A simpler way to save root-treated front teeth?

 

 New Study Puts Two Restoration Methods Head to Head

Article by Dr. Abed Alhade Kheder | abedalhade2223@gmail.com | Fixed Prosthodontics, Tishreen University, Latakia, Syrian Arab Republic

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The Problem: Restoring Badly Damaged Front Teeth After Root Canal Treatment

When a front tooth has been root-treated and has lost a large portion of its original structure, restoring it is one of dentistry's more demanding challenges. The traditional approach involves inserting a post down into the root canal, building up a core on top of it, and then placing a crown — a technique that works but requires removing further tooth material, sometimes weakening what little remains and raising the risk of a root fracture that cannot be repaired. A newer, less invasive option called an endocrown skips the post altogether, drawing its hold entirely from the pulp chamber — the hollow space left after root canal treatment — and covering the tooth with a single ceramic restoration. To find out how these two approaches compare when it matters most, researchers from Tishreen University in Syria put both techniques to a controlled mechanical test on 20 freshly extracted upper central incisors that had been badly damaged and then root-treated, splitting them into two equal groups of ten.

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What the Study Found: Both Methods Break Roughly the Same Way

Each restored tooth was mounted at a 45-degree angle — mimicking the real-life direction of biting forces on front teeth — and subjected to steadily increasing pressure until failure occurred. The researchers then recorded exactly what broke and where, classifying each failure as either "favorable" (meaning the tooth could potentially be repaired or saved) or "unfavorable" (meaning the damage was beyond repair). The results showed no statistically significant difference between the two groups in how or where failures occurred. In the endocrown group, fractures were more varied in location, with 80% classified as favorable. In the post-and-core group, the restoration itself — rather than the tooth root — was the most common point of failure, with 60% classed as favorable. The quartz fiber posts used in the second group have a stiffness close to that of natural tooth root, which allows them to bend slightly under pressure and redirect stress away from the root, explaining why root-level fractures were rare in that group.

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What This Means for Patients and Dentists

The findings suggest that endocrowns are a clinically sound option for restoring severely damaged, root-treated front teeth — not just back teeth, where they have long been the accepted standard. Because endocrowns require less drilling and do not involve post placement, they preserve more of the patient's natural tooth structure, shorten treatment time, and make any future re-treatment considerably less complicated. The study's authors are careful to note that the results come from a laboratory setting, that the sample size was small, and that real-world factors such as temperature changes and long-term chewing cycles were not replicated. Larger clinical studies with extended follow-up periods are needed before definitive recommendations can be made. The research was led by corresponding author Dr. Abed Alhade Kheder of the Department of Fixed Prosthodontics, Tishreen University, Latakia, Syrian Arab Republic. The full article is freely available in The Open Dentistry Journal (DOI: 10.2174/0118742106440539260407102718).

Read the published article here: https://bit.ly/4dllEuI

JOURNAL

The Open Dentistry Journal

 DOI: 10.2174/0118742106440539260407102718

If you want to publish your article please visit : https://bit.ly/4de0DRi

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Journal

The Open Dentistry Journal

DOI

10.2174/0118742106440539260407102718 

Stem cells at the root of tooth aging

 

Peer-Reviewed Publication

International Society for Stem Cell Research

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image: 

The immunofluorescence image of the chase result in dental pulp of adult Nfatc1-CreER; tdTomato; 2.3kb-Col1 GFP strain, which demonstrated the NFATc1+ DPSCs continuously gave birth of odontogenesis in vivo. This image is reported in the study titled NFATc1 Dysfunction-Triggered MSC Senescence Induces Tooth Aging Amenable to Senolytic Therapy in Stem Cell Reports (Fig. 2L).

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Credit: Fanyuan Yu & colleagues

With age, teeth get increasingly brittle and susceptible to damage from tooth decay, which can eventually lead to tooth loss. Teeth have an intrinsic capability to regenerate, a process which is driven by dental pulp stem cells (DPSCs) which replenish the dental pulp including the dentin-producing cells called odontoblasts. DPSCs stops working in aging teeth, divide less, and generate less odontoblasts, a process which is called senescence or the biological process of aging through gradual deterioration. DPSC senescence is thought to be a cause for the declining tooth health with age. 

A research team led by Fanyuan Yu from Sichuan University, China, has now discovered one of the mechanisms of DPSC senescence and identified a potential strategy to counter it. In their work published today in the journal Stem Cell Reports, the researchers first compared the regenerative capacity of young and old human molars affected by severe tooth decay. While most of the young teeth could be preserved, more than half of the aged teeth eventually died off, suggesting that tooth aging impairs dental pulp regeneration.  

To explain this phenomenon, Yu’s team used genetically engineered mouse models to identify a distinct subset of DPSCs responsible for generating new dental pulp cells and odontoblasts in young teeth. These stem cells were nearly absent in the teeth of old mice. Further, when these stem cells were eliminated from the teeth of young mice, the dental pulp underwent senescence and contained significantly less odontoblasts, further underscoring the essential role of this DPSC subset in tooth regeneration.  

A unique feature of these stem cells was the expression of a protein called NFATC1, which was abundant in young DPSCs but significantly reduced in old cells in both mouse and human teeth. NFATC1 was essential for the proper function of the mouse DPSCs, as its deletion halted odontoblast generation, induced senescence in young teeth, and reduced the tooth’s ability to regenerate after injury. Encouragingly, tooth regeneration could be stimulated in NFATC1 deficient mice by a combination of “senolytic” drugs which act by eliminating senescent cells.  

This study shows that a specific type of NFATC1+ DPSCs is essential for tooth regeneration and to prevent senescence. Follow-up studies will be required to show if preserving these stem cells can counteract tooth aging. 

About Stem Cell Reports
Stem Cell Reports is the open access, peer-reviewed journal of the International Society for Stem Cell Research (ISSCR) for communicating basic discoveries in stem cell research, in addition to translational and clinical studies. Stem Cell Reports focuses on original research with conceptual or practical advances that are of broad interest to stem cell biologists and clinicians. Stem Cell Reports is a Cell Press partner journal. Find the journal on X: @StemCellReports.

About ISSCR
Across more than 80 countries, the International Society for Stem Cell Research (@ISSCR) is the preeminent global, cross-disciplinary, science-based organization dedicated to advancing stem cell research and its translation to medicine.

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Journal

Stem Cell Reports

DOI

10.1016/j.stemcr.2026.102925 

Don't rush into braces with disc displacement:

 experts reveal the science of sequential therapy

Peer-Reviewed Publication

KeAi Communications Co., Ltd.

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image: 

This illustration was drafted by Prof. Yang himself and finished by his students. It depicts the sequential strategy for combined joint–mandible–occlusion diagnosis and treatment. Before and after the disc reduction surgery, preoperative orthodontics, postoperative jaw position adjustment and stabilization, and postoperative comprehensive orthodontic treatment are performed.

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Credit: Guo Bai and Qianyang Xie

A new study published in Dental Research reveals that while proper orthodontics can help a healthy jaw joint, incorrect treatment can worsen disc displacement and even cause bone loss. The authors, from Shanghai Ninth People's Hospital, created a "Joint-Mandible-Occlusion" sequential model: first surgically reposition the disc, then address teeth alignment. This approach aims to fix the joint first to ensure stable, long-term results for both bite and facial appearance.

"The aim is to promote balanced bilateral joint growth in growing patients and maintain joint stability in adults," says co-corresponding author Chu Yang. "This idea underpins a pioneering approach to treating temporomandibular joint (TMJ) disc displacement, a common yet often misunderstood condition."

The authors noted that teenagers with receding chins or crooked teeth are usually told their issues were purely dental. "But the real cause is often the jaw joint itself: when the articular disc— a cartilage shock absorber—slips, it can erode the jawbone's condyle over time, leading to facial asymmetry, receding chins and misaligned bites," adds Yang. "This changes treatment entirely."

"Notably, traditional orthodontics alone often relapses, as the joint problem remains unaddressed. For adolescents, this unlocks balanced jaw growth; for adults, it stops bone erosion and restores joint stability," says Yang. "Many patients feel no pain, unknowingly suffering silent bone loss. Screening joint health before orthodontics is key—this root-cause approach delivers stable, long-term results, improving bite, facial harmony and jaw health."

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Contact the author: Please contact Guo Bai and Qianyang Xie from Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University via surgeonb@163.com and Xieqianyang86@126.com.

The publisher KeAi was established by Elsevier and China Science Publishing & Media Ltd to unfold quality research globally. In 2013, our focus shifted to open access publishing. We now proudly publish more than 200 world-class, open access, English language journals, spanning all scientific disciplines. Many of these are titles we publish in partnership with prestigious societies and academic institutions, such as the National Natural Science Foundation of China (NSFC).

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DOI

10.1016/j.dtrs.2025.100001 

Opioids for dental pain still more common in US

 

Despite recent 27% drop in patients filling dental opioid prescriptions, rate is still higher in U.S. states than in Puerto Rico and six other developed countries

Peer-Reviewed Publication

Michigan Medicine - University of Michigan

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People getting their teeth pulled or drilled by dentists in the United States are still much more likely to get powerful opioid medications than dental patients in other developed countries or even the U.S. territory of Puerto Rico, a new study finds.

That’s despite steep drops in dental opioid prescription fills in recent years in the U.S., according to the new findings from a team from the University of Michigan Medical School and University of New South Wales published in the journal JAMA Network Open.

Dentists worldwide have worked in recent years to move away from prescribing opioids for routine dental procedure pain.

Newer dental care guidelines encourage them to advise patients to use other types of pain medication because of the risk that prescription opioids can lead to long-term use, the form of addiction called opioid use disorder, accidental poisoning or overdose.

From 2021 to 2024, the new study shows, there was a 27% drop in the rate of patients in U.S. states filling prescriptions from dentists for opioids, and a 10% drop in Puerto Rico. There were also double-digit decreases in four developed countries the researchers analyzed: Canada, France, Australia and Germany.

But by the end of 2024, the U.S. still had the highest rate of such prescription fills, though it had closed the gap with Canada, the country with the next-highest rate.

By contrast, the Netherlands had a dental opioids prescription fill rate that was 24 times lower than the U.S. rate. In the Netherlands in 2024, just 83 prescriptions for dental opioids were filled for every 100,000 inhabitants. In the U.S., 2,022 such prescriptions were filled for every 100,000 people.

Kao-Ping Chua, M.D., Ph.D., the lead author of the new study, has tracked dental opioid prescribing patters in the U.S. and other countries for years.

“Our study shows that the US dental opioid dispensing rate is decreasing but remains high by international standards", said Chua, who is an Associate Professor of Pediatrics at the U-M Medical School and of Health Management and Policy at the U-M School of Public Health. "This finding suggests that some U.S. dentists are still overprescribing opioids."

Chua is also director of the Susan B. Meister Child Health Evaluation and Research Center or CHEAR.

In 2023, Chua and colleagues showed that the rate of prescribing in the U.S. had dropped 45% between 2016 and 2022., though the progress slowed after the start of the COVID-19 pandemic. Even so, the 2022 rate in the U.S. was four times the 2016 rate in the United Kingdom. The new study does not include UK data.

The senior author of the new paper, Chad Brummett, M.D., is a Professor of Anesthesiology at U-M and co-director of the U-M Opioid Research Institute and the U-M-based opioid guideline and education effort called OPEN.

OPEN offers guides and educational materials for opioid-sparing pain care for dental and oral surgery patients. They’re available for free and have been updated several times.

Chua and Brummett are members of the U-M Institute for Healthcare Policy and Innovation; Romesh Nalliah, DDS, a co-author, was also a member during his time on the U-M faculty. Other authors are three members of the University of New South Wales in Sydney, Australia: Claudia Bruno, Ph.D.; Sallie-Anne Pearson, Ph.D., and Jonathan Brett, MBBS, Ph.D., and Siljia He, M.S., a CHEAR statistician.

The study was funded by the Benter Foundation, with additional funding by the National Institute on Drug Abuse of the National Institutes of Health (R01DA056438, R01DA057284, and R01DA057943), and the Australian National Health and Medical Research Council (1196900, 1196560).

Reference: International Trends in Dental Opioid Prescriptions, JAMA Network Open, doi:10.1001/jamanetworkopen.2026.7824

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Journal

JAMA Network Open

DOI

10.1001/jamanetworkopen.2026.7824 

Fighting oral cancer with bioengineered chewing gum

 

Researchers led by Henry Daniell of the School of Dental Medicine have shown that extracts from bioengineered chewing gum reduce the levels of three microbes known to be associated with head and neck squamous cell cancer (HNSCC), paving the way for more effective and affordable therapies. Their findings are published in Scientific Reports.

Head and neck squamous cell carcinoma (HNSCC) is a common cancer that develops in the lining of the mouth and throat. It can be aggressive and often has poor outcomes, especially when diagnosed at advanced stages, says Daniell. He notes that most recently approved cancer drugs have not significantly improved quality-of-life or five-year survival rates, underscoring the need for better therapies.

Building from their previous work using a chewing gum made from lablab beans (bean gum) containing the naturally antiviral protein FRIL, Daniell and colleagues examined the levels of three microbes linked to cancer—human papilloma virus, or HPV, and two species of bacteria, Porphyromonas gingivalis (Pg) and Fusobacterium nucleatum (Fn)—in oral samples from patients with HNSCC.

“The global increase in oropharyngeal cancer is linked to HPV infection,” says Daniell. “And Pg and Fn infections worsen survival rates of untreated recurrent or metastatic oral cancer, even after surgery and risk-adjusted adjuvant, or supplemental, therapies.”

They found that bean gum extracts reduced HPV levels by 93% in saliva samples and by 80% in oral rinse samples. When they bioengineered the bean gum to also contain protegrin, an antimicrobial peptide that can kill harmful bacteria, they found that a single dose reduced the levels of Pg and Fn to almost zero without affecting the beneficial bacteria normally found in the mouth. This contrasts with radiation therapy, which both reduces beneficial bacteria and increases disease-causing yeast (Candida albicans).

“Lip and oral cavity cancer was the seventh leading cancer type in cancer incidence and mortality rate worldwide in adolescents, young adults, and middle-aged adults in 2022,” says Daniell. “Our findings support the value of advancing these therapies to clinical trials as adjuvants with current treatments or as prophylaxis to prevent infection and transmission.”

Henry Daniell is the W.D. Miller Professor in the Department of Basic & Translational Sciences at the School of Dental Medicine at the University of Pennsylvania.

Other authors are Geetanjali Wakade,& Rahul Singh, and Smruti Nair of Penn Dental Medicine; Andrés M. Bur and Sufi M. Thomas of the University of Kansas Medical Center; Eri S. Srivatsan and Marilene B. Wang of the University of California at Los Angeles; and Saroj K. Basak of the Veterans Administration Greater Los Angeles Healthcare System.

This work was supported NIH (grant 5-R01-HL 107904-13 awarded to Henry Daniell), the Academic Senate Grant of David Geffen School of Medicine at UCLA (the Surgical Education Research program), and National Cancer Institute Cancer Center (Support Grant P30 CA168524).

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Journal

Scientific Reports

DOI

10.1038/s41598-026-39062-w 

Silicone toothbrushes: An underutilized tool in global oral health

 COMPLETE REPORT

Oral diseases are the most prevalent non-communicable diseases worldwide, affecting 3.5 billion people, with a disproportionate impact on those living in low- and middle-income countries. Current oral health promotion strategies rely heavily on plastic and nylon toothbrushes, which present both environmental and accessibility challenges. In response to the growing need for sustainable and affordable preventive oral health solutions, there has been increasing interest in alternatives to conventional toothbrushes. This scoping review aimed to summarize the global literature on silicone toothbrushes, an underutilized tool in preventive oral care. A systematic search of five databases, supplemented by reference screening, identified ten English-language studies investigating silicone toothbrushes. Findings suggest that silicone toothbrushes are effective in plaque removal, have a lower risk of gingival trauma, are well-suited for specific populations, and perform better in environmental impact assessments.

Plaque removal effectiveness

Dental plaque removal effectiveness was a central focus across most included studies. For example, two studies found that silicone toothbrushes demonstrated comparable plaque removal to plastic and nylon toothbrushes among post-secondary students [and children who brushed their teeth or who had support from parents. U-shaped automatic electric toothbrushes with silicone bristles were not effective at removing plaque compared to conventional and habitual toothbrushing practices. The authors suggest that the optimal hardness of the silicone toothbrushes was 60 Shore A, however, there was no soft tissue damage among all hardness levels. Threaded bristles significantly improved the dental plaque removal of silicone toothbrushes. Moreover, their findings indicate that silicone toothbrushes are equally as effective at removing plaque under both wet and dry brushing conditions.

Kids most in need of dental care least likely to benefit from school programs

 

Children who don’t go to the dentist are less likely to participate in school-based cavity prevention programs, according to research published in JAMA Network Open.

“Our study suggests that children who may need these services the most are the ones least likely to receive them,” said health economist and study author Shulamite Huang, an assistant professor of epidemiology and health promotion at NYU College of Dentistry.

In addition, the study found that improving participation in state-wide school dental programs to reach those at high risk for tooth decay could yield significant savings for state Medicaid programs and health care systems, averting up to $2.4 million in emergency department charges annually in New York. 

Children miss more than 34 million hours of school each year to receive emergency dental care. In recent years, hospitals have seen a sharp increase in emergency room visits for pediatric dental issues. 

To prevent tooth decay and the related pain and infections that land kids in the ER, some schools offer cavity prevention programs. New York State recently announced a $10 million initiative to expand access to school-based dental programs and improve children’s oral health.

Research shows that school dental programs, which use non-invasive treatments like sealants, are effective at preventing cavities. But parents must opt in for their kids to receive care in school, and it’s unclear if these programs reach those who are most in need. 

Huang and her colleagues evaluated data from more than 63,000 children living in the Bronx and covered by Medicaid, including more than 1,000 children who participated in school-based cavity prevention programs in local elementary schools. They looked at Medicaid claims data to see whether children had visited a dentist outside of school or received emergency dental care.

 The researchers found that kids who already had a history of dental care were more likely to participate in school-based cavity prevention programs. In contrast, children with no prior dental visits were 18 percent less likely to participate in these programs. Children with a history of dental emergencies (and probably at high risk for tooth decay) were also less likely to participate in school-based programs. 

The researchers then calculated the potential cost savings of expanding school-based dental care across New York State and improving participation among the children most at risk for tooth decay. They estimate that optimizing recruitment to enroll high-need children in school programs could save the state up to $2.4 million annually in dental-related emergency department costs (not including dental care related to accidents or injuries).

“This has staggering implications for Medicaid costs,” said Huang. “As New York expands access to school-based dental care, improving recruitment strategies and reorienting outreach to high risk-children could save the state millions and offset some of the costs of expanding care.”