Investigation of polymorphisms in BMP2, BMP4, SMAD6 and RUNX2 genes and pulp stones.

This study aimed to assess the association between genetic polymorphisms in BMP2 (rs1005464 and rs235768), BMP4 (rs17563), SMAD6 (rs2119261 and rs3934908) and RUNX2 (rs59983488 and rs1200425) and pulp stones (PS). A total of 117 participants, consisting of 63 individuals with PS and 54 without PS, were included. Digital radiographs and a demographic/clinical questionnaire were used. Genomic DNA from salivary cells was genotyped via real-time polymerase chain reaction. Statistical analyses, including Chi-Square, Fisher's exact tests, Poisson regression and dimensionality reduction, were conducted. The rs2119261 polymorphism in the SMAD6 gene showed an association with genotype distribution in the recessive model (p = 0.049). The T-T haplotype in the SMAD6 gene (rs2119261 and rs3934908) was more prevalent in the control group and significantly linked with PS (p = 0.029). No associations were found between PS risk and genetic polymorphisms in BMP2, BMP4 and RUNX2. Polymorphisms in the SMAD6 gene were associated with PS.

Cone-Beam Computed Tomography-Based Investigation of the Prevalence and Distribution of Pulp Stones and Their Relation to Local and Systemic Factors in the Makkah Population: A Cross-Sectional Study.

Objectives This study aimed to assess the prevalence and distribution of dental pulp stones and evaluated their possible associations with local and systemic factors in the Makkah population in Saudi Arabia. Materials and methods Archived cone-beam computed tomography (CBCT) images for 390 patients, from the electronic health records (EHR) in the Dental Teaching Hospital, Umm Al-Qura University, were used. Images were examined in all planes (coronal, sagittal, and axial) for a discrete radiopaque mass in the pulp of all teeth, in both arches. The teeth conditions (the presence of caries, restoration, the periodontal condition, and the presence of pulp stones) were recorded. Additional patient information, including age, gender, and medical condition, was obtained from the patients' archived files. The collected data were statistically analyzed using the Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY) software; a p-value of ≤ 0.05 is considered statistically significant. Results Pulp stone prevalence was 78.97% of the subjects (308 out of 390) and 15.92% of the examined teeth (1644 out of 10326). There were statistically significant differences regarding nationality (p=0.043) and age (p=0.023) but no significant difference between males and females (p=0.876), maxillary and mandibular teeth (p=0.392), and right and left sides (p=0.222) in pulp stone prevalence. Significant differences were found between pulp stone prevalence of sound versus and carious and restored teeth and between periodontally affected teeth and periodontally healthy teeth (p=0.031). Conclusion The prevalence of pulp stones in the Makkah population is high. A positive association was found between nationality, age, tooth restorations, caries, periodontal diseases, and pulp stone prevalence, but no correlation was found with patients' health or gender. The molars were the most affected teeth, while the incisors were the least.

Guided Endodontic Treatment for Calcified Central Incisor with Discoloration, a Conservative Approach Preserving Incisal Edge: A Case Report.

Pulp canal obliteration (PCO) in calcified teeth presents a challenge for endodontic treatment, especially when accompanied by discoloration. Guided endodontic access (GEA) has emerged as an advanced method for root canal therapy (RCT) in such cases. This case report describes the successful treatment of a calcified maxillary central incisor with discoloration using GEA. A 32-year-old female with a history of dental trauma presented with discoloration in the left maxillary central incisor that did not respond to external bleaching. Clinical examination revealed a pulpless infected canal with asymptomatic apical periodontitis. Cone-beam computed tomography (CBCT) and intraoral scanning were utilized to create a three dimensional (3D) template, enabling minimally invasive access preparation through the palatal aspect. The RCT was performed in a single visit, followed by tooth whitening using hydrogen peroxide. At 18 months follow-up, the tooth was asymptomatic, and the apical lesion was healed. GEA offers a predictable and conservative approach, preserving tooth structure and providing enhanced long-term prognosis for teeth with calcified canals and discoloration.

Ex-vivo and in-vivo validation of a novel measuring protocol for guided endodontics.

OBJECTIVES: To (1) validate the use of a post-operative intraoral scan (IOS) versus Cone Beam Computed Tomography (CBCT), gold standard, on its ability to measure the accuracy of guided endodontics, and (2) present clinical data on the accuracy of guided endodontics. METHODS: Four models, including 10 extracted teeth each, were created. Forty guided access cavities were planned on dentin to simulate pulp canal obliteration (PCO). Two operators performed guided access cavities. A post-operative CBCT and IOS were acquired. The coronal, apical, and angular deviations were measured with CBCT and IOS. Clinical accuracy was measured using an IOS acquired immediately after drilling the access cavity with the aid of a guide. Data analysis was performed using multiway Anova and corrected for simultaneous hypothesis testing according to Tukey. P ≤ 0.05 was considered statistically significant. Descriptive statistics on the clinical accuracy of guided endodontics were performed. RESULTS: Thirty-eight cavities were assessed with a mean length of 13.8 mm. No statistical difference between operators and methods was found for all parameters (P > 0.05). Thirty-three patients were treated with guided endodontics and measured using an IOS. Results show an average coronal, apical, and angular deviation of 0.2 mm, 0.45 mm, and 1.91° respectively. The average length of the access cavities was 12.5 mm. CONCLUSIONS: An IOS can be used to measure the accuracy of guided endodontics. Clinical data showed high accuracy of guided endodontics with a mean apical deviation smaller than 0.5 mm and a mean angular deviation of less than 2°. CLINICAL SIGNIFICANCE: The use of an IOS does not involve additional radiation exposure. A safety margin of at least 1 mm around the planned trajectory should be respected when planning the case to minimize the possibility of root perforation.

In vitro study on the accuracy of sleeveless guided endodontics and treatment of a complex upper lateral incisor.

PURPOSE: The present study aims to assess the accuracy of sleeveless guided endodontics for root canal treatment of severe pulp canal obliteration (PCO) in 3D printed jaws. Additionally, the treatment of a complex lateral incisor is presented to illustrate the use of sleeveless guides in a clinical situation. METHODS: Two cone-beam computed tomography (CBCT) volumes of an upper and lower jaw were selected to design 3D printed models with PCO. Virtual planning of the access cavities was performed from right to left second premolar. Then, the models were mounted into a phantom head to simulate an actual patient. Two operators with different levels of experience in endodontics performed guided access cavities. The handpiece was guided by guiding rails placed against each other on the sides of the tooth. A post-operative CBCT scan was taken for analysis. RESULTS: Eighty-eight guided access cavities (44 per operator) were drilled on eight 3D printed models. The mean length of the access cavities was 15.3 mm, with a mean coronal and apical deviation of 0.5 mm and 0.7 mm respectively. The mean angular deviation was 1.5°. No statistically significant difference was found between operators for the three measured parameters. CONCLUSIONS: This study demonstrates, within its limitations, that sleveless guides represent an accurate method for guided endodontic treatment. No statistically significant difference between operators was found when using the guide. CLINICAL SIGNIFICANCE: This method offers a valuable alternative to conventional endodontic guides with similar accuracy results.

Endodontia guiada: tecnologia aplicada na resolução de tratamentos de canais calcificados / Guided endodontics: technology applied in the resolution of treatments of calcified canals / Endodoncia guiada: tecnología aplicada en la resolución de tratamientos de conductos calcificados

As calcificações pulpares provocam alterações morfológicas no interior dos canais radiculares que dificultam o tratamento endodôntico. Para solucionar essa dificuldade, a ferramenta Endoguide ou Endodontia Guiada foi desenvolvida para a resolução de casos complexos. Esta pesquisa objetivou descrever as aplicações da ferramenta Endoguide no tratamento de canais calcificados na endodontia. Todas as buscas foram realizadas por um único pesquisador na base de dados PubMed/MEDLINE e busca manual utilizando os descritores "Endodontics", "Digital", "Cone beam", "Guided". Foram considerados elegíveis os artigos publicados entre 2010 e 2022 e excluídos os estudos cuja publicação não foi obtida na íntegra e ainda aqueles em que os resultados não apresentaram embasamento teórico e prático suficientes para que pudessem ser incluídos no trabalho. Após as buscas, foram encontrados 47 artigos, selecionados inicialmente pelo título e resumos, excluindo as duplicatas. Ao final, a leitura completa e coleta de dados foi realizada em 6 artigos. As informações relevantes dos artigos selecionados foram transcritas em forma de quadro para sumarizar os achados. A endodontia guiada pode ser uma excelente alternativa para tratamentos de casos complexos, necessitando um investimento financeiro mínimo no consultório, pois os equipamentos de captura de imagem, planejamento virtual e de guias podem ser realizados em laboratórios capacitados. Assim, concluímos que o emprego da Endoguide como ferramenta no tratamento de canais calcificados se mostrou bem-sucedido e sua utilização não requer um conhecimento amplo, podendo ser usada por profissionais menos experientes.

Pulp calcifications cause morphological changes inside the root canals that make endodontic treatment difficult. To solve this difficulty, the tool Endoguide or Guided Endodontics was developed to solve complex cases. This research aimed to describe the applications of the Endoguide tool in the treatment of calcified root canals in endodontics. All searches were performed by a single researcher in the PubMed/MEDLINE database and manual search using the descriptors "Endodontics", "Digital", "Cone beam", "Guided". Articles published between 2010 and 2022 were considered eligible, and studies whose publication was not obtained in full text were excluded, as well as those in which the results did not have sufficient theoretical and practical basis for them to be included in the study. After the searches, 47 articles were found, initially selected by title and abstract, excluding duplicates. In the end, the complete reading and data collection was performed with 6 articles. Relevant information from the selected articles was transcribed for a table to summarize the findings. Guided endodontics can be an excellent alternative for treating complex cases, requiring minimal financial investment in the office, as image capture equipment, virtual planning and guides can be performed in trained laboratories. Thus, we conclude that the use of Endoguide as a tool in the treatment of calcified canals proved to be successful and its use does not require extensive knowledge and can be used by less experienced professionals.

Las calcificaciones pulpares provocan cambios morfológicos en el interior de los conductos radiculares que dificultan el tratamiento endodóntico. Para solventar esta dificultad se desarrolló la herramienta Endoguide o Endodoncia Guiada para resolver casos complejos. El objetivo de esta investigación fue describir las aplicaciones de la herramienta Endoguide en el tratamiento de conductos radiculares calcificados en endodoncia. Todas las búsquedas fueron realizadas por un único investigador en la base de datos PubMed/MEDLINE y búsqueda manual utilizando los descriptores "Endodontics", "Digital", "Cone beam", "Guided". Se consideraron elegibles los artículos publicados entre 2010 y 2022, y se excluyeron los estudios cuya publicación no se obtuvo a texto completo, así como aquellos en los que los resultados no tenían suficiente base teórica y práctica para ser incluidos en el estudio. Tras las búsquedas, se encontraron 47 artículos, seleccionados inicialmente por título y resumen, excluyendo los duplicados. Al final, se realizó la lectura completa y la recogida de datos con 6 artículos. La información relevante de los artículos seleccionados se transcribió para elaborar una tabla que resumiera los hallazgos. La endodoncia guiada puede ser una excelente alternativa para el tratamiento de casos complejos, requiriendo una mínima inversión financiera en el consultorio, ya que los equipos de captura de imágenes, la planificación virtual y las guías pueden realizarse en laboratorios capacitados. Así, concluimos que el uso de la Endoguía como herramienta en el tratamiento de conductos calcificados demostró ser exitoso y su uso no requiere de grandes conocimientos y puede ser utilizado por profesionales menos experimentados.

Guided endodontics of calcified canals: The drilling path of rotary systems and intracanal dentin wear.

This study evaluated the drilling path (mm) and the dentin wear (mm3 ) of two instruments used during guided endodontic access. Twenty mandibular incisors with calcified canals were selected using cone-beam computed tomography (CBCT) and fixed in articulated models. Preoperative CBCT scans were performed in combination with intraoral scanning, and the images were reconstructed in the Blue Sky Bio software for access planning and printing the guides. The access cavity was drilled with 1.0-mm-diameter bur (DSP) and 0.8-mm-diameter bur (Munce). Postoperative CBCT was performed, and the images obtained preoperative and postoperative were superimposed for the analyses. Data were analysed by a t-test and linear regression (α = 0.05). No difference was found in the drilling path (p = 0.422). However, the Munce bur had higher dentin wear than the DSP bur (p = 0.011). A positive linear correlation (R2  = 0.859) was found between the factors.

Tratamento Endodôntico de Dente com Calcificação Radicular Pós-Trauma: Relato de Caso Clínico / Endodontic Treatment Of Teeth With Post-Trauma Root Calcification: Case Report

A calcificação do canal radicular é um processo que pode ocorrer posteriormente a um traumatismo dentário ou que pode se desenvolver lentamente em decorrência do envelhecimento dentário fisiológico. É caracterizada pela deposição de tecido duro tanto na câmara pulpar como no canal radicular. Essa condição pode ser diagnosticada através de radiografias periapicais e tomografia computadorizada. Em alguns casos, pode estar associada à necrose pulpar e presença de lesão periapical, e o tratamento pode ser considerado bastante complexo. Este relato de caso clínico aborda o tratamento endodôntico do elemento 21, sintomático, com obliteração do canal radicular e necrose pulpar como sequela de um traumatismo dentário. Após a realização de todos os exames, foi dado o diagnóstico de periodontite apical crônica, sendo proposto o tratamento endodôntico convencional. A maior dificuldade encontrada foi a localização da entrada do canal radicular. Inúmeras radiografias foram realizadas a fim de evitar desvios. Somente ao final do terço médio foi possível localizar a entrada do canal radicular e dar prosseguimento ao tratamento, utilizando a técnica coroa-ápice e medicação intracanal à base de hidróxido de cálcio durante as sessões. Foi possível realizar a obturação do canal radicular quando a paciente se mostrou assintomática. Obteve-se sucesso na realização da técnica, e, após a conclusão do caso, foi possível observar remissão dos sintomas. Após um período de acompanhamento de 6 meses e, posteriormente, de 3 anos, foi possível observar cicatrização dos tecidos periapicais

The calcification of the root canal is a process that may occur after a dental trauma or slowly develop due to physiological dental aging. It is characterized by hard tissue deposition on both the pulp chamber and the root canal. Periapical radiography and computed tomography can be used to diagnose this condition. In some cases, it may be associated with pulp necrosis and the presence of periapical injury, and the treatment may be considered to be quite complex. This case report addresses the endodontic treatment of the central incisor, symptomatic, with root canal obliteration and pulp necrosis as a sequela of dental trauma. After all the tests, chronic apical periodontitis was diagnosed, and conventional endodontic treatment was proposed. The most significant difficulty faced was when locating the root canal's entrance. Numerous radiographs were carried out to avoid deviations. The opening of the root canal could only be found at the end of the middle third, so treatment could proceed by using the crown- down technique and intracanal medication based on calcium hydroxide during the sessions. When the patient was asymptomatic, the root canal has been filled. The accomplishment of the technique was successful, and after finishing the case, there was remission of symptoms. After a six-month follow-up period and three years, the healing of the periapical tissues was observed.

Application of computer-assisted dynamic navigation in complex root canal treatments: Report of two cases of calcified canals.

Root canal treatment and non-vital bleaching of teeth with pulp canal obliteration may represent a complex challenge to the clinician. This report describes the usefulness of the computer-assisted dynamic navigation system for the root canal treatment of two cases of teeth with a history of traumatic injury, extensively obliterated root canals and crown discoloration. Clinical and cone-beam computed tomographic evaluations were completed prior to procedures and 12 months after treatment. Both cases were treated using a computer-assisted dynamic navigation system coupled to a high-speed handpiece in order to establish the location and orientation of the partially obliterated canal and endodontic access route planning. The system allowed an accurate localisation of the root canal with a conservative access cavity. At the 12-month recall examination, the patients continue to be symptom-free, with a normal appearance of the mucogingival complex, adequate restoration of the tooth colour and intact periapical structures.

Root Canal Treatment of Severely Calcified Teeth with Use of Cone-Beam Computed Tomography as an Intraoperative Resource.

The aim of this study was to describe a new strategy, consisting of the use of cone-beam computed tomography (CBCT) in the planning and intraoperative stages of root canal treatment (RCT), associated with the use of radiopaque gutta-percha markers, as an auxiliary tool in the location of severely calcified root canals. Three cases involving anterior and posterior teeth with severe calcification of the root canal were submitted to initial periapical radiographic and CBCT evaluations for diagnosis and planning of the operative steps. In a first intervention, when the location of the canal orifice was not successful, radiopaque markers were inserted in the suggested position of canal orifice with the aid of magnification and the use of ultrasonic devices, in order to perform an intraoperative CBCT analysis that allowed dynamic navigation through the static position of markers. The association of intraoperative CBCT with radiopaque markers allowed the location of the canal orifice and the following RCT execution. The use of CBCT in two different moments of RCT allowed the diagnosis of three-dimensional anatomical variations of root canal. Add, when associated with the use of radiopaque gutta-percha markers, acted as an auxiliary tool in the location of the canal orifice of calcified canals. Therefore, the presented strategy provides the clinician the precision that cases with calcification require and give an important contribution to treatment predictability.

Association between Orthodontic Force and Dental Pulp Changes: A Systematic Review of Clinical and Radiographic Outcomes.

INTRODUCTION: Orthodontic force triggers a sequence of biological responses that can affect dental pulp. The aim of this study was to systematically evaluate the clinical and radiographic findings of orthodontic force application on dental pulp. METHODS: Two reviewers comprehensively and systematically searched 6 electronic databases (Latin American and Caribbean Health Sciences [LILACS], Embase, Cochrane Library, MEDLINE/PubMed, Scopus, and Web of Science) and the gray literature (Google Scholar, OpenGrey, and ProQuest) until April 2021. According to the PICOS criteria, randomized clinical trials and observational studies that evaluated clinical or radiographic findings compatible with dental pulp changes due to orthodontic force were included. Studies in open apex or traumatized teeth, case series or reports, and laboratory-based or animal studies were excluded. The Newcastle-Ottawa Scale and Cochrane Risk of Bias 2.0 tool were used to determine the risk of bias assessment. The overall certainty level was evaluated with the Grading of Recommendations, Assessment, Development and Evaluations tool. RESULTS: Twenty-six studies were included. Among the clinical findings, orthodontic force promoted an increased pulp sensibility response and decreased pulp blood flow. Changes in pulp cavity volume and increased incidence of pulp stones were the radiographic findings observed. The studies presented a moderate risk of bias for most of the domains. The certainty of the evidence was considered very low. CONCLUSIONS: Orthodontic force promoted changes in the dental pulp, generating clinical and radiographic findings. It is crucial to know these changes so that orthodontic mechanics can be safely performed. The clinician has effective noninvasive methods to assess the health and possible pulp changes during orthodontic treatment.

Factors associated with pulp canal obliteration due to traumatic injuries in deciduous teeth: a retrospective study.

Pulp canal obliteration (PCO) presents itself as a frequent pulp complication in traumatized primary teeth, characterized as a progressive deposition of hard tissue in the root canal. In this context, this study aimed to evaluate the association between PCO due to the occurrence of traumatic dental injuries (TDI) in deciduous teeth and specific factors. For this, a retrospective study was carried out through 210 medical records selected from the Dental Trauma Care Program from 2012 to 2019. After applying the eligibility criteria, 371 deciduous teeth were included. Statistical analysis was performed using chi-square and Fischer's exact test. The occurrence of PCO was observed in 4.9%. Associated factors such as age (P=0.63), sex (P=0.47) and search for care (P=0.87) did not influence the occurrence of PCO. Concerning the type of TDI and development of PCO, the injury of subluxation showed a statistically significant association (P=0.01). There was an association of PCO with other TDI complications such as crown discoloration (P<0.01) and acceleration of physiological root resorption (P=0.01). No statistically significant association was found regarding the development of sequelae in permanent successors and PCO (P>0.05). Based on this study, PCO was not a frequent complication of TDI in deciduous teeth in the population evaluated. PCO was associated with subluxation, crown discoloration, and acceleration of physiological root resorption. However, it did not show association with any related factor (age, sex, and seeking care) and the development of clinical or radio graphical sequelae in permanent successors.

Prevalencia y distribución de cálculos pulpares en un grupo de adultos peruanos: un estudio mediante tomografías de haz cónico / Prevalence and Distribution of Pulp Stones in a Group of Peruvian Adults: a Cone Beam Computed Tomography Study

Resumen: El objetivo de este estudio fue evaluar la prevalencia y distribución de cálculos pulpares en un grupo de adultos peruanos mediante tomografía de haz cónico (CBCT). Materiales y métodos: Se analizaron 67 tomografías de haz cónico seleccionadas aleatoriamente de un centro tomográfico en Lima, Perú. Fueron evaluadas 1263 imágenes de piezas dentarias mediante el tomógrafo Point 3D Combi 500 S. El análisis de las imágenes se realizó con el software Real Scan y todas las piezas dentarias fueron evaluadas en las vistas sagital, axial y coronal. Todas las medidas fueron sometidas a prueba de chi cuadrado. (p<0.05). Resultados: De un total de 67 pacientes, un 83,58% presentaron calcificaciones y de 1263 piezas dentarias, un 30.8% a través de la CBCT. La prevalencia de calcificaciones fue mayor en el sexo femenino que masculino. Los molares maxilares y mandibulares fueron los grupos de dientes con mayor frecuencia de cálculos pulpares. Se encontró significancia entre los cálculos pulpares y el género, rango de edad, tipo y estado de pieza dentaria. Conclusiones: La primera molar maxilar tuvo mayor prevalencia de calcificaciones pulpares que la mandibular. La presencia de caries aumentó la posibilidad de aparición de estas calcificaciones, específicamente en maxilar. La CBCT podría ser una herramienta sensible para detectar cálculos pulpares. El conocimiento de la distribución de cálculos pulpares puede ayudar a los dentistas en el tratamiento clínico de endodoncia.

Abstract: The aim of this study was to evaluate the prevalence and distribution of pulp stones in a group of Peruvian adults using cone beam tomography (CBCT). Materials and methods: 60 randomly selected CBCT from a tomographic center in Lima, Peru were analyzed. A total of 1263 images of teeth using the Point 3D Combi 500 S tomograph were evaluated. Images analysis was performed with Real Scan software and all teeth were evaluated in sagittal, axial and coronal views. All measurements were subjected to a chi square test. (p<0.05). Results: Of the 1263 teeth, 30.8% presented pulp calcifications through the CBCT. The prevalence of calcifications was higher in women than in men. The maxillary and mandibular molars were the groups of teeth with the highest frequency of pulp stones. There was significance between the pulp stones and the gender, age range, type and state of the tooth. Conclusions: The maxillary first molars had a higher prevalence of pulp calcifications than the mandibular ones. The presence of caries increased the possibility of the appearance of these calcifications, specifically in the maxillary teeth. CBCT could be a sensitive tool to detect pulp stones. Knowledge of the distribution of pulp stones can help dentists in the clinical treatment of endodontics.

Dynamic navigation: a laboratory study on the accuracy and potential use of guided root canal treatment.

AIM: To evaluate 3D accuracy and outcome of a dynamic navigation method for guided root canal treatment of severe pulp canal obliteration (PCO) in 3D printed jaws. METHODOLOGY: Three operators with different levels of experience in Endodontics performed navigated access cavities, using the Navident system (ClaroNav), in two sets (maxillary and mandibular) of 3D-printed jaw models with teeth presenting severe PCO. Models were mounted on a phantom to mimic a real clinical situation. After treatment, a postoperative high resolution Cone-Beam Computer Tomography (CBCT) scan (NewTom) was taken for each model and registered to the preoperative model. All access cavities were then segmented using 3-Matic Medical software 15.0 (Materialise). Length and volume of each access cavity were measured, and a comparison was done by measuring the distance deviation in mm at the coronal entry point, apical point, vertical deviation, total deviation and angular deviation of the access cavity in comparison with the virtual planning. Additionally, all access cavities were scouted with a size 10 K-file and inspected on the CBCT to confirm that the canal was located. Descriptive statistics for each parameter were performed. Normality of the data was assessed; data were transformed if needed to make it normally distributed. One-way analysis of variance (anova) was applied to assess differences between parameters for tooth type, jaw, and operators and corrected for simultaneous hypothesis testing according to Tukey. Significance level was set at .05. RESULTS: After training with the system (28 cavities per operator), a total of 132 teeth and 168 access cavities (56 per operator) were prepared. All operators located a total of 156 canals, obtaining an overall success of 93% without a difference between operator experience (p > .05). The mean deviation at the apical point was 0.63 mm (SD 0.35) and was significantly lower in anterior teeth in comparison with molars (p < .05). The mean angular deviation from the planning was 2.81° (SD 1.53). CONCLUSION: Dynamic navigation was an accurate approach for root canal treatment in teeth with severely calcified canals. However, the technique has a learning curve and requires extensive training prior to its use clinically.

Guided Endodontics: Use of a Sleeveless Guide System on an Upper Premolar with Pulp Canal Obliteration and Apical Periodontitis.

Guided endodontics has been used for the treatment of anterior teeth with a successful outcome. This approach is not only limited to anterior teeth because it can also be used for the treatment of premolars and molars. However, in such cases, space may be a limitation because a long bur has to be used in addition to the guide being placed on top of the teeth. The aim of this case report was to present a novel guided endodontics technique using a sleeveless 3-dimensional-printed guide. This design can reduce vertical space, allowing an open view of the tooth and irrigation during drilling. A 46-year-old female patient consulted the endodontic department with intermittent pain around tooth #5. Tooth #5 presented pain upon percussion and responded negative to a cold test. The initial periapical radiograph revealed an apical radiolucency with pulp canal obliteration. Clinically, there was no sinus tract. The tooth was diagnosed with pulp necrosis and symptomatic apical periodontitis. Guided endodontic treatment was performed with a sleeveless 3-dimensional-printed guide and long neck carbide bur with a head diameter of 1 mm to drill a minimally invasive access cavity up to the root canal. A completely healed apical area of tooth #5 was visible after 1 year on periapical radiographs. This technique seems to be a promising alternative in comparison with the conventional guided endodontic guide design for the negotiation of pulp canal obliteration in cases in which vertical space is limited.

Differential Responses of Human Dental Pulp Stromal Cells to Bioceramic Materials: A Comparative In Vitro Study.

AIM: The aim of this study was to compare the effects of white MTA-Angelus (wMTA), Biodentine® (Biodentine) and TotalFill® BC Root Repair MaterialTM putty (TotalFill) on human dental pulp stromal cells (hDPSCs) in vitro. MATERIALS AND METHODS: hDPSCs were isolated from third molars of healthy young adults. Material elutes at different concentrations were prepared. Cells were exposed to the eluates for 1, 3, and 7 days. Cell proliferation was evaluated using 3-(4,5-dimethyl-thiazoyl)-2, 5-diphenyl-tetrazolium bromide assay. The expression of alkaline phosphatase (ALP), osteoprotegerin (OPG), osteocalcin (OC), collagen1A (Col1A), runt-related transcription factor 2 (RUNX2), vascular endothelial growth factor-A (VEGF-A), fibroblast growth factor-1 (FGF-1), interleukin 6 (IL6), tumor necrosis factor alpha (TNFα), and interleukin-1-beta (IL1ß) was determined by reverse transcription-polymerase chain reaction (RT-PCR). VEGF-A protein levels and ALP activity were quantified in the culture supernatant. Data were analyzed by two-way analysis of variance (ANOVA). p values <0.05 were considered statistically significant. RESULTS: hDPSC proliferation was decreased in a dose-related manner for all materials on day 3. The same effect was observed with wMTA and TotalFill on day 7. RT-PCR showed that Biodentine increased the expression of the osteogenic markers ALP, OPG, and OC. TotalFill decreased the ALP expression and activity, enhanced the production of angiogenic VEGF-A, and downregulated the inflammatory IL6 on day 7. CONCLUSION: Although the tested materials are used interchangeably in vital pulp therapy, the findings showed varied hDPSC responses. Biodentine did not affect cell proliferation and increased the expression of osteo-/odontogenic markers compared to wMTA and TotalFill, whereas TotalFill decreased cell proliferation and exhibited enhanced angiogenic and anti-inflammatory effects over time. CLINICAL SIGNIFICANCE: The clinical significance of the results needs further investigation in an attempt to provide recommendations on the selection of bioceramic pulp capping material under different scenarios of pulpal pathosis.

Comparison of Abundance of Premolar and Molar Pulp Stones before and after Orthodontic Treatment Using Panoramic Radiography.

Objectives: Pulp stone is a focal calcification in dental pulp, which is often detected on conventional dental radiographs. Pulp stones can complicate easy access to the root canal and pulp chamber in root canal treatment. Orthodontic treatment may be associated with the formation of pulp stones. Therefore, this study examined the number of pulp stones pre- and post-orthodontic treatment. Materials and Methods: In this retrospective cross-sectional comparative study, 222 digital panoramic radiographs collected from private orthodontic offices in Rasht, were divided into two groups: radiographs of patients undergoing orthodontic and non-orthodontic treatment according to the inclusion criteria. The obtained data were analyzed by SPSS via the Wilcoxon and Mann-Whitney tests (P<0.05). Results: The difference in the number of pulp stones pre- and post-orthodontic treatment was significant (P<0.0001). The maximum number of pulp stones after orthodontic treatment was observed in second molars (P=0.016). The change in the number of pulp stones in the mandible (P=0.001) was significantly higher than that in the maxilla (P=0.002). This change was also greater in the left side (P<0.0001) than in the right side (P=0.002). The changes in the number of pulp stones was significant in females (P=0.02). Age had an insignificant effect on pulp stone formation (P>0.05). Conclusion: This study showed the effect of orthodontic treatment on the number of pulp stones. Further studies are required to clarify the underlying mechanisms for this increase and come up with strategies to prevent it.

Estética y color en dientes calcificados: Informe de tres casos clínicos con blanqueamiento / Esthetics and shade in calcified teeth. Report of three clinical cases with whitening

Objetivo: El objetivo de este informe es presentar tres casos clínicos de piezas dentarias anterosuperiores calcificadas y con decoloración, resueltos según tres protocolos clínicos de blanqueamiento diferentes, con un mismo fin: devolver la estética al sector anterior. Casos clínicos: Cada una de las tres situaciones clínicas de decoloración dentaria se trató siguiendo un protocolo diferente. A partir del análisis clínico y radiográfico, se estableció un diagnóstico y un plan de tratamiento acorde. Todos los casos evolucionaron de manera favorable y siguen siendo controlados periódicamente. Conclusiones: En casos clínicos como los que se muestran en este trabajo, en los que el conducto y la cámara pulpar están calcificados u obliterados totalmente, sería posible realizar blanqueamiento interno y externo para recuperar la armonía óptica de forma conservadora. Este tipo de tratamientos permitiría responder a la alta prevalencia de demanda estética debido a traumatismos y cambios de coloración (AU)

Aim: To present three clinical cases of discoloration in calcified upper anterior teeth, that were resolved following different clinical protocols for teeth whitening to return the aesthetics of the anterior teeth. Clinical cases: Each clinical case of discoloration was treated following a different treatment protocol based on a correct clinical and radiographic diagnosis. All cases had a favourable outcome and have no regular review. Conclusion: In clinical cases as those presented in this article where the canal and pulp chamber are totally calcified or obliterated, it was possible to perform internal and or external whitening to restore optical harmony in a conservative way. This type of treatment would allow responding to the high prevalence of aesthetic demand due to trauma and colour changes (AU)

Sialometric and Sialochemical Analysis in Individuals With Pulp Stones.

The aim of this study was to analyze the saliva of patients with pulp stones, with sialometric and sialochemical tests. Eighty individuals, aged between18 and 65 years, of both sexes, were investigated. Patients were included in the pulp stone group when radiographic examination was suggestive of pulp stones in at least one permanent tooth, whereas those without this alteration were considered controls. Saliva was collected by stimulation, followed by salivary flowrate (SFR) and pH analysis tests. The organic components, such as urea (URE), glucose (GLU), total proteins (TPTs), alkaline phosphatase, creatinine (CRE), salivary amylase (SAM), and uric acid (URA), and the inorganic components, such as calcium, iron, and phosphorus, were evaluated by colorimetric techniques in an ultraviolet-visible (UV-vis) spectrophotometer. Differences among pulp stones and control groups were compared using Student's t-test, with a significance level of p < 0.05. In both groups prevailed the female. Statistically significant differences between groups were observed for pH (p = 0.027), SFR (p = 0.002), alkaline phosphatase (p = 0.008), and URA (p = 0.005). None of the inorganic components showed significant difference (p > 0.05). In the analyses stratified by sex, difference between groups was observed for pH (p = 0.007) and URA (p = 0.003) in women. In conclusion, sialometric and sialochemical alterations occurred in patients with pulp stones, with significantly higher levels of pH, SFR, alkaline phosphatase, and URA.

Removal of calcifications from distal canals of mandibular molars by a non-instrumentational cleaning system: A micro-CT study.

Pulpal calcifications can present problems in endodontic treatment. This micro-CT study examined the removal of calcifications by a multisonic cleaning system in uninstrumented mandibular molar distal canals. The teeth were accessed and distal canals located and their patency ensured. Micro-CT images were obtained, and 15 teeth with distal canal calcifications were selected. The volume of distal canals and calcifications were calculated from the micro-CT images before and after cleaning with the GentleWave system. Calcifications were observed in all thirds of the canals. Attached and free calcification were detected. Root canal volumes were slightly increased after GentleWave treatment, whereas the calcifications were completely or partially removed in all canals. Mean reduction percentage of calcification was 86.4 ± 3.9%, in individual canals from 60% to 100%. Calcifications in the distal canals of mandibular molars could be partially or completely removed by the multisonic cleaning system without instrumentation.