Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.696
Filtrar
1.
Am J Case Rep ; 25: e944179, 2024 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-38915185

RESUMO

BACKGROUND The regenerative endodontic procedure (REP) for managing necrotic immature permanent teeth has the advantage of promoting root growth over the traditionally used apexification techniques. However, there is limited evidence on the long-term outcome of standardized REPs performed on immature molars. This case report presents the 5-year clinical and radiographic outcomes of REP performed on an immature mandibular first molar. CASE REPORT A healthy 7-year-old girl with a carious right mandibular first molar was referred to the endodontic clinic for evaluation and treatment. Clinical examination showed large occlusal caries, no tenderness to palpation and percussion tests, and no response to cold and electric pulp tests. Radiographic examination showed deep caries, apical radiolucency related to the open apices, and wide root canal space. Accordingly, the tooth was diagnosed with necrotic pulp and asymptomatic apical periodontitis. The REP was performed following the American Association of Endodontics guidelines, which comprise minimal instrumentation, disinfection with sodium hypochlorite irrigant, use of triple antibiotic paste, induced intracanal bleeding, and application of a coronal mineral trioxide aggregate plug. The patient missed the scheduled follow-up appointments but presented at the clinic 5 years later with an asymptomatic tooth. Clinical and radiographic examination revealed no tenderness to percussion and palpation test, no response to cold test, positive response to electric pulp test, apical healing, apical closure, root lengthening, and canal wall thickening and calcification. CONCLUSIONS While true pulp regeneration is unachievable, the REP, following the current protocol, is clinically successful in achieving root maturation and tooth retention.


Assuntos
Necrose da Polpa Dentária , Dente Molar , Endodontia Regenerativa , Humanos , Feminino , Criança , Necrose da Polpa Dentária/terapia , Combinação de Medicamentos , Periodontite Periapical/terapia
2.
Prim Dent J ; 13(2): 79-83, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38888081

RESUMO

Pre-eruptive intracoronal radiolucency is a rare dental anomaly with unclear aetiology, generally asymptomatic and diagnosed through routine radiographs. Failure to diagnose and treat it early can lead to rapid pulp damage, potentially compromising root development. The presented clinical report describes a mandibular second premolar with pre-eruptive intracoronal radiolucency that caused early pulp necrosis with arrest of root formation and emphasises the endodontic management using regenerative endodontic therapy.


Assuntos
Necrose da Polpa Dentária , Endodontia Regenerativa , Humanos , Necrose da Polpa Dentária/terapia , Necrose da Polpa Dentária/diagnóstico por imagem , Endodontia Regenerativa/métodos , Dente Pré-Molar/anormalidades , Tratamento do Canal Radicular/métodos , Feminino , Masculino
3.
BMC Oral Health ; 24(1): 646, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38824565

RESUMO

BACKGROUND: Immature teeth with necrotic pulps present multiple challenges to clinicians. In such cases, regenerative endodontic procedures (REPs) may be a favorable strategy. Cells, biomaterial scaffolds, and signaling molecules are three key elements of REPs. Autologous human dental pulp cells (hDPCs) play an important role in pulp regeneration. In addition, autologous platelet concentrates (APCs) have recently been demonstrated as effective biomaterial scaffolds in regenerative dentistry, whereas the latest generation of APCs-concentrated growth factor (CGF), especially liquid phase CGF (LPCGF)-has rarely been reported in REPs. CASE PRESENTATION: A 31-year-old woman presented to our clinic with the chief complaint of occlusion discomfort in the left mandibular posterior region for the past 5 years. Tooth #35 showed no pulp vitality and had a periodontal lesion, and radiographic examination revealed that the tooth exhibited extensive periapical radiolucency with an immature apex and thin dentin walls. REP was implemented via transplantation of autologous hDPCs with the aid of LPCGF. The periodontal lesion was managed with simultaneous periodontal surgery. After the treatment, the tooth was free of any clinical symptoms and showed positive results in thermal and electric pulp tests at 6- and 12-month follow-ups. At 12-month follow-up, radiographic evidence and three-dimensional models, which were reconstructed using Mimics software based on cone-beam computed tomography, synergistically confirmed bone augmentation and continued root development, indicating complete disappearance of the periapical radiolucency, slight lengthening of the root, evident thickening of the canal walls, and closure of the apex. CONCLUSION: hDPCs combined with LPCGF represents an innovative and effective strategy for cell-based regenerative endodontics.


Assuntos
Polpa Dentária , Endodontia Regenerativa , Humanos , Feminino , Adulto , Polpa Dentária/citologia , Endodontia Regenerativa/métodos , Necrose da Polpa Dentária/terapia , Transplante de Células/métodos , Transplante Autólogo
4.
Evid Based Dent ; 25(2): 85-86, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38811813

RESUMO

STUDY DESIGN: A randomised parallel controlled clinical trial was conducted between 2013 and 2015 at the University of Sao Paulo, Brazil, to assess the impact of pulpectomy or extraction on the oral health-related quality of life (OHRQoL) of children with pulp necrosis in primary molars. STUDY SELECTION: Children between the ages of 3 and 5 who were in good health but had extensive caries in at least one primary molar with signs of pulpal necrosis (also as seen radiographically, caries reaching the pulp with no signs of internal or external resorption) were considered for inclusion. Additionally, teeth with sufficient structure for rubber dam placement were also included. Children with any systemic, neurological, or other conditions that negatively impacted their growth were excluded. CLINICAL PROCEDURES AND SUCCESS CRITERIA: After computer-generated randomisation, 100 children were assigned randomly into two groups: 50 in the pulpectomy group and 50 in the dental extraction group. A paediatric dentist performed all procedures under local anaesthesia without sedation or general anaesthesia, and a rubber dam was used for pulpectomy with composite restoration in a single session. The OHRQoL scores were evaluated at baseline, 4, 8, and 12 months using the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) via face-to-face interviews with parents conducted by a researcher trained in a single-blinded fashion. Additionally, the child's self-reported dental anxiety was measured using the Facial Image Scale (FIS), and dental pain was assessed using the Wong-Baker Faces Pain Scale (WBFPS) immediately after the treatment as secondary outcomes. RESULTS: The mean difference (SD) in the total B-ECOHIS score between baseline and after 12 months was 12.66 (6.79) for the pulpectomy group and 10.94 (9.28) for the extraction group, with effect sizes of 3.2 (95% CI: 2.42-4.20) and 1.4 (95% CI: 0.84-2.11), respectively. While both treatments significantly improved the children's OHRQoL after 12 months, the pulpectomy group showed greater long-term improvement compared to the extraction group, with mean differences (SD) of 4.86 (6.13) and effect sizes of 0.8 (0.46-1.13; p < 0.001). Moreover, children in the extraction group showed higher levels of anxiety compared with those in the pulpectomy group at 12-month follow-up (OR = 2.52; 95% CI = 1.30-4.89), and they reported 93% more odds of 'dental pain with high level' immediately after treatment than those in the pulpectomy group (OR = 1.93; 95% CI = 0.83-4.49). CONCLUSION: Children treated with pulpectomy in their necrotic primary molars were found to have better OHRQoL than those who had their primary molars extracted.


Assuntos
Dente Molar , Saúde Bucal , Pulpectomia , Qualidade de Vida , Extração Dentária , Dente Decíduo , Humanos , Dente Decíduo/cirurgia , Pulpectomia/métodos , Feminino , Pré-Escolar , Masculino , Dente Molar/cirurgia , Necrose da Polpa Dentária/cirurgia , Brasil
5.
J Clin Pediatr Dent ; 48(3): 171-176, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38755996

RESUMO

To explore a new method to implant deciduous tooth pulp into the canal of young permanent teeth with necrotic pulps and apical periodontitis for the regenerative endodontic treatment of tooth no: 41 in a 7-year-old male. Briefly, 1.5% Sodium Hypochlorite (NaOCl) irrigation and calcium hydroxide-iodoform paste were used as root canal disinfectant at the first visit. After 2 weeks, the intracanal medication was removed, and the root canal was slowly rinsed with 17% Ethylene Diamine Tetraacetic Acid (EDTA), followed by flushing with 20 mL saline and then drying with paper points. Tooth no: 72 was extracted, and its pulp was extracted and subsequently implanted into the disinfected root canal along with induced apical bleeding. Calcium hydroxide iodoform paste was gently placed over the bleeding clot, and after forming a mineral trioxide aggregate (MTA) coronal barrier, the accessed cavities were restored using Z350 resin composite. The root developments were evaluated via radiographic imaging at 6 months, 1 year and 5 years after treatment. Imaging and clinical analysis showed closure of the apical foramen, thickening of the root canal wall, and satisfactory root length growth. Autologous transplantation might be useful to regenerate dental pulp in necrotic young permanent teeth.


Assuntos
Compostos de Alumínio , Compostos de Cálcio , Polpa Dentária , Incisivo , Dente Decíduo , Humanos , Masculino , Criança , Polpa Dentária/irrigação sanguínea , Compostos de Cálcio/uso terapêutico , Compostos de Alumínio/uso terapêutico , Óxidos/uso terapêutico , Combinação de Medicamentos , Necrose da Polpa Dentária/terapia , Silicatos/uso terapêutico , Seguimentos , Endodontia Regenerativa/métodos , Mandíbula/cirurgia , Hidróxido de Cálcio/uso terapêutico , Neovascularização Fisiológica , Tratamento do Canal Radicular/métodos , Irrigantes do Canal Radicular/uso terapêutico , Materiais Restauradores do Canal Radicular/uso terapêutico , Periodontite Periapical/terapia , Periodontite Periapical/cirurgia , Hipoclorito de Sódio/uso terapêutico , Cavidade Pulpar , Hidrocarbonetos Iodados
6.
J Endod ; 50(7): 1017-1021, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38626857

RESUMO

INTRODUCTION: Regional odontodysplasia (ROD) is a rare developmental disorder characterized by hypo-mineralization and hypoplasia of enamel and dentin. Symptoms include poorly developed tooth buds, delayed eruption of permanent teeth in affected quadrants, and ghost teeth. The affected teeth often become necrotic due to abnormal enamel and dentin development, making them susceptible to caries and infection. The aim of this case report is to describe the treatment of ROD through pulp revascularization. CASE REPORT: A 13-year-old girl was referred for endodontic treatment. The mandibular left incisors and first premolar, which were affected by regional odontodysplasia, lost their vitality because of the impaired structure of the enamel. Due to the teeth's early developmental stage, a regenerative endodontic treatment was attempted. All 3 teeth were treated using the same protocol following the AAE guidelines. After 4 weeks, treatment of the premolar was completed, whereas the incisor teeth remained symptomatic and were and therefore, intracanal dressing with calcium hydroxide was repeated and left in place for 5 months. Finally, the regenerative procedure was completed, and the crowns were restored. The patient was scheduled for follow-up examinations after 6 months, and then yearly for the next 3 years. After 1 year, the periapical lesion around the central incisor and premolar had resolved, the lesion around the apex of the lateral incisor was healing, and the roots had continued to develop. After 3 years, complete healing and pulp canal obliteration were observed in the central incisor and in the premolar. However, the root of the lateral incisor tooth was split, and it was recommended to extract this tooth. CONCLUSION: The positive outcomes of regenerative endodontics in the central incisor and premolar suggest that revascularization of the pulp may be optional for the treatment of immature necrotic teeth affected by developmental disorders, such as ROD, amelogenesis imperfecta, or dentinogenesis imperfecta.


Assuntos
Incisivo , Odontodisplasia , Endodontia Regenerativa , Humanos , Adolescente , Feminino , Endodontia Regenerativa/métodos , Incisivo/anormalidades , Dente Pré-Molar/anormalidades , Tratamento do Canal Radicular/métodos , Necrose da Polpa Dentária/terapia
7.
Clin Oral Investig ; 28(4): 209, 2024 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-38467867

RESUMO

AIM: The purpose of the present study was to evaluate permanent teeth with post-traumatic transversal root fractures, for their initial healing modality, the effect of candidate predictors and their long-term prognosis. METHODOLOGY: A retrospective longitudinal clinical study was conducted to evaluate records from patients bearing transversal root fractures in permanent teeth in order to radiographically assess short-term healing and non-healing events in the fracture line, their prognostic factors and their relationship with long term outcomes. The inter-fragmentary tissues were classified as healing: hard tissue (HT), connective tissue (CT) or connective tissue and bone (CT + B) and non-healing: interposition of granulation tissue (GT). A competing risk survival analysis was conducted to estimate the hazards of healing and non-healing events in the short-term and the effect of demographic, clinical, and treatment variables was assessed using the subdistribution regression model (Fine & Gray). RESULTS: Radiographic findings showed 61.4% of healing in the short-term being strongly influenced by the presence and type of concomitant injuries to the coronal fragment. Teeth with concomitant crown fractures (sHR 24.38, 95% CI [3.16-188.3], p = 0.0022), luxations with dislocations (sHR 10.58, 95% CI [1.37-81.9], p = 0.0240) and subluxations (HR 9.66, 95% CI [1.14-81.7], p = 0.0370) were more likely to present non-healing of root fractures in the short-term. The healing rate in the long-term was of 75.9%, most of them with interposition of bone and connective tissue. Kappa statistics demonstrated an overall agreement of 67.1% between short and long-term healing patterns, in special HT and CT + Bone modalities. CONCLUSION: Healing at the fracture site was the most frequent outcome, both in the short-term and in the long-term. Short-term healing modality was strongly influenced by the presence and type of concomitant injuries to the crown fragment, being the worst prognosis observed in root-fractured teeth with concomitant crown fractures, followed by concomitant luxations with dislocation. CLINICAL RELEVANCE: Post-traumatic transversal root fractures have a positive prognosis supporting therefore, a more conservative approach for these teeth before considering more radical treatments.


Assuntos
Fraturas Ósseas , Fraturas dos Dentes , Humanos , Estudos Longitudinais , Estudos Retrospectivos , Necrose da Polpa Dentária , Raiz Dentária/diagnóstico por imagem , Raiz Dentária/lesões , Fraturas dos Dentes/diagnóstico por imagem , Prognóstico
8.
BMC Oral Health ; 24(1): 319, 2024 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-38461281

RESUMO

BACKGROUND: In the regenerative endodontic procedures, scaffolds could influence the prognosis of affected teeth. Currently, there is controversy regarding the postoperative evaluation of various scaffolds for pulp regeneration. The objective of this study was to access whether other scaffolds, used alone or in combination with blood clot (BC), are more effective than BC in regenerative endodontic procedures. METHODS: We systematically search the PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Google Scholar databases. Randomized controlled trials examining the use of BC and other scaffold materials in the regenerative endodontic procedures were included. A random effects model was used for the meta-analysis. The GRADE method was used to determine the quality of the evidence. RESULTS: We screened 168 RCTs related to young permanent tooth pulp necrosis through electronic and manual retrieval. A total of 28 RCTs were related to regenerative endodontic procedures. Ultimately, 12 articles met the inclusion criteria and were included in the relevant meta-analysis. Only 2 studies were assessed to have a low risk of bias. High quality evidence indicated that there was no statistically significant difference in the success rate between the two groups (RR=0.99, 95% CI=0.96 to 1.03; 434 participants, 12 studies); low-quality evidence indicated that there was no statistically significant difference in the increase in root length or root canal wall thickness between the two groups. Medium quality evidence indicated that there was no statistically significant difference in pulp vitality testing between the two groups. CONCLUSIONS: For clinical regenerative endodontic procedures, the most commonly used scaffolds include BC, PRP, and PRF. All the different scaffolds had fairly high clinical success rates, and the difference was not significant. For regenerative endodontic procedures involving young permanent teeth with pulp necrosis, clinical practitioners could choose a reasonable scaffold considering the conditions of the equipment and patients.


Assuntos
Necrose da Polpa Dentária , Endodontia Regenerativa , Humanos , Polpa Dentária , Necrose da Polpa Dentária/terapia , Regeneração , Tratamento do Canal Radicular/métodos
9.
Arch Oral Biol ; 162: 105957, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38471313

RESUMO

OBJECTIVE: The objectives of this study were to isolate, characterize progenitor cells from blood in the root canals of necrotic immature permanent teeth evoked from periapical tissues and evaluate the applicable potential of these isolated cells in Regenerative Endodontics. DESIGN: Ten necrotic immature permanent teeth from seven patients were included. Evoked bleeding from periapical tissues was induced after chemical instrumentation of the root canals. Cells were isolated from the canal blood and evaluated for cell surface marker expression, multilineage differentiation potential, proliferation ability, and target protein expression. Cell sheets formed from these cells were transferred into human root segments, and then transplanted into nude mice. Histological examination was performed after eight weeks. Data analysis was conducted using one-way ANOVA followed by Tukey's post-hoc comparison, considering p < 0.05 as statistically significant. RESULTS: The isolated cells exhibited characteristics typical of fibroblastic cells with colony-forming efficiency, and displayed Ki67 positivity and robust proliferation. Flow cytometry data demonstrated that at passage 3, these cells were positive for CD73, CD90, CD105, CD146, and negative for CD34 and CD45. Vimentin expression indicated a mesenchymal origin. Under differentiation media specific differentiation media, the cells demonstrated osteogenic, adipogenic, and chondrogenic differentiation potential. Subcutaneous root canals with cell sheets of isolated cells in nude mice showed the formation of pulp-like tissues. CONCLUSIONS: This study confirmed the presence of progenitor cells in root canals following evoked bleeding from periapical tissues of necrotic immature teeth. Isolated cells exhibited similar immunophenotype and regenerative potential with dental mesenchymal stromal cells in regenerative endodontic therapy.


Assuntos
Periodontite Periapical , Endodontia Regenerativa , Animais , Camundongos , Humanos , Tecido Periapical/patologia , Necrose da Polpa Dentária/terapia , Camundongos Nus , Periodontite Periapical/patologia , Terapia Baseada em Transplante de Células e Tecidos , Tratamento do Canal Radicular
10.
BMC Oral Health ; 24(1): 330, 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38481211

RESUMO

BACKGROUND: With increasing studies being published on regenerative endodontic procedures (REPs) as a treatment modality for mature necrotic teeth, the assessment of outcomes following regenerative endodontic procedures has become more challenging and the demand for a better understanding of the regenerated tissues following this treatment is rising. The study aimed to correlate cold, electric pulp testing (EPT), and magnetic resonance imaging (MRI) signal intensity (SI) in mature necrotic teeth treated with regenerative endodontic procedures. METHODOLOGY: This retrospective cohort study included eighteen adult patients who experienced tooth necrosis in mature maxillary anterior teeth recruited from the outpatient clinic, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt from July 2017 until December 2018 with 12 months of follow-up. regenerative endodontic procedures via blood clot were performed. The canals were instrumented by ProTaper Next (PTN) files until final sizes X3 or X5. Biodentine was used as cervical plug material. Pre and post-operative clinical follow-up was done where the patients' responses to cold and electric pulp testing were given a scoring system and were compared to the normal contralateral tooth. Pre and post-operative magnetic resonance imaging signal intensity of both the involved tooth and its contralateral at the middle and the apical thirds of the root canals were assessed after 3, 6, and 12 months. Data was analyzed using the ANOVA, Friedman and Bonferroni tests. Significance was set at a p-value < 0.05. RESULTS: All 18 teeth scored a baseline score of "2" for cold and electric pulp testing. There was a significant difference between scores of the cold test at baseline and 12-month follow-up (p < 0.001). There was a significant difference between scores of the electric pulp testing of baseline and 12-month follow-up (p < 0.001). There was a moderately significant indirect (inverse) correlation between magnetic resonance imaging signal intensity and cold test in both the middle and apical thirds at 12 months. No significant correlations were detected between magnetic resonance imaging signal intensity and electric pulp testingat any of the time intervals (p > 0.05). CONCLUSION: Magnetic resonance imaging is a successful non-invasive method to assess outcomes of regenerative endodontic procedures and correlating it with another reliable method of assessing pulpal responses, cold test, could validate these outcomes. CLINICAL TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov (ID: NCT03804450).


Assuntos
Periodontite Periapical , Endodontia Regenerativa , Adulto , Humanos , Polpa Dentária/diagnóstico por imagem , Necrose da Polpa Dentária/diagnóstico por imagem , Necrose da Polpa Dentária/terapia , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Necrose , Periodontite Periapical/terapia , Endodontia Regenerativa/métodos , Estudos Retrospectivos , Tratamento do Canal Radicular/métodos
11.
J Contemp Dent Pract ; 25(1): 92-97, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38514438

RESUMO

AIM: This report addresses the management of a large persistent discharging lesion in an 11-year-old boy. The report describes the use of aspiration-irrigation technique for the management of immature necrotic tooth with persistent discharge after a failed regenerative procedure. BACKGROUND: Regenerative endodontics aim to provide an increase in root canal width, length, and in apical closure. Alternative procedures, such as apexification, should be attempted when regeneration fails. If the canal cannot be dried to persistent discharge, the aspiration-irrigation technique can be used. The technique relies on using aspiration along with irrigation to remove pus from the periapical area. CASE DESCRIPTION: This is a case for an 11-year-old patient who had trauma to tooth #11, which resulted in the complicated crown fracture. He had an emergency management that included pulpectomy and intracanal medication at another clinic. Two years later, the patient was presented to our clinic. Upon examination, the diagnosis was previously initiated therapy with asymptomatic apical periodontitis in immature tooth #11. Regeneration was attempted first but failed. The mineral trioxide aggregate (MTA) plug was removed, and the canal had persistent pus discharge. The canal was filled with intracanal medication, and then 2 weeks later, the canal was filled with triple antibiotic paste (TAP). Next visit, and due to continuous discharge, tooth #11 was treated conservatively with an intracanal aspiration-irrigation technique. An IrriFlex needle attached to a high-volume suction was used to aspirate the cystic fluid. Mineral trioxide aggregate plug apexification was performed in a later visit and the tooth was restored. CONCLUSION: During the 3-month and 16-month follow-up, there was resolution of the symptoms, a decrease in the periapical lesion size, and soft tissues appeared within normal limits. CLINICAL SIGNIFICANCE: Regenerative procedures are a good option for immature necrotic teeth. These procedures may fail due to persistent pus discharge from the root canals. The aspiration-irrigation technique is a good treatment option in cases of consciously discharging canals. How to cite this article: Alsofi L, Almarzouki S. Failed Regenerative Endodontic Case Treated by Modified Aspiration-irrigation Technique and Apexification. J Contemp Dent Pract 2024;25(1):92-97.


Assuntos
Endodontia Regenerativa , Materiais Restauradores do Canal Radicular , Masculino , Humanos , Criança , Apexificação/métodos , Materiais Restauradores do Canal Radicular/uso terapêutico , Ápice Dentário/patologia , Compostos de Cálcio/uso terapêutico , Combinação de Medicamentos , Óxidos/uso terapêutico , Compostos de Alumínio/uso terapêutico , Silicatos/uso terapêutico , Supuração/tratamento farmacológico , Supuração/patologia , Necrose da Polpa Dentária/terapia
12.
Clin Oral Investig ; 28(3): 187, 2024 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-38430349

RESUMO

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.


Assuntos
Avulsão Dentária , Fraturas dos Dentes , Humanos , Necrose da Polpa Dentária/terapia , Estudos Retrospectivos , Polpa Dentária , Avulsão Dentária/complicações , Prognóstico , Medição de Risco
13.
Int J Oral Sci ; 16(1): 22, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38429281

RESUMO

Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy (RCT). Recent research, encompassing bacterial etiology and advanced imaging techniques, contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT. Success in RCT hinges on factors like patients, infection severity, root canal anatomy, and treatment techniques. Therefore, improving disease management is a key issue to combat endodontic diseases and cure periapical lesions. The clinical difficulty assessment system of RCT is established based on patient conditions, tooth conditions, root canal configuration, and root canal needing retreatment, and emphasizes pre-treatment risk assessment for optimal outcomes. The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT. These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.


Assuntos
Materiais Restauradores do Canal Radicular , Tratamento do Canal Radicular , Humanos , Consenso , Tratamento do Canal Radicular/métodos , Guta-Percha/uso terapêutico , Necrose da Polpa Dentária/tratamento farmacológico , Retratamento , Cavidade Pulpar , Materiais Restauradores do Canal Radicular/uso terapêutico , Preparo de Canal Radicular
14.
J Endod ; 50(5): 596-601, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38387795

RESUMO

INTRODUCTION: Modern tissue engineering strategies have elucidated the potential of regenerative endodontic treatment (RET) as an alternative for treating mature teeth. METHODS: Here, we report two cases in which cell-based RET (CB-RET) using encapsulated allogeneic umbilical cord mesenchymal stem cells (UC-MSCs) in a platelet-poor plasma (PPP)-based scaffold was used in two mature teeth with pulp necrosis and apical periodontitis. RESULTS: After 5 years of follow-up, the healing response was satisfactory in both cases, with evidence of pulp revitalization. CONCLUSIONS: This is the first study to report the success of an extended, 5-year follow-up for allogeneic CB-RET. This report presents an innovative and sustainable solution to challenging endodontic scenarios.


Assuntos
Necrose da Polpa Dentária , Periodontite Periapical , Endodontia Regenerativa , Humanos , Necrose da Polpa Dentária/terapia , Transplante de Células-Tronco Mesenquimais/métodos , Periodontite Periapical/terapia , Endodontia Regenerativa/métodos , Tratamento do Canal Radicular/métodos , Engenharia Tecidual/métodos , Alicerces Teciduais , Ápice Dentário
15.
J Endod ; 50(4): 483-492, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38237659

RESUMO

INTRODUCTION: Dental pulp regeneration is challenging in endodontics. Cellular therapy is an alternative approach to induce dental pulp regeneration. Mesenchymal stromal cells (MSCs) have the capacity to induce dental pulp-like tissue formation. In this study, we evaluated the capacity of allogeneic bone marrow MSCs (BM-MSCs) to regenerate pulp following necrosis and apical periodontitis in children's permanent immature apex teeth. METHODS: Patients aged 8 to 12 years with pulp necrosis and apical periodontitis were evaluated. The study included 15 teeth (13 incisors and 2 molars) from 14 patients (8 boys and 6 girls). Radiographic evaluation showed periapical radiolucency and immature apex teeth. There was no response to cold or electric pulp testing. The root canal of each tooth was cleaned, shaped, and Ca(OH)2 used as an interappointment medication. Cryopreserved allogeneic BM-MSCs were thawed, expanded, incorporated into preclotted platelet-rich plasma, and implanted into the tooth's pulp cavity. They were sealed with bioceramic cement and composite. Sensibility, apical foramen, calcium deposits within the root canal, and resolution of periapical lesions were evaluated in each tooth over the following 12 months. RESULTS: Based on 9 variables established for dental pulp-like tissue regeneration, all MSC-treated teeth showed evidence of successful regeneration. Clinical and radiographic evaluation of the treated teeth showed periapical lesion healing, sensitivity to cold and electricity, decreased width of the apical foramen, and mineralization within the canal space. CONCLUSIONS: Transplantation of allogeneic MSCs induces the formation of dental pulp-like tissue in permanent immature apex teeth with pulp necrosis and apical periodontitis. Implant of MSCs constitutes a potential therapy in regenerative endodontics in pediatric dentistry. Future studies incorporating a larger sample size may confirm these results.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Células-Tronco Mesenquimais , Periodontite Periapical , Masculino , Feminino , Criança , Humanos , Necrose da Polpa Dentária/terapia , Necrose da Polpa Dentária/patologia , Polpa Dentária/patologia , Medula Óssea/patologia , Regeneração , Periodontite Periapical/terapia , Periodontite Periapical/patologia , Tratamento do Canal Radicular , Ápice Dentário/patologia , Dentina/patologia
16.
Dent Traumatol ; 40(1): 54-60, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37638617

RESUMO

AIM: The aim of this study is to compare the adverse effects that occur after orthodontic extrusion of teeth that have been traumatically intruded with those of similar teeth that have not experienced any trauma. BACKGROUND: The outcome of incisors intrusion can be affected by the patient's age, extent of injury, root development, and malocclusion. Orthodontic extrusion is a potential solution, but it may also cause complications. MATERIALS AND METHODS: A retrospective study of the effects of extrusion of traumatically intruded teeth was carried out. The study group included 21 teeth in 14 patients. The control group included 32 teeth in 10 patients that underwent orthodontic extrusion with no history of trauma. Patients' age, gender, and stage of root development were recorded. The severity of the intrusion was classified as mild (<3 mm), moderate (3-6 mm), and severe (≥7 mm). A comparison of signs of pulp necrosis and root resorptions between the groups was made. RESULTS: The central incisor is the tooth that is most injured in 80.9% of cases. A majority of these incidents involve severe intrusion, which was found in 42.9% of cases. 90% of the traumatized teeth had already lost their vitality prior to orthodontic treatment. Various forms of root resorption were observed in the study group. In the control group, 31.2% of teeth showed signs of external root resorption, but no endodontic intervention was carried out during the follow-up period, as these teeth remained vital. CONCLUSIONS: Following intrusion, there is a high risk for root resorption and pulp necrosis. Orthodontic repositioning should be carried out with caution and mild force to prevent complications. Long-term follow-ups are required to ensure the best possible outcome.


Assuntos
Reabsorção da Raiz , Avulsão Dentária , Humanos , Incisivo/lesões , Necrose da Polpa Dentária/etiologia , Reabsorção da Raiz/etiologia , Estudos Retrospectivos , Extrusão Ortodôntica , Avulsão Dentária/complicações
17.
Dent Traumatol ; 40(1): 61-75, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37612879

RESUMO

BACKGROUND/AIM: This study aimed at comparing the regenerative potential of injectable platelet-rich fibrin (i-PRF) (Group 1) and platelet-rich plasma (Group 2) scaffolds. MATERIALS AND METHODS: Twenty-three patients, aged from 9 to 24 years, having 24 immature traumatized necrotic maxillary anterior teeth, were enrolled. Teeth trauma was confirmed by patients' history. Preoperative three-dimensional scans were done. In the first visit, canals were irrigated with 1.5% sodium hypochlorite then medicated with calcium hydroxide. After 2 weeks, patients were randomly assigned into one of the treatment groups (n = 12). The platelet concentrate was applied after centrifuging 10 mL of autologous venous blood with respect to the centrifugation protocol for each platelet concentrate. Patients were recalled at 6 and 12 months posttreatment, during which clinical and radiographic examinations and assessment of pulp sensitivity were done. Three-dimensional scanning was done after 12 months. The increase in root length and decrease in root canal diameters were calculated at three canal levels. Statistical analysis was done using the paired t-test and the independent t-test. The significance level was set at p < .05. RESULTS: There was no statistically significant difference between both groups regarding the increase in root length, decrease in coronal and middle canal diameters and the response to the electric pulp tester. Group (1) showed significantly greater decrease in apical canal diameter than Group (2) (p = .008). CONCLUSION: I-PRF can be considered as a valid regenerative scaffold for clinical use and with regards to the easier preparation technique, it is more recommended than platelet-rich plasma.


Assuntos
Fibrina Rica em Plaquetas , Plasma Rico em Plaquetas , Humanos , Necrose da Polpa Dentária/terapia , Regeneração , Tratamento do Canal Radicular/métodos , Criança , Adolescente , Adulto Jovem
18.
Int Endod J ; 57(3): 238-255, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37966465

RESUMO

AIM: The aim of this study was to assess which treatment modality regarding scaffold selection for immature permanent teeth with pulpal necrosis will be the most successful for regenerative endodontic treatment (RET). METHODOLOGY: PubMed, Cochrane, Web of Science and Embase, and additional records until August 2022 were searched providing a total of 3021 articles, and nine of these articles were included for quantitative synthesis. The reviewers selected eligible randomized controlled trials and extracted pertinent data. Network meta-analysis was conducted to estimate treatment effects for primary outcomes (clinical and radiographic healing) and secondary outcomes (apical closure, root length and root wall thickness increase) following RET [mean difference (MD); 95% credible interval (CrI) and surface under the cumulative ranking curve (SUCRA)]. The quality of the included studies was appraised by the revised Cochrane risk of bias tool, and the quality of evidence was assessed using the GRADE approach. RESULTS: Six interventions from nine included studies were identified: blood clot scaffold (BC), blood clot scaffold with basic fibroblast growth factor, blood clot scaffold with collagen, platelet pellet, platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). The PRP scaffold showed the greatest increase in root lengthening at 6-12 months (MD = 4.2; 95% CrI, 1.2 to 6.8; SUCRA = 89.0%, very low confidence). PRP or PRF achieved the highest level of success for primary and secondary outcomes at 1-6 and 6-12 months. Blood clot scaffold (with collagen or combined with basic fibroblast growth factor (bFGF)) achieved the highest level of success for secondary outcomes beyond 12 months follow-up. A very low to low quality of evidence suggests that both PRP and PRF exhibit the greatest success evaluating primary and secondary outcomes within 12 months postoperatively compared to the traditional blood clot scaffold protocol. CONCLUSION: Limited evidence suggests both PRP and PRF exhibit success in the short-term, not long-term. The value of this information stems in its recommendation for future randomized trials prioritizing both of these materials in their protocol.


Assuntos
Endodontia Regenerativa , Trombose , Humanos , Metanálise em Rede , Fator 2 de Crescimento de Fibroblastos , Regeneração , Necrose da Polpa Dentária/terapia , Resultado do Tratamento , Colágeno
19.
J Endod ; 50(2): 189-195, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37923123

RESUMO

The utility and feasibility of pulp regenerative therapy with autologous dental pulp stem cells (DPSCs) in mature teeth with irreversible pulpitis were clinically demonstrated. On the other hand, there is no evidence of the utility of DPSCs in mature teeth with apical periodontitis. The aim of this case report was to describe the potential utility of regenerative cell therapy in mature teeth with apical periodontitis. A 44-year-old man was referred for pulp regeneration due to a periapical lesion in his maxillary first premolar. Root canal disinfection was performed by irrigation and intracanal medication by nanobubbles with levofloxacin and amphotericin B in addition to conventional irrigation. Autologous DPSCs isolated from an extracted third molar were transplanted into the root canal after residual bacteria and fungi were below the detection level by polymerase chain reaction assay using universal genes to amplify specific regions within bacterial 16S ribosomal DNA and fungal ribosomal DNA (ITS1), respectively. There were no adverse events or systemic toxicity assessed for clinical evaluations during the 79-week-follow-up period and laboratory evaluations after 4 weeks. The affected tooth was responsive to the electric pulp test. Cone-beam computed tomographic imaging revealed a reduced lesion size, remission of the periapical tissue, and mineralized tissue formation in the apical part of the canal after 79 weeks. The signal intensity on magnetic resonance imaging of the regenerated tissue in the affected tooth was comparable to that of the normal pulp in the adjacent teeth after 24 weeks. This case report demonstrated the potential use of DPSCs for pulp regenerative therapy in mature teeth with apical periodontitis.


Assuntos
Polpa Dentária , Periodontite Periapical , Masculino , Humanos , Adulto , Regeneração , Periodontite Periapical/terapia , Tratamento do Canal Radicular/métodos , Necrose da Polpa Dentária/terapia , Dente Pré-Molar , Células-Tronco , DNA Ribossômico
20.
J Endod ; 50(2): 181-188, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38013150

RESUMO

INTRODUCTION: The aim of this study was to ascertain the current trends in regenerative endodontic procedures (REPs) among clinicians, including case selection criteria and clinical protocols. METHODS: An online questionnaire consisting of provider demographics, case selection criteria for REPs, and clinical protocols was made available to members of the American Association of Endodontists and members of the Endolit website. Data were analyzed using the Fisher exact test. RESULTS: Two hundred seventy-two responses were analyzed (64.6% were men and 34.7% were women). Of those, 44.5% of respondents practiced in the United States, and 55.5% practiced outside of the Unites States. Most respondents (85.4%) reported performing REPs in their practice, and 92.2% were using sodium hypochlorite as one of their disinfecting irrigants. Calcium hydroxide was the most commonly used intracanal medicament (68.4%), and the majority of respondents use a blood clot alone as the scaffold (73.5%). Most (93%) of the providers reported using a bioceramic material for coronal capping. Practitioners outside the United States were found to be more likely to use adjunctive irrigation activation (P = .003). Younger practitioners preferred REPs over apexification (P = .01). Practitioners outside the United States were more likely to perform an REP in 1 visit (P = .006). Men were found to be more likely to always instrument the canal walls (P = .031). Women were found to be more likely to use manual irrigant activation, whereas men were more likely to use sonic activation (P = .043). CONCLUSIONS: There is significant heterogeneity within REPs regarding case selection and clinical protocol. Notable differences were observed from the reported findings of REPs from 5 years ago.


Assuntos
Endodontia , Endodontistas , Endodontia Regenerativa , Masculino , Humanos , Feminino , Hipoclorito de Sódio , Inquéritos e Questionários , Internet , Necrose da Polpa Dentária
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA