The objectives of this article are to report 2 cases of nonsurgical endodontic treatment for the management of periapical lesions associated with large cortical bone perforations and review the literature on the clinical efficacy of nonsurgical endodontic treatment to draw insights from published case reports. Large, cyst-like periapical lesions in 2 patients were successfully treated with combined modalities of root canal treatment, antimicrobial therapy (calcium hydroxide and triple antibiotic paste [TAP]), and mineral trioxide aggregate (MTA) obturation of the canal space. In both cases, instrumentation was extended 1 mm beyond the apical foramen to facilitate drainage through the root canal, because it was assumed that the periapical lesion could be cystic. After instrumentation, TAP was placed within the canal space to aid in disinfection and healing of the dental, pulpal, and periapical conditions. In both patients, the teeth were asymptomatic and functional at follow-up examinations (case 1, 3 years; case 2, 30 months). Supporting the positive outcomes in the 2 clinical cases, the published literature suggests that the use of biocompatible materials such as MTA, which can promote the deposition of hydroxyapatite, has the potential to contribute to tissue regeneration and the healing of large periapical lesions.

Mineral Trioxide Aggregate (MTA) is the gold standard for vital pulp treatment (VPT), but its superiority over novel calcium silicate-based cements in permanent teeth lacks systematic evidence. This study aimed to compare the efficacy of these materials in VPT through a network meta-analysis. A systematic search was conducted in MEDLINE, EMBASE, Cochrane Library, and Web of Science until January 20, 2024. The inclusion criteria were randomized controlled trials involving VPT with biomaterials and reversible or irreversible pulpitis diagnoses in mature permanent teeth. The primary outcome was the odds ratio (OR) of failure rates with 95% confidence intervals. In the 21 eligible trials, failure rates were significantly higher with calcium-hydroxide than MTA at six (OR 2.26 [1.52-3.36]), 12 (OR 2.53 [1.76-3.62]), and 24 months (OR 2.46 [1.60-3.79]). Failure rates for Totalfill at six (OR 1.19 [0.55-2.58]) and 12 months (OR 1.43 [0.71-2.92]), and Biodentine at six (OR 1.09 [0.66-1.78]), 12 (OR 1.21 [0.74-1.96]), and 24 months (OR 1.47 [0.81-2.68]) were not significantly different from MTA. The results were similar in the direct pulp capping subgroup, whereas, in the partial and full pulpotomy subgroup, there was not enough evidence to achieve significant differences. MTA, Biodentine, and Totalfill are the most efficient materials for VPT. However, calcium-hydroxide-based materials are not recommended in VPT.

OBJECTIVE: This study systematically reviewed the clinical and radiographic outcomes of laser versus conventional pulpotomy in primary teeth. It also compared the success and effectiveness of different lasers to enhance the understanding and use of laser pulpotomy as an alternative treatment.
METHODS: An electronic search was carried out in PubMed and Cochrane from 1st January 1999 to 31st December 2023. The published articles in the English language were searched using MeSH terms and text words. Only randomized controlled trials with a sample size of more than 10 and follow-ups over 6 months were included. Meta-analysis and forest plots were evaluated by utilizing Review Manager 5.4 software. Two reviewers assessed the risk of bias using the RoB 2 tool and discrepancies were resolved by the third reviewer. The success rates were combined using a random effects model to determine clinical and radiographic outcomes. We used risk ratios with 95% confidence intervals (CI) as the primary effect measures and set the significance level at 0.05.
RESULTS: Only 18 studies met the inclusion criteria after an electronic search. Among them, 13 studies evaluated the clinical and radiographic outcomes of laser with formocresol pulpotomy, 2 studies compared with ferric sulfate pulpotomy, and the remaining studies with Mineral trioxide aggregate (MTA) pulpotomy. The various studies showed different levels of bias. There was no significant difference in the clinical success rate (p = 0.47; RR: 1.01; 95% CI 0.98-1.04; I2 = 0%; p = 0.70) and radiographic success rate (p = 0.94; RR: 1.00; 95% CI 0.91-1.09; I2 = 64%; p = 0.001) between laser pulpotomy and formocresol. Similarly, there was no significant difference between laser pulpotomy and ferric sulfate or MTA pulpotomy.
CONCLUSIONS: Diode laser and LLLT can be considered as alternative pulpotomy agents to formocresol in primary teeth. However, high-quality trials are needed to confirm the accuracy and reliability of these findings.

This systematic review aimed to compare the histological response of inflamed pulpodentinal complex to the hydraulic calcium silicate cements in experimental animal models of pulpitis. Articles that evaluated the histological response of inflamed pulp to mineral trioxide aggregate (MTA) in comparison with other restorative materials were selected and analysed in detail. The risk of bias assessment was conducted using SYRCLE\'s RoB tool. The GRADEpro tool was used to determine the overall quality of evidence. Out of the 2947 retrieved articles from databases, five articles fulfilled the inclusion criteria. MTA induced significantly more hard tissue formation compared to calcium hydroxide. The use of pulp-capping material containing fluocinolone acetonide and ASP/PLGA-ASP/ACP/PLLA-PLGA composite membrane was comparable. This systematic review could not demonstrate enhanced efficiency of capping materials compared to MTA. Future well-conducted animal studies are warranted for demonstrating the hard tissue formation abilities of pulp-capping materials with convenient inflammatory conditions.

BACKGROUND: Several efforts have been made to improve mechanical and biological properties of calcium silicate-based cements through changes in chemical composition of the materials. This study aimed to investigate the physical (including setting time and compressive strength) and chemical (including calcium ion release, pH level) properties as well as changes in cytotoxicity of mineral trioxide aggregate (MTA) after the addition of 3 substances including CaCl2, Na2HPO4, and propylene glycol (PG).
METHODS: The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Electronic searches were performed on PubMed, Embase, and Scopus databases, spanning from 1993 to October 2023 in addition to manual searches. Relevant laboratory studies were included. The quality of the included studies was assessed using modified ARRIVE criteria. Meta-analyses were performed by RevMan statistical software.
RESULTS: From the total of 267 studies, 24 articles were included in this review. The results of the meta-analysis indicated that addition of PG increased final setting time and Ca2+ ion release. Addition of Na2HPO4 did not change pH and cytotoxicity but reduced the final setting time. Incorporation of 5% CaCl2 reduced the setting time but did not alter the cytotoxicity of the cement. However, addition of 10% CaCl2 reduced cell viability, setting time, and compressive strength.
CONCLUSIONS: Inclusion of 2.5% wt. Na2HPO4 and 5% CaCl2 in MTA can be advisable for enhancing the physical, chemical, and cytotoxic characteristics of the admixture. Conversely, caution is advised against incorporating elevated concentrations of PG due to its retarding effect.
BACKGROUND: PROSPERO registration number: CRD42021253707.

This retrospective chart review study investigates the long-term clinical outcome of Biodentine® (Tricalcium silicate) as a medicament for pulpotomy in primary molars. Data in this retrospective study was collected from the dental records of all patients that had at least one primary molar receive pulpotomy treatment (CDT code: D3221) between 01 July 2012 and 01 July 2015. This data includes child\'s age, medical history, dental history, dental radiographs, pulpotomy procedure details and follow-up clinical notes. Kaplan-Meier Estimate was used to measure the fraction of successful pulpotomy procedures for up to 24 months. A total of 1758 pulpotomy procedures were performed on 1032 patients in our institute in the three-year period and 21.4% of them (N = 376) had follow-up dental records that qualified for the study. Eleven teeth out of 376 teeth were excluded from the statistical analysis due to loss of/broken stainless steel crowns (3.1%). Seventeen pulpotomy failures were identified out of the remaining 365 procedures. The survival probablity of using Biodentine® as a pulpotomy medicament is 96.3% for 18-month follow-up and 95.4% for 24-month follow-up. Biodentine®, a tricalcium silicate formulation, used as a pulpotomy medicament demonstrates a high clinical success rate (95.4%) over a 24-month peroid in primary molars.

OBJECTIVE: This review aimed to evaluate the in vitro studies done with regard to the cytotoxicity associated with mineral trioxide aggregate (MTA)-based root canal sealers.
BACKGROUND: Root canal sealers are used during endodontic treatment as fillers to seal the gaps between the canal gutta-percha cone and canal walls. It is necessary to understand the cytotoxicity of these materials on human-derived cells as these materials interact with human cells periapically.
RESULTS: Six in vitro studies were chosen for review. In these selected studies, along with MTA-based root canal sealers, other sealers were tested for cytotoxicity on human periodontal ligament (PDL) stem cells, human PDL fibroblasts, and human osteoblast cells. Regarding cytotoxicity, the studies were diverse, and most were based on 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl-2H-tetrazolium bromide) (MTT) assay. In general, the studies suggested that root canal sealers cause mild to severe cytotoxic effects and that several factors influence this effect, such as material setting time, concentration, and duration of exposure.
CONCLUSIONS: All studies in the review indicated that MTA. Fillapex must be used cautiously as it exhibited the highest cytotoxic effect compared to other MTA-based and non-MTA-based sealers.
CONCLUSIONS: Endodontic sealers do serve the purpose of bridging the gaps between the gutta-percha cone and the canal wall but knowing its biocompatibility becomes important as the material is extruded beyond the apical foramen where it comes in contact with the surrounding tissues. The effect of sealers on the surrounding tissues affects the healing and prognosis of the treatment.

BACKGROUND: The results of vital pulp treatments in permanent teeth have been encouraging. Currently, pulpotomy treatment for permanent teeth primarily utilizes mineral trioxide aggregate (MTA) as the dressing material, followed by calcium hydroxide. While other calcium-silicate-based cements have been suggested for pulpotomy, there is a limited number of studies evaluating their long-term effectiveness.
OBJECTIVE: The objective of this systematic review and meta-analysis was to evaluate the success rate of pulpotomies performed on permanent teeth, comparing the use of ProRoot MTA with that of calcium hydroxide and other bioceramic materials.
METHODS: A comprehensive search was conducted in several electronic databases, including PubMed, Cochrane Library, Scopus, Web of Science, Embase and Science Direct until December 2022. The search was guided by PICOS criteria, including only randomized clinical trials (RCTs) that evaluated the success rate of pulpotomy treatments in permanent teeth using ProRoot MTA in comparison to calcium hydroxide and other bioceramic materials. The quality of the included studies was assessed using the RoB-2 tool to evaluate the risk of bias, and relevant data were extracted and analysed in RevMan software 5.3 using fixed-effect models. The GRADE tool was used to determine the overall quality of evidence.
RESULTS: The initial search retrieved 1072 studies and, after eliminating duplicates, 677 studies were screened and 28 studies were considered for eligibility. In the final selection process, 16 studies were included in the systematic review, with 10 being determined as having a high risk of bias. Pulpotomy showed an overall mean success rate of 92% after 1 year. The meta-analysis indicated a significantly higher success rate for pulpotomies utilizing MTA in comparison with calcium hydroxide, while no significant difference was seen between MTA and calcium-enriched mixture (CEM) or Biodentine. The GRADE assessment revealed an overall low level of evidence for the included studies.
CONCLUSIONS: Most randomized controlled trials exhibited a significant absence of control over confounding factors.
CONCLUSIONS: This systematic review and meta-analysis demonstrate that pulpotomy is a highly effective treatment for managing permanent teeth. The results indicate that the success rate of pulpotomy using ProRoot MTA is significantly higher than when using calcium hydroxide. However, the certainty of evidence supporting these findings is low, and there is a need for well-designed RCTs to assess the long-term outcomes of pulpotomy using newer bioceramic materials.
BACKGROUND: This systematic review was registered in the PROSPERO database (registration number CRD42023393970).

UNASSIGNED: The purpose of this systematic review was to analyze the effect of commercially available calcium silicate-based bioactive endodontic cement (BEC) on treatment outcome when used as root repair material in human permanent teeth and to compare it with traditional materials.
UNASSIGNED: PubMed, Embase, and Cochrane Library were searched until June 2020. Randomized clinical studies and observational studies with a minimum 1-year follow-up and sample size of at least 20 were included. Risk of bias (ROB) was assessed using Cochrane\'s ROB tool and the National Institutes of Health Quality Assessment Tool.
UNASSIGNED: Thirty-nine studies were included in the systematic review. Majority of the studies used mineral trioxide aggregate. The pooled success rate for BEC was estimated by a random-effects method as 90.49% (95% confidence interval [CI]: 88.4992.34, I2 = 54%). Eleven studies comparing BEC with traditional materials were included in the meta-analysis. The use of BEC significantly improved the treatment outcome when compared to traditional materials with odds ratio (OR) = 2.15 (95% CI: 1.57-2.96, I2 = 0.8%, P = 0.433).
UNASSIGNED: Very low-to-moderate-quality evidence suggests that the use of BEC as root repair material enhanced the treatment outcome. High-quality studies are required for the newer BEC to establish their clinical performance. Registration: PROSPERO CRD42020211502.

UNASSIGNED: This study aimed at systematically reviewing the clinical success of repaired iatrogenic perforations using different materials in primary teeth.
UNASSIGNED: To compare mineral trioxide aggregate (MTA) with other biomaterials for the repair of iatrogenic perforations in primary molars during endodontic procedures.
UNASSIGNED: A comprehensive literature search was conducted by using three electronic databases (PubMed, Cochrane Library, Google Scholar) to identify articles that evaluated the different intervention materials for the repair of iatrogenic perforation in primary molars. Selection criteria: The articles reporting perforation repair in primary molars having clinical and radiographic success, as their outcome measures with a follow-up period of at least 1 year were included in this review. Studies and case reports with insufficient or unstated follow-up periods, in vitro, and animal studies were excluded.
UNASSIGNED: Two reviewers (SM, LM) independently screened all titles and abstracts according to the inclusion and exclusion criteria. Full texts of the selected studies were obtained for the second stage screening. The consensus was achieved by discussion with the third reviewer (AJ). Data extraction included study design, sample size, age of the patient, year of the study, follow-up period, outcome assessment criteria, material for repair, and success and failure.
UNASSIGNED: A total of seven publications were included in this review. Of which, one was case series, three were case reports, and three were interventional studies. The combined success rate of MTA (80.55%) was inferior to other materials-premixed bioceramics, Atelocollagen, and calcium-enriched mixture (96.07%); the same being statistically significant (p = 0.011).
UNASSIGNED: Within the limitations of our study, it can be concluded that newer biomimetic materials are superior to MTA for iatrogenic perforation repair in primary molars in terms of clinical success.
UNASSIGNED: This paper is a first-of-its-kind investigation comparing different materials used in the repair of perforations in primary molars. It can be a foundation for further research on the topic. In absence of any available guidelines, the above study can be applied in clinical situations with appropriate judgment and caution.
UNASSIGNED: Mungekar-Markandey S, Mistry L, Jawdekar A. Clinical Success of Iatrogenic Perforation Repair Using Mineral Trioxide Aggregate and Other Materials in Primary Molars: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2022;15(5):610-616.