Abstract:Accurate prognosis evaluation of traumatic dental injuries is difficult due to the nature of current studies being retrospective or prospective cohort studies. Lateral luxation is a common traumatic dental injury and has life-long concerns for a patient. It is important for future studies to report on the same outcomes to increase the quality of evidence regarding prognosis and treatment interventions, not only for lateral luxation injuries, but for all traumatic dental injuries.
“…Pulp necrosis and apical periodontitis (AP) as a consequence of trauma or caries arrest root development in injured immature permanent teeth. 1 This leads to weak root canal walls, open root apexes, and an inadequate crown-root ratio. 2 It is impossible for these teeth to receive root canal treatment and they are susceptible to fractures.…”
Once pulp necrosis or apical periodontitis occurs on immature teeth, the weak root and open root apex are challenging to clinicians. Berberine (BBR) is a potential medicine for bone disorders, therefore, we proposed to apply BBR in root canals to enhance root repair in immature teeth. An in vivo model of immature teeth with apical periodontitis was established in rats, and root canals were filled with BBR, calcium hydroxide or sterilized saline for 3 weeks. The shape of the roots was analyzed by micro-computed tomography and histological staining. In vitro, BBR was introduced into stem cells from apical papilla (SCAPs). Osteogenic differentiation of stem cells from apical papilla was investigated by alkaline phosphatase activity, mineralization ability, and gene expression of osteogenic makers. The signaling pathway, which regulated the osteogenesis of SCAPs was evaluated by quantitative real time PCR, Western blot analysis, and immunofluorescence. In rats treated with BBR, more tissue was formed, with longer roots, thicker root walls, and smaller apex diameters. In addition, we found that BBR promoted SCAPs osteogenesis in a time-dependent and concentration-dependent manner. BBR induced the expression of β-catenin and enhanced β-catenin entering into the nucleus, to up-regulate more runt-related nuclear factor 2 downstream. BBR enhanced root repair in immature teeth with apical periodontitis by activating the canonical Wnt/β-catenin pathway in SCAPs.
“…Pulp necrosis and apical periodontitis (AP) as a consequence of trauma or caries arrest root development in injured immature permanent teeth. 1 This leads to weak root canal walls, open root apexes, and an inadequate crown-root ratio. 2 It is impossible for these teeth to receive root canal treatment and they are susceptible to fractures.…”
Once pulp necrosis or apical periodontitis occurs on immature teeth, the weak root and open root apex are challenging to clinicians. Berberine (BBR) is a potential medicine for bone disorders, therefore, we proposed to apply BBR in root canals to enhance root repair in immature teeth. An in vivo model of immature teeth with apical periodontitis was established in rats, and root canals were filled with BBR, calcium hydroxide or sterilized saline for 3 weeks. The shape of the roots was analyzed by micro-computed tomography and histological staining. In vitro, BBR was introduced into stem cells from apical papilla (SCAPs). Osteogenic differentiation of stem cells from apical papilla was investigated by alkaline phosphatase activity, mineralization ability, and gene expression of osteogenic makers. The signaling pathway, which regulated the osteogenesis of SCAPs was evaluated by quantitative real time PCR, Western blot analysis, and immunofluorescence. In rats treated with BBR, more tissue was formed, with longer roots, thicker root walls, and smaller apex diameters. In addition, we found that BBR promoted SCAPs osteogenesis in a time-dependent and concentration-dependent manner. BBR induced the expression of β-catenin and enhanced β-catenin entering into the nucleus, to up-regulate more runt-related nuclear factor 2 downstream. BBR enhanced root repair in immature teeth with apical periodontitis by activating the canonical Wnt/β-catenin pathway in SCAPs.
“…Considering all the adverse outcomes evaluated in the studies included in the meta-analysis, the incidence of any sequela or complication in permanent teeth was 12% for concussion and 18% for to other injuries such as avulsion, where the incidence of pulp necrosis is approximately 67%. [26][27][28][29] The sequelae or complications of concussion and subluxation may be associated with pain or aesthetic impairment, which can negatively impact the daily life. 30,31 .…”
Traumatic dental injuries (TDI) involve damage to the dentoalveolar tissues and their supporting structures. 1 When analyzing the frequency, 15.2% of the worldwide population have had dental trauma, with an estimated incidence rate of approximately three out of one hundred people per year. 2 More than one billion living people have experienced TDI. 2 Dental trauma in the permanent dentition represents 5% of all dental care, and it is still a neglected condition. 3
“…33,34 In those cases, patients may require endodontic treatment in order to save the tooth. 33,34 In those cases, patients may require endodontic treatment in order to save the tooth.…”
Section: Endodontic Treatmentmentioning
confidence: 99%
“…Deep caries lesions as well as traumatic dental injuries such as extrusion, lateral luxation, and intrusion can eventually lead to pulp necrosis. 33,34 In those cases, patients may require endodontic treatment in order to save the tooth. In some severe cases, extraction might be considered as an alternative treatment option.…”
Teeth are vital sensory organs that contribute to our daily activities of living. Unfortunately, teeth can be lost for several reasons including trauma, caries, and periodontal disease. Although dental trauma injuries and caries are more frequently encountered in a younger population, tooth loss because of periodontal disease occurs in the older population. In the dental implant era, the trend sometimes seems to be to extract compromised teeth and replace them with dental implants. However, the long‐term prognosis of teeth might not be comparable with the prognosis of dental implants. Complications, failures, and diseases such as peri‐implantitis are not uncommon, and, despite popular belief, implants are not 99% successful. Other treatment options that aim to save compromised or diseased teeth such as endodontic treatment, periodontal treatment, intentional replantation, and autotransplantation should be considered on an individual basis. These treatments have competing success rates to dental implants but, more importantly, retain the natural tooth in the dentition for a longer period of time. These options are important to discuss in detail during treatment planning with patients in order to clarify any misconceptions about teeth and dental implants. In the event a tooth does have to be extracted, procedures such as decoronation and orthodontic extrusion might be useful to preserve hard and soft tissues for future dental implant placement. Regardless of the treatment modality, it is critical that strict maintenance and follow‐up protocols are implemented and that treatment planning is ethically responsible and evidence based.
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