Primeiro pré-molar inferior com três canais e duas raízes: relato de caso

Introdução: a possibilidade de encontrarmos canais radiculares adicionais deve ser considerada em dentes com baixa frequência de anormalidade na anatomia do sistema de canais radiculares. Objetivo: esse artigo relata um caso relativamente incomum de um primeiro pré-molar inferior com duas raízes e três canais, que foi tratado adequadamente por meio da terapia endodôntica. Métodos: após a radiografia inicial, foi constatada a presença de mais de uma raiz. Cuidado adicional foi necessário para explorar os canais radiculares, confirmando a presença de três canais por meio de um microscópio operatório. Os canais foram instrumentados com a técnica rotatória híbrida preconizada pela Faculdade de Odontologia de Piracicaba, e obturados com a técnica de condensação lateral e cimento Sealer 26. Conclusão: para se atingir o melhor resultado possível no tratamento endodôntico, é importante ter um bom conhecimento da morfologia do sistema de canais radiculares, assim como usar de modo apropriado os métodos de diagnóstico existentes.

Lateral radiographic technique: an alternative approach for anterior teeth.

AIM: To describe the lateral radiographic technique, its use and indication. BACKGROUND: The clinician's difficulty in performing the correct diagnosis for some endodontic situations sometimes leads to a compromised treatment of some teeth. Considering this, an alternative radiographic technique for anterior teeth (lateral radiographic technique - LRT) may be used to help endodontic diagnosis. TECHNIQUE: This technique use a periapical radiographic film or sensor that is placed vertically in the anterior portion of maxilla or mandible and with the beam passing perpendicular to the radiographic film its possible to evaluate the possibility of a fenestration on the buccal cortical bone plate; differentiate overextension and overfilling; indentify root fractures; confirm the presence and location of an instrument in the root canal system; and assess the treatment of root perforations. CONCLUSION: LRT is an easy and cheap technique that can be used to help in anterior teeth diagnosis. CLINICAL SIGNIFICANCE: Considering that LRT is easy to perform and available at low cost, it could be utilized more by clinicians in the dental office in order to quickly assist in diagnosis. As a complimentary radiographic examination for anterior teeth, it could become a useful supplement to aid the clinical practice.

Diagnosis of a horizontal root fracture during retreatment of a maxillary canine utilizing an electronic apex locator and monitoring with CBCT: a case report / Diagnóstico de fratura horizontal durante retratamento de um canino superior com auxílio de localizador apical e tomografia de feixe cônico (Cone Beam): relato de caso

Introduction: The aim of this case report is to demonstrate the retreatment of a maxillary canine diagnosed with a horizontal root fracture utilizing an electronic apex locator and monitored with cone beam computed tomography. Case Report: A 35 year old African American male was referred for root canal retreatment of a maxillary right canine prior to prosthetic rehabilitation. Following removal of gutta percha, an apex locator was utilized to determine the length of the root canal. After a more comprehensive dental history, the patient confirmed a previously unreported history of dental trauma at this time, leading to the suspicion of a horizontal root fracture. Clinical microscopy detected a connective tissue in the apical third of the root canal and multiple periapical and occlusal radiographs enhanced visualization of a horizontal root fracture. The coronal segment was filled with an MTA apical plug and the apical segment remained stable. A recall after 1.5 years was performed with CBCT, which showed no apical radiolucency. Discussion: The present case report reinforces the precept that detailed dental history and careful observation of radiographs are critical factors for obtaining an accurate diagnosis. Fundamental adjuncts, such as microscopy, apex locators and CBCT imaging, can potentially aid in the diagnosis and the subsequent treatment plan of horizontal root fracture

Introdução: O objetivo deste estudo foi mostrar o passo-a-passo do diagnóstico de uma fratura horizontal durante um retratamento, utilizando o localizador apical e a tomografia de feixe cônico como auxiliares do diagnóstico clínico. Relato de caso: Um paciente de 35 anos do gênero masculino afro-americano foi encaminhado com necessidade de retratamento no canino superior direito para posterior reabilitação protética. Seguida da remoção da guta-percha, foi utilizado o localizador apical para determinar o comprimento real do dente. Após uma melhor investigação sobre a história dental do paciente, o paciente confirmou uma história de trauma dental até então não comentada durante a anamnese, levando a suspeita de fratura horizontal no comprimento onde o localizador marcava a posição 0,0. Com o microscópio clínico detectou-se a presença de tecido granulomatoso no terço apical e, através de múltiplas radiografias periapical e uma oclusal foi possível visualizar a fratura horizontal. O segmento coronário instrumentado foi selado com um plug de MTA e, mantido o segmento apical sem tratamento. A proservação após um ano e meio foi realizada com CBCT, não presentando quaisquer alterações periapicais. Discussão: O presente relato de caso reforça ainda mais a necessidade de uma anamnese e história dental detalhada e cuidadosa observação radiográfica como fatores críticos para um diagnóstico preciso. Ferramentas auxiliares, como o microscópio, localizador apical e tomografia podem adicionar ao diagnóstico e consequentemente ao planejamento de fraturas horizontais.

Influence of chlorhexidine and ethanol on the bond strength and durability of the adhesion of the fiber posts to root dentin using a total etching adhesive system.

INTRODUCTION: The aim of this study was to investigate the effects of pretreatment of gel chlorhexidine (CHX) and ethanol (EtOH) on the bond strength and durability of the adhesion of the fiber post relined with resin composite to the root dentin using a total etch adhesive system. METHODS: Forty bovine incisor roots were divided into four groups after phosphoric acid etching: irrigation with physiologic solution (control), 5 minutes with CHX, 1 minute with EtOH, and 5 minutes with chlorhexidine followed by 1 minute with EtOH. Fiber posts relined with resin composite were cemented with either RelyX ARC (3M ESPE, St Paul, MN) and a total etch adhesive system Scotchbond Multi-Purpose (3M ESPE). Each group was randomly divided into two subgroups: 24 hours of storage and 12 months of storage. All roots were sectioned transversely, and the push-out test was performed. Failure modes were observed, and the bond strength means were analyzed by analysis of variance and the Tukey test (α = 0.05). RESULTS: CHX irrigation resulted in homogeneous bond strength values at 24 hours and 12 months of storage (P < .05). A significant bond strength decrease was noticed after 12 months of storage when irrigations were performed with physiologic solution and EtOH application only or associated with CHX (P < .05). CONCLUSIONS: The use of CHX pretreatment could preserve the bond strength of the fiber post relined with resin composite to root dentin for 12 months. The use of EtOH and CHX followed by EtOH did not preserve the bond strength of the total etch adhesive system Scotchbond Multi-Purpose.

Effect of chlorhexidine and ethanol on the durability of the adhesion of the fiber post relined with resin composite to the root canal.

INTRODUCTION: The aim of this study was to investigate the effects of pretreatment of gel chlorhexidine and ethanol on the bond strength and durability of the adhesion of the fiber post relined with resin composite to the root dentin. METHODS: Sixty bovine incisor roots were divided into four groups: irrigation with physiologic solution (control), 5 minutes with chlorhexidine, 1 minute with ethanol, and 5 minutes with chlorhexidine followed by 1 minute with ethanol. Fiber posts relined with resin composite were cemented with RelyX ARC (3M ESPE, St Paul, MN) and a self-etching adhesive system Clearfil SE Bond (Kuraray, Kurashiki, Japan). Each group was randomly divided into three subgroups: 24 hours of water storage, 12 months of water storage, and 12 months of oil storage. All roots were sectioned transversely in the coronal, middle, and apical regions, producing 1-mm thick slices, and the push-out test was performed. Statistical analysis was performed using analysis of variance and the Tukey test for post hoc comparisons (α = 0.05). RESULTS: Immediate groups showed similar bond strength values with or without chlorhexidine and/or ethanol pretreatment (P > .05). A significant decrease in the bond strength in the control group was observed after 12 months of storage in water and oil (P < .05). The use of chlorhexidine- and/or ethanol-preserved bond strength in the groups stored in water and oil for 12 months (P < .05). CONCLUSIONS: Chlorhexidine and/or ethanol pretreatment were capable of preserving the bond strength of the fiber post relined with resin composite to root dentin for 12 months.

Avaliação do sucesso clínico do atendimento de urgência endodôntica na FOP-Unicamp / Evaluation of the success rate of the endodontic emergency appointment at FOP-Unicamp

A dor de origem pulpar ou periapical é um dos mais importantes problemas dentro de um serviço de urgência odontológica. Portanto, um diagnóstico correto e tratamento eficaz nesses casos são imprescindíveis. O objetivo desse estudo foi avaliar o sucesso clínico do atendimento de urgência endodôntica, em 500 pacientes que procuraram o serviço de plantão de urgência da Faculdade de Odontologia de Piracicaba - Unicamp, com diagnóstico de pulpite irreversível ou necrose pulpar associada a pericementite. O atendimento clínico foi realizado conforme preconizado pela Disciplina de Endodontia da FOP-Unicamp e nenhuma medicação sistêmica foi prescrita aos pacientes. Os pacientes foram controlados em 24 horas, através de telefonema. Os resultados mostraram que o atendimento da urgência endodôntica da FOP-Unicamp apresentou índice de sucesso de 92,6%.

The pain from pulpal and periapical disease is one of the most important problem in the emergency services. Therefore the correct diagnosis and treatment of the tooth are essential. The purpose of this study was to evaluate the success of endodontic emergency appointment realized in 500 patients, who were attended at the Emergency Service of the Piracicaba Dental School, with irreversible pulpitis or necrosis associated with periodontitis. The clinical appointment was performed in according to an established endodontic emergency protocol adopted by the Endodontic Area of the Piracicaba Dental School. The follow up of patients was ma de 24 hours after the appointment. The results showed that the endodontic emergency treatment, performed at Emergency Service of the Piracicaba Dental School were successful in 92,6% of cases.

Effect of sonic and ultrasonic retrograde cavity preparation on the integrity of root apices of freshly extracted human teeth: scanning electron microscopy analysis.

Sonic and ultrasonic root-end preparation devices permit the preparation of conservative and straight cavities. However, microfractures and marginal chipping can occur due to the vibratory action of such instruments. The purpose of this study was to evaluate the effect of retrograde preparations by using sonic and ultrasonic tips on the integrity of root-end surfaces. Eighty, human anterior teeth were grouped according to size and treated as follows: treatment 1: root-end resection (RR) and root-end cavity preparation (RP) with KIS ultrasonic retrotip; treatment 2: RR and RP with Satelec S12/90 (no diamond coating) ultrasonic retrotip; treatment 3: RR and RP with a diamond-coated retrotip attached to a sonic device (Sonics); treatment 4: RR and RP with Satelec S12/90D (diamond coated) ultrasonic retrotip. The root-end surface topographies were assayed by means of polyvinylsiloxane impressions and epoxy resin replicas. SEM pictures of each sample were taken before and after preparation, and the images were evaluated by using an image processing and analysis system. The parameters evaluated were shape quality, presence of cracks, and marginal chipping. The results showed no statistically significant differences among anatomic groups, treatments, or tooth sizes (p > 0.05). Because treatment 3 removed more dental structure than the others did, its use on small teeth is inadvisable.