Tratamiento endodóncico y blanqueamiento interno de un 2.1. con metamorfosis cálcica / Endodontic treatment and internal bleaching of a 2.1. with calcium metamorphosis

Introducción: La metamorfosis cálcica se presenta comúnmente tras lesiones traumáticas y se caracteriza por presentar depósitos de tejido duro dentro del espacio pulpar, obliterando parcial o totalmente la cámara pulpar y/o el conducto radicular. Este proceso suele provocar un cambio de coloración de la corona clínica haciéndola más oscura y opaca. Caso clínico: Paciente mujer de 40 años acude a la consulta motivada por una preocupación estética debido al oscurecimiento del diente 21. Se proponen varias opciones de tratamiento, hasta que finalmente se opta por el tratamiento de conductos de forma ortógrada, así como blanqueamiento interno del diente. Conclusión: El plan de tratamiento en dientes con metamorfosis cálcica sin patología periapical y con compromiso estético partirá siempre desde el más conservador. Es esencial en el tratamiento de estos dientes la experiencia del operador, así como el buen manejo del microscopio y los ultrasonidos, herramientas fundamentales para su abordaje

Introduction: Calcium metamorphosis commonly occurs after traumatic injuries and is characterized by hard tissue deposits within the pulp space, partially or totally obliterating the pulp chamber and/or the root canal. This process usually causes a change in the color of the clinical crown, making it darker and more opaque. Clinical case: A 40-year-old female patient came to the clinic motivated by an aesthetic concern due to the darkening of the tooth 21. Various treatment options are proposed, until finally the endodontic treatment is chosen, as well as internal bleaching of the tooth. Conclusion: The treatment in teeth with calcium metamorphosis, without periapical pathology and with aesthetic compromise, should always be the most conservative. It is essential in the treatment of these teeth the experience of the operator, as well as the correct use of the microscope and ultrasounds, which are fundamental tools for its approach

Decision-Making for Residual Periodontal Pockets after Aetiological Treatment.

The practitioner may have difficulties making decisions regarding the most appropriate therapeutic approach in the case of the persistence of periodontal pockets after initial periodontal treatment. Several options may be considered: aetiologic retreatment, maintenance, surgery of the pocket or extraction of the tooth for strategic reasons or when the conservation of the tooth is impossible. There are no clear guidelines for the treatment decision. The aim of this article is to present the main factors involved in making a treatment decision. An algorithm and its background rationale are presented to help the practitioner make a decision about residual periodontal pockets after aetiological treatment.

Removal of organic debris from occlusal fissures: advantage of Carisolv system over sodium hypochlorite.

OBJECTIVE: The purpose of this in vitro study was to evaluate and compare the removal of artificial debris from pits and fissures using the Carisolv system and sodium hypochlorite. STUDY DESIGN: Forty artificial fissures prepared on extracted human teeth were filled with artificial organic debris. Debris was removed using either Carisolv or 10% sodium hypochlorite gel. After stereoscopic observation, samples were filled with a sealant and subjected to microleakage test. RESULTS: Both Carisolv and sodium hypochlorite demonstrated adequate cleaning ability and prevention of microleakage. Although both Carisolv and 10% sodium hypochlorite are effective at removing debris from fissures, Carisolv presents greater advantages in terms of safety and antibacterial properties. CONCLUSION: Fissure cleaning using Carisolv might be an effective approach to improve the retention of fissure sealants.

Analysis of surface roughness and microleakage of fissure sealants following organic debris removal with Carisolv.

OBJECTIVE: The objective of the present study was to improve fissure sealing by pre-treatment with Carisolv in order to remove organic debris. The surface morphology and roughness of fissure cavities and the degree of microleakage after Carisolv application were compared with those after bristle brush treatment in vitro. METHODS: Fifty extracted human teeth were used in this study. The teeth were randomly divided into two groups of 25 each. Artificial fissures were prepared in all teeth into which artificial organic debris was placed. The debris in 25 teeth of one group was removed using Carisolv applied for 30s and excavation was performed with a dental explorer until the gel was clear. The remaining 25 teeth were then cleaned using bristle brush with prophylaxis paste. Surface roughness was analyzed in five samples from each group by color laser three-dimensional (3D) microscopy and by scanning electron microscopic examination. The remaining samples were filled with sealant and subjected to a microleakage test under thermocycling. Statistical analysis was performed using the Mann-Whitney U-test; a value of p<0.05 was considered significant. RESULTS: Morphologically, most of the debris in the fissures was removed by Carisolv treatment, whereas some fissures were not cleaned by bristle brush. Carisolv-treatment with acid-etching resulted in removal of debris-like smear layer leaving enamel prisms open, and 3D laser microscopy demonstrated that the roughness values increased after acid-etching. However, microleakage test of both Carisolv and brush methods showed similar results. CONCLUSIONS: Carisolv-treated surfaces especially when subjected to acid-etching might facilitate good adaptation of sealant to enamel, because of an increase in surface roughness and favorable surface characteristics.

Rate of reformation of tongue coatings in young adults.

BACKGROUND: Reviewing the literature, no study on the rate of regrowth of tongue coatings after tongue cleaning was found. Therefore, the purpose of this study in young adults was to study the rate of reformation of tongue coatings after mechanical removal. MATERIAL AND METHODS: Thirty-five dental students participated in the present study. Following preparatory study instructions, baseline examinations were carried out followed by 3 days of observation. At baseline, tongue coating scores (prescraping) were obtained followed by tongue scrapings and determination of the wet weights of the coatings. A second tongue coating score was then obtained within 5 min of the first score (immediate post-scraping). The subjects returned for repeated tongue coating scores after 1 and 2 days and for final examination after 3 days, which included both tongue coating scores (prescraping and immediate post-scraping) and determination of the wet weights of the coatings. RESULTS: Prior to scraping the tongue at day 0 (baseline), mean tongue coating amounted to a surface extension of 33% of the entire dorsum of the tongue. Scraping the tongue reduced the score to 9%. On average, tongue coating scores had returned to baseline levels on day 2. The mean wet weights of tongue scrapings at days 0 and 3 were similar and amounted to 0.09 +/- 0.07 and 0.09 +/- 0.06 g, respectively. CONCLUSION: If tongue cleaning is to be recommended, the results of this study in dental students indicate that tongue cleaning should be performed on a daily basis.

Sonic and ultrasonic scalers in periodontal treatment: a review.

Periodontal therapy aims at arresting periodontal infection and maintaining a healthy periodontium. The periodic mechanical removal of subgingival microbial biofilms is essential for controlling inflammatory periodontal disease. Mechanical periodontal therapy consists of scaling, root planing and gingival curettage. The sonic and ultrasonic scalers are valuable tools in the prevention of periodontal disease. The vibration of scaler tips is the main effect to remove the deposits from the dental surface, such as bacterial plaque, calculus and endotoxin. However, constant flushing activity of the lavage used to cool the tips and cavitational activity result in disruption of the weak and unattached subgingival plaque. The aim of the study was to review the safety, efficacy, role and deleterious side-effects of sonic and ultrasonic scalers in mechanical periodontal therapy.

Remoção química-mecânica da cárie: revisão de literatura / Chemomechanical caries removal: literature review

O princípio básico da remoção químico-mecânica da cárie consiste na aplicação de agentes químicos específicos que promovam o amolecimento seletivo da dentina degradada durante o processo carioso, seguido de uma leve escavação usando instrumentos manuais especialmrnete adaptados, restando ao final do processo apenas a dentina sadia. O primeiro sistema chegaria ao mercado na década de 80, com o nome de Caridex, contudo, devido a uma série de desvantagens ele sairia de circulação no início da década de 90. O atual sistema, o Carisolv, mostra-se bem mais vantajoso que o sistema anterior, tendo como principais características: ser indolor, dispensando deste modo a anestesia local, ser mais econômico e bem mais simples. O sistema é especialmente indicado para pacientes pediátricos, pacientes com fobia, pacientes sistematicamente comprometidos e para pacientes especiais. O objetivo deste artigo é, através da revisão de literatura, tratar sobre a evolução deste método e suas principais particularidades.

Associations between periodontal disease and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary disease. A systematic review.

BACKGROUND: Several recent studies provide evidence that the oral cavity may influence the initiation and/or the progression of lung diseases such as pneumonia and chronic obstructive pulmonary disease (COPD). RATIONALE: Studies have shown that poor oral hygiene and periodontal disease may foster colonization of the oropharyngeal region by respiratory pathogens, particularly in hospital or nursing home patients. If aspirated, these pathogens can cause pneumonia, one of the most common respiratory infections, especially in institutionalized subjects. Other cross-sectional epidemiologic studies point to an association between periodontal disease and COPD. This systematic review examines the literature to determine if interventions that improve oral hygiene reduce the rate of pneumonia in high-risk populations. FOCUSED QUESTION: Do periodontal diseases or other indicators of poor oral health influence the initiation/progression of pneumonia or other lung diseases? SEARCH PROTOCOL: MEDLINE, pre-MEDLINE, MEDLINE Daily Update, and the Cochrane Controlled Trials Register were searched to identify published studies that related variables associated with pneumonia and other lung disease to periodontal disease. Searches were performed for articles published in English from 1966 through March 2002. INCLUSION CRITERIA: Randomized controlled clinical trials (RCTs), longitudinal, cohort, and case-control studies were included. Study populations included patients with any form of pneumonia or chronic obstructive pulmonary disease (COPD) and periodontal disease, as measured by assessments of gingival inflammation, probing depth, clinical attachment level, and/or radiographic bone loss, or oral hygiene indices. EXCLUSION CRITERIA: Limited to studies of humans. DATA COLLECTION AND ANALYSIS: The summary statistics used to analyze the RCTs included weighted mean differences in rates of disease between control and intervention groups. For cohort studies that measured differences in rates of disease between groups with and without oral disease, weighted mean differences, relative risks, or odds ratios were compared. A meta-analysis was performed on the 5 intervention studies to determine the relationship between oral hygiene intervention and rate of pneumonia in institutionalized patients. MAIN RESULTS: Of the initial 1,688 studies identified, 36 satisfied all inclusion criteria and were read. Of these, 21 (11 case-control and cohort studies [study population 1,413] and 9 RCTs [study population 1,759]) were included in the analysis. 1. A variety of oral interventions improving oral hygiene through mechanical and/or topical chemical disinfection or antibiotics reduced the incidence of nosocomial pneumonia by an average of 40%. 2. Several studies demonstrated a potential association between periodontal disease and COPD. REVIEWERS' CONCLUSIONS: 1. Oral colonization by respiratory pathogens, fostered by poor oral hygiene and periodontal diseases, appears to be associated with nosocomial pneumonia. 2. Additional large-scale RCTs are warranted to provide the medical community with further evidence to institute effective oral hygiene procedures in high-risk patients to prevent nosocomial pneumonia. 3. The results associating periodontal disease and COPD are preliminary and large-scale longitudinal and epidemiologic and RCTs are needed.

Endoscopic visualization of the submarginal gingiva dental sulcus and tooth root surfaces.

BACKGROUND: Direct, real-time visualization of the hard and soft tissues within the gingival sulcus may aid the clinician in diagnosis and therapy of periodontal disease. This report describes an endoscope specifically designed for this purpose and the interpretation of dental endoscopic images. METHODS: Medical endoscope technology was modified for application in the dental environment. A fixed, fused fiber optic bundle, less than 1 millimeter in diameter, was coupled to an active matrix LCD-TFT flat panel video monitor for viewing by the clinician. A bilumen sheath was designed to provide irrigation of the sulcus and a sterile barrier between the patient and the fiber bundle. Standard dental curets and ultrasonic scalers were adapted for instrumentation aided by the endoscope. RESULTS: Endoscope technology has been successfully adapted for use in periodontal diagnosis and therapy. Techniques for identification and interpretation of the hard and soft tissue images, as well as the location of root deposits and caries, have been developed. CONCLUSIONS: The dental endoscope gives the clinician direct, real-time visualization and magnification of the subgingival tooth root surface, aiding in the location of deposits on the tooth root. The subgingival soft tissue, including the gingival attachment, sulcus wall, and sulcus contents, can be assessed. Identification and location of subgingival caries, root fractures, tooth root deposits, post perforations, and open restoration margins may aid the clinician in diagnosis and therapy.

Remnant amount and cleanup for 3 adhesives after debracketing.

The cleanup of remnant bonding adhesive from the enamel surface after debonding is an important factor for clinicians. The purposes of this study were to compare the weight, the surface area, and the cleanup times of remnant adhesive for a composite resin, Transbond (TB); a resin-modified glass ionomer, Fuji ORTHO LC bonded to enamel both conditioned (FOC) and nonconditioned (FONC); and a fluoride-releasing composite resin, Advance (ADV), bonded to nonetched enamel. In addition, 2 qualitative methods for scoring remnant adhesive were compared with the quantitative weight and area data. Forty extracted human incisors were weighed, bonded with brackets, debonded, weighed, and photographed. Area was measured from the photographs with a sonic digitizer. Mean adhesive remnant weights differed between groups (analysis of variance [ANOVA], P =.02): The remnants from ADV and FOC were equal and both significantly heavier than the remnants from FONC; the weights of the TB remnants were intermediate between the heavier ADV and FOC remnants and the lighter FONC remnants. Mean remnant areas differed between groups (ANOVA, P =.03): The remnants from ADV were significantly larger than the remnants from TB and FONC, which were equal; the areas of the FOC remnants were intermediate between the larger ADV remnants and the smaller remnants from TB and FONC. Mean cleanup times also differed between groups (ANOVA, P <.001): TB and FOC had equal times that were significantly longer than the times for ADV and FONC, which were equal. Adhesives bonded to acid-etched or conditioned enamel took about 1 and a half times longer to clean up than did those bonded to nonetched enamel. When bonded to conditioned enamel, the resin-modified glass ionomer had mean remnant adhesive weights, areas, and cleanup times statistically equivalent to TB. ADV had the fastest mean cleanup time per amount of remnant (ANOVA, P <.002). The graphs of scores for 2 qualitative methods used for scoring remnant amount did not closely resemble the graphs based on weight and area. The graph of a newly introduced qualitative method better reflected the area data. Weighing may be a useful method for quantifying remnant adhesive.

A practice based study of a children's power toothbrush: efficacy and acceptance.

Power toothbrushes can offer significant advantages over a manual toothbrush both with respect to plaque removal and compliance. Most studies have, however, been carried out with adult toothbrushes in adult populations. Less is known about the efficacy of children's power toothbrushes, although it is likely that similar advantages will be demonstrated. This practice based study used the Debris Index (DI) component of the Simplified Oral Hygiene Index to compare baseline oral hygiene with results after 2 months of using the Braun Oral-B Kids' Power Toothbrush (D10). The study involved 13 dental offices and a total of 154 children aged 4 to 9 years. For all sites (facial and lingual), using the D10 for 2 months resulted in an approximately 40% reduction in the DI. Questionnaires completed by the parents or guardians, the children, and the dentists indicated a very favorable response to the power toothbrush. Both parents and children preferred the D10 to a manual toothbrush and most said they would continue to use it. The fact that children found the D10 fun to use may well aid compliance. Dentists thought that the D10 was effective and, at the end of the study, most said that they would now recommend a power toothbrush. It is concluded from the results of this practice based study that the D10 can help to reduce plaque levels in a population of children who previously relied on a manual toothbrush. The fact that the D10 is appealing to children and fun to use should aid compliance with long-term oral hygiene.

Laboratory evaluations of two battery-powered toothbrushes and a manual toothbrush for efficacy and safety.

Two laboratory testing procedures, predictive of clinical efficacy and safety, have been used to evaluate two battery-powered toothbrushes (a new prototype, Crest SpinBrush Pro and a commercially available product, Crest SpinBrush) and a standard manual toothbrush (Oral-B Indicator). Interproximal access efficacy (IAE) and depth of deposit removal (DDR) have been evaluated in laboratory methods using pressure-sensitive paper placed around simulated anterior and posterior teeth at a brushing pressure of 250 g with horizontal or vertical brushing motions. Twenty-four tests on each toothbrush design were conducted, and results were statistically analyzed using ANOVA and the post hoc Tukey test. Both of the battery-powered toothbrushes had a significantly (p < 0.001) higher mean overall IAE value compared to the Oral-B Indicator product. The Crest SpinBrush Pro was significantly statistically higher (p < 0.05) compared to the Crest SpinBrush for mean overall IAE (access to interproximal spaces). On overall DDR, both of the powered toothbrushes had a significantly (p < 0.05-0.001) lower mean overall value compared to the Oral-B Indicator toothbrush (higher mean indicates higher irritation potential). Based on these results, both the new prototype Crest SpinBrush Pro and the commercially available Crest SpinBrush are predicted to be more effective clinically for plaque removal, and at least as safe on hard and soft intraoral tissues as the standard manual toothbrush (Oral-B Indicator) tested. In addition, the results support that the new prototype Crest SpinBrush Pro is more effective than the Crest SpinBrush with respect to IAE and predicted plaque removal.

Laboratory stain removal and abrasion characteristics of a dentifrice based upon a novel silica technology.

These laboratory studies examined the stain removal efficacy and hard tissue abrasivity of a new dentifrice formulation--Crest Extra Whitening--based on the incorporation of elevated concentrations of a proprietary silica. Cleaning power assessments were made using a modification of the laboratory test method developed by Stookey and associates at Indiana University Oral Health Research Institute. Abrasion assessments were made using Radioactive Enamel and Radioactive Dentin Abrasivity (REA and RDA) measures. Results show that Crest Extra Whitening dentifrice produced statistically significantly improved stain removal when compared to a number of conventional dentifrices, including Crest Cavity Protection and Crest Tartar Protection, and a number of recently marketed cleaning and whitening dentifrices. Laboratory studies further demonstrated that the Crest Extra Whitening dentifrice produces dentin and enamel abrasivity similar to conventional silica dentifrices.

Subgingival polishing with a teflon-coated sonic scaler insert in comparison to conventional instruments as assessed on extracted teeth. (I) Residual deposits.

BACKGROUND: Recent studies have shown that endotoxins are located on the periodontally diseased root cementum and not within it. These studies led to the suggestion that the root surface could be treated less aggressively during periodontal therapy. Thus, we designed a teflon-tubed sonic scaler insert for subgingival polishing. It was our objective to assess to which extent this new instrument is capable of removing bacterial deposits in deep pockets in comparison with conventional scaling instruments. METHOD: We compared the extent to which plaque and calculus could be removed with a curette, a conventional sonic and ultrasonic scaler insert, a Per-io-tor insert, and a teflon-tubed sonic scaler insert. 84 teeth requiring extraction had been treated with one of these instruments. After extraction, the teeth were stained with Malachite green, and the following areas were assessed: area lacking plaque and calculus, calculus, and area only covered with plaque. For statistical comparison, nonparametric analyses were carried out. RESULTS: Curettes and conventional ultrasonic and sonic-scaler inserts had more area lacking plaque and calculus (97.5%, 92.2%, 92.1%) than did the Per-io-tor (80.1%) or the teflon-coated sonic scaler insert (84.4%). A similar effectivity sequence was observed for residual soft deposits (curette: 1.9%, ultrasonic scaler: 6.1%, sonic scaler: 5.4%, teflon-coated sonic scaler: 5.1% and Per-io-tor: 9.5%). CONCLUSIONS: The Per-io-tor and the teflon-coated sonic scaler insert seem to be suitable for the removal of soft deposits on the root surface, but not for the removal of calculus.

Effects of short professional mechanical tooth-cleaning (PMTC) program in young adults with mental disabilities.

We evaluated the usefulness of a short professional mechanical tooth-cleaning (PMTC) program to improve periodontal conditions and caries susceptibility in 10 young adult patients with mental and/or physical disabilities. The PMTC program was carried out once on each of 6 sextants of the full mouth during 6 visits at two-week intervals. Even one treatment with PMTC was found to be significantly effective in reducing the probing depth in eight of the 10 subjects. A reduction in the total number of bleeding sites on probing was also clearly observed in all subjects. Moreover, the debris index was reduced in nine subjects by the PMTC program. Although caries susceptibility was improved, albeit very slowly, by PMTC, the Cariostat pH values showed no consistent tendency. The effects lasted for more than 6 weeks. Analysis of these results suggests that the PMTC program can be effective in adults with mental disabilities, especially in reducing gingival inflammation.