Pre-Eruptive Intracoronal Resorption (PEIR): A Case Report.

Pre-Eruptive Intracoronal Resorption (PEIR) is a rare yet significant phenomenon in which an abnormal, well-circumscribed, radiolucent area develops in the tooth prior to eruption. This case report outlines the treatment of a 12 year old Hispanic female who was referred for endodontic evaluation of tooth #31 and subsequently diagnosed with PEIR. The patient's chief complaint was recorded as "spontaneous pain" in the lower right quadrant of her jaw. Clinical examination revealed a partially erupted tooth #31 with no visible decay. Radiographic examination, including a cone beam computed tomography scan, led to the detection of a radiolucent area surrounding the pulp chamber on the mesial aspect of tooth #31. Radiographically, the enamel appeared intact with no signs of perforation. Based on the clinical and radiographic evaluation, tooth #31 was determined to have PEIR, with the pulpal and periapical diagnosis of "Symptomatic Irreversible Pulpitis" and "Normal Apical Tissue," respectively. The Orthodontic consultation obtained for this patient recommended that tooth #31 be maintained at least until tooth #32 appeared in the oral cavity and could be used as a replacement. Therefore, a treatment plan involving vital pulp therapy and gingivectomy was selected. During the procedure, granulation tissue was excavated and sent for histological evaluation, which concluded the presence of "granulation tissue with acute and chronic inflammation". No caries were detected. Following the procedure, the tooth was found to be asymptomatic with continued root development. A positive response to Electric Pulp Test was achieved after 3.5 years of follow up.

The Association between Choice of Diagnostic Imaging Modality and Long-term Treatment Outcomes for Patients Undergoing Nonsurgical Root Canal Treatment on Maxillary First Molars.

INTRODUCTION: Radiography has played a fundamental role in the advancement of nonsurgical root canal therapy (NSRCT), allowing for more accurate diagnosis and treatment. Typically, providers choose to perform NSRCT using periapical (PA) radiographs alone or, often in more difficult cases, in conjunction with cone-beam computed tomographic (CBCT) imaging. This study aimed to evaluate the outcomes of NSRCT based on imaging modality selection for the initial treatment of maxillary first molars. METHODS: A retrospective chart review was conducted using 1385 cases of NSRCT on maxillary first molars. Charts were reviewed for patient demographics and treatment outcomes. Based on the imaging modality used, patients were stratified into 2 groups (PA radiographs alone or PA radiographs + CBCT imaging). Those who required additional treatment(s) after the completion of NSRCT were classified as having "posttreatment disease." Statistical analysis was performed to assess the differences between groups. RESULTS: After the completion of primary endodontic therapy, 5.8% (n = 81) of the entire sample had posttreatment disease. CBCT imaging was used in 13.4% (n = 185) of NSRCTs. Although not significant, cases that were difficult enough to require the use of CBCT imaging had a higher rate of posttreatment disease compared to those that could be completed with PA radiographs alone (8.6% vs 5.4%, P > .05). Results from a multivariable logistic regression model showed that the need for CBCT imaging had a nonsignificant positive association with posttreatment disease (P > .05). CONCLUSIONS: The decision to use CBCT imaging appears to serve as a proxy for case complexity and the associated increase in risk of posttreatment disease. This is important to keep in mind when assessing treatment prognosis.

Jumpstart Mirror Trainer: A New Device for Teaching Mirror Skills to First-Year Dental Students.

Learning indirect vision with a dental mirror is challenging and can be overwhelming for beginning dental students. The Jumpstart Mirror Trainer is a new device that allows students to become proficient with mirror use before the start of preclinic without requiring in-class practice sessions. The aim of this study, conducted in 2017, was to compare the effectiveness of the Jumpstart Mirror Trainer with the Mirroprep for teaching indirect motor skills. Forty-seven first-year dental students were randomized into three groups to use the Jumpstart Mirror Trainer, Mirroprep, or a control device for 15 minutes a day for ten days. To assess indirect motor skills improvement, students performed a maxillary cavity preparation before and after using their devices. A survey was used to assess students' comfort level with mirror skills and perceived helpfulness of the exercises. Forty students completed the study. The Jumpstart Mirror Trainer activities improved the students' scores significantly more than the Mirroprep activities (p=0.04) and the control device (p=0.006). Students in the Jumpstart Mirror Trainer group rated their device as being significantly more helpful than the control group rated its device in preparing them for the evaluation (p=0.001). There was no statistically significant difference in perceived helpfulness between the Mirroprep group and the control group (p=0.75). These results suggest that the Jumpstart Mirror Trainer may be able to improve students' indirect motor skills without requiring in-class practice sessions and to do so more effectively than other existing methods.

Incidental Findings in Small Field of View Cone-beam Computed Tomography Scans.

INTRODUCTION: The use of cone-beam computed tomography (CBCT) in endodontics has increased in recent years. In clinical application of small field of view (FOV) CBCTs, these scans are not reviewed routinely by a radiologist. Studies of large FOV CBCT scans show the prevalence of incidental findings to be greater than 90%. The purpose of this study was to evaluate the prevalence of missed findings by endodontic residents as compared with a radiologist on small FOV CBCT scans. METHODS: Two hundred three small FOV CBCTs obtained for endodontic purposes were analyzed by an endodontic resident and a medical radiologist. The reported findings of each practitioner were compared to evaluate for missed incidental findings by the endodontic resident. RESULTS: The radiologist reported abnormalities in 176 of the 203 subjects (87%), with a total of 310 abnormalities reported. The endodontic resident reported abnormalities in 102 of the 203 subjects (50%), with a total of 126 abnormalities reported. The percentage of scans with any abnormality reported by the radiologist was significantly greater than the endodontic resident (P < .001). There was no significant difference between jaw locations in percentage of missed findings for the 3 most common types of finding-rarefying osteitis, sinusitis/mucosal lining thickening, and excess restorative material in the periapical area. Rarefying osteitis was missed significantly less than the other 2 types of findings (P < .001). CONCLUSIONS: A radiologist is significantly more likely to identify incidental findings in small FOV CBCT scans than an endodontic resident. Scan location had no significant association with the rate of missed findings.