-
Journal of Endodontics Sep 2023In a growing child, preservation of traumatized immature permanent upper incisors is challenging. This study aimed to evaluate the long-term outcome of endodontically...
INTRODUCTION
In a growing child, preservation of traumatized immature permanent upper incisors is challenging. This study aimed to evaluate the long-term outcome of endodontically treated traumatized immature upper incisors and associated variables.
METHODS
A total of 183 traumatized immature upper incisors treated with pulpotomy, apexification, or regenerative endodontic procedure (REP), with follow-up between 4 and 15 years, were assessed for presence of pulpal responses or periodontal/bone responses using standardized clinical and radiologic criteria. Logistic regression, including stage of root development, type and complexity of traumatic event, type of endodontic intervention, and history of orthodontic management, were used to estimate impact on tooth survival and occurrence of tissue responses. Study approved by Ethics Committee Research UZ/KU Leuven (S60597).
RESULTS
After a median follow-up of 7.3 years (interquartile range, 6.1-9.2), 159 teeth (86.9%) were still functional. From these teeth, 58 (36.5%) developed tissue responses. This was significantly associated with stage of root development at moment of trauma (root length <¾) and type of endodontic intervention (REP presenting worst outcome). Tooth loss (24 teeth, 13.1%) occurred after a mean time span of 3.2 years (±1.5) and was significantly associated with type and complexity of the traumatic event and type of endodontic intervention, with apexification showing better results than REP (odds ratio, 0.30; 95% confidence interval, 0.11-0.79).
CONCLUSIONS
A large number of endodontically treated traumatized immature teeth could be kept functional. Very immature teeth, teeth with periodontal tissue damage, and teeth treated with REP were at highest risk for an unfavorable outcome.
Topics: Child; Humans; Dental Pulp Necrosis; Incisor; Tooth Injuries; Apexification; Dental Pulp
PubMed: 37385539
DOI: 10.1016/j.joen.2023.06.013 -
International Journal of Clinical... 2023To evaluate and compare the efficacy of 3Mixtatin and mineral trioxide aggregate (MTA) for pulpotomy in primary teeth by assessment of pre- and postoperative clinical...
OBJECTIVE
To evaluate and compare the efficacy of 3Mixtatin and mineral trioxide aggregate (MTA) for pulpotomy in primary teeth by assessment of pre- and postoperative clinical and radiographic data.
MATERIALS AND METHODS
In this randomized clinical trial, 50 primary molars from 48 healthy children aged 3-8 years were randomly allocated into two groups. Deep dentinal caries approaching pulp in primary teeth were treated by pulpotomy using MTA and 3Mixtatin. Over the intervening period, restoration was done using glass ionomer cement (GIC) and composite, followed by stainless steel crown. Clinical and radiographic examinations were conducted at 3, 6, and 12 months after treatment. The data were compared using Chi-squared test at a significance level of 0.05.
RESULTS
A total of 39 patients were available for follow-up study. By the end of 12 months, the overall success rates were 95.5% in MTA and 91.3% in 3Mixtatin. No statistically significant difference was found among the outcomes of MTA and 3Mixtatin groups ( > 0.05).
CONCLUSION
Radiographic and clinical outcomes in MTA and 3Mixtatin group in this study show 3Mixtatin as a suitable alternative for pulpotomy medicament in primary teeth.
HOW TO CITE THIS ARTICLE
Mushtaq A, Nangia T, Goswami M. Comparative Evaluation of the Treatment Outcomes of Pulpotomy in Primary Molars Using Mineral Trioxide Aggregate and 3Mixtatin: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(6):810-815.
PubMed: 38344366
DOI: 10.5005/jp-journals-10005-2720 -
Medicine May 2024Compared with traditional root canal therapy (RCT), vital pulp therapy (VPT) is a personalized and minimally invasive method for the treatment of pulpitis caused by... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Compared with traditional root canal therapy (RCT), vital pulp therapy (VPT) is a personalized and minimally invasive method for the treatment of pulpitis caused by dental caries. However, there are still no clear guidelines for VPT because high-quality randomized clinical trials are scarce. This prospective cohort study evaluated the clinical efficacy of VPT with the light-curable calcium silicate-based material TheraCal LC (TH) and bioceramic material iRoot BP Plus (BP) in reversible and irreversible pulpitis permanent teeth with carious exposures.
METHODS
115 teeth with reversible or irreversible pulpitis caused by deep care were randomly divided into 2 groups. TheraCal LC and iRoot BP Plus were used for the pulp capping. Direct pulp capping (DPC), partial pulpotomy (PP) and full pulpotomy (FP) were performed based on observation of the exposed pulp. Postoperative discomforts were enquired and recorded via follow-up phone calls. Clinical and radiographic evaluations were performed 3, 6, and 12 months postoperatively.
RESULTS
The overall clinical success rate in the first year was 90.4% (47/52) in both groups. The TH group required less operating time, showed lower levels of pain, and had shorter pain duration post-operative (P < .001). According to the binary logistic regression model, preoperative pain duration was significantly correlated with the prognosis of VPT (P = .011).
CONCLUSION
VPT with TheraCal LC and iRoot BP Plus in pulpitis permanent carious teeth both achieved good clinical outcomes, and TheraCal LC can be easily operated for clinical use. Preoperative pain duration of the affected tooth might have a significant correlation with the prognosis of VPT.
Topics: Humans; Pulpitis; Calcium Compounds; Silicates; Female; Male; Pulpotomy; Adult; Prospective Studies; Dental Pulp Capping; Dental Caries; Young Adult; Treatment Outcome; Adolescent; Middle Aged; Drug Combinations; Calcium Hydroxide; Aluminum Compounds; Oxides
PubMed: 38701294
DOI: 10.1097/MD.0000000000038015 -
Invasive Cervical Root Resorption: A Comprehensive Review on Pathogenesis, Diagnosis, and Treatment.Iranian Endodontic Journal 2024Invasive cervical root resorption (ICRR) is a dental pathology, marked by unexpected destruction originating in the cervical region of the tooth. This comprehensive... (Review)
Review
Invasive cervical root resorption (ICRR) is a dental pathology, marked by unexpected destruction originating in the cervical region of the tooth. This comprehensive literature review provides a holistic view into the pathogenesis, clinical manifestation, and precise management of ICRR, aiming to guide endodontists and enhance patient care and treatment outcomes. The review delves into the potential etiology of ICRR, covering contributing factors such as trauma, orthodontic treatment, and other pertinent conditions. It outlines the clinical and radiographic indicators, underscoring the crucial role of early detection and precise diagnosis in effectively managing and halting ICRR progression. The exploration of treatment approaches is thorough, ranging from non-surgical methods like vital pulp therapy or root canal treatment to surgical interventions. This review accentuates the essential role of interdisciplinary collaboration among diverse dental specialties in enhancing ICRR management. It highlights the importance of a consolidated strategy in enhancing treatment outcomes and preserving tooth structure and function. Moreover, it investigates prevention methods, risk evaluation, and identifies prospective research pathways to address the existing knowledge gaps.
PubMed: 38223835
DOI: 10.22037/iej.v19i1.44246 -
Journal of Conservative Dentistry and... Apr 2024This clinical trial aimed to compare the clinical success of coronal pulpotomy and indirect pulp capping (IPC) in managing symptomatic deep proximal caries in molars...
AIM
This clinical trial aimed to compare the clinical success of coronal pulpotomy and indirect pulp capping (IPC) in managing symptomatic deep proximal caries in molars with moderate pulpitis over a 12-month period.
MATERIALS AND METHODS
A total of 108 vital mature permanent molars with moderate pulpitis were randomly allocated to the IPC ( = 54) or coronal pulpotomy group ( = 54). Dycal and Biodentine were used as pulp-capping materials, followed by composite restoration. The absence of periapical infection and asymptomatic teeth that positively responded to the cold pulp sensitivity test (only in IPC) was considered posttreatment success at 12 months. Data from the study were analyzed using the Chi-square test and Kaplan-Meier survival analysis.
RESULTS
There was a statistically significant difference between preoperative symptoms and the cold pulp sensibility test response ( = 0.000), indicating an association between symptoms and pulp sensibility. The average remaining dentine thickness (RDT) value was 0.48 ± 0.5 mm, with no statistically significant difference found between the location of caries and RDT ( = 0.084, P > 0.05). Compared to the IPC group, the pulpotomy group had a greater number of patients at 12 months after treatment that required no intervention. The Kaplan-Meier survival analysis revealed that the mean survival duration for pulpotomy was 48 weeks, and for IPC, it was 42.3 ± 2.35 weeks.
CONCLUSION
Coronal pulpotomy with Biodentine proved more effective in reducing symptoms, achieving radiographic success, and ensuring tooth survival compared to IPC with calcium hydroxide.
PubMed: 38779201
DOI: 10.4103/JCDE.JCDE_63_24 -
Clinical Oral Investigations Jun 2024The study aimed to identify the preferred management techniques used by dentists in Greece for treating deep carious lesions or pulp exposure during the removal of...
The management of deep carious lesions and the exposed pulp in fully developed and immature teeth with irreversible pulpitis: a questionnaire-based study among Greek dentists.
OBJECTIVES
The study aimed to identify the preferred management techniques used by dentists in Greece for treating deep carious lesions or pulp exposure during the removal of carious tissue in teeth with irreversible pulpitis. Additionally, the study sought to explore how patient-related factors (such as age and symptoms) and operator-related factors (like material choice and the use of antibiotics) influence these management decisions.
MATERIALS AND METHODS
The questionnaire, developed by five investigators, was divided into two parts: the first gathered respondent demographics, and the second presented clinical scenarios of deep carious lesions, requesting treatment strategies, materials used, and antibiotic prescription practices. The scenarios described patients with intense spontaneous pain and very deep carious lesions, differentiated by age and tooth development status.Data collection was via Google Drive, with analysis performed using SPSS 28, Chi-square, and Fisher's exact tests, with significance set at p < 0.05.
RESULTS
The study polled 453 Greek dentists about their treatment choices, for deep carious lesions in mature and immature teeth with irreversible pulpitis The majority favored root canal treatment for mature teeth, however quite a few opted for partial or cervical pulpotomy. MTA emerged as the preferred capping material, emphasizing its biocompatibility. Hemostasis management varied, with saline and sodium hypochlorite as popular choices. In cases of immature teeth, a shift towards vital pulp therapy was evident, reflecting a preference for preserving healthy pulp to avoid complex procedures.
CONCLUSIONS
Challenges identified include varying treatment preferences, the significance of bleeding control in vital pulp therapy, and the limited use of antibiotics for irreversible pulpitis. While the study has limitations, including sample size and potential biases, its findings offer valuable insights into the decision-making processes of Greek dentists.
CLINICAL RELEVANCE
Future research and ongoing education within the dental community could contribute to standardizing treatment approaches and optimizing outcomes for patients with deep carious lesions and irreversible pulpitis.
Topics: Humans; Greece; Pulpitis; Dental Caries; Surveys and Questionnaires; Practice Patterns, Dentists'; Female; Male; Adult; Middle Aged; Dental Pulp Exposure; Root Canal Therapy; Pulpotomy; Anti-Bacterial Agents
PubMed: 38844571
DOI: 10.1007/s00784-024-05756-6 -
The Journal of Clinical Pediatric... Jan 2024This retrospective chart review study investigates the long-term clinical outcome of Biodentine® (Tricalcium silicate) as a medicament for pulpotomy in primary molars....
This retrospective chart review study investigates the long-term clinical outcome of Biodentine® (Tricalcium silicate) as a medicament for pulpotomy in primary molars. Data in this retrospective study was collected from the dental records of all patients that had at least one primary molar receive pulpotomy treatment (CDT code: D3221) between 01 July 2012 and 01 July 2015. This data includes child's age, medical history, dental history, dental radiographs, pulpotomy procedure details and follow-up clinical notes. Kaplan-Meier Estimate was used to measure the fraction of successful pulpotomy procedures for up to 24 months. A total of 1758 pulpotomy procedures were performed on 1032 patients in our institute in the three-year period and 21.4% of them (N = 376) had follow-up dental records that qualified for the study. Eleven teeth out of 376 teeth were excluded from the statistical analysis due to loss of/broken stainless steel crowns (3.1%). Seventeen pulpotomy failures were identified out of the remaining 365 procedures. The survival probablity of using Biodentine® as a pulpotomy medicament is 96.3% for 18-month follow-up and 95.4% for 24-month follow-up. Biodentine®, a tricalcium silicate formulation, used as a pulpotomy medicament demonstrates a high clinical success rate (95.4%) over a 24-month peroid in primary molars.
Topics: Child; Humans; Retrospective Studies; Treatment Outcome; Pulpotomy; Oxides; Molar; Tooth, Deciduous; Aluminum Compounds; Drug Combinations; Calcium Compounds; Silicates
PubMed: 38239160
DOI: 10.22514/jocpd.2024.011 -
International Endodontic Journal Aug 2023The aim of this study was to compare the cardiovascular effects [heart rate, oxygen saturation (SpO ) systolic and diastolic blood pressure] and the anaesthetic efficacy... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
The aim of this study was to compare the cardiovascular effects [heart rate, oxygen saturation (SpO ) systolic and diastolic blood pressure] and the anaesthetic efficacy of intraosseous computerized anaesthesia (ICA) versus inferior alveolar nerve block (IANB) in Symptomatic irreversible pulpitis (SIP).
METHODOLOGY
The study protocol was registered with ClinicalTrials.gov (NCT03802305). In a randomized, prospective clinical trial, 72 mandibular molar teeth with SIP were randomly allocated to conventional IANB injection (n = 36) or ICA injection (n = 36), both with 1.8 mL of 4% articaine with 1:100 000 epinephrine. The primary objective was to assess the cardiovascular parameters (heart rate, oxygen saturation, blood pressure) before, during and after the anaesthesia. The secondary objectives were to compare ICA with IANB for success and postoperative outcomes for up to 3 days.
RESULTS
The maximum increase in heart rate in the ICA group was greater than in the IANB. Other cardiovascular parameters did not show differences throughout the clinical procedure. There were no statistically significant differences (p > .05) between groups for sex, age, or anxiety. The total success rate of ICA (91.43%) was significantly higher (p = .0034) than that of IANB (69.44%).
CONCLUSIONS
This study establishes that ICA is safe and efficient in the first intention for the treatment of SIP of the mandibular molar.
Topics: Humans; Pulpitis; Prospective Studies; Nerve Block; Mandibular Nerve; Anesthesia, Dental; Anesthetics, Local; Double-Blind Method; Lidocaine
PubMed: 37209243
DOI: 10.1111/iej.13935 -
Oral Health & Preventive Dentistry Sep 2023While the objective of partial pulpotomy is to preserve the vitality and function of the pulp tissue, the preopera-tive pulp status is the main prognostic factor for its...
PURPOSE
While the objective of partial pulpotomy is to preserve the vitality and function of the pulp tissue, the preopera-tive pulp status is the main prognostic factor for its success. To date, however, there is little data on long-term success rates. Therefore, the aim of this prospective pilot study was to assess the long-term outcome of partial pulpotomy in per-manent teeth after carious pulp exposure without signs or symptoms of irreversible pulpitis, verified clinically, radio-graphically, and via MMP-9 levels.
MATERIALS AND METHODS
Patients in whom permanent teeth with extremely deep carious lesions were diagnosed as com-pletely asymptomatic (n = 8) or with signs of reversible pulpitis (n = 10) underwent non-selective caries removal followed by a blood test to assess the level of MMP-9. The teeth were thereafter partially pulpotomised, MTA-capped, and immedi-ately restored with composite resin. Follow-up examinations were performed by endodontically experienced examiners focusing on clinical and radiographic assessment.
RESULTS
One patient could not be contacted and was lost to follow-up. Overall, the follow-up period ranged from 2-8 years (mean = 4.4 years). The majority of teeth remained functional and without pathology; one tooth was classified as having failed because of a vertical root fracture. There was no statistically significant difference in the groups' success rate (p = 0.3). The estimated overall survival rate was 94.1% (95% CI: 0.84-1.00) after 4 years according to the Kaplan-Meier method.
CONCLUSION
Pulp vitality in permanent teeth can be preserved with high success rates by means of partial pulpotomy after carious pulp exposure in asymptomatic teeth or in teeth with reversible pulpitis.
Topics: Humans; Pulpotomy; Pulpitis; Calcium Compounds; Prospective Studies; Matrix Metalloproteinase 9; Pilot Projects; Drug Combinations; Treatment Outcome
PubMed: 37753855
DOI: 10.3290/j.ohpd.b4438901 -
BMC Oral Health Jul 2023To compare the sealing ability and marginal adaptation of three calcium silicate-based cement (Biodentine, Pro root MTA, MTA Angelus) using a bacterial leakage model and...
OBJECTIVE
To compare the sealing ability and marginal adaptation of three calcium silicate-based cement (Biodentine, Pro root MTA, MTA Angelus) using a bacterial leakage model and scanning electron microscope (SEM).
METHODS
Recently extracted lower first premolars were randomly categorized into three experimental groups (n = 15 samples), positive control (n = 5 samples), and negative control group (n = 5 sample). Samples from the experimental groups and positive control group were subject to cavity Class I occlusal preparation followed by modified coronal pulpotomy. Different types of bioceramic dressing material were placed in 3 mm thickness accordingly, group 1 (Biodentine), group 2 (MTA Angelus), and group 3 (ProRoot MTA). No dressing material was placed in the positive control group (group 4). All samples were placed in the incubator for 24 h at 37℃, 100% humidity, for the materials to be completely set. The final restoration was placed using the Z350 resin composite. A double layer of nail varnish was applied over all the sample surfaces except the occlusal site. Whereas the samples' surfaces in the negative control, were completely covered. A 3 mm length was measured from the root apex of the samples from each group, before proceeding with the resection. The bacterial leakage test was performed using Enterococcus faecalis TCC 23,125, and a sample from each experimental group was randomly chosen for SEM. Data analysis was conducted under the One-way ANOVA test, completed by Tukey's post hoc test.
RESULTS
There is a significant difference in sealing ability and marginal adaptation between the groups. (p < 0.05). The study showed that Pro Root MTA had the superior sealing ability and marginal adaptation compared to Biodentine and MTA Angelus.
CONCLUSION
The ProRoot MTA as a coronal pulpotomy pulp dressing material, was found to have a better marginal adaptation and sealing ability compared to three other bioceramics materials. The material would be the better choice during clinical settings and procedures.
Topics: Humans; Calcium Compounds; Silicates; Dental Pulp; Oxides; Bismuth; Root Canal Filling Materials; Drug Combinations; Aluminum Compounds
PubMed: 37420224
DOI: 10.1186/s12903-023-03129-1