Abstract:One of the most critical elements in achieving effective root canal therapy is efficient chemo-mechanical preparation with a full root canal system seal. However, chemical irrigation is essential for the removal of debris, tissue breakdown, and disinfection. Its main objective is to reach places that are inaccessible to mechanical instruments, such as auxiliary canals, isthmuses, and deltas. It has been demonstrated in the past that irrigation boosts the success rate of root canal therapy, which also has a favourable impact on the healing process.
Sodium hypochlorite (NaOCL) is a proteolytic agent with tissue solvent action, microbicidal, and anti-biofilm characteristics that is used at concentrations ranging from (0.5-6%), but it does not eliminate the smear layer that has been formed during the instrumentation process. As a result, ethylenediaminetetraacetic acid (EDTA), the most often used chelator in endodontics, should be employed subsequently. This standard procedure is called sequential chelation. However, it has several disadvantages, including increasing the dentin erosion inside and around the tubules. In addition, when mixed with NaOCl, EDTA reduces the amount of free available chlorine, reducing NaOCl’s ability to dissolve tissue.
Dual Rinse (HEDP) (Medcem, Weinfelden, Switzerland) became available in 2016 as a commercially certified etidronate chelation powder product that has been clinically authorized for endodontic usage by Dr. Matthias Zehnder. It exists in capsule form and includes 0.9 g powder of etidronate, which must be mixed with 10 mL of sodium hypochlorite solution shortly before root canal therapy to provide a single irrigant.Using a mild chelator (HEDP) in a freshly formed mixture with NaOCL has several advantages, including not interfering with the antibacterial and tissue-dissolving capabilities of the resultant mixture, preventing the accumulation of hard tissue debris and smear layer, reducing the irrigation time and improving the root canal wall conditioning for root-filling materials.
• MedCem is a mild chelator, has short-term biocompatibility with NaOCl, and may be used in conjunction with it, a concept known as ‘continuous chelation’.
• In a continuous chelation protocol, a chelator combined with sodium hypochlorite can be utilized as a single irrigant throughout the root canal instrumentation procedure.
• The dual rinse irrigant MedCem is an effective irrigation that promotes success rate of endodontic treatment.

Abstract The Miracle of Autologous Growth Factors Enriched Bone Graft Matrix (Sticky Bone) In Regenerative Endodontic Micro-Surgery.
:The use of platelet concentrates in dentistry evolves frequently, from the initial platelet-rich plasma (PRP) to sophisticated centrifugation procedures and injectable PRF preparations. Alveolar ridge augmentation, periodontal surgery, implant surgery, and endodontic regeneration are just a few of the disciplines that have used platelet concentrates for hard and soft tissue healing.
With breakthroughs in surgical approaches, some authors have proposed the combination of platelet concentrates with bone graft materials such as synthetic bone, xenografts, and allografts, a novel idea that involves creating “sticky bone,” a growth factor-enriched bone graft matrix. This composite biomaterial, which is a promising autologous material, results in a significant release of cytokines and autologous growth factors that are responsible for healing and tissue recovery. In addition, these growth factors promote the proliferation of mesenchymal stem cells, fibroblasts, and osteoblasts, impacting the development of tissue neoformation.
Sticky bone application in regenerative endodontic surgery in cases of through and through lesions, apico-marginal defects, and non-healed large apical lesions after root canal treatment will modulate the microenvironment in periapical defects that demand guided tissue regeneration (GTR), which combines the use of bone graft material plus a resorbable or non-resorbable membrane, and this may elicit some immunological response. So, using sticky bone after apicoectomy provides us with an autologous growth factor-enriched bone graft matrix that simplifies handling during the surgical operations due to its optimal moldability without disintegration into the surrounding soft tissues. It also allows stabilization of the bone graft in the defect to accelerate tissue healing with the elimination of graft loss and inhibits the ingrowth of soft tissue in the graft, which results in complementing the surgery and increasing the success rate.

Abstract:The use of platelet concentrates in dentistry evolves frequently, from the initial platelet-rich plasma (PRP) to sophisticated centrifugation procedures and injectable PRF preparations. Alveolar ridge augmentation, periodontal surgery, implant surgery, and endodontic regeneration are just a few of the disciplines that have used platelet concentrates for hard and soft tissue healing.
With breakthroughs in surgical approaches, some authors have proposed the combination of platelet concentrates with bone graft materials such as synthetic bone, xenografts, and allografts, a novel idea that involves creating “sticky bone,” a growth factor-enriched bone graft matrix. This composite biomaterial, which is a promising autologous material, results in a significant release of cytokines and autologous growth factors that are responsible for healing and tissue recovery. In addition, these growth factors promote the proliferation of mesenchymal stem cells, fibroblasts, and osteoblasts, impacting the development of tissue neoformation.
Sticky bone application in regenerative endodontic surgery in cases of through and through lesions, apico-marginal defects, and non-healed large apical lesions after root canal treatment will modulate the microenvironment in periapical defects that demand guided tissue regeneration (GTR), which combines the use of bone graft material plus a resorbable or non-resorbable membrane, and this may elicit some immunological response. So, using sticky bone after apicoectomy provides us with an autologous growth factor-enriched bone graft matrix that simplifies handling during the surgical operations due to its optimal moldability without disintegration into the surrounding soft tissues. It also allows stabilization of the bone graft in the defect to accelerate tissue healing with the elimination of graft loss and inhibits the ingrowth of soft tissue in the graft, which results in complementing the surgery and increasing the success rate.

Abstract title:Long-term follow-up of endodontic microsurgical combined with orthograde retreatment of Oehler’s Type III Dens Invaginatus: a case report

Abstract:Aim:
This report describes the management of an unusual case of dens invaginatus in a 48-year-old female patient.
Case description:
Cone beam computed tomography and an initial periapical radiograph showed the presence of type III dens invaginatus with inadequate obturation, poor apical seal, and a periapical lesion related to tooth number #22. The case was managed successfully by a combination of nonsurgical and microsurgical endodontic retreatment. Orthograde endodontic retreatment was performed using rotary files and calcium hydroxide paste as intracanal medication. One week later, the root canal was obturated with thermoplasticized gutta percha and adseal sealer. Then, microsurgery was done one week later. After 3 years of follow-up, the absence of periapical radiolucency and satisfactory healing were observed.
Conclusion:
Microsurgical retrograde with orthograde retreatment of dens invaginatus should be considered to promote periapical healing with complete reconstitution of bone and periodontal ligament regeneration without signs of recurrence over a period of 3 years. Additionally, it preserves the entire tooth.
Keywords: cone beam CT, dens invaginatus, microsurgical endodontics, periapical lesion, retreatment.