Functional Dental Pulp Regeneration: Basic Research and Clinical Translation

Pulpal and periapical diseases account for a large proportion of dental visits, the current treatments for which are root canal therapy (RCT) and pulp revascularisation. Despite the clinical signs of full recovery and histological reconstruction, true regeneration of pulp tissues is still far from being achieved. The goal of regenerative endodontics is to promote normal pulp function recovery in inflamed or necrotic teeth that would result in true regeneration of the pulpodentinal complex. Recently, rapid progress has been made related to tissue engineering-mediated pulp regeneration, which combines stem cells, biomaterials, and growth factors. Since the successful isolation and characterisation of dental pulp stem cells (DPSCs) and other applicable dental mesenchymal stem cells, basic research and preclinical exploration of stem cell-mediated functional pulp regeneration via cell transplantation and cell homing have received considerably more attention. Some of this effort has translated into clinical therapeutic applications, bringing a ground-breaking revolution and a new perspective to the endodontic field. In this article, we retrospectively examined the current treatment status and clinical goals of pulpal and periapical diseases and scrutinized biological studies of functional pulp regeneration with a focus on DPSCs, biomaterials, and growth factors. Then, we reviewed preclinical experiments based on various animal models and research strategies. Finally, we summarised the current challenges encountered in preclinical or clinical regenerative applications and suggested promising solutions to address these challenges to guide tissue engineering-mediated clinical translation in the future.

Non-Surgical Management of Iatrogenic Extrusion of Calcium Hydroxide Based Intracanal Medicament in Clinical Endodontics – A Case Report

Calcium hydroxide is used as an intracanal medicament in endodontics as it reduces intracanal microbial load and exudate discharge from infected teeth. Reports have shown that extrusion of calcium hydroxide periapically leads to an increased incidence of swelling, delayed periapical healing, nerve paraesthesia and other complications. Teeth with immature apex or those undergoing apical resorption are prone to higher chances of periapical medicament extrusion, especially under high pressure delivery systems. This case report discusses nonsurgical management of periapically extruded non-setting calcium hydroxide by an innovative technique which is less invasive and comfortable both for the clinician and the patient. Calcium hydroxide is widely used as an intracanal medicament for the treatment of pulpal and periapical diseases.1 The intracanal placement of calcium hydroxide can be done with a lentulospiral or a syringe-based delivery system.2 If extruded periapically, there is an increased incidence of swelling, delayed periapical healing, nerve paraesthesia and other complications.3 Case reports in the past have suggested surgical management of periapically extruded calcium hydroxide. The purpose of this case report is to discuss an orthograde nonsurgical management of periapically extruded calcium hydroxide based intracanal medicament containing barium sulphate during endodontic treatment.

Effect of Periapical Diseases in Development of MRONJ in Immunocompromised Mouse Model

Objectives. This study aimed to assess the effect of zoledronic acid on an immunocompromised mice model with periapical disease. Materials and Methods. Thirty C57BL/6N mice were randomly divided into three groups (N = 10). All animals were subjected to bilateral ovariectomy (OVX) and then treated with saline (Veh), zoledronic acid (ZA), or concomitant zoledronic acid and dexamethasone (ZA/Dx) for 12 weeks. Eight weeks after starting drug administration, pulpal exposure was conducted on the lower left first molar. Four weeks after pulpal exposure, all mice were sacrificed and the mandibles were collected for radiological and histological examinations. Results. Microcomputed tomography (μ-CT) examination showed significantly reduced periapical bone resorption in the ZA/Dx group and decreased periodontal bone resorption in both ZA and ZA/Dx groups. Higher bone mineral density (BMD) and strengthened microstructure were found in ZA and ZA/Dx groups. More empty lacunae were found in ZA and ZA/Dx groups. Conclusions. Apical periodontitis aggravates MRONJ under immunocompromised circumstances. Concurrent use of ZA and steroids inhibits alveolar bone resorption but increases the risk of developing MRONJ.

Proporsi gambaran radiografis lesi periapikal gigi nekrosis pada radiograf periapikalRadiographic image proportion of necrotic teeth periapical lesions on periapical radiographs

Pendahuluan: Karies merupakan penyakit yang paling banyak terjadi. Pada tahun 2013 kerusakan gigi masyarakat Indonesia adalah 460 buah gigi per 100 orang. Jika dibiarkan tidak dirawat akan berkembang mengarah pada kematian pulpa dan akan menyebar menyebabkan infeksi periapikal. Tahun 2010 penyakit pulpa dan periapikal menempati posisi ke 7 dari 10 penyakit terbanyak pada pasien rawat jalan di rumah sakit di Indonesia. Teknik radiograf yang dapat digunakan untuk diagnosis penyakit pulpa dan periapikal adalah teknik radiografi periapikal. Tujuan penelitian adalah mendapatkan informasi mengenai proporsi gambaran radiografis lesi periapikal gigi nekrosis di RSGM Unpad. Metode: Jenis penelitian deskriptif. Populasi penelitian adalah seluruh radiograf periapiakal gigi nekrosis dengan lesi periapikal pada bulan November 2018 – Januari 2019 di Instalasi Radiologi Kedokteran Gigi RSGM Unpad. Sampel penelitian ditentukan dengan metode purposive sampling. Jumlah sampel sebanyak 54 radiograf periapikal. Hasil: Proporsi gambaran radiografis lesi periapikal yaitu abses periapikal sebanyak 42 kasus (77,78%), granuloma periapikal 8 kasus (14,81%) dan kista periapikal 4 kasus (7,40 %). Simpulan: Proporsi gambaran radiografis lesi periapikal gigi nekrosis di RSGM Unpad didapatkan proporsi tertinggi adalah abses periapikal diikuti granuloma periapikal dan yang terakhir adalah kista periapikal.Kata Kunci: Gigi nekrosis, lesi periapikal, radiograf periapikal ABSTRACTIntroduction: Caries is the most common disease. In 2013, tooth decay of Indonesian people was 460 teeth per 100 people. If left untreated, it will develop, leading to pulp death and will spread, causing periapical infection. In 2010, pulp and periapical diseases were ranked 7th out of the ten most diseases in outpatients of the hospitals in Indonesia. A radiographic technique that can be used for the diagnosis of pulp and periapical disease is a periapical radiographic technique. This study was aimed to obtain information about the radiographic image proportion of necrotic teeth periapical lesions at Universitas Padjadjaran Dental Hospital. Methods: This study was descriptive, with study population was all radiographs of the necrotic teeth periapical lesions in November 2018 - January 2019 at Dentomaxillofacial Radiology Installation of Universitas Padjadjaran Dental Hospital. The research sample was determined by purposive sampling method. The number of samples was 54 periapical radiographs. Results: The radiographic image proportion of necrotic teeth periapical lesions, namely periapical abscesses in 42 cases (77.78%), periapical granuloma in 8 cases (14.81%) and periapical cysts in 4 cases (7.40%). Conclusion: The radiographic image proportion of necrotic teeth periapical lesions at Universitas Padjadjaran Dental Hospital mostly are periapical abscesses, followed by periapical granuloma, and the least is periapical cysts.Keywords: Necrotic teeth, periapical lesions, periapical radiographs

Historical and Contemporary Perspectives on the Microbiological Aspects of Endodontics

The microbiota of the oral cavity plays a significant role in pulpal and periapical diseases. Historically, 100 years ago little was known on microbiota, but after a century of investigations, only now can many of the intimate secrets of microbial growth, expansion, persistence, communal activities, and virulence be revealed. However, with the capabilities of the microbiota for mutation, quorum sensing, and information transference, researchers are hard-pressed to keep up with both the changes and challenges that an amazingly wide range of bacterial species pose for both the scientist and clinician. Fortunately, the development and expansion of a vast array of molecular biological investigative techniques have enabled dentistry and its associated medical fields to attempt to keep pace with the wide and fascinating world of oral microbiology.

Odontal and Protetic Reconstruction in Total Coronar Fractures

Beyond the acute character, two important aspects confer specificity to the dento-periodontal traumas: the age of the patients and the multidisciplinary attend of the therapeutic approach. The traumas, together with the dento-periodontal infections, are real pedodontic emergencies. Dento-periodontal traumas are lesions requiring careful examination to establish a correct diagnosis and a rapid establishment of appropriate treatment. They require a rapid diagnosis, an optimal therapeutic attitude, to resolve dento-periodontal structures and further harmonious development of the jaws. The coronary traumas that amputate the dental crown result from trauma that develop high intensity forces, with a point of application to the tooth cervical area, accompanied by other types of injuries. Radical status evaluation is performed paraclinically by imaging exploration methods. Information on root length, implantation, absence or presence of periapical diseases, endodontic treatment quality are fully provided by these methods.Clinically, the diameter of the roots of the teeth is evaluated. The analysis and synthesis of these data will allow the determination of the method of substitution and the planning of working methods. Material and Method: The study group comprises 39 children aged 6-16, most of them present for emergency treatment. Results and Discussion: The traumatic agent�s force exceeds the resistance and elasticity of tissues, causing discontinuities in the tissue structure, whether soft or rough. Conclusions: The provisional or final treatment of dento-periodontal traumas aims at restoring the morphological, functional and psychological integrity of the traumatized individual.

Accessory Mental Foramen of the Mandible Found With Radiographic Images: A Case Report

The object of this study is to present a case of an accessory mental foramen. Detection of the position of mental foramen is important during surgical procedures in terms of achieving effective mandibular nerve blocks and avoiding injuries to the neurovascular bundles. A 64-year-o1d man visited us for taking treatment. Preoperative panoramic radiography and CT were conducted. A multi-section reconstructed sagittal image showed two mental foramina leading to the mandibular canal on the right side of the mandible, which were considered to be double mental foramina. Although no surgical procedure was planned, the patient was informed about the existence and importance of the anatomical variation with regard to the need for local anesthesia, diagnosis of periapical diseases, and the prevention of nerve damage during surgery in that area of his mandibleJ Shaheed Suhrawardy Med Coll, 2014; 6(2):90-92

Role of Periapical Diseases in Medication-Related Osteonecrosis of the Jaws

Objective. The present study aimed to investigate the role of periapical diseases in inducing medication-related osteonecrosis of the jaws (MRONJ) using an ovariectomized (OVX) mice model. Materials and Methods. Twenty C57BL/6N female mice were randomly assigned to two groups. All mice were subjected to bilateral ovariectomy and then treated with oncologic dose of zoledronic acid (ZA) or vehicle for twelve weeks. Eight weeks after commence of drug administration, a pulpal exposure (PE) operation was performed on the first right lower molar to induce periapical periodontitis; the contralateral non-PE tooth was used as control. All animals were sacrificed four weeks after pulpal exposure, and the mandibles were harvested for radiological and histomorphometrical analysis. Results. Micro computed tomography (μ-CT) examination demonstrated that periapical diseases significantly increased alveolar bone resorption, and the resorption was greatly attenuated by ZA treatment. Concurrent ZA therapy significantly increased bone density and histological osteocyte necrosis in the presence of periapical lesions. Conclusion. ZA treatment reduced bone absorption resulting from periapical disease but increased the risk of developing MRONJ in the ovariectomized mouse model.