Cristina Bucchi

This narrative review explores the potential link and the associated biological mechanisms between apical periodontitis (AP) and blood–brain barrier (BBB) integrity. An electronic literature search to identify publications related to AP and BBB integrity was conducted using the Scopus and PubMed databases. Both experimental and clinical studies were included and qualitatively analyzed. Available evidence shows that serum inflammatory marker levels are elevated in patients with AP compared to healthy controls, including proteins associated with endothelial barrier disruption such as ZO-1 and Claudin-5. Indirect evidence shows that disruption of the BBB can occur due to circulating inflammatory cytokines and pathogen insults. BBB cells express receptors that respond to circulating insults by upregulating pro-inflammatory cytokines, necroptosis, and proteolytic activity, which compromise BBB integrity. Elevated baseline levels of inflammatory markers from other chronic oral diseases, particularly periodontitis, have been linked to an increased risk of neurological disorders. Although similar pathophysiological mechanisms may be involved and recent in vitro experimental evidence suggests that the systemic inflammatory milieu associated with AP may compromise BBB function, direct in vivo and clinical evidence establishing a causal link remains lacking. Although biological plausibility supports a role for AP in BBB disruption, and recent in vitro experimental evidence has provided the first preliminary support for this association, in vivo preclinical studies and prospective clinical longitudinal studies are still needed to establish a clear causal relationship. Given the global burden of neurological disorders, elucidating the potential impact of AP on BBB integrity represents an important avenue for research.

To evaluate the educational value of high‐resolution micro‐CT images and 3D models of maxillary premolars in enhancing dental students' understanding of root canal complexity and reflective reasoning. Eighteen extracted adult maxillary premolars were scanned using a micro‐CT system (SkyScan 1273, Bruker, Belgium) to create high‐resolution images and 3D models compiled into a digital atlas. A mixed‐methods design was implemented. In the quantitative phase, 94 dental students reviewed the materials and completed a seven‐item questionnaire on a 10‐point Likert scale assessing perceived usefulness, motivation, and learning contribution. In the qualitative phase, 15 students participated in focus groups guided by the See/Think/Wonder routine. They analyzed periapical radiographs followed by the micro‐CT images and 3D models and produced hand‐drawn representations of premolars before and after the intervention. Quantitative data were analyzed using descriptive statistics and nonparametric paired tests, while qualitative data were coded and examined with Atlas.ti. Students reported high agreement across items (median scores 9–10), indicating that the digital materials better illustrate root channels, were intuitive, helped them understand better, should complement their studies, motivated them to learn, and contributed to their learning and treatments. Post‐intervention drawings demonstrated significantly greater anatomical detail, including accessory canals and apical deltas. Qualitative findings revealed more complex, clinically oriented reasoning, though some students expressed uncertainty or anxiety upon recognizing anatomical variability. High‐resolution micro‐CT images and 3D models enhance comprehension of root canal complexity and foster reflective reasoning, although increased awareness of anatomical variability may generate anxiety in some learners.

Purpose To analyze the development and application of microfluidic devices representative of the dentin-pulp complex. Methods A systematic literature search was conducted on electronic databases. The inclusion criteria were in vitro studies aimed at developing and/or using microfluidic devices that mimic the dentin-pulp interface. The aspects analyzed included device design, fabrication methods, interface and channel characteristics, culture methods, main outcomes and measurement techniques. The risk of bias was assessed via the QUIN tool. Results Five studies were included. Significant variability was observed in device design, construction, channels, and interface characteristics. Only one study incorporated dynamic fluid flow, whereas the others relied on static culture conditions. The main outcomes measured included cell viability, odontoblastic morphology and metabolic activity. Conclusion This systematic review identified limited research on microfluidic devices that replicate the dentin-pulp complex with high variability in terms of fabrication, design, and materials. Most studies have used static cultures despite the benefits of dynamic flow. Additionally, studies lack detailed information on critical device characteristics. Future research should integrate dynamic features, and comprehensive reporting to improve reproducibility and develop physiologically relevant models.

Background: The scratch assay is commonly used in cell biology to evaluate cell migration; however, it is not a standardized method; it produces highly variable gap dimensions. We design a printable device, comprising a single wounding tool and a guide, and compared the gap produced by our device and the traditional method. The deviceis printable in a standard 3D printer. Cells were seeded on a 24‐well plate. After reaching full confluency, a gap was created using the traditional method (scratch assay with a pipette tip), a pipette tip and the guide of the device, or the single wounding tool and the guide. The gaps were observed for up to 48 h under a light microscope and analyzed.Results: The results show that the traditional method produces irregular and not straight gaps, and had the worst cell migration rates compared to the other groups. The wounding tool produced scrape signs at the well surface.Conclusion: The guide and pipette tip delivered the best results for the scratch assay.Significance: The use of the guide and the pipette tip for the scratch assay allows allows to perform reproducible cell migration experiments.

Odontomas are benign tumors characterized by slow and limited growth with a rare recurrence. Odontomas are generally detected by radiographic findings in the radiopaque stage, where calcification of the tissues is observed. This article seeks to report the recurrence of a radiologically diagnosed odontoma to show the importance of radiographic controls after enucleation as a diagnostic and follow-up method. Case report: A female patient, 9 years old, attended dental care in 2020 due to malpositioned teeth. In the intraoral clinical examination, she presented stage II mixed dentition with crowding. A radiographic exam showed no associated lesions. The patient reported a history of odontoma removal and a supernumerary tooth in sextant II in 2016. Subsequently, she was referred to orthodontics, where permanent dentition with moderate anterior crowding in the maxilla and mandible was observed. The radiographic examination showed a radiopaque area compatible with odontoma, palatal to teeth 12 and 13. Conclusions: Although recurrence is rare, complete removal in the case of an odontoma is critical. This study demonstrates the importance of performing radiographic controls 5 years after enucleation of an odontoma, considering the stages of evolution.

Introduction: To compare the effectiveness of vital pulp therapies (pulpotomy and direct pulp capping) with that of conventional endodontics for the treatment of mature teeth with pulp inflammation and to analyze which pulp capping material is more effective for the treatment of mature teeth with pulp inflammation. Materials and Methods: A bibliographic search of electronic databases (PUBMED, COCHRANE LIBRARY, SCOPUS, ScienceDirect, and SciELo) was conducted. The inclusion criteria were comparative studies in patients who underwent conventional endodontic and vital pulp therapy in mature teeth with pulp inflammation and comparative studies comparing Mineral Trioxide Aggregate (MTA) versus calcium hydroxide as direct pulp capping materials in mature teeth with pulp inflammation. Risk of bias was assessed using RoB2 or ROBINS-I. Results: Eight clinical trials were included, all of which had a high risk of bias. The data analysis showed that pulpotomy has similar clinical success rates to conventional endodontics. No studies comparing conventional endodontics versus direct pulp capping were found. MTA has better clinical results than calcium hydroxide as a direct pulp capping material. Conclusion: Vital pulp therapies are a valid alternative for the treatment of mature teeth with pulp inflammation. There is a need for more clinical trials with longer follow-up time and which consider other variables related to the characteristics of the patient and the tooth.

Objective: To assess the tooth survival rates, adverse events, and need for further treatment of teeth previously treated with regenerative endodontics undergoing orthodontic treatment. Material and Methods: A literature search was performed using MEDLINE, EMBASE, Cochrane, Scopus, and Lilacs databases, grey literature, and endodontic journals, and the date of the last search was 20 April 2022. The included studies involved patients undergoing orthodontic treatment and at least one tooth that was previously treated with regenerative endodontics. A narrative synthesis of the findings was made. The risk of bias and evidence quality were assessed using the Effective Public Health Practice Project tool and the GRADE approach. Results: Five case reports included seven patients and eight teeth with a follow-up of 4 to 11 years. The overall risk of bias was high, and the certainty of evidence was very low. The survival rate was 87.5%. Adverse effects included sinus tracts, root resorption, symptomatology, apical periodontitis, and intracanal tissue necrosis. Five out of eight teeth required further intervention after orthodontics. Conclusions: A high prevalence of adverse effects and further intervention is observed in teeth treated with regenerative endodontics undergoing orthodontic treatment. The low quality of evidence highlights the need for comparative studies and evidence-based guidelines for managing these teeth during orthodontic treatment.