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Sule K, Malik A, Kothari A, Rao V. Management of luxation injuries in line with International Association of Dental Traumatology guidelines - Two case reports. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:561-563. [PMID: 38939538 PMCID: PMC11205171 DOI: 10.4103/jcde.jcde_191_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: 04/08/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 06/29/2024]
Abstract
Luxation injuries represent significant traumatic events for permanent teeth. This article presents the management of intrusive and extrusive luxation injuries, following the International Association of Dental Traumatology (IADT) guidelines, through two case reports. The first case involves a 30-year-old female with an intruded maxillary left central incisor, managed through surgical extrusion, stabilization, and endodontic treatment. The second case features a 15-year-old female with an extruded maxillary left central incisor, repositioned and splinted. Follow-up examinations revealed the resolution of symptoms in both cases. These cases highlight the efficacy of IADT guidelines in diagnosing and treating luxation injuries, resulting in favorable outcomes.
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Affiliation(s)
- Kavita Sule
- Department of Conservative Dentistry and Endodontics, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Akanksha Malik
- Department of Conservative Dentistry and Endodontics, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Anjali Kothari
- Department of Conservative Dentistry and Endodontics, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Vinay Rao
- Department of Conservative Dentistry and Endodontics, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
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Coste SC, Rodrigues MAF, Chaves JFM, Lima TCDS, Colosimo EA, Bastos JV. A retrospective cohort study of pulp prognosis in luxated permanent teeth: a competing risk analysis. Clin Oral Investig 2024; 28:187. [PMID: 38430349 DOI: 10.1007/s00784-024-05574-w] [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: 07/02/2023] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
AIM The present retrospective cohort study aimed to evaluate luxated permanent teeth for pulp prognosis and risk factors. METHODOLOGY Case records and radiographs of 224 patients, involving 427 luxated permanent teeth, referred for treatment at the Dental Trauma Center-School of Dentistry, Universidade Federal de Minas Gerais, (DTC-SD-UFMG) from 2014 to 2022, were assessed for pulp prognosis classified as vitality, necrosis and pulp canal obliteration (PCO). A competing risk survival analysis estimated the hazards of the three outcomes, and the effect of demographic, clinical and treatment variables was tested using a cause specific Cox regression model. RESULTS Pulp vitality was found in163 teeth (38.2%), pulp necrosis in 120 teeth (28.1%) and 55 teeth (12.9%) developed PCO. Pulp vitality decreased in the presence of concomitant crown fractures (HR 0.38 95% CI [0.2-0.8] p = 0.006). The risk of pulp necrosis (HR 0.62 95% CI [0.4-0.96] p = 0.03) was lower in cases with open apices but increased with concomitant crown fractures (HR 4.0 95% CI [2.6-6.1] p = 0.001) and intrusions (HR 2.3 95% CI [1.2-4.1] p = 0.007). Lateral or extrusive luxations (HR 3.0 95% CI [1.3-6.9] p = 0.001) and open apices (HR 2.4 95% CI [1.2-4.7] p = 0.01) showed higher rates of PCO. CONCLUSION Type of luxation, the diameter of the apical foramen, and the presence of concomitant crown fractures were main determinants of pulp prognosis after luxation injuries in permanent teeth. CLINICAL RELEVANCE Pulp prognosis after tooth luxation is dependent on the presence and direction of tooth displacement together with infection control. CLINICAL TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Sylvia Cury Coste
- Restorative Dentistry Department, School of Dentistry, Universidade Federal de Minas Gerais, R. Prof. Moacir Gomes de Freitas, 688, Pampulha, Belo Horizonte/MG, 31270-901, Brazil.
| | - Márcio Augusto Ferreira Rodrigues
- Statistics Department, Institute of Exact Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Brazil
- Institute of Mathematics & Statistics, Universidade Federal de Goiás, Goiânia, 74690-900, Brazil
| | - Júlia Ferreira Maciel Chaves
- Restorative Dentistry Department, School of Dentistry, Universidade Federal de Minas Gerais, R. Prof. Moacir Gomes de Freitas, 688, Pampulha, Belo Horizonte/MG, 31270-901, Brazil
| | - Thiago César da Silva Lima
- Restorative Dentistry Department, School of Dentistry, Universidade Federal de Minas Gerais, R. Prof. Moacir Gomes de Freitas, 688, Pampulha, Belo Horizonte/MG, 31270-901, Brazil
| | - Enrico Antônio Colosimo
- Restorative Dentistry Department, School of Dentistry, Universidade Federal de Minas Gerais, R. Prof. Moacir Gomes de Freitas, 688, Pampulha, Belo Horizonte/MG, 31270-901, Brazil
| | - Juliana Vilela Bastos
- Restorative Dentistry Department, School of Dentistry, Universidade Federal de Minas Gerais, R. Prof. Moacir Gomes de Freitas, 688, Pampulha, Belo Horizonte/MG, 31270-901, Brazil
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Ogle OE. Controversies in Dental Traumatology. Dent Clin North Am 2024; 68:151-165. [PMID: 37951631 DOI: 10.1016/j.cden.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
The management of traumatic dental injuries is more a shade of gray than it is black and white because not all treatment procedures used for dental trauma management are fully evidence based. This chapter has highlighted some of the gray areas related to the treatment and outcome of traumatic dental injuries. Significant controversies in the management of luxation and avulsive injuries have been brought out. Adjunctive treatment such as antibiotic usage, tetanus vaccination, and pain management is also addressed.
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Affiliation(s)
- Orrett E Ogle
- Oral and Maxillofacial Surgery, Woodhull Hospital, Brooklyn, NY 11206, USA.
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Vera J, Thepris-Charaf J, Hernández-Ramírez A, García JG, Romero M, Vazquez-Carcaño M, Arias A. Prevalence of pulp canal obliteration and periapical pathology in human anterior teeth: A three-dimensional analysis based on CBCT scans. AUST ENDOD J 2023; 49:351-357. [PMID: 35877115 DOI: 10.1111/aej.12669] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
This study aimed to determine the prevalence of pulp canal obliteration (PCO) and its association with periapical pathology (Hypodense areas) in cone-beam computed tomography (CBCT) scans of anterior teeth. A total of 2161 CBCT scans from patients 18 years or older taken between 2000 and 2020 were selected. Patient-, tooth- and scan-related data were registered. Two calibrated evaluators recorded the number of teeth with PCO ≥4 mm in the cervical third of the roots and the presence or absence of periapical hypodensities (PH). The length of the root canal that was calcified was also determined. Logistic regression analysis was used to determine whether any of the recorded factors influenced the presence of PCO and the presence of periapical pathology in teeth presenting with PCO. The only factor significantly related to the presence of PCO was patient age. The prevalence of PH in teeth exhibiting PCO was 10%.
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Affiliation(s)
- Jorge Vera
- Endodontics Department, University of Missouri, Kansas City, Missouri, USA
- Endodontics Department, Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico
| | | | | | | | - Mónica Romero
- Endodontics Department, University of Missouri, Kansas City, Missouri, USA
- Endodontics Department, Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico
| | | | - Ana Arias
- Facultad de Odontología, Universidad Complutense de Madrid, Madrid, Spain
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Barendregt D, Andreasen JO, Leunisse M, Eggink E, Linssen M, Van der Weijden F, Louropoulou A. An evaluation of 1654 premolars transplanted in the posterior region-A retrospective analysis of survival, success and complications. Dent Traumatol 2023. [PMID: 37114739 DOI: 10.1111/edt.12849] [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: 02/09/2023] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023]
Abstract
AIM The aim of this retrospective analysis was to evaluate the survival, success and possible complications of transplanted premolars in the posterior region subdivided by developmental stage and patient age. MATERIALS AND METHODS This study included patients who underwent tooth transplantation between April 2004 and December 2021. A total of 1654 premolars were transplanted into 1243 patients. Tooth mobility, oral hygiene and periodontal parameters were clinically evaluated. Intraoral radiographs were used to evaluate pulpal and periodontal healing, and root formation. The cumulative survival rate was calculated using the Kaplan-Meier method. RESULTS Data were subdivided into three groups based on the stage of root development and patient age. The mean age at surgery was 14.5 years. The main indication for transplantation was agenesis, followed by trauma and other indications, such as impacted or malformed teeth. A total of 11 premolars were lost during the study period. The overall survival and success rates in the immature premolar group after an observation period of 10 years were 99.7% and 99.4%, respectively. High survival and success rates (95.7% and 95.5%, respectively) were also observed when fully developed premolars were transplanted into the posterior region of adolescents. In adults, the success rate after 10-year follow-up is 83.3%. CONCLUSIONS Transplantation of premolars with developing and fully developed roots is a predictable treatment modality.
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Affiliation(s)
- Dick Barendregt
- Proclin Rotterdam, Clinic for Periodontology, Endodontics and Restorative Dentistry, Rotterdam, The Netherlands
| | - Jens Ove Andreasen
- Department of Oral and Maxillofacial Surgery, University Hospital in Copenhagen, Copenhagen, Denmark
| | | | - Edwin Eggink
- Proclin Rotterdam, Clinic for Periodontology, Endodontics and Restorative Dentistry, Rotterdam, The Netherlands
| | - Marcel Linssen
- Proclin Rotterdam, Clinic for Periodontology, Endodontics and Restorative Dentistry, Rotterdam, The Netherlands
| | - Fridus Van der Weijden
- Clinic for Periodontology, Utrecht, The Netherlands
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Anna Louropoulou
- Proclin Rotterdam, Clinic for Periodontology, Endodontics and Restorative Dentistry, Rotterdam, The Netherlands
- Clinic for Periodontology, Utrecht, The Netherlands
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Mickeviciene L, Ciruliene V, Greta L. Long Term Outcome of Avulsed Immature Mandibular Incisor with Progressive External Root Resorption: 9 Years Follow-Up. J Oral Maxillofac Res 2023; 14:e5. [PMID: 37521324 PMCID: PMC10382192 DOI: 10.5037/jomr.2023.14205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/13/2023] [Indexed: 08/01/2023]
Abstract
Background Avulsion of permanent teeth is the most common in young permanent dentition. Replantation of immature teeth after avulsion represents a major challenge in terms of treatment management and long-term prognosis. This case report describes 9 years of follow-up for an avulsed and replanted immature mandibular lateral incisor with progressive external root resorption. Methods A 7-year-old patient following an accident in which his mandibular left central incisor was avulsed and replanted within one hour after being stored in a physiological storage medium. However, radiographic examination conducted six weeks after the dental injury revealed inflammatory root resorption of the replanted tooth #31. To address root resorption, endodontic treatment was performed involving the use of calcium hydroxide as an intracanal medication for a short period of time, followed by root canal obturation with mineral trioxide aggregate placed below the crestal bone margin. Results Three months later the root resorption had progressed. Consequently, a decision was made to perform periodontal surgery. While the long-term follow-up revealed that the inflammatory root resorption had damaged half of the root, the tooth remained functional and aesthetically favourable. Conclusions Despite the challenges associated with replantation of an immature tooth following avulsion, this case demonstrated favourable outcomes. The tooth maintained its functionality, exhibited favourable aesthetic, and the dimensions of the alveolar ridge were preserved, allowing for the physiological expansion of the dental arch.
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Affiliation(s)
- Lina Mickeviciene
- Clinic of Dental and Oral Pathology Faculty of Odontology, Lithuanian University of Health Sciences, KaunasLithuania.
| | - Vestina Ciruliene
- Clinic of Dental and Oral Pathology Faculty of Odontology, Lithuanian University of Health Sciences, KaunasLithuania.
| | - Lodiene Greta
- Clinic of Dental and Oral Pathology Faculty of Odontology, Lithuanian University of Health Sciences, KaunasLithuania.
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Hu X, Li Y, Xu J, Li Q, Wang R. Immature permanent incisors with complicated crown fractures treated with partial pulpotomy using white mineral trioxide aggregate and IRoot BP plus-a retrospective long-term study. Dent Traumatol 2023; 39:165-172. [PMID: 36409268 DOI: 10.1111/edt.12804] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND/AIMS Calcium silicate cements have been widely used for pulpotomies in immature permanent teeth with complicated crown fractures due to their superior properties. However, few studies have evaluated the long-term outcomes of white mineral trioxide aggregate (WMTA) and iRoot BP Plus for partial pulpotomies. The aim of this study was to investigate the long-term clinical and radiographic outcomes of WMTA and iRoot BP Plus for partial pulpotomies in immature permanent incisors with complicated crown fractures. MATERIALS AND METHODS Children who had partial pulpotomies of immature permanent incisors with complicated crown fractures using WMTA or iRoot BP Plus as capping agents were enrolled. Eighty immature permanent incisors in 68 children (aged 8-13 years) were included. They were divided into two groups (WMTA and iRoot BP Plus) according to the capping agents. Clinical and radiographic information was collected during a 5-year follow-up period. Study data were analyzed using Chi-square tests or Fisher exact tests. RESULTS The clinical and radiographic success rates in the WMTA (n = 36) and iRoot BP Plus groups (n = 44) were 94.4% versus 97.7% and 88.9% versus 97.7%, respectively (both p < .05). The average observation period was 74.5 ± 13.2 months and 61.9 ± 1.6 months in the WMTA and iRoot BP Plus groups, respectively (p < .01). Five cases presented with periapical radiolucencies. The WMTA group had four cases of pulp canal calcification (11.1%), while the iRoot BP Plus group had two cases (4.6%). There was crown discolouration in all cases in the WMTA group, but none in the iRoot BP Plus group. CONCLUSION Both WMTA and iRoot BP Plus had favorable outcomes in promoting physiological development and maintaining the basic functions of immature permanent incisors with complicated crown fractures. As a partial pulpotomy material, iRoot BP Plus may be more suitable for the esthetic zone than WMTA.
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Affiliation(s)
- Xiaoyan Hu
- Key Lab. of Oral Diseases Research of Anhui Province, College & Hospital of Stomatology, Anhui Medical University, Hefei, China
| | - Yuexiang Li
- Key Lab. of Oral Diseases Research of Anhui Province, College & Hospital of Stomatology, Anhui Medical University, Hefei, China
| | - Jianguang Xu
- Key Lab. of Oral Diseases Research of Anhui Province, College & Hospital of Stomatology, Anhui Medical University, Hefei, China
| | - Quanli Li
- Key Lab. of Oral Diseases Research of Anhui Province, College & Hospital of Stomatology, Anhui Medical University, Hefei, China
| | - Run Wang
- Key Lab. of Oral Diseases Research of Anhui Province, College & Hospital of Stomatology, Anhui Medical University, Hefei, China
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Iqbal A, Sharari TA, Khattak O, Chaudhry FA, Bader AK, Saleem MM, Issrani R, Almaktoom IT, Albalawi RFH, Alserhani EDM. Guided Endodontic Surgery: A Narrative Review. Medicina (B Aires) 2023; 59:medicina59040678. [PMID: 37109636 PMCID: PMC10145231 DOI: 10.3390/medicina59040678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/08/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Background and objectives: Endodontic surgery has evolved over the last two decades. The use of state-of-the-art guided endodontic surgical procedures produces a predictable outcome in the healing of lesions of endodontic origin. The main objective of this review paper is to define and characterize guided surgical endodontics as well as its benefits and drawbacks by reviewing the most recent relevant scientific literature. Methods: A literature search was conducted using multiple databases comprising of MEDLINE (via PubMed), EMBASE, and Web of Science. The terms used for the search were ‘guided endodontics’, ‘surgical endodontics’, and ‘endodontic microsurgery’. Results: In total, 1152 articles were obtained from the analysis of the databases. Unrelated articles from the available full text of 388 articles were excluded. A total of 45 studies were finally included in the review. Conclusions: Surgical-guided endodontics is a relatively new area of study that is still maturing. It has many applications such as root canal access and localization, microsurgical endodontics, endodontic retreatment, and glass fiber post removal. Additionally, it does not matter how experienced the operator is; the procedure can be completed for the patient in less time and provides greater accuracy and safety than conventional endodontics.
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Affiliation(s)
- Azhar Iqbal
- Department of Restorative Dentistry, Jouf University, Sakaka 72388, Saudi Arabia
- Correspondence: (A.I.); (F.A.C.)
| | - Thani Al Sharari
- Department of Restorative and Dental Science, Faculty of Dentistry, Taif University, Taif 11099, Saudi Arabia
| | - Osama Khattak
- Department of Restorative Dentistry, Jouf University, Sakaka 72388, Saudi Arabia
- Edinburgh Medical School, Department of Medical Education, The University of Edinburgh, GU, 316 Chancellor’s Building, Edinburgh EH16 4SB, UK
| | - Farooq Ahmad Chaudhry
- School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad 44000, Pakistan
- Correspondence: (A.I.); (F.A.C.)
| | - Alzarea K. Bader
- Department of Prosthetic Sciences, College of Dentistry, Jouf University, Sakaka 72388, Saudi Arabia;
| | - Muhammad Mudassar Saleem
- Consultant Oral and Maxillofacial Surgeon, Ministry of Health, Dental Center, Yanbu General Hospital, Yanbu 46411, Saudi Arabia
| | - Rakhi Issrani
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka 72388, Saudi Arabia
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Kulinkovych-Levchuk K, Pecci-Lloret MP, Castelo-Baz P, Pecci-Lloret MR, Oñate-Sánchez RE. Guided Endodontics: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13900. [PMID: 36360780 PMCID: PMC9657991 DOI: 10.3390/ijerph192113900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/18/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
The main objective of this paper is to perform an updated literature review of guided endodontics based on the available up-to-date scientific literature to identify and describe the technique, its benefits, and its limitations. Four electronic databases (PubMed, Scopus, Science Direct, and Web of Science) were used to perform a literature search from 1 January 2017 to 13 May 2022. After discarding duplicates, out of 1047 results, a total of 29 articles were eligible for review. Guided endodontics is a novel technique that is currently evolving. It is applied in multiple treatments, especially in accessing and locating root canals in teeth with pulp canal obliteration, microsurgical endodontics, and removing glass fiber posts in endodontic retreatments. In addition, it is independent of an operator's experience, requires less treatment time for the patient, and is more accurate and safer than conventional endodontics.
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Affiliation(s)
- Kateryna Kulinkovych-Levchuk
- Gerodontology and Special Care Dentistry Unit, Faculty of Medicine, IMIB-Arrixaca, Morales Meseguer Hospital, University of Murcia, 30008 Murcia, Spain
| | - María Pilar Pecci-Lloret
- Gerodontology and Special Care Dentistry Unit, Faculty of Medicine, IMIB-Arrixaca, Morales Meseguer Hospital, University of Murcia, 30008 Murcia, Spain
| | - Pablo Castelo-Baz
- Unit of Dental Pathology and Therapeutics II, School of Medicine and Dentistry, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain
| | - Miguel Ramón Pecci-Lloret
- Gerodontology and Special Care Dentistry Unit, Faculty of Medicine, IMIB-Arrixaca, Morales Meseguer Hospital, University of Murcia, 30008 Murcia, Spain
| | - Ricardo E Oñate-Sánchez
- Gerodontology and Special Care Dentistry Unit, Faculty of Medicine, IMIB-Arrixaca, Morales Meseguer Hospital, University of Murcia, 30008 Murcia, Spain
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Kamanski D, Tavares JG, Weber JBB, Feldens CA, Reston EG, da Cunha PFJS, Kramer PF. Crown Fracture of an Unerupted Incisor in a Young Child: Case Report and Restorative Protocol. Int J Clin Pediatr Dent 2022; 15:636-641. [PMID: 36865724 PMCID: PMC9973103 DOI: 10.5005/jp-journals-10005-2437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aim This case report describes a protocol for restoring a crown fracture of an unerupted permanent incisor in a child. Background Crown fractures are an important concern in pediatric dentistry due to the negative impact on oral health-related quality of life (OHRQoL) in children and adolescents resulting from functional limitations as well as consequences related to social and emotional well-being. Case description An enamel and dentin fracture of the crown of unerupted tooth 11 due to direct trauma is being presented in a 7-year-old girl. The restorative treatment involved minimally invasive dentistry, including computer-aided design (CAD)/computer-aided manufacturing (CAM) technology and direct resin restoration. Conclusion The treatment decision was essential for maintaining pulp vitality and continued root development, as well as ensuring esthetic and functional results. Clinical significance Crown fracture of an unerupted incisor may occur in childhood, requiring a long-term clinical and radiographic follow-up. Predictable, positive, and reliable esthetic outcomes can be achieved using CAD/CAM technology combined with adhesive protocols. How to cite this article Kamanski D, Tavares JG, Weber JBB, et al. Crown Fracture of an Unerupted Incisor in a Young Child: Case Report and Restorative Protocol. Int J Clin Pediatr Dent 2022;15(5):636-641.
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Affiliation(s)
- Deise Kamanski
- Department of Pediatric Dentistry, School of Health and Life Science, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Julieta G Tavares
- Department of Pediatric Dentistry, School of Health and Life Science, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Joao BB Weber
- Department of Pediatric Dentistry, School of Health and Life Science, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos A Feldens
- Department of Pediatric Dentistry, School of Dentistry, Universidade Luterana do Brasil (ULBRA), Canoas, Rio Grande do Sul, Brazil
| | - Eduardo G Reston
- Department of Pediatric Dentistry, School of Dentistry, Universidade Luterana do Brasil (ULBRA), Canoas, Rio Grande do Sul, Brazil
| | - Patrícia FJS da Cunha
- Department of Pediatric Dentistry, School of Health and Life Science, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Paulo F Kramer
- Department of Pediatric Dentistry, School of Health and Life Science, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Department of Pediatric Dentistry, School of Dentistry, Universidade Luterana do Brasil (ULBRA), Canoas, Rio Grande do Sul, Brazil
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Dąbrowski W, Puchalska W, Ziemlewski A, Ordyniec-Kwaśnica I. Guided Endodontics as a Personalized Tool for Complicated Clinical Cases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9958. [PMID: 36011600 PMCID: PMC9408804 DOI: 10.3390/ijerph19169958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
The aim of this paper is to present a technique to individualize root canal localization in teeth with calcified root canals using a digitally planned, 3D-printed endodontic guide. Root canal calcification is characterized by the apposition of tertiary dentin along the canal wall. The endodontic treatment of teeth with calcified canals is often challenging. However, digital dentistry meets these challenges. Merging CBCT images with an intraoral scan allows a clinician to prepare an endodontic guide. This article describes the clinical and digital workflow of the guided endodontic access approach in teeth with difficulties in terms of root canal localization due to post-traumatic pulp canal obliteration (PCO) and canal calcification in elderly patients. The path of entry into the root canal system was planned using cone-beam computed tomography (CBCT). The template was printed on a 3D printer using transparent resin. During root canal treatment (RCT), the endodontic tool was inserted through the sleeve until the desired location was reached. The use of an endodontic guide allowed for minimally invasive RCT, avoiding the excessive loss of tooth structures. Navigated endodontics enables clinicians to perform RCT in a more predictable manner and allows clinicians to avoid iatrogenic complications, which improves the treatment prognosis.
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Affiliation(s)
- Wojciech Dąbrowski
- Department of Dental Prosthetics, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Wiesława Puchalska
- Department of Paediatric Dentistry, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
- Private Practice Impladent Medical & Dental Clinic, 80-125 Gdansk, Poland
| | - Adam Ziemlewski
- Private Practice Impladent Medical & Dental Clinic, 80-125 Gdansk, Poland
| | - Iwona Ordyniec-Kwaśnica
- Department of Dental Prosthetics, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
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12
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He R, Chou C, Chen L, Stoller M, Kang M, Ho SP. Insights Into Pulp Biomineralization in Human Teeth. FRONTIERS IN DENTAL MEDICINE 2022. [DOI: 10.3389/fdmed.2022.883336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IntroductionMineralized pulp (MP) compromises tooth function and its causation is unknown. The hypothesis of this study is that pulp mineralization is associated with pulpal tissue adaptation, increased mineral densities, and decreased permeabilities of tubular dentin and cementum. Methods will include correlative spatial mapping of physicochemical and biochemical characteristics of pulp, and contextualize these properties within the dentin-pulp complex (DPC) to reveal the inherent vunerabilities of pulp.MethodsSpecimens (N = 25) were scanned using micro X-ray computed tomography (micro-XCT) to visualize MP and measure mineral density (MD). Elemental spatial maps of MP were acquired using synchrotron X-ray fluorescence microprobe (μXRF) and energy dispersive X-ray spectroscopy (EDX). Extracted pulp tissues were sectioned for immunolabelling and the sections were imaged using a light microscope. Microscale morphologies and nanoscale ultrastructures of MP were imaged using scanning electron (SEM) and scanning transmission electron microscopy (STEM) techniques.ResultsHeterogeneous distribution of MD from 200 to 2,200 mg/cc, and an average MD of 892 (±407) mg/cc were observed. Highly mineralized pulp with increased number of occluded tubules, reduced pore diameter in cementum, and decreased connectivity in lateral channels were observed. H&E, trichrome, and von Kossa staining showed lower cell and collagen densities, and mineralized regions in pulp. The biomolecules osteopontin (OPN), osteocalcin (OCN), osterix (OSX), and bone sialoprotein (BSP) were immunolocalized around PGP 9.5 positive neurovascular bundles in MP. SEM and STEM revealed a wide range of nano/micro particulates in dentin tubules and spherulitic mineral aggregates in the collagen with intrafibrillar mineral surrounding neurovascular bundles. EDX and μXRF showed elevated counts of Ca, P, Mg, and Zn inside pulp and at the dentin-pulp interface (DPI) in the DPC.ConclusionColocalization of physical and chemical, and biomolecular compositions in MP suggest primary and secondary biomineralization pathways in pulp and dentin at a tissue level, and altered fluid dynamics at an organ level. Elevated counts of Zn at the mineralizing front in MP indicated its role in pulp biomineralization. These observations underpin the inherent mechano- and chemo-responsiveness of the neurovascular DPC and help elucidate the clinical subtleties related to pulpitis, dentin-bridge, and pulp stone formation.
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Krastl G, Weiger R, Ebeleseder K, Galler K. Present status and future directions: Endodontic management of traumatic injuries to permanent teeth. Int Endod J 2021; 55 Suppl 4:1003-1019. [PMID: 34862800 DOI: 10.1111/iej.13672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/02/2021] [Indexed: 12/26/2022]
Abstract
The prognosis of traumatized teeth depends largely on the fate of the pulp and its treatment. This review aims to update the present status on the endodontic management of traumatic injuries to permanent teeth and to identify relevant research areas that could contribute to an improvement in diagnosis and treatment of traumatized permanent teeth. Future research should pay greater attention to (1) diagnostic methods to assess the perfusion of the pulp and enhance detection of tooth cracks and initial signs of root resorption; (2) improved materials for vital pulp treatment; (3) studies focusing on type and duration of splinting after root fractures; (4) antiresorptive intracanal medication in case of posttraumatic pulp necrosis and infection-related resorption and (5) long-term data on the apical barrier technique compared to revitalization.
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Affiliation(s)
- Gabriel Krastl
- Department of Conservative Dentistry and Periodontology, Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Germany
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology, Center of Dental Traumatology, University Center for Dental Medicine UZB, University of Basel, Basel, Switzerland
| | - Kurt Ebeleseder
- University Clinic of Dental Medicine and Oral Health, Medical University Graz, Graz, Austria
| | - Kerstin Galler
- Department of Conservative Dentistry and Periodontology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Evaluation of Clinical and Radiographic Findings among Patients with Traumatic Dental Injuries Seeking Delayed Treatment. Int J Dent 2021; 2021:9549508. [PMID: 34471410 PMCID: PMC8405333 DOI: 10.1155/2021/9549508] [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: 06/01/2021] [Revised: 08/09/2021] [Accepted: 08/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Time elapsed between trauma and treatment greatly influences the prognosis of traumatic dental injuries (TDIs). The aim of this study was to analyze clinical and radiographic findings related to complications of TDIs among patients seeking delayed treatment of such injuries. Materials and Methods 123 permanent teeth with a history of previous TDIs were included in the study. Clinical findings analyzed were the type of fracture, type and number of injured teeth, crown discoloration, and pulpal status of the injured tooth (pulpal diagnosis). The radiographic findings analyzed included pulp canal obliteration (PCO), root resorption (RR), and periapical radiolucency (PR). Statistical analysis included descriptive analysis. Results Tooth discoloration was the most common presenting complaint (53.65%), while fall (48.78%) was the most frequent cause of trauma. The range of time duration between trauma and presentation for treatment was 5 months to 30 years (average time 12.82 years). Pulp necrosis (PN) was the most common complication (90.24%). Almost half of the teeth with PN had fracture injury and discoloration along with a high frequency of PR (78.37%). Even teeth with a normal appearance were found to have a high incidence of PN (76.92%) and PR (53.84%). The crown discoloration was the second most frequent finding (48.78%). Many teeth (41.66%) with vital pulp were also discolored. Most of the teeth (79.31%) with yellowish discoloration and all teeth with brownish discoloration were nonvital. A high frequency of PN (90%) and PR (78.33%) was found in teeth with discoloration. PR was the most common radiographic finding (69.10%), while PCO and RR were observed in 17.88% and 21.13% of teeth, respectively. Conclusion The findings of this study support the fact that delayed treatment of TDIs leads to increased complications. PN was the most common complication followed by tooth discoloration, RR, and PCO among patients seeking delayed treatment after TDIs.
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Micro-CT assessment of radicular pulp calcifications in extracted maxillary first molar teeth. Clin Oral Investig 2021; 26:1353-1360. [PMID: 34373955 DOI: 10.1007/s00784-021-04109-x] [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: 02/22/2021] [Accepted: 07/26/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The present study aimed to evaluate the frequency, position, and length of radicular pulp calcifications in three-rooted maxillary first molars using micro-computed tomography. MATERIALS AND METHODS Two hundred three-rooted maxillary first molars were scanned at a pixel size of 10 µm and reconstructed using similar parameters. Three-dimensional models of the mesiobuccal (MB1, MB2, MB3), distobuccal (DB), and palatal (P) canals were qualitatively evaluated for discontinuity in the canal path. Transaxial and sagittal cross-sectional images of the roots were further screened, and the complete obliteration of the canal lumen by pulp calcification was identified when the canal had similar radiodensity to the surrounding dentine. Then, the number, position, and length of the calcifications were recorded for each root. Intra-observer agreement was performed using Cohen's kappa test, while one-way ANOVA and Duncan tests compared the lengths of calcifications among the canals, with α = 5%. RESULTS Intra-observer agreement was perfect for identification of pulp calcifications (ĸ = 1.0; p = 0.000). MB2 and MB3 canals accounted for the highest percentage frequency of calcifications distributed throughout the canal path. In the MB1, DB, and P canals, they occurred mainly at the apical third. Lengths of calcifications were greater in the MB3 (0.89 ± 0.81 mm) and MB2 (0.82 ± 0.93 mm) canals than in the MB1 (0.39 ± 0.32 mm), DB (0.34 ± 0.22 mm), and P (0.28 ± 0.22 mm) canals (p < 0.05). CONCLUSION MB2 and MB3 canals accounted for the highest frequency and length of radicular pulp calcifications. In the MB1, DB, and P canals, calcifications occurred mostly at the apical third, while in the MB2 and MB3, most of calcifications were observed at the orifice level and along the canal path. CLINICAL RELEVANCE In maxillary first molars, radicular pulp calcifications are mainly located at the apical third of the MB1, DB, and P canals, while in the MB2 and MB3 canals, most of them are at the orifice level or along the canal path.
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Krastl G, Weiger R, Filippi A, Van Waes H, Ebeleseder K, Ree M, Connert T, Widbiller M, Tjäderhane L, Dummer PMH, Galler K. Endodontic management of traumatized permanent teeth: a comprehensive review. Int Endod J 2021; 54:1221-1245. [PMID: 33683731 DOI: 10.1111/iej.13508] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 03/05/2021] [Indexed: 12/15/2022]
Abstract
The pulp plays a key role in the treatment of traumatic dental injuries (TDIs) and is strongly associated with the outcome, particularly in severe cases. A correct pulp diagnosis is essential as it forms the basis for developing the appropriate management strategy. However, many TDIs are complex, and their treatment requires a profound knowledge of the physiological and pathological responses of the affected tissues. This comprehensive review will look at the dentine-pulp complex and its interaction with the surrounding tissues following TDIs. The literature up to 2020 was reviewed based on several searches on PubMed and the Cochrane Library using relevant terms. In addition to the recently revised guidelines of the International Association of Dental Traumatology, this article aims to provide background information with a focus on endodontic aspects and to gather evidence on which a clinician can make decisions on the choice of the appropriate endodontic approach for traumatized permanent teeth.
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Affiliation(s)
- G Krastl
- Department of Conservative Dentistry and Periodontology, Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Germany
| | - R Weiger
- Department of Periodontology, Endodontology and Cardiology, University School of Dental Medicine, Basel, Switzerland.,Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland
| | - A Filippi
- Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland.,Department of Oral Surgery, University School of Dental Medicine, Basel, Switzerland
| | - H Van Waes
- Department of Paediatric Dentistry, Clinic for Orthodontics and Paediatric Dentistry, University of Zürich, Zürich, Switzerland
| | - K Ebeleseder
- University Clinic of Dental Medicine and Oral Health, Medical University Graz, Graz, Austria
| | - M Ree
- Private Practice, Purmerend, Netherlands
| | - T Connert
- Department of Periodontology, Endodontology and Cardiology, University School of Dental Medicine, Basel, Switzerland.,Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland
| | - M Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - L Tjäderhane
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Research Unit of Oral Health Sciences, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital, University of Oulu, Oulu, Finland
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - K Galler
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
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Spinas E, Pipi L, Dettori C. Extrusive Luxation Injuries in Young Patients: A Retrospective Study with 5-Year Follow-Up. Dent J (Basel) 2020; 8:E136. [PMID: 33339132 PMCID: PMC7765625 DOI: 10.3390/dj8040136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The purpose of this study was to analyze the influence of the chosen diagnostic and therapeutic approach (repositioning and splinting methods) on the risk, frequency and timing of the onset of pulp canal obliteration and pulp necrosis following extrusive luxation in young patients with permanent dentition. (2) Methods: From an initial sample of 50 subjects affected by extrusive luxation, were selected the clinical data of 13 patients presenting extrusive luxation but no other type of injury to the dental hard tissue. All teeth were examined according to a standardized protocol. Follow-up examinations were performed at regular intervals for 5 years. Statistical associations between pulp consequences and several covariates were assessed using the Mann-Whitney test and Fisher's exact test. (3) Results: Among the 13 studied teeth, only 1 healed completely, whereas 9 showed pulp obliteration and 3 developed pulp necrosis. No tooth with obliteration developed pulp necrosis. The average time to treatment was 11.9 h. The treatment approaches used were manual repositioning, orthodontic repositioning and stabilization splinting. "Time to treatment" was the only covariate that showed a weak statistical association with the onset of pulp consequences. (4) Conclusions: There is still uncertainty over the most appropriate therapeutic approach to adopt in young patients with extrusive luxation injuries, particularly for repositioning of the injured tooth. Extruded teeth should be treated as soon as possible after the traumatic event. This study highlighted the value of orthodontic repositioning of the extruded tooth, which does not seem to aggravate the conditions of the dental pulp. In addition, the study confirmed that prophylactic endodontic treatment is not appropriate for immature teeth affected by extrusive luxation injuries, given the extreme rarity of pulp necrosis in teeth already affected by pulp obliteration.
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Affiliation(s)
- Enrico Spinas
- Department of Surgical Sciences, Sports Dental Research Center, University of Cagliari, Via Ospedale, 40-09124 Cagliari, Italy;
| | - Laura Pipi
- Department of Surgical Sciences, Sports Dental Research Center, University of Cagliari, Via Ospedale, 40-09124 Cagliari, Italy;
| | - Claudia Dettori
- Department of Conservative Dentistry and Endodontics, School of Dentistry, University of Cagliari, Via Ospedale, 40-09124 Cagliari, Italy;
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Hegde SG, Tawani G, Warhadpande M, Raut A, Dakshindas D, Wankhade S. Guided endodontic therapy: Management of pulp canal obliteration in the maxillary central incisor. J Conserv Dent 2020; 22:607-611. [PMID: 33088075 PMCID: PMC7542072 DOI: 10.4103/jcd.jcd_21_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/27/2020] [Accepted: 07/10/2020] [Indexed: 11/12/2022] Open
Abstract
This is a case report of the management of pulp canal obliteration of maxillary central incisor using guided endodontic therapy. Patient reported with discolored and proclined 11. Intraoral periapical (IOPA) Radiographs and cone-beam computed tomography (CBCT) showed periapical radiolucency. The canal was obliterated till the middle third and was patent in the apical 7 mm. Root canal treatment (RCT) was planned using guided endodontics. Information of CBCT and digital surface scan were integrated using Blue Sky Bio software. A transparent three-dimensional (3D) model of the tooth and stent, designed with a sleeve for insertion of bur, was 3D-printed using clear resin. After orientation was found satisfactory on the 3D model, access opening was initiated with the orientation of round bur through the stent. IOPAs were taken after preparation of every 3 mm. The canal was located in the apical third. Cleaning and shaping were performed, and RCT completed successfully. Guided endodontic therapy is useful in the management of calcifications in anterior teeth.
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Affiliation(s)
- Shubha G Hegde
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Nagpur, India
| | - Gopal Tawani
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College, DMIMS (Deemed to be University), Nagpur, India
| | - Manjusha Warhadpande
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Nagpur, India
| | - Abhijeet Raut
- Department of Mechanical Engineering, Visvesvaraya National Institute of Technology, Nagpur, India
| | - Darshan Dakshindas
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Nagpur, India
| | - Sattyam Wankhade
- Department of Prosthodontics and Crown and Bridge, Government Dental College and Hospital, Nagpur, India
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Doranala S, Vemisetty H, Punna R, Alwala AM. Endodontic Management of Canal Calcification in Maxillary Central Incisor Using 3D Prototyping Technique: A Case Report. JOURNAL OF ADVANCED ORAL RESEARCH 2020. [DOI: 10.1177/2320206820901651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Teeth with calcific metamorphosis pose a challenge to the endodontist in achieving proper access, identification, and debridement of the root canal. With the conventional technique, radiographs and bur orientation have dictated the access cavity preparation, which leads to the removal of more sound tooth structure and iatrogenic errors. To overcome these issues, the recent diagnostic imaging techniques such as cone beam computed tomography followed by three-dimensional fabrication of template have been proposed, which aid the clinician to accurately locate and negotiate the obliterated canal. The present case report describes the importance of conservative access cavity preparation with the use of the guided endodontic technique for the treatment of calcified canals in the maxillary central incisor.
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Affiliation(s)
- Suryasowjanya Doranala
- Department of Conservative Dentistry and Endodontics, Kamineni Institute of Dental Sciences, Narketpally, Telangana, India
| | - Harikumar Vemisetty
- Department of Conservative Dentistry and Endodontics, Kamineni Institute of Dental Sciences, Narketpally, Telangana, India
| | - Rajani Punna
- Department of Conservative Dentistry and Endodontics, Kamineni Institute of Dental Sciences, Narketpally, Telangana, India
| | - Aditya Mohan Alwala
- Department of Oral and Maxillofacial Surgery, MNR College of Dental Sciences, Sangareddy, Telangana, India
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21
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Lin LM, Ricucci D, Saoud TM, Sigurdsson A, Kahler B. Vital pulp therapy of mature permanent teeth with irreversible pulpitis from the perspective of pulp biology. AUST ENDOD J 2019; 46:154-166. [DOI: 10.1111/aej.12392] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 01/07/2023]
Affiliation(s)
- Louis M. Lin
- Department of Endodontics New York University College of Dentistry New York New York USA
| | | | - Tarek M. Saoud
- Department of Restorative Dentistry and Endodontics Faculty of Dentistry University of Benghazi Benghazi Libya
| | - Asgeir Sigurdsson
- Department of Endodontics New York University College of Dentistry New York New York USA
| | - Bill Kahler
- The University of Queensland School of Dentistry Brisbane Queensland Australia
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