[Causes, diagnosis and treatment strategies for dental pulp calcification].

Dental pulp calcification can lead to root canal stenosis or obliteration. It is usually difficult to negotiate the root canal if the affected tooth needs to be treated and intraoperative complications are easily brought about during the root canal treatment. The etiologies of dental pulp calcification are complicated and careful considerations should be given to the diagnosis and treatment. Only by weighing the advantages and disadvantages can appropriate treatment plan be chosen. Based on the literature and authors' clinical experiences, the present article summarizes the causes, pathogenesis, diagnosis and treatment strategies of dental pulp calcification, in order to provide some references in diagnosis and treatment for the dental clinicians.

Dental Manifestations of Ehlers-Danlos Syndromes: A Systematic Review.

Ehlers-Danlos syndromes (EDS) are a group of inherited connective tissue disorders characterized by joint hypermobility, skin hyperextensibility, and variable tissue fragility. However, there are limited published data on the dental manifestations of EDS. This review systematically assessed the spectrum of published dental anomalies in various types of EDS. Twenty-four individual case reports/series and 3 longer case-control studies, reporting on a total of 84 individuals with a clinical diagnosis of EDS, were included in the data analysis. The main dental features listed in classical EDS were pulp calcification and localized root hypoplasia. Common dental abnormalities observed in vascular EDS were pulp shape modifications (52.2%), exceeding root length (34.8%), and molar root fusion (47.8%). Dentinogenesis imperfecta is a consistent finding in osteogenesis imperfecta/EDS overlap syndrome. Data on dental manifestations in other types of EDS are both rare and generally inconclusive.

Revascularization-associated Intracanal Calcification: A Case Report with an 8-year Review.

Revascularization-associated intracanal calcification (RAIC) is a common finding in immature teeth managed with regenerative endodontic treatment (RET). The aim of this report was to illustrate a case in which 2 mandibular premolar teeth developed complete canal obliteration and have been reviewed for 8 years. The 3 primary outcome goals as defined by the American Association of Endodontists after RET are resolution of signs and symptoms of pulp necrosis, further root maturation, and achievement of responses to pulp vitality testing. The teeth had been included in an earlier quantitative study in which an increase in root canal width of 72.1% and 39.6% and an increase in root length of 1.7% and 0% were reported for teeth #20 and #29, respectively. Qualitative assessments over the 8-year review period showed no pathosis and a response to electric pulp testing at the final review. A quantitative assessment at the 8-year review showed an increase of 100% for canal width because complete calcification had occurred and no substantive change in root length (-0.17% and 0.68% for teeth #20 and #29, respectively). In this report, complete RAIC occurred in both teeth over time. RAIC has the potential to complicate future endodontic or prosthodontic treatment if necessary. Therefore, it is recommended that the American Association of Endodontists clinical considerations for a regenerative endodontic procedure be updated to include the incidence of RAIC after RET.

Revascularization-associated Intracanal Calcification: Assessment of Prevalence and Contributing Factors.

INTRODUCTION: Intracanal calcifications have been reported in endodontic cases after revascularization. The purpose of the current study was to determine the incidence of intracanal calcification and potential contributing factors in retrospective revascularization cases. METHODS: Among 37 patients who had undergone revascularization between 2010 and 2014, 29 cases were assessed with average follow-up period of 24.9 months. Clinical and radiographic examinations were performed to evaluate the treatment outcomes, eg, resolution of apical periodontitis (AP), root development, and occurrence of intracanal calcification. Radiographic assessment revealed varied calcification patterns, which were classified into calcific barrier or canal obliteration, collectively referred to as revascularization-associated intracanal calcification (RAIC). RESULTS: All 29 cases demonstrated resolution of AP, whereas continued root development with apical closure occurred in 23 of 29 cases (79.3%). RAIC was noted in 18 of 29 cases (62.1%), among which 5 of 18 cases (27.8%) were classified as calcific barrier and 13 of 18 cases as canal obliteration (72.2%). Higher frequency of RAIC was noted in the cases with induced bleeding (16 of 23 cases, 69.6%), whereas the 6 cases without induced bleeding showed RAIC at 33.4%. Also, RAIC occurred more frequently in cases medicated with Ca(OH)2 (10 of 13 cases, 76.9%) than in those medicated with antibiotic pastes (6 of 13 cases, 46.2%). CONCLUSIONS: This study indicated that RAIC is common (62.1%) among cases treated with revascularization. Multiple contributing factors may include the type of medicaments and induction of intracanal bleeding. Although RAIC does not interfere with resolution of AP, some cases may progress to complete obliteration of root canals and would impede normal function of dental pulp tissues.

Life cycles of traumatized teeth: long-term observations from a cohort of dental trauma victims.

Life cycles of dental trauma victims can provide important clinical information, especially when viewed over many years. In this first series of life cycles, the pulp and periodontal responses to traumatic injuries of four patients are documented over periods varying from 26 to 51 years. The dynamics of pulp survival following an intrusive luxation and two avulsions are followed, with particular reference to pulp canal calcification to which a new term, root canal stenosis, has been proposed. The life cycles include the successful management of inflammatory root resorption in a replanted tooth with an open apex contrasting with the early prophylactic endodontic treatment of two replanted teeth in a patient with mature apices. The long-term development of invasive cervical resorption in one of the patient's life cycle highlights the importance of ongoing follow-up examinations for dental trauma victims.

Post-traumatic complications of severe luxations and replanted teeth.

AIM: The aim of this study was to evaluate the main post-traumatic complications of severe luxation and replanted teeth using clinical and radiographic analyses. MATERIALS AND METHODS: Eighty-three patients aged between 7 and 55 years old presenting 180 traumatized teeth that suffered extrusive luxation (n=67), lateral luxation (n=69), intrusive luxation (n=10) and tooth avulsion (n=34) followed by replantation were evaluated. The follow-up period was 24 months. The complications examined were: pulp canal obliteration, pulp necrosis and root resorption (infammatory and replacement). Furthermore, the relationship between time elapsed before receiving dental attendance and development of infammatory resorption was observed. RESULTS: Pulp necrosis was the main complication, occurring in 147 teeth (82.7%). All of the teeth that suffered intrusive luxation and tooth avulsion were diagnosed with pulp necrosis, with significant difference in comparison with another traumas (p<0.001/Fisher's exact test). Infammatory root resorption was observed in 20.5% of the cases and replacement resorption was more related to tooth replantation (94.1%), showing significant prevalence among tooth luxations (p<0.001/Fisher's exact test). In addition, it was noted that patients who seek treatment 9 weeks after the trauma episode presented 10 times more chance of developing infammatory resorption when compared with patients who seek treatment soon after dental trauma (Odds ratio test). CONCLUSION: It may be concluded that pulp necrosis was the main post-traumatic complication observed in traumatized teeth and that delay in seeking treatment may damage the prognosis of severe luxation and replanted teeth. CLINICAL SIGNIFICANCE: Clinical studies describing the main complications that may affect traumatized teeth present great relevance to make the population aware of the importance of seeking immediate treatment and to alert the professional to the need for follow-up. When traumatic injuries are diagnosed and treated early, post-traumatic complications may be controlled, allowing conservation of the tooth in oral cavity.

Apical plug technique in a calcified immature tooth: a case report.

Traumatic injury to an immature tooth may result in pulpal necrosis secondary to pulp canal obliteration, which makes the management of the tooth a clinical challenge for dentists. The present case report describes an innovative apical plug technique with mineral trioxide aggregate in a calcified immature tooth using an ultrasonic tip and long, thin, tapered fissure burs. The technique was proven to be successful clinically and radiographically at 2 years postobturation.

Dentinogenic responses after direct pulp capping of miniature swine teeth with Biodentine.

INTRODUCTION: The aim of this study was to evaluate pulpal responses after experimental direct pulp capping of mechanically exposed teeth with a new calcium silicate-based dentin replacement material. METHODS: Thirty-four anterior and posterior teeth of 3 miniature swine were used. Class V or I cavities were prepared on the buccal or occlusal surfaces, respectively. Pulpal exposures were further performed using a round carbide bur 0.8 mm in diameter. Exposures were treated with white MTA Angelus (Angelus, Londrina, PR, Brazil) or Biodentine (Septodont, Saint Maur des Fosses, France), and the cavities were further restored with Biodentine. The pulpal tissue responses were histologically assessed at postoperative periods of 3 and 8 weeks. Data were statistically analyzed using the Kruskal Wallis and the Mann-Whitney U tests. RESULTS: Inflammatory infiltration or pulp tissue necrosis was not found in any of the specimens. All teeth showed mineralized matrix formation in the form of a complete hard tissue bridge composed of osteodentin or osteodentin followed by a discontinuous or continuous reparative dentin zone. A significantly higher thickness of the hard tissue bridge was found in the group of teeth treated with Biodentine at both 3 and 8 weeks. A number of teeth, which were under root development at the onset of the experimental procedures, exhibited ectopic pulp calcification. CONCLUSIONS: The application of both calcium silicate-based materials in direct contact with the mechanically exposed pulp of healthy miniature swine teeth led to pulp repair with complete hard tissue bridge formation. The thickness of hard tissue bridges was significantly higher after pulp capping with Biodentine.

Trauma to the primary dentition and its sequelae.

UNLABELLED: Trauma to the primary dentition is common. This injury may have an impact on the child and his/her parents. The examining dentist should take appropriate factors into consideration before providing the required treatment. This paper discusses the management of trauma to the primary teeth and describes the sequelae of injury to both the primary and secondary dentitions. CLINICAL RELEVANCE: In cases of trauma to the primary teeth, diagnosis and appropriate management is necessary to alleviate the pain and discomfort for the child and to decrease the risk of damage to the permanent successor. It is important to prevent inducing fear and dental anxiety in children during the management of this injury.

Pulp vitality and histologic changes in human dental pulp after the application of moderate and severe intrusive orthodontic forces.

INTRODUCTION: Orthodontic forces produce a series of changes in dental pulp. However, no one has attempted to investigate the incidence of pulp necrosis after orthodontic therapy in the clinic. In this study, we aimed to investigate pulp vitality and histologic changes after the application of moderate and severe intrusive forces. METHODS: Twenty-seven adolescent patients were assigned to 1 of 3 groups: the control group of 3 subjects; the moderate-force group, with 12 subjects who received a 50-g force to the first premolars bilaterally; and the severe-force group, with 12 subjects who received a 300-g force. The forces were applied for 1, 4, 8, or 12 weeks. An electric pulp tester was used to test for vitality, and teeth that did not respond to the electric pulp tester were subsequently tested thermally with a stick of heated gutta-percha. RESULTS: The teeth with a negative response to the electric pulp tester still responded to the thermal test. We found odontoblast disruption, vacuolization, and moderate vascular congestion in both force groups, but no necrosis was observed. Pulp stones were formed only in the severe-force group. CONCLUSIONS: Dental pulp still has vitality after intrusive treatment with different forces. These data provide new insights into the effects of intrusive orthodontic forces.

Dental findings in a child with osteopathia striata with cranial sclerosis (OS-CS): a case report.

The dental management of an 8-year-old girl with osteopathia striata with cranial sclerosis (OS-CS) is described. The girl presented with various oral abnormalities. The aim of this case report was to describe in detail the dental findings in a patient with OC-CS and the precautions to be taken when planning treatment. In the present case, many dental anomalies, such as delayed eruption of the permanent teeth, obliteration of the dental pulp, short roots, fused roots and taurodontism, were detected. In patients with OS-CS, routine dental care from an early stage is recommended to manage this anomaly properly.

Calcific metamorphosis. Literature review and clinical strategies.

UNLABELLED: Calcific metamorphosis (CM) is a commonly observed phenomenon following traumatic injuries like concussion, subluxation and luxation. Depending on the severity of the injury and the developmental stage of the tooth, there can be either complete or partial obliteration of root canals. However, histologically, there is always persistence of fine residual filaments of pulp tissue or tracts of organic material without the presence of any inflammatory component. A periodic clinical and radiographic follow-up examination is preferred and usually, for cosmetic reasons, only a conservative aesthetic treatment is required. Endodontic treatment is only advocated if there is development of apical periodontitis and, if executed properly, can be highly successful. CLINICAL RELEVANCE: Appropriate management of calcific metamorphosis can present a clinical dilemma to the clinician. Thus a judicious and prudent decision should be made between endodontic intervention for the involved tooth and other available restorative (and/or aesthetic) treatment options.

Histological and immunohistochemical analyses of the chronology of healing process after immediate tooth replantation in incisor rat teeth.

Dental tissues have special characteristics, and its regenerative capacity is noteworthy. However, understanding the circumstances that lead to regeneration is challenging. In this study, the chronology of the healing process after immediate replantation of rat incisor teeth was examined by histological and immunohistochemical analyses within a 60-day period. Thirty-six male Wistar rats had their maxillary right incisors extracted and replanted after 15 min in saline storage. The rats were sacrificed immediately 3, 7, 15, 28, and 60 days after replantation. The histological analysis showed rupture of the periodontal ligament and formation of a blood clot, which started being replaced by a connective tissue after 3 days. At 7 days, the gingival mucosa epithelium was reinserted and areas of root resorption could be seen. At 15 days, the periodontal ligament was repaired. At 3 days, the pulp presented an absence of the odontoblast layer, which started being replaced by a connective tissue. This tissue suffered gradual calcification, filling the root canal at 28 and 60 days. The root ends were closed. The immunohistochemical analysis revealed greater expression of OP, OPG, and RANK proteins in the initial periods (0 and 3 days), while TRAP expression predominated at 28 and 60 days (P < 0.05). In conclusion, in delayed tooth replantation, there is great new bone formation activity in the earlier periods of the repair process, while a predominance of bone resorption and remodeling is observed in the more advanced periods.

Root fracture and its management.

UNLABELLED: Root fractures are uncommon following dental trauma but are mostly diagnosed shortly after the injury, although occasionally at routine dental appointments. This paper presents the management of the different types of root fractures and the types of healing response suggesting the appropriate follow-up of these injuries. CLINICAL RELEVANCE: A thorough clinical examination supplemented with radiographs, vitality tests, appropriate treatment planning and subsequent follow-up of root fractured teeth can improve the prognosis for these teeth and also minimize the need for subsequent extractions. Immature teeth with root fractures have a better chance of healing compared to teeth with fully formed roots.

Drawbacks and unfavorable outcomes of regenerative endodontic treatments of necrotic immature teeth: a literature review and report of a case.

INTRODUCTION: Endodontic treatment of immature necrotic teeth is challenging. Recently a biologically based treatment called regenerative endodontic treatment was introduced. Although regenerative endodontic treatment causes root development, there are several drawbacks and unfavorable outcomes that should be addressed. This article describes regenerative endodontic treatment of 2 maxillary central incisors with poor root development outcomes. METHODS: A healthy 14-year-old female patient was referred. The patient had history of an impact trauma 6 years before the first visit. Clinical and radiographic examinations revealed that maxillary central incisors were immature and necrotic with symptomatic apical periodontitis. After local anesthesia, rubber dam isolation, and access cavity preparation each tooth was irrigated with 20 mL of NaOCl 5.25% and received triple antibiotic dressing (ciprofloxacin, metronidazole, minocycline) for 4 weeks. In the next visit, after eliminating antibiotic dressing, bleeding was induced inside the canals, and then the coronal thirds of the canals were sealed with mineral trioxide aggregate. A week later, both teeth were permanently restored. RESULTS: In clinical and radiographic follow-ups, both teeth were functional, periapical lesions were healed, and the apices formed. However, the roots were not developed. After 6 years, because of moderate discoloration and caries, both teeth received root canal therapy and were permanently restored with casting dowel core and full crown restorations. CONCLUSIONS: Criteria for case selection in regenerative endodontic treatments should be determined.

Enamel renal syndrome: a rare case report.

Enamel renal syndrome is a very rare disorder associating amelogenesis imperfecta with nephrocalcinosis. It is known by various synonyms such as amelogenesis imperfecta nephrocalcinosis syndrome, MacGibbon syndrome, Lubinsky syndrome, and Lubinsky-MacGibbon syndrome. It is characterized by enamel agenesis and medullary nephrocalcinosis. This paper describes enamel renal syndrome in a female patient born in a consanguineous family.

Oral rehabilitation of a patient with amelogenesis imperfecta using removable overlay denture: a clinical report.

AIM: The aim of this study was oral rehabilitation of 17-year old patient with amelogenesis imperfecta using removable overlay denture in order to satisfy her esthetic and functional expectations and enhance her self-image. BACKGROUND: Amelogenesis imperfecta (AI) is a group of genetic disorders that primarily affect the quality and quantity of amelogenesis in both primary and permanent dentitions. The main clinical characteristics are severe attrition, tooth sensitivity and unesthetic appearance. CASE REPORT: This clinical report illustrates the oral rehabilitation of a 17-year-old girl with hypoplastic-hypomature type of AI with cobalt-chromium (Co-Cr) overlay removable partial denture (ORPD) that is one of the most economical and biocompatible replacements for noble metal and nickel-chromium (Ni-Cr) alloy. CONCLUSION: The presented case report suggests that Co-Cr ORPD can be a good temporary or even permanent treatment option for AI patients with limited budget, low esthetic concerns or medical limitations. CLINICAL SIGNIFICANCE: There are major advantages in cast metal ORPDs; they are simpler, less traumatic and less expensive than fixed prosthetic options. This case report supports their use in patients with amelogenesis imperfecta.

The status of dental and jaw bones in children and adolescents after kidney and liver transplantation.

BACKGROUND: Systemic complications in patients after renal or liver transplantation may be localized in the oral cavity. Calcium-phosphate disturbances may affect the structure and metabolism of mandible bones, promote calcification of dental pulp, and in children may cause developmental defects of teeth. The aim of this study was to evaluate the incidence of dental and bone abnormalities in children and adolescents after kidney and liver transplantation with respect to the type of the transplanted organ and maintenance immunosuppression. MATERIAL/METHODS: Overall, 23 kidney and 25 liver recipients (mean age: 13.95±4.2 yrs) were evaluated. Twenty patients received ciclosporin A (CsA) and 28 tacrolimus (TAC). Twenty-one kidney and 14 liver recipients were treated with steroids. Mean time after transplantation was 3.62±2.98 years. RESULTS: The severity of caries and percentage of odontogenic abnormalities (76.0% vs. 60.86%) was higher in liver transplant recipients. Positive correlations were found between discoloration of the deciduous teeth and liver transplantation, between enamel hypoplasia and kidney transplantation, and between treatment with CsA and its dose and blood concentration (p<0.05). Pulp stones were present in 13.04% of kidney vs. 8.0% in liver recipients, more often in those treated with CsA than with TAC. Jaw bone abnormalities were present in 30.43% kidney recipients vs. 12% liver recipients. CONCLUSIONS: Both kidney and liver recipients present dental and bone abnormalities. The incidence of specific types of oral lesions is different in renal and liver graft recipients; however, it is also correlated with specific immunosuppression.