Minimally invasive guided endodontic microsurgery with Zekrya bur: A 48-month follow-up case report.

Endodontic microsurgery guided by navigation systems represents a precise and minimally invasive approach for retreatment of apical periodontitis following failed conventional endodontic therapy. Accurate localization and minimal access to the root apex are paramount for successful outcomes and preservation of anatomical structures. Workflow considerations, such as three-dimensional (3D) virtual planning and endodontic guidance represent new crucial aspects for addressing complex cases. This clinical case report presents the successful reintervention of a complex case using a Zekrya bur, operative microscopy, cone beam computed tomography and biocompatible materials. After a 48-month follow-up, complete healing of the treated area was observed. This minimally invasive technique, employing a simple instrument widely available globally, underscores the potential for efficient and predictable outcomes in complex endodontic microsurgical retreatment.

Treatment of a severely compromised endodontically treated tooth with a 2-piece premanufactured glass-fiber post: A clinical report.

A 2-piece premanufactured glass-fiber post-and-core for a child with a severely compromised endodontically treated tooth to restore dental form, function, and esthetics, is described. A shorter chair time than for the conventional options was needed, and the post provided an adequate biomechanical response with a reduced intracanal cement thickness.

Endodontic guide for the conservative removal of a fiber-reinforced composite resin post.

Prosthetic dentistry involves functional and esthetic restoration. Some situations require the use of fiber-reinforced composite resin posts that help preserve restorations. However, if the initial treatment fails, a new endodontic intervention may be required for fiber-reinforced composite resin post removal. This procedure can be complex and challenging but can be facilitated with guided endodontics. This clinical report describes the use of a prototyped guide created with virtual planning for fiber-reinforced composite resin post removal. The guide improved patient safety, shortened the treatment time, and eliminated the need for a new restoration.

Clinical endodontic procedures modulate periapical cytokine and chemokine gene expressions.

OBJECTIVES: To identify the gene expression of the cytokines IL-9, TNF-α, IL-1, INF-γ, IL-17A, and IL-10 and the chemokines CCL-2/MCP-1 and CCR-6 in the periapical fluid of human root canal infections. MATERIALS AND METHODS: Twenty samples were collected immediately and 7 days after the cleaning and shaping procedures (after reducing the intracanal microbial load) in an attempt to characterize the expression of these genes. The endogenous expression levels of cytokines and chemokines were analyzed by real-time polymerase chain reaction. The Shapiro-Wilk and the Wilcoxon tests analyzed data. RESULTS: Significantly higher levels of the IL-9, INF-γ, TNF-α, IL-1, and IL-10 markers on day 7 were observed compared with day 0 (p < 0.05). However, IL-17A and the chemokines CCL-2/MCP-1 and CCR-6 did not show a significant difference in mRNA expression when comparing both timepoints (p > 0.05). CONCLUSIONS: The clinical variation of the periapical immune status after endodontic therapy suggests that the cytokine and chemokine-mediated pro-inflammatory response appears to be modulated in an IL-10/IL-9-dependent manner. CLINICAL RELEVANCE: Few studies have investigated the role of Th9 cells in periapical lesions. IL-9 presents exciting plasticity, performing immunosuppressive actions, and it is also capable of changing their phenotype in the presence of IL-17. Hence, it is relevant to investigate its role in the context of the known mediators involved the periapical immune process.

3D Apicoectomy Guidance: Optimizing Access for Apicoectomies.

When conventional endodontic treatment resources are depleted, endodontic surgery becomes an alternative treatment for apical periodontitis to remove unreachable infected areas and seal the root canal. Digital workflows have been used more frequently in many dental applications in recent years. In endodontics, virtual 3-dimensional (3D) planning and endodontic guidance are new aspects important for the treatment of complex cases. This report aimed to present 3D Apicoectomy Guidance, a novel method of performing guided ultraconservative endodontic surgery with conventional implant-guided drills, and to describe its application in a case with a complex anatomic scenario and intimate contact with the maxillary sinus. Implantology computer software, as well as cone-beam computed tomography images and a digital scanning 3D impression, enabled virtual planning of the surgical procedure. Subsequently, a 3D template was produced to guide the instruments used in the osteotomy and root resection. The patient was completely asymptomatic at the 1-week follow-up visit. Cone-beam computed tomography scans were performed at 1 and 6 months after surgery and showed that resection of the apex of the root was performed accurately and that a thin dentin slice remained distally, preventing the rupture of the sinus membrane. The patient remained asymptomatic, and the tissue healed normally. The method used was shown to be very straightforward and reliable. This method allowed the patient to be treated expeditiously with very precise tissue removal.

Case Reports in Maxillary Posterior Teeth by Guided Endodontic Access.

The localization of partial or completed root canal obliteration is a challenging task in endodontic practice. Recently, guided endodontics has become an alternative solution for those cases. Although this technique has already been used clinically in managing anterior teeth, in this report, we describe 3 complex clinical scenarios of calcified root canals of 1 molar and 2 premolars using guided endodontics. The clinical cases reported here show that technological evolutions should make guided endodontic procedures more widespread because their execution is relatively fast and safe even in the case of the upper molar. Additionally, 12-month clinical follow-up visits showed the effectiveness of the guided endodontic procedures.

Three-dimensional endodontic guide for adhesive fiber post removal: A dental technique.

This dental technique describes a protocol for adhesive fiber post removal using a prototyped endodontic guide. The removal of an adhesive fiber post is an important step for endodontic retreatment and the resolution of prosthetic problems. Computer-aided design and computer-aided manufacturing (CAD-CAM) technology was used to generate guides with prototyping and is a useful tool for fiber post removal.

Papel protetor das citocinas IL-9/IL-10 em lesões perriradiculares humanas / Papel protetor das citocinas IL-9/IL-10 em lesões periapicais humanas / Protective role of IL-9 and IL-10 in human periradicular lesions

Este estudo tem como objeitvo Identificar a expressão gênica de um novo grupo de linfócitos T, as células Th9, caracteristicamente responsável por produzirem a IL-9 nos tecidos perirradiculares de indivíduos portadores de infecções endodônticas submetidos à terapia endodôntica de rotina, na presença e ausência de infecção assim como as citocinas TNF-α, IL-1. IL-9, INF-É£ e IL-10 e das quimiocinas CCL-2/MCP-1 e CCR-6 no fluido intersticial periapical de infecções de canais radiculares humanas. As amostras foram coletadas imediatamente após os procedimentos de limpeza e formatação e 7 dias mais tarde (após redução da carga microbiana intracanal) para caracterizar a expressão destes genes. A reação em cadeia da polimerase em tempo real demonstrou níveis significativamente maiores de marcadores de IL-1, IL-9, INF-É£, TNFα e IL-10 no dia 7 quando comparado com ao dia 0. Por sua vez, as quimiocinas CCL2/MCP-1 e CCR-6 e a citocina IL-17A não apresentaram diferenças significativas na expressão de mRNA entre os 2 períodos analisados. Ao analisar a variação clínica pós terapia endodôntica sobre a condição imune periapical, este estudo demonstrou que a resposta pró-inflamatória mediada por citocinas e quimiocinas parece ser modulada de forma IL-10/IL-9 dependente.

This study aims to identify the gene expression of a new group of T lymphocytes, Th9 cells, characteristically responsible for producing IL-9 in the periradicular tissues of individuals with endodontic infections submitted to routine endodontic therapy, in the presence and absence of infection as well as the cytokines TNF-α, IL-1. IL-9, INF-γ and IL-10 and CCL-2 / MCP-1 and CCR-6 chemokines in the periapical interstitial fluid of human root canal infections. Samples were collected immediately after cleaning and formatting procedures and 7 days later (after reduction of intracanal microbial load) to characterize the expression of these genes. Real-time polymerase chain reaction demonstrated significantly higher levels of IL-1, IL-9, INF-É£, TNF-α and IL-10 markers at day 7 compared to day 0. In turn, the CCL-2 / MCP-1 and CCR-6 chemokines and IL17A cytokine showed no significant differences in mRNA expression between the 2 periods analyzed. In analyzing the clinical variation after endodontic therapy on periapical immune status, this study demonstrated that the cytokine and chemokinemediated proinflammatory response appears to be modulated in a IL-10 / IL-9 dependent manner.