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*

Objective To explore the effect of Liraglutide(Lir)combined with intravenous thrombolysis on neurological function and prognosis in acute cerebral infarction patients with type 2 diabetes mellitus(T2DM).Methods Totally 137 acute cerebral infarction patients with T2DM were randomly divided into Lir group(69 cases)and Ins group(68 cases).The Ins group was treated with insulin aspart combined with insulin glargine,while the Lir group was treated with Lira combined with insulin glargine.The scores of National Institutes of Health stroke scale(NIHSS)and modified Rankin scale(mRS)were compared between the two groups before and 3 months after treatment.Outpatient follow-up of the two groups was performed to record the recurrence of cerebral infarction and the time.Results After treatment,the scores of NIHSS[(6.51±1.91)vs(8.77±2.03)]and mRS[(2.07±0.58)vs(2.44±0.78)]of Lir group were lower than Ins group(P<0.05).The recurrence risk of cerebral infarction in Lir group was lower than that in Ins group(6.5%vs 22.1%,P<0.05).Conclusions The treatment of Lir combined with intravenous thrombolysis can effectively reduce neurological deficits and the recurrence risk in acute cerebral infarction patients with T2DM.

Tooth development is a complex biomineralization process formed through the interaction between epithelial tissue and mesenchymal tissue. The Ca 2+ transport channel is the intrinsic regulatory mechanism of this process, which regulates the concentration of Ca 2+ inside and outside the cell in time and space, thereby affecting the biological functions of various cells and the growth of extracellular hydroxyapatite. This article reviews the researches on the effects of Ca 2+ transport in tooth biomineralization and corresponding cell development in recent years, with the aim of providing ideas and basis for the prevention of tooth developmental defects, assisting in early clinical diagnosis, and improving treatment methods.

Tooth development is a complex biomineralization process formed through the interaction between epithelial tissue and mesenchymal tissue. The Ca 2+ transport channel is the intrinsic regulatory mechanism of this process, which regulates the concentration of Ca 2+ inside and outside the cell in time and space, thereby affecting the biological functions of various cells and the growth of extracellular hydroxyapatite. This article reviews the researches on the effects of Ca 2+ transport in tooth biomineralization and corresponding cell development in recent years, with the aim of providing ideas and basis for the prevention of tooth developmental defects, assisting in early clinical diagnosis, and improving treatment methods.

Objective To explore the effect of Liraglutide(Lir)combined with intravenous thrombolysis on neurological function and prognosis in acute cerebral infarction patients with type 2 diabetes mellitus(T2DM).Methods Totally 137 acute cerebral infarction patients with T2DM were randomly divided into Lir group(69 cases)and Ins group(68 cases).The Ins group was treated with insulin aspart combined with insulin glargine,while the Lir group was treated with Lira combined with insulin glargine.The scores of National Institutes of Health stroke scale(NIHSS)and modified Rankin scale(mRS)were compared between the two groups before and 3 months after treatment.Outpatient follow-up of the two groups was performed to record the recurrence of cerebral infarction and the time.Results After treatment,the scores of NIHSS[(6.51±1.91)vs(8.77±2.03)]and mRS[(2.07±0.58)vs(2.44±0.78)]of Lir group were lower than Ins group(P<0.05).The recurrence risk of cerebral infarction in Lir group was lower than that in Ins group(6.5%vs 22.1%,P<0.05).Conclusions The treatment of Lir combined with intravenous thrombolysis can effectively reduce neurological deficits and the recurrence risk in acute cerebral infarction patients with T2DM.

Endodontic diseases are a kind of chronic infectious oral disease.Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha.However,it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy(RCT).Recent research,encompassing bacterial etiology and advanced imaging techniques,contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT.Success in RCT hinges on factors like patients,infection severity,root canal anatomy,and treatment techniques.Therefore,improving disease management is a key issue to combat endodontic diseases and cure periapical lesions.The clinical difficulty assessment system of RCT is established based on patient conditions,tooth conditions,root canal configuration,and root canal needing retreatment,and emphasizes pre-treatment risk assessment for optimal outcomes.The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT.These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

The overall health condition of patients significantly affects the diagnosis,treatment,and prognosis of endodontic diseases.A systemic consideration of the patient's overall health along with oral conditions holds the utmost importance in determining the necessity and feasibility of endodontic therapy,as well as selecting appropriate therapeutic approaches.This expert consensus is a collaborative effort by specialists from endodontics and clinical physicians across the nation based on the current clinical evidence,aiming to provide general guidance on clinical procedures,improve patient safety and enhance clinical outcomes of endodontic therapy in patients with compromised overall health.