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Achieving an apical seal is critical for apexification treatment of nonvital immature teeth. While this is commonly accomplished using biocompatible mineral trioxide aggregate (MTA), its limitations, such as prolonged setting time, discoloration, and challenging handling, have driven the search for alternative materials. This study aimed to compare the clinical and radiographic success of bioceramic putty Well-Root PT apical plug compared to MTA in the treatment of nonvital immature permanent incisors. Fifty immature nonvital maxillary permanent central incisors in thirty-eight children aged 8–11 years were randomly divided into two groups (25 teeth/group). Group I received MTA apical plugs, and Group II was treated with Well-Root PT apical plugs. Both groups were recalled at 6 and 12 months for clinical and radiographic evaluations. Statistical analysis was done for the gathered data. Both groups showed improved clinical signs and symptoms during all follow-up periods with no statistically significant difference. Regarding the periapical radiolucency (PAR) area, at twelve months, the mean PAR area in the Well-Root PT group was (0.14 ± 0.08) compared to (2.3 ± 0.9) in the MTA group, with highly statistically significant differences (p < 0.001). The mean periapical bone radiodensity in the Well-Root PT group was (178.2 ± 5.4) compared to (164.8 ± 9.4) in the MTA group at twelve-month follow-up, with highly statistically significant differences(p < 0.001). Well-Root PT, with its reduced technical sensitivity, demonstrates satisfactory clinical and radiographic success as an apical plug for nonvital immature permanent incisors compared to MTA.

Background To evaluate the clinical efficacy and outcomes of C-Root SP bioceramic-based sealers combined with different obturation techniques in nonsurgical root canal treatment for older patients. Methods This prospective, single-center, single-blind, parallel, randomized clinical trial included 240 patients aged ≥ 60 years. Patients were randomly divided into four treatment groups. Group A: C-Root SP combined with single-cone (SC); Group B: C-Root SP combined with warm vertical compaction (WVC); Group C: C-Root SP combined with cold lateral condensation (CLC); Group D: iRoot SP combined with SC (Control). All teeth were subjected to root canal filling using the corresponding methods 7–10 days after root canal preparation and medication. The duration of obturation was recorded. Periapical radiographs were obtained immediately after obturation to determine the length of root canal filling, and postoperative pain on days 1, 2, and 7 was documented. The treatment outcomes based on clinical signs and symptoms as well as periapical index (PAI) were analyzed at 1 year postoperatively. Results Groups A and D exhibited significantly higher filling efficiency than groups B and C ( P  < 0.001). No significant differences were observed in the length of obturation between the groups ( P  > 0.05). Postoperative pain decreased over time in all groups, with group A showing significantly lower pain rates on day 1 than the other groups ( P  < 0.05). After 1 year, all groups exhibited considerable reductions in the PAI scores, with success rates ranging from 91.23 to 94.83%; however, no significant differences were observed between them ( P  > 0.05). Conclusions C-Root SP combined with different obturation techniques yielded similar outcomes to iRoot SP combined with the SC technique in terms of filling length, success rate, and changes in PAI scores. The SC technique demonstrated significant advantages in terms of clinical efficiency and may reduce early postoperative pain when combined with C-Root SP. Trial registration The study was retrospectively registered in chictr.org.cn with the identifier: ChiCTR2400092580 on 11/19/2024.

Objectives The aim of this study is to compare the clinical and radiographic success of MTA versus EBRRM in pulpotomy of permanent teeth with irreversible pulpitis without apical periodontitis. Material and Methods Clinical and radiographic assessments were conducted at baseline, 6 days, 6 weeks, and 6 months. After administration of anesthesia and coronal pulp removal, pulp was capped with MTA or Endo Sequence Bioceramic Root Repair, followed by restoration with a glass ionomer and resin composite. Results The overall success rate for pulpotomy was 71.9%, with MTA and the bioceramic showing success rates of 32.8% and 39.1%, respectively. There was no significant relationship with the type of cavity and failure of pulpotomy. Conclusions MTA and EBBRRM are both practical choices for pulpotomy and there is no notable difference between them in the success rate and pain level. EBBRRM may be more effective in Class 1 cavities than in Class 2 cavities.

Background Molar-incisor hypomineralization (MIH) is a systemic condition characterized by a qualitative defect in the dental enamel. It primarily affects the first permanent molars and is often associated with the permanent incisors. Resin restorations in MIH-affected teeth consistently show worse results than those in normal teeth because of the ultrastructure of hypomineralized enamel, which compromises adhesion. The incorporation of bioactive particles into adhesives is a promising option for inducing remineralization. This study protocol describes a randomized clinical trial evaluating restorative treatment using an adhesive system containing 45S5 bioactive glass for MIH-affected teeth. Methods Restorations will be performed on the upper or lower first permanent molars in children with MIH aged 6–12 years. The inclusion criteria will include MIH teeth with post-eruptive enamel fractures that compromise the middle third of the dentin, with at least two surfaces of hypomineralized enamel near the cavity, without caries, pulpal, or periradicular involvement. Before treatment, children will complete the Child Perceptions Questionnaire 8–10 and 11–14 (CPQ8–10 and CPQ11–14). The teeth will be divided into two groups: a control group (commercial self-etching adhesive system: Clearfil SE Bond (CF) Primer + Bond) and an experimental group (CF Primer + experimental Bond using 10% 45S5 bioglass [Bond 45S5 10%]). Restorations will be made using composite resin, and quality will be assessed using digital radiographs (interproximal and periapical), intraoral photographs, and epoxy resin replicas. Clinical evaluation of the restorations will be performed immediately following the procedure (baseline) and after 1, 3, 6, and 12 months using the World Dental Federation (FDI) criteria. The impact of the treatment on the quality of life will be assessed after 3, 6, and 12 months through the re-administration of CPQ8–10 and CPQ11–14. Discussion 45S5 bioactive glass is capable of enhancing the effect of materials on bone and dental structures, promoting remineralization. The results of this study may aid in the clinical management of patients with MIH, given the challenges of treating sensitive and compromised teeth and the difficulty in achieving long-term restorative success while addressing the individual patient needs. Trial registration Rebec, U1111-1259-1738. Registered on January 10, 2021.

With the current advances in spinal surgery, an understanding of the precise biological mechanism of each bone substitute is necessary for inducing successful spinal fusion. In this review, the categories of bone substitutes include allografts, ceramics, demineralized bone matrix, osteoinductive factors, autogenous platelet concentrate, mesenchymal stem cells, and gene therapy. Further, clinical studies have been evaluated by their levels of evidence in order to elucidate the precise effect of the bone substitute employed and to establish clinical guidance. This article will review both clinical studies based on evidence and basic research in current advances in order to avoid as far as possible any chances of failure in the future and to understand cellular biology in novel technologies.

Abstract BackgroundThe aim of this study was to investigate the effectiveness of core decompression in combination with a nano-hydroxyapatite/polyamide 66 (n-HA/PA66) rod and a porous bioglass bone graft for the treatment of osteonecrosis of the femoral head (ONFH).MethodsSixty-four patients (84 hips) with ONFH were allocated to a program of either core decompression (CD) in combination with a n-HA/PA66 rod and a porous bioglass bone graft (treatment group) or CD with an autologous cancellous bone graft (control group). Clinical and radiographic retrospective follow-ups were performed on all patients with the prospectively collected data.ResultsThe overall clinical failure rate in the treatment group (9/38, 23.68 %) was lower than that of the control group (24/46, 52.17 %) (p < 0.05). Harris hip scores (HHS) were significantly increased in both groups post-surgery (p < 0.05). There was a significant difference between the two groups on HHS improvement for Steinberg IIC and IIIA (p < 0.05 and p < 0.001, respectively). The visual analogue scale (VAS) was significantly decreased in both groups post-surgery (p < 0.05). Especially, significant difference in the VAS improvement was observed between the groups for IIB, IIC and IIIA (p < 0.05, p < 0.05 and p < 0.01, respectively).ConclusionsCore decompression combined with the implantation of a n-HA/PA66 rod and a bioglass bone graft can significantly decrease hip pain, improve hip function, and prevent the collapse of the femoral head in patients with ONFH. As the effectiveness of this approach appears to vary with Steinberg stage, we suggest that this treatment procedure may be suitable for patients with early to middle stage ONFH.

Purpose The purpose of our study is to describe the rationale, the surgical technique and the early clinical and radiographic results of the treatment of patients with early stage osteonecrosis of the femoral head (ONFH) by performing: core decompression, injection of autologous bone marrow concentrate and the use of a new composite injectable bone substitute (PRO-DENSE ® ), as a mechanical supplementation associated with decompression. Methods The study included 37 hips (31 patients, 14 females, 17 males; mean age 43.9 years, range 24–56 years) with stages IC–IIIA ONFH. The outcome was determined by the changes in the Harris hip score (HHS), by progression in radiographic stages and by the need for hip replacement. The mean follow-up was 20.6 months (range 12–32 months). Results At final follow-up the mean HHS increased from 68 points pre-operatively to 86 points post-operatively. The radiological results showed that 29 hips (78.4  %) improved or had no further collapse. The overall clinical success rate of the procedure was 86.5 %, with three conversions to THA, and a failure rate of only 3.3 % in the pre-collapse group. Conclusions We are encouraged by these early results using core decompression, injection of the autologous bone marrow concentrate and backfilling the defect with an injectable bioceramic for the treatment of early stages of ONFH; as far as a conclusion can be drawn from the current data, this treatment seems to relieve hip pain and prevent the progression of ONFH in the majority of the cases.

Waterborne pathogens present a significant threat to people living with the human immunodeficiency virus (PLWH). This study presents a randomized, controlled trial that evaluates whether a household-level ceramic water filter (CWF) intervention can improve drinking water quality and decrease days of diarrhea in PLWH in rural South Africa. Seventy-four participants were randomized in an intervention group with CWFs and a control group without filters. Participants in the CWF arm received CWFs impregnated with silver nanoparticles and associated safe-storage containers. Water and stool samples were collected at baseline and 12 months. Diarrhea incidence was self-reported weekly for 12 months. The average diarrhea rate in the control group was 0.064 days/week compared to 0.015 days/week in the intervention group (p < 0.001, Mann–Whitney). Median reduction of total coliform bacteria was 100% at enrollment and final collection. CWFs are an acceptable technology that can significantly improve the quality of household water and decrease days of diarrhea for PLWH in rural South Africa.

Background The conventional method of core decompression combined with porous bioceramics rod is usually performed under C-arm fluoroscopy for the treatment of early osteonecrosis of the femoral head (ONFH). This study was to evaluate the clinical value and efficacy of three-dimensional (3D) printing guide plate in the process of core decompression plus porous bioceramics rod for the treatment of early ONFH. Methods Forty patients were enrolled, including 20 patients undergoing the surgery with 3D printing guide plate in the experiment group and 20 controls with C-arm fluoroscopy. The following parameters such as surgery time, blood loss, fluoroscopy times, and the accuracy of core decompression for necrosis area, function outcome according to Harris Hip Score (HHS), and any possible complications were recorded and compared between the two groups. All the patients were followed up at 6, 12, and 18 months postoperatively. Results The surgery time, fluoroscopy time, and intraoperative blood loss in the experiment group was significantly less ( P  < 0.05) than those in the control group. There was no statistical significance in the accuracy of core decompression and porous bioceramics rod placement between the two groups ( P  > 0.05). All patients were followed up for 18 months. There was a significant difference between the preoperative and final follow-up HSS scores in both groups ( P  < 0.05). In addition, there was also a significant difference between the groups in the last follow-up HSS scores ( P  < 0.05). Conclusions Compared with the traditional method, 3D printing guide plate could shorten the surgery time and fluoroscopy times and decrease intraoperative blood loss. It seems to be an effective method in the combined core decompression with porous bioceramics rod placement for early ONFH.

Introduction The aim of this study is to evaluate the long-term stabilizing–healing effectiveness and influence on adjacent intact vertebral bodies of a new injectable partly resorbable calcium sulfate (60 wt.%)/hydroxyapatite (40 wt.%) bone substitute employed in vertebral augmentation of osteoporotic collapses. Methods From April 2009 to April 2011, 80 patients underwent vertebral augmentation. Patients enrolling criteria were age >20 years and symptomatic osteoporotic vertebral collapse from low-energy trauma encompassed between levels T5 to L5. Preoperative and postoperative imaging studies consisted of computed tomography, plain X-ray, dual X-ray absorptiometry scanning, and magnetic resonance. Pain intensity has been evaluated by an 11-point visual analog scale (VAS) and physical and quality of life compromise assessments have been evaluated by Oswestry Disability Questionnaire (ODI). All procedures have been performed fluoroscopically guided by left unilateral approach under local anesthesia and mild sedation. Results VAS-based pain trend over the 12-month follow-up has shown a statistically significant ( p  < 0.001) decrease, starting from 7.68 (SD 1.83) preoperatively with an immediate first day decrease at 3.51 (SD 2.16) and 0.96 (SD 0.93) at 12 months. ODI score dropped significantly from 54.78% to 20.12% at 6 months. No device-related complication has been reported. In no case a new incidental adjacent fracture has been reported. Conclusion Data show how this injectable partly resorbable ceramic cement could be a nontoxic and lower stiffness alternative to polymethylmethacrylate for immediate and long-term stabilization of osteoporotic collapsed vertebral bodies.