Pulp Space Research Articles

Effects of High-Energy Curing Lights on Time-Dependent Temperature Changes of Pulp Space During Orthodontic Bonding.

The purpose of this study was to assess the temperature changes and cooling times during orthodontic bonding by a light-emitting diode (LED) and plasma arc lights (PAC) in different time and power modes with thermal imaging. A total of 100 human permanent upper first premolar teeth were included in the study. Five groups were conducted, 20 teeth each, and different energy outputs of curing lights were used for adhesive polymerization with different exposure times. The temperature changes in the pulp space and cooldown times were measured by a thermal imaging system. A paired t-test, analysis of variance (ANOVA), and Student-Newman-Keuls multiple comparison tests were used for data analysis. A statistically significant temperature rise was detected with all curing lights (p<0.05). The greatest temperature changes were observed in the LED standard mode with 10 seconds of exposure time (6.66±1.98°C) and LED extra power mode with 6 seconds of exposure time (6.50±1.64°C) among groups, while using PAC for 3 seconds created the smallest temperature increase (1.81±0.99°C). An application of the LED extra power mode for 6 seconds exhibited the longest cooldown time (205.91±47.48 seconds), and the shortest cooldown time was detected as 71.30±43.15 seconds with the PAC 3-second application. LED lights with an increased exposure time induced significant temperature rises, while no PAC light group exceeded the critical threshold value. The exposure time is more important than the energy output level of the light-curing system on temperature increments of the pulp chamber.

Calcific metamorphosis of pulp after extrusive luxation.

The literature on the pathogenesis of extrusive dental luxation has been focused on periodontal tissue responses, with little attention given to the pulp. The aim of this study was to evaluate the response of dental pulp of teeth following extrusive luxation in a rat model. The maxillary right central incisors of 30 rats were extrusively luxated and repositioned after 5minutes. The animals were euthanized after 7, 15, and 30days to provide three groups: I, II, and III, respectively (n=10). Histological sections were stained with H and E for histomorphometric analysis of the odontoblast layer, reparative dentin deposition, Hertwig's epithelial root sheath, pulp necrosis, and periapical inflammatory infiltrate. In most cases, new vascular formation occured in association with reparative dentin deposition on the root walls and within the pulp. In some cases, dentin deposition occupied the entire pulp space over time, with no other types of non-odontogenic hard tissues being observed. Pulp necrosis with the presence of periapical inflammatory infiltrate was also observed in a few cases. No statistical differences were observed among the studied groups. Following extrusive luxation, calcific metamorphosis of the pulp is very likely to occur.

Calcific Metamorphosis: An Insight

Trauma to the dental hard tissues often leads to clinical complications and the management appears as a challenge to the practitioner. The incidence of calcific metamorphosis is bound to be approximately 4 - 24%. Following calcific metamorphosis, attempt to negotiate canals and working through it to the full working length may lead to iatrogenic complications such as separated instrument, perforation etc. Calcific metamorphosis is distinguished by hard tissue deposition within the pulp space and the characteristic yellowish discoloration of the crown. Various practitioners proposed the treatment modalities for CM according to their experience and suggested that the treatment should be carried out with the earliest detection of CM or to wait and treat till the symptoms or radiographic signs of pulpal death are noticed.

Morphological measurements of anatomical landmarks in human maxillary first molar pulp chambers and evaluation of number of pulp canal orifices using spiral computed tomography: An in vitro study.

Context:Comprehensive understanding of the anatomic position of pulp canal orifices and the measurements of the molar pulp space may maintain the pulp health during conservative tooth preparation and minimize the possibility of mishaps during endodontic therapy.Aims:The idea of the present study was to analyze the morphological measurements of anatomical landmarks in human maxillary first molar pulp chambers and evaluation of number of pulp canal orifices using three-dimensional spiral computed tomography (SCT).Subjects and Methods:One hundred and thirty extracted intact human adult maxillary first molars were chosen from the North Indian population and were analyzed using SCT in axial and coronal sections.Statistical Analysis Used:Standard deviation, mean, and coefficient of variance were calculated. Interobserver reliability was evaluated using kappa value to avoid any bias.Results:The results from our study showed that 69.23% of the sample teeth had four canal orifices, the mesial and distal pulp horns were present at an average distance of 0.80 ± 0.36 mm and 0.41 ± 0.34 mm, respectively, above the cementoenamel junction (CEJ), and the mean distance from the central groove of central fossa to furcation and the central groove of central fossa to the pulp chamber's roof was 8.37 ± 0.33 mm and 3.87 ± 0.29 mm, respectively. The average distance of the pulp chamber's floor from the furcation was found to be 2.47 ± 0.11 mm. The highest degree of variance was observed in case of relation of CEJ to pulp horns, i.e., 44.85% and 82.60%.Conclusions:The dimensions observed in this study and its resemblance to the various studies reported in literature shift the fundamental anatomic approach to a more systemic quantifiable approach to the endodontic maxillary first molar access preparation.

Management of Calcific Metamorphosis with Minimally Invasive Porcelain Veneers-A Case Report

The management of traumatized permanent teeth can present as a significant challenge to the dental practitioner. Calcific metamorphosis occurs commonly in young adults as an end result of trauma. It is usually evident in the anterior region of the mouth and can partially or totally obliterate the pulp space radiographically. Most of the studies and case reports suggest that endodontic therapy is not intervened unless a periapical pathology is detected and/or when the concerned tooth becomes symptomatic. This case report presents the anterior teeth with calcific metamorphosis treated with porcelain veneers.

Современные представления о качестве эндодонтического лечения

The aim of the study is to analyze the factors that prevent the improvement of endodontic treatment. Materials and methods: we considered possible prospects for long-term endodontic treatment and prediction of results. Results of the study: these literature data show that intra- and extracorporeal factors influence the prediction of endodon treatment. Incomplete purification of pulp space after preparation, stability, ability of microflora to maintain apical inflammatory process, synthesis of intra- and extraradiclar biofilm, inactivation of medicines in root canal requires search of alternative irrigation agents and disinfection modes. In addition to the conventional preparation, the use of iodine preparations and physical factors in both primary and repeated endodontic treatment is promising. At the modern stage of endodontia, the size of the periapical lesion is not the main factor in deciding on conservative endodontic treatment or surgical treatment of the lesion. Due to the availability of tools, equipment and treatment techniques, endodontic intervention should ideally end successfully. But in the analysis of treatment results, a number of publications note that an unfavourable outcome is even in the case of «well-treated channels». Intracorneal factors include the complexity of endodontic anatomy, infection, diversity of microflora in the root canal system, its resistance and ability to organize into biofilm. Extracorporeal reasons include extradicular infection, «true» cysts, the presence of endo-periodontal lesions, root resorption, the reaction of periapical tissues to the foreign body (endogenous or exogenous origin) and yatrogenic factors (arising during preparation, irrigation of the root canal), toxic and irritating properties of the used drugs. Several of these etiological factors often lead to the development of the inflammatory process in the periodontal. Each can influence the outcome of endodontic treatment. The failure of conservative treatment is still recommended to be considered as the development of an infectious process.

Guided root canal preparation using cone beam computed tomography and optical surface scans - an observational study of pulp space obliteration and drill path depth in 50 patients.

To report the precision of guided access cavity preparations in relation to demographical and dental variables in 50 patients. This observational study was carried out during the period 2014-2017. The patients were consecutive referrals to a private endodontic practice. The inclusion criteria were as follows: (i) pulp space obliteration associated with signs of apical periodontitis (PAI score >3 or sensitive to percussion, (ii) teeth with pulp space obliteration in need of a post, where the referring dentist had attempted or failed to negotiate the obliterated root canal (and it was not possible to negotiate using the operating microscope within a reasonable time frame) and (iii) a surgical intervention was not justified. A published methodology for guided endodontics was used. Measures on demographical and previous dental history were analysed and related to drill path precision, being evaluated on radiographs as optimal (centre of the root canal) or acceptable (peripheral/tangential). The chi-square test was used for analyses of correlation between predictor variables and binary logistic regression analysis using backward elimination with degree of obliteration, guided access cavity preparation depth and precision as dependent variables. Significance level was 0.05. Thirty-one female (median age 65year) and 19 males (median age 69year) were enrolled. Overall, 88% (n=44) of the teeth had pulp space obliteration associated with signs of apical periodontitis, whereas the remaining teeth were in need of a post. The pulp space obliterations were longer in maxillary compared with mandibular teeth (P=0.024). The performance of the drill path in mandibular teeth versus maxillary teeth resulted in a significantly greater number of optimal precision scores (P=0.033), and when a previous attempt at access and canal negotiation had occurred versus no attempt (P=0.009). Even in cases with the worst outcome, the technique was still successful clinically. The clinical implementation of guided root canal treatment in fifty serial cases of single-rooted teeth with pulp space obliteration was associated with a precision that in all cases led to the location and negotiation of the root canal and completion of the treatment.

Trauma Induced External Inflammatory Root Resorption - A Case Report

<p style="text-align: justify;">Inflammatory root resorption is a serious complication of dental trauma, which leads to progressive loss of the root structure. It is challenging for a dental clinician to diagnose and plan the treatment for root resorption. This case report describes the diagnosis and treatment of a previously traumatized maxillary central incisor which was severely affected by inflammatory root resorption. This case was treated by conventional nonsurgical pulp space therapy. Calcium hydroxide dressing was given as an intra-canal medicament. The entire root was obturated with mineral trioxide aggregate. The radiographic follow up at 12 months showed arrest of root resorption and initiation of periapical healing in the absence of clinical symptoms and mobility. From the present case, it can be concluded that mineral trioxide aggregate obturation can be a viable option that can enhance the healing in cases of severe inflammatory root resorption. <p style="text-align: justify;"><strong> Key words:</strong> Trauma induced external inflammatory root resorption, Mineral trioxide aggregate, Regeneration, Non-surgical endodontic therapy.

A rare case of an immature incisor with horizontal root fracture traumatized at the time of eruption

Dental trauma resulting in root fracture is a rare condition that affects up to 7% of permanent teeth, and injury to immature teeth is even rarer. This case report aimed to show the prognosis of a horizontal root-fractured immature maxillary incisor traumatized at the time of eruption.&#x0D; Because of an accident, a 6-year-old boy was referred to our clinic with horizontal root fracture of the permanent maxillary left central incisor associated with an extrusive luxation. The coronal segment was repositioned, and a dental splint was applied for 7 weeks. After 48 months, clinical examination revealed a positive response to electrical pulp testing and an absence color change of the tooth. Continuation of root development and calcification of the coronal pulp space was observed radiographically. It was concluded that fixation of teeth is a conservative treatment for immature teeth with horizontal root fractures, resulting in the pulp vitality and spontaneous healing with no other treatment.&#x0D; &#x0D; How to cite this article: Erkmen Almaz M, Şaroğlu Sönmez I, Akbay Oba A. A rare case of an immature incisor with horizontal root fracture traumatized at the time of eruption. Int Dent Res 2018;8(2):94-6.&#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Culture-independent Characterization of the Microbiome of Healthy Pulp

IntroductionAdvances in culture-independent molecular biotechnologies have driven a greater appreciation for the function of mutualistic microorganisms in the maintenance of states of health in humans. The purpose of this study was to test the long-held hypothesis that healthy pulp lack bacteria. MethodsStrict inclusion criteria were used to identify 10 pristine teeth from 10 healthy patients that were scheduled to be electively extracted in compliance with an orthodontic treatment plan. Using a rigorous disinfection protocol to isolate the operating field, the pulp space was accessed, and pulp tissue was collected in vivo from each tooth using a barbed broach. Genomic DNA was extracted from each pulp sample and analyzed for the presence of bacterial DNA using universal 16S ribosomal RNA polymerase chain reaction primers and MiSeq sequencing (Illumina, San Diego, CA) of community amplicons. ResultsOne hundred percent (10/10) of the tested pulp tissues demonstrated the presence of bacterial DNA, with a mean of 343 operational taxonomic units per sample (range, 191–479). These were derived from 12 genera in which Ralstonia, Actinetobacter, and Staphylococcus were predominant (43%–78% of total community). None of the negative-field controls and none of the instruments used in the study tested positive for the presence of contaminating DNA. ConclusionsThis study presents evidence to support the conclusion that the pulp spaces of pristine healthy teeth contain detectable bacterial DNA.

The effect of Light Emitting Diode and Sandwich technique on Pulp Temperature during Polymerization of Composite resin

This in vitro study evaluated the effect of glass ionomer liner in limiting temperature rise during composite curing with Light Emitting Diode (LED cure unit) compare it with Conventional visible light-cure lamp.Twenty sound upper premolar teeth were used &amp; on the buccal and palatal surfaces of them, a standardized class V cavity was prepared, 1mm occlusal to the cemento-enamel junction. Cavity dimensions of occluso-gingival height 1.5mm, mesio-distal width of 3mm. The depth of the cavity was 2mm and was calibrated by measuring with a pre marked periodontal probe. The teeth were randomly divided into four groups according to the cure mode and filling teqnique. Each group consist of 5 teeth (10 cavities); Group I; each cavity filled with 2mm (micro-hybrid resin composite) and cured with Quartz Tungsten Halogen light unit (QTH), Group II; the same as Group I but cured with Light Emitting Diod (LED cure unit), Group III; each cavity filled with glass ionomer lining of 0.5mm and 1.5mm (micro-hybrid resin composite), and cured with Quartz Tungsten Halogen light unit (QTH), &amp; Group IV; each cavity filled with glass ionomer lining of 0.5mm and 1.5mm (micro-hybrid resin composite) but cured with Light Emitting Diod (LED cure unit). Temperature was measured before light curing of the composite resin &amp; immediately after it. Then the Temperature was measured by a type K thermocouple.The results revealed that there were significant differences between the groups at p&lt;0.01 with in favor of the group filled with composite resin &amp; cured with LED with glass ionomer lining.The use of sandwich restorations with LED curing unit produced lesser temperature degrees toward the pulp space.

Mid Mesial Canal in Mandibular Molars: Two Case Report and A Review of Literature

&lt;p class="Default"&gt;The main objective of root canal treatment is thorough mechanical and chemical cleansing of the entire pulp space followed by complete obturation with an inert filling material. These molars normally have two roots, one mesial and one distal, and their usual canal distribution is two in the mesial root and one or two in the distal root. This clinical case reports and review of literature describes the management of the mandibular molar with three separate mesial canals including middle mesial canal.&lt;/p&gt;

PERFORACIONES RADICULARES: UNA REVISIÓN

Root perforations are one of the risks when endodontically treating the teeth and depend on the operator that this accident will not be the end of the affected tooth. Root perforations are one of the causes of endodontic failures and are denominated in terms of artificial openings in the root walls created by the milled one, drilled, cut or resorption that turns out in a communication between the pulp space to periodontal tissues, that could cause a secondary periodontal complication and a possible lose of the tooth. They can be induced by iatrogenic causes, resorptives processes or by decay. The purpose of this paper was to review the factors that affect this failure.

Hand infections

The integument provides only a limited barrier to protect the multiple functional structures of the hand from infection by common bacteria and other rare organisms. If infection is limited to just skin cellulitis, then antibiotics and careful monitoring may be all that is needed. Once bacteria become trapped in a deeper soft-tissue space and form an abscess then debridement must be performed to evacuate the purulence and necrotic tissue. Specialized compartments in the hand such as the pulp space, nail folds, joint cavities, and tendon sheaths facilitate bacterial containment and abscess formation, rendering immune response less effective. Osteomyelitis can originate from direct penetration or spread from an adjacent soft-tissue infection. Orthopaedic devices foster the development of a biofilm that can harbor bacteria, making resolution more difficult. The surgeon should obtain tissue for laboratory analysis at the deep infection site and subsequently administer empiric antibiotics while awaiting culture results. Greater duration of antibiotics is needed for infections of synovial tissues and bone. Unique infections caused by rare organisms may affect the hand, requiring recognition based on specific clinical features and confirmation by specialized laboratory testing.

A Cone Beam Computed Tomography Study of the Prevalence of Pulp Stones in a Saudi Arabian Adolescent Population

Objective: To assess the prevalence of pulp stones using Cone Beam Computed Tomography (CBCT) in a Saudi Arabian adolescent population. Material and Methods: CBCT scans of 237 individuals compromising of 1018 teeth were examined. All teeth were analyzed in three dimensions and the presence of pulp stones were identified as a round or oval shaped dense structures in the pulp space. The location of involved tooth in terms of arch, side involved and the status of the tooth were documented. Statistical analysis was carried out by applying Chi-square test. The level of significance was set at 5%. Results: Pulp stones were observed in 119 out of the 237 participants, and in 118 teeth out of 1018 teeth examined, with the patient prevalence of 50.2% and tooth prevalence 10.6%. Pulp stones were observed in 76 (51.3%) of males and 43 (48.3%) of females, with no significant difference (p>0.05). A nonsignificant difference was also noted when maxillary and mandibular arches and the left and right sides were compared. Pulp stones were observed more frequently observed in molars and in carious (8.8%) and restored teeth (17.1%). Conclusion: The prevalence of pulp stones was high in molars and in carious and restored teeth. No significant difference was noticed between gender, arch and side of tooth involved with pulp stones.

Revascularization in Immature and Mature Teeth with Necrotic Pulp: A Clinical Study

The aim of this in vivo study was to evaluate the revascularization procedure both in immature and mature teeth with necrotic pulp and open apices, disinfected with triple antibiotic paste followed by inducing blood clot in the root canal. Fifteen patients were selected who presented with immature and mature permanent teeth with pulpal necrosis and open apices. In the first visit, the root canal was accessed with LA and rubber dam isolation; then the canal was disinfected using triple antibiotic paste containing ciprofloxacin, metronidazole, and clindamycin in the ratio of 1:1:1 and closed with IRM. In the second visit, after administering local anesthesia and isolating with a rubber dam, the triple antibiotic paste was washed out by saline irrigation, and apical papilla beyond the confines of the root canal was stimulated with sterile H file to produce a blood clot. Finally, the access was closed using a double seal with mineral trioxide aggregate (MTA) placed apical to cementoenamel junction and resin bonded cement over the MTA. Radiographic examination and pulp sensibility test was done during the follow-up period of 2,4,6,8 and 10 months. After 10 months follow-up, 10 out of 13 patients showed root development and apical closure. The eight patients out of 13 showed root development, apical closure and lateral thickening of radicular dentin and 2 out of 13 patients showed a positive response to electric sensibility test. Within the limitation of this study, it can be concluded that there is evidence of root development, increase in lateral wall thickness, apical closure and positive response to pulp sensibility test in both mature and immature teeth with necrotic pulp. The conventional approach for management of teeth with necrotic pulp and the open apex is altered with the possibility of tissue regeneration within the pulp space and continued root development through revascularization procedures. It also re-establishes the vitality in a previously nonvital and necrosed tooth.

Endodontic management of six canals in mandibular first molar

Success in root canal treatment is achieved after meticulous mechanical and chemical cleansing of the pulp space succeeded by complete obturation of the root canal in its entire dimension. Pulp tissue remnants present in missed canals and spaces may compromise the treatment outcome. Therefore, it is important to diagnose the peculiar anatomy of such teeth during root canal treatment. This case report describes the diagnosis and successful endodontic management of an unusual mandibular first molar with three mesial and three distal canals.

Endodontic management of type II dens invaginatus with open apex and large periradicular lesion using the XP-endo Finisher: A case report

Dens invaginatus (DI) represents an endodontic challenge because of its complex root canal morphology. This case report presents the clinical management of a 22-year-old woman with type II DI in right maxillary lateral incisor with a painful swelling. Pulp testing revealed no response with the tooth. Type II DI with open apex and large periradicular lesion was seen on radiograph. The treatment was planned by using cone-beam computed tomography (CBCT) imaging. Canal treatment was completed in two appointments with the aid of a dental operating microscope. In the first appointment, the internal anatomy was modified using an ultrasonic tip, and chemo-mechanical preparation was performed using the XP-endo Finisher instrument and NaOCl; calcium hydroxide intracanal dressing was used for one month. In the second appointment, an apical plug of mineral trioxide aggregate (MTA) Repair HP was performed and the remaining pulp space was then filled with gutta-percha and AH Plus sealer using the continuous wave of condensation technique. At the fourteen-month reevaluation, the patient was asymptomatic, the tooth had remained functional, and radiographic and CBCT assessment showed significant osseous healing of the lesion. Successful non-surgical management of the present type II DI was achieved in the present case. The association of CBCT, dental operating microscope, XP-endo Finisher, NaOCl and MTA Repair HP were important for ensuring a predictable outcome. Key words:Cone beam computed tomography, dens invaginatus, MTA apexification, XP-endo Finisher.

Nail Changes in Chilblains Mimicking Lichen Planus

Nail Changes in Chilblains Mimicking Lichen Planus

Comparing Two Views Of Video Demonstration For Access Cavity Preparation: A QuasiRandomized Controlled Trial

Introduction: Demonstration of the access cavity preparation procedures to dental students is challenging due to the limited operating field and detailed nature of the procedures. It is especially difficult to visualize how instruments are functioning inside the pulp space. The aim of this study was to develop and compare two different views of video demonstration in teaching access cavity preparation. Materials and Methods: Two videos of access cavity preparation were filmed, showing occlusal view of a whole tooth (WT) and sagittal view of a sectioned tooth (ST). Using quasirandomization, third year dental students (n=57) were divided into two groups to watch either one of the videos. The perception and performance of both groups were compared using Mann-Whitney U test and Fisher exact test. Results: At baseline, group WT (n=29) and group ST (n=28) were not significantly different in terms of operative scores (p=0.330). After watching the videos, the basic understanding of the theories were similar between both groups. However, ST responded more positively towards the helpfulness of the video in visualizing the inner anatomy of the tooth and in implementing the procedures (p&lt;0.05). ST also completed the exercise within a shorter time (p&lt;0.001). Nevertheless, the quality of the prepared access cavities was not significantly different between groups. Conclusion(s): Using sagittal view of sectioned tooth in video demonstration of access cavity preparation can improve students learning and performance speed. We highly recommend showing the sagittal view of sectioned tooth in video demonstration of access cavity preparation.