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Li M, Wang G, Zhu F, Jiang H, Yang Y, Cheng R, Hu T, Zhang R. Application of personalized templates in minimally invasive management of coronal dens invaginatus: a report of two cases. BMC Oral Health 2024; 24:592. [PMID: 38778368 PMCID: PMC11110288 DOI: 10.1186/s12903-024-04377-5] [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: 03/18/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Treating the coronal dens invaginatus (CDI) with pulp infection commonly involves the removal of invagination, which increases the risk of perforation and fracture, and compromises the tooth structure. Minimally invasive endodontic management of CDI is highly recommended. This report describes two cases of type II CDI with the application of personalized templates. CASE PRESENTATION Two cases of type II CDI, affecting the main root canal in a maxillary canine and a lateral incisor, were diagnosed. A guided endodontics (GE) approach was applied. Cone-beam computed tomography and intraoral scans were imported and aligned in a virtual planning software to design debridement routes and templates. The MICRO principle (which involves the aspects of Mechanical (M) debridement, Irrigation (I), Access cavities (C), Rectilinear routes (R), and Obstruction (O)) was proposed for designing optimal debridement routes for future applications. The templates were innovatively personalized and designed to preserve the tooth structure maximally while effectively debriding the root canal. Root canal treatment with supplementary disinfection was then performed. The follow-up of the two patients revealed favorable clinical and radiographic outcomes. CONCLUSIONS The GE approach could be a feasible method for preserving healthy dental structure while effectively debriding the root canal, thereby achieving successful and minimally invasive endodontic treatment for CDI.
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Affiliation(s)
- Mingming Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Guosong Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Fangzhi Zhu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Han Jiang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yingming Yang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Ran Cheng
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Tao Hu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
| | - Ru Zhang
- Department of Endodontics, School of Stomatology, Capital Medical University, Beijing, P. R. China.
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Wei X, Du Y, Zhou X, Yue L, Yu Q, Hou B, Chen Z, Liang J, Chen W, Qiu L, Huang X, Meng L, Huang D, Wang X, Tian Y, Tang Z, Zhang Q, Miao L, Zhao J, Yang D, Yang J, Ling J. Expert consensus on digital guided therapy for endodontic diseases. Int J Oral Sci 2023; 15:54. [PMID: 38052782 DOI: 10.1038/s41368-023-00261-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/12/2023] [Accepted: 11/12/2023] [Indexed: 12/07/2023] Open
Abstract
Digital guided therapy (DGT) has been advocated as a contemporary computer-aided technique for treating endodontic diseases in recent decades. The concept of DGT for endodontic diseases is categorized into static guided endodontics (SGE), necessitating a meticulously designed template, and dynamic guided endodontics (DGE), which utilizes an optical triangulation tracking system. Based on cone-beam computed tomography (CBCT) images superimposed with or without oral scan (OS) data, a virtual template is crafted through software and subsequently translated into a 3-dimensional (3D) printing for SGE, while the system guides the drilling path with a real-time navigation in DGE. DGT was reported to resolve a series of challenging endodontic cases, including teeth with pulp obliteration, teeth with anatomical abnormalities, teeth requiring retreatment, posterior teeth needing endodontic microsurgery, and tooth autotransplantation. Case reports and basic researches all demonstrate that DGT stand as a precise, time-saving, and minimally invasive approach in contrast to conventional freehand method. This expert consensus mainly introduces the case selection, general workflow, evaluation, and impact factor of DGT, which could provide an alternative working strategy in endodontic treatment.
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Affiliation(s)
- Xi Wei
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua, School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Yu Du
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua, School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lin Yue
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center 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 & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Qing Yu
- Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Benxiang Hou
- Department of Endodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Zhi Chen
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jingping Liang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Clinical Research Center for Oral Diseases; National Center for Stomatology; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Wenxia Chen
- College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
| | - Lihong Qiu
- Department of Endodontics, School of Stomatology, China Medical University, Shenyang, China
| | - Xiangya Huang
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua, School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Liuyan Meng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Dingming Huang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaoyan Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center 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 & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Yu Tian
- Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Zisheng Tang
- Department of Stomatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi Zhang
- Department of Endodontics, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Leiying Miao
- Department of Cariology and Endodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jin Zhao
- Department of Endodontics, First Affiliated Hospital of Xinjiang Medical University, and College of Stomatology of Xinjiang Medical University, Urumqi, China
| | - Deqin Yang
- Department of Endodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Yang
- Department of Endodontics, The Affiliated Stomatological Hospital of Nanchang University, Nanchang, China
| | - Junqi Ling
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua, School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
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Elhakim A, Hwang J, Kim S, Kim E, Kang S. Three-dimensional accuracy of endodontic access preparations using novel nonrestrictive static guides: A laboratory study. AUST ENDOD J 2023; 49:631-640. [PMID: 37697890 DOI: 10.1111/aej.12792] [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: 11/30/2022] [Revised: 06/22/2023] [Accepted: 08/13/2023] [Indexed: 09/13/2023]
Abstract
This study compared the accuracy of traditional endodontic access to conservative access cavities prepared with or without novel nonrestrictive endodontic access guides by operators with different levels of clinical experience without visual aids, using a three-dimensional volumetric accuracy analysis method. The accuracy of the preparations was analysed using a novel 3D volumetric analysis by calculating the intersection and volume of the actual cavities to the planned model cavities. The experienced operator significantly outperformed the inexperienced operator in the free hand groups, while accuracy of conservative access cavities prepared using the novel guides were comparable and significantly higher than the other groups (p < 0.05). The results demonstrated clinical experience enhanced endodontic preparations accuracy and that nonrestrictive guides achieve accurate conservative access cavities which are independent of the operator skill level. Additionally, the three-dimensional volumetric analysis is a consistent and objective method to judge the accuracy of guided endodontic techniques.
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Affiliation(s)
- Ahmed Elhakim
- Department of Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
- Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Junghwan Hwang
- Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sunil Kim
- Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Euiseong Kim
- Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sumi Kang
- Department of Dental Education, College of Dentistry, Yonsei University, Seoul, Korea
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Root Maturation of an Immature Dens Invaginatus Despite Unsuccessful Revitalization Procedure: A Case Report and Recommendations for Educational Purposes. Dent J (Basel) 2023; 11:dj11020047. [PMID: 36826192 PMCID: PMC9955176 DOI: 10.3390/dj11020047] [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: 12/06/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND The clinical management of teeth with complex dens invaginatus (DI) malformations and apical periodontitis may be challenging due to the lack of routine. The aim of this case report is to describe the endodontic treatment of an immature tooth with DI and to discuss strategies for preclinical training for teeth with such malformations. CASE REPORT A 9-year-old male presented with an immature maxillary incisor with DI (Oehlers Type II) and apical periodontitis which was diagnosed by cone beam computed tomography (CBCT). Revitalization was initially attempted but then abandoned after failure to generate a stable blood clot. Nevertheless, considerable increase in both root length and thickness could be detected after medication with calcium hydroxide followed by root canal filling with MTA as an apical plug. CONCLUSIONS The endodontic management of teeth with DI requires thorough treatment planning. In immature teeth, under certain conditions, root maturation may occur even with conventional apexification procedures. From an educational perspective, different strategies including CBCT and 3D-printed transparent tooth models for visualization of the complex internal morphology and redesigned 3D-printed replica with various degrees of difficulty for endodontic training, can be used to overcome the challenges associated with endodontic treatment of such teeth.
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Ribeiro D, Reis E, Marques JA, Falacho RI, Palma PJ. Guided Endodontics: Static vs. Dynamic Computer-Aided Techniques-A Literature Review. J Pers Med 2022; 12:1516. [PMID: 36143301 PMCID: PMC9501573 DOI: 10.3390/jpm12091516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 11/26/2022] Open
Abstract
(1) Background: access cavity preparation is the first stage of non-surgical endodontic treatment. The inaccuracy of this step may lead to numerous intraoperative complications, which impair the root canal treatment's prognosis and therefore the tooth's survival. Guided endodontics, meaning computer-aided static (SN) and dynamic navigation (DN) techniques, has recently emerged as a new approach for root canal location in complex cases. This review aims to compare SN and DN guided endodontics' techniques in non-surgical endodontic treatment. (2) Methods: an electronic search was performed on PubMed, Scopus, and Cochrane Library databases until October 2021. Studies were restricted by language (English, Spanish and Portuguese) and year of publication (from 2011 to 2021). (3) Results: a total of 449, 168 and 32 articles were identified in PubMed, Scopus, and Cochrane Library databases, respectively, after the initial search. Of the 649 articles, 134 duplicates were discarded. In this case, 67 articles were selected after title and abstract screening, of which 60 were assessed for eligibility through full-text analysis, with one article being excluded. Four cross-references were added. Thus, 63 studies were included. (4) Conclusions: guided endodontics procedures present minimally invasive and accurate techniques which allow for highly predictable root canal location, greater tooth structure preservation and lower risk of iatrogenic damage, mainly when performed by less experienced operators. Both SN and DN approaches exhibit different advantages and disadvantages that make them useful in distinct clinical scenarios.
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Affiliation(s)
- Diana Ribeiro
- Dentistry Department, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Eva Reis
- Dentistry Department, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Joana A. Marques
- Institute of Endodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Rui I. Falacho
- Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Institute of Oral Implantology and Prosthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Paulo J. Palma
- Institute of Endodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
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Faus-Matoses V, Faus-Llácer V, Moradian T, Riad Deglow E, Ruiz-Sánchez C, Hamoud-Kharrat N, Zubizarreta-Macho Á, Faus-Matoses I. Accuracy of Endodontic Access Cavities Performed Using an Augmented Reality Appliance: An In Vitro Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11167. [PMID: 36141439 PMCID: PMC9517686 DOI: 10.3390/ijerph191811167] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The purpose of this study was to compare and contrast the accuracy of endodontic access cavities created using an augmented reality appliance to those performed using the conventional technique. MATERIALS AND METHODS 60 single-rooted anterior teeth were chosen for study and randomly divided between two study groups: Group A-endodontic access cavities created using an augmented reality appliance as a guide (n = 30) (AR); and Group B-endodontic access cavities performed with the manual (freehand) technique (n = 30) (MN). A 3D implant planning software was used to plan the endodontic access cavities for the AR group, with a cone-beam computed tomography (CBCT) and 3D intraoral surface scan taken preoperatively and subsequently transferred to the augmented reality device. A second CBCT scan was taken after performing the endodontic access cavities to compare the planned and performed endodontic access for accuracy. Therapeutic planning software and Student's t-test were used to analyze the cavities at the apical, coronal, and angular levels. The repeatability and reproducibility of the digital measurement technique were analyzed using Gage R&R statistical analysis. RESULTS The paired t-test found statistically significant differences between the study groups at the coronal (p = 0.0029) and apical (p = 0.0063) levels; no statistically significant differences were found between the AR and MN groups at the angular (p = 0.6596) level. CONCLUSIONS Augmented reality devices enable the safer and more accurate performance of endodontic access cavities when compared with the conventional freehand technique.
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Affiliation(s)
- Vicente Faus-Matoses
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
| | - Vicente Faus-Llácer
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
| | - Tanaz Moradian
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
| | - Elena Riad Deglow
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain
| | - Celia Ruiz-Sánchez
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
| | - Nirmine Hamoud-Kharrat
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
| | - Álvaro Zubizarreta-Macho
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain
| | - Ignacio Faus-Matoses
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
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Bordone A, Ciaschetti M, Perez C, Couvrechel C. Guided Endodontics in the Management of Intracanal Separated Instruments: A Case Report. J Contemp Dent Pract 2022; 23:853-856. [PMID: 37283022 DOI: 10.5005/jp-journals-10024-3395] [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: 06/08/2023]
Abstract
AIM The aim of this case report is to describe the removal of a fractured file in mandibular right first premolar through the application of an endodontic template to guide a trephine until the file. BACKGROUND The fracture of an endodontic instrument is a rare complication that requires therapeutic management. Removal procedures often cause excessive dentine loss. To limit this inconvenience, several techniques describing the removal of fractured files in the coronal third of the canal have been proposed. The guide facilitates the use of the Zumax removal kit (Zumax Medical Co. Ltd., Suzhou, China). CASE DESCRIPTION A 30-year-old patient was referred to dental office for the endodontic retreatment of his mandibular right first premolar. The tooth was painful to percussion and buccal palpation. The periapical radiograph showed a periapical lesion, a defective root canal treatment, and the presence of a fractured file. It was decided to use the Zumax kit in order to remove the instrument. By using digital implantology software, a guide was constructed with a tube to guide a trephine and achieve straight-line access. The trephine was later driven by the resin guide. After completing the drilling, the instrument was removed with the Zumax extractor and the canal was then prepared, disinfected, and filled. CONCLUSION The current case describes the removal of a separated instrument by use of a new approach that is planned on computer software and guided by a resin guide. CLINICAL SIGNIFICANCE The guided endodontic technique avoids excessive loss of dental structure and simplifies the procedure by reducing chair time and increasing the operator's confidence.
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Affiliation(s)
| | | | - Cyril Perez
- Private Practice, 14 Rue des Capucines, Paris, France, Phone: +33 627717742, e-mail:
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Silva EJNL, De-Deus G, Souza EM, Belladonna FG, Cavalcante DM, Simões-Carvalho M, Versiani MA. Present status and future directions - Minimal endodontic access cavities. Int Endod J 2022; 55 Suppl 3:531-587. [PMID: 35100441 DOI: 10.1111/iej.13696] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/29/2022]
Abstract
In the last decades, the move of Medicine towards minimally invasive treatments is notorious and scientifically grounded. As Dentistry naturally follows its footsteps, minimal access preparation also became a trend topic in the endodontic field. This procedure aims to maximize preservation of dentine tissue, backed up by the idea that this is an effective way to reduce the incidence of post-treatment tooth fracture. However, with the assessment of the body of evidence on this topic, it is possible to observe some key-points (a) the demand for nomenclature standardization, (b) the requirement of specific tools such as ultra-flexible instruments, visual magnification, superior illumination, and three-dimensional imaging technology, (c) minimally invasive treatment does not seem to affect orifice location and mechanical preparation when using adequate armamentarium, but it (d) may impair adequate canal cleaning, disinfection, and filling procedures, and also (e) it displays contradictory results regarding the ability to increase the tooth strengthen compared to the traditional access cavity. In spite of that, it is undeniable that methodological flaws of some benchtop studies using extracted teeth may be responsible for the conflicting data, thus triggering the need for more sophisticated devices/facilities and specifically designed research in an attempt to make it clear the role of the access size/design on long-term teeth survival. Moreover, it is inevitable that a clinical approach like minimal endodontic access cavities that demands complex tools and skilled and experienced operators bring to the fore doubts on its educational impact mainly when confronted with the conflicting scientific output, ultimately provoking a cost-benefit analysis of its implementation as a routine technique. In addition, this review discusses the ongoing scientific and clinical status of minimally invasive access cavities aiming to input an in-depth and unbiased view over the rationale behind them, uncovering not only the related conceptual and scientific flaws, but also outlining future directions for research and clinical practices. The conclusions attempt to skip from passionate disputes highlighting the current body of evidence as weak and incomplete to guide decision making, demanding the development of a close-to-in-situ laboratory model or a large and well-controlled clinical trial to solve this matter.
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Affiliation(s)
- Emmanuel João Nogueira Leal Silva
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.,Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Erick Miranda Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Maranhão
| | | | | | - Marco Simões-Carvalho
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Kamio N, Gomyo N, Matsushima K. Successful Pulp-Preserving Treatment for Peri-invagination Periodontitis of Double Dens Invaginatus With Oehlers Type IIIA and IIIB: A Case Report. J Endod 2021; 47:1515-1520. [PMID: 34102216 DOI: 10.1016/j.joen.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 12/20/2022]
Abstract
Dens invaginatus (DI), which often occurs in the maxillary lateral incisor, is an important issue in endodontics because the treatment complexity increases depending on the degree of invagination and the vitality or nonvitality of the pulp. An 11-year-old female patient with a sinus tract in the gingiva of the maxillary lateral incisors showed peri-invagination periodontitis and double DI on radiography. Cone-beam computed tomographic imaging was used to examine the structure in the root canal in detail, and Oehlers type IIIA and IIIB DI was found. It was also shown that the patient's bone defect was caused by type IIIA. Because a healthy reaction was observed in the pulp test, the final diagnosis was peri-invagination periodontitis associated with type IIIA of the double DI with vital pulp. We expected the lesion to heal by treating only the type IIIA invaginated pseudo-root canal while preserving the healthy pulp. The invaginated root canal was cleaned under a microscope using ultrasonic instruments and nickel-titanium files to minimize irritation to the pulp. Because the lesion shrinkage was confirmed by cone-beam computed tomographic imaging taken 3 months after the start of treatment, vertical compaction of the warm gutta-percha technique was performed. At the 6-month postoperative recall, the pulp was normal, and the lesions were further improved. Treatment of the main root canal of double DI is complicated. However, proper diagnosis and careful cleaning of the invaginated root canal are essential for healing while preserving the pulp.
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Affiliation(s)
- Naoto Kamio
- Department of Endodontics, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan.
| | - Natsuko Gomyo
- Department of Endodontics, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Kiyoshi Matsushima
- Department of Endodontics, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
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Effect of Computer-Aided Navigation Techniques on the Accuracy of Endodontic Access Cavities: A Systematic Review and Meta-Analysis. BIOLOGY 2021; 10:biology10030212. [PMID: 33802134 PMCID: PMC7999608 DOI: 10.3390/biology10030212] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/25/2021] [Accepted: 03/06/2021] [Indexed: 02/07/2023]
Abstract
The present systematic review and meta-analysis aims to determine the effect of computer-aided navigation techniques on the accuracy of endodontic access cavities. MATERIALS AND METHODS A systematic literature review and meta-analysis of clinical studies, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, was performed that evaluated the root canal location rate of computer-aided navigation techniques applied to endodontic access cavities. Four different databases were used to consult the literature: PubMed-Medline, Scopus, Cochrane, and Web of Science. After discarding duplicate articles and applying inclusion criteria, 14 articles were selected for qualitative analysis and 13 for quantitative analysis. RESULTS the root canal location success rate started at 98.1% (CI: 95.7-100%) of the cases performed through a computer-aided navigation technique. The prediction interval ranged from 93.3% to 100%. The meta-analysis did not detect heterogeneity between the combined studies (Q-test = 17.3; p = 0.185; I2 = 25%). No statistically significant differences were found between computer-aided static navigation techniques (success rate: 98.5%) and computer-aided dynamic navigation techniques (success rate: 94.5%) (Q test = 0.57; p = 0.451), nor between in vitro studies (success rate: 96.2%) and in vivo studies (success rate: 100%) (Q test = 2.53; p-value = 0.112). An odds success ratio of 13.1 (CI: 95%; 3.48, 49.1) encourages the use of computer-aided navigation techniques over conventional endodontic access cavity procedures. CONCLUSIONS the endodontic access cavities created using static and dynamic computer-aided navigation techniques are highly accurate in locating the root canal system.
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Zubizarreta-Macho Á, Castillo-Amature C, Montiel-Company JM, Mena-Álvarez J. Efficacy of Computer-Aided Static Navigation Technique on the Accuracy of Endodontic Microsurgery. A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10020313. [PMID: 33467707 PMCID: PMC7830386 DOI: 10.3390/jcm10020313] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 12/22/2022] Open
Abstract
The aim of this systematic review and meta-analysis was to analyze the efficacy of the computer-aided static navigation technique on the accuracy of root apex location in endodontic microsurgery. MATERIAL AND METHODS A systematic literature review and meta-analysis, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, of clinical studies that evaluated the apex location rate of the computer-aided static navigation techniques applied to endodontic microsurgery. A total of four databases were consulted in the literature search: Pubmed-Medline, Scopus, Cochrane, and Web of Science. After eliminating duplicated articles and applying the inclusion criteria, seven articles were selected for the qualitative and the quantitative analysis. RESULTS The root apex location success rate stated at 96.8% (confidence interval (CI): 93.0-100%) of the cases performed through a computer-aided static navigation technique. The prediction interval ranges from 91.4% to 100%. The meta-analysis did not detect heterogeneity between the combined studies (Q-test = 6.15; p-value = 0.407; I2 = 2.4%). The computer-aided static navigation techniques showed a root apex location success rate 27 times higher than conventional endodontic microsurgery procedures (Q test = 0.80; p = 0.671; I2 = 0%). Three studies of computer-aided static navigation techniques and control group were compared using a random effects model with the Mantel-Haenszel method with a statistically significant odds success ratio of 27.7, with a 95% confidence interval between 11.3 and 68.1 (z test = 7.23; p < 0.0001). CONCLUSIONS According to in vitro studies analyzed, endodontic microsurgeries performed through computer-aided static navigation techniques show a high precision.
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Affiliation(s)
- Álvaro Zubizarreta-Macho
- Department of Endodontics, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (Á.Z.-M.); (C.C.-A.)
| | - César Castillo-Amature
- Department of Endodontics, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (Á.Z.-M.); (C.C.-A.)
| | - José María Montiel-Company
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain;
| | - Jesús Mena-Álvarez
- Department of Endodontics, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (Á.Z.-M.); (C.C.-A.)
- Correspondence:
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12
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Loureiro MAZ, Elias MR, Capeletti LR, Silva JA, Siqueira PC, Chaves GS, Decurcio DA. Guided Endodontics: Volume of Dental Tissue Removed by Guided Access Cavity Preparation—An Ex Vivo Study. J Endod 2020; 46:1907-1912. [DOI: 10.1016/j.joen.2020.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 12/18/2022]
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13
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Peng L, Zhao J, Wang ZH, Sun YC, Liang YH. Accuracy of root-end resection using a digital guide in endodontic surgery: An in vitro study. J Dent Sci 2020; 16:45-50. [PMID: 33384777 PMCID: PMC7770308 DOI: 10.1016/j.jds.2020.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/27/2020] [Indexed: 12/04/2022] Open
Abstract
Background/Purpose It is difficult to achieve accurate root-end resection clinically. This in vitro study was conducted to evaluate the operation accuracy of a digital endodontic surgical guide. Materials and methods 56 extracted maxillary anterior teeth were prepared for endodontic surgical models. The models were randomly divided into 4 groups equally according to the guide (with guide/no guide) and the operator (experienced/inexperienced). Endodontic microsurgeries were performed on models in each group. The deviations in length and angle of the root-end resection were measured based on the optical scanning data of the pre- and postoperative teeth. The general linear model was performed to analyze the effect of a guide on root-end resection deviation. Results Using a guide, the mean length deviation for experienced/inexperienced operators reduced from 0.99 mm (95% CI [confidence interval, CI], 0.66–1.33 mm)/1.18 mm (95% CI, 0.50–1.86 mm) to 0.31 mm (95% CI, 0.20–0.42 mm)/0.31 mm (95% CI, 0.24–0.37 mm). The mean angle deviation for experienced/inexperienced operators reduced from 16.74° (95% CI, 10.61–22.86°)/15.06° (95% CI, 9.19–20.94°) to 5.04° (95% CI, 3.31–6.77°)/6.79° (95% CI, 4.91–8.67°). The difference was significant between procedures performed with and without a guide (P < 0.01). Conclusion Application of the digital guide in vitro endodontic surgery could improve the accuracy of root-end resection.
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Affiliation(s)
- Li Peng
- Department of General Dentistry Ⅱ, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jing Zhao
- Dental Clinic, Peking University International Hospital, Beijing, China
| | - Zu-Hua Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yu-Chun Sun
- Center of Digital Dentistry, Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Research Center of Engineering and Technology for Digital Dentistry of Ministry of Health, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Beijing, China
| | - Yu-Hong Liang
- Dental Clinic, Peking University International Hospital, Beijing, China.,Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China
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14
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Accuracy of Computer-Aided Dynamic Navigation Compared to Computer-Aided Static Procedure for Endodontic Access Cavities: An in Vitro Study. J Clin Med 2020; 9:jcm9010129. [PMID: 31906598 PMCID: PMC7019931 DOI: 10.3390/jcm9010129] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 11/27/2022] Open
Abstract
Purpose: To analyze the accuracy of two computer-aided navigation techniques to guide the performance of endodontic access cavities compared with the conventional access procedure. Materials and Methods: A total of 30 single-rooted anterior teeth were selected, which were randomly distributed into three study groups: Group A—guided performance of endodontic access cavities through computer-aided static navigation system (n = 10) (SN); Group B—guided performance of endodontic access cavities through computer-aided dynamic navigation system (n = 10) (DN); and Group C—manual (freehand) performance of endodontic access cavities (n = 10) (MN). The endodontic access cavities of the SN group were performed with a stereolithography template designed on 3D implant planning software, based on preoperative cone-beam computed tomography (CBCT) and a 3D extraoral surface scan, and endodontic access cavities of the DN group were planned and performed by the dynamic navigation system. After endodontic access cavities were performed, a second CBCT was done, and the degree of accuracy between the planned and performed endodontic access cavities was analyzed using therapeutic planning software and Student’s t-test. Results: Paired t-test revealed no statistically significant differences between SN and DN at the coronal (p = 0.6542), apical (p = 0.9144), or angular (p = 0.0724) level; however, statistically significant differences were observed between the two computer-aided navigation techniques and the MN group at the coronal (p < 0.0001), apical (p < 0.0001), and angular (p < 0.0001) level. Conclusion: Both computer-aided static and dynamic navigation procedures allowed accurate performance of endodontic access cavities.
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15
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Moreno‐Rabié C, Torres A, Lambrechts P, Jacobs R. Clinical applications, accuracy and limitations of guided endodontics: a systematic review. Int Endod J 2019; 53:214-231. [DOI: 10.1111/iej.13216] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/06/2019] [Indexed: 12/28/2022]
Affiliation(s)
- C. Moreno‐Rabié
- OMFS‐IMPATH Research Group Department of Imaging and Pathology Faculty of Medicine University of Leuven LeuvenBelgium
| | - A. Torres
- OMFS‐IMPATH Research Group Department of Imaging and Pathology Faculty of Medicine University of Leuven LeuvenBelgium
- Department of Oral Health Sciences Endodontology University Hospitals Leuven Leuven Belgium
| | - P. Lambrechts
- Department of Oral Health Sciences Endodontology University Hospitals Leuven Leuven Belgium
| | - R. Jacobs
- OMFS‐IMPATH Research Group Department of Imaging and Pathology Faculty of Medicine University of Leuven LeuvenBelgium
- Department of Oral and Maxillofacial Surgery University Hospitals Leuven LeuvenBelgium
- Department of Dental Medicine Karolinska Institutet Stockholm Sweden
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16
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Zubizarreta-Macho Á, Ferreiroa A, Agustín-Panadero R, Rico-Romano C, Lobo-Galindo AB, Mena-Álvarez J. Endodontic re-treatment and restorative treatment of a dens invaginatus type II through new technologies. J Clin Exp Dent 2019; 11:e570-e576. [PMID: 31346380 PMCID: PMC6645261 DOI: 10.4317/jced.55840] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/01/2019] [Indexed: 12/11/2022] Open
Abstract
Background The complex anatomy of dens invaginatus makes access cavity to root canal system difficult, which has an impact on the prognosis of these teeth. A novel technique, based on new technologies, is proposed to make access cavity conservative and guided with minimal dental structure lost. Material and Methods This case report shows the root canal retreatment and the endodontic surgery of a dens invaginatus type II in a left lateral upper incisor previously treated which was affected by a chronic apical abscess and an apical fracture. A Cone Beam Computed Tomography was performed to better diagnosis the dental anatomy. An intraoral scan was performed to get a digital 3D model. A computer-guided implant planning software was used to plan the access cavity and design the splint guided. Finally, the clinical crown was restored by a resin nanoceramic veneer made by a chairside system made up of an intraoral scanning unit and a grinding unit. Last, the authors carried through the endodontic surgery to extract the apical fractured fragment. Results Follow-up appointments at 6, 12 and 18 months showed a radiographic reduction of the periapical lesion and absence of clinical signs. Conclusions The splint guide allowed a guided and conservative access cavity to root canal system. It facilitates the root canal retreatment and improves the prognosis of the teeth with dental malformations. Key words:CAD-CAM, Cone-Beam Computed Tomography, dens in dente, dens invaginatus, dental pulp cavity, endodontics.
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Affiliation(s)
- Álvaro Zubizarreta-Macho
- DDS, PhD. Associate professor. Department of Endodontics. Faculty of Health Sciences. Alfonso X el Sabio University. Madrid. Spain
| | - Alberto Ferreiroa
- DDS, PhD. Associate professor. Department of Dental Prosthesis. Faculty of Dentistry. Complutense University. Madrid. Spain
| | - Rubén Agustín-Panadero
- DDS, PhD.Adjunct Professor. Department of Dental Medicine. Faculty of Medicine and Dentistry. University of Valencia. Spain
| | - Cristina Rico-Romano
- DDS, PhD. Associate professor. Department of Endodontics. Faculty of Health Sciences. Alfonso X el Sabio University. Madrid. Spain
| | - Ana-Belén Lobo-Galindo
- DDS, MS. Associate professor. Department of Endodontics. Faculty of Health Sciences. Alfonso X el Sabio University. Madrid. Spain
| | - Jesús Mena-Álvarez
- DDS, PhD. Head Director. Department of Endodontics. Faculty of Health Sciences. Alfonso X el Sabio University. Madrid. Spain
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17
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3D imaging, 3D printing and 3D virtual planning in endodontics. Clin Oral Investig 2018; 22:641-654. [DOI: 10.1007/s00784-018-2338-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/07/2018] [Indexed: 01/22/2023]
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18
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Mena-Álvarez J, Rico-Romano C, Lobo-Galindo AB, Zubizarreta-Macho Á. Endodontic treatment of dens evaginatus by performing a splint guided access cavity. J ESTHET RESTOR DENT 2017; 29:396-402. [DOI: 10.1111/jerd.12314] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jesús Mena-Álvarez
- Endodontics. Faculty of Health Sciences, Alfonso X el Sabio University; Madrid Spain
| | - Cristina Rico-Romano
- Endodontics, Faculty of Health Sciences, Alfonso X el Sabio University; Madrid Spain
| | - Ana Belén Lobo-Galindo
- Department of Dental Pathology and Therapeutic; Faculty of Health Sciences, Alfonso X el Sabio University; Madrid Spain
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19
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Shi X, Zhao S, Wang W, Jiang Q, Yang X. Novel navigation technique for the endodontic treatment of a molar with pulp canal calcification and apical pathology. AUST ENDOD J 2017. [PMID: 28643401 DOI: 10.1111/aej.12207] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Apical periodontitis, the inflammation of periapical tissue, commonly requires root canal treatment to achieve apical healing. However, if it is accompanied by pulp canal calcification, the treatment becomes complicated, and locating the root canal can be challenging. This case report describes a novel approach for treating a molar with pulp canal calcification and apical pathology. Due to the risk of perforation during treatment, a digitally printed template was used to assist in accurately locating the root canal. After six months, the patient was asymptomatic and the periradicular radiolucency was gradually reducing in size.
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Affiliation(s)
- Xilin Shi
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shiyong Zhao
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weidong Wang
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qianzhou Jiang
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuechao Yang
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
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20
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Zhu J, Wang X, Fang Y, Von den Hoff JW, Meng L. An update on the diagnosis and treatment of dens invaginatus. Aust Dent J 2017; 62:261-275. [PMID: 28306163 DOI: 10.1111/adj.12513] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 12/15/2022]
Affiliation(s)
- J Zhu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
- Affiliated Zhongshan Hospital; Sun Yat-sen University; Zhongshan China
| | - X Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
| | - Y Fang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
| | - JW Von den Hoff
- Department of Orthodontics and Craniofacial Biology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - L Meng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
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21
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Pallivathukal RG, Misra A, Nagraj SK, Donald PM. Dens invaginatus in a geminated maxillary lateral incisor. BMJ Case Rep 2015; 2015:bcr-2015-209672. [PMID: 26002668 DOI: 10.1136/bcr-2015-209672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Dens invaginatus (DI) and gemination are two developmental abnormalities that are well reported in the dental literature, but their coexistence in a single tooth is rare. Such situations worsen the risk factors associated with these anomalies, and the treatment plan should be customised as they possess altered morphology and anatomy. A 19-year-old girl came for evaluation of a cracked tooth in the front region of the upper jaw. The tooth showed clinical features of gemination and radiographic features of DI, and was diagnosed as DI in geminated maxillary lateral incisor. The differential diagnoses based on clinical appearance without radiographic investigation may warrant the treatment approach if these two abnormalities coexist in a single tooth. The report also highlights the importance of three-dimensional imaging in diagnosis and treatment planning of teeth with altered pulp canal anatomy. There are few reported cases in the literature detailing the treatment options for these two anomalies occurring in the same tooth.
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Affiliation(s)
| | - Alok Misra
- Faculty of Dentistry, Department of Conservative and Endodontics, Melaka-Manipal Medical College, Melaka, Malaysia
| | - Sumanth Kumbargere Nagraj
- Faculty of Dentistry, Department of Oral Medicine, Oral Diagnosis and Oral Radiology, Melaka-Manipal Medical College, Melaka, Malaysia
| | - Preethy Mary Donald
- Faculty of Dentistry, Department of Oral Medicine, Oral Diagnosis and Oral Radiology, Melaka-Manipal Medical College, Melaka, Malaysia
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