1
|
Alyahya A, Qudeimat MA. Optimal outcomes of pulpotomy in young patients: Long-term prospects for permanent molars with signs and symptoms indicative of irreversible pulpitis. J Dent 2024; 147:105132. [PMID: 38901324 DOI: 10.1016/j.jdent.2024.105132] [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: 05/29/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVES Limited literature addresses the long-term success of complete pulpotomy in permanent molars with signs of irreversible pulpitis in young patients. The aim of this observational study was to prospectively evaluate the long-term outcomes of complete pulpotomy using mineral trioxide aggregate (MTA) over an average period exceeding 11 years. METHODS Out of 27 molars displaying signs suggestive of irreversible pulpitis which underwent MTA pulpotomy, 24 molars were followed-up for a mean duration of 11.0 ± 2.2 years (range 8.2 to 14.8 years). Clinical and radiographic assessments were periodically conducted, tailored to each patient's specific circumstances. Treatment failure criteria included clinical signs and symptoms and radiographic evidence suggesting a lack of pulpal or periapical healing. RESULTS 83 % of molars had signs and symptoms of symptomatic irreversible pulpitis, with 83 % displaying apical periodontitis. Clinically and radiographically, all pulpotomies (100 %) were considered successful. A hard tissue barrier was observed in 71 % of teeth, and continued root maturation was evident in all molars with open apices. Complete pulp canal obliteration (PCO) was present in 21 % of the molars. All radiographic apical radiolucencies completely resolved. CONCLUSIONS This study demonstrates a 100 % success rate over an average 11-year follow-up for complete pulpotomy in managing permanent molars with signs and symptoms of irreversible pulpitis in young patients. It offers evidence for its long-term efficacy in promoting healing of pulp and periapical tissues. CLINICAL SIGNIFICANCE This study showed high long-term success for complete pulpotomy in young permanent molars with irreversible pulpitis, with clinical and radiographic success over 11 years. Despite initial symptoms of pulpitis and apical periodontitis, the treatment resulted in tissue healing, root maturation, and resolution of periapical radiolucencies, suggesting it as an alternative to root canal therapy.
Collapse
Affiliation(s)
- Asma Alyahya
- Discipline of Paediatric Dentistry, College of Dentistry, Kuwait University, Kuwait
| | - Muawia A Qudeimat
- Discipline of Paediatric Dentistry, College of Dentistry, Kuwait University, Kuwait.
| |
Collapse
|
2
|
Alfaisal Y, Idris G, Peters OA, Peters CI, Zafar S. Factors influencing treatment decisions in permanent mature teeth with irreversible pulpitis: a questionnaire-based study. Aust Dent J 2024. [PMID: 38850075 DOI: 10.1111/adj.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Decision-making in dentistry is a complex process, and this study evaluated factors that influence dentists' approaches in permanent mature teeth with irreversible pulpitis. METHODS An online questionnaire was distributed to a group of dental practitioners. The questionnaire surveyed dentists' opinions about the management of vital permanent teeth with irreversible pulpitis including a case scenario. RESULTS Data from 262 respondents were analysed. Barriers to perform vital pulp therapy (VPT) included presuming it an inappropriate long-term treatment (29.7%), lack of knowledge, insufficient access to materials, inadequate training and lack of confidence. Patient's preference (79.44%) and tooth restorability (91%) were the most frequently reported factors influencing treatment decisions. Dentists aged 25-35 years and who have 1-5 years of experience ranked extraction as a more successful treatment (P = 0.008; P = 0.003, respectively). Non-Australian graduates ranked pulpotomy to be a more successful procedure (P = 0.007), and public sector/hospital practitioners favoured extraction more than practitioners from other sectors (P = 0.003). Postgraduates/specialists preferred pulpotomy (P = 0.012) more than general dentists. Participants' clinical approaches for the management of symptomatic irreversible pulpitis: root canal treatment (45.0%), indirect pulp capping (22.9%), direct pulp capping (15.8%), pulpotomy (17.1%) and extraction (6.3%). CONCLUSIONS Female, more experienced, overseas-educated dentists and endodontists preferred VPT for irreversible pulpitis in permanent mature teeth more than other participants. © 2024 Australian Dental Association.
Collapse
Affiliation(s)
- Y Alfaisal
- School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| | - G Idris
- Metro North Hospital and Health Services, Queensland Health, Brisbane, QLD, Australia
| | - O A Peters
- School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| | - C I Peters
- School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| | - S Zafar
- School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
3
|
Gabriel EM, Priyadharshini SS, Sherwood IA, Deepika G, Ragavendran C, Murugadoss V. Treatment outcome of coronal pulpotomy and indirect pulp capping in mature permanent molars with symptoms of moderate pulpitis: A randomized clinical trial. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:434-441. [PMID: 38779201 PMCID: PMC11108425 DOI: 10.4103/jcde.jcde_63_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 05/25/2024]
Abstract
Aim This clinical trial aimed to compare the clinical success of coronal pulpotomy and indirect pulp capping (IPC) in managing symptomatic deep proximal caries in molars with moderate pulpitis over a 12-month period. Materials and Methods A total of 108 vital mature permanent molars with moderate pulpitis were randomly allocated to the IPC (n = 54) or coronal pulpotomy group (n = 54). Dycal and Biodentine were used as pulp-capping materials, followed by composite restoration. The absence of periapical infection and asymptomatic teeth that positively responded to the cold pulp sensitivity test (only in IPC) was considered posttreatment success at 12 months. Data from the study were analyzed using the Chi-square test and Kaplan-Meier survival analysis. Results There was a statistically significant difference between preoperative symptoms and the cold pulp sensibility test response (P = 0.000), indicating an association between symptoms and pulp sensibility. The average remaining dentine thickness (RDT) value was 0.48 ± 0.5 mm, with no statistically significant difference found between the location of caries and RDT (P = 0.084, P > 0.05). Compared to the IPC group, the pulpotomy group had a greater number of patients at 12 months after treatment that required no intervention. The Kaplan-Meier survival analysis revealed that the mean survival duration for pulpotomy was 48 weeks, and for IPC, it was 42.3 ± 2.35 weeks. Conclusion Coronal pulpotomy with Biodentine proved more effective in reducing symptoms, achieving radiographic success, and ensuring tooth survival compared to IPC with calcium hydroxide.
Collapse
Affiliation(s)
- E. Melvin Gabriel
- Department of Conservative Dentistry and Enodontics, C. S. I. College of Dental Sciences and Research, Madurai, India
| | | | - I. Anand Sherwood
- Department of Conservative Dentistry and Enodontics, C. S. I. College of Dental Sciences and Research, Madurai, India
| | - Geeth Deepika
- Department of Conservative Dentistry and Enodontics, C. S. I. College of Dental Sciences and Research, Madurai, India
| | - Chinnasamy Ragavendran
- Department of Cariology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India
| | - Vaanjay Murugadoss
- Department of Conservative Dentistry and Enodontics, C. S. I. College of Dental Sciences and Research, Madurai, India
| |
Collapse
|
4
|
Bilge K, Ataş O, Yildiz Ş, Çalik I, Dündar S, Gezer Ataş A. Histological evaluation of tissue reaction and new bone formation of different calcium silicate-based cements in rats. Aust Dent J 2024; 69:18-28. [PMID: 37715562 DOI: 10.1111/adj.12980] [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] [Accepted: 08/31/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the local reactions and new bone formation of rat subcutaneous and bone tissue to different calcium silicate cements. METHODS In this study, 80 rats were divided into five groups as control, BIOfactor MTA (BIO), NeoMTA Plus (NEO), MTA Repair Hp (REP), Biodentine (DENT) and then into two subgroups according to sacrification times (7, 30 days; n = 8). Polyethylene tubes filled with appropriate materials (test groups); empty tubes (control group) were implanted into the dorsum of each rat subcutaneously. For intraosseous implantation, materials were placed in the cavities created in tibia of rats. Subcutaneous tissue and tibia samples were stained with haematoxylin-eosin and subjected to histopathological analysis. A score (0-3) was used to grade inflammatory reaction and new bone formation. Data were analysed by Kruskal-Wallis and Mann-Whitney U tests (P < 0.05). RESULTS Inflammatory reaction observed in subcutaneous and intraosseous tissues for 7 days decreased significantly in all groups over time (P < 0.05). It was determined that there was significant increase in new bone formation in REP, BIO, DENT groups over time (P < 0.05). CONCLUSION Four contemporary bioceramic materials induced local inflammation and tissues changes shortly after subcutaneous implantation, which were reduced over time. In ıntraosseous implantation, all materials induced new bone formation over time. REGISTRATION NUMBER ADJ-03-23-0134. © 2023 Australian Dental Association.
Collapse
Affiliation(s)
- K Bilge
- Department of Restorative Dentistry, Faculty of Dentistry Firat University, Elazıg, Turkey
| | - O Ataş
- Department of Pediatric Dentistry, Faculty of Dentistry Firat University, Elazıg, Turkey
| | - Ş Yildiz
- Department of Pediatric Dentistry, Faculty of Dentistry Firat University, Elazıg, Turkey
| | - I Çalik
- Department of Pathology, Faculty of Medicine, Firat University, Elazıg, Turkey
| | - S Dündar
- Department of Periodontology, Faculty of Dentistry, Firat University, Elazig, Turkey
| | | |
Collapse
|
5
|
Joo Y, Lee T, Jeong SJ, Lee JH, Song JS, Kang CM. A randomized controlled clinical trial of premixed calcium silicate-based cements for pulpotomy in primary molars. J Dent 2023; 137:104684. [PMID: 37660882 DOI: 10.1016/j.jdent.2023.104684] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVES This study aimed to verify the non-inferiority of Endocem MTA Premixed and Well-Root PT, compared with ProRoot MTA in the pulpotomy of primary molars. In addition, we tried to determine the factors that affect the prognosis of pulpotomy in primary molars. METHODS This randomized clinical trial enrolled 158 molars of 52 children; 153 teeth were finally included and divided into three groups: ProRoot MTA (n = 50), Endocem MTA Premixed (n = 53), and Well-Root PT (n = 50). Clinical and radiographic follow-up was performed at 3, 6, and 12 months postoperatively and at the last visit post-treatment. Data were analyzed using the Fisher's exact test, Cox regression analysis, and the Kaplan-Meier survival curve method. RESULTS The success rates in the ProRoot MTA, Endocem MTA Premixed, and Well-Root PT were 92, 84.9 and 82%, respectively. The cumulative survival rates did not differ significantly among the materials. Among the investigated variables, only ΔF and ΔF max significantly affected the success rates. In the multivariate survival tree model, significant unfavorable survival was observed when the ΔF value was -14.4 or less (hazard ratio, 7.56; P = 0.0295). CONCLUSIONS Considering the clinical effectiveness of Endocem MTA Premixed and Well-Root PT and the operational convenience as a premixed type, they can be used as advantageous materials in the pulpotomy of primary molars in pediatric patients. The QLF method is a useful diagnostic method that can establish treatment plans and determine the prognosis of pulpotomy based on the ΔF value in primary molars. CLINICAL SIGNIFICANCE Endocem MTA Premixed and Well-Root PT can confer high success rates and are non-inferior to ProRoot MTA in pulpotomy for primary molars. We also showed that QLF technology can be applied to predict the success/failure and prognosis of pulpotomies in primary molars.
Collapse
Affiliation(s)
- Youngseo Joo
- Department of Pediatric Dentistry, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seoul 03722, Korea
| | - Taeyang Lee
- Department of Pediatric Dentistry, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seoul 03722, Korea
| | - Su Jin Jeong
- Statistics Support Part, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
| | - Jae-Ho Lee
- Department of Pediatric Dentistry, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seoul 03722, Korea
| | - Je Seon Song
- Department of Pediatric Dentistry, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seoul 03722, Korea
| | - Chung-Min Kang
- Department of Pediatric Dentistry, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seoul 03722, Korea.
| |
Collapse
|
6
|
Duncan HF, El-Karim I, Dummer PMH, Whitworth J, Nagendrababu V. Factors that influence the outcome of pulpotomy in permanent teeth. Int Endod J 2023; 56 Suppl 2:62-81. [PMID: 36334098 DOI: 10.1111/iej.13866] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022]
Abstract
The promotion of minimally invasive treatments focussed on the maintenance of pulp vitality has become a priority area in Endodontics. These vital pulp treatments (VPT) include partial and full pulpotomy, during which diseased coronal pulp tissue is removed prior to placement of a capping biomaterial and restoration. Traditionally, pulpotomies were confined to the treatment of carious primary and traumatized permanent teeth. However, these treatments have now been proposed as definitive solutions for cariously exposed permanent teeth with mild symptoms or even symptoms indicative of irreversible disease. Until recently, it was recommended that carious exposure of mature permanent teeth be managed by root canal treatment. The promotion of pulpotomy as an alternative treatment has opened up a wave of laboratory and clinical research aimed at improving therapies or evaluating clinical outcomes. In modern evidence-based endodontics, it is imperative that the outcomes of both partial and full pulpotomy are considered and important prognostic factors identified, so that improvements can be made to aid clinical decision-making and to direct new research. In this narrative review, the outcomes of partial and full pulpotomy are discussed, before analysis of patient, intraoperative and postoperative factors that influence the outcome of the pulpotomy procedure. The review highlights that although partial and full pulpotomy for the treatment of even pulpal disease are highly successful procedures, this is based on low-quality evidence with a lack of prospective, comparative trials investigating potential prognostic factors. Based on current evidence, it appears that age, gender, tooth type, root development and intraoperative pulpal haemorrhage do not impact significantly on pulpotomy outcome, whilst others such as caries depth, inflammatory status of the pulp, capping material, level of inflammatory pulpal-biomarkers and the final restoration integrity do. Other factors, including the influence of exposure type, periodontal condition, pulpal lavage, magnification, operator experience, isolation of the operating field and type of pulpotomy, require further experimental investigation before definitive conclusions can be made relating to the success of the pulpotomy procedure. Finally, there is not only a need for future well-designed prospective research addressing these issues but also a widening of our understanding of outcome to include patient-reported as well as clinician-reported outcomes.
Collapse
Affiliation(s)
- Henry F Duncan
- Division of Restorative Dentistry & Periodontology, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - Ikhlas El-Karim
- School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Paul M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - John Whitworth
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| |
Collapse
|
7
|
Mousivand S, Sheikhnezami M, Moradi S, Koohestanian N, Jafarzadeh H. Evaluation of the outcome of apexogenesis in traumatised anterior and carious posterior teeth using mineral trioxide aggregate: a 5-year retrospective study. AUST ENDOD J 2022; 48. [PMID: 34699673 DOI: 10.1111/aej.12583] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/02/2021] [Accepted: 09/26/2021] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to evaluate the outcome of apexogenesis with mineral trioxide aggregate (MTA) in traumatised anterior and carious posterior teeth over 5 years. A comprehensive chart review was performed to obtain a retrospective of sequential previously completed cases with recalls. Clinical and radiographic data were collected for 97 vital immature teeth (40 traumatised anterior and 57 carious posterior teeth) pulpotomised (partial or full pulpotomy) using MTA with an average follow-up time of 5 years. Chi-squared test and Fisher's exact test were implemented to analyse data. The success rate in anterior teeth and posterior teeth was 82.5% and 96.4% respectively. Crown discolouration was observed in 25 (62.5%) anterior teeth. There was a significant difference between the number of successful and unsuccessful cases (P < 0.05) and there was no correlation between type of treatment and success/failure (P > 0.05). The success rate of apexogenesis using MTA in immature teeth was relatively high.
Collapse
Affiliation(s)
| | - Mahshid Sheikhnezami
- Dental Trauma Center, Academic Center for Education, Culture and Research, Mashhad, Iran
| | - Saeed Moradi
- Dental Material Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Hamid Jafarzadeh
- Dental Trauma Center, Academic Center for Education, Culture and Research, Mashhad, Iran.,Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
8
|
A Pilot Feasibility Study to Establish Full Pulpotomy in Mature Permanent Teeth with Symptomatic Irreversible Pulpitis as a Routine Treatment in Mexican Public Healthcare Services. Healthcare (Basel) 2022; 10:healthcare10122350. [PMID: 36553875 PMCID: PMC9778542 DOI: 10.3390/healthcare10122350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022] Open
Abstract
Symptomatic irreversible pulpitis is a common dental disease for which root canal treatment (RCT) has been the standard treatment. However, in many countries, RCT is considered a high-cost treatment that is not covered by public healthcare services; this forces patients to have dental extraction as their only option to relieve pain. In the last decade, several investigations have provided evidence that an alternative treatment known as full pulpotomy (FP) could be an alternative for patients who could not afford the cost of an RCT. Nevertheless, evidence is lacking on the success rate that could be obtained if it is performed in a public dental care clinic (PDCC). The present investigation has two main objectives. To be the first approach of a multicentric feasibility study to find out whether an FP performed by a general practice dentist (GPD) in a PDCC could be suitable and establish its success rate and patient satisfaction. Patients attending a PDCC with symptoms of irreversible pulpitis were invited to participate. FP was performed and followed up at 1, 3, 6, 9, and 12 months. The treatment success was assessed by combining three variables, patient satisfaction, clinical, and radiographic outcomes. Forty-one patients from 17 to 78 years old received the intervention. In total, 97.5% were completely satisfied with the treatment and were considered successful since none of the clinical or radiographic variables were present in any of the follow-ups. An FP performed by a GPD in a PDCC could be suitable as a routine treatment for symptomatic irreversible pulpitis due to the excellent success rate and patient satisfaction.
Collapse
|
9
|
Rathod A, Jaiswal P, Bajaj P, Kale B, Masurkar D. Implementation of Low-Level Laser Therapy in Dentistry: A Review. Cureus 2022; 14:e28799. [PMID: 36225465 PMCID: PMC9534528 DOI: 10.7759/cureus.28799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/05/2022] [Indexed: 11/28/2022] Open
Abstract
A type of light therapy known as low-level laser therapy (LLLT) uses only one wavelength of light. Low-level lasers (LLL) do not have a warming effect on the tissues; instead, they have an effect called photobiostimulation. LLL do not evaporate the tissue. The use of LLL to manage a range of illnesses is known as LLLT. Helium-neon lasers are an illustration of an LLLT product. Gallium arsenide, the infrared semiconductor made of gallium aluminum arsenide, is also an example. The performance powers range from 50 to 500 mW with electromagnetic spectrum wavelengths in the red and near-infrared region spanning from 630 to 980 nm and pulsed or continuous-wave emission. In periodontics, LLLT has gained prominence for several applications, including wound healing and pain relief after non-surgical and surgical procedures.
Collapse
|
10
|
Al-Batayneh OB, Abdelghani IM. Outcome of vital pulp therapy in deeply carious molars affected with molar incisor hypomineralisation (MIH) defects: a randomized clinical trial. Eur Arch Paediatr Dent 2022; 23:587-599. [PMID: 35751744 DOI: 10.1007/s40368-022-00722-w] [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: 10/15/2021] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate clinical and radiographic outcomes of vital pulp therapy (VPT) in deeply carious young permanent first molars (PFM) affected with MIH over 24 months. METHODS In this prospective randomized clinical trial, n = 50 children with deeply carious young PFM affected with MIH, and diagnosed with reversible or irreversible pulpitis were randomized into 2 groups: indirect pulp treatment (IPT) and pulpotomy (partial or complete). Teeth were followed up clinically and radiographically for 24 months. Statistical analysis was done using Chi-square test; P ≤ 0.05 was considered significant. RESULTS A total of n = 50 teeth/patients (n = 26 females (52%), n = 24 males (48%)) were included, and 14 upper and 36 lower PFM were treated. Mean age was 11 ± 3.2 years. Clinical and radiographic success rates were: 96% for IPT, 90% for PP and 82% for CP (and 86% for both types of pulpotomy combined) over 24 months. There were no significant differences in outcomes between treatment groups. Age, gender and tooth location/jaw were found to have no statistically significant difference in outcomes among treatment groups, nor did pulpal status or root maturity, regardless of type of VPT and follow up period. CONCLUSIONS VPT is a valid treatment option in deeply carious young permanent first molars affected with MIH over 24 months. IPT had a higher clinical and radiographic success rate (96%) than partial or cervical pulpotomy (total 86%), but the difference was not statistically significant. Future randomized clinical trials on VPT for teeth affected with MIH are recommended with larger sample size and longer follow-up.
Collapse
Affiliation(s)
- Ola B Al-Batayneh
- Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, PO Box 3030, Irbid, 22110, Jordan.
| | - Ibrahim M Abdelghani
- Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, PO Box 3030, Irbid, 22110, Jordan
| |
Collapse
|
11
|
Matoug‐Elwerfelli M, ElSheshtawy A, Duggal M, Tong H, Nazzal H. Vital pulp treatment for traumatised permanent teeth: a systematic review. Int Endod J 2022; 55:613-629. [DOI: 10.1111/iej.13741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - A.S. ElSheshtawy
- Department of Endodontics Faculty of Dentistry Cairo University Egypt
| | - M. Duggal
- College of Dental Medicine QU Health Qatar University Doha Qatar
| | - H.J. Tong
- Discipline of Orthodontics and Paediatric Dentistry Faculty of Dentistry National University of Singapore Singapore
| | - H. Nazzal
- Dentistry Department Hamad Dental Centre Hamad Medical Corporation Doha Qatar
| |
Collapse
|
12
|
Donnelly A, Foschi F, McCabe P, Duncan HF. Pulpotomy for treatment of complicated crown fractures in permanent teeth: A systematic review. Int Endod J 2022; 55:290-311. [PMID: 35076954 PMCID: PMC9304243 DOI: 10.1111/iej.13690] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 11/28/2022]
Abstract
Background Consensus on the treatment of choice for complicated crown fractures of teeth is limited. Recent guidance recommends vital‐pulp‐therapy; however, the preferred type is not specified. Higher success rates for pulpotomy compared to pulp‐capping have been documented, which suggests pulpotomy may be a preferable option for complicated crown‐fractures. Objectives The purpose of this systematic review was to determine the success rate of pulpotomy (partial and complete) on teeth that suffered complicated crown fractures. Participants: patients who have suffered a complicated crown fracture to an anterior permanent tooth. Intervention: pulpotomy (partial or complete). Comparator: pulp‐capping or root canal treatment. Outcome: combined clinical and radiographic success at or after 12 months. Methods A systematic literature using key search terms was conducted using PubMed, Web of Science and Cochrane‐Central‐Register‐of‐Controlled‐Trials (CENTRAL) as well as a grey literature search from inception to May 2021 and without language restricted to English. Strict inclusion criteria were applied. A standardized tool with defined criteria to assess the risk of bias in each study was used. For non‐randomized comparative trials, the Robins‐I tool was used while the Newcastle‐Ottawa scale was used for non‐comparative non‐randomized studies. Results Seven retrospective clinical studies were included. The studies reported high success rates for pulpotomy with overall success ranges for partial or complete pulpotomy ranging from 75% to 96%. One study compared the success rates of pulpotomy to an alternative treatment option pulp capping (90.9% vs. 67%, respectively). Due to the lack of homogeneity in the included studies, a meta‐analysis was not possible. Discussion This review highlights the limited evidence based for the current guidance on treatment of complicated crown fractures. The findings of the review indicate high success rates for pulpotomy; however, there is a moderate risk of bias and small sample sizes in the included studies with the result that the overall results should be interpreted with caution. Conclusion Within the limitations of this review, the benefits and high success rates reported for partial pulpotomy suggest this procedure, rather than pulp‐capping, should be considered as the treatment of choice for both immature and mature teeth that have suffered complicated crown‐fractures.
Collapse
Affiliation(s)
- Aisling Donnelly
- Faculty of Dentistry Oral & Craniofacial Sciences King’s College London London SE1 9RT
| | - Federico Foschi
- Faculty of Dentistry Oral & Craniofacial Sciences King’s College London London SE1 9RT
- University of Plymouth Peninsula Dental School Plymouth UK
- Department of Therapeutic Dentistry I. M. Sechenov First Moscow State Medical University Moscow Russia
| | - Paul McCabe
- Specialist Endodontist Oranmore Endodontics Oranmore Ireland
| | - Henry F. Duncan
- Division of Restorative Dentistry & Periodontology Dublin Dental University Hospital Trinity College Dublin Dublin Ireland
| |
Collapse
|
13
|
YAVUZ HF, BULUT EYÜBOĞLU G. Investigation on the Effect of Blood Contamination of Calcium Silicate-Based Pulp Capping Materials Hardened at Different Times on Shear Bond Strength. CUMHURIYET DENTAL JOURNAL 2022. [DOI: 10.7126/cumudj.1007704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
14
|
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]
|
15
|
Guan X, Zhou Y, Yang Q, Zhu T, Chen X, Deng S, Zhang D. Vital Pulp Therapy in Permanent Teeth with Irreversible Pulpitis Caused by Caries: A Prospective Cohort Study. J Pers Med 2021; 11:jpm11111125. [PMID: 34834477 PMCID: PMC8620894 DOI: 10.3390/jpm11111125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/19/2021] [Accepted: 10/30/2021] [Indexed: 01/09/2023] Open
Abstract
Background: When a tooth is diagnosed with irreversible pulpitis, root canal therapy (RCT) is generally performed to completely remove pulp tissue, which might lead to a higher risk of loss of vascularity, and teeth being more prone to fracture. Vital pulp therapy (VPT) is a personalized method of treating irreversible pulpitis, which conforms to the trend of minimally invasive endodontics. The remaining vital pulp could promote the physiological development of the roots of young permanent teeth with incomplete apical foramen. However, clear guidelines for VPT indication are still missing. Objective: This prospective cohort study evaluated the outcomes of vital pulp therapy (VPT) using iRoot BP Plus (Innovative Bioceramix Inc, Vancouver, BC, Canada) in permanent teeth of 6- to 20-year-old patients with irreversible pulpitis caused by caries and analyzed the preoperative factors affecting VPT prognosis. Methods: Fifty-nine permanent teeth in 59 patients with irreversible pulpitis caused by caries were treated with VPT using iRoot BP Plus. All patients received VPT under a standardized protocol. After informed consent, teeth were isolated with a dental dam, then operators performed VPT with iRoot BP Plus and restored the teeth with composite resin or stainless steel crown. Patients were postoperatively recalled after 3, 6 and 12 months and then recalled annually. Successful cases were defined as successful in both clinical and radiographic evaluations. A statistical analysis was performed using the Fisher exact test, and the level of significant difference was p < 0.05. Results: After 6–36 months of follow-up, a total of 57 teeth from 57 patients were accessible for evaluation. The mean age of subjects was 11.75 ± 3.81 years. The overall clinical and radiographic success rate of VPT was 91.2% (52/57). With an observation time of one year or more, the success rate was 90.5% (38/42). All the symptoms and physical examination findings showed no significant effect on VPT prognosis (p > 0.05) using a binary logistic regression model. Conclusions: Permanent teeth in 6- to 20-year-old patients diagnosed as irreversible pulpitis caused by caries can be successfully treated with VPT using iRoot BP Plus.
Collapse
|
16
|
Taha NA, Al-Khatib H. 4-Year Follow-up of Full Pulpotomy in Symptomatic Mature Permanent Teeth with Carious Pulp Exposure Using a Stainproof Calcium Silicate-based Material. J Endod 2021; 48:87-95. [PMID: 34563506 DOI: 10.1016/j.joen.2021.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/11/2021] [Accepted: 09/11/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study aimed to assess the pulpal and restorative outcome of full pulpotomy in symptomatic mature permanent teeth with carious pulp exposure over 4 years. METHODS Under local anesthesia, full pulpotomy was performed using the aseptic technique and a stainproof calcium silicate-based material (NeoMTA Plus; Avalon Biomed Inc, Bradenton, FL). The pain level was scored preoperatively and at 1 week posttreatment. Clinical and radiographic evaluation was performed at 6 months, 1, 2, and 4 years. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to analyze the data. Failed cases were classified as endodontic or restorative failure. RESULTS Full pulpotomy was completed in 109 teeth in 90 patients with an age range of 14-60 years (mean = 25 years). The study sample available for follow-up was 100 teeth in 86 patients with a recall rate above 90%. Preoperative pulp diagnosis was reversible pulpitis in 39 teeth and irreversible pulpitis in 61 teeth. The cumulative survival rates of pulpotomy were generally high (ie, 98%, 97.4%, 93%, and 83.8% at 6 months and 1, 2, and 4 years, respectively). The overall mean survival time of pulpotomy was 3.89 years (95% confidence interval, 3.84-3.95). The mean survival time was significantly higher for patients aged ≤25 years. However, in the multivariate analysis, the only significant predictor of pulpotomy failure was severe preoperative pain. Over the 4 years, 23 cases failed; only 10 of 23 failures were classified as endodontic failure, and the success of pulpotomy can be assumed to be 90%. CONCLUSIONS Full pulpotomy in cariously exposed pulp of mature permanent teeth sustained a high success rate over 4 years. The coronal seal is crucial for long-term survival.
Collapse
Affiliation(s)
- Nessrin A Taha
- Department of Conservative Dentistry, Jordan University of Science and Technology, Irbid, Jordan.
| | - Hanan Al-Khatib
- Department of Conservative Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
17
|
Fatima S, Alam S, Kumar A, Andrabi SMUN, Rehman A. Minimal intervention treatment of crown-root fracture in a mature permanent tooth by MTA pulpotomy and Fragment Reattachment: A Case Report. AUST ENDOD J 2021; 47:365-371. [PMID: 33314383 DOI: 10.1111/aej.12477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 10/26/2020] [Accepted: 11/21/2020] [Indexed: 12/31/2022]
Abstract
Treatment of crown-root fracture can be complicated, time-consuming and expensive. This paper presents a treatment approach that minimises intra-operatory intervention and preserves the biologic tissue. A 15-year-old boy reported for treatment of an oblique crown fracture in the left permanent maxillary central incisor (#21, Fédération Dentaire Internationale) with mature root apices. The treatment presented an endodontic, periodontal and restorative challenge as the crown fracture exposed the pulp and extended subgingivally. The patient also had accompanying generalised enamel hypoplasia due to dental fluorosis (grade 3 Deans Fluorosis index), making the aesthetic rehabilitation difficult. The case was managed by preserving the vital pulp by MTA pulpotomy, followed by the adhesive bonding of autogenous crown fragment. A three-year follow-up revealed healthy vital pulp tissue and retained bonded fragment with acceptable aesthetics and periodontal health.
Collapse
Affiliation(s)
- Shazra Fatima
- Department of Conservative Dentistry and Endodontics, Dr Z.A Dental College, Aligarh, A.M.U, India
| | - Sharique Alam
- Department of Conservative Dentistry and Endodontics, Dr Z.A Dental College, Aligarh, A.M.U, India
| | - Ashok Kumar
- Department of Conservative Dentistry and Endodontics, Dr Z.A Dental College, Aligarh, A.M.U, India
| | | | - Aaliya Rehman
- Department of Conservative Dentistry and Endodontics, Dr Z.A Dental College, Aligarh, A.M.U, India
| |
Collapse
|
18
|
Xu D, Mutoh N, Ohshima H, Tani-Ishii N. The effect of mineral trioxide aggregate on dental pulp healing in the infected pulp by direct pulp capping. Dent Mater J 2021; 40:1373-1379. [PMID: 34321369 DOI: 10.4012/dmj.2020-393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study aimed to clarify the effect of mineral trioxide aggregate (MTA) on pulp healing in the infected pulp by direct pulp capping (DPC). Thirty-six male ICR mice were divided into infected and uninfected groups. The pulp tissue was exposed to the oral flora for 24 h after pulp exposure in the infected group, or not exposed in the uninfected group, followed by sealing with MTA, calcium hydroxide cement (CH), or no DPC. Pulpal healing process was analyzed by hematoxylin-eosin staining and immunohistochemistry for nestin and Ki67. The active cell proliferation occurred on 1 week in the both MTA and CH groups, followed by the differentiation of odontoblast-like cells on 2 weeks in the MTA group, whereas their differentiation were not facilitated in the CH group. MTA is suggested to be a useful material for DPC with the infected and uninfected pulp tissue.
Collapse
Affiliation(s)
- Duo Xu
- Department of Pulp Biology and Endodontics, Graduate School of Dentistry, Kanagawa Dental University
| | - Noriko Mutoh
- Department of Pulp Biology and Endodontics, Graduate School of Dentistry, Kanagawa Dental University
| | - Hayato Ohshima
- Division of Anatomy and Cell Biology of the Hard Tissue, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences
| | - Nobuyuki Tani-Ishii
- Department of Pulp Biology and Endodontics, Graduate School of Dentistry, Kanagawa Dental University
| |
Collapse
|
19
|
Vital Pulp Therapy in Permanent Mature Posterior Teeth with Symptomatic Irreversible Pulpitis: A Systematic Review of Treatment Outcomes. ACTA ACUST UNITED AC 2021; 57:medicina57060573. [PMID: 34205149 PMCID: PMC8228104 DOI: 10.3390/medicina57060573] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/31/2021] [Indexed: 12/20/2022]
Abstract
Background and Objectives: Symptomatic irreversible pulpitis in permanent mature teeth is a common indication for nonsurgical root canal treatment (NSRCT), but contemporary studies have reported on vital pulp therapy (VPT) applied in such teeth as a less invasive treatment. This systematic review assessed the outcomes of VPT, including partial and full pulpotomy performed with hydraulic calcium silicate cements (HCSCs) in permanent mature posterior teeth diagnosed with symptomatic irreversible pulpitis. Materials and Methods: The PRISMA guidelines were followed. The search strategy included PubMed®, EMBASE, Cochrane library and grey literature electronic databases. The quality assessment of the identified studies followed the Cochrane Collaboration Risk of Bias, ROBINS-I and Newcastle–Ottawa Scale tools. Results: The search of primary databases identified 142 articles, of which 9 randomized controlled trials and 3 prospective cohort studies were selected for review. The risk-of-bias was assessed as ‘high’ or ‘serious’, ‘fair’, and ‘low’ for three, seven and two articles, respectively. One to five years after VPT using HCSCs, the success rates mostly ranged from 78 to 90%. Based on two articles, the outcomes of the VPT and NSRCT were comparable at one and five years. Despite the necessity for the intra-operative pulp assessment in VPT procedures, the majority of the studies did not fully report on this step or on the time needed to achieve hemostasis. Small sample sizes, of under 23 teeth, were reported in three studies. Conclusions: The reviewed 12 articles reported favorable outcomes of the VPT performed with HCSCs in permanent mature posterior teeth with symptomatic irreversible pulpitis, with radiographic success in the range of 81 to 90%. Two articles suggested comparable outcomes of the VPT and root canal treatment. Universal case selection and outcome criteria needs to be established for VPT when considered as an alternative to NSRCT. This evidence supports the need for further research comparing longer-term outcomes of both of the treatment modalities.
Collapse
|
20
|
Leong DJX, Yap AU. Vital pulp therapy in carious pulp-exposed permanent teeth: an umbrella review. Clin Oral Investig 2021; 25:6743-6756. [PMID: 33970319 DOI: 10.1007/s00784-021-03960-2] [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: 12/11/2020] [Accepted: 04/20/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE There has been increasing evidence indicating rather high success rates of vital pulp therapies. This umbrella review aimed to provide an overview of existing systematic reviews regarding the outcomes of vital pulp therapy, specifically direct pulp capping, partial pulpotomy and full pulpotomy, in carious pulp-exposed permanent human teeth. MATERIALS AND METHODS The specific PICO questions were as follows: Population - permanent human teeth with carious pulp exposure; Intervention - direct pulp capping with pulp capping materials; Comparators - partial pulpotomy and full pulpotomy; Outcomes - success rate and prognostic factors. PubMed, Ovid and Cochrane databases were searched in conjunction with hand searching. Grey literature was searched too. Study selection, data extraction and study appraisal were performed independently by two authors. A consensus was reached through discussion when disagreements arose. RESULTS Six articles fulfilled the inclusion criteria. Higher and more predictable success rates of ≥ 2 years were observed for partial pulpotomy and full pulpotomy in carious pulp-exposed permanent human teeth as compared to direct pulp capping. Possible prognostic factors (pre-operative pulp status, pulp capping material and apex closure) yielded conflicting results. Restorative material, periapical status at baseline, final irrigation solution, age and study type did not seem to affect the treatment outcome. CONCLUSIONS Vital pulp therapy is a reliable treatment option for permanent teeth with carious pulp exposure. However, more high-quality studies are required to corroborate this finding. CLINICAL RELEVANCE Vital pulp therapy could be considered as an alternative for root canal treatment for carious pulp-exposed permanent teeth.
Collapse
Affiliation(s)
- Dephne Jack Xin Leong
- Department of Dentistry, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore.
| | - Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore
| |
Collapse
|
21
|
Kermanshah H, Ranjbar Omrani L, Ghabraei S, Fekrazad R, Daneshparvar N, Bagheri P. Direct Pulp Capping With ProRoot MTA Alone and in Combination With Er:YAG Laser Irradiation: A Clinical Trial. J Lasers Med Sci 2020; 11:S60-S66. [PMID: 33995971 DOI: 10.34172/jlms.2020.s10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: Due to the complications of root canal treatment, conservative modalities to preserve pulp vitality are favorable. Direct pulp capping (DPC) refers to the coverage of the pulp tissue exposed by a biocompatible agent that can improve the prognosis of the tooth by 44% to 95%. Some recent studies have reported more predictable results (a success rate of about 90%) for DPC with laser and regenerative materials such as mineral trioxide aggregate (MTA). This study aimed to clinically compare DPC with ProRoot MTA alone and in combination with Er:YAG (erbium-doped yttrium aluminium garnet) laser irradiation (2940 nm). Methods: This clinical trial was conducted on 26 patients with a mean age of 29 years (in the range of 17 to 46 years) who required DPC following pulp exposure during deep caries removal. The teeth were divided into two groups. In the control group, the teeth underwent DPC with ProRoot MTA while in the test group, the teeth were first irradiated with a 2940 nm Er:YAG laser and then underwent DPC with ProRoot MTA. The patients were recalled at one, 3 and 6 months for the follow-up (clinical and radiographic examinations). The data were analyzed using Fisher exact test. Results: The success rate was 75% in the laser group and 93% in the control group. The groups were not significantly different (P>0.05). Conclusion: No significant difference was found in terms of the success rate of DPC with ProRoot MTA alone and in combination with Er:YAG laser irradiation.
Collapse
Affiliation(s)
- Hamid Kermanshah
- Associate Professor, Department of Restorative Dentistry, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Ladan Ranjbar Omrani
- Associate Professor, Department of Restorative Dentistry, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Sholeh Ghabraei
- Associate Professor, Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Fekrazad
- Radiation Science Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran.,International Network for Photo Medicine and Photo Dynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | | | - Parisa Bagheri
- Faculty Member, Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
22
|
Koli B, Chawla A, Logani A, Kumar V, Sharma S. Combination of Nonsurgical Endodontic and Vital Pulp Therapy for Management of Mature Permanent Mandibular Molar Teeth with Symptomatic Irreversible Pulpitis and Apical Periodontitis. J Endod 2020; 47:374-381. [PMID: 33091455 DOI: 10.1016/j.joen.2020.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/30/2020] [Accepted: 10/13/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This prospective study evaluated the outcome of a combination of nonsurgical endodontic (NSET) and vital pulp therapy (VPT) for the management of mature permanent mandibular molar teeth with symptomatic irreversible pulpitis (SIP) and apical periodontitis (AP). METHODS Institutional ethical clearance was obtained. Mandibular molar teeth (N = 60) with a definitive diagnosis of SIP and AP with a radiographic periapical index score (PAI) of ≥3 in either 1 of the roots (mesial or distal) were included. Block randomization was used for allocation. In the NSET group (n = 30), single-visit NSET was performed using a standardized operating protocol. In the NSET-VPT group (n = 30), subsequent to full pulpotomy, at the root orifice where a vital pulp was observed (as determined by the arrest of pulpal bleed upon application of a 2.5% sodium hypochlorite pressure pack), a mineral trioxide aggregate radicular barrier was placed, and it was covered with light-cured resin-modified glass ionomer cement. NSET was performed in the root exhibiting a PAI score ≥3. The tooth was permanently restored. Postoperative pain was assessed at 24, 48, and 72 hours. Teeth were followed up clinically and radiographically at 12 months. The presence/absence of symptoms and the change in PAI scores were noted. The data were statistically analyzed. RESULTS The success rate was 90% in the NSET group and 93.3% in the NSET-VPT group. According to an intergroup comparison between the proportion of teeth healed and nonhealed (radiographic), there was no significant difference (P > .05). CONCLUSIONS The combination of NSET and VPT is a viable biologically based minimally invasive treatment option for multirooted mandibular teeth with SIP and AP.
Collapse
Affiliation(s)
- Bhawna Koli
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Amrita Chawla
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.
| | - Ajay Logani
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Kumar
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Sidhartha Sharma
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
23
|
Ozkurt-Kayahan Z, Turgut B, Akin H, Kayahan MB, Kazazoglu E. A 3D finite element analysis of stress distribution on different thicknesses of mineral trioxide aggregate applied on various sizes of pulp perforation. Clin Oral Investig 2020; 24:3477-3483. [PMID: 32333173 DOI: 10.1007/s00784-020-03218-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/20/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the stress distribution on different thicknesses of mineral trioxide aggregate (MTA) placed on various widths of pulp perforations during the condensation of the composite resin material. MATERIALS AND METHODS The mandibular molar tooth was modeled by COSMOSWorks program (SolidWorks, Waltham, MA). Three finite elemental analysis models representing 3 different dimensions of pulp perforations, 1, 2, and 3 mm in diameter, were created. The perforation area was assumed as filled with MTA with different thicknesses, 1, 2, and 3 mm for each pulp perforation width, creating a total of 9 different models. Then, a composite resin material was layered on MTA for each model. A 66.7 N load was applied and an engineering simulation program (ANSYS, Canonsburg, US) was used for the analysis. Results were presented considering von Mises stress criteria. RESULTS As MTA thickness increased, the stress values recorded within the area between pulp and MTA decreased. Strain was decreased when the thickness of MTA increased. CONCLUSIONS Stresses at MTA-pulp interface and strain on MTA decreased with the increase in MTA thickness. CLINICAL RELEVANCE In clinical practice, when MTA is required for pulp capping, using a thick layer of the material seems to be a better option in order to reduce the stress under forces of hand condensation of overlying restorative materials.
Collapse
Affiliation(s)
- Zeynep Ozkurt-Kayahan
- Department of Prosthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey.
| | - B Turgut
- Department of Mechanical Engineering, Faculty of Natural Sciences and Engineering, Gaziosmanpasa University, Tokat, Turkey
| | - H Akin
- Department of Prosthodontics, Faculty of Dentistry, Sakarya University, Sakarya, Turkey
| | - M B Kayahan
- Department of Endodontics, Faculty of Dentistry, Okan University, Istanbul, Turkey
| | - E Kazazoglu
- Department of Prosthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| |
Collapse
|
24
|
|
25
|
Lee S, Park YT, Setzer FC. Combined Regenerative and Vital Pulp Therapies in an Immature Mandibular Molar: A Case Report. J Endod 2020; 46:1085-1090. [PMID: 32553418 DOI: 10.1016/j.joen.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/09/2020] [Accepted: 04/19/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This report describes the treatment of an immature mandibular molar by combining vital pulp therapy (VPT) and regenerative endodontic procedures (REPs). It details the use of REP to regain functionality and continued root development of an immature root with pulp necrosis and VPT for an immature root containing vital pulpal tissues. METHODS An 8-year old male presented for evaluation of a mandibular first right molar with mild buccal swelling and a nontraceable sinus tract. He recently had received a restoration. After intraoral and radiographic examination, a diagnosis of pulp necrosis and chronic apical abscess was made. After access, pulp necrosis was confirmed in the distal root; however, vital pulp tissues were present in the mesial canals. It was decided on pulpotomy (VPT) in the mesial and REP in the distal root. At the initial visit, pulpotomy was completed in the mesial root, and REP was initiated in the distal root. Three weeks later, the patient was asymptomatic and the sinus tract absent. REP was completed in the distal root, and the tooth was restored. RESULTS At the 6-, 12-, and 18-month follow-up, the patient presented without symptoms, and the tooth responded positively to pulp sensibility tests. Radiographic examinations showed resolution of the apical radiolucency and completed root development. CONCLUSIONS Combined treatment using both VPT and REP for immature molars with different pulpal status in individual roots may be a preferable treatment option because preservation of vital pulp tissues and regeneration of new vital tissues allow for continued root development and functionality.
Collapse
Affiliation(s)
- Sumin Lee
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Frank C Setzer
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
26
|
Taylor GD, Vernazza CR, Abdulmohsen B. Success of endodontic management of compromised first permanent molars in children: A systematic review. Int J Paediatr Dent 2020; 30:370-380. [PMID: 31778237 DOI: 10.1111/ipd.12599] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Endodontic therapies may be required in the management of compromised first permanent molar teeth; their success in children, however, is unknown. AIM To determine the success of endodontic therapies used on first permanent molar teeth in children aged sixteen and under. DESIGN MEDLINE, Embase, Cochrane library, CENTRAL, Clinicaltrials.gov, and the ISRCTN registry as well as relevant paediatric, endodontic, and traumatology journal were searched using a detailed search strategy. References of included studies were hand-searched. A PICOS question was formulated: (P): children aged sixteen and under; (I): endodontic therapies (not pulp capping) on a first permanent molar tooth; (C): no treatment; (O): clinical success of endodontic therapy; and (S): all study types included. Bias was assessed using the Cochrane and Robins-I risk tools. Quality of evidence was assessed using the GRADE approach. Significant heterogeneity precluded meta-analysis. RESULTS 4172 studies were retrieved and eleven were included in the narrative review. Partial and coronal pulpotomies have high success rates in the short term and long term. Limited evidence is available for conventional pulpectomy or regenerative techniques. CONCLUSIONS Partial and coronal pulpotomies are successful endodontic therapies for use in a compromised child's first permanent molar.
Collapse
Affiliation(s)
- Greig D Taylor
- Centre for Oral Health Research, School of Dental Sciences, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher R Vernazza
- Centre for Oral Health Research, School of Dental Sciences, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Bana Abdulmohsen
- Centre for Oral Health Research, School of Dental Sciences, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
27
|
Bahman S, Sara G, Somayeh H, Parvin T, Kalhori KAM, Mona S, Reza F. Combined effects of calcium hydroxide and photobiomodulation therapy on apexogenesis of immature permanent teeth in dogs. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2020; 207:111867. [PMID: 32283500 DOI: 10.1016/j.jphotobiol.2020.111867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/21/2020] [Accepted: 03/24/2020] [Indexed: 11/27/2022]
Abstract
Treatment of high-risk traumatic immature teeth due to incomplete root development is challenging. Apexogenesis is currently the ideal treatment option that allows normal root development. The purpose of this study was to evaluate the apexogenesis process of immature permanent teeth of dogs when co-administered with calcium hydroxide and photobiomodulation therapy (PBMT). A total of 36 immature permanent anterior and premolar teeth were selected from three 4-6-month-old dogs of Iranian mixed generation. The teeth were categorized into two groups, calcium hydroxide with laser irradiation (CHL) and calcium hydroxide without laser irradiation (CH). All the selected teeth received calcium hydroxide pulpotomy. After restoring teeth with amalgam, the CHL group received gallium‑aluminum-arsenide (GaAlAs) diode laser (810 nm, 4.2 J/cm2, 0.3 W, 9 s,CW) on apical one-third of both buccal and lingual roots. The irradiation was repeated every 48 h for fourteen days. Intravenous tetracycline was used to observe newly formed dentin in the first, third, seventh, and fourteenth days. The distance between tetracycline lines (DTL) was examined by Fluorescence microscopy. Generalized estimating equations (GEE) were used for data analysis. In all assessments, the mean DTL were greater in the CHL group. However, the two groups had no significant differences in the amount of deposited dentin between the first and third, third and seventh, and first and seventh lines. Meanwhile, there was a significant difference between the two groups in terms of the distances between lines 7 and 14, 1 and 14 and also 3 to 14 (P < .001). In other words, from the 7th day onwards, there was a significant difference between the two groups. Within the limitation of this study, the combination therapy of PBMT and pulpotomy with calcium hydroxide accelerated apexogenesis in immature permanent dogs' teeth.
Collapse
Affiliation(s)
- Seraj Bahman
- Dental Research Center, Pediatric Dentistry Department, School of Dentistry, Tehran University of Medical Science,Tehran, Iran.
| | - Ghadimi Sara
- Laser Research Center, Pediatric Dentistry Department, School of Dentistry, Tehran University of Medical Science, Tehran, Iran.
| | - Hosseini Somayeh
- Dental Materials Research Center, Operative Dentistry Department, School of Dentistry, Tehran University of Medical Science, Isfahan, Iran
| | - Tamiz Parvin
- Department Of Orthodontics, School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Sohrabi Mona
- Pediatric Dentistry Department, School of Dentistry, Arak University of Medical Science, Arak, Iran
| | - Fekrazad Reza
- Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran; International Network for Photo Medicine and Photo Dynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| |
Collapse
|
28
|
Gemmell A, Stone S, Edwards D. Investigating acute management of irreversible pulpitis: a survey of general dental practitioners in North East England. Br Dent J 2020; 228:521-526. [DOI: 10.1038/s41415-020-1419-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
29
|
Al-Sherbiny IM, Farid MH, Abu-Seida AM, Motawea IT, Bastawy HA. Chemico-physical and mechanical evaluation of three calcium silicate-based pulp capping materials. Saudi Dent J 2020; 33:207-214. [PMID: 34025083 PMCID: PMC8119770 DOI: 10.1016/j.sdentj.2020.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 02/05/2023] Open
Abstract
Aim This study compared biointeractivity (pH of soaking water and calcium ions), porosity, water sorption, solubility, compressive strength, lap shear strength, as well as the apatite forming ability of three calcium silicate-based capping materials: Mineral trioxide aggregate (MTA), Biodentine (BD) and Tech Biosealer capping (BS). Methods One hundred and five discs of the tested materials were prepared in compliance with the manufacturer's instructions. The materials' pastes were placed in Teflon molds and allowed to set before testing. The pH and Ca+2 ions were measured by a potentiometric method. Porosity, water sorption, and solubility were calculated through the measurement of initial mass, mass, saturated mass and dry mass. Apatite forming ability was measured by an Environmental Scanning Electron Microscope that was connected to a secondary electron detector for energy dispersive X-ray analysis. Meanwhile compressive strength was measured by a computer controlled universal testing machine. Lap shear strength was measured by computer software on the testing machine. All data were statistically analyzed. Results The tested materials showed Ca ions release and alkalization, which decreased with soaking time. The BD exhibited a very high Ca release at both short (3 h) and long times (28 days). Significant high values of open and apparent porosities, water sorption, and solubility were measured for BS, which was followed by the MTA then BD (P < .05). The BD had significant higher compressive and lap shear bond strength than the MTA and BS (P < .05). Conclusion MTA, BD and BS are biointeractive bioactive materials that possess the ability to release ions and form calcium phosphate deposits. Unlike BD, BS is incapable of alternating MTA in pulp capping due to its high porosities, water sorption and solubility, as well as poor compressive and lap shear bond strength.
Collapse
Affiliation(s)
- Inas M Al-Sherbiny
- Dental Biomaterials Department, Faculty of Dental Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Mona H Farid
- Oral Biology Department, Faculty of Dental Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Ashraf M Abu-Seida
- Department of Surgery, Anesthesiology & Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Inas T Motawea
- Dental Biomaterials Department, Faculty of Dental Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Hagar A Bastawy
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
| |
Collapse
|
30
|
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: 72] [Impact Index Per Article: 14.4] [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.
Collapse
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
| |
Collapse
|
31
|
İlker A, Sarıyılmaz E, Çakici F. Does Adding Various Accelerators to Mineral Trioxide Aggregate Have a Negatively Effect on Push-Out Bond Strength? Med Princ Pract 2019; 28:36-40. [PMID: 30257258 PMCID: PMC6558319 DOI: 10.1159/000494057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 09/26/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study compares the effect of the white mineral trioxide aggregate (WMTA) accelerators, including disodium hydrogen orthophosphate (Na2HPO4; 2.5 wt%), calcium chloride (CaCl2; 5 and 10 wt%), and KY jelly, on the push-out bond strength of WMTA. The null hypothesis was that the WMTA accelerators would not affect the push-out bond strength of WMTA. MATERIALS AND METHODS Slices (2-mm-thick) were obtained from 75 human mandibular molar distal roots. The slices were enlarged up to size 6 Gates-Glidden burs to obtain a 1.5-mm canal diameter. The slices were randomly divided into 4 experimental groups and a control group (n = 15 in each group). Freshly prepared WMTA mixture was placed into the root slices and stored at 37°C in a 100% humidified atmosphere for 60 days. The force required to dislodge the WMTA cement from the root slice was determined using a universal testing machine. The push-out bond strength was calculated. RESULTS Push- out bond strength of 5- and 10-wt% CaCl2, and 2.5-wt% Na2HPO4 WMTA groups was significantly lower than in the KY-jelly and control groups (p < 0.05). The mean push-out bond strength of KY jelly was lower than in the control group but not statistically significant. CONCLUSION The addition of KY jelly to WMTA did not have an adverse effect on the push-out bond strength of WMTA, in contrast to the other accelerators, including Na2HPO4 and CaCl2, which reduced the push-out bond strength.
Collapse
Affiliation(s)
- Alper İlker
- Ordu University Faculty of Dentistry, Department of Endodontics, Ordu, Turkey
| | - Evren Sarıyılmaz
- Ordu University Faculty of Dentistry, Department of Endodontics, Ordu, Turkey,
| | - Fatih Çakici
- Ordu University Faculty of Dentistry, Department of Endodontics, Ordu, Turkey
| |
Collapse
|
32
|
Taha NA, Abdulkhader SZ. Full Pulpotomy with Biodentine in Symptomatic Young Permanent Teeth with Carious Exposure. J Endod 2018; 44:932-937. [PMID: 29681479 DOI: 10.1016/j.joen.2018.03.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/25/2018] [Accepted: 03/02/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION This prospective study evaluated the outcome of Biodentine (Septodont, Saint Maur des Fosses, France) pulpotomy in young permanent teeth with carious exposure. METHODS Twenty permanent molar teeth in 14 patients with carious pulp exposure were treated with Biodentine pulpotomy. The age of the patients ranged from 9-17 years (12.3 ± 2.7 years). A preoperative pulpal and periapical diagnosis was established. After informed consent, the tooth was anesthetized, isolated via a dental dam, and disinfected with 5% sodium hypochlorite before caries excavation. Full pulpotomy was performed by amputating the exposed pulp to the level of the canal orifices, hemostasis was achieved via a cotton pellet moistened with 2.5% sodium hypochlorite, a 3-mm layer of Biodentine was placed as the pulpotomy agent, a Vitrebond liner (3M ESPE, St Paul, MN) was applied, and the tooth was subsequently restored. Postoperative periapical radiographs were taken after placement of the permanent restoration. Clinical and radiographic evaluation was completed after 6 months and 1 year postoperatively. Pain levels were scored preoperatively and 2 days after treatment. Statistical analysis was performed using the Fisher exact test. RESULTS Clinical signs and symptoms suggestive of irreversible pulpitis were established in all teeth and symptomatic apical periodontitis in 14 of 20 (70%). Two days after treatment, all patients reported complete relief of pain. All teeth were clinically successful at 6 months and 1 year postoperatively. Radiographically, immature roots showed continued root development; dentin bridge formation was detected in 5 of 20 teeth. Seven of 7 teeth with preoperative periapical rarefaction showed signs of healing; 1 tooth had signs of internal root resorption at 1 year with an overall success rate of 95% (19/20). CONCLUSIONS Young permanent teeth with carious exposure can be treated successfully with full pulpotomy using Biodentine, and clinical signs and symptoms of irreversible pulpitis are not a contraindication.
Collapse
Affiliation(s)
- Nessrin A Taha
- Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan.
| | - Sakhaa Z Abdulkhader
- Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
33
|
Galani M, Tewari S, Sangwan P, Mittal S, Kumar V, Duhan J. Comparative Evaluation of Postoperative Pain and Success Rate after Pulpotomy and Root Canal Treatment in Cariously Exposed Mature Permanent Molars: A Randomized Controlled Trial. J Endod 2017; 43:1953-1962. [DOI: 10.1016/j.joen.2017.08.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 11/25/2022]
|
34
|
Linsuwanont P, Wimonsutthikul K, Pothimoke U, Santiwong B. Treatment Outcomes of Mineral Trioxide Aggregate Pulpotomy in Vital Permanent Teeth with Carious Pulp Exposure: The Retrospective Study. J Endod 2017; 43:225-230. [DOI: 10.1016/j.joen.2016.10.027] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/14/2016] [Accepted: 10/17/2016] [Indexed: 01/18/2023]
|
35
|
Ha WN, Kahler B, Walsh LJ. Dental Material Choices for Pulp Therapy in Paediatric Dentistry. Eur Endod J 2017; 2:1-6. [PMID: 33403336 PMCID: PMC7757953 DOI: 10.5152/eej.2017.16053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 11/07/2016] [Accepted: 11/22/2016] [Indexed: 11/30/2022] Open
Abstract
Objective: The purpose of this study was to assess the restorative choices for pulpal therapy by members of the Australian and New Zealand Society of Paediatric Dentistry (ANZSPD). Methods: Members of the ANZSPD were sent an online survey asking about the procedures that they performed and their choice of dental materials. Results: The respondents were 31 general dentists (GD) and 55 specialist paediatric dentists (PD). Materials used for indirect pulp capping included calcium hydroxide [Ca(OH)2] cement (CHC), glass ionomer cement or resin-modified glass ionomer cement (GIC/RMGIC), Ca(OH)2 paste (CHP) and mineral trioxide aggregate (MTA). Materials for direct pulp capping included MTA, CHP and CHC. Materials and techniques used for pulpotomy included MTA, ferric sulphate, formocresol and diathermy, CHP and CHC. GD and PD were similar in their choice of materials. However, there was no preferred product for pulp therapy. Most GD learnt how to use MTA from CPD lectures, while some PD learnt how to use MTA from their postgraduate training as well as CPD lectures. Many GD and PD did not have hands-on training from their education on how to use MTA (GD: 80%, PD: 43%). Most would like to attend hands-on MTA courses (GD: 86%, PD: 65%). Conclusion: There was no clear preferred product for the various types of pulp therapy in paediatric dentistry. Education appears to be the major barrier to the use of MTA rather than the cost of MTA.
Collapse
Affiliation(s)
- William N Ha
- School of Dentistry, University of Queensland, Brisbane, Australia
| | - Bill Kahler
- School of Dentistry, University of Queensland, Brisbane, Australia
| | - Laurence J Walsh
- School of Dentistry, University of Queensland, Brisbane, Australia
| |
Collapse
|
36
|
Çelik BN, Sarı Ş. Carious Exposure versus Mechanical Exposure for MTA Pulpotomy in Primary Teeth. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2753429. [PMID: 27995139 PMCID: PMC5138441 DOI: 10.1155/2016/2753429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/24/2016] [Indexed: 12/02/2022]
Abstract
Introduction. The etiology of exposure determines pulpal response, making it crucial to distinguish between mechanical and carious exposure. This study clinically and radiographically evaluated the success of MTA pulpotomies conducted to treat carious and mechanical pulp exposure. Materials and Methods. This study was conducted with 50 mandibular primary molar teeth. Teeth were divided into 2 groups according to status of the exposure site, with teeth surrounded by carious dentin placed in a carious exposure group and those surrounded by sound dentin in a mechanical exposure group. MTA pulpotomies were performed for both groups. Treatment was followed up clinically and radiographically for 18 months. Results. Clinical and radiographic success rates at 18 months were 100% for both groups. Success rates did not vary significantly between the groups (p = 1.000). Pulp canal obliteration was only seen in the carious exposure group, observed in 2 teeth (8.3%). Conclusion. The long term success rates achieved in this study indicate that MTA can be used as a vital pulpotomy material for the long term success in primary teeth with either mechanical or carious exposure. The findings of the present study highlight the fact that treatment prognosis is dependent upon diagnosis and selection of the appropriate materials for treatment.
Collapse
Affiliation(s)
- Burcu Nihan Çelik
- Department of Pedodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Şaziye Sarı
- Department of Pedodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
| |
Collapse
|
37
|
Abstract
Regenerative endodontic procedures for immature teeth with pulp necrosis have gained a lot of interest. Basic scientific research has documented the potential for dental pulp regeneration in preclinical studies. A number of case reports and case series have shown the control of clinical infection and increases in thickness and length of the roots. Preoperative infection is an important factor that predicts outcome in nonsurgical endodontic treatment in mature teeth and seems to also be an important determinant of outcome in treating immature teeth. However, antimicrobial strategies for the immature tooth in which pulp regeneration is contemplated are different from those used in mature cases. This is because of the interest in disinfecting the root canal to a higher level to promote tissue growth without disrupting the bioactive potential of root dentin and the viability of stem cells from which the regenerated tissue would develop. This review addresses the factors involved in making clinical decisions in this area in light of the information available on the microbiology of endodontic infections, the efficacy to antimicrobial strategies, and the outcomes of regenerative and alternative procedures.
Collapse
Affiliation(s)
- Ashraf F Fouad
- Department of Endodontics, Prosthodontics and Operative Dentistry, School of Dentistry, University of Maryland, Baltimore, Maryland.
| | - Prashant Verma
- Department of Endodontics, Prosthodontics and Operative Dentistry, School of Dentistry, University of Maryland, Baltimore, Maryland
| |
Collapse
|
38
|
Yelamali S, Patil AC. "Evaluation of shear bond strength of a composite resin to white mineral trioxide aggregate with three different bonding systems"-An in vitro analysis. J Clin Exp Dent 2016; 8:e273-7. [PMID: 27398177 PMCID: PMC4930636 DOI: 10.4317/jced.52727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 01/27/2016] [Indexed: 11/16/2022] Open
Abstract
Background Mineral trioxide aggregate (MTA) is a biomaterial that has been investigated for endodontic applications. With the increased use of MTA in pulp capping, pulpotomy, perforation repair, apexification and obturation, the material that would be placed over MTA as a final restoration is an important matter. As composite resins are one of the most widely used final restorative materials, this study was conducted to evaluate the shear bond strength of a composite resin to white mineral trioxide aggregate (WMTA) using three different bonding systems namely the two-step etch and rinse adhesive, the self-etching primer and the All-in-one system. Material and Methods Forty five specimens of white MTA (Angelus) were prepared and randomly divided into three groups of 15 specimens each depending on the bonding systems used respectively. In Group A, a Two-step etch and rinse adhesive or ‘total-etch adhesive’, Adper Single Bond 2 (3M/ESPE) and Filtek Z350 (3M ESPE, St Paul, MN) were placed over WMTA. In group B, a Two-step self-etching primer system, Clearfil SE Bond (Kuraray, Medical Inc) and Filtek Z350 were used. In Group C, an All-in-one system, G Bond (GC corporation, Tokyo, Japan) and Filtek Z350 were used. The shear bond strength was measured for all the specimens. The data obtained was subjected to One way Analysis of Variance (ANOVA) and Scheffe’s post hoc test. Results The results suggested that the Two-step etch and rinse adhesive when used to bond a composite resin to white MTA gave better bond strength values and the All-in-one exhibited the least bond strength values. Conclusions The placement of composite used with a Two-step etch and rinse adhesive over WMTA as a final restoration may be appropriate. Key words:Composite resins, dentin bonding agents, mineral trioxide aggregate, shear bond strength.
Collapse
|
39
|
Qudeimat MA, Alyahya A, Hasan AA, Barrieshi-Nusair KM. Mineral trioxide aggregate pulpotomy for permanent molars with clinical signs indicative of irreversible pulpitis: a preliminary study. Int Endod J 2016; 50:126-134. [DOI: 10.1111/iej.12614] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 01/29/2016] [Indexed: 11/26/2022]
Affiliation(s)
- M. A. Qudeimat
- Department of Developmental and Preventive Sciences; Kuwait University; Safat Kuwait
| | - A. Alyahya
- Department of Developmental and Preventive Sciences; Kuwait University; Safat Kuwait
| | | | | |
Collapse
|
40
|
Kathuria V, Dhillon JK, Kalra G. Low Level Laser Therapy: A Panacea for oral maladies. Laser Ther 2015; 24:215-23. [PMID: 26557737 DOI: 10.5978/islsm.15-ra-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM To review the applications of low level laser therapy on various soft and hard oral tissues. A variety of therapeutic effects of Low Level Laser Therapy have been reported on a broad range of disorders. It has been found amenably practical in dental applications including soft as well as hard tissues of the oral cavity. LLLT has been found to be efficient in acceleration of wound healing, enhanced remodelling and bone repair, regeneration of neural cells following injury, pain attenuation, endorphin release stimulation and modulation of immune system. The aforementioned biological processes induced by Low level lasers have been effectively applied in treating various pathological conditions in the oral cavity. With is article, we attempt to review the possible application of Low Laser Therapy in the field of dentistry.
Collapse
Affiliation(s)
- Vartika Kathuria
- Centre for Dental Education and Research, All India Institute of Medical Sciencese
| | | | - Gauri Kalra
- Division of Pedodontics & Preventive Dentistry, Clove Pental Pvt Ltd
| |
Collapse
|
41
|
Borkar SA, Ataide I. Biodentine pulpotomy several days after pulp exposure: Four case reports. J Conserv Dent 2015; 18:73-8. [PMID: 25657533 PMCID: PMC4313486 DOI: 10.4103/0972-0707.148901] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/10/2014] [Accepted: 10/23/2014] [Indexed: 11/04/2022] Open
Abstract
Conventionally, few-days-old pulp exposures have been treated with root canal treatment. We report four cases of traumatized, fully matured, maxillary permanent central incisors, which have been treated by Biodentine pulpotomy several days after traumatic pulp exposure. Biodentine pulpotomy consisted of pulp tissue removal to a depth of 2 mm, then capping the pulpal wound with Biodentine, followed by immediate restoration. The teeth were assessed clinically through pulpal sensitivity tests and radiographically for periapical healing. At each recall (24 hours, 1 week, 30 days, 3, 6, 12, and 18 months), no spontaneous pain was observed; the pulp showed signs of vitality and absence of periapical radiolucency after 18 months. Biodentine pulpotomy is recommended as a treatment option for cases of vital pulp exposure in permanent incisors due to trauma.
Collapse
Affiliation(s)
- Swati A Borkar
- Department of Conservative Dentistry and Endodontics, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Ida Ataide
- Department of Conservative Dentistry and Endodontics, Goa Dental College and Hospital, Bambolim, Goa, India
| |
Collapse
|
42
|
Affiliation(s)
- Vartika Kathuria
- Centre for Dental Education and Research, All India Institute of Medical Sciencese
| | | | - Gauri Kalra
- Division of Pedodontics & Preventive Dentistry, Clove Pental Pvt Ltd
| |
Collapse
|
43
|
|
44
|
Al-Haj Ali SN, Al-Jundi SH, Ditto DJ. In vitro toxicity of grey MTA in comparison to white MTA on human periodontal ligament fibroblasts. Eur Arch Paediatr Dent 2014; 15:429-33. [DOI: 10.1007/s40368-014-0134-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 05/26/2014] [Indexed: 11/30/2022]
|
45
|
Fekrazad R, Seraj B, Ghadimi S, Tamiz P, Mottahary P, Dehghan MM. The effect of low-level laser therapy (810 nm) on root development of immature permanent teeth in dogs. Lasers Med Sci 2014; 30:1251-7. [DOI: 10.1007/s10103-014-1588-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/24/2014] [Indexed: 05/28/2023]
|
46
|
Comparative Evaluation of Platelet-rich Fibrin and Mineral Trioxide Aggregate as Pulpotomy Agents in Permanent Teeth with Incomplete Root Development: A Randomized Controlled Trial. J Endod 2014; 40:599-605. [DOI: 10.1016/j.joen.2014.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/26/2013] [Accepted: 01/09/2014] [Indexed: 11/19/2022]
|
47
|
Bjørndal L, Demant S, Dabelsteen S. Depth and Activity of Carious Lesions as Indicators for the Regenerative Potential of Dental Pulp after Intervention. J Endod 2014; 40:S76-81. [DOI: 10.1016/j.joen.2014.01.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
48
|
Luotonen N, Kuntsi-Vaattovaara H, Sarkiala-Kessel E, Junnila JJT, Laitinen-Vapaavuori O, Verstraete FJM. Vital pulp therapy in dogs: 190 cases (2001–2011). J Am Vet Med Assoc 2014; 244:449-59. [DOI: 10.2460/javma.244.4.449] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
49
|
Jefferies SR. Bioactive and Biomimetic Restorative Materials: A Comprehensive Review. Part I. J ESTHET RESTOR DENT 2013; 26:14-26. [DOI: 10.1111/jerd.12069] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Steven R. Jefferies
- Donald and Cecelia Platnick Professor, and Director of Biomaterials Research Laboratory, Restorative Dentistry, and Director of Clinical Research; School of Dentistry, Kornberg School of Dentistry, Temple University; Philadelphia PA USA
| |
Collapse
|
50
|
Nosrat A, Peimani A, Asgary S. A preliminary report on histological outcome of pulpotomy with endodontic biomaterials vs calcium hydroxide. Restor Dent Endod 2013; 38:227-33. [PMID: 24303358 PMCID: PMC3843034 DOI: 10.5395/rde.2013.38.4.227] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 09/08/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
Objectives The purpose of the study was to evaluate human dental pulp response to pulpotomy with calcium hydroxide (CH), mineral trioxide aggregate (MTA), and calcium enriched mixture (CEM) cement. Materials and Methods A total of nine erupted third molars were randomly assigned to each pulpotomy group. The same clinician performed full pulpotomies and coronal restorations. The patients were followed clinically for six months; the teeth were then extracted and prepared for histological assessments. The samples were blindly assessed by an independent observer for pulp vitality, pulp inflammation, and calcified bridge formation. Results All patients were free of clinical signs/symptoms of pulpal/periradicular diseases during the follow up period. In CH group, one tooth had necrotic radicular pulp; other two teeth in this group had vital uninflamed pulps with complete dentinal bridge formation. In CEM cement and MTA groups all teeth had vital uninflamed radicular pulps. A complete dentinal bridge was formed beneath CEM cement and MTA in all roots. Odontoblast-like cells were present beneath CEM cement and MTA in all samples. Conclusions This study revealed that CEM cement and MTA were reliable endodontic biomaterials in full pulpotomy treatment. In contrast, the human dental pulp response to CH might be unpredictable.
Collapse
Affiliation(s)
- Ali Nosrat
- Iranian Center for Endodontic Research, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | |
Collapse
|