Diagnosis of the pulpal status: an updated view Update in Endo by Domenico Ricucci 2021 The opinion that a precise diagnosis of the pulp status cannot be made on the bases of clinical symptoms, radiography, and responses to pulp tests is deep rooted among clinicians. This originates from textbooks and previous literature. New emerging evidence is challenging this old belief and it is high time that dentists understand the pulp response to the carious attack and learn how to perform a meticulous examination in the clinical setting. |
Potential of Vital Pulp Therapy Update in Endo by Domenico Ricucci 2021 During excavation of asymptomatic deep caries lesions the occurrence of pulp exposure is still regarded as the evil, because "an exposed pulp is a condemned pulp". Similarly, too many teeth presenting with symptomatic irreversible pulpitis are root canal treated in the daily practice. Based on histopathologic observation and presentation of clinical cases it will be clear that the vitality of a large number of exposed pulp can be maintained in the presence of the correct clinical indications. On the other hand, in teeth with irreversible pulpitis new evidence shows that it is possible to clinically locate the front of infection and selectively remove the diseased/infected tissue through a pulpotomy procedure. Clinical steps are thoroughly described. |
New knowledge about patterns of endodontic infections Update in Endo by Domenico Ricucci 2021 A pulp does not become necrotic overnight. After carious penetration of the pulp, necrosis and bacteria are initially confined to the pulp chamber, but soon the pulp degeneration process extends beyond root canal orifices and moves slowly in apical direction. In histologic sections, bacteria arranged in biofilm structures can be observed on the RTC walls. A radiographically visible periapical lesion appears at an early stage, when a consistent part of the radicular pulp is still vital. The biological and clinical advantages of an incomplete colonization of the pulp space are illustrated. If the condition is not treated, in later stages bacterial colonization occurs in lateral canals, ramifications, isthmuses, with the consequence that infection control is not always achieved with usual chemomechanical procedures. These difficulties are highlighted through the analysis of biopsies obtained from failed cases. |
Extraradicular infection: the most challenging condition Update in Endo by Domenico Ricucci 2021 The possibility that bacteria can occasionally trespass the boundaries of the root canal system, giving rise to a condition known as extraradicular infection, has been elucidated only in recent years, and consistently reported by histobacteriologic evaluations. Out of the canal, bacteria can give rise to cohesive actinomycotic-like colonies within the body of the inflammatory lesion, or form biofilms adhered to the external radicular surface. This condition, which cannot be diagnosed by radiography, has a strong impact on the outcome of the primary endodontic treatment. In fact, given its location outside the root canal, infection is not affected by usual instrumentation procedures. Hints are given concerning identification and management of this unfavorable pathologic condition. |
Dr. Domenico Ricucci Update in Endo by Domenico Ricucci 2021 Dr. Domenico Ricucci received his degree in General Medicine from "La Sapienza" University of Rome in 1982, and his DDS from the same University in 1985. Since then on he has maintained private dental practices limited to endodontics. In addition to his private practice, Dr. Ricucci was Professor of Cariology at "Magna Graecia" University of Catanzaro, Italy in 2002 -2003. He served in the Research Committee of the European Society of Endodontology from 1999 to 2005. Dr. Ricucci's primary research interest relates to pulpal and periapical tissue reactions to caries and treatment procedures, vital pulp therapy (VPT), biofilms in endodontic infections, etiology of RTC treatment failure, pulp regeneration/revascularization. Since 1998 he has run his own histology laboratory and has developed considerable skills in hard tissue preparations for light microscopy. Dr Ricucci has published more than 100 papers and has lectured both nationally and internationally. He has authored the Textbook and Atlas "Endodontology. An integrated biological and clinical view". He has also authored or co-authored sixteen book chapters. |