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Journal of Endodontics Oct 2023Dens evaginatus (DE) is a dental anomaly with a supernumerary tubercle projection that typically contains dentin and pulp tissue. However, the tubercle projection can... (Review)
Review
INTRODUCTION
Dens evaginatus (DE) is a dental anomaly with a supernumerary tubercle projection that typically contains dentin and pulp tissue. However, the tubercle projection can fracture, exposing the dentin and potentially the dental pulp, which induces pulpal diseases. Managing DE should be primarily based on the clinical diagnosis of the pulp.
METHODS
The literature search in prevalence, prophylaxis, and management of dens evaginatus was performed in PubMed database as well as by manual search, in which the related contents were collected and descriptively analyzed.
RESULTS
Of the 264 searched literatures, 62 articles were included for this scoping review. The prophylactic management of the tubercle of DE teeth with a normal pulp should be performed as early as possible by the prep-and-fill technique or the reinforcement technique to preserve tooth vitality and continued root development, with the former reported to be superior compared with the latter. Furthermore, DE teeth with reversible pulpitis should be managed with the prep-and-fill technique. For DE teeth with irreversible pulpitis, vital pulp therapy, ie, partial or full/coronal pulpotomy, should be considered when the pulpal inflammation is limited to the coronal pulp to preserve the vitality of the radicular pulp that induces apexogenesis. A pulpectomy should be performed if the pulpal inflammation has progressed into the radicular pulp. For DE teeth with pulpal necrosis (or after pulpectomy) and immature roots, mineral trioxide aggregate apexification or regenerative endodontic procedures are the treatment options. For DE teeth with pulpal necrosis and complete root formation, nonsurgical root canal treatment is the treatment of choice. A flow chart of the decision-making for managing DE teeth based on pulpal diagnosis is proposed.
CONCLUSION
DE teeth should be properly managed, by prophylaxis or treatment, depending on pulpal diagnosis and related factors.
Topics: Humans; Pulpitis; Bicuspid; Root Canal Therapy; Dental Pulp Necrosis; Inflammation
PubMed: 37506764
DOI: 10.1016/j.joen.2023.07.017 -
Journal of Oral and Maxillofacial... 2023Rickets is a disorder caused by a lack of vitamin D, calcium or phosphate. It leads to softening and weakening of the bones. Dental manifestation of rickets includes...
Rickets is a disorder caused by a lack of vitamin D, calcium or phosphate. It leads to softening and weakening of the bones. Dental manifestation of rickets includes enamel hypoplasia and delayed tooth eruption. The most important oral findings are characterised by spontaneous gingival and dental abscesses occurring without a history of trauma or caries. Radiographic examination revealed large pulp chambers, short roots, poorly defined lamina dura and hypoplastic alveolar ridge. These dental abscesses are common, and therefore, extraction and pulpectomy are the treatment of choice. Oral manifestations of rickets should be diagnosed early by both physicians and dentists to prevent severe dental complications. This article aims to report a case of rickets in a 3-year-old girl, describing the dental findings and the treatment to be performed in these cases.
PubMed: 38304513
DOI: 10.4103/jomfp.jomfp_233_23 -
Community Dentistry and Oral... Feb 2024The aim of this randomized clinical trial was to compare the impact of two management options for primary molars with pulp necrosis (pulpectomy or extraction) on... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
The aim of this randomized clinical trial was to compare the impact of two management options for primary molars with pulp necrosis (pulpectomy or extraction) on children's oral health-related quality of life (OHRQoL).
DESIGN
A total of 100 children aged 3-5 years with at least one necrotic primary molar were selected and randomized into the study groups. The Brazilian version of early childhood oral health impact scale (B-ECOHIS) was completed by the parent proxy reports at baseline and after 4, 8 and 12 months. Differences between the trial groups were assessed through bootstrap linear regression for B-ECOHIS scores, logistic regression for dental pain self-reports and anxiety scores (α = 5%).
RESULTS
The mean (SD) B-ECOHIS scores at baseline and after 12 months were 17.7 (6.5) and 3.0 (4.0) in the pulpectomy group and 18.8 (7.7) and 7.9 (7.7) in the extraction group. Both treatments significantly improved OHRQoL, but tooth extraction group showed higher scores in total B-ECOHIS (p < .001) and most domains, indicating lower OHRQoL. Furthermore, higher anxiety levels were reported for dental extraction compared to pulpectomy (OR = 2.52; p = .008).
CONCLUSION
Pulpectomy resulted in an improved OHRQoL scores after 12 months when compared to tooth extraction and should be considered as the treatment of choice for necrotic primary molars.
Topics: Child, Preschool; Humans; Dental Care; Dental Caries; Oral Health; Pulpectomy; Quality of Life; Tooth Extraction
PubMed: 37519111
DOI: 10.1111/cdoe.12895 -
Australian Endodontic Journal : the... Aug 2023The present meta-analysis aimed to describe the methods to determine the working length in primary teeth pulpectomy, also evaluating and comparing their reliability. A... (Meta-Analysis)
Meta-Analysis Review
The present meta-analysis aimed to describe the methods to determine the working length in primary teeth pulpectomy, also evaluating and comparing their reliability. A systematic review was performed following the PRISMA Statement. The electronic search was conducted on PubMed, Scopus, Cochrane Library and Web of Science. After the screening protocol, a number of 14 studies were included in the qualitative analysis, while seven were included in the quantitative one. The mean working length determined by the electronic apex locator was 11.8 mm (9.0-15.55), while 12.42 mm (11.0-13.52) and 12.3 mm (9.73-15.93) were the mean working length observed with the conventional radiography and the digital radiography, respectively. No statistically significant difference was detected in quantitative analysis between the investigated methods. The present meta-analysis showed that electronic apex locator, conventional radiography and digital radiography are similar in determining working length in primary teeth.
Topics: Pulpectomy; Reproducibility of Results; Odontometry; Tooth Apex; Dental Pulp Cavity; Tooth, Deciduous
PubMed: 35770609
DOI: 10.1111/aej.12652 -
Pediatric Dentistry Nov 2023to update the 2016 systematic review evidence for vital pulp therapy (VPT) for primary teeth affected by caries or trauma. The population, intervention, comparison,... (Meta-Analysis)
Meta-Analysis
to update the 2016 systematic review evidence for vital pulp therapy (VPT) for primary teeth affected by caries or trauma. The population, intervention, comparison, outcomes, and study (PICOS) design inclusion/exclusion was used for multiple databases. Risk of bias, meta-analyses using RevMan, and certainty of evidence was created. A total of 299 studies were included; no trauma was found. Indirect pulp treatment (IPT) resulted in 97 percent success. Two calcium silicate cement (CSC) pulpotomies' success using mineral trioxide aggregate (MTA) and Biodentine were 94 percent and 90 percent, respectively, greater than for direct pulp capping (DPC; 86 percent) and other pulpotomies (moderate certainty). The success of IPT versus pulpotomy at 24 months showed no significant difference (P=0.31). Different liners or capping agents did not affect the success of IPT (P=0.79) or DPC at 24 months (P=0.24). The two CSC pulpotomies were not significantly different based on 24-month success (P=0.34). The formocresol pulpotomy success at 24 months was significantly lower than for MTA (P=0.02). Ferric sulfate had a significant lower success at 24 months than MTA pulpotomy (69 percent versus 92 percent; P=0.03). Zinc oxide eugenol, as a singular pulpotomy, had low success (65 percent). Selective/stepwise caries removal did significantly better at avoiding pulp exposures than complete excavation (P<0.001). Complete, selective, and no caries removal (Hall technique [HT], steel crown placement with no caries removal) had no significant difference in pulp vitality success for deep caries at 24 months (P=0.29). For deep caries affecting vital incisors, pulpotomy had significantly greater success than pulpectomy (P=0.002). The following had no significant effect on MTA pulpotomy success: coronal pulp removal methods; irrigation solution; method to control hemorrhage; base over MTA; treatment in one or two visits; and anterior or posterior teeth. Vital pulp therapy success of indirect pulp treatment or two calcium silicate cement pulpotomies demonstrated improved success over direct pulp capping and other pulpotomies based on 24-month evidence with moderate certainty. The Hall technique did not significantly reduce pulp vitality success versus caries removal.
Topics: Humans; Calcium Compounds; Silicates; Dental Care; Dental Cements; Zinc Oxide-Eugenol Cement; Dental Pulp Capping; Pulpotomy; Glass Ionomer Cements; Tooth, Deciduous; Oxides; Drug Combinations; Treatment Outcome; Aluminum Compounds
PubMed: 38129755
DOI: No ID Found -
Clinical Oral Investigations Sep 2023To compare and evaluate the clinical and radiographic performance, post-operative pain, and anti-inflammatory intake after partial pulpotomy (PP) with calcium hydroxide... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
To compare and evaluate the clinical and radiographic performance, post-operative pain, and anti-inflammatory intake after partial pulpotomy (PP) with calcium hydroxide (CH), mineral trioxide aggregate (MTA), Biodentine (BD), and Emdogain (EMD) as pulp capping agents in mature permanent molars with definitive diagnosis of reversible pulpitis.
MATERIALS AND METHODS
As part of this prospective, randomized clinical trial with four parallel arms (CTRI Registration No.: CTRI/2020/11/029329 dated 24/11/2020), hundred and ten permanent molars with a clinical diagnosis of reversible pulpitis and normal apical tissues, from patients between the ages of 15 and 45 years, were recruited and randomly assigned to four groups-CH, MTA, BD, and EMD. Operative procedure was performed under local anesthesia and dental dam isolation. After carious pulpal exposure, 2 mm of superficially inflamed coronal pulp tissue was amputated and either of the four pulp capping materials was placed. The outcome assessment was carried out at 1, 3, 6, and 12 month(s) and was categorized as success (asymptomatic patients with PAI score = 1) or failure (symptomatic patients or PAI score > 1).
RESULTS
There was a significant difference in post-operative pain and anti-inflammatory medication intake after partial pulpotomy with Emdogain vis-à-vis other three capping agents. No difference in both clinical and radiographic performances was observed among the four capping agents.
CONCLUSION
Partial pulpotomy when performed following evidence-based guidelines results in high success rates regardless of capping agent employed. EMD can be considered a valid and suitable pulp capping agent in PP.
CLINICAL RELEVANCE
Meticulous examination and removal of superficially inflamed pulp under magnification and complete asepsis lead to successful pulpal healing regardless of capping agent employed.
Topics: Humans; Adolescent; Young Adult; Adult; Middle Aged; Pulpotomy; Pulpitis; Prospective Studies; Oxides; Calcium Compounds; Treatment Outcome; Calcium Hydroxide; Pulp Capping and Pulpectomy Agents; Silicates; Aluminum Compounds; Drug Combinations; Pain, Postoperative
PubMed: 37460903
DOI: 10.1007/s00784-023-05136-6 -
International Journal of Clinical... Sep 2023To assess the clinical and radiographic success of conventional pulpectomy and pulpectomy done under an endodontic microscope over a period of 12 months.
AIM
To assess the clinical and radiographic success of conventional pulpectomy and pulpectomy done under an endodontic microscope over a period of 12 months.
MATERIALS AND METHODS
The study was conducted as a single-blinded, parallel-group prospective, randomized, and controlled clinical trial. The enrollment of the study involved the assessment of 258 deciduous molars for eligibility as per the inclusion criteria. A total of 104 teeth were allocated to each group, that is, group I (conventional pulpectomy) and group II (pulpectomy under microscope). However, due to unavoidable circumstances during the coronavirus disease 2019 (COVID-19) pandemic, 98 and 90 teeth were treated in each group, respectively. Pulpectomy in both groups was done using standard protocol except for the use of an endodontic microscope in group II. The clinical and radiographic outcomes were assessed by an independent blinded observer and analyzed using appropriate statistical tests.
RESULTS
The clinical success at 6 months is 95.7 and 96.5%, and at 12 months is 96.6 and 97.7% in groups I and II, respectively. The radiographic success at 6 months is 93.5 and 95.4%, and at 12 months is 95.5 and 98.8% in groups I and II, respectively. The overall success rates of both groups with statistically no significant differences.
CONCLUSION
The present study concludes comparable results are achieved using an endodontic microscope to conventional pulpectomy without magnification.
HOW TO CITE THIS ARTICLE
Kumar G, Rehman F. Comparative Evaluation of Clinical and Radiographic Success of Pulpectomy Done with and without Dental Operating Microscope in Pediatric Patients: An Study. Int J Clin Pediatr Dent 2023;16(S-2):S155-S160.
PubMed: 38078029
DOI: 10.5005/jp-journals-10005-2641 -
BMC Oral Health Mar 2024Pulpotomy as a minimally invasive pulp therapy technique is the treatment of choice for carious pulp exposures, however many pediatric dentists perform pulpectomies in... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Pulpotomy as a minimally invasive pulp therapy technique is the treatment of choice for carious pulp exposures, however many pediatric dentists perform pulpectomies in vital primary incisors. The aim of this split mouth randomized controlled study was to compare formocresol pulpotomy and zinc-oxide and eugenol pulpectomy in the treatment of vital pulp exposure in primary incisors.
METHODS
Contralateral pairs of incisors were randomly assigned to receive pulpotomy or pulpectomy in children aging from 18 to 66 months old and were followed up for 12 months.
RESULTS
39 pairs of incisors were included. Clinical and radiographical success rates showed no statistical significant difference (p = 1, p = 0.8 respectively). Relative risk measures for clinical success rates (RR = 1.03, 95%CI 0.87 to 1.23) and for radiographic success rates (RR = 1.03, 95%CI 0.83 to 1.29) with CIs including number one showing no difference between the two groups. The Survival rate using Kaplan-Meier survival analysis score showed 82% for pulpotomy and 74% for pulpectomy at 12 months (P = 0.2).
CONCLUSIONS
Both pulpotomy and pulpectomy techniques can be used successfully in the treatment of carious vital pulp exposure in primary incisors.
TRIAL REGISTRATION
The trial was retrospectively registered in Clinicaltrials .gov with this identifier NCT05589025 on 21/10/2022.
Topics: Child; Humans; Infant; Child, Preschool; Pulpotomy; Pulpectomy; Incisor; Zinc Oxide; Pulp Capping and Pulpectomy Agents; Tooth, Deciduous; Silicates; Treatment Outcome; Calcium Compounds
PubMed: 38504243
DOI: 10.1186/s12903-024-04116-w -
Maedica Dec 2023Since pain control in dental treatments, including root canal treatment, is challenging, and no study has measured the appropriate pattern of Anaheal Plus drug...
Since pain control in dental treatments, including root canal treatment, is challenging, and no study has measured the appropriate pattern of Anaheal Plus drug consumption in reducing pain after root canal treatment, in this study the appropriate pattern of taking Anaheal Plus drug in reducing pain after root canal treatment was evaluated. The present study examined maxillary and mandibular molar teeth with irreversible pulpitis. Patients were divided into three groups: A) Anaheal Plus capsule; B) control; and C) ibuprofen. Teeth were treated in two sessions, pulpectomy treatment was performed and drugs were used between sessions. A visual analog scale questionnaire was used to assess pain. Patients were asked to record the pain score before the root canal treatment as well as eight hours, 48 hours and five days after root canal treatment. All procedures were done in Amol's private clinic, where root canal treatment was administered by a dentist, and the teeth were obturated after a week. This study examined 90 patients with an average age of 33.94 years. Rescue doses were reported only in the control group, and there was a significant difference between groups (p-value < 0.001). In all groups, pain had decreased significantly (p-value<0.001), but the average pain in groups A and C was lower than that of group B at all times, and there was no difference between them. Anaheal Plus significantly reduced pain after root canal treatment compared to the control group.
PubMed: 38348069
DOI: 10.26574/maedica.2023.18.4.651 -
International Journal of Clinical... Jan 2024To establish lesion sterilization and tissue repair (LSTR) therapy as an alternate treatment option in managing infected primary molars with poor prognosis that were...
BACKGROUND AND AIM
To establish lesion sterilization and tissue repair (LSTR) therapy as an alternate treatment option in managing infected primary molars with poor prognosis that were indicated for extraction, thereby fulfilling the objective of retaining the primary tooth till its normal exfoliation in the dental arch.
MATERIALS AND METHODS
A total of 84 children who met the inclusion criteria requiring extraction in 142 teeth involving primary molars were included in the study. The selected patients were allocated to two groups, that is, group I-LSTR therapy with 3Mix-MP paste and group II-pulpectomy with metapex. All the treated teeth were then clinically and radiographically evaluated after 1, 3, 6, 9, and 12 months, respectively, to determine the success between groups I and II. Pearson's Chi-squared test along with the z-test was used to compare the clinical and radiographic success of the two groups ( < 0.05).
RESULTS
Pain and tenderness were completely resolved within one month of follow-up in both groups. Abscesses were resolved completely at 1 month in the pulpectomy group and mobility was resolved at 6 months follow-up in both groups. Interradicular and periradicular radiolucency persisted even at 12 months of the follow-up period in both groups. The intergroup comparison revealed no statistical differences between LSTR and pulpectomy procedure and both were equally effective at all time intervals ( > 0.05).
CONCLUSION
Both LSTR therapy with 3Mix-MP and pulpectomy with metapex showed 100% clinical success rates. Radiographically no changes were observed even at the 12-month follow-up period in both groups. LSTR therapy can be an alternative treatment option for pulpally involved primary teeth with poor prognosis and in cases where mechanical instrumentation could not be achieved due to physiologic root resorption.
HOW TO CITE THIS ARTICLE
Sefa I, Garg N, Pathivada L, Success of Lesion Sterilization and Tissue Repair Therapy and Pulpectomy in the Management of Infected Primary Molars with Poor Prognosis. Int J Clin Pediatr Dent 2024;17(1):41-47.
PubMed: 38559868
DOI: 10.5005/jp-journals-10005-2750