ENDO, 04/2008

Preserving the health of the dental pulp, or part of it, is important when treating a vital tooth with an exposed pulp; particularly, if the tooth is immature and root formation is incomplete. There is a long tradition of treating the exposed dental pulp by pulp capping. An improved understanding of pulp biology, the development of mineral trioxide aggregate and the advent of regenerative therapies have heralded a new wave of research and treatment methods in this area. The intention of this review is to evaluate the past, present and future of vital pulp treatment in endodontics. Keywords: calcium hydroxide, mineral trioxide aggregate, pulp capping, pulpotomy

The dental pulp is a fascinating tissue that has always attracted much attention within the dental profession. Pulp vitality testing is crucial in monitoring the state of health of the dental pulp and although pulp vitality is just a function of vascular health, traditional methods are based on stimulation of nerve fibres and demonstrate further limitations. However, these methods have been unreliable in children over the years. The recent advances in pulp vitality testing mean that the pulpal blood flow is assessed, which is a true indicator of pulp vitality. This review article discusses the advantages and limitations of traditional and recent methods of pulp vitality testing in children. This article is clinically relevant, as understanding of both the usefulness and limitations of pulp testing methods is essential for effective endodontic diagnosis and treatment planning in children. Keywords: children, neural stimulation, pulpal blood flow, reliability, vitality

Aim: The aim of this study was to determine the extraradicular distribution of lead and cadmium from root canal filling materials, namely gutta-percha, and to compare the content of lead and cadmium in periapical biopsies, taken during apicectomy of teeth with and without root canal fillings. Materials and methods: After formal consent, 80 patients were enrolled in the study. These patients were originally referred to an oral surgeon for an apicectomy or extraction of a tooth. In all teeth the presence of a periapical inflammatory lesion preoperatively had been confirmed radiographically. During oral surgery, inflamed periapical tissue was removed from the root tips of 40 root canal filled teeth and 40 teeth without root canal fillings. The collected tissue samples were examined using mass spectrometry. The data were statistically analysed using the t test. Results: There were no statistically significant differences between the groups for cadmium and lead content in the periradicular tissue. Age, gender, smoking or nutrition of the patients had no significant influence on the results. There was no correlation between the content of lead or cadmium in the periapical tissue and presence or absence of root canal fillings. Conclusion: In the present study no contamination of periradicular tissue with lead and cadmium from root canal filling materials could be detected. Keywords: cadmium, lead, periapical biopsy, root canal filling material

The fracture of rotary nickel-titanium instruments is an unfortunate incident that might complicate and compromise the outcome of endodontic treatment, especially if adequate cleaning and shaping and/or proper sealing cannot be achieved in infected root canals. A great deal of research has been carried out to try to understand the reasons for instrument fracture and how it may be prevented rather than treated. The purpose of this review is to discuss the factors that might influence the performance and clinical safety of rotary nickel-titanium instruments. Keywords: endodontic treatment, instrument fracture, rotary, nickel-titanium

The aim of this article was to report a case of a mandibular second premolar with four root canals. Mandibular premolars have earned the reputation for having aberrant anatomy. A thorough knowledge of the basic root canal anatomy and its variations is necessary for successful root canal treatment. The incidence of four root canals in mandibular second premolars has only been documented in the literature by a few case reports. This clinical article describes the successful root canal treatment of a mandibular second premolar with four root canals with the aid of the operating microscope. Keywords: anatomical variation, endodontic treatment, mandibular second premolar, operating microscope

Teeth presenting external and internal resorption are uncommon, and affected teeth are often only discovered by chance. In most cases, these teeth are symptom-free. In rare cases, the differential diagnosis between external and internal resorption is very difficult, especially for teeth pretreated elsewhere with inadequate documentation of the clinical situation, as in the case presented. Resorption lacunae can also present a challenge for treatment. Invasive cervical resorption affecting the endodontium requires different therapeutic techniques in terms of position and timing. Presented is treatment of a case of pretreated, invasive cervical resorption with irreversible pulpitis. Root canal treatment was performed by filling the initial perforating resorption using MTA, and treatment of the cervical defect occurred later. Compared with incidents such as extrusion of H2O2 or NaOCl into the periradicular tissues during root canal irrigation, air inclusion in the tissue is comparatively less dramatic. However, this should be taken seriously. The present case report describes the treatment of a symptomatic invasive cervical resorption, with the occurrence of massive subcutaneous emphysema during the final cervical composite restoration. Keywords: emphysema, external resorption, invasive cervical resorption, mineral trioxide aggregate (MTA)

Mandibular first molars can show anatomical variations in the form of an additional lingual (radix entomolaris) or buccal root (radix paramolaris). The presence of an additional root can lead to difficulties during endodontic treatment. This case report describes the treatment of a first mandibular right molar with a small radix entomolaris. Keywords: anatomical variations, radix entomolaris, radix paramolaris, three-rooted mandibular molar