Search Results (187)

Regenerative endodontics seeks to restore the vascularized pulp–dentin complex following conventional root canal therapy, yet reliable neovascularization within the constrained root canal remains a key challenge. This study investigates the development of an injectable, dual-curing hydrogel based on methacrylated decellularized amniotic membrane (dAM-MA) and compares its performance to a conventional gelatin methacryloyl (GelMA). The dAM-MA platform was designed for biphasic release, incorporating both free vascular endothelial growth factor (VEGF) for an initial burst and matrix-metalloproteinase-cleavable VEGF conjugates for sustained delivery. The dAM-MA hydrogel achieved shape-fidelity via thermal gelation at 37 °C and possessed tunable stiffness (0.5–7.8 kPa) after visible-light irradiation. While showing high cytocompatibility comparable to GelMA (>125% hDPSC viability), the dAM-MA platform markedly outperformed the control in promoting endothelial tube formation (up to 800 µm total length; 42 branch points at 96 h). The biphasic VEGF release from dAM-MA matched physiological injury kinetics, driving both early chemotaxis and late vessel maturation. These results demonstrate that dAM-MA hydrogels combine native extracellular matrix complexity with practical, dual-curing injectability and programmable VEGF kinetics, offering a promising scaffold for minimally invasive pulp–dentin regeneration. Full article

Background and Clinical Significance: Traumatic dental injuries, particularly complicated crown fractures of permanent incisors, are common in adolescents, with maxillary central incisors most frequently affected due to their prominent position. These injuries, often resulting from sports or accidents, require prompt management to prevent complications such as pulp necrosis or infection, which can compromise long-term prognosis. Fragment reattachment offers a conservative, esthetically favorable approach when the fractured segment is intact, with outcomes comparable to composite restorations. This case report underscores the importance of timely intervention and advanced restorative techniques in pediatric dentistry. Case Presentation: A 16-year-old male presented with a complicated crown fracture of the upper left central incisor sustained during a soccer game. The fracture extended subgingivally with pulp exposure. The patient preserved the fragment in saline. Treatment involved fragment reattachment using a dentin bonding agent and flowable composite resin, followed by single-visit root canal therapy due to delayed presentation (48 h). A glass fiber post was placed to reinforce the restoration due to significant coronal loss. Three years of follow-up visits (1, 3, 6, 12, 24, and 36 months) revealed no clinical or radiographic complications, with the tooth remaining asymptomatic and functional. Conclusions: This case underscores the effectiveness of fragment reattachment when combined with meticulous technique and long-term monitoring. Full article

This critical narrative review presents the concepts and methods that have been or are currently applied in the treatment of periapical tissue changes in mature and immature permanent teeth. Treatment success is defined as the healing of the inflammatory lesion in permanent teeth and, additionally, the completion of root development in immature teeth. Background/Objectives: Endodontics focuses on the prevention and treatment of diseases affecting the dental pulp and periapical tissues. Periapical changes have been managed using various methods depending on factors such as the extent of the lesion and the stage of root and apical development. Conventional root canal treatment, revitalization, and apexification have all been employed. Methods: Three databases (PubMed, Scopus, and Web of Science) were searched for studies discussing different treatment approaches, materials, and the efficacy of techniques used over time in mature and immature permanent teeth. Results: This review includes seven case reports, seven case series, and three cohort studies, each detailing the treatment method, case characteristics, follow-up period, and treatment outcomes. Conclusions: Modern materials have significantly improved the outcomes of revitalization and apexification procedures. These methods can now compete with or even surpass the clinical effectiveness of conventional root canal therapy. Full article

Dens invaginatus is a developmental dental anomaly characterized by the infolding of the enamel organ into the dental papilla during early odontogenesis. This process leads to a broad spectrum of anatomical variations, ranging from minor enamel-lined pits confined to the crown to deep invaginations extending through the root, occasionally communicating with periodontal or periapical tissues. The internal complexity of affected teeth presents diagnostic and therapeutic challenges, particularly in severe forms that mimic root canal systems or are associated with pulpal or periapical pathology. Maxillary lateral incisors are most frequently affected, likely due to their unique developmental timeline and morphological susceptibility. Although various classification systems have been proposed, Oehlers’ classification remains the most clinically relevant due to its simplicity and correlation with treatment complexity. Recent advances in diagnostic imaging, especially cone beam computed tomography (CBCT), have revolutionized the identification and classification of these anomalies. CBCT-based adaptations of Oehlers’ classification allow for the precise assessment of invagination extent and pulpal involvement, facilitating improved treatment planning. Contemporary therapeutic strategies now include calcium-silicate-based cement sealing materials, endodontic microsurgery for inaccessible anatomy, and regenerative endodontic procedures for immature teeth with necrotic pulps. Emerging developments in artificial intelligence, genetic research, and tissue engineering promise to further refine diagnostic capabilities and treatment options. Early detection remains critical to prevent complications such as pulpal necrosis or apical disease. A multidisciplinary, image-guided, and patient-centered approach is essential for optimizing clinical outcomes in cases of dens invaginatus. Full article

Background/Objectives: Among the paranasal sinuses, the maxillary antrum holds unique clinical relevance due to its proximity to the alveolar process of the maxilla, which houses the teeth. This study aimed to evaluate the position of the root apices of the maxillary canines and posterior teeth relative to the maxillary sinus floor in Romanian subjects. Methods: Data for the study were retrospectively obtained from cone-beam computed tomography (CBCT) scans. The evaluation considered the pattern of proximity to the sinus floor for each tooth type, comparisons of the sinus relationships of teeth within the same dental hemiarch, as well as those of homologous teeth, and variation in root-to-sinus distance in relation to sex and age. Nonparametric tests were used for statistical analysis, and multiple comparisons were performed using Bonferroni post hoc correction. Results: The study included 70 individuals aged 20 to 60 years. The distance to the sinus floor decreased progressively from the first premolar to the second molar, with median values of 3.68 mm (first premolar), 1.45 mm (second premolar), 0.50 mm (first molar), and 0.34 mm (second molar) (p < 0.01). Stronger correlations were observed between adjacent teeth than between non-adjacent ones. The distances to the sinus floor were greater on the right side compared to the left; however, these differences were not statistically significant (p > 0.05 for all teeth). Concordance between left and right dental hemiarches regarding the closest tooth to the sinus floor was found in 70% of cases (n = 49), most frequently involving the second molars (n = 38; 54.3%). On average, the distance from the sinus floor was smaller in males compared to females, with statistically significant differences observed only for the second molar. Increased age was associated with a greater distance to the sinus floor. Conclusions: Of all the teeth investigated, the second molar showed the highest combined prevalence of penetrating and tangential relationships with the maxillary sinus. At the dental hemiarch level, the second molar was most frequently the closest tooth to the sinus floor, and in the majority of cases, at least one posterior tooth was located within 0.3 mm. Accurate preoperative assessment of tooth position relative to the sinus floor is essential when performing non-surgical or surgical root canal therapy and extractions of maxillary molars and premolars. CBCT provides essential three-dimensional imaging that improves diagnostic precision and supports safer treatment planning for procedures involving the posterior maxilla. Full article

Objectives: This study aimed to evaluate the success rates of NSRCT performed by AEGD residents and to identify predictive factors associated with clinical outcomes and patient satisfaction. Methods: A retrospective chart review was conducted on cases treated between 2012 and 2021. Eligible cases included fully developed permanent teeth that underwent NSRCT and received a final restoration by general dentistry residents, with a minimum of 12 months of follow-up. Data collected included demographic information, medical history, clinical symptoms, radiographic findings, instrumentation, type and timing of final restorations, and patient satisfaction scores. Treatment success was defined as the absence of symptoms and either the resolution or stability of periapical radiolucency. Patient satisfaction and pain levels were also analyzed. Results: AEGD residents achieved radiographic and clinical RCT success rates of 93.3% and 91.5%, respectively. Multivariate logistic regression showed that the presence of an intact restoration was significantly associated with increased odds of tooth retention (odds ratio [OR] = 3.4, p < 0.001), while post placement in a straight root was also a significant predictor of survival (OR = 4.2, p = 0.02). Conversely, pre-existing radiolucency (OR = 0.37, p = 0.018) and the use of a metal post (OR = 0.23, p = 0.012) were significantly associated with lower odds of tooth retention. Worse periodontal health was significantly associated with increased odds of pain on percussion, with a 74.19% increase in odds per worsening category (OR = 1.74, p = 0.002). Patient satisfaction was significantly higher when restorations remained intact, with esthetic satisfaction increasing by a factor of 3.08 (OR = 3.08, p < 0.001) and functional satisfaction increasing by a factor of 3.9 (OR = 3.9, p < 0.001). Conclusions: Endodontic treatments performed by AEGD residents demonstrated high success rates and favorable patient-reported outcomes. Restoration integrity, periodontal health, and post and final restoration selection play critical roles in treatment success and patient satisfaction. Full article

Introduction: Successful root canal therapy relies on thorough cleaning and disinfection to eliminate microorganisms and residual pulp tissue. Advanced irrigation activation techniques, including Sonic, Ultrasonic, and Diode Laser activation, have improved cleaning efficacy, bacterial reduction, smear layer removal, and irrigant hydrodynamics. On the other hand, these irrigation activation techniques may lead to a temperature rise that may risk the surrounding periodontal tissue. Thus, this study aimed to investigate the temperature rise during different irrigation activation techniques at various time intervals and evaluate the efficacy of these techniques in removing biofilm-mimicking hydrogel BMH of a simulated root canal system in 3D-printed tooth models. Methods: Ten extracted human mandibular premolars, prepared to size 40/0.04 taper, and a hundred 3D-printed resin premolars with simulated main (0.25 mm) and lateral canals (0.15 mm at 3, 7, 11 mm from apex) were used; 50 of them were filled with biofilm-mimicking hydrogel (BMH). Five irrigation activation techniques were evaluated: Diode Laser, Ultrasonic, Sonic, XP-Finisher, and Control (n = 10). Temperature rises were measured on the extracted premolars after 30 and 60 s of activation using a thermographic camera in a controlled environment (23 ± 2 °C). Irrigant penetration, with and without BMH, was assessed in 3D-printed premolars using a 2.5% sodium hypochlorite-contrast medium mixture, visualized with a CMOS radiographic sensor. Penetration was scored (main canal: 3 points; lateral canals: 0–2 points) and analyzed with non-parametric tests. Results: Diode Laser activation technique resulted in the highest temperature rise on the external root surface, followed by the Ultrasonic, with no statistically significant difference observed among the remaining groups. In terms of efficacy, Ultrasonic and Sonic activation achieved significantly greater irrigant penetration in samples without BMH, and greater BMH removal in samples with BMH, compared to Diode Laser, XP-Finisher, and Control groups. Conclusions: In this in vitro study, Diode Laser caused the highest temperature rise, followed by Ultrasonic, with significant increases from 30 to 60 s. Temperature rise did not significantly affect penetration or BMH removal. Ultrasonic and Sonic irrigation techniques achieved the highest depth of penetration (without BMH) and biofilm-mimicking Hydrogel removal (with BMH) compared to Diode Laser, XP-Finisher, and Control. Full article

Background: With the inclusion of evidence-based dentistry, numerous systematic reviews (SRs) and meta-analyses (MAs) have been conducted in endodontics with the best available scientific evidence to improve diagnosis and treatment. Objective: To synthesize the scientific evidence on the effectiveness of irrigation protocols in endodontic therapy. Methods: Following the umbrella review methodology (UR), a comprehensive literature search was conducted using scientific and grey literature databases. A quality evaluation and a descriptive analysis of the included SRs and MAs were conducted. Quantitative comparability between MAs was carried out. Results: Four descriptive SRs and nine MAs were included. Eight articles evidenced high methodological quality. Studies showed the effectiveness and efficacy depending on the study design, the findings of primary clinical trials, and factors related to the type of irrigant, concentration, volume, and irrigation systems. Variability between irrigants and protocols was observed. Follow-up periods extend from hours to years, and there were different study samples. SRs and MAs evidenced limitations regarding methodological aspects. Low overlap of the primary studies was found. Quantitative analyses indicated greater efficacy in microbial reduction and apical healing in favor of passive ultrasonic irrigation (PUI; RD −0.15; 95% CI −0.28, −0.01; p = 0.03; I2 = 60%; RD −0.09; 95% CI −0.16, −0.02; p = 0.01; I2 = 0%, respectively). Conclusions: This UR highlights the importance of root canal disinfection, emphasizing sodium hypochlorite (NaOCl) as the primary irrigant. Enhanced activation methods, such as PUI and lasers, improve irrigant efficiency, while alternatives like chlorhexidine (CHX) offer better biocompatibility. Standardized protocols and evidence-based clinical guidelines are needed. PROSPERO register: CRD42023409044. Full article

Endodontic infections are characterized by complex polymicrobial communities residing within the intricate root canal system. Traditional chemomechanical methods frequently fail to achieve complete microbial eradication, especially in cases involving biofilm-forming and resistant species. This systematic review synthesizes current evidence on the molecular basis and antimicrobial efficacy of the neodymium-doped yttrium aluminum garnet (Nd:YAG) laser in root canal disinfection, particularly against polymicrobial infections. A comprehensive literature search was conducted in the PubMed, Embase, Scopus, and Cochrane databases in accordance with PRISMA 2020 guidelines. Experimental and preclinical studies evaluating the bactericidal properties of Nd:YAG laser therapy were included. The Nd:YAG laser demonstrated significant reductions in total microbial load through photothermal effects, including denaturation of proteins, disruption of cell membranes, and degradation of mixed-species biofilms. Although complete sterilization was not consistently achieved, its ability to penetrate dentinal tubules and target microbial consortia offers substantial adjunctive value. Standardization of laser parameters and further clinical studies are needed to validate these findings and establish Nd:YAG laser use in routine endodontic disinfection protocols. Full article

Pediatric dentistry continually seeks effective and efficient treatments for young patients, especially within pediatric endodontics, where cooperation can often be challenging. This in vivo study aimed to evaluate the effectiveness of a novel photodynamic therapy (PDT) protocol using a 5-aminolevulinic acid gel (Aladent, ALAD) combined with light irradiation during the endodontic treatment of primary teeth. This study included primary teeth requiring root canal therapy due to carious lesions or trauma, with clinical symptoms suggesting irreversible pulpitis or acute apical periodontitis. Following local anesthesia and isolation with a rubber dam, carious lesions were excavated, and access to the pulp chamber was established. Canal preparation included determining the working length and using a sequence of k-files. Afterward, ALAD gel was applied, and the patients were divided into two groups based on their visit duration (Group A with a single visit, Group B returning after one week). Microbiological analysis was conducted on the samples taken before and after treatment. The findings demonstrated significant antibacterial efficacy of the PDT protocol in reducing root canal bacterial load, suggesting ALAD-based PDT may serve as an alternative to traditional endodontic treatment in cases where retaining primary teeth is essential for orthodontic or strategic reasons. Clinically, improvement in symptoms and fistula resolution were observed. Treatment time, patient compliance, and protocol safety in pediatric applications are also discussed, highlighting the protocol’s potential to enhance clinical outcomes in pediatric endodontics. Full article

Background: A 19-year-old female patient reported to the Department of Conservative Dentistry, Medical University of Gdańsk, with pain in the left lateral incisor. During the attempt to perform root canal treatment on tooth 22, we encountered difficulties in locating the canal opening, which resulted in treatment failure. Radiographic examinations revealed Pulp Canal Obliteration and a root fracture with a double fracture line, resulting in two root fragments. The prognosis for this tooth was poor, with extraction being the most likely outcome. Methods: To provide effective therapy, a 3D-printed endodontic guide was utilized, allowing for more precise localization of the canal in a tooth with a calcified root canal and complex fracture morphology. An intraoral scan and cone-beam computed tomography (CBCT) were performed, followed by the design of the guide. This facilitated accurate planning of the entry path for endodontic instruments, promoting minimally invasive treatment and reducing the loss of tooth structure. Results: Through navigated endodontics, the treatment became more predictable, and the risk of iatrogenic complications was minimized, significantly improving the prognosis of the therapy. Clinical and radiological examinations conducted after 12 months demonstrated successful treatment and preservation of the tooth in the oral cavity. Conclusions: The obtained results suggest that the use of guided endodontics can improve outcomes in cases with pulp canal obliteration and complex fractures, offering a minimally invasive and predictable approach. Full article

Background: Regenerative endodontic therapy (RET) allows for continued root development in necrotic immature permanent teeth. Autologous platelet concentrates (APC) such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are proposed alternatives to conventional blood clot scaffolds (BCS). Objectives: This systematic review compared the use of APC and BCS in RET of human necrotic immature permanent teeth. Methods: The electronic databases MEDLINE, CENTRAL and EMBASE were searched for randomized controlled trials (RCTs) which investigated the efficacy of APC and BCS in RET. We conducted this review following PRISMA 2020 guidelines. Quantitative radiographic outcomes of root length and root thickness were considered. The included RCTs were assessed for risk of bias using the Cochrane Risk-of-Bias tool. A meta-analysis was performed using RevMan 5.4. The protocol was registered on PROSPERO (CRD42023391536). Results: Of the 89 records screened, 10 RCTs were included in this review, in which 373 necrotic immature permanent teeth were treated. Both APC and BCS enable continued root development and would therefore be preferred over conventional root canal therapy with or without apexification. The meta-analysis revealed a statistically significant improvement in clinical success for PRP compared to BCS (Risk Ratio [RR] = 1.14, 95% Confidence Interval [CI]: 1.03–1.27, p = 0.02), whereas no significant difference was observed between PRP and PRF (RR = 1.04, 95% CI: 0.95–1.13, p = 0.37). Conclusions: PRP and PRF scaffolds enhance root length and thickness development in REPs compared to BCS. While PRP provides a modest but significant improvement in clinical success over BCS, PRF and PRP exhibit similar clinical outcomes. These findings support the use of platelet concentrates as viable alternatives to conventional blood clot scaffolds in regenerative endodontics. Full article

Background and Clinical Significance: Sodium hypochlorite (NaOCl) is widely used in root canal treatment for its potent antiseptic and antibacterial effects. However, its cytotoxicity—particularly at higher concentrations and in patients with low immune status—has been associated with serious postoperative complications. This case report describes the risks associated with NaOCl exposure in a medically compromised patient and reviews the relevant literature on NaOCl-related injuries, offering insights into potential current management strategies. Case Presentation: This case report describes a challenging scenario of a 25-year-old male with a history of Hodgkin’s lymphoma who developed a non-healing bone in the lower right first molar (LR6) region after NaOCl exposure. Several months after undergoing root canal treatment and an extraction of the LR6, the patient presented with exposed necrotic bone in the region. The case’s complexity was heightened by the patient’s medical and dental history, which included chemotherapy and NaOCl exposure. Following a detailed clinical, radiographic examination and biopsy, the patient was diagnosed with bone necrosis due to NaOCl exposure. The treatment involved the extraction of the LR6, the debridement of the necrotic bone, and long-term follow-up with antimicrobial therapy. Despite efforts to manage the complication, the healing process was prolonged, potentially due to the patient’s immunocompromised state from chemotherapy. The patient’s condition remained unresolved after nearly a year, and ongoing management, including regular follow-up, was necessary to monitor healing and prevent further complications. This case highlights the challenges of treating dental complications in immunocompromised patients, particularly those with Hodgkin’s lymphoma, where delayed healing is a problem that might occur. Conclusions: Given the complexity of this case, different adjunctive treatment options, such as leukocyte–platelet-rich fibrin (L-PRF), pentoxifylline and tocopherol (PENTO), and hyperbaric oxygen therapy (HBOT), were discussed as potential treatments to help manage non-healing sockets in patients with similar conditions. Full article

Clinical root canal therapy which takes place through mechanical and chemical strategies is faced with challenges in eliminating bacteria owing to the intricate and curved nature of the root canal system. Moreover, the plaque biofilm within the root canal hinders drug penetration and limits treatment efficacy. Hence, efficient root canal therapy hinges on penetrating into the root canal and overcoming the barriers presented by the plaque biofilms. To penetrate and eradicate biofilms effectively at the root canal, we designed a novel magnetic nanoparticle (MN)-based nanoplatform which was synthesized by the self-polymerization of dopamine on the surface of Fe₃O₄ MNs, and then loaded minocycline through the electrostatic interaction. The therapeutic efficacy of minocycline-loaded magnetic nanoparticles (FDM MNs) under a magnetostatic field was observed by various antibacterial experiments. The synthesized FDM MNs exhibited favorable biocompatibility and robust anti-biofilm efficacy. The designed nanoparticles could effectively navigate biofilms to eradicate bacteria residing deep with the assistance of magnetic force. Furthermore, FDM MNs penetrated into dentin tubules under a magnetic field, effectively disrupting biofilms for deep sterilization. The significant results offered valuable experimental evidence to support the potential clinical utility of magnetic nanoparticles for managing pulpitis and periapical inflammation. Full article

Background and Objectives: Successful endodontic treatment requires thorough disinfection and removal of the smear layer to prevent reinfection. However, conventional irrigants like sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) can compromise dentin integrity. This study assessed the efficacy of the Synergistic Microbicidal and Ablative Root canal Technique (SMART), which integrates AromaRoot, a biocompatible irrigation solution based on quaternary ammonium compounds, with 980 nm diode laser activation, to enhance bacterial reduction and smear layer removal. Materials and Methods: Sixty extracted single-rooted human teeth were inoculated with Enterococcus faecalis and divided into four treatment groups using NaOCl, AromaRoot, and 980 nm laser, either alone or in combination. Bacterial counts were measured as colony-forming units per milliliter (CFU/mL). For smear layer analysis, 56 extracted teeth were prepared and irrigated using EDTA, AromaRoot, and laser activation, followed by scanning electron microscopy to evaluate dentinal tubule exposure. Data were analyzed using Kruskal–Wallis and ANOVA. Results: The combination of AromaRoot, NaOCl, and laser activation achieved a 99.00% bacterial reduction (from 8082 to 60 CFU/mL, p < 0.001), outperforming NaOCl alone (98.34%, 131 CFU/mL). For smear layer removal, AromaRoot with laser achieved 78.5% open dentinal tubules in the apical third, significantly higher than EDTA alone (64.5%, p < 0.05), though EDTA remained superior in the coronal third (89.0% vs. 81.0%, p > 0.05). Conclusions: The SMART technique significantly improves both disinfection and smear layer removal in root canal therapy, particularly in the apical region. These findings suggest that AromaRoot, especially when laser-activated, may serve as a safe and effective alternative to conventional irrigants, warranting further clinical evaluation. Full article