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Signor B, Poli Kopper PM, Aspesi M, Münchow EA, Scarparo RK. Postoperative pain after single-visit root canal treatment or vital pulp therapy: A systematic review and meta-analysis. J Am Dent Assoc 2024; 155:118-137.e1. [PMID: 38325970 DOI: 10.1016/j.adaj.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/06/2023] [Accepted: 11/05/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND This systematic review aimed to investigate whether vital pulp therapy and root canal treatment (RCT) promote different postoperative pain. STUDIES REVIEWED The authors searched PubMed, Cochrane Library, Embase, and Latin American and Caribbean Health Sciences Literature databases for studies published through June 30, 2022. The authors included randomized clinical trials if they reported on the assessment of postoperative pain after direct pulp capping, partial pulpotomy, pulpotomy, or single-visit RCT. The authors assessed the frequency of no, mild, moderate, and severe postoperative pain. They conducted meta-analyses to compare postoperative pain after full pulpotomy (PULP) and RCT. RESULTS The qualitative synthesis included 57 studies, and the authors conducted meta-analysis of 3. PULP leads to more asymptomatic cases (relative risk [RR], 1.06; 95% CI, 1.01 to 1.11; P < .01; I2 = 67%) and to a lower occurrence of mild (RR, 0.89; 95% CI, 0.79 to 0.99; P < .04; I2 = 37%) and moderate (RR, 0.70; 95% CI, 0.51 to 0.95; P < .02; I2 = 57%) postoperative pain than RCT. The frequency of severe pain was very low for both vital pulp therapy and RCT. Moderate to severe postoperative pain was more common at 48 hours through 72 hours after RCT and up to 36 hours after PULP. Pain intensity after PULP was higher using calcium-enriched material compared with using mineral trioxide aggregate at 12, 18, and 36 hours (P < .001). PRACTICAL IMPLICATIONS PULP showed a significantly higher incidence of no pain and a lower incidence of mild and moderate pain than single-visit RCT. Clinical decisions for RCT or PULP should not be based on differences in postoperative pain. When analgesia is indicated, it probably should be limited to a short time after PULP.
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Vaseenon S, Srisuwan T, Liang G, Chattipakorn N, Chattipakorn SC. Myeloid differentiation factor 2 inhibitors exert protective effects on lipopolysaccharides-treated human dental pulp cells via suppression of toll-like receptor 4-mediated signaling. J Dent Sci 2024; 19:220-230. [PMID: 38303896 PMCID: PMC10829556 DOI: 10.1016/j.jds.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/21/2023] [Indexed: 02/03/2024] Open
Abstract
Background/purpose The toll-like receptor 4 (TLR4)-myeloid differentiation factor 2 (MD-2) complex is known to have a role in inflammation. Blocking MD-2 can suppress inflammatory process. However, the actual action of MD-2 inhibitors, including MAC28, L6H21, and 2i-10, on the inflamed human dental pulp cells (HDPCs) has never been examined. This study aims to determine the pharmacological effects of these 3 compounds on cell viability, inflammation, and osteo/odontogenic differentiation of lipopolysaccharide (LPS)-treated HDPCs. Materials and methods HDPCs were pretreated with 10 μM of MAC28, L6H21, or 2i-10 for 2 h followed by either 20 μg/mL LPS or vehicle for 24 h. Cell viability was assessed using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The mRNA and expression of the proteins TLR4, MD-2, tumor necrosis factor alpha (TNF-α), and interleukin 6 (IL-6) were determined using quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot analysis. Osteo/odontogenic differentiation was investigated using qRT-PCR and Alizarin Red staining. Results LPS did not alter cell viability but significantly increased the expression levels of TLR4, MD-2, TNF-α, and IL-6 in HDPCs while the osteo/odontogenic differentiation ability decreased significantly when compared to the vehicle-treated group. MAC28, L6H21, and 2i-10-pretreatment in LPS-treated HDPCs reduced inflammation and restored osteo/odontogenic differentiation to similar levels as the vehicle-treated group. Conclusion MAC28, L6H21, and 2i-10 exhibited equal efficacy in attenuating inflammation through downregulation of TLR4-MD-2 signaling and restored osteo/odontogenic differentiation in LPS-treated HDPCs. These MD-2 inhibitors could be considered as the potential therapeutic supplement for curing inflammation of dental pulp in future studies.
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Affiliation(s)
- Savitri Vaseenon
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tanida Srisuwan
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Guang Liang
- Chemical Biology Research Center, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Nipon Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C. Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
- Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
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El Karim IA, Duncan HF, Fouad AF, Taha NA, Yu V, Saber S, Ballal V, Chompu-Inwai P, Ahmed HMA, Gomes BPFA, Abushouk S, Cushley S, O'Neill C, Clarke M. Effectiveness of full Pulpotomy compared with Root canal treatment in managing teeth with signs and symptOms indicative of irreversible pulpitis: a protocol for prospectiVE meta-analysis of individual participant data of linked randomised clinical trials (PROVE). Trials 2023; 24:807. [PMID: 38102685 PMCID: PMC10722670 DOI: 10.1186/s13063-023-07836-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Full pulpotomy has been proposed as an alternative to root canal treatment in teeth with signs and symptoms indicative of irreversible pulpitis (IRP), but the evidence is limited, relying on underpowered studies with a high risk of bias. The aim of this study is to conduct a prospective meta-analysis (PMA) of individual participant data of a series of individual randomised trials to provide robust evidence on the clinical and cost-effectiveness of pulpotomy compared with root canal treatment. METHODS Individual participant data will be obtained from a series of randomised trials designed and conducted by a consortium of multi-national investigators with an interest in vital pulp treatment. These individualised trials will be conducted using a specified protocol, defined outcomes, and outcome measures. Ten parallel-group randomised trials currently being conducted in 10 countries will provide data from more than 500 participants. The primary outcome is a composite measure defined as (1) the absence of pain indicative of IRP, (2) the absence of signs and symptoms indicative of acute or chronic apical periodontitis, and (3) the absence of radiographic evidence of failure including radiolucency or resorption. Individual participant data will be obtained, assessed, and checked for quality by two independent reviewers prior to the PMA. Pooled estimates on treatment effects will be generated using a 2-stage meta-analysis approach. The first stage involves a standard regression analysis in each trial to produce aggregate data on treatment effect estimates followed by an inverse variance weighted meta-analysis to combine these aggregate data and produce summary statistics and forest plots. Cost-effectiveness analysis based on the composite outcome will be undertaken as a process evaluation to evaluate treatment fidelity and acceptability by patients and dentists. RESULTS The research question and trial protocol were developed and approved by investigators in all 10 sites. All sites use shared resources including study protocols, data collection forms, participant information leaflets, and consent forms in order to improve flow, consistency, and reproducibility. Each site obtained its own Institutional Review Board approval, and trials were registered in appropriate open access platforms. Patient recruitment has started in most sites, as of July 2023. DISCUSSION PMA offers a rigorous, flexible, and efficient methodology to answer this important research question and provide results with improved generalisability and external validity compared with traditional trials and retrospective meta-analyses. The results of this study will have implications for both the delivery of clinical practice and structured clinical guidelines' development. TRIAL REGISTRATION PROSPERO CRD42023446809. Registered on 08 February 2023.
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Affiliation(s)
- I A El Karim
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, The Wellcome-Wolfson Building, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland, UK.
| | - H F Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Lincoln Place, Dublin 2, Ireland
| | - A F Fouad
- School of Dentistry, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - N A Taha
- Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - V Yu
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - S Saber
- Department of Endodontics, Faculty of Dentistry, The British University, Cairo, Egypt
| | - V Ballal
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences-ManipalManipal Academy of Higher Education, Manipal, India
| | - P Chompu-Inwai
- Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - H M A Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - B P F A Gomes
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas-UNICAMP, Av. Limeira Piracicaba, Areião, SP, 90113414-903, Brazil
| | - S Abushouk
- Department of Oral Rehabilitation, Faculty of Dentistry, Khartoum University, Khartoum, Sudan
| | - S Cushley
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, The Wellcome-Wolfson Building, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland, UK
| | - C O'Neill
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, The Wellcome-Wolfson Building, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland, UK
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BJ, N. Ireland, UK
| | - M Clarke
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, The Wellcome-Wolfson Building, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland, UK
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BJ, N. Ireland, UK
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Teves-Cordova A, Coloma Calle L, Mejia Rojas P, Goncalves-Pereira J, Duarte MAH. Vital Pulp Therapy in Permanent Teeth Diagnosed with Symptomatic Irreversible Pulpitis: Reports with Long-Term Controls. Case Rep Dent 2023; 2023:2694388. [PMID: 38045017 PMCID: PMC10689073 DOI: 10.1155/2023/2694388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/20/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023] Open
Abstract
The aim of this study was to describe the treatment of permanent teeth diagnosed with irreversible pulpitis, which can be effectively managed with partial or total pulpotomy. This alternative approach has shown great clinical and radiographic success in the long term compared to traditional pulpectomies. In this series of clinical cases, all the teeth exhibited symptoms of intense pain upon exposure to cold and at night. The clinical examination revealed extensive caries, while radiographic imaging showed radiolucent lesions in contact with the pulp chamber, indicating symptomatic irreversible pulpitis. The chosen treatment approach was either partial or total pulpotomy. The tooth was anesthetized, and the operative field was isolated and disinfected. After removing caries with a sterile round drill, the area was rinsed with sodium hypochlorite. In some cases, a portion of the pulp tissue was removed, while in others, the entire tissue of the pulp chamber was extracted using diamond burs. Hemostasis was achieved by applying sterile cotton pellets for 2 to 6 minutes. Following that, the tissue exhibited no signs of bleeding. Bioceramic cements were used, and the tooth was definitively restored. Periodic follow-up examinations were conducted, consistently showing positive pulp responses and no evidence of periradicular radiolucent lesions on radiographs.
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Affiliation(s)
- Abel Teves-Cordova
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo-USP, Bauru, Brazil
| | - Luis Coloma Calle
- Faculty of Dentistry of the Catholic University of Cuenca-Azogues, Ecuador
| | - Pierre Mejia Rojas
- Department of Endodontics, School of Dentistry, Cayetano Heredia Peruvian University, Lima, Peru
| | - Juan Goncalves-Pereira
- Department of Endodontics, School of Dentistry, Central University of Venezuela, Caracas, Venezuela
| | - Marco Antonio Hungaro Duarte
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo-USP, Bauru, Brazil
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Alhilou AM, Al-Moraissi EA, Bakhsh A, Christidis N, Näsman P. Pain after emergency treatments of symptomatic irreversible pulpitis and symptomatic apical periodontitis in the permanent dentition: a systematic review of randomized clinical trials. FRONTIERS IN ORAL HEALTH 2023; 4:1147884. [PMID: 37920592 PMCID: PMC10618681 DOI: 10.3389/froh.2023.1147884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/26/2023] [Indexed: 11/04/2023] Open
Abstract
Background Symptomatic irreversible pulpitis (SIP) or symptomatic apical periodontitis (SAP) are two painful conditions often warranting emergency treatment. The most common emergency treatments supported by evidence are pulpotomy and pulpectomy and are normally performed under time-constrained circumstances. However, there is no strong evidence of which treatment suggested in literature a clinician can use to reduce endodontic pain effectively. Therefore, the aim of this systematic review is to investigate the present knowledge on postoperative pain related to the two types of emergency treatments available for treating SIP and SAP. Methods Randomized controlled trials investigating postoperative pain after emergency treatments (pulpotomy and/or pulpectomy) on permanent dentition with signs and symptoms of SIP and/or SAP were searched in three major databases from 1978 until 2022. Risk of bias was assessed with Cochrane's tool. Results Only five studies fulfilled the inclusion criteria. The included studies indicated that pulpotomy and pulpectomy are both suitable treatment options for SAP and SIP, as they provide sufficient alleviation of pain in permanent dentition. However, inconsistent results were found between the included trials on which emergency treatment is more effective in reducing pain. Cochrane's tool revealed that the studies had a low risk of bias. Limitations found in the design of the included randomized control trials decreased the level of evidence. None of the included studies accounted for essential confounding variables, such as factors affecting pain (including the psychological aspects). Moreover, possible non-odontogenic pain was not assessed, and therefore, it was not excluded; hence, affecting the internal validity of the studies. Conclusion There are controversies within the available randomized control trials on which treatment is most effective in reducing emergency pain. This could be due to some weaknesses in the design of the clinical trials. Thus, further well-designed studies are warranted to draw conclusions on which emergency treatment is more effective in reducing pain. Systematic Review Registration PROSPERO (CRD42023422282).
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Affiliation(s)
- Abdelrahman M. Alhilou
- Department of Restorative Dentistry, College of Dentistry, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen
| | - Abdulaziz Bakhsh
- Department of Restorative Dentistry, College of Dentistry, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neurosciences, Huddinge, Sweden
| | - Peggy Näsman
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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Zenaldeen R, Kaddoura R, Alzoubi H, Achour H, Aljabban O. Partial Pulpotomy in Mature Permanent Molars with Symptoms Indicated Irreversible Pulpitis Using MTA: A Study of Three Case Reports over Four-Year Follow-Up. Case Rep Dent 2023; 2023:1344101. [PMID: 37885448 PMCID: PMC10598476 DOI: 10.1155/2023/1344101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/13/2023] [Accepted: 09/08/2023] [Indexed: 10/28/2023] Open
Abstract
VPT is vital pulp therapy, a biologically based procedure that combines several therapeutic techniques to maintain the entire or a portion of the dental pulp. Interest in VPT has grown due to recent developments in bioactive materials and an understanding of biological pulp reparative responses. This case report is aimed at evaluating the success rate of partial pulpotomy in permanent molars with symptoms indicating irreversible pulpitis using MTA and presenting with extremely deep carious lesions over four years of follow-up. All patients came with spontaneous and severe pain. Each tooth was isolated with a rubber dam and disinfected with 5.25% NaOCl before caries excavation. After caries removal, a partial pulpotomy was performed on 2-3 mm of the exposed pulp. Bleeding time was recorded after hemostasis was achieved, and then MTA was placed over the exposed pulp. The permanent restoration was placed after pulp capping, and postoperative periapical radiographs were taken. Patients were scheduled for clinical and radiological examinations for four years based on 6-month intervals. All teeth revealed a successful outcome throughout the follow-up periods (clinically and radiographically) with complete resolution of clinical signs and symptoms. Partial pulpotomy using MTA might be an effective long-term management strategy for permanent molars clinically diagnosed with irreversible pulpitis.
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Affiliation(s)
- Rami Zenaldeen
- Department of Endodontics and Operative Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Rami Kaddoura
- Department of Endodontics and Operative Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Hasan Alzoubi
- Department of Pediatric Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Hassan Achour
- Department of Endodontics and Operative Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Ossama Aljabban
- Department of Endodontics and Operative Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
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Duncan HF, Kirkevang LL, Peters OA, El-Karim I, Krastl G, Del Fabbro M, Chong BS, Galler KM, Segura-Egea JJ, Kebschull M. Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3-level clinical practice guideline. Int Endod J 2023; 56 Suppl 3:238-295. [PMID: 37772327 DOI: 10.1111/iej.13974] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3-level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence-based recommendations for the management of patients presenting with pulpal and apical disease. AIM To develop an S3-level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss. METHODS This S3-level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert-based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders. RESULTS The S3-level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re-evaluations during and after treatment is stressed. CONCLUSION The first S3-level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient's lifetime, according to the best comparative evidence currently available.
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Affiliation(s)
- Henry F Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | | | - Ove A Peters
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Ikhlas El-Karim
- School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Gabriel Krastl
- Department of Conservative Dentistry and Periodontology, University Hospital of Würzburg, Würzburg, Germany
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bun San Chong
- Faculty of Medicine & Dentistry, Institute of Dentistry, Queen Mary University of London, London, UK
| | - Kerstin M Galler
- Department of Operative Dentistry and Periodontology, Friedrich-Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Juan J Segura-Egea
- Department of Stomatology, Endodontics Section, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Moritz Kebschull
- School of Dentistry, Institute of Clinical Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, New York, USA
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Tomson PL, Vilela Bastos J, Jacimovic J, Jakovljevic A, Pulikkotil SJ, Nagendrababu V. Effectiveness of pulpotomy compared with root canal treatment in managing non-traumatic pulpitis associated with spontaneous pain: A systematic review and meta-analysis. Int Endod J 2023; 56 Suppl 3:355-369. [PMID: 36209498 DOI: 10.1111/iej.13844] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pulpitis characterized by spontaneous pain can result in debilitating pain. Dogma has existed to offer only have two treatment options, namely root canal treatment (RCT) or extraction, although pulpotomy has always remained a potential treatment modality. OBJECTIVE This review aimed to answer the following research question: 'Does pulpotomy (partial or full) (I) result in better patient and clinical reported outcomes (O), compared with RCT (C) in permanent teeth with pulpitis characterized by spontaneous pain (P) evaluated at various time intervals?' (T). METHODS Two authors independently performed study selection, data extraction and risk of bias assessment. The literature search was conducted in the following electronic databases: Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials. English language clinical trials comparing the patient and clinical reported outcomes between RCT and pulpotomy were included. The meta-analysis was performed on a fixed-effect model and the quality of evidence assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS Two randomized clinical trials were included. Amongst two trials, one has published four reports at different time points involving the same cohorts. The meta-analysis revealed no difference in postoperative pain (Day 7) between RCT and pulpotomy (OR = 0.99, 95% CI 0.63-1.55, I2 = 0%) and quality of evidence was graded as 'High'. Clinical success was high at year 1, 98% for both interventions, however, decreased over time to 78.1% (pulpotomy) and 75.3% (RCT) at 5 years. DISCUSSION Pulpotomy is a definitive treatment modality that is as effective as RCT. This could have a significant impact on treatment of such patients affording the advantages of retaining a vital pulp and preventing the need for RCT. CONCLUSION This review could only include two trials, hence there is insufficient evidence to draw robust conclusions. The clinical data accumulated so far suggests no difference in pain between RCT and pulpotomy at Day 7 postoperatively and a single randomized control trial suggests that the clinical success rate for both treatment modalities is similar long term. There is a need for more well-designed trials by different research groups to develop a stronger evidence base in this area. REGISTRATION PROSPERO database (CRD42021259744).
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Affiliation(s)
- Phillip L Tomson
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Juliana Vilela Bastos
- Department of Restorative Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jelena Jacimovic
- Central Library, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandar Jakovljevic
- Department of Pathophysiology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Shaju Jacob Pulikkotil
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
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Chen J, Liu S, Liu M, Dong Y. Multivariate prognostic analysis of direct pulp capping using a bioceramic material in mature permanent teeth with carious pulp exposure: a retrospective cohort study. Clin Oral Investig 2023; 27:5287-5296. [PMID: 37490116 DOI: 10.1007/s00784-023-05148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES On the basis of a large sample size and a long follow-up period, the objectives of this study were to evaluate the outcomes of direct pulp capping (DPC) in mature permanent teeth with carious pulp exposure using a kind of bioaggregate putty (BP) which commercially named iRoot BP Plus (Innovative Bioceramix, Inc., Vancouver, Canada) and to analyze the potential prognostic factors. MATERIALS AND METHODS The design of this research was retrospective regarding treatment procedures and prospective regarding the assessment of outcomes. The preoperative diagnosis of the teeth was either normal pulp or reversible pulpitis. Results were assessed based on clinical and radiographic examinations with at least 12 months of follow-up after DPC. No symptoms or signs, a positive response to electric pulp testing, a normal response to cold pulp testing and radiographs showing no abnormalities were considered to indicate success. Kaplan-Meier survival analysis was used to calculate the cumulative survival of teeth after DPC. Univariate and multivariate Cox proportional hazard regressions were used to analyze potential prognostic factors. RESULTS Three hundred thirty-four patients, including a total of 354 teeth, were available for the final clinical examination. The follow-up period ranged from 12 to 85 months, with an average of 27.0 ± 0.8 months. The total success rate was 85% (302/354), and the cumulative survival rates at 1, 2, 3, 4, and 5 years were 92%, 87%, 83%, 76%, and 72%, respectively. Univariate analysis indicated a significantly increased risk of failure in patients aged above 40 years and those treated by resident operators (P ≤ 0.01), with hazard ratios of 2.18 and 2.27, respectively. CONCLUSIONS Under appropriate indication selection and treatment procedures, long-term success is possible in mature permanent teeth with carious pulp exposure by DPC using iRoot BP Plus. Patient age and operator experience are potential prognostic factors. CLINICAL RELEVANCE Clinical data on iRoot BP Plus as a pulp capping medicament in mature permanent teeth with carious pulp exposure is lacking. This study indicated the efficacy of BP in DPC. Younger patient and sophisticated operator are beneficial for the outcome of DPC.
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Affiliation(s)
- Jiaqi Chen
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Siyi Liu
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Muqing Liu
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Yanmei Dong
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China.
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Altunbas D, Ayhan M, Bilgin O. Evaluation of postoperative pain relief after pulpotomy using different procedures for disinfection and hemostasis in symptomatic irreversible pulpitis. Niger J Clin Pract 2023; 26:819-824. [PMID: 37470658 DOI: 10.4103/njcp.njcp_923_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Aim This study aimed to evaluate postoperative pain scores after sodium hypochlorite (NaOCl) and KTP laser pulpotomies in the permanent teeth with symptomatic irreversible pulpitis retrospectively. Materials and Methods: This study is based on the records of patients treated with pulpotomy using sodium hypochlorite or KTP laser for disinfection and hemostasis at the Department of Endodontics. Sixty patients' molar teeth were treated with either NaOCl or KTP laser. Sodium hypochlorite was used on 31 teeth, and KTP laser was used on another 29 teeth, for disinfection and hemostasis. Initial bleeding control was obtained with saline. 2.5% NaOCl or KTP laser was applied to complete hemostasis. Calcium hydroxide was then placed on the chamber floor to cover the canal orifices. The permanent restoration was completed with composite resin. Pre and postoperative pain scores were recorded with a visual analog scale. The evaluation was performed on the 6th, 24th, 48th, 72nd hours, and 7th days depending on the severity of the pain. Results: There was no significant difference between the groups in terms of demographic data and preoperative pain scores (P > 0.05). The postoperative pain score in the KTP laser group was significantly lower at the 24th hour than in the NaOCl group (P < 0.05). No significant difference was found between the groups at other evaluated time intervals (P > 0.05). The greatest pain score was recorded at the 6th hour in both groups. Conclusion Although the level of pain decreased significantly in both groups in the postoperative period, KTP laser-assisted pulpotomy provided better pain control, especially at the 24th hour.
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Affiliation(s)
- D Altunbas
- Department of Endodontics, Faculty of Dentistry, Sivas Cumhuriyet University, Turkey
| | - M Ayhan
- Department of Endodontics, Faculty of Dentistry, Sivas Cumhuriyet University, Turkey
| | - O Bilgin
- Department of Endodontics, Faculty of Dentistry, Sivas Cumhuriyet University, Turkey
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Afrashtehfar KI, Jurado CA, Al-Hadi D, Shetty KP. Pulpotomy versus root canal treatment in permanent teeth with spontaneous pain: comparable clinical and patient outcomes, but insufficient evidence. Evid Based Dent 2023; 24:54-56. [PMID: 37188923 PMCID: PMC10289894 DOI: 10.1038/s41432-023-00878-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 05/17/2023]
Abstract
DESIGN A systematic appraisal and statistical aggregation of primary studies. DATA SOURCES Scopus/ELSEVIER, PubMed/MEDLINE, Clarivate Analytics' Web of Science (i.e., Web of Science Core Collection-WoS, Korean Journal Database-KJD, Russian Science Citation Index-RSCI, SciELO Citation Index-SCIELO), and Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library.The complementary searches consisted of OpenGrey, Google Scholar (first 100 returns), Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, DART-Europe E-theses Portal-DEEP, Opening access to UK theses-EThOS. STUDY SELECTION Human clinical trials studies in English language with at least 10 patients with mature or immature permanent teeth with pulpitis characterized by spontaneous pain in each arm (i.e., root canal treatment [RCT] and pulpotomy) at the end of the study, comparing the patient- (Primary: survival, pain, tenderness, swelling assessed by clinical history, clinical examination, and pain scales; Secondary: tooth function, need for further intervention, adverse effects; OHRQoL using a validated questionnaire) and clinical-reported outcomes (Primary: emerging apical radiolucency as per intraoral periapical radiograph or limited FOV CBCT scan; Secondary: radiological evidence of continued root formation and presence of sinus tract). DATA EXTRACTION AND SYNTHESIS Two independent review authors conducted study selection, data extraction and risk of bias (RoB) assessment and a third reviewer was consulted for solving disagreements. When insufficient or absent information, the corresponding author was reached out to for further explanation. The Cochrane RoB tool for randomized trials (RoB 2.0) was evaluated the quality of studies.The meta-analysis was performed on a fixed-effect model to estimate pooled effect size such as odds ratio (OR) and 95% confidence intervals (CIs) were performed using the R software. The quality of evidence assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach (GRADEpro GDT: GRADEpro Guideline Development Tool [software], McMaster University, 2015). RESULTS Five primary studies were included. Four studies referred to a multicentre trial assessing postoperative pain and long-term success rate after pulpotomy compared with one-visit RCT in 407 mature molars. The other study was a multicentre trial assessing postoperative pain in 550 mature molars treated with pulpotomy and pulp capping with the calcium-enriched mixture (CEM), pulpotomy and pulp capping with mineral trioxide aggregate (MTA) and one-visit RCT. Both trials primarily reported first molars from young adults. When looking at the results of postoperative pain, all the trials included had a low RoB. However, when evaluating the clinical and radiographic outcomes of the included reports, it was determined that there was a high RoB. The meta-analysis found that the likelihood of experiencing pain (i.e., mild, moderate, or severe) at the 7th postoperative day was not affected by the type of intervention (OR = 0.99, 95% CI 0.63-1.55, I2 = 0%).The study design, risk of bias, inconsistency, indirectness, imprecision, and publication bias domains were used to grade the quality of evidence for postoperative pain between RCT and full pulpotomy, resulting in a 'High' grade. In the first year, clinical success was high for both interventions, with a rate of 98%. However, the success rate declined over time, with pulpotomy showing a 78.1% success rate and RCT showing a 75.3% success rate at the 5-year follow up. CONCLUSIONS This systematic review was limited by the inclusion of only two trials, indicating a lack of sufficient evidence to draw definitive conclusions. Nonetheless, the available clinical data suggests that patient-reported pain outcomes do not differ significantly between RCT and pulpotomy at Day 7 postoperatively, and that the long-term clinical success rate of both treatments is comparable, as demonstrated by a single randomized control trial. However, to establish a more robust evidence base, additional high-quality randomized clinical trials, conducted by diverse research groups, are needed in this field. In conclusion, this review underscores the insufficiency of current evidence to draw solid recommendations.
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Affiliation(s)
- Kelvin I Afrashtehfar
- Assistant Professor and Director of the Evidence-Based Practice Unit, Ajman University College of Dentistry, Ajman City, UAE.
- Visiting Research Professor, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | - Carlos A Jurado
- Associate Professor, Department of Prosthodontics, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, USA
| | - Dunia Al-Hadi
- Lecturer in Endodontology, Ajman University College of Dentistry, Ajman City, UAE
| | - Krishna P Shetty
- Lecturer in Endodontology, Ajman University College of Dentistry, Ajman City, UAE
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Ayhan M, Altunbaş D. Efficacy of Potassium Titanyl Phosphate Laser and Sodium Hypochlorite on Postoperative Pain Intensity Following Pulpotomy in Teeth with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial. Photobiomodul Photomed Laser Surg 2023; 41:225-233. [PMID: 37092958 DOI: 10.1089/photob.2022.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Introduction: This study evaluated the postoperative pain intensity in permanent teeth with symptomatic irreversible pulpitis treated by pulpotomy using physiological saline, sodium hypochlorite (NaOCl), or the potassium titanyl phosphate (KTP) laser. Materials and methods: Ninety patients diagnosed with symptomatic irreversible pulpitis in permanent molars were randomly divided into three groups according to the pulpotomy procedures. Preoperative pain levels were recorded. Complete hemostasis was achieved with physiological saline (control group), NaOCl, or the KTP laser after initial bleeding control. Patients were asked to mark their pain level on the visual pain scale at 6, 24, 48, and 72 h and 7 and 30 days depending on the severity of pain. The permanent restoration was completed after 7 days. Data were statistically analyzed using Kruskal-Wallis, Mann-Whitney U, Friedman, and Bonferroni tests at a significance level of p < 0.05. Results: According to the present study, the statistical difference between the groups in terms of preoperative pain and percussion pain levels was insignificant (p > 0.05). There was no significant difference between groups in terms of demographic data (p > 0.05). The postoperative pain level of the KTP laser group was significantly lower at 6 h compared with the saline group (p < 0.05). There was no significant difference between groups in terms of the postoperative pain level at other time intervals (p > 0.05). The highest pain scores were observed in all groups at 6 h (p < 0.05). Conclusions: The KTP laser can be preferred primarily for reducing postoperative pain in pulpotomy treatments. The KTP laser or NaOCl-assisted pulpotomy can be an effective treatment for pain reduction in permanent teeth with symptomatic irreversible pulpitis. This report is registered at clinicaltrials.gov (ID: NCT05424796).
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Affiliation(s)
- Muhammed Ayhan
- Department of Endodontics, Faculty of Dentistry, Sivas Cumhuriyet University, Sivas, Turkey
| | - Demet Altunbaş
- Department of Endodontics, Faculty of Dentistry, Sivas Cumhuriyet University, Sivas, Turkey
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Dong X, Xu X. Bioceramics in Endodontics: Updates and Future Perspectives. Bioengineering (Basel) 2023; 10:bioengineering10030354. [PMID: 36978746 PMCID: PMC10045528 DOI: 10.3390/bioengineering10030354] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Bioceramics, with excellent bioactivity and biocompatibility, have been widely used in dentistry, particularly in endodontics. Mineral trioxide aggregate (MTA) is the most widely used bioceramic in endodontics. Recently, many new bioceramics have been developed, showing good potential for the treatment of endodontic diseases. This paper reviews the characteristics of bioceramics and their applications in various clinical endodontic situations, including root-end filling, root canal therapy, vital pulp therapy, apexification/regenerative endodontic treatment, perforation repair, and root defect repair. Relevant literature published from 1993 to 2023 was searched by keywords in PubMed and Web of Science. Current evidence supports the predictable outcome of MTA in the treatment of endodontic diseases. Although novel bioceramics such as Biodentine, EndoSequence, and calcium-enriched mixtures have shown promising clinical outcomes, more well-controlled clinical trials are still needed to provide high-level evidence for their application in endodontics. In addition, to better tackle the clinical challenges in endodontics, efforts are needed to improve the bioactivity of bioceramics, particularly to enhance their antimicrobial activity and mechanical properties and reduce their setting time and solubility.
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Affiliation(s)
- Xu Dong
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China;
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xin Xu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China;
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Correspondence: ; Tel.: +86-028-85503494
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14
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Singh A, Kaur H, Soni P, Choudhary R, Yeluri R. Evaluation of biodentine pulpotomy in caries-exposed symptomatic vital mature permanent teeth in 9‒13-year-old children: A 24-month clinico-radiographic observation. J Dent Res Dent Clin Dent Prospects 2022; 16:264-269. [PMID: 37560489 PMCID: PMC10407868 DOI: 10.34172/joddd.2022.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/01/2022] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The present study evaluated the clinical and radiographic outcomes of Biodentine pulpotomy for 24 months in symptomatic vital mature permanent teeth with caries exposure. METHODS Seventy-three patients with a chief complaint of spontaneous pain in permanent teeth were screened. Finally, 47 mature permanent teeth underwent a Biodentine pulpotomy procedure. Clinical evaluation of 47 teeth was carried out at 1, 3, 6, 9, 12, and 24 months and radiographic evaluations were made at 6, 12, and 24 months. The success of Biodentine pulpotomy was evaluated using Pearson's chi-square test. The significance level was determined at P<0.05. RESULTS At 24 months, the clinical and radiographic success rate was 97.78%, with only one clinical failure at 9 months. CONCLUSION The clinical and radiographic success of Biodentine pulpotomy was high (97.78%). Thus, Biodentine pulpotomy can be an alternative to root canal treatment (RCT) in symptomatic vital mature permanent teeth.
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Affiliation(s)
- Archana Singh
- Department of Pedodontics & Preventive Dentistry, Runta College of Dental Sciences and Research, Chhatisgarh, India
| | - Harsimran Kaur
- Department of Pedodontics & Preventive Dentistry, Teerthanker Mahaveer Dental College & Research Centre, Uttar Pradesh, India
| | - Priyanka Soni
- Department of Conservative and Endodontics, Buddha Institute of Dental Sciences and Hospital, Bihar, India
| | - Rishika Choudhary
- Department of Pedodontics & Preventive Dentistry, Teerthanker Mahaveer Dental College & Research Centre, Uttar Pradesh, India
| | - Ramakrishna Yeluri
- Department of Pedodontics & Preventive Dentistry, Teerthanker Mahaveer Dental College & Research Centre, Uttar Pradesh, India
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Philip N, Suneja B. Minimally invasive endodontics: a new era for pulpotomy in mature permanent teeth. Br Dent J 2022; 233:1035-1041. [PMID: 36526777 PMCID: PMC9758046 DOI: 10.1038/s41415-022-5316-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/08/2022] [Indexed: 12/23/2022]
Abstract
Emerging clinical and histologic evidence is challenging the long-established dogma that root canal treatment (RCTx) is the only therapeutic option for preservation of vital mature permanent teeth diagnosed with irreversible pulpitis or carious pulp exposure. Vital pulp therapy procedures like pulpotomy are not only technically simpler and more economical, but also afford patients a host of other benefits over conventional RCTx. This narrative review provides an update on the contemporary understanding of pulp pathophysiology and defence mechanisms, the proposed new diagnostic terminologies for pulpal inflammation, and how the biological characteristics of hydrophilic calcium silicate cements have enabled consistent successful outcomes for pulpotomy-treated mature teeth. The paper also details the evidence base from clinical trials and systematic reviews conducted over the past decade and outlines the practical treatment considerations for pulpotomy in mature permanent teeth.
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Affiliation(s)
- Nebu Philip
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar.
| | - Bharat Suneja
- Baba Jaswant Singh Dental College and Hospital, Ludhiana, India
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Shang W, Zhang Z, Zhao X, Dong Q, Schmalz G, Hu S. The Understanding of Vital Pulp Therapy in Permanent Teeth: A New Perspective. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8788358. [PMID: 36132084 PMCID: PMC9484899 DOI: 10.1155/2022/8788358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022]
Abstract
The indications of vital pulp therapy (VPT) are expanding, which cases are suitable for VPT, and how to improve the success rate of VPT is a problem that often bothers us. The main purpose of VPT is to eliminate pulpitis by promoting the formation of reparative dentin or calcium bridge, so that it can continue to perform various physiological functions, and finally achieve the purpose of preserving pulp vitality and long-term preservation of affected teeth. Pulp capping and pulpotomy are the most common methods for VPT. The research field of VPT has attracted the attention of many scholars, who have studied it from many aspects (such as indications, material selection, operation requirements, and long-term prognosis). This article reviews the recent advances in the techniques of VPT in permanent teeth.
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Affiliation(s)
- Wei Shang
- Department of Stomatology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000 Shanxi, China
| | - Zeliang Zhang
- Department of Stomatology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000 Shanxi, China
| | - Xicong Zhao
- Department of Stomatology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000 Shanxi, China
| | - Qingquan Dong
- Department of Stomatology, Changzhi Medical College, Changzhi, 046000 Shanxi, China
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Liebigstr 12, 04103 Leipzig, Germany
| | - Shaonan Hu
- Department of Stomatology, Changzhi Medical College, Changzhi, 046000 Shanxi, China
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Beauquis J, Setbon HM, Dassargues C, Carsin P, Aryanpour S, Van Nieuwenhuysen JP, Leprince JG. Short-Term Pain Evolution and Treatment Success of Pulpotomy as Irreversible Pulpitis Permanent Treatment: A Non-Randomized Clinical Study. J Clin Med 2022; 11:jcm11030787. [PMID: 35160239 PMCID: PMC8836521 DOI: 10.3390/jcm11030787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 02/05/2023] Open
Abstract
The objective of this work was to evaluate (1) the short-term evolution of pain and (2) the treatment success of full pulpotomy as permanent treatment of irreversible pulpitis in mature molars. The study consisted of a non-randomized comparison between a test group (n = 44)—full pulpotomy performed by non-specialist junior practitioners, and a control group (n = 40)—root canal treatments performed by specialized endodontists. Short-term pain score (Heft–Parker scale) was recorded pre-operatively, then at 24 h and 7 days post-operatively. Three outcomes were considered for treatment success: radiographic, clinical and global success. For short-term evolution of pain, a non-parametric Wilcoxon test was performed (significance level = 0.05). For treatment success, a Pearson Chi square or Fisher test were performed (significance level = 0.017–Bonferroni correction). There was no significant difference between test and control groups neither regarding short term evolution of pain at each time point, nor regarding clinical (80% and 90%, respectively) or global success (77% and 67%, respectively). However, a significant difference in radiographic success was observed (94% and 69%, respectively). The present work adds to the existing literature to support that pulpotomy as permanent treatment could be considered as an acceptable and conservative treatment option, potentially applied by a larger population of dentists.
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Affiliation(s)
- Julien Beauquis
- Adult and Child Dentistry, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium; (C.D.); (P.C.); (S.A.); (J.-P.V.N.)
- DRIM Research Group & Advanced Drug Delivery and Biomaterials, Louvain Drug Research Institute, UCLouvain, 1200 Brussels, Belgium;
- Correspondence: (J.B.); (J.G.L.)
| | - Hugo M. Setbon
- DRIM Research Group & Advanced Drug Delivery and Biomaterials, Louvain Drug Research Institute, UCLouvain, 1200 Brussels, Belgium;
- Private Practice, Av. Louise 391, 1050 Brussels, Belgium
| | - Charles Dassargues
- Adult and Child Dentistry, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium; (C.D.); (P.C.); (S.A.); (J.-P.V.N.)
- DRIM Research Group & Advanced Drug Delivery and Biomaterials, Louvain Drug Research Institute, UCLouvain, 1200 Brussels, Belgium;
- Private Practice, Rue Edmond Laffineur 9, 1300 Wavre, Belgium
| | - Pierre Carsin
- Adult and Child Dentistry, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium; (C.D.); (P.C.); (S.A.); (J.-P.V.N.)
- DRIM Research Group & Advanced Drug Delivery and Biomaterials, Louvain Drug Research Institute, UCLouvain, 1200 Brussels, Belgium;
- Private Practice, All. de la Minerva 2, 1150 Brussels, Belgium
| | - Sam Aryanpour
- Adult and Child Dentistry, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium; (C.D.); (P.C.); (S.A.); (J.-P.V.N.)
- DRIM Research Group & Advanced Drug Delivery and Biomaterials, Louvain Drug Research Institute, UCLouvain, 1200 Brussels, Belgium;
- Private Practice, Rte du Lion 10, 1420 Braine-l’Alleud, Belgium
| | - Jean-Pierre Van Nieuwenhuysen
- Adult and Child Dentistry, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium; (C.D.); (P.C.); (S.A.); (J.-P.V.N.)
- DRIM Research Group & Advanced Drug Delivery and Biomaterials, Louvain Drug Research Institute, UCLouvain, 1200 Brussels, Belgium;
| | - Julian G. Leprince
- Adult and Child Dentistry, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium; (C.D.); (P.C.); (S.A.); (J.-P.V.N.)
- DRIM Research Group & Advanced Drug Delivery and Biomaterials, Louvain Drug Research Institute, UCLouvain, 1200 Brussels, Belgium;
- Correspondence: (J.B.); (J.G.L.)
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Ravisankar MS, Arya KS, A Gaffoor F, John S, Girish CS, Aravindan A. To drill or not to drill: A turnabout in endodontic practices during Corona Virus Disease -2019- A South India based study. J Pharm Bioallied Sci 2022; 14:S444-S448. [PMID: 36110635 PMCID: PMC9469366 DOI: 10.4103/jpbs.jpbs_45_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/13/2022] [Accepted: 01/25/2022] [Indexed: 11/04/2022] Open
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Seck A, Ndiaye D, Niang SO, Leye Benoist F, Fioretti F, Toure B. Evaluation of complete pulpotomy with Biodentine® on mature permanent molars with signs and symptoms of symptomatic irreversible pulpitis: 12 months follow-up. J Endod 2021; 48:312-319. [PMID: 34974080 DOI: 10.1016/j.joen.2021.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Complete pulpotomy is the removal of the coronal portion of a vital pulp and is a means of preserving the vitality of the remaining root portion. The objective of this study was to evaluate the 12-month success rate of complete pulpotomy with Biodentine® on mature permanent molars with signs and symptoms of symptomatic irreversible pulpitis. MATERIALS AND METHODS A total of 68 molars diagnosed with symptomatic irreversible pulpitis in 68 patients aged 20 years and older were included in this study. The exclusion criteria were intraoperative clinical signs of pulp necrosis on the molar to be treated such as no bleeding, or uncontrollable pulp hemorrhage (more than 5 min of hemostasis) on at least one canal. A complete pulpotomy with Biodentine® was performed on molars with symptomatic irreversible pulpitis by the same operator and with the same protocol. At 12-month post-operative follow-up was conducted to evaluate clinical and radiological success. RESULTS A total of 66 patients received complete pulpotomy. Fifty-two could be examined at 12 months postoperatively. Clinical and radiological analysis at 12 months postoperatively revealed a success rate of 87% (45/52 molars) and a failure rate of 13% (7/52 molars). There was a relationship between age, tooth type, pre-operative periapical condition and treatment success with P<0.05. CONCLUSION Compliance with the indications and protocol for complete pulpotomy with Biodentine® on mature permanent molars with symptomatic irreversible pulpitis gives positive results at 12 month follow-up.
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Affiliation(s)
- Anta Seck
- Department of Conservative Dentistry and Endodontics, Department of Odontostomatology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Sénégal.
| | - Diouma Ndiaye
- Department of Conservative Dentistry and Endodontics, Department of Odontostomatology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Sénégal
| | - Seydina Ousmane Niang
- Department of Conservative Dentistry and Endodontics, Department of Odontostomatology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Sénégal
| | - Fatou Leye Benoist
- Department of Conservative Dentistry and Endodontics, Department of Odontostomatology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Sénégal
| | - Florence Fioretti
- University of Strasbourg, Faculty of Dental Surgery of Strasbourg, INSERM UMR 1260, Pôle de Médecine et Chirurgie Bucco-Dentaire des Hôpitaux Universitaires de Strasbourg, France
| | - Babacar Toure
- Department of Conservative Dentistry and Endodontics, Department of Odontostomatology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Sénégal
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Outcomes of root canal therapy or full pulpotomy using two endodontic biomaterials in mature permanent teeth: a randomized controlled trial. Clin Oral Investig 2021; 26:3287-3297. [PMID: 34854987 PMCID: PMC8636579 DOI: 10.1007/s00784-021-04310-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/20/2021] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The concept of minimally invasive endodontics recommends less-invasive vital pulp therapy (VPT) modalities over more aggressive traditional endodontic approaches in mature permanent teeth with carious pulp exposure, including irreversible pulpitis (IP) cases. Consequently, VPT needs to be compared with root canal therapy (RCT) in terms of treatment outcomes. This randomized clinical trial compares the results of full pulpotomy using two calcium-silicate cements, i.e., mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement, with RCT in mature permanent teeth. MATERIALS AND METHODS A total of 157 carious pulp exposure cases in two academic centers with/without established IP were selected/included/randomly appointed to three study arms; (i) RCT (n = 51) as the reference treatment, (ii) pulpotomy with ProRoot MTA (PMTA; n = 55), and (iii) pulpotomy with CEM cement (PCEM; n = 51) as two alternative VPT treatments. Two-year clinical/radiographic results were the outcomes of interest. Data were statistically analyzed through the analysis of variance, chi-square, Fisher exact test, and Kruskal-Wallis. RESULTS At 2-year recall, 147 teeth were examined (6.4% dropout). All molars, except for one, were clinically functional/symptom-free, and there was no statistical difference between the three study arms (p = 0.653). The radiographic success rates in RCT, PMTA, and PCEM arms were 98%, 100%, and 97.9%, respectively, without statistically significant differences (p = 0.544). CONCLUSION In the management of mature permanent teeth with/without established IP, all experimental groups exhibited equivalent/comparable results. CLINICAL RELEVANCE Simple VPT using MTA/CEM can be suggested/recommended as a viable advantageous alternative to RCT for the management of carious pulp exposures with/without sign/symptoms of IP.
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Mekhdieva E, Del Fabbro M, Alovisi M, Comba A, Scotti N, Tumedei M, Carossa M, Berutti E, Pasqualini D. Postoperative Pain following Root Canal Filling with Bioceramic vs. Traditional Filling Techniques: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2021; 10:4509. [PMID: 34640531 PMCID: PMC8509229 DOI: 10.3390/jcm10194509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 12/31/2022] Open
Abstract
This meta-analysis aimed to evaluate postoperative pain (POP) following root canal filling (RCF) with gutta-percha/bioceramic sealer (BCS) vs. gutta-percha/traditional sealer (TS) techniques. Electronic databases were searched for randomized trials. Subgroup analyses were performed for analgesic intake, flare-ups, postoperative time (24/48 h), pulp status, and retreatment. The search yielded 682 records, and nine studies were selected. BCS was associated with significantly lower POP vs. TS at 24 h (P = 0.04) and 48 h (P = 0.0005). In addition, non-significant trends favoring BCS for analgesic intake at 24 h (P = 0.14), flare-ups (P = 0.24) and obturation techniques at 24 h (P = 0.41) and 48 h (P = 0.33), non-significant trends for lower POP with TS vs. BCS 24 h and 48 h in vital teeth (P = 0.50, P = 0.18, respectively), and for lower POP with BCS vs. TS in non-vital teeth at 24 h and 48 h (P = 0.16, P = 0.84, respectively). POP was numerically lower with TS vs. BCS at 24 h (P = 0.65) and 48 h after retreatment (P = 0.59). Moreover, POP did not vary between fillers when the treatment was over single (P = 0.28) or multiple visits (P = 0.50). BCS was associated with significantly lower short-term POP, and with a trend for lower analgesic intake and flare-up incidence, as compared to TS.
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Affiliation(s)
- Elina Mekhdieva
- Endodontics and Restorative Dentistry, CIR Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.M.); (M.A.); (A.C.); (N.S.); (M.C.); (E.B.)
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (M.D.F.); (M.T.)
- IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
| | - Mario Alovisi
- Endodontics and Restorative Dentistry, CIR Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.M.); (M.A.); (A.C.); (N.S.); (M.C.); (E.B.)
| | - Allegra Comba
- Endodontics and Restorative Dentistry, CIR Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.M.); (M.A.); (A.C.); (N.S.); (M.C.); (E.B.)
| | - Nicola Scotti
- Endodontics and Restorative Dentistry, CIR Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.M.); (M.A.); (A.C.); (N.S.); (M.C.); (E.B.)
| | - Margherita Tumedei
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (M.D.F.); (M.T.)
- Department of Medical, Oral and Biotechnological Sciences, University “G. d′Annunzio” of Chieti-Pescara, 65122 Chieti, Italy
| | - Massimo Carossa
- Endodontics and Restorative Dentistry, CIR Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.M.); (M.A.); (A.C.); (N.S.); (M.C.); (E.B.)
| | - Elio Berutti
- Endodontics and Restorative Dentistry, CIR Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.M.); (M.A.); (A.C.); (N.S.); (M.C.); (E.B.)
| | - Damiano Pasqualini
- Endodontics and Restorative Dentistry, CIR Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.M.); (M.A.); (A.C.); (N.S.); (M.C.); (E.B.)
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El karim IA, Duncan HF. Reducing Intervention in the COVID-19 Era: Opportunities for Vital Pulp Treatment. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.686701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Over the last 12 months, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) virus has emerged as a significant global health problem with extensive repercussions for the practise of dentistry. As the principle transmission-route is via droplet-spread, aerosol-generating dental procedures (AGPs) present an exquisite challenge, which either has to be avoided or performed using strict infection-control measures, which increase the deployment of resources and cost. This new working environment necessitates the adoption of simplified, yet effective procedures that reduce intervention and minimise clinical chair time to short, single visits. Vital pulp treatment (VPT) has emerged as an attractive, technically less-complicated group of biologically-based management strategies that are aimed at maintaining pulp vitality and avoiding root canal treatment (RCT). These procedures are carried out in a strict aseptic environment using a rubber dam and have a reported high success rate, suggesting that they could be considered as effective and simple alternative therapies to relieve pain and avoid multiple visit RCT and other endodontic procedures. The relevance of promoting a simple, predictable and effective alternative to traditional, more complex dentistry has never been more compelling. In this perspective article, the latest advances in VPT are highlighted, along with an analysis of their relative success and compelling reasons why we as dentists should be adopting these treatment approaches. Thereafter, case selection, prognostic factors, techniques, limitations and future prospects of these procedures are discussed.
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Zafar K, Nazeer MR, Ghafoor R, Khan FR. Success of pulpotomy in mature permanent teeth with irreversible pulpitis: A systematic review. J Conserv Dent 2021; 23:121-125. [PMID: 33384481 PMCID: PMC7720750 DOI: 10.4103/jcd.jcd_179_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/07/2020] [Accepted: 04/24/2020] [Indexed: 12/05/2022] Open
Abstract
The objective of the present systematic review is to evaluate the success of pulpotomy in mature permanent teeth presented with irreversible pulpitis. The following databases were searched: PubMed, Oral and Dentistry Database, Cochrane, and CINAHL plus. We included studies published in the English language only. However, narrative reviews and case reports/series were excluded. The first electronic and hand search yielded a total of 2851 articles. After going through extensive screening and eligibility process, only six articles were finally selected for the review. The follow-up period ranged from 1 to 10 years. Randomized controlled trial compared pulpotomy with the root canal treatment and reported comparable and even better success of the pulpotomy (78% success). All the other studies have also shown better clinical and radiographic success of pulpotomy (68%–100%). Pulpotomy can be considered an alternative option for mature permanent teeth with irreversible pulpitis.
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Affiliation(s)
- Kamil Zafar
- Section of Operative Dentistry, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Rizwan Nazeer
- Department of Operative Dentistry, Baharia University Medical and Dental College, Karachi, Pakistan
| | - Robia Ghafoor
- Section of Operative Dentistry, Aga Khan University Hospital, Karachi, Pakistan
| | - Farhan Raza Khan
- Section of Operative Dentistry, Aga Khan University Hospital, Karachi, Pakistan
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Ates AA, Alomari T, Bhardwaj A, Tabnjh A, Gambarini G. Differences in endodontic emergency management by endodontists and general dental practitioners in COVID-19 times. Braz Oral Res 2020; 34:e122. [PMID: 33146318 DOI: 10.1590/1807-3107bor-2020.vol34.0122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/18/2020] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to assess the differences, if any, between general dental practitioners (GDPs) and endodontists, in the diagnosis and treatment of endodontic emergencies during the worldwide outbreak of COVID-19. An online questionnaire was randomly sent by social media to clinicians in different countries from 24 April, 2020 to May 4, 2020. The survey consisted of a series of questions about demographic characteristics, endodontic emergency diagnoses, approaches to prevent aerosol formation, drug prescriptions in case of symptomatic irreversible pulpitis, and the ways in which dentists managed endodontic emergencies during the COVID-19 lockdown. A total of 1,058 dentists responded to the questionnaire; 344 (32.6%) of the participants were endodontists. Slightly less than half of the participants (n = 485, 45.8%) worked during the lockdown, but only 303 participants (28.6%) treated endodontic cases/emergencies. The responses showed agreement between endodontists and GDPs regarding the diagnosis of symptomatic irreversible pulpitis (SIP), symptomatic apical periodontitis (SAP), reversible pulpitis, and asymptomatic irreversible pulpitis (AIP). SIP and SAP were considered an emergency, whereas reversible pulpitis and AIP were not considered an emergency (p > 0.05). Non-aerosol-generating procedures and treatment approaches differed between the groups (p < 0.05). One-third of the participants did not use rubber dam (p > 0.05). Ibuprofen and amoxicillin-clavulanic acid were the most frequently prescribed drugs for pain associated with SIP. In conclusion, the most relevant findings in our survey were the differences between endodontists and GDPs in diagnosis, precheck triage, deep caries excavation procedures, and endodontic emergency pain relief strategies.
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Affiliation(s)
- Ayfer Atav Ates
- Istanbul Okan University , Faculty of Dentistry , Department of Endodontics , Istanbul , Turkey
| | - Taher Alomari
- Jordan University of Science and Technology , Department of Conservative Dentistry , Ar-Ramtha , Jordan
| | - Anuj Bhardwaj
- College of Dental Science and Hospital , Department of Conservative Dentistry and Endodontics , Indore , India
| | - Abedelmalek Tabnjh
- Jordan University of Science and Technology , Department of Applied Dental Sciences , Ar-Ramtha , Jordan
| | - Gianluca Gambarini
- Sapienza University of Rome , Department of Oral and Maxillo-Facial Sciences , Rome , Italy
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Postendodontic Pain after Pulpotomy or Root Canal Treatment in Mature Teeth with Carious Pulp Exposure: A Multicenter Randomized Controlled Trial. Pain Res Manag 2020; 2020:5853412. [PMID: 32676136 PMCID: PMC7345601 DOI: 10.1155/2020/5853412] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 04/13/2020] [Accepted: 05/06/2020] [Indexed: 12/21/2022]
Abstract
This equivalence, randomized, clinical trial aimed to compare the postoperative pain of root canal therapy (RCT) with pulpotomy with mineral trioxide aggregate (PMTA) or calcium-enriched mixture (PCEM) in permanent mature teeth. In seven academic centers, 550 cariously exposed pulps were included and randomly allocated into PMTA (n = 188), PCEM (n = 194), or RCT (n = 168) arms. Preoperative “Pain Intensity” (PI) on Numerical Rating Scale and postoperative PIs until day 7 were recorded. Patients' demographic and pre-/intra-/postoperative factors/conditions were recorded/analysed. The arms were homogeneous in terms of demographics. The mean preoperative PIs were similar (P=0.998), the mean sum PIs recorded during 10 postoperative intervals were comparable (P=0.939), and the trend/changes in pain relief were parallel (P=0.821) in all study arms. The incidences of preoperative moderate-severe pain in RCT, PMTA, and PCEM arms were 56.5%, 55.7%, and 56.7%, which after 24 hours considerably decreased to 13.1%, 10.6%, and 12.9%, respectively (P=0.578). The time span of endodontic procedures was statistically different; RCT = 69.73, PMTA = 35.37, and PCEM = 33.62 minutes (P < 0.001). Patients with greater preoperative pain, symptomatic apical periodontitis, or presence of PDL widening suffered more pain (P=0.002, 0.035, and 0.023, resp.); however, other pre-/intra-/postoperative factors/conditions were comparable. Pulpotomy with MTA/CEM and RCT demonstrate comparable and effective postoperative pain relief.
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Effect of Pulpotomy Procedures With Mineral Trioxide Aggregate and Dexamethasone on Post-endodontic Pain in Patients with Irreversible Pulpitis: A Randomized Clinical Trial. Eur Endod J 2020; 4:69-74. [PMID: 32161890 PMCID: PMC7006548 DOI: 10.14744/eej.2019.91885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/03/2019] [Indexed: 11/24/2022] Open
Abstract
Objective: Endodontic post-treatment pain continues to be one of the main problems encountered by dental professionals. Therefore, pain control during and after endodontic treatment is one of the most important issues in endodontics. The purpose of this clinical trial was to compare postoperative pain relief achieved with dexamethasone (DEX) and mineral trioxide aggregate (MTA) used as pulp coverage after pulpotomy in human molars with irreversible pulpitis. Methods: This prospective double-blind study was conducted on 54 patients complaining of dental pain due to irreversible pulpitis. The standard pulpotomy procedure was performed by the same dentist in all patients. At the time of the cotton pellet placement, patients were randomly divided into three groups: those in whom a sterile dry cotton (DC) pellet was used, patients treated with a cotton pellet soaked in MTA, and those who were treated with a cotton pellet soaked in DEX. After completion of the treatment, patients received rescue medication every 6 hours for the first day. Postoperative pain was assessed at 6-hour intervals for 24 hours, and then every day until day 7 using a visual analog scale. Results: In general, patients treated with MTA suffered the lowest levels of pain at all time intervals. Post-pulpotomy pain was significantly reduced at 18 and 24 hours and from days 2 to 7 post-treatment in the MTA group. DEX lowered the pain level more than the DC pellet. However, the differences observed in the mean pain scores of the DEX and DC pellet groups at all-time intervals were not statistically significant. Conclusion: Pulpotomy procedures can reduce pain related irreversible pulpitis. Pulpotomy with MTA-soaked cotton pellet significantly reduces pain intensity in patients with irreversible pulpitis.
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Shamszadeh S, Shirvani A, Asgary S. Does occlusal reduction reduce post-endodontic pain? A systematic review and meta-analysis. J Oral Rehabil 2020; 47:528-535. [PMID: 31880822 DOI: 10.1111/joor.12929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/30/2019] [Accepted: 12/20/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Pain management during endodontic therapy is an important issue in clinical practice. The objective of this systematic review and meta-analysis was to evaluate the efficacy of occlusal reduction to control the post-operative endodontic pain in adults undergoing root canal therapy. MATERIALS AND METHODS Electronic database and manual searches of English papers were conducted up to August 2019 to identify randomised placebo-controlled trials. The MeSH terms used were (endodontics OR root canal therapy) AND (postoperative pain) AND (occlusal reduction). The primary outcome measure was the post-operative pain intensity up to 72 hours. Pooled standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using random-effects inverse variance method. The statistical heterogeneity was assessed using the Cochrane Q test. The significance level was set at P < .05. RESULTS In total, six randomised controlled trials including 344 participants were included. Our meta-analyses showed that relief of occlusal surface did not significantly reduce the pain intensity scores at 12- (SMD = -0.46; 95% CI = -1.24, 0.30; P = .239), 24- (SMD = -0.17; 95% CI = -0.73, 0.38; P = .533) and 48- (SMD = -0.67; 95% CI = -1.38, 0.03; P = .063) when compared to placebo. However, at 72 hours, patients received intervention showed significant more pain reduction than placebo groups (SMD = -1.07; 95% CI = -1.81, -0.32; P = .005). CONCLUSION Based on this meta-analysis, the efficacy of occlusal reduction in post-endodontic pain control for up to 2 days is not supported. However, on day three, it had a positive influence on the control of post-endodontic pain.
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Affiliation(s)
- Sayna Shamszadeh
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Armin Shirvani
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Saeed Asgary
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
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28
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Zanini M, Hennequin M, Cousson PY. Which procedures and materials could be applied for full pulpotomy in permanent mature teeth? A systematic review. Acta Odontol Scand 2019; 77:541-551. [PMID: 31146622 DOI: 10.1080/00016357.2019.1614217] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: Coronal pulpotomies were recently re-investigated as an alternative to root canal treatment in vital permanent teeth. General dentists may be interested in knowing how to perform full pulpotomy, in particular in face of difficult endodontic cases of vital teeth. Material and methods: A systematic review was undertaken on the PubMed and Cochrane databases in order to determine which procedure should be applied for pulp capping and coronal restoration in routine dental practice. Fifty-three publications were included and allocated to one of two methodological categories: histological and clinical studies. Results and conclusions: There is no evidence to recommend one single procedure for full pulpotomy in vital permanent teeth that can be indicated for different pulpal diagnoses which differ greatly in terms of the inflammation process from healthy teeth to irreversible pulpitis. For each clinical case, all actions aiming to prevent pre-operative contamination, to control per-operative infection and to achieve a complete seal above the radicular pulp sections are unavoidable steps that should be complied with. Reproducing procedures adopted in high quality trials could insure high success rates.
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Affiliation(s)
- M. Zanini
- University Clermont Auvergne, CROC EA 4847 Clermont-Ferrand, France
- University Paris Diderot, Dental faculty, Paris, France
- Groupe Hospitalier Pitié Salpêtrière, Service Odonto-Stomatologie et Chirurgie Maxillo-Faciale, APHP, Paris, France
| | - M. Hennequin
- University Clermont Auvergne, CROC EA 4847 Clermont-Ferrand, France
- CHU Clermont-Ferrand, Service d’Odontologie, Clermont-Ferrand, France
| | - PY. Cousson
- University Clermont Auvergne, CROC EA 4847 Clermont-Ferrand, France
- CHU Clermont-Ferrand, Service d’Odontologie, Clermont-Ferrand, France
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29
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Bjørndal L, Simon S, Tomson PL, Duncan HF. Management of deep caries and the exposed pulp. Int Endod J 2019; 52:949-973. [PMID: 30985944 DOI: 10.1111/iej.13128] [Citation(s) in RCA: 169] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/10/2019] [Indexed: 01/12/2023]
Abstract
Caries prevalence remains high throughout the world, with the burden of disease increasingly affecting older and socially disadvantaged groups in Western cultures. If left untreated, caries will advance through dentine stimulating pulpitis and eventually pulp infection and necrosis; however, if conservatively managed, pulpal recovery occurs even in deep carious lesions. Traditionally, deep caries management was destructive with nonselective (complete) removal of all carious dentine; however, the promotion of minimally invasive biologically based treatment strategies has been advocated for selective (partial) caries removal and a reduced risk of pulp exposure. Selective caries removal strategies can be one-visit as indirect pulp treatment or two-visit using a stepwise approach. Management strategies for the treatment of the cariously exposed pulp are also shifting with avoidance of pulpectomy and the re-emergence of vital pulp treatment (VPT) techniques such as partial and complete pulpotomy. These changes stem from an improved understanding of the pulp-dentine complex's defensive and reparative response to irritation, with harnessing the release of bioactive dentine matrix components and careful handling of the damaged tissue considered critical. Notably, the development of new pulp capping materials such as mineral trioxide aggregate, which although not an ideal material, has resulted in more predictable treatments from both a histological and a clinical perspective. Unfortunately, the changes in management are only supported by relatively weak evidence with case series, cohort studies and preliminary studies containing low patient numbers forming the bulk of the evidence. As a result, critical questions related to the superiority of one caries removal technique over another, the best pulp capping biomaterial or whether pulp exposure is a negative prognostic factor remain unanswered. There is an urgent need to promote minimally invasive treatment strategies in Operative Dentistry and Endodontology; however, the development of accurate diagnostic tools, evidence-based management strategies and education in management of the exposed pulp are critical in the future.
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Affiliation(s)
- L Bjørndal
- Cariology and Endodontics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S Simon
- Paris Diderot University, Paris, France.,Hôpital de Rouen Normandie, Rouen, France.,Laboratoire IN SERM UMR 1138, Paris, France
| | - P L Tomson
- School of Dentistry, Institute of Clinical Sciences, Birmingham, UK
| | - H F Duncan
- Division of Restorative Dentistry & Periodontology, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
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Antunes JLF, Domaneschi C, Lemos CA. Noninferiority trials in oral medicine. Oral Dis 2018; 25:357-362. [PMID: 29766614 DOI: 10.1111/odi.12892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/09/2018] [Indexed: 11/28/2022]
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31
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Treatment Outcomes of 4 Vital Pulp Therapies in Mature Molars. J Endod 2018; 44:529-535. [PMID: 29397215 DOI: 10.1016/j.joen.2017.12.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/29/2017] [Accepted: 12/07/2017] [Indexed: 11/20/2022]
Abstract
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.
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32
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Eren B, Onay EO, Ungor M. Assessment of alternative emergency treatments for symptomatic irreversible pulpitis: a randomized clinical trial. Int Endod J 2017; 51 Suppl 3:e227-e237. [DOI: 10.1111/iej.12851] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/24/2017] [Indexed: 12/29/2022]
Affiliation(s)
- B. Eren
- Department of Endodontics; Faculty of Dentistry; Baskent University; Ankara Turkey
| | - E. O. Onay
- Department of Endodontics; Faculty of Dentistry; Baskent University; Ankara Turkey
| | - M. Ungor
- Department of Endodontics; Faculty of Dentistry; Baskent University; Ankara Turkey
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33
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Parirokh M, Torabinejad M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part I: vital pulp therapy. Int Endod J 2017; 51:177-205. [PMID: 28836288 DOI: 10.1111/iej.12841] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/21/2017] [Indexed: 01/09/2023]
Abstract
Mineral trioxide aggregate (MTA) is a bioactive endodontic cement (BEC) mainly comprised of calcium and silicate elements. The cement was introduced by Torabinejad in the 1990s and has been approved by the Food and Drug Administration to be used in the United States in 1997. A number of new BECs have also been introduced to the market, including BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, NeoMTA Plus, OrthoMTA, Quick-Set, RetroMTA, Tech Biosealer and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA without its drawbacks. In this article, the chemical composition and the application of MTA and other BECs for vital pulp therapy (VPT), including indirect pulp cap, direct pulp cap, partial pulpotomy, pulpotomy and partial pulpectomy, have been reviewed and compared. Based on selected keywords, all papers regarding chemical composition and VPT applications of BECs had been reviewed. Most of the materials had calcium and silicate in their composition. Instead of referring to the cements based on their chemical compositions, we suggest the term 'bioactive endodontic cements (BECs)', which seems more appropriate for these materials because, in spite of differences in their chemical compositions, bioactivity is a common property for all of them. Numerous articles were found regarding use of BECs as VPT agents for indirect and direct pulp capping, partial pulpotomy and cervical pulpotomy. Most of these investigations used MTA for VPT. In most studies, newly introduced materials have been compared to MTA. Some of the BECs have shown promising results; however, the number of their studies compared to investigations on MTA is limited. Most studies had several methodological shortcomings. Future investigations with rigorous methods and materials are needed.
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Affiliation(s)
- M Parirokh
- Endodontology Research Center, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - M Torabinejad
- Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA, USA
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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34
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Kérourédan O, Jallon L, Perez P, Germain C, Péli JF, Oriez D, Fricain JC, Arrivé E, Devillard R. Efficacy of orally administered prednisolone versus partial endodontic treatment on pain reduction in emergency care of acute irreversible pulpitis of mandibular molars: study protocol for a randomized controlled trial. Trials 2017; 18:141. [PMID: 28351379 PMCID: PMC5371272 DOI: 10.1186/s13063-017-1883-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/07/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Irreversible pulpitis is a highly painful inflammatory condition of the dental pulp which represents a common dental emergency. Recommended care is partial endodontic treatment. The dental literature reports major difficulties in achieving adequate analgesia to perform this emergency treatment, especially in the case of mandibular molars. In current practice, short-course, orally administered corticotherapy is used for the management of oral pain of inflammatory origin. The efficacy of intraosseous local steroid injections for irreversible pulpitis in mandibular molars has already been demonstrated but resulted in local comorbidities. Oral administration of short-course prednisolone is simple and safe but its efficacy to manage pain caused by irreversible pulpitis has not yet been demonstrated. This trial aims to evaluate the noninferiority of short-course, orally administered corticotherapy versus partial endodontic treatment for the emergency care of irreversible pulpitis in mandibular molars. METHODS/DESIGN This study is a noninferiority, open-label, randomized controlled clinical trial conducted at the Bordeaux University Hospital. One hundred and twenty subjects will be randomized in two 1:1 parallel arms: the intervention arm will receive one oral dose of prednisolone (1 mg/kg) during the emergency visit, followed by one morning dose each day for 3 days and the reference arm will receive partial endodontic treatment. Both groups will receive planned complete endodontic treatment 72 h after enrollment. The primary outcome is the proportion of patients with pain intensity below 5 on a Numeric Scale 24 h after the emergency visit. Secondary outcomes include comfort during care, the number of injected anesthetic cartridges when performing complete endodontic treatment, the number of antalgic drugs and the number of patients coming back for consultation after 72 h. DISCUSSION This randomized trial will assess the ability of short-term corticotherapy to reduce pain in irreversible pulpitis as a simple and rapid alternative to partial endodontic treatment and to enable planning of endodontic treatment in optimal analgesic conditions. TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT02629042 . Registered on 7 December 2015. (Version n°1.1 28 July 2015).
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Affiliation(s)
- Olivia Kérourédan
- CHU de Bordeaux, Pôle d’Odontologie et de Santé Buccale, 33000 Bordeaux, France
- INSERM, Bioingénierie Tissulaire, U1026, 33076 Bordeaux, France
- Université de Bordeaux, UFR des Sciences Odontologiques, 33082 Bordeaux, France
| | - Léonard Jallon
- CHU de Bordeaux, Pôle d’Odontologie et de Santé Buccale, 33000 Bordeaux, France
- Université de Bordeaux, UFR des Sciences Odontologiques, 33082 Bordeaux, France
| | - Paul Perez
- CHU de Bordeaux, USMR, Pôle Santé publique, 33076 Bordeaux, France
| | | | - Jean-François Péli
- CHU de Bordeaux, Pôle d’Odontologie et de Santé Buccale, 33000 Bordeaux, France
- Université de Bordeaux, UFR des Sciences Odontologiques, 33082 Bordeaux, France
| | - Dominique Oriez
- CHU de Bordeaux, Pôle d’Odontologie et de Santé Buccale, 33000 Bordeaux, France
- Université de Bordeaux, UFR des Sciences Odontologiques, 33082 Bordeaux, France
| | - Jean-Christophe Fricain
- CHU de Bordeaux, Pôle d’Odontologie et de Santé Buccale, 33000 Bordeaux, France
- INSERM, Bioingénierie Tissulaire, U1026, 33076 Bordeaux, France
- Université de Bordeaux, UFR des Sciences Odontologiques, 33082 Bordeaux, France
| | - Elise Arrivé
- CHU de Bordeaux, Pôle d’Odontologie et de Santé Buccale, 33000 Bordeaux, France
- Université de Bordeaux, UFR des Sciences Odontologiques, 33082 Bordeaux, France
- INSERM, ISPED, Centre INSERM U-897-Epidemiologie-Biostatistique, Bordeaux Cedex, 33076 France
| | - Raphaël Devillard
- CHU de Bordeaux, Pôle d’Odontologie et de Santé Buccale, 33000 Bordeaux, France
- INSERM, Bioingénierie Tissulaire, U1026, 33076 Bordeaux, France
- Université de Bordeaux, UFR des Sciences Odontologiques, 33082 Bordeaux, France
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Abedi-Amin A, Luzi A, Giovarruscio M, Paolone G, Darvizeh A, Agulló VV, Sauro S. Innovative root-end filling materials based on calcium-silicates and calcium-phosphates. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:31. [PMID: 28108959 DOI: 10.1007/s10856-017-5847-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/04/2017] [Indexed: 06/06/2023]
Abstract
This in vitro study evaluated the apical sealing ability, bioactivity and biocompatibility of an experimental calcium silicate-based and two light-curing calcium silicate/calcium-phosphate cements as potential root end filling materials. A calcium silicate Portland-based (Control PC), an experimental calcium silicate (Exp. PC) and two light-curing cements (LC-CaP; LC-Si/CaP) were assessed for their alkalinising activity (pH) and biocompatibility. Single-rooted human canines were endodontically treated, filled with gutta-percha and finally submitted to apicoectomy. Root end fillings were performed using all tested cements, and their apical sealing ability was evaluated up to 4 weeks of immersion in simulated body fluid (SBF). The mineral precipitation at the apical region and the cement adaptation to root dentine were also evaluated through non-destructive optical microscopy both at 24 h and after prolonged water storage (four week). LC-CaP and LC-Si/CaP had neutral pH, the greatest sealing ability (24 h) and excellent cytocompatibility. The Exp. PC cement presented sealing ability after two and four weeks, as well as biocompatibility after four and seven days, similar to LC-CaP and LC-Si/CaP. The control PC cement showed the lowest sealing ability and the greatest cytotoxicity. Mineral precipitation was observed in all groups, while some differences were seen in terms of cement adaptation along the root canal dentine walls. The experimental light-curable cements as well as the experimental PC might be suitable root end filling materials with appropriate (in vitro) sealing ability, biocompatibility and aptitude to induce mineral precipitation.
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Affiliation(s)
- Ali Abedi-Amin
- Departamento de Odontología, Facultad de Ciencias de la Salud, CEU-Cardenal Herrera University, Valencia, Spain
| | - Arlinda Luzi
- Departamento de Odontología, Facultad de Ciencias de la Salud, CEU-Cardenal Herrera University, Valencia, Spain
| | - Massimo Giovarruscio
- Restorative Dentistry, Oral and Dental Science, Bristol Dental Hospital, Bristol, UK
| | - Gaetano Paolone
- Restorative Dentistry, Università Vita-Salute San Raffaele, Milano, Italy
| | - Atanaz Darvizeh
- Departamento de Odontología, Facultad de Ciencias de la Salud, CEU-Cardenal Herrera University, Valencia, Spain
| | - Victoria Vivó Agulló
- Departamento de Odontología, Facultad de Ciencias de la Salud, CEU-Cardenal Herrera University, Valencia, Spain
| | - Salvatore Sauro
- Departamento de Odontología, Facultad de Ciencias de la Salud, CEU-Cardenal Herrera University, Valencia, Spain.
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Zanini M, Hennequin M, Cousson PY. A Review of Criteria for the Evaluation of Pulpotomy Outcomes in Mature Permanent Teeth. J Endod 2016; 42:1167-74. [DOI: 10.1016/j.joen.2016.05.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/13/2016] [Accepted: 05/15/2016] [Indexed: 10/21/2022]
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Rechenberg DK, Held U, Burgstaller JM, Bosch G, Attin T. Pain levels and typical symptoms of acute endodontic infections: a prospective, observational study. BMC Oral Health 2016; 16:61. [PMID: 27234432 PMCID: PMC4884369 DOI: 10.1186/s12903-016-0222-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/24/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND This study aimed to identify key symptoms that could be associated with the diagnosis of acute forms of symptomatic apical periodontitis (SAP) and symptomatic irreversible pulpitis (SIP), and to identify a diagnostic algorithm based on these symptoms. METHODS In this prospective, observational study 173 emergency patients diagnosed with acute pain of endodontic origin and no swelling or fistula were included. Patients were asked 11 specific questions from a checklist with a possible discerning value between acute SAP and acute SIP. Pain levels were recorded using the numeric rating scale (NRS-11). Subsequently, the painful tooth was diagnosed. Logistic regression was used to evaluate the checklist regarding its differentiation between SAP (N = 103) and SIP (N = 70). Moreover, a decision tree was constructed based on recursive partitioning to identify a hierarchy in differentiating symptoms. RESULTS With identical median NRS-11 scores of 8, the teeth diagnosed with acute SAP and SIP were severely painful. The decision tree analysis resulted in a tree with splits according to pain on cold, perceived tooth extrusion, and pain duration. The overall sensitivity of the tree to detect SAP based on key symptoms was 95 %, its specificity was 31 %. CONCLUSIONS The best indicator for SAP was a reported absence of pain to cold stimuli. In teeth that did have a history of pain triggered by cold stimuli, the decision tree correctly identified SAP in 72 % of the teeth that felt too high and had hurt for less than one week.
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Affiliation(s)
- Dan-Krister Rechenberg
- Department of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zürich, Switzerland, Plattenstrasse 11, CH-8032, Zürich, Switzerland.
| | - Ulrike Held
- Department of Internal Medicine, Horten Center for Patient Oriented Research and Knowledge Transfer, University of Zürich, Zürich, Switzerland
| | - Jakob M Burgstaller
- Department of Internal Medicine, Horten Center for Patient Oriented Research and Knowledge Transfer, University of Zürich, Zürich, Switzerland
| | - Gabriel Bosch
- Department of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zürich, Switzerland, Plattenstrasse 11, CH-8032, Zürich, Switzerland
| | - Thomas Attin
- Department of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zürich, Switzerland, Plattenstrasse 11, CH-8032, Zürich, Switzerland
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Shokraneh A, Ajami M, Farhadi N, Hosseini M, Rohani B. Postoperative endodontic pain of three different instrumentation techniques in asymptomatic necrotic mandibular molars with periapical lesion: a prospective, randomized, double-blind clinical trial. Clin Oral Investig 2016; 21:413-418. [PMID: 27041109 DOI: 10.1007/s00784-016-1807-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 03/23/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this prospective, randomized, double-blind study was to compare postoperative pain of root canal treatment in patients with asymptomatic mandibular molar teeth with necrotic pulp and periapical lesion using three different instrumentation techniques: hand, multi-file rotary (ProTaper Universal), and reciprocating single-file (Wave-One) instrumentation techniques. MATERIALS AND METHODS Ninety-six patients who fulfilled specific inclusion criteria were assigned to three groups according to the root canal instrumentation technique used: Hand (G1), ProTaper Universal (G2), and Wave-One (G3). One-visit root canal treatment was carried out, and the severity of the postoperative pain was assessed by the Heft-Parker visual analogue scale 6, 12, 18, 24, 48, and 72 h after treatment. Data were analyzed by Kruskal-Wallis, χ 2, Cochrane Q, one-way ANOVA, and Spearman's correlation analyses (α = 0.05). RESULTS The patients in group 3 reported significantly lower postoperative pain levels at 6, 12, and 18 h compared with the patients in the two other groups (P < .05). In addition, the patients in group 2 reported significantly lower postoperative pain levels at 6 and 12 h compared with the patients in group 1 (P < .05). There were no significant differences in postoperative pain between the three groups at other time intervals (P > .05). The analgesic consumption was significantly higher in group 1 (P < .05), but no difference was seen between the two other groups (P > .05). CLINICAL RELEVANCE Postoperative pain was significantly lower in patients undergoing root canal instrumentation with the Wave-One file compared with the ProTaper Universal and hand files.
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Affiliation(s)
- Ali Shokraneh
- Department of Endodontics, School of Dentistry, AJA University of Medical Sciences, Tehran, 8174755153, Iran.
| | - Majid Ajami
- Department of Endodontics, School of Dentistry, AJA University of Medical Sciences, Tehran, 8174755153, Iran
| | - Nastaran Farhadi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohsen Hosseini
- Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bita Rohani
- Department of Oral Medicine, School of Dentistry, AJA University of Medical Sciences, Tehran, Iran
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Memarpour M, Fijan S, Asgary S, Keikhaee M. Calcium-Enriched Mixture Pulpotomy of Primary Molar Teeth with Irreversible Pulpitis. A Clinical Study. Open Dent J 2016; 10:43-9. [PMID: 27326265 PMCID: PMC4911738 DOI: 10.2174/1874210601610010043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 11/08/2015] [Accepted: 11/10/2015] [Indexed: 11/22/2022] Open
Abstract
Objectives: To evaluate the outcome of vital pulp
therapy in primary teeth with irreversible pulpitis by using calcium-enriched
mixture (CEM) cement according to clinical and radiographic assessment. Participants and Methods: Fifty primary molar teeth with irreversible pulpitis in 50 children aged 6-8 years underwent pulpotomy using CEM cement as the dressing material. Following pulpotomy, pain intensity was
evaluated by use of a visual analog scale at 1 and 7 days from the treatment and
in clinical appointments at 3, 6 and 12 months after baseline. Radiographic
evaluation was performed at 6 and 12 months. Data were analyzed using the
McNemar test. Results: A total of 42 children (mean age 7.26 ± 0.82 year) completed the study. After one day treatment 56 % of children
reported complete relief of pain and after 7 days 62% reported the same.
However, two children complained of increased pain 1 day after treatment. None of
the children reported pain in the subsequent appointments. One child complained
of tenderness in percussion after 6 months. Pulp canal obliteration was the most
common change in the radiographic assessment. There was no significant
difference between clinical (92.8%) and radiographic (90.4%) success (p=0.990). Conclusion: Pulpotomy using CEM cement could present a
successful treatment in primary molar teeth with irreversible pulpitis.
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Affiliation(s)
- Mahtab Memarpour
- Prevention of Oral and Dental Disease Research Center, Department of Pediatric Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soleiman Fijan
- Department of Pediatric Dentistry, School of Dentistry, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Saeed Asgary
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Keikhaee
- Department of Periodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Kunert GG, Kunert IR, da Costa Filho LC, de Figueiredo JAP. Permanent teeth pulpotomy survival analysis: retrospective follow-up. J Dent 2015; 43:1125-1131. [DOI: 10.1016/j.jdent.2015.06.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 06/26/2015] [Accepted: 06/29/2015] [Indexed: 11/25/2022] Open
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Coronal Pulpotomy Technique Analysis as an Alternative to Pulpectomy for Preserving the Tooth Vitality, in the Context of Tissue Regeneration: A Correlated Clinical Study across 4 Adult Permanent Molars. Case Rep Dent 2015; 2015:916060. [PMID: 26097752 PMCID: PMC4449924 DOI: 10.1155/2015/916060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/08/2015] [Accepted: 04/15/2015] [Indexed: 11/22/2022] Open
Abstract
Aim. (1) The aim of the clinical study revolves around the accurate diagnosis, proper case selection, and the management of acute irreversible pulpitis in permanent molars with closed apices using conservative and economical treatment modalities like vital pulpotomies with regenerative approaches over conventional root canal procedures. (2) To evaluate the use of autologous substances such as platelet concentrates and calcium silicate based materials in promoting the healing and regeneration of the inflamed pulp. Summary. Vital pulpotomy was performed on 5 carious involved, permanent molars diagnosed with acute irreversible pulpitis in 17- to 22-year-old patients. Taking into consideration the patient's age and the condition of the underlying pulp tissue, PRF pulpotomy was planned in view of preserving the vitality of the intact radicular pulps. Regenerative procedures with second generation blood matrices were chosen to encourage the recovery of the inflamed pulps. The systematic follow-up examinations performed at 3, 6, 9, 12, 18, 22, and 24 months revealed a successful clinical and radiological outcome. Within the limits of the present clinical study and correlating the success across the treated clinical cases, we safely conclude the potential scope of regenerative pulpotomy approaches in acute irreversible pulpitis in adult permanent teeth.
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Utneja S, Nawal RR, Talwar S, Verma M. Current perspectives of bio-ceramic technology in endodontics: calcium enriched mixture cement - review of its composition, properties and applications. Restor Dent Endod 2014; 40:1-13. [PMID: 25671207 PMCID: PMC4320271 DOI: 10.5395/rde.2015.40.1.1] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 08/31/2014] [Indexed: 01/02/2023] Open
Abstract
Advancements in bio-ceramic technology has revolutionised endodontic material science by enhancing the treatment outcome for patients. This class of dental materials conciliates excellent biocompatibility with high osseoconductivity that render them ideal for endodontic care. Few recently introduced bio-ceramic materials have shown considerable clinical success over their early generations in terms of good handling characteristics. Calcium enriched mixture (CEM) cement, Endosequence sealer, and root repair materials, Biodentine and BioAggregate are the new classes of bio-ceramic materials. The aim of this literature review is to present investigations regarding properties and applications of CEM cement in endodontics. A review of the existing literature was performed by using electronic and hand searching methods for CEM cement from January 2006 to December 2013. CEM cement has a different chemical composition from that of mineral trioxide aggregate (MTA) but has similar clinical applications. It combines the biocompatibility of MTA with more efficient characteristics, such as significantly shorter setting time, good handling characteristics, no staining of tooth and effective seal against bacterial leakage.
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Affiliation(s)
- Shivani Utneja
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Ruchika Roongta Nawal
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sangeeta Talwar
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Mahesh Verma
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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MTA pulpotomy as an alternative to root canal treatment in children's permanent teeth in a dental public health setting. J Dent 2014; 42:1390-5. [DOI: 10.1016/j.jdent.2014.06.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/17/2014] [Accepted: 06/18/2014] [Indexed: 11/20/2022] Open
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Asgary S, Eghbal MJ, Fazlyab M, Baghban AA, Ghoddusi J. Five-year results of vital pulp therapy in permanent molars with irreversible pulpitis: a non-inferiority multicenter randomized clinical trial. Clin Oral Investig 2014; 19:335-41. [DOI: 10.1007/s00784-014-1244-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 04/09/2014] [Indexed: 11/28/2022]
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Al-Kahtani A. Effect of long acting local anesthetic on postoperative pain in teeth with irreversible pulpitis: Randomized clinical trial. Saudi Pharm J 2014; 22:39-42. [PMID: 24493972 DOI: 10.1016/j.jsps.2013.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 01/10/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare the effect of long acting anesthetics on postoperative pain in teeth with irreversible pulpitis. METHODOLOGY Forty patients were randomly assigned into two groups of twenty patients each. Each patient who fit the inclusion criteria was administered local anesthesia before undergoing root canal treatment. The anesthetic solution was either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine. Patients were instructed to complete a VAS pain score at 6, 12, 24 h after single visit root canal treatment. Data were analyzed by Mann-Whitney, Cochrane Q analysis and t test to compare qualitative and quantitative data between the groups. RESULTS The results showed the levels of pain of the patients who received lidocaine as the anesthetic agent and had significantly more postoperative pain after root canal treatment (P < 0.05) but had significantly decreased pain by 24 h compared to the bupivacaine group patients who had significantly lower postoperative pain levels at 6 and 12 h. CONCLUSION The use of long acting local anesthetic can significantly reduce the postoperative pain in teeth with irreversible pulpitis.
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Affiliation(s)
- Ahmed Al-Kahtani
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia
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NAGHAVI N, GHODDUSI J, SADEGHNIA HR, ASADPOUR E, ASGARY S. Genotoxicity and cytotoxicity of mineral trioxide aggregate and calcium enriched mixture cements on L929 mouse fibroblast cells. Dent Mater J 2014; 33:64-9. [DOI: 10.4012/dmj.2013-123] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Saghiri MA, Garcia-Godoy F, Asatourian A, Lotfi M, Banava S, Khezri-Boukani K. Effect of pH on compressive strength of some modification of mineral trioxide aggregate. Med Oral Patol Oral Cir Bucal 2013; 18:e714-20. [PMID: 23722137 PMCID: PMC3731103 DOI: 10.4317/medoral.18922] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 02/16/2013] [Indexed: 11/08/2022] Open
Abstract
Objectives: Recently, it was shown that NanoMTA improved the setting time and promoted a better hydration process which prevents washout and the dislodgment of this novel biomaterial in comparison with WTMA. This study analyzed the compressive strength of ProRoot WMTA (Dentsply), a NanoWMTA (Kamal Asgar Research Center), and Bioaggregate (Innovative Bioceramix) after its exposure to a range of environmental pH conditions during hydration.
Study Design: After mixing the cements under aseptic condition and based on the manufacturers` recommendations, the cements were condensed with moderate force using plugger into 9 × 6 mm split molds. Each type of cement was then randomly divided into three groups (n=10). Specimens were exposed to environments with pH values of 4.4, 7.4, or 10.4 for 3 days. Cement pellets were compressed by using an Instron testing machine. Values were recorded and compared. Data were analyzed by using one-way analysis of variance and a post hoc Tukey’s test.
Results: After 3 days, the samples were solid when probed with an explorer before removing them from the molds. The greatest mean compressive strength 133.19±11.14 MPa was observed after exposure to a pH value of 10.4 for NanoWMTA. The values decreased to 111.41±8.26 MPa after exposure to a pH value of 4.4. Increasing of pH had a significant effect on the compressive strength of the groups (p<0.001). The mean compressive strength for the NanoWMTA was statistically higher than for ProRoot WMTA and Bioaggregate (p<0.001). Moreover, increasing of pH values had a significant effect on compressive strength of the experimental groups (p<0.001).
Conclusion: The compressive strength of NanoWMTA was significantly higher than WMTA and Bioaggregate; the more acidic the environmental pH, the lower was the compressive strength.
Key words:Compressive strength, mineral trioxide aggregate, Nano.
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Affiliation(s)
- Mohammad-Ali Saghiri
- Department of Dental Material, Dental School, Azad University, Tehran Branch and Kamal Asgar Research Center, Tehran, Iran
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Two-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicenter randomized clinical trial. Clin Oral Investig 2013; 18:635-41. [DOI: 10.1007/s00784-013-1003-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
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50
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Asgary S, Ahmadyar M. Vital pulp therapy using calcium-enriched mixture: An evidence-based review. J Conserv Dent 2013; 16:92-8. [PMID: 23716958 PMCID: PMC3659871 DOI: 10.4103/0972-0707.108173] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 05/16/2012] [Accepted: 06/01/2012] [Indexed: 11/09/2022] Open
Abstract
Worldwide, casecontrol studies have revealed that the treatment outcomes of root canal therapy (RCT) are generally favorable; however, the overall epidemiological success rate of RCT in the general population is relatively low. On the other hand, vitality of dental pulp is a key factor in the long-term prognosis of permanent teeth; in recent years, vital pulp therapy (VPT) has received significant consideration as it has been revealed that the inflamed pulp has the potential to heal. In this review article, the current best evidence with regard to VPT using calcium-enriched mixture (CEM) cement in human permanent/primary teeth is discussed. A strategy based on a search using keywords for CEM cement as well as VPT was applied.
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Affiliation(s)
- Saeed Asgary
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Ahmadyar
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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