Academic literature on the topic 'Endodontics; tooth fracture; prosthodentics'

Regenerative endodontics has been defined as “biologically based procedure designed to replace damaged structures, including dentin and root structures, as well as cells of the pulp–dentin complex.” This is an exciting and rapidly evolving field of human endodontics for the treatment of immature permanent teeth with infected root canal systems. These procedures have shown to be able not only to resolve pain and apical periodontitis but continued root development, thus increasing the thickness and strength of the previously thin and fracture-prone roots. In the last decade, over 80 case reports, numerous animal studies, and series of regenerative endodontic cases have been published. However, even with multiple successful case reports, there are still some remaining questions regarding terminology, patient selection, and procedural details. Regenerative endodontics provides the hope of converting a nonvital tooth into vital one once again.

Preservation of natural tooth in dental arch is ultimate objective of dental treatment. After endodontic treatment, tooth becomes brittle and prone to fracture which results in reduction of strength of crown causing fracture of cusp or sometimes weakness of the roots. In order to strengthen crown some anchorage within teeth has to be made and that anchorage and support is gained by rigid structure which is known as post. This article focuses on recent advances in post systems and their application, merits and demerits in endodontics.

Pulpitis and subsequent pulp necrosis results in tissue degradation by-products causing staining of the dentin.This is a common cause of localised intrinsic staining of the teeth. Reversible pulpitis is a condition of pulpal inflammation in which the pulp can be returned to the normal state if the cause of the pulpitis is treated or removed; however, if this is not achieved, the condition will progress to irreversible pulpitis and pulp necrosis. If left untreated, a tooth with pulp necrosis can result in periapical abscess, radicular cyst, granuloma, fistula, osteomyelitis, pathological fracture, periodontal disease and tooth loss. The treatment options for a tooth with pulp necrosis include endodontic or exodontic therapy. The purpose of endodontic therapy is to alleviate pain and to treat or prevent inflammation and infection in order to preserve the tooth function. This case report describes the endodontic treatment of a discolored left maxillary canine tooth in a dog.

During root development, if tooth is subjected to trauma or caries, it results in tooth with immature and open root apices. The primary factor affecting the success of endodontics is achievement of perfect apical seal. Apexification is done to achieve an apical barrier against which the obturating material can be condensed. Various treatment modalities are used to treat immature open root apices. In the following case reports, apexification using different treatment modalities and both traditional and newer biomaterials have been explained.

ABSTRACT Aim To evaluate the prevalence of anterior tooth fracture due to trauma in 2000 patients randomly from the population of south Canara district. Materials and methods The present study was conducted on 2000 patients attending the Department of Conservative Dentistry and Endodontics, AB Shetty Dental College, Mangalore, and rural satellite centers of Nitte University. Each patient was examined for anterior tooth fracture due to trauma under dental chair in a good illumination of light using sterilized mouth mirror, explorer, tweezer and teeth are isolated by cotton roles. The patient who had anterior tooth fracture were questioned with a standard questionnaire from oral health survey WHO format 2013, to find its relation associated to age, gender, location, occupation, etiology, type of fracture and its relation to molar. Results According to the present study, prevalence of anterior tooth fracture due to trauma in south Canara population was low and found to be 18.8% with increase in prevalence in males (56.2%) between the age group of 36 and 45 years (33.2%), common etiological factor seen was falls (44.7%). The most common type of fracture was enamel-dentine fracture (44.7%) with class 1 molar relation (55.6%). Conclusion The prevalence of anterior tooth fracture due to trauma was most commonly seen in males with increased prevalence in age group between 36 and 45 years, common etiological factor being falls, type of fracture most commonly seen are cases with enamel-dentine fracture with class 1 molar relation. How to cite this article Hegde MN, Abootty S, Attavar S. Prevalence of Anterior Tooth Fracture due to Trauma. World J Dent 2015;6(2):77-81.

ABSTRACT This article presents a clinical case of horizontal root fracture, in an adult patient, male, in the apical third, due to the practice of sports, which, along with other factors, has led to pulp necrosis. Initially, the patient sought emergency care, and then he underwent treatment by endodontics, using calcium hydroxide between sessions. After a monitoring period, root canal obturation was performed and the tooth is clinically and radiographically stable 2 years after the trauma. In this case, monitoring is long-lasting, divided into 12-month periods for 10 years, with clinical and radiographic evaluation. Dental fracture in children and teenagers from 10 to 14 years is very common, especially during the practice of sports and recreation activities. It is expected that young male individuals have greater propensity to damage their teeth than young female individuals. Maxillary central incisor is the tooth most commonly involved, and it often evolves to pulp necrosis after trauma.

Management of non-vital immature anterior permanent teeth in children remains a challenge in paediatric dentistry and endodontics. Once the tooth becomes non-vital, root development ceases, rendering the tooth weak, and unable to withstand physiological forces of mastication. This results in a high rate of root fracture with poor prognosis in the medium to long term. Despite being endodontically treated, over 50 % of such teeth will be lost in the first 10 years following trauma. Traditional endodontic treatment does not contribute to any quantitative or qualitative increase in root dimensions resulting in life-long oral disability. The advancement in the science of Endodontics - Regenerative Endodontics has revolutionized current treatment strategies in treating the immature non-vital permanent tooth which has overcome the drawbacks of traditional treatment approaches. This report provides an insight view on successful maturogenesis of immature non-vital permanent incisors by induction of intracanal bleeding along with complications endured during the process. Regenerative endodontics is defined as “biologically based procedures designed to replace damaged structures, including dentin and root structures, as well as cells of the pulp - dentin complex”.1 Continued root development and reestablishment of pulp - dentine complex can be achieved by these procedures. Two major concepts in the regenerative endodontics are guided tissue regeneration (GTR) and tissue engineering. The base of these procedures is stem cells which can differentiate into the desired tissue component, growth factors or other tissue - inducing mediators and scaffold.2 Regenerative endodontic procedure (REP) includes induction of intracanal bleeding, placement of platelet rich fibrin (PRF), and platelet rich plasma (PRP). The goals of these procedures were elimination of signs and symptoms, continued root development, apical healing, and positive response to vitality testing. But preparation of PRP and PRF requires withdrawal of blood and sight of syringe can add emotional stress to young patients. Revascularization may be defined as the invagination of undifferentiated periodontal cells from the apical region in immature teeth.3,4 The nature of tissue formed after revascularization is not certain and can be confirmed by histological evaluation. Presence of blood supply is reliable. Revascularization considers only one facet - nature of newly formed tissue thus making term revascularization inaccurate and thus many authors disagreed with this term.5

Functional forces might also lead to fracture after endodontic treatment. This might occur secondary to exposure to erosion, abrasion, physical trauma, and caries. Interventing against these events can be achieved by conducting long follow-up periods and enhancing the endodontic treatment approaches. The current endodontic treatment modalities aim at tissue preservation to enhance resistance to fractures and prevent potential post-treatment complications. In this context, evidence shows the validity of minimally invasive modalities in endodontic treatment with favorable outcomes and reduced frequency of complications. In the present literature review, we have discussed the efficacy of minimally invasive biological treatment in endodontics. It is vital to maintain the integrity of the structures of the tooth-related paracervical area, particularly when treating molars. This is attributed to enhancing the long-term survival rates of the pericervical dentin of these teeth. The current trends represent a revolution in the field of endodontic treatment. This is attributed to the novel development of the various disinfection modalities, which do not need to shape the canal into a round form and induce flaring reactions. Overall, the main advantages of vital pulp therapy include being simple, reduced cost, and reduced risk of treatment-related complications secondary to overcoming the difficulties with the anatomy of the root canals.

Root canal treatment of teeth presenting immature development is a great challenge for both the patient and the professional. The thinness of the root canal walls of immature teeth may lead to root fracture and thus the outcomes of such treatments are uncertain. Revascularization is based on root canal decontamination followed by the induction of blood migration from the periapical tissues and the development of new vascular tissue in the canal space. The principle of disinfection in regenerative endodontics is that it should be achieved with minimum root canal instrumentation; an intracanal medication is used to inhibit bacterial growth and appropriate sealing of the coronal portion is performed. The American Association of Endodontists (AAE) considerations for regenerative endodontics include calcium hydroxide as an alternative intracanal dressing. This material has also been claimed to diminish the possibility of dental staining during revascularization procedures. The relatively new treatment protocol has been widely reported in the last few years; however it should be performed only when other alternatives are not reasonable. This case report presents a 3-year follow-up of a case of revascularization of a maxillary central incisor using calcium hydroxide as a root canal disinfection dressing.

Dental trauma in young patients is very common in clinical daily life and directly influences the patient’s esthetics and function. The objective of this work is to present a clinical case of a young patient who suffered dental trauma and rehabilitation with Endodontics, cementation of a fiberglass post and restoration of the dental crown with composite resin. Patient AM, 12 years old, attending the Endodontics Specialization at FASURGS, changing a dental trauma with a coronopulpal fracture of the dental element 11, an initial periapical radiograph was performed and it was found the pulp involvement. Exposing the treatment options, the patient and guardian agreed to perform Endodontics and rehabilitate tooth 11 with a fiberglass post and composite resin. Following the treatment plan, the patient was anesthetized and the dental pulp was removed, the root canal system was prepared using 2.5% NaOCl and k # 10 manual and rotary files of the Logic # 25:01, # 25:05, and insertion of MIC (Ultracal). In the second session, the medication was removed and the PQM was completed, filled, a fiberglass post was cemented and the dental element was restored using a silicone guide, which had been previously made. Appropriate planning brings great results with a conservative approach, making it possible to maintain a dental structure that offers comfort, restores aesthetics, and improves the patient’s quality of life.

Magister Chirurgiae Dentium - MChD
Purpose: To compare the intra-oral approach using a contra-angled hand piece with the standard transbuccal approach in the treatment of mandibular angle fractures. Patients and Methods: Thirty patients with isolated fractures of the mandibular angle were treated by open reduction and internal fixation using one three-dimensional “strut” or “geometric” Synthes® angle plate. Patients were selected randomly for placement of two-millimeter self-threading screws, either through the standard transbuccal technique or with an intra-oral approach using a contra-angle hand piece. None of the patients were placed into post-surgical maxillomandibular fixation (MMF). Swelling and pain were measured pre-operatively and again twenty-four hours after surgery. The actual cutting time from first incision to placement of last suture was documented, as well as the perception of difficulty of the specific case by a single operating surgeon. Results: No statistically significant difference in perception of pain was experienced between the two groups of patients during the first twenty-four hours after surgery. There was also no statistically relevant difference in cutting time between the two placement techniques. A small statistically relevant difference (p-value = 0.089) was found in the amount of swelling post-operatively between the two groups, with more swelling in the control group. Conclusion: The use of a contra-angle hand piece to place screws in the compression band area in a mandible angle fracture is an acceptable alternative to the transbuccal approach.
South Africa

O objetivo deste estudo foi comparar à resistência à fratura de três técnicas de colagem usadas para restaurar dentes fraturados hígidos e com tratamento endodôntico associado ou não a colocação de pino de fibra de vidro. Noventa incisivos humanos foram aleatoriamente divididos em três grupos de 30 dentes cada. No grupo A, os dentes não foram tratados endodonticamente, enquanto os dentes dos grupos B e C foram submetidos ao tratamento endodôntico, seguido de restauração da câmara pulpar com resina composta. Todos os dentes foram fraturados por uma carga axial aplicada na superfície vestibular para obter fragmentos dentais. Os dentes de cada grupo foram novamente subdivididos em três subgrupos: colagem simples [CS], chanfro vestibular [CV] e chanfro circunferencial [CC]). Antes da colagem dos fragmentos, pinos de fibra de vidro foram colocados nos dentes do grupo C. Todos os fragmentos dos dentes (grupos A, B e C) foram colados utilizando um cimento de dupla ativação (Duo- Link, Bisco Inc). No grupo CS, nenhum preparo adicional foi realizado após colagem, porém no restante dos dentes realizou-se uma canaleta vestibular (grupo CV) ou uma canaleta circunferencial ao redor da linha de colagem (CC) com aproximadamente 1,0 mm de profundidade. As canaletas foram restauradas com resina composta microhíbrida. Por fim, os espécimes foram submetidos a mesma carga axial no mesmo ponto pré-determinado. A resistência à fratura após o procedimento restaurador foi expressa em porcentagem de resistência do dente íntegro. Os dados foram submetidos a uma análise de variância de dois fatores (Grupo vs. Técnica de colagem) e teste de Tukey (?=0,05). Somente o fator principal Técnica de colagem foi estatisticamente significante (p<0,05). Nenhuma das técnicas de colagem empregadas conseguiu restabelecer a resistência à fratura do dente hígido. A confecção de uma canaleta vestibular e circunferencial proporcionaram uma recuperação de resistência similar (p>0,05) entre si e superior ao alcançado pela técnica de colagem simples (p<0,05). Concluiu-se que o uso de pino de fibra de vidro não é essencial para reforço da estrutura dental antes da colagem de fragmentos de dentes tratados endodonticamente. As técnicas de chanfro vestibular e chanfro circunferencial devem ser preferidas ao se realizar a colagem de fragmentos devido a maior recuperação da resistência do dente hígido em relação a técnica de colagem simples.
The aim of this study was to compare the fracture strength of three techniques used to reattach tooth fragments in sound and endodontically-treated fractured teeth either associated or not with fiber post placement. Ninety human lower incisors were randomly divided into three groups of 30 teeth each. In group A teeth were not subjected to endodontic treatment; while teeth from groups B and C were endodontically treated and the pulp chamber restored with a composite resin. All teeth were fractured by an axial load applied to the buccal area in order to obtain tooth fragments. Teeth from each group were divided again into three subgroups: bonded only [BO], buccal chamfer [BC] and circumferential chamfer [CC]). Before the re-attachment procedures, fiber posts were placed in teeth from group C. All teeth (groups A, B and C) had the fragments re-attached using a dual cure resin luting cement (Duo-Link, Bisco Inc., Itasca, IL). In the BO group, no additional preparation was made. Teeth from groups BC and CC groups had a 1.0 mm-depth chamfer placed in the fracture line either on buccal surface [group BC] or along the buccal and lingual surfaces [group CC]. Increments of microhybid composite resin were used in subgroups BC and CC to restore the chamfer. The specimens were loaded until fracture in the same pre-determined area. The force required to detach each fragment was recorded and a percentage of fracture strength recovery calculated for each tooth. The data was subjected to a two-way analysis of variance (Group vs. Re-attachment technique) and Tukey\'s test (?=0.05). Only the main factor Re-attachment technique was statistically significant (p<0.05). None of the techniques used for teeth re-attachment restored the fracture strength of the intact teeth. The placement of buccal and circumferential chamfer yielded statistically similar (p>0.05) fracture strength recovery, which was superior to the bonded only technique (p<0.05). The use of fiber post is not mandatory for the reinforcement of the tooth structure before reattachment of fragments in endodontically-treated teeth. When bonding a fractured fragment, the buccal or circumferential re-attachment techniques should be preferable in comparison with the simple re-attachment without any additional preparation.

Objectives: This in vitro study investigated the relationship between the cross-sectional area and the location of remaining coronal tooth structure and the fracture resistance of restored endodontically-treated teeth. Materials and Methods: Fifty-five extracted maxillary premolars received root canal treatment and crown preparation and were randomly divided into 11 groups of five teeth each according to the number and the site of the missing axial wall(s). Impressions of the prepared teeth were taken and poured with epoxy resin to construct a die for each tooth that was then sectioned 1mm above the finish line. The surface area was measured using ImageJ software (version 1.41n. Developed by Wayne Rasband. National Institutes of Health, USA.1 All 55 prepared teeth were then restored with composite resin cores, and cast metal crowns. Specimens were thermocycled between 5°C and 55°C for 500 cycles, prior to testing. A universal testing machine was used to apply a compressive load at a crosshead speed of 1mm/min to the palatal surface of the buccal cusp of the crown at an angle of 45 degrees to the long axis of the tooth until failure. Results were analyzed using one-way ANOVA and t-tests. Results: Specimens with all axial walls intact (only access cavity) had mean fracture strength of 1380.5±393.9N. Groups that have a missing palatal wall with one or two proximal walls showed the lowest mean failure loads of 398.4N ± 149.5N and 344.7N ± 91.2N respectively. The coefficient of determination (R²) between the surface area and the fracture resistance was 0.52. Conclusions: For restored endodontically-treated upper premolars there is a positive linear relationship between the remaining dentine surface area and fracture strength. Residual dentine location influences the fracture resistance with the palatal wall having a major role in resisting force.
Thesis (D.Clin.Dent) -- University of Adelaide, School of Dentistry, 2013