RESUMO
OBJECTIVES: The purpose of this prospective, randomized, double-blind study was to compare postoperative pain of root canal treatment in patients with asymptomatic mandibular molar teeth with necrotic pulp and periapical lesion using three different instrumentation techniques: hand, multi-file rotary (ProTaper Universal), and reciprocating single-file (Wave-One) instrumentation techniques. MATERIALS AND METHODS: Ninety-six patients who fulfilled specific inclusion criteria were assigned to three groups according to the root canal instrumentation technique used: Hand (G1), ProTaper Universal (G2), and Wave-One (G3). One-visit root canal treatment was carried out, and the severity of the postoperative pain was assessed by the Heft-Parker visual analogue scale 6, 12, 18, 24, 48, and 72 h after treatment. Data were analyzed by Kruskal-Wallis, χ 2, Cochrane Q, one-way ANOVA, and Spearman's correlation analyses (α = 0.05). RESULTS: The patients in group 3 reported significantly lower postoperative pain levels at 6, 12, and 18 h compared with the patients in the two other groups (P < .05). In addition, the patients in group 2 reported significantly lower postoperative pain levels at 6 and 12 h compared with the patients in group 1 (P < .05). There were no significant differences in postoperative pain between the three groups at other time intervals (P > .05). The analgesic consumption was significantly higher in group 1 (P < .05), but no difference was seen between the two other groups (P > .05). CLINICAL RELEVANCE: Postoperative pain was significantly lower in patients undergoing root canal instrumentation with the Wave-One file compared with the ProTaper Universal and hand files.
Assuntos
Instrumentos Odontológicos , Necrose da Polpa Dentária/cirurgia , Dor Pós-Operatória/epidemiologia , Tratamento do Canal Radicular/instrumentação , Adulto , Método Duplo-Cego , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Dente Molar/cirurgia , Medição da Dor , Estudos ProspectivosRESUMO
AIM: Anterior middle superior alveolar (AMSA) nerve block injection targets the anterior superior alveolar nerve and the middle superior alveolar nerve branches of the infraorbital nerve through nutrient canals. Therefore, the central incisor to the second premolar teeth of one quadrant can be anesthetized. The aim of the present study was to evaluate the efficacy of AMSA nerve block injection with 3% mepivacaine solution at three different injection sites. MATERIALS AND METHODS: In a double-blind crossover study, 47 volunteers participated and three AMSA nerve block injections of 3% mepivacaine solution without epinephrine were administered at the anterior, posterior, and the most common injection sites with a 1-week interval between injections. Anesthesia of the central incisor to the second premolar of the injected side was evaluated by using an electric pulp tester. The success of the injection was considered as lack of response to two consecutive 80 readings. The generalized estimating equation analytic tests were administered (α = 0.05). RESULTS: The success rate of the AMSA nerve block injection ranged from 27.5-47.5% for the most common injection site and 22.5-42.5% for both the anterior and posterior injection sites. CONCLUSION: Changing the injection site did not result in statistically significant improvements (p > 0.05). CLINICAL SIGNIFICANCE: Changing the injection site anteropos-teriorly did not influence the success rate of the AMSA nerve block injection.
Assuntos
Polpa Dentária/inervação , Mepivacaína/administração & dosagem , Bloqueio Nervoso/métodos , Anestesia Dentária , Estudos Cross-Over , Dente Canino/inervação , Método Duplo-Cego , Voluntários Saudáveis , Humanos , Incisivo/inervação , Injeções , Nervo Maxilar , Medição da Dor , Resultado do TratamentoRESUMO
Endodontic treatment of immature necrotic teeth is a real challenge. Recently, a biologically based treatment strategy, referred to as regeneration, has been introduced. Tissue regeneration requires the presence of stems cells, a scaffold, and growth factors. Endodontic regeneration may improve the prognosis of immature necrotic teeth by re-establishing the functional pulpal tissue and further development of the root. However, the tissue formed in the pulpal space may not be original pulp tissue, and in some cases, it may result in uncontrolled calcification of the pulp. This study reports a case of successful endodontic regeneration and compares this process with the normal development of the contralateral tooth. Finally, it discusses the nature of the tissue formed during endodontic regeneration.
Assuntos
Necrose da Polpa Dentária/etiologia , Necrose da Polpa Dentária/cirurgia , Incisivo/lesões , Abscesso Periapical/etiologia , Abscesso Periapical/cirurgia , Regeneração/fisiologia , Traumatismos Dentários/complicações , Traumatismos Dentários/cirurgia , Criança , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/uso terapêutico , Masculino , Transplante de Células-Tronco , Alicerces TeciduaisRESUMO
OBJECTIVE: The aim of this ex vivo study was to evaluate the accuracy of endodontic file length measurement on digital periapical radiographs after application of contrast inversion digital enhancement. MATERIALS AND METHODS: Forty single-rooted single-canal mature permanent human teeth with canals measuring 20-24 mm in length were used in this study. ISO #08 K-files were placed in the root canals of the teeth. The file lengths were measured with a digital caliper as the gold standard. Standard periapical digital images were obtained with the Digora storage phosphor plates and Digora Optime scanner as the original images. The contrast inversion option of Scanora software program version 5.1 was used to produce enhanced images. Three radiologists and three endodontists measured file lengths on the original and enhanced images. The measurements were compared using repeated measures ANOVA and Bonferroni tests (α=0.05). RESULTS: There were significant differences between the measurement accuracy of the original and enhanced images (p<0.05). The enhanced images exhibited longer measurements compared to the original images. However, the two sets of digital radiographs provided significantly longer measurements compared to the gold standard (p<0.05). CONCLUSION: The contrast inversion tool of Scanora software program decreases measurement accuracy of the length of small endodontic files on digital periapical radiographs. It is suggested that contrast inversion should not be used in determining the lengths of small endodontic files.
RESUMO
Laser irradiation has been investigated in terms of preventing leakage in retrofilled root canals. The aim of the present study was to evaluate the effect of neodymium-doped yttrium aluminum garnet (Nd: YAG) laser on the bacterial leakage of mineral trioxide aggregate (MTA)-retrofilled roots. In this ex vivo experimental study, 90 single-rooted incisor teeth were filled with gutta-percha and AH26 sealer. The apical 3 mm of all the roots were resected and 3-mm retrocavities were prepared by an ultrasonic device. The specimens were randomly divided into two experimental (n = 25), one positive control (n = 10), and two negative control (n = 10) groups. In the laser + MTA group, the cavity walls were irradiated by Nd: YAG laser prior to MTA placement. In the MTA group, MTA was placed without laser irradiation. The root surfaces were covered with two layers of nail varnish except for the apical 2 mm. The specimens were then embedded in a bacterial leakage test system and examined daily for 90 days. Contamination periods were recorded. Data were analyzed by Kaplan-Meier and Mann-Whitney U tests (α = 0.05). Five teeth with and five teeth without laser irradiation underwent scanning electron microscopic evaluation. The specimens in the laser + MTA group were contaminated earlier than those in the MTA group (p < 0.05). Comparison of survival times between the two groups showed significant differences (p < 0.05). Nd: YAG laser irradiation can decrease the sealing capacity of MTA in comparison to the apical seal achieved by MTA without laser irradiation. Further studies are recommended to provide a better seal for the MTA-retrofilled teeth after laser irradiation.
Assuntos
Compostos de Alumínio/química , Bactérias/efeitos dos fármacos , Compostos de Cálcio/química , Infiltração Dentária/prevenção & controle , Incisivo/microbiologia , Lasers de Estado Sólido/uso terapêutico , Óxidos/química , Preparo de Canal Radicular/instrumentação , Silicatos/química , Apicectomia/métodos , Bismuto/química , Cavidade Pulpar , Combinação de Medicamentos , Resinas Epóxi/química , Guta-Percha/química , Humanos , Incisivo/efeitos da radiação , Microscopia Eletrônica de Varredura , Neodímio , Materiais Restauradores do Canal Radicular/química , Prata/química , Titânio/químicaRESUMO
OBJECTIVE: Enterococcus faecalis (E. faecalis) is the most frequently isolated strain in failed endodontic therapy cases since it is resistant to calcium hydroxide (CH). Whether a combination of CH and chlorhexidine (CHX) is more effective than CH alone against E. faecalis is a matter of controversy. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the literature. MATERIAL AND METHODS: A comprehensive search in PubMed, EMbase, EBSCOhost, The Cochrane Library, SciELO, and BBO databases, Clinical trials registers, Open Grey, and conference proceedings from the earliest available date to February 1, 2013 was carried out and the relevant articles were identified by two independent reviewers. Backward and forward search was performed and then inclusion and exclusion criteria were applied. The included studies were divided into "comparisons" according to the depth of sampling and dressing period of each medicament. Meta-analysis was performed using Stata software 10.0. The level of significance was set at 0.05. RESULTS: Eighty-five studies were retrieved from databases and backward/forward searches. Fortyfive studies were considered as relevant (5 in vivo, 18 in vitro, 18 ex vivo, and 4 review articles). Nine studies were included for meta-analysis. Inter-observer agreement (Cohen kappa) was 0.93. The included studies were divided into 21 comparisons for meta-analysis. Chi-square test showed the comparisons were heterogeneous (p<0.001). Random effect model demonstrated no significant difference between CH/CHX mixture and CH alone in their effect on E. faecalis (p=0.115). CONCLUSIONS: According to the evidence available now, mixing CH with CHX does not significantly increase the antimicrobial activity of CH against E. faecalis. It appears that mixing CH with CHX does not improve its ex vivo antibacterial property as an intracanal medicament against E. faecalis. Further in vivo studies are necessary to confirm and correlate the findings of this study with the clinical outcomes.
Assuntos
Antibacterianos/farmacologia , Hidróxido de Cálcio/farmacologia , Clorexidina/farmacologia , Enterococcus faecalis/efeitos dos fármacos , Animais , Bovinos , Cavidade Pulpar/efeitos dos fármacos , Cavidade Pulpar/microbiologia , Combinação de Medicamentos , Humanos , Tratamento do Canal Radicular/métodosRESUMO
The aim of the present study was to compare the antibacterial effect of calcium hydroxide (CH), triantibiotic mixture (TAM), and CH in combination with chlorhexidine (CHX), sodium hypochlorite (NaOCl) or colchicine (COL) against Enterococcus faecalis (E. faecalis) in surface and deep dentinal tubules. Seventy five fresh single-rooted human teeth were infected and divided into five experimental groups (n=15). The experimental groups were treated with CH+distilled water, CH+CHX, CH+NaOCl, CH+COL+distilled water and TAM+distilled water. Dentin chips obtained from surface and deep dentin of these root canals were prepared and analyzed by counting the number of colony forming units. There was significant difference between groups in the surface dentin (p<0.05). TAM showed higher antibacterial activity compared to CH-containing groups. There was no significant difference between TAM and CH-containing groups in the deep dentin (p>0.05). CH-containing medications and TAM can be used as effective disinfectants in treatment of infected root canals.
Assuntos
Antibacterianos/farmacologia , Anti-Infecciosos Locais/farmacologia , Hidróxido de Cálcio/farmacologia , Clorexidina/farmacologia , Colchicina/farmacologia , Dentina/microbiologia , Desinfetantes/farmacologia , Enterococcus faecalis/efeitos dos fármacos , Irrigantes do Canal Radicular/farmacologia , Hipoclorito de Sódio/farmacologia , Moduladores de Tubulina/farmacologia , Biofilmes/efeitos dos fármacos , Cavidade Pulpar/microbiologia , Combinação de Medicamentos , Humanos , Técnicas In Vitro , Teste de Materiais , Viabilidade Microbiana/efeitos dos fármacosRESUMO
Objective: Enterococcus faecalis (E. faecalis) is the most frequently isolated strain in failed endodontic therapy cases since it is resistant to calcium hydroxide (CH). Whether a combination of CH and chlorhexidine (CHX) is more effective than CH alone against E. faecalis is a matter of controversy. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the literature. Material and Methods: A comprehensive search in PubMed, EMbase, EBSCOhost, The Cochrane Library, SciELO, and BBO databases, Clinical trials registers, Open Grey, and conference proceedings from the earliest available date to February 1, 2013 was carried out and the relevant articles were identified by two independent reviewers. Backward and forward search was performed and then inclusion and exclusion criteria were applied. The included studies were divided into "comparisons" according to the depth of sampling and dressing period of each medicament. Meta-analysis was performed using Stata software 10.0. The level of significance was set at 0.05. Results: Eighty-five studies were retrieved from databases and backward/forward searches. Fortyfive studies were considered as relevant (5 in vivo, 18 in vitro, 18 ex vivo, and 4 review articles). Nine studies were included for meta-analysis. Inter-observer agreement (Cohen kappa) was 0.93. The included studies were divided into 21 comparisons for meta-analysis. Chi-square test showed the comparisons were heterogeneous (p<0.001). Random effect model demonstrated no significant difference between CH/CHX mixture and CH alone in their effect on E. faecalis (p=0.115). Conclusions: According to the evidence available now, mixing CH with CHX does not significantly increase the antimicrobial activity of CH against E. faecalis. It appears that mixing CH with CHX does not improve its ex vivo antibacterial property as an intracanal medicament against E. faecalis. Further in vivo studies are necessary ...
Assuntos
Humanos , Animais , Bovinos , Antibacterianos/farmacologia , Hidróxido de Cálcio/farmacologia , Clorexidina/farmacologia , Enterococcus faecalis/efeitos dos fármacos , Cavidade Pulpar/efeitos dos fármacos , Cavidade Pulpar/microbiologia , Combinação de Medicamentos , Tratamento do Canal Radicular/métodosRESUMO
The aim of this ex vivo study was to evaluate the effect of using a patency file on apical transportation and curve straightening during canal instrumentation with the ProTaper rotary system. Seventy permanent mandibular first molars with mesiobuccal canals, measuring 18-23 mm in length and with a 25-40° curvature (according to the Schneider method), were selected. The working lengths were determined and the teeth were mounted and divided into two experimental groups: (A) prepared by the ProTaper system without using a patency file (n = 35) and (B) prepared by the ProTaper system using a patency file (n = 35). Radiographs taken before and after the preparation were imported into Photoshop software and the apical transportation, and curve straightening were measured. Data were analyzed using independent t-test. Partial correlation analysis was performed to evaluate the relationship between the initial curvature, transportation, and curve straightening (α = 0.05). Using a patency file during canal preparation significantly decreased both apical transportation and curve straightening (P < 0.001). There were significant relationships between the angle of curvature, transportation and curve straightening in pairs (P < 0.001). Apical patency is recommended during root canal preparation with the ProTaper rotary system.
RESUMO
PURPOSE: The aim of the present study was to evaluate the measurement accuracy of endodontic file length on periapical digital radiography after application of noise reduction digital enhancement. MATERIALS AND METHODS: Thirty-five human single-rooted permanent teeth with canals measuring 20-24 mm in length were selected. ISO #08 endodontic files were placed in the root canals of the teeth. The file lengths were measured with a digital caliper as the standard value. Standard periapical digital images were obtained using the Digora digital radiographic system and a dental X-ray unit. In order to produce the enhanced images, the noise reduction option was applied. Two blinded radiologists measured the file lengths on the original and enhanced images. The measurements were compared by repeated measures ANOVA and the Bonferroni test (α=0.05). RESULTS: Both the original and enhanced digital images provided significantly longer measurements compared with the standard value (P<0.05). There were no significant differences between the measurement accuracy of the original and enhanced images (P>0.05). CONCLUSION: Noise reduction digital enhancement did not influence the measurement accuracy of the length of the thin endodontic files on the digital periapical radiographs despite the fact that noise reduction could result in the elimination of fine details of the images.
RESUMO
BACKGROUND: Conventional tomography used for evaluation of the small areas of the jaws provides acceptable information. It has some advantages of availability, less radiation dose and cost in comparison to computed tomography (CT) and cone beam CT. Double emulsion film usually used for taking tomograms requires less exposure than single emulsion film; on the other hand, the latter provides more sharpness and spatial resolution. The aim of this study was to compare diagnostic accuracy of these two kinds of films in the spiral tomography. MATERIALS AND METHODS: In an experimental study, 20 lines (10 lines anterior and 10 lines posterior to the mental foramen) were selected on two dry human mandibles and tomographic images were taken from each line with and without metal marker by single and double emulsion films. For quantitative assessment, the mandibular width and length was identified and measured on 80obtained tomograms. Afterwards, the mandibles were sectioned on each line and their actual width and height were measured. For each line, the data of tomograms were subtracted from gold standard as measurement error. These errors were divided into three groups: Greater than +1 mm, between +1 mm and -1 mm and less than -1 mm. Obtained data were analyzed by Pearson Chi-square test (α=0/05). RESULTS: There was no significant difference between the single and double emulsion films, with and without markers in the measurement of both height and width of mandible (P > 0.05). CONCLUSION: The single emulsion film is not recommended to be used for taking the spiral tomogram.