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Biodentine, an innovative biocompatible, tricalcium cement, is used widely in endodontics owing to its advantageous properties. Yet limitations concerning its radiopacity and other handling properties have compelled the development of different material modifications. This scoping review aims to map and synthesize the available evidence on the impact of different fillers and additives on the biological, mechanical, and physical properties of Biodentine in endodontics. This review was performed in line with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses Modifications for Scoping Reviews (PRISMA-ScR) guidelines. A Literature search was conducted comprehensively throughout major databases such as Scopus, PubMed, Web of Science, and Google Scholar. In vitro studies evaluating the modifications of Biodentine were included. Information was charted and integrated descriptively. Broad range of modifications were noted, such as the addition of nanoparticles, radiopacifiers, bioactive additives. and antimicrobial agents. These modifications were focused on improving the physical and mechanical properties, improve antimicrobial efficacy and enhance radiopacity while preserving biocompatibility. However, significant heterogeneity was noted in modification process, property evaluating methods, and results. This scoping review indicates that modifications of Biodentine using various additives may enhance its biological, mechanical, and physical properties. Future research should focus on standardizing experimental methodologies to allow meaningful comparison across studies, identifying optimal concentrations of additives to balance material performance, and conducting well-designed in vivo and clinical studies to validate these findings and support their translation into clinical practice.

Immature teeth with pulp necrosis remain challenging because conventional root canal treatment does not restore pulp-dentin vitality. Hydrogel scaffolds for regenerative endodontics should support stem cell viability and provide a microenvironment favourable for dentin-pulp regeneration. This study evaluated κ-Carrageenan (κC)-based hydrogels, with and without gelatin, as scaffolds for stem cells from the apical papilla (SCAP), and examined how formulation-dependent properties influenced SCAP viability and odontogenic differentiation. Hydrogels were prepared as 1% gelatin, 1.5% κC, 2.5% κC, 1.5% κC+gelatin (κCG) and 2.5% κCG, with cells cultured without hydrogel as a control. Physicochemical characterisation included scanning electron microscopy, Fourier-transform infrared spectroscopy, rheology, degradation and swelling at days 1, 3, 7 and 14. SCAP were isolated and characterised using flow cytometry. Cell viability, metabolic activity, spreading, migration, alkaline phosphatase activity, Alizarin Red S staining and qPCR of differentiation-related markers were also assessed. The hydrogels showed formulation-dependent microstructure, degradation, swelling and viscoelastic properties. κC-containing formulations behaved as viscoelastic solids, and 2.5% κCG exhibited the highest storage modulus and lowest Tan (δ). SCAP remained predominantly viable in all groups. Gelatin-containing hydrogels improved long-term cytocompatibility and greater cell spreading compared to lower-concentration κC alone. Migration was comparable across groups. During differentiation, κC-containing formulations showed higher alkaline phosphatase activity and mineral deposition, with increased late-stage mineralisation observed in 2.5% κCG. Gene expression analysis indicated early upregulation of RUNX2 and BSP and increased late-stage expression of OPN, OCN, DMP1 and DSPP, with a more evident maturation-associated response in 2.5% κCG. κC-based hydrogels supported SCAP viability and promoted odontogenic differentiation in vitro. Gelatin incorporation improved late-stage mineralisation and odontogenic marker expression, with 2.5% κCG demonstrating the most favourable overall response. κC-gelatin hydrogels may serve as promising scaffold candidates for dentin-pulp regenerative strategies by supporting SCAP survival and odontogenic maturation within a tunable hydrogel microenvironment.

This clinical report describes the interdisciplinary treatment of a patient with hypoplastic amelogenesis imperfecta (AI) and an anterior open occlusal relationship. Prior to referral to the prosthodontics department, she had undergone active orthodontic treatment for 5 years. As she presented with skeletal, functional, and esthetic concerns, orthodontic treatment alone was insufficient to address her complex treatment goals. Given the complexity, optimal comprehensive management necessitated an interdisciplinary approach involving orthodontics, endodontics, periodontal therapy, orthognathic surgery, and definitive rehabilitation with minimum preparation adhesively bonded complete coverage restorations. A 5-year follow-up confirmed the stability of the results, with the patient reporting no further issues.

Post-endodontic restoration is a complex process that requires careful consideration of multiple factors, with the primary goal of restoring function, esthetics, and structural integrity while preventing microleakage and root fractures. The choice of restorative approach depends largely on the remaining tooth structure. In the present case, a severely weakened endodontically treated tooth with significant loss of radicular dentin was rehabilitated using a customized anatomic fiber post technique. After completion of root canal therapy, the post space was prepared, and a fiber post was relined with composite resin to closely adapt to the canal morphology, ensuring optimal fit and stress distribution. This was followed by core buildup and definitive full-coverage restoration, resulting in satisfactory functional and esthetic outcomes. The use of anatomic posts demonstrated a favorable prognosis, particularly in fragile roots, by enhancing retention, minimizing cement thickness, and reducing the risk of root fracture. This case highlights that individualized post adaptation is superior to conventional prefabricated posts in compromised canals, emphasizing the importance of preserving remaining dentin, achieving proper post adaptation, and selecting materials that mimic the biomechanical properties of natural tooth structure as key learning points for long-term success.

This in vitro study aimed to compare the effects of conventional and ultrasonic root canal preparation on the adhesion of glass fiber posts to root canal dentin. A total of 20 human maxillary central incisors were instrumented and then filled with gutta percha and sealant using the lateral condensation technique. The teeth were randomly divided into 2 equal groups (n = 10), gutta percha was removed, and canals were prepared using a different protocol for each group: in the conventional group, a Gates-Glidden drill, a Largo drill, and post bur kit were used; in the ultrasonic group, ultrasonic tips were operated in endo mode. Microcomputed tomography was used to confirm complete removal of the filling material, and fiber posts were cemented with self-adhesive resin cement. The apical ends of the roots were discarded, and the remaining portions were transversely sectioned into 3 segments, each 1.5 mm thick. The sections underwent push-out testing to determine bond strength, and the adhesion defects were examined with scanning electron microscopy and stereomicroscopy to determine the failure mode. Data normality was assessed using the Kolmogorov-Smirnov test, followed by analysis of variance with Tukey test for group comparisons and chi-square tests to evaluate any associations regarding failure mode. A 5% significance level was applied. Tukey tests revealed that the conventional group exhibited statistically significant lower push-out bond strengths than the ultrasonic preparation groups across all thirds; no statistically significant differences were noted among the cervical, middle, and apical thirds within the same group. There were no statistically significant differences in failure modes between the preparation groups, and adhesive failure was the most prevalent mode. The ultrasonic method effectively removed gutta percha from canals and enhanced the bond strength of fiber posts.

Traumatic dental injuries pose challenges in maintaining pulp vitality and promoting root development. Vital pulp therapy (VPT) and regenerative endodontic procedures (REP) are effective approaches for preserving tooth structure and function. Pulpotomy with calcium hydroxide (Ca(OH)₂) supports apexogenesis, whereas REP facilitates root maturation in necrotic immature teeth. While both techniques offer promising results, long-term clinical outcomes remain underreported. This case report presents a 7-year follow-up of two maxillary incisors managed with VPT and REP, demonstrating sustained pulp vitality and complete root formation. An 8-year-old female presented with a traumatic injury to her maxillary central incisors. Clinical and radiographic examinations revealed that tooth #11 had uncomplicated crown fracture with incomplete root formation, while tooth #21 had undergone initial root canal treatment. Tooth #11 was treated with pulpotomy to support apexogenesis, while tooth #21 underwent REP to promote root development. Follow-up visits over 7 years demonstrated continued root formation in both teeth, with no signs of pathology. This case report demonstrates successful long-term management of two immature maxillary incisors using VPT and REP. Pulpotomy effectively promoted apexogenesis in a vital tooth, while REP facilitated root maturation in a necrotic immature tooth. The 7-year follow-up highlights the importance of treatment planning and extended monitoring to evaluate long-term outcomes. Almaliki M, Almaghraby M, Bakhsh A. Long-term Outcome of Vital Pulp Therapy and Regenerative Endodontic Procedures in Immature Permanent Maxillary Incisors: A 7-year Follow-up Case Report. Int J Clin Pediatr Dent 2026;19(3):403-407.

The increasing demand for minimally invasive and highly esthetic dental restorations has led to the widespread use of ceramic laminate veneers, particularly ultrathin veneers. Due to their reduced thickness and high translucency, the final color of these restorations is influenced not only by the ceramic material but also by the underlying substrate and the resin cement used for luting. Understanding the optical contribution of resin cements is therefore essential for achieving predictable and long-term clinical success. This systematic review aimed to evaluate the influence of resin cement formulation and shade on the final color of ceramic laminate veneers. A comprehensive electronic search was conducted in the PubMed, Web of Science, ProQuest, and Google Scholar databases up to March 2023. In vitro studies assessing the effect of resin-based luting agents on the final color of ceramic laminate veneers using objective color measurement techniques, including the CIE L*a*b* color system and spectrophotometry, were included. Studies involving full-coverage restorations or subjective shade assessments were excluded. Risk of bias was assessed using the Quality Assessment Tool for in vitro Studies (QUIN), adapted for in vitro research. Ten studies met the inclusion criteria. White opaque and high-chroma resin cements consistently resulted in greater color changes (ΔE > 3.3), particularly when used with thin or high-translucency ceramic veneers. In contrast, translucent and low-chroma resin cements produced more esthetically favorable outcomes. Veneer thickness emerged as a key modulating factor, with thinner veneers amplifying the influence of cement shade. Artificial aging studies demonstrated significant discoloration over time, highlighting concerns regarding long-term color stability. Risk-of-bias assessment indicated moderate methodological quality in most included studies. The findings of this systematic review demonstrate that resin cement shade and translucency significantly affect the final color of ceramic laminate veneers. These effects are particularly pronounced in ultrathin and highly translucent restorations. Clinicians should therefore carefully consider resin cement selection when planning esthetic treatments, especially in the anterior region. However, the predominance of in vitro evidence underscores the need for well-designed clinical trials to validate these findings and establish standardized cementation protocols. PROSPERO CRD42023450540.

This study aimed to evaluate the antibacterial effectiveness of three intracanal medicaments: Achyranthes aspera and Trachyspermum ammi based novel polyherbal gel, chlorhexidine gluconate gel, and calcium hydroxide paste, against Enterococcus faecalis in infected root canals by means of Real-Time Polymerase Chain Reaction (qPCR) for bacterial quantification. A triple-arm, randomized controlled trial was conducted on 45 permanent mandibular and maxillary incisor and canine teeth diagnosed with asymptomatic apical periodontitis. Participants were randomly divided into three equal groups (n&#x2009;=&#x2009;15), each receiving a different intracanal medicament. Microbiological samples were collected using sterile absorbent paper points at two time points: before instrumentation and after 7-day of intracanal medicament placement. The intracanal medicaments tested were a novel polyherbal gel, 1% (w/w) chlorhexidine gluconate gel, and calcium hydroxide paste. Total DNA of Enterococcus faecalis was extracted from these samples, and qPCR was performed to determine the bacterial quantification at both intervals. The primary outcome was the reduction in Enterococcus faecalis load, indicating the antibacterial efficacy of each medicament. All the groups showed a significant reduction in Enterococcus faecalis counts from baseline to day 7. However, the chlorhexidine gel and calcium hydroxide paste exhibited significantly greater reductions than the polyherbal gel (p&#x2009;<&#x2009;0.05). All three intracanal medicaments tested were effective in significantly reducing Enterococcus faecalis counts. However, the chlorhexidine gel and calcium hydroxide paste demonstrated significantly greater reductions compared to the polyherbal gel. For routine endodontic practice, chlorhexidine gel and calcium hydroxide remain more reliable choices for intracanal disinfection against Enterococcus faecalis and should be preferred in cases with high microbial load. The polyherbal gel, while antibacterial, may be better suited as an adjunct rather than a primary medicament in endodontic disinfection protocols. [https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NjU0MzY=] Clinical Trials Registry-India with registration number: [CTRI/2022/07/043862].

This systematic review aimed to consolidate the clinical presentation, diagnostic and microbial findings, management approaches, and outcomes of maxillary sinus involvement caused by extruded endodontic filling materials. Searches were performed in PubMed, Web of Science, Embase, Scopus, ScienceDirect, and ProQuest up to August 2025. Observational studies reporting extrusion of filling material into the maxillary sinus, accompanied by clinical, imaging, and/or surgical descriptions, were included. Study quality was critically analyzed using the Joanna Briggs Institute tools. Of 4076 articles initially retrieved, 52 were selected for full-text reading, 39 met the inclusion criteria and were included, comprising 34 case reports and 5 case series. Maxillary first molars were the most frequently involved teeth (59%). Extrusion occurred predominantly during primary endodontic treatment. Filling material was identified in the left maxillary sinus in 21 cases (47%) and in the right maxillary sinus in 24 cases (53%). Clinical presentations ranged from incidental asymptomatic findings to severe manifestations such as acute sinusitis. In the included studies, diagnosis was established using radiographic and tomographic imaging as well as direct endoscopic evaluation. Surgical removal represented the most common definitive management approach. Clinical outcomes were predominantly favorable, with complete symptom resolution and functional recovery. Extrusion of endodontic filling materials into maxillary sinus most often involves maxillary first molars and is associated with clinically significant complications, particularly fungal sinusitis. The present findings emphasize the need for prevention, accurate diagnosis, and timely interdisciplinary care of this iatrogenic event.

Fate of invasive pulp therapies, such as pulpotomy and pulpectomy, is uncertain due to several factors. Despite availability of primary research, no systematic review and meta-analysis (SRMA) have explored long-term outcomes of different pulpal interventions in primary teeth. Our research question is, what are the long-term outcomes of invasive pulp therapies in primary teeth? Two researchers searched literature using keywords in PubMed and other search engines. Articles with full texts and translations in English were included. Randomized clinical trials (RCTs) and other studies with follow-up of a minimum of 2 years, reporting clinical and radiographic parameters, were included. Clinical success of pulpotomy was 92.32% [95% confidence interval (CI) (88.99-95.00)] based on 28 studies with 1,410 teeth; radiographic success of pulpotomy was 85.35% [95% CI (80.94-89.26)] based on 29 studies with 874 teeth. Clinical success of pulpectomy was 79.96% [95% CI (71.86-86.98)] based on 21 studies with 2007 teeth; radiographic success of pulpotomy was 74.07% [95% CI (67.84-79.84)] based on 21 studies with 2007 teeth. Random effects model (REM) was used since heterogeneity was high. Risk of bias was moderate. Publication bias was minimal. Clinical and radiographic success of pulpotomy was higher than pulpectomy in primary teeth after 24-month follow-up. Vaiude A, Jawdekar A, Mistry LN. Long-term Outcomes of Invasive Pulp Therapies in Primary Teeth: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2026;19(3):389-402.

The pathogenesis of pulpitis remains unclear. This study sought to investigate the molecular mechanism by which the long noncoding RNA FOXD2-AS1 participates in pulpitis through regulating the miR-338-3p/THBS1 axis. 110 irreversible pulpitis patients and 80 healthy orthodontic patients were enrolled as the pulpitis and control groups, respectively. Human dental pulp stem cells (hDPSCs) were cultured and stimulated with lipopolysaccharide (LPS) to establish a pulp inflammation model. Expression of FOXD2-AS1, miR-338-3p, and THBS1 was detected by real-time quantitative polymerase chain reaction (RT-qPCR). Cell viability was assessed using the Cell Counting Kit-8 (CCK-8) assay, while levels of inflammatory cytokines and osteogenesis-related proteins were measured by enzyme-linked immunosorbent assay (ELISA). THBS1 protein expression was validated by Western blot. The target regulation was verified by RNA immunoprecipitation (RIP) and dual luciferase reporter assays. In pulpitis tissues, FOXD2-AS1 and THBS1 expression were significantly upregulated, while miR-338-3p expression was significantly downregulated. Furthermore, FOXD2-AS1 demonstrated high diagnostic value for pulpitis. Functional experiments demonstrated that FOXD2-AS1 negatively regulated osteoblast differentiation and promoted LPS-induced inflammatory responses. Specifically, it inhibited alkaline phosphatase (ALP) activity and odontogenic differentiation-related protein expression, reduced cell viability, and promoted inflammatory cytokine release. Moreover, FOXD2-AS1 targeted and adsorbed miR-338-3p, while miR-338-3p directly targeted and inhibited THBS1 expression, forming the FOXD2-AS1/miR-338-3p/THBS1 regulatory axis. Rescue experiments demonstrated that knocking down FOXD2-AS1 exerted anti-inflammatory and pro-osteogenic effects by upregulating miR-338-3p and inhibiting THBS1. Conversely, inhibiting miR-338-3p reversed these protective effects, manifesting as exacerbated inflammation and diminished odontogenic differentiation capacity. On this basis, further knocking down THBS1 reinstates the anti-inflammatory and pro-osteogenic phenotype. In conclusion, FOXD2-AS1 mediates pulpitis inflammation and odontogenic differentiation imbalance by competitively binding to miR-338-3p to upregulate THBS1 expression.

To compare the survival of single-tooth implants placed in sites with previous external cervical root resorption (ECRR) to those placed in unaffected sites. A retrospective matched cohort study was conducted using data from the Swedish National Dental Health Register (2009-2022). Patients receiving a single-tooth implant in a site with previous ECRR were identified and matched 1:1 to controls without such history by age, sex, tooth position, and timing of implant placement (&#xb1;&#x2009;2 years). Implant survival, defined as time from placement to removal, was analyzed using Kaplan-Meier curves and stratified Cox proportional hazards models. Restricted mean survival time (RMST) was estimated up to 10 years. Subgroup and sensitivity analyses assessed robustness. The final cohort included 605 matched pairs (n&#x2009;=&#x2009;1,210). The mean age was 52 years, and 56% of implants were placed in the maxillary anterior region. Implant extraction occurred in 12/571 (2.1%) sites with previous ECRR and 21/564 (3.7%) control sites. Ten-year cumulative survival was 97.3% for sites with previous ECRR and 94.4% for controls. The difference was not statistically significant (HR&#x2009;=&#x2009;0.58; 95% CI: 0.28-1.22; p&#x2009;=&#x2009;0.15). RMST analysis showed a negligible absolute survival difference (0.11 years; 95% CI: -0.04 to 0.25; p&#x2009;=&#x2009;0.15). Within the limitations of registry-based data and a low number of failures, no statistically significant difference in implant survival was detected between sites with and without previous ECRR. These findings suggest comparable survival outcomes but should be interpreted with caution.

Biomimetic fibrous microspheres with a high specific surface area hold substantial promise for bone tissue engineering. In this study, asymmetric open-hollow nanofibrous microspheres (HNMs) were fabricated from polypeptide poly(&#x3b3;-benzyl-L-glutamate) (PBLG) via a combination of emulsion and thermally induced phase separation, yielding PBLG HNMs. To further impart biofunctionality, the copper peptide (GHK-Cu) was covalently grafted onto the microspheres to obtain osteoinductive and pro-angiogenic PBLG-GCu HNMs. The optimized microspheres exhibited an average diameter of 372&#xa0;&#xb1;&#xa0;102&#xa0;&#x3bc;m, which is suitable for injectability, and an opening size of 219&#xa0;&#xb1;&#xa0;53&#xa0;&#x3bc;m, enabling efficient cellular infiltration. The internal surface featured an interconnected nanofibrous network with a fiber diameter of 417&#xa0;&#xb1;&#xa0;78&#xa0;nm, mimicking the extracellular matrix (ECM) microenvironment and providing abundant cell-interactive sites. Live/Dead staining and CCK-8 assays confirmed the cytocompatibility of the PBLG-GCu HNMs. Compared with non-functionalized PBLG HNMs, PBLG-GCu HNMs enhanced bone marrow mesenchymal stem cell (BMSC) mineralization and upregulated osteogenic gene expression, with Runx2, OPN, and OCN expression increased by 1.61-, 3.53-, and 2.29-fold, respectively. In addition, the tube formation assay verified robust angiogenic stimulation. Overall, the PBLG-GCu HNMs integrated hierarchical structural biomimicry with dual osteogenic-angiogenic bioactivity, exhibiting great potential as injectable scaffolds for repairing irregular bone defects.

Alveolar soft part sarcoma (ASPS) is a rare malignant tumour that is considered to lack a normal cell counterpart and is commonly associated with a poorer prognosis. Etio-pathologically, it has been associated with alveolar soft part sarcoma critical region-1-transcription factor for immunoglobulin heavy chain enhancer 3 fusion gene. Diagnosis is usually confirmed through histopathology, immunohistochemistry (IHC) and molecular testing. Being chemo-resistant, surgical excision with clear margins is the primary treatment, with radiation therapy considered adjuvant in advanced cases. Deceptively slow growth and potential metastatic potential make its diagnosis, treatment and prognosis challenging for clinicians. We report a case of ASPS in the left buccal mucosa of a young child who was mistaken for a dental infection by a local dentist. Later on, confirmation with histopathology and IHC, the patient underwent complete excision with hemi-mandibulectomy followed by adjuvant radiation therapy. This case emphasises the diagnostic and therapeutic approach for ASPS in the buccal mucosa of a young child.

Root canal infections, particularly those involving Enterococcus faecalis and Candida albicans, continue to pose significant challenges in endodontic therapy due to both their inherent resistance to conventional agents. This study aimed to evaluate the antimicrobial efficacy of a newly synthesized piperazine-chalcone hybrid compound, both individually and in various formulations with calcium hydroxide, against these clinically relevant pathogens. The antimicrobial activities were assessed using the disk diffusion method over 24 and 48&#xa0;h, whereas in silico analyses were conducted to further investigate the compound's molecular interactions, pharmacokinetics, and toxicity potential. Results demonstrated that the piperazine-chalcone hybrid exhibited strong antimicrobial activity against both pathogens, with inhibition zone diameters ranging from approximately 26-32&#xa0;mm against E. faecalis and 18-28&#xa0;mm against C. albicans, exceeding those observed for calcium hydroxide and standard antimicrobial controls. Molecular docking analysis revealed favorable binding interactions of the hybrid compound with d-alanine:d-alanine ligase, with a docking score of -8.6&#xa0;kcal/mol. In silico toxicological assessment predicted a favorable safety profile, with an LD50 value >5000&#xa0;mg/kg and no major toxicity alerts. These findings suggest that the piperazine-chalcone hybrid holds promise as a safe and effective candidate for enhanced endodontic disinfection.

This study aimed to investigate the effect of exosomes derived from Ligilactobacillus salivarius (L.s-Exo) on the cariogenic potential of Streptococcus mutans (S. mutans) and the underlying metabolic mechanism. L.s-Exo were isolated by ultracentrifugation and characterized using TEM, NTA, and western blot. S. mutans metabolites after L.s-Exo treatment were profiled by GC-MS, and differential pathways were annotated using KEGG. Cariogenic-related phenotypes and acid-stress responses were measured. L.s-Exo displayed exosomal characteristics. Metabolomics revealed widespread metabolic perturbations. L.s-Exo impaired acid tolerance, increased ion leakage, suppressed acid production and glycolytic rate, reduced water-soluble/insoluble EPS, and inhibited biofilm formation. Under acid stress, L.s-Exo elevated proton permeability and decreased cell dry weight, H+-ATPase activity, and intracellular Pi, accompanied by downregulation of key virulence and glycolysis/acid-production genes. L.s-Exo inhibits S. mutans cariogenicity by disrupting metabolic networks and suppressing key virulence gene expression, supporting its use as an anti-caries agent.

This case series highlights the conservative management of complicated crown fractures in permanent incisors using mineral trioxide aggregate (MTA) for pulp capping and adhesive techniques for fragment reattachment. Three patients aged 15-30 were treated and monitored over 12 months.&#xa0;All cases showed positive outcomes with maintained pulp vitality and satisfactory aesthetic and functional results. No signs of periapical pathology or secondary caries were observed. The adhesive reattachment of the tooth fragments provided excellent marginal adaptation and colour match, enhancing the overall success of the treatment.