Clinical Management of Dens Invaginatus Type 3: A Case Report

ABSTRACT: Dens invagination (DI) is a developmental abnormality of teeth which frequently results in a complex internal anatomy of the root canal system. DI type 3 is an anomaly characterized by infolding of enamel and dentin extending into the root apex. This may present difficulties when forming a diagnosis and treatment plan. Many treatment modalities have been presented in case reports for DI type 3, but there is insufficient evidence to recommend a therapy. This case report presents the successful non surgical root canal treatment of a maxillary canine with an open apex DI type 3, necrotic pulp, and an associated large periradicular lesion

Evaluation of Antimicrobial Efficacy of Calcium Hypochlorite as an Endodontic Irrigant on a Mixed-culture Biofilm: An Ex vivo Study

Introduction: Calcium hypochlorite (CH) has been recently suggested as an endodontic irrigant. The aim of this investigation was to evaluate the antimicrobial efficacy of CH compared to sodium hypochlorite (NaOCl) and chlorhexidine (CHX) against multispecies biofilm in surface and deep dentinal tubules. Methods and Materials: Minimal inhibitory concentration (MIC) of irrigant agents was assessed using a microdilution method. One hundred and twenty of human maxillary incisor teeth were prepared and infected with suspension of Entrococcus faecalis, Fusobacterium nucleatum and Prevotella intermedia in an anaerobic jar for 7 days. Depending on irrigation solutions, specimens were divided into 4 groups (n=30); group 1: 2% CHX, group 2: 5.25% sodium hypochlorite, group 3: 5% calcium hypochlorite, group 4: positive control (normal saline (NS)). Fifteen remained specimens were used as negative control. Surviving bacteria were sampled before (S1) and after irrigation from surface (S2) and deep (S3) dentin. The medium turbidity was visualized with spectrophotometry. Data were analyzed using analysis of variance followed by Tukey post hoc test (α=0.05). Results: The MIC of CH against E. faecalis, F. nucleatum and P. intermedia was 25, 8 and 7.5 µg/mL respectively. There were no significant differences in S1 among the test groups. Moreover, 2% CHX and 5% CH had significantly lower medium turbidity at both S2 and S3, in comparison with 5.25% NaOCl (P=0.018 and 0.031, respectively). But there were no significant differences between 2% CHX and 5% CH at both S2 and S3 (P=0.862 and 0.978, respectively). Conclusion: Under the conditions of this ex vivo study, 5% CH and 2% CHX are more effective than 5.25% NaOCl in the reduction of mixed-culture biofilm.Keywords: Calcium Hypochlorite; Chlorhexidine; Endodontics; Sodium Hypochlorite

A Prospective Clinical Study on Blood Mercury Levels Following Endodontic Root-end Surgery with Amalgam

Introduction: The purpose of this clinical study was to compare the blood mercury levels before and after endodontic surgery using amalgam as a root-end filling material. Materials and Methods: Fourteen patients requiring periradicular surgery participated in this prospective clinical study. A zinc-free amalgam was employed as root-end filling material. Blood samples were collected at three intervals: immediately before, immediately after and one week postoperatively. Mercury content of the blood was determined using gold amalgamation cold-vapor atomic absorption spectrometry. Obtained data were analyzed using analysis of variance for repeated measures and paired t-test. Results: The mean (SD) of blood mercury levels was 2.20 (0.24) ng/mL immediately before surgery, 2.24 (0.28) ng/mL immediately after surgery and 2.44 (0.17) ng/mL one week after the periradicular surgery. The blood mercury level one week post-operative was significantly higher than both blood mercury levels immediately before (P<0.001) and immediately after (P=0.005) the surgery. Conclusion: Placement of an amalgam retroseal during endodontic surgery can increase blood mercury levels after one week. The mercury levels however, are still lower than the toxic mercury levels. We suggest using more suitable and biocompatible root-end filling materials

Investigating activity of masticatory muscles in patients with hypermobile temporomandibular joints by using EMG

Background: Temporomandibular joint hypermobility (TMJH) can manifest higher range of motions in mandible. The aim of this study was to investigate and compare the activity of masticatory muscle of TMJs in healthy individuals and patients with mild, moderate and severe TMJH. Material and Methods: In this clinical study, 69 patients (between the ages of 22 to 42) with manifestation of TMJH were included. The patients were divided into three groups based on their maximum mouth opening (MMO): (light) with MMO of 50-55 mm; (moderate) with MMO between 55 to 65 mm; and (severe) with MMO >65 mm. Also, 20 healthy people with profiled tomography in the last 6 months were invited as control group (healthy) with normal MMO (<50 mm). All the groups subjected to electromyogram (EMG) in 2 steps: maximal voluntary clenching (MVC) of the jaws; and during chewing of bread by using one side of the jaws voluntary. The collected data were analyzed by Student T-test and Chi-Square tests using SPSS software version 15 at significant level of 0.05. Results: Both TMJs of light, moderate and severe groups showed significant differences in frequency, time of activity and rest in comparison with healthy group during chewing and MVC (all p values < 0.01). Conclusions: Masticatory muscles activity reduced in relation with the severity of TMJH and higher excessive mouth opening

Effect of Nonsurgical Periodontal Treatment Combined With Diode Laser or Photodynamic Therapy on Chronic Periodontitis: A Randomized Controlled Split-Mouth Clinical Trial

Introduction: The optimum removal of bacteria and their toxins from periodontal pockets is not always obtained by conventional mechanical debridement. Adjunctive therapies may improve tissue healing through detoxification and bactericidal effects. The purpose of the present study was to evaluate the impact of adjunctive laser therapy (LT) and photodynamic therapy (PDT) on patients with chronic periodontitis.Methods: Twenty patients with at least three quadrants involved and each of them presenting pockets 4-8 mm deep were included in the study. Periodontal treatment comprising scaling and root planning (SRP) was accomplished for the whole mouth. Applying a split-mouth design, each quadrant was randomly treated with SRP alone (group A), SRP with LT (group B), and SRP with PDT (group C). The clinical indices were measured at baseline 6 weeks and 3 months after treatment. Microbiological samples were taken and evaluated at baseline and 3-month follow-up. Results: All groups showed statistically significant improvements in terms of clinical attachment level (CAL) gain, periodontal pocket depth (PPD) reduction, papilla bleeding index and microbial count compared to baseline (P &lt; .05). The results showed more significant improvement in the 6-week evaluation in terms of CAL in groups B and C than in group A (P &lt; .05). Group B also revealed a greater reduction in PPD than the other treatment modalities (P &lt; .05).Conclusion: The obtained data suggested that adjunctive LT and PDT have significant short-term benefits in the treatment of chronic periodontitis. Furthermore, LT showed minimal additional advantages compared to PDT

Effect of Phentolamine as Reversal of Soft-Tissue Anesthesia on Post-Endodontic Pain in Patients with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial

Introduction: Phentolamine mesylate (OraVerse) is mostly used to reverse soft tissue anesthesia after dental procedures. The aim of the present study was to evaluate the effect of the injection of OraVerse on postoperative pain after root canal treatment in patients with symptomatic irreversible pulpitis. Methods and Materials: In this randomized single-blind clinical trial study, 100 patients (50 per group) with symptomatic irreversible pulpitis in the first or second mandibular molars, randomly received either OraVerse or sham treatment after a single-visit root canal therapy. Each patient recorded their pain score, using a Heft Parker visual analogue scale, before and after 6, 12, 24, 36, 48, and 72 h of the treatment. They also monitored their soft-tissue anesthesia every 15 min for 5 h. Data were analyzed by t-test and repeated measured ANOVA statistical tests. The level of significance was set at 0.05. Results: Patients who received phentolamine had significantly higher pain scores at 6- and 12-h postoperative intervals compared with those receiving sham treatment (P=0.01 and P=0.00 respectively). Consumption of analgesics in OraVerse group was significantly higher than that of the sham group (P=0.48). Conclusion: Although phentolamine accelerated the reversal of normal soft tissue sensation after the dental visit, it increased postoperative pain in patients suffering from symptomatic irreversible pulpitis, which may limit phentolamine administration in this group.Keywords: Anesthesia; Inferior Alveolar Nerve; Lidocaine; Phentolamine Mesylate; Postoperative Pai

Endodontic periapical lesion-induced mental nerve paresthesia

Paresthesia is a burning or prickling sensation or partial numbness, resulting from neural injury. The symptoms can vary from mild neurosensory dysfunction to total loss of sensation in the innervated area. Only a few cases have described apical periodontitis to be the etiological factor of impaired sensation in the area innervated by the inferior alveolar and mental nerves. The aim of the present paper is to report a case of periapical lesion-induced paresthesia in the innervation area of the mental nerve, which was successfully treated with endodontic retreatment

A Review on Regenerative Endodontics

Background and Aim : Regenerative endodontics with the goal of replacing the lost dental tissues is developing fast. The aim of this study was to review the recent progressions, known limitations and advantages of regenerative treatments compared to other possible treatment modalities .   Materials and Methods : We searched MedLine and PubMed systematically for articles published from May 2000 until May 2013 in English which were relevant to tissue engineering and regenerative procedures using the keywords “cell and tissue based therapy”, “regeneration”, “stem cell” and “tissue engineering”. More valid papers were chosen .   Results : Stem cells, growth factors and an appropriate scaffold are the three essential elements required for tissue regeneration. Revascularization is an ideal regenerative treatment, which uses a fibrin scaffold. This scaffold is made of peri-radicular stem cells, a clot and latent growth factors in dentinal walls. The clinical outcome of revascularization is complete root formation in a premature necrotic permanent tooth. Thus, revascularization is a realistic and worthwhile approach in patients with fair to good prognosis .   Conclusion : Regenerative treatments with the aim of producing a completely formed permanent tooth are going to revolutionize dental science. Regeneration of a fully formed tooth is much more complicated than treatment of an open apex tooth and this issue requires further studies

Effect of Elaeagnus Angustifolia Lozenge on Gag Reflex in Dental Patients

Background and Aim : Gag reflex is one of the most common problems in dental treatment. All researches performed to reduce or eliminate this reflex were not effective or were time-consuming. The aim of this study was to evaluate the use of Elaeagnus Angustifolia lozenge in controlling gag reflex during dental treatment .  Materials and Methods : This study was a randomized double blind controlled trial with convenient sampling on 84 patients that were candidates for radiographic procedures in the School of Dentistry, Isfahan University of Medical Sciences. The cases were randomly divided into two groups of case and control. The case group used Elaeagnus Angustifolia L extracts and the control group used placebo. Fruit extract was formed into lozenge. Before and after intervention, the gag reflex was evaluated by stimulation of the soft palate and pharyngeal tonsils. Data analysis and comparison was performed with SPSS 11 software and Chi-square , McNamara and t tests .  Results : The gag reflex significantly decreased in the soft palate region (p<0.001) and pharyngeal tonsils (p<0.001) in the intervention group. In the placebo group, decrease of gag reflex was not significant in any of these locations (p=0.9). The decrease in gag reflex in the soft palate and the pharyngeal tonsils in the case and control groups before and after the intervention showed statistically significant differences (P<0.01).  Conclusion : Elaeagnus Angustifolia L. extracts seem to be an effective method to control gag reflex during dental treatment. It may be a confident method to use on dental procedures, especially radiographic procedures