Prospective clinical study of transverse development with orthodontics with self-ligating brackets / Estudio clínico prospectivo del desarrollo transversal con ortodoncia con brackets autoligables

ABSTRACT Orthodontics with low friction, low force, passive self-ligating brackets produces alveolar-dental remodeling, resulting in an increase in the transverse diameter of the dental arches, especially in the premolar sector. The aim of this study was to compare the modifications of the transverse diameter in the pre- and post-dental alignment cast models with orthodontics with passive self-ligating brackets in patients with moderate to severe dental discrepancy. The study included 28 patients of both sexes aged 16 to 48 years with dental discrepancies between -6 and -16 mm, treated with self-ligating Damon brackets and thermally activated Nickel- Titanium-Copper arches. With a digital pachymeter, Mitutoyo brand, five measurements were taken per dental arch: distance between canines (C), first premolars (1PM), second premolars (2 PM), first molars (1M) and second molars (2M), before and after orthodontic alignment. The variations were statistically evaluated by Student T Test for paired samples. Average distance between teeth varied with dental alignment in both jaws. The greatest increases in transverse diameter were recorded in the premolar areas. Minor though statistically significant variations also occurred in the 2M of the maxilla and in the C of the mandible In alignment with passive self-ligating brackets, there is an increase in the transverse diameter due to the development of the dental arches, mainly in the premolar sector of both jaws and also at the level of the canines in the mandible.

RESUMEN La ortodoncia con brackets autoligables pasivos, de baja fricción y baja fuerza, produce remodelación alvéolodentaria; con aumento del diámetro transversal de las arcadas, especialmente en el sector de los premolares. El objetivo de este trabajo fue comparar las modificaciones del diámetro transversal en los modelos de yeso pre y post alineación dentaria con ortodoncia con brackets autoligables pasivos en pacientes con discrepancia dentaria moderada a severa. El estudio incluyó 28 pacientes de ambos sexos de entre 16 y 48 años de edad con discrepancia dentaria entre -6 y -16mm, tratados con brackets autoligables sistema Damon y arcos termo activables de Níquel-Titanio-Cobre. Con un paquímetro digital marca Mitutoyo, se tomaron 5 medidas por arcada: distancia entre caninos (C), primeros y segundos premolares (1 PM y 2 PM) y primeros y segundos molares (1M y 2M); pre y post alineación ortodóncica. Las variaciones registradas fueron evaluadas estadísticamente mediante Student T Test para muestras apareadas. La distancia promedio entre dientes varió con la alineación dentaria en ambos maxilares. Los mayores aumentos del diámetro transversal se registraron en las zonas de los premolares. Se produjeron también variaciones menores, aunque estadísticamente significativas, en los 2M del maxilar superior y en los C del maxilar inferior. En la alineación con brackets autoligables pasivos, hay incremento del diámetro transversal por desarrollo de las arcadas, principalmente en el sector premolar de ambos maxilares y en el maxilar inferior también a nivel de los caninos.

Microfiltración apical entre dos cementos de obturación: biocerámico y resinoso en premolares unirradiculares preparadas con protaper, y obturadas con condensación lateral / Apical microfiltration between two filling cements: bioceramic and resinous in unirradicular premolars prepared with protaper and sealed with lateral condensation

Resumen Objetivo: Comparar in vitro la microfiltración apical en premolares unirradiculares obturados con cemento a base de resina epóxica y cemento biocerámico. Método: 40 piezas dentales unirradiculares fueron seleccionadas y divididas en dos grupos para ser obturadas esperando el tiempo de fraguado de acuerdo con las instrucciones del fabricante. El grupo A se obturó con cemento biocerámico Endosequence y, el grupo B, con cemento a base de resina epóxica AH-Plus: posteriormente los dos grupos fueron sellados con barniz de uñas hasta 3mm de la parte apical, luego se colocaron las muestras en la incubadora a 37ºC. Ambos fueron sometidos a 750 ciclos de termociclado, para reproducir el ambiente parecido a la cavidad oral. Para análisis de microfiltración se utilizó el método de difusión del colorante, se sumergieron en azul de metileno al 2 % por 6 días, posteriormente los especímenes fueron sometidos en una bomba de vacío. Los dientes fueron cortados longitudinalmente para ser evaluadas mediante el estereomicroscopio. El análisis estadístico fue hecho mediante T-Student y Chi-Cuadrado. Resultados: El grupo A corresponde a Endosequence obtuvo una medida de 0,55mm y el grupo B corresponde a AH-Plus 1,20mm con un estimado de significancia de p=0,013. Conclusión: El análisis de ambos cementos de obturación demostró que Endosequence posee menor microfiltración apical que AH-Plus.

Abstract Aim: To compare in vitro by the stereomiscroscope the lesser apical microfiltration in uniradicular premolars, between the cement based on Epoxy Resin and Bioceramic cement. Method: The study was performed on 40 uniradicular dental pieces divided into two groups, the samples were prepared using the protaper system and the obturation was performed using the lateral condensation technique, the first group was sealed withEndosequence bioceramic cement and the second group with Cement based on AH-Plus epoxy resin, then sealed with nail varnish up to 3mm from the apical part, then the samples were placed in the incubator at 37ºC, waiting for the set time corresponding to each group according to the manufacturer's instructions . The two groups of the present study were submitted to 750 cycles of thermocycling, to provide an environment similar to the oral cavity, then longitudinal cuts were made to the samples. The microfiltration was evaluated using the dye diffusion method, immersed in 2% methylene blue for 6 days, then the specimens were subjected to a vacuum pump. The teeth were cut longitudinally to be evaluated by the stereomicroscope. The statistical analysis was through T-Student and Chi-Square. Results: Group A corresponds to Endosequence obtained a mean of 0,55mm and Group B corresponds to AH-Plus 1,20mm with an estimated significance of p = 0,013. Conclusion: Both obturation cements have significant differences, therefore Endosequence has less apical microfiltration than AHPlus.

Agenesis of mandibular second premolar in patient with dental bimaxillary protrusion

ABSTRACT The present study reports the treatment carried out in a patient with mandibular second premolar agenesis associated with early loss of a deciduous second molar, deep overbite, severe overjet and dentoalveolar bimaxillary protrusion, which led to lip incompetence and a convex facial profile. The main objectives of this treatment were: to eliminate the spaces in mandibular arch, correct overbite, as well as eliminate bimaxillary protrusion and lip incompetence, thus leading to a balanced profile. The case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) as part of the requirements to obtain the title of BBO diplomate.

RESUMO O presente caso clínico relata o tratamento de uma paciente com agenesia de segundo pré-molar inferior associada à perda precoce do segundo molar decíduo, sobremordida profunda, sobressaliência exagerada e biprotrusão dentoalveolar, que causavam incompetência labial e perfil facial convexo. Os objetivos do tratamento foram eliminar os espaços presentes na arcada inferior, corrigir a sobremordida, eliminar a biprotrusão e a incompetência labial, harmonizando o perfil. Esse caso foi apresentado ao Board Brasileiro de Ortodontia e Ortopedia Facial (BBO) como parte dos requisitos para obtenção do título de Diplomado pelo BBO.

Tratamiento de las discrepancias dentomaxilares en paciente clase II esqueletal. reporte de caso / Treatment of discrepancies dento-maxillary in patient class II skeletal. case report

La clase II esqueletal representa uno de los grandes desafíos a tratar por parte del Ortodoncista. Ésta se presenta cuando existe una discrepancia entre el maxilar y mandíbula, es decir puede haber un crecimiento excesivo del maxilar superior acompañado de una retrusión de la mandíbula. Esto provoca alteraciones tanto esqueléticas como dentarias, presentando apiñamientos, incompetencia labial o perfil convexo, pudiendo ser el tratamiento estrictamente ortodóntico o en ciertos casos requerir de cirugías máxilo faciales. El objetivo de esta investigación fue mejorar el perfil del paciente, conseguir Clase I molar y canina, corregir la incompetencia labial y mejorar la oclusión dental. El plan de tratamiento incluyó la extracción dental de primeros premolares superiores e inferiores y gracias a la aplicación de la técnica ROTH mediante el uso de cadenas elásticas y arcos de retracción se pudo cumplir el objetivo inicial, mejorando la estética y la función de las estructuras dento faciales.

Class II skeletal is one of the major challenges to be treated by the orthodontist. This occurs when there is a discrepancy between the maxilla and mandible, ie may have an overgrowth of the maxilla accompanied by a retrusion of the mandible. This causes both skeletal and dental alterations, presenting crowding, labial incompetence or convex profile and may be strictly orthodontic treatment or in certain cases require maxillo facial surgeries. The objective of this research was to improve the patient's profile, achieving Class I molar and canine, correct lip incompetence and improve occlusion. The treatment plan included tooth extraction first upper and lower premolars and thanks to the implementation of the ROTH technique using elastic chains and arches retraction could meet the initial objective,improving the aesthetics and function of the dento structures facial.

Sensibilidad y Especificidad Clínica del Indice Mandibular Canino y del Ancho Mesiodistal del Diente Canino Para Estimar el Sexo: Ajuste de un Modelo Predictivo / Clinical Sensitivity and Specificity of Mandibular Canine Index and Mesiodistal Canine Width to Estimate Sex: Adjustment of a Predictive Model

Los dientes son un excelente material de investigación en personas vivas y cadáveres, en el ámbito antropológico, genético, odontológico y forense, por sus características (dureza, resistencia al ataque químico, fuego y descomposición). El diente canino mandibular es el menos afectado por enfermedad periodontal, menos extraído, más resistente a traumas severos y el que presenta mayor dimorfismo sexual. Se puede usar para la estimación de sexo, calculando el Índice Mandibular Canino (IMC). El propósito de este estudio es determinar la certeza del IMC en la estimación de sexo respecto al ancho mesiodistal del canino. El estudio fue realizado en 150 sujetos (H:M= 65:85), entre 18­24 años. El ancho mesiodistal del canino y la distancia canina fueron medidos en los modelos obtenidos y el IMC fue calculado. Se calculó la sensibilidad y especificidad para cada uno de los índices en cuestión. El IMC tuvo una sensibilidad del 33,85 % y una especificidad de 75,29 % en la estimación de sexo. El ancho mesiodistal del canino tuvo una sensibilidad de 66,15 % y una especificidad de 84,71 %. El ancho mesiodistal del canino tiene mayor sensibilidad y especificidad que el IMC en la estimación médicolegal de sexo.

Teeth are an excellent research material in living persons and in corpses, in the anthropological, genetic, dental and forensic fields, because of their characteristics (hardness, resistance to chemical attack, fire and decay). Mandibular canine teeth are the least affected by periodontal disease, the least extracted teeth, are more resistant to severe trauma and have a greater sexual dimorphism. They can be used for sex estimation, through the Mandibular Canine Index (MCI). The purpose of this study is to determine the accuracy of the MCI in sex estimation, compared to the mesiodistal canine width method. The study was conducted on 150 subjects (M:F= 65:85), aged 18­24. The mesiodistal width of canine and the intercanine distance were measured on the obtained models, and the MCI was calculated. The sensitivity and specificity for each of the two indexes were also calculated. MCI had a sensitivity of 33.85% and a specificity of 75.29 % in sex estimation. The mesiodistal width of canine had a sensitivity of 66.15 % and a specificity of 84.71 %. The mesiodistal width of canine has a higher sensitivity and specificity than the MCI in the medicolegal estimation of sex.

Longitudinal stability of rapid and slow maxillary expansion

OBJECTIVE: The aim of this retrospective study was to compare the longitudinal stability of two types of posterior crossbite correction: rapid maxillary expansion (RME) and slow maxillary expansion (SME). METHODS: Study casts of 90 adolescent patients were assessed for interdental width changes at three different periods: pretreatment (T1), post-treatment (T2) and at least, five years post-retention (T3). Three groups of 30 patients were established according to the treatment received to correct posterior crossbite: Group A (RME), group B (SME) and group C (control- Edgewise therapy only). After crossbite correction, all patients received fixed edgewise orthodontic appliances. Paired t-tests and one-way ANOVA were used to identify significant intra and intergroup changes, respectively (P < 0.05). RESULTS: Except for intercanine distance, all widths increased in groups A and B from T1 to T2. In the long-term, the amount of relapse was not different for groups A and B, except for 3-3 widths which showed greater decrease in group A. However, the percentage of clinically relapsed cases of posterior crossbite was similar for rapid and slow maxillary expansion. CONCLUSION: Rapid and slow maxillary expansion showed similar stability in the long-term. .

OBJETIVO: o objetivo desse estudo retrospectivo foi comparar a estabilidade em longo prazo em dois tipos de correção da mordida cruzada posterior, sendo a expansão rápida (ERM) e a expansão lenta da maxila (ELM). MÉTODOS: modelos de estudos de 90 pacientes adolescentes foram avaliados quanto às alterações na largura interdentária em três diferentes tempos: pré-tratamento (T1), pós-tratamento (T2) e pelo menos cinco anos pós-contenção (T3). Três grupos de 30 pacientes foram definidos de acordo com o tratamento realizado para a correção da mordida cruzada posterior: Grupo A (ERM), grupo B (ELM) e grupo C (controle - apenas tratamento com técnica Edgewise). Após correção da mordida cruzada, todos pacientes receberam aparelhos ortodônticos fixos corretivos Edgewise. Teste t pareado e análise de variância a um critério (ANOVA) foram realizados para identificar alterações significantes intra- e intergrupos, respectivamente (p < 0,05). RESULTADOS: exceto para a distância intercaninos, todas as larguras aumentaram nos grupos A e B de T1 para T2. Em longo prazo, a quantidade de recidiva não foi diferente para os grupos A e B, exceto para a largura 3-3, que apresentou uma maior diminuição no grupo A. Clinicamente, entretanto, a porcentagem de casos com recidivas da mordida cruzada posterior foi semelhante para expansões rápida e lenta da maxila. CONCLUSÃO: Expansões rápida e lenta da maxila apresentaram estabilidades semelhantes em longo prazo. .

Manejo endodóntico de un primer premolar maxilar con tres raíces / Endodontic management of a three-rooted maxillary first premolar

Objetivo: informar el manejo endodóntico de un primer premolar maxilar con tres raíces, mediante tratamiento de conductos adecuado a estos casos. Caso clínico: un paciente de sexo femenino, de 25 años de edad, se presentó a la consulta con un diagnóstico de pulpitis irreversible asintomática en la pieza 14. A partir de los hallazgos clínicos y radiográficos iniciales -que hacían sospechar una alteración en el número de conductos-, se comprobó la presencia de tres conductos radiculares. Esta situación obligó a realizar el tratamiento endodóntico con cuidados específicos para localizar todos los conductos radiculares y prevenir desgastes excesivos y/o perforaciones. Conclusión: el diagnóstico oportuno de esta variación anatómica permite establecer modificaciones en el protocolo del tratamiento de conductos, a fin de evitar el debilitamiento excesivo o, incluso, la perforación de su estrecha anatomía radicular

Three-dimensional dental arch changes of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusion

INTRODUCTION: This study assessed the three-dimensional changes in the dental arch of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusions at three different periods. METHODS: Landmarks previously identified on upper and lower dental casts were digitized on a three-dimensional digitizer MicroScribe-3DX and stored in Excel worksheets in order to assess the width, length and depth of patient's dental arches. RESULTS: During orthodontic preparation, the maxillary and mandibular transverse dimensions measured at the premolar regions were increased and maintained throughout the follow-up period. Intercanine width was increased only in the upper arch during orthodontic preparation. Maxillary arch length was reduced during orthodontic finalization, only. Upper and lower arch depths were stable in the study periods. Differences between centroid and gingival changes suggested that upper and lower arch premolars buccaly proclined during the pre-surgical period. CONCLUSIONS: Maxillary and mandibular dental arches presented transverse expansion at premolar regions during preoperative orthodontic preparation, with a tendency towards buccal tipping. The transverse dimensions were not altered after surgery. No sagittal or vertical changes were observed during the follow-up periods. .

INTRODUÇÃO: esse estudo avaliou as alterações tridimensionais ocorridas na morfologia das arcadas dentárias de pacientes submetidos ao tratamento ortodôntico-cirúrgico para a correção da má oclusão de Classe II, em três períodos distintos: (T1) modelos iniciais, (T2) modelos pré-cirúrgicos imediatos (de 1 a 15 dias antes da cirurgia) e (T3) modelos pós-cirúrgicos (mínimo de 6 meses após a remoção do aparelho ortodôntico). MÉTODOS: pontos previamente demarcados em cada modelo foram digitalizados por meio do digitalizador tridimensional MicroScribe-3DX, cujas coordenadas, armazenadas em planilhas do programa Excel, deram origem a valores que possibilitaram a avaliação da largura, comprimento e profundidade das arcadas dentárias. RESULTADOS: durante o preparo ortodôntico, houve aumentos nas distâncias transversais superiores e inferiores medidas na região de pré-molares que se mantiveram no período total de acompanhamento. Apenas a distância intercaninos superior apresentou alterações de aumento durante o preparo ortodôntico, assim como a largura da arcada superior, que diminuiu durante a fase de finalização. A profundidade de ambas as arcadas manteve-se estável nas fases avaliadas. Diferenças entre as mudanças dos pontos centroide e gengival sugerem que os pré-molares superiores e inferiores inclinaram para vestibular durante o preparo ortodôntico pré-cirúrgico. CONCLUSÇÕES: conclui-se que as arcadas dentárias superiores e inferiores sofreram expansão transversal na região de pré-molares durante o preparo ortodôntico pré-cirúrgico, com tendência à inclinação vestibular de todos os dentes posteriores. Após a cirurgia, as dimensões transversais ...

Cephalometric effects of the Jones Jig appliance followed by fixed appliances in Class II malocclusion treatment

OBJECTIVE: The aim of this study was to cephalometrically assess the skeletal and dentoalveolar effects of Class II malocclusion treatment performed with the Jones Jig appliance followed by fixed appliances. METHODS: The sample comprised 25 patients with Class II malocclusion treated with the Jones Jig appliance followed by fixed appliances, at a mean initial age of 12.90 years old. The mean time of the entire orthodontic treatment was 3.89 years. The distalization phase lasted for 0.85 years, after which the fixed appliance was used for 3.04 years. Cephalograms were used at initial (T1), post-distalization (T2) and final phases of treatment (T3). For intragroup comparison of the three phases evaluated, dependent ANOVA and Tukey tests were used. RESULTS: Jones Jig appliance did not interfere in the maxillary and mandibular component and did not change maxillomandibular relationship. Jones Jig appliance promoted distalization of first molars with anchorage loss, mesialization and significant extrusion of first and second premolars, as well as a significant increase in anterior face height at the end of treatment. The majority of adverse effects that occur during intraoral distalization are subsequently corrected during corrective mechanics. Buccal inclination and protrusion of mandibular incisors were identified. By the end of treatment, correction of overjet and overbite was observed. CONCLUSIONS: Jones Jig appliance promoted distalization of first molars with anchorage loss represented by significant mesial movement and extrusion of first and second premolars, in addition to a significant increase in anterior face height. .

OBJETIVO: a proposta desse estudo foi avaliar cefalometricamente os efeitos esqueléticos e dentoalveolares do tratamento da má oclusão de Classe II com o distalizador Jones jig, seguido do uso do aparelho fixo corretivo. MÉTODOS: a amostra constituiu de 25 pacientes com má oclusão de Classe II, tratados com o distalizador Jones Jig, seguido do uso de aparelho fixo corretivo, com média de idade inicial de 12,90 anos. O tempo médio de tratamento ortodôntico total foi de 3,89 anos. A fase de distalização durou 0,85 anos, e a fase de aparelho fixo pós-distalização foi de 3,04 anos. Foram utilizadas as telerradiografias nos tempos inicial (T1), pós-distalização (T2) e final do aparelho fixo (T3). Para comparação intragrupo nos três tempos avaliados, foram utilizados os testes ANOVA dependente e de Tukey. RESULTADOS: os resultados demonstraram que o Jones Jig não interferiu no componente maxilar e mandibular, e não promoveu alterações na relação maxilomandibular. O Jones Jig promoveu distalização dos primeiros molares, com perda de ancoragem, mesialização e extrusão significativa dos primeiros e segundos pré-molares, e aumento significativo da altura facial anteroinferior ao final do tratamento. A maioria dos efeitos adversos ocorridos na fase de distalização intrabucal são posteriormente corrigidos durante a mecânica corretiva. Verificou-se vestibularização e protrusão dos incisivos inferiores. Ao final do tratamento, foi observada a correção dos trespasses horizontal e vertical. CONCLUSÕES: o distalizador Jones Jig promoveu a distalização dos primeiros molares, com perda de ancoragem, representada pela mesialização e extrusão significativa dos primeiros e segundos pré-molares, e aumento significativo ...

Transverse effect of Haas and Hyrax appliances on the upper dental arch in patients with unilateral complete cleft lip and palate: A comparative study

Objective: The aim of the present study was to evaluate the transverse effect of rapid maxillary expansion in patients with unilateral complete cleft lip and palate while comparing the Haas and Hyrax appliances. Methods: The sample consisted of 48 patients divided into two groups: Group I - 25 patients treated with modified Haas appliance (mean age: 10 years 8 months); and Group II - 23 patients treated with Hyrax appliance (mean age: 10 years 6 months). Casts were taken during pre-expansion and after removal of the appliance at the end of the retention period. The models were scanned with the aid of the 3 Shape R700 3D scanner. Initial and final transverse distances were measured at cusp tips and cervical-palatal points of maxillary teeth by using the Ortho Analyzer(tm) 3D software. Results: The mean expansion obtained between cusp tips and cervical-palatal points for inter-canine width was 4.80 mm and 4.35 mm with the Haas appliance and 5.91 mm and 5.91 mm with the Hyrax appliance. As for first premolars or first deciduous molars, the values obtained were 6.46 mm and 5.90 mm in the Haas group and 7.11 mm and 6.65 mm in the Hyrax group. With regard to first molars, values were 6.11 mm and 5.24 mm in the Haas group and 7.55 mm and 6.31 mm in the Hyrax group. Conclusion: Rapid maxillary expansion significantly increased the transverse dimensions of the upper dental arch in patients with cleft palate, with no significant differences between the Hass and Hyrax expanders. .

Objetivo: avaliar o efeito transversal na arcada dentária superior do procedimento de expansão rápida da maxila em pacientes com fissura transforame incisivo Aunilateral, comparando os expansores tipo Haas modificado e de Hyrax. Métodos: a amostra constou de 48 pacientes divididos em dois grupos: grupo I, 25 pacientes que utilizaram o aparelho expansor tipo Haas modificado, com média de idade de 10 anos e 8 meses; e grupo II, 23 pacientes que utilizaram o Hyrax, com média de idade de 10 anos e 6 meses. Modelos de gesso foram realizados na fase pré-expansão e após 6 meses de contenção, após a remoção do aparelho. Os modelos foram digitalizados com auxílio do scanner 3Shape R700 3D e as distâncias transversais iniciais e finais foram medidas entre as pontas de cúspides e pontos cervicopalatinos de dentes superiores pelo método digital no software OrthoAnalyserT 3D. Resultados: a média de expansão obtida entre as pontas de cúspides e entre os pontos cervicopalatinos, respectivamente, para a distância intercaninos, foi de 4,80mm e 4,35mm para o Haas e de 5,91mm e 5,91mm para o Hyrax; 6,46mm e 5,90mm para os primeiros molares decíduos ou primeiros pré-molares no grupo Haas, 7,11mm e 6,65mm no grupo Hyrax; e 6,11mm e 5,24mm para os primeiros molares no grupo Haas e 7,55mm e 6,31mm no grupo Hyrax. Conclusão: o procedimento de expansão rápida da maxila produziu aumentos significativos das dimensões transversais da arcada dentária superior em pacientes com fissura, sem diferenças significativas entre os expansores Haas modificado e Hyrax. .

Management of Type III Dens Invaginatus in a Mandibular Premolar: A Case Report

Dens invaginatus is a well-known malformation of teeth, which probably results from an invagination of enamel organ into dental papilla during tooth development. The endodontic treatment of invaginated teeth may be challenging due to difficulties in accessing the root canals and also due to complex variations of internal morphology. This article presents the endodontic management and follow-up in a rare case of right mandibular second premolar with Oehlers' type III dens invaginatus. The result of cold pulp testing was positive for this tooth but it was associated to a sinus tract and periapical lesion. Herein, it is described the root canal therapy of this tooth combined with periapical surgery, emphasizing the importance of proper diagnosis and planning by using cone beam computed tomography (CBCT). This case report presents the proper periapical healing 6 months after the combination of nonsurgical and surgical treatments. It also shows that CBCT is an important auxiliary examination to avoid errors in diagnosis and subsequent treatment of dental anomalies.

Dens invaginatus é uma malformação dentária já bem reconhecida, que provavelmente resulta de uma invaginação do órgão do esmalte para dentro da papila dentária durante o desenvolvimento do dente em questão. O tratamento endodôntico de dentes invaginados pode ser um desafio devido às dificuldades de acesso aos canais radiculares e também devido à complexidade da morfologia interna. Este artigo apresenta o manejo endodôntico e o acompanhamento de um caso raro de segundo pré-molar inferior direito com dens invaginatus Tipo III de Oehlers. O resultado do teste de sensibilidade pulpar ao frio foi positivo para este dente, mas o mesmo estava associado a uma fístula e lesão periapical. Relata-se o tratamento de canal deste dente associado à cirurgia periapical, enfatizando a importância de um correto diagnóstico e plano de tratamento, utilizando a tomografia computadorizada de feixe cônico (TCFC). Este relato de caso mostra reparo periapical adequado 6 meses após a combinação dos tratamentos não-cirúrgico e cirúrgico. Mostra também que a TCFC é um importante exame auxiliar para evitar erros no diagnóstico e posterior tratamento de anomalias dentárias.

Granuloma periapical extenso en la región de molar primario: asociación con agenesia del premolar sucesor / Extensive periapical granuloma in the primary molar region: association with agenesis of the succesor premolar

El objetivo de este trabajo fue explorar la posible asociación entre un granuloma periapical extenso en la región de molares primarios y la agenesia del premolar sucedáneo. Una niña blanca de 10 años con una tumefacción indolora en la región mandibular derecha quien al examen radiográfico reveló presencia de una lesión radiolúcida, única, bien definida y amplia, con un diámetro de aproximadamente 15 mm, en íntima asociación con la región periapical del segundo molar inferior primario derecho con destrucción de la corona clínica por caries, también se observa la ausencia del segundo premolar inferior sucesor derecho. Se procedió a la eliminación total de la lesión intraósea y el diente asociado, el tejido extirpado fue diagnosticado histopatológicamente como un Granuloma Periapical. Después de 3 meses de seguimiento la paciente mostró una buena cicatrización postquirúrgica del defecto óseo por la eliminación de la lesión inflamatoria. Este caso clínico concluye que la etiopatogenia de la agenesia dentaria no es del todo conocida y sugiere que otros factores no genéticos, como grandes lesiones periapicales, podrían influir a nivel local en las primeras etapas de la odontogénesis y llevar a cabo la formación del segundo premolar inferior, aunque se necesitan más estudios sobre el tema

The aim of this study was to explore the possible association between a large periapical granuloma in the primary molar region and agenesia of the successor premolar. A 10 years old white girl with a painless swelling in the right mandibular region in the radiographic examination revealed the presence of a radiolucent lesion, single, well defined and comprehensive, with a diameter of about 15 mm, in close association with the apical region of the second right primary molar widely decayed, also noting the absence of the second premolar successor. Proceeded to the total elimination of the intraosseous lesion and the associated tooth, the removed tissue was histopathologically diagnosed as a periapical granuloma. Three-month follow-up after treatment the patient showed good postoperative bone defect healing by eliminating the inflammatory lesion. This clinical report concludes that the etiopathogenesis of dental agenesis is not entirely known and suggests that other non-genetic factors, such as large periapical lesions, could influence locally in the early stages of odontogenesis and compromise the formation of the lower second premolar, although more research is needed on the subject

Erupted compound odontome associated with impactedmaxillary second premolar: a case report / Odontoma composto erupcionado associado a segundopré-molar superior impactado: um relato de caso

Introduction: Odontomas are the most common odontogenic tumour. They are considered to be hamartomasrather than neoplasms. They are generally asymptomatic and are discovered on routine radiographicexamination. Odontomas might be associated with disturbance in tooth eruption. Other symptoms includeretention of deciduous teeth, pain, swelling, expansion of cortical bone, tooth displacement. Eruption ofodontoma in the oral cavity is rare with only 11 cases being reported about erupted compound odontomas.Case report: An unusual case of erupted compound odontome associated with pain and impacted maxillaryleft second premolar is reported. We have also discussed the clinical, radiographic and histopathologicfeatures of this rare condition.

Introdução: Odontomas são os mais comuns entre os tumores odontogênicos. Eles são considerados hamartomas,ao invés de neoplasias. Eles geralmente são assintomáticos e descobertos em exames radiográficos derotina. Odontomas podem estar associados com distúrbio na erupção dentária. Outros sintomas incluem retençãode dentes decíduos, dor, inchaço, expansão do osso cortical e deslocamento do dente. A erupção de um odontoma na cavidade oral é rara, com apenas 11 casos relatados de odontomas compostos erupcionados.Relato de caso: Um caso incomum de odontoma composto associado à dor e segundo pré-molar superior esquerdoimpactado é relatado neste artigo. Os aspectos clínicos, radiográficos e histopatológicos dessa doençarara também são discutidos.

Displacement of endodontic instruments in inferior alveolar canal.

Endodontic instrument breakage is a common occurrence during root canal treatment but the displacement of the separated instrument into the inferior alveolar canal is rare and has never been reported. We hereby present an unusual case of displacement of a separated instrument in the inferior alveolar canal and its retrieval by a simple technique.

Reliability of Logicon caries detector in the detection and depth assessment of dental caries: An in-vitro study.

Background: Digital radiography has so far not resulted in improved rates of proximal caries detection. Historically, automated caries detection tools have been largely academic. Opinions regarding the performance of the only such commercially available tool, viz., Logicon caries Detector (LCD) have been equivocal. This study was conducted to evaluate the reliability of LCD in the detection and depth assessment of proximal caries. Materials and Methods: Digital images were obtained of 100 proximal tooth surfaces using the Kodak RVG 5000 sensor and analyzed by three observers. The images were then analyzed by the principal investigator using the LCD software. The teeth were then sectioned and magnified photographic images were obtained which were taken as the gold standard. All the grades were entered in proformas and the data were statistically analyzed using the chi-square test. Five parameters of reliability were calculated. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of LCD for the grade No caries were 33, 96, 73, 82, and 81%, respectively; for the grade Enamel caries were 5, 97, 33, 80, and 79%, respectively; and for the grade Dentin caries were 100, 96, 50, 100, and 96%, respectively. Conclusions: In conclusion, LCD appears to be more reliable in ruling out (both enamel and dentin) caries than in detecting caries.

Efficacy of five rotary systems versus manual instrumentation during endodontic retreatment

The purpose of this study was to evaluate the efficiency of ProFile, GT, ProTaper, Race and K3 rotary instruments compared with hand K-files for removal of gutta-percha during retreatment. Sixty mandibular premolars were instrumented with GT rotary files and filled by thermomechanical compaction of gutta-percha and AH Plus sealer. The teeth are randomly divided into 6 groups of 10 specimens each. The roots were split longitudinally, digital images were created using a flatbed scanner, and the areas with remaining filling material were demarcated using Image Tool 1.21 software. The results indicate that GT left significantly less (p<0.05) remaining filling material (1.18 ± 1.47) than hand (3.70 ± 3.16) and Hero instruments (2.99 ± 2.58). There was no statistically significant difference (p<0.05) among the others techniques: ProFile (1.99 ± 2.66), ProTaper (2.00 ± 1.99) and K3 (2.71 ± 2.87) when compared with GT. In conclusion, GT, ProFile, ProTaper and K3 were more effective in removing gutta-percha than manual and Hero instruments.

O propósito deste estudo foi avaliar a eficiência dos instrumentos rotatórios ProFile, GT, ProTaper, Race e K3 comparados com limas K para a remoção do material obturador durante o retratamento. Sessenta pré-molares inferiores foram instrumentados com o sistema rotatório GT e obturados usando a técnica de compactação termomecânica de guta-percha com cimento AH Plus. Os dentes foram divididos aleatoriamente em seis grupos de dez espécimes cada. As raízes foram seccionadas longitudinalmente, imagens digitais foram criadas através de um scanner, e as áreas de remanescentes de material foram medidas usando o programa Image Tool 1.21. Os resultados indicaram que o GT deixou significantemente menos material remanescente (1,18 ± 1,47) do que os instrumentos manuais (3,70 ± 3,16) e os instrumentos Hero (2,99 ± 2,58) (p<0,05). Não houve diferença estatisticamente significante entre as outras técnicas ProFile (1,99 ± 2,66), ProTaper (2,00 ± 1,99) e K3 (2,71 ± 2,87) quando comparadas com o GT. Como conclusão, GT, ProFile, ProTaper e K3 foram revelados como mais efetivos em remover a guta-percha do que os instrumentos manuais e os instrumentos Hero.

[Fatigue resistance and failure mode of endodontically restored premolars with indirect composite resin restoration-in vitro]

The present study aimed at determination of the fatigue resistance and failure mode of cusp-replacing onlays in endodontically treated premolars using indirect composite resin restorations. In this experimental study, 84 human premolars were randomly divided into 7 groups of 12. These groups were prepared as follows: Intact teeth used in group1 as control, the second group covers the endodontically treated teeth, restored with indirect onlays using Z-250 composite resin, the next two groups [i.e. 3, 4] were similar to the second group, but subjected to 1 and 2 million fatigue load cycles, respectively. Groups 5, 6, 7 were similar to groups 2, 3, 4, respectively, however, in these groups Tetric Ceram used as the restorative material. All specimens were loaded using a Universal Testing Machine until fracture occurred and the mode of failure observed with naked eye. Kruskal-Wallis and Chi-Square tests were used to analyze the data [alpha=.05]. All specimens withstood the masticating simulation. The mean fracture strength for groups 1 to 7 were: 1276.92, 1269.05, 1217.80, 1188.13, 1228.97, 1127.86, 1105.58, respectively. No statistically significant differences were found between the groups in fracture strength and failure mode. There was no statistically significant difference between two types of resin composite [P=0.203] and load cycles [P=0.298] after zero, 4 and 8 years aging. Within the limitation of this study, restored premolars with indirect composite onlays show fatigue resistance equal to natural tooth up to 8 years after restoration. Furthermore, no statistically significant differences were found between 4 and 8 years of load cycles. Tetric Ceram Z-250 restoration agent showed no effect on the tooth fracture resistance with the most observed fractures to be occur under CEJ with no capability to be restored

Three root canals in the maxillary second premolar.

In this study, we report an endodontic treatment of the maxillary second premolar with three root canals and distinct foramens. The possibility of three root canals in this tooth is quite small; however, it must be taken into account in clinical and radiographic evaluation during endodontic treatment. Many times, their presence is noticed only after canal treatment due to continuing post-operative discomfort.

Diagnosis and root canal treatment in a mandibular premolar with three canals

This paper presents a case report of a left mandibular second premolar with three canals and three different apical foramina. A 39-year-old male patient presented to our clinic with pain in the mandibular left second premolar. Initially, pain was caused by cold stimulus and later was spontaneously. The intraoral clinical examination revealed a fractured amalgam restoration with occlusal caries. Percussion and cold (Endo-Frost) tests were positive. The radiographic examination showed the presence of two roots. The probable diagnosis was an acute pulpitis. After access cavity, it was observed remaining roof of the pulp chamber and mild bleeding in the tooth lingual area, indicating the possible presence of a third canal. The endodontic treatment was completed in a single session using Root ZX apex locator and K3 NiTi rotary system with surgical diameter corresponding to a .02/45 file in the three canals and irrigation with 1 percent sodium hypochlorite. The canals were obtured with gutta-percha cones and Sealer 26 using the lateral condensation technique. After 1 year of follow-up, the tooth was asymptomatic and periapical repair was observed radiographically. Internal alterations should be considered during the endodontic treatment of mandibular second premolars. The correct diagnosis of these alterations by the analysis of preoperative radiographs can help the location of two or more canals, thereby avoiding root therapy failure.

O presente artigo teve como objetivo a apresentação de um caso clínico de um segundo pré-molar inferior esquerdo com três canais com três forames distintos. Paciente de 39 anos de idade, leucoderma, relatava dor inicialmente estimulada ao frio e posteriormente dor espontânea no referido dente. No exame intraoral foi constatada restauração de amálgama fraturada e cárie oclusal. Os testes de sensibilidade à percussão e ao frio (Endo-Frost) foram positivos. O exame radiográfico evidenciou a presença de duas raízes. O diagnóstico provável foi de pulpite aguda. Após o preparo de acesso à câmara pulpar notou-se a presença de teto remanescente e um leve sangramento, sendo possível localizar um terceiro canal na região lingual. O tratamento endodôntico foi realizado em uma única sessão, com auxílio do localizador apical Root ZX, e o preparo biomecânico com sistema rotatório com limas de NiTi K3 com diâmetro cirúrgico correspondente ao instrumento .02/45 nos três canais, e a solução química auxiliar hipoclorito de sódio 1 por cento. A obturação foi realizada por condensação lateral de guta-percha e cimento Sealer26. Durante o período de proservação de 1 ano, o dente apresentou-se clinicamente assintomático com reparação dos tecidos periapicais observada radiograficamente. Alterações internas devem ser consideradas durante tratamento endodôntico em segundos pré-molares inferiores. O correto diagnóstico destas alterações por meio da análise de radiografias pré-operatórias podem auxiliar na localização de dois ou mais canais, evitando dessa maneira o insucesso do tratamento a ser realizado.

Response of the periapical tissue of dogs' teeth to the action of citric acid and EDTA

The purpose of this study was to analyze the inflammatory response of dog's periapical tissues to 17 percent trisodium EDTA salt (pH 8.0) and 1 percent citric acid (pH 2.0). Saline was used as a control. Six adult dogs were used as the biological model of the study. The experimental units comprised 56 roots of mandibular molars (first and second) and premolars (first, second and third). After coronal opening, pulpectomy and root canal instrumentation were performed using the above-mentioned irrigating solutions. After 24 and 48 hours, the animals were euthanized and the teeth and their supporting tissues were removed and histologically processed. The sections were stained with hematoxylin and eosin and analyzed histopathologically with a light microscope at x100 magnification. The histological analysis focused on the occurrence of acute inflammatory response. The presence of swelling, vasodilatation and inflammatory cells were evaluated and the degree of inflammation was determined for each case. Data were analyzed by Fisher's exact test using the SPSS software with a confidence interval of 95 percent (p<0.05). 17 percent EDTA and 1 percent citric acid caused inflammatory responses in dog's periapical tissues with no significant differences to each other or to saline (control) at either the 24-hour (p=0.482) or 48-hour (p=0.377) periods. It may be concluded that the inflammatory response was of mild intensity for the tested substances.