A 12-month Follow-Up Study of Pulp Oxygen Saturation in Deciduous Molars After Selective and Nonselective Carious-Tissue Removal: A Randomized Pilot Trial

ABSTRACT Objective: To compare the pulp vitality of deciduous molars before and after selective caries removal (SCR) or nonselective caries removal to hard dentin (NSCR) over one year, using oxygen saturation percentage (%SaO2). Material and Methods: Deciduous molars with deep occlusal/proximal-occlusal caries lesions were randomized to SCR (n=22) or NSCR groups (n=22). After the caries removal, the teeth were protected with calcium hydroxide cement and restored with composite resin (Filtek Z250). The pulp condition diagnosis was evaluated at baseline, immediately after caries removal, and follow-up (7 days, 1-, 6- and 12-months) by %SaO2. Pulp exposure and pulp necrosis were primary outcomes, and %SaO2 was secondary. Results: Intraoperative pulp exposure occurred in four teeth of the NSCR group (18.2%) and one tooth of the SCR group (4.5%) (p>0.05). Two cases of pulp necrosis occurred in the NSCR group (10%). No difference in %SaO2 pulp was observed in the inter-and intragroup comparison over time (p>0.05). Conclusion: Advantageously, the %SaO2 minimizes preoperatory pulp vitality diagnosis subjectivity before SCR/ NSCR treatments. Furthermore, the pilot study results suggest the pulp response of deciduous molars, when evaluated by clinical, radiographic, and pulp %SaO2 seems not to differ between teeth treated with SCR or NSCR.

Tratamento Endodôntico de Dente com Calcificação Radicular Pós-Trauma: Relato de Caso Clínico / Endodontic Treatment Of Teeth With Post-Trauma Root Calcification: Case Report

A calcificação do canal radicular é um processo que pode ocorrer posteriormente a um traumatismo dentário ou que pode se desenvolver lentamente em decorrência do envelhecimento dentário fisiológico. É caracterizada pela deposição de tecido duro tanto na câmara pulpar como no canal radicular. Essa condição pode ser diagnosticada através de radiografias periapicais e tomografia computadorizada. Em alguns casos, pode estar associada à necrose pulpar e presença de lesão periapical, e o tratamento pode ser considerado bastante complexo. Este relato de caso clínico aborda o tratamento endodôntico do elemento 21, sintomático, com obliteração do canal radicular e necrose pulpar como sequela de um traumatismo dentário. Após a realização de todos os exames, foi dado o diagnóstico de periodontite apical crônica, sendo proposto o tratamento endodôntico convencional. A maior dificuldade encontrada foi a localização da entrada do canal radicular. Inúmeras radiografias foram realizadas a fim de evitar desvios. Somente ao final do terço médio foi possível localizar a entrada do canal radicular e dar prosseguimento ao tratamento, utilizando a técnica coroa-ápice e medicação intracanal à base de hidróxido de cálcio durante as sessões. Foi possível realizar a obturação do canal radicular quando a paciente se mostrou assintomática. Obteve-se sucesso na realização da técnica, e, após a conclusão do caso, foi possível observar remissão dos sintomas. Após um período de acompanhamento de 6 meses e, posteriormente, de 3 anos, foi possível observar cicatrização dos tecidos periapicais

The calcification of the root canal is a process that may occur after a dental trauma or slowly develop due to physiological dental aging. It is characterized by hard tissue deposition on both the pulp chamber and the root canal. Periapical radiography and computed tomography can be used to diagnose this condition. In some cases, it may be associated with pulp necrosis and the presence of periapical injury, and the treatment may be considered to be quite complex. This case report addresses the endodontic treatment of the central incisor, symptomatic, with root canal obliteration and pulp necrosis as a sequela of dental trauma. After all the tests, chronic apical periodontitis was diagnosed, and conventional endodontic treatment was proposed. The most significant difficulty faced was when locating the root canal's entrance. Numerous radiographs were carried out to avoid deviations. The opening of the root canal could only be found at the end of the middle third, so treatment could proceed by using the crown- down technique and intracanal medication based on calcium hydroxide during the sessions. When the patient was asymptomatic, the root canal has been filled. The accomplishment of the technique was successful, and after finishing the case, there was remission of symptoms. After a six-month follow-up period and three years, the healing of the periapical tissues was observed.

An unusual repair of perforating internal inflammatory root resorption; a case report of endodontic treatment

Internal inflammatory root resorption (IIRR) can occur as a serious complication of dental trauma which leads to progressive loss of the root structure. An early diagnosis could influence the therapeutic approach, but endodontic treatment becomes a challenge with a doubtful prognosis. The present report described an unusual clinical presentation of an IIRR with perforation resulting from a trauma four years previous. A 15-year-old female patient was presented to our service with pain in the maxillary incisor region. Intraoral radiography revealed a large radioloucent area compatible with IIRR, communicating with the periodontium in the middle third on the distal root face of the right central incisor. The root canal of the right central incisor was chemo-mechanically prepared. The calcium hydroxide (CH) intracanal medication was used and renewed periodically four times. The root canal was filled only in the cervical region to the level of resorption by the inverted gutta-percha cone technique. Clinically and radiographically, all follow-up examinations revealed an asymptomatic tooth, evidencing periapical tissue repair and new bone formation. The tooth remained asymptomatic 3 years afterwards. The present case report supports the idea of executing satisfactory intracanal decontamination by chemo-mechanical preparation, thus creating a favourable environment for tissue repair.

Aplicación de Biodentine en Endodoncia Regenerativa: Presentación de Tres Casos Clínicos / Application of Biodentine in Regenerative Endodontics: Presentation of Three Clinical Cases

El Biodentine es un material biocerámico y bioacti-vo que puede emplearse como sustituto activo de la dentina. Entre sus numerosos usos se incorpora su utilización como sellador del coágulo en los procedi-mientos endodónticos regenerativos, logrando me-jores propiedades con respecto al Gold standard. Se presenta la resolución clínica y radiográfica de tres situaciones clínicas, mediante la aplicación del proto-colo de los procedimientos endodónticos regenerati-vos, en los que se utilizó Biodentine como alternativa para el sellado del coágulo a nivel cérvico-radicular, en la obturación a nivel del límite amelocementario (AU)

Biodentine is a bio-ceramic and bioactive material that can be used as an active substitute for dentin. Its many uses include its use as a clot sealer in regenerative endodontic procedures, achieving better properties compared to the Gold standard. The clinical and radiographic resolution of three clinical situations is presented, by applying the protocol of regenerative endodontic procedures, where Biodentine was used as an alternative for sealing the clot at the cervical-radicular level in the obturation at the level of the cementoenamel limit (AU)

Regenerative endodontics model in immature infected rat molars using two step protocol

Aim: to develop a model for regenerative endodontics using newly-weaned Wistar rats immature molars with pulp necrosis to histologically describe the evolution of apical tissues following treatment with a bi-antibiotic paste, induced bloodclot formation and MTA. Methods: Ten 25-day-old female Wistar rats were divided into an initial control group (Ci) and two experimental groups in which pulp necrosis was experimentally induced on the left mandibular first molar by exposing the pulp chamber and leaving it open to the oral environment. One of the experimental groups was left untreated (E1) while the other was submitted to a protocol of regenerative endodontics 10 days thereafter (E2). Fifteen days after placement of a bi-antibiotic paste, bleeding was induced into the root canal space and MTA was placed upon. Animals were euthanized 30 days later. Right mandibular first molars served as an 80-day-old final control group (Cf). Each hemimandible was histologically processed to analyse parameters associated with root development. Statistical analysis was carried by means of ANOVA; p values below 0.05 were considered statistically significant. Results: baseline (i.e. 25-days old) mean root length and apical diameter of the distal root canal were 1.84±0.25 and 0.38±0.02mm respectively. Following the regenerative endodontic protocol, cells lining the walls of the root canal and significant increase to both length (2.37±0.22mm) and diameter (0.32±0.03 mm) were observed. Conclusions: newly-weaned Wistar rats serve as a suitable model to evaluate regenerative endodontic protocols. However, further research is needed in order to disclose the nature of the cells and/or cell mediators involved

Uso do instrumento Reciproc Blue associado à terapia fotodinâmica: relato de caso / Use of the Reciproc Blue instrument associated with photodynamic therapy: case report

Introdução: A presença de microrganismos é considerada a principal causa de insucesso da terapia endodôntica. Além disso, a anatomia interna dos dentes também representa um grande desafio para os endodontistas. Desse modo, lançar mão da tecnologia reduz tempo clínico e aumenta a chance de sucesso da terapia endodôntica. Objetivo: O objetivo do presente estudo foi relatar um caso clínico com a utilização de instrumentação mecanizada e o sistema Reci- proc Blue associados à terapia fotodinâmica. Descrição: Paciente do sexo feminino, melanoderma, compareceu à clínica escola de uma faculdade de Odontologia apresentando duas fístulas intrabucais ativas na região de fundo de vestíbulo próxima aos ápices dos dentes #12 e #22. Após os exames clínicos, radiográficos, testes de sensibilidade e rastreamento de fístulas, estabeleceu-se o diagnóstico de necrose pulpar, sugestível de abscesso apical crônico dos incisivos laterais superiores. Resultados: O tratamento endodôntico dos dois elementos dentários foi realizado em sessão única, utilizando o instrumento Reciproc Blue em movimento reciprocante associado à terapia fotodinâmica. Após 30 dias da conclusão dos tratamentos endodônticos e restauradores, os dentes apresentavam-se assintomáticos e com cicatrização das fístulas intrabucais. Conclusão: O uso do sistema Reciproc Blue associado à terapia fotodinâmica foi eficaz. Constatou-se o sucesso clínico e radiográfico da terapêutica aplicada, verificando-se o restabelecimento da região periapical, com regressão da lesão radiograficamente e ausência de sinais clínicos e sintomas de infecção do canal radicular. O acompanhamento por tempo prolongado é necessário para se avaliar o total reparo da lesão periapical (AU).

Introduction: The presence of microorganisms is considered the main cause of endodontic therapy failure. In addition, an internal anatomy also poses a major challenge for endodontists. In this way, avail a series of quick techniques and increase the chance of success. The reason of this study was to relate clinical cases, root canal treatment, using mechanized instrumentation with the system Reciproc Blue instrument, associated with photodynamic therapy. Case report: A female genetic patient, brown skin, presented at the school clinic of a dental school, with a major complaint of "blistering on the gum." At the clinical examination, the target dates are inside the mouth active in the selection bottom region near the apexes of the elements 12 and 22. Through clinical, radiographic, sensitivity and screening tests of fistulae, diagnosis and diagnosis of pulp necrosis, suggestive of chronic apex abscess of the incisors. Results: Endodontic treatment of the two dental elements was performed in a single session using the Reciproc Blue instrument in a reciprocating motion associated with photodynamic therapy. After 30 days of completion of endodontic and restorative treatments, one patient returned for evaluation and clinical follow-up. The new asymptomatic presentation and with a healing of the intrabucal fistulas. Conclusion: The system Reciproc Blue associated with photo-dynamic therapy was effective. It was verified the clinical and radiographic success of apicality, confirming the reestablishment of the apex region with regression of the radiographic lesion and the absence of clinical signs and signs of infection of the root canal. The patient is with the clinician and radiographic studies (AU).

Nível de conhecimento dos odontopediatras e endodontistas de Ilhéus-BA quanto ao procedimento de revascularização pulpar / Level of knowledge of pediatric dentists and endodontists of Ilheus-BA regarding the pulp revascularization procedure

Dentes necrosados com rizogêneze incompleta representam um desafio para os endodontistas e odontopediatras, visto que as paredes radiculares desses dentes são mais finas, o que as tornam mais susceptíveis a fraturas. Durante muitos anos a técnica preconizada foi a apicificação que ainda é bastante utilizada. Nesta técnica são realizadas trocas constantes de medicação intracanal. O dente continua fragilizado e existe o risco do paciente não concluir o tratamento já que tal técnica demanda várias sessões clínicas. Com os avanços da ciência, surge a revascularização pulpar, trazendo vários beneficíos, entre os quais estão a continuidade apical e o ganho de espessura das paredes, além do benefício de conclusão do tratamento em uma ou duas sessões. Entretanto é necessária sua proservação que leva em média dois anos. O objetivo desta pesquisa foi avaliar o nível de conhecimento dos odontopediatras e endodontistas do município de Ilhéus-Bahia, frente a casos de necrose pulpar de dentes com formação radicular incompleta. O método e forma de análise de dados foram de um estudo observacional, transversal, realizado em consultórios do município de Ilhéus-BA que foram selecionados por amostragem aleatória. Os dados foram coletados por meio de um questionário contendo 10 questões de múltipla escolha sobre revascularização pulpar, especialização do profissional e tempo de formação. 20 profissionais aceitaram participar da pesquisa. Desses, 10% não sabiam ou nunca tinham ouvido falar sobre a revascularização pulpar. Conclui-se que ainda existem especialistas no Município de Ilhéus-BA que apresentam conhecimento insuficiente sobre a terapia endodôntica regenerativa, sendo que os mesmos deveriam ter conhecimento desta técnica já que são os profissionais que prestam o atendimento ao paciente jovem com dentes necrosados, reforçando a necessidade de elaboração de estratégia de conscientização e educação de saúde para habilitação e atualização dos mesmos(AU)

Necrotic teeth with incomplete rizogenesis representa challenge for endodontists and pediatric dentists, since the root walls of these teeth are thinner, which makes them more susceptible to fractures. For many years the recommended technique was apexification, which is still widely used. In this technique, constant changes of intracanal medication are performed. The tooth remains fragile and there is a risk that the patient will not complete the treatment as this technique requires several clinical sessions. With advances in science, pulp revascularization appears, bringing several benefits, among which are the apical continuity and the gain in thickness of the walls, in addition to the benefit of completing the treatment in one or two sessions. However, its preservation is necessary, which takes on average two years. The objective of this research was to evaluate the level of knowledge of pediatric dentists and endodontists in the municipality of Ilhéus-Bahia, in the face of cases of pulp necrosis of teeth with incomplete root formation. The method and form of data analysis were from an observational, cross-sectional study, carried out in offices in the municipality of Ilheus-BA that were selected by random sampling. Data were collected through a questionnaire containing 10 multiple-choice questions about pulp revascularization, professional specialization and training time. 20 professionals agreed to participate in the research. Of these, 10% did not know or had never heard of pulp revascularization. It is concluded that there are still specialists in the municipality of Ilhéus-BA who have insufficient knowledge about regenerative endodontic therapy, and they should have knowledge of this technique since they are the professionals who provide care to young patients with necrotic teeth, reinforcing the need to develop a health awareness and education strategy to enable and update them(AU)

X-radiation does not affect the dental pulp: a morphological study in rats / A radiação X não afeta a polpa dentária: um estudo morfológico em ratos

Introduction: Radiotherapy is one of the methods used as a treatment for malignant tumors in the head and neck region and it can cause tissue damage in the irradiated areas. In head and neck radiotherapy, teeth are often included within the irradiation area and, consequently, the dental pulp; which receives high doses of radiation. Objective: To evaluate the effects of ionizing radiation on the pulp tissue of rat teeth. Methodology: A double-blind experimental assay with 35 Albinus Wistar rats divided into seven groups was performed; one control group, three groups irradiated with 15 Gy, and three groups irradiated with 25 Gy. The irradiated groups were submit-ted to a single dose of radiation and sacrificed 24 hours, 7 days, and 22 days after irradiation, respectively. The samples were evaluated for the morphological presence of inflammatory infiltrate, edema, necrosis, fibrosis, and degeneration of blood vessels. Statistical analysis was performed using the Kruskal-Wallis and Dunn tests with p < 0.05. Results: Hyaline degeneration of the pulp blood vessels in the irradiated teeth was statistically signifi-cant in all irradiated groups. Inflammatory infiltrate, edema, necrosis or fibrosis was not observed. Conclusion:A single X-radiation dose is not able to affect the dental pulp connective tissue in the long term with no clinical damage.

Introdução: A radioterapia é um dos métodos utilizados como tratamento para tumores malignos em região de cabeça e pescoço e que pode causar danos aos tecidos nas áreas irradiadas. Na radioterapia de cabeça e pescoço, os dentes são comumente incluídos dentro da área de radiação e, consequentemente, a polpa dentária, recebe altas doses de radiação. Objetivo: Avaliar os efeitos da radiação ionizante no tecido pulpar de dentes de ratos. Metodologia: Foi realizado um ensaio experimental duplo-cego com 35 ratos Albinus Wistar divididos em sete grupos: um grupo controle, três grupos irradiados com 15 Gy e três grupos irradiados com 25 Gy. Os grupos irradiados foram submetidos a uma dose única de radiação e sacrificados 24 horas, 7 dias e 22 dias após a irradiação, respectivamente. As amostras foram avaliadas quanto à presença morfológica de infiltrado inflamatório, edema, necrose, fibrose e degeneração nos vasos sanguíneos. A análise estatística foi realizada por meio dos testes de Kruskal-Wallis e Dunn com p < 0.05. Resultados: Degeneração hialina nos vasos sanguíneos pulpares dos dentes irradiados foi estatisticamente significante em todos os grupos irradiados. Não foi observado infiltrado inflamatório, edema, necrose ou fibrose. Conclusão: Uma dose única de radiação X não é capaz de afetar o tecido conjuntivo da polpa dentária a longo prazo sem danos clínicos.

Different techniques for the treatment of teeth with an incomplete root development and pulp necrosis: a systematic review / Diferentes técnicas para o tratamento de dentes com rizogênese incompleta e necrose pulpar: uma revisão sistemática

Introduction: The objective of this systematic review was to compare the apexification techniques of calcium hydroxide (Ca(OH)2), or mineral trioxide aggregate (MTA), with the pulp regeneration technique, using cohort studies, and non-randomized and randomized clinical trials. Methods: The methodology was based on electronic research in the following databases: PubMed, MEDLINE, Google Scholar, SciELO, and LILACS. In addition, a manual search was carried out using the references that were listed in the articles found. Results: A total of 403 potentially eligible studies were found, with seven being included in the inclusion criteria of this systematic review. The seven studies involved a total of 312 teeth. The minimum time of a follow-up period was 12 months. The irrigation solution most used was sodium hypochlorite, for both of the apexification and revascularization techniques. The medication commonly chosen in the apexification groups was Ca(OH)2, with antibiotic triple paste in the revascularization groups. The clinical rate of success in the groups treated with revascularization varied from 76% to 100%, while in the groups treated with apexification, it ranged from 68% to 100%. Only two studies reached a success rate equal to 100%. Conclusions: Variable levels of evidence were observed in relation to the treatments. However, it was confirmed that revascularization is an excellent option since its outcomes produced a greater gain of thickness and root length, besides developing a decrease in the apical foramen.

Introdução: O objetivo desta revisão sistemática foi comparar as técnicas de apexificação, com hidróxido de cálcio (Ca(OH)2) ou agregado trióxido mineral (MTA), com a técnica de regeneração pulpar, utilizando estudos coorte, ensaio clínico não randomizado e randomizado. Métodos: A metodologia foi baseada em pesquisa eletrônica nas seguintes bases de dados: PubMed, MEDLINE, Google Acadêmico, SciELO e LILACS. Além disso, foi realizada uma pesquisa manual utilizando as referências listadas nos artigos encontrados. Resultados: Foram encontrados 403 estudos potencialmente elegíveis, sendo sete incluídos nos critérios de inclusão desta revisão sistemática. Os sete estudos envolveram um total de 312 dentes. O tempo mínimo de um período de acompanhamento foi de 12 meses. A solução de irrigação mais utilizada foi o hipoclorito de sódio, para as técnicas de apexificação e revascularização. O medicamento comumente escolhido nos grupos de apexificação foi o Ca(OH)2, com pasta tripla antibiótica nos grupos de revascularização. A taxa clínica de sucesso nos grupos tratados com revascularização variou de 76% a 100%, enquanto nos grupos tratados com apexificação variou de 68% a 100%. Apenas dois estudos atingiram uma taxa de sucesso igual a 100%. Conclusões: Níveis variáveis de evidência foram observados em relação aos tratamentos. No entanto, confirmou-se que a revascularização é uma excelente opção, pois seus desfechos produzem maior ganho de espessura e comprimento radicular, além de diminuir o forame apical.

Accuracy of the dental pulp sensibility test using cold spray for the diagnosis of pulp diseases: an observational clinical study

The dental pulp sensibility test is one of the main auxiliary resources for the diagnosis of pulp pathologies, and its accuracy is still debatable. This cross-sectional observational study evaluated the accuracy of the pulp sensibility test (PST) using cold spray (1,1,1,2-tetrafluoroethane) for the diagnosis of pulp diseases and determined the effect of individual and clinical variables on the reliability of this test. The paper was designed following the STROBE statement. Sixty patients with indications for primary endodontic treatment were selected and examined from August 2017 to July 2018. Data collection was performed through interviews, clinical/radiographic examinations and the PST. The results of the cold test, along with data on sex, age, the tooth type regarding the root number, and the presence of restorations and caries, as well as the recent consumption of analgesics, were recorded. The presence of bleeding within the pulp chamber was used as the gold standard to compare with the clinical diagnosis and to identify the true-positive, false-positive, true-negative, and false-negative responses. The accuracy of PST achieved in subgroups of individual and clinical variables was compared using the chi-square test with a significance level of 5% (p < 0.05). The PST with the use of cold spray showed a sensitivity of 0.88, a specificity of 1.00, a positive predictive value of 1.00, a negative predictive value of 0.86, and an accuracy of 0.93. The accuracy of the cold spray was not affected by individual or clinical variables. The PST with the use of cold spray is an accurate and reliable method for determining the diagnosis of pulp diseases, especially in cases of pulp vitality or irreversible pulpitis.

Eficacia ex vivo de sustancias irrigadoras frente a Enterococcus faecalis en conductos radiculares primarios / Ex vivo efficacy of irrigation substances against Enterococcus faecalis in primary root canals

En la práctica de odontología pediátrica el tratamiento endodóntico es un reto permanente en el profesional, considerando que la clave de un procedimiento exitoso es un adecuado protocolo de irrigación; por ello el objetivo de esta investigación pretende comprobar la eficacia clínica ex vivo frente a Enterococcus faecalis del NaOCl, la clorhexidina, y la solución salina. Se realizó un estudio ex vivo con enfoque cuantitativo, diseño experimental, nivel de investigación descriptiva en ámbito de laboratorio y temporalidad actual. Se analizó doce órganos dentarios deciduos sin distinción específica con indicación previa de extracción en pacientes pediátricos que acudieron a la consulta de Odontopediatría en la Carrera de Odontología de la Universidad Católica de Cuenca durante el periodo 2019 ­ 2020. Se evaluó mediante técnica de observación directa, obteniendo como resultado que el NaOCl y la Clorhexidina mostraron altos índices de inhibición frente al Enterococcus faecalis. Sugiriendo así el NaOCl al 5,25% o gluconato de clorhexidina al 2% como una alternativa en la terapia pulpar, según las condiciones individuales y del caso clínico correspondiente, respaldado también por la Asociación Estadounidense de Odontología Pediátrica (AAPD)(AU)

In the practice of pediatric dentistry, endodontic treatment is a permanent challenge for the professional, considering that the key to a successful procedure is an adequate irrigation protocol; therefore, the objective of this research is to verify the ex vivo clinical efficacy of NaOCl, chlorhexidine and saline solution against Enterococcus faecalis. An ex vivo study was carried out with a quantitative approach, experimental design, descriptive research level in a laboratory setting and current time frame. Twelve deciduous dental organs were analyzed without specific distinction with previous indication of indicated extraction of pediatric patients who attended the Pediatric Dentistry consultation at the Dentistry Department of the Catholic University of Cuenca during the period 2019 - 2020. It was evaluated by means of direct observation technique. As a result, NaOCl 5,25% and Chlorhexidine 2% showed high inhibition indexes against Enterococcus faecalis. Thus suggesting NaOCl or chlorhexidine gluconate as an alternative in pulp therapy according to the individual conditions of the patient and the clinician also supported by the American Association of Pediatric Dentistry (AAPD)(AU)

Técnica de apexificación con un sustituto bioactivo de la dentina en una sola sesión: caso clínico / Apexification technique with a bioactive dentin substitute in a single session: a clinical case

Las piezas con necrosis pulpar y ápice abierto son un desafío de la práctica clínica endodóntica. Durante mucho tiempo estas piezas han sido tratadas con la técnica de apexificación con hidróxido de calcio. Esta técnica estimula la formación de una barrera calcificada a nivel apical, pero a partir de varias sesiones de tratamiento y los riesgos asociados que esto conlleva. Hoy en día, con el desarrollo de nuevas tecnologías, están a disposición materiales biocerámicos que permiten realizar el protocolo en una sola sesión. El Biodentine es un biocerámico con tiempo de fraguado corto y buena capacidad de sellado, que permite reducir los tiempos clínicos. El objetivo de este trabajo es presentar un caso clínico de una pieza dentaria diagnosticada con necrosis pulpar y con apicoformación incompleta, tratada con una técnica de apexificación con Biodentine en una sesión (AU)

Fatores preditivos do sucesso en dodôntico em tratamentos realizados por alunos de graduação§ / Predictive factors of endodontic success in treatments performed by undergraduate / Factores predictivos del éxito endodontico en tratamientos realizados por un estudiante

Resumo Introdução e objetivo: Ainda são escassos os estudos que avaliam com exatidão o sucesso do tratamento e retratamento endodônticos e quais as falhas que realmente impactam no desfecho dos mesmos. Determinar o índice e os fatores preditivos para o sucesso de tratamentos e retratamentos endodônticos, realizados por alunos de graduação com o mesmo nível de aprendizado. Materiais e métodos: Foram verificados os registros de proservação, com pelo menos 12 meses, dos tratamentos endodônticos realizados na Faculdade de Odontologia de Pelotas, analisando o sucesso ou o fracasso endodôntico, de acordo com critérios clínicos e radiográficos. As variáveis preditivas no resultado do sucesso do tratamento foram: dente, número de canais, coroa dentária, sintomas, diagnóstico da polpa e índice periapical radiográfico. As variáveis relacionadas ao tratamento foram: técnica de instrumentação, número de sessões e limite de instrumentação apical. Resultados: 136 tratamentos endodônticos foram realizados com um acompanhamento de, pelo menos, 12 meses. A avaliação mostrou que o sucesso endodôntico foi influenciado pelo número de sessões (P = 0,015), diagnóstico inicial e grupo dentário (P= 0.014). Também foi possível observar que, quanto maior o índice periapical radiográfico inicial, pior o prognóstico endodôntico (P < 0.001). Conclusão: O índice de sucesso do tratamento endodôntico foi de 96.7% para casos de polpa vital, 87.5% para os casos de necrose pulpar e 92.9% em retratamentos. Estes índices foram influenciados pelo dente tratado, diagnóstico inicial, índice periapical radiográfico inicial e pelo número de sessões utilizadas no tratamento.

Abstract Introduction and objective: There are still few studies that accurately address endodontic success and which failures actually impact the endodontic treatment outcome. Determine success rate and predictive factors for successful endodontic treatment and retreatment by undergraduate students of the same learning level. Materials and methods: The preservation records (12 months) of the endodontic treatments performed in the Faculty of Dentistry of Pelotas were verified, indicating the success or failure of the treatment. Predictive variables in the outcome of successful endodontic treatment or retreatment were: tooth, number of channels, dental crown, symptoms, pulp diagnosis, radiographic periapical index. The treatmentrelated variables were: instrumentation technique, number of sessions and apical instrumentation limit. Results: 136 endodontic treatments were performed with a follow-up of at least 12 months. The evaluation showed that endodontic success was influenced by the number of sessions (P = 0.015), initial diagnosis and dental group (P = 0.014). It was also observed that the higher the initial radiographic periapical index, the worse the endodontic prognosis (P < 0.001). Conclusion: The success rate of endodontic treatment was 96.7% for cases of vital pulp, 87.5% for cases of pulp necrosis and 92.9% for retreatments. These indices were influenced by type tooth, initial diagnosis, initial radiographic periapical index and the number of visits used in the treatment.

Resumen Introducción y objetivo: Todavía hay pocos estudios que aborden con precisión el éxito endodóntico y cuáles fracasos realmente impactan el resultado del tratamiento endodóntico. Determinar la tasa de éxito y los factores predictivos para el tratamiento y el retratamiento exitoso de endodoncia por estudiantes universitarios del mismo nivel de aprendizaje. Materiales y métodos: Se verificaron los registros de conservación (12 meses) de los tratamientos de endodoncia realizados en la Facultad de Odontología de Pelotas, lo que indica el éxito o el fracaso del tratamiento. Las variables predictivas en el resultado de un tratamiento o retratamiento endodóntico exitoso fueron: diente, número de canales, corona dental, síntomas, diagnóstico pulpar, índice periapical radiográfico. Las variables relacionadas con el tratamiento fueron: técnica de instrumentación, número de sesiones y límite de instrumentación apical. Resultados: se realizaron 136 tratamientos de endodoncia con un seguimiento de al menos 12 meses. La evaluación mostró que el éxito endodóntico estaba influenciado por el número de sesiones (P = 0.015), el diagnóstico inicial y el grupo dental (P = 0.014). También se observó que cuanto mayor es el índice periapical radiográfico inicial, peor es el pronóstico endodóntico (P <0.001). Conclusión: La tasa de éxito del tratamiento endodóntico fue del 96.7% para casos de pulpa vital, 87.5% para casos de necrosis pulpar y 92.9% para retratamientos. Estos índices fueron influenciados por el tipo de diente, el diagnóstico inicial, el índice periapical radiográfico inicial y el número de visitas utilizadas en el tratamiento.

Comparative analysis of the proteomic profile of the dental pulp in different conditions. a pilot study

Abstract This study aimed to quantitatively compare the difference in protein expression in the progression of pulp pathogenesis, as well as to describe the biological functions of proteins identified in pulp tissue. Samples were obtained from six patients treated at the Araçatuba School of Dentistry and were divided into three groups: normal pulp - from teeth extracted for orthodontic indication; inflamed pulp and necrotic pulp - from patients diagnosed with irreversible pulpitis and chronic apical periodontitis, respectively. After previous proteomic preparation, dental pulp samples were processed for label-free quantitative proteomic analysis in a nanoACQUITY UPLC-Xevo QTof MS system. The difference in expression between the groups was calculated using the Protein Lynx Global Service software using the Monte Carlo algorithm. A total of 465 human proteins were identified in all groups. The most expressed proteins in the inflamed pulp group in relation to the normal pulp group were hemoglobin, peroxiredoxins and immunoglobulins, whereas the less expressed were the tubulins. Expression levels of albumins, immunoglobulins and alpha-2-macroglobulin were higher in the necrotic pulp group than in the inflamed pulp group. As for the qualitative analysis, the most prevalent protein functions in the normal pulp group were metabolic and energetic pathways; in the inflamed pulp group: cellular communication and signal transduction; and regulation and repair of DNA/RNA, while in the necrotic pulp group proteins were associated with the immune response. Thus, proteomic analysis showed quantitative and qualitative differences in protein expression in different types of pulp conditions.

Resumo Este estudo teve como objetivo comparar quantitativamente a diferença da expressão de proteínas na progressão da patogênese pulpar, bem como descrever as funções biológicas das proteínas identificadas no tecido pulpar. As amostras foram obtidas de seis pacientes atendidos na Faculdade de Odontologia de Araçatuba e divididas em três grupos: polpa normal - dentes extraídos por indicação ortodôntica; polpa inflamada e polpa necrótica - pacientes diagnosticados com pulpite irreversível e periodontite apical crônica, respectivamente. Após o preparo proteômico prévio, as amostras de polpa dentária foram processadas para análise proteômica quantitativa livre de marcadores em um sistema nanoACQUITY UPLC-Xevo QTof MS. A diferença de expressão entre os grupos foi calculada usando o software Protein Lynx Global Service através do algoritmo de Monte Carlo. Um total de 465 proteínas humanas foram identificadas em todos os grupos. As proteínas mais expressas no grupo polpa inflamada em relação ao grupo polpa normal foram hemoglobinas, peroxirredoxinas e imunoglobulinas, enquanto as menos expressas foram as tubulinas. Os níveis de expressão de albuminas, imunoglobulinas e alfa-2-macroglobulina foram maiores no grupo polpa necrótica do que no grupo de polpa inflamada. Quanto à análise qualitativa, as funções proteicas mais prevalentes no grupo polpa normal foram vias metabólicas e energéticas; no grupo polpa inflamada: comunicação celular e transdução de sinal; e regulação e reparo de DNA / RNA, enquanto no grupo polpa necrótica as proteínas foram associadas à resposta imune. Assim, a análise proteômica mostrou diferenças quantitativas e qualitativas na expressão de proteínas em diferentes tipos de condições pulpares.

Antimicrobial Photodynamic Therapy in the Endodontic Treatment of Deciduous Teeth: In Vivo Pilot Study

Abstract Objective: To evaluate the Antimicrobial Photodynamic Therapy (aPDT) in infected deciduous teeth by quantifying the viable bacteria in root canal treatment. Material and Methods: Radicular canal cultures were collected (n= 10). Four intra-canal samples were collected at four different times in each of the sampled teeth, as follows: Time 1 (T1), baseline: After opening the pulp-chamber; Time 2 (T2): After application of aPDT; Time 3 (T3): After mechanical, chemical manipulation; Time 4 (T4): After a second application of aPDT. The aPDT was performed with a 4J/cm energy low-intensity diode, together with 0.005% methylene blue as a photosensitizer. The clinical specimens were taken to the laboratory for a bacteria count (colony forming units) and the results were statistically analyzed using the Friedman and Wilcoxon tests, with a significance level of α=0.05. Results: Statistical differences were seen between the numbers of bacteria at times T1-T2, T1-T3 and T1-T4 on the cultivated plates. However, no significant statistical differences were observed between the number of bacteria in samples T2-T3, T2-T4 and T3-T4. Conclusion: Antimicrobial photodynamic therapy can be a good co-adjuvant in root canal decontamination of necrotic primary teeth.

Qualitative and quantitative molecular analysis of bacteria in root canals of primary teeth with pulp necrosis

Abstract Information about bacterial diversity, such as the number of each species in the root canals of primary teeth, contributes to improving our effective management of infections of endodontic origin in primary teeth. This study made a qualitative and quantitative assessment of the bacteria in the root canals of primary teeth with necrotic pulp, using the fluorescence in situ hybridization (FISH) technique. Thirty-one primary teeth with pulp necrosis from 31 children were evaluated using the FISH technique, to detect the presence and density of Aggregatibacter actinomycetemcomitans, Campylobacter rectus, Enterococcus faecalis, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Streptococcus, Streptococcus mutans, Streptococcus sobrinus, Tannerella forsythia and Treponema denticola. Descriptive measures explained the data related to density, and Student's t-test assessed the differences among the densities of each bacterium, according to signs and symptoms. The bacterial density was paired and correlated. All bacteria tested were detected and identified in all the samples. The average number of bacterial individuals from each species ranged from 1.9 x 108 cells/mL (S. mutans) to 3.1 x 108 cells/mL (F. nucleatum) (p > 0.05). The sum of the mean counts of each bacterium represented almost 80% of the entire microbial community. Patients with pain had significantly more T. denticola, and those with edema showed a greater density of Streptococcus and P. nigrescens (p < 0.05). This study revealed that all 12 bacteria evaluated were found in all primary teeth with pulp necrosis. There was no predominance among the species studied; all species had a similar number of individuals.

Is there an association between crown discoloration and pulp necrosis in traumatized permanent teeth? A meta-analysis

Abstract The present study aimed to identify the scientific evidence regarding the association between crown discoloration and pulp necrosis in traumatized permanent teeth. A systematic literature search was conducted in the PubMed/Medline, Lilacs/BBO, Scopus, Web of Science, Cochrane Library databases, and grey literature. Quality assessment and bias control were carried out according to the Fowkes and Fulton guidelines. Meta-analysis was performed, and the odds ratio was calculated with a 95% confidence interval. The quality assessment of the evidence was determined for the meta-analysis outcomes using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. From 2,702 studies identified, five articles met the inclusion criteria. One among these showed no methodological soundness and was excluded from the meta-analysis, and the remaining four studies were included in the meta-analysis. The total number of traumatized permanent teeth evaluated in the meta-analysis was 367. The results showed a positive association between crown discoloration and pulp necrosis in permanent teeth. Teeth with crown discoloration showed 23 times more chance to present pulp necrosis than teeth without crown discoloration (OR 23.82 [1.25, 452.87]; p = 0.03), with a very low certainty of evidence. There is a significant association between crown discoloration and pulp necrosis of traumatized permanent teeth. Due to the very low strength of evidence according to GRADE, this result should be viewed with caution.

Uso do sistema xp-endo para limpeza do sistema de canais radiculares em dente com reabsorção radicular interna e necrose pulpar: relato de caso / Use of XP-Endo system to clean the root canal system of a tooth with internal resorption and pulp necrosis: case report

Objetivo: este estudo reporta um caso clínico de reabsorção radicular interna em um dente com necrose pulpar que foi submetido ao tratamento endodôntico no qual, na fase de preparo químico-mecânico, foi utilizada uma técnica suplementar de irrigação com o instrumento XP-Endo Finisher. Métodos: após radiografia para diagnóstico e realização dos testes semiotécnicos, fez-se a instrumentação com sistema Protaper Universal, ativação da substância irrigadora utilizada (digluconato de clorexidina a 2%), com o sistema XP-Endo Finisher, remoção da smear layer, com EDTA a 17% ativada com o mesmo sistema, inserção de medicação intracanal Calen, com paramonoclorofenol, e selamento provisório da coroa dentária, com coltosol. Na segunda sessão, realizou-se a obturação utilizando a técnica de Schilder associada à técnica híbrida de Tagger. Conclusão: o sistema XP-Endo Finisher se mostrou eficaz como técnica suplementar de irrigação, capaz de favorecer a limpeza do sistema de canais radiculares (AU)..

Objective: This study presented a case of internal root resorption in a tooth with pulp necrosis that was submitted to endodontic treatment. In this treatment, an additional irrigation technique with a XP-Endo Finisher instrument was used during the chemical-mechanical preparation. Methods: After radiographic diagnostics and semi-technique tests, instrumentation was performed with Protaper universal system, activation of irrigation solutions, 2% chlorhexidine digluconate with the XP-Endo Finisher file, removal of the smear layer with EDTA 17% activated with the same system, intracanal medication Calen with paramonochlorophenol, temporary sealing of the tooth crown with Coltosol. In the second session, an obturation procedure was performed using the Schilder technique associated with the Tagger hybrid technique. Conclusions: The XP-Endo Finisher system was effective as supplementary irrigation technique and it facilitated the cleaning of the root canal system (AU).

Development of a mouse model for pulp-dentin complex regeneration research: a preliminary study

OBJECTIVES: To achieve pulp-dentin complex regeneration with tissue engineering, treatment efficacies and safeties should be evaluated using in vivo orthotopic transplantation in a sufficient number of animals. Mice have been a species of choice in which to study stem cell biology in mammals. However, most pulp-dentin complex regeneration studies have used large animals because the mouse tooth is too small. The purpose of this study was to demonstrate the utility of the mouse tooth as a transplantation model for pulp-dentin complex regeneration research. MATERIALS AND METHODS: Experiments were performed using 7-week-old male Institute of Cancer Research (ICR) mice; a total of 35 mice had their pulp exposed, and 5 mice each were sacrificed at 1, 2, 4, 7, 9, 12 and 14 days after pulp exposure. After decalcification in 5% ethylenediaminetetraacetic acid, the samples were embedded and cut with a microtome and then stained with hematoxylin and eosin. Slides were observed under a high-magnification light microscope. RESULTS: Until 1 week postoperatively, the tissue below the pulp chamber orifice appeared normal. The remaining coronal portion of the pulp tissue was inflammatory and necrotic. After 1 week postoperatively, inflammation and necrosis were apparent in the root canals inferior to the orifices. The specimens obtained after experimental day 14 showed necrosis of all tissue in the root canals. CONCLUSIONS: This study could provide opportunities for researchers performing in vivo orthotopic transplantation experiments with mice.

Revascularização pulpar em dentes permanentes imaturos sem vitalidade pulpar: uma revisão integrativa / Pulp revascularization in immature permanent teeth without pulp vitality: an integrative review

Introdução: Dentes permanentes imaturos que evoluem para necrose pulpar representam um desafio para tratamento endodôntico. A endodontia regenerativa e técnicas de revascularização pulpar surgem como um campo dinâmico e potencialmente ideal para terapia clínica em dentes com desenvolvimento radicular incompleto. Objetivo: Revisar a literatura sobre as técnicas de revascularização pulpar no tratamento de dentes com ausência de vitalidade pulpar com ápice radicular imaturo. Métodos: Os descritores "pulp revascularization", "pulp necrosis", "immature permanent tooth", "revascularization", "revitalization", "dental pulp", "regeneration" foram utilizados para obtenção de artigos em língua inglesa, que apresentassem conteúdo disponibilizado na íntegra e publicados nos últimos 15 anos. Foram excluídos os trabalhos de relatos de caso e/ou séries de casos. Conclusão: Artigos revisados apresentaram uma heterogeneidade de resultados quanto à efetividade da técnica de revascularização pulpar, visto que os critérios estabelecidos para determinação do sucesso variavam entre os autores. O material mais comumente utilizado na técnica empregada consiste no Agregado Trióxido Mineral (MTA) em consistência pastosa aplicada sobre coágulo sanguíneo com formação induzida no interior do canal. Foi observada escassez de estudos laboratoriais e clínicos sobre as técnicas e materiais em revascularização pulpar, que suportem sua indicação, o que representa uma lacuna em potencial na literatura e requer cautela na indicação desta técnica.

Introduction: Immature permanent teeth that evolve to pulp necrosis represent a challenge for endodontic treatment. Regenerative endodontics and pulp revascularization techniques appear as a dynamic and potentially ideal field for clinical therapy in teeth with incomplete root development. Objective: To review the literature on pulpal revascularization techniques in the treatment of teeth with absence of pulp vitality with immature root apex. Methods: The descriptors "pulp revascularization", "pulp necrosis", "immature permanent tooth", "revascularization", "revitalization", "dental pulp" and "regeneration" were used to obtain articles in English that presented content available in full and published in the last 15 years. Works of case reports and/or series of cases were excluded. Conclusion: Reviewed articles presented a heterogeneity of results regarding the effectiveness of the pulp revascularization technique, since the established criteria for determining success varied among the authors. The material most commonly used in the technique used consists of the Mineral Trioxide Aggregate (MTA) in paste consistency applied on blood clot with induced formation inside the canal. A shortage of laboratory and clinical studies on pulp revascularization techniques and materials that support its indication has been observed, which represents a potential gap in the literature and requires caution in the indication of this technique.