Management and 5-year follow-up of tooth with bilateral cemental tear and complete pulp canal obliteration.

The aim of this study is to report a rare case of bilateral cemental tear in a completely calcified tooth with successful dental management. A 60-year-old male reported with pain in the upper right central incisor. Radiographic examination revealed complete calcific obliteration of the root canal, inflammatory root resorption of apical third, and bilateral cemental tear and traumatic occlusion. Tooth mobility was within physiologic limits and 3-mm probing depth. Endodontic treatment of the tooth was carried out with intracanal calcium hydroxide therapy. The tooth was relieved of traumatic occlusion, scaling and root planning was carried out. As the tooth did not have any periodontal pocket, the maintenance phase was advised, and the tooth was kept under observation. After a follow-up of 5 years, the nonsurgical periodontal therapy showed satisfactory clinical and radiographic outcome.

Endo-restorative Management of a Type II Dens Invaginatus in Mandibular Premolar Associated with a Large Cyst.

We present the management of a case of Type II dens invaginatus in a mandibular premolar with a large invagination in the coronal third of the root on mesial aspect of the crown in proximity of cementoenamel junction significantly compromising the strength of the crown structure. We describe in detail the various measures taken to assess the internal tooth structure destruction and enhance the fracture resistance of the involved premolar. The case has a long-term follow-up of 36 months showing clinical and radiographic signs of healing. We highlight use of a simple "foil coated fiber postblocker technique" for root reinforcement in the first premolar. Successful management of teeth with dens invaginatus can be effectively done using with careful treatment planning and selection of reinforcing adhesive restorative materials.

Management of large radicular cyst associated with amalgam particles in cystic lining.

The failure of amalgam retrofilling and presence of an associated cystic lesion makes surgical endodontic intervention inevitable. Amalgam retrofilling can also give rise to mucoperiosteal tattoo formation and allow incorporation of amalgam particles in the cystic lining. Such a finding has not yet been reported in the endodontic literature. This case report describes the successful endodontic management of a large radicular cyst associated with failed amalgam retrofilling, mucoperiosteal tattoo and amalgam particles dispersed in the epithelial cystic lining. All four mandibular incisors associated with the lesion presented with Weine Type II canal anatomy. The follow-up revealed clinical and radiographic signs of healing.

Management of a massive resorptive lesion with multiple perforations in a molar: case report.

Internal resorption is usually asymptomatic. Large resorption defects may result in penetration of the root dentin leading to perforation. In this case report, we describe the diagnosis and nonsurgical repair of a large resorptive lesion with multiple perforations in a mandibular first molar using cone-beam computed tomographic technology. The 3 different root perforations were located in the mesial root and repaired using Biodentine (Septodont, Saint-Maur des Fossés, France). The mesial root weakened from resorption was reinforced by replacing the lost root dentin with calcium silicate-based cement and placement of a glass fiber post. The 18-month follow-up confirmed remineralization of the osseous defect and asymptomatic function of the tooth. A further follow-up at 43 months revealed retention of the tooth and absence of root fracture. Usually, a tooth with multiple perforations and such a severe tooth material loss would have been destined for extraction. However, with contemporary diagnostic techniques such as cone-beam computed tomography and use of advanced biomaterials and root reinforcement methods, such teeth can be salvaged.

Biodentine pulpotomy several days after pulp exposure: Four case reports.

Conventionally, few-days-old pulp exposures have been treated with root canal treatment. We report four cases of traumatized, fully matured, maxillary permanent central incisors, which have been treated by Biodentine pulpotomy several days after traumatic pulp exposure. Biodentine pulpotomy consisted of pulp tissue removal to a depth of 2 mm, then capping the pulpal wound with Biodentine, followed by immediate restoration. The teeth were assessed clinically through pulpal sensitivity tests and radiographically for periapical healing. At each recall (24 hours, 1 week, 30 days, 3, 6, 12, and 18 months), no spontaneous pain was observed; the pulp showed signs of vitality and absence of periapical radiolucency after 18 months. Biodentine pulpotomy is recommended as a treatment option for cases of vital pulp exposure in permanent incisors due to trauma.