Autotransplantation of teeth (ATT) is a surgical technique that involves transplanting a non-functional tooth (donor tooth) within the oral cavity to an edentulous area (recipient site). This procedure not only demonstrates re‐liable long-term success and survival rates but also possesses unique osteoinductive capacity and soft tissue preservation advantages, making it particularly suitable for the restoration of dental defects in adolescents. However, ATT is highly technique-sensitive, and its successful implementation depends on the operator’s comprehensive mastery of multidisciplinary knowledge, including alveolar surgery, periodontology, endodontics, prosthodontics, and orthodontics, as well as the precise design and execution of personalized surgical plans. Preoperative systematic evaluation is required to assess the root development stage of the donor tooth, the bone volume condition of the recipient site, and the compatibility between the donor tooth and the recipient site. For teeth with an open apex, pulpal healing through revascularization is often achievable with a high success rate, whereas those with a closed apex typically require root canal treatment 2–4 weeks postoperatively to minimize complications. Utilizing cone beam computed tomography, intraoral scanning, and virtual surgical planning enables accurate assessment of donor-recipient matching and the design of the transplantation plan. Intraoperatively, careful attention must be paid to minimizing tissue trauma through precise planning and gentle manipulation, strictly limiting the extra-oral time of the donor tooth to within 15 min, and maintaining the root surface moist at all times to protect the periodontal ligament and improve surgical outcomes. The application of tools, such as 3D-printed personalized surgical guides, donor tooth replicas, and customized osteotomes, has enhanced the precision of socket preparation. Further, emerging technologies, such as dynamic navigation, surgical robotics, and artificial intelligence, have also demonstrated promising potential in the field of ATT.
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Open Access
Review Article
Issue
Open Access
Prevention and Treatment Practice
Issue
To investigate the diagnosis, treatment and prognosis of nonodontogenic periapical lesions and to provide a reference for clinical diagnosis and treatment.
A case of a patient with right upper molar pulp with apical penetration and local occlusion admitted to the West China Stomatological Hospital of Sichuan University was retrospectively analyzed, and the curative effect of microapical surgery and pith preservation was also analyzed.
The imaging features of tooth 16 showed periradicular radiolucency combined with local radiopaque lesions around the distal buccal apical area. Endodontic microsurgery was performed under local anesthesia. Soft tissue coverage was observed in the distal buccal apical area during the surgery, and no radiopaque tissue was detected. The distal buccal root apex was cut by 3 mm, and mineral trioxide aggregate was used for root-end backfilling. The postoperative pathological results revealed fibrous connective tissue. One-week recall X-ray examination showed tight root-end backfilling and no periradicular radiolucency; an electrical test of pulp vitality showed positive results. The four-year follow-up showed that there was no discoloration in tooth 16 and no significant difference in thermal and electrical tests of pulp vitality compared with control teeth. Combining the clinical manifestations, imaging features, surgical exploration results and pathological reports, the case was most likely to be cemental hypoplasia. Through the literature review, the treatment and healthy pulp preservation of such cases by endodontic microsurgery under the premise of preserving teeth has not been reported.
For maxillary posterior teeth with periapical lesions but healthy pulp, accurate estimation of pulp status, endodontic microsurgical exploration and application of bioactive materials can achieve vital pulp preservation while removing the lesions.
Open Access
Basic Study
Issue
This study aims to compare the incidence of dentinal microcracks produced by ProTaper Universal (PTU) and ProTaper Gold (PTG) file systems during root canal procedures in different curved canals using a dyeing technique.
Sixty extracted human molars were divided into 3 groups of 20 samples each in terms of root curvature (mild bending group, 10 °-19 °; moderate bending group, 20 °-29 °; severe bending group, 30 °-39 °). Ten samples of each group were then randomly allocated to the PTU and PTG file systems. After preparation, all roots were stained using a dyeing method and sectioned at the most curved plane and 2 mm below and above the most curved plane with a low-speed saw under cold water. A stereomicroscope was used to inspect dentinal microcracks at 60 × magnification, and differences between these three instrument groups were analyzed using the chi - square test.
The PTG file system induced significantly fewer dentinal microcracks for total, incomplete and complete cracks (P < 0.05), and the effect was more obvious with increasing canal curvature.
With the limitations of this in vitro study, it can be concluded that ProTaper Gold can result in fewer dentinal microcracks than ProTaper Universal.
Open Access
Review Article
Issue
Endodontic microsurgery is one effective method for preserving teeth affected by periapical disease, and is also an essential technique for treating difficult cases. However, due to the restricted operating space at the posterior site and the proximity of the root apex to the maxillary sinus, endodontic surgery in the posterior maxillary area represents great challenges. This article summarizes the anatomical relationship between the maxillary sinus and the maxillary posterior teeth, the influence on endodontic microsurgery, and the application of assistive techniques on maxillary posterior teeth, such as 3D-printed surgical guides and ultrasonic osteotomes. Literature review results show that the spatial relationship between the apex of maxillary posterior teeth and the maxillary sinus is usually divided into three categories: the apex enters the maxillary sinus; the apex contacts the bottom of the maxillary sinus; and there is a distance between the apex and the bottom of the maxillary sinus. CBCT should be performed before the operation, and the periapical state of the tooth and the maxillary sinus and the distance between the lesions and the sinus floor should be considered to evaluate the difficulty of the operation. Meanwhile, during surgery, equipment such as surgical guides, endoscopes and ultrasonic osteotomes should be used to ensure that the operation is safer, reliable, precise and less invasive, but the clinical popularity of ultrasonic osteotomes still needs further promotion. Moreover, high-quality clinical studies on the long-term effects of micro-apical surgery in the posterior maxillary area are still lacking.
Open Access
Review Article
Issue
Endodontic microsurgery is an important treatment for endodontic disease and maxillary sinusitis of endodontic origin of maxillary posterior teeth. However, endodontic microsurgery is challenging due to the close proximity between the maxillary posterior teeth and the maxillary sinus, which may lead to complications of mucosal perforation of the maxillary sinus floor. Endodontic microsurgery combined with maxillary sinus floor elevation is considered as a solution, namely natural tooth-related maxillary sinus floor elevation. The evaluation and design of natural tooth-related maxillary sinus floor elevation are closely related to local anatomic relationships. This article provides a systematic review of the anatomical considerations of endodontic microsurgery, namely natural tooth-related maxillary sinus floor elevation in the maxillary posterior region in terms of maxillary posterior teeth, alveolar ridge of the maxillary posterior region, and maxillary sinus. The literature review showed that a minimum of 3 mm of the root apex must be removed during endodontic microsurgery to eliminate the majority of apical ramification, lateral canals, and severe root curvatures. The height and thickness of alveolar ridge bone are important indicators for evaluating and designing endodontic microsurgery for maxillary posterior teeth. Maxillary sinus floor mucosa, maxillary sinus ostium, the proximity between maxillary posterior teeth and the maxillary sinus floor, maxillary sinus septa, posterior superior alveolar artery, and greater palatine artery, and possible maxillary sinus cysts are the main maxillary sinus-related considerations. When the maxillary sinus floor is below the line between the buccal and palatal roots, when the root apices contact or protrude into the maxillary sinus floor, or when the apical lesion is directly connected to the maxillary sinus mucosa, natural tooth-related maxillary sinus floor elevation is applicable. Anatomical considerations should be emphasized throughout endodontic microsurgery and natural tooth-related maxillary sinus floor elevation in the maxillary posterior region. Further studies are required to investigate the clinical design and difficulty assessment of natural tooth-related maxillary sinus floor elevation in different local anatomical relationships.
Open Access
Review Article
Issue
Inflammation is a protective response of the body to pathogens and injury. Hence, it is particularly important to explore the pathogenesis and key regulatory factors of inflammation. BMP9 is a unique member of the BMP family, which is widely known for its strong osteogenic potential and insensitivity to the inhibition of BMP3. Recently, several studies have reported an underlying pivotal link between BMP9 and inflammation. What is clear, though not well understood, is that BMP9 plays a role in inflammation in a carefully choreographed manner in different contexts. In this review, we have summarized current studies focusing on BMP9 and inflammation in various tissues and the latest advances in BMP9 expression, signal transduction, and crystal structure to better understand the relationship between BMP9 and inflammation. In addition, we also briefly summarized the inflammatory characteristics of some TGF-β superfamily members to provide better insights and ideas for the study of BMP9 and inflammation.
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