Application of advanced platelet-rich fibrin for through-and-through bony defect during endodontic surgery:Three case reports and review of the literature

BACKGROUND The use of advanced platelet-rich fibrin(A-PRF)membranes for guided bone and tissue regeneration in through-and-through defects after endodontic surgery was explored in three cases.CASE SUMMARY Herein,three patients presented to the endodontic clinic suffering from apical periodontitis,associated with large bone resorption and related to previously endodontically treated teeth.Periapical surgery was indicated in these cases and the osteotomy site was covered by A-PRF membrane.Cone-beam computed tomography(CBCT)was used to assess the cases before and after the surgery.CONCLUSION Four months post-surgery,the recall CBCT scan showed complete obliteration of the osteotomy with newly formed bone.A-PRF membrane showed promising results and was an advantageous addition to surgical endodontic treatment.

以鼻旁组织反复感染为主要表现的根尖周炎诊治经验

目的总结以鼻旁组织反复感染为主要表现的根尖周炎诊治经验。方法将2020年8月~2021年10月在浙江省嘉兴市第一医院治疗的以鼻旁皮肤反复感染或形成窦道为主要表现的根尖周炎病例临床资料进行总结归纳,共计5例,均行患牙拔除及抗感染治疗,期间有3例先行脓肿切开探查术。结果随访6~20个月,5例鼻旁组织感染均无复发,3例伴有鼻旁窦道患者局部表面皮肤均愈合,5例均在术后1个月口腔科门诊继续治疗。结论根尖周炎的主要诊断是依靠上颌骨CT及三维重建检查,根尖周炎并发鼻旁面部感染的治疗主要是在控制感染的情况下先予以患牙的治疗包括根管治疗或拔牙治疗,切忌先行鼻旁组织切开排脓。

Root Canal Treatment Outcome and Restorative Condition of Teeth Treated by Undergraduates—A Clinical and Radiographic Evaluation

Background: The aim was to evaluate the nonsurgical Root Canal Treatment (nRCT) outcome, the restorative condition and the relationship between the coronal restoration quality and the outcome of teeth endodontic treated by undergraduates at the University of Caxias do Sul School of Dentistry (UCS-SD), Brazil, between 2019 and 2021. Materials and Methods: Data from the endodontically treated cases were retrieved, and the patients were recalled for a follow-up appointment at the university. The endodontic diagnosis, radiographs, and the presence of definitive restorations were analyzed in the clinical records. During the follow-up appointment, endodontically treated teeth were classified as present or absent. The nRCT was classified as successful (complete or incomplete healing) or failure (uncertain or unsatisfactory healing). Coronal restoration was classified as absent or present. When it was present, it was classified as permanent or temporary, and its quality as adequate or inadequate restoration. The results were presented as percentages. Results: A total of 257 teeth were endodontically treated. The most prevalent diagnosis was Chronic Apical Periodontitis (33.33%) and the most commonly treated teeth were premolars (46.15%). A total of 52 (21%) treated teeth were clinically and radiographically reexamined. The success rate for the nRCT was 98.08%. About 61.54% of this sample had a definitive composite resin restoration. Conclusion: The nRCT success rate was high. Special attention should be given to the presence and quality of the definitive restoration. Clinical Implications: There was no statistically significant impact between the coronal restoration and the nRCT success (P > 0.05).

Activation of hypoxia-inducible factor 1 attenuates periapical inflammation and bone loss

Hypoxia（low oxygen level） is an important feature during infections and affects the host defence mechanisms. The host has evolved specific responses to address hypoxia, which are strongly dependent on the activation of hypoxia-inducible factor 1（HIF-1）.Hypoxia interferes degradation of HIF-1 alpha subunit（HIF-1α）, leading to stabilisation of HIF-1α, heterodimerization with HIF-1 beta subunit（HIF-1β） and subsequent activation of HIF-1 pathway. Apical periodontitis（periapical lesion） is a consequence of endodontic infection and ultimately results in destruction of tooth-supporting tissue, including alveolar bone. Thus far, the role of HIF-1 in periapical lesions has not been systematically examined. In the present study, we determined the role of HIF-1 in a wellcharacterised mouse periapical lesion model using two HIF-1α-activating strategies, dimethyloxalylglycine（DMOG） and adenovirusinduced constitutively active HIF-1α（CA-HIF1 A）. Both DMOG and CA-HIF1 A attenuated periapical inflammation and tissue destruction. The attenuation in vivo was associated with downregulation of nuclear factor-κappa B（NF-κB） and osteoclastic gene expressions. These two agents also suppressed NF-κB activation and subsequent production of proinflammatory cytokines by macrophages. Furthermore, activation of HIF-1α by DMOG specifically suppressed lipopolysaccharide-stimulated macrophage differentiation into M1 cells, increasing the ratio of M2 macrophages against M1 cells. Taken together, our data indicated that activation of HIF-1 plays a protective role in the development of apical periodontitis via downregulation of NF-κB, proinflammatory cytokines, M1 macrophages and osteoclastogenesis.

Long-term observation of the mineral trioxide aggregate extrusion into the periapical lesion:a case series

One-step apexification using mineral trioxide aggregate(MTA) has been reported as an alternative treatment modality with more benefits than the use of long-term calcium hydroxide for teeth with open apex.However,orthograde placement of MTA is a challenging procedure in terms of length control.This case series describes the sequence of events following apical extrusion of MTA into the periapical area during a one-step apexification procedure for maxillary central incisor with an infected immature apex.Detailed long-term observation revealed complete resolution of the periapical radiolucent lesion around the extruded MTA.These cases revealed that direct contact with MTA had no negative effects on healing of the periapical tissues.However,intentional MTA overfilling into the periapical lesion is not to be recommended.

Immediate implant placement in combination with platelet rich-fibrin into extraction sites with periapical infection in the esthetic zone:A case report and review of literature

BACKGROUND In this case,platelet-rich fibrin(PRF)was added to guided tissue regeneration as a biomaterial in proper order for immediate planting in aesthetic area with periapical infection.CASE SUMMARY With the history of endodontic failure in maxillary central incisor,a 34-year-old female patient required the extraction of maxillary anterior residual root and immediate implantation.Cone beam computed tomography and clinical observation were used to assess the regeneration of soft and bone tissue.Before operation,cone beam computed tomography showed the anterior residual root had serious periapical periodontitis with insufficient labial bone in the aesthetic zone.The patient underwent immediate implant placement and reconstruction of the bone substitution by modified guided bone regeneration.The barrier was a three-layer structure of PRF-collagen membrane-PRF that covered the mixture of PRF and Bio-Oss to promote both osteogenesis and soft tissue healing.At 6 mo postoperatively,the definitive crown was placed after accomplished finial impression.One-year follow-up showed a satisfactory aesthetic effect with no obvious absorption of the labial bone and soft tissue.CONCLUSION The use of PRF in combination with guided bone regeneration can serve as a reliable and simple adjuvant for immediate implanting in infected socket and result in a stable osteogenic effect with good aesthetic outcome.

Use of a new retrograde filling material(Biodentine) for endodontic surgery: two case reports

Mineral trioxide aggregate（MTA） is considered at the present time as the gold standard for root-end filling in endodontic surgery.However, this biocompatible material presents several drawbacks such as a long setting time and handling difficulties. The aim of this article is to present a new commercialized calcium silicate-based material named Biodentine with physical improved properties compared to MTA in a clinical application. Two endodontic microsurgeries were performed by using specific armamentarium（microsurgical instrumentation, ultrasonic tips） under high-power magnification with an operatory microscope. Biodentine was used as a root-end filling in order to seal the root canal system. The two cases were considered completely healed at 1 year and were followed for one more year. The 2-year follow-up consolidated the previous observation with absence of clinical symptoms and radiographic evidence of regeneration of the periapical tissues.

Six cases report of differential diagnosis of periapical diseases

The distinction of some particular forms of periapical area, involving diseases from regular periapical disease, is a matter of considerable importance when choosing a correct treatment. The aim of this study is to describe the differential diagnosis of F,eriapical diseases from six rare cases in clinical practice. The six rare cases are examples of situations where it is difficult to make a differential diagnosis in clinical practice. By retrospective surveys on the clinical examination, radiographs and pathological results, six patients referred to endodontic treatment in our department were analyzed for the accuracy of diagnosis and therapy. The pathoses of the six cases included two atypical radical cysts, periapical cemental dysplasia, cemento-ossifying fibroma, thymus cancer metastasis in the periapical site and tuberculosis. This report indicates that endodontists should be cognizant of a few particular circumstances when clinically treating periapical diseases.

Pulp revascularization on an adult mandibular right second premolar:A case report

BACKGROUND Pulp revascularization has become a new method for the treatment of periapical diseases in young permanent teeth in recent years.Through root canal flushing and disinfection,avoiding mechanical preparation,guiding apical stem cells into the root canal and promoting the continuous development of tooth roots,it has achieved good clinical curative effects.But in adult patients with chronic periapical periodontitis with immature roots and open apices,apical barrier technology is often used to treat these teeth.CASE SUMMARY Pulp revascularization of a 26-year-old patient's tooth was performed using cefaclor instead of minocycline and iRoot BP instead of mineral trioxide aggregate as intracanal medication.The case was followed up for 36 mo.Observations showed evidence of regression of clinical signs and symptoms,resolution of apical periodontitis and no discolouration of affected teeth.CONCLUSION For adult patients with chronic periapical periodontitis with immature roots and open apices,pulp revascularisation showed favourable results in treating these teeth.

Double Roots of Mandibular Premolar in Full-mouth Periapical Films

Objective To evaluate the incidence of two-rooted mandibular premolar morphology using full-mouth periapical film series in a Chinese population,with particular emphasis on bilateral incidence,so as to provide a clinical anatomical basis for root canal treatment in mandibular premolars.Methods A total of 2015 patients who underwent dental treatment and had full mouth periapical radiographs at the Peking University School of Stomatology from April 2011 to April 2012 were enrolled in this study.Three experienced dentists reviewed the patients' periapical films and classified the root morphology of mandibular premolars bilaterally.The incidence of unilateral and bilateral double roots were recorded and calculated,including confirmed and suspected bucco-lingual root types.Results In terms of the morphology of two-rooted mandibular first premolars,of the 2015 cases with complete root formation,two-rooted first premolars were detected in 120 cases,with a total number of 159 teeth.According to the number of teeth,the overall incidence of double roots was 4.03%(159/3972).In terms of the morphology of two-rooted mandibular second premolars,of the 2015 cases with complete root formation,two-rooted second premolars were detected in 24 cases,with a total number of 33 teeth.According to the number of teeth,the overall incidence of double roots was 0.85%(33/3880).Conclusions The roots of mandibular premolars display specific morphological patterns.Based on a large sample,we observed and calculated not only the occurrence rate of bucco-lingual and mesio-distal double roots in first and second mandibular premolars,but also the incidence of unilateral or bilateral double roots within the same mandible.These findings could provide useful information on the anatomical structure of mandibular premolars for endodontic,prosthodontic and surgical procedures,and could improve the quality of treatment and reduce complications.

Horizontally root fractured teeth with pulpal vitality——two case reports

This case study reports the successful outcome of horizontal root fractures of two different patients, which took place in permanent incisors. Report 1 describes a case of a 29-year-old patient who suffered a mandibular trauma affecting mainly the lower central incisors, caused by a car accident. A panoramic radiograph was taken right after the accident and showed a horizontal root fracture in the middle third of tooth 42, which went untreated. Report 2 illustrates a case of a 17-year-old male patient who searched for orthodontic therapy and the periapical radiograph showed horizontal root fracture in tooth 11 caused by a previous trauma, which went untreated as well. There was healing through the reestablishment of pulp activity and dental coloration without professional intervention.

Differentiation of periapical granulomas and cysts by using dental MRI: a pilot study

The purpose of this pilot study was to evaluate whether periapical granulomas can be differentiated from periapical cysts in vivo by using dental magnetic resonance imaging(MRI). Prior to apicoectomy, 11 patients with radiographically confirmed periapical lesions underwent dental MRI, including fat-saturated T2-weighted(T2 wFS) images, non-contrast-enhanced T1-weighted images with and without fat saturation(T1 w/T1 wFS), and contrast-enhanced fat-saturated T1-weighted(T1 wFS+C) images. Two independent observers performed structured image analysis of MRI datasets twice. A total of 15 diagnostic MRI criteria were evaluated, and histopathological results(6 granulomas and 5 cysts) were compared with MRI characteristics. Statistical analysis was performed using intraclass correlation coefficient(ICC), Cohen’s kappa(κ), Mann–Whitney U-test and Fisher’s exact test. Lesion identification and consecutive structured image analysis was possible on T2 wFS and T1 wFS+C MRI images. A high reproducibility was shown for MRI measurements of the maximum lesion diameter(intraobserver ICC = 0.996/0.998; interobserver ICC = 0.997), for the "peripheral rim" thickness(intraobserver ICC = 0.988/0.984; interobserver ICC = 0.970), and for all non-quantitative MRI criteria(intraobserver-κ = 0.990/0.995; interobserver-κ = 0.988). In accordance with histopathological results, six MRI criteria allowed for a clear differentiation between cysts and granulomas:(1) outer margin of lesion,(2) texture of "peripheral rim" in T1 wFS+C,(3)texture of "lesion center" in T2 wFS,(4) surrounding tissue involvement in T2 wFS,(5) surrounding tissue involvement in T1 wFS+C and(6) maximum "peripheral rim" thickness(all: P < 0.05). In conclusion, this pilot study indicates that radiation-free dental MRI enables a reliable differentiation between periapical cysts and granulomas in vivo. Thus, MRI may substantially improve treatment strategies and help to avoid unnecessary surgery in apical periodontitis.

A randomized retrospective clinical study on the choice between endodontic surgery and immediate implantation

Background:Periapical endodontic surgery(PES)for root amputation and tooth replacement by immediate implant placement are two possible treatment options for bone lesions in the root apex of a tooth that has previously undergone endodontic treatment.Treatment methods are performed when the effectiveness of orthograde canal revision is questionable or when such treatment cannot be performed.The effectiveness of these methods varies from study to study.Objective:clinical evaluation of the efficacy of periapical endodontic surgery for root amputation and immediate implant placement with simultaneous tooth extraction in the proximate and long-term treatment.Materials and methods:The study included 183 patients between the ages of 24 and 63.Patients were divided into 2 groups;group I-endodontic surgery was performed to resect the apex of the tooth root(108 patients)and group II-an operation to install an implant with simultaneous tooth extraction(75 patients).In group I,in 36 cases,PES was performed in the area of the first molars and premolars,and 72 cases in the area of incisors and canines.In group II,75 patients received 231 implants.Results:In all 108 patients of group I in the postoperative period and within 1 month,the wounds healed without complications.In none of the 36 operated premolars and molars,there was no definitive elimination of the radiographic bone loss(Rude grade 2 and 3)after 12 months.In the area of incisors and canines,complete healing was observed only in 37.5%of cases(I class according to Rud).In group II,out of 184 implants installed immediately after tooth extraction,one was removed one month after implantation.In other cases,all implants were successfully integrated with the subsequent fabrication of prosthetic construction.Conclusion:The complex“implant(installed in the socket of the tooth immediately after its removal)-bone-soft tissues-prosthetic construction”is stable over time in terms of functional and aesthetic parameters,preservation of bone tissue,and mucous membrane.

Host-derived biomarkers in gingival crevicular fluid for complementary diagnosis of apical periodontitis

Apical periodontitis(AP) develops as a result of the host's immune inflammatory response to pulpal infection of the dental root canals that leads to the generation of an apical lesion of endodontic origin(ALEO) and potentially to systemic metabolic alterations. Misdiagnosed ALEO is not infrequent due to the lack of diagnostic tools to differentiate apical lesions of different natures. Despite the conservative endodontic treatment shows a high success rate, there are refractory cases that can not be identified early enough during follow up. This evidences the need to develop complementary diagnostic tools, such as oral fluid biomarker analysis. Gingival crevicular fluid(GCF) is a serum transudate that becomes an exudate under inflammatory conditions, carrying molecules from local periodontal tissuesand general circulation than can be harvested noninvasively. We aimed to review the available literature analyzing GCF composition in AP patients to evaluate whether GCF has any potential for complementary diagnosis. To the date, only few studies addressing changes of GCF components in AP are available. Most studies support GCF modifications in specific components in APaffected teeth, suggesting that it might reflect periapical inflammation. GCF has potential for diagnostic tool, treatment follow-up and eventually to assess systemic comprise.

Evaluation of 4 different bone graft substitutes and autogenous bone grafting in root-end resection osteotomies after retrograde root-filling with Intermediate Restorative Material(IRM):An experimental study in dogs

Purpose: To investigate the periapical tissue response after root end filling with intermediate restorative material (IRM) and filling of the root-end resection bone defects with autogenous bone or a bone graft substitute in comparison to empty controls. Materials and Methods: Vital roots of the second, third and fourth mandibular premolars in six healthy mongrel dogs were apectomized. The root canals were prepared and sealed with IRM following a standardized surgical procedure. The resection bone defects were either filled with autogenous bone (PB) or one of the bone graft substitutes;CERAMENTTM|BONE VOID FILLER, ChronOS?, TigranTM PTG, Easygraft? CLASSIC or left empty. After 120 days the animals were sacrificed and the specimens were analyzed radiologically and histologically. Kruskal-Wallis and Mann-Whitney tests were performed for statistical evaluation. Results: 34 sections were analyzed histologically. The evaluation revealed a variation in the outcome amongst the tested options, regarding reestablishment of the periapical bone healing and inflammatory infiltration in the sections. According to the tested variables, there was no statistical significant difference between the materials when comparing all groups as a whole. When comparing individual materials to each other there was statistical differences among some of the tested materials. Conclusion: The healing outcome after periapical surgery of a five-wall resection defect could not be increased by infill with autogenous bone or bone graft substitutes. The most important factor for the healing outcome in periapical surgery is the quality of the root-end sealing. The healing outcome after some of the tested bone substitutes, might be improved by longer healing time.

Implant Placement in a Cemento-Osseous Dysplasia:A case report

We present a 45-year-old black woman diagnosed with a florid cemento-osseous dysplasia(FCOD)affecting the right lower quadrant and the anterior mandibular region.The patient requested dental implants to rehabilitate the edentulous central lower incisors area(teeth#31 and#41)corresponding to a periapical cemento-osseous dysplasia(PCOD).Successful osseointegration of the two implants was obtained using a two-step procedure in order to limit the risk of complications associated with implant placement.Follow-up at one year showed no recurrence and good implant stability.Due to the abnormal quality of the bone in cemento-osseous dysplasia(COD),implant placement is generally avoided,and no other case reports have been reported in the literature in patients affected by PCOD.The present case suggests that in an appropriate clinical setting,implant placement may be a successful procedure.

Exploring the practice of common oral diseases among the patients visiting in the selected dental college and hospital in Bangladesh

Background:Having the ability to identify potential health risk factors such as lifestyle,ethnicity,health status,and social determinants associated with oral health status risk,health care providers can take an active role in health screening to discover any need for clinical preventive services,including dental preventive services,and can detect health problems.Methods:A descriptive type of cross-sectional study was conducted to explore the practice of common oral diseases among the patients visiting in the selected dental college and hospital in Bangladesh from October 2019 to December 2019.About 100 patients were interviewed through a semi-structured questionnaire,followed by an oral examination through a checklist and a face-to-face interview.A systematically random sampling technique was employed to select the study population.Results:Among them,the(21-30)year age group shows a maximum 20%,whereas the(71-80)year age group represents the minority with only 2%.Among them,56%were male and 44%were female.Students represent the majority of 26%,whereas others(day laborers)represent only 4%.Decayed teeth remained in 72%of cases,teeth were missing in 31%of cases,and filled teeth were present in 24%of cases.A majority of 71%clean teeth once daily,whereas only 29%clean teeth twice daily.Again,only 30%brush teeth at night and a maximum of 95%brush teeth in the morning.Moreover,a maximum of 68%use toothpaste and brushes,while only 4%use meswak for cleaning their teeth.About 4%of cases with no debris,51%of cases with less than 1/3rd of the tooth with debris,32%of cases with 1/3rd-2/3rd of the tooth with debris,and 13%of cases with more than 2/3rd of the tooth with debris were present.Again,about 30%had no calculus,52%less than 1/3rd of tooth,16%in between 1/3rd and 2/3rd of tooth,and 2%more than 2/3rd of the calculus was present.About 47%of mild,22%of moderate,6%of severe and 25%had no inflammation.Furthermore,for treatment purposes,20.69%was advised for scaling,19.66%for filling,16.90%for root canal treatment,17.59%for extraction,17.24%for prosthodontic treatment,1.03%for orthodontic treatment,2.07%for pulpotomy,2.41%for pulpectomy,and 2.41%for minor surgery.Overall,about 72%of the respondents,mostly the students,are suffering from decayed teeth,which may be due to a lack of frequency of brushing,indicating 95%that it is once daily.In addition,the most alarming situation among them is about 20.69%required scaling,which may be due to improper and inadequate brushing maintenance.Conclusion:to some extent,the above scenario may reflect the negative hallmark for our country’s younger generation in terms of oral health practice.Therefore,the establishment of a preventive oral health policy by our policymakers for the general population,mostly school-going students,on an emergency basis.

Preliminary molecular analysis of bacterial composition in periapical lesions with primary endodontic infections of deciduous teeth

Background The bacterial composition of periapical lesions in deciduous teeth has not been well documented.This study was designed to explore the bacterial compositions,especially the dominant bacteria in periapical lesions using 16S rRNA sequencing.Methods Tissue samples were collected from 11 periapical lesions in deciduous teeth with primary endodontic infections.DNA was extracted from each sample and analyzed using 16S rRNA cloning and sequencing for the identification of bacteria.Results All DNA samples were positive for 16S rRNA gene PCR.One hundred and fifty-one phylotypes from 810 clones were identified to eight phyla,and each sample contained an average of 25.9 phylotypes.In addition,59 phylotypes were detected in more than two samples,and Fusobacterium （F.） nucleatum （8/11）,Dialister （D.） invisus （8/11）,Campylobacter （C.） gracilis （7/11）,Escherichia （E.） coil DH1 （6/11）,Aggregatibacter （A.） segnis （6/11）,and Streptococcus （S.） mitis （6/11） were the most prevalent species.Furthermore,45 as-yet-uncultivated phylotypes were also identified.Conclusions Chronic periapical lesions in deciduous teeth contained polymicrobial infections.F.nucleatum,D.invisus,C.gracilis,E.coli DH1,A.segnis,and S.mitis were the most prevalent species detected by 16S rRNA sequencing.

Antrochoanal polyp derived from periapical granuloma

Antrochoanal polyp （ACP） is an infrequent, benign polypoid lesion that stems from the edematous mucosa of the maxillary sinus, grows from the natural or accessory ostium to the middle meatus, and protrudes toward the choana and nasopharynx. Although the exact causes of ACP are still unknown, chronic sinusitis, allergy, and lower respiratory tract infections are often related to ACE2 Our report is an ACP arising from a secondary infection of the periapical granuloma in the maxillary sinus. Its possible pathological mechanism, unique clinical features, and treatment are also discussed.

Cathepsin C promotes the progression of periapical periodontitis

Although the role of cathepsin C (Cat C) in inflammation is gradually being elucidated, its function in periapical periodontitis, which is one of the most common infectious diseases worldwide, has not been studied. This study evaluated a surgically-induced model of periapical periodontitis in cathepsin C (Cat C) knock-down (KD) mice, which was constructed with a tetracycline operator, to evaluate the role of Cat C in the pathogenesis and progression of periapical periodontitis. Our results showed, for the first time, that there was a statistically significant increase in the expression of Cat C as periapical periodontitis progressed;this increase started from 1 week after surgery and reached a peak at 3 weeks after surgery, before gradually decreasing. The volume of periapical bone resorption in Cat C KD mice was significantly smaller than that in wild-type mice at 3 and 4 weeks after surgery (P<0.05). Inflammatory cell infiltration into the apical tissues of wild-type mice was also significantly higher than that of Cat C KD mice. The expression of receptor activator of nuclear factor-j B ligand (RANKL) in wild-type mice was also higher than that in Cat C KD mice. The difference in the number of osteoclasts in the apical area between the two groups was statistically significant after 2 weeks. Correlation analysis showed that there was a significant correlation between Cat C and RANKL expression (r= 0.835). Therefore, our data indicated that Cat C promoted the apical inflammation and bone destruction in mice.