Discriminatory performance of the pulpal inflammatory biomarkers; Interleukin-8 and TNF-α in patients with symptoms indicative of reversible and irreversible pulpitis: A diagnostic accuracy study.

AIM: The success of vital pulp treatment (VPT) procedures is dependent on an accurate diagnosis of the pulpal inflammatory condition. Compared with current subjective pulpal diagnostic tests, inflammatory molecular biomarkers involved in the pathogenesis of pulpitis represent potential objective indicators of the degree of pulpal inflammation. Therefore, the aim of this study was to quantify level of inflammatory biomarkers - Interleukin 8 (IL-8) and TNF-α in patients diagnosed with reversible pulpitis (RP), irreversible pulpitis (IR) and normal pulp (NP) and investigate their diagnostic accuracy in differentiating between healthy and inflamed conditions. METHODOLOGY: This prospective, cross-sectional study enrolled 72 patients aged 14-53 years with extremely deep carious lesions after establishing a clinical diagnosis of RP (n = 42), symptomatic IR (n = 22) and NP (n = 8). 50 µL of pulpal blood sample was collected from all the patients using a micropipette after pulpal exposure. The level of IL-8 and TNF-α was assessed in pg/mL using enzyme-linked immunosorbent assays. Mann-Whitney U test was applied to establish the association between IL-8/TNF-α level and degree of pulp inflammation. Receiver operating curve (ROC) analysis was carried out to calculate area under the curve (AUC) for RP versus IR. Cut-off values were established using Youden's index. RESULTS: IL-8 and TNF-α levels differed significantly between RP and IR groups (p ≤ .001). The median value of IL-8 in RP and IP groups was 259.8 pg/mL [187.5-310.0] and 1357.8 pg/mL [1036.7-2177.6] respectively. The AUC-ROC curve for RP versus IR was 0.997 with 95.5% sensitivity and 99.76% specificity. The median value of TNF-α in RP and IR groups was 75.4 pg/mL [62.7-95.8] and 157.6 pg/mL [94.1-347.3]. The AUC-ROC curve for TNF-α was 0.812 with a sensitivity and specificity of 59.1% and 92.1%, respectively. IL-8 and TNF-α levels were below detection levels for all NP samples. CONCLUSION: This study showed that pulpal blood could provide an excellent medium for establishing pulpal diagnosis under extremely deep carious lesions. The selected cytokines, IL-8 and TNF-α, demonstrated excellent discriminatory performance for reversible and irreversible pulpitis. Future studies should correlate the IL-8/TNF-α levels with VPT treatment outcomes.

Outcome of partial and full pulpotomy in cariously exposed mature molars with symptoms indicative of irreversible pulpitis: A randomized controlled trial.

AIM: The aim of this study was to assess and compare the clinical and radiographic outcome of partial pulpotomy and full pulpotomy using Biodentine in cariously exposed mature molar teeth with symptoms indicative of irreversible pulpitis. METHODOLOGY: This study is an unicentric, double-arm, randomized superiority clinical trial with parallel experimental groups, registered under CTRI (CTRI/2019/12/022559). Fifty mature permanent molar teeth with carious exposures with symptoms indicative of irreversible pulpitis were randomly allocated equally into two groups. Partial pulpotomy (PP) and full pulpotomy (FP) were performed in the first and second group, respectively, following standardized protocols. Exposed pulp tissue was removed up to a depth of 2-3 mm for partial pulpotomy, whereas complete coronal pulp tissue was removed up to the level of root orifices for full pulpotomy. Haemostasis was achieved with placement of 2.5% sodium hypochlorite-moistened cotton pellets placed on amputated pulp tissue for a maximum of 10 min. Biodentine was used as the pulp capping material. Pain scores were evaluated using 11-point Visual Analogue Scale (VAS) preoperatively, at 24 h, 48 h and 7th day after the intervention(s). Clinical and radiographic evaluation was done at 3 months, 6 months and 1 year. The data were statistically analysed using chi-squared test, Mann-Whitney U-test, Friedman's test and Wilcoxon signed-rank test. The significance level was pre-determined at p < .05. Cumulative survival probabilities were assessed at 12 months using Kaplan-Meier analysis. RESULTS: Intra-group analysis of pain scores revealed significant reduction in pain scores preoperatively and at 24 h, 48 h and 7th day in both the groups. However, the difference in the pain score(s) reduction between both the groups was not statistically significant at any time interval (p > .05). At 1-year follow-up, the success rate was 88% (22/25) and 91.6% (22/24) for PP and FP respectively (p > .05). CONCLUSIONS: Partial pulpotomy showed comparable results to full pulpotomy in terms of clinical/radiographic treatment outcome. If the long-term results remain the same, partial pulpotomy can be proposed as an alternative treatment modality for mature teeth with cariously exposed pulp tissue presenting with signs of symptomatic irreversible pulpitis.

Effect of revascularisation and apexification procedures on biomechanical behaviour of immature maxillary central incisor teeth: a three-dimensional finite element analysis study.

OBJECTIVES: This study aimed to assess the effects of revascularisation and apexification procedures on biomechanical behaviour of immature teeth using 3-dimensional finite element analysis (3D FEA). MATERIALS AND METHODS: Five 3D FEA permanent maxillary incisor models were developed from CBCT scans and available literature data: Model MT: Mature tooth, Model IT: Immature tooth (Cvek's stage 3), Model AT: Apexified tooth-mineral trioxide aggregate (MTA) apexification, Model RTB: Revascularised tooth with blood, and Model RTS: Revascularised tooth with supplementary scaffold. Using FEA, a masticatory load of 240N at 120° was simulated, and the Von Mises and maximum principal stresses within the models were evaluated. Failure index (FI) and weakening% were also calculated for each model. RESULTS: On dentinal stress analysis, model MT (96.16MPa) and IT (158.38MPa) had lowest and highest stress values, respectively. Among the experimental groups, model RTS (131.12MPa) had lower stresses than AT (136.33MPa) and RTB (133.7MPa), with no significant difference among the three. Peak dentinal stresses in all the models were observed in the cervical third of the root and near the apical opening in model IT. The extent of high dentinal stress area in model RTB and RTS was lesser than that of AT. The FI and weakening% values were highest for model AT followed by RTB and RTS, among the experimental groups. However, all these treatments strengthened an immature tooth by more than 20%. CONCLUSIONS: AT, RTB, and RTS treatments lowered the stress values and risk of fracture in immature teeth with no significant difference among the three groups. CLINICAL RELEVANCE: Stress distribution evaluation following revascularisation/apexification was essential, with potential to influence clinical decision-making. MTA apexification and revascularisation with blood clot/supplementary scaffold lowered the stresses in immature teeth, with no significant difference among the three.

Novel application of a calcium silicate‒based cement and platelet-rich fibrin in complex endodontic cases: a case series.

Three-dimensional sealing of root canals is essential for long-term endodontic success. It is sometimes difficult to achieve a fluid-tight seal in cases such as furcation defects, resorption lesions, open apices, and root fractures. Such cases require restorative materials that not only are biocompatible and well accepted by the surrounding periodontium but also will set in the wet oral environment without losing their properties. This case series describes management of an open apex, a furcal perforation, and a horizontal root fracture with a bioactive calcium silicate‒based cement (Biodentine) as root repair material. To prevent extrusion of the cement, platelet-rich fibrin was used as an external matrix. The patients were followed for 2-3 years, and the teeth demonstrated remarkable healing.

The influence of calcium silicate-based cement on osseous healing: A systematic review and meta-analysis.

Objectives: The purpose of this systematic review was to analyze the effect of commercially available calcium silicate-based bioactive endodontic cement (BEC) on treatment outcome when used as root repair material in human permanent teeth and to compare it with traditional materials. Methods: PubMed, Embase, and Cochrane Library were searched until June 2020. Randomized clinical studies and observational studies with a minimum 1-year follow-up and sample size of at least 20 were included. Risk of bias (ROB) was assessed using Cochrane's ROB tool and the National Institutes of Health Quality Assessment Tool. Results: Thirty-nine studies were included in the systematic review. Majority of the studies used mineral trioxide aggregate. The pooled success rate for BEC was estimated by a random-effects method as 90.49% (95% confidence interval [CI]: 88.4992.34, I2 = 54%). Eleven studies comparing BEC with traditional materials were included in the meta-analysis. The use of BEC significantly improved the treatment outcome when compared to traditional materials with odds ratio (OR) = 2.15 (95% CI: 1.57-2.96, I2 = 0.8%, P = 0.433). Conclusion: Very low-to-moderate-quality evidence suggests that the use of BEC as root repair material enhanced the treatment outcome. High-quality studies are required for the newer BEC to establish their clinical performance. Registration: PROSPERO CRD42020211502.

Evaluation of Endosequence Root Repair Material and Endocem MTA as direct pulp capping agents: An in vivo study.

The study aimed to assess the human pulpal response to direct pulp capping using Endosequence Root Repair Material (ERRM) and Endocem MTA against ProRoot MTA as control. Intentional direct pulp capping was done using the three materials in 30 caries-free human premolars. After 30 days, the teeth were extracted, fixed and decalcified. Sections were prepared for histologic examination using light microscopy. Thickness and quality of dentine bridge formed and level of inflammation were evaluated. Difference between dentine bridge thickness of the three groups was statistically significant. Mean thickness of dentine bridges formed in ProRoot MTA group was greater than other two groups, and difference was statistically significant. Difference in dentine bridge thickness between ERRM and Endocem MTA was statistically significant. No significant difference was observed between the 3 groups with respect to inflammation. Results indicate ProRoot MTA performed best with ERRM giving better results than Endocem MTA.

Microscopic and elemental characterization of hydrated dental pulp capping agents.

Context: Characteristics of dental pulp capping agents may influence its interaction with the pulpal cells and can impact the treatment outcome. Aims: This study aims to microscopically characterize various pulp capping agents following hydration. Settings and Design: Original research. Materials and Methods: Disk-shaped specimens of five calcium silicate-based materials, i.e., mineral trioxide aggregate (MTA) Angelus, Biodentine, TheraCal LC, ApaCal ART, and Endocem MTA were prepared. After final set, the materials were immersed in 10 mL of deionized water for 14 days at 37°C. The set materials were characterized by scanning electron microscopy (SEM), X-ray energy dispersive analysis (EDX), and X-ray diffraction (XRD) analysis along with pH analysis of the storage solution using pH meter. Results: On SEM analysis, all the materials showed crystalline deposition on the cement surface with Biodentine exhibiting the most dense and homogenous microstructure. Calcium-silicate-hydrate and calcium hydroxide (CH) were observed as dark-grey and light-grey matrix material, respectively. EDX analysis revealed a high concentration of calcium. The other major elements were oxygen and carbon. The surface calcium concentration in the tested specimens was as follows: Biodentine (42.59 wt.%) > MTA Angelus (38.51wt.%) > Endocem MTA (30.24wt.%) > TheraCal LC (27.51wt.%) > ApaCal ART (22.02wt.%). On XRD analysis, all the materials exhibited peaks for tricalcium silicate and CH, after 14 days of hydration. Conclusions: The higher surface calcium level in Biodentine and MTA Angelus may enhance reparative dentin formation. The surface calcium concentration of Endocem MTA and ApaCal ART was found to be lesser than that of MTA Angelus, but with the added advantage of fast-setting property. Hence, they are potential alternative materials for vital pulp therapy.

Endodontic management of mandibular second molar fused to odontome with 12-month follow-up using cone beam computed tomography: A case report.

Fusion is a developmental anomaly characterised by the union of two adjacent teeth or tooth-like substance. Odontomes are malformation of the dental tissue which arise during normal tooth development. They are usually asymptomatic but often associated with tooth eruption disturbance. In this paper, we report a rare case of fusion involving permanent mandibular second molar with an odontome, which led to a partial eruption of the molar as well as its devitalisation. Successful endodontic management was carried out in this case with a supplementary disinfection procedure using XP Endo finisher (FKG Dentaire, La Chaux-de-Fonds, Switzerland). The use of high-end diagnostic imaging modalities such as cone beam computed tomography (CBCT) helped in making a confirmatory diagnosis; determining the treatment plan before undertaking the actual treatment; for better understanding of the fused tooth's complicated root morphology; and for its effective management and to follow up this unusual case for 12 months.

Comparative Evaluation of Dentinal Microcrack Formation before and after Root Canal Preparation Using Rotary, Reciprocating, and Adaptive Instruments at Different Working Lengths-A Micro-computed Tomographic Study.

INTRODUCTION: This study aimed to compare root dentinal microcrack formation after root canal shaping using rotary, reciprocating, and adaptive instruments at different working lengths using micro-computed tomographic imaging. METHODS: One hundred eighty extracted mature mandibular molar mesial roots with 2 separate canals were selected. The mesial roots were resected at the cementoenamel junction and randomly divided into 4 groups (n = 45) based on the nickel-titanium file system used: ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland), ProTaper Gold (Dentsply Maillefer), Twisted File Adaptive (SybronEndo, Orange, CA), and Reciproc Blue (VDW, Munich, Germany). Each of the 4 groups were then subdivided into 3 groups (n = 15) depending on the working length used for root canal preparation (ie, instrumentation 1 mm short, flush, and 1 mm beyond the major apical foramen). The roots were imaged with micro-computed tomographic scanning before and after root canal preparation. The cross-sectional images generated were screened to detect the presence of new microcracks. RESULTS: The ProTaper Universal system significantly increased the number of postinstrumentation microcracks at all working lengths (P ≤ .05). No significant increase (P > .05) in postinstrumentation microcracks was observed in the ProTaper Gold, Twisted File Adaptive, or Reciproc Blue groups. CONCLUSIONS: Rotary instrumentation induced a higher number of dentinal microcracks compared with reciprocating and adaptive instruments. Instrumentation at different working lengths did not significantly influence the formation of dentinal microcracks.

Evaluation of apical extrusion and cone-beam computed tomography assessment of irrigant penetration in oval-shaped canals, using XP Endo Finisher and EndoActivator.

BACKGROUND: Thorough cleaning of the pulp space is a challenging task. The mechanical instrumentation alone is usually not sufficient to completely debride the canals, and therefore, it requires the chemical action of irrigants also to disinfect the difficult to reach areas. AIM: The purpose of this study was to determine apical extrusion and assess irrigant penetration through cone-beam computed tomography (CBCT) for EndoActivator (EA) and XP Endo Finisher (XP). MATERIALS AND METHODS: Sixty single-rooted mandibular premolars with oval-shaped canals were equally divided into three groups after instrumentation, based on the final irrigation: Group-1 syringe needle (30G Max-I-probe), Group-2 EA, and Group-3 XP. After the final irrigation, the weight of the extruded sodium hypochlorite was calculated. The prepared canals were then irrigated with a radiopaque contrast medium, which was activated according to the group of the sample (Group-1, 2, or 3). The volume of irrigant filled in the canal, especially in the apical third was determined through special tools in CBCT imaging. STATISTICS: One-way ANOVA test was used to compare the different groups. RESULTS AND CONCLUSION: Significantly more apical extrusion was seen in XP (P < 0.001). Both XP and EA have shown complete penetration of irrigant in the canal (100%).

Assessment of Quality of Root Canal Filling with C Point, Guttacore and Lateral Compaction Technique: A Confocal Laser Scanning Microscopy Study.

OBJECTIVE: The purpose of this in vitro study was to compare the quality of root canal filling of C Point, GuttaCore and lateral compaction using confocal laser scanning microscopy. METHODS: Ninety recently extracted human mandibular incisors with single canal were selected. Canals were prepared with ProTaper instruments to size F3 and obturated using C Point, GuttaCore or lateral compaction technique. Endosequence BC sealer was labeled with Rhodamine B dye to allow analysis under a confocal microscope. The percentages of gutta-percha filled area (PGFA), sealer filled area (PSFA), voids (POV) and interfacial adaptation (IA) was assessed at 2, 5 and 8 mm from the apex, using image analysis software. Kruskal-Wallis followed by Mann Whitney U tests were used for data analysis, and the P value was set at 0.05 (P=0.05). RESULTS: No significant difference was seen among the three groups at 2 mm level for PGFA, PSFA and voids (P>0.05). At 5 and 8 mm levels, canals filled with GuttaCore had significantly higher PGFA and lower PSFA than lateral compaction and C Point. Highest POV was seen for lateral compaction group followed by C Point and GuttaCore. CONCLUSION: Out of the three techniques examined, best results in terms of quality of root canal filling were observed for GuttaCore. C Point system was found to be associated with internal defects such as tears and delamination which may adversely affect the long term performance of this system.

Comparative evaluation of the effectiveness of ultrasonic tips versus the Terauchi file retrieval kit for the removal of separated endodontic instruments.

OBJECTIVE: The aim of this study was to perform a comparative evaluation of the effectiveness of ultrasonic tips versus the Terauchi file retrieval kit (TFRK) for the removal of broken endodontic instruments. MATERIALS AND METHODS: A total of 80 extracted human first mandibular molars with moderate root canal curvature were selected. Following access cavity preparation canal patency was established with a size 10/15 K-file in the mesiobuccal canals of all teeth. The teeth were divided into 2 groups of 40 teeth each: the P group (ProUltra tips) and the T group (TFRK). Each group was further subdivided into 2 smaller groups of 20 teeth each according to whether ProTaper F1 rotary instruments were fractured in either the coronal third (C constituting the PC and TC groups) or the middle third (M constituting the PM and TM groups). Instrument retrieval was performed using either ProUltra tips or the TFRK. RESULTS: The overall success rate at removing the separated instrument was 90% in group P and 95% in group T (p > 0.05) The mean time for instrument removal was higher with the ultrasonic tips than with the TFRK (p > 0.05). CONCLUSION: Both systems are acceptable clinical tools for instrument retrieval but the loop device in the TFRK requires slightly more dexterity than is needed for the ProUltra tips.

Influence of Final Apical Width on Smear Layer Removal Efficacy of Xp Endo Finisher and Endodontic Needle: An Ex Vivo Study.

Objective: Chemical disinfection along with mechanical instrumentation, is required to achieve debridement, especially in apical third of root canal. Thus, this study aimed to compare the influence of final apical width on the smear layer removal efficacy of XP Endo Finisher and Endodontic Needle, in mandibular premolars. Methods: 40 single-rooted mandibular premolars were included in the study, prepared using K3 XF rotary files (SybronEndo, Orange, CA). The samples were equally divided into 4 groups: Group 1: Master apical file 30/0.06 taper, final irrigation with endodontic needle (30G Max I probe, Dentsply International, York PA); Group 2: Master apical file 40/0.06 taper, final irrigation with endodontic needle; Group 3: Master apical file 30/0.06 taper, final irrigation with XP-Endo Finisher (FKG Dentaire, La Chaux-de-Fonds, Switzerland); Group 4: Master apical file 40/0.06 taper, final irrigation with XP-Endo Finisher. Smear layer and debris scores were given using SEM. Results: Group 3 and 4 performed significantly better than group 1 & 2 (P<0.05). No significant difference was observed in Group 1&2 (P>0.05); and Group 3&4 (P>0.05). Significantly higher scores were observed in the apical third, as compared to other sections of the root canal, in all the 4 groups. Conclusion: Increase in the final apical width did not significantly improve root canal cleanliness for both XP Endo Finisher and endodontic needle. However, XP endo finisher proved to be significantly better than the endodontic needle.

Long-term follow-up of traumatized immature necrotic permanent teeth treated with regenerative endodontic protocol using platelet-rich fibrin: A prospective case series.

The purpose of this prospective case series was to report the long-term clinical and radiographic outcomes of regenerative endodontic procedures (REP) using platelet-rich fibrin (PRF), in traumatized immature permanent teeth with necrotic pulps. Six immature necrotic permanent maxillary central incisors from six patients were treated with REP supplemented with PRF. Patients were recalled at 6, 12, 18, 24, 36, 48, and 60 months. Radiographic changes in the radiographic root area (RRA), apical diameter, root thickness, and root length were quantified. Clinically, tooth survival in terms of tooth retention in the arch and absence of any sign and symptoms of endodontic pathology were noted. All the teeth survived and met the clinical criteria for success throughout the follow-up period. Follow-up radiographs at 5 years revealed complete resolution of the periapical lesions in all patients and the average apical diameter decrease was 30.96%. An average increase of 13.18% for root length, 40.20% for root thickness, and 26.35% for RRA were noted.

Effect of acid etching on the micro-shear bond strength of resin composite-calcium silicate interface evaluated over different time intervals of bond aging.

INTRODUCTION: With the introduction of calcium silicate materials, pulp capping procedure has been simplified due to their therapeutic pulp capping capabilities and ability to be used as a provisional bulk restorative material simultaneously. The quality of the adhesive bond between these cements and composite is of clinical significance with regard to the longevity of the final laminate restoration. Thus, this study aims to compare the in vitro microtensile bond strengths of resin composite to different calcium silicate cements versus glass ionomer cement (GIC). MATERIALS AND METHODOLOGY: Resin composite was bonded to standardized disks of Biodentine, mineral trioxide aggregate (MTA), and GIC. The samples were divided into the following three groups, and each group was further divided into two subgroups based on the aging time (1 and 2 weeks) of the samples: (1) Group 1 - phosphoric acid etching on Biodentine. (2) Group 2 - phosphoric acid etching on MTA. (3) Group 3 - phosphoric acid etching on GIC. After bond aging, the microtensile bond strength was analyzed using the Instron universal testing machine. RESULTS: There was no significant difference in micro-SBS between 1- and 4-week bond aging of MTA and Biodentine group, while a significant decrease is seen in the GIC group. CONCLUSION: Calcium silicate cements are weak in the early setting phase. Thus, placing the overlying composite is best delayed for at least 2 weeks to allow adequate maturation of the material.

Evaluation of remineralization potential and mechanical properties of pit and fissure sealants fortified with nano-hydroxyapatite and nano-amorphous calcium phosphate fillers: An in vitro study.

OBJECTIVES: The aim of this study was: (i) to formulate pit and fissure sealants (PFS) containing nano-hydroxyapatite (nHAP) filler; nHAP filler and silica co-filler; nHAP and nano-Amorphous Calcium Phosphate (nACP) co-filler, (ii) to evaluate physical properties; degree of conversion (DOC), curing depth (CD) and mechanical properties; microshear bond strength (MBS) of fortified PFS, and (iii) to assess remineralization potential and release of Ca2= and PO4 ions from newly synthesized sealants. MATERIALS AND METHODS: Four PFS were prepared using monomers with mixture of 35.5 wt % BisGMA, 35.5 wt % triethylene glycol dimethacrylate and 28 wt % hydroxyethyl methacrylate. Bioactive nanofillers (nHAP and n-ACP) were added in various concentrations (0%-30%). Three commercial sealants were used as follows: unfilled (Clinpro; 3M ESPE), Fluoride releasing (Delton FS plus, Dentsply), ACP filled (Aegis, Bosworth). The samples (n = 35.5/gp) were tested for MBS, DOC, and CD. Remineralization potential was assessed by scanning electron microscopy (SEM). The concentrations of Ca2= and PO4 released from the sealant specimens were analyzed with Ultraviolet-visible Spectrophotometer. Data obtained was statistically analyzed (one-way analysis of variance, Tukey's test, P < 0.05). RESULTS: 10% hydroxyapatite (HAP) =20% ACP sealant showed significantly higher DOC. A remineralized region on the surface between fissure sealant and tooth enamel was observed by SEM in all three HAP filled bioactive sealants. Decreasing the solution pH significantly increased ion release from sealant filled with 10% nHAP = 20% nACP (P ≤ 0.001). CONCLUSION: Results suggested that admixture of nHAP and nACP to PFS showed remineralizing capability, without declining their mechanical and physical properties.

Evaluation of retention and fracture resistance of different fiber reinforced posts: An in vitro study.

AIM: The aim of this study was to evaluate retention & fracture resistance of different fibre posts. METHODOLOGY: 90 extracted human permanent maxillary central incisors were used in this study. For retention evaluation, after obturation, post space preparation was done in all root canals and posts were cemented under three groups. Later, the posts were grasped & pulled out from the roots with the help of a three-jaw chuck at a cross-head speed of 5mm/min. Force required to dislodge each post was recorded in Newtons. To evaluate the fracture behavior of posts, artificial root canals were drilled into aluminium blocks and posts were cemented. Load required to fracture each post was recorded in Newtons. RESULTS: The results of the present study show the mean retention values for Fibrekleer Parallel post were significantly greater than those for Synca Double tapered post & Bioloren Tapered post. The mean retention values of the Double tapered post & the tapered post were not statistically different. The Synca Double tapered post had the highest mean load to fracture, and this value was significantly higher than those of FibreKleer Parallel & Bioloren Tapered post. The mean fracture resistance values of Parallel & tapered post were not statistically different. CONCLUSIONS: This study showed parallel posts to have better retention than tapered and double tapered posts. Regarding the fracture resistance, double tapered posts were found to be better than parallel and tapered posts.

Evaluation of Biocompatibility and Osteogenic Potential of Tricalcium Silicate-based Cements Using Human Bone Marrow-derived Mesenchymal Stem Cells.

INTRODUCTION: The success of endodontic regeneration lies in the appropriate combination of stem cells and bioactive materials. Several novel dental materials are available on the market in this regard. Hence, the current study aimed to evaluate the proliferation, differentiation, and osteogenic potential of human bone marrow-derived mesenchymal stem cells (hBMSCs) onto biomaterials like ProRoot MTA (MTA; Dentsply Tulsa Dental, Tulsa, OK), Biodentine (BD; Septodont, Saint Maur de Fosses, France), and EndoSequence Root Repair Material (ERRM; Brasseler USA, Savannah, GA). METHODS: Dental cements were formulated into discs and assessed for their biocompatibility. hBMSCs were used to study biocompatitibility and the proliferative and osteogenic potential of these dental cements. A live dead assay was performed using confocal microscopy to study the biocompatibility, proliferation, and cell attachment property of the cements. An 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was also performed on days 1, 3, 5, and 7 to study growth kinetics. The osteogenic potential of these cements was studied by inducing hBMSCs over them using osteogenic differentiation medium (assessed by alkaline phosphatase assay). RESULTS: ERRM and MTA have shown the best biocompatibility among the tricalcium silicate materials used with no significant difference between them. Both have shown significantly higher osteogenic bioactivity than BD. All 3 tricalcium silicate cements support good adherence of hBMSCs. CONCLUSIONS: All of the dental cements used in this study are biocompatible with the potential to induce proliferation and osteogenic differentiation of hBMSCs. Therefore, the newly introduced ERRM can be the material of choice in various endodontic applications.

Management of Dens Invaginatus Type II Associated with Immature Apex and Large Periradicular Lesion Using Platelet-rich Fibrin and Biodentine.

Dens invaginatus (DI) poses peculiar challenges in endodontic treatment of teeth because of distortion of pulpal space. A case of Oehlers type II DI with open apex and large periapical lesion is reported. The case was managed using cone-beam computed tomography (CBCT), operating microscope, platelet-rich fibrin (PRF), and Biodentine. A 15-year-old male patient presented with palatal swelling. Pulp sensibility testing of right maxillary lateral incisor was negative. Intraoral periapical digital radiograph revealed an Oehlers type II DI with open apex and periapical radiolucency. A CBCT scan was performed to study the anatomy, determine the true extent of the periapical lesion, and form a treatment plan. A diagnosis of Oehlers type II DI with pulp necrosis and acute periapical abscess was made. Two-visit endodontic treatment was performed. In the first visit, the invaginated central mass was removed under operating microscope, chemo-mechanical preparation was done, and double antibiotic paste dressing was placed. In the second visit, the canal was sealed with apical matrices of PRF and Biodentine as filling material. The patient was asymptomatic and radiographs revealed continued healing of the osseous defect at follow-up visits. A CBCT scan at 30 months showed complete continuity of periodontal ligament space, healing of labial and palatal cortical plates, and formation of intercortical bone. The advances in endodontic armamentarium and technology, like CBCT and operating microscope, have made successful treatment of challenging cases possible. PRF and Biodentine as apical matrices and filling material, respectively, proved to be effective in the present case.