Endodontic treatments on permanent teeth in pediatric patients aged 6-12 years old.

Backgroud/purpose: The prevalence of carious lesions and traumatic injury in individuals between ages 6 and 12 is high. This study aimed to characterize pediatric patients aged 6-12 treated in the endodontic clinic and investigate the prevalence and patterns of their provided endodontic treatments. Materials and methods: Clinical and radiographic records of patients (ages 6-12) referred to the postgraduate Endodontics clinic from June 2017 to June 2020 were reviewed. Demographics, pre-and post-operative conditions, type of endodontic treatment, and behavioral management were collected. Results: A total of 6350 teeth from 6089 patients were treated in this period, and 425 teeth (6.7%) from 405 patients were included. Ages 9-11 were the most commonly treated age group. Significantly more lower molars (41.9%) and upper anterior teeth (36.7%) were treated (P < 0.05). The majority of teeth were diagnosed with pulp necrosis (39.5%), and the most common periapical diagnosis was normal apical tissues (39.8%), then symptomatic apical periodontitis (38.8%). The most common etiological factor was caries (63.5%). Two hundred six teeth (48.5%) were treated with root canal therapy, 161 teeth (37.9%) with vital pulp therapy, 46 teeth (10.8%) with apexification or regenerative endodontic procedure, 12 teeth (2.8%) with non-surgical retreatment. A statistically high number of patients (87.8%) tolerated the endodontic procedures without any sedation (P < 0.0001). Conclusion: Pediatric patients aged 6-12 compose around 7% of the population treated at the postgraduate Endodontics clinic, reflecting the high demand for endodontic treatment in a pediatric mixed dentition population.

Long-Term Effectiveness of Physical Exercise-Based Swallowing Interventions for Older Adults with Dementia in a Day-Care Center.

Swallowing safety is one of the top health concerns of dementia. Coughing and choking (coughing/choking) are signs of impaired swallowing safety. This study aimed to investigate the effectiveness of regular physical exercise-based swallowing intervention for reducing coughing-choking at the dementia day-care center. This was a retrospective analysis with data from medical records, including age, the clinical dementia rating (CDR), and the frequencies of coughing/choking in ten days (10-day coughing/choking). Those who complied with the exercise programs were assigned to the exercise-based group (n = 22), and those who could not comply were assigned to the non-exercised-based group (n = 7). The non-exercised-based group showed more advanced age and higher CDR than the exercise-based group (p < 0.05). The 10-day coughing/choking showed significant decreases at the 5-month and 19-month in the exercise-based group and at the 5-month in the non-exercise-based group (p < 0.05). Our findings suggested that regular physical exercise-based swallowing intervention effectively alleviated coughing/choking problems of older adults with dementia and its effectiveness was long-lasting. For those who could not comply with exercise programs, noticeably with more advanced age and dementia, the effective swallowing intervention period was short-term.

Surgical management of lateral lesions with intentional replantation in single-rooted mandibular first premolars with radicular groove: 2 case reports.

BACKGROUND: The authors' aim was to describe 2 endodontically treated mandibular first premolars with apical and mesiolingual radiolucencies on radiographs with different approaches that were resolved with intentional replantation. CASE DESCRIPTION: In case 1, a 58-year-old man reported biting sensitivity on endodontically treated mandibular first premolar with good quality restorations. A periapical radiograph (PAX) and cone-beam computed tomography (CBCT) image revealed 2 low-density areas located at the apical and mesiolingual aspects of the root. A radicular groove accessory canal was noted on the mesial root surface during intentional replantation. The patient has been asymptomatic. At a 3-year follow-up, complete healing was observed on PAX and CBCT images. In case 2, a 40-year-old woman reported pinching pain of her mandibular right quadrant that returned a few months after initial root canal treatment. Radiographs revealed periapical radiolucency at the apexes of the mandibular first premolar with a missed lingual canal. Nonsurgical retreatment was performed in 2 visits with calcium hydroxide dressing. Two months later, endodontic microsurgery was performed owing to ongoing symptoms. In addition, CBCT images showed extensive bone loss on the mesiolingual aspect of the root. Intentional replantation was performed 2 weeks later because she had intolerable pain. A radicular groove accessory canal was observed on the mesial root surface during the procedure. The patient reported substantial relief of pain. The radiolucencies healed by the 25-month follow-up as observed on PAX and CBCT images. PRACTICAL IMPLICATIONS: Intentional replantation is recommended in mandibular first premolars with a mesiolingual lesion that cannot be accessed easily with endodontic microsurgery and after conservative retreatment has been performed.

Comparing the incidence of postoperative pain after root canal filling with warm vertical obturation with resin-based sealer and sealer-based obturation with calcium silicate-based sealer: a prospective clinical trial.

OBJECTIVE: This prospective clinical study compares postoperative pain after single-visit, non-surgical root canal treatment of teeth with irreversible pulpitis using two different root canal filling techniques. MATERIAL AND METHODS: All cases were treated by endodontic residents with a standardized protocol (minimum apical size 35) and filled with one of the two techniques: warm vertical compaction technique (WVT) with gutta percha and epoxy resin-based sealer (AH Plus Jet Root Canal Sealer, Dentsply Maillefer, York, PA, USA) or sealer-based filling technique (SBT) with single cone gutta percha and calcium silicate-based sealer (EndoSequence BC Sealer, Brasseler, Savannah, GA, USA). Surveys were given to participating patients to record pain intensity on a numeric rating scale (NRS, 0-10) at 4, 24, and 48 h postoperatively. Statistical significance was set at 0.05 level. RESULTS: One hundred ninety-four surveys were distributed over eighteen months. Ninety-two patients returned the survey (41 WVT and 51 SBT), of which 38% were asymptomatic irreversible pulpitis cases. The NRS values reduced over time for both techniques. No statistical difference was found between the two groups at the three time points assessed (p > 0.05). Postoperative pain was related to age, gender, presence of preoperative pain, and sealer extrusion (p < 0.05), however not related to preoperative periapical symptoms (percussion/palpation), dental arch, root type, and experience of the provider (p > 0.05). CONCLUSIONS: The intensity of postoperative pain for the two obturation techniques was equivalent at evaluated time points. CLINICAL RELEVANCE: The obturation technique does not influence postoperative pain. After endodontic treatment of symptomatic irreversible pulpitis teeth, the pain subsides in 48 h regardless of the technique. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT04462731.

Spectrophotometric Analysis of Coronal Tooth Discoloration Induced by Tricalcium Silicate Cements in the Presence of Blood.

INTRODUCTION: New tricalcium silicate cements have been shown to induce less coronal discoloration. The purpose of this in vitro study was to evaluate the degree of color change induced by various silicate materials in the presence and absence of blood. METHODS: One hundred human extracted anterior single-canal teeth were sectioned to standardized root lengths, accessed, and instrumented. Eight random experimental groups and 2 control groups were created wherein specimens were filled with experimental materials below the buccal cementoenamel junction as follows: EndoSequence RRM putty (Brasseler USA, Savannah, GA), EndoSequence RRM fast set putty (Brasseler USA), Biodentine (Septodont, Saint-Maur-des-Fossés, France), and white mineral trioxide aggregate (Dentsply Sirona, York, PA) either with the presence or absence of blood. Blood-only and saline-only samples were used for the positive and negative controls. After incubation in 100% humidity at 37°C, color changes were evaluated with a spectrophotometer (Ocean Optics, Dunedin, FL) on days 0, 30, 60, and 180 after material placement. Data were transformed into Commission International de I'Eclairage's L∗a∗b color values, and corresponding ΔE values were calculated. The 1-way analysis of variance test was performed for statistical analysis. RESULTS: Discoloration was observed in all specimens in the presence of blood. There was no statistical significance when comparing different materials in contact with blood. Intragroup observation at various time points, Biodentine, and EndoSequence RRM fast set putty showed significant difference between the presence and absence of blood at 180 days (P < .05). CONCLUSIONS: Contamination with blood of tricalcium silicate materials has the potential to cause coronal tooth discoloration.

The Application of "Bone Window" Technique in Endodontic Microsurgery.

Endodontic microsurgery for a tooth with a large periapical lesion and an intact cortical plate may necessitate the removal of extra bone and cause delayed or unfavorable healing. In such cases, the "bone window" technique offers excellent exposure to the operative field and preserves cortical bone without placing any additional graft material. In the reported cases, root-end surgery was performed on the maxillary and mandibular molars with a large periapical lesion. The bone window was fashioned with the aid of thin osteotomy instruments and repositioned to the original site at the end of the procedure, which resulted in minimizing bone loss and acted as an autologous graft for the surgical site. At 12- and 16-month follow-ups, clinical examinations and cone-beam computed tomographic scans revealed the healing of the lesion without symptoms or complications. Cone-beam computed tomographic imaging was used as a presurgical assessment tool for indication selection and precise design of the bone window. The use of a bone window in endodontic microsurgery, which appears to be a reliable technique, should be the method of preference when the large lesion is deeply positioned between intact buccal and lingual cortices.

Intra-articular etanercept attenuates pain and hypoxia from TMJ loading in the rat.

Mechanical overloading of the temporomandibular joint (TMJ) and biochemical changes, like inflammation and hypoxia, contribute to cartilage degeneration and pain associated with osteoarthritis (OA). Yet, how overloading contributes to early dysregulation of chondrocytes is not understood, limiting the development of diagnostics and treatments for TMJ OA. Hypoxia-inducible factors (HIF)-1α/2α in chondrocytes were evaluated at Days 8 and 15 in a rat TMJ pain model induced by jaw loading (1 h/day for 7 days) using immunohistochemistry and compared between cases that induce persistent (3.5 N), acute (2 N), or no (0 N) sensitivity. Hypoxia was measured on Day 8 by immunolabeling of the tracer EF5 and 18 F-EF5 PET imaging. To assess the role of tumor necrosis factor (TNF) in painful TMJ loading, intra-articular etanercept was given before loading. Orofacial sensitivity was evaluated during and after loading. Facial grimace, TNF-α, HIF-2α, and hypoxia levels in the TMJ were measured after loading. HIF-2α was elevated (P = .03) after 3.5 N loading at Day 8, but HIF-1α was unchanged. EF5 uptake increased on Day 8 in the 3.5 N group (P < .048) by tissue assay and 18 F-EF5 PET. At Day 8, both HIF-2α (P = .01) and EF5 uptake (P = .005) were correlated with loading magnitude. Etanercept attenuated sensitivity (P < .01) and the facial grimace on Day 7 (P = .01). It also reduced (P < .01) HIF-2α and EF5 uptake on Day 8; but TNF-α levels were not different from controls at that time. Findings suggest that TMJ loading that induces persistent sensitivity upregulates the catabolic factor HIF-2α and reduces oxygen levels in the cartilage, which may be TNF-driven.

Grading facial expression is a sensitive means to detect grimace differences in orofacial pain in a rat model.

Although pre-clinical models of pain are useful for defining relationships between biological mechanisms and pain, common methods testing peripheral sensitivity do not translate to the human pain experience. Facial grimace scales evaluate affective pain levels in rodent models by capturing and scoring spontaneous facial expression. But, the Rat Grimace Scale (RGS) has not assessed the common disorder of temporomandibular joint (TMJ) pain. A rat model of TMJ pain induced by jaw loading (1 hr/day for 7 days) was used to investigate the time course of RGS scores and compare them between different loading magnitudes with distinct peripheral sensitivity profiles (0N-no sensitivity, 2N-acute sensitivity, 3.5N-persistent sensitivity). In the 3.5N group, RGS is elevated over baseline during the loading period and one day after loading and is correlated with peripheral sensitivity (ρ = -0.48, p = 0.002). However, RGS is not elevated later when that group exhibits peripheral sensitivity and moderate TMJ condylar cartilage degeneration. Acutely, RGS is elevated in the 3.5N loading group over the other loading groups (p < 0.001). These findings suggest that RGS is an effective tool for detecting spontaneous TMJ pain and that spontaneous pain is detectable in rats that develop persistent TMJ sensitivity, but not in rats with acute resolving sensitivity.

The Interface of Mechanics and Nociception in Joint Pathophysiology: Insights From the Facet and Temporomandibular Joints.

Chronic joint pain is a widespread problem that frequently occurs with aging and trauma. Pain occurs most often in synovial joints, the body's load bearing joints. The mechanical and molecular mechanisms contributing to synovial joint pain are reviewed using two examples, the cervical spinal facet joints and the temporomandibular joint (TMJ). Although much work has focused on the macroscale mechanics of joints in health and disease, the combined influence of tissue mechanics, molecular processes, and nociception in joint pain has only recently become a focus. Trauma and repeated loading can induce structural and biochemical changes in joints, altering their microenvironment and modifying the biomechanics of their constitutive tissues, which themselves are innervated. Peripheral pain sensors can become activated in response to changes in the joint microenvironment and relay pain signals to the spinal cord and brain where pain is processed and perceived. In some cases, pain circuitry is permanently changed, which may be a potential mechanism for sustained joint pain. However, it is most likely that alterations in both the joint microenvironment and the central nervous system (CNS) contribute to chronic pain. As such, the challenge of treating joint pain and degeneration is temporally and spatially complicated. This review summarizes anatomy, physiology, and pathophysiology of these joints and the sensory pain relays. Pain pathways are postulated to be sensitized by many factors, including degeneration and biochemical priming, with effects on thresholds for mechanical injury and/or dysfunction. Initiators of joint pain are discussed in the context of clinical challenges including the diagnosis and treatment of pain.