Microleakage of various cementing agents for full cast crowns

The preventive effect of glass ionomer cement restorations on secondary caries formation: A systematic review and meta-analysis

OBJECTIVE

The objective is to compare the preventive effect on secondary caries of glass ionomer cement (GIC) restorations with amalgam or resin-composite restorations.

METHODS

Two independent researchers conducted a systematic search of English publications in PubMed, Web of Science, Cochrane and Scopus. They selected randomized clinical trials comparing secondary caries incidences around GIC restorations (conventional GIC or resin-modified GIC) with amalgam or resin-composite restorations. Meta-analysis of the secondary-caries incidences with risk ratio (RR) and 95% confidence interval (95% CI) as the effect measure was performed.

RESULTS

This review included 64 studies. These studies included 8310 GIC restorations and 5857 amalgam or resin-composite restorations with a follow-up period from 1 to 10 years. Twenty-one studies with 4807 restorations on primary teeth and thirty-eight studies with 4885 restorations on permanent teeth were eligible for meta-analysis. The GIC restorations had a lower secondary caries incidence compared with amalgam restorations in both primary dentition [RR= 0.55, 95% CI:0.41-0.72] and permanent dentition [RR= 0.20, 95% CI:0.11-0.38]. GIC restorations showed similar secondary caries incidence compared with resin-composite restorations in primary dentition [RR= 0.92, 95% CI:0.77-1.10] and permanent dentition [RR= 0.77, 95% CI:0.39-1.51]. Conventional GIC restorations showed similar secondary caries incidence compared with resin-modified GIC-restored teeth in both primary dentition [RR= 1.12, 95% CI:0.67-1.87] and permanent dentition [RR= 1.63, 95% CI:0.34-7.84].

CONCLUSIONS

GIC restorations showed a superior preventive effect against secondary caries compared to amalgam restorations, and a similar preventive effect against secondary caries compared to resin-composite restorations in both primary and permanent teeth. [PROSPERO Registration ID: CRD42022380959].

Mechanical properties of cracked teeth with different dental materials and crown parameters: An in vitro proof-of-concept

OBJECTIVE

This work analyzed and compared the mechanical properties of identical cracked tooth models treated with different materials and crown parameters. Thus, to provide dentists with a more structured way to select materials and geometric parameters and determine the strongest restoration model for cracked teeth.

METHODS

This work used finite element analysis (FEA). We applied 25 restorative models, including five restorative materials, and three preparation parameters. Seven mechanical properties of the cracked tooth preparation were analyzed using correlation analysis.

RESULTS

The highest lifetime of the cracked preparation was obtained for crowns with a 5° of polymerization, width = 0.8 mm, and a length offset of 0.2 mm. The highest lifetime was obtained with ZC crown material, but the least deformation of the cracked tip was obtained with LU material.

SIGNIFICANCE

The results showed that the larger MOE material for the crown and a reasonable increase in the thickness and length of the crown is a favorable method to prevent further cracks to extend. This FEA study, thereby forming a novel basis for clinical guidance as to preparation of dental crowns applicable to cracked teeth.

Does adhesive luting promote improved fatigue performance of lithium disilicate simplified crowns?

The present study aimed to determine the influence of adhesive luting on the fatigue mechanical properties of simplified lithium disilicate crowns luted to dentin analogues preparations, and to compare two different approaches of simulation of a non-adhesive luting procedure. To this end, 30 prosthetic preparations of glass fiber-filled epoxy resin used as dentin analogues were milled and lithium disilicate crowns were pressed (1.5 mm thickness), which were allocated into three different groups: resin cement (RC), resin cement isolated by paraffin oil (RCI) and zinc phosphate cement (ZP). For luting procedures, the ceramic crowns of the RC and RCI groups had their internal surface treated with 5% hydrofluoric acid and universal primer. Afterwards, a thin layer of paraffin oil was applied onto the ceramic crown intaglio surface in the RCI group. The dentin analogues were treated with 10% hydrofluoric acid, followed by primer application and luting as recommended by the manufacturer. No previous surface treatments were performed for the ZP group, and the cement was applied as recommended. The fatigue test was run under cyclic fatigue (load 400-2000 N, step-size 100 N, 15,000 cycles/step, frequency 20 Hz) until failure detection (radial crack) by transillumination. The fatigue failure load (FFL), number of cycles until failure (CFF), and survival rate in each testing step were recorded. The RC group presented a higher FFL, CFF and survival rate compared to the other groups (p < 0.001), which were statistically equal to each other (p > 0.05). Weibull analysis detected no difference between groups for the Weibull module. Therefore, loss of adhesion between the evaluated substrates induces a significant reduction in load-bearing capacity under fatigue of the lithium disilicate crowns, strengthening the strong-importance of long-lasting adhesion for crown's survival. In addition, different methods for the simulation of non-adhesive conditions induce the same performance in the explored outcomes, confirming that both are valid approaches for laboratory studies.

Wear and marginal quality of aesthetic crowns for primary molars

BACKGROUND

Due to limited aesthetics of stainless-steel crowns, the demand for tooth-coloured crowns has recently risen. Few studies have investigated the marginal integrity and wear behaviour of tooth-coloured primary molar crowns under subcritical load in vitro.

AIM

This in vitro study evaluated the marginal quality and wear of newly introduced resin composite and hybrid ceramic crowns compared with metal and zirconia crowns.

DESIGN

Metal, resin composite, hybrid ceramic (CAD/CAM), and various zirconia crowns were investigated. After thermomechanical loading (2,500 thermocycles/100,000 × 50N), marginal quality of luting gaps and wear of crowns/antagonists were evaluated using replicas under a light or 3D laser scanning microscope. Results were analysed with the Mann-Whitney U test or one-way ANOVA (p < .05).

RESULTS

Marginal quality of the new resin composite and hybrid ceramic crowns performed well in comparison with SSC and zirconia crowns. Adhesive bonding of crowns resulted in superior marginal seal compared with conventional GIC (Mann-Whitney U test, p < .05). Regarding wear, zirconia crowns exhibited significantly worse results than resin composite or hybrid ceramic crowns and SSCs (ANOVA, p < 0.05).

CONCLUSION

The new resin composite and hybrid ceramic crown exhibited good performance in comparison with SSCs and zirconia crowns considering both wear and marginal quality after subcritical loading.

Assessment of internal fit and micro leakage of conventionally fabricated ceramometallic restoration versus CAD wax and press veneering (in-vitro study)

Statement of problem

Accuracy of internal fit and microleakage for CAD-CAM systems used in metal coping fabrication and veneered with layering or pressing porcelain in ceramometallic restoration is unclear.

Material and methods

A master metal die was milled to resemble the right mandibular first molar preparation for coverage with ceramometallic restoration. Master die was duplicated to twenty-four resin specimen dies.They were divided into two groups according to metal coping construction technique using either conventional (C) or CAD (D) wax. Each group was subdivided into two subgroups (n = 6) according to the technique of porcelain veneering (layered or pressed) to fabricate ceramometallic restorations, where subgroup (CL, DL) were conventionally layered by porcelain and (CP, DP) were press veneered. A standardized thickness of metal and porcelain was performed in all specimens as per manufacturer’s instructions for techniques ceramometallic restoration construction.

Evaluation of internal fit was done with silicone replica technique using stereomicroscope at ×24 magnification where the thickness of silicon layer was measured at 20 reference points on each specimen. Then specimens were subjected to thermocycling. Sectioned specimens were assessed for microleakage using a stereomicroscope at ×12 magnification along die-cement interface with a five scale score.

Results

Mean internal gap values of veneering showed a statistically nonsignificant difference between specimens made with layering(L) and pressing(P). Different techniques of wax construction showed a non-significant difference in internal gap values between specimens made with conventional(C) and CAD(D) waxing. However, a significant difference was found in the internal gap at different sites. The highest internal gap was found at the occlusal surface, while the lowest gap was found at the finish line. The highest mean microleakage score was found with CAD wax and press veneering, while the lowest mean microleakage score was found with conventional wax and press veneering.

Conclusion

Both construction techniques of ceramometallic restoration were considered reliable in restoration production within a clinically acceptable range regarding internal fit and microleakage. There is a strong positive correlation between internal fit and microleakage of ceramometallic restoration constructed.

Comparative evaluation of microleakage of metallic copings luted with three different commercially available luting cements: An in vitro study

Aim

To evaluate the microleakage of metallic copings luted with three different commercially available luting cements.

Setting and Design

Comparative evaluation in vitro study.

Materials and Methods

Thirty replicas of abutment analog were milled and divided into 3 groups. Nickel chromium copings were fabricated; marginal gap was evaluated with optical microscope and luted with Zinc Oxide Non Eugenol cement, Zinc Polycarboxylate cement and Zinc Phosphate cement. After Thermocycling, cemented specimens were placed into 0.5% aqueous solution of basic fuchsin solution for 24 hours for dye penetration. Copings were longitudinally sectioned and microleakage scores were evaluated.

Statistical Analysis Used

Kruskal-Wallis analysis of variance (ANOVA) followed by Chi-Square test. Pairwise comparison of groups with Mann Whitney U test.

Result

Mean microleakage score was least for Zinc Phosphate cement (1.075 ± 0.85) followed by Zinc Polycarboxylate cement (1.80± 0.23) and most for Zinc Oxide Non Eugenol (2.1± 0.37). The results of the study were statistically significant, P < 0.05.

Conclusions

Within the limitations of the study, it was found that all cements exhibited certain amount of microleakage. Zinc Phosphate cement exhibited a mean microleakage score that was significantly lower than Zinc Oxide Non Eugenol cement and Zinc Polycarboxylate cement. When microleakage scores of Zinc Oxide Non Eugenol cement and Zinc Polycarboxylate cement were compared, the difference was found to be insignificant indicating that microleakage in these cements is similar.

Evaluation of marginal and internal fit of lithium disilicate CAD-CAM crowns with different finish lines by using a micro-CT technique

STATEMENT OF PROBLEM

Whether the precision of fit of computer-aided design and computer-aided manufacturing (CAD-CAM) complete crowns is affected by the finish line configuration is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the marginal and internal fit of CAD-CAM ceramic crowns made from lithium disilicate based on 3 different finish lines (rounded shoulder, chamfer, feather-edge).

MATERIALS AND METHODS

Thirty anterior lithium disilicate complete crowns (n=10 per finish line group) were fabricated by following a completely digital workflow based on digital scans made with the TRIOS scanner. The crowns were adhesively cemented on duplicate dies of the respective prepared Typodont teeth, and the marginal gap, absolute marginal discrepancy, and internal gap were evaluated by using microcomputed tomography (μCT). A total of 66 values were obtained for each specimen from sagittal and transaxial sections, and a rendering software program was used to calculate the volume of the cement gap for each specimen by means of 3D region growing. Two-way ANOVA, Tukey post hoc tests with Bonferroni correction, and the Kruskal-Wallis test were used to compare the values between the experimental groups (α=.05).

RESULTS

Marginal gap and absolute marginal discrepancy values were statistically significantly different between groups. In ascending order, marginal gap values were 23 ±14 μm for rounded shoulder, 54 ±28 μm for chamfer, and 96 ±36 μm for feather-edge finish lines. Absolute marginal discrepancy values were 96 ±34 μm for rounded shoulder, 124 ±37 μm for chamfer, and 157 ±34 μm for feather-edge finish lines. Internal gap values were 111 ±14 μm for feather-edge, 136 ±22 μm for chamfer, and 168 ±25 μm for rounded shoulder finish lines. The differences in cement volume between groups were not statistically significant (P=.200).

CONCLUSIONS

All 3 finish lines produced marginal gaps within the range of clinically accep table values. Lithium disilicate CAD crowns with a rounded shoulder finish line had the best marginal fit but the poorest internal fit, and lithium disilicate CAD crowns with a feather-edge finish line had the best internal fit but the poorest marginal fit.

[Comparison of the film thickness of composites of different degrees of viscosity]

The measurement of the film thickness of the composite cement Variolink Esthetic («Ivoclar-Vivadent», Liechtenstein) and the microhybrid composite Enamel («Micerium», Italy) was carried out according to ISO 4049: 2009 standards with a load force of 5 kg. While reducing the load force to 5 kg, all materials showed an increase in the film thickness; the film thickness of the Variolink Esthetic composite cement was changed from 23 microns (at 15 kg) to 32 microns (at 5 kg), and the film thickness of the microhybrid composite film Enamel was changed from 39 microns (at 15 kg) to 102 microns (at 5 kg). After preheating, the film thickness was changed from 23 microns (at 15 kg) to 44 microns (at 5 kg).

Pulp/Dentin Regeneration: It Should Be Complicated

Stem cell-mediated regenerative endodontics has reached the human clinical trial phase; however, many issues still exist that prevent such technology to be a widely used clinical practice. These issues are not straightforward and are complicated. They should be because pulp regeneration is dealing with a small dead-end space. In addition, when regeneration is needed, the space is often heavily infected. The true standard of pulp regeneration should be everything except generation of some fibrous connective tissue and amorphous mineral deposit. As of now, we are still far short of reaching the standard of complete vascularized and innervated pulp regeneration with newly formed tubular dentin in all types of teeth. Thus, we need to go back to the bench and use established animal models or create new animal models to tackle those issues. This article will address several key issues including the possibility of pulp regeneration in small canals of molar teeth by enhancing the neovascularization, and whether the organized tubular dentin can be generated on the canal walls. Data from our semi-orthotopic tooth fragment mouse model have shown that complete pulp regeneration using dental pulp stem cells (DPSCs) in small canal has been inconsistent because of limited blood supply. This inconsistency is similar in our orthotopic miniature swine model, although in some cases vascularized pulp-like tissue can be formed throughout the canal space after DPSC transplantation. Furthermore, no tubular dentin was observed in the orthotopic pulp regeneration, despite the fact that DPSCs have the capacity to generate some tubular dentin-like structure in the hydroxyapatite/tricalcium phosphate-mediated ectopic pulp/dentin formation model in mice. Potential strategies to be tested to address these regeneration issues are discussed herein.

Evaluation of the Bond Strength and Marginal Seal of Indirect Restorations of Composites Bonded with Preheating Resin

Objective  Preheated resins (PR) are considered a cementing agent option for indirect adhesive restorations of composite inlays and onlays. The objective of this in vitro study was to evaluate the marginal sealing, adhesive interface, and microtensile bond strength of indirect adhesive restorations of composites in terms of dentin cemented with PR.

Materials and Methods  Standardized Class II preparations were performed on 30 extracted human premolars, impressions were taken, and indirect composite restorations were manufactured. In total, 15 restorations were cemented with PR (ENA HRi, SYNCA), and 15 restorations were cemented with self-adhesive resinous cement (RC) (Relyx U200, 3M ESPE), followed by a thermocycling regime. After that, these were segmented sagittally and longitudinally to evaluate the marginal sealing and the adhesive interface with scanning electron microscopy and confocal microscopy. Microtensile bond strength was assessed with a mechanical device (TA. XT Plus C, Stable Micro System).

Statistical analysis  Statistical analysis was conducted using the two-sample Student’s t -test.

Results  The results showed that there is no statistically significant difference in the degree of microfiltration using PR or RC; however, microtensile bond strength is greater when the restoration is cemented with RC (278.75 N/cm ³ ) than with PR (144.49 N/cm ³ ), and better adjustment and sealing were observed for composite restorations with PR.

Conclusion  PR comprise an alternative cementing agent for indirect composite restorations in Class II cavities in premolars.

Polymeric scaffolds for dental pulp tissue engineering: A review

OBJECTIVES

The purpose of this review is to describe recent developments in pulp tissue engineering using scaffolds and/or stem cells. It is crucial to understand how this approach can revitalize damaged dentin-pulp tissue. Widespread scaffold materials, both natural and synthetic, and their fabrication methods, and stem-progenitor cells with the potential of pulp regeneration will be discussed.

DATA AND SOURCES

A review of literature was conducted through online databases, including MEDLINE by using the PubMed search engine, Scopus, and the Cochrane Library.

STUDY SELECTION

Studies were selected based on relevance, with a preference given to recent research, particularly from the past decade.

CONCLUSIONS

The use of biomaterial scaffolds and stem cells can be safe and potent for the regeneration of pulp tissue and re-establishment of tooth vitality. Natural and synthetic polymers have distinct advantages and limitations and in vitro and in vivo testing have produced positive results for cell attachment, proliferation, and angiogenesis. The type of biomaterial used for scaffold fabrication also facilitates stem cell differentiation into odontoblasts and the resulting biochemistry of tissue repair for each polymer and cell type was discussed. Multiple methods of scaffold design exist for pulp tissue engineering, which demonstrates the variability in tissue engineering applications in endodontics. This review explains the potential of evidence-based tissue engineering strategies and outcomes in pulp regeneration.

The effect of adhesive failure and defects on the stress distribution in all-ceramic crowns

OBJECTIVES

To explore the effect of adhesive failure and defects between the crown and cement on the stress distribution within all-ceramic crowns and the corresponding risk of failure.

METHODS

An IPS e.max crown of lithium disilicate produced by CAD/CAM for a first mandibular molar was modeled using finite element analysis based on X-ray micro-CT scanned images. Predefined debonding states and interfacial defects between the crown and cement were simulated using the model. The first principal stress distribution of the crown and cement was analyzed under a vertical occlusal load of 600 N. A concept of failure risk was proposed to evaluate the crown.

RESULTS

Stress concentrations in the crown were identified on the occlusal surface surrounding the region of loading, beneath the area of loading and at the margin of the interior surface. Stress concentrations in the cement were also evident at the boundary of the debonded areas. The lower surface of the crown is safe to sustain the 600 N vertical load, but the top surface of the cement would undergo cohesive failure. According to the evaluation of failure risk of the crown, the conditions of highest risk corresponded to the conditions with highest percentage of cement damage. The risk of failure is not only associated with debonding between the crown and cement, but also associated with its distribution.

CONCLUSIONS

Debonding related defects and cementing defects are more deleterious to the interfacial stress than debonding itself. The axial wall plays a critical role in maintaining the principal tensile stress of the crown at an acceptable level.

Marginal adaptation of lithium disilicate ceramic crowns cemented with three different resin cements

OBJECTIVES

The cementation process and cementation materials have an influence on the marginal adaptation of restorations. The gap could be affected by thermal and mechanical loading (TCML). The computerized x-ray microtomography (μCT) method offers the possibility of measuring the marginal gap without destruction of the restoration. The aim of this study was to evaluate the marginal gap (MG) and the absolute marginal discrepancy (AMD) before and after TCML.

MATERIALS AND METHODS

Thirty-nine human premolars were prepared for full ceramic crowns made of lithium disilicate. The crowns were cemented by three different resins-Panavia F 2.0, Variolink II, and Relyx Unicem. The MG and AMD were evaluated by μCT before and after TCML.

RESULTS

Panavia F 2.0 had the lowest MG (before 118 μm-after TMCL 124 μm) and AMD (before 145 μm-after TMCL 154 μm), followed by Relyx Unicem (MG: before 164 μm-after TCML 155 μm; AMD: before 213 μm-after TMCL 209 μm) and Variolink II (MG: before 317 μm-after TMCL 320 μm; AMD: before 412 μm-after TMCL 406 μm). The differences were statistically significant before and after TCML. Rather than TCML, it appeared the resin cement was responsible for differences between the MG and AMD before and after TCML.

CONCLUSIONS

μCT is an accurate technique for assessing cemented restorations. Panavia F 2.0 has the lowest MG and AMD before and after TCML.

CLINICAL RELEVANCE

The resin material that features a three-step protocol (Variolink II) produced higher MG and AMG values than the Panavia or Relyx Unicem varieties with less or no intermediate steps at all.

Coronal Microleakage of Teeth Restored with Cast Posts and Cores Cemented with Four Different Luting Agents after Thermocycling

PURPOSE

The apical seal provided by a root canal filling may be breached via coronal leakage. This study aimed to compare the teeth restored with custom-made cast metal posts and cores cemented with different luting agents in terms of coronal microleakage after thermocycling.

MATERIALS AND METHODS

This in vitro study was conducted on 32 extracted single-canal teeth. Root canals were prepared by step-back technique and filled with gutta percha and sealer. The coronal 7 mm of gutta percha was removed, and post space was prepared using peeso reamers #2 and #3 consecutively. After fabricating the acrylic resin patterns of the posts and cores, they were cast using Ni-Cr metal alloy. The specimens were divided into 4 groups in which the castings were cemented using one of the following luting agents: zinc phosphate (ZP), glass ionomer (GI), Panavia F 2.0, and Speed CEM. After cementation, the teeth were immersed in distilled water and incubated for 7 days. Then, the teeth were subjected to thermocycling, immersed in silver nitrate for 6 hours, and finally sectioned. The degree of dye penetration into the coronal part of the specimens was measured using a stereomicroscope. Data were analyzed using Kruskal-Wallis and Mann-Whitey U tests with significance level of 0.05.

RESULTS

The median microleakage in ZP, Speed CEM, GI, and Panavia were 171.89, 114.76, 26.51, and 20.02 μm, respectively. Pairwise comparisons among GI and ZP, GI, and Speed CEM, ZP and Panavia, ZP and Speed CEM, and Panavia and Speed CEM groups yielded significant differences (p < 0.05).

CONCLUSION

Complete coronal seal was not achieved with any of the luting agents. The highest and the lowest degree of microleakage was yielded by ZP and Panavia luting agents, respectively.

Calcium phosphate precipitation in experimental gaps between fluoride-containing fast-setting calcium silicate cement and dentin

A novel fast-setting calcium silicate cement containing fluoride (novel-CSC) has been developed for applications in tooth crowns. The aim of this study was to assess the ability of the novel-CSC to close the experimental gaps at the dentin-cement interface. The novel-CSC was tested against Vitrebond and GC Fuji II LC. Experimental gaps of 50 or 300 μm width were created between the materials and dentin. Specimens with the 300-μm-wide gap were immersed in phosphate-buffered saline and the closed gap area was measured during 96 h. All specimens with 50 or 300 μm gap width were analyzed by scanning electron microscopy equipped with energy dispersive X-ray spectroscopy (SEM/EDX) to assess the morphology and chemical composition of the precipitates after 96 h immersion in phosphate-buffered saline. High-resolution micro-computed tomography (μCT) was used to evaluate the integrity and continuity of the precipitiates after 96 h and 180 d. In all novel-CSC samples, precipitates closed the gap area completely after 96 h. The SEM/EDX revealed that the globular precipitates closing the gap area were mainly composed of calcium and phosphorus. After 180 d, μCT indicated thicker precipitates compared with initial precipitates only in the novel-CSC group, whereas no precipitates were observed in resin-modified glass ionomers. Novel-CSC promoted continuous precipitation of calcium phosphate, including apatite, and closed the experimental gaps.

Longevity of metal-ceramic crowns cemented with self-adhesive resin cement: a prospective clinical study

Resin cements are often used for single crown cementation due to their physical properties. Self-adhesive resin cements gained widespread due to their simplified technique compared to regular resin cement. However, there is lacking clinical evidence about the long-term behavior of this material. The aim of this prospective clinical trial was to assess the survival rates of metal-ceramic crowns cemented with self-adhesive resin cement up to six years. One hundred and twenty-nine subjects received 152 metal-ceramic crowns. The cementation procedures were standardized and performed by previously trained operators. The crowns were assessed as to primary outcome (debonding) and FDI criteria. Statistical analysis was performed using Kaplan-Meier statistics and descriptive analysis. Three failures occurred (debonding), resulting in a 97.6% survival rate. FDI criteria assessment resulted in scores 1 and 2 (acceptable clinical evaluation) for all surviving crowns. The use of self-adhesive resin cement is a feasible alternative for metal-ceramic crowns cementation, achieving high and adequate survival rates.

Radiopacity of Composite Luting Cements Using a Digital Technique

PURPOSE

The aim of this in vitro study was to evaluate the radiopacity of 20 common dental composite luting materials using a digital technique.

MATERIALS AND METHODS

A 1-mm-thick specimen of each material with a human tooth slice and aluminium step wedge were tested using digital radiographs under four combinations of exposure and voltage. The radiopacity in pixels was determined using computer software. The equivalent thickness of aluminium for each material was then calculated based on the calibration curve.

RESULTS

All tested materials except one had higher radiopacity than dentin (p > α; α  =  0.01), and 80% of the materials had radiopacity above enamel value (p > α; α  =  0.01). Moreover, 40% of tested materials had radiopacity of three times above the minimal International Organization for Standardization (ISO) values for composite luting cements. At all exposure values, the highest radiopacity was for Solocem and Multilink groups of materials, at three to six times above dentin radiopacity. Only Variolink Veneer showed radiopacity below dentin and enamel.

CONCLUSIONS

Composite luting materials should have radiopacity above ISO values or greater than the dentin or enamel equivalent. The highest radiopacity values were for the Solocem and Multilink family composite luting cements. Clinicians should choose materials with high radiopacity values, and manufacturers should be aware of the radiopacity values when introducing materials on the market.

Correlation between Microleakage and Absolute Marginal Discrepancy in Zirconia Crowns Cemented with Four Resin Luting Cements: An In Vitro Study

Objectives. To evaluate microleakage and absolute marginal discrepancy (AMD) and to assess correlation between AMD and microleakage with four resin luting cements. Material and Methods. 20 extracted human third molars were prepared for full-coverage crowns. 20 zirconia copings were made (LAVA, 3M ESPE) and cemented. Specimens were randomly allocated for each used type of cement into 4 groups, RelyX® (Rx), Multilink® (Mk), PANAVIA 2.1® (P), and Maxcem® (Mx) and immersed in 10% safranin for 72 hours. 20x magnification lenses were used to observe microleakage areas (μm²) and images software was used to measure AMD areas (μm). Discrepancy and microleakage between the cements were compared with one-way ANOVA test with confidence interval of 95%. Results. Rx Group showed microleakage has lowest value and AMD has highest value. P Group showed microleakage has the highest value and Mk Group presented AMD has lowest value. There were no significative differences between the cements. There were no linear correlations between microleakage and AMD; however a complex regression statistical model obtained allowed formulating an association between both variables (microleakage = AMD^0,896). Conclusions. No significative differences were found among 4 types of cements. No linear correlations between AMD and microleakage were found. Clinical Significance. AMD is not easily related to microleakage. Characteristics of cements are fundamental to decreasing of microleakage values.

Microleakage of Glass Ionomer-based Provisional Cement in CAD/CAM-Fabricated Interim Crowns: An in vitro Study

AIM

The aim of this study was to compare in vitro the marginal microleakage of glass ionomer-based provisional cement with resin-based provisional cement and zinc oxide non-eugenol (ZONE) provisional cement in computer-aided design and computer-aided manufacturing (CAD/CAM)-fabricated interim restorations.

MATERIALS AND METHODS

Fifteen intact human premolars were prepared in a standardized manner for complete coverage of crown restorations. Interim crowns for the prepared teeth were then fabricated using CAD/CAM, and the specimens were randomized into three groups of provisional cementing agents (n = 5 each): Glass ionomer-based provisional cement (GC Fuji TEMP LT™), bisphenol-A-glycidyldimethacrylate (Bis-GMA)/ triethylene glycol dimethacrylate (TEGDMA) resin-based cement (UltraTemp® REZ), and ZONE cement (TempBond NE). After 24 hours of storage in distilled water at 37°C, the specimens were thermocycled and then stored again for 24 hours in distilled water at room temperature. Next, the specimens were placed in freshly prepared 2% aqueous methylene blue dye for 24 hours and then embedded in autopolymerizing acrylic resin blocks and sectioned in buccolingual and mesiodistal directions to assess dye penetration using a stereomicroscope. The results were statistically analyzed using a nonparametric Kruskal-Wallis test. Dunn's post hoc test with a Bonferroni correction test was used to compute multiple pairwise comparisons that identified differences among groups; the level of significance was set at p < 0.05.

RESULTS

All groups exhibited marginal microleakage; the Bis-GMA/TEGDMA resin-based provisional cement demonstrated the lowest microleakage scores, which were statistically different from those of the glass ionomer-based provisional cement and the ZONE cement.

CONCLUSION

The provisional cementing agents exhibited different sealing abilities. The Bis-GMA/TEGDMA resin-based provisional cement exhibited the most effective favorable sealing properties against dye penetration compared with the glass ionomer-based provisional cement and conventional ZONE cement.

CLINICAL SIGNIFICANCE

Newly introduced glass ionomer-based provisional cement proved to be inferior to resin-based provisional cement as far as marginal microleakage is concerned.

Comparative evaluation of marginal leakage of provisional crowns cemented with different temporary luting cements: In vitro study

BACKGROUND OR STATEMENT OF PROBLEM

As, the longevity of provisional restorations is related to, a perfect adaptation and a strong, long-term union between restoration and teeth structures, therefore, evaluation of marginal leakage of provisional restorative materials luted with cements using the standardized procedures is essential.

AIMS AND OBJECTIVES

To compare the marginal leakage of the provisional crowns fabricated from Autopolymerizing acrylic resin crowns and bisphenol A-glycidyl dimethacrylate (BIS-GMA) resin crowns. To compare the marginal leakage of the provisional crowns fabricated from autopolymerizing acrylic resin crowns and BIS-GMA resin crowns cemented with different temporary luting cements. To compare the marginal leakage of the provisional crowns fabricated from autopolymerizing acrylic resin (SC-10) crowns cemented with different temporary luting cements. To compare the marginal leakage of the provisional crowns fabricated from BIS-GMA resin crowns (Protemp 4) cemented with different temporary luting cements.

METHODOLOGY

Freshly extracted 60 maxillary premolars of approximately similar dimensions were mounted in dental plaster. Tooth reduction with shoulder margin was planned to use a customized handpiece-holding jig. Provisional crowns were prepared using the wax pattern fabricated from computer aided designing/computer aided manufacturing milling machine following the tooth preparation. Sixty provisional crowns were made, thirty each of SC-10 and Protemp 4 and were then cemented with three different luting cements. Specimens were thermocycled, submerged in a 2% methylene blue solution, then sectioned and observed under a stereomicroscope for the evaluation of marginal microleakage. A five-level scale was used to score dye penetration in the tooth/cement interface and the results of this study was analyzed using the Chi-square test, Mann-Whitney U-test, Kruskal-Wallis H-test and the results were statistically significant P < 0.05 the power of study - 80%.

RESULTS

Marginal leakage was significant in both provisional crowns cemented with three different luting cements along the axial walls of teeth (P < 0.05) confidence interval - 95%.

CONCLUSION

The temporary cements with eugenol showed more microleakage than those without eugenol. SC-10 crowns showed more microleakage compared to Protemp 4 crowns. SC-10 crowns cemented with Kalzinol showed maximum microleakage and Protemp 4 crowns cemented with HY bond showed least microleakage.

Advances in regeneration of dental pulp--a literature review

This review summarizes the biological response of dentin-pulp complexes to a variety of stimuli and responses to current treatment therapies and reviews the role of tissue engineering and its application in regenerative endodontics. An electronic search was undertaken based on keywords using Medline/PubMed, Embase, Web of Science and Ovid database resources up to March 2012 to identify appropriate articles, supplemented by a manual search using reference lists from relevant articles. Inclusion criteria were mainly based on different combinations of keywords and restricted to articles published in English language only. Biological approaches based on tissue engineering principles were found to offer the possibility of restoring natural tooth vitality, with distinct evidence that regeneration of lost dental tissues is possible. Studies to formulate an ideal restorative material with regenerative properties, however, are still under way. Further research with supporting clinical studies is required to identify the most effective and safe treatment therapy.

Effects of curing mode and moisture on nanoindentation mechanical properties and bonding of a self-adhesive resin cement to pulp chamber floor

OBJECTIVE

This study aimed to investigate the effect of dentin surface moisture and curing mode on microtensile bond strength (MTBS) and nanoindentation characteristics of a self-adhesive resin cement.

METHODS

Forty-four extracted human molars were distributed into four groups according to dentin surface moisture (dry or wet) and curing mode of the resin cement (light or chemical). Clearfil SA Cement (Kuraray Noritake Dental, Japan) was used for cementation of composite cores to the pulp chamber dentin. The specimens were sectioned into beams for MTBS test at the pulpal floor. Nanoindentation hardness and creep of the cement layer were measured under 100 mN load with 30s hold segment. Data were statistically analyzed using two-way ANOVA and Weibull distribution of MTBS (α=0.05).

RESULTS

Moisture, curing mode or their interaction did not significantly affect mean MTBS values that ranged 17.6-22.6 MPa (p>0.05); however, the lowest characteristic strength was found in moist chemically cured group. Hardness ranged 437-512 MPa, and was not affected by the experimental factors (p>0.05). Nanoindentation creep ranged 9.3-10.9% with the chemically cured groups showing the highest values, indicating lower cross-linking and deformation resistance of their polymer network.

SIGNIFICANCE

Additional moisture on dentin surface did not contribute to adhesion of the anhydrous self-adhesive resin cement to dentin. Light-curing, despite attenuation through the composite core, was beneficial and improved nanoindentation creep resistance of the cement. The difference was not, however, reflected in the mean bond strength or hardness values.

Sealing properties of three luting agents used for complete cast crowns: a bacterial leakage study

OBJECTIVE

To assess the sealing properties of three different luting materials used for cementation of full cast crowns on extracted human premolars.

METHODS

Thirty noncarious human premolars were prepared in a standardized fashion for full cast crown restorations. All margins were placed in dentin. After impressions of the preparations, stone dies were fabricated on which copings were waxed, which were cast in type III alloy using standardized laboratory methods. Teeth were randomly assigned to three groups of 10 samples each (n=10), for which the following cements were used: 1) a resin-modified glass ionomer cement, Rely X Luting Plus (3M ESPE, St Paul, MN, USA); 2) a self-adhesive resin cement, Maxcem Elite (Kerr Corporation, Orange, CA, USA); and 3) a glass ionomer cement, Ketac Cem (3M ESPE), the latter used as control. After cementation the samples were allowed to bench-set for 10 minutes, stored in water at 37°C, subjected to thermal cycling (2000×, between 5°C and 55°C, dwell time 35 seconds), and then stored in sterile phosphate buffer for seven days at 37°C. Subsequently, the occlusal surface was carefully reduced until the dentin was exposed. Finishing on wet sand paper removed the gold flash caused by grinding. After sterilization, the specimens were subjected to bacterial microleakage in a dual chamber apparatus for 60 days. Bacterial leakage was checked daily. Data were analyzed using the Kaplan-Meier survival test. Significant pairwise differences were analyzed using the log-rank test followed by Fisher exact test at a p<0.05 level of significance.

RESULTS

Rely X Luting Plus showed the lowest microleakage scores, which statistically differed significantly from Maxcem Elite and Ketac Cem (p<0.05).

CONCLUSIONS

Rely X Luting Plus cement displayed significantly lower microleakage scores than a self-adhesive resin-based and conventional glass ionomer cement.

The anti-inflammatory effects of matrix metalloproteinase-3 on irreversible pulpitis of mature erupted teeth

Matrix metalloproteinases (MMPs) are involved in extracellular matrix degradation and the modulation of cell behavior. These proteinases have also been implicated in tissue repair and regeneration. Our previous studies have demonstrated that MMP-3 elicits stimulatory effects on the proliferation and the migration of endothelial cells as well as anti-apoptotic effects on these cells in vitro. In addition, we found that MMP-3 enhanced the regeneration of lost pulp tissue in a rat incisor pulp injury model. However, continuously erupting rodent incisors exhibit significantly different pulp organization compared with mature erupted teeth. Therefore, we have further extended these studies using a canine irreversible pulpitis model to investigate the effects of MMP-3. In this study, the crowns of the canine mature premolars were removed and the pulp tissues were amputated. The amputated pulp tissues remained exposed for 24 or 72 hours to induce mild or severe irreversible pulpitis, respectively, followed by sealing of the cavities. In both models, the whole pulp tissues became necrotic by day 14. In this mild pulpitis model, the regeneration of pulp tissue with vasculature and nerves was observed until 14 days after sealing with MMP-3, followed by extracellular matrix formation in the regenerated pulp tissues until day 28. The treatment with MMP-3 resulted in a decrease in the number of macrophage and antigen-presenting cells and a significant inhibition of IL-6 expression on day 3. The inhibition of MMP-3 activity abolished these anti-inflammatory effects. Immunofluorescence staining demonstrated that MMP-3 was involved in the modification of serum-derived hyaluronan-associated proteins and hyaluronan (SHAP-HA) complexes possibly through the degradation of versican. These results demonstrate that MMP-3 can act as an anti-inflammatory agent and suggest that MMP-3 might represent a useful therapy for the treatment of mild irreversible pulpitis.

The Effects of Different Adhesive Agents on the Shear Bond Strength of a Self-Adhesive Resin Cement

Purpose

To compare the clinical success of a self-adhesive resin cement used in combination with different adhesive bonding systems with that of a conventional dual-cure resin cement.

Methods

The study was performed with 136 freshly extracted molars embedded in acrylic resin blocks and 136 IPS e.max Press discs. Teeth and discs were randomly divided into four equal groups and cemented together using either RelyX ARC (ARC), RelyX Unicem (Unicem), RelyX Unicem+Adper-Prompt L-pop (L-pop), or RelyX and Unicem+Total-etch (Total-etch). Shear bond strength measurements were obtained before and after thermocycling. Following bond testing, the surfaces of one sample per subgroup (thermocycled and non-thermocycled), were assessed using scanning electron microscopy (SEM).

Results

Among the non-thermocylced subgroups, ARC exhibited the highest bond strength values, followed by Total Etch, Unicem and L-pop. ARC also exhibited the highest bond strength values among the thermocycled subgroups, followed by Unicem, Total-etch, and L-pop. SEM analysis clearly revealed the negative effects of thermo-cycling on the mechanical properties of adhesive agents.

Conclusions

RelyX Unicem may be preferable in many cases because of its simplified application and reduced technique-sensitivity.

Fiber post placement with core build-up materials or resin cements-an evaluation of different adhesive approaches

OBJECTIVE

To compare push-out bond strength of fiber-posts luted with different adhesive approaches to root canal dentin.

MATERIALS AND METHODS

Forty maxillary first incisors were decoronated and endodontically treated. Specimens were randomly distributed into five groups (n = 8) and fiber-posts (DentinPost coated, Komet) were inserted using five different luting materials: etch-and-rinse adhesive systems and corresponding core-and-post material in groups 1 (DentinBond/DentinBuild, Komet) and 2 (XP Bond + SCA/Core-X flow, Densply), self-adhesive resin cements in groups 3 (RelyX Unicem, 3M Espe) and 4 (SmartCem 2, Dentsply) and a self-etch adhesive/resin cement in group 5 (ED-Primer II/Panavia F 2.0, Kuraray). The roots were sectioned into eight 1 mm thick serial slices and within 48 h push-out bond strength was investigated. Statistical analyses were performed using non-parametrical Kruskal-Wallis H-test and Mann-Whitney U-test for differences between experimental groups at p < 0.05. The failure modes were analyzed using Chi square test.

RESULTS

The bond strength [MPa] (mean/min-max) for groups 3 (12.35/3.60-32.44), 4 (13.52/4.48-30.69) and 2 (11.15/5.23-35.58) were significantly higher (p < 0.001) compared to groups 1 (6.66/2.34-24.89) and 5 (7.41/0.28-34.18). Adhesive failure between dentin and luting agent was the most frequent failure mode.

CONCLUSIONS

Bond strength of fiber-posts adhesively luted to root canal dentin was significantly higher when self-adhesive resin cements were used. One (group 2) of the tested core-and-post materials/etch-and-rinse adhesive achieved comparable bond strength values.

Microleakage of IPS Empress 2 Inlay Restorations Luted With Self-adhesive Resin Cements

Objective

To assess the microleakage of three self-adhesive and one etch-and-rinse resin cements when luting IPS Empress 2 (Ivoclar Vivadent, Liechtenstein) all-ceramic inlay restorations to the prepared cavities in extracted human molars.

Methods

The cylindrical Class V cavities were prepared on the buccal surfaces of 40 extracted human third molars using diamond burs. The IPS Empress 2 ceramic inlays were placed with Multilink Sprint (Ivoclar Vivadent), RelyX Unicem (3M ESPE, USA), G-Cem (GC, Japan), or Variolink II (Ivoclar Vivadent) as the control group. After storage in distilled water at 37°C for 24 hours, samples were subjected to 1000 thermal cycles between baths of 5°C and 55°C, with a dwell time of 30 seconds. The microleakage scores were examined on the occlusal and gingival margins at 30× magnification after each sample was stained with 0.5% basic fuchsin and sectioned into three parts using a thin diamond blade (Isomet, Buehler, USA) (n=40). The extent of microleakage on both occlusal and gingival margins of the restorations was scored and recorded. The microleakage data were analyzed using Kruskall-Wallis and Mann-Whitney U-tests.

Results

Statistically significant differences were observed between the groups in both margins according to the Kruskall-Wallis and Mann-Whitney U-tests (p&lt;0.05). Microleakage scores on the occlusal margins were Variolink II &lt; RelyX Unicem &lt; G-Cem = Multilink Sprint. Microleakage scores on the gingival margins are Variolink II = RelyX Unicem &lt; G-Cem &lt; Multilink Sprint.

Conclusion

Self-adhesive resin cements displayed higher microleakage scores on the occlusal margins, whereas on the gingival margins RelyX Unicem showed comparable microleakage results with the control samples.

Microleakage and Marginal Gap of Adhesive Cements for Noble Alloy Full Cast Crowns

Very limited comparative information about the microleakage in noble alloy full cast crowns luted with different types of adhesive resin cements is available. The purpose of this study was to evaluate the microleakage and marginal gap of two self-adhesive resin cements with that of other types of adhesive luting cements for noble alloy full cast crowns. Fifty noncarious human premolars and molars were prepared in a standardized manner for full cast crown restorations. Crowns were made from a noble alloy using a standardized technique and randomly cemented with five cementing agents as follows: 1) GC Fuji Plus resin-modified glass ionomer cement, 2) Panavia F 2.0 resin cement, 3) Multilink Sprint self-adhesive resin cement, 4), Rely X Unicem self-adhesive resin cement with pretreatment, and 5) Rely X Unicem with no pretreatment. The specimens were stored in distilled water at 37°C for two weeks and then subjected to thermocycling. They were then placed in a silver nitrate solution, vertically cut in a mesiodistal direction and evaluated for microleakage and marginal gap using a stereomicroscope. Data were analyzed using a nonparametric Kruskal-Wallis test followed by Dunn multiple range test at a p&lt;0.05 level of significance. The Rely X Unicem (with or with no pretreatment) exhibited the smallest degree of microleakage at both tooth-cement and cement-crown interfaces. The greatest amount of microleakage was found for Panavia F 2.0 resin cement followed by GC Fuji Plus at both interfaces. No statistically significant difference in the marginal gap values was found between the cementing agents evaluated (p&gt;0.05). The self-adhesive resin cements provided a much better marginal seal for the noble alloy full cast crowns compared with the resin-modified glass ionomer or dual-cured resin-based cements.

Effect of resin coating and occlusal loading on microleakage of Class II computer-aided design/computer-aided manufacturing fabricated ceramic restorations: a confocal microscopic study

OBJECTIVE

To evaluate the effect of resin coating and occlusal loading on microleakage of class II computer-aided design/computer-aided manufacturing (CAD/CAM) ceramic restorations.

MATERIAL AND METHODS

Molars were prepared for an mesio-occlusal-distal (MOD) inlay and were divided into two groups: non-coated (controls); and resin-coated, in which the cavity was coated with a combination of a dentin bonding system (Clearfil Protect Bond) and a flowable resin composite (Clearfil Majesty Flow). Ceramic inlays were fabricated using the CAD/CAM technique (CEREC 3) and cemented with resin cement (Clearfil Esthetic Cement). After 24 h of water storage, the restored teeth in each group were divided into two subgroups: unloaded or loaded with an axial force of 80 N at a rate of 2.5 cycles/s for 250,000 cycles while stored in water. After immersion in 0.25% Rhodamine B solution, the teeth were sectioned bucco-lingually at the mesial and distal boxes. Tandem scanning confocal microscopy (TSM) was used for evaluation of microleakage. The locations of the measurements were assigned to the cavity walls and floor.

RESULTS

Loading did not have a significant effect on microleakage in either the resin-coated or non-coated group. Resin coating significantly reduced microleakage regardless of loading. The cavity floor exhibited greater microleakage compared to the cavity wall. TSM observation also revealed that microleakage at the enamel surface was minimal regardless of resin coating. In contrast, non-coated dentin showed extensive leakage, whereas resin-coated dentin showed decreased leakage.

CONCLUSIONS

Resin coating with a combination of a dentin-bonding system and a flowable resin composite may be indicated prior to impression-taking when restoring teeth with CAD/CAM ceramic inlays in order to reduce microleakage at the tooth-resin interface.

Setting kinetics and shrinkage of self-adhesive resin cements depend on cure-mode and temperature

OBJECTIVE

To investigate the influence of curing mode and temperature on the shrinkage kinetics of self-adhesive resin cements in comparison to a conventional multi-step resin cement.

METHODS

The shrinkage of self-adhesive resin cements Maxcem Elite (MX), Speedcem (SPC), Smartcem2 (SMC), iCem (IC) and RelyX Unicem (RX) and Nexus Third Generation (NX3) as a multi-step resin cement was measured continuously for 1h using the bonded disk method. All materials were tested with dual-curing (dc) and self-curing (sc) mode. All measurements (n=5 per group) were conducted at room temperature (23°C) as well as at body temperature (37°C). Shrinkage time constants were obtained from a simple exponential growth model. Data were statistically analyzed by ANOVA and the p-values were adjusted for multiplicity according to Hothorn et al. (2008) using the R-package "multcomp".

RESULTS

Shrinkages ranged between 1.84 (RX sc23) and 7.09 (IC sc37). The curing-mode changing from sc to dc had the dominant effect for several materials, especially RX, both on final shrinkage and time constant for setting. Temperature increase had an effect on setting and shrinkage for all materials except RX. Final shrinkage for SPC, SMC and NX3 was statistically equivalent (p>0.05).

SIGNIFICANCE

The 3-fold variation in final shrinkage for these materials is significant for clinical material selection. Light curing can lead to a 10-fold increase in the rate of setting. A self-adhesive universal resin cement (RX) had the lowest shrinkage in the groups examined.

Dental pulp and dentin tissue engineering and regeneration: advancement and challenge

Hard tissue is difficult to repair especially dental structures. Tooth enamel is incapable of self-repairing whereas dentin and cementum can regenerate with limited capacity. Enamel and dentin are commonly under the attack by caries. Extensive forms of caries destroy enamel and dentin and can lead to dental pulp infection. Entire pulp amputation followed by the pulp space disinfection and filling with an artificial rubber-like material is employed to treat the infection -- commonly known as root canal or endodontic therapy. Regeneration of dentin relies on having vital pulps; however, regeneration of pulp tissue has been difficult as the tissue is encased in dentin without collateral blood supply except from the root apical end. With the advent of modern tissue engineering concept and the discovery of dental stem cells, regeneration of pulp and dentin has been tested. This article will review the recent endeavor on pulp and dentin tissue engineering and regeneration. The prospective outcomes of current advancements and challenges in this line of research are discussed.

Microleakage of Posterior Composite Restorations Lined with Self-adhesive Resin Cements

Two self-adhesive resin cements resulted in minimal microleakage scores when used as liners in Class II composite restorations.

In vitro evaluation of microleakage of various types of dental cements

Introduction. Microleakage is defined as the clinically undetectable seepage of oral fluids containing bacteria and debris between cement layer and tooth restoration. Objective. This in vitro study investigated the effect of different dental cements (zinc-phosphate, polycarboxylate, glass-ionomer and resin cement) on microleakage in different ceramic crown systems (metal ceramic crown, metal ceramic crown with a porcelain margin, Empress 2 and In Ceram all-ceramic crowns) fixed on extracted human teeth. Methods. One hundred and sixty intact human premolars were randomized to four groups of forty teeth each, according to the different ceramic crown systems. They were prepared in a standardized manner for metal-ceramic and all-ceramic crowns. Crowns were made following a standard laboratory technique, and each group of crowns were divided into four groups according to the different cement agents and cemented on their respective abutments. The specimens were subjected to thermocycling, placed in methylene blue solutions, embedded in resin blocks and vertically cut in the bucco-oral and meso-distal direction. The microleakage in the area of tooth-cement interface was defined as linear penetration of methylene blue and was determined with a microscope to assign microleakage scores using a five-point scale. Results. A significant association was found between a cement type and degree of microleakage (p=0.001). No statistically significant differences were found among the different ceramic crown systems luted with the same dental cement. The smallest degree of microleakage was observed in specimens luted with resin cement (X=1.73), followed by glass-ionomer cement (X=2.45) and polycarboxylate cement (X=3.20). The greatest degree of microleakage was detected in the crowns fixed with zincphosphate cement (X=3.33). Conclusion. The investigated dental cements revealed different sealing abilities. The use of resin cement resulted in the percentage of 0 microleakage scores. Due to this feature, the resin cement is to be recommended in everyday clinical practice.

Pulp and dentin tissue engineering and regeneration: current progress

Dental pulp tissue is vulnerable to infection. Entire pulp amputation followed by pulp-space disinfection and filling with an artificial rubber-like material is employed to treat the infection - commonly known as root-canal therapy. Regeneration of pulp tissue has been difficult as the tissue is encased in dentin without collateral blood supply except from the root apical end. However, with the advent of the concept of modern tissue engineering and the discovery of dental stem cells, regeneration of pulp and dentin has been tested. This article will review the early attempts to regenerate pulp tissue and the current endeavor of pulp and dentin tissue engineering, and regeneration. The prospective outcome of the current advancement in this line of research will be discussed.