Search Results (81)

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

Background/Objectives: Modern dentistry increasingly requires biomaterials that not only replace damaged tissues but also actively regulate healing processes, modulate inflammation, and provide controlled delivery of therapeutic agents under the complex physicochemical conditions of the oral cavity. This review aims to analyze the potential of PCHs, particularly methacryloyl gelatin (GelMA), as multifunctional platforms for drug delivery in dental applications. Methods: This review provides a structured narrative synthesis of the literature, focusing on the physicochemical, biological, and translational aspects of photocrosslinkable hydrogels in dentistry. Special attention was given to the key functional requirements for hydrogels used in dentistry, including adhesion in a wet environment, antimicrobial properties, and the ability to provide sustained and localized release of active compounds. Natural, synthetic, and semi-synthetic polymers were comparatively evaluated to justify the selection of GelMA as a leading platform due to its tunable mechanical properties, biocompatibility, and photopolymerization capacity. The review also analyzes mechanisms of drug release activation and provides a comparative assessment of commonly used photoinitiators, including Irgacure 2959, lithium phenyl-2,4,6-trimethylbenzoylphosphinate (LAP), and camphorquinone, with emphasis on their cytocompatibility with oral tissues. Results: Applications of these hydrogels in endodontics, periodontology, peri-implantitis therapy, and regeneration of bone and dental pulp are summarized. Conclusions: Overall, photocrosslinkable GelMA-based hydrogels (PC-GelMA) represent promising multifunctional platforms for localized drug delivery and regenerative strategies in modern dentistry. Full article

Background: Metallic and metal oxide nanoparticles are increasingly explored as antimicrobial biomaterials in endodontics due to their multi-target mechanisms of action, largely mediated by metal ion release (e.g., Ag⁺, Cu⁺). However, bacterial metal resistance systems, particularly efflux-related proteins, may influence their antimicrobial performance. This study aimed to analyze the prevalence and distribution of metal resistance-associated proteins in bacteria involved in endodontic infections using a bioinformatic approach. Methods: An in silico, cross-sectional bioinformatic analysis was conducted using publicly available genomes from the Bacterial and Viral Bioinformatics Resource Center (BV-BRC). Bacterial species associated with acute apical abscess (AAA), symptomatic apical periodontitis (SAP), asymptomatic apical periodontitis (AAP), and post-treatment apical periodontitis (PTAP) were included. The presence of selected metal resistance-related proteins (CutC, CopA, CzcA, CusA, SilA, P-type ATPase, and PA3920) was assessed using a binary presence/absence framework. Prevalence, group comparisons (Fisher’s exact test), and co-occurrence patterns (Phi coefficient) were analyzed. Results: Metal resistance-associated proteins were widely distributed across all infection types, with prevalence ranging from 70.0% to 82.9% and no significant differences between groups (p > 0.05). CutC was the most prevalent protein, followed by CopA and CzcA, whereas SilA and PA3920 were not detected. Correlation analysis revealed consistent co-occurrence patterns among key taxa, including Porphyromonas gingivalis, Fusobacterium nucleatum, and Prevotella spp. Conclusions: Metal resistance-related proteins are broadly distributed in endodontic microbiota, indicating a conserved genetic capacity for metal tolerance. These findings suggest that microbial resistance determinants may influence, but do not directly determine, the antimicrobial performance of nanoparticle-based biomaterials. This study provides a hypothesis-generating, bioinformatic framework to support the design and optimization of antimicrobial biomaterials, highlighting the need for experimental validation and integration of phenotypic and biofilm-based analyses. Full article

The Wnt/β-catenin signaling pathway regulates key cellular processes, including proliferation, migration, differentiation, apoptosis and tissue homeostasis, and plays a pivotal role in tooth development and post-developmental dental physiology. In mineralized tissues such as bone and dentin, the Wnt signaling is critically involved in reparative and regenerative mechanisms. The Wnt signaling in the dentin–pulp complex is tightly controlled by extracellular modulators and receptor availability, and its balance appears crucial for an appropriate response. Hydraulic calcium silicate-based cements (HCSBCs) are widely used in endodontics due to their bioactivity and favorable biological properties. Increasing data indicate that HCSBCs promote odontogenic responses and reparative dentinogenesis through the recruitment and activation of dental stem cells (DSCs), possibly via the Wnt/β-catenin signaling pathway modulation. Therefore, the aim of the present narrative review was to summarize current knowledge on the role of the Wnt signaling in oral tissues and its interaction with HCSBCs. It is hypothesized that these materials may enhance pathway activation through the release of ionic products, growth factors and inflammatory mediators, thereby supporting biologically driven reparative processes. Understanding these mechanisms may guide the development of next-generation biomaterials designed to optimize the intrinsic regenerative potential of the dentin–pulp complex. Full article

Three-dimensional (3D) printing, also known as additive manufacturing (AM), has become increasingly integrated into dentistry because of its high precision, efficiency, and ability to fabricate patient-specific devices. This review comprehensively discusses the historical development of 3D printing and outlines the fundamental principles of the most widely used technologies in dentistry, including stereolithography (SLA), digital light processing (DLP), and liquid crystal display (LCD). These technologies enable the accurate and efficient fabrication of dental models, crowns, bridges, dentures, surgical guides, orthodontic appliances, and tissue engineering scaffolds. Current clinical applications are systematically summarized across major dental disciplines, including prosthodontics, orthodontics, oral and maxillofacial surgery, endodontics, periodontics, and pediatric dentistry. Despite existing challenges, such as limited long-term clinical data for certain materials, high initial equipment costs, and post-processing requirements, 3D printing offers substantial advantages in terms of customization, workflow efficiency, and clinical predictability of the final product. Future developments in advanced biomaterials, artificial intelligence-assisted workflows, bioprinting, and four-dimensional (4D) printing are expected to further expand the role of additive manufacturing in personalized and regenerative dentistry. Full article

Stem cell heterogeneity represents a critical yet underexplored variable in laser-assisted regenerative strategies. While photobiomodulation has been shown to influence mesenchymal stem cell (MSC) behavior, it remains unclear whether stem cell maturation status modulates responsiveness to Er,Cr:YSGG irradiation. This study investigated the differential response of magnetically separated STRO-1⁺ and STRO-1⁻ SHED subpopulations to low-power Er,Cr:YSGG laser stimulation (0.10 W and 0.25 W), focusing on viability, extracellular matrix production, and lineage commitment. STRO-1⁺ cells comprised 13.4% ± 1.2% of the total Stem Cells from Human Exfoliated Deciduous teeth (SHED) population. Laser exposure did not impair metabolic activity in either subpopulation. Collagen synthesis demonstrated a power- and time-dependent increase, with maximal enhancement observed in STRO-1⁺ cells at 0.25 W after 7 days. Laser irradiation selectively promoted osteogenic differentiation, as evidenced by increased alkaline phosphatase (ALP) expression at 0.10 W and enhanced mineral deposition, while chondrogenic potential remained unaffected and adipogenesis was reduced following 0.10 W exposure. These findings suggest that ALP expression is temporally and power-dependently modulated during osteogenic progression. Overall, Er,Cr:YSGG photobiomodulation does not uniformly affect heterogeneous SHED populations but modulates lineage allocation and extracellular matrix deposition in a maturation- and power-dependent manner. Integrating stem cell subpopulation selection with laser-based bioactivation may represent a strategy to refine regenerative endodontic and biomaterial-guided therapies. Full article

Background: Calcium silicate-based materials are widely used in retrograde endodontic treatment due to their bioactivity and favorable biological properties. The environmental conditions during setting and the time-dependent release of soluble components may influence cellular responses; however, these factors remain insufficiently investigated. Aim: This in vitro study evaluated the cellular response to three calcium silicate-based materials—MTA+, Biodentine, and NeoPUTTY—after setting under different environmental conditions. Materials and Methods: Cylindrical specimens were allowed to set under three conditions: dry environment, phosphate-buffered saline (PBS), and human blood. Eluates obtained after 1, 3, and 5 days were applied to human BJ fibroblasts. Cell viability, based on metabolic activity measured using the AlamarBlue assay, was evaluated at 48 and 96 h. Biocompatibility was inferred from cell viability, reflecting eluate-mediated effects rather than direct material–cell contact. Results: Cell viability was influenced by both the setting environment and eluate maturation time. PBS-set materials showed variable cellular responses, with high viability at early time points but marked decreases at 96 h for some MTA+ and NeoPUTTY groups. Biodentine demonstrated the most stable cellular response across all conditions. Materials set in blood produced cellular responses comparable to those observed for PBS and dry conditions, with no statistically significant overall reduction in cell viability. Conclusions: Within the limitations of this in vitro eluate-based model, blood exposure during setting had a minimal influence on the cell viability to the tested materials. Among the evaluated materials, Biodentine exhibited the most stable biological profile. These findings reflect time-dependent, eluate-mediated cellular effects and should be interpreted with caution when extrapolating to clinical conditions. Full article

Advancements in biomaterials have transformed the field of endodontics, shifting treatment approaches from mechanical interventions to biologically driven regenerative therapies. This narrative review explores the evolving landscape of endodontic biomaterials, emphasizing their roles in disinfection, obturation, root repair, surgical procedures, and regenerative endodontics. Key materials such as mineral trioxide aggregate (MTA), Biodentine, and calcium-enriched mixture (CEM) cement demonstrate superior sealing, biocompatibility, and osteogenic potential compared to traditional materials. The integration of nanotechnology, bioactive components, and smart drug delivery systems has further enhanced antimicrobial properties and tissue interaction. Clinical applications, including regenerative procedures using platelet-rich fibrin and case-based biomaterial usage, are discussed to illustrate their relevance and effectiveness in real-world practice. Despite significant progress, challenges such as regulatory hurdles, economic limitations, and translational gaps persist. Emerging trends such as 3D printing, personalized medicine, and multifunctional scaffolds offer promising directions for future endodontic care. Continued interdisciplinary collaboration is essential to overcome current barriers and facilitate widespread adoption of next-generation biomaterials. Unlike prior reviews that categorize endodontic biomaterials descriptively by material class or technological advancement, this review introduces an indication-based comparative framework aligning biomaterial properties with specific clinical decision points and corresponding levels of evidence. By integrating biological mechanisms, translational considerations, and clinical application within a structured decision-oriented model, the manuscript offers analytical synthesis rather than a purely descriptive overview. Full article

Mineral trioxide aggregate (MTA) is a calcium silicate-based endodontic biomaterial widely used for its biocompatibility, sealing ability, and osteoconductive potential; however, further enhancement of its bone regenerative capacity without compromising structural stability remains of interest. Strontium apatite (SrAp), a bioactive calcium phosphate phase structurally analogous to bone mineral, may promote osteogenic activity and bone regeneration. In this study, standardized cylindrical defects (2.5 mm diameter, 4 mm depth) were created in the right tibial metaphysis of systemically healthy rats and allocated to four groups: empty defect (control), pure MTA, 25SrAp–MTA, and 50SrAp–MTA. SrAp nanoparticles were synthesized hydrothermally and incorporated into the MTA matrix at predefined weight fractions. Materials were characterized using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDX). After 8 weeks, tibial specimens were harvested and processed for H&E histology; fibrous tissue formation, new bone formation, and osteoblastic cell presence were semi-quantitatively scored. XRD and FT-IR confirmed that SrAp incorporation preserved the fundamental Ca-silicate phase architecture and hydration chemistry of MTA, indicating chemical and crystallographic stability. SEM–EDX demonstrated progressive microstructural densification with increasing SrAp content, with reduced intergranular porosity and homogeneous SrAp distribution. Histologically, both SrAp–MTA groups exhibited significantly higher new bone formation and osteoblastic activity than untreated controls (p < 0.05), while fibrotic tissue formation did not differ significantly among groups. Although SrAp–MTA composites did not show statistically significant superiority over pure MTA after multiple-comparison adjustment, they demonstrated consistent osteogenic trends relative to empty defects. Overall, SrAp reinforcement yields a chemically compatible and structurally stable MTA-based composite that supports an enhanced osteogenic response in vivo without increasing fibrosis, suggesting potential utility in endodontic surgery and bone defect repair; longer-term and quantitative analyses are warranted to optimize SrAp content and confirm long-term performance. Full article

Background: Extended platelet-rich fibrin (e-PRF) membranes are a novel 100% autologous biomaterial with a longer resorption time (4–6 months) than traditional solid-PRF membranes (two weeks). In part 1 of this 2-part publication series, four clinical variations for using these novel e-PRF membranes for socket preservation were introduced. In this randomized clinical trial (RCT), all four iterations of e-PRF membranes were compared to traditional collagen membranes in alveolar ridge preservation for hard and soft tissue dimensional changes and early wound healing outcomes. Methods: A single-center RCT was conducted, including 55 patients requiring the extraction of a single tooth with planned implant placement. All sockets were grafted with a “sticky bone” (bone allograft mixed with PRF) and secured with either a collagen membrane (control) or e-PRF membranes utilizing the four variations present in Part 1 (both formed extra-orally or intra-orally, each with or without an overlying solid PRF membrane). The time of fabrication and application of each e-PRF iteration was recorded. Cone beam computed tomography was utilized to evaluate horizontal and vertical ridge dimensions at baseline and 3 months post-operatively, and soft tissue thickness was also measured at both time intervals utilizing an endodontic reamer. Early wound healing was recorded at 2 weeks, utilizing the Landry, Turnbull, and Howley Index by three blinded clinicians. Results: The results demonstrated that, at 3 months, the e-PRF membranes fabricated utilizing all 4 treatment variations demonstrated equal improvements in horizontal and vertical ridge dimensions and soft tissue thickness when compared to collagen membranes. Additionally, the membrane (p = 0.029) and membrane w/solid (p = 0.021) groups demonstrated statistically significant superior early wound healing compared to the collagen membrane group. Notably, the Bio-Filler groups demonstrated statistically significant reduction in fabrication/application time compared to the membrane groups. Conclusions: Within the limitations of this RCT, all e-PRF iterations performed comparably to collagen membranes in maintaining both hard and soft tissue ridge dimensions when combined with sticky bone, while also significantly improving soft tissue wound healing. Future RCTs with alternative grafting materials, direct wound-margin assessment, and evaluation of patient-reported outcomes are necessary to clarify the advantages of each membrane type. Full article

Background: Periapical surgery is indicated for persistent periapical lesions that do not respond to conventional endodontic therapy, yet postoperative recovery is often hindered by pain, swelling, and delayed healing. Platelet-rich fibrin (PRF) membranes are autologous biomaterials with regenerative potential, capable of modulating inflammation and promoting tissue repair. Methods: This preliminary randomized controlled trial evaluated the effectiveness of PRF membranes in improving postoperative outcomes—specifically pain, swelling, and quality of life—after apicoectomy. Twenty patients requiring periapical surgery were randomly allocated to a PRF group (n = 10) or a control group (n = 10). In the PRF group, autologous PRF membranes were applied over the resected root-end and into the osteotomy cavity before flap closure. In the control group, no PRF membranes or any additional biomaterial were applied, apart from the standard root-end filling material (MTA), which was identically used in both groups as part of the routine apicoectomy protocol. All patients were blinded to allocation, and outcomes were assessed by an independent blinded evaluator. Facial swelling was quantified by 3D facial scanning, pain was recorded daily using a visual analog scale (VAS), and quality of life was evaluated with the PROMIS-29+2 Profile. Results: The PRF group showed significantly reduced swelling (mean volume difference, 7.12 cm³; p = 0.025), lower pain scores (VAS: 1.80 ± 1.22 vs. 3.80 ± 2.44; p = 0.034), and improved quality-of-life domains, including higher Physical Function (p = 0.032) and lower Sleep Disturbance (p = 0.008) scores. Conclusions: Within the limitations of this pilot study, PRF membranes enhanced postoperative recovery after periapical surgery by reducing swelling and pain while improving patient-reported outcomes. Larger multicenter trials are needed to confirm these preliminary findings. Full article

The dental pulp is a dynamic connective tissue essential for tooth vitality, sensory function, immune defense, and reparative dentinogenesis. Conventional endodontic procedures, while effective in eradicating infection, often result in a non-functional, devitalized tooth, highlighting the need for biologically based regenerative approaches. The emergence of three-dimensional (3D) culture systems has transformed pulp biology and endodontic research by providing physiologically relevant microenvironments that better reproduce the dentino-pulp interface, vascular and neural networks, and immune interactions. This review synthesizes current advances in 3D dental pulp modeling, from scaffold-based and hydrogel systems to spheroids, organoids, bioprinted constructs, and microfluidic “tooth-on-a-chip” platforms. Each system’s composition, biological relevance, and translational potential are critically examined with respect to odontogenic differentiation, angiogenesis, neurogenesis, and inflammatory response. Applications in disease modeling, biomaterial screening, and regenerative endodontics are highlighted, showing how these models bridge fundamental biology and therapeutic innovation. Finally, we discuss key challenges including vascularization, innervation, standardization, and clinical translation, and propose integrative strategies combining bioprinting, stem-cell engineering, and organ-on-chip technologies to achieve functional pulp regeneration. Overall, 3D pulp models represent a paradigm shift from reductionist cultures to bioinstructive, patient-relevant platforms that accelerate the development of next-generation endodontic therapies. Full article

The proper selection of bioactive root-end material is one of the main prognostic factors for the successful healing outcome of apical microsurgery (AMS). The aim of the present in vitro study was to evaluate and compare the marginal adaptability of a novel calcium silicate cement (CSC), Harvard MTA Universal, and Biodentine used as root-end filling materials. The endodontic treatment of 20 extracted human maxillary central incisors was performed. The apicoectomy was simulated, and root-end cavities were prepared ultrasonically using universal retrotips. Teeth were randomly assigned into two equal groups (n = 10) according to the retrofilling cement used: Group 1—Harvard MTA Universal and Group 2—Biodentine. The specimens were stored in relative humidity for 48 h and sectioned longitudinally. The data were processed and analyzed statistically. Harvard MTA exhibited a significantly lower mean gap width (1.16 ± 0.37 µm) than Biodentine (2.48 ± 0.38 µm) (p < 0.05), indicating a more intimate interfacial adaptation. Additionally, the phenomenon of material penetration into the dentinal tubules was observed only in the Harvard MTA group. Within the limitations of this in vitro study, Harvard MTA Universal demonstrated better interfacial properties than Biodentine when applied as a root-end filling material. This novel biomaterial could be regarded as a promising alternative for earlier calcium silicate cements in the context of AMS goals. Clinical relevance: The quality of marginal adaptation is a determinative feature for the clinical performance of CSCs and the long-term prognosis of AMS. Full article