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The coffer dam application is still a condition necessary for the successful treatment of pulpitis and periodontitis. It keeps the operating area perfectly dry and prevents incidents in endodontics. The various coffer dam techniques and their indications are described.
One hundred and three teeth with chronic pulpitis, twelve chronic periapical lesions and eleven oral various soft tissue biopsies were used to discuss the presence, the anatomy and function of mast cells. The mast cell induces veinules dilatation during the early phase of inflammation by histamine release, collagen lysis, bone resorption and epithelium proliferation. It can be observed in every chronic lesion and plays a part in both humoral and cellular immunological phenomenons. A more accurate knowledge of its biochemical actions could help in understanding the mechanism of pain in certain clinical dental crisis.
Fifty--three teeth with pulpitis treated by pulp mummification and followed--up for fifteen years were examined. Of them, excellent result was achieved in 11 teeth (20.75%), good in 8 teeth (15.10%) and failure in 34 teeth (64.15%). Radiologically, 8 good cases were characterized by badly delineated periodontal ligament, increased periodontal ligament space in width, indistinct lamina dura and/or local increase in the density of bone; 34 failure cases were characterized by the radiolucent area or small lesion around apex with clear radiopaque line on the circumference of the area or local increase in the density of bone. These radiographs showed that chronic inflammations existed in periapex. Although further investigations are needed to identify the reasons leading to chronic inflammations, the results should be considered seriously when pulp mummification is upon selection.
Once referred to as "flyer's toothache," barodontalgia is defined as tooth pain occurring with changes in ambient pressure. It usually occurs in people who fly or dive. It can develop in conjunction with sinusitis, and in teeth experiencing pulpitis after restorative treatment, new and recurrent caries, intra-treatment endodontic symptoms, dental and periodontal cysts, or abscesses. Although the causal process of barodontalgia is not well understood, it may be related to pulpal hyperemia, or to gases that are trapped in the teeth following incomplete root canal treatment. Patients who are frequently exposed to changes in ambient pressure should be encouraged to follow good oral health practices, attend regularly-scheduled dental recall examinations and accept the timely completion of restorative treatment to minimize the possibility of developing barodontalgia. By employing a classification system to document cases of barodontalgia, dentists will be better prepared to provide appropriate and successful treatment. Seven case reports of barodontalgia are presented and compared to previously documented cases. The author also reviews the reasons why military flyers are more likely to develop barodontalgia than others, although the passengers and crews of commercial airliners may also suffer from this condition.
Breeders of exhibition budgerigars have commented for some years on an increasing prevalence of feather diseases in their birds. A survey of these diseases identified 37 different conditions, but three-quarters of the cases were due to only four conditions: psittacine beak and feather disease, pulpitis, feather mites and feather cysts.
The purpose of this study was to investigate the ability of low-dose fentanyl to produce analgesia when administered via the periodontal ligament injection in teeth with symptomatic, inflamed pulps. All subjects presented for emergency treatment with moderate to severe pain and had a posterior tooth with a clinical diagnosis of irreversible pulpitis. Twenty subjects randomly received either 10 micrograms fentanyl citrate or saline placebo via the periodontal ligament injection in a double-blind manner. The subjects rated their pain prior to injection and rated pain intensity and pain half gone for 59 min postinjection. Low-dose fentanyl delivered via the periodontal ligament injection in inflamed teeth provided significantly greater analgesia than the saline placebo (P < 0.05). Since the dose of fentanyl used was less than the dose required to provide analgesia by a central mechanism, the results of this study may be consistent with a peripheral opioid mechanism of action.
Phytotherapy is a medicinal and ancestral practice in Africa. It deals with all the fields of human pathology. We wanted to ascertain the efficacy of some plants used in odontology as Euphorbia balsamifera traditionally used as antalgic treatment of acute dental pulpitis. The latex of the plant was caught and treated as to get enough stable paste. We used that paste in the same conditions we use arsenical nerve caustics, a pulpal devitalizer widely used in dental offices. The study carried out on 37 teeth has shown that latex of Euphorbia balsamifera is an effective pulpal devitalizing in contact with the pulp. Its lifetime action was comparable to that of the pulpal nerve caustics. The active principles are not known, however the product seems attractive as a pulpal devitalizing agent.
Previous studies have shown a perivascular hyaline thickening affecting restricted regions of the microcirculation in gingivitis and moderate periodontitis and in the pulpal vessels in chronic pulpitis. In the present study of the lesion of advanced periodontitis, immunostaining for type IV collagen and laminin demonstrated widespread deposition of basement membrane material, with manifest involvement of the venous network. Some vessels were associated with an increased deposition of both basement membrane proteins, while others showed preferential deposition of either laminin or type IV collagen. Immunostaining also revealed an extensive trabecular network of type IV collagen throughout the affected gingival tissue that was related to recognizable vessels but was co-extensive with less intense staining for laminin. This network was not associated with viable endothelial cells demonstrable by staining with the endothelial marker Ulex agglutinin (UEA-1). The results indicate extensive vascular pathology in advanced periodontitis that could explain the attenuation of the inflammatory reaction and the restricted ability to develop reparative granulation tissue in this disease.
OBJECTIVE: To assess the complaints of patients who were prescribed antibiotics following orodental problems and the need for antibiotics prescribed for this purpose. SETTING: Examinations were carried out in the Department of Oral Diagnosis and Radiology, Ege University, Turkey. PARTICIPANTS: A total of 203 patients (129 females and 74 males) between 8-70 years of age (mean age 37.7 +/- 13.9). INTERVENTION: Examination and report. MAIN OUTCOME MEASURES: Frequency of unnecessary antibiotic use. RESULTS: Antibiotic therapy was not necessary for 151 (74.4 per cent) cases. Antibiotics were unnecessarily prescribed in 45 cases of acute irreversible pulpitis, 10 chronic apical abscess, 6 acute apical paradontitis, 7 gingivitis, 10 periodontitis, 4 epulis, 2 TMJ (temporomandibular junction) dysfunction, 2 sharp ridge of alveolar bone, 1 burning mouth syndrome and 1 recurrent aphthous stomatitis. In 108 (53.2 per cent) of the cases, the prescribed antibiotics were found to be penicillins, 102 of which were broad-spectrum. It was also determined that only 6 (7.7 per cent) of the 78 cases diagnosed as acute apical abscess were given drainage as local therapy. CONCLUSIONS: Principles for treating dental infections suggest that an antibiotic should only be used to supplement and not substitute for conventional surgical methods. Therefore, in cases with acute apical abscess, mechanical treatment (drainage) should be the first step. Inappropriate antibiotic use is quite widespread in dentistry. Dentists should avoid inappropriate use of antibiotics. To prevent inappropriate administration, necessary precautions need to be taken against dispensing antibiotics without prescription.
BACKGROUND AND OBJECTIVES: Lasers are used for several procedures involving hard and soft tissues of the oral cavity. A potential future application is the use of the CO2 laser to alter the surface structure of tooth enamel to render it more resistant to caries. A new 9.6 microm wavelength transverse excited atmospheric pressure (TEA) CO2 laser (Argus Photonics, Jupiter, FL) has been investigated as a device that can be used for this purpose without harming the dental pulp. STUDY DESIGN/MATERIALS AND METHODS: Erupted caries- and restoration-free third molars (n = 24 participants; 74 teeth) were used in the study. Teeth were irradiated at an incident fluence of 1.5 J/cm2, a repetition rate of 10 Hz and a spot size 1 mm in diameter. At the low and high settings, 200-400 pulses at 5-8 microseconds pulse duration were delivered at 12 mJ per pulse for a total energy of 2.4 or 4.8 J delivered for 20 or 40 seconds, respectively. Other teeth were subjected to a sham dental procedure (positive control) or no procedure (negative control). Prior to testing, radiographs were taken of all teeth, and they were assessed pulpally using heat, cold, and electricity to determine vitality. The teeth were removed either immediately or at 1 week or 1 month after testing. RESULTS: Teeth were bioprepared and examined histologically for signs of inflammation. Only one tooth developed symptoms of sensitivity to cold for 10 days following exposure to the high power level. The sensitivity was of fleeting duration and was judged to be reversible pulpitis. All teeth tested responded normally at pre-testing and pre-extraction time periods. Histological examination of all teeth disclosed no indication of an inflammatory response in the pulp tissue at any time point. All sections appeared normal with no changes seen in the normal pulpal morphology. CONCLUSIONS: We conclude that the 9.6 microm wavelength laser causes no permanent/serious pulpal damage at the energy levels used and can be used safely for caries prevention treatments in humans.
Herein, we suggest that Streptococcus mutans lipoteichoic acid-induced death of dental pulp cells on human deciduous teeth is caused by apoptosis. We provide evidence for the causal role of apoptosis in this process by demonstrating an increase in the proportion of fragmented DNA in such dental pulp cells, which results in a ladder pattern of DNA fragmentation. Additionally, Streptococcus mutans lipoteichoic acid-induced apoptotic cell death is suppressed by caspase inhibitor. Collectively, these findings suggest that Streptococcus mutans lipoteichoic acids may cause apoptosis in human dental pulp cells, and serve as an important factor in pulpitis.
The purpose of this prospective study was to evaluate the clinical performance of a new restorative material (Ceram.X) in combination with a new primer-adhesive (K-0127). One operator placed two Class I or II restorations in molars of 43 patients. One molar was restored with Ceram.X/K-0127, the other one with Tetric Ceram/Syntac Classic. At baseline, after 1 and 2 years, the restorations were evaluated by one evaluator using modified Ryge's criteria. After 2 years, 31 patients were examined. One Ceram.X-restoration had to be removed for root canal treatment due to pulpitis. Thus, failure rate of Ceram.X was 3.2% and of Tetric Ceram, 0%. In both groups, no sensitivity, no recurrent caries, and no changes in surface texture were recorded after 2 years. One restoration in each group showed slight changes in color stability (score B). Marginal discoloration (score B) was found concerning three Ceram.X-restorations (10.0%) and two Tetric Ceram-restoration (6.5%). Marginal integrity was score B for four Ceram.X-restorations (13.3%) and for four Tetric Ceram-restorations (12.9%). No statistically significant differences were found (p>0.05). After 2 years of clinical service, 96.8% of Ceram.X/K-0127 and 100% of Tetric Ceram/Syntac Classic restorations were in place and performed clinically well.
To examine the potential role of the histamine-forming enzyme, histidine decarboxylase (HDC), in oral inflammation and disease, we studied HDC activity in oral tissue after induction by bacterial agents. Following injection of E. coli-derived lipopolysaccharide (LPS) into mice, we measured the quantitative changes in HDC activity over time in dental pulp and gingiva. Oral tissue taken from individual mice was insufficient for detecting precise HDC activity, thus, we combined dental pulp or gingival tissues from four mice and assayed them over the course of 24 h. Our results indicate that LPS stimulated marked elevations of HDC activity in dental pulp and gingiva. This increase reached a maximum at 6 h after LPS injection and remained detectable at for least 24 h. Since mast cells are known to produce histamine through a difference mechanism than HDC induction, we compared LPS-induced HDC activity in dental pulp and gingiva to that in ear skin (a tissue rich in mast cells) and liver (a tissues lacking in mast cells). LPS also induced a marked increase in the HDC activity in liver and ear skin at 6 h after LPS injection. By contrast, saline injection had no effect on the HDC activity in any of the four tissues, although basal levels of HDC activity in ear skin was markedly higher than basal HDC activity in the other three kinds of tissues. Still, the relative increase in LPS-induced HDC activity in dental pulp and gingiva were much greater than that in ear skin. Since liver are devoid of mast cells and ear skin is considered the tissue richest in mast cells, the differences in HDC activity between tissues indicates that histamine induced by LPS may be produced by cells other than mast cells through another mechanism of action. These results also suggest that histamine produced in oral tissues in response to bacterial agents such as LPS could be involved in development of pulpitis or gingivitis (periodontitis), the most common diseases in the dental clinic, and that efforts to inhibit HDC activity, which elevates histamine levels in oral tissues, might offer the basis for novel treatment strategies.
OBJECTIVES: The purpose of this retrospective case study of dental records was to compare the long-term failure rates and modes for resin-bonded sintered feldspathic porcelain veneer crowns (RBPVCs) either containing or without metal substructure reinforcement. METHODS: Two prosthodontists placed 62 RBPVCs fabricated with, and 167 without, metal reinforcement in 143 older adolescent and adult patients treated in a private practice. Clinical judgement determined the type of crown design placed. Preparation margins were generally finished on enamel, and all crowns occluded with opposing teeth. Observations included the patients, operators, crown designs and failure modes. Chi-square or Fisher's exact tests and life table survival statistics were used to evaluate the findings (alpha = 0.05). RESULTS: Over five years, failures occurred in 14.5% of RBPVCs fabricated with, and in 18.6% without, metal reinforcement. Cumulative survival estimates were 74.3 +/- 8.5(Standard Error)% and 72.9 +/- 4.8(SE)%, respectively (P = 0.96). Mandibular posterior crowns comprised 27.1% of the placements, but 47.5% of the failures. Bulk fracture of porcelain occurred in 7.0% of the crowns, all without metal reinforcement. Minor porcelain fractures and debonding were less frequent in both types of crowns. Persistent pulpitis occurred in 3.5% of all teeth. CONCLUSIONS: There was a significant risk of failure for sintered porcelain RBPVCs placed as posterior restorations. Although metal reinforcement was able to reduce the risk of bulk fracture of porcelain, other causes of failure were less affected.
OBJECTIVES: To evaluate the survival and success rates of zirconia dental restorations (ZDRs) and their complications. DATA & SOURCES: Electronic searches of PubMed, Cochrane, Embase and Web of Science were conducted up to January 1, 2026. Clinical studies with at least 1-year follow-up evaluating zirconia dental restorations in natural teeth were included. Survival rates, success rates, and biological and mechanical complications were analyzed. Risk of bias was assessed using RoB 2, Newcastle-Ottawa Scale (NOS), and Joanna Briggs Institute tools (JBI). Certainty of evidence was evaluated using the GRADE approach. STUDY SELECTION & RESULTS: Sixty-six studies published between 2008 and 2025 were included. Pooled survival rates ranged from 92.9% to 98.7% up to 10 years for single crowns (SCs), 77.6% over 10 to 13 years for fixed dental prostheses (FPDs), 97.4% for resin-bonded FPDs (RBFPDs) over 10 to 15 years, from 50.0% to 52.6% over 9 to 13 years for conventional cantilever FPDs (CFPDs) and 89.0% for inlay-retained FPDs (IRFPDs) over 10 years. Pooled success rates were 46.1% for SCs over 10 years, 40.1% for FDPs over 10 to 13 years, 84.3% for RBDPDs over 10 to 15 years, 12.5% to 22.6% for CFPDs over 9 to 13 years and 70.3% for IRFPDs over 10 years. Biological and mechanical complication rates were 12.1% and 53.9% for SCs at 10 years, 19.4% and 46.7% for FPDs over 10 to 13 years, 50.0% and 37.5% for CFPDs at 9 years, 21.4% and 14.3% for IRFPDs at 3 years, and 3.3% and 8.0% for RBFPDs over 10 to 15 years. Restorations treated with airborne-particle abrasion (APA) combined with 10-methacryloyloxydecyl dihydrogen phosphate (MDP) achieved favorable short-term clinical outcomes, with pooled survival and success rates of 98.6% and 97.7% for SCs, and 98.1% and 70.1% for IRFPDs, respectively. The included studies were assessed as having low to moderate risk of bias using RoB 2, NOS, and JBI tools, but GRADE assessment yielded evidence of very low certainty. CONCLUSIONS: ZDRs generally demonstrated acceptable to excellent short- to long-term survival and success outcomes. Mid- to long-term clinical performance was varied according to restoration types. The RBFPDs had relatively low complication rates, followed by the SCs, the FPDs and the IRFPDs. CFPDs exhibited relatively low success rates and high complication rates. The predominant biological complications were secondary caries and pulpitis or apical periodontitis, while chipping and debonding were the most common mechanical complications. APA treatment followed by application of MDP is capable of producing favorable short-term clinical outcomes. CLINICAL SIGNIFICANCE: ZDRs except for CFPDs could achieve favorable mid- to long-term clinical performance. CFPDs should be conducted with caution.
The aim of this study was to evaluate the success of using gray mineral trioxide aggregate (MTA) for partial pulpotomy in cariously exposed young permanent first molars. Thirty-one first permanent molars of 23 patients with a carious exposure were treated using a partial pulpotomy technique. The age of the patients ranged from 7.2 to 13.1 yr with an average of 10 yr. Clinical and radiographic examination revealed a pulpal response within normal limits and normal appearance of the periradicular area respectively. A diagnosis of reversible pulpitis and normal periapex was established. After isolation, caries removal and carious exposure, the exposed pulp tissue was removed with a diamond bur to a depth of 2 to 4 mm. After hemostasis, 2 to 4 mm of gray MTA paste was placed against the fresh wound. The floor of the cavity was covered with a base of glass ionomer. The teeth were restored with amalgam or stainless steel crowns. Teeth were reviewed radiographically and clinically at 3, 6, 12, and 24 month intervals. Twenty-two of the treated teeth did not show any clinical or radiographic signs of failure during the follow-up evaluation period. Six teeth did not respond to vitality testing at the final follow-up period; however, no radiographic signs of failure or clinical symptoms were detected. Gray MTA was a suitable dressing agent for parital pulpotomy in cariously exposed young permanent first molars.
STATEMENT OF PROBLEM: All-ceramic molar onlays continue to have higher failures from bulk fracture than similar cast metal onlays. PURPOSE: The purpose of this retrospective study was to compare long-term failure rates and causes for posterior sintered feldspathic ceramic (Mirage) onlays placed with and without metal substructure reinforcement. MATERIAL AND METHODS: Nineteen onlays were placed with and 78 without metal reinforcement in 50 older adolescent and adult patients treated by 2 prosthodontists in a private practice. All onlays opposed occluding tooth surfaces. Clinical judgment determined the type of onlay placed. Observational factors included patients, clinicians, onlay sites, and failure modes. Acrylic resin maxillary splints were generally provided for patients with multiple onlays or parafunctional habits. Thirty-six dies were also available for comparison of the occlusal thickness and taper of intact and failed molar onlays. The chi-square test or Fisher exact test, Student t test, and life table survival statistics were used to evaluate the data (alpha=.05). RESULTS: Over 6 years, failures occurred in 21.1% of onlays placed with metal reinforcement and in 26.9% without metal reinforcement. Cumulative survival estimates (+/- standard error) were 62.4% +/- 14.7% and 60.5% +/- 6.3%, respectively (P=.84). Bulk fracture occurred in 16.5% of molars, independent of metal reinforcement (P=1.00). Overall, 11.4% of premolar and 33.9% of molar onlays failed. Irreversible pulpitis occurred in 6.2% of all teeth. From the dies, there were no clear relationships between either the thickness of occlusal ceramic material or the internal preparation taper and molar onlay failures, for onlays placed with or without metal reinforcement. CONCLUSION: Sintered ceramic onlays placed with and without metal reinforcement showed a similar incidence of bulk fracture in molars. Preparations for both types of onlays were similar.
OBJECTIVE: The aim of the present report is to report an unusual case of chondroid metaplasia of the dental pulp. STUDY DESIGN: A white 45-year-old female patient appeared with signs and symptoms of an irreversible pulpitis on an upper left decayed third molar. After extraction, the tooth was fixed, demineralized, and processed for light microscopy. RESULTS: Pulp tissue was replaced at one of the pulp horns by a colliquative necrosis surrounded by neutrophil leucocytes and congested blood vessels. Serial sections demonstrated a complete opening of the decayed tooth to the oral environment, and an area of chondroid metaplasia of the pulp was evident. Chondroid tissue was surrounded by a dense concentration of chronic inflammation cells. CONCLUSIONS: According to the best knowledge of the authors, this is possibly the first report of an occurrence of chondroid metaplasia in the dental pulp. This metaplasia could be the result of an attempt at tissue repair by the pulp tissue injured by the carious lesion. The pathologic changes in the dental pulp could have activated some of the mechanisms that have been described in other tissues, producing the formation of chondroid tissue. Pulp tissue may adapt to changed environmental stimuli by a deviation from normal cell differentiation.