Radiographic Evaluation of Regenerative Endodontic Procedures and Apexification Treatments with the Assessment of External Root Resorption.

INTRODUCTION: This multi-centered cohort study evaluated the radiographic outcomes of regenerative endodontic procedures (REPs) and apexification treatments (APEX) of immature teeth with endodontic disease. MATERIALS AND METHODS: This cohort study included a retrospective record review and prospective data collection of pediatric patients with teeth treated with REPs or APEX between 2005-2014. Data including the presence of a periapical lesion, external root resorption (ERR), obliteration, apical hard tissue, apical closure, intracanal calcifications, and radiographic root area (RRA) change based on measurements were collected/measured from radiographic images. Univariate and multivariate analyses were conducted. RESULTS: The cohort included 190 subjects (204 teeth (92 REPs; 112 APEX)). The frequency of pre-treatment periapical pathology was similar between cases in which the clinical treatment failed versus successful treatment cases. However, the frequency of pre-treatment ERR was higher in failed cases than in successful cases (p=0.007). The mean RRA change was greater than twenty percent in 21% of the REPs cases. In traumatized teeth, REP treatment resulted in less hard tissue formation than other endodontic disease etiologies measured by RRA (p=0.001). 53% of cases with ERR (16/30) showed signs of healing/arrest and were mostly treated with REPs (11/16). CONCLUSIONS: The presence of ERR negatively affected the treatment outcome. There was significant variability in RRA change in REPs. Signs of healing/arrest of the resorptive lesion were radiographically visible in many cases treated with REPs.

Recommendations to minimize tooth root remodeling in patients undergoing maxillary osteotomies.

The purpose of this study was to report root remodeling/resorption percentages of maxillary teeth following the different maxillary osteotomies; i.e. one-piece, two-pieces, three-pieces Le Fort I, surgically assisted rapid palatal expansion (SARPE). The possibility of relationships between root remodeling and various patient- and/or treatment-related factors were further investigated. A total of 110 patients (1075 teeth) who underwent combined orthodontic and orthognathic surgery were studied retrospectively. The sample size was divided into: 30 patients in one-piece Le Fort I group, 30 patients in multi-pieces Le Fort I group, 20 patients in SARPE group and 30 patients in orthodontic group. Preoperative and 1 year postoperative cone beam computed tomography (CBCT) scans were obtained. A validated and automated method for evaluating root remodeling and resorption in three dimensions (3D) was applied. SARPE group showed the highest percentage of root remodeling. Spearman correlation coefficient revealed a positive relationship between maxillary advancement and root remodeling, with more advancement contributing to more root remodeling. On the other hand, the orthodontic group showed a negative correlation with age indicating increased root remodeling in younger patients. Based on the reported results of linear, volumetric and morphological changes of the root after 1 year, clinical recommendations were provided in the form of decision tree flowchart and tables. These recommendations can serve as a valuable resource for surgeons in estimating and managing root remodeling and resorption associated with different maxillary surgical techniques.

The Effect of Maxilla Impacted Canine Positions on Root Resorption of Adjacent Teeth Using Cone-Beam Computed Tomography Imaging.

Objective: To determine the effect of the impacted position of the maxillary canine on the root resorption of the adjacent incisor using Cone-beam Computed Tomography (CBCT) imaging. Methods: This was an analytic quantitative study. The research sample determined CBCT images of treatment patients at the Orthodontic Specialist Policlinic in Dental Hospital of Airlangga University over a three-year period and secondary data taken from Pramita Laboratory. CBCT photos that met the inclusion criteria, including mesially impacted canine or close to central or lateral incisors with completely formed anatomy were then analyzed. Multiple linear regression was used to determine x-axis, y-axis, z-axis position of the impacted canine on the severity of root resorption of the adjacent incisor, and the effect of impacted canines on all axes simultaneously on the severity of root resorption of the adjacent incisors. Results: The position of the impacted canine in the x-axis and z-axis planes had a significant influence on the root resorption of the adjacent incisor. Meanwhile, impacted canine from the y-axis plane showed non-significant influence on the root resorption. Conclusion: The position of the impacted canine when viewed in all planes of the tooth axis has a significant effect on the severity of root resorption of the adjacent incisor.

Reinforcement of Teeth Having Reenacted Perforating Internal Resorption Cavities After Repair Using Different Calcium Silicate-based Cements and Backfilling Materials: An In vitro Study.

To evaluate the fracture resistance (FR) of the teeth having reenacted perforating internal resorption cavities repaired by distinctive calcium silicate-based cements (CSCs) specifically: Endocem MTA, Biodentine, NeoMTA Plus, and backfilling materials. Ninety-six freshly extracted human mandibular premolar teeth were selected. Twelve roots were used as the negative control group. Rotary files were used to complete the final irrigation and root canal preparation on the remaining teeth. Following that, burs were used to make standardized internal resorption chambers in the middle part of the roots. Twelve of these samples were used as positive control samples. The remaining 72 root canals were obturated in the apical 4 mm using a single-cone approach, and they were separated into 6 groups based on the CSCs used to fill voids and the materials used as backfilling. Group 1: Endocem MTA (resorption) + Endocem MTA (coronal), Group 2: Endocem MTA (resorption) + Gutta-percha/sealer (coronal), Group 3: Biodentine (resorption) + Biodentine (coronal), Group 4: Biodentine (resorption) + Gutta-percha/sealer (coronal), Group 5: NeoMTA Plus (resorption) + NeoMTA Plus (coronal), and Group 6: NeoMTA Plus (resorption) + Gutta-percha/sealer (coronal). Specimens were inserted in acrylic resin and then subjected to fracture testing. Fracture strength tests were performed using a Universal Testing Machine. The force was employed vertically with a consistent speed of 1 mm/minute. The results were analyzed with Variance and Bonferrini tests at P < 0.005. The mean force of fracture values were 447.00, 201.25, 318.75, 187.50, 596.58, 258.75, 347.50, and 298.75 N for Group 1, 2, 3, 4, 5, 6, 7, and 8, respectively. "There was a significant difference (P < 0.001) between the experimental groups and the control group". Group 5 showed the highest FR as compared to other groups. Backfilling with CSCs appears to be a better material than a gutta-percha/sealer combination. Neo MTA plus furthermore appeared the highest fracture-resistant material, while Biodentine + Gutta percha/sealer showed the least FR.

A clinical dilemma: Performing or avoiding root instrumentation in the treatment of the acute phase of endodontic-periodontal lesions? A case report.

BACKGROUND: This study presents the diagnois, management, and tissue response to an acute periodontal lesion with deep pocketing affecting a maxillary central incisor in a young patient devoid of caries or a history of periodontitis. METHODS: Clinical and radiographic examinations facilitated the diagnosis of the pathology as an endoperiodontal lesion (EPL) with root damage, exhibiting supracrestal invasive root resorption. Orthograde endodontic therapy was employed to decontaminate and seal the endodontic space. The resorptive site was treated through the endodontic access, debrided, and sealed. No periodontal therapy (surgical or nonsurgical) was performed. No mechanical instrumentation was performed within the pocketed root surface. RESULTS: At 6-month and 1-year follow-ups after endodontic therapy the periodontium displayed a physiologically healthy condition without pus or inflammation, exhibiting a circumferential probing depth of 2 mm, and absence of tooth mobility. These favorable outcomes persisted throughout a 4-year follow-up period. CONCLUSIONS: The spontaneous healing of pocketing and abscess occurred without mechanical root instrumentation following endodontic therapy and treatment of external invasive root resorption in an EPL. KEY POINTS: Accurate diagnosis and identification of relevant etiologic factors are pivotal for effectively managing endodontic-periodontal lesions. Once a diagnosis is established, the therapy focuses on eliminating the primary cause, followed by a subsequent diagnostic phase after healing. The definitive understanding of the diagnosis and etiology of endodontic-periodontal lesions often becomes clear in retrospect, based on the outcomes of the therapy. When probing acute periodontal lesions, deep probing depths may occur without permanent loss of periodontal attachment. If the acute lesion was not induced by a periodontal cause and if no periodontal etiology arises secondarily, resolving the primary cause of the endoperiodontal lesion can lead to the spontaneous resolution of the pocketing. This results in spontaneous healing of periodontium without the need for intentional periodontal therapy. A clinical dilemma arises when considering periodontal treatment during the acute inflammatory phase of endo-periodontal pathology. It is advisable to refrain from mechanical root instrumentation particularly if a clear periodontal cause is not apparent, to prevent from iatrogenic damage to periodontal fibers and the potential risk of gingival recessions. However, this does not imply avoiding periodontal therapy entirely for every case. Rather, it is recommended to delay the decision on root instrumentation until a new diagnostic phase is conducted following the healing of the endodontic etiology.

Impacted maxillary canine: Assessment of prevalence, severity and location of root resorption on maxillary incisors: A retrospective CBCT study.

BACKGROUND: The maxillary permanent canine is one of the most frequently impacted teeth, which often requires multidisciplinary management. A common complication of canine impaction is root resorption of the adjacent dentition. The aim of this retrospective study was to report the prevalence of root resorption of maxillary incisors adjacent to impacted maxillary canines from small volume CBCT images by trained clinicians. A secondary objective was to report the location and severity of root resorption. MATERIAL AND METHODS: CBCT images of patients with impacted maxillary canines (unilateral and bilateral) who attended a joint orthodontic/surgical multidisciplinary clinic were screened. Descriptive statistics were used to investigate associations of patient characteristics and presence of root resorption. Generalized estimating equations (GEE) logistic regression model were used to identify predictors of root resorption. RESULTS: In all, 148 impacted maxillary canines (122 patients) were analysed. The majority of patients were under 18 years of age (71.6%) with impacted canines present in more females (68.2%) than males (31.8%). Maxillary lateral incisors showed the highest prevalence of root resorption (38.5%). The apical region was the most common location of resorption for lateral incisors (20.9%) with a variable degree of severity evident: slight (10.1%), moderate (15.6%), and severe (12.8%). Although no significant predictors of root resorption were identified, a weak association was evident for age and root development. CONCLUSIONS: In this cohort of patients, the roots of maxillary lateral incisors are most likely to suffer from root resorption in the presence of an impacted maxillary canine. Clinicians should consider the extent, location and severity of resorption of adjacent teeth when planning treatment decisions and mechanics in cases of impacted maxillary canines.

Challenges in differential diagnosis and treatment of cervical root resorption vs. root caries.

External cervical root resorption may be occasionally mistaken for root caries and vice versa. Radiographical and clinical differential diagnoses of cervical root resorption and root caries are essential for correct treatment planning and a successful treatment outcome. This article reviews the contemporary literature and summarises the prevailing professional consensus pertaining to external cervical root resorption. Clinical diagnostics which help distinguish cervical root resorption from root caries are outlined and treatment approaches of external cervical root resorption are discussed.

Physiological occlusal force attenuates replacement root resorption of replanted teeth: an experimental animal study.

BACKGROUND: Tooth avulsion represents the most severe form of dental trauma, necessitating tooth replantation as the primary treatment. However, the risk of replacement root resorption (RRR) poses a significant threat to tooth retention following replantation. This study preliminarily aimed to investigate the effect of physiological occlusal force on RRR after the replantation of avulsed teeth and to explore the potential underlying mechanisms. METHODS: Thirty-six 4-week-old male Sprague-Dawley rats underwent extraction and immediate replantation of their left maxillary molars. The rats were randomly divided into two major groups: the occluded (n = 18) group, where the opposite mandibular teeth were preserved; non-occluded (n = 18) group, where the opposite mandibular teeth were extracted. Within each major group, there were three subgroups corresponding to 7 days, 14 days, and 2 months, resulting in a total of six subgroups, (n = 6 per subgroup). The right maxillary first molars served as the normal control. Various periodontal characteristics were assessed using haematoxylin-eosin (H&E), tartrate-resistant acid phosphatase (TRAP) staining, and micro-computed tomography (micro-CT). RESULTS: Histological staining revealed that under occlusal force, the early stage (day 7) after tooth replantation mainly manifested as root surface resorption, especially in the non-occluded group, which gradually diminished over time. Cementum and periodontal ligament (PDL) repair was observed on day 14. Micro-CT analysis indicated a significant decrease in PDL width in the non-occluded group two months after replantation, consistent with the histological findings, signifying severe RRR in the non-occluded group. CONCLUSIONS: This study provides preliminary evidence that physiological occlusal force may attenuate osteoclastogenesis during the early stage of tooth replantation, thereby reducing the occurrence of RRR and promoting periodontal healing.

Genetic polymorphisms linked to extreme postorthodontic external apical root resorption in Koreans.

BACKGROUND: External apical root resorption (EARR) is a common undesirable outcome of orthodontic treatment, this study aimed to identify genetic polymorphisms associated with the susceptibility to extreme orthodontic-induced EARR in a Korean population using extreme phenotype analysis sampling. METHODS: Genomic DNA was isolated from the saliva of 77 patients who underwent orthodontic treatment involving two maxillary premolar extractions. The patients were divided into two groups based on EARR values measured on periapical radiographs: The significant resorption group (SG, EARR ≥ 4 mm) and the normal group (NG, EARR < 2 mm). In the NG group, patients with EARR < 1 mm were named the non-resorption group (NonG). Targeted next-generation sequencing was performed using the screened single nucleotide polymorphisms (SNPs), and firth logistic regression analysis was used to determine genetic associations with EARR. Haplotype-based association analysis was performed for specific SNPs. RESULTS: SNPs related to genes TNFSF11, TNFRSF11B, WNT3A, SFRP2, LRP6, P2RX7, and LRP1 were found to be significantly associated with severe EARR (p < 0.05, pre-Bonferroni correction p-values). Additionally, the haplotype CCA of rs17525809, rs208294, and rs1718119 P2RX7 had a higher frequency in the SG group. CONCLUSION: Extreme phenotype analysis has identified eleven SNPs related to genes TNFSF11, TNFRSF11B, WNT3A, SFRP2, LRP6, P2RX7, and LRP1 that are associated with severe root resorption in the Korean population. These findings will contribute to the development of predictive diagnostic tools for identifying severe root resorption that may occur during orthodontic treatment.

Influence of tube current and metal artifact reduction on the diagnosis of external cervical resorption in teeth adjacent to a dental implant in CBCT: an ex-vivo study.

OBJECTIVES: This ex-vivo study aimed to assess the influence of tube current (mA) and metal artifact reduction (MAR) on the diagnosis of early external cervical resorption (EECR) in cone-beam computed tomography (CBCT) in the presence of an adjacent dental implant. MATERIALS AND METHODS: Twenty-three single-rooted teeth were sectioned longitudinally and EECR was induced using a spherical drill and 5% nitric acid in 10 teeth. Each tooth was positioned in the socket of the lower right canine of a dry human mandible and CBCT scans were acquired using 90 kVp, voxel of 0.085 mm, field of view of 5 x 5 cm, and varying tube current (4, 8 or 12 mA), MAR (enabled or disabled) and implant conditions (with a zirconia implant in the socket of the lower right first premolar or without). Five oral radiologists evaluated the presence of EECR in a 5-point scale and the diagnostic values (area under the receiver operating characteristic curve - AUC, sensitivity, and specificity) were compared using multi-way Analysis of Variance (α = 0.05). Kappa test assessed intra-/inter-evaluator agreement. RESULTS: The tube current only influenced the AUC values in the presence of the implant and when MAR disabled; in this case, 8 mA showed lower values (p<0.007). MAR did not influence the diagnostic values (p>0.05). In general, the presence of an implant reduced the AUC values (p<0.0001); sensitivity values with 8 mA and MAR disabled, and specificity values with 4 mA and MAR enabled and 8 mA regardless MAR were also decreased (p<0.0001). CONCLUSIONS: Variations in tube current and MAR were unable to improve EECR detection, which was impaired by the presence of an adjacent implant. CLINICAL RELEVANCE: Increasing tube current or activating MAR tool does not improve EECR diagnosis, which is hampered by the artifacts generated by dental implants.

Comparative Effectiveness of Different Er:YAG Laser-Activated Irrigation Systems on Removing Calcium Hydroxide from Simulated Internal Root Resorption Cavities at Different Root Levels.

Objective: To investigate the effectiveness of Er:YAG laser-activated irrigation (LAI) with a short pulse duration for removing calcium hydroxide (CH) from simulated internal root resorption (IRR) cavities at three root levels. Background: Pulse duration is an important parameter during LAI, which ensures the efficiency of irradiation and the corresponding activation process. Short pulses in the range of a few microseconds enable rapid expansion and successive implosion of irrigants, resulting in distinct fluid movement. There have been few reports on CH removal efficacy from IRR cavities of different LAI systems, including those using short pulse duration. Methods: IRR cavities (1.6 mm diameter) were created at the apical, middle, and coronal root levels in 60 mandibular premolars and filled with a radiopaque CH paste. Samples were assigned to the following irrigation groups (n = 12, each): (1) LAI(P)-F, a prototype laser device that operates with short pulse duration (Morita Manufacturing) with a flat tip; (2) LAI(EA)-F, the ErwinAdverl laser device (Morita Manufacturing) with a flat tip; (3) LAI(EA)-T, the ErwinAdverl laser device with a tapered tip; (4) PIPS-T, the Lightwalker laser device (Fotona) with a tapered tip; and (5) SI, the syringe irrigation group. The laser tips were fixed at the canal entrance. The remaining CH volume and surface area were assessed in IRR cavities using micro-computed tomography and scanning electron microscopy, respectively. Data were statistically analyzed utilizing one-way analysis of variance and Tukey's test at 5% significance level. Results: The LAI(P)-F and PIPS-T groups exhibited the highest CH removal rates at three different levels (p < 0.05). The LAI(EA)-F group had a significantly better efficacy of CH removal compared with the LAI(EA)-T group at the middle level (p < 0.05). Conclusion: The LAI(P)-F and PIPS-T groups demonstrated superior efficiency in removing CH from simulated IRR cavities.

Is there a relationship between the presence of external root resorption in second molars adjacent to impacted mandibular third molars with awake bruxism and masticatory muscle activity?

OBJECTIVES: This study aimed to assess whether awake bruxism and masticatory muscle activity could be related to external root resorption (ERR) in second molars adjacent to impacted mandibular third molars. MATERIALS AND METHODS: Sixty patients, with requests for a cone-beam, computed tomography, were divided into two groups: ERR (patients with ERR in the second molar, n = 30), and control group (n = 30). Awake bruxism was assessed through the Oral Behaviors Checklist (OBC) and an ecological momentary assessment (EMA). Surface electromyography (EMG) was used to assess the masseter and anterior temporal muscle function. Normality and homogeneity of variances were demonstrated. Descriptive analysis was performed, using the T-test and Chi-square test to compare the characteristics of the groups. A multiple regression model was performed. RESULTS: The ERR group presented more non-functional oral activities related to awake bruxism than the control group, according to OBC (p = 0.027) and EMA (p = 0.035). In addition, the ERR group had higher EMG activity than the control group in rest and isotonic protocols (p < 0.05). CONCLUSIONS: Awake bruxism and greater masticatory muscle activity seem to be related to the presence of ERR in second molars adjacent to impacted mandibular third molars. CLINICAL RELEVANCE: The results of the present study can reinforce the theory that triggering ERR in the second molars adjacent to impacted mandibular third molars may be related to mechanical forces coming from the masticatory function.

Root Regeneration with Photobiomodulation of an Upper Lateral Incisor Associated with Root Resorption Due to an Impacted Maxillary Canine: A Case Report.

Objective: To present a case report of maxillary lateral incisor root regeneration after severe root resorption, treated with photobiomodulation (PBM). Background: Impacted maxillary canines often come with the risk of maxillary lateral incisor root resorption, which is widely recognized as the predominant adverse effect in these situations. This progressive process of root resorption is currently irreversible, with no known way to reverse it. Materials and methods: A male patient was 14 years old. Radiographically it was observed that canine 23 is impacting against the root of 22 producing signs of root resorption and having a less than 1:1 crown-to-root ratio with mobility grade 1. From the beginning of the treatment, PBM-assisted orthodontics was proposed. To address the patient's dental concerns, the treatment plan outlined the extraction of the deciduous upper left canine tooth leaving the lateral as long as possible in the mouth. During each appointment, PBM was applied with a diode laser. The wavelength was 810 nm, Ap = 0.2 W, 4.4 J, 22 sec every 21 days, 13 applications in total (57.2J), with a 400 µm inactive surgical tip, in a scanning movement, 1 mm from the mucosa while moving following the vestibular surface of the upper left lateral and canine roots. Results: After 12 months, the 22 had root neoformation and complete closure of the apex with vitality. Conclusions: PBM with an 810 nm diode laser in this clinical case promoted root regeneration of an upper lateral incisor, with severe root resorption, owing to an impacted maxillary canine while still vital.

[Pulp revascularization procedure for external inflammatory dental root resorption treatment]. / Primenenie metodiki regeneratsii pul'popodobnoi tkani dlya ostanovki naruzhnoi vospalitel'noi rezorbtsii kornya zuba.

THE AIM OF THE STUDY: To assess the effectiveness of pulp revascularization procedure in children with external inflammatory root resorption (EIRR) after constant teeth injury. MATERIALS AND METHOS: The study comprised 17 children aged 6-10 years diagnosed with EIRR as a long-term complication of dental trauma in 19 teeth. EIRR was diagnosed with periapical radiographs and CBCT was performed to further assess the pathology extension. Pulp revascularization was carried out in all 19 teeth. RESULTS: There was no resorption progression in all cases. EIRR areas were substituted by bone. In 10 from 19 teeth with early stages of root development bone or cement-like tissue ingrowth into the root canal was observed radiologically. In cases of severe EIRR this ingrowth may partially compensate for lost tissues which is confirmed by a high percentage (94.7%) of functional teeth during mean follow up time of 38±10 months. CONCLUSION: Pulp revascularization is an effective method for retaining teeth with EIRR for a relatively long period of time and allows maintaining alveolar bone volume both due to functional tooth preservation and healing of bone lesions in periapical and resorption areas.

Root resorption in clear aligner treatment detected by CBCT: a Systematic review and Meta-analysis.

OBJECTIVE: The aim of this study was to evaluate the amount of external apical root resorption in patients who had undergone orthodontic treatment with clear aligners evaluated using cone beam computed tomography. METHODS: Studies that evaluated external apical root resorption before and after comprehensive orthodontic treatment with clear aligners were assessed by performing an electronic search from 5 databases comprising PubMed, SCOPUS, EBSCO, Cochrane Library, and LILACS and manual searches in the relevant journals and the reference lists of the included studies. Database search, elimination of duplicate studies, and data extraction were performed independently by 2 authors. The quality of the included studies was assessed using the Risk of Bias in Non-randomised Studies-of Interventions and the Cochrane Collaboration's Risk of Bias Tool. Studies that reported the tooth length or volume were used for quantitative analyses. RESULTS: Nine studies were included in the meta-analysis. The overall root length after clear aligner treatment was significantly decreased compared with the pre-treatment length using cone beam computed tomography (mean differences = -0.56 mm, 95% confidence interval [-0.73, -0.38], P < .00001). However, only the maxillary central incisors, maxillary lateral incisors, and mandibular central incisors had significant reduction in root length. The meta-analysis from 3 studies also indicated that the root volume of the upper incisors also significantly decreased (mean differences = -13.34 mm3, 95% confidence interval [-16.57, -10.10], P < .00001). CONCLUSIONS: Current evidence suggests that clear aligners can cause minimal root resorption. The highest amount of root resorption was observed in the maxillary central incisors.

A 3-year follow-up of implant placement in proximity to canalis sinuosus: Case study.

BACKGROUND: While the nasal fossa and nasopalatine canal are recognized limitations for immediate implants in esthetic areas, the canalis sinuosus (CS) and its branches have been largely overlooked. Neglecting this anatomy can lead to sensory issues, pain, and implant failure underscores the necessity of meticulous pre-surgical assessment and planning to mitigate risks and ensure implant success. This case highlights the need for comprehensive pre-surgical evaluation and precise planning to minimize these complications and ensure successful implant outcomes in this scenario. METHODS AND RESULTS: A 41-year-old woman with a history of root perforation and external root resorption was referred for dental implant placement. Following clinical evaluation and computed tomography, the presence of an accessory canal of the CS was identified. After meticulous planning to avoid implant contact with this structure, ridge preservation was performed. After 6 months, the implant was successfully placed following guided osteotomy. The case demonstrates clinical and radiographic stability after 36 months of follow-up. CONCLUSION: The correct diagnosis and planning, within a multidisciplinary team, can lead to successful implant placement in a challenging site with an anatomical variation. This study, to our knowledge, represents the first to propose an alternative treatment approach in the presence of CS in an esthetic region. KEY POINTS: Why is this case new information? This case emphasizes the importance of thorough pre-surgical evaluation to mitigate potential complications related to the CS. It is the first, to our knowledge, to propose an alternative treatment approach in the presence of this anatomical variation in an esthetic region. What are the keys to successful management in this case? Comprehensive pre-surgical evaluation, precise planning with detailed CBCT assessment to identify the CS, careful consideration of its anatomy during surgical intervention, knowledge of the limitations of tissue reconstructions, and precise clinical strategies to minimize associated complications. What are the primary limitations to success in this case? The need to position the implant with a safety margin from the CS led to implant positioning resulting in fenestration of the buccal bone plate, preventing its reconstruction due to the bone envelope's design, resulting in a discrepant gingival margin compared to the contralateral tooth, which did not allow for further crown lengthening due to a rather short root.

Reliability of information in YouTube™ videos on types of root resorption and related stimulating factors.

BACKGROUND/AIM: Root resorption occurs for various reasons and can also be seen as a treatment complication in orthodontics. This study aimed to assess the reliability and quality of YouTube™ videos on root resorption and to assess whether the videos referred to orthodontic treatment and other stimulation factors. MATERIALS AND METHODS: YouTube was searched using the keyword 'root resorption', which is the most searched term on Google Trends. The first 200 videos identified using the default filter 'sort by relevance' were used. Information such as the source, type, duration, and number of likes were recorded. Videos were analyzed using a 23-point content scale related to root resorption and divided into groups (poor, moderate, and excellent) based on the Global Quality Score. RESULTS: A total of 95 videos were included in the study. Most were uploaded by dentists or dental clinics (n = 64, 67.4%). The mean number of days since upload was 1536 ± 1254, and the mean duration was 5 ± 4 min. The videos had a mean of 80 ± 515 likes and 7043 ± 35,382 views, and a mean viewing rate of 1131.71 ± 8736.83. The most discussed topic was radiographic signs of root resorption. While the highest content score for the videos was 21, the average score was only 4. The mean GQS was 2 ± 1. Grouping videos by GQS showed that 55 (57.9%) were poor, 38 (40%) were moderate, and 2 (2.1%) were excellent. There was a significant relationship between videos that mentioned orthodontics (n = 62; 65.3%) and higher GQS (p = .036), and a significant difference was between GQS groups for total content levels (p < .001). CONCLUSIONS: YouTube videos related to root resorption lack sufficient information and clarity, and their quality needs to be improved. Oral health professionals should strive to produce higher-quality videos.

Hypoxic dental pulp stem cells-released succinate promotes osteoclastogenesis and root resorption.

Introduction: Clinical studies have shown that endodontically-treated nonvital teeth exhibit less root resorption during orthodontic tooth movement. The purpose of this study was to explore whether hypoxic dental pulp stem cells (DPSCs) can promote osteoclastogenesis in orthodontically induced inflammatory root resorption (OIIRR). Methods: Succinate in the supernatant of DPSCs under normal and hypoxic conditions was measured by a succinic acid assay kit. The culture supernatant of hypoxia-treated DPSCs was used as conditioned medium (Hypo-CM). Bone marrow-derived macrophages (BMDMs) from succinate receptor 1 (SUCNR1)-knockout or wild-type mice were cultured with conditioned medium (CM), exogenous succinate or a specific inhibitor of SUCNR1 (4c). Tartrate-resistant acid phosphatase (TRAP) staining, Transwell assays, qPCR, Western blotting, and resorption assays were used to evaluate osteoclastogenesis-related changes. Results: The concentration of succinate reached a maximal concentration at 6 h in the supernatant of hypoxia-treated DPSCs. Hypo-CM-treated macrophages were polarized to M1 proinflammatory macrophages. Hypo-CM treatment significantly increased the formation and differentiation of osteoclasts and increased the expression of osteoclastogenesis-related genes, and this effect was inhibited by the specific succinate inhibitor 4c. Succinate promoted chemotaxis and polarization of M1-type macrophages with increased expression of osteoclast generation-related genes. SUCNR1 knockout decreased macrophage migration, M1 macrophage polarization, differentiation and maturation of osteoclasts, as shown by TRAP and NFATc1 expression and cementum resorption. Conclusions: Hypoxic DPSC-derived succinate may promote osteoclast differentiation and root resorption. The regulation of the succinate-SUCNR1 axis may contribute to the reduction in the OIIRR.

Internal root resorption in permanent mandibular molars - A rare entity: Report of two cases.

The cases presented here aim to highlight the occurrence of a very rare internal root resorption (IRR) of inflammatory type among mandibular molars (prevalence 0.01%-1%). Patients reported in the outpatient department with a chief complaint of pain in the lower posterior region of the jaws, on thorough clinical and radiological examinations a diagnosis of irreversible pulpitis was made and nonsurgical root canal treatment was planned using thermoplastic obturation technique along with the use of magnification, cone-beam computed tomography, endosonics, and intracanal medicament to attain a successful outcome. Six-month follow-up showed arrest of IRR. This report of two cases with a literature review discusses the etiology, prevalence of IRR, the clinical decision, and the therapeutic management. Early detection of such resorption is the key to successful management and preserves the integrity of the tooth.

Prognostic risk factors for apical root resorption in orthodontic patients - Are the Kjær's morphologic characteristics of clinical relevance?

BACKGROUND: Patients undergoing orthodontic treatment (OT) face an increased risk of developing external apical root resorption (EARR). A prognostic risk assessment prior to OT can potentially be conducted through anatomical features in panoramic radiography. This retrospective study aimed to assess the significance of Kjær's morphological characteristics in analyzing the risk of EARR. METHODS: Panoramic radiographs of 1,156 patients (624 females, 532 males) were retrospectively analyzed. Anamnestic and treatment-related data were extracted from patient records. The mean age at the start of OT was 12.8 ± 2.2 years (min. 6.4 years, max. 22.3 years) and at the end of OT 15.9 years (min. 8.5 years, max. 24.1 years). The mean treatment duration was 3.1 ± 1.6 years. Panoramic radiographs with a minimum of two per patient were examined for the presence of Kjær's characteristics. The degree of EARR was registered defining resorption in four degrees of severity. Bivariate analysis and multivariate Poisson regression were performed to assess the association between Kjær's characteristics and EARR patient- and tooth- related (α = 0.05). RESULTS: In total, 72.8% of the patients showed EARR at the end of OT with lateral maxillary incisors most frequently affected. Short roots (p < 0.001) were significantly associated with EARR in patients. Tooth-related microdontia (#12, #22, lower second premolars), narrow crowns (#11, #21, lower incisors), short roots (upper incisors, lower first molars) and ectopia (#11, #21, #13), such as shorter distal roots of the mandibular first molar showed a significant association with EARR depending on severity degree. The type of orthodontic appliance (fixed: p < 0.001, fixed and removeable: p = 0.008), as well as treatment duration (p < 0.001) were also identified as risk factors for EARR. CONCLUSIONS: Although the risk assessment for EARR development through panoramic radiography analysis is limited, predisposition appears to be present in specific dental characteristics and treatment-related factors.