Materials used in endodontics may stain teeth. Therefore, the choice of material should not rely solely on biological and functional criteria, but also take aesthetic considerations into account.
This position statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on revitalization procedures. The statement is based on current clinical and scientific evidence as well as the expertise of the committee. The goal is to provide suitably trained dentists with a protocol including procedural details for the treatment of immature teeth with pulp necrosis as well as a patient consent form. Revitalization is a biologically based treatment as an alternative to apexification in properly selected cases. Previously published review articles provide more detailed background information and the basis for this position statement (Journal of Endodontics, 39, 2013, S30; Journal of Endodontics, 39, 2013, 319; Journal of Endodontics, 40, 2014, 1045; Dental Traumatology, 31, 2015, 267; International Endodontic Journal, 2015, doi: ). As controlled clinical trials are lacking and new evidence is still emerging, this position statement will be updated at appropriate intervals. This might lead to changes to the protocol provided here.
This position statement on the management of deep caries and the exposed pulp represents the consensus of an expert committee, convened by the European Society of Endodontology (ESE). Preserving the pulp in a healthy state with sustained vitality, preventing apical periodontitis and developing minimally invasive biologically based therapies are key themes within contemporary clinical endodontics. The aim of this statement was to summarize current best evidence on the diagnosis and classification of deep caries and caries‐induced pulpal disease, as well as indicating appropriate clinical management strategies for avoiding and treating pulp exposure in permanent teeth with deep or extremely deep caries. In presenting these findings, areas of controversy, low‐quality evidence and uncertainties are highlighted, prior to recommendations for each area of interest. A recently published review article provides more detailed information and was the basis for this position statement (Bjørndal et al. 2019, International Endodontic Journal, doi:). The intention of this position statement is to provide the practitioner with relevant clinical guidance in this rapidly developing area. An update will be provided within 5 years as further evidence emerges.
'Guided Endodontics' allowed an accurate access cavity preparation up to the apical third of the root utilizing printed templates for guidance. All root canals were accessible after preparation.
The presented guided endodontic approach seems to be a safe, clinically feasible method to locate root canals and prevent root perforation in teeth with PCC.
OBJECTIVES This study investigated the influence of proximal box elevation (PBE) with composite resin when applied to deep proximal defects in root-filled molars with mesio-occluso-distal (MOD) cavities, which were subsequently restored with computer-aided designed/computer-aided manufacturing (CAD/CAM) ceramic or composite restorations. MATERIALS AND METHOD Root canal treatment was performed on 48 human mandibular molars. Standardized MOD cavities were prepared with the distal box located 2 mm below the cemento-enamel junction (CEJ). The teeth were randomly assigned to one of four experimental groups (n = 12). In groups G1 and G2, the distal proximal box was elevated up to the level of the CEJ with composite resin (PBE). No elevation was performed in the remaining two groups (G3, G4). CAD/CAM restorations were fabricated with feldspathic ceramic (Vita Mark II, CER) in groups G1 (PBE-CER) and G3 (CER) or with resin nano-ceramic blocks (Lava Ultimate, LAV) in groups G2 (PBE-LAV) and G4 (LAV). Replicas were taken before and after thermomechanical loading (TML; 1.2 Mio cycles; 49 N; 3,000 thermocycles between 50°C and 5°C). Following TML, load was applied until failure. Fracture analysis was performed under a stereomicroscope (×16). Marginal quality before and after TML (tooth restoration, composite restoration) was evaluated using scanning electron microscopy (×200). RESULTS After TML, lower percentages of continuous margins were observed in groups G1-G3 compared with pre-TML assessments; however, the differences were not statistically significant. For group G4-LAV, the marginal quality after TML was significantly better than in any other group. The highest mean fracture value was recorded for group G4. No significant difference was found for this value between the groups with PBE compared with the groups without PBE, regardless of the material used. The specimens restored with ceramic onlays exhibited fractures that were mainly restricted to the restoration while, in teeth restored with composite onlays, the percentage of catastrophic failures (fractures beyond bone level) was increased. CONCLUSION PBE had no impact on either the marginal integrity or the fracture behavior of root canal-treated mandibular molars restored with feldspathic ceramic onlays. CAD/CAM-fabricated composite onlays were more favorable than ceramic onlays in terms of both marginal quality and fracture resistance, particularly in specimens without PBE. CLINICAL RELEVANCE Composite onlays with or without PBE may be a viable approach for the restoration of root-filled molars with subgingival MOD cavities.
AbstractObjectives This study investigated the influence of proximal box elevation (PBE) with composite resin when applied to deep proximal defects in root--filled molars with MOD cavities, which were subsequently restored with CAD/CAM ceramic or composite restorations.
The 'Microguided Endodontics' technique is a safe and minimally invasive method for root canal location and prevention of technical failures in anterior teeth with pulp canal calcification.
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