Hallazgos por imagen de patología dentaria en tomografía computarizada / CT findings for dental disease

La patología dentaria traumática y en especial la inflamatorio-infecciosa son muy prevalentes en nuestro medio. Esta última suele encontrarse de forma incidental en muchos de los estudios radiológicos que incluyen la región orofacial. Además, es una potencial causa de complicaciones graves, lo que hace que su diagnóstico y tratamiento precoz sean importantes. La tomografía computarizada multidetector ofrece un buen rendimiento diagnóstico en la patología dentaria, aunque sus manifestaciones radiológicas pueden ser sutiles y si no se conocen, pasar desapercibidas. Asimismo, son cada vez más frecuentes los procedimientos dentales invasivos, no exentos de complicaciones. Por otra parte, en la práctica diaria pueden encontrarse variedad de lesiones mandibulares radiolucentes o anomalías del desarrollo que pueden llevar a interpretaciones erróneas. Por todo ello, es recomendable que el radiólogo esté familiarizado con los posibles hallazgos en la patología dentaria.(AU)

Traumatic and especially inflammatory-infectious dental lesions are very prevalent in our context. Inflammatory-infectious disease is usually discovered incidentally on imaging studies that include the orofacial region. Moreover, these conditions can result in potentially severe complications, so early diagnosis and treatment are important. Multidetector computed tomography offers good diagnostic performance for dental lesions, although the radiological findings can be subtle and can go undetected if the radiologist is not familiar with them. Likewise, invasive dental procedures are becoming increasingly common, and these can also result in complications. On the other hand, in daily practice a variety of radiolucent mandibular lesions or developmental anomalies can lead to erroneous interpretations. For these reasons, radiologists should be familiar with possible findings related with dental conditions.(AU)

Is periapical surgery follow-up with only two-dimensional radiographs reliable? A retrospective cohort type sensitivity study / ¿El seguimiento de la cirugía periapical se realiza únicamente con radiografías bidimensionales confiable? Un estudio retrospectivo de sensibilidad de tipo cohorte

Background: Two-dimensional (2D) radiographic techniques are commonly used for assessing lesion prognosisafter endodontic surgery. The present retrospective cohort study analyzes the sensitivity and ability of differentradiographic techniques in obtaining area and volume measurements of periapical lesions.Material and Methods: Preoperative and follow-up (6-48 months) periapical and panoramic radiographs (indextest) and cone-beam computed tomography (CBCT) images (reference standard) were selected from an endodonticmicrosurgery database. Sensitivity was analyzed independently by two examiners. The areas of the 2D radio-graphic images and CBCT volumes were studied using Itk-Snap software and Romexis viewer.Results: The sample comprised 105 patients and 105 teeth, with a mean follow-up of 21 months (range 6-48). Preop-eratively, CBCT detected all the periapical areas, periapical radiography detected 67, and panoramic radiographydetected 60. Postoperatively, of the 52 cases in which CBCT detected remains of the periapical area, periapical ra-diography detected 22, and panoramic radiography detected 17. The measurements of the areas obtained by the 2Dmethods, and the volumes obtained by CBCT, had to be transformed into linear measures for comparison purpos-es. The measurements were found to be significantly different in both the preoperative and the follow-up images. Conclusions: Periapical radiography showed greater sensitivity than panoramic radiography, both preoperatively andat follow-up. The lesions measured with CBCT were larger, with significant differences than as evidenced by theperiapical and panoramic radiographs.(AU)

Nonendodontic periapical lesions: a retrospective descriptive study in a Brazilian population / Lesiones periapicales no endodóncicas: un estudio descriptivo retrospectivo en una población brasileña

Background: Several nonendodontic diseases can occur in the periapical region, resembling endodontic inflamma-tory conditions. Therefore, the aim of the present study was to determine the frequency of nonendodontic periapicallesions diagnosed in a Brazilian population.Material and Methods: The files of two Oral Pathology laboratories were reviewed and all cases including at least oneclinical diagnosis of endodontic periapical lesions were selected for the study. After initial selection, demographicand clinical data, clinical diagnosis and final diagnosis were reviewed and tabulated. Final diagnosis included endo-dontic periapical lesions, and benign and malignant nonendodontic periapical lesions. Data were descriptively andcomparatively analyzed among the three groups, with a significance level of 5% (p<0.05).Results: Nonendodontic periapical lesions were identified in 208 (19%) out of the 1.125 registries included in the finalsample. Benign nonendodontic periapical lesions (200 cases, 18%) were mostly odontogenic keratocysts, amelo-blastomas, nasopalatine cysts, dentigerous cysts, glandular odontogenic cysts, and benign fibroosseous lesions. Ma-lignant nonendodontic periapical lesions (8 cases, 1%) included carcinomas, adenocarcinomas, and melanoma. Ingeneral, nonendodontic periapical lesions were more common in males and in the posterior mandible (p>0.05).Conclusions: The frequency of nonendodontic periapical lesions was high and, although the general distribution wassimilar to the results from other populations, some features were probably associated with the profile of the studied pop-ulations and to the methods applied in the present study. Knowledge on differential diagnosis of endodontic and nonen-dodontic periapical lesions is essential to avoid unnecessary treatments and diagnostic delay in routine dental practice.(AU)

Conservative approach in a patient with multiple radiolucent periapical lesions using endodontics and surgery

Case report of a 43- year old male patient with multiple periapical radiolucent lesions caused by endodontic failure in teeth supporting a metalloceramic prosthetic rehabilitation, who came to the clinic to assess the possibility of keeping his teeth. After clinical and radiological examination with periapical x-rays and cone beam computer tomography (CBCT), we decided to use a combined endodontic-surgical approach. Clinical evolution was favourable, and the radiographic and tomographic controls showed complete healing of the periapical radiolucent lesions. Endodontic retreatment combined with periapical microsurgery are effective tools for conservative treatment of teeth with periapical lesions caused by endodontic failures. (AU)

Enfoque conservador en paciente con múltiples lesiones periapicales radiolúcidas: Abordaje combinado endodóntico-quirúrgico / Conservative approach in a patient with multiple radiolucent periapical lesions: Combined endodontic-surgical access

Se presenta el caso de un paciente varón de 43 años con lesiones periapicales radiolúcidas de origen endodóntico en dientes pilares de rehabilitación fija metalocerámica, que acude a consulta para valorar la posibilidad de mantener sus dientes. Tras la exploración clínica y radiológica mediante radiografías periapicales y tomografía computerizada de haz cónico (CBCT) se decide realizar un abordaje combinado endodóntico-quirúrgico. La evolución clínica fue favorable y los controles radiográficos y tomográficos mostraron la resolución de las lesiones radiolúcidas preexistentes. El retratamiento endodóntico combinado con la microcirugía periapical son herramientas eficaces en el tratamiento conservador de dientes con lesiones periapicales de origen endodóntico

In this case report, we present a 43-year old male patient with multiple periapical radiolucent lesions caused by endodontic failure in teeth supporting a metalloceramic prosthetic rehabilitation, who came to the office asking for any possibility to maintain his teeth. After clinical and radiological exploration with periapical x-rays and cone beam computer tomography (CBCT), we decided to use a combined endodontic-surgical approach. Clinical evolution was favourable, and radiologica - tomographic controls showed complete healing of periapical radiolucent lesions. Endodontic retreatment combined with periapical microsurgery are effective tools for conservative treatment in teeth with periapical lesions caused by endodontic failures

Actitud terapéutica frente a una reabsorción interna perforante / Therapeutic attitude against a perforating internal resorption

Atendiendo a la localización de la reabsorción radicular, ésta puede ser clasificada en externa o interna. La reabsorción interna es relativamente poco frecuente, y su etiología y patogénesis no está todavía del todo clara. Este artículo muestra la complejidad de un incisivo central superior con una reabsorción interna inflamatoria perforante. El diagnóstico definitivo lo hallamos a través del examen tridimensional, que confirmó la extensión y comunicación con la superficie externa radicular. Aunque como podremos ver a lo largo de la exposición del caso clínico, la ayuda del microscopio nos permitió abordar el caso con mayor seguridad. En todo momento pudimos eliminar el tejido inflamatorio y preparar el conducto de manera adecuada. La obturación en este tipo de casos supone un reto para el endodoncista, siendo éste, mayor cuando se realiza únicamente de manera ortógrada. Para la obturación realizamos una técnica descrita en la literatura, sellando la zona apical a la reabsorción con gutapercha adaptada mediante condensación vertical; la zona reabsortiva con material biocerámico y, por último, la zona coronal con guta-percha inyectada. Se realizó un 3D a los 26 meses para una nueva evaluación de la zona reabsortiva, y así evaluar el estado óseo alrededor de la misma. La paciente se presenta totalmente asintomática sin signos clínicos y con buena salud de los tejidos periapicales

Based on the location of the root resorption, it can be classified as external or internal. Internal resorption is relatively rare, and its etiology and pathogenesis is not yet entirely clear. This article shows the complexity of a superior central incisor with a perforating inflammatory internal resorption. The definitive diagnosis is found through the three-dimensional examination, which confirmed the extension and communication with the external root surface. Although as we can see throughout the presentation of the clinical case, the help of the microscope allowed us to address the case with greater certainty. At all times we were able to remove the inflammatory tissue and prepare the duct properly. The obturation in this type of cases supposes a challenge for the endodontist, being this one, greater when it is done only in an ortograde way. For the filling, we performed a technique described in the literature, filling the apical area with resorption with gutta-percha adapted by vertical condensation; the resorptive zone with bioceramic material and finally the coronal zone with injected gutta-percha. A 3D was performed at 26 months for a new evaluation of the resorptive zone, and thus evaluate the bone state around it. The patient presents totally asymptomatic without clinical signs and with good health of the periapical tissues

Analysis of bacterial communities of infected primary teeth in a Mexican population

BACKGROUND: The objective of this study was to describe the bacterial communities associated with pediatric patients with endodontic infections of temporal teeth by targeting the 16S rRNA gene using pyrosequencing. MATERIAL AND METHODS: Microbiological samples were obtained from the lower primary molars of thirteen 13 pediatric patients with dental infections. An aspiration method for microbiological sampling was used. The identification of microbiota employing the pyrosequencing method by targeting the 16S gene was performed. RESULTS: Ribosomal 16S RNA gene sequences were amplified, obtaining a total of 16,182 sequences from 13 primary infected molars (13 different individuals) by pyrosequencing. Bacteroidetes phyla (35.15%) were the most abundant followed by Firmicutes (33.3%) and Fusobacteria (10.05%); the presence of specific pathogenic bacteria was determined as well. CONCLUSIONS: The infected root canal of primary teeth contains a high diversity of anaerobic bacteria, and Bacteroidetes, Firmicutes, and Fusobacteria phyla were the most abundant; Prevotella and Streptococcus genera were the most prevalent

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Association between maxillary sinus pathology and odontogenic lesions in patients evaluated by cone beam computed tomography. A systematic review and meta-analysis

BACKGROUND: A study is made of the association between maxillary sinus pathology and odontogenic lesions in patients evaluated with cone beam computed tomography. MATERIAL AND METHODS: A literature search was made in five databases and OpenGrey. Methodological assessment was carried out using the Newcastle-Ottawa tool for observational studies. The random-effects model was used for the meta-analysis. RESULTS: Twenty-one studies were included in the qualitative review and 6 in the meta-analysis. Most presented moderate or low risk of bias. The periodontal disease showed to be associated with the thickening of the sinus membrane (TSM). Mucous retention cysts and opacities were reported in few studies. The presence of periapical lesions (PALs) was significantly associated to TSM (OR = 2.43 (95%CI:1.71-3.46); I2 = 34.5%) and to odontogenic maxillary sinusitis (OMS)(OR = 1.77 (95%CI: 1.20-2.61); I2 = 35.5%). CONCLUSIONS: The presence of PALs increases the probability of TSM and OMS up to 2.4-fold and 1.7-fold respec-tively. The risk differences suggests that about 58 and 37 of out every 100 maxillary sinuses having antral teeth with PALs are associated with an increased risk TSM and OMS respectively. The meta-evidence obtained in this study was of moderate certainty, and although the magnitude of the observed associations may vary, their direc-tion in favor sinus disorders appearance, would not change as a result

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Clinicopathological and ultrastructural characterization of periapical actinomycosis

BACKGROUND: The aim of the present study was to analyze the clinicopathological and the ultrastructural features of periapical actinomycosis (PA) cases. MATERIAL AND METHODS: Data from the files of an oral pathology laboratory were retrieved and the findings of histopathological analysis were evaluated. Hematoxylin-eosin (HE), a modified Brown & Brenn, and Grocott stains as well as ultrastructural analysis using scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX) were utilized. RESULTS: Six cases were obtained, 4 females and 2 males, with a mean age of 34 year-old. Two cases were symptomatic, lower teeth and the anterior region were more commonly affected, and all cases were characterized by periapical radiolucencies. All cases presented sulfur granules with a ray-fungus or club-shaped pattern of the Splendore-Hoeppli phenomenon in HE-stained sections, with filamentous gram-positive bacteria aggregates highlighted by the modified Brown & Brenn stain. SEM analysis revealed abundant packed rod-like and filamentous bacteria associated with an extracellular amorphous material. EDX analysis showed predominant picks of calcium and sulfur in actinomycotic colonies. CONCLUSIONS: Our findings suggest that PA manifests either clinically and radiologically as a non-specific and heterogeneous condition and that the actinomycotic colonies consist in a calcium- and sulfur-rich matrix. Furthermore, the results highlight the importance of submitting periapical specimens after surgical removal to histopathological análisis

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Tratamiento de la periodontitis apical persistente: cirugía periapical versus retratamiento endodóncico no quirúrgico / Treatment of persistent apical periodontitis: periapical surgery versus nonsurgical retreatment

Se denomina Periodontitis Apical Crónica Persistente (PACP) al proceso inflamatorio periapical que se desarrolla o persiste tras el tratamiento de conductos. Las opciones terapéuticas en el tratamiento de la PACP, cuando el diente puede conservarse, son el retratamiento de conductos por vía ortógrada o la cirugía periapical, e incluso puede ser necesaria una combinación de ambos tratamientos. El objetivo de este trabajo ha sido buscar respuesta a la siguiente pregunta: ¿En un paciente con un diente al que se le ha realizado tratamiento endodóncico que ha fracasado y sufre periodontitis apical crónica persistente (PACP), se obtiene mayor tasa de curación del proceso inflamatorio periapical mediante el retratamiento por vía ortógrada o con la cirugía periapical? La búsqueda realizada proporcionó 7 artículos: 3 ensayos clínicos aleatorios, 3 revisiones sistemáticas y 1 revisión no sistemática. La evidencia científica disponible sugiere que no existen diferencias significativas en las tasas de éxito a largo plazo del retratamiento endodóncico por vía ortógrada y la cirugía periapical, en casos de periodontitis apical crónica persistente tras el tratamiento endodóncico. El retratamiento endodóncico por vía ortógrada obtiene mejores resultados a largo plazo, mientras que la cirugía periapical tiene una tasa de curación más rápida. El retratamiento ortógrado conlleva un mejor postoperatorio para el paciente, mientras que la cirugía periapical implica una mayor necesidad de trata-miento analgésico y antiinflamatorio en los primeros 7 días

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Hipoclorito de sodio como irrigante de conductos. Caso clínico, y revisión de literatura / Sodium hypochlorite used as duct irrigation. Clinical case, and literature review

El tratamiento de conductos está indicado en caso de daño pulpar irreversible; en la actualidad se evidencian considerables avances en cuanto al diagnóstico, tratamiento y mantenimiento de un diente endodónticamente tratado, pese a ello persisten elementos y materiales usados desde sus inicios, como es el caso del hipoclorito de sodio (NaOCl.). El objetivo principal de este artículo será enfatizar en los riesgos y las secuelas ocasionadas por el uso de este irrigante y documentar un caso clínico de una reacción anafiláctica severa por su uso, el manejo dado, además se realizara una revisión de la literatura

Endodontics is a treatment that is required after the irreversible pulpal damage. At present, there has been considerable progress in the diagnosis, treatment, and maintenance of an endodontically treated tooth. Despite this there remain elements and materials used since its inception, as is the case of the sodium hypochlorite (NaOCl.) The main objective of this article is to emphasize the risks and the consequences caused by the use of this irrigante and document a clinical case of a severe anaphylactic reaction by its use, management, in addition there will be a review of the literature

Aplicaciones de la tomografía computarizada de haz cónico en endodoncia / No disponible

La Tomografía Computarizada de Haz Cónico (TCHC) (Cone Beam Computed Tomography - CBCT) es un método de imagen que nos ofrece en Endodoncia unas ventajas relevantes sobre la radiografía periapical y otras técnicas radiográficas a la hora de establecer un diagnóstico y plan de tratamiento adecuados. Debemos tener en cuenta, no obstante, que no se debe hacer de manera rutinaria y que no todos los aparatos ni todas las modalidades (campo de adquisición y resolución espacial) están indicadas para su uso en el campo de la endodoncia. Debemos tener un conocimiento técnico mínimo de las cualidades físicas de esta tecnología, para poder realizar una adquisición de datos que sea correcta en cuanto a la radiación del paciente (la menor posible), y en cuanto a la resolución espacial (la mayor posible) para la tarea diagnóstica que vamos a realizar. Repasaremos las indicaciones de uso de el CBCT en endodoncia, el porqué de sus indicaciones y casos clínicos que demuestran la relevancia de la utilización de esta tecnología en Endodoncia

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Influencia de la tomografía computarizada de haz cónico en el plan de tratamiento endodóncico / No disponible

La evaluación radiográfica y las pruebas diagnósticas son de vital importancia para realizar un adecuado plan de tratamiento en endodoncia. En el campo de la endodoncia, tradicionalmente se han utilizado diferentes pruebas como la palpación, la percusión, las pruebas de sensibilidad pulpar y las radiografías periapicales (RP). Hasta la actualidad las RP (convencionales o digitales) han sido un complemento indispensable para realizar el tratamiento endodóntico, así como para determinar el éxito de dicho tratamiento. Sin embargo, está demostrado que las RP presentan ciertas limitaciones como superposiciones de estructuras anatómicas, la visión en dos dimensiones (2D) y la distorsión geométrica. Las imágenes obtenidas mediante RP ofrecen solamente datos de la dimensión mesio-distal, lo que dificulta la detección de cierta información como: la anatomía radicular, la presencia de alteraciones alrededor de las raíces, la pérdida ósea, los diferentes tipos de reabsorciones radiculares, las fracturas radiculares y otros aspectos importantes en la planificación de una cirugía apical. A través de la imágenes obtenidas a partir de la tomografía computarizada de haz cónico (TCHC), en inglés llamada cone-beam computed tomography (CBCT), se puede obtener una mayor información diagnóstica en comparación a las RP preoperatorias; información que influye directamente en el plan de tratamiento del clínico, especialmente en los casos de dificultad alta. Por todo a ello, en este artículo se presentan diferentes situaciones clínicas en las que la CBCT juega un papel fundamental en relación al plan de tratamiento endodóncico

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Periapical implant lesion: A systematic review

Purpose: The aim of this study was to systematically review the evidence for periapical implant lesion, which makes a patient more susceptible to the periapical lesion, frequency, symptoms, signs (including radiological findings) and possible treatment options. Material and Methods: A systematic literature review and analysis of publications included in PubMed, Embase and Cochrane; articles published until March 2016; with a populations, exposures and outcomes (PEO) search strategy was performed, focused on the issue: 'In patients with periapical lesion to the implant during the osseointegration, what symptoms, signs, and changes in complementary examination manifested, for according to that stage, be intervened with the appropriate approach? '. The set criteria for inclusion were peer-reviewed articles. Results: From a total of 212 papers identified, 36 studies were included in this systematic review, with 15461 implants evaluated and 183 periapical implant lesions. Which 8 papers included more than 5 cases and 28 included equal or less than 5 cases. Analysis of the papers revealed that periapical implant lesion is classified according to evolution stages into acute (non-suppurated and suppurated) and subacute (or suppurated-fistulized). In the acute stage and in the subacute if there is no loss of implant stability, the correct treatment approach is implant periapical surgery. In the subacute stage associated with implant mobility the implant must be removed. Conclusions: Evidence on the subject is very limited, there are few studies with small sample, without homogeneity of criteria for diagnosing the disease and without design of scientific evidence. Currently etiology lacks consensus. The early diagnosis of periapical implant periapical lesions during the osseointegration phase and early treatment, will lead to a higher survival rate of implants treated, hence preventing the need for implant extraction (AU)

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Oral manifestations of Diabetes Mellitus. A systematic review

Background: Diabetes Mellitus has become a global epidemic and presents many complications, usually proportional to the degree and duration of hyperglycemia. The aim of this systematic review was to investigate the different oral manifestations associated with Diabetes Mellitus. Material and Methods: A MEDLINE search for "Diabetes Mellitus and oral manifestations" was performed. A further search was conducted for "diabetes" and its individual oral manifestation. Inclusion criteria were as follows: human clinical studies with a minimum of 30 patients; studies published in relevant scientific journals between January 1998 and January 2016. Nineteen studies fulfilled the inclusion criteria and were analyzed, assessing the strength of scientific evidence according to recommendations made by the Centre for Evidence-Based Medicine, Oxford (OCEBM), which permits adequate assessment of prevalence studies. Results: A total 3,712 patients (2,084 diabetics) were included in the studies reviewed. Of the 19 studies analyzed, 4 were longitudinal studies and 15 cross-sectional studies. Periodontal disease, periapical lesions, xerostomia and taste disturbance were more prevalent among diabetic patients. An association between diabetes and caries and mucosal lesions proved positive in 5 out of 10 studies. Conclusions: Despite multiple oral manifestations associated with DM, awareness of the associations between diabetes, oral health, and general health is inadequate. It is necessary for doctors and dentists to be aware of the various oral manifestations of diabetes in order to make an early diagnosis (AU)

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Periimplantitis apical - presentación de serie de 11 casos clínicos / Apical peri-implantitis: a presentation of a series of 11 clinical cases

Objetivos. Evaluar el protocolo quirúrgico y discutir los posibles factores predisponentes de la periimplantitis apical. Material y método. En el presente trabajo, se planteó un estudio descriptivo retrospectivo analizando una serie de 11 casos clínicos de periimplantitis apical diagnosticados y tratados en el ámbito del Hospital de La Princesa (Madrid) y la Clínica Universidad de Navarra (Pamplona) entre 2002 y 2013. Los pacientes sintomáticos fueron tratados mediante legrado de la zona con o sin relleno. Resultados. Se analizaron un número total de 11 casos de periimplantitis apical (4 asintomáticos y 7 con síntomas). La clínica observada fue parecida a la enfermedad dentaria periapical y el tiempo transcurrido hasta el diagnóstico fue variable, inferior a los 3 años. Se observó resolución completa del problema en 6 de los 7 casos tratados con legrado de la zona periapical del implante. En el caso restante se procedió a la explantación del implante afecto. En los casos asintomáticos no se realizó ningún tipo de tratamiento quirúrgico, presentando una tendencia autolimitada. Conclusión. La periimplantitis apical es una enfermedad que puede complicar el tratamiento implantológico. La cirugía conservadora ha tenido resultados satisfactorios en los casos sintomáticos (AU)

Objectives. The purpose of this study was to evaluate the surgical protocol and discuss possible predisposing factors of apical peri-implantitis. Material and methods. A retrospective study was performed by analyzing a series of cases involving 11 patients, all of whom where diagnosed with, and treated for, apical peri-implantitis at La Princesa Hospital in Madrid and at Navarre University Clinic in Pamplona, Spain, between 2002 and 2013. Symptomatic patients were treated with curettage of the area, which was, in some cases, combined with bone regeneration techniques. Results. A total of 11 cases of apical periimplantitis were included (4 asymptomatic and 7 symptomatic). The symptoms observed were similar to dental periapical pathology, and the period of time elapsed until the patients were diagnosed with API was variable, but was less than 3 years. Complete resolution of the pathology was observed in 6 of the 7 patients treated with curettage of the periapical implant area. In the remaining case the affected implant was removed. No surgical treatment was used in asymptomatic cases, as they were self-limiting. Conclusion. Apical periimplantitis is a condition which may complicate the dental implant treatment. Conservative surgical treatment has shown satisfactory results in symptomatic patients (AU)

Obturación con óxido de zinc-eugenol y formocresol en casos de fractura de instrumento intraconducto: seguimiento de 54 casos durante 8 años / Obturation with zinc oxide-eugenol and formocresol in cases of intracanal fractured instruments: 8 years follow-up study of 54 cases

Introducción: El objetivo de este estudio es presentar los resultados del seguimiento durante 8 años de 54 casos de instrumentos rotos intraconducto, que no pudieron ser removidos y/o sobrepasados, y que fueron obturados con óxido de zinc-eugenol (ZOE) y formocresol. Material y métodos: Se incluyeron 54 pacientes con fractura de instrumentos en conductos radiculares de dientes posteriores, 23 no presentaban lesión periapical y 31 tenían lesión. Los instrumentos fracturados tenían longitudes de 2-4 mm en tercio apical y no pudieron ser removidos y/o sobrepasados con ninguna técnica. Los conductos fueron preparados al borde del instrumento fracturado, hasta un calibre 45 en dirección apical con técnica telescópica, irrigando con hipoclorito de sodio al 3% y desmineralizando con 0,25 ml de EDTA al 16%, lavados con 3 ml de solución fisiológica y secados con puntas de papel, se obturaron utilizando 0,01 ml de formocresol, 0,05 ml de eugenol mezclados con óxido de zinc y cono de gutapercha calibre 45 mediante condensación lateral. Los conductos restantes fueron instrumentados telescópicamente y obturados con gutapercha y ZOE mediante condensación lateral. Resultados: Se realizaron controles clínicos y radiográficos a uno, tres, cinco y ocho años. Al año, los casos oscilaron entre 83,9-95,7% asintomáticos y negativos a la percusión, fístula ausente entre 93,5-100% y sin lesión periapical de 32,3-91,3%. A tres años, 96,8-100% asintomáticos y negativos a la percusión, ausencia de fístula y sin lesión de 80,6-95,7%. A cinco años, 96,8-100% asintomáticos y negativos a la percusión, ausencia de fístula y 93,5- 100% sin lesión. A ocho años, 100% asintomáticos, negativos a percusión, ausencia de fistula y 93,5-95,7% sin lesión. Conclusiones: La utilización de ZOE-formocresol es una alternativa terapéutica exitosa en casos de instrumentos fracturados que no pudieron ser removidos y/o sobrepasados

Introduction: The aim of this study is to present the results of monitoring over 8 years of 54 cases of intracanal broken instruments, which could not be removed and/or bypassed, and were sealed with zinc oxide-eugenol (ZOE) and formocresol. Material and methods: Fifty-four patients with broken instruments in root canals of posterior teeth, 23 had no periapical lesion and 31 had periapical lesion. Fractured instruments were had lengths of 2-4 mm in apical third and were not removed and/or exceeded with any technique. Root canals were prepared at the edge of the fractured instrument using the telescope technique up to 45 file. Irrigation was performed with sodium hypochlorite 3% and 0.25 ml of 16% EDTA. Then, the root canals were washed with saline solution 3 ml and dried with paper points. Obturation was carried out using 0.01 ml formocresol plus 0.05 ml of eugenol mixed with zinc oxide and a guttapercha master cone number 45 using lateral condensation. Remaining canals were telescopically instrumented and filled with guttapercha and ZOE by lateral condensation. Results: Clinical and radiographic controls at one, three, five and eight years were performed. After one year, 83.9-95.7% were asymptomatic and negative to percussion, absent fistula between 93,5-100%, without periapical lesion 32,3-91,3%. After three years 96,8-100% asymptomatic and negative on percussion, absence of fistula, without periapical lesion 80,6-95,7%. At five years 96,8-100% asymptomatic and negative on percussion, absence of fistula and 93,5- 100% without periapical lesion. In eight years, 100% asymptomatic, negative percussion and absence of fistula and 93,5-95,7% without periapical lesion. Conclusions: The use of zinc oxide-eugenol and formocresol is a successful therapeutic option in cases of fractured instruments that could not be removed and/or exceeded

Revascularización en una sola sesión de un incisivo inmaduro traumatizado: Caso clínico / Revascularization in a single session of a traumatized immature permanent tooth: a case report

Propósito: Se describe un protocolo de revascularización en una sola sesión para tratar un incisivo superior, con antecedentes de traumatismo, diagnosticado con periodontitis apical asintomática. Resumen: Los dientes inmaduros que reciben procedimientos de revascularización pueden completar su desarrollo, aunque la pulpa se haya necrosado y las bacterias hayan alcanzado la zona apical. Aún no existe un protocolo estandarizado que pueda seguirse. El caso presentado narra la revascularización de un diente 1.1, con el diagnostico de una periodontitis apical asintomática, que fue tratado con irrigación coronal y radicular con hipoclorito de sodio al 5,25%, sin instrumentación y sellado en una sola visita. Conclusión: La correcta evolución de este caso clínico sugiere que el procedimiento de revascularización permite aprovechar la vitalidad de las células madre dentales creando un ambiente adecuado para la regeneración pulpar y el completo desarrollo de la raíz

Background: The revascularization protocol in one session to treat an upper incisor, with a history of trauma, diagnosed with asymptomatic apical periodontitis, is described. Case report: Immature teeth that receives revascularization procedures can complete their development, although its pulp has reached necrotic and bacteria has reached the apical area. There is still no standardized protocol that can be followed. The present case shows the revascularization of a tooth 1.1, with the diagnosis of asymptomatic apical periodontitis. The tooth was treated with coronal and root irrigation of 5.25% sodium hypochlorite, without instrumentation and sealed in a single visit. Conclusion: The correct evolution of this case suggests that the revascularization procedure takes advantage of the vitality of dental stem cells creating a suitable environment for the pulp regeneration and full root development

Aplicación de la tomografía computarizada de haz cónico en el manejo endodóncico de un molar superior en forma de C / Management of a C-shaped maxillary molar: three-dimensional analysis with cone beam computed tomography

Se presenta un caso de un tratamiento endodóntico de un primer molar superior derecho con una morfología radicular atípica en forma de C. Mediante tomografía computarizada de haz cónico (TCHC) se evidenció la fusión de los conductos palatino y distovestibular en una única raíz. En el artículo se describe la importancia de la correcta identificación de esta variación anatómica mediante los distintos métodos imagenológicos. Se revisa también la literatura respecto a la prevalencia de los molares superiores en forma de C, y el reto que supone en relación a la preparación químico-mecánica y a la obturación tridimensional

This clinical case presents an endodontic treatment of a C-shaped right maxillary first molar which represents an unusual root morphology. The cone beam computed tomography (CBCT) shows a complete fusion of the distobuccal and palatine canals in a single root. The article describes the importance of performing an adequate identification of this complex anatomy using different imaging techniques. It also reviews the literature regarding the prevalence of maxillary molars with a C-shape configuration, the challenge concerning chemical and shaping preparation and also the root canal filling

Prognostic factors on periapical surgery: a systematic review

BACKGROUND: Analyze the most important prognostic factors when performing periapical surgery and compare the success rates of distinct authors. INTRODUCTION: Periapical surgery is an approach to treat non-healing periapical lesions and it should be viewed as an extension of endodontic treatment and not as a separate entity. MATERIAL AND METHODS: A search of articles published in Cochrane, PubMed (MEDLINE) and Scopus was conducted with the key words "prognostic factors", "prognosis", "periapical surgery", "endodontic surgery" and "surgical endodontic treatment". The inclusion criteria were articles including at least 10 patients, published in English, for the last 10 years. The exclusion criteria were nonhuman studies and case reports. RESULTS: 33 articles were selected from 321 initially found. Ten articles from 33 were excluded and finally the systematic review included 23 articles: 1 metaanalysis, 1 systematic review, 2 randomized clinical trials, 6 reviews, 12 prospective studies and 1 retrospective study. They were stratified according to their level of scientific evidence using the SORT criteria. CONCLUSIONS: Factors associated with a better outcome of periapical surgery are patients ≤45 years old, upper anterior or premolar teeth, ≤10 sized lesions, non cystic lesions, absence of preoperative signs and symptoms, lesions without periodontal involvement, teeth with an adequate root-filling length, MTA as root-end filling material, uniradicular teeth, absence of perforating lesions, apical resection < 3 mm, teeth not associated to an oroantral fistula and teeth with only one periapical surgery