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IMMUNOHISTOCHEMISTRY, MOLARS, ORAL surgery, HEALTH outcome assessment, PERIODONTAL disease, TOOTH sensitivity, and PULPOTOMY

Aims: To introduce a novel therapeutic approach for the treatment of furcation‐involved maxillary molars by vital root resection and report longer‐term outcomes of a case series. Methods: Eleven patients with 15 maxillary molars affected by double/triple class II (n = 10) or single/double class III (n = 5) furcation defects and advanced vertical bone loss around one root participated. Teeth were treated with deep pulpotomy using a calcium silicate‐based cement. After 4 weeks, the affected roots were removed by periodontal microsurgery and processed for histological evaluation of the pulp. All patients were enrolled into a supportive periodontal care programme. During the follow‐up period, assessments of tooth sensitivity, response to percussion, mobility, pocket probing depth (PPD) and bleeding on probing (BOP) were made, periapical radiographs obtained and patient‐reported outcomes collected. Results: All teeth remained sensitive to pulp testing. After 1 year and 3–7 years of follow‐up, PD was ≤5 mm at all resected teeth. Furcation status was much improved. Neither increasing mobility nor clinical or radiographic signs of periapical pathology were observed throughout the individual observation period. All patients were pleased with the result of therapy. Histologic sections revealed a functional dentin‐pulp complex. Conclusions: This case series demonstrates the possibility of maintaining severely furcation‐involved molars by vital root resection for up to 7 years. Root canal therapy and its associated costs and complications can thus be avoided. [ABSTRACT FROM AUTHOR]

CONE beam computed tomography, SURGICAL procedures, SURGICAL stents, MANDIBULAR nerve, and AERODYNAMICS

Surgical stents allow clinicians to undertake micro‐endodontic surgical procedures with an increased level of accuracy. When planned in combination with cone‐beam computed tomography (CBCT) radiographic imaging, surgical stents can help accurately determine the point of entry of the surgical drill, minimise the size of the osteotomy, ensure accurate resection of the root/s and avoid vital anatomical structures. Fabrication of surgical stents can, however, be a complex and long‐drawn‐out process, adding to the cost of the surgery. This case report presents a relatively easy method of fabricating a surgical guide and showcases the benefits of a planned surgical guide in managing a periapical pathology with close proximity to the mental nerve canal. [ABSTRACT FROM AUTHOR]

PERIAPICAL diseases, FOREIGN body reaction, OPERATIVE surgery, and THERAPEUTICS

Endodontic surgery is a safe and passable alternative when teeth are not responding to traditional endodontic therapy and don't acquire favourable outcomes. Apicoectomy involves surgical management of a tooth with a periapical lesion which cannot be resolved by routine endodontic treatment. Because the term "apicoectomy" consists of only one aspect of a multifaceted series of surgical procedures, i.e removal of root apex, the terms "periapical surgery" or "periradicular surgery" are more apposite. It must only be applied in specific situations. Endodontic treatment failures can be related to: extra-radicular infections such as periapical actinomycosis; to foreign body reactions that can be caused by endodontic material extrusion; to endogenous cholesterol crystal accumulation in apical tissues and unresolved cystic lesion. [ABSTRACT FROM AUTHOR]

TEETH, PROPORTIONAL hazards models, and TOOTH loss

Objectives: The aim of this study was to evaluate long-term (≥5 years) tooth survival after resective therapy of multi-rooted, periodontally treated teeth and investigate the influence of patient-, tooth-, and dentist-related risk factors on tooth loss. Materials and methods: A total of 128 patients with root-resected molars were reexamined. Patient-, tooth-, and dentist-related factors were assessed. Tooth survival times were estimated using the Kaplan-Meier method in addition to a Cox proportional hazard frailty model with survival as the dependent outcome to assess an association with predictor variables. Results: Overall, 100 patients with 130 molars were included. The average postoperative reevaluation period was a 9.62 ± 3.08 year showing an overall survival rate of 56.9% after resective therapy. A cumulative survival rate of 69% (95% CI (61%; 77%)) after 5 years decreasing to 48% (95% CI (35%; 61%)) after 15 years was detected. The median survival time of resected molars was 13.83 years (95% CI (8.75; ∞)). Adherence, smoking, and insurance status were detected to significantly influence the risk for loss of molars after resective therapy. Conclusions: Resective periodontal procedures can still be considered an option to retain periodontally compromised molars. In contrast to dentist- and tooth-related factors, patient-related factors impacted significantly upon tooth survival. Clinical relevance: Periodontally compromised molars could be retained in more than 50% of the cases thus prolonging their life span significantly. This information shall be valuable for clinicians in decision-making, treatment planning, and postoperative management. The weighting of resective therapy to implants especially with regards to the risk of peri-implantitis should be considered. [ABSTRACT FROM AUTHOR]

The successful management of endodontically involved teeth depends on adequate biomechanical preparation and obturation in adherence to a satisfactory coronal seal. However, challenges such as extensive carious involvement, periodontal attachment loss, and iatrogenic mishaps which include ledges, blocked canals, and instrument separation compromise the salvation of the teeth. Treatment options for such mishaps in multirooted teeth can range from endodontic treatment alone, combined endodontic-periodontic treatment, or extraction in cases with poor prognosis. One such treatment in case of file fracture or extensive periodontal involvement in maxillary molars could be root resection, also known as radisection. This procedure offers an economically viable treatment option for the patient to preserve the natural tooth. This article highlights a case report of root resection in maxillary molar with endodontic, periodontic, and prosthetic management with resultant successful oral rehabilitation along with a follow-up of 3 years. [ABSTRACT FROM AUTHOR]

Rehabilitation of periodontally compromised dentitions is always challenging in order to restore the masticatory function as well as to prevent future disease progression. This case report discusses an interdisciplinary approach for managing a case of Stage IV periodontitis in a female patient who presented with multiple mobile furcations involved posterior teeth. By a combined endo-perio-prosthetic effort, the retention and rehabilitation of majority of her teeth was achieved. [ABSTRACT FROM AUTHOR]

One of the crucial challenges that any present-day general dentist confronts is the treatment determination between extracting a tooth and placement of a dental implant or by conserving the natural tooth with an interdisciplinary approach. The rising concern amongst the patients towards preserving their dentition has driven the clinicians towards providing treatment options that are more appropriate and conservative and at the same time does not hamper its functional needs. This report highlights one such way of preserving the periodontally compromised natural tooth with just resecting the diseased part of it and also conserving the proprioceptive capacity of the tooth. One-year of regular follow up and maintenance paving way to a healthy periodontium and complete resolution of mobility concerning the affected tooth is described. This report also provides information on root resection in a mandibular molar as a viable and a definitive treatment modality, providing better access to the remaining tooth structure and thereby enabling successive prosthetic rehabilitation. [ABSTRACT FROM AUTHOR]