Littérature scientifique sur le sujet « Nonvital teeth »

SUMMARY Objective: This randomized clinical trial evaluated the effect of 35% hydrogen peroxide in comparison with 37% carbamide peroxide in a nonvital bleaching technique of “walking bleaching” (four sessions of treatment) on periodontal markers: nuclear factor kappa B-ligand (RANK-L—process of root resorption marker) and interleukin 1β (IL-1β—inflammatory response marker). Methods and Materials: Fifty volunteers presenting with discoloration of nonvital teeth and endodontic treatment in good condition participated. Fifty teeth were randomly divided into two study groups according to bleaching gel: HP = 35% hydrogen peroxide (n=25) and 37% carbamide peroxide (n=25). Nonvital bleaching was performed with a walking bleaching technique consisting of four sessions of bleach application. Gingival crevicular fluid samples were taken in order to quantify the RANK-L and IL-1β levels by enzyme-linked immunosorbent assay. Samples were obtained from six periodontal sites for each bleached tooth: three vestibular and three palatine (mesial, middle, and distal) at seven time periods: baseline, after each of the four sessions of nonvital bleaching, at one week, and at one month after nonvital bleaching. Tooth color variations were analyzed in each session by VITA Bleachedguide 3D-MASTER (ΔSGU). Results: Significant increments in the RANK-L and IL-1β levels were detected in each evaluated time compared with baseline (p<0.05); however, no differences were detected between hydrogen peroxide and carbamide peroxide on increments of the biomarkers studied. The change of color was effective for both nonvital bleaching therapies (p<0.05). Conclusions: Nonvital bleaching induced a significant increment in the RANK-L and IL-1β levels in periodontal tissues around bleached, nonvital teeth.

Our prospective study analyzed clinical, radiographic, and histological characteristics of 102 intrinsically stained teeth. Sixty-nine dogs ranging from one to fifteen years of age were included in this study. Little more than half of the intrinsically stained teeth had no evidence of coronal injury (53.9%, 55/102). We found that most intrinsically stained teeth were histologically nonvital (87.6%, 85/97) and approximately 2/3 of these (57.7%, 56/97) had no histological endodontic or periodontal inflammation at the time of evaluation. Radiographic evidence of endodontic disease was present in 57% (58/102) of the intrinsically stained teeth. Radiographic evidence of periodontal disease was present in 48% (49/102) of intrinsically stained teeth and 28% (29/102) had radiographic evidence of tooth resorption. 18.6% (19/102) of intrinsically stained teeth were radiographically normal. Evidence of pulp necrosis was common in these intrinsically stained teeth, while only occasional teeth (12.4%, 12/97) had histologically confirmed pulpitis. All teeth with radiographic evidence of periapical lucency had pulp necrosis. Based on our histological findings, the majority of intrinsically stained teeth 87.6% are truly nonvital.

SUMMARY Objective: This trial evaluates the impact of psychosocial and esthetic self-perceptions of patients undergoing nonvital tooth bleaching using the walking bleach technique. We also assessed the clinical effectiveness of bleaching tooth discoloration. Methods: Fifty volunteers with nonvital tooth discoloration were enrolled. Teeth were randomized into two groups: 35% hydrogen peroxide (n=25) and 37% carbamide peroxide (n=25). Intracoronal bleaching was performed over four sessions using the walking bleach technique. Tooth color was evaluated at each session to measure total color variation. The shade guide was arranged from highest (B1) to lowest (C4) values to assess the color and calculate the color change in the number of shade guide units. Subjective and objective assessments were compared with the tooth counterpart. Esthetic self-perception and psychosocial factors were assessed before and after treatment. Results: Color change was 15.48<5.17 for hydrogen peroxide and 14.02<4.85 for carbamide peroxide. There was no significant difference at any time point (p>0.05) except at sessions 3 and 4 (p<0.05). Overall, whitened teeth values were similar to those of counterpart teeth (p>0.05). There was a decrease in Oral Health Impact Profile and Psychosocial Impact of Dental Esthetics questionnaire scores after treatment compared with baseline (p<0.05). Conclusion: The walking bleach technique was highly effective on nonvital teeth and had a positive effect on self-esthetic perception and psychological impact for the patients.

AbstractA 9-year-old child reported with chief complaint of broken teeth (11 and 21) and discolored tooth (21). Diagnosis of pulp necrosis with apical periodontitis with regard to 11 and 21 was made based on clinical and radiographic examination. The canals were irrigated with sodium hypochlorite and then dried with paper points. Disinfection of canals was done using photoactivated disinfection (PAD). Platelet-rich fibrin (PRF) was placed as scaffold in canals till the cementoenamel junction (CEJ). A 2-mm thick layer of white MTA was placed, followed by dual seal using glass–ionomer cement (GIC) and composite resin. Follow-up examination was done for 1 year. Clinical examination showed no pain, tenderness on percussion, and no mobility and improvement in color of teeth. Radiographic evaluation revealed continued thickening of the dentinal walls, root lengthening, regression of the periapical lesion, and partial apical closure. This report of pulp revascularization shows that disinfection with photodynamic therapy combined with PRF resulted in satisfactory root development in necrotic immature teeth.

Immature permanent teeth with crown fractures present a unique challenge in human and animal patients. Immature permanent teeth have not yet developed completely, often presenting with thin dentin walls, incomplete apical formation, and increased crown-to-root ratios. Loss of pulp function at this stage has devastating long-term implications for these teeth. Ideally, attempts should be made to preserve pulp vitality in immature permanent teeth to allow for continued dental development. The range of treatment options for vital teeth includes odontoplasty with bonding and sealing +/− restoration, indirect pulp capping, and direct pulp capping/vital pulp therapy. These treatments have long been established in human and veterinary medicine, and cases have been reported in dogs and cats. Apexification using calcium hydroxide is a well-established treatment for nonvital immature teeth. The advent of mineral trioxide aggregate and other bioceramic materials for use in vital pulp therapy and apexification has reduced treatment sessions and improved outcomes. Recent developments in the field of regenerative endodontic therapy further expand treatment options and provide the possibility for continued development of a formerly nonvital tooth. Selecting the appropriate treatment based on the severity of tooth fracture and status of pulp vitality can avoid a lifetime of poor structure and function for the affected tooth. This article provides multiple step-by-step protocols for the management of immature permanent teeth with crown fractures in small animals.

A common problem encountered by dentists is the restorative treatment of nonvital teeth. When the pulp chamber presents appropriate conditions for retention, the endocrown is indicated. This monolithic, ceramic adhesive restoration is singularly used yet warrants wider recognition and use. The endocrown allows preservation of the tooth structure and is minimally invasive. Currently, this treatment option, of a core buildup and full coverage restoration, reduces tooth structure excessively. This treatment presents not only functional limitations but also aesthetic concerns. Recently, the VITA-PM9 system, a leucite-reinforced glass ceramic, has been increasingly used in a variety of clinical situations due to its satisfactory physical-mechanical and aesthetic properties. Therefore, the present study describes a case of surgical restoration of a nonvital tooth using the endocrown technique and the VITA-PM9.

ABSTRACT Achievement of a perfect apical seal in the case of a traumatized nonvital open apex tooth is one of the most important factors affecting its long-term success. It can be treated surgically by placing a retrofill or by a nonsurgical approach by apexification. Currently, apexification with mineral trioxide aggregate (MTA) is the treatment of choice in such cases. Herein, due to large apical diameter, limiting the MTA within the canal space is challenging, making it imperative to use a suitable apical matrix. This case report demonstrates successful management of traumatized nonvital open apex teeth with MTA apexification using demineralized freeze-dried bone allograft apical matrix. How to cite this article Bolli RV, Sumanthini MV, Shenoy VU, Agrawal AM. Management of Traumatized Open Apex Teeth with Mineral Trioxide Aggregate Apexification and Demineralized Freeze-dried Bone Allograft as Apical Matrix. J Contemp Dent 2016;6(3):194-199.

Context: LSTR 3 Mix MP therapy is one of the procedures for the management of nonvital tooth with periapical lesion. The principle of this therapy is the complete sterilization of the total pulp canal space, thereby healing of the periradicular lesion. Objectives: To assess the clinical and radiological outcome of ‘Lesion sterilization and Tissue Repair’ (LSTR) for endodontic treatment of nonvital teeth with periapical lesion. Materials and Methods: This descriptive, observational study allocated 40 nonvital teeth with periapical lesion treated by LSTR 3 Mix MP Therapy. In study subjects, a mixture of Metronidazole, Ciprofloxacin and Minocycline (3 Mix) in a proportion of 1:1:1 in ointment (Macrogol mixed with propylene glycol: MP) was placed at the orifice of the root canal or the bottom of pulp chamber after gaining access in the pulp chamber and removal of necrotic pulp, then sealed with Glass Ionomer cement and further reinforced by composite resin. The protocols for follow up examination were 3, 6 and 12 months post operatively. At the time of follow up examination a standard follow up chart was maintained. Results: Out of 40 cases, in 29 cases had good responses both clinically and radiologically and 8 patients came back with some complications. Out of these 8 patients, 6 patients had uncertain outcome and in 2 patients it was unacceptable. Conclusion: LSTR 3 mix MP therapy reduced clinical signs and symptoms successfully in teeth with periapical lesion and radiological improvement of the periapical index was also noted. TAJ 2020; 33(2): 76-84

Os pacientes, cada vez mais, têm sido atraídos pela estética. Muitas vezes, a alteração de cor dos dentes compromete a harmonia do sorriso. As alterações de cor podem estar presentes nos dentes vitalizados, podendo ser fisiológicas ou relacionadas ao uso incorreto de medicamentos. Podem, também, estar presentes nos dentes tratados endodonticamente, neste caso, o escurecimento pode relacionar-se aos produtos de degeneração pulpar ou ao uso inadequado dos materiais. Para tentar resolver estes problemas existem as técnicas de clareamento dental, que têm por objetivo devolver a harmonia estética do sorriso, tendo como grande vantagem a conservação da estrutura dental, além de ser um procedimento mais simples e barato do que os procedimentos que envolvem trabalhos protéticos. As técnicas de clareamento são diferentes para o tratamento de dentes vitalizados e não vitalizados. O objetivo deste trabalho foi avaliar a efetividade de quatro técnicas para clarear dentes não vitais. Foram utilizados 40 dentes bovinos, manchados artificialmente com sangue. Após o manchamento, os dentes foram divididos em 4 grupos de 10 dentes e cada grupo recebeu um tratamento diferente. As técnicas utilizadas foram as seguintes: Hi-Lite ativado por luz halógena, peróxido de hidrogênio ativado por laser de argônio, peróxido de hidrogênio ativado por espátula aquecida e "walking bleach". Os resultados mostraram que as quatro técnicas foram eficientes, capazes de promover o efeito clareador de maneira satisfatória. Porém, existiram diferenças estatisticamente significantes em relação à tonalidade de cor. Os grupos tratados com peróxido de hidrogênio ativado pelo laser de argônio e pela técnica "walking bleach" apresentaram resultados estéticos superiores em relação aos grupos tratados com Hi-Lite ativado por luz halógena e peróxido de hidrogênio ativado por espátula aquecida.
The patients more and more have been attracted by aesthetics. Many times the discoloration that occurs in the teeth compromises the smile harmony. These shade alterations should happen in vital teeth and could be physiological or related to some medicine and should happen in nonvital teeth too. In this case the darkness should be due to products of pulpal decomposition or due to the incorrect use of medicaments. Trying to solve this problem there are bleaching techniques to be used on the discolored tooth. Bleaching procedure provides an alternative more conservative and cheap modality for treating discolored teeth compared to prosthesis preserving dental structure and turning back the smile aesthetics and harmony. Bleaching systems are different for treating vital and nonvital teeth. The purpose of this research is the evaluation of the effectiveness of four techniques to lighten nonvital teeth. Forty bovine teeth were used, artificially stained with blood. The four techniques used were the following : Hi-Lite activated by halogen light hydrogen peroxide activated by argon laser, hydrogen peroxide activated by heated instrument and walking bleach. The teeth were stained and divided into four groups of ten teeth and each group received a different treatment. The results showed that the four techniques were effective and able to promote satisfactory bleaching. However, some statistically significant differences related to the shades were noted. The two groups: hydrogen peroxide activated by argon laser and walking bleach, showed better aesthetics results in comparison to the other two groups: Hi-Lite activated by halogen light and hydrogen peroxide activated by heated instrument.

Les Traitements Endodontiques Régénératifs (TER) des dents immatures sont une alternative au traitement endodontique classique. Ces procédures s’appliquent après une désinfection et une préparation mécanique du canal radiculaire. Suite au saignement du périapex le sang remonte dans le canal en créant un caillot. Après sa réorganisation en un tissu conjonctif vascularisé, il peut remplacer le tissu endommagé et poursuivre l’apexogénèse. Les résultats des TER sont encourageants mais pas constants dû à une désinfection incomplète, une variabilité des cellules et des facteurs de croissance du sang, des propriétés mécaniques faibles et une dégradation rapide du caillot. Afin d’améliorer ces procédures, cette thèse a thèse a été conduite sur trois axes en ayant pour objectif de développer deux biomatériaux, un résorbable sous la forme de gel injectable et un non-résorbable.1)Mise au point et caractérisation d’un hydrogel à base de Fibrinogène et de sang.Afin d’améliorer les propriétés mécaniques et biologiques du caillot sanguin nous l’avons enrichi en fibrinogène. Du sang humain a été mixé avec du Fibrinogène(Fbg) dilué dans du milieu de culture cellulaire. Plusieurs concentrations des composants ont été testées. Les propriétés mécaniques d’hydrogels et de la pulpe dentaire ont été mesures par microscopie à force atomique et des mesures rhéologiques de cisaillement à faible amplitude. Le taux de dégradation et de gonflement des hydrogels a été évalué. La survie et la prolifération cellulaire ont été évaluées par la microscopie à fluorescence. Le changement de la structure fibrillaire de l’hydrogel a été étudié par la microscopie multiphotonique (MPM). Pour évaluer les propriétés angiogéniques du gel à différentes concentrations de Fbg, un modèle ex vivo basé sur l’utilisation des anneaux de l’aorte de rats a été utilisé. Avec cette première série d’expériences nous avons défini un hydrogel avec des propriétés biomécaniques similaires à la pulpe dentaire, prometteuses pour son utilisation dans le cadre de la revitalisation pulpaire.2)Comparaison histologique entre l’hydrogel à base Fbg-sang et la pulpe dentaire humaine. Nous avons injecté l’hydrogel Fbg-sang avec des cellules de la pulpe dentaire (DPCs) dans la racine de dents humaines extraites et observé le comportement cellulaire et la maturation du tissu néoformé après 4 semaines ex vivo, en comparant l’histologie de l’hydrogel avec celle de la pulpe dentaire humaine. La caractérisation du tissu néoformé, ainsi que de la pulpe de dents saines a été réalisée par: Histologie classique, immunohistochimie pour détecter des marqueurs périvasculaires (CD31, αSMA et Collagène de type IV) et la MPM.Le caractère du tissu obtenu à l’intérieur de la racine est un tissu de réparation présenté sous forme d’un réseau fibreux contenant des cellules. Ce tissu a une architecture semblable à celle de la pulpe dentaire en vue de la disposition cellulaire et de la formation des nouveaux vaisseaux sanguins.3) Nous avons étudié les propriétés biologiques d’un matériau non résorbable et bioactive qui sont dues à la fonctionnalisation de sa surface par un revêtement organique-inorganique. Ce matériau pourrait être utilisé comme une matrice dans TER. L’effet du revêtement dans les DPCs a été évalué in vitro(MTT, ALP, RT-qPCR )et ex vivo en combinant l’utilisation du gel de Fbg-sang avec le matériau bioactif à l’intérieur de la racine. Le tissu formé à l’intérieur du canal a été évalué par histologie classique(He-Eo) et MPM. Les résultats montrent que les surfaces avec revêtement bioactive stimulent la maturation et la différenciation cellulaire. Le modèle ex vivo détecte la formation d’un tissu fibreux organisé et attaché à la surface du matériau avec revêtement qui suggère la bio-intégration au tissu formé par le gel.Les biomatériaux développés au cours de cette thèse sont prometteurs et originaux pour leur application dans le domaine du traitement régénératif endodontique
Regenerative Endodontic Treatment (RET) of necrotic teeth is an alternative to conventional endodontic treatment. Clinical protocol for RET is based on evoked periapical bleeding trough root apex, followed by blood clot formation. After reorganization of the clot a vascularized connective tissue could be formed to replace the damaged pulp and continue apexogenesis.RET on immature necrotic teeth gave encouraging results but they are not consistent. Lack of reproducibility may be due to incomplete root canal disinfection; variability of cells and growth factors of blood and poor mechanical properties and rapid degradation of the blood clot. To improve these procedures, the objective of this thesis was to develop two types of biomaterials, one resorbable - presented like an injectable hydrogel and one non-resorbable bioactive material.The thesis was conducted on 3 main axes: 1) Development and characterization of an Fibrinogen-blood contained hydrogel; 2) Histological comparison between the fibrinogen-blood gel and human dental pulp and 3) Bioactive non resorbable materialIn the first part of the thesis we mixed different concentration of Fibrinogen (Fbg) and of peripheral whole blood to obtain different Fbg-blood hydrogels. Atomic Force Microscopy and small amplitude oscillatory shear rheological measurements were used to characterize their mechanical properties. Swollen and degradation rate were evaluated by weigh changes. Biological properties were evaluated by following dental pulp cells (DPCs) behavior after incubation in the gel up to 3 weeks. Angiogenic potential was assessed by ex vivo rat aortic ring assay. Finally we selected the hydrogel composition which presents biomechanical properties close to human dental pulp with that represents the best environment for DPCs proliferation and possess angiogenic properties.In the second stage, the gel was injected inside endodontically pre-treated root canals for 4 weeks and cultured under laboratory conditions. Characterization of the newly formed tissue was made by histology (H-E and Masson Trichrome), immunohistochemistry (IHC) for perivascular markers detection (CD31, αSMA and Collagen IV) and multiphoton microscopy (MPM: 2- photon excited fluorescence (2-PEF) and second harmonic generation (SHG)). Comparison with human dental pulp was performed. An extracellular matrix mostly composed by autofluorescent fibers (elastin or fibronectin) was detected. Fibers and cell disposition are similar to dental pulp. Positive marked zones to CD31, αSMA and Col IV suggests neo-vessels formation.The following part of the thesis consists on the evaluation of biological properties of a bioactive non resorbable material that could be used as a scaffold for RET. DPC proliferation and differentiation on functionalized non resorbable material surfaces was proved by biological tests (MTT, ALP, RT-qPCR). Surface of the bioactive non resorbable material enhances DPCs maturation and differentiation.This material was also placed inside root canal in vitro and ex vivo. For the in vitro model we injected DPCs after the placement of a bioactive non resorbable material inside the root canal of extracted human teeth. For the ex vivo model functionalized or non-functionalized non resorbable scaffold were placed inside root canals or plastic tips after Fbg-blood gel injection. Samples were incubated for 4 weeks and analyzed by scanning electron microscopy (SEM), multiphoton microscopy (MPM) and classical histological staining (H-E). Bio-integration of functionalized non resorbable scaffold with newly formed tissue and organized fiber formation with a longitudinally disposition was proved by histology and MPM.Developed biomaterials and models show encouraging results, placing them as original approaches in regenerative endodontic field. Next stages for validation of obtained results concerns in vivo application of novel biomaterials with a farther finality of establishment of clinical protocols

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Os estudos clínicos de dentes desvitalizados e restaurados com pinos mostram resultados semelhantes no que diz respeito ao percentual de falhas ou insucessos, apesar de tantas variações técnicas, metodológicas e operatórias entre eles. Os insucessos são maiores quando se tratam de elementos dentais coronariamente destruídos ou comprometidos periapicalmente. Com o objetivo de identificar o efeito das variações clínicas que influenciam na longevidade do tratamento e a prevalência de descimentação de pinos, cárie marginal, fraturas radiculares e de lesões periapicais, foi realizada uma análise retrospectiva do desempenho clínico de dentes restaurados com pino de fibra de carbono. Foram avaliados 139 dentes em 75 pacientes, três anos após a data de cimentação dos pinos. Os dentes foram submetidos a tratamentos endodônticos, incluindo preparos dos condutos para pino, e tratamentos restauradores, realizados pelo mesmo endodontista e protesista, respectivamente, segundo protocolos padronizados. Através de exame clínico, radiográfico, fotográfico, laudos endodônticos e informações obtidas de prontuários, os dentes foram classificados de acordo com: grupos dentais, modalidade de tratamento endodôntico recebida, intervalo decorrido entre a última sessão endodôntica e a cimentação do pino, morfologia do pino, quantidade de remanescente dentinário coronário após preparo protético e sistema da coroa protética utilizado. Não foram constatadas descimentações de pinos, fraturas radiculares, ou cáries, e a classificação foi favorável para 99,3% (138 dentes) dos tratamentos endodônticos realizados. De acordo com os parâmetros analisados, os resultados desse estudo revelaram que as variações clínicas identificadas, consideradas desfavoráveis, não foram fatores determinantes para o insucesso, partindo-se do conjunto de procedimentos e materiais utilizados para o tratamento dos dentes desses pacientes
Clinical studies of devitalized teeth restored with posts show similar outcomes with regard to the percentage of faults or failures, despite many technical variations, methodological and operative between them. The failures are greater when dealing with teeth coronally destroyed or periapically compromised. The aim of this study was identify the effect of clinical variants that influence the longevity of treatment and prevalence of dislodgment of post, marginal caries, root fracture and periapical lesions was performed a retrospective analysis of clinical performance of teeth restored with carbon fiber post. 139 teeth were evaluated in 75 patients, three years after the date of cementing the posts. The teeth were root canal treatments, including preparations of the conduits to posts, and restorative treatments, performed by the same endodontist and prosthetics, respectively, according to standardized protocols. Through clinical, radiographic, photographic, endodontic reports and information obtained from medical records, the teeth were classified according to: tooth groups, type of endodontic treatment received, time span between the last endodontic session and bonded post, morphology of the post, amount of remaining dentin after crown preparation and prosthetic crown system used. There were no dislodgment of post, root fractures, or caries, and the rank was favorably for 99.3% (138 teeth) of endodontic treatment. According to these parameters, the outcomes of this study revealed that the clinical variations identified, that are considered unfavourable, were not determining for the failure, starting from the set of procedures and materials used for dental treatment of these patients

Dental caries is a widespread, chronic, and infectious condition that affects both deciduous and permanent teeth.[1] Dental caries in primary teeth if left untreated invade the pulp tissue and lead to pulpal infection.[2]There are only two treatment modalities to treat the infected pulp one is pulp therapy and the other is the extraction of the infected teeth.[3] The fundamental goal of pulp therapy is to retain the primary teeth in place until they exfoliate, acting as a natural space maintainer until the successor teeth erupts. [4] Pulpectomy is done to treat the nonvital or irreversibly inflamed teeth in which the inflamed tissue is debrided and the pulp canals are filled with a resorbable material.[5]The main criteria for an obturation material are that it should have good antimicrobial properties against oral microbes.[6]The gold standard and traditional material with good antimicrobial properties for obturating a primary tooth is zinc oxide eugenol.[7] Zinc oxide eugenol has drawbacks, such as irritating the tissues of the periapical area, causing cemental and bone necrosis, and exhibiting different resorption rates compared to the normal physiological resorption of primary teeth. These properties were found to be from the eugenol component.[8 9 10] Hence many authors have attempted to replace the eugenol component with various herbal formulations to reduce its limitations.

Traumatic injuries suffered by the anterior teeth mostly occur before completion of the root formation which may have consequences like inflammation or necrosis of the pulp. The most sensitive part of a young permanent tooth to trauma is the Hertwig’s epithelial root sheath (HERS). However, root formation can still continue to occur if there is a disruption of vascularity and cellularity in the apical region, even in the presence of pulpal inflammation and necrosis of the traumatized teeth. Hence, every effort should be made to maintain the viability of HERS as it acts as a source of undifferentiated cells which could give rise to the formation of the hard tissue and it also protects the tooth against the ingrowth of the cells of periodontal ligament into the root canal, which might result in intracanal bone formation and cessation of root development. In cases where complete destruction of Hertwig's epithelial root sheath occurs, the development of a normal root comes to a halt but, this does not mean that there is an end to the deposition of hard tissue in the region of the root apex. Although, once the sheath has been destroyed, there can be no further differentiation of odontoblasts but, the hard tissue can still be formed by cementoblasts which are present in the apical region or by fibroblasts of the dental follicle and periodontal ligament cells that undergo differentiation after the injury. This chapter is specifically oriented towards discussion of the viable methodology and treatment modalities of vital, nonvital immature young permanent teeth.