External cervical root resorption (ECR) is a poorly understood and aggressive form of resorption. The purpose of this study was to examine the prevalence, characteristics, and risk factors associated with the occurrence of ECR in patients seeking endodontic care from private practice settings. Records of 343 patients with 390 teeth diagnosed with ECR were identified from 3 private endodontic practices from 2008 to 2022. The patients’ demographic information, systemic conditions, and dental history were recorded. The characteristics of the cases including Heithersay classification, pulpal and periapical status, and their management were documented. The association between case severity and potential predisposing factors was examined using chi-square analysis. The overall prevalence of ECR among patients seeking endodontic care was low (< 1

BACKGROUND:This retrospective case series describes the outcomes of anterior teeth with complicated fractures treated using mineral trioxide aggregate (MTA) in pulpotomy procedures.METHODS:33 teeth were treated with MTA pulpotomy procedures in an endodontic private practice. All patients had been referred to the practice for diagnosis and treatment of a pulpal exposure due to complicated crown fractures. The teeth were either recalled directly or "indirectly" by the referring dentist. Teeth recalled directly were categorized as healed, healing, non- surgical root canal treatment completed for either aesthetic or restorative reasons, or persistent disease. Teeth recalled indirectly were categorized as successful or failed.RESULTS:27 teeth were available for recall; 20 teeth directly and 7 teeth indirectly. The mean recall for teeth recalled directly was 3.94 years and the mean recall for teeth recalled indirectly was 5.9 years. The recall range for teeth recalled directly was 0.51 to 10.49 years and for teeth recalled indirectly was 3.58 to 10.66 years. Of the cases available for direct recall, 13 of 20 teeth were healed positive to pulp tests, 4 of 20 teeth were healed negative to pulp tests and 3 of 20 teeth had non-surgical root canal treatment completed. 15 of the 20 teeth recalled directly where discolored. 7 of 7 teeth recalled indirect were successful as determined by the radiographs and a report from the restorative dentist.CONCLUSIONS:MTA is a viable alternative to calcium hydroxide for pulpotomies.

When the pulp of a tooth is irreversibly inflamed or necrotic and the apex is open, conventional root canal treatment is difficult to perform and the outcome is uncertain. Traditionally, the apexification procedure has consisted of multiple and long-term applications of calcium hydroxide [Ca(OH) 2 ] to create an apical barrier to aid the obturation. Recently, artificial apical barriers such as those made with mineral trioxide aggregate (MTA) have been used in teeth with necrotic pulps and open apices. More recently, procedures referred to as regenerative endodontics have received much attention as an option for these teeth. The purpose of this article is to provide a comprehensive literature review from May 1952–May 2011 regarding the management of teeth with necrotic pulps and open apices. This review covers the articles published in dental journals and book chapters regarding the definition, history, materials used, animal and human studies, mechanisms of action, prognosis, as well as advantages and disadvantages of apexification, apical plugs, and regenerative endodontics.

Unfortunately, a small percentage of endodontically treated teeth do not respond favorably to non-surgical root canal treatment. Failure to cate and treat an additional nal system is cited as the principle basis for endodontic retreatment. The aim of this retrospective clinical study was to identify the incidence of additional or missed canal systems in molar retreatment cases in a private practice setting. Missed canals were identified in 64 of the 133 previously treated teeth (48%). Of the total missed canals, 11% involved a maxillary second molar and 44% involved a maxillary first molar. For the maxillary first molars, 93% of all missed canal were identified in the mesiobuccal root. In the mandibular second molars, 29% of missed canals were identified in the distal and 71% were identified in the mesial root. In the mandibular first molars, 86% of missed canals were identified in the distal and 14% were identified in the mesial root. The results of the current study support the findings of previous studies and confirm the importance of locating, instrumenting and obturating the endodontic treatment. Given that failure to locate all canal systems of a tooth contributes significantly to unsuccessful endodontic treatment, all measures available to the clinician to maximize canal identification should be used.

Failure to achieve profound anesthesia during dental treatment can be a significant problem for dental clinicians, especially for endodontic procedures on teeth in the mandibular arch with irreversible pulpitis. A number of supplemental local anesthesia techniques exist, the most effective of which may be the intraosseous injection. Two cases are presented demonstrating the dangers associated with the use of the intraosseous anesthesia technique. While the technique can provide profound anesthesia in otherwise difficult to anesthetize cases, care must be taken during its administration. Both cases show the damage done to the root and overlying bone by the injudicious use of the trephine. It is incumbent on the clinician to fully consider the anatomy in the area prior to insertion of the trephine. Intraosseous anesthesia techniques are a valuable addition to the clinicians' armamentarium. However careless administration can result in problems of endodontic or periodontal nature that may be difficult to rectify.

This study is a retrospective analysis of the outcome of initial nonsurgical root canal treatment of teeth with open apices, obturated with mineral trioxide aggregate when no apical barrier existed. One hundred sixteen patients from a single private endodontic office were treated between 1999 and 2006. Treatments on 144 teeth were completed either in one (92/144) or two visits with an interim calcium hydroxide interappointment medication (52/144). Fifty-four percent (78/144) of the teeth were available for recall (60.3% one visit and 39.7% two visits). The maximum time to recall was 4.87 years. The mean time to recall was 19.4 months. Of the cases recalled for period of 1 year or longer, 93.5% of teeth treated in 1 visit healed, and 90.5% of teeth treated in 2 visits healed.

Pulp necrosis in immature teeth subsequent to caries has a major impact on long-term tooth retention. The aim of vital pulp therapy is to maintain pulp viability by eliminating bacteria from the dentin-pulp complex and to establish an environment in which apexogenesis can occur. A complicating factor in treating immature teeth is the difficulty predicting the degree of pulpal damage. The ability of the clinician to manage the health of the remaining pulpal tissue during the procedure is paramount. Currently, the best method appears to be the ability to control pulpal hemorrhage by using sodium hypochlorite. Mineral trioxide aggregate (MTA) currently is the optimum material for use in vital pulp therapy. Compared with the traditional material of calcium hydroxide, it has superior long-term sealing ability and stimulates a higher quality and greater amount of reparative dentin. In the medium-term clinical assessment, it has demonstrated a high success rate. Thus, MTA is a good substitute for calcium hydroxide in vital pulp procedures.

BACKGROUND The greatest threats to developing teeth are dental caries and traumatic injury. A primary goal of all restorative treatment is to maintain pulp vitality so that normal root development or apexogenesis can occur. If pulpal exposure occurs, then a pulpotomy procedure aims to preserve pulp vitality to allow for normal root development. Historically, calcium hydroxide has been the material of choice for pulpotomy procedures. Recently, an alternative material called mineral trioxide aggregate (MTA) has demonstrated the ability to induce hard-tissue formation in pulpal tissue. The authors describe the clinical and radiographic outcome of a series of cases involving the use of MTA in pulpotomy procedures. METHODS Twenty-three cases in 18 patients were treated with MTA pulpotomy procedures in an endodontic private practice. All of the patients had been referred to the practice for diagnosis and treatment of a symptomatic tooth. All of the authors provided treatment. Pulpal exposures were either due to caries or complicated enamel dentin fractures. RESULTS Nineteen teeth in 14 patients were available for recall. The mean time of recall was 19.7 months. Of the 19 cases, 15 involved healed teeth, and three involved teeth that were healing. One of 19 cases involved a tooth with persistent disease. CONCLUSIONS MTA may be useful as a substitute for calcium hydroxide in pulpotomy procedures. Further research, however, is required to clarify this conclusion. CLINICAL IMPLICATIONS MTA conceivably could replace calcium hydroxide as the material of choice for pulpotomy procedures, if future research continues to show promising results.

I am happy to address the questions Dr. Needleman has raised and thank him for his interest in our article. MINERAL TRIOXIDE AGGREGATEThe Journal of the American Dental AssociationVol. 137Issue 9PreviewI am writing regarding Dr. David Witherspoon and colleagues' excellent May JADA article, “Mineral Trioxide Aggregate Pulpotomies: A Case Series Outcomes Assessment” ( JADA 2006;137[5]:610–8 ). As a pediatric dentist who treats young traumatized permanent teeth, I read this article with great interest. Although I have not used mineral trioxide aggregate extensively, I am familiar with the literature on its use in these circumstances. Full-Text PDF

A root perforation is a mechanical or pathological communication formed between the supporting periodontal apparatus of the tooth and the root canal system. Three broad categories of etiological factors exist and these are procedural mishaps, resorption and caries. The diagnosis, management and repair of root perforations require skill and creative thinking. Unfortunately, much of what has been written on the subject of root perforation repair is unsubstantiated and empirical in nature and contributes little to evidence-based support for any specific repair procedure. However, perforation repair frequently provides a very attractive and frequently successful alternative to extraction of the involved tooth. In recent years, the procedure has become more predictable owing to the development of new materials, techniques and procedures.

Summary The successful performance of endodontic surgical procedures is predicated on many factors. However, the ability of achieve sustained tissue haemostasis in the surgical site is crucial to the performance of these procedures. This achievement improves vision in the surgical site, minimizes surgical time, enhances the surgical procedures (root‐end resection, preparation and filling), and reduces surgical blood loss, postsurgical haemorrhage and postsurgical swelling. A multitude of materials have used in dentistry and medicine to achieve both generalized and localized haemostasis, many without full assessment of their biological implications. The purpose of this paper is to provide a thorough and critical review of these materials from the perspective of surgical endodontics, highlighting their development, application and potential role in achieving proper haemostasis.