Robot-Assisted and Haptic-Guided Endodontic Surgery: A Case Report.

There has been a significant increase in robot-assisted dental procedures in the past decade, particularly in the area of robot-assisted implant placement. The objective of this case report was to assess the initial use of the Yomi Robot's assistance and haptic guidance during endodontic microsurgery. The robot was used during the osteotomy and root-end resection of the first and second upper left premolars. The report aims to inform clinicians of the initial implementation of this cutting-edge technology in endodontics and its potential to enhance endodontic microsurgery. The Yomi Robot was used in performing osteotomy and root-end resection during apical surgery in a patient presenting with symptomatic upper left first and second premolars. The treatment procedure was decided after clinical examination, chart data, and radiographic examinations, which showed periapical lesions on both premolars, taking into consideration the failed endodontic retreatment on the first premolar, the post and ceramic coronal restorations on both teeth, and the desire of the patient to save them. The Yomi Robot system provides auditory, visual, and physical guidance to clinicians during surgery while using a cone-beam computed tomography scan for precision planning with greater accuracy and minimized potential for human error. Further studies are needed to prepare a protocol for robotic-guided procedures in endodontics.

Enhancement of Antimicrobial Effect of Endodontic Sealers Using Nanoparticles: A Systematic Review.

INTRODUCTION: The elimination of biofilms during root canal therapy continues to pose a challenge due to complex anatomies and uninstrumented portions of the root canal system. The incorporation of nanoparticles in endodontic sealers is an area of interest for potentially enhancing antimicrobial activity and improving treatment outcomes. This systematic review evaluated the antimicrobial effects of various nanoparticles in endodontic sealers. METHODS: Comprehensive literature review was conducted using the electronic Embase, Web of Science, and PubMed databases followed by citation searching for articles eligible per the inclusion criteria. RESULTS: A total of 1845 citations were screened, of which 13 articles met the inclusion criteria and were included in this review. All included articles were in vitro studies with low-to-moderate quality assessment scores. The incorporation of select nanoparticles was associated with significant enhancement of antibacterial effects in planktonic and/or biofilm forms, whereas other nanoparticles were not. CONCLUSIONS: The incorporation of certain types and concentrations of nanoparticles into endodontic sealers displayed antimicrobial effects in vitro. The need for well-designed clinical studies translating in vitro findings into clinical practice is warranted. The incorporation of nanoparticles may enhance the antimicrobial properties of endodontic sealers and may improve treatment outcomes.

THE PREVALENCE OF A SECOND ROOT CANAL IN MANDIBULAR ANTERIOR TEETH VARIES BY GEOGRAPHIC REGIONS AND DEMOGRAPHIC FACTORS.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Martins JNR et al. Influence of Demographic Factors on the Prevalence of a Second Root Canal in Mandibular Anterior Teeth - A Systematic Review and Meta-Analysis of Cross-Sectional Studies Using Cone Beam Computed Tomography. Arch Oral Biol. 2020 Aug;116:104,749. doi: 10.1016/j.archoralbio.2020.104749. SOURCE OF FUNDING: No funding was obtained for this research TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Survival of endodontically treated permanent teeth among children: a retrospective cohort study.

BACKGROUND: Outcome studies of nonsurgical root canal treatment (NSRCT) in permanent teeth of children are scarce. This study investigated survival and assessed the variables associated with failure of endodontically treated teeth (ETT) in 6- to 18-year-olds. METHODS: Records of subjects who received NSRCT at age 6-18 years at Boston University between 2007 and 2015 were assessed for the occurrence of untoward events. Kaplan-Meier survival curves were used to investigate the survival of ETT in the total sample. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated. RESULTS: The analysis included 341 patients (424 ETT). Kaplan-Meier survival curves differed according to age at treatment (log-rank P = 0.026), with survival being the lowest among the youngest age group. The estimated 5-year survival probability was 80% for 15- to 18-year-olds, 64.8% for 12- to 14-year-olds and 46.4% for 6- to 11-year-olds. Compared to age at treatment of 15-18 years, age at treatment of 6-11 years (aHR: 2.19, 95% CI 1.02-4.67) and 12-14 years (aHR: 2.02, 95% CI 1.15-3.55) was associated with an increased risk of ETT failure. In the total study sample, the estimated cumulative survival probability was 93.3% at 12 months, 88.0% at 24 months, 76.2% at 36 months, 71.0% at 48 months, and 69.1% at 60 months. CONCLUSIONS: In children, ETT are more likely to survive when NSRCTs are performed at an older age.

For pulp treatment in primary teeth, rotary canal instrumentation may be modestly time efficient, but otherwise similar to manual canal instrumentation.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: A systematic review and meta-analysis of randomized clinical trials comparing rotary canal instrumentation techniques with manual instrumentation techniques in primary teeth. Manchanda S, Sardana D, Yiu CKY. Int Endod J. 2020;53(3):333-353. SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Factors Related to the Outcomes of Cracked Teeth after Endodontic Treatment.

INTRODUCTION: Cracked teeth are a common clinical finding; however, their presence renders diagnosis and prognosis unreliable. The purpose of this research was to assess the correlations of multiple factors on the prognosis of cracked teeth that had undergone endodontic treatment. METHODS: A total of 3680 patients who received endodontic treatment by an advanced postdoctoral education program in endodontics with follow-up records of at least 1 year were assessed. From this sample, 62 patients met the inclusion criteria and were included in the final analysis. The factors being evaluated included demographics, clinical symptoms and signs, radiographic findings, and restoration type. Statistical analysis was then completed using the chi-square and Fisher exact tests. RESULTS: The mean follow-up period was 23.3 months, with an overall tooth success rate of 75.8%. The success rates differed significantly when the patient had an existing preoperative periapical lesion, lacked a proper permanent restoration on the treated tooth, or had a post placed after root canal treatment. Data analysis showed that restoring the tooth after endodontic treatment was the single most important factor for prognosis. In fact, the endodontically treated teeth with definitive full-coverage restorations had a 2-year success rate of 93.6%. CONCLUSION: Full-coverage restorations should be considered an important part of the treatment plan for cracked teeth treated endodontically.

The Recommendation of Cone-beam Computed Tomography and Its Effect on Endodontic Diagnosis and Treatment Planning.

INTRODUCTION: Although intraoral radiographs are foundational for diagnosis and planning treatment in dentistry, the resulting 2-dimensional image varies in interpretation requiring judgment. Cone-beam computed tomographic imaging provides a more detailed 3-dimensional image that may affect treatment recommendations. This study aimed to determine the basis for CBCT recommendations and the effect on diagnosis and treatment planning. METHODS: The study involved a sample of 45 cases that presented for endodontic treatment, 30 with a CBCT scan on record and 15 without. For phase 1, all 45 cases were reviewed by 3 examiners without access to the CBCT scans. For phase 2, 4 months later, the 3 examiners reanalyzed the 30 cases, this time with the associated CBCT scan. Intra- and interexaminer agreements were recorded and analyzed. Also, the recommendations for CBCT were compared with the American Association of Endodontists/American Academy of Oral and Maxillofacial Radiology joint statement. RESULTS: Interexaminer agreement in phases 1 and 2 was 65% and 72%, respectively. For endodontic diagnoses, there was a 19% change in the pulpal diagnosis category when CBCT imaging was added, whereas there was a 30% change in the apical category. The selections changed in 55% of the cases when determining etiology and in 49% of the cases when making recommendations. CBCT imaging was recommended 78.8% of the time when the case had a CBCT on record versus 33% of the time in cases without. CONCLUSIONS: CBCT imaging has a significant effect in determining the etiology of endodontic pathoses and in recommending treatment. Furthermore, CBCT imaging is not overprescribed in the endodontic department, and the faculty members adhere to the American Association of Endodontists/American Academy of Oral and Maxillofacial Radiology recommendations.

Intentional Replantation of Teeth is a Viable and Cost-effective Alternative Treatment to Single-Tooth Implants.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: A Systematic Review of the Survival of Teeth Intentionally Replanted with a Modern Technique and Cost-effectiveness Compared with Single-tooth Implants. Mainkar A. J Endod 2017:43(12):1963-8. SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Systematic review/meta-analysis.

Growth and Differentiation of Dental Stem Cells of Apical Papilla on Polycaprolactone Scaffolds.

Biodegradable scaffolds are useful tools in the field of tissue engineering and regenerative medicine. The aim of this study was to test the potential of the human stem cells of apical papilla (SCAP) to attach, proliferate and differentiate on a polycaprolactone (PCL)-based scaffolds. SCAP were extracted from the root apical papillae of freshly extracted immature premolar teeth by using enzymatic digestion. Porous PCL scaffolds were fabricated using particle leaching method and NaCl or mannitol as porogens. SCAP of passage 3 were seeded on non-porous and porous PCL scaffolds for up to 14 days. For control, cells were cultured on glass coverslips. Picogreen DNA quantification was used to assay for cell proliferation. Cell differentiation and development of calcification nodules were examined using scanning electron microscopy and alizarin red staining. SCAP showed a comparable attachment, growth and proliferation patterns on PCL scaffolds and coverslips. Cell proliferation was enhanced on mannitol scaffolds at all time points. Calcification nodules were detected in all PCL scaffolds while it was not present on glass coverslips. These nodules were detected on NaCl-scaffolds by day 7 and on mannitol and non-porous scaffolds by day 14. In conclusion, SCAP were able to attach, proliferate and differentiate on PCL scaffolds without using any inductive media, indicating their potential application for dental tissue regeneration.

Limited Evidence Suggests That Symptomatic Cracked Teeth Share Characteristics Such as Clenching, Grinding, and Molars With Distal Cracks.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Correlation between symptoms and external characteristics of cracked teeth. Hilton TJ, Funkhouser E, Ferracane JL, Gilbert GH, Baltuck C, Benjamin P, Louis D, Mungia R, Meyerowitz. JADA 2017; 148(4):246-56.e1. SOURCE OF FUNDING: National Institutes of Health grant U19-DE-22516 TYPE OF STUDY/DESIGN: Cross-sectional study.

Combination Analgesics Reduce Postoperative Pain in Teeth With a Pulpal Diagnosis of Irreversible Pulpitis.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Double-blind Randomized Placebo-controlled Clinical Trial of Efficiency of Nonsteroidal Anti-inflammatory Drugs in the Control of Post-endodontic Pain. Elzaki WM, Abubakr NH, Ziada HM, Ibrahim YE. J Endod 2016;42(6):835-42. SOURCE OF FUNDING: No source of funding was identified. The study was conducted by the faculty of the Dentistry Department, University of Khartoum and the Khartoum Teaching Hospital emergency clinic TYPE OF STUDY/DESIGN: Double-blind randomized controlled trial.

A Micro-Computed Tomography Study of the Root Canal Morphology of Mandibular First Premolars in an Emirati Population.

OBJECTIVE: To investigate variations in the root canal morphology of mandibular first premolars in a population from the United Arab Emirates using micro-computed tomography (micro-CT) and conventional radiography. MATERIALS AND METHODS: Three-dimensional images of 50 extracted human mandibular first premolars were produced using a micro-CT scanner, and conventional radiography was also used to record the number of roots, the root canal system configuration, the presence of a C-shaped canal system and lateral canals, intercanal communications, and the number and location of apical foramina. The interpretations of micro-CT and conventional radiography were statistically analyzed using Fisher's exact test. RESULTS: Variable root canal configurations based on Vertucci's classification were observed in the teeth (i.e., types I, III, IV, V, and VII). The examined teeth exhibited the following 2 additional root canal configurations, which did not fit Vertucci's classification: type 1-2-3 and type 1-3. A C-shaped canal configuration was present in 14 (28%) cases, and lateral canals were present in 22 (44%) cases. Apical deltas were found in 25 (50%) cases, intercanal communications were seen in 6 (12%) cases, and apical loops were seen in 2 (4%) of the samples. Micro-CT and X-ray imaging identified 39 (78%) and 34 (68%) apical foramina, respectively. A single apical foramen was detected in 33 (66%) samples, and 2 or 3 apical foramina were detected in 14 (28 %) and 3 (6%) samples, respectively. In 18.5 (37%) samples the apical foramina were located centrally, and in 31 (62%) they were located laterally. CONCLUSION: A complex morphology of the mandibular first premolars was observed with a high prevalence of multiple root canal systems.

NOTCH3 is expressed in human apical papilla and in subpopulations of stem cells isolated from the tissue.

NOTCH plays a role in regulating stem cell function and fate decision. It is involved in tooth development and injury repair. Information regarding NOTCH expression in human dental root apical papilla (AP) and its residing stem cells (SCAP) is limited. Here we investigated the expression of NOTCH3, its ligand JAG1, and mesenchymal stem cell markers CD146 and STRO-1 in the AP or in the primary cultures of SCAP isolated from AP. Our in situ immunostaining showed that in the AP NOTCH3 and CD146 were co-expressed and associated with blood vessels having NOTCH3 located more peripherally. In cultured SCAP, NOTCH3 and JAG1 were co-expressed. Flow cytometry analysis showed that 7%, 16% and 98% of the isolated SCAP were positive for NOTCH3, STRO-1 and CD146, respectively with a rare 1.5% subpopulation of SCAP co-expressing all three markers. The expression level of NOTCH3 reduced when SCAP underwent osteogenic differentiation. Our findings are the first step towards defining the regulatory role of NOTCH3 in SCAP fate decision.

Pulpal and periradicular response to caries: current management and regenerative options.

The pulp-dentin complex is a strategic and dynamic barrier to various insults that plague the dentition. Researchers have yet to understand the complete potential of this shifting junction and its components. The most common cause of injury to the pulp-dentin complex is carious breakdown of enamel and dentin. In recent years, there has been a change in restorative management of caries. The emphasis is on strategies to preserve dentin and protect the pulp. This article provides a brief review of the effect of caries on the pulp, of subsequent events on the periradicular tissues, and of current understanding of treatment modalities.

Regenerative therapy: a periodontal-endodontic perspective.

Periodontal and endodontic diseases are inflammatory responses leading to periodontal and pulpal tissue loss. Regenerative therapies aim to restore the lost structures to vitality and function. Various materials and treatments methods have been used such as bone grafts, guided tissue regeneration, enamel matrix derivatives, growth and differentiation factors, and stem cells. Although the current materials and methods demonstrated adequate clinical results, true and complete biological tissue regeneration is not yet attainable. The current article reviews chronologically the materials and methods used in periodontal and endodontic regeneration highlighting their clinical success and shortcomings, and discussing future directions in regenerative therapy.

Regenerative endodontics and tissue engineering: what the future holds?

The work performed by researchers in regenerative endodontics and tissue engineering over the last decades has been superb; however, many questions remain to be answered. The basic biologic mechanisms must be elucidated that will allow the development of dental pulp and dentin in situ. Stress must be placed on the many questions that will lead to the design of effective, safe treatment options and therapies. This article discusses those questions, the answers to which may become the future of regenerative endodontics. The future remains bright, but proper support and patience are required.

Medical and orofacial considerations in traumatic dental injuries.

A complete medical and dental evaluation is imperative following traumatic dental injuries, which are emergent situations that need a quick assessment and appropriate management. The proper diagnosis and treatment rendered determines the prognosis of the case. Proper documentation is important for medicolegal reasons and for baseline reference regarding the traumatic injury. Future treatment modalities and outcomes can be better managed with accurate documentation at the initial assessment.

An evaluation of bacterial contamination of barriers used in periapical tissue regeneration: Part 2--Bacterial penetration.

OBJECTIVE: To compare the relative penetration of Prevotella melaninogenica and Enterococcus faecalis through 3 guided tissue regeneration membranes: Atrisorb, Lambone, and OsseoQuest. It was hypothesized that OsseoQuest would show increased bacterial penetration when compared to Lambone and Atrisorb. METHOD AND MATERIALS: Centrifuge tubes containing trypticase soy broth were sealed with circular sections of membranes and placed in test tubes containing culture media. The bacterial penetration was assessed by passage of bacteria from the outer tube culture media to the inner centrifuge tube media through the membrane. After incubation for 4 and 48 hours, the media from the outer and inner tubes were compared for bacterial count. RESULTS: P melaninogenica exhibited 91% penetration for Lambone in 2 days, while OsseoQuest displayed 87% penetration with E faecalis in the same time. Atrisorb displayed a minimal penetration with both bacteria (2%). CONCLUSION: Atrisorb displayed the least bacterial penetration, which may be attributed to membrane structure, chemical configuration, hydrophobicity, and porosity of tested membranes.