Guided endodontic treatment in a region of limited mouth opening: a case report of mandibular molar mesial root canals with dystrophic calcification.

BACKGROUND: The endodontic treatment of calcified root canals in molars is a challenging and time-consuming procedure. Even with the aid of a surgical microscope, the risk of root perforation is high, especially in the furcation area. The purpose of this study is to report the Computer-Aided-Design and Manufacturing (CAD-CAM) workflow, the innovative strategies for the template ideation, and the guided endodontic treatment of a mandibular molar with dystrophic calcification in the mesial root canals. CASE PRESENTATION: A 58-year-old female patient, ASA I, was referred to endodontic treatment in the right first mandibular molar for prosthetic reasons. The mesiobuccal and mesiolingual canals appeared obliterated in the radiographic images. The absence of dental crown, tooth inclination, and the limited mouth opening of the region contributed to a poor visual reference of the tooth in the dental arch and the direction of the remaining lumens of the canals. Despite using surgical microscopy, the conventional technique led to the deviation of the mesiobuccal canal towards the furcation area. The obliteration of both mesial root canals was confirmed using the Cone Beam Computer Tomography. The clinical history associated with the tomography diagnosis was compatible with dystrophic calcifications in the pulp canals. The patient was submitted to an intra-oral scanning as well. The Digital Imaging and Communications in Medicine data (DICOM) were segmented. The Standard Tessellation Language (STL) files were processed following the CAD-CAM workflow, aiming to create two different endodontic templates with a new open design concept. The templates with open design allowed direct visualization of the operative field, irrigation, and dentin debris removal. The strategy of the guidance sleeves niche as half-cylinders allowed the drill insertion in a limited mouth opening region. CONCLUSIONS: The digital planning and guided access permitted to overcome the case limitations and then re-establish the glide path following the original anatomy of the root canals. The guided endodontic represents a personalized technique that provides security, reduced risks of root perforation, and a significant decrease of the working time to access obliterated root canals even in the mesial root canal of mandibular molars, a region of limited mouth opening.

Calcium silicate-based cements cause environmental stiffness and show diverse potential to induce osteogenesis in human osteoblastic cells.

Calcium silicate-based cements differ markedly in their radiopacifiers and the presence of calcium sulfate, aluminates, carbonates and other components that can affect their biological properties. This study aimed to compare the biological properties of six calcium silicate cements in human osteoblastic cell culture (Saos-2 cells): Bio-C Repair (Bio-C), PBS HP (PBS-HP), Biodentine (Biodentine), MTA Repair HP (MTA-HP), NeoMTA Plus (NeoMTA-P), and ProRoot MTA (ProRoot). After exposure to these materials, the cells were analyzed by MTT, wound healing, cell migration, and alkaline phosphatase activity (ALP) assays, real-time PCR (qPCR) analysis of the osteogenesis markers (osteocalcin or bone gamma-carboxyglutamate protein, BGLAP; alkaline phosphatase, ALPL; bone sialoprotein or secreted phosphoprotein 1, BNSP), and alizarin red staining (ARS). Curiously, the migration rates were low 24-48 h after exposure to the materials, despite the cells showing ideal rates of viability. The advanced and intermediate cell differentiation markers BGLAP and BNSP were overexpressed in the Bio-C, MTA-HP, and ProRoot groups. Only the Biodentine group showed ALPL overexpression, a marker of initial differentiation. However, the enzymatic activity was high in all groups except Biodentine. The mineralization area was significantly large in the NeoMTA-P, ProRoot, PBS-HP, MTA-HP, and Bio-C groups. The results showed that cellular environmental stiffness, which impairs cell mobility and diverse patterns of osteogenesis marker expression, is a consequence of cement exposure. Environmental stiffness indicates chemical and physical stimuli in the microenvironment; for instance, the release of cement compounds contributes to calcium phosphate matrix formation with diverse stiffnesses, which could be essential or detrimental for the migration and differentiation of osteoblastic cells. Cells exposed to Bio-C, PBS-HP, ProRoot, NeoMTA-P, and MTA-HP seemed to enter the advanced or intermediate differentiation phases early, which is indicative of the diverse potential of cements to induce osteogenesis. Cements that quickly stimulate osteoblast differentiation may be ideal for reparative and regenerative purposes since they promptly lead to dentin or bone deposition.

Cimento biocerâmico no tratamento conservador de perfuração radicular em molar inferior / Bioceramic sealer in conservative treatment of mandibular molar root perforation

Introdução: A perfuração radicular é um acidente técnico-operatório que resulta em comunicação da cavidade pulpar com os tecidos periodontais. Esse tipo de acidente pode apresentar prognóstico desfavorável, por afetar significativamente o soalho da câmara coronária ou os terços cervical, médio e apical do canal radicular. Entre os fatores que interferem no prognóstico das perfurações radiculares, destacam-se: localização, extensão, presença ou ausência de bolsa periodontal; tempo decorrido entre a perfuração e o tratamento; e tipo de material obturador. Nesse contexto, os cimentos obturadores de canais denominados biocerâmicos surgiram como uma proposta inovadora para tratamento de perfurações antes consideradas de prognóstico desfavorável. Objetivo: O presente trabalho teve por objetivo relatar o tratamento de uma perfuração radicular em molar inferior com o cimento biocerâmico EndoSequence BC Sealer, com três anos de acompanhamento. Resultados: As imagens radiográficas e os dados clínicos do paciente evidenciaram o sucesso no tratamento da perfuração, com reparo da lesão perirradicular. Conclusão: O cimento endodôntico biocerâmico EndoSequence BC Sealer associado com a retomada do trajeto original do conduto e sua instrumentação favoreceram o reparo dos tecidos perirradiculares, sugerindo propriedades biológicas promissoras de compatibilidade e bioativida (AU).

Introduction: Root perforation is a technical-surgical accident that results in communication of the pulp cavity with periodontal tissues. This type of accident may have an unfavorable prognosis because it significantly affects the floor of the coronary chamber or the cervical, middle and apical thirds of the root canal. Factors that interfere with the prognosis of root perforations include location, extension, presence or absence of periodontal pocket, time elapsed between perforation and treatment, and type of obturator material. In this context, bioceramic canal sealers have emerged as an innovative proposal for treatment of perforations previously considered to have an unfavorable prognosis. Objective: The aim of this study was to report the treatment of a lower molar root perforation with the EndoSequence BC Sealer bioceramic sealer after a 3-year follow up. Results: Radiographic images and patient clinical data showed success in the treatment of perforation with repair of the periradicular lesion. Conclusion: Endo-Sequence BC Sealer bioceramic endodontic sealer associated with the resumption of the original conduit path and its instrumentation favored the repair of periradicular tissues, suggesting promising biological properties of compatibility and bioactivity (AU).

Utilização do BIO-C TEMP® como medicação intracanal em tratamento de um dente permanente avulsionado e reimplantado tardiamente: relato de caso / Use of BIO-C TEMP® as intrachanal medication in treatment of a permanent tooth permanent and replanted later: case report

A avulsão dentária consiste no completo deslocamento traumático do dente do interior de seu alvéolo, ocasionando rompimento do suprimento sanguíneo e fibras periodontais. O reimplante imediato é considerado como melhor conduta, porém, nem sempre é possível. Quando necessário o tratamento endodôntico, é desejável que se utilizem materiais com boas propriedades biológicas e principalmente uma medicação intracanal biocompatível e que estimule a reparação tecidual. Objetivo: relatar um caso clínico de tratamento endodôntico utilizando um material à base de silicato de cálcio como medicação intracanal em um dente permanente avulsionado e reimplantado tardiamente. Relato de caso: paciente do gênero masculino, 13 anos de idade, compareceu à clínica odontológica com o dente 12 avulsionado. O dente permaneceu fora da cavidade oral por cerca de 30 minutos e o meio de armazenamento foi soro fisiológico. Após a limpeza e o reposicionamento do elemento dentário, fez-se necessária a instalação da contenção com fio semirrígido. Posteriormente, o tratamento endodôntico foi realizado, no qual a medicação intracanal de escolha foi o BIO-C TEMP®, sendo realizada a proservação por 24 meses. Consideração final: o uso de um material à base de silicato de cálcio que possui propriedades biológicas importantes e formulação "pronta para uso" pode ser uma alternativa promissora como medicação intracanal em dentes traumatizados.(AU)

Tooth avulsion consists of the complete traumatic displacement of the tooth from the inside of its alveolus, causing rupture of the blood supply and periodontal fibers. Immediate reimplantation is considered the best approach, however, it is not always possible. When endodontic treatment is necessary, it is desirable to use materials with good biological properties and especially biocompatible intracanal medication that stimulates tissue repair. Objective: to report a clinical case of endodontic treatment using a material based on calcium silicate as intracanal medication in an avulsed and late reimplanted permanent tooth. Case report: male patient, 13 years old, came to the dental clinic with the tooth 12 avulsed, remained outside the oral cavity for about 30 minutes, the storage medium was saline. After cleaning and repositioning the element, it was necessary to install the containment with semi-rigid wire. Subsequently, endodontic treatment was performed, in which the intracanal medication was BIO-C TEMP® and followed up for 24 months. Final consideration: the use of calcium silicate-based material has important biological properties and a "ready-to-use" formulation, which can be a promising alternative as an intracanal medication in traumatized teeth.

Avaliação do filtro de luz das câmaras escuras portáteis e de sua influência na qualidade da imagem radiográfica

Introdução: a Portaria 453 do Ministério da Saúde recomenda processar filmes radiográficos intrabucais em câmara escura portátil opaca, sem visor e pelo método temperatura x tempo. Porém, ainda é frequente o processamento pelo método visual em câmaras com visor de polímero de acrílico.O objetivo deste estudo foi avaliar e comparar a capacidade de filtragem de quatro câmaras escuras portáteis (Unemol®,VH®, MPG® e câmara sem identificação) com a de uma câmara escura convencional (controle), e verificar sua influência na qualidade de imagem em diferentes filmes radiográficos (Kodak®: DF-58 Ultra-Speed, E-Speed, IP-21 Insight; e Agfa®Dentus M2). Métodos: os filmes foram expostos junto comum penetrômetro de alumínio e uma placa de chumbo e processados,em soluções Kodak® prontas para uso, em cada câmara portátil e na câmara escura convencional (controle).Os filmes permaneceram três minutos no revelador e a cada minuto eram aproximados do visor, simulando a condição clínica, seguido de banho intermediário e fixação por seis minutos. Foi feita a avaliação fotodensitométrica e os dados foram analisados estatisticamente pelos testes de Mann-Whitneye Kruskal-Wallis. Resultados: o primeiro teste mostrou que, em relação ao grupo controle, somente não houve diferença estatística significativa com a câmara Unemol® quando da utilização dos filmes IP-21 Insight e E-Speed, e com a câmara VH® ao usar o filme IP-21 Insight. O segundo teste mostrou diferença estatística significativa quando da comparação dos filmes entre si. Conclusão: conclui-se que o visor de acrílico aumenta a densidade base e velamento, prejudicando a qualidade da imagem radiográfica