Eyal Rosen's research while affiliated with Tel Aviv University and other places

Background The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3‐level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence‐based recommendations for the management of patients presenting with pulpal and apical disease. Aim To develop an S3‐level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss. Methods This S3‐level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert‐based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders. Results The S3‐level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re‐evaluations during and after treatment is stressed. Conclusion The first S3‐level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient's lifetime, according to the best comparative evidence currently available.

Diabetes is a global epidemic accompanied by impaired wound healing and increased risk of persistent infections and resistance to standard treatments. Therefore, there is an immense need to develop novel methods to specifically target therapeutics to affected tissues and improve treatment efficacy. This study aims to use enzyme‐responsive nanoparticles for the targeted delivery of an anti‐inflammatory drug, dexamethasone, to treat inflammation in diabetes. These nanoparticles are assembled from fluorescently‐labeled, dexamethasone‐loaded peptide‐polymer amphiphiles. The nanoparticles were injected in vivo, adjacent to labeled collagen membranes sub‐periosteally implanted on the calvaria of diabetic rats. Following their implantation, collagen membrane resorption is linked to inflammation, especially in hyperglycemic individuals. The nanoparticles showed strong and prolonged accumulation in inflamed tissue after undergoing a morphological switch into microscale aggregates. Significantly higher remaining collagen membrane area and less inflammatory cell infiltration were observed in responsive nanoparticles‐treated rats, compared to control groups injected with free dexamethasone and non‐responsive nanoparticles. These factors indicate improved therapeutic efficacy in inflammation reduction. These results demonstrate the potential use of enzyme‐responsive nanoparticles as targeted delivery vehicles for the treatment of diabetic and other inflammatory wounds. This article is protected by copyright. All rights reserved

Background: Endodontic-periodontal lesions may need surgical approach and the application of guided tissue regeneration (GTR) to be treated by a combined approach. Objectives: The aim of the present study was to evaluate the effects of GTR on the success (clinical and radiological healing) of teeth with endodontic-periodontal lesions treated by modern surgical endodontic treatment, by means of a systematic review of the literature. Methods: An exhaustive electronic (Medline, Embase and Scopus searched from inception to August 2020) and manual literature search combined with strict inclusion and exclusion criteria was undertaken to identify any clinical (prospective case series or comparative trials) studies that assessed the added benefit of GTR in modern surgical endodontic treatment of teeth with endodontic-periodontal lesions. The success of the treatment was assessed based on radiographic healing and clinical evaluations. The risk of bias of the identified studies was evaluated using the Cochrane's collaboration RoB 2.0 tool and the Joanna Briggs Institute (JBI) critical appraisal tools. Results: A systematic literature search for eligible reports retrieved three randomized controlled trials (RCTs) and one prospective single arm study with a total of 125 teeth in 125 subjects. One of the RCTs has a low risk of bias, while the other two raised some concerns, using the RoB 2.0 tool. Due to the heterogeneity of the results, it was not possible to perform a comparative meta-analysis and the results are presented in a narrative manner and by calculating pooled outcomes. Pooling together the data from all the included studies, the reported outcome was of complete healing in 58.4% of all cases, of scar tissue formation / incomplete healing in 24% of cases, of uncertain healing in 12.8% of cases, and of failure in 4.8% of all analyzed teeth, with a follow-up ranging from 12 to 60 months. Conclusions: The scientific evidence about the use of GTR in modern surgical endodontic treatment of endodontic-periodontal lesion is sparse, and the available results are derived from very heterogeneous studies, thus not permitting to clarify which is the most effective treatment option in these cases, also due to the absence of studies comparing GTR versus no GTR.

Objectives: Vertical root fractures (VRF) can be a major challenge in root canal treatment due to bacterial biofilms' colonization of the fractures. The aim of this study was to evaluate the histological bacterial penetration and proliferation after sealing the simulated VRF with different intracanal sealing materials using confocal laser scanning microscopy (CLSM). Materials and methods: Sixty extracted human single-rooted premolars were used, and VRFs were created after root canal preparation. The canals were filled with either mineral trioxide aggregate (MTA), gutta-percha (GP) with AH plus sealer, or GP with bioceramic (BC) sealer. Enterococcus faecalis bacterial infection was induced, and bacterial colonization was assessed in the dentinal tubules and simulated VRF. Results: In the MTA group, there were significantly more dead bacteria in the dentinal tubules than live bacteria. The AH group had significantly more live bacteria than dead bacteria, and there were significantly more bacteria in the AH group compared to the BC and MTA groups. The study also revealed that bacteria can colonize the simulated VRF, from the part of the fracture to the outer surface. Clinical relevance: Understanding the pathological process following VRF and evaluating the ability of the VRF filling to prevent bacterial migration through the filled root end is crucial. Furthermore, quantifying the exact routes of microbial colonization, at the filling-dentine interfaces, and into the dentinal tubules, can provide valuable information to clinicians for selecting the appropriate root canal filling material to minimize bacterial colonization and improve treatment outcomes.

This study aimed to evaluate the effect of general anesthesia (GA) on the 1-year outcome of Root Canal Treatment (RCT) performed in pediatric patients and to compare it to the outcome of RCT in pediatric patients without GA. Patients admitted for RCT in permanent dentition in a public hospital, dated 2015 to 2020, age 8–15 with a minimum of one year follow-up period, were included in the study. The sample consisted of 326 teeth from 269 patients treated by a single operator, with a recall rate of 81%. Overall, 124 teeth were treated under GA and 142 teeth were without GA. The mean follow-up time was 31.5 months. Data underwent statistical analysis and the significance threshold was set for p < 0.05. Of the total cases, 90% showed favorable outcomes. A significantly higher favorable outcome was seen in the GA group than in the non-GA group (98% and 85%, respectively, p < 0.001). The outcome was significantly affected by the type and quality of the coronal restoration, degree of root development, and lesion size (p < 0.05). According to the current study, in uncooperative pediatric patients, a more favorable outcome of root canal treatment can be obtained under GA than LA if the procedure is carried out with immediate restoration.

(1) The objective of the study is to conduct a comprehensive systematic review of in vitro studies in order to assess the depth to which E. faecalis bacteria penetrate human dentinal tubules after the use of various irrigation solutions. (2) Methods: A literature search of the MEDLINE, Scopus, Cochrane CENTRAL, and Embase databases was conducted, as well as a backward and forward citation search. Two independent reviewers then selected suitable studies based on inclusion and exclusion criteria. Data were extracted and the risk of bias and methodology of the studies were evaluated. (3) Results: Out of a total of 504 papers evaluated following the removal of duplicates, 7 studies met the inclusion criteria and were included in the systematic review. The heterogeneity of the studies made it impossible to perform a meta-analysis. The majority of the studies reported that sodium hypochlorite (NaOCl) and chlorhexidine digluconate (CHX) can affect the penetration depth of E. faecalis suspensions. The studies included in this review possess a moderate to high risk of bias and thus represent moderate evidence that the antimicrobial activity of NaOCl and CHX affects the intra-tubular penetration of bacteria. (4) Conclusions: The evidence indicates that irrigants may affect the bacteria inside human dentinal tubules. Standardized high-quality methods are needed to evaluate bacterial penetration in in vitro studies.

Objectives: The aim of this study was to assess the effect of the imaging modality on the evaluation of the outcome of modern surgical endodontic treatments, based on a systematic review of the literature. Methods: Strict inclusion criteria were adopted in order to identify studies that assessed the outcome of surgical endodontic treatments. Treatment success rates were pooled. The effect of the imaging modality used for the outcome assessment, and the methodological quality of the studies (based on the risk of bias (ROB), were evaluated. Results: Nineteen articles were included. The success rates assessed by periapical (PA) radiography were significantly higher than when cases were evaluated by cone beam computed tomography (CBCT; 90 and 35% respectively). This difference was mainly due to a significant proportion of cases that were assessed by CBCT as uncertain healing (48%) compared to only 4% using PA. The success rates ranged between 86-92% in low ROB studies, and between 19-100% in high ROB studies. Conclusions: Outcome assessment based on CBCT may lead to significantly lower estimates of rate of success, and higher rates of uncertain healing, thus presenting a dilemma in the decision-making following surgical endodontic treatment. The success rates of studies with lower methodological quality are more variable than for high quality studies.

The physiology of an organism in the environment reflects its interactions with the diverse physical, chemical, and biological properties of the surface. These principles come into consideration during model selection to study biofilm–host interactions. Biofilms are communities formed by beneficial and pathogenic bacteria, where cells are held together by a structured extracellular matrix. When biofilms are associated with a host, chemical gradients and their origins become highly relevant. Conventional biofilm laboratory models such as multiwall biofilm models and agar plate models poorly mimic these gradients. In contrast, ex vivo models possess the partial capacity to mimic the conditions of tissue-associated biofilm and a biofilm associated with a mineralized surface enriched in inorganic components, such as the human dentin. This review will highlight the progress achieved using these settings for two models of persistent infections: the infection of the lung tissue by Pseudomonas aeruginosa and the infection of the root canal by Enterococcus faecalis. For both models, we conclude that the limitations of the conventional in vitro systems necessitate a complimentary experimentation with clinically relevant ex vivo models during therapeutics development.

Background: Apart from non-surgical root canal treatment or retreatment, apical surgery may be carried out to manage teeth with apical periodontitis. However, it is unclear which treatment option is more effective. Objective: To systematically review the effectiveness of apical surgery compared with non-surgical treatment or retreatment in terms of clinical and patient-related outcomes in teeth with apical periodontitis. Methods: A literature search of electronic databases, the grey literature, the reference lists of included articles and previous reviews, and a hand search of leading endodontic journals, was conducted. Randomised and non-randomised control trials, and longitudinal observational studies on patients undergoing surgical (treatment group) and non-surgical root canal treatment or retreatment (control group) of teeth with apical periodontitis were included. The risk of bias was appraised using the Cochrane risk-of-bias tool; ROBINS-I and the Newcastle-Ottawa Scale. Results: Five studies, consisting of two randomised clinical trials, two non-randomised clinical trials, and a retrospective cohort study, were included. The interobserver agreement was high and kappa correlation coefficient was good. In total 529 teeth were available for follow-up that varied from 6 months to 8.7 years. The overall risk of bias was high for four studies and raised some concerns in one study. Apical surgery showed seemly better results regarding periapical healing and less need for more and further intervention, although tooth survival was higher in the control group. Given the heterogeneity of the studies, meta-analysis was not possible. Discussion: Previous systematic reviews have conducted an indirect comparison by separately pooling the outcomes of studies analysing either non-surgical, or surgical, treatment. In this systematic review, only studies that compared both treatments were included. Most results of this and previous reviews were similar. Conclusion: No treatment option showed clear superiority. However, to arrive at statistically supported conclusions there is a need for additional high-quality comparative trials.