Giornale Italiano di Endodonzia最新文献

Aim

Ludwig's angina is a rare aggressive infection, often of dental origin, characterized by a rapid spread of cellulitis in the submandibular and sublingual spaces. Ludwig's angina is potentially fatal, if it obstructs the airways and if it is not treated with appropriate antibiotic therapy.

Summary

The case report describes the diagnosis and the management of a Ludwig's angina caused by an endodontic infection in a 16 years-old female patient. The infection has been caused by a decay of the second lower right molar. After hospitalization and systemic antibiotic therapy, in accordance with the patient and the parents endodontic and restorative treatments of the tooth were performed. After 3 and 5 years, the radiological examination revealed no periapical lesions around right lower second molar and the presence of lamina dura.

Key learning points

This aggressive infection may often be undervalued and this may cause dangerous consequences to the patient's life. The infection can be prevented by periodic dental care and interventions, which can avoid odontogenic infections. In the case of Ludwig's angina, early diagnosis is fundamental to save the patient's life. After the initial antibiotic therapy and once the life of the patient is no longer at risk, an appropriate endodontic therapy can be considered a valid therapy for this disease.

Aim

To evaluate the centering ability of ProTaper Next (PTN) and 2Shape (TS) nickel–titanium (NiTi) instruments in terms of maintaining the original root canal configuration in a simulated tooth with severe curvature.

Methodology

Twenty standardized simulated curved root canals were prepared to an apical size of 0.25 mm using PTN and TS (n = 10 canal/group) nickel-titanium files. A gig was constructed to enable reproducible image acquisition using a photographic camera. Pre- and post-instrumented images were recorded and superimposed using a computer software. The ability of the instruments to remain centered in the canal was determined by calculating a centering ratio at three independent points of the simulated canal: coronal, middle and apical third of the curvature, using a computer software. Statistical analysis was performed using one-way analysis of variance (ANOVA) followed by independent sample t-test at 5% significance level.

Results

No significant difference was found between the two systems (p > 0.05). At the apical third, the mean centering ratio was significantly higher than the centering ratio of the coronal and the middle thirds in both TS and PTN (p < 0.05).

Conclusions

There were no significant differences in the centering ability of the ProTaper Next and 2Shape systems in simulated severe curved canals. Both systems exhibited some degree of transportation, especially in the apical third.

Aim

To evaluate cyclic fatigue resistance of different Nickel-Titanium instruments tested with an innovative reciprocating kinematics.

Methodology

Eighty Nickel-Titanium reciprocating instruments were tested in cyclic fatigue resistance: WaveOne Primary (n = 20), WaveOne Gold Primary (n = 20), Reciproc R25 (n = 20) and Reciproc Blue R25 (n = 20). The cyclic fatigue of each brand was measured with two different motors and kinematics settings: (1) X-Smart Plus (Denstply Maillefer) used in “WaveOne All” or “Reciproc All” setting, according to manufacturer's instruction; (2) a 4:1 contra-angle (Cefla, Imola, Italy) with an experimental kinematics (Goldspeed EVOE4 – Cefla, Italy) (EVO) with different rotation angles and based on a sinusoidal acceleration. The time to fracture in an artificial stainless-steel canal (90° angle and a 5-mm radius of curvature) was digitally recorded. Mean life, beta (failure rate) and eta (characteristic life i.e. the number of seconds at which 63.2% of the product has failed) were calculated for each group and compared with Weibull analysis.

Results

Instruments tested with the kinematics EVO presented higher values of eta in all groups. Reciproc Blue showed the highest eta value (233.05) and Wave One Gold the lower failure probability (46.98%). Wave One instruments showed similar fatigue resistance when tested with EVO or X-Smart.

Conclusion

Tested kinematics with different angles and based on sinusoidal reciprocating acceleration had a positive impact on fatigue lifetime of reciprocating instruments. Present findings suggest the possibility of future improvements in the clinical use of reciprocating files.

Aim

This prospective clinical study analyzed the 24-month outcome of conventional apical surgery retro-filled with calcium-silicate cement versus apical surgery with simultaneous orthograde retreatment by means of clinical and radiographic criteria.

Materials and methods

This study included 83 teeth affected by persistent periapical lesions in 68 patients. Mean age was 52 years (median = 51 years; range 19–81 years). Twenty-eight cases were treated with apical surgery, 16 cases with apical surgery with simultaneous orthograde retreatment and 39 cases with orthograde retreatment in previously treated teeth established as control group. Periapical index score (PAI) was used as radiographic criteria. Teeth were examined at 6 months, 1 and 2 years and classified as healed (without any symptoms and PAI ≤ 2), healing (without any symptoms and PAI = 3) or diseased (with symptoms or PAI ≥ 4 and not functional) on the basis of radiographic and clinical criteria. At 24 months evaluation, healed and healing were considered as success and diseased and fracture as failure. Multilevel GLM model and an ordered logistic regression as statistical analysis was made with level of significance set at p < 0.05.

Results

Total drop-out was 7% (n = 6). After 6–9 months, 6 teeth (3 from apical surgery, 2 from simultaneous treatment and 1 from orthograde retreatment) were extracted for root fracture. Twenty-four-month success rate of apical surgery group was 78% (n = 17), apical surgery with simultaneous orthograde retreatment presented 81% (n = 10) and orthograde retreatment success was 80% (n = 24). There was no statistically difference between the groups at 24 months (p = 0.890).

Conclusions

Both surgical techniques revealed a high percentage of healing, similar to that reported by previous studies. Apical surgery with simultaneous orthograde retreatment showed a faster healing after 12 months comparing to the control group.

Aim

Our research investigated the use of human serum (HS) as a safe and clinical-grade culture medium, using a new cell-model: hPCy-MSCs. This article is aimed to concretely applicate the concept of “waste-based regenerative dentistry” to translate it in future endo-periodontal applications.

Methodology

HPCy-MSCs were cultured in 2 different mediums, both containing α-MEM: the 1st with 10% FBS (Control group), and the 2nd with 10% human serum (Test group).

Cell proliferation and stemness assays, gene expression, immunophenotypic analysis and osteogenic differentiation were performed to verify our hypothesis. cDNA samples were amplified with qPCR.

Experiments were performed in triplicate and analysed with statistical software.

Results

The hPCy-MSCs cultivated in a medium with HS were morphologically similar to those cultivated with FBS, and showed a significantly higher proliferation rate. Von Kossa's staining revealed that osteoblasts from hPCy-MSCs in HS implemented with osteogenic induction factors, showed a better osteogenic activity, also confirmed by a significant upregulation of osteopotin (OPN) and matrix extracellular phosphoglycoprotein (MEPE).

Conclusions

HPCy-MSCs cultivated in HS showed phenotypic stability and a clear regenerative binding, thus, suggesting these two components as a clinically-grade construct for future endo-periodontal therapies.

Aim

The aim of this retrospective observational case series study was to evaluate the middle term outcomes on endodontic management of old infected iatrogenic root perforations using Biodentine. The treatments were always concluded in a single visit, without previous medication with calcium hydroxide. Our goal was to facilitate this kind of treatments and to make them more reproducible and manageable even for a general practitioner or a student.

Methodology and methods

Between January 2011 and June 2016, 51 patients with old infected root perforations have been enrolled. All the treatments were performed using Biodentine in a single visit. Infected root perforation repair was performed by supervised dental students (39%) or a qualified endodontist (61%), employing surgical microscope magnification during treatments. After the treatment, the 51 patients were monitored for 18–64 months. We used clinical and radiographic examinations.

Results

Of 51 examined teeth, 48 (94%) were classified as healed. The time, the size and the location of the perforations did not have a significant effect on the outcome. We proved the ineffectiveness of the null hypothesis. According to this latter, the single visit treatment of old infected perforations with Biodentine was inadequate.

Conclusions

In single visit treatments, Biodentine seems to provide a biocompatible and effective seal in acidic environment, in accidental root perforations, even if the treatment is performed by an inexperienced operator and regardless of the location, the size and the time of occurrence of the perforation.