Search Results (21)

Background/Objectives: Complex endodontic lesions characterized by significant periapical bone loss, diverse anatomical variations in the root canal system and apical resorption represent a major therapeutic challenge. Biodentine, a calcium silicate-based bioactive dental restorative material, has gained considerable attention because of its potential to promote and sustain the regeneration of bone tissue. This review aims to evaluate current evidence on Biodentine’s regenerative abilities in treatments of diverse endodontic pathology and highlight the clinical and radiographic outcomes. Material and Methods: A systematic review was conducted in accordance with PRISMA guidelines by searching for articles in three electronic databases: Medline (PubMed), Scopus, and Cochrane Library. Studies describing the application of Biodentine in cases of complex endodontic pathology with destruction of apical bone and apical resorption of roots were considered for inclusion in the study. Quality assessment was carried out using the Cochrane risk of bias assessment tool RoB 2.0. Results: The included clinical and radiographic studies demonstrated positive treatment outcomes after using Biodentine in difficult endodontic lesions, including a reduction in lesion size, improvement in symptoms and progression of periapical bone regeneration after 12 months of follow-up. No significant adverse outcomes were reported in the studies included. Conclusions: Biodentine proved to be an efficient biocompatible material in terms of managing complex endodontic lesions. Due to its bioactive properties and high efficiency as an apical plug, Biodentine is capable of inducing bone regeneration within the affected periapical area. Full article

A three-dimensional finite element analysis (FEA) was performed to evaluate stress accumulation and distribution in endodontically treated immature and mature mandibular molars restored with endocrowns. Three tooth models representing different stages of root development (Cvek 2, Cvek 3, and mature) were generated from cone-beam computed tomography data. Endocrowns were fabricated using lithium disilicate (LDS) and resin nanoceramic (RNC). In immature teeth, two apexification strategies were simulated: a 3 mm mineral trioxide aggregate (MTA) apical plug followed by gutta-percha obturation, and complete canal obturation with MTA. All models were subjected to axial (600 N) and oblique (200 N) loading. A total of 20 finite element models were analysed. Endocrown material and loading direction were the main factors affecting von Mises stress distribution, whereas root development stage and apexification technique showed limited influence. LDS resulted in reduced stress transmission to the residual dentin, despite higher stress accumulation within the restoration itself. In the LDS groups, von Mises stress values in the root dentin ranged from 35.24 to 35.96 MPa under oblique and from 42.93 to 44.45 MPa under axial loading, while the RNC group exhibited higher values (39.36–40.40 MPa and 51.59–53.66 MPa, respectively). These findings indicate that endocrown restoration after apexification is a reliable treatment option for immature mandibular molars with extensive structural loss, with LDS demonstrating more favorable biomechanical behavior. Full article

Background: This study aimed to evaluate the impact of varying durations of ultrasonic condensation on the formation of internal and external voids and the microhardness of apical plugs created with premixed bioceramic putty Well-Root^TM PT in standardized 3D-printed immature permanent teeth using micro-CT imaging and Vickers microhardness testing. Methods: Forty-eight 3D-printed upper incisors with simulated open apices (2 mm canal diameter) were divided into four groups (n = 12 each) based on apical plug condensation technique as follows: Group 1 (control, manual condensation), Group 2 (3-s Ultrasonic at 25 kHz), Group 3 (9-s Ultrasonic at 25 kHz), and Group 4 (15-s Ultrasonic at 25 kHz). Well-Root^TM PT was used to form 5 mm apical plugs under a microscope. Samples were stored at 37 °C and 100% humidity for one week. Micro-CT imaging was used to quantify internal, external, and total void volumes (% of total material volume), while microhardness was measured using a Vickers tester (1 kgf load, 10 s) on polished apical plug sections. Statistical analysis was performed using ANOVA and Tukey post hoc tests. Results: Group 4 (15-s Ultrasonic) exhibited significantly higher external and total void volumes compared to Groups 1–3 (p < 0.001), with no significant differences in internal voids across groups (p > 0.05). Microhardness was highest in Group 1 (mean VHN: 76.95 ± 3.73), followed by Group 2 (73.11 ± 4.82), Group 3 (55.11 ± 5.28), and Group 4 (51.25 ± 7.73) (p < 0.05). Shorter ultrasonic durations (3-s Ultrasonic) resulted in fewer voids and higher microhardness compared to longer durations (15-s Ultrasonic). There was no statistically significant difference in void size among the groups compared (p > 0.05). Fractal dimension analysis showed that prolonged ultrasonic condensation results in less complex voids compared to shorter activation. Conclusion: Manual condensation of premixed bioceramic putty, by promoting denser particle packing without ultrasonic-induced disruptions, leads to higher microhardness. Brief ultrasonic activation (3-s Ultrasonic) optimizes the quality of Well-Root^TM PT apical plugs by minimizing voids and maintaining higher microhardness, thus enhancing the apical seal. Prolonged ultrasonic activation (15-s Ultrasonic) increases void formation and reduces microhardness, potentially compromising the long-term integrity of the apical barrier. Full article

Objective: This randomized controlled trial evaluated postoperative pain (PP), bioceramic extrusion, and procedure duration in necrotic immature incisors treated with three apical barrier methods (ABMs): Bioceramic Putty Apical Plug (BPAP), Single Cone with Bioceramic Sealer (SBS), and Bioceramic Putty–Sealer Mixture (BPSM). Case-related factors influencing these outcomes were also examined. Methods: Ninety-nine children (8–11 years) with necrotic maxillary incisors and moderate periapical lesions were randomly assigned (1:1:1) to BPAP, SBS, or BPSM groups. Standardized protocols included calcium hydroxide dressing and XP-Endo Finisher irrigation. Pain (VAS) was recorded at 1-, 3-, 7-, and 14-day post-treatment. Extrusion (yes/no) and procedure duration were documented. Regression analyses identified predictors of outcomes. Results: At day 1, pain was highest in the BPAP group (mean 3.5) and lowest in the SBS group (mean 1.05; p < 0.001). Pain decreased substantially by day 3 and resolved in all groups by day 14. Extrusion was most frequent in SBS (60.6%) and least frequent in BPAP (21.2%; p = 0.002). Treatment duration was longest in BPAP (25.8 min) and shortest in SBS (12.6 min; p < 0.001). Regression showed that preoperative pain and pulpal diagnosis were the strongest predictors of postoperative pain. Apical size and ABM predicted extrusion, while apical size and child behavior significantly influenced duration. Conclusions: The apical barrier method had a significant impact on short-term outcomes. SBS offered reduced pain and shorter chair time but carried a higher risk of extrusion, while BPAP minimized extrusion but caused more pain and required more extended visits. Clinical selection should balance patient comfort, apical anatomy, behavior, and operator expertise. Longer-term outcomes on periapical healing remain to be evaluated. Full article

We report here, for the first time on the Nubian Shield, the western half of the Arabian–Nubian Shield (ANS), pegmatite-hosted pockets with a unique mineralogy, including pyroxmangite. It represents the second discovery on the ANS, where the first one was at Jabal Aja on the Arabian Shield, the eastern half of the ANS. One of the most remarkable aspects of pyroxmangite is its rarity and the potential economic value of its use in jewelry and decorative applications. Pegmatites are associated with A-type granites of the Gabal El-Bakriya intrusion (GEBI), Eastern Desert, Egypt. Mineralized pegmatites occur at the margin of the alkali-feldspar granite and exhibit gradational contacts with the host rocks. The pegmatites were emplaced as plugs and dikes within the intrusion and along its periphery. Pyroxmangite appears as coarse-grained, massive black aggregates or as disseminated crystals. The pegmatites are composed of K-feldspars and quartz, with subordinate amounts of albite, micas, and mafic minerals. Accessory phases include monazite-(Ce), zircon, fergusonite, xenotime, fluorite, pyrochlore, allanite, thorite, bastnäsite, samarskite, cassiterite, beryl, and pyrochlore. Pyroxmangite-bearing assemblages consist essentially of pyroxmangite and garnet, with accessory pyrochroite, quartz, zircon, magnetite, and fluorite. Geochemically, the pegmatites are highly evolved, with elevated SiO₂ content (76.51–80.69 wt.%) and variable concentrations of trace elements. They show significant enrichment in Nb (Nb > Ta), Y, REE, Zr, Th, U, and F, consistent with NYF-type pegmatites. REE contents range from 173.94 to 518.21 ppm, reflecting diverse accessory mineral assemblages. Tectonically, the pegmatites crystallized in a post-collisional setting, representing a late-stage differentiate of the A-type GEBI magma. Mineralization is concentrated in the apical and marginal zones of the granitic cupola and is dominated by barite, fluorite, Nb-Ta oxides, REE minerals, and uranium-bearing phases. The highly evolved granites, greisens, pegmatites, and quartz-fluorite veins of the GEBI have a high economic potential, deserving further exploration. Full article

Background/Objectives: The management of immature teeth with wide apical foramina presents significant challenges in endodontic treatment due to difficulties in achieving a hermetic seal. The aim of this study was to evaluate void formation in apical plugs created using three calcium silicate-based materials—Biodentine, NuSmile NeoPUTTY, and Well-Root PT—applied with the help of manual, ultrasonic, or rotary file condensation (XP-endo Shaper) in 3D-printed immature teeth. Methods: Micro-computed tomography analysis was used to assess the internal, external, and total void percentage of material volume. The statistical analysis was performed using two-way ANOVA and the post hoc Bonferroni test. Statistical significance was set at p < 0.05. Results: The materials and techniques used individually do not significantly influence the formation of internal voids, but their combination does (F(4, 99) = 2.717, p = 0.034). Both factors and their interaction are significant for external voids (F(4, 99) = 4.169, p = 0.004), and all have a notable effect on total void percentages (F(4, 99) = 3.456, p = 0.012). No significant differences were observed in internal voids across the groups (p > 0.05), ranging from 0.635% to 1.078%. External voids varied significantly, with Well-Root PT and ultrasonic condensation showing the highest values with a significant difference (p < 0.05), while NeoPUTTY and Biodentine with XP-endo Shaper exhibited the lowest. Total voids remained below 4%, with no significant differences among manual condensation groups. Neither material type nor application technique consistently influenced void formation, except for Well-Root PT with ultrasonic condensation. Conclusions: These findings suggest that modern bioceramic materials and application techniques produce comparable, low-void apical plugs, with XP-endo Shaper showing promise for minimizing external voids. The interaction between material and application technique plays a crucial role during the creation of apical plugs. Full article

Background and Clinical significance: Apical fenestration is a rarely reported clinical finding that may be associated with apical periodontitis. However, its diagnosis can often be complicated by overlapping clinical and radiographic features. While management traditionally involves a combination of endodontic and surgical interventions, there is limited documentation regarding successful outcomes achieved through non-surgical treatment alone. Therefore, further reporting and investigation of such cases are warranted to enhance clinical understanding and inform decision-making. Case Presentation: This case report describes the non-surgical management of a 20-year-old patient presenting with symptomatic apical periodontitis and a labial apical fenestration in a previously treated maxillary left central incisor (tooth #21) exhibiting an open apex. Diagnosis was confirmed using cone-beam computed tomography (CBCT), which revealed a bone defect in the facial cortical plate. The treatment protocol involved conservative canal debridement, intracanal placement of calcium hydroxide, and final obturation using an apical plug of calcium silicate-based hydraulic cement (CSBHC) and the monoblock technique. Over a follow-up period of two years and eight months, clinical and radiographic assessments demonstrated resolution of symptoms, healing of the sinus tract, and complete regeneration of the buccal cortical bone. Conclusions: This case highlights the potential for complete healing of apical fenestration associated with apical periodontitis in an open apex tooth through non-surgical endodontic treatment alone. Full article

Background and Objectives: In teeth with open apices, performing single session apexification is a challenging treatment due to the difficulty in handling mineral trioxide aggregate (MTA). Minimally invasive approaches in dentistry have also influenced the cavity designs in endodontics. Until now, different techniques have not been investigated in addition to manual condensation during the process of placing MTA in traditional (TradACs) or conservative (ConsACs) endodontic access cavities. The aim of this in vitro study was to compare and evaluate the obturation quality of MTA apical plugs placed with different techniques in TradACs or ConsACs. Materials and Methods: Sixty upper central teeth were divided into two main groups based on cavity design, and then each main group was further divided into three subgroups according to MTA placement techniques (n = 10): TradAC-manual, TradAC-manual + indirect ultrasonic activation, TradAC-manual + XP-endo Shaper (XPS), ConsAC-manual, ConsAC-manual + indirect ultrasonic activation, and ConsAC-manual + XPS. Subsequently, the porosity percentages in the MTA apical plug were analyzed using micro-computed tomography. The statistical analysis was performed using the Kruskal–Wallis H test and Mann–Whitney U test. Statistical significance was set at p < 0.05. Results: There were differences in volume of porosity percentages (%) according to cavity designs and MTA application techniques (p < 0.05). Except for the XPS group, more porosity was observed in ConsACs compared to TradACs. In TradACs, the significantly lowest open and total porosity was observed in the manual, ultrasonic, and XPS techniques, respectively. In ConsACs, the significantly lowest porosity was observed in the manual, XPS, and ultrasonic techniques, respectively (p < 0.05). Conclusions: In MTA obturation, cavity designs and application techniques had an impact on the MTA porosity. Creating an apical plug in ConsACs may result in more porosity compared to TradACs, especially when manual or indirect ultrasonic activation is preferred. Opting for the manual technique alone may be considered sufficient for controlling porosity for both TradACs and ConsACs. Full article

The aim of this study was to clinically and radiographically assess the effects of two bioceramic cements as coronal plug materials for the revascularization of non-vital, immature, permanent teeth with apical periodontitis. Twenty non-vital, immature, permanent, anterior teeth with apical periodontitis were included in this study. Samples were randomly divided into two groups based on the coronal plug materials used; group I (GI): Well Root PT (Vericom, Gangwon-do, Korea) and group II (GII): MTA Biorep (Itena Clinical, Paris, France) (n = 10). Follow-up was conducted clinically and radiographically for up to 12 months to evaluate the changes in root dimensions and resolution of the periapical disease and investigate the degree of success. Data were statistically analyzed using ANOVA tests and Mann–Whitney U tests at a 0.05 significance level. At 12 months, none of the patients in either test group had clinical signs/symptoms. There was a slight increase in root length (4.4% in GI and 3.4% in GII) and a slight increase in dentin wall thickness (10.2% in GI and 9.9% in GII) with no statistically significant (p > 0.05) differences. Whilst there was a significant decrease in lesion dimension in all patients after 12 moths of treatment (93% in GI and 91% in GII), there were no statistically significant differences between the two study groups (p > 0.05). Regarding the degree of success, all cases (100%) achieved the primary goal (the elimination of symptoms and the evidence of bony healing), while 60% in GI and 40% in GII achieved the secondary goal (increased root wall thickness and/or increased root length). No statistically significant difference was found between groups (p > 0.05). Both bioceramic cements showed satisfactory clinical and radiographic findings. Premixed calcium aluminosilicate and tricalcium silicate cements could be used as coronal plug materials in revascularization procedures. Bioceramic cements can be considered promising coronal plug materials for the revascularization of immature, permanent teeth with necrotic pulps and apical periodontitis due to their physicochemical and biological properties. Full article

Background: The emergence of new hydraulic calcium silicate cements has revolutionized endodontics, addressing the limitations of mineral trioxide aggregate (MTA). The aim of this study is to assess and compare the marginal adaptation of two calcium silicate-based cements (White ProRoot MTA^® and TotalFill^® BC RRM Fast Set Putty^TM), when creating apical plugs for teeth with open apices. Methods: twenty-four single-rooted teeth were divided into two groups—GMTA (plug with MTA^®) and GTBC (plug with TotalFill^® BC RRM Fast Set Putty^TM)—and were sectioned at 1 mm and 2 mm from the apex. The transverse sections were analyzed with scanning electron microscopy and the marginal adaptation of the cements was measured with ImageJ^® 1.3 software. Statistical analysis (IBM^® SPSS^® statistics software version 27) was performed and statistical significance was set at 0.05 (p < 0.05). Results: There was a significant difference in the apical region, favoring White ProRoot MTA^®, with a lower percentage of marginal adaptation failure (1.32 ± 4.47), presenting a statistically significant difference in the apical region (p = 0.029) but not in the cervical region of the apical plugs (p = 0.774). Conclusions: White ProRoot MTA^® showed superior marginal adaptation in the apical section compared to TotalFill^® BC RRM Fast Set Putty^TM. Full article

Introduction: External inflammatory root resorption (EIRR) in immature permanent teeth is a common complication after severe dental trauma. The management of this condition requires thorough disinfection of the root canal in order to arrest the resorptive process. However, current guidelines regarding the recommended treatment of EIRR following traumatic dental injuries vary, mainly in regard to the type of intracanal medication and its retention time in the root canal system. The objective of this case series was to present both the apical barrier technique (MTA plug) and revitalization procedures as valid treatment options in immature teeth with EIRR. Methods: Four cases of post-traumatic immature teeth diagnosed with pulp necrosis and EIRR, with or without apical periodontitis, were treated either by an MTA plug (two teeth) or revitalization (two teeth). Cases were followed between 12 and 24 months. Results: Both treatment methods were efficient in arresting EIRR and enabled bone healing. After revitalization, partial root maturation was observed. Conclusion: Whereas the key to achieve periodontal healing in cases of EIRR is thorough disinfection of the root canal, both a subsequent MTA plug as well as revitalization may represent adequate treatment methods. An additional benefit lies in the potential of revitalization to promote further root maturation through hard tissue apposition. Full article

The aim of this study was to histologically verify the performance of pulp-derived stem cells used in the pulp–dentin complex regeneration. Maxillary molars of 12 immunosuppressed rats were divided into two groups: the SC (stem cells) group, and the PBS (just standard phosphate-buffered saline) group. After pulpectomy and canal preparation, the teeth received the designated materials, and the cavities were sealed. After 12 weeks, the animals were euthanized, and the specimens underwent histological processing and qualitative evaluation of intracanal connective tissue, odontoblast-like cells, intracanal mineralized tissue, and periapical inflammatory infiltrate. Immunohistochemical evaluation was performed to detect dentin matrix protein 1 (DMP1). In the PBS group, an amorphous substance and remnants of mineralized tissue were observed throughout the canal, and abundant inflammatory cells were observed in the periapical region. In the SC group, an amorphous substance and remnants of mineralized tissue were observed throughout the canal; odontoblasts-like cells immunopositive for DMP1 and mineral plug were observed in the apical region of the canal; and a mild inflammatory infiltrate, intense vascularization, and neoformation of organized connective tissue were observed in the periapical region. In conclusion, the transplantation of human pulp stem cells promoted partial pulp tissue neoformation in adult rat molars. Full article

Background: The clinical management of teeth with complex dens invaginatus (DI) malformations and apical periodontitis may be challenging due to the lack of routine. The aim of this case report is to describe the endodontic treatment of an immature tooth with DI and to discuss strategies for preclinical training for teeth with such malformations. Case report: A 9-year-old male presented with an immature maxillary incisor with DI (Oehlers Type II) and apical periodontitis which was diagnosed by cone beam computed tomography (CBCT). Revitalization was initially attempted but then abandoned after failure to generate a stable blood clot. Nevertheless, considerable increase in both root length and thickness could be detected after medication with calcium hydroxide followed by root canal filling with MTA as an apical plug. Conclusions: The endodontic management of teeth with DI requires thorough treatment planning. In immature teeth, under certain conditions, root maturation may occur even with conventional apexification procedures. From an educational perspective, different strategies including CBCT and 3D-printed transparent tooth models for visualization of the complex internal morphology and redesigned 3D-printed replica with various degrees of difficulty for endodontic training, can be used to overcome the challenges associated with endodontic treatment of such teeth. Full article

The purpose of this study was to compare the sealing ability and time required for the formation of Biodentine and mineral trioxide aggregation (MTA) apical plugs, using three different delivery methods: an amalgam carrier (AC), the Micro Apical Placement (MAP) System or a novel tool using a modified cannula (MC). Materials and Methods: A total of 60 uniformed molar roots were divided into three main groups, according to the technique of apical plug formation: AC, MAP, and MC. Each group was divided into two subgroups, according to the filling material used: MTA and Biodentine. A timer was used to calculate the required time for apical plug formation. After setting the filling materials, the apical microleakage of the formed plugs was quantified using the dye extraction method and spectrophotometry. The differences between the groups were analyzed using the one-way ANOVA and LSD post hoc tests. The significance level was set at 0.05. Results: No significant differences were reported in the time required to form the apical plugs in all groups (p > 0.05). However, the apical plugs formed by the AC method had significantly higher microleakage than those formed using the MAP and MC methods (p < 0.05). Conclusion: Within the limitations of this study, the sealing ability of the apical plugs formed by the MC method is comparable to the MAP method and better than the AC method. Full article

This study aimed to evaluate the radiological and clinical outcomes of Biodentine apical plugs compared to mineral trioxide aggregate (MTA) in treating immature molars with apical lesions in children. Materials and Methods: Thirty immature roots of 24 permanent lower first molars with apical lesions were randomly divided into two groups: group 1 (15 roots) treated with MTA apical plugs and group 2 (15 roots) treated with Biodentine apical plugs. Treatment radiological outcomes were assessed using the periapical index (PAI) scale after 6 and 12 months of treatment. The presence or absence of apical calcified barrier (ACB) was assessed after 12 months of treatment. The visual analog scale (VAS) was used to compare the postoperative pain between the two groups after 1, 3, 7, and 14 days of treatment. PAI scores between the two groups were compared using the Mann–Whitney U test, the presence or absence of the ACB was compared using the chi-square test, and the VAS scores were compared using the t-test. The statistical significance threshold was set at 0.05. Results: There were no statistically significant differences in the PAI between the two groups at 6 and 12 months postoperatively. After 12 months, four cases in the Biodentine group showed ACB formation, whereas ACB was not found in any case treated with MTA. The VAS scores were statistically lower in the MTA group on the first day after treatment. Nevertheless, these scores were not statistically significantly different after 3, 7, and 14 days of treatment between the two groups. Conclusions: Biodentine can be used as an apical plug to treat immature permanent molars with apical lesions in a single visit in children. Biodentine showed favorable outcomes in apical lesions healing, which was comparable to MTA but with a decreased treatment time associated with its use. Full article