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Pulp necrosis is the most common complication following dental trauma and is often associated with apical periodontitis. The management of these teeth is challenging in terms of large root canals, open apices, thin dentinal walls, and short roots. Over decades the conventional treatment for these teeth was calcium hydroxide apexification, a time‐consuming procedure despite high success rates. Subsequently after the introduction of mineral trioxide aggregate and hydraulic calcium silicate materials single visit apical plug procedures became increasingly practiced with comparable success rates to the conventional apexification. The search continued afterward for a clinical procedure that may stimulate further root development and apical closure to avoid the long‐term complication of root fracture after apexification. Regenerative procedures using stem cells derived from the apical papilla and blood clots as scaffolds were then introduced for the management of immature teeth, with variable protocols and success rates. This review will cover the evidence available and current position of regenerative endodontic procedures in traumatized immature teeth with apical periodontitis, in terms of clinical protocols, outcome, and potential prognostic factors. [ABSTRACT FROM AUTHOR]

Regional odontodysplasia (ROD) is a rare developmental disorder characterized by hypo-mineralization and hypoplasia of enamel and dentin. Symptoms include poorly developed tooth buds, delayed eruption of permanent teeth in affected quadrants, and ghost teeth. The affected teeth often become necrotic due to abnormal enamel and dentin development, making them susceptible to caries and infection. The aim of this case report is to describe the treatment of ROD through pulp revascularization. A 13-year-old girl was referred for endodontic treatment. The mandibular left incisors and first premolar, which were affected by regional odontodysplasia, lost their vitality because of the impaired structure of the enamel. Due to the teeth's early developmental stage, a regenerative endodontic treatment was attempted. All 3 teeth were treated using the same protocol following the AAE guidelines. After 4 weeks, treatment of the premolar was completed, whereas the incisor teeth remained symptomatic and were and therefore, intracanal dressing with calcium hydroxide was repeated and left in place for 5 months. Finally, the regenerative procedure was completed, and the crowns were restored. The patient was scheduled for follow-up examinations after 6 months, and then yearly for the next 3 years. After 1 year, the periapical lesion around the central incisor and premolar had resolved, the lesion around the apex of the lateral incisor was healing, and the roots had continued to develop. After 3 years, complete healing and pulp canal obliteration were observed in the central incisor and in the premolar. However, the root of the lateral incisor tooth was split, and it was recommended to extract this tooth. The positive outcomes of regenerative endodontics in the central incisor and premolar suggest that revascularization of the pulp may be optional for the treatment of immature necrotic teeth affected by developmental disorders, such as ROD, amelogenesis imperfecta, or dentinogenesis imperfecta. [ABSTRACT FROM AUTHOR]

Aim: Diabetes mellitus (DM) affects an estimated 100 million Indians, ranking second globally in diabetic prevalence. Despite this, the correlation between DM and specific pulpal diagnoses remains underexplored. This study compares pulpal conditions in DM patients and nondiabetic controls. Designs: The study was started after taking ethical approval. Subjects and Methods: Two thousand and five hundred and sixty teeth were examined over 4 months at the institute, evenly distributed between diabetic and nondiabetic cases, we assessed diagnoses - normal pulp, reversible pulpitis (RP), symptomatic irreversible pulpitis, asymptomatic irreversible pulpitis, pulp necrosis (PN), missing teeth (MT), and root canal-treated teeth (RCT). Statistical analysis used the Chi-square test. Results: PN and MT prevalence in DM patients significantly exceeded the control group. Conversely, the control group showed higher RP prevalence in the older subgroup. Conclusions: PN prevalence was higher in diabetics, suggesting reduced pulp sensitivity in individuals over 60 years. This diminished sensitivity might lead to delayed dental treatment, increasing PN prevalence. [ABSTRACT FROM AUTHOR]

Pulp necrosis is diagnosed when the pulp is presented asymptomatic in response to pulp tests. Its conventional management in immature permanent teeth is by apexification. However, this treatment has the disadvantage of weakening the root walls tending to root fracture and pulp does not present revitalization. Due to that, the use of regenerative endodontic treatment has been recommended and it aims to regenerate the dentin-pulp complex, in addition to root growth, maturation and apical closure through cell replacement within the root tissue using stem cells and growth factors. Cloth formation is used as a scaffold for stem cells from the apical papilla to stimulate tissue regeneration. The aim of this review is to synthesize the available information about this treatment and to contribute to the possibility of the creation of a protocol consensus of this treatment.

Background/Aims: Dental trauma resulting in tooth intrusion is a severe injury of permanent dentition, with a prevalence of 0.5%–1.9% among traumatic dental injuries. Currently, treatment guidelines for intruded permanent teeth depend on root development and the degree of intrusion. However, the categorization of tooth maturity as mature or immature simplifies a complex continuum of root development stages. This study aims to investigate the impact of various stages of root development on the success of spontaneous re‐eruption (SRE) of intruded teeth. Materials and Methods: This retrospective study analysed data from 80 children (125 teeth) aged 6–12 years who experienced dental intrusion between 2018 and 2022. Root maturation was classified based on Cvek's classification, eight were categorized as stage 1, 29 as stage 2, 44 as stage 3, 25 as stage 4, and 19 as stage 5. Intruded teeth with immature roots (Cvek's class 1–4) underwent SRE, while mature teeth (Cvek's class 5) were treated with SRE, orthodontic repositioning, or surgical repositioning based on the degree of intrusion. Primary outcome measures were successful re‐eruption and secondary outcomes included observed complications during follow‐up. Results: Regression analysis revealed that the patient's age, degree of root maturation, and degree of intrusion significantly affected spontaneous re‐eruption (p <.05). SRE was more successful in teeth with Cvek's stages 1 and 2 compared to stages 3 and 4. Complications were associated with the treatment method, degree of root immaturity, and degree of intrusion. Conclusion: The study demonstrates that as root maturation progresses, the likelihood of re‐eruption decreases, and the risk of pulp necrosis and infection increases. Therefore, teeth in later stages of immaturity (Cvek stage 4) should be repositioned orthodontically or surgically without waiting for spontaneous re‐eruption. [ABSTRACT FROM AUTHOR]

Aim: The purpose of the present study was to evaluate permanent teeth with post-traumatic transversal root fractures, for their initial healing modality, the effect of candidate predictors and their long-term prognosis. Methodology: A retrospective longitudinal clinical study was conducted to evaluate records from patients bearing transversal root fractures in permanent teeth in order to radiographically assess short-term healing and non-healing events in the fracture line, their prognostic factors and their relationship with long term outcomes. The inter-fragmentary tissues were classified as healing: hard tissue (HT), connective tissue (CT) or connective tissue and bone (CT + B) and non-healing: interposition of granulation tissue (GT). A competing risk survival analysis was conducted to estimate the hazards of healing and non-healing events in the short-term and the effect of demographic, clinical, and treatment variables was assessed using the subdistribution regression model (Fine & Gray). Results: Radiographic findings showed 61.4% of healing in the short-term being strongly influenced by the presence and type of concomitant injuries to the coronal fragment. Teeth with concomitant crown fractures (sHR 24.38, 95% CI [3.16–188.3], p = 0.0022), luxations with dislocations (sHR 10.58, 95% CI [1.37–81.9], p = 0.0240) and subluxations (HR 9.66, 95% CI [1.14–81.7], p = 0.0370) were more likely to present non-healing of root fractures in the short-term. The healing rate in the long-term was of 75.9%, most of them with interposition of bone and connective tissue. Kappa statistics demonstrated an overall agreement of 67.1% between short and long-term healing patterns, in special HT and CT + Bone modalities. Conclusion: Healing at the fracture site was the most frequent outcome, both in the short-term and in the long-term. Short-term healing modality was strongly influenced by the presence and type of concomitant injuries to the crown fragment, being the worst prognosis observed in root-fractured teeth with concomitant crown fractures, followed by concomitant luxations with dislocation. Clinical relevance: Post-traumatic transversal root fractures have a positive prognosis supporting therefore, a more conservative approach for these teeth before considering more radical treatments. [ABSTRACT FROM AUTHOR]

Abstract Background In the regenerative endodontic procedures, scaffolds could influence the prognosis of affected teeth. Currently, there is controversy regarding the postoperative evaluation of various scaffolds for pulp regeneration. The objective of this study was to access whether other scaffolds, used alone or in combination with blood clot (BC), are more effective than BC in regenerative endodontic procedures. Methods We systematically search the PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Google Scholar databases. Randomized controlled trials examining the use of BC and other scaffold materials in the regenerative endodontic procedures were included. A random effects model was used for the meta-analysis. The GRADE method was used to determine the quality of the evidence. Results We screened 168 RCTs related to young permanent tooth pulp necrosis through electronic and manual retrieval. A total of 28 RCTs were related to regenerative endodontic procedures. Ultimately, 12 articles met the inclusion criteria and were included in the relevant meta-analysis. Only 2 studies were assessed to have a low risk of bias. High quality evidence indicated that there was no statistically significant difference in the success rate between the two groups (RR=0.99, 95% CI=0.96 to 1.03; 434 participants, 12 studies); low-quality evidence indicated that there was no statistically significant difference in the increase in root length or root canal wall thickness between the two groups. Medium quality evidence indicated that there was no statistically significant difference in pulp vitality testing between the two groups. Conclusions For clinical regenerative endodontic procedures, the most commonly used scaffolds include BC, PRP, and PRF. All the different scaffolds had fairly high clinical success rates, and the difference was not significant. For regenerative endodontic procedures involving young permanent teeth with pulp necrosis, clinical practitioners could choose a reasonable scaffold considering the conditions of the equipment and patients.

Background: In the regenerative endodontic procedures, scaffolds could influence the prognosis of affected teeth. Currently, there is controversy regarding the postoperative evaluation of various scaffolds for pulp regeneration. The objective of this study was to access whether other scaffolds, used alone or in combination with blood clot (BC), are more effective than BC in regenerative endodontic procedures. Methods: We systematically search the PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Google Scholar databases. Randomized controlled trials examining the use of BC and other scaffold materials in the regenerative endodontic procedures were included. A random effects model was used for the meta-analysis. The GRADE method was used to determine the quality of the evidence. Results: We screened 168 RCTs related to young permanent tooth pulp necrosis through electronic and manual retrieval. A total of 28 RCTs were related to regenerative endodontic procedures. Ultimately, 12 articles met the inclusion criteria and were included in the relevant meta-analysis. Only 2 studies were assessed to have a low risk of bias. High quality evidence indicated that there was no statistically significant difference in the success rate between the two groups (RR=0.99, 95% CI=0.96 to 1.03; 434 participants, 12 studies); low-quality evidence indicated that there was no statistically significant difference in the increase in root length or root canal wall thickness between the two groups. Medium quality evidence indicated that there was no statistically significant difference in pulp vitality testing between the two groups. Conclusions: For clinical regenerative endodontic procedures, the most commonly used scaffolds include BC, PRP, and PRF. All the different scaffolds had fairly high clinical success rates, and the difference was not significant. For regenerative endodontic procedures involving young permanent teeth with pulp necrosis, clinical practitioners could choose a reasonable scaffold considering the conditions of the equipment and patients. [ABSTRACT FROM AUTHOR]

Aim: The present retrospective cohort study aimed to evaluate luxated permanent teeth for pulp prognosis and risk factors. Methodology: Case records and radiographs of 224 patients, involving 427 luxated permanent teeth, referred for treatment at the Dental Trauma Center–School of Dentistry, Universidade Federal de Minas Gerais, (DTC-SD–UFMG) from 2014 to 2022, were assessed for pulp prognosis classified as vitality, necrosis and pulp canal obliteration (PCO). A competing risk survival analysis estimated the hazards of the three outcomes, and the effect of demographic, clinical and treatment variables was tested using a cause specific Cox regression model. Results: Pulp vitality was found in163 teeth (38.2%), pulp necrosis in 120 teeth (28.1%) and 55 teeth (12.9%) developed PCO. Pulp vitality decreased in the presence of concomitant crown fractures (HR 0.38 95% CI [0.2–0.8] p = 0.006). The risk of pulp necrosis (HR 0.62 95% CI [0.4–0.96] p = 0.03) was lower in cases with open apices but increased with concomitant crown fractures (HR 4.0 95% CI [2.6–6.1] p = 0.001) and intrusions (HR 2.3 95% CI [1.2–4.1] p = 0.007). Lateral or extrusive luxations (HR 3.0 95% CI [1.3–6.9] p = 0.001) and open apices (HR 2.4 95% CI [1.2–4.7] p = 0.01) showed higher rates of PCO. Conclusion: Type of luxation, the diameter of the apical foramen, and the presence of concomitant crown fractures were main determinants of pulp prognosis after luxation injuries in permanent teeth. Clinical relevance: Pulp prognosis after tooth luxation is dependent on the presence and direction of tooth displacement together with infection control. Clinical trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to compare the adverse effects that occur after orthodontic extrusion of teeth that have been traumatically intruded with those of similar teeth that have not experienced any trauma. Background: The outcome of incisors intrusion can be affected by the patient's age, extent of injury, root development, and malocclusion. Orthodontic extrusion is a potential solution, but it may also cause complications. Materials and Methods: A retrospective study of the effects of extrusion of traumatically intruded teeth was carried out. The study group included 21 teeth in 14 patients. The control group included 32 teeth in 10 patients that underwent orthodontic extrusion with no history of trauma. Patients' age, gender, and stage of root development were recorded. The severity of the intrusion was classified as mild (<3 mm), moderate (3‐6 mm), and severe (≥7 mm). A comparison of signs of pulp necrosis and root resorptions between the groups was made. Results: The central incisor is the tooth that is most injured in 80.9% of cases. A majority of these incidents involve severe intrusion, which was found in 42.9% of cases. 90% of the traumatized teeth had already lost their vitality prior to orthodontic treatment. Various forms of root resorption were observed in the study group. In the control group, 31.2% of teeth showed signs of external root resorption, but no endodontic intervention was carried out during the follow‐up period, as these teeth remained vital. Conclusions: Following intrusion, there is a high risk for root resorption and pulp necrosis. Orthodontic repositioning should be carried out with caution and mild force to prevent complications. Long‐term follow‐ups are required to ensure the best possible outcome. [ABSTRACT FROM AUTHOR]

Background: Regenerative endodontic procedures (REPs) have emerged as a promising treatment option for young permanent teeth with pulp necrosis, offering the potential for tissue repair and preservation. Materials and Methods: A retrospective analysis was conducted on a cohort of 30 patients aged 8 to 16 years with pulp necrosis in young permanent teeth. The patients underwent REPs, including disinfection, triple antibiotic paste application, and a coronal barrier. Clinical and radiographic data were collected at baseline and follow-up appointments at 6, 12, and 24 months. Radiographs were analyzed for root lengthening, apical closure, and resolution of periapical lesions. Results: The mean increase in root length after 24 months was 3.42 mm (SD ± 1.12 mm), and 90% of cases demonstrated complete apical closure. The overall success rate, defined as the absence of clinical symptoms and radiographic evidence of pathology, was 80%. Conclusion: REPs show promising outcomes in young permanent teeth with pulp necrosis, promoting root development, and apical closure.

The extrusion of bacteria from infected root canals may lead to increase in symptoms, expansion of periapical lesions, and contribution to systemic diseases. The aim of this study is to investigate a potential proof-of-concept model to study the extent to which bacteria can escape from infected root canals under dynamic loading (simulated chewing). The study was completed in 2 experiments performed at 2 institutions. Biofilms of Streptococcus intermedius in the first experiment and S. intermedius and Actinomyces naeslundii were allowed to grow in root canals of single-rooted extracted teeth for 3 weeks. The roots of the teeth were suspended in a small chamber containing dental transport medium and were mounted on a lower sample holder of a chewing simulator. In the experimental group, simulated chewing cycles equivalent to 1 year of function were conducted, and then bacterial migration was quantified and compared with stationary teeth. All experimental samples of the loading group revealed bacterial penetration in both experiments. Several of the unloaded samples revealed no bacterial penetration. In the first experiment, a significantly higher number of bacteria were able to escape into the periapex of the loaded group compared with the unloaded group (P =.017). In the second experiment, there was no significant difference between the 2 bacterial species used in the amount of extruded bacteria; however, there was a highly significant effect for occlusal loading (P =.0001). The potential for occlusal forces to enhance bacterial extrusion from infected root canals should be further explored. [ABSTRACT FROM AUTHOR]

Background: Revitalization procedures primarily aim to eliminate clinical symptoms and heal periapical lesions. Objectives: The objective of the study was to elucidate the effectiveness of revitalization in treating apical periodontitis in necrotic mature and immature permanent teeth based on the following PICO question: In patients with permanent immature or mature teeth and pulp necrosis with or without signs of apical periodontitis (P) what is the effectiveness of revitalization (I) in comparison 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 of apical lesion size, radiographic evidence of normal periodontal ligament space, radiographic evidence of increased root thickness and length (not for mature teeth), tooth function (fracture and restoration longevity), 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). (T) = Defined as a minimum of 1 year and maximum of as long as possible for all outcome measures, except 'pain, tenderness, swelling, need for medication (analgesics)', which is a minimum of 7 days and maximum of 3 months and OHRQoL which is minimum of 6 months and a maximum of as long as possible. Methods: Three databases (PubMed, Embase and Cochrane Library) were searched for human, experimental and observational studies in English, complemented with hand search, until 31/10/2021. Studies recruiting teeth with pulp necrosis (with/without apical periodontitis), with minimum 10 teeth/arm at the end of the study and with a follow‐up of at least 1 year, were included. Records without an abstract and a full text were excluded. The qualitative analysis of the included (non‐) randomized controlled clinical trials was performed with the Revised Cochrane risk‐of‐bias tools (RoB 2 and ROBINS‐I). Meta‐analysis for survival and success (including a subgroup analysis for mature/immature permanent teeth) was performed using the Mantel–Haenszel method. The certainty of evidence was assessed using GRADE (Grades of Recommendation, Assessment, Development and Evaluation). Results: From the 365 identified records, five met the inclusion criteria. The 12 months survival rate was 100% for all (im)mature permanent teeth in all groups (3 studies). The success rate at 12 months was 100% for immature permanent teeth for I and C (1 study), however, reduced to 92% and 80% for mature teeth in I and C respectively (1 study, p >.05). The risk of bias for the most critical outcome (survival) was high for two studies and low for one. For the critical outcome success, all assessed studies were highly biased. Meta‐analyses provided pooled relative risk with no statistically significant difference between I and C for both survival (RR = 1.00, 95%CI = 0.96–1.04, p = 1.00) and success (RR = 1.06; 95%CI = 0.83–1.35, p =.66). The evidence level for survival was kept 'low' and for success was downgraded to 'very low' due to inconsistency and imprecision. Discussion: The survival and success rates were favourable in all included studies and for all groups; however, these outcomes are not reliable due to the low certainty level. Clinically, the most reported adverse event was tooth discolouration, hence the application of bismuth oxide containing calcium silicate cements should be avoided in revitalization. Radiographically, caution is needed when assessing periapical bone healing and further root development with periapical radiographs, due to multifactorial inaccuracies of this imaging technique. Methodological and assessment concerns need to be addressed in future clinical trials. Long‐term results are necessary for studies reporting revitalization of mature permanent teeth, as they seem to be experimental so far. Conclusions: No robust evidence was discovered to support that revitalization is effective to treat apical periodontitis in (im)mature permanent teeth. The success and survival rates of revitalized and fully pulpectomized (im)mature permanent teeth did not differ significantly. Registration: Prospero: CRD42021262466. [ABSTRACT FROM AUTHOR]

Background/Aim: Primary teeth are frequently affected by traumatic dental injuries. Root fractures are rare and have a reported incidence of 2% in the primary dentition. Hence, there is limited evidence on this topic. This study aims to evaluate the risk of healing complications in primary teeth with root fracture and to identify possible sequelae in the permanent dentition following root fracture in the primary dentition. Materials and methods: A retrospective analysis of a cohort of 53 patients with 74 root fractured primary teeth. The standard follow‐up program included clinical and radiographic examination after 4 weeks, 8 weeks, 6 months, and 1 year after the trauma and when the patient was 6 years of age. The following complications were registered: pulp necrosis (PN), pulp canal obliteration (PCO), ankylosis with replacement root resorption (ARR), infection‐related root resorption (IRR), premature tooth loss (PTL), and repair‐related resorption (RRR). Statistics: The Kaplan–Meier and Aalen‐Johansen estimators were employed. The level of significance was 5%. Results: A total of 74 teeth were included. 42 teeth were extracted at the initial examination. Risks estimated after 3 years: PTL 45.9% [95% CI: 28.8–63.0], PCO 12.9% [95% CI: 2.3–23.4], PN 14.9% [95% CI: 3.9–25.9], RRR 2.6% [95% CI: 0.0–7.5]. No teeth showed ARR or IRR. All complications were diagnosed within the first year. Most common sequelae in the permanent dentition was demarcated opacities, with an estimated risk of 20% [95% CI: 8.2–41.3]. Conclusions: There is a low risk of healing complications following a root fracture in the primary dentition. Root fractures often result in early extraction of the coronal fragment. The remaining apical fragment will undergo a physiological resorption. Aside from opacities, there is a low risk of sequelae in the permanent dentition. [ABSTRACT FROM AUTHOR]

Apical periodontitis (AP) is a common consequence of root canal infection leading to periapical bone resorption. Microbial and host genetic factors and their interactions have been shown to play a role in AP development and progression. Variations in a few genes have been reported in association with AP; however, the lack of genome-wide studies has hindered progress in understanding the molecular mechanisms involved. Here, we report the first genome-wide association study of AP in a large and well-characterized population. Male and female adults (n = 932) presenting with deep caries and AP (cases), or deep caries without AP (controls) were included. Genotyping was performed using the Illumina Expanded Multi-Ethnic Genotyping Array (MEGA). Single-variant association testing was performed adjusting for sex and 5 principal components. Subphenotype association testing, analyses of genetically regulated gene expression, polygenic risk score, and phenome-wide association (PheWAS) analyses were also conducted. Eight loci reached near genome-wide significant association with AP (P < 5 × 10−6); gene-focused analyses replicated 3 previously reported associations (P < 8.9 × 10−5). Sex-specific and subphenotype-specific analyses revealed additional significant associations with variants genome-wide. Functionally oriented gene-based analyses revealed 8 genes significantly associated with AP (P < 5 × 10−5), and PheWAS analysis revealed 33 phecodes associated with AP risk score (P < 3.08 × 10−5). This study identified novel genes/loci contributing to AP and specific contributions to AP risk in men and women. Importantly, we identified additional systemic conditions significantly associated with AP risk. Our findings provide strong evidence for host-mediated effects on AP susceptibility. [ABSTRACT FROM AUTHOR]

Background: Regenerative endodontic procedures (REPs) have emerged as a promising treatment option for young permanent teeth with pulp necrosis, offering the potential for tissue repair and preservation. Materials and Methods: A retrospective analysis was conducted on a cohort of 30 patients aged 8 to 16 years with pulp necrosis in young permanent teeth. The patients underwent REPs, including disinfection, triple antibiotic paste application, and a coronal barrier. Clinical and radiographic data were collected at baseline and follow-up appointments at 6, 12, and 24 months. Radiographs were analyzed for root lengthening, apical closure, and resolution of periapical lesions. Results: The mean increase in root length after 24 months was 3.42 mm (SD ± 1.12 mm), and 90% of cases demonstrated complete apical closure. The overall success rate, defined as the absence of clinical symptoms and radiographic evidence of pathology, was 80%. Conclusion: REPs show promising outcomes in young permanent teeth with pulp necrosis, promoting root development, and apical closure. [ABSTRACT FROM AUTHOR]

Abstract Background Restoring vital teeth with indirect restorations may threaten dental pulp integrity. However, the incidence of and influential factors on pulp necrosis and periapical pathosis in such teeth are still unknown. Therefore, this systematic review and meta-analysis aimed to investigate the incidence of and influential factors on pulp necrosis and periapical pathosis of vital teeth following indirect restorations. Methods The search was conducted in five databases, using MEDLINE via PubMed, Web of Science, EMBASE, CINAHL, and Cochrane Library. Eligible clinical trials and cohort studies were included. The risk of bias was assessed using Joanna Briggs Institute’s critical appraisal tool and Newcastle–Ottawa Scale. The overall incidences of pulp necrosis and periapical pathosis following indirect restorations were calculated using a random effects model. Subgroup meta-analyses were also performed to determine the potential influencing factors for pulp necrosis and periapical pathosis. The certainty of the evidence was assessed using the GRADE tool. Results A total of 5,814 studies were identified, of which 37 were included in the meta-analysis. The overall incidences of pulp necrosis and periapical pathosis following indirect restorations were determined to be 5.02% and 3.63%, respectively. All studies were assessed as having a moderate-low risk of bias. The incidence of pulp necrosis following indirect restorations increased when the pulp status was objectively assessed (thermal/electrical testing). The presence of pre-operative caries or restorations, treatment of anterior teeth, temporization for more than two weeks, and cementation with eugenol-free temporary cement, all increased this incidence. Final impression with polyether and permanent cementation with glass ionomer cement both increased the incidence of pulp necrosis. Longer follow-up periods (> 10 years) and treatment provided by undergraduate students or general practitioners were also factors that increased this incidence. On the other hand, the incidence of periapical pathosis increased when teeth were restored with fixed partial dentures, the bone level was 10 years. The certainty of the evidence overall was assessed as low. Conclusions Although the incidences of pulp necrosis and periapical pathosis following indirect restorations remain low, many factors affect these incidences that should thus be considered when planning indirect restorations on vital teeth. Database registration PROSPERO (CRD42020218378).

Dental trauma is injury to the mouth, including teeth, lips, epoxies, lingo, and jawbones. Soft towel injuries to the mouth and dental trauma are generally veritably painful and should admit prompt treatment. It's a single centered retrospective study. Data was collected from the case record system used in private dental institutions and following parameters similar as gender, age of the children with post traumatic history. Case details were analyzed between June 2020 to January 2021 out of which 287 cases who fulfilled the addition and rejection criteria were included in the study. The data obtained was statistically analyzed using SPSS software. In this study, it is observed that time taken by maximum patients was more than 2 months and male children are prone to traumatic injury. Awareness on earlier dental visits with respect to dental trauma and complication of time delay should be improved among general society. [ABSTRACT FROM AUTHOR]

Extraoral draining sinus of odontogenic origin usually lacks intraoral symptoms, thus it may be diagnosed as a cutaneous lesion. It is rare and may be confused with a wide variety of diseases for example furuncle, pericoronitis in relation to the mandibular third molars, parotid fistula, preauricular sinuses, periapical and periodontal pathology, and many more. Patients might seek treatment from their physician as they are not aware of its odontogenic origin and these cases usually are misdiagnosed and leading to inappropriate treatment. Objective: To discuss the detailed management of two cases of extraoral draining sinus that were successfully treated. Case Reports: The first case was referred by the Department of Oral and Maxillofacial Surgery, for management of extraoral draining sinus originating from tooth 36. In the second case, the extraoral draining sinus is caused by pulpal necrosis of several mandibular anterior teeth. Intra-radicular microorganisms in infected root canals primarily obligate anaerobes have been the aetiologic cause of apical periodontitis if left untreated may cause these types of symptoms. Conclusion: As it is uncommon and the absence of any dental symptoms, thus, it’s paramount important to diagnose these types of cases to treat the disease and to avoid unnecessary treatments such as prolonged prescription of antibiotics. Therefore, the dental cause should be ruled out for any cutaneous sinus tract so that a correct diagnosis can be ascertained, and proper management can be delivered to the patient. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) increases the susceptibility to infection. A plausible association between apical periodontitis (AP) and DM has been reported, but the underlying mechanism is not yet elucidated. Aim: To investigate the bacterial quantity and the expression of interleukin‐17 (IL‐17) in necrotic teeth with AP in type 2 DM (T2DM), pre‐diabetic and non‐diabetic control patients. Methodology: In all, 65 patients with necrotic pulp and AP [periapical index (PAI) scores ≥3] were included. The age, gender, medical history and medications list, including metformin and statin intake, were recorded. Glycated haemoglobin (HbA1c) was analysed, and the patients were divided into three groups: T2DM (n = 20), pre‐diabetics (n = 23) and non‐diabetic (n = 22). Bacterial samples (S1) were collected by file and paper points. Bacterial DNA was isolated and quantified using 16S ribosomal RNA gene‐targeted quantitative real‐time polymerase chain reaction (qPCR). For IL‐17 expression, (S2) samples were collected from the periapical tissue fluid using paper points passing through the apical foramen. The IL‐17 total RNA was extracted, and reverse transcription (RT‐qPCR) analysis was performed. Comparisons between the three study groups were conducted using one‐way anova and Kruskal–Wallis test to explore the relationship between bacterial cell counts and IL‐17 expression in each group. Results: The distributions of PAI scores were equivalent among the groups, p =.289. T2DM patients had higher bacterial counts and IL‐17 expression than other groups, but these differences were not statistically significant, p =.613 and p =.281, respectively. T2DM patients taking statin appear to have lower bacterial cell count than those who do not take statin, approaching the significance level, p =.056. Conclusion: T2DM patients had a non‐significant higher bacterial quantity and IL‐17 expression compared to pre‐diabetic and healthy controls. Although these findings indicate a weak association, it may impact the clinical outcome of endodontic diseases in diabetic patients. [ABSTRACT FROM AUTHOR]

Introduction: This randomized clinical trial aimed to determine whether the XP-endo finisher combined with or without foraminal enlargement has any significant effect on the incidence and intensity of postoperative pain in necrotic pulps. Materials and Methods: Clinical pain levels were measured after 6, 12, 24, 48, and 72 hours and at 7 postoperative days. All treatments were performed by an endodontist in a single visit. One hundred and twenty patients were included. All patients had a single tooth treated. The patients were divided into four groups: No FE (None Foraminal Enlargement) (n=30), FE (Foraminal Enlargement) (n=30), No FE+XPF (None Foraminal Enlargement+XP-endo Finisher) (n=30) and XPF+FE (XP-endo Finisher and Foraminal Enlargement) (n=30). The canals were irrigated with sodium hypochlorite, shaped using WaveOne Gold Medium file, and then filled by using a matching single cone and AH-Plus sealer. The cavity was filled using glass ionomer cement. Pain intensity was assessed using the visual analog scale. The data were analyzed with the ANOVA and Games-Howell test. The significance level was 5%. Results: The XPF+FE group experienced a higher level of pain, being classified on the visual analog scale as moderate for 48 postoperative hours and mild for 7 postoperative days (P<0.05). In the other groups, the pain was mild, only with different time intervals (P>0.05). Conclusions: Foraminal enlargement associated with XP-endo Finisher may cause moderate postoperative pain. [ABSTRACT FROM AUTHOR]

Introduction: External inflammatory root resorption (EIRR) in immature permanent teeth is a common complication after severe dental trauma. The management of this condition requires thorough disinfection of the root canal in order to arrest the resorptive process. However, current guidelines regarding the recommended treatment of EIRR following traumatic dental injuries vary, mainly in regard to the type of intracanal medication and its retention time in the root canal system. The objective of this case series was to present both the apical barrier technique (MTA plug) and revitalization procedures as valid treatment options in immature teeth with EIRR. Methods: Four cases of post-traumatic immature teeth diagnosed with pulp necrosis and EIRR, with or without apical periodontitis, were treated either by an MTA plug (two teeth) or revitalization (two teeth). Cases were followed between 12 and 24 months. Results: Both treatment methods were efficient in arresting EIRR and enabled bone healing. After revitalization, partial root maturation was observed. Conclusion: Whereas the key to achieve periodontal healing in cases of EIRR is thorough disinfection of the root canal, both a subsequent MTA plug as well as revitalization may represent adequate treatment methods. An additional benefit lies in the potential of revitalization to promote further root maturation through hard tissue apposition. [ABSTRACT FROM AUTHOR]

Background: Endodontic treatment of primary molars represents one of the challenges in pediatric dentistry. There is a lack of consensus in the literature about the endodontic techniques and filling paste for primary teeth with pulp necrosis. Aim: To compare the effectiveness of the LSTR technique (lesion sterilization and tissue repair) with CTZ paste (chloramphenicol, tetracycline, zinc oxide and eugenol) and pulpectomy with ZOE paste (zinc oxide and eugenol) in the treatment of primary molars with pulp necrosis. Design: Eighty‐eight primary molars with pulp necrosis from 70 children between the ages of 3 and 8 years were included. The teeth were randomized to the LSTR with CTZ paste group or pulpectomy with ZOE paste group. Clinical and radiographic evaluations were performed at 18, 24, 30 and 36 months. Results: At 36 months, clinical success was 86.4% in LSTR with CTZ paste and 90.9% in pulpectomy with ZOE paste (p =.45). Radiographic success was 43.2% in both groups (p = 1.00). The overall success was 40.9% in LSTR with CTZ paste and 43.2% in pulpectomy with ZOE paste (p = 1.00). Conclusion: After 36 months of evaluation, the effectiveness of the LSTR technique with CTZ paste and pulpectomy with ZOE paste was similar for the treatment of primary molars with pulp necrosis. [ABSTRACT FROM AUTHOR]

Regenerative endodontic treatment (RET) has been described as a 'paradigm shift' in the treatment of immature teeth with pulp necrosis. It has been suggested that RET should be the first option for treating immature teeth when the roots are not yet fully developed. The European Society of Endodontology and the American Association of Endodontists have released position statements and clinical considerations for RET. Treatment modalities rely on the tissue engineering concept components stem cells, scaffolds and signalling molecules. Clinically, the treatment involves disinfection of, and often the introduction of a blood clot into, the root canal space. RET has three goals: 1) resolution of clinical signs and symptoms; 2) further root maturation; and 3) restoration of neurogenesis. To date, RET has been unable to establish a real regeneration of the pulp tissue and dentine space. Histologically, healing is achieved with repair from tissues derived primarily for the periodontal and osseous tissues such as bone-like tissue and cementum, rather than pulp tissue and odontoblasts. This review aims to present a clinical focus on RET and to provide a current view on this emerging clinical technique. [ABSTRACT FROM AUTHOR]

Reports on the histopathologic features of external cervical resorption (ECR) in unerupted teeth are scarce. This article reports on 2 maxillary impacted canines from different patients that showed ECR lesions and were surgically removed and histologically evaluated. Case 1 showed symptoms associated with oral communication of the dental follicle and pulpal exposure. Radiographs and cone-beam computed tomographic imaging showed that resorption affected a large part of the root and the crown. Case 2 was asymptomatic, and the resorption cavity was restricted to the tooth crown. Both teeth were extracted and subjected to histologic processing and analysis. In case number 1, the coronal pulp was necrotic and infected, showing areas of exposure to the resorption channels. The apical pulp was vital and uninflamed. The pulp space was surrounded by a continuous pericanalar resorption-resistant sheet. Part of the resorbed area of dentin was occupied by inflamed granulation tissue. More apically, a network of trabecular bone was present in the resorbed area. In case number 2, the pulp around the resorbed area was uninflamed and vital. A large fraction of the lost dentin was replaced by trabecular bone, closely adapted to the irregularly resorbed dentin surface, and no inflammatory cells. Our findings indicate that impacted teeth with ECR may remain asymptomatic until associated with infection. Histologic features of resorption in impacted teeth were similar to those in erupted teeth. In the case associated with infection, the resorbed area was occupied by inflamed tissue and newly formed bone. In the case with no infection, the resorption area was filled with bone undergoing a remodeling process. [ABSTRACT FROM AUTHOR]

The dental pulp may respond favourably or unfavourably to traumatic dental injuries. The most serious unfavourable responses are pulp necrosis and infection of the root canal system. These cause apical periodontitis and/or external inflammatory resorption of the tooth. The following injuries require root canal treatment as part of their emergency management—(A) complicated crown fractures (but some may be suitable for conservative pulp treatments, such as pulp capping, partial pulpotomy or pulpotomy), (B) complicated crown‐root fractures, (C) supra‐crestal coronal third root fractures and (D) injuries where pulp necrosis is predictable or highly likely to occur AND where there has been damage to the root surface and/or periodontal ligament with the aim of preventing external inflammatory resorption. This latter group of injuries are avulsion, intrusion, lateral luxation with a crown fracture, extrusion with a crown fracture (all in fully developed teeth) plus avulsion with a crown fracture and intrusion with a crown fracture (both in incompletely developed teeth). All other injuries should not have root canal treatment commenced as part of the emergency management, but they must be reviewed regularly to monitor the pulp for any adverse changes to its status, particularly pulp necrosis and infection of the root canal system. [ABSTRACT FROM AUTHOR]

Regenerative endodontic procedures (REPs) of immature teeth with necrotic pulp and apical pathosis focus on passive chemomechanical debridement and usually require multiple visits to enhance the antibacterial effect by placing intracanal medications. However, different case reports showed a favorable clinical and radiographic outcome in single-visit REPs of necrotic immature teeth with symptomatic apical periodontitis or chronic apical abscess. To the best of our knowledge, there are no published reports of single-visit REPs on cases with acute apical abscess. Therefore, this case report aimed to present a successful REP performed in a single visit for immature lower molar with necrotic pulp and acute apical abscess. A 9-year-old female patient referred for the management of the lower right molar (#46), with the chief complaint of localized moderate pain with cold drinks in the lower right molar for 1 week. The extraoral clinical examination revealed no significant findings. Intraorally, tooth #46 revealed a deep occlusal caries, with normal response to palpation, mild pain on percussion, and moderate pain to the cold test. The radiographic examination showed deep occlusal caries approaching the pulp, and periapical radiolucency related to the distal root. It was diagnosed as symptomatic irreversible pulpitis with symptomatic apical periodontitis. After accessing the pulp chamber, the radicular pulp on the mesial root was vital, while necrotic in the distal root. Therefore, vital pulp therapy was done for the mesial root, and REPs initiated for the distal root with intracanal medicament placement. However, the patient failed to show up in the scheduled visit to complete the treatment. The father refused to bring her as she was asymptomatic, and he was afraid of the COVID-19 pandemic situation. One month later, she presented to the clinic with pain and facial swelling in the lower right area of her face. Clinical examination revealed extra- and intraoral swelling related to tooth #46 (i.e., acute apical abscess) with severe pain on palpation and percussion. The patient's parents insist to finish the treatment or extract the tooth on the same visit. Hence, a single-visit REP was done. After 20 months, clinical and radiographic examinations showed that the tooth became asymptomatic, responded to sensibility tests, and the periapical pathosis healed. It was concluded that regenerative endodontic treatment can be done in single visit in cases with acute apical abscess. It should be considered in cases of poor complaint, difficulty in accessing dental care, or pandemic curfew. [ABSTRACT FROM AUTHOR]

Background: Restoring vital teeth with indirect restorations may threaten dental pulp integrity. However, the incidence of and influential factors on pulp necrosis and periapical pathosis in such teeth are still unknown. Therefore, this systematic review and meta-analysis aimed to investigate the incidence of and influential factors on pulp necrosis and periapical pathosis of vital teeth following indirect restorations. Methods: The search was conducted in five databases, using MEDLINE via PubMed, Web of Science, EMBASE, CINAHL, and Cochrane Library. Eligible clinical trials and cohort studies were included. The risk of bias was assessed using Joanna Briggs Institute's critical appraisal tool and Newcastle–Ottawa Scale. The overall incidences of pulp necrosis and periapical pathosis following indirect restorations were calculated using a random effects model. Subgroup meta-analyses were also performed to determine the potential influencing factors for pulp necrosis and periapical pathosis. The certainty of the evidence was assessed using the GRADE tool. Results: A total of 5,814 studies were identified, of which 37 were included in the meta-analysis. The overall incidences of pulp necrosis and periapical pathosis following indirect restorations were determined to be 5.02% and 3.63%, respectively. All studies were assessed as having a moderate-low risk of bias. The incidence of pulp necrosis following indirect restorations increased when the pulp status was objectively assessed (thermal/electrical testing). The presence of pre-operative caries or restorations, treatment of anterior teeth, temporization for more than two weeks, and cementation with eugenol-free temporary cement, all increased this incidence. Final impression with polyether and permanent cementation with glass ionomer cement both increased the incidence of pulp necrosis. Longer follow-up periods (> 10 years) and treatment provided by undergraduate students or general practitioners were also factors that increased this incidence. On the other hand, the incidence of periapical pathosis increased when teeth were restored with fixed partial dentures, the bone level was < 35%, and the follow-up was > 10 years. The certainty of the evidence overall was assessed as low. Conclusions: Although the incidences of pulp necrosis and periapical pathosis following indirect restorations remain low, many factors affect these incidences that should thus be considered when planning indirect restorations on vital teeth. Database registration: PROSPERO (CRD42020218378). [ABSTRACT FROM AUTHOR]

The calcification of the root canal is a process that may occur after a dental trauma or slowly develop due to physiological dental aging. It is characterized by hard tissue deposition on both the pulp chamber and the root canal. Periapical radiography and computed tomography can be used to diagnose this condition. In some cases, it may be associated with pulp necrosis and the presence of periapical injury, and the treatment may be considered to be quite complex. This case report addresses the endodontic treatment of the upper left central incisor, symptomatic, with root canal obliteration and pulp necrosis as a sequela of dental trauma. After all the tests, chronic apical periodontitis was diagnosed, and conventional endodontic treatment was proposed. The most significant difficulty faced was when locating the root canal's entrance. Numerous radiographs were carried out to avoid deviations. The opening of the root canal could only be found at the end of the middle third, só treatment could proceed by using the crown-down technique and intracanal medication based on calcium hydroxide during the sessions. When the patient was asymptomatic, the root canal has been filled. The accomplishment of the technique was successful, and after finishing the case, there was remission of symptoms. After a six-month follow-up period and three years, the healing of the periapical tissues was observed.

Little is discussed in the literature about the indication of biopulpectomy in a single session, however, when it comes to necropulpectomy, there are still discussions about it. Therefore, the objective of this work is, through a literature review, to evaluate the success of endodontic treatment of necrotic teeth in a single session. The literature review was carried out by searching the PubMed and Google Scholar databases in May and June 2020. Relevant articles were selected from the endodontic treatment of necrotic teeth in a single session, published between 2000 and 2020. Of the 30 selected articles, fifteen were literature reviews, six were in vivo studies and three were in vitro studies. In the in vivo studies, five were performed in humans and obtained satisfactory results in the filling in a single session. And in vitro studies have demonstrated the antibacterial effect, which is important for the success of endodontic treatment. Therefore, when well executed, it is possible to obtain success in the endodontic treatment of necrotic teeth in a single session, even in cases associated with chronic periapical lesions. [ABSTRACT FROM AUTHOR]

In daily dental practice, it is common for professionals to come across several types of diseases that affect the tissues of the periapical region, such as asymptomatic apical periodontitis, a pathology of an inflammatory nature of slow progression, which often affects periapical tissues. This pathology requires immediate endodontic treatment to prevent tooth loss and to restore the resorbed dental support tissues. This paper aims to present and discuss a clinical case of upper incisors submitted to endodontic treatment with the aid of the M Files®(Easy) preparation system. This innovative system consists of files made of nickel-titanium (NiTi) with thermal treatment along its surface, which according to the manufacturer, allows for more satisfactory results, even in more complex cases such as the one reported. This is a descriptive and experimental study characterized as a case report, with a qualitative and longitudinal approach, carried out at the Uninassau/Unifacimed University Center in a 41-year-old male patient with extensive apical bone loss. In the end, it can be concluded that the use of the new modeling system Files M® proved to be a safe, fast, and effective endodontic resource, presenting centralization and predictability of the diameters of the surgical preparation besides contributing with the recovery of the periodontal tissues. [ABSTRACT FROM AUTHOR]

Background: Relapse and pain are often found after endodontic treatment of pulp necrosis accompanied by periapical granuloma. IFN-γ is known to have a role in macrophage activation, which in turn produces proinflammatory cytokines. However, the exact role of IFN-γ is still uncertain. Methods: The samples in this study were teeth with and without granuloma extracted from patients with pulp necrosis. X-rays were used to detect periapical lesions, followed by an immunohistochemical and histopathological examination to observe IFN-γ expression. Results: Periapical granuloma had a predilection for women and the age group of 36-45 years old (66.67% and 67.%, respectively). Higher expression of IFN-γ was found in necrotic teeth with granuloma than in non-granuloma (p < 0.001). Conclusion: The primary component in the formation of periapical granuloma in pulp necrosis is the increased expression of IFN-γ. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tooth avulsion clinically presents as complete displacement of a tooth from the alveolar socket and it is one of the most severe forms of dental trauma leading to compromised neurovascular supply, loss of periodontal ligament and pulp necrosis. Storing of avulsed tooth in appropriate storage medium to preserve the periodontal cell viability is of prime importance and research to find the appropriate storage media is still on. AIM: The aim of this study was to investigate the effects of green tea and turmeric as a storage media on periodontal cell viability. MATERIALS AND METHODS: This was a prospective, randomized study conducted using sixty single rooted human premolars freshly extracted for orthodontic purpose. Selected subjects were divided into three groups of 20 each. Randomization was done by performing simple random sampling; Group A consisted of teeth to be stored in HBSS, Group B included teeth to be stored in Green tea and Group C included teeth to be store in Turmeric. Periodontal cell viability was assessed by using a Neubauer's chamber under the light microscope after two hours interval. RESULTS: HBSS preserved significantly higher number of viable PDL cells than any other storage solutions. Green tea extract showed better cell viability in comparison with turmeric. CONCLUSION: The present study indicates that HBSS and green tea effectively maintains the viability of PDL for two hours. Turmeric is less effective in preserving the PDL cell viability within the study time interval. [ABSTRACT FROM AUTHOR]

Copyright of Imaging Science & Photochemistry is the property of Imaging Science & Photochemistry Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The prognosis of traumatized teeth depends largely on the fate of the pulp and its treatment. This review aims to update the present status on the endodontic management of traumatic injuries to permanent teeth and to identify relevant research areas that could contribute to an improvement in diagnosis and treatment of traumatized permanent teeth. Future research should pay greater attention to (1) diagnostic methods to assess the perfusion of the pulp and enhance detection of tooth cracks and initial signs of root resorption; (2) improved materials for vital pulp treatment; (3) studies focusing on type and duration of splinting after root fractures; (4) antiresorptive intracanal medication in case of posttraumatic pulp necrosis and infection‐related resorption and (5) long‐term data on the apical barrier technique compared to revitalization. [ABSTRACT FROM AUTHOR]

Introduction: External inflammatory root resorption (EIRR) in immature permanent teeth is a common complication after severe dental trauma. The management of this condition requires thorough disinfection of the root canal in order to arrest the resorptive process. However, current guidelines regarding the recommended treatment of EIRR following traumatic dental injuries vary, mainly in regard to the type of intracanal medication and its retention time in the root canal system. The objective of this case series was to present both the apical barrier technique (MTA plug) and revitalization procedures as valid treatment options in immature teeth with EIRR. Methods: Four cases of post-traumatic immature teeth diagnosed with pulp necrosis and EIRR, with or without apical periodontitis, were treated either by an MTA plug (two teeth) or revitalization (two teeth). Cases were followed between 12 and 24 months. Results: Both treatment methods were efficient in arresting EIRR and enabled bone healing. After revitalization, partial root maturation was observed. Conclusion: Whereas the key to achieve periodontal healing in cases of EIRR is thorough disinfection of the root canal, both a subsequent MTA plug as well as revitalization may represent adequate treatment methods. An additional benefit lies in the potential of revitalization to promote further root maturation through hard tissue apposition.

The regenerative endodontic procedure (REP) represents a treatment option for immature necrotic teeth with a periapical lesion. Currently, this therapy has a wide field of pre-clinical and clinical applications, but no standardization exists regarding successful criteria. Thus, by analysis of animal and human studies, the aim of this systematic review was to highlight the main characteristics of the tissue generated by REP. A customized search of PubMed, EMBASE, Scopus, and Web of Science databases from January 2000 to January 2022 was conducted. Seventy-five human and forty-nine animal studies were selected. In humans, the evaluation criteria were clinical 2D and 3D radiographic examinations. Most of the studies identified a successful REP with an asymptomatic tooth, apical lesion healing, and increased root thickness and length. In animals, histological and radiological criteria were considered. Newly formed tissues in the canals were fibrous, cementum, or bone-like tissues along the dentine walls depending on the area of the root. REP assured tooth development and viability. However, further studies are needed to identify procedures to successfully reproduce the physiological structure and function of the dentin–pulp complex. [ABSTRACT FROM AUTHOR]

Copyright of Scire Salutis is the property of CBPC - Companhia Brasileira de Producao Cientifica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article describes the case of 55-year old with periapical radiolucency, pulpal necrosis and symptomatic apical periodontitis. The DentalVibe VibraPulse injection comfort system was used while anesthetizing the patient for root canal therapy. The patient was administered with local anesthetic Articaine Hydrochloride and epineprine to deal with the symptomatic maxillary tooth.

The current case report documents the clinical approach adopted for a traumatized immature necrotic permanent upper left central incisor after a bike accident. The treatment involved regenerative endodontic procedures (REPs) using "High Plasticity Mineral Trioxide Aggregate" (MTA Repair HP) as a cervical barrier over blood clot. The preservation included three years of follow-up appointments of clinical evaluations and periapical digital radiographs. Cone beam computer tomography (CBCT) was taken at six and thirty-six months for the evaluation of root development. [ABSTRACT FROM AUTHOR]

The maxillary sinus floor is formed by the alveolar process of the maxilla. Frequently, the roots of maxillary molars and premolars may protrude into the sinus cavity, with only a thin membrane separating them. Endodontic infections are characterized by mixed biofilms of anaerobic and proteolytic bacteria that can infect the root canal space and accessory anatomy of those teeth producing apical periodontitis. Due to the close relationship with the maxillary sinus, the persistence of apical periodontitis could potentially lead to odontogenic sinusitis. Understanding maxillary sinus anatomy and its relationship with the posterior maxillary dentition is crucial for diagnosing this entity., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Limited evidence exists on the treatment options of tooth repositioning after intrusive luxation., Aim: The study aimed to investigate the outcomes and complications of orthodontic extrusion in treating intruded maxillary permanent incisors., Design: A prospective study was conducted involving 28 intruded maxillary permanent incisors treated with orthodontic extrusion, compared with a retrospective control group of 29 teeth that underwent spontaneous re-eruption. The success rate of tooth repositioning, as well as pulp condition, periodontal healing, and root development were assessed and compared., Results: The success rate of orthodontic extrusion was 96.4%, excluding one tooth that was ankylosed before treatment. There were no significant differences in pulp condition between the orthodontic extrusion and control groups for teeth with immature root development. Teeth with mature root development in the orthodontic group, however, showed a significantly higher rate of pulp necrosis (100%, p < .05). Periodontal healing outcomes were similar across both groups, regardless of the maturity of root development. The root length continued increasing during orthodontic extrusion treatment., Conclusions: Orthodontic extrusion treatment could effectively reposition moderately to severely intrusive permanent incisors, without increasing the risk of complications compared with spontaneous re-eruption., (© 2024 BSPD, IAPD and John Wiley & Sons Ltd.)