Iranian Endodontic Journal最新文献

Vital pulp therapy (VPT) comprises a range of conservative treatment modalities aimed at preserving the vitality of the compromised dental pulp in primary and permanent teeth. This PubMed-based review comprehensively evaluates seven distinct VPT techniques; including their historical development, broad definitions, clinical protocols and treatment outcomes as evidenced by systematic reviews and meta-analyses. The VPT modalities covered in this review include stepwise excavation, indirect pulp capping, direct pulp capping, miniature pulpotomy, partial pulpotomy, full pulpotomy and partial pulpectomy. Stepwise excavation, as a minimally-invasive option, has demonstrated effectiveness in reducing the risk of pulp exposure, particularly in permanent teeth. Clinical outcomes of indirect and direct pulp capping are promising; specifically with the application of advanced calcium silicate cements. Miniature and partial pulpotomies emphasize the importance of precise definitions and standardised protocols due to their subtle differences. Full pulpotomy has emerged as a viable alternative to root canal treatment, achieving comparable success rates in managing irreversible pulpitis. While partial pulpectomy remains the most invasive approach, it has shown potential in managing complex cases, such as root resorption, through selective tissue preservation. Despite advancements in biomaterials and technique standardisation, challenges remain, including variability in clinical protocols, limited high-quality evidence, and the need for long-term studies to better evaluate anticipated outcomes. Nevertheless, emerging biotechnologies hold promise for enhancing the precision and predictability of VPT procedures in the future.

Paresthesia is described as a burning or prickling sensation or partial numbness caused by neurologic injury. The sensory loss may be the result of a reversible and/or irreversible nerve damage, and it can be caused by local or systemic factors. Local factors include traumatic injuries caused by impacted teeth, local injection, endodontic therapy, implant placement and exposure to toxic materials. This article reports a paresthesia by anesthetic injection. A 44-year-old man reported moderate pain during chewing and exposure to cold. Upon clinical examination, extension of the tooth fracture line was in the mesiodistal region of the mandibular left second premolar crown and was detected with 16× magnification of microscope. The diagnosis was cracked tooth syndrome, and root canal treatment was indicated. After the first appointment the patient reported altered sensation on left side of mandible, numbness and electric shock sensation, and therefore was diagnosed with mental nerve paresthesia. Diclofenac sodium, thiamine, cyanocobalamin, and pyridoxine were prescribed for 7 days as part of the treatment, and then root canal and restorative treatments were completed. Patient was scheduled for follow-up appointments after 1, 3, 6, and 8 months. After the first month, the feeling of paresthesia was still present and the patient was experiencing a painful "electric shock". At the 8-month follow-up visit, the paresthesia had been resolved with return of normal sensation.

Introduction: This systematic review compared the accuracy of guided endodontics with the conventional method in non-surgical endodontic retreatment.

Methods: Two reviewers conducted a systematic search across PubMed/MEDLINE, Scopus, Embase, and Web of Science databases. Inclusion criteria consisted of all in vitro studies up to October 2024 that documented the application of cone-beam computed tomography in creating a guide for endodontic retreatment cases. The reviewers assessed the quality of the selected studies using the QUIN tool. Data regarding the first author and publication year, sample size, tooth type, retreatment application, computer-aided navigation technique, groups, image acquisition method, outcome measures, guided technique results, conventional technique results, and the main results were extracted using a predefined template.

Results: Based on our criteria, seven studies were included in this review. The studies demonstrated variability in the techniques utilized. Iatrogenic errors were less frequent in guided groups, regardless of the operator's level of experience. Most studies indicated that guided endodontics was more effective than conventional methods, particularly in fiber post-removal and access through MTA, minimizing volumetric loss of tooth structure, and preserving fracture resistance. However, when using guided techniques for removal of separated instruments, more iatrogenic errors occurred, and more time was required compared to the freehand technique.

Conclusion: Guided endodontics has shown promise in improving the outcomes of non-surgical retreatment by reducing complications. However, as all included studies were in vitro, clinical evidence is lacking, and the generalization of these results should be done cautiously. Further well-designed clinical studies are required to confirm these findings.

Dens invaginatus is a developmental anomaly resulting from the infolding of enamel and dentin into the dental pulp. Oehlers' Type IIIa dens invaginatus poses significant challenges due to its intricate anatomy and frequent association with immature teeth. This case report outlines the nonsurgical management of a nonvital immature maxillary central incisor with Type IIIa dens invaginatus, presenting with a chronic apical abscess and a history of trauma to the associated primary incisor. Treatment involved thorough chemomechanical debridement followed by bio-obturation using calcium-enriched mixture cement. Regular follow-ups revealed complete resolution of the periapical lesion. This case underscores the importance of precise diagnosis, individualized treatment planning, and the application of advanced biomaterials in addressing complex presentations of dens invaginatus. The successful outcome emphasizes the efficacy of nonsurgical techniques in preserving immature teeth while restoring function and aesthetics.

Permanent maxillary second molars' root canal treatment due to their root configurations complexity and high root canal systems variations, are one of the most problematic teeth. Accordingly, clinicians should consider unusual canal morphology to reduce the rate of missed canals. A thirty-year-old female was referred for root canal treatment of her maxillary right second molar tooth with obvious recurrent caries under restoration and necrotic pulp. Pre-operative radiographs showed the unusual morphology and cone-beam computed tomography was ordered for precise evaluation of the root canal anatomy. The principal aim of this paper is to report a five-root canals maxillary second molar, with two palatal root canals and a palatal root-like enamel pearl canal.

Dens invaginatus is a developmental malformation that is caused by the invagination of the enamel organ into the internal region of the dental papilla before tissue calcification. The aim of the present report is to discuss a clinical case of endodontic treatment of tooth #12, using bioceramic sealer. The extraoral examination revealed atypical anatomy, while vitality and percussion tests were negative, palpation test was positive. Edema was observed in the adjacent gingival mucosa. Based on clinical and tomographic findings, the diagnosis was pulp necrosis with chronic periapical abscess and Oehlers' type II dens invaginatus. In the first session, access surgery was performed with spherical drills with the aid of an operating microscope (OM) and an ultrasonic diamond tip. Four canals were located, and they were partially debrided and medicated. In the second session, odontometry and chemical-mechanical preparation with nickel-titanium instruments were performed. The irrigation solution was 2.5% sodium hypochlorite. The root canals were filled with calcium hydroxide paste and the chamber was temporarily sealed. During the third session, ultrasonic irrigation was applied for final washing and the root canals were filled with Bio-C sealer using the classic single-cone technique. At 6-month follow-up, the tooth was asymptomatic and the radiography revealed significant bone repair. It was concluded that tomography, operating microscope, ultrasonic irrigation, and materials with greater flow, such as bioceramic sealers, enhanced the clinical success of the clinical case.

Introduction: The middle mesial canal (MMC) of mandibular molars is of particular interest in endodontics due to its complexity. This study investigated the association between MMC presence in first and second mandibular molars and the radiolucency in the furcation area using cone-beam computed tomography (CBCT) scans.

Materials and methods: CBCT scans of 400 patients referred to the largest radiology center in Kerman City from January 1, 2022, to January 1, 2023, were examined. All CBCT scans were assessed for radiolucency in the furcation area and the presence of MMC. Variables, including age, gender, tooth number, and MMC presence were recorded. Chi-squared tests and logistic regression analyses were employed to compare MMC frequency and its impact on furcation radiolucency.

Results: Of 201 examined teeth, 37 (18.4%) had MMC, and 23 (11.4%) exhibited furcation radiolucency. However, teeth with a mesial canal showed a higher prevalence of furcation lesions compared to those without (38% vs. 5.2%) (P<0.001). A significant association was observed between a mesial canal and furcation radiolucency, with odds of furcation radiolucency at 12.7 after controlling for age and gender (P<0.001).

Conclusion: A strong association exists between MMC presence in first and second mandibular molars and furcation radiolucency, unaffected by age and gender.

An acute apical abscess (AAA) is a rapid-onset inflammatory condition characterized by spontaneous pain, pus formation, and swelling, often resulting from pulp necrosis. Complications may include systemic manifestations and severe outcomes, such as tooth extrusion. This case report describes a rare instance of AAA causing rapid extrusion of a maxillary central incisor in a 17-year-old female. The patient presented with spontaneous pain and mobility of the extruded tooth, accompanied by localized swelling. Clinical and radiographic evaluations revealed pulp necrosis, an AAA, and apical bone rarefaction. Emergency treatment was initiated, including intracanal medication with calcium hydroxide and temporary splinting of the tooth. Subsequent treatment involved obturation with gutta-percha and sealer, followed by permanent restoration. Radiographic and clinical recalls up to 5 years demonstrated complete periapical healing, normal tooth mobility, and no recurrence of symptoms. Effective management, including timely root canal therapy and splinting, led to successful long-term outcomes. This case underscores the importance of prompt diagnosis and immediate, tailored treatment to manage AAA and prevent severe complications.