Apical Third Horizontal Root Fractures in Anterior.

Horizontal root fractures are a type of traumatic dental injury. Horizontal root fractures are classified as apical third, middle third, and cervical third of the root based on the fracture line and on the degree of dislocation of the coronal fragment. The prognosis of the tooth depends on the patient’s age, stage of root growth, mobility of the coronal fragment and diastasis of the fragments. Proper clinical and radiographic examination should be done to reveal apical root fractures. Hence, the treatment plan can be decided depending on the type of fracture and extent of fracture line. This review was conducted to evaluate the apical third horizontal root fractures in order to determine the appropriate therapy.

Analysis of the rate of maturogenesis of a traumatized Cvek’s stage 3 anterior tooth treated with platelet‑rich fibrinas a regenerative tool using three‑dimensional cone‑beam computed tomography: An original case report.

Regenerative endodontic procedures are biologically based procedures which deal with the regeneration of pulp‑like tissue, more idealistically the pulp‑dentin complex. The regeneration of this pulp‑dentin complex in an infected necrotic tooth with an open apex is possible only when the canal is effectively disinfected. Though there are various procedures for treating open apex ranging from Ca(OH) 2 apexification, mineral trioxide aggregate apexification and surgical approach, regeneration of tissues has always taken superior hand over the repair of tissues. The mechanics behind the regenerative endodontic procedures is that despite the tooth being necrotic, some pulp tissue can survive apically which under favorable conditions proliferate to aid in the process of regeneration. In the past 2 decades, an increased understanding of the physiological roles of platelets in wound healing and after tissue injury has led to the idea of using platelets as therapeutic tools in the field regenerative endodontics. In the present case report with an open apex, high sterilization protocol is followed using triple antibiotic paste as intra‑canal medicament, followed which platelet rich fibrin is used as the regenerative material of choice. Over an 18‑month follow‑up period, clinically patient is asymptomatic and radiographically there is complete regression of the periapical lesion and initiation of the root end closure.

Novel in vitro methodology for induction of Enterococcus faecalis biofilm on apical resorption areas.

Context: Teeth with periapical lesion usually present external root resorption around the apical foramen. These areas facilitate adhesion and co-aggregation of microorganisms developing biofilms. Up to the present moment, there is no methodology in the literature that enables the in vitro evaluation of endodontic irrigants and intracanal dressings on biofilms located in apical external root resorptions of human teeth. Aims: This study aimed to describe a new in vitro methodology for Enterococcus faecalis biofilm development in external apical reportion areas of human extracted teeth in different periods of time. Settings and Design: In vitro qualitative laboratory study. Subjects and Methods: Thirty roots from human extracted teeth presenting external apical resorption had their root canal diameters standardized by means of instrumentation. Next, the roots were randomly divided into three groups (n = 30) according to E. faecalis strains (ATCC 29212) exposure time as follows: Group T5, with 5‑day exposure; Group T10, with 10‑day exposure, and Group T15, with 15‑day exposure. The roots were attached to 24‑well culture plates so that only their apices could be in contact with bacteria for induction of biofilm formation. At the end of these exposure times, the roots were qualitatively evaluated with scanning electron microscope to observe the presence of biofilm in external resorptions around the apical foramen. Results: It was found that microorganisms were present in all exposure times, although structures suggesting the presence of biofilm with great conglomerate of bacteria showing structures similar to polysaccharide extensions were observed at the 10th day of exposure. Conclusions: By means of this new methodology, it was possible to observe biofilm formation in the areas of external apical resorption after 10 days of exposure.

Healing of large periapical lesions following delivery of dental stem cells with an injectable scaffold: New method and three case reports.

Regenerative endodontics is the creation and delivery of tissues to replace diseased, missing, and traumatized pulp. A call for a paradigm shift and new protocol for the clinical management of these cases has been brought to attention. These regenerative endodontic techniques will possibly involve some combination of disinfection or debridement of infected root canal systems with apical enlargement to permit revascularization and use of stem cells, scaffolds, and growth factors. Mesenchymal stem cells (MSCs) have been isolated from the pulp tissue of permanent teeth (dental pulp stem cells (DPSCs)) and deciduous teeth (stem cells from human exfoliated deciduous teeth). Stem cells are characterized as multipotent cells for regeneration.These three case reports describe the treatment of necrotic or immature teeth with periradicular periodontitis, which was not treated with conventional apexification techniques. All cases presented here developed mature apices and bone healing after 3 to 4 months after the initial treatment without complications, and faster than traditional treatments. Our clinical observations support a shifting paradigm toward a biologic approach by providing a favorable environment for tissue regeneration. The mechanism of this continued development and formation of the root end and faster tissue healing is discussed.

An in vitro comparison between the apical sealing abilities of resilon with Epiphany® sealer and gutta-percha with AH plus sealer.

Context: The study assesses the apical sealing ability of two obturating materials (resilon and gutta-percha) with their sealants by means of the dye penetration method using India ink. Aims: To compare the resistance to apical dye penetration between resilon (with Epiphany sealer; Epiphany®, Pentron clinical technologies, USA) and gutta-percha (with AH Plus sealer; Dentsply, Maillefer, Germany). It was hypothesized that there would be no difference between the two groups with regard to apical dye penetration. Settings and design: Hundred mandibular first premolars from individuals aged between 20 to 25 years were selected after their lengths were standardized. Materials and Methods: Instrumentation was performed with NiTi hand protaper files (Dentsply, Maillefer) using EDTA paste and copious irrigation with 2.5% sodium hypochlorite. Experimental group 1 consisted of roots that were treated with Epiphany primer and obturated with resilon (with Epiphany sealer). Experimental group 2 consisted of those obturated with gutta-percha using AH Plus sealer. The samples were immersed in blue India Ink and cleared using 5% nitric acid. Dye penetration was assessed under a stereomicroscope. Statistical analysis: Mann-Whitney U test. Results: Roots obturated with resilon core material and Epiphany sealer exhibited lesser mean apical dye penetration (1.281 mm; SD: 0.742) in comparison to those obturated with gutta-percha and AH plus sealer (2.154 mm; SD: 0.814). The difference was found to be highly significant (P<0.0025). Conclusion: Resilon (with Epiphany sealer) provided better radicular apical sealing in comparison to gutta percha (with AH Plus sealer).