EVALUATION OF INTRAOPERATIVE PAIN OCCURRENCE AND NEED FOR SUPPLEMENTAL ANESTHESIA DURING EMERGENCY DENTAL CARE

Aims: This study aimed to evaluate the intraoperative pain (IOP) occurrence in situations of symptomatic irreversible pulpitis (SIP) and symptomatic apical periodontitis (SAP). Materials and Methods: Patients who sought emergency care presenting a diagnosis of SIP or SAP were included. IOP was measured with a Visual Analogue Scale (VAS) after five minutes of local anesthesia, during access to the pulp chamber, root canal exploration and at the end of procedures. In cases where pain was reported during treatment, supplementary anesthesia was performed. Pain scores were recorded and analyzed using a generalized estimating equation model with posthoc comparisons. Results: 56 patients were included. 35 had a diagnosis of SIP; and 21 a diagnosis of SAP. Mean preoperative pain scores for SAP and SIP were 6.69 (±1.54) and 6.39 (±1.48), respectively (p>0.05). In patients with SIP, significant differences were observed between: preoperative scores and other time points; scores after five minutes of local anesthesia and other time points; scores during pulp chamber access and at the end of procedures; and scores during root canal exploration and at the end of procedures (p<0.05). In patients with SAP, significant differences were observed between preoperative pain scores with all other time points (p<0.05). Chi-square test indicated an association between diagnosis and the need for supplementary anesthesia (p<0.05). Conclusions: In conclusion, there is a strong relationship between reduction of moderate/severe pain after application of local anesthesia. The need for supplemental anesthesia is significantly associated to the diagnosis of symptomatic irreversible pulpitis.

Relationship between periapical lesions and sinus changes on multi-slice computed tomography sean / Relagao entre lesoes periapicais e alteragóes sinusais na tomografia computadorizada multislice

ABSTRACT Differentiating orofacial odontogenic pain/disorders from pain/disorders associated with maxillary sinusitis is important to avoid unnecessary dentalprocedures and to properly refer patients to colleagues/dentists and vice versa. Aim To analyze the association between apical lesions and sinus changes and to evaluate the agreement between the diagnoses of an endodontist, a radiologist, an oral and maxillofacial surgeon, and an otolaryngologist. Materials and Method 385 axial, coronal, and sagittal MSCT scans were selected using an image archiving andcommunication system (PACS). The examinations had been performed between 2018 and 2022. Results Apical lesions were observed in 36.10% of sinusitis cases, 73.8% of unilateralsinusitis cases, 48.7% of sinus floor discontinuity cases, and 67.2% of cases in which endodontic treatment had been performed. Agreement between the diagnoses made by the endodontist and those made by the other investigators was high for most study variables (k > 0.60). The exceptions were mucosal thickening, for which agreement between the endodontist and the other investigators was intermediate (k=0.397), and the presence of periapicallesions (k=0.010), previous endodontic treatment (k=0.013), and mucosal thickness (k=0.024), for which agreement between endodontists and radiologists was low. Conclusions: There was an association between sinus changes and apical lesions.

RESUMO Diferenciar a dor/desordens odontogénicas orofaciais da dor/desordens as sociadas á sinusite maxilar é importante para evitar procedimentos odontológicos desnecessários e para encaminhar adequadamente os pacientes aos colegas/dentistas e vice-versa. Objetivo Analisar a associagdo entre lesoes apicais e alteragóes sinusais e avaliar a concordáncia entre os diagnósticos de um endodontista, um radiologista, um cirurgido bucomaxilofacial e um otorrinolaringologista. Material e Método foram avaliadas 385 imagens. Resultados Aslesoes apicais foram observadas em 36,10% dos casos de sinusite, em 73,8% dos casos de sinusite unilateral, em 48,7% dos casos de descontinuidade do assoalho do seio e em 67,2%odos casos em que o tratamento endodontico havia sido realizado. A concordancia entre os diagnósticos feitos pelo endodontista e os feitos pelos outros pesquisadores foi alta para a maioria das variáveis do estudo (k > 0,60). As excegoes foram o espessamento da mucosa, para o qual a concordáncia entre o endodontista e os outros pesquisadores foi intermediária (k=0,397) e a presenga delesoes periapicais (k=0,010), tratamento endodontico prévio (k=0,013) e espessura da mucosa (k=0,024), para os quais a concordáncia entre endodontistas e radiologistas foi baixa. Conclusoes Houve uma associagdo entre as alteragóes sinusais e aslesoes apicais.

Research progress on the dentin adhesion of Enterococcus faecalis and its influencing factors / 口腔疾病防治

@#Enterococcus faecalis is the main pathogen causing refractory apical periodontitis (RAP). This bacterium can tolerate harsh environments and trigger periapical immune inflammatory responses that result in persistent infection inside and outside the root canal. Adhesion to the dentin wall of root canals and the subsequent formation of biofilms significantly enhances the drug resistance and anti⁃erosion ability of Enterococcus faecalis, which is the key factor medi⁃ ating its pathogenesis. The adhesion of Enterococcus faecalis to dentin involves non⁃specific adhesion and specific adhe⁃ sion, and the latter is mediated by adhesion⁃related virulence factors, mainly including the adhesin of collagen from en⁃terococci (Ace), extracellular surface protein (Esp), gelatinase (GelE), serine protease (SprE), endocarditis and biofilm associated pilus (Ebp) and aggregation substance (AS), which is regulated by multiple two⁃component systems. The two⁃ component system Fsr can promote the expression of gelE and sprE when the cell population density increases. GelE can further reduce Ace, while the two⁃component system GrvRS directly downregulates ace expression in response to the serum environment. The two⁃component systems CroRS and WalRK may also promote and inhibit the expression of vari⁃ ous virulence factors, including ace and gelE, thus affecting the adhesion of Enterococcus faecalis. In addition, the mech⁃ anochemical preparation and the internal environment of the root canal can also influence the adhesion of Enterococcus faecalis to dentin. Avoiding the introduction of Enterococcus faecalis and using adhesion⁃interfering medications during root canal treatment can effectively prevent the adhesion of Enterococcus faecalis, and a variety of activated irrigation protocols can also be effective at increasing the clearance of Enterococcus faecalis from the root canal. The design of ra⁃ tional drugs targeting key factors involved in and regulators of the adhesion of Enterococcus faecalis to dentin is expected to provide new ideas and strategies for root canal infection control. The present paper reviews the adhesion of Enterococ⁃ cus faecalis to dentin and its influencing factors.

MobileNetV3 network-based diagnosis of caries and periapical periodontitis from periapical films / 口腔疾病防治

Objective@#To research the effectiveness of deep learning techniques in intelligently diagnosing dental caries and periapical periodontitis and to explore the preliminary application value of deep learning in the diagnosis of oral diseases@*Methods@#A dataset containing 2 298 periapical films, including healthy teeth, dental caries, and periapical periodontitis, was used for the study. The dataset was randomly divided into 1 573 training images, 233 validation images, and 492 test images. By comparing various neural network models, the MobileNetV3 network model with better performance was selected for dental disease diagnosis, and the model was optimized by tuning the network hyperparameters. The accuracy, precision, recall, and F1 score were used to evaluate the model's ability to recognize dental caries and periapical periodontitis. Class activation map was used to visualization analyze the performance of the network model@*Results@#The algorithm achieved a relatively ideal intelligent diagnostic effect with precision, recall, and accuracy of 99.42%, 99.73%, and 99.60%, respectively, and the F1 score was 99.57% for classifying healthy teeth, dental caries, and periapical periodontitis. The visualization of the class activation maps also showed that the network model can accurately extract features of dental diseases.@*Conclusion@#The tooth lesion detection algorithm based on the MobileNetV3 network model can eliminate interference from image quality and human factors and has high diagnostic accuracy, which can meet the needs of dental medicine teaching and clinical applications.

Research progress on dental materials for preventing root caries / 口腔疾病防治

@#The high incidence and untreated rate of root caries, a common and frequently occurring oral disease with challenging treatment in elderly individuals, is the main cause of tooth loss among elderly people, as rapid development results in pulpitis and periapical periodontitis or residual crown and root, which has been regarded as one of the common chronic oral diseases seriously affecting the quality of life of elderly people. Thus, early intervention and prevention are important. Traditional dental materials for preventing root caries have been widely used in clinical practice; however, they have the disadvantages of tooth coloring, remineralization and low sterilization efficiency. A series of new dental materials for preventing root caries have gradually become a research hotspot recently, which have the advantages of promoting the mineralization of deep dental tissue, prolonging the action time and enhancing adhesion. Future caries prevention materials should be designed according to the characteristics of root surface caries and the application population and should be developed toward simplicity, high efficiency and low toxicity. This review describes current research regarding anti-caries prevention material application, serving as a theoretical underpinning for the research of root caries prevention materials, which is important for both promotion in the effective prevention of root caries and improvement in the status of oral health and the quality of life among old people.

Effect of pulp revascularization on pulp necrosis with periapical periodontitis in young permanent teeth / 中国基层医药

Objective:To investigate the efficacy of pulp revascularization in the treatment of pulp necrosis with periapical periodontitis in young permanent teeth and its effect on the levels of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in gingival crevicular fluid.Methods:From January 2021 to August 2021, 72 young patients with permanent teeth exhibiting pulp necrosis and apical periodontitis who were treated at Haiyang People's Hospital were included in this study. These patients were subsequently divided into a study group ( n = 35) and a control group ( n = 37), depending on their respective treatment methods. The control group underwent conventional apical angioplasty, whereas the study group underwent pulp revascularization. A comparative analysis was conducted to assess the clinical efficacy of both treatments. Additionally, levels of VEGF and bFGF in gingival crevicular fluid were measured before and after surgery, and these values were compared between the two groups. Relevant clinical indicators and the incidence of adverse reactions were also compared between the study and control groups. Results:The overall response rate in the study group was 94.3% (33/35), which was significantly higher than 70.3% (26/37) in the control group ( χ2 = 7.01, P < 0.05). Prior to surgery, there were no notable differences in VEGF level, bFGF level, root length, or root canal thickness between the two groups (all P > 0.05). However, after surgery, VEGF level, bFGF level, root length, and root canal thickness in the study group were (43.25 ± 4.87) ng/L, (40.72 ± 4.83) ng/L, (8.95 ± 0.27) mm, and (3.08 ± 0.24) mm, respectively. These values were (39.90 ± 4.80) ng/L, (36.05 ± 4.66) ng/L, (8.55 ± 0.18) mm, and (2.90 ± 0.20) mm, respectively, in the control group. There were significant differences in VEGF level, bFGF level, root length, and root canal thickness between the two groups ( t = 2.96, 4.18, 5.67, 2.88, all P < 0.05). After surgery, the scores for apical inflammation, root development, and Visual Analogue Scale (VAS) in the study group were significantly higher than those in the control group ( t = 7.61, 4.83, 9.47, all P < 0.001). The incidence of adverse reactions in the study group was 2.9% (1/35), which was significantly lower than 21.6% (8/37) in the control group ( χ2 = 5.79, P < 0.05). Conclusion:Pulp revascularization exhibits superior curative effects compared with conventional apical angioplasty for the treatment of pulp necrosis and apical periodontitis in young permanent teeth. This treatment effectively alleviates pain, markedly improves tooth function, and has a low incidence of adverse reactions, highlighting its clinical value as a therapeutic option.

Research progress on distribution characteristics and pathogenesis of periapical microorganisms in chronic periapical periodontitis / 中国基层医药

Periapical periodontitis arises from the interaction between microbial factors and the inflammatory response of the host's periapical tissues. In this process, bacteria and their byproducts serve as the primary drivers for the initiation, progression, and spread of the disease. Pulp infections and periapical lesions are primarily dominated by gram-negative bacteria. The endotoxin lipopolysaccharide component of these bacteria plays a crucial role in pulp infection, triggering clinical symptoms, inflammatory reactions, and bone tissue resorption. Similarly, lipoteichoic acid and lipopolysaccharide from gram-positive bacteria exhibit similar pathogenic characteristics, causing damage to pulp and periapical tissues. The aim of this review is to delve deeper into the distribution patterns and pathogenesis of periapical microorganisms in chronic periapical periodontitis.

Evaluación de Lesiones Periapicales Utilizando Tres Índices sobre Tomografía Computarizada Cone Beam

El uso de tomografía computarizada Cone Beam (CBCT) puede favorecer el diagnóstico temprano de periodontitis apical e influir en su pronóstico y tratamiento; sin embargo, no existe una estandarización entre los índices que determinan la presencia de lesiones periapicales en esta técnica radiológica. Es por tal motivo que, el objetivo de este estudio fue evaluar lesiones periapicales utilizando tres índices sobre CBCT. La población de estudio estuvo conformada por todas las CBCT realizadas en un centro radiológico peruano durante un año, se realizó un muestreo no probabilístico y se evaluaron 36 tomografías Cone Beam con los índices CBCT-PAI, COPI y CBCT-ERI; los datos recolectados fueron analizados estadísticamente y se determinó que el índice CBCT-PAI identificó 91,7 % lesiones periapicales; el índice COPI, 72,2 % y el índice CBCT-ERI, 88,9 %. Asimismo, se aplicó la prueba x2 de Pearson y se determinó un valor de p=0,05. Por lo tanto, se concluyó que el diagnóstico de lesiones periapicales sobre tomografía computarizada Cone Beam puede presentar resultados similares cuando se evalúa con cualquiera de los índices CBCT-PAI, COPI o CBCT-ERI.

The use of Cone Beam Computed Tomography (CBCT) can favor the early diagnosis of apical periodontitis and influence its prognosis and treatment; however, there is no standardization among the indexes that determine the presence of periapical lesions in this radiological technique. For this reason, the aim of this study was to evaluate periapical lesions using three indices on CBCT. The study population consisted of all the CBCT scans performed in a Peruvian radiological center for one year, a non-probabilistic sampling was performed and 36 Cone Beam tomography's were evaluated with the CBCT-PAI, COPI and CBCT-ERI indexes; the data collected were analyzed statistically and it was determined that the CBCT-PAI index identified 91.7 % periapical lesions; the COPI index, 72.2 % and the CBCT-ERI index, 88.9 %. Likewise, Pearson's x2 test was applied and a value of p=0.05 was determined. Therefore, it was concluded that the diagnosis of periapical lesions on Cone Beam computed tomography can present similar results when evaluated with any of the CBCT-PAI, COPI or CBCT-ERI indexes.

Genetic polymorphism of interleukins 6 and 17 correlated with apical periodontitis: A Cross-sectional study

Abstract Interleukins 6 and 17 act in bone resorption in the presence of infections of endodontic origin for host defense. Genetic polymorphisms may be associated with increased bone loss, represented by areas of large periapical lesions. This study aimed to verify the frequency of interleukin 6 and 17 gene polymorphism in patients with asymptomatic apical periodontitis or chronic apical abscess and to verify the existence of correlations between periapical lesion area with age, gender, and presence of the polymorphism, in the studied population, in the state of Pernambuco. A population consisting of thirty diagnosed individuals was included. The area of the lesions was measured in mm². Genomic DNA was extracted and genotyping was performed by Polymerase Chain Reaction Restriction Fragment Length Polymorphism for interleukin 6 (rs 1800795) and interleukin 17 (rs 2275913). Fisher's exact, chi-square, and odds ratio tests were used. A logistic regression analysis was also performed using sex, age, and the presence of polymorphism as covariates, in addition to linear regression to test the relationship between age and lesion area. All tests used a significance level of 0.05% (p ≤0.05%). There was no statistical significance in the occurrence of large areas of periapical lesions correlated with age, sex, and diagnosis, nor in the distribution of alleles in the polymorphism of interleukins 6 and 17 in the studied groups. The frequency of homozygous and heterozygous polymorphism was high. The polymorphism of these interleukins is not correlated with the increase in the areas of asymptomatic periapical inflammatory lesions.

Resumo As interleucinas 6 e 17 atuam na reabsorção óssea na presença de infecções de oriegem endodôntica para defesa do hospedeiro. Polimorfismos genéticos podem estar associados ao aumento da perda óssea, representada por áreas de lesões periapicais grandes. O objetivo deste estudo foi verificar a frequência do polimorfismo dos genes interleucina 6 e 17 em pacientes com periodontite apical assintomática ou abscesso apical crônico e verificar a existência de correlações entre área de lesão periapical com idade, sexo e presença do polimorfismo, na população estudada, no estado de Pernambuco. Foi incluída uma população constituída por trinta indivíduos diagnosticados. A áreas da lesões foram medidas em mm². O DNA genômico foi extraído e a genotipagem realizada por Polimorfismo de Comprimento de Fragmento de Restrição de Reação em Cadeia da Polimerase para interleucina 6 (rs 1800795) e interleucina 17 (rs 2275913). Os testes exato de Fisher, qui-quadrado e odds ratio foram utilizados. Uma análise de regressão logística também foi realizada usando sexo, idade e presença de polimorfismo como covariável, além de regressão linear para testar a relação da idade e área da lesão. Todos os testes utilizaram um nível de significância de 0,05% (p ≤0.05%). Não houve significância estatística na ocorrência das áreas grandes de lesões periapicais correlacionadas com idade, sexo e diagnóstico nem nas distribuições de alelos no polimorfismo das interleucinas 6 e 17 nos grupos estudados. A frequência de polimorfismo homozigoto e heterozigoto foi alta. O polimorfismo dessas interleucinas não está correlacionado ao aumento das áreas das lesões inflamatórias periapicais assintomáticas.

Prevalence of apical periodontitis in people living with HIV in Southern Brazil / Prevalência de periodontite apical em pessoas vivendo com HIV no Sul do Brasil

Objective: This cross-sectional study aimed to describe the prevalence of apical periodontitis (AP) in people living with HIV (PLHIV) over 50 years old and explore its association with sociodemographic, medical, and oral characteristics. Methods: Data from 59 PLHIV were collected, and the periapical area of 1018 teeth was evaluated through periapical radiographs (Rx) using the periapical index (PAI). The presence and quality of root fillings and restorations (coronal fillings and crowns) were assessed with Rx, and caries presence was based on Rx and clinical data. Viral load (VL) and T CD4 counts were also analyzed. Results: AP prevailed in 71% of individuals and 8% of teeth. Family income of >5 Brazilian minimum wages (OR=0.06, 95% CI=0.005-0.62) and having at least one root-filled tooth (OR=14.55, 95% CI=1.45-145.72) were associated with AP prevalence, whereas VL and T CD4 were not. Caries, root filling, and restorations were associated with AP occurrence. Conclusion: PLHIV presented a high AP prevalence, but intrinsic factors related to HIV infection were not associated with AP in the studied subjects. PLHIV would benefit from oral health policies to prevent AP, as the results indicate that the endodontic disease in the present sub-population might be related to social problems.(AU)

Objetivo: este estudo transversal teve como objetivo descrever a prevalência de periodontite apical (PA) em pessoas vivendo com HIV (PVHIV) acima de 50 anos de idade, e explorar sua associação com características sociodemográficas, médicas e bucais. Métodos: os dados de 59 PVHIV foram coletados e a região periapical de 1018 dentes foi avaliada através de radiografias periapicais (Rx) usando o Índice Periapical (PAI). A presença e qualidade das obturações radiculares e restaurações (restaurações diretas e coroas) também foram avaliadas no Rx; a presença de cárie foi baseada em dados clínicos e radiográficos. Carga Viral (CV) e contagem de linfócitos T CD4 também foram avaliados. Resultados: a prevalência de PA nos indivíduos foi de 71%, e 8% dos dentes apresentaram PA. Renda familiar >5 salários mínimos (OR=0.06, 95% CI=0.005-0.62) e ter pelo menos um dente com obturação endodôntica (OR=14.55, 95% CI=1.45-145.72) foram associados com a prevalência de PA, enquanto que CV e T-CD4 não foram. A presença de cárie, obturação endodôntica e restaurações foram associadas com a presença de PA no dente. Conclusão: PVHIV apresentaram uma alta prevalência de PA, mas fatores intrínsecos relacionados à infecção pelo HIV não foram associados com PA nos sujeitos avaliados. PVHIV se beneficiariam de políticas públicas de saúde para prevenir a PA, uma vez que os resultados indicam que a doença endodôntica na presente subpopulação pode ser relacionada a problemas sociais.(AU)

Asociación entre calidad del tratamiento endodóntico y periodontitis apical, evaluada mediante Tomografía Computarizada de Haz Cónico en una población colombiana / Association between endodontic treatment quality and apical periodontitis assessed through cone beam computarized tomography in a colombian population / Associação entre qualidade do tratamento endodôntico e periodontite apical, avaliada por tomografia computadorizada de feixe cônico em uma população colombiana

Introducción: La prevalencia de periodontitis apical en dientes con tratamiento endodóntico oscila entre el 35 y el 60%, se ha encontrado una fuerte asociación con respecto al grado de inflamación sistémica generada por la periodontitis apical, como por ejemplo altos niveles de citoquinas proinflamatorias, proteína C reactiva e interleuquina 6; estudios refieren que un tratamiento endodóntico adecuado puede reducir los niveles de proteína C reactiva en individuos sanos y con periodontitis apical. Objetivo: Evaluar la frecuencia de periodontitis apical en una población adulta colombiana seleccionada y su correlación con la calidad del tratamiento endodóntico. Materiales y métodos: Estudio observacional analítico de corte transversal, se determinó la frecuencia de periodontitis apical en 318 CBCT (Tomografía Computarizada de Haz Cónico), de pacientes de una subpoblación de Bucaramanga y Medellín y evaluó la asociación de la calidad del tratamiento endodóntico con el estado periapical. Resultados: Sólo el 37,66% de los dientes evaluados fueron considerados sanos; el 44,81% se clasificaron como tratamiento endodóntico adecuado. La calidad del tratamiento endodóntico influyó significativamente en la condición del periodonto apical. Conclusiones: Los tratamientos evaluados presentaron alta frecuencia de periodontitis apical, la cual se asoció en buena parte a la alta frecuencia de tratamientos endodónticos inadecuados.

Introduction: The prevalence of apical periodontitis in teeth with endodontic treatment ranges between 35% and 60%, and a strong association has been found with respect to high levels of systemic inflammation markers (pro-inflammatory cytokines, protein C-reactive and interleukin 6) caused by apical periodontitis. Studies have shown that an adequate endodontic treatment can reduce C-reactive protein levels in healthy individuals and those with apical periodontitis. Objective: To evaluate the frequency of apical periodontitis in a selected Colombian adult population and its correlation with the quality of endodontic treatment. Materials and methods: Observational, analytical, cross-sectional study. The frequency of apical periodontitis was determined in 318 CBCTs of patients from Bucaramanga and Medellin, and the association between quality of endodontic treatment and periapical status was analyzed. Results: Only 37.66% of the observed teeth were considered healthy, whereas 44.81% were classified as teeth with appropriate endodontic treatment. Quality of endodontic treatment significantly affected the condition of the apical periodontium. Conclusions: The analyzed treatments had a high apical periodontitis frequency, which was associated with a high frequency of inadequate endodontic treatments.

Introdução: A prevalência de periodontite apical em dentes com tratamento endodôntico varia entre 35 e 60 %, uma forte associação foi encontrada com relação ao grau de inflamação sistêmica gerada pela periodontite apical, como altos níveis de citocinas pró-inflamatórias, proteína C reativa e interleucina 6; estudos relatam que o tratamento endodôntico adequado pode reduzir os níveis de proteína C-reativa em indivíduos saudáveis ​​e naqueles com periodontite apical. Objetivo: Avaliar a frequência da periodontite apical em uma população adulta colombiana selecionada e sua correlação com a qualidade do tratamento endodôntico. Materiais e métodos: Estudo transversal analítico observacional; a frequência de periodontite apical foi determinada em 318 CBCT de pacientes de uma subpopulação de Bucaramanga e Medellín, foi avaliada a associação da qualidade do tratamento endodôntico com o estado periapical. Resultados: Apenas 37,66% dos dentes avaliados foram considerados saudáveis, 44,81% dos dentes foram classificados como tratamento endodôntico adequado. A qualidade do tratamento endodôntico influenciou significativamente a condição do periodonto apical. Conclusões: Os tratamentos avaliados apresentaram alta frequência de periodontite apical, que foi amplamente associada à alta frequência de tratamentos endodônticos inadequados.

Effect of systemic administration of Bifidobacterium animalis subsp. lactis HN019 on apical periodontitis

Abstract This study aimed to evaluate the effect of Bifidobacterium animalis subsp. lactis (B. lactis) HN019 in drinking water on the development of apical periodontitis (AP) in rats. In total 60 animals were divided into a control group (sound teeth); Group I - regular water without AP; Group II - probiotic water without AP; Group III - regular water with AP; Group IV - probiotic water with AP. AP was induced after 3 days in the control groups and after 7, 21, and 42 days in groups III and IV. The animals were euthanized, and the mandibles were subjected to histotechnical processing. Samples were stained with hematoxylin & eosin (H&E) to identify root canal features, apical and periapical regions. Additionally, histoenzymology was performed to detect osteoclasts, immunohistochemistry was used to identify osteoclastogenesis markers, and the Brown & Brenn technique was applied for microbiological analysis. The data were analyzed using GraphPad Prism 8.0.1 with a significance level of 5%. Although no statistical differences were observed, the groups administered with probiotics showed better conditions in terms of histological aspects seen microscopically. Furthermore, there were no differences in the number of osteoclasts (p > 0.05). The RANKL marker was not found in the probiotic group at 42 days, unlike in group III.

Avaliação da etapa final do sinal insulínico, via inflamatória, estresse oxidativo, mecanismo epigenético por metilação do DNA e expressão de GLUT4 no músculo gastrocnêmio de ratos adultos, proles de ratas com periodontite apical / Assessment of insulin signaling and inflammatory pathways in skeletal muscle and adipose tissues of adult rats, offspring of the rats with periapical lesion

A programação fetal sugere que estímulos adversos quando aplicados durante o início do desenvolvimento fetal podem alterar o metabolismo da prole, aumentando o risco de doenças na sua vida adulta. A metilação do DNA é um dos mecanismos epigenéticos envolvida nesta programação e regula a expressão gênica. Estudos anteriores verificaram que a periodontite apical (AP) materna em ratas promove em sua prole adulta: resistência insulínica (RI), alteração na etapa inicial do sinal insulínico (SI) no músculo gastrocnêmio (MG) e aumento na concentração plasmática de fator de necrose tumoral-α (TNF-α). O TNF-α pode ativar o fator de transcrição nuclear kappa B (NF-kB) que diminui a expressão gênica do transportador de glicose GLUT4. Nesse contexto, mais estudos são necessários para investigar se as alterações no SI observadas em ratos adultos, proles de ratas com AP também estão presentes na continuidade da cascata insulínica. Ademais, sabendo-se que o estresse oxidativo tem sido implicado como fator contribuinte tanto para o início quanto para a progressão do diabetes, torna-se fundamental verificar o grau de estresse oxidativo tecidual nesta prole adulta. Em vista disso, os objetivos deste estudo foram avaliar a RI, estresse oxidativo, etapa final do SI e via inflamatória no MG de ratos adultos, proles de ratas com AP. Para tanto, as 21 ratas Wistar (2 meses de idade) foram distribuídas em 3 grupos: 1) ratas controle; 2) ratas com 1 AP induzida em 1º molar superior direito; 3) ratas com 4 APs induzidas em 1os e 2os molares superiores e inferiores do lado direito. A AP foi induzida empregandose broca em aço carbono dotada de esfera de 0,1 mm na extremidade. Após 30 dias da exposição pulpar, as ratas de todos os grupos foram colocadas para acasalamento. Quando os filhotes machos de todas as ratas completaram 75 dias de idade, foram realizadas as seguintes análises plasmáticas: 1) glicemia; 2) insulinemia; 3) RI. Ademais, foram realizados os seguintes experimentos no MG: 1) grau de fosforilação em serina/treonina da Akt, após o estímulo insulínico; 2) conteúdo proteico de GLUT4; 3) grau de metilação do DNA na região promotora do gene do GLUT4; 4) expressão gênica do GLUT4 e TNF-α; 5) conteúdo proteico de TNF-α e PGC-1α; 6) grau de fosforilação de NF-kB p50 e NF-kB p65; 7) estresse oxidativo (superóxido dismutase ­ SOD e espécies reativas ao tiobarbitúrico ­ TBARS). A análise estatística foi realizada pela análise de variância, seguida do teste de Tukey. O nível de significância adotado foi de 5%. Os resultados mostraram que AP materna (tanto 1 foco de infecção como 4 focos de infecções) promoveu hiperinsulinemia, RI e diminuição na atividade antioxidante da SOD e na concentração de TBARS no MG de sua prole adulta. Entretanto, somente a AP materna em quatro dentes promoveu aumento na massa corpórea, na ingestão alimentar e no grau de fosforilação das subunidades p50 e p65 do NF-kB no MG de proles adultas. Ademais, houve diminuição no grau de fosforilação em serina e treonina da Akt (após estímulo insulínico) e na expressão gênica e conteúdo proteico de GLUT4 no MG em proles adultas de ratas com 4APs. A AP materna não promoveu alteração na glicemia de jejum, conteúdo de PGC-1α, grau de metilação do DNA na região promotora do gene do GLUT4 e expressão gênica e conteúdo proteico de TNF-α no MG de proles adultas. Esses resultados revelam o impacto que a AP materna tem em longo prazo na predisposição às alterações metabólicas na fase adulta da prole. Isso reforça a importância que a manutenção da saúde bucal materna tem sobre a saúde geral da prole(AU)

Fetal programming suggests that adverse stimuli when applied during early fetal development may alter metabolism of offspring, increasing the risk of disease in adulthood. DNA methylation is one of the epigenetic mechanisms involved in this programming and regulates gene expression. Previous studies have shown that maternal apical periodontitis (AP) in rats promotes in their adult offspring: insulin resistance (IR), alteration in the initial steps of the insulin signaling (IS) in the gastrocnemius muscle (GM) and increase in plasma concentration of tumor necrosis factor-α (TNF-α). TNF-α can activate nuclear transcription factor kappa B (NF-kB) thus decreasing gene expression of the GLUT4 glucose transporter. In this context, more studies are needed to investigate whether changes in IS observed in adult rats, offspring of rats with AP are also present in the continuity of the insulin cascade. In addition, since oxidative stress has been implicated as a contributing factor for both the onset and progression of diabetes, it is essential to verify the degree of tissue oxidative stress in this adult offspring. Therefore, the aims of this study were to evaluate IR, oxidative stress, final steps of IS and inflammatory pathway in the GM of adult rats, offspring of rats with AP. For this purpose, 21 female Wistar rats (2 months of age) were distributed into three groups: 1) control rats (CN); 2) group with one AP induced in the upper right first molar (1AP); 3) group with four APs induced in the first and second upper and lower right molars (4AP). AP was induced using a surgical round bur measuring 0.1 mm in diameter. After 30 days of pulp exposure, female rats of all groups were placed for mating. Pregnant rats were separated into individual cages. When the male offspring of all rats reached 75 days of age, the following plasma analyzes were performed: 1) glycemia; 2) insulinemia; 3) IR. Furthermore, the following analyzes were performed in the GM: 1) Akt serine/threonine phosphorylation status, after insulin stimulation; 2) GLUT4 content; 3) degree of DNA methylation in the proximal promoter region of the GLUT4 gene; 4) GLUT4 and TNF- α gene expression; 5) TNF-α and PGC-1α content; 6) p50 and p65 subunits of NF-kB phosphorylation status; 7) oxidative stress (superoxide dismutase ­ SOD and thiobarbiturate reactive species ­ TBARS). Statistical analyzes were performed by analysis of variance, followed by the Tukey test. The level of significance adopted was 5%. Results showed that maternal AP (both 1 infection focus and 4 infection focus) promoted hyperinsulinemia, IR and decrease in SOD antioxidant activity and TBARS concentration in the GM of their adult offspring. However, only maternal AP in four teeth promoted an increase in body weight, food intake and p50 and p65 subunits of NF-kB phosphorylation status in the GM of adult offspring. Furthermore, there was a decrease in Akt serine and threonine phosphorylation status (after insulin stimulation) and in gene expression and protein content of GLUT4 in the GM in adult offspring of rats with 4APs. Maternal AP did not change fasting glycemia, PGC-1α content, degree of DNA methylation in the proximal promoter region of GLUT4, gene expression and protein content of TNF-α in the GM of adult offspring. These results demonstrate that maternal AP is associated with IR and promotes important alterations in IS and inflammation pathways in adult offspring. This reinforces the importance of maternal oral health on the overall health of offspring(AU)

Efeito da fumaça do cigarro na periodontite apical induzida em ratos: análise do perfil inflamatório e imuno-histoquímica macrofágica / Effect of cigarette smoke inhalation on induced apical periodontitis in rats: inflammatory profile and macrophage immunohistochemistry analysis

Objetivo: Avaliar a severidade da periodontite apical (PA) em ratos expostos à fumaça do cigarro, por meio da análise histológica do perfil inflamatório e imunomarcação macrofágica. Material e Métodos: Foram utilizados trinta e dois ratos machos Wistar distribuídos em quatro grupos (n=8): PA (ratos com PA induzida); F (ratos expostos à fumaça do cigarro); FPA (ratos com PA induzida expostos à fumaça do cigarro); C (ratos sem PA e sem exposição ao cigarro). Para inalação da fumaça do cigarro, os animais permaneceram em câmara de tabagismo por oito minutos, três vezes ao dia por vinte dias antes da indução da PA. Em seguida, os animais tiveram as polpas coronárias expostas ao meio oral por 30 dias para a indução da PA e continuaram inalando fumaça até completarem 50 dias. No momento da eutanásia, as hemi-maxilas do lado direito foram removidas para avaliar o perfil inflamatório por coloração em hematoxilina e eosina e imuno-histoquímica para marcação macrofágica F4/80 (macrófago), CD206 (M2) e iNOS (M1). Dados não paramétricos foram analisados por Kruskal-Wallis, seguido de post-hoc Dunn e Mann- Whitney (P<.05). Resultados: O infiltrado inflamatório foi moderado no grupo PA e intenso no grupo FPA (P>.05). Na imunomarcação de macrófagos M1, os grupos C e F apresentaram diferenças significantes quando comparado aos grupos PA e FPA (P<0,05). No anticorpo F4/80 não houve diferença entre os grupos (P>.05). Conclusão: A inalação da fumaça do cigarro em ratos contribuiu para uma reação inflamatória periapical mais intensa, com presença predominante de macrófagos pró-inflamatórios M1, agravando a severidade da periodontite apical(AU)

Objective: To evaluate the severity of apical periodontitis (AP) in rats exposed to cigarette smoke, through histological analysis of the inflammatory profile and macrophage immunostaining. Material and Methods: thirty-two male Wistar rats were used, distributed into four groups (n=8): PA (rats with induced AP); F (rats exposed to cigarette smoke); FPA (AP-induced rats exposed to cigarette smoke); C (rats without AP and without exposure to cigarettes). For cigarette smoke inhalation, animals remained in a smoking chamber for eight minutes, three times daily for twenty days before AP induction. Then, animals had the coronary pulp exposed to oral environment for 30 days to induce AP while continued inhaling smoke until completing 50 days of experimental period. During euthanasia process, the right hemimaxillas were removed to assess inflammatory profile by hematoxylin and eosin staining and immunohistochemistry for macrophage immulabeling: F4/80 (macrophage), CD206 (M2) and iNOS (M1). Nonparametric data were analyzed by Kruskal-Wallis, followed by post-hoc Dunn and Mann-Whitney (P<.05). Results: The inflammatory infiltrate was moderate in the PA group and intense in the FPA group (P<.05). Histomorphometric analysis of M2 macrophages revealed statistical differences between groups C and PA, and F and FPA (P>.05). In the immunostaining of M1 macrophages, groups C and F showed significant differences when compared to groups PA and FPA (P<0.05). While the PA and FPA groups presented a large amount of immunoreactive cells, being higher for the FPA group (P<0.05). In the F4/80 antibody there was no difference between the groups (P>.05)Conclusion: Inhalation of cigarette smoke in rats contributed to a more intense periapical inflammatory reaction, with a predominant presence of pro-inflammatory M1 macrophages, aggravating the severity of apical periodontitis(AU)

Factors related to apical periodontitis in a southern Brazilian population: a multilevel analysis

Abstract The aim of this cross-sectional study was to evaluate the effects of individual-level and tooth-level factors on apical periodontitis (AP) in an urban population in southern Brazil. A random sample of digital panoramic radiographs (n = 545) from a dental school database was evaluated. The diagnosis of AP was determined by using a dichotomous scale (yes/no). AP was assessed according to gender, age, presence and quality of endodontic treatment (ET), presence of an intracanal post, coronal condition, and dental group. Data were analyzed descriptively and through multilevel Poisson regression analysis, considering teeth characteristics (level 1) nested in individuals (level 2). In this sample of 545 participants, the prevalence of AP was 49.5% (n =2 70) and ET was 43.5% (n = 237). Considering 13,595 teeth, AP was identified in 596 (4.4%) and ET in 617 (4.5%). Of the teeth with ET, 153 (24.8%) presented AP. Among individual-level factors, the disease was not significantly associated with gender or age. For tooth-level factors, AP was significantly associated with ET quality: teeth with short fillings (< 3 mm) and teeth with over-fillings had 2.77 (CI: 1.95-3.94, p < 0.001) and 1.08 (CI: 0.39-2.98, p < 0.001) higher prevalence of AP, respectively. There was no association between AP and age, gender, dental group, coronal condition, or the presence of an intracanal post. AP was highly prevalent in this population, and multilevel analysis indicated a significant association with ET quality.

Terapia descompresiva en el manejo no quirúrgico de lesiones perirradiculares de gran tamaño / Decompressive therapy in the non-surgical management of large periradicular lesions

Introducción: La periodontitis apical asintomática es de los diagnósticos endodónticos más comunes que se presentan en la población mundial. Consiste en la afectación del tejido periapical como resultado de la activación de mecanismos de inflamación, los que incluyen lisis y reabsorción de tejidos de soporte como cemento, ligamento y hueso alveolar. El signo patognomónico de la periodontitis apical es la presencia de radiolucidez periapical, resultado de la destrucción de los tejidos periapicales. Su principal tratamiento abarca el manejo endodóntico convencional cuyo objetivo es la eliminación de los irritantes locales dentro del conducto radicular. Sin embargo, cuando se desarrollan lesiones de gran tamaño es necesario complementar con terapias que aceleren la reparación, una de ellas la descompresión, la cual a partir de la reducción de la presión intralesión e intraósea con lo que favorece la formación de tejido fibroso, conectivo y óseo. Objetivo: Describir la técnica de descompresión intraconducto en el manejo de lesiones periapicales de gran tamaño. Presentación del caso: Paciente de 33 años de edad, con diagnóstico de periodontitis apical asintomática y evaluación tomográfica de lesión periapical de gran tamaño (67,5 UH) manejado con terapia endodóntica convencional y descomprensión intraconducto como terapia coadyuvante. Posterior a la restauración se realizaron controles clínicos y radiográficos. A los 24 meses se evidenció reparación de los tejidos involucrados con restauración del espacio del ligamento periodontal. Conclusiones: En este caso, la terapia descomprensiva fue una alternativa en el manejo de una lesión periapical de gran tamaño, que permitió regular la presión intraósea y facilitar la regeneración del tejido óseo, evitando la intervención quirúrgica siendo así más confortante para el paciente(AU)

Introduction: Asymptomatic apical periodontitis is one of the most common endodontic disorders diagnosed in the world population. It consists in damage to the periapical tissue due to activation of inflammation mechanisms, including lysis and resorption of support tissues like cementum, ligament and alveolar bone. The pathognomonic sign of apical periodontitis is the presence of periapical radiolucency due to the destruction of periapical tissue. Its main treatment includes conventional endodontic management aimed at removing local irritants from the root canal. However, when large lesions develop, it is necessary to complement the conventional treatment with therapies speeding up the repair process, such as decompression, which reduces intralesion and intraosseous pressure, fostering the formation of fibrous, connective and bone tissue. Objective: Describe the use of intracanal decompression technique in the management of large periapical lesions. Case presentation: A case is presented of a 33-year-old patient diagnosed with asymptomatic apical periodontitis and a tomographic evaluation of a large periapical lesion (67.5 UH) treated with conventional endodontic therapy and intracanal decompression as adjuvant therapy. Restoration was followed by clinical and radiographic controls. At 24 months it was observed that the tissues involved had been repaired and the periodontal ligament space restored. Conclusions: The use of decompressive therapy as an alternative in the management of a large periapical lesion, made it possible to regulate intraosseous pressure and facilitate bone tissue regeneration, relieving the patient from the discomforts of a surgical intervention(AU)

Alargamento do forame como complemento no tratamento endodôntico para regeneração de uma lesão periapical extensa: relato de caso / Foraminal enlargement as a complement in the endodontic treatment for the regeneration of an extensive periapical lesion. A case report

Introdução: O alargamento do forame refere-se ao alargamento mecânico intencional do forame para reduzir a carga bacteriana em uma área afetada frequentemente por infecções endodônticas além do limite da constrição apical. Objetivo: O objetivo do presente relato de caso é apresentar a técnica de alargamento do forame de um dente com lesão periapical extensa, como complemento do tratamento endodôntico e alternativa precoce à microcirurgia periapical. Métodos: É apresentado o caso de um incisivo lateral superior endodonticamente tratado, com uma extensa lesão periapical associada. Devido à história clínica e radiográfica, tempo decorrido desde o tratamento endodôntico inicial e alta probabilidade de áreas de reabsorção apical com biofilme extrarradicular, o retratamento endodôntico com alargamento do forame foi indicado como primeira opção, adiando a indicação de cirurgia endodôntica de acordo com a evolução. Resultados: Na avaliação de acompanhamento de dois anos, por exame de imagem, observou-se evolução clínica favorável ao retratamento, com aumento total da densidade óssea. O procedimento cirúrgico endodôntico complementar foi descartado. Conclusão: O alargamento do forame é uma alternativa complementar viável em casos de periodontite apical de longa duração com suspeita de biofilme no nível do forame. Pode ser considerado uma opção antes da indicação de retratamento endodôntico cirúrgico (AU).

Introduction: Foraminal enlargement refers to intentional mechanical enlargement of the foramen to reduce the bacterial load in an area frequently affected by endodontic infections beyond the limits of the apical constriction. The objective of this case report is to present the foraminal enlargement technique of a tooth with an extensive periapical lesion as a complement in the endodontic treatment and an early alternative to periapical microsurgery. Materials and methods: The case is presented of an endodontically treated upper lateral incisor with an extensive associated periapical lesion. Due to the clinical and radiographic history, the time elapsed since the initial endodontic treatment, and the high probability of areas of apical resorption with extra-radicular biofilm, endodontic retreatment with foraminal enlargement was indicated as the first option, postponing the indication for endodontic surgery according to evolution. Results: In the follow-up appointment at 2 years, a favorable clinical imaging evolution of retreatment was observed, with a total increase in bone density. The complementary endodontic surgical procedure was discarded. Conclusion: Foraminal enlargement is a viable complementary alternative in cases of long-term apical periodontitis with suspicion of biofilm at the foramen level. It can be considered an option before the indication of surgical endodontic retreatment (AU).

Periodontite apical assintomática com rompimento de cortical óssea em paciente sob tratamento contínuo com isotretinoína: relato de caso / Asymptomatic apical periodontitis with cortical bone disruption in patient under continuous treatment with Isotretinoin: case report

Introdução: A periodontite apical assintomática (PAA) é caracterizada pela inflamação e destruição dos tecidos periapicais, e sua progressão promove reabsorção óssea, podendo ser agravada pelo uso contínuo de isotretinoína. Objetivo: O objetivo do presente estudo foi relatar a resolução de uma PAA com rompimento de cortical óssea mandibular em um paciente sob tratamento contínuo com isotretinoína (Roacutan®), por meio de procedimentos químicos-mecânicos convencionais e controle com tomografia computadorizada de feixe cônico (TCFC). Descrição: Um paciente com 21 anos de idade, ASA I, em tratamento contínuo com isotretinoína, procurou atendimento odontológico com moderada dor na região do elemento dental #38. Após exames clínicos, radiográficos e tomográficos, verificou-se a necessidade de tratamento endodôntico do dente #36. A TCFC mostrou uma imagem apical extensa e hipodensa entre os dentes #36 e #37, compatível com lesão cística óssea, com dimensões de 25,59 mm (largura) x 14,37 mm (altura) x 8,40 mm (profundidade). Também foram observados reabsorção apical da raiz distal, halo hipodenso sob a restauração coronal do #36 e ruptura da cortical externa vestibular e lingual. O tratamento endodôntico foi realizado em três sessões, com auxílio de um microscópio operatório e protocolos químicos-mecânicos, como Easy Clean e terapia fotodinâmica. Resultado: A resolução da PAA foi observada após acompanhamento por três anos. Conclusão: O tratamento endodôntico permitiu o reparo de uma lesão periapical extensa, evitando a cirurgia parendodôntica imediata, e o uso contínuo de isotretinoína não afetou a resolução da PAA(AU).

Introduction: Asymptomatic apical periodontitis (AAP) is characterized by inflammation and destruction of the periapical tissues and its progression leads to bone resorption, which may be aggravated by continuous use of Isotretinoin. The objective of this study was to report the resolution of AAP with mandibular cortical disruption in a patient under continuous treatment with isotretinoin (Roacutan®) and kickboxing practitioner, by conventional chemical-mechanical procedures and cone-bean computed tomography (CBCT) follow-up. Description: A 21-year-old Caucasoid individual, ASA I, under continuous use of isotretinoin and kickboxing practitioner sought dental care with moderate pain at the region of tooth #38. After clinical, radiographic and tomographic examination, the need for endodontic treatment of tooth #36 was verified. The CBCT showed an extensive and hypodense apical image between teeth #36 and #37, compatible with cystic bone lesion, with dimensions of 25.59 mm wide x 14.37 mm high x 8.40 mm deep. Apical resorption of the distal root, hypodense halo under a coronal restoration at #36, and rupture of the external buccal and lingual cortical bone were also observed. The endodontic treatment was performed in three sessions with the aid of a microscope and chemical-mechanical protocols, such as Easy Clean and photodynamic therapy. Result: Resolution of AAP was observed after follow-up for three years. Conclusion: Endodontic treatment allowed healing of an extensive periapical lesion, avoiding immediate parendodontic surgery and the continuous use of isotretinoin did not affect the AAP resolution. (AU).

Efeito da crioterapia intracanal no controle da dor pós-operatória após terapia endodôntica: uma revisão de literatura / Effect of intracanal cryotherapy on postoperative pain control after endodontic therapy: a literature review

Objetivo: O objetivo desta revisão de literatura é investigar e analisar criticamente o uso da crioterapia intracanal durante o tratamento endodôntico, visando através dos achados científicos disponíveis elaborar argumentos sólidos que justifiquem optar ou não pela realização de tal protocolo auxiliar durante a intervenção endodôntica. Revisão de literatura: A alternativa terapêutica conhecida como crioterapia é uma técnica existente há anos, a qual tem sido frequentemente aplicada na Medicina para o tratamento da dor e cuidados pós-operatórios. Recentemente, o uso da crioterapia na Endodontia, através de um protocolo de irrigação final do canal radicular, foi examinado em vários ensaios clínicos randomizados. Discussão: Os estudos revisados demonstraram que a utilização de soro fisiológico frio como agente irrigante final ao preparo químico-mecânico, tem potencial para reduzir os níveis de dor de uma possível sintomatologia dolorosa pós-tratamento endodôntico, além de que, trata-se de um método de fácil aplicação e baixo custo. Conclusão: Embora se tenha poucos estudos sobre o tema, as evidências científicas disponíveis e revisadas neste artigo embasam com propriedade o efeito da crioterapia intracanal na redução da dor pós-operatória proveniente de uma intervenção endodôntica. No entanto, novos estudos são necessários para averiguar possíveis efeitos deletérios e para a elaboração de um protocolo previsível e seguro.

Aim: The aim of this literature review is to investigate and critically analyze the use of intracanal cryotherapy during endodontic treatment and, through scientific findings, elaborate well grouded references that justify or not, carrying out such auxiliary protocol during endodontic intervention. Literature Review: The therapeutic alternative known as cryotherapy is a technique that has existed for years, which has been frequently applied in Medicine for the treatment of pain and postoperative care. Recently, the use of cryotherapy in Endodontics, through a final root canal irrigation protocol, has been examined in several randomized clinical trials. Discussion:The reviewed studies showed that the use of cold saline solution as a final irrigating agent for chemical-mechanical preparation has the potential to reduce pain levels of a possible painful symptomatology after endodontic treatment, in addition to being a method of easy appli-cation and low cost. Conclusion: Although there are few studies on the subject, scientific evidences available and reviewed in this article properly support the effect of intracanal cryotherapy in reducing the postoperative pain of an endodontic intervention. However, new studies should be placed to investigate possible harmful effects and to prepare a predictable and safe protocol.

Different techniques for the treatment of teeth with an incomplete root development and pulp necrosis: a systematic review / Diferentes técnicas para o tratamento de dentes com rizogênese incompleta e necrose pulpar: uma revisão sistemática

Introduction: The objective of this systematic review was to compare the apexification techniques of calcium hydroxide (Ca(OH)2), or mineral trioxide aggregate (MTA), with the pulp regeneration technique, using cohort studies, and non-randomized and randomized clinical trials. Methods: The methodology was based on electronic research in the following databases: PubMed, MEDLINE, Google Scholar, SciELO, and LILACS. In addition, a manual search was carried out using the references that were listed in the articles found. Results: A total of 403 potentially eligible studies were found, with seven being included in the inclusion criteria of this systematic review. The seven studies involved a total of 312 teeth. The minimum time of a follow-up period was 12 months. The irrigation solution most used was sodium hypochlorite, for both of the apexification and revascularization techniques. The medication commonly chosen in the apexification groups was Ca(OH)2, with antibiotic triple paste in the revascularization groups. The clinical rate of success in the groups treated with revascularization varied from 76% to 100%, while in the groups treated with apexification, it ranged from 68% to 100%. Only two studies reached a success rate equal to 100%. Conclusions: Variable levels of evidence were observed in relation to the treatments. However, it was confirmed that revascularization is an excellent option since its outcomes produced a greater gain of thickness and root length, besides developing a decrease in the apical foramen.

Introdução: O objetivo desta revisão sistemática foi comparar as técnicas de apexificação, com hidróxido de cálcio (Ca(OH)2) ou agregado trióxido mineral (MTA), com a técnica de regeneração pulpar, utilizando estudos coorte, ensaio clínico não randomizado e randomizado. Métodos: A metodologia foi baseada em pesquisa eletrônica nas seguintes bases de dados: PubMed, MEDLINE, Google Acadêmico, SciELO e LILACS. Além disso, foi realizada uma pesquisa manual utilizando as referências listadas nos artigos encontrados. Resultados: Foram encontrados 403 estudos potencialmente elegíveis, sendo sete incluídos nos critérios de inclusão desta revisão sistemática. Os sete estudos envolveram um total de 312 dentes. O tempo mínimo de um período de acompanhamento foi de 12 meses. A solução de irrigação mais utilizada foi o hipoclorito de sódio, para as técnicas de apexificação e revascularização. O medicamento comumente escolhido nos grupos de apexificação foi o Ca(OH)2, com pasta tripla antibiótica nos grupos de revascularização. A taxa clínica de sucesso nos grupos tratados com revascularização variou de 76% a 100%, enquanto nos grupos tratados com apexificação variou de 68% a 100%. Apenas dois estudos atingiram uma taxa de sucesso igual a 100%. Conclusões: Níveis variáveis de evidência foram observados em relação aos tratamentos. No entanto, confirmou-se que a revascularização é uma excelente opção, pois seus desfechos produzem maior ganho de espessura e comprimento radicular, além de diminuir o forame apical.