Dens evagination and complete invagination in the same tooth with extraoral fistula: A rare case report.

Key Clinical Message: Successful management of a rare case involving both dens evaginatus and dens invaginatus in the same tooth, monitored over a 24-month follow-up. Abstract: Dens invaginatus (DI) is a congenital dental anomaly characterized by the presence of a tooth that resembles a "tooth within a tooth." Conversely, dens evaginatus (DE) is a developmental anomaly distinguished by an additional tubercle or cusp on the tooth's crown. Both DI and DE can result in pulpal and periapical diseases in the affected tooth. This article presents a case of a healthy 14-year-old male with recurrent swelling under the chin and a wound with pus drainage on the right side of the submental area, associated with his left mandibular lateral incisor affected by both DI and DE. Clinical and radiographic examinations revealed that the tooth was necrotic and had a chronic apical abscess. Cone beam computed tomography (CBCT) confirmed Oehlers' type III DI and a talon cusp on the lingual surface of the same tooth. The patient underwent orthograde endodontic treatment. Passive ultrasonic activation of a 5.25% NaOCl solution and a mixture of Ca(OH)2 and a 2% chlorhexidine solution were utilized to effectively clean and eliminate the persistent pus discharge. After the resolution of the patient's symptoms, the apical third of the root canal and the invaginated space were filled with a plug of mineral trioxide aggregate (MTA), while the remaining root canal was filled using a sealer-based obturation technique. A 24-month follow-up visit revealed complete bone regeneration in the previously affected periradicular tissues.

Effect of conventional cigarettes and e-cigarettes on salivary biomarkers: A systematic review.

Background: E-cigarette consumption is increasing, and like conventional smoking, it can cause some harmful effects. This systematic review compared the effect of conventional cigarettes and e-cigarettes on salivary biomarkers. Methods: The search strategies included electronic databases (Medline/PubMed, Scopus, EMBASE) and related journals up to May 2023. A qualitative assessment was performed on data extracted from the included studies. Seven studies were included in this systematic review (number of patients=563). Results: Eleven biomarkers were assessed and compared between e-cigarette and conventional cigarette smokers. The data showed that the different effects of electronic and conventional cigarettes on the level of these biomarkers were not achievable. Due to the heterogeneity of the studies (I2 statistic>90%), performing a meta-analysis was impossible. Even after a sub-group classification, homogeneous data were not achieved. Conclusion: The current data do not provide evidence of obtainable outcomes between conventional cigarettes and e-cigarettes on salivary biomarkers.

Comparison of the Antibacterial Effect of AH26, Adseal and Beta RCS Root Canal Sealers against Enterococcus Faecalis, an in Vitro Study.

Objectives: Antibacterial activity against endodontic pathogens is a desirable feature for root canal sealers. The objective of this study was to compare the antibacterial effect of three resin-based endodontic sealers (AH26, Adseal, and Beta RCS) against Enterococcus faecalis in vitro. Materials and Methods: The antibacterial properties of the sealers were assessed against E. faecalis using agar diffusion test (ADT) for fresh state (N=10) and direct contact test (DCT) for freshly-mixed and set states of the materials (N=10). In ADT, the diameter of the zones of inhibition was measured after 24h of contact. In DCT, the colony-forming units of the bacteria were counted after 30 minutes and 180 minutes of exposure. The results were analyzed with two-way ANOVA and independent sample t-test. P<0.05 was considered significant. Results: Regarding DCT results, all test materials indicated an antibacterial effect, both in freshly-mixed and set states. The highest antibacterial effect was related to Adseal, whereas the lowest was observed in Beta RCS. There was a significant difference between all study groups (different sealers, setting states, and contact times; P<0.001), except for freshly-mixed AH26 and Adseal at 180 minutes (P>0.05). According to ADT, AH26 and Adseal represented the widest and the smallest inhibition zones, respectively (P<0.001). Conclusion: Within the limitations of this in vitro study, AH26, Adseal, and Beta RCS showed antibacterial effects against E. faecalis in both freshly-mixed and set states. The antibacterial effect increased over time in all of the studied sealers.

The effect of three additives on properties of mineral trioxide aggregate cements: a systematic review and meta-analysis of in vitro studies.

BACKGROUND: Several efforts have been made to improve mechanical and biological properties of calcium silicate-based cements through changes in chemical composition of the materials. This study aimed to investigate the physical (including setting time and compressive strength) and chemical (including calcium ion release, pH level) properties as well as changes in cytotoxicity of mineral trioxide aggregate (MTA) after the addition of 3 substances including CaCl2, Na2HPO4, and propylene glycol (PG). METHODS: The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Electronic searches were performed on PubMed, Embase, and Scopus databases, spanning from 1993 to October 2023 in addition to manual searches. Relevant laboratory studies were included. The quality of the included studies was assessed using modified ARRIVE criteria. Meta-analyses were performed by RevMan statistical software. RESULTS: From the total of 267 studies, 24 articles were included in this review. The results of the meta-analysis indicated that addition of PG increased final setting time and Ca2+ ion release. Addition of Na2HPO4 did not change pH and cytotoxicity but reduced the final setting time. Incorporation of 5% CaCl2 reduced the setting time but did not alter the cytotoxicity of the cement. However, addition of 10% CaCl2 reduced cell viability, setting time, and compressive strength. CONCLUSION: Inclusion of 2.5% wt. Na2HPO4 and 5% CaCl2 in MTA can be advisable for enhancing the physical, chemical, and cytotoxic characteristics of the admixture. Conversely, caution is advised against incorporating elevated concentrations of PG due to its retarding effect. TRIAL REGISTRATION: PROSPERO registration number: CRD42021253707.

Comparison of the Physical Properties of Three Resin-Based Root Canal Sealers: An In-Vitro Study.

Objectives: This in-vitro study aimed to evaluate the physical properties of three resin-based root canal sealers, including BETA-RCS, AH26, and Adseal. Materials and Methods: Flowability, film-thickness, solubility, and radiopacity of BETA-RCS, AH26, and Adseal sealers were evaluated according to ISO 6876/2012 specifications. Three samples of each sealer were used to test each of the properties. Results: The results revealed that the flow rate (mm) of BETA-RCS, Adseal, and AH26 were 23.06±1.58, 22.5±4.23, and 21.85±1.71, respectively. Film-thickness values (µm) for BETA-RCS, Adseal, and AH26 sealers were 52.33±2.51, 18.66±0.57, and 52±2, respectively. No significant difference was observed regarding film-thickness between AH26 and BETA-RCS (P>0.05), while Adseal showed significantly lower film-thickness (P˂0.05). The highest and lowest solubility were related to BETA-RCS and Adseal, respectively. However, all sealers had acceptable solubility and radiopacity. Conclusion: The findings of the current study suggested that all three root canal sealers including BETA-RCS, AH26, and Adseal had similar properties based on ISO 6876 standard criteria. As such, they could be viable choices for facilitating effective root canal procedures. Further long-term clinical studies are warranted to assess their performance and success rates in actual endodontic cases.

Diagnosis and Treatment of an Incomplete Crown-Root Fracture with Intentional Replantation: A Case Report.

Acute traumatic injuries to the maxillary incisors may lead to a crown-root fracture. If the fracture is left untreated, the fracture line will propagate and extend apically, resulting in microbial contamination of the attachment apparatus and subsequent bone loss. In cases with extensive periodontal involvement, extraction has been suggested. However, bonding and sealing the fracture line with a biocompatible material seems to be an effective alternative treatment option. In this case report, management of a central incisor with an incomplete crown-root fracture that showed signs and symptoms of vertical root fracture is discussed. As the extension of the fracture line was not clear, intentional replantation and sealing the fracture line with a glass ionomer was performed. The tooth showed no signs and symptoms at six-month follow up, and the radiographic examination exhibited substantial bone repair.

Reconstruction of lingual sulcus in a severely atrophic mandible using a modified approach as a pre-prosthetic surgery: Case series.

Shallow lingual vestibule and lack of keratinized attached mucosa are considered risk factors for the long-term success of dental implants. This article describes a modified surgical approach accompanied by a free gingival graft to correct the shallow lingual/buccal vestibule and to increase the keratinized tissue around dental implants.

Comparative evaluation of the effect of cold ceramic and MTA-Angelus on cell viability, attachment and differentiation of dental pulp stem cells and periodontal ligament fibroblasts: an in vitro study.

BACKGROUND: Biocompatibility and induction of mineralized tissue formation are the properties expected from a material used in vital pulp therapy and repair of perforations. Cold ceramic (SJM, Iran; CC) is a newly introduced calcium silicate-based cement for above mentioned therapeutic applications. This in-vitro study aimed to compare the effect of CC and White MTA-Angelus (MTA) on cell viability, attachment, odontogenic differentiation, and calcification potential of human dental pulp stem cells (DPSCs) and periodontal ligament fibroblasts (PDLFs). METHODS: Cell viability of DPSCs and PDLFs was assessed using MTT on days 1, 3, 7, and 14 (n = 9) in contact with freshly mixed and set states of CC and MTA. Field emission scanning electron micrographs (FESEM) were taken to evaluate cell-bioceramic interaction (n = 6). Gene expression levels of osteo/odontogenic markers (Dentin sialophosphoprotein, Dentin matrix protein 1, Collagen type I alpha 1, and Alkaline phosphatase (DSPP, DMP1, COL 1A1, and ALP, respectively) (n = 8) were assessed using qrt-PCR. ALP enzymatic activity was evaluated to assess the mineralization potential. A two-way ANOVA test was applied, and p < 0.05 was considered to be statistically significant. RESULTS: The effect of freshly mixed and set MTA and CC on the survival of DPSCs and PDLFs in all study groups was statistically similar and comparable to the positive control group (p > 0.05); the only exception was for the viability of PDLFs in contact with freshly mixed cements on day 1, showing a more significant cytotoxic effect compared to the control and the set state of materials (p < 0.05). PDLFs attached well on CC and MTA. The spread and pseudopodium formation of the cells increased on both samples from day 1 to day 14. Contact of MTA and CC with DPSCs similarly increased expression of all dentinogenesis markers studied on days 7 and 14 compared to the control group (p < 0.001), except for DSPP expression on day 7 (p = 0.46 and p = 0.99 for MTA and CC, respectively). CONCLUSIONS: Within the limitation of this in-vitro study, cold ceramic and MTA-Angelus showed high biocompatibility and induced increased expression of osteo/dentinogenic markers. Therefore, cold ceramic can be a suitable material for vital pulp therapy and the repair of root perforations.

Management of a Large Periapical Lesion Using Decompression: A Case Report with Three-year Follow-up.

Large radicular lesions should be treated initially by orthograde root canal therapy. When the signs and symptoms of the infection (e.g. persistent purulent drainage) do not resolve after this treatment, then surgical approaches should be considered. In the cases of large radicular cysts, total enucleation of the cyst can endanger adjacent structures and teeth. Therefore, decompression or marsupialization techniques are recommended in order to decrease the size of the lesion. In this case report, a 55-year-old woman with previously initiated therapy was referred to endodontic department for management of a sinus tract associated with tooth #7. Root canal treatment was performed and intracanal irrigant (5.25% sodium hypochlorite) activated using passive ultrasonic application, various intracanal medicament (calcium hydroxide, double antibiotic paste) was used in multiple sessions, but intracanal purulent drainage was not resolved. After this, decompression was performed using needle cap to maintain the opening of the cyst and remained for three months. During this period the cavity was kept clean and rinsed by the patient with 0.2% chlorhexidine mouthwash. After three-year follow-up, radiographic examination revealed substantial osseous repair of the defect and clinical signs and symptoms were absent.

Cytotoxicity and Antibacterial Activity of Toothpastes and Mouthwashes Available in the Iranian Market.

Objectives: Toothpastes and mouthwashes contain chemicals that may be harmful to oral tissues. This study assessed the cytotoxicity and antibacterial activity of toothpastes and compare the Iranian and foreign toothpastes and mouthwashes available in the Iranian market in this respect. Materials and Methods: Twenty samples (13 toothpastes and 4 mouthwashes) were selected. The cytotoxicity of 1, 10, and 50 mg/mL of toothpastes and 0.05, 2 and 10 µL of mouthwashes was measured after 1, 15 and 30 min of exposure to human gingival fibroblasts, each in triplicate. The methyl thiazolyl tetrazolium (MTT) assay was used for cytotoxicity testing. The serial dilution method was utilized to determine the minimum inhibitory concentration (MIC) of each sample against Lactobacillus acidophilus (L. acidophilus) and Streptococcus mutans (S. mutans). Two-way ANOVA and Tukey's test were used for data analysis. Results: A significant difference in cytotoxicity was noted among different products (P=0.00). The difference in cytotoxicity of each sample was not significant at 1, 15 and 30 min (P=0.08). The obtained MIC for all toothpastes and mouthwashes was between 0.0039 mg/mL and 0.0156 mg/mL, except for Sensodyne toothpaste and Oral B mouthwash. Conclusion: Some brands of toothpastes have higher cytotoxicity due to their composition, and their cytotoxicity should not be overlooked. The antibacterial activity of the samples was almost equal when they were in contact with L. acidophilus and S. mutans except for the Irsha mouthwash, Sehat, Darugar and Bath toothpastes. The antibacterial effect of toothpastes and mouthwashes increased with an increase in exposure time.

Endodontic Management of a Maxillary Lateral Incisor with Dens Invagination and Periapical Lesion: A Case Report and Mini Review of the Literature.

Dens invagination (DI) is a dental anomaly that can cause pulpal and periapical pathoses of the affected tooth. We describe the treatment of a healthy 18-year-old female with a chief complaint of recurrent facial swelling pertaining to a peg-shaped maxillary lateral incisor with DI. Examinations showed necrosis of the involved tooth with symptomatic apical periodontitis. Cone-beam computed tomography corresponded to Oehlers type II DI. Orthograde endodontic treatment was performed. To completely debride the canal and resolve the persistent purulent discharge, various methods and medicaments were used in separate sessions including passive ultrasonic activation of 5.25% sodium hypochlorite solution, calcium hydroxide mixed with 2% chlorhexidine, and double antibiotic paste as intracanal medicament. After resolution of the symptoms, the root canal and the invaginated space were filled by a mineral trioxide aggregate plug and backfilled with thermoplasticized gutta-percha. At the one-year follow-up, complete bone healing was noted in the affected periradicular area.