Clinical Oral Investigations最新文献

Objectives: Vital pulp therapy (VPT) is shifting from traditional materials toward regenerative strategies that modulate inflammation and stimulate angiogenesis. This review evaluates scaffold-based, scaffold-free, and cell-laden approaches targeting immunomodulatory and angiogenic responses in dental pulp regeneration.

Materials and methods: systematic search up to April 2025 in PubMed, Embase, and Scopus identified in vivo studies assessing VPT outcomes. Included interventions were direct pulp capping or pulpotomy using bioactive scaffolds, biomolecules, or stem cell-laden matrices. Outcomes included histologic or molecular markers of immunomodulation and angiogenesis. Risk of bias was assessed using the SYRCLE tool.

Results: Twenty-six studies met the inclusion criteria. Scaffold-based delivery of Resolvin E1/lipoxin A4, Nell-1, and Nell-1/BMP-2 suppressed key inflammatory mediators and promoted M2 macrophage polarization. Angiogenesis was enhanced by cell-laden scaffolds containing dental pulp stem cells, bone marrow mesenchymal stem cells, or endothelial cells, leading to consistent pulp-like tissue regeneration. However, most studies had short follow-ups, high or unclear bias risk, and methodological heterogeneity, precluding meta-analysis. Interpretation of these findings should be undertaken with caution due to substantial heterogeneity in study design, outcome assessment methods, and evaluation time points.

Conclusions: Biomolecule-loaded and stem cell-laden scaffolds show preliminary promise in modulating inflammation and promoting vascularization in animal models of VPT. However, evidence remains limited by short-term outcomes and inconsistent methods.

Clinical relevance: Scaffold-based delivery of Resolvin E1, Lipoxin A4, or Nell-1/BMP-2, and stem cell-laden matrices (e.g., DPSCs, BMSCs) may enhance immunomodulation and angiogenesis in preclinical VPT. These strategies could support pulp-like tissue regeneration, but standardized outcome measures and validation in large-animal models are needed before clinical application.

Objective: This study aimed to compare the effect of bimaxillary first premolar extractions versus non-extraction orthodontic treatment on the vertical skeletal dimension and dentoalveolar structures in Class I malocclusion.

Materials and methods: A prospective clinical trial was conducted involving 50 adult patients with Class I malocclusion, hyperdivergent facial pattern, and moderate crowding (as low as 4.6 to as high as 7.1 mm) in both arches. The sample was divided into two groups: The extraction group, consisting of 25 patients who underwent extraction of bimaxillary first premolars, and the non-extraction group, composed of 25 patients treated without extraction. The vertical skeletal dimensions and dentoalveolar changes in the three orthogonal planes were assessed on cone beam computed tomography (CBCT) images before and after treatment. Intra- and inter-group comparisons were performed using paired and an independent t-test, respectively.

Results: In the extraction group, the lower anterior facial height (LAFH) significantly increased by 1.35 ± 1.73 mm (P = 0.00), while the mandibular plane angle (SN-MP angle) showed a non-significant decrease. In the non-extraction group, the LAFH significantly increased by 0.8 ± 1.8 mm (P = 0.03), while the SN-MP angle showed a statistically significant decrease of 0.7 ± 0.75 degrees (P = 0.00). No significant difference was found between the two studied groups in all measurements of the skeletal vertical skeletal dimension including LAFH, posterior facial height (PFH), SN-MP angle, and Frankfort mandibular plane angle (FMA).

Conclusions: The vertical skeletal dimension showed no significant difference between extraction and non-extraction orthodontic treatments. The influence of first premolar extractions on the vertical skeletal dimension is often overestimated.

Clinical relevance: The extraction or non-extraction decision in orthodontics is attributed to several factors, in which one of these factors is the impact of treatment on facial divergence of the patient. This study investigates the effect of both treatments and demonstrated the limitations to reduce the vertical skeletal dimension by first premolar extraction. Hence, clinicians need to control the facial divergence by means other than the extraction strategy alone.

Trial registration: The study protocol was registered at ClinicalTrials.gov with an identification number: NCT04151875.

Objectives: This study investigated novel mineral-organic cements based on magnesium and organophosphates, originally developed as resorbable bone adhesives. The aim was to evaluate this new class of materials in a dental context, focusing on their suitability as temporary restorative materials in endodontic treatments.

Materials and methods: Two thermally treated trimagnesium phosphate hydrates (Mg₃(PO₄)₂ ∙ xH₂O and Mg₃(PO₄)₂ ∙ 22H₂O (cattiite)) were each combined with two organophosphates (phosphoserine (OPLS) and sodium phytate (Na-IP6)), resulting in four adhesive formulations. These were compared with a commonly used material for temporary restorations (Cavit™) and a reference adhesive (TTCP + OPLS) regarding mechanical strength, sealing ability (methylene blue penetration) on bovine teeth, and structural integrity.

Results: Shear bond strength to dental hard tissues was significantly higher for the new cements compared to Cavit™, particularly for the OPLS + TMP ∙ xH₂O formulation (4.35 ± 0.71 MPa vs. 0.29 ± 0.16 MPa; initially on dentin). pH and temperature during setting remained within clinical limits. TMP ∙ xH₂O + OPLS also showed the favorable sealing behavior, while Cavit™ performed similarly. Porosimetry, SEM and micro-CT supported the favorable profile of this formulation.

Conclusion: The combination of 400 °C sintered TMP ∙ xH₂O and OPLS proved most suitable in terms of handling, stability, and sealing. This system are promising candidates for temporary restorations, particularly in non-retentive cavities.

Clinical relevance: The tested cements may serve as novel resorbable, adhesive alternatives for temporary restorations. Future applications could include pulp capping or perforation repair.