Search Results (161)

Background: Preclinical dental training requires simulation-based tools to develop fine motor skills, but traditional models like plastic teeth often lack realistic tactile feedback, and systematic evaluations of multi-layered drilling plates are scarce. This study aimed to evaluate the educational utility and perceived realism of a novel multi-layered drilling plate designed to simulate enamel, dentin, and pulp, with null hypotheses that it would not differ in realism from natural dental tissues or in educational utility from existing tools. Methods: Seventy dental educators (mean preclinical teaching experience: 112.9 ± 116.7 months) from 14 institutions across four continents assessed the plates using standardized protocols. Statistical analysis (Mann–Whitney U Test) was performed to analyze the results. Results: Quantitative ratings (1–10 scale) showed high mean scores for drilling quality (enamel: 7.80 ± 1.55, dentin: 7.27 ± 1.94, pulp: 7.48 ± 2.33), surface smoothness (enamel: 8.17 ± 1.55, dentin: 8.17 ± 1.57), and ergonomic visibility (8.56 ± 1.58), with 90% passing grades, rejecting the null hypothesis of no difference in educational utility. Tissue transition scores (enamel/dentin: 7.09 ± 2.56; dentin/pulp: 6.86 ± 2.46) showed significant differences (p < 0.05) in realism from natural tissues, rejecting the null hypothesis of no difference. Inter-rater reliability was poor (Krippendorff’s alpha: 0.449 for failing scores, 0.211 for passing scores). Qualitative feedback praised ease of use but noted limitations in dentin haptic simulation. Conclusions: The drilling plate shows promise for skill development, though without controlled comparisons to existing tools, its relative efficacy remains preliminary. Further research on student outcomes and tool refinement is needed to validate its use in dental education. Full article

Background/Objectives: Pulp inflammation impairs healing, yet the underlying vascular and neural mechanisms remain poorly understood. This study investigated the differential regulation of lymphatic vessels, blood vessels, and neural tissue in pulpitis to elucidate healing limitations in inflamed dental pulp. Methods: This study evaluated 38 pulp samples (14 symptomatic irreversible pulpitis, 13 asymptomatic irreversible pulpitis, and 11 healthy controls) via immunohistochemistry, using D2-40 to identify lymphatic vessels, CD31 to mark blood vessels, and PGP9.5 to detect neural tissue. Vessel counts and neural tissue scoring were performed by blinded examiners and analyzed using appropriate statistical tests. Results: Dental pulp with symptomatic irreversible pulpitis exhibited significantly increased blood vessel density (50.3 vs. 39.2 in asymptomatic irreversible pulpitis and 25.8 in controls, p = 0.001, Cohen’s d = 1.82), while lymphatic vessel density remained unchanged across all groups (p ≥ 0.05), indicating impaired lymphangiogenesis despite inflammation. Neural tissue density was consistent across conditions, with a significant negative correlation between PGP9.5 expression and age (r = −0.5, p = 0.001). CD31 and D2-40 expression showed a positive correlation (r = 0.389, p = 0.016), suggesting coordinated vascular development. Conclusions: Our findings reveal a critical imbalance between enhanced angiogenesis and impaired lymphangiogenesis during pulpitis, potentially explaining the compromised healing capacity of inflamed dental pulp. This vascular dysregulation, combined with persistent neural tissue density, creates an environment in which inflammatory exudates accumulate with limited clearance. These insights indicate a need for new therapeutic strategies aimed at enhancing lymphangiogenesis to improve endodontic outcomes. Full article

Background: Reconstructing maxillofacial defects is important in dentistry, so efforts are being made to develop materials that promote cell migration and repair. Graphene oxide (GO) is used to enhance the biocompatibility of polymethylmethacrylate (PMMA) due to its nanostructure. Objective: to assess cytotoxicity, cell proliferation, and differentiation of human dental pulp stem cells (hDPSC) in response to a conventional PMMA (PMMA) and polymer enriched with GO (PMMA+GO). Methods: Experiments were carried out with primary hDPSC subcultures. The PMMA and PMMA+GO were tested in direct and indirect contact. Cytotoxicity (1 day) and proliferation (3, 7, and 14 days) were evaluated with an MTT bioassay. The osteogenic, adipogenic, and chondrogenic aspects were determinate with alizarin red, oil red, and safranine. Mean values, standard deviation, and percentages were calculated; data were analyzed with Shapiro–Wilks normality and Student’s t-test. Results: The cell viability of PMMA and PMMA+GO in direct contact correspond to 90.8 ± 6.2, 149.6 ± 14.5 (1 day); 99.9 ± 7.0, 95.7 ± 6.1 (3 days); 120.2 ± 14.6, 172.9 ± 16.2 (7 days); and 102.9 ± 17.3, 95.4 ± 22.8 (14 days). For indirect contact, 77.2 ± 8.4, 99 ± 21.4 (1 day); 64.8 ± 21.6, 67.0 ± 9.6 (3 days); 91.4 ± 16.5, 142 ± 18.7 (7 days); and 63 ± 15.8, 79.1 ± 3.1 (14 days). PMMA+GO samples showed enhanced adipogenic, chondrogenic, and osteogenic aspects. Conclusions: The integration of GO into PMMA biopolymers stimulates cell proliferation and differentiation, holding great promise for future applications in the field of biomedicine. Full article

Novel three-dimensional porous composites of alginate–pectin (A/P) with zinc- or manganese-substituted hydroxyapatites (A/P-ZnHA and A/P-MnHA) were synthesized via lyophilization and calcium cross-linking. Powder X-ray diffraction and infrared spectroscopy analyses confirmed single-phase apatite formation (crystallite sizes < 1 µm), with ZnHA exhibiting lattice contraction (*c*-axis: 6.881 Å vs. 6.893 Å for HA). Mechanical testing revealed tunable properties: pristine A/P sponges exhibited an elastic modulus of 4.7 MPa and a tensile strength of 0.10 MPa, reduced by 30–70% by HA incorporation due to increased porosity (pore sizes: 112 ± 18 µm in the case of MnHA vs. 148 ± 23 µm-ZnHA). Swelling capacity increased 2.3–2.8-fold (125–155% vs. 55% for A/P), governed by polysaccharide interactions. Scanning electron microscopy investigation showed microstructural evolution from layered A/P (<100 µm) to tridimensional architectures with embedded mineral particles. The A/P-MnHA composites demonstrated minimal cytotoxicity for the NCTC cells and good viability of dental pulp stem cells, while A/P-ZnHA caused ≈20% metabolic suppression, attributed to hydrolysis-induced acidification. Antibacterial assays highlighted A/P-MnHA′s broad-spectrum efficacy against Gram-positive (Bacillus atrophaeus) and Gram-negative (Pseudomonas protegens) strains, whereas A/P-ZnHA targeted only the Gram-positive strain. The developed composite sponges combine cytocompatibility and antimicrobial activity, potentially advancing osteoplastic materials for bone regeneration and infection control in orthopedic/dental applications. Full article

Background/Objectives: Different sized calcified masses called pulp stones are often detected in dental pulp and can impact dental procedures. The current research was conducted with the aim of measuring the ability of artificial intelligence algorithms to accurately diagnose pulp and pulp stone calcifications on panoramic radiographs. Methods: We used 713 panoramic radiographs, on which a minimum of one pulp stone was detected, identified retrospectively, and included in the study—4675 pulp stones and 5085 pulps were marked on these radiographs using CVAT v1.7.0 labeling software. Results: In the test dataset, the AI model segmented 462 panoramic radiographs for pulp stone and 220 panoramic radiographs for pulp. The dice coefficient and Intersection over Union (IoU) recorded for the Pulp Segmentation model were 0.84 and 0.758, respectively. Precision and recall were computed to be 0.858 and 0.827, respectively. The Pulp Stone Segmentation model achieved a dice coefficient of 0.759 and an IoU of 0.686, with precision and recall of 0.792 and 0.773, respectively. Conclusions: Pulp and pulp stones can successfully be identified using artificial intelligence algorithms. This study provides evidence that artificial intelligence software using deep learning algorithms can be valuable adjunct tools in aiding clinicians in radiographic diagnosis. Further research in which larger datasets are examined are needed to enhance the capability of artificial intelligence models to make accurate diagnoses. Full article

Platelet mitochondria have recently been increasingly considered “co-principal” along with platelet growth factors to facilitate tissue regeneration in platelet-rich plasma therapy cooperatively. To develop a convenient method to test this potential, we examined mitochondrial transfer using a simple two-dimensional culture system. Living human platelets were prepared from PRP obtained from 12 non-smoking healthy male adults (age: 28–63 years) and suspended in medium. Platelet lysates were prepared from sonicated platelet suspensions in PBS. After treatment with ultraviolet-C irradiation, a mitochondrial respiration inhibitor, or a synchronized culture reagent, rat dental pulp-derived fibroblasts (RPC-C2A) were co-cultured with platelets or platelet lysates for 24 h. Mitochondrial transfer was evaluated by visualization using a fluorescent dye for mitochondria or an antibody against human mitochondria. Ultraviolet-C-irradiated cells substantially lost their viability, and treatment with living platelets, but not platelet lysates, significantly rescued the damaged fibroblasts. Fibroblast mitochondria appeared to increase after co-culture with resting platelets. Although more microparticles existed around the platelets on the fibroblast surface, the activated platelets did not show significant increases in any parameters of mitochondrial transfer. This simple co-culture system demonstrated mitochondrial transfer between xenogeneic cells, and this phenomenon should be considered as an additional implication in PRP therapy. Full article

The role of periodontal ligament stem cells (PDLSCs) and dental pulp stem cells (DPSCs) in stimulating angiogenesis has been reported, but their angiogenetic potential has not been directly compared. In this work, paired PDLSCs and DPSCs, i.e., derived from the same donor, were tested for their immunophenotype and multi-differentiation capabilities, with particular emphasis on their pro-angiogenic activity. Flow cytometry was utilized to study the expression of mesenchymal stem cell, pericyte, and endothelial markers, while gene expression was evaluated through real-time PCR. The angiogenic potential was assessed recurring to tubulogenesis assay, co-cultures with Human Microvascular Endothelial Cell (HMEC-1), and VEGF-A quantification. The immunophenotype of DPSCs and PDLSCs was different in CD146+ and CD31+ cell subsets, but both cell types promoted HMEC-1 tubulogenesis in vitro. Consistently, VEGF-A gene expression level and its quantification in cell-conditioned media of PDLSCs and DPSCs was comparable between them, and both promoted the formation of vessel-like structures, when co-cultured with HMEC-1 cells. All together, these results showed the heterogeneity of PDLSCs and DPSCs, which are constituted of different cellular subsets, likely modulated by the microenvironmental cues. PDLSCs and DPSCs showed comparable pro-angiogenic activity, enhanced by the contemporary expression of angiogenic and chemotactic factors. Full article

Background: The combination of two or more different types of traumatic dental injuries occurring concurrently to the same tooth presents a significant clinical challenge. By focusing on a rare combination of injuries, this case study explores the issues of delayed management of root fractures accompanied by coronal extrusions in immature maxillary permanent central incisors, underscoring the necessity for tailored approaches when guidelines for intervention were unmet. Methods: The case involves an eight-year-old boy who delayed seeking care for approximately a year after suffering trauma to his upper front teeth in a fall accident at school. The clinical examination revealed partial displacement of two maxillary central incisors in an incisal direction, resulting in increased mobility. Radiographs further showed horizontal root fractures in the apical third of both extruded incisors. Encouragingly, the injured teeth exhibited a normal response to electric pulp testing without signs or symptoms of pulpal pathology, suggesting pulp vitality and eliminating the need for root canal treatment. The extruded coronal fragments were repositioned orthodontically using a utility arch. Results: At the 14-month follow-up, the affected incisors were clinically asymptomatic, functionally satisfactory, and esthetically pleasing. Conclusions: Conservative orthodontic management of extrusive luxation concomitant with root fracture in immature permanent teeth may prove effective in select cases, particularly when long-term follow-up and proper oral care are maintained. Full article

Optical diagnostic techniques represent an attractive complement to conventional pulp vitality tests, as they can provide direct information about the vascular status of the pulp. However, the complex, multi-layered structure of a tooth significantly influences the detected signal and, ultimately, the diagnostic decision. Despite this, the impact of the various dental components on light propagation within the tooth, particularly in the context of diagnostic applications, remains insufficiently studied. To help bridge this gap and potentially enhance diagnostic accuracy, this study employs digital optical twins based on the Monte Carlo method. Using incisor and molar models as examples, the influence of tooth and pulp geometry, blood concentration, and pulp composition, such as the possible presence of pus, on spectrally resolved transmission signals is demonstrated. Furthermore, it is shown that gingival blood absorption can significantly overlay the pulpal measurement signal, posing a substantial risk of misdiagnosis. Strategies such as shifting the illumination and detection axes, as well as time-gated detection, are explored as potential approaches to suppress interfering signals, particularly those originating from the gingiva. Full article

Background: Regenerative endodontic procedures (REPs) are promising treatments for immature teeth with necrotic pulp. Artificial intelligence (AI) is increasingly used in dentistry; thus, this study evaluates the reliability of AI-generated information on REPs, comparing four AI models against clinical guidelines. Methods: ChatGPT-4o, Claude 3.5 Sonnet, Grok 2, and Gemini 2.0 Advanced were tested with 20 REP-related questions from the ESE/AAE guidelines and expert consensus. Questions were posed in Turkish and English, with or without prompts. Two specialists assessed 640 AI-generated answers via a four-point rubric. Inter-rater reliability and response accuracy were statistically analyzed. Results: Inter-rater reliability was high (0.85–0.97). ChatGPT-4o showed higher accuracy with English prompts (p < 0.05). Claude was more accurate than Grok in the Turkish (nonprompted) and English (prompted) conditions (p < 0.05). No model reached ≥80% accuracy. Claude (English, prompted) scored highest; Grok-Turkish (nonprompted) scored lowest. Conclusions: The performance of AI models varies significantly across languages. English queries yield higher accuracy. While AI shows potential for REPs information, current models lack sufficient accuracy for clinical reliance. Cautious interpretation and validation against guidelines are essential. Further research is needed to enhance AI performance in specialized dental fields. Full article

Vital pulp therapy (VPT) preserves dental pulp and its functions, offering a minimally invasive alternative to root canal therapy. However, the impact of patient-related factors on success remains unclear. This study aimed to estimate the sample size for a multivariate model predicting VPT success for assessing capping material, age, sex, and pulp conditions. A prospective cohort study was conducted with the inclusion of twenty-seven adult patients with carious pulp exposure in mature permanent teeth. Treatment comprised direct pulp capping, partial pulpotomy, or complete pulpotomy with Mineral Trioxide Aggregate Plus (MTA+) or Biodentine. Success rates were evaluated at 6 months through clinical and radiographic examinations. Statistical analysis included Pearson’s Chi-square tests and logistic regression. The success rates were 64% in the Biodentine group and 92% in the MTA+ group (OR: 0.15; p = 0.108). Sex and age had no significant effect. Success declined with increasing pulp condition severity and treatment invasiveness. MTA+ had a higher incidence of discoloration, while Biodentine showed none. Sample size calculations suggested 140 participants would be needed to detect a significant effect of pulp condition. Both materials were effective, though MTA+ showed higher success based on the strict success criteria. More severe pulpitis correlated with lower success, but a larger study is needed for predictive models. Full article

The current medical need to respond to different diseases has sparked great interest in extracellular vesicles (EVs) derived from mesenchymal stem cells (MSCs) due to their great regenerative potential and as drug carriers by playing a critical role in cell–cell communication. However, due to their heterogeneity, there is no standardized universal method for their identification and characterization, which limits their clinical application. This study, following the recommendations and methodologies proposed by MISEV2023 for the characterization of EVs, shows for the first time a detailed morphological, protein, and biochemical comparison between EVs derived from three different MSCs sources (placenta, endometrium, and dental pulp). The information obtained from the different applied assays suggests that there are substantial differences between one EVs source and another. It also offers valuable insights that provide the guidelines to ease their profiling and therefore improve their selection, in order to speed up their use and clinical application; additionally, the knowledge obtained from each characterization test could facilitate new researchers in the field to choose a specific cell source to obtain EVs and select the appropriate methods that provide the necessary information according to their requirements. Full article

Background: Oral cancer is an aggressive malignancy with modest survival rates. It also causes disfigurement following surgical removal of the tumor, thus highlighting the need for new cancer treatment and tissue repair modalities. Carbon-based nanomaterials have emerged as promising tools in both anticancer and regenerative therapies. Objectives: We aimed to synthesize a new carbon-based nanomaterial (CBN) and test its antineoplastic effects, as well as its potential regenerative capacity. Materials and Methods: A carbon nanomaterial, obtained by ball milling graphite flakes, was functionalized with polyvinylpyrrolidone (CBN/PVP). Its physicochemical properties were explored with X-ray diffraction (XRD), attenuated total reflection–Fourier transform infrared spectroscopy (ATR-FTIR), micro-Raman spectroscopy, fluorescent and scanning electron microscopy, and wettability analysis. For the antineoplastic effects investigation, oral cancer cells were treated with CBN/PVP and examined with MTT and migration assays, as well as cell-cycle and ROS production analyses. Gene expression was determined by qPCR. To examine the pro-regenerative capacity of CBN/PVP, dental pulp stem cell cultures (DPSCs) were treated with the nanomaterial and subjected to osteo- and chondro-induction. Results: Lower concentrations of CBN/PVP (50, 100 μg/mL) applied on cancer cells exerted remarkable cytotoxic effects, induced G1 cell-cycle arrest, and reduced cancer cell invasion potential by different mechanisms, including downregulation of the PI3K/AKT/mTOR pathway. In contrast, the addition of 50 µg/mL of CBN/PVP to DPSCs stimulated their survival and proliferation. CBN/PVP significantly enhanced both the osteogenic (p < 0.05) and chondrogenic (p < 0.01) induction of DPSCs. Conclusions: The novel carbon-based nanomaterial displays unique characteristics, making it suitable in anticancer and regenerative therapies concomitantly. Full article

Background: Irreversible pulpitis is a severe inflammation of the dental pulp. The purpose of this clinical trial was to evaluate the effectiveness of an inferior alveolar nerve block (IANB) injection followed by oral dexamethasone administration in reducing the pain associated with symptomatic irreversible pulpitis (SIP) in mandibular molars, without performing conventional pulpotomy. Methods: A sample of 80 subjects suffering from acute pain due to SIP on a mandibular molar were assigned to the dexamethasone group, who received an IANB injection followed by one oral dose of 4 mg of dexamethasone during the emergency visit followed by one dose of 4 mg after 8 h, or the control group, who received a conventional pulpotomy. Both groups received complete endodontic treatment after five to six days. The intensity of the preoperative pain and pain levels were measured in both groups at different times after each intervention. The Mann–Whitney U test was used to compare the pain scores between the groups at the same time point, while Friedman’s test was used to compare the pain scores between the four time points within the same intervention group, followed by the Bonferroni correction for multiple pairwise comparisons. Success was determined when the pain score on the visual analogue scale (VAS) was 20 or lower. Results: A survival analysis was conducted, where the event was considered as the disappearance of symptoms (or success: pain score ≤ 20). For both groups, the pain significantly decreased 8 h postoperatively (p < 0.05). The success rates at 8 and 12 h were significantly higher in the dexamethasone group compared to the control group (p = 0.05). However, the pain scores at 24 h remained comparable. Conclusions: An IANB injection followed by 8 mg of oral dexamethasone could reduce pain significantly in patients with SIP without performing conventional pulpotomy. The oral administration of dexamethasone could therefore be a valuable strategy to temporarily alleviate SIP symptoms until definitive treatment becomes feasible. Dexamethasone is a temporary pain management strategy rather than a replacement for pulpotomy. Full article

Background/Objectives: Pulp stones (PSs) are calcified masses, with rounded or oval shapes, ranging from small particles to masses larger than the chamber and/or canals. There are limited data regarding the prevalence of pulp stones in the Iberian population. Our aim was to determine the prevalence of PSs, using CBCT, in an Iberian population, and its association with gender, age, tooth location (arch and hemiarch), dental group, the presence of caries, restorations, alveolar bone loss, and a history of orthodontic treatment. Methods: In total, 300 CBCTs were analyzed, selected from the database of the Dental Clinic of the University of Valencia. A total of 5485 teeth were included. The images were obtained by NewTom equipment and visualized using NNT software 11 by a single calibrated examiner in the axial, sagittal, and coronal planes. The Chi-square test, ANOVA, and t-test were used to analyze the study variables for a significance level of p < 0.05. Results: The prevalence of PSs was 88.3% from the total number of patients assessed and 61.2% from the total number of teeth assessed. No differences were found by gender or age. A significant association was found within tooth groups between arches and hemiarches. The proportion of PSs was 3.7 times higher in teeth with caries, 4.7 times higher in teeth with fillings, and 2.3 times higher in teeth with alveolar bone loss. Conclusions: PSs were more prevalent in molars. The presence of caries, fillings, and bone loss increased the chance of presenting PSs. Maxillary teeth had a higher prevalence of PSs than mandibular teeth. Full article