Successful Non-Surgical Root Canal Treatment on Auto-Transplanted Maxillary Premolar with Apical Periodontitis.

Auto-transplantation is a procedure that replaces traumatized or congenitally missing teeth. While most auto-transplanted teeth are successfully integrated into recipient sites, the donor tooth may develop apical periodontitis, causing early failure. In the present case report, the periodontic resident performed the procedure on a 15-year-old male by selecting donor teeth #4 and #13 and transplanting them at recipient sites #29 and #20, respectively. After 6 weeks, the patient was referred to the endodontic resident for evaluation of tooth #20 due to symptom development. While one auto-transplanted tooth (donor tooth #4, recipient site #29) was successfully integrated, the other (donor tooth #13, recipient site #20) was unsuccessful: the patient was diagnosed with pulp necrosis and a chronic apical abscess. Because of the patient's age, collaboration among periodontic, endodontic, and orthodontic residents/specialists informed the clinical decision to pursue non-surgical root canal treatment (NSRCT) rather than extraction. The canal was cleaned and shaped to a size #80 using copious irrigation of 2.5% sodium hypochlorite (NaOCl), followed by 17% ethylenediaminetetraacetic acid (EDTA) via the EndoVac Negative Pressure Irrigation system. The tooth was dried with paper points, and then calcium hydroxide was mixed with 2.5% NaOCl and placed with an amalgam carrier 2 mm from the radiographic apex. The tooth was next temporized with Teflon tape and Fuji TRIAGE. Four weeks later, after confirming the patient was asymptomatic and tooth mobility had decreased, the canal was obturated using EndoSequence Bioceramic Root Repair Material Fast Set Putty in 2 mm incremental layers to achieve a three-dimensional fill and create an apical plug to prevent gutta-percha extrusion, then backfilled in incremental layers of gutta-percha to the cementoenamel junction (CEJ). At the 8-month follow-up, the patient was asymptomatic, and the periodontal ligament (PDL) had no signs of periapical pathology. When teeth undergoing auto-transplantation procedures develop apical periodontitis, NSRCT can be implemented.

Outcome Assessment of Teeth with Necrotic Pulps and Apical Periodontitis Treated with Long-term Calcium Hydroxide.

INTRODUCTION: The aim of this retrospective, cohort case series was 2-fold: (1) to evaluate the outcomes of teeth with necrotic pulps and apical periodontitis using long-term calcium hydroxide (Ca[OH]2) (healing was assessed via the periapical index [PAI] system) and (2) to explore the possible association of fractures in relation to long term Ca(OH)2 exposure. METHODS: A total of 242 cases, diagnosed with pulpal necrosis and apical periodontitis, were treated with long-term Ca(OH)2 using a standardized protocol. Injectable and powdered Ca(OH)2 were placed sequentially in the root canal system. All cases were re-evaluated within a 3-month period until radiographic healing was observed. Clinical and radiographic evaluations were performed annually. Pre- and postoperative periapical radiographs were evaluated using the PAI system. RESULTS: Of the 242 cases, 219 participants completed their treatment with annual follow-up. The average Ca(OH)2 time was 5.4 months with a range of 1-12 months. Overall, by the latest follow-up visit, 90.0% (197/219) were classified as "healed." The overall mean preoperative and postoperative PAI scores were 4.07 (±0.80) and 1.76 (±0.70), respectively. Kappa statistics showed an almost perfect agreement for inter-rater (κ = 0.91) and intrarater (κ = 0.95) reproducibility for both examiners. CONCLUSIONS: Within the limitations of this study, the use of long-term Ca(OH)2 in the treatment of teeth with necrotic pulps and apical periodontitis resulted in a predictable high outcome. There was no association observed between long-term Ca(OH)2 use and the incidence of fractures during this study. Ca(OH)2 is a suitable material of choice as an interappointment dressing for teeth diagnosed with pulpal necrosis and apical periodontitis.

Periapical Microsurgery: Assessment of Different Types of Light-emitting Diode Transilluminators in Detection of Dentinal Defects.

INTRODUCTION: This study evaluated 4 different light-emitting diode (LED) transilluminators and the impact of operator experience in the detection of dentinal defects through an ex vivo TRUEJAW surgical model (Dental Engineering Laboratories, Santa Barbara, CA). METHODS: Forty-four extracted and endodontically treated mandibular premolar teeth were evaluated. Teeth were mounted in the models followed by surgical flaps and osteotomies to expose the apical third of the roots. After apical resection, the root-end surfaces were randomly inspected for the presence or absence of dentinal defects using a dental operating microscope (DOM) at ×19.4 magnification by experienced and novice LED evaluators. The assessment was made with the DOM light and 4 masked LED transilluminators of different diameters and luminous flux. The teeth were examined outside the models to establish the ground truth. The sensitivity, specificity, and kappa and McNemar test values of each light source by examiner were calculated. RESULTS: The use of LED transilluminators improved the diagnostic sensitivity of dentinal defects when compared with the DOM light alone for both examiners. For the LED-experienced evaluator, the medium-low transilluminator had statistically significant higher sensitivity than the DOM light and the small-low and small-high transilluminators (P < .05). For the novice LED evaluator, the medium-high transilluminator had the highest sensitivity. There was a statistically significant difference between the sensitivities of the medium-low transilluminator between the examiners (P < .05). CONCLUSIONS: Within the limitations of this ex vivo surgical study, dentinal defects were more often detected with the LED transilluminators with a larger diameter and increased lumens. The operator's LED transilluminator experience was found to have a positive effect on the detection of dentinal defects using transillumination.