In recent years, great progress has been made in research on the treatment of pulpitis, mainly due to the rapid development of basic and clinical researches in this field, and some achievement from basic research has been applied in clinical practice. Advances in the diagnostic methods for pulpitis can help the clinicians to recognize the true state of pulpitis more accurately and to adopt the corresponding treatment methods including indirect/direct pulp capping, pulpotomy, pulp regeneration and root canal therapy. The new theory of pulpitis diagnosis and the studies on immune defense, repair function of dental pulp and new pulp capping materials have significantly improved the success rate of vital pulp therapy. For diffuse coronary pulpitis or radicular pulpitis, which is difficult to achieve vital pulp therapy successfully, methods of pulp revascularization, cell homing and pulp stem cells-mediated pulp regeneration can also be used as treatment options in addition to root canal therapy. The present article focuses on the research progress on pulpitis treatments and related clinical transformation practices, in order to provide reference on vital pulp therapy and pulp regeneration for clinicians.
Dental Pulp ; Dental Pulp Capping ; Humans ; Pulpitis/therapy* ; Pulpotomy ; Regeneration

To assess the treatment effectiveness of vital inflamed pulp therapy (VIPT) in immature permanent teeth with irreversible pulpitis and apical periodontitis. The faculty members in the Department of Pediatric Dentistry, the Ninth People's Hospital were invited to submit consecutive VIPT cases from June 2015 to June 2016 (follow-up periods>12 months). The cases were retrospectively reviewed, clinical symptoms and radiographic changes in periapical radiolucency were evaluated, meanwhile, the data of radiographic changes such as apical diameter and root length were calculated and analyzed with ANOVA. Totally thirteen submitted patients/cases were included (6 males and 7 females) in the present study,. The average age of patients was (9.9±1.4) years old. The average follow-up time was (26.5±6.8) months (17-37 months). At the 12-month visit, all 13 treated teeth survived, 9 out of 11 teeth with apical periodontitis showed normal radiographic manifestation. At the 3, 6 and 12 months visits, the within-case percentage changes in apical diameter were (8.0±5.1)%, (24.1±9.1)% and (70.3±10.7)%, respectively, while the within-case percentage changes in root length were (11.4±9.8)%, (14.5±9.8)% and (27.4±14.2)%, respectively. There were statistically significant differences in the changes of apical diameter (F=18.80, P<0.001) and root length (F=4.64, P=0.047) from the preoperative time to the postoperative follow-ups. VIPT might improve clinical outcomes, even achieve continued root development. VIPT can be an option in treating immature teeth with irreversible pulpitis and apical periodontitis.
Child ; Dentition, Permanent ; Female ; Humans ; Male ; Periapical Periodontitis/therapy* ; Pulpitis/therapy* ; Retrospective Studies ; Root Canal Therapy

Dentists ; legislation & jurisprudence ; Dissent and Disputes ; legislation & jurisprudence ; Humans ; Malpractice ; legislation & jurisprudence ; Medical Records ; Pulpitis ; diagnosis ; therapy

Pulpitis and periapical periodontitis is a type of bacterial infectious disease, and bacteria frequently plant in the entire root canal system during the terminal stage. Main clinical treatment strategy of the disease requires root canal therapy, a key and core procedure for the successful treatment by thoroughly removing the root canal infection. The premise and guarantee of thoroughly removing root canal infection is by determining the accurate root canal working length. However, introduction of the complexity of the apical root anatomical structure, the confusion in determining the position of apical stop, and the method to determine the root canal working length. methods of accurately determining root canal working length, especially determining the position of apical stop, has been a hot topic among endodontic specialists, frequently causing confusion among many clinicians. This review provides a brief
Dental Pulp Cavity ; Periapical Periodontitis ; Pulpitis ; Root Canal Preparation ; Root Canal Therapy ; Tooth Root

OBJECTIVE: This study aimed to investigate the prognosis of permanent teeth with external root resorption (ERR) caused by adjacent impacted teeth. METHODS: A total of 75 ERR teeth (permanent teeth) caused by adjacent impacted teeth of 63 patients were included. The prognosis of ERR teeth was analyzed followed by minimally invasive extraction of the adjacent impacted teeth. The time of follow-up was six months. The relationship between prognosis of ERR teeth and patients' age, gender, root number, type of root resorption and degree of root resorption were analyzed. RESULTS: In the 75 ERR teeth, 67 teeth (89.3%) did not show pulpitis symptoms. The clinical outcome was found to be related with age (r=0.330, P<0.05), whereas no relationships with gender, root number, as well as type and degree of root resorption were observed (P>0.05). Pulpitis symptom was not found in ERR teeth of patients under 30 years old. CONCLUSIONS For ERR teeth caused by adjacent impacted teeth, keeping the pulp vital after surgical removal of impacted teeth is highly probable. Post-operative follow-up instead of preventive root canal therapy of ERR teeth is recommended.
Adult ; Humans ; Prognosis ; Pulpitis ; Root Canal Therapy ; Root Resorption ; Tooth, Impacted

OBJECTIVE: To present a prognostic model for evaluating the outcome of root canal treatment in teeth with pulpitis or apical periodontitis 2 years after treatment. METHODS: The implementation of this study was based on a retrospective study on the 2-year outcome of root canal treatment. A cohort of 360 teeth, which received treatment and review, were chosen to build up the total sample size. In the study, 143 teeth with vital pulp and 217 teeth with apical periodontitis were included. About 67% of the samples were selected randomly to derive a training date set for modeling, and the others were used as validating date set for testing. Logistic regression models were used to produce the prognostic models. The dependent variable was defined as absence of periapical lesion or reduction of periapical lesion. The predictability of the models was evaluated by the area under the receiver-operating characteristic (ROC) curve (AUC). RESULTS: Four predictors were included in model one (absence of apical lesion): pre-operative periapical radiolucency, canal curvature, density and apical extent of root fillings. The AUC was 0.802 (95%CI: 0.744-0.859). And the AUC of the testing date was 0.688. Only the density and apical extent of root fillings were included to present model two (reduction of apical lesion). The AUC of training dates and testing dates were 0.734 (95%CI: 0.612-0.856) and 0.681, respectively. As predicted by model one, the probability of absence of periapical lesion 2 years after endodontic treatment was 90% in pulpitis teeth with sever root-canal curvature and adequate root canal fillings, but 51% in teeth with apical periodontitis. When using prognostic model two for prediction, in teeth with apical periodontitis, the probability of detecting lesion reduction with adequate or inadequate root fillings was 95% and 39% 2 years after treatment. CONCLUSION The pre-operative periapical status, canal curvature and quality of root canal treatment could be used to predict the 2-year outcome of root canal treatment.
Dental Pulp Cavity ; Humans ; Periapical Periodontitis ; Prevalence ; Prognosis ; Pulpitis ; Random Allocation ; Retrospective Studies ; Root Canal Therapy

Dental Caries ; etiology ; therapy ; Denture Precision Attachment ; Denture Retention ; Humans ; Periapical Periodontitis ; etiology ; therapy ; Periodontitis ; etiology ; therapy ; Pulpitis ; etiology ; therapy

Adult ; Child ; Chronic Disease ; Dental Restoration, Permanent ; Female ; Humans ; Problem Solving ; Pulpitis ; therapy ; Root Canal Therapy ; Young Adult

OBJECTIVEThe aim of this study was to examine the levels of prostaglandin E2 in periapical exudates before and after root canal treatment.

METHODSPeriapical exudates specimens were quantitatively sampled from root canals of 25 teeth at consecutive treatment visits, and the concentration of prostaglandin E2 in each sample was determined using a commercial kit.

RESULTSThe mean prostaglandin E2 levels significantly decreased after the endodontic therapy. Significant correlations between the levels of prostaglandin E2 and the clinical features of periapical periodontitis were also found in this study.

CONCLUSIONThe results suggest that the level of prostaglandin E2 in periapical exudates reflects the state of periapical periodontitis.

Adolescent ; Adult ; Aged ; Dinoprostone ; metabolism ; Female ; Humans ; Male ; Middle Aged ; Periapical Periodontitis ; metabolism ; therapy ; Pericardial Effusion ; metabolism ; Pulpitis ; metabolism ; therapy ; Root Canal Therapy

OBJECTIVETo evaluate clinical effects of two types of nickel-titanium rotary instruments in preparation of molars' root canals.

METHODS100 molars with pupal and periapical involvement were instrumented by Protaper and Hero642 files with crown-down technique. All teeth were obturated with lateral condensation method. Straightening of canal curvature was determined. The efficiency of preparation and obturation was analyzed with radiograph before, during and after operation.

RESULTSThe operating time of each NiTi group was short. The two NiTi rotary instruments could achieve continuously tapered root canal shape. The curvature of the canal reduced by -4.02 degrees +/- 2.80 degrees with Protaper and 1.72 degrees with Hero642 (P < 0.001). Five pieces of Protaper with broken, whereas no Hero642 was broken (P < 0.05).

CONCLUSIONSProtaper, Hero642 files showed good shaping ability and improved predictability in root canal obturation. Protaper can lessen canal curvature more significantly. Hero642 files are easy to operate and not easy to separate.

Adult ; Aged ; Dental Alloys ; Humans ; Middle Aged ; Molar ; Nickel ; Periodontitis ; therapy ; Pulpitis ; therapy ; Root Canal Preparation ; instrumentation ; Root Canal Therapy ; Titanium ; Young Adult