Pulpectomía mecanizada en molares primarios: caso clínico / Mechanized pulpectomy in primary molars: a clinical case

Las pulpectomías en molares primarios están indica-das en casos de diagnóstico de pulpitis irreversible o necrosis y reabsorción radicular mínima o nula. Son tratamientos laboriosos y extensos, que sólo pueden ser llevados a cabo en pacientes colaboradores. En búsqueda de simplificar esta terapéutica y mejorar su eficacia, se propone la mecanización de la pre-paración de los conductos de molares primarios. Diversos autores aseguran que esta técnica opti-miza el tiempo clínico y mejora la calidad del trata-miento, obteniendo gran aceptación en la literatura actual. Se presenta la secuencia de procedimientos, resolución y controles de dos tratamientos de pul-pectomía con instrumentación mecanizada en mola-res primarios (AU)

Pulpectomies in primary molars are indicated in cases of irreversible pulpitis or necrosis with mini-mal or no root resorption. They are laborious and ex-tensive treatments, which only can be carried out in cooperative patients. In order to simplify this therapy and improve its effectiveness, the mechanization of root canal preparation is proposed. Several authors assume that this technique optimizes preparation time and improves the quality of treatment, obtaining great acceptance in the current literature. We report the sequence of procedures, resolution, and controls of two pulpectomies with mechanized instrumenta-tion in primary molars (AU)

Effect of Photobiomodulation on Pain Following Single Visit Non-surgical Root Canal Treatment of Molar Teeth with Symptomatic Irreversible Pulpitis

ABSTRACT Objective: To assess the effect of Photobiomodulation (PBM) on post-endodontic pain of mandibular molar teeth with symptomatic irreversible pulpitis. Material and Methods: In this clinical trial, mandibular molars with symptomatic irreversible pulpitis underwent primary endodontic treatment in 90 systemically healthy patients. After root canal treatment, the patients were randomly divided into two groups of PBM with diode laser at 940 nm wavelength and 200 mW output power and placebo (mock PBM therapy). Level of pain was recorded at 6, 12, 24, 48, and 72 hours postoperatively using a visual analog scale (VAS). The data were analyzed using the Mann-Whitney test and the Kruskal-Wallis test. Results: The results showed that post-endodontic pain at all time points was significantly lower in the PBM group compared with the placebo group. The pain score in the PBM group was significantly lower than the placebo group (p<0.05). However, this difference was not significant at 48 h (p=0.18) and 72 h (p=0.12) postoperatively. Also, the results showed that the mean pain score in males and females in the PBM group was significantly lower than in males and females in the placebo group. Conclusion: Photobiomodulation can effectively decrease post-endodontic pain in mandibular molar teeth with symptomatic irreversible pulpitis.

Prediction of pulp exposure risk of carious pulpitis based on deep learning / 华西口腔医学杂志

OBJECTIVES@#This study aims to predict the risk of deep caries exposure in radiographic images based on the convolutional neural network model, compare the prediction results of the network model with those of senior dentists, evaluate the performance of the model for teaching and training stomatological students and young dentists, and assist dentists to clarify treatment plans and conduct good doctor-patient communication before surgery.@*METHODS@#A total of 206 cases of pulpitis caused by deep caries were selected from the Department of Stomatological Hospital of Tianjin Medical University from 2019 to 2022. According to the inclusion and exclusion criteria, 104 cases of pulpitis were exposed during the decaying preparation period and 102 cases of pulpitis were not exposed. The 206 radiographic images collected were randomly divided into three groups according to the proportion: 126 radiographic images in the training set, 40 radiographic images in the validation set, and 40 radiographic images in the test set. Three convolutional neural networks, visual geometry group network (VGG), residual network (ResNet), and dense convolutional network (DenseNet) were selected to analyze the rules of the radiographic images in the training set. The radiographic images of the validation set were used to adjust the super parameters of the network. Finally, 40 radiographic images of the test set were used to evaluate the performance of the three network models. A senior dentist specializing in dental pulp was selected to predict whether the deep caries of 40 radiographic images in the test set were exposed. The gold standard is whether the pulp is exposed after decaying the prepared hole during the clinical operation. The prediction effect of the three network models (VGG, ResNet, and DenseNet) and the senior dentist on the pulp exposure of 40 radiographic images in the test set were compared using receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and F1 score to select the best network model.@*RESULTS@#The best network model was DenseNet model, with AUC of 0.97. The AUC values of the ResNet model, VGG model, and the senior dentist were 0.89, 0.78, and 0.87, respectively. Accuracy was not statistically different between the senior dentist (0.850) and the DenseNet model (0.850)(P>0.05). Kappa consistency test showed moderate reliability (Kappa=0.6>0.4, P<0.05).@*CONCLUSIONS@#Among the three convolutional neural network models, the DenseNet model has the best predictive effect on whether deep caries are exposed in imaging. The predictive effect of this model is equivalent to the level of senior dentists specializing in dental pulp.

Avaliação da ingestão de breu-branco no processo de reparo de incisivos de ratos reimplantados / Evaluation of breu-branco ingestion in the repair process of reimplanted rat incisors

Objetivo: Avaliação histológica da influência da administração sistêmica de solução de Breu-branco, sob o reparo periodontal e pulpar de incisivos de ratos submetidos a reimplante dentário. Material e método: O composto testado foi obtido a partir do fracionamento da resina de P. heptaphyllum (Breu-branco) em coluna cromatográfica e diluído em solução de tween 80. A avulsão foi induzida no incisivo central superior direito de 33 ratos Wistar machos, divididos em três grupos: RI (Reimplante imediato), em que os dentes foram mantidos em meio seco e reimplantados com 5 minutos, RTLI (Reimplante tardio conservado em leite integral), dentes mantidos 60 minutos em leite integral, reimplantados e após os animais foram tratados por 5 dias com soro fisiológico por gavagem, e RTLI+BB (Reimplante tardio conservado em leite integral com administração de solução de breu-branco), os dentes permaneceram 60 minutos em leite integral, reimplantados e os animais foram tratados por 5 dias com breu-branco sistemicamente por gavagem. Após 60 dias foi realizada eutanásia por sobredosagem anestésica e coletada a hemi-maxila direita contendo o incisivo reimplantado. Os cortes histológicos transversais foram corados com hematoxilina-eosina para avaliação histológica em microscopia de luz. Na análise histomorfométrica foram analisadas as características do ligamento periodontal, osso alveolar, cemento, dentina e polpa. Os testes Kruskal-Wallis e post-hoc de Dunn foram utilizados para a comparação entre os grupos. Resultados: Os três grupos no geral apresentaram resultados semelhantes na maioria das variáveis analisadas, somente o grupo RTLI apresentou diferença estatística significativa menor na organização do ligamento periodontal e inflamação aguda em comparação com o grupo controle. Conclusão: A solução de breu-branco apresentou potencial para utilização como medicação sistêmica em casos de reimplante dentário tardio, por mostrar comportamento semelhante ao reimplante imediato no processo de reparo do ligamento periodontal e pulpar(AU)

Objective: Histological evaluation of the influence of systemic administration of Breubranco solution on periodontal and pulpal repair of incisors of rats submitted to dental reimplantation. Material and method: The compound tested was obtained from the fractionation of P. heptaphyllum resin (Breu-branco) in a chromatographic column and diluted in a tween 80 solution. The avulsion was induced in the upper right central incisor of 33 male Wistar rats, divided into three groups: IR (Immediate replantation), in which the teeth were kept in a dry medium and reimplanted after 5 minutes, RTLI (Delayed replantation preserved in whole milk), teeth kept 60 minutes in whole milk, reimplanted and after that the animals were treated for 5 days with saline solution by gavage, and RTLI+BB (Delayed replantation preserved in whole milk with administration of breu-branco solution), the teeth remained 60 minutes in whole milk, reimplanted and the animals were treated for 5 days with breu-branco systemically by gavage. After 60 days, euthanasia was performed by anesthetic overdose and the right hemi-maxilla containing the reimplanted incisor was collected. Cross-sectional histological sections were stained with hematoxylin-eosin for histological evaluation in light microscopy. In the histomorphometric analysis, the characteristics of the periodontal ligament, alveolar bone, cementum, dentin and pulp were analyzed. Kruskal-Wallis and Dunn's post-hoc tests were used for comparison between groups. Results: The three groups in general showed similar results in most of the variables analyzed, only the RTLI group showed a statistically significant lower difference in the organization of the periodontal ligament and acute inflammation compared to the control group. Conclusion: The breu-branco solution showed potential for use as a systemic medication in cases of late dental replantation, as it behaves similarly to immediate replantation in the repair process of the periodontal ligament and pulp(AU)

Cannabis. Usos y aplicaciones en la práctica odontológica diaria: revisión de la literatura / Cannabis. Uses and applications in daily dental practice: a review of the literature

La evidencia científica presente en la literatura indica que el cannabis puede ser utilizado con fines terapéuticos para tratar distintas afecciones odontológicas. Dado el acceso sencillo a la cavidad bucal, las distintas formulaciones de cannabis pueden aplicarse de forma tópica. La aplicación local de dosis bajas de cannabis ha demostrado alta efectividad para tratar distintas afecciones bucales, constituyendo un tratamiento seguro con baja probabilidad de generar repercusiones sistémicas indeseadas. En la actualidad, está siendo incorporado a materiales convencionales de uso e higiene odontológica con la finalidad de aprovechar sus efectos terapéuticos. El cannabis tiene múltiples usos en odontología: como componen-te de enjuagues bucales y soluciones para la desinfección de conductos radiculares, en tratamientos de trastornos de ansiedad bucal, como complemento en terapias oncológicas, como analgésico para atenuar el dolor inflamatorio y el neuropático, como miorrelajante y condroprotector para tratar trastornos de articulación témporomandibular (ATM) y bruxismo, como osteomodulador para el tratamiento de patologías que comprometen la integridad ósea, como la enfermedad periodontal y la osteoporosis, y para la cicatrización ósea asociada a fracturas, extracciones dentarias e implantes, y como inmunomodulador con potencial terapéutico para tratar patologías autoinmunes como las enfermedades reumáticas. El trata-miento local con cannabis es efectivo, bien tolerado por el paciente y con pocos efectos adversos. Por lo tanto, se puede concluir que el cannabis aporta un enorme abanico de posibilidades terapéuticas para tratar distintas afecciones odontológicas, aunque aún se requiere mayor cantidad de estudios científicos que avalen su utilización en cada situación fisiopatológica particular (AU)

The scientific evidence present in the literature indicates that cannabis can be used for therapeutic purposes to treat different dental conditions. Given the easy access to the oral cavity, the different cannabis formulations can be applied topically. The local application of low doses of cannabis has shown high effectiveness in treating different oral conditions, constituting a safe treatment with a low probability of generating unwanted systemic repercussions. It is currently being incorporated into conventional materials for dental use and hygiene in order to take advantage of its therapeutic effects. Cannabis has multiple uses in dentistry: as a component of mouthwashes and solutions for disinfecting root canals, in the treatment of oral anxiety disorders, as a complement in oncological therapies, as an analgesic to reduce inflammatory and neuropathic pain, as a muscle relaxant and chondroprotective to treat temporomandibular joint disorders and bruxism, as an osteomodulator for the treatment of pathologies that compromise bone integrity, such as periodontal disease and osteoporosis, and or bone healing associated with fractures, dental extractions and implants, and as immunomodulator with therapeutic potential to treat autoimmune pathologies such as rheumatic diseases. Local treatment with cannabis is effective, well tolerated by the patient and with few adverse effects. Local treatment with cannabis is effective, well tolerated by the patient and with few adverse effects. Therefore, it can be concluded that cannabis provides an enormous range of therapeutic possibilities to treat different dental conditions, although more scientific studies are still required to support its use in each particular pathophysiological situation (AU)

Study of vital inflamed pulp therapy in immature permanent teeth with irreversible pulpitis and apical periodontitis / 中华口腔医学杂志

To assess the treatment effectiveness of vital inflamed pulp therapy (VIPT) in immature permanent teeth with irreversible pulpitis and apical periodontitis. The faculty members in the Department of Pediatric Dentistry, the Ninth People's Hospital were invited to submit consecutive VIPT cases from June 2015 to June 2016 (follow-up periods>12 months). The cases were retrospectively reviewed, clinical symptoms and radiographic changes in periapical radiolucency were evaluated, meanwhile, the data of radiographic changes such as apical diameter and root length were calculated and analyzed with ANOVA. Totally thirteen submitted patients/cases were included (6 males and 7 females) in the present study,. The average age of patients was (9.9±1.4) years old. The average follow-up time was (26.5±6.8) months (17-37 months). At the 12-month visit, all 13 treated teeth survived, 9 out of 11 teeth with apical periodontitis showed normal radiographic manifestation. At the 3, 6 and 12 months visits, the within-case percentage changes in apical diameter were (8.0±5.1)%, (24.1±9.1)% and (70.3±10.7)%, respectively, while the within-case percentage changes in root length were (11.4±9.8)%, (14.5±9.8)% and (27.4±14.2)%, respectively. There were statistically significant differences in the changes of apical diameter (F=18.80, P<0.001) and root length (F=4.64, P=0.047) from the preoperative time to the postoperative follow-ups. VIPT might improve clinical outcomes, even achieve continued root development. VIPT can be an option in treating immature teeth with irreversible pulpitis and apical periodontitis.

New advances in vital pulp therapy and pulp regeneration for the treatment of pulpitis: from basic to clinical application / 中华口腔医学杂志

In recent years, great progress has been made in research on the treatment of pulpitis, mainly due to the rapid development of basic and clinical researches in this field, and some achievement from basic research has been applied in clinical practice. Advances in the diagnostic methods for pulpitis can help the clinicians to recognize the true state of pulpitis more accurately and to adopt the corresponding treatment methods including indirect/direct pulp capping, pulpotomy, pulp regeneration and root canal therapy. The new theory of pulpitis diagnosis and the studies on immune defense, repair function of dental pulp and new pulp capping materials have significantly improved the success rate of vital pulp therapy. For diffuse coronary pulpitis or radicular pulpitis, which is difficult to achieve vital pulp therapy successfully, methods of pulp revascularization, cell homing and pulp stem cells-mediated pulp regeneration can also be used as treatment options in addition to root canal therapy. The present article focuses on the research progress on pulpitis treatments and related clinical transformation practices, in order to provide reference on vital pulp therapy and pulp regeneration for clinicians.

Dentes gretados: o que clínicos e especialistas precisam saber / Cracked teeth: What clinicians and specialists need to know

A proposta da presente revisão de literatura foi estabelecer as evidências existentes sobre etiologia, sinais e sintomas, métodos de diagnóstico e tratamento de dentes gretados. Segundo a American Association of Endodontists (AAE), o termo dente gretado (DG) foi definido como uma fratura em um plano que quebra a continuidade do esmalte e da dentina, sem separação das partes, geralmente no sentido mesiodistal, passando pela superfície oclusal, podendo envolver uma ou ambas as cristas marginais. Essa fratura, por apresentar profundidade e direção desconhecidas, pode se estender até a polpa e/ou ligamento periodontal, levando a um quadro de pulpite reversível, pulpite irreversível, necrose pulpar ou, até mesmo, evoluir para uma fratura completa. Atualmente, os DGs estão relacionados à terceira maior causa de dentes perdidos, após cárie e doença periodontal. Estudos indicam uma falta de consenso entre profissionais sobre como tratar dentes gretados, uma questão clínica relevante, que precisa ser priorizada e esclarecida. Nesse contexto, essa revisão abordou a etiologia, sinais e sintomas, métodos de diagnósti- co e tratamento de dentes gretados (AU)

The purpose of this literature review is to examine the existing evidence regarding etiology, signs, symptoms, methods of diagnosis, and treatment of cracked teeth. According to the American Association of Endodontists (AAE), the term cracked tooth (CT) is defined as "a fracture in a plane that breaks the continuity of the enamel and dentin, without separation of the parts, usually in the mesiodistal direction, passing through the surface occlusal, which may involve one or both of the marginal ridges." Due to its unknown depth and direction, this fracture can extend to the pulp and periodontal ligament, leading to reversible pulpitis, irreversible pulpitis, pulp necrosis, or even progress to a complete fracture. Currently, cracked teeth are related to the third largest cause of missing teeth, after caries and periodontal disease. Studies indicate a lack of consensus among professionals about treating cracked teeth, a clinically relevant issue that needs to be prioritized and clarified. In this context, this review addressed the etiology, signs and symptoms, diagnostic methods, and treatment of cracked teeth (AU).

Association between Periodontitis and Myocardial Infarction: Systematic Review and Meta-Analysis

Abstract The association between periodontitis and myocardial infarction remains unclear in the literature. Few studies have addressed periodontitis exposure as a predisposing factor for the development of myocardial infarction. Therefore, the present systematic review aims to analyze the association between periodontitis and myocardial infarction. This meta-analysis systematically searched MEDLINE, EMBASE, The Cochrane Controlled Trials Register, SCIELO, LILACS, CINAHL, Scopus, Web of Science and grey literature for studies estimating the association between periodontitis and myocardial infarction. Quality of evidence was assessed for all studies. The meta-analysis was conducted using random-effects models. Four of the six studies selected were included in the meta-analysis, including 1,035,703 subjects. The association between periodontitis and myocardial infarction was: RR: 5.99 (95% CI: 1.17-30.68), but with high heterogeneity (I2 = 100%; p <0.01). The results including only the highest quality articles, was lower: RR: 2.62 (95% CI: 1.47-4.70 3.83), but with lower heterogeneity (I2 = 85.5%; p < 0.01).The present systematic review with meta-analysis showed an association between periodontitis and acute myocardial infarction, but with a high level of heterogeneity.

Oximetría de pulso y su eficacia para diagnosticar vitalidad pulpar / Pulse oximetry and its use in diagnosing pulp vitality

Objetivo: Identificar y analizar en la literatura científica reciente el uso de la oximetría de pulso como método diagnóstico de vitalidad pulpar. Metodología: En este trabajo se llevó a cabo una revisión de la literatura en las plataformas de PubMed y Google Académico, en la cual se analizó el uso de la oximetría de pulso en el diagnóstico y monitoreo odontológico del estado pulpar. Resultados: Después de una exhaustiva revisión, y de acuerdo con los criterios de inclusión y exclusión, se analizaron 21 artículos. La mayoría de los trabajos consideran la oximetría de pulso un método alternativo de diagnóstico indoloro, seguro y eficaz; sin embargo, la adaptación de un instrumento de uso exclusivo odontológico es necesaria para una medición exacta de la saturación de oxígeno en la pulpa dental. Los avances tecnológicos en el campo clínico de la odontología nos han llevado a la búsqueda de nuevas técnicas diagnósticas clínicas para mejorar la atención y los tratamientos de los pacientes que acuden día con día a recibir una consulta odontológica. Conclusiones: En los últimos años la oximetría de pulso ha demostrado ser una herramienta de diagnóstico eficaz para el diagnóstico de la vitalidad pulpar. El análisis de los artículos incluidos en esta revisión concluye que la oximetría de pulso es una técnica innovadora que puede ser utilizada como una herramienta diagnóstica adyuvante en el diagnóstico de la vitalidad pulpar (AU)

Objective: To identify and analyze in the recent scientific literature the use of pulse oximetry as a diagnostic method for pulp vitality. Methodology: In this work, a literature review was carried out on the PubMed and Google Scholar platforms in which the use of pulse oximetry in the dental diagnosis and monitoring of pulp status was analyzed. Results: After an exhaustive review and in accordance with the inclusion and exclusion criteria, 21 articles were analyzed. Most of the studies consider pulse oximetry an alternative method of painless, safe and effective diagnosis, however, the adaptation of an instrument for exclusive dental use is necessary for an exact measurement of the oxygen saturation in the dental pulp. Technological advances in the clinical field of dentistry have led us to search for new clinical diagnostic techniques to improve the care and treatment of patients who come every day to receive a dental consultation. Conclusions: In recent years, pulse oximetry has proven to be an effective diagnostic tool for the diagnosis of pulp vitality. The analysis of the articles included in this review concludes that pulse oximetry is an innovative technique that can be used as an adjunct diagnostic tool in the diagnosis of pulp vitality (AU)

Accuracy of the dental pulp sensibility test using cold spray for the diagnosis of pulp diseases: an observational clinical study

The dental pulp sensibility test is one of the main auxiliary resources for the diagnosis of pulp pathologies, and its accuracy is still debatable. This cross-sectional observational study evaluated the accuracy of the pulp sensibility test (PST) using cold spray (1,1,1,2-tetrafluoroethane) for the diagnosis of pulp diseases and determined the effect of individual and clinical variables on the reliability of this test. The paper was designed following the STROBE statement. Sixty patients with indications for primary endodontic treatment were selected and examined from August 2017 to July 2018. Data collection was performed through interviews, clinical/radiographic examinations and the PST. The results of the cold test, along with data on sex, age, the tooth type regarding the root number, and the presence of restorations and caries, as well as the recent consumption of analgesics, were recorded. The presence of bleeding within the pulp chamber was used as the gold standard to compare with the clinical diagnosis and to identify the true-positive, false-positive, true-negative, and false-negative responses. The accuracy of PST achieved in subgroups of individual and clinical variables was compared using the chi-square test with a significance level of 5% (p < 0.05). The PST with the use of cold spray showed a sensitivity of 0.88, a specificity of 1.00, a positive predictive value of 1.00, a negative predictive value of 0.86, and an accuracy of 0.93. The accuracy of the cold spray was not affected by individual or clinical variables. The PST with the use of cold spray is an accurate and reliable method for determining the diagnosis of pulp diseases, especially in cases of pulp vitality or irreversible pulpitis.

MicroRNAs: emerging players in apical periodontitis

Abstract Apical periodontitis is an inflammatory disorder of periradicular tissues developed from endodontic infections. Understanding its pathophysiology and the underlying molecular mechanisms is key to the advancement of endodontics. MicroRNAs (miRNAs), a group of evolutionarily conserved small non-coding RNAs, may be phenotypically and functionally associated with the pathogenesis of apical periodontitis. Several studies have focused on the role of miRNAs in the pulp and periradicular biology, and they have demonstrated their essential functions, such as initiating odontogenic differentiation and promoting pro- or anti-inflammatory responses in pulpitis. Up to date, over 2,000 miRNAs have been discovered in humans; however, only few have been reported to associate with apical periodontitis. Therefore, identifying miRNAs involved in diseased apical tissues and conducting functional studies are important in expanding our current knowledge of pulp and periradicular biology and exploring novel therapeutic avenues. In this review, we revisit current models of apical periodontitis and miRNA biogenesis, analyze existing evidence of the involvement of miRNAs in diseased apical tissues, and discuss their diverse functions and potential values. Based on their sheer abundance, prolonged stability in biofluid, and relative ease of sampling, miRNAs may be a useful tool to be developed as diagnostic biomarkers for apical periodontitis. Furthermore, it can be used as therapeutic targets in conjunction with conventional endodontic therapies.

Tratamento endodôntico de segundo molar inferior com presença de canal mesiomediano: relato de caso / Endodontic treatment of second mandibular molar with presence of middle mesial canal: case report

Introdução: A identificação de possíveis variações anatômicas é decisiva para o correto diagnóstico e planejamento da terapia endodôntica. Objetivo: Relatar o tratamento endodôntico de um dente #37, no qual foi identificado um terceiro canal na raiz mesial (canal mesio-mediano, CMM). Caso clínico: Dente #37 com diagnóstico de pulpite irreversível sintomática, foi encaminhado para realizar tratamento endodôntico. Durante o acesso coronário, e com auxílio de microscópio operatório (MO), foram identificadas trincas coronárias. Foi solicitada uma tomografia computadorizada de feixe cônico (TCFC), a partir da qual foi descartada a presença de trinca radicular. A TCFC possibilitou, também, identificar a presença de um terceiro canal na raiz mesial, localizado entre os canais mesiovestibular e mesiolingual. O tratamento endodôntico foi executado pelo sistema reciprocante WaveOne GOLD. A solução irrigadora de escolha para o preparo químico-mecânico foi o hipoclorito de sódio a 5,25%. Imediatamente antes da obturação, os canais foram irrigados com EDTA a 17%, para auxiliar na remoção da smear layer e, em seguida, foi realizada nova irrigação com hipoclorito de sódio a 5,25%. Os canais foram secos com pontas de papel absorvente e obturados pela técnica de onda contínua de condensação. Resultados: Os canais radiculares do dente #37 foram devidamente instrumentados e obturados. A paciente não apresentou qualquer sintomatologia pós-operatória, sendo encaminhada para a reabilitação protética final. Conclusão: A TCFC e o microscópio operatório foram decisivos para o correto planejamento do caso, tanto em relação à trinca observa- da quanto à detecção do canal mesiomediano (AU).

Introduction: Identification of possible anatomical variations is crucial for the correct diagnosis and planning of endodontic therapy. Objective: To report the endodontic treatment of tooth #37, in which a third canal was located in the mesial root (middle mesial canal - MMC). Methods: Tooth #37 was diagnosed with symptomatic irreversible pulpitis and referred for endodontic treatment. Coronary cracks were found during coronal access using a dental operating microscope (DOM). A cone-beam computed tomography (CBCT) was requested. CBCT revealed cracks involving the pulp chamber floor and a third root canal in the mesial root, between the mesiobuccal and the mesiolingual canals. Endodontic treatment was performed with the WaveOne GOLD reciprocating system. The chemical-mechanical preparation was performed with 5.25% sodium hypochlorite and 17% EDTA to remove the smear layer, followed by another irrigation with sodium hypochlorite. The canals were dried with absorbent paper points. The root canal obturation was performed with the continuous wave of condensation technique. Results: The root canals of tooth #37 were correctly instrumented and obturated. The patient did not present with any postoperative symptoms, and was referred for final prosthetic rehabilitation. Conclusion: CBCT and DOM were paramount for the correct planning of the case, as regards the presence of cracks and the detection of the middle mesial canal (AU).

Prevalência de dor odontogênica em um serviço de pronto-atendimento odontológico público do Sul do Brasil / Prevalence of odontogenic pain in a public dental urgency service in Southern Brazil

Objetivo: Identificar as principais causas de dor odontogênica que levam à busca pelo atendimento no Serviço de Pronto Atendimento Odontológico (SPAO) da Faculdade de Odontologia da Universidade de Passo Fundo (UPF), que funciona junto ao Hospital São Vicente de Paulo e está ligado ao Sistema Único de Saúde (SUS). Métodos: Realizou-se um estudo epidemiológico transversal e retrospectivo, baseado em dados de prontuários odontológicos de pacientes atendidos entre novembro de 2016 e outubro de 2017. Os dados foram analisados buscando-se a prevalência das diversas origens de dor odontogênica dos pacientes atendidos no período: pulpar (pulpite reversível, pulpite irreversível, necrose); periapical (pericementite, abscesso periapical); ou periodontal (periodontite, abscesso periodontal). Além disso, foi catalogada a conduta realizada durante os atendimentos de urgência. Resultados: Ao todo, foram analisados 1.275 prontuários. Desses, 868 pacientes (68,1%) apresentavam dor ao atendimento. Dos pacientes que relataram dor, 62,3% apresentavam dor odontogênica pulpar; 11,1%, dor periapical; e 12,2%, dor periodontal. A conduta mais adotada para tratamento da dor foi a terapia com analgésicos e/ou antibióticos (21,0% dos casos), seguida por acessos endodônticos (18,7%) e exodontias (17,9%). Conclusão: No serviço de pronto atendimento analisado, prevaleceram os casos de dor de origem pulpar. Os resultados obtidos contribuem para o desenvolvimento de estratégias de controle da dor odontogênica, bem como para a melhoria dos protocolos clínicos adotados na faculdade em questão (AU).

Objective: To identify the main causes of odontogenic pain that lead to people search for care in the Urgency Service of the School of Dentistry of University, Passo Fundo/RS/Brazil (SPAOH), localized in the Hospital São Vicente de Paulo. Methodology: A cross-sectional and retrospective study, carried out between the period from November 1, 2016 to October 31, 2017, when data from dental care records were collected and tabulated. The data were analyzed looking for the prevalence of several causes of odontogenic pain, with pulp origin (reversible, irreversible pulpitis, necrosis); periapical (pericementitis, abscess); periodontal (periodontitis); and others, in addition to the conduct performed in attendance. Results: A total of 1,275 dental records were analyzed, involving 868 patients, of which 68.1% reported the presence of pulp (62.3%), periapical (11.1%) and periodontal (12.2%) odontogenic pains. Analgesic or antibiotic therapies were the most common approaches, totaling 21.0% of cases, followed by endodontic accesses (18.7%) and extractions (17.9%). Conclusion: In the studied dental urgency service, cases of pulp pain prevail. The results obtained contribute to the development of strategies to control odontogenic pain, as well as to the improvement of clinical protocols (AU).

Factores asociados a la evolución clínica de los procesos pulpares reversibles / Factors associated with clinical evolution of reversible pulp processes

RESUMEN La mayoría de los pacientes que acuden a consulta de urgencias de Estomatología refieren una sintomatología dolorosa causada por las enfermedades pulpares. Se realizó un estudio observacional-analítico; la población estuvo conformada por los 252 pacientes que acudieron al Servicio Estomatológico del Policlínico Chiqui Gómez Lubián, Santa Clara, y que fueron diagnosticados con una afección pulpar reversible transitoria, en el período enero-diciembre 2016. La muestra (167 pacientes) fue elegida de forma intencional. El principal objetivo fue describir los agentes causales, relacionar la evolución clínica y las variables clínico-epidemiológicas, e identificar los factores asociados a la evolución clínica en los procesos pulpares reversibles. El rango de edad más afectado fue de 22 a 52 años y predominó el sexo masculino. El agente causal que afectó a la mayor cantidad de pacientes fue el bacteriano; se relacionaron todas las variables con el resultado de la evolución clínica.

ABSTRACT Most of the patients who come to the Dental Emergency Consultation report painful symptomatology caused by pulp diseases. An observational analytical study was performed; the population consisted of 252 patients who were seen at the Dental Service of "Chiqui Gómez Lubián" Polyclinic, Santa Clara, and were diagnosed with a transient reversible pulp condition from January to December 2016. The sample (167 patients) was chosen intentionally. The main objective was to describe the causal agents, relate clinical evolution and clinical-epidemiological variables, and identify factors associated with clinical evolution in reversible pulp processes. The most affected age range was 22 - 52 years old and male gender predominated. The causal agent that affected the greatest number of patients was the bacterial one; all variables were related to the result of clinical evolution.

Evolución clínica de los procesos pulpares reversibles / Clinical evolution of reversible pulp processes

RESUMEN La mayoría de los pacientes acuden a la consulta de Urgencias Estomatológicas a causa de la dolorosa sintomatología que provocan las enfermedades pulpares. La muestra de este estudio quedó conformada por 210 pacientes que fueron diagnosticados clínicamente con una afección pulpar reversible transitoria y que acudieron al Servicio Estomatológico del Policlínico Docente Universitario Martha Abreu de Estévez, en el período enero-septiembre 2018. La información se obtuvo a partir de la anamnesis, el examen clínico y un cuestionario. Se caracterizó la muestra según edad y sexo; también se describieron los agentes causales. La consideración de estos factores puede mejorar la percepción del profesional ante la toma de decisiones terapéuticas y su valoración del pronóstico. Estas acciones contribuirán a preservar la vitalidad pulpar, a disminuir el indicador de pérdida dentaria y contribuirán a mejorar la calidad de vida de los pacientes.

ABSTRACT Most patients come to the Dental Emergency Department because of the painful symptomatology caused by pulp diseases. The sample of this study was made up of 210 patients who were clinically diagnosed with a transient reversible pulp condition and seen at the dental service of "Marta Abreu de Estévez" University Teaching Polyclinic from January to September 2018. The information was obtained from the history record, the clinical examination and a questionnaire. The sample was characterized according to age and gender; the causative agents were also described. Consideration of these factors can improve professionals' perceptions when making therapeutic decisions, as well as, their prognostic assessments. These actions will help to preserve pulp vitality, decrease the indicator of dental loss and contribute to a better quality of life for patients.

Importancia semiológica del dolor durante etapas de un proceso inflamatorio pulpar / Semiological importance of pain during the stages of a pulpal inflammation process

RESUMEN Introducción: Existe la tentativa de realizar un diagnóstico del proceso inflamatorio pulpar, basado en el aspecto histopatológico, el cual es irreal pues no se puede comparar estos hallazgos con los clínicos. Resulta más objetivo y confiable, analizar las características del dolor que expresa la evolución pulpar en cada etapa y establecer un diagnóstico certero que permita precisar el tipo de tratamiento. Objetivo: Interpretar el curso de un proceso inflamatorio pulpar a través de las variables asociadas a estímulos nociceptivos. Métodos: Se realizó una revisión bibliográfica sobre las variables en relación con el dolor y su asociación con un estado inflamatorio pulpar. Se analizaron 24 artículos científicos en relación con el dolor pulpar, se escogieron 15 por ser los más afines al propósito perseguido, y todos corresponden a los últimos 5 años, publicados en revistas internacionales y nacionales. PubMed se utilizó como fuente fundamental de búsqueda; otras bases de datos también consultadas fueron Lilacs, Hinari y Medline. Análisis e integración de la información: Las condiciones pulpares se clasifican como: pulpitis reversible, transicional, irreversible y pulpa necrótica. La semiología del dolor se sustenta en cuatro variables básicas asociadas a los estímulos nociceptivos que son: cualidad del dolor pulpar puede ser punzante o continuo, su curso intermitente o continuo, su localización limitado a una región de la boca, irradiado y referido, y su intensidad considerada como leve, moderado o severo. Conclusiones: Las variables asociadas a los estímulos nociceptivos revisten importancia semiológica, pues permiten valorar las manifestaciones dolorosas por las que transita un proceso inflamatorio pulpar(AU)

ABSTRACT Introduction: Attempts have been made to diagnose the pulpal inflammatory process based on its histopathological features, but to no avail, for these findings cannot be compared with clinical results. It would be more objective and reliable to analyze the characteristics of the pain expressing the pulpal evolution at each stage and establish an accurate diagnosis allowing the choice of the type of treatment to be indicated. Objective: Interpret the course of a pulpal inflammatory process through variables associated to nociceptive stimuli. Methods: A bibliographic review was conducted about the study variables with respect to pain and its association to a pulpal inflammatory state. A total 24 scientific papers were analyzed which dealt with pulpal pain, of which 15 were selected for being the most closely related to the goal pursued and having been published in international and national journals in the last five years. PubMed was the main source searched, while other databases such as Lilacs, Hinari and Medline were also consulted. Data analysis and integration: Pulpal conditions are classified into reversible, transitional, irreversible pulpitis and necrotic pulp. Pain semiology is based on the following four basic variables associated to nociceptive stimuli: pulpal pain quality (sharp or continuous), course (intermittent or continuous), location (limited to a region in the mouth, radiating or referred) and intensity (mild, moderate or severe). Conclusions: The variables associated to nociceptive stimuli are semiologically important, for they make it possible to evaluate the painful manifestations gone through by a pulpal inflammatory process(AU)

Comparative analysis of the proteomic profile of the dental pulp in different conditions. a pilot study

Abstract This study aimed to quantitatively compare the difference in protein expression in the progression of pulp pathogenesis, as well as to describe the biological functions of proteins identified in pulp tissue. Samples were obtained from six patients treated at the Araçatuba School of Dentistry and were divided into three groups: normal pulp - from teeth extracted for orthodontic indication; inflamed pulp and necrotic pulp - from patients diagnosed with irreversible pulpitis and chronic apical periodontitis, respectively. After previous proteomic preparation, dental pulp samples were processed for label-free quantitative proteomic analysis in a nanoACQUITY UPLC-Xevo QTof MS system. The difference in expression between the groups was calculated using the Protein Lynx Global Service software using the Monte Carlo algorithm. A total of 465 human proteins were identified in all groups. The most expressed proteins in the inflamed pulp group in relation to the normal pulp group were hemoglobin, peroxiredoxins and immunoglobulins, whereas the less expressed were the tubulins. Expression levels of albumins, immunoglobulins and alpha-2-macroglobulin were higher in the necrotic pulp group than in the inflamed pulp group. As for the qualitative analysis, the most prevalent protein functions in the normal pulp group were metabolic and energetic pathways; in the inflamed pulp group: cellular communication and signal transduction; and regulation and repair of DNA/RNA, while in the necrotic pulp group proteins were associated with the immune response. Thus, proteomic analysis showed quantitative and qualitative differences in protein expression in different types of pulp conditions.

Resumo Este estudo teve como objetivo comparar quantitativamente a diferença da expressão de proteínas na progressão da patogênese pulpar, bem como descrever as funções biológicas das proteínas identificadas no tecido pulpar. As amostras foram obtidas de seis pacientes atendidos na Faculdade de Odontologia de Araçatuba e divididas em três grupos: polpa normal - dentes extraídos por indicação ortodôntica; polpa inflamada e polpa necrótica - pacientes diagnosticados com pulpite irreversível e periodontite apical crônica, respectivamente. Após o preparo proteômico prévio, as amostras de polpa dentária foram processadas para análise proteômica quantitativa livre de marcadores em um sistema nanoACQUITY UPLC-Xevo QTof MS. A diferença de expressão entre os grupos foi calculada usando o software Protein Lynx Global Service através do algoritmo de Monte Carlo. Um total de 465 proteínas humanas foram identificadas em todos os grupos. As proteínas mais expressas no grupo polpa inflamada em relação ao grupo polpa normal foram hemoglobinas, peroxirredoxinas e imunoglobulinas, enquanto as menos expressas foram as tubulinas. Os níveis de expressão de albuminas, imunoglobulinas e alfa-2-macroglobulina foram maiores no grupo polpa necrótica do que no grupo de polpa inflamada. Quanto à análise qualitativa, as funções proteicas mais prevalentes no grupo polpa normal foram vias metabólicas e energéticas; no grupo polpa inflamada: comunicação celular e transdução de sinal; e regulação e reparo de DNA / RNA, enquanto no grupo polpa necrótica as proteínas foram associadas à resposta imune. Assim, a análise proteômica mostrou diferenças quantitativas e qualitativas na expressão de proteínas em diferentes tipos de condições pulpares.

Induction of root development and apical closure in permanent mandibular molar with irreversible pulpitis through total pulpotomy with application of mineral trioxide aggregate / Inducción del termino de desarrollo radicular y cierre apical en molar mandibular permanente con pulpitis irreversible a través de pulpotomía total con aplicación de agregado de trióxido mineral

Loss of teeth vitality when root formation is incomplete, results in weaker structures leaving them prone to fractures and unfavourable long-term prognosis. Apexogenesis is currently the treatment of choice in immature teeth and is indicated in vital teeth without pulpal pathologies. The treatment aims to eliminate the causal agent of the damage, and provide the necessary conditions to preserve vitality in the tooth and induce apical root closure. A 6-year-old male patient was treated at the Endodontics Clinic, Universidad de La Frontera upon complaining of acute pain in tooth 30. The tooth presented incomplete root development due to dental caries with pulp exposure and a diagnosis of irreversible symptomatic pulpitis. Total pulpotomy was performed with the application of Mineral Trioxide Aggregate and controlled at 1, 4, 6, 7 and 12 months, achieving root development and apical closure in the permanent molar. The result was comparable with studies that support this therapy in teeth with irreversible pulpitis. This work seeks to contribute to the existing evidence on the management of immature permanent teeth with irreversible pulpitis to induce root development and apical closure, and maintain pulp vitality.

La pérdida de vitalidad en dientes con formación radicular incompleta trae como resultado el debilitamiento de estos, dejándolos propensos a fracturas con un desfavorable pronóstico a largo plazo. Las terapéuticas actuales de regeneración pulpar en dientes inmaduros estan principalmente indicadas en cuadros de pulpitis irreversible y buscan eliminar el agente causal de daño y brindarle al diente las condiciones y estímulos necesarios para preservar vitalidad e inducir el cierre apical radicular. Un paciente de 6 años de edad y de sexo masculino, acude a la Clínica de Especialidad de Endodoncia de la Universidad de la Frontera, consultando por un dolor agudo en diente 4.6 el cual presentaba un desarrollo radicular incompleto producto de una caries con exposición pulpar con diagnóstico de Pulpitis Irreversible Sintomática. Se realiza una pulpotomia total con aplicación de Mineral Trioxide Aggregate y se controla a los 1, 4, 6 y 7 meses obteniendo un interesante resultado comparable con estudios que avalan dicha terapeutica en dientes con pulpitis irreversible. Este trabajo busca contribuir a la evidencia existente sobre el manejo de dientes permanentes inmaduros con cuadros de pulpitis irreversible para inducir el desarrollo radicular, cierre apical y mantener vitalidad pulpar.

Frecuencia de patologías pulpares en niños asistentes a la Facultad de Odontología, UNAH, Tegucigalpa, Honduras / Pulp pathologies frequency in children who attended UNAH Dental School, Tegucigalpa, Honduras

Según la Organización Mundial dela Salud (OMS), entre el 60 y 90% de la población infantil presenta lesiones cariosas concavitación. Las patologías pulpares son consecuencia de la evolución de la caries o traumatismo dental, manifestándose con dolor, inflamación o infección, que obliga a los pacientesa acudir de forma urgente a la consulta odontológica con cuadros de pulpitis reversible, irreversible o necrosis pulpar. Dependiendo dela gravedad de la patología, esta puede intervenirse mediante terapias curativas y cuando ha alcanzado un nivel muy avanzado, laúnica opción es la exodoncia, dejando secuelas a corto, mediano y largo plazo en el niño. Objetivo: Analizar las diferentes patologías pulpares en molares de ciduos de pacientes infantiles entre 5 y 9 años que acuden a la clínica de Odontopediatría de la Facultad de Odontología de la Universidad Nacional Autónoma de Honduras (UNAH) durante 2016-2018.Pacientes y métodos: Estudio descriptivo, retrospectivo y cuantitativo.Se recolectaron historias clínicas de niños entre 5 y 9 años que acudieron entre 2014 -2016 con una muestra de 310 expedientes de un universo de1605. Resultados: Predominaron las patologías pulpares en el género masculino (54.2%). La caries dental fue la etiología más registrada (77.34%),predominó la pulpitis reversible (9.3%), el órgano dentario más afectado, en el sistema de nomenclatura FDI, (Federation Dentaire Internationale), fue el primer molar deciduo inferior izquierdo (7,4). El tratamiento más realizado fue pulpotomía (15.2%). Conclusión: en la población infantil la caries dental no tratada evolucionó en su mayoría apulpitis reversible...(AU)