Micro-CT evaluation of maxillary first molars: interorifice distances and internal anatomy of the mesiobuccal root

Abstract: This study aimed to describe the morphometric relationship of root canal orifices on the pulp floor in the presence/absence of mesiobuccal second canal (MB2) in the maxillary first molars and other aspects of its internal anatomy. Sixty-two maxillary first molars were scanned by micro-CT. The presence of the MB2 canal was verified. The distance between the center points of the MB1, MB2, distobuccal (DB), and palatal (P) canal orifices on the pulp floor were measured (MB1-MB2, MB1-DB, MB2-DB, MB1-P, and DB-P). The MB1-P to DB-P ratio was calculated. The distances between the anatomic apex and the MB1 and MB2 apical foramina were measured. The length of the band-shaped isthmus was also measured. Student's t-test was applied to verify the association between the presence of an MB2 canal, the interorifice distances, and the ratio of the MB1-P to DB-P distance (α = 5%). The MB2 canal was present in 43 roots (69.35%). Statistics showed significant differences when MB2 was present for the largest MB1-P distance (p < 0.05) and higher values for the MB1-P to DB-P ratio (p < 0.05). A band-shaped isthmus was detected in 25.8% of MB roots. The mean distance from the apical foramen to the isthmus floor ranged from 1.74 for MB1 canals to 1.42 for MB2 canals. Canal orifice distances on the pulp floor may predict the presence of MB2 canals. There was a high incidence of isthmus, accessory canals, and apical delta in the critical apical zone in MB roots of maxillary first molars.

Apicificação em dente desvitalizado com rizogênese incompleta, associando hidróxido de cálcio e agregado trióxido mineral: relato de caso / Apexification in non-vital teeth with incomplete root formation associating calcium hydroxide and mineral trioxide aggregate: a case report

O objetivo do presente estudo foi descrever o manejo de um caso clínico de dente com rizogênese incompleta e necrose pulpar, em um paciente do sexo masculino, 13 anos de idade, com histórico de traumatismo dentário nos incisivos centrais superiores. Após diagnóstico clínico e radiográfico, com confirmação de necrose pulpar, os dentes foram submetidos ao procedimento de apicogênese com hidróxido de cálcio e posterior apicificação com agregado trióxido mineral (MTA)e obturação dos canais radiculares com guta-percha. Após acompanhamento de 20 meses, observou-se supressão da sintomatologia dolorosa, ausência de comprometimento periodontal e, radiograficamente, redução da lesão periapical. Aos 60 meses, foi observada manutenção da saúde periodontal e completa cicatrização da lesão periapical. (AU).

Introduction: Immature teeth with pulp necrosis constitute a challenge to endodontic therapy. Our objective was to describe the management of a tooth case of with incomplete rizogenesis and pulp necrosis. Methods: Patient, male, 13-years-old, with a history of dental trauma in the maxillary central incisors. After confirmation of pulp necrosis, the teeth were submitted to calcium hydroxide intracanal and, posteriorly, apicification with MTA and obturation with gutta-percha. Results: After 20-month follow-up, suppression of the pain symptomatology, absence of periodontal impairment and reduction of the periapical lesion were observed. At 60 months, periodontal health maintenance and complete healing of the periapical lesion were confirmed. Conclusion: Association of intracanal calcium hydroxide with MTA in apicification procedure is a viable alternative to the endodontic treatment of non-vital teeth with incomplete rizogenesis (AU).

Polymicrobial Leakage and Retention of MTA and Portland Cement in a Model of Apexification

Abstract Objective: To evaluate the sealing capacity and retention of apical barriers made with mineral trioxide aggregate (MTA) and Portland cement (PC). Material and Methods: Fifty-six bovine incisors were sectioned 8 mm above and 12 mm below the cement-enamel junction. The root canal was enlarged with a diamond drill to create a standard 2.5 mm diameter opening. Apical sheets of 5 mm thickness were placed using white MTA-Angelus or white PC. Fifteen samples of each material were exposed to human saliva in a dual chamber apparatus and casting was evaluated at 30 days. Samples without apical barriers and fully sealed samples were used as positive and negative controls (n = 3), respectively. Data were analyzed by Fisher's exact test (p<0.05) after 3 periods: 1 to 10 days (P1); days 11 to 20 (P2); and days 21 to 30 (P3). Then, three 1 mm thick sections were obtained at the apical level of other root samples of each material (n = 10) and the push-out test was performed Results: The leakage rates in P1, P2 and P3 were 60%, 73.3% and 100% for the MTA; and 73.3%, 86.7% and 100% for CP, with no significant difference between materials, regardless of the period analyzed. There were no significant differences between the bond strengths for both cements (p>0.05) Conclusion: Mineral trioxide aggregate and Portland cement apical barriers presented similar sealing ability and bond strength values.

Drying protocol influence on the bond strength and apical sealing of three different endodontic sealers

Abstract The aim of this study was to evaluate the influence of drying protocols (DP) on the apical sealing (AS) and on the bond strength (BS) of teeth filled with different sealers. The root canals of one hundred and fifty-six roots of maxillary canines were prepared with Reciproc rotary files (R50). The teeth were randomly divided into four groups (n = 39), according to the DP: GI-paper points; GII-70% isopropyl alcohol + aspiration with NaviTip points; GIII-95% ethanol + paper points; GIV-EndoVac + paper points. Each group was divided into subgroups, according to the sealer used: AH Plus, Sealapex and MTA Fillapex, using a single-cone technique. Evaluation of AS and BS was performed with fluid filtration (FF) and push-out (PO) methods, respectively. The PO test consisted of sectioning the roots, and subjecting a single slice from each third to testing and analysis for failure type. The data was submitted to two-way and three-way variance analysis (ANOVA) and Tukey (α = 5%). The AS showed no drying protocol influence. The FF results revealed a statistically significant difference between MTA and Sealapex (p < 0.05) sealers. The BS test values showed that there was no statistical significant difference among the canal thirds (p > 0.05), but that there was such a difference among the sealers (p < 0.05), among the protocols (p < 0.05), and in the interaction between sealers and protocols (p < 0.05). AH Plus revealed the highest BS values among the sealers; the highest BS results for the sealers occurred with the specimens used with isopropyl alcohol, compared with ethanol and EndoVac.

Root filling bond strength using reciprocating file-matched single-cones with different sealers

Abstract The aim of the present study was to evaluate the bond strength (BS) of root canal fillings to root dentin using the reciprocating file-matched single-cone or lateral compaction techniques with resin-based and calcium-silicate-based sealers. Maxillary canine roots were prepared and filled using one of the following approaches: Reciproc R40 file and R40 single cone, WaveOne Large file and Large single cone, or ProTaper up to F4 file with lateral compaction. The root filling was performed using AH Plus, Epiphany SE or MTA Fillapex (n = 10). Three 1-mm-thick slices were obtained from each third of each root. Two slices were subjected to a push-out test, and the other slices were prepared for scanning electron microscopy (SEM) to examine the dentin-sealer interface. Data (in MPa) from the push-out tests were analyzed using a two-way ANOVA and Tukey's test (p < 0.05). Failure modes (adhesive, cohesive or mixed) were evaluated at ×25 magnification. The single-cone techniques resulted in lower BS values than the lateral compaction technique. For lateral compaction, AH Plus and Epiphany SE showed the highest and lowest BS values, respectively. Slight differences were observed between sealers when the single-cone techniques were used. A tendency to reduce the BS toward the apical third was observed. Adhesive failures were predominant for all experimental conditions. A closer adaption of the filling material on the root dentin was observed for the AH Plus and lateral compaction techniques. The Reciproc and WaveOne techniques were associated with lower BS values than the lateral compaction technique. However, the effect of the root canal filling technique appears to be sealer-dependent.

Does MTA affect fiber post retention in repaired cervical root canal perforations?

Abstract This study evaluated the effect of mineral trioxide aggregate (MTA) on the retention of fiber posts in repaired root canal perforations. Ten-millimeter post spaces were prepared in 60 endodontically treated bovine incisors. Root perforations were created in half of the root canals in the cervical area prior to being filled with white MTA-Angelus. Fiber posts were luted into the root canals with two self-adhesive (RelyX Unicem or Set) or self-etching (Panavia F) resin cements. The posts were submitted to a pull-out test, and the data were submitted to two-way ANOVA and Tukey's post hoc tests (α = 0.05). The fiber posts exhibited reduced retention in MTA-repaired root canal perforations, regardless of the type of resin cement that was used (p < 0.001). Self-adhesive resin cements provided higher bond strength values than Panavia F, while no difference was observed between RelyX Unicem and Set (p > 0.05). The presence of MTA in repaired root perforations negatively affected post retention. In addition, self-adhesive cements seemed to be the best option to lute fiber posts within a root canal in these cases.

Alternative Techniques to Remove Fractured Instrument Fragments from the Apical Third of Root Canals: Report of Two Cases

This paper describes two cases of instrument fragment removal from the apical thirds of root canals using a customized extractor and a modified needle technique, respectively. In case 1, a customized extractor was manufactured to remove a bur fragment located in the apical root canal of a maxillary central incisor. The use of this extractor enabled successful and conservative removal of the instrument fragment. In case 2, a modified injection needle was used as a trepan to gain access around an instrument fragment located in the curved apical portion of the mesiobuccal canal of a mandibular molar. A segment of steel wire was inserted into the needle lumen to engage the metallic fragment, enabling its removal with counter-clockwise rotation and a simultaneous pull-out motion. Alternative and creative methods are useful for the management of intracanal metallic fragments during root canal treatment.

Este relato descreve dois casos de remoção de fragmentos de instrumentos de terços apicais de canais radiculares utilizando um extrator personalizado e técnica da agulha modificada, respectivamente. No Caso 1, um extrator foi fabricado para remover fragmento de broca localizado no terço apical do canal radicular de um incisivo central superior. O uso deste extrator permitiu a remoção bem sucedida e conservadora do fragmento de instrumento. No Caso 2, uma agulha para anestesia modificada foi utilizada como um trépano para ganhar acesso ao redor de um fragmento de instrumento localizado na porção apical curva do canal mésio-vestibular de um molar inferior. Um segmento de fio de aço foi inserido no lúmen da agulha para envolver o fragmento metálico, permitindo sua remoção com rotação no sentido anti-horário e simultâneo movimento de retração. Métodos alternativos e criativos são úteis para a remoção intracanal de fragmentos metálicos durante o tratamento endodôntico.

Obturation Over an S1 ProTaper Instrument Fragment in a Mandibular Molar with Three Years of Follow-up

This case report describes root canal filling performed over a large S1 ProTaper file fragment in a second mandibular molar with irreversible pulpitis. An S1 ProTaper file was fractured during the instrumentation of the mesiobuccal canal. Approximately 10 mm of file fragment remained in the apical and middle thirds of the canal. The obturation was performed over this fragment using thermomechanically compacted gutta-percha and sealer. Radiographic findings and the absence of clinical signs and symptoms at 3-year follow up indicated successful treatment. Cone-beam computed tomography images revealed absence of periapical lesion and details of intracanal file fragment related to root fillings and apex morphology. In this case, the presence of a large intracanal fractured instrument did not have a negative impact on the endodontic prognosis during the follow up evaluation period.

Este relato de caso descreve a obturação do canal radicular realizada sobre um grande fragmento da lima ProTaper S1 em um segundo molar inferior com pulpite irreversível. Uma lima ProTaper S1 fraturou durante a instrumentação do canal mésio-vestibular. Aproximadamente 10 mm de remanescente do fragmento da lima permaneceu nos terços apical e médio do canal. A obturação foi realizada sobre este fragmento usando guta-percha compactada termomecanicamente e cimento endodôntico. Achados radiográficos e ausência de sinais e sintomas clínicos após 3 anos de acompanhamento indicaram o sucesso do tratamento. Imagens de tomografia computadorizada de feixes cônicos revelaram a ausência de lesão periapical e detalhes do fragmento da lima intracanal relacionados à obturação do canal radicular e à morfologia do ápice. Neste caso, a presença de grande instrumento fraturado intracanal não teve impacto negativo no prognóstico endodôntico durante o período de acompanhamento.

Apical transportation associated with ProTaper Universal F1, F2 and F3 instruments in curved canals prepared by undergraduate students

Objective: This study evaluated apical transportation associated with ProTaper® Universal Fl, F2 and F3 rotary files in curved canais prepared by undergraduate students. Material and Methods: Twenty mesial roots of mandibular molars with curvatures ranging between 25° and 35° were selected. Mesiobuccal canals were instrumented by twenty students with the ProTaper® system (Dentsply-Maillefer, Ballaigues, Switzerland) according to the manufacturer's instructions. Pre-fiaring was performed with Sl and SX files. A #15 K-file was inserted into the root canal up to the working length (WL), and an initial digital radiograph was taken in a buccolingual direction (baseline). Afterwards, the S1, S2, F1, F2, and F3 files were employed up to the WL. Other radiographies were taken in the same orientation of the baseline after the use of the Fl, F2, and F3 files, with each file inserted into the root canal. The radiographic images were overlapped, and the Image J software was used to measure the distance between the rotary files' ends and the #15 K-file's end, characterizing the apical transportation. Data were analyzed by Repeated Measure ANOVA and by the SNK post hoc test (P<0.05). Results: It was verified that file size affected apical transportation significantly (P<0.001). The F3 file showed higher apical transportation than Fl and F2, while between these last files there was no difference. Conclusion: The undergraduate students produced lower apical transportation in curved canals when they did not use the F3 rotary file. .

Midbuccal Canals of Maxillary Molars Evaluated by Cone-Beam Computed Tomography: Endodontic Management of Two Cases

Maxillary molars present variable root canal and root morphologies. This report describes the endodontic management of two cases of midbuccal canals found in maxillary molars. Midbuccal canals were present in a maxillary first molar with a single buccal root (Case 1), and in a maxillary second molar with three buccal roots (Case 2). An assessment of the internal configuration of these teeth was performed using cone-beam computed tomography (CBCT). Magnification with a dental operating microscope, surgical loupes, and the use of an endodontic explorer enabled the identification of the midbuccal canal orifices. The root canals in both cases were chemomechanically prepared and filled. Postobturation radiographic images revealed four (one midbuccal, two mesiobuccal and one palatal) and five (one midbuccal, two mesiobuccal, one distobuccal and one palatal) root canals, which were filled in Cases 1 and 2, respectively. Complex canal configurations of maxillary molars including the presence of midbuccal canals were presented. CBCT was a valuable tool in this diagnosis, as it provided a precise description of these unusual anatomical variations.

Molares superiores apresentam morfologias radiculares e canais radiculares variáveis. Este relato de caso descreve o manejo endodôntico de dois casos de canais mésio-centrais (MC) encontrados em molares superiores. Canais MC estavam presente em um primeiro molar superior com uma única raiz vestibular (Caso 1), e em um segundo molar com três raízes vestibulares (Caso 2). Uma avaliação da configuração interna destes dentes foi realizada usando tomografia computadorizada de feixe cônico (TCFC). Ampliação com microscópio operatório odontológico, lupas cirúrgicas e o uso de um explorador endodôntico possibilitaram a identificação dos orifícios dos canais MC. Os canais radiculares dos dois casos foram preparados e obturados. Imagens radiográficas pós-obturação revelaram quatro (um MC, dois mésio-vestibulares e um palatino) e cinco (um MC, dois mésio-vestibulares, um disto-palatino e um palatino) canais radiculares, que foram obturados nos Casos 1 e 2, respectivamente. Configurações complexas de canais em molares superiores, incluindo a presença de canais MC foram apresentadas. TCFC foi uma ferramenta útil no diagnóstico e propiciou uma descrição precisa destas variações anatômicas incomuns.

Biocompatibilidade e capacidade de selamento do agregado de trióxido mineral em perfurações radiculares / Biocompatibility and sealing ability of mineral trioxide aggregate in root perforations

As perfurações radiculares rompem a barreira biológica entre o endodonto e o espaço periodontal, podendo, em razão da sua extensão e localização, comprometerem, irreversivelmente, a longevidade do elemento dentário. Do ponto de vista terapêutico, o agregado de trióxido mineral é o material selador mais recomendado. O agregado de trióxido mineral é apresentado sob a forma de um pó branco ou cinza, contendo partículas hidrofílicas, cujos componentes principais são silicato tricálcico, aluminato tricálcico, óxido tricálcico, óxido silicato e o óxido de bismuto, responsável pela radiopacidade, além dos elementos cromo e chumbo. Quando incorporado à água destilada, resulta em um gel coloidal que é aplicado diretamente no sítio da perfuração. Seu tempo de presa final é de aproximadamente 3 horas. Esse agregado apresenta satisfatórias propriedades físicas e químicas, bem como compatibilidade com os tecidos perirradiculares, independentemente da sua cor. In vitro, o agregado de trióxido mineral apresenta capacidade de selamento superior a outros biomateriais. No entanto, a maioria das investigações clínicas envolve relatos isolados de casos, com poucas evidências longitudinais dos resultados alcançados.

The alterations provoked by pathologies or iatrogenesis favor the invasion of the periodontium, communicating pulp cavity with periradiculares tissues. Currently, for the treatments of those root perforations, the sealer material more suitable is the mineral trioxide aggregate, that was reported for the first time in 1993 and introduced commercially in 1998. Mineral trioxide aggregate is presented under the form of a powder white or gray that, once incorporate to the distilled water, has an easy manipulation resulting in a colloidal gel whose final time setting is about 3 hours. That aggregate reaches appropriate physical and chemical properties as well as biocompatibility with the periradiculares tissues. In the current review, the use of mineral trioxide aggregate was approached as sealer material of root perforations in both in vitro and in vivo studies. It was evidenced that mineral trioxide aggregate presents good sealing ability, superior the other materials of larger longevity in the dentistry. However, most of the clinical investigations involve isolated case reports, with few longitudinal evidences of the reached results.

Effect of pre-flaring and file size on the accuracy of two electronic apex locators

OBJECTIVE: This ex vivo study evaluated the effect of pre-flaring and file size on the accuracy of the Root ZX and Novapex electronic apex locators (EALs). MATERIAL AND METHODS: The actual working length (WL) was set 1 mm short of the apical foramen in the palatal root canals of 24 extracted maxillary molars. The teeth were embedded in an alginate mold, and two examiners performed the electronic measurements using #10, #15, and #20 K-files. The files were inserted into the root canals until the "0.0" or "APEX" signals were observed on the LED or display screens for the Novapex and Root ZX, respectively, retracting to the 1.0 mark. The measurements were repeated after the preflaring using the S1 and SX Pro-Taper instruments. Two measurements were performed for each condition and the means were used. Intra-class correlation coefficients (ICCs) were calculated to verify the intra- and inter-examiner agreement. The mean differences between the WL and electronic length values were analyzed by the three-way ANOVA test (p<0.05). RESULTS: ICCs were high (>0.8) and the results demonstrated a similar accuracy for both EALs (p>0.05). Statistically significant accurate measurements were verified in the pre-flared canals, except for the Novapex using a #20 K-file. CONCLUSIONS: The tested EALs showed acceptable accuracy, whereas the pre-flaring procedure revealed a more significant effect than the used file size.

Protocolos laboratoriais para remoção de retentores intrarradiculares metálicos usando ultrassom: uma revisão crítica / Laboratory protocols for removal of intraradicular metallic posts using ultrasound: a critical review

Objetivo: investigar na literatura especializada os protocolos laboratoriais para a remoção de retentores intrarradiculares metálicos usando ultrassom. Revisão de literatura: fontes de catalogação bibliográfica identificadas eletronicamente por Pubmed/Medline (www.pubmed.com.br) e Science direct (www.sciencedirect.com) foram utilizadas. Os termos ?intrarradicular?, ?post removal? e ?ultrasound? foram utilizados na busca, incluindo o período de fevereiro de 2004 até dezembro 2010. Os critérios de seleção dos artigos foram relacionados a: 1) vibração ultrassônica: uso ou não de refrigeração, tempo e modo de aplicação e número de aparelhos utilizados; 2) retentores: intervenção no diâmetro/comprimento do núcleo, agentes de cimentação e tipos de pinos. Foram encontrados 11 artigos que abordaram, pelo menos, uma das variáveis descritas. A partir de informações verificadas nesses estudos, constatou-se que o uso de refrigeração, maior tempo e aplicação intermitente do ultrassom, bem como a utilização de mais de um aparelho foram fatores favoráveis para a remoção dos retentores. Esse procedimento também foi otimizado pelos desgastes do diâmetro/comprimento dos núcleos dos retentores previamente à vibração ultrassônica, principalmente quando foram utilizados os cimentos fosfato de zinco e ionômero de vidro. Na maior parte dos estudos as variáveis foram estudadas isoladamente e não associadas. Conclusões: o uso de ultrassom é um método valioso para a remoção de retentores intrarradiculares. No entanto, novas investigações envolvendo a combinação dos diversos procedimentos da vibração ultrassônica são necessárias, visando aumentar a previsibilidade e a eficácia dessa técnica.

Comparison of different ultrasonic vibration modes for post removal

This in vitro study compared different ultrasonic vibration modes for intraradicular cast post removal. The crowns of 24 maxillary canines were removed, the roots were embedded in acrylic resin blocks, and the canals were treated endodontically. The post holes were prepared and root canal impressions were taken with self-cured resin acrylic. After casting, the posts were cemented with zinc phosphate cement. The samples were randomly distributed into 3 groups (n=8): G1: no ultrasonic vibration (control); G2: tip of the ultrasonic device positioned perpendicularly to core surface and close to the incisal edge; and G3: tip of the ultrasonic device positioned perpendicularly to core surface at cervical region, close to the line of cementation. An Enac OE-5 ultrasound unit with an ST-09 tip was used. All samples were submitted to the tensile test using an universal testing machine at a crosshead speed of 1 mm/min. Data were subjected to one-way ANOVA and Tukey's post-hoc tests (α=0.05). Mean values of the load to dislodge the posts (MPa) were: G1 = 4.6 (± 1.4) A; G2 = 2.8 (± 0.9) B, and G3= 0.9 (± 0.3) C. Therefore, the ultrasonic vibration applied with the tip of device close to the core's cervical area showed higher ability to reduce the retention of cast post to root canal.

Este estudo in vitro comparou diferentes modos de vibração ultra-sônica na remoção de pinos intra-radiculares fundidos. As coroas de 24 caninos superiores foram removidas, as raízes foram incluídas em blocos de resina acrílica e tratadas endodonticamente. Os espaços para os pinos intra-radiculares foram preparados e depois moldados com resina acrílica autopolimerizável. Após a fundição, os pinos intra-radiculares foram cimentados com cimento de fosfato de zinco. As amostras foram distribuídas aleatoriamente em três grupos (n=8): G1: sem vibração ultra-sônica (controle), G2: ponta do aparelho ultra-sônico posicionada perpendicularmente à superfície do núcleo e perto da borda incisal e G3: ponta do aparelho ultra-sônico posicionada perpendicularmente à superfície do núcleo na região cervical, perto da linha de cimentação. Uma unidade de ultra-som Enac OE-5 com uma ponta ST-09 foi usada. Todas as amostras foram submetidas ao teste de tração utilizando máquina universal de ensaios a uma velocidade de 1 mm/min. Os dados foram submetidos aos testes ANOVA e Tukey post-hoc (α = 0,05). Os valores médios de carga para deslocar os pinos (MPa) foram: G1 = 4,6 (± 1,4) A; G2 = 2,8 (± 0,9), B e G3 = 0,9 (± 0,3) C. Portanto, a vibração ultra-sônica aplicada com a ponta do dispositivo perto da zona cervical do núcleo apresentou maior capacidade de reduzir a retenção de pinos metálicos fundidos no canal radicular.

Lesões periapicais crônicas: revisão dos aspectos microbiológicos por diferentes métodos de investigação / Chronic periapical lesions: a review of microbiologic aspects by different investigations methods

A necrose pulpar representa a cessação dos processos metabólicos do tecido pulpar, desestruturação e concomitante perda de suas defesas naturais. A partir da necrose pulpar, a cavidade pulpar torna-se progressivamente colonizada por vários micro-organismos habitantes da cavidade bucal e sistemas interligados. Assim, os dentes com necrose pulpar e áreas radiolúcidas periapicais apresentam inúmeros morfotipos microbiológicos no sistema de canais radiculares. Não obstante, de longa data, tem sido questionada a sobrevivência de micro-organismos nos granulomas periapicais. Nesta revisão, verificou-se que na atualidade, pela técnica da cultura microbiológica ou por métodos moleculares, cocos, bacilos e filamentosos, gram-negativos e positivos, predominantemente anaeróbios estritos, identificados no sistema de canais radiculares, também são recuperados na região periapical. Esses micro-organismos também são identificados pela coloração de Brown e Brenn ou pela microscopia eletrônica de varredura no ápice radicular e na estrutura da lesão, numa frequência que oscila de 4% a 100%. Estruturalmente, organizam-se num material amorfo, iodoso, de composição polissacarídica - os biofilmes periapicais.

Starting from the pulp necrosis the pulp cavity becomes progressively colonized by several microorganisms' inhabitants of the oral cavity and interconectives systems. Thus, the teeth with pulp necrosis and radiolucencies periapical areas present countless microbiological morfotypes in the root canal system. Nevertheless, of long date, the survival of the microorganisms in the periapical granuloms has been questioned. In this review it was verified that currently, by culture or molecular methods that the coccus, bacilli and filamentous, gram-negative and positive, predominantly strict anaerobes, identified in the root canal system also are recovered in the periapical lesions. Such microorganisms are also identified for the coloration of Brown and Brenn or for the scanning electronic microscopy in the root apex and in the structure of the lesion, in a frequency that oscillates from 4% to 100%. Structurally, they are organized in an amorphous material, muddy, of polysaccharide composition- the periapical biofilms.

Evidências clínicas da técnica de apicificação utilizando barreira apical com agregado trióxido mineral - uma revisão crítica / Clinical evidence of the apexification technique using apical barrier with mineral trioxide aggregate - a critical review

Objetivo: Avaliar a técnica da apicificação utilizando barreira apical com agregado trióxido mineral (MTA) por meio de estudos clínicos retrospectivos e prospectivos publicados na literatura especializada. Revisão de literatura: Fontes de catalogação bibliográfica identificadas eletronicamente por PUBMED/MEDLINE (http://www.pubmed.gov) foram utilizadas. Os termos apexification MTA, apexification mineral trioxide agreggate, apical closure MTA, apexification immature teeth MTA foram utilizados na busca. Os artigos foram selecionados no período de fevereiro de 2005 até abril de 2010, nos seguintes periódicos: Dental Traumatology, International Endodontic Journal, Journal of Endodontics e Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics. A busca resultou em 28 artigos, reduzidos a cinco após aplicação dos critérios de exclusão: estudos em animais e laboratoriais, relatos de caso, estudo série de casos, estudo epidemiológico descritivo, além de revisão de literatura narrativa. Considerações finais: Os estudos clínicos analisados indicaram que o MTA é apropriado para o manejo clínico endodôntico no processo de apicificação ou quando há reabsorção apical ou amplificação mecânica excessiva da região apical dentária. Esse material promove o reparo biológico e a regeneração do ligamento periodontal e tem boa capacidade de selamento. Porém, estudos clínicos mais conclusivos sobre o uso do MTA como barreira apical nos procedimentos de apicificação são necessários.

Estudo bibliométrico de artigos brasileiros publicados em periódicos internacionais de Endodontia: período 2008-2010 / Bibliometric study of Brazilian manuscripts published in international journals of endodontics: 2008-2010

Objetivo: Investigou-se a representação brasileira nas publicações dos periódicos Journal of Endodontics (J Endod) e International Endodontic Journal (Int Endod J), bem como o perfil dos estudos brasileiros publicados nos dois periódicos. Materiais e Métodos: Todos os artigos publicados entre janeirode 2008 a dezembro de 2010 nos periódicos J Endod e Int Endod J foram acessados por meio do portal deperiódicos da CAPES. Dois pesquisadores avaliaram os artigos quanto ao delineamento, ao tema abordado e ao país de origem. Os estudos brasileiros foram ainda caracterizados quanto ao Estado e instituição de origem dos autores. Foi realizada uma análise descritiva dos dados empregando-se o programa SPSS 17.0. Resultados: Foram publicados, neste período, 1381 artigos (988 no J Endod; 393 no Int Endod J). O Brasilocupou o 2º lugar na produção de artigos científicos, apresentando 232 publicações (16,7%). A maioria dosestudos que geraram essas publicações foram desenvolvidos a partir de experimentos laboratoriais (82,7%)que abordaram principalmente os temas relacionados aos materiais e instrumentos utilizados na práticaendodôntica (55,9%) e à microbiologia endodôntica (23,8%). A maior parte deles eram provenientes de universidades públicas do Estado de São Paulo. Conclusão: O número de artigos brasileiros publicados nos últimos três anos nos periódicos J Endod e Int Endod J foi expressivo, alcançando o segundo lugar mundial.

Atendimento odontológico a adolescentes infratores: abordagem qualitativa em clínica de graduação / Dental care for delinquent adolescents: qualitative approach in an undergraduate dental clinic

Esse estudo avaliou a percepção de adolescentes infratores sobre a convivência familiar e dentro da instituição, sobre a saúde geral e bucal. Foi adotada abordagem qualitativa, com a participação de adolescentes infratores (13 a 17 anos) em processo de ressocialização. Esses adolescentes estavam sendo atendidos em clínica odontológica por alunos de graduação, sob supervisão docente. Após assinatura do termo de consentimento, os adolescentes foram entrevistados, sendo suas falas gravadas, transcritas e submetidas à análise de conteúdo. Para a maioria dos adolescentes, a família foi definida como um espaço de conflitos e distante das suas vidas diárias. Na instituição, eles relataram múltiplas e variadas atividades, esportivas, de arte e educação, que devem ser cumpridas em horários rígidos. Todos falaram, em algum momento da entrevista, sobre a recompensa com diferentes "benefícios", pelo bom comportamento dentro da instituição, sendo a liberdade o mais desejado por todos. A saúde foi definida como: emprego, acesso a programas educativos, acesso a cuidados médicos e de enfermagem e participação nos cursos oferecidos na instituição. Aspectos pessoais de autocuidado, como uma boa alimentação, a prática de esportes e a higiene do corpo foram também citados como determinantes da saúde. Para alguns deles, saúde é liberdade, abandono das drogas e do crime. A saúde bucal foi definida como higiene bucal por todos os adolescentes (AU).

This study evaluated the perception of delinquent adolescents toward family, the correctional institution they attended, and oral and general health. We adopted a qualitative approach with the participation of adolescents (age 13­17) in the process of re-socialization. The adolescents were being treated in a dental clinic by undergraduate students under supervision. After signing a consent form, the adolescents were interviewed and their statements were recorded, transcribed and submitted to content analysis. For most adolescents, family was defined as an area of conflict and remote from their daily lives. As for their correctional institution, they reported that it offered several different activities, sports, art and education, all of which had to be completed according to a rigorous schedule. At some point in the interview, all mentioned the reward gained from different "benefits" for good behavior within the institution, and the greater freedom desired by all. Health was defined as employment, access to educational programs, access to medical care and nursing, and participation in courses offered at the institution. Personal aspects of self-care, such as a good food, sports practice and body hygiene, were also mentioned as determinants of health. To some, health meant freedom, abandonment of drugs and of crime. Oral health was defined by all adolescents as oral hygiene (AU).

Sealing ability of MTA-Angelus with propyleneglycol in furcal perforations

This study evaluated the sealing ability of gray MTA-Angelus mixed with propyleneglycol in furcal perforations using a bacterial leakage test. Furcal perforations were created in 30 human mandibular molars using a size 3 round bur. The samples were divided randomly into 2 experimental groups (n=10) according to the mixing agent. In G1, the MTA powder was mixed with propyleneglycol, while distilled water was used in G2. A 3:1 powder-liquid ratio was used for both groups. The MTA was placed in the perforation with an MTA carrier and condensed with hand pluggers. Nonrepaired (n=5) and totally sealed (n=5) perforations served as positive and negative controls, respectively. Bacterial leakage was assessed daily for 30 days in a double-chamber apparatus with Enterococcus faecalis. Data were analyzed using Fisher exact test (p<0.05) for three leakage periods: 1st to 10th day (P1); 11th to 20th day (P2); and 21st to 30th day (P3). The positive control presented leakage in all specimens within the first 24 hours, while no leakage was observed in the negative control during the experimental period. Leakage was observed in five (50%) of the 10 samples of the propyleneglycol group (G1) and seven (70%) of the distilled water group (G2) by the 20th day, without significant difference between the groups in periods P1 and P2 (p=0.137). The leakage was significantly lower for G1 than G2 in period P3 (50% versus 100%, respectively, p=0.016). In this single aerobic bacterial leakage method, the use of propyleneglycol as a vehicle for gray MTAAngelus increased its sealing ability in furcal perforations at the end of the 30-day experimental period.

Este estudo avaliou a capacidade de selamento do MTA-Angelus cinza manipulado com propilenoglicol em perfuracoes de furca usando um teste de infiltracao bacteriana. Perfuracoes de furca foram criadas em 30 molares inferiores usando uma broca esferica numero 3. As amostras foram divididas aleatoriamente em dois grupos experimentais (n=10) de acordo com o agente de manipulacao. Em G1, o po do MTA foi manipulado com propilenoglicol enquanto que a agua destilado foi utilizada no G2. A proporcao po-liquido de 3:1 foi usada para ambos os grupos. O MTA foi colocado na perfuracao com uma porta- MTA e condensado com condensadores manuais. Perfuracoes nao-reparadas (n=5) e totalmente impermeabilizadas (n=5) serviram como controle positivo e negativo, respectivamente. A infiltracao bacteriana foi verificada diariamente durante 30 dias em um aparato de dupla camara com Enterococcus faecalis. Os dados foram analisados pelo teste exato de Fisher (p<0,05) para tres periodos: 1o ao 10o dia (P1), 11o ao 20o dia (P2) e do 21o ao 30o dia (P3). O controle positivo apresentou infiltracao em todas as amostras nas primeiras 24 horas, enquanto nenhuma infiltracao foi observada no controle positivo durante o periodo experimental. Infiltracao foi observada em 5 (50%) das 10 amostras do grupo do propilenoglicol (G1) e 7 (70%) do grupo da agua destilada no 20o dia, sem diferenca significativa entre o grupos nos periodos P1 e P2 (p=0,0137). A infiltracao foi significantemente menor para G1 que para G2 no periodo P3 (50% versus 100%, respectivamente, p=0,016). Neste metodo de infiltracao de apenas uma bacteria aerobica, o uso do propilenoglicol como veiculo para o MTA-Angelus cinza aumentou sua capacidade de selamento em perfuracoes de furca no final do periodo experimental de 30 dias.