Search Results (39)

Background: Tooth agenesis, particularly hypodontia, poses a clinical and esthetic challenge in growing patients due to limitations in definitive implant placement before skeletal maturity. Traditional solutions such as removable prostheses or orthodontic space closure often fail to provide adequate long-term stability, function, and tissue preservation. In recent years, orthodontic mini-implants have emerged as a promising interim solution. This narrative review aims to synthesize current clinical evidence on the use of orthodontic mini-implants as temporary prosthetic abutments in children and adolescents with hypodontia or post-traumatic tooth loss. Methods: A literature search was conducted using PubMed and Google Scholar databases, covering studies published between January 2004 and March 2025. Inclusion criteria were clinical reports involving skeletally immature patients with congenital or traumatic tooth loss treated with mini-implants, with mandatory radiographic diagnostics and outcome data. Data extracted included patient demographics, etiology, implant site, imaging, follow-up, complications, and outcomes. A total of 17 studies comprising 42 cases were analyzed and summarized in tabular form. Results: Patients aged 6 to 16 years were treated primarily for agenesis of maxillary lateral or central incisors. The mean follow-up duration was 36.9 months. CBCT was used in 28.6% of cases. Mini-implants demonstrated high clinical success with stable soft tissue contours and preservation of alveolar volume. Complications were reported in 21.4% of cases and included crown debonding, minor infraocclusion, soft tissue irritation, and rare instances of osseointegration. Conclusions: Orthodontic mini-implants may provide a minimally invasive and reversible approach to interim tooth replacement in growing patients. Preliminary evidence suggests favorable outcomes in terms of stability, esthetics, and tissue preservation, but further prospective research is needed to validate their long-term effectiveness and standardize clinical application. Full article

Conventional endodontic treatment has several disadvantages, which lead to the introduction of regenerative endodontic procedures aiming to maintain tooth vitality. Platelet concentrates possess relevant biological properties, and their application has been explored in various endodontic procedures. The aim of this scoping review is to identify the applications of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in endodontics. To identify and map the types of studies, the protocols for obtaining PRF/PRP, the most productive authors, and the journals where most articles were published on this topic until 2023. A literature search was performed in four databases (Medline, Embase, Cochrane Library, and Web of Science) until 20 December 2023. From the included articles, the following information was extracted: first author and publication year, endodontic procedure, platelet concentrate used, type of study, and journal of publication. A sampling methodology was adopted, and the five most recent articles for each procedure were used for additional information extraction: sample size and characteristics, pulp and periapical diagnosis, study protocol, platelet substrate and protocol for its obtention, treatment outcome, and follow-up. After selection, 412 articles were included. As for the type of endodontic procedure, regeneration procedures of immature teeth were the most reported, followed by apical surgery and pulpotomy and pulp protection. It was concluded that PRF is the most reported platelet concentrate. Regenerative procedures in immature teeth are the most described endodontic procedure. The success rate of PRF and PRP use is comparable to or even higher than that of conventional procedures and materials. However, there is significant heterogeneity in the protocols used for obtaining PRF and PRP and their clinical application. Full article

Background: The combination of two or more different types of traumatic dental injuries occurring concurrently to the same tooth presents a significant clinical challenge. By focusing on a rare combination of injuries, this case study explores the issues of delayed management of root fractures accompanied by coronal extrusions in immature maxillary permanent central incisors, underscoring the necessity for tailored approaches when guidelines for intervention were unmet. Methods: The case involves an eight-year-old boy who delayed seeking care for approximately a year after suffering trauma to his upper front teeth in a fall accident at school. The clinical examination revealed partial displacement of two maxillary central incisors in an incisal direction, resulting in increased mobility. Radiographs further showed horizontal root fractures in the apical third of both extruded incisors. Encouragingly, the injured teeth exhibited a normal response to electric pulp testing without signs or symptoms of pulpal pathology, suggesting pulp vitality and eliminating the need for root canal treatment. The extruded coronal fragments were repositioned orthodontically using a utility arch. Results: At the 14-month follow-up, the affected incisors were clinically asymptomatic, functionally satisfactory, and esthetically pleasing. Conclusions: Conservative orthodontic management of extrusive luxation concomitant with root fracture in immature permanent teeth may prove effective in select cases, particularly when long-term follow-up and proper oral care are maintained. Full article

Chiggers (chigger mites) and gamasid mites are two groups of ectoparasites on rodents, and they can be the vectors or potential vectors of scrub typhus and hemorrhagic fever with renal syndrome (HFRS), while Bower’s white-toothed rat (Berylmys bowersi) can serve as the reservoir host of the diseases. Based on field investigations at 117 survey sites of southwest China, a total of 2512 mites were collected from 55 B. bowersi rats. Under a microscope, these mites were taxonomically identified as 56 distinct species, comprising 37 chigger mite species and 19 gamasid mite species. The mite infestation burdens on B. bowersi were heavy, with a high prevalence (P_M = 85.45%), mean abundance (MA = 45.67), and intensity (MI = 53.45). Of 56 mite species identified, 7 are vectors of scrub typhus and HFRS. Of the seven vector mite species, Leptotrombidium scutellare was one of dominant chigger species, with a higher infestation index on rats (P_M = 21.82%, MA = 7.76) than the other six vector mite species. The sex ratio of female gamasid mites was higher than that of males. The number and infestation of adult gamasid mites were higher than those of immature mites. The infestation indexes of mites on B. bowersi hosts varied with the host’s sex and age and fluctuated along different environmental gradients. The association coefficient (V) showed a slight positive association between chiggers and gamasid mites, suggesting that these two groups of mites may coexist on B. bowersi rats. Spearman correlation coefficients showed positive correlations among some dominant and vector mite species, indicating that some mite species tend to select the same hosts. A total of 69 mite species (47 chigger mite species and 22 gamasid mite species) on B. bowersi were estimated by species rarefaction and extrapolation curves. In conclusion, Berylmys bowersi has a high susceptibility to mite infestation, and it has the potential to harbor abundant mites, with heavy mite burdens. The occurrence of vector mite species, especially L. scutellare (the dominant species), increases the potential risk of transmission and the focus persistence of scrub typhus and HFRS in southwest China. Full article

Background: Intracranial teratomas are very rare in adults, representing only 0.3–0.5% of all primary brain tumors. They originate from all three germ layers, and are classified as mature, immature, or malignant. Mature teratomas constitute the most prevalent type in the adult population, commonly originating from midline structures such as the pineal and suprasellar regions. However, the localization of these tumors within the cerebellum is exceedingly rare, with only a limited number of cases reported globally. In this manuscript, we describe, to the best of our knowledge, the first documented case of a young adult patient presenting with a mature teratoma situated between the cerebellar hemispheres. Notably, this tumor was accompanied by occipital bone loss, through which a tumor pedicle extended, forming an extracranial component. Methods: After analyzing the clinical picture and additional examinations, the patient was classified for surgery. The intracranial part of the tumor contained numerous cysts with yellow fluid, a tooth, and fat tissue. The tumor was removed radically, with its extracranial part. Results: On the fourth day after surgery, the patient was discharged from the clinic in a good general condition, walking, with marked cerebellar symptoms. In a follow-up at 6 months postoperatively, the neurological examination was normal, with no headaches. MRI at the 6 months follow-up did not show any residual or recurrent tumor. Conclusions: Histopathological examination confirmed the diagnosis of mature teratoma. Full article

In clinical pediatric dentistry, dental professionals may encounter some dental abnormalities. It may progress in various ways; therefore, long-term follow-up is essential. We describe the case of a 5-month-old male, and how the mandibular incisor was lost due to trauma. He was referred to our hospital two days later, but the calcified tissue was detected in the oral cavity, confirming the residual tooth. We extracted the tooth, and a regular dental checkup revealed another residual tooth in the same region one year later. A residual tooth is considered to be affected by the Hertwig’s epithelial sheath, and it may occur when the root is immature. It is important for dental professionals to share this information and to continue long-term follow-up when they encounter patients at young ages who have had such teeth extracted or lost due to trauma. Full article

Background/Objectives: Odontogenic tumors in pediatric patients are uncommon; among all, the intraosseous occurrence of odontogenic myxoma is very rare, accounting for almost 8.5–11.6% of all odontogenic tumors in children. The radiological appearance is highly variable and is often responsible for the diagnostic delay and treatment. Methods: We report a case of odontogenic myxoma occurring in the posterior mandible of a 12-year-old female, found on a panoramic radiograph performed for the delayed eruption of the second inferior molar, treated by conservative surgery. A comprehensive analysis of the literature was also carried out. Results: The radiological features of the presented case were unique, as the lesion was encompassed within the uncompleted (developing) dental crown still unerupted, as confirmed by the macroscopic appearance. Then, the differential diagnosis included odontogenic fibroma, immature dental pulp or follicle from a developing tooth, and ameloblastic fibrodontoma. The histological examination led to the final diagnosis of odontogenic myxoma. As for the literature analysis, after a PRISMA-based selection of the papers, a total of 23 articles (case reports and case series on odontogenic myxomas in pediatric patients, a total of 33 cases) were finally selected and studied; all the pertinent data are widely discussed within the paper. Conclusions: The current case highlights the importance of the radiological investigation in pediatric patients when a delayed eruption lasts for several months, leading to an early diagnosis necessary to avoid more aggressive surgical therapies and possible recurrence; data from the literature about site of occurrence, sex, age, kind of surgical procedure, and recurrence rate are discussed too. Full article

Background and Clinical Significance: Head and neck teratomas are embryonal tumors that develop when totipotent germ cells escape the developmental control of primary organizers and form a more-or-less organoid mass in which tissues from all three germ layers (ectoderm, endoderm, and mesoderm) can be identified. Mature teratomas may either transit into germ cell or non-germ cell malignancies or remain histologically mature with the possibility of growing, thus inducing certain complications when reaching a large size. This article aims to investigate a very rare case of a 6-year-old child who exhibited a recurrent intraoral mass with multiple conflicting biopsies. Case Presentation: A 6-year-old male patient was referred to the postgraduate clinic of the Department of Oral Medicine/Pathology, Dental School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, because his pediatric dentist noticed an exophytic, intraoral mass, distal to tooth #75 during a routine checkup. The first histopathological examination showed a gingival tumor, classified as a small round blue cell tumor, with greater similarity to adamantinoma-like Ewing sarcoma (ALES) and less to synovial sarcoma. The second pathologist examined the same tissue specimen and suggested the extremely rare presence of an immature malignant teratoma. Following chemotherapy, the rest of the teratoma with the adjacent tooth #75 was removed, and the histopathological examination showed a mature teratoma. Conclusions: This case illustrates the crucial role of the dentist, and in this case of the pediatric dentist, to promptly diagnose the underlying disease. Genetic screening may assist in detecting high-risk populations. In such complex histopathological cases, the importance of cooperating with experienced oral and maxillofacial pathologists is highlighted. We describe a rare case of intraoral malignant teratoma, and an extended literature review revealed that our case is the first ever reported. Full article

Performing endodontic treatment on a tooth with an immature apex can be challenging due to the risk of irrigant extrusion beyond the apex. This narrative review investigates the over-apex extrusion of activated irrigants in teeth with open and immature apices and aims to provide crucial insights for practice and research. Two hundred fifty-two results were found from the electronic search. Sixteen duplicates were removed before selection, and 24 were excluded. Of the 212 remaining results, the full text was evaluated for eligibility. One hundred ninety-four results were excluded: in one hundred sixty-five, irrigant activation was not performed; twenty-nine were animal studies; in seven, irrigant activation was not performed to disinfect the canal. Finally, 13 studies were included. They cover a range of topics, from the types of irrigants used to the techniques of activation, and their findings contribute to our understanding of the risks and consequences of irrigant extrusion. All the activation techniques investigated can, to varying degrees, cause the irrigant to extrude beyond the apex. Extrusion may not always be clinically relevant; however, the consequences of excessive irrigant leakage from the apex are dangerous, so try to assess all the variables that may cause it and adopt techniques to reduce it. Full article

The present in vitro study focuses on the filling ability of three different bioceramic cements with or without the addition of a bioceramic sealer in an open apex model on the marginal apical adaptation, tubule infiltrations, and void distributions as well as the interface between the cement and the sealer materials. To this end, sixty mandibular premolars were used. MTA-Biorep (BR), Biodentine (BD), and Well-Root Putty (WR) were used to obturate the open apex model with or without the addition of a bioceramic sealer, namely TotalFill^® BC sealer™ (TF). A digital optical microscope and scanning electron microscope (SEM) were used to investigate the cement–dentin interface, marginal apical adaptation, and the material infiltration into the dentinal tubules. Micro-computed X-ray tomography and digital optical microscopy were used to investigate the cement–sealer interface. The results were analyzed by using the Kruskal–Wallis test. No significant difference was found between the groups for the marginal apical adaptation quality (p > 0.05). Good adaptation of the dentin–cement interface was found for all tested groups and the sealer was placed between the cement material and dentinal walls. All the groups demonstrated some infiltrations into the dentinal tubules at the coronal part except for the BR group. A good internal interface was found between the cement and the sealer with the presence of voids at the external interface. A larger number of voids were found in the case of the BD-TF group compared to each of the other two groups (p < 0.05). Within the limitations of the present in vitro study, all the groups demonstrated good marginal apical adaptation. The use of a sealer in an open apex does not guarantee good filling and, in addition, creates voids at the external interfaces with the dental walls when the premixed sealer is used with powder–liquid cement systems. The use of a premixed bioceramic cement could offer fewer complications than when a powder–liquid cement system is used. Full article

The consequences of traumatic injuries are pulp necrosis, periapical inflammation, and possible external cervical resorption (ECR). The concomitant cessation of root maturation and dentinogenesis in premature teeth result in a fragile tooth. Revascularization of the pulp might be an alternative treatment option. A 12-year-old patient was referred for retreatment of chronic apical periodontitis with acute exacerbation after root canal treatment of an upper central incisor. During gutta-percha removal, an ECR was detected. First, it was closed internally with Biodentine, followed by an external composite closure after a cone beam computed tomography evaluation. In the first session, chemomechanical cleaning was aided with sodium hypochlorite and hyperpure chlorine dioxide, and the canal was dressed with Ca(OH)₂ until the next session. In the next session, only the low-toxicity, but adequate, bactericide hyperpure chlorine dioxide was applied for irrigation, before the provocation of periapical bleeding into the canal. The blood clots were covered with Biodentine, and the tooth was restored with composite filling. During the 24-month follow-up, clinical signs/symptoms had disappeared, and the periapical lesion was resolved. Increased root thickness in the apical third and decreased size of the apical foramen were detected. In conclusion, regenerative endodontic procedures could potentially be used to retreat immature teeth with persistent apical periodontitis and external cervical resorption. Full article

The influence of intracoronal sealing biomaterials on the newly formed regenerative tissue after endodontic revitalisation therapy remains unexplored. The objective of this study was to compare the gene expression profiles of two different tricalcium silicate-based biomaterials alongside the histological outcomes of endodontic revitalisation therapy in immature sheep teeth. The messenger RNA expression of TGF-β, BMP2, BGLAP, VEGFA, WNT5A, MMP1, TNF-α and SMAD6 was evaluated after 1 day with qRT-PCR. For evaluation of histological outcomes, revitalisation therapy was performed using Biodentine (n = 4) or ProRoot white mineral trioxide aggregate (WMTA) (n = 4) in immature sheep according to the European Society of Endodontology position statement. After 6 months’ follow-up, one tooth in the Biodentine group was lost to avulsion. Histologically, extent of inflammation, presence or absence of tissue with cellularity and vascularity inside the pulp space, area of tissue with cellularity and vascularity, length of odontoblast lining attached to the dentinal wall, number and area of blood vessels and area of empty root canal space were measured by two independent investigators. All continuous data were subjected to statistical analysis using Wilcoxon matched-pairs signed rank test at a significance level of p < 0.05. Biodentine and ProRoot WMTA upregulated the genes responsible for odontoblast differentiation, mineralisation and angiogenesis. Biodentine induced the formation of a significantly larger area of neoformed tissue with cellularity, vascularity and increased length of odontoblast lining attached to the dentinal walls compared to ProRoot WMTA (p < 0.05), but future studies with larger sample size and adequate power as estimated by the results of this pilot study would confirm the effect of intracoronal sealing biomaterials on the histological outcome of endodontic revitalisation. Full article

This study aimed to evaluate the effect of general anesthesia (GA) on the 1-year outcome of Root Canal Treatment (RCT) performed in pediatric patients and to compare it to the outcome of RCT in pediatric patients without GA. Patients admitted for RCT in permanent dentition in a public hospital, dated 2015 to 2020, age 8–15 with a minimum of one year follow-up period, were included in the study. The sample consisted of 326 teeth from 269 patients treated by a single operator, with a recall rate of 81%. Overall, 124 teeth were treated under GA and 142 teeth were without GA. The mean follow-up time was 31.5 months. Data underwent statistical analysis and the significance threshold was set for p < 0.05. Of the total cases, 90% showed favorable outcomes. A significantly higher favorable outcome was seen in the GA group than in the non-GA group (98% and 85%, respectively, p < 0.001). The outcome was significantly affected by the type and quality of the coronal restoration, degree of root development, and lesion size (p < 0.05). According to the current study, in uncooperative pediatric patients, a more favorable outcome of root canal treatment can be obtained under GA than LA if the procedure is carried out with immediate restoration. Full article

Background: The clinical management of teeth with complex dens invaginatus (DI) malformations and apical periodontitis may be challenging due to the lack of routine. The aim of this case report is to describe the endodontic treatment of an immature tooth with DI and to discuss strategies for preclinical training for teeth with such malformations. Case report: A 9-year-old male presented with an immature maxillary incisor with DI (Oehlers Type II) and apical periodontitis which was diagnosed by cone beam computed tomography (CBCT). Revitalization was initially attempted but then abandoned after failure to generate a stable blood clot. Nevertheless, considerable increase in both root length and thickness could be detected after medication with calcium hydroxide followed by root canal filling with MTA as an apical plug. Conclusions: The endodontic management of teeth with DI requires thorough treatment planning. In immature teeth, under certain conditions, root maturation may occur even with conventional apexification procedures. From an educational perspective, different strategies including CBCT and 3D-printed transparent tooth models for visualization of the complex internal morphology and redesigned 3D-printed replica with various degrees of difficulty for endodontic training, can be used to overcome the challenges associated with endodontic treatment of such teeth. Full article

Tooth germ autotransplantation of open apices of the teeth exhibits high pulpal healing rates, whereas that of mature permanent teeth normally causes irreversible pulpal necrosis. Extraoral root-end resection (EORER) during transplantation may promote pulpal revascularization (PRV) in transplanted mature teeth and reduce endodontic treatment requirement. This study compared the primary outcomes of survival rates, PRV, and root resorption and determined relevant confounders in autotransplanted mature and immature teeth. The medical charts of consecutive patients who underwent tooth autotransplantation between January 2017 and March 2021 were evaluated. Teeth with a documented follow-up of at least 1 year were included. During the study period, 59 teeth were transplanted in 44 patients. Overall, 2 teeth were excluded owing to missing data; 57 teeth were analyzed, including 25 mature teeth additionally treated with EORER. After a mean follow-up of 21.2 ± 16.1 months, no significant differences in primary outcomes were detected. Fifty-five teeth remained in situ (96.5%), and radiological signs of root resorption were detected in 9/57 teeth (15.8%). PRV was positive in 54/57 teeth (94.7%). Surgical duration and PRV failure were significantly associated with high incidences of root resorption. Mature teeth autotransplantation with EORER yielded similar results to immature teeth autotransplantation and is a feasible treatment option. Long surgery and failed revascularization increased root resorption rates. More factors should be evaluated in larger trials with longer observation periods. Full article