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In 1966, Andreasen and Hjørting-Hansen were the first to describe a relationship between tooth resorption and dental trauma. However, Andreasen's original classification did not include other resorptive processes which have since been identified. Numerous articles have been published suggesting new terminology and definitions for tooth resorption. A uniform language with universally accepted terminology is crucial to eliminate the multiplicity of terms and definitions which only cause confusion within the profession. An electronic literature search was carried out in the PubMed database using the following keywords for articles published in English: "root resorption," "inflammatory root resorption," "replacement resorption," "cervical resorption," "trauma," "ankylosis," "surface resorption," and "internal resorption." The search also included textbooks and glossaries that may not have surfaced in the online search. This was done to identify articles related to tooth resorption and its etiology in dentistry. The aim of this review was to present the history that has led to the variety of terms and definitions for resorption. This review emphasizes the need for a clearer, simpler, and more comprehensive nomenclature for the various types of tooth resorption which are presented in Part 2 of this series.
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Reabsorção da Raiz , Anquilose Dental , Reabsorção de Dente , Humanos , Reabsorção da Raiz/etiologia , Anquilose Dental/etiologia , Reabsorção de Dente/complicaçõesRESUMO
BACKGROUND/AIMS: Decoronation is currently considered the best treatment option for ankylosed teeth and discrepancies in the alveolar bone, particularly in childhood and adolescence. The loss of a front tooth creates aesthetic, functional, and psychological distress in patients and their parents. The aim of this study was to analyze the types of restorations provided after decoronation, their suitability, durability, and follow up until insertion of the final restoration. MATERIALS AND METHODS: A literature review was conducted using Ovid MEDLINE, Embase, and Web of Science to identify eligible articles. English language publications until August 9, 2018, were searched independently and cross-checked by two researchers online, in print, and in press. RESULTS: Of 618 articles screened, 10 included reports on 11 patients with detailed descriptions of 13 provisional restorations. Patients' ages at the time of decoronation were 8-15 years. Seven underwent avulsion and four intrusion. Removable partial denture (nine cases) was the most common restoration. In two cases, the restoration was provisional with a lingual bar with prosthetic crown and in two other cases with an adhesive bridge. Follow up ranged from 3 months to 5 years in nine patients. Two cases were followed until the permanent restoration was placed. CONCLUSIONS: The importance of long-term provisional restorations was disregarded by most authors. A multidisciplinary approach should take into consideration immediate-, mid-, and long-term rehabilitation of the decoronated tooth.
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Incisivo , Anquilose Dental , Adolescente , Criança , Coroas , Humanos , Coroa do DenteRESUMO
AIM: The objective of this study was to compare the accuracy of working length (WL) determination by X-Smart Dual, ENDOAce, and Gold Reciproc motor, in manual mode and mechanical preparation set to auto apical reverse (AAR) mode. MATERIALS AND METHODS: Forty-five anterior teeth were included in the study. The canal length was determined by introducing #10 file into the canal until it emerged at the apical foramen. The incisal edges were adjusted to obtain 18 mm standard length. The teeth were embedded in Plexiglas tubes, filled with alginate, and measured in manual and AAR modes. RESULTS: Within and between the groups, there was no significant difference in WL measurements, both in manual and AAR modes. In the X-Smart Dual group, all manual measurements were within root canal limits, while 13 % of AAR mode measurements were recorded when the file tip passed the apical foramen. In the ENDOAce group, 13 and 7 % of the measurements, in manual and AAR modes respectively, were recorded when the file tip passed the foramen. In the Gold Reciproc motor group, 27 and 33 % of the measurements, in manual and AAR modes respectively, were recorded when the file tip passed the foramen. CONCLUSION: With the limitation of this ex vivo study, the tested devices presented no significant differences in length measurements and were within the clinical accepted margin of error. CLINICAL RELEVANCE: Mechanical preparation must be confined to the root canal system. The adverse results of overinstrumentation emphasize the need to reconsider the ±0.50 mm margin of error that is clinically acceptable for WL measurements.
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Cavidade Pulpar/anatomia & histologia , Odontometria/instrumentação , Preparo de Canal Radicular/instrumentação , Raiz Dentária/anatomia & histologia , Instrumentos Odontológicos , Equipamentos e Provisões Elétricas , Desenho de Equipamento , Humanos , Técnicas In VitroRESUMO
INTRODUCTION: External Inflammatory Root Resorption (EIRR) is a significant complication that can occur following traumatic dental injuries, with a prevalence of approximately 18%. Most cases occur during the early stage of the mixed dentition. Specifically, EIRR occurs in approximately 5-8% of luxation injuries, 30% of replanted teeth following avulsion, and 38% of intruded teeth. Conventional methods for addressing EIRR in immature teeth pose several challenges. This often requires numerous dental visits where Ledermix® and calcium hydroxide are used, which may significantly prolong the treatment. Additionally, the effect of prolonged use of calcium hydroxide medication in the root canal is debatable. Recent publications have highlighted the ability of regenerative endodontic treatment (RET) to effectively stop and repair external inflammatory root resorption (EIRR) in a relatively brief time, yielding impressive results. Nevertheless, the underlying mechanism responsible for this effect remains unclear. METHODS: A hypothesis is proposed and drawn from existing data, explaining the mechanism by which RET triggers alterations in the root dimensions of necrotic immature teeth, facilitating continuous root maturation. The hypothesis suggests that bioactive molecules, including growth factors, might be able to penetrate the denuded dentin, reach the resorbed area, and attract stem cells from the surrounding periodontal ligament (PDL) and adjacent bone, leading to the arrest of the resorption process. RESULTS: This recruitment may trigger repair mechanisms, ultimately resulting in the coverage of the denuded dentin with a new layer of PDL, cementoid, and cementum. CONCLUSIONS: A hypothesis of the potential mechanism in which RET may arrest EIRR is presented along with a case report.
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Purpose: Vital partial pulpotomy (PP) or cervical pulpotomy (CP) in carious pulp-exposed permanent teeth preserves tooth vitality, promotes pulp healing, decreases treatment costs, and shortens treatment duration, which is a significant factor in treating noncooperative children. The aim of this retrospective study was to compare clinical and radiographic outcomes of partial and CP in vital carious-exposed permanent teeth. Materials and methods: All vital permanent teeth with carious pulp exposure, treated by pulpotomy using mineral trioxide aggregate (MTA) during 2017-2019, by two operators in one dental center, were included in the study. Around 118 permanent teeth in 97 children and adolescents (mean age 10.9 years) were evaluated 6-57 months postoperatively. Results: The total success rates of CP and PP were 82.5 and 80.8%, respectively (p = nonsignificant). The only factor that significantly affected the success rate was the presence of preoperative periapical pathology. Teeth without such pathology showed an 87.3% success rate compared to 74.1 and 58.3% in teeth with preoperative enlarged periodontal ligament (PDL) or with periapical radiolucency, respectively (p = 0.0301). Demographic variables, maturation state of the tooth, type of tooth (incisor, premolar, molar), postoperative variables, such as the presence of radiographic dentinal bridge, partial or full obliteration of the pulp during the follow-up period, and the integrity of the final restoration during the recall examinations did not affect the success rate of the treatment. Conclusion: Partial and CP in vital permanent teeth with carious pulp exposure in children and adolescents might be a reliable alternative to full root canal treatment (RCT). How to cite this article: Yoshpe M, Kaufman AY, Lin S, et al. Clinical and Radiographic Outcomes of Mineral Trioxide Aggregate Pulpotomies in Vital Permanent Teeth with Carious Pulp Exposure: A Pioneering Retrospective Study. Int J Clin Pediatr Dent 2023;16(4):555-559.
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INTRODUCTION: Regenerative endodontic procedures (REPs) are aimed to treat apical periodontitis and promote root maturation of immature necrotic teeth. However, REPs are not intended to be a primary indication for treating or arresting external root resorption (ERR). The purpose of this study was to describe REP treatment in the cessation of ERR. METHODS: Four cases (5 teeth) of posttraumatic immature teeth diagnosed with necrotic pulp and apical periodontitis or chronic apical abscess were treated with REPs using plasma-rich fibrin as a scaffold. All the teeth showed ERR and have been followed up to 3 years. RESULTS: This case series shows how REPs arrested ERR. In 3 of the cases, replacement resorption was arrested, thus avoiding complications of ankylosis and the need for decoronation. CONCLUSIONS: In addition to the known advantages of REPs, we show that REPs are a promising treatment modality for arresting ERR, warranting further clinical trials.
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Periodontite Periapical , Endodontia Regenerativa , Reabsorção da Raiz , Anquilose Dental , Necrose da Polpa Dentária , HumanosRESUMO
OBJECTIVES: The purpose of this article was to propose guidelines for dental practitioners facing the dilemma whether to treat, follow up, or disregard random asymptomatic radiographic findings. DATA SOURCES: Searches performed in MEDLINE, Cochrane, and EMBASE databases were followed by a manual search. Related data incorporated by experts included recommendations on asymptomatic root canal treatment, quality of the root canal, and restoration relative to outcome. Evidence tables were developed following quality and inclusion criteria assessment. RESULTS: The initial search retrieved 2,796 MEDLINE, 542 EMBASE, and 152 Cochrane articles, for a total of 3,490 potential articles. After duplicates were removed, 2,946 articles remained. Articles not related to the topic and not meeting eligibility criteria were excluded, resulting in 44 studies included in this scoping review. CONCLUSIONS: The proposed guidelines provide easy access to existing information in endodontics. The findings are common and possess clinical and medico-legal importance.
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Cavidade Pulpar , Endodontia , Odontologia Geral/normas , Humanos , Guias de Prática Clínica como Assunto , Tratamento do Canal RadicularRESUMO
Rehabilitation of missing decoronated permanent incisors in growing children and adolescents is a major challenge. The psychologic impact of the loss of an incisor is significant due to its immediate influence on facial appearance. Final restoration is planned only after skeletal growth cessation. Consequently, the fabrication and installation of an immediate temporary restoration, which is expected to remain in place for a long period, must meet the patient's esthetic demands and be durable in the oral environment. Several proposed removable and fixed restorations have presented significant shortcomings. The purpose of this report is to suggest a comfortable dental device for restoring the missing permanent tooth with improved esthetic, functional, and psychologic benefits. An alternative fixed orthodontic laboratory fabricated appliance for permanent tooth restoration is described among children with posttraumatic tooth decoronation. Unlike removable restorative appliances, this fixed device is not dependent on the child's compliance. Esthetically, no metal part is exposed in the anterior region and the architecture is more sturdy and stable, with minimum interruption to the alveolar ridge's vertical development. CASE REPORT: An alternative fixed orthodontic laboratory appliance is described for intermediate restoration of a missing permanent tooth. CLINICAL RELEVANCE: A posttrauma intermediate fixed orthodontic appliance is a beneficial solution from esthetic, psychologic, functional, and economic perspectives for replacing missing anterior maxillary teeth. This device may be worn by patients for a long period until final restoration is indicated.
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Incisivo/cirurgia , Aparelhos Ortodônticos , Anquilose Dental/cirurgia , Coroa do Dente/cirurgia , Criança , Restauração Dentária Permanente , Feminino , Humanos , Incisivo/lesões , Desenho de Aparelho OrtodônticoRESUMO
The objective of this study was to evaluate the success rate of intraligamentary injections (ILI) using a two- or four-site injection technique. One hundred and fifty-one mandibular molars diagnosed with asymptomatic irreversible pulpitis received ILI at the mesiobuccal and distobuccal aspects of the roots. Patients who experienced pain when the access cavity was performed received additional supplemental ILI in the mesiolingual and distolingual aspects. Pulpal anaesthesia was considered successful when complete analgesia was achieved. The data were analysed by means of the Fisher's exact and Pearson's chi-square tests. IL anaesthesia was successful for 92.1% of the teeth. Forty-eight teeth (31.8%) were sufficiently anaesthetised using the two-site ILI and 91 teeth (60.3%) following supplemental IL anaesthesia in two more sites. The results of this study indicate that the use of four-site IL injections as a primary anaesthetic technique may be considered a favourable alternative to the common IANB.
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Anestésicos Locais/uso terapêutico , Pulpite/tratamento farmacológico , Anestesia Dentária , Humanos , Lidocaína , Nervo Mandibular , Dente Molar , Bloqueio Nervoso , Medição da Dor , Estudos RetrospectivosRESUMO
BACKGROUND: This study explores the pattern of complications occurrence resulting from traumatic dental injuries, the relation of this pattern to the number of years from the time of the injury to its first diagnosis, and other contributing characteristics such as root development and trauma characteristic. MATERIAL AND METHODS: Patients' data treated following dental trauma from 2002 to 2014 were classified and grouped according to age, gender, tooth type, injury type, diagnosis and the time that elapsed between the traumatic event and the diagnosis of complications (TIC). The distribution function of the quantitative parameters was determined with the Kolmogorov-Smirnov test. Fisher exact test was used to test differences between categorical parameters. RESULTS: The review identified 166 patients (114 male and 52 female), with a total of 287 traumatized teeth, and a mean of 1.8 injured teeth per incident. Maxillary teeth were involved significantly more often in traumatic dental injuries. The follow-up period range (TIC) had a mean of 2.99 years. The most frequent complication was pulp necrosis (34.2%). The most frequent complication related to avulsion was ankylotic root resorption (50%) diagnosed after a median TIC of 1.18 years. Open apices at the occurrence of trauma were observed in 52 teeth. Of these, 54.9% experienced pulp necrosis and 9.8% inflammatory root resorption with a median TIC of 1.63 years. Teeth that experienced multiple traumatic events showed significantly more late pulp necrosis compared to teeth that experienced a single traumatic injury (61.9% vs. 25.3%, respectively, p<0.0001). CONCLUSIONS: Follow-up periods should be based on the type of traumatic dental injury and the severity of the potential complications for the tooth. Current recommendations for follow-up after traumatic dental injury should be revised to reflect the need for more frequent and overall prolonged follow-up. Key words:Dental trauma, avulsion, open apex, pulp necrosis, root resorption, follow-up, complications.
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Taurodontism is a morphoanatomical change in the shape of a tooth, which usually occurs in multirooted teeth. An enlarged body and pulp chamber, as well as apical displacement of the pulpal floor, are characteristic features. Endodontic treatment of a taurodont tooth is challenging, because it requires special care in handling and identifying the number of root canals. A case of endodontic treatment of a maxillary first molar with taurodontism is presented.
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Cavidade Pulpar/anormalidades , Dente Molar/anormalidades , Tratamento do Canal Radicular , Adulto , Humanos , Masculino , MaxilaRESUMO
INTRODUCTION: The purpose of this study was to assess the accuracy and reliability of the apex locator function of the Gold Reciproc Motor (VDW GmbH, Munich, Germany) during reciprocating movement. METHODS: Forty extracted incisors with mature apices were included in the study. The canal length was determined by introducing #10 file into the canal until it emerged at the apical foramen. The incisal edge of each tooth was adjusted to obtain 18 mm standard length and to produce a flat reference point. The teeth were embedded in Plexiglas tubes filled with alginate and measured by Root ZX (J. Morita Corp, Tokyo, Japan) and Bingo 1020 (Forum Engineering Technologies, Rishon Lezion, Israel) apex locators. The root canals were instrumented in a reciprocating mode using an R25 Reciproc file in the Gold Reciproc Motor until the green LEDs and orange LED were reached. According to the manufacturer, these LEDs represent the zone between the apical constriction and the apical foramen. RESULTS: No statistically significant differences were found between the length measurements of the 2 electronic apex locators and the third green LED, which is suggested by the manufacturers as the recommended working length. CONCLUSIONS: With the limitation of this ex vivo study, the Gold Reciproc Motor's integrated electronic apex locator was found to be as reliable and accurate as the Root ZX and Bingo 1020 apex locators in terms of length control during root canal preparation in the reciprocation mode.
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Cavidade Pulpar/anatomia & histologia , Odontometria/instrumentação , Preparo de Canal Radicular/instrumentação , Ápice Dentário/anatomia & histologia , Equipamentos e Provisões Elétricas/estatística & dados numéricos , Desenho de Equipamento , Humanos , Incisivo/anatomia & histologia , Teste de Materiais , Odontometria/estatística & dados numéricos , Reprodutibilidade dos Testes , Preparo de Canal Radicular/estatística & dados numéricosRESUMO
INTRODUCTION: Macrodontia of anterior teeth may occur as an isolated condition or as a result of fusion or gemination and may cause clinical problems such as tooth crowding and esthetic problems. Preliminary planning and careful management are often required by a dental team comprising an orthodontist, an endodontist, a prosthodontist, and an oral surgeon. A multidisciplinary treatment approach in a case with fused teeth is presented. METHODS: A 9-year-old girl presented with macrodontia of a left maxillary central incisor. The patient was referred to the orthodontic department because of a large central incisor as a result of fusion with an unspecific supernumerary tooth. The surgical procedure included sectioning off the mesial segment as far as possible, both apically and subgingivally, and extracting 1 of the fused supernumerary teeth. During the sectioning procedure, the pulp of the remaining tooth was exposed at the middle third of the root. Direct pulp capping was performed by an endodontist using mineral trioxide aggregate. Twelve weeks later, orthodontic treatment was commenced, and finally after a 26-month orthodontic treatment period, the central incisors' crown was restored using composite material. RESULTS: A 10-year clinical and radiographic follow-up revealed that the remaining resected central incisor kept its vitality, and the patient was pleased with the esthetic result. CONCLUSIONS: Proper interdisciplinary treatment planning of complicated cases such as anomalous teeth, which involve fusion to a supernumerary tooth, may lead to minimal invasive conservative procedures that maintain tooth vitality and result in a pleasing esthetic result.
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Dentes Fusionados/terapia , Incisivo/anormalidades , Dente Supranumerário/terapia , Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Criança , Terapia Combinada , Resinas Compostas/química , Coroas , Materiais Dentários/química , Capeamento da Polpa Dentária/métodos , Combinação de Medicamentos , Estética Dentária , Feminino , Seguimentos , Dentes Fusionados/cirurgia , Humanos , Incisivo/cirurgia , Má Oclusão Classe II de Angle/terapia , Óxidos/uso terapêutico , Planejamento de Assistência ao Paciente , Equipe de Assistência ao Paciente , Agentes de Capeamento da Polpa Dentária e Pulpectomia/uso terapêutico , Silicatos/uso terapêutico , Coroa do Dente/anormalidades , Coroa do Dente/cirurgia , Técnicas de Movimentação Dentária/métodos , Raiz Dentária/anormalidades , Raiz Dentária/cirurgia , Dente Supranumerário/cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION: Endodontic treatment of immature permanent teeth with necrotic pulp, with or without apical pathosis, poses several clinical challenges. There is a risk of inducing a dentin wall fracture or extending gutta-percha into the periapical tissue during compaction of the root canal filling. Although the use of calcium hydroxide apexification techniques or the placement of mineral trioxide aggregate as an apical stop has the potential to minimize apical extrusion of filling material, they do little in adding strength to the dentin walls. It is a well-established fact that in reimplanted avulsed immature teeth, revascularization of the pulp followed by continued root development can occur under ideal circumstances. At one time it was believed that revascularization was not possible in immature permanent teeth that were infected. METHODS: An in-depth search of the literature was undertaken to review articles concerned with regenerative procedures and revascularization and to glean recommendations regarding the indications, preferred medications, and methods of treatment currently practiced. RESULTS: Disinfection of the root canal and stimulation of residual stem cells can induce formation of new hard tissue on the existing dentin wall and continued root development. CONCLUSIONS: Although the outcome of revascularization procedures remains somewhat unpredictable and the clinical management of these teeth is challenging, when successful, they are an improvement to treatment protocols that leave the roots short and the walls of the root canal thin and prone to fracture. They also leave the door open to other methods of treatment in addition to extraction, when they fail to achieve the desired result.