Synthetic composites versus calcium phosphate cements in bone regeneration: A narrative review.

BACKGROUND: When the natural process of bone remodeling is disturbed, the need arises for a stimulant material in order to enhance the formation of a new healthy and strong osseous tissue to replace the damaged one. Recent studies have reported synthetic biomaterials to be a very good option for supporting bone regeneration. STUDY DESIGN: Narrative review. OBJECTIVE: This review aims to provide a brief presentation of two of the most recently developed synthetic biomaterials, i.e. calcium phosphate cements and synthetic composites, that are currently being used in bone regeneration with promising results. METHODS: Literature searches using broad terms such as "bone regeneration," "biomaterials," "synthetic composites" and "calcium phosphate cements" were performed using PubMed. The osteal cells state of the art was explored by searching topic-specific full text keywords using Google Scholar. CONCLUSIONS: Synthetic polymers such as PCL (poly-ε-caprolactone) and PLGA (poly lactic-co-glycolic acid) can improve the effectiveness of biomaterials like HA (hydroxyapatite) and BG (bioglass). Calcium phosphate, although being a suitable material for stimulating bone regeneration, needs an adjuvant in order to be effective in larger bone defects.

Shaping Efficiency of Rotary and Reciprocating Kinematics of Engine-driven Nickel-Titanium Instruments in Moderate and Severely curved Root Canals Using Microcomputed Tomography: A Systematic Review of Ex Vivo Studies.

INTRODUCTION: This systematic review aimed to compare reciprocating with continuous rotary instrumentation kinematics, by means of microcomputed tomography evaluations, in extracted human permanent teeth with moderate and severe canal curvatures. METHODS: The research protocol was registered in the International Prospective Register of Systematic Reviews and given the reference number CRD42023404035. An electronic search was undertaken in MEDLINE (PubMed), EBSCO, Scopus, Web of Science databases until December 2021. Manual screening of issues in endodontic journals and references of relevant articles were assessed individually. The risk of bias (RoB) of the included articles was evaluated with the QUIN tool (Quality Assessment Tool for In Vitro Studies). RESULTS: Among 1640 retrieved articles, 49 were included in the qualitative synthesis. Fifteen articles had low RoB, 33 articles had medium RoB, and only 1 study was at high RoB. Continuous rotary systems had better centering ability in both moderate and severe canal curvatures and resulted in less apical transportation in severely curved root canals. None of the kinematic systems was capable of instrumenting the entire canal surface area. Reciprocating kinematics systems tended to provide higher increase in surface area of severely curved canals and produced fewer dentinal microcracks in moderately curved canals. CONCLUSIONS: The evidence presented in this review suggests that continuous rotary system seems to be better than reciprocating system in solving the major issues encountered during root canal instrumentation of extracted teeth with moderate and severe curvatures.

Growth factors and beta-tricalcium phosphate in the treatment of periodontal intraosseous defects: A systematic review and meta-analysis of randomised controlled trials.

OBJECTIVE: To evaluate the effectiveness at different points in time, of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) coated onto a beta-tricalcium phosphate (ß-TCP) carrier compared to ß-TCP alone, or to recombinant human growth/differentiation factor-5 (rhGDF-5) adsorbed onto a ß-TCP scaffold in intraosseous periodontal defects. DESIGN: A digital search for randomised controlled trials (RCTs) was conducted on MEDLINE/PubMed. The quality of reporting and the risk of bias of the included RCTs were assessed using the CONSORT guidelines and the Cochrane risk of bias tool. The difference between the means of the outcomes at baseline and at follow-up for each group was tested using the Student's t-test for paired samples. The difference between the means of the outcome changes at follow-up between groups was analysed using the Student's t-test for two independent samples. Prior to each analysis a test of homogeneity of variances (Ansari-Bradley) was performed. RESULTS: From 11 articles assessed for eligibility, 5 RCTs were included in this review. The risk of bias was considered to be low in 2 articles, medium in 1 study and high in 2 studies. CONCLUSIONS: In the treatment of periodontal intraosseous defects the application of rhPDGF-BB/ß-TCP improved all outcomes when compared to ß-TCP at 6 months follow-up. Either rhPDGF-BB/ß-TCP or rhGDF-5/ß-TCP seemed to provide similar results in terms of probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain. The application of rhGDF-5/ß-TCP resulted in a more pronounced reduction in gingival recession (GR) depth at 6 months follow-up compared to rhPDGF-BB/ß-TCP.

Osteotome-mediated sinus floor elevation: a systematic review and meta-analysis.

PURPOSE: The objectives of this study were to systematically review the literature regarding sinus floor elevation using osteotomes with respect to the timing of implant placement, implant characteristics, grafting materials, and intraoperative and postoperative complications and to perform a meta-analysis to determine the influence of initial residual bone height (RBH) on implant success. MATERIALS AND METHODS: A systematic search of articles was conducted on MEDLINE and manually to identify studies of sinus floor elevation using osteotomes. Strict inclusion criteria were applied. The mean observation period was ≥ 1 year after functional loading of implants. The quality of the included papers was assessed using the Newcastle-Ottawa Scale for observational studies and the PEDro Scale for randomized clinical trials, and the heterogeneity of the papers included in the meta-analysis was evaluated. The statistical accuracy was tested using the Cochran C test, and the relationship between initial RBH and implant success was analyzed using the Student t test Welch variant. RESULTS: Twenty-five studies published over a period of 13 years met the inclusion criteria; 15 were retrospective, 9 were prospective, and 1 was a randomized controlled trial. The included articles comprised 3,092 inserted implants with a failure rate of 3.85%. Of the 25 included studies, 8 were selected for the meta-analysis. RBH > 4 mm did not influence implant success/failure; however, there was a significant difference between the success/failure rates of implants, inserted in combination with sinus floor elevation using osteotomes, when the initial RBH was < 4 mm. CONCLUSION: Initial RBH of less than 4 mm influenced the success rates of implants inserted in combination with sinus floor elevation using osteotomes.