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Objective. The causes of internal posteruptive discoloration of teeth are bleeding, necroses, infections, and endodontic filling materials. The aim of this study was to establish the results of bleaching endodontically treated teeth using walking bleach, in-office, and combined techniques, using 30% carbamide peroxide and 35% hydrogen peroxide, as well as the effect of etiological factors, and the time elapsed after endodontic treatment on the success of bleaching. Materials and Methods. The research involved 30 endodontically treated teeth in healthy patients. Retroalveolar X-rays were taken to check the quality of root canal obturation. Endodontic treatment and obturation were carried out on the discolored non-vital teeth without any previous endodontic treatment. Before bleaching, two millimeters of the filling were removed from the root canal and the very entry into the canal was protected with glass ionomer cement. The teeth were divided into three groups, depending on the bleaching technique: walking bleach technique (10 patients), in-office technique (10 patients), and combined technique (10 patients). The teeth were bleached with 30% carbamide peroxide and 35% hydrogen peroxide. The bleaching procedure was repeated in all the patients three times. The color of all teeth was determined based on the Vita Classic guide before and after bleaching. The Χ2 square and Kruskal−Wallis tests were used to identify differences in teeth bleaching results. Results. A statistically significant difference (p < 0.05) was established between bleaching success and the time elapsed after endodontic treatment. There were no statistically significant differences observed between the bleaching success and etiological factors, bleaching techniques, or bleaching agents. Conclusions. The effectiveness of non-vital tooth bleaching is affected by the time elapsed after endodontic treatment.

Nonsurgical and surgical endodontic treatments have a high success rate in the treatment and prevention of apical periodontitis when carried out according to standard and accepted clinical principles. Nevertheless, endodontic periapical lesions remain in some cases, and further treatment should be considered when apical periodontitis persists. Although several treatment modalities have been proposed for endodontically treated teeth with persistent apical periodontitis, there is a need for less invasive methods with more predictable outcomes. The advantages and shortcomings of existing approaches for the diagnosis and treatment of endodontic periradicular lesions are discussed in this review., Competing Interests: Conflict of interest: None declared., (Copyright: © 2020 European Endodontic Journal.)

Background: Elevation of the schneiderian membrane, during maxillary sinus floor augmentation (MSFA) may theoretically result in devitalization of adjacent teeth, which are in a close spatial relationship to the sinus floor., Purpose: To assess retrospectively the probability of devitalization of teeth adjacent to the osteotomy site after MSFA in a relatively large number of patients., Materials and Methods: All MSFA procedures, performed at a university oral surgery clinic within a time period of 10 years, were assessed on the following eligibility criteria: (1) presence of vital teeth (ie, not root canal treated and no periapical radiolucency on a panoramic radiograph taken just after MSFA), (2) presence of a 3 to 12 months postoperative radiograph of the teeth adjacent to the osteotomy site displaying the root apices, and (3) complete medical records up to at least 12 months postoperatively. The radiographs of the different time points were compared and any changes in the radiographic status of the adjacent teeth (eg, development of a periapical lesion, root canal treatment, etc.) were recorded and the spatial relationship of the adjacent teeth to the maxillary sinus classified., Results: Out of 684 MSFAs, 257 fulfilled the inclusion criteria and involved 357 adjacent teeth, of which 221 presented close to and/or intimate relationship to the sinus. In only a single case, tooth vitality might have been lost due to the procedure. Thus, the probability for tooth devitalization for teeth with close to and/or intimate spatial relationship to the sinus floor ranged from 0.45% to 0.7%., Conclusions: Even for teeth with apices very close to and/or intimately related to the sinus tooth devitalization after MSFA is an extremely rare complication; that is, the probability of tooth devitalization after MSFA is ≤0.7%., (© 2018 Wiley Periodicals, Inc.)

Introduction: The effect of rheumatoid arthritis (RA) on the healing and pathophyisiology of apical periodontitis is unknown because there is no study in the literature evaluating the association of RA with the prevalence of periapical rarefying osteitis (PAR) and endodontic treatment. Therefore, the goal of this cross-sectional study was to evaluate the prevalence of PAR and root canal treatment in RA patients when compared with controlled individuals., Methods: Full-mouth radiographs of 131 individuals with RA were examined and compared with 131 controls that were sex and age matched exactly with the diseased group. The total number of teeth, presence or absence of root canal filling, quality of root canal filling, quality of restoration, and periapical status were recorded., Results: Overall, the prevalence of teeth with PAR was 4.0% in the diseased group and 3.5% in the control group (P > .05). The prevalence of root canal-treated teeth was 6.2% in the RA group and 5.6% in the control group (P > .05). Controls have significantly more teeth than those with RA (P = .027)., Conclusions: The prevalence of PAR and endodontic treatment was not significantly different in individuals with RA compared with control patients., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: This study aimed to report a possible effect of the presence of an adjacent implant on the development of a vertical root fracture (VRF) in endodontically treated teeth., Methods: A series of 8 cases in 7 patients with teeth diagnosed with VRF after the placement of implants in the adjacent area is described and analyzed. In addition, a comprehensive literature search with strict inclusion and exclusion criteria was undertaken to identify additional clinical studies that assessed this clinical scenario., Results: The case series analysis revealed that the time from implant placement to the diagnosis of VRF was between 5 and 28 months (average = 11 months). The majority of cases occurred in female patients who received 2 or more implants. Six of the 7 patients were older than 40 years, with an average age of 54 years. The majority of teeth with VRF were premolar or mandibular molar teeth (6/8 teeth). All fractured teeth had been restored with a crown and had a post present, and the quality of the root canal filling was determined to be adequate. The systematic review revealed that implant-associated VRF has not been investigated or reported in the literature yet., Conclusions: Based on a systematic review of the literature, this case series, although limited in its extent, is the first clinical report of a possible serious adverse event of implant-associated VRF in adjacent endodontically treated teeth. Additional clinical studies are indicated to shed light on this potential phenomenon., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Vitality loss is an unusual event that can occur before, during or after an orthodontic treatment. It can lead to loss of sensitivity, color change or necrosis of the pulp tissue. Before starting the orthodontic treatment, we have to identify the tooth's risk (injured tooth, included occlusal trauma...). Knowing that, if an endodontic treatment has to be done, it is better to do it before starting orthodontic forces. Lamps do not provide problems except high intensity halogen ones. RPE on children, Le Fort I and mandibular osteotomies, corticotomies, genioplasties are responsible of a transitory ischemia without reaching a pathogen level. Mini-screws or mini-plates may be iatrogenic, if they impact the root. The repair options depend on the delay before removing the miniscrew and the nature of injured tissue., (© EDP Sciences, SFODF, 2015.)

Background: Survival and success rates of tooth transplantations even after long follow-up periods have been shown to be very high. Nevertheless, it is important to analyse factors potentially influencing these rates. The aim of this study was to assess the influence on success of potential factors., Methods: The research was based on a retrospective analysis of clinical and radiological data from a sample of 59 subjects (75 transplanted teeth). The follow-up period varied from 0.44 to 12.28 years (mean 3.95 years). Success rates were calculated and depicted with Kaplan-Meier plots. Log-rank tests were used to analyse the effect of root development stage, apex width, the use of enamel matrix proteins or the surgeon on success of transplantations., Results: Results for success of premolar transplantations were comparable with already published data, while molars performed worse than shown in other studies. The surgeon performing the transplantation (p = 0.001) and tooth type (p ≤ 0.001) were significantly associated with transplantation success. Use of enamel matrix proteins (p = 0.10), root development stage (p = 0.13), the recipient area (p = 0.48) and apex width (p = 0.59) were not significantly associated with success., Conclusions: Molar transplantations were not as successful as premolar transplantations; however, success rates varied greatly depending on the surgeon's experience. The use of enamel matrix proteins as well as root development stage, the recipient area and apex width did not show significant associations with success of tooth transplantations.

Background: Along with the increasing popularity of oral piercings, the number of reported complications and side effects increases, too., Case Report: The aim of this report is to present a case of substantial bone loss in the area of the mandibular central incisors caused by lingual piercing and persistent bad habits. Dentist should be aware of potential complications associated with oral piercings and warn patients about them.

Background: Maxillary sinus augmentation is a routine procedure performed in implant dentistry in cases with sinus pneumatization. This study presents a series of clinical cases in which tooth devitalization occurred in conjunction with sinus augmentation., Methods: In the three cases presented, a sinus-lift procedure was performed that resulted in devitalization of the adjacent teeth. Patients were referred to an endodontist for evaluation and treatment. Vitality of the teeth was determined by the use of a cold test, electric pulp test, and cavity test. The pulp was considered to be necrotic if the tests were negative., Results: In this case series, loss of pulp vitality of two maxillary left second premolars and one maxillary left first molar occurs after sinus-augmentation procedures. The devitalized teeth were free of caries. In one case, two amalgam restorations were present., Conclusion: Pulp necrosis may occur in conjunction with a sinus-lift procedure in cases when an adjacent root is in close proximity to the sinus floor and the sinus membrane is elevated over the root apex.

Purpose: To compare the complication rate of natural teeth adjacent to implant supported dentures (IFDs) with that of teeth serving as abutments for fixed partial dentures (FPDs). The second goal was to assess the risk factors for complications in teeth adjacent to bounded edentulous spaces., Materials and Methods: The study subjects were selected from patients who received prosthodontic treatment for their bounded edentulous space not exceeding two missing teeth between February 1990 and March 2007. Sixty-one patients were included in the IFD group and 66 patients were included in the FPD group. Tooth complications were defined as tooth extraction, periodontal lesion, periapical lesion, and loss of prosthesis and were assessed by one examiner based on dental records., Results: The 8-year cumulative complication rate for the IFD group (7.9%) was significantly lower than for the FPD group (40.7%). Additionally, the 8-year cumulative complication rate of vital teeth (6%) was significantly lower than that of nonvital teeth (45.9%). A cox proportional hazard analysis revealed that nonvitality of dental pulp was a significant risk factor for tooth complications, whereas treatment modality was not., Conclusions: Teeth adjacent to IFD-treated edentulous spaces presented fewer complications than natural teeth serving as abutments for FPDs. Conservation of teeth adjacent to edentulous spaces as vital teeth was the key finding to limit further tooth loss.

Over the last few decades, many authors have investigated the effect of periodontal disease and treatment on pulpal status with controversial results. This study was conducted to verify whether periodontal disease in a deep intrabony defect and complex therapy, including aggressive root planing such as in periodontal regeneration, have an influence on tooth vitality. One hundred thirty-seven patients who fulfilled the requirements were included. The collected data did not support the need for "preventive" root canal treatment in severely compromised teeth that are planned to undergo periodontal regenerative surgery.

Aim: The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed., Material and Methods: Long-term survival rates were calculated using data from 492 root-fractured teeth in 432 patients. The cause of tooth loss was assessed as being the result of either pulp necrosis (including endodontic failures), new traumas or excessive mobility. The statistics used were Kaplan-Meier and the log rank method., Results and Conclusions: The location of the root fracture had a strong significant effect on tooth survival (P = 0.0001). The 10-year tooth survival of apical root fractures was 89% [95% confidence interval (CI), 78-99%], of mid-root fractures 78% (CI, 64-92%), of cervical-mid-root fractures 67% (CI, 50-85%), and of cervical fractures 33% (CI, 17-49%). The fracture-healing type offered further prognostic information. No tooth loss was observed in teeth with hard tissue fracture healing regardless of the position of the fracture. For teeth with interposition of connective tissue, the location of the fracture had a significant influence on tooth loss (P = 0.0001). For teeth with connective tissue healing, the estimated 8-year survival of apical, mid-root, and cervical-mid-root fractures were all more than 80%, whereas the estimated 8-year survival of cervical fractures was 25% (CI, 7-43%). For teeth with non-healing with interposition of granulation tissue, the location of the fracture showed a significant influence on tooth loss (P = 0.0001). The cause of tooth loss was found to be very dependent upon the location of the fracture. In conclusion, the long-term tooth survival of root fractures was strongly influenced by the type of healing and the location of the fracture., (© 2012 John Wiley & Sons A/S.)

Introduction: Hypophosphatemic vitamin D-resistant rickets (VDRRs) is a metabolic bone disease caused by abnormalities in the vitamin D receptive system or in phosphate and calcium metabolism. This condition occurs in growing skeleton affecting bone and dentin mineralization, resulting in systemic and oral manifestations., Methods: A 15-year-old boy was referred to the private clinic for endodontic treatment in #9. His medical history revealed VDRR disease. The dental findings were multiple periapical lesions in several teeth without obvious reason such as caries or trauma. The radiographic examination showed short roots, enlarged pulp chambers with longer pulp horns, thin dentin and enamel, missing or poorly defined lamina dura, and abnormalities in the cementoenamel junction, all pathognomonic features of the disorder. Conservative endodontic treatment was completed in all teeth with pulp necrosis and rarefactions., Results: A 6-month, 1-year, and 2-year follow-up radiographic examination revealed progressive improvement with bone reconstruction without any clinical symptoms., Conclusions: Early diagnosis, conventional treatment, and continuous radiographic examination are important factors in improving dental alterations in patients with VDRRs., (Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Segmental maxillary osteotomy is a useful adjunct in orthognathic surgery for the correction of vertical and transverse maxillary deformities, but we know of few published reports that document complications. We evaluated the complication rates associated with segmental maxillary surgery in our unit by retrospective review of medical records, radiographs, and study models of 85 consecutive patients (mean age 23.3 years, range 14-51; male:female ratio 1:2) treated from 1995 to 2009. Types of deformity were anterior open bite (n=30, 35%), transverse maxillary deficiency (n=24, 28%), anterior open bite with transverse maxillary deficiency (n=28, 33%), and anterior vertical maxillary excess (n=3, 4%). There were 70 tripartite (82%), 13 bipartite (15%), and two quadripartite (2%) maxillas. Twenty-one patients (25%) had bone grafts. Fixation was done using titanium miniplates in 80 patients (94%), and titanium miniplates and resorbable plates in five (6%). The overall complication rate was 27%. Three patients (4%) had devitalisation of teeth, three (4%) developed minor periodontal defects, and one had tooth loss. Eight patients (9%) had plates removed, and two patients developed persistent postoperative palatal fistula. There was no segmental loss of bone or teeth. Our results show that complications in this cohort were relatively low, and that segmental maxillary surgery is safe as an adjunct in carefully selected cases., (Copyright © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Radicular cysts are commonly found odontogenic cysts in the jaws. The lesion is diagnosed mainly in young patients during the second decade of life. In the majority of cases, it is asymptomatic. This paper reports a rare case in which traumatic occlusion was identified as the etiology of a radicular cyst. Endodontic treatment was performed and the traumatic occlusion also was corrected. A six-month follow-up appointment found good healing of the periapical region.

The sensitivity of teeth anterior to a fracture between the mental and mandibular foramina has been tested and followed up until reinnervation or 3 years has passed. This study assessed the reinnervation period, the number of denervated teeth, and their clinical importance. Fifty patients and 459 teeth were examined. Two hundred and seventy-three teeth were affected and had potentially impaired innervation. Tests after injury showed non-responsive teeth in 81% of affected teeth. Six weeks after injury, 19% of teeth were reinnervated; by 1 year after injury, 92% of initially non-responsive teeth were reinnervated. Most teeth (34%) were reinnervated from 6 weeks to 3 months. All 23/186 initially non-responsive, unaffected, contralateral corresponding teeth were reinnervated within 6 weeks. A year after injury, 95% of incisors, 91% of canines, 94% of premolars, and 82% of molars were reinnervated. Three years after injury, 8% of teeth remain denervated. During the second and third years, no reinnervation occurred, but clinical signs of pulp devitalisation of denervated teeth occurred in 18% or 1% of the initially non-responsive affected teeth. The results revealed the stability of pulp 1 year after injury. Denervated teeth should not be treated if no clinical or radiological signs of devitalisation exist., (Copyright © 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Inflammatory root resorption is a pathologic condition caused by several etiologic factors including traumatic dental injury. In this case report, we describe treatment of a maxillary lateral incisor affected by severe, perforating inflammatory root resorption. An 11-year-old patient presented with a previously traumatized, root-filled maxillary lateral incisor associated with pain, mobility and a sinus tract. Radiographic examination revealed a large periradicular lesion involving pathologic resorption of the apical region of the root. After removal of the root canal filling, the tooth was treated with intracanal calcium hydroxide for 2 weeks. The calcium hydroxide dressing was then removed and the entire root canal was filled with mineral trioxide aggregate. The endodontic access cavity was restored with composite resin. After 1 year, advanced osseous healing of the periradicular region had occurred and no clinical symptoms were apparent.

To assess the treatment outcomes of direct pulp capping with calcium hydroxide, 248 teeth were examined 0.4-16.6 years (mean, 6.1 ± 4.4) after pulp capping. Only teeth diagnosed to be clinical healthy or with spontaneous pain were capped. The treatment outcome was assessed by interviewing for signs or symptoms responsiveness and sensibility testing with CO(2). The overall survival rate was 76.3% after 13.3 years. Of the teeth, 80.2% were found to have a favourable treatment outcome. The pulps of 60-year-old patients showed a significant lower favourable treatment outcome when compared to patients younger than 40 years (p < 0.05). The treatment outcome was significantly less favourable in teeth restored with glass ionomer cement compared to all other teeth (p < 0.01). The likelihood to show an unfavourable treatment outcome after direct pulp capping was significantly higher for teeth with spontaneous pain than for teeth with clinically healthy pulps (p < 0.001). In addition, the likelihood for a tooth to become non-vital after direct pulp capping was significantly higher within the first 5 years after treatment than after more than 5 years (p < 0.001) after treatment.

Introduction: Although it has been suggested that orthodontic treatment might lead to changes in the dental pulp, no clinical study has attempted to investigate the incidence of pulp necrosis after orthodontic therapy. The purpose of this clinical trial was to determine whether pulp testing response is altered after rapid palatal expansion (RPE)., Methods: Twenty-five adolescent patients (9 boys, 16 girls; ages, 10-16 years) participated in the study. A hyrax appliance was cemented on the first permanent molars and first premolars (when fully erupted). The appliance was activated twice daily (0.5 mm) for 2 weeks. An electric pulp tester (EPT) was used to test at the buccal cusp tips of the molars and premolars. Teeth that did not respond to the EPT were subsequently tested thermally with Endo Ice (Hygienic Corporation, Akron, Ohio)., Results: All maxillary molars and erupted premolars of the 25 patients responded positively to pulp tests before cementation of the hyrax appliance. Of the 49 molars tested, 46 responded positively to the EPT, and 3 responded positively to the cold testing (CT). Of the 42 first premolars tested, 40 responded positively to the EPT and 2 to the CT. Of the 38 second premolars tested, 35 responded positively to the EPT and 3 to the CT. Two weeks after the initial activation of the hyrax appliance, 93 teeth in 17 subjects were tested. Of the 93 teeth, 73 teeth responded positively to the EPT and 20 to the CT. Three to 6 weeks after hyrax activation was discontinued, 59 teeth were tested; 48 tested positively to the EPT and 10 to the CT. One tooth (maxillary left first molar) did not respond to either EPT or CT. Finally, 3 to 9 months into retention, all molars and premolars of 23 subjects tested positive to pulp tests, 92 teeth to the EPT and 25 to the CT. The maxillary left first molar that had not responded to the tests at the 3-to-6 week check responded positively to the CT at the final check., Conclusions: After RPE therapy in children and adolescents, the pulp of the posterior permanent teeth examined in this study was vital.

Oral habits that are performed daily, can be a factor in the progression of periodontal and/or endodontic diseases. The purpose of this clinical report was to describe the treatment of a wide periodontal lesion and 18-month follow-up of a 13-year-old male patient's permanent mandibular central incisor that was traumatized due to chronic pencil biting. The lesion was curreted surgically while the compromised mandibular central incisor was endodontically and periodontally treated. The interdisciplinary approach showed a successful clinical outcome, as the survival of the infected tooth and the recovery of the soft tissues and the alveolar bone could have been achieved.

Dens evaginatus is a dental anomaly that occurs more commonly in pre-molar teeth. Although not a cause for alarm in most instances, it can lead to serious consequences if it is damaged. This paper explores the treatment of a necrotic pre-molar with an open apex that caused serious facial swelling in an adolescent patient. It is believed that this swelling was the result of an enamel tubercle, or dens evaginatus, which was knocked off or traumatized.

The purpose of this article is to report a rare case of orthodontically induced external root resorption of a maxillary left central incisor with a large periapical radiolucency; it was treated successfully with a conservative approach that included the use of calcium hydroxide. The tooth was nonvital and had grade III mobility. It was treated endodontically for 2 years with an interim filling of calcium hydroxide mixed with propylene glycol. After 2 years, the postoperative intraoral periapical radiograph showed good periapical healing with complete resolution of periapical radiolucency. There was a significant reduction in the mobility of the tooth, from grade III to grade I.

Pulse oximeter is a well-established and noninvasive method for measuring vascular health by evaluating oxygen saturation. This study compared the efficacy of a custom-made pulse oximeter dental probe with the electric pulp testing and thermal testing for measuring pulp vitality status of recently traumatized permanent teeth. Readings for pulp vitality for 17 recently traumatized maxillary incisors were taken with custom-made pulse oximeter dental probe (group 1), electrical pulp tester (group 2), and thermal testing (group 3) over a 6-month period. The proportion of recently traumatized teeth showing a positive responsiveness in thermal/electric pulp tests increased from no teeth showing responsiveness on day 0 to 29.4% teeth on the 28th day, 82.35% of teeth at 2 months, and 94.11% teeth at 3 months. However, pulse oximeter gave positive vitality readings that remained constant over the study period from day 0 to 6 months in all patients.

The aim of the present study was to perform a retrospective study of autogeneously transplanted teeth in order to examine the influence of clinical criteria such as the type of the donor tooth, the root length at the time of transplantation, donor eruption stage and others on the overall success rate of the transplantation. The material of this study consisted of 194 patients in whom 273 teeth were transplanted. The mean age at the time of autotransplantation was 18.1 years with a standard deviation of 7.5 years. Transplantations were performed in two hospitals. The follow-up period varied from 15 days to 11 years, and the mean follow-up time was 3.8 years. 58/273 teeth showed one or other form of resorption, 37/273 teeth showed ankylosis, 30/273 showed no important changes in pulp chamber size, 104/273 showed major discoloration after transplantation, 92/273 teeth showed positive results for cold test after transplantation and 26/273 teeth showed clinically unacceptable pocket depth. Clinical and radiological evaluations were performed. An association was found between successful transplantation and donor tooth type (P<0.01), root length at the time of transplantation (P<0.0001) and recipient tooth site (P=0.03). There was a borderline association between successful transplantation and donor eruption stage (P=0.05). In conclusion, autotransplantation of teeth performed with a careful surgical procedure at the stage of 1/2-3/4 of their intended or expected root length can render a very useful service to patients.

Aim: Significant delay in tooth eruption may be observed in many orthodontic patients. This delay may lead to complications, such as devitalization, ankylosis, external root resorption, injury to the adjacent teeth, and mucogingival problems. These complications may result in prolonged treatment time, esthetic deformities, damage to the periodontal tissues, and tooth loss. This report investigates the special considerations needed in treating such cases., Methods: Combined orthodontic and surgical treatment can be used in managing teeth exhibiting significant delay in eruption., Results: A high rate of success can be achieved in terms of esthetics, occlusion, and periodontal health., Conclusion: Nontraumatic surgery, adequate control of gingival inflammation, and use of minimal orthodontic forces may ensure a higher percentage of success and prevention of problems associated with teeth exhibiting significant delay in eruption.

Aim: To investigate radiographic manifestations of sickle cell anaemia (SCA) and whether or not a pulpal necrosis may develop without a pathological history., Methodology: Thirty-six patients with homozygous SCA were evaluated, and a further 36 individuals without SCA were included in the study as a control group. All 72 patients participating in the study ranged between the ages of 16 and 40 years. General and dental histories of the individuals were recorded. Electrical pulp test, percussion and thermal tests were applied to all the teeth having no restorations. Orthopantomograms of all the subjects were taken. Data obtained from questionnaires, sensitivity tests and radiographic examinations were evaluated by chi-square and Fischer's exact test., Results: Fifty-one (6%) of the teeth having no restorations or history of trauma were determined as being nonvital in the SCA group. In 30 (83%) of these patients orofacial and dental pain with no obvious cause was detected and in 24 (67%) of the patients the quality of the bone tissue as examined radiologically had deteriorated. In eight (22%) of the patients cortical thinning and irregularity in the mandible was noted. A statistically significant difference between the SCA and control groups (P < 0.05) was found in terms of pulpal sensitivity and radiological findings., Conclusion: SCA is a genetic and systemic disease which may cause pulp necrosis without necessarily having an identifiable aetiology. SCA causes radiographically observable differences in jaw structure especially in the mandible.

Treatment of traumatically intruded teeth is based largely on empirical clinical experience rather than on scientific data. The aim of this qualitative meta-analysis was to provide an evidence base to evaluate the orthodontic repositioning approach. In a MEDLINE search of the literature in English, 14 reported patients involving 22 teeth were found to have been treated by this modality. Additionally, 3 new patients, involving 9 intruded teeth and presented herein, were combined to form a total study sample of 17 subjects (7 girls, 10 boys, aged 8.9 +/- 1.2 years). Orthodontic extrusive forces were applied in the immediate posttrauma period (up to 3 months), with a variety of orthodontic appliances. Repositioning was achieved for 90.3% of the affected teeth but failed in 9.7% because of inflammatory resorption (2 teeth) or a misdiagnosis of root fracture (1 tooth). Early complications included loss of pulp vitality and external root resorption. All intruded teeth with closed root apices lost their vitality regardless of the degree of intrusion, whereas among those with incomplete apices, 45.5% that had been moderately intruded remained vital. External resorption was encountered in 54.8% of the teeth. Loss of marginal bone support was rarely encountered. Late complications included inflammatory root resorption in teeth with closed apices, in which endodontic treatment was not initially performed, and obliteration of the pulp tissue in teeth that remained vital. The results show that this method is superior to other treatment alternatives.

This article describes the long-term outcome of 40 consecutive patients having transplanted premolars. The objective of this ongoing study is to investigate survival rate, pulp survival rate, periodontal condition, and root development of autotransplanted premolars in orthodontic patients. This report covers 17 years; 32 orthodontic patients had 40 premolars transplanted into contralateral or opposing jaw quadrants where a premolar was missing. The teeth were examined systematically with clinical and radiographic measures at 1, 2, 6, 12, and 60 months or more after autotransplantation. The observation time varied from 2 years 5 months to 22 years 3 months, with a mean of 10 years 4 months. Bonded.018-in edgewise appliances were used, subjecting 87.5% of the transplanted teeth to normal orthodontic forces. One tooth was removed because of root fracture during the observation period, and 2 more had complications possibly related to the transplantation. The remaining 37 teeth and their supporting structures were all healthy at the last examination--a 92.5% success rate. Transplants with closed apices received endodontic therapy, but, in those with open or half-open apices, a 66% pulp survival rate was observed. No teeth in the sample had signs of replacement resorption or developed periodontal attachment loss. Inflammatory resorption in 2 teeth was arrested after endodontic treatment. Root formation, when not complete, continued on transplanted teeth, giving normal root form and adequate root length for normal function. It is concluded that autotransplantation of premolars combined with orthodontic treatment should be the first treatment alternative in cases of missing premolars, when a suitable donor tooth is available.

The relation between smoking and apical periodontitis has been little studied to date. The aim of the present study was to investigate whether tobacco smoking might be associated with the prevalence or severity of periapical lesions. A total of 247 individuals, 81 current smokers, 63 former smokers, and 103 non-smokers participated in the study. The periapical condition was expressed as the number and percentage of radiographically detectable lesions and, in addition, as a severity index. The overall prevalence of apical periodontitis was 52% and the overall prevalence of endodontic treatment 58%. There was no significant influence of smoking on the prevalence of either apical periodontitis or endodontic treatment. The mean number (percentage) of periapical lesions per person was 1.9 (6%) in current smokers, 1.5 (4%) in former smokers, and 1.0 (3%) in non-smokers. Controlling for age, the association between smoking and periapical lesions was not statistically significant. The mean periapical severity index including all teeth, or teeth affected by periapical lesions alone, did not significantly differ between smoking groups. It is concluded that the present observations do not lend support to the assumption that tobacco smoking is associated with apical periodontitis.

The reliability of laser Doppler flowmetry in a 2-probe assessment of pulpal blood flow is well known. The purpose of this case report was to determine its use as an exclusive and reliable tool for tooth vitality diagnosis in a long-term follow-up. As a result of a traumatic injury to a 24-years old Caucasian female, tooth pulp vitality was studied in 6 maxillary front teeth over 30 weeks through use of 2-probe laser Doppler flowmetry and current sensitivity tests. A similar assessment was repeated after 228 weeks. Confronted with an alveolar bone fracture with a tooth in the fracture line, one intrusion and several luxated teeth, current sensitivity tests are found not to be so reliable indicators of revascularisation as significant results are given later (7 weeks) compared to laser Doppler flowmetry tests (1 week). A pathway with ischaemia (3 weeks), hyperaemia (7 weeks) and restored blood supply in the pulp measured by laser Doppler flowmetry tests was found and avoided endodontic treatment. Teeth vascularisation evolved normally (228 weeks). Despite a high indication in all sensitivity tests for endodontic treatment, the use of laser Doppler flowmetry tests was clear, more reliable than sensitivity tests and exclusive as denervation was postponed and pulp vascularisation was evident.

This study examines the treatment of non-vital immature permanent incisors using the calcium hydroxide apexification technique. The objectives of the present study were to determine the speed and location of barrier formation and those factors discernible at presentation and during treatment which may be related to it. Forty-four non-vital immature incisors undergoing calcium hydroxide apexification were reviewed in detail. All cases were reviewed every 8-12 weeks for up to 18 months, or until apexification occurred. Details of the time and nature of the injuries and treatment were recorded. The degree of apical development prior to treatment was assessed, and barrier formation, location and time were noted. Mean time to barrier formation was 34.2 weeks (range 13-67 weeks). The strongest predictor of rapid barrier formation was the rate of change of calcium hydroxide and a barrier also formed more rapidly in cases with narrower initial apical width. There was evidence of displacement and a higher mean time for barrier formation in half of the cases. The presence of an abscess was the weakest predictor of rapid barrier formation and the effect was not significant (P = 0.280). The barrier was located at the apex in 28 cases (63.6%) and the distance from the barrier to the apex for the remaining 16 (36.4%) varied from 1 mm to 5 mm. The number of placements of calcium hydroxide varied from 1 to 4 with a mean of 1.9, and there was a higher mean number of calcium hydroxide placements in the cases where the barrier was located at the apex.

Laser Doppler flowmetry is a non-invasive electrooptical technique which allows the semi-quantitative recording of pulpal blood flow. This study aimed to determine the reliability (measured as the sensitivity and specificity) of laser Doppler flowmetry as a method of assessing the vitality of traumatised anterior teeth, and to compare it with standard pulpal diagnostic tests. Recordings of pulpal blood flow were taken from 67 non-vital anterior teeth (55 patients), where the pulpal status was confirmed by pulpectomy. For comparison, recordings were also taken from 84 vital anterior teeth (84 patients). Analysis of the recordings allowed diagnostic criteria to be developed which gave the technique a sensitivity and specificity of 1.0 for this sample. None of the other standard pulpal diagnostic methods tested was as reliable. This was usually due to low sensitivities, which ranged between 0.92 for sensibility testing with ethyl chloride down to 0.36 for periapical radiolucency and 0.16 for a history of pain. Laser Doppler flowmetry was found to be a reliable method of assessing the pulpal status of traumatised anterior teeth, although it is technique-sensitive and time-consuming to use.

Purpose: This study retrospectively evaluated the long-term effects of transverse symphyseal distraction osteogenesis (DO) on the temporomandibular joint (TMJ) symptoms, periodontal health, tooth vitality, and nerve injury after surgery., Patients and Methods: Twenty-three patients were treated with symphyseal DO during a 4-year period. Fifteen patients were available for follow-up from 7 to 45 months postoperatively (ave, 24.5 months). The patients were clinically evaluated for TMJ symptoms, periodontal pocket formation, tooth vitality and mobility, crestal bone loss, and attached gingival tissue changes. Radiographs of the mandibular anterior teeth were used to evaluate for periodontal bone loss, periapical lesions, or widening of the periodontal ligament (PDL)., Results: Preoperatively, 47% of the patients had TMJ symptoms. No patient had symptom worsening or developed new symptoms postoperatively. Five patients' TMJ symptoms improved, and 3 experienced complete resolution of symptoms. No periodontal bone loss or soft tissue recession were evident. Tooth vitality was maintained in 13 patients. Two patients developed Class II mobility of 1 mandibular central incisor, 1 patient had tooth pain and a widened PDL adjacent to the osteotomy/corticotomy site, and 1 patient experienced mental nerve paresthesia., Conclusions: DO can be used to treat transverse discrepancies of the mandible with limited morbidity.

This case report documents the devitalization of an adjacent tooth during osteotomy preparation for implant placement. The fixtures were placed without consulting the patient's dentist. Furthermore, radiographs were not taken during stage 1 surgery. The patient started to experience painful symptoms 1 month after fixture placement, and a radiograph was taken at that time. It revealed periapical pathology on the mandibular left canine, through which the base of the implant penetrated. This traumatic injury at the tooth's apex undoubtedly caused its devitalization. Prompt removal of the fixture and endodontic therapy on the canine resulted in repair of the osseous site within 3 months.

The anomaly of dens evaginatus manifests itself as an innocuous-looking tubercle of enamel on the occlusal surface of a premolar tooth. Problems can arise when the tubercle is either worn, ground, or fractured off, resulting in pulpal exposure and possible loss of vitality of the tooth. Orthodontists should be particularly aware of this dental anomaly, which occurs in at least 2% of the Asian and Native Indian population. Premolar extraction cases should be planned to include extraction of the anomalous premolars instead of the normal ones. In addition, the orthodontist should be wary of occlusal changes during treatment or occlusal equilibration that might jeopardize the vitality of teeth with dens evaginatus. Pulp-capping or partial pulpotomy has been postulated as the most reliable form of treatment to prevent loss of vitality of the affected teeth and to allow continued root maturation where necessary.