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Review of literature on Apexigenesis and Revascularization - NEWSLETTER 1

Review of literature on Apexigenesis and Revascularization - NEWSLETTER 1

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    Endo in vivo newsletter Endo in vivo newsletter Document Transcript

    • ENDO IN VIVO January, 2013 Vol 1Apexfication, Pulp Capping and Apexogenesis To know that we know what we know, and that we do not know what we do not know, that is true knowledge. Henry David Thoreau A Prospective Clinical Study of Mineral Trioxide Aggregate for Partial Pulpotomy in Cariously Exposed Permanent Teeth Kefah Mahmood Barrieshi-Nusair, BDS, MS and Muawia Abdulla Qudeimat, BDS, MDent, Sci, FRCD(C) JOE — Volume 32, Number 8, August 2006 Abstract: The aim of this study was to evaluate gray MTA paste was placed against the fresh the success of using gray mineral trioxide wound. The floor of the cavity was covered with a aggregate (MTA) for partial pulpotomy in base of glass ionomer. The teeth were restored with cariously exposed young permanent first amalgam or stainless steel crowns. Teeth were molars. Thirty-one first permanent molars of 23 reviewed radiographically and clinically at 3, 6, 12, patients with a carious exposure were treated using and 24 month intervals. Twenty-two of the treated a partial pulpotomy technique. The age of the teeth did not show any clinical or radiographic signs patients ranged from 7.2 to 13.1 yr with an average of failure during the follow-up evaluation period. Six of 10 yr. Clinical and radiographic examination teeth did not respond to vitality testing at the final revealed a pulpal response within normal limits and follow-up period; however, no radiographic signs of normal appearance of the periradicular area failure or clinical symptoms were detected. Gray respectively. A diagnosis of reversible pulpitis and MTA was a suitable dressing agent for parital normal periapex was established. After isolation, pulpotomy in cariously exposed young first caries removal and carious exposure, the exposed permanent molars. pulp tissue was removed with a diamond bur to a depth of 2 to 4 mm. After hemostasis, 2 to 4 mm of http://youtu.be/VUfRt8GNhKA
    • In-Vitro Evaluation of Microleakage of an Orthograde Apical Plug of Mineral Trioxide Aggregate in Permanent Teeth with Simulated Immature Apices Ahmed Al-Kahtani, BDS, MS, Sandra Shostad, DMD, MS, Robert Schifferle, DDS, PhD, and Satish Bhambhani, BDS, DDS, MS JOE — Volume 31, Number 2, February 2005 January, 2013 Vol 1Apexfication, Pulp Capping and Apexogenesis Abstract: This in vitro study evaluated the parametric ANOVA with Dunn multiple seal created by varying depths of mineral comparison test p < 0.05). Bacterial leakage trioxide aggregate (MTA) plugs placed in an occurred in 6 (33%) of 18 in the non-ultrasonic orthograde fashion in five groups of 10 MTA group, 2 (11%) of 18 in the ultrasonic MTA teeth. One group received a 2 mm thick group, and 1 (6%) of 18 in the ultrasonic MTA- orthograde apical plug of MTA, the second group composite group. There were no significant a 5 mm apical MTA plug, and the third group a 2 differences at 90 days. A 4-mm thickness of MTA mm apical MTA plug with a second 2 mm followed with an intracanal composite resin increment, 24 h later. The remaining portion of demonstrated a significantly greater resistance to the canal in these groups was left unfilled. Group root fracture than MTA followed with gutta-percha four received a 2 mmMTA plug that set for 24 h and sealer (one-way ANOVA with Newman-Keuls and the canal was then back-filled with multiple comparison test, p < 0.01). The MTA– guttapercha and eugenol based sealer. Group gutta-percha group was not significantly five was a positive control without an MTA plug. different than the MTA unrestored positive The apical seal was tested using a bacterial control. leakage model of Actinomyces viscosus. http://youtu.be/Q0LmbvAIKHE Results showed a statistically significant difference in only the 5 mm apical plug, Evaluation of Mineral Trioxide Aggregate which completely prevented bacterial and Calcium Hydroxide Cement as Pulp- leakage. (page 3 figure) capping Agents in Human Teeth Maria de Lourdes R. Accorinte, DDS, MS, PhD, Roberto Evaluation of Ultrasonically Placed MTA and Holland, DDS, MS, PhD, Alessandra Reis, DDS, PhD, Fracture Resistance with Intracanal Marcelo C. Bortoluzzi, DDS, PhD, Sueli S. Murata, DDS, MS, PhD, Eloy Dezan, Jr, DDS, MS, PhD, Valdir Souza, Composite Resin in a Model of Apexification DDS, MS, PhD, and Loguercio Dourado Alessandro, PhD G.Robert Lawley, DDS, William G.Schindler, DDS, MS, JOE Volume 34, Number 1, January 2008 William A.Walker III, DDS, MS and David Kolodrubetz, PhD JOE - Volume 30, Number 2, March 2004 Abstract This study evaluated the histo- morphologic response of human dental pulps Abstract: The purpose of this study was to capped with mineral trioxide aggregate (MTA) evaluate whether intracoronal delivery of an and Ca(OH)2 cement (CH). Pulp exposures apical barrier of mineral trioxide aggregate (MTA) were performed on the occlusal floor of 40 placed ultrasonically, non-ultrasonically, or human permanent premolars. After that, the pulp ultrasonically with the addition of an intracanal was capped either with CH or MTA and restored composite resin provided a better seal against with composite resin. After 30 and 60 days, teeth bacterial leakage. A second purpose was to were extracted and processed for histologic determine whether intracanal composite resin or exam and categorized in a histologic score gutta-percha and sealer placed against an apical system. The data were subjected to Kruskal- barrier of MTA provided greater resistance to root Wallis and Conover tests ( .05). All groups fracture.In a standardized in vitro open apex model, performed well in terms of hard tissue bridge MTA was placed as an apical barrier at a thickness of formation, inflammatory response, and other 4 mm, with and without ultrasonic vibration.The pulpal findings. However, a lower response of barriers were challenged with bacteria exposure CH30 was observed for the dentin bridge within a leakage model, and fracture resistance was formation, when compared with MTA30 and assessed with increasing forces applied via an Instron MTA60 groups. Although the pulp healing with machine. After 45 days, the addition of ultrasonics calcium hydroxide was slower than that of significantly improved the MTA seal, compared with MTA,both materials were successful for pulp the non-ultrasonics treatment (Kruskal Wallis non- capping in human teeth. ENDO IN VIVO 2
    • Vital Pulp Therapy with New Materials: New January, 2013 Vol 1Apexfication, Pulp Capping and Apexogenesis Directions and Treatment Perspectives— Permanent Teeth David E. Witherspoon, BDS, MS JOE — Volume 34, Number 7S, July 2008 Abstract: Pulp necrosis in immature teeth subsequent to caries has a major impact on long-term tooth retention. The aim of vital pulp therapy is to maintain pulp viability by eliminating bacteria from the dentin-pulp complex and to establish an environment in which apexogenesis canoccur. A complicating factor in treating immature teeth is the difficulty predicting the Clinical Outcomes of Artificial Root-end degree of pulpal damage. The ability of the Barriers with Mineral Trioxide Aggregate in clinician to manage the health of the remaining pulpal tissue during the procedure is paramount. Teeth with Immature Apices David T. Holden, DMD, Scott A. Schwartz, DDS, Timothy C. Currently, the best method appears to be the Kirkpatrick, DDS, and William G. Schindler, DDS, MS ability to control pulpal hemorrhage by using JOE—Volume 34, Number 7, July 2008 sodium hypochlorite. Mineral trioxide aggregate (MTA) currently is the optimum material for use in Abstract: The purpose of this retrospective vital pulp therapy. Compared with the traditional study was to evaluate the clinical outcomes of material of calcium hydroxide, it has superior ProRoot mineral trioxide aggregate used as long-term sealing ability and stimulates a higher an artificial apical barrier in teeth with quality and greater amount of reparative dentin. immature apices. Twenty teeth from 19 patients In the medium-term clinical assessment, it has were included in this study. A healed diagnosis demonstrated a high success rate. Thus, MTA is was based on periapical index scores of 1 or 2 a good substitute for calcium hydroxide in and no clinical signs or symptoms at recall vital pulp procedures. examinations. Eighty-five percent (17/20) of these teeth were healed, and improvements in periapical index scores at recall appointments were shown to be statistically significant (P .001, Wilcoxon signed-rank test). Chi-square test indicated that age, gender, primary treatment versus retreatment, presence of preoperative lesion, and differences in recall times did not significantly influence healing outcome. Overall, these results indicated that the mineral trioxide aggregate apical barrier technique is Results showed a a successful method for obturating teeth with statistically significant immature apices. difference in only the 5 mm apical plug, which http://youtu.be/D8FeuGcKcpo completely prevented bacterial leakage. ENDO IN VIVO 3
    • Retrospective Analysis of Open Apex Teeth Obturated with January, 2013 Vol 1Apexfication, Pulp Capping and Apexogenesis Mineral Trioxide Aggregate David E. Witherspoon, BDSc, MS, Joel C. Small, DDS, John D. Regan, BDS, MS and Martha Nunn, DDS, PhD JOE — Volume 34, Number 10, October 2008 Abstract: This study is a retrospective mineral trioxide aggregate apical plugs. Methods: analysis of the outcome of initial nonsurgical Seventy-two patients with 78 teeth with apical root canal treatment of teeth with open apices, resorption or excessive apical enlargement, obturated with mineral trioxide aggregate treated between 2000 and 2006, were contacted when no apical barrier existed. One hundred for follow-up examination 12 to 68 months after treatment (median 30.9 months). Treatments sixteen patients from a single private endodontic were provided by supervised undergraduate office were treated between 1999 and 2006. students (27%), general dentists (32%), or Treatments on 144 teeth were completed either in dentists who had focused on endodontics (41%). one (92/144) or two visits with an interim calcium The outcome based on clinical and radiographic hydroxide interappointment medication (52/144). criteria was assessed by calibrated examiners Fifty-four percent (78/144) of the teeth were and dichotomized as ‘‘healed’’ or ‘‘disease.’’ available for recall (60.3% one visit and 39.7% Results: Of 56 teeth examined (72% recall), 84% two visits). The maximum time to recall was 4.87 were healed. Teeth without or with preoperative years. The mean time to recall was 19.4 months. periapical radiolucency had a healed rate of Of the cases recalled for period of 1 year or 100% and 78%, respectively. None of the longer, 93.5% of teeth treated in 1 visit healed, variables analyzed had a significant effect on the outcome. Conclusion: The results supported and 90.5% of teeth treated in 2 visits healed. the management of open apical foramina with mineral trioxide aggregate apical plugs. Mineral Trioxide Aggregate Apical Plugs in Teeth with Open Apical Foramina: A Retrospective Evaluation of Radiographic A Retrospective Analysis of Treatment Outcome Outcomes in Immature Teeth With Necrotic Johannes Mente, DMD, Nathalie Hage, Thorsten Pfefferle, Root Canal Systems Treated With Regenerative DMD, Martin Jean Koch, MD, DMD, PhD, Jens Dreyhaupt, DSc, Hans Joerg Staehle, MD, DMD, PhD and Shimon Endodontic Procedures Friedman, DMD JOE — Volume 35, Number 10, October Raison Bose, DDS, Pirkka Nummikoski, DDS, MS and 2009 Kenneth Hargreaves, DDS, PhD JOE — Volume 35, Number 10, October 2009 Abstract Abstract Introduction: Teeth with open apical foramina Introduction: Several case reports on present a challenge during root canal endodontic regeneration involving immature treatment, and little is known about the permanent teeth have recently been clinical outcome of treatment in such teeth. published. These case series have used varying This retrospective study assessed healing of teeth treatments to achieve endodontic regeneration with open apices managed by the placement of including triple antibiotic paste, Ca(OH)2, and formocresol. However, no study has analyzed the overall results. Methods: In this retrospective study, we collected radiographs from 54 published and unpublished endo-dontic regenerative cases and 40 control cases (20 apexification and 20 nonsurgical root canal treatments) and used a geometrical imaging program, NIH ImageJ with TurboReg plug-in, to minimize potential differences in angulations between the preoperative ENDO IN VIVO 4
    • and recall images and to calculate continued Abstract January, 2013 Vol 1Apexfication, Pulp Capping and Apexogenesis development of root length and dentin wall Introduction: The occurrence and potential thickness. Results: The comparison to the 2 orthodontic causes of cervical invasive root control groups provided a validation test for this resorption (CIRR) are unknown. We aimed to method. Forty-eight of the 54 regenerative identify the occurrence of CIRR in molar teeth of cases (89%) had radiographs of sufficiently orthodontic patients treated with fixed appliances. similar orientation to permit analysis. The results Methods: All patients invited for final orthodontic showed regenerative endodontic treatment with recall between November 2009 and March 2011 triple antibiotic paste (P < .001) and Ca(OH)2 (P were included. From 175 patients, 108 (46 men/ < .001) produced significantly greater increases 62 women; mean age, 25+/- 5 years; mean time in root length than either the MTA apexification or after bracket removal, 8 +/- 2 years) were NSRCT control groups. The triple antibiotic paste available. The first and second molar teeth (N = produced significantly greater differences in root 858) of these patients were investigated for wall thickness than either the Ca(OH)2 or clinical and radiographic signs of CIRR. Patients formocresol groups (P < .05 for both). The identified with such signs were asked to have position of Ca(OH)2 also influenced the outcome. limited-volume cone-beam computed tomography When Ca(OH)2 was radiographically restricted to scans performed. Results: No clinical signs of the coronal half of the root canal system, it CIRR were detected. CIRR could not be ruled out produced better results than when it was placed on bite-wing radiographs in 18 patients. CIRR beyond the coronal half. Conclusions: Ca(OH)2 was thus identified in 1 patient in whom a second and triple antibiotic paste when used as an maxillary molar was affected. All first molars had intracanal medicament in immature necrotic been extracted in this patient, and the second teeth can help promote further development molars had been moved mesially over a long of the pulp dentin complex. (see images below) distance. The 3 other second molars showed surface resorption. Conclusions: CIRR in molar Occurrence of Cervical Invasive Root Resorption teeth of orthodontic patients have a low mid- in First and Second Molar Teeth of Orthodontic term occurrence (0.9%; 95% confidence interval, 0.2%–5.2%). Long movement Patients Eight Years after Bracket Removal distances and/or long treatment duration may Raison Bose, DDS, Pirkka Nummikoski, DDS, MS and be related to the development of these Kenneth Hargreaves, DDS, PhD JOE — Volume 35, Number 10, October 2009 lesions. (A) Preoperative radiograph of tooth #20 with an open apex and a diagnosis of pulpal necrosis with apical periodontitis (6). (B) Recall radiograph at 10 months. Notice change in the angulations between (A) and (B). (C) Preoperative radio-graph after image correction with the TurboReg plug-in application of NIH Image J. (D) Recall radiograph used as the source image to define the modeling function used on the pre-operative (target) image. Note the final degree of parallelism of tooth #20 between the modified pre-operative and recall radiographs. ENDO IN VIVO 5