Capacidad de Penetración y Difusión de la Medicación, Intraconducto en Túbulos Dentinales, Conductos Laterales e Istmos. Una Revisión Sistemática

RESUMEN: El objetivo de la terapia endodóntica consiste en tratar o prevenir la periodontitis apical. La efectiva eliminación o disminución de microbiota es esencial para la reparación periapical. Debido a esto, se utiliza el empleo de medicamentos intraconductos para tratar químicamente el sistema de conductos radiculares, y cobra relevancia la capacidad de penetración y difusión de dicho medicamento para entrar en contacto directo con los microorganismos que penetren dentro de los túbulos dentinales, conductos laterales e itsmos. Se realizó una revisión de la literatura en bases de datos electrónicas con los buscadores "Pubmed, Scielo y Google Académico", utilizando palabras clave para identificar la literatura publicada relevante en inglés. El análisis y los criterios de elegibilidad se documentaron de acuerdo con los elementos de informe para revisiones sistemáticas y meta-análisis (Preferred Reporting Items for Systematic Reviews and Meta-Analysis, PRISMA). No se impusieron restricciones sobre la fecha de publicación. Se recogieron datos sobre capacidad de difusión de medicación intraconductos en túbulos dentinales, conductos laterales e itsmos radiculares y se sometieron a análisis descriptivo de datos. La búsqueda bibliográfica en bases de datos electrónicas según los criterios de inclusión arrojó 45 títulos y resúmenes. Entre ellos, 7 artículos fueron seleccionados. Se determinó un rango de penetración del medicamento muy variable, entre 27,7 - 2350 μm y rango de difusión de 200-500 μm. Hay pocos estudios publicados que reporten la capacidad de penetración y difusión de la medicación intraconductos. El vehículo empleado y diámetro de las partículas en la preparación del medicamento y la eliminación de la capa de desecho aumentaría la capacidad de penetración/difusión del medicamento intraconductos dentro del túbulo dentinal, conductos laterales e itsmo.

ABSTRACT: The objective of endodontic therapy is to treat or prevent apical periodontitis. The effective elimination or reduction of the microbiota is essential for periapical repair. Due to this, the use of intracanal drugs is used to chemically treat the root canal system, and the penetration and diffusion capacity of said drug becomes relevant to come into direct contact with the microorganisms that penetrate inside the dentinal tubules, lateral canals and isthmus. A literature review was carried out in electronic databases with the search engines "Pubmed, Scielo and Google Academic", using keywords to identify the relevant published literature in English. The analysis and eligibility criteria were documented according to the reporting items for systematic reviews and meta-analyzes (Preferred Reporting Items for Systematic Reviews and Meta-Analysis, PRISMA). No restrictions were placed on the date of publication. Data on intracanal drug diffusion capacity in dentinal tubules, lateral canals and root isthmus were collected and subjected to descriptive data analysis. The bibliographic search in electronic databases according to the inclusion criteria yielded 45 titles and abstracts. Among them, 7 articles were selected. A highly variable drug penetration range was determined, between 27.7 - 2350 μm and a diffusion range of 200-500 μm. There are few published studies that report the penetration and diffusion capacity of intracanal medication. The vehicle used and the diameter of the particles in the preparation of the drug and the elimination of the waste layer would increase the penetration / diffusion capacity of the drug within the dentinal tubule, lateral canals and isthmus.

Zuma Modified Maneuver as a Treatment to Geotropic Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

Abstract Introduction Benign Paroxysmal Positional Vertigo (BPPV) is the most common vestibular disorder, resulting from detached otoliths that migrate to one of the semicircular canals - canalolithiasis - or one of the cupulas - cupulolithiasis. The present study is related to lateral canal BPPVs, which may be either geotropic or apogeotropic. The geotropic variant of lateral semicircular canal benign paroxysmal positional vertigo (LC-BPPV) is attributed to free floating particles in the posterior arm of the lateral semicircular canal. Objectives To verify the possibility of employing the Zuma repositioning maneuver, with a brief modification, as an alternative treatment for geotropic LC-BPPV. Methods Seven patients with geotropic LC-BPPV were enrolled and treated with the Zuma modified maneuver. Patients were reevaluated 1 hour after a single maneuver, to confirm the resolution of vertigo and positional nystagmus. Results All seven patients achieved immediate resolution of vertigo and positional nystagmus as measured 1 hour after the application of the maneuver. Conclusion The Zuma modified maneuver was effective for geotropic LC-BPPV after a single application. The use of the Zuma maneuver for both apogeotropic and geotropic LC-BPPV may simplify the treatment of these patients.

Study on the incidence of lateral canals and sealing quality in the apical third roots of permanent teeth with failed endodontic treatments / 中华口腔医学杂志

Objective@#To investigate the association between the frequency and filling rate of lateral canals and the sealing quality in the apical third roots of the permanent teeth with failed endodontic treatments, so as to explore the failure factors of root canal therapy.@*Methods@#Clinical records of the permanent teeth with failed endodontic treatments were collected from the Department of Endodontics, Capital Medical University School of Stomatology during a period of 2 years. The teeth were diagnosed as chronic apical periodontitis and then undergone endodontic microsurgery. The sealing quality of the apical root canal was observed by means of periapical radiographs. The surgical treatments were performed and the resected root apices were collected. The samples were scanned by micro-computed tomography and the 3D volume rendered images of the resected root apices were reconstructed. Moreover, the frequency and the filling rate of lateral canals in the apical third roots were calculated. The potential relationship between tooth position and the presence of lateral canals was evaluated.@*Results@#Totally 89 teeth with 89 root apices met the inclusion criteria and were included in the present study. The rate of correct-filling, underfilling and overfilling was 40% (36/89), 32% (28/89), and 28% (25/89), respectively, examined by periapical radiographs. Amongst all of the 89 samples, lateral canals were found in 44 samples. The incidence of apices with lateral canals was 49% (44/89). Furthermore, 3 out of 44 samples were fully filled with material in the lateral canals, and the rest 41 samples showed no filling materials. The filling rate of the lateral canals was 7% (3/44). However, no significant difference was detected between the tooth position and the presence of lateral canals (P>0.05).@*Conclusions@#The sealing quality of the apical third roots in permanent teeth with failed endodontic treatments was not good enough. The incidence of apices with lateral canals was high, but the filling rate of the canals was low. Further studies are needed to explore the relationship between lateral canals and the failure of endodontic treatment.

Evaluación ex vivo del sellado obtenido a nivel del conducto lateral con el uso de diferentes materiales y técnicas de obturación / Ex vivo evaluation of the sealing obtainedat the lateral canal level using different fillingmaterials and techniques

Objetivo: Evaluar ex vivo el sellado obtenido a nivel deconductos laterales simulados en piezas dentarias con conductosradiculares amplios, obturadas con ProRoot MTA, DensellMTA y gutapercha más AHPlus con termocompactación.Materiales y métodos: Se seleccionaron 45 incisivoscentrales superiores humanos extraídos con ápices maduros.Se realizaron las aperturas coronarias y se instrumentaron losconductos radiculares hasta la longitud de trabajo con limastipo K (Dentsply/Maillefer) y luego con fresas Largo #1, #2y #3 (Dentsply/Maillefer). Durante la preparación, los conductosradiculares se irrigaron con agua destilada. Luego, en35 de los 45 dientes se talló un conducto lateral simulado enla cara mesial, a aproximadamente 3 mm del ápice anatómico,empleando un instrumento Engine Reamer #15 (Dentsply/Maillefer). Las raíces de los 35 dientes fueron recubiertaspor una lámina de gomaespuma y envueltas con una cintade teflón, a fin de simular el ligamento periodontal. En estascondiciones, se dividieron los 45 dientes en cuatro grupos de10 especímenes cada uno y un grupo control de 5 especímenes.Grupo control: conducto radicular no obturado. Grupo1: conducto radicular obturado con ProRoot MTA (Dentsply/Maillefer). Grupo 2: conducto radicular obturado con MTACemento Reparador (Densell). Grupo 3: conducto radicularobturado con AHPlus (Dentsply De Trey) y conos de gutaperchacon la técnica híbrida empleando un Guttacondensor#45 (Dentsply/Maillefer). Grupo 4: comprende los 10 especímenesen los que no se habían tallado los conductos lateralessimulados. Se obturaron los conductos radiculares conel mismo procedimiento que el grupo 3, y posteriormente setallaron los conductos laterales simulados...

Aim: Ex vivo evaluation of the sealing obtained at thelevel of simulated lateral canals in teeth with wide root canals,filled with ProRoot MTA, Densell MTA and AHPlus withthermo-compacted gutta-percha.Materials and methods: Forty-five extracted maxillaryhuman central incisors with mature apices were selected.The canals were instrumented at the working length with Kfiles (Dentsply/Maillefer) and then using Largo burs #1, #2,and #3 (Dentsply/Maillefer). During the preparation, the rootcanals were irrigated with distilled water. Later, in 35 of the45 teeth, a simulated lateral canal was drilled in the mesialsurface of each sample at approximately 3 mm coronally tothe anatomic apex using an Engine Reamer #15 (Dentsply/Maillefer). The surfaces of these 35 teeth were wrapped upwith a thin layer of foam and covered with teflon tape to simulatethe periodontal ligament. The 45 teeth were divided intofour groups of 10 specimens each, and a control group of 5specimens. Control group: unfilled root canal. Group 1: rootcanal filled with ProRoot MTA (Dentsply/Maillefer). Group2: root canal filled with MTA Cemento Reparador (Densell).Group 3: root canal filled with AHPlus (Dentsply) and thehybrid technique using gutta-percha and Guttacondensor#45 (Dentsply/Maillefer). Group 4: this group includes the10 specimens in which the simulated lateral canals were notdrilled. The root canals were filled with the same procedureas group 3 and then the simulated lateral canals were drilled...

Surgical endodontic management of infected lateral canals of maxillary incisors

This case report presents surgical endodontic management outcomes of maxillary incisors that were infected via the lateral canals. Two cases are presented in which endodontically-treated maxillary central incisors had sustained lateral canal infections. A surgical endodontic treatment was performed on both teeth. Flap elevation revealed vertical bone destruction along the root surface and infected lateral canals, and microscopy revealed that the lateral canals were the origin of the lesions. After the infected lateral canals were surgically managed, both teeth were asymptomatic and labial fistulas were resolved. There were no clinical or radiographic signs of surgical endodontic management failure at follow-up visits. This case report highlights the clinical significance and surgical endodontic management of infected lateral canal of maxillary incisor. It is important to be aware of root canal anatomy variability in maxillary incisors. Maxillary central incisors infected via the lateral canal can be successfully managed by surgical endodontic treatment.

MRI Evaluation of Disc Lesions Causing Lumbar Canal Stenosis and Backache

Degenerative disease of the lumbar spine refers to a syndrome in which an intervertebral disc with adjacent spine structures is compromised, this can be due to aging process associated with pathology. Thirty five percent of asymptomatic individuals may have degenerative spine findings, including: disc degeneration, modic changes, disc bulges, facet joint arthropathy and spinal stenosis. Plain radiography provides only limited diagnostic information. It cannot show the structural morphology of the intervertebral disc. Magnetic resonance imaging (MRI) is helpful in detecting changes like disc displacement (bulge, protrusion, extrusion, sequestration), OPLL, zygapophyseal joint hypertrophy, buckling or hypertrophy of ligaments. Also MRI is helpful in differentiating central canal stenosis from lateral canal stenosis. Study population included all patients above 20 years of age with LBP with/without radiculopathy who were referred for lumbar spine MRI at Radiology Department, SRMCH from August 2011 to September 2013. All consented patients with LBP with/without radiculopathy referred for lumbar MRI were consecutively included in the study. A total of 280 individuals had lumbar MRI scan from August 2011 to September 2013, but only 250 whom fulfilled the study criterion were studied.

Análise radiográfica do preenchimento de canais laterais por quatro diferentes técnicas de obturação / Radiographic analysis of the lateral canals filling by four different obturation techniques

Muitas técnicas de obturação têm sido desenvolvidas, especificamente com o objetivo de aumentar a qualidade do selamento apical com a associação guta-percha/cimento obturador. O objetivo desta pesquisa foi avaliar, por mei do exame radiográfico, a qualidade do preenchimento de canais laterais de 60 dentes extraídos, utilizando cimento de Grossman conjuntamente com a aplicação de quatro diferentes técnicas obturadoras: McSpadden, híbrida de Tagger, Thermafil e condensação lateral. Os resultados foram obtidos com a análise das radiografias finais, em que se observou a superioridade do sistema Thermafil em relação às demais técnicas testadas para o preenchimento dos canais laterais

Many obturation techniques have been developed, specifically with the purpose of increasing the quality of the apical sealing with theassociation gutta-percha/sealer. The aim of this study was to evaluate,by means of radiographic exam, the sealing quality of 60 extracted teeth lateral canals, using Grossman sealing and four types of obturation techniques: McSpadden, Tagger hybrid technique, Thermafil andlateral condensation. The results were obtained with the analysis ofthe final radiographs, in which could be observed that Thermafil had superiority in relation to the other techniques when testing the sealing of lateral canals.