Cone-beam computed tomographic evaluation of the root canal anatomy of the lower premolars and molars in a Brazilian sub-population

Purpose@#This study evaluated anatomical variations in the root canals of the lower premolars and molars in a Brazilian sub-population using cone-beam computed tomography (CBCT). @*Materials and Methods@#In total, 121 CBCT images of patients were selected from a database. All images contained lower first and second premolars and molars on both sides of the arch, fully developed roots, and no treatment, resorption, or calcifications. In each image, the root canals of the lower premolars and molars were evaluated according to the Vertucci classification in On-Demand 3D software in the multiplanar reconstruction with dynamic navigation. Twenty-five percent of the images were re-assessed to analyze intraobserver confidence with the kappa test. Data were statistically evaluated with linear regression to evaluate the correlations of anatomic variations with age and sex, and the Wilcoxon test to analyze the laterality of variations, with a significance level of 5%. @*Results@#The intraobserver agreement (0.94) was excellent. In general, the root canals of lower premolars and molars showed a higher prevalence of type I than other Vertucci classification types, followed by type V in premolars and type II in molars. When the molar roots were evaluated separately, type II was more frequent in mesial roots and type I in distal roots. Although age showed no correlations with the results, sex and laterality showed correlations with tooth 45 and the lower second premolars, respectively. @*Conclusion@#The lower premolars and molars of a Brazilian sub-population showed a wide range of root canal anatomic variations.

Analgesic-like activity of perillyl acetate: In vivo and in silico studies

Objective: To evaluate the antinociceptive activity of perillyl acetate in mice and in silico simulations. Methods: The vehicle, perillyl acetate (100, 150 and/or 200 mg/kg, i.p.), diazepam (2 mg/kg, i.p.) or morphine (6 mg/kg, i.p.) was administered to mice, respectively. Rotarod test, acetic acid-induced abdominal writhing, formalin-induced nociception, hot plate test, and tail-flick test were performed. Opioid receptors-involvement in perillyl acetate antinociceptive effect was also investigated. Results: Perillyl acetate did not affect the motor coordination of mice. However, it reduced the number of acetic acid-induced abdominal twitches and licking times in the formalin test. There was an increase of latency time in the tail-flick test of 30 and 60 minutes. Pretreatment with naloxone reversed the antinociceptive effect of perillyl acetate (200 mg/kg). In silico analysis demonstrated that perillyl acetate could bind to μ-opioid receptors. Conclusions: Perillyl acetate has antinociceptive effect at the spinal level in animal nociception models, without affecting the locomotor integrity and possibly through μ-opioid receptors. In silico studies have suggested that perillyl acetate can act as a μ-opioid receptor agonist.

Analgesic-like activity of perillyl acetate: In vivo and in silico studies

Objective: To evaluate the antinociceptive activity of perillyl acetate in mice and in silico simulations. Methods: The vehicle, perillyl acetate (100, 150 and/or 200 mg/kg, i.p.), diazepam (2 mg/kg, i.p.) or morphine (6 mg/kg, i.p.) was administered to mice, respectively. Rotarod test, acetic acid-induced abdominal writhing, formalin-induced nociception, hot plate test, and tail-flick test were performed. Opioid receptors-involvement in perillyl acetate antinociceptive effect was also investigated. Results: Perillyl acetate did not affect the motor coordination of mice. However, it reduced the number of acetic acid-induced abdominal twitches and licking times in the formalin test. There was an increase of latency time in the tail-flick test of 30 and 60 minutes. Pretreatment with naloxone reversed the antinociceptive effect of perillyl acetate (200 mg/kg). In silico analysis demonstrated that perillyl acetate could bind to μ-opioid receptors. Conclusions: Perillyl acetate has antinociceptive effect at the spinal level in animal nociception models, without affecting the locomotor integrity and possibly through μ-opioid receptors. In silico studies have suggested that perillyl acetate can act as a μ-opioid receptor agonist.

Digital Planning on Guided Endodontics Technology

Abstract The aim of this review is to discuss the digital planning and the use of guided technology in Endodontics. The complexity of the root canals anatomy and the challenges in the microorganism's control represent risk factors for failure after the infected root canal's treatment. Scientific improvements associated with technological advances have enabled better predictability of therapeutic procedures results. The development of efficient and modern devices provided safer root canal treatments, with shorter clinical visits and greater patient comfort. Digital endodontics incorporated different tools and developed its own, advancing even further in resolving complex cases. The faithful copy of the internal anatomy provided by the advancement of CBCT devices and software's, associated with the digital resources of 3D planning and printing, enabled the advent of guided endodontics. This technique is used at different stages of endodontic treatment, with specific indications and greater result predictability. Therefore, this study critically reviewed the potential clinical application of this guided access technique, and the operative steps for its safe performance in managing complex endodontic cases. The main indications are accessing calcified root canals, performing endodontic surgeries in difficult access areas, removing fiberglass posts, and accessing teeth with developmental anomalies. In summary, guided endodontics has been a precise strategy, effective, safe, and clinically applicable. This procedure represents incorporating technological resources and digital planning in the Endodontist clinical practice, increasing predictability to complex cases.

Resumo O objetivo desta revisão é discutir o planejamento digital e o uso da tecnologia guiada em Endodontia. A complexidade e variabilidade da anatomia dos canais radiculares, em conjunto com o desafio no processo de sanificação e controle de micro-organismos representam fatores de risco ao fracasso após o tratamento dos canais radiculares infectados. O aprimoramento técnico-científico e os avanços tecnológicos tem possibilitado uma melhor previsibilidade de resultados nos procedimentos terapêuticos. O desenvolvimento de ferramentas de trabalho eficientes e modernas proporcionou tratamentos endodônticos seguros, com menor tempo clínico operacional e maior conforto ao paciente. A endodontia digital incorporou diferentes ferramentas e desenvolveu suas próprias, avançando ainda mais na resolução de casos complexos. A cópia fiel da anatomia interna proporcionada pelo avanço dos aparelhos e softwares de TCFC, associada aos recursos digitais de planejamento e impressão 3D possibilitaram o surgimento da endodontia guiada. Esta técnica é utilizada em diferentes etapas do tratamento endodôntico, com indicações específicas e maior previsibilidade de resultados. Este estudo revisou criticamente o potencial de aplicação clínica da técnica de acesso guiado, e os passos operatórios para sua realização de forma segura no manejo de casos endodônticos complexos. As principais indicações da Endodontia Guiada incluem o acesso a canais radiculares calcificados; as cirurgias parendodônticas em áreas de difícil acesso; a remoção de pinos de fibra de vidro; e o acesso a dentes com anomalias de desenvolvimento. Em síntese, a endodontia guiada é uma técnica precisa, eficaz e de fácil aplicação clínica. Esta técnica representa a incorporação dos recursos tecnológicos e planejamentos digitais do Endodontista, dando maior previsibilidade aos casos em que é aplicada na prática clínica.

A CAD/CAM-based strategy for concurrent endodontic and restorative treatment

This case report describes a technique in which endodontic treatment and permanent indirect restoration were completed in the same clinical appointment with the aid of a computer-aided design/computer-aided manufacturing (CAD/CAM) system. Two patients were diagnosed with irreversible pulpitis of the mandibular first molar. After access preparation, root canals were located, irrigation was performed until bleeding ceased, and the coronal tooth structure was prepared for indirect restoration. Then, utilizing an interim 3-mm build-up of the endodontic access cavity, a hemi-arch digital scan was performed with an intraoral scanner. Subsequent to digital scanning, restoration design was performed simultaneously with the endodontic procedure. The root canals were shaped using the Race system under irrigation with 2.5% sodium hypochlorite followed by root canal filling. The pulp chamber was subsequently filled with a 3-mm-thick composite resin restoration mimicking the interim build-up previously utilized to facilitate block milling in the CAD/CAM system. Clinical try-in of the permanent onlay restoration was followed by acid etching, application of a 5th generation adhesive, and cementation of the indirect restoration. Once the restoration was cemented, rubber dam isolation was removed, followed by occlusal adjustment and polishing. After 2 years of follow-up, the restorations were esthetically and functionally satisfactory, without complications.