As periodontal and endodontic tissues have a close association, they come into close touch and have a lot of possible places for communication. In a clinical setting, this correlation promotes infection spread and results in the typical endo-perio lesion appearance. Because the two tissues are in close touch with one another, managing such lesions can be difficult. The success of treatment depends on a thorough examination and careful planning, with the sole focus on repair and regeneration. In these situations, bone graft materials with such characteristics have demonstrated encouraging outcomes. The treatment outcome along with a follow-up for a case of an endo-perio lesion with furcation involvement is shown in the accompanying case report. In treating such instances, a multidisciplinary approach is necessary, emphasizing regeneration.

This case report documents the diagnosis and successful management of a substantial periapical lesion located in the lower left region of the jaw. The patient presented with clinical symptoms indicative of periapical pathology, and radiographic examination revealed an extensive radiolucent lesion. The chosen treatment approach involved endodontic intervention coupled with surgical decompression, leading to the resolution of the lesion and restoration of oral health. This case underscores the significance of an accurate diagnosis and a multidisciplinary treatment approach in addressing large periapical lesions.

OBJECTIVE: The purpose of this systematic review was to appraise the existing literature on the effect of hard tissue defects on the clinical outcome of endodontic microsurgery (EMS).
METHODS: MEDLINE (PubMed), Embase, Web of Science, Cochrane Library and grey literature were searched from January 2000 to May 2023. Study selection and data extraction were performed in duplicate. Eligible studies were critically appraised for the risk of bias using the Cochrane Risk of bias tool. The quality of evidence was assessed using GRADE. Review Manager (RevMan Computer program Version 5.4, The Cochrane Collaboration, 2020) was utilized and the Mantel Haenszel fixed or random effects model was applied, depending on the heterogeneity of the studies. Meta-analysis was performed to estimate the Risk ratio (RR) and 95% Confidence Interval (CIs) to correlate the effects of these factors on treatment outcomes.
RESULTS: Nineteen studies were included. The EMS overall pooled success rate was 84.5%. Five characteristics of hard tissue were identified. The size of the lesion (Small ≤ 5 mm: 78.4% vs. Large > 5 mm: 63.3%, RR = 1.12, 95% CI 1.00-1.26, P ≤ .05), significantly affected the outcomes of EMS. Endodontic lesions exhibited slightly better outcomes than endodontic-periodontal lesions (81.4% vs. 68.2%, RR = 1.14 95% CI 0.98-1.33, P > .05). Cases with the height of the buccal bone > 3 mm also exhibited slightly better outcomes (91.5% vs. 71.4%, RR = 1.20, 95% CI 0.88-1.62, P > .05). Additionally, through and through lesions exhibited better outcomes when grafting was completed during the EMS procedure both in 2D (RR = 1.12 95% CI 0.97-1.29, P > .05) and 3D evaluation ((RR = 1.28 95% CI 0.69-2.37 P > .05). The overall quality of evidence was graded as low to high.
CONCLUSIONS: With a low to high quality of evidence, the size of the lesion is a key prognostic variable that significantly affects the outcome of EMS, as lesions ≤ 5 mm exhibit better outcomes as compared to larger lesions.
CONCLUSIONS: The presence of hard tissue defects can affect the outcome of endodontic microsurgery (EMS). The presented data can aid the clinicians\' decision-making process by examining certain pre-operative prognostic variables, when considering EMS as a treatment option. Clinical cases with more favorable hard tissue characteristics lead to a better prognosis in EMS.

Extrusion of root filling material had been shown to reduce the success of endodontic treatment. This case report describes the management of a patient who reported prolonged, persistent, and increasing pain on an upper root filled central incisor with extruded root filling material. A 28-year-old female patient came with the chief complaint of pain and tenderness on the upper left central incisor. The pain was mostly triggered by mastication. Upon examination and investigation, the tooth of concern was tooth 21 which was a root treated many years ago. It appeared to have tenderness on percussion and palpation. Non-surgical root canal retreatment was completed on tooth 21. However, the patient complained of the same pain while biting even after six months post-obturation. Therefore, endodontic microsurgery was performed to remove the root filling material that was extruded and to enucleate the granulomatous lesion around the periapical region of tooth 21. After enucleation, apical root end resection was performed. Postoperatively, the patient reported comfort and no pain and was able to resume her daily activities. At six months of review, the radiograph showed evidence of complete healing. This case report captured the importance of endodontic microsurgery as a viable treatment option where nonsurgical root canal retreatment failed to relieve the patient\'s symptoms.

BACKGROUND: The outcome of endodontic treatment is generally assessed using a range of patient and clinician-centred, non-standardised clinical and radiographic outcome measures. This makes it difficult to synthesise evidence for systematic analysis of the literature and the development of clinical guidelines. Core outcome sets (COS) represent a standardised list of outcomes that should be measured and reported in all clinical studies in a particular field. Recently, clinical researchers and guideline developers have focussed on the need for the integration of a patient-reported COS with clinician-centred measures. This study aims to develop a COS that includes both patient-reported outcomes and clinician-centred measures for various endodontic treatment modalities to be used in clinical research and practice.
METHODS: To identify reported outcomes (including when and how they are measured), systematic reviews and their included clinical studies, which focus on the outcome of endodontic treatment and were published between 1990 and 2020 will be screened. The COSs will be defined by a consensus process involving key stakeholders using semi-structured interviews and an online Delphi methodology followed by an interactive virtual consensus meeting. A heterogeneous group of key \'stakeholders\' including patients, general dental practitioners, endodontists, endodontic teachers, clinical researchers, students and policy-makers will be invited to participate. Patients will establish, via interactive interviews, which outcomes they value and feel should be included in a COS. In the Delphi process, other stakeholders will be asked to prioritise outcomes identified from the literature and patient interviews and will have the opportunity at the end of the first round to add outcomes that are not included, but which they consider relevant. Feedback will be provided in the second round, when participants will be asked to prioritise the list again. If consensus is reached, the remaining outcomes will be discussed at an online meeting and agreement established via defined consensus rules of outcome inclusion. If consensus is not reached after the second round, a third round will be conducted with feedback, followed by the online meeting. Following the identification of a COS, we will proceed to identify how and when these outcomes are measured.
CONCLUSIONS: Using a rigorous methodology, the proposed consensus process aims to develop a COS for endodontic treatment that will be relevant to stakeholders. The results of the study will be shared with participants and COS users. To increase COS uptake, it will also be actively shared with clinical guideline developers, research funders and the editors of general dental and endodontology journals.
BACKGROUND: COMET 1879. 21 May 2021.

Adequate hemostasis is a critical step in endodontic surgery. It facilitates the procedure and affects the success and prognosis of the operation. This systematic review and network meta-analysis (NMA) aimed to systematically assess the efficacy of hemostatic agents in endodontic surgery and to identify the most effective ones.
PubMed, Scopus, Embase, Cochrane Library, Web of Science, ProQuest, and EBSCOhost databases were searched up to December 2020. We included randomized controlled trials (RCTs) evaluating the efficacy of different hemostatic measures in endodontic surgery, and their risk of bias was assessed using Cochrane\'s randomized trial tool (RoB 2.0). Frequentist network meta-analysis was conducted, with Odds Ratios and 95% confidence intervals (OR, 95% CI) as effect estimates using the \"netmeta\" package in R. The quality of evidence was assessed using the CINeMA approach.
Six RCTs involving 353 patients (mean age 48.12 y) were included. NMA revealed that aluminum chloride achieved higher hemostatic efficacy than epinephrine (OR = 2.55, 95% CI [1.41, 4.64]), while there was non-significant difference when compared with PTFE strips + epinephrine (OR = 1.00, 95% CI [0.35, 2.90]), electrocauterization (OR = 2.67, 95% CI [0.84, 8.46]), or ferric sulfate (OR = 8.65, 95% CI [0.31, 240.92]). Of all hemostatic agents, aluminum chloride ranked first in control bleeding during endodontic surgery (P-score = 0.84), followed by PTFE strips + epinephrine (P-score = 0.80), electrocauterization (P-score = 0.34), epinephrine (P-score = 0.34), ferric sulfate (P-score = 0.18). The quality of evidence was very low.
Based on the limited data, aluminum chloride provides better hemostasis than epinephrine, while there was no significant difference between the remaining hemostatic agents used in endodontic surgery, which could help clinicians choose the hemostatic agent that achieves adequate hemostasis. achieve adequate hemostasis. Given insufficient evidence, future RCTs addressing this evidence gap are required.

BACKGROUND: The aim of this study was to investigate the influence of apical filling material and the modification made to the apical preparation design in surgical endodontics on the areas of stress concentration in the mesial root of a mandibular molar using finite element analysis.
METHODS: The filling material was injected under 2 conditions (ie, with or without mineral trioxide aggregate retrograde filling). The apical preparation design was modified by extending the preparation mesially while maintaining a similar prepared area. We contained the displacement of all the nodes at the base of the supporting bone and applied a force of 150 N to the vertical axis. We analyzed stress generation and concentrations numerically for all cavity design groups.
RESULTS: In the presence of retrograde filling, the von Mises stress decreased gradually according to the enlargement of the prepared cavity in the subgroups. When the retrograde filling was absent, the von Mises stress increased as the prepared cavity enlarged. The modification of the apical preparation extending in the mesial direction showed a drastic decrease in stress concentration.
CONCLUSIONS: Within the limitations of this study, it was advantageous to perform mesial retrograde preparation within the mesial root dentin to maintain a balanced root dentin on both sides of the apical preparation and create a low-stress field. The surgeon should be careful not to wash out or dislodge the retrograde filling material during obturation to avoid failure of surgery.

OBJECTIVE: This systematic review was undertaken to determine the oral health-related quality of life (OHRQoL) before and after endodontic treatment.
METHODS: Based on the PRISMA guidelines, electronic databases (n = 7) were searched and from 1038 citations, 16 papers were included in this review. Information on study design, sample size, intervention/treatment modality, methods of assessing OHRQoL, and the key findings were extracted and analyzed.
RESULTS: Among the 16 studies, 3 were cross-sectional surveys, 9 were longitudinal studies, and 4 were randomized clinical trials. The cross-sectional studies reported improvements in OHRQoL following root canal treatment. Comparative longitudinal studies did not identify a significant association between improvements in OHRQoL and the method of root canal instrumentation or number of instruments used. Clinical trials found that improvements in OHRQoL were significantly associated with instrumentation technique, surgical-incision approach, and the application of platelet-concentrate during surgery. Several methods of assessing OHRQoL were employed with the most common being the Oral Health Impact Profile (OHIP), albeit using different versions.
CONCLUSIONS: The results of this systematic review indicate that the QoL of patients improved after endodontic treatment. Nevertheless, these results are limited to patients who seek endodontic treatment and cannot be generalized. The lack of well-designed observational studies with standardized assessment approaches, coupled with heterogeneity of study design and interventions, precluded quantitative synthesis.
CONCLUSIONS: Pragmatic clinical trials are more meaningful to understand patient-centered outcomes of treatment. This review shows that endodontic treatment does improve the QoL. However, future studies should use standardized tools and data reporting, which are critical to make meta-analyses possible.

This study was designed to examine the morphological features of the resected root apices obtained from endodontic microsurgery using a scanning electron microscope (SEM) as well as their anatomical effect on the clinical outcome of the surgical treatment. One-hundred-six resected root apices from 91 patients/surgeries were obtained by endodontic microsurgery, and fixed immediately for storage. The resected apices were prepared for SEM to examine their morphological features, such as the number and size of the apical foramina. The patients were periodically checked up at least 1 year and the clinical outcome of the microsurgery was judged as a success or failure according to the Molven\'s criteria. The SEM findings and the clinical outcome of apical surgery were evaluated to see any potential correlation between them. The SEM examination revealed that 60.4% of specimens had more than two portals of exit on the resected root apices and the size of the major foramen was at least 386 micrometer and 334 micrometer from maxillary and mandibular molar, respectively. With a recall rate of 72.9%, 91.9% of the surgical cases were decided to have successful outcomes. Based on this SEM study, a relatively high frequency of multiple portals of exit was existed and the sizes of major foramina were bigger than that were reported in previous reports. The clinical outcomes of endodontic microsurgery were not correlated with the anatomical features of resected apical root apices. SCANNING 38:455-461, 2016. © 2016 Wiley Periodicals, Inc.

This case series aims to comprehensively introduce intentional replantation with a focus on its indications and case selection in endodontics. In all represented cases, calcium enriched mixture (CEM) cement is used for root-end filling. This case series demonstrates twenty cases of IR and extraoral root-end resection and filling with CEM cement. All the selected teeth had a failed endodontic treatment and required surgical/nonsurgical endodontic (re)treatment or extraction. Subsequent to gentle tooth extraction, an appropriate root-end cavity was prepared and filled with CEM cement. Then the tooth was replanted; maximun procedure time was 15 min. A total of 18 cases (90%) were successful over a mean follow-up period of 15.5 months. It can be concluded that intentional replantation with careful case selection can have a high success rate over 2 years. Intentional replantation may be a suitable treatment option for both trained general practitioners and specialists provided that the extraction is simple and straightforward.