Dental anxiety, cardiovascular changes and patient preconceptions toward implants and root canal treatments: An observational study.

Background: There is little information about dental anxiety and the patient's vital signs during dental procedures. This study evaluates and compare patient anxiety levels and cardiovascular changes before and during root canal treatment (RCT) and single-tooth implant procedures. Material and Methods: Preoperative data and pre-treatment considerations were recorded. HR and SpO2 were monitored during treatment procedures at five points. Data were analyzed accordingly using Mann Whitney or X2 tests. 80 patients met the inclusion criteria. Results: Anxiety and fear scores were strongly correlated (p< 0.001). Both treatments resulted in low levels of dental anxiety and fear. Patients with a prior dental bad experience presented higher anxiety scores in the implant treatment group (p< 0.05). Implant treatment was considered a more time-consuming and more painful procedure than root canal treatment (p< 0.05). No significant relation was found between the level of anxiety with HR and SpO2. Conclusions: No significant relation was found between the level of dental anxiety with HR and SpO2. Single-implant treatment was pre-considered to be a more time-consuming and more painful procedure when compared with a RCT. HR was higher at the initial stages and decreased as both procedures finished. Key words:Dental anxiety, endodontics, dental implants, oximetry, heart rate.

Guided autotransplant of a first premolar to replace a maxillary ankylosed incisor using a custom-designed osteotome.

BACKGROUND: Autotransplantation is a highly successful technique to replace ankylosed teeth. The authors propose a modified therapeutic approach to guide the autotransplant of an immature maxillary premolar using a tooth-shaped osteotome. CASE DESCRIPTION: A 9-year-old boy reported an avulsion of his maxillary permanent left central incisor with a delayed replantation. An autotransplant of the immature maxillary right first premolar into the position of the affected tooth was planned. A surgical 3-dimensional guiding template and a tooth-shaped osteotome were manufactured to prepare the neo-alveolus (referring to the creation or modification of an alveolus to house the tooth) modification. Although the donor tooth was placed in the recipient socket with the buccal side of the root fully exposed, the transplant outcome was successful. PRACTICAL IMPLICATIONS: The use of 3-dimensionally designed surgical osteotome could improve accuracy and surgical handling of a donor tooth autotransplant, even with substantial bone defects in the recipient site.

Snoring intensity assessment with three different smartphones using the SnoreLab application in one participant.

STUDY OBJECTIVES: To compare the assessment of snoring using the SnoreLab application (app) using three different smartphones by one participant to validate SnoreLab as a method for collecting data for studies on the effectiveness of snoring treatment. METHODS: A person from the research group was monitored for 30 consecutive nights with the SnoreLab app using three different smartphones (Xiaomi MI8Pro, Samsung Galaxy Alpha, and BQ Aquaris V). The SnoreLab app instructions were strictly followed, and data were collected from the app. RESULTS: No significant differences were found in the measurements from the three smartphones in the time in bed, all snoring time, snoring percentage, and quiet time. BQ and Samsung smartphones determined significantly more light snoring time than did the Xiaomi smartphone. The Samsung smartphone assessed significantly less loud snoring time than did the Xiaomi smartphone and measured the shortest epic snoring time. The lowest Snore Score was calculated with the Samsung smartphone, the highest with the Xiaomi smartphone. Pearson's correlation coefficients demonstrated a relatively strong relationship between the Snore Score measured with the three smartphones. CONCLUSIONS: Even though there was a relatively strong relationship between the Snore Score measured with the three smartphones by one participant, the observed differences make it difficult to use this index as a method of collecting data for studies on snoring treatment effectiveness when patients use different smartphones; however, the SnoreLab app may be handy to quantify treatment effectiveness for a specific patient, provided the patient always uses the same smartphone.

Development of Periapical Lesions in Endodontically Treated Teeth with and without Periodontal Involvement: A Retrospective Cohort Study.

INTRODUCTION: The purpose of this study was to investigate the incidence of apical periodontitis (AP) in endodontically treated teeth with and without periodontal involvement. METHODS: The records of 602 patients with 775 root canal-treated teeth were initially examined. Only teeth with adequate root canal filling, adequate coronal restoration, and no AP (periapical index = 1) were selected for further investigation. A total of 194 teeth were included in this cohort study. Age, sex, history of diabetes mellitus, smoking, hypertension, and immunodeficiency disorders were recorded. Two groups were made according to the periodontal status of the patients. The control group included periodontally healthy patients and the periodontal group patients with periodontal disease receiving nonsurgical periodontal treatment. After an observation period of at least 2 years, the incidence of AP was scored using the periapical index. The relationship between patients' variables and AP was conducted using the Cohen kappa test, the chi-square test, odds ratio (OR), and logistic regression analysis. RESULTS: Newly emerged AP was found in 14% of periodontally involved teeth and in 3% of nonperiodontal involved teeth (P < .05, OR = 5.19, 95% confidence interval). The periodontal condition and hypertension were the only significant factors associated with the presence of AP in the follow-up after univariate logistic regression. Adjusting for hypertension, multivariate logistic regressions showed that periodontal status remained significant (OR = 5.25, 95% CI, P < .05). CONCLUSIONS: The risk of developing AP in endodontically treated teeth is 5.19 times higher for patients with periodontal disease compared with patients without periodontal disease.

Danger zone analysis using cone beam computed tomography after apical enlargement with K3 and K3XF in a manikin model.

BACKGROUND: The objective of the study was to evaluate and compare how apical enlargement with K3 and K3XF nickel-titanium (NiTi) rotary instruments reduces the root thickness in the danger zone and affects canal transportation and centering ability in mandibular molar mesial canals in a manikin extracted tooth model. MATERIAL AND METHODS: Seventy-two mesial root canals of first mandibular molars were instrumented. Initial and post-instrumentation Cone Beam Computed Tomography scans were performed after root canal preparation up to size 25, 30, 35 and 40 files. Canal transportation, canal centering and remaining root dentin thickness toward the danger zone were calculated in sections 1, 2 and 3 mm under the furcation level. Data were analyzed using non-parametric Kruskal-Wallis analysis of variance at a significance level of P < 0.05. RESULTS: K3 instruments removed more dentin toward the danger zone compared with K3XF instruments (P< .05) and significant differences in dentin thickness were found when canal enlargement was performed to a #35-40 with both systems (P< 0.05). No significant differences in canal transportation and centering ability were found between systems, except when canal enlargement was performed to a #40 (P = 0,0136). No differences were observed when comparing the number of uses in both systems (P> 0.05). CONCLUSIONS: Under the conditions of this study K3 removed a significant amount of dentin at the furcation level compared with the R-Phase K3XF rotary system in curved root canals. Enlargement to a 35-40/04 file removed significantly more dentin with both systems. Key words:K3, K3XF, R-phase, center ability, canal transportation, dentin thickness, increased apical enlargement, danger zone, dentin thickness.

Failure of ProTaper rotary Ni-Ti instruments used by undergraduate students.

OBJECTIVE: To evaluate the effect of number of uses, angle and radius of curvature and type of instrument on the fracture of ProTaper rotary instruments when used by undergraduate students. STUDY DESIGN: Three hundred and seventy-six molars, with a total of 1114 root canals, extracted were instrumented by undergraduate students using ProTaper instruments according to the manufacturer´s recommendations. When fracture occurred, data were collected concerning the number of uses, type of instrument, level of fracture, angle and radius of curvature. ANOVA test were used to determine the influence of type of instrument in the incidence of instrument fracture. Logistic regression model was used to determine the influence of number of uses, angle and radius of curvature in the incidence of instrument fracture. Significance was set at p< 0.05. RESULTS: A total of 37 Ni-Ti rotary instruments fractured during the treatment. Fracture occurred in 9.84% (37/376) of the teeth treated and 3.32% of the canals prepared with Ni-Ti rotary instruments (37/1114). A decrease in the radius of curvature of the canal significantly increased the likelihood of fracture (p=0.0001). Instrument fracture significantly increased as the number of uses increased (p=0.0037). No significant differences were found between the 6 types of ProTaper instruments (p=0.8). A reduction in the angle of curvature did not produce a significant decrease in the incidence of instrument separation (p=0.08). CONCLUSIONS: The results of this study imply that instrument fracture is linked to radius of curvature and number of uses. Key words:Fracture, ProTaper ®, root canal preparation, undergraduate students.

Conformación de conductos radiculares con sistemas reciprocantes por alumnos de grado: estudio in vitro de la incidencia de fractura / Shaping root canals with reciprocating files by undergraduate students: an in vitro study of fracture frequency

Objetivos: En la práctica clínica, la separación de un instrumento rotatorio de níquel- titanio (NiTi) puede comprometer el resultado del tratamiento de conductos. Ningún estudio ha evaluado la incidencia de fractura de instrumentos reciprocantes cuando son utilizados en dientes humanos extraídos por operadores inexpertos. Por lo tanto, el objetivo de este estudio fue evaluar la incidencia de fractura de los instrumentos ProTaper Universal, WaveOne y Reciproc cuando son utilizados por operadores inexpertos en dientes extraídos. Metodología: Se instrumentaron 240 conductos mesiales de molares mandibulares (80 por grupo) con un ángulo de curvatura entre 20 y 45 grados, utilizando rotación continua (Grupo A: instrumentos ProTaper) y rotación reciprocante (grupo B: Reciproc, y grupo C: WaveOne). Todos los tratamientos de conductos fueron realizados por 120 operadores sin experiencia (estudiantes de tercer año de Odontología). Resultados: Durante la preparación de los 240 conductos curvos no se observó ninguna fractura en los Grupos B y C (Reciproc y WaveOne), mientras que en el Grupo A (ProTaper), se fracturaron 10 instrumentos rotatorio de Níquel Titanio. La prueba de Fisher reveló diferencias estadísticas con respecto a esta variable entre los grupos (p = 0,0001). Conclusiones: Según nuestros resultados los dos sistemas de lima única reciprocantes usados en este estudio son mas seguros que el sistema ProTaper

Purpose: In clinical practice, nickel-titanium (NiTi) rotary instrument separation can compromise the outcome of root canal treatment. No studies have assessed the incidence of fracture of reciprocating instruments when used on extracted human teeth by inexperienced operators. Therefore, the aim of this study was to evaluate the incidence of fracture of ProTaper, WaveOne, and Reciproc instruments when used by novice operators on extracted teeth. Methods: Instrumentation was performed on 240 mesial mandibular molar root canals (80 per group) with an angle of curvature ranged from 20 to 45 degrees using continuous rotation (group A: ProTaper instruments) and reciprocating rotation (group B: Reciproc, and group C: WaveOne instruments). Root canal treatments were performed by 120 inexperienced operators (third-year dental students). Results: During the preparation of the 240 curved of the mandibular no instrument fracture was observed in Groups B and C (Reciproc and WaveOne group), whereas 10 Ni-Ti rotary instruments fractured in Group A (ProTaper group). Fisher´s exact test revealed statistical differences with regard to this variable between the groups (p=0.0001). Conclusions: According to our results the 2 types of single-file reciprocating instrument systems used in this study are safer than ProTaper System

Manejo conservador no quirúrgico de una reabsorción cervical invasiva tipo IV utilizando Biodentine / Nonsurgical conservative management of a class IV invasive cervical resorption using Biodentine

La reabsorción cervical invasiva (RCI) es una entidad poco frecuente de carácter agresivo que causa la destrucción de los tejidos dentales si no se trata. El diagnóstico de la RCI es complejo y de acuerdo a la literatura presente, en estadíos muy avanzados el tratamiento no es predecible, lo que conlleva la extracción del diente. Actualmente, gracias al avance de nuevas tecnologías para el radiodiagnóstico como la tomografía computerizada de haz cónico (CBCT), el microscopio dental, así como la introducción de nuevos materiales como el Agregado Trióxido Mineral (MTA(R)) el enfoque de este tratamiento y el pronóstico en estos casos puede mejorar. Recientemente, se ha introducido el Biodentine(R), un cemento biocerámico, como material sustitutivo del MTA(R) con claras ventajas sobre este como un menor tiempo de fraguado, que no presenta discoloración y unas propiedades mecánicas similares a la dentina. A continuación se presenta un caso de reabsorción cervical invasiva tratada con Biodentine® con controles clínicos, radiográficos y mediante CBCT a 6 meses

Invasive cervical resorption (ICR) is an uncommon but aggresive entity that cause the destruction of dental tissues if left untreaten. The diagnosis of ICR is complex and according to the literature, the treatment in advanced cases is not predictable, which can ultimately lead to extraction of the tooth. The current development of innovative technologies such as the cone-beam computed tomography (CBCT) and the dental operating microscope, as well as new materials such as mineral trioxide aggregate (MTA(R)) can facilitate improvements in the treatment approach and the prognosis of ICR. Recently, BiodentineTM, a new bioceramic cement, has been introduced as a substitutive material for MTA(R) with several advantages related to setting time, the elimination of discoloration and similar mechanic properties as dentine. A case of ICR is presented in which the management of the lesion using Biodentine is reported along with the clinical, radiographic and 6-month CBCT follow-up

Estudio in vivo sobre la precisión de los localizadores de ápice iPex y Root ZX en la determinación de la longitud de trabajo / Evaluation of the accuracy of iPex and Root ZX apex locators determining the working length

Propósito: El propósito de este estudio in vivo es evaluar la precisión de los localizadores de ápice iPex y Root ZX en la determinación de la longitud del conducto. Materiales y Métodos: Se seleccionaron 34 dientes monorradiculares indicados para extracción. Se efectuaron las mediciones electrónicas (ME) con iPex y Root ZX tras la irrigación del conducto con EDTA al 17%. Después de la extracción del diente, se determinó la longitud real (LR) del conducto a 0,5 mm del foramen mayor. Las mediciones electrónicas de cada diente se compararon con la LR mediante, analizándose las diferencias con el test estadístico de análisis de la varianza. Resultados: Se identificaron diferencias estadísticamente significativas entre la LR y ME de Ipex (p = 0,02) y entre ME de Ipex y ME de Root ZX (p = 0,02). No se observaron diferencias estadísticamente significativas entre LR y la ME de Root ZX (p = 0,66). La media de la distancia desde la punta de la lima hasta la LR fue de -0,09 ± 1,06 mm para el Root ZX y de -0,52 ± 1,19 mm para el iPex (p < 0,05). Conclusiones: El Root ZX posee mayor precisión en determinar la longitud del conducto que el Ipex

Purpose: This in vivo study aims to evaluate the accuracy of iPex and Root ZX electronic apex locators in the determination of the oot canal working length. Materials and methods: 34 extracted one-rooted teeth were selected. Electronic measurements (EM) were made with iPex and Root ZX after irrigation of the root canal with EDTA to 17%. After the tooth extraction, real working length (RWL) was determined 0.5 mm from the greater foramen. EM of each tooth was compared with the RWL by analyzing differences in the statistical analysis of variance test. Results: statistically significant differences was identified between RWL and EM with Ipex (p = 0.02) and between EM with Ipex and Root ZX (p = 0.02). No statistically significant differences were observed between RWL and EM with Root ZX (p = 0, 66). The average distance from the tip of the file to the RWL was - 0.09 ± 1.06 mm for Root ZX and -0.52 ± 1.19 mm for iPex (p < 0.05). Conclusions: Root ZX had more accuracy than iPex in the determination of the root canal working length

Reconstrucción del diente endodonciado en sector posterior con técnicas adhesivas. Revisión de la literatura / Reconstruction of endodontically treated posterior teeth with modern restorative adhesive procedures. A literature review

Objetivo. Las opciones de tratamiento del diente endodonciado y sus cambios biomecánicos son motivo de controversia. El objetivo de esta revisión es mostrar las alteraciones de composición y estructura de la pérdida de vitalidad pulpar y proporcionar diferentes enfoques restaurativos adhesivos en dientes posteriores para restaurar el diente endodonciado. Método de la revisión. El proceso de búsqueda incluyó una revisión en la base de datos de Pub/Med entre el 1999 y el 2012 usando una serie de palabras clave solas y combinadas. Información relevante y conclusiones. El impacto de la pérdida de vitalidad parece moderado o insignificante en términos de humedad o propiedades físicas. Por el contrario, los cambios más importantes en la biomecánica y la resistencia a la fractura se asocian con un defecto estructural generado por caries, traumatismos o preparación del diente. Por lo tanto, el método más utilizado en la actualidad para la restauración de los dientes no vitales se basa en los preparativos de invasión mínima con la conservación máxima de los tejidos. Técnicas adhesivas y materiales con propiedades físicas próximas a la dentina parecen ser la opción más adecuada. Sin embargo, estudios más clínicos son necesarios para predecir el éxito a largo plazo (AU)

Objective. Biomechanical alterations and treatment options related to endodontically treated teeth are a matter of controversy. The aim of this review is to present the composition and structural alterations resulting from loss of pulp vitality and to provide different approaches to restorative adhesive procedures for anterior endodontically treated teeth. Review method. The basic search process included a review of the PubMed/Medline database between 1999 and 2012 using single or combined key words and a perusal of the references completed the review. Relevant information and conclusions. he impact of vitality loss appears moderate to negligible in terms of moisture or physical properties. Conversely, the most important changes in biomechanics and fracture resistance are associated with structural defect generated by caries, trauma or tooth preparation. Therefore, the most widely used approach at present for restoring nonvital teeth is based on minimally invasive preparations with maximal tissue conservation. Adhesive techniques and materials with physical properties close to natural dentin seem to be the most suitable option. However, more clinical studies are needed to predict a long-term success (AU)