Vital pulp treatment for traumatized permanent teeth: A systematic review.

BACKGROUND: Traumatic dental injuries involving the pulp are quite common and there is a need to evaluate the quality of evidence on the success of vital pulp treatment (VPT) interventions in traumatised permanent teeth. OBJECTIVES: The aim of this systematic review was to assess the success of VPT in the management of traumatised human vital permanent teeth diagnosed with complicated crown or crown-root fractures. METHODS: An electronic search of the following databases: Web of Science, Scopus, PubMed, MEDLINE, EMBASE, LILACS, Clinical Trial Registries and the grey literature was performed until 25th /8/2021. Controlled clinical trials, cohort studies, case-control studies, case series with at least five cases and a minimum of 12-months follow-up were included. Non-English language literature was excluded. Two independent assessors performed study selection, data extraction and quality assessment using the National Institutes of Health's quality assessment tool. Disagreements were resolved through consensus/with a third assessor. RESULTS: A total of 14-studies (2-controlled clinical trials, 1-case-control, and 11-case series) published between 1978-2020, with a total of 1081 permanent teeth and an age range between 6-42 years-old were included. Bias analysis ranged considerably from 'good' to 'poor'. Meta-analysis was not performed due to data heterogeneity, unclear reporting, and limited number of controlled clinical studies. Partial pulpotomy was the main reported clinical procedure with an overall success rate between 82.9-100%. Complete pulpotomy and direct pulp capping were associated with lower success rates of 79.4-85.7% and 19.5%, respectively. Calcium hydroxide was the main pulp capping material with favourable clinical and radiographic success (79.4-100%). Biodentine® , mineral trioxide aggregate and IRoot® BP were also associated with a high clinical and radiographic success, 80-91%, 80-100%, and 90-100%, respectively, albeit in fewer studies. DISCUSSION: Although a high success rate has been reported when using VPT in managing pulpally involved traumatised teeth, the results of this systematic review clearly highlighted a paucity and low quality of the available evidence. CONCLUSIONS: Overall high success of VPT in the management of traumatised vital permanent teeth were reported, although based on limited evidence of well-conducted clinical studies. REGISTRATION: PROSPERO database (CRD42020205213).

Resolution of Apical Periodontitis-induced Mental Nerve Paresthesia Through Nonsurgical Endodontic Retreatment: A Case Report.

Paresthesia is a potential consequence of unsuccessful root canal treatment. Persistent infection resulting in apical periodontitis may enlarge sufficiently to involve the mental neurovascular bundle. The case presented in this report was referred for endodontic evaluation with a chief complaint of discomfort on mastication and persistent numbness of the lower left lip. Clinical and radiographic evaluation revealed incomplete primary endodontic treatment of the left mandibular second premolar with complex internal anatomy. The untreated root canal system resulted in the progression of apical periodontitis involving the left mental neurovascular bundle as confirmed by cone-beam computed tomography imaging. Nonsurgical root canal retreatment was performed over 2 visits. At the 3-year follow-up visit, the paresthesia had resolved with return of normal sensation. Nonsurgical endodontic retreatment may be sufficient to allow healing of large periapical lesions and resolve complications including paresthesia without the need for surgical intervention.

Outcome of Endodontic Treatment through Existing Full Coverage Restorations: An Endodontic Practice Case Series.

INTRODUCTION: This case series assessed the outcome of nonsurgical endodontic treatment completed through retained full coverage restorations (FCRs) in a board-certified endodontist private practice. The number of cases completed by the first author was 153. METHODS: All cases were performed following a standardized protocol for treatment and restoration depending on the type of FCR. Number of cases that showed up for 2- to 4-year follow-up was 127, with 83% recall rate. The age range of patients was 33-95 years, with mean age of 54.734 years. The mean recall time was 2.448 years. FCRs and their distribution were as follows: 4 anterior teeth, 14 premolars, and 109 molars. There were 103 nonsurgical root canal treatments and 24 retreatments. Patients who presented for recall had 74 porcelain fused to metal crowns, 17 zirconia crowns, 15 abutments of porcelain fused to metal bridges, 14 lithium disilicate crowns, 5 gold crowns, 1 full metal crown, and 1 gold onlay. RESULTS: There were no endodontically related failures. Six cases failed; 3 were due to vertical root fractures, 1 was due to horizontal root fracture, and 2 were due to extensive recurrent caries causing restorative failure. The percentage of healed cases following the American Association of Endodontists outcome criteria adopted in 2004 with intact retained FCR was 95.3%. CONCLUSIONS: The results suggest predictable favorable outcomes for nonsurgical endodontic treatment through FCR following the proposed protocol for diagnosis, treatment, and restoration.