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Gas expansion in body cavities due to pressure changes at high altitudes can cause barodontalgia. This condition may compromise flight safety. To investigate relationships among barodontalgia awareness, dental visit frequency, and barodontalgia prevalence in civilian and military pilots operating at high altitudes. Civilian pilots from Turkish Airlines and military pilots from the Turkish Air Force, flying between November 2022 and January 2023, participated in this study. A 20-question survey was administered to 750 pilots, covering topics such as barodontalgia awareness, dental visit frequency, breaks after dental treatments, in-flight pain, and pain type and severity. The voluntary surveys were distributed by email. Of the 750 pilots, 526 completed the survey; 61% were aware of barodontalgia, and 81% of pilots who had experienced it reported pain at altitudes <2000 feet. The study revealed higher barodontalgia awareness among pilots who had experienced it, with the highest prevalence among jet pilots. Pilots with barodontalgia also showed a higher frequency of dental visits (  < 0.001). Additionally, this group reported more frequent interruption of flight due to dental treatment (IFDT), more problems experienced in flights after treatment (PFAT), and higher instances of bruxism or teeth clenching during flight, suggesting stress and anxiety (  < 0.05). Barodontalgia, a type of pain linked to stress, significantly impacts pilot performance, and can threaten flight safety, even at lower altitudes. Thus, there is a need to educate pilots about stress management, barodontalgia awareness, and the importance of regular dental check-ups.

ObjectivesThe aim of this randomized clinical trial was to compare selective removal to soft dentin (SRSD) and selective removal to firm dentin (SRFD) in permanent teeth. The primary outcome of the study was to compare the success rates of the two caries removal techniques. The secondary outcome of the study was to investigate whether or not calcium silicate-based material (CS) had an effect on the success rate of the treatment.Materials and methodsBetween November 2018 and March 2020, patients with deep caries lesions were invited to participate in the study. Posterior teeth (N = 165) with primary caries lesion radiographically extending ¾ of dentin and positive response to cold test were randomly selected. A total of 134 participants meeting the inclusion criteria were randomized to SRSD and SRFD (control) groups. After the caries removal procedure, teeth with exposed pulps were assigned to the pulp exposure (PE) group, and the SRSD group was further divided into test 1 (with CS) and test 2 groups (without CS). Success was defined as a positive response to the cold test, a negative response to percussion, the absence of pain, an abscess, a fistula, and periapical alterations. Fisher–Freeman–Halton exact tests, Kaplan–Meier survival analysis, and the log-rank tests were performed for comparisons between groups.ResultsNo statistically significant difference was found between the success rates of test 1 (100%) and test 2 (93.5%) groups, whereas the proportion of success in control (82.4%) and PE (84%) groups were significantly lower when compared with test groups (p = 0.024; p < 0.05) at the end of 2-year follow-up.ConclusionsSRSD had a higher success rate when compared to SRFD to treat deep carious lesions after 2 years of follow-up. The use of CS material after SRSD as a liner had no effect on the treatment outcome.Clinical relevanceSRSD with good coronal sealing might be recommended without CS application for the treatment of deep caries lesions in permanent teeth.Trial registrationClinical trial registration number NCT04052685 (08/09/2019).

This study compared the efficacy of apicoectomy and apical curettage with and without leukocyte- and platelet-rich fibrin (L-PRF) in treating large periapical lesions. Sixty-four adults (30 male, 34 female) with a previously endodontically treated tooth and a large periapical lesion were randomized into four groups (n = 16): retrograde obturation (RG), orthograde obturation (OG), RG + L-PRF, and OG + L-PRF. All participants underwent root canal retreatment in two sessions. The RG group underwent root-end resection and retrograde MTA obturation, the RG + L-PRF group underwent L-PRF application to the bone defect following the RG protocol, the OG group underwent orthograde MTA obturation and periapical curettage without root-end resection, and the OG + L-PRF group underwent L-PRF application following the OG protocol. Clinical and radiographic assessments were performed preoperatively, and at 1 week and 1, 3, 6, 9, and 12 months postoperatively. At follow-up visits, pain scores, swelling, tooth mobility, tenderness to percussion (T-PER), tenderness to palpation (T-PAL), and the presence of fistula were clinically assessed. Periapical radiography determined the periapical index (PAI) score and measured the periapical lesion area (PALA). The Kruskal–Wallis test was performed to test the effect of a single independent variable (factor) on a dependent variable. No statistically significant differences were identified between the groups for preoperative PAI scores, pain scores, swelling, tooth mobility, fistula, T-PER, or T-PAL (p > 0.05). At postoperative week 1, the RG + L-PRF group showed a significantly lower T-PER. The RG + L-PRF group showed significantly lower PALA values and significantly higher PALA healing rates at postoperative 1, 6, and 9 months. Both L-PRF groups achieved PALA healing rates of over 90% at 9 months. It was concluded that a combination of apicoectomy and L-PRF effectively treats periapical lesions and promotes both short- and long-term healing and that a combination of periapical curettage and L-PRF offers a less invasive alternative, especially when the crown-to-root ratio is a concern. Trial registration: The protocol was registered at ClinicalTrials.gov (NCT05847647).

This study compares intracanal bacterial reduction between two apical enlargement approaches in teeth with periapical lesions, evaluating the influence of shaping size with irrigation activation during root canal treatment. Twenty-four patients were divided into two groups: minimally invasive (25/0.04) and conventional (35/0.04). Root canal samples were obtained before and after chemomechanical preparation and passive ultrasonic irrigation (PUI). Bacterial load was quantified by droplet digital PCR, and bacterial species were identified by sequencing. Both groups demonstrated a significant reduction in bacterial load exceeding 95% ( p  < 0.01), with no significant intergroup differences ( p  > 0.05). The conventional group exhibited higher preoperative pain scores ( p  = 0.042), while postoperative pain levels were comparable between groups. Pseudomonas spp. were more prevalent at baseline in the conventional group ( p  = 0.048). Despite effective bacterial reduction in both groups, Enterococcus faecalis and Pseudomonas persisted after treatment, indicating the need for improved disinfection protocols and activation techniques for resistant biofilm-forming microorganisms. Trial registration The protocol was registered at www.clinicaltrials.gov (NCT07005219) on 22/5/2025.

The effectiveness of Passive Ultrasonic Irrigation(PUI) and Sonically Activated Irrigation(SAI) techniques was investigated in apical periodontitis(AP) patients based on changes in prostaglandin E2(PGE2), nitric oxide(NO), and interleukin-6(IL-6) levels. Sixty-six AP patients and thirty healthy controls were enrolled. Preoperative gingival crevicular fluid(preGCF) PGE2, NO and IL-6 levels were measured before treatment. After chemo-mechanical preparation, teeth were assigned into two groups according to final irrigation protocol[PUI(n:33) and SAI(n:33)]. The same markers were again measured 1 week after treatment(postGCF) and also 1st order most commonly seen bacteria(FMCB) typing was performed on microbial samples of the patients. PostGCF-PGE2 levels of the PUI group were lower than postGCF-PGE2 levels of the SAI group( p  = 0.0335). Both postGCF-PE2 and IL-6 levels of the PUI group were significantly decreased after treatment( p  < 0.0001), while only postGCF-PE2 levels decreased in the SAI group( p  = 0.0316). The PUI system significantly reduced PGE2 and IL-6 levels by better controlling inflammation in the treatment of AP.

Effective root canal therapy (RCT) depends on proper disinfection rather than complete sterilization of the root canal system. The smear layer created during instrumentation can inhibit disinfection, and its removal is crucial for successful treatment. Recently, various irrigant activation methods, including shock wave enhanced emission photoacoustic streaming (SWEEPS), passive ultrasonic irrigation (PUI), sonic activation (SA), and syringe irrigation (SI), have been developed to enhance cleaning efficacy. Sterilization of the root canal system is crucial for successful root canal therapy. Lasers have emerged as a popular choice for eliminating microorganisms from the root canal. This study aimed to compare the effectiveness of different irrigant activation techniques-SWEEPS, PUI, SA, and SI-in removing the smear layer from root canals prepared with either a conventional access cavity (ConvAC) or an ultraincisal access cavity (UincAC) design. This study aimed to clarify and compare the effectiveness of various irrigant activation techniques in removing the smear layer from canals with conservative and conventional cavity designs. Eighty extracted human maxillary incisors were prepared using a VDW 35/0.04 rotary system and randomly divided into eight groups (  = 10 per group), based on cavity configuration and activation technique: G1: SWEEPS-ConvAC, G2: SWEEPS-UincAC, G3: PUI-ConvAC, G4: PUI-UincAC, G5: SA-ConvAC, G6: SA-UincAC, G7: SI-ConvAC, G8: SI-UincAC. All samples were irrigated with 2.5% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA), followed by distilled water, and examined using scanning electron microscopy (SEM). Data were analyzed with Kruskal-Wallis and Bonferroni-adjusted Mann-Whitney tests (  = 0.05). No statistically significant difference was found in smear layer scores in the coronal and middle thirds among the groups. However, significant differences were observed in the apical third (  < 0.001). The SWEEPS-ConvAC group showed the least smear layer, while the SI-UincAC group exhibited the most. The effectiveness ranking was: SWEEPS, followed by PUI, SA, and SI. While access cavity design alone did not significantly affect smear layer removal, SWEEPS was the most effective activation method. The combination of SWEEPS with conventional cavity design yielded the most effective smear layer removal in the apical third. These results emphasize the importance of selecting not only an effective irrigant but also an appropriate cavity design to optimize apical disinfection in clinical endodontics.

To investigate the relationship between apical periodontitis [AP] severity and inflammatory markers [interleukin (IL)-12, tumor necrosis factor-alpha (TNF-α), and Mid-Regional Pro Adrenomedullin (MR-proADM)] in patients with AP. A total of 162 subjects were divided into three categories: AP group ( n  = 80), periodontitis (P) group ( n  = 42), healthy control group ( n  = 40). The scoring of disease severity in 80 AP patients without any periodontal disease, using dental radiographs, was based on “The Abscess Score” (AS), as those having at least 1 tooth with AP and severity of PAI 3–4 were classified as AS 1 (mild); those with only1 tooth and severity of PAI 5 as AS 2 (moderate) and those having > 2 tooth with severity of PAI 5 as AS 3 (severe). Blood samples were collected from all of the patients. Enzyme-linked immunosorbent assay was used to evaluate the samples. The MR-pro ADM levels of both the AP and P groups were considerably higher than the control group ( p  < 0.01). The IL-12 levels of the AP group were higher than the P and control groups ( p  < 0.05). TNF-α levels of the P group were significantly higher than both the AP and control groups ( p  < 0.01). MR-pro ADM levels of both the AP and Periodontitis groups were higher than the control group. TNF-α was a biomarker of periodontitis, while IL-12 was a biomarker of apical periodontitis.

[Abstract] To investigate the relationship between apical periodontitis [AP] severity and inflammatory markers [interleukin (IL)-12, tumor necrosis factor-alpha (TNF-α), and Mid-Regional Pro Adrenomedullin (MR-proADM)] in patients with AP. A total of 162 subjects were divided into three categories: AP group (n = 80), periodontitis (P) group (n = 42), healthy control group (n = 40). The scoring of disease severity in 80 AP patients without any periodontal disease, using dental radiographs, was based on \"The Abscess Score\" (AS), as those having at least 1 tooth with AP and severity of PAI 3 - 4 were classified as AS 1 (mild); those with only 1 tooth and severity of PAI 5 as AS 2 (moderate) and those having > 2 tooth with severity of PAI 5 as AS 3 (severe). Blood samples were collected from all of the patients. Enzyme-linked immunosorbent assay was used to evaluate the samples. The MR-pro ADM levels of both the AP and P groups were considerably higher than the control group (p < 0.01). The IL-12 levels of the AP group were higher than the P and control groups (p < 0.05). TNF-α levels of the P group were significantly higher than both the AP and control groups (p < 0.01). MR-pro ADM levels of both the AP and Periodontitis groups were higher than the control group. TNF-α was a biomarker of periodontitis, while IL-12 was a biomarker of apical periodontitis.

To compare the effects of different sealers (epoxy resin-based AH Plus [AHP] and calcium silicate-based AH Plus Bioceramic Sealer [AHPbcs]) and obturation techniques (cold lateral condensation [CLC] and warm vertical compaction [WVC]) on radiological healing, sealer extrusion rates, pain, and postoperative treatment success in the treatment of teeth with periapical lesions. 168 patients having single-rooted teeth with apical periodontitis were randomized into four groups: AHP-CLC, AHP-WVC, AHPbcs-CLC, and AHPbcs-WVC. Clinical and radiological evaluations (PAI score, periapical lesion size, periapical healing, sealer extrusion, and treatment success) were performed preoperatively and again at the end of a 1-year follow-up. Post-obturation pain levels and analgesic use were recorded at 6, 24, 72 h, and up to 1-week post-treatment. At the 1-year follow-up, the periapical healing score in the AHPbcs-WVC group was statistically significantly higher compared to that of the AHP-CLC group (p < 0.05). Postoperative pain, albeit relatively, was observed most frequently in the AHPbcs-WVC group (60%) at 6 h. Although the success rates showed relative differences between the groups, they were not statistically significant (p = 0.175). Although no significant difference was observed in overall success rates between the groups, the AHPbcs-WVC combination showed more favorable results in terms of periapical healing and lesion size reduction. Sealer extrusion was significantly associated with both sealer type and obturation technique and occurred more frequently with AHPbcs-WVC. AHPbcs even with an increased risk of extrusion when used with the WVC technique, offer better potential for periapical healing and treatment success. However, patients must be supported by pain management. These results emphasize that the choice of material and technique affects both the long-term success and patient comfort regarding pain in endodontic treatment. ClinicalTrials.gov ID NCT07106307, retrospectively registered on 07/12/2025, https://clinicaltrials.gov/study/NCT07106307.