Vital Pulp Therapy of a Mature Molar with Concurrent Hyperplastic Pulpitis, Internal Root Resorption and Periradicular Periodontitis: A Case Report

Comparative Outcomes of Pulpotomy in Mature Molars with Irreversible Pulpitis: A Non-Randomized Trial Evaluating Calcified and Non-Calcified Pulp Chambers

Introduction

This non-randomized clinical trial investigated the outcomes of full pulpotomy in adult molars with irreversible pulpitis, comparing those with calcified and non-calcified pulp chambers over 6 and 12 months.

Materials and Methods

A total of 101 adult permanent molars with irreversible pulpitis, in individuals over 12 years old, were categorized based on pulp chamber calcification observed in radiographic images by two endodontists. Subsequently, full pulpotomy procedures were performed, achieving hemostasis, and applying a 2 mm layer of calcium-enriched mixture (CEM) cement as a pulp covering agent. After 48 hours, the setting of the CEM cement was verified, followed by the application of a layer of resin-modified glass-ionomer. The tooth was then restored using amalgam. Clinical and radiographic evaluations were conducted at 6-month and 1-year follow-ups by blinded endodontists. Success rates were compared using Fisher's exact test and logistic regression tests with a significance level of 0.05.

Results

Among the 97 patients with 6-month and 1-year follow-ups, all achieved clinical success. Radiographic success rates were 99% at 6 months and 96.9% at 1 year, regardless of pulp calcification. In the 6-month follow-up, success rates were 98.07% for non-calcified pulp chambers and 100% for calcified pulp chambers. At the 1-year follow-up, success rates were 96.1% and 97.8%, respectively. Statistical analysis showed no significant difference in radiographic success rate between the two groups at both follow-ups (P>0.05).

Conclusions

Full pulpotomy using CEM cement is a successful treatment for adult permanent teeth with calcified and non-calcified pulp chambers presenting signs and symptoms of irreversible pulpitis up to a 1-year follow-up. This study provides compelling evidence that vital pulp therapy can be effectively employed in the pulpotomy of calcified teeth, at least in the short term.

Successful Management of a Typical Class 3 Invasive Cervical Root Resorption with Modified Pulpotomy: A Case Report

Invasive cervical root resorption (ICRR) is a rare and clinically complex condition marked by the progressive loss of dental hard tissues below the junctional epithelium. This case report outlines the management of a 32-year-old female patient presenting with ICRR class 3 affecting a maxillary incisor. Despite the absence of symptoms, the expansive nature of the defect warranted conservative surgical intervention. The procedure involved the surgical removal of inflamed tissues, followed by an ultraconservative modified pulpotomy utilizing calcium-enriched mixture (CEM) cement through a surgical window. The selected intervention is substantiated by its potential benefits, such as minimal removal of tooth structure and the inherent biocompatibility and sealing capabilities of CEM cement. A one-year follow-up revealed arrested resorption, re-establishment of periodontal attachment, and successful esthetic restoration, affirming the efficacy of vital pulp therapy in surgically addressing advanced ICRR. Accurate diagnosis, strategic treatment planning, and a patient-centered approach proved critical in achieving favorable outcomes.

Tampon Vital Pulp Therapy in the Management of Excessive Haemorrhage in Inflamed Pulps: A Hypothesis

Current principles in vital pulp therapy (VPT) modalities emphasise the importance of haemostasis and normal clotting in the achievement of successful treatment outcomes. However, the aforementioned notion could be challenged by the new and recent emerging evidence; suggesting that prolonged or excessive bleeding/haemorrhage (PB) in cases of intensly inflamed pulps, conventionally infamous as irreversible pulpitis (IP), may not impede the healing potential of the remaining dental pulp tissue following VPTs using endodontic biomaterials. "Tampon VPT (tVPT)" may be considered a treatment approach for the management of stated IP cases; characterised by severe pulpal inflammation and delayed clotting process. The presented hypothesis evaluates clinical studies, experimental research and molecular impacts on clotting within the inflamed dental pulp, so as to explore the efficacy as well as the safety of tVPT as a viable treatment option. Latest clinical investigations have reported positive outcomes with tVPT; even in the presence of IP with PB. It has been shown that inflamed dental pulp tissues exhibit molecular impacts on the clotting cascade, which may contribute to the delayed clotting process. Nonetheless, the healing capacity of the dental pulp is not negatively affected by hyperaemia. Additionally, enhanced blood flow in the inflamed pulpal tissues may be associated with improved healing and boosted hard tissue formation. Moreover, tVPT could possibly promote pulpal healing and/or regeneration through continuing the presentation of essential nutrients, e.g. oxygen, and growth factors to the injured tissue. Furthermore, increased blood flow may facilitate the recruitment of immune and reparative cells; promoting tissue repair and encouraging the formation of dentinal bridge(s) after VPTs. Consequently, the state-of-the-art research and their findings could support the hypothesis that tVPT may effectively manage IP cases with PB and contribute to favourable outcomes.

Challenging the Misnomer of Irreversible Pulpitis and Deliberating the Urgent Need for Reclassification of Pulpal Diseases Based on the Efficacy of Vital Pulp Therapies: An Overview of Systematic Reviews

Over recent decades, the definition of irreversible pulpitis (IP), as an irrevocable condition of a compromised dental pulp tissue, has forced clinicians towards invasive root canal treatments. However, the current best evidence challenges the alignment between clinical symptoms and the perceived irreversibility of a negotiated dental pulp tissue. In the above-mentioned context, vital pulp therapy (VPT) has emerged as a revolutionary and transformative approach; introducing minimally invasive techniques to sustain pulp vitality in cases of IP. The present paper aimed to rigorously examine the corresponding published systematic reviews to explore the diverse spectrum of VPT modalities and their outcomes in managing IP cases. Besides, the current review seems to have asserted the need to discard the conventional terminology of irreversible pulpitis, based on the effectiveness of VPTs in the achievement of pulp tissue healing within cases clinically diagnosed as IP.

Management of Pink Spot due to Class IV Invasive Cervical Root Resorption using Vital Pulp Therapy: A Case Report

A 30-year-old male patient with the chief complaint of pink spot discoloration of the tooth crown in his upper left central incisor was referred for endodontic and esthetic management. After thorough clinical and radiographic examinations, the final diagnosis was class IV invasive cervical resorption (ICR) which was conservatively treated with an orthograde approach; i.e. vital pulp therapy with calcium-enriched mixture cement (VPT/CEM). The use of VPT/CEM was successful to restore esthetics and stop the ICR; confirmed clinically, radiographically, and tomographically at one-year recall. The above-mentioned minimally invasive approach reported in the current case study may be considered a practical treatment modality for ICR, specifically in anterior teeth.

Outcomes of root canal therapy or full pulpotomy using two endodontic biomaterials in mature permanent teeth: a randomized controlled trial

OBJECTIVE

The concept of minimally invasive endodontics recommends less-invasive vital pulp therapy (VPT) modalities over more aggressive traditional endodontic approaches in mature permanent teeth with carious pulp exposure, including irreversible pulpitis (IP) cases. Consequently, VPT needs to be compared with root canal therapy (RCT) in terms of treatment outcomes. This randomized clinical trial compares the results of full pulpotomy using two calcium-silicate cements, i.e., mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement, with RCT in mature permanent teeth.

MATERIALS AND METHODS

A total of 157 carious pulp exposure cases in two academic centers with/without established IP were selected/included/randomly appointed to three study arms; (i) RCT (n = 51) as the reference treatment, (ii) pulpotomy with ProRoot MTA (PMTA; n = 55), and (iii) pulpotomy with CEM cement (PCEM; n = 51) as two alternative VPT treatments. Two-year clinical/radiographic results were the outcomes of interest. Data were statistically analyzed through the analysis of variance, chi-square, Fisher exact test, and Kruskal-Wallis.

RESULTS

At 2-year recall, 147 teeth were examined (6.4% dropout). All molars, except for one, were clinically functional/symptom-free, and there was no statistical difference between the three study arms (p = 0.653). The radiographic success rates in RCT, PMTA, and PCEM arms were 98%, 100%, and 97.9%, respectively, without statistically significant differences (p = 0.544).

CONCLUSION

In the management of mature permanent teeth with/without established IP, all experimental groups exhibited equivalent/comparable results.

CLINICAL RELEVANCE

Simple VPT using MTA/CEM can be suggested/recommended as a viable advantageous alternative to RCT for the management of carious pulp exposures with/without sign/symptoms of IP.

Multidisciplinary Treatment Approach for Perforated Internal Root Resorption: Three-Year Follow-Up

Internal root resorption (IRR) is described as a resorptive defect of the internal aspect of the root caused by odontoclastic activity associated chiefly with chronic pulp inflammation and trauma. An important variation to consider is the presence of a root perforation, although it is rare. This paper defines the use of CBCT in the diagnosis and combined nonsurgical and surgical multidisciplinary management and follow-up of a maxillary central incisor with perforating IRR in a 9-year-old female patient. At 3-year follow-up, clinical and radiographic findings of the case were satisfactory.

Comparison of Microleakage of CEM Cement Apical Plug in Different Powder/ Liquid Ratio in Immature Teeth Using Fluid Filtration Technique

STATEMENT OF THE PROBLEM

Sealing ability is one of the most important factors for successful endodontic treatment. Some studies have shown that the powder to liquid ratio can influence the properties of dental materials. Subsequently, this may happen for those used for sealing in endodontics.

PURPOSE

The purpose of this research was to assess the microleakage of calcium-enriched mixture (CEM) cement apical plug in different powder to liquid ratio.

MATERIALS AND METHOD

Ninety-six extracted human single root and single canal teeth were decoronated. Working length was determined using ≠15 k-file. Canal preparation was performed using step back method. Samples were divided into 3 groups randomly. CEM cement was placed into the canal with 1.13, 2.27 and 3.40 powder to liquid ratio in the group 1, 2 and 3, respectively. After complete setting of CEM cement, the micro leakage value was evaluated using fluid filtration method. Data were analyzed using ANOVA and Scheffe tests.

RESULTS

The bubble movement in three groups showed a statistically significant difference (p< 0.001). Minimum and maximum bubble movements were observed in the group with powder to liquid ratios of 3.40 and 1.13 respectively.

CONCLUSION

Increased CEM Cement powder to liquid ratio will increase the sealing ability of this material as apical plug. Considering the conditions of this study, the powder to liquid ratio of 3:40 provided the best sealing ability.

Comparison of Microleakage of CEM Cement Apical Plug in Different Powder/ Liquid Ratio in Immature Teeth Using Fluid Filtration Technique

STATEMENT OF THE PROBLEM

Sealing ability is one of the most important factors for successful endodontic treatment. Some studies have shown that the powder to liquid ratio can influence the properties of dental materials. Subsequently, this may happen for those used for sealing in endodontics.

PURPOSE

The purpose of this research was to assess the microleakage of calcium-enriched mixture (CEM) cement apical plug in different powder to liquid ratio.

MATERIALS AND METHOD

Ninety-six extracted human single root and single canal teeth were decoronated. Working length was determined using ≠15 k-file. Canal preparation was performed using step back method. Samples were divided into 3 groups randomly. CEM cement was placed into the canal with 1.13, 2.27 and 3.40 powder to liquid ratio in the group 1, 2 and 3, respectively. After complete setting of CEM cement, the micro leakage value was evaluated using fluid filtration method. Data were analyzed using ANOVA and Scheffe tests.

RESULTS

The bubble movement in three groups showed a statistically significant difference (p< 0.001). Minimum and maximum bubble movements were observed in the group with powder to liquid ratios of 3.40 and 1.13 respectively.

CONCLUSION

Increased CEM Cement powder to liquid ratio will increase the sealing ability of this material as apical plug. Considering the conditions of this study, the powder to liquid ratio of 3:40 provided the best sealing ability.

Comparison of Microleakage of MTA and CEM Cement Apical Plugs in Three Different Media

Introduction:

Microleakage is of the causes of endodontic treatment failure. The aim of this in vitro study, was to compare the microleakage of mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement apical plugs in three environments.

Methods and Materials:

A total of 130 human extracted single rooted teeth were collected. After decoronation, preparation of the root canal space and simulation of open apices, 5 teeth were selected as positive and negative control groups and the rest of the samples were randomly divided into two groups (MTA plug and CEM cement plug) and each group was divided into 3 subgroups (dry, contaminated with saliva and contaminated with blood). In each group apical plug was placed into the canal. After full setting of the apical plug, microleakage of the samples were evaluated using fluid filtration method and the data were analyzed using two-way analysis of variance.

Results:

In dry and saliva contaminated environments, the leakage of MTA samples were 40.906±2.081 and 39.608±2.081, respectively which was significantly more than that of CEM cement samples (26.977±2.081 and 27.000±2.081, respectively). However, in blood-contaminated environments, the amount of leakage in MTA group (21.640±2.081) was significantly lower than CEM cement group (44.358±2.081).

Conclusion:

According to the results of this study, in dry and saliva-contaminated conditions CEM cement provides significantly better seal in comparison to MTA

Interdisciplinary Approach for Management of Iatrogenic Internal Root Resorption: A Case Report

For management of a symptomatic maxillary lateral incisor with dull pain on chewing, suppurative sinus tract, defective metal-ceramic crown and iatrogenic internal root resorption, an interdisciplinary approach was taken. Two-visit nonsurgical treatment with calcium-enriched mixture (CEM) cement, replacement of metal-ceramic crown with all-ceramic crown and corrective periodontal plastic surgery were included in the treatment plan. Six-month and one-year follow-ups revealed complete resolution of signs and symptoms and radiographic healing. This case report highlights the importance of adequate cooling during crown preparation to preserve the pulp vitality and prevent internal resorptive lesions and also the profound sealing ability and biocompatibility of CEM cement.

Miniature Pulpotomy of Symptomatic Mature Permanent Teeth: A Report of Two Cases

Human dental pulp inflammation can progress to periapical lesion formation and conventional root canal treatment (RCT) has been the traditional method for disease management. This observational study presents two cases of vital pulp therapy in mature molars diagnosed with irreversible pulpitis and associated with apical periodontitis. In these two clinical cases, the involved teeth had deep carious lesions with a history of spontaneous/lingering pain and radiographic examinations revealed the presence of apical radiolucencies. A conservative miniature pulpotomy (MP) using calcium-enriched mixture (CEM) was performed and the teeth were permanently restored with amalgam. Clinical evaluations indicated resolution of pain 24 hours after treatment; the teeth showed normal vitality, remained asymptomatic and maintained normal function after recall examinations. Furthermore, the 18-month radiographic evaluation showed healing of the apical lesions. Vital pulp therapy using the MP technique with CEM appeared successful in avoiding RCT intervention. These two reports of case outcome suggest that simple MP using a CEM bioregenerative technique may provide a favorable outcome for permanent teeth diagnosed with irreversible pulpitis and associated with apical periodontitis.