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Objective. In this study, the biological effect of MTA Repair HP (Mineral Trioxide Aggregate Repair High Plasticity) and Biodentine have been tested on a stabilized fibroblast cell line NCTC clone 929. Materials and Methods. We assessed quantitative and qualitative parameters related to cytotoxic effect of the investigated products. The experimental period was 96 hours. Statistical analysis was performed with Kruskal-Wallis and Wilcoxon tests. Results. The detached cells test showed no statistically significant difference on cell culture for Biodentine and MTA Repair HP, while for the cellular density assay we found the same biological effect on the tested fibroblasts in the first 24 and 48 hours, but a significant different cellular response for the investigated pulp capping materials for the next 48 hours of the experiment. Conclusions. The results demonstrated that the materials presented a very low level of cytotoxicity. Biodentine showed in all parameters better biological effects than MTA Repair HP, expressed by lower and limited cellular damage and a higher cell density.

Primary root canal infection is a dynamic process. All species of oral microbiota have comparable abilities to establish in the root canals of necrotic teeth. The essential ecological factors in their biological selection are nutrient availability, anaerobic environment and bacterial interactions. In chronic apical periodontitis, all selected microflora residing in the long-term infected habitat of root canals system are synergistic, and each of them can play the role of an endodontic pathogen. Microorganisms living in the root canal system of pulpless teeth progressively reach through anatomical communications to the periodontal ligament where, sooner or later, they cause the inflammatory and immunological conflict between the infection and the host. The insight into the complexity of the root canal microbiota is improved by the current pyrosequencing and next-generation sequencing diagnostic techniques, which allow the identification of multispecies of the microbiome and their targeted treatment. The insight into the complexity of root canal microbiota is improved by present diagnostic techniques of pyrosequencing and next generation sequencing, which allow the identification of multispecies of the microbiome and their targeted treatment.

Nowadays, digital technologies represent an essential tool for dentists and dental technicians, and the backbone of the communication between them. Aim of the study is to analyze the application of digital technologies in a common dental office and in transferring information to the dental lab. Materials and methods. The retrospective study included patients who presented for treatment to the dentist, in a 12 months period of time. Searched databases included dental charts, radiologic and imagistic data (OPG, CBCT), clinical photos and digital dental impressions. A comparison was made between the used digital tools as frequency. Results: 580 patients were included, 275 men and 305 women, aged between 19 and 82. Digital technologies used in the dental office in the studied period were: OPG (100%), CBCT examinations (25,34%), digital photographic exams (38,10%), intraoral scanning (24,13%), digital intraoral impressions (19,65%). Conclusions: All patients who attended the dental office during the study period received an OPG examination, while significant fewer patients were investigated using other digital technologies. For an easier, faster and complete data transfer between dental office and dental lab, digital evaluation is mandatory.

This review aims to explore and highlight the relationships between heart disease and oral health, highlighting the interconnections between oral health and overall heart condition. In light of recent research, it is becoming increasingly apparent that poor oral health, including conditions such as gingivitis and periodontitis, can contribute to the development or worsening of heart disease. This review looks at the biological mechanisms by which oral health problems can influence cardiovascular health, including aspects such as systemic inflammation and the dissemination of oral bacteria into the bloodstream. Prevention and management strategies for improving oral health in the context of heart disease are also discussed, highlighting the essential role of collaboration between dentists and cardiologists.

This paper examines the effectiveness of custom dental implants in managing oral complications associated with Crohn’s disease, an inflammatory bowel condition that can significantly affect patients’ oral health. By reviewing the existing literature and studying clinical cases, we analyze the success rates of dental implants, their integration in the context of immunosuppressive treatments, the improvement of masticatory function, and their impact on the quality of life of patients. Reviewed studies indicate that, with proper planning and careful postoperative management, dental implants can provide a durable and effective solution for patients with Crohn’s disease, with success rates comparable to those of the general population. We also discuss the importance of an interdisciplinary approach in the planning and implementation of personalized dental treatments, as well as the need for continuous monitoring to prevent complications. The results highlight the potential of dental implants to significantly improve oral functionality and aesthetics, thus contributing to the overall improvement of the quality of life of patients with Crohn’s disease. These findings encourage greater attention to the personalization of dental treatments for this category of patients, given the complexity of managing their health condition.

The root canal irrigation going along with instrumentation is a mandatory attitude in current endodontic practice. To increase the evacuation efficacy of dental pulp remnants, dentin debris and bacterial biofilms from root canals and lateral irregularities including canal isthmuses, various procedures of irrigants activation were conceived. If not yet quite satisfactory, among various techniques of irrigant activation currently used the passive ultrasonic activation proved to be more efficient to achieving cleaning and disinfection of root canal isthmuses.

Treatments in dentistry currently consist of an interdisciplinary approach, including (but not necessarily limited to) the holistic perspective. The different fields of allopathic and complementary medicine are used together to ensure not only a high-quality restorative treatment, but also to provide patients with psychological and emotional support. This perspective also applies to dental anxiety, which consists of complex (emotional, vegetative and psychomotor) manifestations. One of the most well-known complementary therapies for reducing dental fear and anxiety is BachTM Flower Therapy. Even if the mechanism of action of this therapy is not yet scientifically documented, notable results have been and continue to be reported in the literature in several clinical studies on patients with dental diseases. It is indicated for both adults and children, in the latter when they go through major biological changes, such as primary and permanent dentition. As a conclusion, BachTM flower therapy is effective and complementary to dental treatments applied to patients, by reducing stress, anxiety, as well as creating a climate of peace, trust and confidence, both for the patient and the doctor. In addition, it is a relatively accessible and cheap form of care, with no significant adverse effects noted so far.

Proximal surfaces of both anterior and posterior teeth frequently present dental caries, as a result of complex coronal morphology and other associated factors which favors bacterial microfilm retention. In this article we present the second part results of a cross-sectional study, using a questionnaire that was distributed to a number of 110 Romanian dentists. We investigated the most used dental materials and techniques and correlations with oral restorations longevity, and also the failures and patients‘ complaints. The results indicate a modern, up to date approach of direct restoration in adjacent teeth from Romanian interviewed dentist.

CBCT offers many significant advantages in dentistry, while the periapical radiographs provide a cheaper technique and a lower radiation compared to CT scan. The aim of this clinical case was to compare the outcome 1 year after root canal treatment, using digital periapical radiographs versus CBCT. Tooth 46 with necrotic pulp and periapical periodontitis was rotary prepared and filled using continuous wave condensation and AH Plus. X-rays and CBCT scans were made both before and after the treatment, at 1 year recall. On x-ray the lesion appeared to be healed, while on CBCT one can still see a smaller lesion, so the tooth is healing. The increased accuracy of CBCT offers the most relevant information for the outcome of endodontic treatment.

Dental caries located on adjacent approximal tooth surfaces represent one of the most widespread clinical situations dentists encounter in dental practice. This article presents a cross-sectional study, using a questionnaire that was distributed to a number of 110 practicing Romanian dentists, regarding the prevalence, etiology, diagnosis and therapeutic approach of this kind of dental lesions. The results highlights that dentists knowledge and practice are up to date with the most recent diagnosis methods and therapeutic approach.

Syringe irrigation is still the most shared clinical procedure for delivering endodontic irrigants. The shape and size of apical preparation should be matched to the individual morphological profile of the root canal to perform adequate cleaning. The irrigant flow beyond the needle tip seems to be influenced by the flow rate rather than the individual intra-barrel pressure developed within syringe. Proper selected size of the irrigation needle adapted to corresponding apical preparation size and the multiple maneuvers of irrigation should result in an expected cleaning efficacy. Irrigant replacement, shear stress and apical pressure are crucial cleaning factors in mutual contradiction. Presently no consensus came out to establish to whom should be forwarded the main concern.

The modern dental caries adhesive direct restoration requires a working protocol that includes stages and techniques that must be strictly followed to ensure the correct morphological and functional reconstruction, as well as an increased longevity of the restoration and implicitly of the respective tooth in the oral cavity. Failures in achieving these goals are represented by the occurrence of recurrent caries, secondary or residual caries, coronary fractures, leading to pulpal and periodontal complications. They can be due to both incorrect therapeutic maneuvers and other causes, for which the dentist is not responsible, such as manufacturing defects of dental materials that are not visible during inspection or the patient's attitude towards oral hygiene.

A flare-up is defined as a pain and/or swelling of the soft tissues that occurs within a few hous or a few days following the root canal treatment. In some cases, the flare-ups can apear after the finishing of the root canal treatment, due to the penetration or development of the microorganisms into the root canal. The pain felt by the patient depends on the extent of the periradicular tissue injury, its severity and intensity of the inflammatory imune response. The article discusses the microbial irritation of apical periodontal tissue caused by insufficient instrumentation and filling of the root canals, factors that lead to failure of the outcome of root canals treatment.

Though important in current endodontic practice the issue of root canal isthmuses is usually overlooked due to the inefficient means of imagistic identification in clinical setting and appropriate treatment approach. Canal isthmuses are still the dark face of the endodontic system regarding the efficacy of conventional orthograde treatment of the root canals especially in the roots having two or more main canal where these anatomies are chiefly located. Advances in CBCT equipments with small field of image capture (FOV) open a window to an improved treatment outcome.

In current endodontic practice the root canal irrigation by using sodium hypochlorite as primary irrigant of choice coupled subsequently with a chelating agent, usually EDTA, is a crucial mean of cleaning and disinfection of endodontic system. Continuous chelation is a new paradigm relied on the increased role and efficacy of irrigation in root canal treatment. This novel approach of irrigation replaces the alternative use of irrigants according to present accepted treatment protocols by sole irrrigant flushing with a chair side mixture of sodium hypochlorite and a weak chelator, mainly etidronate (Dual Rinse HEDP). Continuous chelation is not inferior to the antimicrobial activity of sodium hypochlorite, allows the dissolution of pulp remnants and removal of smear layer and shortens the time required for chemomechanical treatment of the root canals.

Proper shape and size of apical third of the root canal is pivotal in adequate debridement and disinfection of endodontic system. The apical shaping of the root canal is highly dependent on the anatomical form and topography of the apical constriction. Accurate apical stop performed at apical constriction rather than at the apical foramen should be the main clinical objective. Maintaining the apical patency by recapitulation results in achieving a free access to the apical constriction and a clean apical canal. Apical preparation should be three sizes larger than the first apical binding file as further enlargement did not prove to be more beneficial for the long term prediction. The taper of apical preparation may have at least equal value as its final size.

World wide experience during COVID-19 pandemic disclosed that the endodontic pathology prevailed among all dental emergencies. The endodontist have to handle a large category of patients: COVID-19 positive, either symptomatic or asymptomatic, and unsuspected/nonactive. To minimize the cross-infection risk a rapid and accurate triage is highly asked since the suspected and active patients should be referred to the dedicated dental settings. In stabilized COVID-19 patients it is pivotal to carry out the treatment of endodontic emergencies as much as possible in a definitive and not palliative manner due to the risk of unpredictable worsening of clinical evolution.

The high infection risk in dental offices during COVID-19 pandemic relies on the crucial role of saliva in supporting viral transmission either by airborne droplets and aerosols or by direct-contact. To avoiding cross-infection in dental setting the specific procedures needs fast salivary detecting tests for early diagnosis of both symptomatic and asymptomatic carrier patients. The use of virucidal oral mouthwashes reduces the viral transmission risk mediated through aerosols and salivary droplets. Prior to oral procedures are recommended 30 seconds oral cavity rinses and 30 seconds gargle in the throat with 9 ml 0.2-0.5 % providone-iodine, 15 ml 1-3% hydrogen peroxide, 15 ml 0.05-0.07% cetylpiridinium chloride or 15 ml 0.12% chlorhexidine.

Currently the regenerative endodontics is the treatment of choice in chronic apical periodontitis affecting the immature permanent teeth and is considered a better alternative to apexification. The coronal discoloration, as most visible drawback of regenerative endodontics may be induced by minocycline from the triple antibiotic paste TAP and MTA radiopacifers. Patient centered approach based on recommended guidelines is pivotal in regenerative procedures in order to avoid coronal discoloration and side effects of bleaching procedures such as the invasive external root resorption.

Vertical root fracture involves mostly the endodontically treated teeth being extended from the root canal to the periodontal ligament typically in bucco-lingual plan. Its common efficient treatment is the whole tooth extraction and sometomes root resection or hemisection. As the prevention of vertical root fracture endodontically treated teeth is the best choice it is mandatory to avoid an excessive loss of tooth structure by preparing the access cavity and enlargement of root canals. Aiming long-term clinical success presently the key goal is to strengthen the structure of these teeth. The use of these newcomers, bioceramic sealers in root canal fillings, would be advantageous over time as it result in a monoblock sealer/gutta-percha cone/dentin able to increase the mechanical resistance of the tooth root.

Periodontal tissues are reactive to fluctuation of female sex hormones since they are equipped with estrogen receptors and participate in the hormones turnover. Estrogens and progestins mostly regulate in periodontal tissues the keratinocytes and fibroblasts. The gingival fibroblast ERβ receptor was proved both in cell nucleus and mitochondria. The main periopathogens Porphyromonas, Porphyromonas, and Treponema denticola have the ability to metabolize both estrogens and progesterone. Some climacteric complaints such as dry mouth and burning mouth are developing some years later the hormone deficiency is installed. Though modern oral contraceptives contain reduced estrogen and progestin and are no longer considered a risk factor for periodontal inflammation, it is recommended that their use has to be stipulated in the medical history of each woman.

Diabetes mellitus is one of the most frequent systemic disorders in medically compromised dental patients. Since it seems to be a significant relationship between diabetes mellitus and apical pathology, any diabetic dental patients should be suspected to develop chronic apical periodontitis both in endodontically treated and untreated teeth. A proper follow-up of root-filled teeth associated with periodical glycaemia control is mandatory to increase their survival. The diabetic status of a patient should be a key prognostic factor of decision in conservative endodontic management

Dental wear is a universal experience. It is accepted today that the phenomena of dental wear knows a significant increase especially in young people. Although the causes are not well defined, it is supposed to act as a category of “predisposing factors” specific to age and civilization as well as a category of causal factors. Dental loss of a different etiology than the caries is a normal physiological process carried out by lifetime. Identifying the causes involved in this process is particularly important in order to predict the long-term behaviour of both teeth and restorative treatments. It is difficult to establish the limit to which tissue loss is considered pathological because the notion of normal is still a source of controversy. Material and Method : The study was conducted between 20162017 on a sample of 56 subjects out of a total of 794 persons with erosions. Results and Discussion: Patients were ranked in relation to the type of odontal lesion and the probable etiology incriminated. To determine the factors that caused erosive lesions, we performed the main paraclinical tests using the Dentobuff kit, the determination of salivary flow and the food survey. Conclusions: Acid erosion, by definition, is caused by the action of alimentary or gastric acids dissolving dental surfaces, which also result from our analysis.

Numerically controlled modern CAD-CAM milling machines tools dedicated to dental technology are kinematic structures that work in 4 or 5 axes and represent one of the key links of CAD-CAM technology flow. The 4-axis and 5-axis machines allow for superior quality of the milling surface integrity by controlling both the inclination of the feed angle and the direction of the milling guide on which depends the contact surface between the cutting tool and the workpiece. The milling tools are available for both dental offices and dental laboratories as well as for industrial dental laboratories. The CAD-CAM milling machines provide superior results to conventional methods in terms of mechanical strength in mastication and aesthetics of dental prostheses

Endodontic retreatment in elderly patients for healing periapical periodontitis is more often required. Because of the increasing number of older adults in the population and the desideratum to maintain natural teeth for mastication and esthetics, endodontic treatment outcome in elderly people has to become predictable. Our clinical case highlights that even large, multiple periapical periodontitis can be healed in elderly people. Eliminating microbial infection by correct cleaning and shaping and preventing reinfection by proper root canal filling lead to a decrease in the size or even total healing of apical pathosis in relatively healthy elder patients, no matter the age.

The aim of this study was to examine the risk of stripping perforation of the root canal while shaping with Pro Taper manual system. Resin blocks were instrumented with manual Pro Taper files then photographed. The pictures were entered into a computer program to perform measurements. At 8 mm from the apex, all ProTaper files led to a significant transportation of the inner wall of the curvature compared to the control (p < 0.05). At 5 mm, ProTaper files ranging from S2 to F3 presented important statistical differences compared to the control. Also, file F3 achieved a transportation of 1.89 of the inner wall compared to file S1. At 2mm, the finishing files F2, F3 incurred significant increases of the total diameter (p

The aim of the study was to assess the perforation by stripping after endodontic treatment with stainless steel (SS) and Ni-Ti manual instruments. 65 resin blocks have been prepared using the circumferential filing method with unprecurved 0.02-tapered SS and Ni-Ti K-files and then photographed with a stereomicroscope. The angle and the radius of the canal curve following instrumentation and the transportation distance of the curvature inner wall were measured at 5 and 8 mm from the apex. At 8mm, SS size 40 performed a -2.2 transportation compared to the sample. At 5mm, sizes 35 and 40 recorded modifications after both techniques, translated by an increase of the internal diameter. There were significant differences related to the curvature radiuses achieved both by SS files 35 and 40 and Ni-Ti size 40 by an increase compared to the sample’s curvature radius (P

Proper restoration of proximal contact points is a great challenge for any dentist. The special particularities related to an appropriate anatomical and functional restoration at this level are related first of all to the knowledge of the local topography, to the possibilities of dental isolation, the type and the extension of the loss of hard dental substance. Currently, multiple techniques and specific conformation systems are available, which can be adapted to each clinical situation, so that the outcome of the therapeutic maneuver is a success. [ABSTRACT FROM AUTHOR]

Deep caries progress is associated with tertiary dentin formation and additional reversible or irreversible dental pulp inflammation. It seems that some particular signs of pain in irreversible pulpitis are associated to a particular caries microflora. Streptococcus species, Parvimonas micra and Dialister invisus are prevailing in cases of throbbing pain while Streptococcus mutans is incriminated in sensitivity to vertical percussion of tooth. Continuous pain is thought to be the clinical outcome of Lactobacillus implication. A better understanding of molecular signals and mechanisms induced by microbiome of deep caries that orchestrate the modulation of dental pulp complex response toward tertiary dentinogenesis or pulp inflammation it is supposed to improve diagnosis and conservative therapies of vital pulp. [ABSTRACT FROM AUTHOR]

Regular medical attendance proved to have a positive impact on health, therefore the aim of the study is to detect the reasons and frequency for health care use among a group of 110 urban dental patients aged between 33 and 75 years, 50% males. The subjects completed an anonymous questionnaire with items related to their medical visits patterns: reason (treatment/control and emergency) and frequency of healthcare services use; self-assessed oral and general health and socio-demographic data. Most of the patients were adults (81.8%) and with more than 12 years of study (50%). In terms of reason for attending the dental office, 72% visited the dentist for emergency reasons, mainly men, elderly, patients with low level of education, and those who self-rated their oral health as satisfying or poor. Regarding medical visits, 54% from all patients attended healthcare for emergency reasons, regardless age, gender, education level and self-perceived general health. The results showed that worse healthcare services use is associated with low education level and gender, especially men visited the dentist when there is pain only. There is need to increase the number of individuals who use regular health care, for prevention and early detection of diseases. [ABSTRACT FROM AUTHOR]

The dentine-pulp complex response in deep caries is histological characterized by tertiary formation and mild chronic pulp inflammation. The quiescent primary odontoblasts are reactivated, laying down reactionary tertiary dentine. In more severe carious damage the primary odontoblasts die and reparative tertiary dentine is secreted by odontoblast-like cells, which are differentiated in adult teeth mainly from dental pulp stem cells DPSC. Though associated with reversible pulpitis DPSC still preserve in deep caries the capability of migration, proliferation and differentiation. Some common mechanisms of molecular signals involved in tertiary dentine formation might also explain the balance between inflammation and regeneration of dentine-pulp complex. [ABSTRACT FROM AUTHOR]

During dentition development stages, various defects of the dental structures can appear and can be in shape, number, position, structure. The latter primarily affect the aesthetic appearance, but also the other functions of the dentomaxillary system, when the severity of the lesions is important. Enamel hypoplasia in the frontal area of dental arches, with moderate extension of defects, can be easily treated with modern resin composite materials using adhesive technique, by direct restorations. In this way, the coronal morphological integrity and the harmonious dento-facial appearance are restored. Restorations for this type of dental lesions need to be carefully monitored and retreatment performed if necessary.

During dentition development stages, various defects of the dental structures can appear and can be in shape, number, position, structure. The latter primarily affect the aesthetic appearance, but also the other functions of the dentomaxillary system, when the severity of the lesions is important. Enamel hypoplasia in the frontal area of dental arches, with moderate extension of defects, can be easily treated with modern resin composite materials using adhesive technique, by direct restorations. In this way, the coronal morphological integrity and the harmonious dento-facial appearance are restored. Restorations for this type of dental lesions need to be carefully monitored and retreatment performed if necessary. [ABSTRACT FROM AUTHOR]

Conventionally the cases accepted for direct pulp capping are the inadvertently exposed normal pulps and carious exposures in teeth without apical radiolucency. The recent advances in dental materials, namely the bioceramics, allowed successful vital therapy by direct pulp capping even in young permanent teeth with irreversible pulpitis. The choice of pulp capping material is pivotal in pulp vital therapy of carious exposures as tricalcium silicates shift the balance inflammation-healing toward the regeneration of damaged dentin-pulp complex. Anticipating a reliable outcome, the high anti-inflammatory potential and modulating capacity of cytokines and growth factors proved by bioactive endodontic cements in direct pulp capping should be associated with new molecular diagnostic tests and cautious clinical evaluation. However, it seems that a paradigm shift is expected in the decision of direct pulp capping.

During osseointegration a dental implant early develops special spatial and molecular relationships with surrounding tissues. The surface roughness and microtopography are closely related to a long-term clinical success. A better understanding of various but relevant molecules, and even of genes, that encodes biological factors involved in tissue healing should be considered useful in particular cases. Biocompatibility of implant is not yet considered as a solved problem, at infrastructural and molecular level, at least on long-term. Various biological factors, already in use, such as platelet-rich plasma, and growth factors, should be under control in order to follow a more efficient pathway towards a reliable osseointegration. A paramount attention has to be done, on long-term, to the functional modulation of bone tissue-dental implant, especially in immediate occlusal loading of dental implants.