Acidente de hipoclorito de sódio durante retratamento endodôntico / Sodium hypochlorite accident during endodontic retreatment / Accidente con hipoclorito de sodio durante retratamiento

O retratamento endodôntico é uma intervenção executada em um dente que já apresenta um tratamento realizado anteriormente que foi mal sucedido clínica e/ou radiograficamente. O objetivo deste trabalho foi o de relatar um caso de retratamento endodôntico na clínica de Atenção Básica III da Faculdade de Odontologia de Pernambuco devido ao desconforto estético do incisivo lateral superior que estava fraturado e necessitando de prótese fixa. Após anamnese, exames extra e intra-oral e exames radiográficos, constatou-se o canal do dente 12 havia sido tratado endodonticamente há aproximadamente quatro anos. A remoção da gutta percha contaminada foi realizada com as limas rotatórias EasyLogic RT® 25mm sequência 30.10 torque 4N e 900 RPM, 25.08 torque 4Ne 900 RPM. Após remoção da guta-percha, realizou-se o protocolo de irrigação com solução de hipoclorito de sódio a 2,5% (Biodinâmic). A odontometria foi realizada com localizador apical e confirmada por radiografia periapical e o repreparo do canal radicular confeccionado com a Lima EasyLogic 2® de número 35.06 e posterior irrigação com a solução de Labarraque. Nesse momento, o paciente relatou dor e após aspiração com sugador endodôntico, notou-se sangramento abundante, correspondendo ao extravasamento do hipoclorito de sódio (Enfizema por hipoclorito de sódio. O paciente foi medicado com Amoxacilina 875mg de 12 em 12 horas durante sete dias, Predisin 20mg ­ Corticóide - um comprimido pela manhã por 4 dias e Nimesulida 100mg de 12 em 12 horas durante 5 dias. Após 24 horas o paciente não relatou dor nem edema. Na segunda sessão, 10 dias após o acidente, a obturação foi realizada com cone único de guta-percha 35.06 HBassi (Easy, associado ao cimento Bio C Sealer Fillapex (Angelus®). Concluiu-se que a conduta terapêutica imediata instituída para este caso, foi efetiva para o controle da dor e prevenção de complicações adicionais após injeção acidental de hipoclorito de sódio.

Endodontic retreatment is an intervention performed on a tooth that already has a previously performed treatment that was clinically and/ or radiographically unsuccessful. The objective of this study was to report a case of endodontic retreatment at the Primary Care Clinic III of the Faculty of Dentistry of Pernambuco due to the aesthetic discomfort of the maxillary lateral incisor that was fractured and required a fixed prosthesis. After anamnesis, extra and intraoral exams and radiographic exams, it was found that the root canal of tooth 12 had been endodontically treated for approximately four years. Removal of contaminated gutta percha with those performed with EasyLogic RT® 25mm rotary files sequence 30.10 torque 4N and 900 RPM, 25.08 torque 4N and 900 RPM. After removing the gutta-percha, the irrigation protocol was performed with a 2.5% sodium hypochlorite solution (Biodynamic). Odontometry was performed with an apex locator and confirmed by periapical radiography and root canal re-preparation made with EasyLogic 2® File number 35.06 and subsequent irrigation with Labarraque's solution. At that moment, the patient reported pain and after aspiration with an endodontic sucker, there was profuse bleeding, corresponding to sodium hypochlorite extravasation (Sodium hypochlorite emphysema. The patient was medicated with Amoxicillin 875mg every 12 hours for seven days, Predisin 20mg - Corticosteroid - one tablet in the morning for 4 days and Nimesulide 100mg every 12 hours for 5 days. After 24 hours the patient did not report pain or swelling. In the second session, 10 days after the accident, the filling was performed with a single cone of gutta-percha 35.06 HBassi (Easy, associated with Bio C Sealer Fillapex cement (Angelus®). It was concluded that the immediate therapeutic approach instituted for this case was effective for pain control and prevention of complications. additional doses after accidental injection of sodium hypochlorite.

El retratamiento endodóntico es una intervención que se realiza sobre un diente que ya tiene un tratamiento realizado previamente que resultó clínica y/o radiográficamente fallido. El objetivo de este estudio fue relatar un caso de retratamiento endodóntico en la Clínica de Atención Básica III de la Facultad de Odontología de Pernambuco debido a la incomodidad estética del incisivo lateral maxilar que estaba fracturado y requirió prótesis fija. Después de anamnesis, exámenes extraorales, intraorales y exámenes radiográficos, se encontró que el conducto radicular del diente 12 había sido tratado endodónticamente durante aproximadamente cuatro años. Eliminación de gutapercha contaminada con las realizadas con limas rotatorias EasyLogic RT® 25mm secuencia 30.10 torque 4N y 900 RPM, 25.08 torque 4N y 900 RPM. Tras retirar la gutapercha, se realizó el protocolo de irrigación con una solución de hipoclorito de sodio al 2,5% (Biodynamic). Se realizó odontometría con localizador de ápices y se confirmó mediante radiografía periapical y repreparación del conducto radicular realizada con EasyLogic 2® File número 35.06 y posterior irrigación con solución de Labarraque. En ese momento el paciente refirió dolor y luego de aspiración con ventosa endodóntica presentó sangrado profuso, correspondiente a extravasación de hipoclorito de sodio (Enfisema por hipoclorito de sodio. El paciente fue medicado con Amoxicilina 875mg cada 12 horas por siete días. Predisin 20mg - Corticosteroide - una tableta por la mañana por 4 días y Nimesulida 100mg cada 12 horas por 5 días, luego de 24 horas el paciente no refirió dolor ni hinchazón, en la segunda sesión, 10 días después del accidente, se realizó el relleno con un solo cono de gutapercha 35.06 HBassi (Easy, asociado al cemento Bio C Sealer Fillapex (Angelus®). Se concluyó que el abordaje terapéutico inmediato instituido para este caso fue eficaz para el control del dolor y la prevención de complicaciones. dosis adicionales después de accidente inyección de hipoclorito de sodio.

Efectividad de las Técnicas de Retratamiento Endodóntico en la Remoción de ementos Biocerámicos como Material de Obturación Radicular: Revisión Sistemática

El retratamiento no quirúrgico es la primera opción ante el fracaso del tratamiento endodóntico, por lo que se vuelve importante asegurar el completo retiro del material de relleno del conducto radicular, para mejorar el pronóstico del procedimiento. Los cementos biocerámicos en base a silicatos cálcicos han aparecido en los últimos años, caracterizados principalmente por su bioactividad, lo que adicionalmente se puede traducir en una mayor dificultad para su retiro del conducto radicular. El objetivo de esta revisión es determinar qué técnica de retratamiento es más efectiva en la eliminación de cementos selladores biocerámicos, en base al volumen de material remanente en el conducto radicular, evaluado a través del análisis de imágenes con micro-CT. Se realizó una revisión sistemática mediante la búsqueda de publicaciones en las bases de datos Pubmed, ScienceDirect y SciELO, de los últimos 10 años, en idioma español e inglés. Se incluyeron sólo estudios in vitro de dientes obturados con cemento biocerámico y diferentes técnicas de retratamiento endodóntico, en los que se evalúe la limpieza del conducto post eliminación del relleno mediante micro-CT. De un total de 174 artículos encontrados, 7 fueron seleccionados, analizados y se incluyeron en esta revisión sistemática. Los resultados de los estudios seleccionados no encuentran diferencias significativas en la eliminación de material entre las diferentes técnicas de retratamiento evaluadas. A pesar de la heterogeneidad presente en las metodologías de los artículos analizados, ninguna técnica de retratamiento ni técnicas complementarias lograron dejar completamente limpios los conductos radiculares, por lo que se sugiere realizar nuevos estudios en el futuro que evalúen nuevas técnicas de desobturación radicular.

Non-surgical retreatment is the first option in the case of endodontic treatment failure, so it becomes important to ensure complete removal of the root canal filling material, to improve the prognosis of the procedure. Bioceramic cements based on calcium silicate have appeared in recent years, characterized mainly for their bioactivity, which can additionally translate into greater difficulty in their removal from the root canal. The aim of this review is to determine which retreatment technique is most effective in the removal of bioceramic sealer cements, evaluated through micro-CT image analysis. A systematic review was performed by searching for publications in Pubmed, ScienceDirect and SciELO databases, of the last 10 years in Spanish and English. Only in vitro studies of teeth filled with bioceramic cement and different endodontic retreatment techniques were included, in which the cleaning of the canal after removal of the filling was evaluated by micro- CT. From a total of 174 articles found, 7 were selected, analyzed and included in this systemic review. The results of the included studies did not find significant differences in the removal of material between the different retreatment techniques evaluated. Despite the heterogeneity in the methodologies of the studies, no retreatment technique or complementary techniques were able to completely clean the root canals, it is therefore suggested that new studies be carried out in the future to evaluate new techniques.

Efectividad de tres métodos de desobturación sobre modelos réplica / Effectiveness of three unsealing methods on replica models

El objetivo fue evaluar la eficacia de remoción del material de obturación y el tiempo empleado para la desobturación con tres métodos diferentes, en modelos réplica. Se utilizaron 24 modelos réplica de premolares inferiores instrumentados con sistema Protaper Gold hasta F4, irrigación NaOCl 2,5% y ED-TAC 17%. Obturación termoplastizada sistema Fast Pack Pro. La muestra (n=24) se dividió aleatoriamen-te en tres grupos experimentales (n=8) sometidos a distintos métodos de desobturación. Grupo 1: fresas Gates Glidden II/III y limas Hedstroem. Grupo 2: lima Medium sistema Wave One Gold y punta ultrasóni-ca Ultra X, (Eighteeth). Grupo 3: lima Rotate 35/04 y punta ultrasónica R1 Clearsonic, (Helse). Se midió el tiempo de desobturación. Las piezas se radiogra-fiaron con radiovisiógrafo digital RVG 5200 (Cares-tream), y fueron procesadas con software Image-J. Al analizar cantidad de material de obturación rema-nente, la prueba de Kruskal-Wallis (p<0,05), mostró diferencias estadísticamente significativas entre grupos 2 y 3. Grupo 1 no mostró diferencias signifi-cativas con los otros dos (p>0,05). Al analizar tiempo de desobturación, el test de Kruskal-Wallis no deter-minó diferencias significativas entre grupos 1 y 2 (p>0,05), el grupo 3 tuvo diferencias estadísticamen-te significativas con los grupos 1 y 2 (p<0,05). En con-clusión, ninguno de los sistemas de desobturación evaluados logró eliminar la totalidad del material de obturación. El que combinó limas rotatorias con punta ultrasónica de retratamiento fue el que mos-tró mayor efectividad de remoción y demandó menor tiempo de trabajo (AU)

Objective: to evaluate the effectiveness of obturation material removal and the time that the procedure took, when performing the retreatment with three different methods, in replica models of mandibular premolars. Materials and methods: 24 replica models of lower premolars instrumented with Protaper Gold system up to F4, 2.5% NaOCl irrigation and 17% ED-TAC were used. Thermoplastized sealing with Fast Pack Pro system. The sample (n=24) was randomly divided in three experimental groups (n=8) subjected to different unsealing methods. Group 1: Gates Glid-den burs II and III and Hedstroem files. Group 2: Wave One Gold Medium file system and Ultra X ultra-sonic tip, (Eighteeth). Group 3: Rotate 35/04 file and R1 Clearsonic ultrasonic tip (Helse). Unsealing time was measured. The samples were radiographed with a digital radiovisiograph RVG 5200 (Carestream), and processed with Image-J software. When analyzing the amount of remaining filling material, Kruskal-Wallis test showed statistically significant differences be-tween groups 2 and 3 (p<0,05). Group 1 did not show significant differences with the other two (p>0,05). When analyzing unsealing time, Kruskal-Wallis test determined that there were no significant differ-ences between groups 1 and 2 (p>0,05), but group 3 had statistically significant differences with the other two (p<0.05). None of the unsealing systems evalu-ated managed to eliminate all of the sealing material. The group that combined rotary files with ultrasonic retreatment tip showed the greatest removal effec-tiveness and required less work time (AU)

Effect of thymopentin combined with levofloxacin for retreatment smear positive pulmonary tuberculosis / 中国热带医学

@#Abstract: Objective　To analyze the effect of adjuvant to levofloxacin in the treatment of retreatment smear positive pulmonary tuberculosis, as well as its effect on respiratory function, immune function and inflammatory factors. Methods　One hundred cases of retreatment smear positive pulmonary tuberculosis patients admitted to Rudong County People's Hospital in Nantong city in Jiangsu province from 2017 to 2021 were randomly divided into a control group (n=50) and an observation group (n=50) according to random number table method. Both groups received conventional treatment (3 months of isoniazid, rifampicin, ethambutol, pyrazinamide / 6 months of isoniazid, rifampicin, ethambutol), with levofloxacin added to the control group, and thymopentin added to the observation group for the first three months in addition to routine treatment. The treatment effect of the two groups were compared. Results　The sputum smear conversion rate of the observation group was significantly higher than that of the control group after 3 months and 5 months of treatment (χ2=7.142, P<0.05; χ2=6.250, P<0.05). The cavity absorption time and lesion absorption time in the observation group were significantly lower than those in the control group (t=4.006, P<0.05; t=5.165, P<0.05). The turning time of bacteriological culture in the observation group was significantly lower than that in the control group (t=4.220,P<0.05). After 3 months of treatment, CD4+, CD3+, CD4+/CD8+ of the observation group were higher than those of the control group, the differences were statistically significant (t=8.885, P<0.05; t=6.274, P<0.05; t=4.357, P<0.05). After 3 months of treatment, the IFN-γ (interferon-γ) of the observation group was higher than that of the control group (t=8.892, P<0.05), whereas the , IL-10 (interleukin-10) was significantly lower than that in the control group (t=5.986, P<0.05). After 3 months of treatment, forced vital capacity (FVC), forced expiratory volume in one second (forced expiratory volume in one second, FEV 1) and the one-second rate (forced expiratory volume in one second / forced vital capacity, FEV1/FVC) in the observation group were significantly higher than those in the control group (t=11.223, P<0.05; t=10.128, P<0.05; t=4.464, P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (χ2=0.378, P>0.05). Conclusions　Thymopentin combined with levofloxacin had a significant application effect in the treatment of retreatment smear positive pulmonary tuberculosis, s, which led to improved inflammatory reaction, respiratory function and immune function. Additionally, it can increase sputum smear conversion rate and accelerate patient recovery, improving overall treatment efficacy, with a relatively high clinical application value.

Analysis of influencing factors for multidrug-resistant pulmonary tuberculosis in Hainan Province from 2014 to 2020 / 中国热带医学

@#Abstract: Objective To investigate the occurrence of multidrug-resistance among tuberculosis patients in Hainan Province from 2014 to 2020 and to analyze the influencing factors, aiming to provide reference for formulating drug-resistant tuberculosis control strategies in this region. Methods This study collected sputum samples from the patients with pulmonary tuberculosis admitted to the Second Affiliated Hospital of Hainan Medical University from 2014 to 2020, and performed isolation and identification of Mycobacterium tuberculosis and drug susceptibility testing. After the strains were identified as positive, drug sensitivity tests were conducted, and multi-drug resistant patients were found. Clinical data was retrospectively collected, and chi-square test and unconditioned logistic regression were used to analyze the influencing factors of multidrug resistance. Results A total of 2 672 patients underwent sputum culture, strain identification, and drug susceptibility testing in TB designated hospitals in Hainan Province from January 1, 2014 to December 31, 2020. Among them, 1 942 patients with available drug susceptibility test results and complete clinical data were enrolled, among which 398 cases with drug-resistant TB were included in the case group, and 1 544 cases without drug resistance were included in the control group. Multivariate logistic regression analysis showed that farmers, rural residence, treatment history of retreatment, irregular medication history, number of pulmonary cavities ≥3, and BMI<18.5 were independent risk factors for MDR-TB. The risk of MDR-TB in farmers was higher than that in non-farmers (OR=1.542, 95%CI: 1.150-2.020); patients living in rural areas had a higher risk of multidrug resistance than those living in urban areas (OR=1.445, 95%CI: 1.095-1.907); the risk of MDR in the retreatment patients was higher than that in the initial treatment patients (OR=5.616, 95%CI: 4.250-7.421); the risk of multi-drug resistance in patients with irregular medication was higher than that in patients with regular medication (OR=2.665, 95%CI: 2.012-3.531); the risk of multidrug resistance in patients with pulmonary cavity number ≥3 was higher than that in patients with pulmonary cavity number <3 (OR=5.040, 95%CI: 3.768-6.740); compared with patients with BMI<18.5, patients with BMI=18.5-24.0 and BMI≥24.0 had a lower risk of multidrug resistance (OR=0.735, 95%CI: 0.555-0.975 and OR=0.447，95%CI:0.225-0.888, respectively). Conclusions Retreatment, farmer occupation, rural residence, irregular medication and low BMI may be the risk factors for multidrug resistance in Hainan Province.

Research advances in pathogenesis, risk factors, monitoring, and retreatment of drug-induced liver injury / 临床肝胆病杂志

With the approval and launch of a large number of new drugs, the incidence rate of drug-induced liver injury (DILI) is increasing year by year, which may affect the treatment of primary diseases. As an adverse drug reaction, DILI cannot be completely eliminated, and the clinical goal is to minimize its influence through prevention and control. This article reviews the research advances in the risk factors for DILI, the monitoring of DILI, and retreatment. Studies have shown that the risk of DILI can be increased by certain factors under some circumstances. Early identification of risk factors, rational monitoring, and focus on the timing and method for retreatment can reduce the development or progression of DILI and thus improve the prognosis of patients.

Comparative Evaluation of Efficacy of Three Single File Retreatment Systems for Removal of Gutta Percha and Assessment of Root Canal Transportation - An In Vitro Study

Background: In comparison to multiple file systems, recent advancements in single file retreatment systems had reduced the working time and ease of operation for clinicians. Aim: To compare the efficacy of retreatment systems compared with hand instrumentation, by evaluating their removal efficacy, time required for retreatment and assessment of canal transportation. Methods and Material: Forty premolars were instrumented using ProTaper Gold gold files. Post instrumentation, scan was taken, obturated using warm vertical compaction technique, and stored in artificial saliva for three months and randomly divided into four groups for retreatment. Hand instrumentation (Hi), Neoniti (Nn), Mtwo R (Mt), WaveOne Gold (Wg). Post retreatment, scan was taken. Teeth were sectioned longitudinally and photographed under the stereomicroscope. Retreatment time was recorded, and canal transportation was calculated. Statistical Analysis: The results were analyzed using one?way analysis of variance (ANOVA) followed by Tukey’s post hoc test at 95% confidence level. Results: The retreatment time was significantly longer in the Hi group. Within the test groups, a significantly longer time has been taken by Wg (p < 0.05) compared to Mt and Nn. There was no difference in the canal transportation between the single file systems at 3 mm, 6 mm and 9 mm from the apex, there was statistically significant higher transportation for the Hi group at 9 mm from the apex (p < 0.05). Conclusions: All techniques were effective in removal of filling material with minimal canal transportation. Wg system was shown to increased time compared to Nn and Mt systems. Hi group was slowest with maximum canal transportation at 9 mm from the apex.

Noncontact 3D evaluation of surface topography of reciprocating instruments after retreatment procedures

Abstract This study evaluated the Reciproc R25 and Pro-R 25 instruments in unused condition, after one and a second use in endodontic retreatment employing a noncontact 3D light interferometer profiler, scanning electron microscopy (SEM) and cyclic fatigue tests. Twenty single-root teeth were instrumented with Reciproc R25 and filled with gutta-percha and sealer. A 3D profiler with a 20x objective using the Mx™ software was used to evaluate the cutting blade surfaces of Reciproc R25 and Pro-R 25 (n=5 per group) in unused condition, after the first and second uses in retreatment procedures. After retreatment, SEM was used to evaluate the topographic features of the used instruments. Cyclic fatigue tests were performed to compare new to used instruments. One-way ANOVA followed by Tukey test was used to compare the tested instruments before and after the first and second uses. Student t-test was used to compare the different instruments and for cyclic fatigue evaluation. No significant differences were observed in the cutting blade surfaces of Reciproc and Pro-R before and after one and two uses (p>0.05). Reciproc without use showed higher Sa and Sq when compared to Pro-R without use (p<0.05). No differences were observed between Reciproc and Pro-R after one and two uses (p>0.05). New and unused Reciproc showed longer time to fracture than Pro-R instruments (p<0.05), and only Pro-R showed differences between new and used instruments (p<0.05). Retreatment procedures with Reciproc and Pro-R did not change the surface topography of instruments. Reciproc had greater resistance to cyclic fatigue compared with Pro-R.

Resumo Este estudo avaliou os instrumentos Reciproc R25 e Pro-R 25 sem uso, após um primeiro e um segundo uso em retratamento endodôntico com perfilômetro 3D por interferometria de luz sem contato, microscópio eletrônico de varredura (MEV) e testes de fadiga cíclica. Vinte dentes unirradiculares foram instrumentados com Reciproc R25 e obturados com guta-percha e cimento endodôntico. Um perfilômetro 3D com uma objetiva 20x usando o software Mx ™ foi usado para avaliar as superfícies da lâmina de corte do Reciproc e Pro-R (n = 5 por grupo) na condição sem uso, após o primeiro e após um segundo uso em procedimentos de retratamento. Após retratamento, o MEV foi usado para avaliar as características topográficas dos instrumentos utilizados. Testes de fadiga cíclica foram realizados para comparar instrumentos novos com instrumentos usados. O teste One-way ANOVA seguido pelo teste de Tukey foi usado para comparar os instrumentos testados nos diferentes estágios. Para comparar os diferentes instrumentos e para avaliação de fadiga cílcica, foi utilizado o Student t-test. Não foram observadas diferenças estatisticamente significantes nas superfícies das lâminas de corte dos instrumentos Reciproc e Pro-R antes e após um e dois usos (p> 0,05). O Reciproc na condição sem uso apresentou maior Sa e Sq quando comparado ao Pro-R (p <0,05). Não foram observadas diferenças entre Reciproc e Pro-R após um e dois usos (p> 0,05). O Reciproc sem uso apresentou maior tempo de fratura do que os instrumentos Pro-R (p<0,05), e apenas o Pro-R apresentou diferenças entre instrumentos novos e usados (p<0,05). Os procedimentos de retratamento com Reciproc e Pro-R não alteraram a topografia da superfície dos instrumentos. Reciproc apresentou maior resistência à fadiga cíclica em comparação com o Pro-R.

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.

Shaping Ability of Reciprocating and Rotary Systems After Root Canal Retreatment: a CBCT Study

Abstract The purpose of this in vitro study was to evaluate the shaping ability of reciprocating and continuous rotary systems after root canal retreatment. After preparation and root canal filling, mesial canals of 54 mandibular molars were distributed into 3 groups (n=18), according to the filling material removal and re-instrumentation protocols: WOG group - WaveOne Gold system; PTN group - ProTaper Next system; and PTU group - ProTaper Universal system. Cone-beam computed tomographic (CBCT) images acquisition of the mesial root canals was performed at different moments: (1) before instrumentation (unprepared root canals), (2) after preparation and filling, (3) after filling material removal and (4) re-instrumentation. The apical transportation (AT), centering ability (CA) and change in root canal diameter were assessed by CBCT analysis. The remaining filling material quantification was performed by radiographic examination. The statistical analyses were performed using the 3-way ANOVA, Tukey-Kramer, Kruskal-Wallis and Dunn multiple Comparison tests (p<0.05). The tested instruments did not show full CA (=1.0). PTN group had greater AT at the 5th mm in comparison with the WOG group (p<0.05). After re-instrumentation, WOG group had greater root canal diameter change at the 1st and 5th mm than PTN and PTU groups (p<0.05). There was no significant difference among groups when comparing the amount of remaining filling material after re-instrumentation (p>0.05). The tested systems provided minimal alteration in root canal morphology at the apical portion after root canal retreatment. However, WOG promoted greater change in root canal diameter.

Resumo O objetivo deste estudo in vitro foi avaliar a capacidade de modelagem de sistemas rotatórios e reciprocantes após o retratamento do canal radicular. Após o preparo e obturação do canal radicular, os canais mesiais de 54 molares inferiores foram distribuídos em 3 grupos, de acordo com os protocolos de remoção do material obturador e re-instrumentação: (n=18): grupo WOG - sistema WaveOne Gold; Grupo PTN - sistema ProTaper Next; e grupo PTU - sistema ProTaper Universal. A análise das imagens de tomografia computadorizada de feixe cônico foi realizada em diferentes momentos: (1) antes da instrumentação (canais radiculares não preparados), (2) após o preparo e obturação, (3) após a remoção do material obturador e (4) re-instrumentação. O transporte apical (TA), a capacidade de centralização (CC) e a mudança no diâmetro do canal radicular foram avaliados por análise tomográfica. A quantificação do restante do material obturador foi realizada por exame radiográfico. As análises estatísticas foram realizadas utilizando os testes de ANOVA de 3 fatores, Tukey-Kramer, Kruskal-Wallis e Comparações Múltiplas de Dunn (p<0,05). Os instrumentos não apresentaram CC perfeita (=1,0). PTN apresentou maior TA no 5º mm em comparação ao grupo WOG (p<0,05). Após a re-instrumentação, o grupo WOG apresentou maior aumento no diâmetro do canal radicular no 1° e 5° mm do que os grupos PTN e PTU. Não houve diferença significativa entre os grupos em relação à remoção do material obturador (p>0,05). Os sistemas testados proporcionaram alteração mínima na morfologia do canal radicular na porção apical após o retratamento do canal radicular. No entanto, WOG promoveu maior alteração no diâmetro do canal radicular.

Ability of two reciprocating Nickel-Titanium instruments for guttapercha/ sealer removal in simulated curved root canals / Análisis de la capacidad de dos instrumentos reciprocantes de Niquel-Titanio para la remoción de gutapercha/sellador en conductos curvos simulados

ABSTRACT The aim of this study was to compare the capacity of two reciprocating NiTi instruments in removing gutta-percha/sealer material from simulated curved root canals (SCRC). The time required for filling material removal was also recorded. Twenty SCRCs were divided into two groups of 10 (n=10) samples each. In Group 1, the SCRC were prepared to a R25 Reciproc Blue instrument (RCPB; VDW, Munich, Germany). In Group 2 the SCRC were prepared to a Primary WaveOne Gold instrument (PWOG; Dentsply, Ballaigues, Switzerland). In both groups, the canals were filled with matched-taper single gutta-percha cones and AH Plus sealer. Filling materials were removed with R25 RCPB (Group 1) and PWOG (Group 2). The amount of remaining gutta-percha/sealer was calculated at three predetermined levels of evaluation located at 2, 6 and 10 mm from the WL and expressed in percentages. Canals re-treated with RCPB contained significantly less remaining gutta-percha/sealer compared to canals prepared with PWOG (P=0.02). The RCPB instruments required significantly less time to complete the retreatment procedures (P<0.01). No unwinding or instrument separation was noted. RCPB instruments removed significantly more gutta-percha/sealer from simulated curved root canals than PWOG. However, neither of the tested instruments completely removed all filling materials.

RESUMEN El propósito del presente estudio fue comparar la capacidad de dos instrumentos de NiTi de movimiento reciproco para remover la obturación de gutapercha/sellador durante el retratamiento de conductos curvos simulados (SCRC). El tiempo requerido para la remoción del material fue también registrado. Se utilizaron veinte (n=20) SCRC divididos en dos grupos de diez especimenes (n=10) cada uno. En el Grupo 1 los SCRC se prepararon hasta un instrumento Reciproc Blue R25 (RCPB; VDW, Munich, Germany). En el Grupo 2, los SCRC se prepararon hasta un instrumento WaveOne Gold Primary (PWOG; Dentsply, Ballaigues, Switzerland). En ambos grupos los conductos se obturaron con cono único de gutapercha de conicidad creciente y el sellador AH Plus. La remoción de los materiales de obturación se realizó mediante los instrumentos RCPB R25 (Grupo 1) o PWOG (Grupo 2). La cantidad de gutapercha/sellador remanente se calculó en tres niveles de evaluación predeterminados ubicados a 2, 6 y 10 mm de la LT, y finalmente fue expresada en porcentajes. La cantidad de gutapercha/ sellador remanente en los SCRC retratados con RCPB fue significativamente menor en comparación con los que fueron retratados con PWOG (P=0.02). Los instrumentos RCPB requirieron un tiempo significativamente menor para completar el retratamiento (P<0.01). No se observaron deformaciones o separación de los instrumentos. Los instrumentos RCPB removieron una cantidad significativamente mayor de gutapercha/sellador que los instrumentos PWOG en conductos curvos simulados. Sin embargo, ninguno de los instrumentos ensayados removió completamente los materiales de obturación.

National Brazilian survey on the outcomes of hepatitis c retreatment in patients non-responders to direct antiviral agents

ABSTRACT Background and aims: Treatment of hepatitis C with direct antiviral agents (DAA) is associated with almost 95% of sustained virological response. However, some patients need retreatment. In Brazil, it should be done according to the Ministry of Health guidelines, frequently updated to include newly available drugs. This study aimed to conduct a national survey about the characteristics and outcomes of retreatment of hepatitis C in previously non-responders to DAAs. Patients and methods: Institutions from all over the country were invited to participate in a national registry for retreatment, including information about clinical and epidemiological characteristics of the patients, type and outcomes of retreatment regimens. Only patients previously treated with interferon-free regimens were included. Results: As previous treatments the distribution was: SOF/DCV (56%), SOF/SIM (22%), 3D (11%), SOF/LED (6%) and SOF/RBV (5%). For retreatment the most frequently used drugs were SOF/GP (46%), SOF/DCV (23%) and SOF/VEL (11%). From 159 patients retreated, 132/159 (83%) had complete information in the registry and among them only seven patients were non-responders (SVR of 94.6%). All retreatments were well tolerated, without any serious adverse events or interruptions. Conclusion: The retreatment of patients previously non-responders to DAAs was associated with high rate of SVR in this sample of Brazilian patients. This finding allows us to conclude that the retreatment options available in the public health system in Brazil are effective and safe and are an important component of the strategy of elimination of hepatitis C in our country.

Uso da fototerapia como método complementar no retratamento endodôntico: revisões sistemáticas e meta-análise de ensaios clínicos / Use of phototherapy as a complementary method in endodontic reintervention: systematic reviews and meta-analysis of clinical trials

Este trabalho objetivou realizar duas revisões sistemáticas com as seguintes propostas: 1) Avaliar se a fototerapia com laser resultaria em menor dor pós-operatória (PP) em pacientes submetidos a reintervenção endodôntica; e 2) Avaliar se o uso da terapia fotodinâmica antimicrobiana (aPDT) seria eficaz na desinfecção de canais radiculares em casos de reintervenção endodôntica. As Revisões Sistemáticas foram registradas no PROSPERO (CRD42021243500 e CRD42021260013, respectivamente) e seguiram as diretrizes dos Itens de Relatório Preferenciais para Revisões Sistemáticas e Meta-análise (PRISMA). As buscas foram realizadas nas bases de dados eletrônicas PubMeb, Scopus, Web of Science, Embase, Web of Science, Clinical Trials e Cochrane Library e nos bancos de dados da literatura cinza. A qualidade metodológica e o risco de viés foram avaliados pela ferramenta Cochrane Risk of Bias para ensaios clínicos randomizados (RCT) e pelo qualificador NewcastleOttawa (NOS) para estudos não RCT (prospectivos). A análise da qualidade de evidência foi realizada com base na abordagem GRADE. A meta-análise foi realizada com o R software Meta package, utilizando um intervalo de confiança (IC) de 95%. Quanto aos resultados do Artigo 1: Cinco artigos foram incluídos para análise. Os estudos foram classificados como "baixo" risco de viés. Dos cinco estudos clínicos, quatro estudos mostraram uma diminuição significativa da PP após a reintervenção endodôntica nos grupos de fototerapia a laser quando comparados ao grupo controle, principalmente nos primeiros dias após a intervenção. A certeza de evidência foi classificada como baixa. Devido à alta heterogeneidade clínica entre os estudos, não foi possível realizar qualquer meta-análise. Apesar das limitações desta revisão sistemática, a fototerapia se mostrou uma alternativa promissora na redução e controle da PP na reintervenção endodôntica não cirúrgica. Nos resultados do Artigo 2, dez estudos atenderam aos critérios de elegibilidade e foram incluídos, sendo 8 utilizados na síntese quantitativa. A meta-análise mostrou que todos os dados dos estudos apresentaram diferença significativa antes e depois da terapia fotodinâmica antimicrobiana na redução da carga microbiana em infecções endondônticas secundárias (OR 0,15 [0,07; 0,32], p < 0,0001). No geral, os estudos apresentaram baixo risco de viés e a análise das evidências foi classificada como moderada. Sugere-se que a terapia fotodinâmica seja uma ferramenta benéfica e promissora, mostrando eficácia na redução da carga microbiana nos casos de reintervenção endodôntica. Em suma, a abordagem da utilização da fototerapia se demonstrou eficaz na diminuição da dor pós-operatória e na desinfecção dos canais radiculares, podendo ser uma terapia indicada nos casos de reintervenção endodôntica(AU)

This study aimed to carry out two systematic reviews with the following proposals: 1) Evaluate whether laser phototherapy would result in less postoperative pain (PP) in patients undergoing endodontic reintervention; and 2) Evaluate whether the use of antimicrobial photodynamic therapy (aPDT) would be effective in disinfection of root canals in cases of endodontic reintervention. Systematic Reviews were registered in PROSPERO (CRD42021243500 and CRD42021260013, respectively) and followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Metaanalysis (PRISMA). Searches were performed in the electronic databases PubMeb, Scopus, Web of Science, Embase, Web of Science, Clinical Trials and Cochrane Library and in the gray literature databases. Methodological quality and risk of bias were assessed by the Cochrane Risk of Bias tool for randomized clinical trials (RCT) and by the Newcastle-Ottawa (NOS) qualifier for non-RCT (prospective) studies. The analysis of the quality of evidence was performed based on the GRADE approach. The meta-analysis was performed using the R Meta package software, using a 95% confidence interval (CI). As for the results of Article 1: Five articles were included for analysis. Studies were classified as "low" risk of bias. Of the five clinical studies, four studies showed a significant decrease in PP after endodontic reintervention in the laser phototherapy groups when compared to the control group, mainly in the first days after the intervention. The certainty of evidence was rated low. Due to the high clinical heterogeneity between studies, it was not possible to perform any meta-analysis. Despite the limitations of this systematic review, phototherapy proved to be a promising alternative for the reduction and control of PP in conventional endodontic reintervention. In the results of Article 2, ten studies met the eligibility criteria and were included, being 8 used in the quantitative synthesis. The meta-analysis showed that all data from the studies showed a significant difference before and after antimicrobial photodynamic therapy in reducing the microbial load in secondary endodontic infections (OR 0.15 [0.07; 0.32], p < 0.0001). Overall, the studies presented a low risk of bias and the analysis of evidence was rated as moderate. It is suggested that photodynamic therapy is a beneficial and promising tool, showing efficacy in reducing the microbial load in cases of endodontic reintervention. In summary, the approach to the use of phototherapy has been shown to be effective in reducing postoperative pain and disinfection of root canals, and may be an indicated therapy in cases of endodontic reintervention(AU)

Alargamento do forame como complemento no tratamento endodôntico para regeneração de uma lesão periapical extensa: relato de caso / Foraminal enlargement as a complement in the endodontic treatment for the regeneration of an extensive periapical lesion. A case report

Introdução: O alargamento do forame refere-se ao alargamento mecânico intencional do forame para reduzir a carga bacteriana em uma área afetada frequentemente por infecções endodônticas além do limite da constrição apical. Objetivo: O objetivo do presente relato de caso é apresentar a técnica de alargamento do forame de um dente com lesão periapical extensa, como complemento do tratamento endodôntico e alternativa precoce à microcirurgia periapical. Métodos: É apresentado o caso de um incisivo lateral superior endodonticamente tratado, com uma extensa lesão periapical associada. Devido à história clínica e radiográfica, tempo decorrido desde o tratamento endodôntico inicial e alta probabilidade de áreas de reabsorção apical com biofilme extrarradicular, o retratamento endodôntico com alargamento do forame foi indicado como primeira opção, adiando a indicação de cirurgia endodôntica de acordo com a evolução. Resultados: Na avaliação de acompanhamento de dois anos, por exame de imagem, observou-se evolução clínica favorável ao retratamento, com aumento total da densidade óssea. O procedimento cirúrgico endodôntico complementar foi descartado. Conclusão: O alargamento do forame é uma alternativa complementar viável em casos de periodontite apical de longa duração com suspeita de biofilme no nível do forame. Pode ser considerado uma opção antes da indicação de retratamento endodôntico cirúrgico (AU).

Introduction: Foraminal enlargement refers to intentional mechanical enlargement of the foramen to reduce the bacterial load in an area frequently affected by endodontic infections beyond the limits of the apical constriction. The objective of this case report is to present the foraminal enlargement technique of a tooth with an extensive periapical lesion as a complement in the endodontic treatment and an early alternative to periapical microsurgery. Materials and methods: The case is presented of an endodontically treated upper lateral incisor with an extensive associated periapical lesion. Due to the clinical and radiographic history, the time elapsed since the initial endodontic treatment, and the high probability of areas of apical resorption with extra-radicular biofilm, endodontic retreatment with foraminal enlargement was indicated as the first option, postponing the indication for endodontic surgery according to evolution. Results: In the follow-up appointment at 2 years, a favorable clinical imaging evolution of retreatment was observed, with a total increase in bone density. The complementary endodontic surgical procedure was discarded. Conclusion: Foraminal enlargement is a viable complementary alternative in cases of long-term apical periodontitis with suspicion of biofilm at the foramen level. It can be considered an option before the indication of surgical endodontic retreatment (AU).

Retreatment of mesial roots of mandibular molars filled with resin-based and bioceramic sealers

Aim: The aim of this study was to evaluate, by micro-computed tomography (micro-CT) analysis, the remaining filling material during endodontic retreatment performed with Protaper retreatment without solvent. Methods: Forty mandibular molars were divided into two groups (n = 20) according to the sealer used in the obturation: the bioceramic TotalFill BC (TF) or the resin-based AH Plus (AHP). The specimens were scanned before instrumentation, after obturation and after filling removal. Only the mesial roots were analysed. The filling volumes and the remaining filling material were calculated in the entire root canal and in the cervical, middle and apical thirds. Results: The volume of obturation and the volume of remaining filling material in the entire root canal and in the cervical, middle and apical thirds of the canal between the groups were not statistically different (independent t-test, p > 0.05). In the AHP group, there was a higher percentage of remaining filling material in the middle third than in the cervical third (p < 0.05). Conclusion: The filling material could not be entirely removed from any specimen

The effectiveness of rotary and reciprocating techniques in curved root canals retreatment: a micro- CT analysis

Introduction: Different NiTi rotary systems have been developed to improve efficiency and retreatment success rates. Aim: To evaluate the Protaper Universal retreatment system and WaveOne instrument in removing the filling material from curved canals during retreatment. Materials and Methods: Thirty mesial root canals of extracted human mandibular molar teeth were randomly allocated into 2 groups (n=15). In the PT group, retreatment was performed with ProTaper Universal Retreatment according to the manufacturer's instructions. In the WO group, was used WaveOne Primary. ProTaper Universal F2 and F3 were used to achieve the apical diameter in both groups. The samples were scanned by micro-computed tomography pre and postoperatively to evaluate the filling material remaining. The percentage of material filling was compared between groups using Student's T test and in the same group among thirds was compared using Kruskal-Wallis followed by Dunn's post hoc test. Results: The filling material remaining was not statistically different between the groups (p≥0.05). The apical third presented a greater amount of remaining filling material when compared with the cervical third for both groups (p<0.05). Conclusion: Rotary and reciprocating techniques can effectively, but not completely, remove the filling materials from the root canal system. The apical third presented a more significant amount of remaining filling material.

Effect of handpiece light and material used in pulp chamber on dentin removal during root canal retreatment

Abstract This study evaluated the effect of the use of glass ionomer cement (GIC) and flowable bulk-fill resin composite (BFRC) for filling pulp chambers and the type of high-speed handpiece light used on dentin removal during access preparation for endodontic retreatment in molar teeth. Twenty maxillary molars were treated endodontically. BFRC (Opus Bulk Fill Flow APS, FGM) was used to fill the pulp chamber and replace coronal dentin (n = 10). In the remaining teeth, the pulp chamber was filled with GIC (Maxion R, FGM). Conventional resin composite (Opallis, FGM) was used to restore the enamel layer in all teeth. The samples in each group were divided into two subgroups, and the root canals were reaccessed using a handpiece with white or ultraviolet light. The teeth were scanned using micro-CT before and after root canal reaccess. The dentin volume removed was calculated and analyzed using 2-way analysis of variance and Tukey's test (α = 0.05). The crown and pulp chamber locations with dentin removal are described using frequency distribution. During the access, fewer pulp chamber walls were affected and a lower volume of dentin was removed from the pulpal floor in the group restored with GIC than in the group restored with BFRC. No effect was observed on the coronal dentin walls with respect to the filling protocols and type of light used. For dentin removal from the pulp chamber, handpieces with white light performed better than those with ultraviolet light, irrespective of the filling protocol used. The use of GIC to fill the pulp chamber and use of white handpiece light reduced dentin removal from the pulpal floor and resulted in fewer affected dentin walls.

Resumo Este estudo avaliou os efeitos do cimento de ionômero de vidro (GIC) e da resina composta fluida bulk fill (BFRC) usados como preenchimento da câmara pulpar; e o tipo de iluminação das turbinas de alta rotação na remoção dentinária após cavidades de acesso para retratamento endodôntico em dentes molares. Vinte molares superiores foram tratados endodonticamente. Dez dentes foram restaurados usando BFRC (Opus Bulk Fill Flow APS, FGM) para preencher a câmara pulpar e dentina coronária; e resina composta convencional (Opallis, FGM) para restaurar a camada de esmalte. Os outros dentes foram restaurados usando GIC (Maxion R, FGM) para preencher a câmara pulpar e resina composta (Opallis, FGM). As amostras foram divididas em dois grupos e os canais radiculares foram novamente acessados com turbina de alta-rotação com iluminação branca ou ultravioleta. Os dentes foram escaneados usando micro-CT antes e após o novo acesso ao canal radicular. O volume de dentina removida foi calculado e os dados foram analisados por ANOVA bidirecional e teste de Tukey (α=0,05). As regiões na coroa e na câmara pulpar que apresentaram dentina removida no acesso dos canais foram descritas por meio de distribuição por frequência. A reabertura do canal radicular com GIC resultou em menos paredes afetadas da câmara pulpar e menor volume de dentina removida no assoalho. Nenhum efeito foi observado nas paredes de dentina coronária considerando aos protocolos de preenchimento. A turbina de alta rotação com iluminação branca reduziu a remoção de dentina da câmara pulpar, independentemente do protocolo de restauração utilizado. O uso de turbina de alta rotação com iluminação branca e GIC para preencher a câmara pulpar reduziram a remoção de dentina do assoalho e afetaram menos paredes dentinárias.

Estudio comparativo de los tiempos registrados por los instrumentos TruNatomy y ProTaper Next para alcanzar la longitud de trabajo en conductos curvos simulados obturados con GuttaCore / Comparative study of the times recorded by the TruNatomy and ProTaper Next instruments to reach the working length in simulated curved canals filled with GuttaCore

Objetivo: Comparar el tiempo empleado por los instrumen- tos TruNatomy Medium y ProTaper Next X3 para penetrar hasta la longitud de trabajo la masa de obturaciones realizadas con Gut- taCore Primary y sellador en conductos curvos simulados. Materiales y métodos: Se prepararon 20 conductos curvos simulados con instrumentos rotatorios WaveOne Gold Primary y se obturaron con GuttaCore Primary y AH Plus. Las muestras fueron divididas en dos grupos de 10 cada uno. Grupo 1: El material de obturación fue penetrado hasta la lon- gitud de trabajo con instrumentos TruNatomy Medium. Gru- po 2: El material de obturación fue penetrado hasta la longitud de trabajo con instrumentos ProTaper Next X3. Se registraron los tiempos de penetración requeridos para cada grupo y los valores obtenidos fueron analizados mediante la prueba t de Student. Resultados: Los instrumentos ProTaper Next X3 pe- netraron la masa del material de obturación más rápidamente que los instrumentos TruNatomy MediumTM. Las diferencias observadas entre ambos instrumentos fueron estadísticamente significativas (P <0.01). Conclusión: Si bien los instrumentos ProTaper Next X3 y TruNatomy MediumTM penetraron la masa de Gutta- Core Primary de manera eficiente, ProTaper Next X3 penetró hasta la longitud de trabajo más rápidamente (AU)

Aim: Compare the time required by the instruments TruNatomy Medium and ProTaper Next X3 to penetrate up to the working length the mass of fillings made with GuttaCore Primary and sealant in simulated curved canals. Materials and methods: The simulated canals of 20 EndoTraining Blocks were prepared with WaveOne Gold Pri- mary and obturated with GuttaCore Primary and AH Plus. The sample was divided into two groups of 10 each. Group 1: The sealing material was penetrated up to working length with TruNatomy Medium. Group 2: The sealing material was penetrated up to working length with ProTaper Next X3. The penetration time was recorded in each group and the obtained values were statistically analyzed with the Student's t test. Results: ProTaper Next X3 instruments penetrated the sealing material mass faster than TruNatomy Medium. Statis- tically significant differences were observed between the two instruments (P <0.01). Conclusion: While the ProTaper Next X3 and TruNat- omy Medium penetrated the GuttaCore mass to the working length efficiently, the ProTaper Next X3 did it in less time (AU)

Itinerário terapêutico de pessoas com tuberculose resistente e em retratamento / Itinerario terapéutico de personas con tuberculosis resistente y en retratamiento / Therapeutic itinerary for people with resistant tuberculosis under retreatment

Objetivo: analisar a percepção de pessoas com tuberculose sobre o itinerário terapêutico da tuberculose resistente e em retratamento. Materiais e método: pesquisa descritiva, com abordagem qualitativa, realizada com pessoas com tuber-culose resistente ou em retratamento por abandono ou recidiva. Os dados foram coletados por meio de entrevistas semiestruturadas, que, depois de transcritas, foram submetidas à análise de conteúdo e, posteriormente, analisadas à luz do referencial teórico sobre itinerário terapêutico. Resultados:na percepção das pessoas com tuberculose resistente ou em retratamento, evidenciou-se o pouco entendimento sobre a doença e a recidiva, principalmente quanto à causa. No itinerário terapêutico em busca dos serviços para atender às necessidades de saúde apontaram a centralização do atendimento no serviço hospitalar. A adesão esteve remetida ao abandono do tratamen-to anterior, à necessidade de voltar à rotina e ao medo de transmissão para os familiares. As ações de auto-cuidado se relacionaram à adesão ao tratamento, ao uso de equipamentos de proteção individual e à adoção de hábitos de vida mais saudáveis. Conclusões: os itinerários tera-pêuticos de pessoas com tuberculose aconteceram em diferentes níveis da atenção à saúde, especialmente nos centros especializados. Em cada serviço, analisaramse diferentes experiências quanto ao entendimento sobre a doença, ao tratamento e aos diferentes sentimentos durante o percurso do tratamento. Diante disso, os profissio-nais necessitam fazer uso de estratégias que considerem a complexidade do uso de múltiplos medicamentos, a necessidade de monitoramento da adesão e da atenção às comorbidades.

Objetivo: analizar la percepción de las personas con tuberculosis sobre el itinerario terapéutico de la tuberculosis resistente y en retratamiento. Materiales y método: investigación descriptiva, con enfoque cualitativo, realizada con personas con tuberculosis resistente o en retratamiento por abandono o recaída. Los datos fueron recolectados por medio de entrevistas semiestructuradas, que luego de ser transcritas fueron sometidas a análisis de contenido y posteriormente analizadas a la luz del marco teórico sobre itinerario terapéutico. Resultados: en la percepción de las personas con tuberculosis resistente o en retratamiento había poco conocimiento sobre la enfermedad y la recaída, especialmente en cuanto a la causa. En el itinerario terapéutico en busca de servicios para satisfacer las necesidades de salud, apuntaron a la centralización de la atención en el servicio hospitalario. La adherencia se relacionó con el abandono del tratamiento previo, la necesidad de volver a la rutina y el miedo a la transmisión a los familiares. Las acciones de autocuidado se relacionaron con la adherencia al tratamiento, el uso de equipos de protección personal y la adopción de hábitos de vida más saludables. Conclusiones: los itinerarios terapéuticos de las personas con tuberculosis tuvieron lugar en diferentes niveles de atención de salud, especialmente en centros especializados. En cada servicio se analizaron diferentes experiencias en cuanto a la comprensión de la enfermedad, el tratamiento y las diferentes sensaciones en la trayectoria del tratamiento. Por lo tanto, los profesionales deben hacer uso de estrategias que consideren la complejidad del uso de múltiples medicamentos, la necesidad de monitorear la adherencia y la atención a las comorbilidades

Objective: To study the perception of people with tuberculosis about the therapeutic itinerary of resistant tuberculosis and its retreatment. Materials and method:Descriptive research, with a qualitative approach, carried out with people with resistant tuberculosis or subject to retreatment due to abandonment or relapse. Data were collected through semi-structured interviews, which after being tran-scribed were submitted to content analysis, and, subsequently, analyzed in the light of the theoretical frame-work on therapeutic itinerary. Results: The perception of people with resistant tuberculosis or under retreatment shows little understand-ing about the disease and its relapse, especially regarding the cause of the disease. In the therapeutic itinerary in search of services to meet health needs, they pointed to the centralization of care in the hospital service. Adherence was related to the abandonment of previous treatment, the need to return to a routine, and fear of transmission to family members. Self-care actions were related to adher-ence to treatment, the use of personal protective equipment and the adoption of healthier lifestyle habits. Conclusions: Therapeutic itineraries of people with tuberculosis took place at different levels of health care, particularly in specialized centers. In each service, different experiences were examined regarding the under-standing of the disease, its treatment, and the different feelings involved during the treatment. Therefore, professionals should deploy strategies that consider the complexity of using multiple medications and the need to monitor adherence and existing comorbidities.

Conventional endodontic retreatment of persistent pain on previously treated tooth in an elderly patient: A case report

@#Clinical evaluation for a successful root canal treatment is assessed by various criteria, which are clinical, histopathological, and radiographical criteria. Therefore, failure of endodontic treatment can be described as a recurrence of clinical symptoms, with the presence of a periapical radiolucency or both. Failure factors in the treatment are frequently related to persistent infection. Conventional endodontic retreatment is indicated for symptomatic previously treated teeth or asymptomatic teeth with inadequately done initial endodontic treatment to avoid potential recurrence. Endodontic retreatment in elderly patients is a great challenge because the clinician has to reassure both the physical and psychological factors of the patient to determine whether to save a tooth or perform an extraction. Some difficulties may also be found in root canal retreatment, including finding the root canal hole or root canal blockage found in parts of the root canal that have not been repaired in the previous treatment. A 60-year-old female patient came with the chief complaint of recurrent pain, and subjective discomfort in the maxillary left central incisor. The patient had anxiety about the dental treatment. The tooth had a history of root canal treatment four months ago. The clinical examination showed a positive response to the percussion test. The radiographical analysis showed a root canal underfilling, 2-3 mm short of length from the apex. The tooth was diagnosed as a previously treated tooth with symptomatic apical periodontitis. Endodontic retreatment was performed based on the patient’s clinical condition and consent, followed by composite restoration. The clinical and radiographic re-evaluation after four weeks of follow-up revealed an excellent condition. This favorable result showed that a conventional retreatment plan of persistent pain on the previously treated tooth in an elderly patient led to progressive healing, and a longer follow-up was advised.