Pulpectomía mecanizada en molares primarios: caso clínico / Mechanized pulpectomy in primary molars: a clinical case

Las pulpectomías en molares primarios están indica-das en casos de diagnóstico de pulpitis irreversible o necrosis y reabsorción radicular mínima o nula. Son tratamientos laboriosos y extensos, que sólo pueden ser llevados a cabo en pacientes colaboradores. En búsqueda de simplificar esta terapéutica y mejorar su eficacia, se propone la mecanización de la pre-paración de los conductos de molares primarios. Diversos autores aseguran que esta técnica opti-miza el tiempo clínico y mejora la calidad del trata-miento, obteniendo gran aceptación en la literatura actual. Se presenta la secuencia de procedimientos, resolución y controles de dos tratamientos de pul-pectomía con instrumentación mecanizada en mola-res primarios (AU)

Pulpectomies in primary molars are indicated in cases of irreversible pulpitis or necrosis with mini-mal or no root resorption. They are laborious and ex-tensive treatments, which only can be carried out in cooperative patients. In order to simplify this therapy and improve its effectiveness, the mechanization of root canal preparation is proposed. Several authors assume that this technique optimizes preparation time and improves the quality of treatment, obtaining great acceptance in the current literature. We report the sequence of procedures, resolution, and controls of two pulpectomies with mechanized instrumenta-tion in primary molars (AU)

Effect of Photobiomodulation on Pain Following Single Visit Non-surgical Root Canal Treatment of Molar Teeth with Symptomatic Irreversible Pulpitis

ABSTRACT Objective: To assess the effect of Photobiomodulation (PBM) on post-endodontic pain of mandibular molar teeth with symptomatic irreversible pulpitis. Material and Methods: In this clinical trial, mandibular molars with symptomatic irreversible pulpitis underwent primary endodontic treatment in 90 systemically healthy patients. After root canal treatment, the patients were randomly divided into two groups of PBM with diode laser at 940 nm wavelength and 200 mW output power and placebo (mock PBM therapy). Level of pain was recorded at 6, 12, 24, 48, and 72 hours postoperatively using a visual analog scale (VAS). The data were analyzed using the Mann-Whitney test and the Kruskal-Wallis test. Results: The results showed that post-endodontic pain at all time points was significantly lower in the PBM group compared with the placebo group. The pain score in the PBM group was significantly lower than the placebo group (p<0.05). However, this difference was not significant at 48 h (p=0.18) and 72 h (p=0.12) postoperatively. Also, the results showed that the mean pain score in males and females in the PBM group was significantly lower than in males and females in the placebo group. Conclusion: Photobiomodulation can effectively decrease post-endodontic pain in mandibular molar teeth with symptomatic irreversible pulpitis.

Study of vital inflamed pulp therapy in immature permanent teeth with irreversible pulpitis and apical periodontitis / 中华口腔医学杂志

To assess the treatment effectiveness of vital inflamed pulp therapy (VIPT) in immature permanent teeth with irreversible pulpitis and apical periodontitis. The faculty members in the Department of Pediatric Dentistry, the Ninth People's Hospital were invited to submit consecutive VIPT cases from June 2015 to June 2016 (follow-up periods>12 months). The cases were retrospectively reviewed, clinical symptoms and radiographic changes in periapical radiolucency were evaluated, meanwhile, the data of radiographic changes such as apical diameter and root length were calculated and analyzed with ANOVA. Totally thirteen submitted patients/cases were included (6 males and 7 females) in the present study,. The average age of patients was (9.9±1.4) years old. The average follow-up time was (26.5±6.8) months (17-37 months). At the 12-month visit, all 13 treated teeth survived, 9 out of 11 teeth with apical periodontitis showed normal radiographic manifestation. At the 3, 6 and 12 months visits, the within-case percentage changes in apical diameter were (8.0±5.1)%, (24.1±9.1)% and (70.3±10.7)%, respectively, while the within-case percentage changes in root length were (11.4±9.8)%, (14.5±9.8)% and (27.4±14.2)%, respectively. There were statistically significant differences in the changes of apical diameter (F=18.80, P<0.001) and root length (F=4.64, P=0.047) from the preoperative time to the postoperative follow-ups. VIPT might improve clinical outcomes, even achieve continued root development. VIPT can be an option in treating immature teeth with irreversible pulpitis and apical periodontitis.

New advances in vital pulp therapy and pulp regeneration for the treatment of pulpitis: from basic to clinical application / 中华口腔医学杂志

In recent years, great progress has been made in research on the treatment of pulpitis, mainly due to the rapid development of basic and clinical researches in this field, and some achievement from basic research has been applied in clinical practice. Advances in the diagnostic methods for pulpitis can help the clinicians to recognize the true state of pulpitis more accurately and to adopt the corresponding treatment methods including indirect/direct pulp capping, pulpotomy, pulp regeneration and root canal therapy. The new theory of pulpitis diagnosis and the studies on immune defense, repair function of dental pulp and new pulp capping materials have significantly improved the success rate of vital pulp therapy. For diffuse coronary pulpitis or radicular pulpitis, which is difficult to achieve vital pulp therapy successfully, methods of pulp revascularization, cell homing and pulp stem cells-mediated pulp regeneration can also be used as treatment options in addition to root canal therapy. The present article focuses on the research progress on pulpitis treatments and related clinical transformation practices, in order to provide reference on vital pulp therapy and pulp regeneration for clinicians.

Induction of root development and apical closure in permanent mandibular molar with irreversible pulpitis through total pulpotomy with application of mineral trioxide aggregate / Inducción del termino de desarrollo radicular y cierre apical en molar mandibular permanente con pulpitis irreversible a través de pulpotomía total con aplicación de agregado de trióxido mineral

Loss of teeth vitality when root formation is incomplete, results in weaker structures leaving them prone to fractures and unfavourable long-term prognosis. Apexogenesis is currently the treatment of choice in immature teeth and is indicated in vital teeth without pulpal pathologies. The treatment aims to eliminate the causal agent of the damage, and provide the necessary conditions to preserve vitality in the tooth and induce apical root closure. A 6-year-old male patient was treated at the Endodontics Clinic, Universidad de La Frontera upon complaining of acute pain in tooth 30. The tooth presented incomplete root development due to dental caries with pulp exposure and a diagnosis of irreversible symptomatic pulpitis. Total pulpotomy was performed with the application of Mineral Trioxide Aggregate and controlled at 1, 4, 6, 7 and 12 months, achieving root development and apical closure in the permanent molar. The result was comparable with studies that support this therapy in teeth with irreversible pulpitis. This work seeks to contribute to the existing evidence on the management of immature permanent teeth with irreversible pulpitis to induce root development and apical closure, and maintain pulp vitality.

La pérdida de vitalidad en dientes con formación radicular incompleta trae como resultado el debilitamiento de estos, dejándolos propensos a fracturas con un desfavorable pronóstico a largo plazo. Las terapéuticas actuales de regeneración pulpar en dientes inmaduros estan principalmente indicadas en cuadros de pulpitis irreversible y buscan eliminar el agente causal de daño y brindarle al diente las condiciones y estímulos necesarios para preservar vitalidad e inducir el cierre apical radicular. Un paciente de 6 años de edad y de sexo masculino, acude a la Clínica de Especialidad de Endodoncia de la Universidad de la Frontera, consultando por un dolor agudo en diente 4.6 el cual presentaba un desarrollo radicular incompleto producto de una caries con exposición pulpar con diagnóstico de Pulpitis Irreversible Sintomática. Se realiza una pulpotomia total con aplicación de Mineral Trioxide Aggregate y se controla a los 1, 4, 6 y 7 meses obteniendo un interesante resultado comparable con estudios que avalan dicha terapeutica en dientes con pulpitis irreversible. Este trabajo busca contribuir a la evidencia existente sobre el manejo de dientes permanentes inmaduros con cuadros de pulpitis irreversible para inducir el desarrollo radicular, cierre apical y mantener vitalidad pulpar.

Urgência em Endodontia: diagnóstico e tratamento em casos de pulpite irreversível sintomática / Urgency in Endodontics: Diagnosis and Treatment in Cases of Symptomatic Irreversible Pulpitis

Objetivo: discutir sobre o diagnóstico e a conduta terapêutica em casos de urgência endodôntica em dentes que apresentam pulpite irreversível sintomática. Material e Métodos: realizou-se uma revisão bibliográfica de estudos publicados nos últimos 5 anos (2015- 2020) por meio de busca nas bases de dados: PubMED, BVS (Biblioteca Virtual em Saúde) e Scielo (Scientific Eletronic Library). Para a pesquisa, foram utilizados os seguintes descritores: Pulpite Irreversível (Irreversible Pulpitis), Tratamento (Treatment), Dor (Pain) e Endodontia (Endodontics). Resultados: O diagnóstico é um passo fundamental no tratamento das urgências e emergências de origem endodôntica, pois é a partir do correto diagnóstico que será instituído o tratamento correto, reestabelecendo o conforto do paciente. Quando o profissional dispõe de tempo suficiente para realizar a remoção do tecido pulpar e o preparo do canal radicular, esse é o tratamento de escolha para os casos de pulpite irreversível sintomática, o qual pode ser realizado em sessão única ou em múltiplas sessões. Quando o profissional não dispõe de tempo suficiente para realizar o tratamento endodôntico convencional, a opção de tratamento é realizar apenas o atendimento de urgência para retirar o paciente do quadro de dor aguda presente, e em um momento futuro realizar o tratamento endodôntico completo. Conclusão: As urgências endodônticas sempre estão presentes nos consultórios odontológicos, os profissionais devem estar sempre preparados para realizar um correto diagnóstico e tratamento para cada caso, trazendo assim conforto ao paciente.

Objective: to discuss the diagnosis and therapeutic management in cases of endodontic urgency in teeth with symptomatic irreversible pulpitis. Material and Methods: a bibliographic review of studies published in the last 5 years (2015-2020) was carried out by searching the databases: PubMED, BVS (Virtual Health Library) and Scielo (Scientific Electronic Library). For the research, the following descriptors were used: Irreversible Pulpitis, Treatment, Pain and Endodontics. Results: The diagnosis is a fundamental step in the treatment of urgencies and emergencies of endodontic origin, as it is from the correct diagnosis that the correct treatment will be instituted, reestablishing the patient's comfort. When the professional has enough time to remove the pulp tissue and prepare the root canal, this is the treatment of choice for cases of symptomatic irreversible pulpitis, which can be performed in a single session or in multiple sessions. When the professional does not have enough time to carry out the conventional endodontic treatment, the treatment option is to perform only emergency care to remove the patient from the present acute pain condition, and at a future time to carry out the complete endodontic treatment. Conclusion: Endodontic emergencies are always present in dental offices, professionals must always be prepared to carry out a correct diagnosis and treatment for each case, thus bringing comfort to the patient.

Iodoform Vs Calcium Hydroxide/Zinc Oxide based pastes: 12-month findings of a Randomized Controlled Trial

Abstract This study evaluated clinical and radiographic twelve-month outcomes of root canal treatments (CT) with smear layer removal, performed in primary teeth, using two different root canal filling materials. Pulpectomy was performed on 27 primary teeth with necrosis or irreversible pulpitis, caused by dental caries or trauma, in 23 children (2-7 years old). A single trained operator performed the CT in a single visit in cases without periapical or interradicular radiolucency (PIR) or in multiple visits in cases with PIR. Participants were selected based on specific inclusion and exclusion criteria, and randomly allocated into two groups: Group 1 (G1) - iodoform paste (iodoform + camphorated parachlorophenol + ointment comprising prednisolone acetate 5.0 mg and rifamycin 1.5 mg); Group 2 (G2) - Calen®/ZO paste. Treated teeth were restored with composite resin immediately after the root canal filling. The outcomes were evaluated clinically and radiographically according to specific criteria. Two blinded and standardized evaluators assessed the radiographic outcomes. We used descriptive analyses due to the small sample size. CTs were performed due to caries lesions in 70.4% of the cases and due to trauma in 29.6%. Only one tooth of G1 was unsuccessful; hence, pulpectomy performance in both groups was not influenced by the filling material, nor by any other analyzed variable. The level of the root canal filling was better in the Calen®/ZO group. The clinical and radiographic twelve-month outcomes indicated successful treatment, independently of the root filling material used.

Índice del dolor postratamiento endodóntico / Pain Index after endodontic treatment

Introducción: Pronosticar la aparición de dolor postratamiento endodóntico favorece el juicio clínico de profesionales en relación con este procedimiento. Objetivo: Elaborar un índice a partir de factores que conducen al dolor postratamiento endodóntico en la población objeto de estudio. Métodos: Se realizó una investigación en dos etapas en la ciudad Santo Domingo, provincia Villa Clara. La primera fue un estudio analítico transversal sobre 94 tratamientos endodónticos seleccionados mediante un muestreo aleatorio, entre marzo y diciembre de 2015, para obtener un índice. La segunda fue un estudio transversal realizado sobre 62 tratamientos escogidos también de forma aleatoria, entre enero y mayo de 2016, para valorar la capacidad discriminatoria del índice. Se recopiló información mediante el interrogatorio, examen clínico y radiográfico, y se registró la presencia de dolor al terminar la terapia. Los datos se analizaron empleando estadística descriptiva e inferencial. Para la construcción del índice, se obtuvieron los valores del estadígrafo V de Cramer de cada variable. Resultados: Entre los factores asociados al dolor postratamiento endodóntico se observó como los más relevantes el dolor o inflamación preoperatorio, el dolor durante el tratamiento, el número de citas y el conducto radicular reducido; con valores de la V de Cramer de 0,848; 0,605; 0,595 y 0,592, respectivamente. La sensibilidad del índice propuesto fue del 83,3 pr ciento. Conclusiones: En la población estudiada se observaron varios factores asociados a la presencia de dolor postratamiento endodóntico; el dolor o inflamación preoperatorio resultó el de mayor significación. Estos factores se sintetizaron mediante un índice. El índice propuesto presentó una adecuada sensibilidad, lo que contribuye a establecer juicios pronósticos más acertados con respecto a la aparición posterior del dolor(AU)

Introduction: Predicting the onset of pain after endodontic treatment favors the professionals' clinical judgment regarding this procedure. Objective: To construct an index that combines the factors associated to pain after endodontic treatment in the study population. Methods: A study was carried out in two stages, in Santo Domingo City, Villa Clara Province. The first stage was a cross-sectional analytic study over a random sample of 94 endodontic treatments, collected in the period of March to December of 2015, for the construction of the index. The second stage was also a cross-sectional study over a sample of 62 treatments, carried out between January and May, 2016, with the purpose of assess the discriminatory ability of the obtained index. The information was collected through interrogation, clinical and radiographic examination; the presence of pain after therapy was recorded. The data were analyzed using descriptive and inferential statistics. For the construction of the index, we obtained the Cramer's V statistic values ​​of each variable. Results: Among the factors associated with pain after endodontic treatment pain, the most were described such as preoperative pain or inflammation, pain during treatment, the number of appointments, and a reduced root canal, with Cramer's V values of 0.848, 0.605, 0.595 and 0.592, respectively. The sensitivity of the proposed index was 83.3 por ciento. Conclusions: In the studied population, a multi-causal relationship was observed in the factors associated with the presence of pain after endodontic treatment. The preoperative pain or inflammation was the most influential factor. This factors were synthesized by means of an index. The proposed index presents an adequate sensitivity, which contributes to establish more accurate judgments regarding the subsequent onset of pain(AU)

Manejo de exacerbación en endodoncia / Exacerbation management in endodontics

Introducción: la exacerbación endodóntica es un problema con bajo reporte de incidencia que puede ocurrir después de un tratamiento de endodoncia por la agudización de una condición pulpar asintomática, así como por una afección perirradicular. Lesiones mecánicas y químicas se asocian con frecuencia con su aparición, sin embargo, la lesión causada por microorganismos y sus productos es la causa principal y más común de ella. Puede presentarse posterior a la realización del tratamiento en una cita o entre sesiones. Objetivo: reportar un caso de exacerbación en endodoncia y el manejo de esta. Presentación del caso: paciente femenina de 49 años que acude a consulta por dolor e inflamación luego de haber iniciado tratamiento de endodoncia. Se llevó a cabo el manejo clínico y farmacológico de la exacerbación en un diente con diagnóstico de periodontitis apical asintomática. Luego de 5 días se termina el tratamiento de conducto usando mineral trióxido agregado y gutapercha. Posteriormente el diente es restaurado y se realizan controles clínicos y radiográficos. Conclusiones: es posible prevenir este tipo de complicaciones de causa variable identificando factores de riesgo, así como por medio de la experiencia del clínico e instauración de protocolos de atención adecuados(AU)

Introduction: endodontic exacerbation is a problem with low incidence that can occur after endodontic treatment due to the aggravation of an asymptomatic pulp condition, as well as a periradicular affection. Mechanical and chemical injuries are frequently associated with their onset; however, the injury caused by microorganisms and their products is the main and most common cause for it. It can occur after the treatment is performed at an appointment or between sessions. Objective: to report a case of endodontic exacerbation and its management. Case presentation: a 49-year-old female patient presented with pain and inflammation after beginning the endodontic treatment. The clinical and pharmacological management of the exacerbation was carried out in a tooth with diagnosis of asymptomatic apical periodontitis. After 5 days, the root canal treatment is finished using mineral trioxide aggregate and gutta-percha. The tooth is then restored and clinical and radiographic controls are carried out. Conclusions: it is possible to prevent this type of complications of variable cause by identifying risk factors, as well as through the experience of the clinician and the establishment of proper management protocols(AU)

Tratamientos pulpares en dientes primarios / Pulp therapies in primary teeth

El mantenimiento de las piezas dentarias para desempeñar sus funciones en la alimentación, en la expresión oral, en el mantenimiento de espacios en las arcadas dentarias, en el estímulo para el crecimiento y desarrollo de los maxilares, entre otras acciones, ha sido considerado esencial para el logro de un desarrollo armónico. Por otro lado, y a pesar de los avances en la materia, la caries dental es la causa más frecuente de las patologías pulpares en los dientes primarios y constituye el principal motivo de su deterioro y/o su pérdida. Las características histo-patológicas de la pulpa dental, la brevedad de su ciclo vital, el tamaño relativo de las cámaras pulpares, favorecen el rápido compromiso pulpar y propician que el proceso infeccioso progrese rápidamente a la necrosis. Ello ha determinado y determina el desarrollo de numerosas técnicas y tratamientos, diferentes ofertas terapéuticas de las cuales ninguna ha alcanzado el consenso universal. Como establecen las Guías de Odontología Pediátrica sobre tratamientos pulpares en dientes primarios, la literatura dental en esta área ofrece escasa y pobre evidencia para sustentar las diferentes técnicas y constantemente señalan la necesidad de nuevos y rigurosos estudios que la avalen.

Lesión endoperiodontal combinada secundaria a un traumatismo incisal / Combined endoperiodontal injury secondary to trauma incisal

Introducción: en la práctica estomatológica, es frecuente encontrar situaciones clínicas en las que, en una somera exploración, no es fácil determinar si se trata de una afección endodóntica, periodontal o una combinación de ambas, por lo que la clasificación de estas lesiones se realiza en relación con la fuente primaria de origen, que puede ser pulpar o periapical, y a partir de estas estructuras afectar al diente en su conjunto, extendiendo el proceso infeccioso, incluso hasta las crestas óseas; no existe marcada diferencia en cuanto a grupos de edades y sexo. Objetivos: el objetivo de este trabajo es presentar el caso clínico de lesión endoperiodontal combinada, secundaria a traumatismo incisal y la importancia de la radiografía para su diagnóstico. Datos del caso: paciente de sexo femenino con antecedentes de salud anterior que acude por presentar dolor y aumento de volumen de color rojo intenso en región de incisivos centrales superiores, radiográficamente aparece una lesión que involucra los tercios apicales de incisivos central y lateral, presentando vitalidad en este último. Fue tratada por el servicio de urgencia realizándosele el acceso cameral. Principales comentarios: Fue necesario realizar en una variedad de exámenes tanto clínicos como pruebas diagnósticas para la diferenciación entre las lesiones endodónticas y periodontales verdaderas. El diagnóstico definitivo solo pudo establecerse sobre la base de los hallazgos clínico-radiográficos. Se realizó un tratamiento combinado endodóntico y periodontal con un buen pronóstico(AU)

Introduction: in dental practice, it is common to find clinical situations in which, in a cursory examination, it is not clear whether this is an endodontic, periodontal or a combination of both affections, so that the classification of these lesions is performed in relation to the primary source of origin which may be pulp or periapical and from these structures affect the tooth as a whole; spreading the infection process, even the bony ridges. There are no marked difference in age groups and sex. Objectives: the aim of this paper is to present a case of combined endoperiodontal injury secondary to incisal trauma and the importance of radiography for diagnosis. Facts of the case: female patient with a history of previous health comes having pain and enlargement of deep red upper central incisor region, radiographically injury involving the apical thirds of central and lateral incisors appear, showing vitality in this one. It was treated by the emergency service by cameral access. Main comments: It was necessary in a variety of both clinical examination and diagnostic tests for differentiating between true endodontic and periodontal lesions. The definitive diagnosis could only be established on the basis of clinical and radiographic findings. Combined periodontal and endodontic treatment was performed with a good prognosis(AU)

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

Urgencias estomatológicas por lesiones pulpares / Dental emergencies caused by pulpar lesions

Varias son las enfermedades que llevan a los pacientes a acudir a la consulta de urgencias estomatológicas, la gran mayoría corresponde a afecciones pulpares debido a la sintomatología dolorosa que las caracteriza. El objetivo de este trabajo describir el comportamiento de las enfermedades pulpares en pacientes del área de salud de la clínica estomatológica 27 de Noviembre en el período comprendido entre los meses de octubre 2008 a diciembre 2009, se realizó un estudio analítico de corte transversal en el cual se incluyeron 173 pacientes adultos entre 19 y 59 años que acudieron al servicio con diagnóstico de cualquiera de las enfermedades pulpares agudas. Del total de casos diagnosticados el 81 para un 46,8 por ciento correspondió a la pulpitis aguda irreversible, el 34,7 por ciento a pulpitis transitoria y el 18,5 por ciento a hiperemia pulpar. El grupo dentario más afectado fue el de los molares y el tipo de lesión pulpar resultó independiente del grupo dentario al igual que resultó independiente del factor causal, entre los cuales aparece con un alto predominio la caries dental con un 65,9 por ciento; el dolor tanto en tipo como en intensidad dependen del tipo de lesión que tenga la pulpa según los resultados del estadígrafo X² de Pearson obtenidos en el estudio, donde el dolor espontáneo se presentó solamente para los pacientes con pulpitis aguda irreversible, en los que ningún caso se reportó el dolor con categoría leve(AU)

There is a range of diseases that make the patients go to the dental emergency service; most of them result from pulp disorders due to the painful symptoms that characterize them. The objective of this paper was to describe the behavior of pulp diseases in patients from the health area of 27 de Noviembre dental clinic in the period of October 2008 through December 2009. To this end, a cross-sectional analytical study was conducted in 173 adult patients aged 19 to 59 years and diagnosed as having any of the acute pulp diseases, Out of the total number of diagnosed cases, 81 (46.8 percent) had irreversible acute pulpitis, 34.7 percent suffered transient pulpitis and 18.5 percent presented pulp hyperemia. The most affected teeth were molars and the type of pulp lesion did not depend either on the dental group or on the causative factor, being the dental caries highly predominant, since it accounted for 65.9 percent. Pain, in terms of type and intensity, depends on the type of pulp lesion according to Pearson's statistic X² results achieved in the study. Spontaneous pain, which was not mild in any case, was just present in patients with irreversible acute pulpitis(AU)

Princípios biológicos do tratamento endodôntico de dentes com polpa viva / Biological principles of endodontic treatment of teeth with vital pulp

Na clínica endodôntica diuturna, o profissional se depara basicamente com três condições que requerem tratamento: polpas vitais, polpas necrosadas e casos de retratamento. O sucesso do tratamento endodôntico depende do reconhecimento das idiossincrasias de cada uma destas três condições. Canais radiculares contendo polpa viva são isentos de infecção, a qual geralmente se restringe à porção exposta da polpa coronária. O sucesso do tratamento endodôntico nestes casos então vai depender principalmente da manutenção da cadeia asséptica durante os procedimentos intracanais. Este artigo revisa os princípios biológicos do tratamento de dentes com polpa viva, visando fornecer ao clínico condições para melhorar o resultado do tratamento endodôntico destes casos.

Microscope-aided endodontic treatment of maxillary first premolars with three roots: A case series.

Maxillary premolars have a highly variable root canal morphology. However, the presence of three roots is a rare occurrence. This clinical article describes the unusual anatomy detected in maxillary premolars during routine endodontic treatment using microscope. The diagnosis and clinical management of maxillary first premolars with three roots and canals using radiographic interpretation, access cavity modification and visual enhancement with operative microscopes is discussed in the article.

Importancia de la semiología del dolor en el diagnóstico de un proceso inflamatorio pulpar / Significance of pain's Symptomatology in the diagnosis of pulpal inflammatory process

El dolor es un síntoma de extraordinaria importancia en la práctica estomatológica y particularmente en lo concerniente a las alteraciones de la pulpa dentaria. Con el objetivo de profundizar en el conocimiento de las fases por las que atraviesa un proceso inflamatorio pulpar, que permiten predecir sus manifestaciones dolorosas, se realizó una revisión bibliográfica sobre el tema con un enfoque multidisciplinario y básico-clínico. Se utilizó el método documental para el análisis y tratamiento de la información ofrecida por las fuentes teóricas. El sitio en Internet Google fue empleado como fundamental motor de búsqueda y Lilacs, Hinari, Medline y PubMed fueron las bases de datos más revisadas. La clasificación del estado de inflamación pulpar, que atiende a eventos histopatológicos que no se pueden visualizar, resulta más difícil. Se podría lograr mayor precisión en un diagnóstico basado en el curso que sigue el dolor, de acuerdo a la magnitud del compromiso inflamatorio y apoyado en la rica semiología que se puede obtener si se sigue la trayectoria de las variables del estímulo nociceptivo. El incremento y profundización de los conocimientos en este campo contribuiyó significativamente a un mejor diagnóstico y tratamiento de los procesos inflamatorios pulpares(AU)

Pain is a symptom very important in the stomatologic practice and particularly in that concerning to dental pulp alterations. To deep in the knowledge of phases crossed by a pulpal inflammatory process allowing predicting its painful manifestations, authors made a bibliographic review on this subject with a multidisciplinary and basic-clinical approach, using the documentary method for analysis and management of information offered by theoretical sources. Google was used as a fundamental search tool and LILACS, HINARI, Medline and PubMed were the more reviewed databases. The classification of pulpal inflammation state, taking into account non-visualized histopathology events is more difficult and it may to achieve a great accuracy in a diagnosis based on course after pain, according the magnitude of inflammatory compromise and supported by the potential valuable symptomatology if we follow the trajectory of the nociceptive stimulus variables. The know ledges increase and deepening in this field will contribute in a significant way to a better diagnosis and treatment of pulpal inflammatory processes(AU)

Eficacia del láser en el tratamiento de la pulpitis aguda serosa / Effectiveness of laser in the treatment of serous acute pulpitis

Se desconoce que la sintomatología álgica de la pulpitis aguda serosa es la principal razón por la que acuden nuestros pacientes a consulta de urgencias, así como las posibilidades terapéuticas del láser en el tratamiento de la misma. Objetivo: evaluar la eficacia de la terapia láser en el tratamiento de la pulpitis aguda serosa. Método: se realizó un ensayo clínico fase II temprana, abierto y uní céntrico, el cual fue ejecutado en la consulta de láser terapia de la Clínica Estomatológica Provincial Docente Ismael Clark y Mascar, desde enero de 2006 a octubre de 2007. El tratamiento tuvo un carácter ambulatorio, se aplicó láser con el equipo LASERMED 670DL de fabricación cubana con parámetros antiinflamatorios y analgésicos, con una frecuencia diaria hasta las 72h, a aquellos pacientes a los cuales les fue diagnosticado pulpitis aguda serosa y que estuvieron de acuerdo a participar en el estudio. La intensidad del dolor se evaluó en cada consulta de evolución, a través de una escala descriptiva simple, todo lo cual permitió evaluar la eficacia del tratamiento aplicado. Resultados: el estudio realizado arrojó resultados altamente significativos, ya que el 95 por ciento de los casos en estudio remitieron la sintomatología dolorosa, a partir de las 48h. El grado de satisfacción de los pacientes ante la terapéutica empleada y la condición de satisfactoria, estuvo en relación directa con los resultados obtenidos. Conclusiones: el láser resultó eficaz para el tratamiento de la pulpitis aguda serosa al lograr un alivio del dolor en un período de tiempo corto y no producir efectos colaterales significativos.

Therapeutic possibilities of laser are unknown in the treatment of serous acute pulpitis and it is a disease where the algesic symptomatology, constitutes the main reason for which our patients assist to the urgency consultation. Objective: to determine the effectiveness of the laser therapy in the treatment of serous acute pulpitis. Method: an early stage II, open and unicentric clinical trial was conducted, which was carried out in the laser therapy consultation at the Teaching Provincial Odontology Clinic Ismael Clark y Mascaró, from January 2006 to October 2007. The treatment had an ambulatory character, laser was applied with LASERMED 670DL equipment of Cuban manufacturing with anti-inflammatory and analgesic parameters, to patients that were diagnosed serous acute pulpitis, and also were in agreement to take part in the study, with a daily frequency up to 72h. The intensity of pain was evaluated in each evolution consultation, through a simple descriptive scale, which allowed evaluating the efficacy of the treatment applied. Results: the study showed highly significant results since the 95 percent of cases under study remitted the painful symptomatology, starting from 48h. The grade of patients' satisfaction before the therapy used and the condition of satisfactory was in direct relationship with the obtained results. Conclusions: laser turned out to be effective for the treatment of serous acute pulpitis on achieving a pain relief in a short period of time and do not produce significant collateral effects.