In recent years, sodium hypochlorite and chlorhexidine digluconate have been the gold standard of irrigation solutions utilized within the disinfection protocol during root canal treatments. Nowadays, it is known that, during chemical disinfection of the root canal, consecutive application of sodium hypochlorite and chlorhexidine digluconate leads to the formation of an orange-brown precipitate. This precipitate is described as being chemically similar to para-chloroaniline, which is suspected to have cytotoxic and carcinogenic effects. Concerns also exist regarding its influence on the leakage of root canal fillings, coronal restorations, and tooth discoloration. The purpose of this article is to review the literature on the interaction of sodium hypochlorite and chlorhexidine digluconate on the tooth and its surrounding tissues, and to discuss the effect of the precipitate formed during root canal treatment. We further address options to avoid the formation of the precipitate and describe alternative irrigation solutions that should not interact with sodium hypochlorite or chlorhexidine digluconate.

Background: Vitamin C is one of the major extracellular nonenzymatic antioxidants involved in the biosynthesis of collagen. It promotes the growth of fibroblasts, wound healing processes, and enhances the survival and differentiation of osteoblasts. The potential effects of ascorbic acid on human dental pulp cells (DPC) and the cells of the apical papilla (CAP) used in actual regenerative endodontic procedures remain largely unknown. In this study, we investigated the possible employment of ascorbic acid in the differentiation and regenerative therapies of DPC and CAP. Methods: Nine extracted human wisdom teeth were selected for this study. Subpopulations of stem cells within DPC and CAP were sorted with the mesenchymal stem cell marker STRO-1, followed by treatments with different concentrations (0 mM, 0.1 mM, 0.5 mM, and 1.0 mM) of ascorbic acid (AA), RT-PCR, and Western blot analysis. Results: FACS analysis revealed the presence of cell subpopulations characterized by a strong expression of mesenchymal stem cell marker STRO-1 and dental stem cell markers CD105, CD44, CD146, CD90, and CD29. Treatment of the cells with defined amounts of AA revealed a markedly increased expression of proliferation marker Ki-67, especially in the concentration range between 0.1 mM and 0.5 mM. Further investigations demonstrated that treatment with AA led to significantly increased expression of common stem cell markers OCT4, Nanog, and Sox2. The most potent proliferative and expressional effects of AA were observed in the concentration of 0.1 mM. Conclusions: AA might be a novel and potent growth promoter of human dental cells. Increasing the properties of human dental pulp cells and the cells of the apical papilla using AA could be a useful factor for further clinical developments of regenerative endodontic procedures.

The aim of this clinical study was to evaluate the impact of an additional use of a flowable composite on the clinical success of Class I and II composite restorations. Furthermore, different clinical criteria were recorded to determine if the combination with a flowable material shows significant advantages compared to the composite material alone. In 50 patients, one cavity was solely filled with a nano-hybrid composite (control group) and the second cavity in combination with an additional layer of flowable composite (test group) using a universal adhesive system in the self-etch modus. Clinical assessments were performed according to the modified criteria proposed by USPHS/Ryge. After 24 months, 47 patients were examined resulting in a recall rate of 94%. The cumulative survival rate for all restorations after 24 months was 96.8%. Three restorations (3.2%) failed due to the loss of vitality. All failed restorations were located in the test group (6.4%), and none in the control group (0%). This resulted in a cumulative success rate in the control group of 100% and 93.6% in the test group, showing a significantly different annual failure rate (AFR) of 0% and 3.2%, respectively (p < 0.05; Mann–Whitney U-test). Beside the differences regarding the tooth vitality, success rate, and AFR, no significant influence of the flowable composite on the different evaluated clinical parameters could be detected. Therefore, the application of an additional layer of the flowable composite might have neither a positive nor a negative effect on composite restorations in clinical practice.

The objective of this review is to investigate the effect of an additional layer of flowable composite for cavity lining on the clinical outcome of direct posterior composite restorations. The PICO question (patient, intervention, comparison, and outcome) was stated as follows: Does the additional application of a flowable composite as a cavity liner improve the clinical outcome of Class-I and Class-II restorations? The electronic databases MEDLINE, Web of Science, LILAS, and BBO were assessed for identifying relevant clinical studies. After removal of duplicate records, 309 records could be identified and, after a screening of the title and abstract, 20 articles were selected for full-text analysis. Finally, six studies met the eligibility criteria and were included in this review for further investigation. Four of the included studies have a follow-up period of two years, while the other two studies had an observation period of three and seven years, respectively. No significant differences in annual failure rates were observed between restorations with and without a flowable composite liner. Consequently, the additional usage of flowable composites as a cavity liner seems to have no effect on the clinical longevity of direct composite restorations in Class-I and Class-II cavities. Therefore, the application of a flowable composite is a possible option in everyday dental clinical practice.

The purpose of this randomized, split-mouth-designed controlled and single-blinded clinical study was to evaluate the 3-year clinical performance of Class I and Class II resin composite restorations placed with or without cavity lining with a flowable composite. Fifty patients with treatment needs in two premolars or molars were included. One of the teeth was restored using the nanohybrid composite (Grandio^®SO, control group), in the test group a high viscosity flowable composite was additionally applied as a first layer. In both groups, the same self-etch adhesive system was applied. Clinical evaluation after 3 years was carried out using the modified USPHS/Ryge criteria. At the 3-year follow-up the recall rate was 92%. Four restorations failed in the test group (8.7%), three due to the loss of vitality and one after fracture. The control group exhibited a cumulative success rate of 100%, while the test group achieved a success rate of 91.3%. This led to significant differences in the annual failure rate (AFR) between the two groups, with rates of 0% and 2.9% (p < 0.05; Mann–Whitney U-test). After 3 years the cumulative survival rate including all restorations was 95.7%. Statistical analysis revealed significant differences for the parameters: tooth vitality, marginal discoloration, success rate, and AFR. The other parameters exhibited no significant differences. Consequently, the nanohybrid composite demonstrated excellent performance over a 3-year period, whereas the utilization of a flowable composite for the cavity lining did not appear to exert a beneficial influence on clinical outcomes.

Background/Objectives: Root canal treatment (RCT) is a common dental procedure performed to preserve teeth by removing infected or at-risk pulp tissue caused by caries, trauma, or other pulpal conditions. A successful outcome, among others, depends on accurate identification of the root canal anatomy, planning a suitable therapeutic strategy, and ensuring a bacteria-tight root canal filling. Despite advances in dental techniques, there remains limited integration of computational methods to support key stages of treatment. This review aims to provide a comprehensive overview of computational methods applied throughout the full workflow of RCT, examining their potential to support clinical decision-making, improve treatment planning and outcome assessment, and help bridge the interdisciplinary gap between dentistry and computational research. Methods: A comprehensive literature review was conducted to identify and analyze computational methods applied to different stages of RCT, including root canal segmentation, morphological analysis, treatment planning, quality evaluation, follow-up, and prognosis prediction. In addition, a taxonomy based on application was developed to categorize these methods based on their function within the treatment process. Insights from the authors’ own research experience were also incorporated to highlight implementation challenges and practical considerations. Results: The review identified a wide range of computational methods aimed at enhancing the consistency and efficiency of RCT. Key findings include the use of advanced image processing for segmentation, image analysis for diagnosis and treatment planning, machine learning for morphological classification, and predictive modeling for outcome estimation. While some methods demonstrate high sensitivity and specificity in diagnostic and planning tasks, many remain in experimental stages and lack clinical integration. There is also a noticeable absence of advanced computational techniques for micro-computed tomography and morphological analysis. Conclusions: Computational methods offer significant potential to improve decision-making and outcomes in RCT. However, greater focus on clinical translation and development of cross-modality methodology is needed. The proposed taxonomy provides a structured framework for organizing existing methods and identifying future research directions tailored to specific phases of treatment. This review serves as a resource for both dental professionals, computer scientists and researchers seeking to bridge the gap between clinical practice and computational innovation.