Special Issue "New Ways to Disinfect and Fill Dental Hard Tissues"

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Stomatology".

Deadline for manuscript submissions: closed (29 February 2020).

Special Issue Editor

Prof. Dr. Matthias Zehnder
E-Mail Website
Guest Editor
Division of Endodontology, Clinic of Conservative and Preventive Dentistry, Plattenstrasse 11, CH-8032 Zürich, Switzerland
Interests: endodontics; hard tissue disinfection; molecular diagnostics; biomaterials

Special Issue Information

Dear Colleagues,

We live in exciting times. New concepts deriving from basic science are about to enter the dental clinics. However, whether these new approaches will improve our treatment outcomes is debatable Moreover, currently obtaining market certificates for medical devices is a challenging situation, which may create legal impasses for novel concepts. It may thus be wise to also explore alternative ways to use existing materials, or challenge current clinical concepts with new approaches within the legal framework. Scientists, clinicians, and industry representatives need to get together to identify what is not only new but actually useful.

The main goal of the dentist remains to prevent micro-organisms from establishing biofilms in the wrong niches. If that has already happened, treatments aim to alter or remove these microbial communities, thus, arresting or healing the concurrent hard and soft tissue lesions. This Special Issue will gather studies, thoughts, and knowledge by experts in the field on new ways to disinfect and/or fill dental hard tissues. Contributions may be original scientific studies as well as critical narrative or systematic reviews.

Prof. Dr. Matthias Zehnder
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2000 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • dental caries
  • biomaterials
  • tissue engineering
  • vital pulp therapy
  • dental filling
  • root canal filling
  • disinfection
  • chemomechanical cleaning
  • revascularization
  • periodontology

Published Papers (8 papers)

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Research

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Open AccessArticle
Effects of Contemporary Irrigant Activation Schemes and Subsequent Placement of an Interim Dressing on Bacterial Presence and Activity in Root Canals Associated with Asymptomatic Apical Periodontitis
J. Clin. Med. 2020, 9(3), 854; https://doi.org/10.3390/jcm9030854 - 20 Mar 2020
Abstract
New tools for activating endodontic irrigants have evolved, yet their impact on root canal disinfection, in comparison to the passive placing of an inter-visit medication, have not yet been fully elucidated. The use of DNA- and rRNA-based methods may cast some new light [...] Read more.
New tools for activating endodontic irrigants have evolved, yet their impact on root canal disinfection, in comparison to the passive placing of an inter-visit medication, have not yet been fully elucidated. The use of DNA- and rRNA-based methods may cast some new light on this issue, as they allow a comparison to be made between microbial presence and activity. Therefore, the aim of this single-arm intervention trial is to evaluate the antibacterial effect of endodontic procedures using both molecular methods. Root canal samples were obtained from 20 patients with asymptomatic apical periodontitis after each treatment step: access cavity, chemo-mechanical preparation, adjunctive procedures (XP-endo Finisher file and passive ultrasonic irrigation), calcium hydroxide medication, and 2nd-visit root canal preparation. DNA and cDNA from the samples were subjected to quantitative polymerase chain reaction with universal primers for the bacterial 16S rRNA gene. Chemo-mechanical preparation promoted a drastic reduction in bacterial levels and activity, whereas the adjunctive procedures did not make a significant contribution to further disinfection. At the 2nd visit, bacteria were active after the use of calcium hydroxide medication; however, they were significantly reduced after a 2nd-visit preparation. Consequently, the lowest bacterial levels were found at the end of the treatment. This clinical trial, which used an rRNA and rDNA combined approach, confirmed previous studies showing that root canal preparation represents the main strategy for root canal disinfection. Full article
(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)
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Open AccessArticle
Outcome of Root Canal Treatments Using a New Calcium Silicate Root Canal Sealer: A Non-Randomized Clinical Trial
J. Clin. Med. 2020, 9(3), 782; https://doi.org/10.3390/jcm9030782 - 13 Mar 2020
Abstract
Background: The aim of this study was to compare the success rate of root canal treatments undertaken using a calcium silicate root canal sealer in combination with a single cone with non-calcium silicate cement and warm vertical condensation. Methods: 150 necrotic or pulpitic [...] Read more.
Background: The aim of this study was to compare the success rate of root canal treatments undertaken using a calcium silicate root canal sealer in combination with a single cone with non-calcium silicate cement and warm vertical condensation. Methods: 150 necrotic or pulpitic teeth were treated. (REC: 08/H0804/79). Following standardized root canal chemo-debridement. The canals were obturated using warm vertical condensation of gutta-percha and epoxy-based sealer (AH plus) or a calcium silicate sealer (BioRootTM RCS) with a single cone technique. Follow-up assessment was conducted at 12 months using Cone Beam Computed Tomography (CBCT). Results: At 1-year recall, 104 teeth were assessed (51 AH plus, 53 BioRootTM RCS). The success rate using loose criteria for the CBCT images and PA radiographs was respectively 80% and 89% in the AH plus/warm vertical condensation group, 84% and 90% in the BioRootTM RCS/single cone group. There was no statistically significant difference between the two groups (Fisher exact test p value 0.6099 for the CBCT images). Conclusion: Within the limitations of this non-randomized trial, a calcium silicate cement in combination with single cone resulted in a similar proportion of successful cases compared to warm vertical condensation and epoxy-based sealer. Full article
(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)
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Open AccessArticle
Bioactivity and Physico-Chemical Properties of Dental Composites Functionalized with Nano- vs. Micro-Sized Bioactive Glass
J. Clin. Med. 2020, 9(3), 772; https://doi.org/10.3390/jcm9030772 - 12 Mar 2020
Abstract
Bioactive resin composites can contribute to the prevention of secondary caries, which is one of the main reasons for failure of contemporary dental restorations. This study investigated the effect of particle size of bioactive glass 45S5 on chemical and physical composite properties. Four [...] Read more.
Bioactive resin composites can contribute to the prevention of secondary caries, which is one of the main reasons for failure of contemporary dental restorations. This study investigated the effect of particle size of bioactive glass 45S5 on chemical and physical composite properties. Four experimental composites were prepared by admixing the following fillers into a commercial flowable composite: (1) 15 wt% of micro-sized bioactive glass, (2) 15 wt% of nano-sized bioactive glass, (3) a combination of micro- (7.5 wt%) and nano-sized (7.5 wt%) bioactive glass, and (4) 15 wt% of micro-sized inert barium glass. Hydroxyapatite precipitation and pH rise in phosphate-buffered saline were evaluated during 28 days. Degree of conversion and Knoop microhardness were measured 24 h after specimen preparation and after 28 days of phosphate-buffered saline immersion. Data were analyzed using non-parametric statistics (Kruskal–Wallis and Wilcoxon tests) at an overall level of significance of 5%. Downsizing the bioactive glass particles from micro- to nano-size considerably improved their capability to increase pH. The effect of nano-sized bioactive glass on degree of conversion and Knoop microhardness was similar to that of micro-sized bioactive glass. Composites containing nano-sized bioactive glass formed a more uniform hydroxyapatite layer after phosphate-buffered saline immersion than composites containing exclusively micro-sized particles. Partial replacement of nano- by micro-sized bioactive glass in the hybrid composite did not impair its reactivity, degree of conversion (p > 0.05), and Knoop microhardness (p > 0.05). It is concluded that downsizing bioactive glass particles to nano-size improves the alkalizing potential of experimental composites with no negative effects on their fundamental properties. Full article
(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)
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Open AccessArticle
Antibiofilm and Immune Response of Engineered Bioactive Nanoparticles for Endodontic Disinfection
J. Clin. Med. 2020, 9(3), 730; https://doi.org/10.3390/jcm9030730 - 09 Mar 2020
Abstract
The biological aim of root canal treatment is to facilitate periapical tissue healing following endodontic therapy. This study aimed to develop an organotypic infected root canal model to understand the interaction of bacterial biofilm with macrophages and study the therapeutic effect of engineered [...] Read more.
The biological aim of root canal treatment is to facilitate periapical tissue healing following endodontic therapy. This study aimed to develop an organotypic infected root canal model to understand the interaction of bacterial biofilm with macrophages and study the therapeutic effect of engineered bioactive chitosan nanoparticles (CSnp) on macrophages. Ex-vivo experiments were conducted in two phases; Phase-1: Enterococcus faecalis biofilms (two and six weeks old) developed in organotypic root canal model were used to characterize residual biofilm after conventional chemical treatment alone and combined with CSnp utilizing Confocal Laser Scanning Microscopy, Scanning Electron Microscopy and colony-forming units from pulverized dentin. Phase-2: The interaction of post-treatment biofilm and RAW macrophages was evaluated regarding pro/anti-inflammatory markers, cell viability and spreading at 24, 48 and 72 h. Compared to conventionally disinfected six-week-old biofilm, CSnp resulted in less viable bacteria (p < 0.01). Scanning electron micrographs demonstrated disruption of the biofilm. CSnp exhibited less residual bacterial load in pulverized dentin (p < 0.001). Macrophage interaction with CSnp-treated biofilm reduced proinflammatory markers (nitric oxide, TNF-α, IL-1β, and IL-6), increased anti-inflammatory marker (TGF-β1) and enhanced cell survival and spreading over time (p < 0.01 at 72 h). Engineered chitosan nanoparticles concurrently inactivated biofilm and altered the inflammatory response of macrophages that would promote healing. Full article
(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)
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Open AccessArticle
Time-Dependent Response of Human Deciduous Tooth-Derived Dental Pulp Cells Treated with TheraCal LC: Functional Analysis of Gene Interactions Compared to MTA
J. Clin. Med. 2020, 9(2), 531; https://doi.org/10.3390/jcm9020531 - 15 Feb 2020
Abstract
Pulp capping material should facilitate hard tissue regeneration on the injured pulp tissue. TheraCal LC (TC) was recently developed. Although TC has shown reliable clinical outcomes after direct pulp capping, there are still remaining concerns regarding its detrimental effect on pulp cells. Therefore, [...] Read more.
Pulp capping material should facilitate hard tissue regeneration on the injured pulp tissue. TheraCal LC (TC) was recently developed. Although TC has shown reliable clinical outcomes after direct pulp capping, there are still remaining concerns regarding its detrimental effect on pulp cells. Therefore, this study aimed to identify the gene expression of human deciduous tooth-derived dental pulp cells exposed to TC compared to mineral trioxide aggregate (MTA). The cells were cultured and exposed to TC and MTA for 24 and 72 h. Next, total RNA was isolated. QuantSeq 3′ mRNA-sequencing was used to examine differentially expressed genes (DEGs) in exposed to TC and MTA. Functional analysis of DEGs was performed using bioinformatics analysis. In gene ontology (GO) functional enrichment analysis, cells in TC for 24 h presented significantly enriched immune response (p < 0.001) and inflammatory response (p < 0.01) compared to MTA. TC showed enriched positive regulation of cell migration at 72 h (p < 0.001). In Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, neuroactive ligand–receptor interaction (p = 1.19 × 10−7) and calcium signaling pathway (p = 2.96 × 10−5) were confirmed in the shared DEGs in TC. In conclusion, DEGs in TC may be involved in pathways associated with osteoclastogenesis and osteoclastic differentiation. Full article
(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)
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Open AccessArticle
Pulp-Derived Exosomes in a Fibrin-Based Regenerative Root Filling Material
J. Clin. Med. 2020, 9(2), 491; https://doi.org/10.3390/jcm9020491 - 11 Feb 2020
Abstract
Regenerative endodontics has been described as a paradigm shift in dentistry, despite its current limitation to immature teeth and reparative rather than regenerative outcomes. Cell-free treatments are favored because of regulatory issues. However, the recruitment of host-derived stem cells to the desired site [...] Read more.
Regenerative endodontics has been described as a paradigm shift in dentistry, despite its current limitation to immature teeth and reparative rather than regenerative outcomes. Cell-free treatments are favored because of regulatory issues. However, the recruitment of host-derived stem cells to the desired site remains challenging. We investigated whether dental pulp-derived exosomes, which are extracellular vesicles that contain proteins, lipids, RNA, and DNA and thus mirror their parental cells, may be used for this purpose. The use of exosomes may present appreciable advantages over the direct use of transplanted stem cells due to a higher safety profile, easier isolation, preservation, and handling. Here we harvested exosomes from a cultured third-molar pulp cell and assessed them by transmission electron microscopy and Western blotting. Human mesenchymal stem cells (MSCs) were exposed to these exosomes to assess exosome uptake, cell migration, and proliferation. In addition, a fibrin gel (i.e., a diluted fibrin sealant), was assessed as a delivery system for the exosomes. Our results show that exosomes attracted MSCs, and the fibrin gel enhanced their effect. Moreover, exosomes improved the proliferation of MSCs. Therefore, we propose that pulp-derived exosomes in combination with a fibrin gel could be a powerful combination for clinical translation towards improved cell-free regenerative endodontics and thus represent a new way to fill dental hard tissues. Full article
(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)
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Open AccessArticle
Electrochemical Disinfection of Experimentally Infected Teeth by Boron-Doped Diamond Electrode Treatment
J. Clin. Med. 2019, 8(12), 2037; https://doi.org/10.3390/jcm8122037 - 21 Nov 2019
Cited by 2
Abstract
Disinfection and prevention of re-infection are the decisive treatment steps in endodontic therapy. In this study, boron-doped diamond (BDD) electrodes have been fabricated and used for disinfecting the root canals of extracted human teeth, which had been covered with bacterial biofilms formed by [...] Read more.
Disinfection and prevention of re-infection are the decisive treatment steps in endodontic therapy. In this study, boron-doped diamond (BDD) electrodes have been fabricated and used for disinfecting the root canals of extracted human teeth, which had been covered with bacterial biofilms formed by Bacillus subtilis and Staphylococcus epidermidis. The growth of B. subtilis could be successfully impaired, achieving a complete disinfection after 8.5 min treatment time with the success of disinfection depending on the insertion depth of the electrode in the root canal. S. epidermidis could completely be removed after 3.5 min treatment time. A clinically applicable electrode array led to complete disinfection after treatment times of 10 min for S. epidermidis and 25 min for B. subtilis. BDD electrode application allowed for the improved disinfection of root canals and dentin tubules based on a continuous production of reactive oxygen species and their enhanced penetration of dentin tubules most likely due the formation of a continuous stream of small gas bubbles. The treatment times that are required here will be shortened in clinical application, as mechanical shaping of the canal system would precede the disinfection process. Full article
(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)
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Review

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Open AccessReview
Different Pulp Dressing Materials for the Pulpotomy of Primary Teeth: A Systematic Review of the Literature
J. Clin. Med. 2020, 9(3), 838; https://doi.org/10.3390/jcm9030838 - 19 Mar 2020
Abstract
Background: Pulpotomy of primary teeth provides favorable clinical results over time; however, to date, there is still not a consensus on an ideal pulp dressing material. Therefore, the aim of the present systematic review was to compare pulpotomy agents to establish a [...] Read more.
Background: Pulpotomy of primary teeth provides favorable clinical results over time; however, to date, there is still not a consensus on an ideal pulp dressing material. Therefore, the aim of the present systematic review was to compare pulpotomy agents to establish a preferred material to use. Methods: After raising a PICO question, the PRISMA guideline was adopted to carry out an electronic search through the MEDLINE database to identify comparative studies on several pulp dressing agents, published up to October 2019. Results: The search resulted in 4274 records; after exclusion, a total of 41 papers were included in the present review. Mineral trioxide aggregate (MTA), Biodentine and ferric sulphate yielded good clinical results over time and might be safely used in the pulpotomies of primary molars. Among agents, MTA seemed to be the material of choice. On the contrary, calcium hydroxide showed the worst clinical performance. Although clinically successful, formocreosol should be replaced by other materials, due to its potential cytotoxicity and carcinogenicity. Conclusion: MTA seemed to be the gold standard material in the pulpotomy of primary teeth. Promising results were also provided by calcium silicate-based cements. Further randomized clinical trials (RCTs) with adequate sample sizes and long follow-ups are encouraged to support these outcomes. Full article
(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)
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