Apexification, a well-established endodontic treatment for managing immature permanent teeth with pulp necrosis, aims to create a calcified apical barrier to seal communication with the periapical tissues and allow gutta percha placement. This literature review explores advancements of apexification and introduces a systematic, evidence-based procedure for achieving optimal outcomes for apexification procedures. The discussion compares the materials most commonly used in apexification: calcium hydroxide [Ca(OH)2], mineral trioxide aggregate (MTA), and Biodentine. Compared with Ca(OH)2, contemporary calcium silicate-based materials such as MTA and Biodentine have significantly greater predictability, biocompatibility, and fracture resistance, increasing the longevity of the immature tooth. In addition, the article discusses alternatives to apexification, including regenerative endodontic therapy. A review of the scholarly literature reveals that apexification has long been a cornerstone of treatment for immature permanent teeth with necrotic pulp, offering a predictable method to create a calcified barrier at the apex and enable tooth restoration. While apexification does not promote further root growth, it remains a reliable solution, particularly for cases requiring immediate treatment and a high degree of predictability.

Osteopontin deficiency disturbs dentin bridge formation after direct pulp capping with mineral trioxide aggregate

To comparatively evaluate the effects of mineral trioxide aggregate (MTA) mixed with distilled water (DW), phosphate-buffered saline (PBS), and disodium hydrogen phosphate (DSHP) on the root dentine of teeth affected by diabetes mellitus (DM). Five samples of MTA were mixed with either distilled water (DW), phosphate-buffered saline (PBS), or disodium hydrogen phosphate (DSHP). Then, they were assessed for surface characteristics using high-resolution scanning electron microscopy-energy-dispersive X-ray spectroscopy (HRSEM-EDX), surface microhardness via Vickers indentation, and in vitro bioactivity after 21 days of immersion in simulated body fluid. For the other in vitro tests, 82 single-root human permanent premolars (nondiabetic = 41; diabetic = 41) were decoronated to a standardized length of 12 ± 1mm. Following tubular density evaluation (n = 5) using HRSEM, push-out bond strength (n = 18) and fracture resistance (n = 9) were assessed using a universal testing machine, whereas the cement-dentine interface (n = 9) was analyzed using HRSEM-EDX. The root specimens were then randomly subdivided into subgroups based on the different ionic MTA formulations as follows: subgroup I: MTA + DW, subgroup II: MTA + PBS, and subgroup III: MTA + DSHP. Statistical analysis was conducted using GraphPad Prism 10.4.1, using independent t-tests and two-way analysis of variance with Bonferroni correction for comparisons (P < 0.05). MTA + PBS exhibited a uniform matrix with distinct crystalline structures and the highest microhardness (69.2 ± 3.97 VHN), followed by MTA + DSHP and MTA + DW test materials. All formulations promoted apatite formation, with MTA + PBS showing dense, homogenous platelet-like crystals. Tubular density was reported to be higher in diabetic dentine (P < 0.05). MTA + PBS demonstrated superior cement-dentine interface, push-out bond strength, and fracture resistance, followed by MTA + DSHP and MTA + DW in both DM and non-DM root dentine specimens (P < 0.05). DM significantly affects the physicochemical and biological properties of root dentine. Among the various test ionic formulations, MTA + PBS exhibited superior surface characteristics, physicochemical, and biological characteristics compared to MTA + DSHP and MTA + DW. Hence, MTA mixed with phosphate ionic vehicles, is clinically recommended for effective endodontic management of diabetic dentine. Not applicable.

This in vitro study investigated the push-out bond strength and adaptation of three root canal sealers AH Plus Jet (epoxy resin-based), MTA Fillapex, and EndoSeal Mineral Trioxide Aggregate (MTA) both with and without gutta-percha obturation, utilizing 90 straight, single-rooted teeth randomly assigned to groups and subgroups. Push-out bond strength was measured using an Instron universal testing machine, while adaptation was assessed via scanning electron microscopy, with statistical analysis performed using one-way ANOVA and Tukey's post-hoc test (p&lt;0.05). EndoSeal MTA demonstrated the highest statistically significant push-out bond strength (p&lt;0.001) in both conditions, though no significant difference existed between MTA Fillapex and AH Plus Jet without gutta-percha, where AH Plus Jet still showed higher bond strength at root levels than MTA Fillapex (p&lt;0.001). While adaptation showed no significant differences among sealers with gutta-percha, AH Plus Jet achieved the lowest significant gap percentage in its absence. Ultimately, EndoSeal MTA exhibited the highest push-out bond strength overall, making its superior adhesion a promising choice for root canal obturation.

BackgroundVital pulp therapy (VPT) aims to preserve pulp vitality and tooth function. However, materials like calcium hydroxide and mineral trioxide aggregate have limitations in bioactivity, underscoring the need for improved biomaterials. Strontium-doped hydroxyapatite (Sr-HA) and pro-angiogenic agents have emerged as promising strategies to enhance dentin–pulp complex regeneration.MethodsHollow hydroxyapatite microspheres with 5%, 10%, and 15% Sr substitution were synthesized, and the optimal concentration was identified through Sr2+ release profiling and CCK-8-based cytocompatibility screening. Iloprost was subsequently loaded onto the selected 5% Sr-HA to obtain Ilo@Sr-HA. Human dental pulp stem cells (hDPSCs) were isolated from healthy extracted premolars using the tissue-explant method and identified by flow cytometry and multilineage differentiation assays. The identified cells were used to assess viability, ALP activity, mineralized nodule formation, and odontogenic gene expression. A bilateral rat pulp-exposure model (N = 40; n = 10/group: Blank, Dycal, Sr-HA, Ilo@Sr-HA) was established. Reparative outcomes were quantified using micro-CT and histological scoring at days 7 and 28.ResultsPreliminary screening identified 5% Sr-HA as optimal, with the best ion release and cytocompatibility. Ilo@Sr-HA showed a biphasic release and no cytotoxicity toward hDPSCs. In vitro, Ilo@Sr-HA enhanced hDPSCs proliferation and ALP activity compared with HA and Sr-HA. Mineralized nodule formation increased, with significant DMP1 and DSPP upregulation (P < 0.05). In vivo, Ilo@Sr-HA enhanced reparative dentin formation, with DV/TV reaching 38.91% at 4 weeks vs. 26.53% for Dycal (P < 0.01). Histology confirmed continuous dentin bridges in the Ilo@Sr-HA group, contrasting with incomplete structures in Dycal and Sr-HA. Lower inflammation and better pulp preservation were also observed.ConclusionIlo@Sr-HA combines Sr2+ ionic cues with iloprost’s pharmacological effects to form a bioactive microenvironment that supports pulp repair and reparative dentinogenesis. Ilo@Sr-HA is a promising material for VPT and dentin–pulp regeneration.

Excellent bioactivity and biocompatibility make bioceramics a popular choice in dentistry, especially in endodontics. The most commonly utilised bioceramic in endodontics is mineral trioxide aggregate (MTA). Several emerging bioceramics showed promise for endodontic treatment. This study discusses bioceramics and their use in endodontic treatments like as root-end filling, root canal therapy, vital pulp therapy, apexification/regenerative endodontic treatment, perforation repair, and root defect repair. The applicable research from 1990 to 2023 was screened using keywords in PubMed and Web of Science. According to current research, MTA in the management of endodontic disease is well supported. New bioceramics including Biodentine, EndoSequence, and calcium-enriched mixes have demonstrated encouraging clinical results, but additional controlled trials must be conducted to establish their use in endodontics. To address endodontic problems, bioceramics must be improved for their biologic activity, including antibacterial activity, mechanical qualities, and reduced setting time and solubility. The purpose of this review is to provide an overview of the state of bioceramic technology and to investigate potential avenues for further investigation to improve its regenerative and therapeutic potential in endodontics. Research Question: What developments and potential uses can enhance the endodontic bioceramic-based therapies' regeneration results?

The current research investigated the effects of the addition of nano-carbonated hydroxyapatite (nCHAp) along with influences on physioterico-chemical properties that are applicable to vital pulp therapy in mineral trioxide aggregate (MTA Angelus). Settling time and solubility analyses, pH, compressive strength and surface microhardness were carried out in samples containing 1, 2, 3, 4, and 5 wt% nCHAp. Results were proven to be concentration-dependent, where the 3% nCHAp provided the best results with a significant increase of setting time (64%), decreasing solubility to 0.88±0.15% (672 h), and pH was maintained greater than 9.2 during the 28 days, together with a considerable enhancement of compressive strength (74.00±1.33 MPa) or surface microhardness (78.12±0.97 kg/mm2 at 28 days). High concentrations (more than 4%) had a negative influence on both mechanical stability and the pH stability, a fact related to particle agglomeration and over-substitution. The findings indicate that incorporation of 3% nCHAp into MTA enhances its physicochemical characteristics without altering the main features needed in pulp therapy.

This study compared the biocompatibility and discoloration potential of Malaysian Portland cement (MPC), experimental MPC (EPC), radiopaque nano-zirconium oxide modified EPC (REPC), with ProRoot white mineral trioxide aggregate (WMTA) using human dental pulp stem cells (HDPSCs) with/without lipopolysaccharide (LPS). Cytotoxicity and cell attachment were evaluated using MTT assay and scanning electron microscope (SEM) after 24/72 h. For discoloration, the cements were placed in extracted human permanent maxillary incisors and color was measured spectrophotometrically. Results showed that all extracts except 100 mg/mL were non-cytotoxic. For LPS-treated groups (24 h), WMTA demonstrated higher cell viability than REPC (p<0.008). At 72 h, all groups were comparable. At 24 h, LPS-treated HDPSCs exhibited lower values than untreated HDPSCs (p<0.008). At 72 h, differences were comparable. SEM demonstrated favorable HDPSCs attachment. Tooth discoloration was the highest for WMTA, and lowest for REPC. In conclusion, the biological properties of REPC were comparable with WMTA. REPC did not cause tooth discoloration.

ABSTRACTObjectivesThis in vitro investigation evaluated the microshear bond strength (µSBS) of composite resin to mineral trioxide aggregate (MTA) and a modified polycarboxylate cement containing potassium nitrate (PCC/KNO3), both utilized as pulpotomy materials. The performance of two universal adhesives was compared, applied using self‐etch (SE) and etch‐and‐rinse (E&R) strategies.Materials and MethodsA total of 192 cylindrical acrylic specimens (2 cm height × 1 cm diameter) with a central cavity (4 mm diameter × 2 mm depth) were fabricated and filled with either MTA or PCC/KNO3 (n = 96 each). These were further divided into eight experimental subgroups (n = 12) based on adhesive type (All‐Bond Universal or Gluma Bond Universal), adhesive application method (SE or E&R), and storage duration (24 h or 7 days). After resin composite application, all specimens were stored in 100% humidity at 37°C for 24 h prior to µSBS testing. Data were analyzed using four‐way ANOVA and independent t‐tests (α = 0.05).ResultsPCC/KNO3 exhibited significantly greater bond strength than MTA at both 24‐h (p < 0.001) and 7‐day (p = 0.030) intervals. Neither the adhesive type (p = 0.355) nor the application method (p = 0.358) significantly affected bond strength. Over time, µSBS values increased for MTA in some groups, while a significant decline was observed in most PCC/KNO3 subgroups.ConclusionDue to its superior early bond strength and compatibility with immediate restoration, PCC/KNO3 shows potential as a viable alternative to MTA in vital pulp therapy, regardless of the adhesive strategy employed.

MTA versus Biodentine in Root Perforation Repair: Influence of Obturation Strategy on Fracture Risk in Maxillary First Premolars - A FEA and Weibull Analysis.

The Effect of Intraorifice Barrier Materials on the Fracture Resistance of Endodontically Treated Teeth: A Systematic Review and Network Meta-Analysis.

Application of green nanoparticles in dental materials: A scoping review.

Treatment of immature permanent teeth with blunderbuss apices and thin dentinal walls remains an enigma for endodontists. Various treatment modalities have been used to manage immature teeth, such as non vital pulp therapy with calcium hydroxide or apexification using Mineral Trioxide Aggregate (MTA), Biodentine, or bioceramic putty. However, these methods fail to address the problem of thin dentinal walls, which often leads to tooth fracture and extraction despite successful initial treatment. Regenerative Endodontic Procedures (REPs) offer the best solution for such cases, with the potential to re-establish the dentin-pulp complex, thereby facilitating apexogenesis and root maturation. The development of second-generation platelet concentrates such as Platelet-Rich Fibrin (PRF) has made the success of REPs more predictable compared to procedures that rely solely on induced intracanal bleeding. A 25-yearold female patient presented with pain and swelling in the upper anterior region, with a history of childhood trauma 17 years earlier and recent incomplete dental treatment. Clinical and radiographic examination revealed tenderness on percussion and a well-defined periapical radiolucency (~10×12 mm) involving teeth #21 and #22. Tooth #21 exhibited an open apex and a necrotic pulp, while tooth #22 had previously undergone root canal treatment. A working diagnosis of periapical pathology secondary to pulpal necrosis was made. A Regenerative Endodontic Procedure (REP) was planned for tooth #21, while tooth #22 was left untreated due to satisfactory restoration and obturation. Following disinfection using 1.5% sodium hypochlorite and placement of an interim calcium hydroxide dressing over three visits, Platelet-Rich Fibrin (PRF) prepared from autologous blood was placed as a scaffold. A collagen plug was positioned over the PRF, followed by a 3 mm layer of MTA, and the tooth was sealed with resin-modified glass ionomer cement. Follow-ups at 3, 6, 12, and 24 months revealed complete resolution of the periapical radiolucency with apical closure of tooth #21. The tooth remained asymptomatic and functional, although no response to pulp vitality tests was observed. Regenerative endodontic treatment can be successfully performed alongside conventional endodontic therapy in managing immature permanent teeth with periapical radiolucency. Two teeth involved in the same lesion can be effectively treated using different treatment modalities, and prior conventional endodontic intervention does not hinder the future success of regenerative endodontics.

Physicochemical and antibacterial properties of white mineral trioxide aggregate after replacement of Bi2O3 with ZnO nanoflowers

The Palato-Gingival Groove (PGG) is a rare developmental anomaly most frequently affecting maxillary incisors, predisposing the tooth to plaque retention, localised periodontal destruction, and combined endodontic-periodontal lesions. Owing to its complex anatomy, the diagnosis and management of PGG remain a significant clinical challenge. This case report describes the management of a severe PGG in a 26-year-old male who presented with mobility and a deep periodontal pocket in the maxillary right lateral incisor. Clinical and radiographic examination, including Cone-Beam Computed Tomography (CBCT), confirmed the presence of a deep PGG associated with periapical radiolucency. Root canal therapy was performed, followed by a full-thickness flap surgery. The groove was saucerised and sealed with mineral trioxide aggregate to prevent microleakage and promote healing. Bone grafting was performed to facilitate periodontal regeneration, and the flap was repositioned and sutured. Follow-up evaluations at one, three, and five months demonstrated a significant reduction in probing depth, radiographic evidence of bone fill, and restoration of periodontal stability. The second case involved a 35-year-old male with a history of trauma to the maxillary left central incisor and previous root canal treatment, who reported recurrent pain and swelling. Clinical and CBCT examination revealed a palatal radicular groove associated with periapical pathology. Nonsurgical endodontic retreatment was performed, followed by flap surgery. The groove was sealed with light-cured Glass Ionomer Cement (GIC) to achieve a smooth surface, prevent microleakage, and enhance periodontal healing. Bone grafting and periodontal dressing were placed to promote regeneration. Follow-up evaluations at three and five months showed complete resolution of symptoms, bone fill, and satisfactory gingival healing. This report of two cases emphasises the importance of early recognition of the PGG as an etiological factor in persistent endo-perio lesions. A comprehensive approach involving endodontic, periodontal, and restorative procedures was essential in achieving favourable outcomes. The novelty of this report lies in highlighting the role of multidisciplinary management in preserving a tooth with an otherwise poor prognosis, thereby reinforcing the need for awareness and timely intervention in such rare anatomical anomalies.

This article presents the clinical stages and radiographs of direct pulp capping applications using MTA, a popular material in recent years, in four distinct cases. With the exception of the eight-year-old female patient who presented with trauma complaints in the first case, the other three cases were patients who sought clinical attention due to temperature sensitivity. Following initial radiographic examination, intraoral assessments were conducted. Subsequently, deep caries in the examined teeth were removed, and Mineral Trioxide Aggregate (MTA) was applied to the near-pulpal region. This case report demonstrates that successful pulp capping treatments can allow teeth to remain vital and functional without necessitating root canal therapy.

Root canal treatment (RCT) has traditionally been considered the benchmark for treating teeth diagnosed with irreversible pulpitis or pulpal necrosis. Yet, with advancements in biomaterials and a deeper understanding of pulp biology, there has been a renewed focus on vital pulp therapy (VPT) as a biologically oriented alternative designed to maintain pulp vitality. The introduction of modern calcium silicate–based bioceramics, including mineral trioxide aggregate (MTA), Biodentine, and calcium-enriched mixture (CEM) cement, has enhanced the clinical success of VPT due to their superior sealing capacity, excellent biocompatibility, and regenerative potential, surpassing conventional options such as calcium hydroxide. Current randomized clinical trials and observational research indicate that, in carefully selected cases, VPT can deliver outcomes comparable to RCT, with added benefits such as conservation of tooth structure, shorter treatment duration, and lower cost. This review consolidates evidence on the biological rationale, biomaterials, procedural techniques, clinical indications, success rates, and inherent limitations of VPT versus RCT. It also emphasizes patient-centered aspects such as pain management and economic feasibility, while exploring future directions including regenerative endodontics and tissue engineering. Overall, the review underscores that with appropriate case selection and the use of contemporary bioactive materials, VPT stands as a minimally invasive and promising alternative to conventional RCT in specific clinical scenarios.

Management of necrotic young permanent teeth with incomplete root development represents a significant clinical challenge in pediatric dentistry due to open apices, thin dentinal walls, and increased susceptibility to fracture. Preserving or restoring root development is critical for improving the long-term prognosis of these teeth. Over recent decades, apexification and regenerative endodontic procedures (REPs) have emerged as the primary treatment strategies for addressing pulp necrosis in immature permanent teeth. Apexification aims to induce the formation of a calcified apical barrier that allows effective obturation of the root canal system. Traditionally, calcium hydroxide has been widely used for this purpose, demonstrating high success rates in resolving apical pathology. However, prolonged treatment duration, increased risk of root fracture, and lack of continued root development are important limitations. To overcome these drawbacks, single-visit apexification using bioceramic materials such as mineral trioxide aggregate (MTA) has gained popularity, offering predictable apical barrier formation, reduced treatment time, and favorable clinical outcomes. Regenerative endodontic procedures represent a biologically based treatment approach designed to promote continued root maturation by harnessing the regenerative potential of stem cells from the apical papilla, growth factors, and suitable scaffolds. REPs aim not only to resolve infection but also to facilitate root lengthening, thickening of dentinal walls, apical closure, and reestablishment of vitality-related responses. Clinical studies have reported high survival and success rates for REPs, particularly in teeth with short roots and wide apical openings. This review provides a comprehensive comparison of apexification and regenerative endodontic procedures, focusing on their biological principles, clinical protocols, indications, advantages, and limitations. Emphasis is placed on evidence-based decision-making to guide clinicians in selecting the most appropriate treatment modality based on individual case characteristics. Understanding the strengths and shortcomings of each approach is essential for optimizing clinical outcomes and preserving young permanent teeth in pediatric patients.

Objectives The aim of this study was to evaluate the wettability, surface and molecular characterization of three different restorative materials (Mineral Trioxide Aggregate [MTA], glass ionomer cement [GIC] and alkasite [AL]) added with fucoidan. Materials and Methods Nine experimental groups were established by incorporating 0%, 2.5%, and 5% fucoidan by weight into the powder phase of MTA, AL, and GIC, followed by mixing according to manufacturers’ instructions. Cylindrical samples (3 mm diameter × 2 mm height ) were molded and stored at 37°C under 100% humidity. Contact Angle Analysis, SEM/EDS, and FTIR spectroscopy evaluations were performed. One-way ANOVA and Tukey post-hoc tests (p &lt; 0.05) were applied for statistical analysis. Results Fucoidan incorporation induced material-specific changes in wettability, chemical composition, and surface morphology. While contact angle values increased in MTA and AL, GIC showed improved wettability at 2.5%. FT-IR analysis confirmed chemical interactions, especially through glycosidic and sulfate bands. SEM-EDS revealed disrupted or reorganized microstructures and altered elemental distributions, including increased fluorine and silicate presence. Conclusions Fucoidan addition improved wettability without compromising the matrix, supporting its potential for advanced restorative materials.

INTRODUCTION. Dental pulp stem cells (DPSCs) are of interest in regenerative endodontics due to their multipotency. Mineral trioxide aggregate (MTA) is highly sought after due to its biocompatibility, but the limitations of long setting time and poor handling have created interest in newer products such as Baghdadite. To evaluate the biocompatibility and osteogenic potential of Baghdadite, MTA, and their combination on DPSCs using MTT and Alizarin Red assay. MATERIALS AND METHODS. DPSCs were cultured and characterized by flow cytometry and CFU assays. Experimental groups (MTA, Baghdadite, MTA+Baghdadite) were exposed to cytotoxicity test (MTT assay) and mineralization test (Alizarin Red staining). RESULTS. Cell viability of all the groups was higher than control. Combination group showed maximum viability (mean OD: 0.4066) than Baghdadite (0.3975) and MTA (0.3563). Alizarin Red staining showed the maximum mineralization in combination group (mean OD: 1.7069) than MTA (0.5788) and Baghdadite (0.4020). CONCLUSIONS. The association of MTA and Baghdadite showed improved biocompatibility and osteogenic ability, which is promising for application as a pulp-capping agent in regenerative endodontics.