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Aim Methodology Results Conclusions To assess Spanish dentists' management preferences for deep caries removal and exposed pulps in permanent teeth.A web‐based open and anonymous survey was distributed by social media and a specific website for this project amongst dentists practicing in Spain. The questionnaire comprised 40 questions, divided into five sections: (1) demographic data and professional activity; (2) carious tissue removal; (3) decision‐making regarding pulp exposure; (4) direct pulp capping and (5) pulpotomy procedures in permanent teeth. Results were descriptively analysed. Logistic regression (95% CI) analyses and X2 tests were carried out.A total of 538 responses were received. Half the respondents (53.7%) preferred to perform complete caries excavation for shallow and moderate carious dentin lesions, and selective excavation to firm dentin for deep lesions (57.8%). Selective removal to soft dentin and stepwise removal were much less indicated (15.4% and 10.9%, respectively). Exposed pulps in asymptomatic teeth were treated by direct pulp capping (over 80%), decreasing in the presence of reversible pulpitis symptoms (57.1%). If irreversible pulpitis was diagnosed, a pulpectomy would be performed by 53.5% and 89.9% of the respondents in, respectively, immature and mature teeth. Pulpotomy was performed routinely only by 26.4% of the clinicians. Patients' attitudes and priorities were the most relevant criteria when performing direct pulp capping and pulpotomy, together with the history of pain and the presence of bleeding. Regarding the clinical procedure, dry cotton was preferred to obtain haemostasis and Biodentine was the material of election.Caries removal preferences and management of pulp exposure by dentists practicing in Spain deviated from vital pulp treatment guidelines, mainly regarding indications and case selection. Pulp exposure was managed by direct pulp capping in asymptomatic cases, whilst immature permanent molars favoured the indication of pulpotomy when pulpitis was diagnosed. Most clinicians used hydraulic calcium silicate cement, specifically Biodentine, to perform vital pulp treatments. Postgraduate formation and continuing education in caries lesions management and vital pulp treatments were consistently related to more conservative and updated decisions. [ABSTRACT FROM AUTHOR]

Calcium phosphate-based materials (CaP) are introduced as potential dental pulp capping materials for deciduous teeth. The present study investigated the influence of inorganic phosphate (Pi) on regulating stem cells isolated from human exfoliated deciduous teeth (SHED). SHEDs were treated with Pi. Cell cycle progression and apoptosis were examined using flow cytometry analysis. Osteo/odontogenic and adipogenic differentiation were analyzed using alizarin red S and oil red O staining, respectively. The mRNA expression profile was investigated using a high-throughput RNA sequencing technique. Pi increased the late apoptotic cell population while cell cycle progression was not altered. Pi upregulated osteo/odontoblastic gene expression and enhanced calcium deposition. Pi-induced mineralization was reversed by pretreatment of cells with Foscarnet, or p38 inhibitor. Pi treatment inhibited adipogenic differentiation as determined by decreased PPARγ expression and reduced intracellular lipid accumulation. Bioinformatic analysis of gene expression profiles demonstrated several involved pathways, including PI3K/AKT, MAPK, EGFR, and VEGF signaling. In conclusion, Pi enhanced osteo/odontogenic but inhibited adipogenic differentiation in SHED. [ABSTRACT FROM AUTHOR]

Well-Root PT is a novel bioceramic material developed to overcome limitations of conventional calcium silicate cements. The purpose of this study was to assess the biocompatibility and bioactivity of a premixed putty-type cement, Well-Root PT. Identical cylindrical samples were prepared from ProRoot MTA, Biodentine, and Well-Root PT. In vitro calcium weight volume and calcium ion release from the materials were evaluated with scanning electron microscopy and energy-dispersive spectroscopy and inductively coupled plasma-optical emission spectroscopy. An in vivo rat direct pulp capping model was implemented with the materials (n = 14 per material). The rats were sacrificed at 7 or 28 days. Hematoxylin and eosin and immunohistochemical analyses were performed. In vitro calcium weight volume was 42.83 ± 8.82 % in ProRoot MTA, 47.05 ± 8.83 % in Biodentine, and 29.99 ± 4.94 % in Well-Root PT. Calcium ion releases from Well-Root PT after 7 and 28 days were similar with those from ProRoot MTA, but lower than those from Biodentine (P = 0.001 after 7 and 28 days equally). In an in vivo rat model, hematoxylin and eosin analysis showed no significant differences in inflammatory infiltration (P = 0.393) and hard tissue formation scores among the materials (P = 0.905). Also, both CD68 and DSPP expression showed similar results, with no significant differences among the materials (equally P = 0.874 for both markers). Within the limits of this study, Well-Root PT was comparable to ProRoot MTA and Biodentine in terms of biocompatibility and bioactivity. [ABSTRACT FROM AUTHOR]

Background/Objectives: This numerical analysis of stress distribution in the dental pulp and neuro-vascular bundle (NVB) of lower premolars assessed the ischemic and degenerative–resorptive risks generated by 2 and 4 N during orthodontic movements (rotation, translation, tipping, intrusion and extrusion) in intact periodontium. Methods: The numerical analysis was performed on nine intact periodontium 3D models of the second lower premolar of nine patients totaling 90 simulations. Results: In intact periodontium, both forces displayed a similar stress distribution for all five orthodontic movements but different amounts of stress (a doubling for 4 N when compared with 2 N), with the highest values displayed in NVB. In intact periodontium, 2 N and 4 N induced stresses lower than the maximum hydrostatic pressure (MHP) with no ischemic risks for healthy intact teeth. The rotation was seen as the most stressful movement, closely followed by intrusion and extrusion. Translation was quantitatively seen as the least stressful when compared with other movements. Conclusions: Larger orthodontic forces of 2 N and 4 N are safe (with any expected ischemic or resorptive risks) for the dental pulp and NVB of healthy intact teeth and in intact periodontium. Nevertheless, rotation and translation movements can induce localized circulatory disturbances in coronal pulp (i.e., vestibular and proximal sides) generating ischemic and resorptive risks on previously treated teeth (i.e., direct and indirect dental pulp capping). The intrusion and extrusion movements, due to the higher NVB-induced deformation when compared with the other three movements, could trigger circulatory disturbances followed by ischemia on previously traumatized teeth (i.e., occlusal trauma). [ABSTRACT FROM AUTHOR]

Testing the biocompatibility of commercially available dental materials is a major challenge in dental material science. In the present study, the biocompatibility of four commercially available dental materials Mineral Trioxide Aggregate, Biodentine, Harvard BioCal-CAP and Oxford ActiveCal PC was investigated. The biocompatibility analysis was performed on zebrafish embryos and larvae using standard toxicity tests such as survivability and hatching rates. Comparative toxicity analysis of toxicity was performed by measuring apoptosis using acridine orange dye and whole mount immunofluorescence methods on zebrafish larvae exposed to the dental materials at different dilutions. Toxicity analysis showed a significant decrease in survival and hatching rates with increasing concentration of exposed materials. The results of the apoptosis assay with acridine orange showed greater biocompatibility of Biodentine, Oxford ActiveCal PC, Harvard BioCal-CAP and Biodentine compared to MTA, which was concentration dependent. Consequently, this study has shown that showed resin-modified calcium silicates are more biocompatible than traditional calcium silicates. [ABSTRACT FROM AUTHOR]

BackgroundObjectiveMethodsResultsDiscussionConclusionPulpitis may be pain free or alternatively characterized by mild to severe pain and associated symptoms. Evidence has recently emerged that patients presenting with carious pulp exposure range of symptoms can be treated effectively with pulpotomy.The current systematic review aimed to answer the following research question: “In patients with deep caries lesions in permanent teeth associated with no symptoms, reversible pulpitis or signs and symptoms indicative of irreversible pulpitis (P), is partial pulpotomy (I) as effective as full pulpotomy (C), in terms of a combination of patient and clinical reported outcomes (O), with “tooth survival” as the most critical outcome?The systematic literature search was conducted in the following electronic databases: OVID, Scopus, PubMed (Including MEDLINE), and Cochrane Central Register of Controlled Trials (CENTRAL) supplemented with Grey literature and hand searching of relevant journals. The English language clinical trials comparing the patient and clinical reported outcomes between partial and full/complete were included. After a structured literature search, two authors independently performed study selection, extracted data and performed a risk of bias assessment; a third reviewer resolved disagreements. As there were only two studies with different exclusion criteria, no meta‐analysis was performed and the quality of evidence was assessed by the GRADE approach.After study selection a total of two randomised clinical trials with a total of 156 teeth were included both for the management of teeth with irreversible pulpitis. There were no studies for asymptomatic teeth or teeth with reversible pulpitis. A “Low” risk of bias was noted for both studies with a high level of overall evidence. A meta‐analysis was not carried out due to differences in inclusion criteria between the studies related principally to caries depth. Both studies reported a high rate of clinical success for pulpotomy with a pooled unadjusted success rate for full pulpotomy of 90% and 83% partial pulpotomy of at 1‐year; however, no significant difference between the treatments was noted in either study. There was significantly reduced postoperative pain reported in the full pulpotomy group over 1‐week compared with the partial pulpotomy in one but not in the other study.Pulpotomy as a definitive treatment modality is as effective in managing teeth exhibiting signs and symptoms indicative of irreversible pulpitis and challenges the established protocols to manage this condition. Although based on only two RCTs with a limited number of patients, no difference was shown in terms of clinical or radiographic outcome or postoperative pain between groups. Further well designed randomised clinical trials of longer duration are required in this area to improve the evidence available.There is no consistent difference in patient‐reported pain between partial and full pulpotomy at day 7 postoperatively and the clinical success rate was similar after 1 year for both treatment modalities. [ABSTRACT FROM AUTHOR]

Conventional pulp capping materials have limited anti-inflammatory capacity. It is necessary to develop more effective pulp capping material for the treatment of inflamed pulps. Tannic acid (TA) is a natural, water-soluble polyphenol with antimicrobial and anti-inflammatory properties. This study aimed to investigate the effects of a tannin-containing hydroxypropyl chitin hydrogel (HPCH/TA hydrogel) as an innovative pulp capping material. The physicochemical properties of the composite hydrogels were characterized. The effects of HPCH/TA hydrogel as a pulp capping material were evaluated in vitro and in vivo. The underlying mechanism of the anti-inflammatory effects of HPCH/TA hydrogel was explored. The HPCH/TA hydrogel demonstrated favorable temperature sensitivity, injectability, and antibacterial properties. In vitro, the HPCH/TA hydrogel effectively promoted the proliferation of human dental pulp cells and inhibited interleukin-1β, interleukin-6, and tumor necrosis factor-α expression, possibly by suppressing the nuclear factor kappa-B pathway. In vivo, on the fourth day after capping, the HPCH/TA hydrogel group showed lower inflammatory scores compared to the control and iRoot BP Plus (commercial pulp capping material) group. By the sixth week, complete reparative dentin formation was observed in the HPCH/TA hydrogel group, with no difference in thickness compared to the iRoot BP Plus group. Collectively, the HPCH/TA hydrogel holds promise as a bioactive pulp capping material for promoting the repair of inflamed pulp in vital pulp therapy. [ABSTRACT FROM AUTHOR]

Aim: Calcium hydroxide (CH) has been considered as a direct pulp capping materials (DPC) for the last decades despite having some limitations. Phosphorylate pullulan (PPL) incorporated with CH (CHPPL) is a novel biomaterial that was introduced as a promising DPC material. Thus, the aim of the study was to evaluate the inflammatory response and mineralized tissue formation (MTF) ability of PPL‐based CH formulations on rat molars after DPC. Methodology: This study consisted of six groups: CH with 1% PPL (CHPPL‐1); 3% PPL (CHPPL‐3); 5% PPL (CHPPL‐5); Dycal and NEX MTA Cement (N‐MTA) as the positive control, and no capping materials (NC). One hundred twenty maxillary first molar cavities were prepared on Wistar rats. After capping, all the cavities were restored with 4‐META/MMA‐TBB resin and pulpal responses were evaluated at days 1, 7, and 28. Kruskal–Wallis followed by Mann–Whitney U‐test was performed with a significance level of 0.05. Immunohistochemical expression of IL‐6, Nestin, and DMP‐1 was observed. Results: At day 1, CHPPL‐1, N‐MTA, and Dycal exhibited no to mild inflammation, whilst CHPPL‐3, CHPPL‐5, and NC showed mild to moderate inflammation, and the results were significantly different (p <.05). At day 7, mild to moderate inflammation was observed in CHPPL‐1, N‐MTA, and Dycal, whereas CHPPL‐3, CHPPL‐5, and NC exhibited moderate to severe inflammation. Significant differences were observed between CHPPL‐1 and N‐MTA with NC (p <.05), CHPPL‐1 and CHPPL‐3 with CHPPL‐5 and Dycal (p <.05), and CHPPL‐3 with N‐MTA (p <.05). A thin layer of mineralized tissue formation (MTF) was observed in all groups. At day 28, CHPPL‐1, Dycal, and N‐MTA showed no to mild inflammation, whilst CHPPL‐3, CHPPL‐5, and NC exhibited mild to severe inflammation, and statistically significant difference was detected (p <.05). CHPPL‐1, Dycal, and N‐MTA exhibited continuous MTF, whilst CHPPL‐3, CHPPL‐5, and NC had thicker and interrupted MTF. Significant differences were observed between CHPPL‐1, CHPPL‐3, and N‐MTA with NC group (p <.05). Variable expressions of IL‐6, Nestin, and DMP‐1 indicated differences in the materials' impact on odontoblast‐like cell formation and tissue mineralization. Conclusions: These findings suggest that CHPPL‐1 has the potential to minimize pulpal inflammation and promote MTF and had similar efficacy as MTA cement. [ABSTRACT FROM AUTHOR]

Evaluate a new light-cured material with better properties for vital pulp therapy. Light-cured resin materials consisted of polyethylene glycol (600) diacrylate mixed with different ratios of TCP to HA. In addition to the temperature change (n = 5 for each subgroup) were tested, cell viability and Alizarin Red Staining (ARS) assay were also tested in vitro on human dental pulp cells (n = 6 for each subgroup). Lastly, the material was then compared with Biodentine and control groups in the molars of Wistar rats in vivo for histology assessment. The temperature change for the new materials were under 5 degrees Celsius. For the in vitro assessments, there was no significant difference on day 3 and day 7 for cell viability test. ARS assay showed significantly higher mineralized nodule formation when treated without induction medium for Group D and Biodentine on day 10 compared to Group C and control. On the contrary, Biodentine and control groups treated with induction medium showed significant higher mineralization than the new materials. Histology assessments demonstrated higher mineralized content in Group D and Biodentine on week 3 and week 6. The inflammatory cells in the dental pulp complex of the Biodentine group resolved on week 6 while the inflammation resolved in Group D on week 3. The new material exhibits low heat production, low cytotoxicity, and good calcium ion release capability. Compared to traditional materials, it has shorter setting time and better aesthetic outcomes, making it highly suitable for use in vital pulp therapy. • Light-cured direct pulp capping material with low cytotoxicity and low temperature rise. • New material for vital pulp therapy tested in vitro on human dental pulp cells. • New material for vital pulp therapy tested in vivo in the molars of Sprague-Dawley (SD) rats. • New light-cured material for vital pulp therapy compared with Biodentine. [ABSTRACT FROM AUTHOR]

Objectives: To synthesize casein enzymatic hydrolysate (CEH)-laden gelatin methacryloyl (GelMA) fibrous scaffolds and evaluate the cytocompatibility and anti-inflammatory effects on dental pulp stem cells (DPSCs). Materials and methods: GelMA fibrous scaffolds with 10%, 20%, and 30% CEH (w/w) and without CEH (control) were obtained via electrospinning. Chemo-morphological, degradation, and mechanical analyses were conducted to evaluate the morphology and composition of the fibers, mass loss, and mechanical properties, respectively. Adhesion/spreading and viability of DPSCs seeded on the scaffolds were also assessed. The anti-inflammatory potential on DPSCs was tested after the chronic challenge of cells with lipopolysaccharides (LPS), followed by treatment with extracts obtained after immersing the scaffolds in α-MEM. The synthesis of the pro-inflammatory cytokines IL-6, IL-1α, and TNF-α was measured by ELISA. Data were analyzed by ANOVA/post-hoc tests (α = 5%). Results: CEH-laden electrospun fibers had a larger diameter than pure GelMA (p ≤ 0.036). GelMA scaffolds laden with 20% and 30% CEH had a greater mass loss. Tensile strength was reduced for the 10% CEH fibers (p = 0.0052), whereas no difference was observed for the 20% and 30% fibers (p ≥ 0.6736) compared to the control. Young’s modulus decreased with CEH (p < 0.0001). Elongation at break increased for the 20% and 30% CEH scaffolds (p ≤ 0.0038). Over time, DPSCs viability increased across all groups, indicating cytocompatibility, with CEH-laden scaffolds exhibiting greater cell viability after seven days (p ≤ 0.0166). Also, 10% CEH-GelMA scaffolds decreased the IL-6, IL-1α, and TNF-α synthesis (p ≤ 0.035). Conclusion: CEH-laden GelMA scaffolds facilitated both adhesion and proliferation of DPSCs, and 10% CEH provided anti-inflammatory potential after chronic LPS challenge. Clinical relevance: CEH incorporated in GelMA fibrous scaffolds demonstrated the potential to be used as a cytocompatible and anti-inflammatory biomaterial for vital pulp therapy. [ABSTRACT FROM AUTHOR]

Objective The vitality of the pulp and the formation of new dentin are important for the success of direct pulp capping (DPC). Accordingly, the present study aims to histologically evaluate the pulp reaction to potassium nitrate in polycarboxylate cement (KNO 3 /PCA) compared with mineral trioxide aggregate (MTA) in immature dogs' teeth. DPC was done on 48 teeth in three dogs (16 for each dog, 8 for each material). Materials and Methods After 2, 3, and 4 months, a dog was euthanized at each time interval. Capped teeth were extracted, demineralized, and processed for histopathological examination based on the presence of inflammation, granulation tissue, hard tissue, and dentin bridge. Results Inflammatory changes were absent in both MTA- and KNO 3 /PCA-capped teeth at the three time intervals. The incidence of granulation tissue formation was higher in MTA- (75, 87.5, and 87.5%) than in KNO 3 /PCA-capped teeth (62.5, 75, and 75%) after 2, 3, and 4 months after DPC, respectively. Hard tissue was seen after 3 months of DPC with both MTA and KNO 3 /PCA. It was more evident in MTA-capped teeth with an incidence of 75 and 75%, and 12.5 and 25% in teeth capped with KNO3/PCA after 3 and 4 months, respectively. Dentin bridge was only noticed in MTA-capped teeth after 3 and 4 months intervals. Conclusion Taken all together, pulpal responses in the form of granulation and hard tissues, and dentin bridge formation are more evident in MTA-capped teeth than those capped with KNO 3 /PCA in immature dogs. [ABSTRACT FROM AUTHOR]

Dental pulpitis significantly impacts oral function and quality of life. Treatments like direct pulp capping aim to preserve pulp vitality. This study aims to investigate the application value of Nd:YAG laser irradiation in preserving pulp vitality in children with caries-induced pulpitis. This study, conducted from June 2019 to June 2023, included 89 children undergoing pulp vitality preservation treatment for caries-induced pulpitis. The children were divided into two groups using sealed envelopes: 44 in the control group received pulp capping treatment, while the study group received Nd:YAG laser-assisted pulp capping treatment. The efficacy, oral indicators, oral function, changes in root apex diameter and root length, changes in gingival crevicular fluid inflammatory factors, and incidence of complications were compared between the two groups before and 3 months after treatment. The total effective rates were 97.78% in the study group and 95.45% in the control group, with no significant difference between the groups (p> 0.05). Before treatment, there were no differences in gingival index, plaque index, and probing bleeding index between the groups (p> 0.05). After treatment, both groups showed decreased periodontal indexes compared to before treatment, with the study group showing lower values than the control group (p< 0.05). Chewing and biting function scores were similar between the groups before and after treatment (p> 0.05), but both groups showed decreased scores after treatment (p< 0.05). The study group had a higher percentage decrease in root apex diameter and a greater increase in root length compared to the control group (p< 0.05). During treatment, one case of tooth discoloration occurred in the study group (2.27%), while the control group had two cases of tooth discoloration and one case of secondary caries, resulting in a complication rate of 6.67%. There was no significant difference in the incidence of complications between the groups (p> 0.05). Nd:YAG laser irradiation effectively preserves pulp vitality in children with caries-induced pulpitis, improving periodontal health, reducing root apex diameter, and increasing root length with high safety. [ABSTRACT FROM AUTHOR]

Endo–perio lesions are lesions involving pulp tissue with periodontal tissue. The bacterial infection of the pulp can spread to the furcation area through the accessory canal, causing damage to the furcation area. Regeneration therapy has good success when performed with flap surgery and is performed in cases of Grades I and II furcation involvement. Demineralized freeze‐dried bone allograft (DFDBA) is a regenerating material that has osteoinductive and osteoconductive abilities. It has the advantage of successful treatment of bone defects. Biodentine is an agent used for direct pulp capping, root perforation and furcation repair, and apexification. It can bind and enter the dentinal tubules and create interlocking crystals with dentin. This case report presents the treatment of furcation involvement Grade II originating from endo–perio lesions by using DFDBA and Biodentine as regeneration materials with 6 months of follow‐up. [ABSTRACT FROM AUTHOR]

Mineral Trioxide Aggregate (MTA) is the gold standard for vital pulp treatment (VPT), but its superiority over novel calcium silicate-based cements in permanent teeth lacks systematic evidence. This study aimed to compare the efficacy of these materials in VPT through a network meta-analysis. A systematic search was conducted in MEDLINE, EMBASE, Cochrane Library, and Web of Science until January 20, 2024. The inclusion criteria were randomized controlled trials involving VPT with biomaterials and reversible or irreversible pulpitis diagnoses in mature permanent teeth. The primary outcome was the odds ratio (OR) of failure rates with 95% confidence intervals. In the 21 eligible trials, failure rates were significantly higher with calcium-hydroxide than MTA at six (OR 2.26 [1.52-3.36]), 12 (OR 2.53 [1.76-3.62]), and 24 months (OR 2.46 [1.60-3.79]). Failure rates for Totalfill at six (OR 1.19 [0.55-2.58]) and 12 months (OR 1.43 [0.71-2.92]), and Biodentine at six (OR 1.09 [0.66-1.78]), 12 (OR 1.21 [0.74-1.96]), and 24 months (OR 1.47 [0.81-2.68]) were not significantly different from MTA. The results were similar in the direct pulp capping subgroup, whereas, in the partial and full pulpotomy subgroup, there was not enough evidence to achieve significant differences. MTA, Biodentine, and Totalfill are the most efficient materials for VPT. However, calcium-hydroxide-based materials are not recommended in VPT. [ABSTRACT FROM AUTHOR]

Heparan sulfate (HS) is a major component of dental pulp tissue. We previously reported that inhibiting HS biosynthesis impedes endothelial differentiation of dental pulp stem cells (DPSCs). However, the underlying mechanisms by which exogenous HS induces DPSC differentiation and pulp tissue regeneration remain unknown. This study explores the impact of exogenous HS on vasculogenesis and dentinogenesis of DPSCs both in vitro and in vivo. Human-derived DPSCs were cultured in endothelial and odontogenic differentiation media and treated with HS. Endothelial differentiation of DPSCs was investigated by real-time polymerase chain reaction and capillary sprouting assay. Odontogenic differentiation was assessed through real-time polymerase chain reaction and detection of mineralized dentin-like deposition. Additionally, the influence of HS on pulp tissue was assessed with a direct pulp capping model, in which HS was delivered to exposed pulp tissue in rats. Gelatin sponges were loaded with either phosphate-buffered saline or 101–102 μg/mL HS and placed onto the pulp tissue. Following a 28-day period, tissues were investigated by histological analysis and micro–computed tomography imaging. HS treatment markedly increased expression levels of key endothelial and odontogenic genes, enhanced the formation of capillary-like structures, and promoted the deposition of mineralized matrices. Treatment of exposed pulp tissue with HS in the in vivo pulp capping study induced formation of capillaries and reparative dentin. Exogenous HS effectively promoted vasculogenesis and dentinogenesis of DPSCs in vitro and induced reparative dentin formation in vivo , highlighting its therapeutic potential for pulp capping treatment. [ABSTRACT FROM AUTHOR]

The use of propolis-based materials within endodontics to promote pulp wound healing or disinfect the root canal system has been a recent focus of scientists and clinicians. This is mainly because of the well-documented antimicrobial, anti-inflammatory, immunomodulatory and wound healing properties of propolis. This scoping review critically appraises the literature on the clinical applications of propolis-based compounds during endodontic therapy of primary and permanent teeth. An electronic literature search was performed in Scopus, PubMed, and Web of Science up to and including October 2023 to identify studies assessing the use of propolis during endodontic therapy of primary and permanent teeth. A combination of relevant Medical Subject Headings (MeSH) terms and keywords was used. Only human clinical studies written in English were included. The identified manuscripts were screened and assessed for inclusion by two independent authors. Eligible manuscripts were then subjected to critical appraisal and data extraction with the information being summarised according to their clinical application. A total of 26 human clinical studies were identified and included in the analysis. Propolis was investigated for use in the primary and permanent dentitions as a direct pulp capping or pulpotomy material as well as in root canal disinfection and root canal filling material of teeth with non-vital pulps. Overall, the included studies reported that the use of propolis was associated with promising outcomes in terms of efficacy to control inflammation, enhance tissue repair, and disinfection of the root canal system. However, a critical appraisal of the studies revealed a range of methodological and reporting deficiencies, resulting in unreliable results and conclusions in terms of the clinical outcomes reported. Although the studies on the use of propolis-based materials in endodontics reported promising clinical outcomes, they had a range of methodological and reporting flaws. Therefore, further well-designed and properly reported controlled clinical studies are essential to derive sound evidence-based conclusions on propolis-based materials. Furthermore, guidelines for quality assurance and safe use of propolis-based materials are necessary to enhance their production for commercial use in endodontics. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of leukocyte-and platelet-rich fibrin (L-PRF) as a capping agent in the modulation of inflammation in rat dental pulp. Methods The rat model of pulpitis was established by lipopolysaccharide (LPS) . A total of 30 Sprague-Dawley rats were randomly divided into five groups: Normal control group, Model group, iRoot BP PLUS group, L-PRF group, iRoot BP PLUS+ L-PRF group. Samples were collected on the 14th day after pulp capping. Micro-CT scans, HE and Masson staining, qRT-PCR assays were performed to observe pulp tissue inflammatory and hard tissue formation. Results Micro-CT results: no hard tissue formation was seen in the LPS group, plaque calculus was seen in the L-PRF group, and a more complete calcified bridge was seen at the perforation of the pulp in the BP and combined groups, HE and Masson staining results: the LPS group had the most severe inflammation and no hard tissue formation, the combined group had the least inflammation and the most complete and continuous hard tissue formation, and there was a statistical difference between the two groups(P < 0.01), There was no statistical difference in the degree of inflammatory reaction and hard tissue formation between the BP group and the combined group (P > 0.05), qRT-PCR results: the relative expression levels of TNF-α, IL-1β, and IL-6 mRNA in the pulp tissues of all experimental groups were reduced compared with those of the LPS group, but the differences between the L-PRF and LPS groups were not statistically significant (P > 0.05) . Conclusion The combination of L-PRF and iRoot BP PLUS as a composite pulp capping material can be used for the repair of dental pulp tissue and the regulation of inflammation in dental pulpitis in rats. [ABSTRACT FROM AUTHOR]

Natural-based materials represent green choices for biomedical applications. In this study, resin pulp capping restoration enclosing strengthening silica and bioactive portlandite nanofillers were prepared from industrial wastes. Silica nanoparticles were isolated from rice husk by heat treatment, followed by dissolution/precipitation treatment. Portlandite nanoparticles were prepared by calcination of carbonated lime waste followed by ultrasonic treatment. Both were characterized using x-ray diffraction, energy dispersive x-ray, and transmission electron microscopy. For preparing pulp capping restoration, silica (after silanization) and/or portlandite nanoparticles were mixed with 40/60 weight ratio of bisphenol A-glycidyl methacrylate and triethylene glycol dimethacrylate. Groups A, B, and C enclosing 50 wt.% silica, 25 wt.% silica + 25 wt.% portlandite, and 50 wt.% portlandite, respectively, were prepared. All groups underwent microhardness, compressive strength, calcium release, pH, and apatite forming ability inspection in comparison to mineral trioxide aggregate (MTA) positive control. In comparison to MTA, all experimental groups showed significantly higher compressive strength, group B showed comparable microhardness, and group C showed significantly higher calcium release. Groups B and C showed prominent hydroxyapatite formation. Thus, the preparation of economic, silica-fortified, bioactive pulp capping material from under-utilized agricultural residues (rice husk) and zero-value industrial waste (carbonated lime from sugar industry) could be achieved. [ABSTRACT FROM AUTHOR]

Background: Azathioprine is one of the earliest immunosuppressants prescribed for several autoimmune diseases. Yet there is a lack of research on the impact of azathioprine on pulp healing following the pulp capping procedure. Aim: This study aimed to investigate the effect of azathioprine on the healing ability of mechanically exposed dogs' dental pulps following direct pulp capping with mineral trioxide aggregate (MTA), bio-aggregates (BA), and Calcium hydroxide (Ca(OH)2). Methods: Four mongrel dogs were randomly assigned to two groups (two dogs/30 teeth in each group): immunosuppressed (group I) and control (group II). Group I received azathioprine for two months before surgical treatments and until the dogs were euthanized. Fifteen class V buccal cavities were performed in each dog. Each group was randomly divided into three subgroups (10 teeth each) based on the pulp capping substance. The pulps in subgroups A, B, and C were immediately capped with MTA, BA, and Ca(OH)2, respectively. Inflammation and dentine bridge development were histopathologically evaluated and scored at one and two months. The data were statistically analyzed. Results: The immunosuppressed group exhibited statistically greater inflammatory cell count and decreased dentine bridge thickness, compared to the control group in all subgroups (p < 0.05). Conclusion: Azathioprine has an adverse effect on the healing of exposed dogs' dental pulp following direct pulp capping with MTA, BA, and Ca(OH)2. Therefore, patients using azathioprine as an immunosuppressive medication may experience delayed healing of mechanically exposed pulps following capping with MTA, BA, or Ca(OH)2. [ABSTRACT FROM AUTHOR]

The failure rate of calcium hydroxide [Ca(OH)2] as a pulp protection material is 13.64% one year after treatment. Carbonate apatite (CO3Ap) is a biocompatible material that has the ability to carry and release drugs in a phosphate-buffered saline (PBS) solution that functions to regulate the pH and osmolarity balance of cells. Ellagic acid (EA) is a natural, bioactive phenolic and flavonoid compound. 12.5% EA has been shown to inhibit the growth of Enterococcus faecalis. This research not only aims to develop a formula for Ca(OH)2 combined with CO3Ap, and ellagic acid (EA) solvent, but also investigates their effect on the cytotoxicity and proliferation of fibroblasts. Material samples were prepared by mixing various proportions of Ca(OH)2 with CO3Ap dissolved in 12.5% EA solvent. Baby hamster kidney-21 cells were prepared and incubated in a 96-well microplate for 24 h and 72 h with media containing the material samples. Cell viability was monitored by measuring the absorbance of each microplate using an ELISA reader. After 24 h, group 3 (50% CO3Ap wt%) showed the highest percentage of viable cells; after 72 h, the highest percentage was found in group 3 (50% CO3Ap wt%). Group 5 (87.5% CO3Ap) had the lowest percentage value of living cells after 24 and 72 h treatment. The difference between groups 3 and 5 at 24 hours was significant (p<0.05). The combinations in groups 1, 2, 3, and 4 were nontoxic and able to stimulate the proliferation of fibroblast cells and thus have ideal characteristics as a new candidate material for pulp capping. [ABSTRACT FROM AUTHOR]

Evidence of porcine oral pathology in client-owned domestic pigs has been reported in recent literature. The most common abnormalities are missing teeth and periodontal disease. This case series reviews the diagnosis and treatment of dental disease in 8 pet Vietnamese Pot-Bellied Pigs (Sus scrofa domesticus) over a 6-year period (2015-2021). Inclusion criteria included pigs over 1 year of age that had at least 2 sequential visits involving photographs, full-mouth intraoral radiographs, and dental charting. Eight pigs were identified for study inclusion. The study population included 4 castrated males, 3 spayed females, and 1 intact female. The 8 subjects had a total of 28 visits. Fifty-five intraoral dental extractions were performed and complete healing of 44 extraction sites was observed (11 sites were lost to follow up). Canine tooth reduction was performed on 52 tusks in 7 pigs with exposure of 1 pulp that was treated by partial pulpectomy and direct pulp capping. Restoration of carious lesions was performed on 4 teeth. The most commonly extracted teeth were the right and left maxillary first molars (10 of 47 teeth). Reasons for tooth extraction included: periodontal disease, complicated crown fracture, nonvital +/− periapical pathology, and persistent deciduous teeth. Additional treatments ranged from type 1 crown lengthening with restoration of carious lesions, tusk trimming, closed and open root planing, dental extractions, ultrasonic scaling, and polishing. This article stresses the importance of routine dental healthcare and early intervention for periodontal disease in pigs. [ABSTRACT FROM AUTHOR]

Background. Minimally invasive endodontics is recommended for young, immature teeth to preserve healthy pulp and dentin tissue. Objectives. The aim of the study was to examine the cold sensitivity of immature teeth that received photobiomodulation (PBM) after vital pulp therapy (VPT). Materials and methods. The study followed the STROBE guidelines and included 123 healthy patients aged 8--13. The immature teeth (incisors, premolars and molars) that qualified for VPT received the bioc- eramic material -- Biodentine. In this experiment, teeth were treated immediately and at 24 h post-VPT with a 635-nm diode laser using a power of 100 mW, a power density of 200 mW/cm2 and a total energy of 4 J (PBM group, n = 43), while those not treated were the control group (n = 43). The tooth sensitivity to cold was measured using a visual analogue scale (VAS) before and at 6 h, 1 day, 7, 30, and 90 days after treatment. The predictor variable was PBM skills regarding the ability to decrease cold sensitivity after VPT. The primary endpoint was the time to reverse hypersensitivity to cold, and the secondary endpoint was the occurrence of possible side effects. The Mann--Whitney U test, Friedman test along with Dunn's post hoc test, and the χ² test were used to investigate tooth sensitivity. Results. Eighty-six immature permanent teeth of 86 children were included in the study. It was shown that the difference was significant for sensitivity to a cold stimulus between the groups at 6 h, 24 h, 7 days, and 30 days, but no difference was found preoperatively and at 90 days (6 h, 24 h, 7 days, and 30 days, p < 0.001, and 90 days, p = 0.079). However, patients in both groups reported a decrease in discomfort provoked by cold stimuli throughout the follow-up period. Conclusions. Photobiomodulation decreased postoperative sensitivity and was more acceptable for patients. Further randomized clinical studies with placebo-controlled groups are needed. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the therapeutic effects of mineral trioxide aggregate (MTA) and methyl sulfonyl methane (MSM) on pulp damage due to pulp exposure through the RUNX2 and RANKL pathways. Seventy-two male Sprague-Dawley rats aged 4–6 months and weighing 250–300 g were divided into healthy, control, MTA, and MSM groups. After experimental applications, all rats at 2, 4, and 8 weeks were killed anesthetically with xylazine hydrochloride (Rompun, Bayer) 30 mg/kg and ketamine hydrochloride (Ketalar, Pfizer) 50 mg/kg injections (i.p.). We observed that necrotic odontoblasts, edema, inflammation, and vascular congestion findings were reduced from week 2 to week 8 in the MSM treatment group after pulp capping compared to the control group and MTA group. Similarly, we found a decrease in RUNX2 and RANKL levels in the MSM application group compared to the control and MTA groups (p < 0.05). MSM material has shown therapeutic effects on pulp capping treatment-induced pulp injury via increased RUNX2 ve RANKL expression. [ABSTRACT FROM AUTHOR]

Aim: The primary aim was to evaluate the physicochemical and biological characteristics of pulp capping materials. Materials and Methods: The systematic review report adhered to the latest Preferred Reporting Items for Systematic Reviews and Meta-Analysis statements, and the protocol was pre-registered (CRD42023471030) in the PROSPERO database before its commencement. To retrieve relevant literature, electronic searches were conducted using the Medline and Google Scholar databases from January 2000, up to August 2023. The records obtained through our electronic search were managed using a specialized web application for systematic review screening, and data were extracted using a standardized form. The evaluation of potential bias within the studies employed the modified Consolidated Standards of Reporting Trials (CONSORT) checklist specifically designed for reporting in vitro dental material research. Results: The results revealed that out of 255 identified records, 16 studies were included. An analysis based on the modified CONSORT checklist identified a moderate risk of bias in the included studies, with compliance scores ranging from 50% to 70%. Studies scoring below 50% were omitted from the discussion because of a higher risk of bias. Conclusion: This study concludes that the physicochemical properties of resin-incorporated materials are better than those of calcium silicate cement (CSCs). However, the biological properties of CSCs are superior to those of resin-incorporated materials. [ABSTRACT FROM AUTHOR]

The aim of this study is to introduce a dental capping agent for the treatment of pulp inflammation (pulpitis). Nanohydroxyapatite with Elaeagnus angustifolia L. extract (nHAEA) loaded with metronidazole (nHAEA@MTZ) was synthesized and evaluated using a lipopolysaccharide (LPS) in vitro model of pulpitis. nHAEA was synthesized through sol–gel method and analyzed using Scanning Electron Microscopy, Transmission Electron Microscopy, and Brunauer Emmett Teller. Inflammation in human dental pulp stem cells (HDPSCs) induced by LPS. A scratch test assessed cell migration, RT PCR measured cytokines levels, and Alizarin red staining quantified odontogenesis. The nHAEA nanorods were 17–23 nm wide and 93–146 nm length, with an average pore diameter of 27/312 nm, and a surface area of 210.89 m2/g. MTZ loading content with controlled release, suggesting suitability for therapeutic applications. nHAEA@MTZ did not affect the odontogenic abilities of HDPSCs more than nHAEA. However, it was observed that nHAEA@MTZ demonstrated a more pronounced anti-inflammatory effect. HDPSCs treated with nanoparticles exhibited improved migration compared to other groups. These findings demonstrated that nHAEA@MTZ could be an effective material for pulp capping and may be more effective than nHAEA in reducing inflammation and activating HDPSCs to enhance pulp repair after pulp damage. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusions The European Society of Endodontology outlines best practices for the management of deep caries and the pulp. Despite evidence supporting vital pulp treatments (VPTs) as predictable alternatives to conventional endodontic treatment, studies have shown they are not widely adopted in the UK. This study aimed to explore the barriers to implementation of VPTs by primary care general dental practitioners (GDPs).Qualitative one‐to‐one semi‐structured online interviews were conducted with purposively sampled UK GDPs. Interview transcripts were analysed using reflexive thematic analysis. Recurring themes were iteratively refined as additional transcripts were reviewed.Eleven participants were interviewed. A range of barriers to the provision of VPTs were identified, which aligned with two core themes: ‘Motivational barriers to service provision’ and ‘Educational access & opportunities’. Sub‐themes included lack of access to materials and equipment, deficiencies in knowledge of treatment (including protocols, outcomes and prognosis), lack of confidence (in treatment efficacy and clinical ability), time constraints and public dental service funding and remuneration.This study identifies barriers to the widespread adoption of VPTs among primary care GDPs in public and private settings. Economic constraints, practitioner confidence, time limitations and educational gaps are key challenges. Addressing these may require systemic changes such as policy interventions, education and improved resource allocation. [ABSTRACT FROM AUTHOR]

Introduction: Anadara Granosa (AG) clam shells hydrothermally treated for 18 hours and sintering for 3 hours will produce β-TCP which contains calcium, used to help the process of reparative dentin formation. Nano encapsulation prosess is carried out to prevent excessive calcium absorption. Objective: To investigate cytotoxicity of nano encapsulation of β-TCP from synthesized Anadara granosa shell. Materials and methods: This research was conducted using post-test-only control group design. BHK-21 fibroblast cell culture in 96 wells was divided into two groups, namely the encapsulation group with a stirring time of 7(P1) and 8(P2)hours. The particles resulting from the encapsulation process were measured using particle size analyzer (PSA), MTT assay with color absorbance response converted into percent cell death with a formula. The cell viability data was analyzed using the T-test and see if there is a change in particle size in each group. Results: Two nano encapsulation P1(370 nm) and P2 (385 nm) were determined to be examined for citotoxicity. The cytotoxicity test showed significant difference between groups P(1) (0.31±0.28) and P(2)(0.41±0.38), where both showed no toxic ingredients. The highest viability occurred in the 8 hours encapsulation treatment group. Conclusion: Encapsulation of β-TCP for 8 hour (385 nm) was not cytotoxic to BHK-21 cell fibroblast cell line culture. [ABSTRACT FROM AUTHOR]

Background: Crown fracture is the most common injury in permanent teeth. This study aimed to evaluate the treatment outcomes of permanent teeth with uncomplicated and complicated crown fractures and to investigate potential factors. Materials and Methods: This retrospective study included patients who experienced crown fractures in permanent teeth from 2018 to 2021 with at least 12 months of follow‐up. All complicated crown fractured teeth were treated with pulpotomy, while for teeth with uncomplicated crown fractures, three treatments (restoration, indirect pulp capping, or pulpotomy) were employed. The chi‐square test was used to compare the prognosis of teeth with uncomplicated and complicated crown fractures. Potential factors associated with pulp survival including gender, interval, root development, enamel infraction, mobility, concomitant luxation injury, treatment, and coronal restoration were identified via Cox regression analysis. Results: A total of 307 teeth from 220 children (average age = 9.3 ± 1.4 years; age range, 6–14 years) with a median follow‐up of 23 months were included, and 82.1% of all teeth had immature roots. Complicated crown fractured teeth (93.6%, 102/109) had a significantly higher success rate compared with uncomplicated crown fractured teeth (85.4%, 169/198) (p <.05). Pulpotomy (96.9%) had the highest success rate of all treatments for uncomplicated crown fractures, followed by only restoration (85.0%) and indirect pulp capping (76.9%). The success rate of teeth that received pulpotomy was significantly higher than those treated by indirect pulp capping (p <.05). In uncomplicated crown fractures, teeth with Class II mobility were more vulnerable to failure than teeth without abnormal mobility (HR = 34.83; 95% CI, 9.59–126.56; p <.05); teeth that received pulpotomy were less prone to failure than teeth that received indirect pulp capping (HR = 13.53; 95% CI, 1.58–115.72; p <.05). Conclusion: Crown fractures treated with conservative pulp treatments had a relatively highly favorable prognosis. The prognosis of uncomplicated crown fractured teeth was impacted by the severity of periodontal injury and treatment strategies. Accurate diagnosis and identification of micro‐exposures are important. Dentists should take multiple risk factors into account and select optimal treatment strategies. [ABSTRACT FROM AUTHOR]

Introduction: Pulpal and periradicular diseases stem from immune reactions to microbiota, causing inflammation. Limited blood supply hampers dental pulp self-healing. Managing inflammation involves eliminating bacteria and reducing proinflammatory mediators especially MMP-9, which has a significant correlation with pulpitis. s. Flavonoids like Hesperidin, Baicalein, Epigallocatechin gallate, Genistein, Icariin, and Quercetin show potential for pulp capping. Aim: This in-silico study compares various Flavonoids for their anti-inflammatory effects on MMP-9, with Chlorhexidine as a control, a known MMP-9 inhibitor. Materials and Methods: Protein and Ligand Preparation: The human MMP-9 catalytic domain (PDB ID: 4XCT) structure was retrieved, and necessary modifications were made. Flavonoids from PubChem database were prepared for docking using AutoDock Vina. A grid for docking was created, and molecular dynamics simulations were conducted using Gromacs-2019.4 with GROMOS96 force field. Trajectory analysis was performed, and MM-PBSA calculation determined binding free energies. Results: Analysis of MMP-9 and ligand interactions revealed Hesperidin's high binding affinity, forming numerous hydrogen bonds with specific amino acids. Molecular dynamics simulations confirmed stability, with RMSD, RMSF, Rg, and SASA indicating consistent complex behaviour over 100 ns. MM-PBSA calculation affirmed favourable energy contributions in MMP9-Hesperidin interactions. Conclusion: MMP-9 plays a crucial role in prognosis of pulpitis. Incorporating MMP-9 inhibitors into pulp capping agents may enhance therapeutic efficacy. Hesperidin emerges as a potent MMP-9 inhibitor, warranting further in vivo validation against other agents. [ABSTRACT FROM AUTHOR]

Abstract The main purpose of vital pulp therapy (VPT) is to preserve the integrity and function of the pulp. A wide variety of materials and techniques have been proposed to improve treatment outcomes, and among them, the utilization of lasers has gained significant attention. The application of lasers in different stages of VPT has witnessed remarkable growth in recent years, surpassing previous approaches. This study aimed to review the applications of lasers in different steps of VPT and evaluate associated clinical and radiographic outcomes. An electronic search using Scopus, MEDLINE, Web of Science and Google Scholar databases from 2000 to 2023 was carried out by two independent researchers. The focus was on human studies that examined the clinical and/or radiographic effects of different laser types in VPT. A total of 4243 studies were included in this narrative review article. Based on the compiled data, it can be concluded that although current literature suggests laser may be proposed as an adjunct modality for some procedural steps in VPT, more research with standardized methodologies and criteria is needed to obtain more reliable and conclusive results.

Introduction: Cavity preparation and direct and indirect pulp capping are difficult processes to learn in dentistry. Although plastic teeth are used in universities in Turkey, the standard model does not teach students how to distinguish between dental hard tissues from caries and how this relates to the pulp. The aim of this study was to investigate the differences in learning when a three‐dimensional (3D)‐printed tooth was employed in comparison with the standard model and extracted teeth. The differences are evaluated in the design, feasibility, and contribution of the 3D‐printed dental tooth in pre‐clinical education. Materials and Methods: The multi‐layer 3D‐printed tooth's authentic design and replication of the dental hard tissues and carious lesions are explored with 55 students for pre‐clinical education, which includes caries excavation and direct and indirect pulp capping. The students completed questionnaires evaluating the 3D‐printed teeth through comparison with the plastic and extracted teeth, rated with scores from 1 to 11 (1: poorest conformity; 11: excellent conformity). Results: The questionnaire results indicated that students approved the printed tooth model for the practice of theoretical knowledge and the model received ratings between good and excellent. The results were statistically analysed using the Wilcoxon signed‐rank test, and the printed teeth had the highest approval from the students (p <.001). Conclusion: The results of this study demonstrated that the use of the designed 3D‐printed tooth is preferred by the students based on their perception of learning cavity preparation and pulp capping in a pre‐clinical environment. Workflow and production were cost‐effective with the use of 3D printing technology. The printed tooth allowed students to gain realistic experience before treating patients. [ABSTRACT FROM AUTHOR]

Aim: Conventional root resection in periodontally compromised furcation‐involved maxillary molars requires preceding endodontic treatment and is therefore associated with loss of tooth vitality, higher invasiveness, treatment time and costs, and the risk of endodontic complications. Vital root resection (VRR) could overcome these disadvantages while establishing stable periodontal and endodontic conditions. This case series aimed to introduce the concept of one‐stage VRR with radicular retrograde partial pulpotomy (VRRretro). Summary: Seven vital maxillary molars with residual probing pocket depths (PPD) ≥ 6 mm and furcation ≥ class 2 of five patients with stage III/IV periodontitis were treated with VRRretro using mineral trioxide aggregate. Teeth with residual through‐and‐through furcations were additionally tunnelled. Follow‐up up to 2.5 years postoperatively during supportive periodontal care included full periodontal status, percussion and thermal sensitivity testing. Periapical radiographs were obtained to rule out possible periradicular radiolucencies. All seven treated molars were in‐situ at an average of 26.84 ± 5.37 months postoperatively and were clinically and radiographically inconspicuous independent of tooth position, the resected root, the need for tunnelling and the restorative status. The mean PPD on the seven treated molars was 4.02 ± 0.85 mm (6–10 mm) preoperatively and 2.62 ± 0.42 mm (3–4 mm) at the last follow‐up. Clinical attachment level and bleeding on probing could also be decreased. The teeth showed no mobility over time and furcations class 2 were reduced to class 1 while the tunnelled furcations were accessible with interdental brushes. All molars reacted negatively to percussion and positively to thermal sensitivity testing. Key learning points: In carefully selected cases considering patient‐ and tooth‐related factors, VRRretro could be a promising treatment option to establish stable periodontal and endodontic conditions in furcation‐involved maxillary molars while preserving tooth vitality. [ABSTRACT FROM AUTHOR]

• MTA is the gold standard as the biomaterial of choice in vital pulp therapies, however there is growing interest in Biodentine from the scientific community; • When it comes to vital pulp therapies, the literature has received a recent spike in publications, so the date of publication of the article is not directly related to its prestige; • Henry F Duncan and Lars Bjørndal appear as the authors who published the most in the list of the 50 most cited articles in vital pulp therapies; • This work aims to help student and researchers in the field of endodontics as an impressive source of information. The aim of this study was to identify and analyze the most cited articles on vital pulp therapies. Bibliographical data related to the abstract, citations, keywords, and other relevant information was extracted using different combinations of keywords. Further evaluation and visualization of the selected data were performed with the help of various tools, including MS Excel, Microsoft Word, Google open refine, BibExcel, and VOS viewer. An initial search revealed 91 documents, of which 40 were chosen for further analysis. We used the Kolmogorov–Smirnov test and Spearman correlation coefficient test, and our adopted significance level was p < 0.05. In total, the articles received 1,905 citations, with six of them receiving at least 100 citations. Among the top 40 articles, the United States of America (10 articles) and Ireland (6 articles) were the countries with the highest number of cited articles. The journals "Journal of Endodontics" (14 articles; 650 citations) and "International Endodontic Journal" (13 articles; 577 citations) published most of the articles among the 50 most cited ones. Duncan H. was the author with the highest number of works cited (11 articles; 339 citations). Of the articles, systematic reviews accounted for 32%, literature reviews for 14%, in vitro experimental studies for 12%, clinical trials for 8%. Among the biomaterials used in vital pulp therapies, mineral trioxide aggregate (MTA) was discussed in 37 articles (74%), followed by calcium hydroxide, mentioned in 30 studies (60%). Interestingly, the publication year did not demonstrate a significant impact on citation count. The present study provided a detailed list of the top 50 most cited and classic articles on vital pulp therapies. This will help researchers, students, and clinicians in the field of endodontics with an impressive source of information. [ABSTRACT FROM AUTHOR]

Pulp capping treatment cures reversible pulpitis to restore regular pulses without feeling pain. Calcium hydroxide is often used for pulp capping treatment. Nanochitosan is chitosan in nanoparticle. Chitosan has antibacterial and anti-inflammatory properties and fulfills the requirements to be used as a pulp capping material and applied to the wound area. The study was done in vivo in a laboratory using a sample of the Sprague-Dawley mole Sprague Dawley. The study uses four groups: healthy rat groups, reversible pulpitis, given the Ca(OH)2, and the reversible pulpitis group, in which we are given nanochitosan. After 28 days, the BMP-2 and TGF-ß1 levels were measured using ELISA. The results of One-way ANOVA test showed a significant value of <0.001 for BMP-2 level and p=0,016 for TGF-ß1 level. There is a significant difference in the mean level of BMP-2 and TGF-ß1 in the four groups. This study showed that pulpitis reversible rats that received pulp medicament with nanochitosan had higher levels of BMP-2 and TGF-ß1 than those given calcium hydroxide. [ABSTRACT FROM AUTHOR]

Background and Objectives: The present systematic review aims to assess the success rate of the pulp regeneration treatment, according to the American Association of Endodontists (AAE) criteria, using different bioactive materials in permanent teeth of pediatric subjects (6-17 years of age). Materials and Methods: The study protocol was registered on PROSPERO and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The question formulation was accomplished using the PICO model, and an electronic search was carried out on Scopus, MEDLINE/PubMed, Web of Science, and Cochrane databases till April 1, 2023. A total of 30 studies were established to fulfill the inclusion criteria of this systematic review. Results: A total of 273 teeth have been treated with pulp regeneration treatment. By comparing different biomaterials and the success criteria defined by the AAE, the material associated with a higher success rate was found to be the white mineral trioxide aggregate. However, the overall success rate of pulp regeneration treatment was reported for 248 out of 273 teeth (91.20%). Conclusions: Data obtained support the potential that regenerative endodontics aids in continuing root development in permanent immature teeth. Further studies are needed for a more extensive evaluation of the use of different biomaterials and the success rate in regenerative endodontics. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the immunohistochemical effect of hyaluronic acid (HA) on the mineralization rate of the reparative dentin when it is used as a mixing medium with mineral trioxide aggregate (MTA). Materials and Methods: Direct pulp capping (DPC) was performed on 90 teeth from 10 dogs that had been experimentally exposed. The exposed pulps were divided into three groups according to the mixing medium with MTA: Group I: MTA + distilled water (control group), Group II: MTA + hybrid cooperative complex HA (HCC-HA), Group III: MTA + high molecular weight HA (HMW-HA). After pulp capping, all cavities were restored with final restoration. The dogs were divided randomly into five groups (two dogs each) according to the evaluation periods (7, 14, 21, 30, and 60) days. At the end of the study, the dogs were euthanized, and the sampled teeth were processed for immunohistochemical investigation. Results: Both types of HA (HCC-HA, HMW-HA) showed an increase in the expression of alkaline phosphatase (ALP) at a higher rate than using distilled water with MTA. Conclusions: Within the limitations of this study, HA proved to be an effective additive to MTA for DPC. [ABSTRACT FROM AUTHOR]

Pediatric dentistry plays a critical role in ensuring the oral health and well-being of children and adolescents. The quest for effective dental materials that are safe, biocompatible, and capable of promoting natural remineralization has led to the emergence of biosilicate cements as a promising advancement in this field. Biosilicate cements are bioactive materials composed of amorphous silica, calcium oxide, phosphorus pentoxide, and other trace elements. The bioactivity of biosilicate cements allows them to interact with living tissues, promoting remineralization and stimulating the formation of hydroxyapatite, a vital component of teeth and bones. Their ability to release essential ions, such as calcium, phosphate, and fluoride, supports the natural healing processes, aiding in the preservation of pulp vitality and reducing the risk of secondary caries. Biosilicate cements offer versatility in pediatric dentistry, finding application indirect pulp capping, indirect pulp capping, and small-sized restorations. Their rapid setting time proves advantageous when treating young patients with limited cooperation. Furthermore, the continuous release of fluoride contributes to caries prevention and enhances the long-term oral health of children. While the advantages of biosilicate cements in pediatric dentistry are promising, this manuscript also discusses the limitations and challenges associated with their use. Some biosilicate cements may have different handling characteristics compared to traditional materials, necessitating adaptations in clinical techniques. In addition, long-term clinical data on the performance of these materials in pediatric patients are still limited, requiring further research to establish their efficacy and longevity. This manuscript explores the potential of biosilicate cements in pediatric dentistry. [ABSTRACT FROM AUTHOR]

This study aimed to develop gelatin methacryloyl (GelMA)-injectable hydrogels incorporated with 58S bioactive glass/BG-doped with strontium for vital pulp therapy applications. GelMA hydrogels containing 0% (control), 5%, 10%, and 20% BG (w/v) were prepared. Their morphological and chemical properties were evaluated by scanning electron microscopy/SEM, energy dispersive spectroscopy/EDS, and Fourier transform infrared spectroscopy/FTIR (n = 3). Their swelling capacity and degradation ratio were also measured (n = 4). Cell viability (n = 8), mineralized matrix formation, cell adhesion, and spreading (n = 6) on DPSCs were evaluated. Data were analyzed using ANOVA/post hoc tests (α = 5%). SEM and EDS characterization confirmed the incorporation of BG particles into the hydrogel matrix, showing GelMA's (C, O) and BG's (Si, Cl, Na, Sr) chemical elements. FTIR revealed the main chemical groups of GelMA and BG, as ~1000 cm−1 corresponds to Si-O and ~1440 cm−1 to C-H. All the formulations were degraded by day 12, with a lower degradation ratio observed for GelMA+BG20%. Increasing the concentration of BG resulted in a lower mass swelling ratio. Biologically, all the groups were compatible with cells (p > 0.6196), and cell adhesion increased over time, irrespective of BG concentration, indicating great biocompatibility. GelMA+BG5% demonstrated a higher deposition of mineral nodules over 21 days (p < 0.0001), evidencing the osteogenic potential of hydrogels. GelMA hydrogels incorporated with BG present great cytocompatibility, support cell adhesion, and have a clinically relevant degradation profile and suitable mineralization potential, supporting their therapeutic potential as promising biomaterials for pulp capping. [ABSTRACT FROM AUTHOR]

Aim: This clinical trial aimed to compare the clinical success of coronal pulpotomy and indirect pulp capping (IPC) in managing symptomatic deep proximal caries in molars with moderate pulpitis over a 12-month period. Materials and Methods: A total of 108 vital mature permanent molars with moderate pulpitis were randomly allocated to the IPC (n = 54) or coronal pulpotomy group (n = 54). Dycal and Biodentine were used as pulp-capping materials, followed by composite restoration. The absence of periapical infection and asymptomatic teeth that positively responded to the cold pulp sensitivity test (only in IPC) was considered posttreatment success at 12 months. Data from the study were analyzed using the Chi-square test and Kaplan-Meier survival analysis. Results: There was a statistically significant difference between preoperative symptoms and the cold pulp sensibility test response (P = 0.000), indicating an association between symptoms and pulp sensibility. The average remaining dentine thickness (RDT) value was 0.48 ± 0.5 mm, with no statistically significant difference found between the location of caries and RDT (P = 0.084, P > 0.05). Compared to the IPC group, the pulpotomy group had a greater number of patients at 12 months after treatment that required no intervention. The Kaplan-Meier survival analysis revealed that the mean survival duration for pulpotomy was 48 weeks, and for IPC, it was 42.3 ± 2.35 weeks. Conclusion: Coronal pulpotomy with Biodentine proved more effective in reducing symptoms, achieving radiographic success, and ensuring tooth survival compared to IPC with calcium hydroxide. [ABSTRACT FROM AUTHOR]

The main purpose of vital pulp therapy (VPT) is to preserve the integrity and function of the pulp. A wide variety of materials and techniques have been proposed to improve treatment outcomes, and among them, the utilization of lasers has gained significant attention. The application of lasers in different stages of VPT has witnessed remarkable growth in recent years, surpassing previous approaches. This study aimed to review the applications of lasers in different steps of VPT and evaluate associated clinical and radiographic outcomes. An electronic search using Scopus, MEDLINE, Web of Science and Google Scholar databases from 2000 to 2023 was carried out by two independent researchers. The focus was on human studies that examined the clinical and/or radiographic effects of different laser types in VPT. A total of 4243 studies were included in this narrative review article. Based on the compiled data, it can be concluded that although current literature suggests laser may be proposed as an adjunct modality for some procedural steps in VPT, more research with standardized methodologies and criteria is needed to obtain more reliable and conclusive results. [ABSTRACT FROM AUTHOR]

Study Design: Cross-sectional Objective: This study aimed to assess the dentist's awareness and knowledge about the application of Photobiomodulation in restorative dentistry and endodontics. Methods: A cross-sectional study was carried out on a total number of 300 dental surgeons (Male=150; Female=150) was participated in the study with age ranges from 20- to 55-year-old to know the knowledge, attitude, and perception among dentists about the application of Photobiomodulation in restorative dentistry and endodontics. Convenience sampling method was followed in this study. The Questionnaire was given and data was collected from dental surgeon. The data were entered and analyzed using the Statistical Package for the Social Sciences (SPSS 20). A P-value of less than 0.05 was considered to be statistically significant. Results: The majority of participants, 267(89%) were said that they using dental Photobiomodulation therapy (lasers) in your practice. 255(85%) agreed that they have received proper training to use dental lasers. Of the 300 dentists investigated, when asked about the various applications of Photobiomodulation in restorative dentistry and endodontics procedures, following are the response of participants to direct pulp capping (26%), dentinal hypersensitivity (21%), teeth bleaching (36%), postoperative sensitivity in restorations (5%) and regenerative endodontic procedures (12%). Conclusions: In conclusion, dental laser education is an important aspect of a dentist's training and ongoing professional development. It enables dentists to stay current with technology, offer advanced treatment options to their patients, and provide safer and more efficient dental care. [ABSTRACT FROM AUTHOR]

Dental biomaterials are commonly used in vital pulp therapy to protect dentin against degradation. However, the protection role of the ions diffusing in affected dentin in indirect pulp capping remains not fully understood due to the limitations of experimental techniques to validate it at the atomic scale. In this study, molecular dynamics (MD) is used for studying two bioactive materials, during mineral apatite formation and remineralization. LAMMPS code with DREIDING Force Field and Universal Force-Fields (UFF) simulated the behaviour of calcium hydroxide and mineral trioxide aggregate in the tooth structure in the oral environment. The comparison of the physical parameters provided by the simulation is discussed in detail to explore the possibilities of crystallization depending on potential energy, lattice constant, XRD pattern, atomic volume and radius of gyration. MD results show that the crystallization process occurs in both materials after about 10 ns, at 310 K and 1 bar. [ABSTRACT FROM AUTHOR]

This study aims to investigate the ability of umbilical cord mesenchymal stem cells (UC-MSC) to enhance the regeneration of pulp-dentin complex in immature permanent teeth with irreversible pulpitis. A total of 32 mandibular premolar teeth with immature apices in 5 dogs were used in this in-vivo randomized controlled trial (RCT). Eight healthy teeth without pre-existing pathosis served as the positive control samples and received no treatment, while in another 8 teeth, the pulp was completely extirpated (negative control). Class V cavities were prepared to induce inflammation in the remaining 16 teeth (groups 3 and 4) and the pulp was extirpated 2-4 mm short of the radiographic apex. Of the 16, the 8 teeth in group 4 received 1 mL of cord blood stem cells with a hydrogel scaffold. Blood clots were covered with mineral trioxide aggregates at the cementoenamel junction in the experimental groups, and teeth were filled with RMGI and composite. Three months later, block sections were removed for histologic evaluations for the evaluation of postoperative apical closure, degree of inflammation, and presence of normal pulp tissue. The data were statistically analyzed with the chi-square test (P <.05). All teeth with complete pulp extirpation demonstrated pulpal necrosis with no postoperative closure of their apices, while apical closure was seen in all the teeth in the remaining groups. There was a statistically significant (P <.001) difference in the presence of inflammation and normal pulp tissue between the experimental groups. The teeth in group 3 showed normal pulp tissue extending to the level of MTA, but there was inflammation within the canal space. In contrast, the teeth in the UC-MSC group demonstrated organized, normal pulp tissue with no inflammation. Based on these results, the regeneration of the pulp-dentin complex is possible with no inflammation when UC-MSCs are used and 2-4 mm of the apical pulp remains intact in immature teeth with irreversible pulpitis. [ABSTRACT FROM AUTHOR]

Preserving vital pulp in cases of dental pulpitis is desired but remains challenging. Previous research has shown that bioactive glass (BG) possesses notable capabilities for odontogenic differentiation. However, the immunoregulatory potential of BG for inflamed pulp is still controversial, which is essential for preserving vital pulp in the context of pulpitis. This study introduces a novel approach utilizing polydopamine-coated BG (BG-PDA) which demonstrates the ability to alleviate inflammation and promote odontogenesis for vital pulp therapy. In vitro, BG-PDA has the potential to induce M2 polarization of macrophages, resulting in decreased intracellular reactive oxygen species levels, inhibition of pro-inflammatory factor, and enhancement of anti-inflammatory factor expression. Furthermore, BG-PDA can strengthen the mitochondrial function in macrophages and facilitate odontogenic differentiation of human dental pulp cells. In a rat model of pulpitis, BG-PDA exhibits the capacity to promote M2 polarization of macrophages, alleviate inflammation, and facilitate dentin bridge formation. This study highlights the notable immunomodulatory and odontogenesis-inducing properties of BG-PDA for treating dental pulpitis, as evidenced by both in vitro and in vivo experiments. These results imply that BG-PDA could serve as a promising biomaterial for vital pulp therapy.

AimTo assess clinically and histologically the efficacy of TheraCal LC and Biodentine as Direct Pulp Capping agents. Materials and MethodSixty caries-free maxillary first premolar teeth which were scheduled for orthodontic extraction were selected for the study and were divided equally into Group 1 (Theracal LC) and Group 2 (Biodentine). Thermal and electric pulp testing was performed on the teeth to assess pulp vitality followed by tooth preparation to expose pulp horns under local anesthesia. After achieving hemostasis, the direct pulp capping agent was placed and composite restoration was done. All the teeth were evaluated and compared in terms of clinical and histological findings after 6 weeks. The statistical analysis used was the Kruskal-Wallis test. ResultsTeeth with Theracal LC showed no sensitivity to heat, cold, or percussion, whereas sensitivity to heat, cold, or percussion was noted with Biodentine. Histological evaluation revealed that TheraCal LC has higher efficiency in complete dentin bridge formation, had maximum dentin thickness, and showed minimal or no pulpal disorganization and pulpal inflammation as compared to Biodentine. ConclusionTheraCal LC proves to be a promising future as a direct pulp capping agent.

Abstract Background The aim of the present study was to investigate the micro-shear bond strength (µSBS) of various restorative materials applied on two different fast-setting calcium silicate-based materials and to evaluate the effect of restoration time on µSBS. Methods A total of 180 acrylic blocks with a cavity in the center were randomly divided into 2 main groups according to the capping material to be used (Biodentine or RetroMTA). The specimens were also randomly divided into 3 groups according to the restoration time (3 min, 12 min, 24 h). After the specified waiting periods, glass hybrid material (EQUIA Forte HT), resin composite (Filtek Z550) and light-cured calcium silicate material (Theracal LC) were placed on the specimens with tygon tubes. The specimens were kept for 24 h and then subjected to µSBS test. Statistical analysis was performed by 3-way ANOVA followed by Tukey test for pairwise comparisons (α = 0.05). Results There is a statistically significant difference (p 12 min > 3 min). The µSBS obtained for the Biodentine-resin composite at the end of the 3 min setting time is significantly lower (p