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1.
Int J Oral Sci ; 16(1): 22, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38429281

RESUMO

Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy (RCT). Recent research, encompassing bacterial etiology and advanced imaging techniques, contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT. Success in RCT hinges on factors like patients, infection severity, root canal anatomy, and treatment techniques. Therefore, improving disease management is a key issue to combat endodontic diseases and cure periapical lesions. The clinical difficulty assessment system of RCT is established based on patient conditions, tooth conditions, root canal configuration, and root canal needing retreatment, and emphasizes pre-treatment risk assessment for optimal outcomes. The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT. These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.


Assuntos
Materiais Restauradores do Canal Radicular , Tratamento do Canal Radicular , Humanos , Consenso , Tratamento do Canal Radicular/métodos , Guta-Percha/uso terapêutico , Necrose da Polpa Dentária/tratamento farmacológico , Retratamento , Cavidade Pulpar , Materiais Restauradores do Canal Radicular/uso terapêutico , Preparo de Canal Radicular
2.
Clin Oral Investig ; 28(4): 209, 2024 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-38467867

RESUMO

AIM: The purpose of the present study was to evaluate permanent teeth with post-traumatic transversal root fractures, for their initial healing modality, the effect of candidate predictors and their long-term prognosis. METHODOLOGY: A retrospective longitudinal clinical study was conducted to evaluate records from patients bearing transversal root fractures in permanent teeth in order to radiographically assess short-term healing and non-healing events in the fracture line, their prognostic factors and their relationship with long term outcomes. The inter-fragmentary tissues were classified as healing: hard tissue (HT), connective tissue (CT) or connective tissue and bone (CT + B) and non-healing: interposition of granulation tissue (GT). A competing risk survival analysis was conducted to estimate the hazards of healing and non-healing events in the short-term and the effect of demographic, clinical, and treatment variables was assessed using the subdistribution regression model (Fine & Gray). RESULTS: Radiographic findings showed 61.4% of healing in the short-term being strongly influenced by the presence and type of concomitant injuries to the coronal fragment. Teeth with concomitant crown fractures (sHR 24.38, 95% CI [3.16-188.3], p = 0.0022), luxations with dislocations (sHR 10.58, 95% CI [1.37-81.9], p = 0.0240) and subluxations (HR 9.66, 95% CI [1.14-81.7], p = 0.0370) were more likely to present non-healing of root fractures in the short-term. The healing rate in the long-term was of 75.9%, most of them with interposition of bone and connective tissue. Kappa statistics demonstrated an overall agreement of 67.1% between short and long-term healing patterns, in special HT and CT + Bone modalities. CONCLUSION: Healing at the fracture site was the most frequent outcome, both in the short-term and in the long-term. Short-term healing modality was strongly influenced by the presence and type of concomitant injuries to the crown fragment, being the worst prognosis observed in root-fractured teeth with concomitant crown fractures, followed by concomitant luxations with dislocation. CLINICAL RELEVANCE: Post-traumatic transversal root fractures have a positive prognosis supporting therefore, a more conservative approach for these teeth before considering more radical treatments.


Assuntos
Fraturas Ósseas , Fraturas dos Dentes , Humanos , Estudos Longitudinais , Estudos Retrospectivos , Necrose da Polpa Dentária , Raiz Dentária/diagnóstico por imagem , Raiz Dentária/lesões , Fraturas dos Dentes/diagnóstico por imagem , Prognóstico
3.
Clin Oral Investig ; 28(3): 187, 2024 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-38430349

RESUMO

AIM: The present retrospective cohort study aimed to evaluate luxated permanent teeth for pulp prognosis and risk factors. METHODOLOGY: Case records and radiographs of 224 patients, involving 427 luxated permanent teeth, referred for treatment at the Dental Trauma Center-School of Dentistry, Universidade Federal de Minas Gerais, (DTC-SD-UFMG) from 2014 to 2022, were assessed for pulp prognosis classified as vitality, necrosis and pulp canal obliteration (PCO). A competing risk survival analysis estimated the hazards of the three outcomes, and the effect of demographic, clinical and treatment variables was tested using a cause specific Cox regression model. RESULTS: Pulp vitality was found in163 teeth (38.2%), pulp necrosis in 120 teeth (28.1%) and 55 teeth (12.9%) developed PCO. Pulp vitality decreased in the presence of concomitant crown fractures (HR 0.38 95% CI [0.2-0.8] p = 0.006). The risk of pulp necrosis (HR 0.62 95% CI [0.4-0.96] p = 0.03) was lower in cases with open apices but increased with concomitant crown fractures (HR 4.0 95% CI [2.6-6.1] p = 0.001) and intrusions (HR 2.3 95% CI [1.2-4.1] p = 0.007). Lateral or extrusive luxations (HR 3.0 95% CI [1.3-6.9] p = 0.001) and open apices (HR 2.4 95% CI [1.2-4.7] p = 0.01) showed higher rates of PCO. CONCLUSION: Type of luxation, the diameter of the apical foramen, and the presence of concomitant crown fractures were main determinants of pulp prognosis after luxation injuries in permanent teeth. CLINICAL RELEVANCE: Pulp prognosis after tooth luxation is dependent on the presence and direction of tooth displacement together with infection control. CLINICAL TRIAL REGISTRATION: Not applicable.


Assuntos
Avulsão Dentária , Fraturas dos Dentes , Humanos , Necrose da Polpa Dentária/terapia , Estudos Retrospectivos , Polpa Dentária , Avulsão Dentária/complicações , Prognóstico , Medição de Risco
4.
BMC Oral Health ; 24(1): 330, 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38481211

RESUMO

BACKGROUND: With increasing studies being published on regenerative endodontic procedures (REPs) as a treatment modality for mature necrotic teeth, the assessment of outcomes following regenerative endodontic procedures has become more challenging and the demand for a better understanding of the regenerated tissues following this treatment is rising. The study aimed to correlate cold, electric pulp testing (EPT), and magnetic resonance imaging (MRI) signal intensity (SI) in mature necrotic teeth treated with regenerative endodontic procedures. METHODOLOGY: This retrospective cohort study included eighteen adult patients who experienced tooth necrosis in mature maxillary anterior teeth recruited from the outpatient clinic, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt from July 2017 until December 2018 with 12 months of follow-up. regenerative endodontic procedures via blood clot were performed. The canals were instrumented by ProTaper Next (PTN) files until final sizes X3 or X5. Biodentine was used as cervical plug material. Pre and post-operative clinical follow-up was done where the patients' responses to cold and electric pulp testing were given a scoring system and were compared to the normal contralateral tooth. Pre and post-operative magnetic resonance imaging signal intensity of both the involved tooth and its contralateral at the middle and the apical thirds of the root canals were assessed after 3, 6, and 12 months. Data was analyzed using the ANOVA, Friedman and Bonferroni tests. Significance was set at a p-value < 0.05. RESULTS: All 18 teeth scored a baseline score of "2" for cold and electric pulp testing. There was a significant difference between scores of the cold test at baseline and 12-month follow-up (p < 0.001). There was a significant difference between scores of the electric pulp testing of baseline and 12-month follow-up (p < 0.001). There was a moderately significant indirect (inverse) correlation between magnetic resonance imaging signal intensity and cold test in both the middle and apical thirds at 12 months. No significant correlations were detected between magnetic resonance imaging signal intensity and electric pulp testingat any of the time intervals (p > 0.05). CONCLUSION: Magnetic resonance imaging is a successful non-invasive method to assess outcomes of regenerative endodontic procedures and correlating it with another reliable method of assessing pulpal responses, cold test, could validate these outcomes. CLINICAL TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov (ID: NCT03804450).


Assuntos
Periodontite Periapical , Endodontia Regenerativa , Adulto , Humanos , Polpa Dentária/diagnóstico por imagem , Necrose da Polpa Dentária/diagnóstico por imagem , Necrose da Polpa Dentária/terapia , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Necrose , Periodontite Periapical/terapia , Endodontia Regenerativa/métodos , Estudos Retrospectivos , Tratamento do Canal Radicular/métodos
5.
J Contemp Dent Pract ; 25(1): 92-97, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38514438

RESUMO

AIM: This report addresses the management of a large persistent discharging lesion in an 11-year-old boy. The report describes the use of aspiration-irrigation technique for the management of immature necrotic tooth with persistent discharge after a failed regenerative procedure. BACKGROUND: Regenerative endodontics aim to provide an increase in root canal width, length, and in apical closure. Alternative procedures, such as apexification, should be attempted when regeneration fails. If the canal cannot be dried to persistent discharge, the aspiration-irrigation technique can be used. The technique relies on using aspiration along with irrigation to remove pus from the periapical area. CASE DESCRIPTION: This is a case for an 11-year-old patient who had trauma to tooth #11, which resulted in the complicated crown fracture. He had an emergency management that included pulpectomy and intracanal medication at another clinic. Two years later, the patient was presented to our clinic. Upon examination, the diagnosis was previously initiated therapy with asymptomatic apical periodontitis in immature tooth #11. Regeneration was attempted first but failed. The mineral trioxide aggregate (MTA) plug was removed, and the canal had persistent pus discharge. The canal was filled with intracanal medication, and then 2 weeks later, the canal was filled with triple antibiotic paste (TAP). Next visit, and due to continuous discharge, tooth #11 was treated conservatively with an intracanal aspiration-irrigation technique. An IrriFlex needle attached to a high-volume suction was used to aspirate the cystic fluid. Mineral trioxide aggregate plug apexification was performed in a later visit and the tooth was restored. CONCLUSION: During the 3-month and 16-month follow-up, there was resolution of the symptoms, a decrease in the periapical lesion size, and soft tissues appeared within normal limits. CLINICAL SIGNIFICANCE: Regenerative procedures are a good option for immature necrotic teeth. These procedures may fail due to persistent pus discharge from the root canals. The aspiration-irrigation technique is a good treatment option in cases of consciously discharging canals. How to cite this article: Alsofi L, Almarzouki S. Failed Regenerative Endodontic Case Treated by Modified Aspiration-irrigation Technique and Apexification. J Contemp Dent Pract 2024;25(1):92-97.


Assuntos
Endodontia Regenerativa , Materiais Restauradores do Canal Radicular , Masculino , Humanos , Criança , Apexificação/métodos , Materiais Restauradores do Canal Radicular/uso terapêutico , Ápice Dentário/patologia , Compostos de Cálcio/uso terapêutico , Combinação de Medicamentos , Óxidos/uso terapêutico , Compostos de Alumínio/uso terapêutico , Silicatos/uso terapêutico , Supuração/tratamento farmacológico , Supuração/patologia , Necrose da Polpa Dentária/terapia
6.
BMC Oral Health ; 24(1): 319, 2024 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-38461281

RESUMO

BACKGROUND: In the regenerative endodontic procedures, scaffolds could influence the prognosis of affected teeth. Currently, there is controversy regarding the postoperative evaluation of various scaffolds for pulp regeneration. The objective of this study was to access whether other scaffolds, used alone or in combination with blood clot (BC), are more effective than BC in regenerative endodontic procedures. METHODS: We systematically search the PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Google Scholar databases. Randomized controlled trials examining the use of BC and other scaffold materials in the regenerative endodontic procedures were included. A random effects model was used for the meta-analysis. The GRADE method was used to determine the quality of the evidence. RESULTS: We screened 168 RCTs related to young permanent tooth pulp necrosis through electronic and manual retrieval. A total of 28 RCTs were related to regenerative endodontic procedures. Ultimately, 12 articles met the inclusion criteria and were included in the relevant meta-analysis. Only 2 studies were assessed to have a low risk of bias. High quality evidence indicated that there was no statistically significant difference in the success rate between the two groups (RR=0.99, 95% CI=0.96 to 1.03; 434 participants, 12 studies); low-quality evidence indicated that there was no statistically significant difference in the increase in root length or root canal wall thickness between the two groups. Medium quality evidence indicated that there was no statistically significant difference in pulp vitality testing between the two groups. CONCLUSIONS: For clinical regenerative endodontic procedures, the most commonly used scaffolds include BC, PRP, and PRF. All the different scaffolds had fairly high clinical success rates, and the difference was not significant. For regenerative endodontic procedures involving young permanent teeth with pulp necrosis, clinical practitioners could choose a reasonable scaffold considering the conditions of the equipment and patients.


Assuntos
Necrose da Polpa Dentária , Endodontia Regenerativa , Humanos , Necrose da Polpa Dentária/terapia , Polpa Dentária , Regeneração , Tratamento do Canal Radicular/métodos
7.
Int Endod J ; 57(3): 238-255, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37966465

RESUMO

AIM: The aim of this study was to assess which treatment modality regarding scaffold selection for immature permanent teeth with pulpal necrosis will be the most successful for regenerative endodontic treatment (RET). METHODOLOGY: PubMed, Cochrane, Web of Science and Embase, and additional records until August 2022 were searched providing a total of 3021 articles, and nine of these articles were included for quantitative synthesis. The reviewers selected eligible randomized controlled trials and extracted pertinent data. Network meta-analysis was conducted to estimate treatment effects for primary outcomes (clinical and radiographic healing) and secondary outcomes (apical closure, root length and root wall thickness increase) following RET [mean difference (MD); 95% credible interval (CrI) and surface under the cumulative ranking curve (SUCRA)]. The quality of the included studies was appraised by the revised Cochrane risk of bias tool, and the quality of evidence was assessed using the GRADE approach. RESULTS: Six interventions from nine included studies were identified: blood clot scaffold (BC), blood clot scaffold with basic fibroblast growth factor, blood clot scaffold with collagen, platelet pellet, platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). The PRP scaffold showed the greatest increase in root lengthening at 6-12 months (MD = 4.2; 95% CrI, 1.2 to 6.8; SUCRA = 89.0%, very low confidence). PRP or PRF achieved the highest level of success for primary and secondary outcomes at 1-6 and 6-12 months. Blood clot scaffold (with collagen or combined with basic fibroblast growth factor (bFGF)) achieved the highest level of success for secondary outcomes beyond 12 months follow-up. A very low to low quality of evidence suggests that both PRP and PRF exhibit the greatest success evaluating primary and secondary outcomes within 12 months postoperatively compared to the traditional blood clot scaffold protocol. CONCLUSION: Limited evidence suggests both PRP and PRF exhibit success in the short-term, not long-term. The value of this information stems in its recommendation for future randomized trials prioritizing both of these materials in their protocol.


Assuntos
Endodontia Regenerativa , Trombose , Humanos , Metanálise em Rede , Fator 2 de Crescimento de Fibroblastos , Regeneração , Necrose da Polpa Dentária/terapia , Resultado do Tratamento , Colágeno
8.
J Endod ; 50(2): 181-188, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38013150

RESUMO

INTRODUCTION: The aim of this study was to ascertain the current trends in regenerative endodontic procedures (REPs) among clinicians, including case selection criteria and clinical protocols. METHODS: An online questionnaire consisting of provider demographics, case selection criteria for REPs, and clinical protocols was made available to members of the American Association of Endodontists and members of the Endolit website. Data were analyzed using the Fisher exact test. RESULTS: Two hundred seventy-two responses were analyzed (64.6% were men and 34.7% were women). Of those, 44.5% of respondents practiced in the United States, and 55.5% practiced outside of the Unites States. Most respondents (85.4%) reported performing REPs in their practice, and 92.2% were using sodium hypochlorite as one of their disinfecting irrigants. Calcium hydroxide was the most commonly used intracanal medicament (68.4%), and the majority of respondents use a blood clot alone as the scaffold (73.5%). Most (93%) of the providers reported using a bioceramic material for coronal capping. Practitioners outside the United States were found to be more likely to use adjunctive irrigation activation (P = .003). Younger practitioners preferred REPs over apexification (P = .01). Practitioners outside the United States were more likely to perform an REP in 1 visit (P = .006). Men were found to be more likely to always instrument the canal walls (P = .031). Women were found to be more likely to use manual irrigant activation, whereas men were more likely to use sonic activation (P = .043). CONCLUSIONS: There is significant heterogeneity within REPs regarding case selection and clinical protocol. Notable differences were observed from the reported findings of REPs from 5 years ago.


Assuntos
Endodontia , Endodontistas , Endodontia Regenerativa , Masculino , Humanos , Feminino , Hipoclorito de Sódio , Inquéritos e Questionários , Internet , Necrose da Polpa Dentária
9.
J Endod ; 50(2): 189-195, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37923123

RESUMO

The utility and feasibility of pulp regenerative therapy with autologous dental pulp stem cells (DPSCs) in mature teeth with irreversible pulpitis were clinically demonstrated. On the other hand, there is no evidence of the utility of DPSCs in mature teeth with apical periodontitis. The aim of this case report was to describe the potential utility of regenerative cell therapy in mature teeth with apical periodontitis. A 44-year-old man was referred for pulp regeneration due to a periapical lesion in his maxillary first premolar. Root canal disinfection was performed by irrigation and intracanal medication by nanobubbles with levofloxacin and amphotericin B in addition to conventional irrigation. Autologous DPSCs isolated from an extracted third molar were transplanted into the root canal after residual bacteria and fungi were below the detection level by polymerase chain reaction assay using universal genes to amplify specific regions within bacterial 16S ribosomal DNA and fungal ribosomal DNA (ITS1), respectively. There were no adverse events or systemic toxicity assessed for clinical evaluations during the 79-week-follow-up period and laboratory evaluations after 4 weeks. The affected tooth was responsive to the electric pulp test. Cone-beam computed tomographic imaging revealed a reduced lesion size, remission of the periapical tissue, and mineralized tissue formation in the apical part of the canal after 79 weeks. The signal intensity on magnetic resonance imaging of the regenerated tissue in the affected tooth was comparable to that of the normal pulp in the adjacent teeth after 24 weeks. This case report demonstrated the potential use of DPSCs for pulp regenerative therapy in mature teeth with apical periodontitis.


Assuntos
Polpa Dentária , Periodontite Periapical , Masculino , Humanos , Adulto , Regeneração , Periodontite Periapical/terapia , Tratamento do Canal Radicular/métodos , Necrose da Polpa Dentária/terapia , Dente Pré-Molar , Células-Tronco , DNA Ribossômico
10.
Dent Traumatol ; 40(1): 54-60, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37638617

RESUMO

AIM: The aim of this study is to compare the adverse effects that occur after orthodontic extrusion of teeth that have been traumatically intruded with those of similar teeth that have not experienced any trauma. BACKGROUND: The outcome of incisors intrusion can be affected by the patient's age, extent of injury, root development, and malocclusion. Orthodontic extrusion is a potential solution, but it may also cause complications. MATERIALS AND METHODS: A retrospective study of the effects of extrusion of traumatically intruded teeth was carried out. The study group included 21 teeth in 14 patients. The control group included 32 teeth in 10 patients that underwent orthodontic extrusion with no history of trauma. Patients' age, gender, and stage of root development were recorded. The severity of the intrusion was classified as mild (<3 mm), moderate (3-6 mm), and severe (≥7 mm). A comparison of signs of pulp necrosis and root resorptions between the groups was made. RESULTS: The central incisor is the tooth that is most injured in 80.9% of cases. A majority of these incidents involve severe intrusion, which was found in 42.9% of cases. 90% of the traumatized teeth had already lost their vitality prior to orthodontic treatment. Various forms of root resorption were observed in the study group. In the control group, 31.2% of teeth showed signs of external root resorption, but no endodontic intervention was carried out during the follow-up period, as these teeth remained vital. CONCLUSIONS: Following intrusion, there is a high risk for root resorption and pulp necrosis. Orthodontic repositioning should be carried out with caution and mild force to prevent complications. Long-term follow-ups are required to ensure the best possible outcome.


Assuntos
Reabsorção da Raiz , Avulsão Dentária , Humanos , Incisivo/lesões , Necrose da Polpa Dentária/etiologia , Reabsorção da Raiz/etiologia , Estudos Retrospectivos , Extrusão Ortodôntica , Avulsão Dentária/complicações
11.
Dent Traumatol ; 40(1): 61-75, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37612879

RESUMO

BACKGROUND/AIM: This study aimed at comparing the regenerative potential of injectable platelet-rich fibrin (i-PRF) (Group 1) and platelet-rich plasma (Group 2) scaffolds. MATERIALS AND METHODS: Twenty-three patients, aged from 9 to 24 years, having 24 immature traumatized necrotic maxillary anterior teeth, were enrolled. Teeth trauma was confirmed by patients' history. Preoperative three-dimensional scans were done. In the first visit, canals were irrigated with 1.5% sodium hypochlorite then medicated with calcium hydroxide. After 2 weeks, patients were randomly assigned into one of the treatment groups (n = 12). The platelet concentrate was applied after centrifuging 10 mL of autologous venous blood with respect to the centrifugation protocol for each platelet concentrate. Patients were recalled at 6 and 12 months posttreatment, during which clinical and radiographic examinations and assessment of pulp sensitivity were done. Three-dimensional scanning was done after 12 months. The increase in root length and decrease in root canal diameters were calculated at three canal levels. Statistical analysis was done using the paired t-test and the independent t-test. The significance level was set at p < .05. RESULTS: There was no statistically significant difference between both groups regarding the increase in root length, decrease in coronal and middle canal diameters and the response to the electric pulp tester. Group (1) showed significantly greater decrease in apical canal diameter than Group (2) (p = .008). CONCLUSION: I-PRF can be considered as a valid regenerative scaffold for clinical use and with regards to the easier preparation technique, it is more recommended than platelet-rich plasma.


Assuntos
Fibrina Rica em Plaquetas , Plasma Rico em Plaquetas , Humanos , Necrose da Polpa Dentária/terapia , Regeneração , Tratamento do Canal Radicular/métodos , Criança , Adolescente , Adulto Jovem
12.
J Endod ; 50(3): 344-350, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38142887

RESUMO

INTRODUCTION: This study aims to investigate the ability of umbilical cord mesenchymal stem cells (UC-MSC) to enhance the regeneration of pulp-dentin complex in immature permanent teeth with irreversible pulpitis. METHODS: A total of 32 mandibular premolar teeth with immature apices in 5 dogs were used in this in-vivo randomized controlled trial (RCT). Eight healthy teeth without pre-existing pathosis served as the positive control samples and received no treatment, while in another 8 teeth, the pulp was completely extirpated (negative control). Class V cavities were prepared to induce inflammation in the remaining 16 teeth (groups 3 and 4) and the pulp was extirpated 2-4 mm short of the radiographic apex. Of the 16, the 8 teeth in group 4 received 1 mL of cord blood stem cells with a hydrogel scaffold. Blood clots were covered with mineral trioxide aggregates at the cementoenamel junction in the experimental groups, and teeth were filled with RMGI and composite. Three months later, block sections were removed for histologic evaluations for the evaluation of postoperative apical closure, degree of inflammation, and presence of normal pulp tissue. The data were statistically analyzed with the chi-square test (P < .05). RESULTS: All teeth with complete pulp extirpation demonstrated pulpal necrosis with no postoperative closure of their apices, while apical closure was seen in all the teeth in the remaining groups. There was a statistically significant (P < .001) difference in the presence of inflammation and normal pulp tissue between the experimental groups. The teeth in group 3 showed normal pulp tissue extending to the level of MTA, but there was inflammation within the canal space. In contrast, the teeth in the UC-MSC group demonstrated organized, normal pulp tissue with no inflammation. CONCLUSION: Based on these results, the regeneration of the pulp-dentin complex is possible with no inflammation when UC-MSCs are used and 2-4 mm of the apical pulp remains intact in immature teeth with irreversible pulpitis.


Assuntos
Pulpite , Endodontia Regenerativa , Animais , Cães , Pulpite/cirurgia , Pulpite/patologia , Endodontia Regenerativa/métodos , Polpa Dentária/patologia , Necrose da Polpa Dentária/terapia , Necrose da Polpa Dentária/patologia , Inflamação/patologia
13.
J Contemp Dent Pract ; 24(10): 750-756, 2023 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-38152907

RESUMO

AIM: The purpose of this mixed-case study is to explore the incidence of pulp necrosis of vital teeth after surgical treatment of adjacent lesions of the jaws. MATERIALS AND METHODS: The records of 341 biopsies submitted to the institute's histopathology laboratory were reviewed to include cases that met the inclusion criteria. About 84 biopsies collected from patients during surgical enucleation of lesions in proximity to healthy vital teeth were included of which 22 patients were recalled. Adjacent teeth were examined clinically and radiographically to assess their pulpal and periapical status after at least 8 months of follow-up. RESULTS: There were 7 different pathological lesions diagnosed histologically. The follow-up period ranged between 8 and 72 months; 12 cases (54.6%) have developed pulpal necrosis for at least one tooth after surgical enucleation of the lesion. The other 10 cases (45.4%) showed normal responses to sensibility testing for all the teeth adjacent to the lesion. Ten out of the 12 cases (83%) that underwent pulpal necrosis were associated with odontogenic cysts, whereas the remaining 2 were associated with periapical granuloma and fibrous dysplasia. CONCLUSION: Pulp necrosis is high in vital teeth associated with lesions without pulpal involvement. These teeth may benefit from root canal treatment prior to surgical enucleation of the lesion, which may prevent impaired healing or recurrence of infection. CLINICAL SIGNIFICANCE: Careful treatment planning and thorough discussion should take place between the surgeons, endodontists, and patients prior to executing the treatment. The patient should be aware that there is a possibility that they may need root canal treatment as a preventative measure to enhance the chances of healing following the surgical procedures and in case the patients opted not to perform root canal treatment beforehand, close follow-up in the future should take place to monitor the vitality of the teeth in the follow-up visits.


Assuntos
Necrose da Polpa Dentária , Polpa Dentária , Humanos , Necrose da Polpa Dentária/epidemiologia , Incidência , Tratamento do Canal Radicular/efeitos adversos , Tratamento do Canal Radicular/métodos , Arcada Osseodentária
14.
Aust Dent J ; 68 Suppl 1: S123-S140, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37908151

RESUMO

The dental pulp may respond favourably or unfavourably to traumatic dental injuries. The most serious unfavourable responses are pulp necrosis and infection of the root canal system. These cause apical periodontitis and/or external inflammatory resorption of the tooth. The following injuries require root canal treatment as part of their emergency management-(A) complicated crown fractures (but some may be suitable for conservative pulp treatments, such as pulp capping, partial pulpotomy or pulpotomy), (B) complicated crown-root fractures, (C) supra-crestal coronal third root fractures and (D) injuries where pulp necrosis is predictable or highly likely to occur AND where there has been damage to the root surface and/or periodontal ligament with the aim of preventing external inflammatory resorption. This latter group of injuries are avulsion, intrusion, lateral luxation with a crown fracture, extrusion with a crown fracture (all in fully developed teeth) plus avulsion with a crown fracture and intrusion with a crown fracture (both in incompletely developed teeth). All other injuries should not have root canal treatment commenced as part of the emergency management, but they must be reviewed regularly to monitor the pulp for any adverse changes to its status, particularly pulp necrosis and infection of the root canal system.


Assuntos
Avulsão Dentária , Fraturas dos Dentes , Humanos , Necrose da Polpa Dentária/terapia , Necrose da Polpa Dentária/complicações , Cavidade Pulpar , Coroa do Dente/cirurgia , Tratamento do Canal Radicular , Fraturas dos Dentes/terapia , Avulsão Dentária/terapia , Raiz Dentária
15.
Orthod Fr ; 94(3-4): 453-460, 2023 11 06.
Artigo em Francês | MEDLINE | ID: mdl-37930343

RESUMO

Introduction: It is a fact reported in the literature that the first permanent molar is the most frequently decayed tooth. Our treatment choice is based mainly on two clinical criteria: the degree of coronal decay and the damage to the pulp tissue. In the absence of pulp tissue necrosis, the following therapeutic gradient: indirect pulp capping, direct pulp capping, partial pulpotomy, cameral pulpotomy should be implemented with the objective of maintaining pulp vitality regardless the degree of maturity of the molar. Discussion: In the case of pulp tissue necrosis, if the tooth is immature, stopping root construction and apical closure requires an apexification or endodontic regeneration technique. The prognosis of these necrotic teeth remains uncertain in the medium and long term (risk of fractures). This raises the question of the indication for avulsion of the first permanent molar (FPM). Objectives: The main objectives of this article are to present the means of conservation and their limits. Conclusion: The decision to retain a FPM is based on several criteria, including assessment of pulpal status (which remains problematic, especially on immature permanent teeth) and the feasibility of coronal restoration. The decision to retain or extract a FPM must be the subject of a multidisciplinary discussion between a paediatric dental surgeon and a specialist qualified in dentofacial orthopaedics.


Introduction: C'est un fait rapporté dans la littérature : la première molaire permanente est la dent la plus fréquemment délabrée. Notre choix thérapeutique repose principalement sur deux critères cliniques : le degré de délabrement coronaire et l'atteinte du tissu pulpaire. En l'absence de nécrose du tissu pulpaire, le gradient thérapeutique suivant : coiffage pulpaire indirect, coiffage pulpaire direct, pulpotomie partielle, pulpotomie camérale doit être mis en œuvre avec pour objectif de maintenir la vitalité pulpaire quel que soit le degré de maturité de la molaire. Discussion: En cas de nécrose du tissu pulpaire, si la dent est immature, l'arrêt de l'édification radiculaire et de la fermeture apicale requiert une technique d'apexification ou de régénération endodontique. Or le pronostic de ces dents nécrosées reste incertain à moyen et long termes (risque de fractures). Se pose alors la question de l'indication d'avulsion de la première molaire permanente (PMP). Objectifs: Les principaux objectifs de cet article sont de présenter les moyens de conservation et leurs limites. Conclusion: La décision de conservation d'une PMP repose sur plusieurs critères dont l'évaluation du statut pulpaire (qui reste problématique, surtout sur dent permanente immature) et la faisabilité de la restauration coronaire. La décision de conserver ou d'extraire une PMP doit faire l'objet d'une discussion pluridisciplinaire entre chirurgien-dentiste pédiatrique et spécialiste qualifié en orthopédie dento-faciale.


Assuntos
Polpa Dentária , Dente Molar , Humanos , Criança , Dente Molar/cirurgia , Apexificação , Assistência Odontológica , Necrose da Polpa Dentária , Necrose
16.
Orthod Fr ; 94(3-4): 461-469, 2023 11 06.
Artigo em Francês | MEDLINE | ID: mdl-37930344

RESUMO

Introduction: What if we changed our point of view? What if we approached endodontics from a biological perspective rather than a mechanistic one? What if, in the case of pulpal tissue necrosis, we were to consider an alternative to apexification therapies? Is pulp tissue regeneration now possible? Objective: Regenerative endodontic therapy (RET) aims to regenerate the pulp-dentin complex damaged by infection, trauma, or developmental anomaly of immature permanent teeth with necrotic pulp. The new intracanal tissue formation is expected to display pulp-like architecture and functions. There are two different based to tissue engineering approaches described to perform RET: cell-free CF-RET that attempt to induce host endogenous cells or stem cells to migrate into the root canal for regeneration or cell-based CB-RET which introduce exogenously prepared cells or stem cells into the canal for regeneration. Material and Method: CB-RET is the basis of current protocols recommended by the American Association of Endodontists (AAE) and the European Society of Endodontology (ESE) for the treatment of necrotic immature permanent teeth, with or without LIPOE. In this article, after defining the above-mentioned concepts, we will describe the ESE protocol and discuss the key steps for "getting started with endodontic regeneration". Conclusion: Each stage of the protocol must be carried out rigorously so as not to compromise the stages of the various biological processes involved. The practitioner has to stay informed of advances in knowledge resulting from research and new protocols to be published.


Introduction: Et si nous changions de point de vue ? Et si nous abordions l'endodontie d'un point de vue biologique et non mécanistique ? Et si, devant la nécrose du tissu pulpaire, nous envisagions une alternative aux thérapeutiques d'apexification ? La régénération du tissu pulpaire est-elle désormais possible ? Objectif: L'objectif des thérapeutiques régénératives endodontiques (regenerative endodontic therapy ou RET) est de récréer au sein du canal radiculaire un tissu semblable au complexe dentino-pulpaire tant sur le point de l'organisation cellulaire que sur le point fonctionnel. Deux concepts basés sur les principes de l'ingénierie tissulaire sont décrits : l'un basé sur la transplantation de cellules souches : le CB-RET (Cell-based RET) et l'autre basé sur le cell homing, c'est-à-dire sur le recrutement de cellules souches localisées à proximité de l'apex : le CF-RET (Cell-free RET). Matériel et méthode: Les protocoles actuels recommandés par l'Association Américaine des Endodontistes (American Association of Endodontists ou AAE) et la Société Européenne d'Endodontie (European Society of Endodontology ou ESE) dans le traitement des dents permanentes immatures nécrosées en présence ou non de lésion inflammatoire périapicale d'origine endodontique (LIPOE) sont basés sur le CF-RET. Dans cet article, après avoir défini les concepts cités précédemment, nous décrirons le protocole de l'ESE et discuterons des étapes clés pour « se mettre à la régénération endodontique ¼. Conclusion: Chaque étape du protocole doit être conduite avec rigueur afin de ne pas compromettre les étapes des différents processus biologiques engagés. Le praticien devra se tenir informé des avancées des connaissances issues des travaux de recherche et des nouveaux protocoles qui seront édités.


Assuntos
Endodontia , Endodontia Regenerativa , Humanos , Polpa Dentária , Regeneração , Assistência Odontológica , Necrose da Polpa Dentária/terapia
17.
Clin Oral Investig ; 27(11): 6357-6369, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37870593

RESUMO

OBJECTIVES: This review aims to discuss the implications of anatomy of the root, pulp chamber, and canals on pulpotomy and revitalization procedures (RPs) as treatment alternatives to root canal treatment procedures. METHODS: This narrative review was undertaken to address two main questions - why remove vital pulp tissue in teeth with complex canal anatomy when it can be preserved? And why replace the necrotic pulp in teeth with mature roots with a synthetic material when we can revitalize? This review also aims to discuss anatomical challenges with pulpotomy and revitalization procedures. RESULTS: Maintaining the vitality of the pulp via partial or full pulpotomy procedures avoids the multiple potential challenges faced by clinicians during root canal treatment. However, carrying out pulpotomy procedures requires a meticulous understanding of the pulp chamber anatomy, which varies from tooth to tooth. Literature shows an increased interest in the application of RPs in teeth with mature roots; however, to date, the relation between the complexity of the root canal system and outcomes of RPs in necrotic multi-rooted teeth with mature roots is unclear and requires further robust comparative research and long-term follow-up. CONCLUSIONS: Whenever indicated, pulpotomy procedures are viable treatment options for vital teeth with mature roots; however, comparative, adequately powered studies with long-term follow-up are needed as a priority in this area. RPs show promising outcomes for necrotic teeth with mature roots that warrant more evidence in different tooth types with long-term follow-ups.  CLINICAL RELEVANCE: Clinicians should be aware of the pulp chamber anatomy, which is subject to morphological changes by age or as a defensive mechanism against microbial irritation, before practicing partial and full pulpotomy procedures. RP is a promising treatment option for teeth with immature roots, but more evidence is needed for its applications in teeth with mature roots. A universal consensus and considerably more robust evidence are needed for the standardization of RPs in teeth with mature roots.


Assuntos
Cavidade Pulpar , Pulpotomia , Humanos , Pulpotomia/métodos , Tratamento do Canal Radicular/métodos , Polpa Dentária , Necrose da Polpa Dentária/terapia
18.
Clin Oral Investig ; 27(12): 7531-7543, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37875745

RESUMO

OBJECTIVES: This retrospective study was undertaken to clinically and radiographically evaluate the long-term outcomes of regenerative endodontic procedures (REPs) for nonvital mature permanent teeth, to analyze predictors influencing treatment outcomes. METHODS: Nonvital mature permanent teeth treated by REPs with a minimum follow-up period of 6 months were included from 2015 to 2017. Treatment outcomes were categorized as success and failure. The periapical status and lesion healing were assessed in terms of the periapical index (PAI) and the percentage changes in periapical radiolucency (PARL) area. The clinical and radiographic outcomes of REPs were assessed by Mann-Whitney test at different follow-up period. Kaplan-Meier curves and Univariate Cox regression analysis were conducted to assess the success and identify potential predictors affecting outcomes, respectively. RESULTS: A total of 37 mature teeth with an average follow-up of 4.3 years satisfied the criteria, and 89.2% of the teeth had a successful outcome. Significant differences in PAI scores were found between each period with respect to the baseline (p < .05). Among different periods, there was a significant difference between intervals of 3-6 months and 7-12 months (p = .039) and no significant difference between each interval of more than 12 months (p > .05). Eighty-seven percent of teeth with preoperative PARL presented completely healed. REPs significantly decreased the PARL area at the interval of 7-12 months compared to 3-6 months (p = .025), with no significant difference between each interval of more than 12 months (p > .05). No significant predictor was found for the success of outcome (p > .05). Thirteen teeth (35.1%) regained pulp sensibility, and 40.5% of the teeth exhibited intracanal calcification. CONCLUSIONS: Within the limitations of this study, REPs provided a high long-term success rate and promoted the resolution of PARL as a biologically-based alternative treatment option for nonvital mature teeth. CLINICAL RELEVANCE: REPs provide a high long-term success rate and promoted healing of apical periodontitis comparable with reported outcomes for root canal therapy of mature teeth.


Assuntos
Periodontite Periapical , Endodontia Regenerativa , Dente não Vital , Humanos , Estudos Retrospectivos , Necrose da Polpa Dentária/terapia , Tratamento do Canal Radicular/métodos , Resultado do Tratamento , Periodontite Periapical/terapia
19.
Sci Rep ; 13(1): 16215, 2023 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-37758735

RESUMO

The aim of this observational clinical study (OCS) was to determine the clinical anatomical diameter (CAD) in several dental groups, thus correlating them with gender, age, tooth/canal and pulpoperiradicular diagnosis. Three-hundred fifty-nine teeth/584 vital or necrotic root canals from patients of both genders and different ages composed the sample. After performing the necessary previous procedures, K-Flexofiles were used to determine the CAD. Then, the gender and age of the patients, as well as the pulpoperiradicular diagnosis of the teeth were tabulated to conduct the statistical analysis (p < 0.05). Of the 359 teeth/584 root canals evaluated, 208/342 were from women (mean age 38.85 ± 13.42 years) and 151/242 were from men (mean age 45.41 ± 14.90 years). Statistically significant differences between the CAD means of root canals from women and men were not identified (p = 0.411). The analysis of the correlation between the CAD and age also showed a total independence (p = 0.271). Teeth with pulp necrosis and asymptomatic apical periodontitis diagnosed radiographically (TPNAAPDR) had a significantly larger CAD mean than teeth with pulp necrosis and no asymptomatic apical periodontitis diagnosed radiographically (TPNNAAPDR) and teeth with vital pulp and normal apical tissues (TVPNAT) (p = 0.0297); and the last two did not differ statistically (p > 0.05). The largest CAD mean was observed in single canals of maxillary central incisors. The lowest values of this variable were identified in the mesiobuccal and mesial canals of maxillary and mandibular first molars, respectively. The CAD of the root canals was influenced only by the root canal/tooth and pulpoperiradicular diagnosis.


Assuntos
Necrose da Polpa Dentária , Periodontite Periapical , Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Cavidade Pulpar/diagnóstico por imagem , Incisivo/diagnóstico por imagem , Dente Molar
20.
Clin Oral Investig ; 27(10): 6043-6053, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37624522

RESUMO

OBJECTIVES: There is a lack of studies evaluating the accuracy of the 2009 American Association of Endodontists (AAE) diagnostic criteria for diagnosing pulpal health in primary teeth. This study aimed to estimate and correlate the diagnostic accuracy of clinical diagnosis of reversible and irreversible pulpitis using the 2009 AAE criteria with histological findings in primary teeth. METHODS: Eighty primary teeth that were clinically diagnosed with normal pulp (n = 10), reversible pulpitis (n = 30), irreversible pulpitis (n = 30) and pulp necrosis (n = 10) were collected. The teeth were histo-processed, and pulp tissues were diagnosed histologically as uninflamed pulp, reversible or irreversibly inflamed and necrosis based on previously proposed criteria. RESULTS: The clinical diagnosis of pulp necrosis (sensitivity 70%, specificity 96%) and normal pulp (sensitivity 91%, specificity 100%) matched the histological diagnosis of necrosis and uninflamed pulp in 70% and 100%, respectively. The clinical diagnosis of irreversible pulpitis (sensitivity 64%, specificity 72%) matched the histological diagnosis of irreversible pulp inflammation for 47% of teeth evaluated. For the clinical diagnosis of reversible pulpitis (sensitivity: 65%, specificity: 86%), 80% matched the histological diagnosis of reversible pulp inflammation. Teeth with histologically diagnosed irreversible pulp inflammation were more likely to have lingering (OR 5.08; 95% CI 1.48-17.46, P = 0.010) and nocturnal tooth pain (OR 15.86; 95% CI 1.57-160.47, P = 0.019) when compared to teeth with reversible pulp inflammation. Using the classification and regression tree model, the presence of widened periodontal ligament space and nocturnal tooth pain were useful predictors of irreversible pulp inflammation with an accuracy of 78%. CONCLUSION: The 2009 AAE criteria was acceptable for primary teeth with pulp necrosis and normal pulp but poor for reversible pulpitis and irreversible pulpitis.


Assuntos
Endodontistas , Pulpite , Humanos , Pulpite/diagnóstico , Necrose da Polpa Dentária/diagnóstico , Polpa Dentária , Inflamação/patologia , Necrose/patologia , Dente Decíduo , Dor
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