American Association of Endodontists

A chronic apical abscess is an endodontic condition commonly characterized by the presence of a notable sinus tract through which pus periodically discharges. In general, these cases can be considered ‘straight forward’ to diagnose but on some occasions, diagnosis can be challenging. Any misdiagnosis can compromise the treatment approach for the patient and lead to adverse outcomes such as unnecessary biopsies or referrals. Therefore, clinicians should follow a meticulous treatment approach consisting of appropriate diagnostic measures to establish the correct diagnosis and treatment pathway. CPD/Clinical Relevance: Misdiagnosis of challenging cases can result in inappropriate treatment, especially where odontogenic infections mimic precancerous/cancerous skin lesions.

IntroductionUnprofessional conduct in clinical education refers to behaviours that deviate from accepted professional norms. These behaviours undermine learner well-being, patient dignity, and the development of professional identity. Findings from previous literature suggest that unprofessional conduct is common in Pakistani clinical training and may be reinforced within clinical environments, potentially through the influence of negative elements of the hidden curriculum. While individual incidents are often reported, less is known about how institutional and system-level factors interact to normalise or hinder mistreatment in low-resource clinical education settings. Therefore, this study aimed to explore final-year medical and dental students' perceptions of shared, system-level drivers of unprofessional conduct during clinical rotations, with the goal of producing practice-oriented recommendations for clinical education.MethodologyThis interpretive description study was conducted at a private medical and dental college in Multan, Pakistan. Participants were recruited with purposive sampling that included final-year Bachelor of Medicine, Bachelor of Surgery (MBBS) and Bachelor of Dental Surgery (BDS) students who had completed clinical rotations and consented to audio-recording. Data collection continued until interpretive sufficiency was reached. Semi-structured, in-depth interviews were conducted face-to-face using a pilot-tested, expert-validated guide. Recordings were transcribed manually, and data were analysed using iterative immersion, open coding, constant comparison, development of analytic categories, and construction of higher-order themes consistent with interpretive description.ResultsInterviews revealed five interrelated thematic patterns: (1) hierarchy and power, including unchecked senior authority, social bias, and unfair treatment with paramedical staff; (2) hidden curriculum and norms, including silence and obedience, compensatory acts by clinicians, haphazard training, and informal practices that contradicted formal professionalism teaching; (3) systemic pressures and drivers, including excessive patient loads, resource scarcity and dual-practice incentives which shifted faculty priorities away from clinical teaching and promoted expedient, and instrumental behaviours; (4) challenges to patient-centred practice, where patients were often objectified during teaching, with inadequate communication, privacy breaches, and gendered biases; and (5) student impact and coping, where exposure to unprofessional conduct produced shame, moral distress, and withdrawal, while some students expressed a strong desire for institutional change. Together, these themes indicate that unprofessional behaviour is systemically embedded and socially learned rather than solely individual failings.ConclusionsUnprofessional conduct during clinical rotations reflects the combined influence of unregulated power, negative role-modelling in hidden curricula, and system-level constraints rather than isolated individual failings. Addressing these issues requires institutional strategies that protect teaching time, promote respectful supervision, and provide safe, confidential reporting mechanisms. Such approaches can strengthen learner well-being, uphold patient dignity, and reinforce professionalism in clinical education.

Cone-beam computed tomography (CBCT) has become an integral part of endodontic diagnosis and treatment, with voxel size being a critical parameter affecting spatial resolution and diagnostic outcomes. This systematic review and meta-analysis examined the effect of voxel size on the diagnostic outcome of CBCT images for root canal anatomy assessment. A search was conducted in PubMed, Web of Science, Embase, and Scopus databases without date restrictions. Studies comparing different CBCT voxel sizes for root canal anatomy evaluation using quantitative diagnostic outcomes were included. Two reviewers independently performed study selection, data extraction, and quality assessment using QUADAS-2. Meta-analysis was conducted using random-effects models with subgroup analysis by voxel size categories (≤ 125 μm and > 125 μm). Fifteen studies met the inclusion criteria, evaluating voxel sizes from 75 to 400 μm across various anatomical structures. Seven studies were included in the meta-analysis. Individual studies consistently demonstrated improved visualisation with smaller voxel sizes, particularly for larger structures such as second mesiobuccal canals in maxillary molars. Overall pooled diagnostic accuracy was 80% (95% CI: 75%-84%) with substantial heterogeneity (I2 = 86.74%). Subgroup analysis showed diagnostic accuracy of 75% (95% CI: 68%-82%) for voxel sizes > 125 μm and 85% (95% CI: 80%-90%) for voxel sizes ≤ 125 μm. The difference between the two groups was statistically significant (p = 0.002). Moreover, meta-regression showed a statistically significant association between voxel size and diagnostic accuracy (p = 0.0086). The current study's findings suggest that there is an association between reducing the voxel size and enhancing the diagnostic outcome of CBCT images in assessing root canal anatomy. Although the meta-regression showed a statistically significant correlation, the results should be interpreted cautiously because of methodological heterogeneity, the complex interplay of imaging parameters beyond voxel size alone, and the lack of clinical studies. Future research should focus on standardised clinical studies to examine the impact of voxel size on the diagnostic outcome of CBCT images.

Mineral trioxide aggregate is widely used for apexification in immature permanent teeth owing to sealing ability and biocompatibility; however, placement in teeth with open apices may result in void, potentially compromising the apical seal. This study compared mineral trioxide aggregate (MTA) apical plug quality and procedural time among 3 placement techniques. Thirty extracted human mandibular premolars with simulated open apices (apical diameter, 0.8 mm) were randomly assigned to 3 groups (n = 10). Four-millimeter MTA apical plugs were placed using manual condensation, indirect ultrasonic activation, or sonic-activated rotary compaction. Micro-computed tomography quantified closed porosity (internal voids) and open porosity (interfacial gaps) as percentages of total apical plug volume. Procedural time was recorded, and data were analyzed statistically. Sonic-activated rotary compaction produced the lowest open porosity (0.001% ± 0.001%) and shortest procedural time (160.00 ± 6.50 s) but resulted in the highest closed porosity (0.412% ± 0.076%). Manual condensation demonstrated the highest open porosity (0.122% ± 0.063%) and moderate closed porosity (0.108% ± 0.076%), whereas indirect ultrasonic activation showed intermediate open porosity (0.006% ± 0.002%) and lowest closed porosity (0.079% ± 0.030%). Importantly, closed porosity did not differ significantly between the manual and ultrasonic groups (P = .523). Indirect ultrasonic activation required the longest procedural time (270.30 ± 7.27 s), followed by manual condensation (229.20 ± 6.34 s), whereas sonic-activated rotary compaction was the most time-efficient. All other intergroup differences were statistically significant (P < .001). Sonic-activated rotary compaction demonstrated the lowest open porosity and greatest time efficiency among 3 techniques, although it produced the highest closed porosity.

The meeting point of AI and Cloud Computing is changing the way we approach web development as we allow applications to scale and adapt to meet web's demand in ways we haven't been able to before. This article delves into how data-driven generative AI is revolutionizing the next-generation web development process in the US. Through integrating AI models like GPT, Codex and DALL•E with cloud-native platforms, including AWS, Azure and Google Cloud, developers are now seeing significant uplift in performance, efficiency and deployment agility. Empirical data collected from 150 tech companies operating in the USA show that with generative AI, deployment speeds surge 4x, developer productivity jumps 65% and content generation workflows run 3.5x faster. Additionally, a real-world impact is also demonstrated in the 80% cut in manual testing and 70% improved real-time user personalization accuracy that is realized in AI-enriched development environments. The work also identifies a reduction of 60% in infrastructure costs by BRAIN intelligent cloud orchestration, and 92% of surveyed organizations planning investment in AI-cloud strategies until 2026. By means of use case examples and performance test, we provide a full-fledged framework using generative AI and the cloud computing to develop intelligent, responsive, and scalable web applications that support emerging user requirements in the digital economy.

The fracture of nickel-titanium (NiTi) rotary files may be considered a direct cause of endodontic treatment failure. This study aimed to evaluate the effect of alloy type and fragment length on the efficiency of fractured file removal under standardized simulated conditions. Simulated J-shape canal blocks were shaped up to ProTaper Gold F2 size. The file tips of ProTaper Gold (PTG) F2 and ProTaper Universal (PTU) F2 files were artificially sectioned to make the fragments of 3-mm and 4-mm, respectively (n = 25 for each system and fragment length). The file fragments were positioned 1.5 mm coronally from the apical end of the simulated canal. The file fragments were retrieved using Gates-Glidden drills and ultrasonic instruments at a single optimized power setting. Retrieval time, defined as the duration from ultrasonic activation until fragment removal, was recorded. Statistical analysis evaluated the effects of alloy type and fragment length with a significance level of 95%. For 3-mm fragments, the PTU files demonstrated significantly faster retrieval times than the PTG files (p < 0.05). However, no significant difference in retrieval time was found between PTG and PTU files for 4-mm fragments. Regardless of the file alloy types, the 3-mm fragments were removed in a significantly shorter time than the 4-mm fragments (p < 0.05). Under controlled resin model conditions, both fragment length and alloy type significantly influence fractured NiTi file retrieval efficiency.

Objective:This prospective cohort study evaluated the interrelationship between pain alleviation, chewing efficiency, and anxiety reduction following root canal treatment (RCT) to establish a comprehensive “triad of success” framework for patient-centered outcomes.Materials and Methods:In total, 150 patients undergoing single-rooted RCT were assessed preoperatively and at 24 h, 48 h, 7 days, and 30 days post-treatment. Pain was measured using a 100-mm visual analog scale (VAS), chewing efficiency via VAS, and anxiety using the Modified Dental Anxiety Scale (MDAS). Statistical analysis included repeated-measures ANOVA, paired t-tests, and multivariate regression.Results:Pain scores demonstrated significant reduction from 42.3 mm (±12.1) at 24 h to 3.1 mm (±2.8) at 30 days (F = 286.4, P < 0.001), with 92% achieving mild/no pain by 30 days. Chewing efficiency improved from 4.2 to 8.1 (mean - 3.9, P < 0.001; d = 1.2), while anxiety decreased from 14.7 to 8.3 MDAS (mean - 6.4, P < 0.001; d = 1.8). Regression analysis (R2 = 0.61) identified chewing improvement as the strongest satisfaction predictor (β = 0.42, P < 0.001), followed by negative associations with preoperative anxiety (β = −0.38, P < 0.001) and 48 h pain (β = −0.29, P < 0.001).Conclusion:Successful RCT achieves significant, clinically meaningful improvements across pain, function, and psychological domains. The identified “triad of success” provides clinicians with evidence-based targets for optimizing patient care, emphasizing the importance of addressing both biological and psychosocial aspects of endodontic treatment.

Aim: This study aimed to ascertain the adherence of commercially available gutta-percha cone sizes 25 and 30 (with 0.02 and 0.04 taper) to the current ISO standard, focusing on variability in tip diameter and taper rather than comparing brands. Methods &amp; Materials: Ten cones each of size #25 and #30 with 0.02 taper from four brands, and 0.04 taper from six brands, were conditioned for 24 hours at 23±2 C and 50±5% relative humidity. Samples were blinded, grouped randomly, and assigned serial numbers. A single chief investigator measured D , D , and D diameters using a digital stereoscopic microscope. Raw data was then decoded and statistically analysed. 0 3 16 Results: A large proportion of samples in both 0.02 and 0.04 taper groups did not conform to the exact D diameter, with high percentages of 0 incorrect measurements, some statistically significant. While mean tapers across all brands approximated manufacturer specifications, significant variability existed within individual groups. Despite this variability, all diameter and taper measurements complied with the ANSI/ADA specification due to high diameter tolerance values and the absence of taper tolerance values. Substantial variability in Conclusion: diameter and taper was found both within and between gutta-percha brands. However, this variability was deemed compliant with ANSI/ADA No. 78 due to broad diameter tolerance and no specified taper tolerance. The study concludes that practitioners should anticipate variations, and recommend narrower tip diameter tolerance and inclusion of taper tolerance in specifications to ensure more precise manufacturing.