The Outcome of GaAlAs Diode Laser (980 Nm) Pulpotomy in Patients with Symptomatic Irreversible Pulpitis Assessed Using CBCT - Randomised Controlled Trial with an 18-Month Follow-up

OBJECTIVE

To evaluate the effect of diode laser (GaAlAs-980 nm) for full coronal pulpotomy (FCP) compared to conventional crown pulpotomy (CCP) in mature teeth with symptomatic irreversible pulpitis (SIP) and assess dentine bridge formation after FCP using CBCT.

METHODS

A total of 86 patients (43 per group) with SIP in permanent mandibular molars were included. Access opening and FCP were done, after which haemostasis was achieved with 2.5% NaOCl in the CCP group and a diode laser (GaAlAs-980 nm) in the laser crown pulpotomy group (LCP). Biodentine (Septodont, Saint-Maur-des-Fossés, France) was placed, and the cavity was sealed. Clinical and radiographic follow-ups were done at 6, 12, and 18 months, with additional CBCT evaluation at 18 months. Statistical analysis was performed using the Mann-Whitney U test, and survival rates were assessed using Kaplan-Meier analysis. The Cox proportional model was used to determine the effect of possible covariates on pulpotomy outcomes. P<0.05 was considered to be statistically significant.

RESULTS

The overall success rate for CCP and LCP at 18 months was 88.4% and 93% respectively. At the end of 18 months, 8 cases (5 in CCP, 3 in LCP) failed. The postoperative pain score at 48 hours was significantly higher for CCP (mean +- standard deviation: 1.7+-1.4; p<0.001). CBCT analysis at 18 months revealed thicker dentine bridge formation for LCP (Median & IQR: 0.89, 1.06) compared to CCP (p=0.0479). The Kaplan-Meier curve showed a more rapid decline in the survival rate of CCP (0.89) compared to that of LCP (0.93). Postoperative pain at 48 hours, PAI scores at 6, 12, 18 months, and age were found to affect the hazard ratio based on the Cox regression model.

CONCLUSION

Within the limitations of this trial, there was no significant difference in the outcome between diode laser and conventional pulpotomy. However, LCP resulted in lesser postoperative pain at 48 hours and thicker dentine bridge formation at 18 months, with a longer estimated survival rate. (EEJ-2023-01-011).

Vital Pulp Therapy of Young First Permanent Molars: A Retrospective Study on Radiographic Findings 24 Months Post-treatment

PURPOSE

With success rates comparable to that of root canal treatment, vital pulp therapy (VPT) has gained clinical interest and has been used in the management of young permanent teeth with inflamed pulps. The aim of the present study was to retrospectively evaluate the radiographic success of VPT in young first permanent molars 24 months post-treatment and correlate findings with tooth and treatment-related characteristics.

MATERIALS AND METHODS

Dental records of all patients with first permanent molars which received VPT in the Department of Paediatric Dentistry (National and Kapodistrian University of Athens) were retrieved. Demographic characteristics and data regarding the treatment performed were recorded. Patients' radiographs were evaluated at 6, 12 and 24 months post-treatment by two qualified paediatric dentists blinded regarding the treatment performed. Radiographic success, reasons for failure and continuation of root development were evaluated. Differences were tested using the Χ2 and Student's t-test, and possible correlations were determined by calculating the odds ratio.

RESULTS

Overall radiographic success rate at 24 months was 77%, ranging between 50% for direct pulp capping and 92% for full pulpotomy. Differences were not statistically significant. Continuation of root development was recorded in almost 1/3 of the teeth and completion in almost 1/5. No statistically significant association was recorded between the outcome and any tooth and treatment-related variables.

CONCLUSION

VPT seems to be a reliable option in the long term for the treatment of deep carious lesions in young permanent molars.

Prediction of pulp exposure risk of carious pulpitis based on deep learning

OBJECTIVES

This study aims to predict the risk of deep caries exposure in radiographic images based on the convolutional neural network model, compare the prediction results of the network model with those of senior dentists, evaluate the performance of the model for teaching and training stomatological students and young dentists, and assist dentists to clarify treatment plans and conduct good doctor-patient communication before surgery.

METHODS

A total of 206 cases of pulpitis caused by deep caries were selected from the Department of Stomatological Hospital of Tianjin Medical University from 2019 to 2022. According to the inclusion and exclusion criteria, 104 cases of pulpitis were exposed during the decaying preparation period and 102 cases of pulpitis were not exposed. The 206 radiographic images collected were randomly divided into three groups according to the proportion: 126 radiographic images in the training set, 40 radiographic images in the validation set, and 40 radiographic images in the test set. Three convolutional neural networks, visual geometry group network (VGG), residual network (ResNet), and dense convolutional network (DenseNet) were selected to analyze the rules of the radiographic images in the training set. The radiographic images of the validation set were used to adjust the super parameters of the network. Finally, 40 radiographic images of the test set were used to evaluate the performance of the three network models. A senior dentist specializing in dental pulp was selected to predict whether the deep caries of 40 radiographic images in the test set were exposed. The gold standard is whether the pulp is exposed after decaying the prepared hole during the clinical operation. The prediction effect of the three network models (VGG, ResNet, and DenseNet) and the senior dentist on the pulp exposure of 40 radiographic images in the test set were compared using receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and F1 score to select the best network model.

RESULTS

The best network model was DenseNet model, with AUC of 0.97. The AUC values of the ResNet model, VGG model, and the senior dentist were 0.89, 0.78, and 0.87, respectively. Accuracy was not statistically different between the senior dentist (0.850) and the DenseNet model (0.850)(P>0.05). Kappa consistency test showed moderate reliability (Kappa=0.6>0.4, P<0.05).

CONCLUSIONS

Among the three convolutional neural network models, the DenseNet model has the best predictive effect on whether deep caries are exposed in imaging. The predictive effect of this model is equivalent to the level of senior dentists specializing in dental pulp.

[Study of vital inflamed pulp therapy in immature permanent teeth with irreversible pulpitis and apical periodontitis]

To assess the treatment effectiveness of vital inflamed pulp therapy (VIPT) in immature permanent teeth with irreversible pulpitis and apical periodontitis. The faculty members in the Department of Pediatric Dentistry, the Ninth People's Hospital were invited to submit consecutive VIPT cases from June 2015 to June 2016 (follow-up periods>12 months). The cases were retrospectively reviewed, clinical symptoms and radiographic changes in periapical radiolucency were evaluated, meanwhile, the data of radiographic changes such as apical diameter and root length were calculated and analyzed with ANOVA. Totally thirteen submitted patients/cases were included (6 males and 7 females) in the present study,. The average age of patients was (9.9±1.4) years old. The average follow-up time was (26.5±6.8) months (17-37 months). At the 12-month visit, all 13 treated teeth survived, 9 out of 11 teeth with apical periodontitis showed normal radiographic manifestation. At the 3, 6 and 12 months visits, the within-case percentage changes in apical diameter were (8.0±5.1)%, (24.1±9.1)% and (70.3±10.7)%, respectively, while the within-case percentage changes in root length were (11.4±9.8)%, (14.5±9.8)% and (27.4±14.2)%, respectively. There were statistically significant differences in the changes of apical diameter (F=18.80, P<0.001) and root length (F=4.64, P=0.047) from the preoperative time to the postoperative follow-ups. VIPT might improve clinical outcomes, even achieve continued root development. VIPT can be an option in treating immature teeth with irreversible pulpitis and apical periodontitis.

Effects of the nitric oxide releasing biomimetic nanomatrix gel on pulp-dentin regeneration: Pilot study

Successful disinfection alongside complete endodontic tissue regeneration and revascularization are the most desired clinical outcomes of regenerative endodontics. Despite reported clinical successes, significant limitations to the current regenerative endodontic procedure (REP) have been elucidated. To improve the current REP, an antibiotics and nitric oxide (NO) releasing biomimetic nanomatrix gel was developed. The study evaluates antibacterial effects of an antibiotics and NO releasing biomimetic nanomatrix gel on multispecies endodontic bacteria. Antibiotics, ciprofloxacin (CF) and metronidazole (MN) were mixed and encapsulated within the NO releasing biomimetic nanomatrix gel. The gel was synthesized and self-assembled from peptide amphiphiles containing various functional groups. Antibacterial effects of the antibiotics and NO releasing biomimetic nanomatrix gel were evaluated using bacterial viability assays involving endodontic microorganisms including clinical samples. Pulp-dentin regeneration was evaluated via animal-model experiments. The antibiotics and NO releasing biomimetic nanomatrix gel demonstrated a concentration dependent antibacterial effect. In addition, NO alone demonstrated a concentration dependent antibacterial effect on endodontic microorganism. An in vivo analysis demonstrated the antibiotics and NO releasing biomimetic nanomatrix gel promoted tooth revascularization with maturation of root canals. An optimal concentration of and NO releasing nanomatrix gel is suggested for its potential as a root treatment material for REP and an appropriate protocol for human trials. Further investigation is required to obtain a larger sample size and decide upon ideal growth factor incorporation.

[The value of ultrasonic elastography in diagnosis of salivary gland lesions in patients with Sjogren's syndrome]

PURPOSE

The present study was aimed to clinically evaluate transitional treatment of pulpitis during pregnancy.

METHODS

Sixty pregnant women with pulpitis were divided into the first, second and third trimester. They were anesthetized locally using STA system combined with psychological intervention during treatment. The teeth were given one-appointment root canal preparation and filled with vitapex pasta. Normal obturation of the root canal was conducted after delivery. The effects of dental treatment, pregnancy outcomes and neonatal health status were observed. Data of the survey were analyzed by SPSS 20.0 software package, including Student's t test and chi-square test.

RESULTS

The symptoms of pulpitis were significantly improved 24h after treatment,and the effective rate was 96.7%. The difference of VAS before and after treatment was statistically significant (P<0.05). Patients had no discomfort till the end of pregnancy,and the success rate was 98.3%. No adverse pregnancy outcomes were observed after treatment during different periods of pregnancy. Neonatal health was good. Significant differences were not found in birth gestational age, body weight, malformations, and neonatal complications between three treatment periods (P>0.05).

CONCLUSIONS

Transitional treatment of pulpitis during pregnancy is a safe and effective procedure and worthy of wide use clinically.

[Retrospective analysis of pulp revascularization in immature permanent teeth with diffuse pulpitis]

Objective: To evaluate the treatment effectiveness of revascularization in immature permanent teeth with diffuse pulpitis and to provide an alternative approach for the treatment of these teeth. Methods: Clinical and radiographic data were collected from 17 immature permanent teeth which were diagnosed as diffuse pulpitis and with their pulp extirpated at Emergency Department of Peking University School and Hospital of Stomatology. All these teeth were treated using pulp revascularization at Department of Pediatric Dentistry. Clinical success rate was then evaluated based on the clinical and radiographic findings. The increase of root length and dentin wall thickness of the revascularized teeth and the contralateral control teeth were measured and compared according to the preoperative and recall periapical radiographs. Results: The average follow-uptime is (25.8±9.9) months (12-46 months). Totally 13 out of the 17 teeth showed normal clinical and radiographic manifestation and achieved the increasein root length and dentin wall thickness. They met criteria for success treatment. The rest 4 out of the 17 teeth also showed root length and dentin wall thickness increaseand apical foramen closure. However, periapical inflammations were observed during 12 to 36 monthfollow-ups. These cases were recognized as failed. In all the17 teeth, the increase of root length and dentin wall thickness was not significantly different between the revascularized teeth and the contralateral control teeth (P>0.05). Conclusions: Pulp revascularization in young permanent teeth with diffuse pulpitis resulted in similar clinical outcomes in root development and root canal wall formation compared with the contralateral control teeth. However, reinfection might occur during long-term follow-up.

Single versus multiple visits for endodontic treatment of permanent teeth

BACKGROUND

Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, tooth cracks or chips, or dental trauma. Successful RoCT is characterised by an absence of symptoms (i.e. pain) and clinical signs (i.e. swelling and sinus tract) in teeth without radiographic evidence of periodontal involvement (i.e. normal periodontal ligament). The success of RoCT depends on a number of variables related to the preoperative condition of the tooth, as well as the endodontic procedures. This review updates the previous version published in 2007.

OBJECTIVES

To determine whether completion of root canal treatment (RoCT) in a single visit or over two or more visits, with or without medication, makes any difference in term of effectiveness or complications.

SEARCH METHODS

We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 14 June 2016), Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 5), MEDLINE Ovid (1946 to 14 June 2016), and Embase Ovid (1980 to 14 June 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 14 June 2016. We did not place any restrictions on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and quasi-RCTs of people needing RoCT. We excluded surgical endodontic treatment. The outcomes of interest were tooth extraction for endodontic problems; radiological failure after at least one year, i.e. periapical radiolucency; postoperative pain; swelling or flare-up; painkiller use; sinus track or fistula formation; and complications (composite outcome including any adverse event).

DATA COLLECTION AND ANALYSIS

We collected data using a specially designed extraction form. We contacted trial authors for further details where these were unclear. We assessed the risk of bias in the studies using the Cochrane tool and we assessed the quality of the body of evidence using GRADE criteria. When valid and relevant data were collected, we undertook a meta-analysis of the data using the random-effects model. For dichotomous outcomes, we calculated risk ratios (RRs) and 95% confidence intervals (CIs). For continuous data, we calculated mean differences (MDs) and 95% CIs. We examined potential sources of heterogeneity. We conducted subgroup analyses for necrotic and vital teeth.

MAIN RESULTS

We included 25 RCTs in the review, with a total of 3780 participants, of whom we analysed 3751. We judged three studies to be at low risk of bias, 14 at high risk, and eight as unclear.Only one study reported data on tooth extraction due to endodontic problems. This study found no difference between treatment in one visit or treatment over multiple visits (1/117 single-visit participants lost a tooth versus 2/103 multiple-visit participants; odds ratio (OR) 0.44, 95% confidence interval (CI) 0.04 to 4.78; very low-quality evidence).We found no evidence of a difference between single-visit and multiple-visit treatment in terms of radiological failure (risk ratio (RR) 0.91, 95% CI 0.68 to 1.21; 1493 participants, 11 studies, I² = 18%; low-quality evidence); immediate postoperative pain (dichotomous outcome) (RR 0.99, 95% CI 0.84 to 1.17; 1560 participants, 9 studies, I² = 33%; moderate-quality evidence); swelling or flare-up incidence (RR 1.36, 95% CI 0.66 to 2.81; 281 participants, 4 studies, I² = 0%; low-quality evidence); sinus tract or fistula formation (RR 0.98, 95% CI 0.15 to 6.48; 345 participants, 2 studies, I² = 0%; low-quality evidence); or complications (RR 0.92, 95% CI 0.77 to 1.11; 1686 participants, 10 studies, I² = 18%; moderate-quality evidence).The studies suggested people undergoing RoCT in a single visit may be more likely to experience pain in the first week than those whose RoCT was over multiple visits (RR 1.50, 95% CI 0.99 to 2.28; 1383 participants, 8 studies, I² = 54%), though the quality of the evidence for this finding is low.Moderate-quality evidence showed people undergoing RoCT in a single visit were more likely to use painkillers than those receiving treatment over multiple visits (RR 2.35, 95% CI 1.60 to 3.45; 648 participants, 4 studies, I² = 0%).

AUTHORS' CONCLUSIONS

There is no evidence to suggest that one treatment regimen (single-visit or multiple-visit root canal treatment) is better than the other. Neither can prevent all short- and long-term complications. On the basis of the available evidence, it seems likely that the benefit of a single-visit treatment, in terms of time and convenience, for both patient and dentist, has the cost of a higher frequency of late postoperative pain (and as a consequence, painkiller use).

Morphologic variations in mandibular premolars: a report of three cases

AIM

To report cases with morphologic variations in mandibular premolars.

BACKGROUND

Mandibular premolars have earned the reputation for having aberrant anatomy. The occurrence of three canals with three separate (type V, Vertucci) foramina in mandibular premolars is very rare. In this report, three cases are presented involving the root canal treatment of mandibular premolars with three different root and canal configurations. The present report also emphasizes the use of the dental operating microscope to enhance visualization.

CASE DESCRIPTION

Correlation between radiographic findings, use of dental operating microscope and knowledge of aberrant anatomy helps to identify, locate and treat the aberrant anatomy of the tooth.

CLINICAL SIGNIFICANCE

The treatment was successful as all canals were identified and filled and also as evidenced by relief of symptoms.

CONCLUSION

Success is largely dependent on the use of magnification, which aided in identifying the location of the three individual root canal orifices; thus emphasizing the need to familiarize ourselves with dental microscopy, to obtain maximal anatomic information in endodontic practice.

Pulp therapy in pediatric patients with congenital heart disease: survey of American Academy of Pediatric Dentistry members

PURPOSE

The purpose of this study was to identify treatment options recommended by American Academy of Pediatric Dentistry (AAPD) members concerning pulp treatment in primary teeth in pediatric patients with congenital heart disease (CHD).

METHODS

A web-based survey was sent to all active members of the AAPD. The survey contained radiographs of pulpally involved primary teeth, a description of associated signs/symptoms, and a medical history of the patient who was positive for a type of CHD. Pediatric dentists were requested to report treatment recommendations.

RESULTS

Of the 6,590 surveys sent, 1,493 surveys (23%) were completed. Most respondents preferred to extract the tooth with the clinical presentation of irreversible pulpitis followed by distal shoe space maintenance when the patient presented with a negative medical history. By contrast, approximately half of the respondents elected to extract this tooth without space maintenance for all of the cardiac conditions. By contrast, most respondents elected to perform a pulpotomy in the case of reversible pulpitis regardless of the medical history. Indirect or direct pulp therapy were the least chosen options for both presentations.

CONCLUSIONS

The presence of CHD affects treatment decisions in teeth exhibiting irreversible pulpitis with symptomatic apical periodontitis but not in teeth displaying reversible pulpitis with a normal periodontal status.

Using spiral computed tomography for endodontic management of a mandibular first molar with a middle mesial canal: a case report

The root canal anatomy of a permanent mandibular first molar has been traditionally described as 2 roots--1 mesial and 1 distal--with 2 canals in the mesial root and 1 or 2 canals in the distal root. Nonetheless, other possibilities exist. The presence of a third canal in the mesial root has been reported to have an incidence of 0%-17%. Conventional radiographs are routinely used to determine root canal anatomy; however, these are 2-dimensional representations of a 3-dimensional object. Advanced diagnostic methods that can provide 3-dimensional data, such as spiral computed tomography (SCT), is very helpful in determining complex morphology. This case report presents the management of a mandibular first molar with 3 mesial and 2 distal canals, confirmed with the aid of both SCT and conventional radiographic methods.

Clinical evaluation of three caries removal approaches in primary teeth: a randomised controlled trial

OBJECTIVE

To evaluate the clinical performance and radiographic outcome of glass ionomer cement (GIC) restoration in primary molars using three caries removal techniques.

BASIC RESEARCH DESIGN

Randomised clinical controlled trial.

CLINICAL SETTING

Two standard dental clinics in 2 hospitals near Bangkok.

PARTICIPANTS

A total of 276 children, aged 6-11, having dentinal caries on the occlusal and/or proximal surface extending at least one-third of dentine without signs and/or symptoms of irreversible pulpitis.

INTERVENTION

Children were randomly allocated into 3 study groups with different caries removal techniques: Group 1, partial soft caries removal at enamel-dentine junction (EDJ) by spoon excavation; Group 2, complete soft caries removal by spoon excavation; and Group 3, conventional caries removal by steel burs. All cavity preparations were restored with GIC (Fuji IX, GC Corp., Japan).

MAIN OUTCOME MEASURES

Clinical and radiographic evaluations were carried out at 6 and 12 months after restoration.

RESULTS

After 12 months, 89, 89, and 88 restorations in Groups 1, 2 and 3 were evaluated. The cumulative survival rates of GIC restorations in Groups 1, 2 and 3 were 83%, 83%, and 89% while the cumulative survival rates of pulp were 99%, 100% and 98% respectively. There were no statistically significant differences in the survival of GIC restorations or pulp in the three groups (p > 0.05).

CONCLUSION

The clinical and radiographic evaluations after 12 months indicated that partial soft caries removal at EDJ followed by GIC restoration was comparable to that of ART and conventional approaches.

Clinical and radiographic evaluation of vital pulp therapy in open apex teeth with MTA and ZOE

The purpose of this study was to report the success rate of using mineral trioxide aggregate (MTA) and zinc oxide eugenol (ZOE) as vital pulp therapy agents in immature permanent teeth with carious or traumatic pulp exposure. Subjects were children with permanent teeth requiring pulpotomy (apexogenesis) and without systemic diseases. Both ZOE and MTA treatments as pulpotomy agents showed clinical and radiographic success in immature permanent teeth. Although MTA was more successful, it is more expensive, and dentin bridges may develop over canal orifices, complicating future root canal therapy.

Florid cemento-osseous dysplasia mimicking apical periodontitis: A case report

Cemento-osseous dysplasia may present as a focal, periapical or florid lesion in the mandible or maxilla. The lesion may sometimes appear similar to peri-radicular lesions on a periapical radiograph. This report presents a case with irreversible pulpitis and root resorption as well as a mixed radiolucent/radiopaque lesion around a mandibular molar tooth root. Root canal treatment was performed and because of the radiographic signs of root resorption and the patient's fear of having a malignant disease, periapical surgery was also performed. The histopathology report confirmed the presence of florid cement-osseous dysplasia which was mimicking apical periodontitis. Follow-up radiography 12 months after the surgery illustrated complete healing of the radiolucent area.

Long-term radiologic pulp evaluation after partial pulpotomy in young permanent molars

OBJECTIVE

Radiographic appearance of pulp reactions to partial pulpotomy in young permanent molars with deep caries may determine the efficiency of the procedure. The objective of this study was to determine the value of this procedure by analyzing the pulpal and periapical appearance of permanent molars after long-term follow-up periods.

METHOD AND MATERIALS

Based on predetermined radiologic criteria, periapical radiographs of 49 young permanent molars of 31 females and 13 males, aged 6.9 to 17.7 years (mean, 11.4 years) treated with partial pulpotomy were evaluated and compared to their antimeres. Follow-up time ranged from 7 to 154 months (mean, 49 months).

RESULTS

Based on clinical and radiographic findings, the success rate was considered 93.9% (46 of 49 teeth). Three teeth had chronic pulpitis with periapical exacerbation. In 14 (30.4%) of the 46 teeth, normal radiographic pulp appearance was found, and in 2 (4.3%), pulpal calcifications were similar to their antimere tooth. Dentinal bridges were observed underneath the partial pulpotomy site in 27 molars (58.7%), while radiopacities in the pulpotomized pulp horns of 5 teeth (10.9%) suggested development of obstructive calcifications. Increased calcifications of the pulp were seen in 13 (28.3%) molars, in comparison with their antimeres. Six of the 46 molars with immature root development completed full apexogenesis. No periapical pathoses, total pulp obliteration, or resorption were observed.

CONCLUSION

The long-term radiologic interpretation of the pulp after partial pulpotomy in young permanent molars supports the clinical impression that it is a warranted treatment in well-chosen cases.

Maxillary second molar with 5 roots and 5 canals evaluated using cone beam computerized tomography: a case report

This case report presents the endodontic management of maxillary right second molar exhibiting 5 roots and 5 root canals. The diagnosis was confirmed with the help of cone beam computerized tomography (CBCT). The article also describes the varied morphology associated with maxillary second molar and the use of a high-end diagnostic imaging modality like CBCT in diagnosing and negotiating these anatomic variations.

[Mistakes and complications appearing during treatment of chronic pulpitis of the deciduos teeth in children]

On the basis of clinical data dentists' mistakes and complication appearing in treatment of chronic pulpitis of the deciduous teeth in children in private dental clinics were investigated. Causes of their occurrence were revealed and ways of their prophylaxis were suggested.

The endodontic diagnostic puzzle

Endodontic diagnosis is the cornerstone of endodontic treatment. Endodontic diagnosis can be likened to a puzzle, where the pieces must be gathered and pieced together before a clinician can see the complete picture. This article discusses how to collect the pieces and fit them together to see the pulpal and periapical diagnosis emerge.

Endodontic treatment of a mesotaurodont maxillary first molar: a case report

Taurodontism is an abnormal morphological trait of tooth shape, which usually occurs in multi-rooted teeth. An enlarged pulp chamber and apical displacement of the pulpal floor are characteristics. Endodontic treatment ofa taurodont tooth may be very difficult because it requires special care in identifying and treatment of the complex root canal system. The endodontic treatment ofa taurodont maxillary first molar is presented.

Single versus multiple visits for endodontic treatment of permanent teeth

BACKGROUND

Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, tooth cracks or chips, or dental trauma. Successful RoCT is characterised by an absence of symptoms and clinical signs in teeth without radiographic evidence of periodontal involvement. The success of RoCT depends on a series of variables related to the preoperative condition of the tooth, as well as the endodontic procedures.

OBJECTIVES

To compare the effectiveness of single- and multiple-visit RoCT, measured as tooth extraction due to endodontic problems and radiological success.To assess the difference in short- and long-term complications between single- and multiple-visit RoCT.

SEARCH STRATEGY

The following databases were searched for relevant trials: Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, and EMBASE. Handsearching was performed for the major oral medicine journals. References of included studies and reviews were checked. Endodontics experts were contacted through e-mail. No language limitations were imposed. Date of last search was 6th March 2007.

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials of patients needing RoCT were included. Surgical endodontic treatment was excluded. The outcomes considered were the number of teeth extracted for endodontic problems; radiological success after at least 1 year, that is, absence of any periapical radiolucency; postoperative pain; painkiller use; swelling; or sinus track formation.

DATA COLLECTION AND ANALYSIS

Data were collected using a specific extraction form. The validity of included studies was assessed on the basis of allocation concealment, blindness of the study, and loss of participants. Data were analysed by calculating risk ratios. When valid and relevant data were collected, a meta-analysis of the data was undertaken.

MAIN RESULTS

Twelve randomised controlled trials were included in the review. Four studies had a low risk of bias, four a moderate risk, and another four had a high risk of bias. The frequency of radiological success and immediate postoperative pain were not significantly different between single- and multiple-visit RoCT. Patients undergoing single-visit RoCT reported a higher frequency of painkiller use and swelling, but the results for swelling were not significantly different between the two groups. We found no study that included tooth loss and sinus track formation among its primary outcomes.

AUTHORS' CONCLUSIONS

No difference exists in the effectiveness of RoCT, in terms of radiological success, between single- and multiple-visit RoCT. Most short- and long-term complications are also similar in terms of frequency, although patients undergoing a single visit may experience a slightly higher frequency of swelling and are significatively more likely to take painkillers.

A clinical classification of the status of the pulp and the root canal system

Many different classification systems have been advocated for pulp diseases. However, most of them are based on histopathological findings rather than clinical findings which leads to confusion since there is little correlation between them. Most classifications mix clinical and histological terms resulting in misleading terminology and diagnoses. This in turn leads to further confusion and uncertainty in clinical practice when a rational treatment plan needs to be established in order to manage a specific pathological entity. A simple, yet practical classification of pulp diseases which uses terminology related to clinical findings is proposed. This classification will help clinicians understand the progressive nature of the pulp disease processes and direct them to the most appropriate and conservative treatment strategy for each condition. With a comprehensive knowledge of the pathophysiology of pain and inflammation in the pulp tissues, clinicians may accomplish this task with confidence.

[Comprehensive endodontic treatment with the use of depo- and galvanophoresis with copper hydroxide-calcium]

In the blind and randomized study in cases of routine endodontic treatment of 460 teeth in 372 patients high efficacy of additional use of depo- and galvanophoresis with copper hydroxide-calcium according to the technique modified by the authors.

Dens invaginatus type II: case report with 2-year radiographic follow-up

Dens invaginatus is a malformation of teeth probably resulting from an infolding of the dental papilla during tooth development. Clinically, it is frequently characterized by unusual crown morphology. It is common to see peg- or barrel-shaped teeth. The present case describes dens invaginatus in a lateral maxillary incisor (Oehler type II) with a barrel-shaped crown of a 12-year-old female patient; endodontic treatment and adhesive restoration were performed. After two years the tooth showed no signs of pathosis.

A retrospective assessment of zinc oxide-eugenol pulpectomies in vital maxillary primary incisors successfully restored with composite resin crowns

PURPOSE

The purpose of this retrospective study was to evaluate, via clinical and radiographic assessments, the treatment outcome of zinc oxide-eugenol (ZOE) pulpectomies performed in vital maxillary primary incisors successfully restored with composite resin crowns.

METHODS

Pulpectomized vital primary incisors were treated by a uniformed technique, filled with ZOE paste, and successfully restored with composite resin crowns. Those that remained intact and noncarious for the assessment interval were evaluated for the outcome (success or failure) based on clinical and radiographic findings and compared to: (1) the reason for treatment; (2) the canal filling extent; (3) the type of composite resin crown restoration performed; and (4) the eruption status of its succedaneous tooth.

RESULTS

For 104 maxillary primary incisors meeting the inclusion criteria, failure, as judged by presence of pathologic root resorption and/or apical lucency, was determined to be 24% (25/104), for a mean duration of 18 months observation. Failures were statistically associated with the reason for treatment (higher for trauma), the extent of ZOE paste filler in the pulp canal (higher for gross overfill), and the eruption status of the associated succedaneous permanent incisor (higher for delayed eruption).

CONCLUSIONS

This study determined a failure rate (24%) for pulpectomies-using ZOE paste and performed on vital primary incisors-comparable to that reported for nonvital pulpectomies. A statistically significant increase in failure rates was found for: (1) incisors treated for trauma (42%) vs those treated for dental caries (19%); and (2) grossly overfilled canals (80%) vs canals filled to the apex (0%).

21st Century Endodontics: Part 1

Root canal treatment techniques probably develop and change more frequently than any other area of dental practice and it can be hard for the busy general dental practitioner to keep up to date. The aim of this series of five papers is to give a thorough review of current teaching and practice. This will encompass the rationale of root canal treatment, guidance on the latest technical procedures for preparation and obturation of the entire root canal system, and consideration of how these principles may contribute to successful treatment. The series will address the following issues: diagnosis and treatment planning; root canal morphology and access; control of infection by effective isolation and anti-microbial agents; the philosophy of modern canal preparation techniques; single- or multi-visit treatment with relevant canal medication; obturation; diagnosis of failure and considerations in re-treatment. It is hoped that readers will be encouraged by the series to question their own techniques, audit their outcomes, and adopt new techniques only after careful reflection of the underlying principles involved.

[Clinical results of potassium nitrate use in polycarboxylate cement for biological treatment of reversible pulpitis]

To determine effectiveness of indirect pulp capping with 5% potassium nitrate in polycarboxylate cement for biological treatment of reversible pulpitis, a clinical study of 232 teeth with active caries lesions from 205 healthy patients aged from 16 to 40 years was performed. They were divided into 2 groups: the study group--140 teeth of 127 persons with 5% potassium nitrate in polycarboxylate cement (Carboxy Adhesor); control group--92 teeth of 78 persons with calcium-hydroxide cement (Dycal). Short-term clinical results showed better desensitizing effect and faster recovery to normal values of electric vitality in teeth treated by potassium nitrate in comparison with Dycal lining (p<0.001). Long-term follow-up (up to 2 years) showed good functional conditions, preserved vitality and x-ray status of the treated teeth.

[Role of spiral computed tomography in the diagnosis of complications due to endodontic treatment]

The paper deals with the diagnosis of some errors in endodontic treatment by spiral computed tomography.

[Initial clinic research on curved canal preparation by reverse flaring technique]

OBJECTIVE

Curved canal preparation is much difficult in root canal therapy(RCT). Step back technique and routine technique are still regular methods in curved canal preparation. The purpose of this study was to introduce a new method reverse flaring technique, and to investigate its preparation efficiency in intermediate-curvature canals.

METHODS

48 cases of lower first molars RCT were collected, which were first treated because of pulpitis or apical periodontitis in West China College of Stomatology, Sichuan University from Nov. 2001 to Aug. 2003, mesial canal curvature was intermediate (30 degrees-60 degrees), determined by Schineider method. Cases were divided into two groups, in reverse flaring technique group, canal preparation in 27 cases were finished by reverse flaring technique, 21 cases by step back technique as control. In working length determination and fitting master cone stages, cases in two groups which fit full working length were recorded, determined by radiograph, and analyzed by chi 2 test.

RESULTS

In working length determination stage, cases which fit full working length in reverse flaring technique group were significantly more than that of step back technique group (P < 0.05), in fitting master cone stage, cases which fit full working length in reverse flaring technique group were also significantly more than that of step back technique group(P < 0.05).

CONCLUSION

In working length determination stage, cases which fit full working length in reverse flaring technique group were significantly more than that of step back technique group (P < 0.05), in fitting master cone stage, cases which fit full working length in reverse flaring technique group were also significantly more than that of step back technique group(P < 0.05).

Evaluating IL-2 levels in human pulp tissue

In murine and human CD4+ T cell populations, there are three subpopulations of T helper cell types. Hahn et al. demonstrated the ratio of CD4/ CD8 + cells significantly increases in inflamed dental pulps compared with normal pulps. Elevated levels of interleukin (IL)-2 have been detected in inflamed dental pulps and the level of IL-2 could be used as a marker for inflammation. In this study, levels of IL-2 were evaluated by using a human IL-2 cytokine assay kit on 80 samples of freshly extracted human pulp tissue. Applying standard diagnostic procedures, the tissue samples were clinically categorized into one of three experimental groups. The results demonstrated that there were no significant differences between the concentrations of IL-2 in any of the experimental groups. Our findings are different from results reported previously. Further investigation is warranted to determine if a correlation exists between the concentration of IL-2 or other interleukins and the degree of inflammation present in the dental pulp.

Chronic pigmented purpura associated with odontogenic infection

Five patients with chronic pigmented purpura associated with odontogenic infection are described. Four patients had Schamberg's disease, and one had itching purpura. These patients were resistant to topical corticosteroid treatment, but appearance of purpuric spots ceased after treatment for periodontitis, pulpitis, or both. No circulating immune complexes were detected, and neither immunoglobulin nor complement was deposited in the papillary vessels of the skin. Odontogenic infection might be one of the precipitating factors for chronic pigmented purpura.

Root-canal treatment of a trifid crown premolar

AIM

To describe successful root-canal treatment of a permanent maxillary first premolar with unusual anatomy.

SUMMARY

A diagnosis of irreversible pulpitis of a geminated first premolar was made. Clinical and radiographic examination revealed a tooth with a trifid crown that joined to give the appearance of a single root at the cementoenamel junction. Root-canal treatment involved three separate access openings and treating four canals, three of which joined to exit through a common foramen.

KEY LEARNING POINTS

Symptomatic teeth with morphological aberrations can be saved by root-canal treatment. Careful clinical and radiographic evaluation are essential, as treatment must be modified to address the unusual complexities of the root-canal system(s).

Localized intrinsic staining of teeth due to pulpitis and pulp necrosis in dogs

Dental charts and records of 71 dogs were received and 84 intact tooth crowns were noted to have been entirely discolored in shades of pink, purple, grey, or tan. Endodontic therapy was performed on 49 of these teeth allowing gross examination of the entire pulp. In exploratory pulpotomy was performed in 15 teeth prior to exodontic therapy in order to assess the integrity of the coronal pulp. Gross signs of partial or total pulp necrosis were present in 59 (92.2%) of these teeth. The pulp was not observed grossly in 20 teeth which received exodontic therapy. Overall, of the 84 teeth evaluated, 36 (42.9%) had no radiographic signs of endodontic disease. Gross or radiographic signs of endodontic disease were absent in only 2 (4.1%) discolored teeth receiving endodontic therapy. Based on the low incidence of vital, affected teeth in the dogs of this study, endodontic on exodontic therapy is recommended for discolored teeth.

Results of crown-height reduction and partial coronal pulpectomy in rhesus monkeys (Macaca mulatta)

BACKGROUND AND PURPOSE

In research facilities using non-human primates, crown-height reduction with partial coronal pulpectomy ("vital pulpotomy") is routinely performed on canine teeth of adult male monkeys to reduce self-trauma and the potential for injury to staff or cage-mates. Success of pulpotomy techniques in humans is reportedly 40 to 60%. Failure leads to chronic inflammation and pulp necrosis, which introduces variability in research animals, and may affect research results. The purpose of the study reported here was to determine failure rate of this procedure by evaluating clinical and radiographic findings at 3, 9, and 24 months after crown amputation and partial coronal pulpectomy of maxillary canines in adult male rhesus monkeys.

METHODS

Forty-seven maxillary canine teeth from 24 adult male rhesus monkeys were treated by use of crown amputation and partial coronal pulpectomy, using standard dental technique. Follow-up clinical and radiographic examination was performed 3, 9, and 24 months after surgery.

RESULTS

At three months after surgery, there was no clinical evidence of failure at any of the teeth. On the basis of radiographic findings, 2 of 47 teeth had failed and one was suspicious for early failure. At nine months, clinical evidence of failure was not apparent; radiographically, 5 of 44 teeth appeared to have failed and 3 others were suspect. Two years post-operatively, failure was clinically evident at two teeth, with radiographic evidence of failure in five teeth, and suspicion of early failure in an additional six of 41 teeth [corrected].

CONCLUSIONS

The failure rate of crown amputation and partial coronal pulpectomy of canine teeth in adult male rhesus monkeys is high, and the chronic inflammation associated with this is cause for concern.

Clinical preconditions and treatment modality: effects on pulp surgery outcome

BACKGROUND

The purpose of this research was to evaluate the factors affecting the outcome of localized laser pulp surgery in the canine model.

STUDY DESIGN/MATERIALS AND METHODS

Pulpal exposures 2 mm and 5 mm in diameter were prepared in eight healthy teeth in each of five dogs. The total of 40 teeth were left open to infection from the oral cavity for 3 hours or 72 hours; 2-3 mm of surface pulpal tissue were then removed using a fresh diamond bur or a CO2 laser emitting@9.3 microns, at 3.5 W average power in the Superpulse mode. Teeth were monitored clinically and radiographically by one blinded, pre-standardized clinician for 3 months.

RESULTS

Chi-square test and Fisher's Exact test (2-tail) results associated laser treatment with significantly better clinical and radiographic outcome (P < 0.001). Using regression analysis, duration of pulpal exposure to contamination by the oral environment was identified as primary determinant for treatment outcome within the laser-treated and control groups (P = 0.0018).

CONCLUSION

Clinical preconditions significantly affect the outcome of pulp surgery treatments.

[Dental pulp diseases. Ultramicroscopic studies]

After the description of the anatomic and histologic aspects of the healthy dental pulp, stress is laid on pulpal pathologies and on the use of ultramicroscopic techniques to analyze the cytologic modifications in normal and pathologic dental pulp tissues. The results obtained are presented.

Intracoronal radiolucency in an incompletely erupted permanent molar with a diagnosis of pericoronitis: importance of radiographic examination

Because of clinical signs and symptoms, a diagnosis of pericoronitis in a partially erupted, partially impacted first molar was made. A more thorough diagnosis was made with the help of a periapical radiograph that showed caries and thus revealed an irreversible pulpitis. Appropriate treatment was the result.

Success of pulpotomy in the management of hyperplastic pulpitis

Hyperplastic pulpitis is a variety of chronic open pulpitis which is regarded as irreversible. This condition is usually treated by root canal treatment, unless coronal damage does not permit restoration, in which case extraction is indicated. In the present study, 24 permanent teeth of individuals, aged 10-22 years and diagnosed as hyperplastic pulpitis were treated by pulpotomy using an atraumatic surgical technique with calcium hydroxide alone. The treatment was successful in 22 teeth, according to the following criteria: absence of clinical symptoms, absence of any intraradicular or periradicular radiographic pathological changes, presence of dentine bridge detected by clinical examination and sometimes observed radiographically, and sensitivity to electrical stimulation. The follow-up examination ranged from 12 to 48 months. The high frequency of clinical healing in this study appears to justify recommending pulpotomy as the treatment regime in selected cases of chronic hyperplastic pulpitis.

[Diagnosis of dental caries based on intra-oral roentgenograms]

On 238 intra-oral roentgenograms there were assessed carious process, shape, size, extent and depth of defects as well as the possibility of complications in teeth which were not treated. There were assessed 277 defects, out of which 194 in upper teeth and 83 in lower ones. In all the teeth of the maxilla and of the mandible there was found the greatest number of amorphic defects and semilunar contact surfaces. There were also observed a lot of defects in radiciform cementum, thus, often under the gingivae. These are sites difficult for access for clinical examination. That is why radiologic examination is often conclusive in localizing carious process and in accurate diagnosing in the case of pulpitis going on.