Nonvital Pulps Research Articles

Effect of sublingual fast-dissolving piroxicam premedication on postoperative pain experience in mandibular molars with non-vital pulp: a randomized double-blind controlled trial

BackgroundThe aim of this trial was to evaluate the effect of a preoperative, single dose sublingual fast-dissolving piroxicam (20 mg) compared to placebo on postoperative pain at rest (POP), on biting (POPB) and on percussion (POPer) after single-visit endodontic treatment of asymptomatic mandibular molars with non-vital pulp.MethodsSeventy patients randomly received either piroxicam or placebo 1 h before treatment (n = 35). Patients recorded their pain (POP and POPB) level 6 h, 12 h, 24 h, 48 h, 72 h and 7 days postoperatively using an 11-point numerical rating scale; POPer was assessed after 7 days. Resuce-analgesic intake (RAI) and flare-up incidence (FUI) were recorded. Data were statistically analyzed.ResultsBoth groups had similar baseline characteristics (P > 0.05). Piroxicam showed less POP intensity and incidence than placebo at 6, 12 and 24 h, less POPB intensity and incidence at all timepoints, less POPer intensity and incidence and less RAI (p > 0.05), but similar FUI (P > 0.05). A significant rise in pain compared to baseline occurred with placebo from 6 to 72 h for POP and to 7 days with POPB (p > 0.05); such rise was not detected with piroxicam. POPB showed higher pain intensity than POP at all time points (p < 0.05). No swelling or adverse effects occured.ConclusionsA preoperative single dose of sublingual fast-dissolving piroxicam can be effective in reducing spontaneous pain up to 24 h, stimulated pain up to 7 days, and RAI incidence in asymptomatic mandibular molars with non-vital pulp; it can prevent rise in POP and POPB postoperatively. Stimulated postoperative pain can be more severe and longer lasting than spontaneous pain.Trial registrationClinicaltrials.gov ID: NCT03998826 (2019).

Assessment of Periodontitis Risk Factors in Endodontically Treated Teeth: A Cross-Sectional Study.

The aim of the study was to collect data about the prevalence and risk factors of apical periodontitis in a population of endodontically treated patients. The study group included 151 patients (52 males, 99 females; mean age 48.36 ± 15.708 yrs.) with 391 endodontically treated teeth (mean follow-up of 5.25 ± 1.759 yrs.). According to the initial tooth diagnosis, root-filled teeth were divided into Group A, root-filled teeth treated for pulpitis or for the purpose of prosthetic pulpectomies (vital pulp group), and Group B, root-filled teeth with non-vital pulp (necrotic pulp). Clinical and radiographic evaluation of the root and its periapical area were performed to establish the success/failure of endodontic therapy, the quality of the root canal fillings (length, density, taper), and coronal restoration. The presence of recurrent caries, periodontal pathology, or endo-periodontal lesions were also recorded. Univariate and multivariate analyses were used to determine the risk factors for apical periodontitis and calculate their odds ratios (ORs). For the root-filled vital pulp tooth group, the highest risks for apical periodontitis are associated with inadequate homogeneity (OR 30.938), periodontitis (OR 9.226), and over-filling (OR 8.800). For the root-filled non-vital pulp tooth group, the highest risks are associated with periodontitis (OR 4.235) and age over 60 yrs. (OR 4.875). For the necrotic pulp tooth group, multivariate analysis identified an age > 60 yrs., filled molars, intracanal posts, poor coronal restoration quality, under-filling, and periodontitis as significant combined risk factors. Inadequate root canal filling and periodontitis in both groups were risk factors associated with most cases of apical periodontitis. Other risk factors include age > 60 yrs., poor coronal restoration quality, and the presence of intracanal posts in root-filled teeth with necrotic pulp.

Effect of a Long-Acting NSAID Premedication on Postendodontic Pain in Mandibular Molars with Non-vital Pulp: A Preliminary Randomized Controlled Trial

Effect of a Long-Acting NSAID Premedication on Postendodontic Pain in Mandibular Molars with Non-vital Pulp: A Preliminary Randomized Controlled Trial

Comparison of the Postoperative Pain Following Endodontic Irrigation Using 1.3% Versus 5.25% Sodium Hypochlorite in Mandibular Molars with Necrotic Pulps

Endodontic irrigation plays a crucial role in root canal treatment, aiming to disinfect the root canal system be removing debris, bacteria and tissue remnants. Objective: To compare the postoperative pain between two concentrations (1.3% and 5.25%) of irrigation using sodium hypochlorite (NaOCl) in lower molars with necrotic pulps. Methods: Sixty patients with nonvital pulps in mandibular molars, either gender, mature teeth with a closed apex or age between 18 and 60 years were included. Patients were assessed for postoperative pain in each group at 24 hours. The Chi-square test and student t-test were used to compare the postoperative pain outcome of both groups. Results: The mean age of the patients in group A was 33.76 ± 4.06 years, and in group B was 32.10 ± 5.84 years. Pre-operative pain was statistically insignificant in both groups (p = 0.123), with an average VAS of 3.16 ± 0.64 in group A and 3.40 ± 0.49 in group B. The average pain was significantly lower at 1.33 ± 0.47 in the 1.3% sodium hypochlorite group compared to 1.63 ± 0.66 in the 5.25% NaOCl group (p = 0.051) after 24 hours. The average post-operative pain score was significantly higher in females compared to males in the 1.3% NaOCl group (p = 0.033). However, the average post-operative pain score was statistically insignificant between males and females in the 5.25% NaOCl group (p = 0.445). Conclusion: Endodontic irrigation using 1.3% NaOCl was found to be more effective in reducing post-operative pain compared to endodontic irrigation using 5.25% NaOCl.

What is new in the 2023 European Society of Endodontology S3-level clinical practice guidelines?

The European Society of Endodontology published in 2023, the S3-level clinical practice guidelines, which supersede the Quality Guidelines for Endodontic Treatment published in 2006. This review aims to summarize and compare the above guidelines to support their dissemination. A narrative synthesis of the main differences alongside tabulation according to the main themes. Three tables were prepared according to the following themes: diagnosis of pulpal and apical condition; treatment of pulpitis; and treatment of nonvital pulp and apical periodontitis. A compared and simplified message regarding the most recent clinical practice guidelines has been prepared. Not applicable as a narrative review.

Endodontic Applications of Propolis in Primary and Permanent Teeth: A Scoping Review of Clinical Studies.

The use of propolis-based materials within endodontics to promote pulp wound healing or disinfect the root canal system has been a recent focus of scientists and clinicians. This is mainly because of the well-documented antimicrobial, anti-inflammatory, immunomodulatory and wound healing properties of propolis. This scoping review critically appraises the literature on the clinical applications of propolis-based compounds during endodontic therapy of primary and permanent teeth. An electronic literature search was performed in Scopus, PubMed, and Web of Science up to and including October 2023 to identify studies assessing the use of propolis during endodontic therapy of primary and permanent teeth. A combination of relevant MeSh terms and keywords was used. Only human clinical studies written in English were included. The identified manuscripts were screened and assessed for inclusion by two independent authors. Eligible manuscripts were then subjected to critical appraisal and data extraction with the information being summarised according to their clinical application. A total of 26 human clinical studies were identified and included in the analysis. Propolis was investigated for use in the primary and permanent dentitions as a direct pulp capping or pulpotomy material as well as in root canal disinfection and root filling of teeth with non-vital pulps. Overall, the studies reported that the use of propolis was associated with promising outcomes in terms of efficacy to control inflammation, enhance tissue repair, and disinfection of the root canal system. However, a critical appraisal of the studies revealed a range of methodological and reporting deficiencies, resulting in unreliable results and conclusions in terms of the clinical outcomes reported. Although the studies on the use of propolis-based materials in endodontics reported promising clinical outcomes, they had a range of methodological and reporting flaws. Further well-designed and properly reported controlled clinical studies are essential to derive sound evidence-based conclusions on propolis-based materials. Furthermore, guidelines for quality assurance and safe use of propolis-based materials are necessary to enhance their production for commercial use in endodontics.

Cytokine expression of IL-8 before and after root canal treatment in patients with symptomatic apical periodontitis: A clinical trial.

Thirty-six patients were allocated according to their pulp status into two experimental groups (n = 18) receiving the same treatment protocol; group 1: Vital pulps with SAP, and group 2: non-vital pulps with SAP. Conventional endodontic treatment was done on two visits; isolation and disinfection of the operative field were undertaken, and two-stage access cavity preparation was implemented. The first pre-instrumentation peri-apical sample (S1) was collected prior to cleaning and shaping procedures. A 2.5% NaOCl irrigation was used to thoroughly irrigate the canal after performing root canal preparation utilising the ProTaper Next (PTN) rotary system. After 1 week, the second post-instrumentation peri-apical sample (S2) was collected. Using an ELISA kit, the quantity of IL-8 was evaluated following the collection of all samples. In all pre-instrumentation samples, IL-8 was detected (100%). The level of IL-8 expression was significantly decreased from the S1 to S2 of all samples (p < 0.001). The intra-group comparison showed a statistically significant reduction in the level of IL-8 expression between S1 and S2 in both vital and non-vital groups where p < 0.001* in both groups. The inter-group comparison of levels of IL-8 expression (vital and non-vital) revealed a significant difference between both groups regarding the pretreatment sample with the higher levels of IL-8 shown in the non-vital group (p < 0.001). While in the post-treatment sample, both groups showed a significant reduction in the level of IL-8 expression but the difference between them was not statistically significant (p = 0.226). Root canal instrumentation seems to be efficient in decreasing the levels of anti-inflammatory cytokines, namely IL-8. Further research should clarify how intra-canal medicaments affect inflammatory mediator levels.

Does the rehabilitation treatment predispose the patient with cleft to endodontic treatment?

Aim: to verify the relation between endodontic treatment of teeth adjacent to the cleft area and the rehabilitation of patients with unilateral cleft lip and palate, at the Hospital for Rehabilitation of Craniofacial Anomalies. Methods: the present split-mouth study was composed of 406 individuals with complete unilateral cleft lip and palate who had completed the rehabilitation process in a single tertiary cleft center (55.9% males). The information was collected from the dental history on the patients’ records and radiographs. The frequency of endodontic treatment in the upper incisors and canines was calculated for the cleft and non-cleft sides. The comparison between sides was performed by the chi-square test (p &lt;0.05). Results: endodontic treatment was more frequent in teeth adjacent to the cleft than in contralateral teeth. The frequency of endodontic treatment in at least one tooth adjacent to the cleft was 18.97%, and 11.6% on the contralateral side. It was observed that endodontic treatment was necessary in 63.5% of patients who had been submitted to orthodontic treatment, 42.4% of those rehabilitated with fixed partial dentures and 12.0% of patients who underwent dental reshaping of teeth adjacent to the cleft. The treatments performed included vital pulp therapy (46.1%), non-vital pulp therapy (46.8%) and endodontic retreatment (7.1%). Conclusion: in individuals with complete cleft lip and palate, teeth close to the bone defect area and used for rehabilitation treatment presented greater need of endodontic intervention.

Unusually Large Radicular Cyst of Mandible: A Rare Case Report

A radicular or periapical cyst or periradicular cyst is the most common odontogenic cyst mostly seen in mandible. It is mostly symptomless and are found accidently during periapical radiographs involving non-vital pulp which heals spontaneously after endodontic treatment of the aberrant tooth or after extraction. However, recommended treatment is complete enucleation of the cyst to remove all the epithelial remnants. In this article, we report a case of a 18year old female patient with large periapical cyst along with deep bite and attrition.

Clinical and Antimicrobial Efficacy of Garlic Extract and Formcresol as a Non-vital Pulp Therapy Medicament in Primary Teeth Wael Mahmoud

Clinical and Antimicrobial Efficacy of Garlic Extract and Formcresol as a Non-vital Pulp Therapy Medicament in Primary Teeth Wael Mahmoud

Pulp Therapy of Primary Dentition; its Relevance despite Insufficient Histological Evidence: A Review.

Pulp treatment in primary dentition is generally divided into vital and non-vital pulp therapies and assists in the preservation of pulpally involved primary teeth in the dental arch until the affected tooth naturally exfoliates. The success of pulp therapies depends on several factors; e.g. proper case selection, accurate diagnosis and good coronal seal. To date, studies on the success and failure rates of pulp treatments are based on clinical signs and symptoms, radiographic findings and histological analysis. However, the clinical and radiographic evidence may not completely portray the true status of the dental pulp. Histological evidence remains the gold standard in the assessment of pulp condition, whether it is in a healthy or adverse state. The aims of the current research were to summarise the treatment outcomes of pulp therapy in primary dentition based on clinical, radiographic and histological criteria, and to support its relevance in the presence of limited histological evidence to measure authentic treatment success. An electronic database search of dental literature from 1990 to 2022 was carried out using the MEDLINE, i.e. PubMed, database. Current dental literature showed that the success rates of primary tooth pulp therapy are high. The obtained results were based largely on clinical and radiographic studies with narrow histological investigations to assess the treatment outcome(s) of pulp therapy in primary dentition. Despite the scarcity of histological evidence, pulp therapies in primary teeth are still practical due to their statistically empirical success compared to their failure. Consequently, pulp therapy of primary dentition is still relevant, and should continue to be indicated as an important treatment option.

Lesion sterilization and tissue repair (LSTR) method in irreversible dental pulp changes of primary teeth

Background/Aim: Deep carious lesions on primary teeth usually have been causing infectious dental pulp changes. If indicated, traditional endodontic root canal treatment for these kinds of pulpal infections in primary teeth usually should involve the performing of pulpectomy methods, but often with questionable prognosis. The lesion sterilization and tissue repair (LSTR) approach is one of the good endodontic therapeutic alternatives for affected primary teeth with a poor prognosis, which could otherwise be condemned to premature extraction. Aim was to evaluate the medium-term clinical success in everyday practice of the LSTR method applied in affected primary teeth with irreversible pulpal tissue infections by observation of reduction/absence of their clinical symptoms. Material and methods: The study sample included child patients who had one or more of their affected primary molars with irreversible pulpal tissue changes of poor prognosis treated with the LSTR method. For each patient whose primary molar tooth was endodontically treated with the LSTR method a clinical evaluation of treated tooth was performed at intervals of 1 and 12 months afterwards. Results: Study sample was consisted of 40 child patients aged 4 to 9 years, with 45 primary molars included in total. It was obvious that the symptoms related to affected sample teeth have already been decreased almost immediately after initial action of triple antibiotic paste. Final outcome after 12-months follow-up period was success of applied LSTR method in 43 (95.6%) affected sample teeth in a way that initial clinical symptoms completely decreased and disappeared. Conclusions: LSTR method has been shown as successful pulpotomy technique for noninstrumental endodontic approach in non-vital pulp treatment of primary molar teeth in a 12-months follow-up period.

A Comparative Study of Surgical and Non-Surgical Interventions for the Management of Radicular Cysts

Background: Periapical cysts are slow-growing cysts that are often asymptomatic until they become secondary infections. Periapical cysts are seen in the periapical region. The choice of therapy may be influenced by a number of criteria, including the extent of the lesion, its connection to important structures, its point of origin, clinical features, the patient's level of cooperation, and the patient's overall health. As a result of this, the current research was carried out to evaluate the effectiveness of surgical and non-surgical intervention in the treatment of radicular cysts.Materials and Methods: The investigation included a total of 28 instances, 20 of which were men and 8 of which were females. All of the patients exhibited gradually growing swelling in the anterior area. Clinical examination and radiographs of all of the patients produced conclusive evidence of the presence of a radicular cyst. Both the non-surgical intervention group and the surgical intervention group received an equal share of the overall group. For the purpose of analysis, a t-test on independent samples and a Chi-square test were carried out.Results: The non-surgical group had a mean radiographic lesion of 1.78 + 0.1 and 0.44 + 0.11 at the first and sixth months, respectively, whereas the surgical group had a mean lesion of 1.22 + 0.11 and 0.21 + 0.12. The p values for the two groups, which showed a statistically significant difference, were P = 0.01 and P = 0.00, respectively. After one month, 11 patients in the surgical group were extremely pleased, and after six months, patients in both groups were very satisfied. However, the degree of satisfaction did not demonstrate a significant amount of relevance. The number of patients in the surgery group who had severe pain was somewhat higher than in the non-surgical group; however, after the first month, pain was much less severe in the surgical group as compared to the non-surgical group.Conclusion: Combination procedures, such as the root canal, apicoectomy and decompression or marsupialization , have superior results in treating radicular cysts with non-vital pulp than using each one of these procedures alone.

Does ultrasonic activation of irrigation during endodontic therapy improve the clinical and microbiological effects?

Data sources A comprehensive collection of databases were searched from inception to August 2020, such as Cochrane, MEDLINE, Scopus and Web of science. Also, references and citations of retrieved records, conference proceedings and leading journals were searched.Study selection All randomised clinical trials on root-canal-treated adult permanent teeth that compared the outcomes of ultrasonically activated irrigation (UAI) to syringe irrigation (SI) were eligible. The outcomes considered were post-operative pain, pain intensity, periapical healing after 12 months, the incidence of microbial presence, microbial quantification, lipopolysaccharides (LPS) quantification and lipoteichoic acid quantification. Studies with insufficient data for risk of bias assessment or other outcomes were excluded.Data extraction and synthesis The two independent reviewers did the screening process in title, abstract and full-text assessment steps. Also, the data extraction process and risk of bias assessment were done by two independent reviewers. Any disagreement was resolved by consensus or the opinion of a third reviewer. Any missing information was filled in by contacting the authors. The Cochrane risk-of-bias tool for randomised trials was used to assess the risk of bias. The following domains were evaluated for risk of bias: randomisation process, deviation from the intended interventions, missing outcome data, outcome measurement and the selection of the reported results. If all domains were rated as 'low risk', judgements would be rated as 'low risk', otherwise, 'high risk'. The risk ratios and mean risk difference with 95% confidence interval (CI) were used as measure effect. The random effects model was used to combine the effects. The heterogeneity is measured by I2 test (I2 test >50% and p <0.1 considered as substantial heterogeneity). The level of certainty of evidence for clinically important outcomes was determined using the guidelines of Grading of Recommendations Assessment, Development and Evaluation working group.Results Four studies entered the meta-analysis stage based on pain outcomes. The overall risk of bias for three of them was assessed as high. All of them had examined pain incidence before 24 hours but only two studies have examined the occurrence of pain in the period of 24-72 hours and after 72 hours to 7 days. Considerable heterogeny was among the incidence of pain <24 hours between studies (I2= 83%). Therefore, the incidence of pain in two sub-groups of vital and non-vital pulp has been investigated. In the non-vital pulps, the incidence of pain by UAI was half of the incidence of SI pain (relative risk= 0.50; 95% CI 0.35-0.71; I2 = 0%; 308 teeth). But no significant difference was seen in vital pulps. Also, there was no significant difference in the occurrence of pain after 72 hours between the two methods. Two studies assessed the intensity of pain in three periods: <24 hours, 72-24 hours, more than 72 hours and less than 7 days. The combined results based on vital and non-vital groups resulted in no significant difference in any period. Pooled data of pain outcomes were assessed with very low or low confidence of evidence.Five studies with microbiology-related outcomes entered the final analysis stage. The overall risk of bias for two of them was high. Three studies evaluated the effect of the irrigation method on microbial presence as an outcome. High heterogeneity was among the results of the studies (I2= 72%). However, with and without subgroup analysis, meta-analysis results showed no significant difference between these two methods. A lower microbial count was found with UAI than SI in a meta-analysis of four studies (standardised mean difference-pooled - 0.40; 95% CI [-0.78, -0.02]; I2 = 0%; 126 teeth). Two studies measured LPs. The meta-analysis showed lower values of LPS with UAI compared to SI (34, 37) (mean difference pooled - 0.06; 95% CI [-0.11, -0.01]; 61 root canals; I2 = 29%). One study measured lipoteichoic acid and found no significant difference between the irrigation methods.Three studies with treatment-success-related outcomes entered the meta-analysis stage with an overall high risk of bias. Two studies' pooled data revealed no significant difference between the irrigation methods regarding treatment failure. One study assessed periapical-lesion volume after treatment and found no significant difference between the irrigation methods.Conclusions According to limited data, UAI may reduce the risk of post-operative pain during the first 24 hours and reduce microbial counts, particularly cultivable germs in cases of apical periodontitis. However, most meta-analyses are conducted on a small number of studies and have an overall 'very low' to 'low' certainty of evidence; as a result, the evidence is deemed insufficient to either support or disprove UAI efficacy when compared to SI.

Long-Term Outcome of Nonvital Immature Permanent Teeth Treated With Apexification and Corono-Radicular Adhesive Restoration: A Case Series

IntroductionThis study aimed to evaluate the long-term outcome of 16 permanent maxillary central incisors with nonvital pulps and open apices treated with apexification and corono-radicular adhesive restorations, within a follow-up span of 5 to 22 years. MethodsFourteen patients providing a total of 16 teeth treated with mineral trioxide aggregate (n = 12), Biodentine (n = 3), or β-tricalcium phosphate (n = 1) apical barrier and corono-radicular restoration, with or without fiberglass post, were included. Clinical and radiographic criteria were defined for assessment at recall. Restoration and periapical tissue status evaluation were performed according to FDI World Dental Federation's esthetic, functional, and biological criteria and Ørstavik Periapical Index (PAI). Outcome was dichotomized as “healed” (PAI ≤ 2, asymptomatic with absence of signs of infection) or “not healed” (PAI ≥ 3, presence of clinical signs and/or symptoms). ResultsFourteen of 24 patients were available for the present study (recall rate = 58%). Within a follow-up of 5 to 22 years, 10 (62.5%) teeth were considered “healed,” fulfilling both strict clinical and radiographic success criteria. Only 1 tooth was missing due to root resorption and 1 patient was presenting with clinical signs and symptoms at recall, resulting in a survival rate of 93.8%. ConclusionsAdhesive corono-radicular restoration in nonvital permanent immature teeth treated with apexification allows for favorable long-term outcomes, by ensuring structural reinforcement and coronal microleakage prevention. Teeth sustaining a substantial loss of coronal structure may require post/core placement. In the case of failure, this endodontic-restorative combination ensured teeth survival until growth phase conclusion, thus allowing for proper prosthetic rehabilitation approaches.

Comparison of Mineral Trioxide Aggregate and Biodentine for Open Apex Management in Children with Nonvital Immature Permanent Teeth: A Systematic Review

AbstractTricalcium silicate cements have long been used in dentistry for management of open apex. Biodentine was introduced to overcome the disadvantages of mineral trioxide aggregate (MTA). The aim of this systematic review was to compare the success rates of biodentine and MTA as a material of choice for the management of open apex in children with nonvital immature permanent teeth. PubMed/Medline, Scopus, EMBASE, Cochrane, and Google Scholar were searched until November 30, 2021, with the search terms young permanent teeth, immature permanent teeth, open apex, MTA, and biodentine. Based on the inclusion criteria, the articles were selected following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and assessed for quality using a risk-of-bias assessment tool. The outcomes of the studies were qualitatively synthesized. A total of 379 studies were identified and after refinement only two studies met the eligibility criteria. Both the studies were performed in children with nonvital pulp status. One of the studies showed a clinical success of 91.66% for MTA and 100% for biodentine in revascularization cases while the other study showed 100% for both the materials in apexification cases. Radiographic success was 100% for both the materials at the end of the follow-up period in both the studies. Treatment modality can create heterogeneity that does not allow making a pooled conclusion for the two materials collectively, which is the case in this review where one study used revascularization, while the other used apexification. An overall high risk of bias was noticed for the selected studies. With high risk of bias and low quality of evidence, a strong definitive conclusion cannot be arrived at. Further studies with proper randomization and minimal risk of bias are required to provide a conclusive result. However, as per the included studies, biodentine can be a material of choice for revascularization while both MTA and biodentine can be used for apexification procedures.

Pulp therapy and root canal treatment techniques in immature permanent teeth: an update.

Background According to the Children's Dental Health Survey 2013, around one in ten children in Wales, Northern Ireland and England will have sustained dental trauma to a permanent incisor by the of age 15. Management of an exposed pulp in an immature permanent incisor is often urgent and has an impact on the long-term outcome of the tooth; therefore, it is essential that general dental practitioners feel confident in managing such a scenario to achieve an optimal outcome. This paper discusses the indications, technique, materials and outcomes.Aims This article aims to review the literature, which discusses various treatment modalities and materials for pulpal therapy and root canal treatment in the immature permanent tooth.Method Electronic searches were limited to English language, human studies, published within the past five years and the medical subject heading terms used were: direct pulp capping, apexogenesis, Cvek pulpotomy, full pulpotomy/pulpectomy, partial pulpotomy, apexification, non-vital pulp therapy and mineral trioxide aggregate apexification. Older, seminal articles identified through the references sections have also been included.Conclusion A number of options are available for the management of immature permanent teeth that have suffered an insult such as caries or trauma. This paper reviews the various methods of pulpal treatment, preservation therapy and root canal treatment options depending on the extent of the damage.

Updates in regenerative endodontics for young general practitioners: a literature review

Improvements in science and technology have contributed immensely to every aspect of dental care. Regenerative endodontics (RE) aims to restore the vitality of the non-vital pulp; that is why regenerative therapy is considered as the future of dentistry. RE is anticipated to restore harmed or missing structures, including root, dentin, pulp-dentin complex, and living tissues identical to the exact origin that replaces the normal physiological functions of the pulp-dentin complex. The current review aimed to educate and update young general practitioners about RE by an overarching review of the available literature and give them a clear picture of the state of knowledge on the subject. An electronic search on PubMed and Google Scholar was undertaken to review articles on regenerative procedures and revascularization using specific keywords, such as \&amp;quot;regenerative endodontics,\&amp;quot; \&amp;quot;revascularization,\&amp;quot; \&amp;quot;immature permanent teeth,\&amp;quot; \&amp;quot;stem cells,\&amp;quot; \&amp;quot;case report,\&amp;quot; \&amp;quot;growth factors,\&amp;quot; and \&amp;quot;scaffold,\&amp;quot; to collect enough information and recommendations regarding the indications, medications, and methods of treatment currently practiced. This review article screened about 100 papers published from 1971 to 2020 in appropriate peer-reviewed journals. These articles were initially filtered based on the title and abstract. All the pieces were inspected thoroughly and then chosen as per the inclusion criteria. For additional information, relevant literature for RE in textbooks was also reviewed. Regenerative dental techniques are emerging as a worthy, advanced dentistry field, creating a paradigm shift in many dental specialties, including endodontics. Conventional endodontic therapy aims to preserve or restore the health of periarticular tissues by preventing or healing apical periodontitis. However, the goals of regenerative procedure extend beyond the purposes of conventional endodontic therapy and include continued root development and reestablishment of pulpal vitality.

Vital and Nonvital Pulp Therapy in Primary Dentition: An Umbrella Review.

Dental caries is the most common non-communicable disease in children with significant aesthetic, functional, and quality of life deterioration. Depending on the depth, two approaches may be considered in primary dentition: vital pulp therapy (VPT) or non-vital therapy (NPT). This umbrella review aimed to critically assess the available systematic reviews (SRs) on VPT and NPT. An electronic database search was conducted (PubMed, Embase, Scopus, Cochrane, Web of Science, and LILACS) until June 2021. The Risk of Bias (RoB) of SRs was analyzed using the Measurement Tool to Assess SRs criteria 2 (AMSTAR2). From 272 entries, 33 SRs were included. Regarding the methodological quality, three studies were critically low, nine low, seventeen moderate, and six were rated as high quality. The quality of evidence produced by the available SRs was moderate. Future high standard SRs and well-designed clinical trials are warranted to better elucidate the clinical protocols and outcomes of VPT and NPT.

Treatment of a Secondarily Infected Nasopalatine Duct Cyst: A Case Report

Nasopalatine duct cyst (NPDC) is an intraosseous, developmental, epithelial, non-neoplastic cyst and is considered the most common non-odontogenic cyst of the midline anterior palate. This cyst develops mainly from epithelial remnants in the nasopalatine duct. Following the non-vital pulp, lesions may develop in the periapical area around the apex of the anterior teeth due to the spread of infection and the formation of NPDC. Radiographically, the NPDC is well-defined round or roughly heart-shaped. Enucleation is the preferred treatment plan for removing NPDC. The presented report deals with the diagnosis and treatment of NPDC in a 30-year-old male patient with no complaints or symptoms.