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*

Enamel demineralization, the formation of white spot lesions, is a common issue in clinical orthodontic treatment. The appearance of white spot lesions not only affects the texture and health of dental hard tissues but also impacts the health and aesthetics of teeth after orthodontic treatment. The prevention, diagnosis, and treatment of white spot lesions that occur throughout the orthodontic treatment process involve multiple dental specialties. This expert consensus will focus on providing guiding opinions on the management and prevention of white spot lesions during orthodontic treatment, advocating for proactive prevention, early detection, timely treatment, scientific follow-up, and multidisciplinary management of white spot lesions throughout the orthodontic process, thereby maintaining the dental health of patients during orthodontic treatment.
Humans ; Consensus ; Dental Caries/etiology* ; Dental Enamel/pathology* ; Tooth Demineralization/etiology* ; Tooth Remineralization

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*

The prevalence of Class III malocclusion varies among different countries and regions. The populations from Southeast Asian countries (Chinese and Malaysian) showed the highest prevalence rate of 15.8%, which can seriously affect oral function, facial appearance, and mental health. As anterior crossbite tends to worsen with growth, early orthodontic treatment can harness growth potential to normalize maxillofacial development or reduce skeletal malformation severity, thereby reducing the difficulty and shortening the treatment cycle of later-stage treatment. This is beneficial for the physical and mental growth of children. Therefore, early orthodontic treatment for Class III malocclusion is particularly important. Determining the optimal timing for early orthodontic treatment requires a comprehensive assessment of clinical manifestations, dental age, and skeletal age, and can lead to better results with less effort. Currently, standardized treatment guidelines for early orthodontic treatment of Class III malocclusion are lacking. This review provides a comprehensive summary of the etiology, clinical manifestations, classification, and early orthodontic techniques for Class III malocclusion, along with systematic discussions on selecting early treatment plans. The purpose of this expert consensus is to standardize clinical practices and improve the treatment outcomes of Class III malocclusion through early orthodontic treatment.
Humans ; Malocclusion, Angle Class III/classification* ; Orthodontics, Corrective/methods* ; Consensus ; Child

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 explore the material basis of the anti-inflammatory effect of the petroleum ether extract from Melastoma dodecandrum by establishing its fingerprint and combining it with cellular pharmacodynamics experiments. METHODS HPLC method was adopted； the fingerprints of 20 batches of petroleum ether extract from M. dodecandrum were drawn using The Similarity Evaluation System of TCM Chromatographic Fingerprint （2012 edition）； similarity evaluation and common peak identification were carried out. The lipopolysaccharide-induced inflammation model of mice mononuclear macrophages （RAW264.7） was established； the inhibitory rates of nitric oxide （NO） and tumor necrosis factor α （TNF-α） were used as indexes to investigate the anti-inflammatory activity of the petroleum ether extract from M. dodecandrum； grey correlation degree method and partial least square regression analysis were adopted to study the spectrum-effect relationship. Molecular docking was used to validate the binding activity of the anti-inflammatory active ingredients with TNF-α and iNOS protein receptor. RESULTS There were 19 common peaks in the fingerprint of the petroleum ether extract from M. dodecandrum， the similarity of 20 batches of samples ranged from 0.603-0.990， and five components were identified， such as vitexin （peak 5）， isovitexin （peak 6）， ellagic acid （peak 7）， quercetin （peak 9） and luteolin （peak 10）. The grey correlation degree between 19 common peaks of the petroleum ether extract from M. dodecandrum and the inhibition rates of NO and TNF-α were all greater than 0.7； peaks 19， 13， 9 （quercetin）， 12， 5 （vitexin）， 6 （isovitexin）， 8， 7 （ellagic acid）， 18， 1 were positively correlated with NO inhibition rate， and peaks 8， 10 （luteolin）， 13， 15， 3， 19， 17， 7 （ellagic acid）， 18， 1 were positively correlated with inhibition rate of TNF-α. The binding energies of vitexin， isovitexin and quercetin with iNOS protein receptor were less than －5.0 kcal/mol. CONCLUSIONS Vitexin， isovitexin and quercetin may be the basis of the anti-inflammatory effect of the petroleum ether extract from M.dodecandrum.

Objective:To discuss the effect of long-term use of chlorhexidine on the resistance of Enterococcus faecalis(E.faecalis),and to clarify its mechanism.Methods:The standard strain of E.faecalis was repeatedly exposed to chlorhexidine for 10 generations,and the minimum inhibitory concentration(MIC)was recorded at each passage.The bacteria collected from the 10th generation with increased MIC values were designated as the E.faecalis chlorhexidine-resistant strains(E.faecalis-Cs).The growth curves of two strains were drawn;the morphology of two strains were observed by transmission electron microscope;the number of biofilm formation of two strains was detected by crystal violet staining;the bacterial hydrophobicities of two strains were detected by microbial adhesion to hydrocarbons(MATH)method;the expression levels of S-ribosylhomocysteine lyase(LuxS)mRNA in the bacterial biofilms of two strains were detected by real-time fluorescence quantitative PCR(RT-qPCR)method.Results:From the 0th to the 10th generation,the MIC values of E.faecalis were gradually increased.The growth curves of E.faecalis and E.faecalis-Cs showed no significant differences.The transmission electron microscope observation results showed that both E.faecalis and E.faecalis-Cs appeared oval or diplococcal,with intact cell wall structures,smooth edges,and evenly distributed cytoplasm.There were no significant differences in the morphology,size,cell wall thickness,or integrity between two types of bacteria.The crystal violet staining results showed that compared with E.faecalis,the number of biofilm formation of E.faecalis-Cs was significantly increased(P<0.05).The MATH results showed tha the hydrophobicity of E.faecalis-Cs was significantly higher than that of E.faecalis(P<0.05).The RT-qPCR results showed that the expression level of LuxS mRNA in the biofilms of E.faecalis-Cs was significantly higher than that of E.faecalis(P<0.05).Conclusion:E.faecalis develops the resistance after repeated exposure to the chlorhexidine,and the pathogenicity of the resistant strain is enhanced.The high expressin of quorum sensing(QS)system LuxS gene and stronger biofilm forming ability of bacteria may be the potential mechanism for E.faecalis to tolerate the chlorhexidine.

Wound infections, secondary to acute and chronic wounds caused by mechanical, thermal, chemical factors, etc, not only delay wound healing but also may lead to mortality. The prolonged or inappropriate use of antibiotics lead to the growth of drug-resistant bacteria, resulting in refractory wound infections and poor treatment outcomes, which highlights the urgent need for effective therapies. Bacteriophages show great promise in treating drug-resistant wound infections due to their effectiveness in killing drug-resistant bacteria, their good resistance against bacterial biofilm (BBF) and their absence of cytotoxicity to eukaryotic cells. However, the mechanisms underlying bacteriophages′ resistance against BBF remain incompletely understood and their antibacterial efficacy for wound infections may also vary. For this purpose, the authors reviewed the biological characteristics and mechanisms of bacteriophages and their application in antibacterial therapies for wound infections, aiming to provide a reference for further research and application of bacteriophages in the treatment of wound infections.