Apical enlargement favors endodontic irrigation ­ an in vivo study

Aim: This study evaluated the irrigation penetration during root canal instrumentation and the clinical step in which the irrigation solution can be detected in the apical region. Materials and Methods: Twenty necrotic molars were divided according to the irrigation protocol, saline solution with manual active pressure, and 2.5% sodium hypochlorite with dripping delivery. Solution penetration assessment used a radiopaque component added to each irrigant solely before a periapical radiograph. Instrumentation sequence was: #10, and #15 K-files (step 1), cervical flaring using WaveOne Small (step 2), WaveOne Small at working length (step 3), Hero-642 #35/.02 (step 4), and Hero-642 #40/.02 (step 5). The step each contrasted-irrigant reached the 2-mm-apical region was registered. Shapiro-Wilk and Fisher's exact tests were used for comparisons. Results: In step 3, both contrasted-irrigants started to be detected in the apical region, and after step 5, contrasted-irrigants penetrated in 100% of the cases, without significant difference. Conclusion: Considering distal molar roots, the apical enlargement up to an instrument #40.02 favors the irrigation to reach the 2-mm apical region.

Acute odontogenic maxillary sinusitis treated endodontically ­ two case reports and 15-day CBCT outcome

Patients presented acute recurrences from Otorhinolaryngology treatments with unilateral symptoms compatible with maxillary sinusitis with a dental origin (MSDO). Cone beam computed tomography (CBCT) showed sinus extensive membrane thickening that was not visible at periapical exam associated to the maxillary molar infection in both cases. Respiratory structures assessment was possible using a 6-inches field of view CBCT. Non-surgical endodontic treatment (case 1) performed and retreatment (case 2) showed a fast symptoms relief. Recall examination after 15 days revealed healthy soft tissues with normal periodontal probing and no dental mobility. In addition, 15-day CBCTs revealed initial maxillary sinus membrane recovery after the endodontic approaches in the reported cases. No additional medical intervention nor antibiotics administration were necessary in these MSDO cases management. Long-term follow-up in such cases is advisable to exclude other potential dental or respiratory issues. Diagnose and follow-up using CBCT presented significant sinus membrane thick reduction with no symptom's recurrence after the endodontic treatment

Endodontic retreatment: Analysis of three specialists' retreatment rates / Retratamento endodôntico: avaliação dos índices de três especialistas

Endodontic retreatment is a clinical intervention intended to correct errors that have occurred in a treatment performed previously. There are several causes of failures. The anatomical variations between root canals and the diffi culties of achieving microbial disinfection are reported as two of the main causes. However, in the dental offi ces of both general practitioners and specialists, it is very common that the causes of indications for endodontic retreatment are technical failures due to poorly executed treatment. In view of this, the objective of this study is to analyze the records of three specialists in Endodontics and analyze the causes for referral of their endodontic retreatment patients. Examination of 24,553 treatments conducted over varying periods revealed that cases of retreatment accounted for a considerable proportion of the routine work performed by these specialists, at an average of 23% of cases. The majority of retreatment indications were due to technical failure of the initial treatment, in combination with microbial factors caused by contamination of coronal restorations and poorly executed endodontic preparation and fi lling.

O retratamento endodôntico é uma intervenção clínica destinada para a correção de falhas ocorridas num tratamento anteriormente realizado. Vários são os motivos desencadeadores de insucessos. A variedade anatômica dos canais radiculares e a difi culdade de proporcionar a desinfecção microbiana são referenciadas como duas das causas principais. Entretanto, nos consultórios dentários de clínicos gerais e especialistas, é muito comum a indicação para oretratamento endodôntico por razões técnicas devido a sua mal execução. Estabelecida esta problemática, o objetivo deste estudo consiste em avaliar os prontuários de três especialistas em endodontia e verifi car quais são os motivos de encaminhamentos de seus pacientes para o retratamento endodôntico. Após o exame de 24.553 tratamentos em períodos distintos, verifi couse que os casos de retratamentos chegam a uma média relevante de 23% na rotina destes especialistas e que a maioria das indicações se deram por inabilidade no primeiro tratamento, aliadas ao fator microbiano causado por contaminações de restaurações coronárias, preparos e obturações endodônticas mal executadas.