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Introduction: Denticles are mineralized formations found in the dental pulp of deciduous and permanent dentition. Topographically, they can be classified as free, adjacent, or intratissular. Denticles rarely occur; however, their presence is considered clinically relevant due to the difficulties they cause during endodontic treatment.The aim of this study was to describe clinical cases of denticles located in the tooth pulp chamber. Various methods for their removal are also discussed. Emphasis was placed on the diverse appearance of pulp stones in microscope-captured images and on the necessity of maintaining appropriate clinical proceduresfor highly specialized endodontic treatment, such as working with rubber dams and magnification, to avoid serious complications.Materials and methods: Four cases of molar teeth with suspected intraventricular denticles were subjected to specialised endodontic treatment. Removal procedures were performed in aseptic conditions after dental dam placement and with the use of a dental operative microscope. To remove denticles, carbide long shank rose burs, Munce Discovery Burs, and an ultrasonic device with tips for finishing canal access and locating their orifices were used. Following preparation of a straight line access, the canals were chemically and mechanically cleaned and shaped according to accepted standards of modern endodontics. After obturation of the canal system, control radiographs were performed. Results: During all treatments, the denticles were removed completely, allowing further preparation and obturation of the entire canal system.Conclusions: Removal of denticles from the pulp chamber is a complicated, difficult procedure, requiring knowledge of the anatomy of the root canal system, professional operation skills, magnification of the operating site, and appropriate equipment. Such preparation allows clinicians to avoid potential complications such as perforation and/or excessive weakening of the tooth structure due to excessive removal of hard tissues.

Background and objectives: Pulp stones are hard tissue structures formed in the pulp of permanent and deciduous teeth. Few studies have evaluated their morphology and chemical composition. However, their formation, composition, configuration and role played in overall health status are still unclear. Clinically, they may be symptomatic; technically, they impede access during endodontic therapy, increasing the risk of treatment errors. Thus, this study aimed to morphologically analyze pulp stones and present their chemical quantification, identifying their main chemical elements. It also correlates the results with their possible induction mechanisms. Materials and Methods: Seven pulp nodules were collected from molar teeth needing endodontic treatment. The morphology of the stones was analyzed by scanning electron microscopy (SEM), and their chemical composition was determined by X-ray dispersive energy spectroscopy (EDX). Results: These structures varied considerably in shape, size and topography. The site of the stones in the pulp cavity was the factor that most affected the morphology. The majority of the stones found in the pulp chambers presented nodular morphology, while those in the root canals presented a diffuse shape, resembling root canal anatomy. The topography of the nodules showed heterogeneous relief, revealing smooth and compact areas contrasting with the rugged and porous ones. The chemical composition varied depending on the location of the nodule in the pulp cavity and the relief of the analyzed area. Radicular stones presented considerably lower calcium and phosphorus content than coronary nodules. Conclusions: The high cellularity rate of the coronal pulp predisposes this region to nodular mineralizations around injured cells. The presence of larger caliber vascular bundles and higher collagen fiber content in radicular pulp determines a diffuse morphological pattern in this region. Understanding the morphology and chemical composition of the pulp stones allows future translational pathways towards the prevention or treatment of such conditions.

The main goal of root canal treatment (RCT) is to eradicate or essentially diminish the microbial population within the root canal system and to prevent reinfection by a proper chemo-mechanical preparation and hermetic final obturation of the root canal space. The aim of this study was to assess the quality of the root canal filling and the number of visits needed for completing RCT by operators with different experience, including dentistry students (4th and 5th year), general dental practitioners (GDPs), and endodontists. Data from medical records of 798 patients were analyzed, obtaining 900 teeth and 1773 obturated canals according to the inclusion and exclusion criteria. A similar number of teeth was assessed in each group in terms of density and length of root canal filling and number of visits. The larger number of visits and the lower quality of treatment was observed for 4th year students than for other groups (p < 0.05); in contrast, the endodontists needed the lowest number of visits to complete RCT and more often overfilled teeth than other operator groups (p < 0.05). Interestingly, no statistical difference in quality of root canal filling was noted between 5th year students, GPDs and endodontists. The treatment of lower teeth demanded statistically more visits than that of upper teeth (p < 0.05). The results of the study emphasize that most of the root canal filling performed by operators was considered adequate, regardless of tooth type, files used and number of visits.

IntroductionDetermining the length of a root canal is a significant outcome predictor for endodontic treatment. The aim of this retrospective, clinical study was to evaluate the accuracy of working length (WL) determination using pre-existing conebeam computed tomography (CBCT) images and to compare them with data of the clinical WL determined with an electronic apex locator (EAL) in treated teeth, found in patient records.Materials and methodsThirty five medical records of patients who underwent root canal treatment (RCT) by an endodontist in a private dental practice in Łódź, Poland were analysed. Evaluations were conducted on the data concerning: the WL of the treated tooth as found in the patient’s records, the RadioVisioGraphy (RVG) image after final obturation used as a control, and the CBCT scan before RCT. The Shapiro–Wilk normality test and Student’s t-test were used in statistical analysis. The significance level was set at p < 0.05.ResultsThere were no statistically significant differences between compared groups in terms of WL determined with an EAL than CBCT (p > 0.05). In the case of medical diagnosis (pulpitis vs. necrotic pulp) and treatment (primary vs. retreatment), the obtained results were also statistically insignificant (p > 0.05).ConclusionsThis retrospective, clinical study showed that CBCT scans can be successfully used for endodontic WL determination. Future investigations are needed to evaluate whether pre-existing CBCT scans may replace initial periapical radiographs (PARs).

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