Apical microsurgery is accurate and minimally invasive, produces few complications, and has a success rate of more than 90%. However, due to the lack of awareness and understanding of apical microsurgery by dental general practitioners and even endodontists, many clinical problems remain to be overcome. The consensus has gathered well-known domestic experts to hold a series of special discussions and reached the consensus. This document specifies the indications, contraindications, preoperative preparations, operational procedures, complication prevention measures, and efficacy evaluation of apical microsurgery and is applicable to dentists who perform apical microsurgery after systematic training.
Microsurgery/standards* ; Humans ; Apicoectomy ; Contraindications, Procedure ; Tooth Apex/diagnostic imaging* ; Postoperative Complications/prevention & control* ; Consensus ; Treatment Outcome

Pulpotomy, which belongs to vital pulp therapy, has become a strategy for managing pulpitis in recent decades. This minimally invasive treatment reflects the recognition of preserving healthy dental pulp and optimizing long-term patient-centered outcomes. Pulpotomy is categorized into partial pulpotomy (PP), the removal of a partial segment of the coronal pulp tissue, and full pulpotomy (FP), the removal of whole coronal pulp, which is followed by applying the biomaterials onto the remaining pulp tissue and ultimately restoring the tooth. Procedural decisions for the amount of pulp tissue removal or retention depend on the diagnostic of pulp vitality, the overall treatment plan, the patient's general health status, and pulp inflammation reassessment during operation. This statement represents the consensus of an expert committee convened by the Society of Cariology and Endodontics, Chinese Stomatological Association. It addresses the current evidence to support the application of pulpotomy as a potential alternative to root canal treatment (RCT) on mature permanent teeth with pulpitis from a biological basis, the development of capping biomaterial, and the diagnostic considerations to evidence-based medicine. This expert statement intends to provide a clinical protocol of pulpotomy, which facilitates practitioners in choosing the optimal procedure and increasing their confidence in this rapidly evolving field.
Humans ; Calcium Compounds/therapeutic use* ; Consensus ; Dental Pulp ; Dentition, Permanent ; Oxides/therapeutic use* ; Pulpitis/therapy* ; Pulpotomy/standards*

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*

AIM:Study on the bioequivalence of rivaroxaban tablets from two different manufactur-ers in healthy subjects under fasting and postpran-dial conditions.METHODS:Adopting a single cen-ter,randomized,open,fasting and postprandial,four cycle,fully repeated crossover trial design.28 healthy male and female subjects were given oral administration of either the test or reference for-mulation(10 mg)on an empty stomach or in a post-prandial state,with a cleaning period of 7 days be-tween cycles.The concentration of rivaroxaban in the plasma(heparin sodium)of the subjects was measured using liquid chromatography tandem mass spectrometry(LC-MS/MS),and pharmacoki-netic(PK)parameters were calculated using Phoe-nix WinNonlin 7.0 software to evaluate the bio-equivalence of the test and reference formulations.RESULTS:Fasting group:After oral administration of the investigational drug,the Cmax of the test formula-tion and reference formulation were(200.96±68.99)ng/mL and(196.96±50.97)ng/mL,respec-tively,and the AUC0-t were(1 439.93±493.94)h·ng·mL-1 and(1 395.90±411.49)h·ng·mL-1,respectively,the AUC0-∞ were(1 506.56±511.47)h·ng·mL-1 and(1 451.94±417.89)h·ng·mL-1,respectively,the 90％confidence intervals for the geometric mean ratios of Cmax,AUC0-t,and AUC0-∞ were 91.87％-103.37％,95.00％-105.07％,95.33％-105.57％,respectively,the 90％CI of the intra-individual standard devia-tion ratio(SWT/SWR)for Cmax,AUC0-t,AUC0-∞were 0.88-1.73,0.74-1.45 and 0.72-1.41,respectively.Post-prandial group:After oral administration of the ex-perimental drug,the Cmax of the test and reference formulations were(241.23±54.44)ng/mL and(226.54±48.04)ng/mL,respectively,and the AUC0-t were(1 383.26±437.05)h·ng·mL-1 and(1 333.54±372.53)h·ng·mL-1,respectively,the AUC0-∞ were(1 404.01±439.89)h·ng·mL-1 and(1 352.31±374.45)h·ng·mL-1,respectively,the 90％confi-dence intervals for the geometric mean ratios of Cmax,AUC0-t,and AUC0-∞ were 100.92％-110.50％,98.30％-108.31％,and 98.46％-108.39％,respective-ly,the 90％CI of the intra-individual standard devia-tion ratio(SWT/SWR)for Cmax,AUC0-t and AUC0-∞ were 0.63-1.29,0.78-1.61 and 0.79-1.61,respectively.CONCLUSION:Bioequivalence of the two prepara-tions in fasting and postprandial state in healthy subjects.

Objective:To analyze the relevant studies on fertility concerns intervention programs for breast cancer survivors of childbearing age, and identify the specific content, outcome indicators and intervention effects of intervention, in order to provide reference for clinical staff to implement relevant intervention.Methods:According to the research method of scope review, the studies on the fertility concerns with breast cancer patients of childbearing age in China National Knowledge Infrastructure, WanFang, VIP, China Biomedical Literature Database, CINAHL, PubMed, Cochrane Library, Web of Science etc. were searched. The search period was from database establishment to May 9, 2024. The included literature was classified and analyzed.Results:A total of 12 articles were included, 9 were randomized controlled trials, 2 were self-controlled before and after studies, and 1 was a prospective cohort study. Fertility concerns intervention programs included group fertility counseling centered on couples, fertility support based on a multidisciplinary team collaboration model, and fertility management based on "Internet + reproductive health". The duration of intervention was usually 4 or 24 weeks. The intervention had different effects on the level of fertility concerns, psychological state and marital status.Conclusions:At present, the intervention programs for fertility concerns of breast cancer survivors of childbearing age reflect the importance, professionalism, immediacy and interactivity, but China is in the initial stage, and there are still shortcomings in multidisciplinary teams, fertility referral system, and Internet platform construction. Future research should build a breast cancer fertility intervention program suitable for our country, and promote its application through the Internet.

Objective:To explore the effect of carboxylated polyamidoamine (PAMAM-COOH) in combination with magnesium ions on the remineralization ability of amorphous calcium phosphate (ACP) in inducing remineralization of dentin collagen fibers in a 50% ethanol solution.Methods:Forty-five intact third molars extracted for impaction reasons were obtained from the College & Hospital of Stomatology, Guangxi Medical University. Two types of demineralized dentin specimens were prepared: ①Fully demineralized dentin ( n=30), specimens were immersed in 17% ethylenediaminetetraacetic acid (EDTA) (pH=7.4) at room temperature for 14 days with daily solution refreshment; ②Partially demineralized dentin ( n=15), specimens were treated with 37% phosphoric acid gel (Ultra-Etch, Ultradent) for 15 seconds followed by thorough rinsing with deionized water. Three remineralization groups were established for demineralized dentin treatment: ①Control group, 50% ethanol solution; ②ACMP group, 50% ethanol solution containing amorphous magnesium calcium phosphate (ACMP); ③PAMAM-COOH/ACMP group, 50% ethanol solution incorporating carboxylated polyamidoamine dendrimer-modified ACMP (PAMAM-COOH/ACMP). The chemical composition of remineralization solutions was analyzed by Fourier-transform infrared spectrum (FTIR). The morphology and particle size distribution of nanoparticles were characterized using transmission electron microscope (TEM). The fully demineralized dentin specimens were treated with three different remineralization solutions (37 ℃ for 7 days) respectively. The mineralization of the dentin collagen fibers surface was observed using scanning electron microscope (SEM) and the distribution of minerals inside and outside the collagen fibers was examined by using TEM. The partially demineralized dentin specimens were treated with fluorescence-labeled remineralization solutions (37 ℃ for 7 days) respectively, followed by analysis using confocal laser scanning microscopy (CLSM) to quantitatively evaluate the penetration depth of the mineralization agents. Results:FTIR analysis confirmed the presence of characteristic absorption peaks corresponding to phosphate (PO 43-) groups, carbon-nitrogen bonds, and amide linkages in the PAMAM-COOH/ACMP nanocomposite. TEM observed that the PAMAM-COOH/ACMP nanoparticles exhibited an average particle size of (36.85±8.02) nm in an amorphous state. SEM observation indicates continuous mineral deposition on dentin collagen fibers in the PAMAM-COOH/ACMP group, while no mineral deposition in the control group and only minimal deposition in the ACMP group. TEM showed no mineral deposition inside or outside the collagen fibers in the control group, only external mineral deposition in the ACMP group, and high-density mineral deposition both inside and outside the fibers in the PAMAM-COOH/ACMP group. CLSM analysis revealed a statistically significant difference ( P<0.05) in the depth of mineralized substances entering dentin tubules between ACMP group and PAMAM-COOH/ACMP group. Conclusions:The remineralization system of 50% ethanol solution incorporating PAMAM-COOH/ACMP successfully achieved the internal and external mineralization of demineralized dentin collagen fibers.

Objective:To analyze the relevant studies on fertility concerns intervention programs for breast cancer survivors of childbearing age, and identify the specific content, outcome indicators and intervention effects of intervention, in order to provide reference for clinical staff to implement relevant intervention.Methods:According to the research method of scope review, the studies on the fertility concerns with breast cancer patients of childbearing age in China National Knowledge Infrastructure, WanFang, VIP, China Biomedical Literature Database, CINAHL, PubMed, Cochrane Library, Web of Science etc. were searched. The search period was from database establishment to May 9, 2024. The included literature was classified and analyzed.Results:A total of 12 articles were included, 9 were randomized controlled trials, 2 were self-controlled before and after studies, and 1 was a prospective cohort study. Fertility concerns intervention programs included group fertility counseling centered on couples, fertility support based on a multidisciplinary team collaboration model, and fertility management based on "Internet + reproductive health". The duration of intervention was usually 4 or 24 weeks. The intervention had different effects on the level of fertility concerns, psychological state and marital status.Conclusions:At present, the intervention programs for fertility concerns of breast cancer survivors of childbearing age reflect the importance, professionalism, immediacy and interactivity, but China is in the initial stage, and there are still shortcomings in multidisciplinary teams, fertility referral system, and Internet platform construction. Future research should build a breast cancer fertility intervention program suitable for our country, and promote its application through the Internet.

Objective:To explore the effect of carboxylated polyamidoamine (PAMAM-COOH) in combination with magnesium ions on the remineralization ability of amorphous calcium phosphate (ACP) in inducing remineralization of dentin collagen fibers in a 50% ethanol solution.Methods:Forty-five intact third molars extracted for impaction reasons were obtained from the College & Hospital of Stomatology, Guangxi Medical University. Two types of demineralized dentin specimens were prepared: ①Fully demineralized dentin ( n=30), specimens were immersed in 17% ethylenediaminetetraacetic acid (EDTA) (pH=7.4) at room temperature for 14 days with daily solution refreshment; ②Partially demineralized dentin ( n=15), specimens were treated with 37% phosphoric acid gel (Ultra-Etch, Ultradent) for 15 seconds followed by thorough rinsing with deionized water. Three remineralization groups were established for demineralized dentin treatment: ①Control group, 50% ethanol solution; ②ACMP group, 50% ethanol solution containing amorphous magnesium calcium phosphate (ACMP); ③PAMAM-COOH/ACMP group, 50% ethanol solution incorporating carboxylated polyamidoamine dendrimer-modified ACMP (PAMAM-COOH/ACMP). The chemical composition of remineralization solutions was analyzed by Fourier-transform infrared spectrum (FTIR). The morphology and particle size distribution of nanoparticles were characterized using transmission electron microscope (TEM). The fully demineralized dentin specimens were treated with three different remineralization solutions (37 ℃ for 7 days) respectively. The mineralization of the dentin collagen fibers surface was observed using scanning electron microscope (SEM) and the distribution of minerals inside and outside the collagen fibers was examined by using TEM. The partially demineralized dentin specimens were treated with fluorescence-labeled remineralization solutions (37 ℃ for 7 days) respectively, followed by analysis using confocal laser scanning microscopy (CLSM) to quantitatively evaluate the penetration depth of the mineralization agents. Results:FTIR analysis confirmed the presence of characteristic absorption peaks corresponding to phosphate (PO 43-) groups, carbon-nitrogen bonds, and amide linkages in the PAMAM-COOH/ACMP nanocomposite. TEM observed that the PAMAM-COOH/ACMP nanoparticles exhibited an average particle size of (36.85±8.02) nm in an amorphous state. SEM observation indicates continuous mineral deposition on dentin collagen fibers in the PAMAM-COOH/ACMP group, while no mineral deposition in the control group and only minimal deposition in the ACMP group. TEM showed no mineral deposition inside or outside the collagen fibers in the control group, only external mineral deposition in the ACMP group, and high-density mineral deposition both inside and outside the fibers in the PAMAM-COOH/ACMP group. CLSM analysis revealed a statistically significant difference ( P<0.05) in the depth of mineralized substances entering dentin tubules between ACMP group and PAMAM-COOH/ACMP group. Conclusions:The remineralization system of 50% ethanol solution incorporating PAMAM-COOH/ACMP successfully achieved the internal and external mineralization of demineralized dentin collagen fibers.

AIM:Study on the bioequivalence of rivaroxaban tablets from two different manufactur-ers in healthy subjects under fasting and postpran-dial conditions.METHODS:Adopting a single cen-ter,randomized,open,fasting and postprandial,four cycle,fully repeated crossover trial design.28 healthy male and female subjects were given oral administration of either the test or reference for-mulation(10 mg)on an empty stomach or in a post-prandial state,with a cleaning period of 7 days be-tween cycles.The concentration of rivaroxaban in the plasma(heparin sodium)of the subjects was measured using liquid chromatography tandem mass spectrometry(LC-MS/MS),and pharmacoki-netic(PK)parameters were calculated using Phoe-nix WinNonlin 7.0 software to evaluate the bio-equivalence of the test and reference formulations.RESULTS:Fasting group:After oral administration of the investigational drug,the Cmax of the test formula-tion and reference formulation were(200.96±68.99)ng/mL and(196.96±50.97)ng/mL,respec-tively,and the AUC0-t were(1 439.93±493.94)h·ng·mL-1 and(1 395.90±411.49)h·ng·mL-1,respectively,the AUC0-∞ were(1 506.56±511.47)h·ng·mL-1 and(1 451.94±417.89)h·ng·mL-1,respectively,the 90％confidence intervals for the geometric mean ratios of Cmax,AUC0-t,and AUC0-∞ were 91.87％-103.37％,95.00％-105.07％,95.33％-105.57％,respectively,the 90％CI of the intra-individual standard devia-tion ratio(SWT/SWR)for Cmax,AUC0-t,AUC0-∞were 0.88-1.73,0.74-1.45 and 0.72-1.41,respectively.Post-prandial group:After oral administration of the ex-perimental drug,the Cmax of the test and reference formulations were(241.23±54.44)ng/mL and(226.54±48.04)ng/mL,respectively,and the AUC0-t were(1 383.26±437.05)h·ng·mL-1 and(1 333.54±372.53)h·ng·mL-1,respectively,the AUC0-∞ were(1 404.01±439.89)h·ng·mL-1 and(1 352.31±374.45)h·ng·mL-1,respectively,the 90％confi-dence intervals for the geometric mean ratios of Cmax,AUC0-t,and AUC0-∞ were 100.92％-110.50％,98.30％-108.31％,and 98.46％-108.39％,respective-ly,the 90％CI of the intra-individual standard devia-tion ratio(SWT/SWR)for Cmax,AUC0-t and AUC0-∞ were 0.63-1.29,0.78-1.61 and 0.79-1.61,respectively.CONCLUSION:Bioequivalence of the two prepara-tions in fasting and postprandial state in healthy subjects.