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Guo J, Wang P, Li Y, Liu Y, Ye Y, Chen Y, Kankala RK, Tong F. Advances in hybridized nanoarchitectures for improved oro-dental health. J Nanobiotechnology 2024; 22:469. [PMID: 39113060 PMCID: PMC11305065 DOI: 10.1186/s12951-024-02680-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/01/2024] [Indexed: 08/11/2024] Open
Abstract
On a global note, oral health plays a critical role in improving the overall human health. In this vein, dental-related issues with dentin exposure often facilitate the risk of developing various oral-related diseases in gums and teeth. Several oral-based ailments include gums-associated (gingivitis or periodontitis), tooth-based (dental caries, root infection, enamel erosion, and edentulous or total tooth loss), as well as miscellaneous diseases in the buccal or oral cavity (bad breath, mouth sores, and oral cancer). Although established conventional treatment modalities have been available to improve oral health, these therapeutic options suffer from several limitations, such as fail to eradicate bacterial biofilms, deprived regeneration of dental pulp cells, and poor remineralization of teeth, resulting in dental emergencies. To this end, the advent of nanotechnology has resulted in the development of various innovative nanoarchitectured composites from diverse sources. This review presents a comprehensive overview of different nanoarchitectured composites for improving overall oral health. Initially, we emphasize various oral-related diseases, providing detailed pathological circumstances and their effects on human health along with deficiencies of the conventional therapeutic modalities. Further, the importance of various nanostructured components is emphasized, highlighting their predominant actions in solving crucial dental issues, such as anti-bacterial, remineralization, and tissue regeneration abilities. In addition to an emphasis on the synthesis of different nanostructures, various nano-therapeutic solutions from diverse sources are discussed, including natural (plant, animal, and marine)-based components and other synthetic (organic- and inorganic-) architectures, as well as their composites for improving oral health. Finally, we summarize the article with an interesting outlook on overcoming the challenges of translating these innovative platforms to clinics.
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Affiliation(s)
- Jun Guo
- School of Stomatology, Jiangxi Medical College, Nanchang University, Nanchang, 330006, People's Republic of China.
- Jiangxi Province Key Laboratory of Oral Biomedicine, Nanchang, 330006, People's Republic of China.
- Jiangxi Province Clinical Research Center for Oral Diseases, Nanchang, 330006, People's Republic of China.
| | - Pei Wang
- School of Stomatology, Jiangxi Medical College, Nanchang University, Nanchang, 330006, People's Republic of China
- Jiangxi Province Key Laboratory of Oral Biomedicine, Nanchang, 330006, People's Republic of China
- Jiangxi Province Clinical Research Center for Oral Diseases, Nanchang, 330006, People's Republic of China
| | - Yuyao Li
- School of Stomatology, Jiangxi Medical College, Nanchang University, Nanchang, 330006, People's Republic of China
- Jiangxi Province Key Laboratory of Oral Biomedicine, Nanchang, 330006, People's Republic of China
- Jiangxi Province Clinical Research Center for Oral Diseases, Nanchang, 330006, People's Republic of China
| | - Yifan Liu
- School of Stomatology, Jiangxi Medical College, Nanchang University, Nanchang, 330006, People's Republic of China
- Jiangxi Province Key Laboratory of Oral Biomedicine, Nanchang, 330006, People's Republic of China
- Jiangxi Province Clinical Research Center for Oral Diseases, Nanchang, 330006, People's Republic of China
| | - Yingtong Ye
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen, 361021, People's Republic of China
| | - Yi Chen
- School of Stomatology, Jiangxi Medical College, Nanchang University, Nanchang, 330006, People's Republic of China
- Jiangxi Province Key Laboratory of Oral Biomedicine, Nanchang, 330006, People's Republic of China
- Jiangxi Province Clinical Research Center for Oral Diseases, Nanchang, 330006, People's Republic of China
| | - Ranjith Kumar Kankala
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen, 361021, People's Republic of China.
| | - Fei Tong
- School of Stomatology, Jiangxi Medical College, Nanchang University, Nanchang, 330006, People's Republic of China.
- Jiangxi Province Key Laboratory of Oral Biomedicine, Nanchang, 330006, People's Republic of China.
- Jiangxi Province Clinical Research Center for Oral Diseases, Nanchang, 330006, People's Republic of China.
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Rao AC, Venkatesh KV, Nandini V, Sihivahanan D, Alamoudi A, Bahammam HA, Bahammam SA, Zidane B, Bahammam MA, Chohan H, Albar NH, Yadalam PK, Patil S. Evaluating the Effect of Tideglusib-Loaded Bioactive Glass Nanoparticles as a Potential Dentine Regenerative Material. MATERIALS 2022; 15:ma15134567. [PMID: 35806692 PMCID: PMC9267687 DOI: 10.3390/ma15134567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 12/04/2022]
Abstract
Dental pulp treatment is the least intrusive procedure currently available for preserving the vitality of the pulp. Several studies are underway to improve the bioactivity of pulp capping materials. Tideglusib isa potent anti-inflammatory, antioxidant, and a regenerative drug developed against Alzheimer’s disease and has been shown to be effective in the treatment of dental cavities. However, its bioactive properties encapsulated within the nanoparticles as a component of pulp capping material are largely unknown. In this study, tideglusib-loaded bioactive glass nanoparticles were synthesized (tideglusib-BgNPs) and mixed at various concentrations into the calcium silicate cement to testits physiomechanical and bioactivitiescompared with biodentine (control). The calcium silicate cement with 10wgt% tideglusib-BgNPs showed comparable physiomechanical properties to that of biodentine. Additionally, the assessment of cytotoxicity and bioactivity (cell proliferation, wound healing, and cell migration assays) showed increased bioactivity in terms of better wound healing, increased proliferation, and better migration of human dental pulp stem cells than biodentine. These findings suggest new opportunities to use tideglusib-BgNPs in pulp therapy.
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Affiliation(s)
- Akhil C. Rao
- Department of Conservative Dentistry and Endodontics, SRM Dental College and Hospital, Kattankulathur, Kanchipuram, Chennai 603203, India; (A.C.R.); (K.V.V.); (D.S.)
| | - K. Vijay Venkatesh
- Department of Conservative Dentistry and Endodontics, SRM Dental College and Hospital, Kattankulathur, Kanchipuram, Chennai 603203, India; (A.C.R.); (K.V.V.); (D.S.)
| | - Vidyashree Nandini
- Department of Prosthodontics and Implantology, SRM Dental College and Hospital, Kattankulathur, Kanchipuram, Chennai 603203, India;
| | - Dhanasekaran Sihivahanan
- Department of Conservative Dentistry and Endodontics, SRM Dental College and Hospital, Kattankulathur, Kanchipuram, Chennai 603203, India; (A.C.R.); (K.V.V.); (D.S.)
| | - Ahmed Alamoudi
- Oral Biology Department, Faculty of Dentistry, King Abdulaziz University, Jeddah 80209, Saudi Arabia;
| | - Hammam Ahmed Bahammam
- Department of Pediatric Dentistry, College of Dentistry, King Abdulaziz University, Jeddah 80209, Saudi Arabia;
| | - Sarah Ahmed Bahammam
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, Taibah University, Medina 42353, Saudi Arabia; or
| | - Bassam Zidane
- Restorative Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Maha A. Bahammam
- Department of Periodontology, Faculty of Dentistry, King Abdulaziz University, Jeddah 80209, Saudi Arabia;
- Executive Presidency of Academic Affairs, Saudi Commission for Health Specialties, Riyadh 11614, Saudi Arabia
| | - Hitesh Chohan
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (H.C.); (N.H.A.)
| | - Nassreen H. Albar
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (H.C.); (N.H.A.)
| | - Pradeep Kumar Yadalam
- Department of Periodontics, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Saveetha University, Chennai 602117, India;
| | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
- Centre of Molecular Medicine and Diagnostics (COMManD), Saveetha Dental College & Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, India
- Correspondence:
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Local immunomodulatory effects of intracanal medications in apical periodontitis. J Endod 2022; 48:430-456. [PMID: 35032538 DOI: 10.1016/j.joen.2022.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 12/11/2022]
Abstract
The immune system is an extremely complex biological network that plays a crucial role in the hemostasis of periapical tissue, pathogenesis of apical periodontitis (AP) as well as periapical tissue healing. The successful elimination of microbial infections remains a significant challenge, mostly due to the ever-growing development of antimicrobial-resistant pathogens. The bacterial endurance in the root canal system contributes to features ranging from altered post-treatment healing to exacerbation of chronic periradicular immune response, that compromise the outcome of endodontic treatment. A highly effective strategy for combating infectious diseases and the associated inflammation-mediated tissue damage is to modulate the host immune response in conjunction with antimicrobial therapy. There are several medications currently used in endodontic treatment, however, they suffer various levels of microbial resistance and do not deliver all the required characteristics to simultaneously address both intracanal bacteria and periapical inflammation. Interaction of antimicrobial agents with the immune system can impact its function, leading to immune-suppressive or immune-stimulatory effects. The group of non-conventional antimicrobial medications, such as antimicrobial peptides, propolis, and nanomaterials, are agents that provide strong antimicrobial effectiveness and concomitant immunomodulatory and/or reparative effect, without any host tissue damages. Herein, we provide an overview of local immune modulation in AP and a comprehensive review of the immunomodulatory effect of antimicrobials intracanal medications applied in endodontics with specific emphasis on the antimicrobial nanomaterial-based approaches that provide immunomodulatory potential for successful clinical deployment in endodontics.
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Hussein H, Kishen A. Proteomic profiling reveals engineered chitosan nanoparticles mediated cellular crosstalk and immunomodulation for therapeutic application in apical periodontitis. Bioact Mater 2021; 11:77-89. [PMID: 34938914 PMCID: PMC8665264 DOI: 10.1016/j.bioactmat.2021.09.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/22/2021] [Accepted: 09/13/2021] [Indexed: 12/18/2022] Open
Abstract
Macrophages (MQ) are major constituents of chronically inflamed periapical tissues in apical periodontitis. This study aimed to investigate the immunomodulatory effect of engineered bioactive chitosan-based nanoparticles (CSnp) antibiofilm medication on MQ cocultured with periodontal ligament fibroblasts (PdLF). Cells viability, spreading, PdLF migration, and intracellular CSnp uptake were characterized. Tandem Mass Tag-based proteomics was applied to analyze MQ global protein expression profiles after interaction with Enterococcus faecalis biofilm, CSnp-treated biofilm, and CSnp. Secreted inflammatory mediators were analyzed. Following bioinformatics analyses, candidate proteins were validated via targeted proteomics. CSnp maintained cells viability, increased MQ spreading, and PdLF migration (p < 0.05). Transmission electron micrographs demonstrated CSnp internalization via macropinocytosis, clathrin-mediated endocytosis, and phagocytosis. Proteomic analysis revealed that CSnp-treated biofilm upregulated proteins (>1.5-folds, p < 0.05) showed functional enrichment in the pathway of metal sequestration by antimicrobial proteins, while downregulated proteins showed enrichment in ferroptosis. CSnp upregulated proteins exhibiting antioxidant and immunoregulatory properties. Upregulation of SERPINB1 by CSnp (>1.5-folds, p < 0.05) was validated. CSnp-treated biofilm reduced pro-inflammatory IL-1β and nitric oxide but enhanced anti-inflammatory IL-10 and TGF-β1 (p < 0.05). Internalized engineered bioactive CSnp reprogrammed MQ proteomic and cytokine profiles to modulate biofilm-mediated inflammation, and prompted PdLF migration, emphasizing its potential to regulate healing process in the treatment of apical periodontitis. CSnp internalized via macropinocytosis, clathrin-mediated endocytosis, and phagocytosis. Enterococcus faecalis biofilm altered macrophage proteomic profile. Macrophage proteome upon CSnp-treated biofilm interaction was distinct from biofilm. CSnp upregulated proteins with immunoregulatory and antioxidant activities. CSnp reduced proinflammatory but increased anti-inflammatory mediators.
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Affiliation(s)
- Hebatullah Hussein
- The Kishen Lab, Dental Research Institute, University of Toronto, Toronto, ON M5G 1G6, Canada.,Faculty of Dentistry, University of Toronto, Toronto, ON M5G 1G6, Canada.,Faculty of Dentistry, Ain Shams University, Endodontics Department, Cairo, Egypt
| | - Anil Kishen
- The Kishen Lab, Dental Research Institute, University of Toronto, Toronto, ON M5G 1G6, Canada.,Faculty of Dentistry, University of Toronto, Toronto, ON M5G 1G6, Canada.,School of Graduate Studies, University of Toronto, Toronto, ON M5G 1G6, Canada.,Department of Dentistry, Mount Sinai Health System, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
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Wang Z, Shen Y, Haapasalo M. Antimicrobial and Antibiofilm Properties of Bioceramic Materials in Endodontics. MATERIALS (BASEL, SWITZERLAND) 2021; 14:7594. [PMID: 34947188 PMCID: PMC8706218 DOI: 10.3390/ma14247594] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 12/19/2022]
Abstract
Microbes are prevalent in the root canals of necrotic teeth, and they are the cause of primary and post-treatment apical periodontitis. Bacteria can dwell within the infected root canal system as surface-adherent biofilm structures, which exhibit high resistance to antimicrobial agents. Bioceramic materials, with their biocompatible nature and excellent physico-chemical properties, have been widely used in dental applications, including endodontics. This review focuses on the application of bioceramic technology in endodontic disinfection and the antibiofilm effects of endodontic bioceramic materials. Different bioceramic materials have shown different levels of antibiofilm effects. New supplements have emerged to potentially enhance the antibiofilm properties of bioceramics aiming to achieve the goal of microbial elimination in the root canal system.
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Affiliation(s)
| | | | - Markus Haapasalo
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (Z.W.); (Y.S.)
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Gutiérrez DM, Castillo Y, Ibarra-Avila H, López M, Orozco JC, Lafaurie GI, Castillo DM. A new model for the formation of an Enterococcus faecalis endodontic biofilm with nutritional restriction. J Basic Microbiol 2021; 62:13-21. [PMID: 34874074 DOI: 10.1002/jobm.202100533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/16/2021] [Accepted: 11/27/2021] [Indexed: 11/08/2022]
Abstract
An in vitro model for the formation of an Enterococcus faecalis endodontic biofilm under nutritional restriction was established, simulating clinical conditions for the evaluation of antimicrobial substances. Biofilm formation in dentin was standardized using root quarters incubated with E. faecalis ATCC 29212 at 37°C without nutritional changes. Biofilms were evaluated at 7, 14, and 30 days, counting bacterial colony-forming units using conventional culture and verified scanning electron microscopy. Bacterial viability and biovolume were determined with confocal laser microscopy. Colonization of E. faecalis and biofilm formation on the dentinal surface was confirmed after 7 and 14 days, respectively. Microorganism colonization was homogeneous over the entire root surface at each time point, without significant differences in the viability percentage and biovolume. On the contrary, a decrease in viability and an increase in biovolume were observed when the time was increased. Compared with other incubation times, 14 days was found to be the best time for the establishment of the biofilm in terms of biovolume and bacterial viability. This in vitro model for the formation of endodontic biofilm will allow future evaluation of the efficacy of antimicrobial substances with a more adequate clinical approach.
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Affiliation(s)
- Diana Marcela Gutiérrez
- Unidad de Investigación Básica Oral (UIBO), Vicerrectoría de investigaciones, Facultad de Odontología, Universidad El Bosque, Bogotá D.C, Colombia
| | - Yormaris Castillo
- Unidad de Investigación Básica Oral (UIBO), Vicerrectoría de investigaciones, Facultad de Odontología, Universidad El Bosque, Bogotá D.C, Colombia
| | - Humberto Ibarra-Avila
- Centro de Microscopia-μ-Core I Vicerrectoría de Investigación y Creación, Universidad de los Andes, Bogotá D.C, Colombia
| | - Mónica López
- Centro de Microscopia-μ-Core I Vicerrectoría de Investigación y Creación, Universidad de los Andes, Bogotá D.C, Colombia
| | - Juan C Orozco
- Centro de Microscopia-μ-Core I Vicerrectoría de Investigación y Creación, Universidad de los Andes, Bogotá D.C, Colombia
| | - Gloria I Lafaurie
- Unidad de Investigación Básica Oral (UIBO), Vicerrectoría de investigaciones, Facultad de Odontología, Universidad El Bosque, Bogotá D.C, Colombia
| | - Diana Marcela Castillo
- Unidad de Investigación Básica Oral (UIBO), Vicerrectoría de investigaciones, Facultad de Odontología, Universidad El Bosque, Bogotá D.C, Colombia
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Hussein H, Kishen A. Engineered Chitosan-based Nanoparticles Modulate Macrophage-Periodontal Ligament Fibroblast Interactions in Biofilm-mediated Inflammation. J Endod 2021; 47:1435-1444. [PMID: 34214497 DOI: 10.1016/j.joen.2021.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/20/2021] [Accepted: 06/21/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Crosstalk between immune cells and tissue-resident cells regulates the pathophysiology and posttreatment healing of apical periodontitis. This investigation aimed to understand the influence of residual root canal biofilm on macrophage (MQ)-periodontal ligament fibroblast (PdLF) interaction and evaluate the effect of engineered chitosan-based nanoparticles (CSnp) on MQ-PdLF interactions in residual biofilm-mediated inflammation. METHODS Six-week-old Enterococcus faecalis biofilms in root canal models were disinfected conventionally using sodium hypochlorite alone or followed by calcium hydroxide medication or CSnp dispersed in carboxymethylated chitosan (CMCS). The effect of the treated biofilms (n = 25/group) on the inflammatory response of THP-1-differentiated MQ monoculture versus coculture with PdLF was evaluated for cell viability, MQ morphometric characterization, inflammatory mediators (nitric oxide, tumor necrosis factor alpha, interleukin [IL]-1 beta, IL-1RA, IL-6, transforming growth factor beta 1 [TGF-β1], and IL-10), and the expression of transcription factors (pSTAT1/pSTAT6)/cluster of differentiation markers (CD80/206) after 24, 48, and 72 hours of interaction. PdLF transwell migration was evaluated after 8 and 24 hours. Unstimulated cells served as the negative control, whereas untreated biofilm was the positive control. RESULTS Biofilm increased nitric oxide and IL-1β but suppressed IL-10, IL-1RA, and PdLF migration with significant cytotoxic effects. CSnp/CMCS reduced nitric oxide and IL-1β (P < .01) while maintaining ≥90% cell survival up to 72 hours with evident M2-like MQ phenotypic changes in coculture. CSnp/CMCS also increased the IL-1RA/IL-1β ratio and enhanced TGF-β1 production over time (P < .05, 72 hours). In coculture, CSnp/CMCS showed the highest IL-10 level at 72 hours (P < .01), reduced the pSTAT1/pSTAT6 ratio, and enhanced PdLF migration (P < .01, 24 hours). CONCLUSIONS CSnp/CMCS medication facilitated MQ switch toward M2 (regulatory/anti-inflammatory) phenotype and PdLF migration via paracrine signaling.
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Affiliation(s)
- Hebatullah Hussein
- The Kishen Lab, Dental Research Institute, University of Toronto, Toronto, Canada; Faculty of Dentistry, University of Toronto, Toronto, Canada; Faculty of Dentistry, Endodontics Department, Ain Shams University, Cairo, Egypt
| | - Anil Kishen
- The Kishen Lab, Dental Research Institute, University of Toronto, Toronto, Canada; Faculty of Dentistry, University of Toronto, Toronto, Canada; Department of Dentistry, Mount Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Al‐Manei K, Al‐Manei KK. Nonsurgical endodontic management of mandibular first premolar with incomplete root-end resection. Clin Case Rep 2021; 9:437-444. [PMID: 33489194 PMCID: PMC7813031 DOI: 10.1002/ccr3.3551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/14/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022] Open
Abstract
The complexity of the nonsurgical endodontic retreatment should be weighed against the benefit of surgical approach. This case report describes uncommon diagnosis and successful nonsurgical endodontic management of mandibular first premolar with a previous history of failed apicoectomy and incomplete root-end resection using mineral trioxide aggregate and cone-beam computed tomography.
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Affiliation(s)
- Khaled Al‐Manei
- Unit of EndodonticsDivision of Oral DiseasesDepartment of Dental MedicineKarolinska InstituteHuddingeSweden
- Division of EndodonticsDepartment of Restorative Dental ScienceCollege of DentistryKing Saud UniversityRiyadhSaudi Arabia
| | - Kholod Khalil Al‐Manei
- Division of EndodonticsDepartment of Restorative Dental ScienceCollege of DentistryKing Saud UniversityRiyadhSaudi Arabia
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Zehnder M. New Ways to Disinfect and Fill Dental Hard Tissues. J Clin Med 2020; 9:jcm9051524. [PMID: 32443568 PMCID: PMC7290359 DOI: 10.3390/jcm9051524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Matthias Zehnder
- Division of Endodontology, Clinic of Conservative and Preventive Dentistry, Plattenstrasse 11, CH-8032 Zürich, Switzerland
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