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PubMed2002

Ferric sulphate and formocresol pulpotomies in baboon primary molars: histological responses.

AIM: To compare pulpal reactions to ferric sulphate and formocresol pulpotomies in primary molar teeth with inflamed pulps. STUDY DESIGN: An experimental study in 15 juvenile baboons (Papio ursinus). MATERIALS AND METHODS: Pulpitis was induced with fresh human carious dentine or Streptococcus mutans placed into occlusal cavities in 57 primary molars; after 14 days a pulpotomy was performed on the same primary molars with the two pulp medicaments randomly allocated; the pulp was covered with IRM and the cavity filled with amalgam. After 90 days specimens were harvested and examined under the light microscope with the examiner blind to the treatment. RESULTS: Reaction frequencies in the ferric sulphate-treated and formocresol-treated teeth were: recognisable pulp 52% and 50%, dentine bridges 16% and 12%, internal root resorption 12% and 4%, external resorption 28% and 31%, bacteria 12% and 23%, peri-apical abscesses 32% and 38%. STATISTICS: Fisher's exact probability test showed no statistically significant differences between reaction frequencies in the two treatment groups. CONCLUSION: A pulpotomy in a primary tooth may be clinically successful in the presence of adverse histological reactions.

Journal Article↗

PubMed1992

Dens in dente in a six year old doberman pinscher.

Developmental abnormalities of tooth shape and form are rare. Identification of dens in dente is made by radiographic and clinical examination. Pulpitis, pulp necrosis and periapical inflammation can be associated with this abnormality. The tooth should be evaluated for endodontic therapy. A review of the literature related to dens in dente is described with the findings in a doberman pinscher.

Animals↗

PubMed2003

Capsaicin receptor VR1 and ATP purinoceptor P2X3 in painful and nonpainful human tooth pulp.

AIMS: To investigate the levels of the capsaicin or vanilloid receptor-1 (VR1) and the ATP-gated purinoceptor P2X3 in painful and nonpainful human tooth pulps. METHODS: Immunohistochemistry with specific antibodies and image analysis was used to quantify VR1- and P2X3-positive nerve fibers in painful (n = 13) and nonpainful (n = 33) human tooth pulps, and VR1 immunoreactivity was compared with immunoreactivity for the structural neuronal marker peripherin. RESULTS: Strong VR1-like immunoreactivity was documented for the first time in dental pulp neurons. Weaker P2X3-like immunoreactivity was also detected in fewer nerve fibers. The ratio of VR1 to peripherin immunoreactivity was not significantly different between nonpainful and painful tissues (mean +/- SE% area of VR1 to peripherin; nonpainful 53.4 +/- 4.7%, n = 33; pulpitis 35.1 +/- 7.1%, n = 13; P = .07). CONCLUSION: The presence of VR1 and P2X3 in fibers of human tooth pulp suggest that they may play a role in perception of dental pain, but further studies, including quantitation of their ligands, are necessary to elucidate any role they may play in pathophysiologic states.

Capsaicin↗

PubMed2003

[Outcome of 500 cases of transcortical anesthesia carried out as the first choice].

Transcortical anesthesia, like all anesthetic techniques, is founded on anatomical, physiological and histological principles. Its fundamental principle and clinical data that support it indicate that it could advantageously replace most other techniques. Indeed, a study carried out by 3 dental surgeons involving 500 transcortical procedures as the first choice for anesthesia confirms this possibility and emphasizes the principal advantages: Immediate anesthesia of several (2 to 6) maxillary or mandibular teeth with a single vestibular injection (without additional palatine or lingual injection); elimination of cheek and lip numbness; use of concentrated vasoconstrictor with no risk of necrosis to solve the problem of immediate anesthesia of teeth with pulpitis.

Anesthesia, Dental↗

PubMed2003

[Clinical study on the causes and treatment of endodontic interappointment emergencies].

OBJECTIVE: To investigate the causes and the treatment of endodontic interappointment emergencies. METHODS: An analysis were made for 55 teeth with endodontic interappointment emergencies. The root canals were sealed with dexamethasone and metronidazole,and filled with Vitapex add gutta-percha point after one week. An evaluation of curative effect was made after following up one year. RESULTS: The total incidence of endodontic interappointment emergencies was 12.59%(55/437). There was significant difference between pulpitis and pulp necrosis or apicitis(P<0.01). There was significant difference between anterior teeth and posterior teeth (P<0.01). The success rate was 92.7% after following up one year. CONCLUSION: The cause of endodontic interappointment emergencies was related to pulp status and tooth location,etc. The treatment that sealed the root canals with dexamethasone and metronidazole and filled with Vitapex add gutta-percha point is of availability.

Adult↗

PubMed2001

[Clinical evaluation of pulpotomy in the treatment of deciduous teeth with deep dentine caries].

OBJECTIVE: To study the curative effect of pulpotomy in the treatment of deciduous teeth with deep caries. METHODS: 45 deciduous molars with deep caries from 3 8 years old children were selected at random. Pulpotomy was performed on these treated teeth. Clinical examination and X-ray films for the treated teeth were taken to follow up all the teeth at 6 months, one year and two years respectively after treatment. RESULTS: At one year after treatment, 45 cases were followed up, the rate of success in clinical examination and in X-ray photographs both were 100%. While at two years after treatment, 42 cases were followed up and 3 cases were lost, the rate of success in clinical examination was 95% and the rate of success in X-ray photographs was 88%. The reasons of the failure were internal absorption and pulpitis followed by fracture and exfoliation of the obturators in the treated teeth. CONCLUSION: Pulpotomy in deciduous teeth with deep caries was a reliable and effective method. It is necessary to follow up the treated teeth by X-ray at regular intervals after treatment.

English Abstract↗

PubMed2000

[The management of 126 cases of posterior cracked crown of tooth and its effective observation].

OBJECTIVE: To detect the treatment and effect of posterior cracked tooth. METHODS: 162 posterior cracked teeth of 158 cases, including enamel fissure and dentin fissure, all there cases undergone the synthetical treatment and follow up in different period, the longest observation period was 2.5 years. RESULTS: The healing and improved rate of 162 cracked teeth 90.74%. Among cases of failure, we have founded 6 cases of acute pulpitis (3.7%), 3 cases of alveodental abscess (1.85%), 2 cases of chronic apical periodontitis (1.24%), 4 cases of tooth fracture (2.4%). CONCLUSION: Cracked tooth was caused by multiple factors. Early diagnosis, synthetical treatment, and follow up in different period are 3 main factors in treatment.

English Abstract↗

PubMed1992

Role of intradental A- and C-type nerve fibres in dental pain mechanisms.

The arousal of the two components of pain (the first rapid or sharp pain and the second dull pain) are considered to be related to activation of A delta- and C-type nociceptive primary afferents, respectively. The same dichotomy of pain sensations may also exist in teeth, although due to the short distance between the site of stimulation and the brain the two sensations might not be as clearly separated as in stimulation of, for example, the extremities. The sensations evoked by stimulation of human teeth vary according to the type of the stimuli applied. Low-intensity electrical stimulation is able to induce non-painful (prepain) sensations. At high current intensities pain is evoked. Drilling, probing and air-drying of exposed dentin induce only pain. Most studies also indicate that thermal stimulation only induces painful sensations. The quality of dental pain can vary. Typically, dentinal stimulation of teeth with healthy pulps induces sharp pain. On the other hand intense heat stimulation can result in dull pain which radiates to a wider area of the face and jaws. This component of the stimulus-induced pain seems to share some characteristics of toothache associated with painful pulpitis. Single fibre recordings of intradental nerve activity in experimental animals have shown that in addition to A-fibres a considerable number of C-type primary afferents innervate the dental pulp. This is in accordance with the results of neuroanatomical studies, which indicate that 70-80% of pulpal axons in human, monkey, dog, and cat teeth are unmyelinated. Intradental A- and C-fibre groups seem to be functionally different and can be activated separately by certain external stimuli. Comparison of the response characteristics of the pulp nerve fibres and the sensations induced from human teeth indicate that: 1) A-fibres are responsible for the sensitivity of dentine and thus for the mediation of the sharp pain induced by dentinal stimulation, 2) Prepain sensations induced by electrical stimulation result from activation of the lowest threshold A-fibres some of which can be classified as A beta-fibres according to their conduction velocities. Comparison of the responses of the A beta- and A delta-fibres indicate that they belong to the same functional group, 3) Intradental C-fibres are activated only if the external stimuli reach the pulp proper. Their activation may contribute to the dull pain induced by intense thermal stimulation of the tooth and to that associated with pulpal inflammation.

Animals↗

PubMed1992

Studies on the presence and functional properties of afferent C-fibers in the cat's dental pulp.

The present investigation describes how intradental afferent C-fibers can be identified and characterized in the anaesthetized cat. Functional single fibers innervating the lower canine tooth were recorded from filaments split from the inferior alveolar nerve. Fibers responding to monopolar electrical stimulation of the tooth were classified as slowly and fast conducting according to their conduction velocity (c.v.). The axonal c.v. was determined for 31 slowly conducting fibers by electrical stimulation of the nerve. Sixty-eight percent of these proved to be C-fibers. The slowly conducting fibers had higher activation thresholds, smaller amplitudes and longer durations of the action potentials than the fast conducting fibers. Many of the fast but none of the slowly conducting fibers were repetitively activated by a single stimulus pulse. The highest frequency at which the fibers responded to every stimulus pulse was much lower for the slowly than for the fast conducting fibers. Most of the slowly conducting intradental fibers tested were activated by both hot and cold stimulation of the tooth, by pressure applied to the pulp chamber and by the application of KCl or bradykinin to the pulp. Eight C-fibers responded to mechanical stimulation of the pulp. For some fibers the response magnitude correlated with the stimulus intensity. Many slowly conducting intradental fibers developed an ongoing discharge after heat and pressure stimulation. The results indicate that there exists in the dental pulp of the cat afferent C-fibers that resemble polymodal C-nociceptors. They might be involved in the generation of the dull aching pain present in inflammatory conditions of the pulp. The activation of intradental C-fibers in pulpitis might result either from the elevated pressure and/or by sensitization of the C-fiber endings by inflammatory substances released.

Action Potentials↗

PubMed2001

Electrometric determination of the working length of root canals by means of Apex locator.

AIM: To evaluate an apex locator in determining the working length of root canals and detecting micro-communications with the pulp chamber. METHODS: The apparatus was tested on 21 patients, aged 18 - 70, who received endodontic treatment of 34 teeth with 45 root canals. The apparatus was used in compliance with the instructions of the manufacturer. The precision of the instrument was determined by a radiograph of the tooth with a file inserted in it at a depth equal to the length determined with the Apex locator. The obtained results were divided into three groups: canals determined as longer; canals in which the outline of the instrument was close to the roentgenologic apex; and canals determined as shorter. CONCLUSION: The average deviation from the roentgenologic apex was 1.17 mm, which is, in fact, the area of the physiological apex opening - the ideal limits for treatment and obturation. The apparatus can be successfully used to make differential diagnosis is useful of deep caries with pulpitis chronica ulcerosa. It is ergonomic and easy to use.

Adolescent↗

PubMed2004

[A comparison of the effect between Vitapex paste and antibiotic paste in apexification.].

PURPOSE: To study the effects of two root canal filling material in the apexification. METHODS: 172 juvenile permanent teeth,including 62 teeth with pulpitis, 32 teeth with necrotic pulp and 78 teeth with periapical periodontitis, were divided into two groups.The root canal was filled with Vitapex paste and antibiotic paste.Every patient was examined once three months.The treatment lasted 6-30 months.The outcome of treatment was investigated for three years following treatment. RESULTS: The effective rate in the group of Vitapex paste and antibiotic paste group were 86.0% and 91.9% (P>0.05).In periapical periodontitis group,the effective rate of antibiotic paste group was significantly higher than the other (P<0.05). CONCLUSION: Both Vitapex paste and antibiotics paste were good filling materials in apexification. Antibiotic paste was better than the other in periapical periodontitis group.

Anti-Bacterial Agents↗

PubMed2005

Vanilloid receptor 1 expression in human tooth pulp in relation to caries and pain.

AIMS: To investigate the presence of vanilloid receptor 1 (TRPV1) in human dental pulp and to correlate any expression with caries and pain. METHODS: Permanent mandibular first molars were collected and categorized as intact or grossly carious. Grossly carious teeth were further categorized as carious asymptomatic or carious painful samples. Coronal pulps were removed and processed for indirect immunofluorescence using antibodies raised against TRPV1 and a neuronal marker, either protein gene product 9.5 or alpha-smooth muscle actin, in conjunction with Ulex europaeus agglutinin 1 lectin to fully label the pulp vasculature. RESULTS: Analysis revealed that TRPV1 labeling was not confined to pulpal nerve fibers. TRPV1 was also consistently expressed within pulp microvasculature. Expression of neuronal TRPV1 was significantly increased throughout the pulp in grossly carious samples (P < .05). No significant differences were found between carious asymptomatic and carious painful samples. A significant increase in vascular TRPV1 expression was observed in arterioles present in the midcoronal pulp in carious painful compared with carious asymptomatic samples (mean area +/- SEM [%] of TRPV1 to vascular labeling; 6.48% +/- 4.5% for carious asymptomatic teeth, n = 9; 31.21% +/- 9.6% for carious painful teeth, n = 9; P = .02). CONCLUSION: Expression of TRPV1 in pulpal nerve fibers undergoes marked changes with caries. This may be of relevance in the development of pulpal inflammation, but its relationship to dental pain is still unclear. However, vascular TRPV1 expression does appear to be positively correlated with dental pain, thus providing new insights into symptomatic pulpitis.

Blood Vessels↗

PubMedDate not supplied

Clinical evaluation of indirect resin composite and ceramic onlays over a 24-month period.

The purpose of this study was to compare the clinical performance of ceramic and indirect resin composite onlays over a 24-month period. A total of 94 onlay restorations in 47 patients were included in this study. Cavities were prepared, full-arch impressions were taken, and onlays were fabricated in the laboratory. All restorations were placed with a dual-cured luting resin composite system. Restorations were evaluated at baseline and at 6, 12, 18, and 24 months. Differences between Alpha scores were analyzed statistically. The recall rate of this study was 93.6%. At the six-month evaluation, one onlay failed due to pulpitis. Other than the color match, there was no significant difference between indirect resin composite and ceramic onlays (p > 0.05). For indirect resin composites, Alpha score differences pertaining to color match, marginal adaptation, and surface texture were found to be statistically significant (p < 0.05) between the baseline and the 24-month recall. For ceramic restorations, marginal adaptation criteria was the only significant difference over the 24-month period (p < 0.05). At the end of 24 months, both indirect resin composite and ceramic onlays were considered to be successful clinically.

Adult↗

PubMed2006

Efficient, conservative treatment of symptomatic cracked teeth.

Every practice has patients who complain of cold sensitivity and pain on biting while showing no obvious signs of irreversible pulpitis. After loading each cusp and fossa in a symptomatic quadrant and ruling out pulp and periodontal pathology, definitive treatment can be performed to alleviate the patient's symptoms in a consistent, conservative manner using esthetic computer-aided design/computer-aided manufacturing porcelain restorations. Single-appointment definitive restorations can be advantageous for the patient because of the elimination of many steps involved in laboratory fabrication of porcelain or metal restorations.

Ceramics↗

PubMed1995

[Improved entrance of endodontic treatment :51 cases report.].

The endodontic treatment can be carried out through the improved entrance of labial or buccal surface for the pulpitis and periapical periodontitis of anterior teeth (including premolars) due to the labial or buccal cervical caries and wedge-shaped defects,so that the hard tissues of tooth can be concerted as more as possible and the tooth can be prevented from fracture as a result of too big cavity to be prepared.This paper presents the main points of operation and shows the advantages by means of clinical pictures and radiograph.

English Abstract↗

PubMed2006

Antibiotic prophylaxis in pediatric odontology. An update.

Most orofacial infections are of odontogenic origin, and are of a self-limiting nature, characterized by spontaneous drainage. The causal bacteria are generally saprophytes. On the other hand, invasive dental interventions give rise to transient bacteremia. When an oral lesion is contaminated by extrinsic bacteria, the required antibiotic treatment should be provided as soon as possible. In the case of pulpitis, such treatment is usually not indicated if the infection only reaches the pulp tissue or the immediately adjacent tissues. In the event of dental avulsion, local antibiotic application is advised, in addition to the provision of systemic antibiotics. The dental professional must know the severity of the infection and the general condition of the child in order to decide referral to a medical center. Prophylaxis is required in all immunocompromised patients, as well as in individuals with cardiac problems associated with endocarditis, vascular catheters or prostheses. Penicillin V associated to clavulanic acid and administered via the oral route is known to be effective against odontogenic infections. In the case of allergies to penicillin, an alternative drug is clindamycin. Most acute infections are resolved within 3-7 days. In recent years, the tendency is to reduce general antibiotic use for preventive or therapeutic purposes.

Antibiotic Prophylaxis↗

PubMed2006

Clinical evaluation of a polyacid-modified resin composite (Dyract) in Class III cavities: 5-year results.

PURPOSE: This study evaluated the 5-year clinical performance of Dyract polyacid-modified resin composite material in Class III cavities. METHODS: 62 Class III cavities in 30 patients were restored with Dyract. Two experienced, calibrated examiners evaluated the restorations clinically at baseline and at 1-, 2-, 3-, 4-, and 5-year recalls, according to the modified Ryge criteria. RESULTS: After 5 years, a total of six restorations had failed and the cumulative failure rate was 94.6%. By the 5-year recall, one restoration was replaced due to pulpitis and five were replaced due to secondary caries. After 5 years, marginal discoloration was statistically significant (P= 0.0002).

Acid Etching, Dental↗

PubMed2006

[Tooth and molar pains].

A patient's pain history is the primary source of information in case of toothache (dentoalveolar pain); revealing its location, its main characteristics and its course, both from the onset and during the day. Clinical diagnostic tests that provoke (such as pulp testing or percussion) or eliminate (such as local anaesthesia) pain are most useful. Several mechanisms may underlie dentoalveolar pain. Pain caused by pulpitis shows characteristics of visceral types of pain, whereas pain originating from the periodontal ligament is characterized by musculoskeletal features. It also happens fairly often that the pain is found to originate from a different tooth than the one in which it is perceived, or from an even more distant source (referred pain). These mechanisms emphasize the importance of differential diagnostics.

Anesthetics, Local↗