Combined Management of Apical Root Fracture and Avulsion of Two Maxillary Permanent Central Incisors: A Case Report.

As a result of a skiing accident, a ten-year-old girl suffered combined injuries to both maxillary central incisor teeth (#1.1 and #2.1). The injuries were uncomplicated crown fractures, apical horizontal root fractures, and a severe extrusive luxation of the coronal segments of the teeth. Her mother repositioned the teeth immediately, resulting in good initial healing. Nine months later, the patient was referred to a specialist to manage the endodontic consequences of the trauma. The apexification treatment of the fractured roots, using a preformed apical barrier technique with bioactive cement, was the treatment of choice, administered to both the avulsed roots at two separate recall visits. The best option for managing the fractured apical segments was to continue with the follow-up, which was conducted to assess the overall case at 30 months. The fractured apexes remained normally positioned inside the socket and were asymptomatic (as they presumably maintained a physiological vascular-nerve supply and, consequently, their vitality), while the apexification treatment led to the healing of the periodontal tissues and to hard tissue formation in the area of the interrupted roots in the avulsed portion of the teeth. The management of traumatic injuries in teeth often requires multiple treatment approaches, because these injuries rarely represent one single type of trauma.

Multimodular Assessment of a Traumatic Bone Cyst Overlapped with Apical Periodontitis.

Traumatic bone cyst (TBC), a "pseudocyst" that usually affects long bones, is a rare lesion among cystic lesions in the jaws. The most commonly affected site is the posterior mandible. Most of the time, TBC is asymptomatic and discovered during routine radiographic examination. The treatment recommended for TBC is surgical exploration followed by curettage of the bony walls, which also serves as a diagnostic procedure. A 27-year-old Caucasian male with a noncontributory medical history was referred to our department for the endodontic evaluation of the mandibular right first and second molars, which were connected to an extensive asymptomatic osteolytic lesion. A multimodular diagnostic assessment involving CBCT imaging, ultrasound, and histopathologic examination led to a definite diagnosis of a TBC overlapping with apical periodontitis (AP). Subsequently, a multidisciplinary treatment approach was performed, including surgical excision and biopsy of the lesion, endodontic retreatment of the right mandibular first molar, and postsurgical root canal treatment of the second molar. During the follow-up period of five years, the patient was reassessed periodically once a year and showed, in the absence of signs and symptoms, progressive healing of the affected area. The present article reports a case following the CARE guidelines of a TBC combined with AP where a multimodular diagnostic assessment was performed and discusses the possible pathogenetic mechanisms involved in its generation.

Extrusive Luxation Injuries in Young Patients: A Retrospective Study with 5-Year Follow-Up.

(1) Background: The purpose of this study was to analyze the influence of the chosen diagnostic and therapeutic approach (repositioning and splinting methods) on the risk, frequency and timing of the onset of pulp canal obliteration and pulp necrosis following extrusive luxation in young patients with permanent dentition. (2) Methods: From an initial sample of 50 subjects affected by extrusive luxation, were selected the clinical data of 13 patients presenting extrusive luxation but no other type of injury to the dental hard tissue. All teeth were examined according to a standardized protocol. Follow-up examinations were performed at regular intervals for 5 years. Statistical associations between pulp consequences and several covariates were assessed using the Mann-Whitney test and Fisher's exact test. (3) Results: Among the 13 studied teeth, only 1 healed completely, whereas 9 showed pulp obliteration and 3 developed pulp necrosis. No tooth with obliteration developed pulp necrosis. The average time to treatment was 11.9 h. The treatment approaches used were manual repositioning, orthodontic repositioning and stabilization splinting. "Time to treatment" was the only covariate that showed a weak statistical association with the onset of pulp consequences. (4) Conclusions: There is still uncertainty over the most appropriate therapeutic approach to adopt in young patients with extrusive luxation injuries, particularly for repositioning of the injured tooth. Extruded teeth should be treated as soon as possible after the traumatic event. This study highlighted the value of orthodontic repositioning of the extruded tooth, which does not seem to aggravate the conditions of the dental pulp. In addition, the study confirmed that prophylactic endodontic treatment is not appropriate for immature teeth affected by extrusive luxation injuries, given the extreme rarity of pulp necrosis in teeth already affected by pulp obliteration.

Correction to: The effectiveness of ultrasound examination to assess the healing process of bone lesions of the jaws: a systematic review.

The given names of the authors are swapped with their family names.

Ultrasound Examination to Visualize and Trace Sinus Tracts of Endodontic Origin.

INTRODUCTION: The detection of a tooth with a sinus tract (ST) of endodontic origin and its pathway are conventionally assessed with a periapical radiograph and a gutta-percha cone introduced into its stoma. The aim of this study was to evaluate the possibility to detect STs and trace their route using ultrasound real-time examination. METHODS: Two calibrated examiners performed echography on 10 patients who had a lesion of apical periodontitis (AP) and ST and 10 patients in the control group with AP without an ST recruited in 2 endodontic practices. They also traced the pattern of the STs with a computer program. The images were then submitted to 2 calibrated and blinded observers who were asked to describe the presence of AP and ST and to trace it with the same program. The data obtained were compared with the clinical and radiographic diagnosis of ST. For sensitivity, specificity, accuracy, and positive and negative predictive values, the receiver operating characteristic curve and Fisher exact test were used (P < .05). RESULTS: Interobserver agreement was high as was the diagnostic accuracy of the ultrasound examination of STs (mean value = 97.5%), and the Fisher exact test showed statistical significance (P < .05). High sensitivity and a negative predictive value and 100% specificity and a positive predictive value were also obtained. The application of the 3-dimensional mode further enabled the reconstructions of the more complex paths, and the implementation with color power Doppler disclosed the vascularity surrounding the STs. CONCLUSIONS: The ultrasound examination is a technique feasible to describe and trace the STs of endodontic origin.

Comparison of the Degree of Conversion of Resin Based Endodontic Sealers Using the DSC Technique.

OBJECTIVES: The aim of this study was to determine the degree of conversion (DC) of three resin based endodontic sealers using the DSC technique. METHODS: THE SEALERS TESTED WERE: EndoREZ (ER) (Ultradent, South Jordan, UT); EndoREZ with Accelerator (ER+A) (Ultradent, South Jordan, UT); RealSeal (RS) (SybronEndo, Orange, CA). Two LED units were used to activate the sealers: UltraLume LED 5 (Ultradent, South Jordan, UT, USA); Mini LED Satelec (Satelec Acteon Group, Mérignac Cedex, France). Samples of 4.0 mg were analyzed with a DSC 7 calorimeter (Perkin Elmer Inc., Wellesley, MA, US). Each specimen was irradiated by each lamp four times for 20 seconds at an interval of 2 mins, while the DSC 7 recorded the heat flow developed during the treatment. The degree of conversion and the kinetic curves were calculated from the values of heat developed during each polymerization. The data were statistically analysed with a Kruskal-Wallis one-way ANOVA multiple range and Student-Newman-Keuls (SNK) tests at a P value of .05. RESULTS: STATISTICALLY SIGNIFICANT DIFFERENCES WERE FOUND IN THE DEGREE OF CONVERSION AMONG THE SEALERS: ER+A showed the highest values with both lamps. CONCLUSIONS: The higher polymerization rate in resin sealers is obtained with the addition of a catalyst.

Comparison of tetraacetylethylendiamine + sodium perborate and sodium hypochlorite cytotoxicity on L929 fibroblasts.

INTRODUCTION: Tetraacetylethylenediamine in association with sodium perborate (TAED+P) can be suggested for its use as an endodontic disinfectant because of its antimicrobial activity against different bacterial species when used at low concentrations. The purpose of this study was to measure the cytotoxicity of TAED+P on L929 fibroblasts and to compare it with that of sodium hypochlorite (NaOCl). METHODS: L929 fibroblasts were grown in Dulbecco Modified Eagle Medium containing 10% fetal calf serum (FCS) at 37 degrees C and 5% CO(2). At confluence, cells were split, plated in a 96-well plate, and incubated for 24 hours to allow attachment. The two disinfectants TAED+P and NaOCl were tested at various concentrations. The neutral red uptake and the 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyl tetrazolium bromide assays were used to evaluate the cell viability. The 50% inhibitory dose values for both disinfectants were calculated and statistically analyzed. The effect of both disinfectants on fibroblast viability was also determined in the presence of various concentrations of FCS. One-way analysis of variance with post hoc analysis using Tukey multiple comparison test was used for parametric data. RESULTS: Both disinfectants induced a dose-related loss of cell viability; TAED+P resulted less cytotoxic than NaOCl in all the examined experimental conditions. CONCLUSIONS: These data support the possible use of TAED+P as an endodontic irrigant. Further studies are required to analyze its antibacterial activity against endodontic pathogens.

In vitro cytotoxicity evaluation of a self-adhesive, methacrylate resin-based root canal sealer.

This study compared the cytotoxicity of MetaSEAL (Parkell Inc, Farmington, NY), a methacrylate resin-based sealer with an epoxy resin-based (AH Plus Jet; Dentsply Caulk, Milford, DE) and a zinc oxide-eugenol-based sealer (Pulp Canal Sealer; SybronEndo, Orange, CA). Five-millimeter diameter disks prepared from the respective sealer and disks prepared from Teflon (negative control) and polymethyl methacrylate (positive control) were placed in direct contact with a rat osteosarcoma (ROS) 17/2.8 rat osteoblast-like cell line at six intervals after setting completely at 72 hours and for 5 succeeding weeks after the disks were immersed in simulated body fluid. Succinate dehydrogenase activity was evaluated by using 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyl tetrazolium bromide assay. All sealers exhibited severe toxicity at 72 hours, after which toxicity decreased gradually over the experimental period except for Pulp Canal Sealer, which remained severely toxic. MetaSEAL was more toxic than AH Plus Jet during the first week. Both were similar to the toxicity profile of the positive control after the first week, which was probably diffusion controlled.

Echographic evaluation of bone lesions of endodontic origin: report of two cases in the same patient.

We report on two periapical lesions of endodontic origin detected in the maxillary bone of the same patient, whose echographic examination was used to address a tentative differential diagnosis between a granuloma and a cystic lesion. The patient on whom two periapical lesions were diagnosed with clinical and conventional radiographic findings and scheduled for endodontic surgery, was also examined using echography and color power doppler at the site of the lesions. The lesions were echographically described in each case according to a scheme from a previous work. A tentative differential diagnosis between a cystic lesion and a granuloma was made. One lesion was described as a cyst, the other as a granuloma. After surgical excision, the lesions were examined under light microscopy. In both cases the two echographic diagnoses were confirmed by the histopathologic examination.