Efficacy of disinfection procedures performed prior to regenerative endodontic therapy: An integrative review.

The aim of this integrative review was to identify whether the disinfection procedures performed prior to regenerative endodontic treatment were effective on biofilm removal from the root canals. The research was based on PubMed, Latin American and Caribbean Health Sciences Literature (Lilacs) and Scientific Electronic Library Online (SciELO) databases. Four articles were selected; one of the studies was in vivo and the others ex vivo. Different disinfection procedures were studied, characterised mainly by the use of intracanal medication, highlighting the double antibiotic paste, triple antibiotic paste and calcium hydroxide paste. Disinfection ability was evaluated against Enterococcus faecalis and multispecies biofilms by using the fluorescence technique and colony forming unit counting, for 7 to 21 days. Double antibiotic paste and triple antibiotic paste demonstrated excellent antibiofilm activity, unlike CH paste that showed limited disinfection, even when associated with different antimicrobial agents. Triple antibiotic paste was the most effective medication against biofilm.

Do alternative scaffolds used in regenerative endodontics promote better root development than that achieved with blood clots?

The aim of this integrative review was to identify whether alternative scaffolds used in regenerative endodontics contribute to better root development, in relation to the increase in root length and thickness of dentin walls, compared with blood clot (BC) scaffolds. The literature search was conducted in PubMed, SciELO and Lilacs databases, using descriptors related to the topic. After applying the eligibility criteria, 11 articles were selected and analyzed according to the proposed aim. Five clinical and six in vivo studies, conducted in animals, compared different types of alternative scaffolds with BCs, with emphasis on platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). All scaffolds, alternative or BC, promoted an increase in root length and dentin wall thickness, with varying percentages of increase between studies. In general, there was a significant increase in root length and dentin thickness promoted by PRF and PRP scaffolds, compared with BC. It was concluded that the majority of the scaffolds tested contributed to the increase in root length and thickness of dentin walls, with emphasis on PRF and PRP.

Do alternative scaffolds used in regenerative endodontics promote better root development than that achieved with blood clots?

Abstract The aim of this integrative review was to identify whether alternative scaffolds used in regenerative endodontics contribute to better root development, in relation to the increase in root length and thickness of dentin walls, compared with blood clot (BC) scaffolds. The literature search was conducted in PubMed, SciELO and Lilacs databases, using descriptors related to the topic. After applying the eligibility criteria, 11 articles were selected and analyzed according to the proposed aim. Five clinical and six in vivo studies, conducted in animals, compared different types of alternative scaffolds with BCs, with emphasis on platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). All scaffolds, alternative or BC, promoted an increase in root length and dentin wall thickness, with varying percentages of increase between studies. In general, there was a significant increase in root length and dentin thickness promoted by PRF and PRP scaffolds, compared with BC. It was concluded that the majority of the scaffolds tested contributed to the increase in root length and thickness of dentin walls, with emphasis on PRF and PRP.

Resumo O objetivo desta revisão integrativa foi identificar se os scaffolds alternativos utilizados em endodontia regenerativa contribuem para um melhor desenvolvimento radicular, em relação ao aumento do comprimento e espessura das paredes da dentina, em comparação com os scaffolds de coágulo sanguíneo (BC). A pesquisa bibliográfica foi realizada nas bases de dados PubMed, SciELO e Lilacs, utilizando descritores relacionados ao tema. Após a aplicação dos critérios de elegibilidade, 11 artigos foram selecionados e analisados de acordo com o objetivo proposto. Cinco estudos clínicos e seis in vivo, realizados em animais, compararam diferentes tipos de scaffolds alternativos com BCs, com ênfase no plasma rico em plaquetas (PRP) e fibrina rica em plaquetas (PRF). Todos os scaffolds, alternativos ou BC, promoveram um aumento no comprimento da raiz e na espessura da parede dentinária, com percentuais variáveis de aumento entre os estudos. Em geral, houve um aumento significativo do comprimento da raiz e da espessura da dentina promovido pelos scaffolds PRF e PRP, em comparação com a BC. Concluiu-se que a maioria dos scaffolds testados contribuiu para o aumento do comprimento das raízes e da espessura das paredes dentinárias, com ênfase em PRF e PRP.

A novel antimicrobial-containing nanocellulose scaffold for regenerative endodontics.

OBJECTIVES: The aim of this study was to evaluate bacterial nanocellulose (BNC) membranes incorporated with antimicrobial agents regarding cytotoxicity in fibroblasts of the periodontal ligament (PDLF), antimicrobial activity, and inhibition of multispecies biofilm formation. MATERIALS AND METHODS: The tested BNC membranes were BNC + 1% clindamycin (BNC/CLI); BNC + 0.12% chlorhexidine (BNC/CHX); BNC + nitric oxide (BNC/NO); and conventional BNC (BNC; control). After PDLF culture, the BNC membranes were positioned in the wells and maintained for 24 hours. Cell viability was then evaluated using the MTS calorimetric test. Antimicrobial activity against Enterococcus faecalis, Actinomyces naeslundii, and Streptococcus sanguinis (S. sanguinis) was evaluated using the agar diffusion test. To assess the antibiofilm activity, BNC membranes were exposed for 24 hours to the mixed culture. After sonicating the BNC membranes to remove the remaining biofilm and plating the suspension on agar, the number of colony-forming units (CFU)/mL was determined. Data were analyzed by 1-way analysis of variance and the Tukey, Kruskal-Wallis, and Dunn tests (α = 5%). RESULTS: PDLF metabolic activity after contact with BNC/CHX, BNC/CLI, and BNC/NO was 35%, 61% and 97%, respectively, compared to BNC. BNC/NO showed biocompatibility similar to that of BNC (p = 0.78). BNC/CLI showed the largest inhibition halos, and was superior to the other BNC membranes against S. sanguinis (p < 0.05). The experimental BNC membranes inhibited biofilm formation, with about a 3-fold log CFU reduction compared to BNC (p < 0.05). CONCLUSIONS: BNC/NO showed excellent biocompatibility and inhibited multispecies biofilm formation, similarly to BNC/CLI and BNC/CHX.

Effects of 1-Ethyl-3-(3-Dimethylaminopropyl) Carbodiimide on Adhesion of Posts in Teeth Obturated With Different Sealers.

The aim of this study was to evaluate the effect of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) on bond strength of fiberglass posts in root canals obturated with different endodontic sealers. Seventy-eight mandibular premolars were obturated with three sealers (n=26): Endofill (END), AH Plus (AHP), and Endosequence BC Sealer (EBS). After preparation of the post space, two subgroups were formed according to the cementation of the posts (n=13): with EDC (EDC), and without EDC (control - CON). The specimens were submitted to a pull-out test, failure mode classification, and root canal surface evaluation by scanning electron microscopy after post displacement. Regarding the bond strength, a significant difference between the EDC and CON subgroups occurred only in the END (p=0.001). No difference was detected among the CON subgroups (p=0.339). However, among the EDC subgroups, AHP presented significantly higher values (END versus AHP: p=0.001; AHP versus EBS: p=0.016). Upon classification of failure modes, score 1 (≥ 50% of cement) was the most commonly observed, except for the END + EDC. Remains of endodontic sealers and resin cements were found in the cervical third, but without statistical difference (p=0.269), while in the middle third, difference occurred (p=0.004). In conclusion, EDC decreases bond strength when associated with END sealer, without changing the failure mode between the resin cement and fiberglass post. The best performance was observed when EDC was combined with AHP sealer.

Effects of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide on adhesion of posts in teeth obturated with different sealers

Abstract The aim of this study was to evaluate the effect of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) on bond strength of fiberglass posts in root canals obturated with different endodontic sealers. Seventy-eight mandibular premolars were obturated with three sealers (n=26): Endofill (END), AH Plus (AHP), and Endosequence BC Sealer (EBS). After preparation of the post space, two subgroups were formed according to the cementation of the posts (n=13): with EDC (EDC), and without EDC (control - CON). The specimens were submitted to a pull-out test, failure mode classification, and root canal surface evaluation by scanning electron microscopy after post displacement. Regarding the bond strength, a significant difference between the EDC and CON subgroups occurred only in the END (p=0.001). No difference was detected among the CON subgroups (p=0.339). However, among the EDC subgroups, AHP presented significantly higher values (END versus AHP: p=0.001; AHP versus EBS: p=0.016). Upon classification of failure modes, score 1 (≥ 50% of cement) was the most commonly observed, except for the END + EDC. Remains of endodontic sealers and resin cements were found in the cervical third, but without statistical difference (p=0.269), while in the middle third, difference occurred (p=0.004). In conclusion, EDC decreases bond strength when associated with END sealer, without changing the failure mode between the resin cement and fiberglass post. The best performance was observed when EDC was combined with AHP sealer.

Resumo O objetivo deste estudo foi avaliar o efeito da 1-etil-3- (3-dimetilaminopropil) carbodiimida (EDC) na resistência de união de pinos de fibra de vidro em canais radiculares obturados com diferentes cimentos endodônticos. Setenta e oito pré-molares inferiores foram obturados com três cimentos endodônticos (n=26): Endofill (END), AH Plus (AHP) e Endosequence BC Sealer (EBS). Após o preparo do espaço para pino, dois subgrupos formaram-se conforme a cimentação dos pinos (n=13): com EDC e sem EDC (controle - CON). Os espécimes foram submetidos ao teste pull-out, classificação do modo de falha e avaliação da superfície do canal radicular por microscopia eletrônica de varredura após o deslocamento. Quanto à força de resistência de união, uma diferença estatisticamente significativa ocorreu entre os subgrupos EDC e CON apenas no END (p=0,001). Não foi detectada diferença entre os subgrupos CON (p=0,339). Contudo, no subgrupo EDC, o AHP apresentou maiores valores (END versus AHP: p=0,001; AHP versus EBS: p=0,016). Acerca da classificação dos modos de falha, o escore 1 (≥50% de cimento) foi o mais comumente observado, exceto para END + EDC. Restos de cimentos endodônticos e cimentos resinosos foram encontrados no terço cervical, mas sem diferença estatística (p=0,269), enquanto no terço médio, houve diferença (p=0,004). Em conclusão, o EDC diminui a resistência de união quando associado ao cimento END, sem alterar o modo de falha entre o cimento resinoso e o pino de fibra de vidro. O melhor desempenho foi observado quanto o EDC foi usado com o cimento AHP.

Success rate of endodontic treatments performed by undergraduate students of the university of southern santa catarina

Introduction: Apical periodontitis is an inflammatory disease of the periradicular tissues caused by microbial (re)contamination of the root canal system. Due to its direct relationship to the quality of endodontic treatment, it is extremely important to carry out longitudinal and cross-sectional studies, following-up treatments carried out in universities. Aim: To evaluate the success rate of endodontic treatments performed by undergraduate students of the University of Southern Santa Catarina - UNISUL, Pedra Branca, between August 2015 and July 2017. Materials and Methods: One hundred twenty-four patients with endodontic treatment were contacted. Of these, only 27 attended for treatment follow-up, adding up to a total of 32 treatments analyzed. All teeth were clinically and radiographically evaluated, and the potential indicators related to endodontic treatment success or failure were analyzed. The frequencies of each criterion were calculated, and the data analyzed using the Chi-Square test (α = 5%). Results: 9 cases (28.13%) were considered failure, either because they were associated with symptoms or because there was a periapical alteration. In addition, 88.88% of the failure cases had temporary restorative material. Association was observed only between the number of root canals and symptoms (P = 0.049). Two of the 3 treated teeth with multiple root canals showed symptoms at the follow-up. The endodontic success rate was 71.87%. Conclusion: The success rate of the 32 endodontic treatments performed by undergraduate students from UNISUL was 71.87%.

Effect of different bleaching protocols on whitening efficiency and enamel superficial microhardness.

BACKGROUND: Tooth bleaching is a popular aesthetic treatment to modify the color of teeth. Despite the extensive literature concerning the subject, there is still no consensus regarding the application mode of the different bleaching agents and their effect on enamel. Therefore, this study evaluated the influence of different bleaching protocols on whitening efficiency and enamel superficial hardness. MATERIAL AND METHODS: Bovine enamel fragments were embedded in acrylic resin and wet-sanded to obtain a flat buccal surface. The specimens were then randomly divided into 6 groups (n=10), based on the bleaching material [HP Maxx 35% (35% hydrogen peroxide), HP Blue 35% (35% hydrogen peroxide + Ca) and Whiteness Perfect 10% (10% carbamide peroxide)] and application mode (3 applications of 15 min, 1 application of 45 min, 1 application of 1h30 or 1 application of 3h30). The color and superficial hardness were assessed before and after bleaching. The color was assessed by means of a digital spectrophotometer, using CIELab parameters. Vickers hardness was determined using a load of 200g for 10s. Data were statistically analyzed by one-way ANOVA with repeated measures and Tukey's test (α = 0.05). RESULTS: Concerning the color alteration, the groups were similar to each other, except for at-home bleaching protocols, which were statistically different from each other. Similarly, there was a reduction in hardness values comparing the initial and final periods, with lowest final hardness for the at-home bleaching protocol group applied for 3h30. CONCLUSIONS: It can be concluded that the bleaching protocols influenced the final color and enamel surface hardness, evidencing that lower gel concentrations applied for longer periods promoted greater variation in color and lower final hardness. Key words:Tooth bleaching, roughness, microhardness, in-office, at-home bleaching.

Long-term evaluation of crown and root discoloration induced by different endodontic sealers

Aim: To evaluate crown and root discoloration promoted by different endodontic sealers after root canal filling. Methods: Eighty bovine incisors were prepared and filled with: Endofill, Sealer 26, AH Plus, and MTA Fillapex. Color was recorded using a spectrophotometer before endodontic treatment (T0) and at 24 hours (T1), seven days (T2), 30 days (T3), and 90 days (T4) after treatment. Analyses were performed on the middle and cervical regions of the crown, and on the cervical third of the root, immediately below the cementoenamel junction. The color alterations (ΔE) were calculated using Commission International de I'Eclairage (CIE) L*a*b parameters, and data were analyzed by analysis of variance (ANOVA) and Tukey's test (p<0.05). Results: All sealers induced color alterations. Sealer 26 resulted in the smallest changes in color (E = 5.32). The other materials did not present statistical differences (AH Plus E = 6.98; MTA Fillapex E = 6.88; Endofill E = 6.41). Of the three regions analyzed, the largest discoloration was observed at the cervical third of the root (E=10.67). In terms of time, the largest ΔE values (E=7.72) were observed at T4. Color changes at T1 (E=5.88), T2 (E=6.10), and T3 (E=5.89) were statistically similar. Conclusions: All endodontic sealers promoted discoloration on the tooth crown and root

Calcium hydroxide induces mineralized tissue neoformation: a case report

Trauma in the anterior teeth is a relatively common occurrence during childhood, having as main consequence teeth with incomplete root development and open apices. Patient, male, leucoderma, 10 years old, attended the Dental Clinic of the Southern University of the State of Santa Catarina, reporting as main complaint fracture in the crown of element 11. After clinical and radiographic examination, it was possible to identify the incomplete apexogenesis of this tooth and the presence of necrotic pulp. Aiming to stimulate neoformation of mineralized tissue at the dental apex, the calcium hydroxide based dressing was used. He remained for eight months, always with radiographic control. Apexification was observed radiographically and proved through the use of an instrument introduced inside the canal. The use of calcium hydroxide as intracanal medication for eight months stimulated mineralized tissue neoformation in the apical region of element 11 and allowed endodontic treatment.

Efficacy of Different Cone-beam Computed Tomographic Protocols in the Identification of Mesiobuccal Canals of Maxillary First Molars: A Tomographic and Ex Vivo Study.

INTRODUCTION: Complementary methods of anatomic diagnosis, including cone-beam computed tomographic (CBCT) imaging, may be useful in the diagnosis of mesiobuccal (MB) canals of maxillary molars. METHODS: Thirty-five maxillary first molars were subjected to ex vivo analysis and 4 CBCT protocols: i-CAT Classic (Imaging Sciences International, Hatfield, PA) (ICC group), i-CAT Next Generation (Imaging Sciences International) (ICN group), PreXion 3D (PreXion, San Mateo, CA) (16.8-second acquisition time; PX1 group), and PreXion 3D (33.5-second acquisition time; PX2 group). The images were evaluated by 2 calibrated endodontists who kept records following protocols previously published in the literature. Micro-computed tomographic imaging was used as the control. RESULTS: The correct identification of anatomic variations of MB roots was 54.3% (n = 19) in the ICC group, 65.7% (n = 23) in the ICN group, and 80.0% (n = 28) in the PX1 and PX2 groups. The probability of agreement between the ICC and the control groups was significantly different from the probability of agreement with the PX1 (P < .05) and PX2 (P < .05) groups. The other groups showed no significant differences compared with the control group. There was no difference in the probability of agreement between the tomographic protocols and the ex vivo results. CONCLUSIONS: The PX1 and PX2 groups were more effective for the diagnosis of MB canals. PX1 is the most suitable because it results in a shorter radiation time and diagnostic imaging similar to PX2. The single-canal anatomy was the most prevalent in the study.

Performance of Three Single Instrument Systems in the Preparation of Long Oval Canals.

This study aimed to evaluate the performance of the Wave One, Easy ProDesign Logic and One Shape systems in the preparation of long oval root canals. Forty-two mandibular incisors were randomized into three groups: Group I, Wave One Primary (WO) (#25.08); Group II, Easy ProDesign Logic (EPL) (#25.06) and Group III, One Shape (OS) (#25.06). Micro-computed tomography scans were obtained pre- and post-preparation of the samples. Instrument fractures or loss of working length did not occur in any of the groups. There was a statistically significant difference in total root canal volume between the WO and EPL (p<0.05) and OS systems (p<0.05) The mean percentages of instrumented canal area in the middle thirds were 76.9% in the WO, 62.3% in the EPL and 71.8% in the OS (p>0.05). The OS system had the strongest correlation between volume increase and instrumented area (R=0.63). The WO, EPL and OS systems presented mean preparation times of 2.13 min, 0.54 min, and 2.21 min (p<0.05), respectively. All three systems enabled the safe preparation of long oval root canals. The WO system most effectively increased root canal volume, but it did not affect the instrumented areas. The OS system had the strongest correlation between volume increase and instrumented area, while the EPL system was the fastest.

Performance of Three Single Instrument Systems in the Preparation of Long Oval Canals

Abstract This study aimed to evaluate the performance of the Wave One, Easy ProDesign Logic and One Shape systems in the preparation of long oval root canals. Forty-two mandibular incisors were randomized into three groups: Group I, Wave One Primary (WO) (#25.08); Group II, Easy ProDesign Logic (EPL) (#25.06) and Group III, One Shape (OS) (#25.06). Micro-computed tomography scans were obtained pre- and post-preparation of the samples. Instrument fractures or loss of working length did not occur in any of the groups. There was a statistically significant difference in total root canal volume between the WO and EPL (p<0.05) and OS systems (p<0.05) The mean percentages of instrumented canal area in the middle thirds were 76.9% in the WO, 62.3% in the EPL and 71.8% in the OS (p>0.05). The OS system had the strongest correlation between volume increase and instrumented area (R=0.63). The WO, EPL and OS systems presented mean preparation times of 2.13 min, 0.54 min, and 2.21 min (p<0.05), respectively. All three systems enabled the safe preparation of long oval root canals. The WO system most effectively increased root canal volume, but it did not affect the instrumented areas. The OS system had the strongest correlation between volume increase and instrumented area, while the EPL system was the fastest.

Resumo Este estudo teve como objetivo avaliar o desempenho dos sistemas Wave One, Easy ProDesign Logic e One Shape no preparo de canais radiculares ovais. Quarenta e dois incisivos inferiores foram randomizados em três grupos: Grupo I, Wave One primary (WO) (#25.08); Grupo II, Easy ProDesign Logic (EPL) (#25.06) e Grupo III, One Shape (OS) (#25.06). As amostras foram submetidas a microtomografia computadorizada antes e após o preparo. Não ocorreram fraturas de instrumento ou perda de comprimento de trabalho em qualquer dos três grupos. Houve diferença estatisticamente significante no volume total do canal radicular entre o WO e EPL. A média do percentual de área instrumentada do canal no terço médio foi 76,9% no grupo WO, 62,3% no grupo EPL e 71,8% no grupo OS (p>0,05). O sistema OS teve a correlação mais forte entre o aumento de volume e área instrumentada (R=0,63). Os sistemas WO, EPL e OS apresentaram tempos de preparo médios de 2,13 min, 0,54 min e 2,21 min (p<0,05). Todos os três sistemas foram seguros no preparo canais radiculares ovais. O sistema WO foi mais eficaz no aumento do volume de canal, entretanto, isso não afetou as áreas instrumentadas. O sistema OS teve a correlação mais forte entre o aumento de volume e área instrumentada, enquanto o sistema EPL foi o mais rápido.

Thermoplastic endodontic obturation - TC system: case report

Introduction: The TC system, developed in 2002, allows the endodontic filling by means of a non-conventional technique that uses gutta-percha at alpha phase, thermoplasticized in its own oven, placed into canal through a McSpadden compactor, without using a main cone. Objective: The aim of this case report was to show the TC system used for root canal filling. Case report: Three teeth of a patient was indicated for endodontic treatment, so TC system was used for the root filling. Conclusion: This technique showed to be effective for the root canal filling.

Influence of Cervical and Apical Enlargement Associated with the WaveOne System on the Transportation and Centralization of Endodontic Preparations.

INTRODUCTION: The aim of this study was to evaluate through computed microtomography the transportation and centralization of root canals instrumented using the WaveOne system (Dentsply Maillefer, Ballaigues, Switzerland) associated or unassociated with previous apical and cervical enlargements. METHODS: Thirty-six mandibular molars were selected with independent mesial roots and curvatures and randomized into the following groups: PathFile (Dentsply Maillefer) before WaveOne Primary (the PFWO group), ProTaper Universal SX (Dentsply Maillefer) before WaveOne Primary (the SXWO group), and WaveOne Primary (the WO group). Computed microtomographic imaging was performed pre- and postpreparation to obtain measurements of mesial and distal dentin walls and calculations of root canal transportation (%) and centralization. One-way analysis of variance was performed to compare the different groups, repeated measures analysis of variance for comparison of the root thirds in each group, and the Student t test for comparisons between the mesiobuccal and mesiolingual canals. RESULTS: Transportation of the cervical and middle thirds to the danger zone was observed in both roots, whereas the apical thirds were transported to the outer face of the curvature. In the PFWO and SXWO groups, less transportation was observed in the middle thirds of the mesiobuccal canals compared with the WO group (P < .05). Centralization remained almost unchanged in the SXWO group (P < .05). CONCLUSIONS: In each group, transportation toward the danger zone was mostly observed in the cervical thirds of the mesiobuccal canals. Cervical or apical enlargement resulted in reduced transportation and improved centralization of the middle thirds compared with the exclusive use of the WaveOne system.

Epidemiological data and relevance of care provided in dental emergency service of a private hospital

Introduction and Objective: The aims of this study were to determine the etiology and prevalence of dental emergency visits in a private hospital in the period from July 2009 to July 2011 and the importance of this type of service in private hospitals. Material and methods: During the study period, we analyzed 795 charts from patients seeking emergency services. The emergencies were classified as trauma, odontalgia, prosthesis, periodontal diseases, and traumatic factors. Results: Women and men accounted for 61% and 39% of cases, respectively, and the most prevalent age group was individuals aged 20 to 49 years. The predominant types of dental emergencies observed were odontalgia (52.58%) and dental trauma (22.64%). Pulpitis was the most common pathology (67% of cases) and the most frequent type of trauma was enamel and dentin fracture (54% of cases). Conclusion: A high demand for dental emergency care exists in hospital settings. Most people seek emergency dental services for emergencies related to lack of prevention and dental traumas.

The relationship of a clinical protocol and emergency treatment success of dental trauma running head: clinical protocol in dental trauma

Introduction and Objective: The aim of this study was to investigate whether the sequelae arising from dental trauma in permanent teeth were influenced by the use or non-use of a clinical protocol, in emergency care treatment facilities in the city of Joinville/SC, Brazil. Material and methods: From 2008 to 2010, a total of 70 dental records were reviewed and evaluated 6 months after the completion of treatment. In addition to the data relating to gender, age, etiology, most affected teeth, and most prevalent traumas, the individuals were divided into 2 groups to compare the sequelae observed following either the use or non-use of a clinical protocol for dental trauma treatment. Results: There was a greater incidence of male patients, particularly in the age-range of 8 to 15 years. Falls were the most frequent cause of trauma. The total success rate of the emergency care was of 78.57%. In the group in which the protocol was used, the success rate reached 88.89% compared to 60.0% in the group in which the protocol was not used. Conclusion: The use of a clinical protocol positively influenced the sequelae arising after treatment for dental trauma.

Microbiological aspects of endoperiodontal lesion

Introduction: The endoperiodontal lesion occurs when a tooth undergoing endodontic disease is united to a periodontal lesion with apical progression. Many times, the differential diagnosis between the endodontic and periodontal disease can be of difficult execution and the correct diagnosis and planing of the treatment is of main importance for a good prognosis. Objective: To identify the main microorganisms within the lesion of endodontic and periodontal origin and correlate them with the endoperiodontal lesion. Literature review: The search strategy comprised the electronic studies of databases such as PubMed and Cochrane on the microbiology of the endodontic and periodontal systems through employing the following keywords: microbiology, endodontics, periodontal pocket. Results: There were similarities in the endodontic and periodontal microflora. However, the number of microorganisms within the cross infection is limited, including Bacteroides, Eubacteria, Fusobacteria, spirochaetes, Wolinella. The bacterias forming the red complex are closely related to the severity of the periodontal disease and can also participate in the pathogenesis of the periradicular abscesses. Conclusion: There are many communication routes between the periodontium and pulpal tissue, therefore the contamination from um tissue to another can occur, existing a microbiological inter-relationship between these tissues.