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The current study aims to evaluate in vitro the extrusion of NaOCl, using an artificial root canal with an open apex, using different canal irrigation protocols. For this study, a transparent artificial root canal was used. The apex was shaped to be oversized and irregular in form. After root canal mechanical shaping, the artificial cylindrical chamber, which was made below the large apical foramen, was filled with fuchsine-stained bovine pulp tissue. Afterward, irrigation protocols were carried out and compared regarding their safety with regards to irrigant extrusion. Subsequently, the examiner created two groups, Group A: internal heating associated with ultrasonic activation and Group B: internal heating associated with ultrasonic activation, using the CAB technique. In both the groups, 5.25% sodium hypochlorite solution was used as the irrigant. Regarding assessing the presence or absence of the extrusion, photographs at ×20 were taken and analyzed. For the statistical analysis, a t-test for paired samples was used. Extrusion of irrigant beyond the apex was present only in Group A. The main objective of endodontic treatment is the removal of damaged tissues and bacteria. For this reason, active cleaning is crucial in all endodontic treatment cases. Internal heating followed with ultrasonic activation while using the CAB technique was an effective and safe technique to ensure no irrigant extrusion beyond the open apex.

Aim: The primary aim of this clinical trial was to observe the clinical success in conservative management of symptomatic deep proximal caries in permanent molar teeth with two treatment pulpotomy with Biodentine and indirect pulp capping with calcium hydroxide. Materials and Methods: A total of 71 patients who reported to department for the management of symptomatic proximal deep carious lesions in molar teeth participated in the trial. Posttreatment clinical success at 18 months was defined as asymptomatic teeth positively responding to cold pulp sensibility test (only in indirect pulp capping) and absence of periapical infection. Chi-squared test and Kaplan–Meier survival analysis were done. Results: Chi-squared test revealed no significant association between pulp status and posttreatment follow-up in both the treatment groups. Kaplan–Meier survival analysis showed mean survival of pulpotomy procedure for moderate and ambiguous pulp as 66.16 and 67.77 weeks, respectively, with no significant difference for two different pulp statuses. In indirect pulp capping procedure, there was significant difference (P = 0.038) (Log-rank Mantel-Cox) between the two pulp status category with moderate pulpitis having mean survival period of 69.27 weeks and ambiguous pulp with 42.83 weeks. Conclusion: Pulpotomy with Biodentine yielded better results than compared to indirect pulp capping.

Introduction: The ingredients from the dental restoratives are known to leach and elicit a host response. The prerequisite to deem a material biocompatible requires its toxicologic evaluation. The study was performed to analyze the probable toxicity resulting from silorane-based composite (SBC) with methacrylate-based composite (MBC). Materials and Methods: The in vitro cytotoxicity test, methyl thiazolyl tetrazolium (MTT) assay, evaluated the cell viability and proliferation rate of dental pulp cells (DPCs). The extirpated pulp was cultured in α-MEM-containing supplements and incubated at 37°C. DPCs were subjected to varying doses of SBC or MBC at different time intervals after attaining confluence and monitored for proliferation and viability via MTT assay. An independent Student t test was performed to compare the effect of composites on the DPC. The cytotoxicity levels were compared using one-way analysis of variance and posthoc Tukey multiple comparison test at 5% level of significance and P-value of 90%) in the first 24 hours. The count significantly reduced by the end of 48 hours (minimum 65% in 25 μg/ml) at all concentrations (P < 0.05). SBC had lower survival than MBC in all concentrations and periods. Except at 5 μg/ml concentration at 48 hours in SBC, no statistically significant values were reported. Conclusion: DPCs are prone to the cytotoxicity caused by dental composite. In contrast to MBC, the cytotoxicity of SBC declines overtime.

Aim: The aim of this study was to ascertain ABO blood group from extracted teeth using pulp and dentin tissues with the help of the absorption–elution (AE) technique. Materials and Methods: The study was conducted using an experimental study design and included 60 patients who underwent extraction due to periodontal and therapeutic purposes. Blood group antigens were ascertained for all the study participants using capillary blood by slide agglutination method (Controls). AE technique was used to check blood grouping using powdered dentine and dental pulp immediately after extraction and after 9 months. The study group was compared with the control group for blood group determination at different time intervals to find the sensitivity of dental pulp and a significant difference between those values at different time intervals. The statistical tests used were the Shapiro–Wilk test, chi-squared test, multivariate linear regression, and the Pearson correlation coefficient. Results: A total of 60 study subjects, 39 males and 21 females, were taken. In the estimation of blood group, 54 teeth, that is, 90% of total sample, were positive. We found an inverse relationship between the result for the blood grouping and time intervals, that is, 100% and 80% test results, done on the day of extraction and after 9 months. Conclusion: It could be inferred that the antigens from pulp are biologically stable for long time. This study brings a spotlight on the time duration for which teeth can remain as the prominent source for the detection of blood group.

Introduction: Although missing tooth is not life-threatening, it affects the quality of daily life. Stem cells have emerged as an important player in the generation and maintenance of many tissues. The role of scaffolds has changed from a passive carrier to a bioactive matrix, which can be used to induce cellular behavior. The aim of this study was to determine the possibility of regeneration of dentin-pulp complex with dental pulp stem cells (DPSCs) in an animal model. Materials and Methods: In this animal study after extraction of DPSCs and cultivation, 10 types of scaffolds were made by using platelet-rich plasma (PRP), cancellous bone, and collagen pad. They were inserted in different parts of the dog's mouth. After the 4th month, the area was operated, and the scaffolds were removed. Results: Microscopic examination revealed no sign of cell differentiation and formation of new structures in those models which used collagen scaffolds. However, the dentin-pulp complex emerged in models that the combination of bone scaffolds and PRP or stem cells was used. Conclusion: Using bone scaffolds in combination with PRP or DPSCs to regenerate dentin-pulp complex in dog helped odontoblastic and pulpal differentiation as well as the formation of predentin and tubular dentin.

Taurodontism is defined as lack of usual constriction at the cement-enamel junction, elongated pulp chambers with apical displacement of pulp floor. Affected tooth may not exhibit any characteristic morphologic trait for clinical recognition and require radiologic diagnosis. A special attention is required while planning any treatment for affected tooth. Present article highlights the important of early diagnosis of taurodntism in orthodontic treatment planning. A case report is presented with diagnosis of taurodontism affecting multiple teeth in both maxillary and mandibular arch.

The main aim of restorative dentistry is to protect the vitality of the Pulp tissue. The pin point carious expoure and iatrogenic errors warrant the need for various pulp capping procedures like Indirect Pulp Capping and Direct Pulp Capping. Pulp Capping is dressing of the dental pulp exposed due to mechanical procedure, carious lesion or traumatic injury to preserve its vitality and function. There has been constant evolution and research on materials used to cap the Pulp tissue. The different kind of chemical and biological materials has been used with varying degree of success. The prognosis based on the pulp capping material has dramatically improved with the introduction of bioactive cement. Though MTA and biodentine have shown a high success rate, their properties can be adversely affected with error in powder/liquid ratio and may present with difficulty in the handling characteristic. Premixed bioceramics have been introduced in the market and present with desirable properties as a pulp capping agent. Owing to good handling characteristics, biocompatibility, odontogenic property, and antibacterial action it is a potent pulp capping agent for clinical application. This review is aimed to discuss the introduction of premixed bioceramics, forms of premixed bioceramics available, and its physical, chemical, and biocompatible properties.

Pulp regenerative procedure is one of the treatment options for endodontically involved immature permanent teeth. The regenerative endodontic procedure was performed in a child of 9 years. After thorough canal disinfection using triple antibiotic paste for 21 days, bleeding was induced from the apex to provide for the stem cells. After that hyaluronic acid (HA) hydrogel was introduced into the canal space to act as injectable scaffold for pulp regeneration. This was followed by mineral trioxide aggregate placement to provide tight seal from the coronal aspect. Later, the tooth was restored with composite restoration. This approach offers the clinicians great opportunity to physiologically strengthen the immature root walls. The present report presents a regenerative endodontic procedure with HA hydrogel for a traumatized central incisor with arrested root development. The continued root development in the present case suggests that this treatment option may be able to resume the root maturation process in immature teeth with open apices.

The major objectives of restoration dentistry are to restore teeth in a way that allies conservation of healthy dental tissue, esthetics, function, and durability. The ideal would be to attain restorations that are as strong as the natural teeth, which seems unnoticeable even to dentists and more demanding patients.3 Thus, in many clinical situations, the best option for fractured anterior teeth is reattachment of the tooth fragment because of the following reasons: • It reinstates the natural shape, contour, surface texture, and occlusal alignment. • Original color and brightness of the tooth are maintained. • Incisal edge of the tooth fragment wears at a similar rate to the adjacent teeth, whereas a composite restoration will likely wear more rapidly. • Less chair-side time is required so the reattachment is much more economical. Attachment of a tooth fragment can be achieved with good esthetic and functional results, even in more complex situations where pulp and/or the biologic width are involved.4-10 With the evolution of adhesive systems, offering excellent bonding to dentin,11,12 reattachment of dental fragment has been a noninvasive treatment offering good results,4,5,7,13-17 even when performed under challenging conditions.9 Bevels, chamfers, grooves, and undercuts apparently make no difference in the prognosis.9,18

Dens evaginatus (DE) is a developmental disturbance that clinically appears as an accessory occlusal tuberculated cusp composed of enamel and dentin, enclosing a thin pulp tissue. It mainly involves the mandibular premolars. These cusp-like protrusions are susceptible to wear and fractures with subsequent pulp exposure leading to pulpal necrosis. In most cases, DE is discovered due to periapical inflammation in the absence of obvious clinical presentation of caries, trauma, or other pathologies, thus making it a diagnostic challenge. A case of nonvital tooth with an obscured DE in an 18-year-old male is reported here with a review of literature.

Objective The aim was to evaluate clinically and radiographically the effectiveness of pulpotec and mineral trioxide aggregate (MTA) on the radicular pulp tissue of the primary molars after pulpotomy procedure and compare the results of the tested materials with that of formocresol (FC). Materials and methods Pulpotomy was performed on 90 lower primary molars in 30 children aged 4–8 years then were randomly divided into three treatment groups of 30 molars for each group. Group I: the pulp was treated with Pulpotec. Group II: the pulp was treated with MTA. Group III: the pulp was treated with FC. All treated molars were covered with stainless steel crowns. Clinical evaluation and standardized periapical radiographs were done after 3, 6, and 9 months. Results The three groups were clinically successful as Pulpotec showed (100%) success rate, MTA showed (100%) and FC showed (92.9%) success rate. There was no statistically significant difference (P > 0.05) between the three groups regarding to their clinical performance. While the radiographic examinations showed that Pulpotec had the highest radiographic success rate (100%) in comparison to MTA and FC (92.9, 78.6%, respectively) with statistically significant difference between the three tested materials (P > 0.05). Conclusion Pulpotec and MTA may be promising materials as pulpotomy agents in primary molars.

Background: The management of immature central incisors with nonvital pulp is a challenge for dentists because the goals and criteria for successful root canal treatment are difficult to achieve. A necrotic immature root canal system accompanied by apical periodontitis cannot be disinfected by standard protocols with the aggressive use of endodontic files. This case report demonstrated the advantages of pulp revascularization as a treatment method for necrotic immature teeth based on clinical and radiographic outcomes. Case Report: The patient was an 11-year-old boy with a history of trauma to the upper left central incisor who was treated with a revascularization procedure. Clinical and radiographic evaluations showed nonvital pulp, asymptomatic apical periodontitis, and mucogingival swelling before treatment. At the 1-, 3-, and 6-month follow-up visits, the patient's teeth remained asymptomatic and well-functioning. There was a slight thickening of the tooth wall and loss of lesions, although total closure of the apical foramen was observable. Longer clinical and radiographic controls are needed to evaluate the success of this case.Conclusion: Revascularization is a procedure that promotes thickening of the dentinal wall and closure of the apical foramen, thereby preventing teeth from becoming weak. The minimum expectation of revascularization treatment is the absence of undesirable signs and symptoms, but the ultimate goal is full regeneration of the pulp complex and ideal root development.

Dental trauma is an ordinary complication in childhood period. Most of the traumas are crown fractures in the permanent dentition. Complicated crown fracture, introduced as a crown fracture accompanied by pulp exposure. Treatment plan and long-term prognosis could be modified by different factors, such as fracture line position, root development, alveolar bone fracture, and occlusion. In traumatized open apices teeth, apexogenesis can be occurred after traumatic exposure by vital pulp therapy procedures such as pulp capping, partial or complete pulpotomy in pertinent to the size of the exposure. In this complicated crown fracture case, cervical pulpotomy was performed with a silicate-based biomaterial. Patients smile and esthetic demands play an important role in the perception and judgment that people have of others appearance and character. To reconstruct the patient's smile line, the adhesive reattachment of the coronal fractured fragment to the remaining tooth structure was planned. Reattachment could be suggested as an ideal treatment procedure for crown fracture cases. This technique could be applied to achieve excellent esthetic outcomes and normal function. At 1-year follow-up visit, the patient had no complaints of pain. The clinical and radiographic examination showed a stable reattachment and good periodontal health. Apex diameter was decreased significantly. Physiological root-end closure was obvious. Secondary dentin and calcific barrier were also observed on the radiograph below the Biodentine layer.

Background: The success in endodontic therapy is dependent largely on the absolute elimination of pulp tissue remnants and the maximum reduction of pathologic microbial load present within the root canal system. Aim: The aim of this in vitro study was to compare and evaluate the ability of pulp tissue dissolution with and without activation of 5.25% sodium hypochlorite (NaOCl). Materials and Methods: Pulp tissue samples collected from intact, noncarious extracted third molars were standardized to 8 mg in each group. These samples were placed in conical Eppendorf tubes of 15 ml with 10 ml 5.25% NaOCl for 4 min and were activated suitably according to the group specifications. All the procedures in this study were carried out at room temperature. The preweighed pulp tissue samples were further weighed again after the dissolution phase, and residual weight loss in each group along with its percentage was obtained. The results were then statistically analyzed using one-way analysis of variance and Tukey post hoc test. Results: The maximum amount of pulp tissue dissolution was found in the laser-assisted irrigation group, i.e., NaOCl with Er, Cr: YSGG (P Conclusion: Within the limitations of the study, laser-assisted irrigation with a radial firing tip (NaOCl activated by Er, Cr: YSGG) was the most effective in dissolving the pulp tissue in comparison with other groups. The ultrasonic activation also showed a considerable amount of pulp tissue dissolution comparable to laser-activated irrigation in this study.

Preserving the natural dentition in its normal form and function is one of the major goals of endodontic treatment. Re-establishing the lost vitality and development of root maturation in immature permanent teeth with pulp necrosis/apical periodontitis is quiet challenging clinically. The very basis of regenerative endodontics relies on the concept of tissue engineering using stem cells, biomimetic scaffold, and bioactive growth factors to regenerate the pulp tissue damaged by microbial infection, injury, or developmental defects. In clinical endodontics, this approach is referred to as a “paradigm shift.” Even though repair instead of true regeneration is achieved with current protocols, it is hoped that further research in the area of stem-cell-based tissue engineering will allow for true regeneration and improved treatment outcomes. The aim of this review is to discuss about the various aspects of regenerative endodontics, current clinical protocols, and the future of pulp regeneration techniques.

Dentin dysplasia (DD) is a rare autosomal dominant disorder of dentin development, which is generally divided into two types based on the clinical and radiographic appearance of the affected dentinal tissues: Type-I (Radicular DD) and Type-II (Coronal DD). This paper reports the case of a 17-year-old female patient with both classical and atypical features of radicular DD in the permanent dentition. The present case shows clinically normal appearing crowns, localised mobility in the maxillary teeth, completely obliterated pulp chambers, widened root canals without any obliterations and the presence of multiple periapical radiolucencies. The clinical and radiographic findings observed in this present case report are different from those reported in the past literature, which suggests that the present case could be a variation of radicular DD.

This is a case of swelling originating from dens invaginatus associated with lateral incisor, misdiagnosed as a globulomaxillary cyst. The initial diagnosis of globulomaxillary cyst was made solely from radiographs by observing a reverse pear-shaped radiolucency between the lateral incisor and cuspid. The results following pulp testing and Cone Beam Computed Tomography (CBCT) evaluation revealed the endodontic origin of the lesion, which entailed the treatment carried out by surgical enucleation and apicoectomy. This also details the clinical and diagnostic dilemma as well as conflicts associated with the diagnosis and management of the cystic lesion.

Odontogenic keratocyst (OKC), a rare, locally aggressive developmental cyst, is found incidentally on dental radiographs, most commonly in the posterior mandible. When it occurs in the periapical region in association with nonresponding teeth to pulp sensibility tests, it is often misdiagnosed as other endodontic lesions such as radicular cyst, lateral periodontal cyst and dentigerous cyst. This case report describes the rare occurrence of OKC in the anterior mandibular region managed successfully with endodontic treatment and re-interventional surgery in a conservative approach. This case report also emphasizes on the importance of histopathological examination of the surgically excised tissue specimens as the clinical, radiographic and histopathological correlations are essential for successful treatment.

Calcium hydroxide (Ca(OH)2) is the gold standard material used for pulp-capping but still has a high failure rate. Thus, an alternative material is needed, one of which is propolis. The combination of Ca(OH)2propolis is expected to have better quality and to be biocompatible. The aim of this study is to investigate the viability of human pulp fibroblast after the administration of Ca(OH)2, propolis, and its combination. Human pulp fibroblast culture derived from premolar teeth of 16-year-old patients, were divided into seven groups: Group 1 (10 μg Ca(OH)2); Group 2 (10 μg propolis); Group 3 (15 μg propolis); Group 4 (20 μg propolis); Group 5 (Ca(OH)2-propolis 1:1); Group 6 (Ca(OH)2-propolis 1:1.5); and Group 7 (calcium hydroxide-propolis 1:2). They were placed in a 96 wells plate and put into incubator for 24 h. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide test was conducted to calculate the viability of human pulp fibroblasts. The data were analyzed statistically using Kolmogorov–Smirnov, Levene's test, one-way analysis of variance, and Tukey-honestly significant difference (P < 0.05). The number of living human pulp fibroblast after the administration of Ca(OH)2and propolis combination is greater than the application of Ca(OH)2or propolis with significant different between groups (P < 0.05). The viability of human pulp fibroblasts after the administration of Ca(OH)2-propolis combination is greater than that of the application of Ca(OH)2and propolis alone.

Success of endodontic therapy is dependent on multiple factors such as thorough preoperative evaluation, magnification and isolation techniques, complete debridement of diseased pulp tissue with disinfection of the canal and three-dimensional obturation. The process of root formation can be hampered in young permanent teeth due to trauma. Endodontic treatment of such cases with open apex is a challenge and retreatment in such cases is an even bigger challenge. Use of contemporary materials such as mineral trioxide aggregate, thermoplasticized gutta percha, and magnification in the form of a dental operating microscope can help in achieving predictable and long-term success in such cases.

Mineral trioxide aggregate (MTA) has the advantage of being less soluble than calcium hydroxide and offers an enhanced seal due to its setting expansion which hermetically seals the pulp space, preventing bacterial contamination from the outside. The use of MTA as an alternative material to calcium hydroxide for apexification has gained popularity. This case report presents the use of MTA as an apical plug for an open apex central incisor with periapical lesion.

Background: The natural transition from neonatal deciduous teeth to adult permanent teeth is a physiological phenomenon. Miura et al. reported the isolation and characterization of stem cells from the pulp of human exfoliated deciduous teeth (SHED). The great majority of current stem cell therapies use human adult stem cells. Since adult stem cells are multi-potent. SHED have demonstrated to have the capability to differentiate into osteogenic and odontogenic cells, adipocytes, and neural cells. When transplanted in immunocompromised mice, SHED were able to form bone. In addition, SHED have been able to differentiate into functional odontoblast and angiogenic endothelial cells. Aims and Objective: There are two objectives in our study; First, we want to confirm that SHED cells differentiate into osteogenic and neurotic cells. Second, we shall also examine whether SHED stem cells can also differentiate into cardiomyocytes. Material and Method: SHED stem cells are subjected to cardiomyogenic, neurogenic, and osteogenic induction treatment. The treated cells are the subjected to real time PCR and mmuno-histochemical analysis. The presence of calcium deposits with Alizarin Red S staining for SHED cells treated with osteogenic media was used to confirm osteogenic differentiation. Results: Our study confirmed that SHED cells differentiate into osteogenic and neurotic cells. For the first time we showed that SHED cells can also differentiate into cardiomyocytes. Conclusion: Due to their potentials and its neural crest origin, SHED are an ideal stem cell source for tissue regeneration.

The upper deciduous incisors are frequently the teeth most commonly affected either by dental caries or due to the impact of trauma. In such cases, there may be complete coronary destruction of teeth. As they erupt around 7½–9 months of age and the roots only complete at approximately 18–24 months, pulp involvement may occur even before the end of this process. Hereby, we highlight the case of a 15-month-old male patient who reported with a history of trauma. Treatment plan of apexification was made after confirming with multiple radiographs. Root-end closure was obtained after a period of 7 months.

Aim The aim was to clinically and radiographically evaluate mineral trioxide aggregate (MTA) and TheraCal LC as direct pulp capping (DPC) materials. Materials and methods Twenty male patients aged 17–35 years with immediate mechanical pulp exposure in lower molars were randomly divided into two equal groups (n = 10). Group 1: pulp exposures were capped using MTA. Group 2: pulp exposures were capped using TheraCal LC. Immediately after DPC, a base-line digital bitewing and periapical radiographs were taken. Clinical evaluation was performed at 1, 4, 12, and 24 weeks after DPC for presence/absence of spontaneous pain, tenderness to percussion, draining sinuses and pulp response to thermal pulp vitality test. At 24 weeks after DPC, digital periapical, and bitewing radiographs were taken. Digitalized bitewing radiographs were submitted to image analysis software to measure dentin bridge thickness in comparison to the base-line bitewing radiographic image. Digitalized preoperative and postoperative periapical radiographs were submitted to the same software to evaluate changes in the width of periodontal ligament space. Results Clinically, all cases showed criteria of successful treatment except 3, four cases in groups 1 and 2, respectively. Statistical analysis revealed no statistically significant difference between both groups (P > 0.05). All of the thirteen cases that were available for evaluation after 6 months showed dentin bridge formation. In MTA group, the mean value of dentin bridge formed was higher than in TheraCal LC group with no statistically significant difference (P = 0.710). Changes in the width of periodontal ligament space were not significantly different between both groups recording (P > 0.05). Conclusion Clinically and radiographically, MTA and TheraCal LC are favorable materials for DPC inducing adequate dentin bridge formation and minimal widening of periodontal ligament space.

The maxillary canine is usually single-rooted with a single canal, and deviations from this norm are relatively rare. This article presents a case of endodontic management of a maxillary canine with two root canals in a single root, and use of Cone Beam Computed Tomography (CBCT) to confirm the same. The article further highlights the importance of negotiating and cleaning the anticipated pulp space, along with aberrations, for a successful endodontic treatment.

Perforated peptic ulcer (PPU) is one of the most common non-traumatic emergency cases in the emergency unit, and have a high mortality rate, more than 70% in the elderly. Accurate and early identification of high-risk surgical patients with PPU is important for triage and risk stratification. The objective of this study was to evaluate the mortality in patients with operated PPU. Methods: Between January 2015 to December 2016, 50 consecutive patients with PPU who performed laparotomy were studied retrospectively. This study was a diagnostic test to evaluate the validity of PULP (Peptic Ulcer Perforation) score to predict mortality in patient with operated PPU and determine the best cut-off point. Presentation ? or < 24 hours, age of 65 years old, the presence of preoperative shock, ASA score, the presence of AIDS or active malignancy, liver failure, concomitant use of steroids and serum creatinine > 14.7 g/dL were evaluated in PULP score. Results: The cut-off point for PULP the score in the present study is > 7, based on the optimal cut-off value, patients could be divided into low-risk patients (a score of < 7 points), and high-risk patients (a score of > 7 points). PULP score had 91.7% sensitivity, 65.4% specificity, and 78% accuracy in this study. Positive predictive value and negative predictive the values were 71% and 89.9%. Conclusion: The PULP score is sensitive to predict the mortality risk in patients operated for perforated peptic ulcer and can assist in risk stratification and triage. Keyword: PULP score, perforated peptic ulcer, mortality Cite This Article: Kurniawati, I., Wiargitha, I.K., Mahadewa, T.G.B., Jeanne, B. 2019. Diagnostic validity of PULP (peptic ulcer perforation) score in predicting mortality in patient with operated perforated peptic ulcer in Sanglah Hospital- Denpasar. Neurologico Spinale Medico Chirurgico 2(1): 11-15. DOI:10.15562/nsmc.v2i1.143

Introduction: A persistent infection after cleaning and shaping root canal is the main etiology of root canal treatment failure. Enterococcus faecalis has been considered as one of the most resistant species in root canal treatment. E. faecalis can stimulate receptor activator of nuclear factor-kappa B ligand (RANKL) which can increase nuclear factor of activated T-cell (NFATc1) in chronic apical periodontitis. East Java propolis has antibacterial effects and is biocompatible with in vitro effects. Aim: This study is aimed to analyze the East Java propolis extract as potential intracanal medicament in chronic apical periodontitis caused by E. faecalis bacterial infection. Materials and Methods: This study used 30 Wistar rats divided into three groups. In Group I, the first upper right molar tooth as healthy tooth was used for negative control group. In Group II, the first upper right molar tooth was used for a prepared root canal, and 10 ml brain heart infusion broth containing E. faecalis ATCC29212 106 CFU was injected into the canal and restored with glass-ionomer cement (GIC) for the experimentally induced chronic apical periodontitis group. In Group III, after root canal preparation, E. faecalis ATCC 29212 106 CFU was injected, and then, 10 μl propolis applied and tooth restored with GIC. It took 21 days for the periapical lesions to develop after pulp infection. The rats were then sacrificed to conduct immunohistochemical examinations in order to measure the expressions of RANKL and NFATc1. Results: The average of RANKL and NFATc1 expression in Group III was significantly lower than those in the experimentally induced chronic apical periodontitis group (P < 0.05). Conclusion: It can be concluded that East Java propolis extract is a potential intracanal medicament through the study of experimentally induced chronic apical periodontitis caused by E. faecalis infection in Wistar rats.

Aims and Objectives: Both carious and non-carious lesions covering large dentine areas are indisputable indications of the need to use dentine bonding. Clinically, dental preparation, which is subsequently subjected to dentine bonding application often results in post-restorative pain. Various studies suggest that post-restorative pain is caused by the presence of residual monomers from the imperfect polymerization of a bonding material. The residual monomer can be a free radical that will induce oxidative stress conditions producing a toxic effect on 4-methacryloxyethyl trimellitic anhydride (4-META) monomer as the base material of dentine bonding. The aim of the study was to determine the toxic concentration of 4-META dentine bonding material using acetone as a solvent that destroys 50% of the dental pulp fibroblast cells. Materials and Methods: Human pulp fibroblast cells contained in each well were treated with 4-META-acetone solution at concentrations of 5000, 2500, 1250, 625, 312.5, 156.25, 78.12, 39.06, 19.53, and 9.76 μg/mL. Two wells were left untreated to form the control group. A cytotoxicity test was performed by means of an 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT)-assay test. The optical density of each well was measured with an enzyme-linked immunosorbent assay (ELISA) reader and the percentage of human pulp fibroblast cell destroyed was calculated using the appropriate formula. Results: The concentration of 4-META-based dentine bonding with acetone solvent capable of causing 50% human pulp fibroblast cell death(LC50) was 1250 μg/mL. Conclusion: Toxic concentrations are those greater than or equal to 1250 μg/mL.

Purpose: Sex determination becomes the first priority by a forensic investigator in the process of identification of bodies mutilated beyond recognition due to mass disasters. Sex-determining region Y (SRY) gene is used as a sex-typing marker as the results are said to be 100% accurate. Therefore, an experimental study was conducted to rule out the possibility of the presence of SRY gene in tooth pulp and dentin after being exposed to various environments. Materials and Methods: Twenty extracted teeth of known gender were taken, of which ten were male and ten were female. The tooth samples were subjected to various environmental conditions for 60 days. Results: Among the total twenty samples, DNA isolation was done from all the samples of pulp and dentin. Gender determination using SRY gene was correct in all the samples of the pulp, and no interpretation of SRY was possible from the dentin though the DNA was isolated. Conclusion: The present study has found DNA retrieval can be done from human teeth irrespective of the storage time and environmental conditions for forensic caseworks and SRY gene to be a reliable biomarker for sex determination from the pulp tissue of teeth.

Background: The purpose of this study was to compare the outcome of direct pulp capping by statins with α-tricalcium phosphate (α-TCP) and mineral trioxide aggregate (MTA) on pulp tissue of human teeth through histological evaluation. Aims: The aim of the present study is to compare the pulpal response of statins (simvastatin or atorvastatin) with α-TCP to that of MTA on human teeth by light microscopic histological evaluation. Materials and Methods: Ninety intact premolar teeth scheduled for orthodontic extraction were used for the study. Class 1 cavities were prepared, and the pulp was mechanically exposed under rubber dam isolation. The samples were divided into three groups of thirty teeth each (Group I – simvastatin + α-TCP, Group II – atorvastatin + α-TCP, and Group III – MTA), and the test materials were placed accordingly. After the experimental periods of 7, 30, and 90 days, the teeth were extracted atraumatically. The samples were then evaluated for the degree of inflammation, tissue damage, and hard tissue formation under light microscope, and they were scored based on the histopathologic findings. Statistical Analysis: The results were analyzed statistically using the Chi-square test. Results: There was no statistically significant difference between Groups I, II, and III in terms of inflammation, tissue damage, and hard tissue formation for all the three observation periods (P > 0.05). Conclusions: Simvastatin and atorvastatin with α-TCP were found to be effective in inducing dentin bridge formation which was comparable to MTA.

Odontomas are thought to be hamartomatous malformations in which enamel, dentin, and pulp, and occasionally cementum, is present in a disorganized form. It develops by the completely differentiated epithelial and mesenchymal cells that form ameloblasts and odontoblasts respectively. With no gender predilection and often asymptomatic, it is usually discovered accidentally on a routine radiographic study. They may be related with malformation, aplasia, malposition, delayed eruption of associated teeth and sometimes cystic changes. In these cases, Cone Beam Computed Tomography (CBCT) provides several advantages over conventional radiographs regarding diagnosis and treatment planning. Enucleation is the treatment of choice for these tumors and relapse is very uncommon. This paper highlights the etiology, classification, clinical/radiologic/histopathologic features and treatment options available for odontomas. Although much is known about odontomas but sometimes it presents as an enigma to a dental practitioner that needs to be unfolded with the use of radiography that acts as an indispensable tool in routine dental clinical examination.

Background: Given the side effects of formocresol as a common substance in dental pulpotomy, its substitution with a safe substance seems mandatory. Aim: To compare the clinical and radiographic success of Allium sativum oil and formocresol in the pulpotomy of the primary molars. Materials and Methods: A randomized, split-mouth, double-blind, controlled clinical trial was conducted on children with at least two asymptomatic primary molars requiring pulpotomy. A total of 90 teeth were examined in this study. They were randomly divided into two groups: the A. sativum (ALL) group (n = 45) and the formocresol (FC) group (n = 45). After pulpotomy, A. sativum oil was applied to the radicular pulp in the ALL groups and formocresol in the FC group. The pulp chamber was then filled with reinforced Zinc oxide Eugenol and finally restored by a stainless steel crown. Three and six months after the intervention, the teeth were evaluated by a colleague based on a modified criteria system. The results were analyzed using Wilcoxon’s test. Results: The clinical success rate was 100% in both groups after 3 and 6 months. The radiographic success rate in the ALL group and the FC group after 3 and 6 months was 82.2% and 80% and 88.9% and 84.4%, respectively. The difference between the two groups was not statistically significant (P = 0.46). Conclusion: According to the results of this study, A. sativum oil can be used in the pulpotomy of the primary molars.

Background: Acute exacerbation represents a painful condition whereby the tooth becomes highly sensitive to percussion and bite testing, and it can be aggravated by traumatic occlusion. In general, it results from earlier acute apical periodontitis. Bone destruction can be detected via a radiographic examination, and it can be seen as a radiolucent area at the periapex. Bone resorption is caused by osteoclast activation, which results from pulp inflammation. Nonsurgical endodontic treatment is typically performed to resolve the condition. This study aimed to provide an overview of both the treatment protocol and the role of 2% chlorhexidine gluconate as an endodontic irrigant. Case Report: A 38-year-old woman presented with a major complaint regarding tenderness in her lower second right premolar. The patient reported having experienced similar pain approximately 8 months previously. Clinically, the tooth had lost 50% of its coronal structure, which indicated a Class II cavity. Radiographically, bone resorption was detected in the periapical area of the tooth. An analgesic had been consumed for approximately 3 days. The cavity was cleaned and opened, and working length measurements were performed using an electronic apex locator and conventional radiography. Biomechanical preparation was done using ProTaper NEXTTM files, until size X3. Irrigation was performed using 5.25% sodium hypochlorite at each file change and continued with 17% ethylenediaminetetraacetic acid and 2% chlorhexidine for final irrigation. Sterile Aqua Dest was used for each irrigation change to avoid interaction between irrigants. Obturation was performed by means of warm vertical compaction with an epoxy resin-based sealer. An endocrown composite was recommended for permanent restoration. Four months of follow-up revealed bone regeneration and healing. Conclusion: Bone resorption is a common finding in a diseased tooth, and it stems from the persistent inflammatory process. Osteoclasts are responsible for both bone demineralization and activated pro-inflammatory cytokines. The correct endodontic treatment protocol plays an essential role in periapical bone healing.

Aim: The purpose of this study was to evaluate and compare clinically and radiographically PRF, MTA and Ca(OH)2 as a pulp dressing material in primary molars. Material and Methods: The study was conducted on 30 children between 6-9 years of age. Pulpotomy was performed using MTA(Gp I), PRF + MTA(Gp II) and PRF +Ca(OH)2(Group III). The teeth were evaluated clinically and radiographically after 1,3 and 6 months and were subjected to statistics analysis. Results: After 6 months follow-up the overall success rate was found to be highest in Gp I with success rate of 97% followed by Gp II 95% and Gp III 78.3%. The results were found to be statistically insignificant (P ≤ 0.05). Conclusion: All materials used in the present study were equally effective as the success rates are statistically insignificant.

Context: Comprehensive understanding of the anatomic position of pulp canal orifices and the measurements of the molar pulp space may maintain the pulp health during conservative tooth preparation and minimize the possibility of mishaps during endodontic therapy. Aims: The idea of the present study was to analyze the morphological measurements of anatomical landmarks in human maxillary first molar pulp chambers and evaluation of number of pulp canal orifices using three-dimensional spiral computed tomography (SCT). Subjects and Methods: One hundred and thirty extracted intact human adult maxillary first molars were chosen from the North Indian population and were analyzed using SCT in axial and coronal sections. Statistical Analysis Used: Standard deviation, mean, and coefficient of variance were calculated. Interobserver reliability was evaluated using kappa value to avoid any bias. Results: The results from our study showed that 69.23% of the sample teeth had four canal orifices, the mesial and distal pulp horns were present at an average distance of 0.80 ± 0.36 mm and 0.41 ± 0.34 mm, respectively, above the cementoenamel junction (CEJ), and the mean distance from the central groove of central fossa to furcation and the central groove of central fossa to the pulp chamber's roof was 8.37 ± 0.33 mm and 3.87 ± 0.29 mm, respectively. The average distance of the pulp chamber's floor from the furcation was found to be 2.47 ± 0.11 mm. The highest degree of variance was observed in case of relation of CEJ to pulp horns, i.e., 44.85% and 82.60%. Conclusions: The dimensions observed in this study and its resemblance to the various studies reported in literature shift the fundamental anatomic approach to a more systemic quantifiable approach to the endodontic maxillary first molar access preparation.

Background Despite the clinical and radiographic success of mineral trioxide aggregate (MTA) pulpotomy in primary molars, it does not gain much clinicians acceptance regarding manipulation difficulties. Aim This study aims to assess success rates of Biodentine and MTA used as pulpotomy agents in human primary molars, both clinically and radiographically. Patients and methods A split-mouth controlled clinical trial was carried out on 21 healthy, 3–7-year old children, with 42 pairs (84 molars) of contralateral mandibular primary molars indicated for pulpotomy. One paired tooth in one side was designated to Biodentine (group 1) and the other side for MTA (group 2) as a pulp medicament. All pulpotomized teeth were finally restored with stainless-steel crowns. Patients were monitored clinically and radiographically at 1, 3, 6, and 12 months. Results For all the patients available for the follow up appointments, Biodentine and MTA showed 100% success rate both clinically and radiographically. Conclusion Biodentine and MTA are highly recommended as pulpotomy medicaments in primary molars.

Background: A chronic apical abscess is defined as an inflammatory response to pulp infection and necrosis. It is identified by a step-wise onset, almost no discomfort, and the discontinuous release of pus through a related sinus tract. Radiographically, there are regular indications of bone destruction, such as radiolucency. The source of the infection in the root canal should be eradicated by root canal treatment. The main purpose of endodontic treatment is the finished debridement of the pulp tissue from the canal combined with the shaping and sufficient obstruction of the root canal system. This case report was written to show the proper management of a tooth with a chronic apical abscess and to reveal self-bone regeneration after treatment. Case Report: A 27-year-old woman complained of a cavity on her left lower back tooth, and she wanted it to be filled. There was a history of a fistula that appeared frequently in the gums near the decayed tooth. The radiographic examination showed that the caries had reached the pulp, along with a periapical lesion and bone destruction. The canals were prepared using a file instrument and irrigation with 5.25% sodium hypochlorite, 17% ethylenediaminetetraacetic acid, and 2% chlorhexidine gluconate. Calcium hydroxide paste was used as an intracanal medicament, and the canals were obturated using a continuous wave compaction technique. At the 4-month follow-up, healing of the periapical lesion and bone regeneration was evident. Conclusion: Adequate root canal treatment can result in the healing of periapical lesions and bone regeneration in chronic apical abscesses.

Background and Objectives: This study was done to estimate age using pulp/tooth area ratio (PTR) of permanent left mandibular first premolar on digital orthopantamograph (OPG) with a commercially available software. The estimated age was compared with chronological age of all subjects in different age groups and also in male and female subjects. Materials and Methods: 200 patients of differing ages visiting the outpatient department of our dental hospital were included as study subjects. The digital OPGs were imported to AutoCAD, commercial (Computer Aided Design) software program developed by Autodesk and then the PTR was derived. The estimated age was calculated using linear regression equation and then compared statistically. Results: Age was calculated using linear regression analysis. The results revealed decreased PTR with an increase in age. Application of this formula gave a standard error of 8.586 years. The effect of gender showed low correlation between PTR and age. Analysis of variance test was used to compare chronological and estimated ages in all three age groups and it was found to be closely related to each other. Interpretation and Conclusion: This study confirms a superior age estimation ability of the formula developed, inferring that customized formulas developed for the local population are better suited for age estimation.

Introduction Pulpotomy is a therapeutic procedure that consists of the surgical amputation of coronally inflamed pulp. The wounded surface of the radicular pulp is treated with a medicament or dressing agent to promote healing or to cause fixation of the underlying tissue. This in-vitro study assessed the cytotoxicity of different formulations of omega 3 as pulpotomy agents compared with formocresol (FC) on peripheral blood mononuclear cells. Materials and methods Different formulations were tested using 96-well plates. The optical density of neutral red extract was measured using spectrophotometer, using blanks which contain no cells as a reference. The data were analyzed by Kruskal–Wallis test at the level of significance set at 0.001. Results The results showed that FC, ZnO, and ZnO/Tw/Eth had cytotoxic effects with lower survival rate of cells. There was absence of cytotoxicity after incubation with ZnO/Tw/Eth/ω3, Tw/Eth, MC, and MC/Tw/Eth in comparison with control. Moreover, there was no cytotoxic effect in cases of MC/Tw/Eth/ω3 and Tw/Eth/ω3, which showed higher survival rate of normal cells. Conclusion Omega 3 has no cytotoxic effects on viable cells, and it diminishes the toxic effect of ZnO when formulated with it and enhanced the effect of methylcellulose when compared with the cytotoxic FC.

Introduction: The most accurate method for evaluation of pulpal status is histological examination. Unfortunately, it is clinically inapplicable. The goal of our work is to focus on in situ observation, which is proven to be a historically reliable and clinically applicable means. Materials and Methods: This is a 22-month prospective cross-sectional epidemiological study of 133 cases. For each case, the initial pulpal diagnosis is confronted with the in situ observation. The initial pulpal diagnosis is either retained or corrected according to the in situ observation. Results: The Chi-squared test gave a value of P < 0.005; no correlation is observed between the initial pulpal diagnosis and the final diagnosis (After the in situ observation). Conclusion: Histologically, when the pulp is irritated, a vascular reaction is observed. This reaction will influence the color and the flow of pulp blood. This blood changes can be detected with the naked eye which led us to propose a classification of the different in situ observations to refine the initial pulp diagnosis.

BACKGROUND: Mucositis, one of the devastating consequences of chemotherapy and also limits the efficacy of the treatment. At present, there are no antimucositic agents without side effects. Hence, there is a need for better adjuvant therapy using plant or food sources. Here, we have made an attempt to study the effect of Annona muricata (AM) fruit pulp on etoposide-induced mucositis. MATERIALS AND METHODS: The study was conducted at Central Research Laboratory, Kasturba Medical College, Mangalore. The effect of AM fruit pulp (100 mg and 200 mg/kg body weight) on etoposide-induced mucositis was studied in Wistar rats (n = 36) in comparison with normal and AM controls. Intestinal tissue was collected for histology and estimation of total antioxidants (TAO), glutathione (GSH), myeloperoxidase (MPO), and nitric oxide (NO) levels along with histological changes were studied. Statistical analysis was performed by one-way analysis of variance. RESULTS: TAO and GSH levels were found to be significantly high in the rats which received 200 mg of AM/kg body weight than 100 mg of AM/kg body weight when compared with etoposide control. The levels of inflammatory markers - MPO and NO - were found to be decreased (P < 0.001) in the animals received 200 mg/kg body weight of AM in comparison with etoposide group and lower dosage of AM pulp. Histology of intestine also showed a protective effect of AM (200 mg/kg body weight) against etoposide toxicity. CONCLUSION: The results show that AM fruit pulp has the capacity to act as antimucositic agent and also reduced inflammation.

Dens invaginatus (DI) is one of the rare malformations of teeth which results from an infolding of the dental papilla during the development of teeth. This defect gives rise to a possible communication between the pulp and oral environment, thereby increasing the susceptibility to caries, pulpitis, and pulp necrosis. Thus, early detection and conservative management of this invaginatus is of utmost importance. The present case series describes a conservative endodontic treatment technique for the management of teeth with Type II DI using a guided endodontic approach with three-dimensional printed surgical stents. This technique provides a precise and minimally invasive approach in the conservative management of DI, without compromising the vitality of main pulpal tissue.

Background: Indirect pulp therapy (IPT) is conventional treatment of deep dentinal carious lesions without risk of pulp exposure. Development of new biomaterials with biocompatibility and seal has changed the attitudes toward IPT. Aim/Objectives: This study was conducted to evaluate and compare the clinical and radiographic success of biodentine, 2% chlorhexidine gluconate with resin-modified glass ionomer cement (RMGIC), and calcium hydroxide as indirect pulp-capping materials in primary molars over an observation period of 12 months. Materials and Methods: A total of 54 primary molars within the age group of 3–9 years, which were indicated for IPT were randomized into three groups of 18 samples each; Group I: biodentine, Group II: 2% chlorhexidine gluconate followed by RMGIC, Group III: calcium hydroxide (Dycal). These cases were followed up for evaluation clinically and radiographically at 3, 6, and 12 months. The recorded data were subjected to statistical analysis using Chi-square test. Results: After 12 months, the clinical and radiographic success of biodentine group was 100% (18/18), with 2% chlorhexidine gluconate disinfecting solution followed by RMGIC was 94.4% (17/18) and calcium hydroxide (Dycal) was 94.4% (17/18), failures included one at 3 months with RMGIC and another at 12 months with calcium hydroxide group; but there was no statistically significant difference observed between them with P = 0.361 at 3 months and P = 0.371 at 12 months interval. Conclusion: Biodentine can be effectively used as indirect pulp-capping medicament in primary teeth which has similar clinical and radiographic success as 2% chlorhexidine gluconate in conjunction with RMGIC and calcium hydroxide.

Introduction The fracture of front teeth is one of the routine presentations of traumatic injuries. The treatment of a fractured tooth involving the pulp includes root canal therapy and post placement followed by core build-up or by the extraction of the fractured tooth if it is not restorable. Case Presentation We report a case of an adult male who had traumatized both his maxillary central incisors following a blow experienced during domestic violence. He had lost a fractured fragment of the right central incisor, while the left incisor had complicated fractures with fragments retained attached to the soft tissue. Following radiovisiography (RVG), both incisors were conservatively treated in a single visit by reattachment and post and core techniques. Conclusions The treatment reported for reattachment of the tooth fractures and post and core techniques are reasonably easy while providing immediate and lasting results in patients’ regaining of social confidence and functionality.

Purpose Odontomas, one of the most common benign odontogenic tumors of epithelial and mesenchymal origin, are actually hamartomas or developmental anomalies composed of enamel, dentin, cementum and pulp tissue. Clinically, they may be classified as intraosseous and peripheral odontomas. Very rarely, intraosseous odontomas may erupt into the oral cavity and are termed as erupted odontomas. Although most of the odontomas are asymptomatic, yet these are often associated with tooth eruption disturbances and malocclusion. Presented are two variant forms of compound odontomas, one intraosseous and the other erupted odontoma, causing impaction of permanent teeth and malocclusion in children.

Dentin dysplasia (DD) type I is a hereditary disturbance in dentin formation. In this anomaly, the teeth generally appear clinically unremarkable with normal crowns; and radiographically it is characterized by normal appearing crowns, absence or severe restriction of root formation, obliterated pulp chambers, and periapical radiolucencies without an obvious cause. Clinically, the teeth can be poorly aligned, drifting and mobile, and can prematurely exfoliate due to abnormal root formation. This condition is rarely encountered in dental practice. Little is known about the specific treatment of this disorder and management of patients with DD has presented with problems. This report documents a case of DD type I in a 19-year-old male and the clinical, radiographic, and histopathologic findings of this condition and treatment are described.

Aims and Objectives: Direct pulp capping is a procedure which aims at protecting pulp vitality. When the dental pulp is exposed as a result of trauma, caries or by the dentist preparing for a deep restoration, then, it can be capped with a biocompatible material. It is expected that this procedure was allowed the pulp to heal normally and regenerate reparative dentine, thus preventing the need for more extensive and expensive root canal treatment (RCT). Materials and Methods: A total of 86 teeth of 85 patients diagnosed with reversible pulpitis were included in this study. After administration of local anesthesia, teeth were isolated with rubber dam. Mineral trioxide aggregate (MTA) was mixed according to manufacturers' instructions and 1–2 mm of MTA was placed over the pulpal exposure with a plastic filling instrument. All patients were scheduled for routine recall visits after 1, 3, and 6 months to monitor for pain on visual analog scale. All these readings were recorded on pro forma. The collected data were entered into SPSS version 19 and analyzed accordingly. Mean and standard deviation was calculated for quantitative variables like age. Frequency and percentage were calculated for qualitative variables such as the efficacy of MTA and gender. Stratification with respect to age and gender was done. Poststratification Chi-square test was applied. P ≤ 0.05 was considered statistically significant. Results: The average age of the patients was 37.59 ± 10.88 years. There were 30 (35.29%) male and 55 (64.71%) female. The effectiveness of MTA as a direct pulp capping material in cariously exposed mature permanent teeth was observed in 87.06% (74/85). Conclusion: Taking into consideration, the results of this study, it seems that when an exposure site is immediately sealed with MTA, the prognosis is promising. We found success rate of 87.06%. MTA can induce the formation of reparative dentine thus allow the pulp to heal normally and maintain pulp's vitality and regenerative potential so the need of RCT can be avoided.

Apexification is the process of induction of calcific barrier across the open apex or the continued apical development in an immature tooth with infected necrotic pulp. The presented case was of a 19-year-old male patient with discolored and fractured upper front left tooth and open apex. Immature permanent teeth pose difficulties during endodontic treatment because of the wide-open root apex and thin dentin walls. This article describes single-visit apexification using Biodentine, a new calcium silicate-based material as an apical barrier along with platelet-rich fibrin as internal matrix.

The procedure of regeneration has shown promising results in the treatment of nonvital teeth with immature apices. However, the tissue being regenerated can only be confirmed through histological examination. This report describes an immature nonvital 12 with apical pathology which was treated via revascularization using 3% NaOCl and 17% ethylenediaminetetraacetic acid as irrigants; Ca(OH)2 as intracanal medicament and platelet-rich fibrin (PRF) as scaffold. On follow-up at 6 and 12 months, healing of periapical lesion, dentinal thickening, and apical closure with a canal exit forming distally were evident. The tooth, however, got fractured and was subsequently extracted at 12 months and sent for histopathological examination. It was revealed that a collagenous matrix for forming hard tissue similar to acellular cementum with a diffuse area of calcification could be seen in pulp space being attached with root canal dentin walls, suggesting that PRF may yield favorable outcomes in regenerative endodontic procedures.