The effect of two different root canal sealers on treatment outcome and post-obturation pain in single-visit root canal treatment: A prospective randomized clinical trial.

AIM: This randomized clinical trial aimed to evaluate and compare the effect of mineral trioxide aggregate (MTA)-based bioceramic- and resin-based sealers on the incidence and intensity of post-obturation pain and treatment outcome in asymptomatic vital molar teeth in single-visit root canal treatment. METHODOLOGY: One hundred asymptomatic mandibular molar teeth with vital pulp were randomly assigned into two groups according to the sealer used: MTA Fillapex or AH Plus sealer. WaveOne Gold instruments were used for root canal preparations. Root canals were obturated with WaveOne Gold gutta-percha cones corresponding in size and taper to the last instrument used. MTA Fillapex was used in the first group and AH Plus was used in the second group as the root canal sealer. The effects of age, gender, tooth types and the level of root canal filling on the treatment outcome were evaluated after 1 and 2 years. Postoperative pain at 6, 12, 24, 48, 72 h, 4, 5, 6, 7 and 30 days after root canal treatment was measured with the Numerical Rating Scale. Chi-square test was used for the treatment outcome and Mann-Whitney U, chi-Square and Spearman correlation analyses were used for postoperative pain. α = .05 was the level of significance. RESULTS: Twelve patients did not complete the 2-year follow-up and the study finished with 88 patients. In the MTA Fillapex group 41 correct, one short, two extruded, and in the AH Plus group 40 correct, one short and three extruded root canal fillings were detected. No significant differences were observed between the first- and second-year treatment outcomes between the groups (p > .05).There was no association between age, gender, tooth number, root canal filling length and the treatment success in all evaluated teeth (p > .05). The differences between the groups in terms of postoperative pain incidence and intensity at all time-points were not significant (p > .05). There was no correlation between the age and postoperative pain (p > .05), but pain was statistically higher in women (p < .05). CONCLUSIONS: Mineral trioxide aggregate Fillapex showed similar success rate and post-obturation pain incidence and intensity as AH Plus sealer and can be used as a root canal sealer in asymptomatic mandibular molars with irreversible pulpitis.

USAGE OF CHLORHEXIDINE AS A FINAL IRRIGANT IN ONE-VISIT ROOT CANAL TREATMENT IN COMPARISON WITH CONVENTIONAL TWO-VISIT ROOT CANAL TREATMENT IN MANDIBULAR MOLARS: A RANDOMIZED CLINICAL TRIAL.

OBJECTIVES: The effectiveness of 1-visit root canal treatment (RCT), especially for teeth with large periapical lesions, are still being debated. Although, the use of chlorhexidine (CHX) as a final irrigant have been recommended to provide an optimized approach in 1-visit RCT, there is limited knowledge about the outcome of 1-visit RCT using CHX as the final irrigant. AIM: The aim of this randomized clinical trial was to evaluate the healing of mandibular molar teeth with large periapical lesions after RCT that was completed in 1 visit using 2% CHX as a final irrigant, comparing the results with a conventional 2-visit RCT as a control group. METHODOLOGY: This study is a prospective, parallel-designed, and single-blinded randomized clinical trial. One-hundred asymptomatic mandibular molar teeth with large periapical lesions were randomly assigned to 2 groups. All teeth were instrumented with Reciproc files with 2.5% sodium hypochloride (NaOCl) and 5% ethylenediaminetetraacetic acid (EDTA) as irrigants. In the intervention group, half of the teeth were treated in 1 visit, receiving an additional final rinse with 2% CHX before obturation; the other half of the teeth, however, were treated in 2 visits with calcium hydroxide (CH) dressings, in the control group. All root canals were obturated with Reciproc gutta-percha cones and AH Plus root canal sealer. All patients were recalled and investigated clinically and radiographically for 48 months. Periapical healing was evaluated statistically using the Mann-Whitney U test, followed by the Friedman and the Wilcoxon tests (α = 0.05). RESULTS: During the 48-month follow-up process, 86 teeth (44 in 1-visit and 42 in 2-visit group) were examined. There were no significant differences between the 2 groups regarding the radiographic healing rates (1-visit group 91% and 2-visit group 88%) (P > .05). CONCLUSION: In this study, 1-visit RCT using 2% CHX as final irrigant in asymptomatic mandibular molars with large periapical lesions produced favorable healing results, similar to 2-visit root canal treatment with calcium hydroxide.

Quality of root canal treatment performed by undergraduate students using nickel-titanium reciprocating versus hand instruments.

PURPOSE: To compare the technical quality of root canal treatment (RCT) depending on the incidence of procedural errors performed by undergraduate students using nickel-titanium reciprocating and conventional hand instrumentation techniques, and to assess the impact of case difficulty and localization of the teeth (maxillary or mandibular molars). METHODS: Dental records and periapical radiographs of molars that were treated with either hand or reciprocating WaveOne (WO) instruments were evaluated retrospectively. The technical quality of RCTs, the incidence of ledge formation, perforation, instrument fracture, overinstrumentation, underfilling, overfilling, inadequate root canal filling, and the effects of case difficulty and tooth localization were compared using the chi-square test with a significance of 5% (α = 0.05). RESULTS: While overinstrumentation was more frequent in the WO group (247 teeth), the incidence of inadequate root canal fillings was higher in the hand instrumentation group (245 teeth) (p < 0.01). No significant difference was observed in the incidence of other procedural errors (p > 0.05). The number of teeth with acceptable technical quality in preparation and obturation was 172 (69.6%) in the WO group, whereas it was 142 (58%) in the hand instrumentation group, presenting a significant difference between the instrumentation techniques (p < 0.01). Higher technical quality rates were observed with WO instrumentation in the high difficulty category and in maxillary teeth (p < 0.01). CONCLUSION: Higher technical quality in preparation and obturation can be achieved with WO reciprocating instruments and file-matched greater tapered gutta-percha cones. No significant difference was observed between the groups in the incidence of procedural errors except for overinstrumentation and insufficient root canal filling. WO instrumentation and obturation with file-matched greater tapered gutta-percha cones provided better technical quality in the high difficulty category and in maxillary teeth.

Outcome of single- versus two-visit root canal retreatment in teeth with periapical lesions: A randomized clinical trial.

AIM: The aim of the study was to evaluate the clinical and radiographic outcome of single-visit root canal retreatment and compare the results with conventional two-visit root canal retreatment as control group. METHODOLOGY: One hundred root canal-treated, single-rooted asymptomatic teeth with periapical lesion were retreated by one operator. Fifty of the teeth were randomly assigned to the single-visit group and the others were treated in two visits. In both groups, root canal filling material was removed, and re-instrumentation of the root canal was performed using step-back technique with hand files using 2.5% NaOCl and 5% EDTA as irrigants. In the single-visit group, 5 ml 2% chlorhexidine (CHX) were applied as the final irrigation and in the two-visit group, calcium hydroxide paste was placed into the root canal as an interappointment dressing. All root canal obturations were performed with lateral compaction. All patients were followed up for 24 months. The success was determined depending on both healed and healing cases. The chi-square or Fisher's exact test was used to analyse the differences between the groups for success rates and the factors affecting the outcome. RESULTS: The recall rate was 89 (89%). At 24 months, 39 teeth (88.6%) were considered as healed, three teeth (6.8%) as healing, and two teeth (4.5%) were identified as failed in the single-visit group, while in the two-visit group 39 teeth (86.7%) had healed, two teeth (4.4%) were scored as healing, and four teeth (8.9%) as failed. There was no statistically significant difference in the success rates between the two groups (p > .05). Size of the lesion and the preoperative length of root canal filling had a statistically significant impact on the outcome (p < .05). CONCLUSION: No statistically significant difference was observed in terms of healing in 24-month follow-up of retreatments completed in single visit or two visits in asymptomatic teeth with periapical lesions. The size of the periapical lesion and initial apical level of root canal filling have affected the outcome of root canal retreatment.

YouTube™ as an information source for regenerative endodontic treatment procedures: Quality and content analysis.

BACKGROUND: Regenerative endodontic procedures (REPs) are one of the most important developments in dental practice, and in the era of Covid 19 pandemic, audio-visual contents of YouTube™ could be an information source for dental students, practitioners and patients. The aim of this study was to evaluate the quality, content and the demographics of YouTube™ videos about REPs. METHODS: A search on YouTube™ was performed for REPs using "endodontic regeneration", "pulp regeneration", "regenerative endodontics", "regenerative endodontic procedures", "revascularization" and "revitalization" keywords. Totally 531 videos were found and 60 videos met the inclusion criteria. Following the assessment of the demographic features of the videos and the viewing rate of the videos were calculated. The content of the videos was evaluated based on the selected headings. The quality of the videos was assessed using the video information, quality index (VIQI), Global Quality Score (GQS) and DISCERN. The statistical analysis was performed using Spearman Correlation and linear regression analysis. RESULTS: Majority of the videos about REPs were created by dental professionals (91.7%). The most commonly covered topic was "clinical application" (76.7%). Total content score showed a positive correlation with total VIQI (r = 0.795; p < 0.001) and GQS (r = 0.952; p < 0.001). There were significant relationships between total content score, duration, GQS, total VIQI score and DISCERN. CONCLUSION: The findings revealed that YouTube™ videos about REPs provide predominantly clinical information about patient chairside practice of REPs and they could be considered as a supplementary information source for dental students and practitioners.

Energy-Dispersive X-Ray Spectrometry Analysis and Radiopacity of Five Different Root Canal Sealers.

Root canal sealers should have optimum adhesion to the root dentin, low cytotoxicity, sufficient radiopacity and high dimensional stability, which depend mainly on their chemical composition. The aims of this study were to evaluate the chemical composition of Syntex (Cerkamed, Stalowa Wola, Poland), Adseal (Meta Biomed, Cheongju-si, Korea), Sealapex (SybronEndo, Scafati, Italy), MTA Fillapex (Angelus, Londrina, Brazil) and GuttaFlow Bioseal (Coltene/Whaledent, Altstätten, Switzerland) and to determine their radiopacity comparatively. Stainless steel molds with an inner diameter of 5 mm and a depth of 2 mm were constructed. Tested root-canal sealers were mixed and poured into the molds. Following setting, digital periapical radiographs of the specimens (n=12) were taken under standard exposure conditions and the mean gray-values of specimens were measured using a computer graphics program. Then the specimens were examined by scanning electron microscopy, and Energy-dispersive X-ray analysis was performed. The data were analyzed using One-way ANOVA followed by Holm-Sidak multi-comparison test (p = 0.05). Sealapex showed higher calcium peak than MTA Fillapex, GuttaFlow Bioseal, Adseal and Syntex sealers. MTA Fillapex contained a highest amount of tungstate. Sealapex presented the highest radiopacity value among the tested materials (p < 0.05), whereas MTA Fillapex was the least radiopaque material (p < 0.05). Each root canal sealer contains different compositions of radiopacifiers including bismuth oxide, calcium tungstate and zirconium oxide. The tested root canal sealers had radiopacity values above the ISO-specified limit. Sealapex was the most radiopaque root canal sealer followed by GuttaFlow Bioseal, Syntex, Adseal and MTA Fillapex.

A prospective cohort study evaluating the outcome of root canal retreatment in symptomatic mandibular first molars with periapical lesions.

AIM: To evaluate the impact of various predictors on the outcome of root canal retreatment in symptomatic mandibular first molars with periapical lesions after a minimum of 2 years. METHODOLOGY: One hundred and twenty previously root canal treated symptomatic mandibular first molars with periapical lesions which were diagnosed as symptomatic apical periodontitis or acute apical abscess with localized intraoral swelling were included. Root canal retreatment was performed by an experienced endodontist using a standardized treatment protocol. The teeth were followed up clinically and radiographically and the radiographic outcome was assessed using a modified periapical index scale (PAI). The cumulative success proportion and the influence of predictors on the outcome of the root canal retreatment were analysed using Kaplan-Meier analyses and log-rank tests, and the hazard ratios for the predictors were also investigated using Univariate Cox Proportional Hazard regression analysis at a significance level of 5%. RESULTS: Of the 120 teeth, 103 teeth were re-examined with an 85% recall rate. The cumulative success rate was 88% in which 64% were healed and 24% were healing, and failure rate was recorded as 12%. None of the preoperative predictors, including age, gender, soft tissue tenderness, intraoral swelling, size of the lesion, PAI score, apical level and density of root canal filling before root canal retreatment, nor intraoperative predictors, such as active exudate drainage, density of root canal filling after root canal retreatment and restoration type had an influence on the outcome of root canal retreatment (p > .05). The only factor that significantly reduced the success rate of root canal retreatment was the apical level of the root canal filling; when it was more than 2 mm short of the radiographic apex in teeth where apical patency was not established, the success was significantly lower (p = .023). CONCLUSIONS: Root canal retreatment in symptomatic mandibular first molars with periapical lesions resulted in a success rate of 88%. None of the predictors had a significant influence on the outcome, except for the apical level of the root canal filling after root canal retreatment with short root fillings being associated with significantly more post-treatment endodontic disease.

Energy-Dispersive X-Ray Spectrometry Analysis and Radiopacity of Five Different Root Canal Sealers

Abstract Root canal sealers should have optimum adhesion to the root dentin, low cytotoxicity, sufficient radiopacity and high dimensional stability, which depend mainly on their chemical composition. The aims of this study were to evaluate the chemical composition of Syntex (Cerkamed, Stalowa Wola, Poland), Adseal (Meta Biomed, Cheongju-si, Korea), Sealapex (SybronEndo, Scafati, Italy), MTA Fillapex (Angelus, Londrina, Brazil) and GuttaFlow Bioseal (Coltene/Whaledent, Altstätten, Switzerland) and to determine their radiopacity comparatively. Stainless steel molds with an inner diameter of 5 mm and a depth of 2 mm were constructed. Tested root-canal sealers were mixed and poured into the molds. Following setting, digital periapical radiographs of the specimens (n=12) were taken under standard exposure conditions and the mean gray-values of specimens were measured using a computer graphics program. Then the specimens were examined by scanning electron microscopy, and Energy-dispersive X-ray analysis was performed. The data were analyzed using One-way ANOVA followed by Holm-Sidak multi-comparison test (p = 0.05). Sealapex showed higher calcium peak than MTA Fillapex, GuttaFlow Bioseal, Adseal and Syntex sealers. MTA Fillapex contained a highest amount of tungstate. Sealapex presented the highest radiopacity value among the tested materials (p < 0.05), whereas MTA Fillapex was the least radiopaque material (p < 0.05). Each root canal sealer contains different compositions of radiopacifiers including bismuth oxide, calcium tungstate and zirconium oxide. The tested root canal sealers had radiopacity values above the ISO-specified limit. Sealapex was the most radiopaque root canal sealer followed by GuttaFlow Bioseal, Syntex, Adseal and MTA Fillapex.

Resumo Os cimentos endodônticos devem conter ótima adesão à dentina radicular, baixa citotoxicidade, radiopacidade suficiente e estabilidade dimensional elevada, que dependem principalmente da sua composição química. Os objetivos deste estudo foram avaliar a composição química de Syntex (Cerkamed, Stalowa Wola, Polônia), Adseal (Meta Biomed, Cheongju-si, Coreia), Sealapex (SybronEndo, Scafati, Itália), MTA Fillapex (Angelus, Londrina, Brasil) e GuttaFlow Bioseal (Coltene/Whaledent, Altstätten, Suíça) e determinar comparativamente a sua radiopacidade. Foram construídos moldes de aço inoxidável com um diâmetro interior de 5 mm e uma profundidade de 2 mm. Os cimentos testados foram misturados e vertidos em moldes. Após a fixação, foram feitas radiografias periapicais digitais dos espécimes (n=12) em condições de exposição padrão e os valores médios de cinza dos espécimes foram medidos utilizando um programa de computação gráfica. Em seguida, as amostras foram examinadas por microscopia eletrônica de varredura, e foi realizada uma análise de raios X dispersiva de energia. Os dados foram analisados utilizando a ANOVA unidirecional seguida do teste de comparação múltipla Holm-Sidak (p = 0,05). O Sealapex mostrou um pico de cálcio mais elevado do que os cimentos MTA Fillapex, GuttaFlow Bioseal, Adseal e Syntex. O MTA Fillapex continha uma quantidade mais elevada de tungstato. O Sealapex apresentou o maior valor de radiopacidade entre os materiais testados (p < 0,05), enquanto que a MTA Fillapex foi o material menos radiopaco (p < 0,05). Cada cimento endodôntico contém diferentes composições de radiopacificadores incluindo óxido de bismuto, tungstato de cálcio e óxido de zircônio. Os cimentos testados apresentaram valores de radiopacidade acima do limite especificado pela ISO. Sealapex foi o cimento obturador mais radiopaco seguido por GuttaFlow Bioseal, Syntex, Adseal e MTA Fillapex.

Impact of root canal curvature and instrument type on the amount of extruded debris during retreatment.

OBJECTIVES: The aim of the current study was to assess whether the amount of extruded debris differs for straight and severely curved root canals during retreatment using H-files, R-Endo, Reciproc and ProTaper Universal Retreatment (PTU-R) files. Additionally, the area of residual filling material was evaluated. MATERIALS AND METHODS: Severely curved (n = 104) and straight (n = 104) root canals of maxillary molar teeth were prepared with WaveOne Primary file and obturated with gutta-percha and AH Plus sealer. Root canal filling materials were removed with one of the preparation techniques: group 1: H-file; group 2: R-Endo; group 3: Reciproc; group 4: PTU-R (n = 26). The amount of extruded material and the area of the residual filling material was measured. The data were analyzed with 2-way analysis of variance (ANOVA) and 1-way ANOVA at the 0.05 significance level. RESULTS: Except for Reciproc group (p > 0.05), PTU-R, R-Endo, and H-file systems extruded significantly more debris in severely curved canals (p < 0.05). Each file system caused more residual filling material in severely curved canals than in straight ones (p < 0.05). CONCLUSIONS: All instruments used in this study caused apical debris extrusion. Root canal curvature had an effect on extruded debris, except for Reciproc system. Clinicians should be aware that the difficult morphology of the severely curved root canals is a factor increasing the amount of extruded debris during the retreatment procedure.

Cyclic fatigue resistance and energy dispersive X-ray spectroscopy analysis of novel heat-treated nickel-titanium instruments at body temperature.

The aim of this study was to evaluate the cyclic fatigue resistance of Dia-X, WaveOne Gold and One Curve files in a water bath at intracanal temperature (35°C). Thirty-nine instruments Dia-X, WaveOne Gold, and One Curve systems (n = 13) were tested in an artificial canal with a curvature angle of 60° and a radius of 3 mm. A water bath setup at a temperature of 35°C was used to simulate the intracanal temperature and time to fracture (TTF) as seconds was recorded. The mean data were analyzed statistically using one-way ANOVA, and post hoc Tukey test (p = .05). The fractured surface of the instruments was examined with scanning electron microscopy (SEM) and chemical composition of the instruments were investigated with energy dispersive X-ray spectroscopy (EDS). Statistically significant differences were detected in TTF values of all the systems as follows: One Curve > WaveOne Gold > Dia-X (p < .05). One Curve instruments demonstrated the highest TTF values in all the tested instruments. The EDS microanalysis revealed similar NiTi composition of on the surface of One Curve, WaveOne Gold, and Dia-X instruments. The novel manufacturing process, including C-wire heat treatment and the variable cross-section of the One Curve files, could be the main factors affecting the fatigue life of the instruments.

Cyclic Fatigue Resistance of Multiused Reciproc Blue Instruments during Retreatment Procedure.

INTRODUCTION: Root canal retreatment procedure may reduce the mechanical resistance of nickel-titanium instruments and increase the frequency of instrument fracture. The aim of the present study was to evaluate the effect of multiuse of Reciproc Blue R25 instruments on cyclic fatigue resistance during retreatment procedure in mandibular molar teeth. METHODS: Forty-eight Reciproc Blue R25 files were included in the study. In control group, 12 new Reciproc Blue R25 instruments were subjected to cyclic fatigue test by using a stainless steel artificial canal with a 90° angle and 3-mm radius of curvatures. In experimental groups, Reciproc Blue R25 files (n = 12) were used to remove the root canal filling (RCF) material of 1, 2, and 3 molar teeth, respectively. Then cyclic fatigue tests of these 36 instruments were performed. The number of cycles to fracture (NCF) and the length of the fractured fragment were calculated for each instrument. Working time for retreatment procedures was determined in seconds with a digital chronometer. The data were analyzed by using one-way analysis of variance followed by post hoc Tukey test and mixed-effect analysis (P = .05). RESULTS: No significant difference was found between NCF values of new and first time used files (P > .05), but NCF values of new and first time used files were significantly higher than those of second and third time used files (P < .05). The second and third time used files revealed no difference (P > .05). As the number of uses increased, the average time for retreatment procedure statistically extended (P < .05). CONCLUSIONS: Reciproc Blue R25 instrument can be used to remove RCF material of 2 molar teeth. However, because of its decreased NCF values, multiple use over 2 molars may not be suggested.

Cyclic Fatigue Resistance of Novel Glide Path Instruments with Different Alloy Properties and Kinematics.

INTRODUCTION: The aim of the present study was to evaluate the cyclic fatigue resistance of the WaveOne Gold Glider (Dentsply Maillefer, Ballaigues, Switzerland), R-Pilot (VDW, Munich, Germany), and ProGlider (Dentsply Maillefer) glide path instruments. METHODS: Ten instruments from each glide path system were included in the study. A stainless steel artificial canal with a 90° angle and a 3-mm radius of curvature was used for the testing process. The working lengths of the instruments were fixed at 19 mm, and the instruments were operated using an endodontic motor (X-Smart Plus, Dentsply Maillefer) at recommended setting for each. A digital camera (Sony HDR-XR260; Sony Corporation, Minato, Tokyo, Japan) was positioned on the top of the cyclic fatigue test device, and the time to fracture was recorded in seconds by means of the video camera. For each instrument, the number of cycles to failure was calculated, and the length of the fractured fragment was measured. The data were analyzed using 1-way analysis of variance followed by the post hoc Tukey test. RESULTS: Statistically significant differences in the number of cycles to failure values were observed across the tested groups; the ranking of the instruments was as follows: WaveOne Gold Glider > R Pilot > ProGlider (P < .05). There was no significant difference in the mean length of the fractured fragment of the instruments (P > .05). CONCLUSIONS: Within the limitations of the present study, it can be concluded that improved alloy properties and reciprocating motion could enhance the cyclic fatigue resistance of glide path instruments.

Prognostic factors in direct pulp capping with mineral trioxide aggregate or calcium hydroxide: 2- to 6-year follow-up.

OBJECTIVES: The aim of this retrospective study was to evaluate the influence of various predictors on healing outcomes after direct pulp capping (DPC) using either mineral trioxide aggregate (MTA) or calcium hydroxide (CH) as a pulp-dressing agent. MATERIALS AND METHODS: The present study included 172 mature asymptomatic permanent teeth with carious-exposed pulp. The teeth were treated with DPC, using either MTA or CH, and the treatment outcome was evaluated clinically and radiographically. The effect of potential clinical variables on the treatment outcome of DPC was evaluated clinically and radiographically during a 24-72-month follow-up. In order to assess the cumulative successes of CH and MTA after DPC, Kaplan-Meier survival analysis and log-rank test was used. The subgroups were compared by means of the log-rank test. Also, univariate Cox regression analysis was used to determine hazard ratio of clinical variables. RESULTS: One hundred and fifty-two teeth of 172 capped teeth were available for follow-up, with an overall recall rate of 87.6 % for MTA vs 89.3 % for CH. The mean period of follow-up was 37.3 (±17.2) months. Overall success rates of 85.9 and 77.6 % in the MTA and CH groups were observed, respectively. The cumulative success rate of both materials was not statistically different when analysed by the Cox proportional hazard regression analysis (P = 0.282). The Kaplan-Meier survival curves revealed that 2-year overall pulp survival was 91.4 %, while the 4- and 6-year survival rates were 84 and 65 %, respectively. None of the clinical variables had a considerable influence on the outcome of DPC (p > 0.05). CONCLUSIONS: MTA-capped teeth demonstrated a slightly higher success rate than CH, revealing that it can be recommended as a reliable direct pulp-capping material. None of the clinical variables investigated significantly affected posttreatment healing. CLINICAL RELEVANCE: DPC with MTA is a straightforward procedure with favourable outcome of 24- to 72-month follow-ups in vital mature asymptomatic permanent teeth with cariously exposed pulp, and it may be considered a realistic alternative therapy to RCT.

Amputation of an Extra-root with an Endodontic Lesion in an Invaginated Vital Maxillary Lateral Incisor: A Rare Case with Seven-year Follow-up.

The developmental abnormality of tooth resulting from the infolding of enamel/dentin into the root is called dens invaginatus. Management of such cases is usually challenging due to the morphological complexity of root canal system. This report presents a rare treatment protocol of a clinical case of Oehler's type III dens invaginatus combined with an endodontic lesion in a vital maxillary lateral incisor. Access to the endodontic lesion located between the central and lateral incisors was achieved by reflection of a full mucoperiosteal flap. Granulomatous tissue as well as aberrant root was removed and the surface of the root and adjacent coronal region were reshaped. Three years later, the patient was orthodontically treated. Seven years after completion of surgical/orthodontic management, the tooth remained asymptomatic and functional with normal periodontium/vital pulp. Radiographically, the healing of the lesion was observed. Actually, vitality of the invaginated tooth and communication between the invagination and the root canal were the most important factors in determining such minimally invasive treatment protocol. Depending on the anatomy of the root canal system, surgical amputation of an invaginated root can be performed to achieve a successful outcome in Oehler's type III dens invaginatus cases, even though it is associated with apical periodontitis.

A Prospective Randomized Comparative Study of Cold Lateral Condensation Versus Core/Gutta-percha in Teeth with Periapical Lesions.

INTRODUCTION: The aim of this study was to compare the outcome of root canal treatment using either Thermafil (TF; Dentsply Maillefer, Ballaigues, Switzerland) or the cold lateral condensation (CLC) obturation technique in teeth with periapical lesions and to investigate the influence on postoperative pain and treatment outcomes. METHODS: After standardized root canal preparation technique, 112 teeth were obturated with either the TF or the CLC technique during 2 sessions by single operator. Postoperative pain, obturation length, and treatment outcomes were recorded. The teeth were reviewed clinically and radiographically for 2 years. RESULTS: Although there were no significant differences between the techniques in the incidence of postoperative pain at 24 hours (P > .05), the incidence of pain was significantly higher in the TF group than in the CLC group at 48 hours (P < .05). During the 2-year follow-up period, there was no statistically significant difference in the success rate of the teeth treated with TF (96.4%) in comparison with those treated with CLC (98.2%) (P > .05). CONCLUSIONS: In this study, the outcome of the root canal treatment of teeth using the TF and CLC techniques revealed that these techniques are useful for root canal obturation.

Endodontic management of immature teeth with spontaneous apical closure and periapical lesions: case series and review of the literature.

Spontaneous apical closure in non-vital immature teeth has been rarely encountered and outcome of non-surgical endodontic treatment of related teeth associated with periapical lesions has not yet been adequately elucidated. The aim of this article was to report endodontic management of spontaneous apical closure of infected untreated immature teeth with periapical lesions and to review previously proposed mechanisms for the development of spontaneous hard tissue barrier. Three patients were referred at different time intervals to the endodontic clinic for treatment of their maxillary anterior incisors with acute or chronic apical periodontitis. Dental histories indicated that related teeth had been subjected to trauma approximately 12-18 years previously. Radiographically, the involved teeth exhibited incomplete root formation with spontaneous apical closure and were associated with an apical radiolucency. After biomechanical preparation, calcium hydroxide paste was applied and was changed once or twice within 3 months. All canals were then filled with gutta-percha and AH Plus and the follow-up period was 16-50 months; both clinical and radiographic examinations revealed adequate function, the absence of clinical symptoms and significant healing of the periapical radiolucency.

Delayed partial pulpotomy in a midroot and complicated crown-root-fractured permanent incisor with hyperplastic pulpitis: a case report.

INTRODUCTION: The occurrence of multiple injuries of the same tooth is extremely rare. This case report describes the treatment in a midroot and complicated crown-root-fractured permanent incisor that remained untreated for 4 years after the accident. METHODS: The tooth was treated by delayed partial pulpotomy using calcium hydroxide. RESULTS: At the 3-year follow-up after treatment, the tooth was still vital and functional without any clinical and radiographic signs and symptoms. CONCLUSIONS: A young permanent tooth with hyperplastic pulpitis caused by trauma has a great inherent defensive capacity to heal after delayed partial pulpotomy despite adverse conditions.

Apical microleakage of root-end cavities prepared by Er, Cr: YSGG laser.

The aim of this study is to assess the apical microleakage of the composite filled root-end cavities prepared by an Erbium, Chromium: Yttrium-Scandium-Gallium-Garnet laser. Fifty-five maxillary incisor teeth were enlarged and filled. Following the apical resection, root-end cavities were prepared using conventional methods: either using a bur (n = 30) or an ultrasonic retrotip (n = 15). Root-end cavities of the 15 teeth in the bur group were finished with the laser at 3.5 W. All root-end cavities were filled using two-step self-etching primer and composite resin. After 4 months of storage, apical microleakage was measured by a fluid filtration method. Microleakage of composite filled root-end cavities that were prepared by Er, Cr: YSGG was significantly larger than those made by conventional methods (p < 0.05). In conclusion, using the Er, Cr: YSGG laser has no advantages over conventional root-end cavity preparation methods when a composite filling material is used to seal root-end cavities.

Surgical extrusion of a partially erupted and crown dilacerated incisor.

A case report of treatment for an incompletely erupted maxillary central incisor with crown dilaceration in a 12-year-old boy is described. The tooth was repositioned with surgical extrusion and endodontically treated through use of calcium hydroxide paste. Clinical and radiographic examination 2 years after completion of combined surgical and endodontic treatment revealed periapical healing and no signs of root resorption.