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.

Perception of the clinical endodontic practice of Dentistry graduates in their first years in the job market in southern Brazil

Introduction: Knowledge about the clinical endodontic practices of dental school graduates in the first years of their professional life may contribute to the discussions about Dentistry teaching. Methods: An online questionnaire with seven open and closed questions hosted on the Google forms platform was applied to dentists trained in the first half of 2019 in a School of Dentistry in southern Brazil. The questionnaire is structured to analyze how clinical Endodontics has been practiced in the labor market. The data collected in the questionnaires were transferred to an Excel® spreadsheet and analyzed as absolute and relative frequencies for closed questions and descriptions for open questions. Results: Molars and two-rooted teeth are the dental groups most frequently treated endodontically (64.3% and 35.7%). Both retreatment and conservative treatment of the pulp corresponded to up to 25% of all procedures in the graduates' clinical practice. The endodontic protocol learned in their dental school was used by 64.3% of the graduates who provided endodontic treatments, and 42.9% reported the occurrence of at least one accident. The difficulty in access reported by the participants suggests that more training should be provided for this operative stage. Conclusions: After two years in the job market and having faced the initial difficulties existing in any profession, more than half of the graduates still performed endodontics in their dental clinical practice and used the same protocols learned in dental school.

Percepção de uso e preparo químico mecânico realizado com diferentes instrumentos endodônticos por estudantes de graduação em Odontologia: uma revisão sistemática de estudos laboratoriais / Undergraduate dental students' use perception of different endodontic instruments for mechanical­chemical preparation: a systematic review of laboratory studies

O estudo revisou a literatura existente com o objetivo de comparar a percepção de uso, qualidade e tempo do preparo químico mecânico de canais radiculares realizado por estudantes de graduação em Odontologia com instrumentos de níquel-titânio (NiTi) e aço inoxidável. Para isso, as bases de dados eletrônicas PubMed, LILACS, Scopus, Embase,SciELOe CENTRALforam acessadas para verificar e selecionar estudos relacionados com a questão de pesquisa publicados até janeiro de 2021. Estudos laboratoriaisque compararam o uso de instrumentos de NiTi com aço inoxidável por alunos de graduação em Odontologia foram avaliados. Dois revisores independentemente selecionaram os estudos, coletaram os dados e analisaram o risco de viés.Dos 92 estudos potencialmente relevantes, 10 atenderam aos critérios de inclusão para análise de texto completo e, posteriormente, incluídos na revisão sistemática. O risco de viés foi considerado alto em todos os estudos. Instrumentos de NiTi apresentarammaior preferência e melhor percepção por estudantes de graduação em Odontologia, menor tempo e melhor qualidade do preparo químico mecânico, commenor ocorrência de acidentes como degraus, transporte e desvios de canal, apesar de estarem associados à maior ocorrência de fratura de instrumentos (AU).

This literature review aimed to compare undergraduate dental students' perceptions regarding the use of nickel­titanium (NiTi) and stainless steel instruments for the mechanical-chemical preparation of root canals, focusing on quality and time. PubMed, LILACS, Scopus, Embase, SciELO,and CENTRAL electronic databaseswere accessed to verify and select related studies published as of January 2021. Laboratory studies comparing the use of NiTi instruments with stainless steel instruments by undergraduate dental students were evaluated. Two reviewers independently selected the studies, collected the data, and analyzed the risk of bias. Out of the 92 potentially relevant studies, 10 met the inclusion criteria for a full-text analysis and were subsequently included in the systematic review. The risk of bias was considered high in all studies. Undergraduate dental students demonstrated a greater preference for and better perception of NiTi instruments. NiTi instruments also resulted in less time for and better qualityof the mechanical-chemical preparation. These were associated with a lower incidence of accidents, such as canal ledges, transportations, and deviations, as well as a higher incidence of instrument fractures (AU).

Percepção de egressos de um curso de Odontologia no sul do Brasil sobre a inserção no mercado de trabalho / Perception of entry into in the labor market among dental graduates from a university in southern Brazil

O objetivo do presente estudo foi conhecer a percepção de egressos de um Curso deOdontologiano sul do Brasilsobre a inserção no mercado de trabalho. Para isso, foi aplicado um questionário online, por meio da Plataforma Google Forms, com onzequestões abertas e fechadas aos cirurgiões-dentistasformadosna instituição nos últimos dois anos.O questionário foi estruturado a fim de analisar como está sendo realizada a inserção e a prática profissional dos recém-formados no mercado de trabalho.Os dados coletados foram transferidos para uma planilha e analisados por meio defrequênciasabsoluta e relativanas questões fechadas e descritiva nas questões abertas. Amaioria dos respondentes apontaram estar capacitados para o mercado de trabalho tanto sob ponto de vista técnico,com familiaridade em relação aosmateriais e equipamentos disponíveis,quanto sob o ponto de vista de pessoal. As disciplinas de clínica integrada, os Centros de Especialidades Odontológicasdo Sistema Único de Saúde, extensões e estágios extramuros foramelencados por promoverem uma vivência do trabalho em equipe e da integralidade das diversas especialidades da odontologia (AU).

This study examined the perception of entry into the labor market of graduates from a School of Dentistry in southern Brazil. An online questionnaire with eleven open and closed questions was created using Google Forms and applied to recently graduated dentists in an educational institution in southern Brazil. The questionnaire asked questions about the entry into the labor market and the professional practice of recent graduates. The data collected in the questionnaires were transferred to an Excel® spreadsheet and analyzed using absolute and relative frequency for closed questions and descriptive statistics for open questions. Most respondents felt that they were technically qualified for the labor market, considering familiarity with the materials and equipment available, and personally well prepared. Integrated clinics, Dental Specialties Centers of the Brazilian Unified Health System (SUS), extension courses and internships were listed as factors that promoted teamwork and integrated experiences in the various dental specialties (AU).

Apical extrusion of sodium hypochlorite in immature teeth: comparison of three different cleaning protocols.

This study compared standard needle irrigation, passive ultrasonic irrigation, XP-Endo Finisher and Easy Clean in the apical extrusion of sodium hypochlorite (NaOCl) in a model simulating immature teeth. Ten bovine teeth were maintained in suspension in a container with the apical portion in contact with 0.2% agarose gel containing 0.1% metacresol purple. The canals were irrigated with 2.5% NaOCl, according to each irrigation protocol. After 3 min, apical extrusion of NaOCl was observed by the colour gel change when in contact with NaOCl. The containers were photographed, and the NaOCl extrusion area was measured. All protocols showed NaOCl extrusion, providing similar area (P > 0.05). Considering the similarity among the studied protocols, all of them can be considered during the endodontic treatment of immature teeth. Further studies on the particularities of immature teeth should be performed to evaluate cell viability, cleaning efficiency, disinfection capacity and dentin removal promoted by the irrigation protocols.

How is working length determination taught? A survey to assess what is recommended in undergraduate Schools of Dentistry in Brazil.

INTRODUCTION: To analyse what are the methods for working length (WLD) determination taught for undergraduate students in Brazilian Dental Schools and the perception of professors about the use of electronic WL determination in the clinical practice. METHODS: An online questionnaire with eighteen closed questions was sent to 209 Schools of Dentistry in Brazil using the Google Forms Platform. The questionnaire was structured to analyse the perception of professors in the department of endodontics about the method of working length determination taught in undergraduate courses in Dentistry. The data collected in the questionnaires were transferred to an Excel® spreadsheet and analysed using absolute and relative frequencies. The non-parametric Mann-Whitney test was used to compare groups. RESULTS: Of the 209 schools contacted, 41 (19.61%) returned answers to the questionnaire. According to professors, electronic working length (WL) determination had a shorter length of time to perform it (p < .001), WL measurement accuracy (p < .001) and ease of performance (p < .001). Professors felt safer when maintaining patency when using electronic WL determination (p = .0020). CONCLUSIONS: Both radiographic and electronic methods of WL determination are taught in Brazilian Schools of Dentistry. The electronic method was used more frequently, especially in undergraduate clinical courses.

Influence of dental crown topography on fracture resistance of premolars with MOD preparation and subjected to different restorative protocols.

To evaluate whether dental crown topography influences the fracture resistance of premolars treated endodontically and with MOD preparation subjected to different restorative protocols. Sixty-four human premolars with one or two roots in equal numerical proportions (n) were selected and randomly divided into four groups (n = 8): (S = single-rooted; D = double-rooted) SS: sound single-rooted; SNR: endodontics (E) + MOD cavity preparation; SR: E + MOD + resin restoration (RS); SP: E + MOD + RS + horizontal zirconia post (ZP); DS: sound double-rooted; DNR: E + MOD; DR: E + MOD + RS; and DP: E + MOD + RS + ZP. After allocation to the groups, the samples were thermocycled and then subjected to the fracture resistance test. Failures after the fracture test were classified as irreparable (with pulp floor fracture) or reparable (without pulp floor fracture). Data were analysed using one-way anova and the Tukey test (α = 0.05). Single-rooted premolars were more resistant to fracture than double-rooted premolars. The restorative treatment using a horizontally transfixed zirconia post improved fracture resistance, resembling that of a healthy tooth.

Morphometric evaluation of multirooted artificial teeth used for endodontic training / Avaliação morfométrica de dentes artificiais polirradiculares utilizados para treinamento endodôntico

Introduction Dental practice professionals encounter several urgency cases, mainly related to endodontic problems. To attend to these, professionals need extensive prior preclinical training, being one of the main difficulties the search for models that simulate dental morphology. Aim To compare the external morphometry of multirooted artificial teeth to literature. Material and method The artificial teeth (Upper First Premolar, Upper First Molar and Lower First Molar) were donated by the manufacturers: Fábrica de Sorrisos (FS) and IM do Brasil LTDA (IM), totaling 30 teeth. The total length of the tooth and root, height and buccal-palatal and mesial-distal dimensions of the crown were measured with a digital pachymeter. The data were placed in a spreadsheet and the statistical analysis was performed [ANOVA or Kruskal-Wallis and then, Dunnett's test (α=5%)]. Result The Upper Molar samples of the company Fábrica de Sorrisos presented all variables within the morphometric patterns described in the literature. The other dental groups presented statistically significant differences, maintaining or not a certain proportionality. Conclusion Of all the dental groups analyzed, the upper molar from the company Fábrica de Sorrisos was the only one that presented all the external morphometric aspects according to literature.

Introdução Dentro da prática odontológica, os profissionais podem receber diversos casos de urgência, principalmente relacionados a problemas endodônticos e, para atendê-los, há a necessidade de um extenso treinamento pré-clínico prévio, sendo uma das principais dificuldades a busca por modelos que simulem a morfologia dentária. Objetivo Comparar a morfometria de dentes artificiais polirradiculares à literatura. Material e método Os dentes artificiais (Primeiro Pré-molar Superior, Primeiro Molar Superior e Primeiro Molar Inferior) foram doados pelos fabricantes: Fábrica de Sorrisos (FS) e IM do Brasil Ltda. (IM), totalizando 30 dentes. Foi realizada mensuração do comprimento total do dente e o da raiz, da altura e das dimensões vestíbulo-palatina e mésio-distal da coroa, com paquímetro digital. Os dados foram dispostos em uma planilha de cálculo e realizou-se a análise estatística [ANOVA ou Kruskal-Wallis e, após, teste de Dunnett (α=5%)]. Resultado A amostra de molares superiores da empresa FS apresentou todas as variáveis dentro dos padrões morfométricos descritos na literatura. Os demais grupos dentários apresentaram diferenças estatisticamente significantes, mantendo ou não certa proporcionalidade. Conclusão De todos os grupos dentários pesquisados o molar superior da empresa FS foi o único que apresentou todos os aspectos morfométricos externos de acordo com os dados da literatura.

Avaliação de dentes monorradiculares artificiais utilizados para treinamento endodôntico / Evaluation of artificial monoradicular teeth used for endodontic training

Introdução: É desafio do ensino pré-clínico em Endodontia fornecer aos alunos dentes artificiais que reproduzam a morfologia dos dentes humanos. Objetivo: Comparar a morfologia interna e externa de dentes artificiais monorradiculares com dados da literatura sobre dentes humanos. Material e método: Os dentes artificiais foram doados pelos fabricantes: Fábrica de Sorrisos, empresa A, (n=20), e IM do Brasil Ltda., empresa B, (n=20). Foi realizada mensuração do comprimento total do dente e da raiz, da altura, das dimensões vestibulopalatina e mesiodistal da coroa, com paquímetro digital. A descrição morfológica das raízes, coroas e câmaras pulpares foi realizada. A localização topográfica do forame apical principal foi avaliada após exploração dos canais com instrumento endodôntico tipo K #15 até este atingir visualmente o ápice radicular. Os dados foram dispostos em uma planilha de cálculo e realizou-se a análise estatística [ANOVA e pós-teste de Tukey (α=5%)]. Resultado: A amostra de caninos superiores da empresa B apresentou todas as variáveis dentro dos padrões morfométricos descritos na literatura. Em relação às morfologias interna e externa, a amostra de incisivos laterais superiores da empresa A foi a única a apresentar todas as variáveis dentro dos padrões descritos na literatura. Em relação à localização topográfica foraminal, os dentes da empresa A, assim como o canino inferior da empresa B, apresentaram tendência à posição distalizada e centralizada, vindo ao encontro da literatura. Conclusão: Nenhum dente artificial estudado apresentou total similaridade morfológica e morfométrica com a literatura analisada, diferindo em pelo menos uma das variáveis, sendo indicada aos fabricantes uma revisão dos seus modelos.

Introduction: It is a challenge of pre-clinical teaching in Endodontics to provide students with artificial teeth that reproduce the internal and external morphology of human teeth. Objective: To compare the internal and external morphology of single-rooted artificial teeth with data from the literature on human teeth. Material and method: The artificial teeth were donated from two companies: Fábrica de Sorrisos, company A, (n=20) and IM do Brasil Ltda, company B (n=20). Measurement of total tooth length, root, height, buccal-palatal and mesio-distal crown dimensions with digital caliper was performed. The morphological description of the roots, crown and pulp chamber was performed, the last one only after access. The topographic location of the main apical foramen was evaluated after canal exploration with a K #15 endodontic instrument until it visually reached the root apex. The data were arranged in a spreadsheet and statistical analysis was performed (ANOVA, followed by the Tukey post-test (α=5%)). Result: Regarding the morphometric parameters, the upper canine sample from company B presented all variables within the standards described in the literature. Regarding internal and external morphology, the sample of upper lateral incisors from Company A was the only one to present all variables within the standards described in the literature. Regarding the foraminal topographic location, the teeth of Company A, as well as the lower canine of company B, showed a tendency to the distalized and centralized position, in line with the literature. Conclusion: none of the artificial teeth studied showed total morphological and morphometric similarity with the control, differing in at least one of the variables, and a review of their models is indicated to the manufacturers.

Antimicrobial action, pH, and tissue dissolution capacity of 2,5% sodium hypochlorite gel and solution / Ação antimicrobiana, pH, e capacidade de dissolução tecidual de gel e solução de hipoclorito de sódio 2,5%

Objective: to evaluate antimicrobial action, pH, and tissue dissolution capacity of 2.5% sodium hypochlorite (NaOCl) gel and solution. Methods: The 2.5% NaOCl gel was produced from a colloidal base. The test groups included 2.5% NaOCl gel and solution and the control groups included gel base and distilled water. The antimicrobial activity was evaluated by the broth dilution technique against Enterococcus faecalis (ATCC 29212) at 15 and 30 seconds and at 1, 5, and 10 minutes. To evaluate tissue dissolution capacity, 30 pulp fragments of bovine incisors were weighed, 10 for each test group and 5 for each control group before and after exposure to the chemical auxiliaries. The final mass percentage of each fragment was calculated. The pH of the substances was measured in triplicate through a digital pH meter. Results: pH levels of 13.08 and 9.75 were observed for 2.5% NaOCl solution and gel, respectively. The antimicrobial action of 2.5% NaOCl was the same for both solution and gel, for all tested times. The 2.5% NaOCl solution group showed higher tissue dissolution capacity (Kruskal-Wallis and Student-Newman-Keuls tests P<0.0001). Conclusions: The type of medium, either solution or gel, containing 2.5% NaOCl did not influence the antimicrobial action at any of the tested times. However, 2.5% NaOCl gel did not present tissue dissolution capacity

Objetivo: avaliar a ação antimicrobiana, pH e capacidade de dissolução tecidual promovida por hipoclorito de sódio (NaOCl) 2,5%, nas formas líquida e gel. Métodos: O gel de NaOCl 2,5% foi produzido a partir de base coloidal. Os grupos testes foram NaOCl 2,5% gel e solução e os grupos controle incluíram a base gel e água destilada. A ação antimicrobiana foi avaliada por meio de método de diluição em caldo, frente a Enterococcus faecalis (ATCC 29212) após 15 e 30 segundos, e também a 1, 5 e 10 minutos. Para o teste de diluição tecidual, 35 fragmentos de polpa bovina (sendo 10 para cada grupo teste e 5 para o grupo controle) foram pesadas antes e após a exposição aos auxiliares químicos. O percentual de massa final de cada fragmento foi calculada. O pH dos auxiliares químicos foi medido em pHmetro digital, em triplicata. Resultados: Valores de pH iguais a 13,08 e 9,75 foram observados para solução e para o gel de NaOCl, respectivamente. A ação antimicrobiana do NaOCl foi a mesma para o gel e a solução, em todos os períodos testados. Maior capacidade de dissolução tecidual foi obtida no grupo onde se utilizou a solução de NaOCl 2,5% (Testes de Kruskal-Wallis e Student-Newman-Keuls, P<0,0001). Conclusões: A apresentação na forma de gel ou de líquido do NaOCl 2,5% não modificou a ação antimicrobiana em qualquer um dos períodos testados. Porém, o gel de NaOCl 2,5% não demonstrou capacidade de dissolução tecidual.

Avaliação da formação de smear layer no preparo químico mecânico realizado com solução ou gel de hipoclorito de sódio a 2, 5% / Evaluation of smear layer formation in mechanical chemical preparation performed with 2. 5% sodium hypochloride solution or gel

Introdução: a formação de smear layer durante o preparo dos canais radiculares com o uso de hipoclorito de sódio solução já foi amplamente estudada; entretanto, na apresentação em gel não existem relatos na literatura. Objetivo: avaliar, em MEV, a formação de smear layer durante o preparo endodôntico, utilizando o NaOCl nas formas líquida e gel, associado ou não ao EDTA. Métodos: sessenta raízes palatinas de molares superiores ou distais de inferiores, com comprimento radicular padronizado em 15 mm, foram utilizadas. As amostras foram divididas em quatro grupos controle com n = 5 cada (soro fisiológico ou base gel, associados ou não ao EDTA) e quatro grupos testes com n = 10 cada, de acordo com a substância irrigadora empregada durante o preparo (solução ou gel de NaOCl a 2,5%, associados ou não ao EDTA). Os canais foram modelados e posteriormente clivados para análise em MEV (ampliação de 2000x). Imagens de eletromicrografias foram obtidas nos terços cervical, médio e apical. A presença e as características da smear layer formadas foram categorizadas. As imagens foram analisadas por dois avaliadores, previamente, calibrados. Após a análise de concordância (Kappa = 0,806) dos escores, os dados foram tratados com o uso do teste Kruskall-Wallis, complementado pelo teste de Comparações Múltiplas SNK. O nível de significância foi de 5%. Resultados: a utilização do soro fisiológico e do NaOCl líquido, associados à irrigação final com EDTA, apresentou os melhores resultados de limpeza. Com o uso do NaOCl gel e da base gel, sem associação ao EDTA, houve uma maior quantidade de resíduos sobre as paredes dentinárias. Além disso, independentemente da substância irrigadora testada, pode-se observar que houve uma melhor capacidade de remoção da smear layer no terço cervical em relação ao apical. Conclusões: observou-se formação de smear layer após o preparo do canal radicular associado ao NaOCl líquido ou gel. A aplicação de EDTA promoveu a remoção da smear layer produzida durante o preparo do canal.

Introduction: the formation of smear layer during the preparation of root canals with the use of sodium hypochlorite solution has been widely studied; however, in the gel presentation there aren't reports in the literature. Objective: to evaluate, in SEM, the formation of smear layer during endodontic preparation, using NaOCl in liquid and gel forms, associated or not with EDTA. Methods: sixty palatal roots of maxillary molars or distal roots of lower molars, with a root length of 15 mm, were used. The samples were divided into four control groups with n = 5 each (saline or gel base, associated or not with EDTA) and four test groups (n = 10 each) according to the irrigation substance used during the preparation (2.5% NaOCl solution or gel, associated or not with EDTA). The root canals were instrumented and later split for SEM analysis (2000x magnification). Electromicrographic images were obtained from the cervical, middle and apical thirds. The presence and characteristics of the smear layer formed were categorized. The images were analyzed by two previously calibrated evaluators. After the Kappa analysis (0.806), the data were treated using the Kruskall-Wallis test, complemented by the SNK Multiple Comparison Test. The level of significance was 5%. Results: the use of saline and liquid NaOCl, associated with final rinsing with EDTA, showed the best cleaning results. With the use of NaOCl gel and gel base, with no EDTA association, there was a greater amount of residues on the dentin surfaces. In addition, despite the irrigation substance tested, it can be observed that there was a better capacity of removal of the smear layer in the cervical third in relation to the apical. Conclusion: root canal instrumentation associated with NaOCl solution or gel EDTA produced smear layer. Smear layer was removed with the use of EDTA as a final flushing.

Radiopacidade de dentes artificiais para treinamento pré-clínico de endodontia / Artificial tooth radiopacity for preclinical endodontic training

Resumo Introdução Dentes artificiais têm sido utilizados para a prática odontológica e, segundo seus fabricantes, apresentam muita similaridade aos dentes humanos para treinamento. Objetivo Avaliar a radiopacidade de dentes endodônticos artificiais para uso em atividades de ensino e saber a percepção de docentes quanto à análise radiográfica. Material e método Trinta réplicas de incisivos centrais superiores de três marcas comerciais (Fábrica de Sorrisos, IM do Brasil e Real Dent) e um incisivo humano foram utilizados. Foram dispostos sobre um sensor radiográfico o dente humano e um dente artificial de cada empresa. As análises de radiopacidade foram feitas no programa Photoshop® em triplicata em quatro regiões distintas: porção central da coroa e nos terços cervical, médio e apical do canal. A percepção quanto à utilização dos dentes como instrumento prático de ensino foi avaliada por meio de um questionário aplicado a oito professores de endodontia. Para análise estatística dos valores de radiopacidade, foi utilizada a ANOVA, seguida do teste de Tukey. Foi empregado um nível de significância de 5%. Para análise do questionário, foram empregados métodos descritivos e por porcentagem de dados no que se refere à frequência das respostas. Resultado Houve diferença de radiopacidade entre os diferentes dentes testados em cada região analisada (p > 0,05). Na percepção dos professores com relação à utilização dos dentes no ensino, eles colocaram em ordem crescente os seguintes dentes para uso: IM do Brasil, Fábrica de Sorrisos, Real Dent e humano. Conclusão A radiopacidade dos dentes artificiais foi diferente do humano. O dente artificial da Fábrica de Sorrisos apresentou os maiores valores de radiopacidade. Contudo, os professores consideraram ideais para utilização no ensino apenas o dente humano e o dente da Real Dent.

Abstract Introduction Artificial teeth have been used for dental practice which, acoording to their manufactures, bear much similarity to human teeth for training. Objective To evaluate radiopacity of artificial endodontic teeth for use in teaching activities and to know the perception of teachers regarding radiographic analysis. Material and method Thirty replicates of upper central incisors of three trade marks (Fábrica de Sorrisos, IM do Brasil and Real Dent) and a human incisor were used. On a radiographic sensor, human tooth and one artificial tooth of each marks were arranged. Radiopacity analyzes were performed using Photoshop® in triplicate in four distinct regions: central portion of the crown and in the cervical, middle and apical thirds of the canal. The perception about the use of teeth as a practical teaching instrument was evaluated through a questionnaire applied to eight teachers of Endodontics. For statistical analysis of the radiopacity values ​​ANOVA was used, followed by the Tukey test. Significance level of 5%. For the analysis of the questionnaire were used descriptive methods and percentage of data regarding the frequency of responses. Result There was a difference in radiopacity between the different teeth tested, in each region analyzed (P > 0.05). In the teachers' perception regarding the use of teeth in teaching, the teachers placed the following teeth for use: IM do Brasil, Fábrica de Sorrisos, Real Dent and human. Conclusion The radiopacity of the artificial teeth was different from the human teeth. The artificial tooth of the Fábrica de Sorrisos presented the highest values ​​of radiopacity. The teachers considered ideal for use in teaching only the human teeth and the prototype Real Dent.

Efeito de diferentes soluções irrigadoras na microdureza superficial Knoop de dentes artificiais / Effect of different irrigation solutions on the Knoop surface microhardness of artificial teeth

Resumo Introdução Dentes artificiais têm sido empregados para a prática de ensino pré-clínico. Porém, não se sabe o comportamento dos mesmos frente aos diferentes procedimentos realizados durante um tratamento endodôntico simulado. Objetivo Avaliar a microdureza de réplicas de dentes humanos, frente a diferentes soluções irrigadoras. Material e método Quarenta e cinco incisivos centrais superiores artificiais de três marcas comerciais nacionais (dentes "A", "B" e "C") e 15 incisivos humanos foram utilizados. As amostras foram seccionadas a 5 mm do ápice dentário. Os fragmentos radiculares foram fixados em resina para posterior teste de microdureza. Os ensaios da microdureza Knoop foram realizados em dois momentos: momento 1 - microdureza inicial; momento 2 - microdureza final, que foi feita após o uso das soluções irrigadoras (Cloreto de Sódio a 0,9%, Hipoclorito de Sódio a 2,5% e Gluconato de Clorexidina a 2%). As endentações deixadas na superfície da amostra foram mensuradas. O valor obtido para microdureza de cada amostra foi feita com base na média de três endentações. Para análise estatística, foram utilizados os testes ANOVA e Teste t pareado, com nível de significância de 5%. Resultado Os dentes artificiais "A" e "C" apresentaram valores inferiores de microdureza quando comparados ao dente humano (P = 0,05). Não houve diferença estatística entre os dentes artificiais "B" e o dente humano (P = 0,2428). Quanto ao uso das diferentes soluções irrigadoras, também não houve diferença na microdureza das peças dentárias. Conclusão Embora a solução irrigadora não tenha influenciado a microdureza, os dentes artificiais apresentaram valores de dureza inferiores aos do dente humano.

Abstract Introduction Artificial teeth have been used for preclinical teaching practice. However, the behavior of the same is not known in relation to the different procedures performed during a simulated endodontic treatment. Objective To evaluate the microhardness of replicates of human teeth, in front of different irrigating solutions. Material and method Forty-five artificial upper central incisors of three national trade marks (teeth "A", "B" and "C") and fifteen human incisors were used. Samples were sectioned 5 mm from the apex. The root fragments were fixed in resin for later microhardness test. The Knoop microhardness tests were performed in two moments: moment 1 - initial microhardness; moment 2 - final microhardness, which was done after the use of the irrigating solutions (0.9% sodium chloride, 2.5% sodium hypochlorite and 2% chlorhexidine gluconate). The indentations left on the sample surface were measured. The obtained value for microhardness of each sample was made based on the average of three indentations. ANOVA and Paired t-test were used for statistical analysis. Significance level of 5%. Result Artificial teeth "A" and "C" presented lower values ​​of microhardness when compared to human teeth (P = 0.05). There was no statistical difference between the artificial teeth "B" for the human (P = 0.2428). Regarding the use of different irrigation solutions, there was also no difference in the microhardness of dental pieces. Conclusion Although the irrigating solution did not influence the microhardness, the artificial teeth presented values ​​of hardness inferior to the human tooth.

Desafio da localização clínica de canais radiculares parcialmente mineralizados identificados em tomografia computadorizada de feixe cônico ­ relato de caso / Challenge of clinical location of partially mineralized root canals identified in cone beam tomography ­ case report

O presente relato de caso tem como objetivo demonstrar a relevância da tomografia computadorizada de feixe cônico (TCFC) como ferramenta útil no diagnóstico de canais parcialmente mineralizados e discutir a limitação clínica que uma anatomia atípica impõe. Paciente do sexo feminino, 53 anos de idade, foi encaminhada para tratamento endodôntico do dente 27, o qual apresentava acesso apenas aos canais palatino (P) e mésio-vestibular (MV). Além destes dois canais já acessados, a TCFC identificou a presença dos canais disto-vestibular (DV) e mésio-palatino (MP). Com o uso do microscópio operatório (MO) e por meio de desgaste seletivo com pontas de ultrassom, foi possível localizar o canal DV, entretanto, o canal mésio-palatino (MP) não foi localizado. Em função da grande mineralização presente nos terços cervical e médio deste canal e do risco de perfuração eminente, seu acesso ficou impossibilitado. A TCFC é um recurso auxiliar na Endodontia, sendo indicada para os casos endodônticos complexos onde os benefícios de seu uso superem os seus riscos. Embora a TCFC forneça imagens com maior número de detalhes e informações sobre complexidade anatômica presente, ainda assim existem limitações clínicas que são intransponíveis mesmo com o auxílio de recursos como ultrassom e microscópio operatório, o que demonstra, mais uma vez, o quanto a complexidade anatômica representa um desafio constante para o sucesso endodôntico (AU).

The present case report aims to demonstrate the relevance of cone-beam computed tomography (CBCT) as a useful tool in the diagnosis of partially mineralized canals and to discuss the clinical limitation that atypical anatomy imposes. A 53-year-old female patient was referred to endodontic treatment of tooth 27, which had access only to the palatal (P) and mesiobuccal (MB) canals. In addition to these two root canals which had already been accessed, the TCFC identified the presence of vestibular canal (DV) and mesiopalatal canal (MP). Using the operative microscope (MO) and through selective wear with ultrasound tips, it was possible to locate the DV canal, however the MP canal was not found. Due to the great mineralization present in the cervical and middle thirds of this canal and the risk of imminent perforation, it was impossible to access it. Cone-beam computed tomography (CBCT) is an auxiliary resource in Endodontics and is indicated for complex endodontic cases in which the benefits of its use outweigh its risks. Although the CBCT provides images with greater detail and information on anatomical complexity, there are still clinical limitations that are insurmountable even with the aid of resources such as ultrasound and operative microscope, which demonstrates how much anatomical complexity represents a constant challenge for endodontic success (AU).

O ensino de Endodontia pré-clínica nos cursos de Odontolologia brasileiros / Preclinical Endodontics teaching in Brazilian Dentistry courses

O objetivo desse estudo foi obter informações quanto ao ensino de Endodontia em atividades préclínicas nos diferentes cursos de graduação em Odontologia no Brasil, além de avaliar o perfil e a distribuição por regiões do país dessas instituições. Foi realizado um estudo observacional transversal do tipo censo, envolvendo 246 instituições de ensino, por meio do acesso aos sítios eletrônicos das respectivas instituições, obtendo-se dados de domínio público. As informações relacionadas às instituições de ensino foram obtidas em base de dados pública, em sítio eletrônico do Conselho Federal de Odontologia (CFO). Foram registradas as seguintes variáveis de interesse: dados sobre a instituição de ensino, a distribuição das disciplinas relacionadas ao ensino de pré-clínica na área de Endodontia, e a carga horária e relacionada com o ensino de Endodontia. Foi realizada análise estatística descritiva dos dados obtidos. A maioria dos cursos ocorrem em instituições privadas, localizadas no Sudeste do país, com maior número de cursos diurnos e apresentando duração mínima de 10 semestres. Em relação à presença de informações relativas à estrutura curricular dos Cursos de Odontologia nas instituições avaliadas, verificou-se que foi possível acesso direto em sítios eletrônicos de 190 instituições (77,2%). O Projeto Pedagógico está disponível no sítio eletrônico de 57 cursos (23,2%). Observou-se grande diversidade de organização das disciplinas nas diferentes instituições. Constatou-se que há informações limitadas disponíveis para acesso na forma de domínio público, o que dificulta uma análise mais criteriosa acerca dos modelos didáticos e conteúdos abordados pelas instituições. Ainda, observou-se que as informações disponibilizadas sugerem que há abordagens heterogêneas para o ensino da endodontia pré-clínica (AU).

This study aimed to achieve information concerning the teaching of Endodontics in preclinical activities in different undergraduate courses in Dentistry in Brazil, and analyzed the profile and distribution of these institutions across the country regions. This was a crosssectional observational census study, involving 246 teaching institutions, by accessing the electronic websites of institutions, achieving public domain data. The information related to the teaching institutions were obtained from a public database, on the electronic website of the Brazilian Federal Dental Council (CFO). The following variables of interest were recorded: data on the teaching institution, distribution of disciplines related to preclinical teaching in the field of Endodontics, and workload related to the teaching of Endodontics. Data were submitted to descriptive statistical analysis. Most courses are offered in private institutions, located in the Southeast region of the country, with greater number of daytime courses presenting minimum duration of 10 semesters. Concerning the presence of information related to the curriculum of Dentistry courses in the institutions analyzed, direct access was possible to the electronic websites of 190 institutions (77.2%). The Pedagogical Project was available on the electronic website of 57 courses (23.2%). There was great diversity of organization of disciplines in the different institutions. It was observed that there is limited information available for access as public domain, which impairs a more careful analysis of the didactic models and contentes addressed by the institutions. Also, the information available suggest heterogeneous approaches for the preclinical Endodontics teaching (AU).

Perfil dos usuários e dos atendimentos na especialidade de Endodontia do CEO-UFRGS entre 2016 e 2017 / Profile of users and attendances of Endodontics at CEO-UFRGS between 2016 and 2017

Os Centros de Especialidades Odontológicas (CEO) são uma estratégia da Política Nacional de Saúde Bucal para garantir a atenção secundária em Odontologia, constituindo-se em unidades de referência para a atenção primária. Este estudo transversal analisou as características dos usuários e dos atendimentos na Especialidade de Endodontia do CEO da Universidade Federal do Rio Grande do Sul. Foi formulado um questionário baseado no Manual de Especialidades em Saúde Bucal, acrescido de perguntas que caracterizavam o perfil do usuário e aplicado aos estagiários atuantes no CEO a cada tratamento endodôntico concluído. A amostra totalizou 48 pacientes, obtida por conveniência, em amostragem consecutiva do tipo censo onde foram concluídos 56 tratamentos endodônticos, durante o período de agosto de 2016 a julho de 2017. O perfil dos usuários encaminhados foi, predominantemente, do sexo feminino (62,50%), na faixa etária de 31 a 50 anos (41,67%) e da raça branca (64,58%); os dentes que mais necessitaram tratamento foram os molares (67,86%); e na maioria dos casos encontravam-se em condições compatíveis com as preconizadas pelo Manual de Especialidades em Saúde Bucal; os tratamentos foram concluídos em 2 ou 3 consultas (66,67%); o tempo de espera dos usuários para atendimento foi inferior a 6 meses (83,33%). Os pacientes foram encaminhados por meio da ficha de referência (93,75%). O estudo evidenciou dados que podem contribuir para o desenvolvimento de estratégias que ampliem a produtividade por meio de investimentos em novas tecnologias e equipamentos que possam reduzir o número de consultas necessárias para a finalização dos tratamentos endodônticos, proporcionando atendimento para um número maior pacientes e reduzindo o tempo de espera (AU).

The Dental Specialties Centers (CEO) are a strategy of the National Oral Health Policy to assure the secondary care in Dentistry, constituting referral units for the primary attention. This cross-sectional study analyzed the characteristics of users and attendances in the specialty of Endodontics of the CEO at Universidade Federal do Rio Grande do Sul. A questionnaire was designed, based on the Oral Health Specialties Handout, besides questions that characterized the profile of users, and was applied to the trainees at the CEO at every completed endodontic treatment. The sample included 48 patients, obtained by convenience, inconsecutive census sampling, with conclusion of 56 endodontic treatments during the period August 2016 to July 2017. The profile of users was predominantly females (62.50%), in the age range 31 to 50 years (41.67%) of White ethnicity 64.58%); the teeth with greatest treatment needs were the molars (67.86%); and most cases were in conditions compatible with those advocated by the handout. The treatments were completed in 2 or 3 sessions (66.67%), and the waiting time of users for attendance was shorter than 6 months (83.33%). The patients were indicated using a referral form (93.75%). The study revealed data that may contribute to the development of strategies to broaden the productivity by investments in new Technologies and equipment, aiming to reduce the number of sessions required for finalization of endodontic treatments, providing attendance to a larger number of patients and reducing the waiting time (AU).

Effectiveness of hand and Mtwo TM Instruments in preparing oval-shaped root canals: in vitro study

Objective: This study evaluated through stereomicroscopy the effectiveness of hand and rotary instrumentation techniques, either isolated or combined, in the preparation of oval-shaped root canals. Materials and method: Thirty single-rooted human mandibular incisors were selected. After endodontic access and coronal preflaring, teeth were mounted in a modified Bramante muffle and then sectioned transversely at 3 and 6 mm from the root apex. Images of each section were made under a stereomicroscope at 30× magnification. Teeth were reassembled in the muffle and divided into three groups (n=10) according to the root canal preparation technique: GI - rotary preparation with Mtwo™ basic sequence (10/.04; 15/.05; 20/.06; 25/.06), followed by Mtwo™ complementary instruments (30/.05; 35/.04; 40/.04); GII - rotary preparation with Mtwo™ basic sequence, complemented by hand instruments (#30, #35 and #40); GIII - hand instrumentation using the conventional technique (#10 to #40). All instruments were used in brushing motion. The muffles were separated again so that new images of each section could be obtained. The following parameters were evaluated in pre- and postoperative images: root canal area; perimeter; mesiodistal (MD) and buccolingual (BL) diameters; and mesial (M) and distal (D) wall thickness. Next, the values measured in post- and preoperative images were subtracted for comparison of experimental groups. Data were analyzed using the Kruskal-Wallis test (α=0.05). Results: No significant difference between groups was observed for all parameters. Conclusion: There was no difference among hand, rotary, or combined instrumentation; all techniques were able to increase root canal area, perimeter, and diameter in MD and BL directions. Moreover, the amount of dentin wear on proximal root canal walls was similar for all tested groups. Keywords: Endodontics. Microscopy. Root canal preparation. Root canal therapy. Stereomicroscopy.

Calcium Hypochlorite Solutions: Evaluation of Surface Tension and Effect of Different Storage Conditions and Time Periods over pH and Available Chlorine Content.

INTRODUCTION: The aim of this study was to evaluate the pH and the available chlorine content from sodium hypochlorite (NaOCl) and calcium hypochlorite (Ca[OCl]2) solutions stored in different conditions and time periods and the surface tension of Ca(OCl)2 solutions in comparison with NaOCl. METHODS: Solutions at 0.5%, 1%, 2.5%, and 5.25% concentrations were prepared. The pH level and the available chlorine content of freshly prepared solutions and solutions stored for 30, 60, and 90 days at 25°C, 4°C, or 37°C were evaluated in a digital pH meter and by titration, respectively. Surface tension was tested using a Du Nouy tensiometer (Sigma 702, Force Tensiometer; Attension, Espoo, Finland). Descriptive and inferential statistical analyses were performed. RESULTS: A precipitate formed by 2.5% and 5.25% Ca(OCl)2 solutions was observed. Ca(OCl)2 showed a higher concentration of available chlorine than NaOCl. Both 2.5% and 5.25% NaOCl and Ca(OCl)2 had a decrease in the available chlorine content when compared with freshly prepared solutions; 0.5% and 1% NaOCl tend to have a lower pH compared with 0.5% and 1% Ca(OCl)2. NaOCl, 5.25%, showed higher pH compared with 5.25% Ca(OCl)2. NaOCl and Ca(OCl)2 in 0.5% and 1% concentrations tend to show a reduced pH level, whereas 2.5% and 5.25% solutions showed an increase in pH. The heat contributed to the instability of the solutions. NaOCl showed lower surface tension values than Ca(OCl)2. CONCLUSIONS: Ca(OCl)2 solutions are extremely alkaline and tend to have more available chlorine content than NaOCl but have a higher surface tension than NaOCl. Regarding the available chlorine content, these solutions tend to be stable to 30 days of storage when kept at 4°C or at 25°C.

Análise da superfície de instrumentos de diferentes ligas metálicas após preparo mecanizado / Surface analysis instruments of different metal alloys after mechanical preparation

Este estudo teve como objetivo avaliar, através da microscopia eletrônica de varredura (MEV), a ocorrência de fratura e perda de metal na superfície de instrumentos endodônticos de NiTi do sistema Profile® e de aço inoxidável tipo FlexoFile após o uso no preparo mecanizado. Para isso, foram preparados canais mesiais de molares extraídos com instrumentos FlexoFile, através do sistema de rotação alternada M4, e instrumentos ProFile®, com o sistema de rotação contínua. Os instrumentos nº. 25 e 30 de ambos os sistemas foram analisados em MEV em relação à perda de metal e presença ou não de fratura. As imagens obtidas foram analisadas por um observador calibrado. Os dados obtidos foram submetidos ao teste não paramétrico de Friedman, teste não paramétrico Kruskal-Wallis, complementada pelo teste de comparações múltiplas, com nível de significância de 5%. Através dos resultados, observou-se que os instrumentos de aço inoxidável apresentaram, na média, maior perda de metal em sua superfície a partir do 2º uso, porém sem diferença estatística significativa. Já os instrumentos de níquel titânio mantiveram sua superfície inalterada durante os usos. A partir do 3º uso, houve diferença estatística entre os tipos de instrumentos, em relação à perda de metal. Não houve fratura dos instrumentos analisados (AU).

The aim of this study was to evaluate, by scanning electron microscopy (SEM), the occurrence of fracture and loss of metal on the surface of NiTi endodontic instruments of the system and ProFile® stainless steel type FlexoFile after use in preparing mechanized. For this, channels were prepared mesial molar extracted with FlexoFile instruments through the system alternating rotation M4, and ProFile® instruments, with the continuous rotation system. The instruments 25 and 30, both systems were analyzed by SEM with respect to metal loss and presence or absence of tracture. The images were analyzed by a calibrated observer. The data were subjected to nonparametric Friedman test, test non-parametric Kruskal-Wallis and test complemented by multiple comparisons, with a significance level of 5%. Through the results, it can be observed that the stainless steel instruments had, on average, greater loss of metal on its surface from the 2nd use, though not statistically significant. Already, the nickel- -titanium instruments remained unchanged during its surface uses. From the 3rd use, there was statistical difference between the types of instruments in relation to metal loss. There was no fracture of the instruments analyzed (AU).

Microflora associated with primary endodontic infections: correlations among SEM evaluation, clinical features, and radiographic findings.

The aim of the present study was to characterize, by means of SEM, primary endodontic infections and to correlate with clinical and radiographic findings. Twelve (12) human extracted teeth (19 roots) presenting primary endodontic infection were examined. SEM qualitative observations of bacterial and defense cells, their features and distribution within the root canal lumen and root dentine were recorded for association with clinical and radiographic tabled data. Although a direct correlation between biofilm composition and clinical/radiographic findings was not established, structural organization and distribution of the biofilm, as well as the characteristics of host response, could be easily related to those features. Bacterial biofilm was predominant at the apical third. Symptomatic apical periodontitis was related to presence of bacterial biofilm all thirds. Defense cells could be seen in the apical third of some samples. These cells were present in all thirds in some of the cases with open cavities. The correlations performed in this study allowed a better understanding of the picture of primary endodontic infection, host response and relevant clinical features. The combined use of scanning electron microscopy with clinical and radiographic evaluation has the potential to overcome some limits of the current knowledge related to pulpal and periapical diseases, providing important insights for improving treatment strategies.