[Early loss of primary molar and permanent tooth germ caused by the use of devitalizer during primary molar root canal therapy: Two cases report].

Devitalization has been widely used in the root canal therapy of primary and permanent teeth in China more than ten years ago. With the development of local anesthetic drugs and injection technologies, this treatment method with high potential risks has been gradually abandoned. However, a questionnaire survey targeted all the participants at the 2018 China Pediatric Dentistry Conference showed that the devitalizer utilization proportion was still as high as 38.1% (383/1 005), even though the ratio was much lower than 75.5% (105/139) in 2003. These doctors had pay more attention to tissue burn caused by devitalizer marginal leakage or direct leakage, and know how to identify and handle with devitalizer burn. Devitalizers were usually made of arsenic trioxide, metal arsenic or paraformaldehyde, which have cytotoxicity, allergenicity, mutagenicity, carcinogenicity, and teratogenic effects on animals. Marginal leakage of devitalizers have high risks of causing soft and hard tissue necrosis. Most of the dentists have an understanding of the potential damages of arsenic containing devitalizers, so they will choose parafor maldehyde with relatively less toxicity. Paraformaldehyde has a certain self limitation, and there are few cases reported, so some dentists lack of vigilance. Paraformaldehyde can also causes tissue necrosis if leakage happens, and the treatment methods are similar to that of arsenic containing devitalizers. When handling with devitalizers burn, the necrosed soft and hard tissue, for example gingiva, alveolar bone or teeth that cannot keep, must be completely removed until fresh blood appears, then rinse with large amount of saline and seal with iodoform gauze. This paper described two cases of devitalizer burn during the root canal treatment of primary molars, both of the doctors failed to identify the devitalizer burn symptoms in the early stage, thus didn't do proper treatments immediately after burning. Resulting in the necrosis of large area of gingiva and alveolar bone, loss of primary molars and permanent tooth germs 1-2 months after devitalizer burn. This paper reported these two cases in detail in order to warn dentists the high risks of using any kind of devitalizers, help them learn how to identify and treat devitalizer burn, and remind them to stop using devitalizers as soon as possible.

Novel use of platelet-rich fibrin matrix and MTA as an apical barrier in the management of a failed revascularization case.

METHOD: We report management of a failed revascularization/revitalization case, which could be due to inadequate removal of biofilm and bacteria in dentinal tubules. The use of an apical matrix barrier in form of a platelet-rich fibrin (PRF) membrane for stabilization of MTA in root end apexification procedure is described. The canal was cleansed of old MTA present in the cervical third using H files, irrigated using saline and finally irrigated with 2.5% NaOCl and saline. To obtain canal disinfection, calcium hydroxide paste was temporized in the canal. In subsequent appointments, PRF was placed at the root tip followed by 5-mm apical plug with mineral trioxide aggregate. One week later, the root canal was obturated with thermoplasticized gutta-percha. A 6-month and a 2-year follow ups showed reduction of periapical radiolucency and adequately functional tooth. RESULTS: One-visit apexification techniques provide an alternative treatment for failed revascularization cases. Follow up confirmed complete healing periradicularly. CONCLUSION: Apexification in one step using an apical barrier of PRF and a plug of MTA can be considered a predictable treatment and may be an alternative to long-term revascularization failures.

Gingival and localized alveolar bone necrosis related to the use of arsenic trioxide paste--two case reports.

The leakage of arsenic trioxide paste from tooth fillings has been associated with widespread necrosis of the supporting periodontal tissues. This report describes two cases of arsenic trioxide paste-induced gingival and localized alveolar bone necrosis in the mandible, following the use of arsenic trioxide paste as a pulp-devitalized agent. The first case was a 54-year-old female complaining of a painful white patch on the gingival tissue of the left mandibular second molar (tooth #37) after treatment by a private dentist. She underwent completely debridement of all necrotic soft tissue with physical saline irrigation. The gingival tissue was gradually replaced with vascular tissue and completely healed after 7 weeks. The second case was a 30-year-old female complaining of severe pain and continuous gingival bleeding from the right maxillary first bicuspid (tooth #14) following treatment by a private dentist. She finally accepted debridement of the sequestrum and necrotic alveolar bone with decortication to induce active bleeding. A partial thickness gingival flap was made to cover the wound. Four weeks later, the supporting tissues had completely healed. Arsenic trioxide paste is a cytotoxic agent and may cause harmful adverse effects on adjacent periodontium and supporting hard tissue if leakage occurs, or it is used carelessly. There is no indication for the use of arsenic trioxide paste in modern dental practice.

[Validity of root canal therapy before prosthetic treatment with metal ceramic crowns].

UNLABELLED: Root canal therapy before prosthetic treatment with porcelain fused metal crowns is necessary only in case of special indications. Purpose of our investigation was to identify prevalence and validity of root canal therapy before prosthetic treatment. 873 DCC (Dental Clinical Charts) had been examined retrospective to determine the quantity of root canal treated teeth, non involved teeth, and teeth treated exclusively for prosthetic treatment. RESULTS: 1377 non involved teeth had root canal therapy before prosthetic treatment (84.22% of 1635 investigated teeth), among them 1371 (83.85%) had no specific indications for endodontic therapy.

Mandibular bone necrosis caused by use of arsenic paste during endodontic treatment: two case reports.

AIM: To report that arsenical pastes are still employed in endodontics and to highlight the potentially serious consequences of their use. SUMMARY: Chemotherapeutic agents such as arsenic trioxide and paraformaldehyde were once commonly employed as pulp-necrotizing agents. Their cytotoxic effects are well recognized, and leakage from teeth has been associated with widespread necrosis of periodontal tissues and bone. This report describes two cases of severe bone necrosis affecting the mandible following the use of an arsenical paste. KEY LEARNING POINTS: Pulp-necrotizing agents such as arsenic trioxide can cause severe bone necrosis. Arsenical pastes have no place in contemporary dental practice. Dentists should employ appropriate local anaesthetic techniques for pulp extirpation instead of relying on toxic necrotizing agents.

[Changes in the therapy of pulpal diseases and periapical lesions according to the articles published in the journal Fogorvosi Szemle during the past 100 years (1908-2008)]. / A fogbélbetegségek és a fogbél következményes betegségeinek terápiájában (gyökérkezelés) bekövetkezett változások 100 éve a Fogorvosi Szemle közlemenyeinek tükrében (1908-2008).

Present review makes an attempt to summarize the Hungarian endodontic literature of pulpal and periodontal diseases, published during the past 100 years. The experimental examinations and clinical studies make it possible to follow the changes in the methods and in the medicines, used in the field of pulpal treatment. The overview gives us information about the problem of disinfection, shaping, measuring, and obturation of root canal.

A history of arsenic in dentistry.

The history of the use of arsenic in dentistry has been relegated to dental history. Once hailed as a panacea for the relief of pain and the answer to root canal therapy, it soon fell out of use mainly because of its misuse by unskilled and unscrupulous dentists in search of a quick fix to a complex problem. Such is the story of arsenic.

Early loss of primary molar and permanent tooth germ caused by the use of devitalizer during primary molar root canal therapy: Two cases report / 北京大学学报(医学版)

Devitalization has been widely used in the root canal therapy of primary and permanent teeth in China more than ten years ago. With the development of local anesthetic drugs and injection technologies, this treatment method with high potential risks has been gradually abandoned. However, a questionnaire survey targeted all the participants at the 2018 China Pediatric Dentistry Conference showed that the devitalizer utilization proportion was still as high as 38.1% (383/1 005), even though the ratio was much lower than 75.5% (105/139) in 2003. These doctors had pay more attention to tissue burn caused by devitalizer marginal leakage or direct leakage, and know how to identify and handle with devitalizer burn. Devitalizers were usually made of arsenic trioxide, metal arsenic or paraformaldehyde, which have cytotoxicity, allergenicity, mutagenicity, carcinogenicity, and teratogenic effects on animals. Marginal leakage of devitalizers have high risks of causing soft and hard tissue necrosis. Most of the dentists have an understanding of the potential damages of arsenic containing devitalizers, so they will choose parafor maldehyde with relatively less toxicity. Paraformaldehyde has a certain self limitation, and there are few cases reported, so some dentists lack of vigilance. Paraformaldehyde can also causes tissue necrosis if leakage happens, and the treatment methods are similar to that of arsenic containing devitalizers. When handling with devitalizers burn, the necrosed soft and hard tissue, for example gingiva, alveolar bone or teeth that cannot keep, must be completely removed until fresh blood appears, then rinse with large amount of saline and seal with iodoform gauze. This paper described two cases of devitalizer burn during the root canal treatment of primary molars, both of the doctors failed to identify the devitalizer burn symptoms in the early stage, thus didn't do proper treatments immediately after burning. Resulting in the necrosis of large area of gingiva and alveolar bone, loss of primary molars and permanent tooth germs 1-2 months after devitalizer burn. This paper reported these two cases in detail in order to warn dentists the high risks of using any kind of devitalizers, help them learn how to identify and treat devitalizer burn, and remind them to stop using devitalizers as soon as possible.

Histological study of periradicular tissue responses to uninfected and infected devitalized pulps in dogs.

Uninfected necrotic tissue, such as that which follows a myocardial or cerebral infarct, is capable of inducing an inflammatory reaction. Eventually, the infarct is organized by granulation tissue. Why then, does uninfected devitalized pulp tissue, such as in traumatized teeth, not cause periradicular inflammation and does not become organized by granulation tissue? Four beagle dogs were used in this experiment. A total of 48 teeth, which included 24 maxillary and 24 mandibular incisors, were aseptically devitalized, leaving residual pulp tissues in the root canals, and equally divided into two groups. Group A (24 uninfected): A sterile cotton pellet was placed deep into the canal orifice before the pulp chamber and access opening were closed with a layer of zinc-oxide eugenol cement followed by glass ionomer cement. Group B (24 infected): The teeth were left open to the oral cavity for 7 days and then closed with a cotton pellet and zinc-oxide eugenol and glass ionomer cement. The animals were sacrificed one year after the experiment and prepared for histological examination of periradicular tissue responses to uninfected and infected devitalized pulp tissues. The results indicate that uninfected devitalized pulp tissues did not continuously release inflammatory mediators and cause persistent periradicular inflammation over a period of one year. However, infected devitalized pulp tissues induced various degrees of periradicular inflammation. Only the apical few millimeters of uninfected devitalized pulp tissue in the root canals were organized by granulation tissue from vital periodontal ligament tissue.

Arsenic trioxide-induced osteo-necrosis treatment in a child: mini-review and case report.

BACKGROUND: Arsenic oxide compounds were traditionally used as devitalizing agents. Due to its toxicity, leakage of such compounds into the periodontium can cause gingival and osteo-necrosis. Their use is forbidden in Europe and the USA for decades, however, some dentists seem to still use it. CASE REPORT: We report the case of a 14-year-old girl referred to the paediatric dentistry department of Toulouse University hospital, France, presenting a bone necrosis following the use of an arsenic trioxide product to accelerate pulp necrosis. TREATMENT: The treatment included surgical removal of necrosis bone sequestrum, complete pulpectomy and an intermediate restoration of the tooth 27. FOLLOW-UP: After 1 week, the clinical conditions greatly improved. A restoration using a ceramic crown was performed after 2 months, and complete healing was observed after 1 year follow-up. CONCLUSION: Although arsenic trioxide is neither appropriate nor permitted for use in modern dentistry, especially in paediatric dentistry, some rare cases of arsenic-induced osteo-necrosis can still be encountered. A clearer message must be given to all dental practitioners against the use of arsenic trioxide in modern endodontic treatment.

Treatment options for permanent teeth with deep caries.

The goal of this narrative review was to summarize and compare treatment options for permanent teeth carious lesions that are radiographically close to the pulp chamber. Thanks to adhesive restorative materials, minimally invasive approaches are possible. In this context, the old question arises as to whether caries must be excavated completely, i.e., down to hard dentin, or whether it could be advantageous to leave some soft dentin, or even merely seal the whole lesion. To answer this question, the microbiological aspects of the lesion must be considered, along with the immunological response in the dental pulp, with the concurrent possible negative outcomes for the patient. Both aspects are considered in this review, and clinical studies comparing different treatment modalities are discussed. Situations in which calcium silicate cements could be advantageous over the gold standard calcium hydroxide preparations for covering the dentin/pulp wound are also discussed.

Localized osteomyelitis secondary to endodontic-implant pathosis. A case report.

This case report documents the placement of a single implant fixture in an incisor extraction socket, with the adjacent lateral incisor developing periapical pathosis within 2 weeks. This root-end inflammatory process proceeded to communicate with the surface of the implant fixture. Although endodontic therapy was performed within one week on the devitalized tooth, and extensive osteomyelitis developed around the implant. Three weeks after placement, the fixture had to be removed. The osteotomy site appeared to be healing uneventfully during the one month follow-up period. Seven possible causes for this occurrence are discussed.

Effects of moisture content and endodontic treatment on some mechanical properties of human dentin.

The objective of this study was to determine whether significant differences exist between the mechanical properties of human dentin from treated pulpless teeth and dentin from normal vital teeth. Dentin specimens (n = 262) were obtained from 54 freshly extracted normal vital human teeth and 24 treated human pulpless teeth. These specimens were subjected to different experimental conditions (wet, air dried, desiccated, and rehydrated). Compression, indirect tensile, and impact tests were conducted to measure the mechanical properties of those specimens. All data obtained were analyzed with t tests. The results showed that the dehydration of dentin increases the Young's modulus, proportional limit (in compression), and especially the ultimate strength (in both compression and tension). Substantial dehydration changes the fracture characteristics of dentin specimens under static compressive and indirect tensile loadings. The measurements of impact-breaking energies of desiccated dentin were not found to be significantly decreased. The compressive and tensile strengths of dentin from treated pulpless teeth obtained in this study do not appear to be significantly different from those of normal dentin (p > 0.05), while the mean values of Young's modulus and proportional limit in compression tests appear to be lower. Fifty percent of the dentin specimens from treated pulpless teeth exhibit greater plastic deformation than normal dentin in compression. The results of this study do not support the theory that dehydration after endodontic treatment per se weakens dentin structure in terms of compressive and tensile strengths. Other mechanical properties of treated pulpless teeth, however, may not be the same as those of normal vital teeth.

Are endodontically treated teeth more brittle?

This study compared biomechanical properties (punch shear strength, toughness, hardness, and load to fracture) of 23 endodontically treated teeth (mean time since endodontic treatment: 10.1 yr) and their contralateral vital pairs. Analyses using paired t tests revealed no significant differences in punch shear strength, toughness, and load to fracture between the two groups. Vital dentin was 3.5% harder than dentin from contralateral endodontically treated teeth (p = 0.002). The similarity between the biomechanical properties of endodontically treated teeth and their contralateral vital pairs indicates that teeth do not become more brittle following endodontic treatment. Other factors may be more critical to failure of endodontically treated teeth.

A method to determine the location and shape of an intracoronal bleach barrier.

The external cervical root resorption associated with intracoronal bleaching of pulpless teeth can be a devastating lesion. It often cannot be repaired. To prevent this problem, increasing attention has been focused on placing a barrier between the pulp chamber and the endodontic filling material. The objective of this article is to propose a method for determining the location and shape of an intracoronal bleach barrier.

Bacterial invasion into dentinal tubules of human vital and nonvital teeth.

The difference in resistance to bacterial invasion into the dentinal tubules between vital and nonvital teeth has not been determined. This study was conducted to clarify the effect of vital pulp on bacterial invasion into the dentinal tubules. The specimens were 19 intact pairs of bilateral upper third molars of 19 healthy, young adult male volunteers. In each case, 30 or 150 days before extraction, pulpectomies and root canal fillings were carried out unilaterally and a class V cavity involving the dentin was made on the palatal surface of both the pulpectomized tooth and the nonpulpectomized opposite tooth. The cavities were left unprotected to expose them to oral flora until the extractions were done, and the extracted teeth were examined histologically. When extraction followed 150-day exposure to the oral flora, there was a statistically significant difference in the bacterial invasion rate between the vital and nonvital teeth. It was postulated that vital teeth were much more resistant to bacterial invasion into the dentinal tubules than were nonvital teeth, thereby suggesting that the vital pulp plays some important role in this process.