Search Results (718)

Bone defects from trauma, tumour resection, infection, and degenerative disease remain a major clinical burden, and autografts face limitations of supply and donor-site morbidity. Three-dimensional (3D) printing offers a route to patient-specific, architecturally defined bone scaffolds, while biopolymers from natural sources provide biodegradability, biocompatibility, and extracellular matrix-mimicking cues consistent with sustainable, green biomaterials science. This review synthesises recent progress in 3D printing of biopolymer-based scaffolds for bone tissue engineering. We first examine the principal feedstocks—alginate, gelatin and gelatin methacryloyl, collagen, chitosan, silk fibroin, cellulose, and microbial polyesters—and their preparation, crosslinking chemistry, and printability. We then compare extrusion, light-based, and indirect printing technologies and the process–property relationships governing resolution, mechanical competence, and cell viability. Composite and functionalisation strategies, including biopolymer–bioceramic hybrids and controlled delivery of growth factors and antimicrobial agents, are analysed as routes to osteoinduction, vascularisation, and infection control. Finally, we evaluate translational performance in preclinical models and outline central challenges of vascularisation, mechanical–degradation matching, scalability, and regulatory standardisation. Biopolymer 3D printing is positioned as a ve rsatile, sustainable platform whose clinical maturation depends on integrated material, structural, and biological design. Full article

Background: The objective was to synthesize and critically appraise systematic reviews with meta-analysis evaluating the association between irrigation, instrumentation, and obturation procedures and post-operative endodontic pain. Methods: An umbrella review was conducted following PRISMA guidelines. Electronic searches identified systematic reviews published between 2016 and 2025. Eligible studies are systematic reviews that include meta-analyses, published in English and correlating the presence of post-operative pain in 3 different critical stages of root canal treatments, namely irrigation, instrumentation and obturation. Methodological quality was assessed using the AMSTAR 2 tool. Outcomes included pain prevalence and intensity at different time points. Results: Out of 368 records, 25 systematic reviews with meta-analysis met the inclusion criteria: 9 on irrigation, 8 on instrumentation, and 8 on obturation. NaOCl concentrations, irrigant activation, and intracanal cryotherapy were repeatedly reported as being associated with reduced short-term post-operative pain. For instrumentation, most reviews reported lower pain with rotary systems, but two studies found no difference or favored reciprocating kinematics. Apical patency did not appear to increase pain and foraminal enlargement may increase early pain. No clinically consistent differences were observed between bioceramic/calcium silicate-based and resin-based sealers, although calcium silicate sealers seem to support periapical healing. However, the certainty of these findings was limited by heterogeneity, methodological weaknesses, and overlap among primary studies. Methodological limitations were identified across reviews, mainly related to no protocol registration (n = 4), incomplete reporting of excluded studies with justification (n = 11), limited assessment of publication bias, and poor reporting of funding sources for primary studies. Conclusions: Based on current evidence, irrigation, instrumentation, and obturation procedures may influence short-term post-operative pain. However, these findings remain tentative because of heterogeneity, methodological weaknesses, variable review quality, and overlap among primary studies. Further high-quality reviews and clinical trials are needed. Full article

Background/Objectives: Endodontic perforation repair requires biomaterials that balance sealing ability with minimal cellular injury. AH Plus (epoxy resin-based) remains widely used despite cytotoxicity concerns. CeraSeal (calcium silicate-based bioceramic) is a potentially more biocompatible alternative. However, comparative data on sealer-induced cytotoxicity and inflammatory responses remain limited. This study compared the cytotoxicity and inflammatory profiles of CeraSeal and AH Plus using in vitro and in vivo approaches. Methods: Human periodontal ligament stem cells (hPDLSCs) were exposed to sealer extracts (1:4 AH Plus, 1:8 CeraSeal) for 120 h. Cell death was assessed by MTT, Live/Dead, LDH release, and Annexin V/PI flow cytometry. Oxidative stress was quantified via ROS generation (DCFH-DA). In a rat furcation perforation model (n = 8 teeth/group), inflammatory markers (TNF-α, IL-1β, CD68), osteogenic activity (ALP), and osteoclasts (TRAP) were evaluated. Results: AH Plus was associated with significantly greater necrotic cell death (357.6 ± 47.6% LDH release vs. CeraSeal 128.8 ± 37.5%; p = 0.0079) and reduced hPDLSC viability at all time points (p < 0.0001). ROS generation was comparable between sealers (~32–35%, p > 0.05). In vivo, IL-1β was higher in AH Plus-treated tissues (52.25 vs. 24.88 cells/mm²; p = 0.0002), while TNF-α and CD68 were greater in CeraSeal (p ≤ 0.0011). ALP was higher in AH Plus (median 6.15 vs. 3.68; p = 0.0002), with no difference in TRAP-positive osteoclasts. Morphometric analysis showed superior cellular preservation with CeraSeal (p = 0.0079), while inflammatory infiltration was higher in CeraSeal (p = 0.0002). Conclusions: AH Plus was associated with a necrotic-inflammatory profile with elevated IL-1β and higher ALP expression. CeraSeal demonstrated better cellular preservation, lower LDH release, and a distinct inflammatory signature (higher TNF-α and CD68). These findings establish comparative response profiles for the two sealers and support CeraSeal as a potentially biocompatible alternative, though further mechanistic studies are warranted. Full article

The development of lightweight aluminum matrix composites with improved mechanical performance and thermal stability using sustainable reinforcement materials remains a significant challenge in structural materials engineering. Although ceramic-reinforced aluminum composites exhibit enhanced strength and thermal resistance, the potential of bio-derived snail shell particles as environmentally sustainable reinforcements remains insufficiently explored. In this study, snail-shell-reinforced AA6061 aluminum matrix composites were fabricated by stir casting to investigate their microstructural characteristics, mechanical behavior, phase composition, and thermal stability. Snail shell particles, predominantly composed of CaCO₃, were processed to particle sizes of 50–75 µm before incorporation into the molten aluminum matrix. Characterization was performed using scanning electron microscopy (SEM), energy-dispersive spectroscopy (EDS), X-ray diffraction (XRD), tensile and hardness testing, thermogravimetric analysis (TGA), and differential scanning calorimetry (DSC). The results revealed relatively uniform particle dispersion and satisfactory matrix–reinforcement interfacial compatibility. The tensile strength increased from 155 ± 5 MPa for the unreinforced alloy to 211 ± 4.8 MPa for the reinforced composite, corresponding to an improvement of approximately 36%, while elongation increased from 2.4 ± 0.2% to 4.6 ± 0.4% (92%). XRD analysis confirmed the presence of Al, CaCO₃, Mg₂Si, and minor CaO phases, indicating successful reinforcement incorporation and strengthening phase formation. Thermal analysis demonstrated enhanced thermal stability, increased residual mass retention, and improved resistance to thermal degradation. This work demonstrates that bio-derived snail shell particles are viable and environmentally sustainable reinforcements for lightweight aluminum matrix composites intended for structural engineering applications. Full article

The aim of this study was to evaluate the effect of two laser-assisted disinfection techniques on the porosity and bond strength (BS) of a new premixed calcium silicate sealer. Forty extracted human single-rooted premolars with one root canal were prepared up to 50/05. Samples were randomly assigned to the groups (n = 10 each): 1. shock wave-enhanced emission of photoacoustic streaming (SWEEPS) (20 mJ, 15 Hz, 0.60 W, pulse duration 25 µs), 2. diode laser (975 nm, 1.5 W), 3. conventional needle and syringe irrigation (CI), and 4. control (C), with no final irrigation protocol. Root canals were filled with a premixed calcium silicate sealer using the single-cone obturation technique. Micro-CT scans were performed after two weeks to determine the presence of voids in the filling. Dentinal discs from the middle third were prepared for push-out testing. Kruskal–Wallis and post hoc Dunn tests were used, with significance set at 5%. Micro-CT analysis detected porosity in all samples, with no significant differences among the groups (p > 0.05). SWEEPS showed the highest BS values (median 3.233 MPa) and outperformed CI and C (median 1.923 and 1.989 MPa) (p < 0.05) overall. SWEEPS enhanced the BS compared with CI. Voids were present in all experimental groups. Full article

Background/Objectives: Titanium alloy Ti₆Al₄V remains the gold standard in dental implantology due to its excellent mechanical properties, corrosion resistance, and biocompatibility. However, implant-associated infections and insufficient osseointegration continue to represent major clinical challenges, mainly related to bacterial biofilm formation and suboptimal surface–tissue interactions. Biofilm formation refers to the adhesion, accumulation, and growth of microbial communities embedded within a self-produced extracellular polymeric matrix on implant surfaces, which contributes to bacterial persistence and resistance to host defense mechanisms. This review aims to critically evaluate recent advances in multifunctional bioceramic coatings for dental implants, with a particular focus on zirconia (ZrO₂)-based systems and their antibacterial mechanisms. Methods: A structured literature analysis was conducted using major scientific databases including PubMed, Scopus, and Web of Science, focusing mainly on studies published between 2015 and 2025 related to CaP, Ag, and ZrO₂-based coatings for dental implants. The review examines their physicochemical properties, antibacterial strategies, ion release behavior, and biological responses, including osteogenic activity and biofilm inhibition. Particular attention is given to hybrid systems integrating multiple functional phases. Results: CaP coatings exhibit excellent osteoconductivity and promote early osseointegration but show limited intrinsic antibacterial activity. Ag-based coatings provide strong broad-spectrum antimicrobial effects through controlled Ag⁺ ion release, although concerns regarding cytotoxicity and dose-dependent responses remain. ZrO₂ coatings significantly enhance corrosion resistance and surface stability, while their antibacterial performance can be improved through nanostructuring, laser surface modification, and ionic doping. Hybrid Ag–CaP–ZrO₂ coatings demonstrate improved antibacterial activity, enhanced corrosion resistance, and better regulation of ion release kinetics and osteogenic response compared with single-component coating systems. Conclusions: Multifunctional bioceramic coatings represent a promising strategy for improving the performance of dental implants and addressing the dual challenge of infection control and tissue integration. However, challenges remain regarding long-term stability, controlled ion release, and limited clinical validation. Future research should focus on the development of smart, stimuli-responsive coatings and standardized evaluation protocols to facilitate clinical translation. Full article

Apical perforation is a possible complication during root canal treatment, often caused by instrumentation beyond the working length, and requires prompt, precise sealing. In immature teeth needing endodontic therapy, the same principles used for managing apical perforations apply. Despite the widespread use of calcium silicate cement (CSC)-based materials, there is limited evidence comparing the sealing performance of putty-type CSCs and injectable bioceramic sealers in apical perforations under standardized laboratory conditions. This study aimed to compare the sealing ability of Retro-MTA cement and Endoseal MTA sealer in standardized apical perforations using the fluid-filtration method. In this in vitro study, 34 extracted human maxillary central incisors were used and divided into two groups. In Group 1, apical perforations were sealed with Retro-MTA and obturated using warm vertical compaction. In Group 2, perforations were sealed with Endoseal MTA and obturated using the single-cone technique. Micro-leakage was assessed using the fluid-filtration method. Data were analyzed with an independent t-test (α = 0.05). All samples exhibited leakage after two weeks. However, Retro-MTA demonstrated significantly lower micro-leakage than Endoseal MTA (0.265 vs. 0.473 μL/min/cmH₂O; p < 0.001), corresponding to approximately a 44% difference in leakage values between the two materials. The findings indicate that Retro-MTA provides a superior apical seal and lower leakage rates than Endoseal MTA. Therefore, Retro-MTA appears to be the more effective material for sealing apical perforations and managing open apices, potentially providing more stable apical seal under controlled laboratory conditions. Full article

This investigation addressed challenges in the delivery of poorly soluble drugs, and the colloidal processing of polymer–ceramic composites by fabrication of advanced supramolecular hydrogels. Polygalacturonic acid (PGA) polymer and 18β-glycyrrhetinic acid (GA) drug, both characterized by poor aqueous solubility, were selected as model building blocks for supramolecular hydrogels. Meglumine (MG) served as a multifunctional component in the gels, acting as a building block as well as an alkalizing and solubilizing agent for PGA and GA. Investigations revealed gel formation mechanisms, which were based on the electrostatic interactions of deprotonated anionic carboxylic groups of PGA and GA with protonated amino groups of MG and the hydrogen bonding of PGA polymer and GA molecules. The feasibility of the fabrication of PGA-MG and GA-MG gels opened an avenue for the fabrication of PGA-GA-MG gels. The composite gels provided a platform for drug delivery, and the kinetics of drug release from the composite gels containing MG excipient were investigated. Composite gels were obtained from colloidal dispersions, containing bioceramics, such as hydroxyapatite, silica, and titania, and bioglass in the PGA solutions in the presence of MG. The results of this investigation pave the way for the fabrication of novel supramolecular and composite gels loaded with various functional materials. Full article

Polymer-derived ceramics (PDCs) technology has been established for over five decades as a versatile route for the fabrication of advanced bioceramic materials. However, conventional processing routes for bioceramics, such as melt-quenching and sol–gel methods, still present significant limitations, including high processing temperatures, limited compositional flexibility, long processing times, and difficulties in fabricating complex and highly porous structures required for biomedical applications. In this context, increasing attention has been devoted to polymer-derived ceramics as an alternative approach for the fabrication of bioceramic materials. In this approach, preceramic polymers are converted into ceramic phases through thermal treatment in air or inert atmosphere (e.g., nitrogen), enabling low-temperature processing, high compositional flexibility, and precise control over phase evolution and microstructure. These features make the polymer-derived Ceramic route particularly attractive for the fabrication of complex and functional bioceramic architectures. This review provides an overview of the polymeric precursors employed for the synthesis of Polymer Derived Ceramic-based bioceramics, with particular emphasis on inorganic polymers, typically characterized by a siloxanic backbone, and the mechanisms governing their ceramization behavior. Special attention is given to emerging trends, including the integration of polymer-derived ceramics with additive manufacturing techniques and the development of functional systems for biomedical applications. Full article

Background/Objectives: Reliable detection of residual root canal filling material after retreatment is essential for comparing retreatment protocols. However, available methods quantify different clinical–physical dimensions and may not yield comparable estimates. This in vitro study compared cone-beam computed tomography (CBCT) and digital microscopy (DGM) for detecting residual obturation material after retreatment, using microcomputed tomography (micro-CT) as the reference standard. Methods: Fifteen extracted human mandibular premolars with single, straight canals were instrumented, obturated with gutta-percha and a calcium silicate-based sealer (AH Plus Bioceramic), and retreated with ProTaper Universal Retreatment files. Residual material was assessed in the coronal, middle, and apical thirds using CBCT (voxel size 0.10 mm), micro-CT (voxel size 60 µm), and DGM after longitudinal root splitting. Surface-based (DGM) and volumetric (CBCT and micro-CT) outcomes were analyzed separately using Wilcoxon signed-rank tests, diagnostic accuracy metrics (sensitivity, specificity, predictive values), and Cohen’s kappa for agreement. Results: DGM showed low median residual surface percentages across thirds (0.34–1.52%), whereas CBCT yielded higher median residual volume percentages (10.20–14.20%) than micro-CT (3.27–5.04%). The difference in the middle third between CBCT and micro-CT remained significant after Bonferroni correction (p = 0.002). For binary detection, CBCT showed higher sensitivity but lower specificity (overclassification of positive thirds), whereas DGM showed high specificity but limited sensitivity in the coronal and middle thirds. Conclusions: Within the limitations of this laboratory study, micro-CT was the most reliable reference method. CBCT tended to overestimate residual material, suggesting that clinical decisions based solely on CBCT may lead to unnecessary retreatment. DGM underestimated remnants because it assesses only the exposed split surface. These method-specific limitations should guide both clinical interpretation and future research design. Full article

Background/Objectives: This study aimed to evaluate the effect of intracanal cryotherapy on postoperative pain across obturation materials with different chemical compositions and physical properties in single-visit root canal treatment. Methods: Patients diagnosed with irreversible pulpitis (n = 73), treated in a single visit by the same operator, were categorized based on the obturation material used (AH Plus, TotalFill BC Sealer, and TotalFill BC RRM) and whether intracanal cryotherapy (20 mL of sterile saline at 4 °C for 5 min) was applied. Visual Analog Scale (VAS) scores obtained from patient follow-up forms at 24, 48, and 72 h were evaluated. Results: Cryotherapy (+) groups showed consistently lower pain scores at all time points compared with cryotherapy (−) groups (p < 0.001). Within the cryotherapy (+) groups, both TotalFill BC Sealer and TotalFill BC RRM exhibited significantly lower pain scores than AH Plus at 48 h (p < 0.05). In the cryotherapy (−) groups, TotalFill BC Sealer showed significantly lower pain scores on the third postoperative day (p < 0.05). Conclusions: Intracanal cryotherapy may serve as an effective adjunctive technique associated with lower early postoperative pain scores. Material-related differences became evident at 48 and 72 h, suggesting that obturation material selection may influence postoperative pain patterns and patient comfort during the later postoperative period. Full article

Epoxy resins are widely used thermosetting polymers, but their limited toughness and flexural resilience restrict broader applications. In this study, diglycidyl ether of bisphenol A (DGEBA) epoxy was reinforced with 5 wt.% ceramic fillers of different origins: sol–gel alumina calcined at 550 °C (γ-Al₂O₃) and 1000 °C (α-Al₂O₃), silica derived from rice husk, silica from diatomaceous earth, and a hybrid alumina–silica mixture prepared by sol–gel and calcined at 1000 °C. Fillers were structurally characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and field-emission scanning electron microscopy (FESEM). Mechanical properties were evaluated through tensile (ASTM D638) and flexural (ASTM D790) testing. All reinforcements enhanced the performance of neat epoxy. γ-Al₂O₃ provided superior tensile reinforcement compared to α-Al₂O₃, underscoring the importance of particle morphology and surface reactivity. The hybrid alumina–silica filler achieved the highest flexural strength of 50.6 MPa, compared to 9.91 MPa for the neat epoxy. Bio-derived silica showed improved flexural properties, although its tensile reinforcement was less pronounced compared to the sol–gel derived fillers. These results establish clear structure–property relationships and confirm that filler phase, morphology, and calcination temperature critically govern the mechanical performance of epoxy composites. Full article

This prospective, single-arm post-market study aimed to evaluate the clinical safety and performance of a synthetic calcium phosphate ceramic used in alveolar bone regeneration procedures. Eighty adult patients requiring bone augmentation were treated with β-tricalcium phosphate (β-TCP) under routine clinical indications. Surgical approaches were adapted to defect morphology. Safety outcomes included adverse events (AEs) and device deficiencies (DDs), while performance outcomes focused on two-dimensional radiographic bone assessment. Radiographic bone consolidation was defined as continuous trabecular radiopacity without radiolucent defects or clinical signs of infection. Patients were followed for six months post-surgery, with clinical and radiographic evaluations, as well as assessment of oral health-related quality of life (OHIP-14). All 80 patients (mean age: 47.2 ± 18.9 years; 51% male) completed the immediate postoperative assessment. Eleven DDs (granule loss) were observed postoperatively (13.8%) and no AEs. At six months, 71 patients (88.8%) completed follow-up. Radiographic bone repair was confirmed in all cases clinically observed and with follow-up X-ray (100%). No AEs or DDs reported (AE-free rate: 100%) at this follow-up. The median OHIP-14 score improved significantly at six months (p = 0.037), indicating better self-reported oral health. Given the observational design, absence of a control group, and partial reliance on non-radiographic follow-up, these findings should be interpreted with caution. Within these limitations, the synthetic calcium phosphate ceramic demonstrated a favorable short-term safety profile and apparent bidimensional radiographic signs of clinical performance under real-world conditions, rather than definitive evidence of effectiveness. Further controlled studies incorporating histological and volumetric analyses are warranted to confirm its regenerative potential. Full article

This study investigated the physicochemical properties of three endodontic bioceramics: MTA Flow White (F), MTA Repair HP (HP), and Nishika Canal Sealer BG multi (BG). Disc-shaped samples were immersed in deionized water for 28 days to analyze pH, calcium ion concentration, mass change, and water sorption. Additionally, the effect of varying powder-to-liquid (or paste) ratios was investigated for F and BG. All samples exhibited mass loss due to surface degradation. Results showed that F exhibited the highest alkalinity (pH 10.8–11.3) and significantly greater calcium ion release (173.3–523.3 ppm) than other materials (p < 0.05). HP showed moderate alkalinity (pH 10.4–10.7) with lower calcium release (43.3–66.3 ppm), while BG exhibited the lowest alkalinity (pH 9.3–9.4). Regarding the effect of consistency, variations in the powder-to-liquid (or paste) ratio significantly influenced the physical stability of F and BG—notably shifting F from mass loss to mass gain—but did not significantly affect their pH or calcium ion release kinetics (p > 0.05). Consequently, both null hypotheses were rejected, as significant differences were observed among the materials, and consistency significantly affected mass change and water sorption but not alkalinity or ion release. Full article

In this study, bioceramic composites based on zirconia (ZrO₂) were synthesized and characterized in terms of mechanical properties. Two types of different-sized grains of zirconia powders were used to prepare the composites. A commercial zirconia micropowder (Tosoh) was used as a base for the composites modified with bioactive glass (BG), copper-doped bioactive glass (BGCu), and hexagonal boron nitride (hBN) with a sintering temperature of 1450 °C. The composites with the addition of hydroxyapatite, for which their sintering temperature was 1150 °C, were independently fabricated using a zirconia nanopowder prepared via co-precipitation and hydrothermal methods to achieve high densification and avoid hydroxyapatite decomposition. Mechanical performance of these composites was assessed with regard to biaxial flexural strength, Vickers hardness (HV), and fracture toughness (K_Ic). The reference 3Y-TZP material exhibited Vickers hardness (11.8 GPa) and fracture toughness (6.1 MPa∙m^1/2 values typical for dense tetragonal zirconia ceramics. The addition of all bioactive phases resulted in significant alterations in mechanical properties. Specifically, incorporating 20 wt.% HAp led to a threefold decrease in hardness and a 40% reduction in fracture toughness, while increasing the HAp content to 40 wt.% further reduced these properties. Nonetheless, the fracture toughness of these composites remained higher than that of pure hydroxyapatite materials. The incorporation of BG and BGCu reduced the hardness values by 45% and 30%, respectively, compared to 3Y-TZP. The most significant deterioration of the properties was observed for the 3Y-TZP-hBN composite. The 3Y-TZP–BGCu composite exhibited fracture toughness (5.9 MPa∙m^1/2) representing 95% of the toughness of pure zirconium dioxide, thereby showing the lowest weakness of all the other composites with bioactive additives. A slightly lower fracture toughness value (5.3 MPa∙m^1/2) was also observed in the composite with bioglass but lacking the copper additive. This factor, combined with a relatively small decrease in hardness in both cases, highlights high durability for implantology applications, thus marking the indicated materials the most promising among the composites studied. Full article