Management of internal inflammatory root resorption using injectable platelet-rich fibrin revascularization technique: a clinical study with cone-beam computed tomography evaluation.

OBJECTIVES: The current study evaluated clinically and radiographically the management of internal inflammatory root resorption (IIRR) in permanent anterior teeth with or without periapical lesions using injectable platelet-rich fibrin (i-PRF) regenerative approach. METHODS: Ten systemically healthy patients, with thirteen anterior mature teeth diagnosed with IIRR were selected for the study. At the first visit, the tooth was anesthetized, access cavity opened, root canals were mechanically prepared then medicated with calcium hydroxide and temporarily sealed. After 2-4 weeks, regenerative endodontic procedures were performed by preparing and applying i-PRF inside the canal, then a freshly prepared PRF membrane was placed over it. White mineral trioxide aggregate was placed over the PRF matrix, and the tooth was restored with a glass ionomer cement base and resin composite restoration. The patients were recalled for clinical and radiographic evaluation and follow-up every 3 months for 12 months. Cone-beam computed tomography (CBCT) imaging was performed preoperatively and after 12 months. RESULTS: Clinical evaluation results showed resolution of signs and symptoms through the follow-up period in all of the cases. Both CBCT imaging readings of IIRR lesions and periapical lesions revealed a volumetric significant difference (p = 0.00) between the preoperative and the 12-month follow-up period. CONCLUSIONS: Usage of i-PRF could arrest and allow for healing of IIRR in permanent mature teeth and allow for periapical healing with successful clinical results. CLINICAL RELEVANCE: i-PRF revascularization technique proved to be a successful REP in the treatment of the IIRR, reducing the number of appointments and increasing patient compliance.

Influence of dowel type on push-out bond strength to regional root canal dentin.

PURPOSE: To compare the laboratory bond strengths of three different types of fiber-reinforced composite dowel systems in three different locations of prepared root canal dentin. METHODS: 60 human extracted intact upper central incisors were selected. The coronal aspect of each tooth was removed, and the remaining root received endodontic therapy. The roots were divided into three experimental groups (n = 20). Roots were restored with one of the following dowel systems according to the manufacturers' instructions: carbon fiber (C-Posts), quartz (Aestheti-Plus), glass fiber (FibreKor). A single bond adhesive (OptiBond Solo Plus) was applied to the walls of the dowel spaces, excess carefully removed with paper points, and then light cured for 10 seconds. A dual-polymerizing resin luting agent (Variolink II) was mixed and then placed in the dowel spaces using a lentulo spiral instrument. The roots were placed in light-protected cylinders; then the light source was placed directly on the flat cervical tooth surfaces and the cement was polymerized. Specimens were stored in light-proof boxes for 24 hours. Each root was cut horizontally, and three 1 mm-thick root segments (one apical, one middle, and one cervical) were prepared. Using a push-out test, the bond strength between dowel and dentin was measured using a universal testing machine. The data were analyzed with 2-way analysis of variance and Tukey's Honestly Significant Difference (HSD) test (alpha = 0.05). RESULTS: Dowel type and regional root canal dentin resulted in significant differences for push-out bond strength (P < 0.001). Glass fiber dowels (FibreKor) had significantly higher mean bond strength values (SD) for all dowel space regions: coronal (13.6 [1.5] MPa), middle (10.8 [1.8] MPa), and apical (8.9 [1.1] MPa). The carbon fiber dowels (C-Posts) had significantly lower bond strength values in all dowel space regions: coronal [8.6 (1.1) MPa], middle (4.7 [1.0] MPa), and apical (4.1 [1.1] MPa). Quartz dowels (Aestheti-Plus) had intermediate bond strength values: coronal (10.9 [1.1] MPa), middle (9.6 [1.1] MPa), and apical (7.7 [1.1] MPa). Also, there were differences in bond strength between regional root canal dentin, with a reduction in values from the coronal to middle and apical thirds for all experimental groups (P < 0.001).