Conventional Root Canal Treatment Research Articles

What do we really know about vital pulp therapy?

Retrospective cohort study using STROBE cohort reporting guidelines. Patients from Mehr Dental Clinic in Tehran, Iran, who received different types of vital pulp therapy (VPT) by a single endodontist, due to carious pulpal exposure, between April 2011 and October 2022. These were: Full Pulpotomy (FP), Miniature Pulpotomy (MP) and Direct Pulp Capping (DPC). Data were accessed via the dental clinic's electronic database. Patients were deemed eligible if they had pulpal exposure due to caries, but not trauma. Pre-operative, immediate post-operative and at least one follow-up radiograph at a minimum 3-month interval were required. Demographic, diagnostic, and procedural data as well as informed consent were also required. Teeth with probing depths greater than 4 mm or pulpal necrosis were excluded. Patient, tooth and treatment factors were statistically analysed for an outcome of success or failure using a Cox proportional hazards model. Kaplan/Meier curves were used to establish the mean survival times. The Log-rank test was used to compare survival across the three treatment groups. The Omnibus test of model and the -2 log likelihood ratio (-2LL) were used to assess sensitivity and model fitness. Statistical analyses were determined using the IBM SPSS Statistics for Windows Version 21.0, with P value set at <0.05. 1257 VPTs from 1149 patients had complete data and were used in the analysis. 802 cases were excluded due to no follow up radiograph. The VPT cases were divided into FP (n = 272), MP (n = 217) and DPC (n = 768). The average follow up was 42.21 months, with an overall 116-month survival rate of 99.1% and success rate of 91.6%. FP had a mean survival time of 99.43 months; for MP it was 104.26 months; for DPC it was 102.27 months. There were no significant differences between these groups (P = 0.363). There were statistically significant correlations between symptomatic Irreversible Periodontitis (IP), radiographic signs of Apical Periodontitis (AP), restoration type, restoration surfaces and the outcome of VPT. This is one of the largest cohort studies of its kind, with over 1250 cases of various VPT techniques in 10 years. There was deviation from gold standard practice, with lack of rubber dam. A lack of haemostasis after 2 min could be construed as bacterially infected pulpal tissue and require further resection of pulp. Yet, these approaches still resulted in successful outcomes. Another interesting finding was that symptomatic IP with associated AP was treated with VPT, with a 78% success rate. Considering this study and other emerging evidence in the literature, application of VPT as an alternative to conventional Root Canal Treatment could be adopted in general practice, depending on the skills and knowledge of the practitioner and patient preferences.

Endodontic management of a maxillary first molar with three roots and six root canals

Variations in the root canal anatomy of a maxillary first molar are often challenging to diagnose and treat; thus, clinicians must have a thorough knowledge of the same. This case report highlights the successful nonsurgical endodontic management of a maxillary first molar with an unusual morphology of three roots and six root canals. A total of six root canals (mesiobuccal [MB] 1, MB2, MB3, distobuccal [DB] 1, DB2, and palatal) were detected after initiating root canal therapy and access cavity preparation. Conventional root canal treatment was completed, and postoperative cone-beam computed tomography scanning was done to verify the total number of canals and ensure the adequacy of root canal fillings. Managing such cases with rare variations in the root canal systems could be arduous and thus, clinicians should be well-versed in the methods to identify and manage such complexities to facilitate the successful outcomes of endodontic treatment.

Comparative assessment of the prognostic value of laser assisted root canal treatment and conventional root canal treatment

: Endodontics is a branch of dentistry which deals with complex architecture of dental root associated pathology, diagnosis, prevention, and treatment of dental pulp and associated periradicular tissue. The aim of this study is to conduct a comparative analysis of prognostic value of laser-assisted root canal treatment (LART) and conventional root canal treatment (RCT).: A retrospective analysis of 50 cases equally divided between Laser-assisted root canal treatment (LART) and conventional RCT, was done using Clinician-reported Outcome (ClinRo) protocol by modifying Chugal et al scoring criteria. : Statistical analysis using Mann-Whitney U tests revealed no significant correlation between gender and total treatment quality score. However, significant correlation was found between treatment modalities, and with laser assisted RCT treatment it showed a superior correlation and better prognostic results.: The radiographic analysis focused on periapical lesions and root canal filling quality. Laser-assisted RCT demonstrated a higher proportion of complete healing cases for periapical lesions and improved root canal filling quality compared to conventional RCT. : The study supports the potential benefit of laser assisted RCT in non-surgical endodontic interventions. Laser-assisted RCT showed better prognosis in terms of periapical healing and root canal filling quality when compared to conventional RCT. The study encourages further research and clinical validation to establish laser assisted RCT as a viable option in endodontic therapy.

Postoperative pain of minimally invasive root canal treatment:a randomized clinical trial.

This randomized clinical trial compared postoperative pain between a minimally invasive (MP) and conventional root canal treatment protocol (CP). A total of 170 mature permanent teeth (either with vital or necrotic pulp), were randomly assigned into two groups. In the CP group, ProTaper Gold (Dentsply Sirona, Ballaigues, Switzerland) and a continuous wave of condensation technique were used, whereas, in the MP group, TruNatomy (Dentsply Sirona), ultrasonic-assisted irrigation (UI), calcium hydroxide, and a sealer-based obturation technique were used. Patients recorded preoperative and postoperative pain using a 0-10 numerical rating scale (NRS) at 4h, 1, 2, 3, 4, 5, 6, and 7days after instrumentation and 1day after canal obturation, respectively. There were no significant differences in pain intensity at any time points assessed between the two groups (p > 0.05). The occurrence of moderate/intense pain after instrumentation was significantly associated with preoperative periapical index (PAI) (p = 0.017) and NRS scores (p < 0.001). Preoperative pulp status (p = 0.009) and NRS score (p = 0.006) were identified as significant factors in the occurrence of moderate/intense pain after obturation. Instrumentation unequivocally reduced pain severity for both groups. The post-endodontic pain associated with the use of MP, combined with UI, Ca(OH)2, and calcium-silicate cement, did not differ from that of CP. Preoperative pain score, PAI, and preoperative pulp status were determined to be prognostic factors for postoperative pain.

Comparing Patient Outcomes for Teeth Treated with Traditional Root Canal Therapy Versus Pulpotomy: A Randomized Controlled Trial

ABSTRACT Background: Root canal therapy (RCT) and pulpotomy are two common treatment modalities for managing dental pulp infections, but their comparative effectiveness in terms of patient outcomes remains unclear. This root canal therapy (RCT) aimed to assess and compare patient outcomes between teeth treated with traditional RCT and pulpotomy Materials and Methods: In this single-center RCT, a total of 120 patients presenting with symptomatic dental pulp infections were randomly assigned to either the RCT group or the pulpotomy group. The RCT group received conventional root canal treatment, which involved complete removal of infected pulp and obturation of the root canals. The pulpotomy group underwent a procedure where only the coronal pulp tissue was removed, followed by the placement of a medicament. Pain levels, infection resolution, and tooth survival were assessed at 6 months and 1 year posttreatment. Results: At the 6-month follow-up, patients in the RCT group reported significantly lower pain scores (2.5 ± 0.8) compared with the pulpotomy group (4.3 ± 1.2, P &lt; 0.001). Infection resolution was also higher in the RCT group (92%) compared with the pulpotomy group (78%) at 6 months. Tooth survival rates at 1 year were significantly higher in the RCT group (95%) compared with the pulpotomy group (81%, P &lt; 0.05) Conclusion: This RCT demonstrates that traditional RCT is superior to pulpotomy in terms of pain reduction, infection resolution, and tooth survival. Patients who underwent RCT experienced less pain, faster infection resolution, and better tooth survival rates compared with those who received pulpotomy. These findings support the use of RCT as the preferred treatment modality for dental pulp infections.

An in-vitro comparison of bond strength of three different root end filling materials with Universal testing machine

Bacterial infection is widely known cause of apical periodontitis. Failure of conventional root canal treatment indicates the periapical surgery, this procedure requires root end resection. For the long term success of periapical surgery, root end filling materials are used. To compare the push-out bond strength of Portland cement, ProRoot MTA and Biodentine used as root-end filling materials using Universal Testing Machine. From the middle part of each root, three dentinal slices were made to produce 93 slices which were divided into 3 groups. In Group A: ProRoot MTA, In Group B: Biodentine and In group C: Portland cement were used and were further divided in subgroups based on soaking time in PBS solution i.e. 24hrs and 7 days before assessing the push out bond strength using Universal Testing Machine. The mode of bond failure of material to root dentin was analyzed using microscope. Data was analyzed using ANOVA and post-hoc tukey’s test. After 24hrs, there was statistically non-significant difference but After 7 days, ProRoot MTA showed significantly higher bond strength as compared to other tested groups. While analyzing the mode of bond failure, ProRoot MTA had adhesive failure, Biodentine had cohesive failure and Portland cement had mixed type of bond failure. All the tested materials showed comparable bond strength but ProRoot MTA had highest bond strength to root dentin among the other tested materials.

Assessment of Quality and Readability of Online Patient-Centered Arabic Web-Based Knowledge About Apicoectomy.

Background Endodontic microsurgery (apicectomy) can be considered in cases of persistent infection that is resistant to conventional root canal treatment. The aim of this study was to evaluate the quality and readability of the available online information regarding the apicectomy procedure in Arabic. Methods Online search on the three most commonly used websites (Google, Yahoo, and Bing) using one keyword. The first 100 websites from each search were analyzed for quality and readability using DISCERN instrument scores, the Journal of the American Medical Association (JAMA) benchmarks, the Health On the Net (HON) seal, Flesch Reading Ease Scores (FRES), Flesch-Kincaid Grade Level (FKGL), and the Simplified Measure of Gobbledygook (SMOG) Index. Results Searching using the Arabic translation for "root end resection surgery" revealed 349,900 websites. Following the inclusion criteria, 31 websites were selected and evaluated in this study. The selected websites belonged to either non-profit organizations or commercial websites. The quality of most of the selected websites received a moderate score (83.9%) using the DISCERN tool. None of the selected websites obtained the HON seal. Quality evaluation using the JAMA benchmarks revealed that currency was the most achieved item (45.2%), followed by authorship (22.6%). Evaluation of the readability of the selected websites using the FRES, FKGL, and SMOG showed that the included websites were considered readable. Conclusion Although the included websites were readable, the quality of the websites was moderate. There is an urgent need to create more trustworthy and readable websites explaining the different endodontic treatments.

Pulpotomy: An alternative treatment modality to conventional root canal treatment

Vital pulp therapy is considered a successful treatment modality in primary and immature permanent teeth. The development of bioactive material has led to vital pulp therapy and pulpotomy treatment becoming a popular treatment modality in permanent teeth. This literature review investigates pulpotomy procedures on permanent teeth as a viable option, as opposed to conventional root canal treatment, as presented in the case report included.Aim The aim of this study is to evaluate literature on the reported success of pulpotomy treatment in mature permanent teeth. For this reason, the study specifically reviewed literature detailing the use of pulpotomies including the materials required for the procedure.MethodThe literature review is focused on studies using MTA and bioactive alternatives as pulpotomy material. An electronic search was done on EBSCOhost to source 58 articles published from 1979 to 2022. Results Literature investigated reports that pulpotomy treatment with bioactive materials shows promising results and therefore the possibility exists of it being a suitable treatment option or alternative to conventional root canal treatment.

How to Manage FAN’S C Shape Canals along with S Shape Morphology in Indian Population: A Case Series and Narrative Review

The C-shaped root canals offer greater negotiation, debridement, and obturation difficulty as they present with intercommunications, lateral canals, and reduced dentin thickness. Objective: This case series elaborates on the recognition that these varying configurations is important to enhance adequate cleaning, shaping, and sealing of the root canal. Case Reports: On clinical examination, all the teeth showed caries were nonresponsive to sensibility tests and toother diagnostic tests, suggestive of pulp necrosis with apical periodontitis. Conventional root canal treatment with different techniques and obturation systems have been used. This case series presents the successful management of various C-shaped configurations classified by Fan et al. and emphasizes the different treatment approaches for effective therapy. The cleaning and shaping process should always follow the canal anatomy to maintain the canal shape at the same point the primary and secondary curvatures and thin interconnections are negotiated, prepared, and sealed. Conclusion: The morphological variation existence and their different types and management should be known for improved healing and enhanced success of root canal treatment.

Fracture Strength of Endocrowns Fabricated From Three Different Computer-Aided Design/Computer-Aided Manufacturing Ceramic Materials: An In-Vitro Study.

Endocrown restorations have increased in popularity in recent years due to the advancement of both adhesive and restorative materials. The clinical success of endocrowns depends on several factors, including preparation design, material selection, fracture resistance, and marginal adaptation. The aim of this in vitro study was to compare the fracture strength of endocrown restorations fabricated from three different computer-aided design (CAD)/computer-aided manufacturing (CAM) materials. Thirty extracted mandibular first molars were selected. The teeth underwent conventional root canal treatment before being prepared for endocrown restoration. The teeth were allocated to three groups (n=10), corresponding to each of the three ceramic materials used to fabricate the endocrowns they would receive. The ceramic materials used were zirconia-reinforced lithium silicate glass-ceramic (VITA Suprinity, VITA Zahnfabrik, Bad Säckingen, Germany), polymer-infiltrated hybrid ceramic (VITA Enamic, VITA Zahnfabrik, Bad Säckingen, Germany), and lithium disilicate glass-ceramic (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein). The specimens were scanned, and the digital impressions were transferred into design software to construct the endocrowns. The endocrowns were then milled and cemented. A universal testing machine (5969L3504, Instron, USA) was used for the fracture strength test at a crosshead speed of 1 mm/min until catastrophic failure occurred. Statistical analysis was performed using IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. The one-way analysis of the variance test indicated a significant difference in the fracture strength between the different ceramic groups tested (P=0.037). The Tukey posthoc test showed that the IPS e.max CAD group had marginally higher fracture strength values than the VITA Enamic group (P=055). No significant differences in fracture strength values were found between the VITA Enamic and VITA Suprinity groups or between the VITA Suprinity and IPS e.max CAD groups (P>0.05). The reported fracture strength values for all the tested materials were higher than the strength required to resist masticatory forces. Therefore, endocrowns fabricated using VITA Enamic, IPS e.max CAD, and VITA Suprinity CAD/CAM materials present restorations with a clinically acceptable fracture strength.

Comparison and Evaluation of Effect of Low Level Laser Therapy (LLLT) with Intracanal Medicament on Periapical Healing.

Photobiomodulation (PBM), also commonly referred to as low-level laser therapy (LLLT), uses light energy to elicit biological responses from the cell and normalize cell function. 40 persons with periapical lesions were selected and were assigned randomly into two groups.Group I - Conventional root canal therapy and low-level laser therapy. Group II - Conventional root canal therapy Root canal therapy was completed, and radiographs were obtained and assessed 3, 6, and 9 months postoperative. VAS pain scale was assessed postoperatively on 0, 7th, and 14th days respectively. An independent t-test was used for the evaluation of the data. No significant difference was noted for postoperative pain and PAI scale between both groups Significant difference was noted in the reduction of the periapical lesions for 3 and 9 months follow up, but was not significant for 6 months. The healing was better in Group I which received Low-level laser therapy with the conventional root canal treatment. Low-level laser therapy can be the newer additional treatment modality that can be applied to the periapical lesion for its faster healing.

Periapical Pocket Cyst of Anterior Maxilla: A Case Report

Periapical cyst is an inflammatory odontogenic cyst of endodontic origin. It presents either as an epithelium lined closed pathological cavity (then it is called periapical true cyst) or the epithelium lined cavity is continuous with the root canal of the affected tooth (periapical pocket cyst). The treatment of choice for the majority of the periapical cysts is conventional root canal treatment. However large, true cysts respond less favorably to non-surgical treatment. We present a case of a 20 years old female patient who had a swelling in the upper lip region. A provisional diagnosis of periapical cyst was arrived at considering the clinical and radiographic features. Intra-operatively, the cyst was continuous with the root canal. Histopathological examination was done.

Dens Evaginatus of Bilateral Permanent Mandibular Premolars with Pulpal Involvement: A Case Report

Dens evaginatus (DE) is a rare developmental anomaly resulting in an extra cusp in teeth. This odontogenic malformation occurs during morphodifferentiation before the mineralization of hard tissue. We report an interesting case of an 11-yearold Asian boy who presented with acute pain and tooth mobility on permanent mandibular premolars due to bilateral DE. Radiographic evaluation revealed acute periapical radiolucency indicative of an abscess. Permanent mandibular right first premolar (an immature apex tooth) was treated with apexification while permanent mandibular left second premolar (a mature apex tooth) was treated with conventional root canal treatment. The differential treatments based on the degree of root formation led to favorable outcomes of preserving the teeth. Appropriate DE diagnosis is vital to timely treatments and positive prognosis while avoiding unnecessary extractions.

Prevalence of Periapical Radiolucency and Conventional Root Canal Treatment in Adults: A Systematic Review of Cross-Sectional Studies.

Cross-sectional studies assess a population's health state and the prevalence of diseases or treatments. Few systematic reviews regarding the prevalence of periapical radiolucency (PARL) and nonsurgical root canal treatment (NSRCT) were conducted in the last decade. The goal of this study was to collect and review all updated and available cross-sectional studies that focus on the prevalence of both PARL and NSRCT in adult populations. It involves a systematic literature review of cross-sectional studies on the prevalence of PARL and NSRCT published from 1987 to 2022 in PubMed, Google Scholar, Web of Science, and Scopus with specific keywords used in the search process. A total of 52 articles were included in this systematic review. The majority of the included articles were from different populations. The overall prevalence of teeth with PARL was 43,522 (6.40%), while the prevalence of NSRCT teeth was 52,149 (7.67%). On the other hand, the overall prevalence of PARL in teeth that have received endodontic treatment and teeth that have not received endodontic treatment were 22,110 (3.25%) and 21,412 (3.15%), respectively. A meta-analysis was not performed due to underreporting of publication bias and the high degree of heterogeneity between studies. The overall risk of bias assessment revealed a low risk of bias in 25 (48%) of the included studies. The prevalence of NSRCT was higher at 7.67%, followed by PARL at approximately 6.40%. However, future studies are recommended to investigate the prevalence of both PARL and NSRCT in different patient populations.

Conventional root canal treatment of a mandibular second premolar with three roots and three canals performed by an undergraduate student: A case report with 8-year follow-up

Abstract In developing countries, such as Sudan, there is a lack of advanced endodontic technologies and specialized endodontists. Therefore, challenging endodontic cases are inevitability encountered by undergraduate students and general dental practitioners. Their ability to manage such cases can significantly impact the decision of whether a tooth is saved or extracted. Here, we report the case of a 24-year-old male patient who presented to our clinic with pain in the mandibular second premolar. Tooth #45 had caries and was tender to vertical percussion. An intraoral periapical radiograph (IOPR) revealed a wide periodontal ligament space and thickened lamina dura, with the deep occluso-distal decay reaching the pulp space. A radiograph obtained using the tube shift technique revealed the presence of three distinct roots and canals. The patient was diagnosed with symptomatic irreversible pulpitis and apical periodontitis. His root canal treatment (RCT) was performed by a 5th-year undergraduate student using the conventional radiography technique, hand file instruments, and lateral condensation obturation. At the 8-year follow-up visit, the tooth crown was lost, the patient was asymptomatic, and the IOPR revealed normal periapical bone. This case demonstrates the importance of training undergraduate students from developing countries to perform RCT for challenging endodontic cases using conventional techniques.

Endodontic Management of An Unusual Mandibular First Molar with Six Canals: A Case Report and Systematic Review

The permanent mandibular first molar is frequently involved in conventional root canal treatment due to its function and position in the oral cavity. Additional root canals mandate accurate diagnosis and conservative management to prevent any procedural errors. The first independent middle mesial canal incidence was verified in mandibular molars in 1974, with a global incidence of 10.8–27.0%. Reporting of the middle distal canal in the endodontic literature is scarce, with an incidence of 0.2–3%. The present case report describes the endodontic management of an unusual permanent mandibular first molar with three canals in the mesial and distal roots, diagnosed with irreversible pulpitis and apical periodontitis. A dental operating microscope and multiple angulated radiographs were used to identify the unusual morphology, and this was confirmed with cone-beam computed tomography imaging. The access cavity was modified to a trapezoidal shape, and the pulp chamber was carefully explored following root dentinal maps to expose additional canals by ultrasonic troughing. Incorporating a dental operating microscope and cone-beam computed tomography imaging in routine endodontic cases facilitates a better understanding and visualization of the complex root canal anatomy, making even the management of endodontically challenging cases more predictable.

USAGE OF CHLORHEXIDINE AS A FINAL IRRIGANT IN ONE-VISIT ROOT CANAL TREATMENT IN COMPARISON WITH CONVENTIONAL TWO-VISIT ROOT CANAL TREATMENT IN MANDIBULAR MOLARS: A RANDOMIZED CLINICAL TRIAL

The effectiveness of 1-visit root canal treatment (RCT), especially for teeth with large periapical lesions, are still being debated. Although, the use of chlorhexidine (CHX) as a final irrigant have been recommended to provide an optimized approach in 1-visit RCT, there is limited knowledge about the outcome of 1-visit RCT using CHX as the final irrigant. The aim of this randomized clinical trial was to evaluate the healing of mandibular molar teeth with large periapical lesions after RCT that was completed in 1 visit using 2% CHX as a final irrigant, comparing the results with a conventional 2-visit RCT as a control group. This study is a prospective, parallel-designed, and single-blinded randomized clinical trial. One-hundred asymptomatic mandibular molar teeth with large periapical lesions were randomly assigned to 2 groups. All teeth were instrumented with Reciproc files with 2.5% sodium hypochloride (NaOCl) and 5% ethylenediaminetetraacetic acid (EDTA) as irrigants. In the intervention group, half of the teeth were treated in 1 visit, receiving an additional final rinse with 2% CHX before obturation; the other half of the teeth, however, were treated in 2 visits with calcium hydroxide (CH) dressings, in the control group. All root canals were obturated with Reciproc gutta-percha cones and AH Plus root canal sealer. All patients were recalled and investigated clinically and radiographically for 48 months. Periapical healing was evaluated statistically using the Mann-Whitney U test, followed by the Friedman and the Wilcoxon tests (α = 0.05). During the 48-month follow-up process, 86 teeth (44 in 1-visit and 42 in 2-visit group) were examined. There were no significant differences between the 2 groups regarding the radiographic healing rates (1-visit group 91% and 2-visit group 88%) (P > .05). In this study, 1-visit RCT using 2% CHX as final irrigant in asymptomatic mandibular molars with large periapical lesions produced favorable healing results, similar to 2-visit root canal treatment with calcium hydroxide.

Review of guidance for the selection of regenerative endodontics, apexogenesis, apexification, pulpotomy, and other endodontic treatments for immature permanent teeth.

This review guidance is a work in progress because the limitations of regenerative endodontics are still being discovered. The endodontic treatments for immature permanent teeth with a necrotic pulp can vary considerably among endodontic practitioners. Whereas, regenerative endodontic treatments are growing in popularity and are creating ever more complex treatment protocols, involving revascularization and/or autologous platelet-rich plasma and scaffolds to elicit host stem cell de novo tissue formation to reestablish the vitality of immature teeth for the purpose of continuing root maturation. Despite much evolving controversy about their potential benefits, risks, prognosis, and contraindications, this review is aimed to discuss how to ensure that regenerative endodontic treatments are successful, by strictly adhering to case selection criteria, and following precise steps to accomplish and monitor the success of the treatment. A review of the endodontic literature was performed, together with practical observations of the problems and outcomes of performing regenerative endodontic treatments. Traditionally, apexification has long been the treatment of choice provided to immature teeth with a necrotic pulp. Regenerative endodontics may be provided as an alternative to apexification, if the tooth and patient meet all the case selection criteria, and if there are no contraindications. Regenerative endodontics has the unique potential advantage of being able to continue the root development in immature permanent teeth, thereby potentially saving the teeth for the lifetime of the patient. Whereas, conventional endodontic root canal treatment, Cvek partial pulpotomy, apexogenesis, and apexification, should always be provided when these treatments are more likely to benefit the patient because they can be more successful than regenerative endodontics.

Assessment of outcome of regenerative endodontics for treatment of periapical lesions

Background: Three key elements are essential for performing REPs: stem cells, scaffolds, and activators. The present study was conducted to assess outcome of regenerative endodontics for treatment of periapical lesions. Materials &amp; Methods: 40 patients with mature incisors, canines, or mandibular premolars showing pulp necrosis and apical periodontitis were divided into group I (REP) and conventional root canal treatment (ENDO) group II. Calcium hydroxide medication was used, and the cavity was sealed. 3 weeks later, patients were treated following their assigned protocol of ENDO or REP. Clinical follow-up examinations were performed at 6 months and 12 months. Results: At 6 months, success was seen in 20 teeth in group I and 18 in group II and failure in 2 in group II. At 12 months, success was seen in 20 in each group. The mean height (mm) at 6 months was 2.5 and 2.8 in group I and II, at 12 months was 1.6 and 1.9. Anterior-posterior dimension at 6 months was 2.6 and 2.7 and at 12 months was 1.8 and 2.2. Mesiodistal dimension at 6 months was 3.1 and 2.5 and at 12 months was 1.8 and 2.1 in group I and II respectively.

Multidisciplinary treatment of complicated coronary root fracture: case report

Treatment of trauma to anterior teeth should aim at preserving the affected teeth so as to restore function and esthetic appearance. The management of coronary root fracture is complex and requires a multidisciplinary approach in which various specialties must coordinate to achieve the desired result. This report describes the treatment of a deep crown–root fracture compromising the pulp and extended subgingivally on the buccal aspect. A 57-year-old man presented with pain and mobility in his left maxillary lateral incisor which experienced fall trauma. After using the fractured fragment as a provisional crown, the patient received conventional root canal treatment and a challenger orthodontic extrusion followed by rehabilitation with a postcore- supported prosthetic restoration. A 4-year follow up showed the absence of clinical symptoms and mobility and re-establishment of the periodontal space with satisfactory esthetic results.