Endodontic Treatment for a Mesiodens: A Case Report.

Mesiodens are common supernumerary teeth that prominently erupt in the midline between the maxillary central incisors. If two or more mesiodens are present, they are termed mesiodentes, indicating the presence of multiple supernumerary teeth in the midline. These often cause aesthetic disharmony in the anterior teeth due to their abnormal position, leading to extraction in most cases and resulting in midline diastema when impacted or partially erupted. This case is uncommon, as the patient expressed a desire to preserve their mesiodens as a distinctive feature, considering them a familial trait worth retaining. The family history of the patient revealed the occurrence of mesiodens in three generations, highlighting a hereditary pattern of supernumerary teeth within the family. The endodontic therapy involving root canal treatment successfully treated the mesiodens, alleviating pain, and preserving them as desired.

Incidence of Postoperative Flare-Up After Single-Visit and Multi-visit Endodontic Therapy.

This article presents results obtained from a survey, including patients who underwent endodontic treatment by the single-visit or multi-visit method, after confirmation of the diagnosis of chronic apical periodontitis. OBJECTIVE: The aim of the survey was to obtain data from the studied patients on the frequency and the type of postoperative pain after treatment of chronic apical periodontitis, as well as whether there is a relation between gender, age, and postoperative pain. MATERIALS AND METHODS: A visual analog scale was used to study the intensity of postoperative pain in the treatment of teeth diagnosed with CPP, which are treated by one of two methods - single-visit or multi-visit method. The total number of surveyed patients is 71. The patients were examined and treated at the Dental Clinic "Imperial" in Varna, Bulgaria, in 2020. Thirty-one of them were treated by the single-visit method, and the remaining 40 by the multi-visit method with placement of a temporary dressing or sterile swab. RESULTS: A relatively large proportion (70%) of patients reported mild pain immediately after the root canal filling. A relatively large proportion (90.3%) of patients did not report pain one week after the root canal filling. The more frequent symptoms were observed in cases treated by the multi-visit method, after the application of a temporary dressing. Patients who reported taking analgesics were treated in the multi-visit method. More frequent pain symptoms with both methods of treatment were observed in men aged 36-60 years. CONCLUSION: Although exacerbation has been shown to have no significant effect on the outcome of endodontic treatment, it is highly undesirable. In the short term, the postoperative pain in patients treated by the multi-visit method through the use of intracanal medication is more pronounced. Patients receiving the single-visit treatment reported less postoperative pain.

Effects of Etching Time and Ethanol Wet Bonding on Bond Strength and Metalloproteinase Activity in Radicular Dentin.

(1) Background: The objective of this in vitro study was to evaluate the impact of different etching times and ethanol pre-treatments on the immediate bond strength of a hydrophilic multi-mode universal adhesive (Clearfil Universal Bond Quick, Kuraray, UBQ) and on the consequent gelatinolytic activity of metalloproteinases (MMPs) on radicular dentin. (2) Methods: Sixty single-root teeth were selected and divided into four groups according to the adhesive protocol applied for fiber post cementation: (G1) 15 s H3PO4 application + UBQ; (G2) 30 s H3PO4 application + UBQ; (G3) 15 s H3PO4 application + ethanol pre-treatment + UBQ; (G4) 30 s H3PO4 + ethanol pre-treatment + UBQ. After adhesive procedures, fiber posts were luted into the post space with a dual-curing cement (DC Core, Kuraray) and light-cured for 40 s. To perform the push-out test and nanoleakage analyses for both coronal end apical areas, 1 mm slices were prepared, following a 24 h storage period in artificial saliva. Additionally, an in situ zymographic assay was conducted to explore endogenous MMP activity within the radicular layer. Results were statistically analyzed with ANOVA and Tukey post hoc tests. Statistical significance was set at p < 0.05. (3) Result: ANOVA revealed a statistically significant difference in push-out bond strength related to the pre-treatment variable but did not highlight any significance of etching time. Specimens pre-treated with ethanol wet bond application showed higher bond strength (p < 0.01). In situ zymography quantification analyses revealed that all tested groups, independently of etching time end ethanol pre-treatment, activated MMP gelatinolytic activity. A significant increase in MMP activity was detected for the 30 s etching time. However, ETOH pre-treatment significantly reduced MMP activity within the adhesive interface (p < 0.01). (4) Conclusions: The tested adhesive showed similar results regardless of the etching time protocol. The gelatinolytic activity of MMPs was observed in all the groups. Further investigations and extended follow-ups are required to validate the results of the present study in vivo.

Subcutaneous Emphysema of Periorbital and Canine Space Following Endodontic Treatment.

Emphysema of the subcutaneous tissue is an uncommon complication of dental procedures. Certain dental surgical procedures, such as extraction of teeth using air-driven handpieces and endodontic procedures are more prone to cause subcutaneous emphysema. Subcutaneous emphysema is typically self-limiting and only in a few instances has an impact on the long-term health of the patient. Patients with subcutaneous emphysema experience pain, distress and inconvenience. This paper presents a case of subcutaneous emphysema of the right canine and periorbital space following endodontic treatment of the upper right front tooth.

Adjacent Implant Influence on Tooth Restoration in a Gastro-Esophageal Reflux Disease (GERD) Patient Using Monoblock Post-Fused Crown: A Case Report.

This case report explores how the presence of an adjacent implant influenced the restoration of a tooth with pulpitis in a gastro-esophageal reflux disease (GERD) patient. A patient with GERD requires a tooth-colored crown not only for aesthetics but also to address potential galvanic concerns arising from an adjacent implant. GERD, a condition causing non-cavity erosion, weakens tooth structure over time, presenting significant challenges in treatment. It resulted in bite relapse and insufficient occlusal clarity over time. A comprehensive treatment approach was needed to restore both function and appearance. This involved managing galvanism using non-metallic materials to ensure optimal occlusal clarity, as well as meticulously reinforcing and restoring tooth structure. Monoblock post-fused crowns were chosen for their superior durability, stability, and comfort. The ceramic layering not only effectively prevented galvanic issues by insulating the tooth structure but also significantly improved the natural appearance of teeth, thereby promoting long-term oral health and successfully managing complex dental concerns. The dental team successfully restored the damaged tooth by considering specific factors that influenced the treatment plan, including achieving optimal aesthetic outcomes.

40-Year Outcome of Old-School, Non-Surgical Endodontic Treatment: Practice-Based Retrospective Evaluation.

(1) Background: Non-surgical endodontic treatment has been shown to be clinically successful; however, clinical long-term data are scarce. This practice-based retrospective clinical investigation evaluated endodontic outcomes over 40 years and identified relevant clinical co-factors. (2) Methods: Two experienced dental practitioners in two different private dental practices treated 174 patients with 245 teeth from 1969 to 1993. After root canal obturation, either a new direct restoration (amalgam, resin composite, or glass-ionomer cement) or the re-cementation of a pre-existing prosthetic restoration or renewal of prosthetic restoration followed. Metal posts (operator A) or metal screws (operator B) were inserted when coronal substance loss was significant. The primary outcome (i.e., tooth survival) was achieved when the endodontically treated tooth was, in situ, painless and had full function at the end of the observation period. A secondary outcome, the impact of different prognostic factors on survival rate, was evaluated. (3) Results: The overall mean survival was 56.1% of all treated teeth after 40 years of clinical service, resulting in an annual failure rate of 1.1%. Most investigated clinical co-factors (jaw, tooth position, intracanal dressings, post/screw placement, and gender) showed no significant influence on survival. (4) Conclusions: Even with materials and techniques from the 1970s and 1980s, successful root canal treatment was achievable. Except for post-endodontic restorations, most of the evaluated factors had no significant influence on the clinical long-term survival of root canal-treated teeth.

Endodontic management considerations for Type III dens invaginatus based on anatomical characteristics: A case series.

Dens invaginatus (DI) is a developmental anomaly of the teeth characterised by the in-folding of the enamel into the dentin. Oehlers' Type III DI is the most serious form, in which the inherently invaginated channels communicate with periodontal and dental pulp tissue, increasing the risk of bacterial contamination. However, varying and complex anatomical features make diagnosis and treatment challenging. Conventional endodontic therapies promote healing by avoiding unnecessary interventions (e.g., surgical or other invasive treatments). Radiographic examination can reveal the structural details of such malformations. We obtained multiple procedural details for treating Type III DI based on radiographic analyses from our clinical experience. In addition, we introduce a new classification strategy for the management of Type III DI that is more applicable to treatment needs. This study aimed to discuss the anatomical features and current treatment considerations of Type III DI.

Success of Lesion Sterilization and Tissue Repair Therapy and Pulpectomy in the Management of Infected Primary Molars with Poor Prognosis.

Background and aim: To establish lesion sterilization and tissue repair (LSTR) therapy as an alternate treatment option in managing infected primary molars with poor prognosis that were indicated for extraction, thereby fulfilling the objective of retaining the primary tooth till its normal exfoliation in the dental arch. Materials and methods: A total of 84 children who met the inclusion criteria requiring extraction in 142 teeth involving primary molars were included in the study. The selected patients were allocated to two groups, that is, group I-LSTR therapy with 3Mix-MP paste and group II-pulpectomy with metapex. All the treated teeth were then clinically and radiographically evaluated after 1, 3, 6, 9, and 12 months, respectively, to determine the success between groups I and II. Pearson's Chi-squared test along with the z-test was used to compare the clinical and radiographic success of the two groups (p < 0.05). Results: Pain and tenderness were completely resolved within one month of follow-up in both groups. Abscesses were resolved completely at 1 month in the pulpectomy group and mobility was resolved at 6 months follow-up in both groups. Interradicular and periradicular radiolucency persisted even at 12 months of the follow-up period in both groups. The intergroup comparison revealed no statistical differences between LSTR and pulpectomy procedure and both were equally effective at all time intervals (p > 0.05). Conclusion: Both LSTR therapy with 3Mix-MP and pulpectomy with metapex showed 100% clinical success rates. Radiographically no changes were observed even at the 12-month follow-up period in both groups. LSTR therapy can be an alternative treatment option for pulpally involved primary teeth with poor prognosis and in cases where mechanical instrumentation could not be achieved due to physiologic root resorption. How to cite this article: Sefa I, Garg N, Pathivada L, et al. Success of Lesion Sterilization and Tissue Repair Therapy and Pulpectomy in the Management of Infected Primary Molars with Poor Prognosis. Int J Clin Pediatr Dent 2024;17(1):41-47.

Convenient model of hard tissue simulation for dental radiographic research and instruction.

BACKGROUND: The authors describe a technique for building an alternative jawbone phantom using dental gypsum and rice for research and dental radiology instruction. AIM: To investigate the potential of an alternative phantom to simulate the trabecular bone aspect of the human maxilla in periapical radiographs. METHODS: Half-maxillary phantoms built from gypsum-ground rice were exposed to X-rays, and the resulting images (experimental group) were compared to standardized radiographic images produced from dry human maxillary bone (control group) (n = 7). The images were blindly assessed according to strict criteria by three examiners for the usual trabecular aspects of the surrounding bone, and significant differences between groups and in assessment reliability were compared using Fisher's exact and kappa tests (α = 0.05). RESULTS: The differences in the trabecular aspects between groups were not statistically significant. In addition, interobserver agreement among observers was 0.43 and 0.51 for the control and experimental groups, respectively, whereas intraobserver agreement was 0.71 and 0.73, respectively. CONCLUSION: The tested phantom seemed to demonstrate potential for trabecular bone image simulation on maxillary periapical radiographs.

Comparative Morphology of the Carnassial Teeth Root Canals in Mixed-Breed Dogs and German Shepherds.

Root canal treatment of carnassial teeth in dogs is a common endodontic technique which aims to re-establish or maintain the health of the periapical tissues. In total, 43 dogs were used in this study. Root canal morphology was evaluated in 86 superior fourth premolars and 86 inferior first molars. Apical delta was present in 247 roots, while obliteration of the root canal was found in 11 roots. The most common type of apical delta of the roots of superior fourth premolars was type II, with up to 10 apical ramifications, while type IIIA, with 10-20 apical ramifications, was most commonly present in the roots of inferior first molars. Considering that knowledge of the morphology of root canals is essential for a successful endodontic procedure, the aim of this study was to analyze and compare the morphology of root canals in the carnassial teeth of German shepherds and mixed-breed dogs. Apical resection for the purpose of endodontic therapy of the superior fourth premolar and the inferior first molar is indicated at a length of 4 to 6 mm from the anatomical tip of the roots, which would completely remove the apical delta of these two teeth.

Investigation of the Potential of Nanoparticles as a New Drug Delivery System for Endodontic Treatment: An In Vitro Study.

Background: Endodontic treatment involves the removal of infected dental pulp and subsequent disinfection of the root canal system. The effectiveness of drug delivery systems in root canal disinfection is critical for successful treatment outcomes. This in vitro study explores the potential of nanoparticles as a novel drug delivery system for endodontic treatment. Materials and Methods: Nanoparticles were synthesized using a biocompatible polymer and loaded with an antimicrobial agent. A total of 60 extracted human teeth were prepared to create standardized root canal infections. The teeth were randomly divided into three experimental groups: (1) conventional irrigation, (2) nanoparticle irrigation, and (3) control (no irrigation). The root canals in each group were irrigated with their respective solutions for 5 minutes. After treatment, microbial samples were collected from the root canals and cultured for colony-forming unit (CFU) analysis. The depth of penetration of nanoparticles into dentinal tubules was assessed using scanning electron microscopy (SEM). Results: The conventional irrigation group showed a reduction in microbial load from an average of 7.8 × 10^5 CFU/mL (SD ± 1.2 × 10^5) to 3.4 × 10^4 CFU/mL (SD ± 7.9 × 10^3) (P < 0.001). In contrast, the nanoparticle irrigation group exhibited a more significant reduction, with a decrease in CFU to 1.2 × 10^3 CFU/mL (SD ± 4.2 × 10^2) (P < 0.001). SEM analysis revealed deep penetration of nanoparticles into dentinal tubules, reaching an average depth of 150 µm. Conclusion: Nanoparticles loaded with antimicrobial agents demonstrated superior efficacy in reducing microbial load within root canals compared to conventional irrigation. Their ability to penetrate dentinal tubules suggests their potential as an innovative drug delivery system for endodontic treatment. Further research and clinical trials are warranted to validate these promising in vitro results and assess the safety and efficacy of nanoparticles in clinical practice.

Outcomes of Regenerative Endodontic Treatment Performed Using Different Magnification Devices: A Systematic Review.

Aim: In this systematic review, we assessed whether the effects of the usage of various devices help with magnification in endodontics and whether they resulted in any significant changes in the clinical result of treatment. Materials and Methods: An exhaustive search was performed across MEDLINE and Cochrane Registers for various clinical studies, which were focused on comparing regenerative endodontic treatment based on the usage of magnification devices. Various terms were used to search these clinical trials such as microscope, regenerative endodontic surgery, apicoectomy, endoscope, and loupes. Results: After scrutinizing the studies, around three clinical trials based on magnification in endodontic surgeries were included in the present review. It was observed that no statistically noteworthy betterment of treatment outcome was seen in patients treated with either of the magnification devices such as loupes and microscope. Conclusion: It was evident that these magnification devices can alter the effectiveness of regenerative endodontic treatment in a very minimal way. However, we believe that more randomized clinical studies should be conducted in this area.

Evaluation of Prevalence and Cause of Endodontic Treatment of Permanent Molars in 10-Year-Old Children of Riyadh, Saudi Arabia.

The study aimed to assess the prevalence and cause of endodontic treatment in the first permanent molars of children aged ten in Saudi Arabia. Out of 824 children, 104 had dental caries, with a prevalence rate of 12.62%. The research revealed that the most involved teeth were mandibular left first molar, followed by mandibular right first molar, maxillary left first molar, and maxillary right first molar. Majority of patients had grossly decayed teeth, followed by caries, restorations, and endodontic treatment. The study emphasizes the importance of early dental consultations to reduce morbidity and financial burden on parents.

Amputação radicular para preservação de elemento dentário / Root amputation for tooth preservation

A periodontite é uma doença inflamatória crônica dos tecidos de sustentação e proteção dos dentes. Em dentes posteriores, a perda de inserção pode resultar em vários graus de dano à furca, que se refere à destruição dos tecidos de suporte de dentes multirradiculares caracterizada por reabsorção óssea e perda de inserção no espaço interarradicular. Independente do grau de envolvimento da furca, o tratamento periodontal básico (RAR) é a primeira opção para estabilizar a periodontite, contudo, em algumas situações é utilizada uma terapia cirúrgica periodontal bastante conhecida: a rizectomia ou amputação radicular. O objetivo do trabalho é relatar o caso de uma amputação radicular de um dente comprometido periodontalmente, a fim de se preservar o elemento dentário. O dente 27 foi diagnosticado com periodontite, o que ocasionou a lesão de furca grau III. O tratamento endodôntico foi realizado prévio ao procedimento cirúrgico, viabilizando a amputação da raiz disto-vestibular deste elemento. A partir do relato deste caso, se pode concluir que a amputação radicular é considerada um procedimento conservador, capaz de manter em função molares com histórico de periodontite associado ao envolvimento de lesões de furca(AU)

Periodontitis is a chronic inflammatory disease of the supporting and protective tissues of the teeth. In posterior teeth, attachment loss can result in varying degrees of damage to the furcation, which refers to the destruction of the supporting tissues of multirooted teeth characterized by bone resorption and attachment loss in the interarticular space. Regardless of the degree of furcation involvement, basic periodontal treatment (RAR) is the first option to stabilize periodontitis; however, in some situations, a well-known periodontal surgical therapy is used: rhizectomy or root amputation. Rhizectomy is a treatment option for multirooted teeth. The technique preserves the crown and requires endodontic treatment of the affected tooth, preferably done before surgery(AU)

Predicting early endodontic treatment failure following primary root canal treatment.

BACKGROUND: Understanding when and why endodontic treatments fail could help clinicians make prognoses and thus improve treatment outcomes. This study was aimed to assess potential predictors of early endodontic treatment failure. We explored factors contributing to the failure of initial root canal treatment were explored, with a specific emphasis on evaluating the influence of the time elapsed since the initial treatment. METHODS: This retrospective cohort study enrolled 1262 patients who sought endodontic treatment at our department and 175 patients were included for analysis. Potential causes of endodontic treatment failure were investigated, such as inadequate obturation quality, inadequate coronal status, the presence of additional untreated canals, anatomical complexity, instrument separation, iatrogenic perforation, cracks, and endodontic-periodontal lesions. The patients were divided into "short-term" and "long-term" groups depending on the time that had passed since the initial treatment (i.e., < 5 and > 10 years, respectively). The causes of failure in the short-term and long-term group were analyzed and compared using logistic regression analyses. Subgroup analysis was performed according to the number of years since the initial treatment in the short-term group to further investigate the association between the time and cause of failure (i.e., < 1, 2, 3, and 4 years, respectively). RESULTS: Untreated additional canals were present in 21.7% of all cases, and in 36.9 and 6.4% of cases in the short-term and long-term groups, respectively. Multivariable analysis showed that the presence of untreated additional canals was significantly associated with short-term compared to long-term failure. Untreated additional canals were also associated with endodontic failure within 1, 2, 3, and 4 years. CONCLUSIONS: The presence of untreated additional canals was a predictor of endodontic failure within 5 years following initial root canal treatment. To optimize long-term prognosis, it is important to detect and treat all root canals during the initial treatment.

Unlocking the Potential of Cellular Guidance in Endodontics: Advancing the Process of Pulp Regeneration and Beyond.

Regenerative endodontics represents a paradigm shift in dental therapy, with the potential to not only restore damaged dental tissues but also to preserve the vitality of teeth. At the heart of this innovative approach is cell homing, a technique that harnesses the body's own healing mechanisms by recruiting endogenous stem cells to the site of dental injury for effective tissue regeneration. This review delves into the intricate processes of cell homing in the context of regenerative endodontics, particularly focusing on its application in immature teeth with open apices. It examines the role of bioactive molecules, scaffolds, and growth factors in orchestrating cell migration and differentiation within the root canal space. In addition, the review addresses the current limitations in clinical practice, such as the challenges in completely regenerating the pulp-dentin complex and the unpredictability in long-term outcomes. It also explores future possibilities, including the potential for more refined and effective regenerative strategies. By providing a comprehensive overview of the current state of cell homing in regenerative endodontics, this article aims to contribute to the ongoing development of advanced therapeutic techniques that could revolutionize endodontic treatment and improve patient care.

Locating and Treating Three Calcified Canals in a Mandibular First Molar With Radix Entomolaris and Five Canals: A Case Report.

The success of root canal treatment is highly contingent on the comprehensive shaping, cleaning, and filling of the entire root canal system. Failure to address one or more canals often results in an increased likelihood of post-treatment apical periodontitis. Typically, mandibular first molars feature two roots and three canals, but they may also exhibit anatomical variations, such as a mesial middle canal or radix entomolaris (RE). This article presents a case where three calcified canals in a mandibular first molar with RE and five canals were successfully located and treated.

Endodontic Treatment of Two Calcified Mandibular Central Incisors: A Case Report.

Treating calcified root canals presents significant challenges, as incorrect approaches can result in treatment failure or lead to complications. The necessity for advanced diagnostic and therapeutic tools is often paramount in these situations. This case report demonstrates the successful treatment of two calcified mandibular central incisors, followed up for a period of up to six years. It emphasizes the effectiveness of integrating cone-beam computed tomography, dental operating microscopes, and ultrasonic instruments in the treatment of such challenging cases.

Dental Treatment Needs of Male Inmates in Relation to the Analysis of Medical Databases.

The worldwide incarceration rate per 100,000 people varies from 30 in India, 580 in Europe, to 750 in United States. The health of prisoners is of great concern. Research in many countries has shown poor oral health conditions among prisoners, particularly reflected in the high number of lost and untreated decayed teeth. The aim of our study was to evaluate the quality and range in dental procedures conducted on male prisoners, based on a retrospective analysis of medical history gathered at the Academic Center of Dentistry and Specialistic Medicine of Medical University of Silesia in Bytom for the period 2018-2021, and its correlation with the results obtained from the analysis of the Web of Science (WoS) and SCOPUS medical databases. Our research was carried out on the examined group, 86 men (mean age 31 years old), and a control group, 106 men (mean age 32 years old). The retrospective analysis of the medical history was performed. Results of our own research showed the values for decayed and missing teeth were significantly higher in the examined group while the values for the filled teeth component were significantly higher in the control group. The chance for the occurrence of the radices was 2.5 times higher in the examined group than in the control. The examined group was characterized by 3.6 times higher chance of no root canal treatment than the control group. The number of the endodontically treated teeth was significantly higher in the control group. The examined group was characterized by 4.2 higher probability for periapical lesion occurrence in teeth that were not endodontically treated. The number of teeth qualified for the endodontic treatment was significantly higher in the examined group, while the number of teeth qualified for the reendow treatment was significantly higher in the control group. The probability for the occurrence of both vertical and horizontal atrophy in the alveolar process was twice and three times higher in the examined than in the control group. In conclusion, the oral status of inmates is worse when compared to those who live in freedom, which is why there is a need to prepare a scheme to improve the condition of the stomatognathic system in prisoners.