Clinical Factors Affecting the Results of Regenerative Endodontic Procedure

This study retrospectively analyzed the effect of clinical factors on the outcomes of REP(regenerative endodontic procedure). Patients who received the REP using triple antibiotic paste due to trauma or fracture of dens evaginatus from February, 2011 to January, 2020 were included in the study. Finally, 57 teeth in 54 patients were selected. Investigated clinical factors were as follows: intentional bleeding, etiology, and root development stage. Treatment outcomes evaluated were as follows: improvement of subjective symptoms, changes in the periapical lesion, and the amounts of root development after REP. To compensate for differences in angulation and position between repeated radiographic examinations, images were aligned by Turboreg plugin. To evaluate the amounts of root development, apical diameter, root area, and root length were measured by ImageJ software. Among the aforementioned factors, intentional bleeding had no significant effect on treatment results. Regarding the etiology, the increase in the root area and the root length was significantly less in trauma cases than in dens evaginatus fracture cases. Considering root development stage, more immature teeth presented more increase in the root area.

Void characteristics and tortuosity of calcium silicate-based cements for regenerative endodontics: a micro-computed tomography analysis

Background Internal voids of materials can serve a hub for microorganism and affect the sealing ability. This study aimed to evaluate the sealing performance of calcium silicate-based cements in immature teeth treated with regenerative endodontics. Methods Twenty single root canals from immature permanent premolars were prepared using regenerative endodontic protocols. The root canals were randomly divided into two groups and sealed with mineral trioxide aggregate (MTA) and Biodentine (BD). The teeth were kept in humid environment for 7 days and scanned using micro-computed tomography. The voids within the cements were segmented and visualized using image processing, incorporating the modified Otsu algorithm. The porosity of each sample was also calculated as the ratio between the number of voxels of voids and the volume of the cements. Tortuosity was also calculated using the A-star algorithm. Results Voids larger than 70 μm were predominantly observed in the top and interfacial surface of cements. The others were evenly distributed. MTA and BD showed the same level of porosity and tortuosity at interfacial surfaces. In inner surfaces, MTA showed more less porosity and tortuosity compared to BD (p < 0.05). Conclusions There were no differences in sealing performance between MTA and BD.

Apical Sealing Ability of Two Calcium Silicate-Based Sealers Using a Radioactive Isotope Method: An In Vitro Apexification Model

The aim of this study was to evaluate and compare the sealing ability of two calcium silicate-based sealers (TotalFill BC RRM Fast Set Putty and White ProRoot MTA) when used as apical plugs in immature teeth through nuclear medicine. Single-rooted extracted teeth (n = 34) had their crowns and root tip sectioned to obtain 14 mm long root segments to simulate an in vitro apexification model. Were created two experimental groups, namely MTA (n = 12) and BC (n = 12), and two control groups, PG (positive group, n = 5) and NG (negative group, n = 5). On the 4th day after placing the respective apical plug, the apical portions of the teeth were submerged in a solution of sodium pertechnetate (99mTcNaO4) for 3 h. Statistical analysis showed a significant difference between the MTA group and the controls (p < 0.05). The BC group had a significant difference regarding the negative control (p < 0.001) but showed no statistical significance regarding the positive control (p = 0.168). There was a statistically significant difference (p = 0.009) between the BC group (7335.8 ± 2755.5) and the MTA group (4059.1 ± 1231.1), where the last showed less infiltration. Within the limitations of this study, White ProRoot MTA had a significantly better sealing ability than TotalFill BC RRM Fast Set Putty.

Unpredictable Outcomes of a Regenerative Endodontic Treatment

Regenerative endodontic treatment (RET) is a valuable treatment for necrotic immature teeth with many advantages such as increasing root length and thickness of root wall. The success of RETs is based on healthy stem cells, suitable scaffolds, and growth factors and takes place when bacterial contamination is well controlled. The aim of this article is to address controversy in a case with multiple success criteria. This paper reports a 9-year-old boy with a complicated crown fracture of the maxillary left central incisor about three years prior to referral with a diagnosis of intrusive luxation with spontaneous reeruption. The tooth had an underdeveloped root and a well-defined periapical radiolucent lesion around the root apex. RET was considered according to the stage of root development. Upon the three-week recall session, the clinical examination indicated that the patient was asymptomatic in the affected site. However, the patient returned two weeks later with a sinus tract pertaining to the apex of tooth #9. Therefore, debridement of the root canal space was repeated and the RET redone. On the second trial, the patient was symptom-free, but no more evidence of root maturation was observed on 18-month follow-up. The tooth was asymptomatic (without swelling, drainage, and pain) during this time, and esthetics was provided for the patient.

Regenerative Endodontics Procedure in Treatment of Permanent Immature Teeth with Necrotic Pulp

Aim: To evaluate the radiographical success of Regenerative endodontics procedure in permanent immature teeth with necrotic pulp. Methods: This Descriptive case series was conducted at the Department of Operative Dentistry, de’Montmorency College of Dentistry/ Punjab Dental Hospital, Lahore from November 2015 to November 2016. A total of 30 cases were included using non-probability consecutive sampling. Patients of both genders with age range from 9 to 14 years were considered. Performance of procedure and evaluation of success was done in terms of root development on periapical radiographs. . Data was entered and analysed with IBM SPSS 20. Level of significance was kept at p-value ≤ 0.05 Results: Out of 30 patients, 13 were females and 17 were males. Mean age of patients included in this study was 11.5±1.737. Follow up at 12 months showed 90% success, with 27 cases showed root development on periapical radiograph. There was no significant relation of success with age and gender of patient with p- value greater than 0.05. Conclusion: It is concluded from current study that Regenerative Endodontics procedure in permanent immature teeth is encouraging and can be recommended for the treatment of permanent immature teeth with necrotic pulp. Further research studies are required for evaluation of root development in regenerative endodontics procedure. Key words: Regenerative Endodontics, Permanent Immature teeth, Root development

Evaluation of pulp vitality using a pulse oximeter in patients undergoing radiotherapy for rhabdomyosarcoma or rhinopharynxcarcinoma

The oral cavity is highly susceptible to pathological changes due to the deleterious effects of radiation (RI) on tissues exposed during radiotherapy (RT). The aim of this study was to evaluate the feasibility of using pulse oximeter (PO) as a diagnostic instrument for assessing the pulp oxygenation level (%SpO2) of immature teeth previously exposure to IR. Pulp oxygenation saturation was evaluated in fifteen children or adolescent patients (Group RT) that received previous IR, 6.01 years ago (SD 4.08 years), and fifteen patients without a history of neoplasms or previous chemotherapy or radiotherapy (CO group). As result, the mean %SpO2 measured in Group RT and Group CO was 86.06% (SD 1.61%) and 91.11% (SD 0.87%), respectively. Conclusions: The use of the pulse oximeter adapted for dentistry for pulpal vitality evaluation in patients who received radiotherapy is feasible showing lower level of SpO2 than that of the control group (p<0.05).

The Effect of Two Calcium Silicate Materials on the Fracture Strength of Simulated Immature Teeth during Regenerative Endodontic Treatment

BACKGROUND Necrotic immature permanent teeth undergoing Regenerative Endodontic Treatment (RET) are subjected to functional forces that might lead to their fracture before achieving apical closure. This study compared the fracture strength of simulated immature teeth treated with RET that were subjected to cyclic loading. METHODS Thirty human anterior teeth were randomly assigned into three groups (Group I: control, groups II and III: prepared to simulate immature teeth then subjected to RET with EndoSequence Root Repair Material (ESRRM) and white Mineral Trioxide Aggregate (WMTA) used as coronal barriers, respectively). All specimens were mounted on customized mold and subjected to cyclic loading until fracture or to a maximum of 165,000 cycles. The number of endured cycles and the maximum load applied at failure were recorded. Chi-square analysis was done to compare the frequency of fracture while One - Way ANOVA followed by Tukey’s Post Hoc test were done to compare means for the number of endured cycles and the maximum load applied to failure. RESULTS There was no significant difference between the three groups regarding the frequency of fracture (P > 0.05). There was no significant difference between the mean number of cycles endured or force at failure between group I and II or groups II and III (P > 0.05). However, group III endured significantly less force (P= 0.008) and significantly lower number of cycles (P = 0.014) compared to group I. CONCLUSIONS Within the limitation of this study, there was no significant difference between ESRRM and WMTA regarding their reinforcement of teeth treated with RET. KEY WORDS EndoSequence Root Repair Material, Fracture Strength, Immature Teeth, Mineral Trioxide Aggregate, Regeneration