Vital pulp therapy-Factors influencing decision-making for permanent mature teeth with irreversible pulpitis: A systematic review.

BACKGROUND: There is an increased tendency towards adopting minimally invasive interventions in dentistry, supported by advancement in materials and techniques. However, the decision-making process in choosing conservative or invasive treatments is influenced by several factors, particularly in permanent teeth with irreversible pulpitis. OBJECTIVES: The objective of the study was to systematically review the literature regarding factors that influence decision-making for vital pulp therapy (VPT) as definitive treatment option in permanent mature teeth diagnosed with irreversible pulpitis. METHODS: Two independent reviewers searched five electronic databases (PubMed, Embase, Web of Science, Scopus and Cochrane Library). Grey literature was searched through Google Scholar and contact with experts. Defined search keys were applied, and all peer-reviewed literature published with no language nor publication date limits were included. The All studies investigating the factors influencing treatment decision-making in mature permanent teeth with irreversible pulpitis were included. The quality of included studies was assessed by two independent reviewers using the Joanna Briggs Institute quality assessment tool. RESULTS: Six articles were included in the review. All included studies used questionnaires to characterize clinician preferences and attitudes in choosing treatment options for mature permanent teeth with irreversible pulpitis. The available evidence suggests that dentist-related factors have a significant influence on the chosen treatment in teeth with irreversible pulpitis, with speciality training and years of experience influencing the choice of VPT over other treatment options. COVID-19 reportedly swayed the dentists' decision to favour VPT. Only one article studied the influence of patient-related factors, such as age and presence of spontaneous pain on decision-making. Of note, a history of cardiovascular disease moved dentists towards prescribing VPT. DISCUSSION: Collectively, the included studies demonstrated an overriding influence of dentist-related factors on choosing among treatment options for painful teeth diagnosed with irreversible pulpitis. Patient-related factors were acknowledged but there are also potential factors such as socio-economic constraints that were not included in the component studies. CONCLUSION: In teeth with irreversible pulpitis clinicians educational background influence the decision towards a specific treatment option. Further data, preferably derived from clinical records, is necessary in future investigations to explore the effect of other important factors related to both dentists and patients. REGISTRATION: PROSPERO database (CRD42022339653).

A retrospective cohort study of pulp prognosis in luxated permanent teeth: a competing risk analysis.

AIM: The present retrospective cohort study aimed to evaluate luxated permanent teeth for pulp prognosis and risk factors. METHODOLOGY: Case records and radiographs of 224 patients, involving 427 luxated permanent teeth, referred for treatment at the Dental Trauma Center-School of Dentistry, Universidade Federal de Minas Gerais, (DTC-SD-UFMG) from 2014 to 2022, were assessed for pulp prognosis classified as vitality, necrosis and pulp canal obliteration (PCO). A competing risk survival analysis estimated the hazards of the three outcomes, and the effect of demographic, clinical and treatment variables was tested using a cause specific Cox regression model. RESULTS: Pulp vitality was found in163 teeth (38.2%), pulp necrosis in 120 teeth (28.1%) and 55 teeth (12.9%) developed PCO. Pulp vitality decreased in the presence of concomitant crown fractures (HR 0.38 95% CI [0.2-0.8] p = 0.006). The risk of pulp necrosis (HR 0.62 95% CI [0.4-0.96] p = 0.03) was lower in cases with open apices but increased with concomitant crown fractures (HR 4.0 95% CI [2.6-6.1] p = 0.001) and intrusions (HR 2.3 95% CI [1.2-4.1] p = 0.007). Lateral or extrusive luxations (HR 3.0 95% CI [1.3-6.9] p = 0.001) and open apices (HR 2.4 95% CI [1.2-4.7] p = 0.01) showed higher rates of PCO. CONCLUSION: Type of luxation, the diameter of the apical foramen, and the presence of concomitant crown fractures were main determinants of pulp prognosis after luxation injuries in permanent teeth. CLINICAL RELEVANCE: Pulp prognosis after tooth luxation is dependent on the presence and direction of tooth displacement together with infection control. CLINICAL TRIAL REGISTRATION: Not applicable.

Comparison of two CBCT analysis techniques with conventional periapical radiographs in assessment of tertiary dentin after indirect pulp capping in young permanent teeth.

BACKGROUND AND AIM: To compare two cone beam computed tomography (CBCT) analysis techniques for measuring tertiary dentin (TD) volume, density, and root length increase, after indirect pulp therapy (IPT) in young permanent teeth with conventional periapical radiographs. DESIGN: Comparative study design: Sixty-nine CBCT scans were taken initially (T1) and after 1 year (T2) of IPT. New CBCT analysis technique A, standardization, segmentation, and registration of T1 and T2 scans were performed using ITK-SNAP and 3D Slicer CMF to measure TD volume (mm3), density (gray-level intensity), and root length increase (mm). In the traditional CBCT analysis technique B, analyses were conducted using the In-Vivo software to calculate TD thickness (mm), radiodensity (HU%), and root length increase (mm). Paired t-test and the intraclass correlation coefficient were calculated to compare and assess the reliability of all techniques. RESULTS: No significant difference between the two techniques existed in the measurement of TD mineral density (Mean [SD]:A = 22.4 [15.4]; B = 24.4 [15.4]; p = .47). Technique A resulted in significantly higher root length increase values (Mean [SD]: A = 1.3 [0.6]; B = 1.1 [0.5]; p = .03). The two techniques showed acceptable reliability levels (0.76-0.99). CONCLUSION: CBCT analysis techniques yielded similar findings for mineral density. The new CBCT volumetric analysis technique, although more laborious, produced higher values for root length increase, and allowed for measurement of dentin volume.

Orthodontic movement after regenerative endodontic procedure in mature permanent tooth associated with dens invaginatus: a case report with 4-year follow-up.

BACKGROUND: Regenerative endodontic procedures (REPs) are innovative treatments aimed at restoring damaged dental structures. However, the effect of orthodontic movement on REP-treated teeth is not well understood and may have significant long-term consequences. This study aimed to evaluate the impact of orthodontic movement on a mature permanent tooth associated with dens invaginatus that has undergone a regenerative endodontic procedure (REP). CASE PRESENTATION: This report describes the case of a 13-year-old healthy male who presented with pulp necrosis and a chronic apical abscess (tooth number 2.2). Following REP according to the American Association of Endodontists' guidelines, the patient began non-extraction orthodontic treatment with fixed appliances after a 9-month healing period, which lasted 17 months in the upper arch. Subsequent follow-ups at 24, 36 and 48 months post-REP revealed an asymptomatic state with minimal cervical discoloration and diminished cold sensitivity. Radiographic analyses revealed periapical healing, mild apical remodeling on tooth 2.2, and moderate apical remodeling on other maxillary incisors. The treated tooth displayed a positive response to both REP and orthodontic treatment, yet further research is required to determine the long-term effects of orthodontics on REP-treated teeth. CONCLUSION: Orthodontic movement following REPs in mature permanent teeth is feasible and do not seem to prone teeth to orthodontic tooth resorption. Our experience indicates that a 9-month healing period allows successful orthodontic outcomes following REPs. Nonetheless, the predictability of outcomes and the ideal healing period before orthodontic movement is initiated remain to be established.

Outcome assessment methods of bioactive and biodegradable materials as pulpotomy agents in primary and permanent teeth: a scoping review.

BACKGROUND: Pulpotomy procedures aiming to preserve and regenerate the dentin-pulp complex have recently increased exponentially due to developments in the field of biomaterials and tissue engineering in primary and permanent teeth. Although the number of studies in this domain has increased, there is still scarcity of evidence in the current literature. OBJECTIVES: (1) Report the methods of outcome assessment of pulpotomy clinical trials in both primary and permanent teeth; (2) Identify the various bioactive agents and biodegradable scaffolds used in pulpotomy clinical trials in both primary and permanent teeth. MATERIALS AND METHODS: A scoping review of the literature was performed, including a search of primary studies on PubMed, Scopus, Web of Science, ProQuest and Clinicaltrials.gov. A search for controlled trials or randomized controlled trials published between 2012 and 2023 involving primary or permanent teeth receiving partial or full pulpotomy procedures using bioactive/regenerative capping materials was performed. RESULTS: 127 studies out of 1038 articles fulfilled all the inclusion criteria and were included in the current scoping review. More than 90% of the studies assessed clinical and radiographic outcomes. Histological, microbiological, or inflammatory outcomes were measured in only 9.4% of all included studies. Majority of the studies (67.7%) involved primary teeth. 119 studies used non-degradable bioactive cements, while biodegradable scaffolds were used by 32 studies, natural derivates and plant extracts studies were used in only 7 studies. Between 2012 (4 studies) and 2023 (11 studies), there was a general increase in the number of articles published. India, Egypt, Turkey, and Iran were found to have the highest total number of articles published (28, 28,16 and 10 respectively). CONCLUSIONS: Pulpotomy studies in both primary and permanent teeth relied mainly on subjective clinical and radiographic outcome assessment methods and seldom analyzed pulpal inflammatory status objectively. The use of biodegradable scaffolds for pulpotomy treatments has been increasing with an apparent global distribution of most of these studies in low- to middle-income countries. However, the development of a set of predictable outcome measures as well as long-term evidence from well conducted clinical trials for novel pulpotomy dressing materials are still required.

[Efficacy and radiology evaluation of pulpotomy in mature permanent teeth].

OBJECTIVE: To observe the clinical efficacy of pulpotomy in patients of different ages and to explore the occurrence and characteristics of pulpal calcification. METHODS: A total of 77 patients who underwent pulpotomy for mature permanent premolars and molars with caries-derived pulp exposure in the Department of General Dentistry, Peking University School and Hospital of Stomatology from October 2019 to August 2022 were selected. Pulpotomies were performed in a single visit using iRoot BP Plus bioceramic material as pulp capping agent. The patients were divided into three groups according to age: 25 cases in the adolescent group (11-20 years old) with a mean age of (15.88±2.19) years; 27 cases in the middle-aged group (21-50 years old) with a mean age of (34.59±8.67) years; and 25 cases in the elder-aged group (51-83 years old) with a mean age of (63.84±7.40) years. The patients were reviewed 1 year after the operation to evaluate the clinical efficacy and to record the formation of calcified bridge, thickness of calcified bridge, and pulp calcification index (PCI). RESULTS: There was no statistically significant difference between the three groups in terms of gender, dentition, and tooth position (P > 0.05). The 1-year postoperative follow-up rate was 85.71% (66/77), including 88.00% (22/25) in the adolescent group, 85.19% (23/27) in the middle-aged group, and 84.00% (21/25) in the elder-aged group. The 1-year follow-up clinical success rates of the three groups were 95.45% (21/22), 91.30% (21/23), and 95.24% (20/21), respectively, with no statistically significant difference (P>0.05). Among the clinical success cases, calcified bridges appeared in 12 cases (57.14%, 12/21) in the adolescent group, 8 cases (38.10%, 8/21) in the middle-aged group, and 3 cases (15.00%, 3/20) in the elder-aged group, with statistically significant differences (χ2= 7.810, P = 0.020 < 0.05). The difference was statistically significant (F = 4.434, P = 0.020 < 0.05) when comparing the thickness of calcified bridges among the three groups. Calcified bridge thickness was negatively correlated with age (r = -0.516, P < 0.05). The changes in pulpal calcification index ΔPCI were 0.67 ± 0.58, 0.43 ± 0.51, and 0.25 ± 0.52, respectively, with statistically significant differences among the three groups (F = 3.404, P = 0.040 < 0.05). CONCLUSION: Pulpotomy for caries-derived pulp exposure in elderly patients could also achieve a high success rate. The incidence of calcified bri-dges after pulpotomy and the acceleration of pulpal calcification were age-related. The adolescent group was more likely to form calcified bridges and also showed more pronounced accelerated root canal calcification.

[Application of bioactive ceramics iRoot BP Plus® in pulpotomy for complicated crown fracture of immature permanent anterior teeth in children].

OBJECTIVE: To analyze the clinical and radiographic effectiveness of a calcium silicate-based bioactive ceramic iRoot BP Plus® pulpotomy of immature permanent teeth with complicated crown fracture and to evaluate the factors influencing its long-term success rate. METHODS: The digital medical records of patients under 13 years old who had undergone iRoot BP Plus® pulpotomy in the Department of Oral Emergency or the First Clinical Division, Peking University School and Hospital of Stomatology from March 2017 to September 2022 due to complicated crown fracture of anterior teeth, and had taken at least one post-operation apical radiograph were reviewed. The clinical and radiographic information at the initial examination and follow-up period were obtained, including crown color, mobility, percussion, cold test (partial pulpotomy teeth), dental restoration, fistula, swelling or inflammation of the gingival tissue, the formation of apical foramen, pathologic radiolucency and calcification of pulp chamber or root canal obliteration. Data were tested by Fisher exact test and a multiple comparison. RESULTS: In the study, 64 patients including 37 males (57.8%) and 27 females (42.2%) with a mean age of 9.1 years : ere finally enrolled. The total number of permanent teeth that received pulpotomy was 75, and the average follow-up time was 19.3 months. The success rate was 93.1% with the time interval between dental injury and treatment in 24 h, while the success rate dropped to 88.2% with the time intervals beyond 24 h. The time intervals did not significantly affect the pulp survival rate (P=0.61) after pulpotomy (partial or coronal). The success rate 6 months after pulpotomy was 96. 0%, and one-year success rate was 94. 7%. A total of 23 cases were reviewed for more than 2 years after pulpotomy, and 6 cases failed. The mobility had no significant effect on the success rate (P=0.28). Pulp chamber calcification and pulp canal obli-teration were not observed in all the post-operative radiographs. CONCLUSION: The one year clinical and radiographic success rates obtained in this study indicate that iRoot BP Plus® is an appropriate pulp capping material option for pulpotomy treatment of complicated crown fracture in immature permanent teeth without displacement injuries. This technique has broad promotional value.

The effect of the use of the deproteinization agent hypochlorous acid and two different pit and fissure sealant self-adhesive flowable composites upon its bonding with the enamel.

This study evaluates the effect of the deproteinization agents hypochlorous acid and sodium hypochlorite upon the bonding of the two different pit and fissure sealant, self-adhesive flowable composites with the enamel. Thirty-six third molars were randomly divided into six different groups. The groups were formed as follows: Group 1: 37% phosphoric acid + VertiseTM Flow; Group 2: 200 ppm hypochlorous acid + 37% phosphoric acid VertiseTM Flow; Group 3: 5.25% sodium hypochlorite + 37% phosphoric acid + VertiseTM Flow; Group 4: 37% phosphoric acid + Constic; Group 5: 200 ppm hypochlorous acid + 37% phosphoric acid + Constic; Group 6: 5.25% sodium hypochlorite + 37% phosphoric acid + Constic. In each group, samples were obtained that were rectangular prisms in shape (n = 12). Groups to which a deproteinization agent was applied (Groups 2, 3 and 5, 6) showed statistically higher microtensile bonding strength than Group 1, Group 4. There was no statistically significant difference in terms of microtensile bonding strength values between the Groups 3 and the Group 6. The study found that the groups to which deproteinization agents were applied had statistically higher microtensile bonding strength values compared with those groups to which acid and fissure sealants were applied. In this study, it was concluded that the use of fissure-sealing self-adhesive flowable composites after acid application to permanent tooth enamel provides an acceptable bond strength given the limitations of in vitro studies. In line with the results obtained, it was observed that in addition to the removal of the inorganic structure with the application of acid, the removal of the organic structure with the use of deproteinization agent increased the bond strength to the enamel.

Analysis of indicators of caries of permanent teeth in children according to the endemic features of the Poltava region, Ukraine.

OBJECTIVE: Aim: This research is focused at analyzing the indicators and substantiating the peculiarities of caries prevention in permanent teeth in schoolchildren of Poltava region, taking into account the endemic features of the Poltava region. PATIENTS AND METHODS: Materials and Methods: A comparative study was conducted among 608 pupils of secondary schools in Kremenchuk, who consumed drinking water with fluoride concentrations in the lower limits of the norm, and 1214 pupils of secondary schools in Poltava, who consumed drinking water with fluoride concentrations in the optimal upper limits of the norm. RESULTS: Results: The rates of caries in permanent teeth in children living in a region with fluoride concentrations in drinking water in the optimal-upper normal range are several times lower than in children of the same age living in a region with fluoride concentrations in drinking water in the lower normal range, and a significant increase in the prevalence and intensity of caries is observed from 7 to 9 to 12 years of age, as teeth after eruption are most vulnerable to caries. In a region where the fluoride concentration in drinking water is in the optimal-upper range of the norm, children with early forms of fluorosis have the lowest prevalence and intensity of caries. CONCLUSION: Conclusions: Endemic features of the region directly affect the prevalence and intensity of the caries process. In regions with a fluoride concentration in drinking water within the optimal upper limits of the norm, prevention of caries in permanent teeth in children should be carried out taking into account the presence of fluorosis.

Secondary Caries Detection and Treatment Decision according to Two Criteria and the Impact of a Three-Dimensional Intraoral Scanner on Gap Evaluation.

This study aimed to evaluate the in vitro performance in detecting caries around composite restorations in permanent posterior teeth and the impact of treatment decisions of two visual criteria: International Dental Federation (FDI) criteria and the Caries Associated with Restorations and Sealants (CARS) system. The correlation among secondary caries and the presence of gap measured with a three-dimensional (3D) intraoral scanner was also aimed. One hundred sixteen teeth were assessed by a trained and calibrated examiner according to the FDI criteria or CARS system. A second examiner measured the gap on the 3D models using specific software. The reference standard was the histological examination performed by a third examiner blind to the other evaluations. Other 30 extracted permanent teeth were used only to assess the reproducibility of the methods. The same random sample was selected for re-examination by all three methods, and there were 7 days between the examinations. Unweighted and weighted kappa tests were conducted to assess intra-examiner reproducibility. Spearman's correlation coefficient (Rho) and 95% confidence intervals (95% CI) were calculated between the histological examination and scores obtained with FDI criteria, CARS system, and treatment decisions. Spearman's correlation between the visual and scanner evaluation with the reference standard was performed. Spearman's rank correlation analyses were conducted independently between the gap evaluated and measured by the visual inspection with the gap assessed using the scanner. The reproducibility of the visual score systems reached high values. Spearman's correlation coefficients (Rho; 95% CI) between the following variables versus histology were the FDI presence of caries (0.65; 0.53-0.74); CARS scores (0.65; 0.52-0.74); FDI treatment decision (0.46; 0.31-0.59); and CARS treatment decision (0.62; 0.49-0.72). Rho (95% CI) between histology and the gap assessment by the visual inspection was 0.59 (0.45-0.70), the gap measurement by the visual inspection was 0.49 (0.33-0.62), and the gap measured by the scanner was 0.37 (0.18-0.53). Both visual criteria present similar performance in detecting caries. The correlation among treatment decisions is moderate for the FDI and CARS criteria, and both are moderately correlated with lesion depth, with a slight CARS superiority. However, visual examination presents better performance than the 3D intraoral scanner on gap size assessment.

Success rate of permanent teeth pulpotomy using bioactive materials: A systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: The results of vital pulp treatments in permanent teeth have been encouraging. Currently, pulpotomy treatment for permanent teeth primarily utilizes mineral trioxide aggregate (MTA) as the dressing material, followed by calcium hydroxide. While other calcium-silicate-based cements have been suggested for pulpotomy, there is a limited number of studies evaluating their long-term effectiveness. OBJECTIVES: The objective of this systematic review and meta-analysis was to evaluate the success rate of pulpotomies performed on permanent teeth, comparing the use of ProRoot MTA with that of calcium hydroxide and other bioceramic materials. METHODS: A comprehensive search was conducted in several electronic databases, including PubMed, Cochrane Library, Scopus, Web of Science, Embase and Science Direct until December 2022. The search was guided by PICOS criteria, including only randomized clinical trials (RCTs) that evaluated the success rate of pulpotomy treatments in permanent teeth using ProRoot MTA in comparison to calcium hydroxide and other bioceramic materials. The quality of the included studies was assessed using the RoB-2 tool to evaluate the risk of bias, and relevant data were extracted and analysed in RevMan software 5.3 using fixed-effect models. The GRADE tool was used to determine the overall quality of evidence. RESULTS: The initial search retrieved 1072 studies and, after eliminating duplicates, 677 studies were screened and 28 studies were considered for eligibility. In the final selection process, 16 studies were included in the systematic review, with 10 being determined as having a high risk of bias. Pulpotomy showed an overall mean success rate of 92% after 1 year. The meta-analysis indicated a significantly higher success rate for pulpotomies utilizing MTA in comparison with calcium hydroxide, while no significant difference was seen between MTA and calcium-enriched mixture (CEM) or Biodentine. The GRADE assessment revealed an overall low level of evidence for the included studies. DISCUSSION: Most randomized controlled trials exhibited a significant absence of control over confounding factors. CONCLUSIONS: This systematic review and meta-analysis demonstrate that pulpotomy is a highly effective treatment for managing permanent teeth. The results indicate that the success rate of pulpotomy using ProRoot MTA is significantly higher than when using calcium hydroxide. However, the certainty of evidence supporting these findings is low, and there is a need for well-designed RCTs to assess the long-term outcomes of pulpotomy using newer bioceramic materials. REGISTRATION: This systematic review was registered in the PROSPERO database (registration number CRD42023393970).

Treatment outcomes of regenerative endodontic procedures in nonvital mature permanent teeth: a retrospective study.

OBJECTIVES: This retrospective study was undertaken to clinically and radiographically evaluate the long-term outcomes of regenerative endodontic procedures (REPs) for nonvital mature permanent teeth, to analyze predictors influencing treatment outcomes. METHODS: Nonvital mature permanent teeth treated by REPs with a minimum follow-up period of 6 months were included from 2015 to 2017. Treatment outcomes were categorized as success and failure. The periapical status and lesion healing were assessed in terms of the periapical index (PAI) and the percentage changes in periapical radiolucency (PARL) area. The clinical and radiographic outcomes of REPs were assessed by Mann-Whitney test at different follow-up period. Kaplan-Meier curves and Univariate Cox regression analysis were conducted to assess the success and identify potential predictors affecting outcomes, respectively. RESULTS: A total of 37 mature teeth with an average follow-up of 4.3 years satisfied the criteria, and 89.2% of the teeth had a successful outcome. Significant differences in PAI scores were found between each period with respect to the baseline (p < .05). Among different periods, there was a significant difference between intervals of 3-6 months and 7-12 months (p = .039) and no significant difference between each interval of more than 12 months (p > .05). Eighty-seven percent of teeth with preoperative PARL presented completely healed. REPs significantly decreased the PARL area at the interval of 7-12 months compared to 3-6 months (p = .025), with no significant difference between each interval of more than 12 months (p > .05). No significant predictor was found for the success of outcome (p > .05). Thirteen teeth (35.1%) regained pulp sensibility, and 40.5% of the teeth exhibited intracanal calcification. CONCLUSIONS: Within the limitations of this study, REPs provided a high long-term success rate and promoted the resolution of PARL as a biologically-based alternative treatment option for nonvital mature teeth. CLINICAL RELEVANCE: REPs provide a high long-term success rate and promoted healing of apical periodontitis comparable with reported outcomes for root canal therapy of mature teeth.

Multivariate prognostic analysis of direct pulp capping using a bioceramic material in mature permanent teeth with carious pulp exposure: a retrospective cohort study.

OBJECTIVES: On the basis of a large sample size and a long follow-up period, the objectives of this study were to evaluate the outcomes of direct pulp capping (DPC) in mature permanent teeth with carious pulp exposure using a kind of bioaggregate putty (BP) which commercially named iRoot BP Plus (Innovative Bioceramix, Inc., Vancouver, Canada) and to analyze the potential prognostic factors. MATERIALS AND METHODS: The design of this research was retrospective regarding treatment procedures and prospective regarding the assessment of outcomes. The preoperative diagnosis of the teeth was either normal pulp or reversible pulpitis. Results were assessed based on clinical and radiographic examinations with at least 12 months of follow-up after DPC. No symptoms or signs, a positive response to electric pulp testing, a normal response to cold pulp testing and radiographs showing no abnormalities were considered to indicate success. Kaplan-Meier survival analysis was used to calculate the cumulative survival of teeth after DPC. Univariate and multivariate Cox proportional hazard regressions were used to analyze potential prognostic factors. RESULTS: Three hundred thirty-four patients, including a total of 354 teeth, were available for the final clinical examination. The follow-up period ranged from 12 to 85 months, with an average of 27.0 ± 0.8 months. The total success rate was 85% (302/354), and the cumulative survival rates at 1, 2, 3, 4, and 5 years were 92%, 87%, 83%, 76%, and 72%, respectively. Univariate analysis indicated a significantly increased risk of failure in patients aged above 40 years and those treated by resident operators (P ≤ 0.01), with hazard ratios of 2.18 and 2.27, respectively. CONCLUSIONS: Under appropriate indication selection and treatment procedures, long-term success is possible in mature permanent teeth with carious pulp exposure by DPC using iRoot BP Plus. Patient age and operator experience are potential prognostic factors. CLINICAL RELEVANCE: Clinical data on iRoot BP Plus as a pulp capping medicament in mature permanent teeth with carious pulp exposure is lacking. This study indicated the efficacy of BP in DPC. Younger patient and sophisticated operator are beneficial for the outcome of DPC.

Evaluation of the characteristics of root canal calcification after regenerative endodontic procedures: A retrospective cohort study over 3 years.

AIM: This study aimed to evaluate the characteristics of root canal calcification after regenerative endodontic procedures (REPs) during long-term follow-up. DESIGN: Data of children who underwent REPs and were followed up for >3 years in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China, from January 2013 to January 2019, were collected. All the patients were treated by the protocol of REPs based on the American Association of Endodontists (AAE) protocol. A total of 91 teeth of 54 boys and 37 girls (average age 10.4 ± 1.9 years) with follow-up duration >3 years were included. The follow-up duration ranged from 36 to 92 months (average, 53.2 ± 13.4 months). The prevalence, contributing factors, and long-term prognoses of root canal calcification after REPs are discussed. Independent t-test and χ2 test were used for statistical analysis. RESULTS: The incidence of root canal calcification was 78% (71/91). The use of calcium hydroxide paste was significantly correlated with the occurrence of root canal calcification (p < .05). Some teeth showed aggravation of calcification with time; however, not all teeth showed calcification after longer follow-up duration. CONCLUSIONS: Teeth treated with REPs had a relatively high probability of root canal calcification detection during the long-term follow-up. The occurrence of calcification is related to the use of calcium hydroxide paste but does not affect the long-term prognosis of teeth.

Effectiveness of applying proximal enamel caries with fluoride-releasing sealant and fluoride varnish on caries progression in permanent teeth: A 12-month split-mouth randomized clinical trial.

BACKGROUND: Few studies report on managing initial proximal caries with sealants, and no reports focus on fluoride-releasing sealants. AIM: To compare the effectiveness between applications of a fluoride-releasing sealant and fluoride varnish on proximal enamel caries to control caries progression in permanent teeth. DESIGN: This was a split-mouth randomized controlled trial in forty-four 11- to 16-year-old children with radiographic caries in at least one contralateral pair of teeth with proximal enamel caries. The lesions were evaluated using DIAGNOdent and were also assessed visually after tooth separation. The lesions in each subject were randomly sealed with a fluoride-releasing sealant (Helioseal® F) or applied with fluoride varnish (Duraphat®). The fluoride varnish-treated lesion was reapplied at 3 and 6 months. Clinical examination, bitewing radiograph evaluation, and DIAGNOdent assessment were performed at 6 and 12 months. The caries progression outcome variables were regression, no change, and progression. The data were analyzed with the McNemar-Bowker test. RESULTS: Radiographic examination and DIAGNOdent assessment demonstrated no significant differences in the percentages of regression, no change, or progression at the 12-month follow-up (p > .05). CONCLUSION: Applications of a fluoride-releasing sealant and of fluoride varnish three times resulted in a nonsignificant difference in caries progression of initial proximal caries at the 12-month follow-up.

Treatment outcomes of immature permanent necrotic evaginated teeth: A retrospective study comparing regenerative endodontic procedures with apexification.

BACKGROUND: Few studies have compared the outcomes of regenerative endodontic procedures (REPs) and calcium hydroxide apexification focusing on necrotic teeth with dens evaginatus. AIM: To qualitatively and quantitatively compare the treatment outcomes of REPs and calcium hydroxide apexification in teeth with dens evaginatus. DESIGN: Immature permanent necrotic evaginated teeth treated with REPs or calcium hydroxide apexification for a follow-up period of at least 12 months were included. Tooth success and survival rates were analyzed. Changes in radiographic root length, apical diameter, and radiographic root area (RRA) were quantified. Prognostic factors that might influence RRA were identified via multivariate linear regression analysis. RESULTS: A total of 112 teeth (50 REP cases and 62 apexification cases) with a median follow-up period of 26.5 months were included. Regenerative endodontic procedures and calcium hydroxide apexification exhibited similar satisfactory success and survival rates (p > .05). Additionally, 88 teeth were quantitatively analyzed. The REP group presented a significantly greater percentage increase in RRA and less decrease in apical diameter than the calcium hydroxide apexification group (p < .05). Teeth treated with REPs and with Stages 7 and 8 of root development showed a better gain in RRA (p < .05). CONCLUSION: While REP and calcium hydroxide apexification had similar success and survival rates, teeth with REPs showed an increase in RRA, indicating that REP is the preferred choice.

[X-ray evaluation of pulp calcification in adult permanent teeth after pulpotomy].

OBJECTIVE: To compare the clinical effects of pulpotomy with two kinds of calcium silicate materials, and to evaluate the formation of dentin bridge and pulp calcification after pulpotomy of adult permanent teeth. METHODS: Patients who visited the General Department of Peking University School and Hospital of Stomatology from November 2017 to September 2019 and planned for pulpotomy on permanent premolars and molars with carious exposed pulp were selected. They were randomly divided into two groups. Bioceramic putty material iRoot BP (iRoot group, n=22) and mineral trioxide aggregate MTA (MTA group, n=21) were used as pulp capping agents, respectively. The patients were recalled after one year and two years. The clinical efficacy, dentin bridge index (DBI) and pulp calcification index (PCI) were recorded. Blinding method was used for the patients and evaluators. RESULTS: There was no significant difference in gender, mean age, dentition and tooth position between the two groups (P>0.05). Seven cases were lost during the first year (4 cases in iRoot group and 3 cases in MTA group). In the iRoot group, 1 case had transient sensitivity at the time of 1-year follow-up. The cure rate of the two groups was 100% at the time of 2-year follow-up. The proportion of dentin bridge formation was 38.9% one year after operation, 55.6% two years after operation. The proportion of partial or even complete disappearance of root canal image was 5.6% before operation, 38.9% and 55.6% one and two years after operation, respectively. The difference was statistically significant by rank sum test (P < 0.05). There was no significant difference in dentin bridge formation and pulp calcification between the two groups (P < 0.05). DBI and PCI after operation was as the same as those before operation (44.4% cases of DBI and 25% cases of PCI) or gradually increased (55.6% cases of DBI and 75% cases of PCI). Spearman's nonparametric correlation analysis showed that age was positively correlated with preoperative pulp calcification index (PCI0, P < 0.05), but not with the dentin bridge index (DBI1, DBI2), pulp calcification index (PCI1, PCI2) and the degree of change (DBI2 vs. DBI1, PCI1 vs. PCI0, PCI2 vs. PCI0) 1-year and 2-year after operation (P>0.05). CONCLUSION: According to this study, good clinical effects were obtained within 2-year after pulpotomy of adult permanent teeth with MTA and iRoot. In some cases, the root canal system had a tendency of calcification aggravation, and there was no statistical difference in the development of this trend between the two groups.

Postmortem computed tomography assessment of skeletal and dental age in Polish children, adolescents, and young adults.

This paper presents a retrospective analysis of postmortem computed tomography (PMCT) scans of secondary ossification centers in the medial clavicular epiphysis, iliac crest apophysis, proximal humeral epiphysis, distal femoral epiphysis, proximal tibial epiphysis, and distal tibial epiphysis. At the same time, we analyzed PMCT scans of the maxillary and mandibular incisors, canines, premolars, and molars. We assessed 203 corpses, whose age ranged from 2 to 30 years, including 156 males and 47 females. The purpose of our study was to compare the processes of secondary ossification center fusion and permanent tooth maturation. Our research hypothesis was that certain stages of skeletal and dental maturation occur along consistent timelines that can be related to the chronological age. Secondary ossification center fusion was evaluated based on Kreitner and also McKern and Steward's classifications. The process of permanent tooth maturation was evaluated with Demirjian's method. Spearman's correlation coefficients (Rho) were positive in all analyses, which indicates that epiphyseal fusion progresses with age. The strongest relationship between the age and the stages of ossification was observed in the proximal tibial epiphysis (p < 0.001; Rho = 0.93) in females and in the medial clavicular epiphysis (p < 0.001; Rho = 0.77) in males. Studies show the importance of concomitant analysis of skeletal and dental maturation with a subsequent comparison of the results to achieve a greater precision in age estimation. A comparison of the results obtained in the study population of Polish children, adolescents, and young adults with the results of other studies in populations of similar ages showed a number of similarities in the time windows of dental and skeletal maturation. These similarities may help in age estimation.

Relationship between time to hemostasis and outcomes of pulpotomy using iRoot BP Plus in symptomatic young permanent teeth: a prospective study.

The aim was to investigate the relationship between time to hemostasis and pulpotomy outcomes with the use of iRoot BP Plus (Innovative Bioceramics, Vancouver, Canada) for young permanent teeth of patients aged from 7 to 12 with symptomatic irreversible pulpitis and evaluate the outcomes of pulpotomy. The present study was a prospective cohort study. Two hundred and six young permanent teeth with symptomatic irreversible pulpitis underwent pulpotomy with the use of iRoot BP Plus. All patients underwent pulpotomy in accordance with a standardized protocol. Patients were postoperatively re-called after 3, 6, 12 months. Successful cases were defined according to clinical and radiographic evaluations. Main outcome measures included tooth position, cave shape, previous restoration, preoperative symptoms, time to hemostasis and outcomes. On the basis of univariate linear regression model, the relationships between time to hemostasis was evaluated, and p < 0.05 indicated a difference that achieved statistical significance. One hundred and ninety-three teeth can be evaluated after a follow-up for 6 to 36 months. The mean age of subjects was 9.43 ± 1.51 years. The overall clinical and radiographic success rate of pulpotomy reached 71.5% (138/193). After adjusting potential confounders (age, sex, previous restoration), non-linear relationship was detected between time to hemostasis and pulpotomy outcomes whose point was 4 minutes. The relationship between time to hemostasis and pulpotomy outcomes is non-linear. Pulpotomy outcomes was negatively related with time to hemostasis when time to hemostasis is more than 4 minutes.

Vital pulp therapy following pulpotomy in immature permanent teeth with carious exposure.

This prospective cohort study aimed to evaluate the clinical outcomes of vital pulp therapy (VPT) with the use of iRoot BP Plus (Innovative Bioceramics, Vancouver, Canada) for immature permanent teeth of patients aged from 6 to 10 years with pulp exposure resulting from dental caries and determine the impact of preoperative factors on VPT. Forty-six immature permanent teeth with dental caries underwent pulpotomy using iRoot BP Plus following a standardized protocol. Postoperative follow-ups were conducted on the first 3, 6 and 12 months post-surgery, then annually afterward. Successful treatment outcomes were defined based on clinical and radiographic evaluations. Statistical analysis was performed using the Fisher exact test, with p < 0.05 considered for statistical significance. Forty-four patients included in this study were 8.48 ± 1.49 years old and were followed up for 6 to 36 months. The overall success rate of pulpotomy was found to be 90.9% (40/44). None of the physical examination findings and symptoms significantly affected VPT prognosis (p > 0.05). Immature permanent teeth with caries-induced pulp exposed in patients aged 6 to 10 years can be effectively treated with pulpotomy using iRoot sBP Plus.