As dental trauma is an unpredictable event, the patient is sometimes unable to receive dental care immediately in case of tooth fracture complicated by exposure to the pulp. It is conceivable that a long wait may favor bacterial contamination that can lead to necrosis of the pulp. The aim of this paper is to present a clinical case in which the pulp has been protected domiciliary to reduce post-traumatic hypersensitivity and the risk of pulpal necrosis.
In the presented clinical case, the nail polish was used as an emergency material for the direct capping of the pulp of two fractured incisors. In this way it was possible to protect the pulp and seal the dentinal tubules for 5 days, such it is the time between trauma and therapy.
The application of the nail polish led to a reduction in hypersensitivity; at 2-year follow-up both teeth were still vital.
Based on this experience, it is suggested the possibility to recommend the use of nail polish as a protective material for the pulp and for reducing symptoms in case of complicated and uncomplicated fractures, if the dentist is consulted by telephone and the patient is not in condition to reach it quickly.
This ex-vivo study aimed to compare canal transportation in mesio-buccal canal of mandibular first molars prepared with Mtwo and Revo-S multi-file and Neoniti single-file nickel–titanium (Ni–Ti) rotary systems using cone-beam computed tomography (CBCT).
CBCT scans were obtained from 60 extracted mandibular first molars and the teeth were randomly divided into three groups. Mesio-buccal canal of mesial root was prepared with Revo-S, Neoniti or Mtwo rotary systems according to the instructions of the manufacturers. Post-operative CBCT scans were also obtained. A single operator performed canal preparations while another operator blinded to the group allocation of teeth did the measurements. Data were analyzed using SPSS 20. The mean and standard deviation (SD) of the amount of canal transportation were calculated and compared between the groups using the Friedman test (P ≤ 0.05).
No significant difference was noted in canal transportation among the groups in the middle and apical third (P > 0.05). The rotary single-file instrument caused significantly greater canal transportation in the coronal third.
No significant difference exists among different rotary systems in the amount of canal transportation caused in the middle and apical third of the mesio-buccal canal in mandibular first molars. Although all rotary files caused some degrees of canal transportation, the rotary single-file instrument caused significantly greater canal transportation than the multiple-file sequences in the coronal third.
To assess the influence of the crown height, root length, crown-to-root ratio, and tooth type on the survival of teeth subjected to surgical endodontic retreatment and classified as periapically healed.
A single operator performed endodontic microsurgery interventions between 2008 and 2018 on teeth with refractory apical periodontitis. The present analysis selected the teeth classified as “complete periapical healing” according to the scale suggested by Molven. The postoperative periapical radiographs and those taken at the last recall visit were analysed by two independent calibrated examiners, who measured crown height and root length in a blind manner. The crown-to-root ratio was calculated as the ratio of the two variables. The level of inter- and intra-operator agreement was tested with Bland–Altman plots with 95% limits of agreement. An independent statistician conducted a survival analysis using Kaplan–Meier plots and a log-rank test (α = 0.05) to assess the significance of the differences among the subgroups defined by the following criteria: (a) crown height <median vs. >median; (b) root length <median vs. >median; (c) crown-to-root ratio <1 vs. >1; (d) crown-to-root ratio <median vs. >median; (e) single-rooted teeth vs. multi-rooted teeth.
At the end of the analysis, 42 patients were evaluated, each one contributing to the study with a single tooth. The mean follow-up period was 4.2 ± 2.4 years. Survival estimates were significantly improved for the teeth with roots longer than 8 mm, in comparison with that with shorter roots (p < 0.05). There were no statistically significant differences among the remaining considered subgroups.
Under the conditions of this retrospective study, teeth with longer residual roots after apical surgery exhibited better chances of survival when compared to teeth with roots shorter than 8 mm. The other considered variables did not seem to affect the survival of apically resected teeth.
The purpose of this study was to determine and evaluate the apical preparation size resulting from different pecking times to the working length (WL) with five different file systems.
Fifty standard simulated endodontic J-shaped blocks were instrumented using ProTaper NEXT (PTN), WaveOne (WO), WaveOne Gold (WOG), OneShape (OS) and the Self-Adjusting File (SAF) (n = 10) with different pecking times (1, 2 and 4) to the WL. For the SAF group, instrumentation was done till WL according to the time, i.e. 1, 3 and 4 min. On completion of each stage, silicone impression material was used to take canal impressions for comparison and evaluation of the apical size preparation, using a stereomicroscope. Two-way analysis of variance was applied to determine differences between groups and pecking times.
After four pecking times, a significant increase was observed in the apical diameter of four test groups compared to SAF (P < 0.05), which was not associated with increased apical preparation at all times.
A greater apical enlargement occurs with increasing pecking times; however, SAF instrumentation exhibits the minimum changes in the apical preparation after 1, 3 and 4 min. WO, WOG and OS are able to prepare the apical size similar to their tip at a single peck to the WL.
When an extraction is necessary, it is possible to choose a donor tooth and transplant it into the site of the previous extraction. Aim of the present article is to present a series of cases of tooth autotransplantation to demonstrate how it is possible to preserve natural teeth and avoid or delay implant therapy.
In the 3 cases presented the donor site was initially selected and the compatibility of the roots was evaluated. Then the compromised tooth was atraumatically extracted and the donor tooth was replanted in the receiving site; after 2 weeks the sutures were removed and 2 or 3 months later root canal therapy was performed. The results show medium/long-term success with controls from 4 to 12 years without any primary or secondary complication.
Tooth autotransplantation allowed to completely restore the original functional and morphological condition of patient. Even if implantology is the most common therapy for replacing missing teeth, tooth autotransplantation should be considered as the elective treatment if a donor tooth is available.
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