Pulp Canal Research Articles

Assessment of Correlation between Clinical Parameters and Pulp Canal Pathogens in Endodontic Pathologies: A Microbiological Study.

Success and failure of root canal therapy is largely dependent on the clinician and the patient. Once the tooth is restored into its functional and esthetic place, the root canal therapy is considered to be complete. It is a well-known fact that root canal space acts as a rich reservoir for microorganisms. Past studies show that root canal harbors an array of different microorganisms. Streptococcus mitis and Enterococcus faecalis have been found to be the most prevalent microorganisms isolated from the infected pulp canal space. Hence, we evaluated the association of endodontic signs and symptoms with root canal pathogens. A total of 120 patients were selected for the study and divided broadly into two groups: Group I containing patients with primary infection and group II containing patients in which retreatment was required. Both groups contained 60 patients each. Clinical parameters recorded for the study are pain, tenderness on percussion, swelling, periapical radiolucency on radiographic analysis, caries, sinus formation, and tooth mobility. After assessment, opening, and initial filing, sterile paper points were inserted into the root canal space for collection of microbiological sample, which was further send to laboratory for cultural analysis. All the results were analyzed by Statistical Package for the Social Sciences (SPSS) software. Student's t-test and Fisher's exact test were used to evaluate the level of significance. While comparing the mean age of the patients in the two groups, no significant association was seen. Statistically significant results were obtained while comparing the association between pain and S. mitis. Positive correlation was seen on comparing the association between tenderness on percussion and E. faecalis. Also, a positive association was seen between periapical radiolucency and S. mitis. Strong positive correlation exists between S. mitis and E. faecalis and endodontic signs and symptoms. Sound knowledge regarding the association of microbes of root canal and specific endodontic signs and symptoms could help therapeutic management of root canal infections effectively.

Dental Neglect Leading to Foreign Body Lodgement in Pulp Chamber

Foreign object embedded in a tooth is not an uncommon finding, especially in children undergoing root canal therapy or who has experienced trauma leading to teeth fracture. Many children with a habit of placing various objects in the oral cavity eventually end up with foreign body lodgement into the pulp chamber or root canal leading to pain and infection. Parental negligence is responsible to a great extent in such kind of accident as they fail to keep watch on their children and their teeth. A number of foreign objects have been reported to be lodged in the pulp chamber and root canals of both deciduous and permanent teeth. Various instruments and kits have been used on retrieval of foreign objects lying in the pulp chamber or canal.

Comparison of removal of endodontic smear layer using ethylene glycol bis (beta-amino ethyl ether)-N, N, N', N'-tetraacetic acid and citric acid in primary teeth: A scanning electron microscopic study.

Background:Root canal irrigants are considered momentous in their tissue dissolving property, eliminating microorganisms, and removing smear layer. The present study was aimed to compare the removal of endodontic smear layer using ethylene glycol bis (beta-amino ethyl ether)-N, N, N', N'-tetraacetic acid (EGTA) and citric acid solutions with saline as a control in primary anterior teeth.Materials and Methods:Thirty primary anterior teeth were chosen for the study. The teeth were distributed into three groups having ten teeth each. Following instrumentation, root canals of the first group were treated with 17% EGTA and the second group with 6% citric acid. Only saline was used as an irrigant for the control group. Then, the teeth were subjected to scanning electron microscopy (SEM) study. The scale given by Rome et al. for the smear layer removal was used in the present study.Results:The pictures from the SEM showed that among the tested irrigants, 17% EGTA + 5% sodium hypochlorite (NaOCl) group showed the best results when compared to other groups.Conclusion:The results advocate that the sequential irrigation of the pulp canal walls with 17% EGTA followed by 5% NaOCl produced efficacious and smear-free root canal walls.

Cone-beam Computed Tomography: A Resolution to Paradoxical Judgments in Endodontic Diagnosis

ABSTRACT Recently, various diagnostic tools have emerged with a view to enhance endodontic treatment. Cone-beam computed tomography (CBCT) is presented as a new endodontic tool. The narrow field CBCT reduces the negative effects of anatomic noise, geometric distortion, and technique sensitivity observed on two-dimensional images. It can be used to identify canal morphology, numbers of canals, and relative positioning even in the presence of calcific metamorphosis (CM) and dystrophic calcifications. Calcific metamorphosis is characterized by the deposition of hard tissue within the pulp canal space. Most of the literature advices the treatment of CM through observation and periodic examination. Thus, it is imperative for the clinician to identify calcified canals preoperatively for conservative treatment approach. This case series illustrates about the versatility of CBCT over the conventional radiology for detecting calcified canals. How to cite this article Chougule AR, Kundabala M, Mohan RP, Shetty N. Cone-beam Computed Tomography: A Resolution to Paradoxical Judgments in Endodontic Diagnosis. World J Dent 2016;7(2):100-106.

Success Rate of MTA Pulpotomy on Vital Pulp of Primary Molars: A 3-Year Observational Study

IntroductionVital pulp therapy is a major contributor in the preservation of primary dentition after caries affliction. Introduction of mineral trioxide aggregate (MTA) has revolutionized such treatment.AimThe aim of our study was to evaluate and correlate the effects of MTA clinically and radiographically on pulpotomized primary molars till their exfoliation or extraction followed by histological evaluation.Study designThis is an observational study.Materials and methodsA total of 25 teeth were selected from 5- to 8-year-old children requiring pulp therapy on the basis of inclusion and exclusion criterion. The teeth were treated by conventional pulpotomy technique under aseptic conditions using MTA and were immediately restored with stainless steel crown. The teeth were assessed postoperatively till 36 months. The exfoliated or extracted teeth were examined histologically.ResultsThe pulpotomized teeth were vital with no adverse clinical findings during the observation period. After 3 months, one tooth showed internal resorption, but the same was not observed after 12 months. Pulp canal obliteration was seen in three cases. At the end of the study, five teeth were exfoliated and one tooth was extracted for maintaining arch symmetry. The histological examination of extracted tooth revealed the presence of healthy pulp and the area of true calcification. Remaining exfoliated teeth presented dentin bridge formation.StatisticsFrequencies and percentages were used for descriptive statistics. Fisher’s exact tests were used to see the difference between clinical and radiological findings. The probability value was fixed at 5% level of significance.ConclusionThe response of pulp in primary teeth to MTA was favorable in all cases from clinical and radiographic perspective, and histological evaluation confirmed the observation.How to cite this articleGodhi B, Tyagi R. Success Rate of MTA Pulpotomy on Vital Pulp of Primary Molars: A 3-Year Observational Study. Int J Clin Pediatr Dent 2016;9(3):222-227.

Effect of Different Obturation Techniques on the Prognosis of Endodontic Therapy: A Retrospective Comparative Analysis

Success of root canal therapy (RCT) is largely dependent upon the quality of biomechanical preparation and obturation of the pulp canal. Improperly cleaned or shaped root canal, regardless of the type of obturation method and obturating material, cannot lead to the success of endodontic therapy. Hence, we conducted a clinical comparative analysis of two obturating techniques. A total of 140 patients receiving RCT at the department of Endodontic were included in the present study. The average follow-up time for the patients was 29 months (18-38 months). Patients were grouped into two depending on the type of obturating technique used. Evaluation of the clinical and radiographic follow-up records of the patients was done and analysis was made. One-way analysis of variance (ANOVA) was used for assessing the level of significance. The average age of the patients undergoing obturation with carrier-based obturation (CO) technique and lateral compaction (LC) technique was 43 and 48 years respectively. While comparing failure and success of the teeth at the time of follow-up, nonsignificant results were obtained. Significant difference was seen, while comparing the presence of voids and type of teeth in which endodontic therapy was performed using different obturating techniques. Endodontic therapy done with LC obturating technique or with CO technique shows prognostic difference on the outcome or quality of treatment therapy. Quality of obturation is more important rather than type while performing endodontic therapy for better prognosis.

Evaluation of the Efficacy of TRUShape and Reciproc File Systems in the Removal of Root Filling Material: An Ex Vivo Micro–Computed Tomographic Study

IntroductionThe purpose of this study was to evaluate the efficacy of TRUShape (Dentsply Tulsa Dental Specialties, Tulsa, OK) compared with the Reciproc file (VDW, Munich, Germany) in the removal of filling material from oval canals filled with 2 different sealers and differences in the working time. MethodsSixty-four mandibular canines with oval canals were prepared and divided into 4 groups (n = 16). Half of the specimens were filled with gutta-percha and pulp canal sealer (PCS), and the remainders were filled with gutta-percha and bioceramic sealer (BCS). The specimens were retreated using either the Reciproc or TRUShape files. A micro–computed tomographic scanner was used to assess filling material removal, and the time taken for removal was also recorded. Data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests. ResultsThe mean volume of the remaining filling material was similar when comparing both files (P ≥ .05). However, in the groups filled with BCS, the percentage of remaining filling material was higher than in the groups filled with PCS (P < .05). The reciprocating file allowed for faster filling removal than the TRUShape files (P < .05). Retreatment was faster in the groups that were filled with PCS compared with those filled with BCS (P < .05). ConclusionsThere was no difference regarding the percentage of remaining filling material when comparing both files system; however, Reciproc was faster than TRUShape. BCS groups exhibited significantly more remaining filling material in the canals and required more time for retreatment. Remaining filling material was observed in all samples regardless of the technique or sealer used.

Effectiveness of decoronation technique in the treatment of ankylosis: A systematic review.

Dentoalveolar ankylosis in growing patients is complex leading to continuing root replacement resorption, tooth infra-position, or may even affect the development of alveolar ridge and adjacent teeth. While extraction of ankylosed teeth might be associated with bone loss, decoronation of the offending tooth (removal of crown portion and instrumentation of pulp canal to stimulate bleeding) has been suggested as a more conservative approach of bone preservation until definitive implant placement is planned. To primarily assess the efficacy of bone width and height preservation around ankylosed permanent teeth following decoronation. Pubmed, Embase, Ovid Medline, Thomson's ISI Web of Science and Cochrane library were searched from the year 1984 up to May 2015. Two authors conducted the data extraction. To eliminate publication bias, Open Grey literature and Pro-quest Dissertation Abstracts and Thesis database was also consulted. Through our strict selection criteria, only 12 articles were considered for eligibility. No randomized controlled trials were identified. Only one retrospective cohort study, four case series and seven case reports, were analyzed. Following decoronation, preservation of ridge height and ridge width were both noted. To maximize the benefits of decoronation, a timely and wellmonitored intervention is required. Treatment in patients, who have surpassed pubertal growth peaks, may not yield maximum effective treatment outcomes.

Alveolar process fractures in the permanent dentition. Part 2. The risk of healing complications in teeth involved in an alveolar process fracture.

To analyze the risk of pulp canal obliteration (PCO), pulp necrosis (PN), repair-related resorption (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) for teeth involved in an alveolar process fracture and to identify possible risk factors. A total of 91 patients with 223 traumatized teeth. The risks of PCO, PN, RRR, IRR, ARR, MBL, and TL were analyzed separately for teeth with immature and mature root development using Kaplan-Meier and Aalen-Johansen methods. Possible risk factors for PN (age, fracture in relation to apex, displacement, gingival injury, degree of repositioning, type of splint, duration of splinting, treatment delay, and antibiotics) were analyzed for mature teeth using Cox regression. The level of significance was 5%. Immature: No severe complications (PN, IRR, ARR, MBL, or TL) were diagnosed during follow up. Mature: Estimated risk after a 10-year follow up: PN: 56% (95% confidence interval (CI): 48.1-63.9), IRR: 2.5% (95% CI: 0-5.1), ARR: 2.1% (95% CI: 0.1-4.1), MBL: 2.4% (95% CI: 0.3-4.4), and TL: 7.8% (95% CI: 0-15.7). The following factors significantly increased the risk of PN in teeth with mature root development: fracture in relation to apex (hazard ratio (HR): 2.6 (95% CI: 0.2 - 5.7), P=0.01), displacement in the horizontal part of the fracture >2mm (HR: 1.8; 95% CI: 1.1-3.2, P=0.03), incomplete repositioning (HR: 2.1 (95% CI: 1.3-3.5), P=0.003), and age >30years (HR: 2.3 (95% CI: 1.1-4.6), P=0.02). The type of splint (rigid or flexible), the duration of splinting (more or less than 4weeks), and the administration of antibiotics did not affect the risk of PN. Teeth involved in alveolar process fractures appear, apart from PN, to have a good prognosis. A conservative treatment approach is recommended.

Synodontia between Permanent Mandibular Central &amp; Lateral Incisors

Dental fusion also called ‘synodontia’ is a rare dental developmental anomaly in which the union of two independently developing primary or permanent tooth buds occurs. Tooth fusion is defined as union between the dentin and / or enamel of two or more separate developing teeth. The fusion may be partial or total depending upon the stage of tooth development at the time of union. The etiology of fusion is still unclear. The overall prevalence of the tooth fusion is approximately 0.5%. Fusion may be unilateral or bilateral and most often occurs in primary teeth with more predilections for anterior teeth. Clinically fused anterior teeth frequently have a groove or notch on the incisal edge that goes in buccolingual direction and radiographically, the dentin of fused teeth always appears to be joined in some region with separate pulp chambers and canals. Hence the cases of fusion of permanent teeth in different ages are presented.Bangladesh Journal of Dental Research and Education Vol.5(2) 2015: 70-72

Prevalence of and relationship between pulp and renal stones: A radiographic study

AimThe aim of the present study was to determine the prevalence of and the relationship between pulp and renal in affected patients and in healthy adults. Materials and methodsA total of 240 patients participated in the study. Group A consisted of 120 patients who had renal calculi and Group B had 120 randomly selected controls for the study. The periapical radiographs for all patients were evaluated for the presence or absence of the narrowing of dental pulp chambers and pulp canals. The radiographs were also evaluated to determine the presence or absence of pulp stones. The results were compared and analyzed using the Chi-square test (p<0.001). ResultsA total of 164 patients had pulp narrowing and 112 patients had pulp stones, which included 55 controls and 57 renal calculi patients. There was no statistical correlation between pulp narrowing and renal stones (p>0.001) and also between pulp stones and renal stones (p>0.001). ConclusionHowever, there was no significant correlation between the presence of pulp stones and renal stones, and the incidental findings of pulp stones on periapical radiographs can provide useful information in the early diagnosis of the systemic calcifications.

Pulp canal obliteration after replantation of avulsed immature teeth: a systematic review.

Avulsion of permanent teeth is one of the most serious dento-alveolar traumatic injuries. Pulp canal obliteration (PCO) is one of the consequences after replantation of avulsed immature teeth. The aim of this systematic review was to determine when calcification following replantation of an avulsed immature tooth begins and to evaluate the prevalence of PCO in these cases. Electronic database MEDLINE via Ovid, PubMed, Cochrane, and Web of science databases were searched. Hand searching was performed through reference lists of endodontic and trauma textbooks, endodontic and trauma-related journals, and relevant articles from electronic searching. Pooled data from the selected articles were analyzed for prevalence of healing and PCO as well as mean first evidence of PCO. Pulp healing after replantation of immature teeth occurred in 32.9%, while pulpal necrosis occurred in 67.1% of teeth. PCO was the most frequent outcome of pulpal healing as it occurred in 96% of healed pulps. First evidence of obliteration was observed from 3 to 14months with mean time of 9.5months (95% CI=4.5-14.5months). PCO is considered the mechanism by which the pulp heals after replantation of avulsed immature permanent teeth. PCO is very fast and can be recognized radiographically during the first year from the onset of the trauma.

Descoloração dentinária: aplicação de facetas Componeer®

Pulp canal obliteration is characterized by the reduction of the pulp space and a yellow discoloration of the tooth crown, caused by traumatic injuries to the teeth. The frequency and the extension of the obliteration depend on the severity of the trauma and the stage of the root development. The lack of response to the pulp tests as well as the crown discoloration, common in these cases, demands a differential diagnosis to outwit pulp necrosis. A misdiagnosis may lead to a more invasive therapy and eventually an unnecessary one. With the present report of a single tooth with pulp canal obliteration, due to a traumatic event, the authors want to emphasize the role of an accurate clinical history and the features of the pulp physiology involved, presenting a conservative and stable approach, very rewarding to the patient, using Componeer® veneers

Histology of the heterostracan dermal skeleton: Insight into the origin of the vertebrate mineralised skeleton

ABSTRACTLiving vertebrates are divided into those that possess a fully formed and fully mineralised skeleton (gnathostomes) versus those that possess only unmineralised cartilaginous rudiments (cyclostomes). As such, extinct phylogenetic intermediates of these living lineages afford unique insights into the evolutionary assembly of the vertebrate mineralised skeleton and its canonical tissue types. Extinct jawless and jawed fishes assigned to the gnathostome stem evidence the piecemeal assembly of skeletal systems, revealing that the dermal skeleton is the earliest manifestation of a homologous mineralised skeleton. Yet the nature of the primitive dermal skeleton, itself, is poorly understood. This is principally because previous histological studies of early vertebrates lacked a phylogenetic framework required to derive evolutionary hypotheses. Nowhere is this more apparent than within Heterostraci, a diverse clade of primitive jawless vertebrates. To this end, we surveyed the dermal skeletal histology of heterostracans, inferred the plesiomorphic heterostracan skeleton and, through histological comparison to other skeletonising vertebrate clades, deduced the ancestral nature of the vertebrate dermal skeleton. Heterostracans primitively possess a four‐layered skeleton, comprising a superficial layer of odontodes composed of dentine and enameloid; a compact layer of acellular parallel‐fibred bone containing a network of vascular canals that supply the pulp canals (L1); a trabecular layer consisting of intersecting radial walls composed of acellular parallel‐fibred bone, showing osteon‐like development (L2); and a basal layer of isopedin (L3). A three layered skeleton, equivalent to the superficial layer L2 and L3 and composed of enameloid, dentine and acellular bone, is possessed by the ancestor of heterostracans + jawed vertebrates. We conclude that an osteogenic component is plesiomorphic with respect to the vertebrate dermal skeleton. Consequently, we interpret the dermal skeleton of denticles in chondrichthyans and jawless thelodonts as independently and secondarily simplified. J. Morphol. 276:657–680, 2015. © 2015 The Authors Journal of Morphology Published by Wiley Periodicals, Inc.

The Effect of Calcium Hydroxide on Fibroblast Cells Viability

Calcium hydroxide [Ca(OH)2] is widely used as medicament in dental pulp and root canal therapy. Previous studies demonstrate the ability of calcium hydroxide to induce necrosis in dental pulp tissue. However, the mechanism of tissue destruction remains unknown. The aim of this study was to investigate fibroblast cell viability in response to calcium hydroxide exposure. In this study, Vero fibroblast cell line was treated with various concentrations of calcium hydroxide for 24 hours. Cell viability was measured by using MTT assay. Our results showed significant decrease in cell viability after exposed with calcium hydroxide at concentration 62.5 and 125 µg/ml. The result indicated that calcium hydroxide induced cell death in Vero cell line in a dosedependent manner. This study suggests that fibroblast cell death may involved in the mechanism of pulp tissue necrosis caused by calcium hydroxide

Correlation between prevalence of pulp stones and renal stones in Panchkula region of India

Aim: Pulp stones are discrete calcified bodies found in the dental pulp. The aim of the present study was to determine the prevalence of pulp stones in patients with renal stones and to determine the relationship between the pulp stones and renal stones. Materials and Methods: A total of 240 patients participated in the study. Group A consisted of 120 patients who had renal calculi, and Group B had 120 randomly selected controls for the study. The periapical radiographs for all patients were evaluated for the presence or absence of the narrowing of dental pulp chambers and pulp canals. The radiographs were also evaluated to determine the presence or absence of pulp stones. The results were compared and analyzed using the Chi-square test (P 0.001) and also between pulp stones and renal stones (P > 0.001). Conclusion: However, there was no significant correlation between the presence of pulp stones and renal stones, the incidental findings of pulp stones on periapical radiographs can provide useful information in the early diagnosis of the systemic calcifications.

Effect of Preoperative Pain on Inferior Alveolar Nerve Block

The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. One-hundred seventy-seven adult volunteer subjects, actively experiencing pain in a mandibular molar, participated in this prospective double-blind study carried out at 2 different centers. The patients were classified into 3 groups on the basis of severity of preoperative pain: mild, 1-54 mm on the Heft-Parker visual analog scale (HP VAS); moderate, 55-114 mm; and severe, greater than 114 mm. After IANB with 1.8 mL of 2% lidocaine, endodontic access preparation was initiated. Pain during treatment was recorded using the HP VAS. The primary outcome measure was the ability to undertake pulp access and canal instrumentation with no or mild pain. The success rates were statistically analyzed by multiple logistic regression test. There was a significant difference between the mild and severe preoperative pain group (P = .03). There was a positive correlation between the values of preoperative and intraoperative pain (r = .2 and .4 at 2 centers). The amount of preoperative pain can affect the anesthetic success rates of IANB in patients with symptomatic irreversible pulpitis.

Root canals-from concretion to patency

Teeth with calcification provide an endodontic treatment challenge; traumatized teeth usually develop partial or total pulpal obliteration which is characterized by apparent loss of the pulp space radiographically and a yellow discoloration of the clinical crown. Since only 7-27% of such teeth develop pulp necrosis with radiographic signs of apical periodontitis, it is difficult to decide whether to treat these teeth immediately upon detection of the pulpal obliteration or to wait until signs and symptoms of pulp and/or apical periodontitis occur. This article reviews the etiology, prevalence, classification, mechanism, diagnosis as well as treatment options for teeth with pulp obliteration and the various management approaches and treatment strategies for overcoming potential complications. A search of articles from PubMed and Medline from 1965 to present was done with the keywords dental trauma, discoloration, pathfinding instruments, pulp canal obliteration, and root canal treatment was conducted. A total of 94 abstracts were collected, of which 70 relevant articles were read and 31 most relevant articles were included in this article.

Treatment of Dens Invagination in a Maxillary Lateral Incisor: A Case Report.

Dens invagination is a developmental anomaly requiring specific treatment approaches. Oehler's Type III dens in dente, extends into the root and perforates at the apical area or lateral surface of the root. In this case endodontic treatment of the invaginated tooth was carried out through the central lumen of the invagination with calcium hydroxide without manipulation of the main pulp canal, thereby leaving the tooth vital. The 18-month follow-up examinations were indicative of treatment success; the periapical lesion resolved completely and the tooth remained vital. Conclusion:Information about the three dimensional anatomy of the teeth especially those with an abnormality is necessary for a successful treatment.

Management of Pulp Canal Obliteration Using the Modified-Tip Instrument Technique

The incidence of pulp canal obliteration following dental trauma has been reported to be approximately 4 - 24% and its management can be quite challenging for the practitioner. Locating the canal and negotiating it to full working length may lead to iatrogenic errors such as fractured instrument and perforation. This case report deals with such a case using the modified tip instrument technique to gain access and negotiate the canal to the apex followed by conventional root canal preparation and obturation.