A 12-month follow-up of primary and secondary root canal treatment in teeth obturated with a hydraulic sealer.

OBJECTIVES: This randomized, controlled, pilot study assessed the outcome of non-surgical primary/secondary root canal treatments either with a novel bioactive sealer and the single-cone technique or with gutta-percha, zinc oxide-eugenol sealer (ZOE), and warm vertical compaction. MATERIALS AND METHODS: Sixty-nine patients were randomly divided into two groups that were treated using the single-cone technique with BioRootTM RCS (Septodont) (BIO group) or warm vertical compaction with gutta-percha and ZOE sealer (PCS group). Two subsamples (BIOAP and PCSAP) comprised the cases with apical periodontitis. Treatment was undertaken by four residents using a standardized instrumentation and disinfection protocol. The periapical index (PAI) was recorded, and clinical and radiographic follow-up performed at 1, 3, 6, and 12 months. Treatment success was assessed according to "periapical healing" and "tooth survival". The test for the equality of proportions, t tests for the equality of means, and non-parametric K-sample tests for the equality of medians were applied when appropriate. RESULTS: The survival rate was similar in the BIO and PCS (p = 0.4074) and the BIOAP and PCSAP groups (p = 0.9114). The success rate was higher in the BIO groups, but not statistically significant (p = 0.0735). In both BIOAP and PCSAP groups, a progressive decrease in the PAI was observed. CONCLUSION: At 12 months, both techniques showed reliable results. Further studies and longer follow-ups are needed. CLINICAL RELEVANCE: This study documents the feasibility of using a bioactive sealer in conjunction with the single-cone technique to obturate the root canal and obtaining a predictable outcome. TRIAL REGISTRATION: ClinicalTrials.gov Identifie: NCT04249206.

Correction to: The effectiveness of ultrasound examination to assess the healing process of bone lesions of the jaws: a systematic review.

The given names of the authors are swapped with their family names.

Ultrasound examination with color power Doppler to assess the early response of apical periodontitis to the endodontic treatment.

OBJECTIVES: The purpose of this study was to assess the possibility to detect early vascular changes in apical periodontitis (AP) using ultrasound examination with color power Doppler (US-CPD) and to establish a correlation between the early response of AP to treatment and its potential healing. MATERIALS AND METHODS: Twenty-one apical lesions were visualized with US-CPD before endodontic treatment, 1 week after the first access to endodontic system and 4 weeks after root canal obturation. A differential diagnosis between cystic lesions (CLs) and granulomatous lesions (GLs) was attempted. The vascular modifications were then correlated with long-term radiographic follow-up using Fisher's exact test. RESULTS: The decrease or disappearance of vascular flow observed in AP 4 weeks after root canal obturation was significantly related to a healing trend (p = 0.0206) of the lesions. Combining the data with preoperative US-CPD diagnosis showed a reproducibility for GLs only (p = 0.0022). CONCLUSIONS: This study showed the possibility to detect early vascular changes in AP using US-CPD, correlating them with a healing trend after endodontic treatment. Future investigations should be conducted and more attention should be dedicated to the potential of this alternative and biologically safe imaging technique. CLINICAL RELEVANCE: US-CPD in endodontics may be a helpful tool to identify healing processes after endodontic treatment and to understand the behavior of different forms of AP.

Peri-Implant Tissue Adaptation after Implant Rehabilitation with Shoulderless Abutments with 24 Months of Follow-Up.

An 11-year-old girl presented with agenesis of the maxillary lateral incisors. Orthodontic treatment was performed to close the midline diastema and create adequate space between the central incisors and canines to replace the missing maxillary lateral incisors on both sides. Two-piece implants were placed, and shoulderless abutments were prepared following the "biologically oriented preparation technique" (BOPT) protocol. The soft tissues were allowed to heal directly on the prosthetic emergence profile of the interim crown restorations after implant exposure. Two months later, the gingival tissue adapted to the prosthetic components in a specular manner. No complications were noted at 24 months. The BOPT protocol, originally described for natural teeth, may be applied to dental implants with shoulderless abutments.

Combined Management of Apical Root Fracture and Avulsion of Two Maxillary Permanent Central Incisors: A Case Report.

As a result of a skiing accident, a ten-year-old girl suffered combined injuries to both maxillary central incisor teeth (#1.1 and #2.1). The injuries were uncomplicated crown fractures, apical horizontal root fractures, and a severe extrusive luxation of the coronal segments of the teeth. Her mother repositioned the teeth immediately, resulting in good initial healing. Nine months later, the patient was referred to a specialist to manage the endodontic consequences of the trauma. The apexification treatment of the fractured roots, using a preformed apical barrier technique with bioactive cement, was the treatment of choice, administered to both the avulsed roots at two separate recall visits. The best option for managing the fractured apical segments was to continue with the follow-up, which was conducted to assess the overall case at 30 months. The fractured apexes remained normally positioned inside the socket and were asymptomatic (as they presumably maintained a physiological vascular-nerve supply and, consequently, their vitality), while the apexification treatment led to the healing of the periodontal tissues and to hard tissue formation in the area of the interrupted roots in the avulsed portion of the teeth. The management of traumatic injuries in teeth often requires multiple treatment approaches, because these injuries rarely represent one single type of trauma.

Management of the Sequelae of a Sport-Related Traumatic Dental Injury Using Ultrasound Examination in the Diagnosis and Follow-Up.

About a quarter of all oral pathologies involving the oral cavity and dental apparatus are traumatic injuries, and a substantial number of these cases are the result of sports injuries affecting adolescents and young adults. Here, we report the case of a 25-year-old healthy female referred to the department of Endodontics for the evaluation and management of teeth 1.2 and 1.1 because of a chronic apical abscess in an area involved in a sport-related dental trauma in the past. A multi-modular diagnostic assessment, comprising conventional periapical radiographs, CBCT imaging, ultrasound, and histopathologic examination, led to a final diagnosis of an apical granulomatous lesion connected to both teeth, and an associated sinus tract. During the follow-up period of three years, the patient was reviewed twice a year and showed progressive healing of the bone and absence of the sinus tract. The present report shows the challenges of diagnosing complications arising from past dental trauma. Furthermore, it is the first documented traumatic case where ultrasound examination was fruitfully used. Emphasis should be put on introducing diagnostic ultrasound for the management of both apical periodontitis and the related sinus tract.

Proresolving Mediators in Endodontics: A Systematic Review.

INTRODUCTION: Proresolving lipid mediators are specialized molecules (SPMs) involved in the active resolution of the inflammatory process by regulating tissue homeostasis. The aim of this study was to investigate the scientific literature to assess the potential of SPMs as an adjunct in the treatment of endodontic infection. METHODS: Three electronic databases (PubMed, Web of Science, and Scopus) were searched from their inception until February 2020 (PROSPERO CRD42020164743). Supplemental research was performed by screening the references of the relevant studies eligible for inclusion. A quality assessment of animal studies was performed using the Animal Research: Reporting of In Vivo Experiments guidelines, whereas the Systematic Review Centre for Laboratory animal Experimentation Risk of Bias tool was used to assess the risk of bias. RESULTS: A total of 3295 records were screened, and 8 articles meeting the criteria were included for this qualitative review. The eligible studies showed a high to moderate overall quality and a low to moderate risk of bias. SPMs positively affected the development of pulpitis and apical periodontitis in experimental animal models. The early treatment of pulpitis with the topical application of SPMs was beneficial to control inflammation within 24 hours from contamination. In addition, SPMs delivered within the root canals after disinfection were found effective in promoting periapical healing. CONCLUSIONS: Our findings suggest that SPMs may play a role in the inception and treatment of pulpal-periapical diseases, and they should be considered for future research for developing new therapeutics as an adjunct to endodontic treatment.

Correction of Gingival Architecture Using the Biologically Oriented Preparation Technique in Two Patients with Human Immunodeficiency Virus.

Two female patients positive for human immunodeficiency virus and receiving antiretroviral treatment presented with esthetic concerns due to fixed dental prostheses in the anterior region. The patients had gingival recession and short clinical crowns in the esthetic zone. In both cases, the biologically oriented preparation technique was used to recreate ideal proportions between the teeth and gingivae. Since patients with human immunodeficiency virus experience a progressive deterioration of their immune systems and other significant comorbidities, a reduction in the number of traumatic clinical procedures is recommended. The use of this minimally invasive prosthetic protocol has not been previously reported in patients with human immunodeficiency virus. These cases demonstrate how short clinical crowns and gingival recession in the esthetic zone can be successfully treated with the biologically oriented preparation technique to avoid surgical procedures in patients with human immunodeficiency virus.

Multimodular Assessment of a Traumatic Bone Cyst Overlapped with Apical Periodontitis.

Traumatic bone cyst (TBC), a "pseudocyst" that usually affects long bones, is a rare lesion among cystic lesions in the jaws. The most commonly affected site is the posterior mandible. Most of the time, TBC is asymptomatic and discovered during routine radiographic examination. The treatment recommended for TBC is surgical exploration followed by curettage of the bony walls, which also serves as a diagnostic procedure. A 27-year-old Caucasian male with a noncontributory medical history was referred to our department for the endodontic evaluation of the mandibular right first and second molars, which were connected to an extensive asymptomatic osteolytic lesion. A multimodular diagnostic assessment involving CBCT imaging, ultrasound, and histopathologic examination led to a definite diagnosis of a TBC overlapping with apical periodontitis (AP). Subsequently, a multidisciplinary treatment approach was performed, including surgical excision and biopsy of the lesion, endodontic retreatment of the right mandibular first molar, and postsurgical root canal treatment of the second molar. During the follow-up period of five years, the patient was reassessed periodically once a year and showed, in the absence of signs and symptoms, progressive healing of the affected area. The present article reports a case following the CARE guidelines of a TBC combined with AP where a multimodular diagnostic assessment was performed and discusses the possible pathogenetic mechanisms involved in its generation.

Ultrasound Examination to Visualize and Trace Sinus Tracts of Endodontic Origin.

INTRODUCTION: The detection of a tooth with a sinus tract (ST) of endodontic origin and its pathway are conventionally assessed with a periapical radiograph and a gutta-percha cone introduced into its stoma. The aim of this study was to evaluate the possibility to detect STs and trace their route using ultrasound real-time examination. METHODS: Two calibrated examiners performed echography on 10 patients who had a lesion of apical periodontitis (AP) and ST and 10 patients in the control group with AP without an ST recruited in 2 endodontic practices. They also traced the pattern of the STs with a computer program. The images were then submitted to 2 calibrated and blinded observers who were asked to describe the presence of AP and ST and to trace it with the same program. The data obtained were compared with the clinical and radiographic diagnosis of ST. For sensitivity, specificity, accuracy, and positive and negative predictive values, the receiver operating characteristic curve and Fisher exact test were used (P < .05). RESULTS: Interobserver agreement was high as was the diagnostic accuracy of the ultrasound examination of STs (mean value = 97.5%), and the Fisher exact test showed statistical significance (P < .05). High sensitivity and a negative predictive value and 100% specificity and a positive predictive value were also obtained. The application of the 3-dimensional mode further enabled the reconstructions of the more complex paths, and the implementation with color power Doppler disclosed the vascularity surrounding the STs. CONCLUSIONS: The ultrasound examination is a technique feasible to describe and trace the STs of endodontic origin.

Ultrasonography in the diagnosis of bone lesions of the jaws: a systematic review.

The diagnostic use of ultrasonography in dentistry and maxillofacial surgery has previously been described in the literature. Considering that ultrasonography may be useful for the diagnosis of bone lesions of the jaws, a systematic review was carried out to examine the evidence. This review determined that ultrasonography has been used effectively for the diagnosis of infective and/or inflammatory lesions, cysts, nonodontogenic tumors, odontogenic tumors, and arteriovenous malformations and for the differential diagnosis of lesions of endodontic origin, compared with the gold standard of histologic analysis. Ultrasonography may be a viable adjunct to other special tests for the diagnosis of intraosseous lesions of the jaws, as it is noninvasive and does not involve ionizing radiation exposure of the patient.

Root Canal Treatment versus Single-Tooth Implant: A Systematic Review of Internet Content.

INTRODUCTION: There is an absence of professional consensus regarding when a tooth should be retained with root canal treatment and when to extract and replace it with an implant. Considering that patients often seek health-related information on the Internet, completeness and accuracy of online content are highly desirable. Websites should also fulfill several technical characteristics to be accessible to all. METHODS: The search term root canal treatment implant was entered into 4 search engines. The first 100 webpages per engine search were evaluated. After removal of duplicates, those webpages comparing root canal treatment against single-tooth implant by using the AAE Implant Statement criteria as a benchmark were included. Completeness of information was evaluated against the AAE Statement by using a binary scale assessment tool. The related content was synthesized by using a protocol for systematic review of textual, non-research evidence. The webpages/sites were assessed for accessibility, usability, reliability, and quality of information by using the DISCERN and LIDA tools. RESULTS: Twenty-six relevant webpages were found. Information completeness scores ranged from 1 to 6; however, nearly one third scored 1. Nine syntheses were derived relating to survival rates, tooth restorability, bone quality, esthetic demands, and systemic factors. The median overall scores for LIDA and DISCERN were 72% and 61%, respectively. CONCLUSIONS: There is scarcity of information available on the Internet for the lay public with respect to the specific clinical question, although the webpages' content was consistent with available scientific literature. The accessibility, usability, reliability, and quality of information were largely moderate or low.