Clinical and Radiographic Outcomes of Regenerative Endodontic Procedures in Traumatized Immature Permanent Teeth: Interappointment Dressing or Single-Visit?

IntroductionMore data are needed before affirming that single-visit approaches are effective and safe for regenerative endodontic procedures (REPs). This study compared clinical and radiographic outcomes of REPs between interappointment dressing or single-visit protocols.MethodsTwenty young patients presenting traumatized immature teeth with pulp necrosis were divided into 2 groups. Teeth were submitted to 6% sodium hypochlorite and 2% chlorhexidine irrigation and to 17% EDTA use before blood clot induction. In the interappointment dressing group (n = 11), calcium hydroxide was used with 2% chlorhexidine gel for 21 days before scaffold induction. In the single-visit group (n = 9), the scaffold was induced during the only appointment. Patients were followed up for 24 months. Primary, secondary, and tertiary outcomes were assessed by 3 independent evaluators. Preoperative and follow-up radiographs were assessed for quantitative measurements of the apical diameter, root width, root length, and cervical barrier placement and compared between groups using the t test or Mann-Whitney U test. Categoric variables were assessed with the G test and the Fisher exact test and continuous variables with the Mann-Whitney U test. Statistical significance was set at 5%.ResultsOne tooth showed persistence of infection. No difference was observed in cervical barrier placement (P > .05); between groups regarding primary, secondary, and tertiary outcomes (P > .05); and in parameters of quantitative radiographic outcomes (P > .05).ConclusionsCompleting REPs with an interappointment dressing or a single-visit protocol presented similar clinical and radiographic outcomes. A single-visit protocol of REPs using 6% sodium hypochlorite, 2% chlorhexidine, and 17% EDTA permitted satisfactory outcomes in necrotic immature permanent teeth.     

Dental Pulp Autotransplantation: A New Modality of Endodontic Regenerative Therapy—Follow-Up of 3 Clinical Cases

The aim of this study was to develop a novel method of endodontic therapy, which we refer to as dental pulp autotransplantation. Three patients (2 males and 1 female) were selected for endodontic treatment of a uniradicular premolar and extraction of a third molar (without odontosection). Electric assessment of pulp vitality and computed tomographic imaging were undertaken followed by endodontic access and instrumentation using triantibiotic solution for irrigation in the host tooth. A few minutes before the transplant procedure, the third molar was extracted, the tooth was sectioned with a diamond blade in a low-speed handpiece, and the pulp was carefully removed. After premolar instrumentation, the harvested and preserved pulp tissue was reinserted into the root canal followed by direct pulp capping performed using Biodentine (Septodont, Saint-Maur-des-Fossés, France), a liner of resin-modified glass ionomer cement and composite resin restoration. The teeth were followed up for at least 12 months after the procedures and were analyzed using computed tomographic imaging, electric pulp vitality testing, and Doppler ultrasound examination. At the 3- and 6-month follow-ups, positive pulp vitality and regression of periapical lesions were verified. After 9–12 months, all teeth were revascularized as determined by Doppler imaging, and the tooth vitality was reestablished with no signs of endodontic/periodontal radiolucency or complications. Within the limitations of the study, considering that it was a case series with only 3 patients, we described a highly innovative procedure of pulp autotransplantation, which appears to be feasible, highlighting the potential for clinical application of pulp regeneration using this new modality of endodontic therapy.     

Does the Etiology of Pulp Necrosis Affect Regenerative Endodontic Treatment Outcomes? A Systematic Review and Meta-analyses

ObjectiveTo evaluate if there is a connection between the causes of pulp necrosis (eg, caries, trauma, dental anomaly) and the success of regenerative endodontic treatment.MethodsElectronic databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Embase) were searched for studies on regenerative endodontic treatment, which used both clinical and radiographic evaluation of root maturation after at least 6 months of follow-up. The search terms “necrotic pulp”, “regenerative endodontic treatment”, “revascularization”, and “revitalization” were combined using Boolean operators. The main journals on endodontics and dental traumatology were additionally hand-searched. Studies were included if they specified the causes of pulp necrosis. The primary question under review was, “Does the cause of pulp necrosis affect the outcome of regenerative endodontic treatment?” Other factors such as tooth type, intracanal medicament, irrigation protocol, use of a collagen matrix, and the type of scaffold were evaluated for possible relation with the outcome. The risk-of-bias assessment for randomized and nonrandomized studies was performed separately, using a modified Cochrane Collaboration's tool and risk of bias in non-randomized studies of interventions-I tool, respectively. Meta-analysis was performed, when possible, between studies comparing treatment outcomes of teeth whose pulp necrosis had different etiology. The search strategy yielded 1197 items. After screening, 18 studies reporting 445 regenerative endodontic treatment cases were included.ResultsThe overall success rate for 274 teeth with trauma etiology was 94.8%, for 95 teeth with dens evaginatus etiology was 93.1%, and for 24 teeth with caries etiology was 96%. No significant difference was found between the results of regenerative endodontic treatment among teeth with trauma, dens evaginatus, and caries etiology (P = .055). Meta-analysis of studies comparing teeth with caries vs dens evaginatus and those with trauma vs caries confirmed that there was no evidence for difference in outcomes.ConclusionFurther randomized studies specifically testing such hypothesis are needed to confirm the preliminary results of this review.     

Characteristics of Cracked Teeth with Reversible Pulpitis After Orthodontic Banding—A Prospective Cohort Study

IntroductionCracked teeth with reversible pulpitis can be managed with orthodontic bands in the interim before definitive restorations. The aim of this study was to determine short-term outcomes of these teeth following orthodontic band placement. The time taken for definitive pulp diagnoses after orthodontic band placement and associated prognostic factors was also analyzed.MethodsOne hundred twenty-five patients with a cracked tooth with reversible pulpitis each were recruited. Preoperative data including patient and tooth factors were collected. Cracked teeth were banded and reviewed until symptoms resolved before referral for coronal coverage. Kaplan-Meier and Cox analyses were performed to analyze pulp survival of these teeth. Prognostic factors were investigated using Pearson's chi-square and Student's t-test.ResultsOne hundred twenty-two cracked teeth were analyzed. One hundred thirteen (92.6%) teeth had the pulpitis resolved within 2 months (median 40.0; interquartile range 28–61). The median time taken for progression to irreversible pulpitis or pulp necrosis for teeth that required root canal treatment was 3 months (median 90.0; interquartile range 68–110). No prognostic factors were associated with the resolution of pulpal symptoms. However, higher preoperative triggered pain scores (P < .05, hazards ratio 1.547) and absence of a distal marginal ridge crack (P < .05, hazards ratio 0.638) were correlated with a longer duration before definitive pulp diagnoses.ConclusionFollowing orthodontic band placement, a normal pulp diagnosis was achieved in 92.6% of cracked teeth with preoperative reversible pulpitis. Definitive pulp diagnoses could be determined in approximately 2 months. Teeth with higher preoperative triggered pain scores may require a longer review period.     

Does the Endodontic Education Level Affect Decision-Making for Endodontically Treated Teeth With Apical Periodontitis? A Web-Based Survey

ObjectivesThe management of endodontically treated teeth with apical periodontitis is debated among clinicians. The aim of this study was to evaluate treatment choices for endodontically treated teeth with different sizes of periapical lesions among endodontists, endodontics postgraduate students, general dental practitioners, and undergraduate students who had fulfilled their theoretical and clinical training in endodontics.Materials and MethodsPeriapical lesion images (no periapical lesion and 1-mm, 3-mm, and 5-mm periapical lesions) were formed on 4 different radiographs with a software program, and the survey included 16 radiographs that were emailed to 1881 participants. Treatment options included extraction, surgical or nonsurgical retreatment, and wait and see. The χ² test was used to compare the responses of the participants.ResultsThe survey was returned by 1039 participants (55.23%). There were statistically significant differences among the responses of all participants for all cases (P < .05), except a case with a broken file and no lesion (P = .918). All participants decided to extract at an increased size from a 1-mm periapical lesion to a 5-mm periapical lesion. At all lesion sizes, general dental practitioners planned retreatment less when compared with other groups.ConclusionsThis survey study showed that there was a positive correlation between endodontic education level and retreatment decision-making. Dentists who confront seemingly hopeless endodontically treated teeth such as an instrument fracture, a missing canal, or a large periapical lesion should consult with an endodontist before making the decision to extract the tooth.     

Differences in Masticatory Function in Patients with Endodontically Treated Teeth and Single-implant–supported Prostheses: A Pilot Study

Endodontic treatment and dental implants are both viable treatment options to restore a compromised dentition. How these treatments impact patients' ability to chew has not been studied. The purpose of this study was to compare various parameters of masticatory function in patients with endodontically treated teeth and single-implant supported prostheses. Fifty patients were included in this study. Twenty-five patients had mandibular molar root canals, and 25 had single implant-supported prostheses in the mandibular molar region. The natural tooth contralateral to the treated side served as the internal control. Maximum bite force, chewing efficiency, and areas of occlusal contact and near contact (ACNC) were recorded for each subject, along with a questionnaire to evaluate subjective chewing ability. When compared with contralateral controls, dental implants were found to have significantly lower maximum bite forces, reduced chewing efficiency, and smaller ACNC. Endodontically treated teeth were not statistically different than their contralateral controls. These results indicate that endodontically treated natural teeth may provide more effective occlusal contact during masticatory function compared with implant-supported restorations, leading to more efficient mastication.     

Outcome of Endodontic Surgery: A Meta-analysis of the Literature—Part 3: Comparison of Endodontic Microsurgical Techniques with 2 Different Root-end Filling Materials

Introduction

The aim of the present study was to investigate the influence of root-end preparation and filling material on endodontic surgery outcome. A systematic review and meta-analysis was conducted to determine the outcome of resin-based endodontic surgery (RES, the use of high-magnification preparation of a shallow and concave root-end cavity and bonded resin-based root-end filling material) versus endodontic microsurgery (EMS, the use of high-magnification ultrasonic root-end preparation and root-end filling with SuperEBA [Keystone Industries, Gibbstown, NJ], IRM [Dentsply Sirona, York, PA], mineral trioxide aggregate [MTA], or other calcium silicate cements).

Additional Treatment Indicative of an Unfavorable Endodontic Outcome in a Swedish County—A 10-year Observational Study

IntroductionThis study's aim was to calculate the incidence of first additional endodontic treatment or extraction as the result of an unfavorable endodontic outcome following orthograde root canal treatment (RCT) performed by general dental practitioners during a 10-year period and to identify possible predictors for outcomes.MethodsA randomized cohort of 280 individuals (and as many teeth) with an orthograde RCT was followed for over 10 years. Dental records were reviewed, and individuals were recalled when data were missing. The following terminal events indicative of unfavorable endodontic treatment outcome were orthograde retreatment, surgical endodontics, and tooth extractions exclusively due to endodontic reasons. Selected variables related to individuals and treatment (pre-, intra-, and postoperative) were harvested to analyze possible associations with the terminal events. Unadjusted survival analysis and Cox regression analysis were performed and P < .05 was considered statistically significant.ResultsTerminal events were registered for 22 teeth/individuals and 17 of these were orthograde retreatments. The cumulative 10-year survival of RCTs was 92.7% (standard error 1.7%), with a higher yearly incidence during the first 2 years. The univariate analysis identified 5 factors associated with the outcome. There were too few events to perform a multivariate analysis.ConclusionsThe mean incidence of additional treatment indicative of unfavorable endodontic outcome was 0.7% per year during the first 10 years, but the mean incidence was greater during the first 2 years. Five factors were associated with an unfavorable outcome; however, confounders cannot be excluded from the associations.     

An Innovative Regenerative Endodontic Procedure Using Leukocyte and Platelet-rich Fibrin Associated with Apical Surgery: A Case Report

Regenerative endodontic procedures (REPs) associated with apical surgery could represent an alternative treatment strategy for patients whose teeth present incomplete root formation and extensive apical lesions. Leukocyte platelet-rich fibrin (L-PRF) has potential benefits in REPs; it could promote apical root formation and optimal bone healing. The aim of this case report was to describe innovative regenerative endodontic therapy using L-PRF in the root canal and an extensive apical lesion in an immature tooth with dens invaginatus and asymptomatic apical periodontitis. A healthy 20-year-old woman was referred to the dental clinic of the Universidad de Los Andes, Santiago, Chile, for endodontic treatment in tooth # 22 with incomplete root development and an extensive apical lesion. The diagnosis was asymptomatic apical periodontitis associated with dens invaginatus type II. The patient was treated with an innovative approach using L-PRF in REPs associated with apical surgery. Follow-ups were performed at 6 months and 1 year later. They included periapical radiographs, cone-beam computed tomographic imaging, sensitivity, and vitality tests. The clinical evaluations performed at 6 months and 1 year revealed an absence of symptoms. The radiographic evaluations showed that the apical lesion was resolved. The cone-beam images indicated that the root length increased and the walls had thickened. The sensitivity tests were positive, and the laser Doppler flowmetry showed positive blood flow after 1 year. The success of the results in this case report indicate that L-PRF can be used as a complement in apical surgery and REPs and could provide an innovative alternative treatment strategy for complex clinical cases like these.     

Myofibroma—A Rare Entity with Unique Clinical Presentation

Myofibroma and myofibromatosis is a well-recognized spindle cell neoplasm that occurs predominantly in infants and young children. They have been described under different names since 1951. These lesions are a benign fibroblast and myofibroblast proliferation containing a biphasic presentation of spindle shaped cells surrounding a central zone of less differentiated cells focally arranged in a hemangiopericytoma like pattern. Classically these lesions are described in children younger than two, with 2/3rd present at birth and rarely in adults. Controversy exists as to an autosomal dominant or recessive inheritance or to a sporadic occurrence. Presented here is a unique case of myofibroma involving the mandible in a 11 year-old male patient. Clinically it mimicked more like a beningn tumor and not exhibiting any of its classical signs. The diagnosis could be established only after complete excision of the lesion and histopathological examination. There was no recurrence after a follow up period of 4 months.     

Intracanal Cryotherapy Reduces Postoperative Pain in Teeth with Symptomatic Apical Periodontitis: A Randomized Multicenter Clinical Trial

Introduction

A prospective, multicentered, randomized clinical trial was designed to assess if controlled irrigation with cold saline could result in less incidence and intensity of postoperative pain in patients presenting with pulp necrosis and symptomatic apical periodontitis.

A comparative Study of the Masticatory Efficiency in Complete Dentures Using Acrylic and Metal Occlusal Posterior Teeth—Photocolorimetric Analysis

Masticatory efficiency is always compromised in complete denture patients. The denture teeth with compromised occlusal anatomy and material further compound the inherent limitations of complete dentures. To compare the masticatory efficiency of patients with complete denture using acrylic and metal occlusal posterior teeth. Ten edentulous patients with well-formed ridges were selected. Complete dentures using acrylic and metal occlusal posterior teeth were fabricated. The masticatory efficiency was calculated using photo colorimeter. Complete dentures with 20° acrylic resin posterior teeth were fabricated for ten edentulous patients and masticatory efficiency was measured using raw beetroot as test food on a photocolorimeter after 10, 15, 20 strokes. The acrylic resin posterior teeth were replaced with metal occlusal posterior teeth on the same denture base. The masticatory efficiency was measured by the same method. The mean average percentage of masticatory efficiency with acrylic resin teeth and metal occlusal teeth were first calculated and statistical analysis was done using students unpaired t test. The average masticatory efficiency with acrylic teeth was 46.46% and metal occlusal teeth was 65.62, ‘t’ = 5.38. The difference between the mean average masticatory performance percentage with acrylic teeth and metal occlusal teeth was significant at 1% i.e. P < 0.01. Within the limitation of this study the average percentage value of masticatory efficiency improves considerably when metal occlusal teeth replace normal acrylic teeth without any alteration in position or relation.     

Outcome of Endodontic Micro-resurgery: A Retrospective Study Based on Propensity Score–matched Survival Analysis

Introduction

The purpose of this retrospective study was to evaluate and compare the outcome of endodontic micro-resurgery with that of primary endodontic microsurgery and determine prognostic factors affecting the outcome of micro-resurgery.

In Vitro Comparative Study of the Influence of Instrument Taper on the Fracture Resistance of Endodontically Treated Teeth: An Integrative Approach–based Analysis

Introduction

The objective of this study was to examine the influence of instrument taper on the fracture resistance of endodontically treated roots under in vitro experimental conditions.

Improvement in Oral Health–related Quality of Life after Endodontic Treatment: A Prospective Longitudinal Study

Introduction

To date, evidence of the effectiveness of endodontic treatment and criteria of success have mainly been considered in terms of clinical outcome, and there is a lack of information of treatment outcomes from patients' perspectives. This study aimed to assess changes in quality of life after endodontic treatment and to determine if changes in quality of life were associated with changes in patient-perceived oral health and clinical assessments of success.

Methods

This longitudinal study involved 279 subjects. Patient-reported outcome measures based on oral health–related quality of life was assessed using the short form of the Oral Health Impact Profile (OHIP-14). The patients completed the assessments before endodontic treatment and 1 month and 6 months after root canal obturation. A global oral health transition assessment was ascertained by a single (global) item rating of oral health improvement and clinical assessment mainly based on the Periapical Index (PAI) of periapical radiographs.

Results

There were significant changes in OHIP-14 scores over the study period after conventional orthograde endodontic treatment (from pretreatment–6 months postobturation) (P < .001). The magnitude of statistical change (effect size) was moderate (0.61) in the short-term (after 1 month) and large (0.71) in the longer-term (after 6 months). Changes in the OHIP-14 was associated with changes in patient self-rating oral health status (P < .001), which was also associated with changes in PAI scores (P < .05).

Conclusions

Endodontic treatment improves quality of life. The OHIP-14 measure is both sensitive and responsive to endodontic treatment and is likely to be useful in understanding patients' perspectives of outcomes from endodontic care.     

Endodontic and restorative management of an adult with avulsion of multiple teeth: A case report with 5 years and 9 months of follow-up

Simultaneous avulsion of four or more teeth is a rare event. This case report examines the dental care given to an adult who, during a bicycle accident, experienced the avulsion of a mandibular incisor as well as all of his maxillary incisors. In the immediate aftermath of the accident, four out of the five incisors were located, promptly collected, and stored in a tooth rescue box, all within a 20-min window. Replantation and splinting were performed on the day of the accident. Endodontic treatment involved sequential intracanal dressing with an antibiotic–corticosteroid paste followed by calcium hydroxide prior to root canal obturation. 3 months post-accident, signs of external replacement resorption (ERR) began to appear in all the replanted teeth. The gap created by the missing maxillary central incisor was managed with a three-unit fixed dental prosthesis, despite the onset of ERR in the incisors used as abutment teeth. Regular follow-ups showed a relatively slow ERR progression rate over a span of nearly 6 years. The patient expressed satisfaction with both the esthetic and functional outcomes. This case, marked by multiple avulsions, underscores the importance of immediate and appropriate intervention alongside the imperative for carefully considered long-term management strategies. Given the decelerated bone remodeling rate in adults, ERR generally progresses at a slower pace than in children. Accordingly, this case demonstrates the viability of retaining replanted teeth over the long term, even when these teeth have been subjected to nonphysiological storage for extended durations, a factor known to impede periodontal healing.     

Efficacy of Temporomandibular Joint Arthrocentesis on Mouth Opening and Pain in the Treatment of Internal Derangement of TMJ—A Clinical Study

Purpose

This study was designed to investigate the efficacy of arthrocentesis on mouth opening and pain in the treatment of temporomandibular joint (TMJ) internal derangement patients.

Materials and Methods

Fifteen males and 25 females aged between 18 and 37 years comprised the study material in the department of oral and maxillofacial surgery at Govt Dental College Srinagar (India). The patients’ complaints were limited mouth opening and TMJ pain. Arthrocentesis was performed under aseptic conditions. Clinical evaluation of the patients was done before the procedure, and 1 week and 4 months post-operatively. Intensity of TMJ pain and maximal mouth opening were recorded at each follow-up visit.

Results

There was significant improvement in mouth opening and reduction in pain scores in the post-operative period.

Conclusions

Arthrocentesis is a simple and safe procedure for patients of internal derangement with closed lock for improving mouth opening and decreasing pain.