A saúde na região do Médio Solimões no estado do Amazonas: a centralidade de Tefé / Health in the Middle Solimões region, state of Amazonas: the centrality of Tefé

RESUMO Em um cenário de várzea amazônica com fluxos fluviais, o estudo analisa a articulação da Atenção Básica com a Atenção Especializada, buscando discutir as condições políticas e geográficas que impactam na conformação da rede assistencial em uma região de saúde na Amazônia Ocidental. Adotouse uma combinação de estratégias metodológicas: levantamento de indicadores de morbidade e da rede de saúde, mapeamento dos trajetos intermunicipais, levantamento de despesas em Ações e Serviços Públicos de Saúde e entrevistas com gestores. O município de Tefé concentra serviços bancários, poder judiciário, educacional, órgãos de controle e segurança que lhe conferem uma centralidade de funções. Contudo, a saúde não considera os fluxos existentes no território para definição de quais municípios têm Tefé como referência. A defasagem dos dados nos sistemas de informação em saúde, aliada a ausência do ente estadual no planejamento regional de saúde, apoio para provimento de profissionais especializados, pagamento de insumos e organização do fluxo de referência-contrarreferência na rede têm sido desafios para planejar integralidade da atenção na região, sobrecarregando o município-polo. Apesar do aumento progressivo de despesas em saúde nos municípios analisados, a oferta de serviço para além da Atenção Básica permanece sendo um desafio para o Sistema Único de Saúde (SUS) na Amazônia.

ABSTRACT In an Amazonian floodplain scenario with river flows, the study analyzes the articulation of Primary Care with Specialized Care, seeking to discuss the political and geographical conditions that impact on the formation of the care network in a health region in the Western Amazon. A combination of methodological strategies was adopted: survey of morbidity indicators and the health network, mapping of intercity routes, survey of expenses in Public Health Actions and Services and interviews with managers. Tefé concentrates banking services, judiciary branch, education and security bodies that give it a centrality of functions. However, health does not consider existing flows in the territory to define which municipalities have Tefé as a health reference. Outdated data in the health information systems, combined with the absence of the state government in the regional health planning, support to provide specialized professionals, payment for supplies and the organization of referral-counter-referral flow in the network have been challenges for integrality of the attention in the region, overloading the hub municipality. Despite the progressive increase in health expenses in the analyzed municipalities, the provision of services beyond Primary Care remains a challenge for the Unified Health System (SUS) in the Amazon.

Endodontic treatment during COVID-19 pandemic - Economic perception of dental professionals

Aim: This study evaluated, by the application of questionnaires, the impact of the COVID-19 pandemic on the clinical routine and inspection by the competent authorities, on the flow of patients in the office, as well as on possible changes in Endodontic treatment costs and the amounts charged to patients. Methods: This cross-sectional study was conducted from May 2nd, 2020 to May 6th, 2020, using an online questionnaire with a convenience sample. The inclusion criterion was professionals who perform endodontic treatments in daily clinical practice and who professional setting is private practice. The questionnaire brought questions about the impact on costs and the amount charged to the patient. Results: A total of 1042 questionnaires were answered from all the different states of Brazil, by professional who usually perform Endodontic treatment, and who is working in private practice. A total of 1010 (96.9%) respondents affirm it was necessary to modify the protective equipment in endodontic treatment due to pandemic and longer intervals between appointments was cited by 922 (88.5%), economically affecting the dental practice. There was no association between routine changes and economic impacts with gender, professional experience, area of residence or education level. Conclusion: In conclusion, most dental professionals recognized changes in the routine of endodontic treatment during the COVID-19 pandemic. They have a perception of increase in endodontic costs, and reduction in the volume of patients

Estudo ex vivo da elevação do pH em superfície radicular externa após agitação ultrassônica de diferentes pastas de hidróxido de cálcio / Assessment of pH increase in the external root surface after ultrasonic agitation of different calcium hydroxide pastes: Ex vivo study

Objetivo: O presente estudo teve por objetivo avaliar, ex vivo, a capacidade de elevação do pH da superfície radicular externa de diferentes pastas de hidróxido de cálcio (HC) utilizadas como medicação intracanal, além da influência da ativação ultrassônica (AUS) durante aplicação no interior do canal radicular. Métodos: Foram utilizados 100 incisivos humanos superiores unirradiculares, que tiveram os canais radiculares modelados e divididos aleatoriamente em seis grupos experimentais (n=15), de acordo com a pasta de HC, tendo como variáveis as medicações utilizadas e a ativação da pasta com AUS no momento da aplicação, além de um grupo controle (n=10): Pasta Calen; HC+clorexidina 2% gel (CX2%); e HC + água destilada. Os dentes foram mantidos imersos em água deionizada e as medidas do pH, verificadas nos períodos de 7, 14, 21 e 28 dias, com auxílio de pHmetro. Resultados: De acordo com os dados obtidos, verificou-se elevação do pH nos períodos de 7 e 14 dias em todos os grupos. Apenas os grupos em que foi utilizada a associação do HC com CX2% apresentou evolução com aumento significativo do pH ao longo dos períodos analisados (p<0,05). A ativação das pastas com AUS proporcionou incremento significativo dos valores de pH (p<0,05). Conclusão: De acordo com a metodologia empregada, pode-se concluir que todas as pastas utilizadas promovem elevação do pH no tecido dentinário, e a ativação das pastas com AUS influencia significativamente na elevação do pH no tecido dentinário (AU).

Objective: The aim of the present study was to evaluate, ex-vivo, the pH elevation capacity on the external root surface of different calcium hydroxide (HC) pastes, utilized as intracanal medication, it was also evaluated the influence of the ultrasonic activation at the application within the root canal. Methods: 100 human single root superior incisors were used, which had their root canals shaped and randomly divided into 6 experimental groups (n=15) according to the following HC pastes: Calen; HC + Chlorhex- idine 2% gel (CX2%); HC + distilled water, utilizing the medications and the ultrasonic activation of the paste at the time of the application as variables and 1 control group (n=10). The teeth were kept immersed in deionized water and the pH parameters were verified in 7, 14, 21 and 28 days with a pH measurement machine. Results: According to the data obtained, pH was elevated in the first week in all groups. Only the groups which the association of HC with CX2% was made, did show a significant increase in the pH level over the analyzed periods (p < 0,05). The activation of the pastes with US provided a significant increase in pH values (p < 0,05). Conclusion: According to the methodology used, we can conclude that all the HC pastes used, promote pH elevation in dentin tissue. And the acti- vation of the pastes with US significantly influences the pH increase in dentin tissue

Endodontic treatment during the COVID-19 pandemic - perception and behaviour of dental professionals / Tratamento endodôntico durante a pandemia de COVID-19 - Percepçao e comportamento dos profissionais de odontologia

ABSTRACT This study evaluated the impact of COVID-19 on the endodontic treatment routine. It was a cross-sectional study using an online questionnaire applied to endodontists to collect information about practical modifications during endodontic treatment to protect professionals and patients against the COVID-19 outbreak. A total 1105 participants from Brazil participated in the survey. More than 90% of respondents identify the high risk of COVID-19 infection to dentists and the need to change some clinical practices. Most respondents (60.1%) are partially following social isolation. The need for a change in Personal Protective Equipment (PPE) during dental appointments was mentioned by 97.1% of respondents. The use of minimal adequate PPE during the pandemic period was associated with the area of residence and marital status of participants. Only 30% of respondents say they use the minimal adequate PPE. Most respondents will change cavity access preparation to reduce virus dissemination. Other changes in endodontic appointments were described in the survey: greater attention to biosafety measures, duration of dental appointments, and duration of intervals between appointments. Endodontists still need to identify the best arrangement for performing their procedures safely during the COVID-19 pandemic. Specific guidelines require detailed information for each specialty and its procedures.

RESUMO Este estudo transversal foi realizado por meio de um questionário online. O questionário foi aplicado a endodontistas e coletou informagoes sobre modificagoes práticas durante o tratamento endodontico para combater o surto de COVID-19 e proteger profissionais e pacientes. Um total de 1105 participantes do Brasil participaram da pesquisa. Mais de 90% dos entrevistados identificam o alto risco de infecgao por COVID-19 para os dentistas e a necessidade de mudar algumas práticas clínicas. A maioria dos entrevistados (60,1%) segue parcialmente o isolamento social. A necessidade de mudangas dos Equipamentos de Protegao Individual (EPIs) durante as consultas odontológicas foi referida por 97,1% dos entrevistados. O uso de EPIs mínimos adequados durante o período pandémico foi associado á área de residencia e ao estado civil dos participantes. Apenas 30% dos participantes afirmou usar os EPIs mínimos durante a pandemia. A maioria dos entrevistados mudará a preparagao do acesso á cavidade para reduzir a disseminagao do virus. Outras mudangas nas consultas endodonticas foram descritas na pesquisa: maior atengao ás medidas de biosseguranga, duragao das consultas odontológicas e intervalos entre as consultas. Os endodontistas ainda precisam distinguir a melhor maneira para realizar seus procedimentos com seguranga, durante a pandemia de COVID-19. Diretrizes específicas requerem informagoes detalhadas para cada especialidade e seus procedimentos.

12-year follow-up of regenerative endodontic treatment of immature permanent upper incisors with acute abscess

Abstract This case report discusses the endodontic treatment of a 7-year-old girl who suffered trauma (intrusion) to the immature upper central incisors secondary to a fall from a bicycle. Thirty days after the accident the patient was brought by her mother for clinical and radiographic assessment with a chief complaint of swelling and tenderness to percussion and palpation. Acute apical abscess associated with immature teeth were diagnosed. A decision was made to perform regenerative endodontic treatment. Access cavities were made and the root canals were disinfected by irrigation with 2.5% sodium hypochlorite. Final irrigation was performed with 17% EDTA. Due to pain and presence of secretions, 2% chlorhexidine gel was applied as an intracanal medicament. Seven days later, at the second visit, the root canals were once again disinfected and the canals of the right and left permanent upper central incisors were filled with double antibiotic paste (metronidazole/ciprofloxacin) and calcium hydroxide paste, respectively. Zinc oxide was mixed in both pastes. At the third visit, after 21 more days, the pastes were removed and the periapical areas were stimulated with a #80 K-file to encourage clot formation within the pulp cavities. A mineral trioxide aggregate (MTA) paste cervical plug was placed and the teeth were restored with glass ionomer cement. Radiographs and CBCT scans demonstrated complete root formations. The patient has been followed for 12 years, with evidence of clinical success throughout.

Resumo Este relato de caso discute o tratamento endodôntico de uma menina de 7 anos que sofreu trauma nos incisivos centrais superiores imaturos, após queda de bicicleta. Trinta dias após o acidente, a paciente foi levada pela mãe para avaliação clínica e radiográfica com queixa principal de inchaço e sensibilidade à percussão e palpação. Foram diagnosticados abscessos apicais agudos em ambos os dentes. Foi decidido por realizar o tratamento endodôntico regenerativo. Após acessos coronários, os canais radiculares foram submetidos à protocolos de antissepsia com auxílio de irrigação com hipoclorito de sódio a 2,5% e EDTA 17%. Devido à dor e presença de secreções, foi utilizada medicação intracanal com clorexidina gel 2% por 7 dias. Na segunda sessão, os canais radiculares foram novamente submetidos aos procedimentos de antissepsia e os canais dos incisivos centrais superiores permanentes direito e esquerdo foram preenchidos com pasta antibiótica dupla (Metronidazol / Ciprofloxacina) e pasta de hidróxido de cálcio, respectivamente. Em ambas as pastas foi adicionado o óxido de zinco. Na terceira sessão, após mais 21 dias, as pastas foram removidas e as regiões periapicais foram estimuladas com lima K nº 80 para incentivar a formação de coágulos sanguíneos no interior das cavidades pulpares. Tampões cervicais de MTA foram adaptados e os dentes restaurados com cimento de ionômero de vidro resinoso. Radiografias e tomografias computadorizadas demonstraram formações radiculares completas. A paciente é acompanhada há 12 anos, com evidências clínicas e radiográficas de sucesso.

Efeito do consumo de álcool no desenvolvimento de lesão periapical induzida em ratos: uma análise microtomográfica / The Effect of Alcohol Consumption on the Development of Periapical Lesion Induced in Rats: a Micro-CT Analysis

Objetivo: O objetivo deste estudo foi avaliar a influência do consumo crônico de álcool no aumento da destruição óssea periapical em ratos. Material e métodos: Foram selecionados 12 ratos machos da linhagem Wistar, aleatoriamente divididos nos grupos controle e álcool (n=6). Os ratos do grupo álcool foram submetidos à auto-administração de solução alcoólica contendo 25% de álcool puro. O grupo controle recebeu apenas água filtrada durante o estudo. Após as 5 semanas de adaptação do grupo álcool, todos os ratos foram anestesiados e a polpa dos seus primeiros molares inferiores esquerdos foi exposta à cavidade oral para indução da lesão periapical. Após 28 dias de exposição pulpar, os ratos foram sacrificados por sobredose de anestesia, e suas mandíbulas foram removidas e seccionadas para avaliação microtomográfica. As hemimandíbulas esquerdas foram fixadas e escaneadas no microtomógrafo SkyScan 1173 (Bruker, Kontich, Belgium). O tamanho da lesão periradicular foi medido a partir das imagens de microtomografia computadorizada (micro-CT), onde foram calculados a área de superfície e o volume da lesão. Também foram avaliadas a taxa percentual de ganho de peso e a ingestão de sólidos/líquidos dos grupos. Os dados foram estatisticamente analisados utilizando o teste t de Student (p<0,05). Resultados: Os animais do grupo controle tiveram uma maior taxa percentual de ganho de peso corporal e de ingestão tanto de sólidos como de líquidos (p<0,05). As lesões periapicais apresentaram maior volume e maior área nos animais do grupo álcool, em comparação ao grupo controle (p<0,05). Conclusão: O consumo crônico de álcool contribuiu para o aumento da destruição óssea periapical em casos de periodontite apical.

Objective: the aim of this study was to evaluate the influence of alcohol consumption on the increase of periapical bone destruction in rats. Material and Methods: the sample included 12 Wistar male rats, randomly assigned into a control group and an alcohol group (n=6). Rats in the alcohol group were submitted to self-administration of a 25% pure alcoholic solution. The control group received only filtered water throughout the study. After 5 weeks of adaptation to the alcohol dose, all animals were anesthetized and the pulps of their mandibular left first molar were exposed to the oral cavity to induce periapical lesion. Twenty-eight days after the pulp exposure, those rats were euthanized due to overdose of anesthesia and their mandibles were removed and sectioned to obtain a micro-computed tomographic (micro-CT) scan. The rats' left hemimandibles were fixed and scanned on the SkyScan 1173 (Bruker, Konitch, Belgium) microtomograph. The size of the periradicular lesions was measured from the images obtained on the micro-CT and the surface area and volume were calculated. It was also evaluated the weight gain rate and the ingestion of solid/liquid of both groups. Data were analyzed by the Student's t-test (p<0.05). Results: the control group showed higher rates of weight gain and ingested more solid and liquid than the alcohol group (p<0.05). Periapical lesions found in the alcohol group had higher volume and surface area than the ones of the control group (p<0.05). Conclusion: the chronic consumption of alcohol contributed to the increase of periapical bone destruction in cases of apical periodontitis

Reação tecidual em subcutâneo de ratos frente a um cimento reparador à base de MTA com alta plasticidade / Tissue reaction to repair cement based on MTA with high plasticity in subcutaneous of rats

Este estudo teve como objetivo avaliar a biocompatibilidade, através de análise histopatológica e de imuno-histoquímica, de um novo cimento reparador à base de MTA com alta plasticidade: MTA HP (Angelus Londrina, PR). O MTA branco (Angelus Londrina, PR), e um material a base de óxido de zinco e eugenol (IRM, Dentsply, Petrópolis, RJ) foram utilizados como referências para comparação. Para isso, trinta ratos machos de linhagem Wistar tiveram inoculados no tecido subcutâneo um tubo de polietileno vazio (controle negativo) e mais três tubos, cada um preenchido com um dos materiais testados. Os animais foram eutanasiados após 7, 30 e 60 dias da implantação dos tubos e as amostras foram fixadas e incluídas em parafina. Os cortes histológicos foram corados com hematoxilina e eosina e tricômico de gomori para avaliação das reações inflamatórias e a presença de angiogênese foi realizada utilizando o marcador VEGF (do inglês vascular endothelial growth factor). Os cortes também foram corados com Picrosirius Red para quantificar as fibras colágenas do tipo I e tipo III, assim como a coloração de Weigert foi realizada para observar as fibras elásticas. Os dados não-paramétricos foram analisados usando o ensaio de Kruskal-Wallis seguido do teste de Dunn. Os níveis de significância adotados foram de 5% (P < 0,05). Os resultados mostraram diferença significativa da resposta inflamatória após 60 dias entre os grupos IRM e tubo vazio (P < 0,05). O MTA HP apresentou biocompatibilidade similar ao MTA branco e ao grupo controle negativo em todos os períodos experimentais. Além disso, após 7 dias o MTA HP estimulou a angiogênese de forma menos acentuada que o MTA branco, assim como apresentou inicialmente um remodelamento mais lento da matriz extracelular quando comparado ao MTA branco e o IRM. Foi observado uma diminuição da espessura da cápsula fibrosa, da quantidade de fibras elásticas e da imonumarcação com VEGF em todos os grupos experimentais e controle negativo ao longo do processo de cicatrização. Após 60 dias os grupos experimentais apresentaram matriz extracelular com tecido conjuntivo mais maduro, com predominância de fibras colágenas do tipo I. De acordo com os resultados obtidos no presente estudo, pode-se concluir que o novo cimento reparador com alta plasticidade, MTA HP, apresentou-se biocompatível em todos os períodos experimentais, com resultados similares aos grupos controle negativo e experimentais com MTA branco e IRM.

This study evaluated the biocompatibility, through histopathological analysis and immunohistochemistry of a new repair cement based on MTA with high plasticity: MTA HP (Angelus Londrina, PR). White MTA (Angelus Londrina, PR), and a material based on zinc oxide and eugenol (IRM, Dentsply, Petrópolis, RJ) were used as references for comparison. Thirty male Wistar rats had inoculated into the subcutaneous tissue an empty polyethylene tube (negative control) and three more tubes, each filled with one of the tested materials. The animals were euthanized after 7, 30 and 60 days of tube implantation and the specimens were fixed and embedded in paraffin. The sections were stained with hematoxylin and eosin and gomori trichrome to assess inflammatory reactions, and the presence of angiogenesis was performed using the VEGF (vascular endothelial growth factor) marker. The sections were also stained with Picrosirius Red to quantify as type I and type III collagen fibers, as well as a Weigert staining was performed to observe elastic fibers. Non-parametric data were analyzed using the Kruskal-Wallis assay followed Dunn's test. The significance levels adopted were 5% (P < 0.05). The results demonstrated a significant difference in inflammatory response after 60 days between IRM and empty tube groups (P < 0.05). MTA HP showed similar biocompatibility to the White MTA and the negative control group in all experimental periods. Furthermore, after 7 days MTA HP stimulated less pronounced angiogenesis than White MTA, as it initially exhibited slower extracellular matrix remodeling when compared to White MTA and IRM. A decrease in the thickness of the fibrous capsule, the amount of elastic fibers and the immunostaining with VEGF in all experimental groups and control throughout the healing process was observed. After 60 days, the experimental groups presented extracellular matrix with more mature connective tissue, with predominance of type I collagen fibers. According to the results obtained in the present study, it can be concluded that the new repair cement with high plasticity, MTA HP, was biocompatible in all the experimental periods, presenting similar results to the control and experimental groups with White MTA and IRM.

Avaliação da descontaminação de cones de guta-percha usando diferentes métodos de desinfecção / Evaluation of gutta-percha points decontamination through different disinfection methods

A suscetibilidade ao crescimento bacteriano em cones de guta-percha (GP) e a forma de descontaminação desses cones usando quatro diferentes substâncias químicas foram avaliadas. Seis cones de GP foram selecionados de um ambiente clínico e levados com pinça estéril para um meio de cultura de Brain Heart Infusion (BHI), para avaliação de crescimento bacteriano. Outros doze cones foram divididos em quatro grupos experimentais de três cones, sendo: Grupo 1, hipoclorito de sódio a 2,5%; Grupo 2, álcool a 70%; Grupo 3, clorexidina gel a 2%; e Grupo 4, clorexidina líquida a 0,12%, onde cada cone ficou submerso na substância por um minuto, foi seco por meio de esfregaço com gaze estéril e inserido em meio de cultura BHI, para se avaliar a presença ou não de contaminação. Os resultados encontrados mostraram que os cones de guta-percha não apresentavam contaminação, independentemente de serem submetidos ou não a um processo de descontaminação. Dessa forma, conclui-se que não há necessidade de descontaminação dos cones de guta-percha, contanto que seja respeitada a cadeia asséptica do tratamento endodôntico.

Prevalência de dois canais em incisivos inferiores permanentes humanos / Prevalence of two root canal in humans permanent lower incisors

Introdução e objetivo: O sucesso do tratamento endodôntico requer um amplo conhecimento da anatomia do dente e de suas variações. Assim, o presente estudo teve como objetivo avaliar através das imagens radiográficas a prevalência de dois canais em incisivos inferiores permanentes humanos, determinando com isso o local de união desses canais. Material e métodos: Utilizou-se 100 dentes incisivos inferiores permanentes humanos. Inicialmente, em cada dente obteve-se um corte transversal na junção cemento-esmalte, logo após, realizou-se avaliação radiográfica em todos os dentes, visando identificar a presença ou não de dois canais. Posteriormente, identificou-se o local de bifurcação dos dentes com dois canais, através de radiografias. Resultado: Observou-se no exame radiográfico que 28% dos espécimes (28 dentes) examinados possuíam dois canais. Destes, 85,7% dos espécimes (23 dentes) apresentaram canais com união no terço apical, 7,1% dos espécimes (3 dentes) tinham canais independentes, 3,6% dos espécimes (1 dente) possuíam canais com união no terço médio e nenhum apresentava união dos canais no terço cervical. Em um dos dentes estudados (3,6%), não foi possível fazer essa avaliação. Conclusão: Conclui-se que a prevalência de dois canais em incisivos inferiores permanentes humanos foi de 28% dos espécimes, sendo que o principal local de união é o terço apical (85,7%).

Introduction and Objective: The success of endodontic treatment requires a comprehensive knowledge of tooth anatomy and its variations. So, this study aimed to evaluate the prevalence of two root canals in human permanent lower incisors, determining the place of union of these root canals. Materials and methods: A hundred human mandibular incisors were used. First, a cement-enamel cross section was obtained in each tooth, after that radiographic evaluation was performed in all the teeth in order to identify the presence or not of two root canals. Subsequently, the location of the bifurcation of two root canals teeth was identified through radiography. Results: It was observed through radiographic examination that 28% of the specimens (28 teeth) examined had two root canals. 85.7% of these specimens (23 teeth) presented union in the apical third, 7.1% of the specimens (3 teeth) had independent canals, 3.6% of the specimens (1 tooth) had canals with the union in the third medium and none of them presented union in the cervical third. In one of the teeth studied (3.6%), it was not possible to make this assessment. Conclusion: It was concluded that the prevalence of two root canal in human permanent lower incisors was of 28%, and that most unions occurred is the apical third (85.7%).

In vitro effectiveness evaluation of different substances in decontamination of intracanal metallic

Introduction: The intracanal metallic post, for many years, was the most used intracanal retainer and the best choice to restore endodontically treated teeth, showing until today high rates of success scientifically proven, good adaptation at the configuration of the root canal and resistance. Objective: The purpose of this study was to evaluate the effectiveness of some chemical substances in the decontamination of these intracanal metallic posts. Material and methods: Twenty intracanal metallic posts were divided into 6 experimental groups and 1 control group with 3 specimens each. The groups were divided into G1 (apple cider vinegar), G2 (0.12% chlorhexidine liquid), G3 (2% chlorhexidine gel), G4 (70° ethyl alcohol), G5 (2.5% sodium hypochlorite), and G6 (2% glutaraldehyde). For the control group was used saline solution. Each intracanal metallic post was submerged in your respective substance for 3 minutes and subjected to a smear dried sterile gauze. Immediately after this procedure the specimens were individually placed into tubes containing culture medium broth Brain Heart Infusion (BHI). The set of tubes containing the intracanal metallic post submerged in BHI were taken to the dry out machine and kept there at 37ºC for 48 hours. Results: The tubes that showed turbidity of BHI broth were considered positive, or contaminated. Conclusion: The methodology used in this study showed that all the disinfectants substances utilized were effective in decontaminating of the metallic post.

Accuracy evaluation of three electronic apex locators in teeth with immature apices

Introduction and Objective: The aim of this randomized controlled study was to evaluate the accuracy of Root ZX, iPex and YS-RZ-A apex locators in tooth with incomplete apices. Material and methods: Thirty human mandibular pre-molars without dental caries, fracture and with 1-3mm apical diameter and ¾ of root development stage were used. After coronal access, tooth length was determined with the visualization of a K-file, compatible with the root canal diameter, at the apex. To determine the root canal length using electronic methods, the teeth were included in alginate. The 30 teeth were measured with the three apex locators until achieving the apex foramen. During the measurement, the canals were inundated with 1% sodium hypochlorite. Statistical analysis was performed using Qui-square test (p < 0.05). Results: The Root ZX apex locator showed the higher accuracy (53.3%), with statistical difference in relation to iPex apex locator (33.3%) and YS-RZ-A apex locator (26.7%) (p < 0.05). Regarding the security limit of ±1 mm, the Root ZX apex locator did not show statistical difference in comparison with iPex apex locator (p > 0.05), but both were statistically different in relation to YS-RZ-A apex locator (p < 0.05). Conclusion: The results showed that all the studied apex locators were efficient in determining the root canal length in tooth with incomplete apex, considering the tolerance of ±1 mm. The Root ZX apex locator showed the highest accuracy with 100% of agreement.

Hypochlorite-induced severe cellulitis during endodontic treatment: case report

Introduction: Sodium hypochlorite is a solution used in endodontic treatment, and if an accidental apical extrusion occurs, serious complications may affect soft tissue. Objective: The aim of this article is to present a case of apical extrusion of sodium hypochlorite (NaOCl) during root canal system instrumentation. Case report: A 28-year-old woman sought a local dental service for root canal treatment of tooth #24. Conventional endodontic treatment was adopted, which consisted of the use of 2.5% NaOCl solution as irrigation solution applied with a 10-ml syringe and 22G hypodermic needle. At that time, the patient reported extreme pain and a burning sensation in the left maxillary region, followed by the formation of intense edema. A clinical diagnosis of hypochlorite-induced cellulitis was made. The patient was treated immediately with amoxicillin (500 mg, orally) at intervals of 8 h for 7 days and dexamethasone (4 mg, intramuscularly) at intervals of 24 h for 3 days. In the subsequent endodontic treatment, 2% chlorhexidine gel applied with a 5-ml syringe and 24G needle was used as irrigation for a better control of treatment and to prevent new accidents. The root canals were instrumented using adequate crown-down technique, which provides a conical shape, and filled by lateral condensation technique. The patient was symptom free at the 8-month clinical follow-up. Conclusion: Dentists should always carefully follow all stages of dental treatment planning without neglecting any of them, paying attention to the solutions used and their storage as well as performing a specific technique with maximum accuracy. If an accident occurs, the appropriate handling of the situation will enable the satisfactory completion of treatment.

Assessment of control and epidemiologic details of the schistosomiasis mansoni in Bananal, São Paulo, Brazil / Avaliação do controle e detalhes epidemiológicos da esquistossomose mansoni em Bananal, São Paulo, Brasil

The purpose of our study in the municipality of Bananal, state of São Paulo, Brazil, was to stop the transmission of schistosomiasis mansoni. Particular emphasis was given to such items as the active surveillance and eventual treatment of hosts, mapping parasite foci, and increasing the extent of basic sanitation in the municipality. Now, our records indicate that the eradication of schistosomiasis in the municipality of Bananal is attainable. However, as the vector Biomphalaria tenagophila can still be found in some water bodies within this municipality, it remains included in the area where schistosomiasis is endemic, which calls for very strict measures to avoid the human cases of schistososomiasis. The expansion of the coverage of the basic sanitation network and treatment of Schistosoma mansoni cases diagnosed during periodic surveys are part of the plans to eradicate schistosomiasis in Bananal.

O propósito do nosso trabalho no município de Bananal, estado de São Paulo, Brasil, foi o de interromper a transmissão da esquistossomose mansônica. Foi dada particular atenção a itens como: busca ativa e tratamento dos infectados, mapeamento dos focos de parasitas e aumento da abrangência do saneamento básico do município. Atualmente, nossos dados indicam que a provável erradicação da esquistossomose em Bananal é possível. Entretanto, como o vetor Biomphalaria tenagophila ainda pode ser encontrado em algumas coleções de água deste município, esta permanece incluída em área onde a esquistossomose é endêmica. Isto implica a adoção de medidas muito restritas para evitar novas ocorrências de casos humanos da doença. Fazem parte do plano de erradicação da esquistossomose a expansão da cobertura da rede de saneamento básico e o tratamento dos casos diagnosticados durante as investigações periódicas. .

Prevalência de lesão endodôntica em pacientes diabéticos / Prevalence of apical periodontitis in diabetic patients / Prevalencia de lesión endodóntica de pacientes diabéticos

Investigar a prevalência de lesões endodônticas em pacientes diabéticos e não diabéticos. Métodos: Em estudo transversal, exames radiográficos (panorâmica e seriografia) de 80 pacientes, sendo 40 diabéticos tipo II e 40 não diabéticos, receberam avaliação, por meio de um índice de escores periapicais, das regiões perioendodônticas de todos os elementos dentais presentes. Os dados foram analisados pelo programa BioEstat 5.3®. Resultados: Encontrou-se pelo menos 1 dente apresentando lesão apical em 90% (n=32) dos pacientes diabéticos e 52% (n=21) dos pacientes não diabéticos (p=0,0001). Quanto aos dentes tratados endodonticamente, nos pacientes diabéticos, foram encontrados 44% (n=51) com lesões endodônticas, e apenas 17% (n=17) (p=0,0004) no grupo controle. Os pacientes diabéticos apresentaram maior quantidade de lesões endodônticas em relação aos pacientes não diabéticos (p=0,0189). Conclusão: De acordo com esses resultados, podese concluir que a Diabetes Mellitus tipo II está associada ao aumento da prevalência de lesões endodônticas...

To investigate the prevalence of apical periodontitis (AP) in diabetic and nondiabetic patients. Methods: Cross-sectional study, in which the radiographic records (panoramic and full-mouth periapical radiographs) of 80 patients, being 40 type II diabetic patients and 40 nondiabetic subjects, had the periapical and endodontic regions of all teeth present evaluated by means of the periapical index score. Data was analyzed through BioEstat 5.3TM software. Results: At least one tooth was found with apical periodontitis in 90% (n=32) of the diabetic patients and in 52% (n=21) of nondiabetic subjects (p=0.0001). Regarding root-filled teeth, 44% (n=51) presented AP amongst the diabetic patients, whereas only 17% (n=17) (p=0.0004) were affected in the control group. Conclusion: According to these results, type 2 Diabetes Mellitus is associated with an increase in the prevalence of apical periodontitis...

Investigar la prevalencia de lesiones endodónticas de pacientes diabéticos e no diabéticos. Métodos: Estudio transversal con pruebas radiológicas (panorâmica y seriografía) de 80 pacientes, siendo 40 diabéticos tipo II y 40 no diabéticos que recibieron evaluación a través del índice de puntuaciones periapicales de las regiones perioendodónticas de todos los elementos dentales presentes. Los datos fueron analizados con el programa BioEstat 5.3. Resultados: Se encontró por lo menos un diente con lesión apical en el 90% (n=32) de los pacientes diabéticos y el 52% (n=21) de los no diabéticos (p=0,0001). Respecto a los dientes tratados endodónticamente, el 44% (n=51) de los pacientes diabéticos presentó lesiones endodónticas y solamente el 17% (n=17) (p=0,0004) en el grupo control. Los pacientes diabéticos presentaron más lesiones endodónticas que los no diabéticos (p=0,0189). Conclusión: A partir de los resultados se concluye que la Diabetes Mellitus tipo II está asociada con el aumento de la prevalencia de lesiones endodónticas...

Efficacy of gutta-percha solvents used in endodontic retreatments

Introduction and Objective: The aim of this study was to evaluate the effectiveness of four different solvents and classify them according to their potential of action. Material and methods: Four solvents were tested: xylene, eucalyptol, orange oil and chloroform. Twelve gutta-percha points (medium-large), sectioned at 10 mm were used and divided into four groups, resulting in three samples for each solvent. The gutta-percha points were weighed on an analytical balance before being subjected to the action of solvents and subsequently put onto watch glasses that were immersed into the solutions for the following times: 1, 2, 3, 4 and 5 minutes. The percentage of mass loss was registered through weighing after every minute of action of the solvent on the points. Results: All solvents showed the first minute of action as the period of greatest power of dissolution because they act only on the gutta-percha itself and not on the other components of the point, suggesting that at the remaining minutes there would be a lower percentage of dissolution because there was a smaller amount of gutta-percha within the points. Conclusion: Chloroform and xylene showed similar results regarding the rate of dissolution of gutta-percha, yet they were statistically significant higher than eucalyptol and orange oil from 1 to 5 minutes.

Filling lateral canals: Influence of calcium hydroxide paste as a root canal dressing.

Context: The use of intracanal medication aims to provide antimicrobial activity in the root canal system, leading to a more satisfactory condition for root canal obturation. However, it is important to evaluate whether such medication would affect the sealing-off from the main root canal of ramifications such as lateral canals. Aim: Evaluate the influence of calcium hydroxide [Ca(OH) 2 ] paste on the filling of lateral canals. Settings and Design: Ex vivo quantitative laboratory study. Materials and Methods: Sixty single-rooted teeth with lateral canals created were used, 10 teeth per group. Group A was described respectively as lateral condensation technique (subgroup 1), thermomechanical compaction (subgroup 2), and continuous wave of condensation (subgroup 3). In Group B, subgroups 4, 5, and 6 were filled with Ca(OH) 2 for 7 days before filling using the techniques applied in subgroups 1, 2, and 3. Radiographic evaluation was performed to count the number of filled lateral canals in each group. The teeth were cross-sectioned over the lateral canals; thus, 180 specimens were obtained. Each specimen was immersed in a polyester resin. Digital images were obtained and specific software (Image Tool; ) was used to evaluate the number of obturated lateral canals and the filling length in each lateral canal of groups. Statistical Analysis Used: Data were statistically analyzed using SPSS 12.0 for Windows (Descriptive statistical analysis and Newman-Keuls test). Results: A greater number of simulated lateral canals were filled in Group A (91.1%). Group B had less filled lateral canals (33.3%). The sealing of lateral canals was statistically different between Group B (26.15%) and Group A (74.43%). Conclusions: According to the radiographic analysis and the linear filling measurement, the use of Ca(OH) 2 decreased the number and the length of sealed lateral canals.

Espondilodiscite: um diagnóstico diferencial raro de dor abdominal / Spondylodiscitis: a rare differential diagnosis of abdominal pain

Espondilodiscite é um processo inflamatório, geralmente infeccioso, que acomete os discos intervertebrais e as vértebras associadas. O diagnóstico pode ser bastante difícil, devido à raridade da doença, à sintomatologia insidiosa e à alta prevalência de dor lombar na populaçãogeral. Este relato descreve o caso de paciente admitido em serviço de Gastroenterologia com dor abdominal e lombar, acompanhada de emagrecimento progressivo. A propedêutica realizada foi fundamental para o diagnóstico e a exclusão de outras causas. O tratamento conservador foi suficiente para a completa recuperação do paciente.

Spondylodiscitis is an inflammatory process, often of infectious origin, that attacks the intervertebral disks and related vertebra. Diagnosis may be very difficult because it is a rare disease of insidious symptoms and also because of the high incidence of backache in the general. This report describes the case of a patient admitted to the Gastroenterology service with a complaint of abdominal and lumbar pain followed by progressive weight loss. Propaedeutics used had fundamental importance in the diagnosis and elimination of other causes. Conservative treatment was enough to achieve patient recovery.

Endodontic treatment for necrotic immature permanent teeth using MTA and calcium hydroxide: A retrospective study

Introduction: Endodontic treatment of young permanent teeth with incomplete root formation and necrotic pulp has been a challenge for the dentist. It is necessary to induce the formation of apical barrier (apical plug), enabling the complete root canal filling. Objective: This retrospective clinical study compared the protocols for treatment of teeth with incomplete root formation, using calcium hydroxide (CH) or mineral trioxide aggregate (MTA). Material and methods: 28 patients with incomplete root formation have undergone root canal treatments in the period from 2000 to 2009 were selected. The procedures for cleaning, shaping and intracanal medication (CH paste) were performed in a standardized manner. In 13 patients, after using the CH paste (14 days), apical plugs with MTA were made. In the remaining 15 teeth monthly exchanges with CH paste were executed until it was observed radiographically the formation of the apical barrier. In all cases the canals were filled conventionally with gutta-percha and sealer. Initially, follow-ups were made on a quarterly and semiannually at the end of first year. Results: All apical lesions showed apical healing between 4 and 13 months after starting treatment. There was not noted the continuing process of root formation. Conclusion: It was concluded that the treatment of teeth with incomplete root formation and necrotic pulp with the use of MTA as apical plug has the same clinical results compared with the use of CH, with the advantage of less clinical time.

In vitro analysis of the pH alteration of the dentine after using different calcium hydroxide-based pastes

Introduction: To analyze the pH increase at the external root surface after the use of different calcium hydroxide pastes (Calen, calcium hydroxide associated with 2% chlorhexidine gel, calcium hydroxide associated with saline) with and without EDTA as chelating agent before the topical application of the intracanal medication. Material and methods: One-hundred single-rooted extracted teeth were cleaned and shaped. They were randomly divided into six experimental groups (n = 15) and one control group (n = 10), according to the medication to be used. The teeth were kept immersed in saline solution and the pH measurements were weekly verified with the aid of a pH meter. Results: It was verified the pH increasing at the first week in almost all groups. Only the groups in which Ca(OH)2 was associated with 2% chlorhexidine gel exhibited a significant evolution in the pH increasing over time (p = 0.0116). The use of EDTA did not result in higher pH values (p = 0.2278). Conclusion: i) the pH increased in all associations used; ii) 2% chlorhexidine gel allowed the gradual pH increasing over time; iii) the smear layer removal did not influence on the pH increasing.

Evaluation of apically extruded debris during endodontic retreatment

Introduction: A growing interest to preserve teeth into the mouth by patients resulted in the increasing number of endodontic retreatments, and when these happen, many different types of irritants are extruded through the foramen. Objective: This study analyzed in vitro the amount of debris extruded through the foramen using four instrumentation techniques during endodontic retreatment. Material and methods: Forty mesial-buccal roots of first molars were selected, instrumented with anatomical diameter up to size #30 ISO file and then obturated with gutta-percha and grossman sealer by lateral condensation. After, they were separated and randomly allocated into four groups with 10 teeth each for the endodontic retreatment procedure: G1 - conventional technique + solvent, G2 - conventional technique without solvent, G3 - ProTaper retreatment + solvent, G4 - ProTaper retreatment without solvent. In all groups, gutta-percha in the coronal portion was removed by using size 1-3 Gates Glidden drills. All teeth were irrigated with distilled water. The debris extruded through the foramen were collected and weighed by an analytical balance. Results: Group 4 had the lowest average for material extrusion through the foramen followed by groups 2, 3 and 1. When Tukey test for statistical analysis was applied, no significant difference among groups were found (p = 0.5664). Conclusion: We conclude that all instrumentation techniques used in this study produced debris which goes beyond the foramen.