Intentional tooth replantation (ITR) is an advanced treatment modality and the procedure of last resort for preserving teeth with inaccessible endodontic or resorptive lesions. ITR is defined as the deliberate extraction of a tooth; evaluation of the root surface, endodontic manipulation, and repair; and placement of the tooth back into its original socket. Case reports, case series, cohort studies, and randomized controlled trials have demonstrated the efficacy of ITR in the retention of natural teeth that are untreatable or difficult to manage with root canal treatment or endodontic microsurgery. However, variations in clinical protocols for ITR exist due to the empirical nature of the original protocols and rapid advancements in the field of oral biology and dental materials. This heterogeneity in protocols may cause confusion among dental practitioners; therefore, guidelines and considerations for ITR should be explicated. This expert consensus discusses the biological foundation of ITR, the available clinical protocols and current status of ITR in treating teeth with refractory apical periodontitis or anatomical aberration, and the main complications of this treatment, aiming to refine the clinical management of ITR in accordance with the progress of basic research and clinical studies; the findings suggest that ITR may become a more consistent evidence-based option in dental treatment.
Humans ; Tooth Replantation/methods* ; Consensus ; Periapical Periodontitis/surgery*

Instrument separation is a critical complication during root canal therapy, impacting treatment success and long-term tooth preservation. The etiology of instrument separation is multifactorial, involving the intricate anatomy of the root canal system, instrument-related factors, and instrumentation techniques. Instrument separation can hinder thorough cleaning, shaping, and obturation of the root canal, posing challenges to successful treatment outcomes. Although retrieval of separated instrument is often feasible, it carries risks including perforation, excessive removal of tooth structure and root fractures. Effective management of separated instruments requires a comprehensive understanding of the contributing factors, meticulous preoperative assessment, and precise evaluation of the retrieval difficulty. The application of appropriate retrieval techniques is essential to minimize complications and optimize clinical outcomes. The current manuscript provides a framework for understanding the causes, risk factors, and clinical management principles of instrument separation. By integrating effective strategies, endodontists can enhance decision-making, improve endodontic treatment success and ensure the preservation of natural dentition.
Humans ; Root Canal Therapy/adverse effects* ; Consensus ; Root Canal Preparation/adverse effects*

Objective To study the nasal mucosa absorption of paeonol ofXingbi microemulsion-based thermo-sensitive gel in rats; To evaluate the nasal mucosa absorption of medicine and the rationality of preparation form.Methods According to the nasal administration method, the blood medicine concentration of paeonol was determined at different time points.Results The nasal administration bioavailability of paeonol in Xingbi microemulsion-based thermo-sensitive gel was 78.68%, the plasma concentration reached the maximum (0.3404 μg/mL) after 3 min of administration, and the average residence time was 9.23 h. After reaching Cmax, The plasma concentration changed similar to intravenous administration of paeonol. The concentration data of paeonol in plasma was consistent with a two-compartment model, with a weight of 1.Conclusion Xingbi microemulsion-based thermo- sensitive gel has a higher bioavailability, and the preparation form was reasonable.

Objective To investigate the clinical efficiency,safety,adverse reactions and healthrelated life quality of transdermal fentanyl patches for pain management in terminal cancer patients with hepatic and renal dysfunction and ascites.Methods 98 terminal cancer patients with moderate to serve pain combined with abnormal hepatic and renal dysfunction were randomly divided into two groups.Group Ⅰ (n=56)received transdermal fentany patches.Group Ⅱ,the control group (n=42),received morphine controlledrelease tablets.Terms of pain intensity,function of renal and liver,adverse reactions and heath-related quality of life were assessed before and after treatment.Results Patients were satisfied with their pain management in both groups,and no significant difference in pain release was observed between the groups (x2 =0.01,0.07,0.01,0.04,P ＞ 0.05).The incidences of constipation and dysuresia were significantly less in the group Ⅰ compared with that of the group Ⅱ (x2 =7.32,3.96,P ＜ 0.05).The incidences of hypersomnia,dizzy,nausea and vomiting were similar betwecn the two groups (x2 =0.12,0.54,0.54,0.02,P ＞ 0.05).Most of the adverse reactions would relieve or disappear after symptomatic treatment.Values of BUN,CR,ALT,AST were similar before and after treatment in group Ⅰ (t =1.43,1.67,0.91,0.11,P＞ 0.05).However,in group Ⅱ,these values were significantly increased after treatment (t =17.59,49.17,42.12,36.23,P ＜ 0.05).The heathrelated life quality (appetite,spirit,somnus,fatigue,daily life and countenance) were significantly improved after treatment in both groups (the group Ⅰ t =3.37,4.40,2.07,5.66,4.48,P ＜ 0.05; the group Ⅱ t =2.03,2.27,3.59,4.16,2.79,P ＜ 0.05),the spirit group Ⅰ improved more obviously compared with group Ⅱ (t =2.93,P ＜ 0.05).Conclusion Transdermal fentanyl patches provides equal pain relief compared with Morphine controlled-release tablets in the terminal cancer patients with abnormal hepatic and renal function and ascites.Transdermal fentanyl patches significantly improve health-related quality with less hepatic and renal function influence and low incidence of adverse reaction.It should be recommended in the treatment terminal cancer patients with moderate to serve pain combined with abnormal hepatic and renal function and ascites.