Challenging the Misnomer of Irreversible Pulpitis and Deliberating the Urgent Need for Reclassification of Pulpal Diseases Based on the Efficacy of Vital Pulp Therapies: An Overview of Systematic Reviews

Over recent decades, the definition of irreversible pulpitis (IP), as an irrevocable condition of a compromised dental pulp tissue, has forced clinicians towards invasive root canal treatments. However, the current best evidence challenges the alignment between clinical symptoms and the perceived irreversibility of a negotiated dental pulp tissue. In the above-mentioned context, vital pulp therapy (VPT) has emerged as a revolutionary and transformative approach; introducing minimally invasive techniques to sustain pulp vitality in cases of IP. The present paper aimed to rigorously examine the corresponding published systematic reviews to explore the diverse spectrum of VPT modalities and their outcomes in managing IP cases. Besides, the current review seems to have asserted the need to discard the conventional terminology of irreversible pulpitis, based on the effectiveness of VPTs in the achievement of pulp tissue healing within cases clinically diagnosed as IP

Published endodontic articles in PubMed-indexed journals from Iran

Introduction:  The aim of this survey was to illustrate statistical information about endodontic research published in pubmed index journals from the different universities of Iran.Materials and Methods: A PubMed search was performed to retrieve the endodontic publications of authors affiliated to different universities of Iran. Abstracts were reviewed and unrelated articles were omitted. Citation of each article was obtained from Scopus and Google scholar databases. Data were extracted and transferred to Microsoft Excel to determine the related scintometric indicators.Results: A total of 307 papers were found according to the defined criteria which shows considerable increase from 2 papers in 1992 to 54 in 2011. Majority of the papers (48%) were related to in vitro studies; this number was 33% for in vivo surveys. Meta-analysis, systematic review and clinical trial constituted 10% of all publications. The average number of authors for the overall publications was 3.84; majority of articles (20%) were written by three authors. The average number of citation from Google Scholar (8.93) was higher than those from Scopus (4.74). Most of the endodontic articles originated from the Mashad University of Medical Sciences (16%).Conclusion: Endodontic publication from different universities in Iran has considerably in creased, showing that research in becoming more important

Repair of a Strip Perforation with Calcium-Enriched Mixture Cement: A Case Report

The present report reviews the diagnostic and treatment challenges of a mandibular molar with previous root canal treatment and signs of a procedural mishap, i.e. furcal radiolucency and localized swelling of the gingival margin in which a sinus tract was present. By tracing the sinus tract, it became evident that the lesion originated from the furcation area, not the root apices. This case was treated by cleaning/filling the coronal half of the canals and leaving the rest of obturating material in situ. The strip perforation zone in the mesial root was sealed off with calcium-enriched mixture cement. One-week post-operative, patient’s symptoms faded away and after one year, the lesion completely healed with bone replacement

Miniature Pulpotomy of Symptomatic Mature Permanent Teeth: A Report of Two Cases

Human dental pulp inflammation can progress to periapical lesion formation and conventional root canal treatment (RCT) has been the traditional method for disease management. This observational study presents two cases of vital pulp therapy in mature molars diagnosed with irreversible pulpitis and associated with apical periodontitis. In these two clinical cases, the involved teeth had deep carious lesions with a history of spontaneous/lingering pain and radiographic examinations revealed the presence of apical radiolucencies. A conservative miniature pulpotomy (MP) using calcium-enriched mixture (CEM) was performed and the teeth were permanently restored with amalgam. Clinical evaluations indicated resolution of pain 24 hours after treatment; the teeth showed normal vitality, remained asymptomatic and maintained normal function after recall examinations. Furthermore, the 18-month radiographic evaluation showed healing of the apical lesions. Vital pulp therapy using the MP technique with CEM appeared successful in avoiding RCT intervention. These two reports of case outcome suggest that simple MP using a CEM bioregenerative technique may provide a favorable outcome for permanent teeth diagnosed with irreversible pulpitis and associated with apical periodontitis.Keywords: Calcium-Enriched Mixture, CEM cement, Endodontic, Miniature pulpotomy, Irreversible pulpiti

Repair of an Extensive Furcation Perforation with CEM Cement: A Case Study

Iatrogenic perforation of the furcation area in multi-rooted molars during preparation of the access cavity can potentially lead to tooth extraction. The present case report describes the nonsurgical endodontic management of an extensive pulp chamber floor perforation in a first mandibular molar with calcium enriched mixture (CEM) cement. The perforation was chemically cleaned and then physically sealed with CEM cement. Root canal therapy was completed and the tooth was then restored with amalgam. A one-year follow-up revealed the absence of symptoms of infection/inflammation as well as clinical and radiographic signs/symptoms and therefore, can be interpreted as a favorable treatment outcome

Coronal and apical sealing ability of a new endodontic cement

INTRODUCTION: This in vitro study aims to evaluate the coronal and apical sealing ability of gutta-percha (GP) root filling used with either mineral trioxide aggregate (MTA), new endodontic cement (NEC) or AH26 as filler/sealers. MATERIALS AND METHODS: Forty eight single-rooted extracted teeth were selected, decoronated and then instrumented. Samples were randomly divided into three experimental (n=12) and two control groups (n=6). In group 1, root canals were filled using lateral condensation technique (L); while single cone technique (S) was used for groups 2 and 3. AH26, MTA and NEC were the root canal sealer/fillers in groups 1, 2 and 3, respectively. Samples were immersed in 1% methylene-blue dye and then independently centrifuged apically and coronally. The roots were split longitudinally and linear extent of dye penetration was measured with a stereomicroscope from apical and coronal directions. Data were analyzed using One-way ANOVA and T-test. RESULTS: No statistical differences in mean apical dye penetration between groups LGP/AH26, SGP/MTA and SGP/NEC were found; SGP/NEC group showed significantly less coronal dye penetration (P<0.001). CONCLUSION: Considering the limitations of this in vitro study, it was concluded that the simple single cone technique with NEC can provide favorable coronal and apical seal

Outcomes of Different Vital Pulp Therapy Techniques on Symptomatic Permanent Teeth: A Case Series

In modern endodontics, vital pulp therapy (VPT) has been considered an ultra-conservative treatment modality. Based on the level of pulp preservation, VPT includes stepwise excavation, indirect pulp capping (IDPC), direct pulp capping (DPC), miniature pulpotomy (MP), partial/Cvek pulpotomy and coronal/complete pulpotomy (CP). The present article reviews the treatment outcomes of 94 permanent teeth with irreversible pulpitis treated with either IDPC (n=28), DPC (n=28), MP (n=29) or CP (n=9) using calcium-enriched mixture (CEM) cement. After a mean follow-up time of 12.3 months, 93 treated teeth were radiographic/clinically successful; only one radiographic failure was observed in the DPC group

Microleakage of CEM cement in two different media

INTRODUCTION: Sealing ability of root-end filling materials is of great importance. It can be investigated by measuring microleakage. The purpose of this in vitro study was to evaluate microleakage of calcium enriched mixture (CEM) cement in two different media including phosphate buffer solution (PBS) and distilled water. MATERIALS AND METHODS: Twenty single-rooted human teeth were selected. All teeth were root-end filled with CEM cement. Samples were divided into two groups of 10 each and were placed in PBS or distilled water. The microleakage was measured after 12 and 24 h, 14 and 30 days with Fluid Filtration device. Data were statistically analyzed by repeated measures test. RESULTS: Sealing ability of CEM cement was significantly superior in PBS compared to distilled water (P<0.05). This study also showed that time had no significant effect on the sealing ability of CEM cement. CONCLUSION: Media can significantly affect the microleakage of CEM cement. PBS can provide more phosphorous ions for hydroxyapatite formation of CEM cement; therefore, CEM cement can seal more effectively with PBS

Osseous reaction to implantation of two endodontic cements : mineral trioxide aggregate (MTA) and calcium enriched mixture (CEM)

Aim: The aim of the present in vivo study was to determine bone tissue reaction to calcium enriched mixture (CEM) and mineral trioxide aggregate (MTA) using a rat femur model. Study Design: Sixty-three rats were selected and randomly divided into three groups of 21 each [experimental groups (n=15), control (n=6)]. Implantation cavities were prepared in each femoral bone and randomly filled with the biomaterials only in the experimental groups. The animals in three groups were sacrificed 1, 4, and 8 weeks postoperatively. Histologic evaluations comprising inflammation severity and new bone formation were blindly made on HE-stained decalcified 6-?m sections. Results: At 1, 4, and 8 weeks after implantation number of inflammatory cells had decreased in the CEM, MTA and control groups, respectively, with no statistically significant differences. Conversely, new bone formation had increased in all the experimental and control groups, without statistically significant differences. Conclusion: The results suggest that biocompatibility of MTA, as gold standard, and CEM cement as a new endodontic biomaterial are comparabl