A prevalence survey of cone-beam computed tomography use among endodontic practitioners / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinical application of cone-beam computed tomography (CBCT) among endodontic practitioners, and to analyze the indications and reasonability of CBCT in the diagnosis and treatment of pulpal and periapical diseases.@*METHODS@#The clinical data were collected from patients who visited the Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology and underwent CBCT examination from January to December, 2021. The data with their complete clinical information (including clinical records, radiology request forms/reports, two-dimensional and three-dimensional imaging data) were included. Those who underwent CBCT examination for orthodontic or prosthodontics were excluded. The experience and training background of the endodontic specialists, the number of patients treated in the whole year, the objective and region of interest (ROI) of CBCT examination, technical parameters, such as machine type, field of view (FoV) and radiographic reports were collected and analyzed to evaluate the impact on diagnosis. Wilcoxon and Mann-Whitney tests were used to compare the distribution of CBCT ROI. Chi-squared test and pairwise comparison were used to compare the application of CBCT by endodontic specialists with different clinical experience (senior, middle and junior).@*RESULTS@#In 2021, a total of 3 308 CBCT scans were prescribed by 61 endodontic specialists who treated 34 952 patients throughout the year. 3 218 patients (male ∶female about 1 ∶2) amounting for 10% of the patients treated in the whole year who received CBCT scans with an median age of 35 years (28, 49). Around 98% CBCT examinations were performed after clinical examination and two-dimensional periapical radiographs were taken. The FoV of CBCT scanning less than 10 cm×10 cm accounted for 96% of the total number of the images. Among the 3 308 CBCT scans, 83% of the ROI were in posterior teeth, with a higher number of anterior teeth (Z=-2.278, P < 0.05). Maxillary and mandibular first molars accounted for 35% of the examined teeth. The objectives of CBCT scanning included three aspects: clarifying clinical diagnosis, guiding surgical and non-surgical endodontic treatment (including management of endodontic complications), and outcome assessment, accounting for 1 111 (34%), 1 745 (54%), 311 (10%), respectively. and the others 2%. In the diagnosis process, CBCT was mainly used for the diagnosis of chronic periapical periodontitis, root fracture, root resorption and dental trauma. In the study, 353 CBCT were used in the diagnosis of root fracture, with a positive diagnosis rate of 35% (125/353). 846 CBCT used to reveal the anatomy of the root canal system, of which 297 cases were used to find missed/extra canals after treatment failure, and 58% (171/297) were used to confirm the missed/extra canals. In the management of complications or errors, CBCT was mainly used to assist the diagnosis of perforation and to locate the separated instruments. In the study, 311 CBCT scans were used for outcome assessment, including 240 cases related to non-surgical treatment and 71 cases related to surgical endodontic treatment for follow-up or presence of clinical symptoms, and persistent lesions on 2D films. Among the 61 endodontic specialists who used CBCT, 23 (45%) were with senior experience, 15 (30%) with middle experience, and 23 (25%) with junior experience. The proportion of senior or junior experience prescribing CBCT examination was 10%, higher than that of middle experience (8%, χ12=39.4, χ22=29.1, P < 0.001). The application rate of chief endodontists was 18%, which was higher than that of associate chief endodontists (9%, χ12=139.4, P < 0.001). 31% (1 109/3 308) cases of diagnosis or treatment plans were changed after CBCT was taken.@*CONCLUSION@#Use of CBCT in endodontic practice could provide more clinical information, which is helpful for diagnosis, accurate treatment and prognosis evaluation.

Reabsorción dentinaria interna coronaria: informe de un caso clínico / Coronary internal dentine resorption: report of a clinical case

Objetivo: La reabsorción dentinaria interna es un pro- ceso causado por la actividad odontoclástica asociada princi- palmente a la inflamación pulpar crónica y/o traumatismos, y se caracteriza por la pérdida progresiva de tejido dentinario y la posible invasión al cemento. El presente informe describe el diagnóstico y tratamiento de un molar inferior que presentó un cuadro sintomático de reabsorción dentinaria interna. Caso clínico: Un paciente de 38 años fue derivado a la consulta por presentar una zona de reabsorción interna en un segundo molar inferior. Durante el examen clínico y ra- diográfico se tomó una radiografía preoperatoria periapical con radiovisiógrafo en la que se observó la presencia de un área compatible con el diagnóstico de reabsorción dentinaria interna, el que fue posteriormente confirmado por medio de una tomografía computada de haz cónico. La imagen de la lesión se presentó como una zona radiolúcida deformante de bordes nítidos, localizada a nivel de la cámara pulpar. El tra- tamiento consistió en la extirpación de la pulpa coronaria y de la instrumentación, desinfección y obturación de los conduc- tos radiculares y la cavidad de acceso. En el control clínico y radiográfico realizado luego de 3 años se observó que el paciente estaba asintomático y las estructuras perirradiculares se encontraban dentro de los límites normales. La observación histológica del material removido de la cámara pulpar reveló la presencia de un tejido granulomatoso con numerosos vasos sanguíneos y escasos focos micro hemorrágicos. Hasta el momento, el tratamiento endodóntico es el pro- cedimiento indicado para el tratamiento de la reabsorción dentinaria interna. Se destaca la importancia de la tomografía computada de haz cónico para el diagnóstico y tratamiento temprano de las reabsorciones dentinarias internas a efectos de contar con un pronóstico favorable (AU)

Aim: Internal dentine resorption is aprocess caused by odontoclastic activity, mainly associated with chronic pulpal inflammation and/or trauma, and it'scharacterized by a pro- gressive loss of dentine tissue and the possible invasion of the cementum. This report describes the diagnosis and treatment of a lower molar that presented a symptomatic case of inter- nal dentine resorption. Clinical case: A 38-years old patient was referred to the office because of presenting an area of internal resorption in a lower second molar. During clinical and radiographic exam- ination, a periapical preoperative radiograph with radiovisio- graph was taken, in which the presence of an area compatible with the diagnosis of internal dentine resorption was observed, which was later confirmed by a cone-beam computed tomog- raphy.The image of the lesion was presented as a deforming radiolucent area with sharp edges, located at pulp chamber level. Treatment consisted of the removal of the coronary pulp and the instrumentation, disinfection and filling of the root ca- nals and the access cavity. In the clinical and radiographic control carried out 3 years after procedure, it was observed that the patient was asymptomatic and the periradicular struc- tures were within normal limits. The histological observation of the removed material from the pulp chamber revealed the presence of a granulomatous tissue with numerous blood ves- sels and scarce micro hemorrhagic focus. Until now, the endodontic treatment is the indicated pro- cedure to treat internal dentine resorption. It is necessary to highlight the importance of the cone-beam computerized to- mography for the early diagnosis and treatment of internal dentine resorptions in order to have a favorable outlook (AU)

Retratamientos endodónticos: una realidad que preocupa / Endodontic retreatment: a worrying reality

Las evaluaciones radiográficas de tratamientos endodón- ticos realizadas por graduados muestran un alto porcentaje de procedimientos incorrectos. Esta circunstancia lleva a la rea- lización de un elevado número de retratamientos ortógrados y retrógrados, con los inconvenientes y desventajas que conlle- va recurrir a una reintervención endodóntica. Es responsabili- dad de los profesionales, docentes y autoridades universitarias y gubernamentales revertir esta situación que afecta a la salud bucal de la sociedad. En el presente editorial se proponen di- ferentes alternativas para intentar modificar este preocupante panorama (AU)

Radiographic evaluations of endodontic treatments per- formed by graduates show a high percentage of incorrect procedures. This circumstance leads to the performance of a high number of orthograde and retrograde retreatments, with the inconveniences and disadvantages that entails resorting to an endodontic reintervention. It is the responsibility of pro- fessionals, teachers, university and government authorities to reverse this situation that affects the oral health of society. In this editorial, different alternatives are proposed to try to modify this worrying outlook (AU)

Endodoncia guiada estática, una opción para obliteración del canal pulpar: serie de casos / Static guided endodontics, an option for pulpal canal obliteration: a case series

En la práctica endodóntica, la etapa del acceso al canal radicular es fundamental para el éxito de las siguientes etapas del tratamiento. En casos de canales pulpares obliterados o calcificados (PCO), lograr encontrar la entrada a estos es un reto en la endodoncia convencional dado el alto riesgo de sufrir un accidente intraoperatorio. Actualmente, existen los tratamientos de endodoncia guiada o accesos guiados digitalmente, una alternativa innovadora y con múltiples beneficios para el abordaje de este tipo de dientes. El objetivo de este reporte de casos fue describir el protocolo de cuatro casos de accesos guiados estáticos para endodoncia en canales obliterados, indicando las ventajas y consideraciones del tratamiento. Se presenta un reporte de casos de cuatro pacientes atendidos entre julio 2021 y junio 2022, que requerían tratamientos endodónticos en dientes anteriores con canales pulpares obliterados. Para la realización de estos procedimientos se requirió una Tomografía Computarizada de Haz Cónico (CBCT) y el escaneo intraoral de la zona a tratar, para poder a través de la ayuda de un software, planificar virtualmente la dirección y longitud de acceso al conducto radicular. Posteriormente, se realizó la impresión en 3D de la guía estática, la cual dirige la entrada de la fresa que se utiliza para encontrar el acceso al canal radicular. En los cuatro casos clínicos en que se realizó la planificación virtual e impresión de la guía de acceso, fue posible encontrar el canal radicular en una sesión, pudiendo realizar el tratamiento endodóntico de manera exitosa y conservadora. En conclusión, la endodoncia guiada estática permite realizar los tratamientos endodónticos en PCO de manera segura, a pesar de la alta complejidad que presentaban.

SUMMARY: In endodontics, the access to the root canal is essential for the treatment success. Pulp canal obliteration (PCO) is a challenge for conventional endodontic treatments with a high risk of fracture of endodontic instruments.Currently, guided endodontic treatments, or digitally guided accesses, are novel alternatives with multiple benefits for the treatment of PCO. The objective of this case report is to describe the protocol for static guided access in PCO, indicating the advantages and considerations of the treatment. A case report of four patients treated between July 2021 and June 2022 is presented. These patients required endodontic treatments in anterior teeth with PCO. In order to virtually plan the direction and length of the access, using a software, we used a cone Beam Computed Tomography (CBCT) and an intraoral scan. Then, a 3D printing of the static guide was made, which directs the entry of the drill. With this method, it was possible to find the root canal in one session and perform the endodontic treatment successfully and conservatively. In conclusion, although static guided endodontics requires planification, it allows a safe endodontic treatment in patients with PCO.

Nonsurgical management of an extensive periapical lesion combined with photodynamic therapy: a case report / Manejo não cirúrgico de lesão periapical extensa combinada com terapia fotodinâmica: relato de caso

Introduction: the major goal of endodontic treatment (ET) is the complete elimination and/or maximum possible reduction of bacteria and irritants in the root canal system (RCS). However, persistence of bacterial debris refractory to therapy may leading to ET failure, being necessary to realize conventional or surgical retreatment. Objective: this is a case report on the nonsurgical management of an extensive chronic periapical lesion in teeth 12 and 11 in an adult female patient with history of endodontic treatment failure. She presented with painless swelling and a fistula adjacent to tooth 11. Methodology: conventional ET combined with photodynamic therapy (PDT) was recommended, in addition to calcium hydroxide applications. Regular clinical and radiographic follow-up made over a 2-year period revealed progression of bone regeneration, without sign and symptoms, with a satisfactory outcome. Conclusion: this case report shows that the combination of conservative ET with PDT provided satisfactory results with the resolution of the chronic endodontic infection and bone repair of the extensive periapical lesion.

Introdução: o principal objetivo do tratamento endodôntico (TE) é a eliminação completa e/ou máxima redução possível de bactérias e irritantes no sistema de canais radiculares (SCR). Porém, a persistência de detritos bacterianos refratários à terapia pode levar ao insucesso do TE, sendo necessária a realização do retratamento convencional ou cirúrgico. Objetivo: este relato de caso descreve o manejo não cirúrgico de uma extensa lesão periapical crônica nos dentes 12 e 11 em paciente adulta do sexo feminino com histórico de fracasso endodôntico. A mesma queixava-se de inchaço indolor, com presença de fístula adjacente ao dente 11. Metodologia: preconizou-se a realização do TE convencional associado à terapia fotodinâmica (PDT), com três sessões de troca de hidróxido de cálcio, concluindo-se posteriormente o tratamento. Reavaliações clínicas e radiográficas periódicas ao longo de 2 anos revelaram a progressão da consolidação óssea, com um desfecho satisfatório. Conclusão: este relato de caso mostra que a combinação do TE conservador associado à PDT teve resultados satisfatórios na resolução de infecção endodôntica crônica e no reparo ósseo de lesão periapical extensa.

Overview of technical advances in the diagnosis of pulp and periapical diseases / 中华口腔医学杂志

Pulp and periapical diseases are common and frequently occurring diseases of which diagnosis and treatment must be dealt with by the dental clinicians. The diagnostic techniques of these diseases include evaluation of pulp vitality, measurement of pulp blood circulation and analysis and judgment of root canal anatomy. With the continuous emergence of digital and imaging technologies, the correct application of these technologies in clinic will help clinicians improve their abilities in diagnosis and treatment of related diseases. The present article summarizes and reviews the progress of assistant technology for diagnosing dental pulp and periapical diseases in recent years and puts forward some suggestions for its application.

Diagnóstico y tratamiento de las fístulas cutáneas odontogénicas: revisión sistemática / Diagnosis and treatment of odontogenic cutaneous sinus tracts: a systematic review

Se realizó una revisión sistemática de la literatura científica en relación con las variantes de tratamien-to que recibieron las piezas dentarias permanentes asociadas a la presencia de una fístula cutánea. Se incluyeron reportes de casos clínicos en inglés, pu-blicados en los últimos diez años. Se obtuvieron 481 artículos, 359 excluidos por escasez de datos en títu-lo e incumplimiento de criterios de selección. Se ex-cluyeron 89 por carecer de tratamiento. Se incluye-ron 33 artículos. Se analizaron fístulas de 45 piezas dentarias, superiores e inferiores, anteriores y pos-teriores. En base a los resultados obtenidos se llegó a la conclusión de que las fístulas cutáneas faciales de origen odontogénico se diagnostican de manera errónea; esto conduce a un tratamiento inadecuado y secuela estéticas. Realizar un correcto diagnóstico y adecuado plan de tratamiento permite una curación rápida y predecible. Los hallazgos obtenidos estable-cen que realizar un correcto tratamiento endodóntico en la pieza afectada, es la terapéutica adecuada para lograr el cierre definitivo de la fístula, sin necesidad de tratar quirúrgicamente la misma (AU)

A systematic review of the scientific literature was carried out in relation to the variants of treatment received by permanent teeth associated with the presence of a cutaneous sinus tract. Clinical case reports in English, published in the last ten years, were included. A total of 481 articles were obtained, 359 were excluded due to lack of title data and non-compliance with selection criteria. 89 were excluded due to lack of treatment. 33 articles were included Cutaneous sinus tracts of 45 teeth, upper and lower, anterior and posterior, were analyzed. Based on the results obtained, it was concluded that facial cutaneous sinus tracts of odontogenic origin are misdiagnosed, leading to inadequate treatment and aesthetic sequelae. Carrying out a correct diagnosis and adequate treatment plan allows a quick and predictable healing. The findings obtained establish that performing a correct endodontic treatment in the affected piece is the appropriate therapy to achieve the definitive closure of the cutaneous sinus tract, without the need to surgically treatment (AU)

Guía clínica para el tratamiento de lesiones endoperiodontales sin compromiso radicular en pacientes periodontales / Clinical practice guide for the treatment of endoperiodontal lesions without root compromise in periodontal patients

La comunicación patológica entre la pulpa y el pe-riodonto se denomina lesión endoperiodontal. Puede presentarse de forma aguda o crónica, y su mani-festación más común es la presencia de un absceso acompañado de dolor. Es importante realizar una detenida evaluación clínica y radiográfica para esta-blecer un correcto diagnóstico y plan de tratamiento. Por este motivo, el objetivo de esta guía es presentar un protocolo consensuado entre las Cátedras de Pe-riodoncia y Endodoncia de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA), para su tratamiento (AU)

The pathological communication between the pulp and the periodontium is called Endoperiodontal Lesion. It can be presented in an acutely or chronically form and its most common manifestation is the presence of an abscess accompanied by pain. It is important to carry out a careful clinical and radiographic evaluation to establish a correct diagnosis, prognosis, and treatment plan. For this reason, the objective of this guide is to present a consensus protocol between Periodontics and Endodontics Departments of the Faculty of Dentistry of the University of Buenos Aires (FOUBA) for their treatment (AU)

Uso de propóleo con hidróxido de calcio como medicación intraconducto en periodontitis apical asintomática. Reporte de caso / Uso de própolis com hidróxido de cálcio como medicação intraconducto na periodontite apical assintomática. Relato de Caso / Use of propolis with calcium hydroxide as an intracanal medicament in asymptomatic apical periodontitis. A case report

Resumen La miel y sus productos, a lo largo de la historia, han sido usados por diversas civilizaciones con fines terapéuticos debido a sus efectos curativos. En la actualidad existe un renovado interés en el uso de la apiterapia como coadyuvante en diversos tratamientos médicos, en donde destaca el propóleo por sus propiedades bactericidas, antiinflamatorias, anticancerígenas, entre otras. El objetivo de este artículo es describir un caso de un primer molar inferior izquierdo con diagnóstico de necrosis pulpar y periodontitis periapical asintomática que fue manejado con el uso de la mezcla de propóleo con hidróxido de calcio como medicación intraconducto entre citas, logrando observar un proceso de reparación ósea durante este lapso. Se concluye que el propóleo es una alternativa viable como coadyuvante del hidróxido de calcio en los casos que está indicada la medicación intraconducto.

Resumo O mel e seus produtos, ao longo da história, têm sido utilizados por várias civilizações para fins terapêuticos devido aos seus efeitos curativos. Atualmente, há um interesse renovado no uso da apiterapia como adjuvante em vários tratamentos médicos, onde a própolis se destaca por seu bactericida, antiinflamatório, anticâncer, entre outros. O objetivo deste artigo é descrever um caso de primeiro molar inferior esquerdo com diagnóstico de necrose pulpar e periodontite periapical assintomática que foi gerenciada com o uso da mistura de própolis com hidróxido de cálcio como medicamento intraconducto entre as consultas, conseguindo observar um processo de reparo ósseo durante esse período. Em conclusão, a própolis é uma alternativa viável como adjuvante ao hidróxido de cálcio nos casos indicados por medicação intraconducto.

Abstract Various civilizations have used honey and its products for therapeutic purposes throughout history because of their healing effects. There is a renewed interest in the use of apitherapy as an adjunct in various medical treatments. Propolis stands out for its bactericidal, anti-inflammatory, and anti-cancer properties, among others. This paper aims to describe the case of a lower left first molar diagnosed with pulp necrosis and asymptomatic periapical periodontitis that was managed with a mixture of propolis and calcium hydroxide as an intracanal medicament between appointments. A bone repair process was observed during this period. It is concluded that propolis is a viable alternative as a calcium hydroxide adjuvant when intracanal medication is indicated.

Efecto antibacteriano de los selladores endodónticos en los conductos radiculares / Antibacterial effect of endodontic sealers in root canals

RESUMEN Introducción: Los selladores endodónticos desempeñan un papel crucial en la obturación, dado que dichos materiales, no solo actúan en el momento de su aplicación, sino que continúan haciéndolo con posterioridad, protegiendo al periodonto apical contra los organismos microbianos presentes. Precisamente, una de las propiedades deseadas en los selladores endodónticos es que posean acción antimicrobiana, para eliminar las bacterias remanentes después de la irrigación e instrumentación. Objetivo: Realizar una revisión sistemática del efecto antibacteriano de diferentes selladores endodónticos más utilizados en odontología contra Enterococcus faecalis (E. faecalis). Métodos: Esta revisión sistemática se llevó a cabo siguiendo los lineamientos PRISMA. La búsqueda se realizó en las bases de datos PubMed y Science Direct. Se revisaron los artículos de estudios antimicrobianos in vitro de selladores endodónticos y se excluyeron aquellos de fuente secundaria, como los de revisión de la literatura, así como artículos sobre cementos para otros usos. Desarrollo: Los cementos a base de hidróxido de calcio, resina o biocerámicos son biocompatibles y presentan algún porcentaje de actividad antimicrobiana; sin embargo, se puede apreciar que existe variabilidad en los resultados obtenidos en los estudios incluidos en la revisión, debido al uso de condiciones diferentes para la evaluación antibacteriana, excepto en los selladores endodónticos a base de silicona, los cuales tuvieron, de forma consistente, un efecto antibacterial nulo contra E. faecalis. Conclusión: De acuerdo a la bibliografía revisada, los selladores AH Plus, AH 26, TotalFill, BC Sealer y MTA Fillapex exhibieron efecto antimicrobiano, sin embargo, algunos de ellos mostraron escasa actividad contra E. faecalis(AU)

ABSTRACT Introduction: Endodontic sealers play a crucial role in sealing, for they not only act at the moment of their application, but continue to do so later, protecting the apical periodontium against microbial organisms. One of the properties desired in endodontic sealers is precisely their antimicrobial action against bacteria remaining after irrigation and instrumentation. Objective: Carry out a systematic review about the antibacterial effect of the endodontic sealers most commonly used in dental practice against Enterococcus faecalis (E. faecalis). Methods: The systematic review was based on PRISMA guidelines. The search was conducted in the databases PubMed and Science Direct. Papers were reviewed which dealt with in vitro antimicrobial studies about endodontic sealers, excluding secondary sources such as literature reviews and papers about cements used for other purposes. Discussion: Cements based on calcium hydroxide, resin or bioceramic are biocompatible and display some percentage of antimicrobial activity. However, variability was observed in the results obtained by the studies in the review, due to the use of different conditions for antibacterial evaluation, except for silicone-based endodontic sealers, which consistently displayed no antibacterial activity against E. faecalis. Conclusion: According to the bibliography reviewed, the sealers AH Plus, AH 26, TotalFill, BC Sealer and MTA Fillapex had an antimicrobial effect. However, some of them displayed scant activity against E. faecalis(AU)

Elimination of an intraradicular biofilm composed of enterococcus faecalis and candida albicans using a negative apical pressure irrigation system / Eliminación de una biopelícula intraradicular compuesta por enterococcus faecalis y candida albicans utilizando un sistema de irrigación de presión apical negativa

Endodontic treatment consists of the cleaning and disinfecting the root canal system, which is achieved using adequate mechanical instru-mentation and chemical irrigation. Endodontic microorganisms are present in root canals in the form of a biofilm, and their elimination ensures the success of endodontic treatment. Irrigation is a key factor contributing to the elimination of this intraconduct biofilm, and different irrigator agents and irrigation techniques, such as irrigation with negative apical pressure, a novel automated irrigation mechanism based on suction intraconduct, have been used. In this study, we evaluated the ability of a negative apical pressure system with different concentrations of sodium hypochlorite and durations to reduce the microbial load. Materials and Methods: An intraradicular biofilm composed of Enterococcus faecalis and Candida albicans was generated during twenty-one days of static culture on one hundred mesio-vestibular roots of upper molars with complex curvatures greater than 30°C, and the roots were classified in six groups with different concentrations and contact times of sodium hypochlorite. Subsequently, the reduction in the microbial load was measured with McFarland scale and the enumeration of colony forming units and was evaluated with scanning electronic microscopy. Results: We observed a significant difference in the reduction of the microbial load prior to instrumentation compared with postinstrumentation between the groups treated with 2.25% and 5.25% NaOCl for 30, 60 and 90 seconds of contact time (p<0.05), but we did not observe differences in the reduction of microbial load between different contact times and concentrations of sodium hypochlorite employed (p>0.05). Conclusion: Negative apical pressure is a good option for irrigation in endodontics, as it allows the passage of the irrigation fluid along the total length of the root canal and produces a better antimicrobial effect.

El tratamiento de endodoncia consiste en la limpieza y desinfección del sistema de conducto radicular, lo que se logra utilizando instrumentación mecánica adecuada y riego químico. Los microorganismos endodónticos están presentes en los conductos radiculares en forma de una biopelícula, y su eliminación asegura el éxito del tratamiento endodóntico. La irrigación es un factor clave que contribuye a la eliminación de esta biopelícula intraconductora, y se han utilizado diferentes agentes irrigadores y técnicas de irrigación, como la irrigación con presión apical negativa, un nuevo mecanismo automatizado de irrigación basado en la intraconducción de succión. En este estudio, evaluamos la capacidad de un sistema de presión apical negativa con diferentes concentraciones de hipoclorito de sodio y duraciones para reducir la carga microbiana. Material y Métodos: Se generó una biopelícula intraradicular compuesta por Enterococcus faecalisy Candida albicans durante veintiún días de cultivo estático en cien raíces mesio-vestibulares de molares superiores con curvaturas complejas superiores a 30°C, y las raíces se clasificaron en seis grupos con diferentes concentraciones y tiempos de contacto de hipoclorito de sodio. Posteriormente, la reducción en la carga microbiana se midió con la escala de McFarland y la enumeración de las unidades formadoras de colonias y se evaluó con microscopía electrónica de barrido. Resultado: Observamos una diferencia significativa en la reducción de la carga microbiana antes de la instrumentación en comparación con la postinstrumentación entre los grupos tratados con NaOCl 2.25% y 5.25% durante 30, 60 y 90 segundos de tiempo de contacto (p<0.05), pero lo hicimos No se observan diferencias en la reducción de la carga microbiana entre los diferentes tiempos de contacto y las concentraciones de hipoclorito de sodio empleado (p>0.05). Conclusión:La presión apical negativa es una buena opción para el riego en endodoncia, ya que permite el paso del líquido de riego a lo largo de todo el conducto radicular y produce un mejor efecto antimicrobiano.

Avaliação do tratamento endodôntico em sessão única e retratamento não cirúrgico com alargamento foraminal de dentes com periodontite apical / Evaluation of single visit endodontic treatment and non-surgical retreatment with foraminal enlargment of teeth with apical periodontitis ?

Objective: to evaluate the root canal treatment (RCT) and non-surgical root canal retreatment (NSRCR), associated with foraminal enlargement, performed on a singlevisit. Material and Methods: 125 teeth with apical periodontitis and follow-up period ranging from 6 to 12 months were included. The success was considered by the absence of signs and symptoms and complete or incomplete periapical repair. Logistic regression analyses were used to identify factors associated with the repair (p<0.05). Results: RCT showed 71.58% of complete healing and 23.16% of acceptable healing. NSRCR showed 80% of complete healing and 20% of acceptable healing. Age, gender, type of treatment and preoperative pain were not statistically significant for the healing process (p>0.05). Premolars showed the greatest chance of periapical repair. Pulp Canal Sealer showed a greater chance of periapical repair when compared to Sealapex (p<0.05). Conclusion: RCT and NSRCR using a foraminal enlargement protocol provided a favorable prognosis of periapical healing

Objetivo: avaliar o tratamento endodôntico (TE) e o retratamento não cirúrgico do canal radicular (RNCCR), associado a ampliação foraminal, realizado em sessão única. Material e Métodos: foram incluídos 125 dentes com periodontite apical e proservação de 6 a 12 meses. O sucesso foi considerado pela ausência de sinais e sintomas e reparo periapical completo ou incompleto. Análises de regressão logística foram utilizadas para identificar fatores associados ao reparo (p<0,05). Resultados: o TE mostrou 71,58% de cicatrização completa e 23,16% de cicatrização aceitável. O RNCCR mostrou 80% e 20% cicatrização completa e aceitável, respectivamente. Idade, sexo, tipo de tratamento e dor pré-operatória não foram estatisticamente significantes para o processo de cicatrização (p>0,05). Os pré-molares apresentaram a maior chance de reparo periapical. O cimento Pulp Canal Sealer mostrou maior chance de reparo periapical quando comparado ao Sealapex (p<0,05). Conclusão: o TE e RNCCR utilizando um protocolo de alargamento foraminal, proporcionaram um prognóstico favorável da cicatrização periapical

Limitation of diagnostic value of cone-beam CT in detecting apical root isthmuses

Abstract Isthmuses are reported as common anatomic complexities in teeth often associated with failures in endodontic treatment. They should be considered before starting treatment and a preoperative computed tomography scan (CT) may demonstrate these complexities. Objective To assess the diagnostic value of the highest resolution settings of a cone-beam CT (CBCT) system in identifying and measuring apical isthmuses, using micro-CT as reference. Methodology After micro-CT scanning, 40 humans' lower first molars with isthmuses in the apical-3 mm of mesial roots were scanned by the highest resolution settings of the New Generation i-Cat ® CBCT equipment. Two blinded observers recorded the detection of isthmuses in CBCT scans. The lengths of isthmuses were compared between micro-CT and CBCT to assess the diagnostic value of CBCT. Quantitative data for sensitivity were represented as percentages (95% confidence interval). The Bland-Altman method was used to assess differences between gold standard lengths (micro-CT) and CBCT lengths. Results BCT demonstrated 30 positive findings, representing sensitivity for isthmus identification of 75% (95% CI=0.4114-1.1364). Differences between the lengths in micro-CT (1.99±0.40 mm) and CBCT (1.53±0.41 mm) were significant (p<0.0001). Conclusion The CBCT device used presented limited diagnostic value in the identification and measurement of apical isthmuses in the mesial roots of lower molars. In some cases, the actual anatomy of the apical root canal may not be completely delineated in this type of CBCT system, even using the highest resolution settings.

Effect of passive ultrasonic activation on microorganisms in primary root canal infection: a randomized clinical trial

Abstract Objective: This clinical study sought to evaluate the effectiveness of passive ultrasonic activation (PUA) in eliminating microorganisms in primary endodontic infection (PEI) after instrumentation of root canals using microbiological culture and checkerboard DNA-DNA hybridization. Methodology: Twenty root canals with PEI and apical periodontitis were selected. The root canals were instrumented and then randomly divided into 2 groups, according to the irrigation method: PUA and conventional needle irrigation (CNI). Microbiological samples were collected before instrumentation (S1), after instrumentation (S2) and after irrigation with 17% EDTA (S3). The samples were subjected to anaerobic culture technique and checkerboard DNA-DNA hybridization analysis. Results: A statistically significant difference was found between CNI (23.56%) and PUA (98.37%) regarding the median percentage values for culturable bacteria reduction (p<0.05). In the initial samples, the most frequently detected species was S. constellatus (50%), and after root canal treatment was E. faecalis (50%). Conclusion: Both treatments significantly decreased the number of bacterial species compared with the initial sample. However, no statistical difference in the total microbial load between PUA and CNI groups was detected. The number of cultivable anaerobic bacteria reduced significantly using PUA, and the bacterial composition and number of bacterial species after using either CNI or PUA was similar.

Estudio con Microtomografía de Conductos Tratados con Sistemas Reciprocantes y Obturados con Cementos Biocerámicos / Microtomography Study of Root Canals Treated with Reciprocating Systems and Filled with Bioceramic Cements

Objetivo: Comparar la presencia de poros en los tres tercios del conducto radicular luego de la obturación con cementos biocerámicos. Se trataron endodónticamente 20 premolares inferiores unirradiculares, de anatomía oval. Los mismos fueron divididos en dos grupos y se obturaron con dos cementos biocerámicos diferentes. Todas las muestras fueron analizadas con microtomografía de rayos X para comparar la presencia de poros en los tres tercios radiculares, clasificando los mismos en internos, externos y combinados. En las 20 piezas dentarias obturadas y analizadas se encontraron poros. La cantidad de poros detectados no presentó diferencias significativas mediante análisis estadísticos cuantitativos ni cualitativos. Los poros se presentaron más frecuentemente en el tercio cervical, independientemente del cemento sellador. Ambos grupos presentan una buena adaptación a nivel apical, siendo esto imprescindible para la longevidad y éxito del tratamiento endodóntico (AU)

Uso de plasma rico en fibrina comparado con colágeno en el tratamiento de recesión gingival utilizando la técnica estenopéica. Ensayo clínico aleatorizado / Use of fibrin-rich plasma compared to collagen in the treatment of gingival recession using the stenopic technique. Randomized clinical trial

La recesión gingival (RG) es un problema de salud bucodental frecuente que aumenta con la edad, predispone a hipersensibilidad dentaria, caries radicular, inflamación gingival y efectos antiestéticos. El objetivo de este ensayo clínico aleatorizado fue evaluar comparativamente el efecto clínico del recubrimiento radicular utilizando la técnica estenopéica Pinhole con colágeno y la técnica estenopéica Pinhole modificada al incorporarle plasma rico en fibrina (PRF). Veintiséis participantes sistémicamente sanos, con diagnóstico de RG grado I de Miller, fueron reclutados y seguidos por 6 meses después de la cirugía. Los parámetros clínicos registrados fueron nivel de inserción clínica (NIC), RG y banda de encía queratinizada. Los participantes fueron asignados aleatoriamente a un grupo en quienes se utilizó PRF con 14 participantes, tratando 36 piezas dentales, y otro grupo en quienes se utilizó membrana de colágeno con 12 participantes, tratando 35 piezas dentales. Los resultados muestran un logro de ganancia en el NIC en ambos grupos, (M = 45.24 %, DE = 17.37 %) en el grupo PRF y (M = 47.37 %, DE = 15.67 %) en el grupo colágeno, diferencia que no fue significativa (p = .59). En ambos grupos existió un aumento significativo en la banda de encía queratinizada (p < .01). El uso de PRF como material de relleno al realizar la técnica estenopéica genera resultados similares al ser comparado con la técnica convencional que utiliza colágeno. Al presentar un menor costo el PRF aumenta las posibilidades que más personas tengan acceso al tratamiento.

Gingival recession (GR) is a frequent oral health disease that increases with age and may increase risk of dental hypersensitivity, root decay, gingival inflammation and aesthetic problems. The aim of this randomized clinical trial was to compare clinical parameters of dental root coverage using Pinhole technique with collagen and modi¬fied Pinhole technique using platelet-rich fibrin (PRF). Twenty-six participants, systemically healthy, with Miller class I GR diagnosis, were recruited and measured at baseline and after 6 months follow-up. Clinical parameters measured included clinical attachment level (ICL), GR and keratinized gingival width (KGW). All participants were randomly assigned to a group using PRF, with 14 participants and 36 teeth treated, and other group using collagen, with 12 participants and 35 teeth treated. Both PRF group and collagen group gained ICL, (M = 45.24 %, SD = 17.37 %) in PRF group and (M = 47.37 %, SD = 15.67 %) in collagen group, with no statistically significant difference (p = .59). Both groups gained KGW (p < .01). Use of PRF as filled material by using Pinhole technique resulted in similar clinical improvements compare to collagen as filled material. Considering that PRF is cheaper than collagen, it increases chances that people can have access to treatment.

Terapia endodóntica en pacientes adultos mayores ¿qué debemos tener en cuenta? / Endodontic therapy in elderly patients, what should we consider?

De acuerdo con la tendencia mundial, el número de personas de 60 años y más va en aumento. Este crecimiento demográfico de la población, el aumento de las expectativas de vida de las personas y la tendencia a la disminución de pacientes edéntulos, produce una mayor demanda de procedimientos endodónticos en la población anciana. Es fundamental que el odontólogo conozca la fisiología del envejecimiento para poder abordar, en forma eficaz, el tratamiento en los pacientes pertenecientes a este grupo etario. Se ha descripto que los tejidos dentales sufren cambios a lo largo de la vida; entre ellos, la reducción del número de fibroblastos, de odontoblastos, de vasos sanguíneos y de fibras nerviosas; el aumento de fibras colágenas, de masas calcificadas, aposición de cemento, de dentina secundaria y de dentina de reparación. El objetivo del presente trabajo es realizar una revisión bibliográfica en relación a los cambios que presentan la pulpa dental, la dentina y el cemento, relacionados con el proceso de envejecimiento y sus posibles dificultades al momento de realizar el tratamiento endodóntico; sin olvidar cómo pueden inferir en el éxito del tratamiento las posibles patologías sistémicas que presentan los pacientes a consecuencia de la edad (AU)

According to the world trend, the number of people aged 60 and over is increasing. This demographic growth of the population, the increase in people's life expectancies and the tendency to decrease edentulous patients, produces a greater demand for endodontic procedures in the elderly population. It is essential that the dentist knows the physiology of aging to be able to effectively address the treatment in patients belonging to this age group. It has been described that dental tissues suffer changes throughout life, including the reduction of the number of fibroblasts, odontoblasts, blood vessels and nerve fibers; the increase of collagen fibers, calcified masses, apposition of cement, secondary dentin and repair dentin. The objective of the present work is to carry out a bibliographic review in relation to the changes that the dental pulp, dentine and cement have in relation to the aging process and its possible consequences in the endodontic treatment; without forgetting how it can infer in the success of the treatment the possible systemic pathologies that patients present as a result of age (AU)

Evaluación radiográfica de los tratamientos realizados por alumnos de grado con dos técnicas de obturación endodóntica / Radiographic evaluation of the treatments performed by undergraduate students with two filling techniques

Objetivo: Evaluar radiográficamente, en dientes extraídos, el grado de homogeneidad y adaptación de las obturaciones endodónticas realizadas por alumnos de grado, comparando las técnicas de condensación lateral e híbrida. Materiales y métodos: Entre 2003 y 2017, los alumnos de tercer año de la Escuela de Odontología de la Universidad del Salvador / Asociación Odontológica Argentina realizaron 5.384 tratamientos endodónticos ex vivo empleando, para la obturación, las técnicas de condensación lateral e híbrida. En las radiografías posoperatorias, un docente especialista en endodoncia evaluó la homogeneidad y la adaptación de cada obturación para categorizarla como correcta o incorrecta. Para la comparación entre técnicas, dentro de cada año lectivo, se utilizó la prueba exacta de Fisher, y para el análisis porcentual de las observaciones, la prueba de Chi cuadrado. El nivel de significancia fue establecido en P<0,05. Resultados: Del total de 5.384 tratamientos, 4.970 (92,3%) mostraron obturaciones correctas. Con la técnica de condensación lateral, de los 1.741 tratamientos, 1.560 (89,6%) mostraron obturaciones correctas con la técnica híbrida, de los 3.643 tratamientos, 3.410 (93,6%) tuvieron obturaciones correctas. En función del tamaño total de las muestras, sumando todos los años, puede estimarse con 95% de confianza que la diferencia de obturaciones incorrectas entre ambas técnicas está entre el 2,3% y el 5,7%. Con la prueba del Chi cuadrado, se observa una diferencia significativa de obturaciones correctas a favor de la técnica híbrida (P<0,01) Conclusiones: La evaluación radiográfica de los tratamientos endodónticos realizados ex vivo por alumnos de pregrado mostró un alto porcentaje de obturaciones correctas. Así mismo, el empleo de la técnica híbrida dio, en general, mejores resultados de compactación de la masa del material obturador que la técnica de condensación lateral (AU)

Aim: To evaluate radiographically the degree of homogeneity and adaptation of endodontic obturations completed by undergraduate students in extracted teeth using lateral and hybrid condensation techniques. Materials and methods: Between 2003 and 2017, third year students of a the School of Dentistry of the Universidad del Salvador / Asociación Odontológica Argentina performed 5384 ex vivo endodontic treatments using lateral condensation and hybrid technique. In the postoperative radiographs, a specialist in endodontics assessed the homogeneity and adaptation of each obturation and categorize it as correct or incorrect. The data were submitted to statistical analysis to compare results obtained with the two techniques. Fisher and Chi-square tests were used and significance level was set at P<0.05. Results: Out of 5384 treatments, 4970 (92.3%) showed correct obturation. Within the 1741 treatments completed with the lateral condensation technique, 1560 (89.6%) were correct while within the 3634 where a hybrid technique was used, 3410 (93.6%) were correct. When the whole sample was considered (sum of treatment carried out during each of the academic years) a statistically significant difference (P<0.01) favoring the hybrid technique was found. The difference in incorrect cases can be estimated to be between 2.3% and 5.7% with 95% confidence. Conclusions: The radiographic evaluation completed by undergraduate students in extracted teeth showed a high percentage of correct fillings. The use of the hybrid technique showed, in general, better compaction of the obturation material than the lateral condensation technique (AU)

A comparison of the sealing abilities between Biodentine and MTA as root-end filling materials and their effects on bone healing in dogs after periradicular surgery

ABSTRACT Objectives: To compare the sealing ability and biocompatibility of Biodentine with mineral trioxide aggregate (MTA) when used as root-end filling materials. Methodology: The Cell Counting Kit-8 (CCK-8) assay was used to compare the cytotoxicity of MTA and Biodentine. Twenty-one extracted teeth with a single canal were immersed in an acidic silver nitrate solution after root-end filling. Then, the volume and depth of silver nitrate that infiltrated the apical portion of the teeth were analyzed using micro-computed tomography (micro-CT). Seventy-two roots from 3 female beagle dogs were randomly distributed into 3 groups and apical surgery was performed. After six months, the volume of the bone defect surrounding these roots was analyzed using micro-CT. Results: Based on the results of the CCK-8 assay, MTA and Biodentine did not show statistically significant differences in cytotoxicity (P>0.05). The volume and the depth of the infiltrated nitrate solution were greater in the MTA group than in the Biodentine group (P<0.05). The volume of the bone defect was larger in the MTA group than in the Biodentine group. However, the difference was not significant (P>0.05). The volumes of the bone defects in the MTA and Biodentine groups were smaller than the group without any filling materials (P<0.05). Conclusions: MTA and Biodentine exhibited comparable cellular biocompatibility. Biodentine showed a superior sealing ability to MTA in root-end filling. Both Biodentine and MTA promoted periradicular bone healing in beagle dog periradicular surgery models.