Frontiers in dental medicine最新文献

Background: Dental trauma can jeopardize the long-term success of previous endodontic treatments, especially in teeth affected by orthodontically induced inflammatory root resorption (OIIRR). This case presents the first documented association between secondary trauma-induced acidity and degradation of ProRoot mineral trioxide aggregate (MTA) in such compromised teeth.

Case presentation: A 20-year-old male with a history of orthodontic treatment and severe apical root resorption sustained a subluxation injury to tooth 22, leading to pulp necrosis and apical pathosis. Initial endodontic management with ProRoot MTA achieved favorable outcomes at 6- and 18-month follow-ups. Two-and-a-half years later, secondary trauma occurred. Over the following 18 months, the tooth developed acute symptoms, a periapical lesion, and radiographic signs of MTA disintegration. Endodontic retreatment with Biodentine resolved the symptoms and achieved complete periapical healing, confirmed at 3, 6, and 18 months, and 4 years post-treatment.

Conclusion: This case highlights MTA's susceptibility to acidic degradation in compromised conditions and supports Biodentine as a potentially more pH-resistant alternative. Clinicians should be vigilant when treating traumatized, orthodontically compromised teeth and prioritize restorative materials with high stability in hostile environments to minimize treatment failure risk.

Regenerative endodontics (RE) is a biologically based procedure designed to replace damaged dental structures, including dentin and root structures, and cells of the pulp-dentin complex. It is the first-line treatment for patients with immature permanent teeth (IPT) that have lost vitality due to dentoalveolar trauma (DAT), caries, or developmental anomalies such as dens evaginatus (DE). Beyond resolving clinical signs and symptoms, RE allows for continued root development, substantially improving the long-term prognosis of these cases. Here, we present a clinical case of a 12-year-old female patient who, as a result of dentoalveolar trauma, exhibits asymptomatic apical periodontitis of tooth 1.1 and chronic apical abscess of tooth 2.1 in IPT. Both teeth were treated with regenerative endodontics, achieving successful RE in tooth 2.1 and inducing apical closure with Biodentine in tooth 1.1. In addition, we conducted a bioinformatic analysis to identify key genes associated with the success of post-trauma RE, providing a more complete and mechanistic understanding of the factors determining treatment success. In conclusion, the success of RE procedures in IPT may be conditioned by the type of DAT suffered by the tooth. Moreover, incorporating bioinformatic analysis introduces an innovative approach to unravel the molecular mechanisms involved in post-trauma dental regeneration.

Objectives: This study aimed to synthesize and characterize a novel mucoadhesive hydrogel for oral drug delivery, predominantly for the treatment of oral ulcers. Exosomes derived from mesenchymal stem cells were incorporated into the hydrogel with the intention of enhancing the therapeutic effects and minimizing risks such as drug resistance and secondary infections.

Methods: A basic hydrogel was synthesized via a combination of hyaluronic acid and carbomer. In addition, various antimicrobial agents were added to produce hydrogel variants. Exosomes were incorporated into the hydrogel variants to create a system for drug delivery. Scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), a rheological analysis, mucoadhesive testing, and a swelling and degradation analysis at different pH levels were carried out to characterize the hydrogel. In vitro testing of the basic composition and the hydrogel variants was then carried out, which included a determination of their antimicrobial properties against Escherichia coli, Streptococcus aureus, and Candida albicans, a cytocompatibility analysis via a WST-8 fibroblast quantification assay, and an analysis of exosome release kinetics via UV-Vis spectrophotometry.

Results: The SEM analysis revealed a porous and interconnected structure within the hydrogel matrix, which is essential for loading drugs. The FTIR spectrum's characteristic peaks confirmed the presence of the constituent polymers. The hydrogel exhibited suitable viscoelastic properties, strong mucoadhesion on bovine mucosa and satisfactory swelling and degradation properties at various pH levels. Effective antimicrobial activity against E. coli, S. aureus, and C. albicans was observed in the study groups in addition to cytocompatibility and an increase in exosome release from the hydrogel with time.

Conclusion: This study determined that the exosome-loaded mucoadhesive hydrogel is a promising alternative to traditional oral ulcer treatments. The synthesized hydrogel's viscoelastic and mucoadhesive behavior, along with its antimicrobial activity and biocompatible nature, suggest that it addresses the challenges in conventional oral ulcer treatment.

Objective: To investigate the wear resistance of three resin composites in artificial saliva at varying pH levels.

Methods: Three resin materials-Coltene BRILLIANT™NG, 3M ESPE™Filtek™P60, and Kerr Sonicfill™2-were selected and subjected to reciprocating friction tests in artificial saliva with pH values of 2, 6.8, and 8. Wear volume was measured using a three-dimensional profilometer, and statistical analysis was performed using two-way ANOVA to compare differences in material loss among the resin groups and natural tooth enamel, considering both material type and pH as factors. Surface morphology of worn samples was analyzed via SEM.

Results: Wear scar analysis revealed no statistically significant differences in wear volume among groups under pH 6.8 artificial saliva. In pH 2 artificial saliva, Group A (P60 resin) exhibited the highest wear volume, while Group B (Kerr SonicFill resin) showed the lowest wear volume, closely resembling that of natural enamel. Under pH 8 conditions, Group A again demonstrated the highest wear volume, whereas Group C (Coltene resin) exhibited the lowest. Group B (Kerr SonicFill) displayed wear volumes comparable to natural enamel (Group D). P60 resin showed significantly greater wear volume in pH 2 and pH 8 compared to pH 6.8. Kerr SonicFill resin exhibited lower wear volume in pH 2 than in pH 6.8 and pH 8, with no significant difference between pH 6.8 and pH 8. Coltene resin displayed higher wear volume in pH 2 and pH 6.8 compared to pH 8, but no significant difference was observed between pH 2 and pH 6.8. Natural enamel showed significantly greater volume loss at pH 8 compared to pH 6.8.

Conclusion: Under the tested *in vitro* conditions, Kerr SonicFill resin demonstrated wear behavior most comparable to natural enamel across varying pH environments, showing stable performance. This suggests it could be a suitable choice for dental restorations requiring durability under varying pH conditions, though direct extrapolation to clinical performance requires caution. The increased wear of natural enamel at alkaline pH was an interesting finding warranting further study.

Background/objectives: Inflammatory mediators such as prostaglandin E2 (PGE2) and nitric oxide (NO) are key indicators of pulp response to mechanical trauma. However, the influence of cavity depth on their release dynamics remains unclear. This study aimed to evaluate the effects of different cavity depths-moderate (without pulp exposure) and deep (with pulp exposure)-on the release of PGE2 and NO in the pulp tissue of rat mandibular incisors at two time intervals (3 and 9 h).

Methods: In total, 40 male Wistar rats were divided into two main groups (n = 20) based on cavity depth. A split-mouth design was used, with cavities of different depths prepared on the left mandibular incisors, leaving the right incisors without cavities as controls. All the prepared cavities were sealed with glass ionomer filling until 3 or 9 h (n = 10), when pulp tissue was removed. Homogenates were prepared and analyzed by ELISA for PGE2 and NO levels.

Results: Cavities without pulp exposure elicited 2.1-fold higher PGE2 (median: 3.44 vs. 1.81 ng/mL; p < 0.001) and 1.3-fold higher NO (median: 55.45 vs. 43.76 μmol/L; p < 0.01) compared to exposed cavities at 3 h-a paradoxical finding suggesting intact pulp architecture potentiates acute inflammatory signaling. This disparity persisted at 9 h (PGE2: 3.18 vs. 1.81 ng/mL; NO: 49.94 vs. 44.98 μmol/L), though with attenuated significance (p < 0.05).

Conclusion: Cavity preparation induces an early inflammatory response in the pulp, as indicated by increased PGE2 and NO levels. The inflammatory response was more pronounced in cavities without pulp exposure, suggesting that maintaining pulp integrity favors a regulated inflammatory response conducive to healing, while exposure may promote irreversible damage.

[This corrects the article DOI: 10.3389/fdmed.2024.1485419.].

Background: Bleaching agents are widely used for aesthetic dental enhancement, but concerns remain regarding their effects on enamel mineral content and surface morphology. This study aimed to evaluate the alterations in calcium and phosphorus levels and enamel microstructure following the application of three different bleaching protocols.

Methods: Ninety extracted human premolars were randomly divided into three groups (n = 30): Group 1 - McInnes solution, Group 2 - modified McInnes solution, and Group 3 - Pola Office bleach. Each group was subdivided for calcium, phosphorus, and scanning electron microscopy (SEM) analyses. Enamel samples were collected via microbiopsy at five time points. Calcium and phosphorus were quantified using spectrophotometric analysis, and surface changes were observed using SEM.

Results: All three bleaching agents resulted in measurable mineral loss. The McInnes solution group exhibited the greatest decrease in calcium concentration, particularly at T2 (P = 0.001) and T4 (P = 0.04). SEM revealed pronounced surface alterations in this group compared to modified McInnes and Pola Office groups. Remineralization was observed after storage in artificial saliva, with partial recovery of mineral levels over 14 days.

Conclusion: All bleaching protocols induced varying degrees of mineral loss and surface changes, with the McInnes solution causing the most significant effects. Modified McInnes showed relatively milder alterations, suggesting a potentially safer alternative. Post-bleaching remineralization in artificial saliva showed beneficial effects.

Background: Periodontitis affects 20%-50% of the global population and 74.1% of the population in Indonesia, with 1.1 billion cases worldwide in 2019. Assessing treatment costs is essential to ensure affordability and optimize outcomes, particularly in developing countries.

Objective: This study aimed to estimate the treatment cost for stage I-IV periodontitis, evaluate changes in periodontal parameters [plaque index (PI), papillary bleeding index (PBI), and calculus index (CI)], and analyze both the relationship and differences between treatment cost, number of visits, and changes in periodontal status.

Materials and methods: A retrospective observational study of 64 patient records (2020-2022) from the Periodontology Clinic, Universitas Indonesia Dental Hospital, was conducted. The medical records of single-visit patients or patients who lacked data on the periodontal variables in their medical records were excluded. Data included treatment costs (during the initial, surgical, and supportive phases), number of visits, and periodontal parameters (PI, PBI, and CI). A univariate analysis was performed to describe the distribution of the treatment cost, number of visits, and periodontal parameters. A bivariate analysis was conducted using Pearson's correlation to examine the association between treatment cost, number of visits, and changes in periodontal parameters, while one-way ANOVA was used to assess differences in the mean periodontal changes among the groups with different treatment costs and number of visits, with a significance threshold of p < 0.05. The statistical analyses were performed using SPSS 26.0.

Results: The univariate analysis showed that the highest mean cost was incurred by those with stage IV periodontitis (USD 50.45), while the lowest was incurred by those with stage III periodontitis (USD 18.96). Regarding the treatment phases, the surgical phase incurred the highest mean cost (USD 61.21), whereas the initial phase incurred the lowest (USD 20.08). The bivariate analysis using Pearson's correlation indicated no significant associations between treatment cost or number of visits and changes in PI, PBI, or CI (p > 0.05). Similarly, the one-way ANOVA revealed no significant differences in mean changes in PI, PBI, and CI across the groups based on treatment cost and number of visits (p > 0.05).

Conclusion: Treatment cost and number of visits showed no significant association with periodontal status, suggesting that clinical outcomes are determined by treatment quality rather than expenditure or frequency of visits.

This case report describes the three-dimensional (3D) craniofacial morphology of a patient with severe facial asymmetry caused by unilateral coronal synostosis. The patient was an 11-year-and-3-month-old girl at the time of the first examination. Facial photographs revealed upper facial deviation toward the right (affected) side and lower facial deviation toward the left (non-affected) side. The nasal bridge was bent toward the non-affected side, and the external canthus on the affected side was retracted superolaterally. The midline of the lower dentition deviated toward the non-affected side. Molar relationships were Class III on the affected side and Class I on the non-affected side. A virtual fusion model of the skull and dentition was reconstructed and analyzed using a 3D coordinate system. The model demonstrated absence of the right coronal and sphenofrontal sutures, deviation of the nasal pyramid and vomer toward the affected side, and anterior displacement of the petrous bone. Unlike typical facial symmetry cases, this case exhibited a prominently anterior glenoid fossa and reduced mandibular body length on the affected side. These findings demonstrate the complex craniofacial morphology associated with unilateral coronal synostosis and highlight the role of the coronal suture in maintaining facial symmetry and the mandible's adaptive growth in response to glenoid fossa asymmetry.