Root canal therapy (RCT) is the primary treatment modality for pulpal and periapical diseases. Although the fundamental objective of RCT has remained unchanged for over a century, its technical details have been continuously refined and transformed. Preoperative diagnostic approaches have evolved from two-dimensional imaging to three-dimensional volumetric reconstructions and, more recently, to artificial intelligence-assisted analytical frameworks. Treatment modalities have progressed from manual instrumentation to motor-driven systems and guided or robotic-assisted interventions. Disinfection strategies have also begun to shift from passive chemical irrigation towards actively guided nano-enabled systems. Moreover, obturation materials have advanced from inert substances to bioactive compounds and, prospectively, to adaptive trends. These transitions reflect not only technological progress but also the continuing efforts of endodontists to improve precision, safety, efficiency, and biological outcomes. However, the primary goal of RCT remains the effective elimination of infection and the prevention of reinfection. In this review, the term 'Smart RCT' is used as a conceptual framework that integrates digital intelligence, engineering-based operative assistance, and material-based biological functions. We systematically synthesise contemporary evidence on the development and application of smart technologies across the major stages of RCT. By critically evaluating both the potential and current limitations of these technologies, this review aims to provide an evidence-based perspective on the integration of intelligent advances into contemporary endodontic decision-making and clinical practice.

Abstract Root canal obturation has evolved over the past two centuries with the advancement in root canal instrumentation and irrigation, as well as endodontic microbiology, biomaterials science and regenerative medicine. Traditionally, obturation was regarded as a mechanical procedure aimed at filling and sealing the disinfected root canal system with inert materials to prevent bacterial leakage and reinfection. The introduction of gutta-percha and root canal sealers established the foundation of modern obturation, while subsequent developments focused on improving sealing ability, dimensional stability, adaptability, and clinical handling through techniques such as lateral condensation, warm vertical compaction, thermoplasticized injectable systems, carrier-based obturation, and contemporary single-cone techniques. However, increasing understanding of biofilm-mediated infection has shifted emphasis toward effective disinfection and biological healing rather than obturation technique alone. The emergence of calcium silicate–based bioceramic sealers and other smart biomaterials has further transformed obturation concepts by introducing bioactive, antimicrobial, mineralizing, and regenerative properties. In addition, regenerative endodontic procedures and tissue engineering strategies have challenged the traditional requirement of canal filling by demonstrating that biologic tissue ingrowth may achieve favorable outcomes under appropriate conditions. Collectively, these developments indicate that obturation is evolving from a passive space filling procedure into a future biologically responsive and patient-specific therapeutic strategy.

Vital pulp therapy (VPT) seeks to preserve pulp vitality by using biocompatible with regenerative potential. This study tested the hypothesis that an injectable gelatin methacryloyl (GelMA) hydrogel containing piezoelectric barium titanate promotes odontogenic differentiation of dental pulp stem cells (DPSC) significantly better than a commercially available tricalcium silicate material used for vital pulp therapy. First, the light-curable, injectable piezoelectric hydrogel was engineered and characterized for its physicomechanical, piezoelectric properties and biocompatibility to DPSCs. The effect of this gel on the odontogenic differentiation of DPSCs was determined by measuring the expression level of key genes, compared to Biodentine XP. The hydrogel exhibited excellent injectability (<1 kgf of force), mechanical stability, and generated physiologically relevant voltages under cyclic loading mimicking mastication. MTT and ROS assays show no cytotoxic or damaging oxidative stress effects. When DPSCs were cultured over the materials under cyclic loading, the piezoelectric hydrogel significantly enhanced cell viability and upregulated COL1A1, DSPP, and DMP1 expression compared to Biodentine XP and non-piezoelectric hydrogel controls. These findings establish piezoelectric hydrogel as a self-powered, bioactive platform that converts physiological forces into regenerative bioelectric cues, offering a promising next-generation material for vital pulp therapy.

In breast cancer grading, the subtle differences between HE-stained pathological images and the insufficient number of data samples lead to grading inefficiency. With its rapid development, deep learning technology has been widely used for automatic breast cancer grading based on pathological images. In this paper, we propose an integrated breast cancer grading framework based on a fusion deep learning model, which uses three different convolutional neural networks as submodels to extract feature information at different levels from pathological images. Then, the output features of each submodel are learned by the fusion network based on stacking to generate the final decision results. To validate the effectiveness and reliability of our proposed model, we perform dichotomous and multiclassification experiments on the Invasive Ductal Carcinoma (IDC) pathological image dataset and a generated dataset and compare its performance with those of the state-of-the-art models. The classification accuracy of the proposed fusion network is 93.8%, the recall is 93.5%, and the F1 score is 93.8%, which outperforms the state-of-the-art methods.

INTRODUCTION:Maintaining apical patency has been advocated to minimize canal transportation, ledge formation, and loss of working length, despite increasing debris extrusion. A previous study in 1997 by Cailleteau and Mullaney reported 50% of United States dental schools taught patency. This present study aimed to evaluate recent trends in endodontic education in United States dental schools, in relation to the prevalence of maintaining apical patency and examining the primary methods of working length determination, instrumentation, obturation, and temporization. METHODS:A survey of 20 questions was distributed to 65 schools via e-mail and was available from July 2021 to September 2021. RESULTS:Seventy-three percent of the 46 responding schools reported that they teach patency, with 8% of this number reporting that they do so exclusively to endodontic residents. Notably, a significantly lower number of schools reported teaching patency exclusively to endodontic students compared with the Cailleteau and Mullaney study despite a significantly higher percentage of schools teaching patency overall. The most common method used to determine working length was an electronic apex locator at the 0.5 reading. Vortex Blue was the most commonly used file system used by both predoctoral and postdoctoral programs. Lateral condensation was the primary obturation technique taught in predoctoral programs, whereas warm vertical condensation was the primary obturation technique in postdoctoral programs. The study also found that 57% of schools reported using intraorifice barriers, and the most common temporary filling was glass ionomer. CONCLUSIONS:A greater portion of schools teaches patency compared with the previous study in 1997. The data collected in this survey may serve as a baseline for similar studies in the future regarding changes in endodontic education over time.

PURPOSEThe underlying mechanism of how topographic cues of artificial scaffolds regulate cell function remains poorly understood. Yes-associated protein (YAP) and β-catenin signaling have both been reported to play important roles in mechano-transduction and dental pulp stem cells (DPSCs) differentiation. We investigated the effects of YAP and β-catenin in spontaneous odontogenic differentiation of DPSCs induced by topographic cues of a poly(lactic-co-glycolic acid) (PLGA) membrane.METHODSThe topographic cues and function of a fabricated PLGA scaffold were explored via scanning electron microscopy (SEM), alizarin red staining (ARS), reverse transcription-polymerase chain reaction (RT-PCR), and pulp capping. Immunohistochemistry (IF), RT-PCR, and western blotting (WB) were used to observe the activation of YAP and β-catenin when DPSCs were cultured on the scaffolds. Further, YAP was inhibited or overexpressed on either side of the PLGA membrane, and YAP, β-catenin, and odontogenic marker expression were analyzed using IF, ARS, and WB.RESULTSThe closed side of the PLGA scaffold promoted spontaneous odontogenic differentiation and nuclear translocation of YAP and β-catenin in vitro and in vivo compared to the open side. The YAP antagonist verteporfin inhibited β-catenin expression, nuclear translocation, and odontogenic differentiation on the closed side, but the effects were rescued by LiCl. YAP overexpressing DPSCs on the open side activated β-catenin signaling and promoted odontogenic differentiation.CONCLUSIONThe topographic cue of our PLGA scaffold promotes odontogenic differentiation of DPSCs and pulp tissue through the YAP/β-catenin signaling axis.

Osteoarthritis (OA) involves lesions of the entire joint and remains one of the health problems plaguing the world. The pathological mechanism of OA is complex and involves multiple signaling pathways. Over 300 million people worldwide are living with OA, which imposes a huge burden on society. Nucleic acid nanomaterials are of interest to the biomedical field due to their small dimension, ideal biocompatibility, and structure editability. Various nucleic acids have been used as therapeutic drugs to regulate the pathogenesis and development of OA. Among them, some can enter the cell by themselves and others with the aid of vectors. Apart from high therapeutic efficiency, nucleic acid nanomaterials also act as carriers for transporting drugs. This paper reviews recent advances in nucleic acid nanomaterials in OA therapy, suggesting that nucleic acid nanomaterials-based therapy has good prospects for development.

Periodontal disease is a multifactorial, bacterially induced inflammatory condition characterized by the progressive destruction of periodontal tissues. The successful nonsurgical treatment of periodontitis requires multifunctional technologies offering antibacterial therapies and promotion of bone regeneration simultaneously. For the first time, in this study, an injectable piezoelectric hydrogel (PiezoGEL) was developed after combining gelatin methacryloyl (GelMA) with biocompatible piezoelectric fillers of barium titanate (BTO) that produce electrical charges when stimulated by biomechanical vibrations (e.g., mastication, movements). We harnessed the benefits of hydrogels (injectable, light curable, conforms to pocket spaces, biocompatible) with the bioactive effects of piezoelectric charges. A thorough biomaterial characterization confirmed piezoelectric fillers' successful integration with the hydrogel, photopolymerizability, injectability for clinical use, and electrical charge generation to enable bioactive effects (antibacterial and bone tissue regeneration). PiezoGEL showed significant reductions in pathogenic biofilm biomass (∼41%), metabolic activity (∼75%), and the number of viable cells (∼2-3 log) compared to hydrogels without BTO fillers in vitro. Molecular analysis related the antibacterial effects to be associated with reduced cell adhesion (downregulation of porP and fimA) and increased oxidative stress (upregulation of oxyR) genes. Moreover, PiezoGEL significantly enhanced bone marrow stem cell (BMSC) viability and osteogenic differentiation by upregulating RUNX2, COL1A1, and ALP. In vivo, PiezoGEL effectively reduced periodontal inflammation and increased bone tissue regeneration compared to control groups in a mice model. Findings from this study suggest PiezoGEL to be a promising and novel therapeutic candidate for the treatment of periodontal disease nonsurgically.

Smart biomaterials can sense and react to physiological or external environmental stimuli (e.g., mechanical, chemical, electrical, or magnetic signals). The last decades have seen exponential growth in the use and development of smart dental biomaterials for antimicrobial applications in dentistry. These biomaterial systems offer improved efficacy and controllable bio-functionalities to prevent infections and extend the longevity of dental devices. This review article presents the current state-of-the-art of design, evaluation, advantages, and limitations of bioactive and stimuli-responsive and autonomous dental materials for antimicrobial applications. First, the importance and classification of smart biomaterials are discussed. Second, the categories of bioresponsive antibacterial dental materials are systematically itemized based on different stimuli, including pH, enzymes, light, magnetic field, and vibrations. For each category, their antimicrobial mechanism, applications, and examples are discussed. Finally, we examined the limitations and obstacles required to develop clinically relevant applications of these appealing technologies.

Regenerative endodontic procedures (REPs) is a biologic-based treatment modality for immature permanent teeth diagnosed with pulp necrosis. The ultimate objective of REPs is to regenerate the pulp-dentin complex, extend the tooth longevity and restore the normal function. Scientific evidence has demonstrated the efficacy of REPs in promotion of root development through case reports, case series, cohort studies, and randomized controlled studies. However, variations in clinical protocols for REPs exist due to the empirical nature of the original protocols and rapid advancements in the research field of regenerative endodontics. The heterogeneity in protocols may cause confusion among dental practitioners, thus guidelines and considerations of REPs should be explicated. This expert consensus mainly discusses the biological foundation, the available clinical protocols and current status of REPs in treating immature teeth with pulp necrosis, as well as the main complications of this treatment, aiming at refining the clinical management of REPs in accordance with the progress of basic researches and clinical studies, suggesting REPs may become a more consistently evidence-based option in dental treatment.

Background Regenerative endodontic procedures (REPs) have achieved clinical success on the immature permanent teeth with pulp necrosis, and can promote root development. However, preoperative factors and their effects on root development of REPs have not been definitely concluded. The aim of this study was to investigate the preoperative factors that may influence the root development of REPs. Methods A total of 116 teeth in 110 patients treated with REPs in the Paediatric Dentistry Department and Endodontics Department from 2013 to 2017 were included in this study. Preoperative factors including aetiology, age, diagnosis and initial root morphology were collected retrospectively, and the associations between these factors and root development after REPs were analysed by Fisher's exact test and multivariate logistic regression model. Results The overall rate of root development after REPs was 89.7%. The dens evaginatus group showed a higher rate (98.8%) in root development than the trauma group (67.6%) (P < 0.01). There was no significant difference among the different age groups (7-13 years old) or among different diagnoses groups (P > 0.05). And it showed in the trauma group that the teeth with apical foramen sizes larger than 3 mm significantly promoted root development than those smaller than 3 mm (P < 0.01). Multivariate logistic regression indicated that aetiology was significantly correlated with root development of REPs (OR: 0.07, 95% CI 0.007, 0.627, P < 0.05). Conclusions The REPs promoted more root developments in the dens evaginatus group than the trauma group, indicating that aetiology may be correlated with the root development of REPs.

Abstract Objective to investigate preoperative factors that may influence the root development of regenerative endodontic procedures (REPs). Patients and Methods A total of 116 teeth in 110 patients treated with REPs in the Paediatric Dentistry Department and Endodontics Department from 2013 to 2017 were included in this study. Factors including aetiology, age, preoperative diagnosis and initial root morphology were collected retrospectively, and the associations between these factors and root development after REPs were analysed by Fisher's exact test and multivariate logistic regression model. Results The overall rate of root development after REPs was 89.7%. The dens evaginatus group showed a higher rate (98.8%) in root development than the trauma group (67.6%) (P < 0.01). There was no significant difference among the different age groups (7–13 years old) or among different preoperative diagnoses regarding root development (P > 0.05). And it showed in the trauma group that the teeth with apical foramen sizes larger than 3 mm obviously continued root development than those smaller than 3 mm (P < 0.01). Multivariate logistic regression indicated that aetiology was significantly correlated with root development of REPs (OR: 1.31, 95% CI: 0.007, 0.627, P < 0.05). Conclusions In the limitation of the present study, aetiology was correlated with the root development of REPs and the REPs achieved better outcomes in the cases caused by dens evaginatus than the trauma cases. Clinical Relevance Aetiology would be considered in the case selection of REPs for immature permanent teeth with necrotic pulp.

Background Transmission of COVID-19 via salivary aerosol particles generated when using handpieces or ultrasonic scalers is a major concern during the COVID-19 pandemic. The aim of this study was to assess the spread of dental aerosols on patients and dental providers during aerosol-generating dental procedures. Methods This pilot study was conducted with one volunteer. A dental unit used at the dental school for general dental care was the site of the experiment. Before the study, three measurement meters (DustTrak 8534, PTrak 8525 and AeroTrak 9306) were used to measure the ambient distribution of particles in the ambient air surrounding the dental chair. The volunteer wore a bouffant, goggles, and shoe covers and was seated in the dental chair in supine position, and covered with a surgical drape. The dentist and dental assistant donned bouffant, goggles, face shields, N95 masks, surgical gowns and shoe covers. The simulation was conducted by using a high-speed handpiece with a diamond bur operating in the oral cavity for 6 min without touching the teeth. A new set of measurement was obtained while using an ultrasonic scaler to clean all teeth of the volunteer. For both aerosol generating procedures, the aerosol particles were measured with the use of saliva ejector (SE) and high-speed suction (HSS) followed a separate set of measurement with the additional use of an extra oral high-volume suction (HVS) unit that was placed close to the mouth to capture the aerosol in addition to SE and HSS. The distribution of the air particles, including the size and concentration of aerosols, was measured around the patient, dentist, dental assistant, 3 feet above the patient, and the floor. Results Four locations were identified with elevated aerosol levels compared to the baseline, including the chest of the dentist, the chest of patient, the chest of assistant and 3 feet above the patient. The use of additional extra oral high volume suction reduced aerosol to or below the baseline level. Conclusions The increase of the level of aerosol with size less than 10 µm was minimal during dental procedures when using SE and HSS. Use of HVS further reduced aerosol levels below the ambient levels.

The demand for biomaterials that promote the repair, replacement, or restoration of hard and soft tissues continues to grow as the population ages. Traditionally, smart biomaterials have been thought as those that respond to stimuli. However, the continuous evolution of the field warrants a fresh look at the concept of smartness of biomaterials. This review presents a redefinition of the term "Smart Biomaterial" and discusses recent advances in and applications of smart biomaterials for hard tissue restoration and regeneration. To clarify the use of the term "smart biomaterials", we propose four degrees of smartness according to the level of interaction of the biomaterials with the bio-environment and the biological/cellular responses they elicit, defining these materials as inert, active, responsive, and autonomous. Then, we present an up-to-date survey of applications of smart biomaterials for hard tissues, based on the materials’ responses（external and internal stimuli） and their use as immune-modulatory biomaterials. Finally,we discuss the limitations and obstacles to the translation from basic research（bench） to clinical utilization that is required for the development of clinically relevant applications of these technologies.

This paper aims to explore coevolution of emotional contagion and behavior for microblog sentiment analysis. Accordingly, a deep learning architecture (denoted as MSA-UITC) is proposed for the target microblog. Firstly, the coevolution of emotional contagion and behavior is described by the tie strength between microblogs, that is, with the spread of emotional contagion, user behavior such as emotional expression will be affected. Then, based on user interaction and the correlation with target microblog, the Hawkes process is adopted to quantify the tie strength between microblogs so as to build the corresponding weighted network. Secondly, in the weighted network, the Deepwalk algorithm is used to build the sequence representation of microblogs which are similar to the target microblog. Next, a CNN-BiLSTM-Attention network (the convolutional neural network and bidirectional long short-term memory network with a multihead attention mechanism) is designed to analyze the sentiment analysis of target and similar microblogs. Finally, the experimental results on two real Twitter datasets demonstrate that the proposed MSA-UITC has advanced performance compared with the existing state-of-the-art methods.

Our case reports probe whether intentional replantation is a feasible and successful treatment for teeth with radicular developmental groove. Radicular developmental groove is an anatomical malformation that often leads to combined periodontal-endodontic lesion. Treatment of complex radicular groove presents a great challenge to the operator. Two cases of periodontal compromised teeth with this developmental anomaly were treated with intentional replantation and followed up for 2 years. The teeth were asymptomatic and functional. The periodontal probing depths decreased from original 10 mm to 2-3 mm. The receded gingival papillae associated with the teeth was regenerated two years after intentional replantation. With careful case selection and treatment planning, intentional replantation may be a predictable alternative treatment modality for the combined endodontic-periodontal lesion accompanied with radicular developmental groove.

This paper is dedicated to exploring the dynamical behavior of information diffusion in the Device-to-Device (D2D) communication environment for information security, so as to study how to accelerate the dissemination of beneficial information and curb the spread of malicious information. A mathematical model of information diffusion considering the combined impact of user awareness and social tie between users is proposed. The equilibrium of the model and its stability are fully analyzed. Very importantly, there is a unique (viral) equilibrium that is globally asymptotically stable without any preconditions. This means that the spread of malicious information in the D2D communication environment cannot be completely eliminated whatever measures are taken, but its diffusion scale can be controlled by adjusting the value of the equilibrium, and then the goal of pursuing the best control effect at the minimum cost can be achieved. In the same way, the dissemination scale of beneficial information can be expanded. Finally, the obtained main theoretical results are illustrated by some examples, and some suggestions are also given.

While extensive literature exists about the role of oral bacterial pathogens like Porphyromonas gingivalis and Fusobacterium nucleatum in oral squamous cell carcinoma (OSCC), the role of health-associated species has been largely unexplored. In this study, we assessed the effect of Streptococcus mitis, Rothia mucilaginosa, Neisseria flavescens, Haemophilus parainfluenzae, Lautropia mirabilis, and Veillonella parvula on proliferation and expression of marker genes (IL-6, TNF-α, MMP3, CD36, CCD1, and NANOG) in OSCC cell lines CAL27, SCC25, and SCC4. Porphyromonas gingivalis was included as a pathogenic control. Both bacterial lysates (3 concentrations) and live cells (3 MOIs) were tested. S. mitis, H. parainfluenzae, and N. flavescens resulted in substantial, dose-dependent reduction of proliferation, which was found to be mediated by H2O2 for the former and intracellular infection in the latter two species. However, only H. parainfluenzae showed differential antiproliferative effect against the cancer cell lines vs. the normal control (TIGKs). In the gene expression assays, the health-associated species mostly downregulated CD36, a gene that plays an important role in tumor growth and metastasis, while P. gingivalis upregulated it. IL6 and TNF expression, on the other hand, was upregulated by almost all species, particularly the Gram-negatives including P. gingivalis. The effect on other genes was less evident and varied significantly by cell line. This exploratory study is the first insight into how health-associated bacteria may interact with OSCC. Further studies to explore whether the observed effects may have implications for the prevention or treatment of oral cancer are warranted.

OBJECTIVES:Topographic cues can modulate morphology and differentiation of mesenchymal stem cells. This study aimed to determine how topographic cues of a novel bilayered poly (lactic-co-glycolic acid) (PLGA) scaffold affect osteogenic/odontogenic differentiation of dental pulp stem cells (DPSCs).METHODS:The surface morphology of the scaffolds was visualized by scanning electron microscope, and the surface roughness was measured by profilometry. DPSCs were cultured on each side of the scaffolds. Cell morphology, expression of Yes-associated protein (YAP) and osteogenic/odontogenic differentiation were analysed by immunohistochemistry, real-time polymerase chain reaction, and Alizarin Red S staining. In addition, cytochalasin D (CytoD), an F-actin disruptor, was used to examine the effects of F-actin on intracellular YAP localisation. Verteporfin, a YAP transcriptional inhibitor, was used to explore the effects of YAP signalling on osteogenic/odontogenic differentiation of DPSCs.RESULTS:The closed side of our scaffold showed smaller pores and less roughness than the open side. On the closed side, DPSCs exhibited enhanced F-actin stress fibre alignment, larger spreading area, more elongated appearance, predominant nuclear YAP localization and spontaneous osteogenic differentiation. Inhibition of F-actin alignments was correlated with nuclear YAP exclusion of DPSCs. Verteporfin restricted YAP localisation to the cytoplasm, down-regulated expression of early osteogenic/odontogenic markers and inhibited mineralization of DPSCs cultures.CONCLUSIONS:The surface topographic cues changed F-actin alignment and morphology of DPSCs, which in turn regulated YAP signalling to control osteogenic/odontogenic differentiation.

目的:通过运用机构能力评估工具(organizational capacity assessment tool,OCAT)对社区组织能力进行评估,帮助其开展机构能力建设,提高社区组织机构综合能力.方法:以社区组织成员为主体,通过参与式评估的方法运用OCAT从机构的策略和规划、机构结构和工作流程、资源动员、项目管理等十个方面进行可量化的综合讨论和评分.协助机构制定并实施能力建设计划.结果:一年后,机构在十个方面的评分均比基线调查时有明显提升,十个方面在基线的水平上平均提高22％,最多的提高58％,最少的6％.讨论OCAT是目前社区组织机构能力发展中方便易行且可以量化的评估工具.结论:OCAT的运用有效改善了药物滥用防治领域社区组织自身的机构组织能力,同时也提高了机构提供干预和服务的综合能力.