Lesão endo-perio: classificação e diagnóstico / Endo-perio lesions: classifi cation and diagnosis

Lesões endo-perio são lesões inflamatórias que acometem, em diversos graus, tanto os tecidos periodontais como a polpa dental. O objetivo deste artigo é mostrar, através de uma revisão da literatura, a importância da classificação das lesões endo-perio, assim como o diagnóstico dessas lesões. A partir dos trabalhos revisados, conclui-se que as lesões endo-perio apresentam uma etiologia variada, sendo de fundamental importância o conhecimento do profissional quanto às causas e seu correto diagnóstico. Assim, para o sucesso e a resolução das lesões endo-perio, uma avaliação clínica e radiográfica eficaz determinará a correta classificação e, consequentemente, a melhor forma de tratamento.

Endo-periodontal lesions are inflammatory conditions that affect the periodontal tissues and the dental pulp. The aim of this article is to show the importance of the classification and the diagnosis of the endo-perio lesions. From the studies reviewed, it is concluded that endo-perio lesions present a varied etiology, being of fundamental importance the knowledge of the professional as to its causative factors and its correct diagnosis. Thus, for the success and resolution of endo-perio lesions an effective clinical and radiographic evaluation will determine the correct classification and consequently the best form of treatment.

Clinical longevity of extensive direct composite restorations in amalgam replacement: up to 3.5 years follow-up.

OBJECTIVES: This prospective clinical trial evaluated the longevity of direct resin composite (DRC) restorations made on stained dentin that is exposed upon removal of existing amalgam restorations in extensive cavities with severely reduced macro-mechanical retention for amalgam replacement. METHODS: Between January 2007 and September 2013, a total of 88 patients (57 women, 31 men; mean age: 51.6 years old) received extensive cusp replacing DRCs (n=118) in the posterior teeth. DRCs were indicated for replacement of existing amalgam restorations where dentin substrates were stained by amalgam. After employing a three-step total-etch adhesive technique (Quadrant Unibond Primer, Quadrant Unibond Sealer, Cavex), cavities were restored using a hybrid composite (Clearfil Photo Posterior, Kuraray). At baseline and thereafter every 6 months, restorations were checked upon macroscopically visible loss of anatomical contour, marginal discolouration, secondary caries, fractures, debonding and endodontic problems. Restorations were scored as failed if any operative intervention was indicated for repair, partial or total replacement. RESULTS: Restorations were observed for a minimum of seven, and maximum 96 months (mean: 40.3 months). In total, four failures were observed due to fracture (n=1), endodontic complications (n=2) and inadequate proximal contact (n=1). Failures were related neither to inadequate adhesion nor to secondary caries. Cumulative survival rate was 96.6% (95% CI: 89-95) up to a mean observation time of 40.3 months (Kaplan-Meier) with an annual failure rate of 0.9%. CONCLUSION: In case of amalgam replacement, dentin that is exposed upon removal of existing amalgam restorations does not impair clinical longevity of extended cusp replacing direct resin composite restorations. CLINICAL SIGNIFICANCE: Extensive amalgam restorations can be replaced with a variety of treatment options. This clinical study indicates that in such cases directly applied resin based composites offer a reliable and low-cost treatment option, even if dentin is stained by amalgam corrosion products.

An endodontic conundrum: the association between pulpal infection and periodontal disease.

This paper reviews the classification of periodontal-endodontic lesions and considers the pathways through which inflammatory lesions or bacteria may communicate between the pulp and the periodontium. Such communications have previously underpinned the classification of periodontal-endodontic lesions but a more up-to-date approach is to focus specifically on those lesions that originate concurrently as pulpal infection (and necrosis) and periodontal disease on the affected teeth. In doing so, both conventional periodontal and endodontic treatments are indicated for the affected teeth, although more complex management strategies may occasionally be indicated.

[An index for untreated severe caries]. / Een index voor onbehandelde ernstige cariës.

Hardly any data are available on the clinical consequences of untreated severe caries, because there is no method to quantify the prevalence of oral conditions resulting from untreated caries. In the Philippines, an index was developed which records for (the location of) each tooth whether caries has reached the dental pulp, whether ulceration is present in the surrounding soft tissues due to sharp edges of fragments of a tooth lost due to caries, or whether a fistula or abscess is present. By adding the index to the existing Decayed Missing Filled Tooth index, insight is provided on the extent and the consequences of untreated caries and research may be carried out on its possible impact on the general health and wellbeing of national populations.

Pain prevalence and severity before, during, and after root canal treatment: a systematic review.

INTRODUCTION: Anticipation and experience of root canal associated pain is a major source of fear for patients and a very important concern of dentists. Pretreatment, treatment, and posttreatment pain is anticipated, experienced, remembered, and shared by patients. The purpose was to determine the influence of root canal treatment on pain prevalence and severity and estimate the prevalence and severity of pretreatment, treatment, and posttreatment pain in patients receiving root canal treatment. METHODS: Defined searching of MEDLINE, Embase, Cochrane, and PsycINFO databases identified 5,517 articles. Systematic review, including title scanning, abstract scanning, full-text review, and quality rating, provided 72 studies for meta-analysis. L'Abbe plots were used to evaluate the influence of root canal treatment on pain prevalence and severity. Pretreatment, treatment, and posttreatment pain prevalence and severity data were analyzed. RESULTS: L'Abbe plots revealed that pain prevalence and severity decreased substantially after treatment. Mean pretreatment, 24-hour posttreatment, and 1-week posttreatment pain prevalences with associated standard deviations were 81 (28%), 40 (24%), and 11 (14%), respectively. Pretreatment, 24-hour posttreatment, and 1-week posttreatment pain severities, on a 100-point scale, were 54 (24%), 24 (12%), and 5 (5%), respectively. Supplemental injections were frequently required (60 [24%]). CONCLUSIONS: Pretreatment root canal-associated pain prevalence was high but dropped moderately within 1 day and substantially to minimal levels in 7 days. Pretreatment root canal-associated pain severity was moderate, dropped substantially within 1 day of treatment, and continued to drop to minimal levels in 7 days. Supplemental anesthesia was often required.

Semiología de la pulpa: signos, síntomas y determinación del estado pulpar / Semiology of the pulp: signs, symptoms and pulp status determination

Es sabido que para toda intervención en medicina u odontología es imperativo proceder a realizar un correcto diagnóstico de la patología a tratgar; la operatoria dental no escapa a esta regla, debiendo el profesional realizar el diagnóstico de la lesión de los tejidos duros del diente pero además de su estado pulpar; y es precisamente aquí donde debe agudizar sus sentidos para observar la presencia de alguna patología y determinar en primera instancia el área de su incumbencia, o la derivación a la endodoncia. Es en este punto donde se cometen infinidad de errores ya que existe una sutil línea a partir de la cual la lesión pulpar pasa a un estadio irreversible. Es muy común intentar determinar el estado pulpar por la extensión de la lesión sin reparar en que existen grandes cavidades con tejido pulpar sano y pequeñas lesiones con patologías irreversibles. También es habitual que el profesional se guíe para la toma de decisiones por una radiografía, sin comprender que la misma no determina el estado pulpar. Por todo esto, es necesario conocer diferentes pruebas o tests que nos ayudan a diagnosticar con el menor margen de error posible, para encarar así un adecuado tratamiento.

Strategies for the endodontic management of concurrent endodontic and periodontal diseases.

Endodontic and periodontal diseases can provide many diagnostic and management challenges to clinicians, particularly when they occur concurrently. As with all diseases, a thorough history combined with comprehensive clinical and radiographic examinations are all required so an accurate diagnosis can be made. This is essential since the diagnosis will determine the type and sequence of treatment required. This paper reviews the relevant literature and proposes a new classification for concurrent endodontic and periodontal diseases. This classification is a simple one that will help clinicians to formulate management plans for when these diseases occur concurrently. The key aspects are to determine whether both types of diseases are present, rather than just having manifestations of one disease in the alternate tissue. Once it is established that both diseases are present and that they are as a result of infections of each tissue, then the clinician must determine whether the two diseases communicate via the periodontal pocket so that appropriate management can be provided using the guidelines outlined. In general, if the root canal system is infected, endodontic treatment should be commenced prior to any periodontal therapy in order to remove the intracanal infection before any cementum is removed. This avoids several complications and provides a more favourable environment for periodontal repair. The endodontic treatment can be completed before periodontal treatment is provided when there is no communication between the disease processes. However, when there is communication between the two disease processes, then the root canals should be medicated until the periodontal treatment has been completed and the overall prognosis of the tooth has been reassessed as being favourable. The use of non-toxic intracanal therapeutic medicaments is essential to destroy bacteria and to help encourage tissue repair.

A clinical classification of the status of the pulp and the root canal system.

Many different classification systems have been advocated for pulp diseases. However, most of them are based on histopathological findings rather than clinical findings which leads to confusion since there is little correlation between them. Most classifications mix clinical and histological terms resulting in misleading terminology and diagnoses. This in turn leads to further confusion and uncertainty in clinical practice when a rational treatment plan needs to be established in order to manage a specific pathological entity. A simple, yet practical classification of pulp diseases which uses terminology related to clinical findings is proposed. This classification will help clinicians understand the progressive nature of the pulp disease processes and direct them to the most appropriate and conservative treatment strategy for each condition. With a comprehensive knowledge of the pathophysiology of pain and inflammation in the pulp tissues, clinicians may accomplish this task with confidence.

Procesos endoperiodontales. II. Lesiones endoperiodontales / No disponible

Analiza una clasificación clínica de las lesiones endoperiodontales, la historia clínica para alcanzar un diagnóstico así como las opiniones terapéuticas de las mismas (AU)

Analysis of clinical classification for the endoperiodontal lesions, of the clinical history required to achieve a diagnosis and of their therapeutic options (AU)

Endodontic diagnosis: clinical aspects.

The objectives of this article are to review classic and current concepts on endodontic diagnosis, to describe the current classification of the pulp and periradicular diseases and to present and discuss the diagnostic tools available for endodontic diagnosis. The "SOAP" approach to endodontic diagnosis is a very efficient and simple method to accomplish accurate diagnosis. SOAP serves as a mnemonic to guide the clinician in data collection and stands for: Subjective, Objective, Assessment, and Plan.

Periodontal-endodontic interdisciplinary treatment--a case report.

Periodontal-endodontic lesions pose a difficult diagnostic and therapeutic challenge to the dental practitioner. A careful diagnostic examination consisting of a thorough patient and dental history, comprehensive clinical examination, and use of appropriate dental radiographs is necessary to arrive at a proper diagnosis of the periodontal-endodontic lesion. Despite these measures, it is not always possible to make an accurate diagnosis, which is imperative to provide the proper therapy in the correct treatment sequence. In some instances, endodontic or periodontal therapy alone may suffice; however, in other instances, a combination of endodontic and periodontal therapy may be required to successfully treat the case. In this article, classifications of periodontal-endodontic lesions are discussed, including the appropriate treatment and correct treatment sequence for each classification. Prognosis of periodontal-endodontic lesions depends on the diagnosis, treatment, and chronicity of the lesion, as well as the duration of periodontal involvement. A clinical case is presented in which a periodontal endodontic lesion has been successfully treated with a combination of conventional endodontic therapy and regenerative periodontal surgery.

Apicomarginal defects in periradicular surgery: classification and diagnostic aspects.

The prognosis of periradicular surgery is affected by the amount and location of bone loss. Apicomarginal defects are localized bony defects encompassing the total root length, and periradicular surgery on these teeth is associated with a lower success rate. This paper reviews the etiology, pathogenesis, and morphology of apicomarginal defects as encountered in periradicular surgery on the basis of a series of 24 consecutively treated patients. Periodontal data were recorded before surgery in all patients, and apicomarginal defects were diagnosed after flap reflection or, if applicable, apicoectomy. On the basis of the findings in these cases and on theoretic considerations, a classification system for apicomarginal defects with potential therapeutic and prognostic implications is presented and several criteria for differential diagnosis are discussed.

Long-term follow-up of cases considered healed one year after apical microsurgery.

A previous report demonstrated 96.8% healing within 1 yr after apical surgery was performed with the surgical operating microscope and Super-EBA as the root-end filling material. The purpose of this paper is to report on the long-term follow-up of those cases that were considered healed at the short term. Clinical examinations were made and radiographs were evaluated 5 to 7 yr after the case had first been considered healed. Criteria for determining healed cases were the same as those used in the first report. Of the 59 roots evaluated, 54 (91.5%) remained healed, whereas 5 (8.5%) showed evidence of apical deterioration.