Search Results (553)

Amorphous calcium phosphate (ACP) is a well-established bioceramic material known to promote the remineralization of dental hard tissues. White spot lesions (WSLs) represent the initial stage of enamel demineralization and are frequently observed in patients with fixed orthodontic appliances or inadequate oral hygiene. Although recommendations for remineralizing agents include both the prevention of lesion progression and the stimulation of tissue remineralization, the clinical efficacy of ACP-based materials remains under debate. This systematic review, registered in the PROSPERO database (CRD42024540595), aims to evaluate the clinical efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-based products in the remineralization of WSLs and to compare these outcomes with those achieved using non-bioceramic approaches. Inclusion criteria comprised randomized clinical trials, prospective cohort studies, and pilot studies conducted on human subjects with WSLs affecting permanent teeth. Studies involving artificial WSLs or non-cariogenic enamel lesions were excluded. The quality of the included studies was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Fourteen articles met the inclusion criteria and were analyzed. The main findings indicate that CPP-ACP is clinically effective in promoting the remineralization of WSLs, although the results were inconsistent across studies. Comparisons with placebo and resin infiltration treatments revealed greater efficacy for CPP-ACP. The combination of CPP-ACP with fluoride appeared to further enhance the remineralizing effect on WSLs. Additional standardized clinical studies with longer follow-up periods are warranted to confirm these outcomes. Full article

Continued efforts have been made to enhance the antibacterial properties of root canal sealers by adding antimicrobial agents to them. This study aims to investigate the antibacterial effect of 0.15% silver nanoparticles (NAg) and 5% dimethylaminohexadecyl methacrylate (DMAHDM) when added to EndoSequence Bioceramic (BC) sealer against Enterococcus faecalis (E. faecalis) biofilm and their impact on its physical properties (flowability and film thickness). Four root canal sealers were tested for flow and film thickness properties, as well as against antibiofilm of E. faecalis-impregnated dentin discs, as follows: group 1: EndoSequence BC sealer only; group 2: EndoSequence BC sealer + 0.15% NAg; group 3: EndoSequence BC sealer + 5% DMAHDM; and group 4: EndoSequence BC sealer + 0.15% NAg + 5% DMAHDM. The findings show that all groups had flow and film thickness values that were in accordance with the ISO requirements. Combining 0.15% NAg and 5% DMAHDM in EndoSequence significantly reduced colony-forming unit (CFU) counts by approximately 5 logs. The combination of NAg and DMAHDM offers a promising strategy for developing endodontic sealers with improved antimicrobial properties and acceptable physical performance. Full article

The movement of valves of bivalved invertebrates is enabled through the action of muscles and the interplay between the muscles and the hinge ligament. The muscles that move the valves attach to their internal surface. To promote the structural integrity at the mechanically mismatched interfaces, a specific crystal microstructure and texture are present at the muscle attachment sites. These are different from the crystal microstructure and texture of the rest of the valves. We present here for modern two- and three-layered brachiopod shells (Magellania venosa, Liothyrella neozelanica and Gryphus vitreus) the mode of crystal organisation at sites of adductor and diductor muscle attachments (i) relative to the microstructure and texture that forms the other sections of the valves and (ii) relative to crystal organisation of muscle attachment sites of bivalved invertebrates of other phyla, namely, species of the class Bivalvia. We discuss similarities/differences in Ca-carbonate phase, microstructure and texture between rhynchonellate brachiopods and bivalves, and discuss whether the Ca-carbonate crystal organisation of muscle attachment sites is convergent for bivalved marine organisms. We show significant differences in muscle attachment site architecture and highlight the different structural solutions developed by nature for shells of marine organisms that serve the same purpose. Full article

Although publications have documented the osteo-inductive effects of various bioactive materials on tissue sections, the associated morphologic patterns of tissue remodeling pathways at the cellular level have not been detailed. Therefore, we present a comparative histopathological follow-up evaluation of bone defect repair mediated by silica aerogels and methacrylate hydrogels over a 6-month period, which is the widely accepted time course for complete resolution. Time-dependent microscopic analysis was conducted using the “critical size model”. In untreated rat calvaria bone defects (control), re-ossification exclusively started at the lateral regions from the edges of the remaining bone. At the 6th month, only a few new bones were formed, which were independent of the lateral ossification. The overall ossification resulted in a 57% osseous encroachment of the defect. In contrast, aerogels (AE), hydrogels (H), and their β-tricalcium-phosphate (βTCP)-containing counterparts, which were used to fill the bone defects, characteristically induced rapid early ossification starting from the 1st month. This was accompanied by fibrous granulomatous inflammation with multinucleated giant macrophages, which persisted in decreasing intensity throughout the observational time. In addition to lateral ossification, multiple and intense intralesional osseous foci developed as early as the 1st month, and grew progressively thereafter, reflecting the osteo-inductive effects of all compounds. However, both βTCP-containing bone substituents generated larger amounts and more mature new bones inside the defects. Nevertheless, only 72.8–76.9% of the bone defects treated with AE and H and 80.5–82.9% of those treated with βTCP-containing counterparts were re-ossified by the 6th month. Remarkably, by this time, some intra-osseous hydrogels were found, and traces of silica from AE were still detectable, indicating these as the causative agents for the persistent osseous–fibrous granulomatous inflammation. When silica or methacrylate-based bone substituents are used, chronic ossifying fibrous granulomatous inflammation develops. Although 100% re-ossification takes more than 6 months, by this time, the degree of osteo-fibrous solidification provides functionally well-suited bone repair. Full article

Three-dimensional printing techniques can prepare complex bioceramic parts and scaffolds with high precision and accuracy, low cost, and customized geometry, which greatly broadens their application of 3D-printed bioceramics and bioceramic matrix composites in the clinical field. Nevertheless, the inadequate mechanical properties of 3D-printed bioceramic scaffolds, such as compressive strength, wear resistance, flexural strength, fracture toughness, and other properties, are a bottleneck problem and severely limit their application, which are overcome by introducing reinforcements. Three-dimensional printing techniques and the mechanical property of bioceramics and bioceramic matrix composites with different reinforcements, as well as their potential applications for bone tissue engineering, are discussed. In addition, the biological performance of 3D-printed bioceramics and scaffolds and their applications are presented. To address the challenges of insufficient mechanical strength and mismatched biological performance in bioceramic scaffolds, we summarize current solutions, including the advantages and strengthening effects of fiber, particle, whisker, and ion doping. The effectiveness of these methods is analyzed. Finally, the limitations and challenges in 3D printing of bioceramics and bioceramic matrix composites are discussed to encourage future research in this field. Our work offers a helpful guide to research and medical applications, especially application in the tissue engineering fields of bioceramics and bioceramic matrix composites. Full article

Background and objectives: Post-operative pain (POP) is a common complication after root canal treatment and is influenced by various clinical and patient-related factors. The present study evaluated the incidence and intensity of POP following root canal treatment using a bioceramic sealer performed by operators with different levels of experience. Methods: A total of 115 patients were included in this prospective observational study. Patients were treated by operators with different levels of experience: postgraduate students (PGSs) and endodontic specialists (ESs). Standardized protocols were used in two distinct appointments: an instrumentation visit and an obturation visit. Obturation was performed using the continuous wave condensation technique and Total Fill Hi-Flow BC Sealer (TFHF). POP, mastication discomfort, and sleep disturbance were assessed at 24, 48, and 72 h after the instrumentation and obturation phases using a numeric rating scale (NRS). Results: The results indicate significantly higher POP after the instrumentation phase, compared to the obturation phase (p < 0.001). The pain intensity progressively decreased over time for both phases. No significant differences were observed between the PGS and ES groups regarding POP, mastication discomfort, or sleep disturbance at any time. Sealer extrusion did not significantly impact POP (p > 0.05). Conclusions: This study found that operator experience does not significantly influence POP when a standardized protocol is followed. The use of TFHF with the continuous wave condensation technique was associated with minimal POP. Full article

In this study, phosphogypsum waste collected from a factory dump in Kedainiai, Lithuania, was used for the first time as a starting material in the dissolution–precipitation synthesis of high-quality bioceramic calcium hydroxyapatite (Ca₁₀(PO₄)₆(OH)₂; CHA). The CHA powders were synthesized using the dissolution–precipitation method, employing phosphogypsum in four different conditions: untreated, dried at 100 °C, dried at 150 °C, and annealed at 1000 °C. Various phosphorus sources were used in the CHA synthesis process: Na₂HPO₄; a mixture of Na₂HPO₄ and NaH₂PO₄; or a combination of Na₂HPO₄, NaH₂PO₄, and NaHCO₃. These mixtures were allowed to react at 80 °C for 48 h, 96 h, 144 h, and 192 h. X-ray diffraction (XRD) analysis revealed slight variations in the synthesized products depending on the specific starting materials used. Fourier transform infrared spectroscopy (FTIR) was conducted to confirm the structural characteristics of the synthesized CHA samples. The surface microstructure of the synthesized CHA samples differed notably from that of the raw phosphogypsum. All synthesized CHA samples exhibited Type IV nitrogen adsorption–desorption isotherms with H3-type hysteresis loops, indicating the presence of mesoporous structures, typically associated with slit-like pores or aggregates of plate-like particles. To the best of our knowledge, an almost monophasic CHA has been fabricated from phosphogypsum waste for the first time using a newly developed dissolution–precipitation synthesis method. A key challenge in the high-end market is the development of alternative synthesis technologies that are not only more environmentally friendly but also highly efficient. These findings demonstrate that phosphogypsum is a viable and sustainable raw material for CHA synthesis, with promising applications in the medical field, including the production of artificial bone implants. Full article

The fundamental goal of endodontic surgery is to remove the infection cause and create an ideal environment for periapical tissue and bone recovery. This systematic review aims to present evidence-based findings regarding the healing ability of endodontic materials in retrograde treatment. The study evaluates the advantages and drawbacks of commonly utilized materials, empowering clinicians with valuable insights for preoperative planning in endodontic surgery. A comprehensive search was conducted across multiple databases, including MEDLINE, Scielo, Web of Science, Scopus, Embase, and Google Scholar, using the PIOT framework. A total of 3124 papers were identified, of which 2534 remained after removing duplicates. Following a stringent selection process, 35 clinical studies were included for qualitative assessment. The risk of bias was assessed using the Risk of Bias in Non-randomized Studies—of Interventions (ROBINS-I) tool for non-randomized trials, the Newcastle–Ottawa Scale for cohort studies, and the Joanna Briggs Institute (JBI) critical appraisal checklist for cross-sectional studies. Due to high heterogeneity in study designs and outcomes, a meta-analysis could not be performed. The review identified Super Ethoxybenzoic Acid (Super EBA), Mineral Trioxide Aggregate (MTA), and Intermediate Restorative Material (IRM^®), Retroplast, Endosequence^®, and gutta-percha as the primary retrograde root filling materials. Follow-up periods ranged from 6 months to 17.5 years. Although the materials showed varying degrees of success, the overall findings highlighted that no single material demonstrated universally superior healing ability. The review also emphasized the need for standardization in future clinical trials to facilitate better comparisons. The selection of retrograde filling materials plays a pivotal role in the success of endodontic surgery. New bioceramic materials like MTA and Biodentine offer improved sealing, biocompatibility, and tissue regeneration compared to traditional materials, leading to better clinical outcomes. Full article

(1) Background: Osteonecrosis of the femoral head (ONFH), caused by insufficient blood supply, leads to bone tissue death. Current treatments lack effective bone regeneration materials to reverse disease progression. This study introduces an injectable and self-setting 3D porous bioceramic scaffold (Mg@Ca), combining MgO + SiO₂ mixtures with α-hemihydrate calcium sulfate, designed to promote bone repair through in situ pore formation and osteoinduction. (2) Methods: In vitro experiments evaluated human bone marrow mesenchymal stem cell (h-BMSC) proliferation, differentiation, and osteogenic marker expression in Mg@Ca medium. Transcriptome sequencing identified bone development-related pathways. In vivo efficacy was assessed in a rabbit model of ONFH to evaluate bone repair. (3) Results: The Mg@Ca scaffold demonstrated excellent biocompatibility and supported h-BMSC proliferation and differentiation, with significant up-regulation of COL1A1 and BGLAP. Transcriptome analysis revealed activation of the PI3K-Akt signaling pathway, critical for osteogenesis. In vivo results confirmed enhanced trabecular density and bone volume compared to controls, indicating effective bone repair and regeneration. (4) Conclusions: The Mg@Ca scaffold offers a promising therapeutic approach for ONFH, providing a minimally invasive solution for bone defect repair while stimulating natural bone regeneration. Its injectable and self-setting properties ensure precise filling of bone defects, making it suitable for clinical applications. Full article

The aim of this study is to evaluate the apical sealing ability of novel bioceramic-based (BCB) and widely used resin-based (RB) root canal sealers in combination with traditional or bioceramic-coated gutta-percha points. A total of 92 human single-root extracted teeth were endodontically treated and divided into three groups (A, B, and C) of 30 samples based on the endodontic sealer/type of gutta-percha points/obturation method used. One tooth sample was used for the negative and positive controls (each). Group A: BCB sealer BioRoot RCS (Septodont, Saint-Maur-des-Fossés, France)/bioceramic-impregnated gutta-percha TotalFill BC points (FKG Dentaire, La Chaux-de-Fonds, Switzerland)/cold hydraulic single-cone. Group B: BioRoot RCS (Septodont, France)/traditional Protaper Gold Gutta-Percha Points (Dentsply Sirona, Charlotte, NC, USA)/cold hydraulic single-cone. Group C: RB sealer AdSeal (Meta Biomed, Cheongju, Republic of Korea)/traditional Protaper Gold Gutta-Percha Points (Dentsply Sirona, USA)/warm vertical condensation. A dye penetration method was applied, and the length of apicocoronal penetration was measured using a surgical microscope. The data were statistically analyzed to evaluate differences at the 0.05 significance level. A significant difference was found between groups A and C, p = 0.0003, and groups B and C, p = 0.003. The data analysis proved that the BCB sealer using the cold hydraulic single-cone method ensured a substantially better seal than the RB sealer using the warm vertical condensation method. The choice of the type of gutta-percha points (bioceramic-coated or regular) appeared to be unimportant. No statistical significance was found between groups A and B, which indicates that using bioceramic-coated gutta-percha points does not bring any considerable benefit in view of a no-gap root canal obturation. Full article

This study compared the efficacy of different solutions in achieving patency in teeth filled with AH Plus Bioceramic sealer. Eighty-five premolars with a straight canal were prepared. After sealer placement, a master gutta-percha cone was introduced 2 mm short of the working length. The teeth were stored at 37 °C and 100% humidity for five weeks before retreatment. Filling materials were removed up to the gutta-percha cone’s length. The canals were then randomly assigned to groups: G1 (control, no solution), G2 (5.25% NaOCl), G3 (17% EDTA), G4 (10% citric acid), and G5 (10% formic acid). The apical patency was attempted with a 10 K file within a period of 10 min, by a blinded operator. Additionally, sealer samples were immersed in the solutions, followed by scanning electron microscopy analysis. The Kruskal–Wallis test was used for statistical analysis. Patency was achieved in all canals except one in the control and one in the NaOCl groups. No significant differences were found in the time required to achieve patency. Acid solutions had a greater impact on the sealer’s structural integrity, and a decalcifying effect of EDTA and citric acid was registered. Apical patency in straight canals obturated with AH Plus Bioceramic sealer was consistently achieved regardless of the solution used. Full article

Calcium silicate-based sealers (CSBS) vary in chemical composition, which can influence treatment outcomes. Therefore, the study aimed at comparing several commercially available CSBS regarding microstructure and elemental characterization. Four CSBS (AH Plus Bioceramic Sealer, BioRoot RCS, BioRoot Flow, TotalFill BC Sealer) and a control resin-based sealer (AH Plus) were evaluated using scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), and X-ray powder diffraction analysis (XRD). The specimens were analyzed after setting (SEM, EDX, XRD), as well as after 7 (SEM) and 28 days (SEM, EDX) of incubation in Hank’s balanced salt solution. AH Plus exhibited a uniform matrix and small amounts of calcium (Ca), significantly decreasing after incubation. In contrast, CSBSs exhibited crystalline forms on the surface and increased Ca content, significantly increasing after 28 days of incubation. The main crystalline phase for all tested CSBS was zirconium oxide, while for ERBS it was calcium tungstate. In conclusion, the amount of calcium increased on the surface of CSBSs after incubation, which alkalinized the pH, promoting mineralization, apatite formation, and antibacterial potential. Despite this, the formation of a hydroxyapatite layer was not demonstrated, possibly due to the high dissolution potential of CSBSs. Full article

Background: The primary objective of this study was to evaluate the cytotoxic and genotoxic effects of calcium silicate-based sealers (BioRoot RCS and MTA Fillapex) compared to an epoxy-based sealer (AH Plus). Materials and methods: The study was conducted in vitro with the cell lines HepG2 and V79 to evaluate cytotoxicity and genotoxicity using the comet and micronucleus assays. Eluates of the materials were tested at two different concentrations (3 cm²/mL and 0.5 cm²/mL) after an exposure time of 72 h. Data were analyzed using the Mann–Whitney and Kruskal–Wallis tests (p < 0.05). Results: At lower concentrations in both cell lines, MTA Fillapex showed no significant difference in the measured comet assay parameters compared to the negative control (p > 0.05). In addition, it showed significantly lower genotoxic effects compared to AH Plus for all comet assay parameters, concentrations, and cell lines (p ≤ 0.001). BioRoot RCS showed lower primary DNA damage (p ≤ 0.001) than AH Plus, only at higher concentrations and in the HepG2 cell line. Concerning the two tested bioceramic sealers, BioRoot RCS showed higher tail intensity values compared to MTA Fillapex (p < 0.05). In contrast to the results of the comet assay, BioRoot RCS significantly reduced the number of nuclear buds and nucleoplasmic bridges in the HepG2 cell line compared to MTA Fillapex, whereas reduction in the V79 cell line was only observed for nuclear buds (p < 0.05). Both materials increased the number of apoptotic cells compared to the negative control (p < 0.05). In comparison to AH Plus, BioRoot RCS and MTA Fillapex significantly reduced the number of cells with micronuclei and increased the number of cells with undamaged chromatin (p < 0.05). Conclusions: The findings suggest that MTA Fillapex and BioRoot RCS exhibit superior biocompatibility over AH Plus, as evidenced by their lower cytotoxic and genotoxic effects in vitro. These results support the use of calcium silicate-based sealers in clinical practice, highlighting the need for further studies to evaluate their performance in vivo and their implications for patient safety. Full article

Digital light processing (DLP) technology stands out as a groundbreaking method in the field of biomedical engineering that enables the production of highly precise structures using photopolymerizable materials. Smart materials such as shape memory polymers, hydrogels, and nanocomposites are used as ideal materials for personalized medicine applications thanks to their properties such as superior mechanical strength, biocompatibility, and sensitivity to environmental stimuli in DLP technology. The integration of these materials with DLP enables the production of functional and complex structures, especially in areas such as bone and soft tissue engineering, drug delivery, and biosensor production. However, limited material diversity, scalability problems in production processes, and technical difficulties in optimizing bioprinting parameters are among the main obstacles in this field. This study systematically examines the role of smart biomaterials in DLP-based bioprinting processes. It addresses the innovative applications of these materials in tissue engineering and regenerative medicine. It also comprehensively evaluates its contributions to biomedical applications and discusses future research areas to overcome current limitations. Full article

Tissue engineering represents a revolutionary approach to regenerating damaged bones and tissues. The most promising materials for this purpose are calcium phosphate-based bioactive ceramics (CaPs) and bioglasses, due to their excellent biocompatibility, osteoconductivity, and bioactivity. This review aims to provide a comprehensive and comparative analysis of different bioactive calcium phosphate derivatives and bioglasses, highlighting their roles and potential in both bone and soft tissue engineering as well as in drug delivery systems. We explore their applications as composites with natural and synthetic biopolymers, which can enhance their mechanical and bioactive properties. This review critically examines the advantages and limitations of each material, their preparation methods, biological efficacy, biodegradability, and practical applications. By summarizing recent research from scientific literature, this paper offers a detailed analysis of the current state of the art. The novelty of this work lies in its systematic comparison of bioactive ceramics and bioglasses, providing insights into their suitability for specific tissue engineering applications. The expected primary outcomes include a deeper understanding of how each material interacts with biological systems, their suitability for specific applications, and the implications for future research directions. Full article