Search Results (73)

The development of bioactive materials in endodontics has advanced tissue regeneration by enhancing the biological responses of periradicular tissues. Recently, calcium silicate-based sealers have gained attention for their superior biological properties, including biocompatibility, osteoconductivity, and cementogenic potential. This study aimed to evaluate the cytotoxicity, biocompatibility, and bioactivity of EndoSequence BC Sealer (ES BC) and AH Plus Bioceramic Sealer (AHP BC) using human periodontal ligament stromal cells (hPDLSCs). Biocompatibility was assessed using MTT, Live/Dead, and wound healing assays. ES BC and AHP BC demonstrated significantly higher cell viability and proliferation compared to AH Plus used as a control. Gene expression analysis via real-time quantitative PCR demonstrated that ES BC, especially in set form, significantly upregulated osteogenic markers—alkaline phosphatase (2.49 ± 0.10, p < 0.01), runt-related transcription factor 2 (2.33 ± 0.13), and collagen type I alpha 1 chain (2.85 ± 0.40, p < 0.001)—more than cementogenic markers (cementum protein 1, cementum attachment protein, and cementum protein 23). This differential response may reflect the fibroblast-dominant nature of hPDLSCs, which contain limited cementoblast-like cells. This study supports the superior biocompatibility and regenerative capacity of ES BC and AHP BC compared to AH Plus. While in vitro models provide foundational insights, advanced ex vivo approaches are crucial for translating findings to clinical practice. Full article

Background: Mesenchymal stem cells (MSCs), multipotent and immune-regulatory cells derived from tissues such as bone marrow, dental pulp, and periodontal ligament, emerged as promising agents in regenerative dentistry. Their clinical applications include endodontic tissue regeneration, periodontal healing, and alveolar bone repair, addressing critical challenges in dental tissue restoration. Methods: A systematic review was conducted following PRISMA guidelines and registered in PROSPERO. We searched PubMed, Scopus, and Web of Science databases for open-access, English-language clinical trials and observational studies published from 2015 to 2025. Studies focusing on the application of MSCs in dental tissue regeneration were included based on predefined eligibility criteria. Results: Out of 2400 initial records, 13 studies met the inclusion criteria after screening and eligibility assessment. Most studies investigated MSCs derived from dental pulp and periodontal ligament for regenerating periodontal tissues and alveolar bone defects. The majority reported improved clinical outcomes; however, variations in MSC sources, delivery methods, sample sizes, and follow-up periods introduced methodological heterogeneity. Conclusions: MSCs show significant potential in enhancing bone and periodontal regeneration in dental practice. Nonetheless, the current evidence is limited by small sample sizes, short follow-up, and inconsistent methodologies. Future large-scale, standardized clinical trials are required to validate MSC-based regenerative therapies and optimize treatment protocols. 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

Regenerative Endodontic Therapies (RETs) offer transformative potential by leveraging polymer-based scaffolds, stem cells, and growth factors to regenerate damaged dental pulp tissue, thereby restoring tooth vitality and prolonging tooth function. While conventional treatments focus on infection control, they often compromise the structural and biological integrity of the tooth. RETs, in contrast, aim to restore the natural function of the pulp–dentin complex by promoting cellular regeneration and immune modulation. In this context, biodegradable polymers—such as collagen, gelatin methacryloyl (GelMA), and synthetic alternatives—serve as scaffolding materials that mimic the extracellular matrix, support cell attachment and proliferation, and enable localized delivery of bioactive factors. Together, the tissue engineering triad—polymer-based scaffolds, stem cells, and signaling molecules—facilitates root development, apical closure, and increased fracture resistance. Recent innovations in polymeric scaffold design, including injectable hydrogels and 3D bioprinting technologies, have enhanced clinical translation by enabling minimally invasive and patient-specific RETs. Despite progress, challenges such as immune compatibility, scaffold degradation rates, and the standardization of clinical protocols remain. RETs, thus, represent a paradigm shift in dental care, aligning with the body’s intrinsic healing capacity and offering improved long-term outcomes for patients. Full article

Silver nanoparticles (AgNPs) have emerged as a promising antimicrobial agent in dentistry due to their distinctive physicochemical characteristics and broad-spectrum biocidal activity. For example, silver nanoparticles can be incorporated into oral hygiene products in preventive dentistry, composite resins in restorative treatment, irrigation solutions in endodontic treatment, membranes for guided tissue regeneration in periodontal treatment, acrylic resins and porcelains in prosthodontic treatment, coatings in dental implant treatment, and brackets and wires in orthodontic treatment. This paper focuses on summarizing the current knowledge on the antimicrobial use of silver nanoparticles in dentistry, highlighting their antimicrobial mechanism and potential applications in clinical treatment. The literature indicates that silver nanoparticles are a promising antimicrobial agent in dentistry. However, there are still many issues including fundamental antibacterial mechanisms that need to be completely elucidated before clinical applications. Full article

The root walls of immature permanent teeth are often weak, thin, and short, making regenerative endodontic treatment (RET) necessary. The goal of RET is to create a favorable environment for further root development. A biomimetic approach is essential for thorough disinfection, followed by the preservation and potential stimulation of stem cells from surrounding tissue to enable root regeneration and continued development. The objective of this study was to assess temperature changes on the external root surface, structural alterations in the internal root walls following irradiation with a 940 nm diode laser, and the biocompatibility of stem cells from the apical papilla (SCAPs). Irradiation was performed with varying output powers (0.5 W, 1 W, 1.5 W, and 2 W) in continuous mode for 5 s over four consecutive cycles. Thermographic measurements during irradiation, the micro-CT analysis of root samples, and mitochondrial activity of SCAPs were evaluated. The heating effect correlated directly with a higher output power and thinner root walls. A 1 W output power was found to be safe for immature teeth, particularly in the apical third of the root, while 1.5 W could be safely used for mature mandibular incisors. Diode laser irradiation at 1 W and 1.5 W significantly stimulated SCAPs’ mitochondrial activity within 24 h post-irradiation, indicating a potential photobiostimulatory effect. However, no significant changes were observed at lower (0.5 W) and higher (2 W) output powers. The area of open tubular space inside the root canal was significantly reduced after irradiation, regardless of the applied power. Additionally, irradiation contributed to the demineralization of the dentin on the inner root walls. Future studies should explore the impact of irrigants used between irradiation cycles, the potential benefits of conical laser tips for more even energy distribution, and a thorough analysis of how disinfection protocols affect both the dentin structure and stem cell viability. Full article

With increasing life expectancy and an aging population, the demand for dental treatments that preserve natural teeth has grown significantly. Among these treatments, endodontic therapies for pulpitis and apical periodontitis play a vital role, not only in keeping occlusal function, but also in preventing the exacerbation of systemic diseases. Both pulpitis and apical periodontitis are primarily caused by infections of the oral pathobiont within the root canal, leading to inflammation and destruction of the pulp, apical periodontal tissue, and bone. Standard root canal therapy aims to remove the infection source and facilitate natural tissue healing through the body’s regenerative capacity. However, challenges remain, including limited tooth functionality after complete pulp removal in pulpitis and insufficient recovery of the large bone defect in apical periodontitis. To address these limitations, endodontic regenerative therapies have emerged as promising alternatives. Pulp regeneration therapy seeks to restore the functionality of dental pulp, while bone regeneration therapy aims to repair and regenerate large bone defects affected by apical periodontal tissue. Full article

Background/Objectives: Guided tissue regeneration (GTR) and the use of various grafting materials and platelet concentrates have emerged as promising adjunctive techniques in endodontic surgery to enhance bone regeneration and improve healing outcomes, although evidence regarding their consistent effectiveness remains inconclusive. The aim of this systematic review is to evaluate existing randomized controlled trials (RCTs) and prospective clinical trials to determine the efficacy of bone grafts, membranes, or platelet concentrates on outcomes in endodontic periapical surgery, employing a robust evidence-based approach. Methods: Searches were conducted in MEDLINE (PubMed), Embase, Cochrane Library, and gray literature databases from their inception until March 2024. Study selection and data extraction were conducted independently by two reviewers. Eligible randomized controlled trials (RCTs) and prospective clinical trials underwent critical appraisal for risk of bias and quality of evidence and were subjected to meta-analysis to determine treatment effects. Results: Twelve studies were included. The pool success rate for periapical surgery using any regenerative material (bone graft, membrane, or platelet concentrate) was 2.48 (OR: 2.48, 95% CI: 1.42–4.34). Multiple subgroup analyses based on the type of regenerative material used during treatment were performed, presenting high certainty of evidence. The subgroup analysis, which examined bone graft only, bone graft with membrane, membrane only, concentrated growth factor only, and concentrated growth factor with bone graft, yielded significant results only for concentrated growth factor with bone graft (OR: 15.01, 95% CI: 1.12–271.70). While the success rate of periapical surgery with other regenerative materials did not reach statistical significance, the effect size was substantial. Conclusions: Overall, the findings indicate that utilizing a concentrated growth factor with a bone graft significantly improves the success of bone regeneration procedures over a 12-month follow-up period compared to interventions without these components. However, more research will be needed with larger sample sizes and longer follow-up times. Full article

Conventionally, root canal treatment is performed when the dental pulp is severely damaged or lost due to dental trauma or bacterial endodontic infections. This treatment involves removing the compromised or infected pulp tissue, disinfecting the root canal system, and sealing it with inert, non-degradable materials. However, contemporary endodontic treatment has shifted from merely obturating the root canal system with inert materials to guiding endodontic tissue regeneration through biological approaches. The ultimate goal of regenerative endodontics is to restore dental pulp tissue with structural organization and functional characteristics akin to the native pulp, leveraging advancements in tissue engineering and biomaterial sciences. Dental pulp tissue engineering commonly employs scaffold-based strategies, utilizing biomaterials as initial platforms for cell and growth factor delivery, which subsequently act as scaffolds for cell proliferation, differentiation and maturation. However, cells possess an intrinsic capacity for self-organization into spheroids and can generate their own extracellular matrix, eliminating the need for external scaffolds. This self-assembling property presents a promising alternative for scaffold-free dental pulp engineering, addressing limitations associated with biomaterial-based approaches. This review provides a comprehensive overview of cell-based, self-assembling and scaffold-free approaches in dental pulp tissue engineering, highlighting their potential advantages and challenges in advancing regenerative endodontics. Full article

Cell homing, a process that leverages the body’s natural ability to recruit cells and repair damaged tissues, presents a promising alternative to cell transplantation methods. Central to this approach is the recruitment of endogenous stem/progenitor cells—such as those from the apical papilla, bone marrow, and periapical tissues—facilitated by chemotactic biological cues. Moreover, biomaterial scaffolds embedded with signaling molecules create supportive environments, promoting cell migration, adhesion, and differentiation for the regeneration of the pulp–dentin complex. By analyzing in vivo animal studies using cell homing strategies, this review explores how biomolecules and scaffold materials enhance the recruitment of endogenous stem cells to the site of damaged dental pulp tissue, thereby promoting repair and regeneration. It also examines the key principles, recent advancements, and current limitations linked to cell homing-based regenerative endodontic therapy, highlighting the interplay of biomaterials, signaling molecules, and their broader clinical implications. Full article

Background: Traditional root canal therapy (RCT) effectively removes diseased or necrotic pulp tissue and replaces it with inorganic materials. Regenerative endodontics is an alternative to conventional RCT by using biologically based approaches to restore the pulp–dentin complex. This review explores emerging techniques, including autogenic and allogenic pulp transplantation, platelet-rich fibrin, human amniotic membrane scaffolds, specialized pro-resolving mediators, nanofibrous and bioceramic scaffolds, injectable hydrogels, dentin matrix proteins, and cell-homing strategies. These methods utilize stem cells, growth factors, and biomaterials to regenerate vascularized, functional pulp tissue. Methods: A narrative review was conducted using PubMed, Scopus, and Embase to identify studies published between 2010 and 2023. In vitro, animal, and clinical studies focusing on innovative regenerative endodontic techniques were analyzed. Conclusions: Although regenerative endodontics demonstrates great potential, challenges remain in standardizing protocols, addressing biological variability, and achieving consistent clinical outcomes. Future research must focus on refining these techniques to ensure their safety, efficacy, and accessibility in routine practice. By addressing current limitations, regenerative endodontics could redefine the management of pulpitis, offering biologically based treatments that enhance tooth vitality, structural integrity, and long-term prognosis. Full article

The dehydrated human amnion–chorion membranes (dHACMs) derived from the human placenta have emerged as a promising biomaterial for dental pulp regeneration owing to their unique biological and structural properties. The purpose of this review is to explore the potentials of dHACMs in dental pulp tissue engineering, focusing on their ability to promote cellular proliferation, differentiation, angiogenesis, and neurogenesis. dHACMs are rich in extracellular matrix proteins and growth factors such as TGF-β1, FGF2, and VEGF. They also exhibit significant anti-inflammatory and antimicrobial properties, creating an optimal environment for dental pulp regeneration. The applications of dHACMs in regenerative endodontic procedures are discussed, highlighting their ability to support the formation of dentin and well-vascularized pulp-like tissue. This review demonstrates that dHACMs hold significant potential for enhancing the success of pulp regeneration and offer a biologically based approach to preserve tooth vitality and improve tooth survival. Future research is expected to focus on conducting long-term clinical studies to establish their efficacy and safety. Full article

Introduction: Apical periodontitis (AP) is an inflammatory disease of the periapical tissues that is often asymptomatic and diagnosed through radiographic examination. A challenge in traditional endodontics is disinfection of the root canal system (RCS), which anatomically presents numerous variations, often leading to persistent infections. Antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) offer promising adjuncts, due to their antimicrobial and tissue-healing properties. Objective: The aim of this article was to report five cases of teeth with pulp necrosis and asymptomatic apical periodontitis (AAP) treated with aPDT and PBMT protocols. Materials and Methods: Five cases of pulp necrosis and AAP were treated with conventional endodontic therapy supplemented with aPDT and PBMT. The treatment protocol included chemomechanical preparation (CMP), aPDT using a 660 nm diode laser (DL) with methylene blue (MB) as a photosensitizer (5 min pre-irradiation time), and PBMT using a 940 nm DL. Treatment results were evaluated through cone-beam computed tomography (CBCT)-based evaluation over 1 year of clinical follow-up. Results: All cases showed significant bone regeneration and tissue healing, demonstrating the efficacy of the combination of aPDT and PBMT. Post-operative pain did not occur in any of the patients, suggesting a possible analgesic effect of PBMT. Conclusions: The combination of aPDT and PBMT in endodontic therapy promoted tissue recovery and improved the prognosis of AAP. Further research and randomized control trials are needed to optimize treatment protocols and evaluate the long-term effects. Full article

Regenerative endodontics (REP) is a new clinical modality aiming to regenerate damaged soft and hard dental tissues, allowing for root completion in young adults’ teeth. Effective disinfection is crucial for REP success, but commonly used antimicrobials often harm the niche dental pulp stem cells (DPSCs). To our knowledge, this is the first study to explore the biocompatibility and antimicrobial potential of pectin as a potential natural intracanal medicament for REPs. Low methoxyl commercial citrus pectin (LM) (pectin CU701, Herbstreith&Fox.de) was used in all experiments. The pectin’s antibacterial activity against single species biofilms (E. faecalis and F. nucleatum) was assessed using growth curves. The pectin’s antimicrobial effect against mature dual-species biofilm was also evaluated using confocal laser scanning microscopy (CLSM) after 30 min and 7 days of treatment. The DPSC biocompatibility with 2% and 4% w/v of the pectin coatings was evaluated using live/dead staining, LDH, and WST-1 assays. Pectin showed a concentration-dependent inhibitory effect against single-species biofilms (E. faecalis and F. nucleatum) but failed to disrupt dual-species biofilm. Pectin at 2% w/v concentration proved to be biocompatible with the HDPSCs. However, 4% w/v pectin reduced both the viability and proliferation of the DPSCs. Low concentration (2% w/v) pectin was biocompatible with the DPSCs and showed an antimicrobial effect against single-species biofilms. This suggests the potential for using pectin as an injectable hydrogel for clinical applications in regenerative endodontics. Full article

Regenerative endodontics is a developing field involving the restoration of tooth structure and re-vitality of necrotic pulp. One of the most critical clinical considerations for regenerative endodontic procedures is the disinfection of the root canal system, since infection interferes with regeneration, repair, and stem cell activity. In this study, we aimed to provide the synthesis of injectable biopolymeric tissue scaffolds that can be used in routine clinical and regenerative endodontic treatment procedures using Gelatin methacryloyl (GelMA), and to test the antimicrobial efficacy of Gelatin methacryloyl/Silver nanoparticles (GelMA/AgNP), Gelatin methacryloyl/Hyaluronic acid (GelMA/HYA), and Gelatin methacryloyl/hydroxyapatite (GelMA/HA) composite hydrogels against microorganisms that are often encountered in stubborn infections in endodontic microbiology. Injectable biocomposite hydrogels exhibiting effective antimicrobial activity and non-cytotoxic behavior were successfully synthesized. This is also promising for clinical applications of regenerative endodontic procedures with hydrogels, which are proposed based on the collected data. The GelMA hydrogel loaded with hyaluronic acid showed the highest efficacy against Enterococcus faecalis, one of the stubborn bacteria in the root canal. The GelMA hydrogel loaded with hydroxyapatite also showed a significant effect against Candida albicans, which is another bacteria responsible for stubborn infections in the root canal. Full article