Tratamento endodôntico de incisivo central inferior permanente com dilaceração radicular incomum, após trauma no predecessor decíduo: relato de caso / Endodontic treatment of mandibular central incisor with unusual root dilaceration, following trauma to the deciduous predecessor: case report

Introdução: Alterações morfológicas na cavidade pulpar e na anatomia radicular podem constituir um desafio ao tratamento endodôntico. A dilaceração pode ser resultado de trauma na dentição decídua, na época da formação das raízes, provocando acentuada curvatura da raiz ou da coroa em um dente permanente. Objetivo: O presente relato de caso teve por objetivo descrever o tratamento endodôntico de um dente #41 com acentuada dilaceração radicular. Radiograficamente, a região periapical do dente #41 mostrou extensa área radiolúcida, sugestiva de osteólise periapical em decorrência de necrose pulpar, que foi confirmada pela ausência de resposta aos testes pulpares. O tratamento endodôntico foi realizado. Conclusão: Após 90 meses de acompanhamento, constatou-se ausência de sinais ou sintomas, e o exame radiográfico forneceu evidências de cicatrização óssea periapical (AU).

Introduction: The morphological changes in the pulp cavity and root anatomy can lead to difficulties in carrying out endodontic treatment. Dilaceration can be the result of trauma in primary dentition, in the root formation phase, provoking accentuated root or crown curvature in a permanent tooth. Objective: The present case report aimed to describe the endodontic treatment of tooth 41 with accentuated root laceration. Radiographically, the periapical region of tooth #41 showed an extensive radiolucent area, suggestive of periapical osteolysis due to pulp necrosis, which was confirmed by the lack of response and pulp tests. Endodontic treatment was realized. Conclusion: The follow-up at 90 months showed no signs or symptoms, and the radiographic examination provided evidence of periapical bone healing.

[Pain, anxiety and quality of life related to the oral health of patients treated in a dental emergency clinic]. / Dor, ansiedade e qualidade de vida relacionada à saúde bucal de pacientes atendidos no serviço de urgência odontológica.

The scope of this study was to assess the association between preoperative pain, anxiety and the impact of the oral condition on the quality of life of patients treated at the Dental Emergency Service at the Federal University of the Jequitinhonha and Mucuri Valleys. A retrospective cross-sectional study was conducted evaluating data from 240 patient charts aged from 18 to 65 years. Pain was measured by the Heft-Parker Visual Analog Scale; dental anxiety by Corah's Dental Anxiety Scale; and oral health-related quality of life by the Oral Health Impact Profile (OHIP-14). Associations were analyzed using Pearson's Chi-square test (p < 0.05). A statistically significant association was observed between pain and poorer quality of life, with impacts on psychological discomfort (p < 0.001), physical incapacity (p < 0.001) and the psychological (p < 0.001) and social (p < 0.001) domains. Anxiety influenced poorer quality of life, with impacts on the psychological discomfort (p = 0.009), physical disability (p = 0.016), psychological disability (p = 0.011) and social disadvantage (p = 0.028) domains. This study is relevant for the planning of programs and actions aimed at the oral health of patients treated in dental emergency services, prioritizing those with the greatest psychosocial impact arising from oral problems.

O objetivo deste estudo foi avaliar associação entre dor pré-operatória, ansiedade e impacto da condição bucal na qualidade de vida dos pacientes atendidos no serviço de Urgência Odontológica da Universidade Federal dos Vales do Jequitinhonha e Mucuri. Estudo transversal retrospectivo foi conduzido avaliando dados clínicos de 240 prontuários de pacientes com idades entre 18 e 65 anos. A dor foi mensurada pela Heft-Parker Visual Analogue Scale; ansiedade, pela Corah's Detal Anxiety Scale e qualidade de vida, pelo Oral Health Impact Profile (OHIP-14). Associações foram analisadas pelo Teste qui-quadrado de Pearson (p < 0,05). Foi observada associação estatisticamente significante entre dor e pior qualidade de vida, com impacto nos domínios desconforto psicológico (p < 0,001), incapacidade física (p < 0,001), psicológica (p < 0,001) e social (p < 0,001). Ansiedade influenciou na pior qualidade de vida, com impacto nos domínios desconforto psicológico (p = 0,009), incapacidade fisica (p = 0,016), psicológica (p = 0,011) e desvantagem social (p = 0,028). Esse estudo é relevante para o planejamento de ações voltadas para a saúde bucal dos pacientes atendidos nos serviços de urgência odontológica, priorizando aqueles com maiores impactos psicossociais decorrentes dos problemas bucais.

Dor, ansiedade e qualidade de vida relacionada à saúde bucal de pacientes atendidos no serviço de urgência odontológica / Pain, anxiety and quality of life related to the oral health of patients treated in a dental emergency clinic

Resumo O objetivo deste estudo foi avaliar associação entre dor pré-operatória, ansiedade e impacto da condição bucal na qualidade de vida dos pacientes atendidos no serviço de Urgência Odontológica da Universidade Federal dos Vales do Jequitinhonha e Mucuri. Estudo transversal retrospectivo foi conduzido avaliando dados clínicos de 240 prontuários de pacientes com idades entre 18 e 65 anos. A dor foi mensurada pela Heft-Parker Visual Analogue Scale; ansiedade, pela Corah's Detal Anxiety Scale e qualidade de vida, pelo Oral Health Impact Profile (OHIP-14). Associações foram analisadas pelo Teste qui-quadrado de Pearson (p < 0,05). Foi observada associação estatisticamente significante entre dor e pior qualidade de vida, com impacto nos domínios desconforto psicológico (p < 0,001), incapacidade física (p < 0,001), psicológica (p < 0,001) e social (p < 0,001). Ansiedade influenciou na pior qualidade de vida, com impacto nos domínios desconforto psicológico (p = 0,009), incapacidade fisica (p = 0,016), psicológica (p = 0,011) e desvantagem social (p = 0,028). Esse estudo é relevante para o planejamento de ações voltadas para a saúde bucal dos pacientes atendidos nos serviços de urgência odontológica, priorizando aqueles com maiores impactos psicossociais decorrentes dos problemas bucais.

Abstract The scope of this study was to assess the association between preoperative pain, anxiety and the impact of the oral condition on the quality of life of patients treated at the Dental Emergency Service at the Federal University of the Jequitinhonha and Mucuri Valleys. A retrospective cross-sectional study was conducted evaluating data from 240 patient charts aged from 18 to 65 years. Pain was measured by the Heft-Parker Visual Analog Scale; dental anxiety by Corah's Dental Anxiety Scale; and oral health-related quality of life by the Oral Health Impact Profile (OHIP-14). Associations were analyzed using Pearson's Chi-square test (p < 0.05). A statistically significant association was observed between pain and poorer quality of life, with impacts on psychological discomfort (p < 0.001), physical incapacity (p < 0.001) and the psychological (p < 0.001) and social (p < 0.001) domains. Anxiety influenced poorer quality of life, with impacts on the psychological discomfort (p = 0.009), physical disability (p = 0.016), psychological disability (p = 0.011) and social disadvantage (p = 0.028) domains. This study is relevant for the planning of programs and actions aimed at the oral health of patients treated in dental emergency services, prioritizing those with the greatest psychosocial impact arising from oral problems.

Pattern of Disinfection of Root Canal Dentin by Alternated Acid-Base Irrigating Regimen.

OBJECTIVE: To quantify Enterococcus faecalis density in root canal dentin after chemomechanical preparation (CMP) using alternated irrigating regimen. METHODOLOGY: Root canals (RC) were contaminated with E. faecalis (ATCC 19433) for 3 weeks and evident biofilms were obtained. After initial sampling (S1), the CMP was aided by irrigants: saline solution (control; n=12), a conventional regimen (CR) (group 1; n=12) using 5.25% NaOCl and a final rinse with 17% EDTA, and an alternating regimen (AR) of intercalated use of NaOCl and EDTA (group 2, n=12), followed by a second sampling (S2). After 2 weeks, S3 was obtained. Two roots were analyzed by scanning electron microscopy. Each root was divided into cervical, mild, and apical segments and sampling of the superficial (n=90) and deep (n=90) dentin layers was obtained using Gates-Glidden burs. The E. faecalis density (CFU/mg) in log10 was categorized as residual (0 > 0.2), moderate (0.2 ≥ 0.5), or elevated (> 0.5). The prevalence of positive samples in BHI and BHI-A was analyzed by Pearson's chi-square test. The data were normalized by a log10 transformation of CFU and were analyzed by one-way ANOVA and Tukey's tests. RESULTS: Biofilms were observed only in the control root canal walls. Topographically, the controls and CR showed similar distributions of E. faecalis in the dentin. Microbiologically positive root canals harbored much E. faecalis in the adjacent dentin (p < 0.05). Irrigating saline provided moderate density of E. faecalis in the dentin while CR and AR resulted in a residual density of microorganisms (p < 0.05). CONCLUSIONS: The Enterococcus faecalis density in dentin was influenced by the irrigating regimen and the microbiological status of the root canal. The CMP aided by the alternating regimen interfered with the recolonization of the root canal and topographic distribution of Enterococcus in root dentin.

Reimplante dentário tardio após armazenamento a seco: preservação da função e estética por uma década / Delayed tooth replantation after dry storage: Preservation of function and aesthetics for a decade

Introdução: atualmente, a determinação de estratégias terapêuticas para melhorar o prognóstico da reimplantação tardia de dentes que foram armazenados inadvertidamente em um ambiente seco é um desafio. Relato de caso: paciente com 22 anos de idade procurou atendimento odontológico três dias após a avulsão do incisivo central superior direito. Mecanicamente, raspou-se cuidadosamente a superfície radicular com cureta periodontal e tratou-se quimicamente com hipoclorito de sódio a 5,25%, seguido de EDTA a 17%. Após tratamento extrabucal e preparação quimomecânica, o canal radicular foi preenchido com pasta de hidróxido de cálcio. O paciente não compareceu a todas as reavaliações. Resultados: após 102 meses, o incisivo superior direito estava clinicamente funcional, mas anquilosado. Havia bolsa periodontal por palatina com 5 mm de profundidade e exsudato purulento. A radiografia revelou reabsorção radicular externa avançada. Após o tratamento periodontal, o canal radicular foi preenchido com hidróxido de cálcio e, posteriormente, obturado com MTA. No acompanhamento após 18 meses, a reabsorção radicular se estabilizou. Experimentalmente, um dente extraído, armazenado em condições idênticas, recebeu tratamento semelhante da superfície radicular. Na microscopia eletrônica de varredura, a superfície radicular mostrou um alto grau de limpeza, com os túbulos dentinários patentes, sugerindo permeabilidade radicular favorável. Conclusões: o tratamento superficial da raiz e o curativo intracanal possibilitaram a preservação do dente avulsionado após reimplante tardio, com função e estética satisfatórias por aproximadamente uma década. (AU)

Exploring different photodynamic therapy parameters to optimize elimination of Enterococcus faecalis in planktonic form.

BACKGROUND: The failure of endodontic treatment is linked to the presence of Enterococcus faecalis in the root canals. The scope of this study was to evaluate the influence of the energy dose and frequency of photodynamic therapy (PDT cycles), as well as the volume of bacterial suspensions (BS) in the elimination of Enterococcus faecalis in planktonic form. METHODS: In four successive assays BS of Enterococcus faecalis ATCC 19433 were irradiated with a diode laser (40 mW) using the photosensitizer (PS) methylene blue (MB) (0.005 µg/mL). Group 1 - Effect of energy dose: 100 µâ€¯L of BS and 100 µâ€¯L of PS were irradiated by 1, 2.5, 5, 7.5 and 10 minute s. Group 2 - Effect of PDT cycles: The BS received 1, 2, 3 or 4 PDT cycles (in each cycle 100 m L of PS was added and irradiated by 2.5 minutes). Group 3 - Effect of energy dose and bacterial suspension volume: 10 µâ€¯L of BS and 10 µâ€¯L of PS were irradiated similar to group 1. Group 4 - Effect of energy dose, bacterial suspension volume and PDT cycles: 10 µâ€¯L of BS and 10 µL of PS were irradiated according to group 2. The laser source and MB isolated represented the controls. RESULTS: The mean log reduction after separate applying laser light and MB were 0.01 and 0.07, respectively. It was found that wells with 100 µâ€¯L of BS irradiated with 2.4 to 24 J of energy did not cause significant bacterial elimination (p > 0.05), on the other hand PDT cycles above 12 J increased significantly bacterial elimination (p < 0.05). In 10 µâ€¯L wells irradiation from 12 J of energy provided higher bacterial elimination (p < 0.05) which combined with PDT cycle resulted in the logarithmic elimination of E. faecalis (p < 0.05). CONCLUSIONS: The energy dose, the volume of the bacterial suspension and, especially, the PDT cycles optimized the bacterial elimination of Enterococcus faecalis in planktonic form.

Factors Affecting the Periapical Status of Root-Filled Canals: A Cross-Sectional Study at the Undergraduate Level.

OBJECTIVE: The aim was to evaluate the influence of multiple factors on the periapical status of endodontically treated (ET) teeth. METHODS: The patients were clinically and radiographically reevaluated after root canal therapy. The quality of the root-filled canals, coronal restorations, intraradicular posts, dental caries, and periodontal parameters were associated with the teeth's periapical status. RESULTS: The 122 patients provided 154 ET teeth; 97.4% teeth were asymptomatic, and 75.5% had a normal periapical status. The percentage of perfect, satisfactory, and deficient root-filled canals was of the order of 41.6%, 46.1%, and 12.3%, respectively. The percentage of adequate and inadequate coronal restorations was 31.2% and 68.8%, respectively. A total of 14.9% teeth had intraradicular posts, and 29.2% had cavitated carious lesions in the dentin. Gingival bleeding was observed in 31.8% of teeth, and dental biofilm was visible in 58.4%. A total of 11.7% showed pathologic tooth mobility, and 22.1% teeth were diagnosed with periodontal disease. CONCLUSIONS: Carious lesions, gingival bleeding, and tooth mobility were significantly associated with the occurrence of periapical lesions in root-filled canals.

Biocompatibility of a New Dental Glass Ionomer Cement with Cellulose Microfibers and Cellulose Nanocrystals.

Developing new restorative materials should avoid damage to tissue structures. This study evaluated the biocompatibility of a commercial dental glass ionomer cement (GIC) mechanically reinforced with cellulose microfibers (GIC+CM) or cellulose nanocrystals (GIC+CN) by implantation of three test specimens in subcutaneous tissue in the dorsal region of 15 Rattus norvegicus albinus rats. Each rat received one specimen of each cement, resulting in the following groups (n=15): Group GIC (Control), Group GIC+CM and Group GIC+NC. After time intervals of 7, 30 and 60 days, the animals were sacrificed and the following aspects were histologically evaluated: type of inflammatory cells, fibroblasts, blood vessels, macrophages, giant cells, type of inflammatory reaction and capsule thickness (µm). These events were scored as (-) absent, (+) light, (++) moderate and (+++) intense. The results were statistically analyzed by Kruskal-Wallis test and Mann-Whitney post test. At 7 days, Group GIC+NC showed more favorable tissue repair because quantitatively there were more fibroblasts (p=0.022), fewer macrophages (p=0.008) and mononuclear cells (p=0.033). Polymorphonuclear neutrophils and giant cells were absent in all experimental periods. At 60 days, test specimens in Group GIC+NC were surrounded by a fibrous tissue capsule with reduced thickness (26.72±2.87 µm) in comparison with Group GIC+CM (41.21±3.98 µm) (p=0.025). In general, all biomaterials showed satisfactory biocompatibility, but glass ionomer cement modified with cellulose nanocrystals showed a more advanced tissue repair.

Biocompatibility of a New Dental Glass Ionomer Cement with Cellulose Microfibers and Cellulose Nanocrystals

Resumo Os novos materiais restauradores em desenvolvimento devem evitar danos aos tecidos dentários. Portanto, o objetivo deste estudo foi avaliar a biocompatibilidade de uma marca comercial de cimento de ionômero de vidro convencional (CIV) modificado com microfibras de celulose (CIV+MC) ou nanocristais de celulose (CIV+NC) através da implantação de três amostras em tecido subcutâneo na região dorsal de 15 ratos Rattus norvegicus albinus. Cada rato recebeu um exemplar de cada cimento, resultando nos seguintes grupos (n=15): Grupo CIV (controle, n=15), Grupo CIV+MC e Grupo CIV+NC. Nos intervalos de 7, 30 e 60 dias os animais foram sacrificados e os seguintes aspectos foram avaliados histologicamente: tipo de células inflamatórias, fibroblastos, vasos sanguíneos, macrófagos, células gigantes, tipo de reação inflamatória e espessura da cápsula (µm). Estes eventos foram quantitativamente classificados conforme os escores: (-) ausente, (+) suave, (++) moderado e (+++) intenso. Os resultados foram analisados estatisticamente pelo teste Kruskal-Wallis e pós-teste Mann-Whitney. Aos 7 dias, o Grupo CIV+NC demonstrou um nível mais elevado de reparação tecidual porque havia maior quantidade de fibroblastos (p=0,022) e uma menor quantidade de macrófagos (p=0,008) e células mononucleares (p=0,033). Neutrófilos e células gigantes estavam ausentes em todos os períodos experimentais. Aos 60 dias, o Grupo CIV+NC apresentou cápsula de tecido fibroso com espessura mais reduzida (26,72±2,87 µm) em comparação ao Grupo CIV+MC (41,21±3,98 µm (p=0,025). No geral, todos os materiais apresentaram satisfatória biocompatibilidade, no entanto, o cimento de ionômero de vidro modificado com nanocristais de celulose proveu reparação tecidual mais avançada comparativamente aos demais materiais avaliados.

Developing new restorative materials should avoid damage to tissue structures. This study evaluated the biocompatibility of a commercial dental glass ionomer cement (GIC) mechanically reinforced with cellulose microfibers (GIC+CM) or cellulose nanocrystals (GIC+CN) by implantation of three test specimens in subcutaneous tissue in the dorsal region of 15 Rattus norvegicus albinus rats. Each rat received one specimen of each cement, resulting in the following groups (n=15): Group GIC (Control), Group GIC+CM and Group GIC+NC. After time intervals of 7, 30 and 60 days, the animals were sacrificed and the following aspects were histologically evaluated: type of inflammatory cells, fibroblasts, blood vessels, macrophages, giant cells, type of inflammatory reaction and capsule thickness (µm). These events were scored as (-) absent, (+) light, (++) moderate and (+++) intense. The results were statistically analyzed by Kruskal-Wallis test and Mann-Whitney post test. At 7 days, Group GIC+NC showed more favorable tissue repair because quantitatively there were more fibroblasts (p=0.022), fewer macrophages (p=0.008) and mononuclear cells (p=0.033). Polymorphonuclear neutrophils and giant cells were absent in all experimental periods. At 60 days, test specimens in Group GIC+NC were surrounded by a fibrous tissue capsule with reduced thickness (26.72±2.87 µm) in comparison with Group GIC+CM (41.21±3.98 µm) (p=0.025). In general, all biomaterials showed satisfactory biocompatibility, but glass ionomer cement modified with cellulose nanocrystals showed a more advanced tissue repair.

Management of Cyst-like Periapical Lesions by Orthograde Decompression and Long-term Calcium Hydroxide/Chlorhexidine Intracanal Dressing: A Case Series.

Cyst-like periapical lesions should be treated initially with conservative nonsurgical procedures. In this case series, we describe the clinical and radiographic outcomes of large cyst-like lesions that were treated by orthograde decompression and long-term intracanal use of calcium hydroxide [Ca(OH)2] mixed with 2% chlorhexidine digluconate. Ten cases of cyst-like periapical lesions involving 15 teeth from 10 patients were selected. Maximal radiographic diameters of the lesions ranged from 11 to 28 mm. Nonsurgical procedures were performed, including apical patency, orthograde puncture of cyst-like exudates, chemomechanical preparation, and placement of intracanal Ca(OH)2/CHX dressings, which were periodically replaced during 6-10 months. The root canals were then filled with gutta-percha and sealer. The follow-up periods ranged from 6 to 24 months, and the outcome was classified as healed, healing, or failure. Nine lesions drained copious exudates after canal patency. One lesion only drained bloody serous exudate after periapical overinstrumentation. In 9 patients, intracanal exudation ceased in the first follow-up visit. At the 24-month follow-up, 6 lesions (60.0%) had healed, and 3 lesions (30.0%) were healing, with the corresponding patients being without clinical signs or symptoms. The case of treatment failure was submitted to surgical treatment. Microscopically, the lesion appeared to be an apical cyst with exuberant extraradicular bacterial biofilms attached to the sectioned root apex. This case series supports the use of nonsurgical methods to resolve larger cyst-like periapical lesions.

Monitoring the effectiveness of photodynamic therapy with periodic renewal of the photosensitizer on intracanal Enterococcus faecalis biofilms.

BACKGROUND AND OBJECTIVE: Photodynamic therapy (PDT) can eliminate microorganisms in a root canal. However, the parameters for disinfection remain undefined. This study assessed the effectiveness of a PDT protocol against intracanal Enterococcus faecalis biofilms. MATERIALS AND METHODS: Root canals were contaminated with E. faecalis for 21 days. The instrumentation was associated to irrigation with 0.85% saline or an alternate irrigation (AI) with 5.25% NaOCl and 17% EDTA. Complementary treatments included saline/PDT and AI/PDT. Four PDT cycles were performed using a diode laser (660nm, 40mW) delivered through a tapered optical fiber. In each cycle, the root canal was filled with 1.56µM/mL methylene blue and irradiated for 150s. Microbiological samples were collected before (S1) and after (S2) instrumentation; after PDT (S3); and daily over the course of 14 days (S4-S17). Colony-forming units (CFUs) were counted, positive cultures verified, and data subjected to parametric and proportion's tests. RESULTS: The highest bacterial load reduction was observed in S2. In regard to S3, Saline/PDT reduced 1.3 log(10) CFU counts (p=0.000 for S2) and no CFUs were recovered after AI/PDT treatment. All canals were CFU-free on the 14th day for saline/PDT, AI and AI/PDT. Positive cultures were observed in 60% of saline-irrigated canals on the 14th day, whereas the saline/PDT, AI and AI/PDT treatments resulted in germ-free canals after 10, 5 and 2 days, respectively. CONCLUSION: Our findings suggest immediate and delayed antibacterial effects using the PDT protocol tested.

Shaping Ability of Reciproc, UnicOne, and Protaper Universal in Simulated Root Canals.

The study aimed to compare the shaping effects, preservation of the original curvature, and transportation of the apical foramen of Reciproc (VDW, Munich, Germany), UnicOne (Medin, Nové Mesto na Morave, Czech Republic), and Protaper Universal (Dentsply Maillefer, Ballaigues, Switzerland) in simulated root canals. Thirty resin blocks with simulated curved root canals were distributed into three groups (n = 10), and prepared using Reciproc (RCp), UnicOne (UnO) and the Protaper Universal (PTu). Standardized photographs were taken before and after the instrumentation, after which they were superimposed. Measurements were taken of the quantity of resin removed from the inner and outer walls of the curvature at 6 levels, the curvature angles before and after instrumentation, and the transportation of the apical foramen. RCp obtained the highest values for amount of resin removed from the inner wall while UnO demonstrated similar shaping on both the inner and outer walls. PTu produced the greatest transportation of foramen when compared to the reciprocating instruments. There was no significant difference between the groups in terms of the change in angle (P > 0.05). All the instruments were capable of maintaining the original curvature of the root canal; however, the UnO, which used reciprocating movement, produced more conservative shapes with lower foramen transportation.

Biocompatibilidade e capacidade de selamento do agregado de trióxido mineral em perfurações radiculares / Biocompatibility and sealing ability of mineral trioxide aggregate in root perforations

As perfurações radiculares rompem a barreira biológica entre o endodonto e o espaço periodontal, podendo, em razão da sua extensão e localização, comprometerem, irreversivelmente, a longevidade do elemento dentário. Do ponto de vista terapêutico, o agregado de trióxido mineral é o material selador mais recomendado. O agregado de trióxido mineral é apresentado sob a forma de um pó branco ou cinza, contendo partículas hidrofílicas, cujos componentes principais são silicato tricálcico, aluminato tricálcico, óxido tricálcico, óxido silicato e o óxido de bismuto, responsável pela radiopacidade, além dos elementos cromo e chumbo. Quando incorporado à água destilada, resulta em um gel coloidal que é aplicado diretamente no sítio da perfuração. Seu tempo de presa final é de aproximadamente 3 horas. Esse agregado apresenta satisfatórias propriedades físicas e químicas, bem como compatibilidade com os tecidos perirradiculares, independentemente da sua cor. In vitro, o agregado de trióxido mineral apresenta capacidade de selamento superior a outros biomateriais. No entanto, a maioria das investigações clínicas envolve relatos isolados de casos, com poucas evidências longitudinais dos resultados alcançados.

The alterations provoked by pathologies or iatrogenesis favor the invasion of the periodontium, communicating pulp cavity with periradiculares tissues. Currently, for the treatments of those root perforations, the sealer material more suitable is the mineral trioxide aggregate, that was reported for the first time in 1993 and introduced commercially in 1998. Mineral trioxide aggregate is presented under the form of a powder white or gray that, once incorporate to the distilled water, has an easy manipulation resulting in a colloidal gel whose final time setting is about 3 hours. That aggregate reaches appropriate physical and chemical properties as well as biocompatibility with the periradiculares tissues. In the current review, the use of mineral trioxide aggregate was approached as sealer material of root perforations in both in vitro and in vivo studies. It was evidenced that mineral trioxide aggregate presents good sealing ability, superior the other materials of larger longevity in the dentistry. However, most of the clinical investigations involve isolated case reports, with few longitudinal evidences of the reached results.

Strategy for apexification of wide-open apex associated with extensive periapical lesion in a weakened root.

This case report describes successful apexification for a challenging case involving a 30-year-old man, who suffered from dental trauma involving tooth No. 7 (which had occurred several years earlier) and recently experienced acute periapical abscess in this region. Radiographic analysis revealed incomplete root formation, a wide-open apex, thin root canal walls, and an extensive periapical lesion. Chemomechanical debridement was performed gently using K-files and irrigation with a 1% sodium hypochlorite solution. The root canal was filled with a calcium hydroxide paste, which was replaced periodically. At 18 months post-treatment, an apical barrier tissue and significant reduction of periapical radiolucency were observed; at that time, the entire root canal was filled with gray mineral trioxide aggregate (MTA). At a follow-up 16 months later, the tooth had normal function and periapical repair was complete.

Endodontic management of a long-standing horizontal mid-root fracture: case report in a young patient.

The purpose of this case report was to present the successful endodontic management of a long-standing horizontal mid-root fracture in a permanent maxillary central incisor. A 12-year-old boy with a history of traumatic injury sustained 15 months previously to the maxillary central incisor presented for treatment. Clinical examination revealed physiological mobility, pulp chamber exposed to the oral environment, and the buccal mucosa with a sinus tract in the area of the traumatized tooth. A radiolucent lesion at the fracture line and apical fragment with obliteration of the root canal space were observed radiographically. Conservative root canal treatment of the coronal segment was performed using calcium hydroxide as an intracanal dressing. The calcium hydroxide was replaced every 8 weeks for 10 months. A hard tissue barrier was observed after this period, and the coronal fragment of the root canal was filled. After 4 years, the tooth was asymptomatic and functional and no periapical lesion was observed.

Orthograde retreatment failure with extruded MTA apical plug in a large periradicular lesion followed by surgical intervention: case report.

Absence of periapical healing after orthograde retreatment using an apical plug with mineral trioxide aggregate (MTA) can require surgical intervention. A patient with a root-filled maxillary central incisor with chronic apical periodontitis and sinus tract was referred for endodontic retreatment. Excessive apical enlargement was verified, indicating an MTA apical plug placement; however, an unintentional extrusion of MTA occurred during this step. The root canal was filled with gutta-percha and sealer, and periodic recalls were scheduled. The sinus tract was observed after six months and the lesion remained unaltered, although the extruded MTA had resorbed; therefore, an apicoectomy and retrograde root-end filling with MTA were performed. Absence of sinus tract, normal clinical aspect, and complete repair of the lesion were observed at the two-year follow-up.

Lesões periapicais crônicas: revisão dos aspectos microbiológicos por diferentes métodos de investigação / Chronic periapical lesions: a review of microbiologic aspects by different investigations methods

A necrose pulpar representa a cessação dos processos metabólicos do tecido pulpar, desestruturação e concomitante perda de suas defesas naturais. A partir da necrose pulpar, a cavidade pulpar torna-se progressivamente colonizada por vários micro-organismos habitantes da cavidade bucal e sistemas interligados. Assim, os dentes com necrose pulpar e áreas radiolúcidas periapicais apresentam inúmeros morfotipos microbiológicos no sistema de canais radiculares. Não obstante, de longa data, tem sido questionada a sobrevivência de micro-organismos nos granulomas periapicais. Nesta revisão, verificou-se que na atualidade, pela técnica da cultura microbiológica ou por métodos moleculares, cocos, bacilos e filamentosos, gram-negativos e positivos, predominantemente anaeróbios estritos, identificados no sistema de canais radiculares, também são recuperados na região periapical. Esses micro-organismos também são identificados pela coloração de Brown e Brenn ou pela microscopia eletrônica de varredura no ápice radicular e na estrutura da lesão, numa frequência que oscila de 4% a 100%. Estruturalmente, organizam-se num material amorfo, iodoso, de composição polissacarídica - os biofilmes periapicais.

Starting from the pulp necrosis the pulp cavity becomes progressively colonized by several microorganisms' inhabitants of the oral cavity and interconectives systems. Thus, the teeth with pulp necrosis and radiolucencies periapical areas present countless microbiological morfotypes in the root canal system. Nevertheless, of long date, the survival of the microorganisms in the periapical granuloms has been questioned. In this review it was verified that currently, by culture or molecular methods that the coccus, bacilli and filamentous, gram-negative and positive, predominantly strict anaerobes, identified in the root canal system also are recovered in the periapical lesions. Such microorganisms are also identified for the coloration of Brown and Brenn or for the scanning electronic microscopy in the root apex and in the structure of the lesion, in a frequency that oscillates from 4% to 100%. Structurally, they are organized in an amorphous material, muddy, of polysaccharide composition- the periapical biofilms.

The efficacy of a cervical barrier in preventing microleakage of Enterococcus faecalis in endodontically treated teeth.

The clinical failure of coronal restorations can compromise the healthy periapical status of endodontically treated teeth. The purpose of the present ex vivo study was to assess the effectiveness of the cervical barrier in preventing bacterial microleakage in the eventual loss of the coronal restoration. Following removal of the smear layer and obturation to the cementoenamel junction using gutta-percha, 70 single-rooted mandibular premolars were randomly divided into five different groups: Group 1 received no additional treatment; Groups 2 and 3 had 2 mm and 3 mm of the obturation removed, respectively, followed by placement of a cervical barrier that was the same thickness as the obturation. In Group 4 (positive control), the root canals were filled only with gutta-percha, while in Group 5 (negative control), the root canals were completely impermeabilized following obturation. The filled root canals were incorporated into a split-chamber model system using Enterococcus faecalis as a microbial marker. The apices were suspended in the lower chambers. Leakage was determined daily for 60 days and evaluated for turbidity. According to Fisher's exact test, the cervical barrier in Groups 2 and 3 prevented the microleakage of E. faecalis into the root canals when compared with Groups 1 and 4. This result was similar to that for the completely sealed samples in Group 5 (p = 0.001).

Condição periapical e sua correlação entre a qualidade das restaurações coronárias e a obturação do sistema de canais radiculares na população de Belo Horizonte/MG / Periapical status related to the quality of coronal restorations and root canal filling system in a Belo Horizonte population

O prognóstico do tratamento endodôntico está geralmente correlacionado à sua qualidade técnica de forma direta, seguido de uma adequada restauração. O objetivo deste trabalho foi verificar o status periapical em dentes com tratamento endodôntico em uma população adulta da cidade de Belo Horizonte, Minas Gerais,Brasil. O estudo correlacionou a qualidade das restaurações coronárias e sua interrelação com a situação periapical em amostras de 603 pacientes, perfazendo um total de 1006 dentes, os quais foram submetidos a completo exame radiográfico periapical. A análise dos resultados relacionou a qualidade dos tratamentos endodônticos e das restaurações coronárias, correlacionando com a situação periapical dos dentes. Concluiu-se que a qualidade das restaurações coronárias é tão importante quanto à qualidade do tratamento endodôntico.

Generally speaking, the prognosis of endodontic treatment is directly related to its technical quality, followed by an appropriate restoration. The aim of this study was to verify the incidence of periapical lesions in teeth treated endodontically in the adult population of Belo Horizonte, Minas Gerais, Brazil. This study correlated the quality of coronary obturations of these teeth and their interrelation with the teeth’s periapical situation. Samples from 603 patients, were analyzed, 1006 teeth in all, which were then submitted to a complete periapical radiographic examination. The analysis of the results, correlating the endodontic treatment with the periapicalsituation, was proven. It could be concluded that both, an appropriate coronary restoration as well as an appropriate endodontic treatment should have a direct influence on the success of the treatment.

Radiographic parameters of quality of root canal fillings and periapical status: a retrospective cohort study.

INTRODUCTION: The aim of this study was to radiographically evaluate the relationship between the quality parameters of root canal fillings (apical extension, homogeneity, and taper) and periapical status. In addition, groups of teeth and complicating factors of endodontic treatment were assessed. METHODS: This retrospective cohort study assessed the quality and periapical status of root-filled canals in a 4- to 7-year follow-up period. Each parameter was dichotomized into ideal and altered conditions. A root-filled canal with an ideal condition for all 3 parameters was considered perfect, whereas the loss of 1 or more ideal conditions defined satisfactory or deficient fillings, respectively. The periapical statuses at baseline and follow-up were classified as normal, slight widening of the apical periodontal ligament, or periapical lesion. RESULTS: A total of 291 root-filled canals were evaluated. The prevalence of perfect, satisfactory, and deficient fillings was 54.6%, 37.5%, and 7.9%, respectively (P < .05). The periapical status at follow-up showed normal, slight widening of the apical periodontal ligament, or periapical lesion in 69.8%, 19.2%, and 11% of the roots, respectively (P < .05). The multivariate logistic regression showed that only preoperative periapical lesions (odds ratio, 2.99; 95% confidence interval, 1.27-7.03) and altered tapers (odds ratio, 3.73; 95% confidence interval, 1.51-9.24) were significantly associated with postoperative periapical lesions. CONCLUSIONS: Radiographic parameters of the quality of root-filled canals showed a significant relationship with the periapical status. Nevertheless, an altered taper was the main factor associated with the maintenance or development of periapical lesions after 4- to 7-year follow-up period.