European Society of Endodontology position statement: Management of deep caries and the exposed pulp

This position statement on the management of deep caries and the exposed pulp represents the consensus of an expert committee, convened by the European Society of Endodontology (ESE). Preserving the pulp in a healthy state with sustained vitality, preventing apical periodontitis and developing minimally invasive biologically based therapies are key themes within contemporary clinical endodontics. The aim of this statement was to summarize current best evidence on the diagnosis and classification of deep caries and caries‐induced pulpal disease, as well as indicating appropriate clinical management strategies for avoiding and treating pulp exposure in permanent teeth with deep or extremely deep caries. In presenting these findings, areas of controversy, low‐quality evidence and uncertainties are highlighted, prior to recommendations for each area of interest. A recently published review article provides more detailed information and was the basis for this position statement (Bjørndal et al. 2019, International Endodontic Journal, doi:10.1111/iej.13128). The intention of this position statement is to provide the practitioner with relevant clinical guidance in this rapidly developing area. An update will be provided within 5 years as further evidence emerges

Effects of eluted components from 4-META/MMA-TBB adhesive resin sealer on osteoblastic cell proliferation

Background/purpose: Adhesive resin sealer systems are applied to seal root-canal systems more effectively through the formation of a resin impregnation layer. The purpose of this study was to investigate the effects of eluted components of the adhesive, Super-Bond sealer (SBS), on the proliferation of osteoblastic cells in vitro. Materials and methods: The standard powder:liquid ratio according to the manufacturer\u27s instructions was used to produce a cylindrical block of SBS (5 mm in diameter, 10 mm long) for this elution study. The resin block was placed on a 100-mm culture dish. Osteoblastic cells were seeded at a density of 4 × 10 6 in α-minimum essential medium containing 10% fetal bovine serum and cultured in a humidified incubator. After 3 days of culture with or without SBS, cells were retrieved and lysed according to the manufacturer\u27s instructions. The cellular events induced by the eluted components from SBS were analyzed using an antibody assay for mitogen-activated protein kinases (MAPKs) and a 3-(4,5-dimethylthyazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. Furthermore, the concentration of boron, a component of the catalyst, tri-n-butyl borane (TBB), was analyzed using inductively coupled plasma optical emission spectrometry. Results: Expression of MAPKs increased after SBS application. The MTT assay indicated that TBB, one of the components of SBS, accelerated the proliferation of osteoblastic cells. Values of boron were 1.66 ± 0.37 and 1.74 ± 0.30 ppm in cells cultured with and without FBS, respectively. Conclusions: The eluted components from SBS can increase the expression of some MAPKs related to osteoblastic cell proliferation and differentiation in vitro. Both the elution experiment and treatment of cell culture with SBS components indicated that the boron originating from TBB is likely to be responsible for activation of the proliferation of osteoblastic cells

Survival and Factors Associated with Failure of Pulpectomies Performed in Primary Teeth by Dental Students

Abstract Although endodontic treatment is widely recommended for compromised dental pulp, there is no information regarding the factors associated with failures in primary teeth. The aim of this study was to evaluate the survival and factors associated with failure of pulpectomies performed in primary teeth by dental students. The sample comprised patients treated at a University Dental Service and required endodontic treatment in primary teeth. The study investigated treatment-related variables and patient factors potentially associated with treatment failure. Pulpectomy survival was analyzed by Kaplan-Meier estimator followed by log-rank test (p<0.05). The analysis included 81 pulpectomies performed in 62 children (5.6±1.5 years). The survival reached 62.9% up to 12 months follow-up. Most failures occurred in the first 3 months (p<0.001). Teeth with carious lesions at the start of treatment presented more failures than those with restorations or history of trauma (p=0.002). The survival of endodontically treated teeth restored with composite was higher than the ones filled with GIC (p=0.006). Pulpectomy performed in two or more sessions resulted in more failures (p=0.028). Patients presenting gingivitis had more failures in the endodontic treatment (p=0.022). The failures of root canal treatment in primary teeth were more prone to occur in a short time and when the treatment was performed in teeth presenting carious lesions. The use of composite instead of GIC increased the survival of pulpectomies. Repeated sessions for endodontic treatment and lack of oral hygiene habits had a negative effect on the results

Physical properties and biological effects of mineral trioxide aggregate mixed with methylcellulose and calcium chloride

Objectives: Methylcellulose (MC) is a chemical compound derived from cellulose. MTA mixed with MC reduces setting time and increases plasticity. This study assessed the influence of MC as an anti-washout ingredient and CaCl2 as a setting time accelerator on the physical and biological properties of MTA. Material and Methods: Test materials were divided into 3 groups; Group 1(control): distilled water; Group 2: 1% MC/CaCl2; Group 3: 2% MC/CaCl2. Compressive strength, pH, flowability and cell viability were tested. The gene expression of bone sialoprotein (BSP) was detected by RT-PCR and real­ time PCR. The expression of alkaline phosphatase (ALP) and mineralization behavior were evaluated using an ALP staining and an alizarin red staining. Results: Compressive strength, pH, and cell viability of MTA mixed with MC/CaCl2 were not significantly different compared to the control group. The flowability of MTA with MC/CaCI2 has decreased significantly when compared to the control (

Apecificazione, apicogenesi e procedure endodontiche rigenerative : revisione della letteratura

RiassuntoObiettivoPresentare le alternative terapeutiche per la gestione degli apici immaturi e l'evoluzione delle tecniche e dei materiali utilizzati.Materiali e metodiÈ stata effettuata una ricerca della letteratura in Medline™ limitata agli studi su esseri umani pubblicati negli ultimi 10 anni, con sequenza appropriata di parole chiave.RisultatiNelle tecniche di apicogenesi e apecificazione utilizzando idrossido di calcio o MTA si riscontra una buona percentuale di successo clinico. Le recenti procedure rigenerative pongono dei dubbi sul futuro dell'apecificazione anche in elementi non vitali.ConclusioniL'idrossido di calcio risulta il gold standard tra i materiali utilizzati in elementi immaturi. Nuove tecnologie stanno promuovendo un interesse crescente per strategie atte a mantenere o addirittura ripristinare la vitalità pulpare.SummaryObjectiveTo present the terapheutical approach to the management of the immature apex and the evolution of materials and techniques.Materials and methodsA Medline™ search was performed limited to human studies published in the last 10 years. The keywords searched were apexogenesis, apexification, pulp regeneration, revascularization.ResultsApexogenesis and apexification techniques using Calcium hydroxide or MTA give a good success rate. Recent regeneration procedures may put into discussion the opportunity of apexification in non vital elements.ConclusionsCalcium hydroxide is the gold standard material used for immature teeth. New technologies are promoting incoming interest for strategies of vitality preservation and pulp regeneration