BACKGROUND The complex anatomy of the maxillary first molars has always been a major challenge for complete root canal treatment in endodontic therapy. Here, we present two cases of maxillary first molars, each with o...BACKGROUND The complex anatomy of the maxillary first molars has always been a major challenge for complete root canal treatment in endodontic therapy. Here, we present two cases of maxillary first molars, each with only two root canals, which have been rarely reported. We also perform a literature review of maxillary first molar anatomy.CASE SUMMARY The two patients were referred to the hospital after 1) finding a cavity in their tooth with a color change and, 2) a toothache during mastication, respectively.Both of these cases were diagnosed as apical periodontitis by X-ray imaging and cone beam computed tomography(CBCT). Non-surgical endodontic therapy was performed with the assistance of a dental operating microscope(DOM). CBCT showed rare but accurate images of both patients, each with two root canals and two roots in their maxillary first molars. Both roots were located in the buccal in the palatal direction, and each root had only one clear root canal. In addition,each maxillary first molar in both patients was symmetrical to that on the opposing side with only two separate root canals. Non-surgical endodontic therapy was performed with the assistance of a DOM. Finally, the teeth were restored using composite resin and the patients were satisfied with the results.CONCLUSION Making full use of CBCT and DOM would contribute to helping dentists make correct diagnoses and successfully treat teeth with rare root canal morphologies.展开更多
BACKGROUND Root canal retreatment is common after root canal therapy in clinical situations.Especially,completing the retreatment of variant root canals can be challenging.This is particularly true for the molars loca...BACKGROUND Root canal retreatment is common after root canal therapy in clinical situations.Especially,completing the retreatment of variant root canals can be challenging.This is particularly true for the molars located at the end of the dental arch.However,advancements in digital dental diagnosis and treatment techniques can solve these problems.Here,we describe a case of a maxillary second molar with a variant distobuccal root canal treated via a novel“inlay-guided endodontics”technique based on improved computer-generated programs.CASE SUMMARY A 63-year-old man complained of a defect in the maxillary left second molar.The tooth,diagnosed with post-treatment endodontic disease,was initially treated by conventional methods,which were ineffective.Our“inlay-guided endodontics”technique was subsequently adopted,with the establishment of a precise integrated three-dimensional(3D)plate model of cone-beam computed tomography data and a digital impression of the dentition.An optimal root canal approach was generated for the“virtual file”in the 3D model.The plate data were imported into a 3D printer and printed.With the help of the guide plate,the file was accurately placed into the cervical third of the distal root canal.The root canal and prosthodontic treatments successfully proceeded subsequently.CONCLUSION Our newly developed inlay guide plates may facilitate individualized and minimally invasive root canal treatment.展开更多
BACKGROUND Fused teeth usually involve several complications,such as the development of caries in the groove between fused crowns,tooth impaction,diastemas,aesthetic and periodontal problems,and pulpal pathosis,due to...BACKGROUND Fused teeth usually involve several complications,such as the development of caries in the groove between fused crowns,tooth impaction,diastemas,aesthetic and periodontal problems,and pulpal pathosis,due to the complex anatomical structure of fused teeth.A thorough diagnosis is paramount to forming an accurate treatment plan and obtaining a favourable prognosis.With the advent of cone-beam computed tomography(CBCT),accurate 3-dimensional images of teeth and their surrounding dentoalveolar structures can now be readily obtained,and the technology can accurately provide a minimally invasive approach to acquire detailed diagnostic information.Therefore,we utilize CBCT data herein to generate a digital model for the infected region in a patient,and this model enables us to better plan the management of his case.CASE SUMMARY This report details the diagnosis and endodontic treatment of a rare case involving a fused maxillary second molar and two paramolars with apical periodontitis.The patient experienced pain upon biting and cold sensitivity in the area of the maxillary left molar.No caries or other defects were identified in these teeth,and a normal response to a pulp electric viability test was observed.With the aid of CBCT and digital model technology,we initially suspected that the infection originated from the isthmus between the maxillary second molar and two paramolars.Therefore,we only treated the isthmus by an endodontic approach and did not destroy the original tooth structure;furthermore,the vital pulp was retained,and good treatment outcomes were observed at the 24-month follow-up.CONCLUSION This finding may provide new insights and perspectives on the diagnosis and treatment of fused teeth.展开更多
背景:研究显示,牙髓治疗后牙齿尤其是磨牙牙齿的存留率明显低于活髓牙,失牙危险比为7.4∶1。随着组织再生观念的进步与生物医用材料的发展,人们开始寻求提高牙齿存留率的新型牙髓治疗方式。目的:文章就各种生物材料的临床效果、应用现...背景:研究显示,牙髓治疗后牙齿尤其是磨牙牙齿的存留率明显低于活髓牙,失牙危险比为7.4∶1。随着组织再生观念的进步与生物医用材料的发展,人们开始寻求提高牙齿存留率的新型牙髓治疗方式。目的:文章就各种生物材料的临床效果、应用现状及研究前景做一综述,以帮助临床医师在活髓保存中选择合适的生物材料。方法:以中文检索词“活髓保存,氢氧化钙,MTA,iRoot BP Plus,Biodentine,TheraCal LC,BioAggregate”检索CNKI、万方数据库;以英文检索词“vital pulp therapy,MTA,iRoot BP Plus,Biodentine,TheraCal LC,BioAggregate”检索PubMed数据库,检索时间范围重点为2011年1月至2021年11月。通过阅读文献题目、摘要及全文筛选,最后纳入56篇文献进行综述。结果与结论:①在微创治疗中,为改善预后并且提高牙齿的保存期,除了追求剩余牙体硬组织的完整性外,应尽量保留健康的牙髓组织,活髓保存不仅对根尖未发育完善的年轻恒牙具有重要意义,对于根尖发育完善的恒牙也意义重大;②氢氧化钙是临床上应用时间最长的盖髓剂,其效果稳定、价格低廉,但无法严密封闭牙髓,所诱导形成的牙本质桥存在隧道样缺损,预后不佳;③三氧化矿物凝聚体的生物相容性优于氢氧化钙,封闭性好,能有效控制炎症,同时也存在着价格高、凝固时间长、可能导致牙冠变色等问题;④近年来,iRoot BP Plus、Biodentine、TheraCal LC、BioAggregate等新型生物材料也逐渐走入临床视野,展现出了光明的前景,仍有待于进一步的临床研究。然而无论使用何种盖髓材料,适应证的准确选择是成功保留健康牙髓组织的关键。展开更多
文摘BACKGROUND The complex anatomy of the maxillary first molars has always been a major challenge for complete root canal treatment in endodontic therapy. Here, we present two cases of maxillary first molars, each with only two root canals, which have been rarely reported. We also perform a literature review of maxillary first molar anatomy.CASE SUMMARY The two patients were referred to the hospital after 1) finding a cavity in their tooth with a color change and, 2) a toothache during mastication, respectively.Both of these cases were diagnosed as apical periodontitis by X-ray imaging and cone beam computed tomography(CBCT). Non-surgical endodontic therapy was performed with the assistance of a dental operating microscope(DOM). CBCT showed rare but accurate images of both patients, each with two root canals and two roots in their maxillary first molars. Both roots were located in the buccal in the palatal direction, and each root had only one clear root canal. In addition,each maxillary first molar in both patients was symmetrical to that on the opposing side with only two separate root canals. Non-surgical endodontic therapy was performed with the assistance of a DOM. Finally, the teeth were restored using composite resin and the patients were satisfied with the results.CONCLUSION Making full use of CBCT and DOM would contribute to helping dentists make correct diagnoses and successfully treat teeth with rare root canal morphologies.
基金the Youth Development Project of Army Military Medical University,No.2018XQN014the Clinical Innovation Project of Army Military Medical University,No.2019XLC2014the Science and Technology Foundation of Chongqing,China,No.cstc2014jcyjA10092.
文摘BACKGROUND Root canal retreatment is common after root canal therapy in clinical situations.Especially,completing the retreatment of variant root canals can be challenging.This is particularly true for the molars located at the end of the dental arch.However,advancements in digital dental diagnosis and treatment techniques can solve these problems.Here,we describe a case of a maxillary second molar with a variant distobuccal root canal treated via a novel“inlay-guided endodontics”technique based on improved computer-generated programs.CASE SUMMARY A 63-year-old man complained of a defect in the maxillary left second molar.The tooth,diagnosed with post-treatment endodontic disease,was initially treated by conventional methods,which were ineffective.Our“inlay-guided endodontics”technique was subsequently adopted,with the establishment of a precise integrated three-dimensional(3D)plate model of cone-beam computed tomography data and a digital impression of the dentition.An optimal root canal approach was generated for the“virtual file”in the 3D model.The plate data were imported into a 3D printer and printed.With the help of the guide plate,the file was accurately placed into the cervical third of the distal root canal.The root canal and prosthodontic treatments successfully proceeded subsequently.CONCLUSION Our newly developed inlay guide plates may facilitate individualized and minimally invasive root canal treatment.
基金Supported by the Innovative Talents Promotion Program-Youth Science and Technology Star Project,No. 2019KJXX-086Shaanxi Provincial Natural Science Basic Research Foundation of China,No. 2019JM-376National Nature Science Foundation of China,No. 81970929
文摘BACKGROUND Fused teeth usually involve several complications,such as the development of caries in the groove between fused crowns,tooth impaction,diastemas,aesthetic and periodontal problems,and pulpal pathosis,due to the complex anatomical structure of fused teeth.A thorough diagnosis is paramount to forming an accurate treatment plan and obtaining a favourable prognosis.With the advent of cone-beam computed tomography(CBCT),accurate 3-dimensional images of teeth and their surrounding dentoalveolar structures can now be readily obtained,and the technology can accurately provide a minimally invasive approach to acquire detailed diagnostic information.Therefore,we utilize CBCT data herein to generate a digital model for the infected region in a patient,and this model enables us to better plan the management of his case.CASE SUMMARY This report details the diagnosis and endodontic treatment of a rare case involving a fused maxillary second molar and two paramolars with apical periodontitis.The patient experienced pain upon biting and cold sensitivity in the area of the maxillary left molar.No caries or other defects were identified in these teeth,and a normal response to a pulp electric viability test was observed.With the aid of CBCT and digital model technology,we initially suspected that the infection originated from the isthmus between the maxillary second molar and two paramolars.Therefore,we only treated the isthmus by an endodontic approach and did not destroy the original tooth structure;furthermore,the vital pulp was retained,and good treatment outcomes were observed at the 24-month follow-up.CONCLUSION This finding may provide new insights and perspectives on the diagnosis and treatment of fused teeth.
文摘背景:研究显示,牙髓治疗后牙齿尤其是磨牙牙齿的存留率明显低于活髓牙,失牙危险比为7.4∶1。随着组织再生观念的进步与生物医用材料的发展,人们开始寻求提高牙齿存留率的新型牙髓治疗方式。目的:文章就各种生物材料的临床效果、应用现状及研究前景做一综述,以帮助临床医师在活髓保存中选择合适的生物材料。方法:以中文检索词“活髓保存,氢氧化钙,MTA,iRoot BP Plus,Biodentine,TheraCal LC,BioAggregate”检索CNKI、万方数据库;以英文检索词“vital pulp therapy,MTA,iRoot BP Plus,Biodentine,TheraCal LC,BioAggregate”检索PubMed数据库,检索时间范围重点为2011年1月至2021年11月。通过阅读文献题目、摘要及全文筛选,最后纳入56篇文献进行综述。结果与结论:①在微创治疗中,为改善预后并且提高牙齿的保存期,除了追求剩余牙体硬组织的完整性外,应尽量保留健康的牙髓组织,活髓保存不仅对根尖未发育完善的年轻恒牙具有重要意义,对于根尖发育完善的恒牙也意义重大;②氢氧化钙是临床上应用时间最长的盖髓剂,其效果稳定、价格低廉,但无法严密封闭牙髓,所诱导形成的牙本质桥存在隧道样缺损,预后不佳;③三氧化矿物凝聚体的生物相容性优于氢氧化钙,封闭性好,能有效控制炎症,同时也存在着价格高、凝固时间长、可能导致牙冠变色等问题;④近年来,iRoot BP Plus、Biodentine、TheraCal LC、BioAggregate等新型生物材料也逐渐走入临床视野,展现出了光明的前景,仍有待于进一步的临床研究。然而无论使用何种盖髓材料,适应证的准确选择是成功保留健康牙髓组织的关键。
