Calcium Hydroxide in Endodontics: An Overview

Background: Calcium hydroxide has been used in dentistry since several decades. It has been used in a number of applications in the field of endodontics such as root resorption, intracanal medicament, and root canal sealers. Although this material exhibits several advantages, it also has some limitations. Objectives: To review the role of calcium hydroxide in the field of endodontics, focusing on its mechanism of action, antimicrobial effects, different applications, cytotoxicity or biocompatibility, and its removal from the root canals. Materials and Methods: An electronic search was done using different databases. Out of 2,664 articles, only 33 articles have been selected to be included in this review because they are directly related to the topic and matched the inclusion criteria of this review: “Language: English” and “Year: 2000-2016”. Results: The antimicrobial effect of calcium hydroxide is controversial. Although some studies supported the effectiveness of calcium hydroxide against some bacteria others reported its limitation against fungal infection. Calcium hydroxide can be used effectively as intracanal medicament, root canal sealer, in weeping canals, for perforation management and root resorption. Conclusions: Despite the limitation of antimicrobial activity of calcium hydroxide, it is used effectively in a number of treatment modalities in endodontics. Due to its biological and therapeutical properties, calcium hydroxide is the material of choice for all pulp therapy. However, when using calcium hydroxide as a dressing material in root canal treatment caution should be taken to prevent the overextension of the paste beyond the tooth apex and avoid the harmful side effects.

Surgical treatment of cementoblastoma associated with apicoectomy and endodontic therapy:Case report

This case report describes the surgical removal of cementoblastoma associated with apicoectomy and endodontic therapy. The patient, an 18-year-old man, presented pain in the region of the mandibular body on the right side. On clinical exam, bone expansion was observed in the region at the bottom of the vestibular sulcus, pain on palpation, slight extrusion of tooth 46 with presence of pulp vitality. Radiographic exams demonstrated the presence of a radiopaque area and discrete radiolucent halo associated with the root of tooth 46, suggesting the diagnosis of cementoblastoma. Endodontic treatment of tooth 46 was performed and exeresis of the lesion by apicoectomy. Twelve months after the first surgery, recurrence of the lesion was observed, and a new apicoectomy was necessary, this time up to the middle third of the root. Clinical radiographic control 12 mo after the second surgical intervention demonstrated absence of signs and symptoms, radiographic repair, with tooth 46 shown to be fully functional.

Cone beam computed tomography aided diagnosis and treatment of endodontic cases:Critical analysis

Although intraoral radiographs still remain the imaging method of choice for the evaluation of endodontic patients, in recent years, the utilization of cone beam computed tomography(CBCT) in endodontics showed a significant jump. This case series presentation shows the importance of CBCT aided diagnosis and treatment of complex endodontic cases such as; root resorption, missed extra canal, fusion, oblique root fracture, nondiagnosed periapical pathology and horizontal root fracture. CBCT may be a useful diagnostic method in several endodontic cases where intraoral radiography and clinical examination alone are unable to provide sufficient information.

意向再植术治疗畸形根面沟临床疗效分析

畸形根面沟是一种牙齿发育畸形,可导致严重的牙周牙髓联合病变,其诊断和治疗是一个临床难题。本文报道了临床上两种类型的畸形根面沟病例,采取意向性再植术联合显微根管治疗术、根面沟封闭术以及显微根尖手术进行综合治疗,经过12个月的随访,其临床和影像学表现均取得满意效果,初步证实意向性再植术应用于畸形根面沟治疗可在短期内取得较好的临床效果。

单次根管疏通填充治疗对牙体牙髓病患者治疗效果的影响

目的探析单次根管疏通填充治疗对牙体牙髓病患者治疗效果的影响。方法选取2020年10月至2023年10月于南宁市第一人民医院口腔科就诊的符合纳入标准的80例牙体牙髓炎患者,按照随机数字表法分为对照组和观察组,每组40例。对照组应用重复多次根管疏通填充治疗,观察组应用单次根管疏通填充治疗。比较两组治疗前后龈沟出血情况、疼痛程度、咀嚼功能及临床总有效率。结果观察组临床总有效率明显高于对照组,P<0.05。两组治疗前SBI评分对比,P>0.05;两组治疗3周后上述指标评分均有所下降,且观察组评分比对照组低,P<0.05。两组治疗前VAS评分、咀嚼效率对比,P>0.05;治疗后,两组VAS评分均下降咀嚼效率均提高,且观察组VAS评分更低,咀嚼效率更高,P<0.05。结论牙体牙髓病患者应用单次根管疏通填充治疗可获得理想的临床效果,降低龈沟出血程度,缓解疼痛感,增强咀嚼功能。

热牙胶充填法与冷侧方加压法在牙隐裂伴牙髓病变根管治疗中的应用效果对比

目的:对比热牙胶充填法与冷侧方加压法在牙隐裂伴牙髓病变根管治疗中的应用效果。方法:选取2019年1月—2023年12月靖江市人民医院收治的牙隐裂伴牙髓病变患者80例为研究对象,采用随机数字表法分为对照组和研究组,各40例。两组均实施根管治疗,对照组采用冷侧方加压法进行根管充填,研究组采用热牙胶充填法进行根管充填。比较两组治疗总有效率、治疗满意度、咀嚼功能、牙周状况、生活质量。结果:研究组治疗总有效率高于对照组,差异有统计学意义(P=0.034);研究组治疗满意度高于对照组,差异有统计学意义(P=0.034);治疗后,两组咀嚼效率和咀嚼测试吸光度值高于治疗前,研究组高于对照组,差异有统计学意义(P<0.05);治疗后,两组菌斑指数、软垢指数、牙龈出血指数、牙周探诊深度低于治疗前,研究组低于对照组,差异有统计学意义(P<0.05);治疗后,两组世界卫生组织生活质量测定简表评分高于治疗前,研究组高于对照组,差异有统计学意义(P<0.05)。结论:在牙隐裂伴牙髓病变患者根管治疗中,应用热牙胶充填法进行根管充填的效果优于冷侧方加压法,有助于改善患者的咀嚼功能和牙周状况,提高生活质量及满意度。

Convenient model of hard tissue simulation for dental radiographic research and instruction

BACKGROUND The authors describe a technique for building an alternative jawbone phantom using dental gypsum and rice for research and dental radiology instruction.AIM To investigate the potential of an alternative phantom to simulate the trabecular bone aspect of the human maxilla in periapical radiographs.METHODS Half-maxillary phantoms built from gypsum-ground rice were exposed to X-rays,and the resulting images(experimental group)were compared to standardized radiographic images produced from dry human maxillary bone(control group)(n=7).The images were blindly assessed according to strict criteria by three examiners for the usual trabecular aspects of the surrounding bone,and significant differences between groups and in assessment reliability were compared using Fisher’s exact and kappa tests(α=0.05).RESULTS The differences in the trabecular aspects between groups were not statistically significant.In addition,interobserver agreement among observers was 0.43 and 0.51 for the control and experimental groups,respectively,whereas intraobserver agreement was 0.71 and 0.73,respectively.CONCLUSION The tested phantom seemed to demonstrate potential for trabecular bone image Munhoz EA et al.Model of hard tissue simulation for dental radiography WJM https://www.wjgnet.com 2 March 20,2024 Volume 14 Issue 1 simulation on maxillary periapical radiographs.

意向性牙再植术治疗双根型上颌侧切牙牙周牙髓联合病变1例报道及文献回顾

目的探讨畸形舌侧沟致双根型上颌侧切牙严重牙周牙髓联合病变的临床特点、诊断及治疗方法,为临床诊治提供参考。方法对1例伴畸形舌侧沟及严重牙周牙髓联合病变的双根型左上颌侧切牙,进行完善的根管治疗和意向性再植手术治疗,并结合文献对该类型病例的诊疗进行回顾性分析。结果术后3年患者无不适,左上侧切牙愈合良好,无病理性松动,腭侧龈沟探诊深度约1 mm。文献复习结果表明,患牙预后和治疗方案的选择与舌侧沟向根方的延伸长度及深度、牙周状况和患牙的牙髓状态相关;对轻度畸形舌侧沟、牙髓活力未丧失的患牙,采用翻瓣术、牙成形术,可避免牙髓治疗或再治疗;对深或长的舌侧沟导致了牙周组织的严重丧失,则需要牙髓治疗、牙成形术或者封闭沟裂、引导组织再生;对形成双根的畸形舌侧沟,可通过根管治疗、切除小根并用根尖修复材料进行充填、意向性再植的方法,使患牙得以保留。结论发生于双根型上颌侧切牙的畸形舌侧沟导致严重牙周牙髓联合病变的病例,根据临床表现及影像学检查可减少漏诊,治疗应结合舌侧沟向根方的延伸长度及深度、牙周状况和患牙的牙髓状态选择合适的治疗方案。

生物陶瓷iRoot BP Plus治疗年轻恒牙再生性牙髓的效果及对牙本质桥形成率、钙化物生成体积的影响

目的:探究生物陶瓷iRoot BP Plus治疗年轻恒牙再生性牙髓的效果及对牙本质桥形成率、钙化物生成体积的影响。方法:回顾性分析2019年1月-2021年12月张家口市口腔医院收治的60例(共64颗患牙)年轻恒牙慢性根尖周炎患儿的临床资料,根据治疗方式不同进行分组,其中将接受常规三氧化矿物凝聚体(Mineral trioxide aggregate,MTA)支架再生牙髓手术者纳入MTA组(n=29,共31颗患牙),接受生物陶瓷iRoot BP Plus支架再生牙髓手术者纳入iRoot BP Plus组(n=31,共33颗患牙)。比较两组临床疗效、牙本质桥形成率、钙化物生成体积及根管改善情况,并随访术后1年患牙的恢复情况。结果:iRoot BP Plus组临床总有效率为93.94%,高于MTA组的74.19%(P<0.05)。术后1个月及术后3个月,iRoot BP Plus组牙本质桥形成率与钙化物生成体积均高于MTA组(P<0.05)。术后3个月,两组患牙根管长度及根管壁厚度均较术前增加,且iRoot BP Plus组高于MTA组(P<0.05)。术后1年,iRoot BP Plus组根尖孔封闭、萌出高度增加及牙色泽正常比例均高于MTA组(P<0.05)。结论:生物陶瓷iRoot BP Plus治疗年轻恒牙再生性牙髓的疗效确切,能有效促进牙本质桥与钙化物的形成,且有助于根管改善与患牙恢复,值得临床推广应用。

PRF结合MTA材料支架在龋病性年轻恒牙再生性牙髓治疗中的应用

目的探讨富血小板纤维蛋白(PRF)结合矿物三氧化物凝聚体(MTA)支架在龋病性年轻恒牙再生性牙髓治疗中的应用价值。方法选取2020年1月至2021年10月在濮阳市第三人民医院治疗的龋病性年轻恒牙再生性牙髓患儿86例,采用随机数字表法将患儿分为观察组(43例,50颗)和对照组(43例,52颗),给予观察组PRF结合MTA材料支架治疗,给予对照组iRoot BP Plus支架治疗,观察两组治疗疗效、根管长度、根管壁厚度、患牙恢复情况等。结果观察组治疗效果优于对照组(P<0.05)。与治疗前比较,观察组和对照组治疗后根管长度和根管壁厚度增加(P<0.05);治疗后根管长度和根管壁厚度比较,观察组高于对照组(P<0.05)。观察组牙体色泽正常、萌出高度增加、根尖孔封闭、牙髓活力正常比例高于对照组(P<0.05)。与治疗前比较,观察组和对照组治疗后咬合力和咀嚼效率升高(P<0.05);治疗后两组咬合力和咀嚼效率比较,观察组高于对照组(P<0.05)。结论PRF结合MTA材料支架在龋病性年轻恒牙再生性牙髓治疗中有较好的效果,可帮助改善患儿根管长度、根管壁厚度及患牙恢复情况,治疗后患儿具有良好的咬合力和咀嚼效率,值得临床使用。

2种机用镍钛器械在乳磨牙根管治疗中的临床效果观察

目的探讨Reciproc机用镍钛器械和Protaper机用镍钛器械在乳磨牙根管治疗中的临床应用效果。方法选取2020年1月—2021年1月甘肃中医药大学附属医院口腔科就诊的乳牙牙髓病患儿50例,分别用Reciproc镍钛器械(RE组)和Protaper镍钛器械(PT组)进行根管治疗。分别记录2组的根管预备时间、诊间疼痛评估值和术后X线片检查充填效果。所有的根管治疗操作均为同一医生进行。结果平均每根根管预备时间RE组为(3.70±1.19)min,PT组为(5.43±1.16)min,RE组的预备时间短于PT组,差异有统计学意义(P<0.05)。2组约诊间痛评分和根管充填效果比较,差异无统计学意义(P>0.05)。结论机用镍钛器械Protaper和Reciproc在乳牙根管治疗时具有预备时间短、诊间疼痛反应低、充填效果佳的优点,其中Reciproc在治疗操作时间方面优于Protaper。

不同填充材料在牙体牙髓病患儿根管治疗中的应用效果比较

目的比较不同填充材料在牙体牙髓病患儿根管治疗中的应用效果。方法选取2020年1月至2021年12月于济宁市任城区妇幼保健院行根管治疗的牙体牙髓病患儿126例(患牙200颗),按照随机数字表法分为三组。无极三氧化矿物凝聚体(MTA)组(42例,患牙67颗)采用MTA封闭剂,Viapex组(42例,患牙66颗)采用Viapex封闭剂,Cortisomol组(42例,患牙67颗)采用Cortisomol封闭剂。比较三组术后疼痛情况及临床疗效。结果术后3、7 d,MTA组数字评分法(NRS)评分均低于其余两组,Viapex组NRS评分低于Cortisomol组(P<0.05)。MTA组总有效率高于Cortisomol组(P<0.05)。结论MTA和Viapex封闭剂在牙体牙髓病患儿根管治疗中的应用效果较好,其中MTA在减轻患儿术后疼痛方面更具优势。

多次与一次根管治疗法治疗牙体牙髓病的效果分析

目的:分析多次与一次根管治疗法治疗牙体牙髓病的效果。方法:选取2021年1月—2023年10月于黔西南州人民医院接受根管治疗的牙体牙髓病患者68例作为研究对象,随机分为试验组和对照组,各34例。试验组采用一次根管治疗法,对照组采用多次根管治疗法。比较两组治疗效果、疼痛程度、治疗质量、并发症发生情况。结果:试验组治疗总有效率高于对照组,差异有统计学意义(P=0.021);治疗后1个月、2个月,两组视觉模拟评分法评分降低,试验组低于对照组,差异有统计学意义(P<0.05);治疗后半年,两组上中切牙夹角大于治疗前,上中切牙缘到鼻根点、上齿槽座点连线的垂直距离小于治疗前,试验组优于对照组,差异有统计学意义(P<0.001);试验组并发症总发生率低于对照组,差异有统计学意义(P=0.023)。结论:一次根管治疗法治疗牙体牙髓病的效果优于多次根管治疗法,可减轻疼痛,提高治疗质量,降低并发症发生风险。

运用锥形束CT进行显微根管治疗对诊间急症的影响因素及预后分析

目的:运用锥形束CT(CBCT)对牙根钙化患者进行显微根管治疗,并对出现根管治疗诊间急症(EIAE)的影响因素及预后因素进行分析。方法:选取2020年2月至2023年2月苏州口腔医院收治的80例根管钙化患者,均行CBCT检查并进行显微根管治疗,根据CBCT检查结果,统计EIAE的发生率和1年后预后(漏填、欠填、根管偏移)情况,采用多元logistic回归分析发生EIAE的影响因素。结果:80例患者共100根钙化根管,EIAE发生率为8.75%。logistic回归分析结果显示,性别、治疗前疼痛、治疗前瘘道、根尖阴影及牙髓活力均是影响EIAE发生的因素(OR=2.217、1.249、1.405、1.320、1.835,P<0.05);牙髓活力、治疗前瘘道、术前有无根尖暗影、根管充填长度、充填致密情况及冠渗漏均是影响显微根管治疗预后的因素(OR=1.256、1.425、1.237、1.225、1.280、1.267,P<0.05)。结论:在显微根管治疗中CBCT影像能够更详细了解钙化根管形态并明确根管走向,有助于对患牙个体特征、制定治疗方案和加强预后评估与分析,提升治疗效果。

Conservative endodontic management using a calcium silicate bioceramic sealer for delayed root fracture:A case report and review of the literature

BACKGROUND The success rate of conservative endodontic management for root fracture varies greatly based on different methods used.It has been rarely reported that calcium silicate-based materials are applied in root fracture treatment.CASE SUMMARY A 38-year-old male patient presented with spontaneous pain from the upper left anterior teeth for 1 wk.The spontaneous pain was subsequently relieved,but pain on mastication persisted for 3 d.The patient had a dental trauma from a boxing match 15 years ago.Cone beam computed tomography showed that the maxillary left central incisor had oblique fracture lines and a radiolucent lesion around the fracture line.The tooth was diagnosed with an oblique root fracture with no healing and symptomatic apical periodontitis.In the following conservative endodontic management,the coronal and apical fragments of the canal both were chemo-mechanically prepared and obturated using a single cone gutta-percha with iRoot SP(Innovative BioCreamix Inc,Vancouver,Canada),a new calcium silicate-based bioceramic root canal sealer.At follow-ups at 1,6,12,and 24 mo,the patient was asymptomatic and the radiolucency around the fracture line was healing radiographically.CONCLUSION Conservative root canal treatment is an alternative treatment in some cases of oblique root fracture with no healing.The application of bioceramic sealers and single core obturation techniques may also be essential to obtain an excellent outcome.

Effect of restorative techniques on fracture resistance of endodontically treated premolars

Purpose: This study was aimed to evaluate the effect of restorative materials and glass fiber post on the fracture resistance of endodontically treated premolars. Material and Methods: Fifty extracted single rooted lower premolars were used in this in vitro study and divided into 5 groups: sound teeth (control group);mesial-occlusal-distal (MOD) preparation + endodontic treatment + composite restoration;MOD preparation + endodontic treatment + glass fiber post + composite restoration;MOD preparation + endodontic treatment + amalgam restoration;MOD preparation + endodontic treatment + glass fiber post + amalgam restoration. The specimens were loaded on a universal testing machine at the crosshead speed of1 mm/min until fracture. The data were analyzed using two-way ANOVA test. Results: The mean loads at fracture were 860.11 N, 801.79 N, 761.39 N, 737.14 N and 707.85 N respectively. There were no statistically significant differences (P > 0.05) in the fracture resistance of teeth restored with composite and amalgam, as well as restored with or without glass fiber post. Conclusions: The type of restorative material and the usage of glass fiber post do not have visible influence on the fracture resistance of the endodontically treated mandibular premolars.

Successful management of a tooth with endodontic-periodontal lesion:A case report

BACKGROUND Endodontic-periodontal lesion is a commonly encountered dental condition.However,the prognosis of the condition varies from good to poor.Some cases are associated with a poor prognosis that requires tooth extraction.This report presents a case of an endodontic-periodontal lesion in a tooth that was successfully treated by root canal treatment.CASE SUMMARY A 51-year-old female patient with no medical history complained about persistent pain and discomfort in her left mandibular first molar.Clinical examination showed the left mandibular first molar with poor restoration.It was also associated with underlying necrotic pulp and periodontal involvement.Radiographic examination revealed visible bone defects in the apical and periodontal areas.Based on the findings,the patient was diagnosed with a primary endodontic lesion.A root canal treatment for the endodontic lesion was performed.The patient received a coronal all-ceramic endocrown restoration.A follow-up was arranged to check the prognosis.At the 3 mo follow-up,the clinical and radiography evaluations showed complete disappearance of signs and symptoms and an increase in the radiopacity of the root area.CONCLUSION Despite the poor prognosis associated with many endodontic lesions,this case report highlights that a good prognosis is still possible for an endodontic lesion with apical and periodontal bone loss.In this case,it was achieved via successful root canal treatment without the need for periodontal or surgical intervention.

Endodontic management of the maxillary first molar with special root canals:A case report and review of the literature

BACKGROUND As the complex anatomy of maxillary first molars is one of the major challenges in endodontic therapy,knowledge of the complicated root canal anatomy and configuration is crucial to ensure the success of endodontic treatment and prognosis.This article presents an endodontically managed left maxillary first molar with an unusual palatal root morphology.The available literature on the anatomic variation of maxillary first molars is also reviewed.CASE SUMMARY A 36-year-old man with no medical history presented to the Stomatology Department of Peking University Third Hospital complaining of a toothache during mastication in the maxillary left posterior region for approximately 3 mo.He had a spontaneous and intermittent toothache that had worsened,particularly at night.The diagnosis based on clinical examination,X-ray imaging,and cone beam computed tomography(CBCT)was symptomatic irreversible pulpitis.Nonsurgical endodontic therapy was performed for the left maxillary first molar.Five root canals revealed by CBCT included a special palatal root canal(1-2-1-shaped),two mesiobuccal root canals,and one distobuccal root canal.Evaluation of the CBCT images confirmed the root canal morphology and the clinician performed more effective cleaning,obturation,and therapy.Finally,the tooth was restored using composite resin,and the patient was satisfied with the result.CONCLUSION CBCT and a complete review of the literature may be beneficial for investigating the root canal system to achieve a biological and functional therapeutic effect.

盐酸米诺环素联合替硝唑片辅助根管治疗牙周-牙髓联合病变疗效观察

目的:观察盐酸米诺环素联合替硝唑片辅助根管治疗牙周-牙髓联合病变的临床疗效。方法:选取2017年1月-2020年8月南通市肿瘤医院收治的102例牙周-牙髓联合病变患者为研究对象,按随机数字表抽样法分为观察组和对照组,每组51例。两组病例均按照常规牙周基础治疗和根管治疗处理,对照组给予替硝唑片治疗,观察组在对照组的基础上联合盐酸米诺环素治疗,两组均治疗4周。记录两组治疗后的临床疗效、治疗前后的牙周参数及治疗期间的不良反应发生率。结果:观察组临床治疗有效率为90.20%,高于对照组的68.63%,两组比较差异具有统计学意义(P<0.05);两组治疗后牙周参数各项指标均有所改善,且观察组的各项牙周参数均低于对照组,差异有统计学意义(P<0.05);治疗期间,两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:盐酸米诺环素联合替硝唑辅助根管治疗可有效降低磨牙牙周参数水平,对牙周-牙髓联合病变的疼痛程度和牙龈脓肿有一定的缓解,且两药合用不增加副作用,具有一定的安全性。

基于根管⁃修复序列治疗的口腔临床前实践学科整合教学模式评价

目的评价基于根管⁃修复序列治疗的口腔临床前实践学科整合模式教学的效果,为口腔医学专业教学模式探索提供参考。方法本回顾性研究已通过单位伦理委员会审查批准。研究分为2组,学科整合教学(discipline integration teaching,DIT)组为2018级和2019级共450名学生,将根管治疗及固定修复2门课程的临床前实践教学整合为根管⁃修复序列治疗一门课程;传统教学(traditional teaching,TT)组为2016级和2017级共443名学生,根管治疗及固定修复两门课程临床前实践教学分别开展,2组学生均由相同的2名老师授课。比较2组临床技能考核、案例分析考核得分。此外,采用李克特五级量表对2组学生进行教学方法的问卷调查,对2名老师和DIT组学生进行了DIT方法满意度的调查。结果DIT组临床技能考核得分为(90.2±4.16)分,高于TT组(86.3±3.57)分(P=0.001);在案例分析考核中,DIT组91.8%(413/450)的学生正确制订了治疗方案,高于TT组的74.7%(331/443)(P=0.001)。问卷调查结果表明,DIT组学生对该组教学方法培养临床思维、提升适应证辨析能力、提升操作技能、激发学习兴趣、促进自主学习方面的认可度高于TT组(P<0.05);所有授课教师(2/2)和98.4%(443/450)学生对DIT方法表示满意。结论DIT方法在根管⁃修复序列治疗临床前实践课程中被证明是有效的,显著提高了学生的学习质量及能力,并且更易为师生所接受。DIT组方法比TT方法更加有效地提升学生的临床思维和操作能力。