Iranian Endodontic Journal最新文献

Taurodontism is a dental anomaly characterized by an enlarged pulp chamber and apically displaced pulpal floor. This disorder poses significant challenges in endodontic treatment, especially when perforations occur. The present case study details the endodontic retreatment of a hypertaurodont maxillary second molar in a 36-year-old female patient with a mesial canal perforation. The procedure employed a dental operating microscope for enhanced visualization and precision. Canals were prepared using a crown-down technique, with the perforation site managed using MTA and bioceramic material applied via the second mesiobuccal canal. The remaining canals were obturated using gutta-percha and bioceramic sealer. At the 1-year follow-up, the tooth was functional and asymptomatic, with radiographic evidence of a normal periodontal ligament space. This case demonstrates the efficacy of contemporary endodontic techniques, including bioceramic materials and advanced magnification, in managing the unique challenges posed by taurodontism.

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.

The American Association of Endodontics classifies the management of pulp canal obliteration (PCO) cases as a high-risk difficulty. This classification indicates an increased likelihood of procedural errors. However, advancements in dental technology have simplified the endodontic treatment of calcified teeth. Guided endodontics uses cone-beam computed tomography (CBCT) and a three-dimensional (3D) printer to create a patient-specific guide, enhancing accuracy and predictability in complex cases. A healthy 60-year-old male was referred by a prosthodontist for root canal treatment on teeth #23, #24, and #25. Periapical radiographic examination revealed partial PCO in all teeth. After choosing guided endodontics treatment, CBCT imaging and intraoral 3D scanning were utilized to design a patient-specific endodontic guide. After verifying the stability of the endo-guide, access cavities were prepared using a Munce Discovery bur. Following the negotiation of the canals, the working length was determined. Root canal treatment was performed using rotary files up to size 25/0.04% and sodium hypochlorite irrigation. The obturation was completed using the warm condensation technique. Although PCO was present, no complications occurred during treatment. The teeth remained completely asymptomatic and functional, demonstrating the success of the treatment. Guided endodontics can be a practical and predictable approach for managing PCO in mandibular incisors. This technique provides accurate canal location, reduces procedural errors, and preserves tooth structure. Despite concerns about cost, radiation exposure, and challenges with anatomical variations, it represents a promising advancement in endodontic treatment.

Internal inflammatory root resorption (IRR) poses significant challenges in endodontic treatment due to its potential to compromise tooth integrity. This case report describes the conservative management of IRR in a 40-year-old woman with a radiolucent lesion in the midroot of a maxillary central incisor. Early diagnosis using cone-beam computed tomography prevented perforation and guided treatment planning. Non-surgical endodontic treatment was performed using a dental operating microscope, ultrasonic irrigation, and a hybrid obturation technique. The apical portion of the canal was sealed with a bioceramic sealer and single-cone gutta-percha, while the resorptive defect was filled with calcium-enriched mixture cement due to its biocompatibility and sealing properties. At one-year follow-up, the patient was asymptomatic, with radiographic evidence of healing. This case highlights the efficacy of combining advanced diagnostic tools, bioactive materials, and minimally invasive techniques for successful IRR management.

A thorough understanding of root canal morphology is critical for achieving predictable outcomes in endodontic therapy. Anatomical variations in mandibular second premolars are uncommon compared to other teeth, and the coexistence of a C-shaped root canal configuration with four independent canals and four separate apical foramina is exceptionally rare. This case report describes the nonsurgical endodontic management of a mandibular second premolar exhibiting this unique morphology, confirmed through cone-beam computed tomography (CBCT) and magnification. A 52-year-old male was referred by a prosthodontist for elective root canal treatment before post placement. CBCT imaging revealed a C-shaped root in the coronal third that bifurcated into four separate canals at the midroot level, each terminating in an independent apical foramen. Nonsurgical treatment was performed over two visits, using meticulous chemo-mechanical preparation, intracanal calcium hydroxide dressing, and warm vertical compaction obturation. At the 9-month follow-up, the tooth was functional, asymptomatic, and radiographically stable. This case underscores the importance of preoperative assessment with advanced imaging and magnification in identifying and successfully treating rare endodontic anatomies.

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.

Dentin Dysplasia Type II (DD-II) is a rare genetic disorder that affects the coronal dentin, often leading to pulp stones and complicated endodontic treatment. This case report presents the endodontic management of DD-II in an 11-year-old female patient. The patient, referred for root canal treatment, exhibited symptoms of moderate pain and was diagnosed with pulp necrosis in tooth #19; radiographic findings revealed multiple pulp stones, pulp canal calcification, and apical radiolucency. Endodontic treatment was performed, involving the removal of pulp stones with ultrasonic tips, careful cleaning and shaping of the root canals, and obturation using gutta-percha and AH-26 sealer. Twelve months post-treatment, the patient showed complete healing of the apical lesion, with no related complications. This case underscores the importance of early diagnosis and timely endodontic intervention for favorable outcomes in patients with DD-II.

Regenerative endodontic procedures (REPs) have emerged as a biologically driven approach for managing immature teeth with necrotic pulp and open apices, providing an alternative to traditional apexification techniques. This case report describes the successful treatment of a three-rooted immature mandibular first molar with necrotic pulp and chronic apical periodontitis in a 9-year-old patient using REPs. The treatment followed the guidelines set by the American Association of Endodontists and utilized a two-visit protocol. Concentrated growth factor (CGF) was employed as a biological scaffold in the root canals, while calcium-enriched mixture (CEM) cement was used for the coronal seal. Radiographic evaluations conducted at 6, 12, and 15 months revealed progressive periapical healing, significant root elongation, increased thickness of the root walls, and partial apical closure. Clinically, the patient remained asymptomatic during all follow-ups. This case highlights the potential of CGF and CEM cement-enhanced REPs to promote continued root development and achieve predictable outcomes in immature teeth with necrotic pulps, offering a biologically based alternative to conventional apexification.

Noonan syndrome is a genetic condition characterized by various systemic issues, including cardiac defects, short stature, bleeding problems, and intellectual disabilities. This disorder also shows several manifestations in the oral and maxillofacial region, highlighting the dentist's role in diagnosing and addressing related complications. This report represents the effective dental management of a 15-year-old boy with Noonan syndrome who suffered from several oral and dental problems and was clinically and radiographically asymptomatic in a nine-month follow-up session. Awareness of the medical conditions and orofacial manifestations of patients with Noonan syndrome can be effective in determining a better treatment plan, providing more effective and safer treatment, and subsequently enhancing the long-term prognosis.

Continuous improvement and technological progress in the field of microscopic endodontics enable a gradual increase in indications for non-surgical root canal treatment. While most publications report successful surgical management of overfill or extruded foreign bodies into the periapical area, very few report that this complication can be successfully managed with non-surgical endodontic treatment. This case report presents successful management of a lower left second molar (tooth #37) diagnosed with exacerbated chronic apical periodontitis and massive overfill in a 36-year-old patient WITH non-surgical endodontic treatment AND bent H-file to remove extruded material under dental operating microscope control. It discusses technical aspects of this procedure, as well as its possible complications, including a sodium hypochlorite accident.