Advanced cell therapies with and without scaffolds

Tissue engineering and regenerative medicine aim to produce tissue substitutes to restore lost functions of tissues and organs. This includes cell therapies, induction of tissue/organ regeneration by biologically active molecules, or transplantation of in vitro grown tissues. This review article discusses advanced cell therapies that make use of scaffolds and scaffold-free approaches. The first part of this article covers the basic characteristics of scaffolds, including characteristics of scaffold material, fabrication and surface functionalization, and their applications in the construction of hard (bone and cartilage) and soft (nerve, skin, blood vessel, heart muscle) tissue substitutes. In addition, cell sources as well as bioreactive agents, such as growth factors, that guide cell functions are presented. The second part in turn, examines scaffold-free applications, with a focus on the recently discovered cell sheet engineering. This article serves as a good reference for all applications of advanced cell therapies and as well as advantages and limitations of scaffold-based and scaffold-free strategies.

3D printed poly(ε-caprolactone) scaffolds modified with hydroxyapatite and poly(propylene fumarate) and their effects on the healing of rabbit femur defects

A large variety of approaches have been used to treat large and irregular shaped bone defects with less than optimal success due to material or design issues. In recent years patient specific constructs prepared by additive manufacturing provided a solution to the need for shaping implants to fit irregular defects in the surgery theater. In this study, cylindrical disks of poly(ε-caprolactone) (PCL) were printed by fused deposition modeling and modified with nanohydroxyapatite (HAp) and poly(propylene fumarate) (PPF) to create a mechanically strong implant with well-defined pore size and porosity, controllable surface hydrophilicity (with PPF) and osteoconductivity (with HAp). Cytotoxicity, irritation and inflammation tests demonstrated that the scaffolds were biocompatible. PCL/HAp and PCL/HAp/PPF scaffolds were implanted in the femurs of rabbits with and without seeding with rabbit Bone Marrow Stem Cells (BMSC) and examined after 4 and 8 weeks with micro-CT, mechanically and histologically. BMSC seeded PCL/HAp/PPF scaffolds showed improved tissue regeneration as determined by bone mineral density and micro-CT. Compressive and tension stiffness values (394 and 463 N mm-1) were significantly higher than those of the healthy rabbit femur (316 and 392 N mm-1, respectively) after 8 weeks of implantation. These 3D implants have great potential for patient-specific bone defect treatments.

Micro-CT and nano-CT analysis of filling quality of three different endodontic sealers

OBJECTIVES

To investigate voids in different root canal sealers using micro-CT and nano-CT, and to explore the feasibility of using nano-CT for quantitative analysis of sealer filling quality.

METHODS

30 extracted mandibular central incisors were randomly assigned into three groups according to the applied root canal sealers (Total BC Sealer, Sure Seal Root, AH Plus) by the single cone technique. Subsequently, micro-CT and nano-CT were performed to analyse the incidence rate of voids, void fraction, void volume and their distribution in each sample.

RESULTS

Micro-CT evaluation showed no significant difference among sealers for the incidence rate of voids or void fraction in the whole filling materials (p > 0.05), whereas a significant difference was found between AH Plus and the other two sealers using nano-CT (p < 0.05). All three sealers presented less void volume in the apical third; however, higher void volumes were observed in the apical and coronal thirds in AH Plus using micro-CT (p < 0.05), while nano-CT results displayed higher void volume in AH Plus among all the sealers and regions (p < 0.05).

CONCLUSIONS

Bioactive sealers showed higher root filling rate, lower incidence rate of voids, void fraction and void volume than AH Plus under nano-CT analysis, when round root canals were treated by the single cone technique. The disparate results suggest that the higher resolution of nano-CT have a greater ability of distinguishing internal porosity, and therefore suggesting the potential use of nano-CT in quantitative analysis of filling quality of sealers.

Micro-computed tomographic evaluation of the effects of pre-heating and sonic delivery on the internal void formation of bulk-fill composites

The aim of this study was to compare the effects of conventional, sonic or pre-heating insertion techniques on internal void formation of bulk-fill composites with micro-computed tomography. Standardized cylindrical cavities were prepared in 160 human third molars. Four groups received different paste-like bulk-fill composites: SonicFill 2 (SF2); VisCalor Bulk (VCB); Filtek One Bulk-fill restorative (FBF); Tetric EvoCeram Bulk Fill (TEB); and a conventional posterior composite, Clearfil Majesty Posterior (CMP). A hybrid CAD/CAM block was selected as a control (n=10). Composite restorations were built according to each resin composite type and insertion technique (n=10). Micro-CT was used to assess internal void rates. Data was analyzed with two-way ANOVA and Tukey's multiple comparisons test (α=0.05). CAD/CAM blocks were free of voids. For each composite, the highest void rates were observed for the sonic delivery method (p<0.05) except for SF2. SF2 was not affected by insertion techniques (p>0.05). Other composites showed the lowest void rates with pre-heating technique.

Evaluation of Threshold Values for Root Canal Filling Voids in Micro-CT and Nano-CT Images

While several materials and techniques have been used to assess the quality of root canal fillings in micro-CT images, the lack of standardization in scanning protocols has produced conflicting results. Hence, the aim of this study was to determine a cutoff voxel size value for the assessment of root canal filling voids in micro-CT and nano-CT images. Twenty freshly extracted mandibular central incisors were used. Root canals were prepared with nickel titanium files to an ISO size 40/0.06 taper and then filled with a single cone (40/0.06 taper) and AH Plus sealer. The teeth were scanned with different voxel sizes with either micro-CT (5.2, 8.1, 11.2, and 16.73 μm) or nano-CT (1.5 and 5.0 μm) equipment. Images were reconstructed and analyzed with the NRecon and CTAn software. Void proportion and void volume were calculated for each tooth in the apical, middle, and coronal thirds of the root canal. Kruskal-Wallis and post hoc Mann-Whitney U tests were performed with a significance level of 5%. In micro-CT images, significantly different results were detected among the tested voxel sizes for void proportion and void volume, whereas no such differences were found in nano-CT images (p > 0.05). Micro-CT images showed higher void numbers over the entire root length, with statistically significant differences between the voxel size of 16.73 μm and the other sizes (p < 0.05). The values of the different nano-CT voxel sizes did not significantly differ from those of the micro-CT (5.2, 8.1, and 11.2 μm), except for the voxel size of 16.73 μm (p < 0.05). All tested voxel sizes enabled the detection of root canal filling voids except for the voxel size of 16.73 μm. Bearing in mind the limitations of this study, it seems that a voxel size of 11.2 μm can be used as a reliable cutoff value for the assessment of root canal filling voids in micro-CT imaging.

Construction and in vitro testing of a multilayered, tissue-engineered meniscus

A novel three-dimensional construct was designed to serve as a substitute for the natural meniscus tissue, and tested in vitro. The design consisted of mats of aligned collagen micro/nanofibers, entrapped within a macroporous poly(l-lactic acid)/poly(lactic acid-co-glycolic acid) foam coated with Ca+2-cross-linked alginic acid. Fibrochondrocytes derived from human meniscus were tested in vitro to study cell attachment and proliferation. After a 21-day culture, the cells populating the constructs were shown to produce extracellular matrix components specific for fibrocartilages, such as collagen Types I and II and aggrecan. Coating the foam with alginate increased the compressive modulus of the collagen-containing constructs (from 320 to 381 kPa, after 21 days of incubation with fibrochondrocytes) but decreased cell attachment and proliferation, as well as aggrecan production. Collagen fibers substantially increased the tensile modulus of the cell-seeded constructs (from 0.98 to 1.71 MPa for uncoated and from 0.67 to 1.32 MPa for coated samples). All constructs produced extracellular matrix components specific for fibrocartilages. These findings indicate that these constructs have potential for use as meniscus substitutes.

A two-compartment bone tumor model to investigate interactions between healthy and tumor cells

We produced a novel three-dimensional (3D) bone tumor model (BTM) to study the interactions between healthy and tumor cells in a tumor microenvironment, the migration tendency of the tumor cells, and the efficacy of an anticancer drug, Doxorubicin, on the cancer cells. The model consisted of two compartments: (a) a healthy bone tissue mimic, made of poly(lactic acid-co-glycolic acid) (PLGA)/beta-tricalcium phosphate (β-TCP) sponge seeded with human fetal osteoblastic cells (hFOB) and human umbilical vein endothelial cells (HUVECs), and (b) a tumor mimic, made of lyophilized collagen sponge seeded with human osteosarcoma cells (Saos-2). The tumor mimic component was placed into a central cavity created in the healthy bone mimic and together they constituted the complete 3D bone tumor model (3D-BTM). The porosities of both sponges were higher than 85% and the diameters of the pores were 199 ± 52 μm for the PLGA/TCP and 50-150 μm for the collagen scaffolds. The compression Young's modulus of the PLGA/TCP and the collagen sponges were determined to be 4.76 MPa and 140 kPa, respectively. Cell proliferation, morphology, calcium phosphate forming capacity and alkaline phosphatase production were studied separately on both the healthy and tumor mimics. All cells demonstrated cellular extensions and spread well in porous scaffolds indicating good cell-material interactions. Confocal microscopy analysis showed direct contact between the cells present in different parts of the 3D-BTM. Migration of HUVECs from the healthy bone mimic to the tumor compartment was confirmed by the increase in the levels of angiogenic factors vascular endothelial growth factor, basic fibroblast growth factor, and interleukin 8 in the tumor component. Doxorubicin (2.7 μg.ml^-1) administered to the 3D-BTM caused a seven-fold decrease in the cell number after 24 h of interaction with the anticancer drug. Caspase-3 enzyme activity assay results demonstrated apoptosis of the osteosarcoma cells. This novel 3D-BTM has a high potential for use in studying the metastatic capabilities of cancer cells, and in determining the effective drug types and combinations for personalized treatments.

Local application of gingiva-derived mesenchymal stem cells on experimental periodontitis in rats

BACKGROUND

Stem cell-based approaches in regenerative periodontal therapy have been used in different experimental models. In this study, the effect of local application of gingival mesenchymal stem cells (GMSC) in fibroin/chitosan oligosaccharide lactate hydrogel (F/COS) on periodontal regeneration was evaluated using experimental periodontitis model in rats.

METHODS

Mesenchymal stem cells were isolated from the gingiva of rats and characterized. Viability tests and confocal imaging of GMSC in hydrogels were performed. Healthy control without periodontitis (Health; H; n=10), control with periodontitis but no application (Periodontitis; P; n=10), only hydrogel application (F/COS; n=10), and GMSC+F/COS (n=10) four groups were formed for in vivo studies. Experimental periodontitis was created with silk sutures around the maxillary second molars. GMSC labeled with green fluorescent protein (GFP) (250,000 cells/50 μL) in F/COS were applied to the defect. Animals were sacrificed at 2nd and 8th weeks and maxillae of the animals were evaluated by micro-computed tomography (micro-CT) and histologically. The presence of GFP-labeled GMSC was confirmed at the end of 8 weeks.

RESULTS

Micro-CT analysis showed statistically significant new bone formation in the F/COS+GMSC treated group compared with the P group at the end of 8 weeks (p < 0.05). New bone formation was also observed in the F/COS group, but the statistical analysis revealed that this difference was not significant when compared with the P group (p > 0.05). Long junctional epithelium formation was less in the F/COS+GMSC group compared with the P group. Periodontal ligament and connective tissue were well-organized in F/COS+GMSC group.

CONCLUSION

The results showed that local GMSC application in hydrogel contributed to the formation of new periodontal ligament and alveolar bone in rats with experimental periodontitis. Since gingiva is easly accessible tissue, it is promising for autologous cell-based treatments in clinical applications.

Production of heterogenous bone radiopacity phantom using 3D printing

The aim is to obtain a heterogenous bone radiopacity phantom with adjustable radiopacity in different regions. The heterogenous 3D printed phantom can be used as bone equivalent in medical education, surgical planning, diagnostic radiology, and radiotherapy. This study utilized a hybrid approach, combining both direct and indirect methods, to create phantoms with realistic bone-equivalent radiodensity. Hollow, cube-shaped test blocks were produced using an SLA 3D printer with a photoreactive resin. The attenuation coefficients of the test blocks were evaluated using Dataviewer software by comparing materials such as calcium sulfate dihydrate, barium sulfate, and hydroxyapatite. The photoreactive resin was modified with hydroxyapatite to increase its radiodensity. A hollow jaw phantom model was then designed and printed using the hydroxyapatite-doped resin. The powder hydroxyapatite was added to the cavities of the printed phantom model. The average attenuation coefficient of barium sulfate was 208 ± 1.90 mm- 1, calcium sulfate dihydrate was 187 ± 1.98 mm- 1, hydroxyapatite was 128 ± 2.35 mm- 1, and bone values, which were considered as reference values in the research, was 125 ± 14 mm- 1. The observed difference between the hydroxyapatite added bone model and real bone was not statistically significant (Z:-0.175, p:0.860). The produced mandibular bone phantom has realistic attenuation coefficient values and heterogeneity in terms of radiological features. This study shows that the use of two different methods, which include hydroxyapatite material added into the photoreactive resin during the 3D printing process and the addition of hydroxyapatite as a powder to the gaps in the bone model obtained after printing, yields successful results in the production of bone-equivalent phantoms.

Evaluation of the Effectiveness of Different Caries Removal Methods in Primary Teeth With Micro-Computed Tomography and Scanning Electron Microscopy-Energy Dispersive Spectroscopy of X-Ray

This study evaluated the effectiveness of conventional rotary instruments (CRI), atraumatic restorative treatment (ART), and the BRIX-3000 chemomechanical caries removal gel by measuring bone mineral density (BMD) and mineral composition in vitro. The carious dentin of 50 extracted human primary molar teeth was removed by using three different methods and restored with high-viscosity glass ionomer cement FUJİ-IX. The BMD values measured from all sections of the cavity floor in the BRIX-3000, ART, and CRI groups are 1.72, 1.79, and 1.66 g/cm3, respectively. SEM-EDX measurements were performed on five randomly selected teeth from the groups. In the BRIX-3000 group, the mean wt Ca% was 65.6, wt P% was 25.34, and the Ca/P ratio was 2.57. In the ART group, 65.75, 23.79, and 2.58 were found, respectively. In the CRI group, 65.73, 26.03, and 2.53 were found, respectively. While there was no difference between the wt Ca% values in all groups in the comparison of the cavity floor and adjacent sound dentin of the samples, the wt P% values were statistically significantly higher on the sound dentin surface.

The evaluation of internal adaptation of glass ionomer restorations applied after the use of different cavity conditioners in primary teeth: an in-vitro study

BACKGROUND

This study aimed to comparatively evaluate the effects of different cavity conditioners on internal adaptation (IA) of glass ionomer-based restorative materials applied to primary teeth.

METHODS

80 extracted primary second molar teeth were randomly assigned to four different cavity conditioner groups [10% polyacrylic acid, 20% polyacrylic acid, 17% ethylene diamine tetraacetic acid (EDTA), 35% phosphoric acid]. Class V cavities were prepared on the buccal surfaces and relevant cavity conditioners were applied, and the samples in each cavity conditioner group were randomly assigned to glass hybrid (GHR) or conventional glass ionomer restoratives (CGIR). Subsequently, restorative materials were applied and all samples were thermocycled (5-55 °C, 5000 cycles) and IA were calculated volumetrically by using a Micro Computed Tomography (Micro-CT) system. IA values was recorded as % and data were analyzed with Mann-Whitney U and Kruskal-Wallis H tests. Statistical significance level was set as 5%.

RESULTS

35% phosphoric acid showed the lowest mean internal voids (between the cavity-restoration interface) for both restorative materials (for GHR = 0.180% and for CGIR = 0.936%). However, the highest mean internal voids for GHR and CGIR were observed after the use of 17% EDTA (2.438%) and 10% polyacrylic acid (8.483%), respectively. For both restorative materials, 20% polyacrylic acid showed the second lowest mean internal voids (for GHR = 0.321% and for CGIR = 3.580%), however, no significant difference was found between 35% phosphoric acid and 20% polyacrylic acid (p = 0.941 for GHR and p = 0.061 for CGIR). In the samples applied the cavity conditioners other than 17% EDTA, glass hybrid restoratives showed significantly higher IA quality than conventional glass ionomer (p = 0.0001 for 10% polyacrylic acid, p = 0.001 for 20% polyacrylic acid and p = 0.002 for 35% phosphoric acid).

CONCLUSIONS

Within the limitations of this study, 35% phosphoric acid and 20% polyacrylic acid were determined to be the most successful cavity conditioners in terms of IA, and glass hybrid restorative system showed superior IA quality than conventional glass ionomer. Further studies are needed to confirm the present results.

The Effect of Micro-Computed Tomography Thresholding Methods on Bone Micromorphometric Analysis

Bone micromorphometric parameters are generally analyzed with micro CT to reveal two- and three-dimensional structures. These parameters are generally used for new bone formation studies such as tissue engineering and biomaterials studies. Different threshold methods are used for the image segmentation of bone micromorphometric parameters. However, these different threshold methods provide different results for the bones analyzed. This study aimed to compare thresholding methods to evaluate bone micromorphometric parameters in the mouse bone. A dataset containing 15 mouse tibia was used to analyze the different thresholding methods for bone micromorphometric parameter analysis. These threshold methods were used to analyze the mouse tibia (n = 15) with thresholded bones. The threshold methods and the analysis were used directly from CTAn (Bruker Micro-CT). The results were compared between the threshold methods, which included bone volume, trabecular number, connectivity, trabecular separation, and other parameters. There was agreement to some extent for all bone micromorphometric analyses using the different thresholding methods. The results showed that the thresholding method showed good agreement for connectivity and trabecular thickness, but the other parameters showed limited agreement. The evaluation of threshold methods allows for the comparison of image segmentation and the quantification of mouse tibia micromorphometric parameters. This study may enable the analysis of bone micromorphometric parameters using the relatively close threshold method in image segmentation across different research groups.

Effects of Access Cavity Design and Placement Techniques on Mineral Trioxide Aggregate Obturation Quality in Simulated Immature Teeth: A Micro-Computed Tomography Study

Background and Objectives: In teeth with open apices, performing single session apexification is a challenging treatment due to the difficulty in handling mineral trioxide aggregate (MTA). Minimally invasive approaches in dentistry have also influenced the cavity designs in endodontics. Until now, different techniques have not been investigated in addition to manual condensation during the process of placing MTA in traditional (TradACs) or conservative (ConsACs) endodontic access cavities. The aim of this in vitro study was to compare and evaluate the obturation quality of MTA apical plugs placed with different techniques in TradACs or ConsACs. Materials and Methods: Sixty upper central teeth were divided into two main groups based on cavity design, and then each main group was further divided into three subgroups according to MTA placement techniques (n = 10): TradAC-manual, TradAC-manual + indirect ultrasonic activation, TradAC-manual + XP-endo Shaper (XPS), ConsAC-manual, ConsAC-manual + indirect ultrasonic activation, and ConsAC-manual + XPS. Subsequently, the porosity percentages in the MTA apical plug were analyzed using micro-computed tomography. The statistical analysis was performed using the Kruskal-Wallis H test and Mann-Whitney U test. Statistical significance was set at p < 0.05. Results: There were differences in volume of porosity percentages (%) according to cavity designs and MTA application techniques (p < 0.05). Except for the XPS group, more porosity was observed in ConsACs compared to TradACs. In TradACs, the significantly lowest open and total porosity was observed in the manual, ultrasonic, and XPS techniques, respectively. In ConsACs, the significantly lowest porosity was observed in the manual, XPS, and ultrasonic techniques, respectively (p < 0.05). Conclusions: In MTA obturation, cavity designs and application techniques had an impact on the MTA porosity. Creating an apical plug in ConsACs may result in more porosity compared to TradACs, especially when manual or indirect ultrasonic activation is preferred. Opting for the manual technique alone may be considered sufficient for controlling porosity for both TradACs and ConsACs.

Multifunctional Silk Fibroin/Carbon Nanofiber Scaffolds for In Vitro Cardiomyogenic Differentiation of Induced Pluripotent Stem Cells and Energy Harvesting from Simulated Cardiac Motion

In this proof-of-concept study, cardiomyogenic differentiation of induced pluripotent stem cells (iPSCs) is combined with energy harvesting from simulated cardiac motion in vitro. To achieve this, silk fibroin (SF)-based porous scaffolds are designed to mimic the mechanical and physical properties of cardiac tissue and used as triboelectric nanogenerator (TENG) electrodes. The load-carrying mechanism, β-sheet content, degradation characteristics, and iPSC interactions of the scaffolds are observed to be interrelated and regulated by their pore architecture. The SF scaffolds with a pore size of 379 ± 34 μm, a porosity of 79 ± 1%, and a pore interconnectivity of 67 ± 1% upregulated the expression of cardiac-specific gene markers TNNT2 and NKX2.5 from iPSCs. Incorporating carbon nanofibers (CNFs) enhances the elastic modulus of the scaffolds to 45 ± 3 kPa and results in an electrical conductivity of 0.021 ± 0.006 S/cm. The SF and SF/CNF scaffolds are used as conjugate TENG electrodes and generate a maximum power output of 0.37 × 10-3 mW/m2, with an open-circuit voltage and a short circuit current of 0.46 V and 4.5 nA, respectively, under simulated cardiac motion. A novel approach is demonstrated for fabricating scaffold-based cardiac patches that can serve as tissue scaffolds and simultaneously allow energy harvesting.

Fracture Resistance of Esthetic Prefabricated and Custom-Made Crowns for Primary Molars After Artificial Aging

Purpose: The purpose of this in vitro study was to compare the fracture resistance and survival of various esthetic crowns for primary molars after artificial aging via chewing simulation. Methods: A typodont tooth (mandibular primary second molar) was prepared to receive five different types of crowns as follows (n equals 10): prefabricated fiberglass (PF); CAD/CAM zirconia (CZ); CAD/CAM resin-ceramic (CR); composite- strip (CS); and prefabricated zirconia (PZ) as control. All specimens were subjected to 750,000 cycles of thermomechanical loading to artificially simulate three years of clinical service. None of the crowns from the CS group survived artificial aging. Surviving crowns were evaluated via micro-CT considering microcrack formation, and a load-to-fracture test was applied. Data were analyzed using one-way analysis of variance followed by the Duncan test. Results: Group PZ (557.4±170.1 N) and CR (669.6±255.2) were found to have comparable results (P >0.05), which were lower than the other groups (P<0.05). Group CZ resulted in the highest mean load-to-fracture value (1126.2±180.6; P <0.05). At the end of three years of artificial aging, microcracks were observed for only CS and PF groups. Conclusions: These in vitro data suggest that all tested crowns, except CS crowns, survived three years of artificial aging; however, CAD/CAM zirconia crowns may provide longer service, as they showed the highest fracture resistance with no microcrack formation.

The Value of Micro-CT in the Diagnosis of Lung Carcinoma: A Radio-Histopathological Perspective

Micro-computed tomography (micro-CT) is a relatively new imaging modality and the three-dimensional (3D) images obtained via micro-CT allow researchers to collect both quantitative and qualitative information on various types of samples. Micro-CT could potentially be used to examine human diseases and several studies have been published on this topic in the last decade. In this study, the potential uses of micro-CT in understanding and evaluating lung carcinoma and the relevant studies conducted on lung and other tumors are summarized. Currently, the resolution of benchtop laboratory micro-CT units has not reached the levels that can be obtained with light microscopy, and it is not possible to detect the histopathological features (e.g., tumor type, adenocarcinoma pattern, spread through air spaces) required for lung cancer management. However, its ability to provide 3D images in any plane of section, without disturbing the integrity of the specimen, suggests that it can be used as an auxiliary technique, especially in surgical margin examination, the evaluation of tumor invasion in the entire specimen, and calculation of primary and metastatic tumor volume. Along with future developments in micro-CT technology, it can be expected that the image resolution will gradually improve, the examination time will decrease, and the relevant software will be more user friendly. As a result of these developments, micro-CT may enter pathology laboratories as an auxiliary method in the pathological evaluation of lung tumors. However, the safety, performance, and cost effectiveness of micro-CT in the areas of possible clinical application should be investigated. If micro-CT passes all these tests, it may lead to the convergence of radiology and pathology applications performed independently in separate units today, and the birth of a new type of diagnostician who has equal knowledge of the histological and radiological features of tumors.

Investigation of Phase Transformation and Fracture Pattern as a Result of Long-Term Chewing Simulation and Static Loading of Reduced-Diameter Zirconia Implants

While zirconia implants exhibit osseointegration comparable to that of titanium, concerns arise regarding low-temperature degradation and its potential impact on fracture strength. This study investigated the phase transformation and fracture characteristics of zirconia dental implants after aging through chewing simulation and subsequent static loading. The experimental setup involved 48 one-piece monobloc zirconia implants with diameters of 3.0 mm and 3.7 mm that had straight or angled abutments, with crown restorations, which were divided into six groups based on intraoral regions. The specimens underwent chewing simulation equal to five years of oral service, which was followed by static loading. Statistical analyses were performed for the data obtained from the tests. After dynamic and static loadings, the fractured samples were investigated by Raman spectroscopy to analyze the phase composition and micro-CT to evaluate fracture surfaces and volume changes. According to the results, narrow-diameter zirconia implants have low mechanical durability. The fracture levels, fracture patterns, total porosity, and implant fracture volume values varied according to the implant diameter and phase transformation grade. It was concluded that phase transformation initially guides the propagation of microcracks in zirconia implants, enhancing fracture toughness up to a specific threshold; however, beyond that point, it leads to destructive consequences.

Comparative Retreatment Efficacy of Two Multi-File Systems with Different Access Cavity Designs: A Micro-Computed Tomography Study

Background and Objectives: The access cavity design and instrumentation system could affect the remaining root canal obturation materials in root canal retreatment. This study aimed to evaluate the efficiency of two different multi-file systems in removing obturation materials with two different access cavities utilizing micro-CT scanning. Materials and Methods: Conservative access cavity (CAC) preparation was performed for 80 mandibular premolars. Then, root canal preparation was employed followed by obturation. The retreatment process began by dividing the samples into two separate groups: conservative (CAC) and traditional (TAC) access cavities. Subsequently, these groups were assigned to eight distinct subgroups (n = 10): Group 1; TAC and ProTaper retreatment system (PTR) with ProTaper Next (PTN); Group 2, TAC and PTR + ProTaper Ultimate (PTUL); Group 3, TAC and PTN; Group 4, TAC and PTUL; Group 5, CAC and PTR + PTN; Group 6, CAC and PTR + PTUL; Group 7, CAC and PTN; and Group 8, CAC and PTUL. The samples underwent micro-CT scans before and after the retreatment process, and the volume and percentages of remaining root canal filling material were calculated. Statistical analysis of the data was performed, and significance was determined at the 5% level. Results: The influence of the access cavity design (p = 0.500), the ProTaper system (p = 0.138), and the interaction of these variables (p = 0.513) was insignificant. However, group 3 (TAC and PTN) showed the highest percentage of remaining obturation materials at 29.53%, contrasting with group 6 (CAC and PTR + PTUL). Conclusions: Neither retreatment procedure succeeded in completely removing filling materials. Nevertheless, the impact of access cavity design, different multi-file systems, and their interaction on the remaining root canal obturation materials was deemed insignificant.

Micro-Computed Tomography Analysis of Resin and Calcium Silicate Based Sealers Removal in Mandibular Molars Curved Canals

Objective

The removal of the root canal sealer is an important factor in nonsurgical retreatment. The aim of this study was to compare the removal of AH Plus, Well Root ST, and AH Plus Bioceramic Sealer using Protaper Universal retreatment files.

Methods

The curved mesio-buccal canals of extracted mandibular molars were prepared with the Protaper Gold file system (up to F2). Specimens were randomly divided into 3 groups and filled with the single cone technique using AH Plus, Well-Root ST, and AH Plus Bioceramic Sealer, respectively. After two weeks, the root canal filling of all specimens was removed using Protaper Universal retreatment files. All specimens were scanned using micro-CT. The remaining volume of the root canal filling was recorded in total and the coronal, middle, and apical third of each specimen.

Results

Well-Root ST and AH Plus Bioceramic Sealer groups had a higher percentage of total remaining filling material than the AH Plus group (P<0.05).

Conclusion

This study has shown that the volume of remaining root canal filling was significantly higher in the samples filled with calcium silicate-based sealers.