Management of Chronic Hyperplastic Pulpitis in Mandibular Molars of Middle Aged Adults- A Multidisciplinary Approach

The Management of Hyperplastic Pulpitis in Immature Permanent Molar Using Vital Pulp Therapy: A Case Report with 12 Months Follow-Up

Hyperplastic pulpitis is an irreversible type of pulpitis that primarily affects young patients. It occurs when an inflamed pulp becomes exposed due to factors such as dental caries, dental trauma, or other causes. Root canal treatment is commonly employed to manage hyperplastic pulpitis. However, vital pulp therapy can be considered as a less invasive option. The main objective of this treatment is to preserve the vitality and functionality of the remaining pulp tissue. This case report discusses the potential management of hyperplastic pulpitis in an immature molar using vital pulp therapy instead of a full root canal treatment. The report includes clinical and radiographic follow-up at six and twelve months.

Clinical, radiographic and histological findings of seven teeth from two California sea lions (Zalophus californianus) housed under professional care

Seven teeth extracted from two adult California sea lions (Zalophus californianus) due to pulp exposure and/or to gain access to the mandibular canine teeth were histologically evaluated, and the findings were compared with clinical and radiographic findings. Three teeth were diagnosed with pulp exposure, and two of these showed no radiographic signs of endodontic disease and were histologically vital with prominent coronal pulpitis and a pulp polyp. Another tooth with pulp exposure was showing clinical and radiographic signs of endodontic disease and was histologically confirmed with pulp necrosis. A discoloured incisor tooth was showing radiographic signs of endodontic disease and was also histologically non-vital. Two clinically and radiographically healthy mandibular first premolar teeth and one second incisor tooth had no evidence of pulpitis or pulp necrosis but had pulp canal obliteration. Regular clinical and radiographic follow-up for 5 months to 3 years after the procedures confirmed uneventful healing of the extraction sites, despite initial flap's dehiscence. Although extractions of affected teeth in California sea lions are considered the most practical and beneficial therapy, these are associated with the risks of extensive trauma and anaesthesia and the need to perform these surgical procedures on-site under variable conditions. As California sea lions can be trained to allow conscious dental radiographic re-checks, monitoring teeth with clinical signs of pulp polyp formation and without radiographic signs of endodontic disease warrant further evaluation/reconsideration from previous recommendations. Endodontic treatment of abscessed teeth in California sea lions is reportedly unsuccessful and is discouraged. However, vital pulpectomy could be an alternative treatment to extraction in teeth with pulp polyps as it was found to be highly successful in humans, but the possibility of endodontic failure and need for further treatments should be weighted in the treatment choice.

Diode Laser-Assisted Pulp Polyp Excision and Canal Disinfection in a Primary Molar: A Case Report

This case report presents the successful application of diode laser technology in the management of a pulp polyp in a primary molar, showcasing its efficacy in both excision of the proliferative tissue and subsequent canal disinfection. An eight-year-old patient with a symptomatic primary molar exhibiting a pulp polyp was selected for this intervention. The diode laser, with its specific wavelength and precise tissue interaction, allowed for a minimally invasive and efficient removal of the pulp polyp. Additionally, the laser was utilized for thorough disinfection of the root canals, targeting bacterial pathogens while preserving surrounding healthy tissue. The case was monitored over a three-month follow-up period, demonstrating favorable clinical and radiographic outcomes. This report emphasizes the potential of diode laser technology as a feasible adjunct in the treatment of pulp polyps in primary molars, showcasing its benefits in terms of reduced invasiveness, enhanced precision, and effective canal disinfection in pediatric endodontics.

Hyperplastic Pulpitis Management with Endocrown: A Case Report

Background:

Pulp polyp (PP) or pulp hyperplasia is a type of irreversible pulpitis that occurs more frequently in young teeth. It is characterized by an exophytic proliferation of granulation tissue with a pinkish-red colour and fibrous consistency, usually asymptomatic.

Case Presentation:

Conservative approach for a PP in a young permanent lower molar using orthograde root canal treatment and subsequent endocrown placement with a 6-month follow-up. A detailed clinical history was carried out, as well as a radiographic study of the lesion, palpation and pulp sensitivity tests. The clinical diagnosis was pulp hyperplasia or PP, confirmed by histopathological analysis.

Results:

Treatment of this case required four appointments: surgical excision of the PP, cleaning and shaping of the root canal system, three-dimensional filling of the canals, cementation and adjustment of the endocrown, thereby achieving remission of symptoms and restitution of chewing function.

Conclusion:

Conservative treatment is a reproducible procedure that has shown satisfactory results in the lower first molar with the presence of a PP.

[Clinical radiological evaluation of teeth-part 2 : Caries, inflammatory dental changes and important differential diagnoses]

Inflammatory diseases of the teeth and periodontium are widespread and are frequent secondary diagnoses in head and neck examinations. Periapical inflammation can be the cause of sinusitis or abscess formation in the oral and maxillofacial region. Early detection is important for the patient's course of treatment. For further diagnostics, a dental presentation should be carried out. Dental radiological examinations, such as panoramic radiographs and dental films are used for specific diagnostics. This article is intended to provide an overview of the different stages of caries, the most important inflammatory dental changes and their most frequent differential diagnoses.

Peripheral Exophytic Oral Lesions: A Clinical Decision Tree

Diagnosis of peripheral oral exophytic lesions might be quite challenging. This review article aimed to introduce a decision tree for oral exophytic lesions according to their clinical features. General search engines and specialized databases including PubMed, PubMed Central, Medline Plus, EBSCO, Science Direct, Scopus, Embase, and authenticated textbooks were used to find relevant topics by means of keywords such as “oral soft tissue lesion,” “oral tumor like lesion,” “oral mucosal enlargement,” and “oral exophytic lesion.” Related English-language articles published since 1988 to 2016 in both medical and dental journals were appraised. Upon compilation of data, peripheral oral exophytic lesions were categorized into two major groups according to their surface texture: smooth (mesenchymal or nonsquamous epithelium-originated) and rough (squamous epithelium-originated). Lesions with smooth surface were also categorized into three subgroups according to their general frequency: reactive hyperplastic lesions/inflammatory hyperplasia, salivary gland lesions (nonneoplastic and neoplastic), and mesenchymal lesions (benign and malignant neoplasms). In addition, lesions with rough surface were summarized in six more common lesions. In total, 29 entities were organized in the form of a decision tree in order to help clinicians establish a logical diagnosis by a stepwise progression method.