Rampant caries is an advanced and severe dental disease that affects multiple teeth. This case describes the management of rampant caries in a young teenager suffering from chronic oral graft versus host disease after allogeneic bone marrow transplantation.

Cheung AW, et al. Restor Dent Endod. 2020 Dec;46:e10. https://doi.org/10.5395/rde.2021.46.e10

Minimally invasive endodontic access cavities have gained popularity in academic discussions for their clinical applications in recent years. Although some studies showed an improved fracture resistance of endodontically-treated teeth accessed with a minimally invasive access cavity design, the resulting effectiveness and efficiency of subsequent root canal treatment procedures may be impaired. Aspects that may be impaired are canal detection and negotiation, chemomechanical debridement of the root canal system, quality of the obturation. These are potentially complicated by the increased incidence of procedural mishaps and compromised aesthetic outcomes. In addition, the inherent flaws presented in the methodology of some in vitro studies and the lack of a universal classification system are also of concern. This literature review aims to present a comprehensive overview of the development of the minimally invasive endodontic access cavity and summarise the currently available from a clinical context. (EEJ-2021-05-091)

Cemental tears are an important condition of relevance to Endodontics but are often overlooked. A cemental tear is the partial or complete detachment of the cementum from the cemento‐dentinal junction or along the incremental line within the body of cementum. The limited attention received is most likely due to the limited awareness amongst dental professionals and challenges in accurately diagnosing them, resulting in misdiagnosis and erroneous treatment. The aim of this review is to describe the: (i) epidemiology and predisposing factors; (ii) clinical, radiographic and histological features and (iii) the clinical management and treatment outcomes of cemental tear. The review included 37 articles published in English that comprised eight observational studies and 29 case reports. The prevalence of cemental tears was reported to be lower than 2%; whilst the incidence remains unknown.Internal factorsdue to the inherent structural weakness of cementum and its interface with the dentine, andexternal factorsthat are associated withstresshave been proposed as the two mechanisms responsible for the development and propagation of cemental tears. Predisposing factors that have been implicated weretooth type,gender,age,previous root canal treatment,history of dental trauma,occlusal trauma and excessive occlusal force; however, evidence is limited. Common clinical and radiographic manifestations of cemental tears resemble the presentations of primary endodontic diseases, primary periodontal diseases and combined endodontic–periodontal lesions. Clinical management tended to focus on complete removal of the torn fragments and periodontal treatment, often combined with regenerative treatment. In this article, a new classification for cemental tears is developed that consists ofclasses 0to6andstages A,B,CandDbased on the: (i) location and accessibility of the torn cemental fragment; (ii) the pattern and extension of the associated bony defect in relation to the root length and (iii) the number of root surface/s affected by the cemental tear/s and the associated bony defect. Recommendations for treatment strategies are also provided and linked to the classification to aid in streamlining the process of treatment decision making.

Cone-beam computed tomography (CBCT) has transformed endodontic practice by enabling more precise diagnosis and treatment of pulpal and apical pathologies. The aim of this review was to summarize the current clinical applications, benefits and limitations of CBCT in endodontic practice. A search of electronic databases identified relevant literature on CBCT applications, innovations, and limitations. Emphasis was placed on identifying contemporary studies published in the last 5 years. In general, CBCT demonstrates better diagnostic efficacy across multiple applications, including identifying complex anatomy, detection of apical periodontitis, pre-surgical planning and the diagnosis and management of longitudinal root fractures, traumatic dental injuries and root resorptions. However, clinicians should balance the benefits of CBCT against its shortcomings, such as increased radiation exposure, presence of artifacts and higher costs. Proper use requires adherence to guidelines, optimized machine settings, and interpretation by trained individuals. Recent research explores the integration of CBCT with emerging technologies like artificial intelligence and guided systems. In summary, CBCT remains an essential tool for clinical decision-making in endodontics when used judiciously, with ongoing research continuing to expand its potential applications.

Objective: Teixobactin and its analogues are a new class of antibiotics that have no detectable bacterial resistance. This study was designed to determine the antibacterial and antibiofilm activities of a novel teixobactin analogue, _L-Chg₁₀-teixobactin, against two strains of Enterococcus faecalis (E. faecalis). Materials and Methods: The efficacy of _L-Chg₁₀-teixobactin against two strains of E. faecalis (ATCC 29212 and 47077) was determined using Clinical and Laboratory Standards Institute methods. _L-Chg₁₀-teixobactin was prepared at a stock concentration of 1 mg/mL in 5% DMSO. The minimum inhibitory concentration (MIC) was calculated using a two-fold serial broth dilution method, utilizing a 96-well plate. The minimum bactericidal concentration (MBC) was determined by plating the bacteria onto agar to define the concentration that resulted in 99.9% of bacterial death. Ampicillin was used as the control. The effect of _L-Chg₁₀-teixobactin on the inhibition of ATCC 47077 strain biofilm formation was determined by measuring the minimum biofilm inhibitory concentration (MBIC) using the safranin assay, while the eradication of the preformed biofilm was determined by measuring the minimum biofilm eradication concentration (MBEC) using the XTT assay. For nonlinear data, the log dose–response curve was plotted to calculate the optimum concentration using Excel (version 16.51, Microsoft^® excel. 2021, Microsoft Corporation, Reymond, WA, USA). The data are presented as mean ± standard deviation (SD). Results: The MIC and MBC values of _L-Chg₁₀-teixobactin against both strains of E. faecalis were 0.8 μg/mL. The MIC of ampicillin was 1.25 μg/mL for ATCC 29212 and ranged from 1.25 to 5 μg/mL for ATCC 47077. The MBC of ampicillin for ATCC 29212 and ATCC 47077 was 10 and 20 μg/mL, respectively. The MIC and MBC of ampicillin were much higher compared with those of _L-Chg₁₀-teixobactin. The MBEC₈₀ of _L-Chg₁₀-teixobactin was 4.60 μg/mL for ATCC 47077, which was much lower than that of ampicillin (20 μg/mL). Conclusions:_L-Chg₁₀-teixobactin demonstrated potent antibacterial and antibiofilm effects against E. faecalis, suggesting its potential role an effective antibacterial and antibiofilm agent in endodontic treatment.