Direct pulp capping using mineral trioxide aggregate and calcium hydroxide
Mineral trioxide aggregate (MTA) proved superior to calcium hydroxide (CH) in direct pulp capping (DPC) to treat teeth with carious pulp exposures and reversible pulpitis in a randomized clinical trial comparing the 2 materials, including in terms of postoperative pain intensity. Indian researchers published the results in the July issue of Journal of Endodontics.
“Pulp capping material should provide a suitable condition to encourage regeneration of the dentin-pulp complex; be able to induce differentiation of odontoblastlike cells; and be antibacterial, biocompatible, and nontoxic,” researchers wrote.
The researchers pointed out that CH has been the reference standard in pulp capping materials owing to its antibacterial properties and its ability to stimulate release of bioactive molecules that help repair pulp and remineralize dentin. However, they also noted that CH’s shortcomings include lack of satisfactory sealing, biocompatibility, nonadhesion, dissolution over time, and numerous tunnel defects.
MTA, on the other hand, has been found to elevate expression of transcription factors, induce dentin bridge formation, possess biocompatibility, and sustain a high pH for longer and a close a physiochemical seal with dentin that forms an insoluble barrier to prevent microleakage.
Based on findings of only 2 randomized clinical trials evaluating pulp capping material in permanent teeth, researchers aimed to study DPC with CH and MT in mature mandibular molars with carious pulp exposures to comparatively evaluate their success and assess incidence of postoperative pain.
The study’s null hypothesis was that there would be no difference between CH and MTA when researchers evaluated them as DPC materials.
Included in the study were 64 patients ranging in age from 15 through 40 years who had occlusal deep caries penetrating more than one-half the thickness or more into dentin in mature, mandibular permanent first and second molars showing a closed apex on periapical radiography and with the diagnosis of reversible pulpitis.
Exclusion criteria were primary teeth, lack of pulp exposure after excavation, teeth with irreversible pulpitis or pulp necrosis, presence of periapical lesions as assessed by radiographic examination, periodontal disease, a cracked tooth, internal or external resorption, calcified canals, nonrestorable teeth, pulp bleeding that could not be controlled within 10 minutes using 2.5% sodium hypochlorite, patients who were immunocompromised or pregnant, patients with any systemic disorder, and patients with a positive history of antibiotic and analgesic use within the week before the treatment.
To conduct their study, researchers allocated the 64 participants randomly to the CH and MTA groups. Ultimately, 56 patients were analyzed a year later—29 in the CH group and 27 in the MTA group. The MTA group was successful at a rate of 93% versus a rate of 69% for the CH group. The MTA group also had significantly lower pain scores after 18 hours, although no significant difference in pain was found overall between the 2 groups (P > .05).
For statistical analysis, researchers applied the Shapiro-Wilk test for normality to assess data distribution, the Mann-Whitney U test to compare age and mean pain scores between the groups, and χ2 test for dichotomous variables, the Wilcoxon signed rank test to evaluate pain reduction within the group, and the κ statistic for interexaminer agreement on radiographic interpretation.
Researchers ultimately determined that DPC with MTA can successfully preserve pulp vitality in mature permanent teeth with occlusal carious exposures.
Read the original article here or contact the ADA Library & Archives for assistance.
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Resin-based composite restorations in vital versus endodontically treated teeth
The results of a retrospective study show that despite a superior and significant difference in the success rate of resin-based composite restorations (RBCs) made in vital teeth (VT) compared with those in endodontically treated teeth (ETT), the long-term durability of certain Class II RBCs in ETT is clinically acceptable. Researchers based in Hungary published their results in the June issue of Dental Materials.
The retrospective longitudinal study compared and evaluated Class II direct RBC restorations in VT or ETT. “The purpose of the present study was to compare the long-term survival of Class II direct RBC restorations of posterior vital and root canal treated teeth,” researchers wrote.
They also aimed to investigate the compromising effect of the endodontic procedure on the quality of dentin regarding the potential adhesion of the RBC restorations by comparing them with the RBC restorations of VT according to the United States Public Health Service criteria. Furthermore, they sought to clarify the influence of different risk factors, such as bruxism-related occlusal stress and patient-, tooth- and restoration-related factors on the tooth and restoration survival.
Investigators evaluated 245 patients receiving at least 1 posterior tooth with a Class II direct RBC restoration from the registers of a Hungarian clinical practice (University of Pécs) from January 2004 through December 2012. They established 2 groups. Direct RBC restorations where the reasons for placement were primary caries in VT comprised Group I. Direct RBC where the filling is a post-endodontic restoration following a primary root canal treatment with the diagnosis of acute or chronic irreversible pulpitis, acute or chronic periapical periodontitis comprised Group II.
Using United States Public Health Service criteria, investigators evaluated a total of 597 restorations. Of those, 485 were in VT, and 112 were in ETT. The restorations had a minimum of 2.5 through 3 millimeters of remaining cusp thickness and were made with the same brand of RBC and adhesive.
Within a mean (standard deviation) observation period of 8.6 (2.3) years, investigators detected an annual failure rate in VT and ETT of 0.08% and 1.78%, respectively. “Significantly better performance was observed in RBCs of VT for each evaluated parameter,” researchers wrote.
The significance in difference in the success rate of RBC in VT was 98.97% versus 76.8% in ETT, but researchers declared that the long-term durability of Class II RBC with 2.5- through 3-mm cusp thickness in ETT is also clinically acceptable.
Researchers identified the retrospective design of their study as a limitation due to a lower clinical evidence level than a prospective clinical trial. “Further limitation is the unequal case number in the two compared groups,” researchers wrote. “To provide enough power for the statistics it was necessary to increase the case numbers in Group 1, as the failure number for some evaluated parameters proved to be low. That fact necessitates for careful and prudent interpretation of the results. Further evaluation with increased case number in both groups is necessary to overcome this limitation.”
Read the original article here or contact the ADA Library & Archives for assistance.
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Regenerative endodontic procedure materials and tooth discoloration
Clinicians should consider sealing dentin with a dentin-bonding agent before using disinfectant paste and barrier materials to decrease tooth discoloration associated with materials used in regenerative endodontic procedures, researchers reported in a study published August 28 in Journal of Oral Science.
The Polish investigators who designed the study conducted a literature review with the aim of evaluating the discoloration potential of factors and materials used in regenerative endodontic procedures based on published in vitro studies. According to their own study, “Analysis of the selected studies showed that most materials used in regenerative endodontic procedures have the potential to stain tooth tissues.”
They described regenerative endodontics as the “newest branch of stomatology” that studies the potential for the regeneration of damaged pulp as well as the creation and delivery of replacement pulp-dentin tissues, including the techniques of root canal revascularizarion, pulp implants, 3-dimensional cell printing, postnatal (adult) stem cell therapy, scaffold implants, injectable scaffolds, and gene therapy.
To conduct their study, they searched (without a year limit) 6 digital databases, including PubMed, Google Scholar, the Cochrane Library, Scopus, Latin American and Caribbean Health Sciences Literature, and Web of Science. In vitro studies, studies that used preparations placed into the tooth tissues, and studies that described revitalization procedures were included. The researchers conducted their final search on February 18, 2018.
Ultimately, researchers identified 11 in vitro studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards that reported tooth discoloration induced by materials used in regenerative endodontic techniques. No statistical analysis could be performed owing to different parameters that reviewed studies used.
“Analysis of all the retrieved data showed that tooth discoloration could occur at any stage of treatment, such as after the use of disinfectant paste, promotion of bleeding, or placement of barrier materials,” researchers wrote.
The researchers wrote that further studies are warranted on the topic, noting that they found only a small number of such in vitro studies in the dental literature.
Read the original article here or contact the ADA Library & Archives for assistance.
Vital pulp therapy and invasive cervical root resorption case series
Internal excavation of resorption and vital pulp therapy with calcium-enriched mixture cement may reliably treat invasive cervical root resorption (ICRR), researchers found. They published their findings in a study in the September issue of Journal of Endodontics.
“Although ICRR originates from the periodontium, recent studies show that an internal approach for treatment might be an effective and less periodontally destructive approach for the treatment of advanced lesions,” researchers wrote.
ICRR has been associated with orthodontic treatment, history of trauma, parafunctional habits, cracks, restorations, periodontal surgeries, internal bleaching, hepatitis B, and bisphosphonate therapy with no clear causation determined. “Because the etiology of ICRR is not fully understood, there is not a clear protocol on how to prevent or treat this condition,” researchers wrote.
The case series study used previously established categories for ICRR lesions, based on the size and location of the lesions—crown, coronal one-third of the root, and beyond coronal one-third of the root. Classes 1 and 2 ICRR are limited to the crown without penetration into the root. Classes 3 and 4 lesions penetrate the root.
Researchers aimed to report on the clinical and radiographic outcomes of a series of ICRR cases—classes 2 through 4—treated using vital pulp therapy techniques with calcium-enriched mixture cement. The extent of the ICRR determined the level of pulp removal.
Researchers enrolled 6 patients, including 4 women and 2 men, each with 1 molar diagnosed with ICRR. The patients were 27 through 45 years of age (average, 32.8 years). Researchers classified 2 teeth as class 2 ICRR, 2 teeth as class 3, and 2 teeth as class 4.
Clinicians treated 1 tooth with pulp capping, 1 with partial pulpotomy, 2 with full pulpotomy, and 2 with partial pulpectomy with an average follow-up time of 19.6 months. “After treatment, all teeth remained functional and asymptomatic with a normal periodontium. No progression of the resorption or development of new resorption was observed,” researchers wrote.
In evaluating their study, researchers cited lack of cone-beam computed tomographic imaging for all cases (except case 1) as a shortcoming. They explained that cone-beam computed tomographic imaging helps better define the extension of the resorption in all 3 planes, the accessibility of the resorptive lacuna, and the amount of sound tooth and root structure that remains in teeth with ICRR.
Researchers wrote in conclusion, “It is recommended to select the ‘internal approach’ for the treatment of teeth with advanced invasive cervical root resorption in order to preserve the periodontium. Further clinical studies with larger sample sizes and longer follow-up times are recommended to confirm the favorable outcomes obtained in this study.”
Read the original article here or contact the ADA Library & Archives for assistance.
Endodontics courses scheduled for 2019 and 2020
Essential Dental Seminars has recently added additional hands-on endodontic courses to its expanding curriculum. Courses include its flagship 2-day seminar and various nationally held courses.
Here are some of our many course reviews:
- Excellent Course! Best I've taken. Lots of instruction - Robert Schneider, DDS, Fort Myers, FL
- This was an excellent course. Endo confidence went way up with this course. Thanks! - Todd Anderson, Springfield, MO
- This course was fantastic! It will make me a better dentist after 30 years of doing endo! – Chris Nix, DDS, McCook, NE
2020 dates have just been announced. For additional reviews and complete info visit www.essentialseminars.org.
Learn to sharpen your surgical skills and reduce your patients’ pain
Many of your dental patients come to you for one reason: pain. Having the skills and knowledge to relieve their discomfort quickly means happy—and referring—patients. These 2 CE courses by the ADA will help you improve your surgical and anesthetic skills. Using guided exercises and the latest pharmacotherpeutic information, you will learn how to use the right dental instruments and local anesthesia more proficiently for optimum results.
- Minimally Invasive Exodontia Techniques
- Pharmacotherapeutics for Dental Practitioners: Local Anesthetic Agents
Visit ADACEOnline.org to find out more information about these and other endodontics courses.
Saver meets saver: Dr. Mohamed I. Fayad meets a park ranger
We all know endodontists specialize in saving teeth. But to truly get into the spirit of what’s “worth saving,” the American Association of Endodontists wanted to get to know some other “savers” out there who work to save, preserve and revere something. In this second installment of “AAE Savers,” Dr. Mohamed I. Fayad meets with Kathy Schneider, superintendent of the Pullman National Monument, on location in Chicago, to learn more about what it is that she saves — and also talk teeth.
The consulting editor for JADA+ Specialty Scan — Endodontics is Dr. Susan Wood, Diplomate, American Board of Endodontics. |
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