ABSTRACT
El objetivo del tratamiento de conductos es prevenir o curar la periodontitis apical. Para lograr el éxito es necesario una correcta limpieza y posterior obturación tridimensional. La irrigación y desinfección del sistema de conductos es una parte imprescindible del tratamiento. Su objetivo es eliminar las bacterias y el remanente pulpar contaminado. No obstante, a pesar de muchos esfuerzos siguen existiendo nichos y cepas bacterianas causantes del fracaso endodóntico. Eddy(R), es un nuevo sistema de activación sónica con unas características específicas de su punta de poliamida, la cual oscila a alta amplitud accionada por una pieza de mano generando intraconducto unas microturbulencias o microcorrientes que ayudan en la desinfección microbiana. A continuación se expone un caso, donde se explica paso por paso la técnica clínica de las puntas de activación Eddy®, responsables de una correcta desinfección gracias al movimiento del irrigante
The aim of a root canal treatment is to prevent the apical periodontitis. An effective cleaning and subsequently a three-dimensional obturation are needed to achieve success. The irrigation and disinfection of the root canal system is a necessary part of the root canal treatment. Its aim is to eliminate the bacteria and the infected remnant pulp tissue. Nevertheless, despite our efforts, there are still niches and bacterial strains that cause endodontic failure. Eddy(R) is a new system of sonic activation with specific characteristics of its polyamides tip, which oscillates with high amplitude powered by a handpiece generating microturbulences or microstream that helps in bacterial disinfection. Below a clinical case is presented, in which we are going to explain step by step the clinical technique of the activation tips Eddy® responsible for a proper disinfection thanks to the irrigant movement
Subject(s)
Humans , Male , Adult , Pulpitis/therapy , Root Canal Therapy/instrumentation , Periapical Periodontitis/therapy , Nylons , Disinfection , Therapeutic IrrigationABSTRACT
El objetivo de este estudio es explicar en qué consiste la microtomografía computarizada (µTC) y qué resultados nos puede aportar en el estudio de la complicada anatomía pulpar. Para ello seleccionamos cuatro dientes de un mismo grupo dentario, el primer premolar inferior. Este diente puede presentar una gran variabilidad de anatomías complejas en su sistema de conductos descritas en múltiples artículos clínicos y de investigación. Las muestras fueron sometidas a un análisis microtomográfico (µTC), tras lo que obtuvimos una reconstrucción de su anatomía externa e interna. Entre las posibilidades de la µTC se han descrito el estudio de la estructura ósea, el análisis del espesor de esmalte, la medición de superficies y volúmenes de los dientes y la evaluación de técnicas de instrumentación. El resultado del estudio mediante µTC de morfologías tan extremas como las presentes en el primer premolar inferior, nos muestra unas posibilidades mayores de entendimiento y conocimiento de la anatomía interna dentaria
The aim of this study is to explain the micro-computed tomography (µTC) and the results it can provide in the study of the complicated anatomy of the pulp. We selected four teeth in the same dental group, the first premolar. This tooth can present a great variability of complex anatomies in its canal system, described in multiple clinical and research articles. The samples were subjected to micro-tomographic analysis (µTC) and then, their external and internal anatomies were reconstructed. Among the possibilities of µTC are the study of bone structure, the analysis of enamel thickness, the measurement of surface areas and volumes of the teeth and the evaluation of instrumentation techniques. The result of the study of morphologies as extreme as those present in the first premolar by µTC, shows greater possibilities of understanding and knowing its anatomy
Subject(s)
Humans , Tooth/anatomy & histology , X-Ray Microtomography/methods , Root Canal Therapy/methods , Dental Pulp Cavity/anatomy & histology , Tooth Root/anatomy & histology , Bicuspid/anatomy & histology , Anatomic VariationABSTRACT
La raíz y la morfología del sistema de conductos del primer premolar inferior pueden llegar a ser extremadamente complejas y requiere de una evaluación muy cuidadosa antes de afrontar su tratamiento de conductos. El propósito de nuestro trabajo fue realizar un amplio estudio bibliográfico sobre su anatomía externa e interna. Los diferentes artículos publicados se dividieron y clasificaron en base a diferentes conceptos anatómicos que nos pudieran servir en la interpretación de la propia documentación recopilada. Los resultados de la revisión bibliográfica fueron organizados y estudiados en base a: número de raíces, número de conductos y su morfología, variaciones por razón de sexo, variaciones por origen étnico y artículos clínicos publicados en relación al primer premolar inferior
The root and the morphology of the canal system of the first mandibular premolar can become extremely complex and requires careful evaluation before facing its root canal treatment. The purpose of our work was to conduct a comprehensive literature review on its external and internal anatomy. The various articles published were divided and classified based on different anatomical concepts that we could serve in the interpretation of the documentation collected. The results of the literature review were organized and studied based on: number of roots, number of canals and morphology, gender variations, variations by ethnicity and clinical articles published over the first premolar
Subject(s)
Humans , Bicuspid/anatomy & histology , Anatomic Variation , Root Canal Preparation/methods , Dental Pulp Cavity/anatomy & histology , Dental Pulp Cavity/ultrastructure , Transillumination , Ethnic DistributionABSTRACT
El objetivo de esta revisión bibliográfica sobre los principales artículos publicados en revistas de impacto dentro del campo de la endodoncia es analizar, a las vista de los resultados que encontramos en la literatura la penetración real de nuestros irrigantes dentro de sistemas de conductos. Muchos son los estudios in vitro que obtienen buenos resultados para la irrigación por presión positiva (jeringa) mientras que otros muchos demuestran una efectividad muy limitada. El motivo radica en simular las condiciones perirradiculares adecuadamente. La dinámica de fluidos se ve alterada por completo si los tejidos peiodontales no se simulan adecuadamente obteniendo en dichas investigaciones resultados más que cuestionables. Describiremos los métodos empleados para analizar la penetración de los irrigantes, del mismo modo que compararemos los resultados de los distintos sistemas de irrigación y activación tanto en estudios in vivo como in vitro. Al encontrarnos en sistemas de conductos cerrados la dinámica de fluidos resulta especialmente particular ya que al contrario de los que podamos pensar, el recambio de los irrigantes en la porción apical del conducto es muy limitada así como su acción de limpieza y desinfección. Estos sistemas cerrados posibilitan atrapamientos de aire, que se ven favorecidos por la formación de vapores de amonio y dióxido de carbono producidos por la descomposición de materia orgánica llevada a cabo por el Hipoclorito de Sodio (AU)
The purpose of this review of the main articles published in journals of impact within the field of endodontics is analyzed, the results thant we can find in literatura about the real penetration of irrigants in closed canal systems. Many in vitro studies that performed well for positive pressure irrigation (syringe) while many others show a very limited effectiveness. The reason is adequately simulate of periradicular tissues. The fluid dynamics is altered completely if the periodontal tissues are not adequately simulate make results obtained in these investigations more questionable. We will compare the results of different methods of activitation and deliberation systems of our irrigants, just as we will observe the methods used to analyze the penetration of irrigants both in vivo and in vitro. We are working in close canal Systems, so fluid dynamics is particularly special because unlike what we might think the replacement of the irriganst in the apical portion of the canal is very limited as is their share of Cleaning and disinfection. These closed systems allow air traps, which are favored by the formation of vapors of ammonia and carbon dioxide produced by decomposition of organic matter carried out by the sodium hypochlorite (AU)
Subject(s)
Humans , Root Canal Preparation/methods , Therapeutic Irrigation/methods , Disinfection/methods , Dental Disinfectants/administration & dosageABSTRACT
Son muchas las técnicas de irrigación que existen encaminadas a conseguir conductos libres de bacterias. A finales del 2004, una nueva técnica de irrigación es introducida: irrigación por presión negativa. Consiste en depositar el irrigante en la cámara pulpar, y éste, mediante un sistema introducido a longitud de trabajo, es aspirado, favoreciendo la limpieza en el tercio apical, reduciendo los riesgos de extrusión del hipoclorito de sodio al periápice. A continuación expondremos detenidamente esta técnica y mediante la exposición de un caso clínico explicaremos la secuencia clínica del Endova® sistema patentado por la casa Discus Dental, que emplea como patrón de irrigación, la presión negativa (AU)
There are a lot of techniques of irrigation that exist directed to obtaining free Canals of bacteria. At the end of 2004, one new irrigation technique is introduced; irrigation for negative pressure. It consists of depositing the irrigant in the pulpar chamber, and this one, by means of a system introduced to length or work, is inhaled, favoring the cleaning in the apical third, and reducing the risks of extrusion of the sodium hypochlorite. Later we will explain held up this technique, and by means of the exhibition of a clinical case we will explain the clinical sequence of the Endovac ®, system patented by D iscus Dental, which uses as boss of irrigation the negative pressure (AU)
Subject(s)
Humans , Root Canal Preparation/methods , Therapeutic Irrigation/methods , Sodium Hypochlorite/therapeutic use , Disinfection/methodsABSTRACT
La limpieza mecánica y química del sistema radicular constituye uno de los objetivos de la endodoncia. Para ello es necesaria la localización de todos y cada uno de los conductos que forman parte del entramado radicular. El primer molar inferior es, sin duda, junto al primer molar maxilar, el diente que más tratamientos de conductos precisa. Como sabemos, el primer molar inferior cuenta con dos raíces, generalmente, tres conductos (dos en raíz mesial y uno en la distal), si bien sabemos que pueden existir vacaciones tanto en el número de las raíces como en el número de conductos. En este artículo se expone un caso clínico de un retratamiento de un primer molar inferior con cinco conductos junto a una revisión sobre la incidencia de un tercer conducto en la raíz mesial del primer molar inferior (AU)
Mechanical and chemical cleaning constitutes one of the aims of the canal root treatment. For it, the location is necessary of each and every of the canals that form a part of the studding root. First mandibular molar is, undoubtedly, close to the first maxillary molar, the tooth that needs more treatments. Since we know, first mandibular molar possesses two roots and, generally, three canals (two in the root mesial and one in the distal), though we know that variations can exist both in the number of the roots and in the number of canals. In this article there is exposed a clinical case of a retreatment of the first mandibular molar by five canas close to a review on the incident of the third canal in the root mesial of the first mandibular molar (AU)
Subject(s)
Root Canal Therapy/methods , Dental Pulp Cavity/abnormalities , Root Canal Preparation/methods , Molar/surgeryABSTRACT
El objetivo de este estudio es explicar en qué cosnste la tomorafía convencional, y qué usos podemos aplicarle en el campo de la endodoncia. Para ello seleccionamos cinco dientes y los sometemos a un anáisis tomográfico computarizdo (TC) con reconstrucción posterior. Entre las posibilidades de la TC se encuentra: conocer la longitud de la cámara pulpar tanto en sentido mesio distal como en sentido vestíbulo-lingual, saber el número y la disposicion de los conductos, evaluar la presencia de conductos laterales, istmos de unión entre los conductos , conocer el diámetro del conducto a lo largo de todo el sistema radicular y ealuar el ángulo y radio de curvatura. El resultado supone grades posibilidades en el entendimiento y comportamietno de los sitemas de insrumentación durante la preparación del canal, así como el conocimiento de la antamía externa e interna del sistema de conductos (AU)
The aim of this study is to explain what conventional tomography, which uses can be applied in endodontic. To this end we select five teeth and put it through: an analysis Computed Tomography (CT) with subsequent reconstruction. Among the possibilities for CT include: knowing the length of the pulp chamber, namely the number and arrangement of canals, to assess the presence of lateral canals, isthmuses union between canals, known to the diameter o the canal along the entire root system and evaluate the angle and radius of curvature. The result represents great potential in understanding and behavior of teeth instrumentation systems during the preparation of the canal, as well as knowledge of anatomy external and internal canal root system (AU)
Subject(s)
Humans , Tomography, X-Ray Computed , Dental Pulp Cavity/anatomy & histology , Root Canal Therapy/methods , Tooth, NonvitalABSTRACT
AIM: To determine the pain experienced by patients during root canal treatment and to correlate with age and gender, pulpal diagnosis, previous periapical status, dental characteristics and length of treatment. METHODOLOGY: One hundred and seventy-six patients (68 men and 108 women), with ages ranged from 6 to 83 years, were randomly recruited. Patients completed a 10-cm visual analogue scale (VAS) that ranked the level of pain experienced during root canal treatment. RESULTS: The mean pain level during root canal treatment was 1.2 +/- 0.8 in a VAS between 0 and 10. Fifty-four per cent of patients did not experience pain. There were no significant differences in relation to gender or age groups. Mandibular teeth had a significantly (P < 0.05) higher percentage incidence of pain in comparison with maxillary teeth. Pain was absent in 63% of anterior teeth compared with 44% in posterior ones (P < 0.01). Interventions shorter than 45 min resulted in a significantly higher percentage of pain absence (P < 0.05). Root canal treatment was significantly (P < 0.05) more painful in teeth with irreversible pulpitis and acute apical periodontitis compared to the group with necrotic pulps and chronic apical periodontitis (P = 0.049). CONCLUSIONS: Root canal treatment in teeth with irreversible pulpitis and acute apical periodontitis was more painful. Age, tooth type and length of the treatment were factors associated with increased risk for pain experienced during the procedure. Knowledge of pain levels endured by patients will allow dentists to decide when to use supplemental local anaesthesia.
Subject(s)
Pain/classification , Root Canal Therapy/methods , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Dental Pulp Diseases/physiopathology , Dental Pulp Diseases/therapy , Dental Pulp Necrosis/physiopathology , Dental Pulp Necrosis/therapy , Female , Humans , Male , Mandible/pathology , Maxilla/pathology , Middle Aged , Pain Measurement , Periapical Diseases/physiopathology , Periapical Diseases/therapy , Periapical Periodontitis/physiopathology , Periapical Periodontitis/therapy , Pulpitis/physiopathology , Pulpitis/therapy , Sex Factors , Time Factors , Tooth/pathology , Young AdultABSTRACT
Objetivo. El propósito de este estudio fue evaluar la precisión en las mediciones de dos localizadores electrónicos de ápices (LEAs): Root ZX y ProPex. Material y Métodos: De las 104 raíces unirradiculares con las que comenzó la investigación, finalmente 63 fueron utilizadas. Se desarrolló un nuevo sistema de medición in-vitro, en el que la lima utilizada para hallar las longitudes permanece unida a un calibre electrónico, por lo tanto, los datos se obtienen con una precisión de centésimas de milímetro. Se realizaron tres mediciones de las 63 muestras con cada localizador y se calculó la media. Resultados. Tras analizar los datos obtenidos con el test estadístico de la t de Student, no se observó diferencia estadística significativa entre las mediciones de ambos localizadores. La precisión del Root ZX y del ProPex fue del 63,5% ± 1mm y del 65% ±1mm respectivamente. Conclusiones. Los dos localizadores electrónicos suponen una ayuda muy fiable para situar la lima dentro del conducto radicular. No obstante, su precisión no es exacta, por lo que deberían acompañarse de otras técnicas para confirmar la longitud de trabajo (AU)
Objective: To evaluate the accurate in their measurements of the followings electronic apex locators (EALs): Root ZX and ProPex. Material and methods: From the 104 single-rooted teeth that the study started with, only 63 were able. A new method was developed for the measurement in vitro, which consists that the file used for this purpose keeps attached to the electronic gauge, therefore, the information is registered with a hundredth millimeter precision. Three measurements with each apex locator were done with the 63 samples and the average was calculated. Results. After analyzing the information with the statistic test of t Student, there was no statistic difference between the measurements of both apex locators. The accurate of Root XZ and ProPex was About 63,5% ± 1mm and 65% ± 1mm respectively. Conclusions. It is assumable that both apex locators are very helpful tools to locate the file inside the root canal. Nevertheless, their accurate are not exact, that´s why other techniques should be sued as well to confirm our work lengths (AU)
Subject(s)
Humans , Male , Female , Dental Pulp Cavity/surgery , Dental Pulp Cavity , Tooth Apex/surgery , Apicoectomy/instrumentation , Apicoectomy/statistics & numerical data , Apicoectomy/trendsABSTRACT
Objetivo: Evaluar la extrusión de material y la capacidad de sellado de diferentes diámetros de thermafilen conductos con una misma preparación (diámetro y conicidad). Material y métodos: 60 dientes unirradiculares fueron obturados, 30 dientes con el mismo diámetro de la preparación (25) y 30 dientes con un número mayor (30). Utilizamos un sistema de instumentación mecánica ProTaper, acabando la instrumentación en una F2 (25-8%). Dejamos los dientes en tinta china durante 1 semana, para posteriormente haciendo cortes a 1,2,3 y 5 mm del ápice evaluar, al microscopio esteroscópico ( Estéreo Beta de Visión Engineering, Send, Surrey, UK); la presencia de sobreobturación, profundidad de esta filtración y evaluar si la presencia de vástago en sobre extensiones aumenta el índice de filtración de los casos. Resultados: No se observan diferenicas estadísticamente significativas en la extrusión (p=0,387). En cuanto a la filtración apical notamos un mejor sellado con el Thermafil de calibre mayor en todas las mediciones, aunque éstas no son estadísticamente significativas (p= 0,673). Conclusiones: Por los resultados de este estudio parece ser que al utilizar un Thermafil de un diámetro mayor al de la lima apical maestra hay menor índice de filtración y menor cantidad de sobreobturaciones (AU)
Objective: The purpose of this study was to evaluate the overfilling of material and the apical sealing ability of root canals filled using two obturating diameters of thermafil in canal preparated with the same taper and diameter. Material and methods: Sixty one root canal teeth were obturated with Thermafil, 30 with thermafil diameter 25, and 20 with thermafil diameter 25 and 30 with thermafil diameter 30 both with top seal sealer. One canal instrumentation method was used Protaper toe end the preparation with a 25-8% file (F2). Folowing obturation, the teeth were prepared for evaluation of the seal using India ink for a week, to continue cutting the root in 4 pieces, 1mm, 2mm, 3mm and 5 mm from the apex to evaluate with the stereoscopic microscope (Estéreo Beta of Vision Engineering: The presence of apical overfilling, the depth of lekeage and evaluate if the presence of core in overfilings increase the lekage in our cases. Results. For overfilling capacity, although we got better results with the thermafil of bigger diameter. However, a not significant difference was present at the p>0,05 between the two diameters of thermafil (p=0,673). Conclusions: By the results of this study it seems that the Thermafil of a bigger diameter creates a better seal and less overfilling (AU)
Subject(s)
Humans , Male , Female , Orthodontic Extrusion/methods , Orthodontic Extrusion/trends , Tooth/chemistry , Tooth , Tooth Apex , Tooth Apex , Orthodontic Extrusion/instrumentation , Orthodontic Extrusion/statistics & numerical data , Tooth/ultrastructure , Tooth , Retrograde Obturation , Root Canal ObturationABSTRACT
AIM: To study the prevalence of apical periodontitis in smoker and nonsmoker patients. METHODOLOGY: In a cross-sectional study, the records of 180 subjects, 109 smokers and 71 nonsmokers, were examined. All participants underwent a full-mouth radiographic survey incorporating 14 periapical radiographs. The periapical region of all teeth, excluding third molars, was examined. Periapical status was assessed using the Periapical Index score. Statistical analyses were conducted using the Cohen's Kappa test, analysis of variance and logistic regression. RESULTS: Apical periodontitis in at least one tooth was found in 74% of smokers and in 41% of nonsmokers (P < 0.01; odds ratio = 4.2; 95% C. I. = 2.2-7.9). Amongst smoker patients 5% of the teeth had apical periodontitis, whereas in nonsmoker subjects 3% of teeth were affected (P = 0.008; odds ratio = 1.5; 95% C. I. = 1.1-2.1). The percentage of root filled teeth in smoker and nonsmoker patients was 2.5% and 1.5%, respectively (P < 0.05; odds ratio = 1.7; C. I. 95% = 1.0-2.6). CONCLUSIONS: In this study population, smoking was significantly associated with a greater frequency of root canal treatment and with an increased prevalence of apical periodontitis.
Subject(s)
Periapical Periodontitis/epidemiology , Periapical Periodontitis/etiology , Smoking/adverse effects , Adult , Cross-Sectional Studies , Female , Humans , Logistic Models , Male , Prevalence , Sampling Studies , Spain/epidemiologyABSTRACT
Objetivo. Estudiar las diferencias que encontramos entre tres formas distintas de colocación del Hidróxido de Calcio en el sistema de conductos. Las técnicas estudiadas fueron: Inyección, lima y léntulo. To study the effect of different apical shapes in prepared simulated root canals on the application of a commercially prepared calcium hydroxide pasted by a syringe of léntulo spiral. Material y métodos: Los dientes fueron divididos en tres grupos. Todos ellos fueron instrumentados hasta una lima apical 25.7% (Protaper F2) y rellenados con hidróxido de calcio, empleando una técnica diferente para cada grupo inyección, léntulo y lima. Posteriormente se hicieron placas radiográficas de las distintas muestras. Fueron evaluadas por 2 observadores a doble ciego, y solo se aceptó estas observaciones si la concordancia entre ambos era un índice de Kappa BUENO (mayor de 0.61) (...) (AU)
Objective: To study the effect of different apical shapes simulated root canals on the application of a commercially prepared calcium hydroxide paste by a syringe, lénulo spiral, or file. Material and methods: The teeth were divided in three groups. All of them were orchestrated up to an apical file 25,7% (Protaper F2), and filled up with Calcium Hydroxide, using a different technique for each group: injection, léntulo and file. Later radiograficas plates were made of the different samples. They were evaluated by 2 observers to double blind study, and these thirds of the canal and the possible extrusion of Calcium Hydroxide to periapical tissues. Variance analyses were made as well as the test chi-square, in addition to the test of Kappa of agreement between observers (...) (AU)
Subject(s)
Humans , Root Canal Obturation/methods , Calcium Hydroxide/administration & dosage , Root Canal Therapy/methods , Root Canal Preparation/methods , Case-Control StudiesABSTRACT
En la actualidad, la gutapercha supone el material de elección para la obturación de los conductos radiculares; sin embargo, las desventajas que presenta han promovido la aparición de un nuevo material que intenta solventarlas: ResilonTM. Formulado a base de resinas, trata de llevar la adhesión al interior del conducto radicular para evitar desadaptaciones entre el núcleo de la obturación, el sellador utilizado y la dentina radicular. La supuesta menor filtración coronal con respecto a la gutapercha fue el motivo de elección de este material en el caso clínico que exponemos. Tras revisar la bibliografía disponible, su solubilidad, su biodegrabilidad y la citotoxicidad de su primer autograbante hace necesarios más estudios in vivo antes de abandonar la gutapercha como material habitual de nuestras obturaciones (AU)
Nowadays, the gutta-percha assumes the chosen material for sealing the radicular canals; nevertheless, the disadvantages that it presents have caused the appearance of the new material that follows to resolve them: ResilonTM . Made up of resins, tries to carry the adhesion to the interior of the radical canal in order to avoid adjustment problem between the nucleus of the obturation, the sealant used and the radicular dentin. With respect to the gutta-percha, the motive in choosing this material in the clinical trial that we present nos the supposed lower coronal leakage. After reviewing the available bibliography, its solubility, biodegradability, and cytotoxicity of its primer make wore in vivo studies necessary before abandoning the gutta-percha as the usual material for our obturation (AU)
Subject(s)
Humans , Root Canal Filling Materials/analysis , Root Canal Obturation/methods , Gutta-Percha/therapeutic use , Resins, Synthetic/analysis , Resin Cements/analysisABSTRACT
AIM: To study the prevalence of AP in patients with and without type 2 diabetes mellitus. METHODOLOGY: In a retrospective cohort study, the records of 38 subjects with diabetes and 32 control subjects were examined. All participants underwent a full-mouth radiographic survey incorporating 14 periapical radiographs. The periapical region of all teeth, excluding third molars, was examined. Periapical status was assessed using the periapical index score. Statistical analyses were conducted using the Cohen's kappa test, analysis of variance and logistic regression. RESULTS: Apical periodontitis in at least one tooth was found in 81.3% of diabetic patients and in 58% of control subjects (P = 0.040; OR = 3.2; 95% CI = 1.1-9.4). Amongst diabetic patients 7% of the teeth had AP, whereas in the control subjects 4% of teeth were affected (P = 0.007; OR = 1.8; 95% CI = 1.2-2.8). CONCLUSIONS: Type 2 diabetes mellitus is significantly associated with an increased prevalence of AP.