Conventional bone grafting procedures used to treat bone defects have several limitations. An important aspect of bone tissue engineering is developing novel bone substitute biomaterials for bone grafts to repair orthopedic defects. Considerable attention has been given to chitosan, a natural biopolymer primarily extracted from crustacean shells, which offers desirable characteristics, such as being biocompatible, biodegradable, and osteoconductive. This review presents an overview of the chitosan-based biomaterials for bone tissue engineering (BTE). It covers the basic knowledge of chitosan in terms of biomaterials, the traditional and novel strategies of the chitosan scaffold fabrication process, and their advantages and disadvantages. Furthermore, this paper integrates the relevant contributions in giving a brief insight into the recent research development of chitosan-based scaffolds and their limitations in BTE. The last part of the review discusses the next-generation smart chitosan-based scaffold and current applications in regenerative dentistry and future directions in the field of mineralized tissue regeneration.

Bone tissue engineering is a complicated field requiring concerted participation of cells, scaffolds, and osteoactive molecules to replace damaged bone. This study synthesized a chitosan-based (CS) scaffold incorporated with trichostatin A (TSA), an epigenetic modifier molecule, to achieve promising bone regeneration potential. The scaffolds with various biphasic calcium phosphate (BCP) proportions: 0%, 10%, 20%, and 40% were fabricated. The addition of BCP improved the scaffolds’ mechanical properties and delayed the degradation rate, whereas 20% BCP scaffold matched the appropriate scaffold requirements. The proper concentration of TSA was also validated. Our developed scaffold released TSA and sustained them for up to three days. The scaffold with 800 nM of TSA showed excellent biocompatibility and induced robust osteoblast-related gene expression in the primary human periodontal ligament cells (hPDLCs). To evaluate in vivo bone regeneration potential, the scaffolds were implanted in the mice calvarial defect model. The excellent bone regeneration ability was further demonstrated in the micro-CT and histology sections compared to both negative control and commercial bone graft product. New bone formed in the CS/BCP/TSA group revealed a trabeculae-liked characteristic of the mature bone as early as six weeks. The CS/BCP/TSA scaffold is an up-and-coming candidate for the bone tissue engineering scaffold.

The appropriate storage protocol is one of the main limitations of translating tissue engineering technology to commercialized clinical applications. Recently, the development of a chitosan-derived composite scaffold incorporated with bioactive molecules has been reported as an excellent material to repair a critical size bony defect in mice calvaria. This study aims to determine the storage time and appropriate storage temperature of Chitosan/Biphasic Calcium Phosphate/Trichostatin A composite scaffold (CS/BCP/TSA scaffold) in vitro. The mechanical properties and in vitro bioactivity of trichostatin A (TSA) released from CS/BCP/TSA scaffolds in different storage times and temperatures were evaluated. Different storage times (0, 14, and 28 days) and temperatures (−18, 4, and 25 °C) did not affect the porosity, compressive strength, shape memory, and amount of TSA released. However, scaffolds stored at 25 °C and 4 °C were found to lose their bioactivity after 3- and 7-day storage periods, respectively. Thus, the CS/BCP/TSA scaffold should be stored in freezing conditions to preserve the long-term stability of TSA.

Background/Objectives: An effective inferior alveolar nerve block (IANB) is critical for mandibular third molar surgery, especially for novice student operators who face steep learning curves. This study compared the clinical efficacy and safety of 4% articaine, 2% lidocaine, and 2% mepivacaine in an undergraduate setting. Methods: A prospective observational study was conducted with 189 patients undergoing third molar surgery performed by dental students. Patients received either 4% articaine (n = 69), 2% lidocaine (n = 61), or 2% mepivacaine (n = 59). Anesthetic efficacy was evaluated using a two-stage assessment comprising Vincent’s sign (Stage 1) and profound surgical anesthesia (Stage 2). Intra- and postoperative pain, anesthetic volume, surgical duration, and postoperative complications were recorded and compared among anesthetic groups. Results: Baseline demographics, impaction patterns, and difficulty indices did not differ significantly among groups. Stage 2 profound success rate was significantly higher with articaine (76.8%) than with lidocaine (55.7%) and mepivacaine (61.0%) (p = 0.031). Articaine was also associated with a longer duration of anesthesia (261.7 vs. 164.6 and 192.6 min; p < 0.001), a lower total anesthetic volume (2.1 vs. 2.4 and 2.3 mL; p = 0.007), and significantly lower intraoperative pain scores (14.3 vs. 31.0 and 29.8 mm on the Heft–Parker VAS pain scale (HPS); p < 0.001). Postoperative pain through Day 7 and complication rates were comparable among anesthetics, with no serious adverse events reported. Conclusions: Within the limitations of this observational study, four percent articaine was associated with higher profound IANB success rates and lower intraoperative pain observed in this cohort. These observed associations with higher success and tissue diffusion properties may mitigate the impact of novice technical variability within this cohort.

Background/Objectives: An effective inferior alveolar nerve block (IANB) is critical for mandibular third molar surgery, especially for novice student operators who face steep learning curves. This study compared the clinical efficacy and safety of 4% articaine, 2% lidocaine, and 2% mepivacaine in an undergraduate setting. Methods: A prospective observational study was conducted with 189 patients undergoing third molar surgery performed by dental students. Patients received either 4% articaine (n=69), 2% lidocaine (n=61), or 2% mepivacaine (n=59). Anesthetic efficacy was evaluated using a two-stage assessment comprising Vincent’s sign (Stage 1) and profound surgical anesthesia (Stage 2). Intra- and postoperative pain, anesthetic volume, surgical duration, and postoperative complications were recorded and compared among anesthetic groups. Results: Baseline demographics, impaction patterns, and difficulty indices did not differ significantly among groups. Stage 2 profound success rate was significantly higher with articaine (76.8%) than with lidocaine (55.7%) and mepivacaine (61.0%) (p=0.031). Articaine was also associated with a longer duration of anesthesia (261.7 vs. 164.6 and 192.6 min; p < 0.001), a lower total anesthetic volume (2.1 vs. 2.4 and 2.3 mL; p = 0.007), and significantly lower intraoperative pain scores (14.3 vs. 31.0 and 29.8 mm on the HPS; p < 0.001). Postoperative pain through Day 7 and complication rates were comparable among anesthetics, with no serious adverse events reported. Conclusions: Four percent articaine appeared to be superior to 2% lidocaine and 2% mepivacaine in student-led third molar surgery. Its high efficacy and enhanced tissue diffusion may partially compensate for technical inexperience and prolonged surgical duration, supporting its routine use to improve patient comfort and student confidence in the dental education setting.

Background: Postoperative hemorrhage is one of the major complications of oral surgery. Conventional hemostatic methods, such as chair-side preparation of tranexamic acid (TXA)-soaked gauze or TXA mouthwash, often suffer from dosage variability and increased surgical time. This study aimed to develop a ready-to-use TXA gauze and to evaluate its fabrication process, hemostatic efficiency, and shelf-life stability. Methods: Gauze samples containing TXA concentrations of 2.5% and 5% (w/v) were fabricated using a freeze-drying technique. Characterization was performed using field emission scanning electron microscope (FESEM) and fourier transform infrared spectroscopy (FTIR). The in vitro blood clotting time (BCT) and plasma recalcification time (PRT) were assessed using independent biological replicates from six healthy volunteers ( n = 6). Biocompatibility was assessed via MTT assay on 3T3 fibroblasts. Shelf-life stability was monitored over 180 days under International Conference on Harmonisation (ICH) Zone IV conditions (30 °C/65% RH and 4 °C). Results: The morphological and FTIR measurements confirmed that the gauze fibers were effectively coated with TXA. Meanwhile, the TXA impregnation did not significantly impact the gauze’s physical and biological properties. A burst release of the TXA was observed for the first 3 min, ensuring rapid clot stabilization. In vitro coagulation tests showed that the TXA gauze significantly reduced coagulation times, enhancing the hemostatic process. Similar to 5% TXA gauze, 2.5% TXA gauze had biocompatibility and hemostatic effectiveness. This finding shows that a lower dose (2.5% w/v) achieved hemostasis, maximizing cost-effectiveness and lowering drug toxicity. Stability tests over six months at various temperatures confirmed that the TXA gauze maintained its hemostatic efficacy without significant drug degradation. Conclusions: The prefabricated TXA gauze is a promising material, especially for patients on anticoagulant therapy, with long-term stability and practical deployment potential in clinical settings.