Hayriye Sönmez

Concentrated platelet-rich plasma used in root canal revascularization: 2 case reports.

AIM To present two case reports describing the treatment of immature teeth with necrotic pulps using concentrated platelet-rich plasma (cPRP) with 12-month clinical and radiographic follow-up. SUMMARY Root canal revascularization was performed on immature permanent teeth clinically and radiographically diagnosed as requiring root canal treatment. Following disinfection of the canal space with triple antibiotic paste (1 : 1 : 1: ciprofloxacin, metronidazole and cefaclor), a tissue scaffold was created with cPRP prepared using 2-step centrifugation. The final restoration was completed with white mineral trioxide aggregate and composite resin. The patients were recalled for clinical and radiographic evaluations every 3 months. At the 12-month follow-up apical closure by narrowing of the apical foramen and convergence of the apical walls in the treated teeth was observed.

Efficacy of Platelet-rich Plasma as a Scaffold in Regenerative Endodontic Treatment

INTRODUCTION Current research is concerned with discovering better scaffolds for use in regenerative endodontic treatment. This study aimed to clinically and radiographically evaluate the efficacy of platelet-rich plasma (PRP) used as a scaffold in regenerative endodontic treatment and compare it with that of a conventional blood clot (BC) scaffold. METHODS A total of 20 necrotic, single-rooted immature teeth were randomly distributed into 2 groups. After disinfecting the root canal space with triple antibiotic paste (1:1:1 ciprofloxacin, metronidazole, and cefaclor), a tissue scaffold was created by using either PRP or BC and covered with white mineral trioxide aggregate. Clinical and radiographic follow-up examinations were performed once every 3 months during an 18-month period. Differences in root area were calculated from preoperative and postoperative radiographs. Fisher exact and Mann-Whitney U tests were used to evaluate differences between groups, with P value <.05 considered to be statistically significant. RESULTS All 20 teeth were clinically asymptomatic during 18-month follow-up period; however, 1 tooth in the BC group exhibited periapical pathosis and was judged radiographically unsuccessful. Complete apical closure was observed in a mean of 8.1 months in the PRP group compared with 9 months in the BC group. The PRP group exhibited 9.86% increase in root area, compared with 12.6% increase in the BC group. The difference in success rates between the groups was not statistically significant (P > .05). CONCLUSIONS PRP successfully created a scaffold for regenerative endodontic treatment; however, treatment outcomes did not differ significantly between PRP and conventional BC scaffold.

The relationship between sports activities and permanent incisor crown fractures in a group of school children aged 7-9 and 11-13 in Ankara, Turkey

The objective of the study was to determine the distribution, aetiology of the crown fractures of permanent anterior teeth in children aged 7-9 and 11-13 years and to identify the role of participation in sports associated with crown fractures. The study population comprised 2570 students from 10 primary schools randomly selected from five municipalities in Ankara, Turkey. Two paediatric dentists examined all permanent maxillary and mandibular incisors for evidence of fracture and completed a standardized examination form to obtain information on the age, gender, severity of incisor injury and frequency and type of sports participation for each child, as well as whether or not children used mouthguards during sports activities. Chi-square and z-tests were used to determine differences. A total of 191 (7.43%) of the 2570 subjects examined were affected by dental trauma. The proportion of fractured incisors was significantly higher in males than in females among older children (P < 0.01). Out of a total of 222 fractured teeth, 84% involved the maxillary central incisors. Bicycling caused significantly higher rates of crown fractures than other types of sports (P < 0.05). The percentage of incisal fractures caused by sports-related accidents was 14.14%. The number of children interested in sports is high, and the sports chosen are generally contact sports. The high rate (14.14%) of crown injuries caused by sports activities supports these findings.

Knowledge level of primary school teachers regarding traumatic dental injuries and their emergency management before and after receiving an informative leaflet

AIM The aim of this study was to evaluate via a questionnaire the knowledge level of primary school teachers in Ankara, Turkey, regarding dental trauma; to inform them on the subject through a leaflet; and to evaluate the effectiveness of the leaflet by reapplying the questionnaire. MATERIALS AND METHODS A questionnaire was distributed to 500 teachers in seven randomly selected primary schools. The questionnaire consisted of four different scenarios presented with photographs and a total of eight questions on crown fracture, lateral luxation, root fracture, and avulsion. After responding to the questionnaire, teachers were given a leaflet containing information about traumatic dental injuries and their emergency management. After 1 month, the same questionnaire was distributed, and the responses collected. RESULTS A total of 450 of 500 teachers responded to the questionnaire. Initial responses indicated the knowledge level of teachers to be quite low. Following the distribution of the information leaflet, the rate of correct answers increased for each of the individual questions, and the total scores for the questionnaire increased significantly (P = 0.0001). CONCLUSION There is a clear need to inform teachers about traumatic dental injuries. The use of educational leaflets can be a successful and appropriate means of providing teachers with information.

Treatment of aggressive external root resorption with calcium hydroxide medicaments: a case report

Intrusive luxation is an injury involving the axial displacement of a tooth into the alveolar socket. This paper describes apexification using calcium hydroxide medicaments of an immature permanent central incisor in which spontaneous re-eruption as well as severe inflammatory external root resorption was observed following traumatic intrusion. A 10-year-old boy was referred to the Department of Pediatric Dentistry 3 days after having fallen at school. Intraoral examination revealed intrusive luxation and an enamel-dentin crown fracture of the maxillary left central incisor (Tooth 21). The tooth was not sensitive to percussion and responded positively to electric pulp test. Radiographic examination indicated that the tooth had an open apex and had been intruded approximately 3-4 mm relative to the cemento-enamel junction of the adjacent right central incisor. The tooth was left for possible spontaneous re-eruption. The crown fracture was temporarily restored using glass ionomer cement, and the patient was scheduled for recall in 2 weeks, at which time intraoral examination revealed spontaneous re-eruption of the tooth. However, radiographic examination also showed inflammatory external root resorption. The root canal was accessed and filled with a calcium hydroxide paste; however, follow-up examination indicated continuing resorption after 1 month. Calcium hydroxide plus points (CHPP) was chosen as an alternative treatment. At the end of 6 months of CHPP treatment, examination showed no further progression of external resorption and complete apexification of the tooth. After a 24-month follow-up period, no signs of pathosis were observed.

Review of current concepts of revascularization/revitalization

This review focuses on the current concepts on revascularization/revitalization therapy. Revascularization/revitalization procedures performed under current protocols have reportedly achieved successful clinical and radiographical outcomes for immature permanent teeth with non-vital pulps; however, randomized prospective studies are needed to develop evidence-based methodologies for regenerative endodontic treatment.

Comparative evaluation of Ca(OH)2 plus points and Ca(OH)2 paste in apexification.

AIM  The aim of this study was to compare calcium hydroxide plus points (CHPPs) with the conventional calcium hydroxide paste (CHP) clinically and radiographically as materials used in apexification treatment. MATERIAL AND METHODS  Sixteen children, each with at least one necrotic permanent central incisor requiring apexification treatment, were selected for this study. Twenty-two selected teeth were divided into two test groups (10 CHP and 12 CHPP). The children were recalled for clinical evaluations every 3 weeks, and their radiographical evaluations were carried out every 3 months. Mann-Whitney U and Fishers exact tests were used to evaluate the differences between the groups. RESULTS  The follow-up evaluations revealed that the success rate was 100% for CHP and 92% for CHPP. No statistically significant difference between the groups was observed (P > 0.05). CONCLUSIONS  CHPP-treated central incisors requiring apexification demonstrated good success. CHPP can be used for cases in which traditional Ca(OH)(2) apexification is indicated as it has a similar outcome with CHP.

Orthodontic extrusion of a traumatically intruded permanent incisor: a case report with a 5-year follow up.

This report presents a case of intrusive luxation of the immature left maxillary central incisor in an 8-year-old girl. Initially, it was decided to allow the intruded tooth to spontaneous re-erupt because it had open apices. After 12 weeks of monitoring for spontaneous re-eruption, there was no clinical evidence of its occurrence. Therefore, orthodontic extrusion was initiated. The intruded tooth was repositioned with a fixed multibracketed appliance. Twenty weeks after the beginning of orthodontic extrusion, the position of the intruded maxillary central incisor was restored to its original position before its displacement occurred. After 5 years, no clinical or radiographic pathology was detected and obliteration of the pulp canal of the intruded tooth was observed radiographically.

Horizontal root fracture followed for 6 years.

Intra-alveolar root fractures in permanent teeth are uncommon injuries among dental traumas. Generally, the principles of treating horizontal root fractures of permanent teeth are repositioning and fixation. The present paper reports 6-years follow up of two horizontally root-fractured teeth that were healed with calcified tissue. Both of the teeth were clinically and radiographically symptomless and showed complete pulp canal obliterations.

Fluoride release from microporous poly(2-hydroxyethyl methacrylate) membranes

Fluoride ion is commonly used in the preventive treatment of tooth decay and when provided with extra fluoride, children living in regions that lack fluoride benefit from it. In the present study, the clinical properties of an intraoral controlled release fluoride delivery system were considered. Poly(2-hydroxyethyl methacrylate) (PHEMA) was examined as a fluoride carrier. Membranes were prepared by photopolymerization and then characterised. Contact angles and swelling ratios of fluoride-loaded membranes were determined. The surface morphology of the membranes were examined by using scanning electron microscopy. In vitro fluoride release studies were carried out in an artificial saliva medium. The concentration of fluoride was measured with a fluoride-specific electrode. The amount of released fluoride was determined and the effects of fluoride loading, medium pH and temperature on fluoride release were investigated. The swelling ratio of the PHEMA membrane was 58.5%, that of the fluoride-loaded PHEMA membrane was 17.8%. Increasing in the fluoride loading amount in the PHEMA membrane accelerated the fluoride release. The fluoride release ratio was increased with increasing pH and temperature.