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Introduction and AimPerforming endodontic treatment in an immature permanent tooth that has experienced trauma or carious exposure can pose challenges. The root canals in these teeth are typically open and fragile, making instrumentation and obturation difficult. Traditional apexification, which involves placing calcium hydroxide paste in the root canal for a specified period to induce the formation of a calcified barrier, has been a long-standing approach. While it is a widely used method, leaving the paste in the root for extended periods can weaken it due to the paste’s hygroscopic properties and the proteolytic activities of calcium hydroxide. As a result, researchers have been exploring alternative treatments that allow for the full development of immature teeth. Revascularization has emerged as one such alternative, with a variety of treatment protocols documented in scientific literature. Description of the CaseThis case report, for the first time, describes the use of NeoPutty MTA® and triple antibiotics paste for revascularization in a young female child on a carious, exposed lateral incisor with opex apex with success. ConclusionThe revascularization process attempted on the infected tooth met with success and closure of apex was noticed in a short period of time.

Introduction and Aim: Performing endodontic treatment in an immature permanent tooth that has experienced trauma or carious exposure can pose challenges. The root canals in these teeth are typically open and fragile, making instrumentation and obturation difficult. Traditional apexification, which involves placing calcium hydroxide paste in the root canal for a specified period to induce the formation of a calcified barrier, has been a long-standing approach. While it is a widely used method, leaving the paste in the root for extended periods can weaken it due to the paste's hygroscopic properties and the proteolytic activities of calcium hydroxide. As a result, researchers have been exploring alternative treatments that allow for the full development of immature teeth. Revascularization has emerged as one such alternative, with a variety of treatment protocols documented in scientific literature. Description of the Case: This case report, for the first time, describes the use of NeoPutty MTA® and triple antibiotics paste for revascularization in a young female child on a carious, exposed lateral incisor with opex apex with success. Conclusion: The revascularization process attempted on the infected tooth met with success and closure of apex was noticed in a short period of time. [ABSTRACT FROM AUTHOR]

Abstract Background The present study aimed to investigate whether incorporating metformin in double antibiotic paste (DAP) can promote the regeneration process of non-vital immature teeth. Methods Out of 32 pediatric patients undergoing regenerative endodontic procedures (REPs), 6 cases with a follow-up period of less than 12 months or lack of documentation were excluded then the remaining 26 were analyzed. 15 cases received DAP, and 11 cases received a DAP + metformin as the intra-canal medicament, kept for an average of 23 days. During 18 months of follow-up, clinical and radiographic examinations were performed to evaluate the treatment outcomes based on the resolution of apical periodontitis, root development, and the occurrence of intracanal calcification. The chi-square test was used for the statistical analysis (P

Background: The present study aimed to investigate whether incorporating metformin in double antibiotic paste (DAP) can promote the regeneration process of non-vital immature teeth. Methods: Out of 32 pediatric patients undergoing regenerative endodontic procedures (REPs), 6 cases with a follow-up period of less than 12 months or lack of documentation were excluded then the remaining 26 were analyzed. 15 cases received DAP, and 11 cases received a DAP + metformin as the intra-canal medicament, kept for an average of 23 days. During 18 months of follow-up, clinical and radiographic examinations were performed to evaluate the treatment outcomes based on the resolution of apical periodontitis, root development, and the occurrence of intracanal calcification. The chi-square test was used for the statistical analysis (P < 0.05). Results: All patients demonstrated resolution of apical periodontitis; however, complete apical closure was only seen in 50% of the patients. The rate of apical closure and root length was significantly higher in the DAP + metformin group (P = 0.047), although the two groups were not significantly different in terms of root width (P = 0.184). Canal obliteration was seen in 15% of cases, all of which were in the DAP group. Conclusions: According to the present findings, metformin could promote root development in the regeneration process when incorporated in DAP. Trial registration: This clinical trial was registered on the Iranian Registry of Clinical Trials (IRCT20200120046197N1) on 26.2.2021. [ABSTRACT FROM AUTHOR]

Regenerative endodontic therapy (RET) could result in continued root development, with possible occupancy of the root canal system by vital tissues. RET should be considered for young patients with immature teeth with incomplete root formation. However, much is still unknown about the clinical and biological aspects of RET, especially the long-term effects in the growing child. Several guidelines have been published advocating the use of RET for the management of non-vital immature permanent teeth. An electronic search using electronic databases MEDLINE, EMBASE and EMBASE Classic, and PubMed was undertaken; there are currently 12 published randomised controlled clinical trials on RET. This review discusses current knowledge with respect to RET protocols, as well as survival, success rates and predictability of RET outcomes. Patientcentred outcomes in relation to the young patient, such as tooth discolouration, and orthodontic treatment of RET-treated teeth are discussed. The most current and accepted clinical protocols for RET are outlined. [ABSTRACT FROM AUTHOR]

Background and Aim The research results show tobacco use increases cardiovascular and lung disorders or the probability of periodontitis in humans, while no definitive relations were yet confirmed. This study evaluates the relationship between periodontitis and tobacco use by panoramic radiography in Bandar Abbas City. Methods & Materials A total of 198 panoramic radiographs were classified into periapical healthy (n=99) and patient (n=99) groups. Radiologists assessed radiographs for periodontitis via Total Teeth Numbers (TTN), the quality and length of Root Filling Treatment (RFT), the number (NoRFT), and inadequate root filling treatment (RFTin), age, gender, the cigarette and hookah use, and dental debris. Data were analyzed by Chi-Square, t-test, and logistic regression. Ethical Considerations Due to the lack of therapeutic intervention and the preservation of patients’ characteristics, ethical considerations are not included in this study (Code: IR.HUMS.REC.1399.384) Results Tobacco, hookah use, TTN, and RFTin were different (P<0.01) in groups, but cigarette smoking, debris, RFT, NoRFT, and age were not. Women in the periodontitis group showed high (P<0.01) in tobacco, hookah use, and RFTin, while no gender differences were observed in other parameters. The logistic regression results showed that based on the Odd Ratio NoRFT (39.7), RFTin (36.8), `hookah (8.1), tobacco (6.57), debris (3.62), smoking (3.59), RFT (1.4) and TTN (0.89) were the highest (P<0.01). At the same time, age and gender did not affect periapical tissues. Conclusion Hokka, tobacco, and cigarette use negatively affected the periapical tissues, respectively. The decrease in TTN and increase in debris and RFT were probably the effects of tobacco smoking on the periapical tissues. Age and gender were not related to the periapical lesions. [ABSTRACT FROM AUTHOR]

Background and Aim: The research results show tobacco use increases cardiovascular and lung disorders or the probability of periodontitis in humans, while no definitive relations were yet confirmed. This study evaluates the relationship between periodontitis and tobacco use by panoramic radiography in Bandar Abbas City. Methods & Materials: A total of 198 panoramic radiographs were classified into periapical healthy (n=99) and patient (n=99) groups. Radiologists assessed radiographs for periodontitis via Total Teeth Numbers (TTN), the quality and length of Root Filling Treatment (RFT), the number (NoRFT), and inadequate root filling treatment (RFTin), age, gender, the cigarette and hookah use, and dental debris. Data were analyzed by Chi-Square, t-test, and logistic regression. Ethical Considerations: Due to the lack of therapeutic intervention and the preservation of patients’ characteristics, ethical considerations are not included in this study (Code: IR.HUMS.REC.1399.384) Results: Tobacco, hookah use, TTN, and RFTin were different (P

Purpose: MTA apical plug approach is considered the gold standard in managing immature teeth with necrotic pulp tissues but does not increase root dimensions. Regenerative Endodontic Therapy (RET) has been advocated as an alternative technique for management of these teeth. This study aimed to assess the knowledge, experience and the opinions of dentists treating paediatric patients in the European and Arabian regions on RET. Methods: A cross-sectional, pre-piloted 23-item self-administered questionnaire survey was distributed electronically using the Bristol Online Survey tool through the mailing list of the European Academy of Paediatric Dentistry, the Arabian Academy of Paediatric Dentistry's and the Egyptian Society of Paediatric Dentistry. Results: 308 respondents completed the survey. Approximately half practised RET (N = 158; 51.3%), which was most frequently used to manage non-vital traumatized teeth. Majority of RET practitioners worked in university or dental institute practices. Protocol differences with deviation from the current published RET guidelines were observed. Half of the respondents reported discolouration as an undesirable outcome. Lack of training, materials, evidence and suitable cases were reasons for not using RET. Conclusions: Although RET is being practised by European and Arabian paediatric dentists, different protocols are being used with clear deviations from the current evidence-based guidelines. [ABSTRACT FROM AUTHOR]

Background and Objective: Formocresol is a gold standard medicament in both vital and non-vital pulpotomies due to its potent antibacterial potential but, it has a controversial nature due to its side effects. Therefore, the demand for natural alternatives of Formocresol as a pulp dressing material, with few or no side effects, became imperative. The purpose of the study was to introduce turmeric gel as a non-vital pulpotomy (NVP) medicament in primary teeth by evaluating its antibacterial effect against Streptococcus mutans and Lactobacillus acidophilus. Methods: It was a multiarm parallel randomized controlled trial in which sixty patients aged between 4 and 8 years, each containing at least one non-vital primary molar, were selected and randomly divided into group A (Formocresol) and group B (Turmeric gel). NVP was performed by removing the coronal necrotic pulp. Sterile paper points were dipped in the root canals and taken to the laboratory. Cotton pellets soaked in the respective medicaments were placed over the root canal orifices and filled temporarily. Patients were recalled after 1 week. Samples were again taken, and the tooth was restored. A comparison between bacterial count at baseline and after 1 week of treatment was made and expressed as Colony-Forming Units/ml. Data were entered and analyzed by using Statistical Package for Social Sciences version 25.0. Results: There was a significant reduction in median S. mutans and L. acidophilus bacterial count in each group after 1 week of treatment (p < 0.001). Formocresol showed a higher average reduction than turmeric gel. However, statistically, the difference was insignificant indicating that both the medicaments possessed comparable antibacterial effects. Conclusion: Turmeric gel was found as an effective alternative to Formocresol for its use as a non-vital pulpotomy medicament. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of sodium perborate mixed with distilled water and sodium perborate mixed with 30% hydrogen peroxide as non-vital bleaching agent of anterior discolored teeth., Materials and Methods: A randomized controlled trial was undertaken among 61 patients who presented with 70 discolored anterior teeth at the Conservative and Family Dentistry Clinics of the University College Hospital, Ibadan, Nigeria. The 70 teeth were randomly allocated into two groups of treatments. In Group A, the test group, the coronal part of endodontically treated teeth was further treated with sodium perborate mixed with distilled water while group B, the control group, the coronal part of endodontically treated teeth were also further treated with sodium perborate mixed with 30% hydrogen peroxide. Information on study participants biodata and satisfaction with treatment were obtained. Tooth shade assessment was done using shade guide units of the vitapan shade guide at baseline and during recall visits on days 7, 14, and 21. Frequencies, means, and standard deviations were generated. The Chi-squared test was used to determine the association between two categorical variables at p < 0.05., Results: In the control group, the mean ± SD tooth shade was 12.5 ± 3.2, 8.7 ± 3.8, 4.9 ± 2.8, and 3.1 ± 2.2 at baseline, Day 7, Day 14, and Day 21, respectively. In the test group, the corresponding values were 12.8 ± 3.2, 9.6 ± 3.9, 5.6 ± 3.0, and 4.0 ± 2.9. The mean ± SD tooth shade scores of the control and test groups were 12.5 ± 3.2 and 12.8 ± 3.2, respectively (p = 0.15). Twenty-two (62.9%) and 19 (54.3%) of the study participants in the control and test groups, respectively, reported that they were extremely satisfied (p = 0.60)., Conclusion: The effectiveness of sodium perborate mixed with distilled water and sodium perborate mixed with 30% hydrogen peroxide in lightening the coronal part of endodontically treated non-vital discolored anterior teeth was similar. Both bleaching agents demonstrated similar patient satisfaction., (© Association of Resident Doctors, UCH, Ibadan.)

The success of the endodontic treatment depends on the microbial suppression in the root canal and periapical region. Endodontic instrumentation alone cannot achieve a sterile condition. With the advent of non-instrumentation endodontic treatment and lesion sterilization and tissue repair, local application of antibiotics has been investigated. Triple antibiotic paste (TAP) containing metronidazole, ciprofloxacin, and minocycline has been reported to be a successful regimen in controlling the root canal pathogen and in managing non-vital young permanent tooth. This paper reviews the existing literature on biocompatibility, efficiency, drawbacks of TAP in endodontic therapy and pulp revascularization.

Hypoplasia is the result of disruption in the process of enamel matrix formation, which in turn causes defect in quality and thickness of enamel. Four cases of Turner′s hypoplastic teeth with a previous history of trauma/infection in their primary predecessors at the age of 2-3 years have been reported. These hypoplastic teeth had turned non-vital without any carious insult, cavitation or further trauma. This article thereby stresses the importance of early detection of enamel hypoplasia and proper management at the earliest possible stage to enable an efficient prevention from clinically non-evident microbial invasion in the dentinal tubules and concomitant pulp pathosis.

The main aim of treatment of non-vital teeth with blunderbuss canals is to induce apical closure of the roots against which an obturating material can be placed. The treatment of choice for such teeth is apexification. This paper discusses the case of a 14-yearold boy who complained of tenderness in his left upper central incisor and gave a history of trauma 5 years back. On clinical and radiographic examination, the tooth was found to be discolored with large periapical radiolucency. Apexification was performed on the tooth, and regular radiographs were taken at 1, 3 and 6 months to check for apical closure. The complete apical closure was seen at the end of 6 months with complete resolution of the periapical radiolucency. This case report highlights the effectiveness of calcium hydroxide in creating an antibacterial field at the apical end of the tooth and thereby helping in continued root development of the apex. [ABSTRACT FROM AUTHOR]

Attempts to develop a test for pulp vitality has had a somewhat convoluted history, as the concept of 'vitality' has been the pivotal focus of interpretation, misinterpretation, and empirical dogma , especially when using electrical stimulation. Some researchers attempted histological correlations while others focused exclusively on radiographic correlations to validate electrical methods of pulp testing. Some the early literature rightfully focused on the concept of sensibility (a contemporary term in common usage) instead of vitality. This article will purposefully focus on some of the early thought processes of our forefathers as they attempted to arrive a full-proof method to assess the status of the often-compromised dental pulp., (Copyright 2022 © American Academy of the History of Dentistry.)

Intrinsic discoloration of a non-vital permanent incisor tooth due to trauma may have a significant esthetic and social impact on children and adolescents. Treatment options for discolored Non-vital teeth are bleaching, crowns or veneers. However, this restorative crown or veneer approach has a significant drawback of being an invasive technique. Intervention should be minimal destruction of tooth structure and should not compromise future restorative options. The advantage bleaching over crown is that it offers simple conservative approach in removal of stain and whitening discolored teeth without damaging tooth structure. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of metronidazole gel versus metronidazole solution against Enterococcus faecalis in abscessed primary molars. Study design: A clinical trial. Method: Twenty pulpally involved non-vital carious human primary mandibular second molars with furcal abscess were randomly allocated into two groups to evaluate the efficacy of metronidazole gel (3 % w/v) and metronidazole solution (0.5 % w/v) against E. faecalis. Subjects in the first experimental group were subjected to treatment with metronidazole gel (3 % w/v) and subjects in the second experimental group were treated with metronidazole solution (0.5 % w/v). Two microbial samples (pre-operative and post-operative samples) were obtained from the root canals of each subject from both the groups; sub cultured and efficacy of both the groups were evaluated. Results: Overall percentage reduction of the mean colony forming unit (CFU) count of metronidazole gel (3 % w/v) group was 96.39 % and metronidazole solution (0.5 % w/v) was 90.90 %. Results of intergroup t test of the percentage difference of mean CFU counts between both the groups revealed a statistically highly significant difference, i.e. p value-0.008 ( p < 0.01). Conclusions: Metronidazole gel (3 % w/v) was more effective than metronidazole solution (0.5 % w/v) against E. faecalis. [ABSTRACT FROM AUTHOR]

The process of internal bleaching of discolored teeth has been with us for well over 150 years, during which time both materials and procedures varied significantly. The etiology of tooth discoloration also reflected on a wide range of philosophies and causes, which lent itself to many trials and errors in management. Both success and failure characterized the achievements attained by our forefathers in managing this esthetic challenge, as years ago tooth extraction was often the first pathway chosen., (Copyright 2022 © American Academy of the History of Dentistry.)

The success of the endodontic treatment depends on the microbial suppression in the root canal and periapical region. Endodontic instrumentation alone cannot achieve a sterile condition. With the advent of non-instrumentation endodontic treatment and lesion sterilization and tissue repair, local application of antibiotics has been investigated. Triple antibiotic paste (TAP) containing metronidazole, ciprofloxacin, and minocycline has been reported to be a successful regimen in controlling the root canal pathogen and in managing non-vital young permanent tooth. This paper reviews the existing literature on biocompatibility, efficiency, drawbacks of TAP in endodontic therapy and pulp revascularization. [ABSTRACT FROM AUTHOR]

Hypoplasia is the result of disruption in the process of enamel matrix formation, which in turn causes defect in quality and thickness of enamel. Four cases of Turner's hypoplastic teeth with a previous history of trauma/infection in their primary predecessors at the age of 2-3 years have been reported. These hypoplastic teeth had turned non-vital without any carious insult, cavitation or further trauma. This article thereby stresses the importance of early detection of enamel hypoplasia and proper management at the earliest possible stage to enable an efficient prevention from clinically non-evident microbial invasion in the dentinal tubules and concomitant pulp pathosis. [ABSTRACT FROM AUTHOR]

The article describes a study which examined an effective bleaching technique for non-vital, discolored teeth in children and adolescents. The causes of the discoloration of permanent incisors are presented and the use of inside/outside bleaching technique is described. An overview of the management options for a discolored permanent incisor is also given. Several cases which proved the inside/outside bleaching technique to be successful are also discussed.

An unusual case of injury to the incisors is reported here in a 21 yr old patient. The patient tried to shorten the length of central incisors with nail cutter, resulting into nonvital central incisor on left side., along with this, there were enamel cracks in both the central incisors. [ABSTRACT FROM AUTHOR]