The Outcome of Decoronation in Severe Cases of External Cervical Root Resorption in Young Patients.

This study examines decoronation as a treatment option for teeth with progressive external cervical root resorption (ECR). Six young patients aged 9.5-13, with a total of nine incisor teeth affected by ECR due to previous dental trauma, were treated by decoronation. Six teeth were classified as class 4 and two as class 3, according to Heithersay's classification. Another tooth with class 2 resorption also had a perforation. After decoronation, all cases showed favorable outcomes during a follow-up period of 2.5-8 years. The procedure halted the progression of ECR and promoted vertical and horizontal ridge development above the submerged root. Decoronation can be considered for the successful treatment of advanced cases of ECR in young patients.

An Innovative Treatment Approach Using Digital Workflow and CAD-CAM Part 1: The Restoration of Endodontically Treated Molars in Children.

Stainless steel crowns are the most popular restoration technique for young permanent first molars treated endodontically. However, these restorations are not aesthetically appealing and need to be replaced. Endocrowns constitute a reliable approach for restoring severely damaged molars and premolars. Intraoral scanners (IOSs) are well tolerated by children and are easily and quickly implemented. We present an innovative treatment approach for endodontically treated teeth in children, using a digital workflow with IOS and computer-aided design/computer-assisted manufacturing (CAD/CAM) fabrication of the restoration. The protocol involves a thorough diagnostic phase and comprehensive treatment planning. Among the factors to be considered are the child's behavior, the parents' cooperation and compliance, and initial preparation including inhalation sedation, effective local anaesthesia and the use of a rubber dam. Full attention should be given to 1-2 mm of ferruling by the endocrown, which should be appropriately prepared to accommodate endocrowns for molars. IOSs include scanning of the prepared tooth and its antagonist, and scanning of the bite. CAD-CAM preparation of the restoration is followed by restoration bonding and follow up. Digital workflow should be considered in the treatment of endodontically treated molars since the high accuracy of the scanning enables definitive restoration in young patients.

Computerized three-dimensional design for accurate orienting and dimensioning artificial dental socket for tooth autotransplantation.

OBJECTIVE: To present an improved, accurate, and efficient method for planning and preparing an artificial socket for autotransplantation, by using a three-dimensional (3D) surgical guide and a replica of the transplanted donor tooth. The guide and the tooth replica were fabricated using a computerized 3D simulation. A case treated with this approach is presented. METHOD AND MATERIALS: Cone beam computed tomography (CBCT) and computerized 3D simulations (Simplant plus registration as stereolithography) were used for planning the optimal artificial socket position and dimensions, within the limitations of the alveolar bone borders and the adjacent teeth roots, and for producing a metal replica of the transplanted tooth. The replica was used to assure the correct socket preparation and orientation before extraction and replantation of the donor premolar. RESULTS: The entire procedure time for autotransplantation of a permanent second premolar to the incisor site without the buccal plate was about 45 minutes. At 15 months' follow up, clinical examination of the transplanted tooth demonstrated both normal mobility and no sensitivity to cold stimulation. A radiographic examination revealed continuous root development and pulp obliteration. The adjacent teeth maintained their vitality with no pathologic signs. CONCLUSION: We present an improved technique for autotransplantation based on computerized 3D simulations and guidance for accurate dimensioning and optimal locating of the artificial socket relative to the alveolar bone borders and the adjacent teeth roots. This technique may significantly simplify the autotransplantation procedure and will probably also increase its success rate and use in young patients, even in cases with absence of a buccal plate.

Regenerative endodontic treatment of an immature permanent canine following infant oral mutilation.

Extracting primary canine tooth buds is a ritual ceremony that prevails in some African countries. This procedure is considered infant oral mutilation (IOM) and may damage the permanent successor and adjacent primary and permanent teeth, resulting in dysplastic or deformed teeth. The purpose of this report was to describe regenerative endodontic treatment of a permanent mandibular canine with extensive coronal hypoplasia, immature root, and a periapical radiolucency following damage to the permanent canine that was probably a result of infant oral mutilation. Regenerative endodontic treatment was initiated by irrigating the root canal, followed by applying triple antibiotic paste dressing over three weeks and creating a blood clot scaffold covered with mineral trioxide aggregate. A 4-year clinical and radiographic follow-up demonstrated healing of the periapical radiolucency. This treatment may serve as a substitute for traditional apexification with calcium hydroxide or creation of an artificial apical barrier with mineral trioxide aggregate.

Resin-bonded cantilever and twist-flex wire for maxillary incisor lost due to trauma.

A simple appliance to replace an 8-year-old's central incisor, which was decoronated after a trauma, is described. A natural tooth cantilevered pontic bonded to the adjacent central incisor may be an immediate solution. This appliance may be used when clinical conditions do not allow for the use of a conservative removable or fixed partial denture.

Is a C-shaped configuration possible in teeth other than mandibular molars?

This case report presents a maxillary third molar with a C-shaped canal system. This is the first known description of a maxillary third molar with C-shaped anatomy. This unique pulp chamber morphology was observed under the operating microscope. Root canal treatment consisted of cleaning and shaping combined with ultrasonic irrigation with sodium hypochlorite. A calcium hydroxide dressing was applied between appointments. Obturation of the root canal system was performed with warm vertical condensation. The complexity of this canal morphology requires the prudent clinician to perform strict measures to achieve satisfying results.

The effect of CO2 Laser on the permeability of dentinal tubules: a preliminary in vitro study.

OBJECTIVES: The purpose of this in vitro study was to determine whether there is a change in dentin permeability following 9.6-microm CO(2) laser irradiation and high-speed drilling. MATERIALS AND METHODS: Twenty permanent, intact, non-carious molars were selected. The crowns were separated from the roots at the cemento-enamel junction. The teeth were randomly divided into two groups, control and experimental, each containing 10 teeth. After class I preparation using a high-speed drill, 9.6-microm CO(2) laser irradiation was applied to dentinal areas only on the experimental group. The samples were soaked in 0.5% methylene blue for 48 h; three independent examiners using scanning electron microscopy evaluated dye penetration through the specimens. RESULTS: The results of the three examiners were similar. There was a significant difference in dye penetration into dentin after laser irradiation versus controls (p < 0.05). CONCLUSIONS: The 9.6-microm CO(2) laser appears to be a promising tool in the clinical setting. However, further investigation is needed to ensure maximum effectiveness.

Invasive cervical root resorption: treatment rationale with an interdisciplinary approach.

Invasive cervical resorption (ICR) is a significant and often aggressive pathologic process that, unfortunately, might lead to tooth loss. The presence of such a lesion in the cervical area is always a clinical challenge. This article presents an ICR case in which successful treatment was achieved by combining 4 disciplines: endodontics, orthodontics, periodontics, and prosthetics. Forced eruption combined with fiberotomy was used in this case for pulling the root rapidly from within the alveolar socket, thus exposing sound and healthy tooth material beyond the affected zone suitable for crown preparation. The presented interdisciplinary technique is offered for the prudent clinician as a solution in ICR cases of severe destructive nature.