ABSTRACT
INTRODUCTION: The present study aimed to describe an in vitro study model to investigate root surface strain (RSS) and its correlation with the initiation/propagation of microcracks during different endodontic procedures. METHODS: Four lower human incisors extracted microcrack free were selected by micro-computed tomographic imaging. Two strain gauges were bonded to the root surface of each incisor. Then, the teeth were prepared to reproduce the periodontal ligament artificially. The gauges were attached to a data acquisition system. The RSS was recorded during the entire endodontic procedure, which consisted of accessing the endodontic cavity, cleaning, shaping preparation with an Mtwo rotary system (VDW, Munich, Germany), and filling with a standardized technique. Each incisor was submitted to a different retreatment protocol and supplementary cleaning method as follows: (1) Reciproc (RC, VDW) + Flatsonic (FS; Helse, Santa Rosa de Viterbo, Brazil), (2) RC + XP-endo Finisher (XPF; FKG Dentaire, La Chaux-de-Fonds, Switzerland), (3) Mtwo retreatment (MR) + FS, and (4) MR + XPF. Finally, the teeth were rescanned to establish the postoperative microcrack formation by 2 well-trained and blinded examiners. RESULTS: The maximum and minimum RSS values were -120 and 510 microstrains, respectively, for all of the files. RC showed the highest RSS values during endodontic retreatment compared with MR. FS demonstrated a higher variation between the minimum and maximum RSS than XPF. No microcracks were observed in the specimens. CONCLUSIONS: This preliminary study proposed an experimental model that would combine 2 methods to evaluate the effects of endodontic systems on dentin. Although strain gauges would provide data on the stresses created, the pre- and postoperative evaluation of micro-computed tomographic images would enable microcrack formation to be determined.
Subject(s)
Dental Pulp Cavity , Root Canal Preparation , Brazil , Humans , Retreatment , X-Ray MicrotomographyABSTRACT
Assessment of apical periodontitis (AP) is a challenging task. This case report highlights the CBCT diagnosis and monitoring of periapical radiolucency (PR) using ITK-SNAP software 3.8v in a complex clinical scenario of three traumatized anterior teeth. An 11-year-old male patient complained of recurrent swelling and pain in the maxillary incisor region (teeth #11 and #21). His parents reported a history of traumatic injury affecting these teeth two years back. Digital periapical radiographic (DPR) and cone-beam computed tomography (CBCT) were requested. PR was identified on teeth #11, #21, and # 22. In tooth #22, besides a PR, an area suggesting internal root resorption or oblique root fracture was observed. The teeth were shaped and dressing with calcium hydroxide Ca(OH)2. MTA repair was delivered to the apical portion of the canals (approximately 3 mm). The remainder of the canal was filled with thermoplastic gutta-percha and Endosequence sealer. After one year, the patient returned complaining of pain in tooth #11. Radiographically, the PR of tooth #11 did not reduce. A CBCT was taken, showing a reduction of radiolucency. The patient was clinical and radiographically re-evaluated for 6 months, and he remained asymptomatic. After three years of follow-up, the patient suffered a new trauma on teeth #11 and #21. As tooth #11 presents mobility and biting pain, a new CBCT was requested due to the risk of a possible root fracture. So, the PR was synchronously monitored with linear measurements and volumetric analysis using ITK-SNAP software 3.8v. In this case, the volumetric evaluation was essential to identify the PR's correct dimensions, reducing image interpretation's subjectivity. At 48-month follow-up, the patient was symptoms free and radiographically showed a reduction in the PR's size, compatible with osseous healing.
ABSTRACT
Different restorative techniques have been proposed for the treatment of posterior teeth affected by cracked tooth syndrome (CTS). However, the literature is scarce in protocols of how to solve CTS using ceramic restorations made by computer aided design-computer aided manufacturing (CAD-CAM) system. CAD-CAM provides a fast and efficient restorative treatment usually in a single visit, reducing the risk of contamination and micro-infiltration of the cracked line. The objective of this work was to describe 3 clinical cases of cracked teeth, which presented vertical fracture lines in different directions and extension through the pulp, restored by CAD-CAM system, with 5-year follow-up. Patients with short-term spontaneous masticatory pain, cold sensibility and restored teeth without cuspal coverage were selected. Digital radiographs (DR) were taken to confirm the pulp and periapical status. Periodontal probing depth, sensitivity, percussion, and occlusion tests were performed. The fracture lines with their direction and extension were identified under dental optical microscope (DOM). The treatment plan was performed in two stages: immediate treatment to stabilize the tooth and minimize pain, and final restorative treatment by CAD-CAM system to stabilize the crack. Patients were between the ages of 37 and 45 years. Most of the studied teeth presented extensive restorations without cuspal coverage. The presence of occlusal interference, in lateral movement, was a constant finding. Endodontic treatment was performed in cases of irreversible pulpitis or pulpal necrosis. In all three cases, cavity preparation was performed for full coverage restorations, as the fracture lines extended in several directions, requiring a re-enforcement of the cervical region of the teeth in question. The survival rate of the reported cases was 100% with 5-year clinical and radiographic follow-up, suggesting that CAD-CAM system may be a promising alternative treatment in the management of CTS, improving tooth longevity.
