Estudio comparativo entre coronas, endocoronas y endocoronas con ausencia de una pared axial ante fuerzas de tracción / Comparative study between crown, endocrown and endocrown without one axial wall after tensile strength

Introducción: Las alternativas de tratamiento de órganos dentales con gran destrucción en su estructura varían, no sólo por el material de restauración, sino también por el valor económico y estético. Dentro de las alternativas existe: corona convencional, endocorona cuyo objetivo principal es la elaboración de una restauradora que evita la colocación de postes intraconducto y endocorona con ausencia de una pared axial (EPA) que se realiza cuando una pared, mesial, distal, vestibular o palatina está ausente. Objetivo: Verificar si la endocorona EPA se comporta de igual manera que las coronas convencionales y endocoronas al medir su resistencia ante fuerzas de tracción. Material y métodos: Treinta premolares fueron tratados endodóncicamente, 10 fueron preparados para recibir una corona convencional (grupo A), 10 para endocorona (grupo B) y 10 para endocorona EPA (grupo C). Se realizaron fuerzas de tracción para obtener el valor máximo en el cual las coronas fallaron. Se realizó una prueba ANOVA para comparar los resultados. Resultados: Al someter a los tres tipos de coronas a fuerzas de tracción los resultados obtenidos fueron: 3.04 ± 0.55 MPa para la corona, 7.08 ± 1.6 MPa para la endocorona y 6.17 ± 1.12 MPa para la endocorona EPA. Conclusiones: No existió diferencia significativa entre la endocorona (7.08 MPa) y la EPA (6.17 MPa), convirtiéndose en una alternativa de tratamiento con buen pronóstico en la práctica diaria (AU)

Introduction: The alternatives of treatment of tooth with excessive wear vary not only by the restoration material but also by the economic and aesthetic value. Among the alternatives there is: conventional crown, endocrown whose main objective is the elaboration of a restorative that avoids the placement of intraconducting posts and endocrown without one axial wall (EPA) that is done when a wall; mesial, distal, vestibular or palatal is absent. Objective: To verify if the (EPA) behaves in the same way as the conventional crown and endocrown when measuring its resistance to tensile strength. Material and methods: 30 premolars were treated endodontically, ten were prepared to receive a conventional crown, 10 for endocrown and 10 for EPA. Tensile strength were performed to obtain the maximum value at which the crowns failed, an ANOVA test was performed to compare the results. Results: When the three types of crowns were subjected to tensile strength, the results obtained were; 3.04 ± 0.55 MPa for the crown, 7.08 ± 1.6 MPa for the endocrown and 6.17 ± 1.12 MPa for the EPA endocrown. Conclusions: There was no significant difference between the endocrown (7.08 MPa) and EPA endocrown (6.17 MPa) becoming an alternative treatment with good prognosis in daily practice (AU)

Clareamento dental interno: enfoque na questão do tampão cervical e na descrição da técnica (imediata e/ou mediata) / Internal dental whitening: focus on the cervical buffer issue and on the description of the technique (immediate and / or mediate)

Introdução: A alteração de cor dentária consiste em um dos principais aspectos que corroboram à desarmonia do sorriso. Em situações de dentes não-vitais que apresentem escurecimento, o clareamento dental interno tem sido considerado uma opção conservadora de tratamento, podendo ser efetuado por meio de diferentes técnicas (mediata, imediata e mista). Em quaisquer técnicas, é necessária a confecção de um tampão cervical previamente à aplicação do agente clareador. Objetivo: Consiste em revisar a literatura a respeito do clareamento interno, das principais técnicas pelas quais ele pode ser realizado, sobre a importância do tampão cervical para a prevenção de danos ao dente e para a execução de um tratamento seguro e eficaz. Metodologia: Realizou-se uma busca nas bases de dados eletrônicos PubMed, ScienceDirect, LILACS e SciELO; analisando as publicações entre o período de 2010-2020. Resultados: A técnica mediata consiste em uma das mais utilizadas e indicadas; a imediata, na configuração termocatalítica, encontra-se em desuso, devido à contraindicação do uso do calor. A técnica mista, sendo a combinação das duas técnicas, pode potencializar o resultado clareador. Em todas elas, deve-se efetuar um tampão cervical para evitar o extravasamento do material clareador pelos túbulos dentinários, prevenindo a reabsorção cervical externa, que constitui o principal risco do clareamento interno. Conclusão: Baseado na literatura, todas as técnicas podem ser realizadas, desde que executadas de modo apropriado, seguindo as medidas como a da não aplicação de calor e a da execução do tampão, se adequando às necessidades do paciente a fim de escolher a técnica mais indicada.

Introduction: The change in tooth color is one of the main aspects that corroborate the disharmony of the smile. In situations of non-vital teeth that suffer from darkening, internal tooth whitening has been considered a conservative treatment option and can be carried out through different techniques (mediate, immediate, and mixed). In any of these techniques, it is necessary to make a cervical tampon before the application of the bleaching agent. Objective: To review the literature regarding internal whitening, the main techniques used in this process, the importance of the cervical plug for the prevention of damage to the tooth, and the execution of safe and effective treatment. Methodology: A search was performed in the electronic databases PubMed, ScienceDirect, LILACS, and SciELO, analyzing publications from 2010 to 2020. Results: The mediated technique consists of one of the most used and indicated; the immediate, in the thermocatalytic configuration, has fallen in disuse due to the contraindication of the use of heat. The mixed technique, which is the combination of the two others, can potentiate the whitening result. In all of them, a cervical plug is necessary to avoid the extravasation of the whitening material by the dentinal tubules, preventing external cervical resorption, which is the main risk of internal whitening. Conclusion: Literature suggests all three techniques can be performed if correctly executed, following measures such as the non-application of heat and the execution of the buffer, adapting to the needs of the patient to choose the most suitable technique.

Pinos estéticos de fibra de vidro: técnicas e protocolos clínicos / Aesthetic fiberglass pins: techniques and clinical protocols

Introdução: Os pinos de fibra de vidro (PFVs) apresentam-se como uma alternativa prática e econômica capaz de reabilitar dentes endodonticamente tratados com perdas estruturais superiores a 50%. Objetivo: Realizar uma revisão de literatura sobre o protocolo clínico acerca da utilização dos PFVs, bem como explanar as diferentes técnicas que po-dem ser utilizadas para implementá-los. Materiais e métodos: Realizou-se uma revisão bibliográfica de estudos publicados entre 2000 e 2021 por meio da busca nas bases de dados: PubMED/Medline, Scielo (Scientific Eletronic Library) e Google Acadêmico. Para a pesquisa, foram utilizados os seguintes descritores: Dente não Vital (Non-vital Tooth), Pinos Dentários (Dental Pins) e Técnica para Retentor Intrarradicular (Post and Core Technique). Após criteriosa filtragem, foram selecionados 24 trabalhos para inclusão no estudo, além de 10 livros considerados relevantes para esta revisão. Resultados: Durante o diagnóstico e planejamento, é necessário avaliar determinados fatores para que se obtenha sucesso clínico, como: quantidade de estrutura dentária remanescente, posição dentária e forças oclusais recebidas e necessidades restauradoras e estéticas exigidas pelo caso e pelo paciente. Diante das particularidades de cada caso, o clínico deve selecionar entre as técnicas a mais ideal: Técnica do PFV direto/ técnica convencional; Técnica do pino de fibra de vidro anatômico; ouTécnica direta com PFV associado a pinos acessórios. Conclusão: A técnica do PFV apresenta passos clínicos simplificados e sua correta realização garante sucesso no tratamento. Diante de situações em que o PFV não apresenta correta adaptação, o clínico deve abrir mão da utilização da técnica convencional e utilizar as técnicas de personalização do PFV.

Introduction: Fiberglass posts (FPs) are presented as a practical and economical alternative capable of rehabilitating endodontically treated teeth with 50% structural losses greater than 50%. Objective: To review the literature on the clinical protocol for the use of FPs, as well as explain the different techniques that can be used. Materials and methods: A literature review of studies published between 2000 and 2021 was carried out through a search on the Scielo (Scientific Electronic Library) and Google Scholar databases. The following descriptors were used for the research: Non-Vital Tooth, Dental Pins, and Technique for Intraradicular Retainer (Post and Core Technique). After careful screening, we selected 24 papers and 10 books, considered relevant for this review. Results: During planning, it is necessary to determine specific factors for clinical success, such as the amount of remaining tooth structure, the tooth position and the occlusal forces received, and restorative and esthetic needs required by the case and the patient. Given each case's particularities, the clinician must select among the most ideal techniques: the direct FP technique/convention-al technique; the Anatomical fiberglass post technique, and the direct technique with FP associated with accessory posts. Conclusion: The FP technique has simplified clinical steps and its correct performance is successful in the treatment. Faced with situations in which the FP does not present adequate adaptation, the clinician must not use the conventional technique, using techniques for personalizing the FP.

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.

Direct resin composite restoration of endodontically-treated permanent molars in adolescents: bite force and patient-specific finite element analysis

Abstract Objective To evaluate the influence of three levels of dental structure loss on stress distribution and bite load in root canal-treated young molar teeth that were filled with bulk-fill resin composite, using finite element analysis (FEA) to predict clinical failure. Methodology Three first mandibular molars with extensive caries lesions were selected in teenager patients. The habitual occlusion bite force was measured using gnathodynamometer before and after endodontic/restoration procedures. The recorded bite forces were used as input for patient-specific FEA models, generated from cone-beam computed tomographic (CT) scans of the teeth before and after treatment. Loads were simulated using the contact loading of the antagonist molars selected based on the CT scans and clinical evaluation. Pre and post treatment bite forces (N) in the 3 patients were 30.1/136.6, 34.3/133.4, and 47.9/124.1. Results Bite force increased 260% (from 36.7±11.6 to 131.9±17.8 N) after endodontic and direct restoration. Before endodontic intervention, the stress concentration was located in coronal tooth structure; after rehabilitation, the stresses were located in root dentin, regardless of the level of tooth structure loss. The bite force used on molar teeth after pulp removal during endodontic treatment resulted in high stress concentrations in weakened tooth areas and at the furcation. Conclusion Extensive caries negatively affected the bite force. After pulp removal and endodontic treatment, stress and strain concentrations were higher in the weakened dental structure. Root canal treatment associated with direct resin composite restorative procedure could restore the stress-strain conditions in permanent young molar teeth.

Restauração de dentes tratados endodonticamente com resinas bulk-fill: revisão integrativa / Endodontically treated teeth restored with bulk-fill resins: integrative review

Objetivo: realizar uma revisão de literatura sobre o uso de resinas bulk-fill para restaurar dentes tratados endodonticamente. Materiais e método: a busca dos estudos, clínicos ou laboratoriais, foi realizada no portal PubMed, utilizando os descritores "bulk fill" e "endodontically treated". Os dados extraídos da literatura foram agrupados em um quadro, que apresenta as características metodológicas e os principais resultados de cada estudo. Resultados: Sete estudos foram incluídos na revisão. Dentre eles, cinco avaliaram a resistência à fratura dos dentes após a restauração, um avaliou a adaptação da resina ao assoalho da câmara pulpar, e um realizou um ensaio clínico com acompanhamento de três anos, comparando o uso de resina bulk-fill com resina convencional. Considerações finais: o desempenho das resinas bulk-fill mostrou-se semelhante ao das resinas convencionais nas características de resistência à fratura dos dentes (in vitro) e longevidade (in vivo). A economia de tempo clínico proporcionada pelas resinas bulk-fill pode justificar o seu emprego para a restauração de dentes tratados endodonticamente. (AU)

Objective: the aim of this study was to review the literature regarding the use of bulk-fill resin to restore endodontically treated teeth. Materials and method: the search was performed at PubMed, using the descriptors "bulk fill" AND "endodontically treated". Clinical and laboratorial studies were included. The extracted data was presented on a table showing the methodological features and results of each study. Results: seven studies evaluated the bulk-fill resin on direct restoration. Five of these seven evaluated the resistance to fracture, one assessed the resin adaptation to the floor chamber, and one was a randomized clinical trial comparing the bulkfill resin to conventional resin. Final considerations: the performance of bulk-fill resins was similar to the conventional resins when compared to the in vitro studies on tooth fracture resistance and in vivo study on longevity of restorations. The economy of clinical time may justify its use to restore endodontically treated teeth. (AU)

Current options concerning the endodontically-treated teeth restoration with the adhesive approach

Abstract: Adhesive procedures have changed the way to restore endodontically treated teeth (ETT). It started with the shift from cast post-and-core to fiber post. The original focus on strength also shifted towards failure modes, revealing that catastrophic failures are still a concern when restoring endodontically-treated teeth even with fiber posts. As an alternative, postless approaches have been proposed in order to improve the chances of repair. The goal of this critical review is to present a survey of the current knowledge on adhesive approaches to restore endodontically treated teeth with and without extensive coronal tissue loss. The preservation of tooth structure of endodontically treated teeth is paramount. Partial versus full coverage of ETT, the role of the ferrule, the post type effect on catastrophic failures and postless alternatives as endocrowns and postless build-ups are reviewed. There is a consensus that the remaining tooth structure plays an important role in ETT survival, although the current literature still is contradictory on the influence of post type on root fractures as well as the benefits of avoiding a post or partially restoring a tooth. More clinical studies should be carried out with the modern postless adhesive alternatives to conventional approaches.

Influence of remaining coronal thickness and height on biomechanical behavior of endodontically treated teeth: survival rates, load to fracture and finite element analysis

Abstract Objective To evaluate the effect of restorative strategy (fiber post vs cast post and core), coronal height (0 mm vs 2 mm) and thickness (higher than 1 mm vs lower than 1 mm) on survival rate, fracture resistance and stress distribution. Material and Methods Seventy-two bovine teeth were cleaned and allocated in six groups (n = 12). Twenty-four teeth were sectioned at 13 mm length (no remaining coronal structure) and forty-eight were sectioned at 15 mm (2 mm remaining coronal structure). Half of the forty-eight had remaining coronal thickness lower than 1 mm and the other half had thickness higher than 1 mm. All root canals were prepared at 10 mm (luting length), fiber posts were cemented in thirty-six specimens and cast post and core in other thirty-six. All teeth were restored with metallic crowns. Specimens were submitted to 1.5 million cycles (100 N, 45°, 10 Hz at 2 mm below incisal edge) and evaluated at each 500,000 cycles to detect failures. Specimens that survived were submitted to load to fracture test. Bidimensional (Rhinoceros® 4.0) models were obteined survival data submitted to Kaplan-Meier (α=0.05) analysis and load to fracture values submitted to ANOVA and Tukey tests (α=0.05). Results Groups without remaining coronal structure showed survival rates lower than other groups (p=0.001). ANOVA showed higher values of load to fracture for groups with coronal thickness higher than 1 mm (p=0.0043). Finite element analysis showed better stress distribution in groups with remaining coronal structure and restored with fiber post. Conclusion Specimens without remaining coronal structure have lower survival rates. Specimens with remaining structure lower than 1 mm and without coronal structure support the same load to fracture value independently of the restorative strategy.

How biomechanics can affect the endodontic treated teeth and their restorative procedures?

Abstract: Endodontic treatment is a common dental procedure used for treating teeth which the pulp tissue has become irreversibly inflamed or necrotic as a result of the carious process or dental trauma. This procedure which involves mechanical and chemical preparation of root canal may affect several mechanical and physical properties of the tooth structure. The endodontic treatment can also influence the longevity of the rehabilitation of endodontically treated teeth and biomechanics during the oral function. For restoring endodontically treated teeth several factor and clinical decisions should be observed. The decision of the fiberglass post usage and the restorative materials are related to several factors such as the quantity and quality of remaining dental structure, presence of ferrule, post cementation length and final coronal restoration. In this review, the authors will address the effect of the endodontic treatment procedures on canal shape and mechanical properties of a tooth, and also discuss the parameters and the biomechanical principles of root canal treated teeth.

Evaluation of Stress Distribution in Endodontically Weakened Teeth Restored with Different Crown Materials: 3D-FEA Analysis

Abstract This study evaluated the stress distribution in endodontically treated teeth, weakened (W) or not weakened (NW), restored with different materials of prosthetic crown using 3D-FEA. Models of a maxillary canine were constructed based on micro-CT images and divided into the groups: G1 (control) - sound tooth; G2 to G7 - endodontically treated teeth restored with glass fiber post (GFP); which G2 to G4 simulated NW root and G5 to G7 simulated W root. For crown material the teeth were restored with: G2 and G5: metallic coping and ceramic veneering, G3 and G6: zirconia coping and ceramic veneering, G4 and G7: alumina coping and ceramic veneering. Load of 180 N was applied at the incisal third of lingual surface at 45º. Models were supported by the periodontal ligament (x=y=z=0). The von Mises stress (VMS) values were calculated. The W teeth presented higher VMS at coping when compared to NW teeth and group G1 showed lower VMS value. For crown material, for both W or NW teeth, increasing VMS was found at metallic, zirconia and alumina coping, respectively. Metallic coping showed a better performance despite its unfavorable esthetics, suggesting as an appropriate material for prosthetic restoration of endodontically treated teeth.

Resumo Este estudo avaliou a distribuição de tensão em dentes tratados endodonticamente, fragilizados (F) ou não fragilizados (NF), restaurados com diferentes materiais para a coroa protética utilizando 3D-FEA. Modelos de um canino maxilar foram construídos baseados em imagens de micro-CT e divididos em grupos: G1 (controle) - dente hígido; G2 a G7 - dentes tratados endodonticamente com pino de fibra de vidro (PFV), sendo que G2 a G4 simularam raízes NF e G5 a G7 simularam raízes F. Para o material das coroas os dentes foram restaurados com: G2 e G5: coping metálico e revestimento cerâmico, G3 e G6: coping de zirconia e revestimento cerâmico, G4 e G7: coping de alumina e revestimento cerâmico. Carregamento de 180 N foi aplicado na superfície lingual em seu terço incisal com 45 graus de inclinação. Os modelos foram suportados pelo ligamento periodontal (x=y=z=0). Os valores da tensão de von Mises (VMS) foram calculados. Os dentes F apresentaram maiores valores VMS para o coping quando comparados aos dentes NF, sendo que o G1 apresentou menores valores VMS. Para o material das coroas, ambos F ou NF aumentaram VMS no coping metálico, zirconia e alumina, respectivamente. Copings metálicos apresentaram melhor comportamento mecânico apesar de não favorecerem a estética, o que sugere ser um material apropriado para a restauração de dentes tratados endodonticamente.

Factors affecting the periapical healing process of endodontically treated teeth

Abstract Tissue repair is an essential process that reestablishes tissue integrity and regular function. Nevertheless, different therapeutic factors and clinical conditions may interfere in this process of periapical healing. This review aims to discuss the important therapeutic factors associated with the clinical protocol used during root canal treatment and to highlight the systemic conditions associated with the periapical healing process of endodontically treated teeth. The antibacterial strategies indicated in the conventional treatment of an inflamed and infected pulp and the modulation of the host's immune response may assist in tissue repair, if wound healing has been hindered by infection. Systemic conditions, such as diabetes mellitus and hypertension, can also inhibit wound healing. The success of root canal treatment is affected by the correct choice of clinical protocol. These factors are dependent on the sanitization process (instrumentation, irrigant solution, irrigating strategies, and intracanal dressing), the apical limit of the root canal preparation and obturation, and the quality of the sealer. The challenges affecting the healing process of endodontically treated teeth include control of the inflammation of pulp or infectious processes and simultaneous neutralization of unpredictable provocations to the periapical tissue. Along with these factors, one must understand the local and general clinical conditions (systemic health of the patient) that affect the outcome of root canal treatment prediction.

www crownorfill com, un sitio que proporciona acceso instantáneo a la información basada en evidencia sobre restauraciones dentales posteriores: [Carta al Editor] / www.crownorfill. com Is the online tool that provides instant accessto evidence-based literature on dental restorations:[Letter to the Editor]

Crown-or-Fill© es una aplicación en un sitio web que resume la literaturabasada en la evidencia sobre los resultados del tratamiento para restauraciones en dientes posteriores en función de condiciones preexistentes. Los datos presentados se recogieron en dos revisionessistemáticas publicadas.

Crown-or-Fill© It is an application on a website that summarizes evidence based literature on treatment outcomes for restorations on posterior teeth as a function of pre-existing conditions. The data presented was collected in two published systematic reviews.

Effect of different composite core materials on fracture resistance of endodontically treated teeth restored with FRC posts

Abstract Objective This study evaluated the fracture resistance of endodontically treated teeth restored with fiber reinforced composite posts, using three resin composite core build-up materials, (Clearfil Photo Core (CPC), MultiCore Flow (MCF), and LuxaCore Z-Dual (LCZ)), and a nanohybrid composite, (Tetric N-Ceram (TNC)). Material and Methods Forty endodontically treated lower first premolars were restored with quartz fiber posts (D.T. Light-Post) cemented with resin cement (Panavia F2.0). Samples were randomly divided into four groups (n=10). Each group was built-up with one of the four core materials following its manufacturers’ instructions. The teeth were embedded in acrylic resin blocks. Nickel-Chromium crowns were fixed on the specimens with resin cement. The fracture resistance was determined using a universal testing machine with a crosshead speed of 1 mm/min at 1350 to the tooth axis until failure occurred. All core materials used in the study were subjected to test for the flexural modulus according to ISO 4049:2009. Results One-way ANOVA and Bonferroni multiple comparisons test indicated that the fracture resistance was higher in the groups with CPC and MCF, which presented no statistically significant difference (p>0.05), but was significantly higher than in those with LCZ and TNC (p<0.05). In terms of the flexural modulus, the ranking from the highest values of the materials was aligned with the same tendency of fracture loads. Conclusion Among the cores used in this study, the composite core with high filler content tended to enhance fracture thresholds of teeth restored with fiber posts more than others.

Clinical performance and failure modes of pulpless teeth restored with posts: a systematic review

Abstract The aim of this systematic review was to compare the clinical performance and failure modes of teeth restored with intra-radicular retainers. A search was performed on PubMed/Medline, Central and ClinicalTrials databases for randomized clinical trials comparing clinical behavior and failures of at least two types of retainers. From 341 detected papers, 16 were selected for full-text analysis, of which 9 met the eligibility criteria. A manual search added 2 more studies, totalizing 11 studies that were included in this review. Evaluated retainers were fiber (prefabricated and customized) and metal (prefabricated and cast) posts, and follow-up ranged from 6 months to 10 years. Most studies showed good clinical behavior for evaluated intra-radicular retainers. Reported survival rates varied from 71 to 100% for fiber posts and 50 to 97.1% for metal posts. Studies found no difference in the survival among different metal posts and most studies found no difference between fiber and metal posts. Two studies also showed that remaining dentine height, number of walls and ferrule increased the longevity of the restored teeth. Failures of fiber posts were mainly due to post loss of retention, while metal post failures were mostly related to root fracture, post fracture and crown and/or post loss of retention. In conclusion, metal and fiber posts present similar clinical behavior at short to medium term follow-up. Remaining dental structure and ferrule increase the survival of restored pulpless teeth. Studies with longer follow-up are needed.

Complejidad del tratamiento endodóntico, según factores asociados / Endodontic treatment complexity and associated factors

Introducción: la clasificación de la complejidad de la terapia endodóntica permite estimar factores que pueden interferir su éxito. Objetivo: determinar la correspondencia entre la duración del tratamiento pulporadicular y la complejidad asignada, según el Formulario de Evaluación de las Dificultades del Tratamiento Endodóntico. Métodos: se realizó un estudio descriptivo longitudinal prospectivo con un muestreo por conglomerado bietápico; quedaron incluidos 82 pacientes. Fue aplicado un modelo que recoge factores asociados a la complejidad del tratamiento endodóntico, mediante el interrogatorio, examen clínico y radiográfico. Los datos fueron procesados con el software estadístico SPSS versión 15.0. Se emplearon técnicas de la estadística descriptiva (frecuencias absolutas y porcentajes). Las variables empleadas fueron: edad, sexo, antecedentes patológicos, anestésicos, conducta del paciente, apertura bucal, reflejo nauseoso, complicaciones, dificultad radiográfica, diagnóstico, posición en el arco, inclinación y rotación dentaria, morfología coronaria, ápice radicular, alteración del número de raíces, bifurcación, visibilidad y tamaño de los conductos, acceso cameral, presencia de calcificaciones, reabsorción, enfermedad periodontal y complejidad del tratamiento. Resultados: en 80,8 por ciento de los pacientes, la categoría de elevada dificultad el tratamiento tuvo una duración entre 6 y 10 semanas. El dolor moderado o intenso e inflamación extendida se presentó en 29,3 por ciento de los casos. Dentro de los factores relacionados con el diagnóstico y el tratamiento se observaron las restauraciones extensas, la moderada dificultad en la obtención e interpretación de la imagen radiográfica, así como la inclinación dentaria moderada y los conductos visibles, pero reducidos en 23,2 por ciento, 22,0 por ciento, 20,7 por ciento y 19,5 por ciento, respectivamente. Conclusiones: la duración de la terapia aumenta en correspondencia con la complejidad que asigna el formulario. La evaluación de los factores asociados a la dificultad del tratamiento es importante para propiciar una conducta más razonable ante cada situación específica(AU)

Introduction: classifying the complexity of endodontic therapy makes it possible to identify factors which may interfere with its success. Objective: determine the correspondence between the duration of root canal treatment and the complexity assigned to it on the Endodontic Case Difficulty Assessment Form. Methods: a prospective longitudinal descriptive study was conducted based on two-staged cluster sampling. The resulting study group was composed of 82 patients. A form was used which lists the factors associated with the complexity of endodontic treatment, collected through interviews and clinical and radiographic examination. Data were processed with the statistical software SPSS version 15.0. Use was made of descriptive statistics techniques (absolute frequencies and percentages). The variables studied were age, sex, pathological antecedents, anesthetics, patient behavior, mouth opening, gagging, complications, radiographic difficulty, diagnosis, position in the arch, dental inclination and rotation, crown morphology, root apex, alteration in the number of roots, bifurcation, duct visibility and size, chamber access, presence of calcifications, resorption, periodontal disease and complexity of the treatment. Results: in 80.8 percent of the patients, the category of high treatment difficulty had a duration of 6 to 10 weeks. Moderate or intense pain and extended swelling were present in 29.3 percent of the cases. The following factors related to the diagnosis and treatment were observed: extensive restorations, moderate difficulty to obtain and interpret the radiographic image, moderate dental inclination and visible ducts, occurring in 23.2 percent, 22.0 percent, 20.7 percent and 19.5 percent of the cases, respectively. Conclusions: treatment duration increases in keeping with the complexity assigned by the form. It is important to evaluate the factors associated with treatment difficulty to foster a more reasonable approach to each specific situation(AU)

Postes colados: estudio clínico retrospectivo de 44 años en clínica privada especializada / Cast posts: a forty-four year retrospective clinical study in a specialized private practice

El objetivo de este estudio fue examinar el resultado clínico longitudinal de dientes endodónticamente tratados, rehabilitados con postes colados y una restauración coronaria, durante 44 años. Materiales y Métodos. En 130 pacientes seleccionados al azar, 95 presentaron 297 dientes rehabilitados con un poste colado y una restauración coronaria. El criterio de éxito fue que el diente rehabilitado permaneciera funcional sin patología clínica ni radiográfica. Resultados: Doscientos sesenta y ocho (90%) estaban en función y 29 (10%) habían fracasado. El Indice Kappa de Cohen, fue de 0.78 - 1. Conclusiones. El éxito clínico fue de 90%. La sobrevida media observada de los dientes estudiados fue de 19 años. La tasa de fracaso fue de 10%, siendo la fractura dentaria la falla más prevalente (5% de todos los dientes restaurados)...

The aim of this study was to examine the longitudinal clinical result of the use of cast posts and cores and crown restorations in endodontically treated teeth over a 44-year period. Materials and methods. Out of 130 randomly selected patients, 95 had had 297 teeth rehabilitated with cast posts and cores and crown restorations. The endodontic rehabilitation was considered successful when the tooth remained functional with no clinical or radiographic pathology. Results. The success rate was 90% (268) and the failure rate 10% (29). Cohen’s Kappa index ranged between 0.78 and 1. Conclusions. In this 44-year retrospective study, the clinical success rate was 90%. The mean survival time of the studied teeth was 19 years. The failure rate was 10%; tooth fractures were the most prevalent failures (5% of all restored teeth)...

Do resin cements influence the cuspal deflection of teeth restored with composite resin inlays?

The aim of this study was to evaluate the influence of different resin cements on the cuspal deflection of endodontically treated teeth restored with composite resin inlays. Sixty upper premolars were randomly divided into five groups (n=12): 1 - sound teeth; 2 - cavity; 3 - Rely X ARC; 4 - RelyX Unicem; 5 - SeT. The teeth from groups 2, 3, 4 and 5 received a MOD preparation and endodontic treatment. Impressions were made with vinyl polysiloxane and poured using type IV die stone in groups 3, 4 and 5. Inlays with composite resin were built over each cast and luted with the resin cements. A 200 N load was applied on the occlusal surface, and cuspal deflection was measured using a micrometer. After 24 h, cuspal deflection was measured again using a 300 N load. The Student t-test showed that there was no statistically significant difference between the 200 N and 300 N occlusal loads only for the sound teeth group (p = 0.389) and the RelyX ARC group (p = 0.188). ANOVA and Tukey'test showed that the sound teeth had the lowest mean cuspal deflection, differing statistically from the other groups (p<0.05). The highest cuspal deflections were obtained in the SeT group and the cavity group, with no statistical difference between them. Intermediate values were obtained in RelyX ARC group and RelyX Unicem group, which differed statistically. The self-adhesive resin cements RelyX Unicem and SeT showed less capacity to maintain the stiffness of the tooth/restoration complex than the conventional resin cement RelyX ARC.

O objetivo deste estudo foi avaliar a influencia de diferentes cimentos resinosos na deflexao de cuspides de dentes tratados endodonticamente e restaurados com inlays em resina composta. Sessenta pre-molares foram divididos aleatoriamente em cinco grupos (n=12): grupo 1 - dentes higidos; 2 - cavidade; 3 - Rely X ARC; 4 - RelyX Unicem; 5 - SeT. Os dentes dos grupos 2, 3, 4 e 5 receberam preparos cavitarios MOD e tratamento endodontico. Foram realizadas moldagens com silicone por adicao nos grupos 3, 4 e 5, seguido de vazamento de gesso tipo IV. Inlays em resina composta foram construidas sobre os modelos de gesso, sendo as inlays cimentadas com os cimentos resinosos. Uma carga de 200 N foi aplicada na face oclusal, e a deflexao de cuspide foi medida usando um micrometro. Apos 24 h, a deflexao de cuspide foi medida novamente sob carga de 300 N. De acordo com o teste t-Student, nao houve diferenca estatistica na deflexao de cuspides apenas para o grupo dos dentes higidos (p = 0.389) e o grupo do RelyX ARC (p = 0.188) quando comparada as duas cargas. De acordo com ANOVA e o tese de Tukey, os dentes higidos tiveram a menor media de deflexao de cuspides, diferindo estatisticamente dos outros grupos (p<0.05). A maior deflexao de cuspides foi obtida com o grupo SeT e o grupo cavidades, nao diferindo estatisticamente entre si. Valores intermediarios foram obtidos para os grupos RelyX ARC e RelyX Unicem, diferindo estatisticamente entre si. Os cimentos resinosos autoadesivos RelyX Unicem e SeT mostraram menor capacidade de manter a rigidez do complexo dente/restauracao em comparacao com o cimento resinoso RelyX ARC.

Evaluation of technical quality and periapical health of root-filled teeth by using cone-beam CT

Objective This study aimed to assess the quality of root fillings, coronal restorations, complications of all root-filled teeth and their association with apical periodontitis (AP) detected by cone-beam computed tomography (CBCT) images from an adult Turkish subpopulation. Material and Methods The sample for this study consisted of 242 patients (aging from 15 to 72 years) with 522 endodontically treated teeth that were assessed for technical quality of the root canal filling and periapical status of the teeth. Additionally, the apical status of each root-filled tooth was assessed according to the gender, dental arch, tooth type and age classification, undetected canals, instrument fracture, root fracture, apical resorption, apical lesion, furcation lesion and type and quality of the coronal structure. Statistical analysis was performed using percentages and chi-square test. Results The success rate of the root canal treatment was of 54.4%. The success rates of adequate and inadequate root canal treatment were not significantly different (p>0.05). Apical periodontitis was found in 228 (45.6%) teeth treated for root canals. Higher prevalence of AP was found in patients aging from 20 to 29 years [64 (27%) teeth] and in anterior (canines and incisors) teeth [97 (41%) teeth]. Conclusions The technical quality of root canal filling performed by dental practitioners in a Turkish subpopulation was consistent with a high prevalence of AP. The probable reasons for this failure are multifactorial, and there may be a need for improved undergraduate education and postgraduate courses to improve the clinical skills of dental practitioners in endodontics. .

Use of second-generation platelet concentrate (platelet-rich fibrin) and hydroxyapatite in the management of large periapical inflammatory lesion: A computed tomography scan analysis.

Periapical surgery is required when periradicular pathosis associated with endodontically treated teeth cannot be resolved by nonsurgical root canal therapy (retreatment), or when retreatment was unsuccessful, not feasible or contraindicated. Endodontic failures can occur when irritants remain within the confines of the root canal, or when an extraradicular infection cannot be eradicated by orthograde root canal treatment. Foreign‑body responses toward filling materials, toward cholesterol crystals or radicular cysts, might prevent complete periapical healing. We present here a case report wherein, combination of platelet‑rich fibrin (PRF) and the hydroxyapatite graft was used to achieve faster healing of the large periapical lesion. Healing was observed within 8 months, which were confirmed by computed tomography, following improved bone density. PRF has many advantages over platelet‑rich plasma. It provides a physiologic architecture that is very favorable to the healing process, which is obtained due to the slow polymerization process.

Coronal microleakage of endodontically treated teeth with intracanal post exposed to fresh human saliva

OBJECTIVE: The aim of this study was to investigate the coronal microleakage of endodontically treated teeth prepared to receive an intracanal post and teeth with an intracanal post but without a prosthetic crown and exposed to contamination by fresh human saliva. MATERIAL AND METHODS: A mechanical-chemical preparation following the step-back technique was carried out in 35 extracted single-rooted human teeth. The teeth were randomly divided into five groups: G1=root canals instrumented, obturated, and prepared to receive an intracanal post (N=10); G2=root canals with cemented posts but without coronal sealing (N=10); PC1=positive control root canals instrumented and open (N=5); PC2=positive control 2 root canals without instrumentation and open (N=5); and NC=negative control healthy teeth (N=5). The crowns were removed except for the control group of intact teeth. The root canals were obturated and sterilized with cobalt 60 gamma irradiation and were then adapted in an apparatus using a Brain Heart Infusion (BHI) medium and fresh human saliva for contamination. Microbial growth was indicated by the presence of turbidity in the BHI liquid medium. RESULTS: Data were submitted to the Kaplan-Meier Survival Analysis and the Holm-Sidak statistic method, which observed an index of 90% of microleakage in root canals after 24 hours for G1 and 70% of microleakage in samples at the end of 40 days for G2. CONCLUSION: The results show that root canals with an intracanal post but without a prosthetic crown can be recontaminated when exposed to fresh human saliva in a short period. .