A laboratory study comparing the static navigation technique using a bur with a conventional freehand technique using ultrasonic tips for the removal of fibre posts.

AIM: There are currently no high-quality studies comparing the static navigation technique with conventional methods of fibre post removal. The aim of this ex vivo study was to compare the effectiveness of fibre post removal between a static navigation technique and a conventional freehand technique using ultrasonics by experienced and inexperienced operators. METHODOLOGY: Forty-eight extracted single-rooted human premolars were root-filled. A fibre post was cemented in all 48 teeth, which were then divided randomly into the following groups: static navigation group using burs; static navigation-ultrasonic group; and non-guided group using ultrasonic tips. The following parameters were evaluated for both experienced operators and inexperienced operators: reaching the gutta-percha root filling successfully, the time required to remove the entire post, the occurrence of lateral root perforations, and the amount of root dentine removed. The Kolmogorov-Smirnov test was used to examine the normality of the data; the anova test was used to compare the significant differences among groups; and Tukey tests were used for all two-by-two comparisons. The significance level was set at 0.05. RESULTS: In the static navigation group, the gutta-percha was reached significantly more frequently than in the non-guided group (p < .05). The static navigation approach required significantly less time than the non-guided approach to reach the gutta-percha (p < .05). The total removal of posts was significantly different between groups (p < .05), but there was no significant difference between experienced and inexperienced operators in the static navigation group (p > .05). More perforations were associated with the non-guided group than with the other two groups. The total mean loss of dentine in the non-guided group in all directions was 0.39 (±0.17) mm, with 0.25 (±0.09) mm for experienced, and 0.42 (±0.16) mm for inexperienced operators. CONCLUSION: When compared to a conventional ultrasonic technique for the removal of fibre posts, the static navigation method using burs resulted in less dentine removal, more rapid access to the gutta-percha root filling, less overall time to remove the posts, and fewer complications. When using static navigation, there was no difference in performance between experienced and inexperienced operators.

Effectiveness of endodontic tissue engineering in treatment of apical periodontitis: A systematic review.

BACKGROUND: Regenerative endodontics has evolved in recent years with tissue engineering concepts in particular appearing promising. Endodontic tissue engineering (ETE) describes the various approaches based on the orthograde introduction of scaffolds or biomaterials (with or without cells) into the root canal to achieve pulp tissue regeneration. There are currently no systematic reviews investigating whether ETE is a suitable method for the treatment of endodontic disease in both mature and immature permanent teeth. OBJECTIVES: The purpose of this systematic review was to determine the effectiveness of ETE in permanent teeth with pulp necrosis in comparison with conventional endodontic treatment. METHODS: We searched MEDLINE, Embase and the Cochrane Library for published reports as well as Google Scholar for grey literature up to November 2021. Included were studies of patients with permanent immature or mature teeth and pulp necrosis with or without signs of apical periodontitis (P) comparing ETE (I) with calcium hydroxide apexification, apical plug and root canal treatment (C) in terms of tooth survival, pain, tenderness, swelling, need for medication (analgesics and antibiotics), radiographic evidence of reduction in apical lesion size, radiographic evidence of normal periodontal ligament space, function (fracture and restoration longevity), the need for further intervention, adverse effects (including exacerbation, restoration integrity, allergy and discolouration), oral health-related quality of life (OHRQoL), presence of sinus tract and response to sensibility testing (O). An observation period of at least 12 months was mandatory (T) and the number of patients in human experimental studies or longitudinal observational studies had to be at least 20 (10 in each arm) at the end (S). Risk of bias was appraised using the Cochrane risk-of-bias (RoB 2) tool. Two authors independently screened the records, assessed full texts for eligibility and evaluated risk of bias. Heterogeneity of outcomes and limited body of evidence did not allow for meta-analysis. RESULTS: Two randomized clinical trials investigating cell transplantation approaches with a total of 76 participants (40 treated immature teeth and 36 treated mature teeth) were included for qualitative analysis. Both studies had moderate concerns in terms of risk of bias. Due to the lack of homogeneity a meta-analysis was not possible. Tooth survival for ETE, root canal treatment and apexification was 100% after 12 months. Teeth treated with ETE showed a higher number of cases with positive pulpal responses to sensitivity tests and with blood perfusion compared with root canal treatment or apexification. DISCUSSION: This systematic review highlights that there is limited evidence for ETE approaches. Even though the results of this review suggest a high survival with ETE in mature and immature teeth, there is a moderate risk of bias due to methodological limitations in the included studies, so the overall results should be interpreted with caution. Lack of a robust control group was a common problem during literature screening, and outcomes besides dental survival were reported inconsistently. Future clinical trials need to address methodical as well as assessment concerns and report long-term results. CONCLUSION: The benefits and high survival rates reported for ETE techniques suggest that this procedure might be an alternative to conventional procedures for permanent teeth with pulpal necrosis. However, more appropriate studies are needed to derive clinical recommendations. REGISTRATION: PROSPERO (CRD42021266350).

Guided autotransplant of a first premolar to replace a maxillary ankylosed incisor using a custom-designed osteotome.

BACKGROUND: Autotransplantation is a highly successful technique to replace ankylosed teeth. The authors propose a modified therapeutic approach to guide the autotransplant of an immature maxillary premolar using a tooth-shaped osteotome. CASE DESCRIPTION: A 9-year-old boy reported an avulsion of his maxillary permanent left central incisor with a delayed replantation. An autotransplant of the immature maxillary right first premolar into the position of the affected tooth was planned. A surgical 3-dimensional guiding template and a tooth-shaped osteotome were manufactured to prepare the neo-alveolus (referring to the creation or modification of an alveolus to house the tooth) modification. Although the donor tooth was placed in the recipient socket with the buccal side of the root fully exposed, the transplant outcome was successful. PRACTICAL IMPLICATIONS: The use of 3-dimensionally designed surgical osteotome could improve accuracy and surgical handling of a donor tooth autotransplant, even with substantial bone defects in the recipient site.

Manejo conservador no quirúrgico de una reabsorción cervical invasiva tipo IV utilizando Biodentine / Nonsurgical conservative management of a class IV invasive cervical resorption using Biodentine

La reabsorción cervical invasiva (RCI) es una entidad poco frecuente de carácter agresivo que causa la destrucción de los tejidos dentales si no se trata. El diagnóstico de la RCI es complejo y de acuerdo a la literatura presente, en estadíos muy avanzados el tratamiento no es predecible, lo que conlleva la extracción del diente. Actualmente, gracias al avance de nuevas tecnologías para el radiodiagnóstico como la tomografía computerizada de haz cónico (CBCT), el microscopio dental, así como la introducción de nuevos materiales como el Agregado Trióxido Mineral (MTA(R)) el enfoque de este tratamiento y el pronóstico en estos casos puede mejorar. Recientemente, se ha introducido el Biodentine(R), un cemento biocerámico, como material sustitutivo del MTA(R) con claras ventajas sobre este como un menor tiempo de fraguado, que no presenta discoloración y unas propiedades mecánicas similares a la dentina. A continuación se presenta un caso de reabsorción cervical invasiva tratada con Biodentine® con controles clínicos, radiográficos y mediante CBCT a 6 meses

Invasive cervical resorption (ICR) is an uncommon but aggresive entity that cause the destruction of dental tissues if left untreaten. The diagnosis of ICR is complex and according to the literature, the treatment in advanced cases is not predictable, which can ultimately lead to extraction of the tooth. The current development of innovative technologies such as the cone-beam computed tomography (CBCT) and the dental operating microscope, as well as new materials such as mineral trioxide aggregate (MTA(R)) can facilitate improvements in the treatment approach and the prognosis of ICR. Recently, BiodentineTM, a new bioceramic cement, has been introduced as a substitutive material for MTA(R) with several advantages related to setting time, the elimination of discoloration and similar mechanic properties as dentine. A case of ICR is presented in which the management of the lesion using Biodentine is reported along with the clinical, radiographic and 6-month CBCT follow-up