Search Results (1,706)

Background/Objectives: Dental pulp stem cells (DPSCs) are of significant interest due to their mesenchymal lineage and relative availability from extracted teeth. This study aims to examine the relationship between fibronectin-adherent, non-fibronectin-adherent, and explant-derived DPSC populations in terms of the population doubling rate in culture and the expression of mesenchymal cell surface markers and their capacity for osteodifferentiation. Methods: Human pulp tissue was removed from healthy extracted human teeth, enzymatically digested prior to seeding onto fibronectin-coated plates, and left to adhere for 20 min, yielding a fibronectin-adherent population. The remaining non-adherent cells were transferred and designated ‘non-fibronectin-adherent.’ Intact pulp was placed on uncoated plastic for 5 days, with the migrated cells designated ‘explant-derived’. DPSCs from these populations were examined in terms of population doubling rates, the expression of CD90, CD44, CD105, and CD73, and the expression of RUNX2, SPP1, and BGLAP after 7 days in osteoinductive media. Results: The fibronectin-adherent cells had the greatest population doubling over time. All populations demonstrated comparable percentages of cells positive for mesenchymal markers, though individual marker expression varied slightly. The explant-derived cells showed increased expression of RUNX2 after 7 days in osteoinductive media, while the treated single-cell-suspension-derived populations showed increased expression of SPP1 mRNA. Conclusions: Fibronectin enrichment resulted in a population with the greatest rate of population doubling over extended culture compared to the other two populations. The proportion of cells positive for all four mesenchymal surface markers was the same between populations. The fibronectin-adherent and non-adherent cultures may have responded more rapidly to osteoinductive media than the explant-derived cells. Full article

Objectives: Early observations often fail to detect anomalies that may impact the health and quality of life of newborns. This study aimed to determine the prevalence of oral anomalies in newborns and explore their possible associations with sociodemographic factors. Methods: A cross-sectional study was conducted in Quito, Ecuador, analyzing a sample of 241 newborns. The presence of oral anomalies was recorded, and their association with sex, birth weight, maternal age, and gestational factors was evaluated. Results: The prevalence of oral anomalies was 72.3%, with Epstein’s pearls being the most common (50%). Other findings included Bohn’s nodules and dental lamina cysts, while no cases of natal teeth or congenital epulis were observed. Ankyloglossia was identified in 1.36% of newborns. No significant correlations were found between the presence of oral anomalies and sex, birth weight, maternal age, or gestational factors. Conclusions: The high prevalence (72.3%) of oral anomalies in the studied newborns underscores the importance of early detection and management. Epstein’s pearls were the most frequent anomaly, followed by Bohn’s nodules, dental lamina cysts, and ankyloglossia, while no cases of natal teeth or congenital epulis were identified. No statistically significant associations were found with sex, birth weight, maternal age, or pregnancy complications. These findings emphasize the need for early pediatric dental assessment and an interdisciplinary approach to ensure proper neonatal oral health. Further research is recommended to explore potential causes and interventions to optimize oral health from birth. Full article

Bioceramic materials for endodontic treatments have gradually transformed over the years into materials with enhanced biocompatibility and chemical and mechanical properties compared to earlier generations. In endodontics procedures, these materials are used as restorative material in applications such as root-end fillings, pulp capping, perforations repair, and apexification repair procedures. However, they have far from ideal mechanical and handling properties, biocompatibility issues, aesthetic concerns due to tooth discolouration, limited antibacterial activity, and affordability, which are amongst several key limitations. Notably, bioceramic materials are popular due to their biocompatibility, sealing ability, and durability, consequently surpassing traditional materials such as gutta-percha and zinc oxide–eugenol sealers. A lack of recent advancements in the field, combined with nanomaterials, has improved the formulations of these materials to overcome these limitations. The existing literature emphasises the benefits of bioceramics while underreporting their poor mechanical properties, handling difficulties, cost, and various other drawbacks. The key gaps identified in the literature are the insufficient coverage of emerging materials, narrow scope, limited insights into future developments, and underreporting of failures and complications of the existing materials. Consequently, this review aims to highlight the key limitations of various endodontic materials, primarily focusing on calcium silicate, calcium phosphate, and bioactive glass-based materials, which are the most abundantly used materials in dentistry. Based on the literature, bioceramic materials in endodontics have significantly improved over recent years, with different combinations of materials and technology compared to earlier generations while preserving many of their original properties, with some having affordable costs. This review also identified key innovations that could shape the future of endodontic materials, highlighting the ongoing evolution and advancements in endodontic treatments. Full article

Background/Objectives: This double-blinded study aimed to evaluate the clinical performance of a giomer restorative material in comparison to a nanotechnology-based restorative system for the restoration of non-carious cervical lesions over a period of 48 months. Methods: A 48-month randomized, controlled, split-mouth trial was conducted with 49 subjects at its baseline, which was reduced to 34 subjects at follow-up, yielding a statistical power of 69.55%. Cervical lesions were restored using either BEAUTIFIL II LS (BL) or 3M/ESPE Filtek Supreme Universal Restorative (FS). Clinical assessments were performed by blinded examiners, excluding the one who placed the restorations. Evaluations were based on the Hickel criteria, covering esthetic, functional, and biological properties, with comparisons made using the Wilcoxon signed-rank test. Results: Hickel scores were analyzed with the Mann–Whitney U test to compare BL and FS groups within subjects. Changes in median Hickel scores, sensitivity, and the gingival index were assessed via Friedman’s test, followed by Wilcoxon signed-rank tests with a Bonferroni correction for post-hoc comparisons. The p-values under 0.05 were considered significant, except with the Bonferroni correction. Statistical analysis showed no significant differences between materials across most Hickel parameters (p > 0.05), though BL exhibited a trend of better surface staining (76.5% excellent with BL vs. 76.5% excellent with FS) and adjacent mucosa, while FS showed slight advantages in surface luster and color match. Conclusions: The clinical evaluation of restorations for non-carious cervical lesions using giomer and nanotechnology-based restorative systems revealed no statistically significant differences according to the Hickel criteria, indicating a similar clinical performance for both restorative materials. Full article

Background/Objectives: This study tested a method for evaluating the internal fit of indirect resin-based composite (RBC) restorations, as well as the influence of different combinations of impression and die materials on the reproducibility of the topography of teeth prepared for indirect RBC restoration. Methods: Bovine incisors received flattened and cavitated areas at the cervical and middle thirds of the buccal surface, respectively. The samples were randomly assigned to two groups according to the material used for impression taking (n = 5): irreversible hydrocolloid and polyvinyl siloxane (PVS). Die replicas were obtained with Type IV gypsum or elastomeric material. RBC restorations were fabricated through an indirect technique (test) and a direct-indirect technique as the control. The internal fit of restorations was assessed by measuring the cementation line thickness with a digital caliper (simulated cementation protocol with ultra-light PVS) and validated using scanning electron microscopy (SEM). Surface topography (Sa, Sq, and Sz) was analyzed via optical profilometry, and wettability was assessed through the water contact angle method. The data were analyzed using t-test, ANOVA, and Pearson correlation tests (α = 5%). Results: The simulated cementation resulted in internal gap values positively correlated to the values from SEM (R² = 0.958; p = 0.0102). The internal gap of restorations was not significantly correlated with the discrepancies between the topography of the die and tooth substrate (p ≥ 0.067). The combination of irreversible hydrocolloid and gypsum resulted in restorations with the lowest cementation line thickness, although in terms of roughness, this combination was the only one that resulted in significant differences from the control (p ≤ 0.028). The internal mean gap values of restorations were significantly correlated to the cumulative wettability difference of materials used during impression taking, fabrication of die replica, and restoration build-up (R² = 0.981; p = 0.003). Conclusions: The reproducibility of topographical characteristics of the tooth in the die replica did not affect the internal adaptation of indirect RBC restorations, whereas surface wettability of materials presented a more relevant effect on the overall gap formation. The simulated cementation technique tested in the study shows potential as a simpler, cost-effective, and non-destructive method for evaluating the adaptation of indirect RBC restorations. Full article

Objectives: This study aimed to histologically evaluate, in humans, the orientation of collagen fibers around screw-less, Morse taper, hemispherical base abutments. Methods: This study was designed as an observational, case–control, clinical trial to evaluate the histological orientation of collagen fibers around implants. Biopsies of the peri-implant tissue were performed 8 (group A, control) or 16 (group B, test) weeks of implant uncovering, and histologically analyzed under optical microscope using Hematoxylin and Eosin, Masson, and Picro Sirius histochemical staining and a scanning electron microscope. Results: Eight patients were enrolled in this study and 16 biopsies were performed. All the biopsies were correctly analyzed. The histological examination of cross-sectional portions of the tissue taken 8 weeks after implant uncovering showed the almost complete absence of epithelial lining, while the connective tissue bundles in the superficial portion showed a lower circular pattern. The histochemical cross-section examination of the tissue taken 16 weeks after implant uncovering showed the partial presence of non-keratinizing epithelial lining at the implant site and the collagen bundles showed a greater organization, with a circumferential course around the abutment. At 8 weeks, the final histological analysis showed an average height of 1.01 mm for the keratinized epithelium, 0.83 mm for the non-keratinized epithelium, and 1.39 mm for the connective tissue. While, at 16 weeks, the values were 1.20 mm, 0.48 mm, and 1.11 mm, respectively. No statistically significant differences were found between the groups (p > 0.05). Conclusions: Histologically, there were not any differences in the height and profile of the gingiva between 8 and 16 weeks of healing after prosthesis delivery. Greater organization of the collagen fibers with a circumferential course around the abutment was found in the test group (16 weeks) compared with the control group (8 weeks). Full article

Objectives: The objective of this study is to compare the bone-regenerating capacity between chitosan foam and chitosan membrane scaffolds. Methods: A medium-weight chitosan acidic mixture was used to prepare two scaffolds of freeze-dried chitosan foam (CF). One of the two CF scaffolds was physically crosslinked by NaHCO₃ to obtain chitosan membrane (CM). A morphological assessment of the specimens’ porosity was carried out by scanning electron microscopy (SEM). An MTT assay of the CM and CF specimens using rats’ bone marrow mesenchymal stem cells (MSCs) was carried out. Then, 38 albino rats were subjected to surgical implantation in a critical-size defect of the femur bone. The rats were divided into three groups according to the type of implanted scaffold (Control (no scaffold) n = 10, CM (chitosan membrane) n = 14, CF (chitosan foam) n = 14). Each group was equally subdivided into two subgroups according to the time of euthanasia (21 d, 35 d). The femur bones were dissected for a histological analysis (hematoxylin and eosin, and Masson trichrome). The results of the histological analysis were graded according to a scoring system. A statistical analysis of the pore size and histological grading was carried out. Results: CF had a higher mean pore size (65.42 µm) compared to CM (6.44 µm); CM showed a significantly higher proliferation of MSCs at 72 h. Both the CM and CF groups showed a significantly higher bone regeneration and lower inflammation than the control group. The CF group showed a significantly higher bone regeneration score than the CM group, especially at 35 d with more dense compact lamellar bone structure. Conclusions: The higher mean pore size of CF allowed for a higher bone regenerating capacity than the crosslinked CM. Full article

Background/Objectives: The purpose of this study was to develop a digital workflow to incorporate the mucosal projection of the pathways of the greater palatal artery into a static surgical guide used for free gingival graft harvesting and connective-tissue grafting techniques. Methods: A cone-beam computed tomography file was uploaded and segmented using specific tools from digital design software. The artery pathways were identified and marked on cone-beam computed tomography. A standard tessellation file format was obtained and uploaded into three-dimensional mesh-processing software; this was merged into an intraoral scan file. New files were obtained and uploaded into three-dimensional modeling software. The final model with projections of the artery pathways was generated using specific tools. The digital model was uploaded into guided surgery planning software to design a digital surgical guide that could later be printed with the artery pathways marked on its surface. Results: The static surgical guide to the palatal mucosa could be used during a surgical approach for marking the safe-zone area against the artery pathways. Conclusions: The proposed technique is a viable method for visualization and marking the artery pathway projection on a static surgical guide when performing free gingival graft harvesting and connective-tissue grafting techniques. Full article

Background/Objectives: Intraoral (IO) radiographs are critical for endodontic diagnostics, yet conventional orthoradial imaging often results in superimposition, limiting the visibility of individual root canals. Maxillary first premolars pose challenges due to their anatomical characteristics and positioning within the dental arch. This study aimed to retrospectively analyze cone-beam computed tomography (CBCT) data to determine the horizontal X-ray beam angulations for maxillary first premolars at which root canals overlap and neighboring tooth superimposition occur, providing clinically relevant guidance for optimizing IO radiographic techniques. Methods: CBCT scans from 85 patients were analyzed using ImageJ software to measure the angles at which maxillary first premolar root canals overlap or become obscured by adjacent teeth. The mean angles for canal overlap and neighboring tooth superimposition were determined. Statistical analysis was performed using SPSS Version 29.0, and the level of significance was set to 5%. Results: The mean angle for root canal overlap was 93.56° (±10.08). The angles at which neighboring teeth began to superimpose were 124.38° (±9.91) for the distal contour of the canine and 63.46° (±9.38) for the mesial root contour of the second premolar. No significant differences were observed between apical and coronal measurements for root canal overlap but tapering of the roots led to significant differences in neighboring tooth superimposition (p < 0.05). Conclusions: A mesial beam shift within a calculated safe corridor (98.5–129.5°) optimizes canal separation without superimposition from adjacent teeth. For ideal visualization, a mesial angulation close to 40° is recommended. These findings support improved IO radiographic techniques while minimizing the risk of retakes in adherence to the ALARA principle. Full article

Background: Digital planning and the use of a static surgical guide for implant placement provide predictability and safety for patients and practitioners. The aim of this study was to investigate differences in the accuracy and fit of long and short guides. Methods: In patients with at least one missing tooth, long (supported by the entire dental arch) and short templates (supported by two teeth, mesial and distal) were compared via intraoral scans and the superimposition of the STL files of the initial planning and the actual position in the patient’s mouth along the X-, Y- and Z-axes. Furthermore, this study evaluated the conditions (e.g., mouth opening, the implant position) under which fully guided implantation can be realized. Results: The largest deviation was observed in the Z-axis, although this deviation was not as high for the short templates (0.2275 mm) as it was for the long templates (0.4007 mm). With respect to the 3D deviation (dXYZ), the average deviation from the mean value was 0.2953 mm for the short guides and 0.4360 mm for the long guides (p = 0.002). The effect size (Cohen’s d) was 0.709, which was between the medium (0.50) and large effect sizes (0.80). The shorter templates showed a smaller deviation from the actual plan by 80%. With a mouth opening ≥50 mm, fully guided surgery can be performed in the molar region. In the premolar region, the lower limit was 32 mm. Conclusions: The 3D accuracy was significantly higher for the shorter template, which could therefore be favored. Full article

Background: Dental biofilm-induced gingivitis is a prevalent condition caused by dental plaque accumulation. Chlorhexidine mouthwash is a gold standard for plaque control but is associated with adverse effects such as tooth staining and altered taste. This study aimed to evaluate the clinical and antimicrobial effectiveness of 0.2% tea tree oil mouthwash as a natural alternative to 0.2% chlorhexidine mouthwash. Methods: A comparative study was conducted on 60 participants aged 18–60 years, divided into two groups: Group T (tea tree oil) and Group C (chlorhexidine), each comprising 30 participants. Clinical outcomes assessed included Plaque Index (PI), Gingival Index (GI), Bleeding on Probing (BOP), and microbiological Colony Forming Units (CFUs). Parameters were recorded at baseline, 7 days, and 28 days. Results: Group T exhibited significantly lower PI and BOP scores at 7 and 28 days compared to Group C (p < 0.05). Both groups showed comparable reductions in CFU counts, indicating similar antimicrobial efficacy. Importantly, tea tree oil had fewer adverse effects, with no reports of tooth staining or altered taste, unlike chlorhexidine. Conclusion: Tea tree oil mouthwash demonstrated equivalent or superior clinical outcomes compared to chlorhexidine, with fewer side effects. It is a viable and well-tolerated alternative for managing plaque-induced gingivitis, supporting further research into its long-term use and efficacy. Full article

Background/Objectives: With the increasing use of dental implants in edentulous patients and the high prevalence of peri-implantitis, understanding its microbial and risk factors is crucial. This study investigated Romanian patients from two private dental clinics in Cluj-Napoca, Romania, diagnosed with peri-implantitis, focusing on identifying the predominant bacterial species at affected sites compared with healthy implant sites. Additionally, we examined the impact of factors such as smoking, gender, age, and prosthetic restoration type on disease prevalence. Methods: This cross-sectional study, conducted between January 2023 and December 2024, included randomly selected patients who met the predefined inclusion and exclusion criteria. We enrolled 22 patients and 50 implants in the study. Data collected from medical records, clinical evaluations, and microbiological assessments were subsequently entered into a computerized database. Clinical data were analyzed using Social Science Statistics software(Jeremy Staangroom 2018). Bacterial samples were assessed, incubated, and subsequently identified using the Vitek 2 Compact System (BioMérieux, Marcy—l’ Étoile, France). Results: Peri-implantitis incidence was found to be independent of gender, more prevalent in the mandible, and equally affected smokers and non-smokers. The disease involves a complex polymicrobial infection, with pathogenic bacteria triggering the condition and opportunistic bacteria sustaining it. Conclusions: Peri-implantitis is a complex polymicrobial infection that arises from the interaction of strict pathogenic bacteria and opportunistic bacteria. Peri-implantitis results from intricate interactions of local, systemic, and microbial factors. Identifying its causes is essential for developing effective treatments, with future research emphasizing the role of opportunistic bacteria in disease progression. Full article

Background/Objectives: C-shaped canals represent a challenge in endodontic procedures. The present study aimed to investigate the prevalence and characteristics of C-shaped canals in mandibular second molars in Guayaquil, Ecuador. Methods: CBCT records from two radiology centers were examined (2020–2022). A total of 400 CBCT scans (800 mandibular second molars) were analyzed using Fan’s classification. Data on the presence or absence of C-shaped canals, gender, and bilateral occurrence were collected. Statistical analysis included the test for differences in proportions and the chi-squared test to assess the significance of correlations between variables. Results: C-shaped canals were found in 28% of mandibular second molars, affecting 33.75% of the patient sample. The prevalence was significantly higher in females (42.9%) compared to males (20.4%). Bilateral occurrences were observed in 63% of affected patients. Morphologic variability was pronounced, with Fan C1 and C4 dominating in the coronal and apical thirds, respectively, while a shift toward Fan C2 and C3 was observed in the middle third. Only 19.2% of the teeth maintained a consistent morphology. Conclusions: C-shaped canals were found in 28% of mandibular second molars and occurred predominantly in females. Notably, most cases were bilateral, highlighting the importance of effectively adapting endodontic techniques to treat this unique anatomical variation. Further research into genetic and environmental influences could deepen our understanding and help develop refined diagnostic and therapeutic strategies. Full article

Background/Objectives: Retrospective analysis of long-term periodontal tooth loss (PTL) during supportive periodontal care (SPC) in patients with Stage III/IV periodontitis who received strictly non-surgical periodontal treatment. Methods: Fully documented medical documentation of SPC > 5 years was analyzed at T0 (baseline), T1 (after Steps 1/2), and during SPC (T2). PTL, periodontal pocket depth (PD), bleeding on probing (BOP), tooth mobility (TM), furcation involvement (FI), and frequency of SPC were recorded. Each parameter was tested for significance in a bivariate analysis, before a multilevel logistic regression analysis was performed to identify possible factors with an impact on PTL during SPC. Results: A total of 51 women/64 men (T1 mean age 55.4 ± 10.3 yrs) were surveilled after 9.0 ± 2.4 yrs; 2647 teeth were included. On average, patients attended 10.6 ± 3.8 SPC sessions between T1 and T2; 77 patients (67%) attended at least 1/year. At T1, 68 teeth were lost; 6.1% of the remaining teeth showed FI, and 13.8% showed TM. During SPC, the PTL range was 118 (1.03 ± 1.21/patient). TM, FI, mean PD, and Stage IV periodontitis proved to be statistically significantly associated with increased PTL. Conclusions: PTL was low in this cohort. Nevertheless, at T1, it may be beneficial to focus on stopping TM by splinting the mobile teeth and reducing the PD or treating FI appropriately, understanding that these precise applications of surgical procedures could positively affect long-term tooth retention. Full article

Background/Objectives: The socket-shield technique (SST) was developed to preserve the facial/buccal portion of a tooth root to prevent post-extraction ridge resorption. It has gained attention for use in anterior implant sites, but its application in posterior sites remains unexplored. The aim of this case report was to report a proof-of-principle case using SST in a lower molar site and evaluate its effectiveness in preserving tissues. Methods: A 34-year-old non-smoking patient with a non-restorable mandibular first molar (tooth #36) underwent immediate implant placement with the SST. The tooth’s crown was removed, and the buccal segments of the roots were retained as “shields” while the implant was placed in the center of the socket. Preoperative and postoperative cone-beam CT (CBCT) scans and clinical exams were used to assess outcomes up to 12 months. Results: The SST procedure was completed uneventfully. CBCT after 4 months and 12 months showed minimal horizontal bone loss: ~0.2 mm at 4 months; ~0.1 mm additional loss by 12 months. The peri-implant soft tissue profile remained stable, and the implant achieved osseointegration with high primary and secondary stability. Conclusions: In this clinical case, the socket-shield technique effectively preserved alveolar bone and soft tissue contours in a molar extraction site, avoiding the ridge collapse often seen post-extraction. This suggests SST may be a viable tissue preservation approach in posterior sites; however, long-term follow-up and further studies are needed to confirm sustained outcomes and validate the technique’s predictability. Full article