Combined Root Canal Therapies in Multirooted Teeth with Pulpal Disease

Effect of Sodium Hypochlorite Concentration on the Outcome of Full Pulpotomy in Mature Permanent Teeth with Irreversible Pulpitis - A Systematic Review

ABSTRACT

To determine the outcome of full pulpotomy in management of mature permanent teeth with irreversible pulpitis when 2.5% versus other concentrations of sodium hypochlorite (NaOCl) were used to achieve haemostasis. Electronic searches were performed in PubMed, Embase, Web of Science, International Clinical Trials Registry Platform, and ClinicalTrials.gov for English language articles until July 2021. Randomised clinical trials and cohort, cross-sectional, and case-control studies where full pulpotomy was performed to manage mature permanent molar teeth with irreversible pulpitis and no periapical radiolucency were included. Newcastle Ottawa Scale and the Cochrane risk of bias tool were used for quality assessment. The success rate for full pulpotomy was documented. The protocol was registered in PROSPERO database (CRD42020177214). Out of 861 studies, four were considered for data analysis. Three studies were single-arm prospective trials on pulpotomy, while one was a randomised control trial comparing pulpotomy and root canal treatment. A combined success rate of 93% from 117 teeth was reported from three studies using 2.5% NaOCl as a haemostatic agent. One study used 5% NaOCl and reported a success rate of 100% (n = 6 teeth). The certainty of evidence substantiated by the GRADE approach was of low quality. Overall quality assessment revealed a considerable risk of bias in three studies. Irrespective of the NaOCl concentration, the success rate of pulpotomy in mature permanent teeth with irreversible pulpitis was high. No study compared the different concentrations of NaOCl as a haemostatic agent. Further, randomised controlled trials are required to investigate the effect of NaOCl concentration for haemostasis on the outcome of pulpotomy.

Regenerative endodontic procedure combined with non-surgical root canal treatment in an immature permanent maxillary molar: A 7-year follow-up case report

The aim of this report is to present the results of a personalised endodontic treatment for an immature molar, using regenerative endodontic procedure (REP) combined with non-surgical root canal treatment (NSRCT), with 7 years of follow-up. The tooth#3 presented combined endodontic pathologies in each root, with different pulpal and periapical status. A REP in the palatal (P) canal and a NSCRT in the mesio-buccal (MB) and disto-buccal (DB) canals were performed. Absence of clinical signs/symptoms and continuous palatal root development with apical closure were observed over 4-years. After 5-years an apical lesion in the MB root was observed. Both MB canals were selectively retreated by completely filling them with TotalFill BC RRM Fast Set putty. After 7-years, the tooth remained functional and the apical lesion was resolving. The palatal root was completely mature. This case report reveals the potential for use of combined treatment approaches for immature multirooted teeth.

Tissue Characteristics in Endodontic Regeneration: A Systematic Review

The regenerative endodontic procedure (REP) represents a treatment option for immature necrotic teeth with a periapical lesion. Currently, this therapy has a wide field of pre-clinical and clinical applications, but no standardization exists regarding successful criteria. Thus, by analysis of animal and human studies, the aim of this systematic review was to highlight the main characteristics of the tissue generated by REP. A customized search of PubMed, EMBASE, Scopus, and Web of Science databases from January 2000 to January 2022 was conducted. Seventy-five human and forty-nine animal studies were selected. In humans, the evaluation criteria were clinical 2D and 3D radiographic examinations. Most of the studies identified a successful REP with an asymptomatic tooth, apical lesion healing, and increased root thickness and length. In animals, histological and radiological criteria were considered. Newly formed tissues in the canals were fibrous, cementum, or bone-like tissues along the dentine walls depending on the area of the root. REP assured tooth development and viability. However, further studies are needed to identify procedures to successfully reproduce the physiological structure and function of the dentin–pulp complex.

Combined conventional and regenerative treatment in molars with coexistent closed and open apices: A case series

Regenerative endodontic treatment (RET) may not be suitable in some necrotic young permanent molars due to coexistent roots with closed and open apices, and/or inadequate apical bleeding in one or more roots. Here, we present a combined treatment approach utilising conventional root canal treatment in the closed-apex roots and RET on the open-apex roots of necrotic young molars. The closed-apex roots of 8 molars received root fillings, and their open-apex roots were treated with a regenerative endodontic procedure. In another molar, the failed RET on one root was retreated by conventional root canal filling, preserving other revitalised roots. After 4-6 years, all teeth showed periapical healing in the absence of clinical symptoms. The combined conventional and regenerative treatment approach can yield favourable healing outcomes in necrotic, young molar roots with different levels of apical closure. Likewise, failed revitalised roots can be retreated separately with conventional root filling.