Search Results (139)

Introduction: Digital planning and evolution of technology is allowing dentistry to be more efficient in time than before. In orthodontics the main purpose is to obtain fewer patient visits and to reduce the bonding time. For that, indirect bonding planned with CAD-CAM softwares is used to obtain a shorter treatment period, in general, and less chair-time. This waste of chair-time should also be reduced in other fields of dentistry such as endodontics, surgery, prosthodontics, and aesthetics. Methods: A total of 504 teeth were embedded into epoxy resin models mounted as a dental arch. Customized lingual multibracket appliances were bonded by a current adhesion protocol. After that, they were debonded, the polishing of cement remnants was performed with three different burs and two drills. The polishing time of each group was recorded by an iPhone 14 chronometer. Results: Descriptive and comparative statistical analyses were performed with the different study groups. Statistical differences (p < 0.005) between diamond bur and tungsten carbide and white stone burs and turbine were obtained, with the first being the slowest of them. Discussion: Enamel roughness was widely studied in orthodontics polishing protocol as the main variable for protocols establishment. However, in lingual orthodontics, due the difficulty of the access to the enamel surfaces, the protocol is not clear and efficiency should be considered. It was observed that the tungsten carbide bur is the safest bur. It was also recommended that a two-step protocol of polishing by tungsten carbide bur be followed by polishers. Conclusions: A tungsten carbide bur mounted in a turbine was the most efficient protocol for polishing after lingual bracket debonding. Full article

Dens invaginatus is a developmental dental anomaly characterized by the infolding of the enamel organ into the dental papilla during early odontogenesis. This process leads to a broad spectrum of anatomical variations, ranging from minor enamel-lined pits confined to the crown to deep invaginations extending through the root, occasionally communicating with periodontal or periapical tissues. The internal complexity of affected teeth presents diagnostic and therapeutic challenges, particularly in severe forms that mimic root canal systems or are associated with pulpal or periapical pathology. Maxillary lateral incisors are most frequently affected, likely due to their unique developmental timeline and morphological susceptibility. Although various classification systems have been proposed, Oehlers’ classification remains the most clinically relevant due to its simplicity and correlation with treatment complexity. Recent advances in diagnostic imaging, especially cone beam computed tomography (CBCT), have revolutionized the identification and classification of these anomalies. CBCT-based adaptations of Oehlers’ classification allow for the precise assessment of invagination extent and pulpal involvement, facilitating improved treatment planning. Contemporary therapeutic strategies now include calcium-silicate-based cement sealing materials, endodontic microsurgery for inaccessible anatomy, and regenerative endodontic procedures for immature teeth with necrotic pulps. Emerging developments in artificial intelligence, genetic research, and tissue engineering promise to further refine diagnostic capabilities and treatment options. Early detection remains critical to prevent complications such as pulpal necrosis or apical disease. A multidisciplinary, image-guided, and patient-centered approach is essential for optimizing clinical outcomes in cases of dens invaginatus. Full article

Aim: hydraulic calcium silicate-based cements (HCSCs) are widely used in endodontics for vital pulp therapy and other clinical procedures due to their favorable physicochemical and biological properties. This study evaluates the biological properties of two HCSCs—MTA Flow™ and MTA Flow™ White (in a 3:2 liquid-to-powder ratio, thick consistency)—on human dental pulp stem cells (hDPSCs). Methodology: hDPSCs were exposed to leachates from MTA Flow™, MTA Flow™ White, and ProRoot^® MTA. pH changes, cytotoxicity, cell proliferation, cell morphology, and cell death (apoptosis/necrosis) were assessed in vitro. Results: MTA Flow™ White and ProRoot^® MTA leachates produced a strongly alkaline pH (~10–12) compared to the negative control, whereas MTA Flow™ leachate caused a smaller pH increase (~9.4). Freshly mixed cements showed moderate cytotoxicity (around 40–60% cell viability at 100% concentration), while hardened cement leachates did not significantly affect cell viability. At 100% concentration, MTA Flow™ and MTA Flow™ White leachates significantly inhibited hDPSC proliferation and caused cell death, but at lower concentrations (≤50%) they supported cell viability and proliferation comparable to ProRoot^® MTA. hDPSCs exposed to MTA Flow™ and MTA Flow™ White leachates appeared more elongated morphologically than those exposed to ProRoot^® MTA. Notably, cells treated with MTA Flow™ White leachates were significantly smaller than those treated with MTA Flow™. Conclusions: MTA Flow™ and MTA Flow™ White, used in 3:2 thick consistency, demonstrated biocompatibility comparable to ProRoot^® MTA in vitro. While 100% leachates showed moderate cytotoxicity, lower concentration dilutions (≤50%) supported hDPSC viability, proliferation, and morphology. These findings support their potential as safe alternatives for vital pulp therapy. Further in vivo studies and dynamic models are needed to confirm long-term biological performance. Full article

This study evaluated the effects of mechanical agitation of Aloe vera Barbadensis Miller solution at different concentrations using passive ultrasonic irrigation (PUI), XP Endo Finisher (XPF), XP Clean (XPC), and Easy Clean (ECL), compared to conventional endodontic irrigation (CIE), on bond strength and adhesive failure patterns in the cervical, middle, and apical thirds of the root canal. Aloe vera solutions at 1%, 3%, and 5% were tested to reverse collagen fiber collapse induced by hypochlorous acid, a free radical released by 2.5% sodium hypochlorite, which impairs dentin hybridization and the light curing of resin cement. Fiberglass posts were cemented using an etch-and-rinse adhesive system (Ambar; FGM) and conventional dual resin cement (Allcem Core) in root dentin across all thirds. Human teeth underwent chemical–mechanical preparation, and the Aloe vera solution was agitated using the CIE, PUI, XPF, XPC, or ECL protocols. Slices from each root third were evaluated under a stereomicroscope at 10× magnification and subjected to the push-out test. Cytotoxicity was assessed by applying various Aloe vera concentrations to stem cells from the apical papilla (SCAPs) for 24 h, followed by analysis of cell metabolism (Alamar Blue), viability (Live/Dead), and proliferation (F-actin). Aloe vera demonstrated significant biological activity and enhanced bond strength, particularly at 3% and 5%, irrespective of the agitation method or root third. Thus, it can be concluded that using Aloe vera solution is an alternative for pre-treatment before the cementation of fiberglass posts with conventional dual-cure resin cement in endodontically treated dentin. Full article

Background/Objectives: Endodontically treated molars are structurally weakened due to internal tissue loss, increasing their risk of fracture. Endocrowns, developed as a conservative alternative to post–core systems, have gained popularity with the rise of digital dentistry, CAD/CAM workflows, and 3D-printed restorations. In this context, the aim of the present pilot study was to investigate the influence of cement layer thickness, intracoronal depth, and dentine wall thickness on the fracture resistance of molars restored with 3D-printed endocrowns. Methods: Twelve extracted human molars were endodontically treated and restored with endocrowns fabricated from a 3D-printed resin material, SprintRay Crown^TM (SprintRay Inc. Los Angeles, CA, USA), via masked stereolithography (MSLA) on a Prusa SL1 printer. Cementation was performed using RelyX Universal Resin Cement (3M, Maplewood, MN USA). Cone beam computed tomography (CBCT) was used to measure the dentine thickness and intracoronal depth before cementation and cement thickness after cementation. The fracture resistance was evaluated using a universal testing machine. For each variable (Td, Dp, Tc), the 12 specimens were divided into two groups (n = 6). Statistical analysis included Pearson correlation, a one-way ANOVA, and the non-parametric Mann–Whitney U test. Results: Within the limitations of this pilot in vitro study, cement thickness demonstrated a strong positive correlation with fracture resistance (r = 0.577) and was the only variable showing statistical significance in the ANOVA (F = 7.847, p = 0.019). In contrast, intracoronal depth and dentine wall thickness exhibited weaker and nonsignificant correlations. No significant mechanical advantage was observed from increasing the pulp chamber depth or peripheral dentine wall thickness. This result was further supported by nonparametric Mann–Whitney U testing (p = 0.015). Conclusions: Cement layer thickness is a key biomechanical factor influencing the fracture resistance of endocrown restorations. Preparation depth and dentine wall geometry appear to have a less direct impact. Full article

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

Purpose: The aim of this in vitro study was to investigate the adhesive bond strength of glass fiber posts when cemented with universal resin cement in two different adhesion modes: adhesive and self-adhesive. Methods: A total of 20 extracted single-root teeth were endodontically treated, decoronated and prepared to receive glass fiber posts (GFPs) with a diameter of 1.6 mm (RelyX fiber post 3D). Specimens were randomly divided into two groups: (G1) GFPs were cemented using RelyX Universal cement in self-adhesive mode, and (G2) GFPs were cemented using Scotch Bond Universal Plus and RelyX Universal cement (adhesive mode). Afterwards, the specimens were sliced at three root levels: coronal, middle and apical. Bond strength was measured using a push-out test. Data were analyzed with a two-way analysis of variance (ANOVA) test and independent sample T-test. Results: Bond strength was significantly influenced by the adhesive strategy (p < 0.025) and the position of the root third (p < 0.007). Microscopic analysis of failure mode revealed a higher prevalence of adhesive failures (cement–dentine). Conclusions: Glass fiber posts cemented with universal resin cement applied in adhesive mode showed significantly higher push-out bond strength than when applied in self-adhesive mode. In both study groups, the apical root regions exhibited the highest retention values, followed by the middle and coronal regions. Full article

Background: Root canal sealers remain in long-term contact with dental tissues, raising concerns about their potential adverse effects. Methods: This study evaluates the physicochemical properties and ion-release profiles of three dental materials: zinc oxide/eugenol-based sealer, zinc phosphate cement (luting agent), and glass-ionomer cement (restorative material) under acidic (pH 4) and neutral (pH 7) conditions over 24 h and 30 days to determine their behavior and bioactivity in vitro. The materials were evaluated for their setting time, consistency, film thickness, solubility, and ion release using atomic emission spectrometry. The influence of pH and exposure time on ion release was analyzed using multiple regression analysis. Results: All tested materials met the ISO standards for their respective categories. The zinc oxide/eugenol and zinc phosphate cements released increased levels of zinc in acidic environments (pH 4), suggesting potential antimicrobial properties. The glass-ionomer cement exhibited higher silicon and strontium release under a neutral pH (pH 7), indicating potential remineralization effects. Silver from the zinc oxide/eugenol material was below the detection limit of the applied method, suggesting minimal ion release under the tested conditions. Maximum zinc release from root canal sealer occurred after 30 days at pH 4 (1.39 ± 0.26 mg), while the highest silicon release from glass-ionomer cement was observed at pH 7 after 30 days (1.03 ± 0.21 mg). Conclusions: Zinc oxide/eugenol materials exhibited increased zinc release under acidic conditions. In contrast, the restorative and luting materials demonstrated distinct ion-release patterns, aligning with their respective intended applications rather than endodontic purposes. Full article

The classical approach for the preparation of an endodontically treated molar with a post and core involves widening the anatomically complex system of canals, which may be narrow or curved with variable angulation. The aforementioned along with the fact that restorative dentistry stands against the wastage of tooth tissue make endocrowns an appealing alternative. Bindl and Mörmann first described an all-ceramic crown anchored to the internal portion of the pulp chamber and on the cavity margins, thus obtaining macromechanical retention provided by the axial opposing pulpal walls and microretention attained with the use of adhesive cementation. The purpose of this report is to describe the protocol for the treatment plan selection, preparation, impression, and adhesive cementation of an endocrown with a follow-up of 5 years. A 56-year-old male patient presented to the Postgraduate Clinic of Prosthodontics seeking rehabilitation for tooth No. #36. A clinical examination revealed multiple immediate composite resin restorations with unacceptable morphology and adaptation to the remaining tooth as well as a lack of a contact point but, rather, a large, concave contact area facilitating food entrapment. Since the tooth was endodontically treated, the proposed treatment plan included the fabrication of an all-ceramic endocrown. The steps of preparation, attribution of the correct shape, impression, and adhesive luting under rubber dam isolation are thoroughly described. The final functional and aesthetic result, patient’s satisfaction, and the 5-year follow-up render restorations such as endocrowns, which draw their retention from adhesive luting, a viable alternative to conventional approaches. Full article

The number of resin cements marketed for fiber post cementation has increased significantly. This study compared the push-out bond strength (PBS) of self-adhesive and universal resin cements used to lute fiber posts at 24 h and after 6 months of aging in artificial saliva. Fiber posts were luted to eighty human roots endodontically treated with four self-adhesive/one-step resin cements, with one of them also used in combination with its appropriate tooth primer; one universal resin cement, applied as one-step or together with its corresponding universal adhesive (multi-step); and one adhesive/multi-step resin cement, as a control. After storage (24 h or 6 months), the interfaces were subjected to PBS tests and the data were analyzed by two-way ANOVA and Tukey and Student’s t-tests (p < 0.05 defined as statistical significance). The results showed that Scotchbond Universal Plus + RelyX Universal attained statistically higher values at 24 h and 6 months. At 24 h, all resin cements yielded similar PBS to root dentin, while at 6 months, NormoCem obtained the lowest PBS. Storage for 6 months significantly decreased PBS for NormoCem and Multilink Automix. Root section did not influence PBS regardless of storage time. It was concluded that PBS is resin cement dependent. The universal resin cement, RelyX Universal, applied in combination with Scotchbond Universal Plus adhesive, obtained a higher and more stable PBS than the other resin cements tested. Full article

Restoring endodontically treated teeth has always been a challenge in dentistry. Dental posts are used when further retention is required for the final restoration, indicating that the tooth is already structurally compromised. Varying survival rates have been reported by previous studies, and there does not seem to be consensus on what factors are favorable regarding the survival of teeth treated with dental posts. Background/Objectives: This study investigated the survival of teeth treated with direct and indirect posts placed by dentists and dental students at an Australian university over a five-year period. Methods: This retrospective study included 684 direct and indirect posts placed from January 2018 to December 2022 at Griffith University dental clinic. The survival of the teeth treated with dental posts was assessed using Kaplan–Meier analysis. The potential effect of patient, tooth and operator factors was assessed using Cox regression analysis. Results: The posts had a five-year survival rate of 94% and survival time of 46.16 months. No statistically significant difference in survival was noted between the different groups in this study. Conclusions: Teeth treated with dental posts have been shown to have good short-term survival; however, long-term survival could not be commented on. Within the limitations of this study, survival was not associated with the location of the tooth, type of tooth, operator expertise, post material, cement, restoration or opposing dentition. Full article

The ability of the cement to release calcium ions, which participate in the remineralization of dentin by forming apatite which improves root canal sealing with time, is of particular importance. Five recently introduced calcium-silicate commercial dental cements were investigated with a view to the influence of the physicochemical characteristics on the possibility of releasing calcium ions in an aqueous medium. Two hybrid calcium-silicate cements in the form of a paste-like ready mix (BioCal^® Cap and TheraCal LC) and three calcium-silicate cements consisting of two components—powder and liquid (Harvard MTA Universal, Rootdent, and BioFactor) were subjected to powder XRD, SEM, and EDS for detailed examination. The cements were immersed in water for 28 days and the phase composition and morphology of the cements before and after soaking were studied. The total calcium release for each cement was determined by ICP-OES. BioFactor and BioCal^® Cap release the highest amount of calcium ions, while the lowest release is registered with Rootdent and TheraCal LC. The PDT treatment of BioFactor does not influence substantially the calcium release. The impact of the elemental and phase composition on the calcium release and calcium carbonate formation was discussed. A reciprocal relation between the aluminum content and the quantity of the released calcium has been found. Full article

(1) Background: This study aimed to enhance the biological properties of hydraulic calcium silicate cements (HCSCs) by incorporating organic and inorganic components, specifically elastin-like polypeptides (ELPs) and bioactive glass (BAG). We focused on the effects of these composites on the viability, migration, and osteogenic differentiation of human periodontal ligament fibroblasts (hPDLFs). (2) Methods: Proroot MTA was supplemented with 1–5 wt% 63S BAG and 10 wt% ELP. The experimental groups contained various combinations of HSCS with ELP and BAG. Cell viability was assessed using an MTT assay, cell migration was evaluated using wound healing and transwell assays, and osteogenic activity was determined through Alizarin Red S staining and a gene expression analysis of osteogenic markers (ALP, RUNX-2, OCN, and Col1A2). (3) Results: The combination of ELP and BAG significantly enhanced the viability of hPDLFs with an optimal BAG concentration of 1–4%. Cell migration assays demonstrated faster migration rates in groups with 2–4% BAG and ELP incorporation. Osteogenic activity was the highest with 2–3% BAG incorporation with ELP, as evidenced by intense Alizarin Red S staining and the upregulation of osteogenic differentiation markers. (4) Conclusions: The incorporation of ELP (organic) and BAG (inorganic) into HCSC significantly enhances the viability, migration, and osteogenic differentiation of hPDLFs. These findings suggest that composite HCSC might support healing in destructed bone lesions in endodontics. Full article

The effectiveness of biocements applied in specialistic endodontic procedures can be influenced by multiple factors, including the postplacement chemical action of the irrigating solution. This in vitro study aimed to assess the impact of 2% chlorhexidine digluconate on the surface structure and chemical composition of Biodentine as a perforation repair cement. A total of 54 Biodentine specimens were prepared with strict adherence to the manufacturer’s instructions and irrigated with 2% chlorhexidine with or without ultrasonic activation. The material specimens were divided into three setting-time-based groups: group A—rinsed after 12 min of setting, group B—after 45 min, and group C—after 24 h. The control group was not subjected to any irrigation protocol. The evaluation of the microappearance of biocement surface was performed with the aid of a scanning electron microscope (SEM). The chemical composition of Biodentine was analyzed with the energy dispersive spectroscopy (EDS) method. The SEM images of the specimens in group B and C revealed a heterogeneous and layered surface morphology. The EDS results are comparable between pairs of cement specimens in both groups: after 5 min and 20 min CHX irrigation as well as after 5 min and 20 min ultrasonically activated CHX irrigation. To conclude, the 12 min Biodentine setting time is not recommended when used in perforation closure. Irrigation protocol involving 2% chlorhexidine visibly affected the tested material surface. The EDS results did not confirm any significant changes in Biodentine chemical composition. Further research is required to analyze the influence of the observed changes on the outcome of the endodontic treatment. Full article

Bioceramic endodontic cements, known for their antibacterial properties, calcium ion release, and alkaline pH, may come into contact with various irrigants after furcal perforation repair. This study aimed to evaluate the effect of different irrigating solutions and setting times on the shear bond strength (SBS) of Biodentine^® (Septodont, Saint-Maur-des-Fosses Cedex, France) to a self-adhering flowable composite. Sixty Biodentine^® (Septodont, Saint-Maur-des-Fosses Cedex, France) blocks were prepared and divided into two groups based on the setting time: 72 h and 7 days. These were further subdivided into five subgroups based on the irrigation solution applied: distilled water, sodium hypochlorite, ethylenediaminetetraacetic acid, chlorhexidine, and phosphoric acid. They were then restored with Dyad Flow^TM (Kerr^TM, Orange, CA, USA). SBS and failure modes were assessed at 24 h and 6 months. A two-way analysis of variance (ANOVA) test was performed to analyze the effect of the different irrigating solutions and setting times on the SBS of Biodentine^® (Septodont, Saint-Maur-des-Fosses Cedex, France) and Dyad Flow^TM (Kerr^TM, Orange, CA, USA). The level of significance was set at a ≤0.05. At 24 h, SBS was significantly influenced by both the irrigant solution (p = 0.029) and setting time (p = 0.018); at 6 months, SBS was influenced only by the irrigating solutions (p < 0.001). The predominant mode of bond failure was adhesive across all groups. In conclusion, while the setting time did not affect the bond strength, certain irrigating solutions reduced it. Thus, careful consideration of surface treatments applied to Biodentine^® is crucial for successful endodontic and restorative outcomes. Full article