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Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy (RCT). Recent research, encompassing bacterial etiology and advanced imaging techniques, contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT. Success in RCT hinges on factors like patients, infection severity, root canal anatomy, and treatment techniques. Therefore, improving disease management is a key issue to combat endodontic diseases and cure periapical lesions. The clinical difficulty assessment system of RCT is established based on patient conditions, tooth conditions, root canal configuration, and root canal needing retreatment, and emphasizes pre-treatment risk assessment for optimal outcomes. The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT. These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics., (© 2024. The Author(s).)

Background: Regenerative endodontics has evolved in recent years with tissue engineering concepts in particular appearing promising. Endodontic tissue engineering (ETE) describes the various approaches based on the orthograde introduction of scaffolds or biomaterials (with or without cells) into the root canal to achieve pulp tissue regeneration. There are currently no systematic reviews investigating whether ETE is a suitable method for the treatment of endodontic disease in both mature and immature permanent teeth., Objectives: The purpose of this systematic review was to determine the effectiveness of ETE in permanent teeth with pulp necrosis in comparison with conventional endodontic treatment., Methods: We searched MEDLINE, Embase and the Cochrane Library for published reports as well as Google Scholar for grey literature up to November 2021. Included were studies of patients with permanent immature or mature teeth and pulp necrosis with or without signs of apical periodontitis (P) comparing ETE (I) with calcium hydroxide apexification, apical plug and root canal treatment (C) in terms of tooth survival, pain, tenderness, swelling, need for medication (analgesics and antibiotics), radiographic evidence of reduction in apical lesion size, radiographic evidence of normal periodontal ligament space, function (fracture and restoration longevity), the need for further intervention, adverse effects (including exacerbation, restoration integrity, allergy and discolouration), oral health-related quality of life (OHRQoL), presence of sinus tract and response to sensibility testing (O). An observation period of at least 12 months was mandatory (T) and the number of patients in human experimental studies or longitudinal observational studies had to be at least 20 (10 in each arm) at the end (S). Risk of bias was appraised using the Cochrane risk-of-bias (RoB 2) tool. Two authors independently screened the records, assessed full texts for eligibility and evaluated risk of bias. Heterogeneity of outcomes and limited body of evidence did not allow for meta-analysis., Results: Two randomized clinical trials investigating cell transplantation approaches with a total of 76 participants (40 treated immature teeth and 36 treated mature teeth) were included for qualitative analysis. Both studies had moderate concerns in terms of risk of bias. Due to the lack of homogeneity a meta-analysis was not possible. Tooth survival for ETE, root canal treatment and apexification was 100% after 12 months. Teeth treated with ETE showed a higher number of cases with positive pulpal responses to sensitivity tests and with blood perfusion compared with root canal treatment or apexification., Discussion: This systematic review highlights that there is limited evidence for ETE approaches. Even though the results of this review suggest a high survival with ETE in mature and immature teeth, there is a moderate risk of bias due to methodological limitations in the included studies, so the overall results should be interpreted with caution. Lack of a robust control group was a common problem during literature screening, and outcomes besides dental survival were reported inconsistently. Future clinical trials need to address methodical as well as assessment concerns and report long-term results., Conclusion: The benefits and high survival rates reported for ETE techniques suggest that this procedure might be an alternative to conventional procedures for permanent teeth with pulpal necrosis. However, more appropriate studies are needed to derive clinical recommendations., Registration: PROSPERO (CRD42021266350)., (© 2022 The Authors. International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society.)

Introduction: This retrospective cohort study aimed to estimate the success rate (SR) of primary root canal treatment on teeth with a diagnosis of pulp necrosis (PN) and asymptomatic apical periodontitis (AAP) when using 2% chlorhexidine gel as an auxiliary chemical substance and foraminal enlargement instrumentation technique., Methods: This study evaluated 178 patients with 206 teeth submitted to primary root canal treatment performed by graduate residents in endodontics. The inclusion criteria were patients who underwent treatment over a period of 1-7 years on teeth with a diagnosis of PN and AAP. The SR was evaluated clinically and radiographically and categorized considering strict (complete resolution of the periradicular lesion) or loose (reduction in the size of the existing periradicular lesion) criteria. Cases of clinical and/or radiographic absence of repair were classified as a failure. Two calibrated examiners independently assessed treatment outcomes using ImageJ software (National Institutes of Health, Bethesda, MD)., Results: The SRs were 81.1% (95% confidence interval, 75.7%-86.4%) and 87.4% (95% confidence interval, 82.8%-91.9%) when considering the strict or loose criteria, respectively. Females had a higher SR when strict criteria were applied. Also, the SR was significantly reduced when there was an increase in the patient's age., Conclusions: Teeth with a diagnosis of PN and AAP and treated with 2% chlorhexidine gel and foraminal enlargement achieved substantial SR. Sex and age were prognostic factors that played a significant role in the SR. Future randomized controlled trials should further investigate the effects of foraminal enlargement and 2% chlorhexidine gel as an auxiliary chemical substance., (Copyright © 2023 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: This study compared the effect of diode laser (DL) 980 nm and double antibiotic paste (DAP) on response of mature teeth with necrotic pulp and apical periodontitis to regenerative endodontic therapy in a dog model., Methods: Pulp necrosis and periapical pathosis were induced in 40 mature double rooted premolars in four 2-year-old mongrel dogs. These teeth were randomly divided according to disinfection protocol into four equal groups (10 teeth each/20 roots), group I: DAP; group II: DL980 nm; group III: positive control (without treatment) and group IV: negative control (untouched teeth). These groups were further subdivided into 2 subgroups (5 teeth each/10 roots) according to evaluation period, subgroup (A): one month and subgroup (B): three months. Revascularization techniques were performed using bleeding induction and application of platelet rich fibrin (PRF). The coronal cavities were sealed with mineral trioxide aggregate (MTA) and glass ionomer cement. The inflammatory response, vital tissue in-growth, new hard tissue formation and bone resorption were assessed. Statistical analysis was done utilizing ANOVA, Tukey's post hoc and paired t tests., Results: In both subgroups, there were no significant differences between DAP and DL980 in terms of inflammatory cell count, vital tissue in-growth, new hard tissue formation and bone resorption (P ≤ 0.05)., Conclusion: Diode laser 980 nm can alternate DAP as a disinfection method of the root canal during RET for mature necrotic teeth, therefore it may accelerate regenerative endodontic therapy for both the patient and dentist and allows for RET in a single appointment., (© 2023. The Author(s).)

Background/aim: The evidence for any benefit of systemic antibiotic therapy on pulp survival following extrusive luxation and avulsion is inconclusive. The aim of this study was to evaluate the effect of systemic antibiotic therapy with amoxycillin and tetracycline for 7 days on different aspects of dental pulp repair in a murine model., Material and Methods: The right maxillary incisor of 180 4 to 8-week-old male Wistar rats underwent extrusive luxation or avulsion. The animals were then treated with saline solution (control), tetracycline, or amoxicillin administered intra-gastrically for 7 days, and euthanized at 7, 15, and 30 days post-operatively. The layer of odontoblast cells, reparative dentin deposition, Hertwig's epithelial root sheath, pulp necrosis, and periapical inflammatory infiltrate were histomorphologically analyzed and scored. Mann-Whitney, Kruskal-Wallis, and Dunn tests were used to compare mean scores for the different procedures, treatments, and times (p ≤ .05)., Results: Significant differences were observed between luxated and avulsed teeth (p < .05). In luxated teeth, no differences were observed among treatments and times, except for more tertiary dentin deposition in the coronal third with the use of tetracycline compared with amoxicillin at 15 days (p < .05). In avulsed teeth, higher scores for the layer of odontoblast cells and lower scores for periapical inflammatory infiltrate at 7 days and pulp necrosis at 7 and 15 days were observed in the amoxicillin group compared to the saline and tetracycline groups (p < .05). At 30 days, however, no differences were observed among treatments., Conclusions: The use of systemic antibiotic therapy with tetracycline or amoxicillin for 7 days did not contribute to pulp repair following extrusive luxation or avulsion in rats. However, the results warrant further research into the use of amoxicillin for a more extended period of time in cases of avulsion., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: In young individuals, deciduous tooth pulp might be used as a natural, biologic scaffold for the regenerative endodontic treatment (RET) of young permanent teeth with necrotic pulps and apical periodontitis. The present case series demonstrates the clinical and radiographic outcomes of a novel RET using deciduous pulp autotransplantation in traumatized, necrotic young permanent incisors., Methods: Five previously traumatized maxillary incisors of four 8- to 11.5-year-old patients were treated with a RET protocol that used 2.5% NaOCl irrigation and placement of calcium hydroxide dressing in the first visit. After 4 weeks, the intracanal medication was removed, and the whole pulp tissue harvested from the neighboring maxillary deciduous canine was transplanted into the disinfected root canal without induced apical bleeding. Following placement of a mineral trioxide aggregate coronal barrier, the access cavities were restored with acid-etch resin composite. The root canals of donor primary canines were filled with calcium hydroxide-iodoform paste and were restored as with the permanent incisors., Results: Three patients were followed-up for 24 months, and 1 patient for 12 months. All teeth demonstrated radiographic evidence of complete periapical healing, slight increase in dentinal wall thickness, and continued apical closure in the absence of clinical symptoms. A positive response to cold test was obtained in 1 incisor at 12 months and 2 at 24 months., Conclusions: Based on 12- and 24-month clinical and radiographic findings, the present cases demonstrate a favorable outcome of a RET protocol using deciduous pulp autotransplantation in young permanent incisors with pulp necrosis., (Copyright © 2022 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to compare the effect of different application techniques of ozone on the prevalence of postendodontic pain in patients undergoing single-visit root canal treatment., Methods: hundred eight patients with necrotic pulp in single-rooted teeth and apical periodontitis participated in the trial. A standard single-visit endodontics protocol was followed with 5.25% sodium hypochlorite and rotary nickel-titanium files. After shaping and cleaning, patients were randomly allocated into the following groups: group 1 (n = 21), ozone treatment with no activation (NA); group 2 (n = 22), ozone treatment with manual dynamic activation (MDA); group 3, (n = 21), ozone treatment with passive ultrasonic activation (PUA); group 4 (n = 23), ozone treatment with sonic activation (SA); and group 5 (n = 21), no ozone treatment (the control group). Patient levels of discomfort were recorded at 6 different time intervals using the visual analog scale (VAS). Comparison of the mean difference between the groups and time intervals was performed using 2-way analysis of variance followed by a post hoc Bonferroni test. The level of significance was set at 5%., Results: VAS scores were highest for the control > NA > MDA > SA > PUA groups. A statistically significant reduction in VAS scores was observed in the PUA and SA groups in comparison with the NA, control, and MDA groups. Timewise comparison showed a highly significant decline in VAS scores at all time intervals (P < .001)., Conclusions: Ultrasonic and sonic activation of ozone resulted in less pain in patients undergoing single-visit endodontics compared with no ozone treatment., (Copyright © 2021 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: Pulp revascularization is an effective treatment for immature necrotic teeth. Calcium hydroxide has been used in pulp revascularization as an intracanal medication due to its antimicrobial action and the non-exhibition of crown discoloration and cytotoxicity for stem cells from the apical papilla. Our study aimed to investigate the clinical success and quantitative radiographic changes of root development in immature traumatized teeth using calcium hydroxide plus 2% chlorhexidine gel as intracanal medication., Methodology: In this retrospective study, 16 patients were treated with a standardized pulp revascularization protocol. Calcium hydroxide and 2% chlorhexidine gel were manipulated in a 1:1 (v/v) ratio and inserted into root canals with Lentulo spirals (Dentsply Maillefer, Baillaigues, Switzerland). Patients were followed up for a period from 9 to 36 months for the evaluation of clinical and radiological data. Radiographic measurements of root length, root width, apical diameter, and MTA placement from the apex were quantified using software ImageJ. Wilcoxon test and t-test were used, according to nonparametric or parametric data, respectively, for changes over time in root length, root width, and apical diameter., Results: Fifteen teeth survived during the follow-up period (93.75%) and met the criteria for clinical success. Although the changes seem to be very small in many cases, significant increases in the average root length (14.28%, p<0.0001), root width (8.12%, p=0.0196), and decrease in apical diameter (48.37%, p=0.0007) were observed. MTA placement from the apex and age at the time of treatment was not significantly associated with the quantitative radiographic outcomes., Conclusions: Pulp revascularization in traumatized immature teeth treated with calcium hydroxide plus 2% chlorhexidine gel as intracanal medication had high success and survival rates, showing periodontal healing and resolution of signs and symptoms. However, concerning the continued root development, the outcomes can still be considered unpredictable.

Introduction: Regenerative endodontic therapy (RET) has gained considerable attention and wide approval. Although it is being performed routinely, the outcomes remain unpredictable, and the optimal approaches for treatment are not established. It has been shown that bacterial persistence in root canals in these cases significantly interferes with healing and root maturation. However, few objective clinical studies have evaluated the complex microflora present in the infections or the efficacy of various clinical procedures. In addition, the extent of the infection and biofilm maturation in immature teeth with necrotic pulp has been understudied. Furthermore, most models used in preclinical evaluation of these issues do not fully elucidate the complexity or variability of the clinical situation., Results and Conclusion: In this review, the main biological and clinical problems pertaining to RET will be discussed. Contemporary analysis of complex microbial communities will be reviewed with emphasis on how these types of analyses can provide clinically useful data. In addition, current and proposed approaches for the effective disinfection of the root canal environment without interference with stem cell viability or integrity of the dentin matrix in these cases will be explored. The future of research in this field, including better and more customizable approaches in RET, in light of recent technological advances and progress in endodontics, will be outlined., (Copyright © 2020 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: This study evaluated the antibacterial efficiency and ability of propolis to promote regeneration of immature permanent non-vital dogs' teeth., Methods: Ninety six immature permanent premolars teeth in 6 mongrel dogs were divided randomly into: experimental teeth (N = 72) and control teeth (N = 24). Periapical pathosis was induced in all experimental and positive control teeth. Experimental teeth were classified according to the used intra-canal medication into: group I (N = 36), propolis paste was used and group II (N = 36), triple antibiotic paste (TAP) was used. Bacteriologic samplings were collected before and after exposure to intra-canal medicaments. After the disinfection period (3 weeks), revascularization was induced in all experimental teeth. Each group was subdivided according to the root canal orifice plug into: subgroup A (N = 18), propolis paste was used and subgroup B (N = 18), mineral trioxide aggregates (MTA) was used. Each subgroup was further subdivided according to the evaluation period into 3 subdivisions (6 teeth each): subdivision 1; after 2 weeks, subdivision 2; after one month and subdivision 3; after 2 months. Positive control group had 12 teeth with induced untreated periapical pathosis. Negative control group had 12 untouched sound teeth. All teeth were evaluated with radiography and histology. The bacteriologic and radiographic data were analyzed using repeated measures ANOVA and post-hoc Tukey tests. The histologic data were analyzed using Kruskal-Wallis test, Mann-Whitney U test with Bonferroni's adjustment and Chi-square test. The significance level was set at P ≤ .05., Results: There was no significant difference in the antibacterial effectiveness between TAP and propolis groups (P > .05). In all subdivisions, there was no significant difference between the experimental groups in terms of increase in root length and dentin thickness, decrease in apical closure, new hard tissue formation, vital tissue formation inside the pulp canal and apical closure scores (P > .05)., Conclusion: Propolis can be comparable with TAP as a disinfection treatment option in regenerative endodontic. As a root canal orifice plug after revascularization of necrotic immature permanent teeth in dogs, propolis induces a progressive increase in root length and dentin thickness and a decrease in apical diameter similar to those of MTA.

Objective: To asses clinically and radiographically the effect of using two types of coronal plug materials in revascularization of non-vital immature teeth., Methods: A total of 26 necrotic immature permanent anterior teeth were enrolled for pulp revascularization using a double antibiotic mix for root canal disinfection. They were randomly divided into the following based on coronal plug materials used: Biodentine (Group I) and white Mineral Trioxide Aggregate (Group II; n = 13). Clinical and radiographic assessments were performed after 3, 6, 9, and 12 months., Results: When comparing the overall clinical successes and percentage of increase in root length between the two groups, there was no statistically significant difference (P > 0.05). There was a significant difference in the distribution of discoloration between the two groups. One case was reported in Group I, and seven cases were reported in Group II (P = 0.01)., Conclusions: Both Biodentine and Mineral Trioxide Aggregate were successful clinically regarding the resolution of signs and symptoms associated with the necrotic teeth., (© 2019 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The interradicular region of primary molars is permeated by many foramina, channels and accessories that connect the pulp cavity with the periapical tissues anatomically. Thus, pulp decomposition products or drugs used in endodontic treatment can trigger inflammatory reactions. The aim of this study was to evaluate the blood cell profile of the alveolar region after extraction of primary molars treated with CTZ paste. Forty-eight primary molars were selected with clinical and radiographic signs of extraction. The sample was divided into three groups with 16 teeth each: Group 1-healthy teeth; Group 2-untreated decayed teeth; and Group 3-teeth treated with CTZ paste. Immediately after the extraction, blood from the interface of the tooth socket was collected and smears were performed for further evaluation. The slides were stained by the Fast Panoptic ® method and analysed by two previously trained examiners who counted the leucocytes in sets of 100 cells/slide, differentiating them into neutrophils, lymphocytes, monocytes, eosinophils and basophils. The data were analysed statistically by the MANOVA test. The blood samples from Group 2 differed significantly from Group 1 samples for all classes of leucocytes, except basophils, with higher average for lymphocytes (62.56), monocytes (7.81) and eosinophils (2.31). For Group 3, there was a relative difference (P < 0.05) to Group 2, of monocytes and eosinophils values. The blood cellularity interface in the tooth socket of primary teeth treated with CTZ paste is similar to those of healthy, exfoliated teeth and physiologically different from untreated decayed teeth., (© 2018 The Authors. International Journal of Experimental Pathology © 2018 International Journal of Experimental Pathology.)

Aim: The aim of this in vivo study is to evaluate the antimicrobial efficacy of calcium hydroxide (Ca(OH) 2 ), chlorhexidine (CHX), and metronidazole gel as intracanal medicaments against aerobic and facultative anaerobic microorganisms found in root canals of human primary teeth with necrotic pulp., Setting and Design: It is a double-blinded randomized clinical trial., Materials and Methods: Pulp canals of 45 single-rooted primary maxillary anterior teeth with pulp necrosis in 34 children were included in the study. They were divided into three groups of 15 samples each: Group I: Ca(OH) 2 ; Group II: 1% CHX gel; and Group III: 1% metronidazole gel. Microbial count was obtained from each tooth at two different stages - (1) after instrumentation and (2) after placement of the medication. Statistical analysis using the SPSS 10.0 software program (SPSS Inc., Chicago, IL, USA) with Wilcoxon signed-rank test after grouping the samples was performed., Results: Ca(OH) 2 , 1% CHX gel, and 1% metronidazole gel were ineffective in completely eliminating aerobic and facultative anaerobic microorganism from root canal of human primary teeth with necrotic pulp., Conclusion: None of the commonly used intracanal medicaments, that is Ca(OH) 2 , 1% CHX gel, and 1% metronidazole gel, was effective in completely eliminating aerobic and facultative anaerobic microorganism from root canal of human primary teeth with necrotic pulp. Ineffectiveness of these medicaments against aerobic and facultative anaerobic microorganism has opened new door of research regarding the manner of bacterial growth in unfavorable environmental and nutritional conditions, the way root canal environment favors biofilm formation and the use of suitable intracanal medicaments against single and multispecies biofilms., Competing Interests: There are no conflicts of interest

Aim: To determine the knowledge of undergraduate Spanish dental students regarding the indications of systemic antibiotics in the management of endodontic infections., Methodology: The final year dental students from four Spanish dental schools were requested to answer a one-page questionnaire on the indications for systemic antibiotics in the treatment of endodontic infections. One hundred and seventy-five students were asked to participate in this research. Data were analysed using descriptive statistics and chi-square test., Results: One hundred and four students (93.7%) completed satisfactorily the survey and were included in the study. The average duration of antibiotic therapy was 7.0 ± 2.0 days. All respondents chose amoxicillin as the first-choice antibiotic in patients with no medical allergies, alone (47%) or associated with clavulanic acid (53%). The first drug of choice for patients with an allergy to penicillin was clindamycin 300 mg (99%). For cases of irreversible pulpitis, up to 63% of students would prescribe antibiotics. For the scenario of a necrotic pulp, symptomatic apical periodontitis and no swelling, 44% would prescribe antibiotics. Almost 40% of students would prescribe antibiotics for necrotic pulps with asymptomatic apical periodontitis and a sinus tract., Conclusions: It is necessary for the Spanish schools of dentistry to improve students' knowledge about antibiotics and their indications in endodontics. Interactive education analysing real endodontic cases using problem-based learning would help students acquire better skills in prescribing antibiotics in pulp-periapical pathosis., (© 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

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.)

Background: The endodontic treatment of teeth with immature root has always been a challenge. To achieve a better prognosis, regenerative endodontic treatment may become a treatment trend for teeth with apical periodontitis and immature roots., Methods: Clinical and radiographic data were collected from 38 endodontic treated immature teeth (21 apexification and 17 regeneration). Measure the radiographic outcome by quantifying the apical lesion., Results: There was no statistical difference between the two treatments regarding PAI scores at the 1-, 3-, 6-, and 12-month follow-up (p > 0.05). In addition, different operators and the different stages of root development for both techniques showed no significant statistical difference on the final treatment results., Conclusions: In this study, assessment of the radiographic outcomes indicated that regenerative endodontic treatment were identical to the apexification technique., (Copyright © 2016 Chang Gung University. Published by Elsevier B.V. All rights reserved.)

Background: Arsenic oxide compounds were traditionally used as devitalizing agents. Due to its toxicity, leakage of such compounds into the periodontium can cause gingival and osteo-necrosis. Their use is forbidden in Europe and the USA for decades, however, some dentists seem to still use it., Case Report: We report the case of a 14-year-old girl referred to the paediatric dentistry department of Toulouse University hospital, France, presenting a bone necrosis following the use of an arsenic trioxide product to accelerate pulp necrosis., Treatment: The treatment included surgical removal of necrosis bone sequestrum, complete pulpectomy and an intermediate restoration of the tooth 27., Follow-Up: After 1 week, the clinical conditions greatly improved. A restoration using a ceramic crown was performed after 2 months, and complete healing was observed after 1 year follow-up., Conclusion: Although arsenic trioxide is neither appropriate nor permitted for use in modern dentistry, especially in paediatric dentistry, some rare cases of arsenic-induced osteo-necrosis can still be encountered. A clearer message must be given to all dental practitioners against the use of arsenic trioxide in modern endodontic treatment.

Revascularization of immature teeth with necrotic pulps traditionally involves the use of triple antibiotic paste, which may sometimes lead to undesirable complications. The objective of this study was to assess tissue repair in immature dog teeth with apical periodontitis subjected to revascularization, comparing two different pastes used for root canal disinfection. Apical periodontitis was induced in 30 dog premolars. Teeth were randomly divided into three experimental groups: root canals filled with triple antibiotic paste (n = 10); root canals filled with 1% propolis paste (n = 10); and no medication (n = 10). An additional group (n = 10, no intervention) was used as control. After 7 months, the jaws were histologically evaluated for the following variables: newly formed mineralized tissue (present/absent); vital tissue in the canal space (absent/periodontal ligament-like/pulp-like); apical extension of root (present/absent); and severity of inflammatory process (absent/mild/moderate/severe). There were no statistically significant differences among the experimental groups in new mineralized tissue formation and apical root development. The formation of vital tissue in the canal space, in turn, was statistically different between the triple paste and propolis groups: vital tissues were present in all revascularized teeth disinfected with propolis paste (100%), compared to 71% of those disinfected with the triple paste. Severity of inflammatory process was different between the triple paste and no medication groups. The new tissues formed onto canal walls and in the root canal space showed characteristics of cementum and periodontal ligament, respectively. Propolis may have some advantages over the triple paste for the revascularization of immature teeth.

Introduction: The lack of mechanical debridement and reduced concentrations suggested for chemical debridement to maintain stem cell viability call into question the disinfection efficacy of current regenerative protocols. Current protocols vary in the concentration and type of antibiotic medicaments used. The aim of this study was to determine if simulated immature teeth infected with Enterococcus faecalis can be completely disinfected by following current standardized regenerative protocols and to evaluate the probable effects of residual bacteria on stem cell toxicity., Methods: Sixty-eight caries-free maxillary incisors were used. S1 sampling protocols were validated in both negative and positive control groups via culture, scanning electron microscopy, and confocal laser scanning microscopy. All teeth, except the negative controls, were inoculated with E. faecalis. The teeth were divided into the following groups: group 1, triple antibiotic paste (ciprofloxacin:metronidazole:minocycline) at concentrations of 10, 1, and 0.1 mg/mL; group 2, double antibiotic paste (ciprofloxacin:metronidazole) at concentrations of 10, 1, and 0.1 mg/mL; group 3: Ultracal XS calcium hydroxide (Ultradent, St Louis, MO); and controls, negative and positive controls. Current regenerative protocols recommended by the American Association of Endodontists were followed. S2 sampling was performed after 4 weeks and tested for bacterial presence via culturing, scanning electron microscopy, and confocal laser scanning microscopic analysis., Results: The data showed that calcium hydroxide and the current recommended antibiotic concentrations are not capable of completely eliminating bacteria from simulated necrotic immature permanent teeth., Conclusions: Overall, this study focuses on the need to re-evaluate the balance between stem cell toxicity and bacterial elimination in order to determine the appropriate concentrations and medicaments for successful regenerative endodontic procedures., (Published by Elsevier Inc.)

Introduction: Patients without a dentist or access to care may present to emergency rooms with pain. They are often prescribed medications until they can be treated. There are no studies to show if emergency endodontic debridement is better than giving medications during this symptomatic period. The purpose of this prospective, randomized study was to compare debridement versus no debridement on postoperative pain in emergency patients with symptomatic teeth, a pulpal diagnosis of necrosis, and a periapical radiolucency., Methods: Ninety-five patients presenting with moderate to severe pain were analyzed. The patients were randomly divided into 2 groups: group 1 received anesthesia and endodontic debridement, and group 2 received anesthesia but no debridement. At the end of the appointment, all patients were given ibuprofen/acetaminophen. If needed, they could receive an escape medication. Patients received a 5-day diary to record their pain levels and medication taken. Success was defined as no or mild postoperative pain and no use of escape medication. Success data were analyzed using a logistic regression., Results: Both groups had a decrease in postoperative pain and medication use over the 5 days. The debridement group had a significantly higher success rate than the no debridement group. There was no significant difference between the 2 groups with respect to escape drug use., Conclusions: Patients receiving debridement or no debridement had a decrease in postoperative pain over the 5 days. Debridement resulted in a statistically higher success rate, but there was no significant difference in the need for escape medication., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

This review focuses on the current concepts on revascularization/revitalization therapy. Revascularization/revitalization procedures performed under current protocols have reportedly achieved successful clinical and radiographical outcomes for immature permanent teeth with non-vital pulps; however, randomized prospective studies are needed to develop evidence-based methodologies for regenerative endodontic treatment., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: The purpose of the present study was to evaluate and compare the short-term clinical outcomes of direct pulp capping using ProRoot MTA (Dentsply, Tulsa, OK) or Endocem (Maruchi, Wonju, Korea) as capping materials in a prospective randomized controlled study., Materials and Methods: This study was conducted with subjects who were recruited from the pool of patients from the Department of Conservative Dentistry at the Dental College of Yonsei University, Seoul, Korea, between January and May 2013. Of the 48 teeth confirmed to be eligible for direct pulp capping, a total of 46 teeth were randomly assigned to either the ProRoot MTA or the Endocem group (23 teeth per group). Direct pulp capping was performed using these 2 materials, and clinical and radiographic evaluations were performed at 1, 2, 4, and 12 weeks after the treatments. Teeth with no response to pulp vitality test and those exhibiting clinical or radiographic signs and/or symptoms of irreversible pulpitis or pulp necrosis were considered to be failures., Results: Thirty-two patients (43 teeth) were examined at the 3-month follow-up (patient recall rate = 91.4%); 22 of these teeth were in the ProRoot MTA group, and 21 were in the Endocem group. The overall success rate was 93%, and the success rates in the ProRoot MTA and Endocem groups were 95.5% (21/22 teeth) and 90.5% (19/21 teeth), respectively. Statistical analyses of these success rates did not reveal any significant difference between the groups (P = .522)., Conclusions: In this randomized controlled study, no significant difference in the short-term clinical outcomes of direct pulp capping using ProRoot MTA or Endocem as the capping material was found. Furthermore, the favorable short-term outcome success rate of 93% indicates that direct pulp capping may be a reliable treatment for pulp exposure in adult teeth., (Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

A 48-year-old male patient presented to the Department of Endodontics for evaluation of right first permanent molar, which had received non-surgical root canal treatment two years ago and was restored with core material. The presenting symptoms included swelling in the buccal vestibule and pain overnight. Clinical examination demonstrated that the mandibular right first molar was sensitive to percussion and also showed fluctuant swelling in the vestibule proximal to the molar and mild mobility. Radiographic examination revealed a poor quality obturation of the mesial and distal root, distal root resorption, extensive periapical and furcation radiolucency and bone loss. A diagnosis of acute periapical abscess of the mandibular right first molar was made. Tooth was treated non-surgically by the manual application of MTA in the root canal. Follow-up evaluation was performed at one year after the treatment. Clinically, treatment was considered successful due to the absence of clinical signs, symptoms and radiographic appearance with substantial reduction (more than 50%) in the diameter of the periapical radiolucency. Mineral trioxide aggregate monoblock obturation technique appears to be a valid technique to obtain periradicular healing in re-treatment of previously root canal treated teeth with periapical lesion.

Purpose: The purpose of this report was to review an emerging alternative treatment to pulpectomies and extractions for nonvital primary teeth called lesion sterilization and tissue repair (LSTR) and provide the results of three clinical case applications. LSTR is a noninstrumentation endodontic treatment that involves a triantibiotic mixture in a propylene glycol vehicle, which is used to disinfect root canal systems. This concept was developed by the cariology research unit of the School of Dentistry, Niigata University, Niigata, Niigata Prefecture, Japan. This article reviews the development of the technique, clinical procedures required for the technique, three clinical applications and radiographic documentation and follow-up, and a short literature review of the current evidence supporting its application in clinical practice.

Introduction: Pulp necrosis in immature teeth and the resulting periodontal apical inflammation negatively affect root formation. Resolvin E1 (RvE1) is a lipid-derived endogenous pro-resolution molecule that controls inflammation. The aim of this investigation was to evaluate the impact of RvE1 applied as an intracanal medication on root formation in nonvital immature teeth., Methods: To arrest root development, pulpectomy was performed in the lower first molars of 4-week-old Wistar rats. After 3 weeks, irrigation with 2.5% sodium hypochlorite and 0.9% sterile saline was performed, and either a triple antibiotic paste (TAP) or RvE1 in saline was applied into the root canals. In the control group, access openings drilled into molars were left exposed to the oral environment. Root development and periapical repair were evaluated radiographically and histologically at 3 and 6 weeks after treatment., Results: RvE1 reduced periapical lesion size compared with the control at 3 weeks, which was similar to TAP. Inflammatory response in the RvE1-treated group was markedly reduced compared with both TAP and control specimens. At 6 weeks, root development was observed in both groups, but RvE1 treatment produced less cellularity with more regular calcified tissue deposition., Conclusions: RvE1 and TAP had a positive impact on reducing inflammation and promoting root formation. RvE1 was more effective in reducing inflammation at earlier stages. RvE1 has potential to be used as root canal dressing to control inflammation in endodontically compromised teeth before complete root formation. Stability of RvE1 within the root canal and its delivery are issues to be addressed before its clinical use., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Ten patients presented with non-vital immature teeth for root canal treatment. In all these cases the pre-operative clinical examination revealed apical periodontitis with a buccal sinus tract of endodontic origin. These cases were treated by a mineral trioxide aggregate (MTA) monoblock obturation technique. Follow-up evaluations were performed at 1 - 2 years after treatment. Eight out of 10 cases were associated with periradicular healing at follow-up evaluation. Mineral trioxide aggregate Monoblock obturation technique appears to be a valid material to obtain periradicular healing in teeth with open apices and necrotic pulps.

These 3 case reports the outcome of revascularization treatment in necrotic immature molars. During treatment, a tri antibiotic mix was used to disinfect the pulp for 2 weeks. Then a blood clot was created in the canal, over which mineral trioxide aggregate was placed. After 24 months, the immature molars showed continuation of root development. The patients were asymptomatic, no sinus tracts were evident and apical periodontitis was resolved Results from these cases show that revascularization/regeneration using 3Mix-MP method could be effective for managing immature permanent molar teeth with pulpal necrosis.

Introduction: Endodontic treatment of immature permanent teeth with necrotic pulp, with or without apical pathosis, poses several clinical challenges. There is a risk of inducing a dentin wall fracture or extending gutta-percha into the periapical tissue during compaction of the root canal filling. Although the use of calcium hydroxide apexification techniques or the placement of mineral trioxide aggregate as an apical stop has the potential to minimize apical extrusion of filling material, they do little in adding strength to the dentin walls. It is a well-established fact that in reimplanted avulsed immature teeth, revascularization of the pulp followed by continued root development can occur under ideal circumstances. At one time it was believed that revascularization was not possible in immature permanent teeth that were infected., Methods: An in-depth search of the literature was undertaken to review articles concerned with regenerative procedures and revascularization and to glean recommendations regarding the indications, preferred medications, and methods of treatment currently practiced., Results: Disinfection of the root canal and stimulation of residual stem cells can induce formation of new hard tissue on the existing dentin wall and continued root development., Conclusions: Although the outcome of revascularization procedures remains somewhat unpredictable and the clinical management of these teeth is challenging, when successful, they are an improvement to treatment protocols that leave the roots short and the walls of the root canal thin and prone to fracture. They also leave the door open to other methods of treatment in addition to extraction, when they fail to achieve the desired result., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this randomized controlled clinical trial was to investigate the antimicrobial efficacy of traditional positive pressure (PP) irrigation compared with apical negative pressure (ANP) in tapered as well as non-tapered root canal preparation techniques., Method and Materials: Patients referred for treatment of mandibular permanent molars with necrotic pulps and apical periodontitis were considered for this study. A total of 32 eligible teeth were evaluated based on strict inclusion and exclusion criteria and randomly assigned as follows: Group 1: LightSpeed LSX 0.02 preparation and A NP irrigation (n = 8). Group 2: LightSpeed LSX 0.02 preparation and PP irrigation (n = 8). Group 3: ProTaper preparation and A NP irrigation (n = 8). Group 4: ProTaper preparation and PP irrigation (n = 8). A ll teeth were sampled immediately upon access (S1), after completion of the chemo- mechanical preparation (S2), and one week later after intracanal medication (S3). All samples were microbiologically processed immediately and plated in duplicates on aerobic plates, anaerobic plates, and chocolate plates and colonies statistically analyzed., Results: No statistically significant differences were found between groups at S1. When comparing colony-forming unit (CFU) levels at S1 and S2 within groups, the reduction was statistically significant in all groups. While no significant difference was found in the proportion of teeth that culture positive at either S2 or S3 by shaping groups, a significant difference was noted when comparing PP irrigation and A NP groups. The percentage of samples in the PP irrigation group with a negative culture at both time points was 67%, compared to 100% among the A NP group., Conclusion: Within the limitations of the present study, taper and apical size failed to demonstrate a difference in microbiological reduction of cultivable bacteria. On the other hand, A NP revealed a significant difference when compared to PP irrigation.

Aim: The purpose of this study is to evaluate and compare the clinical and radiographic effectiveness of Ciprofloxacin, Minocycline, Metronidazole combination with Ciprofloxacin, Minocycline and Tinidazole combination when used for Lesion Sterilization and Tissue Repair in primary teeth., Method: 25 healthy children, visiting Dept. of Pediatric & Preventive Dentistry, D.A.P.M.R.V. Dental College, Bangalore, India, aged between 6-9 years who were having 30 infected primary teeth are selected and divided into 2 groups. In Group A, a mixture of 3mix-MP Ciprofloxacin, Metronidazole and Minocycline was placed on the floor of the pulp chamber covering the root canal orifices. In Group B a mixture of Ciprofloxacin, Tinidazole and Minocycline was placed as a layer on the floor of the pulp chamber. The procedure was completed in a single visit. Post operative clinical evaluation was done after 1,6,12 and 24 months. Postoperative radiographic evaluation was done at 6, 12 and 24 months., Results: No statistically significant difference is observed between both the groups and a combination of Ciprofloxacin, Minocycline and Tinidazole antibacterial drugs can be used on teeth pulpally involved with physiologic root resorption., Conclusion: After a 24 Month follow up, we can conclude that primary teeth with the periradicular lesions, can be conserved by using combination of Ciprofloxacin, Minocycline and Tinidazole antibacterial drugs.

Introduction: The use of calcium hydroxide is an effective step in killing bacteria that remain after cleaning and shaping procedures. It also induces hard-tissue formation and is effective for stopping inflammatory exudates., Methods: The aim of this study was to assay and to compare the influence of calcium hydroxide on periapical interstitial fluid from human root canals. The mRNA expression levels of the cytokines interferon (IFN)-γ, tumor necrosis factor-α, interleukin (IL)-1β, IL-17A, and IL-10 as well as the chemokine MCP-1 were assayed by real-time polymerase chain reaction immediately after root canal cleaning and 15 days later., Results: Levels of IL-1β, IFN-γ, IL-10, and the chemokine CCL2/MCP-1 were increased in teeth without endodontic dressings. With calcium hydroxide interappointment dressings, no statistically significant changes were observed in cytokine mRNA expression. However, when comparing teeth that received the medication with those that did not, expression levels of IL-1β, IFN-γ, and IL-10 were statistically lower in those teeth that received calcium hydroxide., Conclusions: Analyses of cytokines and the chemokine CCL-2/MCP-1 demonstrated the benefits of calcium hydroxide as a root canal dressing because it impedes the increase of all mediators during the experimental time., (Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: Perception of midline diastema differs among individuals and cultures. To some, it is a feature of beauty, while to others it is aesthetically appalling. From a scientific point of view, midline diastema is a deviation from normal adult dentition. It is not uncommon among some African natives to find individuals demanding for artificially created midline diastema from dental practitioners., Objective: To present a rare case of pulpal necrosis involving maxillary and mandibular central incisors as a result of poorly executed teeth modification in a bid to create upper and lower midline diastemata., Result: A 23-year old lady presented with history of spontaneous, sharp, persistent pain associated with palatal swelling and discharging sinus of two weeks duration in relation to maxillary central incisors (11, 21). The complaint was preceded by a history of recurrent pain in relation to 11, 21, 31 and 41 which started soon after obtaining artificially created maxillary and mandibular midline diastemata from a dental quack. Periapical x-ray revealed periapical radiolucency in relation to 21 and 41. Vitality test confirmed necrotic pulp in the lower central incisors. The affected teeth were scheduled for root canal therapy (RCT) and porcelain fused to metal crown. The RCT of 11 and 21 had been completed but further treatment stalled due to financial constraint., Conclusion: This is a case of obsession for midline diastema, poor dental health education, and illegal dental practice.

Introduction: The present study aimed at developing an experimental model in rat molars for evaluating treatment strategies in necrotic immature teeth., Methods: To define the periods to be adopted in the experimental procedures and to confirm induction of periapical lesions and interruption of root embryogenesis, the left lower first molars of 4-weeks-old Wistar rats underwent pulpectomy and were left open to the oral environment. Comparisons with the right lower first molars (vital teeth) were performed in animals with ages of 7, 10, 13, and 16 weeks. In another group of animals the teeth were left open for 3 weeks, and then interventions for disinfection including the use of an antibiotic paste were carried out. Root formation was then assessed after 3 and 6 weeks on the basis of radiographic and histologic evaluation., Results: Vital teeth showed increase of root length and hard tissue thickness throughout the experimental periods. On the other hand, induction of necrosis arrested root formation. Teeth subjected to disinfection with sodium hypochlorite associated with the triple antibiotic paste showed significant reduction of periapical lesions, gain in root length, and increased wall thickness compared with the control (P < .05)., Conclusions: The root canal disinfection protocol used was able to reduce periapical lesion size and improve root development. The experimental model presented should contribute to studies that aim at improving therapeutic strategies for necrotic immature teeth by using a rat model., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Dental pulp has intrinsic capacity for self-repair. However, it is not clear whether dental pulp cells can be recruited endogenously for regenerating pulp tissues, including mineralizing into dentin. This work is based on a hypothesis that dental pulp stem/progenitor cells can be induced to migrate by chemotactic cytokines and act as endogenous cell sources for regeneration and mineralization. Dental stem cells (DSCs) were isolated from adult human tooth pulp and seeded on the surfaces of 3D collagen gel cylinders that were incubated in chemically defined media with stromal-derived factor-1α (SDF1), basic fibroblast growth factor (bFGF), or bone morphogenetic protein-7 (BMP7). Significantly more cells were recruited into collagen gel by SDF1 or bFGF than without cytokines in 7 days, whereas BMP7 had little effect on cell recruitment. BMP7, however, was highly effective, equally to dexamethasone, in orchestrating mineralization of cultured DSCs. Cell membrane receptors for SDF1, bFGF, and BMP7 were up-regulated in treated DSCs. Upon in vivo delivery, bFGF induced re-cellularization and re-vascularization in endodontically treated human teeth implanted into the dorsum of rats. Thus, endogenous dental pulp cells, including stem/progenitor cells, may be recruited and subsequently differentiated by chemotaxis of selective cytokines in the regeneration of dental pulp.

Background: A paradigm shift in the treatment of immature, necrotic teeth has occurred with biologically-based principles and regenerative endodontic protocols replacing traditional 'apexification' procedures. Preliminary research suggests that stem and progenitor cells from the pulp and/or periodontium contribute to continued root development when regenerative procedures are followed., Methods: A mandibular premolar tooth with a chronic periapical abscess was irrigated with sodium hypochlorite with minimal instrumentation and then dressed with tri-antibiotic paste consisting of ciprofloxacin, metronidazole and amoxicillin. At a subsequent visit a blood clot was evoked in the canal by irritating periapical tissues and the canal sealed with mineral trioxide aggregate, glass ionomer cement and composite resin., Results: Resolution of apical periodontitis and the draining sinus, continued root maturation and apical closure occurred over an 18-month period. The tooth became responsive to pulp sensibility testing., Conclusions: It is important that dentists recognize the potential of regenerative endodontics in the treatment of necrotic, immature teeth. Initial management should involve irrigation with sodium hypochlorite only. Intra-canal medicaments, such as calcium hydroxide, are contraindicated as they inhibit further root growth. This report uses a variation of the tri-antibiotic paste currently recommended for regenerative procedures that avoided the discolouration of the crown associated with current protocols. Regenerative endodontics with continued root growth may reduce the risk of fracture and premature tooth loss associated with traditional 'apexification' procedures where the root remains thin and weak., (© 2010 Australian Dental Association.)

Purpose: To study the evolution of 308 necrotic primary teeth after pulpectomy technique with resorbable paste (Kri-1 + calcium hydroxide + metacresol-formaldehyde) after 30 months., Methods: 134 children between 2-9 years were included, among which they had 348 pulpectomized teeth. Out of these 348 teeth, 308 had necrotic pulp and were included in the study. The filling material consisted of a paste based on Walkhoff's master formula and consisted of the combination of Kri-1a (80.8% iodoform, 2.025% parachlorophenol, 1.215% menthol, 4.68% camphor and excipient 15 mg), pure calcium hydroxide and metacresol formaldehyde (metacresol 20 mg, formaldehyde 20 mg, eugenol 20 mg, eucalyptus 6 mg and excipient 40 mg). Root canal filling was performed in one session by one operator., Results: Pain, swelling, and fistula resolution was observed in most cases at the first recall. Progressive remission of radiolucent areas was also observed. A relationship between fistula and radiolucency in pre-treated furcation area was observed, and, in some cases, premature eruption of permanent teeth was recorded. Only two cases out of 308 treated teeth required extraction.

Introduction: A triple antibiotic mixture of ciprofloxacin, metronidazole, and minocycline was used as an intracanal medicament in an attempt to disinfect the root canal system for revascularization of a tooth with a necrotic pulp. However, discoloration developed after applying the triple antibiotic mixture., Methods: Six weeks after a triple antibiotic paste had been applied to the root canal of tooth #8 of a 7-year-old girl, the tooth showed a dark discoloration. An in vitro experiment with human extracted teeth was performed to determine which of the 3 antibiotics caused the tooth discoloration. Another experiment was then carried out to examine whether a currently used dentin bonding agent would prevent or reduce such discoloration. The degree of discoloration was assessed by using a colorimeter., Results: Among the components of the triple antibiotic paste, only minocycline caused the tooth discoloration. Moreover, the dentin bonding agent reduced the intensity of the discoloration but did not prevent it., Conclusions: The possible esthetic problems with the tooth color should be considered when using minocycline as a canal medication., (Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to compare the clinical and radiographic success of 3Mix and Vitapex((R)) for root canal treatment of pulpally involved primary molars., Methods: Fifty teeth from 37 healthy children aged 3-8 years with pulpally involved primary molars needing root canal procedures were treated with 3Mix or Vitapex((R)) before restoration with stainless steel crowns. The research employed a prospective single-blinded randomized design. The subjects were followed up clinically and radiographically at 6 and 12 months, respectively. The outcome was compared using a Z-test with a significance level of 0.05., Results: Both groups showed 100% and 96% clinical success at 6 and 12 months, respectively. At 6 months, radiographic success of 3Mix and Vitapex((R)) was 84% and 80%, respectively, and at 12 months, radiographic success of 3Mix and Vitapex((R)) was 76% and 56%, respectively. Considering the radiographic findings at the end of 6 and 12 months, no statistically significant differences were found between the two groups (P = 0.356 and 0.068, respectively)., Conclusion: 3Mix and Vitapex((R)) can be used as a root canal treatment agent in pulpally involved primary teeth.

Aim: To identify antibiotic prescription practices in the treatment of endodontic infections amongst Spanish oral surgeons., Methodology: Members of the Spanish Oral Surgery Society (SECIB) were surveyed on antibiotic prescription on six different pulpal and periapical diagnoses. A total of 200 questionnaires were delivered with 127 returned (64%)., Results: The average duration of antibiotic therapy was 7.0 +/- 1.0 days. Ninety five percent of respondents selected amoxicillin as the first choice antibiotic in patients with no medical allergies, alone (34%) or associated to clavulanate (61%). The first drug of choice for patients with an allergy to penicillins was clindamycin 300 mg (65%), followed by azithromycin (15%) and metronidazole-spiramycin (13%). For cases of irreversible pulpitis, 86% of respondents prescribed antibiotics. For the scenario of a necrotic pulp, acute apical periodontitis and no swelling, 71% prescribed antibiotics. Almost 60% of respondents prescribed antibiotics for necrotic pulps with chronic apical periodontitis and a sinus tract; in this clinical situation, odontologists prescribed more frequently antibiotics compared to stomatologists (P = 0.0080; odds ratio = 8.0; C. I. 95% = 1.7-37.1)., Conclusions: The majority of the members of the SECIB were selecting the appropriate antibiotic for use in endodontic infections, but there are still many who are prescribing antibiotics inappropriately. The use of antibiotics for minor infections, or in some cases in patients without infections, could be a major contributor to the world problem of antimicrobial resistance.

Aim: To describe a case in which a mandibular right second premolar with a necrotic pulp, sinus tract, periradicular radiolucency and an immature apex underwent revascularization via a single treatment approach., Summary: Revascularization procedures have the potential to heal a partially necrotic pulp, which can be beneficial for the continued root development of immature teeth. However, it is not clear which revascularization protocols are the most effective. This case report details the outcome of a successful revascularization procedure on tooth 45 (FDI) in a 12-year-old patient, eliminating the associated periapical pathosis within 19 months. The tooth was treated using coronal root irrigation with 6% NaOCl and 2% chlorhexidine without instrumentation in a single visit. The successful outcome of this case report suggests that this conservative revascularization treatment approach can preserve the vitality of the dental pulp stem cells and create a suitable environment for pulp regeneration, resulting in the completion of root maturation., Key Learning Points: The noninstrumentation procedure using 6% NaOCl and 2% chlorhexidine coronal irrigation may help preserve the remaining vital dental pulp stem cells believed to be critical for pulp revascularization. A single visit pulp revascularization protocol can be a favourable treatment option for an immature permanent tooth with a partially necrotic pulp.

Introduction: The purpose of this study was to determine the prescribing habits of active members of the Spanish Endodontic Society (AEDE) with regard to antibiotics., Methods: A one-page questionnaire was sent to the active members of the AEDE. Of the 508 surveys mailed, 158 surveys were returned, and 140 were found to be usable. The overall response rate was 31.1%. The data were analyzed by using descriptive statistics and chi-square tests of independence., Results: The average duration of antibiotic therapy was 6.8 +/- 1.8 days. In patients with no medical allergies, most of the responders (86.1%) selected amoxicillin as the first-choice antibiotic, alone (44.3%) or associated with clavulanate (41.8%); metronidazole-spiramycin and clindamycin were prescribed by 7.6% and 3.7% of the respondents. The first drug of choice for patients with an allergy to penicillins was clindamycin 300 mg (63.2%) followed by metronidazole-spiramycin (23.7%). For cases of irreversible pulpitis, 40.0% of respondents prescribed antibiotics. For the scenario of a necrotic pulp, acute apical periodontitis, and no swelling, 52.9% prescribed antibiotics. Almost 21.5% prescribed antibiotics for necrotic pulps with chronic apical periodontitis and a sinus tract., Conclusions: For the most part, the majority of the members of the AEDE were selecting the appropriate antibiotic for use in orofacial infections, but there are still many who are prescribing antibiotics inappropriately. The use of antibiotics for minor infections, or in some cases in patients without infections, could be a major contributor to the world problem of antimicrobial resistance.

The purpose of this study was to evaluate photodynamic therapy in deciduous teeth with necrotic pulp by means of fully quantifying viable bacteria, before and after instrumentation and after the use of photodynamic therapy. Radicular canal cultures were conducted (n = 10): the first one was performed right after access and location of the radicular canal; the second was performed after the conclusion of chemical-mechanical instrumentation, and the last one after photodynamic therapy. The photodynamic therapy was performed with 4 J/cm energy low-intensity diode together with toluidine blue. The results (log(10)) were submitted to a descriptive analysis and Wilcoxon test. The percentage of reduction was submitted to the Mann-Whitney test. The instrumentation resulted in a reduction of 82.59% of viable bacteria, and, after photodynamic therapy, the microbial reduction observed was 98.37% (P = 0.0126). Photodynamic therapy is recommended as adjunct therapy for microbial reduction in deciduous teeth with necrotic pulp.

Antibiotics are an extremely valuable addition to the armamentarium available to health practitioners for management of bacterial infections. Due to the potential risk of adverse systemic effects of systemic applications and ineffectiveness of systemic antibiotics in the necrotic pulpless tooth and the periradicular tissues, local application of antibiotics may be a more effective mode for delivering antibiotics to infected root canals. This paper reviews the history, rationale, and applications of antibiotics and antibiotics-containing medicaments in endodontics.

This case series reports the outcomes of 8 patients (ages 9-14 years) who presented with 9 immature permanent teeth with pulpal necrosis and apical periodontitis. During treatment, 5 of the teeth were found to have at least some residual vital tissue remaining in the root canal systems. After NaOCl irrigation and medication with ciprofloxacin, metronidazole, and minocycline, these teeth were sealed with mineral trioxide aggregate and restored. The other group of 4 teeth had no evidence of any residual vital pulp tissue. This second group of teeth was treated with NaOCl irrigation and medicated with ciprofloxacin, metronidazole, and minocycline followed by a revascularization procedure adopted from the trauma literature (bleeding evoked to form an intracanal blood clot). In both groups of patients, there was evidence of satisfactory postoperative clinical outcomes (1-5 years); the patients were asymptomatic, no sinus tracts were evident, apical periodontitis was resolved, and there was radiographic evidence of continuing thickness of dentinal walls, apical closure, or increased root length.

Aim: To examine the effect of recombinant granulocyte colony-stimulating factor (G-CSF) on the number and function of neutrophils and on the histopathology of pulpal inflammation in normal and neutropenic rats., Methodology: The effect of G-CSF on changes in pulpal tissue was investigated at 2, 4, 7, and 10 days after pulpal exposure of the mandibular first molar of normal rats and of those with methotrexate-induced neutropenia. The area of pulpal necrosis was measured. The neutrophil count in peripheral blood was determined, and their phagocytosis and chemotactic reaction were also examined. Statistical significance was examined by use of the two way analysis of variance., Results: In untreated rats, G-CSF significantly (P < 0.05) increased the number of peripheral neutrophils and their chemotactic reaction, but did not affect pulpal inflammation. In methotrexate-induced neutropenic rats, the phagocytosis and migration of neutrophils reduced, and the area of pulpal necrosis enlarged. After the G-CSF injection, the decreases in neutrophil count and their functions significantly (P < 0.05) reversed, and the enlargement of pulpal necrosis inhibited., Conclusions: These findings indicate that G-CSF prevented the reduction in neutrophil function and reduced the pulpal necrosis observed in the neutropenic rats, and suggest that neutrophils defend against bacterial invasion in pulpal tissue.

We investigated the photodynamic effects of methylene blue on multispecies root canal biofilms comprising Actinomyces israelii, Fusobacterium nucleatum subspecies nucleatum, Porphyromonas gingivalis, and Prevotella intermedia in experimentally infected root canals of extracted human teeth in vitro. The 4 test microorganisms were detected in root canals by using DNA probes. Scanning electron microscopy showed the presence of biofilms in root canals before therapy. Root canal systems were incubated with methylene blue (25 microg/mL) for 10 minutes followed by exposure to red light at 665 nm with an energy fluence of 30 J/cm(2). Light was delivered from a diode laser via a 250-microm diameter polymethyl methacrylate optical fiber that uniformly distributed light over 360 degrees. Photodynamic therapy (PDT) achieved up to 80% reduction of colony-forming unit counts. We concluded that PDT can be an effective adjunct to standard endodontic antimicrobial treatment when the PDT parameters are optimized.

This study analyzed the antimicrobial effect of photodynamic therapy (PDT) in association with endodontic treatment. Twenty patients were selected. Microbiological samples were taken after accessing the canal, endodontic therapy, and PDT. At the end of the first session, the root canal was filled with Ca(OH)(2), and after 1 week, a second session of the therapies was performed. Endodontic therapy gave a mean reduction of 1.08 log. The combination with PDT significantly enhanced the reduction (1.83 log, p = 0.00002). The second endodontic session gave a similar diminution to the first (1.14 log), and the second PDT was significantly more effective than the first (p = 0.002). The second total reduction was significantly higher than the second endodontic therapy (p = 0.0000005). The total first + second reduction (3.19 log) was significantly different from the first combination (p = 0.00006). Results suggest that the use of PDT added to endodontic treatment leads to an enhanced decrease of bacterial load and may be an appropriate approach for the treatment of oral infections.

Background and Objectives: The purpose of this study was to evaluate clinical and radiographic success of endodontic treatment of infected primary teeth using combination of ciprofloxacin, metronidazole, and minocycline., Materials and Methods: The treatment was performed on selected 60 teeth, which were randomly divided into two groups, viz. Group A and B with 30 teeth in each group. In Group A, only the necrotic coronal pulp was removed, whereas in Group B both necrotic coronal as well as all accessible radicular pulp tissue was extirpated. The orifice of the canal was enlarged in both the groups and was termed as "Medication cavity." The medication cavity was half-filled with antibacterial mix, sealed with glass-ionomer cement and reinforced with composite resin. Resolution of clinical signs and symptoms was evaluated within a month after the treatment. At every subsequent visit, clinical and radiographic evaluation was done once in 6 months for a period of one year., Results: Both the groups showed considerable clinical and radiographic success, but Group B showed greater clinical and radiographic success than Group A.

Objective: To evaluate the outcome of 1-(OH) vitamin D and oral phosphate treatment on dentin structure in patients with familial hypophosphatemic rickets, and expression of SIBLINGs (a family of non-collagenous proteins involved in dentinogenesis) and osteocalcin., Patients and Methods: Seven patients with familial hypophosphatemic rickets (age 3-16 years) were studied before or during treatment. Deciduous and permanent teeth were prepared for scanning electron microscopy (SEM) analysis and immunohistochemistry., Results: Untreated or inadequately treated patients had necrotic teeth with impaired dentin mineralization including unmerged calcospherites and accumulation of non-collagenous proteins in wide interglobular spaces. Most of the primary incisors analyzed displayed fissures linking enamel subsurface to pulp horn. These elements may explain the bacterial penetration and dental abscesses despite the absence of carious lesions. Well-treated patients had healthy teeth with good dentin mineralization and little evidence of calcospherites., Conclusion: Treatment of hypophosphatemic children with 1-(OH) vitamin D and oral phosphate insures good dentin development and mineralization, and prevents clinical anomalies such as the dental necrosis classically associated with the disease. Starting treatment during early childhood and good adherence to the therapy are mandatory to observe these beneficial effects.

Aim: The efficacy of antibiotic prophylaxis before endodontic treatment of necrotic teeth in the prevention of post-treatment flare-up pain and swelling was evaluated., Methods: A total of 47 teeth with diagnosis of pulpal necrosis were selected in 39 patients, independently from the pre-operative symptomatology (painful or asymptomatic). Teeth were randomly divided into 2 groups. The first group (n=23) was given an antibiotic prophylaxis with 2 g amoxicillin 1 h before every appointment; the second group (n=24) did not receive any treatment (control group). The endodontic therapy was performed by shaping canals using the crown-down technique with hand devices, 5% sodium hypochlorite irrigations and 2 intermediate medications with Ca(OH)(2). Obturation was performed using randomly the vertical obturation technique or the no-stop wave technique. At the end of each appointment a questionnaire was given to each patient. The patient had to indicate if pain (absent, light, mild, severe) or swelling were present at 4, 8, 12, 24 h after every appointment. Data were statistically analysed with the Mann-Whitney, Wilcoxon and chi2 test., Results: Only a case of flare-up pain and swelling was found in a patient of the study group. The statistical analysis showed that there were no significant differences between the 2 groups., Conclusions: An accurate endodontic treatment of necrotic canals is sufficient to guarantee an adequate control of post-treatment pain, with no need of antibiotic prophylaxis.