A Conservative Approach to Surgical Management of Root Canal Perforation.

This study describes a conservative approach to surgical management of root canal perforation in maxillary lateral incisors. A patient was referred for retreatment of a maxillary lateral incisor. Her chief complaint was discomfort in the buccal mucosa. Periapical radiography showed radiopaque material consistent with sealing material inside the root canal. A CBCT scan was acquired and revealed a gutta-percha cone outside the root canal, from the middle third to beyond the root apex. The imaging examination showed that the pulp cavity had not been affected. Thus, we took the clinical alternative of surgically managing the perforation by sealing with MTA, thereby avoiding endodontic treatment, and followed up with only clinical and radiographic control. At the two-year follow-up, after the surgical procedure to remove the extruded filling material, we observed bone tissue formation and positive response to pulp tests, without any clinical signs or symptoms. Root perforation is considered an unpleasant error in an operative procedure. Once a perforation is properly diagnosed, located, and sealed with biomaterial, a favorable prognosis is often achieved. MTA offered good sealing of the perforation, with promising results. Decision-making using the CBCT scan enabled us to adopt a conservative approach and favored more reliable treatment predictability.

Working Length Determination Using Cone-Beam Computed Tomography, Periapical Radiography and Electronic Apex Locator in Teeth with Apical Periodontitis: A Clinical Study.

INTRODUCTION: The purpose of this clinical study was to compare the accuracy of working length (WL) determination using cone-beam computed tomography (CBCT), conventional periapical radiographies and electronic apex locator. METHODS AND MATERIALS: This study was conducted during root canal treatment of 19 patients with a total of 30 single-rooted teeth diagnosed with apical periodontitis. After taking the initial parallel periapical radiographies, the initial file was advanced into the canal until the WL was detected by the apex locator. Subsequently, the WL was measured and WL radiographies were taken with the file set in the canal. Afterwards, CBCT images were acquired. These three measurements were tabulated and compared and the data were analyzed using the Friedman test. The level of significance was set at 0.05. RESULTS: The mean values for WL determination by electronic apex locator, periapical radiograph and CBCT images were 22.25, 22.43 and 22.65, respectively which was not statistically significant (P>0.05). CONCLUSION: Working length determination using CBCT images was precise when compared to radiographic method and electronic apex locator.

Intraosseous lipoma in the periapical region of a maxillary third molar.

INTRODUCTION: Images of oral lesions can look so exceptionally similar that a diagnosis hypothesis could be difficult. Lesions mimicking apical periodontitis must be considered when making a differential diagnosis. Intraosseous lipoma is a rare benign tumor of low incidence among all bone tumors, and therefore few cases have been reported in the literature. METHODS AND RESULTS: A case of intraosseous lipoma associated with the distobuccal root of tooth #1 in a 39-year-old woman is described. The dental general practitioner did not perceive anything of note in terms of the radiographic aspect, so consequently the periapical lesion went unnoticed. However, after tooth extraction, a different feature was noticed in the surgical specimen. The lesion associated to the roots of tooth #1 was surrounded by soft tissue forming a fibrous capsule (10 mm in diameter). A histopathologic examination showed an area of bone of lamellar aspect surrounding a central area of fat tissue diagnosed as intraosseous lipoma. This type of lesion is asymptomatic, and its etiology is unclear. CONCLUSIONS: Intraosseous lipoma should be considered in the differential diagnosis of other jaw lesions. A histologic examination is mandatory for the diagnosis, because this lesion is characterized by bone of lamellar aspect surrounding a central area of fat tissue. The treatment chosen in this case was surgical excision, and the outcome was favorable.

Influência do cimento obturador no sucesso endodôntico / Influence of the endodontic sealer in the success

Avaliou-se em estudos longitudinais a influência do cimento obturador no sucesso endodôntico, pormeio de revisão sistemática. Utilizou-se de fontes de catalogação bibliográfica identificadas eletronicamentepor MEDLINE (http://www.ncbi.nlm.nih.gov/PubMed), de 1966 até 14 de Janeiro de 2008. Como estratégiade busca empregou-se os termos - Sealapex or AH Plus or Epiphany or Kerr Pulp Canal Sealer or GrossmanSealer or Sealer 26. A busca apresentou 456 artigos relacionados. Dos 132 estudos in vivo, 1 estudo satisfezos critérios de inclusão. Os cimentos contendo hidróxido ou óxido de cálcio mostraram bom desempenho noprocesso de reparo clínico-radiográfico com elevada taxa de sucesso.

The longitudinal studies about biological sealing provided by the endodontic sealer were evaluated,through the systematic review. It was used sources of bibliographic catalogation identified electronically byMEDLINE (http://www.ncbi.nlm.nih.gov/PubMed), from 1966 until 14th January 2008. As searching strategythe following terms were used - Sealapex or AH Plus or Epiphany or Kerr Pulp Canal Sealer, or GrossmanSealer or Sealer 26. The searching presented 456 related articles. From 132 in vivo studies, 1 study satisfiedthe inclusion criteria, what possibilitated the data analysis. It can be inferred that, the sealers containing calciumhydroxide or calcium oxide show good results on endodontic success.