RESUMO
Abstract This article reported two clinical cases in which the guided endodontics was used to perform the access to the root canals. The first case presents a 40-year-old female with a history of pain related to the left maxillary canine. After radiographic examination, the presence of severe calcification up to the apical third of the root canal, associated with a periapical radiolucency, was noted. In the second case, an 85-year-old male was referred to our service with pain upon palpation, at the right mandibular first molar. The radiographic images revealed the presence of endodontic treatment and a fiberglass post in the distal root canal, which was associated with extrusion of the filling material and a periapical lesion. The 3D-guides were planned based on cone beam computed tomography and intraoral digital scanning, which were aligned using a specific software. Therefore, implant drills could be guided up to the root canal length required for each case. In the first case, a surgical root canal was created and the patient was free of signs and symptoms after the treatment was completed. In the second case, it was observed that the fiber post was worn by the drill, allowing free access to the filling material. It was possible to perform the endodontic reintervention in a more predictable way and in less time. In both cases, the use of the guided endodontics allowed the preservation of a large part of the dental structure. The procedures were performed faster, without the occurrence of fractures and perforations.
Resumo Este artigo relatou dois casos clínicos em que a endodontia guiada foi utilizada para realizar o acesso aos canais radiculares. O primeiro caso apresenta uma mulher de 40 anos com história de dor relacionada ao canino superior esquerdo. Após exame radiográfico, notou-se a presença de calcificação acentuada até o terço apical do canal radicular, associada a radioluscência periapical. No segundo caso, um homem de 85 anos foi encaminhado ao nosso serviço com dor à palpação no primeiro molar inferior direito. As imagens radiográficas revelaram a presença de tratamento endodôntico e pino de fibra de vidro no canal radicular distal, que estava associado à extrusão do material obturador e lesão periapical. Os guias-3D foram planejados com base em tomografia computadorizada de feixe cônico e escaneamento intraoral digital, os quais foram alinhados por meio de um software específico. Desta forma, brocas de implante puderam ser guiadas até o comprimento necessário do canal radicular para cada caso. No primeiro caso, foi confeccionado um canal radicular cirúrgico e o paciente ficou sem sinais e sintomas após o término do tratamento. No segundo caso, observou-se que o pino de fibra foi desgastado pela broca, permitindo o livre acesso ao material obturador. Foi possível realizar a reintervenção endodôntica de forma mais previsível e em menos tempo. Em ambos os casos, o uso da endodôntica guiada permitiu a preservação de grande parte da estrutura dentária. Os procedimentos foram realizados com maior agilidade, sem a ocorrência de fraturas e perfurações.
RESUMO
Objetivo: o objetivo do presente estudo foi comparar a resistência à fratura de quatro tipos de pinos intrarradiculares pré-fabricados: fibra de vidro, fibra de vidro customizado com resina composta, fibra de carbono e fibra de carbono customizado com resina, em dentes bovinos. Métodos: foram utilizados 60 dentes bovinos unirradiculares, que receberam tratamento endodôntico e foram divididos nos seguintes grupos: FV = pino de fibra de vidro; FVP = pino de fibra de vidro customizado; FC = pino de fibra de carbono; FCP = pino de fibra de carbono customizado; e Controle = restauração coronária com resina composta. Os dentes foram inseridos em blocos de resina acrílica, a 2 mm da junção amelocementária, simulando a interface dente-osso. Os espécimes foram submetidos ao teste de resistência à fratura em máquina de ensaio universal, sob uma carga de 0,5mm/min, até a fratura do corpo de prova. Os valores obtidos foram submetidos ao teste ANOVA, com pós-teste de Tukey. Foi realizada, também, uma análise dos padrões de fratura, por meio do teste Kruskal- -Wallis. Resultados: o grupo FCP mostrou os maiores valores de resistência à fratura, seguido pelos grupos FV, FVP e FC. O grupo controle mostrou menor resistência do que os demais, que receberam pinos intrarradiculares. Os pinos de FVP apresentaram o maior número de fraturas reparáveis, em contraste ao controle, no qual houve o maior número de fraturas desfavoráveis. Conclusão: o uso de pinos customizados reduziu a incidência de fraturas catastróficas. A ausência de pino intrarradicular ocasionou a maior incidência de fraturas irreparáveis. (AU)
Objective: The aim of this study was to compare the fracture resistance of four types of prefabricated intraradicular posts - glass fiber, glass fiber customized by composite resin, carbon fiber, and customized carbon fiber - on bovine teeth. Methods: Sixty bovine teeth were submitted to endodontic treatment and divided into the following groups: GF - glass fiber post; CGF - customized glass fiber post; CF - carbon fiber post; CCF - customized carbon fiber post; control - composite resin restoration. The teeth were embedded in acrylic resin blocks at 2 mm from the cement-enamel junction, simulating the teeth-bone interface. The specimens were submitted to a fracture resistance test in a universal test machine under a 0.5 mm/min load until the fracture of the specimen. The values obtained were submitted to ANOVA and Tukey tests. The analysis of the fracture patterns was performed by the Kruskal-Wallis test. Results: The CCF group presented the highest values of fracture resistance, followed by GF, CGF, and CF posts. The control group offered less resistance than the other groups that received intraradicular posts. The CGF presented the highest number of favorable fractures, in contrast to the control group, which presented the highest number of unfavorable fractures. Conclusion: The use of customized posts reduced the incidence of catastrophic fractures. The lack of intracanal posts led to a higher incidence of irreparable fractures (AU).
Assuntos
Fraturas dos Dentes , Pinos Dentários , Endodontia , Técnica para Retentor Intrarradicular , Restauração Dentária PermanenteRESUMO
Abstract This study analyzed the influence of different retreatment protocols on amount of remaining filling material and amount of new sealer after endodontic retreatment. Forty mandibular molars with curved mesial roots were prepared with ProTaper Universal system, and filled with AH Plus sealer mixed with 0.1% rhodamine B and gutta-percha. After 7 days, the specimens were randomized according to the retreatment protocol (n = 10): ProTaper Retreatment System (PTR); PTR+Orange Oil (PTR+OO); PTR+Passive Ultrasonic Irrigation (PTR+PUI). No retreatment was performed in the control group (CG). After retreatment, the root canals were filled with AH Plus mixed with 0.1% fluorescein and gutta-percha. Samples were evaluated under confocal laser scanning microscopy and analyzed using Image J software. Data were analyzed using Kruskal-Wallis and Dunn tests (p < 0.05). Regarding presence of residual filling, the Kruskal-Wallis test indicated no differences among the different retreatment techniques in the perimeter and the isthmus analyses (p > 0.05); however, PTR+PUI was associated with a lesser amount of residual filling material in the canal area analysis (p < 0.05). In evaluating the new filling, the perimeter analysis showed a lesser amount of new endodontic sealer in the PTR group (p < 0.05). Moreover, the PTR+PUI group presented a significantly greater amount of new endodontic sealer in the canal area analysis (p < 0.05). There was no difference among groups in the isthmus analysis (p > 0.05). It can be concluded that PTR associated to PUI yielded better results in removing root canal filling material from the canal area. However, none of the protocols resulted in root walls completely free of remnants.