Non-Surgical Endodontic Management of Large Periapical Lesions After Traumatic Dental Injuries.

Traumatic dental injuries of permanent teeth result in multiple immediate and long-term consequences depending upon the severity of trauma, age of the patient, the status of root maturity, and the emergency care provided. The healing responses may get disturbed due to severe damage, loss of vascularity of the supporting structures, and infections. As a result, the prohealing mediators and pathways are overpowered by the destructive stimuli often manifested by an increased osteoclastic activity. Among the various late complications, the apical periodontitis or the periapical lesions are most worrisome for the patients and create clinical dilemma for the dentists. In the past, many such lesions were classified as cysts and subjected to surgical management. However, better understanding of lesion pathophysiology, three-dimensional imaging, and molecular pathways have established their inflammatory nature. The advancements in materials such as calcium silicates, and regenerative techniques have propelled the research related to non-surgical endodontic management as its clinical acceptability. The treatment largely follows the recommendations of regenerative medicine and is based on four principles: (a) establishing the drainage or an endodontic access to the area, (b) removal of most of the triggering agents such as necrosed pulp, toxins, and inflammatory mediators, (c) disinfection of the area, controlling inflammation and reversal of the acidic pH, and (d) maintenance of this infection/inflammation-free state for a long time through adequate sealing. This review aims to highlight the rationale of the approach, case selection, pathophysiology of the causation and healing, clinical protocols, and the limitations of non-surgical endodontic management of large periapical lesions secondary to traumatic dental injuries.

Accuracy and Consistency of Gemini Responses Regarding the Management of Traumatized Permanent Teeth.

BACKGROUND: The aim of this cross-sectional observational analytical study was to assess the accuracy and consistency of responses provided by Google Gemini (GG), a free-access high-performance multimodal large language model, to questions related to the European Society of Endodontology position statement on the management of traumatized permanent teeth (MTPT). MATERIALS AND METHODS: Three academic endodontists developed a set of 99 yes/no questions covering all areas of the MTPT. Nine general dentists and 22 endodontic specialists evaluated these questions for clarity and comprehension through an iterative process. Two academic dental trauma experts categorized the knowledge required to answer each question into three levels. The three academic endodontists submitted the 99 questions to the GG, resulting in 297 responses, which were then assessed for accuracy and consistency. Accuracy was evaluated using the Wald binomial method, while the consistency of GG responses was assessed using the kappa-Fleiss coefficient with a confidence interval of 95%. A 5% significance level chi-squared test was used to evaluate the influence of question level of knowledge on accuracy and consistency. RESULTS: The responses generated by Gemini showed an overall moderate accuracy of 80.81%, with no significant differences found between the responses of the academic endodontists. Overall, high consistency (95.96%) was demonstrated, with no significant differences between GG responses across the three accounts. The analysis also revealed no correlation between question level of knowledge and accuracy or consistency, with no significant differences. CONCLUSIONS: The results of this study could significantly impact the potential use of Gemini as a free-access source of information for clinicians in the MTPT.

A Comparative Evaluation of Real-Time Guided Dynamic Navigation and Conventional Techniques for Post Space Preparation During Post Endodontic Management: An In Vitro Study.

INTRODUCTION:  The three-dimensional (3D) dynamic navigation system (DNS; Navident, ClaroNav Technology, Toronto, ON) is a revolutionary technique in endodontics that offers superior precision and efficiency compared to existing techniques for post space preparation. AIM: The aim is to evaluate and contrast the efficacy and efficiency of the DNS with conventional post space preparation techniques. This assessment considers several parameters, notably canal deviation (global coronal and apical deviation and angular deflection), duration of the procedure, and total volumetric loss of instrumented root canal and volumetric loss of instrumented root canal above 4 mm from the apex. MATERIALS AND METHODS: Freshly extracted maxillary central incisors were chosen for this study. A total sample size of 60 (n) was included. The extracted teeth samples were divided into two groups: 3D DNS (group I; n = 30) and conventional techniques (group II; n = 30). The samples were taken, and 50% of the crown structure was reduced for post space preparation to ensure standardization between the two groups. The samples were root canal-treated and mounted in a 3D-printed maxillary cast. Preoperative micro-computed tomography (micro-CT) and cone-beam computed tomography (CBCT) were taken for both groups. For group I, post space preparation was conducted with the DNS, which provided comprehensive guidance. The procedure was stopped when post space preparation was 4 mm short of the apex, as indicated in the system display. For group II, post space preparation was done without the guidance of DNS. Time taken for the procedure was assessed using a timer; canal deviation was evaluated using CBCT analysis, and volumetric loss was estimated using micro-CT analysis. RESULTS: The dynamic navigation group achieves significantly more precise outcomes in post space preparation than the conventional technique. The DNS group has significantly lesser global coronal and apical deviation and angular deflection compared to the conventional group (p < 0.05). The DNS group has reduced the volumetric loss of instrumented root canals compared to the conventional group (p < 0.05). Furthermore, the DNS group requires significantly less time than the conventional method, with a mean difference of about 10.567 minutes (p < 0.05). CONCLUSION: Implementing dynamic navigation improves precision in post space preparation, with a notable reduction in canal deviation and volumetric loss and a decrease in procedure time compared to the conventional method.

Endodontic Management of a Mandibular Second Premolar with Three Root Canals and Taurodontism: A Case Report.

A complete understanding of canal morphology is essential to achieve successful endodontic treatment. Although mandibular second premolars are reported to have usually only one root canal at the apex, in this case we reported a mandibular second premolar with three root canals and taurodont morphology. A patient was referred to the endodontic department at Mashhad Faculty of Dentistry with a chief complaint of pain in her mandibular right second premolar tooth. The diagnosis of pulpal necrosis and chronic apical periodontitis was established. The initial radiograph showed a taurodont premolar with two roots. However, with cone-beam computed tomography assistance, three root canals were confirmed. The root canal treatment process was successfully managed with a dental operating microscope. Using cone-beam computed tomography and a dental operating microscope greatly facilitated the determination of tooth morphology and successful following nonsurgical endodontic treatment.

Diagnosis of Vertucci Type VII Anatomy in the Mandibular Left Lateral Incisor Using Digital Radiography: An Ex Vivo Case Study.

Mandibular lateral incisors sometimes feature an additional lingual canal, which, if not identified and missed during endodontic treatment, can lead to postoperative pain. Thus, a proper diagnosis of the internal anatomy of a tooth is necessary before treatment begins. Radiovisiography (RVG), a cost-effective and widely employed dental imaging technique, is used in clinics to visualize the internal root structure of teeth. The zoom function of RVG allows for a detailed examination of complex internal anatomical variations, facilitating a more accurate diagnosis and treatment planning process. This case study identified a rare Vertucci Type VII root canal system in a mandibular left lateral incisor using the zoom-in feature of radiovisiography (Vatech, EZ sensor). Additionally, horizontal sectioning was performed, and these sections were imaged to verify the accuracy of digital radiographs in diagnosing such cases as part of a preclinical demonstration for aspiring endodontists.

Unlocking the Potential of Cellular Guidance in Endodontics: Advancing the Process of Pulp Regeneration and Beyond.

Regenerative endodontics represents a paradigm shift in dental therapy, with the potential to not only restore damaged dental tissues but also to preserve the vitality of teeth. At the heart of this innovative approach is cell homing, a technique that harnesses the body's own healing mechanisms by recruiting endogenous stem cells to the site of dental injury for effective tissue regeneration. This review delves into the intricate processes of cell homing in the context of regenerative endodontics, particularly focusing on its application in immature teeth with open apices. It examines the role of bioactive molecules, scaffolds, and growth factors in orchestrating cell migration and differentiation within the root canal space. In addition, the review addresses the current limitations in clinical practice, such as the challenges in completely regenerating the pulp-dentin complex and the unpredictability in long-term outcomes. It also explores future possibilities, including the potential for more refined and effective regenerative strategies. By providing a comprehensive overview of the current state of cell homing in regenerative endodontics, this article aims to contribute to the ongoing development of advanced therapeutic techniques that could revolutionize endodontic treatment and improve patient care.

Endodontic management of maxillary first molar with protostylid: a rare case report.

BACKGROUND: A protostylid is a relatively rare dental developmental aberration characterized as an extra cusp located on the mesial half of the buccal surface of the molars. A protostylid is rarely to be reported due to its low rate of occurrence. This case report describes a patient referred for endodontic treatment due to the presence of a protostylid on the buccal surface of the maxillary first molar that induced apical periodontitis. CASE PRESENTATION: A 53-year-old female reported a 3-month history of pain of chewing with her upper left posterior teeth over 3 months. In the clinical examination, an abraded anomalous cusp-like structure was found on the buccal surface of tooth 26, Cone beam computed tomography (CBCT) revealed a supernumerary cusp with an intact root canal inside, which was fused with the mesiobuccal (MB) root canal in the middle of the root. In addition, extensive periapical radiolucency was observed around tooth 26. The tooth was diagnosed as apical periodontitis, and endodontic treatment was performed. The initial lesion in tooth 26 gradually healed over 1 year of observation. CONCLUSIONS: To our knowledge, this case is the first to describe the endodontic management of a maxillary first molar with a protostylid and advances our understanding of supernumerary cusps. This case provides a reference for the treatment of protostylid.

Three-dimensional Assessment of Two-rooted Maxillary Central Incisor with Labiogingival Groove: Endodontic and Periodontal Surgical Management.

Understanding the diversity of root canal systems and their anatomical/morphological variations helps in achieving improved outcomes of root canal treatment. The outcome of endodontic treatment depends on a thorough knowledge of dental anatomy and its variations. Maxillary central incisor with two roots is a rare entity, so a complete clinical and radiological examination is important before initiating the treatment. Recently, three-dimensional (3D) radiography has improved the diagnosis and treatment planning in endodontics. So, the current report describes the endodontic and periodontal surgical management of traumatized discolored maxillary central incisors with two separated roots and root canals identified by two-dimensional (2D) and 3D radiographic examination. How to cite this article: Prasad P, Galani M, Nawal RR, et al. Three-dimensional Assessment of Two-rooted Maxillary Central Incisor with Labiogingival Groove: Endodontic and Periodontal Surgical Management. Int J Clin Pediatr Dent 2023;16(3):528-533.

Challenges and Treatment Considerations with Comprehensive Rehabilitation of a Case of Taurodontism in Primary Dentition: A Case Report and Review.

Background: Taurodontism is an anomalous developmental condition where the coronal portion of the tooth is enlarged while the radicular portion is compromised. This may have important clinical implications while considering endodontic or exodontic procedures which may affect the technique of the treatment or its prognosis. Case Report: This article describes the case of a 4-year-old female girl with molars exhibiting taurodontism with its clinical management and a review of this unique clinical condition. Conclusion: This case report and review summarizes the diagnosis, classification, clinical management challenges and comprehensive rehabilitation of taurodontism in primary teeth. How to cite this article: Gupte MP, Mistry LN, Jawdekar A. Challenges and Treatment Considerations with Comprehensive Rehabilitation of a Case of Taurodontism in Primary Dentition: A Case Report and Review. Int J Clin Pediatr Dent 2023;16(3):510-514.

Management of Endodontic Flare-Up in the Presence of Periapical Radiolucency: Case Report and Overview.

Flare-ups following root canal therapy (RCT) are of significant concern in dentistry. They are characterized by the occurrence of pain or swelling during or even after a root canal procedure. They affect a considerable proportion of cases, up to 16% and occasionally even 50%, and they often necessitate unscheduled appointments. Whenever a flare-up occurs within hours or days following RCT, it demands emergency treatment. Flare-ups can be attributed to multiple factors, including mechanical, chemical, and microbial causes. Identifying these factors beforehand and utilizing the expertise of clinicians can help better manage patients after the procedure and assure a long-term successful outcome. It has been observed that retreatment cases with periapical periodontitis treated in a single appointment have higher flare-up rates. Despite the prevalence and the impact of flare-ups, the endodontic community has yet to adopt scientifically validated and approved preventive measures to manage and prevent flare-ups. Hence, in this case report, the ethical letter was approved (TUCDREC/250923). It provides insight into the management of an interappointment flare-up with an overview.

Comprehensive Strategies in Endodontic Pain Management: An Integrative Narrative Review.

This narrative review comprehensively examines the current and emerging strategies for pain management in endodontics, encompassing a wide range of pharmacological and non-pharmacological approaches. Through an extensive exploration of 20 distinct parts, the review discusses traditional analgesics, antibiotics, the use of corticosteroids, and the role of novel treatments such as platelet-rich fibrin (PRF) and cryotherapy. The review also delves into the intricacies of clinical methods, such as trephination and occlusal reduction, and discusses the potential of advanced techniques such as GABAergic signaling, acupuncture, in silico modulation, and low-level laser therapy (LLLT) for the effective management of endodontic pain. The analysis reveals a trend toward integrative methods that combine established practices with cutting-edge research, highlighting the importance of a tailored approach in endodontic pain management. The findings underscore the significance of understanding the complex nature of dental pain and the need for multifaceted treatment strategies. The review emphasizes that while traditional pharmacological methods remain foundational, emerging therapies offer promising adjuncts or alternatives, especially in cases where conventional treatments may be inadequate or unsuitable. This review aims to serve as a comprehensive resource for endodontic practitioners and researchers, offering insights into the multifarious aspects of pain management in endodontics. It underscores the ongoing evolution in the field and suggests directions for future research, particularly in refining and validating new pain management techniques.

Present status and future directions: Endodontic management of traumatic injuries to permanent teeth.

The prognosis of traumatized teeth depends largely on the fate of the pulp and its treatment. This review aims to update the present status on the endodontic management of traumatic injuries to permanent teeth and to identify relevant research areas that could contribute to an improvement in diagnosis and treatment of traumatized permanent teeth. Future research should pay greater attention to (1) diagnostic methods to assess the perfusion of the pulp and enhance detection of tooth cracks and initial signs of root resorption; (2) improved materials for vital pulp treatment; (3) studies focusing on type and duration of splinting after root fractures; (4) antiresorptive intracanal medication in case of posttraumatic pulp necrosis and infection-related resorption and (5) long-term data on the apical barrier technique compared to revitalization.

European Society of Endodontology position statement: endodontic management of traumatized permanent teeth.

This position statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on the endodontic management of traumatized permanent teeth. A recent comprehensive review with detailed background information provides the basis for this position statement (Krastl et al. 2021, International Endodontic Journal, https://doi.org/10.1111/iej.13508). The statement is based on current scientific evidence as well as the expertise of the committee. Complementing the recently revised guidelines of the International Association of Dental Traumatology, this position statement aims to provide clinical guidance for the choice of the appropriate endodontic approach for traumatized permanent teeth. Given the dynamic nature of research in this area, this position statement will be updated at appropriate intervals.

Endodontic management of traumatized permanent teeth: a comprehensive review.

The pulp plays a key role in the treatment of traumatic dental injuries (TDIs) and is strongly associated with the outcome, particularly in severe cases. A correct pulp diagnosis is essential as it forms the basis for developing the appropriate management strategy. However, many TDIs are complex, and their treatment requires a profound knowledge of the physiological and pathological responses of the affected tissues. This comprehensive review will look at the dentine-pulp complex and its interaction with the surrounding tissues following TDIs. The literature up to 2020 was reviewed based on several searches on PubMed and the Cochrane Library using relevant terms. In addition to the recently revised guidelines of the International Association of Dental Traumatology, this article aims to provide background information with a focus on endodontic aspects and to gather evidence on which a clinician can make decisions on the choice of the appropriate endodontic approach for traumatized permanent teeth.

Endodontic management of a patient with dystrophic epidermolysis bullosa: A case report.

Epidermolysis bullosa is a congenital genetic disease that causes blistering and erosion of the skin and mucosa. The main known forms include simple, junction, dystrophic and mixed subtypes. This case report presents the endodontic management and 1-year follow-up of a 27-year-old female patient with epidermolysis bullosa who was referred to the Faculty of Dentistry, Kirikkale University, Turkey. An extraoral examination showed that the patient had multiple scars and blisters. The intraoral examination revealed ankyloglossia, microstomia, shallow buccal and vestibular sulci, enamel hypoplasia, gingival inflammation, mouth ulcers, symptomatic and asymptomatic deep caries, a tooth with an apical lesion and a tooth with pulpitis. The dental treatment was divided into four stages: (i) oral hygiene motivation and elimination of gingival bleeding, (ii) restorative and/or endodontic procedures, (iii) extractions and prosthetic treatments and (iv) recall appointments. A 1-year follow-up radiographic examination of the periapical status of the root canal treatments was clear.

Endodontic Management of Traumatised Permanent Anterior Teeth.

Traumatised permanent anterior teeth can require endodontic treatment which may be immediate as part of acute trauma management, or delayed due to the development of sequelae. This paper will enable clinical decision making by exploring a range of situations in which endodontic treatment may be indicated, and also offer practical advice regarding effective endodontic treatment for paediatric dental trauma patients.Endodontic treatment of traumatised permanent teeth in paediatric patients is often challenging. However, with timely decision making and appropriate treatment, these teeth can often last throughout childhood and adolescence thus ensuring that a young patient does not have the social burden of a missing tooth and needing a prosthesis, and has the maximum restorative options available to them as they enter adulthood.

Endodontic management of maxillary first molar with an anatomical variation of two palatal canals: A case report.

An in-depth knowledge of the root canal anatomy is important for any successful root canal treatment; however, complexities exist within the root canal morphology. The maxillary first molar has variations in its root morphology and canal configurations. In literature, this variation is only observed in an estimated 1.12%-1.17%. One such case is described in this case report which provides the endodontic management of a left maxillary first molar with two palatal canals using loupes magnification.

Permanent maxillary first molar with three mesiobuccal canals.

It is mandatory for every clinician to have a thorough knowledge about the normal internal anatomy of teeth; equally important is the awareness about variations in internal anatomy that could be seen with different teeth. The outcome of a root canal therapy depends significantly on the clinician's awareness about root canal anatomy, followed by their clinical skills. Literature states that the permanent maxillary first molar shows a wide variation in the number of canals particularly with respect to the mesiobuccal root. This case report describes the endodontic management of a permanent maxillary first molar with three distinct mesiobuccal canals.

Latest Concepts in the Endodontic Management of Patients with Cardiovascular Disorders.

There are several cardiovascular interventions that need special considerations in the provision of treatments within the scope of endodontics. If these interventions are not carefully identified, diagnosed, and considered in the overall treatment plan for the patient, they may result in fatal conditions. These include hypertension that causes fatal cardiac disorders, such as angina pectoris, ischemic heart diseases, and myocardial infarction, and also cerebrovascular diseases; congestive heart failure; infective endocarditis, valvular diseases, and carrying pacemakers; and the use of antiplatelet and anticoagulant drugs that are commonly prescribed for patients who have experienced heart stroke. The aim of this article is to review the newest recommendations for patients with these disorders who require endodontic treatments.

Maxillary Second Molar with Fused Root and Six Canals- A Case Report.

One of the known aberrations in root canal morphology of maxillary second permanent molars is the presence of collateral mesiobuccal canals. This case report describes the endodontic management of a maxillary second molar that had a single fused root with six canals that was successfully managed with the aid of dental operating microscope. Six canal orifices were located namely MB1 (Mesiobuccal), MB2, MB3, DB1 (Distobuccal), DB2 and palatal. During the cleaning and shaping, instrument separation occurred at the apical third of the palatal canal which was removed with ultrasonics. After cleaning and shaping, the canals were obturated with resin sealer and laterally condensed gutta-percha. The patient was recalled for periodic review. After two years of follow up the patient remained asymptomatic. Cone Beam Computed Tomography (CBCT) evaluation revealed satisfactory periapical status.