Intentional tooth replantation (ITR) is an advanced treatment modality and the procedure of last resort for preserving teeth with inaccessible endodontic or resorptive lesions. ITR is defined as the deliberate extraction of a tooth; evaluation of the root surface, endodontic manipulation, and repair; and placement of the tooth back into its original socket. Case reports, case series, cohort studies, and randomized controlled trials have demonstrated the efficacy of ITR in the retention of natural teeth that are untreatable or difficult to manage with root canal treatment or endodontic microsurgery. However, variations in clinical protocols for ITR exist due to the empirical nature of the original protocols and rapid advancements in the field of oral biology and dental materials. This heterogeneity in protocols may cause confusion among dental practitioners; therefore, guidelines and considerations for ITR should be explicated. This expert consensus discusses the biological foundation of ITR, the available clinical protocols and current status of ITR in treating teeth with refractory apical periodontitis or anatomical aberration, and the main complications of this treatment, aiming to refine the clinical management of ITR in accordance with the progress of basic research and clinical studies; the findings suggest that ITR may become a more consistent evidence-based option in dental treatment.
Humans ; Tooth Replantation/methods* ; Consensus ; Periapical Periodontitis/surgery*

Immature permanent teeth refer to those that have erupted but have not yet formed and matured in terms of shape and structure. The characteristics of their disease onset and treatment methods are different from those of ordinary permanent teeth. Children with special healthcare needs often lack the capacity to cooperate during routine dental procedures, making treatment under general anesthesia (GA) the preferred option. With social advancements, the demand for pediatric dental GA has considerably increased. This study discuss the treatment strategies for immature permanent teeth under GA, including diagnosis, therapeutic principles, key considerations, and clinical approaches for dental caries, pulpitis periapical periodontitis, etc.
Child ; Humans ; Anesthesia, General ; Dental Caries/diagnosis* ; Dentition, Permanent ; Periapical Periodontitis/therapy* ; Pulpitis/therapy*

Dens invaginatus is a rare developmental anomaly of the teeth that is caused by the infolding of enamel organs or the penetration of their proliferations into dental papillae before calcification has occurred. The presence of double dens invaginatus is extremely rare. This paper describes the use of cone beam computed tomography in the evaluation of a maxillary lateral incisor with double dens invaginatus and periapical periodontitis. The tooth was treated through microscopic root canal therapy. The tooth was free of clinical symptoms, and the periradicular lesion narrowed during the follow-up period of 1 year.
Humans ; Dental Pulp Cavity/abnormalities* ; Dens in Dente/pathology* ; Incisor/pathology* ; Root Canal Therapy ; Periapical Periodontitis/pathology*

There is a high incidence of chronic periapical periodontitis of deciduous teeth, however, there is a low incidence of the apical cyst. This paper reports a 7-year-old child with deciduous periodontitis caused by chronic periapical periodontitis of deciduous teeth. Through literature review, the etiology, imaging characteristics, diagnosis, differential diagnosis, and treatment methods were discussed to provide the basis for clinical diagnosis and treatment.
Child ; Humans ; Cysts ; Diagnosis, Differential ; Periapical Periodontitis/therapy* ; Tooth, Deciduous

Root canal therapy is the common treatment for endodontic infections. Successful root canal therapy depends on favorable root canal preparation, root canal medication and three-dimensional obturation of the root canal system. The key to successful root canal therapy is to prevent re-infection of the highly complex root canal systems by removing infecious biofilms and bacterial toxins in the root canal system. The present paper reviews the pathogenic mechanism of the Enterococcus faecalis in the harsh environment of root canal system, the inflammation and immunity of refractory periapical periodontitis and the progress of infection control methods.
Dental Pulp Cavity ; Enterococcus faecalis ; Humans ; Periapical Periodontitis/therapy* ; Persistent Infection ; Root Canal Irrigants ; Root Canal Preparation ; Root Canal Therapy

Conservative Treatment ; Dens in Dente/therapy* ; Humans ; Incisor ; Periapical Periodontitis/therapy* ; Root Canal Filling Materials

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

Once pulp necrosis or apical periodontitis occurs on immature teeth, the weak root and open root apex are challenging to clinicians. Berberine (BBR) is a potential medicine for bone disorders, therefore, we proposed to apply BBR in root canals to enhance root repair in immature teeth. An in vivo model of immature teeth with apical periodontitis was established in rats, and root canals were filled with BBR, calcium hydroxide or sterilized saline for 3 weeks. The shape of the roots was analyzed by micro-computed tomography and histological staining. In vitro, BBR was introduced into stem cells from apical papilla (SCAPs). Osteogenic differentiation of stem cells from apical papilla was investigated by alkaline phosphatase activity, mineralization ability, and gene expression of osteogenic makers. The signaling pathway, which regulated the osteogenesis of SCAPs was evaluated by quantitative real time PCR, Western blot analysis, and immunofluorescence. In rats treated with BBR, more tissue was formed, with longer roots, thicker root walls, and smaller apex diameters. In addition, we found that BBR promoted SCAPs osteogenesis in a time-dependent and concentration-dependent manner. BBR induced the expression of β-catenin and enhanced β-catenin entering into the nucleus, to up-regulate more runt-related nuclear factor 2 downstream. BBR enhanced root repair in immature teeth with apical periodontitis by activating the canonical Wnt/β-catenin pathway in SCAPs.
Animals ; Berberine ; pharmacology ; Cell Differentiation ; drug effects ; Dental Papilla ; Male ; Osteogenesis ; drug effects ; Periapical Periodontitis ; therapy ; Rats ; Stem Cells ; cytology ; drug effects ; metabolism ; Wnt Signaling Pathway ; drug effects ; Wnt3A Protein ; genetics ; metabolism ; X-Ray Microtomography

Navigation of the main root canal and dealing with a dens invaginatus (DI) is a challenging task in clinical practice. Recently, the guided endodontics technique has become an alternative method for accessing root canals, surgical cavities, and calcified root canals without causing iatrogenic damage to tissue. In this case report, the use of the guided endodontics technique for two maxillary lateral incisors with multiple DIs is described. A 16-year-old female patient was referred with the chief complaint of pain and discoloured upper front teeth. Based on clinical and radiographic findings, a diagnosis of pulp necrosis and chronic periapical abscess associated with double DI (Oehler's type II) was established for the upper left lateral maxillary incisor (tooth #22). Root canal treatment and the sealing of double DI with mineral trioxide aggregate was planned for tooth #22. For tooth #12 (Oehler's type II), preventive sealing of the DI was planned. Minimally invasive access to the double DI and the main root canal of tooth #22, and to the DI of tooth #12, was achieved using the guided endodontics technique. This technique can be a valuable tool because it reduces chair-time and, more importantly, the risk of iatrogenic damage to the tooth structure.
Adolescent ; Dental Pulp Cavity ; Dental Pulp Necrosis ; Diagnosis ; Endodontics ; Female ; Humans ; Incisor ; Methods ; Miners ; Periapical Abscess ; Printing, Three-Dimensional ; Tooth

PURPOSE: The aim of this study was to evaluate clinical and radiographic changes and the survival rate after periodontal surgery using deproteinized bovine bone mineral (DBBM) with 10% collagen or DBBM with a collagen membrane in endo-periodontal lesions. METHODS: A total of 52 cases (41 patients) with at least 5 years of follow-up were included in this study. After scaling and root planing with or without endodontic treatment, periodontal regenerative procedures with DBBM with 10% collagen alone or DBBM with a collagen membrane were performed, yielding the DBBM + 10% collagen and DBBM + collagen membrane groups, respectively. Changes in clinical parameters including the plaque index, bleeding on probing, probing pocket depth, gingival recession, relative clinical attachment level, mobility, and radiographic bone gains were evaluated immediately before periodontal surgical procedures and at a 12-month follow-up. RESULTS: At the 12-month follow-up after regenerative procedures, improvements in clinical parameters and radiographic bone gains were observed in both treatment groups. The DBBM + 10% collagen group showed greater probing pocket depth reduction (4.52±1.06 mm) than the DBBM + collagen membrane group (4.04±0.82 mm). However, there were no significant differences between the groups. Additionally, the radiographic bone gain in the DBBM + 10% collagen group (5.15±1.54 mm) was comparable to that of the DBBM + collagen membrane group (5.35±1.84 mm). The 5-year survival rate of the teeth with endo-periodontal lesions after periodontal regenerative procedures was 92.31%. CONCLUSIONS: This study showed that regenerative procedures using DBBM with 10% collagen alone improved the clinical attachment level and radiographic bone level in endo-periodontal lesions. Successful maintenance of the results after regenerative procedures in endo-periodontal lesions can be obtained by repeated oral hygiene education within strict supportive periodontal treatment.
Collagen ; Education ; Follow-Up Studies ; Gingival Recession ; Guided Tissue Regeneration ; Hemorrhage ; Membranes ; Miners ; Oral Hygiene ; Periapical Periodontitis ; Periodontitis ; Retrospective Studies ; Root Planing ; Survival Rate ; Tooth