ENDO, 03/2020

The recent development of new biomaterials and improved understanding of pulp biology have allowed a reconsideration of the systematisation of endodontic treatments in the case of pulp exposure. The importance of tissue conservation for the durability of treatments has been demonstrated. Pulp capping corresponds to the placement of a biomaterial in direct contact with the pulp. The objective of the treatment is to obtain a biological seal of the site. The prognosis of pulp capping depends on the material used, the age of the patient, the topographical location of the exposure and, above all, the inflammatory status of the pulp. Clinical evaluation of the inflammatory status of the pulp has proven to be the main limiting constraint to systematisation of this procedure. To mitigate this difficulty, in coming years, chamber pulpotomy could be considered as an alternative therapeutic option to endodontic treatment. Clinical implications: The objective of this article is to review the knowledge required for optimisation of therapeutics for pulp vitality conservation and to detail the factors that influence the prognosis. Keywords: pulp capping, pulp chamber pulpotomy, pulp vitality

Regenerative endodontic treatment is a biologically based approach for the treatment of immature teeth with pulp necrosis. In this approach, a sequence of procedural steps, such as disinfection of the root canal space, introduction of a scaffold into the root canal, sealing of the scaffold with an intracanal coronal barrier and restoration of crowns, is followed. Most commonly, hydraulic calcium silicate cements such as mineral trioxide aggregate have been used as the coronal barrier in regenerative endodontic treatment. Although there is still much to be known regarding the details of each step, the procedures performed before and after establishment of the coronal barrier may interact with hydraulic calcium silicate cements and play a role in some of the outcomes of regenerative endodontic treatment. Tooth discolouration has been reported as a common unwanted patient-orientated outcome. This review provides an overview of the probable impact of each procedural step on hydraulic calcium silicate cements in regenerative endodontic treatment, with special attention paid to tooth discolouration. Keywords: hydraulic calcium silicate cement, immature teeth, regenerative endodontic treatment, tooth discolouration

Hydraulic calcium silicate–based sealers have been available to dentists for over a decade. How have these materials changed views on root canal treatment? Is there demand for a change in the standard treatment protocols that are accepted when using common sealers? Do hydraulic calcium silicate–based sealers offer a new understanding of the root canal filling material, developing its properties from sealing abilities to healing abilities? A number of issues must be addressed when using hydraulic calcium silicate–based sealers for root canal obturation. This narrative review provides an overview of the clinically relevant aspects of root canal obturation with hydraulic calcium silicate–based sealers. Keywords: cold lateral compaction, intracanal medicament, irrigation, single-cone obturation, warm vertical compaction

Root-end surgery is necessary when primary endodontic treatment fails and the tooth cannot be managed successfully by conventional retreatment strategies. Over the last two decades, root-end surgical techniques have changed considerably due to the introduction of microscopes, ultrasonic instruments and dedicated root-end filling materials. This clinical perspective focuses on the development and use of hydraulic calcium silicate materials for root-end surgery. Keywords: clinical protocols, hydraulic calcium silicate cements, material properties, root-end surgery

Endodontic success is based on the eradication of root canal infections and prevention of recontamination. The presence of any form of communication between the endodontium and surrounding tissue, in particular the oral cavity, provokes prompt infection relapse. Most of these communications are represented by iatrogenic perforation caused during endodontic procedures. The use of CBCT has significantly improved diagnosis and treatment planning when facing such clinical situations. The introduction of the surgical operating microscope has been another major improvement, allowing precise application of the repair material. Finally, the introduction of biocompatible and even bioactive hydraulic cements, including mineral trioxide aggregate, has been a significant development in improving the outcome of perforation repair, allowing a predictable and perduring seal that prevents further bacterial contamination. Some confusion persists regarding the clinical steps required to treat the different presentations. The present article illustrates the main techniques for repairing perforations based on their position. Suborifice perforation repair requires use of an appropriate sandwich technique. Keywords: bioceramic, case report, case series, hydraulic cements, perforation

Nowadays, in order to prevent the early loss of cariously or traumatically damaged teeth in paediatric dentistry, different types of endodontic treatments are considered. Over the past decade, paediatric dentistry has primarily shifted its focus towards the preservation of vital tissues and improvement of treatment outcomes, and has benefitted immensely from the introduction of effective and safe bioactive endodontic materials. Since 1993, the year in which mineral trioxide aggregate was introduced, hydraulic calcium silicate–based biomaterials have made a significant impact on endodontic treatments. There is a growing body of evidence demonstrating that hydraulic calcium silicate cements are beneficial for both the least aggressive and most invasive type of vital pulp therapies, as well as for the management of non-vital primary/permanent young teeth. Moreover, clinicians' skills and knowledge regarding the applications of hydraulic calcium silicate–based biomaterials play a crucial role in achieving success with the applied methods. The objective of this review is to summarise the recent developments concerning hydraulic calcium silicate–based biomaterials and provide an overview of some existing trends alongside current theories that have significantly influenced the art and science of paediatric endodontics. Keywords: Biodentine, calcium-enriched mixture, calcium silicate–based, CEM cement, endodontics, hydraulic calcium silicate cement, mineral trioxide aggregate, primary teeth, pulpotomy, vital pulp therapy