Bypass de instrumento endodôntico fraturado: relato de caso / Bypass of a fractured endodontic instrument: case report

Introdução: Mesmo com toda evolução tecnológica desses instrumentos, com o desenvolvimento das limas de liga de níquel-titanio (NiTi) e sistemas mecanizados, as fraturas podem ocorrer durante o preparo químico/mecânico. Existem três abordagens mais regulamente aplicadas para solucionar essa intercorrencia: tentativa de remoção do instrumento com ultrassom, tentativa de ultrapassálo (bypass) ou a obturação do segmento. Objetivo: Relatar um caso da técnica de bypass em instrumento fraturado no canal radicular. Descrição do caso: Paciente, sexo feminino, 47 anos, brasileira, sem condições sistêmicas associadas, foi encaminhada à clínica do Curso de Odontologia da UNIFENAS, Divinópolis, Minas Gerais, Brasil, para resolução de fratura de instrumento no canal mésio- vestibular do primeiro molar superior direito (16). Optou-se pelo tratamento pela técnica de bypass, que envolveu as seguintes etapas: anestesia, abertura, utilização de lima C-Pilot #08 para ultrapassar o instrumento fraturado, odontometria, escalonamento regressivo a partir da lima k#20, desinfecção com hipoclorito de sódio 5%, medicação com hidróxido de cálcio por 21 dias, agitação da substância irrigadora e obturação dos canais radiculares. Conclusão: O bypass ao instrumento é uma técnica conservadora, eficaz e uma solução adequada em casos de fratura de limas endodônticas dentro dos canais radiculares. Essa técnica visa preservar o máximo possível da estrutura dental original, evitando procedimentos mais invasivos.(AU)

Introduction: Even with all technological evolution of these instruments, with the development of nickel-titanium alloy (NiTi) files and mechanized systems, fractures can occur during chemical/mechanical preparation. There are three most commonly applie to resolve this complication: attempting to remove the instrument with ultrasound, attempting to bypass it, or obturating the segment. Objective: To report a case of bypass technique in fractured instrument in the root canal. Case description: A 47-year-old female patient from Brazil, with no associated systemic conditions, was referred to the clinic of the Dentistry Course at UNIFENAS, Divinópolis, Minas Gerais, Brazil, for resolution of an instrument fracture in the mesio-vestibular canal of the right upper first molar (16). Treatment was performed using the bypass technique, which involved the following steps: anesthesia, opening, use of a C-Pilot #08 file to bypass the fractured instrument, odontometry, regressive scaling from the k#20 file, disinfection with 5% sodium hypochlorite, medication with calcium hydroxide for 21 days, agitation of the irrigating substance and root canal filling. Conclusion: Instrument bypass is a conservative, effective technique and an adequate solution in cases of endodontic file fracture within root canals. This technique aims to preserve as much of the original tooth structure as possible, avoiding more invasive procedures.(AU)

The effect of rotation speed of XP-endo Shaper on apically extruded debris during endodontic procedures: an In Vitro study / El efecto de la velocidad de rotación de XP-endo Shaper sobre los desechos extruídos apicalmente durante los procedimientos de endodoncia: un estudio in vitro

Abstract The aim of this study was to evaluate the effect of using a higher rotation speed with the XP-endo Shaper (XPS) on apically extruded debris and operation time during endodontic treatment and retreatment procedures. Sixty mesial roots of mandibular first molar teeth were randomly assigned to four groups (Initial treatment groups: XPS used at 1000 or 3000rpm rotation speeds and Retreatment groups: XPS used at 1000 or 3000rpm rotation speeds). During the initial treatment and retreatment procedures preweighed eppendorf tubes were used to collect apically extruded debris, and the operation time was recorded in seconds. The extruded debris was quantified by subtracting the preinstrumentation from the postinstrumentation weight of the Eppendorf tubes. Data were analysed using two-way ANOVA at a significance level of 0.05. In all groups, the use of the XPS at 1000 or 3000rpm rotation speeds had no statistically significant effect on the amount of apically extruded debris (p>0.05). The use of the XPS at a 3000rpm rotation speed significantly decreased the instrumentation time (p<0.05). In summary, the use of the XPS at high rotation speeds in initial treatment and retreatment procedures did not have a significant effect on the amount of apically extruded debris but significantly decreased the operation time.

Resumen El objetivo de este estudio fue evaluar el efecto del uso de una mayor velocidad de rotación con XP-endo Shaper (XPS) sobre los desechos extruidos apicalmente y el tiempo de operación durante el tratamiento endodóntico y los procedimientos de retratamiento. Sesenta raíces mesiales de los primeros molares mandibulares se asignaron aleatoriamente a cuatro grupos (grupos de tratamiento inicial: XPS usado a velocidades de rotación de 1000 o 3000rpm y grupos de retratamiento: XPS usado a velocidades de rotación de 1000 o 3000rpm). Durante el tratamiento inicial y los procedimientos de retratamiento se utilizaron tubos Eppendorf pesados previamente para recoger los desechos extruidos apicalmente, y el tiempo de operación se registró en segundos. Los residuos extruidos se cuantificaron restando la preinstrumentación del peso postinstrumentación de los tubos Eppendorf. Los datos se analizaron mediante ANOVA bidireccional a un nivel de significación de 0,05. En todos los grupos, el uso del XPS a velocidades de rotación de 1000 o 3000rpm no tuvo un efecto estadísticamente significativo sobre la cantidad de detritos extruidos apicalmente (p>0.05). El uso del XPS a una velocidad de rotación de 3000rpm disminuyó significativamente el tiempo de instrumentación (p<0.05). En resumen, el uso del XPS a altas velocidades de rotación en los procedimientos de tratamiento inicial y retratamiento no tuvo un efecto significativo en la cantidad de detritos extruidos apicalmente, pero disminuyó significativamente el tiempo de operación.

HerboDontics A Descriptive Review

Background:Herbal ingredients have been a part of human life since ancient times when they relied upon only the plants and their products for curing ailments. There is vast research on the efficacy of Ayurveda in curing diseases. However need is felt regarding extensive studies on the usage of such historic natural products in oral health care and especially in endodontics. One of the important factors for successful root canal treatment is complete eradication of microbes, which require efficient bio-mechanical preparation of root canal system. There are variety of chemical based solutions available for the purpose of endodontic irrigation. Due to various safety concerns including oral and peri-radicular toxicity, there is the need for such solutions which can be usedas their alternative. In recent years, there has been a profound increase in the literature and research regarding the use of herbal solutions as endodontic irrigants. This article aims at providing a comprehensive overview about various herbal solutions that can be used in endodontic treatment.

Post-obturation pain and its relationship with reference time and other risk factors / Dor pós-obturação e sua relação com o tempo de referência e outros fatores de risco

Objective: To evaluate incidence and intensity of postoperative pain in patients treated in the Residency Program in Endodontics at the State University of Maringá. The influence of factors inherent to the patient and treatment on preoperative pain was also the focus of our study. Material and Methods: 99 patients participated in this study and underwent non-surgical endodontic treatment. Initially, palpation, vertical and horizontal percussion were performed on the tooth to be treated. After the root canals filling, patients received a printed Numerical Rating Scale and were instructed to record the level of pain in the postoperative periods of 24, 48 and 72 hours. For each postoperative period, the patient recorded the values. A descriptive analysis of the data and a model of generalized estimation equations were performed to verify the relationship between the variables and postoperative pain, at a significance level of 5%. Results: During the follow-up period, the pain rates found were low represented by 16%, 11% and 7% in the periods of 24, 48, and 72h, respectively. In addition, the rates significantly decreased after 72h. Only one case of flare-up was recorded. Presence of pain on palpation, use of reciprocating file and use of 2.5% sodium hypochlorite influenced the results (p<0.05), increasing the changes of post-operative pain by 3.36, 0.4 and 0.2 times, respectively. Conclusion: Incidence and intensity of postoperative pain monitored in the residency program reduced significantly after 72 hours. Postoperative pain was associated with pain on palpation, use of reciprocating files and irrigation with 2.5% hypochlorite.(AU)

Objetivo: Avaliar a incidência e intensidade da dor pós-operatória em pacientes atendidos no Programa de Residência em Endodontia da Universidade Estadual de Maringá. A dor do paciente foi monitorada após 24, 48 e 72 horas após a obturação do canal radicular. A influência de fatores inerentes ao paciente e ao tratamento na dor pré-operatória também foi foco de nosso estudo. Material e Métodos: 99 pacientes participaram deste estudo e foram submetidos a tratamento endodôntico não cirúrgico. Inicialmente, foram realizadas palpação, percussão vertical e horizontal no dente a ser tratado. A presença de dor foi classificada em uma Escala Numérica de Avaliação (NRS). Após a obturação dos canais radiculares, os pacientes receberam a NRS impressa e foram orientados a registrar o nível de dor nos pós-operatórios de 24, 48 e 72 horas. A cada pós-operatório, um pesquisador entrava em contato com o paciente e registrava os valores. Foi realizada uma análise descritiva dos dados e um modelo de equações de estimativa generalizada (GEE) para verificar a relação entre as variáveis e a dor pós-operatória, ao nível de significância de 5%. Resultados: Durante o período de acompanhamento, os índices de dor encontrados foram baixos representados por 16%, 11% e 7% nos períodos de 24, 48 e 72h, respectivamente. Além disso, as taxas diminuíram significativamente após 72h. Apenas um caso de reagudecimento foi registrado. Presença de dor à palpação, uso de lima reciprocante e uso de hipoclorito de sódio 2,5% influenciaram os resultados (p<0,05) aumentando as alterações da dor pós-operatória em 3,36, 0,4 e 0,2 vezes, respectivamente. O tempo médio de encaminhamento foi de 6,28 meses, o que não influenciou nos resultados. Conclusão: A incidência e intensidade da dor pós-operatória monitorada no programa de residência reduziram significativamente após 72 horas. A dor pós-operatória foi associada à dor à palpação, uso de limas reciprocantes e irrigação com hipoclorito a 2,5%. (AU)

Endodoncia y ortodoncia. Parte 2: casos clínicos / Endodontics and orthodontics. Part 2: clinical cases

Objetivo: Describir el tratamiento endodóncico de cuatro casos clínicos de reabsorción radicular desarrollada durante o tras un tratamiento ortodóncico. Casos clínicos: Después de la preparación y la desinfección de los conductos radiculares, estos fueron obturados por un tiempo prudencial con una medicación intraconducto de hidróxido de calcio, que luego fue reemplazada por MTA. Luego de un período de entre uno y cuatro años, según el caso, los tratamientos fueron evaluados clínica y radiográficamente. Los dientes que debieron ser extraídos fueron analizados histológicamente. Según la evolución clínica y radiográfica de los casos presentados, el uso inicial de hidróxido de calcio y su posterior reemplazo por MTA parecería ser un protocolo adecuado para completar el proceso de reparación de los tejidos apicales y perirradiculares en casos de reabsorciones radiculares provocadas por fuerzas ortodóncicas excesivas. Las enfermedades sistémicas deben ser tenidas en cuenta para la elección de la terapéutica (AU)

Aim: To describe the endodontic treatment of four clinical cases of permanent teeth suffering root resorption during or after orthodontic treatment. Clinical cases: Four clinical cases of permanent teeth with root resorption were endodontically treated. After the root canals were prepared and disinfected, they were medicated with calcium hydroxide. After an appropriate observation period, the canals were finally filled with MTA. The treatment outcomes were clinically and radiographically assessed at an interval between one to four years according to the clinical case. The histological findings of teeth that required extraction was also described. Our clinical and radiographic observations suggest that a temporary filling with calcium hydroxide and further obturation with MTA can provide a favorable intracanal environment for apical and periradicular tissue reparation. The clinician needs a full medical history to be aware of the systemic diseases in patients with root resorption that will be of importance for the proper selection of treatment (AU)

Consideraciones para la atención de tratamientos endodóncicos en el contexto de la pandemia de COVID-19 / Considerations for the care of endodontic treatments in the context of the COVID-19 pandemic

La enfermedad COVID-19 fue declarada pandemia por la Organización Mundial de la Salud el 11 de marzo de 2020. El síndrome respiratorio agudo severo coronavirus-2 (SARS-CoV-2) es un virus transmitido de animales a seres humanos, altamente contagioso, cuyo periodo de incubación es de uno a 14 días. Los momentos por los que atraviesan la mayoría de los países debido a la pandemia declarada del COVID-19 han llevado a la proclamación de órdenes gubernamentales y/o recomendaciones en relación a la atención dental que debe dispensarse. En el momento actual, no se dispone de protocolos específicos oficiales, ni nacionales ni internacionales, que aborden de manera clara cómo debe proceder el odontólogo en su práctica diaria en la etapa posterior al confinamiento para trabajar con las mejores garantías de protección para los pacientes y el equipo humano de la consulta odontológica. Este estudio tuvo como objetivo analizar consideraciones para la atención de tratamientos endodóncicos en el contexto de la pandemia de COVID-19. Para lograr este objetivo se realizó una revisión bibliográfica en diferentes bases de datos, como: Google Scholar, Springer Link, Scopus, PubMed, para ello se emplearon estrategias de búsqueda, utilizando descriptores como: «endodontic¼, «recomendations¼, «odontology¼, «COVID-19¼, «pandemic¼ y operadores booleanos, con la finalidad de obtener información relevante y precisa. Contribuyendo a la práctica de la endodoncia con un protocolo general para el manejo de emergencias que muestre el fundamento del diagnóstico, los procedimientos clínicos y el uso de equipos de protección personal y barreras en el consultorio odontológico durante el brote de COVID-19 (AU)

The COVID-19 disease was declared a pandemic by the World Health Organization on March 11, 2020. The severe acute respiratory syndrome coronavirus (SARS-CoV-2) is a virus transmitted from animals to humans, highly contagious, whose incubation period is one to 14 days. The times that most countries are going through due to the declared COVID-19 pandemic have led to the proclamation of government orders and/or recommendations regarding the dental care that should be provided. At the present time, there are no specific official national or international protocols that clearly address how the dentist should proceed, in their daily practice, in the post-confinement stage, to work with the best guarantees of protection for the patients and the human team of the dental practice. The objective of this study was to analyze considerations for the care of endodontic treatments in the context of the COVID-19 pandemic. To achieve this objective, a bibliographic review was carried out in different databases, such as: Google Scholar, Springer Link, Scopus, PubMed, for this, search strategies were used, using descriptors such as: «endodontic¼, «recommendations¼, «odontology¼, «COVID-19¼, «pandemic¼ and Boolean operators, in order to obtain relevant and accurate information. Contributing to the practice of endodontics a general protocol for emergency management that shows the rationale for diagnosis, clinical procedures and the use of personal protective equipment and barriers in the dental office during the COVID-19 outbreak (AU)

Instrumentación rotatoria comparado con instrumentación manual para tratamiento endodóntico en dientes permanentes / Rotary instrumentation compared to manual instrumentation for endodontic treatment in permanent teeth

RESUMEN: Introducción: El éxito del tratamiento endodóntico requiere de la desinfección completa del sistema de canales radiculares. Convencionalmente este procedimiento se realiza a través de maniobras de instrumentación rotatoria o manual e irrigación química. Dentro de las diferentes técnicas de instrumentación, la de tipo rotatoria ha surgido como una alternativa a la instrumentación manual, cuyos beneficios en comparación a ésta aún deben ser dilucidados. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos cinco revisiones sistemáticas que en conjunto incluyeron 15 estudios primarios, de los cuales, 10 corresponden a ensayos aleatorizados. Concluimos que el uso de instrumentación rotatoria en comparación a instrumentación manual probablemente disminuye la incidencia del dolor postoperatorio. Además, la instrumentación rotatoria podría disminuir el uso de analgésicos post tratamiento endodóntico. Sin embargo, podría resultar en poca o nula diferencia en la intensidad del dolor, pero la certeza de la evidencia es baja. Además, no es posible establecer con claridad si el uso de instrumentación rotatoria en comparación a la instrumentación manual aumenta la reparación apical debido a que la certeza de la evidencia existente ha sido evaluada como muy baja.

ABSTRACT: Introduction: Successful root canal therapy (endodontic treatment) requires complete disinfection of the root canal system. Traditionally, disinfection of the root canal system involves rotary or manual instrumentation and chemical irrigation. Various rotary instrumentation techniques have emerged as an alternative to manual instrumentation, but its benefits against manual techniques need to be clarified. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified five systematic reviews that together included 15 primary studies, of which 10 correspond to randomized trials. We conclude that the use of rotary instrumentation compared to manual instrumentation probably reduces the incidence of pain. Also, rotatory instrumentation may reduce the use of postoperative analgesics. However, it could result in little or no difference in pain intensity, but the certainty of the evidence is low. Furthermore, it is not possible to clearly establish whether the use of rotary instrumentation increases apical repair as the certainty of the evidence has been assessed as very low.

Instrumentação foraminal: repercussões locais e sistêmicas / Foraminal enlargement: Local and systemic repercussions

Introdução: A infecção endodôntica pode alcançar a saída foraminal e, inclusive, ir além dela. Logo, a determinação da constrição apical como o limite ideal para instrumentação e obturação tem sido questionada. A instrumentação foraminal intencional é realizada com o intuito de diminuir o contingente microbiano a níveis mais favoráveis ao reparo. Entretanto, repercussões locais e sistêmicas estão associadas à sua execução. Objetivo: Realizar uma revisão crítica da literatura sobre repercussões locais e sistêmicas relativas à instrumentação foraminal intencional. Métodos: Em março de 2018, uma busca eletrônica realizada na base de dados PUBMED utilizando os termos "foraminal enlargement" OR "foraminal widening" OR "apical limit" AND "endodontics" identificou 74 artigos científicos. Esses artigos, a análise de suas referências bibliográficas e a utilização de mais 5 artigos base resultaram nos 111 estudos consultados para a realização dessa pesquisa. Resultados: A ampliação foraminal intencional nem sempre pode ser praticada em virtude de razões anatômicas e morfológicas. Quanto maior a ampliação do forame apical, maior a possibilidade de extravasamento de substâncias e/ou materiais utilizados para a realização do tratamento endodôntico. A instrumentação foraminal intencional parece ser contraindicada em pacientes que fazem ou fizeram uso de bisfosfonatos recentemente, com distúrbios de coagulação e/ou sob uso crônico de anticoagulantes e com alto risco de bacteremia. Conclusões: Os impactos da instrumentação foraminal intencional sobre o sucesso do tratamento endodôntico devem ser investigados. Contudo, os delineamentos metodológicos dos estudos clínicos devem ser cuidadosos, principalmente no tocante às condições sistêmicas dos pacientes que farão parte do universo amostral (AU).

Introduction: endodontic infection can reach and even go beyond the apical foramen. Therefore, determining apical constriction as the ideal limit for instrumentation and obturation has been questioned. Intentional foraminal enlargement is performed for the purpose of reducing the microbial contingent to levels more favorable to repair. However, local and systemic repercussions have been associated with this approach. Objectives: to critically review the literature on local and systemic repercussions relative to intentional foraminal enlargement. Methods: in March 2018, an electronic search performed on the PUBMED database using the terms "foraminal enlargement" OR "foraminal widening" OR "apical limit" AND "endodontics" identified 74 scientific articles. These articles, analysis of their references and use of another 5 base articles resulted in the 115 studies used for performing this research. Results: intentional foraminal enlargement cannot always be performed due to the anatomical and morphological conditions. The greater the apical foramen enlargement, the greater the possibility of extrusion of substances and/or materials used to perform endodontic treatment. Intentional foraminal enlargement seems to be contraindicated in patients who are taking or have recently used bisphosphonates, those with coagulation disorders and/ or under chronic use of anticoagulants and at high risk for bacteremia. Conclusions: the impacts of intentional foraminal enlargement on the success of endodontic treatment should be investigated. However, the methodological procedures of clinical studies should be carefully designed, especially taking into consideration the systemic conditions of patients who will be part of the sample (AU).

Antibacterial Effectiveness of Calcium Hydroxide Combined with Cresotin against Enterococcus faecalis

ABSTRACT@#The goal of endodontic treatment is to prevent and control of pulp and periradicular infections. Calcium hydroxide has a beneficial biological property as an intracanal medicament and can be combined with cresotin to disinfect bacteria in root canals, especially Enterococcus faecalis (E. faecalis) which is the most frequently isolated strain in the root canals. The aim of this study was to investigate in vitro the antimicrobial activity of calcium hydroxide, cresotin, and combination calcium hydroxide and cresotin (Ca[OH]2+Cresotin, 1:1 and 1:2) against E. faecalis. Antibacterial activity was determined by the agar diffusion method. The test medicaments were placed inside the hole that made in the inoculated agar medium. The zone of growth inhibition was measured and recorded after incubation for each plate, and the result was analysed statistically with ANOVA. The in vitro antimicrobial effects of combination calcium hydroxide and cresotin (Ca[OH]2+Cresotin, 1:2) has more prominent antimicrobial activity than others, and calcium hydroxide is more effective than cresotin alone. The antimicrobial activity of combined calcium hydroxide and cresotin is more effective in killing E. faecalis in comparison to the other treatments.

Inferior alveolar nerve paraesthesia after overfilling into the mandibular canal, confirmed by cone-beam computed tomography: a case report / Parestesia do nervo alveolar inferior após extravasamento de material obturador para o canal mandibular, confirmado por meio da tomografia computadorizada de feixe cônico: relato de caso

The filling material should be restricted to the root canal, and not extend to the periradicular tissues. Overextension occurs when there is an overflow of gutta-percha and sealer, whereas overfilling refers to the overflow only of sealer beyond the apical foramen. Both may cause several negative clinical consequences. Nevertheless, an accurate diagnosis of where they occurred cannot always be performed by conventional radiographic examination, because of the two-dimensional aspect of the image. This paper describes a clinical case of labiomandibular paraesthesia after overfilling into the mandibular canal (MC), as diagnosed by cone-beam computed tomography (CBCT), later used to perform the treatment planning. A 34-year-old Caucasian female patient sought a private dental clinic complaining of pain in the right mandibular posterior region. After taking the anamnesis and performing clinical and radiographic exams, the patient was diagnosed with pulp necrosis in the second right mandibular molar, and underwent root canal treatment. The final radiography showed overextension or overfilling, probably into the MC. About 2 hours after the procedure, the patient reported paraesthesia of her lower right lip and chin. A CBCT confirmed a small overfilling into the MC. For this reason, vitamin B12 was prescribed as the first treatment option. After 7 days, the patient reported a significant decrease in paraesthesia, and was completely normal after 15 days. This case report shows that CBCT is an effective radiographic diagnostic tool that can be used as an alternative in clinical cases of labiomandibular paraesthesia caused by overextension or overfilling (AU)

O material obturador deve preencher todo o canal sem extravasar para os tecidos perirradiculares. O extravasamento de guta-percha e cimento além do forame apical, denomina-se sobrextensão, enquanto o termo sobreobturação refere-se ao extravasamento de cimento endodôntico. Ambos podem causar consequências clínicas negativas, porém um preciso diagnóstico nem sempre é logrado somente a partir do exame radiográfico convencional em razão de sua natureza bidimensional. O presente relato descreve um caso clínico de parestesia de lábio inferior e mento após o extravasamento de cimento obturador para o canal mandibular (CM), diagnosticado por meio da tomografia computadorizada de feixe cônico (TCFC), também utilizada para o planejamento do tratamento. Paciente do gênero feminino, 34 anos, leucoderma, procurou atendimento odontológico particular queixando-se de dor odontogênica na região posterior direita da mandíbula. Finalizados a anamnese e o exame clínico-radiográfico, diagnosticou-se a necrose pulpar do segundo molar inferior direito, ulteriormente submetido ao tratamento endodôntico. A radiografia final evidenciou provável extravasamento de material obturador para o interior do CM. Aproximadamente 2 horas após, a paciente relatou parestesia no lábio inferior direito e no queixo, e a TCFC confirmou a presença de pequena quantidade de cimento obturador no CM. Por conseguinte, a prescrição de vitamina B12 foi o tratamento de escolha. Decorridos 7 dias, a paciente referiu significativa diminuição da parestesia e após 15 dias os padrões de normalidade estavam completamente restabelecidos. O presente relato de caso demonstra que a TCFC é uma ferramenta de diagnóstico potencialmente empregada em casos de parestesia labiomandibular causada por sobrextensão ou sobreobturação (AU)

1 429 cases treated with nitrous oxide inhalation sedation in dental clinic: a retrospective study / 口腔疾病防治

Objective@#The use and effect of nitrous oxide sedation techniques in oral clinics were analyzed retrospectively.@*Methods@#Patients who were treated with nitrous oxide inhalation sedation in the clinic of the Affiliated Stomatological Hospital of Guangzhou Medical University from January 1, 2016, to December 30, 2018, were examined. Age and gender of the patients, dental treatments involved, reasons for nitrous oxide inhalation, sedative effects and adverse reactions were compiled.@* Results @#A total of 1 429 cases were examined, comprising 587 males and 842 females, and the average age was 32.64±16.34 years old. Among the patients who underwent nitrous oxide inhalation sedation in the oral clinic, 79.98% needed tooth extraction, and 79.50% had a dental fear of procedures. The patients were divided into following 7 age groups: 5-15 years old, 16-25 years old, 26-35 years old, 36-45 years old, 46-55 years old, 56-65 years old and > 65 years old. The sedation satisfaction rate of the 5-15-year-old group was 45.71%, and the sedation satisfaction rate of the other 6 age groups was 90.83%- 96.20% (P < 0.001). The incidence of total adverse reactions was 5.39%; the incidence was higher in females than in males, and the incidence was higher in the 16-25 age group than in the other age groups (P < 0.05). The most frequent adverse reaction was vertigo (81.82%).@*Conclusion@# Among the four common oral outpatient treatment programs including the extraction of teeth, dental implants, pulp treatment and periodontal treatment, patients undergoing inhalation sedation of nitrous oxide in the dental extraction most. The most common reason for requiring sedation is dental fear, and the sedative effect of the 5-15-year-old group was significantly worse than that of the other age groups. The incidence of adverse reactions of nitrous oxide sedation was low and manageable.

Utilização do BIO-C TEMP® como medicação intracanal em tratamento de um dente permanente avulsionado e reimplantado tardiamente: relato de caso / Use of BIO-C TEMP® as intrachanal medication in treatment of a permanent tooth permanent and replanted later: case report

A avulsão dentária consiste no completo deslocamento traumático do dente do interior de seu alvéolo, ocasionando rompimento do suprimento sanguíneo e fibras periodontais. O reimplante imediato é considerado como melhor conduta, porém, nem sempre é possível. Quando necessário o tratamento endodôntico, é desejável que se utilizem materiais com boas propriedades biológicas e principalmente uma medicação intracanal biocompatível e que estimule a reparação tecidual. Objetivo: relatar um caso clínico de tratamento endodôntico utilizando um material à base de silicato de cálcio como medicação intracanal em um dente permanente avulsionado e reimplantado tardiamente. Relato de caso: paciente do gênero masculino, 13 anos de idade, compareceu à clínica odontológica com o dente 12 avulsionado. O dente permaneceu fora da cavidade oral por cerca de 30 minutos e o meio de armazenamento foi soro fisiológico. Após a limpeza e o reposicionamento do elemento dentário, fez-se necessária a instalação da contenção com fio semirrígido. Posteriormente, o tratamento endodôntico foi realizado, no qual a medicação intracanal de escolha foi o BIO-C TEMP®, sendo realizada a proservação por 24 meses. Consideração final: o uso de um material à base de silicato de cálcio que possui propriedades biológicas importantes e formulação "pronta para uso" pode ser uma alternativa promissora como medicação intracanal em dentes traumatizados.(AU)

Tooth avulsion consists of the complete traumatic displacement of the tooth from the inside of its alveolus, causing rupture of the blood supply and periodontal fibers. Immediate reimplantation is considered the best approach, however, it is not always possible. When endodontic treatment is necessary, it is desirable to use materials with good biological properties and especially biocompatible intracanal medication that stimulates tissue repair. Objective: to report a clinical case of endodontic treatment using a material based on calcium silicate as intracanal medication in an avulsed and late reimplanted permanent tooth. Case report: male patient, 13 years old, came to the dental clinic with the tooth 12 avulsed, remained outside the oral cavity for about 30 minutes, the storage medium was saline. After cleaning and repositioning the element, it was necessary to install the containment with semi-rigid wire. Subsequently, endodontic treatment was performed, in which the intracanal medication was BIO-C TEMP® and followed up for 24 months. Final consideration: the use of calcium silicate-based material has important biological properties and a "ready-to-use" formulation, which can be a promising alternative as an intracanal medication in traumatized teeth.

Analgesic Efficacy of Corticosteroids Used as Intracanal Solutions to Control Inter Appointment Pain during Root Canal Treatment – A Systematic Review

Patients often associate endodontic treatment with pain. Inter appointment pain is common during endodontic treatment and is due to acute inflammation of the apical periodontal ligament space. Till date, several agents have been employed to manage inter appointment pain by administering them through different routes. All the agents for pain control were administered orally in the past. In order to bypass the unwanted side effects and achieve immediate and effective pain control, local administration was followed by intracanal administration. This systematic review analyzes the effect of intracanal delivery of various steroid solutions and their effectiveness in pain management. A search was performed in electronic database (i.e. Pubmed Central, Google and Hand Search) till August 2019.All in vivo studies that used intracanal corticosteroids for controlling inter appointment pain during endodontic treatment were selected.The outcome measure was to evaluate the reduction of pain in the inter appointment period after intracanal drug delivery

Evaluación radiográfica de la capacitación preclínica de alumnos de grado en el uso del sistema ProTaper Next en endodoncia / Radiographic evaluation of the preclinical training of undergraduate students in the use of ProTaper Next system in endodontics

Objetivo: Evaluar radiográficamente 162 tratamientos endodónticos realizados ex vivo en premolares inferiores y superiores humanos mediante el empleo del sistema ProTaper Next por parte de alumnos de grado de una cátedra de endodoncia de una universidad argentina. Materiales y métodos: Se evaluaron 162 tratamientos endodónticos realizados ex vivo durante los años 2017, 2018 y 2019 (54 por cohorte) en premolares inferiores y superiores humanos por alumnos de grado de la cátedra de Endodoncia I de la Escuela de Odontología de la Universidad del Salvador / Asociación Odontológica Argentina. Para la instrumentación fue empleado el sistema ProTaper Next. La muestra se tomó de forma aleatoria. En un programa de presentación de computadora se incluyeron las radiografías periapicales pre- y posoperatoria para su evaluación. Un evaluador externo analizó las imágenes radiográficas de los tratamientos y los categorizó como correctos o incorrectos teniendo en cuenta tres requisitos excluyentes: la conformación de la preparación quirúrgica, el límite apical y la homogeneidad de la obturación. Para el análisis estadístico, se utilizó la frecuencia relativa (intervalo de confianza 95%) y la prueba de chi-cuadrado. Resultados: La evaluación radiográfica de los tratamientos endodónticos realizados mostró un número considerable de tratamientos correctos. Los resultados para cada cohorte (años 2017, 2018 y 2019) fueron del 96,3% (87,2- 99,5%), el 94,4% (84,6-98,8%) y el 98,2% (90,1-99,9%) respectivamente. El porcentaje global de tratamientos correctos fue del 96,3% (92,1-98,6%). La diferencia entre las cohortes no fue estadísticamente significativa (P>0,05). Conclusión: El empleo del sistema ProTaper Next por parte de estudiantes de grado evaluados mostró resultados radiográficamente satisfactorios en la instrumentación ex vivo de conductos radiculares de premolares inferiores y superiores humanos (AU)

Aim: To evaluate radiographically, 162 endodontic treatments performed ex vivo by three cohorts of students from a school of dentistry in Argentina, using ProTaper Next rotatory system in mandibular and maxillary human premolars. Materials and methods: 162 mandibular and maxillary human premolars received endodontic treatment by undergraduate students from the Department of Endodontics I of the School of Dentistry USAL/AOA. The treatments were performed ex vivo during the academic years 2017, 2018 and 2019 (54 teeth were chosen for each cohort) using the rotatory system ProTaper Next. The samples were taken randomly. Pre and postoperative radiographs were included in a computer presentation program for its evaluation. An external examiner analysed the radiographic images by the shape of the preparation, the apical limit, and the homogeneity of the obturation, considering the treatments well obturated (correct) or ill obturated (incorrect). To be considered correct the case had to meet all the requirements. The statistic calculations used in this study were: relative frequency (confidence interval 95%) and the chi-square test. Results: The radiographic evaluation showed a considerable number of endodontic treatments correctly done using ProTaper Next system. The percentages for each cohort were 96.3% (87.2-99.5%), 94.4% (84.6-98.8%) y 98.2% (90.1-99.9%) for years 2017, 2018 y 2019 respectively. Global percentage of correctly endodontic treatments was 96.3% (92.1-98.6%). The difference between the cohorts was not statistically significant (P>0.05). Conclusion: The use of ProTaper Next by the dental students evaluated showed satisfactory results in the ex vivo instrumentation of mandibular and maxillary human premolar root canals (AU)

Remoção Manual não Cirúrgica de Instrumento Endodôntico Fraturado no Terço Apical de Pré-Molar Superior: Relato de Caso / Surgical Manual Removal of Fractured Endodontic Instrument in the Apical Third of Maxillary Premolar: Case Report

A fratura acidental de um instrumento durante o tratamento endodôntico pode ocorrer devido à falta de conhecimento anatômico do elemento dentário, ao uso de instrumentos inadequados ou à falha técnica do operador. O objetivo do presente estudo foi apresentar um relato de caso clínico da remoção de um instrumento fraturado no terço apical de um pré-molar superior. O fragmento localizava-se no terço apical da raiz vestibular. A primeira tentativa de remoção do fragmento foi realizada sem sucesso. Após 15 dias, em uma nova tentativa, o instrumento foi removido com o auxílio de ultrassom e inserto específico. Entre as sessões, utilizou-se medicação intracanal à base de hidróxido de cálcio, paramonoclorofenol canforado e propilenoglicol. Decorridos 15 dias, o dente mostrou-se assintomático e foi obturado pela técnica da condensação lateral. Assim, a paciente foi encaminhada para a realização da restauração definitiva. Após 3 meses, foi observada radiograficamente a regressão da lesão perirradicular. Conclui-se que a retirada do fragmento no caso descrito se mostrou uma opção eficiente, propiciando a manutenção do dente com ausência de sinais e sintomas.

Accidental fracture of an instrument during endodontic treatment can occur due to lack of dental anatomy knowledge, use of inadequate instruments or technical failure of the operator. The aim of the present study is to present a case report of instrument fragment removal from a superior premolar. The fragment was identified to be in the apical third of the buccal root. The first attempt to remove the instrument was made without success. After 15 days, in a new attempt, the instrument was removed with the aid of an ultrasonic endodontic tip. The intracanal medication between sessions was calcium hydroxide, camphorated paramonochlorophenol and propylene glycol. After more 15 days, the tooth was asymptomatic and was filled by lateral condensation. Thus, the patient was referred for definitive restoration. After 3 months, it was observed radiographically the regression of the periradicular lesion. In conclusion, the removal of the fragment proved to be an efficient option, providing the maintenance of the tooth with no signs and symptoms.

Influence of root canal preparation on formation of dentinal microcracks: a systematic review

Abstract The effect of root canal preparation technique on microcrack initiation is a controversial issue. This systematic review aimed to assess the role of root canal preparation techniques with different kinematics (manual, rotary, reciprocating, adaptive, self-adjusting file) on microcrack initiation. In vitro and in situ studies comparing the influence of at least two different root canal preparation techniques on the initiation of dentin microcracks were searched in PubMed/MEDLINE and SCOPUS up to June 5, 2018 without language and period restriction. Two authors independently reviewed all identified titles and abstracts for eligibility. Tables were generated to summarize the included studies, and the included studies were assessed for bias. Fifty-four (n=54) articles met the eligibility criteria. The results were classified according to the method used for microcrack evaluation, and most studies that used micro-computed tomography showed no formation of new cracks after root canal preparation. In general, the instrumentation techniques induced microcrack formation when the methods were destructive, irrespective of kinematics. In relation to the apex region, when the preparation working length was set as the root canal length subtracted of 1 mm, the risk of microcrack initiation reduces. The majority of the included studies had low risk of bias for all assessed domains. Our results seem to indicate that the various root canal preparation techniques considered in this study will not cause damage to the dental structure when adequately employed and the proper methodology is applied.

Resumo O efeito da técnica de preparo do canal radicular na iniciação e/ou propagação de microfissuras dentinárias é um tema controverso. Essa revisão sistemática teve como objetivo avaliar o papel das técnicas de preparo do canal radicular com diferentes cinemáticas (manual, rotatória, reciprocante, adaptativa e self-adjusting file) na iniciação e/ou propagação de microfissuras dentinárias. Estudos in vitro e in situ comparando a influência de pelo menos duas técnicas diferentes de preparo do canal radicular foram identificados no PubMed/MEDLINE e SCOPUS até 05 de junho de 2018 sem restrição de idioma e tempo. Dois autores revisaram de maneira independente todos títulos e resumos para elegibilidade dos estudos. Tabelas foram criadas para sumarizar os estudos incluídos e os estudos foram avaliados quanto ao risco de viés. Cinquenta e quatro (54) estudos enquadraram-se nos critérios de elegibilidade. Os resultados foram classificados de acordo com o método utilizado para avaliação das microfissuras. A maioria dos estudos que utilizaram micro-tomografia não demonstraram formação de novas microfissuras após preparo do canal radicular. Em geral, técnicas de instrumentação induziram formação de microfissuras quando os métodos de avaliação foram destrutivos, independente da cinemática. Em relação a região do ápice, quando comprimento de trabalho foi definido como o comprimento do canal menos 1 mm, o risco de indução de microfissuras é reduzido. A maioria dos estudos incluídos apresentaram baixo risco de viés para todos os domínios apresentados. Nossos resultados parecem indicar que as diferentes técnicas de preparo do canal radicular não causam danos a estrutura dental quando adequadamente utilizadas e a metodologia adequada é utilizada.

Determinación de la Longitud de Trabajo Mediante Localizador Electrónico de Foramen Apical y CBCT a Través del Software 3D Endo de Dentsply Sirona: Estudio Comparativo in vitro / Determination of Working Length Using Electronic Locator for Apex and CBCT with 3D Endo Dentsply Sirona Software: Comparative in vitro Study

RESUMEN: En la historia de la Endodoncia, se han utilizado distintos métodos para determinar la longitud de los canales radiculares, como sensación táctil y radiografías. Últimamente, han adquirido gran importancia los localizadores apicales electrónicos, por su gran precisión. Actualmente se ha incorporado el uso de imagenología con Cone Beam. Debido a que existen muchas formas de medir dicha longitud, es necesario ponerlos a prueba y ver si se asemejan a la técnica gold estándar definida en la literatura como el localizador electrónico de foramen apical. El propósito de esta investigación es determinar si existen diferencias estadísticamente significativas en la medida de la longitud de trabajo entre el localizador electrónico de foramen apical, y el uso de Cone Beam procesado con el software 3D endo de Dentsply Sirona. Para esto, se seleccionaron 30 premolares extraídos; se les tomó un Cone Beam para ser analizados con el software 3D endo y medir la longitud de trabajo. Una vez hecho esto, se realizó manualmente cavidad de acceso y se preparó el tercio cervical con fresas Gates Glidden 1 y 2; luego, los dientes fueron colocados en un modelo Pro Train, que asemejó las propiedades de los dientes en la cavidad oral, para permitir el uso del localizador electrónico de foramen y determinar la longitud de trabajo. Una vez obtenidos los datos, fueron comparados a través del Test de Proporciones (p=0.05 hipotético), dando como resultado p=0,2 lo que indica que no existen diferencias estadísticamente significativas en la medida de la longitud de trabajo entre ambos métodos.

ABSTRACT: Various methods have been used in the history of endodontics, to determine the length of the root canals (working length), such as tactile sensation and X-rays. Recently, apical locators have acquired importance, due to their precision. The use of Cone Beam has now also been incorporated. Because there are many ways to measure this length, it is necessary to test them and see if they resemble the standard gold measurement technique defined in the literature as the electronic apex locators. The purpose of this research is to determine whether there are statistically significant differences in the working length between the electronic apex locators, and the use of Cone Beam processed with the Software 3D Endo by Dentsply Sirona. For this, 30 extracted pre-molars were selected, for Cone Beam tomography and 3D endo Software analysis, to measure the working length. Once this was carried out, cavity preparation was performed manually, and the cervical third approached with gates glidden drills 1 and 2. Subsequently, the teeth were placed in a Pro Train model, which resembled the properties of the teeth in the oral cavity, to allow the use of the electronic apex locators to determine the working length.Once the data were obtained, they were compared through the proportions Test (p = 0.05 hypothetical), resulting in p = 0.2, indicating that there are no statistically significant differences in the working length between the two methods.

Influence Of Music Therapy On Anxiety, Pain Perception, Heart Rate And Blood Pressure Of Patients Undergoing Endodontic Treatment - A Randomized Control Trial

There is a very peculiar role of “Kshar Karma” (an Anushastra), in the management of Arsha, as described by Sushrutacharya.Acharyas have mentioned Kadali as suitable for the Kshara formulation. Patients suffering from AbhyantaraArsha are subjected to KadaliPratisaraneeyaKshar and efficacy ofKadaliKsharPratisaran and inj. Setrol is compared in the management of AbhyantarArsha. In Clinical study an Open randomized controlled clinical trial is conducted of trial group A and control group B for 30 patients in each group.In observations a detailed explanation is given aboutdistribution of patients according to age, sex, occupation.The results of the study are analyzed statistically compared and are presented in tables and graphs form. By highlighting the outcome of the study along with limitations and scope of further improvement it is concluded that KadaliKsharpratisarana gives potent effects in AbhyantarArsha.

Permanent Maxillary Premolars With Three Canals- A Case Report

Maxillary first premolar is a bi-rooted tooth with several variations in the root canal morphology. Usually it has 2 canals, however at times there could be an additional third canal present which could easily be missed by the clinician owing to lack of awareness and knowledge about the canal variations. Awareness of internal and external anatomy of tooth and also about its variations are essential for successful endodontic therapy. Prevalence of three canals in maxillary premolar is very low. This case report describes the endodontic management of permanent maxillary premolars with three root canals.

Analysis of Pediatric Dentistry Patients Treated Under General Anesthesia

This study was to determine the characteristics of children treated under general anaesthesia according to age, gender and medical condition, to investigate different indications for the dental treatment in children, and to assess the mean number of different dental procedures performed under general anaesthesia, in a single dental care unit in one year, according to age groups, indications and medical conditions. Methods: A retrospective study was designed. Data were collected from patients rehabilitation under general anaesthesia over a one year period (February-2018 to January-2019). The information collected from the records included age, gender, general health status, indications for general anaesthesia, type of procedure, attendance for review appointment and treatment provided including the number of primary and permanent teeth extracted and restored. Results: A total of 107 patients, 64 male and 43 female received dental treatment under general anaesthesia at private dental clinic in Istanbul, Turkey. The main indications for general anaesthesia were behaviour management problem (44.6%). It was determined that the number of dental fillings in primary teeth was higher (60.16%) in the 2-5 year age group. Conclusion: It has been observed that application of general anesthesia is an effective and efficient way in providing dental treatment to disabled individuals with special healthcare needs, young children with poor cooperation and children requiring comprehensive dental treatment as the dental treatment can be completed in a single session.