Clinical Testing of Walking Bleach, In-Office, and Combined Bleaching of Endodontically Treated Teeth.

Objective. The causes of internal posteruptive discoloration of teeth are bleeding, necroses, infections, and endodontic filling materials. The aim of this study was to establish the results of bleaching endodontically treated teeth using walking bleach, in-office, and combined techniques, using 30% carbamide peroxide and 35% hydrogen peroxide, as well as the effect of etiological factors, and the time elapsed after endodontic treatment on the success of bleaching. Materials and Methods. The research involved 30 endodontically treated teeth in healthy patients. Retroalveolar X-rays were taken to check the quality of root canal obturation. Endodontic treatment and obturation were carried out on the discolored non-vital teeth without any previous endodontic treatment. Before bleaching, two millimeters of the filling were removed from the root canal and the very entry into the canal was protected with glass ionomer cement. The teeth were divided into three groups, depending on the bleaching technique: walking bleach technique (10 patients), in-office technique (10 patients), and combined technique (10 patients). The teeth were bleached with 30% carbamide peroxide and 35% hydrogen peroxide. The bleaching procedure was repeated in all the patients three times. The color of all teeth was determined based on the Vita Classic guide before and after bleaching. The Χ2 square and Kruskal−Wallis tests were used to identify differences in teeth bleaching results. Results. A statistically significant difference (p < 0.05) was established between bleaching success and the time elapsed after endodontic treatment. There were no statistically significant differences observed between the bleaching success and etiological factors, bleaching techniques, or bleaching agents. Conclusions. The effectiveness of non-vital tooth bleaching is affected by the time elapsed after endodontic treatment.

Substantial bone loss in the mandibular central incisors area as a complication of tongue piercing: a case report.

BACKGROUND: Along with the increasing popularity of oral piercings, the number of reported complications and side effects increases, too. CASE REPORT: The aim of this report is to present a case of substantial bone loss in the area of the mandibular central incisors caused by lingual piercing and persistent bad habits. Dentist should be aware of potential complications associated with oral piercings and warn patients about them.

Root fractures: the influence of type of healing and location of fracture on tooth survival rates - an analysis of 492 cases.

AIM: The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed. MATERIAL AND METHODS: Long-term survival rates were calculated using data from 492 root-fractured teeth in 432 patients. The cause of tooth loss was assessed as being the result of either pulp necrosis (including endodontic failures), new traumas or excessive mobility. The statistics used were Kaplan-Meier and the log rank method. RESULTS AND CONCLUSIONS: The location of the root fracture had a strong significant effect on tooth survival (P = 0.0001). The 10-year tooth survival of apical root fractures was 89% [95% confidence interval (CI), 78-99%], of mid-root fractures 78% (CI, 64-92%), of cervical-mid-root fractures 67% (CI, 50-85%), and of cervical fractures 33% (CI, 17-49%). The fracture-healing type offered further prognostic information. No tooth loss was observed in teeth with hard tissue fracture healing regardless of the position of the fracture. For teeth with interposition of connective tissue, the location of the fracture had a significant influence on tooth loss (P = 0.0001). For teeth with connective tissue healing, the estimated 8-year survival of apical, mid-root, and cervical-mid-root fractures were all more than 80%, whereas the estimated 8-year survival of cervical fractures was 25% (CI, 7-43%). For teeth with non-healing with interposition of granulation tissue, the location of the fracture showed a significant influence on tooth loss (P = 0.0001). The cause of tooth loss was found to be very dependent upon the location of the fracture. In conclusion, the long-term tooth survival of root fractures was strongly influenced by the type of healing and the location of the fracture.

Treatment of severe inflammatory root resorption in a young permanent incisor with mineral trioxide aggregate.

Inflammatory root resorption is a pathologic condition caused by several etiologic factors including traumatic dental injury. In this case report, we describe treatment of a maxillary lateral incisor affected by severe, perforating inflammatory root resorption. An 11-year-old patient presented with a previously traumatized, root-filled maxillary lateral incisor associated with pain, mobility and a sinus tract. Radiographic examination revealed a large periradicular lesion involving pathologic resorption of the apical region of the root. After removal of the root canal filling, the tooth was treated with intracanal calcium hydroxide for 2 weeks. The calcium hydroxide dressing was then removed and the entire root canal was filled with mineral trioxide aggregate. The endodontic access cavity was restored with composite resin. After 1 year, advanced osseous healing of the periradicular region had occurred and no clinical symptoms were apparent.

Can traumatic occlusion cause endodontic problems? A case report.

Radicular cysts are commonly found odontogenic cysts in the jaws. The lesion is diagnosed mainly in young patients during the second decade of life. In the majority of cases, it is asymptomatic. This paper reports a rare case in which traumatic occlusion was identified as the etiology of a radicular cyst. Endodontic treatment was performed and the traumatic occlusion also was corrected. A six-month follow-up appointment found good healing of the periapical region.

Long-term evaluation of direct pulp capping--treatment outcomes over an average period of 6.1 years.

To assess the treatment outcomes of direct pulp capping with calcium hydroxide, 248 teeth were examined 0.4-16.6 years (mean, 6.1 ± 4.4) after pulp capping. Only teeth diagnosed to be clinical healthy or with spontaneous pain were capped. The treatment outcome was assessed by interviewing for signs or symptoms responsiveness and sensibility testing with CO(2). The overall survival rate was 76.3% after 13.3 years. Of the teeth, 80.2% were found to have a favourable treatment outcome. The pulps of 60-year-old patients showed a significant lower favourable treatment outcome when compared to patients younger than 40 years (p < 0.05). The treatment outcome was significantly less favourable in teeth restored with glass ionomer cement compared to all other teeth (p < 0.01). The likelihood to show an unfavourable treatment outcome after direct pulp capping was significantly higher for teeth with spontaneous pain than for teeth with clinically healthy pulps (p < 0.001). In addition, the likelihood for a tooth to become non-vital after direct pulp capping was significantly higher within the first 5 years after treatment than after more than 5 years (p < 0.001) after treatment.

Pulp vitality after rapid palatal expansion.

INTRODUCTION: Although it has been suggested that orthodontic treatment might lead to changes in the dental pulp, no clinical study has attempted to investigate the incidence of pulp necrosis after orthodontic therapy. The purpose of this clinical trial was to determine whether pulp testing response is altered after rapid palatal expansion (RPE). METHODS: Twenty-five adolescent patients (9 boys, 16 girls; ages, 10-16 years) participated in the study. A hyrax appliance was cemented on the first permanent molars and first premolars (when fully erupted). The appliance was activated twice daily (0.5 mm) for 2 weeks. An electric pulp tester (EPT) was used to test at the buccal cusp tips of the molars and premolars. Teeth that did not respond to the EPT were subsequently tested thermally with Endo Ice (Hygienic Corporation, Akron, Ohio). RESULTS: All maxillary molars and erupted premolars of the 25 patients responded positively to pulp tests before cementation of the hyrax appliance. Of the 49 molars tested, 46 responded positively to the EPT, and 3 responded positively to the cold testing (CT). Of the 42 first premolars tested, 40 responded positively to the EPT and 2 to the CT. Of the 38 second premolars tested, 35 responded positively to the EPT and 3 to the CT. Two weeks after the initial activation of the hyrax appliance, 93 teeth in 17 subjects were tested. Of the 93 teeth, 73 teeth responded positively to the EPT and 20 to the CT. Three to 6 weeks after hyrax activation was discontinued, 59 teeth were tested; 48 tested positively to the EPT and 10 to the CT. One tooth (maxillary left first molar) did not respond to either EPT or CT. Finally, 3 to 9 months into retention, all molars and premolars of 23 subjects tested positive to pulp tests, 92 teeth to the EPT and 25 to the CT. The maxillary left first molar that had not responded to the tests at the 3-to-6 week check responded positively to the CT at the final check. CONCLUSIONS: After RPE therapy in children and adolescents, the pulp of the posterior permanent teeth examined in this study was vital.

Endodontic Periapical Lesion: An Overview on the Etiology, Diagnosis and Current Treatment Modalities.

Nonsurgical and surgical endodontic treatments have a high success rate in the treatment and prevention of apical periodontitis when carried out according to standard and accepted clinical principles. Nevertheless, endodontic periapical lesions remain in some cases, and further treatment should be considered when apical periodontitis persists. Although several treatment modalities have been proposed for endodontically treated teeth with persistent apical periodontitis, there is a need for less invasive methods with more predictable outcomes. The advantages and shortcomings of existing approaches for the diagnosis and treatment of endodontic periradicular lesions are discussed in this review.

Apexification of non-vital pre-molar stemming from possible dens evaginatus.

Dens evaginatus is a dental anomaly that occurs more commonly in pre-molar teeth. Although not a cause for alarm in most instances, it can lead to serious consequences if it is damaged. This paper explores the treatment of a necrotic pre-molar with an open apex that caused serious facial swelling in an adolescent patient. It is believed that this swelling was the result of an enamel tubercle, or dens evaginatus, which was knocked off or traumatized.

Nonsurgical management of a nonvital tooth with orthodontically induced external root resorption and extensive periapical pathology.

The purpose of this article is to report a rare case of orthodontically induced external root resorption of a maxillary left central incisor with a large periapical radiolucency; it was treated successfully with a conservative approach that included the use of calcium hydroxide. The tooth was nonvital and had grade III mobility. It was treated endodontically for 2 years with an interim filling of calcium hydroxide mixed with propylene glycol. After 2 years, the postoperative intraoral periapical radiograph showed good periapical healing with complete resolution of periapical radiolucency. There was a significant reduction in the mobility of the tooth, from grade III to grade I.

Devitalization of adjacent teeth following maxillary sinus floor augmentation: A retrospective radiographic study.

BACKGROUND: Elevation of the schneiderian membrane, during maxillary sinus floor augmentation (MSFA) may theoretically result in devitalization of adjacent teeth, which are in a close spatial relationship to the sinus floor. PURPOSE: To assess retrospectively the probability of devitalization of teeth adjacent to the osteotomy site after MSFA in a relatively large number of patients. MATERIALS AND METHODS: All MSFA procedures, performed at a university oral surgery clinic within a time period of 10 years, were assessed on the following eligibility criteria: (1) presence of vital teeth (ie, not root canal treated and no periapical radiolucency on a panoramic radiograph taken just after MSFA), (2) presence of a 3 to 12 months postoperative radiograph of the teeth adjacent to the osteotomy site displaying the root apices, and (3) complete medical records up to at least 12 months postoperatively. The radiographs of the different time points were compared and any changes in the radiographic status of the adjacent teeth (eg, development of a periapical lesion, root canal treatment, etc.) were recorded and the spatial relationship of the adjacent teeth to the maxillary sinus classified. RESULTS: Out of 684 MSFAs, 257 fulfilled the inclusion criteria and involved 357 adjacent teeth, of which 221 presented close to and/or intimate relationship to the sinus. In only a single case, tooth vitality might have been lost due to the procedure. Thus, the probability for tooth devitalization for teeth with close to and/or intimate spatial relationship to the sinus floor ranged from 0.45% to 0.7%. CONCLUSIONS: Even for teeth with apices very close to and/or intimately related to the sinus tooth devitalization after MSFA is an extremely rare complication; that is, the probability of tooth devitalization after MSFA is ≤0.7%.

Comparison of electrical, thermal, and pulse oximetry methods for assessing pulp vitality in recently traumatized teeth.

Pulse oximeter is a well-established and noninvasive method for measuring vascular health by evaluating oxygen saturation. This study compared the efficacy of a custom-made pulse oximeter dental probe with the electric pulp testing and thermal testing for measuring pulp vitality status of recently traumatized permanent teeth. Readings for pulp vitality for 17 recently traumatized maxillary incisors were taken with custom-made pulse oximeter dental probe (group 1), electrical pulp tester (group 2), and thermal testing (group 3) over a 6-month period. The proportion of recently traumatized teeth showing a positive responsiveness in thermal/electric pulp tests increased from no teeth showing responsiveness on day 0 to 29.4% teeth on the 28th day, 82.35% of teeth at 2 months, and 94.11% teeth at 3 months. However, pulse oximeter gave positive vitality readings that remained constant over the study period from day 0 to 6 months in all patients.

Prevalence of Periapical Rarefying Osteitis in Patients with Rheumatoid Arthritis.

INTRODUCTION: The effect of rheumatoid arthritis (RA) on the healing and pathophyisiology of apical periodontitis is unknown because there is no study in the literature evaluating the association of RA with the prevalence of periapical rarefying osteitis (PAR) and endodontic treatment. Therefore, the goal of this cross-sectional study was to evaluate the prevalence of PAR and root canal treatment in RA patients when compared with controlled individuals. METHODS: Full-mouth radiographs of 131 individuals with RA were examined and compared with 131 controls that were sex and age matched exactly with the diseased group. The total number of teeth, presence or absence of root canal filling, quality of root canal filling, quality of restoration, and periapical status were recorded. RESULTS: Overall, the prevalence of teeth with PAR was 4.0% in the diseased group and 3.5% in the control group (P > .05). The prevalence of root canal-treated teeth was 6.2% in the RA group and 5.6% in the control group (P > .05). Controls have significantly more teeth than those with RA (P = .027). CONCLUSIONS: The prevalence of PAR and endodontic treatment was not significantly different in individuals with RA compared with control patients.

Implant-associated Vertical Root Fracture in Adjacent Endodontically Treated Teeth: A Case Series and Systematic Review.

INTRODUCTION: This study aimed to report a possible effect of the presence of an adjacent implant on the development of a vertical root fracture (VRF) in endodontically treated teeth. METHODS: A series of 8 cases in 7 patients with teeth diagnosed with VRF after the placement of implants in the adjacent area is described and analyzed. In addition, a comprehensive literature search with strict inclusion and exclusion criteria was undertaken to identify additional clinical studies that assessed this clinical scenario. RESULTS: The case series analysis revealed that the time from implant placement to the diagnosis of VRF was between 5 and 28 months (average = 11 months). The majority of cases occurred in female patients who received 2 or more implants. Six of the 7 patients were older than 40 years, with an average age of 54 years. The majority of teeth with VRF were premolar or mandibular molar teeth (6/8 teeth). All fractured teeth had been restored with a crown and had a post present, and the quality of the root canal filling was determined to be adequate. The systematic review revealed that implant-associated VRF has not been investigated or reported in the literature yet. CONCLUSIONS: Based on a systematic review of the literature, this case series, although limited in its extent, is the first clinical report of a possible serious adverse event of implant-associated VRF in adjacent endodontically treated teeth. Additional clinical studies are indicated to shed light on this potential phenomenon.

Tooth transplantations: a descriptive retrospective study.

The aim of the present study was to perform a retrospective study of autogeneously transplanted teeth in order to examine the influence of clinical criteria such as the type of the donor tooth, the root length at the time of transplantation, donor eruption stage and others on the overall success rate of the transplantation. The material of this study consisted of 194 patients in whom 273 teeth were transplanted. The mean age at the time of autotransplantation was 18.1 years with a standard deviation of 7.5 years. Transplantations were performed in two hospitals. The follow-up period varied from 15 days to 11 years, and the mean follow-up time was 3.8 years. 58/273 teeth showed one or other form of resorption, 37/273 teeth showed ankylosis, 30/273 showed no important changes in pulp chamber size, 104/273 showed major discoloration after transplantation, 92/273 teeth showed positive results for cold test after transplantation and 26/273 teeth showed clinically unacceptable pocket depth. Clinical and radiological evaluations were performed. An association was found between successful transplantation and donor tooth type (P<0.01), root length at the time of transplantation (P<0.0001) and recipient tooth site (P=0.03). There was a borderline association between successful transplantation and donor eruption stage (P=0.05). In conclusion, autotransplantation of teeth performed with a careful surgical procedure at the stage of 1/2-3/4 of their intended or expected root length can render a very useful service to patients.

[Vitality loss: influence of orthodontic process]. / Perte de vitalité : influence des procédures orthodontiques.

Vitality loss is an unusual event that can occur before, during or after an orthodontic treatment. It can lead to loss of sensitivity, color change or necrosis of the pulp tissue. Before starting the orthodontic treatment, we have to identify the tooth's risk (injured tooth, included occlusal trauma...). Knowing that, if an endodontic treatment has to be done, it is better to do it before starting orthodontic forces. Lamps do not provide problems except high intensity halogen ones. RPE on children, Le Fort I and mandibular osteotomies, corticotomies, genioplasties are responsible of a transitory ischemia without reaching a pathogen level. Mini-screws or mini-plates may be iatrogenic, if they impact the root. The repair options depend on the delay before removing the miniscrew and the nature of injured tissue.

A retrospective analysis of factors influencing the success of autotransplanted posterior teeth.

BACKGROUND: Survival and success rates of tooth transplantations even after long follow-up periods have been shown to be very high. Nevertheless, it is important to analyse factors potentially influencing these rates. The aim of this study was to assess the influence on success of potential factors. METHODS: The research was based on a retrospective analysis of clinical and radiological data from a sample of 59 subjects (75 transplanted teeth). The follow-up period varied from 0.44 to 12.28 years (mean 3.95 years). Success rates were calculated and depicted with Kaplan-Meier plots. Log-rank tests were used to analyse the effect of root development stage, apex width, the use of enamel matrix proteins or the surgeon on success of transplantations. RESULTS: Results for success of premolar transplantations were comparable with already published data, while molars performed worse than shown in other studies. The surgeon performing the transplantation (p = 0.001) and tooth type (p ≤ 0.001) were significantly associated with transplantation success. Use of enamel matrix proteins (p = 0.10), root development stage (p = 0.13), the recipient area (p = 0.48) and apex width (p = 0.59) were not significantly associated with success. CONCLUSIONS: Molar transplantations were not as successful as premolar transplantations; however, success rates varied greatly depending on the surgeon's experience. The use of enamel matrix proteins as well as root development stage, the recipient area and apex width did not show significant associations with success of tooth transplantations.