Sexual Dimorphism in Apical Periodontitis Severity Detected by CBCT.

Introduction: Although several elegant studies have reported apical periodontitis prevalence in different populations, far less is known about its associated bone loss and its correlation to sex and age. Thus, this study investigated the impact of sex and age differences on the severity of apical periodontitis (AP) using cone-beam computed tomography (CBCT) and a volumetric periapical index (CBCT-PAI).

Material And Methods: CBCT scans of 401 patients (1,027 teeth) were analyzed by calibrated examiners in CBCTPAI.

Innervation Changes in Apical Periodontitis and its Correlation with Preoperative Symptoms.

Introduction: Previous anatomical studies have demonstrated the cellular composition of apical periodontitis (AP) lesions, primarily focusing on immune cells. Only recently has the innervation of an apical lesion been reported, but evidence regarding the quantity and quality of neural innervation in AP lesions remains largely unknown. Importantly, periapical innervation has been shown to modulate cellular response in AP, and the voltage-gated sodium channels Nav1.

Biomechanical Characterization of Immature Roots Following Regenerative Endodontic Treatment and MTA Apexification: A Clinical Study.

Introduction: This clinical investigation aims to determine and compare the volume, hardness, and elastic modulus of immature roots following regenerative endodontic treatment (RET) and mineral trioxide aggregate (MTA) apexification.

Methods: A total of six volunteers aged between 9 and 14 years participated in the study, each providing a pair of mandibular or maxillary premolars with normal pulp and periapex planned for extraction due to orthodontic reasons. After full pulpectomy, each pair received either an MTA obturation or RET using blood clot as scaffold, followed by permanent restoration.

Comparative Evaluation of Three Calcium Silicate-Based Materials for Direct Pulp Capping: An Study in Mice.

Introduction: Vital pulp treatments (VPT) aim to conservatively manage deep caries and/or damage to preserve the vitality and function of the pulp. This minimally invasive approach is still debated when performing direct pulp capping (DPC), a treatment in which a protective biocompatible material is directly placed over the dental pulp, due to microbial risks inherent with pulp exposure and difficulties in sealing the exposure to protect the pulp from subsequent bacterial ingress. Several limitations associated with Mineral Trioxide Aggregate (MTA) such as long setting time and discoloration have promoted the development of next-generation MTA derivatives with enhanced physical, chemical, and biological properties.

Immediate postoperative anesthesia with either lidocaine or bupivacaine: A short-term clinical response.

Background: The purpose of this randomized, three-armed clinical trial is to determine if a postoperative injection of 0.5% bupivacaine is more effective than 2% lidocaine in controlling pain after periodontal flap surgery.

Methods: Seventy-six patients planned for similar periodontal surgeries were included.

The impact of intravenous versus submucosal dexamethasone on short-term patient response: A randomized controlled trial.

Background: The purpose of this randomized, cross-over trial was to determine if a preoperative dose of dexamethasone administered submucosally is as effective as intravenous (IV) dexamethasone in reducing pain, swelling, and analgesic consumption after periodontal flap surgery.

Methods: Thirty-nine patients planned for two similar flap surgeries under IV sedation were included. Before the first surgery, patients were randomized to receive 8 mg of IV or submucosal dexamethasone.

Peri-implantitis induction and resolution around zirconia versus titanium implants.

Background: This study compared titanium and zirconia implant ligature-induced peri-implant defect progression and response to regenerative surgical intervention.

Methods: Eight tissue-level endosseous implants were placed in 6 mixed-breed foxhounds, with 2 zirconia and 2 titanium alternating in each hemimandible. Cotton ligatures were placed subgingivally for 16 weeks followed by 8 weeks of spontaneous progression.

Sex-specific nociceptor modulation of the apical periodontitis transcriptome.

Apical periodontitis (AP) is a painful disease that develops quickly following dental infections and is primarily characterized by robust inflammation surrounding the tissues of the affected tooth, resulting in disruption of bone homeostasis and periradicular bone loss. Moreover, there are distinct clinical presentations, symptoms, and responses to AP treatment between male and female subjects, creating a desperate need to further understand the sex-specific mechanisms of AP. With the growing evidence that nociceptors modulate AP development, we utilized RNA sequencing in nociceptor-ablated (Nav1.

A Case of Respiratory Epithelium-Lined Cyst with Enriched Nociceptor Innervation.

Apical lesions of endodontic origin can be classified as either granulomas or cysts. In rare cases, respiratory epithelium can proliferate and encapsulate a lesion, forming a cyst. Moreover, the innervation of apical lesions has only been previously reported in animal models of apical periodontitis.

Expression of Toll-like Receptors in Stem Cells of the Apical Papilla and Its Implication for Regenerative Endodontics.

Regenerative therapies to replace cells and tissues damaged due to trauma and dental infections require temporal and spatial controlled recruitment and the differentiation of progenitor/stem cells. However, increasing evidence shows microbial antigens can interfere with this process. Toll-like receptors (TLRs) are crucial in recognizing pathogen-associated molecular patterns.

Nociceptors regulate osteoimmune transcriptomic response to infection.

Osteoimmune diseases, such as apical periodontitis, are prevalent, often painful, inflammatory conditions resulting in bone loss and reduced quality of life. There is growing evidence that the nociceptive fibers densely innervating affected tissues regulate disease progression; therefore, we hypothesized that nociceptors regulate the transcriptomic profile of the periapical osteolytic lesion in a mouse model of apical periodontitis. Male control and nociceptor-ablated mice underwent pulp exposures, and after 0, 7, or 14 days, total RNA from periapical tissues was submitted for sequencing and bioinformatic analysis.

Effect of Dentin Conditioning with EDTA and Diode Lasers on Expression of Odontoblast-like Cell Markers of Dental Pulp Stem Cells.

Regenerative endodontic procedures rely on the delivery of mesenchymal stem cells into the root canal and on the effect of local growth factors from the dentin and blood clot. The aim of this study was to assess the effect of dentin conditioning with ethylenediamine tetraacetic acid (EDTA) and diode lasers with different wavelengths (808 nm and 980 nm) on the expression of odontoblast-like cell markers. Forty dentin cylinders were divided into four groups according to the irrigation protocol: EDTA, EDTA + 808 nm diode laser, EDTA + 980 nm diode laser, and phosphate-buffered saline as the control group.

A randomized controlled trial evaluating the effect of epithelial removal on free soft tissue autograft healing.

Background: The purpose of this study is to determine if there is a difference in dimensional change of a free soft tissue autograft (FSTA) with epithelium compared to without epithelium. The secondary aim is to determine the patient and professional evaluation of color match and graft texture between the two groups.

Methods: Patients with ≤2 mm keratinized tissue indicated for a FSTA were randomly assigned to control group (FSTA with epithelium) or test group (de-epithelialized FSTA).

Endocannabinoids Modulate Production of Osteoclastogenic Factors by Stem Cells of the Apical Papilla In Vitro.

Introduction: Many mediators are produced during pulp inflammation and necrosis, including endocannabinoids (ECbs), which might affect the function of stem cells of the apical papilla (SCAP), cells of paramount importance for root formation, and regenerative endodontic treatment. The aim of this study was to evaluate the production of osteoclastogenesis-related mediators by SCAP modulated by ECbs and lipopolysaccharide (LPS) in vitro.

Methods: SCAP were cultured and treated with ECb anandamide (AEA), 2-arachidonoylglycerol, or N-arachidonoylaminophenol.

Microbiome Changes during Regenerative Endodontic Treatment Using Different Methods of Disinfection.

Introduction: The purpose of this study was to characterize qualitatively and quantitatively the changes in the endodontic microbiome, in teeth with necrotic pulp, open apexes, and apical periodontitis, with 3 antimicrobial protocols, undertaken in a multicenter clinical trial.

Methods: Microbiological samples were collected from 116 regenerative endodontic teeth, and 97 qualified for inclusion. The teeth were randomly divided into 3 treatment groups: apexification (APEX), regeneration (REGEN), and revascularization (REVASC), all in 2 appointments.

Trigeminal neurons control immune-bone cell interaction and metabolism in apical periodontitis.

Apical periodontitis (AP) is an inflammatory disease occurring following tooth infection with distinct osteolytic activity. Despite increasing evidence that sensory neurons participate in regulation of non-neuronal cells, their role in the development of AP is largely unknown. We hypothesized that trigeminal ganglia (TG) Nav1.

Pharmacological Management of Acute Endodontic Pain.

Pain associated with infections of the tooth pulp and periapical tissues is intense and often the most common reason for patients seeking emergency dental care. Effective management of acute dental pain requires a deep understanding of pain mechanisms, which enables accurate diagnosis and definitive treatment. While drugs are only used as an adjunct to definitive dental treatment, a thorough understanding of their mechanism of action and effectiveness enables clinicians to effectively control intra-operative and post-operative pain and prevent persistent pain.