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Journal of Conservative Dentistry and... Apr 2024The cases presented here aim to highlight the occurrence of a very rare internal root resorption (IRR) of inflammatory type among mandibular molars (prevalence...
The cases presented here aim to highlight the occurrence of a very rare internal root resorption (IRR) of inflammatory type among mandibular molars (prevalence 0.01%-1%). Patients reported in the outpatient department with a chief complaint of pain in the lower posterior region of the jaws, on thorough clinical and radiological examinations a diagnosis of irreversible pulpitis was made and nonsurgical root canal treatment was planned using thermoplastic obturation technique along with the use of magnification, cone-beam computed tomography, endosonics, and intracanal medicament to attain a successful outcome. Six-month follow-up showed arrest of IRR. This report of two cases with a literature review discusses the etiology, prevalence of IRR, the clinical decision, and the therapeutic management. Early detection of such resorption is the key to successful management and preserves the integrity of the tooth.
PubMed: 38779212
DOI: 10.4103/JCDE.JCDE_65_24 -
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 -
Journal of Applied Oral Science :... 2024To compare the effect of submucosal cryotherapy using cold saline to dexamethasone sodium phosphate and diclofenac sodium injections on substance P and interleukin 6... (Comparative Study)
Comparative Study
Effect of submucosal cryotherapy compared with steroids and NSAIDs injections on Substance P and Interleukin 6 pulpal release in experimentally induced pulpal inflammation in rabbits.
OBJECTIVE
To compare the effect of submucosal cryotherapy using cold saline to dexamethasone sodium phosphate and diclofenac sodium injections on substance P and interleukin 6 release in experimentally induced pulpal inflammation in rabbits' molar teeth.
METHODOLOGY
Fifteen rabbits were randomly classified into 3 groups according to the submucosal injection given: cold saline, dexamethasone sodium phosphate, and diclofenac sodium. A split-mouth design was adopted, the right mandibular molars were experimental, and the left molars served as the control without injections. Intentional pulp exposures were created and left for 6 hours to induce pulpitis. Pulpal tissue was extracted and examined for SP and IL-6 levels using ELISA. Within each group, the level of cytokines released was measured for both control and experimental groups for intragroup comparison to determine the effect of injection. The percentage reduction of each mediator was calculated compared with the control side for intergroup comparison then the correlation between SP and IL-6 levels was analyzed using Spearman's rank order correlation coefficient. Statistical analysis was performed, and the significance level was set at p<0.05.
RESULTS
Submucosal cryotherapy, dexamethasone sodium phosphate, and diclofenac sodium significantly reduced SP and IL-6 pulpal release. Submucosal cryotherapy significantly reduced SP more than and IL-6 more than dexamethasone sodium phosphate and diclofenac sodium. Pulpal reduction of SP and IL-6 showed a strong positive significant correlation.
CONCLUSIONS
Submucosal cryotherapy reduces the pulpal release of SP and IL-6 and could be tested as an alternative to premedication to potentiate the effect of anesthesia and control postoperative endodontic pain.
Topics: Animals; Rabbits; Pulpitis; Diclofenac; Dexamethasone; Interleukin-6; Random Allocation; Cryotherapy; Substance P; Anti-Inflammatory Agents, Non-Steroidal; Dental Pulp; Enzyme-Linked Immunosorbent Assay; Time Factors; Reproducibility of Results; Treatment Outcome; Male; Statistics, Nonparametric; Disease Models, Animal; Anti-Inflammatory Agents; Saline Solution; Reference Values
PubMed: 38775598
DOI: 10.1590/1678-7757-2024-0017 -
Scientific Reports May 2024Despite advancements in vital pulp therapy (VPT), a subset of cases fails to achieve desired outcomes. This study based on a previous large-scale cohort study involving...
Despite advancements in vital pulp therapy (VPT), a subset of cases fails to achieve desired outcomes. This study based on a previous large-scale cohort study involving 1257 VPT-treated teeth, aiming to describe the demographic data and clinical characteristics of all failed cases and their management protocols. Clinical records/images of 105 failed cases treated by a single endodontist (2011-2022) were examined, including 10 extracted teeth. Asymptomatic cases with PDL widening received no intervention, while others underwent management protocols, including (selective) RCT and (tampon) re-VPT. These retreatments were assessed for success (defined as radiographic evidence of healing) and survival (characterized by the retention/function of the treated tooth) using Kaplan-Meier analysis. While 51.4% of all initial failures were diagnosed due to symptoms, 48.6% were symptom-free. Notably, failed cases with symptomatic irreversible pulpitis, and apical periodontitis/widened PDL before initial treatment significantly outnumbered asymptomatic cases and normal PDL, respectively (P = 0.001). Moreover, most of the initial failures were observed in teeth with composite resin rather than amalgam restorations (P = 0.002). The success and survival rates for the management protocols were 91.78% and 95.79%, respectively, over an average follow-up period of 36.94 (± 23.30) months. RCT and re-VPT procedures provide successful outcomes for managing unsuccessful VPTs.
Topics: Humans; Male; Female; Retrospective Studies; Adult; Middle Aged; Dentition, Permanent; Treatment Failure; Treatment Outcome; Pulpitis; Dental Pulp; Kaplan-Meier Estimate; Root Canal Therapy
PubMed: 38773252
DOI: 10.1038/s41598-024-62565-3 -
Indian Journal of Dental Research :... Oct 2023To estimate the working length of teeth using conventional tactile technique, radiovisiography technique, Apex locator, and confirmation of working length by cone beam... (Comparative Study)
Comparative Study
AIM
To estimate the working length of teeth using conventional tactile technique, radiovisiography technique, Apex locator, and confirmation of working length by cone beam computed tomography technique.
MATERIALS AND METHODS
Forty patients with the age group between 20 and 50 years with irreversible pulpitis were included in this study. After taking a preoperative radiograph, the procedure was started. The cavity wall buildup was done using composite in the cases needed and then rubber dam application was done. The working length of mesiobuccal and mesiolingual canal was taken using cone beam computed tomography and this was considered as the standard value. Then using tactile method, length of the canal was measured using radiovisiographic software followed by apexlocator.
RESULT
The Apex locator has showed best result as compared to tactile and radiovisiography.
CONCLUSION
Apex locator values were closest to cone beam computed tomography working length measurement values and electronic apexlocator can be used efficiently as an alternative method for working length determination. The quality of various techniques according to ranks of working length determination was found to be Cone beam computed tomography (CBCT) > Apexloc > Radiovisiography (RVG) > Tactile. Thus, Apex locator can be used as an alternative to cone beam computed tomography for working length determination.
Topics: Humans; Cone-Beam Computed Tomography; Adult; Middle Aged; Young Adult; Female; Male; Dental Pulp Cavity; Odontometry; Pulpitis; Tooth Apex
PubMed: 38739821
DOI: 10.4103/ijdr.ijdr_404_22 -
Biochemical and Biophysical Research... Jul 2024Pulpitis constitutes a significant challenge in clinical management due to its impact on peripheral nerve tissue and the persistence of chronic pain. Despite its...
Pulpitis constitutes a significant challenge in clinical management due to its impact on peripheral nerve tissue and the persistence of chronic pain. Despite its clinical importance, the correlation between neuronal activity and the expression of voltage-gated sodium channel 1.7 (Nav1.7) in the trigeminal ganglion (TG) during pulpitis is less investigated. The aim of this study was to examine the relationship between experimentally induced pulpitis and Nav1.7 expression in the TG and to investigate the potential of selective Nav1.7 modulation to attenuate TG abnormal activity associated with pulpitis. Acute pulpitis was induced at the maxillary molar (M1) using allyl isothiocyanate (AITC). The mice were divided into three groups: control, pulpitis model, and pulpitis model treated with ProTx-II, a selective Nav1.7 channel inhibitor. After three days following the surgery, we conducted a recording and comparative analysis of the neural activity of the TG utilizing in vivo optical imaging. Then immunohistochemistry and Western blot were performed to assess changes in the expression levels of extracellular signal-regulated kinase (ERK), c-Fos, collapsin response mediator protein-2 (CRMP2), and Nav1.7 channels. The optical imaging result showed significant neurological excitation in pulpitis TGs. Nav1.7 expressions exhibited upregulation, accompanied by signaling molecular changes suggestive of inflammation and neuroplasticity. In addition, inhibition of Nav1.7 led to reduced neural activity and subsequent decreases in ERK, c-Fos, and CRMP2 levels. These findings suggest the potential for targeting overexpressed Nav1.7 channels to alleviate pain associated with pulpitis, providing practical pain management strategies.
Topics: Animals; NAV1.7 Voltage-Gated Sodium Channel; Mice; Male; Pulpitis; Trigeminal Ganglion; Neurons; Nerve Tissue Proteins; Proto-Oncogene Proteins c-fos; Voltage-Gated Sodium Channel Blockers; Disease Models, Animal; Intercellular Signaling Peptides and Proteins
PubMed: 38718567
DOI: 10.1016/j.bbrc.2024.150044 -
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 -
Journal of Cellular and Molecular... May 2024Mechanical force induces hypoxia in the pulpal area by compressing the apical blood vessels of the pulp, triggering pulpal inflammation during orthodontic tooth...
Mechanical force induces hypoxia in the pulpal area by compressing the apical blood vessels of the pulp, triggering pulpal inflammation during orthodontic tooth movement. However, this inflammation tends to be restorable. Macrophages are recognized as pivotal immunoreactive cells in the dental pulp. Whether they are involved in the resolution of pulpal inflammation in orthodontic teeth remains unclear. In this study, we investigated macrophage polarization and its effects during orthodontic tooth movement. It was demonstrated that macrophages within the dental pulp polarized to M2 type and actively participated in the process of pulpal inflammation resolution. Inflammatory reactions were generated and vascularization occurred in the pulp during orthodontic tooth movement. Macrophages in orthodontic pulp show a tendency to polarize towards M2 type as a result of pulpal hypoxia. Furthermore, by blocking M2 polarization, we found that macrophage M2 polarization inhibits dental pulp-secreting inflammatory factors and enhances VEGF production. In conclusion, our findings suggest that macrophages promote pulpal inflammation resolution by enhancing M2 polarization and maintaining dental health during orthodontic tooth movement.
Topics: Dental Pulp; Tooth Movement Techniques; Animals; Macrophages; Inflammation; Mice; Cell Polarity; Male; Vascular Endothelial Growth Factor A; Pulpitis; Macrophage Activation
PubMed: 38700030
DOI: 10.1111/jcmm.18350 -
The Saudi Dental Journal Apr 2024Pulp therapy aims to maintain the health and integrity of teeth and their supporting tissue and preserve the vitality of the tooth pulp affected by dentinal caries or... (Review)
Review
Pulp therapy aims to maintain the health and integrity of teeth and their supporting tissue and preserve the vitality of the tooth pulp affected by dentinal caries or severe traumatic injury. Thus, the best clinical practice provides pulpal health or pathosis diagnosis and various therapeutic interventions evidenced in both the deciduous and permanent dentition for endodontic treatment. The pulp health status determines the type of pulpal therapy used. Vital pulp therapies for primary teeth include protective liners, pulp capping, and pulpotomy for reversible pulpitis; for permanent teeth, pulpotomy can be considered for irreversible pulpitis. For reversible or irreversible pulpitis, invasive management of decayed teeth has traditionally been performed. However, at present, coronal pulpotomy-like vital pulp therapy has led to successful treatment outcomes that are less invasive. Compared to root canal treatments, coronal pulpotomy is cost-effective, less time-consuming, and less technically demanding. The success of a pulpotomy depends on the clinician's experience, appropriate clinical techniques, and materials used. This narrative review provides insights into the systematic analysis of pulpotomy failure, causes and signs of failure, and alternative endodontic interventions.
PubMed: 38690395
DOI: 10.1016/j.sdentj.2024.01.005 -
Cureus Mar 2024Pain is the primary reason dental patients seek endodontic therapy. Post-treatment endodontic discomfort is a sequelae of periapical inflammation and anti-inflammatory...
BACKGROUND AND OBJECTIVES
Pain is the primary reason dental patients seek endodontic therapy. Post-treatment endodontic discomfort is a sequelae of periapical inflammation and anti-inflammatory drugs such as corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) would be reasonable therapy options. The purpose of this study was to compare and assess the efficacy of intramuscular injections of dexamethasone and ketorolac tromethamine versus placebo in reducing post-treatment endodontic pain in individuals undergoing root canal treatment.
METHODOLOGY
Patients diagnosed with symptomatic irreversible pulpitis were selected. Nonsurgical endodontic therapy was carried out in a single visit. After completion of the root canal therapy, the patients were randomly assigned to one of the three groups for intramuscular drug administration. In group 1, 2 ml of sterile saline was administered, in group 2, 1 ml of 4 mg dexamethasone was administered; and in group 3, 1 ml of 30 mg ketorolac tromethamine was administered. Preoperative and postoperative pain intensity was measured by a verbal rating scale. Postoperatively, the incidence and severity of pain were recorded after four, 24, and 48 hours.
RESULTS
All three groups showed a highly statistically significant reduction in pain scores when compared to preoperative levels. At the end of four hours, dexamethasone and ketorolac tromethamine showed highly significant results. Dexamethasone significantly reduced pain after 24 hours when compared to ketorolac and placebo groups. At the conclusion of 48 hours, all three groups experienced a gradual decrease in pain levels.
CONCLUSION
Effective and complete debridement of infected root canal system provides predictable gradual reduction of post-endodontic pain.
PubMed: 38681426
DOI: 10.7759/cureus.57086