Search Results (165)

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

Background: The aim of this study was to investigate the effect of 2% chitosan nanoparticles (NPs) as an irrigating solution during pulp revascularization of immature dog teeth using histological and histomorphometric analyses. Materials and Methods: Pulp necrosis and periapical pathosis were induced in 52 incompletely formed roots in four dogs (6–8 months age). These teeth were randomly allocated to Group I (n = 20; irrigation with NaOCl + EDTA) and Group II (n = 20; irrigation with NaOCl + chitosan NPs); DAP was used as a medication in both groups. Positive control (6 roots): teeth with induced periapical infections, no treatment procedure, and left open. Negative control (6 roots): teeth that were left untreated for the normal maturation process. Each experimental group was subdivided into two subdivisions in accordance with the post-treatment evaluation periods (1–3 months). The experimental teeth were re-entered following the infection period and disinfected using the assigned irrigation and medication protocol, and the access cavities were sealed. After the evaluation period, medication was removed, and blood clot formation was created through over-instrumentation. Mineral trioxide aggregate (MTA) was applied, followed by glass ionomer restoration (GIC). Results: At both 1 and 3 months, Group II demonstrated significantly superior histological organization and higher collagen-positive area percentages compared with Group I (p < 0.01), while the negative control showed the highest values and the positive control the lowest. Conclusions: Irrigation with 2% chitosan NPs significantly improved regenerative outcomes compared with the conventional NaOCl/EDTA protocol in immature canine teeth. 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

In the oral environment, silicone (polysiloxane) supports healing by creating low-permeability interfaces that limit microleakage, whereas silicon/silica systems support healing via hydroxyapatite nucleation. We synthesized human evidence on intraoral healing associated with silicone and silicon/silica-based materials and assessed translational differences between preclinical models and clinical settings. A systematic review (1990-September 2025) identified 14 clinical studies of bioactive glass (BAG) that met the inclusion criteria. Periodontal outcomes included probing depth (PD), clinical attachment level (CAL), and radiographic fill; endodontic outcomes included the periapical index (PAI). Human BAG studies showed periodontal benefits versus controls in intrabony defects, with reduced PD, improved CAL, and greater radiographic fill. For endodontic healing, a multicenter randomized clinical trial reported improved PAI at 12 months in both the zinc-oxide-eugenol and silicone-sealer groups without a significant between-group difference. The literature supports a functional split: silicone primarily provides sealing and permissive healing, whereas silicon/silica-based materials support signaling, interfacial bonding, and regenerative healing. Clinically, BAG appears most relevant for contained periodontal intrabony defects, whereas silicone sealers should be viewed primarily as stable sealing adjuncts to well-executed root canal therapy. 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

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 and Objectives: The regeneration of the pulp–dentin complex represents an alternative to conventional root canal treatment, aiming to preserve tooth biology and function. Cell-free regenerative endodontic therapy (CF-RET) exploits endogenous stem cells from the periapical region without ex vivo cell manipulation. Despite growing interest, the biological mechanisms, clinical indications, and predictability of CF-RET remain not clearly defined. This structured narrative review aimed to update a previous review by analyzing recent human studies on CF-RET. Materials and Methods: This review was conducted using the PRISMA 2020 guidelines to guide transparent reporting of the literature search and study selection process and was registered in PROSPERO (CRD420251075131). In vitro and in vivo human studies published between January 2017 and December 2024 investigating CF-RET were included, while studies involving cell transplantation, non-human models, case reports, and reviews were excluded. Study selection, data extraction, and quality assessment using the QuADS tool were performed, and the evidence was synthesized using a qualitative narrative approach. Results: Sixty-four studies were included. In vitro studies reported favorable effects of growth factors, exosomes, and biomimetic scaffolds on stem cell viability, migration, proliferation, odontogenic differentiation, and angiogenesis, while neurogenic differentiation was less consistently investigated. Scaffold composition, microstructure, and rheological properties were also considered. In vivo studies mainly focused on immature teeth with incomplete root development and demonstrated positive clinical and radiographic outcomes, including root development and canal diameter reduction. Conclusions: The current evidence supports the biological potential of CF-RET as a regenerative approach; however, substantial heterogeneity, the limited number of clinical studies and the absence of standardized protocols preclude definitive conclusions, highlighting the need for further well-designed translational and clinical investigations considering clinical applicability. 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

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

Hydraulic calcium silicate cements (HCSCs) are contemporary materials in vital pulp therapy (VPT) and regenerative endodontic therapy (RET) due to their favorable effects on pulpal and periodontal cells, including cell differentiation and hard tissue formation. Recent studies also indicated the involvement of several S100A proteins in inflammatory, differentiation, and mineralization processes of the pulp. The aim of the present study was to investigate the effects of HCSCs on S100A gene expression in human dental pulp stem cells (hDPSCs). Human DPSCs were isolated and characterized by multi-lineage stem-cell markers and differentiation protocols. In stimulation experiments hDPSCs were exposed to ProRoot^®MTA, Biodentine^®, IL-1β, and dexamethasone. Cell viability was determined by XTT assay. IL-6 and IL-8 mRNA expression was measured to analyze proinflammatory response. In addition, odontogenic differentiation and biomineralization assays were conducted (DSPP- and ALP-mRNA expression, ALP activity, and Alizarin Red staining). Differential expression of 13 S100A genes was examined using qPCR. Low concentrations of HCSCs enhanced the proliferation of hDPSCs, whereas higher concentrations exhibited cytotoxic effects. HCSCs induced a pro-inflammatory response and led to odontogenic differentiation and biomineralization. This was accompanied by significant alterations in the expression levels of various S100A genes. ProRoot^®MTA and Biodentine^® significantly affect the expression of several S100A genes in hDPSCs, supporting their role in inflammation, differentiation, and mineralization. These findings indicate a link between the effects of HCSCs on human pulp cells during VPT or RET and S100A proteins. Full article

Background/Objectives: Effective removal of organic tissue extruded beyond the apex is crucial in regenerative endodontics, particularly in teeth with immature apices; therefore, this study aims to compare the efficacy of standard needle irrigation (SNI), ultrasonic irrigation (UI), photon-induced photoacoustic streaming (PIPS), and shock wave-enhanced emission photoacoustic streaming (SWEEPS) techniques in dissolving periapical tissue in a simulated model. Methods: Sixty single-rooted human premolars and sixty bovine palatal mucosa specimens were used. A custom model was created by placing mucosal tissue in contact with the apical area. Specimens were divided into four groups (n = 15) according to the irrigation method: SNI, UI, PIPS, and SWEEPS. Each canal received 15 mL of 2% NaOCl. Tissue samples were weighed before and after treatment. One-way ANOVA and Tukey’s post hoc test were used for statistical analysis (p < 0.05). Results: UI showed significantly less tissue dissolution than the other methods (p < 0.05). SNI, PIPS, and SWEEPS showed no significant differences (p > 0.05). Conclusions: All methods led to tissue loss, but UI was significantly less effective. SNI, PIPS, and SWEEPS performed similarly. Full article

Preserving dental pulp vitality is a key goal in minimally invasive dentistry. Conventional materials such as calcium hydroxide and mineral trioxide aggregate (MTA) are effective but limited in bioactivity and mechanical strength. This systematic review evaluated the biological efficacy of chitosan-based nanoparticles and biomaterials for pulp capping and regeneration. Following PRISMA 2020 guidelines, electronic searches were conducted across five databases up to April 2025. Controlled in vitro and animal studies using chitosan-based nanoparticles, hydrogels, or composite scaffolds were included. Risk of bias was assessed using SYRCLE (animal) and ToxRTool (in vitro), and certainty of evidence was rated via the GRADE-Preclinical framework. Due to methodological heterogeneity, data were synthesized using direction-of-effect coding and visualized through Albatross and heatmap plots. Sixteen studies met the criteria, consistently demonstrating enhanced cell viability, mineralization, and upregulation of odontogenic and angiogenic markers (BMP-2, TGF-β₁, VEGF, DSPP) compared with MTA or calcium hydroxide. Animal models confirmed improved angiogenesis, reparative dentin formation, and pulp vitality preservation. Despite uniformly positive biological outcomes, the overall certainty was rated Low to Very Low owing to small samples and unclear randomization. Chitosan-based biomaterials show promising regenerative potential, warranting well-designed preclinical and clinical studies for translational validation. Full article

Decellularized tissue scaffolds mimic the native pulp-dentin microenvironment and support the odontogenic development of stem cells. This study investigated the dentinogenic effect of Wharton’s Jelly Mesenchymal Stem Cells (WJMSCs) in decellularized human dental pulp (DHDP) with bone morphogenic protein-7 (BMP-7) at three concentrations: 0 ng/mL (control), 25 ng/mL, and 50 ng/mL. The effects of BMP-7 were evaluated by histological examination, WJMSC viability using AlamarBlue, dentinogenic gene expression by qPCR, and dentinogenic protein expression by ELISA. By day 21, all three groups exhibited cell distribution along the pore surfaces of DHDP, followed by the presence of a collagen matrix in the tissue. WJMSC viability treated with 25 ng/mL and 50 ng/mL showed a statistically significant increase on days 7, 14, and 21 compared to the control group (p < 0.05). Gene expression analysis of dentin sialophosphoprotein (DSPP) and dentin matrix protein-1 (DMP-1), and odontogenic marker (Runx2) revealed 25 ng/mL BMP-7 resulted in significantly higher expression levels for DMP-1 and Runx2 on day 21 compared to control and 50 ng/mL BMP-7 group (p < 0.05). DSPP and DMP-1 protein expressions also showed trends similar to those of gene expressions. BMP-7 (25 ng/mL) can maintain cell viability and promote dentinogenic effects of WJMSC in the DHDP scaffold. Full article