Conservative Dentistry Journal

A review of tissue engineering in regenerative endodontic treatment

Eric Priyo Prasetyo — 2024-07-24

Background: Regenerative endodontic treatments are classified based on approach in the procedures and principles. One is cell-free approach that involves a revitalization procedure to achieve continued root growth while the other is cell-based approach which involves pulp/dentin regeneration through isolation and ex vivo expansion of stem cells seeded in the scaffold and then transplanted into the canal space. Technically, the cell-free approach is simpler than cell-based approach because the former does not concern about external stem cell isolation and culture. Currently, the gold standard and the one that has been clinically performed is cell-free approach. Cell-based approach is still not a standard because currently the cell-based approach is still in the clinical trial stage. Purpose: to evaluate the biological basis and clinical protocols recently used in regenerative endodontic treatment and discuss potentially future treatment approaches. Review: The literature review was searched in PUBMED with the keywords: immature permanent teeth, pulp revascularization, stem cells and regenerative endodontics. The regenerative endodontic treatments with various procedures and techniques result in a significant increase in root length and dentinal wall thickness. Stimulation of stem cells in apical root canal system is required to induce tissue formation and continued root maturation. Conclusion: The success of regenerative endodontic therapy relies on the development of a technique that enables clinicians to create functional pulp tissue within cleaned and shaped root canal systems. It is hoped that further research studies are required to define advantages and limitations of cell-free and cell-based approach.

In office external bleaching of teeth with discoloration: a case report

Cinitra Anindya — 2024-07-24

Background: Tooth discoloration is a prevalent issue that significantly impacts an individual's self-confidence. Fortunately, dentists offer highly effective and non-invasive teeth whitening techniques that use higher concentrations of hydrogen peroxide (HP) of around 35% to 40%. These techniques can help resolve the problem of teeth discoloration better than at-home methods designed to deliver faster results. This is particularly helpful when immediate whitening is required. Purpose: This case study aims to report cases of in-office external bleaching of discolored teeth. Case: A 29-year-old woman complained about the yellowish shade of her teeth, which made her feel less confident due to the yellowish color. Case Management: The management for discoloration of teeth was done with dental bleaching using 40% hydrogen peroxide. As a result of the treatment, the desired tooth color increased from 3M1 to 1M1 Vita 3D Master and from Opalescence no.6 to 4. Conclusion: In-office dental bleaching is a highly effective treatment option for correcting tooth discoloration that dental professionals widely use. The procedure can significantly improve the appearance of discolored teeth and increase self-confidence of the patient.

Differences of compressive strength between calcium carbonate from blood clam shells and calcium hydroxide as a candidate for pulp capping material

Widya Saraswati — 2024-07-24

Background: Pulp capping is one of the treatments for reversible pulpitis and aims to maintain pulp vitality. This treatment requires a material that can protect the pulp with good biocompatibility. The physical and mechanical properties, bio interactivity and bioactivity of pulp capping materials are very important for the formation of reparative dentin. Calcium hydroxide (Ca(OH)₂) as the gold standard material in pulp capping treatment also has some disadvantages. Another alternative for pulp capping material is blood clam shell because it contains 98% calcium carbonate (CaCO₃), which is a compound with a bone-like structure and can induce pulp cell differentiation. Objective: To investigate and explain the difference in compressive strength between CaCO₃ from blood clam shells and Ca(OH)₂as a candidate pulp capping material. Methods: This research is a laboratory experimental study with post test only control group design method. Ca(OH)₂ and CaCO₃ samples were formed with a mixture of powder and aquadest with 4x6 mm sample size. The samples were dried at room temperature and the compressive strength was measured using a universal testing machine (UTM). Result: There is a significant difference in compressive strength between Ca(OH)₂ and CaCO₃ blood clam shells in the Mann-Whitney test results (p<0.05). Conclusion: The results of the compressive strength test between the mixture of Ca(OH)₂ with aquadest in a ratio of 1:1 are greater than the mixture of CaCO₃ blood clam shells with aquadest in a ratio of 3:1 so that pure CaCO₃ blood clam shells with distilled water without other additives cannot be used as a candidate for capping pulp material.

Apexification treatment on tooth with a history of trauma: A case report

Devi Eka Juniarti — 2024-07-24

Background: Traumatic dental injuries to the teeth may result in pulpal and periapical disease. Most dental traumas occur in the 7 -10-year-old age group with incomplete apical root development. Apexification is the procedure to close the apex using bioactive material to create an apical plug. MTA can be used as a material of choice to treat open apex. Purpose: To perform an apexification of open apex with MTA apical plug. Case: A 30-year-old female patient with a chief complaint to fix her missing anterior filling and blackened tooth. The tooth had a history of trauma when the patient was 7 years old. One year ago, the tooth had intermittent pain so the tooth was treated and filled by another dentist. Case Management: Access opening is performed and apical gauging is determined. Then, working length was established. Debridement was done with H-file #80. Irrigation sequence with NaOCl 1,5% - Aquadest – EDTA 17% -aquadest. Ca(OH)₂ dressing was given and temporary restoration was placed. On the second visit, temporary restoration was removed, followed by a root canal filled with MTA 3 mm from the apex using MAP carrier then confirmed with a radiograph. Conclusion: Trauma that occurs during tooth formation may cause an open apex that is treatable using an MTA plug.

The effect of nano propolis on surface color changes of nanohybrid composite resins

Bernardus Daniel Christian — 2024-07-24

Background: Nanohybrid composite resins have many advantages, but one disadvantage is their absorbent nature which can lead to discoloration. Phenols and flavonoids in nano propolis cause diffusion and affect the matrix and pigments of nanohybrid composite resins. The accumulation of reduction-oxidation reactions causes new compounds of nanohybrid composite resins to occur so that they have different colors. Objective: The study was conducted to determine the changes in surface color of nanohybrid composite resin after immersion in nano propolis at 5% concentration. Methods: Research experimental laboratory method with pre and post test design was applied to 25 nanohybrid composite resin fruit samples of size (5x5x1.5) mm embedded in bovine incisive, then immersed in 5% nano propolis and 25 ml of distilled water at 37oC for five days. The color change (ΔE) was measured with a DSLR camera and processed with Adobe Lightroom Classic software in CIE L*a*b* format. Results: The anova test on ΔE in the data showed the p-value of sphericity assumed was smaller than 0.05. There is a difference in the average measurement results on the first day to the fifth day in the treatment group. Independent t-test of control and treatment data showed a significant difference in measurement results. The results of the post hoc test with the Tukey method showed that the treatment groups at 4x24 hours and 5x24 hours did not have significant differences. P-value at 4x24 hours and 5x24 hours was 0.957. Conclusion: There was a change in the surface color of the nanohybrid composite resin after being immersed in a nano-solution of propolis with a concentration of 5%.

Assessing the antibacterial efficacy of nano propolis concentrations on Streptococcus mutans

Mohammad Gerald Athallah Putra — 2024-07-24

Background: Dental caries is a common disease among the Indonesian population, with a prevalence of dental caries in Indonesia reaching 88.8%. Streptococcus mutans is one of the types of bacteria found in caries lesions. Nano propolis has antibacterial properties that can help inhibit the growth of Streptococcus mutans bacteria, reducing the risk of dental caries. Objective: This study aims to determine the effective concentration of nano propolis ranging from 2.5% to 0.625%. Methods: The research evaluates various concentrations of nano propolis, and the minimum concentration that inhibits the growth of Streptococcus mutans is observed using the colony count method. Results: The growth of Streptococcus mutans at a concentration of 2.5% nano propolis was 0, at 1.8% it was 6, at 1.25% it was 11.4, and at 0.625% it was 42. The positive control group containing BHIB media and Streptococcus mutans bacteria showed an average colony growth of 161. Conclusion: Nano propolis at a concentration of 1.25% is effective in inhibiting the growth of Streptococcus mutans.

Antimicrobial activity of calcium hydroxide, calcium oxide, and mineral trioxide aggregate paste against α-Hemolytic Streptococcus

Eveline Yulia Darmadi — 2024-07-24

Background: The bacteria mostly found in the root canals are aerobic and facultative anaerobic bacteria, such as α-Hemolytic Streptococcus. Calcium hydroxide has alkaline characteristics with pH of 12.5, and antimicrobial properties. Calcium oxide is hydrophilic and has a smaller molecular weight than calcium hydroxide. Mineral trioxide aggregate (MTA) has alkaline properties, good biocompatibility, stimulates healing and inhibits bacterial growth. Purpose: The purpose of this study was to examine the differences of antimicrobial activity between calcium hydroxide, calcium oxide, and mineral trioxide aggregate (MTA), also to find which of these materials has the highest antimicrobial activity. Methods: The design of this study was a post-test only control group design. The study subjects were divided into 4 groups. K (-) was control group without any treatment, P1 was treated with calcium hydroxide, P2 was treated with calcium oxide, and P3 was treated with MTA. Each group consisted of 7 samples. The α-Hemolytic Streptococcus were spread on Mueller Hinton agar. Antimicrobial test was using diffusion method and diameter of inhibition zones were measured with caliper. Results: Average inhibitory zone of each sample was P1 (30.9643 mm ± 0,7431), P2 (35,2357 mm ± 0,7099), P3 (28,6 mm ± 1,5532). Tukey HSD test showed significances results between samples P1 and P2 (p=0,001), P1 and P3 (p=0,002), P2 and P3 (p=0,001). Conclusion: The highest antimicrobial activity against α-Hemolytic Streptococcus was calcium oxide followed by calcium hydroxide and MTA.

Minimally invasive teeth whitening enhancements after orthodontic treatment with in-office bleaching: two case reports

Noor Hikmah — 2024-07-24

Background: Teeth discoloration is one of the adverse effects of orthodontic treatment which causes aesthetic issues that effect on a person’s appearance. The management of teeth discoloration can be done with bleaching because it is easier to perform, faster, more effective, and more conservative than other treatments such as crowns and veneers. There are two types of bleaching techniques supervised by dentists: home bleaching and in-office bleaching. In-office bleaching is one of the most conservative and non-invasive treatment options to restore the aesthetics of discolored teeth. Purpose: This case report observes management of tooth discoloration after orthodontic treatment with in office bleaching using hydrogen peroxide 40%. Case 1: A 24-year-old woman came to Universitas Hasanuddin Dental and Oral Hospital with complaints of yellowish upper and lower teeth after removal of her fixed orthodontic appliance. Case 2: A 24 years old woman came to Universitas Hasanuddin Dental and Oral Hospital with complaints of upper and lower front teeth appearing yellowish in color, noticed from 2 years ago and had undergone orthodontic treatment for four years. Case Management: From clinical examination, both patients’ teeth have no history of caries, sensitive tooth and gingival recession. The Teeth were sensitive to vitality test. The discoloration was treated with external bleaching using 40% hydrogen peroxide.
Conclusion: External Bleaching using 40% hydrogen peroxide have results in significant discoloration without changing the shape and arrangement of the patient’s teeth

Esthetic crown lengthening treatment on the maxillary anterior teeth

Dian Agustin Wahjuningrum — 2024-07-24

Background: Asymmetrical smile design due to uneven gingival margin heights of the anterior upper teeth can lead to aesthetic issues and inadequate crown restorations, necessitating crown lengthening treatment. Purpose: The objective of this case report is to demonstrate the outcomes of crown lengthening to achieve improved aesthetics and symmetric gingival margin heights. Case: A 16-year-old female patient sought treatment for decayed left maxillary anterior teeth. Clinical examination revealed a non-vital tooth (tooth 21) with decay and excessively low gingival margins, along with asymmetrical gingival heights between the incisors and canines. Radiographs indicated radiolucent mass in the pulp chamber. Case Management: Crown lengthening was performed on teeth 12, 11, 21, and 22, and apexification was conducted on tooth 21 using a customized fiber post and lithium disilicate crown. Follow-up evaluations showed no complaints, well-maintained crowns, and healthy gingiva. Conclusion: Crown lengthening is feasible for anterior teeth with low gingival margins, enhancing clinical crown length to support aesthetic and final restorations in maxillary anterior teeth.

Aesthetic surgical crown lengthening on teeth 11 and 21

Mardikaning Riasta Saptaningrum — 2024-07-24

Background: In dental treatment planning, aesthetic considerations are crucial due to the relationship between a smile and facial beauty. Crown lengthening is a procedure used to achieve aesthetic smiles, particularly in cases of subgingival caries, fractures, and short clinical crowns. Purpose: The purpose of this case report is to achieve aesthetic improvement of the central incisors through crown lengthening procedures. Case: A 31-year-old female patient presented with a complaint of a broken upper left front tooth and easily bleeding gums. Clinical examination revealed Ellis class 1 fracture at the incisal-distal of tooth 21. The patient exhibited poor oral hygiene with visible calculus on upper and lower jaw teeth. There was gingival hyperplasia, redness, bleeding tendency, and the gingival margin height of teeth 11 and 21 appeared lower than teeth 12 and 22. Radiographically, the alveolar crest was distant from the CEJ. Case Management: Treatment plan included crown lengthening on teeth 11 and 21 with composite restoration on tooth 21. Crown lengthening, a surgical procedure designed to increase the extent of supragingival tooth structure for restorative or aesthetic purposes by repositioning the gingival margin apically was performed. This procedure is indicated for teeth with subgingival caries, extensive caries shortening the tooth, fractures, and short clinical crowns. Conclusion: Crown lengthening should consider the biological width to prevent bone resorption, gingival recession, inflammation, or hypertrophy. When performed under ideal clinical conditions, crown lengthening provides satisfactory outcomes both functionally and aesthetically.