Regenerative Procedures Research Articles

Major maxillary sinus augmentation techniques for dental implant: a systematic review

Introduction: In around 25% of all maxillary sinuses, there is an accessory bone that is located in a lower portion than the main ostium. When a dental element is lost in the posterior region of the maxilla, there is natural reabsorption of the alveolar process and at the same time, pneumatization of the maxillary sinus occurs. It will increase its volume towards the location where the roots existed and this will often make it difficult or unfeasible to restore implants in that location. Various surgical techniques can be used to reconstruct the atrophic alveolar ridge, techniques alone or associated with autogenous, allogeneic, xenogeneic grafts, and alloplastic biomaterials. Objective: It was to develop a systematic review to list the main clinical and surgical approaches to bone elevation techniques for dental implants. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from January to March 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 119 articles were found, 35 articles were evaluated in full and 23 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 15 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=71.6%>50%. It was concluded that the placement of the implant with the simultaneous use of PRP or PRF creates a good relationship between the hard tissue and the soft tissue. The Bio-Oss® biomaterial is one of the most used in guided bone regeneration procedures in regenerative dentistry, and its particles become an integral part of the newly formed bone structure and retain their volume in the long term. Furthermore, Bio-Oss® offers a lot of space for the formation of blood vessels (angiogenesis) and the deposit of neoformed bone, helping the growth of osteoblasts. Notable studies have shown results on the combined use of Bio-Oss® and PRF. Also, it is possible to develop a pre-operative planning method, associated with the area of implant dentistry, using digital images. Furthermore, the conventional surgical guide has some advantages such as being cheaper, simpler, and easier to perform, however, it leads to a greater operative risk for the patient. However, the accuracy of the location to be implanted is not the best and there is a greater probability of this guide becoming worn out, due to the contact of the drills with it.

Clinical efficacy of titanium prepared platelet rich fibrin in periodontal regeneration: A systematic review and meta-analysis.

Periodontal regeneration therapies frequently involve autologous platelet concentrates (APCs). They can be used in sinus lift surgeries and socket preservation, among other clinical settings. Platelet rich fibrin (PRF) membrane has been used to treat gingival recession in individuals or groups of individuals using a coronally progressed or lateral pedicle flap. In the treatment of mixed periodontic endodontic lesion/furcation defect, PRF functions as a healing and interpositional biomaterial, filling a cystic cavity. PRF is known to help the bone regeneration process. In the last few years, efforts have been made to enhance the PRFs characteristics and quality. One of them is titanium platelet rich fibrin (T-PRF). Third-generation platelet concentrate no longer contains silica, and its preparation in glass vacuum containers, that no longer creates any known concerns. The effectiveness PRF's has been evaluated in connective tissue and bone repair. The aim of this study is to compare T-PRF to other platelet concentrates and different treatment modalities for periodontal regenerative procedures. A protocol of this systematic review have been registered in prospero (CRD42022293545). The online database searched were PUBMED, COCHRANE for published articles up to November 2022 without language restrictions. Studies in trial registers, handsearching, bibliographic references of relevant articles were also checked. Data collection and analysis was done by individual authors. Independent eligibility assessments were conducted by four review authors. Then, using the standard Cochrane methodology, four review authors extracted the data and evaluated the risk of bias for individual studies. We developed "Summary of findings" tables and used GRADE to evaluate the evidence. Three studies were included for meta-analysis. Results of meta-analysis supported that T-PRF is effective for correction of both hard and soft tissue defects. The overall qualitative and quantitative analysis suggest that T-PRF has superior structural properties and thicker fibrin network for ensuring predictable success periodontal regenerative procedures.

Access to Care Considerations for the Endodontic Treatment of Immature Permanent Teeth: A National Survey of Pediatric Dentists and Endodontists

IntroductionThis study aimed to investigate access to care and financial considerations associated with the endodontic treatment of immature permanent teeth. MethodsSurveys were distributed to endodontists (n = 2,457) and pediatric dentists (n = 3,974) in the United States. Data were analyzed using X2 analysis and logistic regression. The level of significance was set to 0.05. ResultsThe response rate was 13% (n = 840). Respondent specialist groups were similar by age and years since specialty residency completion, but significantly different with regard to primary practice setting (eg private practice, Federally Qualified Health Center, hospital), (P = .001). The majority (91%) of respondents reported participation with dental insurance. Pediatric dentists (69%) were significantly more likely than endodontists (17%) to participate with public-payer dental insurance (P < .001). The majority of respondents (82%) indicated that patients reported economic factors (time or money) as a barrier to accessing endodontic treatment. Pediatric dentists were significantly more likely to consider economic factors when planning for treatment (P < .001). Pediatric dentists were more likely than endodontists to have the opinion that endodontic procedures for treatment of necrotic immature permanent teeth should cost less than root canal therapy (apexification, P < .001; regenerative endodontic procedures, P = .002). Pediatric dentists (33%) reported encountering barriers when attempting to refer their patients to an endodontist. Inability to find an endodontist that participates with dental insurance was the most frequently cited barrier. ConclusionsLimited clinician participation with dental insurance and gaps in insurance coverage for endodontic procedures appear to contribute to access to care barriers for pediatric patients.

Impact of using XP-endo finisher and nanobubble water during EDTA dentin conditioning on TGF-β1 release in regenerative endodontic procedures.

Transforming Growth Factor-Beta 1 (TGF-β1) plays a crucial role in the success of Regenerative Endodontic Procedures (REPs) as they directly impact the proliferation and differentiation of stem cells. TGF-β1 is released by conditioning of the dentin matrix using 17% EDTA. EDTA was found to have deleterious effects on dentin especially in immature teeth with fragile dentin walls. Decreasing the irrigation time was reported to decrease these effects. Accordingly, enhancement and activation of the EDTA solution to maintain its efficiency in TGF-β1 release from dentin and thus compensating the reduction in irrigation time was employed. EDTA solution was enhanced by adding Nanobubble (NB) water which contains oxygen filled cavities less than 200nm in diameter. Additionally, EDTA was activated with XP-endo Finisher rotary file. The aim of this study was to assess the impact of NB enhancement and/or XP-endo Finisher activation of the EDTA solution on the TGF-β1 release from dentin. Fifty standardized root segments with open apex were allocated to two main groups according to whether EDTA was enhanced with NB water or not, and within each group whether XP-endo Finisher activation was used or not in addition to a Negative Control group. The concentration of the released TGF-β1 in the root canal was measured using enzyme-linked immunosorbent assay (ELISA). The statistical analysis was done using the Shapiro- Wilk, Kolmogorov Smirnov, ANOVA and Post-hoc Tukey tests. All groups released a considerable amount of TGF-β1 with the highest values in the EDTA/NB/XP group, followed by EDTA/NB, EDTA/DW/XP, EDTA/DW and Negative Control groups respectively. The results of this study suggest that NBs can promote the success of REPs since it revealed a significant increase in the TGF-β1 release following its use in the enhancement of the EDTA solution. A comparable effect was obtained by XP-endo finisher activation of the EDTA solution. The combined use of NBs and XP-endo Finisher can be a promising addition in REPs. Accordingly, Enhancement and activation of the EDTA solution may compensate decreasing the EDTA irrigation time attempted to avoid the deleterious effect of EDTA on dentin.

Effect of Calcium Silicate-Based Intracanal Medicament and Calcium Hydroxide on Growth Factor TGF-β1 Release from Root Canal Dentine.

Effective root canal disinfection and the subsequent release of natural growth factors from dentin are crucial to the success of regenerative endodontic procedures. This study evaluated the effect of newly introduced calcium silicate-based temporary intracanal medicament Bio-C Temp and calcium hydroxide-based material UltraCal XS on the release of transforming growth factor β1 (TGF-β1) from root canal dentin. Twenty-two intact and fully developed human premolars from patients aged 15-18 were shaped and irrigated according to the current clinical recommendations. The teeth were then gently split in half, and the root canal dentin of paired samples was covered with Bio-C Temp or UltraCal XS. After 3 weeks of incubation, the specimens were conditioned with 17% EDTA and the collected solution was subjected to the quantification of the released TGF-β1 by performing an ELISA. One-way analysis of variance (ANOVA), followed by Tukey's test, was selected to determine the statistically significant differences between the groups at the 0.95 confidence level. The highest mean value of released TGF-β1 (1993.1 pg/mL) was detected in the control group, where the root canal dentin was conditioned with 17% EDTA alone. Regarding the experimental groups, Bio-C Temp released a statistically significantly higher amount of TGF-β1 (282.14 pg/mL) compared to UltraCal XS (114.28 pg/mL; p = 0.0158). Bio-C Temp affected the release of growth factors from root canal dentin less than UltraCal XS and may therefore serve as an intracanal medicament for regenerative endodontic procedures.

Bioinspired poly-dopamine/nano-hydroxyapatite: an upgrading biocompatible coat for 3D-printed polylactic acid scaffold for bone regeneration.

Poly-lactic acid (PLA) has been proposed in dentistry for several regenerative procedures owing to its biocompatibility and biodegradability. However, the presence of methyl groups renders PLA hydrophobic, making the surface less ideal for cell attachment, and it does not promote tissue regeneration. Upgrading PLA with inductive biomaterial is a crucial step to increase the bioactivity of the PLA and allow cellular adhesion. Our purpose is to evaluate biocompatibility, bioactivity, cellular adhesion, and mechanical properties of 3D-printed PLA scaffold coated with poly-dopamine (PDA) and nano-hydroxyapatite (n-HA) versus PLA and PLA/n-HA scaffolds. The fused deposition modelling technique was used to print PLA, PLA with embedded n-HA particles, and PLA scaffold coated with PDA/n-HA by immersion. After matrices characterization for their chemical composition and surface properties, testing the compressive strength was pursued using a universal testing machine. The bioactivity of scaffolds was evaluated by monitoring the formation of calcium phosphate compounds after simulated body fluid immersion. The PLA/PDA/n-HA scaffold showed the highest compressive strength which was 29.11 ± 7.58 MPa with enhancing calcium phosphate crystals deposition with a specific calcium polyphosphate phase formed exclusively on PLA/PDA/n-HA. With cell viability assay, the PDA/n-HA-coated matrix was biocompatible with increase in the IC50, reaching ⁓176.8 at 72 without cytotoxic effect on the mesenchymal stem cells, promoting their adhesion and proliferation evaluated by confocal microscopy. The study explored the biocompatibility, bioactivity, and the cell adhesion ability of PDA/n-HA coat on a 3D-printed PLA scaffold that qualifies its use as a promising regenerative material.

Clinical Outcomes of Polyetheretherketone (PEEK) Hybrid Prosthesis in All-on-Four Rehabilitation: A Systematic Review Protocol

Background The “all-on-four” concept represents a significant advancement in dental implantology. particularly beneficial in cases of extensive jaw bone loss where invasive bone regeneration procedures are typically required. However, the successful implementation of this technique necessitates meticulous planning concerning implant selection, materials, and prosthesis design. The recent introduction of PEEK (Polyetheretherketone) in dentistry, especially in all-on-four prosthetics, prompts questions regarding its clinical efficacy and comparative biomechanical and biological advantages over conventional materials such as titanium and zirconia. While some studies have compared PEEK with other materials, systematic reviews evaluating its efficacy are scarce. This systematic review protocol intends to assess the evidence regarding the viability of PEEK as a potential alternative within the all-on-four approach in dental implantology. Methods This systematic review protocol will adhere to the Cochrane Handbook for Systematic Review of Interventions and align with the Methodological Expectations of the Cochrane Intervention Reviews (MECIR) guidelines. Utilizing a comprehensive search strategy, multiple databases, including PubMed, EMBASE, Scopus, EBSCO, Web of Science, Cochrane Central, and registries of clinical trials, will be explored. The search aims to identify randomized controlled trials and non-randomized studies investigating the application of PEEK in the all-on-four approach for dental procedures. Emphasizing clinically relevant outcomes such as implant survival, prosthesis success, peri-implant complications, and patient satisfaction, this review aims to provide insights into the effectiveness and potential benefits of using PEEK in all-on-four prosthetics. Non-randomized studies will be assessed for bias using ROBINS-I, while randomized controlled trials will undergo evaluation with the Cochrane Risk of Bias assessment tool, ROB II. Discussion The outcomes derived from this systematic review hold great significance for dental practitioners exploring the all-on-four concept. Understanding PEEK’s advantages and limitations compared to titanium and zirconia facilitates tailored treatment plans, enhancing success and satisfaction, ultimately improving dental care quality. Systematic review registration PROSPERO: CRD42024531175 (Registered on 13/04/2024).

Impact of jasmonates, salicylic acid, and fungal elicitor on the health of &lt;i&gt;Hippeastrum hybridum&lt;/i&gt; bulbs achieved by &lt;i&gt;in vitro&lt;/i&gt; procedure

Production of high-quality vigorous plant materials obtained by micropropagation requires not only a good regeneration procedure but also efficient ways to enhance their post-transplanting ability to cope with external environmental factors. There is increasing interest in &lt;i&gt;Hippeastrum hybridum&lt;/i&gt; on the horticultural market. However, the traditional method of cultivation using seeds and bulbs does not meet the growing demand and requirements of available priming procedures, thus leading to a search for more effective methods of reproduction. The aim of the study was to assess the morphogenetic abilities of bulb and flower explants for regeneration and investigate whether the enrichment of the multiplication process by exposure to elicitors will improve the health of the obtained plants through faster synthesis of phytoalexin. The study revealed that high regeneration efficiency can be obtained by using twin-scales, peduncles, and receptacles. Over 76% of explants were capable of bulblet induction and the micropropagation rates were 2.3, 2.7, and 5.0, respectively. At the rooting stage, the use of regulator-free medium was required, yielding a high percentage of rooted shoots of over 90% (shoots obtained on twin-scales and peduncles). The materials obtained &lt;i&gt;in vitro&lt;/i&gt; did not differ morphologically from the initial materials. However, it was noted that, after exposure to the &lt;i&gt;Phoma narcissi&lt;/i&gt; fungal elicitor or to jasmonic acid (JA) and jasmonic acid methyl ester (MeJA), the &lt;i&gt;in vitro&lt;/i&gt;-derived bulbs were able to synthesize phytoalexin with higher efficiency than the untreated ones. Therefore, the described methods can be useful for &lt;i&gt;H. hybridum&lt;/i&gt; multiplication. Moreover, the enrichment of the multiplication process with the stage of exposure to elicitors ensures initial immunity of &lt;i&gt;H. hybridum&lt;/i&gt; to the pathogen &lt;i&gt;Phoma narcissi&lt;/i&gt;, which can be used as a priming procedure.

Preservation of Socket for Immediate Dental Implants in Aesthetic Zone from Upper Jaw: Aesthetic Approach-Case Report

Ensuring optimal aesthetic outcomes in dental implant cases within the maxillary anterior area requires careful consideration of socket preservation and atraumatic tooth extraction. These factors play a crucial role in achieving successful and aesthetically pleasing treatments. The objective of this study is to present a series of clinical cases involving dental extractions of anterior maxillary teeth with a poor prognosis. This study highlights the importance of socket preservation and atraumatic tooth extraction in ensuring optimal aesthetic results in dental implant cases within the maxillary anterior area. In these cases, a two-armed lever technique was planned for atraumatic alveolar preservation during the extraction process.Following the tooth extraction, the fresh socket was reclassified, and dental implants were subsequently placed using a modified drilling technique in certain cases. The authors assessed the primary stability of the implants, while in other cases, bone regeneration procedures were performed. The presented clinical cases demonstrate the successful implementation of the two-armed lever technique for atraumatic alveolar preservation, leading to favorable outcomes in terms of primary implant stability and bone preservation. Techniques for bone preservation after tooth extraction aim to minimize post-extraction bone resorption. By implementing appropriate protocols, such as the concept of the dual zone and the two-armed lever technique, successful outcomes can be achieved in terms of both aesthetics and preservation of the alveolar bone.

Negotiation of Calcified Canals.

The gradual formation of hard tissue along the root canal walls is a natural process associated with aging, typically progressing slowly over time. In reaction to tooth wear, operative procedures, vital pulp treatments, or regenerative endodontic procedures, hard tissue may also accumulate within the pulp canal space at a slow rate. In certain cases, such as dental trauma, autotransplantation, or orthodontic treatment, this deposition of hard tissue can accelerate unexpectedly, resulting in rapid narrowing or complete closure of the root canal space. This situation is called calcific metamorphosis (CM), root canal calcification, or pulp canal obliteration (PCO). Performing conventional endodontic therapy on severely calcified canals presents significant challenges and increases the risk of procedural accidents. Calcified canals introduce such complexity that dedicated negotiation concepts and specially designed instruments have been developed to deal with the challenge. This article seeks to review the existing methods for effectively navigating calcified canals and to introduce the buckling resistance activation test (BRAT) technique.

Revascularisation in Immature Permanent Teeth – A Case Series

Abstract Immature permanent teeth with developing, root apices with dental pulp infections resulting from caries or trauma represent a formidable clinical challenge. Biologically based principles of regenerative endodontic procedures in the treatment of immature, necrotic teeth have replaced the traditional ‘apexification’ procedures. Revascularisation by induction of apical bleeding is a potential source of stem cells and it creates a blood clot that would act as a biological scaffold for the recruited stem cells which in turn aids in the continued root maturation. The purpose of this case series was to investigate the outcome of the pulpal revascularisation procedure on five immature permanent teeth with or without apical periodontitis. Induction of blood clot was the technique selected for root closure if the tooth was asymptomatic. Apexification was initiated if the tooth remains symptomatic. Out of the five teeth selected for the study, revascularisation was successful, and continued root-end closure was obtained in four teeth. Revascularisation technique in immature permanent teeth offers clinicians’ great potential to avoid the need for traditional apexification procedures.

Patient-specific beta-tricalcium phosphate scaffold for customized alveolar ridge augmentation: a case report

BackgroundBeta-tricalcium phosphate (β-TCP) is a biocompatible ceramic material widely used in the field of oral regeneration. Due to its excellent biological and mechanical properties, it is increasingly utilized for alveolar ridge augmentation or guided bone regeneration (GBR). With recent advances in computer-aided design and manufacturing (CAD/CAM), β-TCP can now be used in the form of digitally designed patient-specific scaffolds for customized bone regeneration (CBR) of advanced defects in a two-stage implant therapy concept. In this case report following the CARE case report guidelines, we present a novel application of a patient-specific β-TCP scaffold in pre-implant mandibular alveolar ridge augmentation.Case presentationA 63-year-old female patient with significant horizontal bone loss in the posterior mandible was treated with a custom β-TCP scaffold in the context of a two-stage backward-planned implant therapy. Cone-beam computed tomography nine months after augmentation showed successful integration of the scaffold into the surrounding bone, allowing implant placement. Follow-up until two years after initial surgery showed excellent oral and peri-implant health.ConclusionsThis case highlights the potential of patient-specific β-TCP scaffolds for alveolar ridge augmentation and their advantage over traditional techniques, including avoidance of xeno-, allo-, and autografts. The results provide encouraging evidence for their use in clinical practice. Patient-specific β-TCP scaffolds may be a promising alternative for clinicians seeking to provide their patients with safe, predictable, and effective alveolar ridge augmentation results in customized bone regeneration procedures.

Effectiveness of using platelet concentrate and blood clot in regenerative endodontic treatment: A systematic review and metaanalysis

This review sought to compare the efficacy of blood clots, Platelet-rich Plasma (PRP), and Platelet-rich Fibrin (PRF) in regenerative endodontic procedures. A systematic electronic search was conducted across major databases. The primary endpoints encompassed radiographic evidence of periapical healing, sustained root development, and root dentin thickening in studies with a follow-up duration of at least 6 months. Fourteen randomized controlled trials were encompassed within the analysis. Among these, five instances were documented as treatment failures, while the remaining studies exhibited complete resolution of symptoms across all three intervention groups. Meta-analysis was performed using failure rate data extracted from the selected studies, revealing no statistically significant discrepancies between the groups. Despite inherent limitations, the findings suggest comparable outcomes between the use of platelet concentrates as scaffolds and blood clots in the specified clinical context.

Unveiling the consequences of early human saliva contamination on membranes for guided bone regeneration.

GBR membranes have various surface properties designed to elicit positive responses in regenerative clinical procedures; dental clinicians attempt to employ techniques to prevent the direct interaction of contaminated oral fluids with these biomaterials. However, saliva is uninterruptedly exhibited in oral surgical procedures applying GBR membranes, suggesting a persistent interaction with biomaterials and the surrounding oral tissues. This fundamental study aimed to investigate potential alterations in the physical, chemical, and key biological properties of membranes for guided bone regeneration (GBR) caused by isolated early interaction with human saliva. A reproducible step-by-step protocol for collecting and interacting human saliva with membranes was developed. Subsequently, membranes were evaluated for their physicochemical properties, protein quantification, DNA, and 16S rRNA levels viability of two different cell lines at 1 and 7 days, and ALP activity. Non-interacted membranes and pure saliva of donors were applied as controls. Qualitative morphological alterations were noticed; DNA extraction and 16S quantification revealed significantly higher values. Furthermore, the viability of HGF-1 and MC3T3-E1 cells was significantly (p < .05) reduced following saliva interaction with biodegradable membranes. Saliva contamination did not prejudice PTFE membranes significantly in any biological assay. These outcomes demonstrated a susceptible response of biodegradable membranes to isolated early human saliva interaction, suggesting impairment of structural morphology, reduced viability to HGF-1 and MC3T3-E1, and higher absorption/adherence of DNA/16S rRNA. As a result, clinical oral procedures may need corresponding refinements.

Enhancing oral function: A case report on mandibular overdenture utilization with custom-made subperiosteal implant.

Subperiosteal implants, previously set aside because of complications, are now emerging again as effective treatments for severe mandibular atrophy, aided by recent improvements in digital dentistry. Traditional dentures in such cases often face challenges with support and retention, necessitating complex regenerative procedures. This paper presents a case report of a 54-year-old male patient with significant mandibular atrophy who received a custom-made subperiosteal implant, showcasing promising results. The implant was precisely designed utilizing computed tomography (CT) scans, a 3D-printed model, the selective laser melting (SLM) technique, and constructed with biocompatible Ti6Al4V material. This innovative approach offered a practical solution, resulting in high patient satisfaction and no complications over a year of use.

FUNCTIONAL CROWN LENGTHENING AS A PRE-RESTORATIVE PROCEDURE IN THE AESTHETIC ZONE

Introduction: Crown lengthening is a surgical procedure to increase the height of the clinical crown for aesthetic and restorative purposes, or combination. The indications include treatment of subgingival caries and altered passive eruption. Functional crown lengthening for restorative purposes in the esthetic zone should consider the concept of biologic width and the ideal proportion of the dentogingival complex. Case: A 39-year-old male patient was referred from the Department of Conservative Dentistry, RSGM UGM Prof. Soedomo to expose the maxillary anterior teeth crowns for full crown and veneer restorations. Clinical examination showed 11, 12, and 12 post root canal treatment with 3-4 mm remaining crowns. Teeth 13, 21, 22, and 23 appear short, excessive gingival display of 3 mm, with a diagnosis of altered passive eruption type 1B. Treatment: Functional crown lengthening was performed by gingivectomy followed by flap elevation, ostectomy, and osteoplasty. A fenestration was found at the apical of 22 and treated with regenerative procedure. Full crowns and veneers insertion was done 3 months after surgery. Crown lengthening as a pre-restorative procedure is a multidisciplinary treatment that considers the need for restoration by re-establishing the biologic width, to prevent inflammation and bone loss. In addition, adequate post- surgical tissue healing time prior to restoration is necessary to avoid gingival margin rebound and to assure long-term success of the restoration. Conclusionn : Functional crown lengthening as a pre-restorative procedure in the esthetic zone can gives satisfactory and stable results, with careful examination and correct surgical procedure.

Application of nanotechnology in periodontal therapy: Narrative review

The potential of nanotechnology to improve human health, optimize natural resource utilization, and reduce environmental pollution is remarkable. With the ever-growing advancement in dentistry, one of the breakthroughs is using nanotechnology. Nanotechnology in periodontics has touched every aspect of treatment modality, from non-surgical therapy to implant procedures, including regenerative procedures. Understanding of their mechanism plays a pivotal role in more efficient usage of nanotechnology, better treatment procedures, and eventually better outcomes. In this paper we review the application of nanotechnology in periodontal therapy. We performed the search for papers in Scopus using the key words and phrases as follows: “nanodentistry”; “dentistry and nanotechnology”; “dentistry and nanoparticles”; “dentistry and nanomedicine”; “dentistry and nanorobots”. There were found 530 papers in total. Some papers belonged to two and more categories. It is revealed that the number of papers versus year does not follow any specific pattern, but the cumulative amount of papers versus year is fitted with the exponential regression. There were also selected papers using certain inclusion/exclusion criteria. Only the selected papers were analyzed. Nanomedicine is subjected to intensive studies nowadays. There are some promising results that will likely be implemented into praxis soon in the fields of medical diagnostics and clinical therapeutics. The appearance of nanotechnology can have a considerable impact on treatment of periodontal diseases.

Periodontal tissue regeneration: current therapeutic strategies and future directions in further research

Chronic and progressive destruction/damage of the periodontal tissues resulted from periodontitis is the leading cause of tooth loss in adults. Traditional periodontal therapies such as scaling and root planning or flap surgery have demonstrated effective in controlling local inflammation and in suppressing/arresting the disease progression of periodontitis. However, those infection control measures cannot help to regenerate lost periodontal tissues to a statistically or clinically significant degree. Although some successes regarding the reduction of the intrabony defect and maintenance of the periodontal homeostasis have been achieved in periodontal regenerative procedures, comprising but not limited to guided tissue regeneration (GTR) or bone grafting technique, the restorative effectiveness of the architecture and function of the lost or injured tissues is far from our clinical expectation. The use of the concept, technique, and method of tissue engineering for periodontal regeneration is a hotspot and animal studies have shown interesting outcomes in terms of functional regeneration of lost/damaged support tissues in the periodontium, including alveolar bone, periodontal ligament, and cementum. However, numerous issues need to be addressed before those regenerative approaches can be responsibly transformed to novel clinical therapies. Recently, paradigm that induces homing of host stem cells to site of the periodontium and encourage the body's innate capability to repair is a new research field termed endogenous regeneration. Given that endogenous regenerative technique avoids ex-vivo cell culture and transplantation, it should be relatively easier to be used in the treatment of clinical patients. Due to the limited oral microenvironment and harsh periodontal local condition for tissue regeneration, as well as poor understanding of periodontal regenerative biology, there is still a long way ahead to explore new effective, practical, and economical therapies to save and protect natural tooth and for combating highly prevalent periodontal disease.

Regenerative Endodontic Procedures in Immature Teeth Affected by Regional Odontodysplasia

IntroductionRegional odontodysplasia (ROD) is a rare developmental disorder characterized by hypo-mineralization and hypoplasia of enamel and dentin. Symptoms include poorly developed tooth buds, delayed eruption of permanent teeth in affected quadrants, and ghost teeth. The affected teeth often become necrotic due to abnormal enamel and dentin development, making them susceptible to caries and infection. The aim of this case report is to describe the treatment of ROD through pulp revascularization. Case reportA 13-year-old girl was referred for endodontic treatment. The mandibular left incisors and first premolar, which were affected by regional odontodysplasia, lost their vitality because of the impaired structure of the enamel. Due to the teeth's early developmental stage, a regenerative endodontic treatment was attempted. All 3 teeth were treated using the same protocol following the AAE guidelines. After 4 weeks, treatment of the premolar was completed, whereas the incisor teeth remained symptomatic and were and therefore, intracanal dressing with calcium hydroxide was repeated and left in place for 5 months. Finally, the regenerative procedure was completed, and the crowns were restored. The patient was scheduled for follow-up examinations after 6 months, and then yearly for the next 3 years. After 1 year, the periapical lesion around the central incisor and premolar had resolved, the lesion around the apex of the lateral incisor was healing, and the roots had continued to develop. After 3 years, complete healing and pulp canal obliteration were observed in the central incisor and in the premolar. However, the root of the lateral incisor tooth was split, and it was recommended to extract this tooth. ConclusionThe positive outcomes of regenerative endodontics in the central incisor and premolar suggest that revascularization of the pulp may be optional for the treatment of immature necrotic teeth affected by developmental disorders, such as ROD, amelogenesis imperfecta, or dentinogenesis imperfecta.

Knowledge, perceptions, and preferences for bone grafts in periodontal regenerative therapy (Indonesian society of periodontology study)

Objective: To evaluate the knowledge, perceptions, and preferences of Indonesian periodontists and resident students regarding the use of bone transplants in periodontal regeneration treatment. Material and Methods: This is a cross-sectional descriptive study using questionnaires given to members of The Indonesian Society of Periodontology. Results: All respondents had various knowledge and preferences regarding using bone grafts in periodontal regenerative therapy. Oral hygiene and radiographic appearance are parameters that must be evaluated before regenerative procedures. The most widely chosen graft is the xenograft due to better results, biocompatibility, and bioactivity of the material. Cost is the main reason why the respondents do not use bone grafts. Bone grafts are often combined with the GTR and membrane techniques, and the granular form is the most frequently used form of graft. Bone grafts are often used in periodontitis cases with vertical bone loss followed by implant placement. Conclusion: Xenografts are the most widely used bone graft material in Indonesia. There was no statistically significant difference between the two groups' perceptions of using bone grafts in periodontal regenerative therapy. Respondents were more satisfied with using bone grafts than with other materials.