Complete Root Development Research Articles

Stress induced on permanent mandible first molar and space maintainer under normal masticatory forces: a finite element study.

The band and loop space maintainer is used to maintain the missing space of deciduous molars which are lost early. When the second deciduous molar is lost prematurely, the stress on the first permanent molar during different degrees of development may vary when it is the abutment. The design and use of the space maintainer may also lead to damage of the loop. The purpose of this article is to use the finite element method to study the stress on the first permanent molar and the loop with or without occlusal contact, with the first permanent molar of four different degrees of development serving as the abutment. We aimed to guide the clinical design and use of the space maintainer. We developed finite element models of the mandibular first permanent molar and the band and loop space maintainer, and simulated alveolar bone, periodontal ligament (PDL), enamel and dentin. The four developmental stages were 1/2 (I), 2/3 (II), 3/4 (III) and full development (IV). Ansys Workbench was used to analyze the effects of root development and occlusal contact between the loop and the opposite jaw on abutment teeth and the loop. Abutment teeth were statically loaded vertically and obliquely with a force of 70 N. The loop was statically loaded vertically with a force of 14 N. The stress on all structures and the displacement trends of the loop were calculated. The stress on enamel, dentin, PDL and alveolar bone were similar, and the concentration was consistent. But if there was occlusal contact, the loop produced maximum displacement at the near middle edge of contact with the anterior teeth. When the loop was in occlusal contact with the opposing occlusal tooth, the peak value of the equivalent stress on the space maintainer under vertical load was: group I > group IV > group III > group II, and the maximum principal stress peak change was: group I > group III > group II > group IV. The change of the equivalent stress peak value of the loop under oblique load was: group I > group III > group IV > group II, and the maximum principal stress peak change was: group III > group I > group II > group IV. When the loop was not in occlusal contact with the opposing occlusal tooth, the peak value of the equivalent stress on the space maintainer under vertical load was: group IV > group I > group II > group III, and the maximum principal stress peak change was: group IV > group I > group II > group III. The change of the equivalent stress peak value of the space maintainer under oblique load was: group I > group IV > group II > group III, and the maximum principal stress peak change was: group I > group IV > group II > group III. Our results suggested that whenever possible, choosing the teeth with nearly complete root development as the abutment of the space maintainer is advisable. The design and use of the band and loop space maintainer should avoid occlusal contact with the occlusal teeth to prevent deformation of the loop.

Liability and Medico-Legal Implications in Estimating the Likelihood of Having Attained 14 Years of Age in Pediatric Clinical Practice: A Pilot Study

Accurate methods of age estimation are more essential than ever due to the rise in undocumented individuals without proper identification, often linked to illegal immigration and criminal activities. This absence of reliable records presents challenges within the legal systems, where age thresholds in the context of children’s rights vary across countries. Age 14 has global significance, as established by the UN Convention on the Rights of the Child and the EU for administrative purposes. Accurate age estimation is crucial in medical decisions, reproductive health, and forensics. This study focuses on age estimation via dental radiographs, proposing a method for estimating the likelihood of having attained the age of 14. Orthopantomograms were analyzed from two samples, 191 Italian children (aged 5–15) and 822 Chilean subjects (aged 11–22), using dental maturity indices. These indices evaluated open tooth apices and complete root development. Statistical analysis confirmed the method’s reliability in identifying individuals aged 14 or older, with sex-specific cut-offs. The proposed method particularly advocates an approach based on dental mineralization, which could surpass those relying on bone growth. The collaboration between medical experts, including pediatricians and diagnostic imaging specialists, is vital for standardized age estimation strategies. Ethical concerns regarding radiation exposure and accountability are recognized, although the method’s low radiation doses are deemed acceptable. The proposed method will help health professionals to accurately predict whether or not the 14-year threshold has been reached, opening up new avenues of medico-legal interest and laying the foundations for a legal framework that would allow the pediatrician, when involved, to use a valid and recognized diagnostic approach.

Analysis of the achievement of primary and secondary goals and influencing factors in single-rooted immature permanent teeth after regenerative endodontic procedures: a retrospective study

ObjectiveThis study explored the achievement of primary and secondary goals and factors influencing their achievement in regenerative endodontic procedures (REPs) for immature permanent teeth.MethodsDental records of all patients who received REPs for immature permanent teeth at the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology between January 2012 and January 2023 were retrieved. The evaluation of the primary goal was based on medical and radiographic records. The achievement of the primary goal was defined as the absence of clinical signs and symptoms, such as pain, swelling, or sinus tract and the absence of periapical radiolucency, as assessed on postoperative periapical radiographs. The achievement of secondary goal represented increased root wall thickness and/or increased root length, that is, continued root development. Periapical radiographs before and after treatment were used to evaluate the achievement of the secondary goal. The secondary goal was required to be achieved alongside the achievement of primary goal.ResultsA total of 436 teeth (136 anterior and 300 posterior teeth) were included in this study, 96.1% of which demonstrated achievement of the primary goal. Signs of failure (17 teeth) included crown fracture and uncontrolled and recurrent periapical lesions. In addition, 77.8% of teeth demonstrated achievement of the secondary goal, and more than half of the teeth exhibited a complete root development. Evaluation factors included patients’ age, sex, tooth type, etiology, preoperative periapical lesion, duration of clinical signs and symptoms, follow-up period, and stage of root development. The achievement of the primary and secondary goals were significantly related to age and tooth type (p < 0.05).ConclusionsChildren with a younger initial visit age are more likely to achieve primary and secondary goals. Additionally, posterior teeth had an advantage over anterior teeth in achieving primary and secondary goals.

A Case Report of Different Management Protocols for Uncomplicated Crown Fracture in Young Permanent Teeth; Fragment Reattachment vs. Resin Restoration

Introduction: An uncomplicated crown fracture (enamel-dentin fracture) is the most clinically reported traumatic injury. Many techniques have been reviewed to manage this traumatic injury. The literature has no consensus on the best strategy to establish optimal biological, functional, and esthetical success. Objective: This clinical case reports different management of uncomplicated crown fractures in young permanent teeth that were successfully treated using both tooth fragment reattachment and composite build-up. Case Report: A 9-year-old female presented as an emergency patient with immature fractured upper central incisors. She hit her mouth into a solid wall and broke her front teeth during playing. Upon parental advice, the fragments were stored in a container of milk since the incident. For dental management, two treatment approaches were used. Conclusion: After a two-year follow-up, the treatment is considered successful and the traumatized teeth are vital, functional and presented with a complete root development.

Tooth autotransplantation: review of the relevant procedural aspects for the clinical success

Background. Tooth autotransplantation may be considered as valuable treatment option to overcome adverse effects of tooth loss and prevent implant-related complications. The essence of such manipulation based on removing targeted (donor) tooth from its present location with its further placement at some other tooth position within the oral cavity of the same patient in the least traumatic way.&#x0D; Objective. To systematize and analyze relevant procedural aspects of tooth autotransplantation associated with its’ clinical success.&#x0D; Materials and Methods. A comprehensive search strategy was realized through databases PubMed (https://pubmed.ncbi.nlm.nih.gov/) and Cochrane Library (https://www.cochranelibrary.com/), and also via Google Scholar (https://scholar.google.com/) search engine to expand possibilities for targeted publications identification. Primary extraction of the targeted studies was provided by their title and abstract. The criteria for eligibility included publications with described original practical and theoretical aspects regarding tooth autotransplantation procedure, while publications with repetitive information or non-sufficiently argumented/non evidence based statements were excluded from further analysis.&#x0D; Results. The final number of eligible studies for analysis was 82 publications with adequate reporting of outcomes associated with present research objective. Out of this number 8 were presented in the form of systematic reviews, 3 in the form of literature reviews, while all others were presented in forms of case reports, case series, protocols, recommendations, follow-ups, experimental and clinical studies.&#x0D; Conclusion. Correct surgical manipulations, which should be as atraumatic as possible to preserve the periodontal ligament of the transplanted tooth, is a key of autotransplantation successful outcome. The success of the treatment is also related with the stage of root development. In cases of transplanting the teeth with complete root development endodontic treatment should be performed approximately in 2 weeks after primary intervention.

Frequency of Pericoronal Radiolucency in Impacted Teeth: A Panoramic Radiography Study

Aim All permanent teeth can remain impacted. Impacted teeth can remain in the jaw for years without showing any symptoms and causing a pathological event, and they can also cause neuralgiform pain, infection, teinporomandibular joint complaints, root resorption in neighboring teeth, and pathologies. Pericoronal radiolucency observed over 2.5 mm in radiographic imaging is suspicious. The aim of this study is to investigate the frequency of pericoronal radiolucency in impacted teeth examined on panoramic radiographs.&#x0D; Methods The study was conducted by retrospectively examining panoramic radiographs of 1128 patients (633 females, 495 males) over the age of 18. Permanent impacted teeth with complete root development were included in the study, and primary teeth, mesiodens, supernumerary and supplemental impacted teeth were excluded from the study. Pericoronal radiolucency was recorded as 'present' in case of pericoronal radiolucency (&gt;3 mm) associated with impacted permanent tooth on panoramic radiographs. SPSS v.21 (IBM Corp., Armonk, NY, USA) program was used to analyze the data.&#x0D; Results The mean age of the individuals included in the study was 31±11 years (18-85). A total of 2247 impacted teeth from 1128 individuals were evaluated. Pericoronal radiolucency was detected in 208 impacted teeth (9.3%). There was a statistically significant relationship between gender and the frequency of pericoronal radiolucency (p

Accuracy of Demirjian's and Cameriere's Methods for Age Estimation in 6- to 10-Year-Old Iranian Children Using Panoramic Radiographs.

Objective This study assessed the accuracy of Demirjian's and Cameriere's methods for age estimation in Iranian children using panoramic radiographs. Materials and Methods This cross-sectional study evaluated 212 panoramic radiographs of 6- to 10-year-old children retrieved from the archives of an oral and maxillofacial radiology department from 2011 to 2017. The chronological age of children at the time of radiography was determined by subtracting the date of radiography from their birth date. The developmental stage of 7 permanent left mandibular teeth was determined according to Demirjian's method. The stage of dental maturation was determined according to Cameriere's method by using the normalized values for 7 permanent left mandibular teeth and the number of teeth with complete root development. The error value of the two methods was calculated by comparing them with the actual chronological age of male and female children, and the absolute error values of the two methods were compared with paired t-tests. Results The mean error value of Demirjian's and Cameriere's methods was found to be 0.84 and −0.06 in girls and 0.93 and 0.04 in boys, respectively. Significant differences were noted in the absolute error of the two methods compared with the chronological age of male and female children (both Ps < 0.001). Conclusion In conclusion, this study indicated that Cameriere's method was more accurate than Demirjian's method for age estimation in Iranian children.

Propagación de Arctostaphylos pungens Kunt procedente de bosques templados del centro-norte de México

Introduction:Arctostaphylos pungens Kunt is a species with significant characteristics for restoration; however, there are few studies on its propagation. Objective: To evaluate the effect of pre-germinative treatments and the use of vegetative propagation methods in A. pungens. Materials and methods: Eight pre-germinative treatments were evaluated, consisting of scarification with H2SO4 (98 %) for 5 and 6 h, gibberellic acid immersion (1 000 ppm), cold stratification (4 °C for 30, 60 and 90 days) and heat shock (100 °C for 5 min), as well as combinations of these. Vegetative propagation was analyzed by cuttings and air layering. Results and discussion: The highest germination (73.33 ± 15.63 %) was for immersion in H2SO4 for 5 to 6 h; heat shock and cold stratification treatments showed low or no germination. Root formation was not achieved in cuttings but was achieved in 37.50 ± 25 % of 20-week air layering. Conclusion: The best treatments consisted of immersion in H2SO4. It is recommended to continue experimenting with vegetative propagation by leaving air layering for more than the 20 weeks used in this study to achieve complete root development.

Comparative Evaluation of Two Antibiotic Pastes for Root Canal Disinfection

Aim and objectiveTo compare the efficacy of triple antibiotic paste (TAP) and double antibiotic paste (DAP) for root canal disinfection during revascularization of immature pulpless teeth.Materials and methodsA sample of 20 immature teeth in subjects aged 8–13 years was selected for a revascularization procedure. The teeth were randomly distributed in two groups corresponding to the medicament received—TAP group (n = 10) and DAP group (n = 10). Microbial samples were collected using dry paper points at the beginning of treatment and thereafter every 3 weeks till sterile reading was obtained. Microbial samples were then sent to the microbiological lab for identification.ResultsA variety of opportunistic microbes were detected in samples obtained before placement of medicaments with no significant difference between the two medicament groups. The efficacy of TAP to eliminate microbes was lower in comparison to DAP after 3 weeks of placement of medicaments, whereas it was found to be more efficacious in comparison to DAP after 6 weeks and no significant difference (p> 0.05) was observed between the two groups.ConclusionImmature permanent teeth with pulp necrosis can achieve complete root development with regenerative endodontic technique. The use of antibiotic pastes including TAP and DAP can help achieve a successful outcome with thorough decontamination of the root canal.How to cite this articleGoswami M, Baveja CP, Bhushan U, et al. Comparative Evaluation of Two Antibiotic Pastes for Root Canal Disinfection. Int J Clin Pediatr Dent 2022;15(S-1):S12-S17.

Evaluation of the root canal cross-sectional morphology in maxillary and mandibular premolars in Saudi subpopulation

Introduction: Cone-beam computed tomography (CBCT) is a recent advancement in diagnostic radiology in dentistry which allows the clinician to have a clear 3D view of the root canals before starting the endodontic treatment. The goal of the present research was to assess the root canal cross-sectional shape (RCCSS) in maxillary and mandibular premolars in the Saudi Arabian subpopulation.Materials and Methods: In the present study, radiographs of 330 patients who had teeth with complete root development and closed apices were selected. Root canal shapes were assessed at the coronal and middle thirds, and in the apical third, 1 mm above the apical foramen using CBCT. Categorical variables were explained as frequencies and percentages and evaluated using the Chi-square test.Results: 1666 premolars were evaluated in the study. Maxillary first and second premolars were found to have a maximum circular cross-sectional shape at the coronal, middle, and apical sections in most of them followed by flattened and oval cross-sectional shapes except the maxillary right second premolars where the most frequent RCCSS was flattened in the coronal section (71%), circular in the middle (14%), and apical (10%) section. The most recurring coronal RCCSS in mandibular first and second premolars was oval followed by flattened and circular, while the most frequent cross-sectional shape in the middle and apical sections was found to be circular followed by oval and flattened RCCSS.Conclusion: Marked variations were observed in the coronal and middle RCCSS of maxillary and mandibular premolars though the most prominent RCCSS in the apical section was the circular shape.

Periodontal Tissue Healing After Autologous Tooth Transplantation: A Retrospective Analysis of Case Series.

Tooth transplantation is a treatment that uses non-functional teeth to compensate for defects caused by tooth extractions. Surgical procedures have yielded high success rates in autologous tooth transplantation using a tooth with a complete root. This study aimed to evaluate periodontal tissue healing after transplantation of 14 molar teeth. Fourteen individuals aged 28-53 years who underwent autologous transplantation of third molars with completely developed roots between December 2010 and March 2017 were included in the study. The donor tooth was carefully extracted, placed into the prepared transplant site, and stabilised with an orthodontic wire and 4-0 silk sutures for a few weeks. Endodontic treatment was performed after 3-4 weeks. To evaluate the periodontal tissue healing, clinical measurements of the probing pocket depth (PPD), clinical attachment level (CAL), and keratinised gingival width (KGW) were performed, along with radiographic examinations of bone defect fill (BDF) at baseline and at 6 and 12 months after surgery. Statistical analysis was performed using the Mann-Whitney U test. The changes in PPD and CAL at baseline, 6, and 12 months were statistically significant (P <0.05). KGW did not show a statistically significant decrease. The postoperative-BDF amount at 6 and 12 months was 2.2 ± 1.4 and 4.2 ± 1.4 mm, respectively. Periodontal tissue healing may occur in tooth autotransplantation even in the presence of complete root development in the donor tooth.

Apexification of A Permanent Immature Central Incisor

Aim: To report the induction of apical root development in an open apex central incisor with necrosed pulp by calcium hydroxide Summary: A 27-year‐old female patient came to dental OPD with ache and discoloration of tooth #11 with a history of dental trauma. There was negative response on pulp sensitivity test on tooth #11. Periapical radiograph showed incomplete root formation with wide canal, divergent foramina, and fragile dentinal walls tooth #11. After giving local anesthesia on her first appointment, access was opened, working length was measured and pulp was extirpated. Chemo-mechanical debridement was done with 2.5% sodium hypochlorite solution and application of calcium hydroxide paste was placed. Access was then closed and patient was recalled for subsequent appointments. After a duration of 9-months, radiograph showed the evidence of complete root development with closure of foramina opening. Canal was filled with sealer and Gutta-Percha by thermo-chemical compaction.

Prognostic markers of post-traumatic dental external root resorption in children-a pilot study.

External inflammatory root resorption (EIRR) is a frequent complication of traumatic dental injuries (TDI). The aim of this cohort study was to identify novel non-invasive markers of post-traumatic EIRR by assessing the changes in the pulp's blood flow and the composition of gingival sulcus fluid (GCF) in children after dental trauma. Thirty-two children were enrolled and assessed within 48h of a TDI to their permanent incisors and during an additional three visits over a 6-months follow up period. During each visit, a radiograph and laser Doppler flow (LDF) measurements of the pulp blood flow were performed on the injured tooth, and the GCF was sampled. The permanent first molar tooth of the same subject served as a control for the LDF measurements and the GCF sampling. Concentrations of IL-1α in the GCF were measured using enzyme-linked immunosorbent assays. Radiographs were used to confirm EIRR. EIRR occurred in fourteen (43.8%) teeth in 32 patients. The teeth with EIRR showed diminished LDF readings when compared with controls at all visits. The LDF readings of the injured teeth continued to decrease at follow up visits. In the EIRR group, levels of IL-1α in the GCF of teeth with EIRR were increased and significantly higher than those of the control teeth at the visit when EIRR was diagnosed. The IL-1α levels were significantly higher in the EIRR group when compared to the injured teeth of patients without EIRR at the last follow-up visit. The occurrence of EIRR after mechanical trauma of permanent teeth with complete root development is accompanied by a significant reduction in the blood flow of the tooth's pulp. It is accompanied by an increase in concentrations of IL-1α in the GCF of EIRR affected teeth. The results of this pilot study identified the use of IL-1α in GCF and LDF as non-invasive markers of EIRR.

Three-dimensional analysis of the root canal preparation with Reciproc Blue\xae, WaveOne Gold\xae and XP EndoShaper\xae: a new method in vivo

BackgroundThe purpose of this study was to evaluate the changes in canal volume after root canal preparation in vivo with 3 different single-file techniques (Reciproc-Blue®, WaveOne-Gold® and XP-EndoShaper®), with a new method using CBCT and 3D reconstruction.MethodsIn this prospective study, thirty human lower premolars from healthy patients were used, in which extraction was indicated for orthodontic reasons. All the teeth used were caries- and restoration-free with complete root development, without signs of periodontal disease or traumatic occlusion, and with only one straight canal (up to 25º curvature). Teeth were randomly divided into three different groups: Reciproc-Blue, WaveOne-Gold and XP-EndoShaper. CBCT scans before root canal preparation were used to create a 3D reconstruction with RHINOCEROS 5.0 software to assess the initial canal volume, and then compared with 3D reconstructions after canal preparation to measure the increase in canal volume. Student’s t test for paired data were used to determine statistically significant differences between the before and after canal volumes. Anova test was used to determine statistically significant differences in the percentage of canal volume increase between the groups and Tukey's post-hoc test were used to paired comparison.ResultsReciproc-Blue showed the higher increase in canal volume, followed by WaveOne-Gold and XP-EndoShaper (p = 0.003). XP-EndoShaper did not show a statistically significant increase in canal volume after root canal preparation (p = 0.06).ConclusionWith this model, Reciproc-Blue showed higher increase in root canal volume, followed by WaveOne-Gold, while XP-EndoShaper did not significantly increase root canal volume during preparation.

Anatomical Evaluation of Maxillary Premolars in a Saudi Population: An In Vivo Cone-beam Computed Tomography Study

Evaluation of the root canal morphology of maxillary premolars was the primary objective of this study, on the criteria of the roots present, canals detected in the roots, and anatomical canal patterns according to Vertucci's classification observed in the Saudi population using cone-beam computed tomography (CBCT) radiographic analysis comparing them to previous reports in the same population. A total of 710 maxillary 1st and 2nd premolars were considered in this research; of which 351 were 1st premolars and 359 were 2nd premolars. These premolars were investigated for their external and internal anatomy using CBCT. Teeth with apical closure and complete root development were included in the study. Endodontically treated teeth, teeth with calcified canals or resorbed roots, as well as unclear teeth on CBCT images were excluded. Among the 351 maxillary 1st premolars, 40.7% of teeth had 1 root, 57.5% had 2 roots, and 1.7% had 3 roots. Around 93.2% of teeth had 2 canals, 3.7% had 1 canal, 2.6% had 3 canals, and 0.4% had 4 canals. According to Vertucci's classification, 63.8% of teeth had class IV configuration, 14.8% had class V configuration, 7.7% had class III configuration, and 6.8% had class II configuration. Likewise, among the maxillary second premolars, 88% of teeth had 1 root and 12% of teeth had 2 roots. Around 38.2% of teeth had a single canal while 61.0% of teeth had 2 canals, and 3 teeth were found with the extra canal (had 3 canals). More than one-third (38.2%) of teeth had Vertucci type I, 19.2% had Vertucci type IV, 15.3% had Vertucci type III, and 12.3% had Vertucci type V. Maxillary first premolars had a higher prevalence of 2 roots, whereas one root was predominant in second premolars. Most of the maxillary premolars had 2 canals with the majority having Vertucci type IV in the first premolars and type I in the second premolars. Maxillary premolars present with external and internal anatomical variations, so clinician should be aware about these varieties by taking small field of view CBCT when needed which will be of great value.

Técnica de revascularización en odontopediatría paso a paso. A propósito de un caso

Introducción: La revascularización es un procedimiento actual para dientes necróticos con ápice inmaduro; supone una opción de manejo clínico más conservador con respecto a los tratamientos tradicionales de apicoformación, en el cual, por medio de la inducción de las células madre de la papila dental periapical, se crea un sangrado dentro del conducto radicular, el cual se convierte en un coágulo estable que permite la maduración fisiológica radicular, a la vez que el engrosamiento de las paredes del conducto. El objetivo de este tratamiento es permitir un cierre completo del ápice. Caso clínico: Se presenta el caso de un niño de 7 años de edad con abceso apical en el diente 21, se realiza un tratamiento de revascularización siguiendo la técnica descrita por Hoshino (1996) de apósitos intraconducto con alguna modificación. Siguiendo la teoría descrita por Iwaya en 2001, y Banchs y Trope en 2004, el canal casose desinfecta con abundante irrigación y se rellena con una combinación de pasta bi-antibiótica. Una vez que se completa el protocolo de desinfección, el ápice se irrita mecánicamente para iniciar el sangrado en el canal y producir un coágulo sanguíneo hasta el nivel de la unión cemento-esmalte, colocando Agregado Trióxido Mineral como barrera entre el coágulo y la restauración final. En este caso, la combinación de un canal desinfectado, una matriz en la que podría crecer tejido nuevo y un sello coronal efectivo parece producir el ambiente necesario para una revascularización exitosa. Conclusiones: Bajo las circunstancias de este caso, se puede concluir que el protocolo del tratamiento seguido (regeneración apical y tapón de MTA) es un tratamiento de éxito clínico para conseguir el cierre apical en dientes inmaduros. Este éxito también dependerá de variables como el material de desinfección radicular: el Cloruro Sódico seguido de una solución salina es capaz de desinfectar los conductos sin tener que instrumentar las débiles paredes dentinarias. El uso de pasta bi-antibiótica intracanal utilizada en el caso clínico previene de la pigmentación dental que provocan las tetraciclinas cuando se utilizan en la pasta tri-antibiótica. Se necesitan revisiones de control radiográfico cada 3 meses el primer año y anualmente hasta los 4 años de realizada la revascularización, para comprobar el éxito del tratamiento. Actualmente la regeneración tisular está enfocada hacia el desarrollo de sistemas de cultivo que permitan reproducir células embrionarias hacia tejidos dentales perdidos.

Expression of early angiogenesis indicators in mature versus immature teeth

BackgroundProper oxygen balance in the dental pulp is essential for cell metabolism. Angiogenesis in the pulp is a constant process during the life of the tooth. Hypoxia indicators in a tissue, such as HIF-1α, as well as vascular destabilization markers, such as ANG2 and its receptor TIE2, are necessary for angiogenesis. Therefore the purpose of this study is to evaluate the expression of HIF-1α, ANG1, ANG2 and TIE2 in dental pulp as early angiogenesis indicators in teeth with complete and incomplete root development.MethodsForty human dental pulps were obtained from freshly extracted third molars divided into two groups: incomplete (n = 20) and complete (n = 20) root development. Dental pulps were stored at − 80 °C, defrosted in an ice bath and re-frozen with their respective thaws to disintegrate the tissue. Three sonication cycles were performed until the tissues were homogenized, then thaw were centrifuged and the supernatant was collected for the detection of the markers to be studied. The samples were processed for the ELISA test using the ELISA-sandwich principle. Student t and Mann–Whitney U tests were performed to determine statistically significant differences between groups.ResultsIn the complete root development, HIF-1α, ANG1, ANG2 and TIE2 expressions were significantly higher than their expression in the incomplete root development group.ConclusionsThe angiogenic process seems to be a physiological process in the dental pulp. Angiogenic activity is higher in teeth with mature than immature apex teeth.

Regenerative endodontic treatment options for immature permanent teeth: a case report with 21-month follow-up

The treatment of choice for necrotic teeth with incompletely formed roots is apexification with calcium hydroxide, which induces the formation of a hard tissue barrier at the apex, however, in the long term, this medicament may increase the brittleness of dentin walls because of its hygroscopic and proteolytic properties, in addition to the disadvantage of requiring multiple appointments. A treatment option for young permanent teeth with necrotic pulps is pulp regeneration, whose advantage lies in the stimulation of new tissue formation within the root canal. Pulp revascularization is based on the disinfection of the root canal system, often performed with irrigating solutions and intracanal medicaments, accompanied by induction of periapical bleeding and formation of a blood clot that will fill the root canal. The aim of this study was to present a case of avulsion of teeth 11 and 21, both with open apices, treated with replantation associated with regenerative endodontic therapy, but varying the intracanal medicaments used: calcium hydroxide in tooth 11 and double antibiotic paste in tooth 21. Pulp revascularization proved to be effective with both intracanal medicaments used, promoting symptom resolution and complete root development, including apical closure, even in the absence of a well-defined clinical

Gene expression of growth factors with angiogenic potential in human dental pulptissue from teeth with complete and incomplete root development.

To quantify the expression of angiogenic growth factors (ANG2, VEGFA, TGFß1) and their corresponding receptors (VEGFR1, VGFR2, NRP1 and TGFßR1) in human dental pulps from extracted third molars with complete and incomplete root development. Fifty-six dental pulp samples obtained from freshly extracted human third molars were divided equallyinto two groups according to their stage ofroot development; 28 third molars with complete root development and 28 third molars with incomplete root development. All samples were processed and total RNA was extracted, cDNA was then synthetized for each sample and the target genes expression profiles for ANG2, VEGFA, VEGFR1, VEGFR2, NRP1, TGFß1 and TGFßR1 were obtained by RT2-PCR. The data was analysed with a Student's t-test to compare the replicate ∆∆Ct values for each gene. Teeth with incomplete root development were associated with a significantly greater gene expression of TGFβR1 (P=0.03), whereas in teeth with complete root development the genes that had significantly greater expression were VEGFA (P=0.04). The angiogenic growth factors (ANG2, VEGFA, TGFβ1) and their receptors (NRP1, VEGFR1, VEGFR2 and TGFßR1) were expressed in pulps of teeth with complete and incomplete root development measured by RT2-PCR, with TGFBR1 genes being significantly different in teeth with incomplete root development and VEGFA genes in teeth with complete root development.

Regenerative Endodontic Procedures Using Contemporary Endodontic Materials

Calcium hydroxide apexification and Mineral Trioxide Aggregate (MTA) apexification are classical treatments for necrotic immature permanent teeth. The first tend to fail for lack of compliance given the high number of sessions needed; the second has technical difficulties such as material manipulation and overfilling. With both techniques, the root development is interrupted leaving the tooth with a fragile root structure, a poor crown-to-root ratio, periodontal breakdown, and high risk of fracture, compromising long-term prognosis of the tooth. New scientific literature has described a procedure that allows complete root development of these specific teeth. This regenerative endodontic procedure (REP) proposes the use of a combination of antimicrobials and irrigants, no canal walls instrumentation, induced apical bleeding to form a blood clot and a tight seal into the root canal to promote healing. MTA is the most used material to perform this seal, but updated guidelines advise the use of other bioactive endodontic cements that incorporate calcium and silicate in their compositions. They share most of their characteristics with MTA but claim to have fewer drawbacks with regards to manipulation and aesthetics. The purpose of the present article is to review pertinent literature and to describe the clinical procedures protocol with its variations, and their clinical application.