General dentistry最新文献

Extrusion of irrigants or obturation materials during endodontic therapy may result in significant complications, ranging from postoperative pain to nerve damage and chronic inflammation. Many of these adverse outcomes can be prevented through detailed anatomical assessment and thoughtful treatment planning. This article explores how anatomical complexities, including root apex morphology, proximity to vital structures, and apical resorption, contribute to extrusion risk.

Vital pulp therapy (VPT) has been the principal treatment option used to preserve pulp function during apical development of immature permanent teeth affected by caries and trauma. Advances in VPT protocols and bioactive materials have made this approach a possible treatment option for mature permanent teeth. This article presents a clinical VPT protocol for mature permanent teeth and compares 2 failed cases and 2 successful cases completed in the general dentistry clinic of a dental school. The objective is to allow general dentists to be more comfortable with providing VPT procedures as a treatment option. Four men underwent VPT in mature permanent teeth using established treatment protocols. In 2 treatments that failed, avascular pulp tissue removal was incomplete and/or inferior capping materials were used. In 2 treatments that were successful, all adversely affected pulp tissue was removed, and calcium silicate cements were used. The outcome differences in these cases support the application of advanced dental biomaterials and techniques to maintain pulpal vitality. Advanced VPT is more comprehensive than previous techniques, as it focuses on the removal of affected pulp tissue and the use of biomaterials to promote mineralized, hard tissue barriers. An accurate diagnosis, removal of inflamed necrotic/avascular pulp tissue, examination of the pulp tissue condition using magnification, and placement of calcium silicate cement directly on the exposed pulp tissue are critical to success.

The objectives of this article are to report 2 cases of trauma-induced invasive cervical resorption (ICR) treated with surgical and nonsurgical restoration modalities and to review the literature on the clinical effectiveness of these approaches. Both surgical and nonsurgical techniques resulted in successful outcomes for 2 patients with trauma-induced ICR, classified as class 4 in the Heithersay classification and 3Bp in the 3-dimensional classification proposed by Patel et al. In the first case, the inapproachable resorptive lacuna was restored surgically, while in the second case, the large, approachable resorptive lacunae was treated nonsurgically. Treatment included root canal therapy, removal of granulation tissue, and placement of trichloroacetic acid and mineral trioxide aggregate to restore the resorptive lacuna. Follow-up examinations at 24 and 18 months for cases 1 and 2, respectively, indicated no recurrence, demonstrating successful management. Supporting the positive outcomes observed in these 2 clinical cases, the published literature suggests that the use of advanced diagnostic tools and appropriate treatment modalities tailored to each specific case can substantially increase the long-term retention of teeth affected by ICR.

Lichen planus (LP) is a chronic or recurrent autoimmune mucocutaneous inflammatory disease. The etiology is uncertain, and it is considered to originate from a multifactorial process. A diagnosis can be made clinically if the disease presents with classic patterns of oral or skin lesions; if these patterns are absent, a biopsy is necessary to establish a diagnosis. Although the World Health Organization has classified oral LP (OLP) as an oral potentially malignant disorder, there is controversy in the literature. Malignancy usually occurs around 60 years of age, with a slight predilection for women. The objective of this case report is to describe a possible occurrence of this process. A 53-year-old woman who sought treatment for oral lesions in 2018 was diagnosed with OLP with epithelial dysplasia and underwent standard treatment with a topical corticosteroid. After ceasing to attend follow-up examinations, the patient continued periodontal treatment with different providers. In 2024, she developed a lesion on the maxillary right alveolar ridge that led to tooth loss in the region. A biopsy was performed, and histopathologic evaluation of the specimen led to a diagnosis of squamous cell carcinoma. There are several differential diagnoses for the clinical forms of OLP, in addition to the possibility of manifestation of concomitant pathoses, and the final diagnosis must reflect a combination of clinical and histopathologic examinations. Patients should be advised about the importance of returning for follow-up appointments, as malignant transformation of OLP may occur.

Nonodontogenic cysts and pseudocysts pose diagnostic challenges due to their similarity to other maxillofacial lesions in clinical and radiographic appearance. However, these lesions are studied less frequently than odontogenic lesions. This retrospective cross-sectional study aimed to evaluate the frequencies and characteristics of nonodontogenic lesions in an Iranian population over a 20-year period. Archived records of 7036 patients referred to the Department of Oral and Maxillofacial Pathology, Shahid Beheshti University Faculty of Dentistry, Tehran, were reviewed. Data on the age and sex of the patients and the type, clinical and radiographic features, and histopathologic diagnoses of the lesions were collected. Statistical analyses included Fisher exact, Kruskal-Wallis, and chi-square tests, and a value of P < 0.05 was considered statistically significant. Nonodontogenic cysts were found in 0.5% of all referred patients, while pseudocysts were identified in 2.6%. After a review of records, 218 patients with a confirmed diagnosis of oral pseudocysts or nonodontogenic cysts were included in a more detailed analysis. Mucocele was the most common lesion (63.8%), followed by simple bone cyst (13.8%) and nasopalatine duct cyst (11.9%). The mean (SD) age of these patients was 30.5 (15.7) years, and 53.7% of all the lesions occurred in men. Statistically significant relationships were observed between cyst type and sex (P = 0.001; Fisher exact test), age (P < 0.001; Kruskal-Wallis test), and location (P < 0.001; chi-square test). Most pseudocysts occurred on the lower lip, while nonodontogenic cysts and intraosseous pseudocysts were predominantly found in the maxilla and mandible, respectively. The results of this study highlight the varied demographics and clinical and radiographic presentations of nonodontogenic cysts and pseudocysts, emphasizing the need for thorough radiographic and histopathologic analyses to guide appropriate treatment strategies.

Cannabis use is widespread, raising concerns about a myriad of health problems, notably regarding pulmonary disease and head and neck cancer (HNC). The objective of this review is to examine the association between cannabis exposure and HNC, including a discussion of epidemiologic findings and molecular mechanisms. A recent cohort study established that individuals with cannabis-related disorder have a significantly increased risk for HNC, including laryngeal, oral, nasal, sinus, and oropharyngeal cancers. Moreover, molecular studies suggest that cannabis smoke upregulates carcinogenetic pathways. Dental healthcare providers should inform their patients that heavy cannabis use may be associated with an increased risk of HNC.

Cystic fibrosis (CF) is an autosomal recessive disorder characterized by defective ion transport in epithelial cells, leading to the development of viscous mucus and glandular duct obstruction. Individuals with CF often present with gingival inflammation, dental enamel defects (DEDs), caries, and reduced salivary flow. This cross-sectional study of 82 patients with CF investigated the population's oral health in relation to systemic CF manifestations. Clinical oral examinations and medical record analyses were conducted for the entire sample, and panoramic radiographs were obtained for 26 patients. Data on oral hygiene practices, DEDs, gingival inflammation (gingival index [GI] score), caries, malocclusion, breathing pattern, and systemic health parameters were collected. The sample included 44 female and 38 male patients with a mean age of 11.5 years (range 8 months to 26 years). DEDs, predominantly affecting the permanent maxillary anterior teeth, were observed in 47.6% of the patients. Gingival inflammation was noted in 57.3% of the patients, and patients with higher GI scores reported reduced brushing frequency, experienced longer hospitalizations, and were more likely to develop exacerbation of pulmonary symptoms. Dental caries affected 17.1% of the cohort. Panoramic radiographs revealed nasal septum deviation (46.2% of the cohort), sinus opacification (38.5%), and dental agenesis (19.2%), primarily involving the premolars and the maxillary lateral incisors. Oral or mixed breathing was identified in 41.5% of the sample, and malocclusions were present in 28.0%. Fifteen patients with advanced lung disease exhibited infrequent toothbrush replacement, high plaque index scores, and severe gingival inflammation. While the prevalence of caries was relatively low in this small sample, the proportions of CF patients exhibiting DEDs, gingival inflammation, and occlusal abnormalities were high, particularly among those with advanced systemic disease. These findings underscore the importance of integrating dental care into the multidisciplinary management of CF to address patients' specific oral health challenges and improve overall quality of life.

Periodontitis is an inflammatory destructive condition influenced by obesity and type 2 diabetes mellitus (T2DM). Apelin, a bioactive peptide, is linked to periodontitis, obesity, and T2DM. This study aimed to investigate apelin levels in individuals with periodontitis who are affected by obesity and T2DM. This cross-sectional observational study included 84 participants categorized into 3 main groups of 24 patients based on their periodontal status, body mass index (BMI), and glycated hemoglobin (HbA_1c) levels. Group 1 comprised systemically healthy participants, group 2 comprised individuals with obesity (BMI of 30.0 to 39.0 kg/m2), and group 3 comprised individuals with both obesity and T2DM (HbA_1c of 6.5% to 8.5%). Each group was subcategorized based on the presence or absence of chronic periodontitis (CP), resulting in 6 subgroups with 14 participants each. The clinical parameters assessed included the Sulcus Bleeding Index (SBI), probing depth (PD), clinical attachment loss (CAL), BMI, and HbA_1c level. Apelin levels in serum and saliva were quantified using enzyme-linked immunosorbent assay. Data were analyzed using 1-way analysis of variance and independent samples t test. Pearson correlation coefficients were calculated to assess relationships between different parameters. Within groups, individuals with CP had lower serum and salivary levels of apelin than those without CP, and the differences were statistically significant except in the case of salivary levels in patients with obesity (P < 0.05). Individuals with obesity, as well as those with both T2DM and obesity, had elevated levels of serum apelin compared with systemically healthy individuals. A significant negative correlation was observed between serum apelin and periodontal parameters (SBI, PD, and CAL) in specific subgroups. Apelin could be a valuable biomarker for evaluating periodontal disease affected by obesity and T2DM. However, further longitudinal research with a larger patient sample is needed. Trial registration: Clinical Trials Registry - India No. CTRI/2019/02/017522.

This in vitro study examined the influence of aging in different beverage solutions on the Knoop hardness and surface roughness of provisional fixed denture materials. A total of 160 resin blocks were created and divided into 4 groups (n = 40) based on the provisional material: Structur 2 SC bis-acrylic resin, Protemp 4 bis-acrylic resin, Z350 XT nanoparticle composite resin, or Acri Duralay acrylic resin. The material groups were subdivided into 4 groups (n = 10) according to the beverage solution used to simulate aging: distilled water (control), red wine, orange juice, or soda (Coca-Cola). After 24 hours, the specimens were polished, and the initial microhardness and surface roughness were measured using a microhardness tester and profilometer, respectively. The specimens were then submerged in different beverage solutions for 4 weeks, and microhardness and surface roughness measurements were taken again. Two-way repeated-measures analysis of variance and Fisher least significant difference test were performed (α = 0.05). The aging process with different beverage solutions resulted in significantly lower hardness values compared with baseline for both Z350 XT and Acri Duralay materials (P < 0.05); however, Z350 XT still demonstrated significantly higher hardness values than all other materials regardless of the aging condition (P < 0.05). In general, Protemp 4 and Z350 XT exhibited lower surface roughness values than Structur 2 SC and Acri Duralay regardless of the solution used (P < 0.05). Beverage solutions significantly influenced the mechanical properties of the materials, with Protemp 4 bis-acryl-based resin material demonstrating hardness and surface roughness values that were less affected by aging.

Coronectomy is recommended for third molars that require extraction and are located near the inferior alveolar nerve (IAN) or the mandibular base. The procedure is aimed at reducing the risk of complications, but root migration is among the possible sequelae of this surgical technique. This report describes 3 clinical cases of root migration after coronectomy of impacted mandibular third molars. All 3 cases involved women aged 21 to 31 years and followed the surgical principles recommended for the technique: local anesthesia, periodontal ligament detachment, pericoronal ostectomy, sectioning of the dental crown, and crown removal with complete elimination of enamel from the roots, which remain impacted below 3 mm of bone. The patients were followed up with clinical and imaging examinations for 1 year. Panoramic radiographs at 1 year revealed root migration of 3 to 5 mm. None of the patients opted for removal of the residual root fragments because they were not causing any pain. Root migration after coronectomy cannot be perceived as a failure of this relatively safe alternative to extracting mandibular third molars near the IAN because the root always moves away from the nerve and usually causes no additional symptoms. Secondary surgery to remove the residual root should only be performed if migration results in root exposure, pain, or infection.