Pulp canal obliteration (PCO) is a frequent finding associated with pulpal revascularization after luxation injuries of young permanent teeth. The underlying mechanisms of PCO are still unclear, and ...no experimental scientific evidence is available, except the results of a single histopathological study. The lack of sound knowledge concerning this process gives rise to controversies, including the most suitable denomination. More than a mere semantic question, the denomination is an important issue, because it reflects the nature of this process, and directly impacts the treatment plan decision. The hypothesis that accelerated dentin deposition is related to the loss of neural control over odontoblastic secretory activity is well accepted, but demands further supportive studies. PCO is seen radiographically as a rapid narrowing of pulp canal space, whereas common clinical features are yellow crown discoloration and a lower or non-response to sensibility tests. Late development of pulp necrosis and periapical disease are rare complications after PCO, rendering prophylactic endodontic intervention useless. Indeed, yellowish or gray crown discoloration may pose a challenge to clinicians, and may demand endodontic intervention to help restore aesthetics. This literature review was conducted to discuss currently available information concerning PCO after traumatic dental injuries (TDI), and was gathered according to three topics: I) physiopathology of PCO after TDI; II) frequency and predictors of pulpal healing induced by PCO; and III) clinical findings related to PCO. Review articles, original studies and case reports were included aiming to support clinical decisions during the follow-up of teeth with PCO, and highlight future research strategies.
Regenerative endodontics: a comprehensive review Kim, S. G.; Malek, M.; Sigurdsson, A. ...
International endodontic journal,
December 2018, 2018-Dec, 2018-12-00, 20181201, Letnik:
51, Številka:
12
Journal Article
Recenzirano
The European Society of Endodontology and the American Association for Endodontists have released position statements and clinical considerations for regenerative endodontics. There is increasing ...literature on this field since the initial reports of Iwaya et al. (Dental Traumatology, 17, 2001, 185) and Banchs & Trope (Journal of Endodontics, 30, 2004, 196). Endogenous stem cells from an induced periapical bleeding and scaffolds using blood clot, platelet rich plasma or platelet‐rich fibrin have been utilized in regenerative endodontics. This approach has been described as a ‘paradigm shift’ and considered the first treatment option for immature teeth with pulp necrosis. There are three treatment outcomes of regenerative endodontics; (i) resolution of clinical signs and symptoms; (ii) further root maturation; and (iii) return of neurogenesis. It is known that results are variable for these objectives, and true regeneration of the pulp/dentine complex is not achieved. Repair derived primarily from the periodontal and osseous tissues has been shown histologically. It is hoped that with the concept of tissue engineering, namely stem cells, scaffolds and signalling molecules, that true pulp regeneration is an achievable goal. This review discusses current knowledge as well as future directions for regenerative endodontics. Patient‐centred outcomes such as tooth discolouration and possibly more appointments with the potential for adverse effects needs to be discussed with patients and parents. Based on the classification of Cvek (Endodontics and Dental Traumatology, 8, 1992, 45), it is proposed that regenerative endodontics should be considered for teeth with incomplete root formation although teeth with near or complete root formation may be more suited for conventional endodontic therapy or MTA barrier techniques. However, much is still not known about clinical and biological aspects of regenerative endodontics.
– The main purpose of this review is to present the aetiological factors and the mechanism that cause dilaceration of the maxillary central incisors. In early developmental stages, the permanent ...tooth germ of the maxillary incisor is situated palatally and superiorly to the apex of the primary incisor and gradually changes direction in a labial direction with its crown coming closer to the resorbing primary root. For reasons of this close relationship between the permanent tooth germ and the apex of the primary incisor, it is believed that an acute trauma to the primary predecessor can cause dilaceration of the long axis of the permanent successor. Clinically, dilaceration can be revealed by palpation high in the labial sulcus or in the hard palate, while its radiographic view is characteristic. The therapeutic approach to the dilacerated maxillary central incisors has to be carefully planned and needs the cooperation of several specialities to attain the final objective.
To analyze the impact of desensitizing (D) and/or whitening (W) dentifrices on erosion and erosion-abrasion.
Enamel specimens were allocated into 10 groups (n = 20): 1. Artificial saliva (control); ...2. Sensodyne Repair&Protect (SRP–D); 3. Sensodyne Repair&Protect Whitening (SRP–W); 4. Colgate Sensitive Pro-Relief (CSPR–D); 5. Colgate Sensitive Pro-Relief Real White (CSPRR–W); 6. Colgate Total 12 (CT); 7. Colgate Total 12 Professional Whitening (CTP–W); 8. Sensodyne True White (ST–W); 9. Curaprox Black is White (CB–W); 10. Oral-B 3D White Perfection (OB3D-W). For abrasion (n = 10), 30,000 brushing strokes were performed and surface roughness (SR) was evaluated. Erosion-abrasion (n = 10) consisted of 1 % citric acid (2 min), artificial saliva (60 min); 6×/day; 5 days. Toothbrushing was carried out 2×/day (45 strokes). Surface loss (SL) was determined with an optical profilometer. Data were statistically analyzed (α = 0.05).
Relative to SR, only OB3D-W had a significantly rougher surface than the control (p = 0.014). SRP-D, CSPR-D and ST-W showed no difference from the baseline. High SL was observed for ST-W, OB3D-W and CTP-W, without significant differences from the control. CT showed the lowest SL, not differing from SRP–D and SRP–W. There was a weak negative correlation between SL and concentration of free fluoride in the slurries, SL and SR, and SL and pH, all p > 0.05.
Only one dentifrice increased surface roughness of enamel to a higher degree than brushing with saliva. Brushing with the test dentifrices did not cause higher enamel erosive wear than brushing with saliva.
This study enhances our knowledge on the effect of desensitizing and whitening dentifrices, indicating that they do not worsen enamel loss due to abrasion and they might be a safe option for individuals with erosive tooth wear.
The purpose of this study was to evaluate the short-term impact of rapid maxillary expansion (RME) on the eruption paths of ectopically and normally erupting maxillary canines in the mixed dentition.
...Thirty-two patients with 49 ectopically erupting canines (EEC group; age, 9.53 ± 1.10 years) and 18 patients with 27 normally erupting canines (NEC group; age, 9.25 ± 1.06 years) underwent RME. Thirty-six subjects with 54 normally erupting canines composed the untreated control group (UC group; age, 9.03 ± 0.72 years). Horizontal, vertical, and angular positions of canines and adjacent teeth were evaluated in the expanded (EEC and NEC groups) and unexpanded (UC group) patients using panoramic radiographs taken at 2 times with a 1-year interval. The radiographic evaluation methods included score ranking and proportional measurements to minimize panoramic radiograph limitations. Statistical comparisons were performed among the groups (P <0.05).
Before expansion, the EEC group's canines were significantly closer to the midline, more distant from the occlusal plane, and more mesially angulated than those in the UC group. After expansion, the canine positions in the EEC and UC groups were similar, whereas the NEC group had a more favorable canine position for eruption. The EEC and NEC groups showed similar canine positional changes, whereas the UC group had the smallest changes. The positions of teeth adjacent to the canine were also significantly affected by RME, and these changes may be associated with improvement of the ectopic canine position.
The changes produced by RME reduced the percentage of ectopic eruption paths and maintained the nonectopic eruption percentage.
•RME had a significant short-term impact on position and eruption speed of canines.•Canine eruption speed was faster after RME.•Canine eruption path was more upright and farther from the midline after RME.•Similar changes were seen in first premolar eruption path and speed.•Changes in neighboring teeth may be associated with canine position improvement.
Aim
To investigate the response of immature permanent teeth with nonvital pulps after revitalization procedures using cone beam computed tomography imaging and conventional radiograph.
Methodology
...Clinical records of patients who had undergone revitalization between 1997 and 2014 were collected. Seventeen patients attended the follow‐up examination. Clinical examination and radiographic examination by means of CBCT imaging and conventional radiographs were conducted to evaluate treatment outcomes, especially the dimensional changes of the root and the pattern of root maturation. Statistical analysis was conducted using Fisher's exact test and Monte Carlo test to investigate the effect of potential outcome predictors.
Results
For the follow‐up period as far as 96 months, thirteen teeth (76%) were classified as a ‘success’. Conventional radiographs showed various degrees of dimensional changes in the immature roots ranging from 0% to 73% changes. The mean percentage changes of root length and root wall thickness were 14.38 ± 20.92% and 13.82 ± 11.17%, respectively. CBCT images illustrated various patterns of root maturation including incomplete root development with wide‐open apices and fully formed roots with various apical shapes. Root canal contents varied radiographically from empty canals to many degrees of unpredictable patterning of radiopaque deposits.
Conclusion
Revitalization in immature teeth with nonvital pulps resulted in unpredictable responses in terms of continued root development. Various types of root maturation and root canal contents were observed radiographically, which were different from typical root development.
Abstract Objectives There is a lack of clinical data on the impact of timing of dietary acid intake and toothbrush abrasion when attempting to control erosive tooth wear progression. The aim of this ...study was to estimate the association of theoretical causative factors with erosive tooth wear to inform evidence-based guidelines. Methods Using case-control study design, 300 participants with dietary erosive tooth wear and 300 age-matched controls were recruited from the restorative clinics of King’s College London Dental Institute. A previously validated questionnaire was adapted to be interviewer-led and to assess frequency, timing and duration of dietary acid intake in addition to alternate drinking habits prior to swallowing. Timing of toothbrushing in relation to meals and dietary acid intake was investigated. Associations with erosive tooth wear were assessed in crude and adjusted logistic regression models. Results Fruit intake between meals (p < 0.001), but not with meals (p = 0.206), was associated with erosive tooth wear and contrasted with acidic drinks which maintained a strong association regardless of timing of intake (OR up to 11.84 95% CI: 5.42–25.89, p < 0.001). Prolonged fruit eating and alternate drinking habits prior to swallowing (OR 12.82 95% CI: 5.85–28.08 and 10.34 95% CI: 4.85–22.06 respectively) were as strongly associated with erosive tooth wear as three or greater daily acid intakes (OR 10.92 95% CI: 4.40–27.10). Toothbrushing within 10 min of acid intake was not associated with erosive tooth wear following adjustments for dietary factors (OR 1.41 95% CI: 0.82–2.42, p = 0.215). Conclusion Significantly increased odds ratios were observed when acids were consumed between meals in this cohort of patients. Universal advice to delay brushing after meals may not be substantiated. Clinical significance Prevention should be focused on avoiding dietary acids between meals, eliminating habits which increase contact time with the acid and reducing daily intake of acidic drinks. Toothbrushing after meals was not associated with erosive wear. Toothbrushing immediately after an acid challenge requires further investigation.
To review current knowledge of tooth whitening with respect to external bleaching methods.
The scope is the external bleaching of vital teeth and focuses on mechanisms; in vivo and in vitro ...measurement methods, and factors influencing the efficacy of the whitening process.
“Medline” and “ISI Web of Science” databases from 1966 and 1974, respectively were searched electronically with key words tooth, teeth, colo*r, white*, bleach* and peroxide.
The importance of tooth whitening for patients and consumers has seen a dramatic increase in the number of products and procedures over recent years, with a concomitant rise in publications on this topic. Literature suggests that the mechanisms of tooth whitening by peroxide occur by the diffusion of peroxide through enamel to cause oxidation and hence lightening of coloured species, particularly within the dentinal regions. A number of approaches are available for measuring changes in tooth colour. These include visual measurements by trained clinicians and instrumental measurements using spectrophotometry, chromameters and digital image analysis. The key factors that affect tooth whitening efficacy by peroxide containing products are concentration and time. In general, higher concentrations are faster than lower concentrations. However, lower concentrations can approach the efficacy of higher concentrations with extended treatment times. Alternative bleach systems to peroxide have received only minor attention. The efficacy of light activated systems versus non-light activated controls in clinical studies is limited and conflicting. Other factors which can influence tooth bleaching outcome include type of stain, initial tooth colour and subject age.
Abstract Introduction An immature tooth with pulpal necrosis and apical periodontitis presents a unique challenge to the endodontist. Endodontic treatment options consist of apexification, apical ...barriers, or more recently, revascularization. The purpose of this case series is to report three cases that used revascularization protocol as described by Banchs and Trope. Each case presented its own special circumstances and challenges. The lessons learned from each case provided guidance for more predictable outcomes on subsequent cases. Methods Six immature teeth with apical periodontitis (in three patients) were treated via the revascularization protocol using irrigants, a triple antibiotic paste, and a coronal seal of mineral trioxide aggregate and composite. Results For follow-up, all six teeth showed resolution of periapical radiolucencies, whereas three of six teeth showed continued root development. Two teeth displayed a positive response to vitality testing. Conclusions Results from this case series show that revascularization is a technically challenging but effective treatment modality for the immature tooth with apical periodontitis. Based on this case series, the following recommendations are made to help with the revascularization technique: (1) clinicians should consider the use of an anesthetic without a vasoconstrictor when trying to induce bleeding, (2) a collagen matrix is useful for the controlled placement of MTA to a desired and optimal level, (3) patients/parents should be informed about the potential for staining, especially in anterior teeth when the paste contains minocycline, and (4) patient/parent compliance with the necessary multiple appointment treatment plan may be significant for case selection.
Objective
The aim is to review the most important aspects about tooth whitening treatments, their side effects, and the new emerging approaches to overcome them.
Overview
This review is focused on ...origin of tooth stains, the whitening systems and their chemistry, their side effects, and the new approaches. The search of bibliography of the period 1965‐2018 has been analyzed.
Conclusions
Tooth whitening has become one of the most requested dental treatments by the public. Tooth stains are classified according to their origin into two categories: intrinsic and extrinsic. The whitening systems are generally organized into two classes: in‐office and at‐home products. Most of the whitening systems use hydrogen peroxide as the active oxidative agent to degrade the organic compounds that cause stains. The concentration ranges depending on the treatment, and it may be applied directly or produced in a chemical reaction from carbamide peroxide that is more stable. Besides its popularity, tooth whitening still has some side effects being tooth hypersensitivity the most common. In order to decrease these side effects, new treatments are constantly in renewal processes.
Clinical Significance
Despite all the data and new strategies known about tooth whitening, there are many aspects that are not totally fully understood and methodologies that are not completely effective. Therefore, the development of effective, efficient, and long‐lasting whitening treatments is still necessary.
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