Resistance to fracture evaluation of endodontically treated roots of first maxillary premolars

Introduction:One of the most common dental procedures associated to vertical root fractures is the endodontic treatment with excessive dentin wall wear and another increasing risk factor is the use of intraradicular post. Objective: This study evaluated the resistance to fracture of the buccal and palatal roots of maxillary first premolars with endodontically treated canals and spaces for posts. Material and methods: Twenty two first permanent premolar roots (11 buccal and 11 palatal) composed the experimental sample. The canals were prepared with Protaper Universal® system until file F3 and then filled with gutta-percha cone F3 and endodontic sealer and received spaces for posts keeping 4 mm of filling at the apical third. The roots were subjected to compression test in a universal testing machine (Kratus). The roots were subjected to a progressive compression stress at a speed of 0.5 mm / min. A load cell of 200 kg was used. Results: Statistical analysis revealed significant differences between the strength values and resistance limit between groups (P<0.05), as analyzed by t Student test. The values of resistance to fracture of 0.44 kgf/mm2 for group 1 (buccal roots) and 0.31 kgf/mm2 for group 2 (palatal roots) were found. Conclusion: The resistance to fracture of the buccal roots was higher than that of palatal roots of first premolars submitted to biomechanical preparation and root preparation for intraradicular post.

Avaliação de fraturas radiculares em imagens digitais com variações de angulagens / Evaluation of root fracture using digital images with angular

O objetivo da pesquisa foi avaliar a influência da variação da angulagem horizontal no diagnóstico de FRVs em dentes tratados endodonticamente. Vinte e dois pré-molares permanentes com raízes retas e ápices formados foram divididos em grupos: Grupo 01(controle): dois dentes, um deles com núcleo intrarradicular; Grupo 2: dez dentes com fratura; Grupo 3: dez dentes com fratura e núcleo intrarradicular. As amostras foram submetidas a testes de compressão com uma carga de 200 kg a uma velocidade de 0,5 mm / min. Radiografias periapicais foram obtidas (70 kVp, 10 mA, e tempo de exposição de 0,3 seg.) pelo Sistema Digora® em ângulos horizontais, na direção orto radial e com uma mudança de ângulo de 25º para a direita e para a esquerda. As imagens foram avaliadas por cinco endodontistas. O diagnóstico de dentes fraturados e não fraturados foi maior para o 1.º pré-molar (51,66%) que para o 2.º (43,1%). A presença de fratura vertical foi registrada em 60,9% e 66,7% para o 1.º e 2.º prémolares, respectivamente. A presença de fratura mostra associação estatisticamente significante com a presença de núcleo intrarradicular e a variação de angulagem no 2.º pré-molar (p-valor = 0,011). Esses resultados sugerem que variações na angulagem horizontal podem otimizar o diagnóstico de FRVs... (AU)

This study aimed to evaluate the influence of changing horizontal angle during periapical radiography on the diagnosis of VRFs in endodontically treated teeth. Twenty-two single-rooted premolars with straight root canals and apex formation were divided into groups: Group 1 (control) - two non-fractured teeth, one of them with intraradicular post; Group 2 - ten fractured teeth; and Group 3 - ten fractured teeth with intraradicular post. Specimens were subjected to compression testing with a load of 200 kg at a speed of 0.5 mm/min. Periapical radiographs were obtained (70 kVp, 10mA, and 0.3 sec exposure time) in a Digora™ system at horizontal angles in the orthoradial direction and with a 25º angle shift to the right and to the left. Images were evaluated by five endodontists. The diagnosis of fractured and non-fractured roots was higher for the first premolar (51.6%) than for the second premolar (43.1%). The presence of VRFs was recorded in 60.9% of cases for the first premolar, and in 66.7% for the second premolar. Presence of VRFs showed a statistically significant association with presence of intraradicular post and angle variation in the second premolar (p=0.011). These results suggest that changes in horizontal angulation, may optimize the diagnosis of VRFs... (AU)

The clinical diagnosis and treatment of 78 cracked teeth with pulpitis / 重庆医学

Objective To analysis the causes and characteristic of cracked teeth with pulpitis and explore clinical diagnosis and treatment methods.Methods A total of 78 tooth that was identified as a cracked tooth with pulpitis was recorded and analyzed in terms of the age,the position in the mouth,and the location of crack-line.After reducing the cusp height,root canal therapy and crown restoration,the patients were followed up for one year and the treatment effectiveness was reviewed.Results The most prevalent age was 39-49 years.The most of cracked teeth were found in the maxillary molars.There were 65 cases (83.33%)that were treated successfully,the function of 1 1 cases (14.10%)were improved,and the rate of failure were 2.56% (2 cases).Conclu-sion Reasonable clinical diagnosis and treatment can contribute to the retention of the cracked teeth.Coronal restoration after root canal therapy might be a very effective way to treat cracked teeth with pulpitis.

Clinical study of onlay treatment of cracked teeth with vital pulp / 重庆医学

Objective To investigate the effect of cobalt chromium alloy onlay on the direct repair of cracked vital pulp teeth with the resin compostie filling and porcelain-fused-to-metal (PFM ) crown repair as the control .Methods 201 cracked vital pulp teeth from 201 cases were randomly divided into 3 groups according to the clinical symptoms :mild discomfort at occlusion (group A) ,pain at occlusion accompanied with transient pain to cold or hot stimulation (group B) and pain at occlusion accompanied with continuous pain to cold or hot stimulation(group C) .The cracked teeth directly were restored by the resin composite filling ,cobalt chromium alloy onlay and PFM crown repair and the effective rate in each group was observed after 2-year follow up .Results The effective rate of the group A ,B and C were statistically significant different from each other (P<0 .05) .The effective rate of the co-balt chromium alloy onlay and the PFM crown was statistically significant higher than that of resin composite (P<0 .05) .Conclusion The direct repair with cobalt chromium alloy onlay is an effective repair method for the cracked vital pulp teeth with mild discomfort at occlusion and mild pain accompanied with transient pain to cold or hot stimulation .

Clinical Application of Restoring of Short Coronal Cracked Molar with Cutting Titanium Inlay Crown / 天津医药

Objective To estimate the clinical effect of cutting titanium inlay crown in the restoration of short cracked molar. Methods Sixty-four short coronal cracked teeth were randomly divided into group A and group B. Group A were treated by crown. Group B were treated by titanium inlay crown. The curative effect was evaluated every year and lasted 2 years. Results One year after the repair, there was no significant difference in the achievement ratio between two groups (93.8%vs 100%,χ2=2.064, P>0.05). Two years after the repair, the success rate was significantly higher in group B (96.9%) than that of group A (68.8%,χ2=8.892, P<0.01). The failed cases of group A were treated by cutting titanium inlay crown, showing good retention. Conclusion The retention of a short cracked molar can be improved by means of cutting titanium inlay crowns.

Detecção e avaliação da atividade de lesões de cárie primária e secundária em superfícies oclusais: estudos in vitro e in vivo / Detection and activity assessment of primary and secondary caries on occlusal surfaces: in vitro and in vivo studies

O objetivo do presente estudo foi avaliar a efetividade de métodos empregados na detecção e na avaliação da atividade de lesões de cárie primárias e secundárias em superfícies oclusais de dentes decíduos e permanentes. Para tanto, foram realizadas quatro pesquisas. (1) O objetivo desta pesquisa foi avaliar in vitro a influência de métodos de profilaxia profissional nas medidas de fluorescência e no desempenho de três aparelhos baseados na captação da fluorescência induzida por luz na detecção de lesões de cárie oclusal em dentes permanentes. Os exames foram realizados em 110 dentes permanentes por dois examinadores no início, após a profilaxia profissional e lavagem e após uma segunda lavagem. Foram utilizados os aparelhos DD (DIAGNOdent 2095, KaVo, Alemanha), DDpen (DIAGNOdent 2190, KaVo, Alemanha) e VP (VistaProof, Dürr Dental, Alemanha). Os dentes foram aleatoriamente distribuídos de acordo com o método de profilaxia profissional empregado: jato de bicarbonato de sódio ou pasta profilática. Pode-se concluir que a escolha do método de profilaxia professional pode influenciar significativamente as medidas de fluorescência e o desempenho de métodos baseados na captação da fluorescência induzida por luz na detecção de lesões de cárie oclusal. (2) O objetivo deste estudo in vivo foi determinar os pontos de corte ideais para o DD, o DDpen e a VP, e avaliar a validade clínica de métodos convencionais e de métodos baseados na captação da fluorescência induzida por luz na detecção de lesões de cárie oclusal em dentes permanentes. Foram selecionados 105 dentes permanentes posteriores indicados para extração em 88 pacientes adultos. Um examinador experiente avaliou os dentes usando métodos baseados na captação da fluorescência induzida por luz (DD, DDpen e VP), ICDAS e exame radiográfico (Rx). Pode ser concluído que o ICDAS, o DD e o DDpen apresentaram boa validade em detectar lesões de cárie oclusal in vivo. Entretanto, o Rx e a VP foram pouco eficientes em detectar, respectivamente, todas os tipos de lesões e lesões em dentina. Além disso, os pontos de corte dos métodos baseados na captação da fluorescência induzida por luz não devem ser considerados pelos dentistas como limiares exatos na decisão de tratamento. (3) Os objetivos deste estudo foram comparar in vivo dois critérios clínicos para avaliação de atividade de lesões de cárie, comparar esses resultados in vivo com os resultados in vitro obtidos pelo novo método baseado em luminescência e comparar ambos critérios com esse método para determinar o status da atividade de lesões de cárie reexaminadas após 2 meses de acompanhamento clínico. Os dois critérios clínicos foram comparados em 88 molares decíduos de 58 crianças com idade entre 9 e 12 anos. Uma parte da amostra (n=10) foi reexaminada após 2 meses. Após a esfoliação ou extração, os dentes foram analisados por um novo método baseado em luminescência (Carivis, LUX DS, Reino Unido). Em conclusão, os critérios clínicos apresentaram uma alta correlação quando empregados in vivo. Sugere-se que o método de luminescência apresente capacidade em avaliar a atividade de lesões de cárie in vitro. (4) Neste estudo in vitro foi avaliado o desempenho do critério visual ICDAS e de novas tecnologias na detecção de lesões de cárie natural ao redor de restaurações de amálgama e de resina composta em dentes permanentes e determinada a relação entre a presença da lesão de cárie secundária e a presença/ausência de diferentes tamanhos de defeitos marginais. Foram selecionados cento e oitenta dentes com restaurações de amálgama (n=90) e de resina composta (n=90). Dois examinadores analisaram os dentes utilizando o critério visual ICDAS, o aparelho de fluorescência a laser (DD), o aparelho baseado em LED (Midwest Caries I.D., DENTSPLY Professional, EUA), o aparelho QLF (QLF-clin, Inspektor Research Systems BV, Holanda) e um protótipo baseado na tecnologia da imagem da fluorescência do esmalte (PCDS, Therametrics Technologies, EUA). O tamanho do defeito marginal foi analisado por meio de uma sonda exploradora. O padrão outro foi determinado pela microscopia confocal de varredura a laser (CLSM). Em conclusão, o ICDAS e o DD apresentaram bom desempenho na detecção de lesões de cárie ao redor de restaurações de resina composta, e o QLF e o PCDS na detecção de lesões de cárie ao redor de restaurações de amálgama e de resina composta. O tamanho do defeito marginal foi irrelevante na determinação da presença de lesões de cárie ao redor de restaurações. Por meio desta pesquisa, observou-se que os métodos descritos acima para detecção e avaliação da atividade de lesões de cárie parecem contribuir de forma positiva no processo de diagnóstico. No entanto, devem ser considerados como auxiliares aos métodos convencionais nesse processo

The aim of this study was to evaluate the effectiveness of methods for caries detection and caries activity assessment on occlusal surfaces of primary and secondary caries in deciduous and permanent teeth. For this reason, four studies were carried out: (1) The aim of this study was to evaluate the effects of professional prophylaxis procedures on fluorescence measurements and on three fluorescence-based devices in detecting occlusal caries in permanent teeth. All assessments were performed in 110 permanent teeth by two examiners at baseline, after professional prophylaxis and rinsing, and after a second rinsing. The devices LF (DIAGNOdent 2095, KaVo, Germany), LFpen (DIAGNOdent 2190, KaVo, Germany) and FC (VistaProof, Dürr Dental, Germany) were used. The teeth were randomly divided according to the professional prophylaxis used: sodium bicarbonate jet or prophylaxis paste. It can be concluded that the choice of professional prophylaxis method can significantly influence the fluorescence measurements and the performance of fluorescence-based methods for detection of occlusal caries. (2) This in vivo study proposed clinical cut-off limits for three fluorescence-based methods and evaluated the validity of conventional and fluorescencebased methods for occlusal caries detection in permanent teeth. A total of 105 posterior permanent teeth with an indication for extraction were selected in 88 adult patients. One experienced examiner assessed the teeth using fluorescence-based methods (LF, LFpen and FC), ICDAS and bitewing radiographs (BW). It can be concluded that ICDAS, LF and LFpen demonstrated good validity in detecting occlusal caries in vivo. However, BW and FC showed the lowest validity to detect all lesions and dentin lesions, respectively. Besides, the fluorescence-based methods cut-off limits should not be considered as exact thresholds for dentists' treatment decision. (3) The aims of this study were to compare two clinical criteria for caries activity assessment in primary teeth in vivo, to compare these in vivo results with the in vitro results obtained by a novel luminescence assay, and to compare both criteria with the luminescence assay to determine the activity status on lesions subject to a 2-month in vivo follow-up. The two in vivo criteria were compared in 88 primary molars of 58 children aged 9-12 years. A subsample (n=10) was re-examined after 2 months. After exfoliation or extraction, the teeth were evaluated by a novel luminescence assay (Carivis, LUX DS, United Kingdom). In conclusion, the clinical criteria exhibited a high correlation when applied in vivo. It could be suggested that the luminescence assay presents ability to assess caries activity status in vitro. (4) This in vitro study evaluated the performance of the ICDAS visual criteria and new technologies for detecting natural caries around amalgam and composite resin restorations in permanent teeth, and the relationship between the presence of caries around restorations and the presence/absence of different gap sizes. One hundred and eighty teeth with amalgam (n=90) and composite resin (n=90) restorations were selected. Two examiners analyzed the teeth using the ICDAS visual criterion, laser fluorescence (LF), LED device (MID) (Midwest Caries I.D., DENTSPLY Professional, USA), quantitative lightinduced fluore scence system (QLF) (QLF-clin, Inspektor Research Systems BV, The Netherlands) and a prototype system based on the Fluorescence Enamel Imaging (PCDS) (Professional Caries Detection System, Therametrics Technologies, USA). Additionally, gap size was evaluated using an explorer probe. The gold-standard was determined by means of confocal laser scanning microscopy (CLSM). In conclusion, ICDAS and LF presented good ability to detect caries around composite resin restorations, and QLF and PCDS to detect caries around amalgam and composite resin restorations. Gap size was found to be irrelevant to determine the presence of caries around restorations. From this study, it could be observed that the methods described above for detection and activity assessment appear to contribute positively in the diagnosis process. However, they should be considered as adjuncts to conventional methods in this process

Aspectos clínico, radiográfico e microbiológico da pigmentação em molares decíduos sob monitoramento preventivo: estudo longitudinal / Clinical, radiographic and microbiological aspects of pigmentation in primary molars under preventive monitoring: longitudinal study

Este estudo verificou os aspectos clínico, radiográfico e microbiológico da pigmentação de fossas e fissuras pigmentadas em molares decíduos no período de 18 meses. Observou-se o dente e a superfície dentária mais acometidos pela pigmentação, a distribuição da mesma na superfície, a cor, a ocorrência de cavitação, a textura, a presença ou não de radioluscência, tipo de tratamento, bem como os microrganismos mais frequentes. Participaram do estudo 116 pacientes (63-grupo experimental e 53-grupo controle). Em 155 molares decíduos de 63 pacientes (grupo experimental) na faixa etária de 3 a 10 anos, foi realizada a coleta de biofilme, exame clínico nas fossas e fissuras pigmentadas, bem como exame radiográfico interproximal. Realizou-se a análise qualitativa de microrganismos das fossas e fissuras pigmentadas por meio do PCR convencional e quantitativa dos cocos cariogênicos (Streptococcus mutans e Streptococcus sobrinus) por “Real-Time PCR”. A análise estatística utilizou o software Statistica versão 9 aplicando os testes do quiquadrado, de correlação linear, de Komolgorov-Smirnov e Lilliefors e coeficiente de concordância de Kendall. O nível de significância foi de 5%. Observou-se que os dentes mais acometidos pela pigmentação nas fossas e fissuras foram os segundos molares, em especial o superior do lado esquerdo (21,93%). A predominância da superfície oclusal (67,74%) foi significativa para todos os dentes. Para os segundos e primeiros molares, o predomínio do padrão parcial de distribuição da pigmentação foi estatisticamente significante (75,48%). A cor marrom predominou significativamente (85,81%) em todos dentes analisados. A ocorrência de cavitação foi maior no período inicial de 6 meses, decrescendo ao longo do tempo e sem significância para todos os dentes. A maioria dos dentes manteve a textura dura ao longo dos períodos estudados. Uma minoria do grupo amostral recebeu procedimento restaurador/selante. A análise radiográfica evidenciou que o escore 0...

This study evaluated the clinical, radiographic and microbiological aspects of pigmentation in pits and fissures in primary molars during 18 months. It was observed the dental surface that was more pigmented, pigmentation distribution on the surface, color, presence of cavitation, texture, presence or not of radiolucency, treatment type, and microorganisms that were more frequent. Study participants were 116 patients (63-experimental group and 53-control group). It was conducted the collection of biofilm, clinical exam of the pigmented pits and fissures, and interproximal radiographic exam in 155 deciduous molars of 63 patients (experimental group) aged from 3 to 10 years. The qualitative analysis of the microorganisms in the pigmented pits and fissures was conducted by the conventional PCR while the quantitative analysis of the cariogenic cocos (Streptococcus mutans and Streptococcus sobrinus) was obtained with the “Real-Time PCR”. The software Statistica version 9 was applied for the statistical analysis with chi-squared test, linear correlation, Komolgorov-Smirnov and Lilliefor, and Kendall’s coefficient of concordance at 5% level of confidence. The second molars presented higher frequency of pigmentation in the pits and fissures, mainly the left superior second molar (21,93%). The occlusal surface was significantly more frequent (67,74%) for all teeth. For the first and second molars, the pattern of partial distribution of pigmentation was statistically significant (75,48%). The brown color was significantly more frequent (85,81%) in all teeth. The occurrence of cavitation was higher at initial of 6 months and reduced with the time with no significance for all teeth. Most of the teeth maintained the texture during the periods of evaluation. A minority of the sample was submitted to restorative procedure/sealant. The radiographic analysis revealed that the score O (absence of radiolucent) was more frequent in both evaluations. It was observed the prevalence…

Aspectos clínico, radiográfico e microbiológico da pigmentação em molares decíduos sob monitoramento preventivo: estudo longitudinal / Clinical, radiographic and microbiological aspects of pigmentation in primary molars under preventive monitoring: longitudinal study

Este estudo verificou os aspectos clínico, radiográfico e microbiológico da pigmentação de fossas e fissuras pigmentadas em molares decíduos no período de 18 meses. Observou-se o dente e a superfície dentária mais acometidos pela pigmentação, a distribuição da mesma na superfície, a cor, a ocorrência de cavitação, a textura, a presença ou não de radioluscência, tipo de tratamento, bem como os microrganismos mais frequentes. Participaram do estudo 116 pacientes (63-grupo experimental e 53-grupo controle). Em 155 molares decíduos de 63 pacientes (grupo experimental) na faixa etária de 3 a 10 anos, foi realizada a coleta de biofilme, exame clínico nas fossas e fissuras pigmentadas, bem como exame radiográfico interproximal. Realizou-se a análise qualitativa de microrganismos das fossas e fissuras pigmentadas por meio do PCR convencional e quantitativa dos cocos cariogênicos (Streptococcus mutans e Streptococcus sobrinus) por “Real-Time PCR”. A análise estatística utilizou o software Statistica versão 9 aplicando os testes do quiquadrado, de correlação linear, de Komolgorov-Smirnov e Lilliefors e coeficiente de concordância de Kendall. O nível de significância foi de 5%. Observou-se que os dentes mais acometidos pela pigmentação nas fossas e fissuras foram os segundos molares, em especial o superior do lado esquerdo (21,93%). A predominância da superfície oclusal (67,74%) foi significativa para todos os dentes. Para os segundos e primeiros molares, o predomínio do padrão parcial de distribuição da pigmentação foi estatisticamente significante (75,48%). A cor marrom predominou significativamente (85,81%) em todos dentes analisados. A ocorrência de cavitação foi maior no período inicial de 6 meses, decrescendo ao longo do tempo e sem significância para todos os dentes. A maioria dos dentes manteve a textura dura ao longo dos períodos estudados. Uma minoria do grupo amostral recebeu procedimento restaurador/selante. A análise radiográfica evidenciou que o escore...

This study evaluated the clinical, radiographic and microbiological aspects of pigmentation in pits and fissures in primary molars during 18 months. It was observed the dental surface that was more pigmented, pigmentation distribution on the surface, color, presence of cavitation, texture, presence or not of radiolucency, treatment type, and microorganisms that were more frequent. Study participants were 116 patients (63-experimental group and 53-control group). It was conducted the collection of biofilm, clinical exam of the pigmented pits and fissures, and interproximal radiographic exam in 155 deciduous molars of 63 patients (experimental group) aged from 3 to 10 years. The qualitative analysis of the microorganisms in the pigmented pits and fissures was conducted by the conventional PCR while the quantitative analysis of the cariogenic cocos (Streptococcus mutans and Streptococcus sobrinus) was obtained with the “Real-Time PCR”. The software Statistica version 9 was applied for the statistical analysis with chi-squared test, linear correlation, Komolgorov-Smirnov and Lilliefor, and Kendall’s coefficient of concordance at 5% level of confidence. The second molars presented higher frequency of pigmentation in the pits and fissures, mainly the left superior second molar (21,93%). The occlusal surface was significantly more frequent (67,74%) for all teeth. For the first and second molars, the pattern of partial distribution of pigmentation was statistically significant (75,48%). The brown color was significantly more frequent (85,81%) in all teeth. The occurrence of cavitation was higher at initial of 6 months and reduced with the time with no significance for all teeth. Most of the teeth maintained the texture during the periods of evaluation. A minority of the sample was submitted to restorative procedure/sealant. The radiographic analysis revealed that the score O (absence of radiolucent) was more frequent in both evaluations. It was observed the prevalence...

Avaliação da superfície dentinária com o microscópio clínico após remoção de retentor intra-radicular utilizando o ultra-som / Evaluation of dentinal surface with clinical microscope after intra-radicularretainer removal using ultrasound

Objetivo: Avaliar o tempo despendido e possíveis linhas de fissura, trincas e outros danos causados na superfície dentinária ao redor do retentor intra-radicular submetido à vibração ultra-sônica para a sua remoção, utilizando o microscópio clínico. Métodos: Foram utilizadas 15 raízes de incisivos centrais inferiores bovinos, portadoras de retentores intra-radiculares Flexi-Post nº 3 cimentados com o cimento resinoso RelyX CRA® e incluídas em um alvéolo artificial, envoltas com uma camada de silicone. Os retentores foram submetidos à vibração ultra-sônica com o aparelho ENAC modelo EO-5 na sua potência máxima e, após a remoção, foi realizada uma avaliação a olho nu e outra com o microscópio clínico nos aumentos de 5, 8, 12,5 e 20 vezes. Resultados: Os resultados mostraram que nenhuma superfície dentinária apresentou linhas de fissura, trincas ou outros danos, e que o tempo médio para remoção dos retentores foi de 13,25 minutos. Conclusão: O ultra-som demonstrou ser um aparelho eficaz e seguro para a remoção de retentores intra-radiculares.

Objective: To evaluate the time spent and possible fissure lines, fractures and other damage caused on the dentinal surface around the intra-radicular retainer submitted to ultrasonic vibration to remove it, using a clinical microscope. Methods: The roots of 15 bovine mandibular central incisors were used. These contained Flexi-Post No. 3 intra-radicular retainers cemented with RelyX CRA® resinous cement and were included in an artificial alveolus, surrounded by a layer of silicone. The retainers were submitted to ultrasonic vibration with the ENAC model EO-5 appliance at maximum power, and after removal, an evaluation was made by the naked eye, and another with a clinical microscope, at magnifications of 5, 8, 12.5 and 20 times. Results: The results showed that no dentinal surface presented fissure lines, cracks or other damage, and that the mean time for removal of the retainers was 13.25 minutes. Conclusion: Ultrasound was shown to be an efficient and safe appliance for intra-radicular retainer removal.