C-shaped canal configuration in lower molar: Case report / Canal radicular com configuração em C em molar inferior: Relato de caso

A configuração de canais em formato de C em molares é uma variação anatômica que dificulta o diagnóstico e tratamento. O objetivo deste estudo foi relatar um caso de configuração de canal em C no segundo molar inferior. O exame radiográfico do paciente revelou uma cárie extensa na porção mesial do segundo molar inferior, sem a presença de lesão periapical e foi clinicamente observada a configuração em C do canal radicular, que se estendeu desde o canal mesiovestibular até o canal distal. A terapia endodôntica foi realizada e após a obturação dos canais, o dente foi restaurado. Concluiu-se que após 12 meses de acompanhamento clínico e radiográfico, verificou-se que a terapia teve um resultado satisfatório.

C-shape configuration in molars is an anatomical variation that difficults diagnosis and treatment. The aim of this study was to report a case of C-shape endodontic configuration in a mandibular second molar. The radiographic examination of one patient revealed the extent of caries in the mesial aspect of mandibular second molar, without the presence of periapical lesion and was clinically noted the C-shape configuration of the root canal, extending from the mesiobuccal to the distal canal. Endodontic therapy was performed and after the root canal filling, the tooth was restored. We conclude that after 12 months of clinical and radiographic follow-up, satisfactory outcome of the treatment was observed

Alternativa estética em dente cromaticamente alterado através do esvaziamento dentinário / Aesthetic alternative for discolored tooth through dentin removal

O objetivo deste trabalho é descrever o tratamento estético em um dente escurecido empregando a técnica de esvaziamento dentinário. Após a substituição de parte da dentina coronária escurecida por uma resina composta, verificou-se mudança cromática do dente. Concluímos que o esvaziamento coronário é uma opção estética para a manutenção do aspecto natural do esmalte sem a utilização de facetas diretas ou coroas protéticas em dentes cromaticamente alterados.

The aim of this paper is to describe the treatment of a darkened tooth using the removal dentin technique. After, the replacement of the discolored dentin by composite resin, a dramatic improvement of the tooth shade was verified. We conclude that the removal of dentin is an aesthetic option for maintaining the natural appearance of enamel without the use of direct veneers or prosthetic crowns in chromatically changed teeth.

Efeito solvente das soluções de hipoclorito de sódio, comercializadas na região de Pelotas/RS, sobre o tecido pulpar bovino / Solvent effect of sodium hypochlorite solutions commercialized in Pelotas / RS, on bovine pulp tissue

Objetivo: avaliar a dissolução de tecido pulpar bovino nas soluções de hipoclorito de sódio comercializadas na região de Pelotas/RS. Métodos: foram testados o líquido de Dakin, a solução de Milton, licor de Labarraque e soda clorada duplamente concentrada, aviadas em farmácias de manipulação e adquiridas em lojas de materiais odontológicos. Avaliaram-se, também, as águas sanitárias das marcas Qboa, Clorofina e Brilhante, adquiridas em estabelecimentos comerciais, e uma solução aviada em farmácia de manipulação. Para a realização dos testes de dissolução tecidual, utilizou-se uma bomba peristáltica contendo 15ml de solução de hipoclorito de sódio, na qual foram inseridos fragmentos de polpa bovina, previamente seccionados, em frações de 10mm de sua porção central. Os dados de dissolução pulpar, segundo diferentes delineamentos, foram submetidos ao teste de normalidade de Anderson-Darling, que direcionou para os testes paramétricos ou não-paramétricos. Resultados: os hipocloritos a 5% exibiram a maior capacidade de solver o tecido pulpar bovino, enquanto o líquido de Dakin exibiu a menor, e os produtos a 2,5% e de 2,0 a 2,5% exibiram capacidade intermediária de dissolução pulpar bovina. A capacidade de solver o tecido pulpar bovino não foi observada na totalidade das amostras testadas

Abordagem multidisciplinar para o tratamento das sequelas de uma reabsorção radicular cervical / Multidisciplinary approach for treatment of cervical root resorption lesions

O presente trabalho relata o tratamento clínico integrado de uma seqüela de reabsorção cervical que evoluiu para fratura da coroa dentária, com a invasão do espaço biológico periodontal. Paciente de 14 anos de idade, do sexo masculino, relatando trauma no incisivo lateral direito na infância, apresentava sinais de reabsorção cervical severa, com comprometimento abaixo da junção esmalte-cemento associada a calcificação pulpar parcial. O exame clínico-radiográfico inicial sugeriu prognóstico duvidoso para o caso clínico, no entanto, uma extrusão ortodôntica radicular propiciou nova acomodação dos tecidos periodontais, além da exposição radicular adequada para reabilitação protética. O acompanhamento clínico evidenciou reabilitação protética associada à saúde periodontal, concluindo-se que a abordagem clínica multidisciplinar foi a chave para a resolução do problema.

The present study reports the clinical treatment of cervical root resorption lesions that progressed to crown fracture with biological width invasion. A 14-year-old male patient, reporting a dental trauma of the maxillary right lateral incisor presented signs of severe cervical root resorption with involvement of cemento-enamel junction associated with a partial pulp calcification. The initial clinical-radiographic suggested a doubtful prognosis. However, orthodontic root extrusion for six months improved the periodontal tissues and exposed properly the root for prosthetic rehabilitation. Clinical follow-up showed a satisfactory prosthetic rehabilitation associated with an excellent periodontal health, allowing us to conclude that the multidisciplinary approach was the key to solve the problem.

Antimicrobial activity of alexidine alone and associated with N-acetylcysteine against Enterococcus faecalis biofilm.

The purpose of this study was to assess the efficacy of alexidine (ALX), alone and combined with N-acetylcysteine (NAC), in eradicating two Enterococcus faecalis strain biofilms. The biofilms of E. faecalis ATCC 29212 and the clinical isolate E. faecalis D1 were grown in the MBEC-high-throughput device for 24 h and were exposed to five twofold dilutions of ALX (2%-0.007 8%) alone and combined with 100 mg⋅mL(-1) NAC, for 1 and 5 min. Eradication was defined as 100% kill of biofilm bacteria. The Student's t-test was used to compare the efficacy of the associations of the two irrigants. After 1-min contact time, ALX eradicated the biofilms at all concentrations except for 0.007 8% and 0.015 6%-0.007 8% with E. faecalis ATCC 29212 and E. faecalis D1, respectively. Similar results for eradication and concentration were obtained when it was combined with 100 mg⋅mL(-1) NAC. After 5 min of contact time, ALX alone and combined with NAC eradicated all enterococci biofilms. ALX showed antimicrobial properties against the two E. faecalis strain biofilms tested at very low concentrations, and its combined use with NAC was not seen to enhance its activity.

Frequência de reabsorção radicular inflamatória decorrente de trauma em dentes anteriores / Inflammatory root resorption frequency due to trauma in anterior teeth

Objetivo: a reabsorção radicular inflamatória é uma das consequências do traumatismo dentário, sendo a detecção e o tratamento precoces determinantes na limitação de seus danos. Assim, o objetivo deste estudo foi investigar, em dentes anteriores permanentes traumatizados, a prevalência de reabsorção radicular inflamatória, relacionando-a com os diferentes tipos de traumatismos nos tecidos de sustentação e dentários. Sujeitos e método: os dados relativos à reabsorção inflamatória foram coletados a partir de 111 dentes, nos prontuários de 74 pacientes de um serviço de tratamento de trauma dental da FO/UFPel, no período de 2005 a 2011. Foram registrados, ainda, o sexo e a idade dos pacientes, os dentes envolvidos no trauma, a presença de rizogênese completa ou não e o tempo inicial para o aparecimento da reabsorção. A avaliação dos dados foi realizada por estatística descritiva e teste qui-quadrado, com correção de Yates, ao nível de significância de 5%. Resultados: a reabsorção radicular inflamatória foi mais frequente em pacientes do sexo masculino, em incisivos superiores, em dentes com rizogênese completa e nas lesões de menor gravidade nos tecidos dentários e de sustentação. Ainda, as lesões nos tecidos de sustentação, quando não combinadas às fraturas dentárias, apresentaram maior frequência de reabsorção. O tempo inicial para o aparecimento da patologia foi dentro dos primeiros trinta dias após o trauma. Conclusão: é importante diagnosticar detalhadamente os traumas nos tecidos dentários, a fim de verificar o comprometimento dos tecidos de sustentação, devendo a proservação desses casos ser sistemática e contínua para interceptar a reabsorção radicular.

Objective: inflammatory root resorption is one of the consequences of dental trauma so its early detection and treatment are crucial in limiting their damage. Thus, this study aimed to investigate the prevalence of inflammatory root resorption in traumatized permanent anterior teeth, relating it to the different types of trauma in support and dental tissues. Subjects and method: data concerning inflammatory resorption were collected from 111 teeth, in medical records of 74 patients of a dental trauma care in UFPel’s Dentistry School, from 2005 to 2011. Gender and age of patients, teeth involved in the trauma, presence or absence of full rooting, and the initial time of root resorption emergence were also registered. Data assessment was performed by descriptive statistics and chi-square test with Yate’s correction, at significance level of 5%. Results: inflammatory root resorption was most frequent in male patients, in upper incisors, in teeth with complete root formation, and in minor injuries of dental and support tissues. Also, the supporting tissues injury presented higher resorption frequency when not combined with dental fractures. The starting time for pathology emergence was within the first thirty days after the trauma. Conclusion: it is important to thoroughly diagnose the trauma in dental tissues to verify the impairment of support tissues, since the proservation of these cases should be systematic and continuous to intercept root resorption.

Location and negotiability of second mesiobuccal canal in upper molar by tomographic and anatomical macroscopic analysis.

PURPOSE: The aim of this study was to assess the presence and negotiability of second mesiobuccal (MB2) canal at pulp chamber, cervical, medium and apical levels comparing the findings obtained by anatomical evaluation with cone-beam computed tomography (CBCT) images. METHODS: 56 and 43 human maxillary first and second upper molars, respectively, were assessed. The specimens were placed on an acrylic platform in a stationary position to identify the presence of MB2 canal at the pulp chamber floor, cervical, medium, and apical level. The samples were analyzed using two image acquisition softwares (XoranCat and DentalSlice) and subsequently by macroscopic anatomical analysis with a 4× magnifying glass. All data were summarized, and mean values, frequencies, and percentage values were calculated for each group of specimens. RESULTS: DentalSlice and XoranCat images of first molars showed a rate concordance index (CI) of present MB2 canals in comparison to anatomic evaluations of 65.2 and 70.1%, respectively. On the second molars, the rate of CI reached about 80 % in both sets of images. In the first molars, 29.9% of canals localized by XoranCat images did not display anatomical negotiability; 34.8% of canals localized by DentalSlice images did not display anatomical negotiability. Among second molars, 18.6% of canals localized by XoranCat did not display anatomical negotiability; 19.8% of canals localized by DentalSlice did not display anatomical negotiability. On the first molars with anatomical negotiability, errors not identified by XoranCat and DentalSlice reached rates of 22.3 and 25.4%, respectively. Among second molars, error rates were 8.7% (XoranCat) and 11.6% (DentalSlice). CONCLUSION: Our study indicated that (1) the tomographic image is an auxiliary way to detection and mapping of the MB2 canal in maxillary molars, (2) the tomographic image is ineffective in determining negotiability. Both image software packages used in this study showed similar results.

Reabilitação restauradora em dentes anteriores que sofreram trauma: relato de caso / Restorative rehabilitation in traumatized anterior tooth: case report

Os dentes anterossuperiores são os mais comumente acometidos em casos de fraturas coronárias. Além dos traumatismos dentários acidentais, vários fatores predispõem tais fraturas, como a presença de sobremordida, dentes fragilizados por amplas restaurações, lesões de cárie extensa, além de dentes tratados endodonticamente. Em fraturas sem comprometimento pulpar, sempre que possível, realiza-se a colagem do fragmento, porém, quando ele não estiver presente, a segunda opção é a restauração com resinas compostas de uso direto, que permitem resultados estéticos satisfatórios. O objetivo deste trabalho é descrever um caso clínico de fratura coronária, no qual se optou pela restauração com resina composta do remanescente fraturado.

The anterior teeth are most commonly affected in cases of coronal fractures. In addition to the accident itself, several factors can contribute to this type of fracture such as: the presence of overbite, large restorations, large carious lesions and endodontic treatment. In fractures without pulpal compromising, tooth fragment reattachment is preferable whenever is possible. However, when the fragment is not available, the second option is direct restorations using composite resins, allowing satisfactory esthetic results. The aim of this work is to describe a clinical case of coronal fracture, where was chosen a restoration using composite resin.

Mandibular molar rehabilitation using orthodontic extrusion associated with odontoplasty.

The aim of this clinical report is to describe the successful treatment of a mandibular first molar presenting an extensive fracture at the buccal aspect in a young patient. The extension of the fracture was a negative prognostic factor for tooth maintenance. An alternative clinical treatment was proposed since the patient was young and presented with good oral hygiene and periodontal health. The treatment was based on orthodontic forced eruption associated with odontoplasty. A 3-year follow-up after the surgical procedure demonstrated the maintenance of periodontal health and good plaque control. It can be concluded that orthodontic forced eruption associated with odontoplasty promoted favorable conditions for prosthetic rehabilitation and is a feasible procedure in the treatment of tooth fracture extended below the cementoenamel junction.

Reanatomização de incisivos centrais superiores para fechamento de diastema e modelagem gengival / Recontouring of maxillary central incisors for closure of a diastema and gingival modeling

O objetivo deste trabalho é descrever a técnica restauradora utilizada na região de incisivos centrais superiores que apresentavam severo diastema. Em vista do espaço existente, a papila incisal apresentava-se quase plana. A reanatomização dos incisivos centrais com adequado contorno e polimento possibilitou nova arquitetura da zona papilar, melhorando a estética do sorriso. Na avaliação de quatro meses, a abordagem empregada no caso clínico exposto solucionou o problema da papila incisal sem prejuízo à estética vermelha e a saúde dos tecidos periodontais

The aim of this paper is to describe the restorative treatment of a patient presented severe diastema in the region of the maxillary central incisors. In view of this space by diastema, the incisal papilla presented almost flat. Recontouring of the central incisives with appropriate shape and polishing, enabled a new architecture of the papilla zone improving the esthetics of the smile. Four-month clinical evaluation revealed that the approach solved the problem of incisal papilla without impairment to the red esthetics and the health of periodontal tissues

Odontoplasty associated with clinical crown lengthening in management of extensive crown destruction.

AIM: The aim of this study was to evaluate the clinical outcome of teeth submitted to odontoplasty during clinical crown lengthening surgery (CCLS), when compared to their contralateral non-operated teeth. MATERIALS AND METHODS: Fourteen patients submitted to odontoplasty during CCLS were evaluated according to plaque index, bleeding on probing, probing depth and final restoration outcome (total success, relative success and failure). RESULTS: The mean follow-up period was 13.57 (± 8.00) months, and ranged from 6 to 24 months. Twelve cases presented total success of the final rehabilitation and 2 cases presented relative success. The cases of relative success were due to the necessity for a new periodontal intervention (scalling). No differences were observed with respect to periodontal parameters (P>0.05) and the patients that showed relative success presented generalized poor oral hygiene. CONCLUSIONS: The odontoplasty during clinical crown lengthening surgery is a feasible procedure in the management of extensive crown destruction.

Clinical technique for invasive cervical root resorption.

This clinical case report describes the diagnosis and treatment of an external invasive cervical resorption. A 17-year-old female patient had a confirmed diagnosis of invasive cervical resorption class 4 by cone beam computerized tomography. Although, there was no communication with the root canal, the invasive resorption process was extending into the cervical and middle third of the root. The treatment of the cervical resorption of the lateral incisor interrupted the resorptive process and restored the damaged root surface and the dental functions without any esthetic sequelae. Both the radiographic examination and computed tomography are imperative to reveal the extent of the defect in the differential diagnosis.

Reabilitação estética em dentes anteriores com lesões de cárie proximais: relato de caso / Esthetic rehabilitation in anterior teeth with proximal carious lesions: case report

O objetivo do presente trabalho é o de descrever um caso de reabilitação estética na região dentária anterior. Paciente queixando-se das manchas escuras nos dentes anteriores superiores apresentava lesões de cárie nos dentes ântero-superiores, causando uma desarmonia estética no seu sorriso. Dentro do plano de tratamento reabilitador da paciente, realizaram-se restaurações classe III dos elementos dentários 11 e 12, classe IV do 21 e classe V do 13 e do 14. Frente ao caso clínico exposto, conclui-se que a reabilitação restauradora, além de promover saúde, pode proporcionar uma aparência estética mais favorável do sorriso, elevando a autoestima do paciente.

The aim of this study is to describe a case of esthetic rehabilitation in the maxillary incisive. Patient complaining of black stain on the maxillary teeth had carious lesions in teeth that cause great disharmony of your smile. Within the rehabilitation plan of patient, took place Class III restorations of the teeth 11 and 12, class IV of 21 and class V of the 13 and 14. It was concluded that, the present approach, allowed the anterior restorative rehabilitation, promote health and provide a more favorable aesthetic appearance of the smile, raising self-esteem of the patient.

Hypercementosis: a challenge for endodontic therapy

Introduction and objective: The purpose of this study was to describe through literature review, the morphological characteristics of teeth with hypercementosis that are relevant to endodontic practice. Literature review: The pathologic deposition of cement increases proportionally as the patient's age increases. Genetic factors seem to be related to hypercementosis occurrence in young patients. Based on literature, it is possible to notice a lack of scientific studies which guide the endodontist for treating teeth with hypercementosis, since the cement deposition lead to the length increase of the cementum canal, and consequently, to the increase of the distance from CDC junction to apical root end. Conclusion: Thus, it is clinically relevant to correlate the morphology of teeth with hypercementosis with the specific aspects of endodontic therapy, aiming to establish the limits of root canal treatment in cases of hypercementosis.

Cirurgia periodontal estética associado ao clareamento dentário empregando o twist pen: relato de caso / Aesthetic periodontal surgery associated with tooth whitening using the twist pen system: case report

O objetivo deste trabalho foi descrever um tratamento cirúrgico periodontal associado ao clareamento dentário na arcada dentária superior. A gengivectomia associada à plastia gengival constitui-se de procedimentos que viabilizam a estética periodontal de dentes com extensão da margem gengival excessivamente atípica. Associou-se ao tratamento plástico periodontal um clareamento nos dentes vitalizados empregando o peróxido de hidrogênio a 35% através de uma caneta aplicadora. Observou-se a modificação cromática favorável dos dentes, de acordo com a escala Vita, de 3L para 2L. Concluímos, assim, que o procedimento instituído permitiu a realização da cirurgia periodontal e da ação clareadora de forma adequada, solucionando o problema estético e possibilitando a manutenção da saúde periodontal.

The aim of this paper is to describe a periodontal surgery procedure associated with tooth whitening in the upper maxillary. Gingivectomy associated with gingivoplasty are procedures to enable the aesthetics of teeth with very atypical periodontal extension of the gingival margin too atypical. Together with the periodontal surgery it was made a bleaching in vitalized teeth, using 35% peroxide hydrogen with the use of a pen applicator. We observed the change of color in the color of teeth, according to the scale Vita, 3L to 2L. We conclude that the approach used allowed the periodontal surgical procedure and the bleaching adequately solving the aesthetic problem enabling the maintenance of periodontal health.

Clareamento em dentes vitalizados empregando-se o Sistema Twist Pen: relato de caso / Vital tooth bleaching using the Twist Pen System: a case report

Este trabalho descreve o tratamento clareador em dentes vitalizados, empregando-se o sistema Twist Pen. Foi utilizado o peróxido de hidrogênio a 35%, com caneta aplicadora, e monitorou-se a mudança cromática da cor dos dentes, de acordo com a escala Vitapan 3D-Master. Conclui que, desde que sejam tomados os devidos cuidados clínicos e de diagnóstico e planejamento, o clareamento de consultório com o sistema Twist Pen é excelente opção estética e conservadora, para tratamento de dentes cromaticamente alterados...

The aim of this paper is to describe the vital tooth bleaching using the Twist Pen system. This product is a 35% hydrogen peroxide bleaching agent delivered by a pen applicator. Tooth color changes were recorded according to a Vitapan 3D-Master shade guide. It was concluded that, provided that proper diagnosis and treatment planning are made and the product is thoughtfully applied, bleaching using this approach is an excellent option for esthetic and conservative treatment of discolored teeth...

Anatomical evaluation of the root canal diameter and root thickness on the apical third of mesial roots of molars.

The purpose was to determine the diameter of the main root canal and wall thickness in the apical dentin in mesial roots of maxillary and mandibular molars. Forty mesiobuccal and mesial root specimens were sectioned horizontally at 1, 2 and 3 mm from the apex, and measured at each top surface by using optical microscopy to an accuracy of ×20 magnification. The anatomical parameters were established as the following points of reference: AB, two points connected by a line from the outer edge of the mesial wall to the outer edge of the distal one through the center of the root canal to measure the thickness of the root and mesiodistal diameter of the root canal (CD). A second line (EF) was designed to evaluate the diameter of the root canal in the buccolingual direction. All data were summarized, and values were assessed statistically by ANOVA and Bonferroni multiple comparisons. The buccolingual (BL) root canal diameters at 1, 2 and 3 mm in the mandibular and maxillary molars were greater than in the mesiodistal (MD), showing statistically significant differences (p < 0.05). The MD root thicknesses at 1, 2 and 3 mm in mandibular and maxillary molars were statistically significant (p < 0.05). The lowest value to 1 mm from the apex in the mandibular molars was 1.219 mm and the highest at 3 mm from the root apex in maxillary molars was 1.741 mm. The BL diameters in maxillary and mandibular molars were higher than the MD diameter. The thickness (MD) of maxillary and mandibular molars decreased as a function of apical proximity.

Segundo molar inferior com configuração do canal radicular em forma de C: relato de caso / C-shaped canal configuration of mandibular second permanent molar: case report

OBJETIVO: O objetivo deste trabalho é apresentar e discutir o tratamento endodôntico de molar inferior apresentando configuração de canal radicular em formato de /"C/", variação anatômica radicular de difícil diagnóstico e tratamento. RELATO DO CASO E DISCUSSÃO: O orifício do canal apresentava extensão do canal mesio-vestibular para o canal distal. Não havia presença de lesão periapical; extensa lesão cariosa na face distal da coroa. Tratamento endodôntico com limas Flexofile™, com emprego de solução de hipoclorito de Na a 1% e desmineralizante EDTA, 17%. Obturação convencional, com cones de guta-percha e cimento endodôntico. CONCLUSÃO: A condição anatômica conhecida como formato em “C”, mesmo acarretando dificuldades para a terapia endodôntica, não impede o adequado tratamento, como realizado no presente caso.

OBJECTIVE: The aim of this paper is to present and discuss the endodontic treatment of a mandibular molar showing a C-shape root canal configuration, a root anatomical variations with difficult diagnosis and treatment. CASE REPORT AND DISCUSSION: Open access during the root canal demonstrated an extension of the mesiobuccal canal to the distal canal. There was not any periapical lesion although extensive carious lesions were present on the distal aspect of the crown. Flexofile™ endodontic treatment with the use of 1% sodium hypochlorite solution and demineralising (EDTA, 17%) was performed, followed by conventional obturation with gutta-percha and endodontic sealer. CONCLUSION: The anatomical condition known as format in /"C/", causes difficulties during endodontic therapy, although that does not preclude the proper treatment, as was performed in this present case.

Crown-down preflaring in the determination of the first apical file.

In this study, scanning electron microscopy (SEM) was used to evaluate the adaptation of the first apical file after preflaring in mesiobuccal (MB) and mesiolingual (ML) canals of mandibular molars considering the tactile sensibility as a reference. The mesial canals (n = 22) of human mandibular molar teeth were used, and the first instrument to bind to the working length was determined after preflaring and crown-down shaping. Digital images of the root apex were acquired and a single examiner determined the contact of the file with the walls using Image J software. The results showed that the file was in contact in 47.83% and 31.71% in the MB and ML canals, respectively. When the apexes are fused, the average was 40.03%. A descriptive analysis showed that the first apical file did not touch all dentin walls in any of the samples.