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1.

Introduction

Questions exist regarding the efficacy of resin-containing materials such as TheraCal directly applied on the pulp. This study sought to investigate the clinical efficacy of TheraCal as compared with Biodentine and ProRoot mineral trioxide aggregate (MTA) for partial pulpotomy.

Methods

In this clinical trial, partial pulpotomy was performed for 27 sound human maxillary and mandibular third molars scheduled for extraction. The teeth were randomly divided into 3 groups (n = 9) and underwent partial pulpotomy with TheraCal, Biodentine, and ProRoot MTA. The teeth were then restored with glass ionomer cement. Clinical and electric pulp tests were performed after 1 and 8 weeks. The teeth were radiographed and extracted at 8 weeks. Histologic sections were prepared and analyzed for pulp inflammation and dentinal bridge formation. Data were analyzed by using one-way analysis of variance.

Results

Clinical examination showed no sensitivity to heat, cold, or palpation in ProRoot MTA and Biodentine groups. Two patients in TheraCal group (20%) reported significant pain at 1 week. Periapical radiographs showed no periapical pathology, and electric pulp test revealed a normal pulp response with no hypersensitivity. Inflammation was absent with all materials at 8 weeks. Normal pulp organization was seen in 33.33% of the teeth in ProRoot MTA, 11.11% in TheraCal, and 66.67% in Biodentine group (P = .06). Biodentine group showed complete dentinal bridge formation in all teeth, whereas this rate was 11% and 56% in TheraCal and ProRoot MTA groups, respectively (P = .001).

Conclusions

Overall, Biodentine and MTA performed better than TheraCal when used as partial pulpotomy agent and presented the best clinical outcomes.  相似文献   

2.

Introduction

Mineral trioxide aggregate (MTA) has been used in pulp capping of cariously exposed mature permanent teeth with promising results. The search for alternative materials that seal better and set faster than MTA and do not stain is ongoing. Biodentine (Septodont, St Maur-des-Fossés, France) exhibits these advantages but has not been tested yet for a prolonged duration in mature teeth. This study aimed to evaluate the clinical performance of Biodentine and white MTA (Angelus, Londrina, Brazil) in cariously exposed mature permanent teeth.

Methods

This was a prospective longitudinal randomized controlled study of 68 vital permanent teeth with deep caries. Patients were randomly allocated into 2 study arms: Biodentine and MTA. Teeth were assessed clinically and radiographically before the procedure. Caries were excavated under local anesthesia; hemostasis was achieved after pulp exposure using sodium hypochlorite and capped with Biodentine or MTA. Clinical and radiographic follow-ups were performed by a blinded calibrated evaluator after 6 months and 1, 2, and 3 years.

Results

There were no significant differences in the overall success rate between Biodentine and MTA; it was 93.3% (Biodentine = 93.1% and MTA = 93.5%) at 6 months. The overall success rate increased to 96.2% (Biodentine = 96.0% and MTA = 100%) at 1 year and to 100% at 2 years. At the 3-year follow-up, it decreased to 93.8% (Biodentine = 91.7% and MTA = 96.0%).

Conclusions

Biodentine and MTA have favorable and comparable success rates when used as direct pulp capping or pulpotomy material in permanent mature teeth with carious exposure. The remaining tooth structure and durability of coronal restoration might affect significantly the long-term success of vital pulp therapy.  相似文献   

3.

Introduction

This study aimed to compare the success rates of direct pulp capping (DPC) by using either ProRoot Mineral Trioxide Aggregate (MTA) or Biodentine in the cariously exposed permanent teeth of 6- to 18-year-old patients. Gray discoloration was also evaluated.

Methods

Fifty-nine cariously exposed permanent teeth, including teeth with diagnosis of normal pulp, reversible pulpitis, or irreversible pulpitis, early periapical involvement, and exposure size of up to 2.5 mm, were included. Each patient with only 1 cariously exposed tooth was randomly allocated to DPC with either ProRoot MTA (n = 30) or Biodentine (n = 29). Patients were recalled every 6 months. Clinical and radiographic examinations were used to determine success.

Results

Fifty-five patients (mean age, 10 ± 2 years), 27 treated with ProRoot MTA and 28 with Biodentine, were included in the analysis. At mean follow-up of 18.9 ± 12.9 months, the success rate was 92.6% with ProRoot MTA and 96.4% with Biodentine (P > .05; difference, 4%; 95% confidence interval [CI], –8% to 16%). Biodentine was non-inferior to ProRoot MTA. Failures were distributed equally in all categories of pulpal diagnosis and occurred in teeth with no periapical involvement and small exposures (0.5 mm). The survival probabilities of DPC with ProRoot MTA and Biodentine were 0.92 (95% CI, 0.73–0.98) and 0.96 (95% CI, 0.80–0.99). No significant difference was observed between them (P > .05). Gray discoloration was observed only with ProRoot MTA (55%).

Conclusions

Biodentine was non-inferior to ProRoot MTA when used as a DPC material for cariously exposed permanent teeth of 6- to 18-year-old patients. However, Biodentine did not cause any gray discoloration in this study.  相似文献   

4.

Introduction

The aim of this study was to investigate the sequelae of direct pulp capping (DPC) using mineral trioxide aggregate (MTA) and Biodentine in mature permanent teeth with carious exposure.

Methods

Clinical records of 30 patients (15 each with MTA and Biodentine) treated with DPC technique from January 2015 to June 2015 were retrieved. Success rates (based on symptoms, sensibility tests, and radiographic analysis) and adverse events were analyzed.

Results

The patients were reviewed at 1, 3, 6, 12, and 18 months after treatment. Four cases (2 each of MTA and Biodentine) were lost to follow-up. MTA and Biodentine groups showed success rates of 84.6% and 92.3%, respectively, with overall success rate of 88.5%. Radiographically visible dentin bridge formation was observed in 69.2% (9/13) and 61.5% (8/13) of cases done with MTA and Biodentine, respectively. The cases done with MTA showed coronal discoloration on review. Diffuse calcifications of the pulp chamber were observed in 1 (7.7%) case done with MTA and 3 (23.1%) cases done with Biodentine.

Conclusions

The advent of bioceramic materials with better biocompatibility and sealing properties can make the outcome of DPC technique in mature permanent teeth with carious exposure more predictable. The success rate observed in this study should be confirmed through randomized controlled trials with long follow-up periods. Effects of adverse events like coronal discoloration and calcifications of the pulp chamber also need to be evaluated.  相似文献   

5.

Introduction

Vital pulp therapy (VPT) is a biological approach to minimally invasive endodontics. This randomized clinical trial aimed to evaluate and compare clinical and radiographic success of 4 VPTs (indirect pulp capping [IPC], direct pulp capping [DPC], miniature pulpotomy [MP], and full pulpotomy [FP]) using calcium-enriched mixture cement for deep caries management of mature permanent molars including teeth with clinical signs of irreversible pulpitis and the presence of apical periodontitis.

Methods

Blinded participants (N = 302) were randomly allocated to 4 study arms. Random allocation was disregarded when visible pulp exposures did not happen after complete caries removal and the tooth was transferred to the IPC arm. Pre- and intraoperative data including vitality test results, pulpal/periapical status, and exposure type/location were recorded. Pain was measured using a numeric rating scale before treatment initiation up to 1 week postoperatively. Participants were followed up for 1 year.

Results

The groups were homogenous in terms of age, sex, marital status, education, and practitioner; pre- and intraoperative conditions were similar in all arms and did not affect the long-term success. Preoperative pain and apical periodontitis were significantly different among arms (P < .05); however, it was not the case when the IPC group was excluded. After baseline pain adjustment, pain relief was continuous with similar patterns in all treatment groups. The 3- and 12-month success rates of the VPT techniques were comparable in the IPC (98.7% and 100%, respectively), DPC (98.4% and 94.7%, respectively), MP (98.4% and 91.4%, respectively), and FP (93.5% and 95.5%, respectively) arms, respectively (P > .05).

Conclusions

In deep caries management of mature permanent molars, the 4 VPTs were associated with favorable/comparable clinical and radiographic outcomes. The pulpal and periapical status as well as pulpal exposure type/location had no effect on treatment outcomes.  相似文献   

6.

Introduction

A lack of information exists regarding the efficacy of RetroMTA (BioMTA, Seoul, Korea) directly applied on the pulp in vital pulp therapy. This study was designed to examine the clinical efficacy of RetroMTA compared with ProRoot mineral trioxide aggregate (MTA) (Dentsply Tulsa Dental, Tulsa, OK) for partial pulpotomy.

Methods

Partial pulpotomy was performed in 22 healthy human maxillary and mandibular third molars planned for extraction. The teeth were randomly divided into 2 groups (n = 11) and underwent partial pulpotomy with RetroMTA and ProRoot MTA as the control. The teeth were then restored with glass ionomer cement. Clinical and electric pulp tests were performed after 1 and 8 weeks. The teeth were radiographed and extracted at 8 weeks. Histologic sections were prepared and analyzed for pulp inflammation and dentinal bridge formation. Data were analyzed using the Mann-Whitney U test.

Results

Clinical examination after 1 and 8 weeks showed no sensitivity to heat, cold, or palpation in the ProRoot MTA and RetroMTA groups. Periapical radiographs taken before the extraction of teeth showed no evidence of periapical pathology. Electric pulp testing revealed no sensitivity. Data comparisons using the Mann-Whitney U test showed no significant difference between the materials with regard to the pulp inflammation type, intensity and extension (P = .3), or bridge continuity (P = .12). However, these data revealed a significant difference between the 2 materials in pulp morphology (P < .05) and bridge thickness (P < .01).

Conclusions

This is the first work to evaluate a RetroMTA histologic outcome in partial pulpotomy in human permanent teeth. It shows pulp disorganization, an absence of inflammation, and discontinuous mineralization, which may represent a potential drawback with RetroMTA in this indication.  相似文献   

7.

Introduction

The purpose of this study was to determine the prevalence and size of periapical radiolucencies using cone-beam computed tomographic (CBCT) imaging in teeth without apparent signs of intraoral radiographic lesions.

Methods

One hundred twenty roots from 53 patients who had been determined to have no signs of intraoral radiographic lesions were included in this study. Limited-volume CBCT scans were taken at 0.125-mm3 voxel size. The widest area of apical radiolucency of each root canal–treated tooth was measured and assigned a numeric score based on the CBCT-Endodontic Radiolucency Index (ERI). CBCT data were evaluated by 2 radiologists with an interclass correlation coefficient of 0.96.

Results

The majority of roots (53.3%) had periodontal ligament widths ≤0.5 mm; 26.7% had radiolucency widths of 0.5 < x ≤ 1 mm, 15.0% had radiolucency widths of 1.0 < x ≤ 1.5 mm, 0.8% had radiolucency widths of 1.5 < x ≤ 2.0 mm, 1.7% had radiolucency widths of 2.0 < x ≤ 2.5 mm, and 2.5% had radiolucency widths of >2.5 mm. Patient age, recall interval, tooth type, and arch type had no statistically significant effect on the ERI distribution.

Conclusions

Twenty percent of teeth with successful root canal treatment based on conventional periapical imaging had CBCT radiolucencies measuring greater than 1 mm. Because these radiolucencies may not be pathological changes, clinicians are cautioned against overtreatment of them before determining the true nature of these findings. Clinical studies with long follow-up times are needed to determine the proper course of actions for these cases.  相似文献   

8.

Introduction

NeoMTA Plus (Avalon Biomed Inc, Bradenton, FL) is a tricalcium silicate material similar to the first mineral trioxide aggregate product, ProRoot MTA (Dentsply Sirona, York, PA), but with improvements such as decreased setting time, increased ion release, increased water sorption, and nonstaining radiopacifiers. Quick-Set2 (Avalon Biomed Inc) is a newly formulated calcium aluminosilicate material that has a faster setting time and increased acid resistance and is nonstaining. The purpose of this study was to compare the healing of pulpal and periapical tissues in dogs after exposure to NeoMTA Plus and Quick-Set2 after pulpotomy and root-end surgery procedures.

Methods

Seventy-two teeth (36 for each procedure) in 6 beagle dogs received pulpotomy or root-end surgery using either NeoMTA Plus or Quick-Set2. The dogs were sacrificed at 90 days, and the teeth and surrounding tissues were prepared for histologic evaluation. Sixty teeth were evaluated and scored histologically (29 with pulpotomies and 31 with root-end resections). Specimens were scored for inflammation, quality and thickness of dentin bridging, pulp tissue response, cementum and periodontal ligament formation, and apical bone healing.

Results

Both materials displayed favorable healing at 90 days. The only significant difference was the quality of dentin bridge formation in pulpotomies using NeoMTA Plus compared with Quick-Set2.

Conclusions

Quick-Set2 and NeoMTA Plus had similar effects on inflammation, pulp response, periodontal ligament and cementum formation, and apical tissue healing in dogs. NeoMTA Plus had superior dentin bridge quality compared with Quick-Set2.  相似文献   

9.

Introduction

Direct pulp capping treatment is intended to preserve pulp vitality, to avoid or retard root canal treatment, and, in cases with an open apex, to allow continued root development. Historically, calcium hydroxide (CH) was the gold standard material, but nowadays calcium silicate materials (CSMs) are displacing CH because of their high bioactivity, biocompatibility, sealing ability, and mechanical properties. However, more randomized clinical trials are needed to confirm the appropriateness of CSMs as replacement materials for CH in direct pulp capping procedures.

Methods

A randomized clinical trial was conducted that included 169 patients (mean age, 11.3 years) from the Maipo district (Chile). The inclusion criterion was patients with 1 carious permanent tooth with pulpal exposure, a candidate for a direct pulp capping procedure. The patients were randomly allocated to one of the experimental groups (CH, Biodentine, or mineral trioxide aggregate [MTA]). Clinical follow-up examinations were performed at 1 week, 3 months, 6 months, and 1 year. The Fisher exact test was performed.

Results

At the follow-up examination at 1 week, the patients showed 100% clinical success. At 3 months, there was 1 failure in the CH group. At 6 months, there were 4 new failures (1 in the CH group and 3 in the MTA group). At 1 year, there was another failure in the CH group. There were no statistically significant differences among the experimental groups.

Conclusions

CSMs appear to be suitable materials to replace CH. Although no significant differences were found among the materials studied, Biodentine and MTA offered some advantages over CH.  相似文献   

10.

Introduction

Several variables have been associated with a better prognosis of periapical surgery. The aim of this study was to evaluate the influence of 2 hemostatic agents on the prognosis of periapical surgery at 12 months.

Methods

A prospective study was designed with 2 randomized parallel groups established depending on the hemostatic agent used: epinephrine or aluminum chloride. The analysis of the hemorrhage control was recorded as 0 (no hemorrhage control), 1 (slight but apparent intermittent bleeding persisted after application of the material), or 2 (complete hemorrhage control). At 12 months, periapical lesion healing was determined clinically and radiologically as success, improvement, or failure.

Results

Ninety-five patients (67 women and 28 men) with periapical lesions involving a single tooth were enrolled in this study; in 45 teeth, epinephrine was used and in 50 teeth aluminum chloride. In the epinephrine group, 28 teeth were classified as successes, 10 as improvements, and 7 as failures. In the aluminum chloride group, 34 teeth were classified as successes, 11 as improvements, and 5 as failures. No statistically significant difference was found.

Conclusions

The present study found no association between the use of epinephrine or aluminum chloride as hemostatic agents on the prognosis of periapical surgery. The efficacy of hemostatic agents at the time of surgery showed no relationship with the healing outcome.  相似文献   

11.

Introduction

A regenerative endodontic procedure (REP) is a biologically based treatment to functionally replace the pulp of infected immature permanent teeth. The purpose of this retrospective case series was to assess the outcome of REPs of infected immature permanent teeth in terms of periapical bone healing (PBH), root development (RD), and pulp vitality.

Methods

Five patients (1 tooth/patient) who had undergone a REP based on the cell homing concept were recalled 3, 6, 12, 24, and 36 months postoperatively. At each recall session, clinical and periapical radiographic (PR) investigations were performed. Cone-beam computed tomographic (CBCT) imaging was taken before and 36 months after REPs. Qualitative and quantitative PR assessments were performed on the teeth that underwent REPs. Quantitative CBCT analyses were performed on the teeth that underwent REP and contralateral teeth.

Results

At each recall session, all teeth were asymptomatic but reacted negatively on carbon dioxide snow and electrical pulp testing. All teeth that underwent a REP showed complete PBH and further RD on PR and CBCT assessments when comparing the baseline with the final recall radiographs. CBCT analyses indicated increases in root hard tissue volume and RL for all teeth that underwent a REP, but they were 5 and 3 times less, respectively, than the contralateral teeth. The postoperative CBCT images presented bone ingrowth inside the root canal, calcification, or nonuniform RD.

Conclusions

Thirty-six months after the REPs (based on the cell homing concept), this RCS resulted radiographically and clinically in functional and asymptomatic teeth with complete PBH and continued reparative RD. CBCT quantitative measurements and qualitative root development observations are more reliable and accurate than PR analysis.  相似文献   

12.

Introduction

Intrusive luxation is one of the most severe traumatic injuries of permanent teeth that may adversely affect the pulp and the periodontium. Pulp necrosis and root resorption are the main pathologic entities associated with this injury. The present report describes the endodontic management of an intruded immature maxillary central incisor presented with pulp necrosis and severe inflammatory root resorption by using the regenerative approach.

Methods

A 7-year-old boy with dental trauma to the anterior maxillary region was referred for the management of a traumatized maxillary central incisor. Clinical examination revealed an uncomplicated crown fracture, whereas radiographic examination showed that the tooth was immature, confirming the intrusion that was calculated between 3 and 4 mm. The tooth was left to re-erupt, but after 2 months the boy presented with intraoral swelling. Radiographic examination showed initial signs of root resorption. The tooth was treated by using a regenerative endodontic approach.

Results

Clinical and radiographic examinations during the initial follow-up period showed resolution of the signs and symptoms as well as inhibition of the resorption process. At the follow-up examinations, the tooth remained free of signs and symptoms and completely functional. The radiographic recall examinations showed a gradual thickening of the root canal walls but incomplete apical closure.

Conclusions

The present case shows that severely injured teeth with uncertain prognosis may have a considerable percentage of chance to remain functional and free of signs and symptoms by using a regenerative endodontic procedure, confirming the efficacy of this procedure as a viable treatment option.  相似文献   

13.

Background

Cracked teeth are ubiquitous in the adult dentition. The objective of this study was to determine which patient traits and behaviors and external tooth and crack characteristics correlate with cracked teeth being symptomatic.

Methods

Dentists in The National Dental Practice-Based Research Network enrolled a convenience sample of patients each with a single, vital posterior tooth with at least 1 observable external crack in this observational study; they enrolled 2,975 cracked teeth from 209 practitioners. The authors collected data at the patient level, tooth level, and crack level. They used generalized estimating equations to obtain significant (P < .05) independent odds ratios (OR) associated with teeth that were symptomatic for a crack.

Results

Characteristics positively associated with cracked tooth symptoms, after adjusting for demographics, included patients who clenched, ground, or pressed their teeth together (OR, 1.30; 95% confidence interval [CI], 1.12-1.50), molars (OR, 1.58; 95% CI, 1.30-1.92), teeth with a wear facet through enamel (OR, 1.22; 95% CI, 1.01-1.40), carious lesions (OR, 1.31; 95% CI, 1.07-1.60), cracks that were on the distal surface of the tooth (OR, 1.31; 95% CI, 1.13-1.52), and cracks that blocked transilluminated light (OR, 1.31, 95% CI, 1.09-1.57). Teeth with stained cracks were negatively associated with having cracked tooth symptoms (OR, 0.68; 95% CI, 0.55-0.84).

Conclusions

The greatest likelihood of a cracked tooth being symptomatic was found when patients reported clenching or grinding their teeth and had a molar with a distal crack that blocked transilluminated light.

Practical Implications

This information can help inform dentists in the decision-making process regarding the prognosis for a cracked tooth.  相似文献   

14.

Introduction

This report includes outcomes for a group of patients with significant periapical lesions who were treated and evaluated in two single-arm, multicenter, prospective, nonsignificant risk clinical studies.

Methods

Forty-five teeth were from 45 patients who met the inclusion criteria and consented for the clinical studies and were diagnosed with periapical lesions with periapical index score ≥3. Patients were treated with a standardized treatment protocol including instrumentation to an apical diameter of #20 without orifice enlargement, the GentleWave Procedure, and warm vertical obturation. Clinical signs and radiographic assessments were evaluated at 12 months to assess healing. Success was classified as healing or healed and accounted for the cumulative success rate of healing. Statistical analyses were performed by using Fisher exact test, Pearson correlation, and multivariate logistic regression analyses.

Results

At 12 months, 44 of 45 teeth (97.8%) were evaluated. The cumulative success rate for the GentleWave Procedure was 97.7%. Forty-three of 44 teeth were completely functional; all teeth had complete resolution for measured indices of mobility, soft tissue lesions, sinus tract, and furcation involvement. No patients experienced moderate or severe pain at 2, 7, and 14 days after procedure. Although only 1 patient was unsuccessful and the presence of clinical symptoms and type of periradicular diagnosis at 12 months were correlated with an unsuccessful outcome, the analyses were limited by the sample size.

Conclusions

In this case series analysis, treatment of sizable periapical lesions with the GentleWave Procedure resulted in a success rate of 97.7% at 12-month re-evaluation.  相似文献   

15.

Objectives

The purpose of this study was to investigate the inflammatory response of periodontium to experimentally induced Furcal perforations in dogs' primary teeth repaired by Mineral Trioxide Aggregate (MTA) and Biodentine.

Methods

The design of the study was split mouth design. This study was carried out on 96 primary molars of 12 puppy dogs, these teeth were perforated at the furcation area and then divided into 2 experimental groups and 2 control groups. The experimental groups were repaired with MTA and Biodentine respectively and the control groups were perforated but not repaired. Then the histopathological findings and severity of inflammation were evaluated at the perforated areas at one, two and three months respectively.

Results

Data was statistically analysed to test the significance of difference between groups, the results showed that there was no statistical significant difference between MTA group and Biodentine group at each follow up period, also there was no significant difference for both groups when observed for the three different follow up periods, however significant difference was observed between experimental groups (MTA and Biodentine) and their control groups.

Conclusion

Biodentine can be used for Furcal perforation repair in primary teeth and give the same favorable results as MTA.  相似文献   

16.

Introduction

The outcome of periapical surgery has been directly improved with the introduction of novel material formulations. The aim of the study was to compare the retrograde obturation quality of the following materials: calcium silicate (Biodentine; Septodont, Saint-Maur-des-Fosses, France), mineral trioxide aggregate (MTA+; Cerkamed Company, Stalowa Wola, Poland), and glass ionomer cement (Fuji IX; GC Corporation, Tokyo, Japan).

Methods

Materials' wettability was calculated concerning the contact angles of the cements measured using a glycerol drop. Cements' porosity was determined using mercury intrusion porosimetry and micro–computed tomographic (μCT) imaging. Extracted upper human incisors were retrofilled, and μCT analysis was applied to calculate the volume of the gap between the retrograde filling material and root canal dentin. Experiments were performed before and after soaking the materials in simulated body fluid (SBF).

Results

No statistically significant differences were found among the contact angles of the studied materials after being soaked in SBF. The material with the lowest nanoporosity (Fuji IX: 2.99% and 4.17% before and after SBF, respectively) showed the highest values of microporosity (4.2% and 3.1% before and after SBF, respectively). Biodentine had the lowest value of microporosity (1.2% and 0.8% before and after SBF, respectively) and the lowest value of microgap to the root canal wall ([10 ± 30] × 10?3 mm3).

Conclusions

Biodentine and MTA possess certain advantages over Fuji IX for hermetic obturation of retrograde root canals. Biodentine shows a tendency toward the lowest marginal gap at the cement-to-dentin interface.  相似文献   

17.

Objectives

The objectives of this study were to compare the fracture resistance of simulated human immature teeth that have undergone mineral trioxide aggregate (MTA) apexification and have been root-filled with fiber post, composite resin, MTA, or gutta-percha.

Methods

Fifty-six human permanent maxillary incisors were selected. Ten teeth received no treatment (intact teeth group). The root canals of 46 teeth were prepared to an internal diameter of 1.75 mm. Six teeth were used as simulated immature teeth group. The remaining teeth received MTA apexification and were divided into 4 groups: MTA, fiber post, composite resin, and gutta-percha groups. The root canals of each group were filled with each test material. All teeth were thermocycled and received cyclic loading before compression testing by an Instron universal testing machine. The load to fracture was recorded. Data were subjected to statistical analysis by using one-way analysis of variance and Tukey multiple comparison test.

Results

All teeth fractured at the cervical area of the root. The mean load to fracture of the intact tooth, MTA, fiber post, composite resin, gutta-percha, and the simulated immature tooth groups was 1988 N, 1921 N, 1691 N, 1623 N, 1476 N, and 962 N, respectively. Statistically, load to fracture of the simulated immature tooth group was significantly lower than in the intact tooth, MTA, fiber post, and composite resin groups but was not significantly different from the gutta-percha group.

Conclusions

Within the limit of this study, after MTA apexification, intraradicular reinforcement with MTA, fiber post, or composite resin increased the fracture resistance of simulated immature teeth.  相似文献   

18.

Introduction

Although regenerative treatment approaches in teeth with incomplete root formation and pulp necrosis have become part of the suggested therapeutic endodontic spectrum, little is known about the effect of orthodontic movement in the tissue that has been regenerated. Furthermore, as the number of adults undergoing orthodontic treatment increases, there is an increasing need to investigate the changes that these tissues may undergo during orthodontic movement. Here we describe the alterations observed after the application of orthodontic forces in a case of an apically root-fractured necrotic immature root that had been managed with regenerative endodontic procedures in the past.

Methods

A 9-year-old male patient was referred after suffering the third incidence of trauma in the anterior maxilla. Radiographic evaluation revealed a periapical rarefaction associated with an apically root-fractured immature central incisor. Clinical evaluation revealed a buccal abscess and grade 3 tooth mobility. Periodontal probing was within normal limits. The tooth was accessed and disinfected by using apical negative pressure irrigation of 6% NaOCl. Intracanal dentin conditioning was achieved by using 17% EDTA for 5 minutes. A blood clot was induced from the periapical area, and calcium silicate–based cement was placed in direct contact with the blood clot at the same visit. The composite resin restoration was accomplished in the same appointment.

Results and Conclusions

Recall radiographic examination after 24 months revealed healing of the periapical lesion and signs of continuous root development despite the apical root fracture. Clinical evaluation revealed normal tooth development, normal mobility, and a resolving buccal infection. The tooth was subjected to orthodontic treatment because of Class II division 1 malocclusion with an overjet of 11 mm. After completion of the orthodontic treatment, 5.5 years after the initial intervention, the radiographic image revealed marked remodeling of the periapical tissues and repair of the apical fractures, and the buccal infection had resolved completely.  相似文献   

19.

Background

Remineralizing agents are found to be effective in the remineralization of early enamel caries and the remineralized enamel crystallites are more resistant to decalcification and also have the same orientation as the original enamel crystallites. Although child formula fluoridated dentifrices are used safely by young children their remineralizing capability remains questionable.

Aim

To evaluate the remineralizing potential of three commercially available pediatric dentifrices on artificial carious lesions in primary teeth.

Materials and methods

A total of fifty sound human primary teeth were coated with nail varnish leaving a window of 2 mm × 4 mm on buccal surface and were subjected to demineralization for a period of 96 h and then sectioned. Out of the hundred sections obtained, ninety sections are equally divided into three groups with thirty in each group: Group I (Colgate Spider man), Group II (Kids bunny), Group III (Kidodent) subjected to remineralization respectively for 10 days using pH cycling model. The sections were then evaluated under the stereomicroscope for the remineralization values using MICAP image analyser software.

Results

Statistical analysis was done by using ANOVA test which showed that all the three dentifrices showed remineralization with artificial carious lesions. Among the three test groups, Group I showed higher remineralization potential compared with the other two pediatric dentifrices which was statistically significant (p < 0.05).

Conclusion

All the three dentifrices demonstrated remineralization of carious lesions by virtue of decrease in lesion depth.  相似文献   

20.

Introduction

Long-term studies examining the treatment outcomes of “cracked teeth” that received orthograde root canal treatment in the United States do not exist. The purpose of the present study was to examine the distribution and 1-year treatment outcomes of cracked teeth receiving orthograde root canal treatment in 1 private endodontic practice over a 25-year period.

Methods

A total of 3038 cracked teeth were initially examined, and data from 2086 unique patients were analyzed. Pulpal and periapical diagnoses, year of treatment, tooth type, restorative material, and number of restored surfaces at the time of examination were recorded for all patients. Periodontal probing depths were also recorded. The patients’ age and sex were added retrospectively for all patients whose data were available. Univariate frequency distributions for all collected variables were evaluated. Bivariate associations were analyzed between explanatory variables and the success of the root canal therapy.

Results

Of the 2086 cracked teeth observed among unique patients, the most common were mandibular second molars (36%) followed by mandibular first molars (27%) and maxillary first molars (18%). Among the 363 teeth eligible for multivariable regression analysis, 296 (82%) were deemed successes after 1 year. There were no statistically significant differences in success based on pulpal diagnosis (irreversible pulpitis, 85%; necrosis, 80%; previously treated, 74%), patients’ age, sex, year of treatment, tooth type, restorative material, or number of restored surfaces at the time of examination. The 3 factors most significant in bivariate analyses were pocket depth, distal marginal ridge crack, and periapical diagnosis, which were used to generate a prognostic index for success of orthograde root canal therapy in cracked teeth called the Iowa Staging Index.

Conclusions

The results of this study suggest that cracked teeth that received root canal treatment can have prognoses at higher success rates than previously reported. The Iowa Staging Index may prove to be useful in clinical treatment decision making.  相似文献   

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