RESUMO
INTRODUCTION: The elimination of biofilms during root canal therapy continues to pose a challenge due to complex anatomies and uninstrumented portions of the root canal system. The incorporation of nanoparticles in endodontic sealers is an area of interest for potentially enhancing antimicrobial activity and improving treatment outcomes. This systematic review evaluated the antimicrobial effects of various nanoparticles in endodontic sealers. METHODS: Comprehensive literature review was conducted using the electronic Embase, Web of Science, and PubMed databases followed by citation searching for articles eligible per the inclusion criteria. RESULTS: A total of 1845 citations were screened, of which 13 articles met the inclusion criteria and were included in this review. All included articles were in vitro studies with low-to-moderate quality assessment scores. The incorporation of select nanoparticles was associated with significant enhancement of antibacterial effects in planktonic and/or biofilm forms, whereas other nanoparticles were not. CONCLUSIONS: The incorporation of certain types and concentrations of nanoparticles into endodontic sealers displayed antimicrobial effects in vitro. The need for well-designed clinical studies translating in vitro findings into clinical practice is warranted. The incorporation of nanoparticles may enhance the antimicrobial properties of endodontic sealers and may improve treatment outcomes.
Assuntos
Anti-Infecciosos , Nanopartículas , Materiais Restauradores do Canal Radicular , Materiais Restauradores do Canal Radicular/farmacologia , Anti-Infecciosos/farmacologia , Antibacterianos/farmacologia , Resinas EpóxiRESUMO
INTRODUCTION: The diagnosis and treatment planning of cracked teeth depend on the understanding of how cracks affect the surrounding tissues. This study evaluated the dentin and pulp conditions in teeth affected by cracks and attrition. METHODS: Specimens under investigation included 12 cracked posterior teeth and 8 teeth with severe attrition. These teeth were obtained consecutively in a private practice and were extracted for reasons not related to this study. Teeth were processed for histopathologic and histobacteriologic analyses. RESULTS: Cracks were histologically detected in all specimens, including the teeth with severe attrition. The cracks in all teeth were colonized by bacterial biofilms. One tooth showed several craze lines in the enamel, one of which reached dentin to a shallow depth. In some teeth, the crack ended in the dentin. Dentinal tubules were invaded by bacteria, especially when the crack extended perpendicularly into the dentin. Severe accumulations of inflammatory cells were present in the pulp zone subjacent to tubules involved with the crack. In many cases, the crack extended to the pulp, leading to reactions with intensities ranging from acute inflammation to total pulpal necrosis. Symptoms occurred in most cases in which the pulp was affected. In some cases, polymorphonuclear neutrophils were seen migrating from the pulp into the crack space and facing the bacterial biofilm located therein. Severe pulp reactions were also observed when the crack extended to the pulp chamber floor. CONCLUSIONS: Cracks are always colonized with bacterial biofilms. The pulp tissue response varies according to the location, direction, and extent of the crack.
Assuntos
Síndrome de Dente Quebrado/microbiologia , Síndrome de Dente Quebrado/patologia , Adulto , Idoso , Prótese Dentária , Feminino , Humanos , Masculino , Mandíbula/patologia , Pessoa de Meia-Idade , Dente Molar/patologia , Dor/etiologia , Adulto JovemRESUMO
INTRODUCTION: C-shaped canals are anatomic features that present the clinician with both diagnostic and operational challenges. The aim of this study was to compare the efficacy of the Self-Adjusting File (SAF; ReDent, Ra'anana, Israel) in shaping C-shaped canals with that of the rotary ProTaper file system (Dentsply-Maillefer, Ballaigues, Switzerland). METHODS: Sixteen mandibular second molars and 4 maxillary second molars with C-shaped canals were obtained, originating from native Chinese population. They were divided into 2 equal groups of 10 teeth each, based on similar canal morphology as presented in preliminary micro-computed tomography-derived images. One group was shaped using the SAF, whereas the other was shaped using the ProTaper file system. Reconstructed micro-computed tomographic images before and after treatment were superimposed over each other, and the percentage of the canal wall unaffected by the procedure was calculated. Comparison of the 2 groups for this parameter was performed using the Student t test. RESULTS: When treated with the SAF, 41% ± 14% of the canal walls remained unaffected by the procedure, whereas 66% ± 6% of the wall area was unaffected when using ProTaper, which was significantly higher than that of the SAF-treated group (P < .001). CONCLUSIONS: The SAF was more effective than the ProTaper file system in shaping the walls of C-shaped root canals.
Assuntos
Cavidade Pulpar/patologia , Preparo de Canal Radicular/instrumentação , Quelantes/uso terapêutico , Ácido Edético/uso terapêutico , Desenho de Equipamento , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Dente Molar/patologia , Irrigantes do Canal Radicular/uso terapêutico , Rotação , Hipoclorito de Sódio/uso terapêutico , Vibração , Microtomografia por Raio-X/métodosRESUMO
There are several variables which must be considered before initiating endodontic treatment, including assessing the feasibility of endodontic treatment, addressing past, present and future periodontal concerns, determining the restorability of the tooth, and detecting root fractures. If these parameters are not carefully evaluated, then short- or long-term endodontic success may be questionable. Endodontic prognosis assessment is often subjective, based on objective finding, but ultimately determined by the experience of the operator. Although dentists must rely upon evidence-based research to determine the best modality of treatment, good clinical judgment and experience may override the most objective findings. This article discusses the objective and subjective criteria which must be evaluated for determining the potential prognosis of endodontic treatment.
Assuntos
Tratamento do Canal Radicular/métodos , Perda do Osso Alveolar/prevenção & controle , Apicectomia , Doenças da Polpa Dentária/diagnóstico , Restauração Dentária Permanente , Humanos , Planejamento de Assistência ao Paciente , Doenças Periodontais/prevenção & controle , Prognóstico , Retratamento , Reabsorção da Raiz/prevenção & controle , Fraturas dos Dentes/diagnóstico , Fraturas dos Dentes/terapia , Raiz Dentária/lesões , Resultado do TratamentoRESUMO
It's a fact: Perfect endodontic treatment can be unsuccessful. Unfortunately, endodontic failure often can result from an inadequate preliminary diagnosis or prognosis assessment. Many variables should be considered before endodontic treatment begins, including assessing the endodontic case, addressing periodontal concerns, determining restorative issues, and detecting root fractures. If these parameters are not evaluated carefully, then short- or long-term endodontic failure will result. Unfortunately, an endodontic prognosis assessment is often subjective. Although dentists must rely on evidence-based research to determine the best modality of treatment, good clinical judgment and experience may override the most objective findings. This article discusses the objective and subjective nuances involved in evaluating the potential prognosis of endodontic treatment.
Assuntos
Planejamento de Assistência ao Paciente , Tratamento do Canal Radicular , Apicectomia , Cárie Dentária/diagnóstico , Doenças da Polpa Dentária/diagnóstico , Restauração Dentária Permanente , Humanos , Doenças Periodontais/diagnóstico , Prognóstico , Radiografia Interproximal , Retratamento , Reabsorção da Raiz/diagnóstico , Fraturas dos Dentes/diagnóstico , Raiz Dentária/lesões , Falha de TratamentoRESUMO
A 43-year-old African-American female with anemia secondary to uterine leiomyomas and menorrhagia presented with induration and stiffness of the right arm and hand four weeks after receiving intravenous iron infusions at multiple infusion sites along the right proximal forearm. Multiple intravenous sites between her right antecubital fossa and wrist had to be used because developing pain necessitated the site changes. The iron infusions were performed because the patient had refused blood transfusions and her symptoms failed to resolve on oral iron supplementation. The skin induration persisted and progressed for several months at which time a skin biopsy was performed. The skin histology was consistent with eosinophilic fasciitis and her complete blood count was notable for a peripheral eosinophilia. Because of the location of the fibrosis and the time proximity in relation to her infusions, a relationship between the iron infusions and eosinophilic fasciitis was made. Cutaneous fibrosis has been linked to immunologic dysfunction, autoantibody production, tissue hypoxia, and vascular damage, which may have been contributing factors in this patient. Eosinophilic fasciitis has been linked to certain drugs and chemicals, notably L-tryptophan ingestion and the statin family of drugs.
Assuntos
Eosinofilia/induzido quimicamente , Fasciite/induzido quimicamente , Compostos Férricos/efeitos adversos , Hematínicos/efeitos adversos , Adulto , Anemia Ferropriva/terapia , Feminino , Compostos Férricos/administração & dosagem , Óxido de Ferro Sacarado , Ácido Glucárico , Hematínicos/administração & dosagem , Humanos , Infusões IntravenosasRESUMO
INTRODUCTION: The presence of cracks and fractures in teeth can pose difficulties in diagnosis, prognosis assessment, and treatment recommendations. When a tooth has no significant restorations or caries, whereby the pulp is nonvital in the absence of a luxation injury, it is suggested that this necrosis is likely caused by a significant longitudinal crack that extends from the occlusal surface and into the pulp. This type of presentation has been termed "fracture necrosis." METHODS: Twenty-seven teeth with nonvital pulps were evaluated that had no restorations or minimally deep restorations and no signs of caries. These teeth were extracted and evaluated as to the depth and location of any potential fracture. RESULTS: All evaluated teeth were found to have cracks that extended from the occlusal surface into the pulp and progressed to an external root surface. CONCLUSION: Pulp necrosis, in the absence of restorations, caries, or luxation injuries, is likely caused by a longitudinal fracture extending from the occlusal surface and into the pulp. Based on the available literature, these types of teeth may have a poor prognosis after endodontic treatment, with the potential ramification of extensive periodontal and/or periapical bone loss. Extraction may be considered as the primary treatment option.
Assuntos
Perda do Osso Alveolar/etiologia , Necrose da Polpa Dentária/etiologia , Fraturas dos Dentes/diagnóstico , Raiz Dentária/patologia , Dente não Vital/patologia , Perda do Osso Alveolar/patologia , Perda do Osso Alveolar/terapia , Necrose da Polpa Dentária/patologia , Necrose da Polpa Dentária/terapia , Feminino , Humanos , Masculino , Prognóstico , Extração Dentária , Fraturas dos Dentes/complicações , Fraturas dos Dentes/terapia , Dente não Vital/terapia , Microtomografia por Raio-XRESUMO
Achieving successful endodontic treatment requires an accurate diagnosis and appropriate cleaning, shaping, and three-dimensional obturation of the canals. This article describes a new obturation technique that utilizes a warm plugger or spreader, delivered (in conjunction with vibration) with a single cordless device, the DownPak.
Assuntos
Guta-Percha/uso terapêutico , Materiais Restauradores do Canal Radicular/uso terapêutico , Obturação do Canal Radicular/métodos , Cavidade Pulpar/anatomia & histologia , Temperatura Alta/uso terapêutico , Humanos , Obturação do Canal Radicular/instrumentação , Preparo de Canal Radicular , Vibração/uso terapêuticoRESUMO
Teeth with vertical root fractures (VRFs) have complete or incomplete fractures that extends through the enamel, dentin and pulp, down the long axis of the tooth. Several different variables were investigated and statistically evaluated as to their correlation with the presence of VRFs. Specifically analyzed were gender, tooth location, age, radiographic and clinical findings, bruxism, and pulpal status. The data were collected from three different endodontists, from three different geographic locations, comprising a total of 227 teeth. Although VRFs may occur in conjunction with any of the parameters investigated, only certain factors were found to occur in a significant number of cases. The results indicate that VRFs are statistically more prevalent in mandibular molars and maxillary premolars. They are associated with periradicular bone loss, pain to percussion, extensive restorations, and seem to occur more often in females and older patients. However, VRFs are not necessarily related to periapical bone loss, a widening of the periodontal ligament space, associated periodontal pockets, a sinus tract, particular pulpal status, or bruxism.
Assuntos
Fraturas dos Dentes/diagnóstico , Fraturas dos Dentes/etiologia , Raiz Dentária/lesões , Adulto , Fatores Etários , Idoso , Perda do Osso Alveolar/complicações , Dente Pré-Molar/lesões , Bruxismo/complicações , Doenças da Polpa Dentária/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dente Molar/lesões , Tratamento do Canal Radicular/efeitos adversos , Fatores Sexuais , Odontalgia/complicaçõesRESUMO
BACKGROUND: Early detection and management of vertical root fractures, or VRFs, remain a vexing issue that has caused needless suffering for patients as well as for dentists. The authors present techniques to aid the dentist in recognizing VRFs. METHODS: During a five-year period, the authors examined 36 patients who had VRFs. Absent control subjects and a larger number of patients, the authors did not design this investigation for statistical analysis. They diagnosed VRFs through dental histories and clinical and radiographic examinations. RESULTS: The study revealed VRFs in 36 teeth, two of which were vital and 34 of which were nonvital (that is, endodontically treated). The 34 VRFs resulted from excessive operative procedures performed in the root canal after endodontic therapy. Thirty-one of these 34 VRFs were caused by poorly designed dowels (too long, too wide or both) or inappropriate selection of the tooth as a bridge abutment; two VRFs were caused by a restoration that exerted lateral pressure on the axial walls of the preparation; and one VRF was caused by overzealous endodontic forces. The VRFs in the two vital teeth were in men who had a history of bruxism or clenching. CONCLUSIONS AND CLINICAL IMPLICATIONS: VRFs can be detected early by listening to the patient's chief complaints, carefully examining periapical and bitewing radiographs and performing a thorough clinical examination.
Assuntos
Fraturas dos Dentes/diagnóstico , Raiz Dentária/lesões , Adulto , Idoso , Dente Pré-Molar/lesões , Dente Suporte/efeitos adversos , Planejamento de Prótese Dentária/efeitos adversos , Restauração Dentária Permanente/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dente Molar/lesões , Técnica para Retentor Intrarradicular/efeitos adversos , Técnica para Retentor Intrarradicular/instrumentação , Radiografia , Tratamento do Canal Radicular/efeitos adversos , Fraturas dos Dentes/diagnóstico por imagem , Dente não Vital/complicaçõesRESUMO
Recent changes have made it possible to perform endodontic treatment more efficiently, with improved precision and greater patient acceptance. This article reviews these various concepts and highlights how endodontics now can be performed with enhanced abilities and clinical results.
Assuntos
Tratamento do Canal Radicular/tendências , Anestesia Dentária , Cimentos Dentários , Teste da Polpa Dentária , Endodontia/educação , Humanos , Pulpite/terapia , Irrigantes do Canal Radicular , Obturação do Canal Radicular/instrumentação , Obturação do Canal Radicular/métodos , Preparo de Canal RadicularRESUMO
Inflammatory root resorption (IRR) is a common sequelae to oral trauma. Anticipating root resorption after trauma and taking some preventive measures may avoid this outcome. Endodontics and radiographic examination play an important role in the early diagnosis and treatment of root resorption. Subtle radiographic clues can lead to timely implementation of appropriate treatment (if any) according to the kind of resorption discovered. This article describes the most current classification of inflammatory root resorption (usually following trauma) and utilizes a clinical study to provide radiographic clues for its early detection.