Therapeutic Approach in Large Periapical Cyst: Clinical Case Report / Abordagem Terapêutica em Cisto Periapical de Grande Proporção: Relato de Caso Clínico

Periapical cysts of endodontic origin originate from an infection that affects the apical region, causing pulpal necrosis that stimulates an inflammatory response. Among many pathologies found on radiographs, one of them is the root cyst, considered to be a lesion frequently found in the maxilla and mandible, associated with the apex of a tooth with pulp necrosis. They present slow growth and are discovered in routine examinations because they are asymptomatic. Due to the chronic aggression, the lesion does not present painful symptoms in most cases, and grows slowly, thus being able to reach large extensions, with the presence of swelling and sensitivity, as well as slight mobility in the affected tooth and adjacent ones. The objective of this study was to report a clinical case of swelling in the anterior region of the mandible, which was diagnosed as a periapical cyst, in this way the treatments performed and the final result after 18 months of follow-up will be reported. However, to achieve good results during periapical cyst treatment, it is necessary to make a correct diagnosis, followed by adequate planning, always performing clinical and radiographic follow-up, in addition to the patient's cooperation, so that good results can be achieved during the treatment. It can be observed that a well-performed endodontic treatment, associated with a elaborated surgical technique, in addition to anatomopathological evidence and radiographic follow-up, make the therapeutic success to be obtained in cases of large periapical cysts.(AU)

Os cistos periapicais de origem endodôntica, originam-se a partir de uma infecção que acomete em região apical, ocasionando uma necrose pulpar que estimula uma resposta inflamatória. Das várias patologias encontradas radiograficamente, o cisto radicular tem sido o mais frequente encontrado, tanto em maxila, quanto em mandíbula, associado ao ápice de um dente com necrose pulpar. Apresentam crescimento lento e são descobertos nos exames de rotina, por serem assintomáticos. Devido a agressão crônica, a lesão não apresenta sintomatologia dolorosa, na maioria dos casos, tendo seu crescimento lento, desta maneira podendo atingir grandes extenções, com presença de tumefação e sensibilidade, além de leve mobilidade no dente acometido e nos adjacentes. O objetivo deste estudo foi relatar um caso clínico de tumefação na região anterior de mandíbula, o qual foi diagnosticado como cisto periapical, desta forma serão relatados os tratamentos realizados e o resultado final após 18 meses de acompanhamento. Contudo, para que sejam alcançados bons resultados durante o tratamento do cisto periapical é necessário realizar um correto diagnóstico, seguido por um planejamento adequado, realizando sempre o acompanhamento clínico e radiográfico, além da colaboração do paciente, para que possam ser atingidos bons resultados durante o tratamento. Pode-se observar que um tratamento endodôntico bem realizado, associado à uma técnica cirúrgica bem elaborada, além de comprovação anatomo-patológica e acompanhamento radiográfico, fazem com que o sucesso terapêutico seja obtido para os casos de cistos periapicais de grande proporção.(AU)

Final irrigation protocols can be used to promote stable long-term bond strength of AH Plus to dentin

Abstract Irrigation solutions might affect dentin surface characteristics and, consequently, endodontic sealers adhesion. Objective This study analyzed the effect of different final irrigation protocols on push-out bond strength (BS) of AH Plus to dentin seven days and 20 months after obturation. Scanning electron micrographs were obtained from the dentin surface of one sample/group after final irrigation. Methodology Canals of bovine incisors were instrumented and received final irrigation with (n=21): G1 - 2.5% sodium hypochlorite (NaOCl) + distilled water; G2 - 2.5% NaOCl + 17% EDTA; G3 - 2.5% NaOCl + 17% EDTA + 2.5% NaOCl; G4 - 2.5% NaOCl + 17% EDTA + 2% chlorhexidine (CHX); G5 - mixture 5% NaOCl + 18% etidronate (HEDP); and G6 - mixture 5% NaOCl + 10% tetrasodium EDTA (Na4EDTA). After irrigation, one root/group was split and images were obtained by scanning electron microscopy (SEM). The other 20 roots/group were filled with only AH Plus sealer. Three slices/root were used for push-out assessment seven days and 20 months after obturation. One-way analysis of variance and Tukey (α<0.05) were used to compare the results among experimental groups, and unpaired t-test (α<0.05) was used to compare the results of the same group over time. Results The photomicrographs showed that, excepting G1, all groups completely removed the smear layer from the samples. In G2 and G4, the opening of the dentin tubules enlarged. In G3, erosion was observed in the peritubular and intertubular dentin. Values of the BS in the seven days were G2=G3=G4=G5>G6=G1 and in the 20 months were G3=G5>G6=G4>G1=G2. G3, G5, and G6 presented values of BS in 20 months similar to the values of seven days (P>0.05). Conclusions The final irrigation protocols tested produced dentin surfaces with different characteristics. Only G3 and G5 presented high BS values that were stable over time.

Comparative analysis between dactyloscopy and rugoscopy

Records form the evolutional history show primitive attempts of human individualization by hand printingon cave walls. Later, still under the need of differentiating among other animals, the ancestral used developedprocesses for personal identification. Nowadays, the human individualization continues based on unique morphological characteristics. This study aims to analyze the correlation between the fingerprints and the palatal rugae. A sample of 93 patients, out of 100, aged between 18 and 35 years, was selected. Fingerprintswere collected by impression on paper, and palatal rugae were registered through intra-oral photography.The Vucetich’s method was applied for the fingerprints analysis and the Carrea’s method was utilized for theanalysis on palatal rugae. Frequency of distribution was applied to describe the incidence of fingerprints andpalatal rugae patterns. The Chi-square test was used for correlation analysis between the two variables. Theexternal clip was the most common pattern among fingerprints on the right hand (48,39%), on the oppositeside the internal clip had major incidence (50,54%). The pattern type IV was observed as the most commonamong the palatal rugae (42,55%). The Chi-square test demonstrated significant result only when correlatedright and left hands. No statistical correlation was found involving palatal rugae. It is possible to concludethat genetic intervention is the main factor to explain relevant results on correlations between opposite hands.Considering the absence of previous studies in the literature, this research aims to provide initial support forfurther investigations.