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Mareque-Bueno MS, Nagendrababu V, Dummer PMH, Ruíz-Piñón M, Arias-Moliz T, Uroz-Torres D, Garrido-Parada S, Martín-Biedma B, Castelo-Baz P. A retrospective clinical study to compare the ability of cone-beam computed tomographic images and periapical radiographs to reveal cracked teeth, split teeth, and teeth with vertical root fractures. J Am Dent Assoc 2024:S0002-8177(24)00212-5. [PMID: 38795077 DOI: 10.1016/j.adaj.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/03/2024] [Accepted: 04/15/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND This retrospective clinical study aimed to compare the sensitivity of cone-beam computed tomographic (CBCT) images and periapical (PA) radiographs to reveal cracked teeth, split teeth, and teeth with vertical root fractures (VRFs). METHODS The authors included 98 patients (98 teeth) diagnosed with a longitudinal tooth fracture (LTF) (cracked tooth, split tooth, VRF) through direct visualization after extraction and with comprehensive clinical and radiographic records. They collected demographic, clinical, and radiographic data. The authors evaluated PA radiographs and CBCT images to identify fractures, fracture lines, and the different patterns of bone loss associated with these teeth. They used the McNemar test to compare PA radiographs and CBCT scans when assessing bone loss. They used the Fisher test to determine statistical relationships between fracture types and demographic, clinical, and radiologic traits. They used an analysis of variance test to compare patient age with fracture types. RESULTS CBCT images were significantly more effective (P < .05) in detecting bone loss patterns associated with LTFs than with PA radiographs, with 71% of cases detected via CBCT images compared with 42% via radiographs. Mean age was significantly greater (P < .05) in patients with teeth with VRFs than in patients with split teeth. A significant relationship was observed between the type of fracture and the following variables: root canal treatment (split, VRF, P = .002), deep probing depth (≥ 5 mm) (VRF, P = .026), and having more than 8 teeth extracted from the mouth (VRF, P = .032). Overall, there was a significant difference (P < .001) between the visualization of fracture lines (45% on PA radiographs, 65% on CBCT images). CONCLUSIONS CBCT scans provided more information on LTFs than PA radiographs, particularly in the identification of periradicular bone changes. PRACTICAL IMPLICATIONS CBCT imaging can assist in making the clinical diagnosis of LTFs through observation of bone loss patterns, providing more information than PA radiographs.
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Ek B, Zweig S, Roges RG, Berdan Y, Roges RA, Abulhamael A, Kutbi A, Alqutub AW, Alothmani OS, Siddiqui AY. Prevalence of Vertical Root Fractures in a University Endodontics Program versus a Private Endodontics Office. Int J Dent 2023; 2023:2098629. [PMID: 38149084 PMCID: PMC10751159 DOI: 10.1155/2023/2098629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/30/2023] [Accepted: 12/05/2023] [Indexed: 12/28/2023] Open
Abstract
Introduction Vertical root fractures (VRFs) typically have a poor prognosis with an extraction or occasionally root amputation as the preferred treatment. VRFs have been considered an epidemic, motivating changes in the access openings, as well as in the preparation and disinfection protocols of endodontic treatment. Hence, we aimed to evaluate the prevalence of VRFs by tracking cases in both a University Endodontic Program (UEP) and a private endodontics practice (PP). We also evaluated changes in prevalence during COVID-19 along with the alterations in the frequency of cases diagnosed by clinical and radiographic signs which were later confirmed by direct visualization compared to those in which the suspicion was based on clinical and radiographic signs alone. Methods and Materials This retrospective study looked at the prevalence of VRF in patient records at UEP and a PP. Data for the pre-COVID-19 and COVID-19 time periods were extracted from patient records and referral letters then compared. Data for suspected and confirmed prevalence were compared. Results The UEP group included 21,156 patients while the PP group comprised 7,209 patients. The prevalence of VRFs in the former cohort was 1.80%, while 2.62% of the latter cohort exhibited VRFs with a combined total of 2.01%. The combined total prevalence of VRFs pre-COVID-19 was 1.72%, increasing from 2.1% to 3.82% during COVID-19 (p < 0.0001). The same applied to suspected cases for both clinical settings. The increase in confirmed cases between the two periods was statistically significant for the UEP group (p=0.0202) but it was insignificant for the PP group (p=0.0721). Conclusion The combined prevalence for VRFs was 2.01% for all years denying the claim that VRF is a pandemic phenomenon. COVID-19 period saw almost a double increase in the prevalence of VRF compared to pre-COVID-19 era. This was consequently associated with a significant increase in the number of suspected VRF cases.
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Affiliation(s)
- Berit Ek
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Stefan Zweig
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Ramon G. Roges
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Yaara Berdan
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Rafael A. Roges
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Ayman Abulhamael
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abrar Kutbi
- University Dental Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Alaa W. Alqutub
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Osama S. Alothmani
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amna Y. Siddiqui
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Karumaran CS, Srinivasan MR, Ramachandran AK, Venkatesan R, Nirmala C, Sreelakshmi PS. A novel management of vertical root fracture in an endodontically treated mandibular premolar with titanium screw: A case report. Indian J Dent Res 2023; 34:344-347. [PMID: 38197362 DOI: 10.4103/ijdr.ijdr_104_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Introduction Vertical root fracture is one of the conditions prevalent in endodontically treated teeth. The treatment options include extraction of the fracture fragment or the affected tooth as a whole. This case report highlights the successful management of vertical root fracture in an endodontically treated mandibular first premolar. Method Surgical intervention was initiated, and a full-thickness flap was elevated. The separated fracture segment was safely retrieved, and the existing caries were removed and then reattached to the main fragment with the help of a titanium screw. The tooth was rehabilitated with a composite resin core followed by a porcelain-fused metal crown and the patient was followed up for 7 years. Result The tooth was functional with evidence of new bone formation. Conclusion Reattachment of the fracture fragments with a titanium screw might be considered as an option for managing vertical root fracture cases with poor prognosis.
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Affiliation(s)
| | - M R Srinivasan
- Department of Conservative Dentistry and Endodontics, Sri Venkateshwara Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Anil Kumar Ramachandran
- Department of Conservative Dentistry and Endodontics, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Remya Venkatesan
- Department of Conservative Dentistry, Maran Dental Clinic, Chennai, Tamil Nadu, India
| | - Chandrasekaran Nirmala
- Department of Conservative Dentistry and Endodontics, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
| | - P S Sreelakshmi
- Department of Conservative Dentistry, Maran Dental Clinic, Chennai, Tamil Nadu, India
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Haupt F, Wiegand A, Kanzow P. Risk factors for and clinical presentations indicative of vertical root fracture in endodontically treated teeth - a systematic review and meta-analysis. J Endod 2023:S0099-2399(23)00323-0. [PMID: 37307871 DOI: 10.1016/j.joen.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The aim of this study was to identify specific clinical signs or symptoms and potential risk factors which are most likely associated with the presence of a vertical root fracture (VRF) in endodontically treated teeth (ETT). METHODS Electronic databases (MEDLINE via PubMed, EMBASE via Ovid, Scopus, and Web of Science) were searched by two reviewers in October 2022 for clinical studies, in which at least either the clinical presentation or potential risk factors associated with a VRF were assessed. Risk of bias was assessed using the Newcastle-Ottawa scale. Meta-analyses of odds ratios (ORs) were performed separately for several signs or symptoms and risk factors. RESULTS Fourteen sources reporting on 2,875 teeth (489 with VRF and 2,388 without VRF) were included in the meta-analyses. Regarding the clinical presentation, the presence of sinus tracts (OR=4.87; 95%-CI: 1.58-15.0), increased periodontal probing depths (OR=13.24; 95%-CI: 5.44-32.22), swelling/abscess (OR=2.86; 95%-CI: 1.74-4.70), and tenderness to percussion (OR=1.74; 95% CI: 1.18-2.61) were significantly associated with the presence of a VRF (Padj. value<.05). None of the assessed risk factors (sex, type of teeth, tooth location, posts, indirect restoration, apical extension of the root canal filling), were found to be significantly associated with the presence of a VRF (Padj. value>.05). CONCLUSIONS Four clinical presentations were identified to be the most significant signs or symptoms for a VRF in ETT: presence of sinus tracts, increased probing depths, swelling/abscess, tenderness to percussion. None of the assessed risk factors pointed out to be significantly associated with a VRF. REGISTRATION CRD42022354108 (PROSPERO).
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Affiliation(s)
- Franziska Haupt
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Germany.
| | - Annette Wiegand
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Germany
| | - Philipp Kanzow
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Germany
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Groenke BR, Idiyatullin D, Gaalaas L, Petersen A, Law A, Barsness B, Royal M, Fok A, Nixdorf DR. Sensitivity and Specificity of MRI versus CBCT to Detect Vertical Root Fractures Using MicroCT as a Reference Standard. J Endod 2023; 49:703-709. [PMID: 36972896 PMCID: PMC10330038 DOI: 10.1016/j.joen.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Vertical root fracture (VRF) in root-canal-treated teeth frequently results in tooth loss, partly because VRFs are difficult to diagnose and when detected the fracture is often beyond the point of preservation with surgical intervention. Nonionizing magnetic resonance imaging (MRI) has demonstrated the ability to detect small VRFs, but it is unknown how its diagnostic capabilities compare with the current imaging standard for VRF detection, cone-beam computed tomography (CBCT). This investigation aimed to compare the sensitivity and specificity between MRI and CBCT for detecting VRF, using micro-computed tomography (microCT) as a reference. METHODS A total of 120 extracted human tooth roots were root canal treated using common techniques, and VRFs were mechanically induced in a proportion. Samples were imaged using MRI, CBCT, and microCT. Axial MRI and CBCT images were examined by 3 board-certified endodontists, who evaluated VRF status (yes/no) and gave a confidence assessment for that decision, from which a receiver operating characteristic curve was generated. Intra- and inter-rater reliability were calculated, sensitivity and specificity, and area under the curve. RESULTS Intra-rater reliability was 0.29-0.48 for MRI and 0.30-0.44 for CBCT. Inter-rater reliability for MRI was 0.37 and for CBCT 0.49. Sensitivity was 0.66 (95% confidence interval [CI], 0.53-0.78) and 0.58 (95% CI, 0.45-0.70), and specificity 0.72 (95% CI, 0.58-0.83) and 0.87 (95% CI, 0.75-0.95) for MRI and CBCT, respectively. Area under the curve was 0.74 (95% CI, 0.65-0.83) for MRI and 0.75 (95% CI, 0.66-0.84) for CBCT. CONCLUSIONS There was no significant difference in sensitivity or specificity between MRI and CBCT in detecting VRF, despite the early-stage development of MRI.
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Affiliation(s)
- Beth R Groenke
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, Minnesota.
| | | | - Laurence Gaalaas
- Department of Radiology, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
| | - Ashley Petersen
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Alan Law
- Private Practice, The Dental Specialists, Woodbury, Minnesota; Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
| | | | - Mathew Royal
- Private Practice, The Dental Specialists, Roseville, Minnesota
| | - Alex Fok
- Minnesota Dental Research Center for Biomaterials and Biomechanics, Minneapolis, Minnesota
| | - Donald R Nixdorf
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, Minnesota; Departments of Radiology & Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota
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Chen S, Arola D, Ricucci D, Bergeron BE, Branton JA, Gu LS, Tay FR. Biomechanical perspectives on dentine cracks and fractures: Implications in their clinical management. J Dent 2023; 130:104424. [PMID: 36657703 DOI: 10.1016/j.jdent.2023.104424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES The present review discussed the biomechanical properties of cracks and fractures in crown and root dentine and attempted to explain why cracked teeth and vertical root fractures are so frequent despite the existence of multiple crack toughening mechanisms in dentine. The implications of this knowledge were used to justify how these defects are managed clinically. DATA, SOURCES AND STUDY SELECTION Literature search was conducted on PubMed, Web of Science, and Scopus for a narrative review on fracture mechanics of crown and root dentine as well as the clinical management of cracked teeth and teeth with vertical root fracture. CONCLUSIONS Although dentine is tougher and less brittle than enamel, it's facture toughness is considerably lower than most ductile metals. Because the initiation toughness of dentine is very low, cracks initiate from incipient damage under low stress While crack toughening mechanisms exist that enable dentine to resist crack extension, these mechanisms are often inadequate for protecting dentine from crack propagation that ultimately leads to catastrophic failure. Additional factors such as ageing also reduces the resistance of dentine to crack growth. Because dentine cracks are eventually filled with bacteria biofilms upon exposure to oral fluids, they enable rapid bacteria ingress into the dental pulp via open dentinal tubules. To date, treatment options for cracked teeth are limited. While most teeth with vertical root fracture are recommended for extraction, new strategies have been reported that appeared to achieve short-term success in preserving these teeth. CLINICAL SIGNIFICANCE Current strategies for the management for dentine cracks and fractures are limited and their long-term effectiveness remain uncertain. Understanding the characteristics, toughening mechanism and weakening factors of tooth cracks is helpful in designing better treatment.
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Affiliation(s)
- Sishi Chen
- Hospital of Stomatology, Sun Yat-sen University & Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Dwayne Arola
- Department of Materials Science and Engineering, University of Washington, Seattle, WA USA
| | | | - Brian E Bergeron
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - John A Branton
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Li-Sha Gu
- Hospital of Stomatology, Sun Yat-sen University & Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, PR China.
| | - Franklin R Tay
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, GA, USA.
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Detecting Vertical Root Fractures Using Modified Methylene Blue Dye: A Preliminary In Vitro Study. Healthcare (Basel) 2023; 11:healthcare11040504. [PMID: 36833038 PMCID: PMC9957168 DOI: 10.3390/healthcare11040504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/11/2023] Open
Abstract
Diagnostically, vertical root fractures (VRFs) can be a frustrating experience for the dentist. Misdiagnosis could result in significant time and effort losses involved in erroneously intervening endodontically and/or periodontally. Certainly, diagnosing VRFs is often very difficult, and diagnoses based on speculations have led to the extraction of many salvageable teeth. This study was conducted in the radiology unit of College of Dentistry, Prince Sattam bin Abdulaziz University, between December 2021 and June 2022 to evaluate the ability to detect VRFs following the use of a novel radio-opaque dye using periapical radiographs (PARs) and cone-beam computed tomography (CBCT). After carefully inducing VRFs on extracted, single-rooted, virgin premolars (n = 26), they were assigned to control (n = 2) and experimental groups (n = 24). The fracture site of the tooth in the control group received methylene blue dye, whereas the experimental group received a novel dye. Two differently angled PARs were obtained for all the teeth, followed by a CBCT image. Three blinded investigators participated in scoring a Likert scale form with a set of questions. Inter-/intra-examiner reliability showed excellent consistency using Cronbach's alpha test. The Z-test revealed CBCT and PAR to be equally adept at detecting VRFs, with the mean values showing no statistically significant differences. The extent of the VRFs and dye penetration were significantly better when angled radiographs and axial view CBCT were evaluated. Within the limitations of this study, the dye tested showed promising initial results as an aid in radiographically detecting VRFs. The use of such minimally invasive methods is critically needed for diagnosing and managing VRFs. However, further testing should be performed prior to its clinical use.
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Dulundu M, Helvacioglu-Yigit D. The Efficiency of the BTR-Pen System in Removing Different Types of Broken Instruments from Root Canals and Its Effect on the Fracture Resistance of Roots. MATERIALS (BASEL, SWITZERLAND) 2022; 15:5816. [PMID: 36079199 PMCID: PMC9457077 DOI: 10.3390/ma15175816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
The study aimed to evaluate the efficiency of the BTR-Pen system in removing different types of instrument fragments from root canals and to assess its effect on fracture resistance of the roots after the removal of the instruments. One hundred thirty human teeth were divided into 10 groups (2 control groups and 8 study groups) according to the localization and type of the fractured fragment as well as the retrieval techniques. Broken instruments were extracted either with BTR-Pen system loops or removed using solely ultrasonic tips. The success rate of instrument removal and consumed time were recorded. All the teeth were subjected to a load at a 1 mm/min rate in a universal testing machine for mechanical testing. The success of removing broken instruments using the BTR-Pen and ultrasonic was 86.7% and 83.3%, respectively (p > 0.05). When the time is compared, the BTR-Pen system (23.97 ± 8.35 min) showed similar results to that of the ultrasonic technique (24.1 ± 8.28 min) (p > 0.05). The BTR-Pen group required less force to fracture than the ultrasonic group (p = 0.024). In conclusion, the BTR-Pen and ultrasonic groups showed no significant difference in terms of the success rate and removal time. The roots that underwent instrument removal using the BTR-Pen system had less fracture resistance.
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Affiliation(s)
- Merve Dulundu
- Faculty of Dentistry, Kocaeli University, Kocaeli 41190, Turkey
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Guo J, Wu Y, Chen L, Long S, Chen D, Ouyang H, Zhang C, Tang Y, Wang W. A perspective on the diagnosis of cracked tooth: imaging modalities evolve to AI-based analysis. Biomed Eng Online 2022; 21:36. [PMID: 35706023 PMCID: PMC9202175 DOI: 10.1186/s12938-022-01008-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
Despite numerous clinical trials and pre-clinical developments, the diagnosis of cracked tooth, especially in the early stages, remains a challenge. Cracked tooth syndrome is often accompanied by dramatic painful responses from occlusion and temperature stimulation, which has become one of the leading causes for tooth loss in adults. Current clinical diagnostical approaches for cracked tooth have been widely investigated based on X-rays, optical light, ultrasound wave, etc. Advances in artificial intelligence (AI) development have unlocked the possibility of detecting the crack in a more intellectual and automotive way. This may lead to the possibility of further enhancement of the diagnostic accuracy for cracked tooth disease. In this review, various medical imaging technologies for diagnosing cracked tooth are overviewed. In particular, the imaging modality, effect and the advantages of each diagnostic technique are discussed. What's more, AI-based crack detection and classification methods, especially the convolutional neural network (CNN)-based algorithms, including image classification (AlexNet), object detection (YOLO, Faster-RCNN), semantic segmentation (U-Net, Segnet) are comprehensively reviewed. Finally, the future perspectives and challenges in the diagnosis of the cracked tooth are lighted.
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Affiliation(s)
- Juncheng Guo
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Yuyan Wu
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Lizhi Chen
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Shangbin Long
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Daqi Chen
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Haibing Ouyang
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Chunliang Zhang
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Yadong Tang
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou, 510006, China
| | - Wenlong Wang
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China.
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Wan B, Chung BH, Zhang MR, Kim SA, Swain M, Peters OA, Krishnan U, Moule A. The effect of varying occlusal loading conditions on stress distribution in roots of sound and instrumented molar teeth. A finite element analysis. J Endod 2022; 48:893-901. [DOI: 10.1016/j.joen.2022.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
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Shenoy N, Shenoy A. Periodontal Manifestations in Vertical Root Fractured Teeth. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0041-1741416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractVertical root fractures are more commonly encountered following endodontic treatment and in teeth without endodontic treatment, with habits like bruxism and eating coarse, hard food. The teeth most predisposed to fracture are the premolars of the maxilla and mandible, the mesial roots and mesiobuccal roots of the mandibular molars, maxillary molars and the mandibular incisors. Timely identification of cracked teeth and fractures is the key since it permits a conservative and preventive approach. Delay in diagnosis and treatment will result in the involvement of the underlying periodontium, causing periodontal pockets, abscess formation, and bone loss, thereby further complicating the outcome. Appropriate diagnosis, education, and counseling of the patient by the dentist and coronal restoration following root canal treatment are mandatory to prevent the loss of teeth in patients. The prognosis of multirooted teeth is more favorable. Affected single-rooted teeth may, however, require immediate extraction. MEDLINE database and Scopus search (www.scopus.com) were performed using the key words “vertical root fracture” or “longitudinal root fracture.” Text book chapters were manually checked.
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Affiliation(s)
- Nina Shenoy
- Department of Periodontics, AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Arvind Shenoy
- Department of Conservative Dentistry and Endodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India
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12
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Liao WC, Chen CH, Pan YH, Chang MC, Jeng JH. Vertical Root Fracture in Non-Endodontically and Endodontically Treated Teeth: Current Understanding and Future Challenge. J Pers Med 2021; 11:jpm11121375. [PMID: 34945847 PMCID: PMC8707645 DOI: 10.3390/jpm11121375] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/22/2021] [Accepted: 10/25/2021] [Indexed: 12/12/2022] Open
Abstract
A vertical root fracture (VRF) is a complex complication that usually leads to tooth extraction. The aim of this article is to review the prevalence, demography, distribution, diagnostic methods, etiology and predisposing factors, clinical features, radiographic characteristics and treatment strategies of VRFs in non-endodontically treated teeth (VRFNETT) and endodontically treated teeth (VRFETT). Search terms for each subject related to VRFNETT and VRFETT were entered into MEDLINE, PubMed and Google Scholar. Systematic reviews, retrospective cohort studies, demographic research, clinical studies, case reports and case series were reviewed. Most of the VRFs were found in patients older than 40 years old. Older populations were discovered in the non-endodontically treated VRF group when compared to the endodontically treated VRF group. Male patients were found at a greater prevalence than females in the non-endodontically treated VRF group. The initial occurrence of a VRF may accompany radiolucent lines within the root canal, unusual space between the canal wall and intracanal material, a widening of the PDL space along the periradicular surfaces, angular bony destruction, step-like bone defects, V-shaped diffuse bone defects, or root resorptions corresponding to the fracture line before the clear separation of the fractured fragment. The indicative clinical and radiographic signs of VRF included a coronally positioned sinus tract, deep-narrow periodontal defects, the displacement of a fractured fragment, periradicular radiolucent halos and the widening of the root canal space. Interestingly, VRFNETT are more often observed in the Chinese population. Some patients with multiple VRFs were observed, suggesting possible predisposing factors in genetics and tooth development. The management of a VRF usually involves a multidisciplinary approach. The common distribution and features of VRFNETT and VRFETT were elucidated to facilitate recognition and diagnosis. Besides extraction, variable therapeutic schemes, such as the repair of the VRF, root amputation and others reported in earlier literature, are available. A long-term prognosis study of the various therapeutic strategies is needed.
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Affiliation(s)
- Wan-Chuen Liao
- School of Dentistry, College of Medicine, National Taiwan University, Taipei 100229, Taiwan; (W.-C.L.); (C.-H.C.)
- Department of Dentistry, National Taiwan University Hospital, Taipei 100229, Taiwan
| | - Chi-Hung Chen
- School of Dentistry, College of Medicine, National Taiwan University, Taipei 100229, Taiwan; (W.-C.L.); (C.-H.C.)
- Department of Dentistry, National Taiwan University Hospital, Taipei 100229, Taiwan
| | - Yu-Hwa Pan
- Department of Dentistry, Chang Gung Memorial Hospital, Taipei 105406, Taiwan;
| | - Mei-Chi Chang
- Department of Dentistry, Chang Gung Memorial Hospital, Taipei 105406, Taiwan;
- School of Nursing, Chang Gung University of Science and Technology, Taoyuan 333324, Taiwan
- Correspondence: (M.-C.C.); (J.-H.J.)
| | - Jiiang-Huei Jeng
- School of Dentistry, College of Medicine, National Taiwan University, Taipei 100229, Taiwan; (W.-C.L.); (C.-H.C.)
- Department of Dentistry, National Taiwan University Hospital, Taipei 100229, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan
- Correspondence: (M.-C.C.); (J.-H.J.)
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Malentacca A, Zaccheo F, Scialanca M, Fordellone F, Rupe C, Lajolo C. Repair of teeth with cracks in crowns and roots: An observational clinical study. Int Endod J 2021; 54:1738-1753. [PMID: 34291470 DOI: 10.1111/iej.13598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
AIM This retrospective observational study investigated the survival rate of teeth with radicular cracks that were restored using composite materials. METHODOLOGY The study was approved by the Ethical Committee of Sistema Sanitario Nazionale (prot. N°2370CELazio1), Clinicaltrials.gov identifier: NCT04430205. Between 1991 and 2019, 87 teeth with radicular cracks (87 patients [46 men, 41 women, mean age 50.2 years]) were treated with adhesive composite restorations. Forty-five cracks were observed in the maxillary posterior teeth (molars and premolars), 40 in the mandibular posterior teeth and only two cracks in the anterior teeth, both in maxilla. Based on the depth of the crack, teeth were categorized as proximal radicular cracked teeth (PRCT), in which the fracture line was restricted within the pulpal floor or the coronal one-third of the root and deep radicular cracked teeth (DRCT), in which the fracture line extended to the middle and apical thirds of the root canal up to the apex. Bone loss/recovery was evaluated radiographically at 1-year follow-up. All patients were treated using surgical microscopy by the same operator. Logistic regression analysis was performed to determine independent predictors of extraction. Kaplan-Meier survival curves were used to analyse PRCT and DRCT. RESULTS Among 87 cracked teeth, 66 were molars, 19 premolars and 2 incisors. Fifty-two were DRCT, 35 were PRCT, 46 had a periodontal probing defect. Patients were followed up for a mean of 66.9 months (standard deviation 44.6, min 1 to max 172). Lack of probing depth was a significant protective factor against extraction (odds ratio [OR] 0.027, 95% confidence interval [CI] 0.003-0.27, p < .05), whereas further bone loss (OR 10.63, 95% CI 2.08-54.36, p < .05) was a risk factor for extraction. More than 50% of teeth treated with the adhesive protocol were functional (46 of 87 teeth [χ2 test], p < .05) at 5-year follow-up. Among the PRCT group, a 78% survival rate at 5 years was found, while among the DRCT group, a 58% survival rate was found. CONCLUSION Composite resin restorations resulted in tooth survival in >50% of patients; 85.4% of PRCT and 61.5% of DRCT were functional after 5 years of follow-up.
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Affiliation(s)
| | | | | | | | - Cosimo Rupe
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS" - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Lajolo
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS" - Università Cattolica del Sacro Cuore, Rome, Italy
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14
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Uysal S, Akcicek G, Yalcin ED, Tuncel B, Dural S. The influence of voxel size and artifact reduction on the detection of vertical root fracture in endodontically treated teeth. Acta Odontol Scand 2021; 79:354-358. [PMID: 33337942 DOI: 10.1080/00016357.2020.1859611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of voxel size and artefact reduction (AR) on the identification of vertical root fractures (VRFs) in endodontically treated teeth. METHODS A total of a hundred sound, extracted human mandibular single-rooted premolars were decoronated, after which root canal preparation was performed, canals were filled with gutta percha by single cone technique. Randomly selected fifty specimens were fractured, repositioned and glued together. The teeth were examined with cone beam computed tomography (CBCT) in five different voxel sizes (0.125, 0.200, 0.250, 0.300, and 0.400 voxels). Two scans were performed for each tooth, one with AR and one without AR. Two radiologists evaluated the CBCT scans. RESULTS All voxel dimensions were successful in detecting VRFs in CBCT scans. But as the voxel size increased, the percentage of detecting VRFs decreased. High accuracy, sensitivity, specificity and predictive values were found for VRF detection on CBCT scans. Accuracy and sensitivity values decreased (from 100 to 82) while voxel dimensions increased (from 0.125 to 0.400). High-resolution images (0.125, 0.200, and 0.250 voxels) caused an increase in sensitivity for detection of VRFs. AR did not affect the accuracy, sensitivity, specificity and predictive values for VRF detection on CBCT scans. CONCLUSIONS High-resolution CBCT images resulted in an increase in sensitivity and specificity for detection of VRFs compared with lower-resolution CBCT images. The use of AR did not further improve its diagnostic potential.
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Affiliation(s)
- Serdar Uysal
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Gokcen Akcicek
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Eda Didem Yalcin
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
| | - Behram Tuncel
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Sema Dural
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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15
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Pedercini A, Weitz DF, Heyse JD, Pedercini C, Kormas I, Koutlas IG, Johnson DK, McClanahan SB. Cemental tear: An overlooked finding associated with rapid periodontal destruction. A case series. Aust Dent J 2021; 66 Suppl 1:S82-S87. [PMID: 33864270 DOI: 10.1111/adj.12844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
Cemental tear is defined as cementum fragment completely or partially detached from the root surface, and it has been associated with localized rapid periodontal breakdown. Although history of trauma and/or attrition may be risk factors, the etiopathology of cemental tear remains unknown. This case series aims to discuss the clinical, radiographic and histopathologic features of cemental tears to aid clinicians in making differential diagnosis. Three teeth from three patients presenting a periradicular lesion underwent an exploratory surgery to determine the cause and provide treatment. Soft and hard tissue biopsies were obtained from each lesion and forwarded for histopathologic evaluation. Two patients received a guided tissue regeneration (GTR) procedure, which allowed the tooth to be retained. One patient received an extraction with simultaneous guided bone regeneration (GBR) due to a hopeless prognosis of the tooth. The results after histopathologic evaluation yielded a final diagnosis of cemental tear for all three patients. Cemental tears may be overlooked, and therefore, they should be included in the differential diagnosis of periapical periodontitis, endodontic-periodontal lesion and vertical root fracture (VRF).
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Affiliation(s)
- A Pedercini
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - D F Weitz
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - J D Heyse
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - C Pedercini
- School of Oral Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - I Kormas
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - I G Koutlas
- Oral Pathology Laboratories, Department of Diagnostic and Biological Sciences, Division of Oral and Maxillofacial Pathology, University of Minnesota, Minneapolis, MN, USA
| | - D K Johnson
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - S B McClanahan
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
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16
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Yong D, Cathro P. Conservative pulp therapy in the management of reversible and irreversible pulpitis. Aust Dent J 2021; 66 Suppl 1:S4-S14. [PMID: 33818812 DOI: 10.1111/adj.12841] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/05/2021] [Accepted: 03/30/2021] [Indexed: 11/26/2022]
Abstract
Conservative pulp therapy is an alternative treatment option to tooth removal and root canal treatment in the management of deep caries, traumatic pulp exposures and developmental anomalies. Pulp tissue preservation can extend the long-term survival of teeth through relatively simple restorative procedures. This article aims to update clinicians on the current state of research in materials, techniques and outcomes of vital pulp therapies and provide practical guidelines for their implementation into daily practice.
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Affiliation(s)
- D Yong
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago Dental School, Dunedin, New Zealand
| | - P Cathro
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago Dental School, Dunedin, New Zealand
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17
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Kasahara Y, Iino Y, Ebihara A, Okiji T. Differences in the corono-apical location of sinus tracts and buccal cortical bone defects between vertically root-fractured and non-root-fractured teeth based on periradicular microsurgery. J Oral Sci 2020; 62:327-330. [PMID: 32475865 DOI: 10.2334/josnusd.19-0328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This retrospective study aimed to investigate whether the corono-apical location of sinus tracts differs according to the presence/location of vertical root fracture (VRF) in microsurgically treated root-filled teeth. The cases included were (1) anterior and premolar teeth without a preoperative diagnosis of VRF, (2) those with a periodontal probing depth of ≤3 mm, and (3) those for which preoperative cone-beam computed tomography (CBCT) scans and intraoperative video records were available. VRF was diagnosed intraoperatively. The locations of buccal cortical bone defects and fracture lines were categorized on video images, and the corono-apical sinus tract locations were determined by superimposing video images onto volume-rendered CBCT images. Eleven of the 78 teeth investigated had VRF, and there was no significant difference in the incidence of sinus tracts between vertically fractured and non-fractured teeth (Mann-Whitney U-test, P > 0.05). The location of the sinus tract was significantly more coronal in vertically fractured than in non-fractured teeth (Mann-Whitney U-test, P < 0.0001). The location of sinus tracts was high correlated with cortical bone defects (Spearman's correlation, P < 0.0001). In microsurgically treated anterior and premolar teeth with a normal probing depth, sinus tracts were located more coronally in vertically fractured than in non-fractured teeth, and were highly correlated with the location of cortical bone defects.
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Affiliation(s)
- Yuki Kasahara
- Department of Pulp Biology and Endodontics, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Yoshiko Iino
- Department of Pulp Biology and Endodontics, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Arata Ebihara
- Department of Pulp Biology and Endodontics, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Takashi Okiji
- Department of Pulp Biology and Endodontics, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
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18
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Chen Y, Li X, Wu J, Lu W, Xu W, Wu B. Dental pulp stem cells from human teeth with deep caries displayed an enhanced angiogenesis potential in vitro. J Dent Sci 2020; 16:318-326. [PMID: 33384815 PMCID: PMC7770258 DOI: 10.1016/j.jds.2020.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/03/2020] [Indexed: 01/15/2023] Open
Abstract
Background/purpose Dental pulp stem cells can be isolated from human teeth with deep caries (cDPSCs), but their biological characteristics are still unclear. The aim of this study was to investigate the angiogenic potential of cDPSCs and compare them to dental pulp stem cells from human normal teeth (nDPSCs). Materials and methods Cells were isolated from human pulp tissue of normal and infected teeth with deep caries. Basic mesenchymal stem cell (MSC) characterization was conducted. Colony forming units and proliferation ability were evaluated in nDPSCs and cDPSCs. Expression of VEGF in both tissues and cells was examined by immunohistochemical staining. After stimulating nDPSCs and cDPSCs with an angiogenic medium, angiogenic markers were evaluated by qRT-PCR and western blotting. Finally, tube formation assays were used to evaluate the in vitro angiogenesis potential of both cell populations. Results Both nDPSCs and cDPSCs possessed typical MSC characteristics. cDPSCs had enhanced colony formation and proliferation capacities than nDPSCs did. The expression of VEGF was higher in pulp tissue from teeth with deep caries and cDPSCs than in normal tissue and nDPSCs. When both cell types were grown in vitro under angiogenic conditions, cDPSCs expressed a higher level of angiogenic markers and showed a stronger angiogenesis potential than nDPSCs did. Conclusion cDPSCs maintained MSC traits and presented a higher angiogenesis potential than nDPSCs.
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Affiliation(s)
- Yan Chen
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xinzhu Li
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jingyi Wu
- Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Wanyu Lu
- Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Wenan Xu
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Buling Wu
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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19
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Cemental Tear on Maxillary Anterior Incisors: A Description of Clinical, Radiographic, and Histopathological Features of Two Clinical Cases. Eur Endod J 2020; 4:90-95. [PMID: 32161894 PMCID: PMC7006551 DOI: 10.14744/eej.2019.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 11/28/2022] Open
Abstract
In this case report, three teeth with complete or incomplete cemental tear in two patients were presented. Even though periapical radiograph could detect cemental tear in these three teeth, the cone-beam computed tomography scanning clearly revealed the pattern of the cemental tear, which was later confirmed by histopathological examination. Therefore, this case report shows the benefits of incorporating both cone-beam computed tomography and histopathological examination to diagnose cemental tear.
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Afrashtehfar KI, MacDonald D. Vertical Tooth Root Fracture Detection through Cone-beam Computed Tomography: An Umbrella Review Protocol Testing Four Hypotheses. Open Dent J 2019. [DOI: 10.2174/1874210601913010449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Detecting vertical root fractures represents an immense challenge for oral health professionals. One of the main tools used to detect this type of biological complication is the periapical radiograph. However, conventional radiography consists of two-dimensional imaging that is limited by the superimposition of bony structures that complicate the detection of root fractures. The alternative, a Cone-Beam Computed Tomography (CBCT) scan, cannot be prescribed in every case since radiation should be kept to a minimum as stipulated by the “As Low As Reasonably Achievable” (ALARA) principle. Therefore, to justify the use of a CBCT scan to detect a vertical tooth root fracture, the clinician must prove that it has significant benefits over traditional imaging. Since few systematic reviews have compared CBCT technology to traditional radiography for the diagnosis of vertical root fractures, it is of utmost importance in clinical practice, especially in endodontology and clinical dental medicine, where the available reviews are examined to generate a clinical recommendation. The four hypotheses of this protocol are that (1) CBCT is superior to traditional radiography for detecting vertical root fractures of vital teeth; (2) CBCT is superior to traditional radiography for detecting longitudinal root fractures of vital teeth with radiopaque restorations; (3) CBCT is superior to traditional radiography for detecting vertical root fractures of root-filled teeth without a radiopaque post that may cause artifacts; and (4) CBCT is superior to traditional radiography for detecting vertical root fractures of root-filled teeth with a radiopaque post regardless of its longitude. To test these hypotheses, all the current secondary resources related to the aim of this meta-review are evaluated. If there is sufficient evidence to support clinical decisions, then the appropriate recommendations will be formulated.
PROSPERO ID: CRD42018067792
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Doğanay Yıldız E, Arslan H, Ayaz N, Gündoğdu M, Özdoğan A, Gundogdu EC. Effect of Super-Bond C&B and self-adhesive dual-cured resin cement on the fracture resistance of roots with vertical root fracture. J Dent Res Dent Clin Dent Prospects 2019; 13:153-157. [PMID: 31592312 PMCID: PMC6773922 DOI: 10.15171/joddd.2019.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 07/02/2019] [Indexed: 12/18/2022] Open
Abstract
Background. Vertical root fracture might occur during root canal preparation, obturation, post procedures or endodontic treatment.
Methods. Fifty-four single-rooted human teeth were decoronated to obtain a standardized length. The root canals were enlarged up to #50 and obturated with gutta-percha and root canal sealer. Eighteen teeth were used as a control group, and vertical root fracture was induced in the remaining teeth. The samples were randomly divided into three groups, as follows: control group (without vertical root fracture), Super-Bond C&B group (fragments were attached with Super-Bond C&B), and self-adhesive dual-cured resin cement group (fragments were attached with self-adhesive dual-cured resin cement). Each specimen was subjected to a fracture resistance test, and data were statistically analyzed using chi-squared test, one-way ANOVA and post hoc Tukey tests (P=0.05).
Results. The fracture resistance values of the control and Super-Bond C&B groups were higher than those of the self-adhesive dual-cured resin cement group (P<0.05). However, there were no significant differences between the control and Super-Bond C&B groups (P>0.05).
Conclusion. Within the limitations of the present study, Super-Bond C&B was beneficial in obtaining higher fracture resistance in endodontically treated roots with vertical root fracture.
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Affiliation(s)
- Ezgi Doğanay Yıldız
- Department of Endodontics, Faculty of Dentistry, Kırıkkale University, Kırıkkale, Turkey
| | - Hakan Arslan
- Department of Endodontics, Faculty of Dentistry, Health Sciences University, Istanbul, Turkey
| | - Nilay Ayaz
- Department of Endodontics, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
| | - Mustafa Gündoğdu
- Department of Prosthodontics, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
| | - Alper Özdoğan
- Department of Prosthodontics, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
| | - Eyup Candas Gundogdu
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
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22
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Yang H, Li G, Han N, Zhang X, Cao Y, Cao Y, Fan Z. Secreted frizzled-related protein 2 promotes the osteo/odontogenic differentiation and paracrine potentials of stem cells from apical papilla under inflammation and hypoxia conditions. Cell Prolif 2019; 53:e12694. [PMID: 31568642 PMCID: PMC6985663 DOI: 10.1111/cpr.12694] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/31/2019] [Accepted: 08/17/2019] [Indexed: 12/15/2022] Open
Abstract
Objectives Mesenchymal stem cell (MSC)‐based dental tissue regeneration is a potential treatment method in future, while inflammation and hypoxia niche will affect MSC‐mediated tissue regeneration. In this research, we intended to investigate the influence and mechanism of secreted frizzled‐related protein 2(SFRP2) on MSC function under inflammation and hypoxia conditions. Material and methods Stem cells from apical papilla (SCAPs) were used in this study. The alkaline phosphatase (ALP) activity, Alizarin Red S staining, scratch‐simulated wound migration and transwell chemotaxis assay were used to evaluate the functions of SFRP2. The Western blot, real‐time RT‐PCR and ChIP assays were used to evaluate the mechanism of SFRP2. Results Under inflammation and hypoxia conditions, the over‐expression of SFRP2 could enhance the osteo/odontogenic differentiation ability. Mechanismly, SFRP2 inhibited canonical Wnt/β‐catenin signalling pathway and then inhibited the target genes of nuclear factor kappa B (NFkB) signalling pathway. Inflammation or hypoxia conditions could promote the expression of lysine demethylase 2A (KDM2A) and repress SFRP2 transcription through decreasing histone methylation in the SFRP2 promoter. Besides, proteomic analysis showed that SFRP2 promoted SCAPs to secret more functional cytokines, which improve the migration, chemotaxis and osteo/odontogenic ability of MSCs. Conclusions Our discoveries revealed that SFRP2 enhanced the osteo/odontogenic differentiation and paracrine potentials of SCAPs under hypoxia and inflammation conditions and provided a potential cytokine for promoting tissue regeneration in hypoxia and inflammatory niche.
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Affiliation(s)
- Haoqing Yang
- Laboratory of Molecular Signaling and Stem Cells Therapy, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China
| | - Guoqing Li
- Laboratory of Molecular Signaling and Stem Cells Therapy, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China.,Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China
| | - Nannan Han
- Department of Periodontology, Capital Medical University School of Stomatology, Beijing, China
| | - Xiuli Zhang
- Laboratory of Molecular Signaling and Stem Cells Therapy, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China.,Department of Periodontology, Capital Medical University School of Stomatology, Beijing, China
| | - Yangyang Cao
- Laboratory of Molecular Signaling and Stem Cells Therapy, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China
| | - Yu Cao
- Department of General Dentistry, Capital Medical University School of Stomatology, Beijing, China
| | - Zhipeng Fan
- Laboratory of Molecular Signaling and Stem Cells Therapy, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China
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23
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Aydin U, Gormez O, Yildirim D. Cone-beam computed tomography imaging of dentoalveolar and mandibular fractures. Oral Radiol 2019; 36:217-224. [PMID: 31102106 DOI: 10.1007/s11282-019-00390-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 05/06/2019] [Indexed: 11/28/2022]
Abstract
Three-dimensional imaging methods have an important role in the diagnosis of dentomaxillofacial fractures that can not be seen on the plain films. Cone-beam computed tomography (CBCT) is one of the three-dimensional imaging methods and has facilitated dental professionals' access to cross-sectional imaging. CBCT units allow different technical parameters and the data acquired by CBCT, can be reformatted. Osseous structures are correctly examined with this technique but the technique is not useful for the examination of soft tissues. Therefore, the purpose of its use should be based on the expected diagnostic gain. The aim of this review is to present the use of CBCT with different multi-planar reformatted sections and three-dimensional reconstructions of dentoalveolar and mandibular fractures.
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Affiliation(s)
- Ulkem Aydin
- Department of Dentomaxillofacial Radiology, Cyprus Health and Social Sciences University School of Dental Sciences, Morphou, North Cyprus
| | - Ozlem Gormez
- Department of Dentomaxillofacial Radiology, Suleyman Demirel University Faculty of Dentistry, Doğu Kampüsü, Çünür, 32000, Isparta, Turkey.
| | - Derya Yildirim
- Department of Dentomaxillofacial Radiology, Suleyman Demirel University Faculty of Dentistry, Doğu Kampüsü, Çünür, 32000, Isparta, Turkey
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24
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Guo XL, Li G, Yin S, Ma RH, Guo YJ, Bornstein MM. Effect of fracture orientation on detection accuracy of vertical root fractures in non-endodontically treated teeth using cone beam computed tomography. Clin Oral Investig 2019; 23:4433-4439. [DOI: 10.1007/s00784-019-02905-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/04/2019] [Indexed: 11/25/2022]
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25
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Shi R, Yang H, Lin X, Cao Y, Zhang C, Fan Z, Hou B. Analysis of the characteristics and expression profiles of coding and noncoding RNAs of human dental pulp stem cells in hypoxic conditions. Stem Cell Res Ther 2019; 10:89. [PMID: 30867055 PMCID: PMC6417198 DOI: 10.1186/s13287-019-1192-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/08/2019] [Accepted: 02/25/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Human dental pulp stem cell (DPSC)-mediated regenerative endodontics is a promising therapy for damaged teeth; however, the hypoxic environment in root canals can affect tissue regeneration. In this study, we investigate the characteristics and possible regulatory mechanisms of DPSC function under hypoxic conditions. METHODS Human DPSCs were cultured under normoxia (20% O2) and hypoxia (3% O2). DPSC proliferation and osteo/odontogenic differentiation potential were assessed by Cell Counting Kit-8 (CCK8) assay, carboxyfluorescein succinimidyl ester (CFSE) assay, alkaline phosphatase (ALP) activity, Alizarin red staining, real-time RT-PCR assays, and western blot analysis. Microarray and bioinformatic analyses were performed to investigate the differences in the mRNA, lncRNA, and miRNA expression profiles of DPSCs. RESULTS DPSCs exhibited a more powerful proliferation ability and lower osteo/odontogenic differentiation potential in hypoxic conditions. A total of 60 mRNAs (25 upregulated and 35 downregulated), 47 lncRNAs (20 upregulated and 27 downregulated), and 14 miRNAs (7 upregulated and 7 downregulated) in DPSCs were differentially expressed in the hypoxia group compared with the normoxia group. Bioinformatic analysis identified that 7 mRNAs (GRPR, ERO1L, ANPEP, EPHX1, PGD, ANGPT1, and NQO1) and 5 lncRNAs (AF085958, AX750575, uc002czn.2, RP3-413H6.2, and six-twelve leukemia (STL)) may be associated with DPSCs during hypoxia according to CNC network analysis, while 28 mRNAs (including GYS1, PRKACB, and NQO1) and 13 miRNAs (including hsa-miR-3916 and hsa-miR-192-5p) may be involved according to miRNA target gene network analysis. The depletion of one candidate lncRNA, STL, inhibited the osteo/odontogenic differentiation potentials of DPSCs. CONCLUSIONS Our results revealed that hypoxia could enhance the proliferation ability and impair the osteo/odontogenic differentiation potential of DPSCs in vitro. Furthermore, our results identified candidate coding and noncoding RNAs that could be potential targets for improving DPSC function in regenerative endodontics and lead to a better understanding of the mechanisms of hypoxia's effects on DPSCs.
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Affiliation(s)
- Ruitang Shi
- Department of Endodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Haoqing Yang
- Laboratory of Molecular Signaling and Stem Cells Therapy, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Xiao Lin
- Department of Implant Dentistry, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Yangyang Cao
- Laboratory of Molecular Signaling and Stem Cells Therapy, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Chen Zhang
- Laboratory of Molecular Signaling and Stem Cells Therapy, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Zhipeng Fan
- Laboratory of Molecular Signaling and Stem Cells Therapy, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China.
| | - Benxiang Hou
- Department of Endodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China.
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Guo XL, Li G, Zheng JQ, Ma RH, Liu FC, Yuan FS, Lyu PJ, Guo YJ, Yin S. Accuracy of detecting vertical root fractures in non‐root filled teeth using cone beam computed tomography: effect of voxel size and fracture width. Int Endod J 2019; 52:887-898. [PMID: 30661246 DOI: 10.1111/iej.13076] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/15/2019] [Indexed: 01/16/2023]
Affiliation(s)
- X. L. Guo
- Department of Oral and Maxillofacial Radiology Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
| | - G. Li
- Department of Oral and Maxillofacial Radiology Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
| | - J. Q. Zheng
- Center of Digital Dentistry & Department of Prosthodontics Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
| | - R. H. Ma
- Department of Oral and Maxillofacial Radiology Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
| | - F. C. Liu
- Department of Epidemiology and Biostatistics School of Public Health Peking University Beijing China
| | - F. S. Yuan
- Center of Digital Dentistry & Department of Prosthodontics Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
| | - P. J. Lyu
- Center of Digital Dentistry & Department of Prosthodontics Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
| | - Y. J. Guo
- Department of Stomatology Beijing Children's Hospital Capital Medical University Beijing China
| | - S. Yin
- Department of Oral and Maxillofacial Radiology Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
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Aslan T, Üstün Y, Çınar F, Düzgün S, Şener İ. Fortification of Fractured Instrument Removal Simulated Roots Using Several Calcium Silicate-Based Materials. CUMHURIYET DENTAL JOURNAL 2018. [DOI: 10.7126/cumudj.391219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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The association between clinical diagnostic factors and the prevalence of vertical root fracture in endodontic surgery. J Formos Med Assoc 2018; 118:713-720. [PMID: 30193836 DOI: 10.1016/j.jfma.2018.08.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/16/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND/PURPOSE Diagnosis of vertical root fractures (VRFs) can often be challenging due to the similarity of signs and symptoms with other common dental infectious diseases. This study was aimed at evaluating the potential relationship between VRFs and commonly used clinical diagnostic factors. METHODS 330 root-filled teeth with endodontic failures were subjected to endodontic microsurgery over a six-year period. VRFs were identified in 61 teeth. A randomly age- and sex-matched retrospective case-control study was conducted on a subset of 59 root-filled teeth with VRFs (cases) and 177 root-filled teeth without VRFs (controls). The strength of association between preoperative signs and radiographic findings and VRFs was evaluated using logistic regression model. RESULTS Sinus tract, periodontal pocket depth ≥5 mm, periodontal swelling or abscess, and radiological image of J-shaped or "halo" radiolucency were significantly more frequent in cases than in controls (p < 0.05). With regard to logistic regression analysis, J-shaped or "halo" radiolucency demonstrated the greatest association with VRF, followed by periodontal pocket depth ≥5 mm, sinus tract, and periodontal swelling or abscess. Approximately 70% of cases manifested themselves as combinations of at least two of these factors. Teeth having two and three or four of these factors had 3.14 times and 11.64 times higher risks for the presentations of VRFs, respectively (p < 0.001). CONCLUSION The major risk for VRFs was represented by those presenting radiological image of J-shaped or "halo" radiolucency, periodontal pocket depth ≥5 mm, sinus tract, and periodontal swelling or abscess simultaneously.
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Fox A, Basrani B, Lam EW. The Performance of a Zirconium-based Root Filling Material with Artifact Reduction Properties in the Detection of Artificially Induced Root Fractures Using Cone-beam Computed Tomographic Imaging. J Endod 2018; 44:828-833. [DOI: 10.1016/j.joen.2018.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/28/2018] [Accepted: 02/04/2018] [Indexed: 11/17/2022]
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Ashmawy MS, Yamany I, Abou-Khalaf A, Farid MM, Rady M. Detection of simulated vertical root fractures; which is better multi-detector computed tomography or cone beam computed tomography? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Barayan M, Nasseh I, Geha H, Noujeim M. The Effects of Imaging Enhancement Tools in the Detection of Horizontal Root Fractures. J Clin Diagn Res 2017; 11:ZC98-ZC101. [PMID: 28969284 DOI: 10.7860/jcdr/2017/26775.10490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 07/13/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Detection of root fracture is challenging both clinically and radiographically. Root fractures occur in different planes with unpredictable presentations. AIM The aim of the study was to evaluate the diagnostic accuracy of selected digital image enhancement tools in the detection of horizontal Root Fracture (RF). MATERIALS AND METHODS Fifty three roots, of single and multi-rooted teeth, in eight dentate human cadaver mandibles were selected for this study. Following minimally traumatic extraction of the teeth, horizontal fractures were induced in 23 roots and remounted in the empty sockets of their respective human dry mandibles. The remaining teeth with no fractures were used as the control group. Twenty two periapical radiographs were obtained by using the paralleling technique and using Complementary Metal Oxide Semiconductor (CMOS). Image J software was used to enhance the original images with the Inversion (IN), Histogram-Equalization (EQ) and Polynomial (Poly) tools. A total of 88 periapical images (original and three enhanced images) were reviewed independently by three Oral and Maxillofacial Radiologists and two Endodontists. Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the accuracy of fracture detection and the kappa statistic was used to assess agreement among reviewers. RESULTS The diagnostic accuracy for one of the observers was significantly different in detection of RF with only EQ enhancement tool. Sensitivity and specificity were not significantly different. Interobserver agreement showed no significant difference between imaging methods. Intra-observer agreement was high to moderate. CONCLUSION There was no significant difference between the different imaging modalities. No statistical difference for the agreement was found among or between the endodontists and radiologists in this study.
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Affiliation(s)
- Mohammed Barayan
- Oral Radiology Graduate, Department of Comprehensive Dentistry, University of Texas, Health Science Center, San Antonio, Texas, USA
| | - Ibrahim Nasseh
- Professor and Chairman, Department of Dentomaxillofacial Radiology and Imaging, Faculty of Dentistry, Beirut, Lebanon
| | - Hassem Geha
- Assistant Professor, Department of Comprehensive Dentistry, University of Texas, Health Science Center, San Antonio, Texas, USA
| | - Marcel Noujeim
- Professor, Department of Comprehensive Dentistry, University of Texas, Health Science Center, San Antonio, Texas, USA
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Jeng PY, Luzi AL, Pitarch RM, Chang MC, Wu YH, Jeng JH. Cemental tear: To know what we have neglected in dental practice. J Formos Med Assoc 2017; 117:261-267. [PMID: 28969877 DOI: 10.1016/j.jfma.2017.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022] Open
Abstract
Cemental tear is a special kind of root surface fracture, contributing to periodontal and periapical breakdown. However, it is a challenge for doctors to diagnose, resulting in delayed or improper treatment. We reviewed the predisposing factors, location, radiographic/clinical characteristics, diagnosis and treatments of cemental tears. From the literature, patients with cemental tear were mainly males, over 60 year-old. Possible predisposing factors include gender, age, tooth type, traumatic occlusal force and vital teeth. Cemental tears were common in upper and lower anterior teeth, single or multiple, and can be present in cervical, middle and apical third of roots. Morphology of cemental tears can be either piece-shaped or U-shaped. Clinically, cemental tear shows a unitary periodontal pocket and signs/symptoms mimicking localized periodontitis, apical periodontitis and vertical root fractures. Treatment of cemental tears include scaling, root planning, root canal treatment, periodontal/periapical surgery, guided tissue regeneration, bone grafting, and intentional replantation. Recurrence of cemental tear is possible especially when the fracture involves root apex. Extraction is recommended for teeth with poor prognosis. In conclusion, cemental tears can involve both periodontal and periapical area. Dentists should understand the predisposing factors and clinical features of cemental tears for early diagnosis/treatment to prevent bone loss/tooth extraction.
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Affiliation(s)
- Po-Yuan Jeng
- Department of Dentistry, Universidad CEU Cardenal Herrera, Valencia, Spain
| | - Arlinda Luzi Luzi
- Department of Dentistry, Universidad CEU Cardenal Herrera, Valencia, Spain.
| | | | - Mei-Chi Chang
- Chang Gung University of Science and Technology, Kwei-Shan, Taoyuan City, Taiwan; Department of Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Yu-Hsueh Wu
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jiiang-Huei Jeng
- School of Dentistry, National Taiwan University Medical College and Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
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Influence of Intracanal Materials in Vertical Root Fracture Pathway Detection with Cone-beam Computed Tomography. J Endod 2017; 43:1170-1175. [DOI: 10.1016/j.joen.2017.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/31/2017] [Accepted: 02/12/2017] [Indexed: 11/21/2022]
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Alsani A, Balhaddad A, Nazir MA. Vertical root fracture: a case report and review of the literature. GIORNALE ITALIANO DI ENDODONZIA 2017. [DOI: 10.1016/j.gien.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Nakashima M, Iohara K, Murakami M, Nakamura H, Sato Y, Ariji Y, Matsushita K. Pulp regeneration by transplantation of dental pulp stem cells in pulpitis: a pilot clinical study. Stem Cell Res Ther 2017; 8:61. [PMID: 28279187 PMCID: PMC5345141 DOI: 10.1186/s13287-017-0506-5] [Citation(s) in RCA: 225] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/05/2017] [Accepted: 02/10/2017] [Indexed: 02/06/2023] Open
Abstract
Background Experiments have previously demonstrated the therapeutic potential of mobilized dental pulp stem cells (MDPSCs) for complete pulp regeneration. The aim of the present pilot clinical study is to assess the safety, potential efficacy, and feasibility of autologous transplantation of MDPSCs in pulpectomized teeth. Methods Five patients with irreversible pulpitis were enrolled and monitored for up to 24 weeks following MDPSC transplantation. The MDPSCs were isolated from discarded teeth and expanded based on good manufacturing practice (GMP). The quality of the MDPSCs at passages 9 or 10 was ascertained by karyotype analyses. The MDPSCs were transplanted with granulocyte colony-stimulating factor (G-CSF) in atelocollagen into pulpectomized teeth. Results The clinical and laboratory evaluations demonstrated no adverse events or toxicity. The electric pulp test (EPT) of the pulp at 4 weeks demonstrated a robust positive response. The signal intensity of magnetic resonance imaging (MRI) of the regenerated tissue in the root canal after 24 weeks was similar to that of normal dental pulp in the untreated control. Finally, cone beam computed tomography demonstrated functional dentin formation in three of the five patients. Conclusions Human MDPSCs are safe and efficacious for complete pulp regeneration in humans in this pilot clinical study.
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Affiliation(s)
- Misako Nakashima
- Department of Stem Cell Biology and Regenerative Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.
| | - Koichiro Iohara
- Department of Stem Cell Biology and Regenerative Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Masashi Murakami
- Department of Stem Cell Biology and Regenerative Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hiroshi Nakamura
- Department of Endodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Yayoi Sato
- Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yoshiko Ariji
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Kenji Matsushita
- Department of Dental and Oral Infrastructure Development, Center of Advanced Medicine for Dental and Oral Diseases, National Center for Geriatrics and Gerontology, Obu, Japan
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Vertical root fracture. J Am Dent Assoc 2017; 148:100-105. [DOI: 10.1016/j.adaj.2016.11.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/07/2016] [Accepted: 11/14/2016] [Indexed: 11/19/2022]
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Sugaya T, Tomita M, Motoki Y, Zaman K, Miyaji H, Kawanami M. Periodontal tissue repair after sealing of the gap in vertical root fracture. Odontology 2016; 105:202-207. [PMID: 27655624 DOI: 10.1007/s10266-016-0270-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/11/2016] [Indexed: 02/06/2023]
Abstract
The aim of this study was to determine whether sealing of fracture gap using adhesive resin through the root canal can prevent inflammation of periodontal tissue, and resealing the incompletely sealed fracture gap from outside can resolve such inflammation in experimentally created vertical root fractures. Vertical root fractures were created in incisor of beagles. In the experimental group, the fracture gap was sealed through the root canal with adhesive resin. After 5 weeks, sites with the clinical attachment level ≥4 mm were further divided randomly into the poor-replanting group and the poor-untreated group. In the poor-replanting group, the tooth was extracted and replanted after resealing the fracture gap with adhesive resin from the outer surface. Sites with clinical attachment level ≤3 mm after 5 weeks were considered as the satisfactory group. The poor-untreated group and the satisfactory group were subjected to no further treatment. The clinical attachment level was evaluated at baseline and after 2, 5, and 9 weeks. After 9 weeks, histological measurements were made to determine the length of the epithelial downgrowth and the area of alveolar bone resorption. The clinical attachment level and the area of bone resorption were significantly smaller in the poor-replanting group and the satisfactory group than in the poor-untreated group (p < 0.05). The results indicate the possibility that periodontal inflammation along the fracture line can be prevented and improved if the fracture gap is sealed.
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Affiliation(s)
- Tsutomu Sugaya
- Department of Periodontology and Endodontology, Hokkaido University Graduate School of Dental Medicine, Kita 13 Nishi 7 Kita-ku, Sapporo, 060-8586, Japan.
| | - Mahito Tomita
- Department of Periodontology and Endodontology, Hokkaido University Graduate School of Dental Medicine, Kita 13 Nishi 7 Kita-ku, Sapporo, 060-8586, Japan
| | - Youji Motoki
- Department of Periodontology and Endodontology, Hokkaido University Graduate School of Dental Medicine, Kita 13 Nishi 7 Kita-ku, Sapporo, 060-8586, Japan
| | - Khurshiduz Zaman
- Department of Dentistry, Dinajpur Medical College and Hospital, Dinajpur, 5200, Bangladesh
| | - Hirofumi Miyaji
- Department of Periodontology and Endodontology, Hokkaido University Graduate School of Dental Medicine, Kita 13 Nishi 7 Kita-ku, Sapporo, 060-8586, Japan
| | - Masamitsu Kawanami
- Department of Periodontology and Endodontology, Hokkaido University Graduate School of Dental Medicine, Kita 13 Nishi 7 Kita-ku, Sapporo, 060-8586, Japan
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Taschieri S, Del Fabbro M, El Kabbaney A, Tsesis I, Rosen E, Corbella S. Microsurgical re-treatment of an endodontically treated tooth with an apically located incomplete vertical root fracture: a clinical case report. Restor Dent Endod 2016; 41:316-321. [PMID: 27847754 PMCID: PMC5107434 DOI: 10.5395/rde.2016.41.4.316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/25/2016] [Indexed: 11/17/2022] Open
Abstract
Although it is challenging, the early diagnosis of a vertical root fracture (VRF) is crucial in order to ensure tooth preservation. The purpose of this clinical case report was to describe reparative surgery performed to treat a tooth affected by an incomplete VRF. A 26 year old male patient was suspected to have a VRF in a maxillary left central incisor, and an exploratory flap was performed in order to confirm the diagnosis. After detecting the fracture, the lesion was surgically treated, the fracture and the infected root-end were removed, and a platelet-rich plasma membrane was used to cover the defect in order to prevent bacterial migration. A 24 month clinical and radiological follow-up examination showed that the tooth was asymptomatic and that the healing process was in progress. The surgical approach described here may be considered an effective treatment for a combined endodontic-periodontal lesion originating from an incomplete VRF and a recurrent periapical lesion.
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Affiliation(s)
- Silvio Taschieri
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Massimo Del Fabbro
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Ahmed El Kabbaney
- Conservative Dentistry and Endodontic Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Igor Tsesis
- Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Rosen
- Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Stefano Corbella
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
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Rosen E, Beitlitum I, Tamse A, Taschieri S, Tsesis I. Implant-associated Vertical Root Fracture in Adjacent Endodontically Treated Teeth: A Case Series and Systematic Review. J Endod 2016; 42:948-52. [PMID: 27106717 DOI: 10.1016/j.joen.2016.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/22/2016] [Accepted: 03/27/2016] [Indexed: 01/23/2023]
Abstract
INTRODUCTION This study aimed to report a possible effect of the presence of an adjacent implant on the development of a vertical root fracture (VRF) in endodontically treated teeth. METHODS A series of 8 cases in 7 patients with teeth diagnosed with VRF after the placement of implants in the adjacent area is described and analyzed. In addition, a comprehensive literature search with strict inclusion and exclusion criteria was undertaken to identify additional clinical studies that assessed this clinical scenario. RESULTS The case series analysis revealed that the time from implant placement to the diagnosis of VRF was between 5 and 28 months (average = 11 months). The majority of cases occurred in female patients who received 2 or more implants. Six of the 7 patients were older than 40 years, with an average age of 54 years. The majority of teeth with VRF were premolar or mandibular molar teeth (6/8 teeth). All fractured teeth had been restored with a crown and had a post present, and the quality of the root canal filling was determined to be adequate. The systematic review revealed that implant-associated VRF has not been investigated or reported in the literature yet. CONCLUSIONS Based on a systematic review of the literature, this case series, although limited in its extent, is the first clinical report of a possible serious adverse event of implant-associated VRF in adjacent endodontically treated teeth. Additional clinical studies are indicated to shed light on this potential phenomenon.
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Affiliation(s)
- Eyal Rosen
- Department of Endodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ilan Beitlitum
- Department of Periodontology and Dental Implantology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviad Tamse
- Department of Endodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences, Research Centre in Oral Health, Università degli Studi di Milano, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Igor Tsesis
- Department of Endodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Sugaya T, Tomita M, Motoki Y, Miyaji H, Kawamami M. Influence of enamel matrix derivative on healing of root surfaces after bonding treatment and intentional replantation of vertically fractured roots. Dent Traumatol 2016; 32:397-401. [PMID: 26996758 DOI: 10.1111/edt.12270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIM The objectives of this study were to histopathologically evaluate cementum regeneration on root surfaces when an enamel matrix derivative (EMD) was used to bond a vertically fractured root and to evaluate the effectiveness of EMD in inhibiting root resorption. MATERIAL AND METHODS A total of 40 roots from 24 maxillary premolars in beagles were used. The root was vertically fractured using a chisel and mallet. Super-Bond was then used to bond the fractured root. In the experimental group, the root surface was treated with ethylenediaminetetraacetic acid and an EMD. The control group received no treatment. The root was then replanted in its original location. Histopathological observation and measurement using image-analyzing software were carried out after 8 weeks. RESULTS In the experimental group, shallow resorption cavities developed on the root planed surfaces with new acellular cementum appearing over them. In the control group, no new cementum was seen on the planed surfaces, and there was connective tissue joining the roots. In some of the samples, resorption and multinucleated giant cells were seen. The experimental group showed a significantly larger volume of cementum formation (P < 0.001), and the volume of root resorption was significantly smaller (P = 0.004). CONCLUSION When bonding and replanting tooth roots after a vertical fracture, the application of EMD was effective in regenerating cementum on root surfaces from which periodontal ligament had been lost in the area around the fracture line and in reducing the incidence of root resorption.
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Affiliation(s)
- Tsutomu Sugaya
- Department of Periodontology and Endodontology, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan.
| | - Mahito Tomita
- Department of Periodontology and Endodontology, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
| | - Youji Motoki
- Department of Periodontology and Endodontology, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
| | - Hirofumi Miyaji
- Department of Periodontology and Endodontology, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
| | - Masamitsu Kawamami
- Department of Periodontology and Endodontology, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
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Cone-beam Computed Tomography for Detecting Vertical Root Fractures in Endodontically Treated Teeth: A Systematic Review. J Endod 2016; 42:177-85. [DOI: 10.1016/j.joen.2015.10.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 09/25/2015] [Accepted: 10/05/2015] [Indexed: 11/17/2022]
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Uzun I, Gunduz K, Celenk P, Avsever H, Orhan K, Canitezer G, Ozmen B, Cicek E, Egrioglu E. Comparing the Effect of Different Voxel Resolutions for Assessment of Vertical Root Fracture of Permanent Teeth. IRANIAN JOURNAL OF RADIOLOGY : A QUARTERLY JOURNAL PUBLISHED BY THE IRANIAN RADIOLOGICAL SOCIETY 2015; 12:e18290. [PMID: 26557279 PMCID: PMC4632561 DOI: 10.5812/iranjradiol.18290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 10/22/2014] [Accepted: 12/01/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The teeth with undiagnosed vertical root fractures (VRFs) are likely to receive endodontic treatment or retreatment, leading to frustration and inappropriate endodontic therapies. Moreover, many cases of VRFs cannot be diagnosed definitively until the extraction of tooth. OBJECTIVES This study aimed to assess the use of different voxel resolutions of two different cone beam computerized tomography (CBCT) units in the detection VRFs in vitro. MATERIALS AND METHODS The study material comprised 74 extracted human mandibular single rooted premolar teeth without root fractures that had not undergone any root-canal treatment. Images were obtained by two different CBCT units. Four image sets were obtained as follows: 1) 3D Accuitomo 170, 4 × 4 cm field of view (FOV) (0.080 mm(3)); 2) 3D Accuitomo 170. 6 × 6 cm FOV (0.125 mm(3)); 3) NewTom 3G, 6˝ (0.16 mm(3)) and 4) NewTom 3G, 9˝ FOV (0.25 mm(3)). Kappa coefficients were calculated to assess both intra- and inter-observer agreements for each image set. RESULTS No significant differences were found among observers or voxel sizes, with high average Z (Az) results being reported for all groups. Both intra- and inter-observer agreement values were relatively better for 3D Accuitomo 170 images than the images from NewTom 3G. The highest Az and kappa values were obtained with 3D Accuitomo 170, 4 × 4 cm FOV (0.080 mm(3)) images. CONCLUSION No significant differences were found among observers or voxel sizes, with high Az results reported for all groups.
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Affiliation(s)
- Ismail Uzun
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - Kaan Gunduz
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - Peruze Celenk
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - Hakan Avsever
- Department of Dentomaxillofacial Radiology, Gulhane Military Medical Academy (GATA), Ankara, Turkey
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Near East University, Mersin, Turkey
| | - Gozde Canitezer
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - Bilal Ozmen
- Department of Pedodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - Ersan Cicek
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - Erol Egrioglu
- Department of Statistics, Ondokuz Mayis University, Samsun, Turkey
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Safi Y, Aghdasi MM, Ezoddini-Ardakani F, Beiraghi S, Vasegh Z. Effect of Metal Artifacts on Detection of Vertical Root Fractures Using Two Cone Beam Computed Tomography Systems. IRANIAN ENDODONTIC JOURNAL 2015. [PMID: 26213543 PMCID: PMC4509129 DOI: 10.7508/iej.2015.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction: Vertical root fracture (VRF) is common in endodontically treated teeth. Conventional and digital radiographies have limitations for detection of VRFs. Cone-beam computed tomography (CBCT) offers greater detection accuracy of VRFs in comparison with conventional radiography. This study compared the effects of metal artifacts on detection of VRFs by using two CBCT systems. Methods and Materials: Eighty extracted premolars were selected and sectioned at the level of the cemento enamel junction (CEJ). After preparation, root canals were filled with gutta-percha. Subsequently, two thirds of the root fillings were removed for post space preparation and a custom-made post was cemented into each canal. The teeth were randomly divided into two groups (n=40). In the test group, root fracture was created with Instron universal testing machine. The control teeth remained intact. CBCT scans of all teeth were obtained with either New Tom VGI or Soredex Scanora 3D. Three observers analyzed the images for detection of VRF. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for VRF detection and percentage of probable cases were calculated for each imaging system and compared using non-parametric tests considering the non-normal distribution of data. The inter-observer reproducibility was calculated using the weighted kappa coefficient. Results: There were no statistically significant differences in sensitivity, specificity, PPV and NPV between the two CBCT systems. Conclusion: The effect of metal artifacts on VRF detection was not significantly different between the two CBCT systems.
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Affiliation(s)
- Yaser Safi
- Department of Oral and Maxillofacial Radiology, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Aghdasi
- Department of Oral and Maxillofacial Radiology, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ezoddini-Ardakani
- Department of Oral and Maxillofacial Radiology, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samira Beiraghi
- Department of Oral and Maxillofacial Radiology, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Vasegh
- Department of Oral and Maxillofacial Radiology, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
This article reviews the diagnosis and treatment of cracked teeth, and explores common clinical examples of cracked teeth, such as cusp fractures, fractures into tooth furcations, and root fractures. This article provides alternative definitions of terms such as cracked teeth, complete and incomplete fractures and crack lines, and explores the scientific rationale for dental terminology commonly used to describe cracked teeth, such as cracked tooth syndrome, structural versus nonstructural cracks, and vertical, horizontal, and oblique fractures. The article explains the advantages of high magnification loupes (×6-8 or greater), or the surgical operating microscope, combined with co-axial or head-mounted illumination, when observing teeth for microscopic crack lines or enamel craze lines. The article explores what biomechanical factors help to facilitate the development of cracks in teeth, and under what circumstances a full coverage crown may be indicated for preventing further propagation of a fracture plane. Articles on cracked tooth phenomena were located via a PubMed search using a variety of keywords, and via selective hand-searching of citations contained within located articles.
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45
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Anitha S, Rao DSC. Hemisection: A Treatment Option for an Endodontically treated Molar with Vertical Root Fracture. J Contemp Dent Pract 2015; 16:163-5. [PMID: 25906809 DOI: 10.5005/jp-journals-10024-1654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Vertical root fractures (VRF) in endodontically treated teeth have long been reported and pose diagnostic difficulties. A hemisection/root resection procedures removes the fractured fragments completely, and retains a portion of the compromized tooth offers a predictable treatment option. The key to this rests in ideal case selection involving balancing all indications and contraindications. The success of the treatment depends on careful case selection based on a firm set of guidelines. This article presents a case with VRF in an endodontic treated molar. This article describes the case of a 65-year-old man with a VRF on the mesial root and a healthy periodontium supporting the distal root making it ideal for retention as well as restoration and support of the final prosthesis. Also, the patient was motivated to try and save as much of the tooth as possible. Postoperatively no untoward complication was reported making it an alternative treatment option in patients with VRF in a molar, willing to retain the remaining tooth portion. With all other factors balanced, it allows for retaining the remaining intact portion of the tooth structure.
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Affiliation(s)
- S Anitha
- Associate Professor, Department of Periodontics, JSS Dental College and Hospital, Jagadguru Sri Shivarathreeswara University, Mysore, Karnataka, India, e-mail:
| | - Deepika S C Rao
- Department of Periodontics, JSS Dental College and Hospital, Jagadguru Sri Shivarathreeswara University, Mysore, Karnataka, India
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Sharma R, Hegde V, Siddharth M, Hegde R, Manchanda G, Agarwal P. Endodontic-periodontal microsurgery for combined endodontic-periodontal lesions: An overview. J Conserv Dent 2014; 17:510-6. [PMID: 25506135 PMCID: PMC4252921 DOI: 10.4103/0972-0707.144571] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 08/24/2014] [Accepted: 09/19/2014] [Indexed: 12/28/2022] Open
Abstract
Endodontic and periodontal microsurgery has surpassed the success rates for traditional endodontic and periodontal surgical procedures. Excellent healing results are being attributed to both the techniques, when employed, for isolated endodontic or periodontal defects. Combined endodontic-periodontal lesions have been referred to as a true challenge, requiring not only endodontic microsurgical management but also concurrent bone grafting and membrane barriers techniques. The prevention of epithelial downgrowth and regeneration of periodontal cementum, fiber, and bone seals the fate of these cases. Achieving primary closure with submergence of grafts has a positive effect on GTR outcome. New techniques of periodontal microsurgery, such as minimally invasive papilla preserving flaps with passive internal mattress suturing, have managed to obtain 90% primary flap closure over grafted sites. Root surface treatment and conditioning has also shown to be beneficial for GTR. Endodontic microsurgery for the combined lesion has not integrated these advances yet. These advances, along with a recently suggested treatment strategy, are ushering in the level next in management of the combined lesions. This article offers an overview of the combined lesion, the disease, its classification, treatment strategy, regenerative tools, microsurgical recommendations, and outcome studies.
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Affiliation(s)
- Ritu Sharma
- Department of Conservative Dentistry and Endodontics, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Vivek Hegde
- Department of Conservative Dentistry and Endodontics, MA Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India
| | - M Siddharth
- Department of Periodontics, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Rashmi Hegde
- Department of Periodontics, MA Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India
| | - Gunsha Manchanda
- Department of Conservative Dentistry and Endodontics, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Pratul Agarwal
- Department of Conservative Dentistry and Endodontics, Sharda University, Greater Noida, Uttar Pradesh, India
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47
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Corbella S, Tamse A, Nemcovsky C, Taschieri S. Diagnostic issues dealing with the management of teeth with vertical root fractures: a narrative review. GIORNALE ITALIANO DI ENDODONZIA 2014. [DOI: 10.1016/j.gien.2014.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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48
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Corbella S, Del Fabbro M, Tamse A, Rosen E, Tsesis I, Taschieri S. Cone beam computed tomography for the diagnosis of vertical root fractures: a systematic review of the literature and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:593-602. [DOI: 10.1016/j.oooo.2014.07.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 06/24/2014] [Accepted: 07/29/2014] [Indexed: 11/29/2022]
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49
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Kansal R, Rajput A, Talwar S, Roongta R, Verma M. Assessment of Dentinal Damage during Canal Preparation Using Reciprocating and Rotary Files. J Endod 2014; 40:1443-6. [DOI: 10.1016/j.joen.2014.02.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/13/2014] [Accepted: 02/19/2014] [Indexed: 10/25/2022]
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50
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Abraham S, Chacko LN. 'Split posterior tooth': conservative clinical re-attachment. CASE REPORTS 2014; 2014:bcr-2013-202695. [DOI: 10.1136/bcr-2013-202695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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