Non-vital Teeth Research Articles

Evaluation of blood clot and collagen sponge in regeneration of nonvital immature permanent anterior teeth

Introduction Traumatic dental injuries (TDI) of permanent anterior teeth is a common dental problem among the children. Pulpal necrosis is the critical result of traumatic dental injury as it makes a challenge in endodontic and restorative procedures. Revascularization is one of most recent treatment of such teeth. Aim The purpose of this study was to evaluate and compare the regenerative potential of the blood clot and collagen sponge as scaffold in revascularization of nonvital immature permanent anterior teeth using biodentine for coronal bacterial tight seal. Materials and methods This study was conducted on 30 anterior teeth on healthy children aged from 7 to 9 years. The selected patients were divided into two groups according to scaffold used: group I (blood clot scaffold) and group II (combined blood clot and collagen scaffold). Clinical and radiographic outcomes were assessed at 3, 6, 9, 12, 15 and 18 months follow up. Results The results revealed that there was no statistically significant difference between the two groups regarding clinical and radiographic outcomes. Conclusion It was concluded that, the revascularization with blood clot and collagen sponge has no significant differences in clinical and radiographic evaluation criteria.

Myeloperoxidase: A Circulating Marker of Inflammation and Tooth Infection

BackgroundAtherosclerotic cardiovascular disease and tooth infection are common in primary care, and both significantly reduce quality of life. Our study aimed to examine signs of vascular inflammation associated with loss of tooth vitality before and after a single tooth extraction. MethodsAn observational cohort study was performed with adults who had a nonvital tooth and an indicated desire for tooth extraction. Concentrations of total cholesterol, high-density lipoprotein-cholesterol, high-sensitivity C-reactive protein (hs-CRP), myeloperoxidase (MPO), and troponin T were measured in venous blood serum or plasma at baseline and 6-weeks after tooth extraction. ResultsCirculating hs-CRP levels were > 3 mg/dL in 15 participants (68.2%) and MPO levels were > 350 pmol/L in 9 (40.9%) of 22 participants at baseline. After tooth extraction (n = 18), MPO levels decreased significantly compared with baseline (P < .00006) and hs-CRP levels moved directionally downward. The response rate for MPO was 88.9% (confidence interval: 65.1%-98.6%) from visit 1 to visit 2. Those with high MPO levels at baseline demonstrated larger reductions in MPO levels by visit 2 than those with lower baseline MPO levels (r = .81; P < .0001). A total of 13 individuals (72.2%) achieved MPO levels < 350 pmol/L and 11 (61.1%) achieved hs-CRP levels < 3 mg/dL at visit 2. Total cholesterol, high-density lipoprotein-cholesterol, and troponin T levels did not significantly change from visit 1 to visit 2. ConclusionA link between dental infection and circulating levels of inflammation was observed, suggesting that oral infection could be a risk factor for atherosclerotic cardiovascular disease.

Bleaching intracoronal gigi insisif pertama pasca perawatan endodontik (Laporan Kasus)

Background: Non-vital anterior tooth discoloration is a common concern in everyday clinics. Increased patient demand for affordable and excellent results makes bleaching treatment for discolored teeth one of the most popular treatment options. Bleaching offers a more conservative and aesthetic solution compared to treatments like dental crown. Objective: To restore the color of the upper right maxillary incisor after endodontic treatment using internal bleaching with 35% hydrogen peroxide. Case: A 22-year-old male patient came with a complaint of discoloration of upper right maxillary incisor. On clinical examination, upper right maxillary incisor was discolored. On radiographic examination, radiolucency was observed in the periapex. Endodontic treatment was performed with biomechanical preparation using circumferential filing technique and obturation of root canals using a thermoplastic injection technique. At the next visit, an intraoral photo was taken, and the color upper right maxillary incisor was determined using a shade guide. Intracoronal bleaching was performed using 35% hydrogen peroxide bleaching gel. After the color of upper right maxillary incisor has blend well, then the teeth were restored using a composite resin. Conclusion: Intracoronal bleaching treatment with 35% hydrogen peroxide is a conservative and aesthetic treatment to restore the color of the tooth with an excellent result.

Clinical Testing of Walking Bleach, In-Office, and Combined Bleaching of Endodontically Treated Teeth.

Objective. The causes of internal posteruptive discoloration of teeth are bleeding, necroses, infections, and endodontic filling materials. The aim of this study was to establish the results of bleaching endodontically treated teeth using walking bleach, in-office, and combined techniques, using 30% carbamide peroxide and 35% hydrogen peroxide, as well as the effect of etiological factors, and the time elapsed after endodontic treatment on the success of bleaching. Materials and Methods. The research involved 30 endodontically treated teeth in healthy patients. Retroalveolar X-rays were taken to check the quality of root canal obturation. Endodontic treatment and obturation were carried out on the discolored non-vital teeth without any previous endodontic treatment. Before bleaching, two millimeters of the filling were removed from the root canal and the very entry into the canal was protected with glass ionomer cement. The teeth were divided into three groups, depending on the bleaching technique: walking bleach technique (10 patients), in-office technique (10 patients), and combined technique (10 patients). The teeth were bleached with 30% carbamide peroxide and 35% hydrogen peroxide. The bleaching procedure was repeated in all the patients three times. The color of all teeth was determined based on the Vita Classic guide before and after bleaching. The Χ2 square and Kruskal−Wallis tests were used to identify differences in teeth bleaching results. Results. A statistically significant difference (p < 0.05) was established between bleaching success and the time elapsed after endodontic treatment. There were no statistically significant differences observed between the bleaching success and etiological factors, bleaching techniques, or bleaching agents. Conclusions. The effectiveness of non-vital tooth bleaching is affected by the time elapsed after endodontic treatment.

Biomimetic Approaches in Clinical Endodontics.

In the last few decades, biomimetic concepts have been widely adopted in various biomedical fields, including clinical dentistry. Endodontics is an important sub-branch of dentistry which deals with the different conditions of pulp to prevent tooth loss. Traditionally, common procedures, namely pulp capping, root canal treatment, apexification, and apexigonesis, have been considered for the treatment of different pulp conditions using selected materials. However, clinically to regenerate dental pulp, tissue engineering has been advocated as a feasible approach. Currently, new trends are emerging in terms of regenerative endodontics which have led to the replacement of diseased and non-vital teeth into the functional and healthy dentine-pulp complex. Root- canal therapy is the standard management option when dental pulp is damaged irreversibly. This treatment modality involves soft-tissue removal and then filling that gap through the obturation technique with a synthetic material. The formation of tubular dentine and pulp-like tissue formation occurs when stem cells are transplanted into the root canal with an appropriate scaffold material. To sum up tissue engineering approach includes three components: (1) scaffold, (2) differentiation, growth, and factors, and (3) the recruitment of stem cells within the pulp or from the periapical region. The aim of this paper is to thoroughly review and discuss various pulp-regenerative approaches and materials used in regenerative endodontics which may highlight the current trends and future research prospects in this particular area.

One Visit Endodontic with Internal Bleaching on Tooth 12 Post Trauma: A Case Report

Introduction: Post-traumatic non-vital teeth is one of the indications for One Visit Endodontic. Trauma to the teeth may arise from conditions that cause the teeth to become necrotic so that the teeth will look darker and experience discoloration. Clinical conditions that indicate the death of the dental pulp and teeth require endodontic treatment. This situation will cause discoloration of the teeth that occur as a result of the metamorphosis of calcified pulp. Internal whitening is a treatment that can be done after the first treatment. Purpose: To provide information about discolored teeth management after trauma which causes pulp necrosis by doing root canal treatment and internal bleaching to change tooth color. Case: A 31-year-old woman came to the RSKGMP Universitas Airlangga with a referral from the orthodontics department where her teeth were darker in color and interfered with her appearance. In the previous history, the patient had an accident and trauma 10 years ago. Case Management: The first step is access opening and a good glide path. Root canal preparation was performed using the Crown Down Pressureless technique. The obturation technique used is Single Cone. The results were good and there were no symptoms during the control. Conclusion: One visit endodontic can be a treatment option for post-traumatic non-vital teeth. Internal bleaching with Walking Bleach Technique is also proven effective in restoring the original tooth color without excessive reduction of the dental crown.

Evaluation of Postoperative Pain Following Sonic and Ultrasonic Root Canal Irrigation Activation Protocols in Patients with Non-vital Teeth Associated with Apical Periodontitis (Randomized Clinical Trial

Aim: Evaluate the degree of postoperative pain in patients with necrotic teeth with symptomatic apical periodontitis in mandibular first molar teeth at 6, 12, 24, 48 and 72 hrs time interval after using different irrigation activation techniques in single-visit endodontic treatment. Material and Methods: Seventy-eight patients diagnosed with necrotic mandibular first molar with symptomatic apical periodontitis were randomly allocated into 1 of 3 separate groups (n=26); Navitip group (control), EndoUltra group, or Eddy group. After a single visit root canal treatment and a specific method of agitation, depending on each group, the patients were given a questionnaire on which the patient would mark the degree of pain in a scale from 0 to 10 at 6, 12, 24, 48, 72 hours and 7 days post-obturation. Data were statistically analyzed with a significance level of P≤0.05. Results: EndoUltra ultrasonic agitation and Eddy sonic agitation as a final irrigation protocol showed significantly lower pain values than the control group, but there was no significant difference in pain values between the experimental groups. Conclusion: There was significantly less pain associated with EndoUltra ultrasonic and Eddy sonic agitation compared to Navitip irrigation

Comparative Evaluation of Postoperative Pain Following Single Visit and Two Visit Endodontic Therapy in Non-vital Teeth

Management of postoperative pain is a challenge for clinicians providing root canal therapy and a primary concern for patients as it directly affects their quality of life. Traditionally, multiple-visit endodontic treatment has been employed. In modern endodontics, single-visit endodontic therapy is becoming popular. Objectives: To compare frequency of postoperative pain following single and two-visit endodontic therapy in non-vital teeth. Methods: Randomized Controlled Trial was conducted at Operative Dentistry Department, Islamic International Dental Hospital, Islamabad. Each patient was assigned to group A or B with 140 participants in each group. Access, cleaning, and shaping were performed on the first visit. At the first visit, teeth in group A were obturated using guttapercha, whereas Group B was obturated after one week. Patients were instructed to mark the severity of pain at intervals of 6 hours, 24 hours, and 7 days after treatment. Results: 280 patients were divided into two groups of 140 each. Overall mean age and standard deviation was 27.35 + 7.18. At 6 hours, 123 group A and 119 group B patients experienced pain. 113 patients in group A and 105 patients in group B reported pain at 24 hours. On the 7th day, the number of patients in groups A and B that had pain was 8 and 7 respectively. P-value was not statistically significant. Conclusion: This study found no difference in the incidence of postoperative pain in non-vital teeth, irrespective of the number of endodontic treatment visits.

Clinical indications, complications, and outcomes of internal bleaching

Different bleaching treatments may be used to try to remove intrinsic stains and more tenacious extrinsic discoloration. Intracoronal tooth whitening, sometimes known as non-vital tooth whitening can be used to whiten teeth. By oxidizing the organic discoloration in the tooth, the bleaching treatment lightens the color of the teeth. The underlying etiology of the discoloration affects the effectiveness and efficacy of tooth bleaching. Internal bleaching is a minimally invasive and cost-effective dental technique that doesn't alter the tooth's size or position on the dental arch. Trauma can cause a tooth to become nonvital and lose its natural color without ever requiring endodontic treatment. In these situations, the first course of treatment should be a root canal. We can move forward with the internal bleaching technique if the tooth has had endodontic treatment. Before placing all ceramic restorations, an interior bleaching may occasionally be required too. Pulp chamber origin discoloration is an indication for internal bleaching. Inflammation-mediated external root resorption known as cervical root resorption can occur after trauma and after intracoronal bleaching. Another internal bleaching issue was the coronal fracture, which is thought to have been brought on by desiccation or changes to the physicochemical properties of the dentin and enamel. The absence or minimal color difference between the treated and untreated teeth has traditionally been considered a sign of immediate treatment efficacy.

Caffeic Acid Phenethyl Ester Induces Vascular Endothelial Growth Factor Production and Inhibits CXCL10 Production in Human Dental Pulp Cells.

The survival rate of root non-vital teeth is lower than that of vital teeth. Therefore, to preserve the dental pulp is very important. The vascular endothelial growth factor (VEGF) is the most potent angiogenic factor involved in the vitality of dental pulp including reparative dentin formation. Caffeic acid phenethyl ester (CAPE) is a physiologically active substance of propolis and has some bioactivities such as anti-inflammatory effects. However, there are no reports on the effects of CAPE on dental pulp inflammation. In this study, we investigated the effects of CAPE on VEGF and inflammatory cytokine production in human dental pulp cells (HDPCs) to apply CAPE to an ideal dental pulp protective agent. We found that CAPE induced VEGF production from HDPCs. Moreover, CAPE induced the phosphorylation of p38 mitogen-activated protein kinase (MAPK), extracellular signal-regulated kinases (ERK), and stress-activated protein kinase/c-Jun N-terminal kinase (SAP/JNK) in HDPCs. Furthermore, CAPE inhibited C-X-C motif chemokine ligand 10 (CXCL10) production in Pam3CSK4- and tumor necrosis factor-alpha (TNF-α)-stimulated HDPCs. In conclusion, these results suggest that CAPE might be useful as a novel biological material for vital pulp therapy by exerting the effects of VEGF production and anti-inflammatory activities.

A Study to Assess Perception of Dentist Regarding Single-Visit Root Canal Treatment at Dental Clinics In India

Introduction: Single-visit root canal treatment attempts instrumentation, disinfection and obturation of the root canal system in one visit. One of the main debates that have occurred in Endodontics is about the amount of sessions required to complete Root canal treatment. There are very different philosophies regarding this matter. Objective: the aim of this study was to investigate the General Dentists point of view regarding single visit root canal treatment, identifying the basis on which the choice is made and how the information necessary for the choice is acquired. Material and methods: 100 registered Dentists in the dental practice were contacted, and if they agreed to participate, they were send a questionnaire. The following topics were addressed: demographics, current clinical procedures, treatment rationales and preferences. Results: Majority 60 % of the dental practitioners responded vitality of pulp was the reason for choosing the single-visit RCT followed by patient’s choice 22%, patent and normal roots 11 %, non-vital tooth with sinus 5 % and other reasons 2 % respectively Conclusion: It can be concluded that when pulp vitality is not compromised there is an increase in the number of dentists who choose single visit root canal treatment.

The Efficacy of Advanced Platelet-rich Fibrin in Revascularization of Immature Necrotic Teeth

The present study aims to compare advanced platelet-rich fibrin (A-PRF) and conventional blood clot as scaffolds in the regenerative endodontic procedure (REP) and to evaluate their effectiveness in the development of traumatized nonvital immature teeth roots. Regenerative endodontic procedure was carried out on 20 traumatized nonvital immature maxillary incisors of 17 patients between the ages of 8 and 12 years. Irrigation with 1.5% sodium hypochlorite (NaOCl) and 17% ethylene diamine tetra-acetic acid was done following minimal mechanical debridement. Canal disinfection was achieved using calcium hydroxide paste. According to the scaffold type, teeth were randomly allocated into A-PRF (n = 10) and conventional blood-clot groups (n = 10). Apical width and root dimensions (length and thickness) were analyzed radiographically and statistically after 3-, 6-, and 12-month follow-up. Fifteen patients with 18 teeth (A-PRF n = 9, blood clot n = 9) completed the follow-up, and 2 patients were excluded. Patients in both groups were asymptomatic. There was a significant increase within each group in respect to root length, root thickness at one- and two-thirds, and root apex width for all timepoints. While percent of change between the two groups was statistically insignificant. Regenerative endodontic procedure for traumatized immature nonvital teeth with either conventional blood clot or A-PRF as scaffold was comparable, except in cases where adequate bleeding cannot be achieved. Advanced platelet-rich fibrin provides a suitable scaffold that can be used in REP of teeth with close proximity to vital structures such as inferior alveolar nerve (IAN) or mental nerve, where using a sharp instrument to induce bleeding can cause damage and also in cases where adequate bleeding cannot be achieved.

A Total of 1,132 All-Ceramic Single-Tooth Restorations Show Acceptable Survival Rates up to 15 Years in a Non-University Setting.

To evaluate the long-term survival of IPS Empress 2 and IPS e.max (Ivoclar Vivadent) restorations in a non-university setting. A retrospective study design was used to evaluate the survival rate of 1,132 Empress 2 and IPS e.max restorations placed in 251 patients with regard to patient age, gender, tooth type, tooth vitality, material, restoration form (inlay vs partial crown vs crown), cementation mode (self-adhesive vs non-self-adhesive), and bruxism activity. Kaplan-Meier and regression analyses were used for statistical analyses. Of the 1,132 restorations, a total of 15 (IPS e.max = 3, Empress 2 = 12) failed. The overall survival rate for all restorations was 98.7% after 15.4 years. A significantly reduced survival rate was found for nonvital teeth (P = .002), patient age > 60 years (P = .002), crowns (vs inlays and partial crowns; P = .002), and self-adhesive resin materials (P = .018). Within the limitations of this study, glass-ceramic single-tooth restorations made of Empress 2 and IPS e.max show good survival rates up to a period of 15 years.

The Effect of Etiology on the Function of Hertwig\'s Epithelial Root Sheath in Regenerative Endodontic Procedures—A Review of Literature

AbstractThe management of nonvital immature permanent teeth poses quite a challenge. The apexification procedure is in use for long-term now but the treated teeth are more prone to fracture questioning the long-term prognosis of this technique. The introduction of regenerative procedures for the treatment of these teeth is quite favorable; however, despite the increasing use of regenerative endodontic therapy procedures, inconsistent results are seen in the root development. Conservation of Hertwig's epithelial root sheath may have a prime role and selecting the cases with viable root sheath may impact on the consistent positive results treated with regenerative procedures. This article aims to look at the database to find the role of etiology and its implication on Hertwig's epithelial root sheath in the outcome of regenerative endodontics.

A 5-year retrospective study of computer aided design and computer aided manufacturing ceramic endocrowns in endodontically treated posterior teeth

Objective: To evaluate the clinical outcomes of computer aided design and computer aided manufacturing (CAD/CAM) ceramic endocrowns in endodontically treated posterior teeth after five years by a retrospective study. Methods: Patients who received CAD/CAM ceramic endocrowns after endodontically treatment in Department of Endodontics, School of Stomatology, The Fourth Military Medical University between January 2016 and June 2017 were invited for this clinical study. Clinical performance was evaluated in the aspect of color match, anatomic form,marginal adaptation, restoration integrity and secondary caries. Survival rate of the restorations was calculated by the use of Kaplan-Meier method. Log-rank test was applied as well for the sake of analyzing the effect of tooth position, sex and materials to the survival rate of the restorations. Results: Seventy-four patients, 25 men and 49 women with age of (38.8±10.2) years, participated in this study for a total of 101 CAD/CAM ceramic endocrowns after observation period of (62.8±12.0) months. There were 8 failed cases among 101 restorations, 5 were loss of retention, 2 were ceramic fracture and 1 was secondary caries respectively. In particular, 93% (89/96) restorations got score A on anatomic form and 95% (91/96) restorations got score A on marginal adaptation, while 38% (36/96) restorations showed the good color match compared with the abutment teeth. The estimated cumulative survival rate of CAD/CAM ceramic endocrowns in endodontically treated posterior teeth after 5 years was 93.0% (95%CI: 87.9%-98.1%). The single-factor Log-rank analysis demonstrated that there was no statistically significant difference in the survival rate of CAD/CAM ceramic endocrowns among men and women, premolars and molars, position in the dental arch, or different materials (χ²<0.01, P=0.957; χ²=0.64, P=0.422; χ²=0.69, P=0.407; χ²=0.88, P=0.349). Conclusions: Based on this clinical study, the clinical performance of CAD/CAM ceramic endocrowns in endodontically treated posterior teeth after five years is reliable, which could be a general option to restore nonvital teeth.

Clinical outcomes of single crown and 3-unit bi-layered zirconia-based fixed dental prostheses: An upto 6- year retrospective clinical study: Clinical outcomes of zirconia FDPs

ObjectivesThe aim of this retrospective clinical study was to evaluate the survival and the occurrence of technical and biological complications in bi-layered zirconia-based (Zi) single crown and 3-unit fixed dental prostheses (FDPs). Also, the study aimed to analyze the effects of tooth vitality (vital versus non-vital), abutment location (anterior versus posterior), and luting cement (self-adhesive resin versus resin-reinforced glass ionomer) on clinical outcomes. MethodsA total of 147 prostheses (in 94 patients) placed by undergraduate dental students in a university dental center during the period 2015–2021 were examined clinically using modified United States Public Health Service (USPHS) and California Dental Association (CDA) criteria. The mean duration of follow-up was 37 months (range, 6 - 63 months) for the single crowns (n = 77) and 25 months (range, 6 - 68 months) for the 3-unit FDPs (n = 70). Data were descriptively analyzed to determine the types and rates of complications based on USPHS and CDA criteria. The Kaplan-Meier survival estimation method was used to determine the cumulative survival and success rates of the prostheses (α=0.05). Differences in clinical outcomes (survival or failure) according to tooth vitality, luting cement, and location were statistically analyzed using cross-tabulations and Х2 test (α=0.05). ResultsThe Kaplan-Meier cumulative survival rate was estimated as 96% for the Zi 3-unit FDPs after 5.5 years, and 90% for the Zi single crowns after 4.8 years. The 5-year estimated success rate was 68% for both 3-unit FDPs and single crowns. Seven (9.1%) 77Zi single crowns and 70 2 (2.9%) Zi 3-unit FDPs were recorded as failures with occlusal roughness being the most commonly-observed complication (crowns: 4 [5.6%]; 3-unit FDPs: 8 [11.4%]). In terms of clinical outcomes, statistically significant differences were found between all included vital and non-vital teeth (p = .006), and cement types (p = .028). Taking single crowns alone, significant differences in clinical outcomes according to tooth vitality were noted (p = .036), but not for PFDPs. The location of the prostheses did not produce any significant differences in the clinical outcomes, for both prostheses types independently or combined (p > .05). ConclusionsThe estimated cumulative survival rates in this study for single crowns and 3-unit Zi FDPs concurred with the ranges reported in systematic reviews. Zi-based prostheses on vital teeth produced better clinical outcomes than those placed on non-vital teeth, and type of luting cement influenced the final clinical outcome. Clinical significanceZi crowns and 3-unit PFDPs fabricated using the specific CAD-CAM system used in the controlled environment of this study showed good clinical performance with minimal veneer porcelain chipping. Root canal treated teeth seem to be at higher risk for failure of Zi prostheses compared with vital teeth.

Dentigerous cyst enucleation

Dentigerous cyst is a type of odontogenic cysts and generally occurs in the ages of twenties or thirties. Dentigerous cyst always includes a tooth which cannot complete the eruption process and occurs around the crown by the fluid accumulation between the layers of enamel organ. In rare cases, dentigerous cyst occurs in the first decade of life and develops in an immature permanent tooth as a result of a chronic inflammation of overlying nonvital primary tooth. In this report, a case of dentigerous cyst in primary dentition in a 9-year-old child patient and its treatment were presented. The standardized treatment for a dentigerous cyst is enucleation and extraction of the involved tooth. In cases of larger cysts, an initial marsupialization to diminish the size of the osseous defect, followed by enucleation and tooth extraction, has been advocated. However, if the patient is a child and the cyst is small, removal of cystic lining followed by extraction of deciduous tooth usually results in disappearance of the cyst and preservation of the permanent tooth. When dealing with larger lesions, enucleation and tooth extraction have been favored. This can lead to functional, cosmetic, and psychologic consequences for the child.

Outcomes reporting in systematic reviews on revitalization: A scoping review for the development of a core outcome set.

Revitalization is a type of regenerative endodontic treatment (RET) that offers the exciting prospect of revitalizing damaged tissue, therefore improving outcomes for non-vital immature teeth. To evaluate its potential, there needs to be consistency in outcome reporting of clinical studies investigating revitalization to allow for evidence synthesis and inform clinical decision making. The aim of this scoping review was to identify outcomes that are reported in systematic reviews on revitalization including how and when these outcomes are measured. Additionally, evidence of selective reporting bias in the reviews was assessed. A comprehensive electronic search of healthcare databases and grey literature was conducted to identify systematic reviews published in the English language reporting outcomes of revitalization in permanent immature teeth. There was no restriction on the date of publication. Outcome data was extracted by four reviewers independently and mapped with a healthcare taxonomy into five core areas: survival, clinical/physiological changes, life impact, resource use and adverse events. Selective reporting bias and how it was measured was assessed independently by two reviewers. Twenty-six systematic reviews were included in this scoping review. There was lack of standardization in reporting and significant heterogeneity across reviews in outcome endpoints. The outcomes reported could be aligned within the five core areas of the taxonomy including tooth survival which was reported in nine reviews. Patient-reported outcomes were generally limited and no review reported on Oral Health Related Quality of Life. Many of the reviews reporting on randomized control trials were at low risk of selective reporting bias whilst other study designs were at higher risk. Consistency in outcome reporting is necessary to realize the benefits of old but particularly novel therapies. Data from this review confirmed heterogeneity in reporting outcomes of revitalization and the need for development of a core outcome set (COS). Several important outcomes including survival, root development, tooth discolouration and periapical healing have been identified in this review which could inform the development of a COS in this area. Core Outcome Measures in Effectiveness Trials (COMET) database (registration no. 1879).

Malunion of Mandible Fracture: A Case Report

Radicular cysts are the most common odontogenic cystic lesions of jaws. They are asymptomatic lesions associated with the root apex of a non-vital tooth that slowly progresses rarely to large symptomatic swelling. Here we describe a patient with large radicular cyst involving maxillary sinus secondary to traumatized non-vital tooth 21 treated by surgical enucleation. Key words: Maxillary sinus, Radicular cyst, Surgical enucleation

Amelogenin as a regenerative endodontic molecule for immature teeth with apical periodontitis. An experimental study.

Vitality of the dentin-pulp complex depends on cell activity and signalling processes. Amelogenin protein regulates cell signalling pathways during tooth development by activating the Wnt/β-catenin intercellular signalling pathway. This study aimed to regenerate a vascularized pulp using recombinant amelogenin protein, in necrotic root canals by cell homing. Access opening was performed for a total of 120 root canals and were left open to become contaminated with oral microbes for 14 days then cleaned. Canals were divided into 2 groups; in the First group, the canals were filled with amelogenin, while in the 2nd group the canals were left empty. Samples were evaluated histologically and with immunodetection of Sox2, Oct4, Vascular endothelial growth factor (VEGF), Wnt1a, Wnt 3a, Wnt 10b, and Glial Fibrillary Acidic Proteins (GFAP). IC50 was used to determine the cytotoxicity of amelogenin. Regenerated dense cellular tissue was seen in the apical part of amelogenin-treated root canals, and regenerated delicate vascularized tissue was observed in the radicular and pulp chamber. Cells found in the regenerated soft tissue expressed Wnt family members that regulate stem cell pluripotency. Also, Sox2 and Oct4, Pluripotency markers, could be identified in the newly formed apical papilla and dental follicle. Furthermore, VEGF in the regenerated pulps indicated neovascularization. While the GFAP immune reactivity demonstrated that the neuro-sensory organ was being replicated in the regenerated dental pulps. Finally, IC50 test showed that recombinant amelogenin protein has a safe dose at high-level concentrations. Recombinant amelogenin protein induces pulp regeneration most likely from the Sox2 identified stem cells within the apical papilla and can enhance apex formation in non-vital immature teeth.