Search Results (79)

The effects of aging on dental pulp stem cells (DPSCs) have been extensively investigated in recent years. Senescent DPSCs may negatively affect pulpal regeneration in the aged tooth and be a driver of chronic inflammation. In the near future, targeting key inducers of cellular senescence may therefore become central to the development of new strategies to enhance the regenerative capacities of DPSCs. The aim of this perspective article is to provide an overview of the molecular mechanisms driving cellular senescence in DPSCs. Furthermore, potential clinical applications of targeting DPSC senescence in regenerative endodontics are discussed, including strategies to preserve exposed pulp, promote pulp-like tissue through revascularization or revitalization, and achieve complete pulp regeneration. Full article

Background: Regenerative endodontic procedures (REPs) aim to restore pulp vitality and promote root development in immature necrotic permanent teeth. Scaffold materials provide a 3D framework to support cellular migration, proliferation, and differentiation and play a critical role in regenerative interventions. Commonly used scaffolds include PRP, PRF, and collagen; however, hyaluronic acid has also demonstrated promising treatment outcomes. Objective: To evaluate whether hyaluronic acid (HA) provides superior regenerative outcomes compared to PRP, PRF, and collagen scaffolds. Methods: A systematic electronic search was conducted across PubMed, Scopus, and EBSCOhost. A total of 952 articles were identified in the initial search, of which 19 articles were included in the final review. Due to heterogeneity, a narrative synthesis was performed. Results: PRF demonstrated the most consistent improvement in root development and dentinal wall thickening. Apical closure and periapical healing were achieved across all scaffold types. Evidence for HA was limited, with no clear superiority identified. Conclusions: Current evidence does not support the superiority of HA over established scaffolds. Further standardised clinical trials are required to make definitive comparisons on scaffold effectiveness. Full article

Introduction: Three-dimensional (3D) bioprinting is a promising approach for endodontic tissue engineering, enabling scaffolds with controlled architecture and bioactivity to support pulp regeneration. Objectives: This systematic review assessed the following: “What 3D bioprinting applications are reported in endodontics-related studies?” Materials and Methods: Following PRISMA 2020 guidelines, PubMed/MEDLINE, Scopus, Embase, Cochrane Library, Web of Science, SciELO, LILACS, and Google Scholar were searched up to January 2026 with no date or language limits. Two reviewers independently screened studies; risk of bias in in vitro studies was assessed with the QUIN tool. As only one study reported complete antimicrobial outcomes, an intra-study quantitative comparison (MD, 95% CI) of inhibition halos was performed (not a meta-analysis). Results: From 518 records, nine studies were included. Outcomes mainly addressed physicochemical properties (n = 9), cell viability (n = 7), biocompatibility (n = 5), and cell differentiation (n = 5); antimicrobial activity was evaluated in two studies. Most used hDPSCs and extrusion-based printing, testing calcium silicate composites, alginate hydrogels, functionalized PCL, and modified PLA. Modified PLA scaffolds showed greater antimicrobial activity, strongest with naringin and nHA formulations. Overall risk of bias was moderate (58.33%), largely due to limited reporting of randomization, blinding, and sampling. Conclusion: 3D-bioprinted scaffolds/bioinks generally improved cellular responses and bioactivity, especially with MTA, Biodentine, nHA, or naringin; antimicrobial effects were most evident in functionalized PLA (PLA/NAR and PLA/nHA/NAR). Full article

Predictable pulp-dentin regeneration continues to represent a major challenge in regenerative endodontic procedures (REPs). Although collagen-based scaffolds are widely investigated for their excellent biocompatibility, their ability to deliver consistent clinical and histological outcomes requires critical evaluation. This review summarizes recent advances in the application of collagen scaffolds for REPs. Clinical studies demonstrate that these scaffolds support high tooth survival rates and promote vitality recovery, root wall thickening, and apical closure. However, consistent root lengthening remains elusive. Histologically, the newly formed mineralized tissue from collagen scaffolds within REPs tends to be cementum-like or bone-like rather than reparative dentin, a pattern closely associated with the physicochemical properties of collagen, including pore size, porosity, concentration, stiffness, viscosity, and viscoelasticity. We conclude that while collagen scaffolds represent a “promising platform” for REPs due to their biocompatibility and clinical performance, current evidence indicates that they do not consistently achieve true pulp-dentin regeneration. We therefore propose targeted modification and advanced tissue engineering strategies to direct genuine regeneration. This review offers a framework for the rational design of next-generation collagen constructs toward more predictable regenerative outcomes. 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

Background: Regenerative endodontic treatment (RET) has emerged as a biologically based alternative to traditional apexification for managing immature permanent teeth with pulp necrosis. By promoting tissue ingrowth and continued root development, RET aims not only to eliminate infection but also to reinforce structurally compromised roots. Although its clinical use has expanded, evidence regarding the long-term predictability and durability of RET remains limited, as most published studies provide only short- or mid-term follow-up. Case presentation: This report describes two pediatric cases involving regenerative procedures performed on three immature permanent maxillary incisors, each followed for more than six years. The first case involved a 7-year-old girl who developed pulp necrosis in a maxillary lateral incisor after acute dental trauma. Management followed a regenerative protocol using triple antibiotic paste (ciprofloxacin, metronidazole, and minocycline) as intracanal medication and mineral trioxide aggregate as the coronal barrier. The second case concerned an 8-year-old girl presenting with chronic infection and sinus tracts affecting both maxillary central incisors. These teeth were treated using a regenerative approach with calcium hydroxide as the intracanal medicament and Biodentine as the sealing material. Clinical, radiographic, and cone beam computed tomography evaluations demonstrated complete symptom resolution and periapical healing but incomplete progressive apical closure. All treated teeth developed a calcified apical barrier, and outcomes remained stable throughout the extended follow-up period. Conclusions: While inherently limited by the nature of case reports, these findings support RET as a reliable and durable therapeutic option for necrotic immature permanent teeth, including cases in which conventional apexification has not been successful. Full article

This study investigates the bactericidal efficacy and penetration ability inside dentinal tubules of calcium hydroxide (CH) and a modified tri-antibiotic paste (ciprofloxacin, metronidazole, clarithromycin) (TAP) during regenerative endodontic procedures (REPs). The blood clot serving as a biological scaffold was introduced into the root canal to assess its influence on bacterial regrowth. Forty-four human extracted teeth were infected with E. faecalis and divided in four experimental groups (N = 10) with positive and negative controls (N = 4). Samples were treated with either CH or TAP as intracanal dressing. Bacterial viability and depth of penetration were evaluated using confocal laser scanning microscopy (CLSM) after fluorescent vital staining. The same analysis was performed with or without blood clot exposure and the data were analyzed by one-way ANOVA and a post hoc Bonferroni test (p < 0.05). TAP demonstrated significantly stronger bactericidal activity than CH (p = 0.008). However, its efficacy significantly decreased in the presence of blood clot (p = 0.032). CH showed a moderate antibacterial effect, with its efficacy reduced in the presence of blood. Blood clot exposure consistently reduced the bactericidal efficacy in both groups (p = 0.01) and the dye penetration in CH group (p = 0.041). In conclusion, TAP demonstrated superior antibacterial performance compared to CH and blood clot exposure seemed to decrease antimicrobial efficacy and depth of disinfection during REPs. 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

For decades, regeneration of alveolar bone defects has depended on traditional grafting options, such as autogenous/allogenic grafts or allografts. Recently, extracted teeth was introduced as an alternative graft source. Tooth autografts are being used and have gained significant attention due to their biocompatibility, osteoconductivity, osteoinductivity, and osteogenic properties. Furthermore, tooth allografts have potential to act as natural biocomposites for oral regeneration procedures and might be advantageous options in near future. Recent advances in tooth banking, including cryopreservation, can serve to maintain bioactivity and to improve the safety, viability, and regenerative potential of teeth. They might be revolutionary in oral surgery, offering a more sustainable solution to the growing demand for bone regeneration procedures. Nevertheless, challenges such as immunogenic responses, ethical issues, and regulatory constraints persist. Ongoing research and technological innovation continue to address these problems. To date, the success rates of tooth autografts are promising, and they are regarded as a reliable option in clinical practice, with predictable outcomes in alveolar ridge preservation, sinus augmentation, periodontal regeneration, guided bone regeneration (GBR), and endodontic surgery by providing natural scaffolds for cell integration and bone remodeling. However, the scientific literature on tooth allografts is lacking. Therefore, this review aimed to comprehensively evaluate the scientific literature for comparing the properties of tooth grafts with other grafting options, in terms of processing techniques, and various clinical applications, positioning them as versatile biocomposites for the future, bridging material science and regenerative dentistry. Furthermore, possible applications of allogenic tooth grafts and overcoming current limitations are also discussed. Full article

Regenerative endodontic procedures (REPs) are a promising treatment for immature teeth with pulpal necrosis. However, the outcomes remain unpredictable, partly due to scaffold limitations. Beta-glucan (BG), a bioactive polysaccharide with regenerative properties, may enhance scaffold performance. This study aimed to fabricate BG-coated polyvinylpyrrolidone/cellulose acetate (PVP/CA) electrospun scaffolds and evaluate their physicochemical properties and cell attachment. Electrospun scaffolds were fabricated by electrospinning a 10% w/v PVP/CA (70:30) solution in acetone and N,N-dimethylacetamide (2:1) (PC). BG (8% w/v in 1 M NaOH) was electrosprayed onto the scaffold at 0.1, 0.2, and 0.4 mL volumes, generating PC-BG01, PC-BG02, and PC-BG04, respectively. Scaffold characterization included SEM, FTIR, BG enzymatic assay, water absorbance, degradation, and cell adhesion assays. SEM images of the scaffolds exhibited smooth cylindrical fibers (547.3–585.9 nm diameter) with high porosity (42.37–49.91%). BG particles were confirmed by elemental analysis and BG enzymatic assay. At 28 days, the PC group showed significant fiber diameter and porosity reduction. BG particle degradation was observed at 14 and 28 days. Notably, BG-coated scaffolds significantly enhanced initial apical papilla cell adhesion at 1 and 24 h. These findings highlight the potential of BG-coated scaffolds as bioactive scaffolds for REPs. Full article

Dehydrated human-derived amnion–chorion membranes (ACM), known for their bioactive composition of growth factors and cytokines, have demonstrated potential as a bioactive scaffold in regenerative medicine; however, their clinical application in regenerative endodontic procedures (REPs) remains unexplored. This retrospective study aimed to evaluate the clinical and radiographic outcomes of REPs using ACM compared to collagen matrices (CM) in immature necrotic permanent teeth. Forty-one immature necrotic teeth from 38 patients (mean age: 14.68 ± 7.43 years) were treated with REPs using either ACM (n = 21) or CM (n = 20) scaffolds over a mean follow-up period of 23.23 months. Outcomes assessed included survival, success, root development measured by radiographic root area (RRA), and pulp sensibility. Independent t-tests compared outcomes between groups, while Cox regression and generalized linear models identified predictors of treatment outcomes. Overall survival and success rates were 87.8% and 82.9%, respectively. ACM-treated teeth achieved 90.5% survival and 85.7% success rates, while CM-treated teeth demonstrated 85.0% survival and 80.0% success rates, with no statistically significant differences between groups (p > 0.05). Root development occurred in 85.4% of cases overall, with significant RRA increases of 13.89 ± 13.95% for ACM and 11.24 ± 11.21% for CM (p < 0.05 within each group). Pulp sensibility recovery was observed in 51.2% of treated teeth overall, with 42.9% for ACM-treated teeth and 55.0% for CM-treated teeth (p > 0.05). Notably, ACM-treated teeth demonstrated earlier sensibility recovery compared to those of CM-treated teeth. Age was identified as a significant negative predictor of root development outcomes (p < 0.05). This clinical study demonstrates that both ACM and CM are clinically effective scaffolds for REPs, achieving high survival rates and promoting root development in immature necrotic teeth. While overall success rates were comparable, ACM showed faster sensibility recovery, suggesting potential biological advantages for enhanced tissue regeneration and earlier functional recovery. 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

Conventional endodontic treatment has several disadvantages, which lead to the introduction of regenerative endodontic procedures aiming to maintain tooth vitality. Platelet concentrates possess relevant biological properties, and their application has been explored in various endodontic procedures. The aim of this scoping review is to identify the applications of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in endodontics. To identify and map the types of studies, the protocols for obtaining PRF/PRP, the most productive authors, and the journals where most articles were published on this topic until 2023. A literature search was performed in four databases (Medline, Embase, Cochrane Library, and Web of Science) until 20 December 2023. From the included articles, the following information was extracted: first author and publication year, endodontic procedure, platelet concentrate used, type of study, and journal of publication. A sampling methodology was adopted, and the five most recent articles for each procedure were used for additional information extraction: sample size and characteristics, pulp and periapical diagnosis, study protocol, platelet substrate and protocol for its obtention, treatment outcome, and follow-up. After selection, 412 articles were included. As for the type of endodontic procedure, regeneration procedures of immature teeth were the most reported, followed by apical surgery and pulpotomy and pulp protection. It was concluded that PRF is the most reported platelet concentrate. Regenerative procedures in immature teeth are the most described endodontic procedure. The success rate of PRF and PRP use is comparable to or even higher than that of conventional procedures and materials. However, there is significant heterogeneity in the protocols used for obtaining PRF and PRP and their clinical application. 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

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