This systematic review aims to assess the efficacy of chemical agents (CA) in subgingival irrigation as an adjunct to non-surgical periodontal treatment (NSPT) in the treatment of periodontitis. Search strategies were developed for MEDLINE via PubMed, Web of Science, and LILACS databases for publications up to March 2025. Risk of bias was assessed according to the RoB 2.0 tool. Random-effects meta-analyses were conducted for clinical attachment level (CAL), probing pocket depth (PPD), and bleeding on probing (BOP). From 1244 studies initially screened, 16 randomized clinical trials were included for qualitative and quantitative analyses. Studies assessed the effects of the following chemical agents: Povidone-iodine (PVP-I), Essential Oils (EOs); Chlorhexidine (CHX), Ozonated water (OW) and Boric Acid (BA). Overall, the meta-analysis showed that the adjunctive use of CA as subgingival irrigation did not provide additional benefit in PPD reduction, CAL gain, and BOP compared with controls (P > 0.05). Most studies raised some concerns with risk of bias, and 2 showed a high risk of bias. Adjunctive use of chemical agents in subgingival irrigation during NSPT for periodontitis patients does not appear to provide additional benefit over NSPT alone, although evidence levels are low to very low. CA are frequently used as adjuncts to NSPT, despite uncertainty regarding their real clinical contribution. The findings of this study help clinicians make more evidence-based decisions and avoid unnecessary use of adjunctive subgingival irrigation strategies during periodontal treatment.

Pulpectomy is the standard treatment for irreversibly inflamed or infected primary molars. It depends on effective root canal cleaning and shaping. Traditional manual preparation and irrigation techniques face challenges when dealing with complex root canal systems in primary teeth. This study aims to retrospectively evaluate the clinical and radiographic outcomes of two rotary nickel-titanium file systems with distinct tapers (M3 and S3) combined with ultrasonic irrigation, compared to conventional manual K-files and syringe irrigation,inpulpectomy for primary molars. A retrospective cohort study included patients aged 4- to 9-year who underwent RCT for mandibular primary molars at the Pediatric Dentistry Clinic of the Third Hospital of Hebei Medical University. Participants were categorized into three groups based on the instrumentation and irrigation protocol used: M3 rotary files with ultrasonic irrigation (n=98), S3 rotary files with ultrasonic irrigation (n=84), and manual K-files with syringe irrigation (n=78). Instrumentation time was measured using a digital stopwatch. Obturation quality was radiographically classified as optimal, underfilled, or overfilled. Postoperative pain was assessed at 24-, 48-, and 72 h using the Wong-Baker FACES scale. Clinical and radiographic outcomes at the 12-month follow-up were categorized as success, uncertain, or failure. The M3 rotary group showed the shortest instrumentation time (210.45 ± 6.85 s) and the highest rate of optimal obturation (87.1%), significantly outperforming the S3 and manual file groups (P<0.05). Both rotary systems led to significantly lower pain scores at 24 and 48 hours compared to manual instrumentation (P<0.01). No significant differences were observed in pain at 72 hours or in 12-month therapeutic success rates among the groups (P>0.05). This study demonstrates that combining modern NiTi rotary instrumentation (specifically the 0.04 tapered M3 system) with ultrasonic irrigation significantly outperforms conventional manual techniques in operative efficiency, obturation quality, and postoperative pain control. The integration of NiTi and ultrasound translates into a clinically superior, patient-beneficial protocol for primary teeth pulp therapy, optimizing procedural experience without compromising therapeutic success.

Pulp necrosis in immature permanent teeth arrests root development and compromises long-term prognosis. This study aimed to develop a multifunctional scaffold integrating structural biomimicry, mechanical matching, and sustained growth factor release for orderly root regeneration. A poly(ε-caprolactone) (PCL) conical scaffold was fabricated via melt electrowriting (MEW) combined with mechanical winding. Bone morphogenetic protein‑2 (BMP‑2)-loaded microspheres were prepared and physically incorporated into the scaffold. The scaffold surface was modified with collagen. Human dental pulp stem cells (hDPSCs) were cultured on the scaffold to evaluate proliferation, adhesion, and osteogenic differentiation. The scaffold exhibited a trilayer "collagen-microsphere-PCL" architecture with mechanical compatibility (elastic modulus: 22.5MPa; fracture strength: 5.29MPa; elongation: 441.59%). Microspheres (2.86 ± 0.45μm) showed a gradient distribution and sustained release (70-75% over 90 days). In vitro, the scaffold promoted hDPSC adhesion and proliferation and significantly enhanced osteogenic differentiation with elevated alkaline phosphatase activity, upregulated the expression of osteogenic-related genes, and increased protein levels. The scaffold integrates structural support, controlled growth factor delivery, and a bioactive interface, offering a promising strategy for root development in immature permanent teeth. By enabling physiological root development, the scaffold addresses a critical unmet need, offering a viable alternative to conventional root canal therapy.

To evaluate the influence of instruments with identical tip diameters but increasing taper on shaping efficiency and dentin preservation in the root canals of mandibular molars using micro-CT. Twelve extracted mandibular molars with Vertucci Type III mesial canals and Type I distal canals were scanned using micro-CT before and after each instrumentation step. Mesial canals were sequentially prepared with 25/0.03, 25/0.05, 25/0.06, and 25/.08v instruments, whereas distal canals were prepared with 40/0.03, 40/0.05, and 40/.06v instruments. Co-registered datasets were used to quantify canal volume, surface area, percentage of unprepared canal surface, dentin removal, and minimum dentin thickness. In addition, dentin thickness values were categorized according to clinically relevant thresholds (< 0.5mm, 0.5-1.0mm, and > 1.0mm). Data were analyzed using generalized linear and mixed-effects models (α = 0.05). In mesial canals, unprepared area decreased significantly with larger tapers; reductions were significant with 25/0.06 (-21.9%) and 25/.08v (-37.9%), but not with 25/0.05. Dentin removal increased markedly and progressively with taper, reaching ~ 350% with 25/.08v compared with 25/0.03 (p < 0.001). In distal canals, taper did not significantly affect the unprepared area; however, dentin removal increased significantly with 40/0.05 and 40/.06v. Directional analyses confirmed a stepwise increase in dentin reduction, following the pattern mesiobuccal > mesiolingual > distal at all levels. Threshold analysis showed that the proportion of dentin thickness measurements within the 0.5-1.0mm range increased with larger tapers, particularly on the distal aspect of the mesial roots. Increasing instrument taper improves shaping efficiency in mesial canals but substantially increases dentin removal and shifts dentin thickness toward potentially vulnerable ranges. Conservative taper selection may therefore better balance shaping effectiveness and structural preservation in mandibular molars. Larger tapers may improve canal wall contact but can substantially reduce dentin thickness in anatomically vulnerable regions, emphasizing the importance of anatomy-guided taper selection during root canal preparation.

This study aimed to map the complex relationships among physiological, psychological, and social factors of oral frailty using network analysis. The primary goal was to identify the most central and influential elements within this network to guide future intervention strategies. A cross-sectional study included 991 community-dwelling older adults in Jiangsu Province, China. Data were collected on oral frailty (OFI-8), oral health self-efficacy (GSEOH), depressive symptoms (GDS-5), family support (APGAR), personal mastery (PMS), and nutritional appetite (SNAQ). A Gaussian Graphical Model network was constructed, and centrality indices were calculated to identify key nodes. The analysis revealed a stable network where personal mastery (PMS), nutritional appetite (SNAQ), and oral health self-efficacy (GSEOH) emerged as the most central nodes. The strongest connection was found between GSEOH and SNAQ, highlighting a key psycho-physiological link. Notably, oral frailty (OFI) exhibited lower centrality and was negatively associated with these core psychosocial resources. Oral frailty should be conceptualized as an outcome of dysregulation within a broader biopsychosocial system, rather than a central driver. Personal mastery, nutritional appetite, and oral health self-efficacy form a critical, interconnected core. A holistic approach strengthening these hubs may be more effective in managing oral frailty than focusing on oral symptoms alone. This study advocates for a clinical shift from reactive symptom management to proactively enhancing older adults' psychological resources, such as personal mastery. Interventions targeting the feedback loop between nutritional appetite and self-efficacy represent a promising strategy to prevent oral frailty and promote healthy aging.