Use of Vital Pulp Therapies in Primary Teeth 2024

Purpose: The purpose of this study was to present an evidence-based guideline for primary teeth with deep caries or trauma requiring vital pulp therapies (VPT). Methods: A systematic review/meta-analysis on vital primary teeth resulting from trauma or caries was conducted using GRADE to assess the certainty of evidence for clinical recommendations. A decision tree was provided for choosing VPTs. Results: No articles on trauma VPT were found. For VPT in primary teeth with deep caries, indirect pulp treatment (IPT) or pulpotomy using the calcium silicate cement (mineral trioxide aggregate [MTA] or Biodentine®) show increased success over using direct pulp capping (DPC) and other pulpotomies. Different liners do not affect IPT success (high certainty) or DPC capping agents' success (very low certainty) after 24 months. It is strongly recommended, with high certainty from 24-month data, that calcium silicate cement pulpotomy is preferred over formocresol, ferric sulfate, zinc oxide eugenol pulpotomy, and other pulpotomies. Using selective caries removal and IPT for deep caries is strongly recommended with moderate certainty over complete and stepwise removal. Statistically, this results in significantly fewer pulp exposures. No caries removal and Hall technique crown may be used when indicated (moderate certainty at 24 months). For vital primary incisors with deep caries, pulpotomy was significantly better statistically than pulpectomy. Teeth diagnosed with/without reversible pulpitis pain showed comparable success after 12 months of treatment by IPT or calcium silicate cement pulpotomy. The following had little or no significant effect on MTA pulpotomy success: coronal pulp removal methods; irrigation solution; method to control hemorrhage; base over MTA; treatment in one or two visits; anterior or posterior teeth. Conclusions: Indirect pulp treatment or calcium silicate cement pulpotomy is likely to increase vital pulp therapy success over other VPTs such as direct pulp capping and other pulpotomies after 24 months (moderate certainty).

The Evolving Landscape of the American Board of Endodontics' Certification Process: What it Means for the Future of the Specialty

INTRODUCTION

The American Board of Endodontics certification is an evolving process to ensure the continuing existence of the specialty of endodontics. Recent examination changes have resulted in greater numbers of Diplomates. To fully understand the implications of such changes and evaluate current Diplomates' views of the examination process, a specific set of questions was developed focusing on beliefs and perceptions, age relationships, test components, and hypotheticals for potential changes. An analysis of the examination process has never been reported in the literature, and, as such, the survey was designed to provide the endodontic community with critical information on the past, current, and potentially future examination process.

METHODS

A Web-based survey consisting of 25 questions was e-mailed to 1522 Diplomates.

RESULTS

A total of 736 Diplomates responded to the survey for a response rate of 48.4%. Descriptive statistics and regression analysis (p < .05) were used to explore relationships in the data.

CONCLUSIONS

A lack of perceived importance of being board certified was a major barrier. Respondents opposed de-emphasizing literature, offering the oral examination in a videoconferencing virtual format, eliminating mandatory recalls, and entirely removing 1 component of the examination to increase the numbers of Diplomates. Respondents supported reviewing the case history portfolio examination on a rolling basis. Respondents disagreed that molar cases alone demonstrated clinical competency. Older Diplomates felt the strongest that the meaning of being a Diplomate has been diluted by the changes in the certification process. The authors believe the American Association of Endodontists, program directors, and the College of Diplomates must continually emphasize the importance and value of board certification as the process continues to evolve.

Periradicular Lesions in Cancellous Bone Can Be Detected Radiographically

INTRODUCTION

The purpose of this study was to evaluate whether naturally occurring periradicular lesions confined to cancellous bone can be detected on periapical digital radiography and whether the size of the lesion had any effect on lesion detection.

METHODS

One hundred twenty-nine roots were chosen based on cone-beam computed tomographic imaging and categorized as having no lesion, a lesion confined to cancellous bone, a lesion that encroaches on junctional corticocancellous trabeculae, or a lesion with cortical involvement. The largest buccolingual dimension of the lesions was measured on cone-beam computed tomographic imaging. Two observers separately viewed the corresponding periapical radiographs in their original version as well as in the edge-enhanced setting on MiPACS (LEAD Technologies Inc, Charlotte, NC). Observers were asked to evaluate and interpret the periapical radiographs as having a lesion present, absent, or "unsure." Evaluations of images were conducted at 2 times 1 week apart. Data were analyzed, and the level of significance was set at P = .05.

RESULTS

Lesion size, not the degree of cortical involvement, significantly affected the observers' ability to accurately detect lesions. As the size of the lesion increased, the probability of correctly identifying a lesion increased (P = .0008). Lesions were correctly identified 97.6%, 94.1%, 91.6%, and 89.3% of the time, respectively, when in cortical bone, at the junction of corticocancellous bone, in cancellous bone, and when no lesion was present. Observers were "unsure" whether a lesion was present or absent 10.7% of the time. Only lesions in cortical bone significantly increased observers' certainty in making a diagnosis.

CONCLUSIONS

This study concluded that lesions confined to cancellous bone can be detected radiographically at a high rate. Lesion size was positively correlated with correct lesion identification, whereas the degree of cortical involvement had no significant effect. This suggests that lesion size may be a better predictor for correct lesion identification than lesion location.