Iranian Endodontic Journal最新文献

Maxillary incisors are typically straightforward cases for root canal therapy. While it is commonly assumed that maxillary central incisors have a single root canal, they may occasionally exhibit variations in their root canal system anatomy. In this report, we present a case of a maxillary central incisor with multiple root canals and provide a review of relevant literature on this anatomical variation. A 13-year-old female with deep carious lesion in tooth 11 was admitted in Department of Endodontics. Following a precise clinical and radiographic examination, a maxillary central incisor with necrotic pulp and chronic apical periodontitis along with unusual root anatomy was found and considered for non-surgical root canal treatment. Successful treatment results depend on various factors and awareness of root canal system anatomy is one of them. Due to an increasing number of reported cases of maxillary central incisors with different anatomy, it is imperative to consider anatomical variations even in the most routine cases.

Introduction: The purpose of this review is to investigate the contribution of non-surgical endodontic treatment in the healing process of large periapical lesions as well as looking over other potential non-surgical endodontic treatment options.

Materials and methods: two females and one male patient were referred to the private office, complaining of having pain in the anterior maxillary region which was pertinent to the presence of a large periapical lesion, and subsequently were managed by a non-surgical endodontic approach using cold ceramic. The archive of PubMed and Google Scholar databases was also searched for finding relevant articles in which a nonsurgical endodontic approach was performed to improve the healing process of large periapical lesions.

Results: Clinical examination of the case series subjects revealed no signs and symptoms following treatment while relative improvement of the lesion and apical closure was apparent in radiographs 7 months, 9 months, and 4 years subsequently. In twenty-two reviewed clinical trials, a total number of 107 teeth with large periapical lesions were treated by nonsurgical endodontic approaches using MTA, biodentine, gutta-percha, and bioceramic iRoot Bp plus. Complete healing occurred in 38 cases (35.5%) after 12-17 months.

Conclusions: Although surgical interventions have been used previously in the management of large periapical lesions, a nonsurgical endodontic approach with cold ceramic seems to be effective, leading to complete healing of the periapical lesion in treated subjects. Further clinical research is recommended to identify the effectiveness of cold ceramic for the treatment of extensive periapical lesions.

Introduction: This study aimed to compare the efficacy of ibuprofen, Novafen, mefenamic acid (MA), and celecoxib for pain relief in patients with symptomatic irreversible pulpitis prior to emergency endodontic treatment.

Materials and methods: This clinical trial was conducted on 120 patients with moderate to severe pain due to symptomatic irreversible pulpitis seeking emergency endodontic treatment. The patients were randomly divided into 4 groups to receive Novafen, MA, Celecoxib, and ibuprofen. The pain score of patients was measured before and 1 hour after analgesic intake using a visual analog scale (VAS). The success of analgesic treatment was analyzed by the binary logistic regression model.

Results: A total of 117 patients including 76 females and 41 males with a mean age of 30.29 years completed the study and were statistically analyzed. Ibuprofen had the highest analgesic efficacy followed by Novafen, and caused a significantly greater reduction in pain score compared with MA and celecoxib [OR (Ibuprofen vs MA)=1.28, OR (Ibuprofen vs Celecoxib)=3.74, OR (Novafen vs MA)=2.94, OR (Novafen vs Celecoxib)=2.94, P<0.05]. Ibuprofen and Novafen had no significant difference in analgesic efficacy (P>0.05). Baseline pain score was a predictive factor for the success of analgesics (P<0.05). The success of analgesic treatment decreased by 0.68 times with each unit increase in pain score (P<0.05). Gender and age of patients had no significant effect on success of analgesics (P>0.05).

Conclusion: Both ibuprofen and Novafen can serve as the analgesics of choice for pain relief in patients with symptomatic irreversible pulpitis with moderate to severe pain when emergency endodontic treatment cannot be immediately performed.

Introduction: This study aimed to evaluate if the apical patency can influence the adaptation of the master cone of gutta-percha, quantifying the volume of voids and areas at the last 2 mm of the working length (WL).

Materials and methods: Sixty distobuccal canals of extracted upper molars were divided into 3 groups (n=20) based on the patency length (A: passed 1 mm beyond the apical foramen (AF), B: at the AF and C: 1 mm short of the AF) with the Easy ProDesign Logic 25/0.01 file. Each group was subdivided into 2 subgroups (n=10) based on the WL established to prepare the root canal (1: 1 mm short of the AF or 2: at the AF) with the Easy ProDesign Logic 25/0.05 file. After the scan, void volumes were calculated from the last 2 mm of the WL and void areas at 0 mm, 1 mm and 2 mm of the last of WL, as well as the relation between the tip and taper of the master cone with the amount of void volume and areas. To investigate statistically significant differences, we used the Kruskal-Wallis statistical test.

Results: There were more voids in volume when patency was achieved 1 mm beyond the AF and the root canal preparation was conducted at 1mm short of the AF (A1 group). Furthermore, the same group showed more voids areas, mainly on the last millimeter of WL.

Conclusion: Achieving apical patency at 1 mm beyond the AF followed by instrumentation 1 mm short of the AF created more voids between the master gutta-percha cone and the root canal wall, especially on the last millimeter of WL.

Successful endodontic treatments are contingent upon establishing a hermetic seal within the root canal system. This seal is pivotal in preventing/resolving apical periodontitis. This case report introduces a simplified orthograde apical plug and intra-orifice barrier technique as an effective alternative to previously unsuccessful invasive nonsurgical and surgical treatments. A 28-year-old patient presented with persistent discomfort and localized swelling in the furcation area of the mandibular left first molar. The tooth had previously undergone both root canal therapy and surgical retreatment. A distinctive feature of this case was the unconventional amputation of the mesial root, unlike conventional periradicular surgery or root amputation. This unusual scenario was accompanied by the presence of a large endodontic lesion. An apical plug, utilizing calcium-enriched mixture (CEM) cement, was placed, complemented by the use of CEM intra-orifice barriers to ensure the hermetic sealing of the entire root canal system. Long-term follow-up assessment demonstrated the complete healing of the preexisting large endodontic lesion. This case underscores the significance of proper diagnosis, right treatment planning, and considering conservative treatment options for complex cases, highlighting the pivotal role played by a reliable seal in achieving successful results in endodontic procedures.

The current case study presents the surgical endodontic retreatment of a central incisor with a large periapical cyst that had extended to the adjacent lateral incisor. After anaesthesia, a full mucoperiosteal flap was carefully incised and completely reflected. Then, the cyst was cautiously excised without performing curettage of the apical region of the adjacent tooth. A 3-mm deep root-end cavity on tooth #21 was prepared, filled and sealed with calcium-enriched mixture cement. At 6-month and 4-year follow-ups, tooth #21 was fully functional and exhibited no clinical signs/symptoms, and complete periapical healing was evident. This report indicates the importance of proper diagnosis as well as a careful surgical approach in the successful management of comparable cases without the overtreatment of involved teeth.

Current principles in vital pulp therapy (VPT) modalities emphasise the importance of haemostasis and normal clotting in the achievement of successful treatment outcomes. However, the aforementioned notion could be challenged by the new and recent emerging evidence; suggesting that prolonged or excessive bleeding/haemorrhage (PB) in cases of intensly inflamed pulps, conventionally infamous as irreversible pulpitis (IP), may not impede the healing potential of the remaining dental pulp tissue following VPTs using endodontic biomaterials. "Tampon VPT (tVPT)" may be considered a treatment approach for the management of stated IP cases; characterised by severe pulpal inflammation and delayed clotting process. The presented hypothesis evaluates clinical studies, experimental research and molecular impacts on clotting within the inflamed dental pulp, so as to explore the efficacy as well as the safety of tVPT as a viable treatment option. Latest clinical investigations have reported positive outcomes with tVPT; even in the presence of IP with PB. It has been shown that inflamed dental pulp tissues exhibit molecular impacts on the clotting cascade, which may contribute to the delayed clotting process. Nonetheless, the healing capacity of the dental pulp is not negatively affected by hyperaemia. Additionally, enhanced blood flow in the inflamed pulpal tissues may be associated with improved healing and boosted hard tissue formation. Moreover, tVPT could possibly promote pulpal healing and/or regeneration through continuing the presentation of essential nutrients, e.g. oxygen, and growth factors to the injured tissue. Furthermore, increased blood flow may facilitate the recruitment of immune and reparative cells; promoting tissue repair and encouraging the formation of dentinal bridge(s) after VPTs. Consequently, the state-of-the-art research and their findings could support the hypothesis that tVPT may effectively manage IP cases with PB and contribute to favourable outcomes.

Minimally invasive vital pulp therapy (VPT) techniques have become increasingly popular for treating mature permanent teeth with irreversible pulpitis. However, in cases where less invasive VPT approaches, such as miniature pulpotomy, fail to provide symptom relief and desired outcomes, alternative treatment strategies need to be explored. This case report presents the successful application of tampon pulpotomy, a modified full pulpotomy technique, in a vital molar tooth with irreversible pulpitis, after a previous miniature pulpotomy failure. The tampon pulpotomy procedure involved the placement of an endodontic biomaterial (i.e. calcium-enriched mixture cement) over the pulpal wound to stop bleeding and create a favorable environment for pulpal healing/regeneration. The patient was followed up for a period of 10 years, during which the tooth remained asymptomatic, functional, and exhibited normal periodontal ligament. This case report highlights the potential effectiveness of tampon/full pulpotomy as a retreatment option in cases where more conservative VPT techniques have shown limited success, offering a conservative approach to preserve tooth structure and pulpal vitality.

Introduction: The nonsurgical endodontic retreatment (NERT) is the first choice of dental ministration when primary/initial endodontic treatment fails. The present study aimed to investigate the presence of postoperative pain (POP) after NERT in permanent asymptomatic teeth as well as possible factors associated with POP.

Materials and methods: A comprehensive search of literature was performed in Pubmed/MEDLINE, Embase, Scopus and Web of Science databases, up to January 2023; including randomized clinical trials and prospective studies. The risk of bias was assessed with RoB 2.0 and ROBINS-I tools. Subgroups analyses were conducted to evaluate the differences in the incidence or level of POP between the number of visits, the use/not use of solvent, the removal technique of gutta-percha, and the period of POP analysis. Mean differences and confidence intervals (CI) of 95% were used as measures of effect, and meta-regression was used along with subgroup analysis. The certainty of evidence was assessed using GRADE, and the probability value of <0.05 was considered significant.

Results: Twenty-four studies were selected, with thirteen included in the meta-analysis. There was a statistical difference between the incidence of POP after 24 h (95% CI, 0.28 to 0.52) and one week (95% CI, 0.02 to 0.13) from the endodontic retreatment (P<0.01). However, there was no statistical difference between different techniques, number of visits and use of solvent (P>0.05) in the same period. In addition, the certainty of evidence was very low.

Conclusions: Post-operative pain is a common response to NERT, independent of the retreatment technique(s) applied, number of visits and use of solvent(s); with very low certainty of evidence as well as low risk of bias. Moreover, the current analysis showed a (very) serious risk of inconsistency and imprecision. However, POP was significantly reduced within 1 week of the NERT.