A randomized controlled phase I/II clinical trial was designed to evaluate the safety and efficacy of encapsulated human umbilical cord mesenchymal stem cells in a plasma-derived biomaterial for regenerative endodontic procedures (REPs) in mature permanent teeth with apical lesions. The trial included 36 patients with mature incisors, canines, or mandibular premolars showing pulp necrosis and apical periodontitis. Patients were randomly and equally allocated between experimental (REP) or conventional root canal treatment (ENDO) groups. On the first visit, cavity access and mechanical preparation of the root canal were performed. Calcium hydroxide medication was used, and the cavity was sealed. Three weeks later, patients were treated following their assigned protocol of ENDO or REP. Clinical follow-up examinations were performed at 6 and 12 mo. Categorical variables were evaluated by Fisher’s exact test. Quantitative variables were compared using the Mann-Whitney test. The evolution over time of the percentage of perfusion units and the dimensions of lesion and cortical compromise were explored. After the 12-mo follow-up, no adverse events were reported, and the patients showed 100% clinical efficacy in both groups. Interestingly, in the REP group, the perfusion unit percentage measured by laser Doppler flowmetry revealed an increase from 60.6% to 78.1% between baseline and 12-mo follow-up. Sensitivity tests revealed an increase of the positive pulp response in the REP group at 12-mo follow-up (from 6% to 56% on the cold test, from 0% to 28% on the hot test, and from 17% to 50% on the electrical test). We present the first clinical safety and efficacy evidence of the endodontic use of allogenic umbilical cord mesenchymal stem cells encapsulated in a plasma-derived biomaterial. The innovative approach, based on biological principles that promote dentin-pulp regeneration, presents a promising alternative for the treatment of periapical pathology (ClinicalTrials.gov NCT03102879).

PurposeThis study used cone-beam computed tomography (CBCT) to characterize mandibular molar root and canal morphology and its variability in Belgian and Chilean population samples.Materials and MethodsWe analyzed the CBCT images of 515 mandibular molars (257 from Belgium and 258 from Chile). Molars meeting the inclusion criteria were analyzed to determine (1) the number of roots; (2) the root canal configuration; (3) the presence of a curved canal in the cross-sectional image of the distal root in the mandibular first molar and (4) the presence of a C-shaped canal in the second mandibular molar. A descriptive analysis was performed. The association between national origin and the presence of a curved or C-shaped canal was evaluated using the chi-squared test.ResultsThe most common configurations in the mesial root of both molars were type V and type III. In the distal root, type I canal configuration was the most common. Curvature in the cross-sectional image was found in 25% of the distal canals of the mandibular first molars in the Belgian population, compared to 11% in the Chilean population. The prevalence of C-shaped canals was 10% or less in both populations.ConclusionIn cases of unclear or complex root and canal morphology in the mandibular molars, CBCT imaging might assist endodontic specialists in making an accurate diagnosis and in treatment planning.

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TRABAJO INVESTIGACIÓN RESUMENObjetivo: Evaluar la maduración de la sutura palatina media en adolescentes y adultos jóvenes chilenos, mediante valoración morfológica de imágenes de tomografía computarizada de haz cónico del maxilar. Material y método: Se analizó la sutura palatina media de 150 sujetos entre 15 y 30 años, seleccionados desde la base de datos radiológicos de un centro universitario de salud. La maduración sutural fue evaluada en el corte axial, utilizando el método de Angelieri y cols., clasificándola en cinco etapas (A, B, C, D y E). Se utilizaron las pruebas de correlación de Pearson para medir la concordancia intra e interexaminador, y T-Student para las diferencias entre sexos. Resultados: El estado de maduración más frecuente fue C (43,3%), seguido por E (33,3%) y D (22%). En hombres, la etapa C fue más frecuente (49%), mientras que en mujeres fue la etapa E (39%). Sin embargo, no se encontraron diferencias estadísticamente significativas entre ambos sexos. Conclusiones: Aunque la mayoría de la muestra presentó una etapa tardía de maduración sutural, el 45% presentó estados de maduración sutural donde sería posible la expansión de naturaleza no quirúrgica. Debido a la variabilidad observada en adolescentes y adultos jóvenes, se recomienda la evaluación individual con imagenología 3D.

All the mandibles have one or more lingual foramina. The most frequent positions were superior and inferior. Many of the lingual foramina found were over 1 mm in diameter. The lingual canal length was over 5 mm for all the positions.