UNASSIGNED: The purpose of this study was a retrospective cross-sectional study of the Polish subpopulation, performed to evaluate the quality of endodontic treatment (ET) and the condition of the periapical tissues of permanent teeth based on cone-beam computed tomography (CBCT) images.
UNASSIGNED: The retrospective study included a group of patients who underwent CBCT at the University Dental Clinic of the Pomeranian Medical University in Szczecin. An endodontically treated tooth index (ETTI) was used to evaluate ET. Once apical periodontitis was recognised, the size, extent, and ratio of adjacent anatomical structures were assessed using the complex periapical index (COPI).
UNASSIGNED: Analysis of the CBCT images showed that ET was performed in 9.9% of the teeth examined, of which 52.7% of the canals were treated correctly, while 28.1% of the root canals were found to be underfilled, 6.8% were overfilled, 9.3% of the root canals were not obturated at all, and in 3.1% of the teeth examined, the filling material was only visible in the pulp chamber. Apical periodontitis was observed in 6% of all teeth examined, while the percentage of teeth following ET was 38.5%.
UNASSIGNED: The quality of the ET provided to the Polish subpopulation is unsatisfactory. Lack of root canal filling homogeneity is a significant risk factor for ET failure. Improper ET and poor quality of crown restoration after ET have an impact on the increased risk of occurrence, size, degree of root coverage, and extent of inflammatory periapical lesions in relation to adjacent anatomical structures.

BACKGROUND: Regenerative endodontic procedures (REPs) is effective for treating young permanent teeth with pulp necrosis. However, its efficacy on delayed replanted avulsed teeth is unclear.
OBJECTIVE: This retrospective study aimed to assess the efficacy of REPs in treating delayed replanted immature permanent teeth with apical periodontitis.
METHODS: Avulsed teeth receiving REPs were systematically screened based on predetermined criteria. This study assessed the REP outcomes, postoperative periodontal healing, and overall treatment efficacy. Samples were grouped by REP outcomes and root development stage, with Fisher\'s exact tests used to compare outcomes among different groups.
RESULTS: Among the included 17 teeth, 47.1% exhibited successful REPs and periodontal healing. Another 47.1%, due to replacement resorption or REP failure, were categorized as tooth survival. Healing of periapical lesions was observed in 88.2% of the cases, but only 41.2% demonstrated continued root development. Although differences were not significant (p = 0.05), teeth with continued root development had a higher rate of functional healing (85.7%) compared to those without (30%).
CONCLUSIONS: Within the limitations of this study, REPs presented reliable outcomes for treating delayed replanted immature permanent teeth with apical periodontitis mainly in periapical lesion healing. Teeth with continued root development after REPs exhibited a higher rate of functional healing. Further investigation is required to explore potential synergies between REP outcomes and periodontal healing.

OBJECTIVE: To evaluate M1 and M2 macrophage polarization in radicular cysts and periapical granulomas through an immunohistochemical analysis and the correlation between macrophage polarization and histopathological diagnosis, clinical characteristics and lesion volume using cone-beam computed tomography.
METHODS: Periapical biopsies diagnosed as radicular cysts (n = 52) and periapical granulomas (n = 51) were analysed by immunohistochemical method. Teeth with periapical lesion with no history of root canal treatment (primary lesion) and lesions persistent to root canal treatment (persistent lesions) were included. Pathological diagnosis, patients\' age, gender and clinical characteristics were obtained from treatment records. A cone-beam computed tomographic periapical volume index (CBCTPAVI) score was assigned to each periapical lesion based on the volume of the lesion. Immuno-expressions of CD68 and CD163 were quantified. The CD68/CD163 ratio was adopted to represent M1 or M2 macrophage polarization. Mann-Whitney U test was used to determine the different CD68/CD163 ratio between groups of radicular cyst and periapical granuloma. Spearman\'s correlation test was performed to assess the correlation between the CD68/CD163 ratio and lesion volume and CBCTPAVI score.
RESULTS: Radicular cysts and periapical granulomas had CD68/CD163 median of 2.05 (IQR = 1.33) and 1.26 (IQR = 0.81), respectively. A significantly higher CD68/CD163 ratio was observed in radicular cysts (p < .001). In contrast, periapical granulomas had significantly lower median of CD68/CD163 ratio. Larger lesions had a higher median of CD68/CD163 ratio, while smaller lesions had lower median of CD68/CD163 ratio (p = .007, rs = .262). CD68/CD163 ratio was significantly correlated with the CBCTPAVI score in the overall periapical lesions (p = .002, rs = .306). The higher CD68/CD163 ratio in larger lesions indicated a higher degree of M1 polarization compared to smaller lesions. Regarding the pathological diagnosis, there was a significant positive correlation between CBCTPAVI score and CD68/CD163 ratio in periapical granulomas (p < .001, rs = .453), whereas the negative correlation was observed for radicular cysts (p < .001, rs = -.471).
CONCLUSIONS: Periapical granulomas are characterized by a M2-dominant macrophage polarization, while radicular cysts have significantly higher M1 macrophages. The higher degree of M1 macrophage polarization was significantly correlated with larger volume and higher CBCTPAVI scores of overall periapical lesion and periapical granuloma.

Aim This study aimed to assess the impact of positive pressure, negative pressure (EndoVac), and sonic-activated irrigation (EndoActivator) on postoperative pain with symptomatic irreversible pulpitis and symptomatic apical periodontitis. The hypothesis tested the superiority of negative pressure irrigation in reducing pain and analgesic requirements. Methodology Forty-eight eligible patients meeting inclusion criteria were enrolled, ensuring comprehension through verbal and written patient information sheets. The sample size calculation, based on prior data, determined 14 teeth per group with consideration for potential dropouts, resulting in 16 teeth per group. Inclusion criteria included healthy individuals aged 16-65 years with single-rooted teeth diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis, while exclusion criteria comprised recent analgesic intake, pregnancy, lactation, and specific dental conditions. Participants were allocated to three groups using computer-generated block randomization with allocation concealment via sequentially numbered opaque sealed envelopes. While blinding of the operator was not feasible, patient and assessor blinding was ensured. Preoperative data collection included patient demographics, tooth details, and pain intensity assessed on a Visual Analogue Scale (VAS). Root canal therapy procedures, conducted in two visits, included instrumentation and irrigation using 3% NaOCl across three groups: positive pressure irrigation, negative pressure irrigation, and sonic activation. Postoperative pain and analgesic intake were evaluated using VAS at specific intervals. One assessor tabulated and analyzed all the information. Results Postoperative pain assessments revealed that the EV group experienced the lowest pain levels, followed by the EA and SVN groups, with significant differences observed at six and 24 hours postoperatively (p < 0.05). Analgesic requirements correlated with pain levels, with the SVN group requiring the most analgesics and the EV group the least, highlighting the efficacy of the interventions. Conclusions Negative pressure irrigation (EndoVac) significantly reduced postoperative pain compared to conventional side-vented needle irrigation. These findings enhance understanding and guide evidence-based recommendations for optimizing endodontic procedures and prioritizing patient comfort and outcomes.

BACKGROUND: This study reported on the outcome of the nonsurgical root canal treatment/retreatment of teeth with large apical periodontitis lesions. The influence of some variables on the prognosis was also evaluated.
METHODS: The study included 199 teeth with large apical periodontitis lesions from 184 patients, treated/retreated by a single operator. Most teeth were managed in a single visit using NaOCl irrigation. Cases were followed up periodically from >1 to 8 years. Treatment/retreatment outcome was evaluated by clinical and radiographic/tomographic criteria and categorized as healed, healing, or diseased. For statistical analysis, data were dichotomized in such a way that healing cases were considered as success in a loose criterion or failure in a rigid one.
RESULTS: Clinical/radiographic analyses revealed that 67% of the initial treatment cases were classified as healed, 22.5% as healing, and 11% as diseased. Treatment success rates were 89% (loose) and 67% (rigid). Variables that influenced the treatment outcome included previous abscess and antibiotic use, very large lesions (≥10 mm), and a sinus tract. The median follow-up time for treatment was 31.5 months. As for retreatment cases, 47% were healed, 32% were healing, and 21% were diseased. Retreatment success rates were 79% (loose) and 47% (rigid), in a median follow-up of 32 months. Cases evaluated by cone-beam computed tomography had lower healed rates.
CONCLUSIONS: Findings demonstrate that high favorable outcome rates can be achieved by nonsurgical root canal treatment or retreatment of teeth with large apical periodontitis lesions.

OBJECTIVE: The purpose of this prospective study was to evaluate the incidence and intensity of postoperative pain in oncological patients with infected teeth subjected to nonsurgical root canal treatment or retreatment.
METHODS: Teeth with apical periodontitis from healthy control patients and oncological patients (n = 70 per group) were root canal treated/retreated and evaluated for the development of postoperative pain. Patients from the two groups were matched for tooth type, gender, clinical manifestation of apical periodontitis, and intervention type. A visual analogue scale (VSA) was used to evaluate the incidence of postoperative pain at 24 h, 72 h, 7d, and 15d after chemomechanical procedures. Data were statistically analyzed for the incidence and intensity of postoperative pain in the two groups.
RESULTS: Preoperative pain occurred in 10% of the individuals and in all these cases pain showed a reduction in intensity or was absent after endodontic intervention at 24-h evaluation. The overall incidence of postoperative pain at 24 h was 14% in oncology patients and 30% in controls (p = 0.03). At 72 h, the respective corresponding figures were 4% and 8.5% (p > 0.05). At 7 and 15 days, all patients were asymptomatic, irrespective of the group.
CONCLUSIONS: No significant differences in postoperative pain were found between control and oncological patients. The low incidence of postoperative pain observed in both groups supports the routine use of nonsurgical root canal treatment/retreatment as valid options in oncological patients.
CONCLUSIONS: Oncological patients had no increased risk of postoperative pain in comparison with control patients.

OBJECTIVE: The present study investigated the influence of apical periodontitis (AP) on the severity of rheumatoid arthritis (RA) using a Wistar rat model.
METHODS: Forty male Wistar rats were distributed across four groups (n = 10) based on the induction of RA and AP: Control, RA, AP, and RA + AP. RA was induced through two immunisations with type II collagen emulsified in incomplete Freund\'s adjuvant, followed by one immunisation with complete Freund\'s adjuvant. After 21 days of RA induction, AP was induced by exposing the pulp of four molars. Animals were euthanized after 28 days of pulp exposure. Through the experiment, visual and behavioural assessments tracked RA development and the knees and hind paw joints were measured. Micro-computed tomography scans of knees and hind paws, as well as mandibles and maxillae, were conducted to evaluate RA severity and the presence of AP, respectively. Serum samples were collected to analyse proinflammatory cytokines (IL-1β, IL-2, IL-17, and TNF-α). Non-parametric data were analysed using the Kruskal-Wallis test followed by Student-Newman-Keuls test, while one-way anova followed by Tukey\'s test was performed for parametric data. A significance level of 5% was employed.
RESULTS: All molars submitted to access cavity developed AP. All joints subjected to arthritis induction developed the disease, with AP + RA demonstrating a higher arthritis severity when compared to the RA group (p < .05). RA + AP group displayed a significantly larger hind paw and knee circumference compared to the RA group (p < .05). Micro-CT images of RA and RA + AP groups revealed joints with erosions and bone deformities, with a significantly lower bone surface density, lower trabecular number and higher trabecular separation in the hind paw and a significantly lower percent bone volume and higher trabecular separation in the knees of RA + AP group compared to RA group (p < .05). RA + AP group exhibited a significantly higher level of TNF-α and a lower level of IL-2 compared to all other groups (p < .05). Both RA and RA + AP groups had significantly higher IL-17 levels (p < .05), while there was no significant difference in IL-1β levels among the groups (p > .05).
CONCLUSIONS: The findings from this study underscore a possible relationship between apical periodontitis and the exacerbation of rheumatoid arthritis.

UNASSIGNED: This study aims to assess the effect of apical foraminal enlargement on inflammatory markers and pain in patients with asymptomatic single-rooted mandibular teeth with apical periodontitis.
UNASSIGNED: The study included 60 patients based on inclusion and exclusion criteria. Before beginning root canal treatment (RCT), a blood sample was obtained from the antecubital fossa to evaluate the inflammatory markers, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Access opening was done and initial irrigation was done. Working length (WL) was determined with an electronic apex locator and verified with a radiograph. In the control group, the determined WL was maintained, while in the experimental group, the WL was set till the apical foramen. Biomechanical preparation was done in both groups till F2 or F3 based on the initial apical file, followed by final irrigation and obturation based on the master apical file size. Patients were given a Visual Analog Scale to record pain sensations at 24, 48, and 72 h postoperative. After 72 h, patients were recalled for follow-up appointments, and blood was taken from the antecubital fossa again to evaluate inflammatory markers.
UNASSIGNED: The resultant findings for the reduction in inflammatory markers before and after RCT with or without foraminal enlargement were statistically analyzed using the Student\'s t-test. The pain was statistically examined with one-way \"analysis of variance\" and Tukey\'s post hoc test for inter-group comparison of pain. The level of significance was set at P < 0.05. The statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 23 for Windows (SPSS Inc., Chicago, IL, USA). As pain in the control groups is zero before and after RCT, statistical analysis is not required as the overall pain score is zero.
UNASSIGNED: The P values of the CRP and ESR of the control group were 0.02 and 0.03, respectively, which indicates it is significant whereas the P values of the ESR and CRP of the experimental group were 0.0002 and 0.0008 which indicates it is highly significant. Results indicate that the experimental group is more effective compared to the control group in reducing inflammatory markers. Pain in the control group after RCT was zero at the end of 24, 48, and 72 h. In the experimental group, where RCT was done with apical foraminal enlargement, mild pain was present at the end of 24 h which gradually decreased at the end of 48 h and no pain was reported at the end of 72 h.
UNASSIGNED: Reduction in inflammatory markers was more effective in RCT with apical enlargement than without apical enlargement. RCT with apical enlargement caused mild pain in the patients immediately after treatment which gradually decreased over time.

UNASSIGNED: This study aimed to evaluate and compare postoperative pain (PP) in single-visit nonsurgical endodontic retreatment (SV NSER) with 2% chlorhexidine (CHX), 0.1% octenidine (OCT) with or without ozone, and 5.25% sodium hypochlorite (NaOCl).
UNASSIGNED: In this randomized, parallel, prospective, double-blind, clinical trial, 132 single-rooted, root-filled teeth with symptomatic apical periodontitis (AP) requiring NSER were allocated into six groups randomly (n = 22/group): 2% CHX with NaOCl (CHXH), 2% Ozonated CHX without NaOCl (OCHX), 2% Ozonated CHX with NaOCl (OCHXH), 0.1% OCT with NaOCl (OCTH), 0.1% Ozonated OCT without NaOCl (OOCT), and 0.1% Ozonated OCT with NaOCl (OOCTH). Standard NSER protocol was followed groups were irrigated with 15 ml of ozonated or nonozonated irrigant (CHX/OCT) for 3-5 min with ultrasonic agitation. PP at baseline, after 6, 12, 24, 48 h, and 7 days was recorded using the Visual Analog Scale (VAS). Logistic regression of predictor variables was compared using the Chi-square test. For group-wise and time-wise comparisons, a two-way analysis of variance followed by the post hoc Bonferroni test was carried out.
UNASSIGNED: None of the patient-related variables in logistic regression obtained a statistically significant (P > 0.05) role in PP. The VAS score after 6 h was OCHX (4.72) > OOCT (4.42) > CHXH (4.23) > OCTH (3.95) > OCHXH (3.42) > OOCTH (3.21). OOCTH and OCHXH groups demonstrated statistically significant reductions in VAS scores at various time intervals (P < 0.05).
UNASSIGNED: SV NSER with ozonated OCT, CHX irrigation, and NaOCl resulted in lesser PP at all time intervals, i.e., 6, 12, 24, 48 h, and 7 days in patients with symptomatic AP.

A high prevalence of post-treatment apical periodontitis associated to variables such as endodontic treatment quality and missed canals has been reported.
OBJECTIVE: The aim of this study was to evalúate the quality of endodontic treatment and the frequency of missed canals associated with teeth with apicalperiodontitis (AP) through CBCTin a Colombian sub-population.
METHODS: This was a cross-sectional study assessing 318 cone beam computed tomography (CBCT) scans of endodontically treated teeth from Colombian individuals. The scans were taken using J Morita X550 (J Morita Corporation, Osaka, Japan), with voxel size 0.125 to 0.20 mm. All endodontically treated teeth were assessed for quality of treatment, presence of missed canals and AP. Allsamples were analyzed bytwo endodontics specialists and an radiology specialist. Chi-square or Fisher \'s test and odds ratio were calculated to identify the association and risk relationship between the presence of AP and the study variables.
RESULTS: Missed canals were found in 18.61% (86/462), and 95.3% were associated with AP. The frequency of AP was 62.34% (288/462) for all the evaluated teeth. AP was found in 27.43 % (79/288) of the teeth with adequate endodontic treatment, in contrast to 72.57% (209/288) of the teeth with inadequate treatment (P<0.01). The frequency of missed canals was highest in maxillary molars, with 55.23% (58/105), with 96.55% presenting AP. The second mesiobuccal canal wasthe most frequently missed canal, 88.52%o(54/61), with AP in 90.74% (49/54) of the cases.
UNASSIGNED: There was a high frequency of teeth with missed canals and PA. More than half of the teeth with missed canals were maxillary molars, with MB2 being the most common canal, commonly presenting apical periodontitis.
Uma alta prevalência de periodontite apical pós-tratamento associada a variáveis como qualidade do tratamento endodôntico e fracasso do tratamento é relatada na literatura. O objetivo deste estudo foi avaliar a qualidade do tratamento endodôntico e a frequência e fracasso do tratamento associados a dentes com periodontite apical (PA) por meio de tomografia computadorizada de feixe cônico (TCFC) em uma subpopulação colombiana.
UNASSIGNED: Este foi um estudo transversal que avaliou 318 tomografias computadorizadas de dentes tratados endodonticamente de indivíduos colombianos. Os exames foram realizados utilizando o tomógrafo J Morita X550, com tamanho de voxel de 0,125 a 0,20 mm. Todos os dentes tratados endodonticamente foram avaliados quanto à qualidade do tratamento, presença de canais não localizados e AP. Todas as amostras foram avaliadas por dois especialistas em endodontia e um especialista em radiologia. Foram calculados o teste qui-quadrado ou de Fisher e a razão de chances para identificar associação e relação de risco entre a presença de PA e as variáveis do estudo.
RESULTS: Foram encontrados canais não localizados em 18,61% (86/462) e 95,3% estavam associados à PA. A frequência de AP foi de 62,34% (288/462) para todos os dentes avaliados. AP foi encontrada em 27,43% (79/288) dos dentes com tratamento endodôntico adequado, em contraste com 72,57% (209/288) dos dentes com tratamento inadequado (P<0,01). A frequência de canais não localizados foi maior nos molares superiores, com 55,23% (58/105), sendo que 96,55% apresentavam PA. O canal mésio-palatino (MB2) apresentou maior frequência de canal não localizado (88,52% - 54/61), com PA em 90,74% (49/54) dos casos.
UNASSIGNED: Houve alta frequência de dentes com canais não localizados e com PA. Mais da metade dos dentes com canais não localizados eram molares superiores, sendo o MB2 é o canal com a maior frequência, comumente apresentando periodontite apical.