Confocal laser scanning microscopic analysis of the penetration of an epoxy resin-based sealer into dentinal tubules after calcium hydroxide dressing.

This study assessed the penetration of an epoxy resin-based sealer into dentinal tubules of root canals previously medicated with calcium hydroxide. Sixteen palatal root canals of upper molars were instrumented and distributed into two groups: (G1) root canals medicated with calcium hydroxide and obturated after its removal; (G2) root canals obturated without the use of dressing. Sealer mixed with rhodamine B provided fluorescence for confocal laser scanning microscopy. Measurements of area and linear penetration of the sealer were assessed in three thirds by ImageJ software. The data were statistically compared by Kruskal-Wallis, Dunn's and Mann-Whitney U tests (P < 0.01). The calcium hydroxide decreased the penetration of the sealer. The coronal and middle thirds had similar areas and linear penetrations in both groups, whereas the apical third had less penetration. In conclusion, the penetration of the epoxy resin-based sealer is influenced by the calcium hydroxide dressing used between appointments.

Reimplante intencional visando a remoção de instrumento endodôntico fraturado - relato de caso / Intentional reimplantation in order to remove a fractured endodontic instrument - case report

O objetivo deste relato de caso foi apresentar uma alternativa de tratamento após a ocorrência de um insucesso no tratamento endodôntico. O exame radiográfico mostrou o segundo molar mandibular direito tratado endodonticamente de forma satisfatória com a presença de um instrumento fraturado no terço apical e em contato direto com os tecidos periapicais. Em vista do espaço interoclusal limitado do paciente e a oposição de se submeter a uma cirurgia apical, foi sugerido o reimplante intencional como uma alternativa de tratamento. O procedimento consistiu na extração do dente de forma atraumática seguidamente remoção do fragmento, apicectomia, retro-obturação com MTA e, finalmente, reimplantação no alvéolo. Os exames periódicos foram feitos aos 15 dias, 6 meses, 12 meses e 5 anos. Na última visita, pôde-se observar sucesso clínico e radiográfico com base no teste de mobilidade, nenhuma sintomatologia dolorosa relatada, profundidade de sondagem normal, ausência de reabsorção radicular (inflamatória ou por substituição) e integridade óssea alveolar. O trabalho mostrou que reimplante intencional pode ser indicado corretamente como último recurso de tratamento para os casos em que a terapia endodôntica conservadora e técnica cirúrgica não podem ser executadas.

The objective of this case report was to present an alternative treatment to manage an endodontic failure. The radiographic examination showed the with presence of a fractured instrument in contact with the periapical tissues on the second right molar endodontically treated. Due to the limited interocclusal space and patientÆs opposition to undergo an apical surgery, the intentional replantation was suggested as an alternative treatment. The procedure consisted in atraumatic tooth extraction, followed by the removal of the fragment; apicoectomy, retro-obturation with MTA; and finally reimplantation. Patient returned for radiographic and clinical examination after 15 days, 6 months, 12 months, and 5 years. On the last visit, clinical and radiographic success was observed considering mobility test normal probing depth, alveolar bone integrity as well as the absence of painful symptoms root resorption (inflammatory or by substitution). The work showed that intentional reimplantation can be indicated properly as a last resort treatment for cases in which conservative endodontic therapy and surgical technique cannot be performed.