Multivariate prognostic analysis of direct pulp capping using a bioceramic material in mature permanent teeth with carious pulp exposure: a retrospective cohort study.

OBJECTIVES: On the basis of a large sample size and a long follow-up period, the objectives of this study were to evaluate the outcomes of direct pulp capping (DPC) in mature permanent teeth with carious pulp exposure using a kind of bioaggregate putty (BP) which commercially named iRoot BP Plus (Innovative Bioceramix, Inc., Vancouver, Canada) and to analyze the potential prognostic factors. MATERIALS AND METHODS: The design of this research was retrospective regarding treatment procedures and prospective regarding the assessment of outcomes. The preoperative diagnosis of the teeth was either normal pulp or reversible pulpitis. Results were assessed based on clinical and radiographic examinations with at least 12 months of follow-up after DPC. No symptoms or signs, a positive response to electric pulp testing, a normal response to cold pulp testing and radiographs showing no abnormalities were considered to indicate success. Kaplan-Meier survival analysis was used to calculate the cumulative survival of teeth after DPC. Univariate and multivariate Cox proportional hazard regressions were used to analyze potential prognostic factors. RESULTS: Three hundred thirty-four patients, including a total of 354 teeth, were available for the final clinical examination. The follow-up period ranged from 12 to 85 months, with an average of 27.0 ± 0.8 months. The total success rate was 85% (302/354), and the cumulative survival rates at 1, 2, 3, 4, and 5 years were 92%, 87%, 83%, 76%, and 72%, respectively. Univariate analysis indicated a significantly increased risk of failure in patients aged above 40 years and those treated by resident operators (P ≤ 0.01), with hazard ratios of 2.18 and 2.27, respectively. CONCLUSIONS: Under appropriate indication selection and treatment procedures, long-term success is possible in mature permanent teeth with carious pulp exposure by DPC using iRoot BP Plus. Patient age and operator experience are potential prognostic factors. CLINICAL RELEVANCE: Clinical data on iRoot BP Plus as a pulp capping medicament in mature permanent teeth with carious pulp exposure is lacking. This study indicated the efficacy of BP in DPC. Younger patient and sophisticated operator are beneficial for the outcome of DPC.

Splicing mutations in AMELX and ENAM cause amelogenesis imperfecta.

BACKGROUND: Amelogenesis imperfecta (AI) is a developmental enamel defect affecting the structure of enamel, esthetic appearance, and the tooth masticatory function. Gene mutations are reported to be relevant to AI. However, the mechanism underlying AI caused by different mutations is still unclear. This study aimed to reveal the molecular pathogenesis in AI families with 2 novel pre-mRNA splicing mutations. METHODS: Two Chinese families with AI were recruited. Whole-exome sequencing and Sanger sequencing were performed to identify mutations in candidate genes. Minigene splicing assays were performed to analyze the mutation effects on mRNA splicing alteration. Furthermore, three-dimensional structures of mutant proteins were predicted by AlphaFold2 to evaluate the detrimental effect. RESULTS: The affected enamel in family 1 was thin, rough, and stained, which was diagnosed as hypoplastic-hypomature AI. Genomic analysis revealed a novel splicing mutation (NM_001142.2: c.570 + 1G > A) in the intron 6 of amelogenin (AMELX) gene in family 1, resulting in a partial intron 6 retention effect. The proband in family 2 exhibited a typical hypoplastic AI, and the splicing mutation (NM_031889.2: c.123 + 4 A > G) in the intron 4 of enamelin (ENAM) gene was observed in the proband and her father. This mutation led to exon 4 skipping. The predicted structures showed that there were obvious differences in the mutation proteins compared with wild type, leading to impaired function of mutant proteins. CONCLUSIONS: In this study, we identified two new splicing mutations in AMELX and ENAM genes, which cause hypoplastic-hypomature and hypoplastic AI, respectively. These results expand the spectrum of genes causing AI and broaden our understanding of molecular genetic pathology of enamel formation.

Decomposing socioeconomic inequalities in dental caries among Chinese adults: findings from the 4th national oral health survey.

OBJECTIVE: This cross-sectional study aimed to investigate socioeconomic inequalities in dental caries among adults (35 years and older) in China and explore the contributions of various factors to these inequalities. METHODS: This study included 10,983 adults (3,674 aged 35-44 years, 3,769 aged 55-64 years and 3,540 aged 65-74 years) who participated in the 4th National Oral Health Survey (2015-2016) in China. Dental caries status was evaluated by the decayed, missing and filled teeth (DMFT) index. Concentration indices (CIs) were applied to quantify the different degrees of socioeconomic-related inequality in DMFT, decayed teeth with crown or root caries (DT), missing teeth due to caries or other reasons (MT), and filled teeth without any primary or secondary caries (FT) among adults of different age groups. Decomposition analyses were conducted to identify the determinants and their associations with inequalities in DMFT. RESULTS: The significant negative CI indicated that DMFT for the total sample were concentrated among socioeconomically disadvantaged adults (CI = - 0.06; 95% confidence interval [CI], - 0.073 to - 0.047). The CIs for DMFT for adults aged 55-64 and 65-74 years were - 0.038 (95% CI, - 0.057 to - 0.018) and - 0.039 (95% CI, - 0.056 to - 0.023), respectively, while the CI for DMFT for adults aged 35-44 years was not statistically significant (CI = - 0.002; 95% CI, - 0.022 to 0.018). The concentration indices of DT were negative and concentrated in disadvantaged populations, while FT showed pro-rich inequalities in all age groups. Decomposition analyses showed that age, education level, toothbrushing frequency, income and type of insurance contributed substantially to socioeconomic inequalities, accounting for 47.9%, 29.9%, 24.5%,19.1%, and 15.3%, respectively. CONCLUSION: Dental caries was disproportionately concentrated among socioeconomically disadvantaged adults in China. The results of these decomposition analyses are informative for policy-makers attempting to develop targeted health policy recommendations to reduce dental caries inequalities in China.

Regulation of cellulase expression, sporulation, and morphogenesis by velvet family proteins in Trichoderma reesei.

Homologs of the velvet protein family are encoded by the ve1, vel2, and vel3 genes in Trichoderma reesei. To test their regulatory functions, the velvet protein-coding genes were disrupted, generating Δve1, Δvel2, and Δvel3 strains. The phenotypic features of these strains were examined to identify their functions in morphogenesis, sporulation, and cellulase expression. The three velvet-deficient strains produced more hyphal branches, indicating that velvet family proteins participate in the morphogenesis in T. reesei. Deletion of ve1 and vel3 did not affect biomass accumulation, while deletion of vel2 led to a significantly hampered growth when cellulose was used as the sole carbon source in the medium. The deletion of either ve1 or vel2 led to the sharp decrease of sporulation as well as a global downregulation of cellulase-coding genes. In contrast, although the expression of cellulase-coding genes of the ∆vel3 strain was downregulated in the dark, their expression in light condition was unaffected. Sporulation was hampered in the ∆vel3 strain. These results suggest that Ve1 and Vel2 play major roles, whereas Vel3 plays a minor role in sporulation, morphogenesis, and cellulase expression.

In vitro evaluation of the impact of a bioceramic root canal sealer on the mechanical properties of tooth roots.

Bacground/purpose: Endodontically treated teeth are more prone to vertical root fracture with the mechanical property changes to some extent during root canal treatment. This study aimed to investigate the effects of a bioceramic sealer on the mechanical properties of tooth roots. Materials and methods: Dentin discs were dried by two different methods (ethanol drying and paper points drying) and then filled with a BC sealer named iRoot SP. SEM and EDS were used to analyze the newly formed minerals in dentin tubules. Elastic modulus and hardness of the secondary dentin in areas proximal to the primary dentin (PD-SD) and areas proximal to canal or iRoot SP (SD-C/SD-iRoot SP) were measured using nanoindentation technique. The compressive strength of roots filled with iRoot SP were tested by compressive loading test. Results: (1) Penetration and mineralization: Paper points drying was more conducive to iRoot SP adhesion, spreading and penetration into the dentin tubules than 95% ethanol drying. (2) Micromechanical properties: After filling root canal with iRoot SP, the elastic modulus and hardness of SD-iRoot SP were higher than those of PD-SD (P = 0.001 and P = 0.000). (3) Fracture resistance: The compressive strength of the roots filled with iRoot SP was not significantly different from that of the roots unprepared and unfilled (P = 0.957), but was higher than that of the roots prepared and unfilled (P = 0.009). Conclusion: Excessive drying (95% ethanol drying method) is not conducive to the penetration and mineralization of the BC sealer iRoot SP into dentin tubules. The good bioactivity of iRoot SP was responsible for increasing the elastic modulus and hardness of dentin, which strengthened the prepared roots.

Alkali-extracted proteins from the tooth dentin matrix as a mixture of bioactive molecules for cartilage repair and regeneration.

Introduction: Dentin matrix extracted protein (DMEP) is a mixture of proteins extracted from the organic matrix of a natural demineralized dentin matrix that is rich in a variety of growth factors. However, the effect of DMEP on cartilage regeneration is unclear. The aim of this study was to investigate the efficacy of DMEP extracted via a novel alkali conditioning method in promoting cartilage regeneration. Methods: Alkali-extracted DMEP (a-DMEP) was obtained from human dentin fragments using pH 10 bicarbonate buffer. The concentration of chondrogenesis-related growth factors in a-DMEP was measured via enzyme-linked immunosorbent assay (ELISA). Human bone marrow mesenchymal stem cells (hBMMSCs) in pellet form were induced with a-DMEP. Alcian blue and Safranin O staining were performed to detect cartilage matrix formation, and quantitative real-time polymerase chain reaction (qRT-PCR) was used to assess chondrogenic-related gene expression in the pellets. Rabbit articular osteochondral defects were implanted with collagen and a-DMEP. Cartilage regeneration was assessed with histological staining 4 weeks after surgery. Results: Compared with traditional neutral-extracted DMEP, a-DMEP significantly increased the levels of transforming growth factor beta 1(TGF-ß1), insulin-like growth factor-1(IGF-1) and basic fibroblast growth factor (bFGF). After coculture with hBMMSC pellets, a-DMEP significantly promoted the expression of the collagen type II alpha 1(COL2A1) and aggrecan (ACAN) genes and the formation of cartilage extracellular matrix in cell pellets. Moreover, compared with equivalent amounts of exogenous human recombinant TGF-ß1, a-DMEP had a stronger chondrogenic ability. In vivo, a-DMEP induced osteochondral regeneration with hyaline cartilage-like structures. Conclusions: Our results showed that a-DMEP, a compound of various proteins derived from natural tissues, is a promising material for cartilage repair and regeneration.

Promoting bond durability by a novel fabricated bioactive dentin adhesive.

OBJECTIVE: To prepare a bioactive dentin adhesive and investigate its effect on promoting bonding durability of dentin. METHODS: The mineralization of the bioactive glass with high phosphorus (10.8 mol% P2O5-54.2 mol% SiO2-35 mol% CaO, named PSC) and its ability to induce type I collagen mineralization were observed by SEM and TEM. The Control-Bond and the bioactive dentin adhesive containing 20 wt% PSC particles (PSC-Bond) were prepared, and their degree of conversion (DC), microtensile bond strength (µTBS), film thickness and mineralization performance were evaluated. To evaluate the bonding durability, dentin bonding samples were prepared by Control-Bond and PSC-Bond, and mineralizated in simulated body fluid for 24 h, 3 months, and 6 months. Then, the long-term bond strength and microleakage at the adhesive interface of dentin bonding samples were evaluated by microtensile testing and semiquantitative ELIASA respectively. RESULTS: The PSC showed superior mineralization at 24 h and induced type I collagen mineralization to some extent under weakly alkaline conditions. For PSC-Bond, DC was 62.65 ± 1.20%, µTBS was 39.25 ± 4.24 MPa and film thickness was 17.00 ± 2.61 µm. PSC-Bond also formed hydroxyapatite and maintained good mineralization at the bonding interface. At 24 h, no significant differences in µTBS and interface microleakage were observed between the Control-Bond and PSC-Bond groups. After 6 months of aging, the µTBS was significantly higher and the interface microleakage was significantly lower of PSC-Bond group than those of Control-Bond group. SIGNIFICANCE: PSC-Bond maintained bond strength stability and reduced interface microleakage to some extent, possibly reducing the occurrence of secondary caries, while maintaining long-term effectiveness of adhesive restorations.

An explainable predictive model of direct pulp capping in carious mature permanent teeth.

OBJECTIVE: To introduce a novel approach for predicting the personalized probability of success of DPC treatment in carious mature permanent teeth using explainable machine learning (ML) models. METHODS: Clinical data were obtained from our previous single-center retrospective study, comprising 393 carious mature permanent teeth from 372 patients who underwent DPC and attended 1-year follow-up between January 2015 and February 2021. Six ML models were derived based on 80 % cases of the cohort, with the remaining 20 % cases used for validation. Shapley additive explanation (SHAP) values were utilized to assess feature importance and the clinical relevance of prediction models. RESULTS: Within the cohort, 9.67 % (38 out of 393) of teeth experienced failure at the 1-year follow-up after DPC treatment. Among the six evaluated ML models, the XGBoost model exhibited the highest discriminative ability. By prioritizing features based on their importance, streamlined and interpretable XGBoost model with 11 features were developed for 1-year prognostication post-DPC. The model demonstrated predictive accuracy with area under the curve (AUC) scores of 0.86 for the 1-year prediction. The final model has been translated into a web application to facilitate clinical decision-making. CONCLUSION: By incorporating demographic and clinical examination data, the XGBoost model offered a user-friendly tool for dentists to predict personalized probability of success, thereby improving personalized dental care and patient counseling. The utilization of SHAP for model interpretation provided transparent insights into the decision-making process.

Polydopamine-coated bioactive glass for immunomodulation and odontogenesis in pulpitis.

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.

Heparin-Functionalized Bioactive Glass to Harvest Endogenous Growth Factors for Pulp Regeneration.

Pulp and periapical diseases can lead to the cessation of tooth development, resulting in compromised tooth structure and functions. Despite numerous efforts to induce pulp regeneration, effective strategies are still lacking. Growth factors (GFs) hold considerable promise in pulp regeneration due to their diverse cellular regulatory properties. However, the limited half-lives and susceptibility to degradation of exogenous GFs necessitate the administration of supra-physiological doses, leading to undesirable side effects. In this research, a heparin-functionalized bioactive glass (CaO-P2O5-SiO2-Heparin, abbreviated as PSC-Heparin) with strong bioactivity and a stable neutral pH is developed as a promising candidate to addressing challenges in pulp regeneration. Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, and thermogravimetric analysis reveal the successful synthesis of PSC-Heparin. Scanning electron microscopy and X-ray diffraction show the hydroxyapatite formation can be observed on the surface of PSC-Heparin after soaking in simulated body fluid for 12 h. PSC-Heparin is capable of harvesting various endogenous GFs and sustainably releasing them over an extended duration by the enzyme-linked immunosorbent assay. Cytological experiments show that developed PSC-Heparin can facilitate the adhesion, migration, proliferation, and odontogenic differentiation of stem cells from apical papillae. Notably, the histological analysis of subcutaneous implantation in nude mice demonstrates PSC-Heparin is capable of promoting the odontoblast-like layers and pulp-dentin complex formation without the addition of exogenous GFs, which is vital for clinical applications. This work highlights an effective strategy of harvesting endogenous GFs and avoiding the involvement of exogenous GFs to achieve pulp-dentin complex regeneration, which may open a new horizon for regenerative endodontic therapy.

[Growth ability of human dental pulp cells on three bioactive scaffolds].

OBJECTIVE: To investigate the proliferation and differentiation of the human dental pulp cells (hDPCs) on the bioactive scaffolds. METHODS: Primary HDPCs were harvested from impacted third molars of healthy adult individuals (18-25 years of age) by enzyme digestion, expanded and cultured. The cells used for this investigation were the 4 th passage. Immunohistochemical methods were used to verify that the cells were dental pulp cells. The expression of stromal precursor antigen-1 (STRO-1) was determined by flow cytometry. Three different types of scaffolds were used: collagen (COL), collagen / bioglass (COL-BG) and collagen / bioglass / polycaprolactone (COL-BG-PCL). Cell proliferation on the scaffolds was determined using a MTT assay at hour 6, on days 1, 3, 5, 7, 14 and 21. On day 14, the scaffolds were stained with the alkaline phosphatase (ALP) staining kit. RESULTS: The tested cells had STRO-1 positive cells. The proliferation of HDPCs was significantly higher on the COL-BG scaffold and COL-BG-PCL scaffold as compared with COL scaffold (P<0.05). Especially on days 14 and 21, the optical density value of bioglass composite scaffold were 5 times that of the COL scaffold. The ALP positive staining area was observed more extensively on the COL-BG scaffold and COL-BG-PCL scaffold than on the COL scaffold. CONCLUSION: As comparison with the COL scaffold, HDPCs' proliferation and differentiation present more activity on the COL-BG and COL-BG-PCL scaffolds.

Effect of a bioactive glass-based root canal sealer on root fracture resistance ability.

Background/purpose: The root fracture resistance of endodontically treated teeth is decreased significantly, and it is more likely to fracture. This study aimed to evaluate the effect of a novel root canal sealer based on bioactive glass (BG) on root fracture resistance and explore its mechanism. Materials and methods: The BG-based root canal sealer (BG Sealer) was prepared by mixing a kind of bioactive glass (10.8% P2O5, 54.2% SiO2, 35% CaO, mol.%, named PSC), zirconia (ZrO2) powder, sodium alginate (SA) and phosphate solution (PS). A pH meter was used to measure the pH of simulated body fluid (SBF) after immersion with BG Sealer at different time. After preparing the samples of BG sealer with a diameter of 4 mm and a height of 6 mm, the compressive strength was tested by a universal testing machine. The scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS) were used to detect and analyze the mineral status of root canal systems filled with BG Sealer. The push out test was used to measure the push out bond strength of BG Sealer. The fracture resistance of root canals filled with BG Sealer was detected by the compressive loading test. Bioceramic root canal sealer iRoot SP was set as the control group. Results: (1) Physicochemical properties: The pH value of SBF immersed with BG Sealer increased slightly up to 7.68, while the pH of SBF immersed with iRoot SP increased to 12.08. The compressive strength of the novel BG Sealer was 4.62 ± 1.70 MPa, which was lower than that of iRoot SP (P < 0.05). (2) Mineralization: The hydroxyapatite layers were observed on the surface of BG Sealer and iRoot SP after being immersed in SBF for 4 weeks. BG Sealer and iRoot SP were both able to penetrate into the dentin tubules, duplicate the morphology of root canals well, and form a layer of hydroxyapatite. (3) Adhesion to dentin: There was no significant difference between the push out bond strength of the novel BG Sealer and iRoot SP (P > 0.05). (4) Fracture resistance: After immersion in SBF for 4 weeks, the fracture resistance of roots filled with BG Sealer and iRoot SP was 454.16 ± 155.39 N and 445.50 ± 164.73 N, respectively, both of which were not statistically different from that of the roots unprepared and unfilled (394.07 ± 62.12 N) (P > 0.05), whereas higher than that of the roots prepared and unfilled (235.36 ± 83.80 N) (P < 0.05). Conclusion: The novel BG Sealer has good adhesion to the root dentin, can penetrate into the dentin tubules to generate minerals, and meanwhile can improve the fracture resistance of the roots after root canal treatment. It is expected to be a bioactive root canal sealer with good clinical application prospects.

Novel dentin sialophosphoprotein gene frameshift mutations affect dentin mineralization.

OBJECTIVE: This study aimed to identify candidate genes for inheritable dentin defects in three Chinese pedigrees and characterize the property of affected teeth. DESIGN: Clinical and radiological features were recorded for the affected individuals. Genomic DNA obtained from peripheral venous blood or saliva were analyzed by whole-exome sequencing. The density and microhardness of affected dentin was measured. Scanning electron microscopy (SEM) was also performed to obtain the microstructure phenotype. RESULTS: 1) General appearance: the affected dentitions shared yellowish-brown or milky color. Radiographs showed that the pulp cavity and root canals were obliterated in varying degrees or exhibited a pulp aspect in the 'thistle tube'. Some patients exhibited periapical infections without pulpal exposure, and some affected individuals showed shortened, abnormally thin roots accompanied by severe alveolar bone loss. 2) Genomic analysis: three new frameshift mutations (NM_014208.3: c.2833delA, c.2852delGand c.3239delA) were identified in exon 5 of dentin sialophosphoprotein (DSPP) gene, altering dentin phosphoprotein (DPP) as result. In vitro studies showed that the density and microhardness of affected dentin were decreased, the dentinal tubules were sparse and arranged disorderly, and the dentinal-enamel-junction (DEJ) was abnormal. CONCLUSIONS: In this study, we identified three novel frameshift mutations of dentin sialophosphoprotein gene related to inherited dentin defects. These mutations are speculated to cause abnormal coding of dentin phosphoprotein C-terminus, which affect dentin mineralization. These results expand the spectrum of dentin sialophosphoprotein gene mutations causing inheritable dentin defects and broaden our understanding of the biological mechanisms by which dentin forms.

[Effects of ionic-dissolution of sol-gel bioactive glasses on human dental pulp cells].

OBJECTIVE: To evaluate the effects of ionic-dissolution of sol-gel bioactive glasses (BG) on proliferation and alkaline phosphatase (ALP) activity of human dental pulp cells (HDPCs) . METHODS: The primary HDPCs were isolated from intact premolar and third molars and were cultured in DMEM. Then the 4 th generation of HDPCs were cultured in DMEM, which contained 1 g/L of one of 58S, Nano-58S, and 45S5 ionic-dissolution products. Meanwhile HDPCs were cultured in DMEM without BG as control group. Proliferation of the cells was evaluated by MTT assay on days 1,3,5 and 7. ALP activity was measured on day 14 using ALP Assay Kit. RESULTS: Compared with the control group, HDPCs' proliferation in the Nano-58S group increased significantly. HDPCs cultured in Nano-58S and the 58S groups showed higher ALP activity (P<0.01); but in 45S5 group showed an inhibition on the HDPCs' proliferation (P<0.01) and lower ALP activity (P<0.05). CONCLUSION: Present work has shown that Nano-58S and 58S sol-gel BG can promote the proliferation and ALP activity of HDPCs.

A novel bioactive glass-based root canal sealer in endodontics.

BACKGROUND/PURPOSE: Bioactive glass (BG), one type of bioceramics, shows similar or better characteristics to calcium silicate which has been regarded as a promising root filling material in endodontics. This study aimed to develop a novel BG-based root canal sealer for endodontics. MATERIALS AND METHODS: The novel BG-based root canal sealer was composed of phytic acid derived bioactive calcium phosphosilicate glass named PSC mixed with zirconium oxide (ZrO2) as powder, and phosphate solution (PS) dissolved with sodium alginate (SA) named PS-SA as liquid. Moreover, the physicochemical properties, mineralization, sealing ability and biocompatibility of the novel BG-based root canal sealer were evaluated. RESULTS: This study developed a novel BG-based sealer named BGS-SA-Zr which contained the powder of PSC and ZrO2 and the liquid of PS-SA. Results indicated that the flow, film thickness and radiopacity of BGS-SA-Zr conformed to ISO 6876:2012. The setting time and solubility of BGS-SA-Zr were 53.7 ±â€¯1.5 min and 21.46 ±â€¯0.54%, respectively. The pH value of the simulated body fluid (SBF) immersed with BGS-SA-Zr raised slightly up to 7.70. The CCK-8 assay indicated that BGS-SA-Zr had no cytotoxic effects on MG-63 cells. After immersion in SBF for 4 weeks, dense hydroxyapatite crystals were observed on the surface of BGS-SA-Zr. Furthermore, there was no difference in the sealing ability between BGS-SA-Zr and the bioceramic sealer iRoot SP whether setting at 1 day or immersed in SBF for 4 weeks (P > 0.05). CONCLUSION: Our results suggest that the novel BG-based sealer may be a promising sealer for endodontic treatment.

The additive effects of photobiomodulation and bioactive glasses on enhancing early angiogenesis.

Bioactive glasses (BG) have been widely utilized as a biomaterial for bone repair. However, the early angiogenesis of BG may be inadequate, which weakens its osteogenic effects in large-sized bone defects and often leads to the failure of bone regeneration. In this study, we explored the effects of photobiomodulation (PBM) combined with BG on early angiogenesis to solve this bottleneck problem of insufficient early angiogenesis.In vitro, human umbilical vein endothelial cells (HUVECs) were cultured with BG extracts and treated with PBM using 1 J cm-2. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, real-time reverse transcription-polymerase chain reaction (real-time RT-PCR) and tubule formation assay were utilized to detect HUVECs' proliferation, vascular growth factor genes expression and tubules formation.In vivo, bone defects at the femoral metaphysis in Sprague-Dawley rats were treated with BG particulates and PBM at 120 J cm-2. Hematoxylin-eosin staining was used to observe the inflammatory response, tissue formation and biomaterial absorption of bone defects. Immunohistochemical staining was applied to observe the vascular-like structure formation. Thein vitroresults showed that PBM combined with BG significantly promoted HUVECs' proliferation, genes expression and mature tubules formation. On days 2, 4 and 7, the mRNA expression of VEGF in BG + PBM group was 2.70-, 2.59- and 3.05-fold higher than control (P< 0.05), and significantly higher than PBM and BG groups (P< 0.05). On days 4 and 7, the bFGF gene expression in BG + PBM group was 2.42- and 1.82-fold higher than control (P< 0.05), and also higher than PBM and BG groups (P< 0.05). Tube formation assay showed that mature tubules were formed in BG + PBM and PBM groups after 4 h, and the number in BG + PBM group was significantly higher than other groups (P< 0.05).In vivoresults further confirmed PBM induced early angiogenesis, with more vascular-like structures observed in BG + PBM and PBM groups 2 week post-surgery. With the optimum PBM fluence and BG concentration, PBM combined with BG exerted additive effects on enhancing early angiogenesis.

Induction of Cartilage Regeneration by Nanoparticles Loaded with Dentin Matrix Extracted Proteins.

Due to the limited self-repair capacity of articular cartilage, tissue engineering has good application prospects for cartilage regeneration. Dentin contains several key growth factors involved in cartilage regeneration. However, it remains unknown whether dentin matrix extracted proteins (DMEP) can be utilized as a complex growth factor mixture to induce cartilage regeneration. In this work, we extracted DMEP from human dentin and improved the content and activity of chondrogenic-related growth factors in DMEP by alkaline conditioning. Afterward, mesoporous silica nanoparticles (MSNs) with particular physical and chemical properties were composed to selectively load and sustain the release of proteins in DMEP. MSN-DMEP promoted chondrogenic differentiation of rat bone marrow-derived mesenchymal stem cells with fewer growth factors than exogenously added transforming growth factor-ß1 (TGF-ß1). Therefore, MSN-DMEP may serve as a promising candidate for cartilage regeneration as an alternative to expensive synthetic growth factors. Impact statement Several growth factors embedded in dentin matrix could be involved in cartilage regeneration. This article reports that alkaline conditioning could improve the content and activity of chondrogenic-related growth factors in dentin matrix extracted proteins (DMEP). Mesoporous silica nanoparticles (MSNs) with particular physical and chemical properties performed well in loading and sustained releasing of proteins in DMEP. In vitro and in vivo studies suggest that MSN-DMEP could be a promising candidate for cartilage regeneration as an alternative to expensive synthetic growth factors.

Alkaline activation of endogenous latent TGFß1 by an injectable hydrogel directs cell homing for in situ complex tissue regeneration.

Utilization of the body's regenerative potential for tissue repair is known as in situ tissue regeneration. However, the use of exogenous growth factors requires delicate control of the dose and delivery strategies and may be accompanied by safety, efficacy and cost concerns. In this study, we developed, for the first time, a biomaterial-based strategy to activate endogenous transforming growth factor beta 1 (TGFß1) under alkaline conditions for effective in situ tissue regeneration. We demonstrated that alkaline-activated TGFß1 from blood serum, bone marrow fluids and soaking solutions of meniscus and tooth dentin was capable of increasing cell recruitment and early differentiation, implying its broad practicability. Furthermore, we engineered an injectable hydrogel (MS-Gel) consisting of gelatin microspheres for loading strong alkaline substances and a modified gelatin matrix for hydrogel click crosslinking. In vitro models showed that alkaline MS-Gel controllably and sustainably activated endogenous TGFß1 from tooth dentin for robust bone marrow stem cell migration. More importantly, infusion of in vivo porcine prepared root canals with alkaline MS-Gel promoted significant pulp-dentin regeneration with neurovascular stroma and mineralized tissue by endogenous proliferative cells. Therefore, this work offers a new bench-to-beside translation strategy using biomaterial-activated endogenous biomolecules to achieve in situ tissue regeneration without the need for cell or protein delivery.

[Effects of light-curing modes on the polymerization shrinkage and surface hardness of composite resins].

OBJECTIVE: To investigate the effects of light-curing modes on the polymerization shrinkage and surface hardness of resins and to explore the related clinical relevance. METHODS: Resins with filler content of 76%(mass fraction) were light-cured by high intensity, low intensity and soft start curing modes for 10 s and 20 s, respectively. Specimens for detecting volumetric shrinkage and surface hardness were prepared. Volumetric shrinkage was measured with Acuvol (n=7) and surface hardness were tested with an indenter (n=5). RESULTS: The volumetric shrinkage of composites cured by high intensity, low intensity and soft-start curing mode was: 2.95% ± 0.08%/3.06% ± 0.03% (10 s/20 s), 2.98% ± 0.12%/3.05% ± 0.13% (10 s/20 s), and 3.03% ± 0.05%/3.11% ± 0.07% (10 s/20 s), respectively. No significant difference existed among polymerization shrinkage of composites cured by the three light-curing modes (P>0.05). The hardness of composites cured by high intensity, low intensity and soft-start curing mode was: (36.82 ± 4.45) MPa/(47.58 ± 3.16) MPa (10 s/20 s), (32.30 ± 1.33) MPa/(41.60 ± 1.83) MPa (10 s/20 s), and (34.56 ± 1.38) MPa/(44.62 ± 2.13) MPa (10 s/20 s), respectively. There existed significant difference among hardness of composites cured by the three light-curing modes (P<0.05). Polymerization shrinkage was correlated with energy density (r=-0.363,P=0.018). Surface hardness was also correlated with energy density (r=-0.890,P<0.001). CONCLUSION: It would be better to use high intensity curing mode to improve the physical properties of restorations. In order to keep the physical properties of composites, it is necessary to prolong the curing time using soft-start/low intensity curing modes to increase the energy density.

Effect of mesoporous bioactive glass on odontogenic differentiation of human dental pulp stem cells.

Healthy pulp tissue plays an important role in normal function and long-term retention of teeth. Mesoporous bioactive glass (MBG) as a kind of regenerative biomaterials shows the potential in preserving the vital pulp. In this study, MBG prepared by organic template method combined with sol-gel method were used in human dental pulp cell culture and ectopic mineralization experiment. Real-Time PCR was used to explore its ability to induce odontogenic differentiation of dental pulp cells. MBG and rat crowns were implanted under the skin of nude mice for 4 weeks to observe the formation of pulp dentin complex. We found that MBG can release Si and Ca ions and has a strong mineralization activity in vitro. The co-culture of MBG with human dental pulp cells promoted the expression of DMP-1 (dentin matrix protein-1) and ALP (alkalinephosphatase) without affecting cell proliferation. After 4 weeks of subcutaneous implantation in nude mice, the formation of hard tissue with regular structure under the material could be seen, and the structure was similar to dentin tubules. These results indicate that MBG can induce the differentiation of dental pulp cells and the formation of dental pulp-dentin complex and has the potential to promote the repair and regeneration of dental pulp injuries.