Anastasia Agrafioti

Regenerative Endodontic Therapy: A Data Analysis of Clinical Protocols

INTRODUCTION The aim of the present study was to systematically analyze the protocols that have been used in regenerative endodontic therapy and to detect any variations in clinical procedures. METHODS An electronic search was executed in PubMed using appropriate Medical Subject Heading terms covering the period from January 1993 to May 2014. Additional publications from hand searching and the reference section of each relevant article enriched the article list. The relevance of each article was initially evaluated by scanning all titles and corresponding abstracts. The definite inclusion of each article in the study was determined by using specific criteria applied independently by 3 reviewers. RESULTS Sixty relevant publications were finally included. The canal walls were not mechanically instrumented in 68% of the clinical articles. Sodium hypochlorite was included in 97% of the clinical studies either as the only irrigant or in combination with other irrigants. Antibiotic combination paste was used as the intracanal medicament in 80% of the clinical articles. Sodium hypochlorite, chlorhexidine, and EDTA were used in the final irrigation protocol in 75%, 4%, and 13% of the clinical studies, respectively. Neither the creation of a blood clot nor the use of platelet-rich plasma/platelet-rich fibrin was described in 13% of the clinical articles. Mineral trioxide aggregate was used as an intracanal coronal barrier in 85% of the relevant clinical studies. CONCLUSIONS The variability of the clinical protocols applied during regenerative enododontic procedures is considerably high. A thorough analysis of regenerative protocols may constitute an additional source to provide useful clinical considerations for REPs.

Influence of dentin from the root canal walls and the pulp chamber floor on the pH of intracanal medicaments.

INTRODUCTION The objective of this study was to evaluate the alterations in the pH of calcium hydroxide (Ca[OH]2), 2% chlorhexidine (CHX) gel, and their combination after adding dentin powder from the root canal walls and the pulp chamber floor. METHODS Ca(OH)2 paste, 2% CHX gel, and their combination were examined. Dentin powder was obtained from the root canal walls and the pulp chamber floor of bovine teeth and added as 1.8% to the volume of the medications. The pH values of the mixtures were assessed immediately after preparation, after 24 hours, and on days 7 and 14. Data were analyzed statistically by analysis of variance and the Students t test (P = .05). RESULTS pH values of Ca(OH)2 were always above 12 in the presence or absence of dentin powder during the 14 days of the study. A significant decrease in pH values of Ca(OH)2 was observed after 14 days when dentin from the root canal wall was added (P < .001). The pH values of CHX gel were significantly increased by the presence of dentin (P = .001). The t test showed a significant difference in the increase of the pH values when the different dentin types were added (P = .002). The pH of the Ca(OH)2 and CHX gel combination was not influenced by dentin powder from the root canal walls, and a reduction was observed after 14 days, exactly like in the control group. The pH values of the combination did not alter after 14 days when pulp chamber floor dentin was added. CONCLUSIONS The different dentin types variably affect the pH of Ca(OH)2 paste, 2% CHX gel, and their combination in the studied periods.

A quantitative and diametral analysis of human dentinal tubules at pulp chamber ceiling and floor under scanning electron microscopy.

The purposes of this study are (i) to evaluate and compare the dentinal tubule density, tubule diameter and percentage area of dentin occupied by tubules at the pulp chamber ceiling and floor; and (ii) to evaluate the effects of age on the number and dimensions of tubule openings. Twelve intact, human mandibular third molars were recruited. Six teeth belonged to patients up to 30 years of age and six teeth belonged to patients over 50 years. Scanning electron microscopic evaluations were made at two different locations: the pulp chamber ceiling and floor. The pulp chamber ceiling presented higher tubule density (P < 0.0001) and greater percentage area of dentin occupied by tubule openings (P < 0.0001) compared to the pulp chamber floor. Also, younger age group had greater tubule diameter (P < 0.0001), higher tubule density (P < 0.0001) and greater percentage area of dentin occupied by tubule openings (P < 0.0001) compared to older age group. Pulp chamber ceiling presents higher tubule density and greater area of exposed tubules. In younger people, the pulp chamber floor presents considerably high tubule diameter. The number and dimensions of dentinal tubule openings significantly decrease with age.

Re-establishing apical patency after obturation with Gutta-percha and two novel calcium silicate-based sealers

Objective: Aim of the present study was to evaluate the retreatability and reestablishment of apical patency of two calcium silicate-based sealers, TotalFill BC Sealer (BCS) and mineral trioxide aggregate Fillapex (MTA F), versus AH Plus, when used in combination with Gutta-percha (GP). Materials and Methods: The canals of 54 single-rooted anterior teeth were instrumented and filled with GP/AH Plus (Group A), GP/MTA F (Group B), or GP/BCS (Group C) using continuous wave obturation technique. The groups were subdivided into subgroups with the master-GP cone placed to the working length (WL) or intentionally 2 mm short. The retreatment procedures were performed using ultrasonics, chloroform, rotary, and hand files. The ability to establish the patency and reach WL was determined as well as the time taken to reach WL was calculated in minutes. Furthermore, the samples were observed under a dental, optical microscope, after vertically splitting them. Results: The WL and patency were reestablished in 100% of specimens in all groups. The Mann–Whitney U-test indicated that there was a significant difference in the amount of time required to reach WL between the groups (P < 0.05) with group GP/BCS short of the WL showing the most amount of time to be retreated. Conclusion: The novel calcium silicate-based sealers are negotiable under simple root canal anatomy. However, the conventional retreatment techniques are not able to fully remove them.

Interaction of dental pulp stem cells with Biodentine and MTA after exposure to different environments.

ABSTRACT Objective: The aim of the present study was to evaluate and compare the cytotoxic effects of Biodentine and MTA on dental pulp stem cells (DPSCs) and to assess cell viability and adherence after material exposure to an acidic environment. Material and Methods: DPSCs were cultured either alone or in contact with either: Biodentine; MTA set for 1 hour; or MTA set for 24 hours. After 4 and 7 days, cell viability was measured using the MTT assay. Biodentine and MTA were also prepared and packed into standardized bovine dentin disks and divided into three groups according to the storage media (n=6/group): freshly mixed materials without storage medium (Group A); materials stored in saline (Group B); materials stored in citric acid buffered at pH 5.4 (Group C). After 24 hours, DPSCs were introduced in the wells and cell adherence, viability, and cellular morphology were observed via confocal microscopy after three days of culture. Cell viability was analyzed using repeated-measures analysis of variance test with Tukeys post hoc tests (α=0.05). Results: Biodentine expressed significantly higher cell viability compared with all other groups after 4 days, with no differences after 7 days. Notably, cell viability was significantly greater in 24-hour set MTA compared with 1-hour set MTA and control groups after 7 days. Material exposure to an acidic environment showed an increase in cell adherence and viability in both groups. Conclusions: Biodentine induced a significantly accelerated cell proliferation compared with MTA. Setting of these materials in the presence of citric acid enhanced DPSC viability and adherence.

Full-text publication rates of research abstracts presented at the European Society of Endodontology congresses in the last 20 years

AIM To evaluate the full-text publication rates of scientific research abstracts presented at the European Society of Endodontology (ESE) Congresses held between 1993 and 2013 (a total of 11 occasions) and to determine factors associated with the manuscripts. METHODOLOGY An electronic database search was conducted from January 2015 to December 2016 to identify full text English written publications of the research abstracts presented at the last 11 ESE Biennial Congresses from 1993 to 2013. For each occasion, research abstract information were retrieved from the International Endodontic Journal (IEJ) through the official website of the ESE and the following parameters for each abstract presentation were recorded: Year of presentation, first authors affiliation, geographic origin, and type of study. Following full-text article identification, additional information was recorded such as: Year and journal of publication, elapsed time until full publication and number of authors per presentation and publication. RESULTS A total of 1165 research abstracts were presented, of which 401 (34.4%) were finally published as full-length articles. Overall 235 articles (58.6%) were published either in the International Endodontic Journal (IEJ, 35.7%) or Journal of Endodontics (JOE, 22.9%). The mean time between abstract presentation and full-text publication was 18.95 months. Munich (2001) had the highest publication rate (44%) whereas Lisbon (2013) had the highest number of published articles (77). Turkey was the country with the highest number of published abstracts (56). However, the Netherlands was the country with the highest number of publications related to the number of presentations (21/26) (80.7%). Differences in authorship between presentation and full publication were found in 179 (44.6%) articles. CONCLUSIONS A substantial number of research abstracts presented at ESE congresses were not published in peer reviewed journals. Authors prefer to publish their research papers in international journals with high impact factor. This article is protected by copyright. All rights reserved.

Different Patterns of Restoration Provision Between Initial Endodontic Treatment and Retreatment: A Retrospective Clinical Study

PURPOSE The aim of this study was to investigate the relationship between type of endodontic treatment and choice of definitive restoration and to show the prevalence of endodontic treatment options according to patient age and type of tooth. MATERIALS AND METHODS Data were collected from the archive system of the School of Dentistry, National and Kapodistrian University of Athens in Athens, Greece. The sample included endodontically treated teeth being restored definitively at the time of data collection. RESULTS Statistically significant difference was found regarding the type of restoration between initial endodontic treatments and retreatments (P < .001). CONCLUSION Endodontic retreatment seemed to have a significant effect on the choice of definitive restoration of the tooth.

Primary Inadequate Management of Dental Trauma.

Tooth fractures are common complications due to trauma in the oral cavity. Tooth fragments and foreign bodies may be embedded in soft tissues as a result of dentofacial trauma and go unnoticed in emergency situations. The inadequate management of such cases may lead to complications, such as foreign-body reaction and scarring. This report describes two cases with dental fragments embedded in the lower lip, which went unnoticed until the patients presented later for completely different treatments and emphasizes the importance of clinical and radiographic examination of soft tissues, even in cases that present late for dental trauma management.

The Decision for Regenerative Endodontic Therapy

Regenerative endodontics is described as biologically based procedures designed to replace damaged structures, including dentin and root structures, as well as cells of the pulp-dentin complex, and is considered as an optimal approach for treating the immature permanent tooth with a necrotic pulp. Since the establishment of the foundations of regenerative endodontic therapy in 1960’s a plethora of relevant clinical cases and studies have been published. However, until now the case selection as well as the clinical protocol applied during regenerative endodontic therapy have not been totally determined and supported by clinical studies with high level of evidence. This review summarizes the current literature regarding the prognostic factors and clinical outcomes of regenerative endodontic therapy and the various applied clinical protocols in terms of administration of mechanical instrumentation, irrigation, intracanal medicaments, intracanal bleeding and intracanal coronal barrier. The aim of this review is to clarify and determine all the factors that willcontribute to the decision making for the application of regenerative endodontic therapy.