Bypass de instrumento endodôntico fraturado: relato de caso / Bypass of a fractured endodontic instrument: case report

Introdução: Mesmo com toda evolução tecnológica desses instrumentos, com o desenvolvimento das limas de liga de níquel-titanio (NiTi) e sistemas mecanizados, as fraturas podem ocorrer durante o preparo químico/mecânico. Existem três abordagens mais regulamente aplicadas para solucionar essa intercorrencia: tentativa de remoção do instrumento com ultrassom, tentativa de ultrapassálo (bypass) ou a obturação do segmento. Objetivo: Relatar um caso da técnica de bypass em instrumento fraturado no canal radicular. Descrição do caso: Paciente, sexo feminino, 47 anos, brasileira, sem condições sistêmicas associadas, foi encaminhada à clínica do Curso de Odontologia da UNIFENAS, Divinópolis, Minas Gerais, Brasil, para resolução de fratura de instrumento no canal mésio- vestibular do primeiro molar superior direito (16). Optou-se pelo tratamento pela técnica de bypass, que envolveu as seguintes etapas: anestesia, abertura, utilização de lima C-Pilot #08 para ultrapassar o instrumento fraturado, odontometria, escalonamento regressivo a partir da lima k#20, desinfecção com hipoclorito de sódio 5%, medicação com hidróxido de cálcio por 21 dias, agitação da substância irrigadora e obturação dos canais radiculares. Conclusão: O bypass ao instrumento é uma técnica conservadora, eficaz e uma solução adequada em casos de fratura de limas endodônticas dentro dos canais radiculares. Essa técnica visa preservar o máximo possível da estrutura dental original, evitando procedimentos mais invasivos.(AU)

Introduction: Even with all technological evolution of these instruments, with the development of nickel-titanium alloy (NiTi) files and mechanized systems, fractures can occur during chemical/mechanical preparation. There are three most commonly applie to resolve this complication: attempting to remove the instrument with ultrasound, attempting to bypass it, or obturating the segment. Objective: To report a case of bypass technique in fractured instrument in the root canal. Case description: A 47-year-old female patient from Brazil, with no associated systemic conditions, was referred to the clinic of the Dentistry Course at UNIFENAS, Divinópolis, Minas Gerais, Brazil, for resolution of an instrument fracture in the mesio-vestibular canal of the right upper first molar (16). Treatment was performed using the bypass technique, which involved the following steps: anesthesia, opening, use of a C-Pilot #08 file to bypass the fractured instrument, odontometry, regressive scaling from the k#20 file, disinfection with 5% sodium hypochlorite, medication with calcium hydroxide for 21 days, agitation of the irrigating substance and root canal filling. Conclusion: Instrument bypass is a conservative, effective technique and an adequate solution in cases of endodontic file fracture within root canals. This technique aims to preserve as much of the original tooth structure as possible, avoiding more invasive procedures.(AU)

Estado actual de la infección focal y del éxito del tratamiento endodóntico / Current status of focal infection and the success of endodontic treatment

Frente a la difusión en medios de comunicación de medias verdades con enunciados alarmantes y anticientíficos, este editorial busca revisar las bases científicas para determinar el comportamiento clínico. Así, el texto discurre por el concepto de infección focal desde su origen, yendo al encuentro de sus transformaciones conceptuales a través de los descubrimien- tos científicos, teniendo en cuenta las características emocio- nales propias de cada paciente como un todo y los peligros a los que se puede estar expuestos frente a las medias verdades (AU)

Facing the diffusion of alarming and anti-scientific state- ments in the media, this editorial seeks the scientific bases to determine the clinical behavior. Thus, the text runs through the concept of focal infection from its origin and across its conceptual transformations through scientific discoveries, by considering the emotional characteristics of each patient as a whole and the dangers to which they may be exposed in the face of half-truths (AU)

Tratamento de lesão periradicular, de origem endodôntica, com auxílio de laserterapia: uma revisão sistemática da literatura e apresentação se caso clínico / Treatment of periradicular injury, of endodontic origin, with the aid of laser therapy: a systematic review of the literature and presentation if clinical case

É sabido que a cavidade oral é a porta de entrada para muitos microrganismos e que possui alguns gêneros de bactérias que quando se associam ou proliferam em excesso, com a falta de higienização correta, fatores ambientais e imunológicos podem causar danos em algumas partes dos dentes como no tecido pulpar e canais radiculares. Neste sentido, a endodontia tem sido capaz de tratar pessoas com problemas dentários em fases muito precoces como as medidas profiláticas até casos infeciosos que afetam a polpa dos dentes causando as lesões perirradiculares que são infecções causadas por microrganismos, Para tanto, é necessário que a odontologia ofereça transformações positivas por meio de técnicas que sejam mais previsíveis para os tratamentos. A literatura tem indicado o uso da laserterapia como técnica auxiliar para o tratamento endodôntico pelo seu potencial mínimo invasivo, preciso e eficaz em menor tempo de cura de patologias orais como as lesões perirradiculares. Este estudo pretendeu abordar a importância da laserterapia sobre as variáveis patológicas de pacientes com lesão perirradiculares. Para realiza-lo foi necessário buscar na literatura estudos que associem este tipo de tratamento e sua eficiência no tratamento desta patologia. Para realizar esta pesquisa foi necessário buscar dados na literatura que tratam sobre o tema para investigar o tempo indicado ao tratamento com a laserterapia bem como o estágio em que as lesões podem ser tratadas com auxílio deste método. Corroborando com o estudo apresentamos um caso clínico(AU)

It is known that the oral cavity is the gateway to many microorganisms and that it has some genera of bacteria that when they associate or proliferate in excess, with the lack of correct hygiene, environmental and immunological factors can cause damage in some parts of the teeth such as in pulp tissue and root canals. In this sense, endodontics has been able to treat people with dental problems at very early stages such as prophylactic measures to infectious cases that affect the pulp of teeth causing perirradicular lesions that are infections caused by microorganisms, therefore, it is necessary that dentistry offer positive transformations through techniques that are more predictable for treatments. The literature has indicated the use of laser therapy as an auxiliary technique for endodontic treatment for its minimal invasive, precise and effective potential in shorter time of cure of oral pathologies such as perirradicular lesions. This study aimed to address the importance of laser therapy on the pathological variables of patients with perirradicular lesions. To accomplish this, it was necessary to seek studies in the literature that associate this type of treatment and its efficiency in the treatment of this pathology. To carry out this research it was necessary to seek data in the literature that deal with the subject to investigate the time indicated for treatment with laser therapy as well as the stage at which lesions can be treated with the aid of this method. Corroborating the study, we present a clinical case(AU)

Reabilitação estética e funcional com resina composta após trauma dentário: relato de caso / Aesthetic and functional rehabilitation with composite resin after dental trauma: case report

As lesões dentárias traumáticas são um problema de saúde pública mundial, dentre as quais a fratura dentária é a de maior ocorrência, envolvendo principalmente os dentes anteriores. A abordagem de grandes fraturas anteriores é um desafio para cirurgiões dentistas de qualquer nível pois, além da função, afetam diretamente a estética do paciente, fazendo-se necessário um planejamento que envolva diferentes especialidades na odontologia. Objetivo: Relatar um caso clínico de reabilitação funcional e estética de fratura dentária nos incisivos centrais superiores envolvendo tratamento endodôntico, instalação de pino de fibra de vidro e restauração direta em resina composta. Relato de Caso: O paciente de 17 anos sofreu fratura nos incisivos centrais superiores causada por uma queda de bicicleta. Devido à busca tardia por tratamento o elemento 21 foi diagnosticado com necrose pulpar e, portanto, foi submetido à tratamento endodôntico pela Técnica Crown Down e reabilitação com pino de fibra de vidro Splendor-SAP. Posteriormente, os elementos 11 e 21 foram restaurados com facetas diretas em resina composta pela técnica incremental. Conclusão: A reabilitação com instalação de pino de fibra de vidro associada à técnica de estratificação incremental em resina composta se mostra como uma boa opção para reabilitação estética pois permite dar forma anatômica ao dente com riqueza de detalhes na estratificação da dentina e esmalte, além de máxima preservação da estrutura dental. Os resultados obtidos reforçam o sucesso estético e funcional com significativo impacto na qualidade de vida do paciente(AU)

Traumatic dental injuries are a worldwide public health problem, among which dental fractures are the most frequent, mainly involving the anterior teeth. The approach of large anterior fractures is a challenge for dental surgeons of any level because, in addition to function, they directly affect the patient's esthetics, requiring a plan that involves different specialties in dentistry. Objective: Report a clinical case of functional and aesthetic rehabilitation of dental fractures in maxillary central incisors involving endodontic treatment, installation of a fiberglass post and direct restoration in composite resin. Case Report: The 17-year-old patient suffered a fracture in the upper central incisors caused by a fall from a bicycle. Due to the late search for treatment, element 21 was diagnosed with pulp necrosis and, therefore, underwent endodontic treatment using the Crown Down Technique and rehabilitation with a Splendor-SAP fiberglass pin. Later, elements 11 and 21 were restored with direct veneers in composite resin using the incremental technique. Conclusion: Rehabilitation with the installation of a fiberglass post associated with the incremental layering technique in composite resin is a good option for aesthetic rehabilitation as it allows the anatomical shape of the tooth with rich details in the layering of dentin and enamel, in addition to maximum preservation of the tooth structure. The results obtained reinforce the aesthetic and functional success with a significant impact on the patient's quality of life(AU)

Morphological alterations of the apical foramen after foraminal enlargement: a systematic review of ex vivo studies / Alterações morfológicas do forame apical após ampliação foraminal: uma revisão sistemática de estudos ex vivo

Foraminal enlargement has been recommended to optimize the disinfection of infected root canals, although some authors still claim that the foramen should be kept in its original shape and position. This study aimed to evaluate morphological alterations of apical foramen after foraminal enlargement through a systematic review. An electronic search was conducted until April 2022. Ex vivo studies evaluating influence of foraminal enlargement in the morphologic changes of apical foramen were included. Studies without a control group or available full text were excluded. Foraminal deformation and area increase were considered as primary outcomes. Risk-of-bias assessment was performed according to a modified Joanna Briggs Institute's Checklist. From 702 studies retrieved, five were eligible. Most studies used single-rooted teeth, and rotary systems for instrumentation ranging from ­ 2 mm to + 1 mm to the apex. All studies found increased major foramen deformation after foraminal enlargement. Among four studies that evaluated foraminal area, all found increased area after foraminal enlargement. Insufficient data for touched/untouched walls by instruments and dentinal microcrack formation was observed. A low risk of bias was found. Foraminal enlargement during root canal preparation seems to increase deformation and major apical foramen area. Future investigations with standardized methodologies are encouraged (AU)

A ampliação foraminal tem sido recomendada para otimizar a desinfecção de canais radiculares infectados, embora alguns autores ainda afirmem que o forame deve ser mantido em sua forma e posição originais. Este estudo teve como objetivo avaliar alterações morfológicas do forame apical após ampliação foraminal por meio de uma revisão sistemática. Uma busca eletrônica foi realizada até abril de 2022. Foram incluídos estudos ex vivo que avaliaram a influência da ampliação foraminal nas alterações morfológicas do forame apical. Foram excluídos estudos sem grupo controle ou com texto completo indisponível. A deformação foraminal e o aumento da área foram considerados desfechos primários. A avaliação do risco de viés foi realizada de acordo com uma lista de verificação modificada do Instituto Joanna Briggs. Dos 702 registros recuperados, cinco foram elegíveis. A maioria dos estudos utilizou dentes unirradiculares e sistemas rotatórios para instrumentação, com comprimento de trabalho variando de ­ 2 mm a + 1 mm até o ápice. Todos os estudos encontraram aumento da deformação do forame maior após ampliação foraminal. Dos quatro estudos que avaliaram a área foraminal, todos encontraram aumento de área após alargamento foraminal. Foram observados dados insuficientes para paredes tocadas/intocadas pelos instrumentos e formação de microfissuras dentinárias. Um baixo risco de viés foi encontrado. A ampliação foraminal durante o preparo do canal radicular parece aumentar a deformação e a área do forame apical. Futuras investigações com metodologias padronizadas são incentivadas (AU)

Análise da prática endodôntica realizada em clínicas odontológicas em uma cidade do Sul do Brasil / Analysis of endodontic practices in dental clinics in a Southern Brazilian city

Introdução: O desenvolvimento de novas técnicas, tecnologias e materiais influenciam a prática clínica da endodontia e impactam consideravelmente a forma como o tratamento do canal radicular é realizado. Embora existam informações sobre as várias formas de tratamentos praticados por dentistas em outras cidades e/ou países, muito pouco se sabe sobre as endodontias realizadas em clínicas odontológicas na cidade de Porto Alegre/RS. Objetivo: Analisar a prática endodôntica realizada por dentistas nas clínicas odontológicas na cidade de Porto Alegre/RS, visando explorar as técnicas, materiais e equipamentos empregados durante o tratamento. Material e método: Foi aplicado um questionário online, por meio da Plataforma Google Forms, com vinte e seis questões abertas e fechadas aos dentistas que realizam tratamentos endodônticos em clínicas odontológicas. O questionário foi estruturado a fim de analisar os materiais, técnicas e equipamentos que estão presentes nos tratamentos endodônticos realizados pelos dentistas nas clínicas odontológicas aqui avaliadas. Os dados coletados nos questionários foram transferidos para uma planilha Excel®. A análise dos dados foi feita de duas formas: frequência absoluta e relativa para as questões fechadas, e descritiva para as questões abertas. Resultado: 15,57% das clínicas odontológicas registradas no CRO/RS participaram da presente pesquisa. Foi possível verificar que a maioria dos materiais e técnicas aplicadas no tratamento endodôntico são os mesmos recomendados pela literatura científica. Conclusão: Os protocolos clínicos em endodontia seguidos pelos participantes do presente estudo apresentam embasamento clínico e científico na literatura.

Introduction: The evolution of new techniques, technologies, and materials significantly influences the clinical practice of endodontics, thus profoundly impacting the approach to root canal treatments. While information about various treatment methods practiced by dentists in other cities or countries is available, there is a notable gap in our understanding of endodontic practices in the Porto Alegre city. Objective: The objective of this study is to analyze the endodontic practices employed by dentists in dental clinics located in Porto Alegre city. We aimed to explore the techniques, materials, and equipment routinely utilized during endodontic treatments. Material and method: An online questionnaire using the Google Forms platform was administered, consisting of twenty-six open and closed questions to dentists performing endodontic treatments in dental clinics. The questionnaire was structured to assess the materials, techniques, and equipment employed during endodontic procedures. Data collected from the questionnaires were recorded in an Excel® spreadsheet. Data analysis encompassed both absolute and relative frequency for closed questions and also a descriptive approach for open-ended questions. Results: Participation was obtained from 15.57% of dental clinics registered with CRO/RS. The findings indicated that the majority of materials and techniques applied in endodontic treatment could be aligned with recommendations found in the scientific literature. Conclusion: The clinical protocols observed by the participants in endodontic practice demonstrated a solid foundation in both clinical and scientific literature.

Endodontic file separation and its management among dentists in Punjab, Pakistan: a cross-sectional study

The study aimed to find the incidence and awareness of endodontic instrument separation and its management among dental house officers, postgraduate trainees, demonstrators, consultants, and general dentists. Methods: This online questionnaire-based cross-sectional study was conducted with the approval of the IRB in private and public dental hospitals and dental clinics in Punjab. The authors developed the survey tool, which comprises 24 closed-ended items regarding demographics, the incidence of file separation, and awareness about its management. The data were analyzed using IBM SPSS version 24. The Chi-Square Test was used to compare percentages of categorical variables. Results: Postgraduate trainees experienced the most instrument separations (43.6%), made the most retrieval attempts (49.2%), and experienced the most secondary errors during retrieval (52.1%) (p<0.001). Around four out of ten respondents always informed the patients (39.6%) and department (41.6%) about errors. Manual files (69.8%), stainless steel files (75.8%), and short files (60.4%) were more frequently separated, and the most frequent cause was older fatigue files (57.7%). Manual files were more frequently broken in public dental institutes (p=0.003). Two-thirds of the file separations (72.5%) occurred during cleaning and shaping in the apical third of molars (65.1%), especially in mesiolingual canal (56.4%). Bypass attempt was the most common in symptomatic teeth (47.7%). Conclusions: Preventive approaches such as limiting file reuse and constructing a glide path can reduce the occurrence of file separation. Operators should be familiar with the number of uses of the instrument before fatigue and should be trained through workshops and refresher courses

Influence of different working lengths on the shaping ability of Reciproc Blue in the apical third and apical foramen: a micro-computed tomographic study

Aim: This study aimed to assess the shaping ability of Reciproc Blue in the apical third and apical foramen of moderately curved canals at different working lengths (WLs), by micro-computed tomography. Methods: Thirty-six mesial roots (mesiobuccal and mesiolingual canals) were included, each with 2 separate root canals and independent apical foramina, according to type IV of Vertucci's classification of first and second mandibular molars. The canals were instrumented at three different WLs: G-1, 1mm short of the major apical foramen; G0, at the major apical foramen; G+1, 1mm beyond the major apical foramen. The groups were assessed for changes in root canal volume and untouched wall area in the apical third. Groups G0 and G+1 were also compared for percentage of untouched walls at the apical foramen. One-way ANOVA (post hoc Tukey test) and Student's t-test adopted a 5% level of significance. Results: Root canal volumes (mm3) in the apical third were 22.86±10.46, 44.48±24.91, and 55.71±21.32 in G-1, G0 and G+1, respectively. G-1 volume following instrumentation increased significantly less than that of G0 or G+1 (P>.05); G0 did not differ from G+1. The percentage of untouched wall area in the apical third did not differ among the three groups (P>.05). G0 and G+1 did not differ regarding untouched walls in the major apical foramem walls. Conclusion: Extending the WL from 1mm short of the apical foramen to a point at and beyond the WL increases the apical third volume without increasing the prepared area. Untouched surface areas of the apical foramen were not modified by instrumentation at or beyond the foramen

Effect of Photobiomodulation on Pain Following Single Visit Non-surgical Root Canal Treatment of Molar Teeth with Symptomatic Irreversible Pulpitis

ABSTRACT Objective: To assess the effect of Photobiomodulation (PBM) on post-endodontic pain of mandibular molar teeth with symptomatic irreversible pulpitis. Material and Methods: In this clinical trial, mandibular molars with symptomatic irreversible pulpitis underwent primary endodontic treatment in 90 systemically healthy patients. After root canal treatment, the patients were randomly divided into two groups of PBM with diode laser at 940 nm wavelength and 200 mW output power and placebo (mock PBM therapy). Level of pain was recorded at 6, 12, 24, 48, and 72 hours postoperatively using a visual analog scale (VAS). The data were analyzed using the Mann-Whitney test and the Kruskal-Wallis test. Results: The results showed that post-endodontic pain at all time points was significantly lower in the PBM group compared with the placebo group. The pain score in the PBM group was significantly lower than the placebo group (p<0.05). However, this difference was not significant at 48 h (p=0.18) and 72 h (p=0.12) postoperatively. Also, the results showed that the mean pain score in males and females in the PBM group was significantly lower than in males and females in the placebo group. Conclusion: Photobiomodulation can effectively decrease post-endodontic pain in mandibular molar teeth with symptomatic irreversible pulpitis.

Evaluation of Dental Interns' Perception and Self-Confidence Levels Regarding Endodontic Treatment"- A Questionnaire Study

ABSTRACT Objective: To evaluate the perception and self-confidence of Dental interns regarding endodontic treatment performed on patients. Material and Methods: A total of 111 dental interns from 5 different educational institutes of a state in South India participated in a questionnaire-based survey. The questionnaire consisted of 12 questions related to root canal procedures performed on patients. Analysis was done using SPSS version 17.0. Results: Sixty-five interns (59%) performed less than 10 root canal treatments on patients during the course of the internship. Twenty-eight interns (25% of the intern population) took up more than 10 root canal treatment cases, whereas only 18 interns (16%) did not perform the treatment on patients and answered the questionnaire based on their experience with extracted teeth model work. Only five interns out of 111 were 'Very confident' and 22 were 'Confident' in performing the root canal treatment. Conclusion: The present study indicates that the self-perceived confidence level among dental interns can affect their clinical performance. It also recommends additional hands-on workshops, problem-based learning and clinical guidance for the dental interns to become more confident with the root canal procedure.

Revascularização pulpar, uma nova opção na terapêutica endodôntica: revisão da literatura e caso clínico em paciente adulto / Pulpar revascularization, a new option in endodontc therapy: literature review and case report in adult patient

Introdução: A revascularização pulpar é uma terapêutica que visa regenerar parte do complexo dentino pulpar, proporcionando a continuidade do desenvolvimento radicular, sanando a fragilidade e propensão a fratura que a apicificação apresentava. É um tratamento direcionado a dentes diagnosticados com rizogênese incompleta. Entretanto, a possibilidade de realização da técnica em dentes maduros tem sido alvo de pesquisas e estudo. Objetivo: O objetivo deste estudo, é apresentar através da revisão de literatura e caso clínico, os benefícios dos procedimentos endodônticos regenerativos (REPs), em dentes jovens e maduros, em relação à apicificação. Metodologia: O estudo é uma revisão de literatura, desenvolvida através de pesquisa exploratória e realizada uma abordagem qualitativa. Para a coleta de dados, foi aplicada a técnica de análise documental e revisão bibliográfica consultando PUBMED, Scielo, Google Acadêmico e monografias acadêmicas. O caso clínico foi realizado de acordo com o protocolo atualizado pela AAE em 2016. Discussão: A revascularização pulpar tem mostrado ser um tratamento promissor na endodontia, é preconizada a desinfecção e medicação intracanal, já que não pode haver instrumentação mecânica. Os agentes irrigadores devem ser bactericidas, bacteriostáticos e devem ter baixo teor de toxicidade, já a medicação intracanal deve ter papel inibidor em bactérias gram positivas e gram negativas. Conclusão: A apicificação mesmo com o uso de MTA, que não exige trocas excessivas de medicações, não sana as necessidades que um dente com rizogênese incompleta requer. Sendo assim, a revascularização foi eleita o tratamento de melhor prognóstico para dentes jovens e necrosados. O caso clínico demonstrou qualidade moderada, no tratamento regenerativo em um dente maduro com reabsorção externa, abrindo novas perspectivas para os (REPs)(AU)

Introduction: Pulp revascularization is a therapy that aims to regenerate part of the pulp dentin complex, providing continuity of root development, remedying the fragility and propensity to fracture that apexification presented. It is a treatment aimed at teeth diagnosed with incomplete rhizogenesis. However, the possibility of performing the technique on mature teeth has been the subject of research and study. Objective: The aim of this study is to present, through literature review and clinical case, the benefits of regenerative endodontic procedures (REPs), in young and mature teeth, in relation to apexification. Methodology: The study is a literature review, developed through exploratory research and carried out a qualitative approach. For data collection, the technique of document analysis and bibliographic review was applied, consulting PUBMED, Scielo, Academic Google and academic monographs. The clinical case was performed according to the protocol updated by the SEA in 2016. Discussion: Pulp revascularization has shown to be a promising treatment in endodontics, intracanal disinfection and medication is recommended, as there can be no mechanical instrumentation. Irrigating agents must be bactericidal, bacteriostatic and must have a low level of toxicity, whereas intracanal medication must have an inhibiting role in gram positive and gram negative bacteria. Conclusion: Apexification, even with the use of MTA, which does not require excessive medication changes, does not meet the needs that a tooth with incomplete rhizogenesis requires. Therefore, revascularization was chosen as the treatment with the best prognosis for young and necrotic teeth. The clinical case demonstrated moderate quality in regenerative treatment in a mature tooth with external resorption, opening new perspectives for (REPs)(AU)

Eficácia e importância da patência foraminal em casos de dentes despolpados e em dentes com vitalidade pulpar / Efficacy and importance of apical foramen patency in procedures involving pulpless teeth and teeth with vital pulps

A ciência endodôntica possui um vasto conhecimento e com esse conhecimento os seus inúmeros questionamentos. Algumas teorias e conceitos mudam constantemente e trazem à tona contradições e divergências clínicas no âmbito biológico e prático. A patência foraminal é uma prática que permite que um instrumento de pequeno calibre ultrapasse o forame apical, com o intuito de limpar passivamente e prevenir o acúmulo de detritos e inibir a proliferação de microorganismos que podem causar infecções pós tratamento endodôntico. Essa prática gera discussão interna entre especialistas da área, mas as vantagens da técnica são inúmeras, principalmente no que diz respeito aos casos de polpa necrosada. Casos como esse não são solucionados com sucesso sem a utilização da patência apical. Por outro lado, existem contradições em relação aos casos em que a polpa está viva. Esse trabalho tem como objetivo analisar as vantagens e desvantagens da patência apical, bem como, se os benefícios excedem os possíveis danos que ela pode trazer(AU)

Endodontic science has vast knowledge and with this knowledge its countless questions. Some theories and concepts are constantly changing and bring to light clinical contradictions and divergences in the biological and practical scope. Foraminal patency is a practice that allows a small-caliber instrument to go beyond the apical foramen, in order to passively clean and prevent the accumulation of debris in the region and inhibit the proliferation of microorganisms that can cause infections after endodontic treatment. This practice generates internal discussion among specialists in the field, but the advantages of the technique are numerous, especially with regard to cases of necrotic pulp. Cases like this are not successfully resolved without the use of apical patency. On the other hand, there are contradictions regarding the cases where the pulp is alive. This work aims to analyze the advantages and disadvantages of apical patency, as well as whether the benefits exceed the harm it can bring(AU)

Retratamientos endodónticos: una realidad que preocupa / Endodontic retreatment: a worrying reality

Las evaluaciones radiográficas de tratamientos endodón- ticos realizadas por graduados muestran un alto porcentaje de procedimientos incorrectos. Esta circunstancia lleva a la rea- lización de un elevado número de retratamientos ortógrados y retrógrados, con los inconvenientes y desventajas que conlle- va recurrir a una reintervención endodóntica. Es responsabili- dad de los profesionales, docentes y autoridades universitarias y gubernamentales revertir esta situación que afecta a la salud bucal de la sociedad. En el presente editorial se proponen di- ferentes alternativas para intentar modificar este preocupante panorama (AU)

Radiographic evaluations of endodontic treatments per- formed by graduates show a high percentage of incorrect procedures. This circumstance leads to the performance of a high number of orthograde and retrograde retreatments, with the inconveniences and disadvantages that entails resorting to an endodontic reintervention. It is the responsibility of pro- fessionals, teachers, university and government authorities to reverse this situation that affects the oral health of society. In this editorial, different alternatives are proposed to try to modify this worrying outlook (AU)

Endodoncia guiada estática, una opción para obliteración del canal pulpar: serie de casos / Static guided endodontics, an option for pulpal canal obliteration: a case series

En la práctica endodóntica, la etapa del acceso al canal radicular es fundamental para el éxito de las siguientes etapas del tratamiento. En casos de canales pulpares obliterados o calcificados (PCO), lograr encontrar la entrada a estos es un reto en la endodoncia convencional dado el alto riesgo de sufrir un accidente intraoperatorio. Actualmente, existen los tratamientos de endodoncia guiada o accesos guiados digitalmente, una alternativa innovadora y con múltiples beneficios para el abordaje de este tipo de dientes. El objetivo de este reporte de casos fue describir el protocolo de cuatro casos de accesos guiados estáticos para endodoncia en canales obliterados, indicando las ventajas y consideraciones del tratamiento. Se presenta un reporte de casos de cuatro pacientes atendidos entre julio 2021 y junio 2022, que requerían tratamientos endodónticos en dientes anteriores con canales pulpares obliterados. Para la realización de estos procedimientos se requirió una Tomografía Computarizada de Haz Cónico (CBCT) y el escaneo intraoral de la zona a tratar, para poder a través de la ayuda de un software, planificar virtualmente la dirección y longitud de acceso al conducto radicular. Posteriormente, se realizó la impresión en 3D de la guía estática, la cual dirige la entrada de la fresa que se utiliza para encontrar el acceso al canal radicular. En los cuatro casos clínicos en que se realizó la planificación virtual e impresión de la guía de acceso, fue posible encontrar el canal radicular en una sesión, pudiendo realizar el tratamiento endodóntico de manera exitosa y conservadora. En conclusión, la endodoncia guiada estática permite realizar los tratamientos endodónticos en PCO de manera segura, a pesar de la alta complejidad que presentaban.

SUMMARY: In endodontics, the access to the root canal is essential for the treatment success. Pulp canal obliteration (PCO) is a challenge for conventional endodontic treatments with a high risk of fracture of endodontic instruments.Currently, guided endodontic treatments, or digitally guided accesses, are novel alternatives with multiple benefits for the treatment of PCO. The objective of this case report is to describe the protocol for static guided access in PCO, indicating the advantages and considerations of the treatment. A case report of four patients treated between July 2021 and June 2022 is presented. These patients required endodontic treatments in anterior teeth with PCO. In order to virtually plan the direction and length of the access, using a software, we used a cone Beam Computed Tomography (CBCT) and an intraoral scan. Then, a 3D printing of the static guide was made, which directs the entry of the drill. With this method, it was possible to find the root canal in one session and perform the endodontic treatment successfully and conservatively. In conclusion, although static guided endodontics requires planification, it allows a safe endodontic treatment in patients with PCO.

Lesiones perirradiculares asociadas a primeros molares superiores tratados endodónticamente: estudio a través de tomografías computadas / Periradicular lesions associated with endodontically treated maxillary first molars: study through computed tomography

Objetivos: Estudiar con tomografías computadas de haz cónico (CBCT) las lesiones perirradiculares de primeros molares superiores tratados endodónticamente; evaluar la lo- calización y, en los que tenían lesión en la raíz mesiovestibu- lar (MV), evaluar la frecuencia del conducto MV2. Materiales y métodos: A partir de una muestra de 179 tomografías, que incluían primeros molares superiores, se seleccionaron y analizaron aquellas en las cuales estos ha- bían recibido un tratamiento endodóntico previo, presentaban lesiones perirradiculares y conservaban una restauración co- ronaria. Las variables analizadas fueron: la localización de áreas radiolúcidas compatibles con lesiones perirradiculares de origen endodóntico y la correlación entre diferentes loca- lizaciones y la calidad del tratamiento realizado (adecuado, defectuoso o sin tratamiento). Los datos fueron analizados mediante la prueba de chi-cuadrado y la prueba de Spearman. Resultados: De las 179 CBCT que incluían primeros molares superiores, 90 reunían las condiciones requeridas. La frecuencia de las lesiones perirradiculares fue significativa- mente mayor en la raíz MV al compararla con las raíces disto- vestibular y palatina (p<0,05). El conducto MV1 presentó un tratamiento adecuado en todos los casos. El conducto MV2 recibió un tratamiento adecuado en 4 casos (4,44%), defec- tuoso en 4 casos (4,44%) y no tratado en 82 casos (91,1%); con una diferencia estadísticamente significativa (p<0,05). Conclusiones: En la muestra analizada, la localización de lesiones perirradiculares postratamiento endodóntico en primeros molares superiores se encontró con mayor frecuencia asociada a la raíz mesiovestibular, donde en la mayoría de los casos el con- ducto MB2 no fue tratado o presentó un tratamiento defectuoso (AU)

Aim: To study with cone-beam computed tomography (CBCT) the periradicular lesions of maxillary first molars with endodontical treatment; to evaluate its localization and, in those with a mesiobuccal root (MB) injury, assess the fre- quency of the MB2 root canal. Materials and methods: From a sample of 179 tomog- raphies (CBCT) that included maxillary first molars, those in which they had received previous endodontic treatment, pre- sented periradicular lesions and had a coronary restoration were selected and analyzed. The analyzed variables were: localization of radiolucent areas compatible with periradic- ular lesions of endodontic origin and the correlation between different localizations and quality of the performed treatment (adequate, defective, or untreated). Data were analyzed by the chi-square test and the Spearman test. Results: Of the 179 CBCT that included maxillary first molars, 90 met the required conditions. The frequency of periradicular lesions was significantly higher in the MB root when compared with distobuccal and palatal roots (P<0,05). The MB1 canal presented an adequate treatment in all cas- es. The MB2 canal received adequate treatment in 4 cases (4.44%), a defective one in 4 cases (4.44%) and was untreated in 82 cases (91.1%). The differences among these frequencies were statistically significant (P<0.05). Conclusions: In the analyzed sample, the localization of periradicular lesions after endodontic treatment in maxillary first molars was associated more frequently with the mesio- buccal root in which in the majority of cases the MB2 canal was untreated or presented a defective treatment

Diagnóstico clínico, radiográfico e histológico de un caso de fibrosis periapical posendodóntica / Clinical, radiographic, and histologic diagnosis of a postendodontic periapical fibrosis case

Objetivo: La fibrosis periapical posendodóntica es un proceso reparativo asintomático, radiolúcido y no progresivo que se interpreta con frecuencia como una lesión patológica persistente. El diagnóstico de esta entidad suele ser dudoso y sólo puede definirse mediante la correlación de las obser- vaciones clínicas, radiográficas e histológicas. El objetivo de este informe es describir el caso de un paciente que presenta un área radiolúcida periapical persistente y asintomática en un incisivo lateral superior. Caso clínico: Luego de cuatro años y dos meses de ha- ber recibido un tratamiento endodóntico el paciente concurre a la consulta para un examen de rutina. El examen radiográfico del diente revela un área radiolúcida persistente y bien defini- da. A causa de una fractura radicular irreparable, se indicó la extracción de la pieza dentaria. Esto permitió realizar el estu- dio histológico del tejido blando que permanecía adherido en el ápice de la raíz, lo que confirmó y completó el diagnóstico de fibrosis periapical posendodóntica.(AU)

Aim: The postendodontic periapical fibrosis is an asymp- tomatic radiolucent and non-progressive healing process that is often interpreted as a persistent pathological lesion. The diagnosis of this entity is usually uncertain, and it is only de- fined by the correlation of clinical, radiographic and histo- logical observations.The aim of this report is to describe the case of a patient with a long-term persisting asymptomatic and radiolucent area in a upper lateral incisor. Clinical case: Four years and two months after receiv- ing an endodontic treatment the patient comes to our office for a routine control. Radiographic examination revealed the presence of a persistent well defined radiolucent area. Sur- gical tooth extraction was required due to the presence of a complicated root fracture.This allowed to perform a histolog- ical study of the soft tissue attached to the apex of the ex- tracted root, which confirmed and completed the diagnosis of postendodontic periapical fibrosis (AU)

Reabsorción dentinaria interna coronaria: informe de un caso clínico / Coronary internal dentine resorption: report of a clinical case

Objetivo: La reabsorción dentinaria interna es un pro- ceso causado por la actividad odontoclástica asociada princi- palmente a la inflamación pulpar crónica y/o traumatismos, y se caracteriza por la pérdida progresiva de tejido dentinario y la posible invasión al cemento. El presente informe describe el diagnóstico y tratamiento de un molar inferior que presentó un cuadro sintomático de reabsorción dentinaria interna. Caso clínico: Un paciente de 38 años fue derivado a la consulta por presentar una zona de reabsorción interna en un segundo molar inferior. Durante el examen clínico y ra- diográfico se tomó una radiografía preoperatoria periapical con radiovisiógrafo en la que se observó la presencia de un área compatible con el diagnóstico de reabsorción dentinaria interna, el que fue posteriormente confirmado por medio de una tomografía computada de haz cónico. La imagen de la lesión se presentó como una zona radiolúcida deformante de bordes nítidos, localizada a nivel de la cámara pulpar. El tra- tamiento consistió en la extirpación de la pulpa coronaria y de la instrumentación, desinfección y obturación de los conduc- tos radiculares y la cavidad de acceso. En el control clínico y radiográfico realizado luego de 3 años se observó que el paciente estaba asintomático y las estructuras perirradiculares se encontraban dentro de los límites normales. La observación histológica del material removido de la cámara pulpar reveló la presencia de un tejido granulomatoso con numerosos vasos sanguíneos y escasos focos micro hemorrágicos. Hasta el momento, el tratamiento endodóntico es el pro- cedimiento indicado para el tratamiento de la reabsorción dentinaria interna. Se destaca la importancia de la tomografía computada de haz cónico para el diagnóstico y tratamiento temprano de las reabsorciones dentinarias internas a efectos de contar con un pronóstico favorable (AU)

Aim: Internal dentine resorption is aprocess caused by odontoclastic activity, mainly associated with chronic pulpal inflammation and/or trauma, and it'scharacterized by a pro- gressive loss of dentine tissue and the possible invasion of the cementum. This report describes the diagnosis and treatment of a lower molar that presented a symptomatic case of inter- nal dentine resorption. Clinical case: A 38-years old patient was referred to the office because of presenting an area of internal resorption in a lower second molar. During clinical and radiographic exam- ination, a periapical preoperative radiograph with radiovisio- graph was taken, in which the presence of an area compatible with the diagnosis of internal dentine resorption was observed, which was later confirmed by a cone-beam computed tomog- raphy.The image of the lesion was presented as a deforming radiolucent area with sharp edges, located at pulp chamber level. Treatment consisted of the removal of the coronary pulp and the instrumentation, disinfection and filling of the root ca- nals and the access cavity. In the clinical and radiographic control carried out 3 years after procedure, it was observed that the patient was asymptomatic and the periradicular struc- tures were within normal limits. The histological observation of the removed material from the pulp chamber revealed the presence of a granulomatous tissue with numerous blood ves- sels and scarce micro hemorrhagic focus. Until now, the endodontic treatment is the indicated pro- cedure to treat internal dentine resorption. It is necessary to highlight the importance of the cone-beam computerized to- mography for the early diagnosis and treatment of internal dentine resorptions in order to have a favorable outlook (AU)

Abordagem multidisciplinar no tratamento de incisivo lateral com fratura oblíqua e lesão periapical: relato de caso clínico / Multidisciplinary approach in the treatment of lateral incisor with oblique fracture and periapical injury: clinical case report

Casos de fraturas dentárias oblíquas muitas vezes possuem um prognóstico desfavorável, geralmente com indicação da extração do elemento dental. O presente artigo visou relatar o tratamento do caso clínico de um paciente do sexo masculino, 12 anos, que compareceu à Unidade de Saúde Bucal do Hospital Universitário de Brasília com encaminhamento de extração do dente 12, apresentando fratura oblíqua que se estendia subgengivalmente na face vestibular. O trauma havia ocorrido há três anos e o paciente havia sido submetido a diversas intervenções endodônticas, apresentando no momento da consulta inicial por nossa equipe uma lesão periapical extensa. Após a realização da anamnese, exame clínico e radiográfico, foi adotada uma abordagem multidisciplinar conservadora com a manutenção do dente e a realização da enucleação da lesão periapical por meio de intervenção cirúrgica e posterior reabilitação. Em uma mesma sessão, foi realizada a obturação do conduto com cone de guta percha e cimento sealer 26 e a cirurgia parendodôntica juntamente com a apicoplastia. Uma semana após a intervenção cirúrgica foi realizada restauração classe IV com resina composta baseada no enceramento dos modelos de diagnóstico montados em articulador. Com base em uma avaliação criteriosa e multidisciplinar, foi possível adotar uma abordagem conservadora no caso em questão, com a manutenção e reabilitação de um dente permanente em um paciente jovem, evitando a indicação de exodontia(AU)

Cases of oblique dental fractures often have an unfavorable prognosis, usually with the indication of extraction of the dental element. The present article aimed to report the treatment of the clinical case of a 12-year-old male patient, who attended the Oral Health Unit of the Hospital Universitário de Brasília with a referral for extraction of tooth 7, presenting an oblique fracture that extended subgingivally on the labial surface. The trauma had occurred three years ago and the patient had undergone several endodontic interventions, presenting an extensive periapical lesion at the time of the initial consultation by our team. After anamnesis, clinical and radiographic examination, a conservative multidisciplinar approach was adopted with the maintenance of the tooth and the enucleation of the periapical lesion through surgical intervention and subsequente rehabilitation. In the same session, the conduit was filled with gutta-percha cone and sealer cement 26 and parendodontic surgery was performed together with apicoplasty. One week after the surgical intervention, class IV restoration was performed with composite resin based on the waxing of the diagnostic models mounted on an articulator. Based on a careful and multidisciplinary evaluation, it was possible to adopt a conservative approach in the case in question, with the maintenance and rehabilitation of a permanent tooth in a young patient, avoiding the indication of extraction(AU)

Odontometria eletrônica em dentes decíduos: revisão de literatura e relato de caso / Eletronic working length determination in primary tooth: review of literature and case report

Objetivo: Realizar uma revisão dos principais artigos encontra-dos na literatura acerca do uso dos Localizadores Eletrônicos Foraminais (LEF) em dentes decíduos e representar através de um relato de caso clínico, a importância do uso destes dispositivos durante o tratamento endodôntico em dentes decíduos. Revisão da literatura: Foi realizada uma busca nas principais bases de dados, e selecionados 13 artigos consi-derados mais relevantes. Todos os estudos mostraram que a determinação da odontometria em dentes decíduos utilizando o LEF é bastante segura e com boa acurácia, podendo ser utilizado o localizador para esta finalidade. Relato do caso:No caso clínico apresentado, o uso do LEF foi fundamental para a obtenção de uma odontometria precisa, além da diminuição do tempo de cadeira e identificar reabsorções não detectáveis radiograficamente. O caso foi conduzido em duas sessões, onde na primeira foi realizada a cirurgia de acesso, odontometria eletrônica, preparo manual dos canais e utilização de medicação intracanal de hidróxido de cálcio. Na segunda sessão foi removida a medicação intracanal e os canais foram obturados utilizando pasta iodoformada. Discussão: O uso do LEF no tratamento endodôntico de dentes decíduos tem se mostrado uma ferramenta segura e eficiente, tendo melhor performance na determinação do comprimento de trabalho quando comparado a outros métodos. Conclusão: De acordo com os estudos apresen-tados na revisão de literatura e o caso clínico apresentado, pudemos constatar que o uso do LEF contribui positivamente ao tratamento, principalmente quanto ao ganho de tempo e determinação confiável e segura do comprimento de trabalho.

Aim: To review the main articles found in the literature on the use of Electronic Apex Locators (EAL) in deci-duous teeth, and to represent, through a clinical case report, the importance of using these devices during endodontic treatment in deciduous teeth. Review of literature: A search was performed in the main data-bases, and 13 articles considered most relevant were selected. All studies showed that the determination of odontometry in deciduous teeth using LEF is quite safe and with good accuracy, and the localizer can be used for this purpose. Case report: In the clinical case presented, the use of EAL was fundamental to obtain an accurate odontometry, besides the reduction of chair time and exposure to ionizing radiation. The case was conducted in two sessions, where in the first one the access surgery was performed, electronic odontometry, manual preparation of the canals and use of intracanal medication of calcium hydroxide. In the second session the intracanal medication was removed and the canals were filled using iodoform paste. Discussion: The use of LEF in the endodontic treatment of primary teeth has been shown to be a safe and efficient tool, with better permormance in determining the working length when compared to other methods. Conclusion: According to the studies presented in the literature review and the clinical case presented, we could verify that the use of LEF contributes positively to treatment, especially in terms of time gain and acurate determination of working length.

Incidencia de fracturas dentales verticales reportadas en la Ciudad de Chihuahua y su relación con la evolución de la pandemia por COVID-19 / Incidence of vertical dental fractures reported in Chihuahua City and its relationship with the evolution of the COVID-19 pandemic

Durante la pandemia por COVID-19, la presencia de un incremento de fracturas y/o fisuras verticales ha sido reportada por Cirujanos Dentistas en diferentes países y foros, Objetivo: Determinar por medio de un análisis si existe una relación con este aumento de casos y la evolu- ción de la pandemia. Material y método: Se recopilaron los casos de fracturas verticales no restaurables durante el periodo de mayor índice de casos de contagio y defunciones por COVID-19 en la Ciudad de Chihuahua, México. Resultados: Durante el primer pico de casos y defunciones causadas por la pandemia, se incrementó el número de casos de fracturas verticales no tratables. Conclusiones: Existió una relación entre la evolución de la pandemia con la aparición de casos de fracturas dentales verticales no restaurables (AU)

During the COVID-19 pandemic, the presence of an increase in fractures and/or vertical fissures has been reported by Dental Surgeons in different countries and forums. Objective: To determine through an analysis, if there is a relationship with this increase in cases and the evolution of the pandemic. Material and methods: The cases of non-restorable vertical fractures were collected during the period of highest rate of cases of contagion and deaths due to COVID-19 in the City of Chihuahua, Mexico. Results: during the 1st peak of cases and deaths caused by the pandemic, the number of cases of untreatable vertical fractures increased. Conclusions: There was a relationship between the evolution of the pandemic and the appearance of cases of non-restorable vertical dental fractures (AU)