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

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

BACKGROUND: Local anesthetics alone or in combination with adjuncts, such as oral medications, have routinely been used for pain control during endodontic treatment. The best clinical choice amongst the vast numbers of agents and techniques available for pain control for irreversible pulpitis is unclear. This network meta-analysis combined the available evidence on agents and techniques for pulpal anesthesia in the maxilla and mandible, in order to identify the best amongst these approaches statistically, as a basis for future clinical trials.METHODS: Randomized trials in MEDLINE, DARE, and COCHRANE databases were screened based on inclusion criteria and data were extracted. Heterogeneity was assessed and odds ratios were used to estimate effects. Inconsistencies between direct and indirect pooled estimates were evaluated by H-statistics. The Grading of Recommendation, Assessment, Development, and Evaluation working group approach was used to assess evidence quality.RESULTS: Sixty-two studies (nine studies in the maxilla and 53 studies in the mandible) were included in the meta-analysis. Increased mandibular pulpal anesthesia success was observed on premedication with aceclofenac + paracetamol or supplemental 4% articaine buccal infiltration or ibuprofen+paracetamol premedication, all the above mentioned with 2% lignocaine inferior alveolar nerve block (IANB). No significant difference was noted for any of the agents investigated in terms of the success rate of maxillary pulpal anesthesia.CONCLUSION: Direct and indirect comparisons indicated that some combinations of IANB with premedication and/or supplemental infiltration had a greater chance of producing successful mandibular pulpal anesthesia. No ideal technique for maxillary anesthesia emerged. Randomized clinical trials with increased sample size may be needed to provide more conclusive data. Our findings suggest that further high-quality studies are required in order to provide definitive direction to clinicians regarding the best agents and techniques to use for mandibular and maxillary anesthesia for irreversible pulpitis.
Acetaminophen ; Anesthesia ; Anesthetics, Local ; Carticaine ; Lidocaine ; Mandible ; Mandibular Nerve ; Maxilla ; Odds Ratio ; Population Characteristics ; Premedication ; Pulpitis ; Root Canal Therapy ; Sample Size

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

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

OBJECTIVETo evaluate the effectiveness and safety of a computer-controlled periodontal ligament (PDL) injection system to the local soft tissues as the primary technique in endodontic access to mandibular posterior teeth in patients with irreversible pulpitis.

METHODSA total of 162 Chinese patients who had been diagnosed with irreversible pulpitis in their mandibular posterior teeth without acute infection or inflammation in the periodontal tissues were enrolled in this clinical study. The patients were divided into 3 groups according to the position of the involved tooth: the premolar group (PM, n=38), first molar group (FM, n=66), and second molar group (SM, n=58). All the patients received computer-controlled PDL injection with 4% articaine and 1:100 000 epinephrine. Immediately after the injection, endodontic access was performed, and the degree of pain during the treatment was evaluated by the patients using Visual Analogue Scale for pain. The success rates were compared among the 3 groups. The responses of local soft tissues were evaluated 3-8 days and 3 weeks after the procedure.

RESULTSThe overall success rate was 76.5%. There was a significant difference in success rates among the PM, FM, and SM groups (92.1%, 53.0%, 93.1%, respectively; χ² = 34.3, P<0.01). Both the PM and SM groups showed higher success rates than that of the FM group (v=1, χ² = 16.73, P<0.01; v=1, χ² = 24.5, P<0.01). No irreversible adverse effects on the periodontal soft tissues at the injection sites were observed in the follow-up visits in any of the groups.

CONCLUSIONThe computer-controlled PDL injection system demonstrates both satisfactory anesthetic effects and safety in local soft tissues as primary anesthetic technique in endodontic access to the mandibular posterior teeth in patients with irreversible pulpitis.

Adolescent ; Adult ; Anesthesia, Dental ; adverse effects ; methods ; Anesthesia, Local ; adverse effects ; methods ; Anesthetics, Local ; administration & dosage ; Carticaine ; administration & dosage ; Drug Delivery Systems ; Humans ; Injections ; Mandible ; Mandibular Nerve ; Middle Aged ; Molar ; Nerve Block ; adverse effects ; methods ; Pain Measurement ; Periodontal Ligament ; Pulpitis ; therapy ; Therapy, Computer-Assisted ; Treatment Outcome ; Young Adult

This case report describes the diagnosis and endodontic therapy of maxillary fused second and third molars, using cone-beam computed tomography (CBCT). A 31-year-old Chinese male, with no contributory medical or family/social history, presented with throbbing pain in the maxillary right molar area following an unsuccessful attempted tooth extraction. Clinical examination revealed what appeared initially to be a damaged large extra cusp on the buccal aspect of the distobuccal cusp of the second molar. However, CBCT revealed that a third molar was fused to the second molar. Unexpectedly, the maxillary left third molar also was fused to the second molar, and the crown of an unerupted supernumerary fourth molar was possibly also fused to the apical root region of the second molar. Operative procedures should not be attempted without adequate radiographic investigation. CBCT allowed the precise location of the root canals of the right maxillary fused molar teeth to permit successful endodontic therapy, confirmed after 6 months.
Adult ; Cone-Beam Computed Tomography ; methods ; Follow-Up Studies ; Fused Teeth ; diagnostic imaging ; Humans ; Image Processing, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; methods ; Male ; Maxilla ; Molar ; abnormalities ; Molar, Third ; abnormalities ; Pulpitis ; diagnostic imaging ; Root Canal Therapy ; Tooth Root ; abnormalities ; Tooth, Supernumerary ; diagnostic imaging ; Tooth, Unerupted ; diagnostic imaging

China ; Contract Services ; legislation & jurisprudence ; Delivery of Health Care ; legislation & jurisprudence ; Dental Caries ; therapy ; Dentists ; legislation & jurisprudence ; Female ; Humans ; Liability, Legal ; Middle Aged ; Pulpitis ; therapy ; Tooth Extraction ; Treatment Failure

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