Healing Of Periapical Tissues Research Articles

Retrospective analysis and clinical features of periapical tissue regeneration

Background: Chronic periodontitis is associated with changes in periapical tissues. Untimely diagnosis and lack of appropriate mechanical treatment increase the incidence of chronic periodontitis. Periodontitis that causes destructive changes due to long-term inflammation of periapical tissues is of particular concern. Thus, the treatment of destructive periodontal diseases is a pressing issue in modern dentistry. Aim: To assess periapical tissue regeneration following treatment in chronic periodontitis patients. Materials and Methods: A retrospective analysis of the destruction and regeneration of periapical tissues before and after treatment during 3–6 months was performed in 20 patients. Results: A retrospective analysis of X-ray findings in 20 patients revealed bone destruction of varying degrees. Low-quality root canal preparation was due to various factors, primarily the anatomy and topography of root canals. Of the 20 patients who required treatment for chronic periodontitis with varying degrees of destruction, 16 came back for follow-up appointments and received endodontic treatment. Following treatment, X-ray findings were used to identify taper root canal preparation and assess the quality of obturation up to the root apex. X-ray examination was performed after 3 months in patients with clinical signs of periodontitis and after 6 months in patients without clinical signs of periodontitis. After 3 months, X-ray findings showed a reduction in bone destruction in the causative tooth area, indicating an improvement. Conclusion: The study of periapical tissue regeneration following treatment in chronic periodontitis patients revealed that effective apical preparation, as well as appropriate irrigation and root canal filling, promote regeneration in periodontitis. Healing of periapical tissues is essential for effective root canal treatment.

Clinical efficacy of platelet-rich fibrin, injectable platelet-rich fibrin, and advanced platelet-rich fibrin in regenerative endodontics: A case series

Background: This series investigates the efficacy of regenerative endodontic therapy (RET) using various platelet-rich fibrin (PRF) formulations in treating apical periodontitis and necrotic pulp in immature permanent teeth. Aim: This study aims to evaluate the effectiveness of different PRF formulations in RET. Materials and Methods: Three cases involving patients aged 15–16 with immature teeth and necrotic pulp were treated with RET using PRF, injectable PRF, and advanced PRF. The procedure included inducing bleeding with a Hedstrom file, applying PRF variants, and sealing with mineral trioxide aggregate and composite resin. Patients were followed up at 1, 3, 6, 12 and 18 months. Results: Radiographic evidence showed apical closure, root maturation, and healing of periapical tissues in all cases. However, pulp sensibility tests were negative. Conclusion: RET using PRF variants promotes root development and apical healing in immature teeth. Further research with larger sample sizes is needed to understand these therapies’ potential and limitations.

The impact of root end filling material type and the application of bone graft on healing of periapical tissues after endodontic microsurgery (a clinical randomized controlled trial)

To evaluate the effect of combining different bioactive root-end filling materials with composite bone graft (xenogeneic mixed with autogenous bone fragments) on the healing process of periapical tissues after endodontic micro-surgery procedure. In this triple-blinded clinical trial, 56 patients were divided into 2 main groups (28 each) according to the root-end filling material and 2 subgroups according to the presence or absence of the composite bone graft material. Group I: MTA root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Group II: TotalFill root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Healthy patients whose ages range from 20 to 50 years with small-to-medium size radiolucency in CBCT related to single-rooted maxillary teeth were included in this study. Patients were assigned a number starting from 1 to 56 and were randomly allocated to four test groups (2 main groups and 2 sub-groups) following simple randomization procedure guidelines described by IBM SPSS V23 (IBM USA) statistical analysis software. This trial was triple-blind where the patient, the outcome assessors, and the main operator were blinded to the applied intervention. Every patient was evaluated clinically and by CBCT at two main observation periods: presurgical and 12-month post-operative. They were also examined and evaluated clinically and radiographically through periapical x-rays after one week, three, and six months. Statistical analysis was performed with IBM SPSS Statistics for Windows Version 23.0. Armonk, NY: IBM Corp. Of the 56 patients enrolled in the study, 49 patients were available for the final analysis. All groups showed no statistically significant differences with regard to healing or success rates at the 12-month follow-up mark. No adverse effects were encountered. Results showed that high success rates were achieved using MTA and TotalFill in the healing of periapical lesions after endodontic surgery. The addition of bone graft in small-to-medium size lesions did not affect the success rate of endodontic surgeries.

Periapical bacterial disinfection is critical for dental pulp regenerative cell therapy in apical periodontitis in dogs

BackgroundApplication of pulp regenerative cell therapy for mature teeth with periapical lesions is a critical clinical challenge. The bacterial infection in inaccessible location within the root canal system and in the periapical lesions could cause resistance and impediment, leading to limitations in successful therapy. Thus, the aim of this study was to examine the effect of residual bacteria on the outcome of pulp regeneration in mature teeth with apical periodontitis in dogs.MethodsPeriapical lesions were induced in 32 root canals of 4 dogs in two different models in severities, model A and model B. Model A (moderate infection): the canal exposed to the oral cavity for 2 weeks and then closed for 2 weeks. Model B (severe infection): the canal exposed to the oral cavity for 2 months and then closed for 5 months. All root canals were irrigated with 6% sodium hypochlorite, and 3% EDTA and further with 0.015% levofloxacin-containing nanobubbles, which was also used as an intracanal medicament. The aseptic conditions were examined by bacterial anaerobic culture and/or PCR analyses. The root canal treatment was repeated several times, and allogeneic dental pulp stem cells were transplanted into the root canals. The radiographic evaluation of periapical lesions was performed by cone-beam computed tomography before the first treatment, just after cell transplantation, and after 2 months and 6 months in both model A, model B, respectively. The animals were then sacrificed and the jaw blocks were harvested for histological and histobacteriological evaluations of pulp regeneration and periapical tissue healing. Furthermore, the DiI-labelled DPSCs were transplanted into the root canals after complete disinfection (n = 4) or without root canal treatment (n = 4) in the apical periodontitis model (model A) in one dog, and cell localization was compared 72 h after transplantation.ResultsIn 8 out of 12 canals from model A, and 10 out of 15 canals from model B, pulp regeneration with good vascularization, innervation, and a significant reduction in the radiolucent area of the periapical lesions were observed. However, in the other 4 canals and 5 canals from model A and model B, respectively, no pulp tissue was regenerated, and inflammation in the periapical tissue, and external resorption or healed external resorption were detected. The presence of residual bacteria in the periapical tissues and severe inflammation were significantly associated with inhibition of regenerated pulp tissue in these 9 unsuccessful canals (P < 0.05, each) (OR = 0.075, each) analyzed by multiple logistic regression analysis. For cellular kinetics, transplanted cells remained in the disinfected root canals, while they were not detected in the infected root canals, suggesting their migration through the apical foramen under the influence of inflammation.ConclusionsA true pulp-dentin complex was regenerated in the root canal by the pulp regenerative therapy in mature teeth with apical lesions. The successful pulp regeneration was negatively associated both with residual bacteria and inflammation in the periapical tissue.

Effect of Recombinant Human Platelet-Derived Growth Factor on Healing of Chronic Periapical Tissue Pathosis Following Apical Surgery in a Canine Model: A Histomorphometric and Microcomputed Tomography Analysis.

This canine in vivo study assessed the effect of recombinant human platelet-derived growth factor (rhPDGF) on the healing of periapical tissues following apical surgery. From a total of 96 premolar teeth, 64 teeth from six beagle dogs (2 years old) were classified as experimental and were randomly assigned to four experimental groups (16 teeth per group). After having the pulp extirpated, leaving teeth open to the oral cavity for 1 week, and sealing with an immediate restorative material for 8 weeks, nonsurgical endodontic treatment was performed. A split-mouth design was used, and intra-animal randomization of treatment sides was applied to the groups as follows: apical curettage + 1.5-mm root-end resection (Group 1); apicoectomy + mineral trioxide aggregate (MTA) root-end filling (Group 2); apicoectomy + MTA root-end filling + rhPDGF (Group 3); and apical curettage + rhPDGF (Group 4). The animals were sacrificed 24 months after apical surgery, and histologic and μCT analyses were performed for bone volume loss (BVL). Group 1 showed partial resolution of the periapical lesions without signs of tissue regeneration (BVL: 49.09 ± 10.97 mm3). Group 2 had minimal bone regeneration and showed cementum reformation in 9 teeth, with no direct attachment to the MTA (BVL: 35.34 ± 10.97 mm3). Group 3 showed regeneration of all damaged apical tissues without direct contact between the cementum and MTA (BLV: 4.51 ± 1.55 mm3). Group 4 showed regeneration of PDL, bone, and cementum and attachment of functional cementum fibers (BVL: 2.82 ± 2.3 mm3). The difference in BVL was statistically significant only for Groups 1 and 2 (P < .05). rhPDGF may help regenerate apical tissue structures following apical surgery.

Electrochemical Disinfection of Root Canals Bears No Risk of Damaging Periapical Tissues in a Dog Model

Boron-doped diamond (BDD) electrodes have been advocated as a potential treatment alternative to the established methods for root canal disinfection. As healing of periapical tissue is important in this context, the associated risk of host tissue damage was to be evaluated. Following in vitro cell culture experiments (HeLa cells), root canal treatment was performed in an animal trial comparing BDD electrode application and the currently used rinsing media with respect to cell viability and host tissue damage. Statistical analyses comparing the size of radiolucency were based on Kruskal-Wallis and Nemenyi’s All Pairs tests (α = 0.05). The direct application of BDD electrodes had a time-dependent effect on cell viability comparable to H2O2, NaOCl, and CHX application. In contrast to the chemical treatment, the effect of BDD electrodes was transient. Conventionally treated teeth and teeth additionally treated with BDD electrodes did not significantly differ from each other with respect to the size of the periapical radiolucency as observed radiographically (vertical p = 0.998 and horizontal p = 0.878) and histologically (vertical p = 0.940 and horizontal p = 0.862). While showing greater disinfection efficiency, the application of BDD electrodes for the electrochemical disinfection of root canals does not have a greater risk of host tissue damage compared to the conventional treatment.

Usage of naturally available herbal-based products in endodontics: ‘Naturodontics’: A research-based survey of the literature

Introduction: Irrigation is a major part of successful root canal treatment due to the fulfilment carried out of various essential mechanical, chemical and miro-biological functions that include the healing of periapical tissues. This way, they reach areas of the root canal wall easier, which are not touched by any mechanical instrumentation. The important factor is to go for the initial and primary endodontic treatment, otherwise known as root canal treatment. The focus should be on using root canal disinfection to prevent infection. The widely used endodontic irrigant is sodium hypochlorite. It has many limitations; therefore, there has been a study going on for many years to replace to get an ideal root canal irrigant! Various studies are being conducted in an attempt to replace sodium chloride with newer root canal irrigants. There has been wide research conducted for several years to use new endodontic irrigant materials in place of sodium hypochlorite and ethylenediaminetetraacetic acid. Many solutions are available in the new age practice of endodontic practice with plenty of advantages. Hence the objective of this study is to conduct an in depth research of such available literature in lieu of usage of natural based products in endodontics. Materials and Methods: By making use of the Google Scholar, MEDLINE and PubMed databases, this study has been conducted. Large data covering the relevant and potential literature, along with review articles in the English language were looked upon. Results: The extensive research of literature resulted in the varied examples of the usage of herbal products in the field of endodontics are pulp–dentine repair, cleaning, disinfection, removal of smear layer, sealer cement for lubricating, removal of obturation material by dissolving it, etc. This signifies that there is a strong possibility for establishing the fact that herbal based products can be effectively be used in endodontics with further detailed studies being conducted. Conclusion: As per the research conducted, “Naturodontics” does have a good potential although there is an extensive need for elaborative in-vitro and in-vivo studies, confirming the same.

Iatrogenic Extrusion of Calcium Silicate Cements on Teeth Associated with Large Periapical Lesion: A Case Report with 12-Month Follow-up

Traumatic dental injuries can result in pulp necrosis and apical periodontitis, impairing root development. When this condition is left untreated, it causes inflammation in the tissues at the apex, which may lead to significant damage of the periapical alveolar bone. Tooth with open apex may have a risk of iatrogenic error of extrusion material during the stage of root canal obturation. Objective: This case report discussed the bone healing of large periapical lesion of an iatrogenic extrusion of calcium silicate cement in an open apex maxillary left central incisor. Case report: A 35-year-old female patient presented with a main complaint of a discoloured upper front tooth that was affecting with her appearance. Clinical examination showed her left maxillary central incisor was diagnosed with pulp necrosis and symptomatic apical periodontitis. Periapical radiograph revealed the tooth has an open apex and large periapical lesion. After chemomechanical disinfection, an apical plug was placed with bioceramic material. Periapical radiographs taken postoperatively demonstrated the extrusion of bioceramic material into the periapical lesion. After a year, the tooth does not exhibit any symptoms, and periapical radiographs showed that the periapical region has totally healed. Conclusion: Extruded bioceramic material has no detrimental impact on periapical tissue healing, as evidenced by 12-month follow-up observations.

Obstructive Sleep Apnea - A Review

Irrigation is a key part of successful root canal treatment as it fulfils several important mechanical, chemical and (micro) biological functions including the healing of periapical tissues.

Maxillary unilateral parastyle: An Orthodontist’s Conundrum

Irrigation is a key part of successful root canal treatment as it fulfils several important mechanical, chemical and (micro) biological functions including the healing of periapical tissues.

Evaluating the knowledge of sports participants regarding dental emergency procedures in National Sports University, Imphal

Irrigation is a key part of successful root canal treatment as it fulfils several important mechanical, chemical and (micro) biological functions including the healing of periapical tissues.

Evaluation of Healing of Periapical Tissue in Permanent Incisors with Open Apices after Unintentional Extrusion of Mineral Trioxide Aggregate - A Retrospective Study.

Aim:The aim of the present study was to retrospectively assess the healing of periapical lesions in permanent central incisors with open apices after unintentional extrusion of mineral trioxide aggregate (MTA).Materials and Methods:The clinical and radiographic records of 75 maxillary permanent central teeth treated by MTA apexification were evaluated. Teeth with unintentionally extruded MTA formed the study group (Group 1, n = 28), whereas the teeth with no MTA extrusion formed the control group (Group 2, n = 47). For both the groups, the records were analyzed for a follow-up period of 3 years.Results:Complete healing (CH) was observed in 25 teeth in the study group, whereas all the teeth in the control group showed CH (P > 0.05). Within the study group, 6 teeth (21%) showed CH in the 6th month in Group 1, whereas in the control group, 34 teeth (72.3%) showed CH (P < 0.001). At the 1-year follow-up appointment, 19 teeth (67.8%) showed CH in Group 1, whereas 9 teeth (19.1%) showed the same result in Group 2 (P < 0.001). At the end of the 3-year follow-up period, it was noticed that in 21 (84%) teeth, extruded MTA remained unchanged, whereas it was reduced in 4 (16%) of them (P < 0.001).Conclusion:Extrusion of MTA does not have a significant effect on the healing of the periapical lesion. However, it may lead to a delay in the healing of periapical healing. Patients should be informed about the complication and consequences of extruded MTA and should be kept on follow-up to observe periapical healing.

Evaluation of papillo-incisal distance in different arch forms and with different shapes of incisive papilla in Moradabad population - A descriptive study

Irrigation is a key part of successful root canal treatment as it fulfils several important mechanical, chemical and (micro) biological functions including the healing of periapical tissues.

Management of Maxillary Radicular Cyst by Using the Titanium-Prepared Platelet-Rich Fibrin (T-PRF): A Case Report

Radicular cysts are the most common inflammatory cysts of the jaws. Surgical intervention aims to eliminate periapical pathology in order to allow bone regeneration and healing of periapical tissues. Autologous platelet-rich fibrin is a healing biomaterial in oral surgical defects with the new perspective of accelerated healing. Titanium-prepared platelet rich fibrin (T-PRF) is a third-generation platelet concentrate developed to overcome the harmful effects of silica in glass tubes and also has a longer resorption rate. The purpose of this case report is to present the effects of T-PRF applied to the bone defect that occurs after the enucleation of the radicular cyst. A significant increase in bone density was observed after eight months of follow-up. T-PRF has been shown to be effective in the treatment of bone defects. Therefore, it is thought that it can be used as the only regenerative material in the treatment of bone defects.

Teeth with Apical Periodontitis Obturated in the Presence or Absence of Cultivable Micro-Organisms: A Two-Year Prospective Study of Treatment Outcomes

Objective: This prospective study aims to evaluate the one-year and two-year outcomes of root canals with apical periodontitis obturated in the presence or absence of cultivable micro-organisms, and define the influence on endodontic treatment outcome from different independent variables. Methods: 87 patients with 45 exposed and 43 unexposed canals who previously participated in a microbiological study of primary endodontic infections were invited back for review in 12 and 24 months after endodontic treatment. The review involves clinical examination, questionnaire interview and radiographic assessment in order to determine the treatment outcomes. The influence of independent variables, such as gender, age, tooth location, etc., on the treatment outcome, has also been analysed. Results: A total of 85 teeth of 84 patients were reviewed one and two years after obturation. Chisquare test for trend showed that the one-year radiographic healing of apical lesions was significantly different between culture-positive and negative canals (P&lt;0.05). However, there is no significant difference in the two-year radiographic healing between the two groups of canals (P&gt;0.05). None of the independent variables was found to be significant in affecting the endodontic treatment outcome on logistic regression analysis. Conclusions: The presence of positive culture prior to obturation seemed to affect the healing of periapical tissues in a one-year review, but the effect appeared to be temporal and not affected the long-term outcome.

Endodontic treatment of maxillary incisor with dens invaginatus and dens exvaginatus: Case report

Irrigation is a key part of successful root canal treatment as it fulfils several important mechanical, chemical and (micro) biological functions including the healing of periapical tissues.

Role of Irrigants in Endodontics

Irrigation is a key part of successful root canal treatment as it fulfils several important mechanical, chemical and (micro) biological functions including the healing of periapical tissues.

A typical non-surgical healing of a large periapical lesion: An accident or decree? -A case report

Abstract: Periapical diseases are mostly induced as a result of direct or indirect involvement of oral bacteria. The causative factors include oral contaminants through the root canal or degenerating pulpal tissues. Hence, only surgical removal of the periapical lesions without proper root canal disinfection and obturation will not result in the healing of periapical tissues. The aim of this case report is to present a biologic rationale for the non -surgical endodontic management of large periapical pathosis of pulpal origin. Emphasis is laid on thorough debridement, placement of intracanal medicament and three dimensional obturation of root canal system by a simple lateral condensation technique in a non-compliant patient. Keywords: Periapical lesion, nonsurgical healing, intracanal medicament

Antibiofilm and Immune Response of Engineered Bioactive Nanoparticles for Endodontic Disinfection.

The biological aim of root canal treatment is to facilitate periapical tissue healing following endodontic therapy. This study aimed to develop an organotypic infected root canal model to understand the interaction of bacterial biofilm with macrophages and study the therapeutic effect of engineered bioactive chitosan nanoparticles (CSnp) on macrophages. Ex-vivo experiments were conducted in two phases; Phase-1: Enterococcus faecalis biofilms (two and six weeks old) developed in organotypic root canal model were used to characterize residual biofilm after conventional chemical treatment alone and combined with CSnp utilizing Confocal Laser Scanning Microscopy, Scanning Electron Microscopy and colony-forming units from pulverized dentin. Phase-2: The interaction of post-treatment biofilm and RAW macrophages was evaluated regarding pro/anti-inflammatory markers, cell viability and spreading at 24, 48 and 72 h. Compared to conventionally disinfected six-week-old biofilm, CSnp resulted in less viable bacteria (p < 0.01). Scanning electron micrographs demonstrated disruption of the biofilm. CSnp exhibited less residual bacterial load in pulverized dentin (p < 0.001). Macrophage interaction with CSnp-treated biofilm reduced proinflammatory markers (nitric oxide, TNF-α, IL-1β, and IL-6), increased anti-inflammatory marker (TGF-β1) and enhanced cell survival and spreading over time (p < 0.01 at 72 h). Engineered chitosan nanoparticles concurrently inactivated biofilm and altered the inflammatory response of macrophages that would promote healing.

Healing of Periapical Lesions After Surgical Endodontic Retreatment: A Systematic Review.

Background: Surgical root canal retreatment is required when peri-radicular pathosis associated with endodontically treated teeth cannot be treated by non-surgical root canal therapy (retreatment), or when retreatment was ineffective, not feasible or contraindicated. Endodontic failures maybe happen when irritants remain within the confines of the root canal, or when an extra-radicular infection cannot be eradicated by orthograde root canal treatment. Following enhanced microsurgical techniques in the last years, the success rates of surgical root canal retreatment have improved considerably.Objective: The aim of this systematic review is to gather updated data in regard to the surgical root canal (retrograde) retreatment to heal the periapical lesions.Materials and methods: The electronic databases PubMed and Google Scholar were searched in this review using specific inclusion and exclusion criteria. The search was performed in June 2019 and updated in November 2019. Among 3900 studies, 10 studies satisfied the eligibility criteria and were included in the review to be analyzed.Results: The 10 studies showed the importance of surgical root canal retreatment as a treatment option in removing infections within the root canal system and its efficiency in periapical tissue healing. These studies investigated different aspects of healing of periapical lesion after surgical (retrograde) retreatment including success rates, follow-up duration, and updated studies in surgical (retrograde) retreatment.Conclusions: Surgical root canal (retrograde) retreatment demonstrates its efficiency in reducing the period needed for healing of the periapical lesions in short-term follow-up compared to conventional orthograde retreatment.