Influence of concentration, irrigation method, and root canal third on intratubular penetration of sodium hypochlorite - a broad statistical analysis.

Background: The permanence of microorganisms in the root canal system represents the main cause of endodontic failure. Considering the impossibility of effective action of the endodontic files in ramifications of the main canal and mainly inside the dentinal tubules, a better understanding of the irrigation dynamics to enhance endodontic prognosis is essential. Objective: To evaluate the depth of intratubular penetration values of sodium hypochlorite (NaOCl) (dependent variable) by comparing different concentrations, methods of irrigation, and root canal thirds (independent variables) and to investigate the existence of interactions among them, capable of influencing the dependent variable. Material and Methods: 40 roots from extracted human maxillary central incisors were stained and instrumented according to four irrigation protocols (n. 10): conventional irrigation (CI) at each use or change of instrument, and final irrigation with 5ml of 2.5% or 5.25% NaOCl, with or without passive ultrasonic irrigation (PUI), respectivelly. Measurements based on stereomicroscopic images were obtained, and the data were subjected to statistical analysis (p< 0.05). Results: The highest depth values of intratubular penetration of NaOCl were observed in the cervical third, at 5.25%, and by PUI. When only two independent variables were analyzed in association, the highest penetration depth values of NaOCl were obtained at 5.25%, regardless of irrigation method, at 5,25%, in the cervical third, and; in the cervical third, despite of irrigation method. Considering the three independent variables simultaneously, the highest depth values of intratubular penetration of NaOCl were observed in the cervical third, at 5.25%, no matter the irrigation method. The interaction between the independent variables on the penetration depth values of NaOCl was only confirmed considering the irrigation method and root canal third. Conclusions: Intratubular penetration of NaOCl was influenced by the three independent variables individually and when the irrigation method and root canal third were considered simultaneously. Key words:Dentinal tubules, Depth, Disinfection, Irrigation, Root canal system, Sodium hypochlorite.

Clinical determination of anatomical diameter in different dental groups correlating them with gender, age, tooth/canal and pulpoperiradicular diagnosis: an observational clinical study.

The aim of this observational clinical study (OCS) was to determine the clinical anatomical diameter (CAD) in several dental groups, thus correlating them with gender, age, tooth/canal and pulpoperiradicular diagnosis. Three-hundred fifty-nine teeth/584 vital or necrotic root canals from patients of both genders and different ages composed the sample. After performing the necessary previous procedures, K-Flexofiles were used to determine the CAD. Then, the gender and age of the patients, as well as the pulpoperiradicular diagnosis of the teeth were tabulated to conduct the statistical analysis (p < 0.05). Of the 359 teeth/584 root canals evaluated, 208/342 were from women (mean age 38.85 ± 13.42 years) and 151/242 were from men (mean age 45.41 ± 14.90 years). Statistically significant differences between the CAD means of root canals from women and men were not identified (p = 0.411). The analysis of the correlation between the CAD and age also showed a total independence (p = 0.271). Teeth with pulp necrosis and asymptomatic apical periodontitis diagnosed radiographically (TPNAAPDR) had a significantly larger CAD mean than teeth with pulp necrosis and no asymptomatic apical periodontitis diagnosed radiographically (TPNNAAPDR) and teeth with vital pulp and normal apical tissues (TVPNAT) (p = 0.0297); and the last two did not differ statistically (p > 0.05). The largest CAD mean was observed in single canals of maxillary central incisors. The lowest values of this variable were identified in the mesiobuccal and mesial canals of maxillary and mandibular first molars, respectively. The CAD of the root canals was influenced only by the root canal/tooth and pulpoperiradicular diagnosis.

Analysis of obtaining apical patency indexes during endodontic treatments considering gender, age, pulpoperiradicular diagnosis and canal/tooth-A clinical study.

This study aimed to perform an analysis of obtaining apical patency indexes during endodontic treatments considering gender, age, pulpoperiradicular diagnosis and canal/tooth (n. 639/383). Following previous clinical procedures, a thin K-File (No. 20, 15, 10 or 08) was used to achieve apical patency. These specific data and some demographic and clinical information were submitted to the statistical analysis (p < 0.05). Significant statistical differences were not identified considering gender (p = 0.156) and age (p = 0.793). However, in 14.6% of the canals of vital teeth and 14.1% of the canals of necrotic teeth without periapical lesions, apical patency could not be achieved, which occurred in only 7% of the canals of necrotic teeth with periradicular disease (p = 0.009). Considering canal/tooth, apical patency was more challenging to obtain in canals of posterior teeth (p = 0.000). The pulpoperiapical diagnosis and canal/tooth significantly influenced the obtaining of apical patency.

Incidence of fracture of ProDesign Logic system instruments: A cross-sectional retrospective study.

The aim of the present study was to analyze the incidence of fracture of ProDesign Logic system instruments in endodontic treatments performed by a specialist, in addition to identifying the dental group, arch, and the root canal thirds in which the fractures occurred more frequently. Digital radiographs and medical records were initially analyzed and resulted in the selection of 561 teeth (1302 canals) treated between 2018 and 2020, using the ProDesign Logic system instruments. These data were reassessed to determine the occurrence of fractures and identify the dental group and root canal thirds in which they occurred. Then, the data were statistically analyzed using the Fisher's Exact Test (p < 0.05). The general fracture rates were 8.5 and 3.69%, considering the number of teeth and canals treated, respectively. Mandibular first molars were the teeth most associated with the occurrence of fractures (19.1%). When the arches were compared, there was no statistical difference regarding the number of fractures in the different root canal thirds (p = 0.307). However, they were more frequent in the apical third in both arches (p = 0.000). The incidence of fracture of ProDesign Logic system instruments was relatively high and occurred more frequently in the apical third of molars.

Incidence of periodontal compromise in teeth indicated for undergoing endodontic treatment: A clinical study.

OBJECTIVE: The aim of this study was to evaluate the periodontal status of teeth indicated for undergoing endodontic treatment. MATERIALS AND METHODS: Two hundred and nine teeth were evaluated using probing depth tests at three vestibular and three palatine/lingual sites before the patients underwent treatment. Teeth that presented up to 3-mm probing depth were considered as healthy. Those that presented at least one site with probing depth >3 mm were considered periodontally compromised. The data were statistically analyzed by means of applying the Chi-square test, with a level of significance of 5%. RESULTS: Of the total of 209 teeth evaluated, 40 (19.10%) presented periodontal compromise. There was statistically significant difference related to the compromised teeth of patients of the female gender (22.80%) compared with teeth of patients of the male gender (12.30%) (P < 0.05). CONCLUSIONS: Fewer than 20% of the teeth evaluated presented a periodontal compromise. Patients of the female gender presented a higher number of periodontally compromised teeth than patients of the male gender.

Residual smear layer after root canal instrumentation by using Niti, M-Wire and CM-Wire instruments: A scanning electron microscopy analysis.

OBJECTIVE: The purpose of this study was to compare the amount of residual smear layer after root canal instrumentation by using Ni-Ti, M-Wire, and CM-Wire instruments. MATERIALS AND METHODS: Seventy-two mandibular incisors were randomly divided into six groups according to the system used: WaveOne (WO), Reciproc (RP), Unicone (UC), ProTaper Next (PN), Mtwo (MT), and HyFlex (HF). Afterward, the specimens were cleaved in the mesiodistal and buccolingual direction for analysis by scanning electron microscopy. RESULTS: Considering both directions and root canal thirds, there was no difference between HF, MT, and PN. RP, UC, and WO presented a significant difference between the directions, and the cervical third showed a significantly smaller quantity of residual smear layer compared with the apical third. When the systems were compared among them, there was a significant difference only between RP and WO. CONCLUSIONS: Residual smear layer observed after instrumentation with the different systems was similar, except for quantities between the reciprocating systems.

Surgical resolution of an aggressive iatrogenic root perforation in a maxillary central incisor: a case report with a 4-year follow-up.

The prognosis of teeth with root perforations depends on several factors, including size, location, and time since occurrence. Root perforations are clinical situations that can be solved by either nonsurgical or surgical approaches. The purpose of this article is to present a case of an aggressive iatrogenic root perforation in a maxillary right central incisor solved surgically using mineral trioxide aggregate (MTA). Even in an unfavorable situation, MTA was able to induce new bone formation and reestablish gingival and periodontal health, as confirmed in follow-up examinations at 2 and 4 years.

The Impact of Apical Patency in the Success of Endodontic Treatment of Necrotic Teeth with Apical Periodontitis: A Brief Review.

Accumulation of soft tissue or dentinal remnants in the apical region is a common event that can cause blockage of root canals. This event can be avoided if apical patency is performed during the root canal shaping procedures. However, there is no consensus on the role of apical patency in relation to the success of endodontic treatment of necrotic teeth with apical periodontitis. Therefore, the purpose of this paper was to conduct a brief review on the role of apical patency in guaranteeing the success of endodontic treatments of necrotic teeth with apical periodontitis considering two other key points; the root canal anatomy and microbiology.

Antimicrobial activity of calcium hydroxide associated with anew vehicle (Triethanolamine) / Atividade antimicrobiana do hidróxido de cálcio associado à um novo veículo (Trietanolamina)

Objetivo: O objetivo deste estudo foi avaliar a capacidade antimicrobiana do hidróxido de cálcio associado à dois veículos convencionais (anestésico líquido e azeite de oliva) e um novo veículo (Trietanolamina). Material e Métodos: Inicialmente, os micro-organismos foram coletados de quatro incisivos superiores de um mesmo paciente que apresentavam tratamentos endodônticos insatisfatórios e periodontites apicais persistentes utilizando cones de papel absorvente esterilizados inseridos nos canais radiculares após a remoção do material obturador. Em seguida, estes foram cultivados em BHI durante 24 h e colocados em 10 placas de Petri com três orifícios preenchidos com as medicações avaliadas. Após 48 e 72 h, os halos de inibição foram aferidos. Resultados: Após aplicação do teste de Kruskal-Wallis com nível de significância de 1% (α = 0,01) foi observado que, hidróxido de cálcio associado à Trietanolamina, apresentou resultados semelhantes àqueles produzidos pelo líquido anestésico. Ambas as combinações foram superiores ao hidróxido de cálcio veiculado ao azeite de oliva. Conclusão: Considerando os resultados deste estudo in vitro, é possível concluir que Trietanolamina pode ser uma alternativa viável para ser utilizada como veículo associado ao hidróxido de cálcio.

Objective: The aim of this study was to evaluate the antimicrobial effectiveness of calcium hydroxide associated with a two conventional (anesthetic liquidand olive oil) and a new vehicle (Triethanolamine). Material and methods: Initially, microorganisms were collected from four upper incisors presenting unsatisfactory root canal treatments and persistent apical periodontitis from the same patient using sterile absorbent paper cones placed inside the root canal following initial access and root filling removal. Next, they were grown in a BHI culturemedium for 24 h. Afterwards, they were placed in 10 Petri dishes with 3 holes, where different formulations of the medications studied were placed. After 48 and 72 h, readings were taken of the growth inhibition halos. Results: After using Kruskal-Wallis test with significance level of 1% (α = 0.01) it was observed that, calcium hydroxide associated with Triethanolamine, produced results similar to those produced by the anesthetic liquid. Both combinations were superior to the association with olive oil. Conclusion: Considering the results of this in vitrostudy, it is possible to consider that Triethanolamine can be a viable alternative to be used as a vehicleassociated with the calcium hydroxide.

Influence of antimicrobial solutions in the decontamination and adhesion of glass-fiber posts to root canals.

OBJECTIVE: This study evaluated the effect of root canal disinfectants on the elimination of bacteria from the root canals, as well as their effect on glass-fiber posts bond strength. MATERIAL AND METHODS: Fifty-three endodontically treated root canals had post spaces of 11 mm in length prepared and contaminated with E. faecalis. For CFU/ml analysis, eight teeth were contaminated for 1 h or 30 days (n=4). Teeth were decontaminated with 5% NaOCl, 2% CHX, or distilled water. As control, no decontamination was conducted. After decontamination, sterile paper points were used to collect samples, and CFU/ml were counted. For push-out, three groups were evaluated (n=15): irrigation with 2.5% NaOCl, 2% CHX, or sterile distilled water. A bonding agent was applied to root canal dentin, and a glass-fiber post was cemented with a dual-cured cement. After 24 h, 1-mm-thick slices of the middle portion of root canals were obtained and submitted to the push-out evaluation. Three specimens of each group were evaluated in scanning electron microscopy (SEM). Data were analyzed with one-way ANOVA and Dunnett's T3 test (α=0.05). RESULTS: The number of CFU/ml increased from 1 h to 30 days of contamination in control and sterile distilled water groups. Decontamination with NaOCl was effective only when teeth were contaminated for 1 h. CHX was effective at both contamination times. NaOCl did not influence the bond strength (p>0.05). Higher values were observed with CHX (p<0.05). SEM showed formation of resin tags in all groups. CONCLUSION: CHX showed better results for the irrigation of contaminated root canals both in reducing the bacterial contamination and in improving the glass-fiber post bonding.

Influence of antimicrobial solutions in the decontamination and adhesion of glass-fiber posts to root canals

AbstractObjective This study evaluated the effect of root canal disinfectants on the elimination of bacteria from the root canals, as well as their effect on glass-fiber posts bond strength.Material and Methods Fifty-three endodontically treated root canals had post spaces of 11 mm in length prepared and contaminated with E. faecalis. For CFU/ml analysis, eight teeth were contaminated for 1 h or 30 days (n=4). Teeth were decontaminated with 5% NaOCl, 2% CHX, or distilled water. As control, no decontamination was conducted. After decontamination, sterile paper points were used to collect samples, and CFU/ml were counted. For push-out, three groups were evaluated (n=15): irrigation with 2.5% NaOCl, 2% CHX, or sterile distilled water. A bonding agent was applied to root canal dentin, and a glass-fiber post was cemented with a dual-cured cement. After 24 h, 1-mm-thick slices of the middle portion of root canals were obtained and submitted to the push-out evaluation. Three specimens of each group were evaluated in scanning electron microscopy (SEM). Data were analyzed with one-way ANOVA and Dunnett’s T3 test (α=0.05).Results The number of CFU/ml increased from 1 h to 30 days of contamination in control and sterile distilled water groups. Decontamination with NaOCl was effective only when teeth were contaminated for 1 h. CHX was effective at both contamination times. NaOCl did not influence the bond strength (p>0.05). Higher values were observed with CHX (p<0.05). SEM showed formation of resin tags in all groups.Conclusion CHX showed better results for the irrigation of contaminated root canals both in reducing the bacterial contamination and in improving the glass-fiber post bonding.

Ausência de correlação entre a densidade radiográfica da obturação e sua capacidade seladora / Lack of correlation between radiographic density of filling and fluid infiltration

Objetivo: o objetivo deste estudo foi avaliar a existênciade correlação entre a densidade radiográfica das obturaçõese sua capacidade de selamento. Material: foramselecionados para esta pesquisa 56 incisivos inferiorescom canais únicos e retos, completa formação radiculare sem complexidades anatômicas. Essas característicasforam observadas visualmente e radiograficamente.Todos os espécimes foram instrumentados utilizandoo sistema Profile 04 até o instrumento 35 seguindo omesmo protocolo de irrigação. As obturações foramexecutadas pela técnica de condensação lateral e cimentoAH Plus. Em seguida, foram feitas radiografias nosentido mesiodistal para análise da densidade radiográ-fica das obturações pela mensuração de espaços vaziosutilizando o software Axiovision. Resultados: As médiase os desvios-padrão foram de 0,311 ± 0,215μL/min e7,97 ± 3,93% para a infiltração e a porcentagem de espaçosvazios nas obturações, respectivamente. Conclusões:de acordo com os resultados deste estudo, nenhumacorrelação foi encontrada entre e porcentagemde espaços visíveis radiograficamente e a capacidade deselamento das obturações (p = 0,587).

Perfuração radicular apical iatrogênicarealizada durante o retratamento de umincisivo central inferior: relato de um caso clínico com cinco anos de acompanhamento / Iatrogenic apical root perforation performed during retreatment of a mandibular central incisor: a five-year follow-up case study

Introdução: as perfurações radiculares iatrogênicas ocorremem cerca de 2 a 12% dos casos. Estas estão associadas,principalmente, à realização de acessos incorretos, tentativade localização de canais, instrumentações, reinstrumentaçõese remoção de instrumentos fraturados. Quando ocorrem nosterços apicais, podem levar, inclusive, à perda do elementodentário devido à maior complexidade do tratamento. Objetivo:o objetivo deste trabalho foi relatar a ocorrência de umaperfuração radicular apical iatrogênica realizada durante o retratamentode um incisivo central inferior. Métodos: após arealização dos exames clínicos e radiográficos, chegou-se a umdiagnóstico de necrose pulpar e lesão periapical assintomáticano incisivo central inferior direito. Consequentemente, o tratamentoendodôntico não cirúrgico foi recomendado. Após arealização da primeira intervenção, foi possível observar umresultado radiográfico insatisfatório. Por este motivo, decidiu--se pelo retratamento. Após a realização deste procedimento,a radiografia final evidenciou uma ampla perfuração apicaldecorrente de um desvio durante a fase de instrumentação.Em virtude da ausência total de sintomatologia e pela complexidadedo caso, optou-se somente pelo acompanhamento.Resultados: o monitoramento clínico e radiográfico apóscinco anos mostraram o êxito do tratamento. Conclusão:Em situações com características semelhantes, tão importantequanto as ações clínicas propriamente ditas, é estabelecer umacorreta decisão visando tanto o conforto do paciente quanto alongevidade do elemento dentário na cavidade bucal.

Ultrapassagem de instrumentos fraturados no terço apical: uma série de casos utilizando a mesma técnica / Bypassing separated files in the apical third: A case series using the same technique

Introdução: a alta incidência de instrumentos fraturados continua sendo um grande desafio a ser superado na prática clínica endodôntica. Independentemente do instrumento, o ideal seria a sua completa remoção visando um melhor processo de limpeza e sanificação do sistema de canais radiculares. No entanto, como isto nem sempre é possível, a sua ultrapassagem pode ser a única alternativa conservadora viável, especialmente quando estes estão localizados nos terços apicais. Objetivo: o objetivo desse artigo é relatar uma série de casos detalhando o processo de ultrapassagem de instrumentos fraturados no terço apical. Material: em três casos, uma nova técnica segura e de fácil execução é apresentada detalhadamente. Resultados: a nova técnica proposta foi capaz de ultrapassar os fragmentos sem causar desvios,perfurações e danos à estrutura dental. Conclusão: Considerando os resultados clínicos obtidos nos três casos apresentados, a técnica proposta representa uma alternativa segura para a ultrapassagem de instrumentos fraturados no terço apical evitando desvios e perfurações radiculares diante desta situação clínica.

Cirurgia paraendodôntica utilizando o cimento de Portland como material retrobturador: relato de um caso clínico com cinco anos de acompanhamento / Paraendodontic surgery using Portland cement as retrofilling material: A 5-year follow-up case report

Cirurgia paraendodôntica utilizando o cimento de Portland como material retrobturador: relato de um caso clínico com cinco anos de acompanhamento

Etiologia, diagnóstico e tratamento da reabsorção cervical externa: revisão de literatura / Etiology, diagnosis and treatment of external cervical resorption: literature review

Introdução: a reabsorção cervical externa (RCE) é uma forma progressiva e agressiva de destruição da estrutura dental, caracterizada pela localização cervical e pela presença de tecido fibrovascular preenchendo a região reabsorvida. A RCE não apresenta uma etiologia específica, embora existam alguns fatores predisponentes para que ela ocorra. Devido à ausência de sintomas, a reabsorção cervical externa acaba se tornando um achado radiográfico, sendo detectada em exames de rotina. Algumas vezes, pode ocorrer a comunicação da lesão com o canal radicular e surgirem sintomas relacionados à pulpite. Em outros casos, clinicamente, a RCE pode ser identificada apenas como uma mancha rosa na margem gengival da coroa do dente afetado. Para o correto diagnóstico da RCE, além da técnica radiográfica convencional, é indicada a realização da tomografia computadorizada cone beam para avaliar a exata extensão e localização da lesão. O tratamento dependerá do estágio de evolução da reabsorção e, mesmo com a aplicação de materiais como o MTA, aRCE tem um prognóstico duvidoso na maioria dos casos. Objetivo: rever a literatura sobre a etiologia, diagnóstico e o tratamento da reabsorção cervical externa. Conclusão: a reabsorção cervical externa quanto mais cedo detectada melhor será seu prognóstico. Pacientes que apresentem algum fator predisponente devem ser acompanhados por meio de exame radiográfico de rotina e, quando necessário, o clínico pode solicitar tomada tomográfica para avaliar a extensão e localização da reabsorção, bem como, definir o tratamento adequado para cada caso.

Introduction: External cervical resorption (ECR) is a progressive and aggressive destruction of tooth structure, characterized by the cervical location and the presence of fibrovascular tissue filling the reabsorbed region. The ETS does not present a specific etiology, although there are some predisposing factors to occur. Due to the absence of symptoms, the external cervical resorption turns out to be a radiographic finding, being detected in routine tests. Sometimes, may occur the communication of the lesion with the root canal and develop symptoms related to pulpite. In othercases, clinically the ECR can only be identified as a pink spot at the gingival margin of the crown of the affected tooth. Besides the conventional radiographic technique,it is important for the correct diagnosis of ECR perform the cone beam computed tomography to evaluate the exact extent and location of the lesion. The treatment will depend on the evolution stage of resorption, and even with the application of materials such as MTA, the ECR has a dubious prognosis in most cases. Aim: review the literature about the etiology, diagnosis and treatment of external cervical resorption. Conclusion: External cervical resorption detected the sooner the better your prognosis. Patients who have some predisposing factor must be accompanied by routine radiographic examination and, where necessary, the clinician may request tomographic taking to assess the extent and location of resorption, as well as define the appropriate treatment for each case.