Regenerative Endodontic Treatment in Immature Noninfected Ferret Teeth Using Blood Clot or SynOss Putty as Scaffolds.

INTRODUCTION: SynOss Putty (Collagen Matrix, Oakland, NJ) has shown the formation of mineralized tissues when used as a scaffold in regenerative endodontic treatment (RET) in immature human teeth. The aim of this study was to compare the outcome of RET in immature ferret teeth using 2 scaffolds: a blood clot and SynOss Putty. METHODS: Thirty-two immature canine teeth in 8 ferrets (95-105 days old) were divided into 4 groups: group 1, no treatment (positive control, n = 8); group 2, full pulpectomy with no further treatment (negative control, n = 8); group 3, revascularization using a blood clot (n = 8); and group 4, revascularization using a SynOss Putty scaffold (n = 8). After 3 months, the animals were euthanized, and the newly formed tissues were examined histologically. The data were statistically analyzed using chi-square and Fisher exact tests. RESULTS: Normal pulps were found in group 1. No pulp tissue was found in teeth in group 2. In group 3, the pulp tissue and the odontoblastic layer were absent, and the root canal spaces were filled with a hard tissue characterized as bonelike and cementumlike tissues. All teeth except 1 in group 4 showed no hard tissue formation and intracanal/periapical inflammation. SynOss Putty was significantly associated with a lack of tissue formation and intracanal/periapical inflammation (P < .05). CONCLUSIONS: Intracanal hard tissue formation was observed in immature teeth after RET using a blood clot. No tissue regeneration was found in the majority of samples using SynOss Putty as a scaffold.

A Retrospective Comparison of Outcome in Patients Who Received Both Nonsurgical Root Canal Treatment and Single-tooth Implants.

INTRODUCTION: Currently, no study has compared the outcome of nonsurgical root canal treatment (NSRCT) and single-tooth implants (STIs) provided to the same patient. The purpose of this study was to determine if the survival outcome of the 2 treatment modalities is different. METHODS: The medical/dental records of 3671 patients with at least 1 STI and 1 NSRCT were reviewed. One hundred seventy patients with at least a 5-year follow-up were included. The survival outcome of NSRCT and STI and related factors were evaluated. RESULTS: Both treatments had a 95% survival rate with a mean 7.5-year follow-up. Most preoperative and postoperative factors involved in both procedures had no significant effect on the treatment outcomes. The number of adjunct and additional treatments, the number of appointments, the elapsed time before the final restoration, the number of prescribed medications, and the cost of the treatment were significantly higher for STI in comparison with NSRCT. CONCLUSIONS: Both NSRCT and STI are highly successful treatments. Compromised teeth that could otherwise be saved by NSRCTs and deemed restorable should not routinely be treatment planned for STI.

Effect of Residual Dental Pulp Tissue on Regeneration of Dentin-pulp Complex: An In Vivo Investigation.

INTRODUCTION: Current pulp revascularization procedures in teeth with necrotic pulps and open apices have produced histologic evidence of connective tissue growth, cementum, and bone within the root canals of experimental animals. This study aims to investigate the effect of maintaining uninflamed residual apical pulp tissue on the histologic outcome of pulp-dentin complex regeneration after a revascularization procedure in immature ferret cuspid teeth. METHODS: Twenty-eight cuspid teeth from 7 young male ferrets were used in this experiment. Seven teeth were reserved to serve as positive control samples without any treatment. In another 7 teeth, the pulp was completely extirpated (negative control), whereas the pulp of the remaining 14 teeth were removed to either 1-2 mm short of the apex (7 samples) or 2-4 mm short of the apex (7 samples). Blood clots were covered with mineral trioxide aggregate at the cementoenamel junction level of each tooth. Three months later, block sections were removed for histologic evaluations, and the data were statistically analyzed with the chi-square test (P < .05). RESULTS: All teeth with complete pulp extirpation showed the presence of bone inside the root canal. In contrast, the root canals for most teeth with pulp amputation 1-4 mm from the radiographic apex were filled with normal pulp, which extended coronally to the mineral trioxide aggregate, where hard tissue bridges had formed. CONCLUSIONS: Based on these results, we concluded that regeneration of the pulp-dentin complex is possible when the apical 1-4 mm of the apical pulp remains intact in immature teeth.

In vitro Comparison of Apical Debris Extrusion Using Rotary and Reciprocating Systems in Severely Curved Root Canals.

INTRODUCTION: The aim of this in vitro study was to compare the amount of apically extruded debris after root canal preparation using rotary and reciprocating systems in severely curved root canals. METHODS AND MATERIALS: Thirty six extracted human mandibular first molars with 25-35° curvature in their mesiobuccal (MB) canal (according to Schneider's method) were cleaned and shaped with ProTaper and WaveOne systems. The extruded debris was collected and their net weight was calculated. To compare the efficiency of the two systems, the operation time was also measured. The data were analyzed with t-test. RESULTS: The amount of extruded debris in WaveOne group was significantly greater in comparison with ProTaper group (26%). The operating time for ProTaper was however, significantly longer than WaveOne. CONCLUSION: Both root preparation systems caused some degree of debris extrusion through the apical foramen. However, this amount was greater in WaveOne instruments.

Alloplastic mandibular reconstruction: a systematic review and meta-analysis of the current century case series.

BACKGROUND: Alloplastic mandibular reconstruction remains insufficiently predictable, with no systematic reviews to assess its scope and limitations. METHODS: The PubMed, CINAHL, EMBASE, and Web of Science databases were searched for English study reports, published in the current century, of mere alloplastic surgical reconstruction of mandibular ablative defects. RESULTS: In 14 articles, there were 944 patients, with a median age of 58.7 years (interquartile range, 53.2 to 62 years); 58.7 percent (interquartile range, 66.7 to 78.6 percent) were male. Cases of squamous cell carcinoma per study constituted 93.5 percent (interquartile range, 81.5 to 100 percent). Defects were mostly lateral (Boyd classification) (60.5 percent; interquartile range, 56.2 to 62 percent) and received mostly conventional bridging plates (in 64.3 percent of the studies) and pedicled flaps (45.3 percent; interquartile range, 37.1 to 58.3 percent); 60.7 percent (interquartile range, 53.5 to 58.8 percent) received adjuvant therapy. At 32-month follow-up, the complication and failure rates were 40.1 percent (interquartile range, 26.7 to 58.6 percent) and 30.8 percent (interquartile range, 11.7 to 48.1 percent), respectively. The overall survival rate was 55 percent (interquartile range, 27.8 to 74 percent). Radiotherapy seemed to be a relative risk factor for complications (1.387; p = 0.014) and plate loss (1.585; p = 0.006). Crossing the midline seemed to be a relative risk factor for plate exposure (1.533; p = 0.000) and overall complications (1.385; p = 0.002). CONCLUSIONS: The results should be generalized cautiously. Alloplastic reconstructive surgery faces a remarkable lack of evidence. Relatively high complication and failure rates are areas of further concern.

Freeman-Sheldon syndrome: combined surgical and non-surgical approach.

BACKGROUND: Many Freeman-Sheldon syndrome patients suffer from extensive microstomia resulting in possible inhibition of dental and skeletal development as well as difficulties in eating, speech and dental hygiene. Oral commissure contraction treatments vary from patient education to complicated surgical and/or prosthetic treatments, but recurrence is often described. This article reports on a combined surgical and non-surgical approach in order to increase maximum mouth opening and maintain the result of the surgery. TECHNIQUE: The patient underwent bilateral commissuroplasty using 2 rhomboid flaps for each side. After two steps of intraoral and perioral tissue impression taking, a master cast was poured and a retractor was fabricated from thermoplastic material. The patient was encouraged to wear the retractor the entire day and night except at meal times. RESULTS: After surgery maximum mouth opening was increased from 20 mm to 37 mm and remained the same six months after the surgery. Psychosocial factors were improved and the patient was satisfied with the results of her treatment. CONCLUSION: The use of bilateral commissuroplasty in combination with this customized dynamic oral commissure retractor may be applicable in other syndromic patients with a small oral commissure and also in patients with circumoral burns.

Use of cone beam computed tomography to detect and remove a broken suture needle.

Suture needles can break when they are used to suture the oral mucosa, especially if they have been bent or if excessive force is applied. Several retrieval modalities have been discussed in the literature; these have focused mainly on locating the needle. Although the segment often is found and removed by the surgeon during the procedure, more extensive procedures and paraclinical diagnostics may be necessary. This article presents a case in which a lost suture needle was located using a cone beam computed tomography scan and retrieved via surgery.

Free gingival graft immobilization: a pilot study on a newly designed stent.

The presence of adequate gingiva with firm attachment to the underlying periosteum and bone is important for the overall long-term success of implant-supported oral rehabilitation. In the presence of an atrophic edentulous mandible, peri-implant soft tissue management is a challenging task. Therefore, mucosal grafts are sometimes necessary in patients with insufficient attached gingiva around abutments. Immobilization of this graft is mandatory for its survival. The study design included 5 edentulous patients with inadequate attached gingival zone, all candidates for implant surgery and free gingival graft. In the first surgery the implants were inserted, and in the second operation a free gingival graft was obtained from the palate and sutured to the mandibular site. A newly designed stent was applied for the stabilization of the graft. Two to 3 weeks after the second surgery, the stents were removed and the attached gingival width was measured. Long-term evaluations were performed to follow the survival of the graft. All grafts were intact at the time of stent removal. In all cases, the long-term evaluations revealed adequate attached gingiva around the implant. It may be concluded that immobilization of free gingival graft in the recipient site increases its success rate and its survival rate. The application of the newly designed stent can serve as a proper and easy immobilizer for peri-implant soft tissue management.

The "crescent" graft: a new design for bone reconstruction in implant dentistry.

Immediate implantation after extraction is advantageous when clinical circumstances allow it. However, it is often problematic. The most common problem in such cases is confronting bone loss after tooth extraction because of long-standing periodontitis. Although there are many techniques designed to manage these complications, autogenous grafts are considered to be the gold standard in grafting procedures because of their osteoinductive properties. There are many sites from which to harvest bone for grafting procedures, each possessing advantages and disadvantages. We present a new site for bone harvesting and a new graft design for osseous reconstruction in implant dentistry.