Endodontic variables in patients with SARS-CoV-2 infection (COVID-19) in relation to the severity of the disease

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is the cause of the ongoing coronavirus disease 2019 (COVID-19) pandemic. It has been hypothesized oral health may be related to the severity and complications of COVID-19. The aim of this study was to analyze the prevalence of apical periodontitis and the frequency of root canal treatment in a sample of patients with SARS-CoV-2 infection (COVID-19), correlating them with the severity of the disease. Material and methods: This retrospective study was conducted following the Strengthening Reporting Observational Studies in Epidemiology (STROBE) guidelines. The study examined 280 patients with positive real time PCR COVID-19 test whose treatment was performed in our hospital. Fifty-two patients aged 52.3 ± 17.3 years, including 30 males and 22 females, who had an orthopantomography in their clinical record, performed in the last 2 years, were included. Patients with SARS-CoV-2 infection were grouped as mild or moderate (MM) and severe or critical (SC) illness groups, according to the NIH COVID-19 Treatment Guidelines (Wu & McGoogan 2020). Radiographic records were analyzed and apical periodontitis (AP) was diagnosed as radiolucent periapical lesions (RPLs), using the periapical index score (PAI). Student's t test, χ2 test and multivariate logistic regression were used in the statistical analysis. Results: The number of carious teeth was significantly higher in the SC group (3.4 ± 4.1), which showed more than twice as many teeth with carious lesions than the MM group (1.4 ± 1.8) (p = 0.02). Multivariate regression analysis showed association between the number of carious teeth and the severity of SARS-CoV-2 disease (OR = 1.5; 95% CI = 1.1-2.1; p = 0.017). Endodontic status (OR = 7.12; 95% CI = 1.2-40.9; p = 0.027) also correlated with the disease severity. (AU)

Etiología, fisiopatología y tratamiento de la periodontitis apical. Revisión de la literatura / Etiology, pathophysiology and treatment of apical periodontitis. Literature review

La periodontitis apical (PA) es una inflamación y destrucción de los tejidos periapicales comúnmente causada por bacterias como resultado de caries o traumatismos dentales. Aunque los mecanismos de defensa del huésped están activados, la acción bacteriana provoca la destrucción apical. Se ha identificado la microbiota relacionada con esta patología en el interior del conducto radicular. Enterococcus faecalis es un coco grampositivo presente en casos clínicos persistentes de PA. Un tratamiento de conducto puede eliminar los agentes infecciosos. Sin embargo, si la PA persiste, se puede considerar un retratamiento del conducto radicular o una apicectomía. Aunque el diagnóstico definitivo de PA se logra mediante un examen histopatológico, los estudios de investigación confirman que es más probable que la tomografía computarizada de haz cónico detecte PA que la radiografía periapical (RP). El objetivo de esta revisión de la literatura es describir la etiología, índice periapical, clasificación de la periodontitis apical: aguda y crónica, así como pruebas diagnósticas adicionales y alternativas de tratamiento para su abordaje clínico. (AU)

Apical Periodontitis (AP) is an inflammation and destruction of the periapical tissues commonly caused by bacteria as a result of dental caries or trauma. Although the host's defense mechanisms are activated, the bacterial action causes apical destruction. The microbiota related to this pathology has been identified inside the root canal of teeth. Enterococcus faecalis is a gram-positive cocci present in persistent clinical cases of AP. A root canal treatment can eliminate the infectious agents. However, if AP persists, a root canal retreatment or an apicoectomy can be considered. Although the definitive diagnosis of AP is achieved by histopathological examination, research studies confirm that cone beam computed tomography is more likely to detect AP than periapical radiography (RP). The objective of this literature review is to describe the etiology, periapical index, apical periodontitis classification: acute and chronic, as well as additional diagnostic test and treatment alternatives for its clinical approach. (AU)

Ameloblastomas mimicking apical periodontitis: a case series

Background: Ameloblastomas are benign odontogenic tumors that can eventually mimic the clinical and radiological features of apical periodontitis. The aim of the present study was to evaluate the clinical, radiological andhistological characteristics from a series of ameloblastomas mimicking apical periodontitis diagnosed in a 14-yearperiod.Material and Methods: all cases histologically diagnosed as ameloblastomas from 2005 to 2018 presenting aclinical diagnosis of periapical lesion of endodontic origin were selected for the study. Clinical, radiological andhistological characteristics from all cases were tabulated and descriptively and comparatively analyzed.Results: Twenty cases composed the final sample, including 18 solid and 2 unicystic ameloblastomas. Mean age ofthe affected patients was in the fifth decade with predilection for males (72%). The most common anatomical location was the posterior mandible (55%) and most cases presented a radiolucent unilocular (80%) well-defined (95%)image. Most cases were asymptomatic, but the presence of local swelling and bone cortical rupture were common.Conclusions: Ameloblastomas mimicking periapical lesions of endodontic origin are mostly diagnosed in adultmales as well-defined radiolucent unilocular lesions producing local swelling and bone cortical rupture. (AU)

Contexto epidemiológico de la periodontitis apical en asistentes a Odontosánitas Bogotá, 2011-2016 / Epidemiological context of apical periodontitis in attendees to Odontosánitas Bogotá, 2011-2016

Introducción:La periodontitis apical (PA) como enfermedad prevalente conecta la salud oral al estado general del individuo. Se pretendió caracterizar bajo un contexto epidemiológico integral la presencia de PA en una población de una clínica de Odontosánitas en Bogotá.Materiales y métodos:Este estudio transversal incluyó registro retrospectivo documental de 3981 pacientes asistentes al servicio de endodoncia. La condición periapical; ausencia o presencia de PA, fue registrada clínica y radiográficamente. Como variables sociodemográficas e individuales: sexo, edad, procedencia, tipo de aseguramiento, tipo y localización del diente. La condición médica incluyó presencia o ausencia de enfermedades sistémicas, el consumo de medicamentos y hábito de fumar. Se estimó un cálculo de 345 pacientes, con un índice de prevalencia de 43,6%. Análisis uni/bivariados, registraron la prevalencia. Un modelo multivariado de correspondencias múltiples (ACM), identificó espacialmente, la asociación y la frecuencia de los factores analizados.Resultados:Un total de 378 asistentes con una prevalencia de PA del 51,6% [IC 95% (46,5 %, 56,6%)] y 48.98 años de edad promedio. A partir de la PA, se observó mayor prevalencia en mujeres (51,8%), molares (40%) y maxilar superior (63,3%).Discusión:El ACM, identificó que la PA se distribuyó equitativamente entre las variables, sin establecer asociación entre la PA y la condición sistémica. (AU)

Periapical periodontitis (PP), as a prevalent disease, connects oral health to the individual health condition. It was intended to characterize the presence of PP in a population of an Odontosánitas clinic center-Bogotá under a comprehensive epidemiological context. A Cross-sectional study that included the retrospective documentary registry of 3981 patients attending the endodontic service. The periapical condition, absence or presence of PP, was recorded clinically and radiographically asexplanatory variable. As sociodemographic and individual variables: sex, age, local area, type of insurance, and tooth. Medical condition included the presence or absence of systemic diseases, association with the type of medicine, and smoking. Calculation of 345 patients was estimated, with a prevalence rate of 43,6%. Uni / bivariate analysis recorded the prevalence. A multivariate multiple correspondence analysis (MCA) spatially identified the association and frequency of the factors analyzed.A total of 378 attendees were included, with a prevalence of PP of 51,6% [95% CI (46,5%, 56.6%)] and a mean age of 48,98 years. From the PP, it was observed higher prevalence in women (51,8%), molars (40%), and maxilla (63,3%). The MCA identified that the PP was equally distributed among the variables, without establishing an association between the PP and the systemic condition. (AU)

Prevalence of endodontic infection in patients with Crohn´s disease and ulcerative colitis / Prevalencia de infección endodóntica en pacientes con enfermedad de Crohn y colitis ulcerosa

Background: Previous studies have linked apical periodontitis (AP) to inflammatory bowel disease (IBD). Theaim of this study was to compare the prevalence of AP and root canal treatment (RCT) in patients with ulcerativecolitis (UC) and Crohn´s disease (CD).Material and methods: A cross-sectional study, including 28 patients with Crohn´s disease and 26 with ulcerativecolitis, was conducted. AP was diagnosed as radiolucent periapical lesions (RPLs), using the periapical indexscore (PAI). Student’s t test, χ2 test and multivariate logistic regression were used in the statistical analysis.Results: Multivariate logistic regression run with age, gender, number of teeth, number of RFT, periodontal dis -ease and the type of IBD as covariates, taking as dependent variable and outcome “periapical status” (0 = notooth with RPL; 1 = at least one tooth with RPL), showed that both UC and CD patients had the prevalence api-cal periodontitis (OR = 1.03; C.I. 95% = 0.25 – 4.31; p = 0.97). The multivariate analysis, including all the abovecovariates, shows that both in UC and CD patients the prevalence of RCT was similar (OR = 0.76; C.I. 95% =0.17 – 7.31; p = 0.73). Periapical status was significantly associated with endodontic status (OR = 42.72; C.I. 95%= 3.87 – 472.15; p = 0.002), regardless of IBD type. Conclusions: The results of the present study show similar frequency of AP and RFT in both UC and CD patients.The type of IBD does not appear to affect the prevalence of radiographically detectable periapical lesions or theprevalence of root canal treatment.(AU)

Cardiovascular diseases and apical periodontitis: association not always implies causality

BACKGROUND: Several studies published in the last two decades have found an association between the prevalence of apical periodontitis (AP) or root canal treatment (RCT) and cardiovascular diseases (CVDs). However, the demonstration of association does not prove by itself the existence of a cause-effect relationship. Two diseases can appear as statistically related without any of them directly affecting the values of the other, resulting in a non-causal relationship. The aim of this narrative review is to summarize the current state of knowledge regarding the association between AP and CVDs, analysing it according to the Hill's causality criteria. MATERIALS AND METHODS: Epidemiological studies carried out on the association between CVDs and AP or RCT published I n English until 8 December 2019 were identified. For ty-four articles were selected and its results were analysed. RESULTS: Numerous cross-sectional epidemiological studies have found significant relationship between CVDs and AP. The odds ratio values range 1.6 - 5.4. However, other studies have not found significant association. Respect to RCT, some studies found correlation, but others found no association or even found that RCT is a protective factor against CVDs. CONCLUSIONS: The results are inconsistent and a causal relationship between CVDS and endodontic disease cannot be stablished. The risk factors common to both diseases can act as confounding factors, biasing the results. To reach definitive conclusions about the type of association (causal or non-causal) between both diseases, longitudinal epidemiological studies must be carried out to establish the temporal relationship and the dose-response gradient

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Regeneración pulpar: una segunda oportunidad al diente inmaduro. A propósito de un caso / Regenerative endodontics: at second chance to immature apex. A case report

Desde la introducción del término revascularización en 1971, muchos han sido los protocolos descritos para el tratamiento de un diente inmaduro con necrosis pulpar y periodontitis apical. La complejidad que supone la realización de técnicas de apicoformación en dientes con raíces cortas, paredes frágiles, ápices no formados y divergentes, permiten que el tratamiento de endodoncia regenerativa esté indicado. El caso que presentamos a continuación se trata de un paciente de corta edad que acude a la consulta por presentar dolor en el cuarto cuadrante. Tras la anamnesis y pruebas complementarias, llegamos al diagnóstico de necrosis pulpar con periodontitis apical sintomática del diente 44. En la radiografía podemos apreciar la presencia de una raíz corta, con paredes frágiles y ápice no formado. Tras hablar con los padres del paciente decidimos optar por el tratamiento de endodoncia regenerativa. Discutiremos a lo largo del caso la técnica empleada durante la realización de este caso clínico, centrándonos en la desinfección del interior del sistema de conductos, y la posterior creación de una matriz de andamiaje necesaria para poder colocar nuestro material biocerámico. En el apartado de discusión acercaremos al clínico las distintas opciones presentes en la literatura para afrontar la desinfección, medicación intraconducto y material de sellado, pilares fundamentales para el éxito del tratamiento de endodoncia regenerativa. En el seguimiento del caso, el paciente se presenta totalmente asintomático, con un desarrollo radicular completo y una formación de las paredes que devuelven la integridad al diente inmaduro

Since the introduction of the term revascularization in 1971, there have been many specific protocols for the treatment of an immature tooth with pulp necrosis and apical periodontitis. The complexity of performing apexification techniques on teeth with short roots, fragile walls, and non-formed and divergent apices, allows regenerative endodontic treatment to be indicated. The case presented below is about a young patient who comes to the office for presenting pain in the fourth quadrant. After the anamnesis and complementary tests, we arrived at the diagnosis of pulp necrosis with symptomatic apical periodontitis of tooth 44. On radiography, we can detect the presence of a short root, with fragile walls and an unformed apex. After talking with the patient's parents, we decided to opt for regenerative endodontic treatment. We will discuss throughout the case the technique used during the realization of this clinical case, focusing on the disinfection of the interior of the duct system, and the subsequent creation of a scaffolding matrix necessary to be able to place our bioceramic material. In the discussion section we will approach the clinician the different options present in the literature to deal with disinfection, intra-conduction medication and sealing material, fundamental pillars for the success of regenerative endodontic treatment. In the follow-up of the case, the patient appears totally asymptomatic, with a complete root development and a formation of the walls that restore integrity to the immature tooth

Prevalence of Apical Periodontitis in patients with Multiple Myeloma

BACKGROUND: Previous reports have been analyzed the prevalence/association of apical periodontitis (AP) with systemic diseases. The present study aims to analyze the prevalence of healthy/diseased periapex and endodontic treatments in patients with Multiple Myeloma (MM) and compare the results with those of control subjects. MATERIAL AND METHODS: Panoramic radiographs of 50 individuals with MM were evaluated and compared with 50 controls that were sex and age matched exactly with the diseased group. Radiographic analysis was performed by two experienced endodontists under standardized conditions. The periapical status (presence or not of AP) was assessed using the periapical index (PAI). Data included systemic health, technical quality of root fillings, total number of teeth, quality of restoration, and periapical status. Statistical evaluation of differences between groups used chi-squared tests and Fisher's exact tests. RESULTS: The prevalence of root canal-treated teeth was 10.11% in the MM group and 12.05% in the control group (p = 0.90). The average root canal-treated teeth in the test group was 2,34 and 2.48 in the control group, where the difference was statistically significant (p = 0.05). AP in 1 or more teeth was found in 86 % and in 78% of the patients in the MM and the control groups, respectively. When analyzed by subject, there was no statistically significant difference in the prevalence of AP (p > 0.72). Similarly there was also no statistically significant difference in the prevalence of PA (p = 0.85), when analyzed by tooth, AP was found in 63.2% and 62.9% in MM and control groups. CONCLUSIONS: The presence of AP and endodontic treatment was not significantly different in individuals with MM compared with control subjects. Future studies are needed to elucidate and confirm the association between MM and AP

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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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Efecto de la esterilización en la Resistencia a fatiga cíclica de limas Hyflex CM®,a nivel coronal y apical / Effect of sterilization cycles on cyclic fatigue resistance of hyflex CM files, at coronal and apical levels

Objetivo: comparar la resistencia a fatiga cíclica de las limas HyFlex CM® nuevas y esterilizadas tanto a nivel apical como coronal. Material y método: 180 limas se dividieron en seis grupos (n=30): dos de limas nuevas (A5, A11), dos de limas esterilizadas una vez (B5, B11) y dos de limas esterilizadas dos veces (C5,C11). Se evaluó la resistencia a fatiga cíclica (FC) a 5 mm y a 11 mm de la punta. El análisis de Weibull se utilizó para calcular los parámetros de vida media, beta y eta y comparar los grupos. Resultados: Las limas nuevas fueron significativamente más resistentes a la FC que las esterilizadas una o dos veces, con una probabilidad de 72% y 61% a 5 mm de la punta y de un 75% y 72% a 11 mm de la punta, respectivamente. No hubo diferencias estadísticamente significativas entre la vida media de las limas esterilizadas una o dos veces a 11 mm de la punta, sin embargo las limas esterilizadas dos veces fueron significativamente más resistentes a 5 mm de la punta, con una probabilidad de 63%. En todos los grupos, las limas fueron significativamente más resistentes a nivel apical que coronal con una probabilidad superior al 99%. Conclusiones: Las limas HyFlex CM® fueron más resistentes a la FC a nivel apical que coronal. Los instrumentos HyFlex CM® no esterilizados fueron los más resistentes

Aim: to compare cyclic fatigue resistance of new and sterilized HyFlex CM® files at apical and coronal levels. Methods: 180 files were divided in six groups (n=30): two of new files (A5, A11), two autoclaved once (B5, B11) and two autoclaved twice (C5, C11). Cyclic fatigue resistance was tested at 5 mm and at 11 mm from the tip. Weibull analysis was used to calculate the mean life, beta, and eta parameters. Results: New files will last significantly longer than files that were sterilized once or twice, with a probability of 72% and 61% at 5 mm from the tip and 75% and 72% at 11 mm from the tip, respectively. There was no statistically significant difference between the mean life of the files sterilized once or twice at 11 mm from the tip, but at 5 mm from the tip, files sterilized twice was significantly longer than those sterilized once, with a probability of 63%. Files will last significantly longer at 5 mm than 11 mm from the tip with a probability higher than 99%. Conclusions: HyFlex CM® files were more resistant to cyclic fatigue at the apical than the coronal levels. Unsterilized HyFlex CM® files were the most resistant

MTA como material de sellado en cirugía endodóntica: puesta al día / MTA as sealing material in endodontic surgery: update

La cirugía endodóntica tiene por objetivo eliminar quirúrgicamente el tejido patológico a nivel periapical y permitir el sellado hermético apical. Para ello resulta fundamental obturar la cavidad realizada con un material que sea biocompatible, insoluble y que impida la filtración bacteriana. Ninguno de los materiales de sellado clásicos ha sido capaz de satisfacer todos los requerimientos necesarios para ser denominado el material ideal en cirugía endodóntica. Sin embargo, con la introducción del Agregado Trióxido Mineral (MTA), se ha presentado un material altamente biocompatible que evita la filtración de bacterias y que es hidrófilo, por lo que podría emplearse en campos húmedos como son los tejidos apicales. El presente trabajo de revisión bibliográfica permitió investigar cuáles son las ventajas que aporta el MTA en cirugía endodóntica. Se han estudiado sus características con respecto a su biocompabilidad y capacidad de sellado. Además, se ha revisado cómo la literatura hace frente a sus desventajas como material de sellado, sobre todo, en referencia su difícil manejo y a su potencial de decoloración del diente obturado (AU)

Endodontic surgery treatment pretends to surgically remove pathological tissue in the periapical area, with the aim to obtain a hermetic and apical seal. For this, it is essential to seal the cavity with a material that is biocompatible in the periapical tissues, insoluble in oral fluid, and that prevents bacterial leakage in dental tissues. None of the conventionally used root end filling materials has been able to meet all the requirements to be designated as the ideal material for this treatment. however, with the introduction of Mineral Trioxide Aggregate (MTA), it was found to be a highly biocompatible material, which prevents bacterial leakage and is hydrophilic, so that the problem of its use in areas with moisture such as the apical tissues can be avoided. This literature review allowed us to investigate the advantages of the MTA in endodontic surgery. Its characteristics have been studied regarding its biocompatibility and sealing ability. Furthermore, it has been revised how the literature confronts its disadvantages regarding the troublesome handling and the potential discoloration of the filled tooth (AU)

Una mirada al futuro de la endodoncia / Looking towards the future of endodontics

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Periodontitis apical y estado de salud oral en individuos con diferentes condiciones sistémicas y hábitos de tabaquismo en una población portuguesa / Apical periodontitis and oral status in patients with different systemic conditions and smoking habits in Portuguese population

Objetivo: Determinar la prevalencia de periodontitis apical (PA), tratamiento endodóncico (TE) y estado de salud oral en individuos con diferentes condiciones sistémicas y hábitos de tabaquismo. Métodos: se evaluaron las radiografías panorámicas y procesos clínicos de la primera consulta de 199 pacientes en la Facultad de Medicina Dentaria de la Universidad de Porto. Se registraron el número y presencia de PA y TE, el estado de salud oral (número de dientes ausentes, caries y raíces) y la presencia de diabetes mellitus (DM), enfermedades cardiovasculares (ECV), alergias y hábitos de tabaquismo en cada individuo. Los dientes fueron evaluados de acuerdo con el Índice Periapical de Ørstavik. Los datos fueron analizados por medio de estadística inferencial, considerando un nivel de significancia de 5%. Resultados: La prevalencia de PA y TE por individuo fue de 44,2% (IC 95%, 37,3%-51,4%) y 47,2% (IC 95%, 40,2%-54,4%), respectivamente. Se verificó una asociación entre el número de PA (≥3) e individuos fumadores (p = 0,025). Se detectó que el número de dientes ausentes aumentaba con la edad (r = 0,723; p < 0,005) y era mayor en individuos diabéticos (p = 0,000). Un mayor número de dientes perdidos, caries y raíces fue detectado en los individuos con AP (p = 0,02, p = 0,000, p = 0,000, respectivamente) y con ECV (p = 0,000, p = 0,001, p = 0,040, respectivamente). Conclusiones: La PA y el TE eran altamente prevalentes en la populación estudiada, independientemente de la condición sistémica o hábitos de tabaquismo del paciente. Se verificó que una mayor prevalencia del número de dientes ausentes, caries y raíces estaba asociada a ciertas condiciones sistémicas, lo que sugiere una mayor susceptibilidad de estos individuos a desarrollar lesión endodóncica primaria

Objective: To determine the prevalence of apical periodontitis (AP), endodontic treatment (ET), and oral status in patients with different systemic conditions and smoking habits. Methods: Panoramic radiographs and clinical processes of 199 patients from their first visit to the clinic of the Faculty of Dentistry of the University of Porto were assessed. The number and presence of AP and ET, the oral status (number of missing teeth, caries, and roots), and the presence of diabetes mellitus (DM), cardiovascular diseases (CVD), allergies, and smoking habits were registered. Teeth were assessed according to Ørstavik’s periapical index. Data were analyzed using inferential statistics, based on a significance level of 5%. Results: The prevalence of AP and ET per patient was 44.2% (95% CI, 37.3%-51.4%) and 47.2% (95% CI, 40.2%-54.4%), respectively. An AP ≥ 3 was associated with smokers (p = 0.025). The number of missing teeth increased with age (r = 0.723; p = 0.005) and was higher in patients with DM (p = 0.000). A higher number of missing teeth, caries, and roots was detected in patients with AP (p = 0.002, p = 0.000, p = 0.000, respectively) and patients with CVD (p = 0,000, p = 0,001, p = 0.040, respectively). Conclusions: AP and ET were highly prevalent in the studied population, regardless of the patient’s systemic condition and smoking habit. A higher prevalence of missing teeth, caries, and roots was associated with certain systemic conditions, thus suggesting a higher susceptibility of these patients to develop primary endodontic disease

Activación con puntas Eddy(R): A propósito de un caso / Activation tips Eddy(R): With regard to a case

El objetivo del tratamiento de conductos es prevenir o curar la periodontitis apical. Para lograr el éxito es necesario una correcta limpieza y posterior obturación tridimensional. La irrigación y desinfección del sistema de conductos es una parte imprescindible del tratamiento. Su objetivo es eliminar las bacterias y el remanente pulpar contaminado. No obstante, a pesar de muchos esfuerzos siguen existiendo nichos y cepas bacterianas causantes del fracaso endodóntico. Eddy(R), es un nuevo sistema de activación sónica con unas características específicas de su punta de poliamida, la cual oscila a alta amplitud accionada por una pieza de mano generando intraconducto unas microturbulencias o microcorrientes que ayudan en la desinfección microbiana. A continuación se expone un caso, donde se explica paso por paso la técnica clínica de las puntas de activación Eddy®, responsables de una correcta desinfección gracias al movimiento del irrigante

The aim of a root canal treatment is to prevent the apical periodontitis. An effective cleaning and subsequently a three-dimensional obturation are needed to achieve success. The irrigation and disinfection of the root canal system is a necessary part of the root canal treatment. Its aim is to eliminate the bacteria and the infected remnant pulp tissue. Nevertheless, despite our efforts, there are still niches and bacterial strains that cause endodontic failure. Eddy(R) is a new system of sonic activation with specific characteristics of its polyamide’s tip, which oscillates with high amplitude powered by a handpiece generating microturbulences or microstream that helps in bacterial disinfection. Below a clinical case is presented, in which we are going to explain step by step the clinical technique of the activation tips Eddy® responsible for a proper disinfection thanks to the irrigant movement

Obturación tridimensional: un factor clave en el pronóstico del tratamiento endodóncico: caso clínico / Tri-dimensional filling: a key factor in the outcome of endodontic treatment: case report

La calidad de la obturación del conducto radicular está considerada en la actualidad como un factor de gran influencia en el resultado del tratamiento endodóncico (TE). La tomografía computerizada de haz cónico (CBCT) puede ser utilizada para confirmar un diagnóstico sobre la morfología del conducto radicular, y está indicada en la evaluación de complicaciones post-tratamiento, cuando el examen radiográfico convencional no aporta suficiente información. Estudios recientes realizados con micro-CT muestran variaciones anatómicas que pueden estar implicadas en el fracaso del TE. Los clínicos deben tener en cuenta las variaciones anatómicas de los dientes y las ventajas de utilizar el CBCT en situaciones específicas. Este caso clínico pretende resaltar la importancia de una obturación tridimensional en el éxito del TE

The quality of the root canal filling is currently recognized as a factor that influences the outcome of the endodontic treatment (ET). Cone beam computerized tomography (CBCT) can be used to confirm a diagnosis of root canal morphology and is indicated in the evaluation of post-treatment complications, when conventional radiographic examination does not provide sufficient information. Recent studies with micro-CT present anatomic variations which can be implicated in the ET failure. Clinicians should be aware of the teeth’s morphological variations and of the advantages of using CBCT in specific situations. This case report aims to highlight the importance of a tri-dimentional filling in the success of the ET

Association of Toll-like receptors 2, 3, and 4 genes polymorphisms with periapical pathosis risk

BACKGROUND: The aim of this study was to investigate the role of gene variations of Toll-like receptors (TLR) 2, 3, and 4 on genetic susceptibility to periapical pathosis. MATERIAL AND METHODS: One hundred patients were included in the study and divided into two groups as follows; Control Group (n=50) that have root canal treatment and no periapical lesion, Patient Group (n=50) that have root canal treatment and periapical lesion. TLR2 Arg753Gln, TLR3 (c.1377C/T) and TLR4 Asp299Gly and Thr399Ile polymorphisms were genotyped by using PCR-RFLP. Genotypical analysis of control and patient groups were investigated to disclose whether there is any association between periapical lesions and gene variations. RESULTS: There are no significant statistical differences between control and patient groups according to TLR 2 and 4 gene sequence. On the contrary, CC allele detected 74% for TLR 3 in patient group, and this difference was found to be statistically significant (p < 0.005). CONCLUSIONS: According to these results, it can be suggested that patients with Toll-like receptor 3 gene polymorphisms could be susceptible to periapical pathosis

Reimplante intencional para el tratamiento de un surco de desarrollo / Intentional replantation for the treatment of a palatogingival groove

El surco de desarrollo es una malformación anatómica que predispone al diente a un defecto periodontal. El diagnóstico supone un reto en casos de necrosis pulpar. Se han sugerido diferentes alternativas terapéuticas para su manipulación. En el presente caso, se describe el tratamiento de un surco de desarrollo en un incisivo lateral superior con un defecto periodontal severo. Se optó por un abordaje combinado en el que se realizó el reimplante intencional, posterior a la endodoncia, con el objetivo de tratar el surco fuera de la cavidad oral. Después de un año de control, se observó curación radiográfica y periodontal, por lo que se puede concluir que el reimplante intencional es un tratamiento predecible para el manejo de esta entidad

The palatogingival groove is an anatomic malformation that predisposes the involved tooth to a periodontal defect. The diagnosis may be challenging in case of pulp necrosis. Different treatment alternatives have been suggested for the treatment of this entity. In this case report, we describe the treatment of a palatogingival groove in a lateral upper incisor with a severe periodontal defect. A combined treatment approach, involving both root canal treatment and intentional replantation was perfomed, with the aim of the manipulation of the palatogingival groove out of the oral cavity. After one year follow-up, radiographic and periodontal healing can be observed, for this reason, it can be concluded that intentional replantation offers a predictable procedure for the management of this entity

Retratamiento endodóntico de una reabsorción radicular interna asociada a un conducto lateral / Endodontic retreatment of an internal root resorption associated with a lateral canal

La reabsorción radicular interna (RRI) es una patología que se caracteriza por la destrucción de las paredes del conducto radicular generando una forma de "ampolla". Está asociada a una afección pulpar, por el efecto de causas físicas, químicas y/o bacterianas que estimulan la actividad clástica. El tratamiento endodóntico se presenta como la solución óptima para detener dicha reabsorción. A continuación se muestra un caso clínico de retratamiento ortógrado, donde la RRI está asociada a la presencia de un conducto lateral, concomitante con una radiolucidez perirradicular

Internal root re-absorption (IRR) is a pathology characterized by the destruction of the root canal walls generating a shape of "blister". It is associated with the invasion of the pulp of the tooth, due to the effect of physical, chemical and / or bacterial causes which stimulate clastic activity. Endodontic treatment is presented as the best solution to stop this re-absorption. A clinical case of retrograde root canal re-treatment is reported, where the IRR is associated with the presence of a lateral canal with concomitant periradicular radiolucency

Terapia fotodinámica en un primer molar mandibular con periodontitis apical crónica e istmo intermesial permeable / Photodynamic therapy of a first mandibular molar with chronic apical periodontitis and a permeable inter-mesial isthmus

La terapia fotodinámica (TFD) es un procedimiento terapéutico con capacidad antimicrobiana demostrada en la literatura científica. Esta constatado que su empleo, después de la preparación químico-mecánica convencional, reduce la carga microbiana en el diente necrótico. Esto supone una ventaja en los casos de necrosis en dientes con anatomías complejas, como cuando existe un istmo. Por otro lado, la TFD podría ser una alternativa al empleo de medicaciones intraconducto en los dientes con patología periapical. El propósito de este articulo es describir la técnica de uso de la TDF, empleando una lámpara de diodos LED de baja potencia (FotoSan®) como fuente lumínica y azul de toluidina como fotosensibilizador, y mostrar los resultados de su asociación con el tratamiento endodóncico convencional, en un caso de un primer molar mandibular con istmo permeable, necrosis pulpar y periodontitis apical crónica

Photodynamic therapy (PDT) has been shown to exert antimicrobial action. Following conventional chemical-mechanical preparation, PDT reduces the microbial burden in the necrotic tooth. This implies an advantage in cases of necrosis in teeth with complex anatomical features, such as the presence of an isthmus. On the other hand, PDT could constitute an alternative to the use of drugs within the canal of teeth with periapical disease. This study describes the PDT technique using a low-power LED lamp (FotoSan®) as light source and toluidine blue as photosensitizer. A description is provided of the results obtained on combining the technique with conventional endodontic treatment of a first mandibular molar with a permeable isthmus, pulp necrosis and chronic apical periodontitis

Reimplante intencional de un segundo premolar maxilar: seguimiento de dos años con tomografía computadorizada de haz cónico / Intentional replantation of a maxillary second premolar: two years follow-up with cone beam computerized tomography

Introducción: El reimplante intencional de un diente endodonciado está indicado en casos de fracaso del tratamiento de conductos, con periodontitis apical persistente, cuando no se puede realizar retratamiento ortógrado ni cirugía endodóncica. Caso clínico: Se presenta un caso de reimplante intencional de un segundo premolar maxilar. El diente fue extraído cuidadosamente y, extraoralmente en la mano, se realizó la resección de los 3 mm apicales, la preparación de la cavidad a retro y la obturación, reimplantándose posteriormente en su posición original. Conclusiones: Dos años después del tratamiento, la paciente continúa asintomática y el diente no presenta signos de periodontitis apical. La tomografía computadorizada de haz cónico muestra el espacio del ligamento periodontal intacto, sin evidencia de reabsorción radicular ni anquilosis (AU)

Aim: Intentional replantation of teeth with root canal treatment failure can be useful for teeth with apical periodontitis that cannot be treated with nonsurgical retreatment therapy or endodontic surgery. Case report: This case report describes the intentional replantation of a maxillary second premolar. The tooth was extracted with minimal trauma. Then, with the tooth out of socket, root resection was done, root-end cavity was prepared and sealed with MTA, and the tooth was replanted into the socket. Conclusions: Two years after treatment the patient is asymptomatic. The cone beam computed tomography shows the normal appearance of the periradicular area and no evidence of periapical lesion, root resorption or ankylosis (AU)