{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:51:48Z","timestamp":1787014308854,"version":"build-2736575974"},"reference-count":89,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100021792","name":"British Endodontic Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100021792","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Endodontic J"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Solubilized endogenous dentine extracellular matrix components (\n                      <jats:styled-content style=\"fixed-case\">dECMs<\/jats:styled-content>\n                      ) are potent mediators in pulp regeneration and could potentially promote similar healing effects in diseased periradicular tissues by upregulating local mesenchymal stem cell\u2010derived regenerative events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>(1) Determine if endodontic treatment outcomes with irrigation regimes promoting dECM release (17% ethylenediaminetetraacetic acid [EDTA]) are equivalent to conventional regimes (5.25% sodium hypochlorite [NaOCl]) in mature permanent teeth with asymptomatic apical periodontitis. (2) Explore changes in pain scores, expressions of periradicular tissue fluid (PTF)\u2010derived inflammatory mediators, and volumtric changes in lesion size\u00a0between the different irrigant regimes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Forty single\u2010rooted teeth, from 37 healthy adults, were block randomized into parallel groups of irrigation with either 17% EDTA, optimized for dECM solubilization, or 5.25% NaOCl (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200920). All other aspects of the endodontic protocol were standardized over two visits with 14\u2009days of calcium hydroxide intracanal medicament. Patient\u2010reported pain scores were recorded at six hours and then daily for one week post\u2010instrumentation and post\u2010obturation. PTF samples were collected pre\u2010instrumentation and pre\u2010obturation, where analyte profiles (pg\/TPC) were determined using an O\u2010link Target\u201048 cytokine array. Treatment outcomes were clinically and radiographically assessed with cone beam computed tomography at 1\u2009year using dichotomous criteria (favourable\/unfavourable) based on volumetric change in lesion size. Participants, operators and assessors were blinded, and per\u2010protocol analyses were conducted using binary logistic regression models with initial alpha values for statistical comparisons set at\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A 90% recall rate was achieved at one year (NaOCl: 19; EDTA: 17). Favourable outcomes were observed in 89.5% of treatments using NaOCl and 94.1% of treatments using EDTA irrigation, with median lesion volume reductions of 92.5% (IQR: 67.33\u201399.13) and 95.84% (IQR: 78.81\u2013100), respectively, (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u2009.05). Odds of unfavourable periradicular healing with EDTA irrigation were 0.53 [95% CI: 0.04\u20136.44;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u2009.05]. No serious adverse effects or atypical pain patterns were reported, although two acute exacerbations occurred post\u2010instrumentation with NaOCl irrigation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u2009.05). Target\u201048 panels consistently detected 15 inflammatory analytes in both groups (CCL\u20102, \u20103, \u20104; CSF\u20101; CXCL\u20108; HGF; IL\u20101\u03b2, \u20106, \u201018; MMP\u20101, \u201012; OLR\u20101; OSM; TNFSF\u201010; VEGF\u2010A), all of which reduced pre\u2010obturation. At this stage, IL\u20106 and \u201018 were significantly more abundant in the intervention group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Therapeutic irrigant regimes promoting dECM solubilization resulted in one\u2010year treatment outcomes equivalent to conventional irrigant protocols with no serious adverse effects reported.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iej.14233","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T09:16:05Z","timestamp":1748337365000},"page":"965-990","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Therapeutic Irrigant Procedures for Treating Apical Periodontitis (\n                    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