Concept: Endodontic therapy
The requirement for immediate vascularization of engineered dental pulp poses a major hurdle towards successful implementation of pulp regeneration as an effective therapeutic strategy for root canal therapy, especially in adult teeth. Here, we demonstrate a novel strategy to engineer pre-vascularized, cell-laden hydrogel pulp-like tissue constructs in full-length root canals for dental pulp regeneration. We utilized gelatin methacryloyl (GelMA) hydrogels with tunable physical and mechanical properties to determine the microenvironmental conditions (microstructure, degradation, swelling and elastic modulus) that enhanced viability, spreading and proliferation of encapsulated odontoblast-like cells (OD21), and the formation of endothelial monolayers by endothelial colony forming cells (ECFCs). GelMA hydrogels with higher polymer concentration (15% w/v) and stiffness enhanced OD21 cell viability, spreading and proliferation, as well as endothelial cell spreading and monolayer formation. We then fabricated pre-vascularized, full-length, dental pulp-like tissue constructs by dispensing OD21 cell-laden GelMA hydrogel prepolymer in root canals of extracted teeth and fabricating 500 µm channels throughout the root canals. ECFCs seeded into the microchannels successfully formed monolayers and underwent angiogenic sprouting within 7 days in culture. In summary, the proposed approach is a simple and effective strategy for engineering of pre-vascularized dental pulp constructs offering potentially beneficial translational outcomes.
BACKGROUND: Shape of the dental root canal is highly patient specific. Automated identification methods of themedial line of dental root canals and the reproduction of their 3D shape can be beneficial forplanning endodontic interventions as severely curved root canals or multi-rooted teeth may posetreatment challenges. Accurate shape information of the root canals may also be used bymanufacturers of endodontic instruments in order to make more efficient clinical tools. METHOD: Novel image processing procedures dedicated to the automated detection of the medial axis of theroot canal from dental micro-CT and cone-beam CT records are developed. For micro-CT, the 3Dmodel of the root canal is built up from several hundred parallel cross sections, using imageenhancement, histogram based fuzzy c-means clustering, center point detection in the segmentedslice, three dimensional inner surface reconstruction, and potential field driven curve skeletonextraction in three dimensions. Cone-beam CT records are processed with image enhancement filtersand fuzzy chain based regional segmentation, followed by the reconstruction of the root canalsurface and detecting its skeleton via a mesh contraction algorithm. RESULTS: The proposed medial line identification and root canal detection algorithms are validated on clinicaldata sets. 25 micro-CT and 36 cone-beam-CT records are used in the validation procedure. Theoverall success rate of the automatic dental root canal identification was about 92% in bothprocedures. The algorithms proved to be accurate enough for endodontic therapy planning. CONCLUSIONS: Accurate medial line identification and shape detection algorithms of dental root canal have beendeveloped. Different procedures are defined for micro-CT and cone-beam CT records. Theautomated execution of the subsequent processing steps allows easy application of the algorithms inthe dental care. The output data of the image processing procedures is suitable for mathematicalmodeling of the central line. The proposed methods can help automate the preparation and design ofseveral kinds of endodontic interventions.
BACKGROUND: Recent studies reported on the very complex morphology of the pulp system in equine cheek teeth. The continuous production of secondary dentine leads to distinct age-related changes of the endodontic cavity. Detailed anatomical knowledge of the dental cavities in all ages is required to explain the aetiopathology of typical equine endodontic diseases. Furthermore, data on mandibular and maxillary pulp systems is in high demand to provide a basis for the development of endodontic therapies. However, until now examination of the pulp cavity has been based on either sectioned teeth or clinical computed tomography. More precise results were expected by using micro-computed tomography with a resolution of about 0.1 mm and three-dimensional reconstructions based on previous greyscale analyses and histological verification. The aim of the present study was to describe the physiological configurations of the pulp system within a wide spectrum of tooth ages. RESULTS: Maxillary teeth: All morphological constituents of the endodontic cavity were present in teeth between 4 and 16 years: Triadan 06s displayed six pulp horns and five root canals, Triadan 07-10s five pulp horns and four root canals and Triadan 11s seven pulp horns and four to six root canals. A common pulp chamber was most frequent in teeth <=5 years, but was found even in a tooth of 9 years. A large variety of pulp configurations was observed within 2.5 and 16 years post eruption, but most commonly a separation into mesial and distal pulp compartments was seen. Maxillary cheek teeth showed up to four separate pulp compartments but the frequency of two, three and four pulp compartments was not related to tooth age (P > 0.05). In Triadan 06s, pulp horn 6 was always connected to pulp horns 1 and 3 and root canal I. In Triadan 11s, pulp horns 7 and 8 were present in variable constitutions. Mandibular teeth: A common pulp chamber was present in teeth up to 15 years, but most commonly seen in teeth <=5 years. A segmented pulp system was found in 72% of the investigated teeth. Segmentation into separate mesial and distal pulp compartments was most commonly present. Pulp horn 4 coalesced either with the mesial pulp horns 1 and 3 or with the distal pulp horns 2 and 5. CONCLUSIONS: Details of the pulpar anatomy of equine cheek teeth are provided, supporting the continuous advancement in endodontic therapy. Numerous individual configurations of the pulp system were obtained in maxillary cheek teeth, but much less variability was seen in mandibular cheek teeth.
Root canal therapy (RCT) represents a standard of treatment that addresses infected pulp tissue in teeth and protects against future infection. RCT involves removing dental pulp comprised of blood vessels and nerve tissue, decontaminating residually-infected tissue through biomechanical instrumentation, and root canal obturation using a filler material to replace the space that was previously comprised of dental pulp. Gutta percha (GP) is typically used as the filler material as it is malleable, inert, and biocompatible. While filling the root canal space with GP is the standard of care for endodontic therapies, it has exhibited limitations including leakage, root canal reinfection, and poor mechanical properties. To address these challenges, clinicians have explored the use of alternative root filling materials other than GP. Among the classes of materials that are being explored as novel endodontic therapy platforms, nanodiamonds (NDs) may offer unique advantages due to their favorable properties, particularly for dental applications. These include versatile faceted surface chemistry, biocompatibility, and their role in improving mechanical properties, among others. This study developed a ND-embedded GP (NDGP) that was functionalized with amoxicillin, a broad-spectrum antibiotic commonly used for endodontic infection. Comprehensive materials characterization confirmed improved mechanical properties of NDGP over unmodified GP. In addition, digital radiography and micro-computed tomography imaging demonstrated that obturation of root canals with NDGP could be achieved using clinically-relevant techniques. Furthermore, bacterial growth inhibition assays confirmed drug functionality of NDGP functionalized with amoxicillin. This study demonstrates a promising path towards NDGP implementation in future endodontic therapy for improved treatment outcomes.
Aim The aim of this retrospective study was to examine the outcome of patients referred to a dedicated clinic for dental extractions while they were prescribed either oral or intra-venous (IV) bisphosphonates (BPs). The following parameters were assessed: mode of BP administration, indication for BP prescription, incidence of BRONJ, concomitant risk factors for development of bisphosphonate-related osteonecrosis of the jaws (BRONJ) and demographic details.Material and methods The clinical records of 225 patients who underwent dental extraction while receiving oral or intravenous bisphosphonates were reviewed. Their clinical outcome, specifically the development of BRONJ was determined.Results Of the 225 patients, 202 were prescribed oral and 23 IV BPs. 34.8% (8/23) of patients prescribed IV BPs developed BRONJ following dental extraction, which was a significantly (p <0.001) higher proportion than that of the oral BP group, which was 2.5% (5/202 patients). 12.3% (8/65) patients taking BPs with steroids were at a significantly increased risk of a BRONJ (p <0.003). 12.3% (7/57) males developed a BRONJ compared with 3.6% (6/168) females where p = 0.015. All of the patients who developed a BRONJ as a result of oral BP prescription had been taking this medication for three years or more.Conclusion In our patient cohort the risk of developing a BRONJ following dental extractions was greatest in those patients receiving IV BPs and those on oral BPs with concomitant steroid medication.
To describe a technique for the placement of apical Mineral trioxide aggregate (MTA) plugs in canals with wide apices.
To investigate the cytotoxicity of BioAggregate and iRoot BP Plus root canal sealer (iRoot BP Plus) to human dental pulp cells (hDPCs) and their effect on proliferation and mineralization of hDPCs and to compare their performance with that of mineral trioxide aggregate (MTA).
External cervical resorption is the loss of dental hard tissue as a result of odontoclastic action; it usually begins on the cervical region of the root surface of the teeth. This case report demonstrates an external cervical resorption in a maxillary central incisor of a 24-year-old male patient. After surgical intervention and root canal treatment, the resorption was subsequently sealed with mineral trioxide aggregate. The 18 months follow-up demonstrates no pathological changes on clinical and radiographic examination. This case report presents a treatment strategy that might improve the healing outcomes for patients with external cervical resorption.
The retreatability of recent calcium silicate or mineral trioxide aggregate (MTA) sealers has not yet been assessed. The aim of this study was to evaluate the removal of 2 MTA-based sealers (MTA Fillapex [Angelus Soluções Odontológicas, Londrina, PR, Brazil] and MTA Plus [Prevest-Denpro, Jammu City, India]) using a rotary retreatment system, considering an epoxy resin sealer (AH Plus [Dentsply Maillefer, Ballaigues, Switzerland]) as the standard for comparison.
AIM: (i) To assess the impact of primary root canal treatment on the perceived quality of life amongst a cohort of Jordanian patients, (ii) to assess this cohort’s satisfaction of their primary root canal treatment, and (iii) to evaluate the association of the level of training and experience of clinicians with these two parameters. METHODOLOGY: A systematic random sample of 302 subjects was selected from patients who attended undergraduate, graduate and specialty clinics of Jordan University of Science and Technology. Participants were interviewed before and two weeks after completion of root canal treatment. The study instrument included the Oral Health Impact Profile questionnaire (Dugas et al. 2002) and seven semantic differential scales. Data analyses included descriptive statistics and nonparametric analyses. RESULTS: More than 90% of subjects reported improvements in the sense of taste, pain, eating, altering food temperature, self-consciousness, waking up during sleep, interruption of meals, difficulty to relax and difficulty to sleep after root canal treatment. There was no significant difference in terms of improvement amongst patients treated by specialists, graduate students or undergraduate students. The overall semantic differential score of intraoperative pain, pleasantness, chewing ability and general satisfaction was about 8. Satisfaction of root canal treatment by specialists was higher in terms of time involved, intraoperative pain, pleasantness and general satisfaction than those treatments by undergraduate students. Patients treated by specialist were least satisfied with the treatment cost compared to those patients treated by graduate or undergraduate students. CONCLUSIONS: The impact of root canal treatment on the quality of life was apparent. Satisfaction with root canal treatment approximates 8 on the semantic differential scale with preference for specialists over dental students.