Root canal therapy and endodontic surgery are conventional treatments for pulpal and periapical diseases. Compared with naked-eye operations, the application of dental operating microscope has enhanced the procedural accuracy and prognosis efficiently. However, root canals with pulp calcification/obliteration, apical lesions with thick cortical bone or adjacent to important anatomic structures are even challenging for experienced operators to achieve predictable clinical outcomes. Recently, with the advances in the field of digitalized information sciences, the above mentioned complicated endodontic cases can be solved under static and dynamic guidance. Before the treatment begins, virtual path is designed from data collected by cone-beam CT and oral image scanning using guidance software. Afterwards, root canal therapy and endodontic surgery can be performed precisely under the assistance of three-dimensional printed guide or dynamic guidance system. The present review describes the classification, features and clinical applications of the guided endodontics.
Cone-Beam Computed Tomography ; Dental Pulp Cavity ; Endodontics ; Humans ; Periapical Diseases/diagnostic imaging* ; Root Canal Therapy

Bioactive materials is defined as substances that elicit special chemical bonding at the interface between tissues and the material. In recent years, more and more bioactive materials have emerged in endodontic treatment. The present article introduces the definition, classification and application of bioactive materials in endodontics. Combined with evidence-based medicine and bioactive materials, optimum treatment recommendations for various endodontic diseases are provided and the development trend of bioactive materials in endodontics is also discussed.
Dental Care ; Dental Pulp Diseases ; Endodontics ; Humans

Pulpal and periapical diseases are the most prevalent dental conditions damaging the oral health of children in China. In view of China's national condition, the level of diagnosis and treatment for pulpal and periapical diseases of deciduous teeth is uneven and clinically there are inconsistent standards on the selection of operation methods for the endodontic treatment in deciduous teeth. Targeting these problems, the Society of Pediatric Dentistry, Chinese Stomatological Association organized experts from several famous universities and hospitals in China to carry out a panel discussion. The results of domestic and overseas researches and diagnosis and treatment experiences on dental pulp disease and periapical disease of deciduous teeth were also referred to. The present guideline was finally developed for the reference of dental clinicians.
Child ; Dental Care ; Dental Pulp ; Dental Pulp Necrosis ; Humans ; Periapical Diseases ; Tooth, Deciduous

The essence of pulp and periapical disease is bacterial infection. Thus, satisfactory infection control is the premise and foundation of healing, in which root canal preparation is a critical procedure. Root canal system anatomy, infection degree, physical cutting during root canal preparation, and certain cleaning measures affect the quality of infection control. Appropriate evaluation of the grades of infected root canals before treatment is necessary because different grades of root canal infection demand various disinfection schedules to facilitate tissue healing and guarantee the long-term success rate of endodontic treatment.
Dental Pulp Cavity ; Humans ; Infection Control ; Periapical Diseases ; Periapical Periodontitis ; Root Canal Irrigants ; Root Canal Preparation ; Root Canal Therapy

Although anti-aging activities of melatonin, a hormone secreted by the pineal gland, have been reported in senescence-accelerated mouse models and several types of cells, its impact and mechanism on the senescence of human dental pulp cells (HDPCs) remains unknown. In this study, we examined the impact of melatonin on cellular premature senescence of HDPCs. Here, we found that melatonin markedly inhibited senescent characteristics of HDPCs after exposure to hydrogen peroxide (H₂O₂), including the increase in senescence-associated β-galactosidase (SA-β-gal)-positive HDPCs and the upregulation of p21 protein, an indicator for senescence. In addition, as melatonin attenuated H₂O₂-stimulated phosphorylation of c-Jun N-terminal kinase (JNK), while selective inhibition of JNK activity with SP600125 significantly attenuated H₂O₂-induced increase in SA-beta-gal activity. Results reveal that melatonin antagonizes premature senescence of HDPCs via JNK pathway. Thus, melatonin may have therapeutic potential to prevent stress-induced premature senescence, possibly correlated with development of dental pulp diseases, and to maintain oral health across the life span.
Aging* ; Animals ; Dental Pulp Diseases ; Dental Pulp* ; Humans* ; Hydrogen Peroxide ; JNK Mitogen-Activated Protein Kinases ; MAP Kinase Signaling System ; Melatonin* ; Mice ; Oral Health ; Phosphorylation ; Pineal Gland ; Up-Regulation

Dental pulp tissue plays a role in forming dentin, providing nutrition, conducting pain, and generating protective responses to environmental stimuli. Bacterial infection is the main cause of pulp disease, where histopathological changes are the histological basis for determining the choice of treatment and the evaluation of therapeutic effect. Thus, particular attention should be given to eliminate infection, as well as preserve and maintain pulpal health in teeth that show reversible or limited pulpal injuries. Vital pulp therapy, especially its indications and prognostic factors, has been a research hotspot that often causes confusion among clinicians. In this paper, we briefly introduce the confusion and solution for vital pulp therapy in terms of indications, pulp condition assessment, infection elimination, and capping material selection. In addition, we develop a clinical pathway and an operation normalization of vital pulp therapy to better perform the therapy.
Dental Care ; Dental Pulp ; Dental Pulp Capping ; Dental Pulp Diseases ; Dentin, Secondary ; Humans

X-linked hypophosphatemia (XLH) is a hereditary metabolic disease caused by the loss of phosphate through the renal tubules into the urine, and an associated decrease in serum calcium and potassium phosphate. Its dental features include spontaneous dental abscesses that occur in the absence of trauma or dental caries. The aim of this case report was to describe the dental problems of XLH patients and to evaluate limitations in their treatment. A 14 year old male and a 38 year old female with XLH were referred to the Department of Conservative Dentistry for endodontic treatment. The dental findings were periapical abscesses without obvious trauma or caries. Conservative endodontic treatment was performed in teeth with pulp necrosis and abscess. In case 1, the treated teeth showed improvements in bone healing, without clinical symptoms. However, in case 2, the implants and the treated tooth showed hypermobility, and the final restoration was therefore postponed. Early diagnosis, periodic examinations, and communication with the patient's pediatrician are important in the dental management of patients with XLH.
Abscess ; Calcium ; Dental Caries ; Dental Pulp Necrosis ; Dentistry ; Early Diagnosis ; Familial Hypophosphatemic Rickets* ; Female ; Humans ; Hypophosphatemia ; Male ; Metabolic Diseases ; Periapical Abscess ; Potassium ; Tooth

The pathogenesis of pulpal and periapical diseases is related with not only bacterial infection but also physicochemical irritations such as trauma and thermal changes. During orthodontic therapy, the application of orthodontic forces on teeth may produce a series of changes in periodontal ligament, alveolar bone and pulpo-dentinal complex. This article reviewed the influences of orthodontic therapy on dental pulp and periapical tissues.
Dental Pulp ; Dental Pulp Diseases ; etiology ; Dentin ; Humans ; Orthodontics ; Periapical Diseases ; etiology ; Periapical Tissue ; Periodontal Ligament

Dental Pulp Diseases ; diagnosis ; therapy ; Humans ; Root Canal Therapy

A tooth with primary endodontic disease that demonstrates a periodontal defect might be extracted because of misdiagnosis as severe periodontal disease or a vertical root fracture. The aim of this case report was to demonstrate the long-term survival of endodontically treated teeth, which had been initially considered unsavable. With meticulous evaluation including the patient's dental history, clinical and radiographic examinations, teeth with primary endodontic lesions could be differentiated and saved after proper root canal treatment. Pain history, vitality test, and radiographic examinations, as well as a general periodontal condition check with periodontal probing on an affected tooth, might be the key methods to differentiate endodontic pathosis from that of periodontal disease.
Dental Pulp Cavity ; Diagnosis* ; Diagnostic Errors ; Follow-Up Studies* ; Methods ; Periodontal Diseases* ; Tooth*