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Ciardo A, Rampf S, Kim TS. Vital root resection with radicular retrograde partial pulpotomy in furcation-involved maxillary molars in patients with periodontitis: Technique description and case series considering clinical and economic aspects. Int Endod J 2024; 57:617-628. [PMID: 38306111 DOI: 10.1111/iej.14031] [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: 10/30/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/03/2024]
Abstract
AIM Conventional root resection in periodontally compromised furcation-involved maxillary molars requires preceding endodontic treatment and is therefore associated with loss of tooth vitality, higher invasiveness, treatment time and costs, and the risk of endodontic complications. Vital root resection (VRR) could overcome these disadvantages while establishing stable periodontal and endodontic conditions. This case series aimed to introduce the concept of one-stage VRR with radicular retrograde partial pulpotomy (VRRretro). SUMMARY Seven vital maxillary molars with residual probing pocket depths (PPD) ≥ 6 mm and furcation ≥ class 2 of five patients with stage III/IV periodontitis were treated with VRRretro using mineral trioxide aggregate. Teeth with residual through-and-through furcations were additionally tunnelled. Follow-up up to 2.5 years postoperatively during supportive periodontal care included full periodontal status, percussion and thermal sensitivity testing. Periapical radiographs were obtained to rule out possible periradicular radiolucencies. All seven treated molars were in-situ at an average of 26.84 ± 5.37 months postoperatively and were clinically and radiographically inconspicuous independent of tooth position, the resected root, the need for tunnelling and the restorative status. The mean PPD on the seven treated molars was 4.02 ± 0.85 mm (6-10 mm) preoperatively and 2.62 ± 0.42 mm (3-4 mm) at the last follow-up. Clinical attachment level and bleeding on probing could also be decreased. The teeth showed no mobility over time and furcations class 2 were reduced to class 1 while the tunnelled furcations were accessible with interdental brushes. All molars reacted negatively to percussion and positively to thermal sensitivity testing. KEY LEARNING POINTS In carefully selected cases considering patient- and tooth-related factors, VRRretro could be a promising treatment option to establish stable periodontal and endodontic conditions in furcation-involved maxillary molars while preserving tooth vitality.
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Affiliation(s)
- Antonio Ciardo
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Sarah Rampf
- Section of Endodontology and Dental Traumatology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Ti-Sun Kim
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg Faculty of Medicine, Heidelberg University, Heidelberg, Germany
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Garrido BDTM, Vitor LLR, Cruvinel T, Machado MAAM, Oliveira TM, Lourenço Neto N. Dentists' Self-evaluated Ability in Diagnosing and Updating About Pulpotomy. Int Dent J 2023; 73:319-324. [PMID: 35393116 PMCID: PMC10023525 DOI: 10.1016/j.identj.2022.03.002] [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: 12/15/2021] [Revised: 01/26/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aimed to self-evaluate the knowledge of different dental professionals' profiles in Brazil on diagnosing and indicating pulpotomy in primary teeth and how these groups updated on this theme. METHODS Three groups (G1: professors, G2: specialists, and G3: professionals) answered an online questionnaire containing 20 questions and returned 416 questionnaires. Data were subjected to Chi-square associative tests and t tests, with P < .05. RESULTS G1 and G2 reported to indicate pulpotomy, highlighting the tendency of these groups towards seeking updates on this subject. All 3 groups used academic materials for updating. However, G2 had a high demand for updates through congresses, whilst G3 had a high demand for updates through social media (Google and Google Scholar). The most cited indication by G1 and G2 was "accidental pulp exposure" and by G3 was "teeth with extensive carious lesions that have involved the pulp with radiographic confirmation." All 3 groups opted for pulpotomy to keep the tooth in the arch. Thus, G1 and G2 are the groups who are more updated on the subject, using mainly academic materials, which can be associated with the fact that such groups indicated pulpotomy in primary teeth. The lower interest in searching about pulpotomy in G3 can be understood as a nonclinical application of the topic for this group. CONCLUSIONS Professionals who work directly with paediatric dentistry (professors or specialists) felt more capable of diagnosing and treating cases of pulpotomy. In addition, most of the professionals used scientifically based sources for getting information and actualisation on the subject of pulp therapies.
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Affiliation(s)
- Beatriz Della Terra Mouco Garrido
- Department of Pediatric Dentistry, Orthodontics and Community Dentistry, Discipline of Pediatric Dentistry, Bauru School of Dentistry-University of São Paulo, Bauru, Brazil
| | | | - Thiago Cruvinel
- Department of Pediatric Dentistry, Orthodontics and Community Dentistry, Discipline of Pediatric Dentistry, Bauru School of Dentistry-University of São Paulo, Bauru, Brazil
| | - Maria Aparecida Andrade Moreira Machado
- Department of Pediatric Dentistry, Orthodontics and Community Dentistry, Discipline of Pediatric Dentistry, Bauru School of Dentistry-University of São Paulo, Bauru, Brazil; Hospital for the Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Thais Marchini Oliveira
- Department of Pediatric Dentistry, Orthodontics and Community Dentistry, Discipline of Pediatric Dentistry, Bauru School of Dentistry-University of São Paulo, Bauru, Brazil; Hospital for the Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Natalino Lourenço Neto
- Department of Pediatric Dentistry, Orthodontics and Community Dentistry, Discipline of Pediatric Dentistry, Bauru School of Dentistry-University of São Paulo, Bauru, Brazil.
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Firoozi P, Salman BN, Aslaminabadi N. Clinical and radiographic comparison of Biodentine and Formocresol: an updated meta-analysis with trial sequential analysis. Eur Arch Paediatr Dent 2022; 23:855-867. [PMID: 35596042 DOI: 10.1007/s40368-022-00715-9] [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: 12/21/2021] [Accepted: 04/19/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE This meta-analysis aimed to compare the clinical and radiographic success rate of Biodentine as an alternative to Formocresol to provide a critical appraisal of the available literature and evidence-based conclusion as well as update the previous systematic review. METHODS MEDLINE, CENTRAL, Web of Science, Scopus, and Google Scholar databases were searched up to 20 October 2021 to identify RCTs evaluating pulpotomy with Biodentine/Formocresol in carious primary molars among children ≤ 10 years old. The risk of bias was assessed using the Cochrane RoB-2 tool. RRs and corresponding 95% CIs were calculated to pool results that RR ˃ 1 indicated a higher success rate in the Biodentine group and RR < 1 indicated a higher success rate in the Formocresol group. Heterogeneity was calculated using the I2 and τ2 statistics. In addition, trial sequential analysis was performed to adjust results for type I and type II errors and evaluate power of the meta-analysis. RESULTS Nine RCTs were identified and eight RCTs were included in the meta-analysis and trial sequential analysis. The obtained evidence showed no significant difference between Biodentine and Formocresol in terms of clinical efficacy. However, considering the radiographic success rate the results of the meta-analysis and trial sequential analysis significantly favoured Biodentine. CONCLUSION Within the limitations of the present review and based on the retrieved findings it has been clearly shown that Biodentine is superior compared to Formocresol in terms of radiographic success rate with firm evidence in this regard. Although the performed meta-analysis showed no significant clinical difference between Biodentine and Formocresol, however, trial sequential analysis revealed a lack of firm evidence in this regard.
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Affiliation(s)
- Parsa Firoozi
- Student Research Committee, School of Dentistry, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Bahareh Nazemi Salman
- Department of Pediatric Dentistry, School of Dentistry, Zanjan University of Medical sciences, Zanjan, Iran
| | - Naser Aslaminabadi
- Department of Pediatric Dentistry, School of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran.
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Vital and Nonvital Pulp Therapy in Primary Dentition: An Umbrella Review. J Clin Med 2021; 11:jcm11010085. [PMID: 35011827 PMCID: PMC8745069 DOI: 10.3390/jcm11010085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 12/27/2022] Open
Abstract
Dental caries is the most common non-communicable disease in children with significant aesthetic, functional, and quality of life deterioration. Depending on the depth, two approaches may be considered in primary dentition: vital pulp therapy (VPT) or non-vital therapy (NPT). This umbrella review aimed to critically assess the available systematic reviews (SRs) on VPT and NPT. An electronic database search was conducted (PubMed, Embase, Scopus, Cochrane, Web of Science, and LILACS) until June 2021. The Risk of Bias (RoB) of SRs was analyzed using the Measurement Tool to Assess SRs criteria 2 (AMSTAR2). From 272 entries, 33 SRs were included. Regarding the methodological quality, three studies were critically low, nine low, seventeen moderate, and six were rated as high quality. The quality of evidence produced by the available SRs was moderate. Future high standard SRs and well-designed clinical trials are warranted to better elucidate the clinical protocols and outcomes of VPT and NPT.
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Bolukbasi B, Kucukyilmaz E. Evaluation of the bond strengths of restorative materials to primary tooth dentin treated with different pulpotomy techniques. Microsc Res Tech 2021; 84:1309-1320. [PMID: 33754435 DOI: 10.1002/jemt.23689] [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: 09/17/2020] [Revised: 12/05/2020] [Indexed: 11/06/2022]
Abstract
The aim of this study was to investigate the changes of different pulpotomy techniques on the primary tooth dentin and to evaluate the effects of these pulpotomy methods on the shear bond strength of restorative materials to primary tooth dentin. Two hundred and forty dentin specimens were distributed randomly to the study groups as; control, ferric sulphate, Biodentine® , Nd:YAG laser, photobiomodulation, and atmospheric pressure cold plasma (APCP). After the application of pulpotomy methods, samples were again randomly divided to two restorative materials (glass hybrid and composite resin) (n = 20) and shear bond strength (SBS) test was performed. Then, 12 new dentin specimens were prepared for all groups for surface analysis. Surface examination (n = 12) and fracture analyses (n = 240) were carried out with scanning electron microscope (SEM). Statistical significance range was accepted as α <.05 for all data. A statistically significant difference was obtained among all study groups for glass hybrid material as well as composite material (p <.05). While the highest mean SBS value was obtained with Nd:YAG laser (7.58 ± 0.60 MPa), the lowest value was observed with Biodentine® (6.70 ± 0.91 MPa; p = .001) for glass hybrid material. For composite material, the highest mean SBS value was calculated for Nd:YAG laser (13.79 ± 1.24 MPa), while the lowest value was obtained with ferric sulphate (10.17 ± 1.45 MPa; p = .001). Fracture modes were mainly adhesive and mixed type according to SEM analysis. Moreover, morphological changes were observed with SEM on the dentin surfaces of ferric sulphate, Biodentine® and Nd:YAG laser. Within the limitations of this study, Nd:YAG laser increased the shear bond strength values in groups of composite resin. RESEARCH HIGHLIGHTS: In this article, we report the results of the shear bonding strength test of two restorative materials (glass-hybrid vs. composite resin) to primary tooth dentin following the application of five different pulpotomy techniques (ferric sulfate, Biodentine® , Nd:YAG laser, photobiomodulation, and atmospheric pressure cold plasma) were reported. This article will contribute to the literature that there are considerably limited researches concerning the bond strength of glass hybrid to primary dentin and also atmospheric pressure cold plasma in pulpotomies. The SEM examination was performed in two stages in this study; the morphological changes in both treated dentin surfaces and the surfaces of the samples subjected to the shear bond strength test.
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Affiliation(s)
- Basak Bolukbasi
- Faculty of Dentistry, Department of Pediatric Dentistry, Izmir Katip Celebi University, Izmir, Turkey
| | - Ebru Kucukyilmaz
- Faculty of Dentistry, Department of Pediatric Dentistry, Izmir Katip Celebi University, Izmir, Turkey
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Sanz JL, Forner L, Llena C, Guerrero-Gironés J, Melo M, Rengo S, Spagnuolo G, Rodríguez-Lozano FJ. Cytocompatibility and Bioactive Properties of Hydraulic Calcium Silicate-Based Cements (HCSCs) on Stem Cells from Human Exfoliated Deciduous Teeth (SHEDs): A Systematic Review of In Vitro Studies. J Clin Med 2020; 9:jcm9123872. [PMID: 33260782 PMCID: PMC7761433 DOI: 10.3390/jcm9123872] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 02/06/2023] Open
Abstract
The implementation of hydraulic calcium silicate-based endodontic cements (HCSCs) in biologically based endodontic procedures for the primary dentition has been recently investigated, focusing on the biological response of stem cells from human exfoliated deciduous teeth (SHEDs) towards them. The present systematic review aimed to present a qualitative synthesis of the available literature consisting of in vitro assays, which assessed the cytocompatibility and bioactive properties of HCSCs in direct contact with SHEDs. Following the PRISMA statement, an electronic database search was carried out in Medline, Scopus, Embase, Web of Science, and SciELO on March 31st and updated on November 16th, 2020. In vitro studies evaluating the biological response of SHEDs to the treatment with HCSCs were eligible. Within the term biological response, assays assessing the cytocompatibility (i.e., cell viability, migration, proliferation), cell plasticity or differentiation (i.e., osteo/odontogenic marker expression), and bioactivity or biomineralization (i.e., mineralized nodule formation) were included. A total of seven studies were included after the selection process. The study sample comprised an extensive range of cell viability, migration, proliferation, adhesion, and bioactivity assays regarding the biological response of SHEDs towards five different commercially available HCSCs (MTA, ProRoot MTA, Biodentine, iRoot BP Plus, and Theracal LC). Biodentine, MTA, and iRoot BP Plus showed significant positive results in cytocompatibility and bioactivity assays when cultured with SHEDs. The results from in vitro assays assessing the cytocompatibility and bioactivity of the HCSCs MTA, Biodentine, and iRoot BP Plus towards SHEDs support their use in vital pulp treatment for the primary dentition.
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Affiliation(s)
- José Luis Sanz
- Departament d’Estomatologia, Facultat de Medicina I Odontologia, Universitat de València, 46010 Valencia, Spain; (J.L.S.); (C.L.); (M.M.)
| | - Leopoldo Forner
- Departament d’Estomatologia, Facultat de Medicina I Odontologia, Universitat de València, 46010 Valencia, Spain; (J.L.S.); (C.L.); (M.M.)
- Correspondence: ; Tel.: +34-963864175
| | - Carmen Llena
- Departament d’Estomatologia, Facultat de Medicina I Odontologia, Universitat de València, 46010 Valencia, Spain; (J.L.S.); (C.L.); (M.M.)
| | - Julia Guerrero-Gironés
- Cellular Therapy and Hematopoietic Transplant Research Group, Biomedical Research Institute, Virgen de la Arrixaca Clinical University Hospital, IMIB-Arrixaca, University of Murcia, 30120 Murcia, Spain; (J.G.-G.); (F.J.R.-L.)
- Department of Dermatology, Stomatology, Radiology and Physical Medicine, Morales Meseguer Hospital, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain
| | - María Melo
- Departament d’Estomatologia, Facultat de Medicina I Odontologia, Universitat de València, 46010 Valencia, Spain; (J.L.S.); (C.L.); (M.M.)
| | - Sandro Rengo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80138 Napoli, Italy; (S.R.); (G.S.)
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80138 Napoli, Italy; (S.R.); (G.S.)
- Institute of Dentistry, I. M. Sechenov First Moscow State Medical University, Moscow 119146, Russia
| | - Francisco Javier Rodríguez-Lozano
- Cellular Therapy and Hematopoietic Transplant Research Group, Biomedical Research Institute, Virgen de la Arrixaca Clinical University Hospital, IMIB-Arrixaca, University of Murcia, 30120 Murcia, Spain; (J.G.-G.); (F.J.R.-L.)
- Department of Dermatology, Stomatology, Radiology and Physical Medicine, Morales Meseguer Hospital, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain
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Oliveira LV, Silva GR, Souza GL, Magalhães TEA, Barbosa GLR, Turrioni AP, Moura CCG. A laboratory evaluation of cell viability, radiopacity and tooth discoloration induced by regenerative endodontic materials. Int Endod J 2020; 53:1140-1152. [DOI: 10.1111/iej.13308] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/07/2020] [Indexed: 12/12/2022]
Affiliation(s)
- L. V. Oliveira
- Department of EndodonticsFederal University of Uberlândia Uberlândia Brazil
| | - G. R. Silva
- Department of Operative Dentistry and Dental MaterialsFederal University of Uberlândia Uberlândia Brazil
| | - G. L. Souza
- Department of EndodonticsFederal University of Uberlândia Uberlândia Brazil
| | | | - G. L. R. Barbosa
- Department of Stomatological Diagnosis School of DentistryFederal University of UberlândiaUberlândiaBrazil
| | - A. P. Turrioni
- Department of Pediatric School of Dentistry Federal University of Uberlândia Uberlândia Brazil
| | - C. C. G. Moura
- Department of EndodonticsFederal University of Uberlândia Uberlândia Brazil
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Sanz JL, Forner L, Almudéver A, Guerrero-Gironés J, Llena C. Viability and Stimulation of Human Stem Cells from the Apical Papilla (hSCAPs) Induced by Silicate-Based Materials for Their Potential Use in Regenerative Endodontics: A Systematic Review. MATERIALS 2020; 13:ma13040974. [PMID: 32098171 PMCID: PMC7078727 DOI: 10.3390/ma13040974] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/13/2020] [Accepted: 02/20/2020] [Indexed: 12/12/2022]
Abstract
Blood clot formation in the apical third of the root canal system has been shown to promote further root development and reinforcement of dentinal walls by the deposition of mineralized tissue, resulting in an advancement from traditional apexification procedures to a regenerative endodontic treatment (RET) for non-vital immature permanent teeth. Silicate-based hydraulic biomaterials, categorized as bioactive endodontic cements, emerged as bright candidates for their use in RET as coronal barriers, sealing the previously induced blood clot scaffold. Human stem cells from the apical papilla (hSCAPs) surviving the infection may induce or at least be partially responsible for the regeneration or repair shown in RET. The aim of this study is to present a qualitative synthesis of available literature consisting of in vitro assays which analyzed the viability and stimulation of hSCAPs induced by silicate-based hydraulic biomaterials. A systematic electronic search was carried out in Medline, Scopus, Embase, Web of Science, Cochrane and SciELO databases, followed by a study selection, data extraction, and quality assessment following the PRISMA protocol. In vitro studies assessing the viability, proliferation, and/or differentiation of hSCAPs as well as their mineralization potential and/or osteogenic, odontogenic, cementogenic and/or angiogenic marker expression in contact with commercially available silicate-based materials were included in the present review. The search identified 73 preliminary references, of which 10 resulted to be eligible for qualitative synthesis. The modal materials studied were ProRoot MTA and Biodentine. Both bioceramic materials showed significant positive results when compared to a control for hSCAP cell viability, migration, and proliferation assays; a significant up-regulation of hSCAP odontogenic/osteogenic marker (ALP, DSPP, BSP, Runx2, OCN, OSX), angiogenic growth factor (VEGFA, FIGF) and pro-inflammatory cytokine (IL-1α, IL-1β, IL-6, TNF-α) expression; and a significant increase in hSCAP mineralized nodule formation assessed by Alizarin Red staining. Commercially available silicate-based materials considered in the present review can potentially induce mineralization and odontogenic/osteogenic differentiation of hSCAPs, thus prompting their use in regenerative endodontic procedures.
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Affiliation(s)
- José Luis Sanz
- Dental Pathology and Therapeutics Unit, Department of Stomatology, Universitat de València, 46010 Valencia, Spain; (J.L.S.); (A.A.); (C.L.)
| | - Leopoldo Forner
- Dental Pathology and Therapeutics Unit, Department of Stomatology, Universitat de València, 46010 Valencia, Spain; (J.L.S.); (A.A.); (C.L.)
- Correspondence: ; Tel.: +34-96386-4175
| | - Alicia Almudéver
- Dental Pathology and Therapeutics Unit, Department of Stomatology, Universitat de València, 46010 Valencia, Spain; (J.L.S.); (A.A.); (C.L.)
| | - Julia Guerrero-Gironés
- Special Care and Gerodontology Unit, Department of Stomatology, University of Murcia, 30100 Murcia, Spain;
| | - Carmen Llena
- Dental Pathology and Therapeutics Unit, Department of Stomatology, Universitat de València, 46010 Valencia, Spain; (J.L.S.); (A.A.); (C.L.)
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