Regenerative Endodontic Procedures in Immature Teeth Affected by Regional Odontodysplasia.

INTRODUCTION: Regional odontodysplasia (ROD) is a rare developmental disorder characterized by hypo-mineralization and hypoplasia of enamel and dentin. Symptoms include poorly developed tooth buds, delayed eruption of permanent teeth in affected quadrants, and ghost teeth. The affected teeth often become necrotic, due to abnormal enamel and dentin development, making them susceptible to caries and infection. The aim of this case report is to describe the treatment of ROD through pulp revascularization. CASE REPORT: A 13-year-old girl was referred for endodontic treatment. The mandibular left incisors and first premolar, which were affected by regional odontodysplasia, lost their vitality because of the impaired structure of the enamel. Due to the teeth's early developmental stage, a regenerative endodontic treatment was attempted. All three teeth were treated using the same protocol following the AAE guidelines. After 4 weeks treatment of the premolar was completed, whereas the incisor teeth remained symptomatic and were and therefore, intracanal dressing with calcium hydroxide was repeated and left in place for five months. Finally, the regenerative procedure was completed, and the crowns restored. The patient was scheduled for follow-up examinations after 6 months, and then yearly for the next 3 years. After one year, the periapical lesion around the central incisor and premolar had resolved, the lesion around the apex of the lateral incisor was healing, and the roots had continued to develop. After three years, complete healing and pulp canal obliteration were observed in the central incisor and in the premolar. However, the root of the lateral incisor tooth was split, and it was recommended to extract this tooth. CONCLUSION: The positive outcomes of regenerative endodontics in the central incisor and premolar suggest that revascularization of the pulp may be optional for the treatment of immature necrotic teeth affected by developmental disorders, such as ROD, amelogenesis imperfecta or dentinogenesis imperfecta.

The consequences of orthodontic extrusion on previously intruded permanent incisors-A retrospective study.

AIM: The aim of this study is to compare the adverse effects that occur after orthodontic extrusion of teeth that have been traumatically intruded with those of similar teeth that have not experienced any trauma. BACKGROUND: The outcome of incisors intrusion can be affected by the patient's age, extent of injury, root development, and malocclusion. Orthodontic extrusion is a potential solution, but it may also cause complications. MATERIALS AND METHODS: A retrospective study of the effects of extrusion of traumatically intruded teeth was carried out. The study group included 21 teeth in 14 patients. The control group included 32 teeth in 10 patients that underwent orthodontic extrusion with no history of trauma. Patients' age, gender, and stage of root development were recorded. The severity of the intrusion was classified as mild (<3 mm), moderate (3-6 mm), and severe (≥7 mm). A comparison of signs of pulp necrosis and root resorptions between the groups was made. RESULTS: The central incisor is the tooth that is most injured in 80.9% of cases. A majority of these incidents involve severe intrusion, which was found in 42.9% of cases. 90% of the traumatized teeth had already lost their vitality prior to orthodontic treatment. Various forms of root resorption were observed in the study group. In the control group, 31.2% of teeth showed signs of external root resorption, but no endodontic intervention was carried out during the follow-up period, as these teeth remained vital. CONCLUSIONS: Following intrusion, there is a high risk for root resorption and pulp necrosis. Orthodontic repositioning should be carried out with caution and mild force to prevent complications. Long-term follow-ups are required to ensure the best possible outcome.

Enhanced socket preparation during autotransplantation: a new treatment protocol.

OBJECTIVE: Tooth autotransplantation (AT) is a viable option for the replacement of unrestorable or missing teeth. Recently, the use of a 3D replica of a donor tooth constructed from CBCT scans was described. The model is made to assess the recipient site's size and minimize the required extraoral time of the donor tooth after extraction. The aim of the paper was to describe a new technique for AT using the 3D replica as a socket preparation tool. CASE REPORT: A 13-year-old boy who presented with hypodontia was referred for consultation and treatment. The treatment plan included combined orthodontic treatment and AT of the mandibular left second premolar into the site of the congenitally missing maxillary right canine. A titanium 3D model of the donor tooth was printed by a direct metal laser 3D printer utilizing the model from the CBCT scan. An intrasulcular flap was elevated, and the edentulous maxillary ridge was prepared using implant trephine burs with increasing diameters. A surgical mallet was utilized to apply vertical forces to the 3D-printed model, which was inserted into the prepared socket to allow a perfect fit for the donor tooth. After atraumatic extraction of the mandibular left second premolar, the donor tooth was inserted into the ready socket and splinted. Follow-up examinations at 1, 3, and 6 months, and 1 year after surgery demonstrated a successful outcome. CONCLUSION: The titanium replica was successfully used for precise preparation of the recipient site, minimizing the extraoral time of the procedure to 4 minutes, and thereby improving the expected outcome. (Quintessence Int 2023;54:142-148; doi: 10.3290/j.qi.b3649031).

An Assessment of the Effects of Orthodontic Treatment after Apexification of Traumatized Immature Permanent Teeth: A Retrospective Study.

INTRODUCTION: Root resorption may occur in traumatized necrotic teeth that have undergone apexification after orthodontic treatment. This study examined the effects of orthodontic treatment on the outcome of apexification. METHODS: This retrospective study included 36 children presenting with anterior permanent traumatized teeth with immature roots who were treated by apexification and root canal treatment. The orthodontic group consisted of 17 children with 24 teeth that were subjected to orthodontic treatment after apexification. The control group consisted of 19 children with 21 teeth that underwent only apexification without orthodontic treatment. Almost half of the teeth in both groups underwent apexification with calcium hydroxide, whereas the other half were treated with mineral trioxide aggregate. The effects of sex, stage of root development, and apexification material on the outcomes of apexification were analyzed and compared between the 2 groups. RESULTS: Apexification was successful in 88% of cases after at least 5 years of follow-up. Neither apexification technique nor sex had a significant effect on treatment outcome. The stage of root development had a positive effect on outcome, although it was not statistically significant. Some root resorption (average = 0.3 mm) was observed after orthodontic treatment, whereas teeth that underwent apexification without orthodontic treatment exhibited some root elongation (average = 0.1 mm). This difference was highly significant. CONCLUSIONS: Minor root resorption was observed in the orthodontic group compared with a minor increase in root length in the control group. Orthodontic movement of immature traumatized teeth after apexification appears to be safe.

Incidence of cholesterol in periapical biopsies among adolescent and elderly patients.

INTRODUCTION: Cholesterol clefts are common histologic findings in periapical biopsies; they have a reported incidence in periapical periodontitis of up to 44%. Cholesterol crystals are also recognized in advanced atherosclerotic plaques in humans. Male sex, genetic abnormalities, and age have been associated with advanced atherosclerotic lesions. Among these nonmodifiable risk factors, age is the most dominant. The aim of the study was to evaluate if age is also linked to cholesterol deposition in periapical periodontitis. METHODS: The database of biopsy reports obtained between 2006 and 2009 was searched for specimens diagnosed as radicular cysts or periapical granulomas. Only data relating to biopsies obtained from adolescent (13-21 years old) and elderly (over 60 years old) patients were selected. The biopsies were examined by a pathologist under a light microscope (Zeiss, Jena, Germany) at magnifications of 40×-200×. The available material was scanned for the presence of cholesterol clefts and foamy cells in radicular cysts and granulomas. RESULTS: A total of 41 specimens were collected in the adolescent group and 48 specimens in the elderly group over a 4-year period. A higher incidence of cholesterol was found in the elderly group compared with that in the adolescent group (odds ratio = 6.857). CONCLUSIONS: The highly significant incidence of cholesterol deposits in periapical biopsies among elderly patients may be a possible cause for the lack of repair. The mechanism for cholesterol accumulation is probably similar to the process leading to atherosclerosis and coronary artery disease. Statin administration may be advantageous for the treatment of persistent lesions. A clinician should be aware of the risk for persistent lesions after endodontic treatment in elderly patients.

The effect of dentin on the pulp tissue dissolution capacity of sodium hypochlorite and calcium hydroxide.

INTRODUCTION: Sodium hypochlorite (NaOCl) and calcium hydroxide (Ca[OH]2) have tissue dissolution capacity. The aim of this study was to evaluate the potential effect of dentin on their tissue dissolution capacity in a novel dentin model. METHODS: Dentin models were prepared from 25 freshly extracted human molar teeth; the crowns were separated from the roots, and a rectangular inner shape was prepared. Pulp tissue samples adjusted to similar weights of 6.5 ± 0.2 mg were randomly divided into 6 groups: NaOCl groups in test tubes or dentin models for 1 hour, Ca(OH)2 groups in test tubes or dentin models for 1 week, and control groups saline in test tubes or dentin models for 1 week. The final weights after the experimental period were checked and compared with the initial weights. The differences were statistically analyzed. RESULTS: The tissue dissolution capacity of Ca(OH)2 was affected by the presence of dentin. Similarly, NaOCl lost its effect on the pulp tissue after incubation in dentin. Comparison between all test groups showed highly significant differences (P < .001). CONCLUSIONS: Dentin has a detrimental effect on the ability of NaOCl and Ca(OH)2 to dissolve pulp tissue. The dentin model appears to be an efficient tool for the study of interactions between local endodontic medicaments, dentin, and pulp tissue.

Synergistic effect of Er:YAG laser irradiation in combination with chlorhexidine on the viability of Enterococcus faecalis: an in vitro study.

OBJECTIVE: This study aimed to examine the potential synergistic effect of laser and chlorhexidine (CHX) applications on the growth of Enterococcus faecalis. BACKGROUND DATA: CHX has been recommended for root canal irrigation because of its antibacterial properties. Er:YAG 2.94??m laser irradiation was shown to be beneficial in disinfecting infected root canals. Producing minimal side effects is the goal of any clinical procedure. One means of achieving this is via a synergistic effect caused by simultaneously introducing two applications with reduced dosages, with no compromise on their biological effect. METHODS: Bacterial suspensions of E. faecalis supplemented with 0.01?0.0001% v/v CHX solutions were lased at energy levels between 300 and 500?mJ. Bacterial growth was continuously monitored for 18?h using a GENios apparatus. RESULTS: Laser irradiation between 350 and 500?mJ delayed initiation of bacterial growth for 6?h. A concentration of 0.0001% CHX did not delay bacteria growth. However, a combination of 0.0001% CHX and laser irradiation had a synergistic effect on bacterial growth. A maximal inhibition period of bacterial growth was observed at energy levels of 500?mJ with 0.0001% CHX. CONCLUSIONS: Laser combined with CHX has a synergistic effect in killing E. faecalis. A combined regimen of a low concentration of CHX with laser irradiation was found to be a potential means of inhibiting bacterial growth.

Is a C-shaped configuration possible in teeth other than mandibular molars?

This case report presents a maxillary third molar with a C-shaped canal system. This is the first known description of a maxillary third molar with C-shaped anatomy. This unique pulp chamber morphology was observed under the operating microscope. Root canal treatment consisted of cleaning and shaping combined with ultrasonic irrigation with sodium hypochlorite. A calcium hydroxide dressing was applied between appointments. Obturation of the root canal system was performed with warm vertical condensation. The complexity of this canal morphology requires the prudent clinician to perform strict measures to achieve satisfying results.

Odontogenic sinus tracts: a cohort study.

OBJECTIVE: To determine the prevalence,location, and distribution of sinus tracts in patients referred for endodontic consultation. METHOD AND MATERIALS: This cohort study included 1,119 subjects referred for endodontic consultation, 108 of whom presented with sinus tracts. Following clinical and radiographic examination, the diameter of the rarifying osteitis lesion on the radiograph was measured and the path and origin of the sinus tracts determined. Signs and symptoms, tooth site,buccal/lingual location, and diameter were recorded. Data were statistically analyzed using Pearson chi-square test. RESULTS: Sinus tracts originated mainly from maxillary teeth (63.1%); only 38.9% originated from mandibular teeth. Chronic periapical abscess was the most prevalent diagnosed origin (71.0%). Broken restorations were highly associated with the presence of sinus tracts (53.0%). The most frequent site of orifices was buccal(82.4%), followed by lingual or palatal (12.0%). Orifices on the lingual aspect of the gingiva were observed in mandibularmolars. There was an 86.8% correlation between the occurrence of an apically located sinus tract and apical rarifying osteitis(P<.01). CONCLUSION: Sinus tract in the lingual or palatal aspect of the gingiva is relatively common. Practitioners should look for signs of sinus tract during routine examination

Restoration of endodontically treated teeth review and treatment recommendations.

Coronal restorations and posts can positively influence the long-term prognosis of teeth following root canal therapy. Final sealing the canal by placing an appropriate post and core will minimize leakage of oral fluids and bacteria into the periradicular area and is recommended as soon as possible after completion of root canal filling. Glass ionomer or MTA placed over the residual root canal filling after post space preparation may be effective to prevent bacterial leakage. A ferrule of 1-2 mm of tooth tissue coronal to the finish line of the crown significantly improves the fracture resistance of the tooth and is more important than the type of the material the core and post are made of.

Multiple sinus tracts as a result of root fracture: a case report.

Sinus tracts are a consequence of chronic apical disease or vertical root fractures. They are usually diagnosed upon routine clinical examination or in response to patient complaints of swelling and occasional pus secretion. An unusual case report of a maxillary canine with multiple orifices of sinus tracts is presented. Vertical root fracture was confirmed after removal of the root canal filling under an operating microscope. Clinicians should suspect vertical root fracture when multiple sinus tracts originating from the same tooth are observed.

Antibacterial properties of four endodontic sealers.

The purpose of this study was to evaluate the antimicrobial effects of root canal sealers. The direct contact test (DCT) was used to assess the antibacterial properties of AH plus, Apexit Plus, Epiphany SE, and RoekoSeal when in contact with Enterococcus faecalis. The materials were examined immediately after setting and 1, 2, 7, and 14 days after aging in phosphate-buffered-saline. Statistical analysis with two-way analysis of variance, one-way analysis of variance, and Tukey multiple comparison was applied to the data. Apexit Plus had a short-term antibacterial effect of 1 day on E. faecalis, whereas Epiphany SE enhanced bacterial growth for at least 7 days. AH plus and RoekoSeal were ineffective.

The effect of CO2 Laser on the permeability of dentinal tubules: a preliminary in vitro study.

OBJECTIVES: The purpose of this in vitro study was to determine whether there is a change in dentin permeability following 9.6-microm CO(2) laser irradiation and high-speed drilling. MATERIALS AND METHODS: Twenty permanent, intact, non-carious molars were selected. The crowns were separated from the roots at the cemento-enamel junction. The teeth were randomly divided into two groups, control and experimental, each containing 10 teeth. After class I preparation using a high-speed drill, 9.6-microm CO(2) laser irradiation was applied to dentinal areas only on the experimental group. The samples were soaked in 0.5% methylene blue for 48 h; three independent examiners using scanning electron microscopy evaluated dye penetration through the specimens. RESULTS: The results of the three examiners were similar. There was a significant difference in dye penetration into dentin after laser irradiation versus controls (p < 0.05). CONCLUSIONS: The 9.6-microm CO(2) laser appears to be a promising tool in the clinical setting. However, further investigation is needed to ensure maximum effectiveness.

The effect of CO(2) laser on the microhardness of human dental hard tissues compared with that of the high-speed drill.

OBJECTIVE: The purpose of this study was to examine the effect of 9.6-microm CO(2) laser energy on the microhardness of human dental hard tissues compared with that of high-speed drill cavity preparation, and to determine the applicability of this laser in clinical treatment. MATERIALS AND METHODS: A total of 10 caries-free human single-rooted teeth were used for this study. The crowns were resected and the roots were longitudinally sectioned into two halves. In each slice one half of the enamel and the dentin were treated with 9.6-microm CO(2) laser irradiation, and in the other half the enamel and dentin were treated with a high speed drill, each half for 3 s. Following treatment, the samples were polished and tested for microhardness. The results were compared using analysis of variance. RESULTS: Statistically significant differences in dentin microhardness were found between specimens treated with 9.6-microm CO(2) laser energy as compared with specimens treated with the high-speed drill (p = 0.0156). There were no statistically significant differences in enamel microhardness between specimens treated with 9.6-microm CO(2) laser energy and specimens treated with the high-speed drill. CONCLUSION: The clinical use of 9.6-microm CO(2) laser energy for cavity preparation should be further analyzed, and compared with different types of lasers used in dentistry, such as 10.6-microm CO(2) or Er-YAG.

Healing of a fibrous dysplastic lesion in a permanent molar after endodontic therapy.

Fibrous dysplasia presents in two forms: monostotic and polyostotic. Both forms are more widespread among children and juveniles and may result in facial asymmetry. Neoplastic bone lesions, localized over the root apices and mimicking periapical pathosis, have been observed. Irregular pulp morphology not previously reported is described in the following case report. A 14-year-old boy diagnosed with fibrous dysplasia was referred for endodontic treatment as the result of a necrotic pulp in an upper molar. A periapical lesion was diagnosed when the tooth was intact. After complex root canal treatment the periapical lesion healed.

Retrieval of amalgam from the root canal space.

Removal of foreign objects from the root canal can be very frustrating. The use of a variety of instruments and techniques has been suggested for the retrieval of obstacles from root canals during endodontic treatment. This article describes a method for retrieving a large mass of amalgam restoration that was wedged into the root canal. The amalgam, which had served as the provisional restorative material during apexification of an immature ante rior tooth, was inadvertently pushed into the root canal. After the mass was bypassed, the amalgam was loosened with the aid of copious irrigation, chelation, and flotation. Hedstrom files twisted around the object allowed sufficient grip for its retrieval, enabling completion of the root canal treatment.

The effect of the distance between post and residual gutta-percha on the clinical outcome of endodontic treatment.

To determine whether the distance between the post and the residual gutta-percha influences the clinical outcome of endodontic treatment, 94 endodontically treated teeth following post and core restoration were evaluated radiographically. The teeth were divided into three groups: (I) no gap between the gutta-percha and the post; (II) a gap of >0 to 2 mm; (III) a gap of >2 mm. Treatment outcome was evaluated in follow-up radiographs, taken 1 yr after treatment and up to 5 yr posttreatment. In group I, 83.3% of the teeth were evaluated normal, 53.6% of group II, and only 29.4% of group III. A gap between the gutta-percha and the post was related to an increased rate of emerged disease in endodontically treated teeth restored with a post and core.

Effect of sodium hypochlorite on dentin microhardness.

This study was designed to evaluate the effect on root dentin microhardness of 2.5% and 6% sodium hypochlorite solutions for various irrigation periods. Forty-two bovine roots were divided into seven groups. The control group was irrigated with saline. The experimental samples were continuously irrigated with 2.5% or 6% NaOCl for 5, 10, or 20 min. Microhardness was measured at depths of 500 mum, 1000 mum, and 1500 mum from the lumen. A decrease in microhardness was found at 500 mum between the control and samples irrigated with 6% NaOCl and 2.5% NaOCl (p = 0.352, p = 0.084 respectively) at all irrigation periods. There also was a significant difference in groups irrigated for 10 or 20 min (p = 0.001, p < 0.001 respectively). At all distances, the decrease in microhardness was more marked after irrigation with 6% NaOCl than 2.5% NaOCl.

A novel multidisciplinary approach for the treatment of an intruded immature permanent incisor.

The optimal treatment for intruded permanent teeth has not yet been determined. The ideal treatment option is the one with the lowest probability of developing complications such as external root resorption and marginal bone loss. Each case should be considered individually, bearing in mind the severity of the intrusion, the stage of root development, and tooth mobility. Management of an intruded permanent tooth may consist of: (1) observation for spontaneous eruption; (2) surgical crown uncovering; (3) orthodontic extrusion (with or without prior luxation of the intruded tooth); (4) and partial surgical extrusion, immediately followed by orthodontic extrusion and surgical repositioning. The purpose of this article was to review the treatment options for intruded immature permanent incisors, and to present a new modality of an elective internal strengthening of the immature root weakened by external root resorption. A case of an intrusive luxation injury in a 7 1/2-year-old child and the resulting complications utilizing this technique is described. This is the first known report in the pediatric dentistry literature of performing an elective (preventive) internal strengthening of an immature root weakened by severe external inflammatory resorption. The child was followed for 5 years with an excellent clinical outcome. This technique should be considered for treatment of immature permanent teeth with thin cervical root dentin and external or internal root resorption due to trauma or caries.