Restorative Dentistry & Endodontics

Fracture resistance of regenerated immature teeth in different simulated stages of root development: an in vitro cyclic loading study: Kyveli-Artemis Polydora, Konstantinos Kodonas, Anastasia Fardi, Christos Gogos; Published online April 28, 2026; DOI: https://doi.org/10.5395/rde.2026.51.e21 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Objectives
This in vitro study aimed to assess the fracture resistance of simulated stages of root maturation following regenerative endodontic treatment using a cyclic loading method.
Methods
Ninety extracted maxillary central incisors were randomly allocated into three experimental groups representing different stages of root development, following revitalization: Group A for completely immature teeth immediately after treatment; Group B for teeth with apical closure, and Group C for teeth with apical closure and wall thickening. Two control groups were also included: Group D for intact teeth and Group E for simulated immature teeth without the bioceramic material. Following simulation of immature apices and treatment with a bioceramic material, all specimens were subjected to cyclic loading using a step-stress fatigue protocol until failure. The number of cycles to fracture and the peak load were recorded and statistically analyzed.
Results
Statistically significant differences in loading forces were observed between the negative control group (Group D) and Groups A, B, and E (p < 0.05). However, no statistically significant differences were detected among the experimental groups. These results indicate that apical closure and dentinal wall thickening alone did not substantially improve mechanical reinforcement under cyclic loading conditions.
Conclusions
Although intact teeth exhibited superior mechanical performance, apical closure and wall thickening alone were insufficient to enhance reinforcement under cyclic loading.

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Interplay of hypoxia, angiogenesis, and macrophages in pulp and periapical lesions: an immunohistochemical cross-sectional study: Puja Chatterjee, Mala Kamboj, Shweta Mittal, Anjali Narwal, Anju Devi; Published online April 23, 2026; DOI: https://doi.org/10.5395/rde.2026.51.e22 [Epub ahead of print]

Abstract PDF PubReader ePub: Objectives
This study evaluated and correlated the immune expression of hypoxia and angiogenesis with macrophages in periapical granuloma (PG), radicular cyst (RC), and healthy pulp (HP).
Methods
An observational study was performed on 51 tissue blocks equally divided among the groups, stained immunohistochemically for hypoxia-inducible factor (HIF)-1α, vascular endothelial growth factor (VEGF), and CD68, and the mean expression was calculated. Data were analyzed using Kruskal-Wallis, Mann-Whitney, Spearman correlation tests (p < 0.001), and multiple linear regression analysis (p ≤ 0.05).
Results
HIF-1α expression was highest in PG than RC and HP (p < 0.001). Significant differences were found between HP, PG, and RC (both p < 0.001). VEGF expression was highest in RC than in PG and HP (p < 0.001), with significant differences between HP and both PG and RC (p < 0.001); pairwise comparisons were significant between all groups (p < 0.001, p < 0.001, p = 0.018). Correlation analysis showed significant correlations between VEGF and CD68 in HP and PG (p = 0.007 and p = 0.028, respectively). Linear regression showed that study groups were significantly associated with mean scores of HIF-1α, VEGF, and CD68 (p = 0.002, p = 0.001, p < 0.001).
Conclusions
HIF-1α, VEGF, and CD68 showed increased expression in PGs and RCs, suggesting an association between hypoxic conditions, enhanced angiogenic activity, and macrophage presence within the periapical inflammatory microenvironment. Future studies exploring HIF-1α and VEGF inhibitors as potential treatment modalities for periapical lesions are warranted.

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Effect of high irradiance and short exposure curing time on the fracture toughness of bulk-fill resin-based composite: an in vitro study: Beatriz Ometto Sahadi, Tainah Oliveira Rifane, Carolina Bosso André, Vitaliano Gomes Araújo-Neto, Richard Thomas Bengt Price, Marcelo Giannini; Published online April 20, 2026; DOI: https://doi.org/10.5395/rde.2026.51.e23 [Epub ahead of print]

Abstract PDF PubReader ePub: Objectives
This study aimed to determine the effect of high irradiance and short exposure time on the fracture toughness of bulk-fill resin-based composites (RBCs).
Methods
Three RBCs were tested: Tetric PowerFill (TPF; Ivoclar Vivadent), Opus Bulk Fill APS (OBF; FGM Dental Group), and Filtek One Bulk Fill (FOB; Solventum). Sixty single-edge-notched disc specimens were prepared using a fracture toughness mold. Each group consisted of 20 samples, divided into two subgroups (n = 10). The RBCs were lightcured either for 3 seconds in high-irradiance mode (‘3s cure’) or for the manufacturer-recommended times (TPF, 10 seconds; OBF, 30 seconds; FOB, 20 seconds) in ‘high power’ mode using the Bluephase PowerCure (Ivoclar Vivadent). The peak spectral wavelength was measured using a spectrophotometer. Specimens were tested on a universal testing machine, and data were analyzed by two-way analysis of variance and Bonferroni test (α = 0.05).
Results
Radiant exposure values (J/cm²) were 9.5 for the 3-second mode and 12.4, 24.8, and 37.1 for 10, 20, and 30 seconds (high power mode), respectively. FOB (4.22 and 3.79 MPa∙m^0.5 for 20 and 3 seconds) had the highest mean fracture toughness, while OBF showed the lowest (2.01 and 2.10 MPa∙m^0.5 for 30 and 3 seconds). TPF produced intermediate results (2.72 and 2.70 MPa∙m^0.5 for 10 and 3 seconds). Exposure time did not affect TPF and OBF, while the 3-second exposure significantly reduced the fracture toughness for FOB.
Conclusions
The RBCs tested had different fracture toughness values regardless of exposure time. High irradiance and short exposure can reduce fracture toughness depending on the RBC tested.

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Effectiveness of silver diamine fluoride in managing hypersensitivity of molar-incisor hypomineralization affected molars: a scoping review: Vo Truong Nhu Ngoc, Do Trong Hieu, Tran Anh Tuan, Vo Nhat Minh, Trinh Khanh Linh; Published online April 13, 2026; DOI: https://doi.org/10.5395/rde.2026.51.e19 [Epub ahead of print]

Abstract PDF PubReader: This study aimed to evaluate the efficacy of dentinal hypersensitivity treatment with silver diamine fluoride (SDF) in molar-incisor hypomineralization (MIH)-affected molars. This scoping review was designed and structured according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and its extension for scoping reviews. A search strategy was conducted across PubMed, The Cochrane Library, ScienceDirect, and Google Scholar to identify articles related to the topic. Two authors screened titles, abstracts, and full texts for review. Five studies met the eligibility criteria, comprising four randomized controlled trials and one case report, with sample sizes ranging from four to 200 participants. All included studies reported improvements in clinical outcomes, including reduced hypersensitivity following SDF application, as indicated by lower Schiff cold air sensitivity scale scores. SDF is a promising treatment strategy for reducing hypersensitivity in MIH-affected molars; however, further research using SDF alone is needed to evaluate its exact effectiveness.

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Initial attachment, viability, proliferation, and migration of osteoblastlike SaOS-2 cells on two resorbable xenogeneic membranes for guided tissue regeneration: in vitro experimental study: Rafael Fernández-Grisales, Giovanna García-Suárez, Ximena Guerrero-Rodríguez, Carolina Berruecos-Orozco, Marco Calle-Jaramillo, Wilder Javier Rojas, Vanessa Esmeralda Duque, Daniela Serna-Guisao, Néstor Ríos-Osorio; Published online April 13, 2026; DOI: https://doi.org/10.5395/rde.2026.51.e20 [Epub ahead of print]

Abstract PDF PubReader ePub: Objectives
This study evaluated the biocompatibility of a new xenogeneic resorbable membrane derived from porcine esophagus membrane (Quirumatrix, Cells Tech Co.) and compared it with a porcine pericardium membrane (Straumann Jason, Straumann Holding AG.) traditionally used for guided tissue regeneration. The parameters investigated were the viability, migration, and adhesion of SaOS-2 osteoblast-like cells derived from osteosarcoma on both membranes.
Methods
The cells were cultured in 100 mm plates in RPMI 1640 medium (40 mL), supplemented. They were incubated at 37°C in a humidified atmosphere with 95% air and 5% to 10% CO₂. Cell morphology and adhesion were evaluated using phase contrast optical microscopy and scanning electron microscope. Cell viability and proliferation were evaluated using a fluorometric resazurin reduction assay, with fluorescence intensity measured at 48, 72, and 96 hours. Cell migration was evaluated using staining with Alexa Fluor 555 Phalloidin (Cell Signaling Technology) and DAPI, with a reference line. Cell migration was analyzed by measuring displacement within the delineated area using an Axio Imager M2 fluorescence microscope (Carl Zeiss). Each membrane was photographed. The statistical analysis was performed using GraphPad Prism ver. 10.2.3 (GraphPad Software). A p-value <0.05 was considered significant between experimental groups.
Results
Both membranes were shown to be biocompatible. The porcine pericardium membrane showed greater cell adhesion and proliferation compared to the porcine esophagus membrane. Cell migration was significantly greater in the Jason membrane.
Conclusions
The results revealed that both evaluated membranes are biocompatible and non-cytotoxic; further research is needed to understand their long-term behavior, interactions with other types of cells, and performance in specific therapeutic situations.

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The recovery effect of dentin biomodifiers on microtensile bond strength and sealer-penetration depth of coronal and radicular dentin: an in vitro experimental study: Mona Rizk Aboelwafa, Yasmin Tawfik Mohamed Sobh; Published online April 7, 2026; DOI: https://doi.org/10.5395/rde.2026.51.e15 [Epub ahead of print]

Abstract PDF PubReader ePub: Objectives
This study aimed to assess the outcomes of bromelain enzyme and chlorhexidine (CHX) following endodontic irrigation by evaluating coronal dentin microtensile bond strength (μTBS) and radicular dentin sealer penetration depth.
Methods
Fifty-one human molars with flat mid-dentin surfaces were soaked in sodium hypochlorite, then randomly assigned to three groups relying on the biomodification approach (n = 17): group 1, saline; group 2, 8% bromelain; and group 3, 2% CHX. After bonding and resin composite build-ups, the μTBS, failure mode, and bond interface were evaluated. Forty-two root canals of human molars were mechanically prepared and randomly distributed among three groups (n = 14), similar to the coronal-dentin biomodification protocol. The sealer-penetration depth was measured utilizing the scanning electron microscope. One- and two-way analyses of variance and the pairwise t- and chi-square tests were utilized.
Results
The bromelain group showed the highest statistically significant resin-dentin μTBS values, followed by the CHX and control groups. For sealer-penetration assessment, the bromelain group showed the highest penetration at the middle and apical root levels, whereas CHX demonstrated the highest penetration at the coronal level.
Conclusions
Bromelain biomodification positively influenced the resin-dentin bond strength and the sealer-penetration depth in apical and middle levels.

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Clinical outcomes of tooth autotransplantation: a systematic review and meta-analysis of survival: Jasmine Wong, Elise Hoi Wan Fok, Kar Yan Li, Chengfei Zhang, Gary Shun Pan Cheung; Published online April 2, 2026; DOI: https://doi.org/10.5395/rde.2026.51.e17 [Epub ahead of print]

Abstract PDF PubReader ePub: Objectives
Autotransplantation is a procedure that involves the extraction and transplantation of a tooth from one site to another within the same individual. This systematic review and meta-analysis aimed to investigate how clinical outcomes of autotransplanted teeth evolve over time and the principal reasons for extraction.
Methods
Studies were identified from five databases. A meta-analysis was performed to estimate the survival rates in the short-term (1 to ≤4 years), medium-term (>4 to ≤8 years), and long-term (>8 years) periods. Subgroup analysis was performed for age and root development. Risks of bias, reasons for extraction, and patient-reported outcome measures were evaluated.
Results
Of the 3,941 reports initially identified, 46 were included. The estimated short-, medium-, and long-term survival rates were 96.31% (95% confidence interval [CI], 94.80–97.82), 88.23% (95% CI, 85.59–90.87), and 84.80% (95% CI, 76.70– 92.91), respectively. There were no significant differences in outcomes between age and root development groups. The most common reason for tooth loss was root resorption. High patient satisfaction rates were reported.
Conclusions
Autotransplanted teeth exhibit high survival rates in the short- to medium-term. Minimizing root surface damage and excluding pulpal contaminants may promote longevity. The procedure appeared equally successful for teeth at different stages of root development and across various age groups.

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Effect of sugar and sweetener on the bleachability of coffee and tea-induced stains on composites: an in vitro experimental study: Nilay Bayraktar, Osman Kerim Arda Karaca, Yunus Ekşılı, Mustafa Furkan Yıldırım, Osman Tolga Harorli; Published online April 1, 2026; DOI: https://doi.org/10.5395/rde.2026.51.e16 [Epub ahead of print]

Abstract PDF PubReader ePub: Objectives
This in vitro study evaluated the effects of various sugary and non-sugary beverages on the color change of a dental composite and the subsequent bleaching efficacy.
Methods
Forty-nine disc-shaped composite samples (Neo Spectra ST, Dentsply Sirona) were split into seven groups at random (n = 7). Distilled water was used to hydrate each sample for 24 hours at 37°C. After 24 hours, the first color measurements (T0) were made by using a clinical spectrophotometer (VITA Easyshade Compact; VITA Zahnfabrik). Color measurements were repeated after 7 days (T1) and 14 days (T2) of immersion in distilled water (control), tea, coffee, sugary tea, sugary coffee, tea with sweetener added, and coffee with sweetener added. After staining for 2 weeks, the specimens were bleached for 6 hours a day for a week using 16% carbamide peroxide (Opalescence Ultradent Products). Color measurements were taken again after bleaching (T3). Using CIEDE2000, color differences (ΔE) were computed. Analysis of variance (ANOVA) and repeated measures ANOVA with a Tukey post hoc test were used to evaluate the data.
Results
After 1 week, coffee-containing solutions produced significantly greater discoloration than the control (p < 0.001). By 2 weeks, tea groups exhibited similar discoloration to coffee groups (p < 0.001). The addition of sugar or sweetener had no significant effect (p > 0.05). Post-bleaching, coffee groups showed lower Whiteness Index values than the control, without statistical significance (p > 0.05).
Conclusions
Coffee and tea markedly stain resin composites, with discoloration persisting post-bleaching, while sugar or sweetener additions exert no significant effect.

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Artificial intelligence hallucinations in endodontics: implications for scientific integrity and clinical decision-making: Emmanuel João Nogueira Leal da Silva, Fernanda Nehme Simão Jorge Riche; Published online April 7, 2026; DOI: https://doi.org/10.5395/rde.2026.51.e18 [Epub ahead of print]

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