Faculty Bibliography

INTRODUCTION: Regenerative endodontic therapy is currently used to treat immature permanent teeth with necrotic pulp and/or apical periodontitis. However, mature teeth with necrotic pulp and apical periodontitis have also been treated using regenerative endodontic therapy. The treatment resulted in resolution of apical periodontitis, regression of clinical signs and symptoms but no apparent thickening of the canal walls, and/or continued root development. A recent study in an animal model showed that the tissues formed in the canals of mature teeth with apical periodontitis after regenerative endodontic therapy were cementumlike, bonelike, and periodontal ligament-like tissue with numerous blood vessels. These tissues are similar to the tissues observed in immature permanent teeth with apical periodontitis after regenerative endodontic therapy. METHODS: A 23-year-old woman had a history of traumatic injury to her upper anterior teeth when she was 8 years old. Subsequently, #8 developed pulp necrosis and an acute apical abscess and #7 symptomatic apical periodontitis. The apex of #8 was slightly open, and the apex of #7 was completely formed. Instead of nonsurgical root canal therapy, regenerative endodontic therapy was attempted, including complete chemomechanical debridement on #8 and #7. This was based on the premise that filling of disinfected root canals with the host's biological vital tissue might be better than filling with foreign materials. RESULTS: After regenerative endodontic therapy of #8 and #7, there was radiographic evidence of periapical osseous healing and regression of clinical signs and symptoms. The pulp cavity of #8 decreased in size, and the apex closed. The pulp cavity of #7 appeared to be obliterated by mineralized tissue. These indicated ingrowth of new vital tissue into the chemomechanically debrided canals. CONCLUSIONS: Regenerative endodontic therapy of mature teeth with apical periodontitis and apical abscess can result in the regression of clinical signs and/or symptoms and healing of apical periodontitis but no apparent thickening of the canal walls or continued root development. Filling of the disinfected canals with the host's vital tissue may be better than with foreign materials because vital tissue has innate and adaptive immune defense mechanisms.

OBJECTIVES: The aim of the study was to measure the percentage of volume of voids and gaps in the apical third of root canals obturated with two techniques using micro-computed tomography. MATERIALS AND METHODS: Fifty-four single-rooted teeth were collected and root canal-prepared. The roots were randomly allocated into two groups; each group was obturated by using thermoplasticized technique with a different material (gutta-percha and Topseal for Thermafil, Resilon and RealSeal for RealSeal 1). Roots were then scanned, and volume measurements for voids and gaps in the obturated roots were carried out using specialized CT software. Percentage of gaps and voids was calculated. RESULTS: The present study showed that none of the root canal-filled teeth was gap free. Student t test was conducted. No significant difference was found between Thermafil and RealSeal 1 concerning percentage of voids in the apical third (P > 0.05). Both materials showed statistically significant difference between the levels where 1 mm showed the highest volume of voids (P < 0.05). CONCLUSIONS: Both carrier-based techniques allowed a good sealing ability in root canals but none of the materials was gap free. Statistically significant difference between the levels was found and 1 mm showed the highest volume of voids. CLINICAL RELEVANCE: This study shows the efficiency of carrier-based obturation systems in filling root canals hermetically. It compares new adhesive endodontic materials with the traditional gold standard gutta-percha. Results show the good sealing ability of both techniques making them appropriate to use in daily endodontic obturations.

Despite efforts in reducing the number of dental traumas, most current studies indicate that the incidence of dental trauma remains unchanged and is at a relatively high level for children and young adults. When reviewing the literature on prevention, it is clear that until now the main focus has been on making and promoting mouthguards. The majority of the published studies on mouthguards have focused on materials used and how those behave and protect in vitro. The few epidemiologic studies that have been published on the possible protectiveness of the mouthguards in vivo are mostly of low level of evidence, and even those studies do not all agree on how much they actually protect the dentition. To compound the problem is the fact that the proportional ratio of dental trauma in organized sports is low compared with injuries that occur during children's play or leisure activities. It could be argued that the best strategic measure for preventing dental and oral injuries is education on both how to avoid them and what to do if an injury occurs. The demand of evidence-based dentistry and medicine calls for large prospective studies with randomized intervention to investigate the actual protection of mouthguards and faceguards. In addition, more emphasis should be placed on which is the best and most constructive way to educate youngsters and teenagers on how to avoid traumatic injuries to their teeth by using contemporary means like the Internet and apps.

Despite efforts in reducing the number of dental traumas, most current studies indicate that the incidence of dental trauma remains unchanged and is at a relatively high level for children and young adults. When reviewing the literature on prevention, it is clear that until now the main focus has been on making and promoting mouthguards. The majority of the published studies on mouthguards have focused on materials used and how those behave and protect in vitro. The few epidemiologic studies that have been published on the possible protectiveness of the mouthguards in vivo are mostly of low level of evidence, and even those studies do not all agree on how much they actually protect the dentition. To compound the problem is the fact that the proportional ratio of dental trauma in organized sports is low compared with injuries that occur during children's play or leisure activities. It could be argued that the best strategic measure for preventing dental and oral injuries is education on both how to avoid them and what to do if an injury occurs. The demand of evidence-based dentistry and medicine calls for large prospective studies with randomized intervention to investigate the actual protection of mouthguards and faceguards. In addition, more emphasis should be placed on which is the best and most constructive way to educate youngsters and teenagers on how to avoid traumatic injuries to their teeth by using contemporary means like the Internet and apps.

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of avulsed permanent teeth.

There is no greater treatment challenge for the dental practitioner than the scenario resulting when an immature permanent anterior tooth in a young and growing child becomes ankylosed following traumatic injury. In such cases the clinician has few good treatment options because there is no known therapy to reverse ankylosis. At the some time, without treatment the ankylosed tooth poses both developmental and esthetic problems because it will not erupt further nor will it allow the alveolar bone to grow and develop and follow the eruption of adjacent teeth. This review article will present the most commonly recommended treatment options for this clinical challenge. Of the possible options, a decoronation procedure offers one of the best and most predictable clinical outcomes. This procedure involves the removal of the crown of on ankylosed tooth, leaving the root in its alveolar socket in situ. It has been shown that performing this procedure at the appropriate time allows for the facio-palatal width of the alveolus to be maintained for years, while allowing additional vertical growth of the alveolus. The long-term goal of this procedure is allow for the placement of an implant after growth completion in such a manner that the esthetic outcome is maximized, while allowing for an implant placement procedure that is both easier and more predictable.

Traumatic dental and maxillofacial injuries are common occurrences, and affect worldwide approximately 20% to 30% of permanent dentition, often with serious aesthetic, functional, psychological, and economic consequences. With such a high frequency of injuries, prevention becomes a primary goal. A prevention approach relies on the identification of etiologic factors, and on giving rise to measures aimed at avoiding those factors or at reducing their impact. This article reviews the etiology and preventive strategy regarding dental injuries, and examines the role and manufacture of appliances, especially mouthguards, in preventive dentistry.