Accuracy of the American Association of Endodontists diagnostic criteria for assessing pulp health in primary teeth.

OBJECTIVES: There is a lack of studies evaluating the accuracy of the 2009 American Association of Endodontists (AAE) diagnostic criteria for diagnosing pulpal health in primary teeth. This study aimed to estimate and correlate the diagnostic accuracy of clinical diagnosis of reversible and irreversible pulpitis using the 2009 AAE criteria with histological findings in primary teeth. METHODS: Eighty primary teeth that were clinically diagnosed with normal pulp (n = 10), reversible pulpitis (n = 30), irreversible pulpitis (n = 30) and pulp necrosis (n = 10) were collected. The teeth were histo-processed, and pulp tissues were diagnosed histologically as uninflamed pulp, reversible or irreversibly inflamed and necrosis based on previously proposed criteria. RESULTS: The clinical diagnosis of pulp necrosis (sensitivity 70%, specificity 96%) and normal pulp (sensitivity 91%, specificity 100%) matched the histological diagnosis of necrosis and uninflamed pulp in 70% and 100%, respectively. The clinical diagnosis of irreversible pulpitis (sensitivity 64%, specificity 72%) matched the histological diagnosis of irreversible pulp inflammation for 47% of teeth evaluated. For the clinical diagnosis of reversible pulpitis (sensitivity: 65%, specificity: 86%), 80% matched the histological diagnosis of reversible pulp inflammation. Teeth with histologically diagnosed irreversible pulp inflammation were more likely to have lingering (OR 5.08; 95% CI 1.48-17.46, P = 0.010) and nocturnal tooth pain (OR 15.86; 95% CI 1.57-160.47, P = 0.019) when compared to teeth with reversible pulp inflammation. Using the classification and regression tree model, the presence of widened periodontal ligament space and nocturnal tooth pain were useful predictors of irreversible pulp inflammation with an accuracy of 78%. CONCLUSION: The 2009 AAE criteria was acceptable for primary teeth with pulp necrosis and normal pulp but poor for reversible pulpitis and irreversible pulpitis.

Tratamento endodôntico em dente permanente traumatizado com rizogênese incompleta: relato de caso / Endodontic treatment in permanent traumatised tooth with incomplete rhizoganis: case report / Tratamiento endodóntico en diente permanente traumatizado con rizoganis incompleta: presentación de un caso

Os traumatismos dentários representam um problema de saúde pública devido à alta prevalência e impacto psicossocial, sendo muito frequentes em crianças podendo resultar em necrose pulpar e culminar na rizogênese incompleta de dentes permanentes. Nestes casos de traumatismos em dentes permanentes com rizogênese incompleta e necrose pulpar, o tratamento mais indicado pela literatura é a apicificação, sendo um tratamento complexo e longo. Considerando a importância deste tema, o objetivo deste trabalho é relatar o caso de um paciente com traumatismo dental e necrose pulpar, que acarretou a interrupção do desenvolvimento completo e adequado do ápice dentário, sendo necessária a intervenção por meio da técnica de apicificação e o acompanhamento a longo prazo. O caso trata-se de uma menina em que um traumatismo dentário acarretou fratura de um incisivo central superior com formação radicular incompleta, comprometendo tanto a estética quanto a vitalidade do dente. Foi realizado o tratamento endodôntico com apicificação e posteriormente ao plug apical de MTA. O dente foi restaurado definitivamente com resina composta e realizado acompanhamento do paciente. Nas consultas de acompanhamento houve ausência de sintomatologia dolorosa e satisfação da paciente com a aparência atual. Sendo assim, a apicificação apresenta-se como uma ótima alternativa para dentes com rizogênese incompleta e necrose pulpar, embora longo houve uma melhora estética e satisfação do paciente.

Dental trauma represents a public health problem due to its high prevalence and psychosocial impact, being very frequent in children and can result in pulp necrosis and culminate in incomplete root formation of permanent teeth. In these cases of trauma to permanent teeth with incomplete root formation and pulp necrosis, the most indicated treatment in the literature is apexification, which is a complex and long treatment. Considering the importance of this topic, the objective of this work is to report the case of a patient with dental trauma and pulp necrosis, which caused the interruption of the complete and adequate development of the dental apex, requiring intervention through the apexification technique and follow-up. long-term. The case is about a girl in which a dental trauma resulted in a fracture of a maxillary central incisor with incomplete root formation, compromising both the esthetics and the vitality of the tooth. Endodontic treatment was performed with apexification and then apical MTA plug. The tooth was definitively restored with composite resin and the patient was followed up. In the follow- up consultations, there was no painful symptomatology and the patient was satisfied with her current appearance. Thus, the apexification presents itself as a great alternative for teeth with incomplete root formation and pulp necrosis, although in the long run there was an aesthetic improvement and patient satisfaction.

Los traumatismos dentales representan un problema de salud pública debido a su alta prevalencia e impacto psicosocial, siendo muy frecuentes en niños y pudiendo dar lugar a necrosis pulpar y culminar en la formación incompleta de la raíz de los dientes permanentes. En estos casos de traumatismos en dientes permanentes con formación radicular incompleta y necrosis pulpar, el tratamiento más indicado en la literatura es la apexificación, que es un tratamiento complejo y largo. Considerando la importancia de este tema, el objetivo de este trabajo es relatar el caso de una paciente con traumatismo dentario y necrosis pulpar, que causó la interrupción del desarrollo completo y adecuado del ápice dentario, requiriendo intervención a través de la técnica de apexificación y seguimiento. a largo plazo. Se trata de una niña en la que un traumatismo dental provocó la fractura de un incisivo central maxilar con formación radicular incompleta, comprometiendo tanto la estética como la vitalidad del diente. Se realizó tratamiento endodóntico con apexificación y posterior taponamiento apical con MTA. El diente fue restaurado definitivamente con resina compuesta y el paciente fue sometido a seguimiento. En las consultas de seguimiento, no había sintomatología dolorosa y la paciente estaba satisfecha con su aspecto actual. Así, la apexificación se presenta como una gran alternativa para dientes con formación radicular incompleta y necrosis pulpar, aunque a la larga se produjo una mejoría estética y satisfacción de la paciente.

Unusual Location of Dens Invaginatus Causing a Difficult-to-Diagnose Pulpal Involvement.

This article reports on an unusual case of dens invaginatus in a maxillary third molar that was causing severe symptoms of irreversible pulpitis. This malformation was not clinically or radiographically identified, and the occurrence of referred pain made the early identification of the responsible tooth difficult. Determination of the tooth that was the source of symptoms was only possible after an observation period and fast aggravation of the pathologic process to cause pulp necrosis and extreme tenderness to percussion. The diagnosis of dens invaginatus was made only after extraction and sectioning. Histopathologic and histobacteriologic features of this case are illustrated.

Diagnostic accuracy of three placement sites for the cold test in subjects amongst different age groups.

BACKGROUND: The cold test is a specific test of pulp sensitivity and is part of the endodontic diagnosis. The aim of this study was to identify the diagnostic accuracy including sensitivity, specificity, accuracy, positive predictive value and negative predictive value in three sites for the cold test in teeth with a need for endodontic treatment within different age groups from both genders. METHODS: A cross-sectional study was performed, evaluating 425 subjects. Two hundred and fifty-eight subjects from both genders from the ages of 17-27, 28-39, 40-50, and 51-65 years-old participated in the study. The cold test studied was 1, 1, 1, 2-tetrafluoroethane, and the gold standard was established through direct pulp inspection. The sites evaluated in the study were: The sites evaluated in the study were: a) the middle third of the buccal surface; b) the cervical third of the buccal surface, and c) the middle third of the lingual surface. RESULTS: The highest diagnosted accuracy was observed on the middle third buccal surface with an accuracy of = 0.97, a sensitivity of = 1.00, a specificity of 0.95, a predictive value of = 0.95 and a negative predictive value of = 1.00. This was in the female group aged from 40 to 50 years old. CONCLUSION: The tables of this study can be used as an auxiliary for pulp sensitivity tests.

Diagnosis and management of transverse root fractures.

BACKGROUND: Root fractures are not a common injury, but a thorough understanding of their etiology, healing responses, diagnosis, management, and prognosis is essential. REVIEW: The prognosis is largely related to the patient's age; degree of displacement, if any, of the coronal fragment; and the location and orientation of the fracture. The more apical the fracture is located, the better the prognosis. Teeth with root fractures located supracrestally may have the worst prognosis, but their management and outcome depend on many factors, with the most influential factor being the ability to restore the tooth because the coronal fragment usually needs to be removed. In contrast, root fractures located in the apical and middle thirds and those subcrestally in the coronal third of the root have a good prognosis and usually require little, if any, treatment apart from immediate repositioning (if the coronal fragment has been displaced) and stabilization. Monitoring of root-fractured teeth over time is essential to determine the healing response and to assess whether the pulp survives or not. In some cases, the pulp in the coronal fragment may necrose and become infected, thus requiring root canal treatment, but this should only be done to the fracture line. Pulp necrosis and infection typically occur within the first 3-4 months if it is a direct result of the trauma. However, pulp necrosis and infection can also occur many years later, in which case it is likely to be a result of bacterial penetration via cracks or breakdown of restorations. CONCLUSION: Overall, root fractures should be managed conservatively unless they are located supracrestally.

The diagnostic accuracy of laser Doppler flowmetry in assessing pulp blood flow in permanent teeth: A systematic review.

BACKGROUND/AIM: Pulp necrosis is a frequent complication following dental trauma. The diagnosis of the state of the dental pulp can be challenging as most commonly used diagnostic tools are subjective and rely on a response from the patient, potentially making their use unreliable, especially in the child population. The aim of the study was to systematically review the evidence on the use of laser Doppler flowmetry in the assessment of the pulp status of permanent teeth compared to other sensibility and/or vitality tests. METHODS: A systematic literature search, using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, www.clinicaltrials.gov and www.controlled-trials.com, in addition to citation and manual reference list searches, was conducted up to 15th January 2018. A risk of bias assessment was performed using the quality assessment for diagnostic accuracy studies tool (QUADAS-2) with all steps performed independently by two reviewers. RESULTS: Four studies with a high risk of bias were included in the final analysis. Laser Doppler flowmetry was reported to be more accurate in differentiating between teeth with normal pulps and pulp necrosis with a sensitivity of (81.8%-100%) and specificity of 100% in comparison to other vitality tests such as pulp oximetry (sensitivity = 81.3%, specificity = 94.9%) and sensibility tests such as electric pulp testing (sensitivity = 63.3%-91.5%, specificity = 88%-100%). CONCLUSION: Despite the higher reported sensitivity and specificity of laser Doppler flowmetry in assessing pulp blood flow, these data are based on studies with a high level of bias and serious shortfalls in study designs. More research is needed to study the effect of different laser Doppler flowmetry's parameters on its diagnostic accuracy and the true cut-off ratios over which a tooth could be diagnosed as having a normal pulp.

Analysis of the characteristics of cracked teeth and evaluation of pulp status according to periodontal probing depth.

BACKGROUND: The purpose of this study was to analyze the characteristics of cracked teeth and to evaluate pulp status according to periodontal probing depth (PPD). METHODS: A total of 182 cracked teeth were included. The location and type of the cracked teeth, age and gender of the patients, restoration type, pulp status, PPD, and radiographic findings were analyzed. RESULTS: Mandibular second molars (25.3%) were the most frequently involved teeth, followed by mandibular first molars (22.5%), maxillary first molars (22.0%), and maxillary second molars (17.6%). The patient age was most frequently 50-59 years. Cracks occurred mainly in nonbonded restorations, such as gold (26.9%), and were usually found in intact teeth (37.9%). A total of 103 teeth (56.6%) had an initial PPD of less than 3 mm, while 40 (22.0%) had a PPD of 4-6 mm, and 39 (21.4%) had PPD of 7 mm or more. A total of 33 cracked teeth (18.1%) were diagnosed with pulp necrosis, 40 (22.0%) with irreversible pulpitis, and 97 (53.3%) with reversible pulpitis. The incidence of pulp necrosis was 31.8% among cracked teeth with a PPD of 4-6 mm, and 28.6% among those with a PPD of 7 mm or more. CONCLUSIONS: Cracks occurred mainly in molar teeth, and were commonly found in intact teeth with no restoration. Patients with cracked teeth were most frequently aged 50-59 years. Cracked teeth showing a PPD of more than 4 mm were more likely to show pulp necrosis.

Management of coronal discolouration following a regenerative endodontic procedure in a maxillary incisor.

Pulpal necrosis and infection in an immature anterior tooth subsequent to traumatic injury is a challenging situation. Regenerative endodontics, resulting in continued development of the tooth, provides a biological response to this clinical challenge. Regenerative endodontic procedures require disinfection of the infected root canal and sealing of the pulp canal space. Mineral trioxide aggregate (MTA) provides a good seal, is biocompatible and allows the formation of a hard tissue to occur within the root canal. MTA, however, can lead to significant staining of the crown of the tooth that is difficult to mask. This case report describes the management of discolouration in an 11 year old girl subsequent to a regenerative endodontic procedure in an immature traumatized maxillary central incisor.

Tratamiento endodóntico no instrumentado en dientes deciduos: reporte de caso / Non instrumentation endodontic techniques in deciduous teeth. case report

Actualmente, se han publicado diversos casos cl¡nicos que describen la esterilizaci¢n de la lesi¢n pulpar en dientes deciduos como un tratamiento alternativo a la pulpectom¡a, evitando la exodoncia en dientes con necrosis pulpar y absceso. El procedimiento incluye: anestesia local, aislamiento absoluto, apertura cameral, remoci¢n de la pulpa cameral, ampliaci¢n de la entrada a los conductos, colocaci¢n de una pasta triantibi¢tica y la restauraci¢n. Se presenta el reporte de caso de una ni¤a de 4 a¤os de edad, la cual acude a la Cl¡nica Estomatol¢gica Central de la Facultad de Estomatolog¡a Roberto Beltr n de la Universidad Peruana Cayetano Heredia; con dolor, aumento de volumen en la regi¢n inferior izquierda y movilidad de la pieza 75. Radiogr ficamente se observa reabsorci¢n de la ra¡z distal de 1/3 y una lesi¢n osteol¡tica a nivel de la furcaci¢n. Por lo cual se decide realizar el tratamiento endod¢ntico no instrumentado de conductos, acompa¤ado de controles hasta los 12 meses, donde cl¡nicamente permanece asintom tico acompa¤ado con una regeneraci¢n de tejidos blandos, y radiogr ficamente una aposici¢n ¢sea en furca. Se concluye que el tratamiento endod¢ntico no instrumentado, muestra resultados prometedores y podr¡a ser una alternativa a la pulpectom¡a y/o exodoncia en dientes deciduos en algunos casos.

Now a days, clinical cases has been published in which describes the esterilization of pulpar lesi¢n on primary teeths as an alternative treatment to the pulpectomies avoiding the toot extractions on primary and necrotics or abscessed teeth. The procedure includes: local anesthesia, isolation with a rubber dam, remove the necrotic tissue from the coronal portionof the pulp chamber, enlarged of the canal orificie and a three mix paste placed over the pulpar floor. A case of 4 years old girl is presented in this work , that went to “Cl¡nica Estomatol¢gica Central de la Facultad de Estomatolog¡a Roberto Beltr n de la Universidad Cayetano Heredia”, with pain, mandibular left posterior swelling and mobility of her mandibular left second primary molar. X-ray shows 1/3 distal root resorption and furcation radiolucency. The clinical procedure ofnon- instrumented endodontic treatment was performed successfully and 12 months posterior controls was maded, in which soft tissue healing was showed, increased trabeculation in the furcation area, normal mobility and the patient was symptom-free. It concludes that this treatment shows promising results for the future pediatric dentistry and is an alterantive to pulpectomy and tooth extraction.

Single- versus two-visit pulpectomy treatment in primary teeth with apical periodontitis: A double-blind, parallel group, randomized controlled trial.

CONTEXT: Reduction of the bacterial populations to levels compatible with periradicular tissue healing is the primary microbiological goal of the endodontic treatment of teeth with apical periodontitis. The number of visits required to treat teeth with apical periodontitis represents one of the most debatable issues in endodontics. OBJECTIVES: The objective of this study was to compare and evaluate the clinical and radiographic outcome of single- versus two-visit pulpectomy treatment in primary teeth with apical periodontitis at the end of 6-month healing period. SETTINGS AND DESIGN: A parallel group, double-blind, randomized controlled trial was carried out in 64 children aged 4-8 years. Nonvital primary teeth with apical periodontitis with enough coronal structure were selected. Sixty-four children were assigned randomly into two groups (32 children each) by block randomization, and allocation concealment was done with closed envelop method. METHODS AND MATERIALS: Group I underwent single-visit pulpectomy followed by obturation with zinc oxide eugenol (ZOE). Group II underwent conventional two-visit pulpectomy with intracanal calcium hydroxide, followed by obturation with ZOE. Postoperative clinical and radiographic evaluation was carried out at 1, 3, and 6 months after the end of the treatment. STATISTICAL ANALYSIS USED: The data were analyzed by Wilcoxon's signed rank test, Mann-Whitney U-test, and Friedman test. RESULTS: There was no statistically significant difference in clinical and radiographic outcomes in both the groups at the end of 6-month healing period. CONCLUSION: Single-visit pulpectomy can be considered as a viable option for the treatment of primary teeth with apical periodontitis.

Pulse oximetry: a useful test for evaluating pulp vitality in traumatized teeth.

BACKGROUND AND AIM: Subjective pulp tests are not trustworthy, particularly in traumatized teeth, and may lead to inaccurate diagnosis. The use of an objective test such as pulse oximetry (PO) could be a more reliable method to properly evaluate pulp status in this condition. The aim of this study was to analyze the effectiveness of PO in determining pulp vitality in traumatized teeth based on oxygen saturation measurements (%SpO2 ). SUBJECTS AND METHODS: Fifty-nine permanent teeth that had undergone lateral luxation, and which were unresponsive to a cold spray test and were free from signs of necrosis, were selected and tested with PO at 7, 30 and 60 days after trauma. RESULTS: Fifty-nine teeth were tested. At 7 days after trauma, 8 teeth had low rates of oxygenation, compared to 10 at 30 and 60 days. Low rates were defined as a saturation reading ≤77%SpO2 . These teeth were assigned to the pulp necrosis (PN) group. The other 49 teeth were either considered to have healthy pulps (HP) (saturation ≥90%SpO2 ) or were assigned to a pulpitis (PP) group (saturation ≥78 to ≤89%SpO2 ). The 10 non-responsive teeth were followed up for 1 year and all exhibited indications for endodontic treatment. The other 49 teeth (HP or PP) began to show positive responses to the cold spray (after 3-9 months of follow up). No significant differences (P < 0.05) were detected between the three periods analyzed, but %SpO2 rates were significantly different (P < 0.01) between the groups (HP vs PP, HP vs PN and PP vs PN). CONCLUSIONS: PO can be extremely useful for the assessment of dental pulp status in traumatized teeth, particularly when these teeth do not show signs of PN and do not respond to cold tests.

Validity of Preoperative Clinical Findings to Identify Dental Pulp Status: A National Dental Practice-Based Research Network Study.

INTRODUCTION: Endodontic diagnostic tests are often used clinically to assess pulp status as a basis for the diagnosis and determination of whether root canal treatment (RCT) is indicated. Response to cold and pain on percussion are 2 common tests, yet their validity in identifying nonvital pulp in regular dental practice has not been reported. METHODS: We assessed the validity of cold and percussion tests to identify nonvital pulp in teeth requiring RCT in a dental practice setting performed by 46 general dentists and 16 endodontists in the National Dental Practice-Based Research Network. The influence of patient-, tooth-, and dentist-related characteristics was investigated. Observed bleeding from the pulp chamber was the clinical reference. Sensitivity (SN), specificity (SP), overall test accuracy (TA), positive (PPV) and negative (NPV) predictive values, and likelihood and diagnostic odds ratios (LR+, LR-, dORs) were calculated for each single test and the combined cold and percussion tests. RESULTS: Seven hundred eight patient teeth were included. Cold test showed high validity to identify a nonvital pulp status (SN = 89%, SP = 80%, TA = 84%, PPV = 81%, NPV = 88%, LR+ = 4.35, LR- = 0.14, dOR = 31.4), whereas pain on percussion had lower validity (SN = 72%, SP = 41%, TA = 56%, PPV = 54%, NPV = 60%, LR+ = 1.22, LR- = 0.69, dOR = 1.78). Combining the 2 tests did not increase validity, whereas preoperative pain, medication intake, patient age and sex, and dentist training level affected test validity significantly. CONCLUSIONS: In regular dental practice, the cold test exhibits higher validity to discriminate between vital and nonvital pulp than the tooth percussion test.

Adult Dental Trauma: What Should the Dental Practitioner Know?

The management of adult dental trauma can be a daunting challenge for practitioners at any level. Like medical emergencies, initial management can have a large influence on prognosis. It is important that practitioners understand the basic principles of managing the acute presentations of dental trauma. This article aims to illustrate a step-by-step approach in order to improve the management within general dental practice for better outcomes for patients.

Effect of maintaining apical patency on endodontic pain in posterior teeth with pulp necrosis and apical periodontitis: a randomized controlled trial.

AIM: To evaluate the association between apical patency and post-operative pain in posterior teeth with pulp necrosis and apical periodontitis. METHODOLOGY: Sixty-eight patients requiring primary root canal treatment in mandibular first molars with necrotic pulps and apical periodontitis were included. The patients were randomly allocated to one of two groups: patency (n = 34) and nonpatency (n = 34). After administering local anaesthesia, root canal preparation was completed using ProTaper rotary instruments. A size 10 K-file was used as a patency file and carried 1 mm beyond the working length (WL) between each instrument change in the patency group, while it was carried up to WL in the nonpatency group. Patients were asked to record their pain experience on a pain chart daily for 7 days. Three patients (two in the patency group, one in the nonpatency group) did not return with completed pain charts on the subsequent visit, resulting in a total of 65 patients for the final analysis (patency, n = 32; nonpatency, n = 33). Data was analysed using Chi Square test, t-test, Mann-Whitney test and Wilcoxon Signed Ranks test. RESULTS: Overall, 43% of the patients experienced post-operative pain. The patency group had less incidence of pain (34%) as compared to the nonpatency group (52%), but the difference was not significant (P = 0.163). CONCLUSION: Maintenance of apical patency during chemomechanical preparation had no significant influence on post-operative pain in posterior teeth with necrotic pulps and apical periodontitis.

Combined Endodontic Therapy and Intentional Replantation for the Treatment of Palatogingival Groove.

A palatogingival groove is an anatomic malformation that predisposes the involved tooth to a severe periodontal defect. When the condition is complicated by pulpal necrosis, affected teeth often present a dilemma in terms of diagnosis and treatment planning. In this report, we describe the case of a patient with a maxillary lateral incisor with a deep palatogingival groove extending to the root apex and severe periodontal destruction (local pocketing). Suggested treatment modalities included curettage of the affected tissues, elimination of the groove by grinding and/or sealing with a variety of filling materials, and surgical procedures. In this case, a combined treatment approach, involving both endodontic therapy and intentional replantation after restoration with a self-etching flowable composite, resulted in periodontal healing and significant healing of the periradicular radiolucency at 12 months. In short, intentional replantation offers a predictable procedure and should be considered a viable treatment modality for the management of palatogingival grooves, especially for single-rooted teeth.

Management of dens in dente associated with a chronic periapical lesion.

Dens in dente is characterised as a developmental anomaly resulting from invagination of the enamel organ into the dental papilla. It is a rare malformation of teeth, showing a wide spectrum of morphological variations such as gemination, microdontia, taurodontism, dentinogenesis imperfecta, supernumerary tooth and hyperplasias, resulting frequently in early pulp necrosis. Maxillary lateral incisors are the commonest teeth to be affected by dental malformations-supernumerary tooth, talon cusp, congenitally missing tooth and dens in dente. We describe the management of a case of dens in dente in a maxillary lateral incisor with a periradicular lesion.

Revascularización en una sola sesión de un incisivo inmaduro traumatizado: Caso clínico / Revascularization in a single session of a traumatized immature permanent tooth: a case report

Propósito: Se describe un protocolo de revascularización en una sola sesión para tratar un incisivo superior, con antecedentes de traumatismo, diagnosticado con periodontitis apical asintomática. Resumen: Los dientes inmaduros que reciben procedimientos de revascularización pueden completar su desarrollo, aunque la pulpa se haya necrosado y las bacterias hayan alcanzado la zona apical. Aún no existe un protocolo estandarizado que pueda seguirse. El caso presentado narra la revascularización de un diente 1.1, con el diagnostico de una periodontitis apical asintomática, que fue tratado con irrigación coronal y radicular con hipoclorito de sodio al 5,25%, sin instrumentación y sellado en una sola visita. Conclusión: La correcta evolución de este caso clínico sugiere que el procedimiento de revascularización permite aprovechar la vitalidad de las células madre dentales creando un ambiente adecuado para la regeneración pulpar y el completo desarrollo de la raíz

Background: The revascularization protocol in one session to treat an upper incisor, with a history of trauma, diagnosed with asymptomatic apical periodontitis, is described. Case report: Immature teeth that receives revascularization procedures can complete their development, although its pulp has reached necrotic and bacteria has reached the apical area. There is still no standardized protocol that can be followed. The present case shows the revascularization of a tooth 1.1, with the diagnosis of asymptomatic apical periodontitis. The tooth was treated with coronal and root irrigation of 5.25% sodium hypochlorite, without instrumentation and sealed in a single visit. Conclusion: The correct evolution of this case suggests that the revascularization procedure takes advantage of the vitality of dental stem cells creating a suitable environment for the pulp regeneration and full root development

Efficiency and Reliability of Thermal and Electrical Tests to Evaluate Pulp Status in Primary Teeth with Assessment of Anxiety Levels in Children.

OBJECTIVE: Assessing the pulp status plays a vital role in diagnosis and treatment planning in dentistry especially in children, who may not be able to verbalize their dental symptoms. Pulp sensibility test is used as a valuable investigation to evaluate the state of pulp. The aim of this study is to assess the efficiency and reliability of thermal and electrical pulp tests in primary teeth and to rule out the anxiety level involved in each tests. STUDY DESIGN: 30 children aged between 6 to 8 years with carious primary molar teeth in need of conservative pulp therapy were included in this study. 3 tests at random were employed on each tooth which includes cold, heat, electrical pulp test. The sensitivity, specificity, positive predictive value and negative predictive value were evaluated based on the clinical visual examination on access opening and the accuracy for each test was calculated. The Facial Image Scale (FIS) was used to assess the state of dental anxiety in children due to these pulp sensibility tests. RESULTS: The highest accuracy rate was calculated for EPT (0.814) followed by cold test (0.777) and heat test (0.759). CONCLUSION: No significant association was found between the accuracy of all the three tests. (P value > 0.05). Cold test is the most reliable test due to its simplicity and ease to perform. (FIS -1.53).

Electrical Pulp Testing: Sources of Error.

INTRODUCTION: Accurate identification and assessment of an inflamed or necrotic tooth is essentialfor endodontic treatment. The purpose of this research was to investigate possible sources of error associated with the use of the electric pulp tester (EPT). METHODS: Forty-six intact teeth (23 tooth pairs) in 22 patients were evaluated in vivo. For the tooth pairs, one tooth had to have been previously endodontically treated and restored with a class II amalgam restoration. The restoration was required to have proximal contact with a class II amalgam of another vital posterior tooth. EPT was performed on pulpless and vital teeth for experimental groups (enamel, restoration, contacting, or isolated). RESULTS: The highest rate of false positive responses (82%) was found in the pulpless restored contacting group, suggesting that EPT impulses are able to travel through proximal metallic contacts and stimulate teeth distant from the EPT probe. All vital tooth groups had a high rate of positive responses with no significant diferences. CONCLUSIONS: If a tested tooth contains an interproximal restoration contacting adjacent restorations or the gingival, the teeth must be isolated (rubber dam) and the EPT probe should be placed in a region suspected to have uninterrupted tubule paths to the pulp.