搜索结果：Journal of endodontics

This scoping review aimed to map the existing literature on OHRQoL in endodontics by identifying the types of treatments investigated, measurement instruments used, and assessment time points, as well as to highlight current knowledge gaps and directions for future research. Three electronic databases (MEDLINE, the Cochrane Central Register of Controlled Trials, and Scopus) were searched until February 22, 2025. A total of 3961 records were identified; 132 were screened and assessed for eligibility, and 67 articles were included. The findings showed that (1) an increasing incorporation of patient-reported outcomes was observed, particularly in non-surgical root canal treatment; (2) the Oral Health Impact Profile-14 (OHIP-14) was the most frequently used OHRQoL instrument; (3) substantial heterogeneity was found in outcome measures and assessment time points; and (4) the lack of methodological consistency limits comparability across studies and underscores a need for standardised assessment frameworks. This scoping review highlights growing use of OHRQoL as a patient-reported outcome in endodontic research. However, substantial methodological heterogeneity limits cross-study comparability, underscoring the need for standardised outcome measures and follow-up protocols to strengthen patient-centred evidence in endodontics. Patient-reported outcomes are increasingly recognized as essential indicators of treatment success in endodontics. This review identifies significant variability in OHRQoL assessment methods, which hinders evidence synthesis and clinical applicability. The development of standardized, consensus-based outcome measures is crucial to strengthen patient-centred evidence and improve the translation of research findings into everyday endodontic care.

Disinfection is critical for regenerative endodontic procedures, yet the antibiofilm activity of root canal irrigants remains poorly characterized. This study investigated the effects of sodium hypochlorite (NaOCl) (1, 3, and 6%) and chlorhexidine (CHX) (2%) on biofilm viability and extracellular matrix composition. Multispecies biofilms were developed for 7 or 21 days and treated with CHX or NaOCl. Untreated biofilms served as controls. Biofilms were subject to multimodal assessment including (1) quantification of bacterial viability, (2) characterization of three-dimensional architecture, and (3) quantification of extracellular matrix composition using a selective fluorescence-binding assay and confocal microscopy. Data were statistically analyzed by 2-way analysis of variance (ANOVA) and Tukey multiple comparisons test, with significance set at P< .05. Both NaOCl and CHX significantly reduced biofilm bacterial viability compared to the untreated control in 7-day old biofilms (P< .05), with no significant difference between any NaOCl concentration and CHX (P> .05). However, against 21-day biofilms, all NaOCl concentrations killed significantly more bacteria than CHX (P< .05). All NaOCl concentrations significantly reduced biovolume compared to 2% CHX in young biofilms (P< .05), whereas only 3% and 6% NaOCl achieved greater reductions than CHX in mature biofilms (P< .05). All NaOCl concentrations significantly outperformed CHX in reducing eDNA and exopolysaccharide levels at both timepoints (P< .05). CHX exhibited limited antibiofilm activity against mature biofilms, while 3 and 6% NaOCl achieved superior bacterial killing and matrix disruption compared to 1% NaOCl and CHX both in mature biofilms.

The aim was to identify and analyse publication trends, bibliometric indicators, and research characteristics of artificial intelligence studies published in Endodontic journals. An advanced search was performed in "Web of Science All Databases" and "Scopus" employing the keywords "Endodontics", "Endodontic", "Artificial Intelligence", and "AI". Articles published in journals containing the terms "Endodontic", "Endodontics", or "Endodontology" were included. A total of 214 authors contributed to the 48 analyzed studies. MohammadRahimi, H., and Nosrat, A., were the most productive authors. The United States contributed the highest number of publications. The Journal of Endodontics was the primary outlet. Publications increased sharply between 2024 and 2025. Basic research predominated, with radiology as the dominant study field. Deep learning was the most frequently used AI methodology, particularly convolutional neural networks for radiographic diagnosis and segmentation. AI research in endodontics has expanded markedly in recent years, driven predominantly by advances in deep learning and imaging analysis.

Occurrence of post-treatment apical periodontitis characterizes the failure of endodontic treatment. This study described the histobacteriologic and histopathologic features of biopsy specimens of teeth with post-treatment apical periodontitis. The material comprised sequential biopsy specimens of 71 human root canal-treated teeth with apical periodontitis. Specimens were obtained by apical surgery or extraction and consisted of root apexes with attached lesions, which were processed for histobacteriologic and histopathologic evaluation of the cause of failure, infection distribution, and the type of lesion. Different aspects of infection were evaluated for associations with demographic, clinical, radiographic and histopathologic parameters. Intraradicular bacteria were found in the apical root canal system of 94% of the specimens, often organized in biofilm structures (79% of the cases). Infection extended to dentinal tubules and ramifications in many cases. The occurrence of biofilms in the main apical canal lumen was significantly more frequent in teeth with underfillings and inadequate root canal treatment (P < .05). An extraradicular infection occurred in 37% of the cases; in all but one case, it was associated with an intraradicular infection. Extraradicular bacteria were observed as a biofilm (sometimes with calcification foci) attached to the outer root surface and as planktonic cells or flocs at the lesion body or in the cyst lumen. Extraradicular infection was significantly more present in cases with symptoms and sinus tracts, abscesses, large lesions, and retreatment (P < .05). Nonepithelialized granuloma was the most frequent type of post-treatment apical periodontitis (42%). Intraradicular infection was the major factor associated with post-treatment apical periodontitis. Extraradicular infection was observed in about one-third of the cases, and in the large majority of them associated with concomitant intraradicular infection. Granuloma was the most common histopathologic diagnosis of posttreatment lesions.

This study investigated riboflavin as a bioactive signaling molecule with anti-inflammatory and odontogenic effects under inflammatory (+lipopolysaccharide [LPS]) and noninflammatory conditions (-LPS), and its incorporation into a novel hydrogel system for regenerative endodontics. Human dental pulp stem cells were stimulated with E. coli lipopolysaccharide (LPS; 10 &#x3bc;g/mL, 7 days) to model chronic inflammation and treated with riboflavin (0, 3, 30, or 300 &#x3bc;M). Intracellular reactive oxygen species, nitric oxide production, migration, proliferation, collagen synthesis, and mineralized matrix deposition were evaluated. Based on these outcomes, a thermo-crosslinked Pluronic F127 hydrogel was developed with or without riboflavin. Release kinetics were assessed and the same biological assays were performed under &#xb1;LPS conditions using a transwell system. Riboflavin reduced reactive oxygen species at all concentrations and decreased nitric oxide in a dose-dependent manner, with significant effects at 30 and 300 &#x3bc;M under +LPS. Riboflavin at 300 &#x3bc;M enhanced cell migration under both &#xb1;LPS and restored proliferation, particularly under +LPS. Collagen synthesis and mineralized matrix deposition were improved at all concentrations under +LPS. Riboflavin-loaded hydrogel showed initial burst release followed by sustained delivery. Under +LPS, riboflavin-loaded hydrogel significantly reduced oxidative stress, enhanced migration, proliferation, collagen synthesis, and mineralized matrix deposition, whereas unloaded hydrogel did not improve these deficits. Riboflavin exerted potent anti-inflammatory and regenerative effects on inflamed human dental pulp stem cells. When incorporated into a controlled-release hydrogel system, it reduced inflammatory response and restored odontogenic properties to levels comparable with noninflammatory conditions, underscoring its potential as a cell-free tissue engineering strategy for vital pulp therapy.

The professional relationship between general practitioners and endodontists is essential for high-quality patient care. The purpose of this study was to provide a dual-perspective evaluation of the referral patterns and professional perceptions held by both referring dentists (RDs) and endodontists (EDs) to identify modern barriers to effective collaboration. An anonymous 22-item online survey was distributed to EDs and RDs through professional networks and social media. The questionnaire addressed demographics, clinical workflows, and professional perceptions. Data were analyzed using Pearson chi-squared tests and binary logistic regression (P < .05). A total of 1,352 responses were analyzed (793 EDs, 559 RDs). Clinical procedural problems were the primary driver for referral for both RDs (47.2%) and EDs (50.7%). However, significant perceptual gaps were identified: 30% of RDs believed restorability assessment was primarily the endodontist's responsibility, compared to 20.6% of EDs (P < .05). Although RDs reported high satisfaction with specialist reports, 44.2% of EDs found referral letters inadequate more than 30% of the time. While both groups prioritized phone communication for relationship maintenance (RD: 51.4%; ED: 25.7%), EDs placed a significantly higher value on personal office visits (18.2%) than RDs (7.4%). Relationship termination also differed, with RDs most commonly citing patient dissatisfaction (30.7%) and EDs citing divergent treatment philosophy (40.0%) as the primary reasons for discontinuing referral. The RD-ED referral pathway is characterized by shared clinical goals but significant discrepancies in documentation expectations and responsibility for restorability. Implementing standardized referral templates and improving bidirectional communication of restorative intent are essential for reducing professional friction and enhancing the continuity of patient care.

To conduct a bibliometric analysis of the literature on C-shaped canal systems in mandibular second molars (MSMs) and to review key research themes and evolving trends. A comprehensive search of the Web of Science Core Collection (WoS-CC) was conducted for publications through 31 December 2024. Following study selection and data extraction, bibliometric data such as publication years, authors, citation counts, institutions, countries/regions, journals, and keywords were analyzed using VOSviewer, CiteSpace, SPSS, and Microsoft Excel. A related review was also performed to synthesize key research themes and evolving trends. 166 publications from 1979 to 2024 met the inclusion criteria, with 50.6% published within the past 5 years. The most cited article received 239 citations. Research originated from 52 countries/regions, with China contributing the largest number of publications (n=34), followed by the United States (n=26). Wuhan University, the University of Hong Kong, and Texas A&M University were the leading institutional contributors. Journal of Endodontics (JOE) published the most articles (n=38), while International Endodontic Journal (IEJ) accumulated the highest total citations (n=1 666). James L. Gutmann was the most prolific author (n=12), and Bing Fan was the most cited (n=577). Keyword co-occurrence analysis revealed "C-shaped canal" and "cone-beam computed tomography" as the most frequent terms, while "deep learning" demonstrated a recent and marked citation burst. This study provides an overview of influential studies on C-shaped canal systems in MSMs and identifies key research themes and evolving trends, serving as a reference for future research and clinical practice.

Hydraulic calcium silicate cement-based sealers (CSC sealers) are now frequently used with warm vertical compaction in root canal treatment. However, the impact of heat on the biological properties of CSC sealers remains unclear. Therefore, this study investigated the effects of thermal pretreatment on the material characteristics, antimicrobial activity, and cytocompatibility of CSC sealers, assessed immediately after setting and after a 28-day post-setting maturation period. An epoxy resin-based sealer (AH Plus) and 2 CSC sealers (AH Plus Bioceramic and BioRoot Flow) were evaluated. The sealers were heated to 100&#xb0;C for 30 seconds and subsequently cooled to 37&#xb0;C. Materials were characterized by field emission scanning electron microscopy, energy-dispersive spectroscopy, and X-ray diffraction analysis. The leaching profile, pH, surface roughness, and contact angles were also assessed. All tests were performed immediately after setting and after 28 days of post-setting maturation. The antimicrobial activity of freshly mixed and set sealers was assessed against 3-day Enterococcus faecalis biofilms by quantifying colony-forming units. The osteogenic cell line MC3T3-E1 was assessed with regard to cell viability and cell migration/proliferation following exposure to sealer leachates. Statistical analyses included one-way analysis of variance with Tukey's post hoc test for group comparisons and paired t-tests for temperature and post-setting maturation period, alongside nonparametric tests where appropriate (P < .05). Microstructural changes in the CSC sealers were observed after thermal pretreatment at 100&#xb0;C. Calcium ion release significantly decreased in BioRoot Flow after thermal pretreatment (P < .05). Thermal pretreatment significantly increased antimicrobial activity in AH Plus Bioceramic after a 72-hour setting period (P < .05), whereas no significant change was observed in BioRoot Flow (P > .05). Regardless of thermal pretreatment, BioRoot Flow maintained its antimicrobial activity after 28 days of post-setting maturation. Both CSC sealers maintained alkalinity for up to 28 days. No significant differences were observed between the 100&#xb0;C pretreated and 37&#xb0;C control groups in cell viability or proliferation (P > .05). Thermally pretreated AH Plus Bioceramic and BioRoot Flow exhibited changes in microstructure and calcium ion release, which may affect early antimicrobial activity in a material-dependent manner, but did not influence cytocompatibility or alkalinity.

Persistent periapical lesions (PePL) represent a clinical challenge because of their inadequate response to conventional endodontic therapies. Studies indicate differences in immunoinflammatory mechanisms between primary periapical lesions (PrPL) and PePL but the findings remain conflicting. This study aimed to evaluate CD4+ and CD8+ T lymphocytes and the expression of immune checkpoint proteins (programmed cell death protein 1 [PD-1] and its ligand [PD-L1]) in PrPL and PePL, correlating the findings with the intensity of the inflammatory infiltrate and pattern of the cystic epithelial lining. Ten primary radicular cysts, 10 persistent radicular cysts (PeRC), 10 primary periapical granulomas (PrPG), and 10 persistent periapical granulomas were submitted to immunohistochemical analysis using anti-CD8, anti-CD4, anti-PD-1, and anti-PD-L1 antibodies. Higher median T lymphocyte counts were observed in PeRC when compared to the other groups, with a statistically significant difference in CD8+ T cells compared to PrPG (P < .05). Regarding PD-L1, PeRC exhibited higher median percentages of positivity in connective tissue and epithelial lining, which differed significantly from the other groups (P < .005). There were no statistically significant differences in the numbers of CD4+ or CD8+ T lymphocytes nor in the expression of PD-1 or PD-L1 according to morphologic parameters (P > .05). Immunoexpression of PD-L1 and CD4+ T lymphocyte count showed a positive correlation in PrPL (r = .592; P < .005) and PePL (r = .532; P < .05). In the latter, PD-L1 and CD8+ T lymphocyte count were also positively correlated (r = .690; P < .001). The results suggest the involvement of PD-1 and PD-L1 in the regulation of immunoinflammatory responses in PrPL and PePL. These immune checkpoint proteins may be particularly important for the suppression of CD4+ and CD8+ T lymphocyte activities in the periapical lesions studied, contributing to their chronicity.

Matrix metalloproteinases (MMPs) are zinc-dependent proteolytic enzymes involved in extracellular matrix remodelling in oral and dental tissues, including the periodontal ligament, alveolar bone, dentin, dental pulp, and periapical tissues. This narrative review summarises selected evidence on the role of MMPs and tissue inhibitors of metalloproteinases (TIMPs) in orthodontic tooth movement, dental trauma and root resorption, restorative adhesive dentistry, and pulp/periapical disease. Particular attention is given to signalling pathways that regulate MMP/TIMP activity, including nuclear factor kappa B (NF-&#x3ba;B), mitogen-activated protein kinase (MAPK), Wnt/&#x3b2;-catenin, and transforming growth factor beta (TGF-&#x3b2;)/Smad-related mechanisms. The review also discusses the biomarker potential and translational status of MMP-targeted strategies. Across clinical contexts, MMP activity contributes to both matrix degradation and tissue repair, and its biological effect depends on local stimuli, TIMP-mediated regulation, pathway crosstalk, and the stage of disease or treatment.

Oral mucositis is a frequent adverse effect of chemotherapy that significantly affects patients' quality of life and treatment continuity. Despite its clinical relevance, effective preventive strategies remain limited. This study aims to compare the efficacy and safety of betamethasone mouthwash with those of sodium gualenate hydrate mouthwash for preventing chemotherapy-induced oral mucositis. This Phase II, multicenter, open-label, randomized controlled trial aims to enroll 296 adult patients (&#x2265;18 years) undergoing chemotherapy for solid tumors (excluding head and neck and hematological cancers). Participants will be randomized 1:1 into two arms: a betamethasone mouthwash (intervention) group and a sodium gualenate hydrate mouthwash (control) group. The primary outcome is the prevention of Grade 1 oral mucositis, assessed using the Common Terminology Criteria for Adverse Events v3.0 and v5.0. Secondary outcomes include prevention of Grade 2-3 oral mucositis, the incidence of oral candidiasis, and chemotherapy completion rates. Data will be analyzed using Kaplan-Meier survival curves, log-rank tests, and Cox regression models. This study aims to establish betamethasone mouthwash as an effective preventive strategy for potentially enhancing the quality of life of patients with cancer. This study was registered with the Japan Registry of Clinical Trials on September 20, 2024 (jRCTs071240060).

Traumatic dental injuries (TDIs) require prompt and accurate guidance, yet little is known about how the prompting influences the quality of artificial intelligence (AI) chatbot responses in these situations. Four dental trauma scenarios were developed by expert endodontists. For each scenario, a series of questions was posed to 4 AI chatbots (Claude Sonnet 3.5, Microsoft Copilot, GPT-4, Gemini Pro 2.5) using 2 approaches: unprompted layperson phrasing (n = 10) and endodontist's prompts referencing International Association of Dental Traumatology guidelines (n = 10). Responses were independently evaluated by 2 raters for validity, completeness, and relevance using a 5-point ordinal scale. Scores (n = 1920) of responses to endodontist questions were associated with significantly higher odds of receiving superior ratings across all 3 domains: validity (odds ratio [OR] = 1.82; 95% confidence interval [CI]: 1.35-2.38; P < .001); completeness (OR = 2.50; 95% CI: 1.85-3.33; P < .001) and relevance (OR = 2.94; 95% CI: 2.04-4.17; P < .001). When a threshold-based acceptability (score &#x2265;4) was applied, responses to endodontist queries were more often acceptable in criterion-based as well as overall analyses (P < .05). The quality of AI chatbot guidance in TDIs is significantly associated with how questions are asked. While clinically structured prompts yield more reliable responses, most patients facing dental trauma are unlikely to formulate questions in this way. This gap highlights an important limitation of current AI chatbot applications in TDIs and underscores the need for caution when relying on these tools without professional input.

This paper explores the historical evolution of dentistry through the lens of eponyms, focusing particularly on endodontics. From the era of extractions to the introduction of restorations by Pierre Fauchard and the development of prosthodontics and root preservation in the 19th century, dentistry has advanced in parallel with scientific breakthroughs in microbiology and technology. These innovations enabled the understanding and treatment of pulpal disease and the creation of effective root canal techniques. We highlight 31 key eponyms-32 individuals whose contributions to instruments, methods, materials, or classifications shaped modern endodontics and whose legacies remain embedded in practice.

This study evaluated the effects of vitamin D on the immune response and regenerative properties of dental pulp stem cells (DPSCs) under lipopolysaccharide (LPS)-induced inflammatory conditions. DPSCs were exposed to predetermined concentrations of vitamin D and LPS, administered individually, concomitantly or sequentially. DPSCs cultured in the growth medium without further treatment were used as the control group. Cell proliferation and migration assays were performed, and inflammatory mediator expression was assessed to determine the immunomodulatory impact of vitamin D. Odontogenic/osteogenic differentiation was assessed using Alizarin Red staining, alkaline phosphatase (ALP) assay and immunocytochemical analysis of dentin matrix protein 1 (DMP1), dentin sialophosphoprotein (DSPP) and nestin expression. Data were analyzed statistically. LPS stimulation significantly reduced cell proliferation, migration, ALP activity, and mineral deposition while increasing inflammatory mediator expression (p<0.05). In contrast, vitamin D treatment attenuated mediator levels and preserved cellular functional capacity (p<0.05). Concomitant exposure to vitamin D and LPS resulted in improved proliferation and migration compared with LPS exposure alone (p<0.05). Both concomitant exposure and the sequential protocol in which vitamin D was administered after LPS exposure demonstrated significantly higher ALP activity, enhanced mineralization, increased DMP1 and DSPP expression and decreased nestin expression compared with LPS exposure alone (p<0.05). However, the sequential protocol in which LPS was administered after vitamin D exposure showed no significant differences compared with LPS exposure alone (p>0.05). Continuous vitamin D exposure was associated with attenuation of the inflammatory response and better preservation of the regenerative capacity of DPSCs compared with prior vitamin D exposure alone.

This study aimed to evaluate the accuracy, consistency, and scientific reliability of two AI-powered chatbots-ChatGPT-3.5 and ChatGPT-4o-in clinical endodontic decision-making, using the recently published European Society of Endodontology (ESE) S3-level Clinical Practice Guideline as the gold standard reference. Twenty-five dichotomous (yes/no) questions were developed based on the ESE guideline and presented to both chatbots across three time intervals, yielding 300 total responses. Each response was evaluated for accuracy and consistency, and the quality of the supporting references was assessed according to their journal ranking (Q1, Q2, others). Both ChatGPT versions demonstrated high internal consistency across repeated measurements. ChatGPT-3.5 showed 94.4% agreement (&#x3ba; = 0.824; 95% confidence interval [CI]: 0.786-0.898; p < 0.001), whereas ChatGPT-4o demonstrated 98.9% agreement (&#x3ba; = 0.937; 95% CI: 0.893-0.965; p < 0.001). The accuracy of ChatGPT-3.5 relative to the guideline-based answers was 81.4%, 88.9%, and 82.2% in the morning, afternoon, and evening sessions, respectively, while ChatGPT-4o achieved 82.9%, 83.3%, and 85.4%, respectively. No statistically significant differences were observed between the models across the three time intervals (p > 0.05). The proportion of Q1/Q2-ranked references was high and comparable between ChatGPT-3.5 (74-82%) and ChatGPT-4o (76-84%). Both ChatGPT-3.5 and ChatGPT-4o demonstrated substantial alignment with the ESE S3-level clinical practice guideline. However, these findings should not be interpreted as definitive assessments of current clinical conversational AI systems, and further evaluation of evolving models is required.

The aim of this study was to compare the filling ability of different root canal obturation techniques for the sealing of internal root resorption (IRR) located in the middle root canal third. Thirty maxillary central incisors were printed based on the standard tessellation language digital file obtained from a preoperative cone beam micro-computed tomography, which was edited to design IRRs in the middle root canal third (n = 30). Subsequently, the group was randomly subdivided according to the following obturation techniques: Group A: rigid carrier-based technique (n = 10) (GuttaCore); Group B: warm vertical condensation technique (n = 10) (Calamus); and Group C: single-cone technique with bioceramic cement (n = 10) (Bioceramic). Subsequently, postoperative micro-computed tomography scans were performed and extracted files were quantified using Fiji/ImageJ software The following volumetric parameters were quantified: channel resin volume (mm3), IRR "sphere" resin volume (mm3), "root" volume (without sphere) (mm3), residual resin volume (mm3) and total resin volume (mm3). Differences among the root canal filling techniques were evaluated using analysis of variance (ANOVA). ANOVA revealed statistically significant differences in the resin penetration volumes between the different obturation techniques evaluated for the "channel," resorptive cavity "sphere," "root," and "residual" resin volumes (mm&#xb3;) (P = .0001, P = .0001, P = .0065, and P < .0001, respectively). The warm vertical condensation technique demonstrated a sealing ability comparable to that of the single-cone bioceramic technique in cases of IRR located in the middle third of the root canal system, as well as the overall root canal system, when compared to the GuttaCore carrier-based obturation technique.

The aim of this study was to evaluate the clinical success rate and the effects of different root canal shaping systems (hand files, reciprocating, and rotary) on postoperative pain in patients with symptomatic irreversible pulpitis (SIP) in vital mandibular molars. A total of 63 patients with a Numerical Rating Scale pain score &#x2265;7 and SIP in mandibular first or second molars were included. Patients were randomly divided into 3 groups (n = 21) and root canal shaping was performed using reciprocating or rotary files; preparation using hand files served as the control. Irrigation was performed using sodium hypochlorite and EDTA, calcium hydroxide was used for temporary medication. In all cases, obturation was completed using AH Plus Bioceramic sealer in a second appointment one week later. Postoperative pain was assessed using the Numerical Rating Scale at 6, 12, and 24 hours after the emergency appointment, and on days 2 through 7 and day 30, postoperatively. Clinical success was evaluated clinically and radiographically after 6 and 12 months. Although the postoperative pain decreased over time in all groups (P < .05), it did not differ significantly between the groups (P > .05). Despite the lack of significance, the hand file group reported higher pain levels at most follow-up intervals. Clinical success was 96.8% at 6 months and 85.7% at 12 months, respectively, with a significant correlation observed between the level of root canal filling and treatment success at 12 months (P < .05). No significant difference between the instrument systems in terms of success was observed. In symptomatic and severely painful vital teeth, the hand files, reciprocating and rotary systems showed comparable levels of postoperative pain.

To evaluate whether systemic supplementation with L. rhamnosus LR-04 and L. acidophilus LA-14 modulates the expression of TLR4, hBD-2, and hBD-3 in a rat model of experimental apical periodontitis (AP), and to assess potential histopathological alterations in the liver. Twenty-four male Wistar rats were randomly allocated into three groups (n=8): control (AP + water), AP + L. rhamnosus LR-04, and AP + L. acidophilus LA-14. AP was induced by exposing the pulp chambers of the first mandibular molars for 30 days. From the day of induction, probiotics (109 CFU/day via oral gavage) or water (control) were administered daily. After 30 days, the rats were euthanized. Mandibles were processed for immunohistochemical analysis of hBD-2, hBD-3, and TLR4 expression, which was assessed semi-quantitatively. Liver samples were collected, fixed, and stained with hematoxylin-eosin for histopathological evaluation of lobular inflammation, necrosis, portal inflammation, and fibrosis. Data were analyzed using the nonparametric Kruskal-Wallis test at a 5% significance level. No hepatic histopathological alterations were observed in any group. Probiotic supplementation resulted in significantly greater hBD-2 immunoreactivity in periapical tissues compared to the control group (P<0.05). hBD-3 expression was significantly higher in the L. acidophilus LA-14 group than in both the control and L. rhamnosus LR-04 groups (P<0.05). TLR4 expression in periapical lesions was increased in both probiotic groups relative to control (P<0.05). Systemic supplementation with L. rhamnosus LR-04 and L. acidophilus LA-14 enhanced the local immune response in apical periodontitis, as evidenced by upregulation of TLR4, hBD-2, and hBD-3, without inducing detectable hepatic histopathological alterations.

Herpes zoster (HZ), caused by the reactivation of varicella zoster virus, presents a major diagnostic challenge in dentistry, particularly when involving the trigeminal nerve. The prodromal symptoms of HZ can closely resemble endodontic pain, leading to misdiagnosis and delayed appropriate treatment. This case report described a 54-year-old male who presented to the emergency dental clinic with severe unilateral, radiating maxillary pain originating from posterior to anterior teeth. Initially diagnosed with symptomatic apical periodontitis on a previously endodontically treated tooth #3, the patient's condition underwent a shift in diagnosis 2 days later when a unilateral vesicular rash appeared along the maxillary division of the trigeminal nerve. The patient's acute nonodontogenic pain attributed to HZ was successfully managed through systemic antiviral and adjunctive therapies without endodontic intervention on tooth #3. While the acute symptoms of HZ were resolved, the patient subsequently developed postherpetic neuralgia and enduring sensory disturbances. A comprehensive review of the literature revealed that beyond postherpetic neuralgia, patients may experience other complications manifesting years after the HZ episode, including pulp necrosis, root resorptions, and osteonecrosis. It is evident that early recognition and diagnosis are paramount in the treatment of HZ. Understanding orofacial manifestations and effective management of HZ are crucial to prevent diagnostic mistakes, ensure optimal patient care and mitigate potential complications.