Highly efficient optical fiber sensor for instantaneous measurement of elevated temperature in dental hard tissues irradiated with an Nd:YaG laser.

In this in vitro experiment, the effect of 1.064 µm pulsed laser on both enamel- and dentin-dental tissues has been investigated. A total of fifty-five dental hard tissue samples were exposed to Nd:YAG laser that possesses a pulse width of 9 ns and 850 mJ of total energy. An optical fiber sensor was put behind the samples to measure the temperature instantaneously. A novel, to the best of our knowledge, fiber sensor has been proposed and used to measure the heat generated in dental hard tissues instantaneously after the application of laser irradiation on the tissue surface. This optical sensor exhibits a fast response time of about 1 ms and high sensitivity with about 1.975 nm/°C. The findings of this study in decreasing the probability of pulpal necrosis structure while handling the tooth, whether for ablation, welding, or tooth resurfacing purposes, may establish standards for dentists and laser manufacturers (healthcare professionals) that should be followed.

Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial.

OBJECTIVE: This multicenter randomized controlled clinical trial aimed to compare the outcomes of stepwise excavation (SW) and partial caries removal (PCR) regarding the maintenance of pulp vitality in deep caries lesions over 5 years. METHODS: At baseline, 299 permanent molars with deep caries lesions were randomly assigned to control or test groups. The control group received the stepwise excavation treatment (SW), while the test group received partial caries removal from the pulpal wall followed by restoration in a single session (PCR). Treatments were conducted in two centers located in the cities of Porto Alegre (South Brazil) and Brasília (Midwest Brazil). Survival analysis was performed to compare PCR and SW over time (Weibull regression models). The primary outcome of this study was pulp vitality, determined by the combination of the following characteristics: positive response to cold test, negative response to percussion, absence of spontaneous pain, and absence of periapical lesion (radiographic examination). RESULTS: This 5-year study includes data pertaining to 229 teeth: 121 teeth actually examined at the 5-year appointment, and 108 teeth contributed with data collected in previous follow-ups (18 months or 3 years). Survival analysis showed success rates of 80% in PCR group and 56% in SW group (p < 0.001). Failure was significantly associated with treatment [PCR, HR=0.38; 95%CI=0.23-0.63)] and region [South, HR=2.22; 95%CI=1.21-4.08]. CONCLUSION: PCR significantly reduced the occurrence of pulp necrosis when compared with SW. CLINICAL RELEVANCE: This study supports the PCR as a single-visit technique to manage deep caries lesions in permanent teeth.

A retrospective study of traumatic dental injuries in primary dentition: treatment outcomes of splinting.

OBJECTIVE: Splinting in primary dentition is limited to several traumatic dental injuries. The prognosis associated with splint use has not been fully investigated. In this study, we investigated the outcomes of traumatic injuries in primary teeth treated with splinting. MATERIALS AND METHODS: We retrospectively analysed 137 children with root fractures and lateral and extrusive luxation injuries to their primary teeth who were treated with semi-rigid splints between 2010 and 2016. Treatment outcomes were analysed in patients with follow-up periods of >6 months. The outcomes of splinting were based on clinical and radiographic evaluations performed during follow-up examinations. RESULTS: In total, 182 primary teeth were examined, and of these, 90 teeth were treated using semi-rigid splints. In the splint group, pathological root resorption (31.1%) was the most common complication, whereas pathological tooth loss (25.0%) was found most common in the observation group. Splinting in root fractures showed a good prognosis, whereas in lateral and extrusive luxations, it did not (p < .05). There were no relationship between treatment delay and prognosis (p > .05). CONCLUSIONS: Depending on the type of luxation, splint therapy results in acceptable outcomes and may be a feasible treatment option.

Natural reversal of tooth discoloration and pulpal response to testing following removal of a miniscrew implant for orthodontic anchorage: a case report.

AIM: To highlight the reversal of signs suggesting pulpal necrosis following removal of a mini-implant without endodontic intervention. SUMMARY: A 23-year-old woman presented with a class III malocclusion, with crowded and malformed teeth and excessive gingival display. During orthodontic treatment, a Tomas orthodontic miniscrew was placed between the root apices of the maxillary central incisors. This was carried out by an orthodontic specialist who had treated more than 700 patients (with more than 2000 mini-implants) over the past 9 years. After 2 weeks of treatment, the right maxillary central incisor discoloured and did not respond to electrical pulp tests (EPT) but was sensitive to endo-ice. The miniscrew was removed under local anaesthesia. Teeth 11 and 21 were fixed with ligation wire, and glass-ionomer cement (GIC) was added to the occlusal surfaces of the first and second maxillary molars to heighten the occlusion and disclude the maxillary anterior teeth. After 4 months, the colour and pulp reactions to EPT and endo-ice of tooth 11 returned to normal. Because the use of a miniscrew had appeared to damage the pulp, subsequent a conservative orthodontic treatment using, traditional 'J' hooks was used and achieved satisfactory results. After 23 months of orthodontic treatment, the treatment was complete and a 15-month follow-up showed a successful outcome.

Pulp necrosis of teeth retained at the mandibular fracture site and the effect of dexamethasone on its occurrence.

OBJECTIVES: The main purpose was to determine the occurrence of pulp necrosis (PN) of teeth retained at the mandibular fracture site. An additional purpose was to investigate whether perioperative use of dexamethasone increases the risk of PN. PATIENTS AND METHODS: A follow-up study on 24 adult dentate patients with mandibular body, symphysis or parasymphysis fracture. These patients had been selected from a larger cohort who had participated in a randomized study of maxillofacial fractures and dexamethasone. All patients who were suspected of having a need for endodontic treatment were evaluated by an endodontist. RESULTS: PN was diagnosed in six patients (25.0%) in one or two teeth. Of a total of 33 teeth situated in the fracture line, six (18.2%) were diagnosed as having PN. PN was more common in teeth in which the fracture line ran through the apex (21.7%) than in those in which the fracture line was in contact with the tooth cranially to the apex (10.0%). The association between PN and dexamethasone was not significant. CONCLUSION: PN is common after mandibular fractures, particularly when the fracture line runs through the apex of the tooth. Use of short-term, high-dose dexamethasone perioperatively did not significantly increase the risk for PN.

[Spontaneous dental abscesses in familial hypophosphatemic rickets]. / Multipele spontane odontogene abcessen bij familiaire hypofosfatemische rachitis.

Symptoms of familial hypophosphatemic rickets are growth retardation, the formation of O- or X-legs, pain of the joints, spontaneous dental abscesses, and delayed tooth eruption. The dental symptoms are predominantly attributable to the demineralization of dentin. In absence of adequate preventive measurements,familial hypophosphatemic rickets may lead to spontaneous pulpal necrosis. The prophylactic application of occlusal sealants might be effective in preventing abscess formation.

Vital pulp therapy for the primary dentition.

The goal of primary tooth pulp therapy is the preservation of the primary teeth until their normal time of exfoliation. Teeth with carious involvement approaching the pulp can be treated with a variety of approaches, including three pulpotomy techniques--diluted formocresol, ferric sulfate, and mineral trioxide aggregate--and an indirect pulp therapy technique. Accurate diagnosis of the vitality status of the pulp is critical to the success of each treatment and involves careful radiographic and clinical assessment of the teeth to make sure that they are either healthy or reversibly inflamed.

Effects of antibacterial agents on dental pulps of monkeys mechanically exposed and contaminated.

OBJECTIVE: The purpose of this study was to compare the effectiveness of antibacterial agents and mineral trioxide aggregate in the healing of bacterial contaminated primate pulps. STUDY DESIGN: The experiment required four adult male primates (Cebus opella) with 48 teeth prepared with buccal penetrations into the pulpal tissues. The preparations were performed under general anesthesia and the exposed pulps were exposed to cotton pellets soaked in a bacterial mixture consisting of microorganisms normally found in human pulpal abscesses obtained from the Endodontic Clinic of UNESP. Following bacterial inoculation (30 minute exposure), the pulpal tissue was immediately treated with either sterile saline, Cipro HC Otic solution (12), diluted Buckley' formecresol solution (12) or Otosporin otic solution (12) for 5 minutes. After removal of the pellet, hemostasis was obtained and a ZOE base applied to the DFC treated pulps and the non-treated controls (12). After hemostasis, the other exposed pulps were covered with mineral trioxide aggregate (ProRoot). The pulpal bases were all covered with a RMGI (Fuji II LC). The tissue samples were collected at one day, two days, one week and over four weeks (34 days). RESULTS: Following perfusion fixation, the samples were demineralized, sectioned, stained and histologically graded. After histologic analysis, presence of neutrophilic infiltrate and areas of hemorrhage with hyperemia were observed. The depth of the neutrophilic infiltrate depended on the agent or material used. The pulpal tissue treated with Otic suspensions demonstrated significantly less inflammation (Kruskal Wallis non parametric analysis, H = 9.595 with 1 degree of freedom; P = 0.0223) than the formocresol and control groups. The hard tissue bridges formed over the exposure sites were more organized in the MTA treatment groups than in the control and ZOE groups (Kruskal Wallis non parametric analysis, H = 18.291 with 1 degree of freedom; P = 0.0004). CONCLUSIONS: Otic suspensions and MTA are effective in treating bacterial infected pulps and stimulate the production of a hard tissue bridge over the site of the exposure.

Zinc oxide eugenol and Endoflas pulpectomy in primary molars: 24-month clinical and radiographic evaluation.

CONTEXT: Despite modern advancement in material and technical aspect, management of infected primary molars is of prime concern in pediatric endodontics. An effective root canal material plays the major role in achieving the fluid impervious seal by defending against variant microflora and maintaining the tooth in function for longer duration. AIMS: This study aims to evaluate and compare the success of endoflas as root canal filling material in infected primary molars with zinc oxide eugenol (ZOE). MATERIALS AND METHODS: Primary molars with necrotic pulp in healthy, cooperative children were selected. Ethical clearance and informed consent was obtained. Standardized pulpectomy procedure was done and root canals were filled with either ZOE or endoflas. Further follow-up with clinical and radiographic evaluation was carried at 0, 3, 6, 12, and 24 months. The findings obtained were statistically analyzed using Chi-square test. RESULTS: Endoflas showed acceptable results as root canal filling material in primary molars even at 2-year follow-up, though overfilling of root canals led to low success rate compared to teeth with combined optimal and under fillings. There was no significant difference between the two materials (P > 0.05). CONCLUSIONS: Endoflas could be a potential alternative to ZOE for preserving infected primary molars.

Preservation in Young Patients of Pulp Vitality and Anatomical-Functional Restoration of the Lost Structure.

Often, young patients (≤30 years old) present with carious lesions that progress acutely, compromising a large amount of tooth structure. In these cases, a treatment to prevent the occurrence of pulp exposure and promote remineralization of caries-affected dentin is necessary to maintain healthy dental structure and allow more conservative interventions. The approach will be different when pulp exposure occurs: The therapeutic treatments will be focused on reparative dentin formation and prevention of microorganisms penetrating the pulp organ. Due to the different possible treatments that can be performed to avoid pulp necrosis and the various materials that can be used for this purpose, professionals may have some difficulties understanding all the indications for conservative pulp treatments. The objective of this article is to describe and discuss a successful pulp capping and stepwise excavation associated with restorative treatment for deep caries lesions of anterior upper teeth.

Management of coronal discolouration following a regenerative endodontic procedure in a maxillary incisor.

Pulpal necrosis and infection in an immature anterior tooth subsequent to traumatic injury is a challenging situation. Regenerative endodontics, resulting in continued development of the tooth, provides a biological response to this clinical challenge. Regenerative endodontic procedures require disinfection of the infected root canal and sealing of the pulp canal space. Mineral trioxide aggregate (MTA) provides a good seal, is biocompatible and allows the formation of a hard tissue to occur within the root canal. MTA, however, can lead to significant staining of the crown of the tooth that is difficult to mask. This case report describes the management of discolouration in an 11 year old girl subsequent to a regenerative endodontic procedure in an immature traumatized maxillary central incisor.

Clinical evidence and literature to compare two different therapeutic protocols in tooth avulsion.

AIM: This is to assess the priority in tooth avulsion: replantation as quickly as possible and deferred endodontic treatment, or replantation and elimination of every irritating stimulus for the periodontal ligament. The objective is to establish a univocal protocol by analysing and comparing the various components of these therapeutic procedures. STUDY DESIGN: 20 patients were selected and divided into 2 groups: in group A we focused our attention on the rapidity of replantation, in group B we focused on the elimination of the necrotic pulp and every possible irritating stimulus that might lead to root resorption of inflammatory nature. RESULTS: Clinically, dental mobility seems to be greater in the first group. However after 15 days teeth have a comparable mobility and after one month they all show a mobility degree 1. Radiographically a greater incidence of resorption can be observed in group A compared to group B as in the first one a higher number of replanted teeth undergo resorption. Such lesions have the tendency to remain constant or even increase. CONCLUSIONS: The results of this study seem to take only one direction: extraoral endodontic therapy.

Temperature changes in dental pulp associated with use of power grinding equipment on equine teeth.

OBJECTIVE: To quantify the temperature changes in the dental pulp associated with equine dental procedures using power grinding equipment. DESIGN: A matrix experimental design with replication on the same sample was followed to allow the following independent variables to be assessed: horse age (young or old), tooth type (premolar or molar), powered grinding instrument (rotating disc or die grinder), grinding time (15 or 20 seconds) and the presence or absence of water coolant. PROCEDURE: Sound premolar and molar teeth from a 6-year-old horse and a 15-year-old horse, which had been removed postmortem, were sectioned parallel to the occlusal plane to allow placement of a miniature thermocouple at the level of the dental pulp. The maximum temperature increase, the time taken to reach this maximum and the cooling time were measured (n=10 in each study). The teeth were placed in a vice and the instrument used on the tooth as per clinical situation. RESULTS: Significant differences were recorded for horse age (P < 0.001), instrument type (P < 0.001), grinding time (P < 0.001) and presence or absence of coolant (P < 0.001). There was no significant difference for tooth type. CONCLUSION: Thermal insult to the dental pulp from the use of power instruments poses a significant risk to the tooth. This risk can be reduced or eliminated by appropriate selection of treatment time and by the use of water irrigation as a coolant. The increased dentine thickness in older horses appears to mitigate against thermal injury from frictional heat.

Consequences of crown shortening canine teeth in Greenland sled dogs.

OBJECTIVES: To evaluate the consequences of crown shortening, focusing on the prevalence of pulp exposure and periapical pathology in Greenland sled dogs that had had their canine crowns shortened at an early age. METHODS: Five cadaver heads and 54 sled dogs underwent an oral examination for dental fractures and pulp exposure of canines. All canines were radiographed and evaluated for periapical pathology. RESULTS: The prevalence of canine pulp exposure in 12 (5 heads and 7 dogs) crown shortened dogs was 91 · 7%, and 21 · 3% in 47 not-crown shortened dogs. A significant (P < 0 · 001) risk of pulp exposure of the canines in the crown shortened group compared to the not-crown shortened group was seen with a relative risk of 4 · 3 on a dog basis and a relative risk of 12 · 2 on a tooth basis. In dogs with pulp exposure of canines (n = 51) the prevalence of periapical pathology was 82 · 4%, but only 0 · 8% in dogs without pulp exposure (n = 133) resulting in a significant (relative risk, 109 · 5; P < 0 · 001) risk of periapical pathology in teeth with pulp exposure compared to teeth without pulp exposure. CLINICAL SIGNIFICANCE: The high risk of periapical pathology observed in teeth with pulp exposure confirms that these teeth should not be neglected in affected dogs.

Reduction of infection-stimulated periapical bone resorption by the biological response modifier PGG glucan.

Pulpal and periodontal diseases are bacterial infections which result in local connective tissue and bone destruction. Effective host resistance to these infections is primarily mediated by neutrophils and other phagocytic cells. PGG glucan (poly-beta 1-6-glucotriosyl-beta 1-3-glucopyranose glucan) is a biological response modifier which stimulates the production of neutrophils and upregulates their phagocytic and bactericidal activity. In the present studies, the effect of PGG glucan on infection-stimulated alveolar bone resorption was tested in an in vivo model. Periapical bone resorption was induced in Sprague-Dawley rats by surgical pulp exposure and subsequent infection from the oral environment. Animals were administered PGG glucan (0.5 mg/kg) or saline (control) subcutaneously the day before and on days 2, 4, 6, 9, 11, 13, 16, and 18 following the pulp exposure procedure. PGG glucan enhanced the number of circulating neutrophils and monocytes and increased neutrophil phagocytic activity approximately two-fold. PGG glucan-treated animals had significantly less infection-stimulated periapical bone resorption than control animals, as determined radiographically (-48.0%; p < 0.001) and by histomorphometry (-40.8% and -42.4% for first and second molars, respectively; p < 0.001). PGG glucan-treated animals also had less soft tissue destruction, as indicated by decreased pulpal necrosis. Only 3.3% of the first molar pulps from PGG glucan-treated animals exhibited complete necrosis, as compared with 40.6% of pulps from controls. Finally, PGG glucan had no effect on either PTH- or IL-1-stimulated bone resorption in vitro.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of antibacterial capping agents on dental pulps of monkeys mechanically exposed to oral microflora.

The effects of antibacterial drugs on bacterially contaminated dental pulps were investigated in monkeys. Class V buccal cavities with pulpal exposures were prepared and then left open to the oral environment for 24 h. The exposed pulps were capped with alpha-tricalcium phosphate (alpha-TCP) containing a mixture of antibacterial drugs. Either alpha-TCP or Ca(OH)2 was used as a control. Pulpal responses were histologically evaluated after 4 wk. Those teeth capped with alpha-TCP alone showed total pulp necrosis and bacterial growth within the pulp chamber. By contrast, the pulps capped with alpha-TCP containing mixed antibacterial drugs remained almost normal without any necrotic layer, but showed persistent absorbing response to capping materials and no signs of hard tissue barrier formation. In teeth capped with Ca(OH)2, a hard tissue barrier was formed below the exposure site, with a wide loss of pulp tissue. No inflammation was seen under the barrier. These results indicate that mixed antibacterial drugs added to alpha-TCP effectively disinfected pulpal lesions, without destroying any of the sound pulp tissue. However, hard tissue barrier formation was delayed by this mixture as compared with Ca(OH)2.

Pulpotomy reconsidered: application of an adhesive system to pulpotomized permanent primate pulps.

OBJECTIVE: This study was undertaken to compare the healing response of permanent primate pulps to pulpotomy procedures following hemorrhage control and adhesive hybridization to their response after conventional treatments. METHOD AND MATERIALS: Forty-two cavities were placed throughout the dentitions of 4 adult monkeys. In 24 teeth, following mechanical bur exposure and pulpotomy, hemorrhage was controlled with application of 3% sodium hypochlorite. The cavity was rinsed and the enamel-dentin-pulp surface was restored with an adhesive system for 6 and 7 months. Calcium hydroxide, formocresol, and resin-modified glass-ionomer cement were placed as conventional treatments in 18 teeth for 70 days and cavities were sealed with resin-modified glass-ionomer cement. Following perfusion fixation, tissues were demineralized, sectioned, stained, and histologically graded using defined criteria. RESULTS: Of 24 adhesive system pulps, 10 showed no or minimal pulpal response, 1 showed an acute response, 6 showed a chronic response, 2 showed a severe response, and 5 showed compartmentalized zones of localized necrosis. Only 8 adhesive system pulps showed stained bacteria associated with inflamed tissues. Thirteen adhesive system pulps showed dentin bridging directly at the adhesive system interface. Calcium hydroxide-treated specimens showed healing and dentin formation, while resin-modified glass-ionomer cement and formocresol treatments failed to result in any bridging. Apical tissues in all adhesive-treated specimens showed normal pulps and primary odontoblasts along their entire walls. CONCLUSION: Permanent pulps without periapical radiolucencies may survive pulpotomy, provided that hemorrhage is properly controlled and the pulp-restoration interface is hybridized to exclude all microleakage.

Postreplantation management of avulsed teeth: an endodontic literature review.

Today's dental treatment goals are directed at reducing the incidence of root resorption resulting from periodontal ligament devitalization or pulp necrosis. Although the American Association of Endodontists recommends the use of long-term therapy, short-term therapy may be utilized with confidence in well-defined clinical applications. Early final obturation with gutta-percha will increase the long-term prognosis in those cases where patient motivation is questionable or long-term follow-up prior to obturation is not possible. However, where inflammatory resorption is already present, long-term calcium hydroxide therapy is indicated. Long-term post treatment follow-up is imperative in both calcium hydroxide therapies.

[Injuries of permanent incisors: epidemiology and management in a public health clinic in Dakar]. / Traumatismes des incisives permanentes: épidemiologie et prise en charge en pratique publique à Dakar.

This prospective study done in a dental care center in a near suburb of Dakar during a period between January 1999 and December 2000, bas shown that permanent incisors traumatism's frequency is about 10.30% (61 teeth) which come within common values of the literature; and a sex ratio of 2.25. These traumatisms concern central maxillary incisors (75.41%) on patients less than 20 years old; falls, violence and road accidents are the major etiology. The consulting time limit is quite disadvantaged to preserve pulp vitality and dental re-implant in case of recent traumatisms. 53.33% of old dental traumatisms are observed to patients between 20 and 40 years old. And overall 80.76% of endodontic treatments realised in this case were not finished. The control of pain and anxiety would ease the emergency treatment. The information's of patients about significance of the consulting time limit, their motivation on differed dental treatments and/or endodontic treatments, as well the post traumatic watch would improve the management and the prognostic by setting of a referenced dental care units.

Effects of dental trauma on the pulp.

Infection of the root canal system following dental trauma induces pulp and periapical disease and prevents healing of previously healthy pulp. A clinical goal in treating trauma is the maintenance of pulp vitality, and clinicians should be aware of factors that influence pulp healing. The learning objective of this article is to review the factors and techniques that influence pulp vitality and examine the influence pulp has on the healing of adjacent tissues. The potential routes for bacterial infection of the root canal system are discussed, with the clinical crown as the primary portal of entry. Uncomplicated and complicated crown fractures, as well as the crown-root and root fractures, are reviewed. Complications in pulp healing include canal obliteration, disturbed root development, apexogenesis, apexification, and the various forms of resorption.