Determining the setting of root canal sealers using an in vivo animal experimental model.

OBJECTIVES: To present and explore the potential of an animal-based experimental model developed to determine the set of root canal sealers in vivo. The setting of AH Plus, BioC Sealer, TotalFill BC Sealer, and Sealapex was determined using either ISO 6876 or the novel in vivo method proposed in this study. MATERIAL AND METHODS: The in vitro setting time of the sealers tested was determined in accordance with ISO 6876:2012. In determining the in vivo set, 24 adult Wistar rats were followed up for two evaluation periods: 1 and 4 weeks. Their upper-right incisor was extracted, and its pulp tissue was removed. The root canal was then filled from retrograde with one of the 4 sealers, and the tooth was re-implanted and fixed with a layer of a flowable composite resin. After 1 or 4 weeks of the surgical procedures, the animals were euthanized, and their incisors were extracted. Two-mm-thick slices of the middle third of the tooth root were obtained and assessed with a Gillmore device, to determine whether or not the sealer had set. RESULTS: The following in vitro results were obtained by using ISO 6876 methodology: AH Plus set after a mean time of 423 ± 20 min and 476 ± 35 min, in metal and plaster molds, respectively. BioC Sealer set after 7 days (in dental plaster molds), whereas TotalFill BC Sealer and Sealapex did not set even after 25 days in both tested conditions (metal or dental plaster molds). Using the novel in vivo methodology, AH Plus, BioC Sealer, and TotalFill BC Sealer set after both 7 and 30 days. In contrast, Sealapex did not set at either time point. CONCLUSIONS: AH Plus and BioC Sealer set under both in vitro and in vivo test conditions. TotalFill BC Sealer did not set under in vitro conditions but did after 1 week under in vivo conditions. Sealapex did not set under either in vitro or in vivo conditions. CLINICAL RELEVANCE: The influence of the testing conditions on the setting results is a clear indication that new in vivo experimental models should be useful in future studies on Bioceramics root canal sealers.

Assessment of Mechanical Root Canal Preparation with Centric Reciprocating or Eccentric Rotary Kinematics: A Micro-computed Tomographic Study.

INTRODUCTION: The aim of this study was to compare, using micro-computed tomographic imaging, the preparation of mesial canals of mandibular molars with the Reciproc (VDW GmbH, Munich, Germany) and XP-endo Shaper (FKG, La Chaux-de-Fonds, Switzerland) systems, evaluating changes in dentin and canal volume, the percentage of untouched walls, the volume of accumulated hard tissue debris, and root canal deviation in the apical third. METHODS: Twenty-four mandibular molars with 2 mesial root canals and a single foramen were anatomically paired and divided into 2 experimental groups (n = 12) according to the system used. The specimens were scanned before and after preparation with the SkyScan 1176 microtomographic scanner (Bruker-microCT, Kontich, Belgium) at a resolution of 17.42 µm. The resulting data were statistically compared at a significance level of 5% using the Student t test and the Mann-Whitney test. RESULTS: A significant difference was observed in the untouched surface area for the total canal and the cervical and middle thirds, with the lowest untouched surface area in the XP-endo Shaper group (P < .05). The volume of accumulated hard tissue debris was significantly higher in the Reciproc group in the total canal as well as in the middle and apical thirds. There was no significant difference between the groups regarding the volume of dentin removed or the increase in canal volume and surface area (P > .05). CONCLUSIONS: The XP-endo Shaper touched more walls and left less accumulated hard tissue debris in the root canal system than the Reciproc group. Although the XP-endo Shaper showed superior results, neither system was able to fully prepare the root canal.

Effectiveness of XP-Endo Finisher in the reduction of bacterial load in oval-shaped root canals.

This study investigated the effectiveness of XP-Endo Finisher (XPF) associated with XP-Endo Shaper (XPS) or Reciproc Blue (RB) files in reducing bacterial load in oval-shaped root canals (RC) during chemomechanical preparation (CMP) using 0.9% saline solution (NaCl) or 2.5% sodium hypochlorite (NaOCl). Eighty mandibular incisors with single oval-shaped RC were contaminated with Enterococcus faecalis. The teeth were randomly assigned to eight experimental groups (n = 10) according to the CMP, as follows: G1: XPS, G2: XPS + XPF, G3: RB, and G4: RB + XPF. CMP was performed with NaCl or NaOCl. The reduction of bacterial load was assessed by colony-forming unit count before (S1) and after (S2) CMP. Data normality was verified by using Shapiro-Wilk test. ANOVA, Tukey's test, and Bonferroni post-hoc test were used at a 5% significance level. Culturable bacteria were present in all S1 samples (p>0.05). All instrumentation techniques were effective in reducing bacterial load, irrespective of the irrigating solution (p < 0.05). With the use of NaCl, RB was more effective than XPS (p = 0.035). With the use of NaOCl, XPS and RB presented similar effectiveness (p = 0.779). XPF enhanced the bacterial reduction of both systems tested (p < 0.05). The use of NaOCl improved the CMP, irrespective of the instrumentation technique used (p < 0.05). In conclusion, XPS and RB files are effective in reducing bacterial levels in oval-shaped RC. The use of XPF as a method of agitation of the irrigating solution improved the cleaning efficiency of both file systems tested. Mechanical preparation performed with saline solution decreased culturable bacteria from the root canal, but antimicrobial substances such as NaOCl should be used to achieve a significantly better disinfection.

Effectiveness of XP-Endo Finisher in the reduction of bacterial load in oval-shaped root canals

Abstract: This study investigated the effectiveness of XP-Endo Finisher (XPF) associated with XP-Endo Shaper (XPS) or Reciproc Blue (RB) files in reducing bacterial load in oval-shaped root canals (RC) during chemomechanical preparation (CMP) using 0.9% saline solution (NaCl) or 2.5% sodium hypochlorite (NaOCl). Eighty mandibular incisors with single oval-shaped RC were contaminated with Enterococcus faecalis. The teeth were randomly assigned to eight experimental groups (n = 10) according to the CMP, as follows: G1: XPS, G2: XPS + XPF, G3: RB, and G4: RB + XPF. CMP was performed with NaCl or NaOCl. The reduction of bacterial load was assessed by colony-forming unit count before (S1) and after (S2) CMP. Data normality was verified by using Shapiro-Wilk test. ANOVA, Tukey's test, and Bonferroni post-hoc test were used at a 5% significance level. Culturable bacteria were present in all S1 samples (p>0.05). All instrumentation techniques were effective in reducing bacterial load, irrespective of the irrigating solution (p < 0.05). With the use of NaCl, RB was more effective than XPS (p = 0.035). With the use of NaOCl, XPS and RB presented similar effectiveness (p = 0.779). XPF enhanced the bacterial reduction of both systems tested (p < 0.05). The use of NaOCl improved the CMP, irrespective of the instrumentation technique used (p < 0.05). In conclusion, XPS and RB files are effective in reducing bacterial levels in oval-shaped RC. The use of XPF as a method of agitation of the irrigating solution improved the cleaning efficiency of both file systems tested. Mechanical preparation performed with saline solution decreased culturable bacteria from the root canal, but antimicrobial substances such as NaOCl should be used to achieve a significantly better disinfection.

Micro-computed Tomography Assessment of Dentinal Micro-cracks after Root Canal Preparation with TRUShape and Self-adjusting File Systems.

INTRODUCTION: The aim of the present study was to evaluate the percentage frequency of dentinal micro-cracks observed after root canal preparation with TRUShape and Self-Adjusting File (SAF) systems by means of micro-computed tomography imaging analysis. A conventional full-sequence rotary system (BioRace) and a single-file reciprocation system (Reciproc) were used as reference techniques for comparison because of their known assertive cutting efficiency. METHODS: Forty anatomically matched mandibular incisors were selected, scanned at a resolution of 14.25 µm, and assigned to 4 experimental groups (n = 10), according to the preparation protocol: TRUShape, SAF, BioRace, and Reciproc systems. After the experimental procedures, the specimens were scanned again, and the registered preoperative and postoperative cross-section images of the roots (n = 70,030) were screened to identify the presence of dentinal micro-cracks. RESULTS: Overall, dentinal defects were observed in 28,790 cross-section images (41.11%). In the TRUShape, SAF, BioRace, and Reciproc groups, dentinal micro-cracks were visualized in 56.47% (n = 9842), 42.38% (n = 7450), 32.90% (n = 5826), and 32.77% (n = 5672) of the slices, respectively. All dentinal defects observed in the postoperative data sets were already present in the corresponding preoperative images. CONCLUSIONS: None of the preparation systems induced the formation of new dentinal micro-cracks.

Cytotoxicity Profile of Endodontic Sealers Provided by 3D Cell Culture Experimental Model.

The aim of the present study was to evaluate the cytotoxic effects of five endodontic sealers (AH Plus, Endomethasone N, EndoSequence BC, MTA Fillapex and Pulp Canal Sealer EWT) using a three-dimensional (3D) cell culture model. A conventional bi-dimensional (2D) cell culture model was used as reference technique for comparison. Balb/c 3T3 fibroblasts were cultured in conventional bi-dimensional cell culture and in rat-tail collagen type I three-dimensional cell culture models. Then, both cell cultures were incubated with elutes of freshly mixed endodontic sealers for 24 h. Cell viability was measured by the methyl-thiazol-diphenyltetrazolium assay (MTT). Data were statistically analyzed using ANOVA and the Tukey test at a significance level of p<0.05. All tested sealers exhibited cytotoxic effects; however, cytotoxic effect was culture model- and sealer-dependent. Sealers showed higher cytotoxicity in 2D than in 3D cell culture model (p<0.05). In both conditions, EndoSequence BC showed the lowest cytotoxicity (p<0.05). MTA Fillapex was much more cytotoxic than the other tested endodontic sealers (p<0.05), with the exception of AH Plus in the 2D cell culture model (p>0.05). Endomethasone N and Pulp Canal Sealer EWT showed lower cytotoxic effects than AH Plus in 2D cell culture model (p<0.05); however no statistical differences was observed among these sealers in 3D cell culture model. It may be concluded that cytotoxicity was higher in 2D cell culture compared to 3D cell culture. EndoSequence BC sealer exhibited the highest cytocompatibility and MTA Fillapex the lowest cytocompatibility.

Cytotoxicity Profile of Endodontic Sealers Provided by 3D Cell Culture Experimental Model

Abstract The aim of the present study was to evaluate the cytotoxic effects of five endodontic sealers (AH Plus, Endomethasone N, EndoSequence BC, MTA Fillapex and Pulp Canal Sealer EWT) using a three-dimensional (3D) cell culture model. A conventional bi-dimensional (2D) cell culture model was used as reference technique for comparison. Balb/c 3T3 fibroblasts were cultured in conventional bi-dimensional cell culture and in rat-tail collagen type I three-dimensional cell culture models. Then, both cell cultures were incubated with elutes of freshly mixed endodontic sealers for 24 h. Cell viability was measured by the methyl-thiazol-diphenyltetrazolium assay (MTT). Data were statistically analyzed using ANOVA and the Tukey test at a significance level of p<0.05. All tested sealers exhibited cytotoxic effects; however, cytotoxic effect was culture model- and sealer-dependent. Sealers showed higher cytotoxicity in 2D than in 3D cell culture model (p<0.05). In both conditions, EndoSequence BC showed the lowest cytotoxicity (p<0.05). MTA Fillapex was much more cytotoxic than the other tested endodontic sealers (p<0.05), with the exception of AH Plus in the 2D cell culture model (p>0.05). Endomethasone N and Pulp Canal Sealer EWT showed lower cytotoxic effects than AH Plus in 2D cell culture model (p<0.05); however no statistical differences was observed among these sealers in 3D cell culture model. It may be concluded that cytotoxicity was higher in 2D cell culture compared to 3D cell culture. EndoSequence BC sealer exhibited the highest cytocompatibility and MTA Fillapex the lowest cytocompatibility.

Resumo O objetivo do presente estudo foi avaliar os efeitos citotóxicos de cinco cimentos endodônticos (AH Plus, Endomethasone N, EndoSequence BC, MTA Fillapex e Pulp Canal Sealer EWT) utilizando um modelo de cultura celular tridimensional (3D). Utilizou-se um modelo convencional de cultura de células bidimensionais (2D) como técnica de referência para comparação. Os fibroblastos Balb/c 3T3 foram cultivados em culturas de células bidimensionais convencionais e em modelos de cultura de células tridimensionais de colagéno de cauda de rato do tipo I. Em seguida, ambas as culturas de células foram incubadas com eluções dos cimentos endodônticos recém manipulados, durante 24 h. A viabilidade celular foi medida pelo ensaio de MTT. Os dados foram analisados estatisticamente utilizando ANOVA e o teste de Tukey com nível de significância de p<0,05. Todos os cimentos testados exibiram efeitos citotóxicos. Contudo, o efeito citotóxico foi dependente do modelo de cultura e do cimento testado. Os cimentos apresentaram maior citotoxicidade no modelo 2D do que no modelo 3D (p<0,05). Em ambas as condições, a EndoSequence BC apresentou a menor citotoxicidade (p<0,05). MTA Fillapex foi mais citotóxico do que os outros cimentos endodônticos testados (p<0,05), com exceção do AH Plus no modelo de cultura de células 2D (p>0,05). Endomethasone N e EWT mostraram efeitos citotóxicos mais baixos do que AH Plus no modelo de cultura de células 2D (p<0,05); entretanto, não houve diferenças estatísticas entre esses cimentos no modelo de cultura de células 3D. Pode concluir-se que a citotoxicidade foi maior na cultura de células 2D em comparação com a cultura de células 3D. EndoSequence BC selante exibiu a maior citocompatibilidade e MTA Fillapex a menor citocompatibilidade.

Push-out bond strength of MTA HP, a new high-plasticity calcium silicate-based cement.

This study was designed to investigate the resistance to dislodgment provided by MTA HP, a new high-plasticity calcium silicate-based cement. Biodentine and White MTA Angelus were used as reference materials for comparison. Three discs 1 ± 0.1 mm thick were obtained from the middle third of the roots of 5 maxillary canines. Three 0.8-mm-wide holes were drilled on the axial surface of each root disc. Standardized irrigation was performed. Then the holes were dried with paper points and filled with one of the three tested cements. The filled dental slices were immersed in a phosphate-buffered saline (PBS) solution (pH 7.2) for 7 days before the push-out assessment. The Kruskal-Wallis test was applied to assess the effect of each endodontic cement on the push-out bond strength. Mann-Whitney with Bonferroni correction was used to isolate the differences. The alpha-type error was set at 0.05. All specimens had measurable push-out values and no premature failure occurred. There were significant differences among the materials (p <0.05). The Biodentine specimens had the highest push-out bond strength values (p < 0.05). MTA HP had significantly higher bond strength than White MTA (p < 0.05). MTA HP showed better push-out bond strength than its predecessor, White MTA; however, Biodentine had higher dislodgment resistance than both MTA formulations.

Comparison of the Incidence of Postoperative Pain after Using 2 Reciprocating Systems and a Continuous Rotary System: A Prospective Randomized Clinical Trial.

INTRODUCTION: The objective of the present study was to clinically compare the incidence of postoperative pain and the intake of analgesic medication (frequency and quantity) after endodontic treatment of posterior teeth using 2 reciprocating systems and a continuous rotary system. METHODS: In a prospective randomized clinical study, 210 patients with vital teeth indicated for conventional endodontic treatment were treated by 5 specialists according to a pre-established protocol. The teeth were randomly assigned to 1 of 3 groups (n = 70) according to the instrumentation system used: ProTaper Next (Dentsply Tulsa Dental Specialties, Johnson City, TN), WaveOne (Dentsply Tulsa Dental Specialties), or Reciproc (VDW, Munich, Germany). Treatments were performed in a single visit. After the visit, the patients were given a prescription for ibuprofen 400 mg to be taken every 6 hours if they experienced pain. Participants were asked to rate the intensity of the postoperative pain on a visual analog scale according to 4 classes (no pain, mild pain, moderate pain, and severe pain) after 24 hours, 48 hours, 72 hours, and 7 days. Patients were also asked to record the number of prescribed analgesic medication tablets taken at these time points. RESULTS: No statistically significant difference was found among the 3 groups in relation to postoperative pain or analgesic medication intake at the 4 time points assessed (P > .05, Kruskal-Wallis test). CONCLUSIONS: The reciprocating systems and the continuous rotary system were found to be equivalent in regard to the incidence of postoperative pain and intake of analgesic medication at the time points assessed.

Evaluation of the Efficacy of TRUShape and Reciproc File Systems in the Removal of Root Filling Material: An Ex Vivo Micro-Computed Tomographic Study.

INTRODUCTION: The purpose of this study was to evaluate the efficacy of TRUShape (Dentsply Tulsa Dental Specialties, Tulsa, OK) compared with the Reciproc file (VDW, Munich, Germany) in the removal of filling material from oval canals filled with 2 different sealers and differences in the working time. METHODS: Sixty-four mandibular canines with oval canals were prepared and divided into 4 groups (n = 16). Half of the specimens were filled with gutta-percha and pulp canal sealer (PCS), and the remainders were filled with gutta-percha and bioceramic sealer (BCS). The specimens were retreated using either the Reciproc or TRUShape files. A micro-computed tomographic scanner was used to assess filling material removal, and the time taken for removal was also recorded. Data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests. RESULTS: The mean volume of the remaining filling material was similar when comparing both files (P ≥ .05). However, in the groups filled with BCS, the percentage of remaining filling material was higher than in the groups filled with PCS (P < .05). The reciprocating file allowed for faster filling removal than the TRUShape files (P < .05). Retreatment was faster in the groups that were filled with PCS compared with those filled with BCS (P < .05). CONCLUSIONS: There was no difference regarding the percentage of remaining filling material when comparing both files system; however, Reciproc was faster than TRUShape. BCS groups exhibited significantly more remaining filling material in the canals and required more time for retreatment. Remaining filling material was observed in all samples regardless of the technique or sealer used.

Push-out bond strength of MTA HP, a new high-plasticity calcium silicate-based cement

Abstract This study was designed to investigate the resistance to dislodgment provided by MTA HP, a new high-plasticity calcium silicate-based cement. Biodentine and White MTA Angelus were used as reference materials for comparison. Three discs 1 ± 0.1 mm thick were obtained from the middle third of the roots of 5 maxillary canines. Three 0.8-mm-wide holes were drilled on the axial surface of each root disc. Standardized irrigation was performed. Then the holes were dried with paper points and filled with one of the three tested cements. The filled dental slices were immersed in a phosphate-buffered saline (PBS) solution (pH 7.2) for 7 days before the push-out assessment. The Kruskal-Wallis test was applied to assess the effect of each endodontic cement on the push-out bond strength. Mann-Whitney with Bonferroni correction was used to isolate the differences. The alpha-type error was set at 0.05. All specimens had measurable push-out values and no premature failure occurred. There were significant differences among the materials (p <0.05). The Biodentine specimens had the highest push-out bond strength values (p < 0.05). MTA HP had significantly higher bond strength than White MTA (p < 0.05). MTA HP showed better push-out bond strength than its predecessor, White MTA; however, Biodentine had higher dislodgment resistance than both MTA formulations.

Negotiability of Second Mesiobuccal Canals in Maxillary Molars Using a Reciprocating System.

The aim of this prospective case series report was to assess the frequency in which the Reciproc R25 instrument (VDW, Munich, Germany) is able to scout and reach the full working length (WL) in second mesiobuccal (MB2) canals from maxillary molars. Conventional hand file negotiation was used as the reference technique for comparison. Maxillary molars (270 first molars and 71 second molars) were included in this study. After local anesthesia, the tooth was isolated with a rubber dam, and traditional straight-line access was made. After locating both first mesiobuccal and MB2 canals, patients were randomly assigned to one of the experimental groups (conventional hand filing preparation or R25 Reciproc preparation). All cases in which the hand files (G1) and R25 instrument (G2) were able to reach the fully electronically determined WL were classified as "reaching full WL" (RFWL). All cases in which the hand files (G1) and R25 instrument (G2) were unable to negotiate the full-length canal were classified as "not reaching full WL" (NRFWL). The number of root canals classified as RFWL and NRFWL from both groups were recorded and tabulated on an Excel data sheet (Microsoft, Redmond, WA). The frequency distributions (%) of root canals classified as RFWL and NRFWL were compared with overall-treated canals and for each treatment approach (hand file and R25 instrument) using a Pearson chi-square test. In group 1, the hand file approach reached the full WL in 57.48% of cases, whereas in group 2 the R25 instrument reached the full WL in 85.63% of cases. Three file separations occurred in each group while negotiating the MB2 canal. According to this study, the R25 instrument was 32% more effective when compared with hand files in scouting and negotiating MB2 canals in maxillary first and second molars. There was no difference with regard to file separation when comparing both preparation techniques.

Success rates for removing or bypassing fractured instruments: a prospective clinical study.

INTRODUCTION: The objective of this study was to evaluate the success rates of standardized techniques for removing or bypassing fractured instruments from root canals and determine whether visualization of the fractured instrument with the aid of an operating microscope has any impact on the success rates. METHODS: In this prospective study, attempts were made to visualize 112 fractured instruments under a dental operating microscope after creating a straight-line access to the fragment. By using ultrasonic tips alone or associated with bypassing, the Ruddle technique was attempted to remove the 68 visible instruments. Bypassing was performed for the 44 nonvisible fragments. The χ(2) test was performed to assess whether any significant difference occurred between the success rates observed for the visible and nonvisible fractured instrument groups. RESULTS: The overall success rate (removal and bypassing) was 70.5% (n = 79). In the visible fragment group, the success rate was 85.3% (n = 58), and in the nonvisible fragment group it was 47.7% (n = 21). Success rates were significantly higher when the fragment was visible (P = .0009). CONCLUSIONS: The standardized techniques used in this study for removing or bypassing fractured instruments were effective, and approximately 2 times greater success rate was obtained when the fragment was visible inside the root canal compared with when it was nonvisible.

Localização de canais em incisivos inferiores com uso de microscópio operatório / Location of canals in mandibular incisors using a dental operating microscope

O objetivo desse trabalho foi determinar se o uso do Microscópio Operatório poderia aumentar o número de orifícios de canais radiculares localizados em incisivos inferiores de humanos. Foram utilizados 100 incisivos inferiores. Após a cirurgia de acesso realizada a olho nu, o total de canais localizados foram anotados. Utilizando um microscópio operatório com magnificação variando de X8 a X20, todos os dentes tiveram o preparo da cirurgia de acesso revisados. Após o uso do microscópio, foram localizados 20 canais a mais, o que representou um aumento significativo de 17,85% no total do número de canais localizados. O microscópio proporciona melhor visualização aumentando o número de orifícios de canal lingual encontrados em incisivos inferiores extraídos de humanos.

The purpose of this study was to determine whether the use of the dental operating microscope (DOM) could increase the number of root canal orificies located in human mandibular incisors. One hundred extracted incisors were used. With naked eye, ali access cavities were prepared and orifices were located. Using DOM with x8 - x12 magnification ali access cavities preparations were again examined. After the DOM examination, 20 more canais could be visualized. With the use of operating microscope, we have an increase of located canais in mandibular incisors, what representing an increase of 17,85%.

Localização de canais calcificados com auxílio do microscópio clínico operatório: série de casos clínicos / Calcified canal location with the aid of a clinical aperating microscape: case series

A presença de tecido duro mineralizado obliterando o espaço pulpar representa uma dificuldade clínica para a exploração dos canais durante o tratamento endodôntico. O objetivo deste relato de casos clínicos foi apresentar um protocolo de tratamento utilizando o microscópio clínico operatório e insertos de ultrassom para a localização de canais calciflcados. De quarenta e dois dentes indicados para especialistas com este objetivo, em trinta e cinco dentes os canais puderam ser explorados e o tratamento endodôntico concluído normalmente, representando um índice de sucesso de 83,33%.

The presence of mineralized dentin obliterating the pulpal space, is still a challenge for the clinician during root canal theraphy. The purpose of this case series report was to describe a protocol using a clinical operating microscope and ultrasonic inserts for location of calcified canais. From 42 teeth refered to specialists with this objetive, 35 had ali the canais explorated and root canal therapy could be completed, representing a levei of sucesso of 83,33%.

Sinais e sintomas clínicos associados à fratura da raiz (FVR): relato de 203 casos / Clinical signs symptoms related to vertical root fracture (VRF): a case with 203 teeth

O reconhecimento e diagnóstico de dentes com fratura vertical da raiz (FVR) ainda é um desafio para o clínico. O objetivo deste relato de 203 dentes diagnosticados com fratura vertical da raiz (FVR) é apresentar os sinais e sintomas clínicos mais frequentemente associados a essa patologia. Os fatores avaliados mais recorrentes foram: dor à mastigação, fístula localizada no terço cervical e médio da raiz, aumento do espaço do ligamento periodontal ou lesões ósseas laterais.

Recognition and diagnosis of teeth with vertical root fracture (VRF) is challenge for the clinician. The objective of this case series of 203 teeth with confirmed diagnosis of VRF was to present clinical signs and symptoms frequently associated with this pathology. From all factors studied the most frequent were: pain during chewing, fistulae located in the medial/cervical portion of the roots and widening of periodontal membrane or lateral osseous lesions.

Retreatment efficacy of gutta-percha removal using a clinical microscope and ultrasonic instruments: part I--an ex vivo study.

OBJECTIVE: This study compared the efficacy of gutta-percha/sealer removal from endodontically treated extracted human teeth with and without the aid of a clinical operating microscope/ultrasonic instruments. STUDY DESIGN: Forty human extracted maxillary central incisors were prepared using a modified crown-down technique and filled with lateral compactation. Teeth were divided into 2 groups: group I, re-treated using a conventional technique with burs and solvent; and group II, re-treated using a conventional technique with burs and solvent plus clinical operating microscope/ultrasonic tips. Teeth were split longitudinally and photographed, and coded photos transfered to a computer workstation. Total canal space and remaining gutta-percha/sealer were quantified, and ratio of remaining filling material and root canal periphery was computed. Mean percentage of remaining gutta-percha/sealer in each group was compared using analysis of variance. RESULTS: The average percentage of remaining gutta-percha/sealer was 25.21% in group I and 9.31% in group II, showing a statistically significant difference (P = .05). CONCLUSION: The use of the dental operating microscope and ultrasonic tips removed the filling material from root canal walls better, but all examined teeth, in both groups, had remaining filling material on canal walls.

Fístula extra-oral de origem dental / Cutaneous sinus tracts of dental origen

Fístulas cutâneas extra-orais de origem dental podem representar um desafio diagnóstico na área da saúde. Este artigo descreve o caso de uma paciente em tratamento dermatológico, no qual a causa de uma fístula cutânea estava associada a um pré-molar superior portador de lesão óssea periapical de origem endodôntica. Serão apresentados e discutidos tanto a rotina de diagnóstico odontológico quanto os protocolos do tratamento endodôntico.

Cutaneous sinus tracts of dental origen are a diagnostical challenge in the medical held. This article describes the case of patient during dermatalogical treatment but the origin of a cutaneous sinus tract was associated with a superior premolar with periapical endodontic lesion. It will be presented and discussed the dental diagnostic routin as well as the endodontic protocols of treatment.

O uso do microscópio clínico na solução de complicações endodônticas / Using the clincial microscope when dealing with endodontic complications

O tratamento de complicações endodônticas representa um desafio até mesmo para os profissionais mais experientes. A recente introdução do uso do microscópio clínico propicia um campo operatório com magnificação e iluminação adequadas, conferindo maior precisão aos procedimentos clínicos. Este relato de caso envolvendo três dificuldades conjuntas - remoção de cones de prata, localização de canal calcificado e tratamento de perfuração de furca - em um único dente, permite discutir e ilustrar a utilização dessa nova tecnologia, que é simples, apresenta resultado previsível e permite um prognóstico favorável