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The present case report highlights the need to identify variations in root canal anatomy as a prerequisite for effective nonsurgical root canal therapy planning. As clinicians, we need to develop our observational and clinical abilities as well as amend our understanding of the complexities of the canal anatomy. Reports describing the structure of teeth and pulp canals rarely report the presence of two pulp canals in two permanent upper 1st molars. In this case, it describes the nonsurgical root canal therapy of the upper right 1st permanent molar with two pulp canals, which was confirmed by a cone beam.

The primary objective of root canal treatment is complete cleaning and shaping of all root canals so that microorganism and debris are removed from the root canal that result in hermetic seal of root canal space. The endodontic treatment of every tooth poses some endodontic challenges which have to be carefully managed by proper clinical and radiographic evaluation before treatment. The teeth with partial or complete obliteration of pulp canal results in endodontic challenge due to difficulty in negotiation of canal orifice. It is always important to take necessary precautions while locating canal orifice to apex, otherwise it will result in iatrogenic errors including perforation and separation of instrument. This present case describes the successful location and management of calcified canal in maxillary central incisor with proper knowledge of internal anatomy, thorough radiographic assessment and canal orifice locating instrument such as c+ files under microscope. Keywords: Calcified tooth, Dental Operating Microscope, Maxillary central incisor

Objectives This study aimed to retrospectively evaluate clinical and radiographic outcomes of partial pulpotomy performed in permanent teeth with carious pulp exposure. Materials and methods Records of patients undergoing treatment at an undergraduate dental clinic between 2010 and 2019 were screened for partial pulpotomies in teeth with a presumptive diagnosis of normal pulp or reversible pulpitis. The follow-up had to be ≥ 1 year. Patient data were retrieved and analyzed using Mantel-Cox chi square tests and Kaplan–Meier statistics. The level of significance was set at α = 0.05. Results Partial pulpotomy was performed in 111 cases, of which 64 (58%) fulfilled the eligibility criteria. At the time of partial pulpotomy, the mean age was 37.3 (± 13.5) years (age range 18–85). The mean observation period was 3.1 (± 2.0) years. Two early failures (3.1%) and five late failures (7.7%) were recorded. The overall success rate of maintaining pulp vitality was 89.1%, with 98.4% tooth survival. The cumulative pulp survival rates of partial pulpotomy in patients aged 40 years were 100%, 75.5%, and 90.5%, respectively, with no significant difference between the age groups (p = 0.225). At follow-up, narrowing of the pulp canal space and tooth discoloration were observed in 10.9% and 3.1% of cases, respectively. Conclusions Across age groups, partial pulpotomy achieved favorable short and medium-term outcomes in teeth with carious pulp exposure. Clinical relevance Adequate case selection provided, partial pulpotomy is a viable operative approach to treat permanent teeth with deep carious lesions irrespective of patients’ age.

Objective The aim of this study was to evaluate the influence of the incorporation of chlorhexidine-hexametaphosphate nanoparticles (CHX-HMP NPs) on antibacterial, cytotoxic and physicochemical properties of AH Plus (AH), MTA Fillapex (MTA) and Pulp Canal Sealer (PCS). Methods The NPs were synthesized and characterized by Scanning Electron Microscopy (SEM), Dynamic Light Scattering (DLS), zeta potential, Atomic Force Microscopy (AFM) and Energy-Dispersive X-ray Spectroscopy (EDS). The incorporation was made by weight, 2% and 5% of NPs. The antimicrobial activity, cytotoxicity, flow, radiopacity, setting time, solubility and pH were evaluated. The statistical analysis was performed by two-way analysis of variance test and Tukey post hoc test (P Results SEM analysis showed the tendency for CHX-HMP NPs to cluster, the effective mean diameter measured by DLS: 169.39 nm and the zeta potential: -10.18 mV. The NPs were individually measured by AFM: 22.99–52.75 nm. EDS analysis identified the presence of C, N, O, Na, P, Cl. After incorporation: The Direct Contact Test showed an increase in the antimicrobial action of AH, PCS and MTA; the sealers showed a decrease in flow and at 24 h of immersion also an increase in solubility, but did not affect the radiopacity of the samples; AH setting time increased and MTA did not reach setting under any of the conditions tested. All samples showed a decrease in pH value as the immersion time progressed. Significance The incorporation of NPs can improve the antimicrobial performance of endodontic sealers without impairing other biological and physicochemical properties.

Endodontic freshly mixed sealers display toxic effects; however, these are significantly reduced and most become relatively inert in the set state but there is no information about the possible inflammatory reaction promoted by them. Four contemporary and different formulated endodontic set sealers (MTA Fillapex, BioRoot RCS, AH Plus, and Pulp Canal Sealer) were evaluated. Human periodontal ligament cells and human peripheral blood mononuclear cells were stimulated for 3, 6, 12 and 24 h. Interleukin-6, tumour necrosis factor-alpha, interleukin-8 and interleukin-10 concentrations were measured by enzyme-linked immunosorbent assay. All endodontic set sealer eluates promoted a similar production (P ˃ 0.05) of the four cytokines. However, their concentrations decreased within a short time period to nearly undetectable concentrations after 24 h, suggesting that the studied endodontic set sealers do not possess inflammatory properties which has favoured their long-term use in clinical practice.

AIM To evaluate the correlation between the volume of dental hard tissues removed and the fracture resistance of mandibular molar teeth with ultraconservative (UltraAC) or traditional (TradAC) access cavity preparations. METHODOLOGY Sixty recently extracted and intact mandibular first molars were scanned in a microcomputed tomographic (micro-CT) device, anatomically matched and assigned at random to 2 groups (n = 30), according to the access cavity type: UltraAC or TradAC. After access preparation, mesial and distal canals were prepared using Reciproc instruments and a new scan was taken. The volumes of pulp chamber and dental hard tissues in each specimen were measured before and after the experimental procedures, and the percentage volume reduction of hard tissues calculated for the entire tooth and for the crown separately. Teeth were then root filled, restored and subjected to fracture resistance tests in an universal testing machine. The force required to fracture was recorded in Newtons (N). The adherence of the variables to a Gaussian curve was verified using a Shapiro-Wilk test. Skewed data were analysed with nonparametric Wilcoxon signed rank or Spearman correlation tests, whilst the normally distributed data were analysed with a dependent samples Student t-test. Level of significance was set at 5%. RESULTS Pre-operatively, no difference was observed between groups regarding the volume of pulp canal space or dental hard tissues (P > 0.05). After access preparation, volumes of the removed hard tissues from the entire tooth and from the crown were significantly greater in teeth prepared with TradAC than with UltraAC (P

Background: A desirable property of an obturation material in primary teeth is its antibacterial effect, this property promotes the disinfection of the pulp canals and improve the prognosis of pulpectomy and treatment outcomes. Aim of the study: evaluation the antibacterial potential of various obturation materials for primary teeth; Zinc oxide eugenol (ZOE) only, calcium hydroxide with iodoform (Metapex) and a mixture of zinc oxide eugenol, calcium hydroxide and iodoform (Endoflas) against selected strains of bacteria; Enterococcus faecalis and Bacteroid fragilis. Materials and Methods: Agar diffusion method was used in which the antibacterial potential was tested by measuring the inhibition zone around each tested obturating material. Results: (Endoflas) showed the highest mean value of inhibition zone, in both types of bacteria, over the (Zinc-oxide and Eugenol) and (Metapex). The difference between the three obturating materials was statistically significant. Conclusion: The three obturating materials reported different antibacterial effect however, Endoflas was superior to Metapex and ZOE.

A detailed knowledge of the pulp canal anatomy and variations in individual tooth is important to effectively clean and shape the root canal system. Identification of such variations and their instrumentation together with adequate disinfection can avoid need for future retreatment and surgical intervention. Several case reports reported variations in tooth morphology and root canal systems related to the mandibular first premolars. The occurrence of three roots in the mandibular first premolar is unusual. This article reports the identification and management of mandibular first premolar with aberrant root and root canal system. Keywords: Anatomical variations, Mandibular first premolar, Three root canals.

Background: Root canal Therapy is one of the procedures for the management of nonvital tooth with periapical lesion. The principle of this therapy is the complete sterilization of the total pulp canal space thereby healing of the periradicular lesion. Objectives: This experimental study assessed the clinical and radiological outcome of root canal treatment for nonsurgical management of nonvital teeth with periapical lesion. Materials and Methods: A total number of 40 infected teeth with periapical lesion were treated by conventional root canal treatment. Irritants from the root canal system was removed by mechanical instrumentation( Crown down Technique), chemical irrigation with NaOCL and by using Calcium Hydroxide as intracanal medicaments and fluid tight obturation both apically and coronally resulting repairs of inflamed periradicular tissues. The protocol for follow up examination will be 3, 6 and 12 months post operatively. At the time of follow up examination a standard follow up chart will be maintained. Results: Among 40 cases 32 cases could be treated as acceptable as their responses were good both clinically and radiologically and 5 patients came back with some complications among them 3 cases were uncertain and 2 cases were unacceptable. Conclusion: It was concluded that conventional root canal treatment reduced clinical signs and symptoms successfully in teeth with periapical lesion and radiologically. TAJ 2020; 33(1): 25-30

Fracture of an endodontic file inside a primary root canal is a rare but critical complication during the pulpectomy treatment, because the mechanical obstruction impedes the optimal cleaning and obturation of the pulp canal, compromising seriously the clinical outcome. This accidental event is mainly associated with over-use and excessive torque of intracanal files. Most clinicians opt to proceed with the extraction of the affected tooth followed by a space maintainer placement. Other practitioners attempt the non-surgical retrieval of the separated fragment through available proven techniques in permanent teeth; however, these methods may involve significant damage to the tooth and surround tissues. On the other hand, preservation of the metallic fragment might affect the treatment prognosis and interfere with the physiological root resorption. La fractura de una lima endodóntica dentro de un conducto radicular primario es una complicación rara aunque critica durante el tratamiento de pulpectomía, debido a que la obstrucción mecánica impide la limpieza y obturación óptimas del conducto pulpar, comprometiendo seriamente el resultado clínico. Este evento accidental está principalmente asociado con el sobreuso y torque excesivo de las limas dentro del conducto. La mayoría de los clínicos optan por realizar la extracción del diente afectado, seguido por la colocación de un mantenedor de espacio. Otros practicantes intentan la remoción no quirúrgica del fragmento separado a través de técnicas disponibles probadas en dientes permanentes; sin embargo, estos métodos pueden causar daños significativos al diente y tejidos circundantes. Por otra parte, la preservación del fragmento metálico puede afectar el pronóstico del tratamiento e interferir con el proceso de reabsorción radicular fisiológico.

It is important to understand pulp canal configuration to have a successful endodontic treatment. Cone Beam Computed Tomography (CBCT) radiography is able to assess the pulp canal configuration, especially on the lingual/palatal, compared to the periapical radiography. The objective of the research is to know the prevalence pulp canal configuration of mandibular molar teeth in Indonesia subpopulation Mongoloid race using CBCT radiography. This research is a descriptive survey with a cross-sectional approach, using 38 CBCT radiographs from the patients undergoing dental treatments in hospitals in Medan. The subjects were selected based on research criteria; then their CBCT radiographs were interpreted and analyzed. The result shows the existence of mandibular mesial root type 2-1 (28.94%), 1-2-1 (5.26%), 2-2 (55.26%), 2-1-2-1 (2.64%), 3-2 (5.26%), 3-1 (2.64%), distal root type 1-1 (36.84%), 2-1 (23.68%), 1-2-1 (15.79%), 1-2 (2.63%), 2-2 (13.17%), 2-1-2-1 (5.26%), 1-3-1 (2.63%). The distolingual root of mandibular first molars consisted of type 1-1 (100%). Mesial root of mandibular second molars of type 1-1 (2.63%), 2-1 (50%), 1-2-1 (5.26%), 2-2 (36.85%), 2-1-2-1 (2.63%), 1-2-1-2 (2.63%), distal root type 1-1 (57.89%), 2-1 (15.79%), 1-2-1 (13.16%), 2-2 (10.53%), 2-1-2 (2.63%). This variation of the pulp canal can be influenced by the shape of roots. A flat root usually contains pulp canal configuration type II – VIII Vertucci, similarly to mandibular molar mesial canals. As a summary, there is a variation of pulp canal configuration in mandibular first and second molars on Indonesian Mongoloid race, as seen from the CBCT radiographs.

The purpose of this study was to compare the speed of removal of root canal filling material and re-establishment of apical patency in root canals filled with a tricalcium silicate-based sealer (BioRoot RCS [BRCS]; Septodont, Saint-Maur-des-Fossés, France) versus a zinc oxide-eugenol sealer (Pulp Canal Sealer [PCS]; Sybron Endo Kerr, Orange, CA) and to analyze the effect of the operator's experience.One hundred twenty root canals of 40 Dentalike dental simulators (Dentsply Sirona, York, PA) were shaped with a WaveOne (Dentsply Sirona) reciprocating file using short 3-mm strokes. Root canals were obturated using a single gutta-percha cone and either BRCS or PCS. Samples treated either with BRCS or PCS were equally dispatched between experienced practitioners and junior practitioners. The time required to remove root filling material and establish apical patency was recorded for each root canal. Samples were compared according to the sealer used and the practitioner's experience (Mann-Whitney test).One hundred fifteen root canals were successfully retreated. No differences in the time required to remove the filling material were observed between the 2 materials for mesiobuccal or distobuccal canals (P.05). In contrast, the procedure was longer for palatal canals filled with BRCS compared with PCS (79.10 vs 182.45 seconds, P.01). Experienced practitioners took significantly less time than junior practitioners (P.05).BRCS can be successfully removed from root canals as quickly as a zinc oxide-eugenol sealer in both mesiobuccal and distobuccal canals but not in palatal ones. The duration of the procedure was affected by the operator's experience independent of the filling material used or the canal type.

Equine dentistry is a rapidly developing clinical specialty. It has benefitted from key advances in anatomical and physiological research, development of equipment and instrumentation, utilisation of standing sedation and anaesthesia protocols, a change towards minimally invasive surgical techniques, and the introduction of restorative and endodontic techniques translated from techniques used in human and canine dentistry. Anatomical research has provided further insight into the endodontic system of incisors and cheek teeth and how it changes throughout development with age. Studies of the periodontium have demonstrated a rich vascular supply and repair capacity. Routine dental visits are increasingly being performed utilising sedation and clinical instruments for routine examinations. Equipment has become more efficient, battery-operated and miniaturised giving benefits to both equine dental maintenance work and advanced techniques, assisting the transition to minimally invasive techniques, and the development of endodontic and restorative dentistry. Diagnosis has also benefitted from advances in equipment such as patient-side digital radiography systems, high definition oroscopy, and small diameter flexible fibrescopes that are capable of visualising inside a pulp canal. Dental units combining endodontic high- and low-speed drills, suction and air or water flush are becoming increasingly used and adapted for equine use. Sedative combinations and standing anaesthesia protocols have meant that revisions of traditional techniques, as well as novel techniques, can be performed with almost no requirement for general anaesthesia. Equine dentistry can only continue to advance in this way if there is early identification of dental disease through clinical oral examinations, leading to a system based on prophylaxis, as in human dentistry. This necessitates a change in attitude of the public and industry in general to a proactive approach, with early intervention based on examination and diagnostic findings of practitioners and not necessarily based on the clinical signs displayed by the patient.

Aim This 3-year retrospective case series evaluated the clinical and radiographic outcome of ferric sulfate and formocresol pulpotomy in primary molar teeth in a dental teaching hospital in Malaysia. Materials and methods Clinical and radiographic records of all pediatric patients who had pulpotomy of primary molar teeth between July 2005 and October 2008 were evaluated. A total of 55 pulpotomized primary molars were observed. Clinical assessments were carried out during the second visit to assess the presence of sinus tract, gingival swelling, excessive tooth mobility, tenderness to percussion, and abnormal exfoliation of the treated teeth. Periapical radiographs were reviewed for evidence of pathologic root resorption, radicular and/or periapical radiolucency, and abnormal pulp canal calcification. Treatments were regarded as failure in the presence of one or more of the above clinical and/or radiographic signs and symptoms. Results Of 55 pulpotomized teeth, 26 (47.3%) remained free from any clinical signs and symptoms and 48 (87.3%) showed no pathological radiographic findings. The clinical success rates of ferric sulfate and formocresol pulpotomy were 44.4% and 60.0%, respectively, whereas the radiographic success rates of ferric sulfate and formocresol pulpotomy were 86.7% and 90.0%, respectively. Although teeth treated with formocresol had higher both clinical and radiographic success rates compared with those treated with ferric sulfate, it was not statistically significant. Conclusion The clinical success rates of pulpotomy were lower compared with radiographic success rates. Ferric sulfate is an alternative to formocresol; however, the use of both agents in the dental undergraduate teaching at Universiti Sains Malaysia can still be recommended. Clinical significance Formocresol and ferric sulfate are advocated as pulpotomy agents in primary molar teeth since both agents showed comparable clinical and radiographic success rates. How to cite this article Sanusi SY, Jamaludin SA, Al-Batayneh OB, et al. Fate of Pulpotomized Teeth in Pediatric Patients: A 3-year Case Series in a Malaysian Dental Teaching Hospital. Int J Clin Pediatr Dent 2020;13(1):79–84.

The aim of this study was to compare the biocompatibility of two new calcium phosphate – based root canal sealers (CPC-I, CPC-II) with a commercially available zinc oxide eugenol based-sealer [Pulp canal sealer EWT (PCS EWT)] and Sealapex after implantation in the subcutaneous tissue of rats. Sterile polyethylene tubes were filled with the test materials. The tubes were implanted in the dorsum of male rats and after 1, 2, 4 and 8 weeks, the animals were killed, obtaining 5 specimens for each sealer. Empty tubes were used as negative control. Inflammation, major cell types, and fibrous connective tissue thickness next to each inserted sample were all measured. At week one, all sealers induced similar inflammatory reactions in the animals' connective tissue, with most specimens displaying a moderate to severe chronic inflammatory response. After 2 weeks, CPC-II and (PCS EWT) showed a severe inflammatory reaction with presence of acute inflammatory cells, while CPC-I and Sealapex induced mild and moderate inflammatory reactions respectively. After 4 weeks, connective tissue in contact with CPC-I and Sealapex was more organized, while the tissue close to CPC-II and (PCS EWT) showed a moderate inflammatory reaction and had similar results to each other. After 8 weeks, mild inflammatory reactions were observed for CPC-I, (PCS EWT), and Seal apex. CPC-I induced the lowest inflammatory response at all evaluation periods, only CPC-II did not show a decrease in the inflammatory reaction over time. CPC-I sealer can be assigned a favorable biocompatibility level based on the study’s histological findings.

Loeys-Dietz syndrome type 1 (LDS1) is caused by a mutation in the transforming growth factor-beta receptor 1 (TGFBR1) gene. We previously characterized the oral and dental anomalies in a cohort of individuals diagnosed with LDS and showed that LDS1 had a high frequency of oral manifestations, and most affected individuals had enamel defects. However, dentin anomalies were not apparent in most patients in the cohort. In this cohort, we had identified dentin anomalies in a patient with LDS1, harboring mutationTGFBR1c.1459C>T (p.Arg487Trp), and in this report, we present clinical and radiographic findings to confirm the dentin anomaly. The proband had gray-brown discoloration of most teeth typical for dentinogenesis imperfecta (DI). A radiographic exam revealed obliterated or very narrow pulp canals, with maxillary anterior teeth being affected more than the posterior teeth. The son of the proband, who also has the same mutation variant, had a history of DI affecting the primary teeth; however, his permanent teeth were normal in appearance at the time of exam.TGFBR1is expressed by odontoblasts throughout tooth development and deletion ofTGFBR1in mouse models is known to affect dentin development. In this report, we present a rare case of abnormal dentin in two individuals with LDS1. These dental anomalies may be the first obvious manifestation of a life-threatening systemic disease and demonstrate the variable and multi-organ phenotypic effects in rare diseases.

Purpose: To evaluate clinically, radiographically and histologically the postoperative success of Ankaferd Blood Stopper (ABS) and formocreosl (FC) in pulpotomy procedures for primary teeth. Materials and Method: 70 Primary molars found in 27 patients were selected according to inclusion criteria. In the first part of the study pulpotomy was accomplished in 22 patients having 60 teeth (30 each group) and depending on the type of radicular pulp medicament, the teeth were divided randomly and equally into 2 groups: Group I(FC) and Group II (ABS). Clinical follow up was done after 1,3,6 and 9 months.Periapical radiographs were taken at 3 ,6 and 9 months follow up visits . In the second part of the study 10 primary molars were found in 5 patients planned for extraction due to orthodontic purpose were treated by pulpotomy procedure. Teeth were divided into2 groups(5 each group) and the teeth were extracted after 2 months for observation under light microscope. Results: No statistically significant difference between groups in the overall cumulative clinical or radiographic success at follow up periods. Histopathological examination revealed dentin bridge formation and continuous regular arrangement of odontoblastic layer at the pulp dentin junction along the root length in primary molars treated with ABS while FC specimens revealed Severe pulp hyperemia with thrombus formation at the entrance of pulp canal. Conclusion: ABS can be considered as good natural alternative to FC in primary molars pulpotomy.

Introduction The balance between periapical tissue inflammation and regeneration after the removal of necrotic/infected tissues is pivotal in determining the success of endodontic treatment. This study was designed to investigate the effect of silicate-based root canal sealer BioRoot RCS (BRCS; Septodont, Saint-Maur-des-Fosses, France) on modulating the inflammatory mechanisms and early steps of regeneration initiated by human periodontal ligament (PDL) fibroblasts. Methods Samples of BRCS and Pulp Canal Sealer (PCS; SybronEndo, Orange, CA) were incubated in culture medium to obtain material extracts. To simulate bacterial infection and endodontic sealer use, PDL fibroblasts were stimulated with lipopolysaccharides and cultured with material extracts. The secretion of proinflammatory cytokine (interleukin 6) and growth factor (transforming growth factor beta 1) were quantified by enzyme-linked immunosorbent assay. Inflammatory cell recruitment sequence was investigated using a human inflammatory monocytic cell line (THP-1) that can be activated into macrophage-like cells. The adhesion of THP-1 to endothelial cells (human umbilical vein endothelial cells) was studied using fluorescent THP-1, their migration using Boyden chambers, and their activation into macrophage-like cells using a cell adhesion assay. The proliferation of PDL fibroblasts was quantified by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, whereas the migration of PDL stem cells was investigated using Boyden chambers after immunofluorescence and reverse transcription polymerase chain reaction characterization. Results Interleukin 6 secretion decreased with BRCS, whereas it increased with PCS. Transforming growth factor beta 1 secretion significantly increased only with BRCS. The material extracts did not affect THP-1 adhesion to human umbilical vein endothelial cells, but only BRCS inhibited their migration. Moreover, activation of THP-1 decreased with BRCS and to a lesser extent with PCS. Finally, BRCS increased PDL fibroblast proliferation without affecting PDL stem cell migration. By contrast, PCS decreased PDL fibroblast proliferation and PDL stem cell migration. Conclusions This work shows that the endodontic sealers modulate the PDL inflammatory and regeneration potentials in vitro. It demonstrates that BRCS has anti-inflammatory effects and the potential to promote tissue regeneration.

This paper describes a case with a 5- year follow-up of Antimicrobial Photodynamic Therapy (aPDT) associated with long-term success in endodontic treatment in a tooth with separated instruments. The patient presented with a tooth exhibiting a periapical lesion, slight swelling, and severe pain. A radiograph revealed the presence of two separated files in the middle and apical thirds of the mesial root on a lower first molar. Attempts at bypassing were not successful. In the mesial root, instrumentation was limited to the coronal ends of the separated instruments. The apical patency could not be achieved due to the blockage of the separated files. aPDT was performed in two visits, at a 660-nm wavelength and 100 mW of power, for 90 s to a total energy of 9.0 Joules. Methylene blue solution was used as photosensitizer at concentration of 0005%. A 300-μm light diffusor was coupled to the diode laser and was inserted into the root canal 2 mm short of WL, where it was set to allow better diffusion of light. Each root canal was sealed with gutta-percha by warm vertical compaction and Pulp Canal Sealer™. After 5 years of follow-up, clear evidence of remineralization of the radiolucency and bone healing was observed. This case report suggests that the addition of aPDT to conventional endodontic treatment improved microbial disinfection leading to a successful long-term outcome.

Tooth development is regulated by sequential and reciprocal epithelium-mesenchymal interactions and their related molecular signaling pathways, such as bone morphogenetic proteins (BMPs). Among the 14 types of BMPs, BMP9 (also known as growth differentiation factor 2) is one of the most potent BMPs to induce osteogenic differentiation of mesenchymal stem cells. The purpose of this study was to examine potential roles of BMP9 signaling in tooth development. First, we detected the expression pattern of BMP9 in tooth germ during postnatal tooth development, and we found that BMP9 was widely expressed in odontoblasts, ameloblasts, dental pulp cells, and osteoblasts in alveolar bones. Then, we established a BMP9-KO mouse model. Gross morphological examination revealed that the tooth cusps of BMP9-KO mice were significantly abraded with shorter roots. Micro-computed tomography and three-dimensional reconstruction analysis indicated that the first molars of the BMP9-KO mice exhibited a reduced thickness dentin, enlarged pulp canals, and shortened roots, resembling the phenotypes of the common hereditary dental disease dentinogenesis imperfecta. Further, the alveolar bone of the BMP9-KO mutants was found to be shorter and had a decreased mineral density and trabecular thickness and bone volume fraction compared with that of the wild-type control. Mechanistically, we demonstrated that both dentin sialophosphoprotein and dentin matrix protein 1 were induced in dental stem cells by BMP9, whereas their expression was reduced when BMP9 was silenced. Further studies are required to determine whether loss of or decreased BMP9 expression is clinically associated with dentinogenesis imperfecta. Collectively, our results strongly suggest that BMP9 may play an important role in regulating dentinogenesis and tooth development. Further research is recommended into the therapeutic uses of BMP9 to regenerate traumatized and diseased tissues and for the bioengineering of replacement teeth.

The objective of this report is to describe a surgical treatment in a traumatized tooth presenting pulp canal calcification (PCC) and periapical pathology. Three months after a patient had suffered injuries by luxation in the right central mandibular incisor, complete calcification of root canals was radiographically observed in addition to a radiographic image compatible with apical periodontitis. The chosen treatment was endodontic surgery and apical root sealing with mineral trioxide aggregate endodontic cement. After 4 months, the tooth showed complete apical repair. We concluded that the endodontic surgery is a procedure specifically indicated for cases of impossibility of conventional endodontic treatment, as in teeth with PCC.

Dentoalveolar ankylosis in growing patients is associated with continuing replacement root resorption, tooth infrapositioning, and the local arrest of alveolar bone growth. While extraction of ankylosed teeth might be associated with bone loss, decoronation of the offending tooth (removal of crown portion and instrumentation of pulp canal to stimulate bleeding) has been suggested as a more conservative approach of bone preservation until definitive implant placement is planned. This is a case presentation of a 14-year-old patient who presented with root resorption in relation to the left maxillary central incisor such that decoronation with a prosthetic tooth replacement was decided as the treatment option.

These case reports aimed to describe the management of lateral perforation in the middle cervical third of the root in two maxillary incisors with pulp canal calcification using Bio-C Repair, with safe and viable clinical treatment strategies. Digital radiographic exams were obtained with different angles and analyzed using different filters. Cone-beam computed tomography (CBCT) images were requested to show the actual position of the canal, location of the perforation, and guide the strategic planning of the case. Subsequently, cavity access was prepared with the aid of dental operating microscopy. After perforation was identified, granulation tissue was removed and the original canal was identified and then dressed with calcium hydroxide. In the second visit, the perforation was filled with Bio-C Repair and the canal system filled with gutta-percha points and a root canal sealer (Bio-C Sealer). The teeth were restored with glass fiber post, 4 mm beyond the perforation level, and provisory crowns. Both teeth treated as described above were functional and asymptomatic with a 1-year clinical and radiographic assessment. The Bio-C Repair is suggested as a new cement option for the management of lateral canal perforations, with effective results as observed after a one-year follow-up. Resumo O presente relato de caso teve como objetivo descrever o manejo da perfuração lateral no terço médio cervical da raiz em dois incisivos superiores com calcificação pulpar utilizando o Bio-C Repair, com estratégias de tratamento clínico seguras e viáveis. Radiografias digitais foram obtidas em diferentes ângulos e analisadas com diferentes filtros. Imagens de tomografia computadorizada de feixe cônico (TCFC) foram solicitadas para mostrar a real posição do canal e a localização da perfuração, e orientar o planejamento estratégico do caso. Posteriormente, o acesso à cavidade foi preparado com auxílio de microscopia cirúrgica. Após a identificação da perfuração, o tecido de granulação foi removido, o canal original foi identificado e, em seguida, recebeu medicação intracanal à base de hidróxido de cálcio. Na segunda visita, a perfuração foi selada com Bio-C Repair e o sistema de canais obturado com cones de guta-percha e cimento endodôntico (Bio-C Sealer). Os dentes foram restaurados com pino de fibra de vidro, 4 mm além do nível da perfuração, e coroas provisórias. Ambos os dentes tratados conforme descrito acima se mostraram funcionais e assintomáticos na avaliação clínica e radiográfica de 1 ano. O Bio-C Repair é sugerido como uma nova opção de cimento endodôntico para o manejo de perfurações laterais, com resultados efetivos observados após um ano de acompanhamento.

Endodontic treatment in severely calcified canals is always a challenging task because it can result in accidents such as deviations or perforations. Recently, guided endodontics has become an alternative approach for pulp canal calcification, facilitating the location of root canals more predictably through the combined use of cone-beam computed tomography, oral scanning, and endodontic access guides. Although several reports have shown that guided endodontics is safer, faster, and can be performed without an operating microscope and by less experienced operators, the technique has limitations, and iatrogenesis may occur. This article describes the limitations of static-guided endodontics and possible causes of failures. In the present case, not fixing the guide to the bone and inaccuracies generated by manually performing mesh merger software led to root perforation. | Endodontic microsurgery was effective in resolving this case and should be considered the treatment of choice where guided endodontics cannot be employed safely or when it fails.

The aim of this review was to evaluate the effects of different access cavity designs on endodontic treatment and tooth prognosis. Two independent reviewers conducted an unrestricted search of the relevant literature contained in the following electronic databases: PubMed, Science Direct, Scopus, Web of Science, and OpenGrey. The electronic search was supplemented by a manual search during the same time period. The reference lists of the articles that advanced to second-round screening were hand-searched to identify additional potential articles. Experts were also contacted in an effort to learn about possible unpublished or ongoing studies. The benefits of minimally invasive access (MIA) cavities are not yet fully supported by research data. There is no evidence that this approach can replace the traditional approach of straight-line access cavities. Guided endodontics is a new method for teeth with pulp canal calcification and apical infection, but there have been no cost-benefit investigations or time studies to verify these personal opinions. Although the purpose of MIA cavities is to reflect clinicians' interest in retaining a greater amount of the dental substance, traditional cavities are the safer method for effective instrument operation and the prevention of iatrogenic complications.

BACKGROUND/AIM Tooth displacement during avulsion causes total rupture of the pulp's neurovascular supply. Revascularization and pulp healing may occur in immature teeth, which gives rise to the recommendation that root canal treatment may not be required. The aim of this study was to evaluate the prognostic factors for the pulp's response after replantation of young permanent teeth. METHODS Records from 117 patients with 133 replanted permanent immature teeth were reviewed, and pulp outcomes were classified as healing (hard tissue deposition on the dentinal walls followed by narrowing of the pulp lumen or ingrowth of bone-like tissue inside the pulp canal) or non-healing (pulp necrosis with infection). The effect of clinical and demographic co-variates on the hazards of both outcomes was assessed performing a competing risk model. RESULTS Pulp necrosis with infection was diagnosed in 78.2% of the teeth, and healing was observed in 12.8% of the teeth. A total of 12 teeth (9.0%) were censored due to prophylactic removal of the pulp or severe external root resorption caused by eruption of adjacent canines. The cs-Cox model demonstrated that the hazards of pulp healing increased in teeth with extra-alveolar periods

Pulp canal calcification is 1 of the possible outcomes after certain types of dental trauma. This can make endodontic treatment more challenging should it become necessary. Because of the increased degree of difficulty, sometimes procedural incidents do occur during root canal treatment. This case report demonstrates an unusual clinical presentation of a root perforation and missed canal, which had undergone calcification as a result of trauma some years earlier. A contemporary approach to treatment involved a combination of treating the biological complication of the calcified canal combined with surgical repair of the iatrogenic complication of a perforation using modern imaging techniques and materials.

Objectives Assess the antibacterial, physical and chemical properties of AH Plus, BioRoot RCS and Pulp Canal Sealer (PCS) in contact with 2% chlorhexidine digluconate (CHX) used as final irrigant prior to root canal obturation. Methods The antimicrobial properties were investigated by direct contact tests for planktonic and biofilm growth of E. faecalis, S. mutans, S.epidermidis and S.aureus in vitro. The setting time, wettability, microhardness and surface roughness were also assessed. The sealers were studied in no contact, 1-minute (short-term) and continuous contact (long-term) with CHX. Chemical characterization of sealers was performed by scanning electron microscopy, X-ray diffraction analysis and Fourier-transform infrared spectroscopy after CHX or saline used as the last irrigant in an ex vivo tooth model and in endo training blocks. Results CHX increased the antibacterial activity of all the sealers investigated against planktonic bacteria and biofilms with PCS exerting the highest antimicrobial activity with and without the presence of CHX. The setting of AH Plus and BioRoot RCS was retarded, while for PCS accelerated in the presence of CHX. AH Plus and PCS were more hydrophilic after contact with CHX, whilst BioRoot RCS was hydrophobic in a time-dependent manner. The microhardness of sealers was compromised and the surface roughness increased after CHX exposure for AH Plus and BioRoot RCS, and decreased for PCS. CHX did not affect the sealers’ chemistry, but PCS that exhibited two extra phases. Significance CHX improved the antibacterial efficacy of endodontic sealers but further evidence is needed to confirm its suitability as a final irrigant prior to root canal obturation.

Objective The rehabilitation of extensively damaged teeth with great structural loss and calcified root canals represents a challenge for dentistry. Classically, this restorative procedure of endodontically treated teeth involves intraradicular post placement. Retentive function post that can closely adapt to the root canal without the excessive wear of intraradicular dentin has a fundamental importance to ensure the longevity of the restoration. Clinical considerations This report presents a clinical case of 3D guided access to a severely calcified pulp canal followed by the cementation of a fiberglass post that is adaptable to the root canal and prosthetic rehabilitation with full ceramic crown. Conclusions 3D guided access allowed conservative and safe root canal treatment. The adaptable fiberglass post meets the specific needs of the described case and has a simple technique and low cost. Clinical significance Guided endodontics is a minimally invasive approach for teeth with calcified root canals. The post used in this study meets the demands of teeth endodontically treated with conservative techniques. The professional should not need to adapt the anatomy of the root canal to the anatomical reality of the post. This one adapts itself to the shape of the canal.

International audience; Introduction: Endodontic treatment success is achieved not only when the cement provides a hermetic seal but also when the injured periapical tissue is regenerated. However, an exaggerated inflammatory reaction hinders tissue regeneration and it has been shown that dental materials affect the inflammatory response through modulation of cytokine secretion. This work was set to investigate the effects of the presence of hydrocortisone in zinc oxide eugenol sealers (Endomethasone N) on modulating the initial steps of inflammation in vitro.Material and methods: Hydrocortisone and eugenol leaching from Endomethasone N and Pulp Canal Sealer (PCS) were quantified by ELISA and spectrofluorometry, respectively. The effects of Endomethasone N and Pulp Canal Sealer were studied on lipopolysaccharides (LPS)-stimulated human periodontal ligament (hPDL) cells. Cytokine (IL-6, TNF-α) secretion from cells was quantified by ELISA. Inflammatory cell (THP-1) adhesion to activated endothelial cells, their migration and activation were studied in vitro.Results: Endomethasone N decreased secretion of IL-6 and TNF-α from hPDL cells. THP-1 adhesion to activated endothelial cells (HUVECs) and migration significantly decreased with Endomethasone N while no effect was observed with PCS. Activation of THP-1 decreased with both materials’ extracts but was significantly lower with Endomethasone N than with PCS.Conclusion: These results performed in vitro show that Endomethasone N anti-inflammatory effects are due to the presence of hydrocortisone.Clinical relevance: Endomethasone N has potential local anti-inflammatory effects which appear to be due to its hydrocortisone rather than eugenol content. Decreasing the inflammatory response is a pre-requisite to initiate the periapical healing.

Pulp canal calcification is characterized by the deposition of calcified tissue along the canal walls. As a result, the root canal space can become partially or completely obliterated. Recently, "guided endodontics" has been reported as an alternative solution in cases of partial or completed canal obliteration. Although this technique can enhance minimally invasive access to the calcified canal, it has been shown that the incisal surfaces are often removed during the access of anterior teeth. This report describes 2 cases of guided endodontics using conventional palatal access in calcified anterior teeth and discusses the applicability of this approach in cases of pulp canal calcification with apical periodontitis and acute symptoms. The method demonstrated high reliability and permitted proper root canal disinfection expeditiously, without the unnecessary removal of enamel and dentin in the incisal surface.

Optical coherence tomography (OCT) is a noninvasive diagnostic technique providing cross-sectional images of biologic structures based on the differences in tissue optical properties. OCT has been widely used in numerous clinical applications and is becoming popular as a promising technology in dentistry. Today, dental hard (tooth) and soft (hard palate mucosa and gingiva mucosa) tissues are visualized with OCT. With new developments in technology, the applications of OCT are being investigated in various fields in dentistry, such as to detect microleakage around restoration, tooth cracks/fractures, examination of periodontal tissues/pockets, early detection of oral cancerous tissues, and in endodontics for location of pulp canal.

The mucosa exogenous pigmentation may occur in consequence of dental materials contact, such as amalgam pigmentation. Aim: This paper reports a rare case of oral pigmentation due to extrusion of N-Rickert root canal sealer from a pre-existing fistula associated with a lateral canal in a 47-year-old female patient. Subjects and Methods: The clinical presentation was a well-defined grayish macule of about 3 mm located in the attached gingiva close to the maxillary left central incisor. Analysis Used and Results: Upon identification of endodontic treatment and a mesial lateral canal, a CT scan was requested. According to the endodontist that performed the prior treatment the tooth was filled with Rickert Pulp Canal SealerTM (Sybron Endo) and there was a material extrusion through a fistula associated with the infected lateral canal at the time. Conclusion: The knowledge of exogenous pigmentations caused by dental materials is necessary to proper diagnosis.

Aim: To evaluate tissue engineering technology to regenerate pulp-dentin like tissues in pulp canals of immature necrotic permanent teeth with apical periodontitis in dogs. Study design: The study was performed on 36 teeth in 12 dogs. The experiment was carried out using split mouth design. In each dog 3 teeth were selected for implementing the study procedure. Apical periodontitis was induced in Group A and B teeth. Group (A): immature upper left 2nd permanent incisors that were transplanted with a construct of autologous dental pulp stem cells with growth factors seeded in a chitosn hydrogel scaffold. Group (B): immature upper right 2nd permanent incisor that received only growth factors with scaffold. A third tooth in each dog was selected randomly for isolation of dental pulp stem cells (DPSCs). Both groups were closed with a double coronal seal of white MTA (Mineral trioxide aggregate) and glass ionomer cement. Both groups were monitored radiographically for 4 months and histologically after sacrificing the animals. Results: There was no statistically significant difference in radiographic findings between group (A) and group (B) for healing of radiolucencies, while there was statistically significant difference between group (A) and group (B) regarding radicular thickening, root lengthening and apical closure. Histologically, group (A) teeth showed regeneration of pulp- dentin like tissue while group (B) teeth did not show any tissue regeneration. Conclusion: Dental pulp stem cells and growth factors incorporated in chitosan hydrogel are able to regenerate pulp- dentine like tissue and help in complete root maturation of non-vital immature permanent teeth with apical periodontitis in dogs.

Aim To study the prevalence of additional root canal orifices of upper first permanent molars in Saudi subpopulation in Jeddah, Kingdom of Saudi Arabia, utilizing micro-computed tomography X-ray (micro-CT). Materials and methods One hundred extracted upper first permanent molars of Saudi patients were included in the study. Micro-CT was used to detect the prevalence of extra root canal orifices of the permanent upper first molars. Results The evaluation of three-dimensional (3D) images of this study showed that of 100 upper permanent first molars scanned and analyzed, 10.53% had 6 pulp canal orifices, 35.09% had 5 pulp canal orifices, 47.37% had 4 pulp canal orifices and 7.01% had 3 pulp canal orifices. Conclusion The current data showed the highest prevalence of 4 and 5 root canal orifices compared to 3 and 6 root canal orifices. Clinical significance The knowledge of anatomic variations of teeth before starting root canal treatment can help dentists to detect and manage all root canals successfully.

Triplication is a rare dental anomaly and defined as the fusion of three teeth. In the present case report, a five-year-old healthy girl with the triplication of the two mandibular primary right incisors along with a supernumerary tooth was presented. A periapical radiograph, panoramic radiograph and cone-beam tomography of the triple tooth revealed separate pulp chambers combining in the cervical area and forming one pulp canal along the root. In the treatment planning, pit and fissure sealant was applied for prevention and the patient was recalled for regular follow-up appointments. After 24 months, the triple tooth had been replaced by the permanent successor without any dental abnormality.

Objectives To compare the effectiveness of different sealer cleaning methods on bonding of a self-etch adhesive to root canal sealer-contaminated dentine. Methods Forty-nine extracted molars were divided into seven groups. Dentine surfaces were exposed and cotaminated with a thin layer of epoxy resin-based sealer (AH Plus (AHP)) or zinc oxide eugenol-based sealer (Pulp Canal Sealer (PCS)). Three cleaning protocols were examined: dry cotton pellet, 70% ethanol-saturated cotton pellet or a surfactant-based cleaner (KatanaTM Cleaner (KC), Kuraray Noritake Dental Inc.). Uncontaminated dentine served as control. The dentine surfaces were bonded with a two-step self-etch adhesive and restored with resin composite. Bond strength testing was performed using a microtensile approach. Two teeth from each group were used for scanning electron microscopy (SEM) and energy-dispersive X-ray analysis (EDX). The pulpal floor of the teeth was covered with sealer and cleaned. The percentage of zinc/zirconium on the dentine surface was detected to indicate the amount of remnant sealer. Results Tensile bond strength for uncontaminated dentine control was 46.4±7.3 MPa; bond strength decreased significantly for the dry cotton group (29.6±4.2 MPa for AHP, 24.7±4.7 MPa for PCS, p Conclusions KatanaTM Cleaner decontaminates root canal sealer-smeared dentine surfaces effectively and restores the bonding performance of a self-etch adhesive to dentine. Clinical significance The surfactant-based KatanaTM Cleaner, originally designed for cleaning zirconia surfaces prior to adhesive bonding, may be used as for cleaning dentine that has been contaminated with unset root canal sealers after root canal treatment to restore the bonding strength of a self-etch adhesive to sealer-contaminated dentine.

Aim To present a novel miniaturized and minimally invasive treatment approach for root canal localization in mandibular incisors with pulp canal calcification and apical periodontitis. Summary A 51-year-old male patient presented with pain from his mandibular incisors. The patient had a history of severe dental trauma over 30 years ago. Both mandibular central incisors (teeth 31, 41) were tender to percussion and had a yellowish discoloration. They did not respond to thermal and electrical sensitivity tests. Two periapical radiographs from different projections revealed severe pulp canal calcifications and signs of periapical periodontitis. To facilitate the ‘Microguided Endodontics’ technique, a CBCT and an intra-oral surface scan were aligned using special software. This allowed the virtual planning of optimal access cavities up to the apical third of the root. In this technique, a 3D-printed template guides a customized drill to the orifice of the root canal. After negotiation of the root canals, conventional root canal treatment was performed. This case report demonstrates that minimally invasive and apically extended access cavities are feasible in mandibular incisors with this technique. Key learning points The ‘Microguided Endodontics’ technique is a safe and minimally invasive method for root canal location and prevention of technical failures in anterior teeth with pulp canal calcification.

Apical periodontitis, the inflammation of periapical tissue, commonly requires root canal treatment to achieve apical healing. However, if it is accompanied by pulp canal calcification, the treatment becomes complicated, and locating the root canal can be challenging. This case report describes a novel approach for treating a molar with pulp canal calcification and apical pathology. Due to the risk of perforation during treatment, a digitally printed template was used to assist in accurately locating the root canal. After six months, the patient was asymptomatic and the periradicular radiolucency was gradually reducing in size.

Objectives: The purpose of this study was to evaluate the cytotoxicity of a new bioceramic-based root canal sealer (BioMM) by direct and indirect contact with human fibroblasts and to compare it with a zinc oxide-eugenol sealer, the Pulp Canal Sealer-extended working time (PCS-EWT). Materials and Methods: Cell viability was assessed through direct and indirect contact between human fibroblasts and sealer. Direct contact was performed at 24 h, whereas the indirect contact was performed at 24 and 48 h at different concentrations: 100%, 50%, and 25%. After direct contact, 3-4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was used and the optical density was measured by a spectrophotometer. Giemsa stain was also performed for a qualitative evaluation of the cells.Statistical Analysis Used: Shapiro–Wilk test was used to verify the normality of distribution of the variable. Data were analyzed by analysis of variance and Tukey tests using SPSS for Windows software 18.0. The significance level used was P < 0.05.Results: Direct contact showed a significantly higher cell viability with BioMM as compared to PCS-EWT (P = 0.002). Cell viability at 24 h was significantly higher with BioMM compared to PCS-EWT for the concentrations of 50% (P = 0.004) and 25% (P = 0.003), whereas no significant difference was noted at 100% (P = 0.141). Cell viability at 48 h was significantly higher with BioMM as compared to PCS-EWT at 25% (P = 0.007). No significant difference was observed at 100% (P = 0.484) and 50% (P = 0.185).Conclusion: BioMM may be considered minimally cytotoxic if accidentally extruded into the periapical tissues.

Pulpal necrosis and infection in an immature anterior tooth subsequent to traumatic injury is a challenging situation. Regenerative endodontics, resulting in continued development of the tooth, provides a biological response to this clinical challenge. Regenerative endodontic procedures require disinfection of the infected root canal and sealing of the pulp canal space. Mineral trioxide aggregate (MTA) provides a good seal, is biocompatible and allows the formation of a hard tissue to occur within the root canal. MTA, however, can lead to significant staining of the crown of the tooth that is difficult to mask. This case report describes the management of discolouration in an 11 year old girl subsequent to a regenerative endodontic procedure in an immature traumatized maxillary central incisor.