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Introduction: This study aimed to determine the correlation between proximal caries and the extent and site of pulp canal obliteration (PCO) in cone-beam computed tomographic (CBCT) scans of mandibular molar teeth., Methods: A total of 1491 CBCT scans of patients 18-49 years of age were selected from the database (2002-2022). From them, 328 teeth with proximal caries and satisfying inclusion criteria were evaluated by 2 calibrated evaluators. PCO was observed in the sagittal and coronal planes. PCO and proximal caries were compared concerning different age groups, sexes, and sites using an independent sample t test., Results: The prevalence of PCO among patients with proximal caries is 47%. In mesial proximal caries, the extent of PCO is significantly greater in the distal root canal (73.4%), whereas in distal proximal caries, PCO is more often found in the mesial canal (77.3%). The mean extent of intraradicular calcification was higher in the distal canal (P < .001). Moreover, mesial proximal caries showed a greater extent of intraradicular obliteration (P < .001). The probability of developing PCO was significantly higher in females (P = .003)., Conclusions: Within the limitations of this study, it can be concluded that the extent of calcification is more common on the opposite side of the location of the proximal caries. Moreover, such intraradicular calcification is greater in a distal canal compared to a mesial canal. Sex plays a significant role in the calcification process, showing higher predilection in females compared to males., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: Identification of tooth ankylosis before comprehensive orthodontic treatment can be challenging. This case series illustrates different presentations of tooth ankylosis, the importance of early diagnosis, the use of surgical luxation to aid orthodontic alignment of ankylosed teeth and its sequelae., Case Presentation: All three cases were adolescents: a 14-year-old girl with a highly placed upper left lateral incisor and history of general anaesthesia; a 14-year-old boy with an impacted upper right first premolar and history of dental trauma; and a 13-year-old girl with an infraoccluded upper left central incisor with history of replantation due to avulsion. Iatrogenic malocclusion developed from attempts to align these ankylosed teeth. Subsequently, surgical luxation was performed, and the ankylosed teeth were successfully aligned. However, it was associated with pulp calcification, root resorption and recurrence of ankylosis., Conclusion: Surgical luxation and orthodontic alignment of ankylosed teeth can be considered a useful short-term solution to delay the need of surgical removal and teeth replacement., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Single tooth orange discoloration secondary to root canal calcification occurs as a consequence of dental trauma, orthodontic treatment, or for unknown rea- sons. A correct case history must be compiled and a CBCT study carried out in order to establish the diag- nosis and define the best treatment plan in each case. The aim of the present study was to offer a therapeutic protocol involving a clinical decision-making tree dia- gram based on the presence or absence of apical dis- ease and the degree of canal calcification. Dental bleaching and the use of ceramic veneers allow es- thetic restoration in such cases.

Dental pulp calcification can lead to root canal stenosis or obliteration. It is usually difficult to negotiate the root canal if the affected tooth needs to be treated and intraoperative complications are easily brought about during the root canal treatment. The etiologies of dental pulp calcification are complicated and careful considerations should be given to the diagnosis and treatment. Only by weighing the advantages and disadvantages can appropriate treatment plan be chosen. Based on the literature and authors' clinical experiences, the present article summarizes the causes, pathogenesis, diagnosis and treatment strategies of dental pulp calcification, in order to provide some references in diagnosis and treatment for the dental clinicians.

Ehlers-Danlos syndromes (EDS) are a group of inherited connective tissue disorders characterized by joint hypermobility, skin hyperextensibility, and variable tissue fragility. However, there are limited published data on the dental manifestations of EDS. This review systematically assessed the spectrum of published dental anomalies in various types of EDS. Twenty-four individual case reports/series and 3 longer case-control studies, reporting on a total of 84 individuals with a clinical diagnosis of EDS, were included in the data analysis. The main dental features listed in classical EDS were pulp calcification and localized root hypoplasia. Common dental abnormalities observed in vascular EDS were pulp shape modifications (52.2%), exceeding root length (34.8%), and molar root fusion (47.8%). Dentinogenesis imperfecta is a consistent finding in osteogenesis imperfecta/EDS overlap syndrome. Data on dental manifestations in other types of EDS are both rare and generally inconclusive.

Revascularization-associated intracanal calcification (RAIC) is a common finding in immature teeth managed with regenerative endodontic treatment (RET). The aim of this report was to illustrate a case in which 2 mandibular premolar teeth developed complete canal obliteration and have been reviewed for 8 years. The 3 primary outcome goals as defined by the American Association of Endodontists after RET are resolution of signs and symptoms of pulp necrosis, further root maturation, and achievement of responses to pulp vitality testing. The teeth had been included in an earlier quantitative study in which an increase in root canal width of 72.1% and 39.6% and an increase in root length of 1.7% and 0% were reported for teeth #20 and #29, respectively. Qualitative assessments over the 8-year review period showed no pathosis and a response to electric pulp testing at the final review. A quantitative assessment at the 8-year review showed an increase of 100% for canal width because complete calcification had occurred and no substantive change in root length (-0.17% and 0.68% for teeth #20 and #29, respectively). In this report, complete RAIC occurred in both teeth over time. RAIC has the potential to complicate future endodontic or prosthodontic treatment if necessary. Therefore, it is recommended that the American Association of Endodontists clinical considerations for a regenerative endodontic procedure be updated to include the incidence of RAIC after RET., (Copyright © 2018 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Intracanal calcifications have been reported in endodontic cases after revascularization. The purpose of the current study was to determine the incidence of intracanal calcification and potential contributing factors in retrospective revascularization cases., Methods: Among 37 patients who had undergone revascularization between 2010 and 2014, 29 cases were assessed with average follow-up period of 24.9 months. Clinical and radiographic examinations were performed to evaluate the treatment outcomes, eg, resolution of apical periodontitis (AP), root development, and occurrence of intracanal calcification. Radiographic assessment revealed varied calcification patterns, which were classified into calcific barrier or canal obliteration, collectively referred to as revascularization-associated intracanal calcification (RAIC)., Results: All 29 cases demonstrated resolution of AP, whereas continued root development with apical closure occurred in 23 of 29 cases (79.3%). RAIC was noted in 18 of 29 cases (62.1%), among which 5 of 18 cases (27.8%) were classified as calcific barrier and 13 of 18 cases as canal obliteration (72.2%). Higher frequency of RAIC was noted in the cases with induced bleeding (16 of 23 cases, 69.6%), whereas the 6 cases without induced bleeding showed RAIC at 33.4%. Also, RAIC occurred more frequently in cases medicated with Ca(OH) 2 (10 of 13 cases, 76.9%) than in those medicated with antibiotic pastes (6 of 13 cases, 46.2%)., Conclusions: This study indicated that RAIC is common (62.1%) among cases treated with revascularization. Multiple contributing factors may include the type of medicaments and induction of intracanal bleeding. Although RAIC does not interfere with resolution of AP, some cases may progress to complete obliteration of root canals and would impede normal function of dental pulp tissues., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Life cycles of dental trauma victims can provide important clinical information, especially when viewed over many years. In this first series of life cycles, the pulp and periodontal responses to traumatic injuries of four patients are documented over periods varying from 26 to 51 years. The dynamics of pulp survival following an intrusive luxation and two avulsions are followed, with particular reference to pulp canal calcification to which a new term, root canal stenosis, has been proposed. The life cycles include the successful management of inflammatory root resorption in a replanted tooth with an open apex contrasting with the early prophylactic endodontic treatment of two replanted teeth in a patient with mature apices. The long-term development of invasive cervical resorption in one of the patient's life cycle highlights the importance of ongoing follow-up examinations for dental trauma victims., (© 2016 Australian Dental Association.)

Traumatic injury to an immature tooth may result in pulpal necrosis secondary to pulp canal obliteration, which makes the management of the tooth a clinical challenge for dentists. The present case report describes an innovative apical plug technique with mineral trioxide aggregate in a calcified immature tooth using an ultrasonic tip and long, thin, tapered fissure burs. The technique was proven to be successful clinically and radiographically at 2 years postobturation.

Aim: The aim of this study was to evaluate the main post-traumatic complications of severe luxation and replanted teeth using clinical and radiographic analyses., Materials and Methods: Eighty-three patients aged between 7 and 55 years old presenting 180 traumatized teeth that suffered extrusive luxation (n=67), lateral luxation (n=69), intrusive luxation (n=10) and tooth avulsion (n=34) followed by replantation were evaluated. The follow-up period was 24 months. The complications examined were: pulp canal obliteration, pulp necrosis and root resorption (infammatory and replacement). Furthermore, the relationship between time elapsed before receiving dental attendance and development of infammatory resorption was observed., Results: Pulp necrosis was the main complication, occurring in 147 teeth (82.7%). All of the teeth that suffered intrusive luxation and tooth avulsion were diagnosed with pulp necrosis, with significant difference in comparison with another traumas (p<0.001/Fisher's exact test). Infammatory root resorption was observed in 20.5% of the cases and replacement resorption was more related to tooth replantation (94.1%), showing significant prevalence among tooth luxations (p<0.001/Fisher's exact test). In addition, it was noted that patients who seek treatment 9 weeks after the trauma episode presented 10 times more chance of developing infammatory resorption when compared with patients who seek treatment soon after dental trauma (Odds ratio test)., Conclusion: It may be concluded that pulp necrosis was the main post-traumatic complication observed in traumatized teeth and that delay in seeking treatment may damage the prognosis of severe luxation and replanted teeth., Clinical Significance: Clinical studies describing the main complications that may affect traumatized teeth present great relevance to make the population aware of the importance of seeking immediate treatment and to alert the professional to the need for follow-up. When traumatic injuries are diagnosed and treated early, post-traumatic complications may be controlled, allowing conservation of the tooth in oral cavity.

Introduction: The aim of this study was to evaluate pulpal responses after experimental direct pulp capping of mechanically exposed teeth with a new calcium silicate-based dentin replacement material., Methods: Thirty-four anterior and posterior teeth of 3 miniature swine were used. Class V or I cavities were prepared on the buccal or occlusal surfaces, respectively. Pulpal exposures were further performed using a round carbide bur 0.8 mm in diameter. Exposures were treated with white MTA Angelus (Angelus, Londrina, PR, Brazil) or Biodentine (Septodont, Saint Maur des Fosses, France), and the cavities were further restored with Biodentine. The pulpal tissue responses were histologically assessed at postoperative periods of 3 and 8 weeks. Data were statistically analyzed using the Kruskal Wallis and the Mann-Whitney U tests., Results: Inflammatory infiltration or pulp tissue necrosis was not found in any of the specimens. All teeth showed mineralized matrix formation in the form of a complete hard tissue bridge composed of osteodentin or osteodentin followed by a discontinuous or continuous reparative dentin zone. A significantly higher thickness of the hard tissue bridge was found in the group of teeth treated with Biodentine at both 3 and 8 weeks. A number of teeth, which were under root development at the onset of the experimental procedures, exhibited ectopic pulp calcification., Conclusions: The application of both calcium silicate-based materials in direct contact with the mechanically exposed pulp of healthy miniature swine teeth led to pulp repair with complete hard tissue bridge formation. The thickness of hard tissue bridges was significantly higher after pulp capping with Biodentine., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Orthodontic forces produce a series of changes in dental pulp. However, no one has attempted to investigate the incidence of pulp necrosis after orthodontic therapy in the clinic. In this study, we aimed to investigate pulp vitality and histologic changes after the application of moderate and severe intrusive forces., Methods: Twenty-seven adolescent patients were assigned to 1 of 3 groups: the control group of 3 subjects; the moderate-force group, with 12 subjects who received a 50-g force to the first premolars bilaterally; and the severe-force group, with 12 subjects who received a 300-g force. The forces were applied for 1, 4, 8, or 12 weeks. An electric pulp tester was used to test for vitality, and teeth that did not respond to the electric pulp tester were subsequently tested thermally with a stick of heated gutta-percha., Results: The teeth with a negative response to the electric pulp tester still responded to the thermal test. We found odontoblast disruption, vacuolization, and moderate vascular congestion in both force groups, but no necrosis was observed. Pulp stones were formed only in the severe-force group., Conclusions: Dental pulp still has vitality after intrusive treatment with different forces. These data provide new insights into the effects of intrusive orthodontic forces., (Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Unlabelled: Trauma to the primary dentition is common. This injury may have an impact on the child and his/her parents. The examining dentist should take appropriate factors into consideration before providing the required treatment. This paper discusses the management of trauma to the primary teeth and describes the sequelae of injury to both the primary and secondary dentitions., Clinical Relevance: In cases of trauma to the primary teeth, diagnosis and appropriate management is necessary to alleviate the pain and discomfort for the child and to decrease the risk of damage to the permanent successor. It is important to prevent inducing fear and dental anxiety in children during the management of this injury.

The dental management of an 8-year-old girl with osteopathia striata with cranial sclerosis (OS-CS) is described. The girl presented with various oral abnormalities. The aim of this case report was to describe in detail the dental findings in a patient with OC-CS and the precautions to be taken when planning treatment. In the present case, many dental anomalies, such as delayed eruption of the permanent teeth, obliteration of the dental pulp, short roots, fused roots and taurodontism, were detected. In patients with OS-CS, routine dental care from an early stage is recommended to manage this anomaly properly.

Dental tissues have special characteristics, and its regenerative capacity is noteworthy. However, understanding the circumstances that lead to regeneration is challenging. In this study, the chronology of the healing process after immediate replantation of rat incisor teeth was examined by histological and immunohistochemical analyses within a 60-day period. Thirty-six male Wistar rats had their maxillary right incisors extracted and replanted after 15 min in saline storage. The rats were sacrificed immediately 3, 7, 15, 28, and 60 days after replantation. The histological analysis showed rupture of the periodontal ligament and formation of a blood clot, which started being replaced by a connective tissue after 3 days. At 7 days, the gingival mucosa epithelium was reinserted and areas of root resorption could be seen. At 15 days, the periodontal ligament was repaired. At 3 days, the pulp presented an absence of the odontoblast layer, which started being replaced by a connective tissue. This tissue suffered gradual calcification, filling the root canal at 28 and 60 days. The root ends were closed. The immunohistochemical analysis revealed greater expression of OP, OPG, and RANK proteins in the initial periods (0 and 3 days), while TRAP expression predominated at 28 and 60 days (P < 0.05). In conclusion, in delayed tooth replantation, there is great new bone formation activity in the earlier periods of the repair process, while a predominance of bone resorption and remodeling is observed in the more advanced periods., (© 2012 John Wiley & Sons A/S.)

Unlabelled: Calcific metamorphosis (CM) is a commonly observed phenomenon following traumatic injuries like concussion, subluxation and luxation. Depending on the severity of the injury and the developmental stage of the tooth, there can be either complete or partial obliteration of root canals. However, histologically, there is always persistence of fine residual filaments of pulp tissue or tracts of organic material without the presence of any inflammatory component. A periodic clinical and radiographic follow-up examination is preferred and usually, for cosmetic reasons, only a conservative aesthetic treatment is required. Endodontic treatment is only advocated if there is development of apical periodontitis and, if executed properly, can be highly successful., Clinical Relevance: Appropriate management of calcific metamorphosis can present a clinical dilemma to the clinician. Thus a judicious and prudent decision should be made between endodontic intervention for the involved tooth and other available restorative (and/or aesthetic) treatment options.

Background: Systemic complications in patients after renal or liver transplantation may be localized in the oral cavity. Calcium-phosphate disturbances may affect the structure and metabolism of mandible bones, promote calcification of dental pulp, and in children may cause developmental defects of teeth. The aim of this study was to evaluate the incidence of dental and bone abnormalities in children and adolescents after kidney and liver transplantation with respect to the type of the transplanted organ and maintenance immunosuppression., Material/methods: Overall, 23 kidney and 25 liver recipients (mean age: 13.95±4.2 yrs) were evaluated. Twenty patients received ciclosporin A (CsA) and 28 tacrolimus (TAC). Twenty-one kidney and 14 liver recipients were treated with steroids. Mean time after transplantation was 3.62±2.98 years., Results: The severity of caries and percentage of odontogenic abnormalities (76.0% vs. 60.86%) was higher in liver transplant recipients. Positive correlations were found between discoloration of the deciduous teeth and liver transplantation, between enamel hypoplasia and kidney transplantation, and between treatment with CsA and its dose and blood concentration (p<0.05). Pulp stones were present in 13.04% of kidney vs. 8.0% in liver recipients, more often in those treated with CsA than with TAC. Jaw bone abnormalities were present in 30.43% kidney recipients vs. 12% liver recipients., Conclusions: Both kidney and liver recipients present dental and bone abnormalities. The incidence of specific types of oral lesions is different in renal and liver graft recipients; however, it is also correlated with specific immunosuppression.

Unlabelled: Root fractures are uncommon following dental trauma but are mostly diagnosed shortly after the injury, although occasionally at routine dental appointments. This paper presents the management of the different types of root fractures and the types of healing response suggesting the appropriate follow-up of these injuries., Clinical Relevance: A thorough clinical examination supplemented with radiographs, vitality tests, appropriate treatment planning and subsequent follow-up of root fractured teeth can improve the prognosis for these teeth and also minimize the need for subsequent extractions. Immature teeth with root fractures have a better chance of healing compared to teeth with fully formed roots.

Introduction: Endodontic treatment of immature necrotic teeth is challenging. Recently a biologically based treatment called regenerative endodontic treatment was introduced. Although regenerative endodontic treatment causes root development, there are several drawbacks and unfavorable outcomes that should be addressed. This article describes regenerative endodontic treatment of 2 maxillary central incisors with poor root development outcomes., Methods: A healthy 14-year-old female patient was referred. The patient had history of an impact trauma 6 years before the first visit. Clinical and radiographic examinations revealed that maxillary central incisors were immature and necrotic with symptomatic apical periodontitis. After local anesthesia, rubber dam isolation, and access cavity preparation each tooth was irrigated with 20 mL of NaOCl 5.25% and received triple antibiotic dressing (ciprofloxacin, metronidazole, minocycline) for 4 weeks. In the next visit, after eliminating antibiotic dressing, bleeding was induced inside the canals, and then the coronal thirds of the canals were sealed with mineral trioxide aggregate. A week later, both teeth were permanently restored., Results: In clinical and radiographic follow-ups, both teeth were functional, periapical lesions were healed, and the apices formed. However, the roots were not developed. After 6 years, because of moderate discoloration and caries, both teeth received root canal therapy and were permanently restored with casting dowel core and full crown restorations., Conclusions: Criteria for case selection in regenerative endodontic treatments should be determined., (Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Enamel renal syndrome is a very rare disorder associating amelogenesis imperfecta with nephrocalcinosis. It is known by various synonyms such as amelogenesis imperfecta nephrocalcinosis syndrome, MacGibbon syndrome, Lubinsky syndrome, and Lubinsky-MacGibbon syndrome. It is characterized by enamel agenesis and medullary nephrocalcinosis. This paper describes enamel renal syndrome in a female patient born in a consanguineous family.

Aim: The aim of this study was oral rehabilitation of 17-year old patient with amelogenesis imperfecta using removable overlay denture in order to satisfy her esthetic and functional expectations and enhance her self-image., Background: Amelogenesis imperfecta (AI) is a group of genetic disorders that primarily affect the quality and quantity of amelogenesis in both primary and permanent dentitions. The main clinical characteristics are severe attrition, tooth sensitivity and unesthetic appearance., Case Report: This clinical report illustrates the oral rehabilitation of a 17-year-old girl with hypoplastic-hypomature type of AI with cobalt-chromium (Co-Cr) overlay removable partial denture (ORPD) that is one of the most economical and biocompatible replacements for noble metal and nickel-chromium (Ni-Cr) alloy., Conclusion: The presented case report suggests that Co-Cr ORPD can be a good temporary or even permanent treatment option for AI patients with limited budget, low esthetic concerns or medical limitations., Clinical Significance: There are major advantages in cast metal ORPDs; they are simpler, less traumatic and less expensive than fixed prosthetic options. This case report supports their use in patients with amelogenesis imperfecta.

Unlabelled: The traumatized primary teeth have a great clinical significance because it not only have consequences on itself but also on its succedaneous developing permanent teeth due to its close anatomical relationship. The extent of severity is adjudged by the type of trauma and the age of the child at the time of trauma. For instance, avulsion and intrusive injuries present with high percentage of developmental disturbances in permanent teeth than subluxation and extrusive injuries. When considering the age of the child at the time of trauma, consequences are less severe in children over 4 years of age than in the younger age group., Clinical Significance: It highlights the sequelae of trauma to primary teeth with the aim of aiding in detection of probable alterations in the traumatized primary teeth and its succedaneous permanent teeth.

Purpose: The purpose of this study was to determine the occurrence of pulp canal obliteration (PCO) in traumatized primary maxillary central incisors and its association with secondary pulp necrosis, type of trauma, and further incidence of trauma., Methods: A retrospective descriptive study on 112 traumatized teeth was carried out (9-year follow-up) using the clinical and radiographic data from 82 patient charts at the Traumatized Patient Care Program of the Universidade Federal de Santa Catarina., Results: A total of approximately 54% of the teeth exhibited PCO; in approximately 58% of these cases, obliteration was diagnosed within 12 months following the trauma. An association between PCO and crown discoloration was confirmed (P<.001). PCO was not significantly associated with patient gender, age, type of trauma, or recurrence of trauma. There were no cases of secondary pulp necrosis., Conclusions: The findings of the present study reveal that the occurrence of PCO in traumatized primary teeth was high, while the type and recurrence of trauma were not risk factors for the development of PCO. Moreover, there was no association between PCO and secondary pulp necrosis.

Aim: To establish the prevalence of pulp calcifications in 946 patients at the Research and Clinical Center of Dental Trauma in Primary Teeth., Study Design: The clinical and radiographic records of l675 traumatized primary teeth were evaluated. Statistical analysis was performed using chi-square and univariate logistic regression., Results: 197 (20.8%) patients showed pulp calcification (PC). A total of 250 (14.9%) calcified teeth were observed In most teeth, PC appeared within the first 12 months following trauma. PC prevalence was higher in cases of repeated trauma (29.6%) than in single trauma (16.4%), p < 0.05, with a 2.14 chance of showing pulp calcification when a child suffered recurrent trauma. Most teeth showing calcified pulp, suffered trauma to the supportive tissue (67.4%), being statistically significant in relation to the trauma to dental tissue (p < 0.05)., Conclusion: PC is a sequelae in cases of trauma to the primary dentition; teeth that suffered recurrent traumatic injuries show higher risk of presenting.

Surgical repositioning is a treatment option for an impacted tooth with root dilaceration in an inverted position. In this case report, surgical repositioning of an abnormally impacted and labially dilacerated maxillary right central incisor is described. The impacted and dilacerated maxillary incisor was surgically repositioned in the early root development period and erupted into proper position with normal root development during a 2-year follow-up period.

Introduction: Pulp stones are frequently formed as a pathologic calcification product in dental pulp tissues, but the pathogenesis is poorly understood. We previously found that osteopontin (OPN) was produced by dental pulp cells, and its expression was associated with formation of the pulp stone matrix. It was reported that amorphous calcification appeared in the dental pulp of diabetic patients. The aim of this study was to determine the relationship between OPN expression and pathologic calcification in rat diabetic pulp., Methods: The effect of glucose on OPN production and alkaline phosphatase activity in cultured rat dental pulp cells (RPC-C2A) was investigated, and then dental pulp calcification and OPN expression in diabetic rats were determined and compared with those in healthy rats by histologic and immunohistochemical analyses., Results: In RPC-C2A cells, biochemical analysis showed that a high concentration of glucose (50 mmol/L) increased OPN protein production and alkaline phosphatase activity 1.3-fold and 1.5-fold, respectively. Histologic observations showed more calcified particles in dental pulp tissues in diabetic than in nondiabetic rats. Moreover, a thickened layer of predentin was formed in the radicular pulp of diabetic rats. OPN was more strongly stained around the calcified particles and in the odontoblast zone under the thickened predentin in diabetic rats., Conclusions: OPN might be a key molecule involved in the increase of pathologic pulp calcifications, which are frequently observed in diabetic patients., (Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

The purpose of the present retrospective study was to evaluate the post-traumatic healing of the pulp and periodontium of 32 permanent teeth with horizontal root fractures. Twenty-nine patients, 8-48 years old, who presented at our department with a root fracture between January 2001 and April 2007, participated in the study. Root-fractured teeth with a loosened or dislocated coronal fragment were repositioned and splinted for 14-49 days (average: 34 days). In cases of severe dislocation of the coronal fragment, prophylactic endodontic treatment was performed. Follow-up examinations were conducted routinely after 1,2,3,6, and 12 months. For this study, follow-up took place for up to 7 years post trauma. Of 32 root-fractured teeth, 29 (91%) survived. 10 teeth (31%) exhibited pulpal healing; 13 teeth (41%) were prophylactically endodontically treated within 2 weeks of injury. At the fracture line, interposition of calcified tissue was evident in 6 teeth (19%), and interposition of granulation tissue was observed in 8 teeth (25%). The prognosis of the root-fractured teeth was good, and one-third of the teeth with root fractures possessed a vital pulp at the final examination.

Pulp canal obliteration (PCO) is a sequela of tooth trauma. The dental clinician faced with this condition has to make a difficult decision. The aim of this study was to evaluate the clinical signs and symptoms associated with teeth with PCO and to assess the status of the periapical tissues using the periapical index (PAI) as an aid in making a treatment decision. The study included teeth diagnosed with PCO in patients with a history of traumatic injury to the involved teeth. Histories of associated signs and symptoms including pain, swelling and drainage from a sinus tract were elicited. Tooth color, sensibility to electric pulp testing, mobility and percussion tenderness were recorded. The periapical status was assessed using the PAI. Two hundred and seventy-six teeth were diagnosed with PCO. One hundred and fifty-seven (56.9%) and 119 (43.1%) demonstrated partial or total PCO, respectively. Yellow discoloration presented most frequently, occurring in 186 (67.4%) teeth. Sixty-two (33.3%) of these had developed periapical lesions and reacted negatively to sensibility testing. Fifty-seven (30.7%) of these teeth presented radiographically with a normal periapical appearance and reacted normally to sensibility testing, whereas 67 (36.0%) presented with small changes in the periapical bone pattern and reacted in the high normal range to sensibility testing. Teeth with PAI scores < or =2 presented with occasional spontaneous pain. Teeth with PAI scores > or =3 presented with clinical symptoms and signs ranging from pain on percussion to spontaneous pain, and slight swelling to sinus tract drainage. Based on the findings of this study, endodontic treatment should be initiated in teeth with tenderness to percussion, PAI scores > or =3 and a negative response to sensibility testing.

A 37-year-old man reported to our department with the history of gunshot injury to the mandible 15 years before. His anterior mandible had been resected earlier and bone graft was seen. Intraoral examination of lower jaw revealed 4 remaining mandibular molars. These teeth were severely rotated such that they lay horizontal with respect to the mandibular base. Preoperative Dentascan spiral computerized tomography (CT) of the patient revealed obliteration of the mesial canals of the mandibular right first molar and pear-shaped internal resorption defect in the distal canal of the same tooth. This paper reports the challenging endodontic management of a rare case of severely angulated teeth also exhibiting traumatic sequelae in both roots of the impact tooth. It also highlights the usefulness of spiral CT scan in diagnosis of traumatic sequelae such as pulp canal obliteration and internal resorption.

Intrusion is defined as the axial dislodgment of the tooth into its socket and is considered one of the most severe types of dental trauma. This longitudinal outcome study was undertaken to evaluate clinically and radiographically severely intruded permanent incisors in a population of children and adolescents. All cases were treated between September 2003 and February 2008 in a dental trauma service. Clinical and radiographic data were collected from 12 patients (eight males and four females) that represented 15 permanent maxillary incisors. Mean age at the time of injury was 8 years and 9 months (range 7-14 years and 8 months). Mean time elapsed to follow-up was 26.6 months (range 10-51 months). The analysis of data showed that tooth intrusion was twice as frequent in males. The maxillary central incisors were the most commonly intruded teeth (93.3%), and falling at home was the main etiologic factor (60%). More than half of the cases (53.3%) were multiple intrusions, 73.3% of the intruded teeth had incomplete root formation and 66.6% of the teeth suffered other injuries concomitant to intrusion. Immediate surgical repositioning was the treatment of choice in 66.7% of the cases, while watchful waiting for the tooth to return to its pre-injury position was adopted in 33.3% of the cases. The teeth that suffered additional injuries to the intrusive luxation presented a fivefold increased relative risk of developing pulp necrosis. The immature teeth had six times more chances of presenting pulp canal obliteration that the mature teeth and a lower risk of developing root resorption. The most frequent post-injury complications were pulp necrosis (73.3%), marginal bone loss (60%), inflammatory root resorption (40%), pulp canal obliteration (26.7%) and replacement root resorption (20%). From the results of this study, it was not possible to determine whether the type immediate treatment had any influence on the appearance of sequelae like pulp necrosis and root resorption after intrusive luxation, but the existence of additional injuries and the stage of root development influenced the clinical case outcome in a negative and positive manner, respectively.

Unlabelled: THE AIM of this study was to analyze the pulp behavior 17 hemisectioned primary second mandibular molars, exposed into the oral environment. The mesial crown and root portions were extracted after 8 months and analyzed histologically., Results: The cardinal signs such as pain, sensitivity and necrosis were not found in any of these teeth with the exception of one case which had a previous restoration. The formation of pulp polyps, pulp calcifications and pulp obliteration were seen as a normal physio-pathological response., Conclusions: Exposed pulps, reacted forming pulp polyps and in a similar fashion to exfoliating primary teeth but in an accelerated manner.

The objectives of this study were to describe the prevalence of pulp chamber calcifications in a sample of Turkish dental patients and to report associations between presence of pulp chamber calcifications and dental status, gender, age, and cardiovascular diseases (CVDs). Data were collected through radiographic examination of periapical and bitewing radiographs of 15,326 teeth from 536 dental patients, comprising 270 male and 266 female patients aged between 13 and 65 years. Definite radiopaque focuses inside the radiolucent pulp chamber were defined as pulp chamber calcifications. When the pulp chamber was completely radiolucent, that tooth was scored as tooth without pulp chamber calcification. The dental status was scored as intact, carious, restored, or restored + carious. Pulp chamber calcifications were identified in 204 (38%) patients examined. Of the 15,326 teeth, 747 (4.8%) had pulp chamber calcifications. Gender and dental status were found to be correlated with the presence of pulp chamber calcifications. The high prevalence of pulp chamber calcifications in carious, restored, and restored + carious teeth support the view that the occurrence of pulp chamber calcifications can be a response to long-standing irritants. However, to report any associations between occurrence of pulp chamber calcifications and different dental or clinical status, further studies are still needed.

Orofacial trauma is a serious orodental and general health problem that may have medical, esthetic and psychological consequences for children and their parents. When the root of the primary tooth is close to the unerupted permanent tooth, primary tooth trauma may result in developmental disturbances and pulpal reaction in that permanent tooth. We report an unusual case in which injury to the primary dentition resulted in developmental disturbances in the crown and the calcified structures in the pulp chamber of the permanent tooth. Localized malformation of the crown and enamel hypoplasia were treated with a light-cured composite resin restoration. We also discuss the formation of pulp calcification and the need for endodontic treatment.

Dentin dysplasia is a genetic defect of dentin formation inherited as an autosomal dominant trait. It is characterized by normal enamel but atypical dentin formation with abnormal pulpal morphology. Once thought to be a single entity, dentin dysplasia has now been divided into type I (radicular) and II (coronal). Type I is by far the more common. Both types include multiple/generalized involvement of primary and permanent dentition. Combinations of both types have also been described in the literature. Four distinct forms of dentin dysplasia type I and 1 form of dentin dysplasia type II are identified. Although there seems to be no need to identify more than 2 distinct types of this relatively rare inherited defect of human dentin, the possible existence of additional forms of the disease cannot be ruled out. Here is a case report of dentin dysplasia in a single tooth, with crown and roots of normal dimensions, associated with severe pain and mobility and histologically involving both coronal and radicular dentin. Focal odontoblastic dysplasia or dentin dysplasia type III could be the new entity.

Objective: To examine pulpal vitality in teeth suffering dental trauma during orthodontic therapy with fixed appliances., Materials and Methods: Pulpal condition was evaluated in 59 teeth that had suffered dental trauma during orthodontic treatment (TO-group), in 800 orthodontically treated teeth without previous dental trauma (O-group), and in 193 orthodontically untreated teeth with previous dental trauma (T-group). Pulpal vitality was examined clinically and with radiographs. Degree of pulp obliteration was rated as absent, partial, or total. All teeth in the TO-group showed a positive sensibility test prior to resumption of orthodontic therapy., Results: Teeth in the TO-group revealed a significantly higher frequency of pulp necrosis than teeth in the O-group or teeth in the T-group (P < .001, respectively). In the TO-group, teeth with extrusive or lateral luxation (P = .031) and teeth with intrusive luxation (P = .015) injuries showed a significantly higher rate of pulp necrosis than teeth with fracture of enamel. In addition, teeth with total pulp obliteration showed a significantly higher frequency of pulp necrosis than teeth without pulp obliteration (P = .013)., Conclusion: Teeth with severe periodontal injury during orthodontic therapy and subsequent total pulp obliteration have an increased risk of pulp necrosis during additional orthodontic treatment stages.

Aim: To evaluate the pulp and periodontal healing of laterally luxated permanent teeth., Material and Methods: Patients presenting with lateral luxation of permanent teeth during 2001-2002 were enrolled in this clinical study. Laterally luxated teeth were repositioned and splinted with a TTS/composite resin splint for 4 weeks. Immediate (prophylactic) root-canal treatment was performed in severely luxated teeth with radiographically closed apices. All patients received tetracycline for 10 days. Re-examinations were performed after 1, 2, 3, 6, 12 and 48 months., Results: All 47 laterally luxated permanent teeth that could be followed over the entire study period survived. In 10 teeth (21.3%), a prophylactic root-canal treatment was performed within 2 weeks following injury. The remaining 37 teeth showed the following characteristics at the 4-year re-examination: 19 teeth (51.4%) had pulp survival (no clinical or radiographic signs or symptoms), nine teeth (24.3%) presented with pulp canal calcification, and pulp necrosis was seen in another nine teeth (24.3%), within the first year after trauma. None of the teeth with a radiographically open apex at the time of lateral luxation showed complications. External root resorption was only seen in one tooth., Conclusions: Laterally luxated permanent teeth with incomplete root formation have a good prognosis, with all teeth surviving in this study. The most frequent complication was pulp necrosis that was only seen in teeth with closed apices.

Objective: The purpose of this study was to examine the prevalence of pulp calcifications in patients with Marfan syndrome., Study Design: The prevalence of pulp stones and pulp obliteration was evaluated on bitewing radiographs in 21 subjects with Marfan syndrome and in 100 healthy controls., Results: Subjects with Marfan syndrome older than 30 years of age showed a significantly higher prevalence of pulp stones (P = .027) or pulp obliteration (P < .001). Pulp stones were present in 20.7% and pulp obliteration was found in 7.9% of the examined teeth in this group. Subjects with Marfan syndrome also revealed a significant correlation between age and number of teeth with pulp stones or pulp obliteration., Conclusion: The results of the present study indicate that pulp calcifications are frequent findings in subjects with Marfan syndrome. This should be taken into consideration in endodontic or orthodontic treatment.

Aim: To present two cases of external root resorption and in so doing highlight rarer causative factors as well as the difficulties in classifying root resorption., Summary: Root resorption in the permanent dentition is usually pathological. Local factors are the most frequent causes of resorption, most commonly excessive pressure and inflammation. However, many systemic abnormalities have been implicated in the resorption process. Resorption is often an incidental finding during routine examination. Otherwise, late in the disease process, tooth mobility or infection may arise. A rarer form of root resorption is external apical root resorption which may or may not be linked to systemic disease. In most cases, no causative factors are found. At present there is no curative treatment for external apical root resorption. The current management for these patients is symptomatic, minimal intervention and long-term monitoring., Key Learning Points: * Apical resorption may be associated with a systemic disease or of an idiopathic origin. It may also occur in association with orthodontic treatment or with pathoses such as tumours, cysts, etc. * In the absence of signs or symptoms of pulpal and/or periapical disease, endodontic treatment is not indicated. * Long-term monitoring of affected patients is essential.

The root fractures occur relatively rarely and account for 0.5-2.5% of all dental injuries. The fracture type, severity of dislocation, mobility of fragments and diastasis have negative influence on the healing process. The aim of this study was to describe the treatment and the 42-month follow-up period of three trauma histories in a 12-year-old patient in 1 year and to emphasize the negative effects of recurrent traumas on the healing pattern and prognosis of root fractures.

Objective: To evaluate the prognosis of luxated permanent teeth and analyze the associated factors of pulp healing after luxation injuries., Methods: The dental records of patients presented for treatment due to luxation injuries at the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology from January 2000 to December 2006 were collected, and the follow-up period was not shorter than six months. The following information was recorded, age and gender; type of injury; location of injured tooth; stage of root development; time elapsed between the injury and the first dental care; emergency treatment or not; pulp healing. Logistic regression was used to compare qualitative data and determine the associated factors of pulp healing after luxation injuries., Results: The study was comprised of 157 patients with 238 luxated permanent teeth. The frequency of pulp necrosis was 16.0%, dental pulp calcification 2.1% and pulp survival 81.9%. The frequency of pulp necrosis was highest in intrusion (66.7%). The factors significantly affecting pulp healing were stage of root development and type of injury., Conclusions: The risk of pulp necrosis was greatest in intrusion. The stage of root development and the type of injury were significant factors related to pulp healing after luxation injuries.

The purpose of the study was to evaluate and assess the survival rate of 534 root fractured teeth, including factors that may affect the survival rate but were not included in previous long-term studies. Location of fracture was registered as in the cervical, cervical/middle, middle and apical one-third of the root, and root development was categorized into five stages. Altogether, 383 (78%) showed healing of the fracture, with either formation of hard tissue or interposition of soft tissue between the fragments. In these teeth, no significant difference was found between positions in the root or types of healing. In 325 teeth, the healing remained unchanged throughout the control period, while 58 teeth showed a posthealing complication. A new injury occurred in 47 teeth; in 21 of these, the injury healed spontaneously, in four after endodontic treatment. Increased mobility of the coronal fragment was recorded for 32 teeth, and in 11 of these, the looseness of the fragment was so pronounced that the teeth had to be extracted. No healing, i.e. radiolucency in the alveolar bone, adjacent to fracture, took place in 109 teeth (22%). Of these teeth, 34 were extracted during the observation time while 75 (69%) showed healing after endodontic therapy. At the final assessment of survival (including all parameters) of 534 root fractured teeth, 425 (80%) showed survival and 109 (20%) were extracted during the observation period. It was concluded that the survival of root-fractured teeth was high for up to 10 years of observation (mean = 63 months). The highest frequency of tooth loss (70%) was found in 77 teeth with horizontal fractures restricted to the cervical part of the root. When these teeth were excluded, the frequency of survival in remaining teeth rose to 88%.

Although horizontal root fractures connote a serious trauma to the tooth, they present a favorable prognosis, as the vitality of the pulp remains. Small displacements of the fragments minimize the failure of the healing process; however, even when they occur, the reduction of the diastasis between root fragments is always necessary. A majority of cases are asymptomatic and heal spontaneously even though no therapeutic measures have been adopted. A case of root fracture that was discovered only 1 year after the trauma is presented. Thirteen years later, the tooth is well positioned in the maxillary arch and has kept its pulp vitality despite the obliteration of the root conduct. Expectant management was adopted at the moment of the first examination, and the follow-up of the patient showed it to have been the best choice.

Ten immature autotransplanted lower premolars from six patients from 7 to 12 years of age were studied and assessed clinically and radiographically at Regional Clinical Hospital in Temuco between January 2004 and April 2006. All transplantations were performed both because of a missing anterior tooth by dental trauma or by healing complications after injuries. The mean age at the time of the surgery was 10 years (range 7-12 years) and the postoperative follow-up period varied from 5 to 27 months with a mean of 16.9 months. All teeth were stabilized with flexible composite resin wire splints. Within the follow-up period, clinical evaluation was made through percussion and mobility tests. At radiographic evaluation, pulpal canal obliteration (PCO), presence of perirradicular area, inflammatory root resorption (IRR), replacement resorption (RR), stage of root development, lamina dura formation, outline of the periodontal membrane, and arrest in root growth were registered. Pulp healing was observed in 6 of 10 teeth; the other transplanted teeth developed pulp necrosis after 6-8 months possibly related to operative aesthetic procedures. Four teeth showed different grades of PCO at radiographic examination. None of transplanted teeth developed replacement resorption or ankylosis. In this 27-month follow-up period, the survival rate was 100%, regarding aesthetics, function, clinical appearance, and radiographic image of alveolar process.

Background and Objective: Our previous study showed that topical alendronate, an inhibitor of bone resorption, reduces root resorption and ankylosis for 21 d after replantation of rat teeth. The aim of the present study was to evaluate the long-term inhibitory effects of topical alendronate in the replanted teeth., Material and Methods: The rat maxillary first molars were extracted, placed in saline containing 1 mm alendronate (alendronate group) or saline (saline group) for 5 min and then replanted. The maxillae were dissected at 60 and 120 d. Microcomputed tomography horizontal sections at three root levels were analyzed for root and bone resorption, ankylosis and pulp mineralization., Results: In the alendronate group at 60 and 120 d, the frequencies of resorption of roots and bone were lower than those in the saline group. The p values show statistical significances of lower frequencies in the alendronate group than in the saline group by chi-square test (see Table 1). Ankylosis and pulp mineralization occurred in the alendronate and saline groups. Bone marrow spaces were narrowed in conjunction with bone tissue expansion around the replanted teeth in the alendronate group., Conclusion: The inhibitory effects of topical alendronate were retained on root and bone resorption, but not on ankylosis and pulp mineralization, in the replanted teeth for 4 mo. Alendronate might also stimulate bone formation around the rat replanted teeth.

The syndrome of enamel dysplasia with hamartomatous atypical follicular hyperplasia (EDHFH) is an unusual syndrome and is unique to black South Africans. Major criteria for the syndrome are enamel dysplasia with generalized amelogenesis imperfecta-like features and atypical hyperplastic dental follicles with microscopic features of central odontogenic fibroma WHO-type (follicle analogue) attached to the crowns of multiple impacted teeth. Minor features of some cases are anterior open-bite malocclusion, supernumerary teeth, pulpal calcification, aberrant roots with hypercementosis, and hypodontia. The pathogenic mechanisms that lead to the development of EDHFH are unknown. We speculate that faulty synthesis of enamel matrix proteins may interfere with enamel formation and play a role in the generalized enamel hypoplasia described in this syndrome. Alterations in inductive signalling by the odontogenic epithelium mediated by enamel matrix proteins may explain the development of the follicle analogues, the root hypercementosis and the presence of dysplastic cementum deposition juxtaposed to odontogenic epithelium in the gingival overgrowth. Thus, alterations in the function of enamel matrix protein function, may be the common denominator responsible for the development of the EDHFH phenotype.

Intra-alveolar root fractures in permanent teeth are uncommon injuries among dental traumas. Generally, the principles of treating horizontal root fractures of permanent teeth are repositioning and fixation. The present paper reports 6-years follow up of two horizontally root-fractured teeth that were healed with calcified tissue. Both of the teeth were clinically and radiographically symptomless and showed complete pulp canal obliterations.

The purpose of this study was to compare the type of injuries, complications and treatment in permanent traumatized teeth with single and multiple dental trauma episodes (MDTE). One hundred and fifty-five children, aged 6-14 years, sustaining one or more traumatic episodes to permanent teeth were included in this investigation. After the medical and dental history the patients were examined clinically and radiographically and the diagnosis of trauma, the treatment plan and the applied treatment were recorded. Also, information regarding the number of traumatic episodes, the number of injured permanent teeth and the vitality of the pulp was collected. In follow-ups, traumatized teeth were examined clinically and radiographically to evaluate the treatment applied and to detect any complication. The t-statistic was used to test differences in the mean number of teeth per patient with different types of injury, complications and treatment between permanent traumatized teeth with single and multiple trauma episodes. A 95% probability level was used. The results showed that MDTE significantly affected the mean number of teeth per patient with fractured restoration, root fracture, concussion, pulp canal obliteration, root replacement resorption, filling therapy, surgery and prosthetic treatment. It was concluded that MDTE increase the risk of having certain types of injury, complications and treatment.