Regenerative Procedures Research Articles

Investigating the Efficacy of Regenerative Therapy With Autogenous Platelet-Rich Plasma in Vertical Bone Defects.

Context and objective The main goal of periodontal therapy is to remove periodontopathogenic microorganisms and regenerate destructured periodontal tissues. Advances in biomaterials have improved the results of regenerative procedures. However, there is limited data available to determine the best material for vertical bone deformities treated with regenerative treatment. Studies on autogenous platelet-rich plasma (PRP) have been conducted, but it is often combined with other biomaterials. The objective of this study is to examine the exact efficacy of solely administering autogenous PRP in regenerative therapy of vertical bone defects. Materials and methods The study was conducted from August 2022 to July 2023 at the Faculty of Dental Medicine, Medical University Varna, BGR, using the University Medical and Dental Center as its base. It includes 12 cases with bipartite, tripartite, or a combination of the listed vertical bone defects. Participating patients met the following criteria: signed informed consent; age between 18 and 65 years; individuals in good health without diagnosed systemic disease, and adequate dental care. The clinical parameters investigated and recorded immediately before regenerative therapy with autogenous PRP and six months after the surgical intervention were probing depth, margo gingivalis level, clinical attachment level, and cone beam computed tomography (CBCT)-indicators A (the distance from the cemento-enamel junction to the bottom of the bone defect), B (the distance from the cemento-enamel junction to the apex of the bone defect), and C (the width of the defect). The results obtained from the measurements immediately before the regenerative therapy with PRP and six months after the surgical intervention were compared and analyzed. Results and conclusions The clinical outcomes for vertical bone defects at the six-month mark following the PRP therapy showed an average 3.83 mm reduction in probing depth, an average 0.08 mm coronal migration of the gingival margin, and an average 3.92 mm gain of the clinical level of attachment. The CBCT showed bone filling, which is supported by the average decrease for points A, B, and C of 1.69 mm, 0.51 mm, and 0.36 mm, respectively. The study's findings primarily illustrate the strong potential of autogenous PRP as an independently applicable substance for regeneration therapy in periodontology.

Can Whole-heart Tissue Engineering Products by Recellularization from Scaffolds Be Utilized on Humans in the Next Ten Years?

Diseases like organ failure lead to irreversible damage to our body, making organ transplantation the only treatment. However, though organ transplantation may be an effective treatment, problems of organ shortage and post-transplantation immune rejection still remain unresolved, making the development of alternative technologies vital. Organ regeneration is, therefore, a promising treatment as it aims to lower the chance of immune responses and may potentially solve the issue of organ shortage. An average procedure of organ regeneration has two steps: decellularization and recellularization. Decellularization techniques include physical, chemical, and enzymatic treatments, and these methods are often combined to maximize cell depletion, turning the organ into an extracellular matrix scaffold and minimizing the chances of immune rejection. Recellularization is the process of repopulating the scaffold with patient-specific cells, and is often completed through using perfusion systems by performing vascular perfusion and intramyocardial injections with the help of a bioreactor. This article explains the concept of whole-heart regeneration and assesses different methods of decellularization and recellularization to find the treatment with the highest efficacy and efficiency, while also conducting a case study on cultured epidermal autografts and primary research, in the form of a questionnaire, to look at the social acceptance of this technology, estimate the progress of whole-heart regeneration, and discuss its limitations.

New titanium mesh design method in customized bone regeneration of the jaws: preliminary study on a sample of 11 patients

The aim of this study is 1) to present a new method of virtually-designed custom made scaffolds to be employed in customized bone regeneration (CBR) for segmental jaw atrophies and 2) to evaluate long-term clinical results in terms of bone regeneration success and implant rehabilitation success. A total of 11 patients with edentulousness and bone atrophy in a localized area of the mandible or the maxilla were recruited for the study. To fulfill the research inquiries, CT images of the pre-regeneration mandibular or maxillary arch of each patient were collected. A dedicated Mevislab 2.4 software was employed to virtually design custom bone regeneration meshes designed to fit the atrophic sector of each patient's mandible or maxilla. Subsequently, a second Meshmixer software was used to refine the margins of each of the designed meshes. All patients underwent oral surgery, during which a mixture of autologous and heterologous bone in a 1:1 proportion was grafted into the atrophic site, a custom-made mesh was placed, and a resorbable membrane was inserted. The mesh was removed after this procedure, and implant rehabilitation was performed. All patients underwent the bone regeneration procedure, with eight undergoing titanium mesh removal. A total of seven patients completed implant rehabilitation. Average horizontal bone augmentation was 3.525 ± 1.36 mm; average vertical bone augmentation was 4.45 ± 2.22 mm. Implant survival was 92.85%. During the healing phase, complications occurred in 9.09% of patients. The use of dedicated software, Mevislab 2.4 and Meshmixer, for titanium mesh design is an accurate, predictable, effective, and quick-to-use method. The learning curve for design is uncomplicated and rapid. Mesh exposure does not necessarily lead to bone graft failure; this complication can be treated by chlorhexidine aids.

Preparation and characterization of bovine dental pulp-derived extracellular matrix hydrogel for regenerative endodontic applications: an in vitro study

BackgroundThe use of biological scaffolds in regenerative endodontics has gained much attention in recent years. The search for a new biomimetic scaffold that contains tissue-specific cell homing factors could lead to more predictable tissue regeneration. The aim of this study was to prepare and characterize decellularized bovine dental pulp-derived extracellular matrix (P-ECM) hydrogels for regenerative endodontic applications.MethodsFreshly extracted bovine molar teeth were collected. Bovine dental pulp tissues were harvested, and stored at -40º C. For decellularization, a 5-day protocol was implemented incorporating trypsin/EDTA, deionized water and DNase treatment. Decellularization was evaluated by DNA quantification and histological examination to assess collagen and glycosaminoglycans (GAGs) content. This was followed by the preparation of P-ECM hydrogel alone or combined with hyaluronic acid gel (P-ECM + HA). The fabricated scaffolds were then characterized using protein quantification, hydrogel topology and porosity, biodegradability, and growth factor content using Enzyme-linked immunosorbent assay (ELISA): transforming growth factor beta-1(TGF-β1), basic fibroblast growth factor (bFGF), bone morphogenetic protein 2 (BMP-2) and vascular endothelial growth factor (VEGF).ResultsDecellularization was histologically confirmed, and DNA content was below (50 ng/mg tissue). P-ECM hydrogel was prepared with a final ECM concentration of 3.00 mg/ml while P-ECM + HA hydrogel was prepared with a final ECM concentration of 1.5 mg/ml. Total protein content in P-ECM hydrogel was found to be (439.0 ± 123.4 µg/µl). P-ECM + HA showed sustained protein release while the P-ECM group showed gradual decreasing release. Degradation was higher in P-ECM + HA which had a significantly larger fiber diameter, while P-ECM had a larger pore area percentage. ELISA confirmed the retention and release of growth factors where P-ECM hydrogel had higher BMP-2 release, while P-ECM + HA had higher release of TGF-β1, bFGF, and VEGF.ConclusionsBoth P-ECM and P-ECM + HA retained their bioactive properties demonstrating a potential role as functionalized scaffolds for regenerative endodontic procedures.

Characteristics and optimization strategy of microwave thermal regeneration of spent activated carbon based on a multi-physical field model

Microwave thermal regeneration is an efficient and low-consumption way to recycle spent activated carbon. However, traditional experimental approaches are difficult to analyze the electromagnetic field distribution in the microwave cavity, heat and mass transfer process of adsorbates, and optimization of the microwave reactor. Therefore, in this work, a multi-phase porous media model coupled with electromagnetism, heat and mass transfer is established to study the characteristics of microwave thermal regeneration procedure and to propose an optimization strategy for the microwave reactor. The results showed that the absorption of microwave by the sample can be strengthened by adjusting the width to height ratio of the waveguide. The optimal waveguide size (width:length = 80 mm:10 mm) increased the microwave utilization efficiency from 65.4 % to 98.5 %. In addition, the combination of rotary and intermittent microwave heating significantly optimized the temperature uniformity in both lateral and vertical directions and reduced the microwave heating time. The combined microwave heating time was reduced from the initial 136 s to 80 s, saving 41 % of energy consumption. The temperature difference of the sample was also reduced from the initial 536 K to 191 K, and the covariance COVT decreased from 0.52 to 0.24. The results provide a valuable technical guideline for the optimization of the microwave reactor in order to improve the regeneration efficiency and the quality of the regenerated carbon.

Bovine pulp extracellular matrix hydrogel for regenerative endodontic applications: in vitro characterization and in vivo analysis in a necrotic tooth model

BackgroundRegenerative endodontic procedures (REPs) offer the promise of restoring vitality and function to a previously necrotic and infected tooth. However, the nature of regenerated tissues following REPs remains unpredictable and uncontrollable. Decellularized extracellular matrix scaffolds have gained recent attention as scaffolds for regenerative endodontics.ObjectivesPreparation and characterization of a bovine dental pulp-derived extracellular matrix (P-ECM) hydrogel for regenerative endodontic applications. Biocompatibility and regenerative capacity of the prepared scaffold were evaluated in vivo in a canine animal model.MethodsFifteen freshly extracted bovine molar teeth were used to prepare P-ECM hydrogels following approval of the institutional review board of the faculty of dentistry, Alexandria University. Decellularization and lyophilization of the extracted pulp tissues, DNA quantification and histological examination of decellularized P-ECM were done. P-ECM hydrogel was prepared by digestion of decellularized pulps. Prepared scaffolds were evaluated for protein content and release as well as release of VEGF, bFGF, TGF-β1 and BMP2 using ELISA. Rabbit dental pulp stem cells’ (rDPSCs) viability in response to P-ECM hydrogels was performed. Finally, proof-of-concept of the regenerative capacity of P-ECM scaffolds was assessed in an infected mature canine tooth model following REPs versus blood clot (BC), injectable platelet-rich fibrin (i-PRF) or hyaluronic acid (HA). Statistical analysis was done using independent t test, the Friedman test and chi-square tests (p value ≤ 0.05).ResultsDNA was found to be below the cut-off point (50 ng/mg tissue). Histological evaluation revealed absence of nuclei, retention of glycosaminoglycans (GAGs) and collagen content, respectively. P-ECM hydrogel had a total protein content of (493.12 µg/µl) and protein release was detected up to 14 days. P-ECM hydrogel also retained VEGF, bFGF, TGF-β1 and BMP2. P-ECM hydrogel maintained the viability of rDPSCs as compared to cells cultured under control conditions. P-ECM hydrogel triggered more organized tissues compared to BC, i-PRF and HA when used in REPs for necrotic mature teeth in dogs. Periapical inflammation was significantly less in HA and P-ECM groups compared to blood-derived scaffolds.ConclusionBovine dental pulp-derived extracellular matrix (P-ECM) hydrogel scaffold retained its bioactive properties and demonstrated a promising potential in regenerative endodontic procedures compared to conventional blood-derived scaffolds.

Response of a Blood Clot Adherent to Bone, Oral Mucosa and Hard Dental Tissues to a Uniaxial Tensile Test: An In Vitro Study.

Background and Objectives: Periodontal therapy aims to arrest the progression of periodontal diseases and possibly to regenerate the periodontal apparatus. To shift healing from repair to regeneration, the blood clot that fills the periodontal defect and remains in contact with structures such as tooth root, mucosa and bone needs to be stable, which is a reason why the treatment of non-containing periodontal bone defects, in which the clot may undergo displacement, is challenging. The gingival soft tissue, properly sutured, may act as a wall for blood clot stabilization. Knowledge on the response of the blood clot to stress and how it might vary according to the characteristics of the tissues it gets in contact with might be deepened. The aim of this study was to investigate in vitro, by means of a micro-loading device, the response of the complex formed by a blood clot and diverse tissues, simulating those involved in periodontal regeneration, to a displacing tensile test. Materials and Methods: Experimental samples made of two layers of either hard dental tissues, cancellous bone or oral mucosa, between which fresh blood was interposed, underwent a debonding experiment by means of a micro-loading device that measured their response to uniaxial tensile stress. Results: The peak of tensile stress and the overall work needed for the complete rupture of the clot's fibrin filaments were significantly higher for hard dental tissues than for other tissues. However, mucosa sustained the highest maximal strain in terms of relative displacement between the plates of the micro-loading device to accomplish the complete rupture of the fibrin filaments compared to the other tissues, suggesting that the mucosa might act as a stable interface with the clot and be able to sustain tensile stresses. Conclusions: This in vitro study seems to support the use of mucosa to act as a wall for regenerative procedures of suprabony periodontal defects given its capability to form a stable interface with the clot.

Successful Regenerative Endodontic Therapy of a Dens Evaginatus Mandibular Second Premolar with an Acute Apical Abscess and Extensive Periapical Bone Loss: A Case Report.

Regenerative endodontics is a rapidly growing field within dentistry that aims to replace damaged tooth structures and cells of the pulp-dentin complex. This case report presents the successful management of an immature permanent second mandibular premolar with an acute apical abscess and extensive apical bone loss caused by a dens evaginatus. This tooth was unexpectedly treated with long-term calcium hydroxide (Ca(OH)2) that was replenished several times over 6 months. During the treatment process, this tooth became reinflamed developing a chronic apical abscess after resolution of the initial acute apical abscess, which resulted in the replacement and prolonged use of Ca(OH)2. The final regenerative procedures were completed using a bioceramic fast set putty placed directly over the blood clot and an occlusal composite restoration. At the 6-month follow-up, the patient was asymptomatic with a fully healed radiographic lesion, new periodontal ligament, and the apex closed with thickening of the mesial and distal aspects of the root. At the 15-month follow-up, the patient remained asymptomatic with continued evidence of radiographic development of the apical aspect of this tooth, displaying root end closure and thickening. This is a unique case report of the management of a complex infection process in an immature tooth with regenerative techniques with repeated and long-term use of Ca(OH)2. This novel report provides dental practitioners with a new potential protocol for the management of these immature cases with advanced periapical infections that require extensive disinfection to have successful outcomes.

Regeneration and Single Stage Batch Adsorber Design for Efficient Basic Blue-41 Dye Removal by Porous Clay Heterostructures Prepared from Al13 Montmorillonite and Pillared Derivatives.

Porous clay heterostructures are a hybrid precursor between the pillaring process and organoclays. In this study, the organoclay was substituted by an aluminium intercalated species clay or pillared alumina clays. A porous clay heterostructure was successfully achieved from an aluminium intercalated species clay, due to the easy exchange of the aluminium species by the cosurfactant and silica species. However, using alumina pillared clays, the porous clay heterostructures were not formed; the alumina species were strongly attached to clay sheets which made difficult their exchange with cosurfactant molecules. In this case, the silica species were polymerized and decorated the surface of the used materials as indicated by different characterization techniques. The specific surface area of the porous clay heterostructure material reached 880 m2/g, and total pore volume of 0.258 cc/g, while the decorated silica alumina pillared clays exhibited lower specific surface area values of 244-440 m2/g and total pore volume of 0.315 to 0.157 cc/g. The potential of the synthesized materials was evaluated as a basic blue-41 dye removal agent. Porous clay heterostructure material has a removal capacity of 279 mg/g; while the other materials exhibited lower removal capacities between 75 mg/g and 165 mg/g. The used regeneration method was related to the acidity of the studied materials. The acidity of the materials possessed an impact on the adopted regeneration procedure in this study, the removal efficiency was maintained at 80% of the original performance after three successive regeneration cycles for the porous clay heterostructure. The Langmuir isotherm characteristics were used to propose a single-stage batch design. Porous clay heterostructures with a higher removal capacity resulted in a decrease in the quantities needed to achieve the target removal percentage of the BB-41 dye from an aqueous solution.

Trends in Cartilage Repair Techniques for Chondral Defects in the Hip in Germany: An Epidemiological Analysis from 2006 to 2022.

Cartilage repair techniques for chondral defects in the hip are crucial for treating conditions like femoroacetabular impingement, developmental dysplasia, and osteonecrosis, especially in young patients to delay the progression of osteoarthritis. This study aims to present age and sex distributions and trends in hip-preserving surgeries in Germany from 2006 to 2022, analyzing 116,179 procedures using the German OPS coding system. The procedures were categorized into three groups: debridement, refixation, and regeneration. Arthroscopy was more common than arthrotomy (98,916 vs. 17,263). Males underwent more procedures than females (63,771 vs. 52,408). Debridement had a monomodal age distribution peaking at 43.42 years, while refixation and regeneration exhibited bimodal patterns. Regenerative procedures were primarily performed on younger patients (average 27.73 years). A Joinpoint analysis showed an initial increase in procedures, peaking around 2013, followed by a decline. Arthroscopic procedures peaked at approximately 9000 in 2013, whereas arthrotomies peaked at around 1200 after 2014. The decline in procedures post-2013 may reflect refined surgical indications and a shift towards outpatient settings. These findings underscore the trend towards minimally invasive, scaffold-based treatments, with regenerative techniques showing promising outcomes in younger patients. Future research should focus on prospective comparative studies and cost-benefit analyses to guide clinical decision-making.

Repairing Dehiscence Defects at Implant Sites using β-Tricalcium Phosphate/Calcium Sulfate versus Xenograft Combined With Membrane: A Randomized Clinical Trial.

Guided bone regeneration (GBR) typically involves bone grafts and a membrane to enhance bone formation. Beta-tricalcium phosphate calcium sulfate (β-TCP/CS) is a novel material with self-hardening and tissue growth inhibition properties and can potentially replace the need for a membrane. This study compares β-TricalciumPhosphate/CalciumSulfate with deproteinized bovine bone mineral and a collagen membrane (DBBM/CM) to repair bone defects at implant sites over six months. Sixteen implant defects were divided into β-TCP/CS (n = 8) and DBBM/CM (n = 8). The results showed no significant differences in vertical and horizontal defect fill in millimeters between β-TCP/CS (2.87±1.25 and 2.37±1.06 mm., respectively) and DBBM/CM (3.5±0.92 and 2.87±1.12 mm. , respectively). Buccal bone thickness (BT) alterations at the implant platform levels (BT0) were similar for both materials. However, β-TCP/CS exhibited greater bone alteration at the 2-mm level (BT2: -1.85 mm vs. -0.47 mm) and 4-mm level (BT4: -1.79 mm vs. 0.12 mm) apical to the implant platform compared to DBBM/CM. When assessing volume alteration, β-TCP/CS showed a significantly greater reduction at the platform to the 2 mm level (-61.98% vs. -23.76%) than DBBM/CM. In conclusion, β-TCP/CS demonstrated promise for treating buccal bone defects around implants but exhibited higher graft reduction. This suggests that while β-TricalciumPhosphate/CalciumSulfate may offer clinical benefits, its potential for greater graft reduction should be considered. Further research and evaluation are warranted to fully understand the long-term implications of using β-TCP/CS in guided bone regeneration procedures.

Concentrated Growth Factor (CGF): A Potential New Player in Periodontal Regeneration

Regenerative procedures have become a key focus in contemporary rehabilitation therapies. In dentistry, research on growth factors for bone regeneration has identified autologous growth factors as the most effective stimuli for tissue regeneration and healing. These bioactive proteins play a crucial role in wound healing. Concentrated growth factor (CGF) is a recent advancement in 2 nd generation platelet concentrates. The use of different centrifugation speeds helps to obtain a significantly dense fibrin. Also, it contains more amount of growth factors than the other platelet concentrates available.

Regenerative Endodontic Procedures With Minced Pulp Tissue Graft in Mature Permanent Teeth: A Clinical Study

IntroductionRegenerative endodontic procedures (REPs) using cell-based approaches have emerged as novel treatment modalities. This clinical study aimed to present the outcomes and explore factors influencing REPs with minced pulp tissue (MP) grafts in a mature tooth. MethodsHealthy patients requiring non-surgical root canal treatment were enrolled. MP obtained from the third molar was grafted into the instrumented, disinfected, and blood-filled root canal. After treatment, patients were evaluated clinically and radiographically. ResultsFollow-ups for 6 cases (male patients aged 20–27) ranged from 19 to 42 months. Radiographically, all the teeth showed favorable outcomes. Among the 6 teeth, 2 showed neither intracanal calcification nor recovery in sensibility tests, and one had no intracanal calcification with an inapplicable sensibility test evaluation. In 2 teeth, intracanal calcification was observed in the apical third; however, there was no recovery in the sensibility tests. One tooth exhibited intracanal calcification in the apical third and showed recovery in the sensibility tests. Considering these outcomes and clinical variables, the size of the apical foramen and the composition of the transplanted pulp tissue were identified as tentative influencing factors. ConclusionsThis exploratory clinical study on simplified cell-based REPs using autologous MP grafts for pulp/dentin regeneration in adult teeth not only enhances our understanding of REPs but also suggests its potential as an alternative treatment option to conventional endodontic treatment.

Tympanic Membrane Regeneration Therapy for Pediatric Tympanic Membrane Perforation.

To evaluate tympanic membrane regeneration therapy (TMRT) for pediatric tympanic membrane perforations (TMPs). Intervention study. Research institute hospital. In this study, 20 patients with chronic TMP (M/F: 13/7, 13/8 ears, age 0-15 years) treated with TMRT were evaluated. As comparison, 20 pediatric patients with chronic TMP who underwent myringoplasty/tympanoplasty were included. For the TM repair procedure, the edge of the TMP was disrupted mechanically, and gelatin sponge immersed in basic fibroblast growth factor was placed inside and outside the tympanic cavity and covered with fibrin glue. The TMP was examined 4 ± 1 weeks later. The protocol was repeated up to four times until closure was complete. Closure of the TMP and hearing improvement were evaluated at 16 weeks after the final regenerative procedure. Adverse events were monitored. The mean follow-up period was 427.1 days. The TM regenerated in all cases, but pinhole reperforation occurred in two cases, and the final closure rate was 90.5% (19 of 21). Hearing improved to 24.9 ± 7.6 dB on average before surgery and to 13.8 ± 5.4 dB after surgery. The AB gap improved from 12.9 ± 8.0 to 5.2 ± 3.5 dB.The myringoplasty/tympanoplasty group had significantly lower AB gap improvement compared with the TMRT group. There were no adverse events. TMRT can be expected to regenerate near-normal TMs with a high closure ratio, resulting in better-hearing improvement compared with the myringoplasty/tympanoplasty group, and is an effective treatment for children with long life expectancy.

Innovations in the comprehensive management of orofacial defects - Combined strategies of maxillofacial surgery, endodontics, orthodontics and Implants for the optimization of clinical results: A Narrative Review

Orofacial defects caused by congenital anomalies, trauma, or surgical procedures present complex challenges that affect physical function and psychological well-being. Maxillofacial rehabilitation, incorporating surgery, endodontics, orthodontics, and implants, aims to restore form, function, and aesthetics. This review evaluates innovative multidisciplinary strategies for orofacial defect management. A narrative review was conducted using PubMed and Google Scholar databases. Search terms included "management of orofacial defects," "maxillofacial surgery," "endodontics in complex cases," "orthodontics in facial surgery," and "dental implants." Articles published between 2014 and 2024 were reviewed, focusing on human studies demonstrating integrated treatment strategies. The interdisciplinary approach to managing orofacial defects, integrating maxillofacial surgery, endodontics, orthodontics, and implants, has demonstrated significant improvements in both functional and aesthetic outcomes. Combined surgical techniques, such as the use of iliac and fibula grafts, offer enhanced graft success through improved vascularization. Technological advancements in endodontics, including CBCT and regenerative procedures, optimize treatment precision. Orthodontic innovations, like clear aligners and mini-implants, enhance patient comfort and treatment efficiency, while digital implant planning reduces complications. The incorporation of growth factors, bioactive materials, and AI further boosts clinical success in treating complex orofacial defects.

Enhancing early-stage healing responses through the modified "Poncho" technique in customized titanium mesh-mediated bone regeneration: A soft tissue management approach-case series.

Soft tissue management is critical in bone augmentation surgery to prevent wound dehiscence. Several strategies for passive tissue primary closure have been explored. This article introduces a flap design known as the modified "Poncho" technique (MPT), integrated with customized titanium mesh-mediated bone regeneration, and investigates the healing quality during the initial stages of an incision. The cohort consisted of 5 patients undergoing customized bone regeneration procedures, concerned primarily with the successful integration and healing of the augmented bone site without complications such as wound dehiscence or infection. All patients were diagnosed with insufficient bone volume requiring augmentation to support future dental implants, necessitating the use of customized titanium mesh for guided bone regeneration. The MPT was detailed and applied during the customized bone regeneration procedures. Postoperative evaluations included recording complications and using Landry's healing index at intervals of 3, 7, 14, and 30 days post-surgery to assess the technique's performance in early wound closure. The study found that 95.7% of surgery sites experienced uneventful soft tissue healing within the observation period. Only 1 of 23 sites exhibited partial wound dehiscence at postsurgical days 14 and 30, accompanied by mild inflammation. The Landry's healing index increased from 3 ± 0.47 to a final value of 4.69 ± 1.06, indicating substantial improvement in healing over time. The MPT shows promise as an innovative approach for promoting passive and predictable primary wound closure beneath a digitally customized titanium mesh for bone regeneration, demonstrating a high rate of successful healing and minimal complications during the early postoperative phase.

Outcome of regenerative endodontic procedures in delayed replanted immature permanent teeth with apical periodontitis: A retrospective study.

Regenerative endodontic procedures (REPs) is effective for treating young permanent teeth with pulp necrosis. However, its efficacy on delayed replanted avulsed teeth is unclear. This retrospective study aimed to assess the efficacy of REPs in treating delayed replanted immature permanent teeth with apical periodontitis. Avulsed teeth receiving REPs were systematically screened based on predetermined criteria. This study assessed the REP outcomes, postoperative periodontal healing, and overall treatment efficacy. Samples were grouped by REP outcomes and root development stage, with Fisher's exact tests used to compare outcomes among different groups. Among the included 17 teeth, 47.1% exhibited successful REPs and periodontal healing. Another 47.1%, due to replacement resorption or REP failure, were categorized as tooth survival. Healing of periapical lesions was observed in 88.2% of the cases, but only 41.2% demonstrated continued root development. Although differences were not significant (p = 0.05), teeth with continued root development had a higher rate of functional healing (85.7%) compared to those without (30%). Within the limitations of this study, REPs presented reliable outcomes for treating delayed replanted immature permanent teeth with apical periodontitis mainly in periapical lesion healing. Teeth with continued root development after REPs exhibited a higher rate of functional healing. Further investigation is required to explore potential synergies between REP outcomes and periodontal healing.

Palatal groove associated with periodontal lesions: a systematic review illustrated by a decisional tree for management

BackgroundPalatal groove represents a relatively uncommon developmental root anomaly, usually found on the palatal aspect of maxillary incisors. While its origin is controversial, its presence predisposes to severe periodontal defects.AimThis study aimed to provide a systematic review of the literature focusing on the varied diagnostic techniques and treatment modalities for periodontal lesions arising from the presence of palatal groove. Based on the existing evidence and knowledge, the study also provides a comprehensive decisional tree, guiding clinicians in the challenging decision-making process face to a palatal groove.MethodsThe literature search was conducted on Medline and Cochrane databases by two independent reviewers, who also performed the screening and selection process, looking for English written articles reporting on diagnosis and management (all treatment approaches) of periodontal lesion(s) associated with a palatal groove. Based on this literature, a comprehensive decisional tree, including a standardized palatal groove evaluation and tailored treatment approaches, is proposed. Moreover, a clinical case is described to demonstrate the practical application of the developed decisional tree.ResultsOver a total of 451 articles initially identified, 34 were selected, describing 40 patients with 40 periodontal lesions associated with palatal grooves. The case report illustrates a deep, large, circumferential intra-bony defect on the palatal side of the tooth #22 associated with a shallow, moderately long palatal groove in an 18-year-old male patient. Following reevaluation, a single flap surgery was deemed necessary, combined with a regenerative procedure. At 2 years post-treatment, the tooth #22 is healthy, in a functional and esthetic position. The decision-making process, based on local and systemic patient’s conditions, should allow an early and precise diagnosis to prevent further complications and undertake an adequate treatment.ConclusionPalatal grooves are relatively rare; however, they are frequently associated with severe periodontal defects. The identification, diagnosis, prompt, and tailored management of the associated lesion is essential to mitigate potential periodontal and endodontic complications related to the presence of palatal groove.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/], identifier [C CRD42022363194].

Three-Dimensionally Printed Biphasic Calcium Phosphate Ceramic Substrates as the Sole Inducer of Osteogenic Differentiation in Stromal Vascular Fraction Cells.

The stromal vascular fraction (SVF) is a derivate of fat tissue comprising both adipose-derived mesenchymal stem cells and endothelial cells and serves as a promising cell source for engineering vascularized bone tissues. Its combination with osteoconductive biphasic calcium phosphate (BCP) ceramic may represent a point-of-care agent for bone reconstruction. Here we assessed the proliferation and osteogenic differentiation capacities of SVF on 3D printed BCP implants, in comparison with isolated adipose-derived mesenchymal stem cells (AD-MSCs). AD-MSCs and SVF isolated from human donors were seeded on plastic or 3D printed BCP ceramics with sinusoidal or gyroid macrotopography and cultured in the presence or absence of osteogenic factors. Vascular, hematopoietic and MSC surface markers were assessed by flow cytometry whereas osteogenic activity was investigated through alizarin red staining and alkaline phosphatase activity. Osteogenic factors were necessary to trigger osteogenic activity when cells were cultured on plastic, without significant difference observed between the two cell populations. Interestingly, osteogenic activity was observed on BCP implants in the absence of differentiation factors, without significant difference in level activity between the two cell populations and macrotopography. This study offers supportive data for the use of combined BCP scaffolds with SVF in a perspective of a one-step surgical procedure for bone regeneration.

Mahidol Study 2: Treatment Outcomes and Prognostic Factors of Regenerative Endodontic Procedures in Immature Permanent Teeth

IntroductionStudies on the clinical outcomes and prognostic factors of regenerative endodontic procedures (REPs) in a large population and long-term recall period have been limited. Therefore, the aims of this study were to evaluate treatment outcomes and prognostic factors of REPs. MethodsImmature permanent teeth treated with REPs with a minimum one-year follow-up period were included. Treatment outcomes (functional retention, healed rate, root development, and sensibility test response) and any prognostic factors were analyzed with multivariable Cox regression, linear regression, and modified Poisson regression. ResultsOne-hundred-twenty REPs teeth with a mean 41.7-month recall period were included with a functional retention rate of 97.5%. The healed, healing, and diseased rates of REPs were 80%, 9.2%, and 10.8%, respectively. Significant prognostic factors for healed were age (<12 years old) and root development stage (stages 4 and 5). Changes in the apical diameter, root length, root width, and radiographic root area after REPs were 56.8%, 8.3%, 23.2%, and 21.7%, respectively. Significant prognostic factors for continued root developmevnt were age and etiology of pulpal disease (from caries or dental anomalies). The sensibility test response rate was 41.7% with significant positive factors of ethylenediaminetetraacetic acid irrigation and capping material level above the cemento-enamel junction. ConclusionREPs demonstrated high functional retention and healed rates. Patients <12 years old presented a higher healed rate and continued root development (excluding root length). Dental caries or anomalies had higher continued root development compared with dental trauma. The sensibility test response was related to ethylenediaminetetraacetic acid irrigation and level capping material.