Pulp Necrosis Research Articles

ALLOPECIA AREATA AND PERIODONTITIS: A CASE REPORT

This case report examines the interrelationship between periodontitis and Alopecia areata (AA), an autoimmune condition, within the broader context of the impact of oral health on systemic diseases. The concept of "oral primary foci," encompassing various oral pathologies such as periodontitis, dentoalveolar abscesses, and pulpal necrosis, is highlighted as a key factor in systemic diseases and complications. The report details the case of a 50-year-old female patient with AA who exhibited significant improvement in her condition following periodontal treatment. This improvement underscores the potential systemic influence of oral health conditions, particularly periodontitis, which is characterized by a dynamic interplay between bacterial infection and the host's immune response. The presence of autoantibodies in periodontitis suggests an autoimmune component, potentially linking it to autoimmune diseases like AA. The patient's case also aligns with the epidemiological data on AA, emphasizing its complex etiology and association with various systemic conditions. The report concludes that effective management of oral health, especially periodontal diseases, is crucial in the systemic health and management of conditions such as AA. It advocates for a holistic approach in healthcare, integrating oral health as a fundamental aspect of managing systemic diseases, and calls for continued research into the mechanisms connecting oral and systemic autoimmune responses. This research is vital for developing comprehensive treatment strategies that address both oral and systemic health, thereby enhancing overall patient outcomes.

Maxillofacial infections of dental origin

Aim: to evaluate the occurrence of maxillofacial infection cases, which were treated at local hospital, identifying the main risk factors that determine the need for hospitalization of patients and the factors associated with staying length. Methods: A retrospective review of 191 records of patients with maxillofacial infection of odontogenic origin was performed, statistically evaluated by frequency and percentage of involvement, p values (based on the chi-square test) and odds ratio with a 95% confidence interval. A p-value <0.05 was considered statistically significant. Results: Among all the 191 patients, 31 had some harmful habits, such as smokers (13%) and alcoholics (1%). In addition, 39 patients reported some general health problem, such as systemic arterial hypertension (8.3%), depression (6.8%), diabetes (3.6%) and some immunosuppression (1.57%). Involvement of infection in deep facial spaces was present, with 119 patients presenting a deeper infection (62.3%) and 72 patients a superficial infection (37.7%). The most prevalent clinical signs and symptoms in the initial evaluation were pain (91.1%) and edema (90.1%), followed by erythema/hyperemia (44.5%), trismus (37.7%), abscess (30.9%), cellulitis (27.7%), f istula (16.8%), fever (16.8%), dysphagia (11%), dehydration (9.9%), odynophagia (7.9% ) and dyspnea (3.7%). Pulp necrosis was considered a risk factor for treatment in a hospital environment (0.032) and root canal treatment decreases the risk of hospitalization (p=0.002). Considering the evaluated patients, 146 (76.4%) were admitted and 45 (37.7%) were not admitted for hospitalization after initial clinical evaluation. Conclusion: there is a high occurrence of maxillofacial infection cases of dental origin, considering that involvement of infection in deeper facial spaces, as well as presence of pain, edema, erythema/hyperemia, trismus, abscess, cellulitis and pulp necrosis, represent the main risk factors for hospitalization and staying length.

Characterization of cells in blood evoked from periapical tissues in immature teeth with pulp necrosis and their potential for autologous cell therapy in Regenerative Endodontics

ObjectiveThe objectives of this study were to isolate, characterize progenitor cells from blood in the root canals of necrotic immature permanent teeth evoked from periapical tissues and evaluate the applicable potential of these isolated cells in Regenerative Endodontics. DesignTen necrotic immature permanent teeth from seven patients were included. Evoked bleeding from periapical tissues was induced after chemical instrumentation of the root canals. Cells were isolated from the canal blood and evaluated for cell surface marker expression, multilineage differentiation potential, proliferation ability, and target protein expression. Cell sheets formed from these cells were transferred into human root segments, and then transplanted into nude mice. Histological examination was performed after eight weeks. Data analysis was conducted using one-way ANOVA followed by Tukey’s post-hoc comparison, considering p < 0.05 as statistically significant. ResultsThe isolated cells exhibited characteristics typical of fibroblastic cells with colony-forming efficiency, and displayed Ki67 positivity and robust proliferation. Flow cytometry data demonstrated that at passage 3, these cells were positive for CD73, CD90, CD105, CD146, and negative for CD34 and CD45. Vimentin expression indicated a mesenchymal origin. Under differentiation media specific differentiation media, the cells demonstrated osteogenic, adipogenic, and chondrogenic differentiation potential. Subcutaneous root canals with cell sheets of isolated cells in nude mice showed the formation of pulp-like tissues. ConclusionsThis study confirmed the presence of progenitor cells in root canals following evoked bleeding from periapical tissues of necrotic immature teeth. Isolated cells exhibited similar immunophenotype and regenerative potential with dental mesenchymal stromal cells in regenerative endodontic therapy.

Intraradicular reinforcement of traumatized immature anterior teeth after MTA apexification.

This review article describes the methods and clinical recommendations for reinforcing traumatized anterior immature teeth with pulp necrosis treated with mineral trioxide aggregate (MTA) apexification. Traumatic injury can cause pulp necrosis and incomplete root formation in immature teeth. MTA apexification is the treatment of choice for necrotic immature teeth, particularly during the middle or late stages of root development. MTA apexification has a high success rate; however, failures due to cervical or root fractures occasionally occur. The risk of fracture is higher in immature teeth with thin root dentin, particularly those with external root resorption. Furthermore, the loading force from any parafunctional habit also increases fracture risk. Therefore, intra-radicular reinforcement may be necessary after MTA apexification. Invitro, intraradicular restoration with a resin composite/core build-up material or a prefabricated fiber post demonstrated better root reinforcement than root canal obturation materials (i.e., gutta-percha and sealer). However, the root-reinforcement effect of MTA orthograde filling in the entire root canal remains unclear. Invivo, the survival of fractured teeth with intraradicular restorations (resin composite/core build-up material or prefabricated fiber posts) is extremely high. Moreover, the survival of teeth with gutta-percha/sealer obturation or MTA orthograde filling and restoration with resin composite extending into the cervical third of the root canal approximately 1-2 mm below the cemento-enamel junction is acceptably high. Based on this evidence, the remaining tooth/root structure and loading force should be carefully examined when considering intra-radicular reinforcement of immature anterior teeth treated with MTA apexification.

A retrospective cohort study of pulp prognosis in luxated permanent teeth: a competing risk analysis.

The present retrospective cohort study aimed to evaluate luxated permanent teeth for pulp prognosis and risk factors. Case records and radiographs of 224 patients, involving 427 luxated permanent teeth, referred for treatment at the Dental Trauma Center-School of Dentistry, Universidade Federal de Minas Gerais, (DTC-SD-UFMG) from 2014 to 2022, were assessed for pulp prognosis classified as vitality, necrosis and pulp canal obliteration (PCO). A competing risk survival analysis estimated the hazards of the three outcomes, and the effect of demographic, clinical and treatment variables was tested using a cause specific Cox regression model. Pulp vitality was found in163 teeth (38.2%), pulp necrosis in 120 teeth (28.1%) and 55 teeth (12.9%) developed PCO. Pulp vitality decreased in the presence of concomitant crown fractures (HR 0.38 95% CI [0.2-0.8] p = 0.006). The risk of pulp necrosis (HR 0.62 95% CI [0.4-0.96] p = 0.03) was lower in cases with open apices but increased with concomitant crown fractures (HR 4.0 95% CI [2.6-6.1] p = 0.001) and intrusions (HR 2.3 95% CI [1.2-4.1] p = 0.007). Lateral or extrusive luxations (HR 3.0 95% CI [1.3-6.9] p = 0.001) and open apices (HR 2.4 95% CI [1.2-4.7] p = 0.01) showed higher rates of PCO. Type of luxation, the diameter of the apical foramen, and the presence of concomitant crown fractures were main determinants of pulp prognosis after luxation injuries in permanent teeth. Pulp prognosis after tooth luxation is dependent on the presence and direction of tooth displacement together with infection control. Not applicable.

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.

Combined Endodontic and Surgical Management of a Maxillary Lateral Incisor with Type 3 of Dens Invaginatus

Dens invaginatus (DI) is a developmental anomaly characterized by invagination of the enamel organ into the dental papilla before calcification of the dental tissues. The etiology of this phenomenon has been related either to focal growth retardation or focal growth stimulation, or localized external pressure in certain areas of the tooth bud. In this case of upper lateral incisor showing type 3 dense invaginatus and diagnose as necrotic pulp with chronic apical abscess and treated by nonsurgical root canal treatment during follow up patient comlaing of recurrent swelling associated with treated tooth so we did surgical approach has been employed to resolve patient chief complaint. A follow up of one year is also presented to show healing.

The Correlation between the Bone Morphotype and Density and Root Apical Resorption of the Anterior Teeth Due to Orthodontic Forces

The potential side effects of modern orthodontic treatment and its unfavorable impact on dentition and hard tissues have been extensively discussed in professional literature for decades. The presence of uncontrolled forces can result in pulp necrosis, radicular reabsorption, and/or loss of alveolar bone. Dehiscence and fenestration are more commonly found in anterior than posterior teeth, where only the periodontal ligament and the mucosa protect the dental root.&#x0D; Most studies investigating the effect of periodontal phenotype over gingival recession in orthodontic patients have primarily focused on examining the soft tissues. However, due to the vulnerability of thin alveolar bone, the previous evaluation of orthodontic candidate patients may also include the analysis of hard tissues. Bone density plays an important role in facilitating orthodontic tooth movement, such that reductions in bone density can significantly increase movement velocity. These types of localized density changes can affect the rate of orthodontic tooth movement and may also influence the risk of unwanted outcomes, such as the occurrence of dental external apical root resorption.&#x0D; According to the literature, the links of root resorption with the bone morphotype and the density are relevant in clinical dentistry but have not been studied in detail. However, the existing data is not yet conclusive.

Revolutionizing Endodontics: Innovative Approaches for Treating Mature Teeth With Closed Apices and Apical Lesions: A Report of Two Cases

IntroductionModern tissue engineering strategies have elucidated the potential of regenerative endodontic treatment (RET) as an alternative for treating mature teeth. MethodsHere, we report two cases in which cell-based RET (CB-RET) using encapsulated allogeneic umbilical cord mesenchymal stem cells (UC-MSCs) in a platelet-poor plasma (PPP)-based scaffold was used in two mature teeth with pulp necrosis and apical periodontitis. ResultsAfter 5 years of follow-up, the healing response was satisfactory in both cases, with evidence of pulp revitalization. ConclusionsThis is the first study to report the success of an extended, 5-year follow-up for allogeneic CB-RET. This report presents an innovative and sustainable solution to challenging endodontic scenarios.

Clinical, radiographic and histological findings of seven teeth from two California sea lions (Zalophus californianus) housed under professional care.

Seven teeth extracted from two adult California sea lions (Zalophus californianus) due to pulp exposure and/or to gain access to the mandibular canine teeth were histologically evaluated, and the findings were compared with clinical and radiographic findings. Three teeth were diagnosed with pulp exposure, and two of these showed no radiographic signs of endodontic disease and were histologically vital with prominent coronal pulpitis and a pulp polyp. Another tooth with pulp exposure was showing clinical and radiographic signs of endodontic disease and was histologically confirmed with pulp necrosis. A discoloured incisor tooth was showing radiographic signs of endodontic disease and was also histologically non-vital. Two clinically and radiographically healthy mandibular first premolar teeth and one second incisor tooth had no evidence of pulpitis or pulp necrosis but had pulp canal obliteration. Regular clinical and radiographic follow-up for 5 months to 3 years after the procedures confirmed uneventful healing of the extraction sites, despite initial flap's dehiscence. Although extractions of affected teeth in California sea lions are considered the most practical and beneficial therapy, these are associated with the risks of extensive trauma and anaesthesia and the need to perform these surgical procedures on-site under variable conditions. As California sea lions can be trained to allow conscious dental radiographic re-checks, monitoring teeth with clinical signs of pulp polyp formation and without radiographic signs of endodontic disease warrant further evaluation/reconsideration from previous recommendations. Endodontic treatment of abscessed teeth in California sea lions is reportedly unsuccessful and is discouraged. However, vital pulpectomy could be an alternative treatment to extraction in teeth with pulp polyps as it was found to be highly successful in humans, but the possibility of endodontic failure and need for further treatments should be weighted in the treatment choice.

Evaluation of Presence of Enterococcus faecalis in Root Canals of Deciduous Molars with Necrotic Pulp by Agar Culture and Polymerase Chain Reaction.

To assess the presence of Enterococcus faecalis in root canals of deciduous molars with necrotic pulp by agar culture and polymerase chain reaction (PCR) assay. This is an experimental study, where a total of 120 endodontic samples were taken from deciduous molars with necrotic pulps. The presence of Enterococcus faecalis was assessed by culture, using Enterococcus confirmatory agar, and by PCR assay. Statistical analysis of the results was performed using McNemar's test. The presence of Enterococcus faecalis was detected in 20 samples (16.67% of total) by microbial culture and in 45 samples (37.5% of total) by PCR assay, with a statistically significant difference between the two methods (p < 0.001). Microbial culture and PCR both detect Enterococcus faecalis, with the latter detecting an additional 25 positive samples. In this study, PCR assay was significantly more sensitive than agar culture method in detecting the presence of Enterococcus faecalis in root canals of deciduous molars with necrotic pulp, that is, 37.5% of all samples. Importance of presence of Enterococcus faecalis in necrotic pulps of deciduous teeth, as it is primarily responsible for failure of endodontic treatment, thus helping clinicians to advocate the use of local drug delivery in primary teeth endodontics and also aids clinicians in choosing the most effective intracanal medication. Nalawade TM, Bhat KG, Kale AD, et al. Evaluation of Presence of Enterococcus faecalis in Root Canals of Deciduous Molars with Necrotic Pulp by Agar Culture and Polymerase Chain Reaction. Int J Clin Pediatr Dent 2023;16(6):816-819.

3D-bioprinted hydrogels with instructive niches for dental pulp regeneration

Infections to dental pulp commonly result in pulpitis and pulp necrosis, and surgical removal of the infected tissues is the only therapeutic approach. Dental pulp injury remains a challenging medical issue due to the limited regenerative capability of dental pulp. In this work, a dental pulp guidance construct (DPGC) with the instructive niche was bioprinted to mimic native teeth for dentin and neovascular-like structure reconstruction. GelMA-Dextran aqueous emulsion was used as an ink for in situ printing of porous DPGC to induce predominant nuclear localization of Yes-associated protein (YAP) in the encapsulated dental pulp stem cells (DPSCs) and enhance their stemness properties. Furthermore, the DPSCs encapsulated in DPGC with microporous structures exhibited enhanced viability, migration, and spreading. Meanwhile, we found that DPGC could promote capillary tube formation and induce neurogenesis. In a mouse subcutaneous implant model, the DPGC consisted of porous structures, such as odontoblasts and newly formed vascular structures, that mimic dental pulp characteristics. This study demonstrated a new strategy to design DPGC with instructive niche for dental pulp regeneration, presenting a potential treatment alternative to root canal therapy.

Teaching pulpectomy in paediatric dentistry: A national cross-sectional survey of dental schools in Brazil.

Pulpectomy is used to treat primary teeth with irreversibly inflamed or necrotic pulp tissue. There is, however, a lack of consensus on clinical protocols for teaching pulpectomy at dental schools. To determine what faculty members at Brazilian dental schools are teaching about pulpectomy in primary teeth. A cross-sectional, observational study was conducted using a 39-question survey available via the Google Forms® platform. A snowball sampling strategy was used for recruitment. Invitations to participate were sent via e-mail, WhatsApp® and Instagram®. The data were analysed descriptively. A total of 177 (58.4%) responses were obtained. Most faculty members recommended the use of Kerr hand files (66.1%), and 1% sodium hypochlorite was the most common choice for the irrigating solution (35.3%). Iodoform pastes were the first choice of faculty members (41.6%), and 60.5% of the faculty members recommended composite resin as the definitive restoration. Similarities were found in the teaching of pulpectomy for primary teeth among faculty members at dental schools in Brazil.

Use of Endodontic Procedures in Young Permanent Teeth.

Regenerative endodontic procedures (REPs) have emerged as a promising treatment option for young permanent teeth with pulp necrosis, offering the potential for tissue repair and preservation. A retrospective analysis was conducted on a cohort of 30 patients aged 8 to 16 years with pulp necrosis in young permanent teeth. The patients underwent REPs, including disinfection, triple antibiotic paste application, and a coronal barrier. Clinical and radiographic data were collected at baseline and follow-up appointments at 6, 12, and 24 months. Radiographs were analyzed for root lengthening, apical closure, and resolution of periapical lesions. The mean increase in root length after 24 months was 3.42 mm (SD ± 1.12 mm), and 90% of cases demonstrated complete apical closure. The overall success rate, defined as the absence of clinical symptoms and radiographic evidence of pathology, was 80. REPs show promising outcomes in young permanent teeth with pulp necrosis, promoting root development, and apical closure.

Long-term Success of Regenerative Endodontic Procedures

ABSTRACT Background: Regenerative endodontic procedures (REPs) have emerged as a transformative approach to treating immature permanent teeth with necrotic pulp tissue Materials and Methods: A prospective study was conducted, enrolling 100 patients with immature permanent teeth requiring REPs. All procedures were performed by a single experienced endodontist following established protocols. Patients were followed up for a minimum of 5 years’ post-treatment. Clinical examinations, radiographic assessments, and patient-reported outcomes were recorded at regular intervals. Data were analyzed using statistical methods to determine the success rates, complications, and factors influencing long-term outcomes. Results: The results of this original research reveal a significant and sustained success rate for REPs. After a minimum follow-up period of 5 years, an arbitrary value of 92% for tooth survival was achieved. Radiographic assessments demonstrated consistent healing of apical lesions, and continued root development was observed in the majority of cases. Patient-reported outcomes indicated a high level of satisfaction with the procedure. Complications such as crown discoloration and tooth fracture occurred in a minority of cases but were effectively managed without compromising the overall success of REPs Conclusion: This original research provides strong evidence for the long-term success of REPs in the treatment of immature permanent teeth with necrotic pulp tissue. The high tooth survival rate, continued root development, and patient satisfaction support the efficacy of REPs as a reliable treatment option.

Role of Actinomyces in the Progression of Medication-related Osteonecrosis of the Jaws in an Immunocompromised Mouse Model with Periapical Disease

ObjectivesThis study aimed to investigate the role of Actinomyces on the development of MRONJ in an immunocompromised mouse model with periapical disease. MethodsThirty ovariectomized C57BL/6N female mice were treated with zoledronic acid (ZA) and dexamethasone (DX) for 12 weeks. At the eighth week of drug administration, pulpal exposure operation was performed on the lower right first molar in Group B and C, meanwhile Actinomyces inoculation was performed at the pulpal entrance of Group C. Group A received no operation as control. After 4 weeks, loads of total bacteria and Actinomyces in the oral cavity were assessed by real-time polymerase chain reaction (PCR). Mandibles were harvested for micro-computed tomography (CT) and histological analysis. ResultsReal-time PCR revealed positive detection of Actinomyces in 30% samples in Group C and negative detection in all samples in Group B and control group. Micro-CT examination demonstrated that in ZA treated mice, pulpal exposure significantly increased periapical bone loss, which was significantly aggravated by Actinomyces inoculation. Histological assessment showed vasodilation, acute exudative changes and pulp necrosis in Group B and C. ConclusionsThe present study revealed that inoculation of Actinomyces compromises the bone quality but does not further aggravate bone necrosis significantly.

DENTIST’S ROLE IN COLLABORATIVE MANAGEMENT OF TETANUS PATIENT

Tetanus was a life-threatening infection causing muscle contractions. The need for qualified collaborative management was crucial due to the potential for poor prognosis and complications. Dentists can contribute significantly to the treatment, as the mouth can be one of the entry points for tetanus-causing bacteria. A 45-year-old male tetanus inpatient was referred from the Intensive Care Unit to the Oral Medicine Unit at Universitas Indonesia Hospital to evaluate the possible source of oral focus infection. A boil was on his back, suspected to be the main port of entry for tetanus bacteria. The definitive diagnosis was Tetanus of moderate to severe severity (Philips score 24, Dakar score 1, Ablett score 2). Extra oral examination shows lip inflammation. An intra-oral examination cannot be done optimally despite his trismus. The oral foci of infection found were chronic gingivitis and pulp necrosis on 47 48, in addition to the diagnosis of cheilitis simplex. Since the comprehensive management of the foci of infection could only be done in an outpatient setting, the nurse was instructed to clean the intra-oral using sterile gauze moistened with NaCl 0.9% solution to improve the patient's oral hygiene (OH). Comprehensive management includes periodically visiting to maintain OH, administering muscle relaxants, antibiotics, and analgesics, and administering Tetanus toxoid vaccination. The patient was recovered. Management of tetanus cases needs a multidisciplinary approach. Dentists are pivotal in identifying oral infection sources and ensuring its management. A dentist's role in the collaborative management of tetanus patients might significantly contribute to the patient's prognosis.

Spleen Toxicity Assessment of Propanil Exposure in Swiss Albino Mice

Pesticides or their metabolites may have the capacity to disturb and hinder the functions of some essential organs including spleen. This study examined side effects of propanil on the spleen of mice. Experimental groups were exposed to propanil through oral administration for 30 consecutive days. The separation of capsule from the splenic parenchyma, a thickening of the capsule, congestion in the splenic parenchyma, dilated sinusoids, and arteriolar enlargement, karyolysis in megakaryocytes and amyloid formation were determined in the low-dose group. Hemorrhage and separation in the capsule, amorphous megakaryocytes, karyolysis in megakaryocytes, congestion in the splenic tissue and sinusoidal enlargement, fibrosis, lobule formation, enlargement of the white pulp and deformation of arteriole were detected in the medium-dose group. Hemorrhage in separated capsule, karyolysis in megakaryocytes, congestion in the splenic parenchyma, enlargement of the white pulp, fibrosis, necrosis in the white pulp, congestion in the enlarged sinusoid and cellular swelling in the splenic red pulp were observed in the high-dose group. These findings clearly demonstrated that propanil induced important dose-related histopathological damages. Based on our results, we can clearly say that it may have the capacity to cause this organ’ failure.

Revascularization of Non-Vital, Immature, Permanent Teeth with Two Bioceramic Cements: A Randomized Controlled Trial

The aim of this study was to clinically and radiographically assess the effects of two bioceramic cements as coronal plug materials for the revascularization of non-vital, immature, permanent teeth with apical periodontitis. Twenty non-vital, immature, permanent, anterior teeth with apical periodontitis were included in this study. Samples were randomly divided into two groups based on the coronal plug materials used; group I (GI): Well Root PT (Vericom, Gangwon-do, Korea) and group II (GII): MTA Biorep (Itena Clinical, Paris, France) (n = 10). Follow-up was conducted clinically and radiographically for up to 12 months to evaluate the changes in root dimensions and resolution of the periapical disease and investigate the degree of success. Data were statistically analyzed using ANOVA tests and Mann–Whitney U tests at a 0.05 significance level. At 12 months, none of the patients in either test group had clinical signs/symptoms. There was a slight increase in root length (4.4% in GI and 3.4% in GII) and a slight increase in dentin wall thickness (10.2% in GI and 9.9% in GII) with no statistically significant (p &gt; 0.05) differences. Whilst there was a significant decrease in lesion dimension in all patients after 12 moths of treatment (93% in GI and 91% in GII), there were no statistically significant differences between the two study groups (p &gt; 0.05). Regarding the degree of success, all cases (100%) achieved the primary goal (the elimination of symptoms and the evidence of bony healing), while 60% in GI and 40% in GII achieved the secondary goal (increased root wall thickness and/or increased root length). No statistically significant difference was found between groups (p &gt; 0.05). Both bioceramic cements showed satisfactory clinical and radiographic findings. Premixed calcium aluminosilicate and tricalcium silicate cements could be used as coronal plug materials in revascularization procedures. Bioceramic cements can be considered promising coronal plug materials for the revascularization of immature, permanent teeth with necrotic pulps and apical periodontitis due to their physicochemical and biological properties.

Management of Cutaneous Draining Sinus Tract of Odontogenic Origin

Chronic inflammation of the dental pulp is one of the reasons for cutaneous sinus tract of odontogenic origin. A cutaneous sinus or extra oral sinus from a lesion of endodontic origin is rare as compared to an intra oral sinus and may occur as result of long-standing inflammatory process associated with necrotic pulp. Such patients are usually healthy and are unaware of the underlying asymptomatic dental problem. Thus, the treatment protocol should be elimination of the etiological factors first. A 24-year-old male was presented with a draining sinus tract on his left cheek. In radiographic assessment, periapical lesion was noticed associated with the roots of the affected tooth. Root canal treatment was performed using Calcium hydroxide as an intracanal medicament. The sinus tract disappeared one weeklater. However, longterm clinical and radiological evaluation is necessary.