Apical root canal microbiome associated with primary and posttreatment apical periodontitis: A systematic review.

BACKGROUND: Microorganisms colonizing the apical root canal system are conceivably the ones directly involved with the causation and maintenance of apical periodontitis. OBJECTIVES: This article systematically reviews the reports on the microbiome occurring exclusively at the apical root canal of teeth with primary and posttreatment apical periodontitis. METHODS: The electronic databases PubMed, Embase, Web of Science, Science Direct, and Proquest were searched up to August 2023. Clinical studies using culture and molecular microbiology methods to identify the microbial taxa present exclusively in the apical root canal segment of infected teeth with apical periodontitis were included. Studies were critically assessed using the Joanna Briggs Institute Critical Prevalence Assessment Checklist. RESULTS: From 2277 articles initially detected, 52 were selected for full reading and 21 were eventually included in this review. Of these, molecular methods were used in 19 and culture in 2 studies. Ten studies evaluated primary infections, 8 evaluated posttreatment infections, and 3 included both. Cryopulverization of the apical root specimens was conducted in 11 studies. All studies evaluated the prevalence and diversity of bacteria, and only one also reported on fungi. Overall, the most frequent/abundant bacterial taxa found in the apical canal of primary infections were Pseudoramibacter alactolyticus, Olsenella uli, Fusobacterium species, Streptococcus species, Porphyromonas endodontalis, Prevotella species, Actinomyces species, Parvimonas micra, Treponema denticola, Synergistetes species, and an as-yet uncharacterized taxon. In posttreatment infections, the most prevalent/abundant bacterial taxa included species of Streptococcus, Enterococcus, Fusobacterium, Actinomyces, Pseudoramibacter, Pseudomonas, and Propionibacterium. At the phylum level, Firmicutes was the most represented. The average apical bacterial load ranged from 105 to 106 in primary infections and from 103 to 104 in posttreatment infections. DISCUSSION: Microbial diversity in the apical part of the root canal system was examined encompassing data from both primary and posttreatment infections. Heterogeneity amongst the studies, especially in sample collection and microbial identification methods, is an important limitation that prevented a meta-analysis. CONCLUSIONS: There is a pronounced bacterial diversity in the infected apical canal, with a high interindividual variability. Different microbiome compositions at the species/genus level are observed according to the infection type. REGISTRATION: PROSPERO CRD42021275886.

Photodynamic therapy in the coadjuvant treatment of Sporothrix schenckii complex.

INTRODUCTION: Sporotrichosis, a zoonosis caused by animal, mainly cat, scratches or bites, is caused by fungi belonging to the Sporothrix complex. Treatment usually consists in antifungal administration, although treatment failure and hepatotoxicity reports have been noted. Alternative sporotrichosis treatment methods, such as antimicrobial photodynamic therapy (aPDT), may, therefore, be indicated. CASE REPORT: In this context, this study followed a 56-year-old male renal transplanted patient displaying disseminated sporotrichosis, presenting erythematous skin lesions with ulcerated backgrounds and hardened consistency on the nose, oral and scalp. The lesions were present for about 2 months and the patient coexisted with cats. Intravenous amphotericin B administration was initiated, and immunosuppression was suspended. Seven aPDT sessions were also performed in 48 h intervals on the oral lesions, employing 0.01% methylene blue gel as the photosensitizing agent. After the 4th aPDT session, the patient was discharged, amphotericin B administration was suspended, and the treatment was continued with itraconazole, without immunosuppression. Red laser was applied to the oral lesions after the 7th aPDT session. Significant lesion improvement was observed after the final aPDT session and complete palate lesion repair was noted after two red laser sessions. CONCLUSION: These findings indicate that aPDT is a valuable strategy as an adjunct sporotrichosis treatment.

Influence of brushing motions on the shaping of oval canals by rotary and reciprocating instruments.

OBJECTIVE: The effects of brushing on shaping with three different instruments were assessed in oval canals. DESIGN: Mandibular incisors were assigned to 6 groups (n = 12/group) according to the system, each one with or without brushing: Reciproc Blue, VDW.Rotate, and Race EVO. Micro-computed tomography was performed before and after preparation. RESULTS: Brushing strokes caused no increase in canal volume, surface area, and structure model index independently of the system (p > 0.05), except for RaCe EVO in the full canal surface area (p < 0.05). Brushing did not increase the prepared areas (p > 0.05), except for Reciproc in the apical canal (p < 0.05). Reciproc with no brushing exhibited less pericervical dentin than with brushing (p < 0.05), while RaCe EVO with brushing resulted in less remaining dentin (p < 0.05). CONCLUSIONS: The brushing motion had no effects on the overall shaping performance of the 3 instruments tested. An exception was the increase in prepared surface area in the apical canal segment when the Reciproc instrument was used with brushing strokes.

The impact of the COVID-19 pandemic on dental trauma attendance: a systematic review and meta-analysis.

This systematic review and meta-analysis aimed to analyze the impact of the COVID-19 pandemic on dental trauma patient attendance. The study was registered in the PROSPERO system, using the CRD42021288398 protocol. Searching was performed in PubMed, Scopus, Web of Science, Embase, Lilacs, and OpenGrey databases, using the following keywords: "Tooth injuries," "Dental trauma," "Traumatic Dental injury," and "COVID-19". We included observational studies evaluating dental trauma in the context of the COVID-19 pandemic. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Studies. Meta-analysis was performed in RevMan 5.4 software with Odds Ratios as a pooled measure of effect, with a 95% confidence interval, and using random-effects modeling. After applying the eligibility criteria, 32 studies were included for qualitative analysis, in which 10 were used to assess the frequency of dental trauma diagnoses in dental emergencies. Despite the decrease of visits during COVID-19, the analysis revealed no difference between the pandemic and pre-pandemic periods. Regarding the type of dental trauma, two of the studies revealed no differences for the periods before and during the pandemic. This study revealed that the COVID-19 pandemic has not impacted the frequency or type of dental trauma compared to previous periods.

The impact of the COVID-19 pandemic on dental trauma attendance: a systematic review and meta-analysis

Abstract This systematic review and meta-analysis aimed to analyze the impact of the COVID-19 pandemic on dental trauma patient attendance. The study was registered in the PROSPERO system, using the CRD42021288398 protocol. Searching was performed in PubMed, Scopus, Web of Science, Embase, Lilacs, and OpenGrey databases, using the following keywords: "Tooth injuries," "Dental trauma," "Traumatic Dental injury," and "COVID-19". We included observational studies evaluating dental trauma in the context of the COVID-19 pandemic. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Studies. Meta-analysis was performed in RevMan 5.4 software with Odds Ratios as a pooled measure of effect, with a 95% confidence interval, and using random-effects modeling. After applying the eligibility criteria, 32 studies were included for qualitative analysis, in which 10 were used to assess the frequency of dental trauma diagnoses in dental emergencies. Despite the decrease of visits during COVID-19, the analysis revealed no difference between the pandemic and pre-pandemic periods. Regarding the type of dental trauma, two of the studies revealed no differences for the periods before and during the pandemic. This study revealed that the COVID-19 pandemic has not impacted the frequency or type of dental trauma compared to previous periods.

Clinical Approach of Extensive Periapical Lesion with Periradicular Regenerative Surgery: A Case Report with 7 Year Follow Up

The aim of this study is to report a case of two maxillary incisors with chronic apical abscess and through-and-through lesion submitted to periradicular regenerative surgery, with clinical follow-ups and evaluation through cone-beam computerized tomography for 7 years. In the presentation, there was a persistent sinus tract in the palate and sensibility to touch at the apical region of the central and left lateral maxillary incisors. The initial tomography revealed the presence of an extensive radiolucent area in the apical third of the referred teeth, with loss of the buccal and palatal cortic es. For the treatment, a periradicular regenerative surgery was performed, an association of endodontic surgery with Guided Tissue Regeneration technique, using bovine bone xenograft and bioabsorbable membrane. The clinical and radiographic evaluations, including cone-beam computerized tomography, at seven years postoperatively, showed absence of symptomatology and sinus tract, probing depth within normal standards and apical bone neoformation.

El objetivo de este estudio fue reportar un caso de dos incisivos superiores con absceso apical crónico y lesión transversal sometidos a cirugía regenerativa perirradicular, con seguimiento clínico y evaluación mediante tomografía computarizada de haz cónico durante 7 años. En la presentación, había un trayecto sinusal persistente en el paladar y sensibilidad al tacto en la región apical de los incisivos maxilares laterales central y lateral izquierdo. La tomografía inicial reveló la presencia de una extensa zona radiolúcida en el tercio apical de los dientes referidos, con pérdida de las cortezas bucal y palatina. Para el tratamiento se realizó una cirugía regenerativa perirradicular, asociación de cirugía endodóntica con técnica de Regeneración Tisular Guiada, utilizando xenoinjerto óseo bovino y membrana bioabsorbible. Las evaluaciones clínicas y radiográficas, incluida la tomografía computarizada de haz cónico, a los siete años del posoperatorio, mostraron ausencia de sintomatología y tracto sinusal, profundidad de sondaje dentro de los estándares normales y neoformación ósea apical.

Photodynamic Therapy as an adjunct in the Treatment of Medication-Related Osteonecrosis of the Jaw: A Case Report.

Introduction: Medication-related osteonecrosis of the jaw (MRONJ) corresponds to an adverse effect of the use of drugs such as bisphosphonates and denosumab. This condition is often associated with pain, infection, purulent secretion, paraesthesia, tooth mobility and halitosis, decreasing the patient's quality of life. The management of MRONJ tends to be conservative, through the guidance of oral hygiene, antibiotic therapy and mouthwashes. However, the use of antimicrobial photodynamic therapy (aPDT) has shown promise in the treatment of these injuries. The purpose of this article is to report a case of MRONJ treatment associated with aPDT. Case Report: A 75-year-old patient, with a history of breast cancer and use of intravenous Zoledronic Acid, presented with bilateral MRONJ lesions in tuberosity on the right and left sides. Treatment was conservatively instituted with the use of aPDT as an adjuvant. After 12 aPDT sessions, complete regression of the lesion was observed. However, after two weeks, the presence of a new lesion was noted, this time in the anterior region of the maxilla. The same protocol previously established was followed and after two aPDT sessions, the patient returned with complete lesion regression. Conclusion: The use of aPDT may represent an important adjuvant within a set of clinical protocols in the treatment of MRONJ.

The Role of the Dental Surgeon in Controlling the Dissemination of COVID-19: A Literature Review.

As early as December 2019 in the province of Hubei, China, contamination of patients with pneumonia of an unknown etiology occurred. These patients presented with symptoms such as coughing, sore throat, malaise, diarrhea, high fever, and dyspnea. This emerging disease was named COVID-19 due to being part of the group of coronaviruses (CoVs) belonging to the subfamily Orthocoronavirinae, in the Coronaviridae family and in the Nidovirales order. COVID-19 is most commonly transmitted through speech, coughing, sneezing, and salivary sputum. Because dental professionals work closely with the oral cavity, it is imperative that infection prevention controls are strictly adhered to. It is important that the dental profession treats patients while also limiting the possible contamination through the production of aerosol in the dental environment. Furthermore, the dental professional also has a key role in raising awareness and guidance amongst the population concerning COVID-19 related biosafety measures. This literature review aims to inform dental professionals about the COVID-19 pandemic and to present the implications of the virus to the dentist. Dental professionals are considered to be at high risk for contracting SARS-CoV-2.

Micro-CT analysis of dentinal microcracks on root canals filled with a bioceramic sealer and retreated with reciprocating instruments.

This study aimed to analyze the potential occurrence of dentinal defects after the removal of a root canal filling with two different sealers using Reciproc (RC) or Reciproc Blue (RB). The mesial roots of 60 mandibular molars with a Vertucci type IV configuration were selected. The samples were initially instrumented with Reciproc (R25) and then divided into the following four experimental groups according to the endodontic sealer and retreatment instrument (n = 15): BC Sealer/Reciproc (BCRC); BC Sealer/Reciproc Blue (BCRB); AH Plus/Reciproc (AHRC); and AH Plus/Reciproc Blue (AHRB). Then, the samples were scanned under micro-CT after obturation and removal of the filling material. Two analyses were conducted. First, an evaluation was performed on all the axial images, and another analysis evaluated each millimeter of the 10 mm from the apex. Dentinal defects were observed in all the samples. All of the identified defects in the images after filling material removal were present in the corresponding images after obturation. The use of AH Plus and EndoSequence BC Sealer, and filling material removal using RC and RB instruments did not induce dentinal defects.

Antibacterial Effect of Photodynamic Therapy on Root Canal Disinfection Combined with Different Irrigation Protocols.

Introduction: Photodynamic therapy (PDT) is an emerging alternative therapy to conventional endodontic treatment to optimize bacterial elimination. The aim of this study was to evaluate the in vitro antibacterial effect of PDT combined with different irrigation protocols on root canals inoculated with Enterococcus (E.) faecalis. Methods and Materials: Ninety uni-radicular human premolars were prepared and contaminated with E. faecalis for 4 days. Teeth were randomly divided into six groups: positive control group (C+) consisted of conventional needle irrigation with 2.5% sodium hypochlorite (NaOCl); negative control group (C-) consisted of no treatment after contamination; PDT group as treated with 0.005% methylene blue and diode laser irradiation for 90 sec at wavelength of 660 nm, energy of 9 Joules, power of 100 mW; the fourth group consisted of NaOCl+PDT, the fifth group were treated with passive ultrasonic irrigation (PUI) with NaOCl+PDT (PUI+PDT); and the final group were treated with XP Endo Finisher with NaOCl+PDT (XP Endo+PDT). The contents of the root canals were collected with sterile absorbent paper points at two times: before and 24 h after decontamination protocols. The number of colony-forming units (CFU) was determined for each root canal. ANOVA and the Tukey test were used, with significance set at 5% (P<0.05). Results: The inhibition percentage ranged from 10.72 (C-) to 100% (XP Endo+PDT), with CFU/mL counts differing among all protocols tested (P<0.05). The different protocols significantly influenced bacterial inhibition (P<0.05). However, the XP Endo+PDT protocol resulted in the highest inhibition percentage (100%), followed by NaOCl+PDT (65.85%). Conclusions: PDT combined with different final irrigation protocols was more effective in inhibiting E. faecalis growth than photodynamic therapy alone. XP Endo was the best irrigation protocol to eradicate this microorganism.

Reciproc and Reciproc Blue in the removal of bioceramic and resin-based sealers in retreatment procedures.

OBJECTIVES: To compare the remaining root canal filling material, dentin removal, apical transportation, and apical extrusion of debris after the retreatment of canals filled with bioceramic or resin-based sealers using the Reciproc or Reciproc Blue instruments. MATERIALS AND METHODS: Sixty mandibular molars with severely curved mesial roots were selected. The samples were initially instrumented with Reciproc (R25) and then divided into four experimental groups according to the endodontic sealer and retreatment instrument (n = 15): BC Sealer/Reciproc (BCRC), BC Sealer/Reciproc Blue (BCRB), AH Plus/Reciproc (AHRC), and AH Plus/Reciproc Blue (AHRB). The procedure time was measured, and an Eppendorf tube was used in each root canal to store the debris extrusion. The samples were scanned by micro-CT before and after retreatment. The apical transportation, volume of dentin, and filling material were evaluated. RESULTS: There were no significant differences in the reduction of the volume of obturator material or dentin removal between groups (p > .05). There were also no differences in the amount of extruded material or apical transportation (p > .05). The retreatment time for the AHRC group was significantly lower than that for the other groups (p = .004). CONCLUSIONS: All tested instruments obtained similar efficacy in filling material removal procedures, although no system completely removed the filling material. Retreatment of canals filled with bioceramic BC Sealer may be more time consuming. CLINICAL RELEVANCE: This study reported that Reciproc and Reciproc Blue can be indicated in retreatment of severely curved root canals filled either with bioceramic or resin-based sealers.

Quantitative analysis of apically extruded bacteria following preparation of curved canals with three systems.

This study compared the amount of apically extruded bacteria following preparation of curved root canals using two continuously rotating multifile and one reciprocating single-file systems. Mesiobuccal canals from maxillary molars were contaminated with Enterococcus faecalis and divided into three groups according to the instrumentation system: Reciproc (R25 instrument, 25/.08), BT-RaCe (10/.06, 35/.00 and 35/.04), and Mtwo (25/.06, 30/.05 and 35/.04). Apically extruded material was collected by a customized apparatus with 1.5% agarose gel covering the root apex to simulate the periradicular tissues. The extruded material was extracted from the gel and subjected to bacteriological culture for bacterial quantification. The three systems showed a high frequency of bacterial extrusion (>70%). There were no statistically significant differences in the counts of extruded bacteria between groups (P > 0.05). The incidence and amount of apical bacterial extrusion were similar between the three systems. The customized apparatus was effective in collecting apically extruded bacteria.

Bacterial Reduction after Gutta-Percha Removal with Single vs. Multiple Instrument Systems.

INTRODUCTION: The aim of this study was to evaluate the effectiveness of a reciprocating single-instrument system (Reciproc-REC) compared with combined continuously rotating multiple-instrument systems [D-Race (DR) and BioRace (BR)] in reducing Enterococcus faecalis (E.f.) after gutta-percha removal. METHODS AND MATERIALS: Forty-six extracted human maxillary incisors were prepared and contaminated with E.f. strain (ATCC 29212) for 30 days. The samples were obturated and randomly divided into two experimental groups for gutta-percha removal (n=23): a REC group (R50) and a DR/BR group (DR1, DR2 and BR6). A standardized irrigation with 0.9% saline solution was performed. Root canal samples were taken with paper points before (S1) and after (S2) the removal of gutta-percha to establish bacterial quantification by culture. The time required for gutta-percha removal was also recorded. Positive and negative control groups (n=6) were used to test bacterial viability and control asepsis, respectively. Data were analysed using t-Student and one-way ANOVA tests (5% margin of error). RESULTS: The mean percentage of bacterial reduction was significantly higher in DR/BR group (84.2%) than in REC group (72.3%) (P<0.05). The mean time for obturation removal was 74.00 sec in REC group and 107.53 sec in DR/BR group (P<0.05). CONCLUSION: The combined continuously rotating multiple-instrument system was more effective in reducing bacteria after the removal of gutta-percha than the single-instrument system. None of the tested systems was able to completely eliminate root canal infection after gutta-percha removal. Thus, additional techniques should be considered.

Effects of Reciproc, ProTaper Next and WaveOne Gold on Root Canal Walls: A Stereomicroscope Analysis.

INTRODUCTION: The aim of this study was to analyse the potential occurrence of dentinal defects after root canal preparation using three engine-driven instruments. METHODS AND MATERIALS: Eighty permanent mandibular incisors were selected. Twenty teeth did not undergo preparation, and the remaining teeth were divided into three groups (n=20): Reciproc (REC), ProTaper Next (PTN) and WaveOne Gold (WOG). The samples were dyed with methylene blue, sectioned perpendicularly to the long axis in 3-, 6- and 9-mm slices and were finally observed under a stereomicroscope (under 25×). The absence/presence of dentinal defects was documented by two blind observers. The data were analysed using Pearson's chi-squared test with a confidence level of 95% (P=0.05). The time to prepare the samples was recorded, and the groups were compared using F-test (ANOVA). RESULTS: The control group did not present any defects, and the differences between the control and experimental groups were statistically significant (P<0.05). WOG, PTN and REC caused microcracks on 60%, 33.33% and 18.33% of the samples, respectively. No significant differences between the groups in the 3-mm sections (P=0.126) were observed. There were significant differences in the 6-mm (P=0.042) and 9-mm sections (P<0.001). When WOG and PTN were used to perform root canal preparation, a significant difference was found in the average time (P=0.047). CONCLUSION: All the used instruments caused dentinal defects in the root dentin. All the instruments were used to perform the preparation with a similar average time.

Occurence of dentinal defects after root canal preparation with R-phase, M-Wire and Gold Wire instruments: a micro-CT analysis.

BACKGROUND: This study aims to evaluate the frequency of dentinal defects after root canal preparation with the ProTaper NEXT, K3XF and WaveOne GOLD systems using microcomputed tomography. METHODS: Sixty permanent mandibular incisors with a single canal were selected. Inspection of the teeth was performed under a stereomicroscope (15x) to observe the presence of pre-existing cracks and fractures lines. Samples were divided into three experimental groups (n = 20): ProTaper NEXT (PTN), K3XF (K3XF) and WaveOne GOLD (WOG). Specimens were scanned through high-resolution microcomputed tomography before and after the preparation of the root canal. Subsequently, all the axial images were examined by two different methods to find possible dentinal defects. Furthermore, an analysis of each millimeter of ten apical millimeters was also performed. The absence or presence of dentinal defects was screened by 3 pre-calibrated blinded examiners. RESULTS: After analysing all 45,720 slices, dentinal defects were observed in 48,33% (22096 slices). PTN, K3XF and WOG groups represented 11,11% (5079 slices), 17,22% (7873 slices) and 20% (n = 9144) of the cross-sectional images, respectively. At 10 apical millimeters (600 slices), 33,33% (200 slices) presented some dentinal defects, representing 7,22% (43 slices), 13,33% (80 slices) and 12,77% (77 slices) of the cross-sectional images in the PTN, K3XF and WOG groups, respectively. All the dentinal defects presented in the postoperative images existed in the images prior to instrumentation. CONCLUSIONS: There was no correlation between the preparation of a root canal using the PTN, K3XF and WOG systems and the formation of new dentinal defects.

Apical Extrusion of Debris Produced during Continuous Rotating and Reciprocating Motion.

This study aimed to analyse and compare apical extrusion of debris in canals instrumented with systems used in reciprocating and continuous motion. Sixty mandibular premolars were randomly divided into 3 groups (n = 20): the Reciproc (REC), WaveOne (WO), and HyFlex CM (HYF) groups. One Eppendorf tube per tooth was weighed in advance on an analytical balance. The root canals were instrumented according to the manufacturer's instructions, and standardised irrigation with 2.5% sodium hypochlorite was performed to a total volume of 9 mL. After instrumentation, the teeth were removed from the Eppendorf tubes and incubated at 37°C for 15 days to evaporate the liquid. The tubes were weighed again, and the difference between the initial and final weight was calculated to determine the weight of the debris. The data were statistically analysed using the Shapiro-Wilk, Wilcoxon, and Mann-Whitney tests (α = 5%). All systems resulted in the apical extrusion of debris. Reciproc produced significantly more debris than WaveOne (p < 0.05), and both systems produced a greater apical extrusion of debris than HyFlex CM (p < 0.001). Cross section and motion influenced the results, despite tip standardization.

Abordagem dos cirurgiões-dentistas do Estratégia de Saúde da Família do município de Patos-PB a usuários com hipertensão arterial / Approach of dentists of the family health strategy of the city of Patos-PB to users with hypertension

Objetivo: o objetivo deste trabalho é verificar o conhecimento dos cirurgiões-dentistas dos Estratégias de Saúde da Família (ESF) do município de Patos-PB, no atendimento a usuários com hipertensão arterial (HA). Materiais e métodos: é um estudo do tipo transversal e analítico, no qual foi aplicado um questionário estruturado com 21 profissionais dos ESFs de Patos-PB. Os dados obtidos foram analisados a partir da estatística descritiva e inferencial bivariada (testes Qui-Quadrado e Exato de Ficher). Resultados: dos pesquisados, 85,7% definiram hipertensão arterial, mas apenas 44,4% desses responderam corretamente; 95,2% responderam corretamente o valor normal da pressão arterial. A xerostomia foi a alteração causada pelo uso de anti-hipertensivo mais citada (85,71%); a lidocaína foi o anestésico de escolha (61,9%); a interação medicamentosa mais citada (48,6%) foi a dos anti-hipertensivos com os anti-inflamatórios não estereoidais e com os analgésicos com ácido acetilsalicílico (AAS). Participam do Programa Hiperdia 66,7% dos entrevistados e 33,3% relataram aferir a pressão dos usuários, dependendo da anamnese realizada. Observou-se a associação estatística entre trabalhar em outro local e definir correta-mente a HA (p=0,006). Conclusão: os profissionais que participaram da pesquisa mostraram um conhecimento relativamente adequado/producente, realizando uma conduta condizente com o que a literatura sugere, mas, ainda, necessitando de maiores esclarecimentos sobre o tema, para suprir suas dificuldades.

Sucesso da cirurgia perirradicular na resolução de infecção endodôntica persistente com controle tomográfico de 2 anos / Success of periradicular surgery in persistent endodontic infection resolution with CT control of 2 years

O presente relato de caso tem como objetivo descrever e discutir o tratamento de um dente incisivo central superior direito tratado endodonticamente, com presença de reabsorção radicular apical e radiolucencia periapical. Ao exame clínico a paciente se encontrava com fístula na região apical da mucosa vestibular do referido dente. Ao exame por imagens a radiografia periapical e tomografia computadorizada conebeam, revelaram a presença de área radiolúcida no terço apical, dentro do canal radicular, inacessível aos procedimentos do preparo químico-mecânico tornado o retratamento endodôntico incerto. Dessa forma, a cirurgia perirradicular foi a terapêutica instituída, com a realização da apicectomia, retropreparo e retrobturação do canal radicular, com uso de insertos ultrassônicos apropriados e do Agregado Trióxido Mineral (MTA), respectivamente. Após dois anos de proservação pôde-se observar o controle da infecção endodôntica. O tratamento foi considerado um sucesso, visto que a paciente se encontrava assintomática, com ausência de fístula e com regressão completa da radiolucência periapical e neoformação ãssea. Pode-se concluir que a cirurgia perirradicular apresentou-se como um tratamento eficaz para a resolução do referido caso clínico, possibilitando um grau de desinfecção compatível com a cura perirradicular para o paciente... (AU)

This case report aims to describe and discuss the treatment of a right maxillary central incisor tooth, endodontically treated, with presence of an internal root resorption and periradicular radiolucency. On clinical examination the patient presented a sinus tract at the apical buccal mucosa of this tooth. The periapical radiograph and cone beam computed tomography detected the presence of radiolucent area inside root canal (apical third). This area showed to be inaccessible to adequate chemical-mechanical preparation, so, the endodontic retreatment would give an uncertain prognosis. Thus, the periradicular surgery was the indicated therapy for this case, including apicectomy, retropreparation and root canal retrofilling, with the use of appropriated ultrasonic inserts and Mineral trioxide aggregate (MTA), respectively. After two years of follow-up, the endodontic infection control was observed. The treatment was considered a success, as the patient was asymptomatic, with no sinus tract and with complete regression of periapical radiolucency and bone formation. It can be concluded that the periradicular surgery was an effective treatment for the patient, allowing a degree of disinfection compatible with periradicular cure... (AU)

Analysis of the effect of ultrasonic agitation on the cleaning of root canals using different periods during the final irrigation

Introduction: The ultrasonic agitation was introduced as an adjuvant to conventional chemo-mechanical debridement during endodontic treatment to overcome the persistence of biofilms. Objective: To verify the cleaning of root canals irrigated with sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA), with or without an ultrasonic agitation, using different time periods and images obtained by scanning electron microscope (SEM). Material and methods: Forty mandibular incisors were cleaned, shaped and randomly divided into five groups according to the final irrigation protocol: SH10 group (ultrasonic agitation with NaOCl for 10 s), SH30 group (ultrasonic agitation with NaOCl for 30 s), SHE30 group (ultrasonic agitation with NaOCl and EDTA for 10 s), SHE90 group (ultrasonic agitation with NaOCl and EDTA for 30 s), and control group (NaOCl and EDTA without ultrasonic agitation). The teeth were prepared and analyzed by SEM at ×2000. The Kruskal-Wallis test was used with a 5% level of significance. Results: For the cervical and medial thirds, there was no statistically significant difference in cleaning among the protocols used (p > 0.05). For the cleaning of the apical third, SHE90 group demonstrated a significant difference (p < 0.05), as compared to the control and SH10 groups. Conclusion: For the final irrigation, an ultrasonic agitation with NaOCl and EDTA for 30 s allowed a better cleaning of the debris in the apical third of the root canal.

Análise in vitro da infiltração cervical bacteriana em dentes preenchidos com pastas de hidróxido de cálcio / In vitro analysis of coronal bacterial leakage in teeth filled with calcium hydroxide pastes

Objetivo: Avaliar o efeito de barreira física de duas pastas de hidróxido de cálcio com diferentes veículos em canais radiculares expostos à saliva humana por um período de vinte dias. Método: Cinqüenta dentes humanos uniradiculares foram divididos em dois grupos experimentais com vinte dentes cada, um grupo controle positivo com 5 dentes e um grupo controle negativo com 5 dentes. O preparo químico-mecânico tipo coroa-ápice foi realizado sob irrigação com NaOCl a 1% e E.D.T.A. a 17%. Após esterilização dos dentes, foram aplicadas a pasta de hidróxido de cálcio em água destilada (Grupo I) e pasta de hidróxido de cálcio com paramonoclorofenol canforado (PMCC) em polietilenoglicol 400 (Grupo II). O comportamento do efeito de barreira física das pastas foi observado durante um período de 20 dias, através do uso de aparato nos quais foram inseridos meio de cultura Brain Heart Infusion (BHI), o dente com as referidas pastas e saliva humana em BHI, todos acomodados separadamente. Resultados: Após período analisado, ocorreu turvação em apenas 1 caso dos vinte espécimes (5%) do grupo com hidróxido de cálcio em água destilada (Grupo I). No grupo com hidróxido de cálcio e PMCC em polietilenoglicol 400 (Grupo II) ocorreu turvação em 5 meios de cultura (25%). Conclusão: Ambas as pastas de hidróxido de cálcio analisadas atuaram como barreira física à infiltração cervical de canais radiculares expostos ao meio contaminado, contudo observou-se que o grupo com hidróxido de cálcio em água destilada obteve menor número de espécimes infiltrados, com diferença estatística comprovada, em relação ao grupo com hidróxido de cálcio e PMCC em polietilenoglicol 400.

Objective: To evaluate the physical barrier effect of two calcium hydroxide pastes prepared with different vehicles in root canals exposed to human saliva for 20 days. Method: Fifty single-rooted human teeth were divided into two experimental groups with 20 teeth each, one positive control group with 5 teeth and one negative control group with 5 teeth. A crown-down chemomechanical preparation was performed under irrigation with 1% NaOCl and 17% EDTA. After sterilization of the teeth, the canals were filled with either a paste of calcium hydroxide and distilled water (Group I) or a paste of calcium hydroxide with camphorated paramonochlorophenol (PMCC) and polyethylene glycol 400 (Group II). The behavior of the physical barrier effect of the pastes was observed during 20 days, through the use of an apparatus in which were placed brain heart infusion (BHI) culture medium, the tooth filled with paste and human saliva in BHI, all of them accommodated separately. Results: After the established period, turbidity occurred in only 1 of the 20 specimens (5%) of the group filled with a paste of calcium hydroxide and distilled water (Group I). In the group filled with a paste of calcium hydroxide and PMCC in polyethylene glycol 400 (Group II) turbidity occurred in 5 specimens (25%). Conclusion: It may be concluded that both calcium hydroxide pastes analyzed in the study acted as a physical barrier to coronal leakage in root canals exposed to a contaminated environment; however, the group filled with calcium hydroxide and distilled water showed a smaller number of specimens with leakage, differing significantly from the group filled with calcium hydroxide with PMCC and polyethylene glycol 400.