Search Results (25)

Background/Objectives: Odontogenic cysts are pathological cavities lined by cells arising from odontogenic epithelial cells, occurring mostly on the tooth-bearing areas of the jaws. It is common to find that the apices of the teeth around the cyst are within the cyst’s cavities due to its expansion. This study aims to assess the outcome of cyst enucleation on the associated teeth, specifically the latter’s responsiveness after cyst enucleation. Methods: This retrospective study examined a sample of patients who had been previously treated for odontogenic cysts from 1 January 2000 to 31 December 2021. A list of patients was obtained and included whether they met the imposed inclusion criteria. The data collected included the patients’ preoperative and postoperative electric pulp testing readings and their timings. Results: In total, 77 individual teeth from 19 patients were included after meeting the inclusion/exclusion criteria. Overall, 57 out of the 77 (74%) teeth were responsive following long-term follow-up. Among the 57 teeth with a positive response, 8 teeth were initially non-responsive and regained their responsiveness after a period of time. Pulp responsiveness recovery was seen even 300 days after surgery. Conclusions: It is not certain that a tooth with apices involved in a cyst cavity will be non-vital following enucleation. It is recommended that these teeth be reassessed for a minimum of 10 months postoperatively before proceeding with root canal treatment. Full article

Background: Root fractures are defined as injuries involving dentine, cementum, and the pulp. They are rare, and they account for 0.5–7% of the dental injuries in the permanent teeth. Root fractures may be the result of direct trauma to the teeth or indirect trauma to the oral cavity. Their incidence is highest in the group of adolescent patients aged 11 to 20 years. The purpose of the paper is to review the literature supported by a case series with three different types of root fractures with various healing patterns, though all with successful long-term treatment outcomes. Case series: All presented patients were boys aged 10 to 11 years. Root fractures occurred as a result of direct impact with the teeth by an object. Only one boy had his root-fractured teeth endodontically treated. However, one of the teeth was misdiagnosed with pulp necrosis, and the other became non-vital after additional trauma. Conclusions: Root fractures in young patients have good healing potential. Appropriate and early diagnostic and therapeutic procedures for treating root-fractured teeth are necessary to achieve favorable healing and a good long-term prognosis. Regardless of the pattern of healing of fractured roots and the treatment provided, patients require long-term follow-up and the need to plan a management strategy in case complications occur. Failure of the healing of fractured root is a worst-case scenario, especially in patients of developmental age. In such cases, the primary goal of treatment is to preserve the alveolar ridge until growth is complete. Full article

The aim of the study was to collect data about the prevalence and risk factors of apical periodontitis in a population of endodontically treated patients. The study group included 151 patients (52 males, 99 females; mean age 48.36 ± 15.708 yrs.) with 391 endodontically treated teeth (mean follow-up of 5.25 ± 1.759 yrs.). According to the initial tooth diagnosis, root-filled teeth were divided into Group A, root-filled teeth treated for pulpitis or for the purpose of prosthetic pulpectomies (vital pulp group), and Group B, root-filled teeth with non-vital pulp (necrotic pulp). Clinical and radiographic evaluation of the root and its periapical area were performed to establish the success/failure of endodontic therapy, the quality of the root canal fillings (length, density, taper), and coronal restoration. The presence of recurrent caries, periodontal pathology, or endo-periodontal lesions were also recorded. Univariate and multivariate analyses were used to determine the risk factors for apical periodontitis and calculate their odds ratios (ORs). For the root-filled vital pulp tooth group, the highest risks for apical periodontitis are associated with inadequate homogeneity (OR 30.938), periodontitis (OR 9.226), and over-filling (OR 8.800). For the root-filled non-vital pulp tooth group, the highest risks are associated with periodontitis (OR 4.235) and age over 60 yrs. (OR 4.875). For the necrotic pulp tooth group, multivariate analysis identified an age > 60 yrs., filled molars, intracanal posts, poor coronal restoration quality, under-filling, and periodontitis as significant combined risk factors. Inadequate root canal filling and periodontitis in both groups were risk factors associated with most cases of apical periodontitis. Other risk factors include age > 60 yrs., poor coronal restoration quality, and the presence of intracanal posts in root-filled teeth with necrotic pulp. Full article

This study aimed to review the considerations for choosing a suitable sealer according to various endodontic scenarios. An electronic search of PubMed, Scopus, and the Web of Science was undertaken for the keywords of ‘sealer choosing’, ‘appropriate sealer’, ‘suitable sealer’, ‘sealer for clinical scenario’, and ‘sealer for clinical situations’. However, the literature review revealed a lack of studies with practical clinical recommendations regarding the choice of appropriate endodontic root canal sealers for particular clinical situations of root canal treatment. Therefore, a narrative review was undertaken under the basis of the characteristics of an epoxy resin-based sealer (ERS) versus a calcium silicate-based sealer (CSS). Based on the evidence found through the review, the choice of an appropriate sealer in a variety of clinical scenarios was proposed. An ERS is recommended for one-visit non-vital cases, teeth with periodontal involvement, cracked teeth, and internal root resorption without root perforation. A CSS is recommended for vital or non-vital cases in multiple visits, teeth with internal root resorption with perforation or internal approach for external cervical resorption, teeth with open apices, and teeth with iatrogenic aberrations. Full article

The aim of this study was to clinically and radiographically assess the effects of two bioceramic cements as coronal plug materials for the revascularization of non-vital, immature, permanent teeth with apical periodontitis. Twenty non-vital, immature, permanent, anterior teeth with apical periodontitis were included in this study. Samples were randomly divided into two groups based on the coronal plug materials used; group I (GI): Well Root PT (Vericom, Gangwon-do, Korea) and group II (GII): MTA Biorep (Itena Clinical, Paris, France) (n = 10). Follow-up was conducted clinically and radiographically for up to 12 months to evaluate the changes in root dimensions and resolution of the periapical disease and investigate the degree of success. Data were statistically analyzed using ANOVA tests and Mann–Whitney U tests at a 0.05 significance level. At 12 months, none of the patients in either test group had clinical signs/symptoms. There was a slight increase in root length (4.4% in GI and 3.4% in GII) and a slight increase in dentin wall thickness (10.2% in GI and 9.9% in GII) with no statistically significant (p > 0.05) differences. Whilst there was a significant decrease in lesion dimension in all patients after 12 moths of treatment (93% in GI and 91% in GII), there were no statistically significant differences between the two study groups (p > 0.05). Regarding the degree of success, all cases (100%) achieved the primary goal (the elimination of symptoms and the evidence of bony healing), while 60% in GI and 40% in GII achieved the secondary goal (increased root wall thickness and/or increased root length). No statistically significant difference was found between groups (p > 0.05). Both bioceramic cements showed satisfactory clinical and radiographic findings. Premixed calcium aluminosilicate and tricalcium silicate cements could be used as coronal plug materials in revascularization procedures. Bioceramic cements can be considered promising coronal plug materials for the revascularization of immature, permanent teeth with necrotic pulps and apical periodontitis due to their physicochemical and biological properties. Full article

Internal bleaching is a conservative treatment applied to a darkened endodontically treated tooth to restore its original colour, either as a single treatment or as a treatment prior to a subsequent prosthetic phase. The aim of this study was to objectively measure and compare using an experimental model the expansive capacity of four bleaching groups: carbamide peroxide 37% (CP 37%), hydrogen peroxide 30% (HP 30%), HP 30% mixed with sodium perborate (SP) and SP mixed with distilled water. A total of 150 lower incisors (n = 30 in each group) were prepared for the Walking Bleach technique and a glass tube with oil was introduced into the coronal access cavity to measure the expansive capacity through oil displacement, due to the reaction that occurs when bleaching agents interact with dental tissues. The results after 10 days were analysed with the Games–Howell post hoc test to compare the samples. Significant higher expansion was observed with HP 30% (p < 0.05) and lower expansion with SP (p < 0.05) compared to the other groups. No significant differences were observed between CP 37% (p > 0.05) and HP 30% + SP (p > 0.05). This provides significant and observable information on the behaviour of each bleaching group and its evolution after 10 days. Full article

Nowadays, the ceramic veneer approach can be considered more predictable than direct composite veneer. To date, there is a lack of studies comparing the clinical performance of anterior veneers cemented on vital teeth (VT) and non-vital teeth (NVT). This longitudinal clinical study investigated the performance of ceramic veneers in VT or anterior NVT. A total of 55 patients were evaluated in the study. Two groups were defined based on the vitality status of the teeth (93 teeth—vital and 61 teeth—non-vital). The United States Public Health Service (USPHS) criteria were used to assess the clinical status. The data were evaluated statistically with the Mann–Whitney U test. All restorations were considered acceptable, and only one veneer in VT failed for the criteria of secondary caries. There were no statistically significant differences in any of the criteria evaluated (p ≤ 0.671). The ceramic veneers evaluated showed a satisfactory clinical performance both in VT and NVT. Full article

Objectives: This study aims to retrospectively evaluate the survival rate of pulpectomy performed under dental general anesthesia (DGA) through long-term follow-up and to explore the risk factors associated with treatment failure. Methods: The medical records of the children who were diagnosed with S-ECC and received pulpectomy treatment under general anesthesia (GA) from 1 August 2014 to 1 December 2019, in the Stomatological Hospital of Xi’an Jiaotong University, were collected. Two dentistry postgraduates extracted the necessary information and filled in a predesigned excel form. Survival analysis was performed using the Kaplan-Meier method. The shared frailty model was used to explore possible factors affecting the success rate of pulpectomy in primary teeth. Results: A total of 381 children (mean age 3.49 ± 0.90) with S-ECC and 1220 teeth were included in the study, including 590 primary anterior teeth and 630 primary molars. The overall 35-month survival rate was 38.5%, which was 52.9% for anterior teeth and 31.1% for molars. The overall median survival time was 31 months, in which anterior teeth were 35 months and molars were 26 months. The older the children were, the greater the risk of treatment failure (HR 1.56, 95% CI 1.09, 2.24). The risk of pulpectomy failure of primary molars was 1.9 times that of primary anterior teeth (95% CI 1.36, 2.65) and the teeth with abnormal radiological findings before treatment was 1.41 times higher than that of teeth without imaging abnormalities (95% CI 1.74, 3.36). Conclusion: The survival rate of primary tooth pulpectomy is acceptable but decreased gradually with time. The failure rate of pulpectomy in primary molars is higher than that of primary anterior teeth. When the primary caries has extended to the pulp and resulted in a nonvital lesion, pulpectomy could be an option for maximum retention of the primary tooth. Full article

Objective. The causes of internal posteruptive discoloration of teeth are bleeding, necroses, infections, and endodontic filling materials. The aim of this study was to establish the results of bleaching endodontically treated teeth using walking bleach, in-office, and combined techniques, using 30% carbamide peroxide and 35% hydrogen peroxide, as well as the effect of etiological factors, and the time elapsed after endodontic treatment on the success of bleaching. Materials and Methods. The research involved 30 endodontically treated teeth in healthy patients. Retroalveolar X-rays were taken to check the quality of root canal obturation. Endodontic treatment and obturation were carried out on the discolored non-vital teeth without any previous endodontic treatment. Before bleaching, two millimeters of the filling were removed from the root canal and the very entry into the canal was protected with glass ionomer cement. The teeth were divided into three groups, depending on the bleaching technique: walking bleach technique (10 patients), in-office technique (10 patients), and combined technique (10 patients). The teeth were bleached with 30% carbamide peroxide and 35% hydrogen peroxide. The bleaching procedure was repeated in all the patients three times. The color of all teeth was determined based on the Vita Classic guide before and after bleaching. The Χ² square and Kruskal–Wallis tests were used to identify differences in teeth bleaching results. Results. A statistically significant difference (p < 0.05) was established between bleaching success and the time elapsed after endodontic treatment. There were no statistically significant differences observed between the bleaching success and etiological factors, bleaching techniques, or bleaching agents. Conclusions. The effectiveness of non-vital tooth bleaching is affected by the time elapsed after endodontic treatment. Full article

In the last few decades, biomimetic concepts have been widely adopted in various biomedical fields, including clinical dentistry. Endodontics is an important sub-branch of dentistry which deals with the different conditions of pulp to prevent tooth loss. Traditionally, common procedures, namely pulp capping, root canal treatment, apexification, and apexigonesis, have been considered for the treatment of different pulp conditions using selected materials. However, clinically to regenerate dental pulp, tissue engineering has been advocated as a feasible approach. Currently, new trends are emerging in terms of regenerative endodontics which have led to the replacement of diseased and non-vital teeth into the functional and healthy dentine-pulp complex. Root- canal therapy is the standard management option when dental pulp is damaged irreversibly. This treatment modality involves soft-tissue removal and then filling that gap through the obturation technique with a synthetic material. The formation of tubular dentine and pulp-like tissue formation occurs when stem cells are transplanted into the root canal with an appropriate scaffold material. To sum up tissue engineering approach includes three components: (1) scaffold, (2) differentiation, growth, and factors, and (3) the recruitment of stem cells within the pulp or from the periapical region. The aim of this paper is to thoroughly review and discuss various pulp-regenerative approaches and materials used in regenerative endodontics which may highlight the current trends and future research prospects in this particular area. Full article

The aim of the present study was to evaluate the fatigue to cyclic and static resistance of indirect restorations with different preparation designs made either of lithium disilicate (LS) or polymer-infiltrated ceramic network (PICN). Eighty-four (n = 84) molars were chosen, endodontically treated, and prepared with standardized MOD cavities. The molars were randomly divided into 6 study groups (n = 14) taking into account the “preparation design’’ (occlusal veneer with 1.2 mm occlusal thickness; overlay with 1.6 mm occlusal thickness; adhesive crown with 2 mm occlusal thickness) and the “CAD/CAM material’’ (E-max CAD, Ivoclar vivadent; Vita Enamic, Vita). A fatigue test was conducted with a chewing simulator set at 50 N for 1,500,000 cycles. Fracture resistance was assessed using a universal testing machine with a 6 mm diameter steel sphere applied to the specimens at a constant speed of 1 mm/min. A SEM analysis before the fracture test was performed to visually analyze the tooth-restoration margins. A statistical analysis was performed with a two-way ANOVA and a post-hoc pairwise comparison was performed using the Tukey test. The two-way ANOVA test showed that both the preparation design factor (p = 0.0429) and the CAD/CAM material factor (p = 0.0002) had a significant influence on the fracture resistance of the adhesive indirect restorations. The interaction between the two variables did not show any significance (p = 0.8218). The occlusal veneer had a lower fracture resistance than the adhesive crown (p = 0.042) but not lower than the overlay preparation (p = 0.095). LS was more resistant than PICN (p = 0.002). In conclusion, in the case of endodontically treated teeth, overlay preparation seems to be a valid alternative to the traditional full crown preparation, while occlusal veneers should be avoided in restoring non-vital molars with a high loss of residual tooth structure. LS material is more resistant compared to PICN. Full article

The survival rate of root non-vital teeth is lower than that of vital teeth. Therefore, to preserve the dental pulp is very important. The vascular endothelial growth factor (VEGF) is the most potent angiogenic factor involved in the vitality of dental pulp including reparative dentin formation. Caffeic acid phenethyl ester (CAPE) is a physiologically active substance of propolis and has some bioactivities such as anti-inflammatory effects. However, there are no reports on the effects of CAPE on dental pulp inflammation. In this study, we investigated the effects of CAPE on VEGF and inflammatory cytokine production in human dental pulp cells (HDPCs) to apply CAPE to an ideal dental pulp protective agent. We found that CAPE induced VEGF production from HDPCs. Moreover, CAPE induced the phosphorylation of p38 mitogen-activated protein kinase (MAPK), extracellular signal-regulated kinases (ERK), and stress-activated protein kinase/c-Jun N-terminal kinase (SAP/JNK) in HDPCs. Furthermore, CAPE inhibited C-X-C motif chemokine ligand 10 (CXCL10) production in Pam3CSK4- and tumor necrosis factor-alpha (TNF-α)-stimulated HDPCs. In conclusion, these results suggest that CAPE might be useful as a novel biological material for vital pulp therapy by exerting the effects of VEGF production and anti-inflammatory activities. Full article

Aims: This case demonstrates the adverse sequelae that can follow a traumatic dental injury at a young age. It also highlights the importance of taking a full history and undertaking a thorough exam, independent of the information in the referral. Case presentation: A 9-year-old boy was referred for treatment of “an extra tooth” and “hypoplastic and non-vital” maxillary left permanent incisors. Examination revealed a sinus tract labial to these incisors (21,22) with increased probing depth. However, the teeth were otherwise normal. The child sustained a fall as a baby and lost one of his primary teeth that was never recovered. Information collected suggested the most likely diagnosis was an undiagnosed complete intrusion of a primary incisor, with subsequent hypoplasia and malalignment in the developing teeth. Management included the removal of the intruded primary tooth and monitoring of the hypoplastic permanent incisors until complete eruption and root maturation. Aesthetic restorations were then provided. The patient was referred for orthodontic correction of the malalignment. Conclusion: Misdiagnosis and inappropriate management of dental trauma can cause additional damage. In this case, endodontic therapy in the permanent incisors was avoided by correct diagnosis. Clinicians have to correctly assess and justify their decisions on each individual case. Full article

Intra-coronal bleaching is a treatment that whitens non-vital teeth from within the pulp chamber, a procedure by which oxygen and free radicals are released. This in vitro study analyzed and compares the oxygen expansion produced when different bleaching agents encounter dental tissues during this type of bleaching. Here, 120 lower incisors were included and prepared to achieve conditions as close as practicable to internal bleaching with the walking bleach technique. The access cavity of the lingual surface was prepared to seal glass tubes with oil inside them by adhesive restoration once the bleach was placed inside the pulp chamber. The following bleaching groups were used: hydrogen peroxide (HP) 30% (n = 30), sodium Perborate (SP) with distilled water (n = 30), a mixture of HP 30% with SP (n = 30) and a control group (n = 30). After 10 days, the oil displacement that took place through the tube due to oxygen release was measured daily. Displacement of the oil was observed in all groups except the control group. The final mean expansion at 10 days was 335.24 ± 76.85 mm for the HP 30% group, 8.40 ± 1.74 mm for the SP group and 183.07 ± 49.93 mm for the HP30% + SP mixture. Significant statistical differences were observed between the three groups using the Games–Howell post hoc test, where HP30% caused the greatest expansion and SP the least expansion. These results suggest that the higher the amount of HP in the sample, the more oxygen expansion is observed, so that temporary restoration must be performed more carefully to avoid displacement. Full article

There is ample evidence to support the use of endocrowns to restore endodontic teeth. However, the influence of the position of the interproximal margins on fracture strength has not yet been studied. The aim was to determine the relationship between the apicocoronal position of the interproximal restorative margins and fracture resistance in nonvital teeth restored with CAD/CAM endocrown overlays. Forty extracted human maxillary premolars were prepared for endocrown overlay restorations without ferrule on the interproximal aspects and classified according to the position of the interproximal restoration margins in relation to the alveolar crest: 2 mm (group A), 1 mm (group B), 0.5 mm (group C), and 0 mm (group D). Fracture strength was measured using a universal testing machine applying a compressive force to the longitudinal tooth axis. Group A had a mean fracture resistance of 859.61 (±267.951) N, group B 1053.9 (±333.985) N, group C 1124.6 (±291.172) N, and group D 780.67 (±183.269) N, with statistical differences between groups. Group C had the highest values for fracture strength compared to the other groups (p < 0.05). The location of the interproximal margins appears to influence the fracture resistance of CAD/CAM endocrown overlays. A distance of 0.5 mm between the interproximal margin and the alveolar crest was associated with increased fracture resistance. Full article