Management of Longstanding Furcation Perforation Using a Novel Approach

4-META/MMA-TBB resin containing nano hydroxyapatite induces the healing of periodontal tissue repair in perforations at the pulp chamber floor

We aimed to evaluate the materials based on 4-methacryloxyethyl trimellitate anhydride/methyl methacrylate tri-n-butylborane (Super-bond [SB]) and nano hydroxyapatite (naHAp) for the repair of perforation at pulp chamber floor (PPF) in vitro and in vivo models. SB and naHAp were mixed in the mass ratio of 10% or 30% to produce naHAp/SB. Human periodontal ligament stem cells (HPDLSCs) were cultured on resin discs of SB or naHAp/SB to analyze the effects of naHAp/SB on cell adhesion, proliferation, and cementoblastic differentiation. A rat PPF model was treated with SB or naHAp/SB to examine the effects of naHAp/SB on the healing of defected cementum and periodontal ligament (PDL) at the site of PPF. HPDLSCs were spindle-shaped and adhered to all resin discs. Changing the resin from SB to naHAp/SB did not significantly alter cell proliferation. Both 10% and 30% naHAp/SB were more effective than SB in promoting cementoblastic differentiation of HPDLSCs. In the rat PPF model, 30% naHAp/SB was more effective than SB in promoting the formation Sharpey's fiber-like structures with expression of the PDL-related marker and cementum-like structures with expression of cementum-related markers. In conclusion, 30% naHAp/SB can be the new restorative material for PPF because it exhibited the abilities of adhering to dentin and healing of defected periodontal tissue.

Furcation Involvement in Periodontal Disease: A Narrative Review

Furcation-involved teeth, commonly seen in dental practice, have a higher likelihood of needing extraction as the severity of periodontal furcation involvement increases. Studies consistently show that periodontitis in teeth with multiple roots significantly increases the risk of tooth loss, especially in the area where the furcation is involved. These furcation defects pose a major problem for dentists because of their location, accessibility issues, and the unpredictable healing process. The biggest hurdle in treating furcation defects is their irregular shape, which makes it hard to achieve complete debridement. While various treatments have been explored, non-surgical methods have not shown much success. This article comprehensively provides a review and discussion on the classification, assessment, and treatment options, including surgical and non-surgical management of furcation-involved molar teeth. Properly understanding the severity of the disease and its confounding factors and managing and treating the lesions appropriately have been shown to impart satisfactory survival rates for these teeth. Enhancing the understanding of managing these teeth can also lead to better outcomes for patients.

Assessment of the diagnostic accuracy of strip and furcal perforations in different sizes by cone beam computed tomography

OBJECTIVE

Root perforation is an adverse event that may accidentally occur during root canal treatment and can adversely affect the treatment plan and tooth prognosis. This study aimed to assess the accuracy of cone beam computed tomography (CBCT) for detecting the strip and furcal perforations with different sizes.

METHODS

The mesiolingual canals of 155 extracted human mandibular first molars were instrumented and randomly divided into four experimental groups and one control group (n = 31). Furcal (in the pulp chamber floor) and strip perforations with 0.5, 1, 1.5, and 2 mm in diameter were manually created. The teeth were randomly mounted in bovine ribs and scanned using CBCT. Two radiologists unaware of the study groups observed the images and reported the greatest perforation diameter. The inter-observer agreements were calculated. The diagnostic accuracy was compared for furcal and strip perforations with different sizes.

RESULTS

The inter-observer agreement for detecting furcal and strip perforations with different sizes were good. The diagnostic accuracy was 100% for the absence of perforation in each group.

CONCLUSIONS

CBCT can detect the absence of perforation with high accuracy. The diagnostic accuracy of CBCT in the presence of strip and furcal perforation with different sizes was not significant.

Biomimetic Approaches in Clinical Endodontics

In the last few decades, biomimetic concepts have been widely adopted in various biomedical fields, including clinical dentistry. Endodontics is an important sub-branch of dentistry which deals with the different conditions of pulp to prevent tooth loss. Traditionally, common procedures, namely pulp capping, root canal treatment, apexification, and apexigonesis, have been considered for the treatment of different pulp conditions using selected materials. However, clinically to regenerate dental pulp, tissue engineering has been advocated as a feasible approach. Currently, new trends are emerging in terms of regenerative endodontics which have led to the replacement of diseased and non-vital teeth into the functional and healthy dentine-pulp complex. Root- canal therapy is the standard management option when dental pulp is damaged irreversibly. This treatment modality involves soft-tissue removal and then filling that gap through the obturation technique with a synthetic material. The formation of tubular dentine and pulp-like tissue formation occurs when stem cells are transplanted into the root canal with an appropriate scaffold material. To sum up tissue engineering approach includes three components: (1) scaffold, (2) differentiation, growth, and factors, and (3) the recruitment of stem cells within the pulp or from the periapical region. The aim of this paper is to thoroughly review and discuss various pulp-regenerative approaches and materials used in regenerative endodontics which may highlight the current trends and future research prospects in this particular area.

Outcomes of furcal perforation management using Mineral Trioxide Aggregate and Biodentine: a systematic review

Furcal perforation is an iatrogenic or pathologic communication between the pulp chamber floor and the alveolar bone. The outcome of perforation sealing depends greatly on the tissue compatibility and bioactivity and sealing properties of the repair materials. Mineral trioxide aggregate (MTA) and Biodentine are currently the most used materials to treat this condition. The present systematic review aimed to report the treatment outcome of repaired furcal perforation using MTA and Biodentine and identify which material would yield a better outcome.

METHODOLOGY

A comprehensive search was conducted using the PubMed database to identify experimental studies and case reports that describe treatment of furcal perforation. Studies and case reports that evaluated the outcome of repaired furcal perforations using MTA and Biodentine, published in English from 2018 to April 2022, were identified. Unavailable full texts were excluded.

RESULTS

Initial screening of 724 articles (670 studies and 54 case reports). After discarding the duplicated studies, we reviewed 50 studies, selecting 13 for abstract analysis. We retrieved and evaluated full texts of eight studies and five case reports. Both materials had an equivalent success rate in the first three months but by 12 months Biodentine performed better than MTA clinically and radiographically.

CONCLUSIONS

Repair of furcal perforation with Biodentine yields a better outcome compared to MTA.

Effect of an enamel matrix derivative (Emdogain) on the microhardness and chemical composition of human root dentin: an in vitro study

The advantage of using an Enamel matrix derivative EMD Emdogain as an intracanal medication could be a manner to strength the tooth structure, improving the physical and chemical properties of dentin. We tested, in vitro, the effect of Emdogain on the surface microhardness and chemical composition of root dentin. Ten human teeth were used to produce dentin specimens originated from the canal walls (n = 30) that remained in contact to Emdogain gel for 90 days. Baseline and 90-days after Emdogain treatment measurements were performed using Fourier Transform Infrared Spectroscopy (ATR/FTIR), Scanning Electron Microscopy/Energy Dispersive Spectroscopy (SEM/EDS) and Knoop indenters. The use of EMD (Emdogain) for 90 days in contact with human root canal dentin specimens did not alter the microhardness and morphology of dentin. The elemental structure of dentin was altered because there was a reduction in carbonate content.

Guided endodontics: accuracy of access cavity preparation and discrimination of angular and linear deviation on canal accessing ability-an ex vivo study

BACKGROUND

Guided endodontics technique has been introduced for years, but the accuracy in different types of teeth has yet to be assessed. The aim of this study is to evaluate the accuracy of three dimensional (3D)-printed endodontic guides for access cavity preparation in different types of teeth, and to evaluate the predictive ability of angular and linear deviation on canal accessibility ex vivo.

METHOD

Eighty-four extracted human teeth were mounted into six jaw models and categorised into three groups: anterior teeth (AT), premolar (P), and molar (M). Preoperative cone beam computed tomography (CBCT) and surface scans were taken and matched using implant planning software. Virtual access cavity planning was performed, and templates were produced using a 3D printer. After access cavities were performed, the canal accessibility was recorded. Postoperative CBCT scans were superimposed in software. Coronal and apical linear deviations and angular deviations were measured and evaluated with nonparametric statistics. The receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of angular and linear deviation for canal accessibility in SPSS v20.

RESULTS

A total of 117 guided access cavities were created and 23 of them were record as canal inaccessibility, but all canals were accessible after canal negotiation. The average linear deviation for all groups was 0.13 ± 0.21 mm at coronal position, 0.46 ± 0.4 mm at apical position, and 2.8 ± 2.6° in angular deviation. At the coronal position, the linear deviations of the AT and P groups were significantly lower than M group deviation (P < 0.05), but no statistically significant difference between AT group and P group. The same results were found in linear deviation at the apical position and in angular deviation. The area under the ROC curve was 0.975 in angular deviation, 0.562 in linear deviation at the coronal position, and 0.786 at the apical position. Statistical significance was noted in linear deviation at the apical position and in angular deviation (P < 0.001).

CONCLUSIONS

In conclusion, this study demonstrated that the accuracy of access cavity preparation with 3D-printed endodontic guides was acceptable. The linear and angular deviations in the M group were significantly higher than those in the other groups, which might be caused by the interference of the opposite teeth. Angular deviation best discriminated the canal access ability of guided access cavity preparation.

Selective Retreatment and Sinus Lift: An Alternative Approach to Surgically Manage the Palatal Roots of Maxillary Molars

Endodontic microsurgery on the palatal root of maxillary molars presents a clinical challenge because of the root position and approximation from the maxillary sinus floor. Attempting a buccal or a palatal approach to address the root is associated with limited accessibility and visibility as well as the risk of injury to the maxillary sinus membrane and/or the greater palatine nerves and vessels. If all the maxillary molar roots require surgical intervention, two flaps may even be needed, which can make the procedure technically more difficult and lengthier. This case report presents 2 clinical cases in which apicoectomy was needed on the palatal roots of maxillary molars. The treatment includes selective nonsurgical retreatment of the palatal root and obturation using a root repair material followed by a surgical intervention from a buccal approach to treat the buccal roots, sinus lift using piezosurgery, and root resection of the palatal root. The approach was successful in both cases without any untoward events. We monitored the radiographic changes using cone-beam computed tomographic imaging immediately after the surgery and at multiple follow-up appointments. The cone-beam computed tomographic images revealed healing of the periapical disease around all the roots up to 14 and 24 months and apical repositioning of the maxillary sinus floor.

Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part II: other clinical applications and complications

Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapies (VPT), protecting scaffolds during regenerative endodontic procedures, apical barriers in teeth with necrotic pulps and open apices, perforation repairs as well as root canal filling and root-end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials have calcium and silicate in their compositions; however, bioactivity is a common property of these cements. These materials include the following: BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick-Set, Retro MTA, Tech Biosealer, and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this review, the available information on the chemical composition of the materials listed above was reviewed and their applications for VPT was discussed. In this article, the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root-end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials following their clinical applications is reviewed. These drawbacks include their discolouration potential, systemic effects and retreatability following use as a root filling material. Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the relevant clinical applications. Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA. Despite promising results for some materials, the number of publications using BECs for various clinical applications was limited. Furthermore, most studies had several methodological shortcomings and low levels of evidence.

Cytotoxicity, Biocompatibility, and Biomineralization of the New High-plasticity MTA Material

INTRODUCTION

Mineral trioxide aggregate (MTA) has excellent biological properties, but its handling properties have been criticized for both ProRoot MTA (Tulsa Dental Products, Tulsa, OK) and white MTA-Angelus (MTA-Ang; Angelus Indústria de Produtos Odontológicos S/A, Londrina, PR, Brazil). Angelus MTA HP (high plasticity) (Angelus Indústria de Produtos Odontológicos S/A) has been introduced recently. Considering the importance of biological properties of materials that will be in contact with the tissues, this study evaluated the cytotoxicity, biocompatibility, and biomineralization of MTA HP compared with white MTA-Ang.

METHODS

L929 fibroblast cell lines were cultured, and cell viability was assessed at 6, 24, 48, and 72 hours using the alamar Blue assay (Thermo Fisher Scientific, Waltham, MA). A subcutaneous implant test was performed with polyethylene tubes containing 1 of the materials or empty tubes (control) using 20 Wistar rats. After 7 and 30 days of implantation, the tubes with surrounding tissues were removed for analysis using hematoxylin-eosin or von Kossa stain or they remained unstained for observation under polarized light. The results were statistically analyzed (P < .05).

RESULTS

A significant increase in cell viability for MTA HP was observed after 24, 48, and 72 hours compared with the control (P < .05). At 72 hours, MTA HP exhibited a higher viability compared with white MTA-Ang (P < .05). Histologic analysis performed at 7 days showed moderate inflammation and a thick fibrous capsule in all groups (P > .05). At 30 days, mild inflammation and a thin fibrous capsule were observed in all groups (P > .05). All materials had structures positive for von Kossa and birefringent to polarized light.

CONCLUSIONS

MTA HP showed biocompatibility and biomineralization similar to MTA-Ang. In addition, MTA HP showed increased fibroblast cell viability compared with white MTA-Ang after a longer period.