Ajay Logani

Efficacy of Revascularization to Induce Apexification/Apexogensis in Infected, Nonvital, Immature Teeth: A Pilot Clinical Study

Endodontic treatment options for immature, nonvital teeth conventionally include surgical endodontics, apexification with calcium hydroxide, or single visit mineral trioxide aggregate plug. A new treatment option of revascularization has recently been introduced. It involves disinfecting the root canal system, providing a matrix of blood clot into which cells could grow, and sealing of the coronal access. The present pilot clinical study was undertaken to evaluate the efficacy of revascularization in 14 cases of infected, immature teeth. Endodontic treatment was initiated, and after infection control, revascularization was performed. The access cavity was sealed with glass ionomer cement. The cases were followed up at regular intervals of 3 months; the range in follow-up was 0.5-3.5 years. The outcomes were as follows. Radiographic resolution of periradicular radiolucencies was judged to be good to excellent in 93% (13 of 14) of the cases. In the majority of cases, a narrowing of the wide apical opening was evident. In 3 cases, thickening of apical dentinal walls and increased root length were observed. The striking finding was complete resolution of clinical signs and symptoms and appreciable healing of periapical lesions in 78% (11 of 14) of cases. Thickening of lateral dentinal walls was evident in 57% (8/14) of cases, and increased root length was observed in 71% (10/14) of cases. None of the cases presented with pain, reinfection, or radiographic enlargement of preexisting apical pathology. This pilot study documented a favorable outcome of revascularization procedures conducted in immature nonvital, infected permanent teeth.

Revascularization with and without Platelet-rich Plasma in Nonvital, Immature, Anterior Teeth: A Pilot Clinical Study

INTRODUCTION This study was conducted to evaluate and compare maturogenesis induced by revascularization with and without platelet-rich plasma (PRP). METHODS Twenty patients with nonvital, immature anterior teeth were randomly categorized into 2 groups. Subsequent to chemomechanical preparation, revascularization with and without PRP carried on a collagen sponge was induced in groups 1 and 2, respectively. The cases were followed up clinically and radiographically at 6- and 12-month intervals. RESULTS Clinically, all cases were asymptomatic with complete resolution of signs and symptoms. Radiographically, there was a marked difference in periapical healing, apical closure, and dentinal wall thickening in group 2 in comparison with group 1. However, root lengthening was comparable for both of the procedures. CONCLUSIONS Revascularization is a conservative and an effective method for inducing maturogenesis in nonvital, immature teeth. Supplementations with PRP can potentially improve the desired biological outcome of this regenerative technique.

RETRACTED: The Evaluation of Computed Tomography Scans and Ultrasounds in the Differential Diagnosis of Periapical Lesions

Traditionally, the definitive diagnosis of periapical lesion depends on histopathological examination of the tissues, which is impractical in cases planned for nonsurgical treatment. Recently, some authors have used ultrasound with power Doppler and computed tomography in differential diagnosis between a cyst and a granuloma. The aim of this study was to evaluate and compare the use of computed tomography (CT) scan and ultrasound with power Doppler flowmetry in differential diagnosis of periapical lesions. Twelve periapical lesions were imaged with the help of CT scans and ultrasound with color-power Doppler flowmetry. A provisional preoperative diagnosis was made based on history, clinical presentation, and radiographic features. The cases were treated by surgical endodontics. In all 12 cases, the diagnosis with CT scan and ultrasound coincided with the histopathological diagnosis of the lesions. It is proposed that CT scans and ultrasound with power Doppler flowmetry can provide an additional dignostic tool without invasive surgery, where treatment option is nonsurgical.

Endodontic Management of a Maxillary First Molar with Two Palatal Canals with the Aid of Spiral Computed Tomography: A Case Report

This case report presents the endodontic management of a maxillary first molar with 2 palatal canals with separate orifices and apical foramen. The diagnosis was confirmed with the help of spiral computed tomography. This article discusses the variations in the canal morphology and the use of latest adjuncts in successfully diagnosing and negotiating them.

Comparative evaluation of rotary ProTaper, Profile, and conventional stepback technique on reduction in Enterococcus faecalis colony-forming units and vertical root fracture resistance of root canals.

OBJECTIVE The purpose of this in vitro study was to evaluate the effect of various root canal instrumentation techniques with different instrument tapers on cleaning efficacy and resultant vertical root fracture (VRF) strength of the roots. STUDY DESIGN Fifty human mandibular first premolar roots were enlarged to ISO size 20, inoculated with Enterococcus faecalis [ATCC2912] for 72 hours and divided into 5 groups: group I: prepared with .02 taper hand instruments ISO size 40; group II: Profile .04 taper size 40; group III: Profile .06 taper size 40; group IV: ProTaper size F4; and group V (control group) further divided into: Va: with bacterial inoculation and no mechanical instrumentation; and Group Vb: neither bacterial inoculation nor mechanical instrumentation. Cleaning efficacy was evaluated in terms of reduction of colony forming units (CFUs). The VRF strength was evaluated using D11 spreader as wedge in an Instron testing machine. RESULTS Root canals instrumented with ProTaper and 6% Profile instruments showed maximum reduction in CFUs, with statistically insignificant difference between them. The VRF resistance decreased in all instrumented groups. The difference of VRF between 2% and 4% taper Profile groups was statistically insignificant (P = .195). One-way analysis of variance showed that canals instrumented with ProTaper F4 showed maximum reduction in VRF resistance compared with control uninstrumented group. CONCLUSIONS Profile 6% taper instruments offer the advantage of maximum debridement without significant reduction in root fracture resistance.

Recent advances in imaging technologies in dentistry

Dentistry has witnessed tremendous advances in all its branches over the past three decades. With these advances, the need for more precise diagnostic tools, specially imaging methods, have become mandatory. From the simple intra-oral periapical X-rays, advanced imaging techniques like computed tomography, cone beam computed tomography, magnetic resonance imaging and ultrasound have also found place in modern dentistry. Changing from analogue to digital radiography has not only made the process simpler and faster but also made image storage, manipulation (brightness/contrast, image cropping, etc.) and retrieval easier. The three-dimensional imaging has made the complex cranio-facial structures more accessible for examination and early and accurate diagnosis of deep seated lesions. This paper is to review current advances in imaging technology and their uses in different disciplines of dentistry.

Comparative outcome of revascularization in bilateral, non-vital, immature maxillary anterior teeth supplemented with or without platelet rich plasma: A case series

Loss of pulp vitality in an immature permanent tooth arrests root development. This leads to tooth with open apex and weak lateral dentinal walls. Management of such necrotic teeth with immature roots poses several treatment challenges. The documented study was performed to evaluate and compare apexogenesis induced by revascularization, with and without platelet rich plasma (PRP) in non-vital, immature anterior teeth. Three patients having bilateral, non-vital, immature maxillary central incisors with apical periodontitis were recruited after institutional ethical clearance. Subsequent to chemo-mechanical preparation, revascularization with and without PRP was randomly induced in either of the tooth. The cases were followed-up clinically and radiographically at 6 and 12 months. There was a marked difference in periapical healing, apical closure and dentinal wall thickening of teeth treated by revascularization with PRP.

Apically extruded debris with three contemporary Ni-Ti instrumentation systems: An ex vivo comparative study

AIM To comparatively evaluate the amount of apically extruded debris when ProTaper hand, ProTaper rotary and ProFile systems were used for the instrumentation of root canals. MATERIALS AND METHODS Thirty minimally curved, mature, human mandibular premolars with single canals were randomly divided into three groups of ten teeth each. Each group was instrumented using one of the three instrumentation systems: ProTaper hand, ProTaper rotary and ProFile. Five milliliters of sterile water were used as an irrigant. Debris extruded was collected in preweighed polyethylene vials and the extruded irrigant was evaporated. The weight of the dry extruded debris was established by comparing the pre- and postinstrumentation weight of polyethylene vials for each group. STATISTICAL ANALYSIS The Kruskal-Wallis nonparametric test and Mann-Whitney U test were applied to determine if significant differences existed among the groups ( P< 0.05). RESULTS All instruments tested produced a measurable amount of debris. No statistically significant difference was observed between ProTaper hand and ProFile system ( P > 0.05). Although ProTaper rotary extruded a relatively higher amount of debris, no statistically significant difference was observed between this type and the ProTaper hand instruments ( P > 0.05). The ProTaper rotary extruded significantly more amount of debris compared to the ProFile system ( P< 0.05). CONCLUSION Within the limitations of this study, it can be concluded that all instruments tested produced apical extrusion of debris. The ProTaper rotary extruded a significantly higher amount of debris than the ProFile.

SealBio: A novel, non-obturation endodontic treatment based on concept of regeneration.

Introduction: “SealBio”, an innovative, non-surgical endodontic treatment protocol, based on “regenerative concept” has been developed to manage pulp and periapically involved teeth. Materials and Methods: Subsequent to Institutes ethical clearance, 18 patients presenting with signs and symptoms of pulp and periapical disease were included in the study. (11/M, 7/F; Mean age - 44.7 years; range 15-76 years). The protocol included a modified cleaning and shaping technique involving apical clearing and foramen widening, combined with inducing bleeding and clot formation in the apical region. Calcium-sulphate based cement was condensed with hand pluggers into the canal orifices. An appropriate permanent restoration was given. The patients were followed-up clinically and radiographically at regular interval of 6 months. Six teeth in 3 patients were also evaluated pre and post treatment CBCT at 6-months. Results: The novel treatment protocol was found to be favourable in resolving periapical infection, both clinically and radiographically. Conclusions: This innovative endodontic treatment protocol highlights and reiterates the importance of cleaning and shaping and puts forth the possible role of stem cells and growth factors in healing after non-surgical endodontic therapy.

Complicated crown fractures – management and treatment options

AIM Complicated crown fractures involve enamel, dentine and the pulp. The incidence of complicated crown fractures ranges from 2% to 13% of all dental injuries and the most commonly involved tooth is the maxillary central incisor. Various treatment modalities are available depending upon the clinical, physiological and radiographic status of the involved tooth. The aim of this article was to discuss techniques for the management of complicated crown fractures. SUMMARY Management of complicated crown fractures depends upon several factors with the result that various clinical modalities have been suggested. Seven case reports of complicated crown fractures are presented and risks/benefits of the treatment plans are discussed. KEY LEARNING POINTS Proper diagnosis, treatment planning and follow-up care are important factors in the prognosis of complicated crown fractures. Thorough understanding of the available treatment modalities and their specific indications is critical. The risks and benefits of each treatment option should be carefully evaluated during the treatment planning process.