Conventional Root Canal Treatment Research Articles

Management of extraoral sinus via nonsurgical root canal treatment

Cutaneous sinus tracts of dental origin have been well-documented in the medical literature. However, these lesions continue to be a diagnostic dilemma. A review of several reported cases reveals that patients have had multiple surgical excisions, radiotherapy, multiple biopsies, and multiple antibiotic regimens, all of which have failed, with a recurrence of the cutaneous sinus tract, as the primary etiology was dental that was never correctly diagnosed or addressed. This case report demonstrates the healing of an extraoral draining sinus by means of conventional nonsurgical root canal treatment.

The Influence of Adalimumab on the Healing of Apical Periodontitis in Ferrets

IntroductionGiven the increasing use of anti–tumor necrosis factor α (anti-TNFα) biologic medications, and their interferences with the immune-inflammatory response, this study evaluated the effect of adalimumab (anti-TNFα), on healing and healing time of apical periodontitis (AP) in ferrets. MethodsTwelve male ferrets received cone beam computed tomography of the jaws at baseline health (T0); AP confirmation (T1); and 30 (T2), 60 (T3), and 90 (T4) days after root canal treatment (RCT) to monitor healing. All animals had AP induced in the canines; 3 ferrets (12 teeth) provided the positive controls for the histologic evaluation; 9 ferrets were randomly divided into 3 treatment groups with 12 teeth each in the following manner: Systemic: conventional RCT and systemic anti-TNFα; Local: RCT and periapical administration of anti-TNFα before canal obturation; conventional RCT only (control). Two calibrated radiologists assessed the cone beam computed tomography images independently and blindly for AP identification and quantification. Rank-based analysis of covariance was used for statistical analysis of lesion size. ResultsAP was induced in all teeth. Following RCT, all AP lesions in the 3 groups showed a significant reduction in size. Specific pairwise comparisons of the related samples (Friedman's 2-way analysis of variance by ranks within each group) demonstrated a decreasing trend in lesion size with healing time in all 3 groups, most pronounced for local group (local adalimumab). No statistical difference was noticed between groups. ConclusionsBoth systemic and local anti-TNFα did not hinder AP healing in this animal model and a faster healing response may also be anticipated. These findings encourage follow-up studies with larger sample sizes.

Success Rate of Root Canal Treatment by Conventional Root Canal Therapy Without Using Intracanal Medicament in Infected Canals

Background: Root canal system, when becomes infected is managed by thorough debridement and specific shaping of the root canal. It is to be followed by a specific type of filling. The ultimate goal of these approaches is to create an environment in which the body’s immune system can produce healing of the apical periodontal attachment apparatus. Thorough debridement and shaping are carried out usually by biomechanical preparation of root canal system along with intracranial medicament. The use of intracanal medicaments is still debatable. This study was designed to evaluate the usefulness of root canal treatment without using any biomedical preparation.Methods: The study was carried out in the Department of Conservative Dentistry and Endodontics, BSMMU, Dhaka July 2003 to July 2004. In the present study, 36 cases of endodontically involved infected teeth were treated by conventional root canal treatment without using intracanal medicaments and patients were followed up at 6 and 12 months after root canal treatment.Results: At 6 and 12 months follow up, an overall treatment success was revealed in clinical and radiological findings.Conclusion: It is the biomechanical preparation of the canal which decides the success rate of root canal treatment of infected teeth, not the use or nonuse of intracanal medicament.Birdem Med J 2017; 7(3): 221-223

Treatment Options for Failing Regenerative Endodontic Procedures: Report of 3 Cases

IntroductionRegenerative treatments in necrotic immature teeth are suggested as alternatives to conventional multiple or single-step apexification procedures. Although case reports and case series provide promising results, the treatment protocol is not yet fully established and regenerative procedure might fail. Once failure is encountered, the apexification treatment options still remain. MethodsRepetition of the regenerative procedure after initial revitalization failure has not been suggested yet. Here, 3 cases of failing regenerative endodontic procedures are reported. All 3 cases had been initially treated by single-step disinfection/revascularization procedures. In different time intervals, all cases showed signs of recurrent disease. The first case was managed with renegotiation and apical mineral trioxide aggregate plug placement; the second case was managed with renegotiation and conventional root canal treatment; and the third case was managed with renegotiation, long-term calcium hydroxide disinfection, and repetition of the regenerative endodontic procedure. ResultsTwo years after the second intervention, all cases were considered successful. ConclusionsRepetition of failed regenerative treatment procedures might be a viable alternative to conventional apexification procedures.

Decellularized Human Dental Pulp as a Scaffold for Regenerative Endodontics

Teeth undergo postnatal organogenesis relatively late in life and only complete full maturation a few years after the crown first erupts in the oral cavity. At this stage, development can be arrested if the tooth organ is damaged by either trauma or caries. Regenerative endodontic procedures (REPs) are a treatment alternative to conventional root canal treatment for immature teeth. These procedures rely on the transfer of apically positioned stem cells, including stem cells of the apical papilla (SCAP), into the root canal system. Although clinical success has been reported for these procedures, the predictability of expected outcomes and the organization of the newly formed tissues are affected by the lack of an available suitable scaffold that mimics the complexity of the dental pulp extracellular matrix (ECM). In this study, we evaluated 3 methods of decellularization of human dental pulp to be used as a potential autograft scaffold. Tooth slices of human healthy extracted third molars were decellularized by 3 different methods. One of the methods generated the maximum observed decellularization with minimal impact on the ECM composition and organization. Furthermore, recellularization of the scaffold supported the proliferation of SCAP throughout the scaffold with differentiation into odontoblast-like cells near the dentinal walls. Thus, this study reports that human dental pulp from healthy extracted teeth can be successfully decellularized, and the resulting scaffold supports the proliferation and differentiation of SCAP. The future application of this form of an autograft in REPs can fulfill a yet unmet need for a suitable scaffold, potentially improving clinical outcomes and ultimately promoting the survival and function of teeth with otherwise poor prognosis.

Management of Internal Resorption: A Catch-22 Situation

ABSTRACT Internal resorption (IR), a rare phenomenon, is considered to be a catch-22 situation from the standpoints of both its diagnosis and treatment. It begins initially in the pulpal space and extends into the surrounding dentin. Its diagnosis and management have been a challenge to dental practitioners. Due to its insidious pathology, IR can progress to a great extent before its detection. It is usually asymptomatic and discovered by chance on routine radiographic examinations or by a classic clinical sign, “pink spot” in the crown. The treatment of this condition should be initiated as soon as possible to prevent further loss of hard tissue or an eventual root perforation. The resorption, if progressed to involve an external communication, has poor prognosis, and the tooth cannot be retained in most cases, and hence, extraction of the tooth is indicated. In modern dentistry, patients demand more than restoration of function; they are particular about the esthetics as well, especially in the anterior region. Once the proper diagnosis is made, the treatment modality should include steps taken to conserve the tooth structure as much as possible to restore tooth form, function, and esthetics. This case report describes the management of an IR of a maxillary central incisor that was treated nonsurgically with conventional root canal treatment followed by reinforcing the tooth with esthetic fiber post and conserving the natural tooth as such. A 9-month follow-up demonstrated clinically asymptomatic and adequately functional tooth, with radiographic signs of healing. In this case report, care was taken to conserve the tooth structure and avoid further weakening of the already compromised tooth. A tooth deemed having questionable prognosis was preserved intact and showed satisfactory healing with no progression of the resorptive defect. How to cite this article Karanath SAK, Geeta IB, James JM. Management of Internal Resorption: A Catch-22 Situation. J Oper Dent Endod 2017;2(1):31-35.

Study of effect of Qingwei-Sanhuo decoction combined with routine root canal plus antibiotic therapy on the patients with periodontal-endodontic lesions

Objective To evaluate the effect of Qingwei-Sanhuo decoction combined with routine root canal plus antibiotic therapy for the periodontal and pulpal lesions. Methods A total of 168 patients with periodontal - pulpal disease were randomly divided into two groups, 84 patients in each group. The control group was treated with conventional root canal plus antibiotic anti-inflammatory treatment. The observation group was treated with Qingwei-Sanhuo decoction based on the control group. Both groups were treated 30 days. The changes of gingival index (GI), plaque index (PLI), probing depth (PD) and sulcular bleeding index (SBI) were assessed. Results The total effect rate was 96.4% (81/84) in the observation group and 78.6% (66/84) in the control group. There was significant difference between the two groups (χ2=26.435, P=0.014). After treatment, the PD (3.29 ± 0.76 mm vs. 4.95 ± 1.02 mm, t=3.796), GI (1.02 ± 0.31 vs.1.96 ± 0.63, t=2.983), SBI (3.62 ± 0.89 vs. 4.66 ± 1.01, t=3.424), PLI (2.23 ± 0.42 vs. 3.88 ± 0.81, t=6.897) in the observation group were significantly lower than those in the control group (P<0.05). Conclusions The Qingwei-Sanhuo decoction combined with routine root canal plus antibiotic therapy can reduce the periodontal index of patients with periodontal - pulp disease, and improve the clinical curative effect. Key words: Periodontal diseases; Dental pulp diseases; Qingwei-Sanhuo decoction; Root canal therapy; Antibiotic therapy

Clinical and Radiographic Evaluation of Mineral Trioxide Aggregate Pulpotomy in Permanent Teeth

Abstract Aim and objective: The aim of the present study was to evaluate clinical and radiographic outcome of MTA as a pulpotomy agent in permanent teeth as an alternative to conventional root canal treatment. Materials and Methods: Ten permanent teeth with symptoms of irreversible pulpitis with vital pulp were selected for the study. MTAPulpotomy procedure was done in all the cases using standard protocol. Teeth were evaluated for various clinical and radiographic parameters at 3, 6, 9 and 12 months of follow up. Results: None of the patients reported any kind of clinical discomfort or radiographic abnormality during the follow up period of 3, 6, 9 and 12 months. All the teeth responded positive on electric pulp test at all successive follow ups. Conclusions: MTA Pulpotomy may be used as an alternative treatment modality to root canal treatment in permanent teeth with irreversible pulpitis, if future research continues to show promising results.

Non-surgical Management of Endodontic Periradicular Pathosis - A Clinical Research

Background: In most cases the aetiological factors of periradicular diseases are oral contaminants through the root canal or degenerating pulpal tissues. Therefore, the mere surgical removal of the periapical lesions without proper root canal disinfection and obturation will not result in the healing of the periradicular tissues. On the other hand, traditional surgical technique rather fearful and troublesome job due to various reasons. So successful apical and periapical repair depends on conventional root canal treatment - a non surgical procedure. Crucial to this management and ultimate success is the complete debridement of the root canal system, followed by three-dimensional obturation to seal both the apical foramen and coronal orifice. Objective: Thus, the purpose of this study was to clinically verify the possibility of management of periradicular pathosis by non-surgical conventional root canal therapy. Methods: The present study was a prospective observational study carried out in the department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka. Here, 75 cases of eondodontically involved symptomatic non-vital teeth having periradicular pathosis were managed by conventional root canal therapy. Result: After 18 months follow up with post operative clinical and radiological evaluations, in this study the final outcome was favourable-88%, doubtful-08 %, and failure-04%. Key words: Endodontics; Periarticular pathosisDOI: 10.3329/bsmmuj.v1i1.3694 BSMMU J 2008; 1(1): 22-28

Effects of Stem Cell Factor on Cell Homing During Functional Pulp Regeneration in Human Immature Teeth.

Conventional root canal treatment in immature permanent teeth can lead to early tooth loss in children because root formation is discontinued. We investigated whether the stem cell factor (SCF) could facilitate cell homing in the pulpless immature root canal and promote regeneration of a functional pulp. In vitro, human mesenchymal stem cells (hMSCs) were exposed to SCF at various concentrations for assessing cell migration, proliferation, and differentiation toward odonto/osteoblasts by 3D-chemotaxis slides, WST-1 assay, and alkaline phosphatase activity, respectively. Fibrin gels were used to deliver 15 μg/mL SCF for in vivo experiments. The release kinetic of SCF was assessed in vitro. Two corresponding human immature premolars, with or without SCF, were placed at rat calvariae for 6 and 12 weeks. All tooth specimens were either analyzed histologically and the percentage of tissue ingrowth determined or the cells were extracted from the pulp space, and the mRNA level of DMP1, DSPP, Col1, NGF, and VEGF were assessed by quantitative polymerase chain reaction. In the presence of SCF, we saw an increase in hMSCs directional migration, proliferation, and odonto/osteogenic differentiation. SCF also increased the extent of tissue ingrowth at 6 weeks but not at 12 weeks. However, at this time point, the formed tissue appeared more mature in samples with SCF. In terms of gene transcription, DMP1, Col1, and VEGF were the significantly upregulated genes, while DSPP and NGF were not affected. Our results suggest that SCF can accelerate cell homing and the maturation of the pulp-dentin complex in human immature teeth.

Esthetic Restoration of Complicated Crown-Root Fractures Utilizing Orthodontic Extrusion

Complicated crown-root fracture of permanent incisors cause esthetic, functional, and psychological problems to patients. Therefore, treatment is important and multidisciplinary treatment is required. This case report describes the clinical procedures involved in the treatment of trauma-induced complicated crown-root fractures in the maxillary incisor of two young patients. Conventional root canal treatment and apexification were performed in each patient. To expose the fracture margins to the supragingival level and to reestablish the biologic width, orthodontic extrusions with fixed appliances were performed followed by a retention period. During the retention period, fiber-optic posts and cores were built up and provisional crowns were placed. Finally, ceramic crowns manufactured using a computer-aided design/computer-aided manufacturing (CAD/CAM) system were placed. In both patients, the teeth presented satisfactory functional and esthetic outcomes without relapse. The periodontal tissues were healthy.

Nonsurgical Endodontic Management of a Molar-Incisor Malformation-affected Mandibular First Molar: A Case Report

A molar-incisor malformation (MIM) is a newly reported type of dental anomaly that involves a characteristic root malformation in permanent first molars and deciduous second molars and a crown defect in permanent central incisors. This case report describes a nonsurgical root canal treatment of a MIM-affected molar by aid of a reformatted axial view of the tooth cone-beam computed tomography (CBCT). A MIM-affected molar has calcified canal orifices and a few immature accessory furcal canals. Conventional root canal treatment with the aid of CBCT followed by resin restoration was performed on the tooth. The malformed roots of MIM teeth generally make it difficult to apply conventional endodontic treatment; however, it was possible to do with the aid of the reformatted axial view of the CBCT.

Incidence of postoperative pain after use of calcium hydroxide mixed with normal saline or 0.2% chlorhexidine digluconate as intracanal medicament in the treatment of apical periodontitis.

ObjectiveTo compare the incidence of postoperative pain after the use of calcium hydroxide powder mixed with normal saline or 0.2% chlorhexidine digluconate as intracanal medicament.ParticipantsFifty-five subjects aged 17–60 years with teeth diagnosed to have apical periodontitis.InterventionTwo-visit conventional root canal treatment of seventy teeth. The teeth were divided by randomization (balloting) into two groups: control group and experimental group, each with thirty-five teeth treated with calcium hydroxide mixed with normal saline or with 0.2% chlorhexidine digluconate as intracanal medicament respectively. Incidence of postoperative pain was assessed using the universal pain assessment tool and whether or not analgesic was taken.Main outcome measuredIncidence of post-operative pain.ResultPostoperative pain occurred only at 1-day and 1-week reviews. In the control group, the overall incidence of pain was the same at both review periods (5.7%), while the experimental group showed a slight decrease in incidence between 1-day (17.2%) and 1-week (11.4%) reviews. Incidence of flare-ups was more in the experimental group (11.4%) than in the control group (5.7%). No significant statistical differences between the two groups were observed (p > 0.05).ConclusionThe incidence of postoperative pain was lower in the normal saline treatment group, but the difference was not statistically significant.

Stem Cell Transplantation for Pulpal Regeneration: A Systematic Review.

For treating pulpal pathological conditions, pulpal regeneration through transplanted stem/progenitor cells might be an alternative to conventional root canal treatment. A number of animal studies demonstrated beneficial effects of stem/progenitor cell transplantation for pulp-dentin complex regeneration, that is, pulpal tissue, neural, vascular, and dentinal regeneration. We systematically reviewed animal studies investigating stem/progenitor cell-mediated pulp-dentin complex regeneration. Studies quantitatively comparing pulp-dentin complex regeneration after transplantation of stem/progenitor cells versus no stem/progenitor cell transplantation controls in intraoral in vivo teeth animal models were analyzed. The following outcomes were investigated: regenerated pulp area per root canal total area, capillaries per total surface, regenerated dentinal area per total defect area, and nerves per total surface. PubMed and EMBASE were screened for studies published until July 2014. Cross-referencing and hand searching were used to identify further articles. Standardized mean differences (SMD) and 95% confidence intervals (95% CI) were calculated using random-effects meta-analysis. To assess possible bias, SYRCLE's risk of bias tool for animal studies was used. From 1364 screened articles, five studies (representing 64 animals) were included in the quantitative analysis. Risk of bias of all studies was high. Stem/progenitor cell-transplanted pulps showed significantly larger regenerated pulp area per root canal total area (SMD [95% CI]: 2.28 [0.35-4.21]) and regenerated dentin area per root canal total area (SMD: 6.91 [5.39-8.43]) compared with no stem/progenitor cell transplantation controls. Only one study reported on capillaries per or nerves per total surface and found both significantly increased in stem/progenitor cell-transplanted pulps compared with controls. Stem/progenitor cell transplantation seems to enhance pulp-dentin complex regeneration in animal models. Due to limited data quantity and quality, current evidence levels are insufficient for further conclusions.

Influence of Root Canal Disinfectants on Growth Factor Release from Dentin

IntroductionDuring dentinogenesis, growth factors become entrapped in the dentin matrix that can later be released by demineralization. Their effect on pulpal stem cell migration, proliferation, and differentiation could be beneficial for regenerative endodontic therapies. However, precondition for success, as for conventional root canal treatment, will be sufficient disinfection of the root canal system. Various irrigation solutions and intracanal dressings are available for clinical use. The aim of this study was 2-fold: to identify a demineralizing solution suitable for growth factor release directly from dentin and to evaluate whether commonly used disinfectants for endodontic treatment will compromise this effect. MethodsDentin disks were prepared from extracted human teeth and treated with EDTA or citric acid at different concentrations or pH for different exposure periods. The amount of transforming growth factor-β1 (TGF-β1), fibroblast growth factor 2, and vascular endothelial growth factor were quantified via enzyme-linked immunosorbent assay and visualized by gold labeling. Subsequently, different irrigation solutions (5.25% sodium hypochloride, 0.12% chlorhexidine digluconate) and intracanal dressings (corticoid-antibiotic paste, calcium hydroxide: water-based and oil-based, triple antibiotic paste, chlorhexidine gel) were tested, and the release of TGF-β1 was measured after a subsequent conditioning step with EDTA. ResultsConditioning with 10% EDTA at pH 7 rendered the highest amounts of TGF-β1 among all test solutions. Fibroblast growth factor 2 and vascular endothelial growth factor were detected after EDTA conditioning at minute concentrations. Irrigation with chlorhexidine before EDTA conditioning increased TGF-β1 release; sodium hypochloride had the opposite effect. All tested intracanal dressings interfered with TGF-β1 release except water-based calcium hydroxide. ConclusionsGrowth factors can be released directly from dentin via EDTA conditioning. The use of disinfecting solutions or medicaments can amplify or attenuate this effect.

Unusual Endodontic Treatment: A Surprise

Failures of endodontic treatment can be related to various causes. In this case, it was probably due to foreign body reactions that caused by the periapical extrusion of an improper endodontic material. An apicoectomy is performed to eliminate the infection at the tip of the tooth that conventional root canal treatment cannot reach. This procedure involves surgical removal of the tip of the tooth’s root, along with any infected tissue. This is a clinical case report of a tooth with failure of conventional endodontic treatment, leading to persistent periapical lesion and sinus tract. It was chosen to retreat the tooth and perform apicoectomy. The treatment was perceived successful due to healing of sinus tract due to periapical bone repair.

The Efficacy of Calcium Hydroxide Powder mixed with 0.2% Chlorhexidine Digluconate or mixed with Normal Saline as Intracanal Medicament in the Treatment of Apical Periodontitis.

To compare the efficacy of calcium hydroxide powder mixed with 0.2% chlorhexidine digluconate or mixed with normal saline as intracanal medicament in the treatment of apical periodontitis. Subjects were 55 in number aged 17 to 60 years. Two-visit conventional root canal treatment was performed on 70 teeth. The teeth were divided by randomization (balloting) into two groups: control group and experimental group, each with 35 teeth treated with calcium hydroxide mixed with normal saline or with 0.2% chlorhexidine digluconate as intracanal medicament respectively. All treated teeth were evaluated clinically and radiographically for signs and symptom of periapical infection at specified periods postoperatively. Overall efficacy of medicament was rated based on quality guidelines for endodontic treatment by the European Society of Endodontology 2006. A postoperative favorable outcome of 97.1% in the control group and 94.3% in the experimental group was observed at 6-month review. This difference was not statistically significant (p > 0.05). The use of normal saline or 0.2% chlorhexidine digluconate to mix calcium hydroxide used as intracanal medicament during endodontic treatment resulted in high postoperative favorable outcomes. Efficacy of 0.2% chlorhexidine digluconate as a vehicle for mixing calcium hydroxide as an intracanal medicament in the treatment of apical periodontitis is comparable to the efficacy of calcium hydroxide mixed with normal saline.

Ineffectiveness of Antibiotic-Based Pulpotomy for Primary Molars: a Survival Analysis

Objective: To investigate the two-year survival rate of primary molars treated with non-instrumentation endodontic treatment with mixed antibiotic paste containing chloramphenicol, tetracycline, zinc oxide and eugenol (CTZ pulpotomy), and compare it to the conventional root canal treatment with calcium hydroxide paste. Material and Methods: Thirty-six children, mean age 6.2 years old (standard deviation, SD=1.5), presenting at least one primary molar with irreversible pulpitis or necrotic pulp, were included in this prospective clinical study. Teeth were assigned to CTZ pulpotomy (Group I) or calcium hydroxide pulpectomy (Group II) and assessed clinically and radiographically for up to 26 months. Data were analyzed using descriptive statistics, Chi-square test, Kaplan-Meier survival analysis and Log-rank test. Results: Fifty-three primary molars were treated in Group I (n=37) or Group II (n=16). Children were followed up for 1 to 26 months (mean=12.0; SD=7.1). Treatment failure rates were 73.0% in Group I and 31.3% in Group II. Overall, mean survival time was 15.2 months (95% confidence interval, CI 12.6–17.9); Group I (mean 13.2; 95% CI 10.2-16.3) had a lower survival rate than Group II (mean 18.9; 95% CI 14.5-23.2) (p=0.02). Necrotic pulp treatments had significantly lower survival rates (p=0.01) than pulpitis treatments. Conclusion: Non-instrumentation endodontic treatment of primary molars with CTZ paste resulted in a low survival rate in a two-year follow-up; its radiographic ineffectiveness discourages its use instead of conventional root canal endodontic treatment.

Temporary Mental Nerve Paresthesia Originating from Periapical Infection.

Many systemic and local factors can cause paresthesia, and it is rarely caused by infections of dental origin. This report presents a case of mental nerve paresthesia caused by endodontic infection of a mandibular left second premolar. Resolution of the paresthesia began two weeks after conventional root canal treatment associated with antibiotic therapy and was completed in eight weeks. One year follow-up radiograph indicated complete healing of the radiolucent periapical lesion. The tooth was asymptomatic and functional.

Management of six root canals in mandibular first molar.

Success in root canal treatment is achieved after thorough cleaning, shaping, and obturation of the root canal system. This clinical case describes conventional root canal treatment of an unusual mandibular first molar with six root canals. The prognosis for endodontic treatment in teeth with abnormal morphology is unfavorable if the clinician fails to recognize extra root canals.