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Almohareb RA, Barakat RM, Algahtani FN, Almohaimel MA, Alaraj D, Alotaibi N. Effect of bioceramic intracanal medication on the dentinal bond strength of bioceramic cements: an ex-vivo study. PeerJ 2024; 12:e17826. [PMID: 39071126 PMCID: PMC11283773 DOI: 10.7717/peerj.17826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 07/08/2024] [Indexed: 07/30/2024] Open
Abstract
Background The present study evaluated the effect of a bioceramic intracanal medicament (Bio-C Temp) on the push-out bond strength of bioceramic cements. Methods Forty-eight human single-canaled premolars were prepared and randomly divided into three groups: Group (A) received no intracanal medicament; Group (B) calcium hydroxide (CH); and Group (C) Bio-C Temp. After medicament removal, the roots were sectioned transversely. The slices in each group were separated into two subgroups (n = 16): in Subgroup (1), mineral trioxide aggregate (MTA) was placed, and in Subgroup (2) Bio-C Repair. Push-out bond strength was determined using a universal testing machine, applying a constant compressive force on the cement until bond failure. The failure mode was also evaluated. Data were analyzed using the Chi-square test and two-way ANOVA followed by Tukey's post hoc tests. The level of significance was set at 5%. Results The pushout bond strength of Bio-C Repair was significantly higher than that of MTA irrespective of intracanal medication (p = 0.005). The placement of Bio-C Temp was associated with significantly lower bond strength (p = 0.002, p = 0.001). Conclusion Bio-C Repair showed better bond strength compared to MTA, irrespective of intracanal medication. Bio-C Temp intracanal medicament, however, decreased the bond strength of both these cements.
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Affiliation(s)
- Rahaf A. Almohareb
- Department of Clinical Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Reem M. Barakat
- Dental Clinics Department, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Fahda N. Algahtani
- Department of Clinical Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | - Denah Alaraj
- College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Norah Alotaibi
- College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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Odabaşı Tezer E, Buyuksungur A, Celikten B, Dursun PH, Sevimay FS. Effects of Access Cavity Design and Placement Techniques on Mineral Trioxide Aggregate Obturation Quality in Simulated Immature Teeth: A Micro-Computed Tomography Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:878. [PMID: 38929495 PMCID: PMC11205533 DOI: 10.3390/medicina60060878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: In teeth with open apices, performing single session apexification is a challenging treatment due to the difficulty in handling mineral trioxide aggregate (MTA). Minimally invasive approaches in dentistry have also influenced the cavity designs in endodontics. Until now, different techniques have not been investigated in addition to manual condensation during the process of placing MTA in traditional (TradACs) or conservative (ConsACs) endodontic access cavities. The aim of this in vitro study was to compare and evaluate the obturation quality of MTA apical plugs placed with different techniques in TradACs or ConsACs. Materials and Methods: Sixty upper central teeth were divided into two main groups based on cavity design, and then each main group was further divided into three subgroups according to MTA placement techniques (n = 10): TradAC-manual, TradAC-manual + indirect ultrasonic activation, TradAC-manual + XP-endo Shaper (XPS), ConsAC-manual, ConsAC-manual + indirect ultrasonic activation, and ConsAC-manual + XPS. Subsequently, the porosity percentages in the MTA apical plug were analyzed using micro-computed tomography. The statistical analysis was performed using the Kruskal-Wallis H test and Mann-Whitney U test. Statistical significance was set at p < 0.05. Results: There were differences in volume of porosity percentages (%) according to cavity designs and MTA application techniques (p < 0.05). Except for the XPS group, more porosity was observed in ConsACs compared to TradACs. In TradACs, the significantly lowest open and total porosity was observed in the manual, ultrasonic, and XPS techniques, respectively. In ConsACs, the significantly lowest porosity was observed in the manual, XPS, and ultrasonic techniques, respectively (p < 0.05). Conclusions: In MTA obturation, cavity designs and application techniques had an impact on the MTA porosity. Creating an apical plug in ConsACs may result in more porosity compared to TradACs, especially when manual or indirect ultrasonic activation is preferred. Opting for the manual technique alone may be considered sufficient for controlling porosity for both TradACs and ConsACs.
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Affiliation(s)
- Emine Odabaşı Tezer
- Department of Endodontics, Faculty of Dentistry, Ankara University, Ankara 06560, Turkey; (A.B.); (B.C.); (P.H.D.); (F.S.S.)
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Wang L, Ren S, Sun X, Guo S. Six-year clinical evaluation of iRoot BP Plus as apical barrier in permanent teeth of periapical periodontitis. AUST ENDOD J 2024; 50:115-122. [PMID: 37994232 DOI: 10.1111/aej.12815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023]
Abstract
The apical barrier technique in permanent teeth with extensive destruction of the periapical tissue and a long infection time is much more difficult to succeed, which is a clinical challenge. This study aimed to evaluate the long-term effects of iRoot BP Plus as an apical material in adult teeth. Fifty incisors and premolars were chosen for this study. All teeth were performed apical barrier with the same operator. After treatment, the teeth were clinically and radiographically evaluated at 1, 2 and 6 years. At the 1-year follow-up, 35 teeth had healed, and three patients developed an apical abscess due to root fracture at the 2-year follow-up. Six years postoperatively, one tooth showed root resorption, which was considered a failure. The long clinical evaluation confirmed that iRoot BP Plus is a suitable material for the apical barrier of mature teeth with open apices and periapical lesions.
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Affiliation(s)
- Lijun Wang
- Department of Endodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Shuangshuang Ren
- Department of Endodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiujuan Sun
- Department of Endodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Shiliang Guo
- Department of Endodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Goswami M, Jangra B. Management of traumatic dental injuries in a hemophiliac patient: A challenge! Case report with nine years follow-up. J Family Med Prim Care 2024; 13:1094-1098. [PMID: 38736808 PMCID: PMC11086756 DOI: 10.4103/jfmpc.jfmpc_1223_23] [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: 07/27/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 05/14/2024] Open
Abstract
Traumatic dental injuries (TDIs) are frequently associated with an injury pattern that requires accurate diagnosis for developing the appropriate treatment plan. When children with special healthcare needs, i.e., Hemophilia experience TDIs, managing the situation becomes a challenging task for pediatric dentists due to the requirement of a multidisciplinary approach in their care. This case report highlights the successful management of extrusive luxation injury of a young permanent tooth with an open apex in an eight-year-old male child with severe Hemophilia A. After a follow-up of nine years, the pulp showed significant healing with physiological closure of the apical foramen. The study further emphasizes that timely management of such injuries can lead to improved tooth prognosis.
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Affiliation(s)
- Mridula Goswami
- Department of Pediatric and Preventive Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Babita Jangra
- Department of Pediatric and Preventive Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India
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5
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Alsofi L, Almarzouki S. Failed Regenerative Endodontic Case Treated by Modified Aspiration-irrigation Technique and Apexification. J Contemp Dent Pract 2024; 25:92-97. [PMID: 38514438 DOI: 10.5005/jp-journals-10024-3601] [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] [Indexed: 03/23/2024]
Abstract
AIM This report addresses the management of a large persistent discharging lesion in an 11-year-old boy. The report describes the use of aspiration-irrigation technique for the management of immature necrotic tooth with persistent discharge after a failed regenerative procedure. BACKGROUND Regenerative endodontics aim to provide an increase in root canal width, length, and in apical closure. Alternative procedures, such as apexification, should be attempted when regeneration fails. If the canal cannot be dried to persistent discharge, the aspiration-irrigation technique can be used. The technique relies on using aspiration along with irrigation to remove pus from the periapical area. CASE DESCRIPTION This is a case for an 11-year-old patient who had trauma to tooth #11, which resulted in the complicated crown fracture. He had an emergency management that included pulpectomy and intracanal medication at another clinic. Two years later, the patient was presented to our clinic. Upon examination, the diagnosis was previously initiated therapy with asymptomatic apical periodontitis in immature tooth #11. Regeneration was attempted first but failed. The mineral trioxide aggregate (MTA) plug was removed, and the canal had persistent pus discharge. The canal was filled with intracanal medication, and then 2 weeks later, the canal was filled with triple antibiotic paste (TAP). Next visit, and due to continuous discharge, tooth #11 was treated conservatively with an intracanal aspiration-irrigation technique. An IrriFlex needle attached to a high-volume suction was used to aspirate the cystic fluid. Mineral trioxide aggregate plug apexification was performed in a later visit and the tooth was restored. CONCLUSION During the 3-month and 16-month follow-up, there was resolution of the symptoms, a decrease in the periapical lesion size, and soft tissues appeared within normal limits. CLINICAL SIGNIFICANCE Regenerative procedures are a good option for immature necrotic teeth. These procedures may fail due to persistent pus discharge from the root canals. The aspiration-irrigation technique is a good treatment option in cases of consciously discharging canals. How to cite this article: Alsofi L, Almarzouki S. Failed Regenerative Endodontic Case Treated by Modified Aspiration-irrigation Technique and Apexification. J Contemp Dent Pract 2024;25(1):92-97.
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Affiliation(s)
- Loai Alsofi
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia, Phone: +966 555318481, e-mail:
| | - Sara Almarzouki
- Department of Endodontics, University Dental Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
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Kalaoglu EE, Duman C, Capan BS, Ocak M, Bilecenoglu B. Comparison of three different biomaterials used in in vitro molar apexification models. BMC Oral Health 2023; 23:434. [PMID: 37391750 PMCID: PMC10311754 DOI: 10.1186/s12903-023-03180-y] [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: 04/20/2022] [Accepted: 06/27/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVES New biomaterials had some advantages such as mixing and easier application as compared to traditional MTA in single step apexification method. This study aimed to compare the three biomaterials used in the apexification treatment of immature molar teeth in terms of the time spent, the quality of the canal filling and the number of x-rays taken to complete the process. METHODS The root canals of the extracted thirty molar teeth were shaped with rotary tools. To obtain the apexification model, ProTaper F3 was used retrograde. The teeth were randomly assigned into three groups based on the material used to seal the apex; Group 1: Pro Root MTA, Group 2: MTA Flow, Group 3: Biodentine. The amounts of the filling, the number of radiographs taken until treatment completion and the treatment duration were recorded. Then teeth were fixed for micro computed tomography imaging for quality evaluation of canal filling. RESULTS Biodentine was superior to the other filling materials according to time. MTA Flow provided greater filling volume than the other filling materials in the rank comparison for the mesiobuccal canals. MTA Flow had greater filling volume than ProRoot MTA in the palatinal/distal canals(p = 0.039). Biodentine had greater filling volume more than MTA Flow in the mesiolingual/distobuccal canals (p = 0.049). CONCLUSIONS MTA Flow was found as a suitable biomaterial according to the treatment time and quality of root canal fillings.
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Affiliation(s)
- Elif Ece Kalaoglu
- Faculty of Dentistry, Department of Pedodontics, Istanbul Gelisim University, Istanbul, Turkey.
| | - Canan Duman
- Faculty of Dentistry, Department of Pedodontics, Istanbul Atlas University, Istanbul, Turkey
| | - Belen Sirinoglu Capan
- Faculty of Dentistry, Department of Pedodontics, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Mert Ocak
- Faculty of Dentistry, Department of Anatomy, Ankara University, Ankara, Turkey
| | - Burak Bilecenoglu
- Faculty of Medicine, Department of Anatomy, Ankara Medipol University, Ankara, Turkey
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Gupta R, Patel A, Nikhade PP, Chandak M, Ikhar A. Management of Ellis Class-IV Fractured Tooth With an Open Apex: A Case Report. Cureus 2022; 14:e29681. [PMID: 36320983 PMCID: PMC9615100 DOI: 10.7759/cureus.29681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/28/2022] [Indexed: 11/29/2022] Open
Abstract
Dental professionals face difficulty in managing "immature non-vital teeth with an open apex." It is considered to be challenging because, in this situation, root canal filling material should be confined within the boundaries of the root canal without extruding peri-apically. Apexification tries to create a hard tissue barrier that will cause the open apex to close, allowing root filling to be compacted. The current case report describes the application of mineral trioxide aggregate (MTA) to create an apical plug in an open apex, as MTA is considered a versatile material for apexification, which was followed by the reinforcing of the weekend root using glass fiber post and core build-up to manage the Ellis class IV fracture.
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Gupta G, Agarwal A, Ansari AA, Singh RK. Non-surgical management of a large periapical lesion with internal resorption using PRF, hydroxyapatite and MTA. BMJ Case Rep 2022; 15:e248907. [PMID: 36113960 PMCID: PMC9486192 DOI: 10.1136/bcr-2022-248907] [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] [Indexed: 12/31/2022] Open
Abstract
Periapical lesions of endodontic origin are caused by microbial infection of pulp. According to various studies, it is known that necrosis of pulp provides a favourable habitat for microbes to replicate and release various toxins into the periapical tissue leading to inflammation and formation of a periapical lesion. A variety of non-invasive methods to manage such lesions include conservative root canal treatment, aspiration-irrigation technique, decompression technique, calcium hydroxide therapy, lesion sterilisation and tissue repair therapy, and the apexum procedure. We present a case report describing non-surgical management of a large periapical lesion associated with a permanent central incisor displaying internal inflammatory resorption using platelet rich fibrin (PRF), bone graft and mineral trioxide aggregate (MTA).
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Affiliation(s)
- Geetika Gupta
- Department of Paediatric and Preventive Dentistry, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Abhilasha Agarwal
- Department of Paediatric and Preventive Dentistry, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Afroz Alam Ansari
- Department of Paediatric and Preventive Dentistry, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Rajeev Kumar Singh
- Department of Paediatric and Preventive Dentistry, King George Medical University, Lucknow, Uttar Pradesh, India
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de Carvalho KKT, Petean IBF, Silva-Sousa AC, de Camargo R, Mazzi-Chaves JF, Silva-Sousa YTC, Sousa-Neto MD. Evaluation of rotary instruments with whipping motion in the biomechanical preparation of large root canals of young permanent teeth. AUST ENDOD J 2022; 49:130-139. [PMID: 35649116 DOI: 10.1111/aej.12633] [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: 10/26/2021] [Revised: 04/05/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
Shaping ability evaluation of taper ./01 instruments in large root canals, by microcomputed tomography (micro-CT) and scanning electron microscopy (SEM). Maxillary central incisors with large diameter root canals were divided into two groups (n = 10): XP-Endo Shaper (FKG-Dentaire, Switzerland) and manual instrumentation (FKG-Dentaire). Two- and three-dimensional parameters from cervical to apical root thirds were evaluated by micro-CT. Apical stop was evaluated by SEM images. Data were analysed by ANOVA and Tukey tests (α = 5%). XP-Endo Shaper allowed a regular biomechanical preparation with less dentinal wear compared with manual instrumentation, which showed excessive wear of the thin root canal walls (p < 0.05). Roundness and SMI showed similarity between both protocols (p > 0.05). XP-Endo Shaper SEM showed a regular and well-defined shape of the apical foramen suggesting the formation of the apical stop. Reduced diameter and taper instruments promoted a conservative wear and a well-defined apical stop formation in large root canals.
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Affiliation(s)
| | - Igor Bassi Ferreira Petean
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Alice Corrêa Silva-Sousa
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Rafael de Camargo
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Jardel Francisco Mazzi-Chaves
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | | | - Manoel Damião Sousa-Neto
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Saxena N, Hugar SM, Soneta SP, Joshi RS, Dialani PK, Gokhale N. Evaluation of the Treatment Protocols in the Management of Pulpally Involved Young Permanent Teeth in Children: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2022; 15:S103-S113. [PMID: 35645501 PMCID: PMC9108820 DOI: 10.5005/jp-journals-10005-2218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In children with young permanent teeth, dental caries and traumatic injuries are the most common problems leading to pulp necrosis. Since, root development is completed in two to three years after eruption of the tooth into the oral cavity, loss of pulp vitality in young permanent tooth creates distinctive problems. In spite of exceeding availability of treatment procedures there is a need to search for a substantial procedure to treat young permanent teeth effectively. Aim The aim of this systematic review was to evaluate the treatment protocols in the management of pulpally involved young permanent teeth in children. Method Systematic search was conducted on databases PubMed, Cochrane, and Google Scholar among studies published from 1st January 2010 till 31st May 2020. Studies meeting the inclusion criteria were included in the review and were then assessed for quality with the help of predetermined criteria which categorized studies into high, medium, and low. Results Search strategy yielded 4,846 articles. After screening through titles and abstracts, 33 articles remained which were further screened for full text. At the end, 14 articles were included in systematic review. Furthermore, the included articles were statistically evaluated by meta-analysis. Conclusion In apexogenesis and apexification procedures, newer biomimetic materials like mineral trioxide aggregate and biodentine have more success rate than conventionally used calcium hydroxide. Among regenerative endodontic procedures platelet-rich plasma and platelet- rich fibrin showed better results. Clinical significance To amend clinician perceptions towards acceptance of the newer regenerative procedures and their effectiveness in management of young permanent tooth. How to cite this article Saxena N, Hugar SM, Soneta SP, et al. Evaluation of the Treatment Protocols in the Management of Pulpally Involved Young Permanent Teeth in Children: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2022;15(S-1):S103–S113.
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Affiliation(s)
- Nivedita Saxena
- Department of Pediatric and Preventive Dentistry, Kaher's KLE VK Institute of Dental Sciences, Belgaum, Belagavi, Karnataka, India
| | - Shivayogi M Hugar
- Department of Pedodontics and Preventive Dentistry, Kaher's KLE VK Institute of Dental Sciences, Belgaum, Belagavi, Karnataka, India
- Shivayogi M Hugar, Department of Pedodontics and Preventive Dentistry, Kaher's KLE VK Institute of Dental Sciences, Belgaum, Belagavi, Karnataka, India, Phone: +91 9986436448, e-mail:
| | - Sanjana P Soneta
- Department of Pedodontics and Preventive Dentistry, Kaher's KLE VK Institute of Dental Sciences, Belgaum, Belagavi, Karnataka, India
| | - Riddhi S Joshi
- Department of Pedodontics and Preventive Dentistry, Kaher's KLE VK Institute of Dental Sciences, Belgaum, Belagavi, Karnataka, India
| | - Pooja K Dialani
- Department of Pediatric and Preventive Dentistry, Kaher's KLE VK Institute of Dental Sciences, Belgaum, Belagavi, Karnataka, India
| | - Niraj Gokhale
- Department of Pedodontics and Preventive Dentistry, Kaher's KLE VK Institute of Dental Sciences, Belgaum, Belagavi, Karnataka, India
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Arhakis A, Cotti E, Kotsanos N. Pulp Therapy in Pediatric Dentistry. Pediatr Dent 2022. [DOI: 10.1007/978-3-030-78003-6_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Krastl G, Weiger R, Ebeleseder K, Galler K. Present status and future directions: Endodontic management of traumatic injuries to permanent teeth. Int Endod J 2021; 55 Suppl 4:1003-1019. [PMID: 34862800 DOI: 10.1111/iej.13672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/02/2021] [Indexed: 12/26/2022]
Abstract
The prognosis of traumatized teeth depends largely on the fate of the pulp and its treatment. This review aims to update the present status on the endodontic management of traumatic injuries to permanent teeth and to identify relevant research areas that could contribute to an improvement in diagnosis and treatment of traumatized permanent teeth. Future research should pay greater attention to (1) diagnostic methods to assess the perfusion of the pulp and enhance detection of tooth cracks and initial signs of root resorption; (2) improved materials for vital pulp treatment; (3) studies focusing on type and duration of splinting after root fractures; (4) antiresorptive intracanal medication in case of posttraumatic pulp necrosis and infection-related resorption and (5) long-term data on the apical barrier technique compared to revitalization.
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Affiliation(s)
- Gabriel Krastl
- Department of Conservative Dentistry and Periodontology, Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Germany
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology, Center of Dental Traumatology, University Center for Dental Medicine UZB, University of Basel, Basel, Switzerland
| | - Kurt Ebeleseder
- University Clinic of Dental Medicine and Oral Health, Medical University Graz, Graz, Austria
| | - Kerstin Galler
- Department of Conservative Dentistry and Periodontology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Pereira IR, Carvalho C, Paulo S, Martinho JP, Coelho AS, Paula AB, Marto CM, Carrilho E, Botelho MF, Abrantes AM, Marques Ferreira M. Apical Sealing Ability of Two Calcium Silicate-Based Sealers Using a Radioactive Isotope Method: An In Vitro Apexification Model. MATERIALS 2021; 14:ma14216456. [PMID: 34771981 PMCID: PMC8585189 DOI: 10.3390/ma14216456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/03/2022]
Abstract
The aim of this study was to evaluate and compare the sealing ability of two calcium silicate-based sealers (TotalFill BC RRM Fast Set Putty and White ProRoot MTA) when used as apical plugs in immature teeth through nuclear medicine. Single-rooted extracted teeth (n = 34) had their crowns and root tip sectioned to obtain 14 mm long root segments to simulate an in vitro apexification model. Were created two experimental groups, namely MTA (n = 12) and BC (n = 12), and two control groups, PG (positive group, n = 5) and NG (negative group, n = 5). On the 4th day after placing the respective apical plug, the apical portions of the teeth were submerged in a solution of sodium pertechnetate (99mTcNaO4) for 3 h. Statistical analysis showed a significant difference between the MTA group and the controls (p < 0.05). The BC group had a significant difference regarding the negative control (p < 0.001) but showed no statistical significance regarding the positive control (p = 0.168). There was a statistically significant difference (p = 0.009) between the BC group (7335.8 ± 2755.5) and the MTA group (4059.1 ± 1231.1), where the last showed less infiltration. Within the limitations of this study, White ProRoot MTA had a significantly better sealing ability than TotalFill BC RRM Fast Set Putty.
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Affiliation(s)
- Inês Raquel Pereira
- Faculty of Medicine, Institute of Endodontics, University of Coimbra, 3000-075 Coimbra, Portugal; (I.R.P.); (C.C.); (S.P.); (J.P.M.)
| | - Catarina Carvalho
- Faculty of Medicine, Institute of Endodontics, University of Coimbra, 3000-075 Coimbra, Portugal; (I.R.P.); (C.C.); (S.P.); (J.P.M.)
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
| | - Siri Paulo
- Faculty of Medicine, Institute of Endodontics, University of Coimbra, 3000-075 Coimbra, Portugal; (I.R.P.); (C.C.); (S.P.); (J.P.M.)
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
| | - José Pedro Martinho
- Faculty of Medicine, Institute of Endodontics, University of Coimbra, 3000-075 Coimbra, Portugal; (I.R.P.); (C.C.); (S.P.); (J.P.M.)
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
| | - Ana Sofia Coelho
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Anabela Baptista Paula
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Carlos Miguel Marto
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3000-075 Coimbra, Portugal
- Faculty of Medicine, Institute of Experimental Pathology, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Eunice Carrilho
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Maria Filomena Botelho
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, Institute of Biophysics, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Ana Margarida Abrantes
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, Institute of Biophysics, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Manuel Marques Ferreira
- Faculty of Medicine, Institute of Endodontics, University of Coimbra, 3000-075 Coimbra, Portugal; (I.R.P.); (C.C.); (S.P.); (J.P.M.)
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
- Correspondence: ; Tel.: +351-239-484-183
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Pinheiro LS, Kopper PMP, Quintana RM, Scarparo RK, Grecca FS. Does MTA provide a more favourable histological response than other materials in the repair of furcal perforations? A systematic review. Int Endod J 2021; 54:2195-2218. [PMID: 34418122 DOI: 10.1111/iej.13617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/20/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND There is no consensus on which furcal perforation repair material induces a more favourable histological response. This systematic review of laboratory studies provides an overview of the studies comparing repair materials in animal models. OBJECTIVES To evaluate whether mineral trioxide aggregate (MTA) yields a more favourable histological response than other materials when used to repair furcal perforations in animal experimental models. METHODS This review followed the PRISMA checklist. The studies included various materials used to repair furcal perforations and compared the histological responses with MTA. An electronic search was conducted in EMBASE, PubMed, Scopus and Web of Science up to 2 September 2020, with no language or publication date restrictions. Studies whose full text was unavailable were excluded. The ARRIVE and SYRCLE tools were used to assess the methodological quality and risk of bias (RoB) of the studies. RESULTS The studies included in the qualitative synthesis were conducted in rat (n = 3) and dog (n = 17) models. They were classified as having a low quality, high methodological heterogeneity and high RoB. MTA and Biodentine, the materials most often compared, reduced the inflammatory reaction to mild over time. In addition, a mineralized tissue was formed in all studies. The response yielded by MTA was better than or equivalent to that of the other tested materials. DISCUSSION This review confirmed that MTA is the reference standard material for furcal perforation repair. However, research using animal models has inherent limitations, and the substantial methodological heterogeneity across the studies included should be considered. Therefore, the knowledge generated by this systematic review should be translated into clinical practice cautiously. CONCLUSIONS Features described in the report and quality assessment guidelines, such as PRIASE, ARRIVE and SYRCLE, should guide researchers. Despite the high RoB and the low methodological quality of the studies included, findings indicated that MTA yields a more favourable histological response than other materials in the repair of furcal perforations. REGISTRATION PROSPERO (CRD42020181297).
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Affiliation(s)
- Lucas Siqueira Pinheiro
- Postgraduate Program in Dentistry, Dental School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Patricia Maria Poli Kopper
- Postgraduate Program in Dentistry, Dental School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ramiro Martins Quintana
- Postgraduate Program in Dentistry, Dental School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Fabiana Soares Grecca
- Postgraduate Program in Dentistry, Dental School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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15
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Krug R, Ortmann C, Reich S, Hahn B, Krastl G, Soliman S. Tooth discoloration induced by apical plugs with hydraulic calcium silicate-based cements in teeth with open apices-a 2-year in vitro study. Clin Oral Investig 2021; 26:375-383. [PMID: 34151389 PMCID: PMC8791895 DOI: 10.1007/s00784-021-04009-0] [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: 11/05/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022]
Abstract
Objectives To assess tooth discoloration induced by different hydraulic calcium silicate-based cements (HCSCs), including effects of blood and placement method. Materials and methods Eighty bovine teeth cut to a length of 18 mm (crown 8 mm, root 10 mm) were randomly assigned to 10 groups (n = 8), receiving orthograde apical plug treatment (APT). Apical plugs were 4 mm in length and made of ProRoot MTA (Dentsply), Medcem MTA (Medcem), TotalFill BC RRM Fast Set Putty (Brasseler), or Medcem Medical Portland Cement (Medcem) plus bismuth oxide (Bi2O3) with and without bovine blood. Further, orthograde (with or without preoperative adhesive coronal dentin sealing) and retrograde APT were compared. Teeth were obturated with gutta-percha and sealer, sealed with composite and stored in distilled water. Tooth color was measured on apical plug, gutta-percha/sealer, and crown surface before treatment versus 24 h, 1, 3, 6, 12, and 24 months after treatment by spectrophotometry. Color difference (ΔE) values were calculated and analyzed by Shapiro–Wilk test, ANOVA with post hoc tests, Friedman test, t test, and post hoc tests with Bonferroni correction (α = .05). Results Tooth discoloration occurred in all groups with no significant differences between HCSCs (p > .05). After 24 months, color changes were prominent on roots but insignificant on crowns. Blood contamination induced a significantly decreased luminescence (p < .05). Blood had a stronger impact on tooth color than Bi2O3. No relevant effects of retrograde placement (p > .05) or preoperative dentin sealing (p > .05) were detected. Conclusions Apical plugs of the tested HCSCs cause discoloration of bovine roots, but not discoloration of bovine tooth crowns within a 24-month period. Clinical relevance APT should be performed carefully while avoiding direct contact with the coronal dentin, and in that case no aesthetic impairments occur.
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Affiliation(s)
- Ralf Krug
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany.
| | | | | | - B Hahn
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - G Krastl
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - S Soliman
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
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16
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Krastl G, Weiger R, Filippi A, Van Waes H, Ebeleseder K, Ree M, Connert T, Widbiller M, Tjäderhane L, Dummer PMH, Galler K. Endodontic management of traumatized permanent teeth: a comprehensive review. Int Endod J 2021; 54:1221-1245. [PMID: 33683731 DOI: 10.1111/iej.13508] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 03/05/2021] [Indexed: 12/15/2022]
Abstract
The pulp plays a key role in the treatment of traumatic dental injuries (TDIs) and is strongly associated with the outcome, particularly in severe cases. A correct pulp diagnosis is essential as it forms the basis for developing the appropriate management strategy. However, many TDIs are complex, and their treatment requires a profound knowledge of the physiological and pathological responses of the affected tissues. This comprehensive review will look at the dentine-pulp complex and its interaction with the surrounding tissues following TDIs. The literature up to 2020 was reviewed based on several searches on PubMed and the Cochrane Library using relevant terms. In addition to the recently revised guidelines of the International Association of Dental Traumatology, this article aims to provide background information with a focus on endodontic aspects and to gather evidence on which a clinician can make decisions on the choice of the appropriate endodontic approach for traumatized permanent teeth.
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Affiliation(s)
- G Krastl
- Department of Conservative Dentistry and Periodontology, Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Germany
| | - R Weiger
- Department of Periodontology, Endodontology and Cardiology, University School of Dental Medicine, Basel, Switzerland.,Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland
| | - A Filippi
- Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland.,Department of Oral Surgery, University School of Dental Medicine, Basel, Switzerland
| | - H Van Waes
- Department of Paediatric Dentistry, Clinic for Orthodontics and Paediatric Dentistry, University of Zürich, Zürich, Switzerland
| | - K Ebeleseder
- University Clinic of Dental Medicine and Oral Health, Medical University Graz, Graz, Austria
| | - M Ree
- Private Practice, Purmerend, Netherlands
| | - T Connert
- Department of Periodontology, Endodontology and Cardiology, University School of Dental Medicine, Basel, Switzerland.,Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland
| | - M Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - L Tjäderhane
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Research Unit of Oral Health Sciences, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital, University of Oulu, Oulu, Finland
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - K Galler
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
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17
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Moazzami F, Sahebi S, Shirzadi S, Azadeh N. Comparative in vitro Assessment of Tooth Color Change under the Influence of Nano Fast Cement and MTA. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2021; 22:48-52. [PMID: 33718530 PMCID: PMC7921768 DOI: 10.30476/dentjods.2020.85057.1113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Statement of the Problem Tooth color changes followed by treatment with bioceramic materials are always a matter of concern. Purpose The aim of the present in vitro study was to compare tooth discoloration that occurs in human teeth filled with ProRoot WMTA (DENTSPLY Tulsa Dental Specialties, Tulsa, OK) and those filled with Nano Fast Cement (NFC) over the course of 3 months. Materials and Method In this experimental study, Thirty human intact premolars were obtained. The roots of all teeth were removed by a horizontal cut about 2 mm below the cementoenamel junction. The pulp tissues were removed using a barbed broach (Mani, Tokyo, Japan).The teeth were randomly divided to 3 groups (n= 10) including the control (no material), ProRoot WMTA and NFC. The experimental materials were condensed into the crowns and the teeth ends were sealed with light-cure glass ionomer cement (GC Corporation, Tokyo, Japan). The color was assessed at TBL (baseline; after preparation of the cavities but before placement of the materials), TPO (immediately after placement of the filling material and provisional restoration), T4 (after 4weeks of storage), and T12 (after 12weeks) of storage. Results The discoloration was evident in all teeth, immediately (TPO) after applying MTA and NFC. The highest ΔΕ was noted in WMTA at 12 weeks, followed by NFC; however, there was no significant difference between the discolorations induced by these two materials. Conclusion Similar levels of clinically observable tooth discoloration were detected by using either WMTA or NFC.
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Affiliation(s)
- Fariborz Moazzami
- Dept. of Endodontic, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Safoora Sahebi
- Dept. of Endodontic, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sareh Shirzadi
- Dept. of Endodontic, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Niloufar Azadeh
- Dept. of Orthodontic, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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18
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Plascencia H, Díaz M, Ordinola-Zapata R, Vázquez-Sánchez ME, Juárez-Broon N, Ruíz-Gutiérrez A, Gascón G, Cruz A. Intra- and Interobserver Agreement during the Assessment of the Different Stages of Root Development Using 4 Radiographic Classifications. J Endod 2021; 47:906-913. [PMID: 33705830 DOI: 10.1016/j.joen.2021.02.014] [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: 08/26/2020] [Revised: 02/18/2021] [Accepted: 02/27/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This study analyzed intra- and interobserver agreements during radiographic assessment of the different stages of root development using the dichotomous, Moorrees, Demirjian, and Cvek classifications, as well as the effect of the observer's level of experience on the result. METHODS Two hundred eighty-five digital periapical radiographs were examined via visual inspection by 3 experienced and 3 nonexperienced observers (n = 6) under strict technological and viewing conditions. After observer calibration, determination of the presence or absence of an open apex and the assignment of a root development stage according to the different subdivisions of the 4 indexes were performed. This evaluation was carried out by each observer in duplicate in the first round (n = 8) and repeated in the second round (n = 8). The 16 examinations performed by each observer (N = 96) were analyzed to determine the percentage of concordance followed by intraobserver, interobserver, and global observer agreement using the kappa coefficient and a weighted kappa. Additionally, to determine the level of concordance between the visual determination of an open or closed apex and the apical foramen width measured in millimeters, a dichotomized kappa coefficient was applied. RESULTS A good level of global observer agreement was found for the dichotomous, Demirjian, and Cvek classifications. However, a significantly low percentage of total concordance and global observer agreement (6.66% and 0.498, respectively) was obtained using the Moorrees classification, which was more pronounced among nonexperienced observers (0.247). Apical foramen width measurements indicated the presence of 143 roots with an open apex (50.2%) and 142 with a closed apex (49.8%), and the dichotomized kappa coefficient test revealed a good level of agreement during the visual determination of an open or closed apex (range, 0.611-0.636). CONCLUSIONS The classifications of Cvek and Demirjian provided reliable results when determining the different stages of root development. In contrast, the Moorrees classification provided the lowest agreement values, with a significant negative effect among nonexperienced observers. Finally, the visual estimation of the presence (or absence) of an open apex provided a good level of concordance with the radiographic apical foramen width.
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Affiliation(s)
- Hugo Plascencia
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico.
| | - Mariana Díaz
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
| | - Ronald Ordinola-Zapata
- Division of Endodontics, University of Minnesota School of Dentistry, Minneapolis, Minnesota
| | - María Eugenia Vázquez-Sánchez
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
| | - Norberto Juárez-Broon
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
| | - Aloysia Ruíz-Gutiérrez
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
| | - Gerardo Gascón
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
| | - Alvaro Cruz
- Research Institute in Biomedical Sciences, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
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The Apical Extent of Mineral Trioxide Aggregate Apical Barrier Does not Influence the Treatment Outcome in a Nonvital Immature Permanent Anterior Tooth: A Split-Mouth Clinical Study. Eur Endod J 2021; 6:44-49. [PMID: 33609017 PMCID: PMC8056805 DOI: 10.14744/eej.2020.08760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: The study aimed to compare treatment outcomes when MTA apical plugs are placed to different apical extents in nonvital immature permanent anterior teeth with an open apex. Methods: Six participants (five male & one female) between the age group of 8-18 years exhibiting bilateral traumatized nonvital immature permanent maxillary anterior teeth (n=12) with non-blunderbuss canal (Cvek’s stage 4) were included. Standardized endodontic procedures were performed, and an inter-appointment calcium hydroxide medicament placed for one week. Based on the apical position of the MTA apical barrier, two study groups were defined. Accordingly, Group I {(n=6) (4mm MTA plug up to the radiographic root end)} and Group II {(n=6) (4 mm MTA plug 2 mm short of the radiographic root-end)}. Teeth were obturated after twenty-four hours with thermoplasticized gutta-percha technique. They were evaluated clinically and radiographically at 12 and 24 months. Radiographs were assessed for periapical healing based on the periapical index (PAI) scores that were dichotomized as score <3 as healed and ≥3 as not healed. The data were compared using Mann Whitney U test, Kruskal Wallis and post hoc analysis. Results: At 24 months, all teeth in Group I and II were healed clinically and radiographically. On inter-group comparison, radiographically, all teeth (n=12) exhibited a PAI score <3 and were categorized as healed (P=1.00). Conclusion: The apical extent of MTA plug does not influence the treatment outcome. The clinician can place MTA apical plug either up to or 2 mm short of the radiographic root-end.
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20
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What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis? Eur Arch Paediatr Dent 2021; 22:311-340. [PMID: 33420674 PMCID: PMC8213569 DOI: 10.1007/s40368-020-00575-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/17/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate and assess the current knowledge about apexification and regenerative techniques as a meaningful treatment modality and to map the scientific evidence for the efficacy of both methods for the management of traumatised immature teeth with pulp necrosis and apical periodontitis. METHODS This systematic review searched five databases: PubMed, Web of Science, Cochrane Library, Ovid (Medline), and Embase. Published articles written in English were considered for inclusion. The following keywords were used: Regenerative endodontic treatment OR regenerat* OR revital* OR endodontic regeneration OR regenerative endodontics OR pulp revascularization OR revasculari* OR 'traumatized immature teeth'. Only peer-reviewed studies with a study size of at least 20 cases followed up for 24 months were included. Eligibility assessment was performed independently in a blinded manner by three reviewers and disagreements were resolved by consensus. Subgroup analyses were performed on three clinical outcomes: survival, success, and continued root development. RESULTS Seven full texts out of 1359 citations were included and conventional content analysis was performed. Most of the identified citations were case reports and case series. CONCLUSIONS In the present systematic review, the qualitative analysis revealed that both regenerative and apexification techniques had equal rates of success and survival and proved to be effective in the treatment of immature necrotic permanent teeth. Endodontic regenerative techniques appear to be superior to apexification techniques in terms of stimulation of root maturation, i.e. root wall thickening and root lengthening. Knowledge gaps were identified regarding the treatment and follow-up protocols for both techniques.
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21
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Camilleri J, Borg J, Damidot D, Salvadori E, Pilecki P, Zaslansky P, Darvell BW. Colour and chemical stability of bismuth oxide in dental materials with solutions used in routine clinical practice. PLoS One 2020; 15:e0240634. [PMID: 33176336 PMCID: PMC7657490 DOI: 10.1371/journal.pone.0240634] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/29/2020] [Indexed: 11/19/2022] Open
Abstract
Bismuth(III) oxide is included as a radio-opacifier in dental materials, including hydraulic silicate cements, the material of choice for several endodontic procedures. It has been implicated in tooth discoloration after contact with endodontic irrigants, in particular NaOCl solution, To date, there has been no work on the chemistry: all reports have been of clinical findings only. The purpose now was to report the reactions leading to colour change from Bi2O3 in contact with solutions used in routine endodontic practice. Ten-gram portions of Bi2O3 were immersed in either water, NaOH, NaCl, NaOCl or HCl solution, either in the dark or exposed to visible light, and samples retrieved at 1, 4, 12 and 24 weeks. After washing, these were exposed to either added CO2 or not, for 1 week while drying, and under the same dark or light conditions. Changes in appearance were monitored by photography and colour measurement, and chemically by X-ray diffraction and Fourier-transform infrared spectroscopy. 24-week material was studied using electron paramagnetic resonance and Raman spectroscopy; NaOCl-treated material was also examined by scanning electron microscopy. With water, NaCl and NaOH, bismuth subcarbonate was formed. With or without added carbon dioxide, discoloration occurred from pale yellow to light brown when exposed to light, and to a lesser extent in the dark, intensifying with time. In contrast, exposure to NaOCl rapidly formed a dark brown-black sodium bismuthate. With HCl, white BiOCl was formed. Bi2O3 is not at all inert in this context as is commonly believed, denying its principle of use. Previously unreported solution-mediated reaction occurs readily even in water and NaCl solution, forming new compounds that discolour. In contact with NaOCl sodium bismuthate is formed; severe darkening occurs rapidly. The reactivity is such that Bi2O3 is not indicated for dental materials and should be withdrawn from use.
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Affiliation(s)
- Josette Camilleri
- School of Dentistry, University of Birmingham, Birmingham, United Kingdom
| | - Joseph Borg
- Systems Engineer, Triq L-Uqija Ta L-Ibrag, Is-Swieqi, Malta
| | - Denis Damidot
- Department of Civil and Structural Engineering, Faculty of Civil Engineering, Ecole de Mines, LGCgE-GCE, Douai, France
| | | | - Peter Pilecki
- Imaging and Microscopy, King’s College London, London, United Kingdom
| | - Paul Zaslansky
- Department for Operative and Preventive Dentistry, Centrum für Zahn-, Mund- und Kieferheilkunde, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Brian W. Darvell
- School of Dentistry, University of Birmingham, Birmingham, United Kingdom
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Liu J, Zhang YR, Zhang FY, Zhang GD, Xu H. Microscopic removal of type III dens invaginatus and preparation of apical barrier with mineral trioxide aggregate in a maxillary lateral incisor: A case report and review of literature. World J Clin Cases 2020; 8:1150-1157. [PMID: 32258086 PMCID: PMC7103979 DOI: 10.12998/wjcc.v8.i6.1150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/05/2020] [Accepted: 02/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Invaginated teeth pose greater challenges in clinical management because of their complex configuration. With advancements in equipment and materials, such as the dental operation microscope, cone-beam computed tomography and mineral trioxide aggregate, the preservation rate of type III dens invaginatus could be greatly increased.
CASE SUMMARY This case report presented a 31-year-old woman with complaints of spontaneous swelling and pain in the right maxillary lateral tooth. With the aid of cone-beam computed tomography, type III dens invaginatus with apical periodontitis was diagnosed and confirmed. Three-visit endodontic treatment was performed. In the first visit, the invagination was carefully removed under the dental operation microscope, and chemomechanical preparation was done. In the second visit, mineral trioxide aggregate apical barrier surgery was performed in this tooth. In the third visit, the canal was finally obturated with thermoplastic gutta-percha to recover the crown morphology. A 26-mo follow-up revealed a satisfied outcome both in the radiographic and oral examinations.
CONCLUSION In this case, removal of the entire abnormal structure provided great convenience for the follow-up treatment. When confronted with the same clinical case in the future, we can take a similar approach to address it.
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Affiliation(s)
- Jie Liu
- Department of General Dentistry, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Yue-Rong Zhang
- Department of General Dentistry, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Fu-Yu Zhang
- Department of General Dentistry, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Guang-Dong Zhang
- Department of General Dentistry, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Hai Xu
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
- Department of Conservative Dentistry and Endodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
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Yadav A, Chak RK, Khanna R. Comparative Evaluation of Mineral Trioxide Aggregate, Biodentine, and Calcium Phosphate Cement in Single Visit Apexification Procedure for Nonvital Immature Permanent Teeth: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2020; 13:S1-S13. [PMID: 34434008 PMCID: PMC8359875 DOI: 10.5005/jp-journals-10005-1830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Aim and objective This study assesses the efficacy of mineral trioxide aggregate (MTA), biodentine, and calcium phosphate cement (CPC) as single visit apexification agents for nonvital immature permanent teeth, both clinically and radiographically. Materials and methods The study was conducted as a double-blinded randomized, controlled clinical trial after approval of the Institutional Ethical Committee of King George's Medical University, Lucknow, Uttar Pradesh, India, the approval letter (Ref. no. 81st ECM II B-Thesis/P24). A total of 60 patients in the age group of 6–15 years, fulfilling all the inclusion and exclusion criteria were enrolled for the study. Patients were randomly divided into three groups having 20 in each group. Results On the basis of present study, it can hence, be inferred that clinical success for MTA, biodentine and calcium phosphate cement in apexification was 100%. The radiographic outcomes of calcium phosphate cement showed better results as compared to MTA and biodentine at 9 months of follow-up periods. Conclusion These finding suggest that calcium phosphate cement can be used as a substitute for MTA and biodentine because of its comparable clinical and superior radiographic success. How to cite this article Yadav A, Chak RK, Khanna R. Comparative Evaluation of MTA, Biodentine and Calcium Phosphate Cement in Single Visit Apexification Procedure for Nonvital Immature Permanent Teeth: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2020;13(S-1):S1–S13.
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Affiliation(s)
- Anjali Yadav
- Department of Paediatric and Preventive Dentistry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rakesh K Chak
- Department of Pedodontics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Richa Khanna
- Department of Paediatric and Preventive Dentistry, King George's Medical University, Lucknow, Uttar Pradesh, India
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Primus CM, Tay FR, Niu LN. Bioactive tri/dicalcium silicate cements for treatment of pulpal and periapical tissues. Acta Biomater 2019; 96:35-54. [PMID: 31146033 PMCID: PMC6717675 DOI: 10.1016/j.actbio.2019.05.050] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/15/2019] [Accepted: 05/19/2019] [Indexed: 12/11/2022]
Abstract
Over 2500 articles and 200 reviews have been published on the bioactive tri/dicalcium silicate dental materials. The indications have expanded since their introduction in the 1990s from endodontic restorative and pulpal treatments to endodontic sealing and obturation. Bioactive ceramics, based on tri/dicalcium silicate cements, are now an indispensable part of the contemporary dental armamentarium for specialists including endodontists, pediatric dentists, oral surgeons andfor general dentists. This review emphasizes research on how these materials have conformed to international standards for dental materials ranging from biocompatibility (ISO 7405) to conformance as root canal sealers (ISO 6876). Potential future developments of alternative hydraulic materials were included. This review provides accurate materials science information on these important materials. STATEMENT OF SIGNIFICANCE: The broadening indications and the proliferation of tri/dicalcium silicate-based products make this relatively new dental material important for all dentists and biomaterials scientists. Presenting the variations in compositions, properties, indications and clinical performance enable clinicians to choose the material most suitable for their cases. Researchers may expand their bioactive investigations to further validate and improve materials and outcomes.
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Affiliation(s)
- Carolyn M Primus
- Department of Endodontics, The Dental College of Georgia, Augusta University, USA.
| | - Franklin R Tay
- Department of Endodontics, The Dental College of Georgia, Augusta University, USA
| | - Li-Na Niu
- Department of Endodontics, The Dental College of Georgia, Augusta University, USA; State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China; The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Hena, China
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25
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Regenerative Endodontic Procedures Using Contemporary Endodontic Materials. MATERIALS 2019; 12:ma12060908. [PMID: 30893790 PMCID: PMC6471897 DOI: 10.3390/ma12060908] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/28/2019] [Accepted: 03/13/2019] [Indexed: 12/12/2022]
Abstract
Calcium hydroxide apexification and Mineral Trioxide Aggregate (MTA) apexification are classical treatments for necrotic immature permanent teeth. The first tend to fail for lack of compliance given the high number of sessions needed; the second has technical difficulties such as material manipulation and overfilling. With both techniques, the root development is interrupted leaving the tooth with a fragile root structure, a poor crown-to-root ratio, periodontal breakdown, and high risk of fracture, compromising long-term prognosis of the tooth. New scientific literature has described a procedure that allows complete root development of these specific teeth. This regenerative endodontic procedure (REP) proposes the use of a combination of antimicrobials and irrigants, no canal walls instrumentation, induced apical bleeding to form a blood clot and a tight seal into the root canal to promote healing. MTA is the most used material to perform this seal, but updated guidelines advise the use of other bioactive endodontic cements that incorporate calcium and silicate in their compositions. They share most of their characteristics with MTA but claim to have fewer drawbacks with regards to manipulation and aesthetics. The purpose of the present article is to review pertinent literature and to describe the clinical procedures protocol with its variations, and their clinical application.
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26
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Shao W, Xiao F, Xu ZX, Ren RH, Wang Y, Wu YQ. Treatment of severe periodontic-endodontic combined lesions with minocycline hydrochloride ointment combined with mineral trioxide aggregate. Exp Ther Med 2018; 16:1389-1396. [PMID: 30116388 DOI: 10.3892/etm.2018.6341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/10/2018] [Indexed: 11/06/2022] Open
Abstract
Periodontic-endodontic combined lesions affect the quality of life of patients. The present study aimed to explore a way to achieve maximal effect in treating periodontic-endodontic combined lesions by using a combination of minocycline hydrochloride ointment (MHO) and mineral trioxide aggregate (MTA). In the present study, 294 patients were randomly divided into four groups: Control group, MHO group, MTA group and combination group. Endodontic and periodontic therapy was applied simultaneously on the anterior and posterior teeth of patients, and patient characteristics, gingival index (GI) and probing depth (PD) were noted when the patients were treated with the different strategies. Reexamination was performed 4 weeks after treatment and follow-up was performed 2 years later. The present study demonstrated that medical history, root filling and periapical condition within the patients were deemed as key factors in determining the success of treatment of periodontic-endodontic combined lesions. The effect of the combination treatment significantly exceeded that of either treatment alone (P<0.05). In addition, the teeth were significantly improved for patients with pathological types I, II and III in the combination group compared with either treatment group alone (P<0.05). Furthermore, compared with the MTA and MHO groups alone, the combination group demonstrated a significant decrease in PD and GI in severe periodontic-endodontic combined lesions. In conclusion, the present findings implied that combination treatment is significantly superior to single treatments applied to patients with severe periodontic-endodontic combined lesions.
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Affiliation(s)
- Wen Shao
- The 2nd Dental Center, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, P.R. China
| | - Feng Xiao
- Department of Dentistry, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230600, P.R. China
| | - Zhong-Xin Xu
- Department of Counterterrorism Research, Zhejiang Police College, Hangzhou, Zhejiang 310053, P.R. China
| | - Rui-Han Ren
- Department of Dentistry, People's Hospital of Linyi, Linyi, Shandong 276000, P.R. China
| | - Yong Wang
- Department of Oral and Maxillofacial Surgery, The Ninth People's Hospital, College of Stomatology, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai 200011, P.R. China
| | - Yi-Qun Wu
- The 2nd Dental Center, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, P.R. China
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27
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Dembinskaite A, Veberiene R, Machiulskiene V. Successful treatment of dens invaginatus type 3 with infected invagination, vital pulp, and cystic lession: A case report. Clin Case Rep 2018; 6:1565-1570. [PMID: 30147906 PMCID: PMC6099029 DOI: 10.1002/ccr3.1647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/07/2018] [Accepted: 05/23/2018] [Indexed: 12/14/2022] Open
Abstract
All efforts should be aimed to safe permanent tooth for adolescents. Presented rare case confirms a possibility to save a tooth with Oehlers Type 3 anomaly with peri-invaginated periodontitis and to preserve vitality of the tooth pulp, even when surgical cyst removal is performed.
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Affiliation(s)
- Ausra Dembinskaite
- Clinic of Dental and Oral PathologyFaculty of OdontologyLithuanian University of Health SciencesKaunasLithuania
| | - Rita Veberiene
- Clinic of Dental and Oral PathologyFaculty of OdontologyLithuanian University of Health SciencesKaunasLithuania
| | - Vita Machiulskiene
- Clinic of Dental and Oral PathologyFaculty of OdontologyLithuanian University of Health SciencesKaunasLithuania
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Regenerative Endodontic Treatment or Mineral Trioxide Aggregate Apical Plug in Teeth with Necrotic Pulps and Open Apices: A Systematic Review and Meta-analysis. J Endod 2017; 43:1806-1820. [DOI: 10.1016/j.joen.2017.06.029] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/12/2017] [Accepted: 06/16/2017] [Indexed: 12/29/2022]
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Torabinejad M, Parirokh M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part II: other clinical applications and complications. Int Endod J 2017; 51:284-317. [PMID: 28846134 DOI: 10.1111/iej.12843] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/22/2017] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- M Torabinejad
- Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA, USA
| | - M Parirokh
- Endodontology Research Center, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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31
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Ree MH, Schwartz RS. Long-term Success of Nonvital, Immature Permanent Incisors Treated With a Mineral Trioxide Aggregate Plug and Adhesive Restorations: A Case Series from a Private Endodontic Practice. J Endod 2017; 43:1370-1377. [PMID: 28578893 DOI: 10.1016/j.joen.2017.02.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/15/2017] [Accepted: 02/26/2017] [Indexed: 10/19/2022]
Abstract
This case series evaluated the long-term clinical outcome of nonvital immature teeth treated with mineral trioxide aggregate (MTA) as an apical barrier and an adhesive restoration with or without a fiber post. Eighty-three teeth in 72 patients were treated by the first author with an apical MTA plug and an adhesive restoration of composite resin and in 45 of the 83 teeth 1 or more fiber posts. All of the patients had been referred to the first author's private endodontic practice with at least 1 immature tooth with signs of pulpal necrosis and subsequent apical periodontitis that had been caused by a variety of traumatic dental injuries. Three teeth presented had dens invaginatus. Of 83 teeth, 69 teeth in 60 patients were available for follow-up after 5 to 15 years (recall rate = 83%). The mean follow-up time was 8.29 years. No teeth were lost because of a root fracture. Ninety-six percent (66/69) of the recalled teeth were characterized as healed. Based on periapical radiographs and clinical examination, 96% of teeth treated with the MTA barrier technique and adhesive restorations were characterized as "healed" and were in function after 5 to 15 years (mean = 8.29 years). These results indicate that this is a viable and predictable treatment approach for the long-term success of nonvital immature teeth.
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Affiliation(s)
- Marga H Ree
- Private Practice, Purmerend, Netherlands; and Private Practice, San Antonio, Texas.
| | - Richard S Schwartz
- Private Practice, Purmerend, Netherlands; and Private Practice, San Antonio, Texas
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Graziele Magro M, Carlos Kuga M, Adad Ricci W, Cristina Keine K, Rodrigues Tonetto M, Linares Lima S, Henrique Borges A, Garcia Belizário L, Coêlho Bandeca M. Endodontic Management of Open Apex Teeth Using Lyophilized Collagen Sponge and MTA Cement: Report of Two Cases. IRANIAN ENDODONTIC JOURNAL 2017; 12:248-252. [PMID: 28512495 PMCID: PMC5431724 DOI: 10.22037/iej.2017.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Teeth with open apices, such as in immature teeth or those with apical root resorption are clinical cases with difficult immediate resolution. With the use of mineral trioxide aggregate (MTA) in dentistry, it was possible to optimize the treatment time of these cases by immediate placement of apical plug and the root canal filling. However, some negative effects can occur if MTA is extruded beyond the apex. To avoid this accident, it has been recommended to use of an apical matrix prior to placement of MTA. This study reports two clinical cases of apical plug placement in teeth with pulp necrosis and open apices. One case had an immature apex due to dental trauma and the other case had apical resorption due to the presence of endodontic infection in the root canal. MTA apical plug with approximately 4 mm thickness, was placed in the apical zone of the root and immediately the canal was obturated with gutta-percha and endodontic sealer. Follow-up evaluations showed clinical and radiographic evidence of success.
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Affiliation(s)
- Miriam Graziele Magro
- Department of Restorative Dentistry, Araraquara Dental School, Univ. Estadual Paulista, Araraquara, SP, Brazil
| | - Milton Carlos Kuga
- Department of Restorative Dentistry, Araraquara Dental School, Univ. Estadual Paulista, Araraquara, SP, Brazil
| | - Weber Adad Ricci
- Department of Restorative Dentistry, Araraquara Dental School, Univ. Estadual Paulista, Araraquara, SP, Brazil
| | - Kátia Cristina Keine
- Department of Restorative Dentistry, Araraquara Dental School, Univ. Estadual Paulista, Araraquara, SP, Brazil
| | - Mateus Rodrigues Tonetto
- Department of Postgraduate Program in Integrated Dental Science, University of Cuiaba-UNIC, Cuiabá, MT, Brazil
| | - Suellen Linares Lima
- Department of Postgraduate Program in Dentistry, CEUMA University-UNICEUMA, São Luis, MA, Brazil
| | - Alvaro Henrique Borges
- Department of Postgraduate Program in Integrated Dental Science, University of Cuiaba-UNIC, Cuiabá, MT, Brazil
| | - Lauriê Garcia Belizário
- Department of Restorative Dentistry, Araraquara Dental School, Univ. Estadual Paulista, Araraquara, SP, Brazil
| | - Matheus Coêlho Bandeca
- Department of Postgraduate Program in Dentistry, CEUMA University-UNICEUMA, São Luis, MA, Brazil
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Duggal M, Tong HJ, Al-Ansary M, Twati W, Day PF, Nazzal H. Interventions for the endodontic management of non-vital traumatised immature permanent anterior teeth in children and adolescents: a systematic review of the evidence and guidelines of the European Academy of Paediatric Dentistry. Eur Arch Paediatr Dent 2017; 18:139-151. [PMID: 28508244 PMCID: PMC5488080 DOI: 10.1007/s40368-017-0289-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 04/10/2017] [Indexed: 01/09/2023]
Abstract
Aim This systematic review was undertaken in order to develop guidelines for the European Academy of Paediatric Dentistry for the management of non-vital permanent anterior teeth with incomplete root development. Methods Three techniques were considered; apexification by single or multiple applications of calcium hydroxide, use of Mineral Trioxide Aggregate (MTA) for the creation of an apical plug followed by obturation of the root canal, and finally a Regenerative Endodontic Technique (RET). Scottish Intercollegiate Guideline Network (SIGN) Guidelines (2008) were used for the synthesis of evidence and grade of recommendation. Results Variable levels of evidence were found and generally evidence related to these areas was found to be weak and of low quality. It was not possible to produce evidence-based guidelines based on the strength of evidence that is currently available for the management of non-vital immature permanent incisors. Conclusions Based on the available evidence the European Academy of Paediatric Dentistry proposes Good Clinical Practice Points as a guideline for the management of such teeth. It is proposed that the long term use of calcium hydroxide in the root canals of immature teeth should be avoided and apexification with calcium hydroxide is no longer advocated. The evidence related to the use of a Regenerative Endodontic Technique is currently extremely weak and therefore this technique should only be used in very limited situations where the prognosis with other techniques is deemed to be extremely poor. The current review supports the use of MTA followed by root canal obturation as the treatment of choice.
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Affiliation(s)
- M Duggal
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, The Worsley Building, Clarendon Way, Leeds, LS2 9LU, UK. .,Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, 11 Lower Kent Ridge Road, Singapore, 119083, Singapore.
| | - H J Tong
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, 11 Lower Kent Ridge Road, Singapore, 119083, Singapore
| | - M Al-Ansary
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, The Worsley Building, Clarendon Way, Leeds, LS2 9LU, UK
| | - W Twati
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, The Worsley Building, Clarendon Way, Leeds, LS2 9LU, UK
| | - P F Day
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, The Worsley Building, Clarendon Way, Leeds, LS2 9LU, UK
| | - H Nazzal
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, The Worsley Building, Clarendon Way, Leeds, LS2 9LU, UK
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Nicoloso GF, Pötter IG, Rocha RDO, Montagner F, Casagrande L. A comparative evaluation of endodontic treatments for immature necrotic permanent teeth based on clinical and radiographic outcomes: a systematic review and meta-analysis. Int J Paediatr Dent 2017; 27:217-227. [PMID: 27529749 DOI: 10.1111/ipd.12261] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Dental trauma and deep caries are frequent findings in children and adolescents that may lead to pulp necrosis in young permanent teeth. As a consequence, the root stops its development, and managing these immature teeth becomes challenging due to the presence of open apexes and fragile dentinal walls. AIM We aimed to carry out a systematic review including a meta-analysis to compare the endodontic treatments available in the management of immature necrotic permanent teeth and determine which one provides the best clinical and radiographic outcomes. DESIGN The literature was screened via PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials databases until August 2015 to select randomized clinical trials that compared at least two different treatments regarding immature necrotic permanent teeth comprising clinical and radiographic success as outcome. Two reviewers independently performed the screening and evaluation of the articles. A total of 648 studies were retrieved from the databases, in which only 14 were selected to full-text analysis by the appliance of inclusion criteria. After the exclusion criteria, the remaining seven studies had their data extracted and assessed for bias risk. Pooled-effect estimates were obtained comparing clinical and radiographic success rates among MTA Versus other treatments. RESULTS Evaluation of clinical (Z = 2.32, P = 0.02, OR = 5.37, 95% CI: 1.29-22.23, I = 0%) and radiographic (Z = 2.45, P = 0.01, OR = 4.31, 95% CI: 1.34-13.82, I = 0%) outcomes favored the MTA (control group) when compared to other endodontic treatments (P < 0.05). No evidence of heterogeneity was detected among the studies (I < 50%), whereas a moderate risk of bias was identified in five of them. CONCLUSIONS Although almost all of the identified studies presented moderate risk of bias, MTA apexification seems to produce overall better clinical and radiographic success rates among the endodontic treatment available in immature necrotic permanent teeth.
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Affiliation(s)
- Gabriel Ferreira Nicoloso
- Specialist in Pediatric Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil
| | - Isabel Garcia Pötter
- Specialist in Pediatric Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil
| | | | - Francisco Montagner
- Department of Conservative Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil
| | - Luciano Casagrande
- Department of Surgery and Orthopedics, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil
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Silujjai J, Linsuwanont P. Treatment Outcomes of Apexification or Revascularization in Nonvital Immature Permanent Teeth: A Retrospective Study. J Endod 2017; 43:238-245. [DOI: 10.1016/j.joen.2016.10.030] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/07/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
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36
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Sisli SN, Ozbas H. Comparative Micro–computed Tomographic Evaluation of the Sealing Quality of ProRoot MTA and MTA Angelus Apical Plugs Placed with Various Techniques. J Endod 2017; 43:147-151. [DOI: 10.1016/j.joen.2016.09.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 09/09/2016] [Accepted: 09/12/2016] [Indexed: 11/29/2022]
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Linsuwanont P, Sinpitaksakul P, Lertsakchai T. Evaluation of root maturation after revitalization in immature permanent teeth with nonvital pulps by cone beam computed tomography and conventional radiographs. Int Endod J 2016; 50:836-846. [DOI: 10.1111/iej.12705] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Affiliation(s)
- P. Linsuwanont
- Department of Restorative Dentistry; Faculty of Dentistry; Chulalongkorn University; Bangkok Thailand
| | - P. Sinpitaksakul
- Department of Radiology; Faculty of Dentistry; Chulalongkorn University; Bangkok Thailand
| | - T. Lertsakchai
- Department of Restorative Dentistry; Faculty of Dentistry; Chulalongkorn University; Bangkok Thailand
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Alsubait S, Al-Haidar S, Al-Sharyan N. A Comparison of the Discoloration Potential for EndoSequence Bioceramic Root Repair Material Fast Set Putty and ProRoot MTA in Human Teeth: An In Vitro Study. J ESTHET RESTOR DENT 2016; 29:59-67. [DOI: 10.1111/jerd.12264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- S. Alsubait
- Assistant Professor, Division of Endodontics, Department of Restorative Dental Sciences, College of Dentistry; King Saud University; Riyadh Saudi Arabia
| | - S. Al-Haidar
- Dental intern, College of Dentistry; King Saud University; Riyadh Saudi Arabia
| | - N. Al-Sharyan
- Dental intern, College of Dentistry; King Saud University; Riyadh Saudi Arabia
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Bayram E, Bayram HM. Fracture resistance of immature teeth filled with mineral trioxide aggregate, bioaggregate, and biodentine. Eur J Dent 2016; 10:220-224. [PMID: 27095900 PMCID: PMC4813439 DOI: 10.4103/1305-7456.178310] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: The purpose of this study was to evaluate fracture resistance of teeth with immature apices treated with coronal placement of mineral trioxide aggregate (MTA), bioaggregate (BA), and Biodentine. Materials and Methods: Forty-one freshly extracted, single-rooted human premolar teeth were used for the study. At first, the root length was standardized to 9 mm. The crown-down technique was used for the preparation of the root canals using the rotary ProTaper system (Dentsply Maillefer, Ballaigues, Switzerland) of F3 (30). Peeso reamer no. 6 was stepped out from the apex to simulate an incompletely formed root. The prepared roots were randomly assigned to one control (n = 5) and three experimental (n = 12) groups, as described below. Group 1: White MTA (Angelus, Londrina, Brazil) was prepared as per the manufacturer's instructions and compacted into the root canal using MAP system (Dentsply Maillefer, Ballaigues, Switzerland) and condensed by pluggers (Angelus, Londrina, Brazil). Group 2: The canals were filled with DiaRoot-BA (DiaDent Group International, Canada). Group 3: Biodentine (Septodont, Saint Maur des Fosses, France) solution was mixed with the capsule powder and condensed using pluggers. Instron was used to determine the maximum horizontal load to fracture the tooth, placing the tip 3 mm incisal to the cementoenamel junction. Mean values of the fracture strength were compared by ANOVA followed by a post hoc test. P < 0.05 was considered statistically significant. Results: No significant difference was observed among the MTA, BA, and biodentine experimental groups. Conclusion: All the three materials tested, may be used as effective strengthening agents for immature teeth.
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Affiliation(s)
- Emre Bayram
- Department of Endodontics, University of Gaziosmanpaşa, Tokat, Turkiye
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Soares ADJ, Prado MD, Brazão MA, Gomes BPFDA, Zaia AA. The biocompatibility of a new endodontic paste used in dental trauma. REVISTA DE ODONTOLOGIA DA UNESP 2015. [DOI: 10.1590/1807-2577.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
<title>Abstract</title><sec><title>Objective</title><p>This study investigated the short-term subcutaneous tissue reaction of a new endodontic paste, based on the association among calcium hydroxide [Ca(OH)<sub>2</sub>], 2% chlorhexidine gel (CHX) and zinc oxide (ZnO) in comparison with a control paste, and the individual substances alone.</p></sec><sec><title>Material and method</title><p>Twenty-four male wistar rats were used. Polyethylene tubes containing the materials were implanted into the dorsal connective tissue of rats. Empty implanted tubes served as controls. The materials used were: Ca(OH)<sub>2</sub>+CHX+ZnO paste in two different proportions (2:1:2) and (2:1:3), a control paste, Ca(OH)<sub>2</sub>+CHX (2:1), and the substances alone. After time intervals of 2, 3, 7 and 15 days, the animals were euthanized and the specimens prepared for histological processing. Data were evaluated qualitatively according to the levels of tissue repair and the degree of inflammation.</p></sec><sec><title>Result</title><p>On the second day all the materials were observed to cause a severe inflammatory response. On the third day, the pastes Ca(OH)<sub>2</sub>+CHX+ZnO (2:1:2) and (2:1:3) showed reduction in degree of inflammation. On seventh day the tissue was already more organized with presence of collagen fibers in all materials. After 15 days it was found that compound Ca(OH)<sub>2</sub>+CHX+ZnO (2:1:2) showed areas with no inflammatory infiltrate.</p></sec><sec><title>Conclusion</title><p>The experimental pastes, Ca(OH)<sub>2</sub>+CHX+ZnO in two different proportions (2:1:2) and (2:1:3), showed favorable results with respect to biocompatibility, when evaluated for a short-term.</p></sec>
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Fernandes M, de Ataide I. Nonsurgical management of a large periapical lesion associated with an immature tooth displaying external inflammatory resorption. J Conserv Dent 2015; 18:349-53. [PMID: 26180425 PMCID: PMC4502136 DOI: 10.4103/0972-0707.159758] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 04/13/2015] [Accepted: 05/27/2015] [Indexed: 11/23/2022] Open
Abstract
Immature nonvital teeth can often be associated with periapical lesions. Presence of external inflammatory resorption can complicate the treatment plan. A 21-year-old female patient presented with a large periapical lesion in relation to teeth 11 and 12. Tooth 11 was an immature tooth undergoing external inflammatory resorption. Aspiration through the root canal was carried out to evacuate the purulent fluid in the periapical lesion. Triple antibiotic paste was then placed as an intracanal medicament for a period of 2 weeks, followed by calcium hydroxide therapy for a period of 2 months. Mineral trioxide aggregate was then placed as an apical barrier to a thickness of about 4 mm. Obturation of the remainder of the canal space was done after 48 h. Complete periapical healing was evident after 1 year and 6 months. Nonsurgical healing of a large periapical lesion associated with an immature tooth displaying external inflammatory resorption can be successfully achieved.
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Affiliation(s)
- Marina Fernandes
- Department of Conservative Dentistry and Endodontics, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Ida de Ataide
- Department of Conservative Dentistry and Endodontics, Goa Dental College and Hospital, Bambolim, Goa, India
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Apexification of an Immature Permanent Incisor with the Use of Calcium Hydroxide: 16-Year Follow-Up of a Case. Case Rep Dent 2015; 2015:984590. [PMID: 26171256 PMCID: PMC4480250 DOI: 10.1155/2015/984590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 11/17/2022] Open
Abstract
Apexification is a process of forming a mineralized apical barrier and had been performed by using calcium hydroxide paste, due to its biological and healing performances in cases of existent trauma. This clinical report aims to report the results of a 16-year follow-up study of an apexification treatment applied to nonvital tooth 22 of a healthy 8-year-old male after a trauma.
Clinical inspection of the tooth showed fractures of the incisal edge and mesial angle, absence of coronal mobility, and negative pulp vitality under cold testing. Radiographic analysis of the root revealed incomplete apex formation. The possibility of fracture into the root or luxation injury was rejected, and the diagnosis of pulp necrosis was verified. Apexification by calcium hydroxide and subsequent endodontic treatment were planned. Initial formation of the mineralized apical barrier was observed after 3 months, and the barrier was considered to be completed after 8 months. Clinical, radiographic, and CBCT examinations after 16 years verified the success of the treatment, although the choice of calcium hydroxide for apexification treatment is discussed.
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Camilleri J. Staining Potential of Neo MTA Plus, MTA Plus, and Biodentine Used for Pulpotomy Procedures. J Endod 2015; 41:1139-45. [DOI: 10.1016/j.joen.2015.02.032] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 02/21/2015] [Accepted: 02/25/2015] [Indexed: 11/25/2022]
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Kang SH, Shin YS, Lee HS, Kim SO, Shin Y, Jung IY, Song JS. Color changes of teeth after treatment with various mineral trioxide aggregate-based materials: an ex vivo study. J Endod 2015; 41:737-41. [PMID: 25732402 DOI: 10.1016/j.joen.2015.01.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/07/2015] [Accepted: 01/18/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Mineral trioxide aggregate (MTA) materials have been used for many years as a pulp therapy material. The most widely used product, ProRoot MTA (Dentsply, Tulsa, OK), has a major drawback in that it causes tooth discoloration. Alternatives have recently been developed such as ENDOCEM Zr (MARUCHI, Wonju, Korea) and RetroMTA (BioMTA, Seoul, Korea). The purpose of this study was to compare the discoloration of these various MTA-based materials. METHODS Discoloration of discs prepared from 4 different MTA-based materials (ProRoot MTA, MTA Angelus [Angelus, Londrina, PR, Brazil], ENDOCEM Zr, and RetroMTA) were observed at 15 and 30 minutes after exposure to light at an intensity of 1000 mA/cm(2). In a tooth model, 12 premolars were used per each group to retrofill the pulp chamber with MTA-based materials. The degree of discoloration was measured over a 16-week period using a digital spectrophotometer. RESULTS Distinct color changes were observed for discs made from ProRoot MTA and MTA Angelus, but no clear change was observed for those made from either ENDOCEM Zr or RetroMTA. In the tooth model, more distinct, time-dependent color changes were observed for teeth filled with ProRoot MTA and MTA Angelus than for those filled with ENDOCEM Zr and RetroMTA. CONCLUSIONS Less discoloration was observed with ENDOCEM Zr and RetroMTA (which contain zirconium oxide) than with ProRoot MTA and MTA Angelus (which contain bismuth oxide) in both of the test models used.
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Affiliation(s)
- Shin-Hong Kang
- Department of Pediatric Dentistry, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Young-Seob Shin
- Department of Pediatric Dentistry, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Hyo-Seol Lee
- Department of Pediatric Dentistry, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Seong-Oh Kim
- Department of Pediatric Dentistry, College of Dentistry, Yonsei University, Seoul, Republic of Korea; Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Yooseok Shin
- Department of Conservative Dentistry, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Il-Young Jung
- Department of Conservative Dentistry, College of Dentistry, Yonsei University, Seoul, Republic of Korea; Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Je Seon Song
- Department of Pediatric Dentistry, College of Dentistry, Yonsei University, Seoul, Republic of Korea; Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Republic of Korea.
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Berger T, Baratz AZ, Gutmann JL. In vitro investigations into the etiology of mineral trioxide tooth staining. J Conserv Dent 2014; 17:526-30. [PMID: 25506138 PMCID: PMC4252924 DOI: 10.4103/0972-0707.144584] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 11/30/2022] Open
Abstract
Aim: To investigate the role of bismuth oxide, a constituent of contemporary mineral trioxide aggregate (MTA) materials, and its response to various solutions that may contribute to the potential discoloration that occurs following MTA applications within the scope of endodontics. Setting and Design: Laboratory assessment of chemical reactions with white ProRoot® MTA and white Portland cement (WPC). Materials and Methods: Set specimens and freshly mixed specimens of white ProRoot® MTA and white ProRoot® MTA powder, along with specimens of WPC were exposed to distilled water, phosphate buffered saline (PBS), 10% formalin, hydroxyethylmethacrylate (HEMA), sodium hypochlorite, sodium hydroxide (NaOH) base, and hydrochloric acid (HCl) acid. Specimens were visually inspected periodically for color changes. Results: All forms of ProRoot MTA showed discoloration when exposed to 10% formalin within 30 min, as opposed to WPC, and were completely blackened at 4 days. Bismuth oxide alone and with calcium oxide also turned black within 30 min after exposure to 10% formalin. No discoloration was seen when exposed to the other solutions. Conclusions: Exposing MTA in various forms to a variety of liquids has determined that bismuth oxidein combination with other chemical moieties is the prime cause of staining observed by clinicians.
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Affiliation(s)
- Todd Berger
- Department of Research and Development, Dentsply Tulsa Dental Specialties, Tulsa, Oklahoma, USA
| | - Adam Z Baratz
- Department of Research and Development, Dentsply Tulsa Dental Specialties, Tulsa, Oklahoma, USA
| | - James L Gutmann
- Department of Restorative Sciences/Endodontics, Texas A&M University Baylor College of Dentistry, Dallas, Texas, USA
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Alobaid AS, Cortes LM, Lo J, Nguyen TT, Albert J, Abu-Melha AS, Lin LM, Gibbs JL. Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexification: a pilot retrospective cohort study. J Endod 2014; 40:1063-70. [PMID: 25069909 DOI: 10.1016/j.joen.2014.02.016] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/28/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION This retrospective cohort study compared clinical and radiographic outcomes of endodontic treatment performed in immature nonvital permanent teeth by apexification (calcium hydroxide or apical barrier with mineral trioxide aggregate) versus revascularization. METHODS A comprehensive chart review was performed to obtain a cohort of previously completed cases with recalls. Clinical and radiographic data were collected for 31 treated teeth (19 revascularization and 12 apexification) with an average follow-up time of 17 months and a recall rate of 63%. Tooth survival, success rate, and adverse events were analyzed. Changes in radiographic root length, width, and area were quantified. RESULTS The majority of treated teeth survived throughout the study period, with 30 of 31 (97%) teeth surviving (18/19 [95%] revascularization and 12/12 apexification). Most cases were also clinically successful, with 27 of 31 (87%) meeting criteria for success (15/19 [78%] revascularization and 12/12 apexification; nonsignificant difference). A greater incidence of adverse events was observed in the revascularization group (8/19 [42%] vs 1/12 [11%] in apexification) (risk ratio = 5.1; P = .04; 95% confidence interval, 0.719-35.48). Although more revascularization cases than apexification cases showed an increase in radiographic root area and width, the effect was not statistically significant. CONCLUSIONS In this study, revascularization was not superior to other apexification techniques in either clinical or radiographic outcomes. Studies with large subject cohorts and long follow-up periods are needed to evaluate outcomes of revascularization and apexification while accounting for important covariants relevant to clinical success.
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Affiliation(s)
- Adel S Alobaid
- New York University College of Dentistry, New York, New York
| | - Lina M Cortes
- New York University College of Dentistry, New York, New York
| | - Jeffery Lo
- New York University College of Dentistry, New York, New York
| | - Thuan T Nguyen
- New York University College of Dentistry, New York, New York
| | - Jeffery Albert
- New York University College of Dentistry, New York, New York
| | | | - Louis M Lin
- New York University College of Dentistry, New York, New York
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Shin JH, Jang JH, Park SH, Kim E. Effect of mineral trioxide aggregate surface treatments on morphology and bond strength to composite resin. J Endod 2014; 40:1210-6. [PMID: 25069935 DOI: 10.1016/j.joen.2014.01.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/07/2014] [Accepted: 01/21/2014] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the micromorphologic changes that accompany different surface treatments on mineral trioxide aggregate (MTA) and their effect on the bond strength to the composite resin with 4 adhesive systems. METHODS Three types of MTA cement, ProRoot MTA (WMTA) (Dentsply, Tulsa, OK), MTA Angelus (AMTA) (Angelus, Londrina, PR, Brazil), and Endocem MTA (EMTA) (Maruchi, Wonju, Korea), were prepared and stored for a week to encourage setting. Surface treatment was performed using phosphoric acid or self-etch primer, and an untreated MTA surface was prepared as a control. The surface changes were observed using scanning electron microscopy. MTA surfaces were bonded with 4 adhesive systems, including Scotchbond Multipurpose (3M ESPE, St Paul, MN), Single Bond 2 (3M ESPE), Clearfil SE BOND (Kuraray, Osaka, Japan), and AdheSE One F (Ivoclar Vivadent, Schaan, Liechtenstein), to evaluate the adhesive effectiveness of MTA followed by composite resin restoration. The shear bond strength of the polymerized specimens was tested. RESULTS For WMTA and AMTA, untreated surfaces showed an irregular crystalline plate with clusters of globular aggregate particles. For EMTA, the untreated surface presented a reticular matrix with acicular crystals. After surface treatment, superficial crystalline structures were eroded regardless of the MTA cement and adhesive system used. WMTA bonded significantly more strongly than AMTA and EMTA, regardless of the adhesive system used. In the WMTA and AMTA groups, AdheSE One F showed the highest bond strength to the composite. For EMTA, no significant differences were found across adhesive systems. CONCLUSIONS Acidic treatment of the MTA surface affected the micromorphology and the bond strength to the composite. Within the limitations of this study, using a 1-step self-etch adhesive system might result in a strong bond to WMTA when the composite resin restoration is required over MTA cement.
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Affiliation(s)
- Joo-Hee Shin
- Department of Conservative Dentistry, Korea University Medical Center, Korea University, Seoul, Korea
| | - Ji-Hyun Jang
- Department of Conservative Dentistry, Kyung Hee University Dental Hospital at Gangdong, Seoul, Korea
| | - Sang Hyuk Park
- Department of Conservative Dentistry, Kyung Hee University Dental Hospital at Gangdong, Seoul, Korea; Oral Biology Research Institute, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Euiseong Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea.
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Miyashin M. Determination of H-file sizes being more suitable for measuring of working length in immature teeth using an EAL. PEDIATRIC DENTAL JOURNAL 2014. [DOI: 10.1016/j.pdj.2014.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Treatment options: apexogenesis and apexification. J Endod 2014; 39:S26-9. [PMID: 23439042 DOI: 10.1016/j.joen.2012.11.046] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 11/18/2012] [Accepted: 11/26/2012] [Indexed: 12/30/2022]
Abstract
This article will describe requirements for case selection and review the procedures for apexogenesis and apexification in immature permanent teeth. Nonclinical and clinical data will be presented to support the recommendations, and outcomes will be presented from clinical studies. The dental pulp is an ectomesenchymally derived connective tissue with certain unique properties such as being encased in hard tissues, which limits its collateral circulation. The pulp provides a matrix for binding of its cells and provides support allowing communication between the cells. In addition to immune cells, the dental pulp contains odontoblasts, which are specialized cells capable of producing dentin. In the absence of a vital pulp, dentin deposition is arrested. When an immature tooth is affected by caries or trauma, the pulp requires proper management according to the degree of inflammation and its vitality. Maintenance of pulp vitality will allow continued root development along the entire root length. If the pulp is irreversibly inflamed or necrotic, root-end closure procedures are required when the apex has not fully formed.
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