Inyección accidental de hipoclorito de sodio. Reporte de un caso / Accidental Injection of Sodium Hypochlorite. Case Report

El hipoclorito de sodio (NaOCl) es la solución de irrigación más utilizada en endodoncia. Se caracteriza por su gran poder disolvente de tejido orgánico, su actividad antibacteriana y su bajo costo. Pero tiene la desventaja de su alto poder irritante sobre los tejidos vitales. El accidente con NaOCl es poco frecuente en la terapia endodóntica. La mayoría de las complicaciones se deben a la extrusión accidental de la solución por el foramen apical, esto provoca cuadros muy aparatosos, pese a que no suelen comprometer la vida del paciente. El presente artículo describe un caso de inyección accidental de hipoclorito de sodio a través de una perforación lateral del conducto radicular y las acciones terapéuticas correspondientes

Sodium hypochlorite (NaOCl) is the most widely used irrigating solution in endodontics. It is characterized by its high solvent power of organic tissue, antibacterial activity and low cost. But it has the disadvantage of their highly irritation power on vital tissues. The accident is rare in endodontic therapy with NaOCl. Mostly complications are caused by accidental extrusion of the solution through the apical foramen, this causes very bulky pictures, although usually do not compromise expose the life of the patient. This article describes a case of an accidental injection of sodium hypochlorite through a root canal lateral drilling and the related therapeutic actions

Apical extrusion of debris by manual and mechanical instrumentation.

The aim of the present study was to assess the presence of apically extruded debris and evaluate the influence of canal curvature on the amount of debris produced by manual and mechanical techniques. Forty single-rooted mature teeth with 15 to 30 degree of root canal curvature were selected. The presence of only one foramen was confirmed using a magnifying lens. A size 15 K-file was placed up to the apical foramen to determine the patency. Working length was determined with the same instrument, 1 mm short of the foramen. According to the employed technique, the groups were labeled as follows: Group 1 - Manual instrumentation with Mor-flex files; Group 2 - Mechanical instrumentation with Cursor and Mor-flex files; Group 3 - Manual instrumentation with Flexi-cut files; Group 4 - Mechanical instrumentation with Cursor and Flexi-cut files. During instrumentation, the root canals were irrigated with 20 mL. Debris extruded through the apical foramen was collected using the Myers and Montgomery technique. The values (in mg) were: Group 1: 0.422 +/- 0.683; Group 2: 0.688 +/- 0.795; Group 3: 0.409 +/- 0.323; Group 4: 0.810 +/- 0.708. Data were analyzed statistically by ANOVA at 5% significance level. There was no statistically significant difference among the groups (p<0.05). No statistically significant differences were found between slight and moderate curvatures in terms of the amount of extruded debris (p>0.05).

Comparación de dos métodos para evaluar la transportación apical / A comparison of two methods to evaluate apical transportation

El objetivo del presente trabajo fue comparar un método radiográfico con un método anatómico para medir la transportación apical en conductos curvos. Se seleccionaron 60 molares inferiores humanos, con angulaciones en sus conductos mesio-vestibularees de 15º a 45º. La raíz distal de cada pieza fue eliminada, para evitar la interferencia en las radiografías con incidencia mesio-distal. Aplicando el procedimiento propuesto por Bramante modificado, la raíz mesial antes de ser seccionada fue incluida en resina transparente usando una mufla de grilon como llave para la reposición de los fragmentos. Las piezas incluidas fueron radiografiadas con incidencia vestíbulo-lingual y mesio-distal utilizando un dispositivo plástico para sistematizar las tomas radiográficas pre y pos operatorias. Luego, las raíces fueron seccionadas horizontalmente a 3 mm del ápice y fotografiadas. Los segmentos fueron reposicionados en la mufla y los conductos instrumentados con técnicas manual y mecanizada. Completada la instrumentación se tomaron radiografías de las raíces y fotografías de los segmentos. La medición radiográfica de la transportación apical se realizó con calibre micrométrico sobre trazados de las proyecciones ampliadas 8 veces de ambas tomas radiográficas. La medición anatómica se realizó analizando las fotografías pre y pos instrumentación con un equipo de digitalización de imágenes Macintosh (Image 1.45). Los métodos radiográfico y anatómico presentan datos diferentes debido a los distintos niveles y criterios de medición. El análisis estadístico (ANOVA) mostró diferencias significativas entre el método radiográfico y el método anatómico (p<0.0001). La comparación entre las medidas de transportación obtenidas radiográficamente y anatómicamente en cada uno de los grupos no mostró diferencias (p=0.21).

The purpose of the present study was to compare a radiographic versus anatomic method for apical transportation measurement in curved root canal. Sixty recently removed human mandibular molars with buccolingual curved root canals ranging from 15º to 45º, were selected. The distal roots were removed to avoid radiographs interferences with mesiodistal incidence. Before been sectioned mesial roots were inclosed in transparent resin using a grilon key-like muffle with modificated Bramante´s procedure. The inclosed teeth were radiographed buccolingually and mesiodistally using a plastic dispositive to allow for standart pre and postinstrumentation radiographs. The roots canals were horizontally sectioned. Cuts made at 3 mm from the apex and photographed. The sections were reassembled in the muffle and the canals were instrumented with manual and mechanized techniques. After instrumentation was finished, radiographs of the teeth and photographs of the segment were taken. Transportation radiographic measurement was made with a micrometer on radiographic projection tracing magnified 8 times, in two planes. Transportation anatomic measurement was made analyzing photographs pre and posinstrumentation using and Image 1.45 Sofware Macintosh computer. Radiographic and anatomic methods showed different data due to the different levels and criteria of measurement. Statistical analysis (ANOVA) showed significant difference (p<0.0001) between radiographic and anatomic methods. Media comparison between radiographic and anatomic transportation, in each group, showed no significant difference (p=0.21).

Apical extrusion of debris by manual and mechanical instrumentation

The aim of the present study was to assess the presence of apically extruded debris and evaluate the influence of canal curvature on the amount of debris produced by manual and mechanical techniques. Forty single-rooted mature teeth with 15 to 30 degree of root canal curvature were selected. The presence of only one foramen was confirmed using a magnifying lens. A size 15 K-file was placed up to the apical foramen to determine the patency. Working length was determined with the same instrument, 1 mm short of the foramen. According to the employed technique, the groups were labeled as follows: Group 1 - Manual instrumentation with Mor-flex files; Group 2 - Mechanical instrumentation with Cursor and Mor-flex files; Group 3 - Manual instrumentation with Flexi-cut files; Group 4 - Mechanical instrumentation with Cursor and Flexi-cut files. During instrumentation, the root canals were irrigated with 20 mL. Debris extruded through the apical foramen was collected using the Myers and Montgomery technique. The values (in mg) were: Group 1: 0.422 ± 0.683; Group 2: 0.688 ± 0.795; Group 3: 0.409 ± 0.323; Group 4: 0.810 ± 0.708. Data were analyzed statistically by ANOVA at 5 percent significance level. There was no statistically significant difference among the groups (p<0.05). No statistically significant differences were found between slight and moderate curvatures in terms of the amount of extruded debris (p>0.05).

O objetivo deste trabalho foi registrar a presença de material extruído apicalmente e estudar a influência da curvatura dos canais radiculares na quantidade de material, após a instrumentação manual e mecânica. Foram selecionados 40 dentes uniradiculares com ápice maduro, com curvatura do canal entre 15 e 30 graus e somente um forame apical. Verificou-se a patência do forame usando uma lima tipo-K no. 15 e se determinou a extensão de trabalho a 1 mm do forame. Considerando a técnica empregada, se formaram os seguintes grupos: Grupo 1 - instrumentação manual com limas Mor-flex; Grupo 2 - instrumentação mecânica com Cursor e limas Mor-flex; Grupo 3 - instrumentação manual com limas Flexi-cut e Grupo 4 - instrumentação mecânica com Cursor e limas Flexi-cut. Cada canal foi irrigado, enquanto era preparado, com 20 mL de água destilada. Para a coleta do material se aplicou a técnica proposta por Myers e Montgomery. Os valores, em miligramas obtidos em cada grupo foram: Grupo 1 - 0,422 ± 0,683; Grupo 2 - 0,688 ± 0,795; Grupo 3 - 0,409 ± 0,323 e Grupo 4 - 0,810 ± 0,708. A análise estatística (ANOVA) não detectou diferenças estatisticamente significantes (p> 0,05) nas quantidades médias de material extruído em cada grupo. Comparando a influência da curvatura dos canais, não se encontrou diferenças estatisticamente significantes nas quantidades médias de material extruído segundo as curvaturas foram leves ou moderadas (test t para variâncias desiguais p>0,05).

Transportation of curved canals instrumented with manual and mechanical techniques.

The purpose of this study was to compare the effect of manual and mechanical instrumentation techniques in curved root canals using area of dentine removed and canal axis movement as the end-points. Sixty mandibular molars with curved root canals with angulations ranging from 15 degrees to 45 degrees were selected. The teeth were embedded in transparent resin in a grilon key-like muffle using Bramante's procedure. The roots were horizontally sectioned at three levels and pre and post instrumentation photographs were taken. The sections were reassembled in the muffle and the canals were instrumented with manual and mechanical techniques using Cursor (W&H). Anatomic measurements of transportation were made employing pre and post instrumentation photographs and Macintosh Image 1.45 Software. Statistical analysis of the data was performed by ANOVA. There were no significant differences in canal center axis movement among the groups. Differences in area of dentine removed between manual and mechanical instrumentation techniques were observed at the apical level only.

Shaping of curved root canals instrumented with stainless steel and nickel titanium files.

The cleaning efficiency and the quality of the surgical preparation is mainly conditioned by root canal anatomy, the instruments and the technique employed. The purpose of the present study was to evaluate the extent of straightening of curved root canals and the changes in endodontic anatomy caused by the use of Flex-R, Onyx-R and Nitiflex files with the balanced forces technique. Sixty mandibular molars were selected for evaluation of angulation and transportation. Pre and post instrumentation radiographs were taken of the mesiodistal and buccolingual aspects of each tooth. The radiographs were projected on a transparent sheet, the contours of each tooth and file were outlined and the canal curvature was measured. Pre and post instrumentation tracings were overlaid and the extent of transportation was measured with a micrometric caliper. Statistical analysis of the data was performed employing Student's "t" test, Analysis of Variance and Bonferroni's test. The results showed that all the instruments reduced canal curvature significantly. Transportation in the mesiodistal direction did not reach statistical significance whereas transportation in the buccolingual direction was statistically significant.

Shaping of curved root canals instrumented with stainless steel and nickel titanium files / Conformación de conductos curvos instrumentados con limas de acero inoxidable y níquel-titanio

La eficacia de la limpieza y la calidad de la preparación quirúrgica están condicionadas de manera fundamental por la anatomía de los conductos, el instrumental y la técnica utilizada. Los objetivos del presente estudio fueron evaluar, utilizando la técnica de fuerzas balanceadas, la rectificación de conductos curvos y las modificaciones de la anatomía endodóntica, producidas por limas Flex-R, Onyx-R y Nitiflex. Para los estudios de angulación y transpòrtación se seleccionaron 60 molares inferiores. Se tomaron radiografías pre y posoperatorias en ambos sentidos; estas radiografías fueron proyectadas sobre hojas transparentes, trazándose los contornos de dientes y limas y midiendo las angulaciones. Superponiendo las transparencias, se midió la transportación de los conductos con un calibre micrométrico. Los datos fueron estudiados estadísticamente con "t" test, análisis de varianza y tes de BOnferroni. Los resultados demostraron que los instrumentos disminuyeron significativamente el grado de curvatura. Respecto a la transportación, en sentido mesiodistal no hubo diferencia estadística significativa, pero sí la hubo en sentido vestíbulolingual

Transportation of curved canals instrumented with manual and mechanical techniques / Transportación de conductos curvos instrumentados con técnicas manual y mecanizada

El objetivo del presente trabajo fue compara en conductos curovs, técnicas de instrumentación manual y mecanizadas registrando el desplazamiento del eje de los conductos y el área de dentina removida. Se seleccionaron 60 molares humanos con conductos radiculares con angulaciones entre 15 y 45º. Las piezas fueron incluidas en resina transparente utilizando como llave un dispositivo plástico, siguiendo el procedimiento de Bramante modificado. Las raíces fueron seccionadas horizontalmente en tres niveles, a la altura de la furcación, donde se inicia la curva y a 3 mm del ápice. Se tomaron fotografías pre y posinstrumentación en los tres niveles. Las piezas fueron reposicionadas en el dispositivo plástico e instrumentadas en forma manual o mecanizada con Curso W&H. Para evaluar la transportación por medio de coordenadas, se determinó el centro de cada imagen del conducto antes y después de su instrumentación y su desplazamiento fue medido utilizando el programa Image 1.45. La diferencia entre el área pre y posoperatoria sirvió para determinar el área de dentina removida. Los datos fueron analizados con ANOVA. En cuanto a la transportación no hubo diferencias significativas entre los grupos. Con respecto al área de dentina removida hubo diferencias entre las técnicas manuales y mecanizadas sólo a nivel apical

Shaping of curved root canals instrumented with stainless steel and nickel titanium files / Conformación de conductos curvos instrumentados con limas de acero inoxidable y níquel-titanio

La eficacia de la limpieza y la calidad de la preparación quirúrgica están condicionadas de manera fundamental por la anatomía de los conductos, el instrumental y la técnica utilizada. Los objetivos del presente estudio fueron evaluar, utilizando la técnica de fuerzas balanceadas, la rectificación de conductos curvos y las modificaciones de la anatomía endodóntica, producidas por limas Flex-R, Onyx-R y Nitiflex. Para los estudios de angulación y transpòrtación se seleccionaron 60 molares inferiores. Se tomaron radiografías pre y posoperatorias en ambos sentidos; estas radiografías fueron proyectadas sobre hojas transparentes, trazándose los contornos de dientes y limas y midiendo las angulaciones. Superponiendo las transparencias, se midió la transportación de los conductos con un calibre micrométrico. Los datos fueron estudiados estadísticamente con "t" test, análisis de varianza y tes de BOnferroni. Los resultados demostraron que los instrumentos disminuyeron significativamente el grado de curvatura. Respecto a la transportación, en sentido mesiodistal no hubo diferencia estadística significativa, pero sí la hubo en sentido vestíbulolingual (AU)

Transportation of curved canals instrumented with manual and mechanical techniques / Transportación de conductos curvos instrumentados con técnicas manual y mecanizada

El objetivo del presente trabajo fue compara en conductos curovs, técnicas de instrumentación manual y mecanizadas registrando el desplazamiento del eje de los conductos y el área de dentina removida. Se seleccionaron 60 molares humanos con conductos radiculares con angulaciones entre 15 y 45º. Las piezas fueron incluidas en resina transparente utilizando como llave un dispositivo plástico, siguiendo el procedimiento de Bramante modificado. Las raíces fueron seccionadas horizontalmente en tres niveles, a la altura de la furcación, donde se ini

Transportation of curved canals instrumented with manual and mechanical techniques.

The purpose of this study was to compare the effect of manual and mechanical instrumentation techniques in curved root canals using area of dentine removed and canal axis movement as the end-points. Sixty mandibular molars with curved root canals with angulations ranging from 15 degrees to 45 degrees were selected. The teeth were embedded in transparent resin in a grilon key-like muffle using Bramantes procedure. The roots were horizontally sectioned at three levels and pre and post instrumentation photographs were taken. The sections were reassembled in the muffle and the canals were instrumented with manual and mechanical techniques using Cursor (W&H). Anatomic measurements of transportation were made employing pre and post instrumentation photographs and Macintosh Image 1.45 Software. Statistical analysis of the data was performed by ANOVA. There were no significant differences in canal center axis movement among the groups. Differences in area of dentine removed between manual and mechanical instrumentation techniques were observed at the apical level only.

Shaping of curved root canals instrumented with stainless steel and nickel titanium files.

The cleaning efficiency and the quality of the surgical preparation is mainly conditioned by root canal anatomy, the instruments and the technique employed. The purpose of the present study was to evaluate the extent of straightening of curved root canals and the changes in endodontic anatomy caused by the use of Flex-R, Onyx-R and Nitiflex files with the balanced forces technique. Sixty mandibular molars were selected for evaluation of angulation and transportation. Pre and post instrumentation radiographs were taken of the mesiodistal and buccolingual aspects of each tooth. The radiographs were projected on a transparent sheet, the contours of each tooth and file were outlined and the canal curvature was measured. Pre and post instrumentation tracings were overlaid and the extent of transportation was measured with a micrometric caliper. Statistical analysis of the data was performed employing Students [quot ]t[quot ] test, Analysis of Variance and Bonferronis test. The results showed that all the instruments reduced canal curvature significantly. Transportation in the mesiodistal direction did not reach statistical significance whereas transportation in the buccolingual direction was statistically significant.