157 results on '"Dental Pulp Necrosis diagnostic imaging"'
Search Results
2. Correlation between pulp sensibility and magnetic resonance signal intensity following regenerative endodontic procedures in mature necrotic teeth- a retrospective cohort study.
- Author
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El-Kateb NM, Abdallah AM, and ElBackly RN
- Subjects
- Adult, Humans, Dental Pulp diagnostic imaging, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Necrosis, Retrospective Studies, Root Canal Therapy methods, Periapical Periodontitis therapy, Regenerative Endodontics methods
- Abstract
Background: With increasing studies being published on regenerative endodontic procedures (REPs) as a treatment modality for mature necrotic teeth, the assessment of outcomes following regenerative endodontic procedures has become more challenging and the demand for a better understanding of the regenerated tissues following this treatment is rising. The study aimed to correlate cold, electric pulp testing (EPT), and magnetic resonance imaging (MRI) signal intensity (SI) in mature necrotic teeth treated with regenerative endodontic procedures., Methodology: This retrospective cohort study included eighteen adult patients who experienced tooth necrosis in mature maxillary anterior teeth recruited from the outpatient clinic, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt from July 2017 until December 2018 with 12 months of follow-up. regenerative endodontic procedures via blood clot were performed. The canals were instrumented by ProTaper Next (PTN) files until final sizes X3 or X5. Biodentine was used as cervical plug material. Pre and post-operative clinical follow-up was done where the patients' responses to cold and electric pulp testing were given a scoring system and were compared to the normal contralateral tooth. Pre and post-operative magnetic resonance imaging signal intensity of both the involved tooth and its contralateral at the middle and the apical thirds of the root canals were assessed after 3, 6, and 12 months. Data was analyzed using the ANOVA, Friedman and Bonferroni tests. Significance was set at a p-value < 0.05., Results: All 18 teeth scored a baseline score of "2" for cold and electric pulp testing. There was a significant difference between scores of the cold test at baseline and 12-month follow-up (p < 0.001). There was a significant difference between scores of the electric pulp testing of baseline and 12-month follow-up (p < 0.001). There was a moderately significant indirect (inverse) correlation between magnetic resonance imaging signal intensity and cold test in both the middle and apical thirds at 12 months. No significant correlations were detected between magnetic resonance imaging signal intensity and electric pulp testingat any of the time intervals (p > 0.05)., Conclusion: Magnetic resonance imaging is a successful non-invasive method to assess outcomes of regenerative endodontic procedures and correlating it with another reliable method of assessing pulpal responses, cold test, could validate these outcomes., Clinical Trial Registration: The study was registered with ClinicalTrials.gov (ID: NCT03804450)., (© 2024. The Author(s).)
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- 2024
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3. Multimodal Imaging of Dental Pulp Healing Patterns Following Tooth Autotransplantation and Regenerative Endodontic Treatment.
- Author
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EzEldeen M, De Piero MNSP, Xu L, Driesen RB, Wyatt J, Van Gorp G, Meschi N, Van Meerbeek B, Lambrichts I, and Jacobs R
- Subjects
- Humans, Regeneration, Transplantation, Autologous, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Collagen, Multimodal Imaging, Dental Pulp diagnostic imaging, Regenerative Endodontics methods
- Abstract
Introduction: Understanding the healing process of dental pulp after tooth autotransplantation (TAT) and regenerative endodontic treatment (RET) of immature teeth is important both clinically and scientifically. This study aimed to characterize the pattern of dental pulp healing in human teeth that underwent TAT and RET using state-of-the-art imaging techniques., Materials and Methods: This study examined 4 human teeth, 2 premolars that underwent TAT, and 2 central incisors that received RET. The premolars were extracted after 1 year (case 1) and 2 years (case 2) due to ankylosis, while the central incisors were extracted after 3 years (cases 3 and 4) for orthodontic reasons. Nanofocus x-ray computed tomography was used to image the samples before being processed for histological and immunohistochemical analysis. Laser scanning confocal second harmonic generation imaging (SHG) was used to examine the patterns of collagen deposition. A maturity-matched premolar was included as a negative control for the histological and SHG analysis., Results: Analysis of the 4 cases revealed different patterns of dental pulp healing. Similarities were observed in the progressive obliteration of the root canal space. However, a striking loss of typical pulpal architecture was observed in the TAT cases, while a pulp-like tissue was observed in one of the RET cases. Odontoblast-like cells were observed in cases 1 and 3., Conclusions: This study provided insights into the patterns of dental pulp healing after TAT and RET. The SHG imaging sheds light on the patterns of collagen deposition during reparative dentin formation., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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4. Clinical and radiographic outcomes of regenerative endodontic procedures for traumatized permanent necrotic teeth with apical periodontitis and external root resorption.
- Author
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Lu J, Lu Y, Lu Z, and Kahler B
- Subjects
- Humans, Necrosis, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Root Canal Therapy methods, Root Resorption diagnostic imaging, Root Resorption therapy, Regenerative Endodontics, Periapical Periodontitis diagnostic imaging, Periapical Periodontitis therapy
- Abstract
Aim: This clinical study was undertaken to assess the effect of treatment with regenerative endodontic procedures (REPs) on 20 teeth with pulp necrosis, apical periodontitis, and external root resorption (ERR)., Methodology: Teeth were treated with REPS utilizing the American Association of Endodontists (AAE) protocol. Quantitative assessment of changes in radiographic root area (RRA) were statistically analysed to assess changes in root dimensions after an average follow-up period of 3 years., Results: All 20 teeth survived, 14 teeth (70%) were classified successful, and only 1 tooth (5%) failed throughout the study period. Based on the radiographic examination, all 20 teeth showed complete repair of the periapical lesions and arrested ERR. However, 5 teeth (25%) subsequently developed replacement resorption. The RRA between baseline and 3-year follow-up showed a significant difference for the total 20 teeth (p = .009). An analysis according to the trauma type and the extra-oral time showed the RRA increase was significantly different in the non-avulsion group (p = .015) and for the avulsion group with an extra-oral time less than 60 min (p = .029). The RRA increase was not statistically significant in the avulsion group of extra-oral time more than 60 min (p = .405). Nine teeth (45%) and 10 teeth (50%) responded to cold and electric pulp testing, respectively., Conclusions: Within the limitations of this study, the favourable outcomes of REPs were further confirmed for traumatized permanent necrotic teeth with ERR in terms of periapical lesion healed and a significant increase in RRA. The study contributes further evidence of the role of REPs in arresting ERR., (© 2023 The Authors. International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society.)
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- 2023
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5. Herpes Zoster and association with pulp necrosis and development of apical periodontitis - a review and presentation of two case reports.
- Author
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Heithersay GS and Chew T
- Subjects
- Humans, Female, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Herpesvirus 3, Human, Periapical Periodontitis diagnostic imaging, Periapical Periodontitis therapy, Herpes Zoster complications, Dental Pulp Diseases complications
- Abstract
The varicella zoster virus as an aetiological agent for endodontic disease is not a well-recognised entity despite several published case reports. While advances in DNA molecular analysis techniques (PCR) have contributed to the current understanding of the potential role of the varicella zoster virus in the initiation and progression of endodontic disease, a review indicates a need for ongoing research. Case reports are presented of two female patients with a history of herpes zoster who developed pulp necrosis, with one patient progressing to apical periodontitis. Both patients received non-surgical endodontic therapy, followed by intra-coronal bleaching in one of the patients due to tooth discolouration which developed during the prodromal and acute phases of the herpes zoster infection. Clinical and radiographic examinations at 23 and 22 years, respectively, showed the affected teeth to be retained in an asymptomatic and aesthetically satisfactory state with no radiographic evidence of apical pathosis., (© 2021 Australian Society of Endodontology Inc.)
- Published
- 2022
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6. Radiographic outcomes and prognostic factors in nonvital immature permanent teeth after apexification with modified calcium hydroxide paste: a retrospective study.
- Author
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Lu H, Lu J, Guo J, Zeng B, Zeng Q, Zhao W, and Lin J
- Subjects
- Apexification, Calcium Hydroxide therapeutic use, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Humans, Oxides therapeutic use, Prognosis, Retrospective Studies, Silicates therapeutic use, Tooth Apex diagnostic imaging, Root Canal Filling Materials therapeutic use, Tooth, Nonvital diagnostic imaging, Tooth, Nonvital therapy
- Abstract
Objective: To assess the radiographic outcomes and prognostic factors in nonvital immature permanent teeth after apexification with modified calcium hydroxide paste., Materials and Methods: Clinical and radiographic data were collected from 115 necrotic immature permanent teeth (71 caused by trauma and 44 caused by dens evaginatus) treated with apexification using a modified calcium hydroxide. Postoperative root morphology and changes in radiographic root area (RRA) on periapical radiographs were determined and statistically evaluated. Regression analysis was performed to identify factors associated with the outcomes of apexification., Results: The average time for a calcified barrier formation was 10.66 ± 6.37 months. The root morphology after apexification with calcium hydroxide + iodoform paste was similar to that previously described after calcium hydroxide apexification. Compared with the trauma cases, the dens evaginatus cases revealed more type I (40.91% vs 16.9%) and less type II morphology (45.45% vs 67.61%). Although the changes in RRA were limited, the dens evaginatus cases showed greater increment of RRA than the trauma cases (4.12% ± 5.58% vs 0.70% ± 5.21%, P < 0.001). A significant association was found between the preoperative stage of root development and postoperative percentage change in RRA (P < 0.001)., Conclusions: Teeth caused by dens evaginatus had better outcomes after apexification than teeth caused by trauma. Early stages of root development were associated with superior radiographic outcomes., Clinical Relevance: Apexification provided reliable outcomes in the treatment of immature teeth with pulp necrosis and apical periodontitis, even though the root development is limited. Treatment decision should be made with comprehensive evaluation of prognostic factors., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
- Published
- 2022
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7. Endodontic pulp revitalization in traumatized necrotic immature permanent incisors: Early failures and long-term outcomes-A longitudinal cohort study.
- Author
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Wikström A, Brundin M, Romani Vestman N, Rakhimova O, and Tsilingaridis G
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- Cohort Studies, Humans, Incisor diagnostic imaging, Longitudinal Studies, Pain, Prospective Studies, Root Canal Therapy methods, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Root Resorption
- Abstract
Aim: This prospective cohort study evaluates clinical and radiographical outcomes of endodontic pulp revitalization (PR) of traumatized necrotic incisors., Methodology: Pulp revitalization was performed in 75 traumatized necrotic immature incisors from 71 patients. The radiographic outcome measures were continued root formation (width and length), root resorption, apex closure, periapical index, and root development stage. The clinical outcome measures were percussion pain, palpation pain, pathological tooth mobility, swelling, sinus tract, ankylosis, crown discolouration, response to pulp sensitivity test, and subjective pain. Treatment outcomes were categorized as a success based on the absence of clinical symptoms and when radiographic evidence was present for apical healing and continued root development. The performed statistical tests were repeated measures anova, pairwise comparisons of interactions (t-test), McNemar's test, and linear regression model., Results: In 45 of 75 teeth (60%), PR was successful with the resolution of clinical and radiographic signs and continued root development. PR failed due to the absence of bleeding (n = 19) and persistent infection (n = 11). PR showed statistically significant increases in root length (11%), and dentinal wall thickness (30%), root maturation (pre-operative 3.38 [CI 1.88; 4.88]; post-operative 4.04, [CI 2.56; 5.52]) apical closure (71.4%), healing of pre-operative apical periodontitis (100%), and healing of pre-operative inflammatory root resorptions (100%). Three predictive variables for continued root maturation were identified - root development stage at entry (p = .0001, β 0.649), [CI 0.431; 0.867], trauma to the soft tissues (p = .026, β -0.012), [CI -0.0225; -0.015], and pre-operative dentinal wall thickness (p = .009, β -0.001); [CI -0.001; 0.0001]., Conclusions: Our findings indicate that PR provides satisfactory clinical and radiographical outcomes in traumatized necrotic incisors. The failed cases were related to lack of bleeding and persistent infections, indicating that new techniques are needed to improve the predictability of PR., (© 2022 The Authors. International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society.)
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- 2022
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8. Radiographic differences observed following apexification vs revascularization in necrotic immature molars and incisors: a follow-up study of 18 teeth.
- Author
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Caleza-Jiménez C, Ribas-Pérez D, Biedma-Perea M, Solano-Mendoza B, and Mendoza-Mendoza A
- Subjects
- Humans, Aluminum Compounds therapeutic use, Dental Pulp, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Drug Combinations, Follow-Up Studies, Incisor diagnostic imaging, Molar, Oxides therapeutic use, Regeneration, Silicates therapeutic use, Tooth Apex diagnostic imaging, Tooth Apex pathology, Apexification methods, Root Canal Filling Materials therapeutic use
- Abstract
Purpose: To evaluate the effectiveness of apexification versus revascularization in the treatment of necrotic immature teeth and determine which strategy affords the greatest radiological success rate., Methods: An analysis was made of 18 teeth subjected to mineral trioxide aggregate (MTA) apical plugging and regenerative endodontic treatment, assessing healing of the apical lesions and the changes in root dimensions., Results: Significantly greater root growth was observed with revascularization in terms of the percentage change in length (12.75% at 6 months) and dentin thickness (34.57% at 6 months) (p < 0.05). There were no significant differences between the two treatments in terms of the apical healing scores after 6 months of follow-up (p > 0.05)., Conclusion: Apexification with an MTA apical plug and pulp regeneration are reliable treatments for non-vital immature teeth. The radiographic outcomes are comparable between the immature teeth subjected to MTA apexification versus those subjected to revascularization. The results of the present study indicate a greater increase in root length and width with regenerative endodontic treatment., (© 2022. The Author(s).)
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- 2022
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9. Combined conventional and regenerative treatment in molars with coexistent closed and open apices: A case series.
- Author
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Cehreli ZC, Erbas Unverdi G, Eymirli P, Mergen I, Arslan E, and Esenturk G
- Subjects
- Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Humans, Molar diagnostic imaging, Root Canal Therapy methods, Periapical Periodontitis therapy, Regenerative Endodontics
- Abstract
Regenerative endodontic treatment (RET) may not be suitable in some necrotic young permanent molars due to coexistent roots with closed and open apices, and/or inadequate apical bleeding in one or more roots. Here, we present a combined treatment approach utilising conventional root canal treatment in the closed-apex roots and RET on the open-apex roots of necrotic young molars. The closed-apex roots of 8 molars received root fillings, and their open-apex roots were treated with a regenerative endodontic procedure. In another molar, the failed RET on one root was retreated by conventional root canal filling, preserving other revitalised roots. After 4-6 years, all teeth showed periapical healing in the absence of clinical symptoms. The combined conventional and regenerative treatment approach can yield favourable healing outcomes in necrotic, young molar roots with different levels of apical closure. Likewise, failed revitalised roots can be retreated separately with conventional root filling., (© 2022 Australian Society of Endodontology Inc.)
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- 2022
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10. Regenerative endodontic procedures for the treatment of necrotic mature teeth: A preliminary randomized clinical trial.
- Author
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Youssef A, Ali M, ElBolok A, and Hassan R
- Subjects
- Dental Pulp, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Humans, Prospective Studies, Platelet-Rich Fibrin, Regenerative Endodontics
- Abstract
Aim: This preliminary randomized, prospective, controlled trial aimed to compare the clinical and radiographic outcomes of two regenerative endodontic procedures (REPs), revitalization and a platelet-rich fibrin (PRF)-based technique, in the treatment of mature permanent teeth with necrotic pulps., Methodology: The trial has been reported according to the Preferred Reporting Items for Randomized Trials in Endodontics 2020 guidelines. The study protocol was registered at the clinical trial registry (ClinicalTrials.gov) with identifier number NCT04158232. Twenty patients with mature necrotic anterior teeth with large periapical lesions were randomly allocated into two groups (n = 10): group I, treated with revitalization with the blood clot (BC) technique and group II, treated with a PRF-based technique. The follow-up was for 12 months. Periradicular healing was assessed using standardized radiographs taken at baseline, and at 6 and 12 months after treatment. An electric pulp tester was used to assess whether pulp sensibility had been regained during the follow-up period. Statistical analysis was conducted using Mann-Whitney test and Wilcoxon test for non-parametric data. For parametric data, repeated measures analysis of variance was used. The significance level was set at p ≤ .05., Results: There was a significant increase in periradicular healing in both groups at 6 and 12 months, compared to that at baseline, with no significant difference between the studied groups after 12 months (p = .143). There was a significant difference between the tooth sensibility readings at baseline, 6-month and 12-month follow-up timepoints (p < .001)., Conclusions: The findings of this preliminary trial indicate the potential for using REPs, such as revitalization or PRF-based techniques, as treatment options for mature teeth with necrotic pulps. A higher level of evidence obtained through adequately powered clinical trials and longer follow-up periods are required to conclusively validate the different outcomes of REPs., (© 2022 International Endodontic Journal. Published by John Wiley & Sons Ltd.)
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- 2022
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11. CBCT influences endodontic therapeutic decision-making in immature traumatized teeth with suspected pulp necrosis: a before-after study.
- Author
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Mota de Almeida FJ, Hassan D, Nasir Abdulrahman G, Brundin M, and Romani Vestman N
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- Cone-Beam Computed Tomography, Controlled Before-After Studies, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Humans, Endodontics, Spiral Cone-Beam Computed Tomography
- Abstract
Objective: To evaluate the impact of cone-beam computed tomography (CBCT) in endodontic therapeutic decision-making of immature traumatized teeth with suspected pulp necrosis., Methods: Over two years, consecutive patients with a dental trauma in their front teeth (apex >0.5 mm) and with suspected pulp necrosis based on clinical and radiographic findings were referred to a specialist clinic in Sweden. Fifteen patients aged 6-13 (18 teeth) were included and clinically examined by an endodontist. Intraoral radiographs and CBCT examinations were obtained. Five practitioners, three endodontists and two residents in endodontics, used these examinations to determine the most appropriate treatment for the 18 cases (all central incisors) on two occasions scheduled 19 weeks apart. On the first occasion, the practitioners had access to clinical information and the intraoral radiographs ('before' CBCT); on the second occasion, the practitioners had also access to a radiologist report and the CBCT images ('after' CBCT). Their treatment plans - no treatment, watchful waiting, endodontic orthograde treatment, or extraction - were made anonymously and independently. Results were analysed using descriptive statistics and Wilcoxon signed-rank test., Results: 'After' CBCT, practitioners changed treatment plans in 30% of the 90 assessments, 74% of which were more aggressive ( p = 0.028). In 49% of the assessments, practitioners who chose the watchful and waiting treatment plan 'before' CBCT changed to a more aggressive therapy such as endodontic orthograde treatment and extraction 'after' CBCT ( p = 0.005)., Conclusion: This study provides evidence that CBCT influences endodontic therapeutic decision-making regarding immature traumatised teeth with suspected pulp necrosis, chiefly when expectant management ( i.e., watchful and waiting) was selected before access to CBCT.
- Published
- 2021
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12. Regenerative Endodontic Procedure of Immature Permanent Teeth with Leukocyte and Platelet-rich Fibrin: A Multicenter Controlled Clinical Trial.
- Author
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Meschi N, EzEldeen M, Garcia AET, Lahoud P, Van Gorp G, Coucke W, Jacobs R, Vandamme K, Teughels W, and Lambrechts P
- Subjects
- Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Dentition, Permanent, Humans, Leukocytes, Platelet-Rich Fibrin, Regenerative Endodontics
- Abstract
Introduction: The aim of this nonrandomized, multicenter controlled clinical trial was to evaluate the impact of leukocyte-platelet-rich fibrin (LPRF) on regenerative endodontic procedures (REPs) of immature permanent teeth in terms of periapical bone healing (PBH) and further root development (RD)., Methods: Healthy patients between 6-25 years with an inflamed or necrotic immature permanent tooth were included and divided between the test (= REP + LPRF) and control (= REP-LPRF) group depending on their compliance and the clinical setting (university hospital or private practice). After receiving REP ± LPRF, the patients were recalled after 3, 6, 12, 24, and 36 months. At each recall session, the teeth were clinically and radiographically (by means of a periapical radiograph [PR]) evaluated. A cone-beam computed tomographic (CBCT) imaging was taken preoperatively and 2 and 3 years postoperatively. PBH and RD were quantitatively and qualitatively assessed., Results: Twenty-nine teeth with a necrotic pulp were included, from which 23 (9 test and 14 control) were analyzed. Three teeth in the test group had a flare-up reaction in the first year after REP. Except for 2 no shows, all the analyzed teeth survived up to 3 years after REP, and, in case of failure, apexification preserved them. Complete PBH was obtained in 91.3% and 87% of the cases based on PR qualitative and quantitative evaluation, respectively, with no significant difference between the groups with respect to the baseline. The PR quantitative change in RD at the last recall session with respect to the baseline was not significant (all P values > .05) in both groups. The qualitative assessment of the type of REP root healing was nonuniform. In the test group, 55.6% of the teeth presented no RD and no apical closure. Only 50% of the 14 teeth assessed with CBCT imaging presented complete PBH. Regarding volumetric measurements on RD 3 years after REP for the change with respect to the baseline in root hard tissue volume, mean root hard tissue thickness, and apical area, the control group performed significantly in favor of RD than the test group (P = .03, .003, and 0.05 respectively). For the volumetric change 3 years after REP with respect to the baseline in root length and maximum root hard tissue thickness, no significant difference (P = .72 and .4, respectively) was found between the groups. The correlation between the PR and CBCT variables assessing RD was weak (root lengthening) to very weak (root thickening)., Conclusions: REP-LPRF seems to be a viable treatment option to obtain PBH and aid further RD of necrotic immature permanent teeth. Caution is needed when evaluating REP with PR., (Copyright © 2021 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)
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- 2021
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13. Clinical and Radiographic Outcomes of Regenerative Endodontic Procedures in Traumatized Immature Permanent Teeth: Interappointment Dressing or Single-Visit?
- Author
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Cerqueira-Neto ACCL, Prado MC, Pereira AC, Oliveira ML, Vargas-Neto J, Gomes BPFA, Ferraz CCR, Almeida JFA, and de-Jesus-Soares A
- Subjects
- Bandages, Calcium Hydroxide therapeutic use, Chlorhexidine therapeutic use, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Humans, Root Canal Therapy, Regenerative Endodontics
- Abstract
Introduction: More data are needed before affirming that single-visit approaches are effective and safe for regenerative endodontic procedures (REPs). This study compared clinical and radiographic outcomes of REPs between interappointment dressing or single-visit protocols., Methods: Twenty young patients presenting traumatized immature teeth with pulp necrosis were divided into 2 groups. Teeth were submitted to 6% sodium hypochlorite and 2% chlorhexidine irrigation and to 17% EDTA use before blood clot induction. In the interappointment dressing group (n = 11), calcium hydroxide was used with 2% chlorhexidine gel for 21 days before scaffold induction. In the single-visit group (n = 9), the scaffold was induced during the only appointment. Patients were followed up for 24 months. Primary, secondary, and tertiary outcomes were assessed by 3 independent evaluators. Preoperative and follow-up radiographs were assessed for quantitative measurements of the apical diameter, root width, root length, and cervical barrier placement and compared between groups using the t test or Mann-Whitney U test. Categoric variables were assessed with the G test and the Fisher exact test and continuous variables with the Mann-Whitney U test. Statistical significance was set at 5%., Results: One tooth showed persistence of infection. No difference was observed in cervical barrier placement (P > .05); between groups regarding primary, secondary, and tertiary outcomes (P > .05); and in parameters of quantitative radiographic outcomes (P > .05)., Conclusions: Completing REPs with an interappointment dressing or a single-visit protocol presented similar clinical and radiographic outcomes. A single-visit protocol of REPs using 6% sodium hypochlorite, 2% chlorhexidine, and 17% EDTA permitted satisfactory outcomes in necrotic immature permanent teeth., (Copyright © 2021 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)
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- 2021
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14. Presentation and non-surgical endodontic treatment of two patients with X-linked hypophosphatemia: a case report.
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Bradley H, Dutta A, and Philpott R
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- Aluminum Compounds, Apexification, Calcium Compounds, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Drug Combinations, Humans, Male, Oxides, Root Canal Preparation, Silicates, Tooth Apex, Familial Hypophosphatemic Rickets complications, Familial Hypophosphatemic Rickets diagnostic imaging, Familial Hypophosphatemic Rickets therapy, Root Canal Filling Materials
- Abstract
Aim: To describe two patients with X-linked hypophosphatemia presenting with spontaneous signs of pulpal necrosis in multiple intact teeth. The presentation and management are discussed, along with the diagnostic and endodontic treatment challenges., Summary: Two young male patients with X-linked hypophosphatemia were referred to the Department of Restorative Dentistry at the Edinburgh Dental Institute, UK for management of dental infection. Both patients were referred due to their unusual clinical presentation and abnormal root canal morphology. They subsequently presented on multiple occasions with pain or sinus tracts over a 3- and 5-year period whilst under care. Clinical examination revealed intact teeth with buccal swellings, draining buccal sinuses and negative responses to pulp sensibility testing. Radiographic examination, generally consisting of periapical radiographs, revealed intact teeth with a range of unusual morphological features including large pulp chambers, wide canals, short roots and open apices, all with associated periapical radiolucencies. Due to the unusual morphology, some teeth required apexification with a mineral trioxide aggregate plug. Patient 1 underwent root canal treatment on teeth 21 and 43 over a 3-year period. Patient 2 underwent root canal treatment on 10 permanent teeth over a 5-year period. At follow-up, both patients were asymptomatic and clinically the teeth had no signs of infection or periapical inflammation. Radiographic examination confirmed complete resolution of the apical radiolucencies on 11 out of 12 teeth. Favourable outcomes have been demonstrated up to a follow-up of 4.5 years., Key Learning Points: Patients with X-linked hypophosphatemia may present with 'spontaneous' signs of pulp necrosis in multiple teeth in the absence of caries and trauma posing a diagnostic challenge. Abnormal morphological features, including wide canals and open apices, may present challenges during root canal treatment. Outcomes demonstrate that an appropriate root canal treatment protocol, including the application of apexification procedures, may be implemented to successfully manage such cases., (© 2021 The British Endodontic Society. Published by John Wiley & Sons Ltd.)
- Published
- 2021
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15. Long-Term Follow-up for Immature Teeth Treated with Regenerative Endodontic Procedures That Underwent Orthodontic Treatment.
- Author
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Alharbi M and Lee SM
- Subjects
- Child, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Follow-Up Studies, Humans, Male, Periapical Abscess, Periapical Periodontitis therapy, Regenerative Endodontics
- Abstract
Although regenerative endodontic procedures (REPs) have become one of the widely accepted treatment modalities for necrotic immature teeth with apical periodontitis, little is known about the long-term outcomes and the effect of orthodontic tooth movement on this procedure. This report presents a case that underwent two REPs and orthodontic treatment over a period of seven years. A 9-year-old male was referred for evaluation of traumatized maxillary central incisors. Based on clinical and radiographic examinations, a diagnosis of pulp necrosis with acute apical abscess was established. REP was performed for both teeth, and the patient was brought in for follow-up annually. Orthodontic treatment was performed during the follow-up period. Annual follow-up visits demonstrated complete resolution of signs and symptoms of disease with the thickening of the roots. At the six-year follow-up visit, the patient presented with a sinus tract and periapical radiolucency. A second REP was performed for both teeth. The one-year recall visit after the second REP revealed complete resolution of clinical symptoms and radiographic signs of healing of apical pathology with further development of the roots. In conclusion, the effect of orthodontic treatment on teeth undergoing REP should be investigated and yearly follow-up visits should be recommended for patients undergoing REP as this case showed signs of deterioration six years after the treatment.
- Published
- 2021
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16. Efficacy of i-PRF in regenerative endodontics therapy for mature permanent teeth with pulp necrosis: study protocol for a multicentre randomised controlled trial.
- Author
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Liang Y, Ma R, Chen L, Dai X, Zuo S, Jiang W, Hu N, Deng Z, and Zhao W
- Subjects
- Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Humans, Multicenter Studies as Topic, Randomized Controlled Trials as Topic, Regeneration, Root Canal Therapy, Platelet-Rich Fibrin, Regenerative Endodontics
- Abstract
Background: Dental pulp necrosis, a common health problem, is traditionally treated with root canal therapy; however, it fails in restoring the vitality of damaged pulp. Most studies regarding regenerative endodontic therapy (RET) are limited to the treatment of immature necrotic teeth. Given that injectable platelet-rich fibrin (i-PRF) has shown great potential in regenerative medicine as a novel platelet concentration, this study is designed to explore whether i-PRF can serve as a biological scaffold, extending the indications for RET and improving the clinical feasibility of RET in mature permanent teeth with pulp necrosis., Methods: This is a randomised, double-blind, controlled, multicentre clinical trial designed to evaluate the clinical feasibility of RET for mature permanent teeth with pulp necrosis and to compare the efficacy of i-PRF and blood clots as scaffolds in RET. A total of 346 patients will be recruited from three centres and randomised at an allocation ratio of 1:1 to receive RET with either a blood clot or i-PRF. The changes in subjective symptoms, clinical examinations, and imaging examinations will be tracked longitudinally for a period of 24 months. The primary outcome is the success rate of RET after 24 months. The secondary outcome is the change in pulp vitality measured via thermal and electric pulp tests. In addition, the incidence of adverse events such as discolouration, reinfection, and root resorption will be recorded for a safety evaluation., Discussion: This study will evaluate the clinical feasibility of RET in mature permanent teeth with pulp necrosis, providing information regarding the efficacy, benefits, and safety of RET with i-PRF. These results may contribute to changes in the treatment of pulp necrosis in mature permanent teeth and reveal the potential of i-PRF as a novel biological scaffold for RET., Trial Registration: ClinicalTrials.gov NCT04313010 . Registered on 19 March 2020.
- Published
- 2021
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17. Regenerative endodontic therapy of immature permanent molars with pulp necrosis: a cases series and a literature review.
- Author
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Tzanetakis GN, Giannakoulas DG, Papanakou S, Gizani S, and Lygidakis N
- Subjects
- Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Humans, Male, Molar diagnostic imaging, Root Canal Therapy, Periapical Periodontitis diagnostic imaging, Periapical Periodontitis therapy, Regenerative Endodontics
- Abstract
Aim: To present the application and the outcome of the regenerative endodontic therapy (RET) in a series of symptomatic immature mandibular molars with pulp necrosis and apical periodontitis and to review the relevant literature for the documentation of the procedure as a potential treatment option., Methods: Three young male patients were referred with pain in the left mandibular region resulting from pulp necrosis and apical periodontitis of the first permanent molar. Regenerative endodontic approach was performed for the complete resolution of the lesions and the thickening of the apical root canal walls. The databases of Medline, Pubmed and Google Scholar were also searched for articles in which a regenerative approach has been undertaken for the endodontic management of immature permanent molars with pulp necrosis and apical periodontitis., Results: Follow-up examinations showed that the teeth remained functional without any signs or symptoms. Final radiographic examination at 12, 18 and 36 months, respectively, revealed complete resolution of the lesions and complete apical closure in the two out of three cases. The search of the literature revealed the existence of only 25 clinical articles in which necrotic immature molars were treated by the regenerative approach. The total number of the treated teeth were 46., Conclusions: Regenerative endodontic approach may be applied in posterior non-vital molar teeth with a possible favorable outcome. However, the literature support for the documentation of the procedure as a predictable and reproducible treatment option in posterior immature molar teeth is at present limited.
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- 2021
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18. Regenerative endodontic therapy: a follow-up of 47 anterior traumatised teeth.
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Elfrink MEC, Heijdra JSC, Krikken JB, Kouwenberg-Bruring WH, Kouwenberg H, Weerheijm KL, and Veerkamp JSJ
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- Child, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Follow-Up Studies, Humans, Netherlands, Root Canal Therapy, Regenerative Endodontics
- Abstract
Purpose: To collect long-term survival data in anterior traumatised teeth on the outcome of Regenerative Endodontic Treatments (RET) with a network of dentists working in different clinics to overcome the problem of anecdotical evidence., Methods: The seven dentists from Paediatric REsearch Project (PREP) performed RET treatments following the same protocol in five different secondary dental care clinics in the Netherlands. Treatment resulting in pain, apical problems, sinus tracts, resorption or fracture were considered as failure of treatment., Results: 47 teeth in 38 children were treated between January 2009 and September 2017 and had at least 6 month follow-up (mean 35 months). Apical closure was seen in 27 teeth (25 cases) and root length growth in 6 teeth (6 cases). Thickening of the root walls was seen in 20 teeth (20 cases) and obliteration of the root canal in 30 teeth (25 cases). Of 38 teeth with apical inflammation at the start of treatment, no radiographic sign of apical inflammation was visible at 3 months in 13 of 28 teeth; taking up to 42 months for radiographic signs of apical inflammation to be not visible. Nineteen of 35 teeth showed discoloration at the beginning of treatment. After 18 months two teeth showed signs of ankylosis, but were still functional. After 36 months one more tooth showed signs of new apical inflammation and 2 months later it was extracted., Conclusions: With three failures in 47 treated teeth, RET seems to be a promising treatment for difficult to treat anterior traumatised teeth with an open apex.
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- 2021
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19. Regenerative endodontics: a promising tool to promote periapical healing and root maturation of necrotic immature permanent molars with apical periodontitis using platelet-rich fibrin (PRF).
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Yoshpe M, Kaufman AY, Lin S, and Ashkenazi M
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- Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Humans, Molar diagnostic imaging, Tooth Apex diagnostic imaging, Periapical Periodontitis diagnostic imaging, Periapical Periodontitis therapy, Platelet-Rich Fibrin, Regenerative Endodontics
- Abstract
Purpose: Currently, mineral trioxide aggregate (MTA) apexification is recommended as the preferred treatment for permanent anterior immature necrotic teeth. Apexification treatment does not enable further development and maturation of the teeth, resulting in short roots with thin root canal walls, that often are prone to cervical fractures. This study presents the regenerative endodontic procedure (REP) as an alternative treatment for immature necrotic molars with apical periodontitis or a chronic apical abscess. REP enables periapical healing as well as root lengthening and widening of the dentinal root canal walls., Case Series Results: Six immature first molars teeth (five mandibular, one maxillary) with apical periodontitis or chronic apical abscess were treated with REP. Patients underwent periodic follow-up visits every 3 months the first year and twice a year thereafter. The final clinical examination revealed no symptoms, no gingival pockets, and no sensitivity to percussion. Cold sensitivity tests were negative. Radiographs revealed full periapical healing in all the treated molars, remarkable root lengthening, and dentinal wall thickening., Conclusion: REP with PRF is feasible and may have some advantages over MTA apexification since it facilitates root elongation, dentinal thickening of the root canals walls, and narrowing of the apical foramen.
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- 2021
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20. Radiographic evaluation of immature traumatized incisors following different endodontic treatments.
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Wu J, Li X, Xu L, Tang Z, Zhao J, Xiang Y, Zhang Y, Yang J, and Ye L
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- Apexification, Child, Humans, Incisor diagnostic imaging, Pulpotomy, Retrospective Studies, Tooth Apex diagnostic imaging, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Root Canal Filling Materials
- Abstract
Background/aims: Indirect pulp capping, pulpotomy, and apexification are three common endodontic treatments for immature traumatized incisors. They all affect tooth root development to some extent. The aim of this retrospective study was to compare the influence of these treatments on root development of immature permanent incisors following dental trauma., Materials and Methods: Twenty-one indirect pulp capping, 48 pulpotomy, and 58 apexification cases with a mean age of 8.4 ± 1.0 years and median follow up of 12 months were included. NIH ImageJ with TurboReg plug-in was used to correct angular differences between the pre-operative and recall periapical radiographs, and to calculate variations of root length, dentin wall thickness, and apical closure. Kruskal-Wallis ANOVA followed by pairwise comparisons was applied to compare the radiographic variations. The type of apical closure was assessed qualitatively and analyzed using Fisher's exact test., Results: The apexification group had a lower trend toward apical closure than the other two groups (P < .05). It also showed thinner dentin wall thickness compared with the pulpotomy group (P = .001). There was no significant difference between pulpotomy and indirect pulp capping in the trend to apical closure (P > .05) or dentin wall thickness (P = .775). There was no significant difference in the variation of root length among the three groups (P = .06). There was a moderate correlation between the treatment and the type of apical closure (Cramer's V Coefficient = .375). Pulpotomy tended to form a normal apical constriction rather than a calcific barrier while apexification showed the opposite inclination. Indirect pulp capping had no specific inclination toward any type of apical closure., Conclusions: Apexification resulted in an abnormal root development mostly by affecting the dentin wall thickness and apical closure. Pulpotomy was beneficial for normal root development of immature traumatized teeth., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2021
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21. Three-dimensional qualitative and quantitative analyses of the effect of periradicular lesions on the outcome of regenerative endodontic procedures: A prospective clinical study.
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Shetty H, Shetty S, Kakade A, Mali S, Shetty A, and Neelakantan P
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- Cone-Beam Computed Tomography, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Humans, Prospective Studies, Root Canal Therapy, Tooth Apex, Periapical Periodontitis diagnostic imaging, Periapical Periodontitis therapy, Regenerative Endodontics
- Abstract
Objectives: Qualitative and quantitative evaluation of the outcomes of regenerative endodontic procedure (REP) on human immature necrotic teeth with apical periodontitis using cone-beam computed tomography (CBCT) MATERIALS AND METHODS: Immature permanent teeth (n = 50) with necrotic pulp and periradicular pathosis were treated with a cell-homing concept-based REP. Following the procedure, a limited field-of-view CBCT scan was obtained. At each recall session (6, 12, 18 months), clinical tests were performed, and a digital periapical radiograph was taken. When significant radiographic changes were evident in the follow-up, a final CBCT scan was taken for qualitative and quantitative assessment. These initial and follow-up CBCT scans were assessed for quantification of changes in root length, pulp space diameter and periradicular lesion size. The data were statistically analysed using t test, one-way ANOVA, post hoc test and paired t test (P = 0.05)., Results: Of the teeth, 94.6% were clinically successful based on the lack or regression of signs and symptoms after 48 months follow-up. REP resulted in a statistically significant increase in root length, decrease in pulp space diameter and periradicular radiolucency (P < 0.05). CBCT images illustrated various patterns of root maturation including an increased thickening of the canal walls and continued root maturation (37.1%), continued root development with the apical foramen remaining open (57.1%), severe calcification (obliteration) of the canal space (2.9%) and hard tissue barrier formation in the canal space between the coronal plug and the root apex (2.9%)., Conclusion: This study highlighted that the expected outcome of radiographic root development was less predictable when immature permanent teeth with periradicular pathosis were treated with REP., Clinical Relevance: The size and extent (expansion/destruction of the cortical plate) of periradicular lesions and abscesses influence the outcome of REP. These factors must be taken into consideration during treatment planning.
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- 2021
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22. Unusual Location of Dens Invaginatus Causing a Difficult-to-Diagnose Pulpal Involvement.
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Ricucci D, Milovidova I, and Siqueira JF Jr
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- Dental Pulp, Dental Pulp Necrosis complications, Dental Pulp Necrosis diagnosis, Dental Pulp Necrosis diagnostic imaging, Humans, Incisor, Dens in Dente complications, Dens in Dente diagnosis, Dens in Dente diagnostic imaging, Pulpitis complications, Pulpitis diagnosis, Pulpitis diagnostic imaging
- Abstract
This article reports on an unusual case of dens invaginatus in a maxillary third molar that was causing severe symptoms of irreversible pulpitis. This malformation was not clinically or radiographically identified, and the occurrence of referred pain made the early identification of the responsible tooth difficult. Determination of the tooth that was the source of symptoms was only possible after an observation period and fast aggravation of the pathologic process to cause pulp necrosis and extreme tenderness to percussion. The diagnosis of dens invaginatus was made only after extraction and sectioning. Histopathologic and histobacteriologic features of this case are illustrated., (Copyright © 2020 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)
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- 2020
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23. Radiographic and Clinical Findings of Single-Visit Root Canal Treatments with Apical Enlargement in Necrotic Teeth: A Retrospective Cohort Study.
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Eyüboğlu TF, Olcay K, Erkan E, and Özcan M
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- Adult, Female, Humans, Male, Middle Aged, Radiography, Dental, Retrospective Studies, Root Canal Therapy adverse effects, Root Canal Therapy statistics & numerical data, Treatment Outcome, Dental Pulp Cavity diagnostic imaging, Dental Pulp Cavity pathology, Dental Pulp Cavity surgery, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis pathology, Dental Pulp Necrosis surgery, Root Canal Therapy methods, Tooth Apex diagnostic imaging, Tooth Apex pathology, Tooth Apex surgery
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This study evaluated the long-term clinical outcomes of single-visit root canal treatments with apical enlargement on patients with necrotic pulp tissue retrospectively. A total of 137 teeth with necrotic pulp tissue which underwent single-visit root canal treatments were included. The root canals were shaped up until the apical constriction, which was determined by an apex locator. The outcomes were evaluated by two independent and calibrated endodontists clinically and radiographically. Teeth were dichotomized into healed (PAI ≤ 2, no signs or symptoms) and nonhealed (PAI > 2, with/without signs or symptoms) groups. Each patients' preoperative PAI and lesion size were recorded to evaluate the preoperative periapical status as well as several other prognostic factors. Statistical analyses were performed ( p = 0.05) on ninety teeth. The mean observation time was 60 months. Out of ninety teeth, 87 (96.7%) were healed and 3 (3.3%) were nonhealed. No correlations were found between the prognostic factors and the outcomes ( p > 0.05). Cohen's kappa and Gwet's agreement coefficient scores between the preoperative PAI scores and preoperative lesion sizes showed good agreements, with values of 0.834 and 0.898, respectively. Apical enlargement is a viable treatment option for single-visit root canal treatments., Competing Interests: The authors declare no conflict of interest regarding any of the materials used in this study., (Copyright © 2020 Tan F. Eyüboğlu et al.)
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- 2020
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24. Endodontical treatment of periapical tooth injury with photodynamic therapy: Case report.
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Lopes CS, de Azevedo Moreira S, Nícoli GA, Ramirez I, and Viola NV
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- Dental Pulp Necrosis diagnostic imaging, Disinfection methods, Humans, Root Canal Filling Materials therapeutic use, Sodium Hypochlorite therapeutic use, Dental Pulp Necrosis therapy, Photochemotherapy methods, Root Canal Irrigants therapeutic use, Root Canal Therapy methods
- Abstract
This article describes the use of Photodynamic Therapy (PDT) during the endodontic treatment of teeth with periapical lesion. Patients presented tooth 35 with diagnostic hypotheses of Periapical Cyst or Granuloma. The Crown-Down preparation was performed with the HyFlex CM system. In case I it was not possible to reach the working length, in case II the foraminal debridement was performed at the actual tooth length. In the final irrigation, the E1 - Irrisonic ultrasonic insert was used, promoting sequentially agitation of NaOCl 2.5%, EDTA 17% and NaOCl 2.5%. Then, PDT was applied with 0.005% methylene blue dye. Calcium Hydroxide with Parammonochlorophenol was used and after 15 days, the final irrigation protocol and PDT were performed again. After 90 days of case I and 1 year of case II, the total lesion regression was observed in both cases. It is concluded that the proposed treatment improved the microbial disinfection favoring the regression of the periapical alterations providing satisfactory clinical and radiographic results., (Copyright © 2019 Elsevier B.V. All rights reserved.)
- Published
- 2019
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25. Evaluation of 3Mix-MP and pulpectomies in non-vital primary molars.
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Zacharczuk GA, Toscano MA, López GE, and Ortolani AM
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- Child, Endodontics, Female, Humans, Male, Prospective Studies, Treatment Outcome, Anti-Bacterial Agents therapeutic use, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Molar diagnostic imaging, Pulpectomy adverse effects, Root Canal Filling Materials therapeutic use, Tooth, Deciduous
- Abstract
Pulpectomies in primary molars are often hindered by several factors, including anatomical and physiological characteristics of posterior primary teeth and young patients' lack of cooperation with laborious treatments. This study was undertaken in search of easier but equally effective therapies that could eliminate infection, preserve the teeth and avoid extractions. The aim of the study was to estimate and compare clinical and radiographic success between pulp treatment with 3Mix-MP and pulpectomy with Maisto-Capurro paste in primary necrotic molars. A longitudinal prospective study was conducted at the Department of Comprehensive Pediatric Dentistry of the Faculty of Dentistry of the University of Buenos Aires (20152017). The study included 46 primary molars with necrotic pulp of children without immune or metabolic compromise. Children and their legal guardians provided assent and informed consent. Selected molars were randomly divided into 2 groups: G1: Pulpectomy treatment with Maisto-Capurro paste; and G2: Treatment with 3Mix-MP paste. Treatments were evaluated at 1, 3, 6,12 and 18 months (intra and inter-rater agreement 0.92 and 0.84). Clinical success was considered to be the absence of any of the following: pain, sensitivity to percussion or palpation, swelling, fistula and non-physiological mobility, while radiographic success was considered to be: absence of internal or external non-physiological resorption, no progression or reduction of radiolucent periapical/interradicular lesion and evidence of bone regeneration. Percentages, 95% C.I., and CHI2 were calculated for the comparison between groups. Overall clinical success was 91.5% and 87.5% (p=0.48) and overall radiographic success was 88.3% and 82.3% (p=0.31) for G1 and G2 respectively. No significant clinical or radiographic difference was found between groups. Both treatments showed similar clinical and radiographic behavior during the study periods., (Sociedad Argentina de Investigación Odontológica.)
- Published
- 2019
26. Complete Healing of a Large Cystic Lesion Following Root Canal Treatment with Concurrent Surgical Drainage: A Case Report with 14-Year Follow-Up.
- Author
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Cho YS and Jung IY
- Subjects
- Combined Modality Therapy, Dental Pulp Necrosis complications, Dental Pulp Necrosis diagnostic imaging, Female, Follow-Up Studies, Humans, Middle Aged, Periapical Periodontitis complications, Periapical Periodontitis diagnostic imaging, Radicular Cyst complications, Radicular Cyst diagnosis, Time Factors, Treatment Outcome, Conservative Treatment methods, Dental Pulp Necrosis therapy, Disinfection methods, Drainage methods, Periapical Periodontitis therapy, Radicular Cyst therapy, Root Canal Irrigants administration & dosage, Root Canal Therapy methods, Sodium Hypochlorite administration & dosage
- Abstract
We describe complete healing of an extensive cystic lesion by using a conservative approach: root canal treatment with concurrent surgical drainage. A silicone Foley catheter drain was modified into a surgical drainage stent, which was then used for 4 weeks. Disinfection of the root canal was achieved by the use of hand files and irrigation with 5.25% NaOCl for a minimum of 30 minutes. The irrigant changes were performed at 5-minute intervals, and no intracanal dressing was used. At subsequent follow-up examinations, cone-beam computed tomography and periapical radiographs confirmed that complete healing had occurred around the periapical and lateral areas of affected teeth. This case report indicates the potential for healing of large cystic lesions by nonsurgical root canal treatment., (Copyright © 2018 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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27. Cutaneous draining sinus tract of odontogenic origin. A case of chronic misdiagnosis.
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Al-Obaida MI and Al-Madi EM
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- Adult, Cheek, Cutaneous Fistula diagnostic imaging, Female, Humans, Cutaneous Fistula etiology, Dental Pulp Necrosis complications, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Diagnostic Errors, Root Canal Therapy
- Abstract
This is a case of a patient with a buccal cutaneous sinus tract, originally misdiagnosed, with delayed healing and potential malpractice. An odontogenic cutaneous sinus tract is a pathologic canal that initiates in the oral cavity but opens externally at the cutaneous surface of the face or neck. It is frequently misdiagnosed, leading to inappropriate treatment. Once correct diagnosis is made, definitive treatment, through oral therapy to eliminate the source of infection, is simple and effective. This case was initially misdiagnosed as a sebaceous cyst and laceration of parotid gland. The case was correctly diagnosed through detailed examination and evaluation, using tracing and advanced imaging technology (cone beam imaging). Endodontic treatment was performed, which resulted in rapid resolution of the case, followed by dermatologic treatment with fractional laser to treat the scar formed.
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- 2019
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28. Correlation between crestal alveolar bone loss with intracanal bacteria and apical lesion area in necrotic teeth.
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Muniz FWMG, Montagner F, Jacinto RC, Rösing CK, and Gomes BPFA
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- Adult, Alveolar Bone Loss diagnostic imaging, Brazil, Dental Pulp Cavity diagnostic imaging, Dental Pulp Necrosis diagnostic imaging, Female, Humans, Male, Middle Aged, Periapical Abscess diagnostic imaging, Reproducibility of Results, Alveolar Bone Loss microbiology, Dental Pulp Cavity microbiology, Dental Pulp Necrosis microbiology, Periapical Abscess microbiology
- Abstract
Objective: This study aimed to analyze the correlation between crestal alveolar bone loss with the presence of some bacterial species in root canals and the apical lesion area of necrotic teeth., Design: Data from 20 patients with diagnosis of pulp necrosis and acute apical abscesses, without active periodontal diseases, were evaluated. Patients with history of antibiotic usage three months prior to the study, with exposed pulp cavity, and with probing depth >3 mm were not included. The root size, the distance between the bone crest to the tooth apex in the mesial and distal surfaces, and the apical lesion area were measured from standard periapical radiographies by a calibrated examiner. Root canal samples were collected using sterilized paper points. In multirooted teeth, the largest root canal was sampled. Culture, microbial isolation and identification by phenotypic methods were performed. Spearman correlation and exact Fischer test were calculated between higher/lower existing bone crests, according to the median and the presence of specific bacteria., Results: No statistically significant differences were found between occurrence of pathogenic bacteria, such as Porphyromonas gingivalis, Porphyromonas endodontalis, and Prevotella intermedia, and groups with higher/lower degree of bone loss (p > 0.05). A negative significant correlation was found between Parvimonas micra and periodontal bone loss (p = 0.02). Additionally, no statistically significant association was found between crestal bone loss and the apical lesion area., Conclusions: It was concluded that, in patients without active periodontitis, the presence of pathogenic bacteria in the root canal was not correlated with periodontal bone loss., (Copyright © 2018 Elsevier Ltd. All rights reserved.)
- Published
- 2018
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29. Management and Histobacteriological Findings of Mucosal Fenestration: A Report of 2 Cases.
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Ricucci D, Siqueira JF Jr, Loghin S, Grosso A, Valois EM, and Leal ASM
- Subjects
- Adult, Biofilms, Calculi pathology, Dental Plaque pathology, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Endodontics methods, Female, Humans, Male, Maxilla, Middle Aged, Mouth Diseases therapy, Periapical Periodontitis diagnostic imaging, Periapical Periodontitis therapy, Tooth Apex surgery, Treatment Outcome, Calculi microbiology, Dental Plaque microbiology, Dental Pulp Necrosis complications, Incisor, Mouth Diseases etiology, Mouth Diseases pathology, Mouth Mucosa pathology, Periapical Periodontitis etiology, Periapical Periodontitis microbiology, Tooth Apex microbiology, Tooth Apex pathology
- Abstract
This article describes 2 unusual cases of mucosal fenestration associated with necrotic infected teeth, resulting in exposure of the root apex to the oral cavity. Both cases consisted of maxillary incisors with pulp necrosis and radiographic/tomographic evidence of apical periodontitis. Clinically, the root apex was exposed to the oral cavity through a fenestration in both bone and mucosa and covered with bacterial plaque and calculus. These teeth were treated by a combination of nonsurgical and surgical endodontic treatment. During surgery, the root apices were resected to within the alveolus and the fenestrated area covered by the flap. Specimens consisting of the root apex and surrounding soft tissues were subjected to histopathological and histobacteriological analyses. Histobacteriological analysis revealed extensive resorptive defects on the root apices filled with thick bacterial biofilm, irregular detachment of the cementum layers with consequent infection of the underlying spaces, and heavy infection in the apical foramina. The soft tissue specimens exhibited no or minimal inflammation. The 2 cases showed satisfactory postsurgical healing of the hard and soft tissues. Both cases of mucosal fenestration showed root apices covered with dense bacterial biofilms and associated with a bone crypt with no significant inflammatory tissue therein. The 2 cases were successfully treated by conservative approaches involving a combination of nonsurgical and surgical endodontic treatment with root-end resection., (Copyright © 2018 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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30. Zinc oxide eugenol and Endoflas pulpectomy in primary molars: 24-month clinical and radiographic evaluation.
- Author
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Pandranki J, V Vanga NR, and Chandrabhatla SK
- Subjects
- Child, Child, Preschool, Dental Pulp Necrosis diagnostic imaging, Drug Combinations, Humans, Infection Control, Molar diagnostic imaging, Pulpitis diagnostic imaging, Tooth, Deciduous diagnostic imaging, Anti-Infective Agents therapeutic use, Barium Sulfate therapeutic use, Dental Pulp Necrosis prevention & control, Eugenol therapeutic use, Hydrocarbons, Iodinated therapeutic use, Pulpectomy methods, Pulpitis prevention & control, Root Canal Filling Materials therapeutic use, Zinc Oxide-Eugenol Cement therapeutic use
- Abstract
Context: Despite modern advancement in material and technical aspect, management of infected primary molars is of prime concern in pediatric endodontics. An effective root canal material plays the major role in achieving the fluid impervious seal by defending against variant microflora and maintaining the tooth in function for longer duration., Aims: This study aims to evaluate and compare the success of endoflas as root canal filling material in infected primary molars with zinc oxide eugenol (ZOE)., Materials and Methods: Primary molars with necrotic pulp in healthy, cooperative children were selected. Ethical clearance and informed consent was obtained. Standardized pulpectomy procedure was done and root canals were filled with either ZOE or endoflas. Further follow-up with clinical and radiographic evaluation was carried at 0, 3, 6, 12, and 24 months. The findings obtained were statistically analyzed using Chi-square test., Results: Endoflas showed acceptable results as root canal filling material in primary molars even at 2-year follow-up, though overfilling of root canals led to low success rate compared to teeth with combined optimal and under fillings. There was no significant difference between the two materials (P > 0.05)., Conclusions: Endoflas could be a potential alternative to ZOE for preserving infected primary molars., Competing Interests: There are no conflicts of interest
- Published
- 2018
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31. Novel navigation technique for the endodontic treatment of a molar with pulp canal calcification and apical pathology.
- Author
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Shi X, Zhao S, Wang W, Jiang Q, and Yang X
- Subjects
- Adult, Calcinosis diagnostic imaging, Calcinosis therapy, Cone-Beam Computed Tomography methods, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis pathology, Female, Humans, Molar, Periapical Periodontitis diagnostic imaging, Periapical Periodontitis therapy, Root Canal Irrigants therapeutic use, Treatment Outcome, Dental Pulp Cavity diagnostic imaging, Dental Pulp Cavity pathology, Dental Pulp Necrosis therapy, Root Canal Therapy methods
- Abstract
Apical periodontitis, the inflammation of periapical tissue, commonly requires root canal treatment to achieve apical healing. However, if it is accompanied by pulp canal calcification, the treatment becomes complicated, and locating the root canal can be challenging. This case report describes a novel approach for treating a molar with pulp canal calcification and apical pathology. Due to the risk of perforation during treatment, a digitally printed template was used to assist in accurately locating the root canal. After six months, the patient was asymptomatic and the periradicular radiolucency was gradually reducing in size., (© 2017 Australian Society of Endodontology Inc.)
- Published
- 2018
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32. Management of Intruded Immature Maxillary Central Incisor with Pulp Necrosis and Severe External Resorption by Regenerative Approach.
- Author
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Tzanetakis GN
- Subjects
- Child, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis etiology, Humans, Incisor diagnostic imaging, Incisor pathology, Male, Maxilla, Root Resorption diagnostic imaging, Root Resorption etiology, Tissue Engineering methods, Dental Pulp Necrosis therapy, Incisor injuries, Root Canal Therapy methods, Root Resorption therapy
- Abstract
Introduction: Intrusive luxation is one of the most severe traumatic injuries of permanent teeth that may adversely affect the pulp and the periodontium. Pulp necrosis and root resorption are the main pathologic entities associated with this injury. The present report describes the endodontic management of an intruded immature maxillary central incisor presented with pulp necrosis and severe inflammatory root resorption by using the regenerative approach., Methods: A 7-year-old boy with dental trauma to the anterior maxillary region was referred for the management of a traumatized maxillary central incisor. Clinical examination revealed an uncomplicated crown fracture, whereas radiographic examination showed that the tooth was immature, confirming the intrusion that was calculated between 3 and 4 mm. The tooth was left to re-erupt, but after 2 months the boy presented with intraoral swelling. Radiographic examination showed initial signs of root resorption. The tooth was treated by using a regenerative endodontic approach., Results: Clinical and radiographic examinations during the initial follow-up period showed resolution of the signs and symptoms as well as inhibition of the resorption process. At the follow-up examinations, the tooth remained free of signs and symptoms and completely functional. The radiographic recall examinations showed a gradual thickening of the root canal walls but incomplete apical closure., Conclusions: The present case shows that severely injured teeth with uncertain prognosis may have a considerable percentage of chance to remain functional and free of signs and symptoms by using a regenerative endodontic procedure, confirming the efficacy of this procedure as a viable treatment option., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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33. Evaluation of antibiotic mix in Non-instrumentation Endodontic Treatment of necrotic primary molars.
- Author
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Raslan N, Mansour O, and Assfoura L
- Subjects
- Child, Ciprofloxacin therapeutic use, Clindamycin therapeutic use, Drug Combinations, Female, Humans, Male, Metronidazole therapeutic use, Minocycline therapeutic use, Reproducibility of Results, Root Canal Filling Materials therapeutic use, Root Resorption, Tooth, Deciduous, Treatment Outcome, Anti-Bacterial Agents therapeutic use, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Molar diagnostic imaging
- Abstract
Aim: To compare the clinical and radiographic success rates of an antibiotic mix consisting of metronidazole, minocycline and ciprofloxacin (3Mix-MP) and another mix where minocycline was replaced with clindamycin (3Mix-MP-R) in non-instrumentation endodontic treatment (NIET) of necrotic primary molars and to determine the effect of root resorption on the success of the treatment., Materials and Methods: Forty-two necrotic mandibular primary molars from 22 healthy children were randomly assigned to either mixture. Blinded clinical evaluation was conducted after 1, 3, 6 and 12 months by the operator, and blinded radiographic evaluation was conducted at 6 and 12 months follow-ups by other two investigators with inter-examiner reproducibility of 0.95., Results: Overall success rates of 3Mix-MP and 3Mix-MP-R were 80.96% and 76.20% respectively, with no statistically significant difference. Radiographically, resorption of more than one third of the root length had a lower failure rate with no statistically significant difference (p<0.5)., Conclusion: Primary teeth with necrotic pulp can be treated with 3Mix-MP or 3Mix-MP-R irrespective of the degree of root resorption.
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- 2017
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34. Long-term treatment outcomes in immature permanent teeth by revascularisation using MTA and GIC as canal-sealing materials: a retrospective study.
- Author
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Peng C, Yang Y, Zhao Y, Liu H, Xu Z, Zhao D, and Qin M
- Subjects
- Child, Dental Pulp Necrosis diagnostic imaging, Dentition, Permanent, Drug Combinations, Follow-Up Studies, Humans, Male, Molar diagnostic imaging, Neovascularization, Physiologic, Radiography, Retrospective Studies, Treatment Outcome, Aluminum Compounds, Calcium Compounds, Dental Pulp Necrosis therapy, Glass Ionomer Cements, Oxides, Root Canal Filling Materials, Root Canal Therapy, Silicates
- Abstract
Background: Pulp revascularisation with MTA sealing has been accepted as an alternative treatment for non-vital immature permanent teeth. Successful revascularisation cases with GIC sealing were also reported, but lack of long-term researches., Aim: To evaluate long-term outcomes of revascularisation using MTA and GIC as canal-sealing materials in non-vital immature permanent teeth., Design: Clinical and radiographic data of 60 non-vital immature permanent teeth treated with revascularisation (36.8 ± 12.4 months of follow-up) were reviewed. Of these, 28 teeth were sealed with MTA, and 32 with GIC. Tooth survival, success rate, and increases in root length and dentine wall thickness were evaluated., Results: Teeth in MTA group showed a similar survival rate (96%) to GIC group (100%). The success rate in MTA group (93%) was greater than that in GIC group (59%). Eight of fourteen failed teeth due to recurrent apical disease (seven teeth in GIC group and one in MTA group) achieved complete root development. There was no statistically significant difference in root length or dentine wall thickness increase between the groups., Conclusions: Long-term outcome of revascularisation in non-vital immature permanent teeth sealed with GIC was not as good as that with MTA. Although more recurrent apical disease developed, results on root development were acceptable in GIC sealed cases., (© 2017 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Published
- 2017
- Full Text
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35. Clinical and Radiographic Assessment of the Efficacy of a Collagen Membrane in Regenerative Endodontics: A Randomized, Controlled Clinical Trial.
- Author
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Jiang X, Liu H, and Peng C
- Subjects
- Child, Dental Pulp Necrosis diagnostic imaging, Endodontics methods, Female, Humans, Male, Regeneration, Tooth, Nonvital diagnostic imaging, Biocompatible Materials therapeutic use, Collagen therapeutic use, Dental Pulp Necrosis drug therapy, Periapical Diseases drug therapy, Tooth, Nonvital drug therapy
- Abstract
Introduction: Recent reviews confirm a general lack of randomized, controlled clinical studies on the efficacy of regenerative endodontics in immature teeth affected by pulp and periapical diseases. Moreover, we have no evidence of the curative efficacy of collagen membranes used as scaffolds in regenerative endodontics. Here, we evaluated whether a Bio-Gide collagen membrane (Geistlich Pharma AG, Wolhusen, Switzerland) has efficacy in promoting dentin formation in regenerative endodontics., Methods: Forty-three patients yielding a total of 46 nonvital immature teeth were divided randomly into 2 groups. Subsequent to chemomechanical preparation, regenerative endodontics with (the experimental group) and without (the control group) Bio-Gide were performed. All cases were followed up clinically and radiographically every 3 months for at least 6 months. Quantitative analyses using an imaging program yielded percentage changes in root dimensions based on a comparison between preoperative and recall radiographs., Results: The results of 40 patients (43 teeth) were included in the final analyses. All patients from both groups showed clinical success with complete resolution of signs and symptoms. Radiographically, the thickness of the dentin wall at the middle third of the root was higher for the experimental group than the control group. However, other indicators were comparable between both groups., Conclusions: The use of the Bio-Gide collagen membrane promoted the development of the dentin wall in the middle third of the root in patients undergoing regenerative endodontic procedures. The convenience of operation and the assured positioning of the sealing material make the Bio-Gide collagen membrane especially suitable for handling wide root canals., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
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36. Intentional Replantation of an Avulsed Immature Permanent Incisor: A Case Report.
- Author
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Maniglia-Ferreira C, de Almeida Gomes F, and Vitoriano MM
- Subjects
- Aluminum Compounds therapeutic use, Anti-Bacterial Agents therapeutic use, Calcium Compounds therapeutic use, Calcium Hydroxide therapeutic use, Child, Dental Pulp Necrosis diagnostic imaging, Drug Combinations, Glass Ionomer Cements therapeutic use, Humans, Oxides therapeutic use, Silicates therapeutic use, Tooth Avulsion diagnostic imaging, Dental Pulp Necrosis therapy, Incisor injuries, Root Canal Therapy methods, Tooth Avulsion therapy, Tooth Replantation methods
- Abstract
This case report discusses the successful endodontic treatment of an open apex maxillary right permanent central incisor that had been avulsed and incorrectly replanted in a 7-year-old patient. The tooth was carefully re-extracted followed by cleaning of the alveolar socket and immediate replantation. However, pulp necrosis was diagnosed, and regenerative endodontic treatment was performed. The root canal system was disinfected by passive ultrasonic irrigation with 2.5% sodium hypochlorite. At the first visit, the tooth was repositioned and immobilized with an appropriate semirigid splint. After 14 days, the splint was removed, and the diagnosis of pulp necrosis was confirmed by thermal testing. The root canal was emptied, disinfected, and filled with calcium hydroxide paste, which was left in place for 7 days. At the third visit, calcium hydroxide was removed with hand files and passive ultrasonic irrigation, and the canal was filled with a mixture of double antibiotic paste (metronidazole/ciprofloxacin) and zinc oxide. The antibiotic paste was left in place for 30 days. At the final visit, the paste was removed and the periapical area stimulated with a #80 K-file to encourage clot formation within the pulp cavity. A mineral trioxide aggregate paste cervical plug was placed, and the tooth was restored with glass ionomer cement. Clinical and imaging (radiographic and tomographic) follow-up at 3, 6, 12, and 36 months showed endodontic success with continued root formation., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
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37. Long-term Success of Nonvital, Immature Permanent Incisors Treated With a Mineral Trioxide Aggregate Plug and Adhesive Restorations: A Case Series from a Private Endodontic Practice.
- Author
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Ree MH and Schwartz RS
- Subjects
- Adolescent, Adult, Child, Composite Resins therapeutic use, Dental Pulp Necrosis diagnostic imaging, Drug Combinations, Female, Follow-Up Studies, Humans, Male, Periapical Periodontitis diagnostic imaging, Post and Core Technique, Tooth, Nonvital diagnostic imaging, Treatment Outcome, Aluminum Compounds therapeutic use, Calcium Compounds therapeutic use, Dental Pulp Necrosis therapy, Dental Restoration, Permanent methods, Incisor, Oxides therapeutic use, Periapical Periodontitis therapy, Root Canal Filling Materials therapeutic use, Root Canal Therapy methods, Silicates therapeutic use, Tooth, Nonvital therapy
- Abstract
This case series evaluated the long-term clinical outcome of nonvital immature teeth treated with mineral trioxide aggregate (MTA) as an apical barrier and an adhesive restoration with or without a fiber post. Eighty-three teeth in 72 patients were treated by the first author with an apical MTA plug and an adhesive restoration of composite resin and in 45 of the 83 teeth 1 or more fiber posts. All of the patients had been referred to the first author's private endodontic practice with at least 1 immature tooth with signs of pulpal necrosis and subsequent apical periodontitis that had been caused by a variety of traumatic dental injuries. Three teeth presented had dens invaginatus. Of 83 teeth, 69 teeth in 60 patients were available for follow-up after 5 to 15 years (recall rate = 83%). The mean follow-up time was 8.29 years. No teeth were lost because of a root fracture. Ninety-six percent (66/69) of the recalled teeth were characterized as healed. Based on periapical radiographs and clinical examination, 96% of teeth treated with the MTA barrier technique and adhesive restorations were characterized as "healed" and were in function after 5 to 15 years (mean = 8.29 years). These results indicate that this is a viable and predictable treatment approach for the long-term success of nonvital immature teeth., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
38. Traumatic periapical lesion only identified through cone beam computed tomography: a case report.
- Author
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Cosme-Silva L, Marcos AFO, Ferreira JF, Gomes Filho JE, and Viola NV
- Subjects
- Adult, Bruxism psychology, Cuspid diagnostic imaging, Cuspid injuries, Cuspid surgery, Female, Humans, Maxilla diagnostic imaging, Maxilla surgery, Radiography, Dental, Digital, Bruxism complications, Cone-Beam Computed Tomography, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis etiology, Dental Pulp Necrosis surgery, Root Canal Therapy methods
- Abstract
This case report describes the diagnosis of a traumatic periapical lesion, caused by parafunctional habits (bruxism) and associated with bone rarefaction, that had not been identified by periapical radiography. Slight edema was observed clinically at the apical region of the maxillary left canine; however, the tooth demonstrated only physiologic mobility, and the results of a pulpal sensitivity test were inconclusive. A cone beam computed tomogram (CBCT) showed the presence of a periapical lesion. After preparation of the root canal, intracanal medication (calcium hydroxide and paramonochlorophenol) was placed and changed once a month for 2 months. After 60 days (at the time of the second medication change), the edema at the apical region was no longer visible. The root canal was filled, and CBCTs obtained 30 days and 24 months after completion of treatment showed that the lesion had regressed with bone repair. Although it is an expensive procedure, CBCT is important in the examination and diagnosis of periapical lesions that may not be seen in periapical radiographs.
- Published
- 2017
39. A comparative evaluation of endodontic treatments for immature necrotic permanent teeth based on clinical and radiographic outcomes: a systematic review and meta-analysis.
- Author
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Nicoloso GF, Pötter IG, Rocha RO, Montagner F, and Casagrande L
- Subjects
- Adolescent, Child, Humans, Outcome and Process Assessment, Health Care, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis therapy, Dentition, Permanent, Radiography, Dental, Tooth, Nonvital
- Abstract
Background: Dental trauma and deep caries are frequent findings in children and adolescents that may lead to pulp necrosis in young permanent teeth. As a consequence, the root stops its development, and managing these immature teeth becomes challenging due to the presence of open apexes and fragile dentinal walls., Aim: We aimed to carry out a systematic review including a meta-analysis to compare the endodontic treatments available in the management of immature necrotic permanent teeth and determine which one provides the best clinical and radiographic outcomes., Design: The literature was screened via PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials databases until August 2015 to select randomized clinical trials that compared at least two different treatments regarding immature necrotic permanent teeth comprising clinical and radiographic success as outcome. Two reviewers independently performed the screening and evaluation of the articles. A total of 648 studies were retrieved from the databases, in which only 14 were selected to full-text analysis by the appliance of inclusion criteria. After the exclusion criteria, the remaining seven studies had their data extracted and assessed for bias risk. Pooled-effect estimates were obtained comparing clinical and radiographic success rates among MTA Versus other treatments., Results: Evaluation of clinical (Z = 2.32, P = 0.02, OR = 5.37, 95% CI: 1.29-22.23, I = 0%) and radiographic (Z = 2.45, P = 0.01, OR = 4.31, 95% CI: 1.34-13.82, I = 0%) outcomes favored the MTA (control group) when compared to other endodontic treatments (P < 0.05). No evidence of heterogeneity was detected among the studies (I < 50%), whereas a moderate risk of bias was identified in five of them., Conclusions: Although almost all of the identified studies presented moderate risk of bias, MTA apexification seems to produce overall better clinical and radiographic success rates among the endodontic treatment available in immature necrotic permanent teeth., (© 2016 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Published
- 2017
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40. Longitudinal Cohort Study of Regenerative Endodontic Treatment for Immature Necrotic Permanent Teeth.
- Author
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Chan EK, Desmeules M, Cielecki M, Dabbagh B, and Ferraz Dos Santos B
- Subjects
- Child, Dental Pulp Necrosis diagnostic imaging, Dentition, Permanent, Female, Humans, Longitudinal Studies, Male, Radiography, Dental, Regeneration, Tooth Root diagnostic imaging, Dental Pulp Necrosis therapy, Root Canal Therapy, Tooth Root physiology
- Abstract
Introduction: The treatment of immature necrotic permanent teeth presents several clinical challenges in endodontics. Regenerative endodontic procedures (REPs) permit root development, increased canal wall thickness, and apical closure. This longitudinal cohort study aimed to evaluate the long-term clinical and radiographic outcomes of REPs of immature necrotic permanent teeth over a 30-month period., Methods: This study was performed at the Division of Dentistry of the Montreal Children's Hospital, Montreal, Quebec, Canada. Twenty-eight immature necrotic permanent teeth from 22 patients were included in this study. All teeth were treated with a standardized REP protocol. Patients had follow-up appointments at 1, 2, 3, 6, 12, 18, 24, and 30 months. At each appointment, signs and symptoms were evaluated. Radiographic evaluation was also performed by a calibrated endodontist in order to analyze different parameters., Results: Our results show a high survival rate (96.4%), clinical success (92.8%), and resolution of apical pathology (100%). Significant increases in the average root length (8.1%, P < .0001) and root thickness area (11.6%, P = .03) were observed after 30 months. In the study period, a significant decrease in the apical diameter was also noted, with 30.8% of the cases showing complete apical closure. Teeth with more immature stages of root development had a higher percentage of change in root thickness, length, and apical diameter; however, these results were not statistically significant., Conclusions: Teeth treated with REPs presented resolution of symptoms. Although clinical meaningful change was not achieved in all cases, increased root thickness, root length, and apical closure were observed at 30 months., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
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41. Management of coronal discolouration following a regenerative endodontic procedure in a maxillary incisor.
- Author
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D'Mello G and Moloney L
- Subjects
- Aluminum Compounds, Calcium Compounds, Child, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis etiology, Dental Pulp Necrosis prevention & control, Diagnosis, Differential, Drug Combinations, Female, Humans, Oxides, Root Canal Filling Materials, Silicates, Tooth Apex, Dental Pulp Necrosis diagnosis, Incisor injuries, Maxilla
- Abstract
Pulpal necrosis and infection in an immature anterior tooth subsequent to traumatic injury is a challenging situation. Regenerative endodontics, resulting in continued development of the tooth, provides a biological response to this clinical challenge. Regenerative endodontic procedures require disinfection of the infected root canal and sealing of the pulp canal space. Mineral trioxide aggregate (MTA) provides a good seal, is biocompatible and allows the formation of a hard tissue to occur within the root canal. MTA, however, can lead to significant staining of the crown of the tooth that is difficult to mask. This case report describes the management of discolouration in an 11 year old girl subsequent to a regenerative endodontic procedure in an immature traumatized maxillary central incisor., (© 2016 Australian Dental Association.)
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- 2017
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42. Clinical and Radiographic Outcomes in Immature Permanent Necrotic Evaginated Teeth Treated with Regenerative Endodontic Procedures.
- Author
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Li L, Pan Y, Mei L, and Li J
- Subjects
- Child, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis pathology, Female, Humans, Male, Prospective Studies, Radiography, Dental, Tooth Root diagnostic imaging, Tooth Root pathology, Treatment Outcome, Dental Pulp Necrosis surgery, Regenerative Medicine methods, Root Canal Therapy methods
- Abstract
Introduction: Regenerative endodontics is a promising alternative treatment for immature permanent teeth with necrotic dental pulp. The present study assessed the time to resolution of clinical symptoms and radiographic changes in root dimensions in immature permanent necrotic teeth with dens evaginatus., Methods: In this prospective study, clinical and radiographic data were collected for 20 teeth with dens evaginatus treated with a revascularization protocol for 1 year. Tooth survival and success rate were analyzed, and radiographic changes in the radiographic root area, apical diameter, and root length were quantified., Results: All 20 treated teeth (100%) survived and met the clinical criteria for success throughout the study period. The within-case percent change in radiographic root area was 28.14% at 3 months and had increased to 97.58% at 12 months. The within-case percent change in apical diameter after 3 months was 21.40% and had increased to 72.90% by 12 months, with 40% (8 of 20) showing complete apical closure at 12 months. The within-case percent change in root length was 2.65% at 3 months and had increased to 23.37% at 12 months., Conclusions: In this study, revascularization allowed the continued development of roots in teeth with necrotic pulp as well as excellent overall survival and success rates., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
43. Pulp and apical tissue response to deep caries in immature teeth: A histologic and histobacteriologic study.
- Author
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Ricucci D, Siqueira JF Jr, Loghin S, and Lin LM
- Subjects
- Adolescent, Bacteria pathogenicity, Bicuspid pathology, Biofilms growth & development, Child, Dental Caries diagnostic imaging, Dental Pulp diagnostic imaging, Dental Pulp Cavity diagnostic imaging, Dental Pulp Cavity pathology, Dental Pulp Diseases pathology, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis pathology, Dentin diagnostic imaging, Dentin pathology, Dentin, Secondary diagnostic imaging, Dentin, Secondary pathology, Female, Fibroblasts pathology, Humans, Inflammation, Male, Molar pathology, Odontoblasts pathology, Pulpitis diagnostic imaging, Pulpitis pathology, Radiography, Dental, Tooth Apex diagnostic imaging, Tooth Extraction, Tooth Root diagnostic imaging, Tooth Root pathology, Dental Caries microbiology, Dental Caries pathology, Dental Pulp microbiology, Dental Pulp pathology, Tooth Apex microbiology, Tooth Apex pathology
- Abstract
Descriptions of the pathologic changes in the pulp and associated apical structures of human immature teeth in response to deep caries are lacking in the literature., Objectives: This article describes the histologic events associated with the radicular pulp and the apical tissues of human immature teeth following pulp inflammation and necrosis., Methods: Twelve immature teeth with destructive caries lesions were obtained from 8 patients. Two intact immature teeth served as controls. Teeth were extracted for reasons not related to this study and immediately processed for histopathologic and histobacteriologic analyses. Serial sections were examined for the pulp conditions and classified as reversible or irreversible pulp inflammation, or pulp necrosis. Other histologic parameters were also evaluated., Results: In the 3 cases with reversible pulp inflammation, tissue in the pulp chamber showed mild to moderate inflammation and tertiary dentin formation related to tubules involved in the caries process. Overall, the radicular pulp tissue, apical papilla and Hertwig's epithelial root sheath (HERS) exhibited characteristics of normality. In the 3 cases with irreversible pulp inflammation, the pulps were exposed and severe inflammation occurred in the pulp chamber, with minor areas of necrosis and infection. Large areas of the canal walls were free from odontoblasts and lined by an atubular mineralized tissue. The apical papilla showed extremely reduced cellularity or lack of cells and HERS was discontinuous or absent. In the 6 cases with pulp necrosis, the coronal and radicular pulp tissue was necrotic and colonized by bacterial biofilms. The apical papilla could not be discerned, except for one case. HERS was absent in the necrotic cases., Conclusion: While immature teeth with reversible pulpitis showed histologic features almost similar to normal teeth in the canal and in the apical region, those with irreversible pulpitis and necrosis exhibited significant alterations not only in the radicular pulp but also in the apical tissues, including the apical papilla and HERS., Clinical Significance: Alterations in the radicular pulp and apical tissues help explain the outcome of current regenerative/reparative therapies and should be taken into account when devising more predictable therapeutic protocols for teeth with incomplete root formation., (Copyright © 2016 Elsevier Ltd. All rights reserved.)
- Published
- 2017
- Full Text
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44. Endodontics: beyond the basics.
- Author
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Dinsbach N
- Subjects
- Dental Pulp Necrosis complications, Dental Pulp Necrosis diagnostic imaging, Female, Humans, Middle Aged, Periapical Periodontitis complications, Radiography, Dental, Dental Pulp Necrosis diagnosis, Periapical Periodontitis diagnosis, Root Canal Therapy methods, Tooth Replantation methods
- Published
- 2017
45. Numb chin syndrome associated with vertical root fracture and odontogenic infection.
- Author
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Brooks JK, Schwartz KG, Ro AS, and Lin CD
- Subjects
- Diagnosis, Differential, Humans, Magnetic Resonance Imaging, Middle Aged, Pain Measurement, Radiography, Panoramic, Syndrome, Tomography, X-Ray Computed, Tooth Extraction, Chin, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis surgery, Hypesthesia etiology, Tooth Fractures diagnostic imaging, Tooth Fractures surgery, Tooth Root injuries
- Abstract
Numb chin syndrome (NCS) is a multifactorial neuropathic disorder associated with paresthesia to the chin, lip, and oral mucosa, particularly arising as a sequela to various dental-related procedures or infections in the mandible. Timely elucidation of the underlying etiology is of paramount importance as the presentation of NCS could serve as a harbinger of malignancy or metastatic disease. This report describes an unusual case of NCS developing synchronously with a vertical root fracture and odontogenic infection in a mandibular first molar. Clinicians should consider the inclusion of a vertical root fracture as plausible cofactor for the development of NCS.
- Published
- 2017
- Full Text
- View/download PDF
46. Single versus multiple visits for endodontic treatment of permanent teeth.
- Author
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Manfredi M, Figini L, Gagliani M, and Lodi G
- Subjects
- Anti-Bacterial Agents therapeutic use, Appointments and Schedules, Dental Pulp Necrosis diagnostic imaging, Humans, Pain, Postoperative etiology, Pulpitis diagnostic imaging, Radiography, Randomized Controlled Trials as Topic, Root Canal Therapy adverse effects, Tooth Extraction, Treatment Outcome, Analgesics therapeutic use, Dental Pulp Necrosis therapy, Dentition, Permanent, Office Visits statistics & numerical data, Pulpitis therapy, Root Canal Therapy methods
- Abstract
Background: Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, tooth cracks or chips, or dental trauma. Successful RoCT is characterised by an absence of symptoms (i.e. pain) and clinical signs (i.e. swelling and sinus tract) in teeth without radiographic evidence of periodontal involvement (i.e. normal periodontal ligament). The success of RoCT depends on a number of variables related to the preoperative condition of the tooth, as well as the endodontic procedures. This review updates the previous version published in 2007., Objectives: To determine whether completion of root canal treatment (RoCT) in a single visit or over two or more visits, with or without medication, makes any difference in term of effectiveness or complications., Search Methods: We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 14 June 2016), Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 5), MEDLINE Ovid (1946 to 14 June 2016), and Embase Ovid (1980 to 14 June 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 14 June 2016. We did not place any restrictions on the language or date of publication when searching the electronic databases., Selection Criteria: We included randomised controlled trials (RCTs) and quasi-RCTs of people needing RoCT. We excluded surgical endodontic treatment. The outcomes of interest were tooth extraction for endodontic problems; radiological failure after at least one year, i.e. periapical radiolucency; postoperative pain; swelling or flare-up; painkiller use; sinus track or fistula formation; and complications (composite outcome including any adverse event)., Data Collection and Analysis: We collected data using a specially designed extraction form. We contacted trial authors for further details where these were unclear. We assessed the risk of bias in the studies using the Cochrane tool and we assessed the quality of the body of evidence using GRADE criteria. When valid and relevant data were collected, we undertook a meta-analysis of the data using the random-effects model. For dichotomous outcomes, we calculated risk ratios (RRs) and 95% confidence intervals (CIs). For continuous data, we calculated mean differences (MDs) and 95% CIs. We examined potential sources of heterogeneity. We conducted subgroup analyses for necrotic and vital teeth., Main Results: We included 25 RCTs in the review, with a total of 3780 participants, of whom we analysed 3751. We judged three studies to be at low risk of bias, 14 at high risk, and eight as unclear.Only one study reported data on tooth extraction due to endodontic problems. This study found no difference between treatment in one visit or treatment over multiple visits (1/117 single-visit participants lost a tooth versus 2/103 multiple-visit participants; odds ratio (OR) 0.44, 95% confidence interval (CI) 0.04 to 4.78; very low-quality evidence).We found no evidence of a difference between single-visit and multiple-visit treatment in terms of radiological failure (risk ratio (RR) 0.91, 95% CI 0.68 to 1.21; 1493 participants, 11 studies, I
2 = 18%; low-quality evidence); immediate postoperative pain (dichotomous outcome) (RR 0.99, 95% CI 0.84 to 1.17; 1560 participants, 9 studies, I2 = 33%; moderate-quality evidence); swelling or flare-up incidence (RR 1.36, 95% CI 0.66 to 2.81; 281 participants, 4 studies, I2 = 0%; low-quality evidence); sinus tract or fistula formation (RR 0.98, 95% CI 0.15 to 6.48; 345 participants, 2 studies, I2 = 0%; low-quality evidence); or complications (RR 0.92, 95% CI 0.77 to 1.11; 1686 participants, 10 studies, I2 = 18%; moderate-quality evidence).The studies suggested people undergoing RoCT in a single visit may be more likely to experience pain in the first week than those whose RoCT was over multiple visits (RR 1.50, 95% CI 0.99 to 2.28; 1383 participants, 8 studies, I2 = 54%), though the quality of the evidence for this finding is low.Moderate-quality evidence showed people undergoing RoCT in a single visit were more likely to use painkillers than those receiving treatment over multiple visits (RR 2.35, 95% CI 1.60 to 3.45; 648 participants, 4 studies, I2 = 0%)., Authors' Conclusions: There is no evidence to suggest that one treatment regimen (single-visit or multiple-visit root canal treatment) is better than the other. Neither can prevent all short- and long-term complications. On the basis of the available evidence, it seems likely that the benefit of a single-visit treatment, in terms of time and convenience, for both patient and dentist, has the cost of a higher frequency of late postoperative pain (and as a consequence, painkiller use).- Published
- 2016
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47. Histologic characterization of regenerated tissues after pulp revascularization of immature dog teeth with apical periodontitis using tri-antibiotic paste and platelet-rich plasma.
- Author
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Stambolsky C, Rodríguez-Benítez S, Gutiérrez-Pérez JL, Torres-Lagares D, Martín-González J, and Segura-Egea JJ
- Subjects
- Aluminum Compounds pharmacology, Animals, Bicuspid, Calcium Compounds pharmacology, Cefixime pharmacology, Ciprofloxacin pharmacology, Combined Modality Therapy, Dental Pulp Necrosis diagnostic imaging, Dogs, Drug Combinations, Female, Metronidazole pharmacology, Oxides pharmacology, Periapical Periodontitis diagnostic imaging, Random Allocation, Root Canal Irrigants pharmacology, Silicates pharmacology, Sodium Hypochlorite pharmacology, Dental Pulp blood supply, Dental Pulp Necrosis therapy, Periapical Periodontitis therapy, Platelet-Rich Plasma, Root Canal Therapy methods
- Abstract
Introduction: This study evaluates histologically the efficacy of 4 revascularization protocols in necrotic-infected immature dog teeth with apical periodontitis (AP)., Methods: Forty double-rooted immature premolar teeth from 4 female Beagle dogs aged 5 months were used. Four teeth were left untouched as negative controls; the other 36 teeth were infected to develop pulp necrosis and AP. Four teeth were left untreated and assigned to the positive control group. The last 28 teeth were randomly assigned into four experimental groups of 8 teeth, each one treated with a different treatment protocol: A1, sodium hypochlorite (SH)+blood clot (BC); A2, SH+platelet-rich plasma (PRP); B1, SH+modified tri-antibiotic paste (mTAP)+BC; B2, SH+mTAP+PRP. The animals were sacrificed, histologic sections were prepared and three parameters were assessed: (1) presence or absence of new hard tissue on the internal root dentinal walls, (2) presence or absence of continued apical closure, and (3) presence or absence of vital tissue within the canal space., Results: Significant differences (p<0.05) between the four experimental groups were evident in the percentage of teeth showing histological apical closure (34.5%) and vital tissue within the canal space (68.8%). Group B2 showed the maximal improvement in the three variables assessed (p<0.05). Group A1 showed the minimum percentages in the three parameters assessed (p<0.05)., Conclusions: These results suggest that an intracanal dressing of mTAP, and the use of PRP as scaffold, improves the success rate of the revascularization procedure., (Copyright © 2016 Elsevier Ltd. All rights reserved.)
- Published
- 2016
- Full Text
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48. Erythematous gingival lesion.
- Author
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Patni P and Patni MJ
- Subjects
- Female, Humans, Middle Aged, Radiography, Dental Pulp Necrosis complications, Dental Pulp Necrosis diagnostic imaging, Periapical Periodontitis diagnostic imaging
- Published
- 2016
49. Cutaneous sinus tract of dental origin.
- Author
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Patni PM, Jain P, and Patni MJ
- Subjects
- Cone-Beam Computed Tomography, Dental Pulp Necrosis therapy, Humans, Male, Root Canal Therapy, Young Adult, Cutaneous Fistula diagnostic imaging, Dental Fistula diagnostic imaging, Dental Pulp Necrosis diagnostic imaging
- Published
- 2016
- Full Text
- View/download PDF
50. The use of a single-step regenerative approach for the treatment of a replanted mandibular central incisor with severe resorption.
- Author
-
Chaniotis A
- Subjects
- Child, Dental Pulp Necrosis diagnostic imaging, Dental Pulp Necrosis etiology, Edetic Acid therapeutic use, Female, Humans, Incisor diagnostic imaging, Mandible, Pemetrexed, Radiography, Dental, Sodium Hypochlorite therapeutic use, Therapeutic Irrigation, Tooth Resorption diagnostic imaging, Tooth Resorption etiology, Dental Pulp Necrosis therapy, Incisor injuries, Tooth Injuries complications, Tooth Resorption therapy
- Abstract
Aim: To report the clinical and radiographic treatment outcome of an immature replanted mandibular incisor with severe inflammatory external root resorption following a single-step regenerative approach., Summary: A 7-year-old female patient was referred 1 week following an extrusion injury to her mandibular central incisor (tooth 31). There was a history of a 6 months previous avulsion injury to the same tooth, which had been replanted after 20 min of extra-oral time. On clinical examination, all teeth were asymptomatic and there was an arch wire splint placed on the mandibular incisors. Radiographic examination revealed severe inflammatory external root resorption of tooth 31. A diagnosis of necrotic pulp and asymptomatic apical periodontitis was made. Under local anaesthesia and rubber dam isolation, an access cavity was prepared. The canal was irrigated using 6% NaOCl solution delivered through the EndoVac negative pressure irrigation system (Endo Vac, Axis/SybronEndo, Coppell, TX, USA). A 17% EDTA solution was used for 5 min followed by a final rinse of sterile water. The periapical tissues were probed using a K-file, and bleeding was induced. A blood clot was allowed to form filling the entire canal. A thick plug of MTA was placed in direct contact with the blood clot. The tooth was restored with composite resin. All procedures were performed in a single visit. The splint was removed 2 weeks later. Recall examination after 24 months revealed healthy soft tissues with normal periodontal probing and mobility. The 24 months radiographic evaluation revealed healing of the severe inflammatory external root resorption and continuous root development/dentine wall thickening of the apical third. No signs of ankylosis or significant discoloration was present., (© 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.)
- Published
- 2016
- Full Text
- View/download PDF
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