Evaluation of stress distributions in endodontically treated anterior incisors under occlusal and trauma-induced forces following various restoration treatments: A finite element analysis.

BACKGROUND: The aim of this study was to calculate the stress distribution of fiberglass post associated with resin composite crown restoration and fiberglass posts with zirconia restorations in mature and immature endodontically treated central maxillary incisor under various loading conditions. MATERIALS AND METHODS: The study created six different study models in a virtual environment: healthy mature maxillary central teeth, intact immature maxillary central teeth, mature maxillary central teeth with fiberglass post associated with resin composite crown restoration, immature maxillary central teeth with fiberglass post associated with resin composite crown restoration, mature maxillary central teeth with fiberglass posts and zirconia restoration, and immature maxillary central teeth with fiberglass posts and zirconia restoration. Loading conditions simulating mastication, trauma, and bruxism were applied to each of the models at different angles and amounts. The von Mises and the maximum and minimum principal stress values in tooth structures (dentin) and support structures (bone, PDL) and materials were observed using finite element stress analysis. RESULTS: The highest stress values in the tissue and the restoration structure were observed for masticating force and crowns rehabilitated with zirconia restorations. None of the compared loading conditions and restorations showed destructive stress values on periodontal ligament or bone. CONCLUSION: The mature and immature endodontically treated central maxillary incisors can be better rehabilitated using fiberglass post associated with resin composite crown restoration and may be preferred to zirconia restorations in order to reduce the stresses on the surrounding tissues and teeth. However, further clinical studies are needed to fully explore this topic.

Awareness, Knowledge and Attitudes Toward Management of Avulsed Permanent Incisors Among Primary School Teachers.

Introduction: Dental trauma is known as main concern for public health and is a prevalent issue among children as it leads to functional, aesthetic, and psychological complications. This study aimed to evaluate the awareness and knowledge of primary school teachers regarding emergency first aid management for tooth avulsion at Agadir. Methods: The study was conducted in 46 randomly selected primary schools in Agadir and included all teachers from these schools. Data collection was carried out through a self-administered questionnaire focusing on teachers' socio-demographic characteristics, understanding of the importance of emergency management and familiarity with emergency procedures. Data analysis was performed using Jamovi Version 2.3.21.0. Results: A total of 202 teachers participated in the study, 61% being female and 39% male. It has been found that 59.4% of the teachers had encountered an avulsed tooth accident at school. Of these, 23.9% indicated they would immediately replant the avulsed tooth, while 76.7% would contact the child's parents. Regarding storage, 6.8% would preserve the avulsed tooth in milk, while 30.1% preferred using paper. No significant differences were found in term of seniority and age groups (p>0.05). Discussion: An educational programs is needed to enhance the management and prognosis of permanent tooth avulsion among children in Morocco.

The Outcome of Decoronation in Severe Cases of External Cervical Root Resorption in Young Patients.

This study examines decoronation as a treatment option for teeth with progressive external cervical root resorption (ECR). Six young patients aged 9.5-13, with a total of nine incisor teeth affected by ECR due to previous dental trauma, were treated by decoronation. Six teeth were classified as class 4 and two as class 3, according to Heithersay's classification. Another tooth with class 2 resorption also had a perforation. After decoronation, all cases showed favorable outcomes during a follow-up period of 2.5-8 years. The procedure halted the progression of ECR and promoted vertical and horizontal ridge development above the submerged root. Decoronation can be considered for the successful treatment of advanced cases of ECR in young patients.

Knowledge and attitude of traumatic dental injuries in Mongolian schoolteachers.

BACKGROUND: Traumatic dental injury (TDI) is a growing public health concern worldwide, and children and adolescents are commonly affected. Because TDI often occurs at school, the response of teachers to these injuries is crucial. However, teachers in various countries have been shown to lack knowledge of effective TDI first-aid response and need an intervention to improve their knowledge. The aim of the study presented here was to ascertain and analyze teachers' knowledge of and attitude about TDI in Mongolia. MATERIALS AND METHODS: A cross-sectional study of full-time teachers in Mongolia was performed using an online questionnaire (compiled from relevant studies) from September 2022 to December 2022. The questionnaire consists of 47 items and among them 14 were used to assess the teacher's knowledge, and 5 were for attitude towards TDI. The maximum possible score was 14 points and grouped as follows good, moderate, and poor. T-test, ANOVA test (post-hoc) and linear regression analysis were performed. RESULTS: The online survey provided quantitative data from 2821 participants: 28% were elementary school teachers, 29% middle school teachers, and 42% high school teachers. Their mean age was 36.7 ± 9 years, and 2433 (86%) were female. The mean score of the TDI knowledge of the teachers was 5.3 ± 2.1 out of 14. The ANOVA test showed that older (p < 0.01) and more experienced teachers (p < 0.01) had higher scores. Teachers in the eastern (5.46 ± 2.2) and southern (5.49 ± 2.2) provinces had higher mean scores than in the other provinces (p < 0.02). Teachers majored in natural sciences (5.4 ± 2.2) had a higher score than those in the social sciences (5.2 ± 2.1) and difference were significant (p < 0.02). The multiple regression model statistically significantly predicted a one-year increase in experience, the TDI score increased 0.034 (95% CI 0.026, 0.043) unit. CONCLUSIONS: The knowledge regarding TDI and effective first-aid response to such injury is low in teachers in Mongolia. However, the teachers' attitude about TDI was positive and they wanted to learn and improve their knowledge. Therefore, further education and training programs are advised.

Endodontic sequelae associated with repetitive impacts to the dentofacial region during boxing activities.

AIM: To explore self-reported dentofacial trauma and their potential endodontic sequelae in boxers using a questionnaire, followed by clinical and radiographic assessment to (1) compare the nature and number of self-reported dentofacial injuries with physical evidence of injury sequelae; and (2) investigate potential risk factors influencing dentofacial trauma and their endodontic sequelae. METHODOLOGY: A focus group validated questionnaire was completed by 176 boxers recruited from 16 London boxing clubs; 61 boxers from this cohort then attended a London dental hospital, for a clinical and radiographic assessment. Data from the questionnaire and clinical assessments were then collated and analysed using Chi-squared or t-tests. RESULTS: Questionnaire data revealed 87.5% of boxers reported a history of dentofacial trauma during boxing activity. The clinical and radiographic assessment detected evidence of dentofacial trauma in 91.8% of boxers and dental injury or endodontic-related injury sequelae in 68.9% of boxers. There was a significant association between dentofacial trauma and boxers who did not participate in weekly neck weight sessions (p < .001), and there was a significant association between trauma-related endodontic sequelae and: boxer age (p = .01); competitions per month (p = .002); and defensive skill (p = .007). CONCLUSIONS: A majority of the cohort had suffered dentofacial injuries and endodontic sequelae. The questionnaire data under-reported musculoskeletal injuries and endodontic sequelae, suggesting that some hard-tissue injuries following repetitive dentofacial trauma may have a subclinical presentation. Injury risk may be related to increased boxer age, defensive skills, frequency of participation in competitions, and frequency of neck weight sessions per week.

Cone-beam computed tomography-based descriptive classification for transverse root fracture.

Transverse root fracture (TRF) is classified as a cervical, middle or apical third root fracture on a periapical radiograph. The International Association of Dental Traumatology (IADT) suggests that cone-beam computed tomography (CBCT) should be considered, when conventional radiographs provide 'insufficient' information for diagnosis and treatment planning. Considering that CBCT can divulge additional information, it would be beneficial to have a clinically pertinent three-dimensional classification for TRF. The proposed alphanumeric classification includes the traumatised tooth number, describes the number of TRF, the facial and lingual location of each fracture line on the anatomic root, and its position relative to the crest of the alveolar bone. Further, diastasis, displacement of the coronal fragment and status of the alveolar bone at the site of TRF are also documented. This comprehensive classification system would provide a standard format for reporting, aid in referral communication and can be applied for future outcome studies on TRF.

A review of oral health promotion programmes in Eastern Mediterranean Region.

Background: Oral health conditions, such as dental caries, periodontal disease, tooth loss, dental fluorosis, dental trauma, and oral cancer, are prevalent in the WHO Eastern Mediterranean Region. However, there has been no systematic review of oral health promotion interventions in the region. Aims: To review existing literature on oral health promotion programmes in the Eastern Mediterranean Region and recommend improvements for the future. Method: We reviewed on PubMed and Google Scholar 61 articles published in the Eastern Mediterranean Region between 2010 and 2023. Quality assessment of included studies was performed using established criteria. We used the content analysis approach to create appropriate themes from the studies and to document meaningful conclusions about oral health promotion. Results: Majority of the studies were cross-sectional, a few were randomized controlled, quasi-experimental, longitudinal studies, or reviews. Oral health problems identified included poor oral health knowledge, dental caries, periodontal disease, tooth loss, dental fluorosis, and oral cancer. Although oral disorders were common in most of the countries, very few have implemented oral health promotion programmes. Conclusion: We recommend prioritization of oral health promotion programmes in the Eastern Mediterranean Region to tackle the diverse oral health challenges. To be effective, such programmes should be region- and context-specific. More studies on oral health promotion are needed in the region.

THE PREVALENCE OF DENTAL CARIES AMONG CHILDREN IN ORPHANAGES IN IBADAN.

Background: A number of challenges are being faced by children in orphanages, a major one being their oral health as a common unmet need. Studies have shown high prevalence of dental caries and oro-facial trauma. This has been attributed to overcrowding, lack of adequate staff, poor oral hygiene, improper dietary habits, inadequacies in the orphanage system, as well as inadequacies in the healthcare system.This study aimed at assessing the prevalence and factors affecting dental caries and trauma among children in orphanages in Ibadan. Materials and Method: All the children within the age group (7 - 15 years) in all the 18 registered orphanages in the 5 Local Government Areas within Ibadan metropolis were recruited into the study. Intra-oral examination was done under natural light and caries detection was done using tactile and visual method. Sterile mouth mirrors and CPI probes were used for this purpose. Dental caries status and the predisposing factors in each child were assessed. Presence of dental trauma and the predisposing factors were also assessed. Data processing was carried out with the aid of SPSS version 21. Results: One hundred and forty-six children participated in the study, 51.4% of them were males while 48.6% were females. The age range and the mean age of the children were 7 - 15 years 9. 69 ± 3.78 respectively. The prevalence of dental caries among the children was 17.8% while that of dental trauma was 7.5%. The mean DMFT/dmft was found to be 0.42 ± 1.06. Gender and the presence of deep pits and fissures were the statistically significant predictors of dental caries. Conclusion: Oral health is of utmost importance across all ages, much more pertinent among institutionalized children who are prone to dental caries and trauma as revealed by this study. An average child in an orphanage may be affected by both dental caries and trauma, but appears to be more prone to dental caries in this environment.

Radiographic Evaluation of Regenerative Endodontic Procedures and Apexification Treatments with the Assessment of External Root Resorption.

INTRODUCTION: This multi-centered cohort study evaluated the radiographic outcomes of regenerative endodontic procedures (REPs) and apexification treatments (APEX) of immature teeth with endodontic disease. MATERIALS AND METHODS: This cohort study included a retrospective record review and prospective data collection of pediatric patients with teeth treated with REPs or APEX between 2005-2014. Data including the presence of a periapical lesion, external root resorption (ERR), obliteration, apical hard tissue, apical closure, intracanal calcifications, and radiographic root area (RRA) change based on measurements were collected/measured from radiographic images. Univariate and multivariate analyses were conducted. RESULTS: The cohort included 190 subjects (204 teeth (92 REPs; 112 APEX)). The frequency of pre-treatment periapical pathology was similar between cases in which the clinical treatment failed versus successful treatment cases. However, the frequency of pre-treatment ERR was higher in failed cases than in successful cases (p=0.007). The mean RRA change was greater than twenty percent in 21% of the REPs cases. In traumatized teeth, REP treatment resulted in less hard tissue formation than other endodontic disease etiologies measured by RRA (p=0.001). 53% of cases with ERR (16/30) showed signs of healing/arrest and were mostly treated with REPs (11/16). CONCLUSIONS: The presence of ERR negatively affected the treatment outcome. There was significant variability in RRA change in REPs. Signs of healing/arrest of the resorptive lesion were radiographically visible in many cases treated with REPs.

Pattern of Traumatic Dental Injuries and Treatment Receipt among Children Attending the University Dental Hospital in Saudi Arabia.

Objective: The aim of this study was to investigate the pattern and distribution of traumatic injuries to primary and permanent anterior teeth in 2-14-year-old pediatric dental patients in AlHassa region of Saudi Arabia. Methods: The study sample consisted of pediatric dental patients visiting the university dental complex seeking treatment for traumatic dental injuries (TDIs) during the period from February 2022 to April 2023. Data were collected by means of interviewing the children and/or parents regarding the history of trauma and clinical examination for evidence of dental trauma to primary and permanent teeth. Results: A total of 122 children (184 teeth) including 78 (63.9%) boys and 44 (36.1%) girls sustained traumatic injuries to their teeth. The most common reason for dental trauma was falls, and maxillary right central incisor was the most frequently affected permanent teeth. Enamel-dentine fractures in permanent teeth and luxation injuries among primary teeth were predominantly noted. Majority of the injuries (47.5%) have been found to have not received timely attention for treatment. Conclusions: Early treatment of dental trauma should be emphasized, and preventive strategies targeted at parents and teachers at the community level are needed to promote and reduce the burden of TDIs.

Outcomes of apexification in immature traumatised necrotic teeth and risk factors for premature tooth loss: A 20-year longitudinal study.

BACKGROUND/AIM: To evaluate the long-term survival of immature traumatized incisors with pulp necrosis and apical periodontitis after endodontic treatment with two apexification techniques (calcium hydroxide apexification and MTA-apical plug) and to identify major factors affecting the survival of these teeth. MATERIALS AND METHODS: Records of 2400 children and adolescents were screened for presence of traumatic dental injuries to immature incisors where endodontic treatment with the two apexification techniques was performed during January 2003 and December 2022, compared to a control group of mature teeth treated with conventional endodontic techniques. The studied variables were age; sex; apexification technique, presence of luxation and hard tissue injuries; preoperative root development stage (RDS), preoperative and postoperative periapical index (PAI), the time-point for tooth loss, and overall survival time in years. Kaplan-Meier estimates were used to graphically present the survival functions and Cox proportional hazard model to calculate hazard ratios (HR, 95% CI). RESULTS: The median survival time was 10 years for calcium hydroxide apexification, 16.1 for MTA-apexification, for luxation injuries other than intrusions and avulsions 15.5 years, for intrusions 12.5 years and for avulsions 6.8 years. The variables with significant negative impact on tooth survival were calcium hydroxide apexification, avulsion and postoperative PAI 3-5. No significant relationships were found for the variables MTA apexification, concussion; subluxation; lateral luxation; extrusion, intrusion, hard tissue injuries, preoperative RDS and PAI scores and postoperative PAI 1-2. After adjustment, the risk for premature tooth loss was 13.5 times higher in calcium hydroxide apexification, approximately 2 to 4 times higher in PAI 3-5, and 5.6 times higher in avulsions. CONCLUSIONS: Calcium hydroxide apexification, avulsion, and postoperative PAI 3-5 were identified as prognostic variables with significant negative impact on the risk for premature tooth loss.

Assessment of artificial intelligence applications in responding to dental trauma.

BACKGROUND: This study assessed the consistency and accuracy of responses provided by two artificial intelligence (AI) applications, ChatGPT and Google Bard (Gemini), to questions related to dental trauma. MATERIALS AND METHODS: Based on the International Association of Dental Traumatology guidelines, 25 dichotomous (yes/no) questions were posed to ChatGPT and Google Bard over 10 days. The responses were recorded and compared with the correct answers. Statistical analyses, including Fleiss kappa, were conducted to determine the agreement and consistency of the responses. RESULTS: Analysis of 4500 responses revealed that both applications provided correct answers to 57.5% of the questions. Google Bard demonstrated a moderate level of agreement, with varying rates of incorrect answers and referrals to physicians. CONCLUSIONS: Although ChatGPT and Google Bard are potential knowledge resources, their consistency and accuracy in responding to dental trauma queries remain limited. Further research involving specially trained AI models in endodontics is warranted to assess their suitability for clinical use.

Color stability and translucency of newly developed composites for splinting teeth.

This study aimed to investigate the colorimetric properties of newly developed composites for dental trauma splints using various staining solutions during the clinical splinting period. The clear shades of G-Fix (GF), Ortho Connect Flow (OC), Light Fix (LF), and Filtek Z350XT (FZ) were fabricated into 96 disk-shaped specimens. Specimens from each composite group were stored in distilled water, coffee, tea, and red wine solutions at 37ºC. CIE values were measured using a spectrophotometer at 24 h after specimen preparation and at 1 day, 1 week, 2 weeks, 3 weeks, and 4 weeks after storage in each solution. Color differences and translucency parameters were calculated using the initial and measured values. Within the experiment period, the color differences of GF, OC, and LF compared to the initial measurement were smaller than that for FZ for all staining solutions except distilled water. There were no significant color differences between the GF, OC, and LF groups.

Specialists' management of permanent dentition traumatic dental injuries in 7-16-year-olds: A qualitative study.

BACKGROUND/AIM: Specialist paediatric dentists are integral to dental trauma care pathways. General dentists rely on specialist input, more so in complex cases. Little is known about specialists' role in these pathways or the perceived barriers they face. The aim is to explore specialists' role in managing traumatic dental injuries in the permanent dentition in children. MATERIAL/METHODS: Face-to-face (remote video) online semi-structured interviews were undertaken. All UK specialists were invited by email. Purposeful sampling aimed to investigate representation from the devolved nations, presence/absence of working within a managed-clinical network and level of care provision. Interviews were audio-recorded and transcribed verbatim. Transcripts were thematically analysed. RESULTS: Data saturation was reached after nine interviews. Three main themes established were: inconsistent access to care; the need to formalise traumatic dental injuries care pathways; educationally upskilling general dentists. Geographical variation in provision of specialist and out-of-hours/emergency department care meant patients risked not receiving care by the most appropriate individual. Formalizing care pathways by clearly defining the role of each stakeholder (specialist, dentist, medical professionals and parents) and developing a method to assess complexity was perceived to be essential to improving treatment outcomes. Upskilling general dentists in trauma management appeared essential. A potential lack of engagement was raised, with a suggestion that trauma management education should become core continuing-professional development. CONCLUSIONS: Specialist input should be available in the management of traumatic dental injuries. Current access to specialist care is inequitable across the UK. Formalizing care pathways and upskilling general dentists could ease inconsistencies.

Anterior Esthetic Restorations with the Stratified Stamp Technique: A Case Report.

Anterior teeth restoration represents a challenge for dentists, who often rely on the dental technician's wax-up. The proposed Stratified Stamp Technique (SST) allows for clinically reproducing the wax-up in a quick and easy way. A patient with fractures and discoloration on the upper central incisors was treated with resin-based composite direct restorations. Using SST, a 1 mm thick thermoformed polyethylene-terephthalate-glycol (PETG) template, based on the technician's wax-up, was produced. Enamel Selective Area Reduction (SAR) was performed to guarantee adequate space for the restorations, and the fracture margins were rounded and finished. Traditional layering procedures according to the five color dimensions of teeth were performed, except for the final labial layer, which was realized with warm composite loaded inside the template and polymerized through it, in order to ensure accurate tooth morphology reproduction. SST offers a reliable method for transferring technician's wax-up morphology to direct composite restorations in anterior teeth. Compared with other methods, SST allows for better isolation with a rubber dam and permits traditional layering with multiple composite shades, thus leading to satisfactory esthetic outcomes.

Endodontic Treatment for a Mesiodens: A Case Report.

Mesiodens are common supernumerary teeth that prominently erupt in the midline between the maxillary central incisors. If two or more mesiodens are present, they are termed mesiodentes, indicating the presence of multiple supernumerary teeth in the midline. These often cause aesthetic disharmony in the anterior teeth due to their abnormal position, leading to extraction in most cases and resulting in midline diastema when impacted or partially erupted. This case is uncommon, as the patient expressed a desire to preserve their mesiodens as a distinctive feature, considering them a familial trait worth retaining. The family history of the patient revealed the occurrence of mesiodens in three generations, highlighting a hereditary pattern of supernumerary teeth within the family. The endodontic therapy involving root canal treatment successfully treated the mesiodens, alleviating pain, and preserving them as desired.

Dental injuries in Swiss children - an analysis of Swiss national health insurance data from the year 2019.

This study, the first to analyze accident data from a major compulsory Swiss health insurer (Concordia), reviewed 5,063 dental accident reports of 122,370 children under the age of 16. The predominant cause of injury was a "fall," with "playing" being the foremost activity mentioned and "ground" identified as the primary object of impact. The analysis of the involved objects showed that dental injuries occur most frequently with scooters, bicycles, and stairs. In 2019, 8.14% of children aged one and insured by Concordia suffered a dental injury. By age 16, 58.8% of all children had experienced a dental injury. 0.72% had suffered a primary dentition crown fracture with pulp involvement. Regarding their permanent teeth, 0.21% suffered an avulsion, 0.84% another luxation injury, 0.65% a crown fracture with pulp involvement, and 0.16% a root fracture. A significant increase in injuries per day was observed after the summer holidays. On weekends, there were 28% fewer injuries per day on average than on weekdays. Despite differences among the cantons, the dataset can be considered to be representative for Switzerland. Accident descriptions were often too brief for detailed prevention strategies. Detailed accident information is essential for effective structural measures, which are more effective than promoting behavioural changes. A detailed recording could also be used to draw up a list of the objects frequently involved in accidents. An updated insurance form with an improved nomenclature, the option of digital submission, photo uploads and AI-supported data recording could greatly improve the quality and interpretability of injury data.

[Pulp revascularization procedure for external inflammatory dental root resorption treatment]. / Primenenie metodiki regeneratsii pul'popodobnoi tkani dlya ostanovki naruzhnoi vospalitel'noi rezorbtsii kornya zuba.

THE AIM OF THE STUDY: To assess the effectiveness of pulp revascularization procedure in children with external inflammatory root resorption (EIRR) after constant teeth injury. MATERIALS AND METHOS: The study comprised 17 children aged 6-10 years diagnosed with EIRR as a long-term complication of dental trauma in 19 teeth. EIRR was diagnosed with periapical radiographs and CBCT was performed to further assess the pathology extension. Pulp revascularization was carried out in all 19 teeth. RESULTS: There was no resorption progression in all cases. EIRR areas were substituted by bone. In 10 from 19 teeth with early stages of root development bone or cement-like tissue ingrowth into the root canal was observed radiologically. In cases of severe EIRR this ingrowth may partially compensate for lost tissues which is confirmed by a high percentage (94.7%) of functional teeth during mean follow up time of 38±10 months. CONCLUSION: Pulp revascularization is an effective method for retaining teeth with EIRR for a relatively long period of time and allows maintaining alveolar bone volume both due to functional tooth preservation and healing of bone lesions in periapical and resorption areas.

The various forms of tooth resorption.

Tooth resorption refers to the loss of the organic and inorganic components of tooth structure by clastic cells. The complex and multifaceted nature of its aetiology, along with the several classification schemes published in the area, are likely to create confusion amongst researchers and clinicians, and may lead to compromised treatment decisions. Therefore, this paper will categorise and address tooth resorption based on aetiology in order to help clinicians diagnose and filter treatment options based on the pathophysiology of the resorption at hand. With recent advancements in the literature, the purpose of this paper is to provide clinicians with a current, clinically relevant summary of the various forms of tooth resorption, with a focus on aetiologically driven treatment strategies and suggestions that facilitate their recognition, diagnosis and management.

Development of clobetasol-loaded biodegradable nanoparticles as an endodontic intracanal medicament.

AIM: The aim of current study is the development and optimization of biodegradable polymeric nanoparticles (NPs) to be used in the field of Endodontics as intracanal medication in cases of avulsed teeth with extended extra-oral time, utilizing PLGA polymers loaded with the anti-inflammatory drug clobetasol propionate (CP). METHODOLOGY: CP-loaded nanoparticles (CP-NPs) were prepared using the solvent displacement method. CP release profile from CP-NPs was assessed for 48 h against free CP. Using extracted human teeth, the degree of infiltration inside the dentinal tubules was studied for both CP-NPs and CP. The anti-inflammatory capacity of CP-NPs was evaluated in vitro measuring their response and reaction against inflammatory cells, in particular against macrophages. The enzyme-linked immunosorbent assay (ELISA) was used to examine the cytokine release of IL-1ß and TNF-α. RESULTS: Optimized CP-NPs displayed an average size below 200 nm and a monomodal population. Additionally, spherical morphology and non-aggregation of CP-NPs were confirmed by transmission electron microscopy. Interaction studies showed that CP was encapsulated inside the NPs and no covalent bonds were formed. Moreover, CP-NPs exhibited a prolonged and steady release with only 21% of the encapsulated CP released after 48 h. Using confocal laser scanning microscopy, it was observed that CP-NPs were able to display enhanced penetration into the dentinal tubules. Neither the release of TNF-α nor IL-1ß increased in CP-NPs compared to the LPS control, displaying results similar and even less than the TCP after 48 h. Moreover, IL-1ß release in LPS-stimulated cells, decreased when macrophages were treated with CP-NPs. CONCLUSIONS: In the present work, CP-NPs were prepared, optimized and characterized displaying significant increase in the degree of infiltration inside the dentinal tubules against CP and were able to significantly reduce TNF-α release. Therefore, CP-NPs constitute a promising therapy for the treatment of avulsed teeth with extended extra-oral time.