Neural Basis of Etiopathogenesis and Treatment of Cervicogenic Orofacial Pain.

(1) Background and Objectives: The aim of this narrative review was to analyze the neuroanatomical and neurophysiological basis of cervicogenic pain in cervico-cranial pain syndromes, focusing particularly on cervico-orofacial syndromes as a background for the proper diagnosis and non-surgical treatment. Relevant literature on the topic from past 120 years has been surveyed. (2) Material and Methods: We surveyed all original papers, reviews, or short communications published in the English, Spanish, Czech or Slovak languages from 1900 to 2020 in major journals. (3) Results: The cervicogenic headache originates from the spinal trigeminal nucleus where axons from the C1-C3 cervical spinal nerves and three branches of the trigeminal nerve converge (trigeminocervical convergence) at the interneurons that mediate cranio-cervical nociceptive interactions. The role of the temporomandibular joint in the broad clinical picture is also important. Despite abundant available experimental and clinical data, cervicogenic orofacial pain may be challenging to diagnose and treat. Crucial non-surgical therapeutic approach is the orthopedic manual therapy focused on correction of body posture, proper alignment of cervical vertebra and restoration of normal function of temporomandibular joint and occlusion. In addition, two novel concepts for the functional synthesis of cervico-cranial interactions are the tricentric concept of mouth sensorimotor control and the concept of a cervicogenic origin of bruxism. (4) Conclusions: Understanding the basis of neuroanatomical and neurophysiological neuromuscular relations enables an effective therapeutic approach based principally on orthopedic manual and dental occlusal treatment.

Ex Vivo Effect of Novel Lipophosphonoxins on Root Canal Biofilm Produced by Enterococcus faecalis: Pilot Study.

(1) Background: The root canal system has complex anatomical and histological features that make it impossible to completely remove all bacteria by mechanical means only; they must be supplemented with disinfectant irrigation. Current disinfectants are unable to eliminate certain microorganisms that persist in the root canal, resulting in treatment failure. At the Institute of Organic Chemistry and Biochemistry, Prague, novel substances with the bactericidal effect, termed lipophosphonoxins (LPPOs), have been discovered. The aim of this pilot study was to investigate the ex vivo effects of second- and third-generation LPPOs on Enterococcus faecalis and compare them with 5% sodium hypochlorite (NaOCl), 0.12% chlorhexidine digluconate, and 17% ethylenediaminetetraacetic acid (EDTA). (2) Methods: The root canal's dentin was used as a carrier for biofilm formation in the extracted human mature mandibular premolars. The samples were filled with cultivation broth and 0.25% glucose with tested solutions. In control samples, only fresh cultivation broth (negative control) and cultivation broth with bacterial suspension (growth control) were used. Each sample was inoculated with E. faecalis CCM4224 except for the negative control, and cultivation was performed. To determine the number of planktonic cells, the sample content was inoculated on blood agar. To evaluate biofilm formation inhibition, samples were placed in tubes with BHI. (3) Results: LPPOs exhibited a reduction in biofilm growth and bacteria comparable to NaOCl, and they were superior to other tested disinfectants. (4) Conclusions: The study results suggest the effect of lipophosphonoxins on E. faecalis CCM 4224 reduces planktonic bacterial cells and inhibits formation of biofilm in root canal samples.

Conservative Treatment of Complicated Crown Fracture and Crown-Root Fracture of Young Permanent Incisor-A Case Report with 24-Month Follow-Up.

The complicated crown-root fracture of young permanent teeth is an uncommon traumatic dental injury that is usually treated in a complex way and is demanding not only for the dentist but even for the treated child. In this case report, we present the conservative treatment of a maxillary central incisor in a 10-year-old boy after a traumatic dental injury. Treatment included partial pulpotomy and adhesive fragment reattachment after reflection of the mucoperiosteal flap. The patient was fully asymptomatic at 24-month follow-up, with an aesthetically acceptable outcome. Vital pulp therapy and adhesive fragment reattachment can be a viable treatment option for complicated crown-root fractures, especially when treating immature permanent teeth.

Clinical and Radiographic Outcomes of Immature Teeth Treated with Different Treatment Protocols of Regenerative Endodontic Procedures: A Retrospective Cohort Study.

Regenerative endodontic procedure (REP) is a progressive treatment modality for immature permanent teeth with necrotic pulp. The ambiguousness about the predictability of REP outcome in relation to complete disinfection of the root canal system and the occurrence of discoloration still exists. The aim of this retrospective study was to analyze two treatment protocols on clinical success rate, radiographic root development and the occurrence of discoloration. Eighteen patients were treated by a single operator by either treatment protocol according to the American Association of Endodontists (AAEP, n = 9) or a modified protocol (MP, n = 9) with the use of 5% sodium hypochlorite and sandblasting. Patients were followed up after 3, 6, 9, 12, 18 and 24 months and clinical success, radiographic root development and the occurrence of discoloration were assessed. The clinical success of MP was significantly higher in two years follow-up (p = 0.015), but the change in radiographic root area was higher for AAEP (p = 0.017) and the occurrence of discoloration was higher in AAEP (p = 0.029). The use of 5% sodium hypochlorite for a longer period of time leads to a higher success rate. The sandblasting of the access cavity reduces the occurrence of discoloration.

The influence of gingival phenotype on the morphology of the maxillary central papilla.

BACKGROUND: Preservation of the interdental papilla is an essential part of the functional and esthetic rehabilitation of dental treatment. It has been described that thicker gingival tissues are more resistant to recession. The main objective of this investigation was to analyze whether a thin gingival phenotype represents a potential risk indicator affecting interdental papilla fill, height, or width in an esthetic region between maxillary central incisors. The secondary goals were: (1) to analyze parameters describing the papilla-fill, height, width, and effect of papilla base width on the vertical papillary dimension; (2) to determine correlation between different non-invasive measurements of gingival thickness; (3) to compare both sexes. METHODS: A total of 54 periodontally healthy students (20-30 years old) were included in the study. Gingival thickness was measured using Pirop Ultrasonic Biometer. Gingival phenotype was also assessed by gingival probe transparency. Papilla height and width were measured, and the degree of papilla recession was classified. RESULTS: No significant relationship between papilla fill, height, width and gingival probe transparency or gingival thickness was found. Gingival thickness and gingival probe transparency showed a significant relationship (P < 0.001). There was a significant relationship between papilla height and papilla fill (P = 0.028). A papilla which filled the interdental space completely seemed to be shorter. A strong positive correlation between papilla height and papilla width was found (P < 0.0001). The papilla between maxillary central incisors was significantly higher in males (P = 0.01). CONCLUSION: The appearance of the interdental papilla may be influenced by various factors. Within the limitations of this study, the results showed that the thin gingival phenotype alone is no potential risk indicator affecting interdental papilla fill, height, or width. It seems that there may be some effect of papilla base width on its vertical dimension. Gingival probe transparency is a simple reliable method of assessment of gingival thickness with a threshold value of 1-mm gingival thickness between the thick and thin phenotypes.

Students´ preparedness, learning habits and the greatest difficulties in studying Histology in the digital era: A comparison between students of general and dental schools.

INTRODUCTION: There are only sporadic references in literature regarding general medicine and dentistry student´s preparedness for Histology, study resources and how students might use them in the era of virtual microscopy. METHODS: A structured questionnaire was used to evaluate students´ opinion, with 192 students of general medicine and 82 students of dentistry responding. RESULTS: The dentistry students evaluate their previous knowledge of basic high school disciplines as less helpful when compared to their general medicine colleagues, but this difference diminishes during the first year of medical school studies. Students of dentistry display a better orientation in the amount of study resources (electronic vs printed) and also the ways of their use (practical vs theoretical preparation). The main problems surfacing in the study of Histology have been: the lack of time due to the high demands of Anatomy, problems with correct identification of structures in specimens and correct orientation in a large number of available study resources. Students indicate that they would appreciate the introduction of interactive exercise tests to verify practical and theoretical knowledge. CONCLUSION: We revealed significant differences between students of general medicine and dentistry in terms of student´s preparedness and learning habits. According to our findings, it is still necessary to further develop teaching methods utilising virtual microscopy, taking into account the needs of both general medicine and dental school students.

Evaluation of the effectiveness of the presentation of virtual histology slides by students during classes. Are there any differences in approach between dentistry and general medicine students?

INTRODUCTION: Virtual microscopy, used as a method to teach histology, has many undeniable advantages. However, the usefulness of this method is somewhat limited by the difficulties students face in finding their way through huge amounts of digital data, compounded by decreased interaction between students and teachers. We describe the results of a recent pilot project which combined the modern teaching methods of active learning, where students themselves present histological slides and make use of the virtual microscopy system. METHODS: Students' responses to a structured questionnaire and examination results were evaluated. RESULTS: We found that a combination of both electronic materials and textbooks was commonly used by students to prepare for practical teaching sessions, with electronic resources being used regularly by the majority of students. No statistically relevant differences were found between the approaches of dentistry vs general medicine students. Cooperation between students' groups during the preparation for individual presentations was seen to be beneficial by a majority of dentistry students; they reported that the introduction of student-led presentations improved their quality of preparation for practical lessons, as well as increasing their participation and activity level in the lessons themselves. These different approaches and motivations between students of dentistry and general medicine are reflected in the test results where dentistry students are more successful. CONCLUSION: We confirm that there are differences in motivation, approaches and examination results between both groups of students, which should be taken into account and which could lead to differentiation of future curricula for both study courses.

Imaging of growth factors on a human tooth root canal by surface-enhanced Raman spectroscopy.

Endodontic treatment of immature permanent teeth with necrotic pulp poses several clinical challenges and is one of the most demanding interventions in endodontics. Recently, with new discoveries in the field of tissue engineering, novel treatment protocols have been established. The most promising treatment modality is revascularization, whose integral part is the exposure of collagen matrix and embedded growth factors. However, optimization of the treatment protocol requires a development of analytical procedures able to analyze growth factors directly on the sample surface. In this work, method based on surface-enhanced Raman spectroscopy (SERS) was developed to investigate the influence of the time of the medical treatment using EDTA on exposure and accessibility of the growth factors, namely TGF-ß1, BMP-2, and bFGF on the dentine surface. The nanotags, which consist of magnetic Fe3O4@Ag nanocomposite covalently functionalized by tagged antibodies (anti-TGF-ß1-Cy3, anti-BMP-2-Cy5, and anti-bFGF-Cy7), were employed as a SERS substrate. Each antibody was coupled with a unique label allowing us to perform a parallel analysis of all three growth factors within one analytical run. Developed methodology presents an interesting alternative to a fluorescence microscopy and in contrary allows evaluating a chemical composition and thus minimizing possible false-positive results. Graphical abstract.

Discoloration after Regenerative Endodontic Procedures: A Critical Review.

Discoloration remains an unfavourable complication of otherwise successful regenerative endodontic procedure of immature teeth with necrotic pulp. This review presents a critical view on current knowledge of discoloration sources, its treatment and possible preventive modalities, dealing mainly with the use of antibiotics, ethylendiaminotetraacetic acid, calcium hydroxide, mineral trioxide aggregate, calcium silicate cements, sodium hypochlorite and chlorhexidin during regenerative treatment and their possible interactions. Bleaching as a discoloration treatment modality is discussed as well.

Retreatment of failed revascularization/revitalization of immature permanent tooth - A case report.

The aim of this article is to describe the clinical case of the non-surgical retreatment of a failed revascularization/revitalization treatment (RRT). The retreatment was preceded by two sessions including an interim medication with calcium hydroxide and a modified irrigation protocol containing a highly-concentrated sodium hypochlorite and prolonged usage of ethylenediaminetetraacetic acid (EDTA) to reverse unacceptable side effects of hypochlorite. During a 15- month follow-up, the healing of the periapical lesion, increased thickening of root canal walls and maturation of root was apparent. The repeated RRT represents a possible treatment modality for s failed RRT. Key words:Retreatment, revascularization, revitalization, maturogenesis, immature tooth.

In Vitro Mechanical Properties of Mineral Trioxide Aggregate in Moist and Dry Intracanal Environments.

INTRODUCTION: The purpose of this study was to examine the microhardness and modulus of elasticity (MOE) of White ProRoot MTA (Dentsply Tulsa Dental, Tulsa, OK) after setting in moist or dry intracanal conditions. METHODS AND MATERIALS: To simulate root canal system, 14 polyethylen molds with internal diameter of 1 mm and height of 12 mm were used. These molds were filled with 9-mm thick layers of White ProRoot Mineral Trioxide Aggregate (MTA; Dentsply Tulsa Dental, Tulsa, OK). The experimental group (n=7) had a damp cotton pellet with 1.5 mm height and a 1.5 mm layer of resin composite placed on it. In control group (n=7) the whole 3 mm above MTA were filled with resin composite. The specimens were kept in 37°C and relative humidity of 80% for 4 days in order to simulate physiological conditions. Specimens were longitudinally sectioned and nanoindentation tests were carried out using Berkovich indenter at loading rate of 2 mN/s at 4×5 matrices of indents which were located in the coronal, middle and apical thirds of the specimen's cross section, to evaluate the microhardness and modulus of elasticity of the specimen to appraise the progression of the setting process. Differences were assessed using nonparametric generalized Friedman rank sum and Wilcoxon Rank-Sum tests. RESULTS: Statistical analysis showed that there was a significant difference in microhardness and MOE between control and experimental groups at coronal (P<0.001), middle (P<0.001) and apical (P<0.001) thirds of the simulated rod from simulated apical foramen. Kruskal-Wallis test showed no significant effect of depth on microhardness of material in experimental or control groups. CONCLUSION: Within limitations of this in vitro study, it seems that moist intracanal environment improves setting of MTA in various depths.

Paradigm Shift from Stem Cells to Cell-Free Regenerative Endodontic Procedures: A Critical Review.

Regenerative endodontic procedures of immature teeth with necrotic pulp have become a part of therapeutic endodontic spectrum and are considered as an alternative to calcium hydroxide or mineral trioxide aggregate apexification. In last decade, numerous case reports and series with usage of cell-free approaches known as revascularization, revitalization, or maturogenesis have been published. This cell-free approach prevails in clinical regenerative endodontics because of its relative ease of performance, lower financial demands, and absence of complications such as tumorigenesis of used stem cells. In this article, the integral steps of cell-free treatment approaches such as source of stem cells, possible endogenous scaffolds, sources of growth factors, and width of apical foramen in the context of sufficient disinfection of root canal system and outcome of treatment are discussed. Despite not being a fully established treatment protocol, the achieved outcomes are promising regardless of it having a reparative character than a regenerative one.

Root Maturation in Teeth Treated by Unsuccessful Revitalization: 2 Case Reports.

This article deals with the unusual course of failed revascularization/revitalization cases. Up to this date the evidence of success and failure rates of revascularization/revitalization treatment is scarce. These case reports present "unsuccessful" revascularization/revitalization treatment of permanent immature teeth with apical periodontitis. Although the teeth were treated by protocol suggested by the American Association of Endodontists and the symptoms disappeared, maturation of teeth continued, and periapical lesion was reduced, the teeth went symptomatic during the follow-up. Subsequently, regular root canal treatment was performed. Despite chronic infection that was probably left inside the root canal after a disinfection protocol, the secondary aims of the treatment were achieved even when the primary ones were not. The possible causes of failures of revascularization/revitalization treatment and their prevention are discussed.