Periodontal Ligament Space Research Articles

Three-Dimensional printed model for preclinical training in oral radiology.

3D printing is experiencing significant growth in the teaching and learning process. This study aims to present a 3D printed skull model for preclinical intraoral radiographic practice. Two 3D printed mannequins were created. One mannequin used an STL file of a skull that was edited using two 3D modelling software (Meshmixer and Netfabb). The second mannequin was designed directly from a patient's segmented CBCT data and then converted into an STL file. Both mannequins were printed using fused deposition modelling (FDM) technology and polylactic acid (PLA) filament; teeth for the second mannequin were also printed using digital light processing (DLP). The printed skull bones were attached, the mandible was articulated to the articular fossa of the temporal bone, and the teeth were inserted into the alveoli. Intraoral radiographs of both mannequins were taken using a digital sensor (RVG 5100, Carestream). Both 3D printed mannequins showed satisfactory radiographic appearance, allowing geometric representation of each intraoral radiographic projection, regardless of STL file origin. Anatomical structures, such as the periodontal ligament space, zygomatic process of the maxilla and intermaxillary suture, were represented. The material cost of the first and second printed prototype was $34.00 and $39.00, respectively. The use of 3D printed models is presented as an alternative to artificial commercial phantoms for the preclinical training of intraoral radiographic techniques through the combined benefits of superior radiographic projection quality, the possibility of model manipulation and an affordable price.

Radiographic outcome of root canal treatment in dogs: 281 teeth in 204 dogs (2001-2018).

To evaluate the radiographic outcome of root canal treatment (RCT) in dogs and compare outcomes with those reported for a previous study performed at the same institution in 2002. 204 dogs representing 281 teeth that underwent RCT. The medical record database of a veterinary teaching hospital was searched to identify dogs that underwent RCT between 2001 and 2018. Only dogs that had undergone at least 1 radiographic recheck appointment a minimum of 50 days after RCT were included in the study. Dental radiographs were reviewed. Treatment was considered successful if the periapical periodontal ligament space was within reference limits and preexisting external inflammatory root resorption (EIRR), if present, had stabilized. Treatment was considered to show no evidence of failure (NEF) if preoperative EIRR had stabilized and any preoperative periapical lucency (PAL) remained the same or had decreased in size but had not completely resolved. Treatment was considered to have failed if EIRR or a PAL developed after RCT, if a preoperative PAL increased in size, or if preexisting EIRR progressed. Follow-up time ranged from 52 to 3,245 days (mean, 437 days). RCT was classified as successful for 199 (71%) teeth, NEF for 71 (25%) teeth, and failed for 11 (4%) teeth. Results showed that almost 2 decades after RCT outcome in dogs was first evaluated, during which time numerous advances in dental materials and techniques had been made, the success rate of RCT was virtually unchanged.

Analysis of the cells isolated from epithelial cell rests of Malassez through single-cell limiting dilution

The epithelial cell rests of Malassez (ERM) are essential in preventing ankylosis between the alveolar bone and the tooth (dentoalveolar ankylosis). Despite extensive research, the mechanism by which ERM cells suppress ankylosis remains uncertain; perhaps its varied population is to reason. Therefore, in this study, eighteen unique clones of ERM (CRUDE) were isolated using the single-cell limiting dilution and designated as ERM 1–18. qRT-PCR, ELISA, and western blot analyses revealed that ERM-2 and -3 had the highest and lowest amelogenin expression, respectively. Mineralization of human periodontal ligament fibroblasts (HPDLF) was reduced in vitro co-culture with CRUDE ERM, ERM-2, and -3 cells, but recovered when an anti-amelogenin antibody was introduced. Transplanted rat molars grown in ERM-2 cell supernatants produced substantially less bone than those cultured in other cell supernatants; inhibition was rescued when an anti-amelogenin antibody was added to the supernatants. Anti-Osterix antibody staining was used to confirm the development of new bones. In addition, next-generation sequencing (NGS) data were analysed to discover genes related to the distinct roles of CRUDE ERM, ERM-2, and ERM-3. According to this study, amelogenin produced by ERM cells helps to prevent dentoalveolar ankylosis and maintain periodontal ligament (PDL) space, depending on their clonal diversity.

Histological evaluation of periapical tissue response after implantation of experimental nanostructured calcium aluminate cement - in vivo study

Introduction. ALBO-HA (Vinca, Serbia) is new nanostructured calcium aluminate cement, synthesized as a potential alternative to mineral trioxide aggregate (MTA). The purpose of this study was to compare the periapical tissue response to new nanostructured calcium aluminate cement ALBO-HA with white MTA (MTA Angelus, Londrina, Brasil) as root-filling material into the root canal of sheep?s teeth. Material and methods. Sixteen mandibular incisors from two 24-month-old sheep were used. Root canals were prepared and filled with ALBO-HA (group 1) or MTA (group 2) (eight teeth per group in each sheep). After four weeks the animals were sacrificed, teeth with surrounding tissue removed, and histologically processed. The sections were analyzed for determination of scores of the following parameters: periapical inflammatory infiltrate, newly mineralized apically formed tissue, apical periodontal ligament space thickness and resorption of dentin, cementum and bone. Data were analyzed statistically (?=0.05) using Mann-Whitney U test. Results. Slight inflammatory infiltrate was observed in 75.0% and 62.5% of samples in the group 1 and group 2, respectively (p>0.05). Partial newly mineralized apically formed tissue was found in 75.0% of samples in the group 1, and 87.5% of samples in group 2 (p>0.05). No significant difference was noted for periodontal ligament space thickness (p>0.05). Resorption of dentin, cementum or bone was not observed. Conclusion. ALBO-HA and white MTA Angelus had a similar effect on inflammation, newly mineralized apical tissue formation and thickness of periodontal ligament space after root canal filling under the present experimental conditions.

Sealing ability of mineral trioxide aggregate, Biodentine, and EndoSequence RRM putty used as retrograde restorative material: An in vitro bacterial leakage model study

Sealing ability of mineral trioxide aggregate, Biodentine, and EndoSequence RRM putty used as retrograde restorative material: An in vitro bacterial leakage model study

Food hardness can regulate orthodontic tooth movement in mice.

Orthodontic treatment is often accompanied with prescription of softer foods to patients. The question to ask is, is this prescribed load regimen congruent with Wolff's law, and does it provide an adequate mechanical stimulus to maintain the functional health of periodontal complex? This question was answered by studying the effects of mice chewing on soft food (SF) and hard food (HF) while undergoing experimental tooth movement (ETM). Three-week-old C57BL/6mice (n=18) were fed either hard pellet (HF; n=9) or soft-chow food (SF; n=9). ETM was performed on mice at 8weeks of age, and mice were euthanized at 1min, 2weeks, and 4weeks (8, 10, and 12weeks old, respectively). A logistic regression model was applied to the experimental data to extrapolate the prolonged effects of ETM on the physical features of the dentoalveolar joint (DAJ). By 12weeks, mice that chewed on SF expressed wider periodontal ligament space than those that chewed on HF. Mice that chewed on SF demonstrated increased alveolar socket roughness with larger alveoli and decreased bone volume fraction but with significantly lower bone mineral density and reduced overall tooth movement. These altered physical features when contextualized within the DAJ illustrated that (a) the regions farther away from the "site of insult" also undergo significant adaptation, and (b) these adaptations vary between mesial and distal sides of the periodontal complex and topographically differentiate in the direction of the ETM. These insights underpin the main conclusion, in that there is a need to "regulate chewing loads" as a therapeutic dose following ETM to encourage regeneration of periodontal complex as an effective clinical outcome. The discussed multiscale image analyses also can be used on patient cone beam computed tomography data to identify the effectiveness of orthodontic treatment within the realm of masticatory function.

Functional Adaptation of LPS-affected Dentoalveolar Fibrous Joints in Rats.

The functional interplay between cementum of the root and alveolar bone of the socket is tuned by a uniquely positioned 70-80µm wide fibrous and lubricious ligament in a dentoalveolar joint (DAJ). In this study, structural and biomechanical properties of the DAJ, periodontal ligament space (PDL-space also known as the joint space), alveolar bone of the socket, and cementum of the tooth root that govern the biomechanics of a lipopolysaccharide (LPS)-affected DAJ were mapped both in space and time. The hemi-maxillae from 20 rats (4 control at 6weeks of age, 4 control and 4 LPS-affected at 12weeks of age, 4 control and 4 LPS-affected at 16weeks of age) were investigated using a hybrid technique; micro-X-ray computed tomography (5µm resolution) in combination with biomechanical testing in situ. Temporal variations in bone and cementum volume fractions were evaluated. Trends in mineral apposition rates (MAR) in additional six Sprague Dawley rats (3 controls, 3 LPS-affected) were revealed by transforming spatial fluorochrome signals to functional growth rates (linearity factor - RW) of bone, dentin, and cementum using a fast Fourier transform on fluorochrome signals from 100-µm hemi-maxillae sections. An overall change in LPS-affected DAJ biomechanics (a 2.5-4.5X increase in tooth displacement and 2X tooth rotation at 6weeks, no increase in displacement and a 7X increase in rotation at 12weeks; 27% increase in bone effective strain at 6weeks and 11% at 12weeks relative to control) was associated with structural changes in the coronal regions of the DAJ (15% increase in PDL-space from 0 to 6weeks but only 5% from 6 to 12weeks compared to control). A significant increase (p < 0.05) in PDL-space between ligated and age-matched control was observed. The bone fraction of ligated at 12weeks was significantly lower than its age-matched control, and no significant differences (p>0.05) between groups were observed at 6weeks. Cementum in the apical regions grew faster but nonlinearly (11% and 20% increase in cementum fraction (CF) at 6 and 12weeks) compared to control. Alveolar bone revealed site-specific nonlinear growth with an overall increase in MAR (108.5µm/week to 126.7µm/week after LPS treatment) compared to dentin (28.3µm/week in control vs. 26.1µm/week in LPS-affected) and cementum (126.5µm/week in control vs. 119.9µm/week in LPS-affected). A significant increase in CF (p<0.05) in ligated specimens was observed at 6weeks of age. Anatomy-specific responses of cementum and bone to the mechano-chemo stimuli, and their collective temporal contribution to observed changes in PDL-space were perpetuated by altered tooth movement. Data highlight the "resilience" of DAJ function through the predominance of nonlinear growth response of cementum, changes in PDL-space, and bone architecture. Despite the significant differences in bone and cementum architectures, data provided insights into the reactionary effects of cementum as a built-in compensatory mechanism to reestablish functional competence of the DAJ. The spatial shifts in architectures of alveolar bone and cementum, and consequently ligament space, highlight adaptations farther away from the site of insult, which also is another novel insight from this study. These adaptations when correlated within the context of joint function (biomechanics) illustrate that they are indeed necessary to sustain DAJ function albeit being pathological.

Impact of Different Evaluation Methods for Diagnostic Tasks in Panoramic Radiography

The aim of this study was to evaluate the observers’ diagnostic performance in panoramic radiography using monitor, tablet, X-ray image view box, and against window daylight as a visualization method in different diagnostic tasks. Thirty panoramic radiography were assessed by three calibrated observers for each visualization method, in standardized light conditions, concerning dental caries, widened periodontal ligament space, and periapical bone defects from the four first molars; mucosal thickening and retention cysts in maxillary sinus; and stylo-hyoid ligament calcification and atheroma. A five-point confidence scale was used. The standard-reference was performed by two experienced observers. Diagnostic values using window light were significantly lower for caries and periapical bone defect and retention cyst, stylo-hyoid ligament calcification detection (p&lt;0.05). For atheroma detection, X-ray image view box, tablet, and widow light had lower accuracy than the evaluation on the monitor (p&lt;0.05). Observer’s diagnostic performances are worsened using window light as an evaluation method for panoramic radiography for dental, sinus, and calcification disorders, while the monitor was the most reliable method.

A comparative clinical study of bioceramic and calcium hydroxide based root canal sealer in the treatment of non-vital permanent tooth with periapical lesion

Introduction: The use of Bioceramic sealer in the obduration of the root canal system has been expected by many of the previous studies. However, the clinical outcome has not yet been established. Objective: To compare the effectiveness of bioceramic and calcium hydroxide based root canal sealer in treatment of non-vital permanent teeth with periapical lesion (Periapical periodontitis). Materials and Methods: A total 100 mature permanent anterior teeth were selected after clinical and radiological examination which had non-vital pulp with periapical lesion. Clinically pulp vitality test, palpation and percussion test was performed maintaining standard procedure. Following cavity preparation and biomechanical preparation, each canal was obturated either with bioceramic (Endosequence BC) or calcium hydroxide based sealer (Sealapex, Kerr). All participants were evaluated immediately after obturation, at 3 and 6 months for the assessment of change in size of periapical lesion, condition of periodontal ligament space, lamina dura and incidence of post-operative pain, swelling. Statistical analysis was performed using Chi- square(X2) test and t-test. A value of p&lt;0.05 was considered as statistically significant. Results: Bioceramic was more effective in reducing the lesion size than that of calcium hydroxide. At 6 months, the mean lesion size was reduced from 3.52±0.7 to 1.30±0.462 mm in Bioceramics and from 3.48±1.07 to 1.58± 0.498 mm in sealapex treated teeth.. Furthermore, 98% of bioceramic treated teeth and 94% of sealapex treated teeth showed absence of swelling. The differences between two groups were statistically significant (p&lt;0.05). Conclusion: In this short period of study, Bioceramics based sealer seems to be more effective than calcium hydroxide based sealer in repair of periapical lesions of the nonvital teeth. Update Dent. Coll. j: 2021; 11(2): 26-31

Macrodontia in guinea pigs (Cavia porcellus)–Radiological findings and localization in 131 patients

Guinea pigs with dental disease usually present with nonspecific signs such as reduced food intake, difficulty eating and poor general condition. It is assumed that deficient dental attrition is the cause for overlong teeth. Giant teeth, or Macrodonts, have been mentioned as an occasionally occurring pathology. Guinea pigs with clinically and radiologically confirmed dental disease presented between 2011 and 2014 and with complete sets of radiographs of the skull (laterolateral, dorsoventral, oblique and isolated views of the mandible and maxilla) were included in this retrospective study (n = 131). Every tooth was radiologically assessed and documented as changed, if an alteration in tooth width, tooth structure, periodontal ligament space, alveolar bone lamina dura and, in the incisors, pulp cavity was present. Special focus was placed on macrodonts and their additional alterations besides increase in width. The majority (89% = 116/131) of all guinea pigs had at least one macrodont; more than half (58% = 246/422) of all abnormal teeth were macrodonts. In total, 246 teeth (54 incisors, 192 cheek teeth) were diagnosed as macrodonts by means of radiography based on the presence of tooth expansion. Mandibular incisors were much more often affected by macrodontia (87%, 47/54). Furthermore, 91% (175/192) of cheek teeth macrodonts were found in the last two tooth positions. In the present study 97% of all macrodonts (238/246) showed both expansion and structural loss. Alterations to the periodontal ligament space were found in 76% (118/246) of macrodonts. The lamina dura of alveolar bone was changed in 46% (113/246) of cases. Abnormalities of the pulp cavity were present in 80% (43/54) of incisor macrodonts. In conclusion, macrodonts occur much more often than previously documented and present a common diagnostic finding in guinea pigs with dental disease. Macrodontia is radiologically characterised by expansion of the tooth and structural loss.

Assessment of Clinical and Radiographic Success Rate of Formocresol-based Pulpotomy versus Collagen-based Pulpotomy: An In Vivo Study

The aim of the study is (a) To use collagen as a pulpotomy material in comparison with the gold standard formocresol-based pulpotomy, (b) to assess the clinical and radiographic success rate of formocresol pulpotomy and collagen-based pulpotomy, and (c) to compare the success rate of formocresol-based pulpotomy and collagen-based pulpotomy over a definitive interval of time. Totally 30 primary first or second molars indicated for pulpotomy after confirming with the operative diagnosis were taken as samples for this study. This split-mouth technique consists of two groups: Group 1-formocresol pulpotomy (n = 15), and group 2-collagen-based pulpotomy (n = 15). Both the procedures were done in the same patient on regular appointments. Pre- and postoperative radiographs were taken. The children were recalled for clinical and radiographic follow-up at 2, 4, and 6 months. The success of the procedure was assessed based on clinical signs (pain, tenderness to percussion, abscess, swelling, fistula, and pathologic mobility) and radiographic findings (radicular radiolucency, internal and external root resorption, periodontal ligament (PDL) space widening, and furcation radiolucency). The Chi-square test was used to compare the differences between the groups. The overall success rate for formocresol pulpotomy (n = 15) was 14, 13, and 10 for the second-, fourth-, and sixth-month review period, respectively. For collagen pulpotomy group (n = 15), the overall success rate was 14, 14, and 14 for the second-, fourth-, and sixth-month review period, respectively. The obtained data from the overall success rate were subjected to statistical analysis, and chi-square test was used. The p-value less than 0.1 was considered a statistically significant result. The chi-square value for the fourth- and sixth-month review was 0.37 and 3.33, respectively. Statistically significant value was obtained from the sixth-month review period (p <0.1), which describes that the overall success rate was better for the collagen pulpotomy group when compared with the formocresol pulpotomy group. Collagen had proven to be a very good alternative for formocresol, its biocompatibility, and regenerative efficiency and is a benchmark for a better clinical success rate in dentistry. However, its implication in pulpotomy should be subjected to further comparative research study on mineral trioxide aggregate (MTA), Biodentine, etc. Keywords: Collagen-based pulpotomy, Formocresol-based pulpotomy.

Trauma from occlusion—types, clinical signs and clinical significance. A review

Traumatic occlusal forces lead to occlusal trauma of teeth with intact or reduced periodontium. Traumatic occlusion can be classified according to the type of traumatic forces (acute and chronic) and according to the capacity of the periodontal tissues (primary and secondary). The main clinical sign of occlusal trauma is the increased tooth mobility due to the destruction of the periodontal fibers and enlargement of the periodontal ligament space. Other signs are also fremitus, tooth drifting, tooth abrasion, occlusal discrepancies, tooth fracture, root resorption. Occlusal trauma is reversible. Тhe tissues of the periodontium are restored when the excessive occlusal forces are eliminated.

Clinical and radiological evaluation of dentomaxillofacial involvement in Type I Gaucher disease.

This study aimed to evaluate the oral findings and dentomaxillofacial involvement of patients diagnosed with Type I Gaucher Disease (GD), and to compare these findings with the control group. A total of 32 patients, 5 males, and 11 females in both the study (range 19-60, mean age 34.56) and control group (range 18-49, mean age 34.63) were included in the study. The file records of all patients obtained in the first evaluation were examined, and the hematological, visceral, and bone examination findings were recorded. Subsequently, oral examinations were performed for oral findings and dentomaxillofacial involvement, and radiological examinations were performed in panoramic images and cone-beam computed tomography (CBCT) images. There was mandible involvement in 9 (56.3%), and involvement in both jaws in 4 (25.0%) of the patients with Type I GD. According to the CBCT findings, generalized rarefaction in 10 (62.5%) patients, enlarged marrow spaces in 12 (75.0%) patients, thinning of the lamina dura in 10 (62.5%) patients, and loss in the cortical borders of the mandibular canal in 7 (43.8%) patients were among the common radiographic findings. When the control and study group were compared, in panoramic images, a significant difference was found in terms of generalized rarefaction and enlarged marrow spaces, while significant differences were found in CBCT images regarding generalized rarefaction, enlarged marrow spaces, loss in the cortical margins of the mandibular canal and widening in the periodontal ligament space. The roadmap for the diagnosis of Gaucher lesions in the jawbones includes a comprehensive medical history and a clinical and radiological examination. In conclusion, dentists should be familiar with the dentomaxillofacial findings of GD and be aware of possible oral and dental complications that may develop.

Prevalence of Missed Canals and Their Association with Apical Periodontitis in Posterior Endodontically Treated Teeth: A CBCT Study.

Background This study aimed to assess the prevalence of missed canals in endodontically treated teeth and their association with apical periodontitis in a Saudi Arabian population using CBCT. Materials and Methods A total of 208 CBCT radiographs were investigated. For each tooth, radiographs of axial, coronal, and sagittal segments were acquired to appraise the external as well as the internal structure of the root canal system and apical area. In root canal-treated teeth, unfilled canals appearing from the cementoenamel junction to the apex were defined as missed untreated canals; and a periapical lesion was considered when disruption of the lamina dura was detected, and the low-density area associated with the radiographic apex was at least twice the width of the periodontal ligament space. The data were presented as frequencies and percentages. The Z-test was used to analyze the differences in proportions with the significance level set at P value <0.05. Results The overall prevalence of missed canals among endodontically treated teeth was 18%. The prevalence of missed canals was higher in maxillary first molars with 40.6%. The overall prevalence of apical periodontitis among teeth with missed canals was 90%. It was 84.2% in the maxilla and 100% in the mandible. The second mesiobuccal canal in the maxillary first molars and mesiobuccal and distobuccal canals in mandibular teeth were the most missed canals. Conclusion Apical periodontitis in root canal-treated teeth with missed canals was high (90%), with most identified missed canals in maxillary and mandibular first molars.

Prevention of endodontic perforation - A review article

Endodontic perforation is an iatrogenic error which results in the communication between the crown and the oral cavity/root and the periodontal ligament space and bone. It’s the most common type of endodontic mishap occurs while negotiating canals. The primary cause of endodontic perforations is poor knowledge of the internal anatomy of the tooth. Other factor includes calcification, rotation, malposed tooth, and resorption. The diagnosis of root perforation is pivotal for treatment and good prognosis. Prime diagnosis of perforation was done by Clinical and radiographic examination. Cone-beam computed tomography play an important role for the diagnosis perforation, even with other materials superimposing the defect. This article mainly focuses on prevention of endodontic perforations. Keywords: Perforation, Straight line access, Illumination, Access

BiodentineTM Full Pulpotomy in Mature Permanent Teeth with Irreversible Pulpitis and Apical Periodontitis

Vital pulp therapy, including direct pulp capping and partial and full pulpotomy, is primarily indicated for immature or mature permanent teeth with reversible pulpitis. Mature permanent teeth with irreversible pulpitis are frequently treated with root canal therapy. This report presents two cases of full pulpotomy using BiodentineTM in mature permanent teeth with irreversible pulpitis and acute apical periodontitis. The periapical radiograph illustrated a deep carious lesion extended to the pulp with apical radiolucency lesion or widened periodontal ligament space. Full pulpotomy with a tricalcium silicate-based cement was chosen as the definitive treatment. After decayed tissue excavation under a rubber dam, the exposed pulp tissue was amputated to the level of the canal orifice with a new sterile bur. BiodentineTM was applied as the pulp capping agent after hemostasis was obtained and for temporary restoration. The clinical signs disappeared quickly after the treatment. After one month, the coronal part of the temporary restoration was removed, and a composite resin was placed over the capping agent as a final restoration. At two-year follow-ups, the teeth were asymptomatic. Radiographs showed healing of the periapical lesion and periodontal ligament. BiodentineTM full pulpotomy of mature permanent teeth with irreversible pulpitis and apical periodontitis can be an alternative option to root canal therapy.

Tissue reaction to novel customized calcium silicate cement based dental implants. A pilot study in the dog

ObjectivesThe purpose of this study was to determine the level of periodontal tissue regeneration in a canine model following post-extraction placement of an implant molded from a composite material made from extracted tooth dentin and a calcium silicate cement (CSC) material. The investigation used autologous dentin in conjunction with a CSC material to form a composite implant designed for immediate tooth replacement.MethodsTwo (2) beagles had a periodontal and radiographic examination performed to rule out any pre-treatment inflammation, significant periodontal disease, or mobility. Then, ination eleven (11) teeth were extracted and polyvinyl siloxane molds were made to fabricate three different types of implants: Particulate Implant (Test Group 1, n = 4), Shell Implant Alone (Test Group 2, n = 2), Shell Implant with Emdogain® (Test Group 3, n = 3). Teeth in the control group were extracted, scaled (n = 2), and then re-implanted into their respective fresh extraction sockets. At 4 weeks, a clinical, radiographic, and histologic assessment was performed.ResultsClinical evaluation revealed no mobility in any of the test or control implants and no radiographic evidence of significant bone loss or active disease. Based on the MicroCT analysis, direct bone to implant contact was observed in some areas with an apparent periodontal ligament space. Implant-related inflammation, on average, was similar among all groups, with low numbers of infiltrates. Implant-related inflammatory reaction was generally minimal and not interpreted to be adverse.ConclusionThe proposed novel composite materials revealed that not only do these materials demonstrate high biocompatibility, but also their successful integration in the alveolus is likely secondary to a partial ligamentous attachment. The current investigation may lead to the use of calcium silicate-based materials as custom dental implants. Further research on this novel composite’s biomechanical properties is necessary to develop the optimal material composition for use as a load-bearing dental implant.

Management of apical periodontitis using WaveOne gold reciprocating files, single-cone endodontic approach: A case series

IntroductionThe endodontic treatment of apical periodontitis (AP) without surgical intervention presents a unique clinical challenge. This case series aimed to test the changes in size of periapical lesion scale and healing in post-treatment of AP by cone beam computed tomography (CBCT) using Waveobe Gold reciprocating file with single cone treatment approach. Presentation of casesA total of 20 patients with 20 teeth (9 M, six premolars, one canine, and four incisors) with AP underwent CBCT scanning before and after non-surgical root canal treatment (NSRCT) or non-surgical retreatment (NSReTx). Standardized root canal chemo-debridement and instrumentation with WaveOne Gold (WOG) reciprocating files was used. The canals were obturated using epoxy-based sealer (AH Plus) with a single WaveOne Gold conform fit gutta-percha cone technique. After one year, assessment with CBCT images showed that the success and healing rate using (AH Plus) with single cone technique was very high. DiscussionApical periodontitis is an inflammatory disease at the root end of teeth. Following NSRCT or NSReTx, evaluation of lesion size by radiograph has been essential to the evaluation of lesions post-operatively. In addition to the absence of symptoms, complete restitution of the lamina dura and periodontal ligament (PDL) space on post-operative radiograph has been considered the optimal outcome success. ConclusionsWithin the limitations of this study, NSRCT or NSReTx using reciprocating WaveOne Gold and single cone with AH plus sealer resulted in healing of AP as assessed by CBCT.

Follow Up on Simple (Closed) Extraction of Fractured Maxillary Canine Teeth in Domestic Ferrets (Mustela putorius furo).

Fractured canine teeth (especially maxillary canine teeth) are common in domestic ferrets (Mustela putorius furo). We evaluated (detailed oral/dental and radiographic examination under general anesthesia) 18 domestic ferrets affected by 23 complicated crown fractures of periodontally healthy permanent maxillary canine teeth over a 2-year period. Average age of the ferrets at the time of diagnosis was 2.6 years. Only three teeth were discolored on clinical examination. Out of 23 teeth, 22 were radiographically evaluated. No radiographic evidence of endodontic disease was observed in 11/22 canine teeth. Inflammatory root resorption was observed in 5/22, periapical lucency in 5/22 teeth, apical widening of periodontal ligament space in 6/22 teeth, and failure of the pulp cavity to narrow in 3/22 teeth. All animals were treated by simple (closed) extraction of the affected teeth. Histological examination of eight teeth was performed. Pulp appeared histologically vital in five (3/5 showed no radiographic evidence of endodontic disease), pulpitis was diagnosed in two (both without radiographic evidence of endodontic disease) and pulp necrosis in one case (dental radiographs revealed apical widening of periodontal ligament space and failure of the pulp cavity to narrow). All extraction sites healed uneventfully by the 2-week recheck examination. Long-term follow-up revealed development of post-extraction upper lip entrapment with mandibular canine tooth in eight out of 18 ferrets, which appeared clinically irrelevant. According to clients seven out of 18 ferrets showed an improved quality of life. Simple tooth extractions are warranted in ferrets affected by complicated crown fracture of the periodontally healthy permanent maxillary canine teeth.

The Radiological Assessment of Root Features and Periodontal Structures in Endodontically Treated Teeth Subjected to Forces Generated by Fixed Orthodontic Appliances. A Prospective, Clinical Cohort Study.

The various side effects of orthodontic treatment with fixed orthodontic appliances (FOAs) and their impact on apical and periodontal structures have been widely reported. However, the existing data is not yet conclusive. Aims and objectives: To investigate the status of roots and periodontium in endodontically treated teeth that have undergone orthodontic treatment with the use of FOAs and to evaluate their impact on apical/periodontal structures. Material and methods: The prospective clinical cohort study initially involved 69 participants aged 16–40, without underlying systemic conditions, who received orthodontic treatment with ligatureless FOA systems due to different types of mild and moderate malocclusions. To meet the required criteria, 88 teeth in 34 patients were assessed clinically and radiologically. Participants had at least one tooth treated endodontically while the corresponding tooth from the same anatomical group on the opposite side was vital and intact (a ‘split-mouth’ approach). Four cohorts were allocated: Group IA consisted of 15 teeth, treated utilising the principles of modern endodontics, that were subjected to orthodontic forces no less than six months after completing the root canal obturation. Group I consisted of 13 similarly endodontically treated teeth, which commenced orthodontic treatment at least six months after the completed endodontic therapy. Group II contained 16 teeth treated by conventional endodontic methods and the control group, Group III, contained 44 clinically and radiologically intact teeth (incisors and premolars) with vital and sound dental pulp. The response of apical and periodontal structures to FOAs was determined by data collected from intraoral periapical radiographs taken within the course of five consecutive appointments during the orthodontic treatment. Results: No statistically significant differences were observed in susceptibility to FOA-induced external apical root resorption (EARR) between combined Groups IA + IB and II. An association was, however, demonstrated, between the occurrence of EARR and the degree of expansion of the periodontal ligament (PDL) space, regardless the method of root canal treatment. Cumulative data revealed a positive correlation between the width of the PDL space and the stage of FOA treatment (the third and the fourth appointment). The subtle changes in radiological length of roots have been observed (min 0 mm/max 0.38 mm), particularly between the second and third appointment in Group II (p < 0.05). Conclusions: The standard orthodontic therapy with FOAs is a safe option with predictable outcome for persons who have recently received endodontic therapy. The anterior teeth, predominantly incisors, were more susceptible to minimal EARR than premolars, which suggests that the rate of EARR occurrence may depend upon the original morphology of the apical portion of the root. The use of additional orthodontic forces increases the risk of EARR and is associated with a higher incidence of radiologically detected PDL space widening.