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

Opportunistic bacteria in apical periodontitis (AP) may pose a risk for systemic dissemination. Mucosal-associated invariant T (MAIT) cells are innate-like T cells with a broad and potent antimicrobial activity important for gut mucosal integrity. It was recently shown that MAIT cells are present in the oral mucosal tissue, but the involvement of MAIT cells in AP is unknown. Here, comparison of surgically resected AP and gingival tissues demonstrated that AP tissues express significantly higher levels of Vα7.2-Jα33, Vα7.2-Jα20, Vα7.2-Jα12, Cα and tumour necrosis factor (TNF), interferon (IFN)-γ and interleukin (IL)-17A transcripts, resembling a MAIT cell signature. Moreover, in AP tissues the MR1-restricted MAIT cells positive for MR1-5-OP-RU tetramer staining appeared to be of similar levels as in peripheral blood but consisted mainly of CD4 subset. Unlike gingival tissues, the AP microbiome was quantitatively impacted by factors like fistula and high patient age and had a prominent riboflavin-expressing bacterial feature. When merged in an integrated view, the examined immune and microbiome data in the sparse partial least squares discriminant analysis could identify bacterial relative abundances that negatively correlated with Vα7.2-Jα33, Cα, and IL-17A transcript expressions in AP, implying that MAIT cells could play a role in the local defence at the oral tissue barrier. In conclusion, we describe the presence of MAIT cells at the oral site where translocation of oral microbiota could take place. These findings have implications for understanding the immune sensing of polymicrobial-related oral diseases.
Adult ; Aged ; Female ; Humans ; Immunity, Mucosal ; immunology ; Male ; Microbiota ; Middle Aged ; Mucosal-Associated Invariant T Cells ; Natural Killer T-Cells ; immunology ; Periapical Periodontitis ; microbiology ; surgery

Dens invaginatusis a rare malformation of the teeth, resulting in frequent pulp necrosis and chronic apical periodontitis. In this paper, the apical barrier technology was used to treat a case of chronic apical periodontitis caused by type Ⅱ dens invaginatus.
Dens in Dente ; Dental Pulp Necrosis ; Humans ; Incisor ; Periapical Periodontitis ; Root Canal Therapy

BACKGROUND AND OBJECTIVES: Recombinant amelogenin protein (RAP) was reported to induce soft-tissue regeneration in canine infected endodontically treated permanent teeth with open apices. To characterize identities of the cells found in the RAP regenerated tissues compared to authentic pulp by identifying: 1) stem cells by their expression of Sox2; 2) nerve fibers by distribution of the axonal marker peripherin; 3) axons by their expression of calcitonin gene–related peptide (CGRP); 4) the presence of astrocytes expressing glial fibrillary acidic proteins (GFAP).METHODS: A total of 240 open-apex root canals in dogs were used. After establishment of oral contamination to the pulp, the canals were cleaned, irrigated, and 120 canals filled with RAP, and the other 120 with calcium hydroxide.RESULTS: After 1, 3, and 6 months, teeth were recovered for immune-detection of protein markers associated with native pulp tissues. Regenerated pulp and apical papilla of RAP group revealed an abundance of stem cells showing intense immunoreactivity to Sox2 antibody, immunoreactivity of peripherin mainly in the A-fibers of the odontoblast layer and immunoreactivity to CGRP fibers in the central pulp region indicative of C-fibres. GFAP immunoreactivity was observed near the odontoblastic, cell-rich regions and throughout the regenerated pulp.CONCLUSIONS: RAP induces pulp regeneration following regenerative endodontic procedures with cells identity by gene expression demonstrating a distribution pattern similar to the authentic pulp innervation. A- and C-fibers, as well as GFAP specific to astrocytic differentiation, are recognized. The origin of the regenerated neural networks may be derived from the Sox2 identified stem cells within the apical papilla.
Amelogenin ; Animals ; Astrocytes ; Axons ; Calcitonin ; Calcitonin Gene-Related Peptide ; Calcium Hydroxide ; Dental Pulp Cavity ; Dental Pulp Necrosis ; Dogs ; Gene Expression ; Glial Fibrillary Acidic Protein ; Nerve Fibers ; Odontoblasts ; Periapical Periodontitis ; Regeneration ; Stem Cells ; Tooth

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