The Experts below are selected from a list of 327 Experts worldwide ranked by ideXlab platform
Giorgos N Tzanetakis - One of the best experts on this subject based on the ideXlab platform.
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management of intruded immature maxillary central incisor with Pulp Necrosis and severe external resorption by regenerative approach
Journal of Endodontics, 2017Co-Authors: Giorgos N TzanetakisAbstract:Abstract Introduction Intrusive luxation is one of the most severe traumatic injuries of permanent teeth that may adversely affect the Pulp and the periodontium. Pulp Necrosis and root resorption are the main pathologic entities associated with this injury. The present report describes the endodontic management of an intruded immature maxillary central incisor presented with Pulp Necrosis and severe inflammatory root resorption by using the regenerative approach. Methods A 7-year-old boy with dental trauma to the anterior maxillary region was referred for the management of a traumatized maxillary central incisor. Clinical examination revealed an uncomplicated crown fracture, whereas radiographic examination showed that the tooth was immature, confirming the intrusion that was calculated between 3 and 4 mm. The tooth was left to re-erupt, but after 2 months the boy presented with intraoral swelling. Radiographic examination showed initial signs of root resorption. The tooth was treated by using a regenerative endodontic approach. Results Clinical and radiographic examinations during the initial follow-up period showed resolution of the signs and symptoms as well as inhibition of the resorption process. At the follow-up examinations, the tooth remained free of signs and symptoms and completely functional. The radiographic recall examinations showed a gradual thickening of the root canal walls but incomplete apical closure. Conclusions The present case shows that severely injured teeth with uncertain prognosis may have a considerable percentage of chance to remain functional and free of signs and symptoms by using a regenerative endodontic procedure, confirming the efficacy of this procedure as a viable treatment option.
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a prospective study of the incidence of asymptomatic Pulp Necrosis following crown preparation
International Endodontic Journal, 2015Co-Authors: Evangelos G Kontakiotis, Christos G Filippatos, Spyridon Stefopoulos, Giorgos N TzanetakisAbstract:Aim To determine the incidence of asymptomatic Pulp Necrosis following crown preparation as well as the positive predictive value of the electric Pulp testing. Methodology A total of 120 teeth with healthy Pulps scheduled to receive fixed crowns (experimental teeth) were included. Teeth were divided into two groups according to the preoperative crown condition (intact teeth and teeth with preoperative caries, restorations or crowns) and into four groups according to tooth type (maxillary anterior teeth, maxillary posterior teeth, mandibular anterior teeth and mandibular posterior teeth). Experimental and control teeth were submitted to electric Pulp testing on three different occasions before treatment commencement (stage 0), at the impression making session (stage 1) and just before the final cementation of the crown (stage 2). Teeth that were considered to contain necrotic Pulps were submitted to root canal treatment. Upon access, absence of bleeding was considered as a confirmation of Pulp Necrosis. Data were analysed using bivariate (chi-square) and multivariate analysis (logistic regression). All reported probability values (P-values) were based on two-sided tests and compared to a significance level of 5%. Results The overall incidence of Pulp Necrosis was 9%. Intact teeth had a significantly lower incidence of Pulp Necrosis (5%) compared with preoperatively structurally compromised teeth (13%) [(OR: 9.113, P = 0.035)]. No significant differences were found amongst the four groups with regard to tooth type (P = 0.923). The positive predictive value of the electric Pulp testing was 1.00. Conclusions The incidence of asymptomatic Pulp Necrosis of teeth following crown preparation is noteworthy. The presence of preoperative caries, restorations or crowns of experimental teeth correlated with a significantly higher incidence of Pulp Necrosis. Electric Pulp testing remains a useful diagnostic instrument for determining the Pulp condition.
Nadia Chugal - One of the best experts on this subject based on the ideXlab platform.
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Alkaline Materials and Regenerative Endodontics: A Review
Materials, 2017Co-Authors: Bill Kahler, Nadia ChugalAbstract:Periapical health is the primary goal of endodontic treatment in mature and immature teeth. In addition, the goals of treatment of immature teeth with arrested root development include root growth to length and maturation of the apex, as well as thickening of the canal wall. These goals are valid for immature teeth that have been subjected to trauma and dental caries or that are the result of developmental anomalies that expose the tooth to the risk of Pulp Necrosis and consequently result in the cessation of root maturation. Regenerative endodontic procedures (REPs) have been described as a “paradigm shift” in the treatment of immature teeth with Pulp Necrosis and underdeveloped roots, as there is the potential for further root maturation and return of vitality. Treatment with REPs is advocated as the treatment of choice for immature teeth with Pulp Necrosis. REP protocols involve the use of alkaline biomaterials, primarily sodium hypochlorite, calcium hydroxide, mineral trioxide aggregates and Biodentine, and are the essential components of a successful treatment regimen.
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an evidence based review of the efficacy of treatment approaches for immature permanent teeth with Pulp Necrosis
Journal of Endodontics, 2017Co-Authors: Bill Kahler, Giampiero Rossifedele, Nadia ChugalAbstract:Abstract Introduction Two fundamental assumptions for teeth treated with regenerative endodontic procedures (REPs) are (1) that the clinical outcome is comparable with the traditional techniques of calcium hydroxide apexification and mineral trioxide aggregate apical barrier techniques and (2) that REPs will result in further root maturation. Methods A systematic review of the electronic databases (Scopus, PubMed, and Web of Science) involved a search for studies that used quantitative assessments of root maturation. The search terms were “dental Pulp,” “regenerative endodontic therapy,” “revascularization,” and “revitalization.” The identified studies were further screened for cohort studies that compared clinical outcomes between teeth treated with REPs and apexification/apical barrier approaches. The primary question under review was framed according to the population, exposure, and outcome format. Results Of the 368 studies identified by the search, 6 cohort studies used quantitative assessments of any further root maturation after REPs, and a subset of 4 of these cohort studies assessed and compared clinical outcomes between the different treatment approaches. Conclusions Immature teeth with Pulp Necrosis treated with REPs generally show further root maturation although the results are variable. Clinical outcomes were similar for both groups. Patient-based criteria such as tooth discoloration, indications for changing the treatment option, and number of treatment appointments are all important for discussion before electing the appropriate treatment plan for the management of immature teeth with Pulp Necrosis.
Bill Kahler - One of the best experts on this subject based on the ideXlab platform.
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Alkaline Materials and Regenerative Endodontics: A Review
Materials, 2017Co-Authors: Bill Kahler, Nadia ChugalAbstract:Periapical health is the primary goal of endodontic treatment in mature and immature teeth. In addition, the goals of treatment of immature teeth with arrested root development include root growth to length and maturation of the apex, as well as thickening of the canal wall. These goals are valid for immature teeth that have been subjected to trauma and dental caries or that are the result of developmental anomalies that expose the tooth to the risk of Pulp Necrosis and consequently result in the cessation of root maturation. Regenerative endodontic procedures (REPs) have been described as a “paradigm shift” in the treatment of immature teeth with Pulp Necrosis and underdeveloped roots, as there is the potential for further root maturation and return of vitality. Treatment with REPs is advocated as the treatment of choice for immature teeth with Pulp Necrosis. REP protocols involve the use of alkaline biomaterials, primarily sodium hypochlorite, calcium hydroxide, mineral trioxide aggregates and Biodentine, and are the essential components of a successful treatment regimen.
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an evidence based review of the efficacy of treatment approaches for immature permanent teeth with Pulp Necrosis
Journal of Endodontics, 2017Co-Authors: Bill Kahler, Giampiero Rossifedele, Nadia ChugalAbstract:Abstract Introduction Two fundamental assumptions for teeth treated with regenerative endodontic procedures (REPs) are (1) that the clinical outcome is comparable with the traditional techniques of calcium hydroxide apexification and mineral trioxide aggregate apical barrier techniques and (2) that REPs will result in further root maturation. Methods A systematic review of the electronic databases (Scopus, PubMed, and Web of Science) involved a search for studies that used quantitative assessments of root maturation. The search terms were “dental Pulp,” “regenerative endodontic therapy,” “revascularization,” and “revitalization.” The identified studies were further screened for cohort studies that compared clinical outcomes between teeth treated with REPs and apexification/apical barrier approaches. The primary question under review was framed according to the population, exposure, and outcome format. Results Of the 368 studies identified by the search, 6 cohort studies used quantitative assessments of any further root maturation after REPs, and a subset of 4 of these cohort studies assessed and compared clinical outcomes between the different treatment approaches. Conclusions Immature teeth with Pulp Necrosis treated with REPs generally show further root maturation although the results are variable. Clinical outcomes were similar for both groups. Patient-based criteria such as tooth discoloration, indications for changing the treatment option, and number of treatment appointments are all important for discussion before electing the appropriate treatment plan for the management of immature teeth with Pulp Necrosis.
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Sequelae to trauma to immature maxillary central incisors: a case report
Dental Traumatology, 2008Co-Authors: Bill Kahler, Geoffrey S. HeithersayAbstract:This case report highlights (i) a rare example of spontaneous apexification despite Pulp Necrosis and periradicular pathosis, and (ii) Pulpal Necrosis and periapical pathosis following secondary trauma. The initial trauma occurred in a seven-year-old female who received secondary trauma 4 years later. The diagnosis and management of both maxillary central incisors as well as follow-up assessments for both immature and mature teeth subjected to trauma is discussed.
J O Andreasen - One of the best experts on this subject based on the ideXlab platform.
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combination injuries 3 the risk of Pulp Necrosis in permanent teeth with extrusion or lateral luxation and concomitant crown fractures without Pulp exposure
Dental Traumatology, 2012Co-Authors: Eva Lauridsen, Nuno V. Hermann, Thomas A. Gerds, Søren Steno Ahrensburg, Sven Kreiborg, J O AndreasenAbstract:Abstract – Aim: To analyze the influence of a crown fracture without Pulp exposure on the risk of Pulp Necrosis (PN) in teeth with extrusion or lateral luxation. Material and methods: The study included 82 permanent incisors with extrusion from 78 patients (57 male, 21 female) and 179 permanent incisors with lateral luxation from 149 patients (87 male, 62 female). A total of 25 teeth with extrusion and 33 teeth with lateral luxation had suffered a concomitant crown fracture (infraction, enamel fracture or enamel-dentin-fracture). All the teeth were examined and treated according to a standardized protocol. Statistics: The risk of PN was analyzed separately for teeth with immature and mature root development by the Kaplan–Meier method, the log-rank test and Cox regression (lateral luxation only). The level of significance was set at 5%. Risk factors included in the analysis were gender, age, crown fracture, and response to electric Pulp test at the initial examination. Results: A concomitant crown fracture significantly increased the risk of PN in teeth with lateral luxation. For teeth with immature root development (hazard ratio: 10 [95% confidence interval (CI): 1.1–100] P = 0.04), the overall risk increased from 4.7% (95% CI: 0–10.8) to 40% (95% CI: 2.8–77.2). For teeth with mature root development [hazard ratio: 2.4 (95% CI: 1.4–4.2) P 0.05). Conclusion: A concomitant crown fracture without Pulp exposure significantly increased the risk of PN in teeth with lateral luxation. This risk factor may be used to identify teeth at increased risk of PN following lateral luxation injury.
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combination injuries 2 the risk of Pulp Necrosis in permanent teeth with subluxation injuries and concomitant crown fractures
Dental Traumatology, 2012Co-Authors: Eva Lauridsen, Nuno V. Hermann, Thomas A. Gerds, Søren Steno Ahrensburg, Sven Kreiborg, J O AndreasenAbstract:– Background: The reported risk of Pulp Necrosis (PN) is generally low in teeth with subluxation injuries. A concomitant crown fracture may increase the risk of PN in such teeth. Aim: To analyse the influence of a concomitant trauma-related infraction, enamel-, enamel–dentin- or enamel–dentin–Pulp fracture on the risk of PN in permanent teeth with subluxation injury. Material and Methods: The study included 404 permanent incisors with subluxation injury from 289 patients (188 male, 101 female). Of these teeth, 137 had also suffered a concomitant crown fracture. All the teeth were examined and treated according to a standardized protocol. Statistical Analysis: The risk of PN was analysed separately for teeth with immature and mature root development by the Kaplan–Meier method, the log-rank test and Cox regression analysis. The level of significance was set at 5%. Risk factors included in the analysis were gender, patient age, crown fracture type, mobility and response to an electric Pulp test (EPT) at the initial examination. Results: Teeth with immature root development: The risk of PN was increased in teeth with a concomitant enamel fracture (log-rank test: P = 0.002), enamel–dentin fracture (log-rank test: P < 0.0001), enamel–dentin–Pulp fracture (log-rank test: P < 0.0001) and in teeth with no response to EPT at the initial examination [hazard ratio: 21 (95% confidence interval, CI: 2.5–172.5), P = 0.005]. Teeth with mature root development: the risk of PN was increased in teeth with an enamel–dentin fracture [hazard ratio: 12.2 (95% CI: 5.0–29.8), P < 0.0001], infraction [hazard ratio: 5.1 (95% CI: 1.2–21.4) P = 0.04] and in teeth with no response to EPT at the initial examination [hazard ratio: 8 (95% CI: 3.3–19.5), P < 0.0001]. Conclusion: A concomitant crown fracture and no response to EPT at the initial examination may be used to identify teeth at increased risk of PN following subluxation injury.
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incidence of Pulp Necrosis subsequent to Pulp canal obliteration from trauma of permanent incisors
Journal of Endodontics, 1996Co-Authors: Agneta Robertson, F M Andreasen, J O Andreasen, Gunnar Bergenholtz, Jorgen G NorenAbstract:Little long-term data are available on the frequency by which Pulp canal obliteration (PCO) subsequent to trauma leads to Pulp Necrosis (PN). In this study, 82 concussed, subluxated, extruded, laterally luxated, and intruded permanent incisors presenting with PCO were followed for a period of 7 to 22 yr (mean 16 yr). At final clinical examination, 51% of the observed teeth responded normally to electric Pulp testing (EPT). An additional 40% of the teeth although not responding to EPT were clinically and radiographically within normal limits. Yellow discoloration was a frequent finding. During the observation period, periapical bone lesions suggesting PN developed in seven teeth (8.5%). Twenty-yr Pulp survival rate was 84%, as determined from life-table calculations. There was no higher frequency of PN in obliterated teeth subjected to caries, new trauma, orthodontic treatment, or complete crown coverage than intact teeth. Although the incidence of PN in teeth displaying PCO seems to increase over the course of time, prophylactic endodontic intervention on a routine basis does not seem justified.
Massimo Del Fabbro - One of the best experts on this subject based on the ideXlab platform.
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does the etiology of Pulp Necrosis affect regenerative endodontic treatment outcomes a systematic review and meta analyses
Journal of Evidence Based Dental Practice, 2020Co-Authors: Massimo Del FabbroAbstract:Abstract Aim To evaluate if there is a connection between the causes of Pulp Necrosis (eg. caries, trauma, dental anomaly), and the success of regenerative endodontic treatment. Materials and Methods Electronic databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Embase) were searched for studies on regenerative endodontic treatment, which used both clinical and radiographic evaluation of root maturation after at least 6 months of follow-up. The search terms “necrotic Pulp”, “regenerative endodontic treatment”, “revascularization” and “revitalization” were combined using Boolean operators. The main Journals on endodontics and dental traumatology were additionally hand-searched. Studies were included if they specified the causes of Pulp Necrosis. The primary question under review was: “Does the cause of Pulp Necrosis affect the outcome of regenerative endodontic treatment?” Other factors like tooth type, intracanal medicament, irrigation protocol, use of a collagen matrix and the type of scaffold were evaluated for possible relation with the outcome. The risk-of-bias assessment for randomized and non-randomized studies was performed separately, using a modified Cochrane Collaboration’s tool and ROBINS-I tool, respectively. Meta-analysis was performed, when possible, between studies comparing treatment outcomes of teeth whose Pulp Necrosis had different etiology. The search strategy yielded 1197 items. After screening, 18 studies reporting 445 regenerative endodontic treatment cases were included. Results The overall success rate for 274 teeth with trauma etiology was 94.8%, for 95 teeth with dens evaginatus etiology was 93.1% and for 24 teeth with caries etiology was 96%. No significant difference was found between the results of regenerative endodontic treatment among teeth with trauma, dens evaginatus and caries etiology (p=0.055). Meta-analysis of studies comparing teeth with caries vs. dens evaginatus, and trauma vs. caries confirmed that there was no evidence for difference in outcomes. Conclusion Further randomized studies specifically testing such hypothesis are needed to confirm the preliminary results of this review.
