Search Results (366)

Background and Clinical Significance: Traumatic dental injuries, particularly complicated crown fractures of permanent incisors, are common in adolescents, with maxillary central incisors most frequently affected due to their prominent position. These injuries, often resulting from sports or accidents, require prompt management to prevent complications such as pulp necrosis or infection, which can compromise long-term prognosis. Fragment reattachment offers a conservative, esthetically favorable approach when the fractured segment is intact, with outcomes comparable to composite restorations. This case report underscores the importance of timely intervention and advanced restorative techniques in pediatric dentistry. Case Presentation: A 16-year-old male presented with a complicated crown fracture of the upper left central incisor sustained during a soccer game. The fracture extended subgingivally with pulp exposure. The patient preserved the fragment in saline. Treatment involved fragment reattachment using a dentin bonding agent and flowable composite resin, followed by single-visit root canal therapy due to delayed presentation (48 h). A glass fiber post was placed to reinforce the restoration due to significant coronal loss. Three years of follow-up visits (1, 3, 6, 12, 24, and 36 months) revealed no clinical or radiographic complications, with the tooth remaining asymptomatic and functional. Conclusions: This case underscores the effectiveness of fragment reattachment when combined with meticulous technique and long-term monitoring. Full article

Background: Gingival recession is a common condition involving apical displacement of the gingival margin, leading to root surface exposure and associated complications such as dentin hypersensitivity and root caries. Among the most effective treatment options are the tunneling technique (TUN) and the coronally advanced flap (CAF), both combined with connective tissue grafts (CTGs). This study aimed to evaluate and compare the clinical outcomes of TUN + CTG and CAF + CTG in terms of root coverage and keratinized tissue width (KTW) over a 6–12-month follow-up. Methods: A randomized, double-blind clinical trial was conducted following CONSORT guidelines (ClinicalTrials.gov ID: NCT06228534). Participants were randomly assigned to receive either TUN + CTG or CAF + CTG. Clinical parameters, including gingival recession depth (REC) and KTW, were assessed at baseline as well as 6 months and 12 months postoperatively using a calibrated periodontal probe. Statistical analysis was performed using descriptive statistics and linear mixed models to compare outcomes over time, with a significance level set at 5%. Results: Both techniques demonstrated significant clinical improvements. At 6 months, mean root coverage was 100% in CAF + CTG cases and 97% in TUN + CTG cases, while complete root coverage (REC = 0) was observed in 100% and 89% of cases, respectively. At 12 months, root coverage remained stable, at 99% in the CAF + CTG group and 97% in the TUN + CTG group. KTW increased in both groups, with higher values observed in the CAF + CTG group (3.53 mm vs. 3.11 mm in TUN + CTG at 12 months). No significant postoperative complications were reported. Conclusions: Both TUN + CTG and CAF + CTG are safe and effective techniques for treating RT1 and RT2 gingival recession, offering high percentages of root coverage and increased KTW. While CAF + CTG achieved slightly superior coverage and tissue gain, the TUN was associated with better aesthetic outcomes and faster recovery, making it a valuable alternative in clinical practice. Full article

Continued efforts have been made to enhance the antibacterial properties of root canal sealers by adding antimicrobial agents to them. This study aims to investigate the antibacterial effect of 0.15% silver nanoparticles (NAg) and 5% dimethylaminohexadecyl methacrylate (DMAHDM) when added to EndoSequence Bioceramic (BC) sealer against Enterococcus faecalis (E. faecalis) biofilm and their impact on its physical properties (flowability and film thickness). Four root canal sealers were tested for flow and film thickness properties, as well as against antibiofilm of E. faecalis-impregnated dentin discs, as follows: group 1: EndoSequence BC sealer only; group 2: EndoSequence BC sealer + 0.15% NAg; group 3: EndoSequence BC sealer + 5% DMAHDM; and group 4: EndoSequence BC sealer + 0.15% NAg + 5% DMAHDM. The findings show that all groups had flow and film thickness values that were in accordance with the ISO requirements. Combining 0.15% NAg and 5% DMAHDM in EndoSequence significantly reduced colony-forming unit (CFU) counts by approximately 5 logs. The combination of NAg and DMAHDM offers a promising strategy for developing endodontic sealers with improved antimicrobial properties and acceptable physical performance. Full article

Chemical endodontic irritants can lead to the demineralization of the inorganic tooth structure, its loss of integrity, microhardness changes, erosion, and an increased risk of fractures. We investigated the action of iron oxide nanomagnet particles (IONPs) as an irrigant solution for improving hardness and identifying the concentration of element ions in the root canal. There were six groups in total: a control group (no treatment) and experimental groups (UN: ultrasound agitation normal saline, UI: ultrasound agitation IONPs, MSI: magnetic field and endodontic needle with syringe agitation IONPs, MUI: magnetic field and ultrasound agitation IONPs, and EDTA: ethylenediaminetetraacetic acid). We hypothesized that IONPs with magnetic agitation would preserve microhardness better than EDTA. Vickers hardness testing was used to evaluate microhardness, which was then analyzed using energy-dispersive X-ray spectroscopy (EDS) to investigate the calcium/phosphorus ratio and the presence of iron. The IONP groups exhibit a higher VHN value than the EDTA group (p < 0.05). These results support our hypothesis, indicating that utilizing an IONP irrigant solution with an external magnetic field does not change microhardness but enhances it compared to the EDTA group, suggesting that employing an external magnetic field to deliver nanoparticles to the root canal wall does not affect the properties of the tooth structure compared to conventional instrumentation techniques, which lead to unnecessary loss of root structure. Full article

The effect of root canal irrigants on the mechanical properties of dentin is crucial in endodontic treatment planning. While antiseptics such as sodium hypochlorite and EDTA are widely used, their potential to weaken dentin structure remains a concern. Polyhexanide-based formulations may offer a safer alternative. To assess the impact of a polyhexanide-based antiseptic composition, compared to standard irrigants, on the microhardness, Young’s modulus, and elastic deformation energy of dentin. Sixty extracted human teeth were sectioned and polished to prepare dentin samples. Baseline measurements of Vickers microhardness, Young’s modulus, and elastic deformation work were performed using a Microhardness Tester (CSM Instruments, Switzerland) with a Berkovich indenter. Samples were then divided into six groups (n = 10 per group) and exposed to different irrigants (NaCl 0.9%, NaOCl 3%, chlorhexidine 2%, EDTA 17%, and polyhexanide-based solutions—0.1% and 0.2% Lavasept). Post-treatment measurements were performed. Statistical analysis was conducted using non-parametric tests with Bonferroni correction. Sodium hypochlorite (3%) caused the most pronounced reduction in dentin microhardness and mechanical strength, though not always statistically significant. Polyhexanide-based solutions (0.1% and 0.2% Lavasept) showed a milder effect, with statistically significant changes observed only in elastic deformation energy for 0.2% polyhexanide. EDTA treatment led to severe surface destruction, precluding reliable post-treatment measurements. Polyhexanide-based irrigants demonstrated a more favorable impact on dentin mechanical properties compared to traditional irrigants, supporting their potential use in endodontic protocols aimed at preserving dentin integrity. Full article

Enterococcus faecalis (E. faecalis) is a major pathogen responsible for refractory apical periodontitis (RAP). It can penetrate deep into dentinal tubules, form persistent biofilms, and exhibit antibiotic resistance, thereby limiting the efficacy of conventional antimicrobial treatments. Bacteriophages (phages), due to their strong lytic activity and host specificity, have emerged as promising alternatives. In this study, a novel strictly lytic phage, ZXL-01, was isolated from lake water in Jilin, China. ZXL-01 demonstrated remarkable stability under extreme conditions, including thermal tolerance at 60 °C for 1 h and a wide pH range (4–11). Whole-genome sequencing (GenBank accession number: ON113334) revealed a genome of 40,804 bp with no virulence or tRNA genes, confirming its identity as an E. faecalis phage. Importantly, ZXL-01 exhibited potent antibiofilm activity, reducing biofilm biomass by approximately 69.4% in the inhibition group and 68.4% in the lysis group (both p < 0.001). In an in vitro root canal infection model induced by E. faecalis, scanning electron microscope (SEM) observations confirmed that ZXL-01 effectively inhibited biofilm formation and disrupted mature biofilms. These findings highlight the potential of ZXL-01 as a novel antimicrobial agent for the treatment of E. faecalis-associated apical periodontitis. 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

Endodontic infections are characterized by complex polymicrobial communities residing within the intricate root canal system. Traditional chemomechanical methods frequently fail to achieve complete microbial eradication, especially in cases involving biofilm-forming and resistant species. This systematic review synthesizes current evidence on the molecular basis and antimicrobial efficacy of the neodymium-doped yttrium aluminum garnet (Nd:YAG) laser in root canal disinfection, particularly against polymicrobial infections. A comprehensive literature search was conducted in the PubMed, Embase, Scopus, and Cochrane databases in accordance with PRISMA 2020 guidelines. Experimental and preclinical studies evaluating the bactericidal properties of Nd:YAG laser therapy were included. The Nd:YAG laser demonstrated significant reductions in total microbial load through photothermal effects, including denaturation of proteins, disruption of cell membranes, and degradation of mixed-species biofilms. Although complete sterilization was not consistently achieved, its ability to penetrate dentinal tubules and target microbial consortia offers substantial adjunctive value. Standardization of laser parameters and further clinical studies are needed to validate these findings and establish Nd:YAG laser use in routine endodontic disinfection protocols. 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

Background/Objectives: The removal of a fiber post (FP) during endodontic retreatment can be the source of significant complications. This study evaluated two commonly used techniques in removing a fiber post from an endodontically treated tooth by investigating three metrics: volume of dentin removed, efficiency, and temperature increase. Methods: Thirty extracted, single-rooted teeth were decoronated at the CEJ, then underwent endodontic treatment and post-space preparation. Fiber posts were bonded within the canal space. Teeth were pair-matched and randomly assigned to undergo post removal via Munce bur (MB) or diamond-coated ultrasonic tip (US). Teeth were scanned with micro-CT prior to post placement and after post removal. Results: The volume of dentin removal was not statistically significant between groups (p > 0.05), but the Munce bur resulted in eccentric removal patterns. There was a statistically significant difference in the time required to remove the fiber post between MB and US (p < 0.05). Removal of a fiber post with a Munce bur took an average of 58 s. Removal of a fiber post with an ultrasonic tip took an average of 502 s. There was no statistically significant difference in maximum temperature generated during post removal between MB and US (p > 0.05). Conclusions: Removal of a FP with a Munce bur requires significantly less time when compared to using an ultrasonic tip, with reduced risk of generating excessive heat for either technique with adequate coolant. US can stay more centered in the canal during FP removal when compared to Munce burs, potentially reducing unfavorable outcomes. 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/Objectives: This study aimed to assess and compare the elimination of the smear layer and microhardness of dentin in root canals after sequential versus continuous chelation using different agitation techniques. Methods: Sixty-four palatal roots of upper first molars were instrumented to size X3 (Protaper Next files). According to the irrigant solution, samples were assigned to two groups (N = 32/group), 3% NaOCl irrigation followed by 17% EDTA (sequential chelation (SC)), or dual-rinse (3% NaOCl/9% HEDP) irrigation (continuous chelation (CC)). Each group has been divided into four subgroups (n = 8/subgroup), based on agitation techniques used: conventional needle (CN) (control group), EndoActivator (EA), ultrasonic agitation (UAI), and Er.Cr.YSGG 2780 nm (laser). SEM images assessed the smear layer, and Vicker microhardness (VHN) was performed at 50 and 100 µm depths. Data were analyzed using: Kruskal–Wallis, Wilcoxon, and the Mann–Whitney U test. Statistical significance was set at p < 0.05. Results: In the UAI and laser agitation, CC significantly reduced the smear layer presence compared to SC in the apical and coronal thirds, respectively (p < 0.05), and no significant differences were observed in the CN and EA groups between SC and CC (p > 0.05). There were significantly higher VHNs of dentine in CC groups than in SC groups in all sections and depths, except in the apical of the CN group at 50 µm and the coronal section of EA and UAI groups at 100 µm. Conclusions: CC was comparable to SC in smear layer removal. CC had a less detrimental effect on dentin compared with SC. Full article

Background and Objective: Immature maxillary incisors (IMIs) are especially susceptible to failure due to their thin dentinal walls and compromised structural integrity following endodontic treatment. This study aims to evaluate the stress distribution within the root dentin after various post-endodontic treatments. Materials and methods: A personalized finite element analysis model of IMI was created using cone beam computed tomography (CBCT) data. Based on data from the literature, five stages of root development were reconstructed: half root development (S1), three-quarter development (S2), more than three-quarter development (S3), fully developed root with open apex (S4), and fully developed root with closed apex (S5). Six experimental groups were analyzed: GC Fiber Post (PS1); RelyX Post (PS2); metal post Unimetric 1.0 (PS3); everStick Post (PS4); positive control group with only the gutta-percha filling (PC), and intact maxillary incisor as negative control group (NC). The resulting equivalent stresses were evaluated using the Hencky–von Mises (HMH) strength theory. Results: The mean HMH stress within the root dentin was statistically significantly higher at the cervical level in all stages, except in stage S1 and models PS2 and PS3 in stage S2, where it was significantly higher at the apical level (p < 0.001 for all models, except stage S3 [PC model p < 0.005; NC model p < 0.008]). The PS4 model showed the lowest stress values at the cervical level in stages S1, S2, and S3 (55.19 MPa, 58.78 MPa, 58.84 MPa) and the PS1 model in stages S4 and S5 (57.48 MPa, 58.81 MPa). At the apical level, model PS3 showed the lowest stress values in stage S1 (69.60 MPa), model PS1 in stages S2, S3, and S5 (35.99 MPa, 44.30 MPa, 12.51 MPa) and model PC in stage S4 (17.85 MPa). Conclusions: The results showed that the greatest stress in an immature maxillary central incisor occurred at the cervical level, except during the early stage of root development. Post placement did not reduce root dentin stress. Full article

Clinical root canal therapy which takes place through mechanical and chemical strategies is faced with challenges in eliminating bacteria owing to the intricate and curved nature of the root canal system. Moreover, the plaque biofilm within the root canal hinders drug penetration and limits treatment efficacy. Hence, efficient root canal therapy hinges on penetrating into the root canal and overcoming the barriers presented by the plaque biofilms. To penetrate and eradicate biofilms effectively at the root canal, we designed a novel magnetic nanoparticle (MN)-based nanoplatform which was synthesized by the self-polymerization of dopamine on the surface of Fe₃O₄ MNs, and then loaded minocycline through the electrostatic interaction. The therapeutic efficacy of minocycline-loaded magnetic nanoparticles (FDM MNs) under a magnetostatic field was observed by various antibacterial experiments. The synthesized FDM MNs exhibited favorable biocompatibility and robust anti-biofilm efficacy. The designed nanoparticles could effectively navigate biofilms to eradicate bacteria residing deep with the assistance of magnetic force. Furthermore, FDM MNs penetrated into dentin tubules under a magnetic field, effectively disrupting biofilms for deep sterilization. The significant results offered valuable experimental evidence to support the potential clinical utility of magnetic nanoparticles for managing pulpitis and periapical inflammation. Full article