A New Approach to Root Formation

Background: This paper analyzed the distribution of treatments for permanent teeth with necrotic pulps and open apices according to the stage of root development. Material and Methods: Dental records from all root canal procedures performed in permanent teeth with necrotic pulps and open apices over a period of 14 years by residents of the Speciality of Endodontics, University of Gua-dalajara, Mexico, were analized. Results: Records from 206 treatments were mainly divided into the following 3 different stages according to criteria described by Cvek: stage IV (n = 79, 38.3%), stage V (n = 66, 32%) and stage III (n = 53, 25.7%). Few cases involved the initial stages of root development (stages I and II) (n = 8, 3.8%). Such teeth were submitted to four different treatments: MTA apical barrier (n = 69), Ca(OH) 2 replacements (n = 34), gutta-percha (n = 67) and a plug of Ca(OH) 2 /gutta-percha (n = 36). The teeth with intermediate root development (Cvek stage III) showed a predi-lection for the MTA apical barrier and Ca(OH) 2 replacement techniques (P ≤ 0.001). Furthermore, the stage of root development did not influence the apical extent of the root filling. Conclusions: The finding of permanent teeth with necrotic pulp and open apices is not exclusive to young patients with an open apex. Moreover, teeth with fragile, irregular and divergent apical morphologies, such as Cvek's sta-ges´I and II, were not common and may be considered to be unusual findings. The diverse endodontic procedures were reliable regardless of the stage of root development.

Oral surgery, oral medicine, and oral pathology, 1970

Dental Journal of Advance Studies

The management of nonvital immature permanent teeth poses quite a challenge. The apexification procedure is in use for long-term now but the treated teeth are more prone to fracture questioning the long-term prognosis of this technique. The introduction of regenerative procedures for the treatment of these teeth is quite favorable; however, despite the increasing use of regenerative endodontic therapy procedures, inconsistent results are seen in the root development. Conservation of Hertwig's epithelial root sheath may have a prime role and selecting the cases with viable root sheath may impact on the consistent positive results treated with regenerative procedures. This article aims to look at the database to find the role of etiology and its implication on Hertwig's epithelial root sheath in the outcome of regenerative endodontics.

Journal of Dental Health and Oral Research, 2022

The formation of the tooth crown implies dentin and pulp construction (including mantle dentin, odontoblasts, Höhl cells, and vascular, axons and pulp cells). The root formation involves acellular and cellular cementum, peripheral and central dentins. Vascular cells and nerves are located in the central part of the root, whereas the superficial layer (Hopewell-Smith and Tomes granular layers) are located at the periphery. In the central part of the pulp, fibroblasts and immunocompetent cells are identified as T-lymphocytes, B-lymphocytes, dendritic cells, NK cells. In human deciduous teeth, HLA-DR+, CD68+, and factor XIIIa are present, whereas T and B-lymphocytes form clusters. The Hertwig's Epithelial Enamel Epithelium (HERS's) is formed by two layers. The HERS's cells dissociate, and cells, taking origin from the dental follicular sac and from the papilla, migrates. The OEE becomes periodontal ligament cells whereas the IEE becomes cementoblasts. The interconversion of epithelial cells into mesenchymal cells seems to be a crucial event in tooth root formation. Tooth eruption is associated to root lengthening. The temporary tooth is gradually destroyed (root cementoclasts), whereas the permanent coronal part of the tooth erupts and acquire it final shape and position.

Teeth with calcification provide an endodontic treatment challenge; traumatized teeth usually develop partial or total pulpal obliteration which is characterized by apparent loss of the pulp space radiographically and a yellow discoloration of the clinical crown. Since only 7-27% of such teeth develop pulp necrosis with radiographic signs of apical periodontitis, it is difficult to decide whether to treat these teeth immediately upon detection of the pulpal obliteration or to wait until signs and symptoms of pulp and/or apical periodontitis occur. This article reviews the etiology, prevalence, classification, mechanism, diagnosis as well as treatment options for teeth with pulp obliteration and the various management approaches and treatment strategies for overcoming potential complications. A search of articles from "PubMed" and "Medline" from 1965 to present was done with the keywords dental trauma, discoloration, pathfinding instruments, pulp canal obliteration, and root canal treatment was conducted. A total of 94 abstracts were collected, of which 70 relevant articles were read and 31 most relevant articles were included in this article.

Mansoura Journal of Dentistry, 2020

The fixation process in histology is an important process that will eventually determine the quality of the histology slides. Fixation of the dental pulp involves the entry of the fixative agent into the dental pulp through the root canals that are found at the apical part of the root. The objective of this study was to evaluate the effectiveness of four methods of tooth preparation (teeth cut longitudinally or cervically, removal of apical third of root and whole uncut teeth) on the fixation process of the dental pulp for producing high quality histology slides. Among the four methods of tooth preparation, removal of the apical one-third of the root produced high quality histology slides as fixation of the dental pulp was improved and hence, preservation of the pulp’s architecture and contents were achieved. It is concluded that removal of the apical one-third of the root improves the fixation process of the dental pulp in teeth. Removal of the apical one-third of the root improves the fixation process of the dental pulp in teeth.

Successful root canal therapy requires a thorough knowledge of root anatomy and root canal morphology which may be quiet variable. The significance of internal root canal morphology has been emphasized by studies demonstrating that variations in canal morphology may affect the endodontic outcome. Consequently, in treating each tooth the clinician must assume that complex anatomy occurs often enough to be considered normal. Root dilaceration is one of the variations that may complicate the endodontic therapy. It is important for a clinician to have complete knowledge of internal anatomy relationships, careful interpretation of radiographs; proper access preparation and a detailed exploration of the interior of the tooth to achieve a successful treatment outcome. This paper reports successful endodontic therapy of severe dilaceration of the root of mandibular first molar and bayonet shaped root of maxillary first premolar and highlights the clinical considerations to be followed during the endodontic procedures to get the successful outcome. RESUMO Um tratamento de canal bem sucedido requer conhecimento profundo da anatomia da raiz dentária e morfologia do canal radicular, que pode ser variável. A importância da morfologia interna do canal radicular tem sido enfatizada por estudos que demonstram que as variações na morfologia do canal podem afetar o resultado do tratamento endodôntico. Consequentemente, no tratamento de cada dente, o clínico deve assumir que uma anatomia complexa ocorre com frequência suficiente para ser considerada normal. A dilaceração da raiz dentária é uma das variações que podem complicar o tratamento endodôntico. É importante para o clínico ter conhecimento completo das relações da anatomia interna, fazer uma interpretação cuidadosa de radiografias; preparar adequadamente o acesso e realizar uma exploração detalhada do interior do dente para conseguir um resultado de tratamento bem sucedido. Este artigo relata casos de terapia endodôntica bem sucedida de dilaceração severa da raiz do primeiro molar inferior e de raiz em forma de baioneta de um primeiro pré-molar superior e destaca as considerações clínicas a serem seguidas durante os procedimentos endodônticos para se obter êxito no tratamento. Termos de Indexação: Cavidade pulpar. Tratamento do canal radicular. Raiz dentária.

Journal of Orofacial Research, 2014

Endodontics is a specialty which is very receptive to new ideas and concepts. Management of open apex is a challenge to the endodontist. The treatment of choice for necrotic teeth is apexification, which is induction of apical closure to produce more favorable conditions for conventional root canal filling. The most commonly advocated medicament is calcium hydroxide, although recently considerable interest has been expressed in the use of mineral trioxide aggregate. Introduction of techniques for one-visit apexification provide an alternative treatment option in these cases. Research, published studies, and clinical results support this material, and have served to increase the expectation that nonsurgical treatment success is both possible and attainable. This paper highlights a case reports for apexification using mineral trioxide aggregate.

Journal of Dental Problems and Solutions

Introduction: External resorptions often occur as a lesion of inflammatory origin. The origin of the process begins on the side of the root cementum and goes towards the pulp of the tooth. The changes consist of the pathological loss of root cement, dentin, and bone surrounding the tooth. The dynamics of the process are enhanced by inflammatory or necrotic pulp changes. Aims: This study aimed to present contemporary views on the resorption of external tooth roots and the possibility of their treatment. Material and methods: The technique of observation and clinical and radiological diagnostics were used by the case-by-case method Result: Endodontic treatment was undertaken, consisting of chemo-mechanical preparation of the canal system and simultaneous obturation of the gutta percha canals with the AH + sealant and the BL thermal system. Conclusions: The applied treatment inhibited the progression of the resorption and led to the healing of periapical periodontitis.