Healing after horizontal root fractures: 3 cases with 2-year follow-up

Clinical applications of calcium silicate-based materials: a narrative review

Calcium silicate-based materials are hydrophilic materials with biocompatibility and bioactivity properties. Despite many advantages, they might present some problems related to discolouration, setting time, manipulation and solubility depending on the composition of the product and the type of clinical application. Calcium silicate-based materials can be evaluated under two types according to their intended use: calcium silicate-based cements (CSCs) and calcium silicate-based sealers (CSSs). CSCs can be used in many endodontic procedures including perforation repair, resorption repair, apical barriers, guided endodontic repair, vital pulp treatment, endodontic surgery, root fractures and root canal filling as a core obturation material. CSSs are available for use with gutta-percha to obturate root canals using cold and warm techniques, including the sealer-based obturation technique. The purpose of this review is to evaluate the available literature on CSCs and CSSs and to provide up-to-date information and recommendations for their clinical applications.

A three-dimensional finite element analysis of stress distribution in maxillary central incisor with a horizontal mid root fracture after various management protocols

Context

The incidence of root fractures is about 1.2%-7% in permanent teeth and horizontal mid root fractures are most common in maxillary anteriors.

Aims

This study aims to evaluate the stress distribution in a maxillary central incisor with mid root fracture after various management protocols using three-dimensional finite element (FE) analysis.

Materials and Methods

Four three dimensional FE models were constructed: Model 1-Normal tooth, Model 2-tooth with horizontal mid root fracture, Model 3-tooth with horizontal mid root fracture, coronal fragment filled with Biodentine, and access cavity sealed with composite resin cement and apical fragment left untreated and Model 4-tooth with horizontal mid root fracture restored with intraradicular fiber post as a splint and access cavity sealed with composite resin cement. The properties of materials were assigned and a force of 100 N was applied at 45° angle to the longitudinal axis of the tooth onto the palatal surface incisal to the cingulum.

Statistical Analysis

Von-Mises stress along the length of the root analyzed and compared.

Results

The maximum stress distribution was observed at the palatal end of the coronal radicular fragment in both without treatment and with biodentine treatment. The stress distribution was concentrated more at the junction of the splinted area in the intraradicular fiber post splinted model.

Conclusions

The model with intraradicular fiber post as a splint exhibited more stress concentration at the splinted area due to bending forces. These stresses may adversely affect the healing around the fracture site and affect the longevity.

Endodontic Treatment of a Tooth with Traumatic Fracture of Root Middle Third

Root fracture occurs in 0.5 to 7% of all dental injuries. Subsequent to this injury, the coronal segment is displaced, while the apical segment is rarely displaced. Emergency treatment involves repositioning of the coronal segment close to the radicular segment as much as possible to enhance the chance of pulp revascularization. If pulp necrosis occurs, the infective products cause an inflammatory response and radiolucency is seen at the fracture line. In the present case, the patient had two maxillary central incisors with horizontal middle third root fractures due to a traumatic accident four years earlier. The right central incisor showed an endodontic abscess due to pulp infection in the coronal segment. The coronal fragment was treated. In this case study all signs and symptoms resolved after treatment and three year follow-up showed a successful treatment outcome. The left central incisor had a vital pulp according to vitality tests, so "observation only" strategy was considered for this tooth.

The Horizontal Root Fractures. Diagnosis, Clinical Management and Three-Year Follow-Up

Objective:

The aim of this retrospective analysis is to describe and to evaluate the middle third horizontal root fractures, long term clinical management results and to estimate the effect of treatments factors upon healing and survival rate.

Methods:

Our clinical study included 42 patients presenting a middle third horizontal root fracture in permanent dentition. For each patient at t₀ the parameters recorded were: diastasis, mobility, sensibility, periodontal inflammation, pulpal pathology, associated fracture and dislocation of the coronal fragment. The follow-up was performed after 6 (t1), 12 (t2) and 36 (t3) months after the trauma, both clinically and radiologically. Clinical examination, vitality tests and a radiological evaluation (periapical x-ray) were performed.

Results:

At t₀ it was observed: diastasis (14, 3%), mobility (28, 6%), thermal sensibility (61, 9%), periodontal inflammation (4, 8%), pulpal pathology (38, 1%) and dislocation of the coronal fragment (47, 6%) of the patients. The treatment plan started with the coronal fragment repositioning and the blockage (splint) with the adjacent teeth in 47, 6% of cases.

A root canal treatment was performed at t₀ in 52,4% of the fractured teeth. Statistical analysis showed the highest level of significance between pulpal lesions (t₀) and associated fractures. The mobility, sensibility and pulpar lesions parameters, showed a reduction in relation to the follow up timing, with a main variation remarkably evident between t₀ and t1. The ratio between observation time and the presence of diastasis was statistically significant.

Conclusion:

The analysis of the clinical results exhibits the high success rate of a conservative approach in the treatment of teeth fractured in the middle third of the root.

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

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