Yara Teresinha Corrêa Silva-Sousa

Residual temporary cement may hinder fiber post bonding. Therefore, efficient root canal cleaning protocols are essential. This study investigated the effects of three cleaning methods on bond strength, adhesive interface quality as evaluated using scanning electron microscopy (SEM), and intratubular penetration of a self-adhesive resin cement as evaluated using confocal laser scanning microscopy (CLSM). Forty-two mandibular premolars were prepared using Reciproc R50, filled with AH Plus, and restored with provisional retainers cemented with Bifix Temp. Specimens were allocated to three groups (n = 14) according to the cleaning protocol: standardized drill (SD), drill with an ultrasonic insert (UI), or drill with a prophylactic brush (PB). Fiber posts were cemented using a self-adhesive resin cement. Push-out testing, failure mode analysis, and SEM/CLSM evaluations were performed. Bond strength (MPa) was analyzed using two-way ANOVA followed by Tukey's test, whereas failure patterns were analyzed using the chi-square test, and interface adaptation was analyzed using nonparametric tests. PB (4.42 ± 2.60 MPa) and UI (4.55 ± 2.41 MPa) showed significantly higher bond strength values and greater cement penetration than SD (3.04 ± 1.70 MPa) (p < 0.05). Mixed adhesive failures predominated, and SEM revealed no significant differences in interface adaptation. Cleaning with a PB or UI enhanced adhesive performance and resin cement penetration during fiberglass post cementation.

To evaluate the impact of different root canal filling techniques on the push-out resistance to dislodgment of the filling material to dentin, the quality of the filling interface, and root temperature variation in teeth with open apex. Forty-eight human maxillary canines with open apex were divided into 4 experimental groups, according to the technique for root canal filling: Group I - apical barrier with MTA and backfill technique, Group II - apical filling with conventional points and continuous wave technique (4mm/200ºC), Group III - apical filling with low-fusion gutta-percha points and continuous wave technique (4mm/100ºC), Group IV - conventional single cone technique. Temperature changes on the outer surface of the root were measured in thirds during the filling. BS was evaluated using the push-out test. The adhesive interface was examined using scanning electron microscopy. Analysis of variance was used to analyze BS and temperature variation data, while the chi-square test was used to analyze failure type. The fit of the filling material to the dentin wall was evaluated using non-parametric Mann-Whitney and Kruskal-Wallis tests, followed by Dunn’s test. The group using the MTA barrier (4.5±3.5) showed higher BS values compared to the conventional points (2.8±1.1), low-fusion points (3.1±2.1), and the single cone technique (2.7±2.3) (p<0.05). In terms of temperature variation, a greater temperature increase was observed in the low-fusion points group (p<0.05). MTA barrier exhibited the highest BS values and adhesive interface quality, while the continuous wave condensation technique, regardless of the type of gutta-percha point used, showed intermediate values compared to the single cone technique.

Aim: To evaluate the impact of polymorphisms in SOCS‐1, TNF‐α and RANKL on gene expression of RANK , RANKL , TNFRSF1, SOCS‐1, IL‐10 , IL‐1β and TNF‐α , and to evaluate the histopathological, immunohistochemical and microbiological aspects of persistent apical periodontitis (PAP) after root canal treatment (RCT) in Brazilian individuals. Methodology: Patients with pulp necrosis and apical periodontitis at the time of the non‐surgical RCT (NSRCT) were followed up for at least 1 year after NSRCT. In view of the need for surgical intervention (cases assessed with a CBCTPAI score of 4 and 5, with the presence of symptoms), 20 patients were selected for endodontic surgery, which was planned using cone beam computed tomography images. Initially, saliva was collected as a source of genomic DNA, and the individuals were genotyped for SOCS‐1 , TNF‐α and RANKL polymorphisms by real‐time PCR. After collecting the biological material, the periapical lesions obtained were subjected to analysis of gene expression levels for RANK , RANKL , TNFRSF1, SOCS‐1, IL‐10 , IL‐1β and TNF‐α , and histopathological evaluation for characterisation and differentiation into periapical granulomas and cysts; immunohistochemical evaluation for SOCS‐1 and IL‐1β protein labeling; and microbiological analysis to identify the microorganisms involved in persistent periapical infection. The relative mRNA expression values of each gene in each group, according with genotypes in different SNPs, were analysed using one‐way analysis of variance followed by Tukey's post‐test or T ‐test ( α = 5%). Results: Different expression values of the genes evaluated were observed according to the genotypes of the polymorphisms evaluated in relation to PAP ( p < 0.05). Among the cases submitted for histopathological evaluation, 66.7% were diagnosed as periapical granuloma and 33.3% as periapical cyst. Immunohistochemical analysis showed strong positivity for SOCS‐1 and IL‐1β in the lesions classified as periapical cyst, while the lesions diagnosed as periapical granuloma were not labelled. In the microbiological analysis, four different species of bacteria were isolated: Pseudomonas aeruginosa , Staphylococcus epidermidis , Enterococcus faecalis and Bacillus cereus . Conclusions: This exploratory study indicates that genetic polymorphisms can modulate gene expression and protein activity in PAP, shaping the host's inflammatory and reparative response. These findings highlight their potential as biomarkers and establish a basis for future translational studies.

Cone-beam computed tomography (CBCT) has become a reference imaging method in dentistry, providing higher diagnostic accuracy and detailed visualization of complex internal anatomy. This study evaluated the impact of examiner training and three-dimensional (3D) reconstruction on CBCT detection of anatomical microstructures. CBCT scans obtained from 30 teeth with anatomical variations were evaluated by examiners across five skill levels. The same anatomical structures (root canals, isthmuses, and foramina) were assessed using dynamic navigation with multiplanar reconstruction (MPR) and a 3D reconstruction tool available in the e-Vol DX software. The experimental groups included the examiners: undergraduate student, undergraduate student with specific CBCT training, general practitioner, endodontist, and radiologist (control). Each examiner analyzed axial slices with and without 3D reconstruction, recording the number of structures identified and the influence of 3D assistance. Data were analyzed using Kolmogorov-Smirnov, Mann-Whitney, and Kruskal-Wallis tests (p < 0.05). For the general practitioner, 3D reconstruction significantly increased identification of root canals and foramina (p < 0.05), while other groups showed no significant differences between analyses. All examiners reported higher diagnostic confidence when using 3D reconstruction, with endodontists, general practitioners, and trained undergraduates indicating benefit in 100% of cases, and untrained undergraduates in 60%. The 3D reconstruction tool positively influenced the general practitioner's ability to detect root canals and foramina in mandibular premolars with complex anatomy. When using 3D reconstruction, examiners at all training levels achieved good diagnostic performance, enhancing both accuracy and confidence in anatomical interpretation.

This study evaluated the effect of different light-curing units on the conversion degree of resin materials used for luting glass fiber posts and the bond strength to root dentin. One hundred bovine roots received endodontic treatment and were randomly assigned to five groups (n = 10) according to the luting material: RelyX U200 (self-adhesive resin cement), RelyX Ultimate (adhesive resin cement), Filtek Bulk Fill Flow (bulk-fill flowable composite with camphorquinone), Tetric N-Flow Bulk-Fill (bulk-fill flowable composite with ivocerin), and Filtek Supreme Flowable (flowable composite resin). Light activation was performed using either an LED singlewave (Radii Plus) or a polywave LED (Valo Cordless), both at 1000 mW/cm². The degree of conversion was analyzed using Raman spectroscopy, and bond strength was assessed using the push-out test, followed by failure mode analysis. ANOVA and Tukey (α=0.05) demonstrated that RelyX Ultimate and Filtek Bulk Fill Flow provided higher strength values, different (p<0.05) from Tetric N-Flow Bulk-Fill, RelyX U200, and Filtek Supreme Flowable, which had the lowest values. Regarding light-curing units, LED polywave showed the highest bond strength difference (p<0.05) from LED singlewave. Adhesive failures were predominant across all groups, regardless of the material, light source, or root third. RelyX U200, RelyX Ultimate, and Filtek Bulk Fill Flow showed a higher degree of conversion than Tetric N-Flow Bulk-Fill and Filtek Supreme Flowable. Overall, both the choice of luting material and the light-curing unit influenced bonding effectiveness. RelyX Ultimate and Filtek Bulk Fill Flow showed superior performance, and the polywave LED generally produced better adhesion outcomes.

This study evaluated the diagnostic performance of large language models (LLMs)-ChatGPT 5.0 (OpenAI) and Gemini Flash 2.0 (Google Inc.)-in detecting periapical lesions on periapical radiographs using a standardized multimodal prompt. Seventy-five anonymized periapical radiographs of anterior teeth from the maxilla and mandible were analyzed, evenly distributed between cases with and without lesions. A calibrated endodontic specialist provided the reference diagnosis. Each image was independently assessed five times by both LLMs using the prompt: “Does this image show a periapical lesion? Answer ‘Yes’ or ‘No’. If ‘Yes’, which tooth?”. Balanced accuracy, sensitivity, specificity, and F1-score were calculated with 95% confidence intervals (CIs) obtained via bootstrap resampling. Performance was also stratified by diagnostic difficulty, and the models were compared using the exact McNemar test (α = 0.05). ChatGPT 5.0 showed higher overall performance than Gemini Flash 2.0, with sensitivity of 0.97 (95% CI: 0.95-0.99), specificity of 0.11 (95% CI: 0.07-0.16), and balanced accuracy of 0.54 (95% CI: 0.52-0.57). Gemini Flash 2.0 achieved sensitivity of 0.84 (95% CI: 0.79-0.89), specificity of 0.11 (95% CI: 0.07-0.16), and balanced accuracy of 0.48 (95% CI: 0.44-0.51). Both models showed high false-positive rates and frequent errors in tooth localization. The McNemar test confirmed a significant difference between models (p < 0.05), favoring ChatGPT 5.0. Both LLMs demonstrated high sensitivity but poor specificity, resulting in intermediate diagnostic performance and a bias toward positive classifications. General-purpose LLMs are therefore not yet suitable for radiographic diagnostic use.

Clinical and translational research play a decisive role in advancing evidence-based endodontics by bridging basic science with clinical applications. This narrative review provides a comprehensive overview of the current state and advances in clinical and translational research in Endodontics, addressing methodological foundations, diagnostic challenges, and emerging technologies. It highlights the importance of well-designed randomized controlled trials, robust outcome definitions, and the inclusion of patient-reported outcome measures. The integration of advanced imaging, particularly cone-beam computed tomography, has significantly improved diagnostic accuracy and treatment monitoring. Molecular biology techniques, including polymerase chain reaction and biomarker profiling, have expanded the understanding of endodontic microbiome, immune responses, and host factors related to treatment outcomes. Despite these advances, persistent limitations include diagnostic imprecision, lack of standardized criteria, and underutilization of biomarkers and omics data in clinical practice. The rise of precision dentistry, propelled by genomics, bioinformatics, and artificial intelligence, holds the potential to revolutionize endodontic care through personalized diagnostic and therapeutic strategies. Bridging existing gaps will require rigorous study designs, coordinated multicenter efforts, and the effective integration of molecular diagnostics, all of which are critical to advancing endodontic science and optimizing patient outcomes. Likewise, the full potential of translational science can be harnessed to reshape the future of endodontics.

Objective This randomized, parallel-group clinical trial aimed to evaluate the one-year clinical performance of the Beautibond Xtreme adhesive system (Shofu Inc., Kyoto, Japan) applied with different bonding strategies in Class I and Class II posterior restorations. Methodology A total of 22 patients (14 female and 8 male, aged ≥18 years) requiring restorative treatment provided 152 teeth with Class I or Class II carious lesions or defective restorations. Restorations were randomly assigned to six groups, including two control groups (Class I and II using the total-etch technique) and four test groups (Class I and II using either the self-etch technique or selective enamel etching). All restorations were performed using Beautibond Xtreme adhesive combined with Beautifill LS composite resin. Clinical performance was assessed at baseline, six months, and one year using modified United States Public Health Service (USPHS) criteria, including anatomic form, marginal adaptation, marginal discoloration, color match, surface texture, secondary caries, postoperative sensitivity, and retention. Randomization was performed with a computer-generated sequence, and two calibrated, blinded examiners (Kappa = 0.84) conducted all evaluations. Results No significant changes were observed in anatomic form, color match, surface texture, secondary caries, postoperative sensitivity, or retention over time in any group (p>0.05). However, restorations performed using the self-etch technique showed significant deterioration in marginal adaptation and marginal discoloration from baseline to six months and one year (p<0.05). Significant differences were also observed when comparing these restorations to the total-etch and selective enamel etching groups (p<0.05). Conclusion The Beautibond Xtreme adhesive system demonstrated better clinical performance when applied with total-etch or selective enamel etching techniques compared to the self-etch mode for both Class I and Class II restorations after one year of follow-up.