbiota signatures and identify diagnostic biomarkers.Design Supragingival plaque samples from 21 patients with MAFLD and 20 healthy individuals were subjected to metagenomic sequencing. Potential oral biomarkers were identified bioinformatically and further validated using a MAFLD mouse model.Results Patients with MAFLD exhibited significantly reduced supragingival microbial diversity, altered composition, and enhanced consortial interactions compared to healthy individuals. Seven resident oral species were identified as candidate biomarkers. Among these, Actinomyces naeslundii was notably enriched in the oral cavity of patients with MAFLD and strongly correlated with clinical indices. In vivo experiments further demonstrated that the oral administration of A. naeslundii significantly aggravated MAFLD phenotypes and induced gut dysbiosis in mice fed a high-fat diet.Conclusion This study reveals a potential link between the oral microbiota and MAFLD. Specifically, the excessive enrichment of the oral resident bacterium A. naeslundii is associated with the MAFLD progression in mice.

Streptococcus mutans is a key cariogenic pathogen of dental caries due to its strong ability to synthesize extracellular glucans and form biofilms. Glucosyltransferases, encoded by gtfB/C/D genes in S. mutans, are responsible for producing biofilm exopolysaccharides (EPS) and are considered to be critical virulence factors. Previous studies have highlighted the roles of various regulatory factors of gtf genes in S. mutans. Here, we investigated the role of the global transcriptional regulator CcpA encoded by ccpA in regulating the EPS synthesis and biofilm formation of S. mutans. A ccpA in-frame deletion strain was observed to develop shiny, round colonies and longer cell length. In addition, the deletion of ccpA resulted in impaired growth, diminished synthesis of EPS, and reduced biofilm formation. Transcriptome analysis revealed that differentially expressed genes in the ccpA deletion strain were significantly enriched in pathways of carbohydrate transport and metabolism, in which the expressions of gtfB and gtfC were downregulated markedly. Electrophoretic mobility shift assays confirmed that CcpA directly binds to the promoter sequences of gtfB and gtfC, with a higher affinity for gtfC. Moreover, the expression level of ccpA in part explained differences in the ability to synthesize sufficient EPS and form stable biofilm in clinically isolated strains. These findings highlight that CcpA plays a crucial role in the EPS production and biofilm formation of S. mutans through directly binding to the promoter regions of gtfB and gtfC. This study provides novel insights into the pathogenic mechanisms of S. mutans and potential strategies for the prevention and treatment of dental caries.

Oral microbiota is a highly complex and dynamic ecosystem whose composition is continuously reshaped by transmission events. Transmission occurs primarily through two routes: vertical transmission and horizontal transmission. Vertical transmission encompasses intergenerational processes such as childbirth and feeding, while horizontal transmission depends on close contact and cohabitation among individuals. This transmission network is influenced by various factors, including host genetics, physiological states, dietary patterns, smoking and alcohol consumption habits, oral hygiene status, and strain-specific phenotypes. The host plays a role by altering the oral microenvironment, modulating local immune responses, or imposing ecological selective pressures. Microbial phenotypes, including environmental tolerance, colonization capacity, and virulence, collectively dictate transmission potential and mode. In addition, this review outlines intervention strategies based on the microbial transmission network, including probiotics and engineered probiotics, prebiotics and synbiotics, bacteriophages, and oral microbiota transplantation. This review aims to systematically clarify the transmission mechanisms of oral microbiota, and to lay a theoretical foundation for the early prevention and targeted intervention of oral diseases.

The microbiota of the oral-gut axis influences systemic physical health, but the exact mechanisms remain unknown. In this study, magnetic supraparticles modified with polyacrylic acid and 3-azido-D-alanine hydrochloride (MSP@PAA-ADA) were constructed, and a magneto-fluorescence sequential labeling strategy was established for microbiota viability labeling in combination with a cyanine 5-labeled D-amino acid (Cy5ADA) fluorescent probe. MSP@PAA-ADA, with a particle size of approximately 160 nm, exhibited good hydrophilicity, high magnetic responsiveness, and low bacterial toxicity. MSP@PAA-ADA achieved efficient labeling of oral bacteria through interaction with peptidoglycan in bacterial cell walls. The experimental results indicated that MSP@PAA-ADA can be able to widely bind salivary microbiota, and the labeled salivary bacteria translocated along the oral-gut axis. A small amount of fluorescent signal could still be detected in the mice 36 h after gavage. MSP@PAA-ADA was employed as a magnetic probe for the in vitro labeling of oral bacteria, and sequential labeling was conducted using the fluorescent metabolic probe Cy5ADA. The oral bacteria labeled with MSP@PAA-ADA can be effectively magnetically separated after intestinal translocation through the gastrointestinal tract. The magnetically responsive and fluorescently imaged oral bacteria demonstrate their activity after intestinal translocation. The magneto-fluorescence sequential labeling strategy that enables controllable spatiotemporal tracing and simultaneous viability assessment of intestinal oral bacteria in the gut, providing a new technical approach for dissecting biological mechanisms along the oral-gut microbiota axis.

根管治疗是牙髓根尖周病治疗有效的首选方法,其成功率达到90％左右,初次治疗无效的患牙通过根管再治疗术获得的成功率为50％～80％.经非手术根管治疗无效的迁延不愈患牙,以往通过拔除患牙治疗颌骨病变.

Fibroblast growth factors (FGFs) form an evolutionarily conserved signaling system that governs embryonic patterning, tissue regeneration, and systemic metabolic homeostasis. Through coordinated interactions with fibroblast growth factor receptors (FGFRs) and context-specific cofactors, FGF signaling enables precise spatial and temporal control of cellular fate and interorgan communication. While canonical FGFs coordinate local tissue dynamics, endocrine members like FGF19, FGF21, and FGF23 function as systemic hormones to regulate bile acid, glucose, and phosphate metabolism. Despite rapid advances in understanding these pathways, a unified framework that integrates their structural diversity, complex regulatory mechanisms, and the contrasting roles they play in health and disease remains fragmented. In this review, we systematically summarize the classification, structural features, and receptor specificity of the FGF family, with particular emphasis on canonical, endocrine, and intracellular FGFs. We delineate canonical and non-canonical FGF signaling pathways and their multilayered regulation by heparan sulfate proteoglycans, Klotho coreceptors, and intracellular feedback mechanisms. Furthermore, we integrate emerging insights into the roles of FGFs in organ development, tissue repair, metabolic regulation, and disease pathogenesis. A core translational insight emphasized throughout is the therapeutic duality of targeting the FGF axis: harnessing FGF agonism for tissue regeneration and metabolic regulation, versus employing FGF antagonism to block oncogenic signaling in cancer. By providing an integrated and mechanistic overview, this review clarifies key knowledge gaps and establishes a conceptual foundation for future FGF-based therapeutic innovation.

Streptococcus mutans is considered the key contributor to human dental caries. The LuxS/AI-2 quorum‑sensing (QS) system in S. mutans plays a crucial role in the development of cariogenic oral biofilms. Many QS systems rely on regulation carried out by small RNAs (sRNAs) to achieve optimal performance. However, the identities and functions of sRNAs in S. mutans QS system are not well elucidated. Here, we identify two novel sRNAs named SmqsR2 and SmqsR4 (Streptococcus mutans quorum-sensing-related small RNA 2 and 4), which respond to luxS expression and support biofilm formation by mediating exopolysaccharides (EPS) synthesis. We showed that overexpression of SmqsR2 and SmqsR4 in S. mutans, respectively, resulted in declined growth rates, altered biofilm architecture, increased EPS production, and upregulated expression of gtfB/C/D genes. Transcriptome analysis revealed that several genes related to carbohydrate utilization were differentially expressed, with ccpA being markedly upregulated in both SmqsR2 and SmqsR4 overexpression strains. Specifically, SmqsRs promoted ccpA transcript, and CcpA triggered transcription of SmqsR2 and SmqsR4 via direct binding, thus forming a positive feedback loop. We speculate that SmqsRs augment LuxS-mediated biofilm matrix production, most likely through the activation of gtfB/C/D expression and the reprogramming of S. mutans central carbon metabolism by ccpA. In summary, we have confirmed that SmqsR2 and SmqsR4 function as supporting factors that maintain the optimal status of the LuxS/AI-2 system in S. mutans, which is important for cell growth, EPS synthesis, and biofilm formation. Hence, sRNA activity may represent a promising target to modulate S. mutans cariogenicity.

Root canal therapy is a prevalent dental procedure for treating pulp infections; however, its complexity due to the intricate variability of root canal anatomies frequently results in procedural errors, excessive tooth structure loss, and suboptimal outcomes, especially in multi-rooted teeth. Although Guided Endodontics enhances precision and predictability, it depends on manual planning using non-dedicated software, rendering the process labor-intensive, subjective, and confined to single-rooted teeth, thereby limiting broader adoption. In this study, we introduce EndoPlanner, an adaptive and pioneering framework that streamlines preoperative planning for Guided Endodontics solely from cone-beam computed tomography scans, seamlessly integrating automated dental segmentation, endodontic landmark detection, access cavity design, and surgical template generation. Specifically, we propose a unified bottom-up multi-peak encoding and graph-based decoding paradigm for root canal landmark localization and topology recognition, augmented by an anatomy-aware loss for targeted heatmap optimization and a self-supervised inference-time refinement strategy to bolster generalization across diverse root canal morphologies. Additionally, a tunable, geometry-guided algorithm is devised for automatic drill path planning, incorporating minimally invasive principles. Extensive evaluations affirm the superior performance and robustness of our method, yielding an average MRE of 0.767 mm, with SDRs of 74.9% within the strict 1.0 mm safety margin and 94.3% within the broader 2.0 mm tolerance for landmark localization, while attaining clinically acceptable standards for access planning. Deployed as a 3D Slicer extension, it completes preoperative preparation in an average of ∼4 min, reducing time by up to 96.05% relative to traditional workflows. Moreover, successful in-vitro experiments and clinical cases validate the efficacy of patient-specific access solutions facilitated by our efficient, reproducible, and minimally invasive planning schemes, highlighting their potential for routine practice, particularly among less-experienced practitioners.

Osteoporosis is a prevalent systemic skeletal disorder that leads to bone fragility and an elevated risk of fractures. Osteomodulin (OMD) is recognized for its essential role in bone morphogenetic protein 2 (BMP2)-driven osteogenic differentiation. However, its role in osteoporosis, has not been systematically investigated. Here, we carried out omics studies on osteoporotic data obtained from the NCBI database and showed that OMD is mainly expressed in osteoprogenitor cells and that OMD expression levels are down-regulated under bone loss conditions. OMD osteoblast-specific conditional knockout mice (OSTEOCALCIN-Cre (OC-Cre); Omdflox/flox) were generated by CRISPR and an ovariectomy (OVX)-induced model of osteoporosis was constructed in mice. Micro-CT of OVX mice indicated that the trabecular bone volume fraction (BV/TV) was significantly decreased in OC-Cre; Omdflox/flox mice. Tartrate resistant acid phosphatase (TRAP) staining showed an increase in the number of osteoclasts in the femurs of OC-Cre; Omdflox/flox mice. TRAP and immunofluorescence staining indicated that OMD treatment inhibited osteoclast differentiation of bone marrow-derived macrophages (BMDMs) in vitro. RNA sequencing showed that OMD treatment significantly affected osteoclast differentiation signaling pathways, while western blot analysis revealed that OMD treatment decreased the phosphorylation of JNK, ERK, p38, AKT, and IκBα in BMDMs. Molecular docking analysis predicted that OMD binds to receptor activator of nuclear factor kappa beta ligand (RANKL), which was verified by co-immunoprecipitation. Further molecular docking simulations indicated that OMD shares overlapping binding regions on RANKL with osteoprotegerin and RANK. Together, our findings indicate that OMD deficiency exacerbates bone loss in osteoporosis. Furthermore, OMD may impede osteoclastic differentiation in BMDMs by binding to RANKL.

Osteomodulin (OMD), a member of the small leucine-rich proteoglycan family, distributes in mineralized tissues and is positively regulated by bone morphogenetic protein 2 (BMP2). However, the exact function of OMD during mineralization and its association with BMP2 remain poorly understood. Herein, the expression pattern of OMD during osteogenesis was investigated in human dental pulp stem cells. Silencing OMD gene significantly suppressed the alkaline phosphatase activity, mineralized nodule formation and osteogenesis-associated gene transcription. Besides, OMD could enhance BMP2-induced expression of SP7 and RUNX2 with concentration dependence in vitro. Rat mandibular bone defect model revealed that scaffolds injected with the combination of OMD and suboptimal BMP2 exhibited more mature and abundant mineralized bone than that treated with OMD or suboptimal BMP2 alone. Mechanistically, OMD could bind to BMP2 via its terminal leucine-rich repeats and formed complexes with BMP2 and its membrane receptors, thus promoting BMP/SMAD signal transduction. In addition, OMD was a putative target gene of SMAD4, which plays a pivotal role in this pathway. Collectively, these data elucidate that OMD may act as a positive coordinator in osteogenesis through BMP2/SMADs signaling.

Objective To investigate the characteristics of salivary and supragingival plaque viromes in patients with metabolic dysfunction-associated fatty liver disease(MAFLD),and provide new insights for noninvasive oral screening and ecological intervention for MAFLD.Methods This study included 21 MAFLD patients and 20 healthy controls.Saliva and supragingival plaque samples were collected,and metagenomic sequencing was used to analyze the characteristics of the oral virome.Results The α-diversity and β-diversity of the salivary virome did not differ significantly between MAFLD patients and healthy individuals(P>0.05).However,compared with healthy individuals,the α-diversity(Shannon index)and β-diversity(Bray-Curtis distance)of the supragingival plaque virome showed significant differences(P=0.030 3,P=0.001).For species with a relative abundance greater than 0.1%,14 viral species in saliva and 5 in supragingival plaque differed significantly in relative abundance between the two groups(P<0.05),with multiple Streptococcus phages enriched in the saliva of MAFLD patients.LEfSe and random forest analyses identified potential biomarkers in saliva and supragingival plaque.Receiver operating characteristic(ROC)curve analysis showed strong diagnostic performance for these biomarkers in both saliva(area under the curve[AUC]=0.954 8,95%CI:0.889 8-1.000 0)and supragingival plaque(AUC=0.895 2,95%CI:0.777 4-1.000 0).Spearman correlation analysis revealed associations between viral species in saliva or supragingival plaque and various disease indicators(P<0.05).Compared with healthy individuals,MAFLD patients showed higher node counts,significant relationship numbers,and average node degrees in the co-occurrence networks of salivary and supragingival plaque viromes.Conclusion Differences in the species composition and structure of the oral virome between MAFLD patients and healthy individuals suggest that oral viral species could serve as potential biomarkers for diagnosing MAFLD.

Objectives: Well-qualified obturation, especially in the apical region, is the key to successful root canal treatment. The objective of the current study was to evaluate and compare the apical sealing ability of the calcium silicate–based root canal sealer nRoot SP with AH Plus and iRoot SP using both single-cone (SC) and continuous wave condensation (CWC) techniques. Methods: In total, 102 extracted human anterior teeth were decoronated and 12 mm of each root was preserved. After root preparation, the teeth were randomly divided into 6 groups of 17 teeth each: AH Plus with the SC technique, AH Plus with the CWC technique, iRoot SP with the SC technique, iRoot SP with the CWC technique, nRoot SP with the SC technique and nRoot SP with the CWC technique. The apical sealing ability of the teeth was measured by dye penetrant examination and scanning electron microscopy (SEM). The data were analysed using student’s t-test or one-way ANOVA with Tukey’s post hoc analysis for multiple comparisons. The results were considered statistically significant if P < .05. Results: nRoot SP and iRoot SP combined with both SC and CWC techniques demonstrated less apical dye leakages than did the AH Plus groups (P < .001). However, nRoot SP and iRoot SP showed similar apical dye leakages in both the SC and CWC subgroups (nRoot SP/SC and iRoot SP/SC groups (P = .673); nRoot SP/CWC and iRoot SP/CWC groups (P = .959)). Meanwhile, the apical dye leakages of the 3 sealers used within the SC and CWC subgroups were not statistically significant (AH Plus/SC and AH plus/CWC (P = .072); iRoot SP/SC and iRoot SP/CWC (P = .231); nRoot SP/SC and nRoot/CWC (P = .081)). In addition, the microgaps in both the nRoot SP and iRoot SP groups were much smaller than those in the AH Plus groups. Finally, the gap widths in the SC subgroups were slightly larger than those in the CWC subgroups. Conclusion: The apical sealing ability of nRoot SP is similar to that of iRoot SP with the SC and CWC techniques. nRoot SP and iRoot SP demonstrate better apical sealing ability than AH Plus with the SC and CWC techniques.

Pulpitis is a common infective oral disease in clinical situations. The regulatory mechanisms of immune defense in pulpitis are still being investigated. Osteomodulin (OMD) is a small leucine-rich proteoglycan family member distributed in bones and teeth. It is a bioactive protein that promotes osteogenesis and suppresses the apoptosis of human dental pulp stem cells (hDPSCs). In this study, the role of OMD in pulpitis and the OMD-induced regulatory mechanism were investigated. The OMD expression in normal and inflamed human pulp tissues was detected via immunofluorescence staining. Intriguingly, the OMD expression decreased in the inflammatory infiltration area of pulpitis specimens. The cellular experiments demonstrated that recombined human OMD could resist the detrimental effects of lipopolysaccharide (LPS)-induced inflammation. A conditional Omd knockout mouse model with pulpal inflammation was established. LPS-induced inflammatory impairment significantly increased in conditional Omd knockout mice, whereas OMD administration exhibited a protective effect against pulpitis. Mechanistically, the transcriptome alterations of OMD overexpression showed significant enrichment in the nuclear factor-κB (NF-κB) signaling pathway. Interleukin-1 receptor 1 (IL1R1), a vital membrane receptor activating the NF-κB pathway, was significantly downregulated in OMD-overexpressing hDPSCs. Additionally, the interaction between OMD and IL1R1 was verified using co-immunoprecipitation and molecular docking. In vivo, excessive pulpal inflammation in Omd-deficient mice was rescued using an IL1R antagonist. Overall, OMD played a protective role in the inflammatory response via the IL1R1/NF-κB signaling pathway. OMD may optimize the immunomodulatory functions of hDPSCs and can be used for regenerative endodontics.

Pulpotomy, which belongs to vital pulp therapy, has become a strategy for managing pulpitis in recent decades. This minimally invasive treatment reflects the recognition of preserving healthy dental pulp and optimizing long-term patient-centered outcomes. Pulpotomy is categorized into partial pulpotomy (PP), the removal of a partial segment of the coronal pulp tissue, and full pulpotomy (FP), the removal of whole coronal pulp, which is followed by applying the biomaterials onto the remaining pulp tissue and ultimately restoring the tooth. Procedural decisions for the amount of pulp tissue removal or retention depend on the diagnostic of pulp vitality, the overall treatment plan, the patient’s general health status, and pulp inflammation reassessment during operation. This statement represents the consensus of an expert committee convened by the Society of Cariology and Endodontics, Chinese Stomatological Association. It addresses the current evidence to support the application of pulpotomy as a potential alternative to root canal treatment (RCT) on mature permanent teeth with pulpitis from a biological basis, the development of capping biomaterial, and the diagnostic considerations to evidence-based medicine. This expert statement intends to provide a clinical protocol of pulpotomy, which facilitates practitioners in choosing the optimal procedure and increasing their confidence in this rapidly evolving field.

Instrument separation is a critical complication during root canal therapy, impacting treatment success and long-term tooth preservation. The etiology of instrument separation is multifactorial, involving the intricate anatomy of the root canal system, instrument-related factors, and instrumentation techniques. Instrument separation can hinder thorough cleaning, shaping, and obturation of the root canal, posing challenges to successful treatment outcomes. Although retrieval of separated instrument is often feasible, it carries risks including perforation, excessive removal of tooth structure and root fractures. Effective management of separated instruments requires a comprehensive understanding of the contributing factors, meticulous preoperative assessment, and precise evaluation of the retrieval difficulty. The application of appropriate retrieval techniques is essential to minimize complications and optimize clinical outcomes. The current manuscript provides a framework for understanding the causes, risk factors, and clinical management principles of instrument separation. By integrating effective strategies, endodontists can enhance decision-making, improve endodontic treatment success and ensure the preservation of natural dentition.

MUC7, a highly glycosylated protein in saliva and respiratory tract, plays potential roles in facilitating bacterial clearance and preventing microbial invasion. The complexity of glycan structures and multiplicity of glycosylation sites of MUC7 make it very difficult to explore accurate biofunctions against pathogens. Here, we report an efficiently convergent chemoenzymatic approach to firstly synthesize highly O-glycosylated MUC7 glycopeptides with nine glycosylation sites bearing various glycoforms via the combined use of hydrophobic tag-assisted liquid-phase peptide synthesis and enzymatic-catalyzed glycan elongation. Biological evaluations reveal that different glycoforms of synthetic MUC7 glycopeptides mediate unique activities against biofilm formation of Pseudomonas aeruginosa, among which sialylated MUC7 glycopeptide exhibits better inhibitory activity and has the potential to develop antibacterial drugs.

INTRODUCTION:Jaw cystic lesions are common oral and maxillofacial conditions that may affect teeth and important anatomical structures. Decompression and 2-stage curettage are widely used treatments for this condition. This study aims to compare the pulp vitality of affected teeth in patients with jaw cystic lesions before and after decompression and 2-stage curettage, thereby clarifying the impact on the pulp vitality of the involved teeth. METHODS:Thirty patients diagnosed with cystic lesions of the jawbone underwent decompression followed by 2-stage curettage treatment. The pulp vitality of the affected teeth was assessed using an electric pulp test before decompression, 3 months after decompression, and 3 months after curettage. RESULTS:Among 102 teeth from 30 patients initially included in the study, 79 teeth from 24 patients were analyzed after excluding patients lost to follow-up. Before decompression, 64 (81.01%) and 15 (18.99%) teeth showed positive and negative pulp responses, respectively, compared with 69 (87.34%) and 10 (12.66%) teeth 3 months after decompression. After curettage, 68 teeth (86.08%) showed positive pulp responses, while 11 (13.92%) showed negative pulp responses. CONCLUSION:Decompression not only preserves natural teeth but also helps maintain pulp vitality. A comprehensive evaluation of the affected teeth is recommended before surgery for jaw cystic lesions, and root canal treatment should not be initiated hastily.

INTRODUCTION:This study aimed to diagnose vertical root fracture (VRF) of endodontically treated teeth using clinical features and bone loss information from cone beam computed tomography with machine learning models. METHODS:A total of 887 patients with 941 teeth undergoing endodontic surgery were included in this retrospective study. The clinical factors and bone defects detected via cone beam computed tomography were measured and recorded. Linear machine learning models, logistic regression model and nonlinear models, including XGBoost, LightGBM, and CatBoost were used to diagnose VRF. Model performance was evaluated using 5-fold cross-validation and based on various performance parameters, including the area under the curve, sensitivity, specificity, precision, and F score. Model interpretations were visualized by Shapley Additive Explanations. RESULTS:Of the 941 teeth, 112 VRF teeth (11.9%) were identified during endodontic surgery or after tooth extraction. XGBoost and LightGBM showed excellent performance with area under the curves of 0.98 [0.96, 0.99], specificity of 0.978 and 0.983, sensitivity of 0.883 and 0.803, and precision of 0.846 and 0.865, respectively. Shapley Additive Explanations values showed that lingual/buccal bone defect, the ratio of bone defect height above the root apex to the defect total height, width of bone defect and age were the top 5 contributors. CONCLUSIONS:Machine learning models for the diagnosis of VRF using age, sex, tooth type, the quality of root canal filling and bone loss position, height, width, and depth are valuable for clinical decision making after root canal treatment.